Question 1

A client with Crohn's disease is recovering from a fourth bowel resection and is being dismissed. The nurse determines that teaching goals have been met when the client indicates that s/he will watch for manifestations of
A) chronic constipation.
B) fatigue and weakness.
C) Heberden's nodules.
D) malabsorption syndrome.

Accepted Answer

Malabsorption syndrome occurs because the shortened bowel does not have adequate length to absorb intestinal fluids, causing watery stools. After four bowel resections, this is potentially a major complication. Fatigue and weakness do accompany Crohn's disease, but malabsorption is a specific risk associated with this many bowel resections.

Question 2

Until a diagnosis is made, the nurse caring for a client being evaluated for acute appendicitis should treat pain and discomfort with
A) comfort touch and reassurance.
B) frequently changing the client's position.
C) narcotic pain medication.
D) warm compresses applied to the belly.

Accepted Answer

Comfort touch and reassurance can help a client cope and manage pain with or without pain medication. Pain medication would be withheld until a diagnosis of appendicitis is confirmed. Warm compresses or heat should not be applied as they may cause the appendix to rupture.

Question 3

In counseling a client with ulcerative colitis for 25 years about health maintenance plans, the nurse would include the advice that the client should
A) avoid red meat.
B) obtain genetic counseling.
C) reduce physical exercise.
D) schedule regular proctoscopic examinations.

Accepted Answer

Cancer of the colon is more common among clients with ulcerative colitis than in the general population. The other three options are not relevant to the health maintenance of a client with ulcerative colitis.

Question 4

A nurse is caring for a postoperative client who has developed peritonitis. An assessment finding that would require immediate action would be
A) a decrease in blood pressure of more than 15 mm Hg.
B) an increase in urine output of more than 300 ml/day.
C) pulse deficit of more than 20 beats/minute.
D) weight gain of more than 5 pounds.

Accepted Answer

Postoperatively, the nurse should closely monitor the client for development of postoperative complications (e.g., adult respiratory distress syndrome [ARDS], sepsis, shock) by changes in vital signs, immediately reporting any manifestations of sepsis (e.g., decrease/increase in temperature, decrease in blood pressure). A urine output of only 300 ml in 1 day is below normal for an adult (30-50 ml/hr). Pulse deficit and weight gain would not indicate a common postoperative complication.

Question 5

The nurse caring for a client with an intestinal malignancy assesses for bleeding, which would most likely be manifested by
A) abdominal discomfort.
B) hematemesis.
C) hematochezia.
D) hypotension.

Accepted Answer

Bleeding may be caused by trauma, ulceration, inflammation, or a growth that erodes through a blood vessel. The usual manifestation is blood in the stool (hematochezia) rather than in the vomitus (hematemesis). Hypotension would be a late sign of bleeding.

Question 6

In caring for a client with Crohn's disease and the nursing diagnosis of Imbalanced Nutrition: Less Than Body Requirements related to diarrhea, the nurse would plan to observe for
A) bradycardia.
B) increased urine output.
C) increasing blood pressure.
D) manifestations of anemia.

Accepted Answer

The client may have associated nutritional deficiencies, weight loss, anorexia, pain, anemia, debility, fatigue, and mental disturbances.

Question 7

The nurse is instructing a client with a new colostomy on its care and notes that the stoma is large and dusky. The most appropriate nursing intervention at this time is to
A) assess the client's reaction to the ostomy site.
B) assist the client to irrigate the colostomy.
C) notify the surgeon immediately.
D) reassure the client that the stoma will decrease in size.

Accepted Answer

The nurse should assess the client's stoma closely. The stoma should be red and moist. If it becomes dark or dusky, the nurse must report this to the surgeon immediately as this probably represents ischemia.

Question 8

The nurse taking the history of an 80-year-old woman diagnosed with gastroenteritis would recognize that the most significant factor in determining potential for complications in this client is
A) age.
B) family history.
C) gender.
D) prior bouts of gastroenteritis.

Accepted Answer

Most cases of gastroenteritis are temporarily disabling and self-limiting, with resolution in 1 to 5 days. However, gastroenteritis can be fatal in debilitated, older, or very young people. Dehydration is a common cause of death in these cases, and the elderly tend to be slightly dehydrated as a baseline.

Question 9

A 13-year-old client with ulcerative colitis says, "I am so glad I will grow out of this disease. It's so embarrassing at school." Which action by the nurse would best address this statement?
A) Ask the client to explain what he/she means.
B) Encourage the client to become active in school activities or sports.
C) Review the pathophysiology of ulcerative colitis.
D) Tell the client about other people who live successfully with the disease.

Accepted Answer

Ulcerative colitis, a progressive inflammatory process involving contiguous portions of the bowel, has remissions and exacerbations, and physical exertion and fatigue can bring on an attack. Clients do not outgrow ulcerative colitis; surgical intervention is the only cure. Exploring the statement further can direct the nurse to provide more helpful information and can elicit coping mechanisms.

Question 10

A client recovering from a recent colostomy is very reluctant to participate in self-care. To initiate the client's interaction, the nurse should
A) allow care to be deferred until the client will participate.
B) evaluate the level to which the client can tolerate participation.
C) insist the client become involved in self-care.
D) provide the client with a mirror to observe the stoma.

Accepted Answer

The nurse should carefully assess the client's physical condition and emotional and mental attitude toward the colostomy before attempting to teach ostomy self-care. Teaching is paced according to the client's level of acceptance of the colostomy and the client's ability to manage it.

Question 11

To help a client with a new ostomy integrate its appearance into the client's body image, the home health nurse would
A) discourage the client's negative remarks about the stoma.
B) discuss clothing options that will hide the appliance.
C) limit family interaction in the client's stomal care.
D) use humor and jokes regarding the ostomy.

Accepted Answer

The approach to integrate ostomies into body image should include using correct terminology for stoma and appliances, encouraging the venting of feelings about the ostomy, examining clothing options, and using helpful family responses. Discouraging client remarks is not using best therapeutic communication techniques. Family interaction may be helpful in client acceptance. Judicious use of humor may be helpful in the health care setting; however, without a thorough assessment of the client and a good relationship, humor and jokes may well make the client feel worse.

Question 12

A client with inflammatory bowel disease (IBD) takes sulfasalazine (Azulfadine) for management of manifestations. To counteract a side effect of this drug, the nurse would encourage the client to increase intake of
A) any citrus fruits.
B) bananas and apples.
C) fish and seafood.
D) peas and beans.

Accepted Answer

Peas and beans are rich in folic acid. Folic acid absorption may be impaired in the client taking sulfasalazine. Fruits and seafoods are not good sources of folic acid.

Question 13

A client with ulcerative colitis is scheduled for surgical creation of an ileoanal reservoir (J pouch). What information should the nurse include in this client's teaching plan?
A) The client will need an easily removable appliance.
B) The client will need to plan for a daily irrigation.
C) The stool will be expelled through the rectum eventually.
D) The transverse loop ostomy will be temporary.

Accepted Answer

The ileal pouch-anal anastomosis (also known as the J pouch) prevents the need for an ostomy and preserves the rectal sphincter muscle. The rectal mucosa is excised and the colon removed. An ileoanal reservoir is then created in the anal canal, and a temporary loop ostomy is formed. After healing has taken place, the ileostomy is reversed and stool drains into the reservoir.

Question 14

A client with ulcerative colitis has severe diarrhea. Further assessments by the nurse are aimed at early recognition of
A) dehydration.
B) hemorrhoids.
C) metabolic alkalosis.
D) nephrolithiasis.

Accepted Answer

Severe diarrhea can cause a loss of 500 to 17,000 ml of water in 24 hours.

Question 15

A client is admitted with dysentery caused by Clostridium difficile, or pseudomembranous colitis. To elicit the most helpful information about the cause of the dysentery, the nurse would ask the client
A) "Are you taking any antibiotics?"
B) "Do you ever go barefoot outside your home?"
C) "Does anyone else in your family have bowel problems?"
D) "Have you traveled in any foreign countries lately?"

Accepted Answer

Infection with C. difficile is a bacterial dysentery often seen in clients who have been receiving large doses of antibiotics or who have taken antibiotics over a long period.

Question 16

A client is admitted with appendicitis and is awaiting surgery. The client states, "Now instead of pain in just one spot, the pain is kind of all over my abdomen." Which action by the nurse takes priority?
A) Assess the client's abdomen.
B) Get a set of vital signs.
C) Call the physician.
D) Prepare the client for another x-ray.

Accepted Answer

A complication of appendicitis is rupture. Any change in pain warrants a further assessment of the client. Pain that goes from more localized to generalized throughout the abdomen is characteristic of rupture. An abdominal exam may reveal a hard, board-like abdomen, which is further evidence of rupture. This information is vital to give the physician.

Question 17

The nurse caring for a client with abdominal distention and vomiting that is fecal in nature should conduct further assessment aimed at discovering
A) a distal, small intestinal obstruction.
B) gastric ulceration.
C) gastrointestinal (GI) bleeding.
D) ulceration of the esophagus.

Accepted Answer

Vomiting that contains fecal material usually indicates a distal obstruction in the small intestine.

Question 18

When a client is admitted to the emergency department with a hernia, the classification of hernia that would represent a surgical emergency is
A) incisional.
B) inguinal.
C) reducible.
D) strangulated.

Accepted Answer

Incarcerated hernias usually become strangulated. This situation is a surgical emergency because unless the bowel is released, it soon becomes gangrenous from a lack of blood supply. An incisional hernia is one occurring at a surgical site, most often in clients with poor wound healing. A reducible hernia can be replaced into the abdominal cavity.

Question 19

For a client who has returned to the nursing unit after creation of a continent ileostomy (Kock pouch), the action the nurse would include in the plan of care is
A) attach the catheter to straight drainage initially for several days.
B) irrigate the pouch daily with sterile solutions only.
C) provide a permanent appliance and assist the client in application.
D) restrict oral intake until ileal drainage is profuse.

Accepted Answer

During the surgical formation of the Kock pouch, an evacuation catheter is inserted. A skin barrier and special gauze dressing are then applied to hold the catheter in an upright position to avoid stress on the healing nipple valve. It is imperative to avoid distention of the ileostomy reservoir in the early postoperative period because of the pressure that distention would put on the suture line. Thus the Kock pouch is attached to straight drainage initially for several days, then emptied every 2 hours for about 2 weeks.

Question 20

In caring for a client with peritonitis from inflamed diverticuli, the nurse should assign priority to assessing
A) bowel sounds.
B) intake and output.
C) neurologic status.
D) vital signs.

Accepted Answer

Assessment of bowel signs is a priority because paralytic ileus can develop suddenly from the inflammation. Vital signs and intake and output are important as well, but not as high a priority.

Quiz 33: Management of Clients with Intestinal Disorders

A client with Crohn's disease is recovering from a fourth bowel resection and is being dismissed. The nurse determines that teaching goals have been met when the client indicates that s/he will watch for manifestations of

Until a diagnosis is made, the nurse caring for a client being evaluated for acute appendicitis should treat pain and discomfort with

In counseling a client with ulcerative colitis for 25 years about health maintenance plans, the nurse would include the advice that the client should

A nurse is caring for a postoperative client who has developed peritonitis. An assessment finding that would require immediate action would be

The nurse caring for a client with an intestinal malignancy assesses for bleeding, which would most likely be manifested by

In caring for a client with Crohn's disease and the nursing diagnosis of Imbalanced Nutrition: Less Than Body Requirements related to diarrhea, the nurse would plan to observe for

The nurse is instructing a client with a new colostomy on its care and notes that the stoma is large and dusky. The most appropriate nursing intervention at this time is to

The nurse taking the history of an 80-year-old woman diagnosed with gastroenteritis would recognize that the most significant factor in determining potential for complications in this client is

A 13-year-old client with ulcerative colitis says, "I am so glad I will grow out of this disease. It's so embarrassing at school." Which action by the nurse would best address this statement?

A client recovering from a recent colostomy is very reluctant to participate in self-care. To initiate the client's interaction, the nurse should

To help a client with a new ostomy integrate its appearance into the client's body image, the home health nurse would

A client with inflammatory bowel disease (IBD) takes sulfasalazine (Azulfadine) for management of manifestations. To counteract a side effect of this drug, the nurse would encourage the client to increase intake of

A client with ulcerative colitis is scheduled for surgical creation of an ileoanal reservoir (J pouch) . What information should the nurse include in this client's teaching plan?

A client with ulcerative colitis has severe diarrhea. Further assessments by the nurse are aimed at early recognition of

A client is admitted with dysentery caused by Clostridium difficile, or pseudomembranous colitis. To elicit the most helpful information about the cause of the dysentery, the nurse would ask the client

A client is admitted with appendicitis and is awaiting surgery. The client states, "Now instead of pain in just one spot, the pain is kind of all over my abdomen." Which action by the nurse takes priority?

The nurse caring for a client with abdominal distention and vomiting that is fecal in nature should conduct further assessment aimed at discovering

When a client is admitted to the emergency department with a hernia, the classification of hernia that would represent a surgical emergency is

For a client who has returned to the nursing unit after creation of a continent ileostomy (Kock pouch) , the action the nurse would include in the plan of care is

In caring for a client with peritonitis from inflamed diverticuli, the nurse should assign priority to assessing