Nokea
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.
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The nurse is caring for a patient with an exacerbation of ulcerative colitis who is having 15-20 stools daily and has external hemorrhoids. Which of the following patient behaviours indicate that teaching regarding maintenance of skin integrity has been effective?
- A. The patient uses incontinence briefs to contain loose stools.
- B. The patient asks for antidiarrheal medication after each stool.
- C. The patient uses witch hazel compresses to decrease anal discomfort.
- D. The patient cleans the perianal area with soap and water after each stool.
Correct Answer: C
Rationale: Witch hazel compresses are suggested to reduce anal irritation and discomfort. Incontinence briefs may trap diarrhea and increase the incidence of skin breakdown. Antidiarrheal medications are not given 15-20 times a day. The perianal area should be washed with plain water after each stool.
The nurse is caring for a patient who had an exploratory laparotomy with a resection of a short segment of small bowel two days previously. The patient has gas pains and abdominal distension. Which of the following nursing actions is best to take at this time?
- A. Give a return-flow enema.
- B. Assist the patient to ambulate.
- C. Administer the ordered IV morphine sulphate.
- D. Insert the ordered promethazine suppository.
Correct Answer: B
Rationale: Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. Morphine will further reduce peristalsis. A return-flow enema may decrease the patient's symptoms, but ambulation is less invasive and should be tried first. Promethazine is used as an antiemetic rather than to decrease gas pains or distension.
The nurse is caring for a patient with ulcerative colitis who underwent a proctocolectomy with an ileostomy. Which of the following information should the nurse include in patient teaching?
- A. Restrict fluid intake to prevent constant liquid drainage from the stoma.
- B. Use care when eating high-fibre foods to avoid obstruction of the ileum.
- C. Irrigate the ileostomy daily.
- D. Change the pouch every day to prevent leakage of contents onto the skin.
Correct Answer: B
Rationale: High-fibre foods are introduced gradually and should be well chewed to avoid obstruction of the ileostomy. Patients with ileostomies lose the absorption of water in the colon and need to take in increased amounts of fluid. The pouch should be drained frequently but is changed every 5-7 days. The drainage from an ileostomy does not require daily irrigation.
The nurse is teaching a patient who has persistent constipation, about the use of psyllium. Which of the following information should the nurse include?
- A. Absorption of fat-soluble vitamins may be reduced by fibre-containing laxatives.
- B. Dietary sources of fibre should be eliminated to prevent excessive gas formation.
- C. Use of this type of laxative to prevent constipation does not cause adverse effects.
- D. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.
Correct Answer: D
Rationale: A high fluid intake is needed when patients are using bulk-forming laxatives to avoid worsening constipation. Although bulk-forming laxatives are generally safe, the nurse should emphasize the possibility of constipation or obstipation if inadequate fluid intake occurs. Although increased gas formation is likely to occur with increased dietary fibre, the patient should gradually increase dietary fibre and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool softeners and lubricants, not by bulk-forming laxatives.
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.