Nokea
The nurse is caring for a patient with an acute exacerbation of ulcerative colitis having 14-16 bloody stools a day and crampy abdominal pain associated with the diarrhea. Which of the following actions should the nurse take?
- A. Place the patient on NPO status.
- B. Administer IV metoclopramide.
- C. Teach the patient about total colectomy surgery.
- D. Administer cobalamin injections.
Correct Answer: A
Rationale: An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO. Cobalamin (vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. Although total colectomy is needed for some patients, there is no indication that this patient is a candidate. Metoclopramide increases peristalsis and will worsen symptoms.
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Which of the following actions should the nurse implement when initiating the initial plan of care for a patient admitted with acute diverticulitis?
- A. Give stool softeners.
- B. Administer IV fluids.
- C. Order a diet high in fibre and fluids.
- D. Prepare the patient for colonoscopy.
Correct Answer: B
Rationale: A patient with acute diverticulitis will be NPO and given parenteral fluids. A diet high in fibre and fluids will be implemented before discharge. Bulk-forming laxatives, rather than stool
The nurse is preparing a 50-year-old patient for an annual physical examination. Which of the following diagnostic tests should the nurse teach to the patient?
- A. Endoscopy
- B. Fecal occult blood test
- C. Computerized tomography screening
- D. Carcinoembryonic antigen (CEA) testing
Correct Answer: B
Rationale: At age 50, individuals with an average risk for colorectal cancer (CRC) should begin screening for CRC, including a fecal occult blood test (FOBT). Colonoscopy is the gold standard for CRC screening. The other diagnostic tests are not recommended as part of a routine annual physical examination at age 50.
The nurse is teaching a patient with ulcerative colitis about sulphasalazine. Which of the following patient statements indicates that the teaching has been effective?
- A. I will need to take this medication for at least one year.
- B. I will need to avoid contact with people who are sick.
- C. The medication will need to be tapered if I need surgery.
- D. The medication will prevent infections that cause the diarrhea.
Correct Answer: A
Rationale: Sulphasalazine usually has a maintenance dose that the patient takes for one year. It is not used to treat infections. Sulphasalazine does not reduce immune function. Unlike corticosteroids, tapering of sulphasalazine is not needed.
Before undergoing a colon resection for cancer of the colon, a patient has an elevated carcinoembryonic antigen (CEA) test. Which of the following explanations should the nurse provide to the patient about this test?
- A. It confirms the diagnosis of colon cancer.
- B. It monitors the tumour status after surgery.
- C. It identifies the extent of cancer spread or metastasis.
- D. It determines the need for postoperative chemotherapy.
Correct Answer: B
Rationale: CEA is used to monitor for cancer recurrence after surgery. CEA levels do not help determine whether there is metastasis of the cancer. Confirmation of the diagnosis is made on the basis of biopsy. Chemotherapy use is based on factors other than CEA.
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.