Question 1

The nurse is caring for a client with perineal excoriation caused by diarrhea from acute gastroenteritis.Which client statement indicates that additional teaching about perineal care is needed?

Accepted Answer

Toilet paper can irritate the sensitive perineal skin,so warm water rinses or soft cotton washcloths should be used instead.Although aloe vera may facilitate healing of superficial abrasions,it is not an effective skin barrier for diarrhea.Skin barriers such as zinc oxide and vitamin A and D ointment help protect the rectal area from the excoriating effects of liquid stools.Patting the skin is recommended instead of rubbing the skin dry.

Question 2

A female client is admitted with an exacerbation of ulcerative colitis.Which laboratory value does the nurse correlate with this condition?

Accepted Answer

The erythrocyte sedimentation rate (ESR)is an indicator of inflammation,which is elevated during an exacerbation of ulcerative colitis.The normal range for the ESR is 0 to 33 mm/hr.Diarrhea caused by ulcerative colitis will result in loss of potassium and hypokalemia with levels lower than 3.5 mEq/L.Bloody diarrhea will lead to anemia,with hemoglobin levels lower than 12 g/dL in females.The sodium level is normal.

Question 3

A client underwent the first stage of a restorative proctocolectomy with ileo-anal anastomosis (RPC-IPAA).What topic is a high priority for the nurse to teach?

Accepted Answer

In the first stage of the RPC-IPAA procedure,the temporary ileostomy is created.Because the effluent is caustic,severe skin irritation can occur.The client needs good instruction on ostomy care and comfort measures.Perineal care is not needed because stool drains through the ostomy.Nutrition therapy and relaxation techniques are not as high a priority as preventing skin damage.

Question 4

The nurse helps a client with diverticular disease choose appropriate dinner options.Which menu selections are most appropriate?

Accepted Answer

Whole grains (rice pilaf),uncooked fruits and vegetables (salad,fresh fruit cup),and high-fiber foods (cup of bean soup)should be avoided with a low-residue diet.Canned or cooked vegetables are appropriate.Apple juice does not contain fiber and is acceptable for a low-residue diet.

Question 5

The nurse conducts a physical assessment for a client with severe right lower quadrant (RLQ)abdominal pain.The nurse notes that the abdomen is rigid and the client's temperature is 101.1° F (38.4° C).Which laboratory value does the nurse bring to the attention of the health care provider as a priority?

Accepted Answer

This client may have appendicitis based on RLQ pain.A white blood cell count of 22,000/mm³ is severely elevated and could indicate a perforated appendix,as could the fever.The nurse should bring these findings to the provider's attention as soon as possible.A left shift would be expected in uncomplicated appendicitis.The sodium reading is only slightly high; this could be due to hemoconcentration from vomiting or from decreased intake.The creatinine level is normal.

Question 6

The nurse is caring for a client who is taking mesalamine (5-aminosalicylic acid)(Asacol,Rowasa)for ulcerative colitis.The client has trouble swallowing the pill.Which action by the nurse is most appropriate?

Accepted Answer

Asacol is enteric coated and should not be crushed,chewed,or broken.If the client is unable to swallow the Asacol pill,Rowasa enemas may be administered instead,with a provider's order.Asacol is not available as a suspension or elixir.

Question 7

The nurse is caring for a client who is having approximately 20 foul-smelling stools each day.Laboratory Gram stain testing indicates the presence of white blood cells (WBCs)and red blood cells (RBCs)in the stool.Which organism does the nurse expect to see in the culture report?

Accepted Answer

Campylobacter gastroenteritis causes foul-smelling diarrhea with up to 20 to 30 stools per day for 7 days.Both RBCs and WBCs are present in a Gram stain of the stools.Infection with Clostridium causes not diarrhea,but constipation,paralysis,and respiratory failure.H.pylori is a common cause of gastric ulcers,not gastroenteritis.Norwalk virus produces milder illness with diarrhea and vomiting.

Question 8

The nurse is preparing to begin teaching the client about how to care for a new ileostomy.Which consideration is the highest priority for the nurse when planning teaching for this client?

Accepted Answer

The nurse should wait until the client is ready to look at the ostomy and stoma before initiating teaching about ostomy care.The nurse should monitor clues from the client and encourage him or her to start taking an active role in management.Effective learning will occur only when the learner is ready.The other considerations are of lower priority for the client and nurse.

Question 9

The nurse is caring for a teenage girl with a new ileostomy.She tells the nurse tearfully that she cannot go to the prom with an ostomy.Which is the nurse's best response?

Accepted Answer

The ostomy nurse is a valuable resource for clients,providing suggestions for supplies and methods to manage the ostomy.A larger dress size will not necessarily help hide the ostomy appliance.Avoiding broccoli and carbonated drinks does not offer reassurance for the client.Ileostomies have an almost constant liquid effluent,so pouch removal during the prom is not feasible.

Question 10

The nurse is caring for a client with ulcerative colitis and severe diarrhea.Which nursing assessment is the highest priority?

Accepted Answer

Although the client with severe diarrhea may experience skin irritation and hypovolemia,the client is most at risk for cardiac dysrhythmias secondary to potassium and magnesium loss from severe diarrhea.The client should have her or his electrolyte levels monitored,and electrolyte replacement may be necessary.Abdominal percussion is an important part of physical assessment but has lower priority for this client than heart rate and rhythm.

Question 11

The nurse is caring for a client with Crohn's disease and colonic strictures.Which assessment finding requires the nurse to consult the health care provider immediately?

Accepted Answer

The presence of strictures predisposes the client to intestinal obstruction.Abdominal distention may indicate that the client has developed an obstruction of the large bowel,and the client's provider should be notified right away.Low-grade fever,bloody diarrhea,and crampy abdominal pain are common symptoms of Crohn's disease.

Question 12

The nurse is caring for an older client with Salmonella food poisoning.Which is the priority action of the nurse?

Accepted Answer

Dehydration can occur quickly in older clients with Salmonella food poisoning caused by diarrhea,so maintenance of fluid balance is a high priority.Monitoring vital signs and providing perineal care are important nursing actions,but are of lower priority than fluid replacement.Contact Isolation is not regularly instituted for Salmonella infection.Standard Precautions are usually sufficient.

Question 13

The nurse is caring for a client with severe ulcerative colitis who has been prescribed adalimumab (Humira).Which client statement indicates that additional teaching about the medication is needed?

Accepted Answer

Adalimumab (Humira)is an immune modulator that must be given via subcutaneous injection.It does not need to be given with food or milk.Nausea and vomiting are two common side effects.Adalimumab can cause immune suppression,so clients receiving the medication should avoid large crowds and people who are sick,and should practice good handwashing.

Question 14

The nurse is caring for a client who had ileostomy surgery 10 days ago.The client verbalizes concerns that the effluent has not become formed and is still liquid green.Which is the nurse's best response?

Accepted Answer

Effluent from an ileostomy will become less liquid (but not solid)over time as the body adapts to loss of the large bowel.This process takes time and the client should be reassured of this.Clients with a new ileostomy should avoid high-fiber diets for the first few weeks because blockage of the bowel may occur.Buttermilk,yogurt,and carbonated drinks will not affect this process.

Question 15

The nurse is caring for an older client with gastroenteritis.Which order does the nurse consult with the health care provider about?

Accepted Answer

Lomotil can cause drowsiness and can increase the older client's risk for falls.The nurse should consult with the provider to see if this medication is really necessary and,if an antidiarrheal medication is warranted,what other options might be available.The other orders are appropriate,although the nurse would have to monitor the client's total 24-hour Tylenol dosage to ensure that the client did not receive more than 4000 mg/24 hr.

Question 16

The nurse provides discharge teaching for a client who was hospitalized for Salmonella food poisoning.Which client statement indicates that additional teaching is needed?

Accepted Answer

Cipro should be taken for 10 to 14 days to treat Salmonella infection,and should not be stopped once the diarrhea has cleared.Clients should be advised to take the entire course of medication.People with Salmonella should not prepare foods for others because the infection may be spread in this way.Dishes and eating utensils should not be shared and should be cleaned thoroughly.Hands should be washed with antibacterial soap before and after eating to prevent spread of the bacteria.Clients can be carriers for up to 1 year.

Question 17

The nurse is caring for a client who has acute viral gastroenteritis.Which dietary instruction does the nurse provide to the client?

Accepted Answer

The client should drink plenty of fluids to prevent dehydration.Clients are not necessarily restricted to clear liquids.Milk products may not be tolerated.Caffeinated beverages increase intestinal motility and should be avoided.

Question 18

The nurse is teaching a client how to care for a new ileostomy.Which client statement indicates that additional teaching is needed?

Accepted Answer

A client with an ileostomy should call the provider if no drainage has come from the ostomy in 6 to 12 hours.The other statements indicate good understanding of self-management.

Question 19

The nurse conducts a physical assessment for a client with abdominal pain.Which finding leads the nurse to suspect appendicitis?

Accepted Answer

Right lower quadrant pain,specifically at McBurney's point,is characteristic of appendicitis.Usually if nausea and vomiting begin first,the client has a gastroenteritis.Abdominal pain due to appendicitis decreases with knee flexion.Marked peristalsis and hyperactive bowel sounds are not indicative of appendicitis.

Question 20

The nurse is caring for a client who is hospitalized with exacerbation of Crohn's disease.What does the nurse expect to find during the physical assessment?

Accepted Answer

The nurse expects high-pitched,rushing bowel sounds due to narrowing of the bowel lumen in Crohn's disease.Dullness in the lower abdominal quadrants and hypoactive bowel sounds are not commonly found with Crohn's disease.Nightly worsening of abdominal cramping is not consistent with Crohn's disease.A positive Murphy's sign is indicative of gallbladder disease,and rebound tenderness often indicates peritonitis.

Quiz 60: Care of Patients With Inflammatory Intestinal Disorders