Nokea
The nurse is caring for a client who has had diarrhea for 3 days. What major problem(s) associated with severe or prolonged diarrhea should the nurse monitor for when caring for this client? Select all that apply.
- A. Oral candidiasis
- B. Dehydration
- C. Electrolyte imbalances
- D. Vitamin deficiencies
- E. Rectal fissures
Correct Answer: B,C,D
Rationale: Three major problems associated with severe or prolonged diarrhea include dehydration, electrolyte imbalances, and vitamin deficiencies.
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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.
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 realizes that regular use of laxatives has led to bowel pattern improvement. However, the nurse cautions this client against the prolonged use of laxatives for which reason?
- A. The client may develop inflammatory bowel disease.
- B. The client may develop arthritis or arthralgia.
- C. The client's natural bowel function may become sluggish.
- D. The client's appetite may be depleted.
Correct Answer: C
Rationale: It is essential for the nurse to caution the client against the prolonged use of laxatives because it decreases muscle tone in the large intestine. Prolonged use of laxatives may cause the client's natural bowel function to become sluggish. Laxatives do not increase the risk of developing inflammatory bowel disease, arthritis, or arthralgia, nor do they cause a loss in appetite.
Which test will best determine whether a client has an abnormality of the muscles surrounding the anal sphincter?
- A. Kidneys, ureters, bladder (KUB)
- B. Colonic transit studies
- C. Defecography
- D. Abdominal radiography
Correct Answer: C
Rationale: In defecography, a thick barium paste is inserted into the rectum. Radiographs are taken as the client expels the barium to determine whether there are any anatomic abnormalities or problems with the muscles surrounding the anal sphincter. A KUB will not determine this. Colonic transit studies are used to determine how long it takes for food to travel through the intestines. Abdominal radiography will show the structure but does not determine the muscle ability surrounding the anal sphincter.
A client reports taking a stimulant laxative in order to be able to have a bowel movement daily. What should the nurse inform the client about taking a stimulant laxative?
- A. They can be habit forming and will require increasing doses to be effective.
- B. If the client is drinking 8 glasses of water per day, it is all right to continue taking them.
- C. The laxative is safe to take with other medication the client is taking.
- D. The client should take a fiber supplement along with the stimulant laxative.
Correct Answer: A
Rationale: The nurse should discourage self-treatment with daily or frequent enemas or laxatives. Chronic use of such products causes natural bowel function to be sluggish. In addition, laxatives containing stimulants can be habit forming, requiring continued use in increasing doses. Although the nurse should encourage the client to have adequate fluid intake, laxative use should not be encouraged. The laxative may interact with other medications the client is taking and may cause a decrease in absorption. A fiber supplement may be taken alone but should not be taken with a stimulant laxative.