Nokea
A client with a diagnosis of acute appendicitis is awaiting surgical intervention. The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and board-like. What complication does the nurse determine may be occurring at this time?
- A. Constipation
- B. Paralytic ileus
- C. Peritonitis
- D. Accumulation of gas
Correct Answer: C
Rationale: Lack of bowel motility typically accompanies peritonitis. The abdomen feels rigid and board-like as it distends with gas and intestinal contents. Bowel sounds typically are absent. The diagnosis of acute appendicitis correlates with the symptoms of rupture of the appendix and peritonitis. A paralytic ileus, constipation, and gas alone do not produce these symptoms.
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The instructor is teaching a group of students about intestinal obstruction. The instructor determines that the teaching was effective when the students identify which of the following as a cause of a functional obstruction?
- A. Volvolus
- B. Intussusception
- C. Tumor
- D. Abdominal surgery
Correct Answer: D
Rationale: In functional obstruction, the intestine can become adynamic from an absence of normal nerve stimulation to intestinal muscle fibers. For example, abdominal surgery can lead to paralytic ileus. Mechanical obstructions result from a narrowing of the bowel lumen with or without a space-occupying mass. A mass may include a tumor, adhesions (fibrous bands that constrict tissue), incarcerated or strangulated hernias, volvulus (kinking of a portion of intestine), intussusception (telescoping of one part of the intestine into an adjacent part), or impacted feces or barium.
A client is recently diagnosed with Crohn disease and is beginning treatment. What first-line treatment does the nurse expect that the client will be placed on to decrease the inflammatory response?
- A. Ciprofloxacin
- B. Methotrexate
- C. Azathioprine
- D. Sulfasalazine
Correct Answer: D
Rationale: Considered first-line treatment for inflammatory bowel disease, 5-ASA drugs contain salicylate, which is bonded to a carrying agent that allows the drug to be absorbed in the intestine. These drugs work by decreasing the inflammatory response. Methotrexate or azathioprine are used when failure to maintain remission necessitates the use of an immune-modulating agent. Ciprofloxacin is used as an effective adjunct to treat the disease.
A client is diagnosed with colon cancer, located in the lower third of the rectum. What does the nurse understand will be the surgical treatment option for this client?
- A. Colectomy
- B. Segmental resection
- C. Abdominoperineal resection
- D. A low colectomy
Correct Answer: C
Rationale: A cancerous mass in the lower third of the rectum will result in an abdominoperineal resection with a wide excision of the rectum and the creation of a sigmoid colostomy. An encapsulated colorectal tumor may be removed without taking away surrounding healthy tissue. This type of tumor, however, may call for partial or complete surgical removal of the colon (colectomy). Occasionally, the tumor causes a partial or complete bowel obstruction. If the tumor is in the colon and upper third of the rectum, a segmental resection is performed. In this procedure, the surgeon removes the cancerous portion of the colon and rejoins the remaining portions of the GI tract to restore normal intestinal continuity.
The nurse is teaching a client with constipation to increase dietary fiber intake to 25 g/day. Which recommendation would the nurse include?
- A. Avoiding bran cereals and beans in the diet
- B. Adding fiber-rich foods to the diet gradually
- C. Limiting fluid intake to 5 to 6 glasses per day
- D. Minimizing activity levels for at least 2 months
Correct Answer: B
Rationale: The nurse instructs the client to add fiber-rich foods to the diet gradually to avoid bloating, gas, and diarrhea. It is essential for a client to include bran cereals and beans in the diet because they ease defecation. The nurse also instructs the client to increase fluids to 6 to 8 glasses per day to prevent hard, dry stools. The client should also develop a regular exercise program to increase peristalsis and promote bowel elimination.
A client with a hernia decides to manage the herniation with a truss. The nurse would emphasize which of the following?
- A. Using laxatives to ensure regular bowel movement
- B. Wearing warm, woolen clothes to avoid dryness
- C. Applying a sunscreen to prevent exposure to direct sunlight
- D. Using cornstarch to absorb moisture in the area
Correct Answer: D
Rationale: When a client is managing herniation with a truss, the nurse informs the client to keep the skin clean and dry or to use cornstarch to absorb moisture. This minimizes the risk for infection. Use of warm, woolen clothes will not help reduce moisture, it may increase the moisture and increase the risk of infections. If the client's bowel movements are regular, laxatives would not be necessary. However, the client would need teaching to prevent constipation. Applying sunscreen is a general recommendation for any client to reduce the risk of exposure to ultraviolet radiation from the sun.