Nokea
After teaching a client who has a new colostomy, the nurse provides feedback based on the client's ability to complete self-care activities. Which statement should the nurse include in this feedback?
- A. I realize that you had a tough time today, but it will get easier with practice.
- B. You cleared the stoma well. Now you need to practice putting on the appliance.
- C. You seem to understand what I taught you today. What else can I help you with?
- D. You seem to understand. Do you want your daughter to care for your ostomy?
Correct Answer: B
Rationale: Feedback should be objective and constructive, acknowledging what was done well (clearing the stoma) and identifying areas for improvement (applying the appliance). General reassurance, vague inquiries, or suggesting someone else manage the ostomy are not constructive.
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A nurse assesses a client who is hospitalized with an exacerbation of Crohn's disease. Which clinical manifestation should the nurse expect to find?
- A. Positive Murphy's sign with rebound tenderness to palpation
- B. Dull, hypoactive bowel sounds in the lower abdominal quadrant
- C. High-pitched, rushing bowel sounds in the right lower quadrant
- D. Reports of abdominal cramping that is worse at night
Correct Answer: C
Rationale: High-pitched, rushing bowel sounds are expected in Crohn's disease due to narrowing of the bowel lumen. Positive Murphy's sign indicates gallbladder disease, and rebound tenderness suggests peritonitis. Dull, hypoactive bowel sounds and nightly worsening of cramping are not typical of Crohn's disease.
A nurse assesses a client with ulcerative colitis. Which complications are paired correctly with their physiologic processes? (Select all that apply.)
- A. Lower gastrointestinal bleeding - Erosion of the bowel wall
- B. Abscesses - Localized pockets of infection develop in the ulcerated bowel lining
- C. Toxic megacolon - Transmural inflammation resulting in pyuria and fecaluria
- D. Non-mechanical bowel obstruction - Paralysis of colon resulting from colorectal cancer
- E. Fistulas - Dilation and decreased motility caused by paralysis of the colon
Correct Answer: A,B,D
Rationale: Lower GI bleeding results from bowel wall erosion, abscesses form in ulcerated bowel lining, and non-mechanical bowel obstruction occurs due to colon paralysis from colorectal cancer. Toxic megacolon involves colon dilation, not pyuria/fecaluria, and fistulas result from transmural inflammation, not paralysis.
A nurse cares for a client with ulcerative colitis. The client states, 'I feel like I am tied to the toilet. This disease is controlling my life.' How should the nurse respond?
- A. Let's identify stress factors that worsen your symptoms to help you gain more control.
- B. If you take the prescribed medications, you will no longer have diarrhea.
- C. To decrease distress, do not eat anything before you go out.
- D. You must take control of your life. I will consult a therapist to help.
Correct Answer: A
Rationale: Identifying stress factors that exacerbate ulcerative colitis symptoms empowers the client to manage their condition. Medications reduce but do not eliminate diarrhea, fasting is not practical, and suggesting a therapist without discussion dismisses the client's concerns.
A nurse cares for a client who is prescribed mesalamine (Asacol) for ulcerative colitis. The client states, 'I am having trouble swallowing this pill.' Which action should the nurse take?
- A. Contact the clinical pharmacist and request the medication in suspension form.
- B. Empty the contents of the medication into suspension or pudding for administration.
- C. Ask the health care provider to prescribe the medication as an enema instead.
- D. Crush the pill carefully and administer it in applesauce or pudding.
Correct Answer: C
Rationale: Asacol is an enteric-coated pill that should not be crushed, chewed, or broken, as this would disrupt its delayed-release mechanism. It is not available as a suspension or elixir. A mesalamine enema (Rowasa) is an alternative formulation that can be prescribed if the client cannot swallow the oral form.
A nurse cares for a client who is prescribed 5 mg/kg of infliximab (Remicade) intravenously. The client weighs 110 lbs and the pharmacy supplies infliximab 100 mg/10 mL solution. How many milliliters should the nurse administer to this client? (Record your answer using a whole number)
- A. 20 mL
- B. 25 mL
- C. 30 mL
- D. 35 mL
Correct Answer: B
Rationale: The client weighs 110 lbs (50 kg). The dose is 5 mg/kg, so 5 mg/kg ? 50 kg = 250 mg. The pharmacy supplies 100 mg/10 mL, so 250 mg ÷ 100 mg/10 mL = 25 mL.