HESI: IBD Flashcards
[UC] The nurse anticipates that client will describe her diarrhea as:
Bloody.
Green and frothy.
Gray with observable fat.
Clay-colored.
Bloody.
Because rectal bleeding is a common finding in ulcerative colitis, which additional information is important for the nurse to obtain from the client?
Hear a ringing in ears.
Fatigued or light-headed.
Tremors or headaches.
Trouble remembering recent events.
Fatigued or light-headed.
Continuous rectal bleeding will result in anemia, causing the client to feel fatigued, dizzy, light-headed, and weak.
Client has no other GI symptoms at the present time. She does report that her body is stiff and aching when she rises in the morning, for which she takes a non-steroidal medication to help relieve the pain.
What is the nurse’s best response to this information?
That may indicate that the colitis has spread throughout the GI tract.
Ulcerative colitis can cause problems in areas other than the colon.
Probability this is related to the stress, not the colitis.
That has no bearing on current problems related to the colitis.
Ulcerative colitis can cause problems in areas other than the colon.
Clients with moderate to extensive ulcerative colitis can experience extraintestinal complications. Some of the common manifestations affect the large joints with symptoms of arthritis and the eyes with symptoms such as blurred vision and light sensitivity (photophobia).
Which instruction(s) are important for the nurse to provide client regarding food and fluid intake during the stool specimen collection? (Select all that apply. One, some, or all options may be correct.)
Select all that apply
Avoid caffeine.
Avoid red meat.
Increase fluid intake.
Remain NPO after midnight.
Do not take supplemental ascorbic acid (Vitamin C).
Avoid red meat.
Do not take supplemental ascorbic acid (Vitamin C).
Which explanation of the procedure for the barium enema should the nurse provide?
X-ray is used to visualize the large intestine after barium is instilled.
Movement of barium in the colon is observed through a scope.
A barium-based dye is injected intravenously, followed by abdominal scanning.
A digital exam is performed after the barium is removed by an enema.
X-ray is used to visualize the large intestine after barium is instilled.
A barium enema involves a series of x-rays taken to visualize the colon. These x-rays are taken after barium is instilled into the colon through a rectal catheter.
What instruction should the nurse provide to a client who just completed a barium enema?
Remain NPO for 24 hours.
Limit fluid intake.
Resume normal fluid intake.
Drink extra fluids.
Drink extra fluids.
Extra fluids are important to help flush out the barium and prevent constipation and bowel obstruction
Immediately following the sigmoidoscopy, it is important for the nurse to assess for which indicator of a potential post-procedure complication?
Headache.
Rectal bleeding.
Concentrated urine.
Inelastic skin turgor.
Rectal bleeding.
Rectal, bleeding, abdominal distention, tenderness, or guarding may indicate perforation of the intestine.
The diagnostic test results confirm that client has acute ulcerative colitis. During the acute phase, edema and ulceration of the bowel mucosa are seen, with resultant hemorrhage. Further changes in the colon occur as the disease progresses and becomes chronic.
After the healthcare provider (HCP) explains the diagnosis to client, and the necessary treatment, the nurse observes that client is visibly upset and that she is trying to refrain from crying. When the nurse sits down next to the client she says her life is over and she will have to quit college and move home with her parents to let them take care of her. The client also states that her boyfriend won’t want to spend time with someone who has diarrhea all the time.
In responding to client, the nurse recognizes that her remarks reflect which of Erikson’s developmental stages?
Ego integrity versus despair.
Generativity versus self-absorption.
Intimacy versus isolation.
Identity versus inferiority.
Intimacy versus isolation.
Young adulthood, between the ages of 18 and 35 years, is seen by Erikson as the developmental stage in which a priority concern is the maturing relationship of oneself to surrounding social systems. A major life event can greatly impact how a young adult relates to others.
What is the nurse’s best response?
“This all seems very overwhelming right now.”
“I know you are feeling very angry about this.”
“You won’t have to quit college or move home.”
“You are beginning to cope with a new situation.”
“This all seems very overwhelming right now.”
The nurse identifies that priority outcomes for client include control of her pain and her diarrhea. She receives prescriptions for diphenoxylate PRN, prednisone, sulfasalazine, and azathioprine. Her prescription for sulfasalazine reads, “Take 1 gram three times a day.” The client takes the medication at 0800, 1200, and 1800, which are her mealtimes. After 2 weeks of this regimen, she reports that her diarrhea has worsened and that she vomits frequently.
What instruction should the nurse provide?
“Stop the medication immediately. You are experiencing an allergic reaction.”
“You need to increase the length of time between each dose of the medication.”
“You should take the medication on an empty stomach to avoid these problems.”
“Your symptoms are worsening, so you will probably need a higher dose.”
“You need to increase the length of time between each dose of the medication.”
Adverse GI manifestations can increase if the dose of sulfasalazine is too large or if the doses are taken too close together. Client should be instructed to take the dose as close to an every-8-hours dosing schedule as possible.
Which assessment finding indicates that the diphenoxylate is having the desired effect?
Reported decrease in abdominal pain.
No evidence of blood in the stool.
Increase in bowel sound activity.
Decreased number of bowel movements.
Decreased number of bowel movements.
Diphenoxylate is an antidiarrheal medication. Therefore, the best measure of the effectiveness of the medication is assessment of the number of bowel movements. Diphenoxylate should be used with extreme caution for clients with ulcerative colitis because excessive use may result in colonic dilatation, causing additional problems such as toxic megacolon.
What instruction is most important to include when teaching about the prednisone?
Urine may appear concentrated or reddish-orange in color.
Take the daily dose at bedtime to avoid daytime drowsiness.
Cover exposed skin when spending time in direct sunlight.
Monitor mouth sores for white patches or increased discomfort.
Monitor mouth sores for white patches or increased discomfort.
Client may develop mouth sores as a manifestation of her ulcerative colitis. Corticosteroids, such as prednisone, have antiinflammatory and immunosuppressive effects that increase the risk for infection and may also mask signs of infection, so this places client at risk for the development of an oral Candida infection. She should be instructed to report any signs of infection, including mouth sores with white patches and increasing discomfort.
Client initially follows a low-fiber, low-lactose diet.
To maintain this diet, which snack choice is best?
Butter-free popcorn and a cola.
An apple and flavored water.
Nachos and light beer.
Angel food cake and cranberry juice.
Angel food cake and cranberry juice.
Juices are acceptable on a low-fiber diet, as long as they are strained or pulp-free.
Malabsorption: Management of Total Parenteral Nutrition
Client’s symptoms are managed for the next year, and she is able to gradually add many foods to her diet, finding that only alcohol, fresh fruits and vegetables, excessively greasy and spicy foods, and caffeine produce significant diarrhea. However, during her senior year in college, a number of stressful life events occur, including the death of her father and her application to graduate school. Following graduation, she reports severe, uncontrolled diarrhea that has been ongoing for the last 2 months. She is pale and dyspneic with mild exertion and reports constant fatigue and abdominal discomfort. She is hospitalized for an acute exacerbation of the ulcerative colitis.
Her hemoglobin and hematocrit are low.
Which additional serum lab value best reflects nutritional malabsorption?
Albumin 1.5 g/dL (15 g/L).
Calcium 8.5 mg/dL (2.13 mmol/L).
BUN 20.0 mg/dL (7.1 mmol/L).
Sodium 148.0 mEq/L (148 mmol/L).
Albumin 1.5 g/dL (15 g/L).
This value is significantly lower than normal adult values of 3.5–5.0 g/dL (35-50 g/L) in an adult, which is most likely the result of malnutrition
Client is placed on bowel rest, and she agrees that total parenteral nutrition (TPN) should be started.
Since the course of TPN treatment will last about 10 days, the nurse plans to prepare client for the insertion of which access device?
Percutaneous endoscopic gastrostomy.
Implanted port below the clavicle.
Peripheral IV in the antecubital fossa.
Multi-lumen subclavian catheter.
Multi-lumen subclavian catheter.
A subclavian catheter provides access to a large, central vein, which will tolerate the hyperosmotic solution of TPN. These catheters are appropriate for short-term use, such as the 10-day course of treatment anticipated for client.
