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The nurse is caring for a patient who is incontinent of watery diarrhea and has been diagnosed with Clostridium difficile. Which of the following actions should the nurse include in the plan of care?
- A. Order a diet with no dairy products for the patient.
- B. Place the patient in a private room with contact isolation.
- C. Teach the patient about why antibiotics are not being used.
- D. Educate the patient about proper food handling and storage.
Correct Answer: B
Rationale: Because C. difficile is highly contagious, the patient should be placed in a private room and contact precautions should be used. There is no need to restrict dairy products for this type of diarrhea. Metronidazole is frequently used to treat C. difficile. Improper food handling and storage do not cause C. difficile.
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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.
The nurse is providing teaching to a patient with a new ileostomy. Which of the following daily drainage amounts should the nurse inform the patient is expected after the bowel adjusts to the ileostomy?
- A. 400 mL
- B. 600 mL
- C. 800 mL
- D. 1000 mL
Correct Answer: C
Rationale: After the proximal small bowel adapts to reabsorb more fluid, the average amount of ileostomy drainage is about 800 mL daily.
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.
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.
The nurse is caring for a patient who has had a total proctocolectomy and permanent ileostomy who tells the nurse, 'I cannot bear to even look at the stoma. I do not think I can manage all these changes.' Which of the following actions is best?
- A. Develop a detailed written plan for ostomy care for the patient.
- B. Ask the patient more about the concerns with stoma management.
- C. Reassure the patient that care for the ileostomy will become easier.
- D. Postpone any patient teaching until the patient adjusts to the ileostomy.
Correct Answer: B
Rationale: Encouraging the patient to share concerns assists in helping the patient adjust to the body changes. Acknowledgement of the patient's feelings and concerns is important rather than offering false reassurance. Because the patient indicates that the feelings about the ostomy are the reason for the difficulty with the many changes, development of a detailed ostomy care plan will not improve the patient's ability to manage the ostomy. Although detailed ostomy teaching may be postponed, the nurse should offer teaching about some aspects of living with an ostomy.