Nokea
The nurse is caring for a patient who has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight loss of 4.5 kg over 2 months. Which of the following topics should the nurse plan to include in the teaching plan?
- A. Medication use
- B. Fluid restriction
- C. Enteral nutrition
- D. Activity restrictions
Correct Answer: A
Rationale: Medications are used to induce and maintain remission in patients with inflammatory bowel disease (IBD). Decreased activity level is indicated only if the patient has severe fatigue and weakness. Fluids are needed to prevent dehydration. There is no advantage to enteral feedings.
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The nurse is caring for a patient who has a large bowel obstruction that occurred as a result of diverticulosis. Which of the following symptoms should the nurse monitor for when assessing the patient?
- A. Referred back pain
- B. Metabolic alkalosis
- C. Projectile vomiting
- D. Abdominal distension
Correct Answer: D
Rationale: Abdominal distension is seen in lower intestinal obstruction. Metabolic alkalosis is common in high intestinal obstruction because of the loss of HCl acid from vomiting. Referred back pain is not a common clinical manifestation of intestinal obstruction. Bile-coloured vomit is associated with higher intestinal obstruction.
The nurse is providing discharge teaching for a patient with a new colostomy. Which of the following patient actions indicates that the teaching has been effective?
- A. Empties the colostomy bag once it is one-third full.
- B. Drinks at least 1000 mL of fluid a day.
- C. Contacts the health care provider if there is pain or erythema in the peristomal area.
- D. Takes acetaminophen when a temperature of 38.3°C is present.
Correct Answer: C
Rationale: The health care provider should be contacted if there is pain or erythema in the peristomal area. If the patient has a temperature, the health care provider should be contacted. The colostomy should be emptied before it becomes one-third full. The patient should drink at least 1500-2000 mL per day to avoid dehydration.
Which of the following nursing actions is most important to include in the plan of care for a patient who had an abdominal-perineal resection the previous day?
- A. Teach about a low-residue diet.
- B. Monitor output from the stoma.
- C. Assess the perineal drainage and incision.
- D. Encourage acceptance of the colostomy stoma.
Correct Answer: C
Rationale: Because the perineal wound is at high risk for infection, the initial care is focused on assessment and care of this wound. Teaching about diet is best done closer to discharge from the hospital. There will be very little drainage into the colostomy until peristalsis returns. The patient will be encouraged to assist with the colostomy, but this is not the highest priority in the immediate postoperative period.
The nurse is obtaining a history for a female patient who is being evaluated for acute lower abdominal pain and vomiting. Which of the following questions is most useful in determining the cause of the patient's symptoms?
- A. Is it possible that you are pregnant?
- B. Can you tell me more about the pain?
- C. What type of foods do you usually eat?
- D. What is your usual elimination pattern?
Correct Answer: B
Rationale: A complete description of the pain provides clues about the cause of the problem. The usual diet and elimination patterns are less helpful in determining the reason for the patient's symptoms. Although the nurse should ask whether the patient is pregnant to determine whether the patient might have an ectopic pregnancy and before any radiology studies are done, this information is not the most useful in determining the cause of the pain.
Which of the following nursing actions should be included in the plan of care for a male patient with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)?
- A. Encourage the patient to express feelings and ask questions about IBS.
- B. Suggest that the patient increase the intake of milk and other dairy products.
- C. Educate the patient about the use of metronidazole to reduce symptoms.
- D. Teach the patient to avoid using nonsteroidal anti-inflammatory drugs (NSAIDs).
Correct Answer: A
Rationale: Because psychological and emotional factors can affect the symptoms for IBS, encouraging the patient to discuss emotions and ask questions is an important intervention. Metronidazole is an antimicrobial used for infections, not IBS, at the present time. Although yogurt may be beneficial, milk is avoided because lactose intolerance can contribute to symptoms in some patients. NSAIDs can be used by patients with IBS.