Nokea
A patients health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohns disease, rather than ulcerative colitis, as the cause of the patients signs and symptoms?
- A. A pattern of distinct exacerbations and remissions
- B. Severe diarrhea
- C. An absence of blood in stool
- D. Involvement of the rectal mucosa
Correct Answer: C
Rationale: Bloody stool is far more common in cases of UC than in Crohns. Rectal involvement is nearly 100% in cases of UC (versus 20% in Crohns) and patients with UC typically experience severe diarrhea. UC is also characterized by a pattern of remissions and exacerbations, while Crohns often has a more prolonged and variable course.
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A teenage patient with a pilonidal cyst has been brought for care by her mother. The nurse who is contributing to the patients care knows that treatment will be chosen based on what risk?
- A. Risk for infection
- B. Risk for bowel incontinence
- C. Risk for constipation
- D. Risk for impaired tissue perfusion
Correct Answer: A
Rationale: Pilonidal cysts frequently develop into an abscess, necessitating surgical repair. These cysts do not contribute to bowel incontinence, constipation, or impaired tissue perfusion.
A nurse is caring for an older adult who has been experiencing severe Clostridium difficile-related diarrhea. When reviewing the patients most recent laboratory tests, the nurse should prioritize which of the following?
- A. White blood cell level
- B. Creatinine level
- C. Hemoglobin level
- D. Potassium level
Correct Answer: D
Rationale: In elderly patients, it is important to monitor the patients serum electrolyte levels closely. Diarrhea is less likely to cause an alteration in white blood cell, creatinine, and hemoglobin levels.
A 16-year-old presents at the emergency department complaining of right lower quadrant pain and is subsequently diagnosed with appendicitis. When planning this patients nursing care, the nurse should prioritize what nursing diagnosis?
- A. Imbalanced Nutrition: Less Than Body Requirements Related to Decreased Oral Intake
- B. Risk for Infection Related to Possible Rupture of Appendix
- C. Constipation Related to Decreased Bowel Motility and Decreased Fluid Intake
- D. Chronic Pain Related to Appendicitis
Correct Answer: B
Rationale: The patient with a diagnosis of appendicitis has an acute risk of infection related to the possibility of rupture. This immediate physiologic risk is a priority over nutrition and constipation, though each of these concerns should be addressed by the nurse. The pain associated with appendicitis is acute, not chronic.
A nurse caring for a patient with colorectal cancer is preparing the patient for upcoming surgery. The nurse administers cephalexin (Keflex) to the patient and explains what rationale?
- A. To treat any undiagnosed infections
- B. To reduce intestinal bacteria levels
- C. To reduce bowel motility
- D. To reduce abdominal distention postoperatively
Correct Answer: B
Rationale: Antibiotics such as kanamycin (Kantrex), neomycin (Mycifradin), and cephalexin (Keflex) are administered orally the day before surgery to reduce intestinal bacteria. Preoperative antibiotics are not given to treat undiagnosed infections, reduce motility, or prevent abdominal distention.
A 35-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. In collaboration with the primary care provider, what intervention should the nurse prioritize?
- A. Insertion of a nasogastric tube
- B. Insertion of a central venous catheter
- C. Administration of a mineral oil enema
- D. Administration of a glycerin suppository and an oral laxative
Correct Answer: A
Rationale: Decompression of the bowel through a nasogastric tube is necessary for all patients with small bowel obstruction. Peripheral IV access is normally sufficient. Enemas, suppositories, and laxatives are not indicated if an obstruction is present.