Nokea
The client diagnosed with ulcerative colitis is prescribed a low-residue diet. Which meal selection indicates the client understands the diet teaching?
- A. Grilled hamburger on a wheat bun and fried potatoes.
- B. A chicken salad sandwich and lettuce and tomato salad.
- C. Roast pork, white rice, and plain custard.
- D. Fried fish, whole grain pasta, and fruit salad.
Correct Answer: C
Rationale: A low-residue diet minimizes fiber to reduce bowel irritation, so roast pork, white rice, and plain custard (low-fiber foods) are appropriate. The other options include high-fiber foods like wheat, vegetables, and whole grains, which are contraindicated.
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The client developed a paralytic ileus after abdominal surgery. Which intervention should the nurse include in the plan of care?
- A. Administer a laxative of choice.
- B. Encourage the client to increase oral fluids.
- C. Encourage the client to take deep breaths.
- D. Maintain a patent nasogastric tube.
Correct Answer: D
Rationale: Maintaining a patent NG tube decompresses the bowel in paralytic ileus, preventing complications. Laxatives and oral fluids are contraindicated, and deep breathing is unrelated.
The client is diagnosed with an acute exacerbation of IBD. Which priority intervention should the nurse implement?
- A. Weigh the client daily and document in the client's chart.
- B. Teach coping strategies such as dietary modifications.
- C. Record the frequency, amount, and color of stools.
- D. Monitor the client's oral fluid intake every shift.
Correct Answer: C
Rationale: Recording stool frequency, amount, and color is critical in acute IBD exacerbation to assess disease activity and guide treatment. Weight and fluid monitoring are important but secondary, and teaching is less urgent during an acute phase.
The client of Chinese ethnicity has diarrhea and refuses to drink the prescribed oral hydration solution, insisting on having chicken broth instead. Which statement about clients of Chinese ethnicity should be the basis for the nurse’s intervention in this situation?
- A. They consider chicken a food with yang qualities.
- B. They believe extra protein is needed to treat diarrhea.
- C. They believe high-sodium foods are needed to treat diarrhea.
- D. They mistrust modern medicine and eat broth to treat disease.
Correct Answer: A
Rationale: A. Loose stools are a yin symptom, which should be treated with foods that have yang qualities, one of which is chicken. B. There is no belief in the Chinese culture related to consuming high-protein foods. C. There is no belief in the Chinese culture related to consuming high-sodium foods. D. The Chinese do not mistrust modern medicine but may combine Western medicine and Chinese herbal medicines to treat disease.
An adult is being treated for a peptic ulcer. The physician has prescribed cimetidine (Tagamet) for which reason?
- A. It blocks the secretion of gastric hydrochloric acid.
- B. It coats the gastric mucosa with a protective membrane.
- C. It increases the sensitivity of histamine (H2) receptors.
- D. It neutralizes acid in the stomach.
Correct Answer: A
Rationale: Cimetidine, an H2 receptor blocker, reduces gastric acid secretion, aiding peptic ulcer healing.
Which sign/symptom should the nurse expect to find in a client diagnosed with ulcerative colitis?
- A. Twenty bloody stools a day.
- B. Oral temperature of 102°F.
- C. Hard, rigid abdomen.
- D. Urinary stress incontinence.
Correct Answer: A
Rationale: Ulcerative colitis commonly causes frequent bloody stools due to inflammation and ulceration of the colon mucosa. Fever may occur but is less specific, a hard abdomen suggests complications like perforation, and urinary incontinence is unrelated.