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The nurse is providing patient teaching about recommended dietary choices for a patient with an acute exacerbation of inflammatory bowel disease (IBD). Which of the following diet choices by the patient indicates a need for more teaching?
- A. Scrambled eggs
- B. White toast and jam
- C. Oatmeal with cream
- D. Pancakes with syrup
Correct Answer: C
Rationale: During acute exacerbations of IBD, the patient should be on a low-residue diet and avoid high-fibre foods such as whole grains. High-fat foods also may cause diarrhea in some patients. The other choices are low residue and would be appropriate for this patient.
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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 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 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 conducting preoperative preparation for a patient scheduled for an abdominal-perineal resection. Which of the following actions should the nurse implement?
- A. Give IV antibiotics starting 24 hours before surgery to reduce the number of bowel bacteria.
- B. Teach the patient that activities such as sitting at the bedside will be started the first postoperative day.
- C. Instruct the patient that another surgery in 8-12 weeks will be used to create an ileal-anal reservoir.
- D. Administer polyethylene glycol lavage solution (GOLYTELY) to ensure that the bowel is empty before the surgery.
Correct Answer: D
Rationale: A bowel-cleansing agent is used to empty the bowel before surgery to reduce the risk for infection. Oral antibiotics (rather than IV antibiotics) are given to reduce colonic and rectal bacteria. Sitting is contraindicated after an abdominal-perineal resection. A permanent colostomy is created with this surgery.
A patient tells the nurse, 'I have problems with constipation now that I am older, so I use a suppository every morning.' Which of the following actions should the nurse take first?
- A. Encourage the patient to increase oral fluid intake
- B. Inform the patient that a daily bowel movement is unnecessary.
- C. Assess the patient about individual risk factors for constipation.
- D. Suggest that the patient increase dietary intake of high-fibre foods.
Correct Answer: C
Rationale: The nurse's initial action should be further assessment of the patient for risk factors for constipation and for usual bowel pattern. The other actions may be appropriate but will be based on the assessment.