Question 1

A 26-year-old patient is diagnosed with Crohn's disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg) over 2 months. The nurse will plan to teach the patient about

Accepted Answer

Corticosteroids are used to achieve remission in IBD, and systemic corticosteroids will be used in Crohn's disease to affect the small intestine. Decreased activity level is indicated only if the patient has severe fatigue and weakness. Fluids are needed to prevent dehydration. There is no advantage to enteral feedings.

Question 2

A patient has a newly formed ileostomy for treatment of ulcerative colitis. In teaching the patient about the care of the ileostomy, the nurse informs the patient about the need to

Accepted Answer

High-fiber foods are introduced gradually and should be well chewed to avoid obstruction of the ileostomy. Patients with ileostomies lose the absorption of water in the colon and need to take in increased amounts of fluid. The pouch should be drained frequently but is changed every 5 to 7 days. The drainage from an ileostomy is liquid and continuous, so control by irrigation is not possible.

Question 3

A patient with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, foul-smelling urine. The nurse will teach the patient

Accepted Answer

Fistulas between the bowel and bladder occur in Crohn's disease and can lead to UTI. There is no information indicating that the patient's risk for UTI is caused by poor cleaning or not voiding before and after intercourse. Steroid use may increase the risk for infection, but the characteristics of the patient's urine indicate that a fistula has occurred.

Question 4

A patient has a large bowel obstruction that occurred as a result of a fecal impaction. During nursing assessment of the patient, a finding by the nurse that is consistent with a large bowel obstruction includes

Accepted Answer

Abdominal distension is seen in lower intestinal obstruction. Metabolic alkalosis is common in high intestinal obstruction because of the loss of HCl acid from vomiting. Referred back pain is not a common clinical manifestation of intestinal obstruction. Bile-colored vomit is associated with higher intestinal obstruction.

Question 5

A patient is hospitalized with severe vomiting and colicky abdominal pain that is somewhat relieved with the vomiting. The health care provider orders an IV infusion of lactated Ringer's solution and placement of an NG tube. An appropriate collaborative problem for the nurse to identify for the patient at this time is

Accepted Answer

Metabolic alkalosis is a complication of NG suction resulting from loss of HCl from the stomach. Volvulus and thromboembolism are not associated with NG placement. The patient is hydrated with IV fluids to avoid renal insufficiency or failure.

Question 6

Before undergoing a colon resection for cancer of the colon, a patient has an elevated carcinoembryonic antigen (CEA) test. The nurse explains that the test is used to

Accepted Answer

CEA is used to monitor for cancer recurrence after surgery. CEA levels do not help determine whether there is metastasis of the cancer. Confirmation of the diagnosis is made on the basis of biopsy. Chemotherapy use is based on other factors than CEA.

Question 7

A 42-year-old patient recently developed abdominal distention, weight loss, steatorrhea, and flatulence. A diagnosis of adult celiac disease is made, and treatment is initiated. The nurse determines that teaching about the treatment of the disease has been effective when the patient says,

Accepted Answer

Avoidance of gluten-containing foods is the only treatment for celiac disease. Folic acid deficiency may occur, but once the inflammatory process is resolved, the patient will not need to take folic acid. Antibiotics are not helpful in the treatment of the inflammatory process. Avoidance of dietary fat is not necessary.

Question 8

A total proctocolectomy with a permanent ileostomy is performed for a patient with ulcerative colitis. The patient is very upset and tells the nurse, "I can not bear to even look at the stoma. I do not think I can manage all these changes." The nurse's best approach to the patient's remarks is to

Accepted Answer

A visitor from an ostomy support group who has had similar experiences may be helpful to the patient. In the response beginning, "reassure the patient," the nurse does not acknowledge the patient's feelings. The response beginning "develop a detailed written plan" also fails to acknowledge the patient's emotional response to the ostomy. The nurse should act to assist the patient with body image changes, not just wait for the patient to adjust as in the remaining response.

Question 9

A patient newly diagnosed with Crohn's disease asks the nurse what to expect in the future. The best response by the nurse is,

Accepted Answer

Crohn's disease has recurrent acute exacerbations that occur at unpredictable intervals. There are many lifestyle changes that patients need to make with regard to diet and medication use. The preference is to treat Crohn's disease with medications rather than with surgery. Patients with Crohn's disease are at high risk for cancer of the small intestine, but the risk for colon cancer is lower.

Question 10

A recent colonoscopy revealed an increased number of polyps in a 22-year-old patient with a history of moderately severe familial adenomatous polyposis (FAP). In planning care for the patient, the nurse recognizes that the medical recommendation for patients with familial adenomatous polyposis includes

Accepted Answer

Patients with FAP have a high likelihood of developing colorectal cancer by age 40; therefore, total colectomy with ileostomy is recommended for these patients. Frequent colonoscopy is required, but patients are encouraged to have a colectomy. Patients with FAP have too many polyps to be removed by polypectomy. The patient has an 80% chance of developing colorectal cancer.

Question 11

During the initial postoperative assessment of a patient's stoma formed with a transverse colostomy, the nurse finds it to be red with moderate edema and a small amount of bleeding. The nurse should

Accepted Answer

The stoma appearance indicates good circulation to the stoma. There is no indication that surgical intervention is needed or that frequent stoma monitoring is required. Swelling of the stoma is normal for 2 to 3 weeks after surgery, and an ice pack is not needed.

Question 12

During preoperative preparation for a patient scheduled for an abdominal-perineal resection, the nurse will

Accepted Answer

A bowel-cleansing agent is used to empty the bowel before surgery to reduce the risk for infection. Oral antibiotics are given to reduce colonic and rectal bacteria. Sitting is contraindicated after an abdominal-perineal resection. A permanent colostomy is created with this surgery.

Question 13

The nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements for a patient who is hospitalized with an acute exacerbation of Crohn's disease, based on the finding of

Accepted Answer

A hemoglobin count of 10 g/dl indicates that the patient's iron and possibly protein intake are low. Fatigue and weakness may be due to the acute inflammatory response and to lack of rest because of frequent stools. A 2-pound weight loss over 2 days is not unusual in patients who are well nourished. A 1500-calorie diet may be sufficient to meet patient needs, depending on the patient's size.

Question 14

While obtaining a nursing history from a 55-year-old patient scheduled for a colonoscopy, the nurse will be most concerned about

Accepted Answer

Rectal bleeding is associated with colorectal cancer. Recent changes in bowel patterns are a clinical manifestation of colorectal cancer, but lifelong constipation is not an indication. Nausea and vomiting are not common clinical manifestations of problems with the distal GI tract. An appendectomy is not a risk factor for cancer of the colon.

Question 15

The nurse explains to a patient with a new ileostomy that after the bowel adjusts to the ileostomy, the usual drainage will be about

Accepted Answer

After the proximal small bowel adapts to reabsorb more fluid, the average amount of ileostomy drainage is about 500 ml daily.

Question 16

A patient returns from surgery following an abdominal-perineal resection with a sigmoid colostomy and abdominal and perineal incisions. The colostomy is dressed with petroleum jelly gauze and dry gauze dressings. The perineal incision is partially closed and has two drains attached to Jackson-Pratt suction. On the first postoperative day, the nurse gives the highest priority to

Accepted Answer

Because the perineal wound is at high risk for infection, the initial care is focused on assessment and care of this wound. Teaching about diet is best done closer to discharge from the hospital. There will be very little drainage into the colostomy until peristalsis returns. The patient will be encouraged to assist with the colostomy, but this is not the highest priority in the immediate postoperative period.

Question 17

In providing discharge teaching for a patient who has undergone a hemorrhoidectomy at an outpatient surgical center, the nurse instructs the patient to

Accepted Answer

Bowel movements may be very painful, and patients may avoid defecation unless pain medication is taken before the bowel movement. Delay of bowel movements is likely to lead to constipation. A high-residue diet will increase stool bulk and prevent constipation. Sitz baths are used to relieve pain and keep the surgical area clean.

Question 18

After teaching a patient to irrigate a new colostomy, the nurse will determine that the teaching has been effective if the patient

Accepted Answer

Irrigating container should be hung 18 to 24 inches above the stoma.

Question 19

When implementing the initial plan of care for a patient admitted with acute diverticulitis, the nurse will

Accepted Answer

A patient with acute diverticulitis will be NPO with parenteral fluids. A diet high in fiber and fluids will be implemented before discharge. Bulk-forming laxatives, rather than stool softeners, are usually given, and these will be implemented later in the hospitalization. The patient with acute diverticulitis will not have colonoscopy because of the risk for perforation and peritonitis.

Question 20

The nurse identifies a nursing diagnosis of acute pain related to edema and surgical incision for a patient who has had a herniorrhaphy performed for an incarcerated inguinal hernia. An appropriate nursing intervention for this problem is to

Accepted Answer

Because swelling is likely to affect the scrotum, a scrotal support and ice are used to reduce edema. Stool softeners will not decrease pain or swelling. Sitz baths or moist heat application will not reduce swelling or edema in the scrotal area.

Quiz 43: Nursing Management: Lower Gastrointestinal Problems