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42 Cards in this Set

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1. Situation: Your client is a 21-year-old woman who presents with abdominal pain, cramping, and diarrhea. She is having 10 to 12 liquid bloody stools per day. A stool sample for ova and parasites is negative. The diagnosis of ulcerative colitis is made.
The client is started on sulfasalazine. What is the goal of this therapy?
A. To stop the diarrhea and bloody stools.
B. To relieve the cramping.
C. To reduce inflammation.
D. To minimize gastrointestinal discomfort
C Sulfasalazine is one of the primary treatments. It is thought to inhibit prostaglandin synthesis to reduce inflammation.
Situation: Your client is a 21-year-old woman who presents with abdominal pain, cramping, and diarrhea. She is having 10 to 12 liquid bloody stools per day. A stool sample for ova and parasites is negative. The diagnosis of ulcerative colitis is made.
The client is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What should you include in your teaching about this medication?
A. Be aware of the symptoms of toxic megacolon.
B. Be aware of increases in diarrhea.
C. Avoid becoming pregnant.
D. Decrease dose of sulfasalazine.
A Antidiarrheal drugs may precipitate colonic dilatation and toxic megacolon. Toxic megacolon is characterized by enlarged colon with fever, leukocytosis, and tachycardia.
Your client is a 21-year-old woman who presents with abdominal pain, cramping, and diarrhea. She is having 10 to 12 liquid bloody stools per day. A stool sample for ova and parasites is negative. The diagnosis of ulcerative colitis is made.
Your client has been on sulfasalazine and corticosteroid therapy. She appears to be past the exacerbation of this disease. What changes would you expect in her medication regimen?
A. Stop the sulfasalazine.
B. Stop the corticosteroids.
C. Taper the sulfasalazine.
D. Taper the corticosteroids.
D Once clinical improvement has been established, the corticosteroids are tapered over a 2- to 3-month period.
A client with ulcerative colitis has been scheduled for a total proctolectomy and permanent ileostomy. All of the following actions are included in the preoperative care plan. Which action will be most appropriate for the RN to delegate to an LPN?
A. Determine whether a visit with an ostomate is appropriate.
B. Administer neomycin sulfate (Mycifradin).
C. Assess preoperative nutritional status.
D. Mark the skin to indicate ostomy location
B The LPN would be familiar with the purpose, adverse effects, and client teaching for neomycin. Assessment of nutrition and fluid status and whether the client would benefit from a visit with an ostomate are more complex tasks that are more appropriate for the RN. Choosing the site for an ostomy is best done by an enterostomal therapist.
A home health client who is receiving daily assistance with self-care by the home health aide complains of having severe diarrhea for the last 24 hours. All of the following actions are included in the client’s care plan. Which of these actions will the RN delegate to the home health aide?
A. Instruct about the use of electrolyte containing oral rehydration products.
B. Give 30 mL of bismuth subsalicylate (Pepto-Bismol) from the medicine cabinet.
C. Assess for orthostatic blood pressure and pulse changes.
D. Teach how to clean the perineal area after each loose stool.
C Assessment of blood pressure and pulse changes that occur with changing position is included in the education of home health aides and other assistive personnel. The other actions are higher level skills and will be accomplished by licensed nursing staff.
An 80-year-old client is admitted to the medical-surgical unit with gastroenteritis. Symptoms include myalgia, nausea, vomiting, and diarrhea for the last 2 days. All of the following orders are received from the health care provider. Which order will the nurse accomplish first?
A. Obtain stool specimen for culture and sensitivity.
B. Administer acetaminophen (Tylenol) 650 mg PR.
C. Draw blood for blood urea nitrogen, creatinine, and electrolytes.
D. Give 5% dextrose in 0.45 normal saline at 125 mL/hr.
D Fluid therapy is the focus of treatment for clients with gastroenteritis. Older clients are at increased risk for the complications of dehydration, such as hypovolemia and acute renal failure.
An RN who usually works in the intensive care unit (ICU) is "floated" to the medical-surgical unit. Which of the following clients will be most appropriate to assign to the float nurse?
A. A client with an exacerbation of Crohn’s disease who has a draining enterocutaneous fistula
B. A client with ulcerative colitis who needs discharge teaching about the use of hydrocortisone enemas
C. A client who has many questions about how to care for a newly created Kock’s ileostomy
D. A client with peritonitis who has just returned from surgery with multiple drains in place
D The ICU nurse would be familiar with the care of a client with peritonitis, including monitoring for the complications such as sepsis and renal failure. The other clients would be best to assign to nursing staff who would be more familiar with the care and teaching needed for clients with inflammatory bowel disorders.
The RN has just received a change of shift report about all of the following clients. Which client should be assessed first?
A. A 20-year-old client with ulcerative colitis who has had six stools during the previous shift
B. A 25-year-old client who has just been admitted with possible appendicitis and has a temperature of 102° F
C. A 56-year-old client who has had a colon resection and whose colostomy bag does not have any stool in it
D. A 60-year-old client admitted with acute gastroenteritis who is complaining of severe cramping and nausea
B This client may have developed perforation and be at risk for peritonitis. Rapid assessment and possible surgical intervention are needed.
Identify all appropriate expected outcomes in clients with chronic inflammatory bowel disease.
A. The client will have formed stools.
B. The client will have either an alleviation or reduction in pain to an acceptable level for the client.
C. The client will manifest appropriate coping skills with the diagnosis.
D. The client will maintain adequate hydration.
E. The client will not exhibit signs of perforation.
A, B, C, D, E
Alexis has undergone an ileostomy and is being discharged to home soon. Which statement, if made by Alexis, demonstrates a good understanding of the postoperative care?
A. “I need to eat foods that are high in fiber.”
B. “I need to change the entire pouch system daily.”
C. “If I don't have any stool for 6 to 12 hours then I should take a laxative.”
D. “I shouldn't take any medications that are enteric-coated or capsules.”
Andrew presents to the emergency department with vague symptoms pointing to the diagnosis of an acute inflammatory bowel disorder. When evaluating which specific disorder the client has, which symptom supports the diagnosis of appendicitis?
A. Abdominal pain referred to the client’s shoulder
B. Anorexia
C. Rigid, boardlike abdomen
D. Hypotension
As part of her home care plan, Nancy teaches Henry and his family about the medication management of Crohn's disease. Which statement should not be included in her teaching?
A. “All of the same drugs used for Crohn’s disease are the same as the ones used to treat ulcerative colitis.”
B. “Flagyl 250 to 500 mg PO three times daily has been helpful in clients with fistulas.”
C. “Imuran is an immunosuppressant agent that may be used for a year.”
D. “Methotrexate may be given to suppress immune activity
Cara is explaining the difference between ulcerative colitis and Crohn's disease to her junior medical-surgical group of nursing students. Which statement, if made by a nursing student, demonstrates that further teaching is needed?
A. “Ulcerative colitis begins in the rectum and proceeds in a continuous manner toward the cecum.”
B. “Clients with Crohn’s disease experience about five to six loose stools per day that are rarely bloody.”
C. “Complications of Crohn’s disease include fistulas, nutritional deficiencies, hemorrhage, and perforation.”
D. “Peak incidence of Crohn’s disease is between 15 and 40 years of age.”
Maria went to lunch with a co-worker at a popular food chain. About 12 hours after eating her lunch, Maria and her co-worker both develop fever, chills, nausea and vomiting, cramping abdominal pain, and diarrhea. The symptoms last for 4 days. How could the manger of the restaurant prevent this from happening to other patrons?
A. Make sure that canned foods are not punctured or swollen.
B. Continue to grind beef and pork in the same grinder.
C. Cook sauces with milk products that are within a day of their expiration date.
D. When canning their own foods, the containers must be sterilized by boiling for 5 minutes.
Mr. Carter demonstrates manifestations of acute peritonitis. Which nursing intervention should be performed first?
A. Medicate the client for pain.
B. Provide calm and reassuring comments.
C. Assess for a temperature greater than 101° F.
D. Assess breath sounds.
Mrs. Cooper is being seen by her physician today for complaints of an anal fissure. Which intervention would promote perineal comfort in this client?
A. Administer enemas if the client is constipated to avoid straining.
B. Cleanse the perineal area with an antibacterial soap.
C. Rub the perineal area dry to avoid excess wetness.
D. Use witch hazel wipes to relieve pain.
Rita has been experiencing a flare up of her diverticulitis and has been told to consume a diet low in fiber. Which of the following choices is consistent with this suggestion?
A. Brown rice
B. Strained fruit juices
C. Whole-grain bread
D. Dried fruit
Sharon is suffering from gastroenteritis. She is trying to prevent the spread of gastroenteritis to her 5-year-old daughter. Which action, if taken by Sharon, will most likely prevent the spread of infection?
A. Preparing her family's meal after washing her hands
B. Washing her hands with a mild soap to prevent drying of her hands
C. Keeping the commode clean to prevent exposure to her stool
D. Using toothpaste from the medicine cabinet
When Nancy, a home care nurse, is assigned to Henry, a client with Crohn's disease, she needs to decide upon her plan of care. Which nursing intervention should Nancy perform first?
A. Assess for signs and symptoms of dehydration.
B. Assess the client’s coping skills.
C. Assess the condition of the perineal skin.
D. Assess the client's knowledge of medications.
A client with colorectal cancer who is scheduled for a colon resection and colostomy the next day is being cared for on the surgical unit. Which of these tasks is most appropriate for the RN charge nurse to delegate to a newly hired RN who is being oriented to the unit?
A. Help the client choose an appropriate site for the ostomy.
B. Administer “whole gut” lavage before surgery.
C. Discuss the possible complication of postoperative incontinence.
D. Describe the locations of postoperative drains and the colostomy.
B This is the least complex of the nursing tasks. The other interventions will be better to delegate to an RN who is more experienced in the perioperative care of clients having a colon resection/colostomy.
Following an abdominoperineal resection, a 75-year-old client is referred to a home health agency. Which of the following staff members will be best for the nurse manager to assign to do the initial assessment for this client?
A. An LPN with 20 years of experience in the home health agency
B. A new graduate RN who worked as a nursing assistant in this agency before graduating
C. An LPN with 10 years of experience in the home health agency who has a colostomy
D. An RN who has worked in the home health agency for the last year
D The Medicare requirements indicate that the initial assessment must be done by an RN. The RN who worked in the agency for a year will be most experienced with the initial assessment procedure and developing the plan of care.
Following an automobile accident, a client is admitted with possible abdominal trauma. All of the following orders are written by the physician. Which of the orders will the nurse implement first?
A. Take the client for computed tomography of the abdomen.
B. Insert nasogastric tube and connect to intermittent suction.
C. Start IV and infuse normal saline at 200 mL/hr.
D. Obtain a complete blood count and coagulation panel.
C After completing the initial airway, breathing, and circulation assessment, the most immediate concerns are the high risk for hemorrhage and shock. In order to rapidly treat for these possible complications, IV access and infusion of fluids will be necessary.
The client in a long-term care facility is being cared for by a team consisting of an LPN and a nursing assistant after having an open repair of an indirect inguinal hernia 2 days previously. Which of these tasks will be best for the RN nurse manager to delegate to the LPN?
A. Assist the client to stand to void.
B. Check the client’s vital signs.
C. Help the client to cough and deep breathe.
D. Assess the incision for signs of infection
D Assisting the client to stand and checking vital signs are included in the nursing assistant's role. The client should not cough after an open hernia repair to avoid placing too much pressure on the incision. Wound assessment is a higher level function that requires education at the LPN level or above.
The RN working on the medical-surgical unit has just received report about the following four clients. Which client will the RN assess first?
A. A client who has returned to the unit after a colon resection with a new colostomy stoma, which is dark pink
B. A client who has been admitted following a motor vehicle accident and has ecchymoses on both flanks
C. A client with pneumonia who has abdominal distention and markedly decreased bowel tones
D. A client with familial adenomatous polyposis (FAP) who is scheduled for a colonoscopy
B Ecchymoses in the flank area (Turner’s sign) may indicate intraperitoneal bleeding. This client requires rapid assessment and interventions.
Your client is a 66-year-old man with colorectal cancer. He has been started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. A relatively new chemotherapeutic agent, oxaliplatin (Eloxatin), has been added to his treatment regimen. He complains of peripheral sensory neuropathy.
How do you explain the diarrhea and mouth ulcers to your client?
A. It is the result of the combination of chemotherapeutic agents.
B. It is a symptom of the advanced stage of the disease.
C. 5-FU cannot discriminate between cancer and healthy cells.
D. It is the result of the radiation treatment.
C Therefore, the side effects are diarrhea, mucositis, leucopenia, mouth ulcers, and skin ulcers.
Situation: Your client is a 66-year-old man with colorectal cancer. He has been started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. A relatively new chemotherapeutic agent, oxaliplatin (Eloxatin), has been added to his treatment regimen. He complains of peripheral sensory neuropathy.
What other medications could you expect to administer to clients with advanced colorectal cancer for relief of symptoms?
A. Steroids and anti-inflammatory medication.
B. Analgesics and antiemetics.
C. Analgesics and benzodiazepines.
D. Steroids and analgesics
B Clients with advanced colorectal cancer and metastasis also receive drugs for relief of symptoms such as analgesics and antiemetics.
Your client is a 66-year-old man with colorectal cancer. He has been started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. A relatively new chemotherapeutic agent, oxaliplatin (Eloxatin), has been added to his treatment regimen. He complains of peripheral sensory neuropathy.
Which is the dose-limiting toxicity for Eloxatin?
A. The diarrhea.
B. The mouth ulcers.
C. The fatigue.
D. The peripheral neuropathy.
D The dose-limiting toxicity for this agent is peripheral sensory neuropathy
When a client is being screened for colorectal cancer, he again escapes this diagnosis. Additional teaching is done to prevent the chance of developing this disease. Which foods should be avoided? Select all that apply.
A. Red meat
B. Fatty foods
C. Fried fish
D. Concentrated sweets
E. Cabbage
A, B, C, D
Carol, a 36-year-old businesswoman has been suffering with constipation as a result of her irritable bowel syndrome (IBS). Her nurse practitioner is performing teaching for Carol. Which statement, if made by Carol, demonstrates a good understanding of her IBS plan?
A. “Soda is still an acceptable beverage to have with dinner.”
B. “If I begin treatment with Zelnorm, I’ll need to use extra birth control since the medicine decreases the effect of oral contraceptives.”
C. “I should maintain a low-fiber diet in order to manage my constipation.”
D. “Drinking plenty of fluids is contraindicated in my treatment plan.”
Janie is teaching her client who just had hemorrhoids removed. Which statement, if made by the client, demonstrates a good understanding of his plan of care?
A. “I should eat a diet high in fiber.”
B. “I should apply ice to the surgical area to help with pain.”
C. “I should limit my fluids to help with constipation.”
D. “I should use Ex-Lax right after surgery.”
Jim has a strong family history of colon cancer. He is followed up regularly in order to detect any colon cancer early. Which laboratory result would be indicative of colorectal cancer?
A. Elevated hemoglobin
B. Negative test for occult blood
C. Decrease in liver function tests
D. Elevated carcinoembryonic antigen
Karen is a nursing student who is studying malabsorption syndrome. Which statement, if made by the student, demonstrates that further teaching is needed related to the pathophysiology of malabsorption syndrome?
A. “Malabsorption is a syndrome associated with a variety of disorders and intestinal surgical procedures.”
B. “Malabsorption interferes with the ability to absorb nutrients.”
C. “Physiologic mechanisms limit absorption of nutrients due to bile salt deficiencies, enzyme deficiencies, or the presence of bacteria.”
D. “It is the result of a generalized flattening of the mucosa of the large intestine.”
Kyle is a 17-year-old boy admitted to the emergency department following a stab wound to his abdomen while involved in a schoolyard fight. Once stabilized, the client is admitted to the general medical-surgical unit. Which nursing intervention should be done first?
A. Assess skin temperature and color.
B. Medicate for pain.
C. Assess urine output.
D. Assess vital signs.
Mr. Kelly is a 48-year-old man admitted with colon cancer. He is to undergo exploratory surgery and a colostomy procedure. Which statement, if made by Mr. Kelly, demonstrates a good understanding of his procedure?
A. “I will not have any tubes after surgery except for the colostomy.”
B. “I will have a pain pump for the first day or two after surgery.”
C. “I will be allowed to eat solid food 6 hours after surgery.”
D. “I will not be allowed to walk for 3 days after the surgery.”
Mrs. Hunter is being evaluated in the emergency department for a small bowel obstruction. Which symptoms would be expected in this client if she has a small bowel obstruction?
A. Upper abdominal distention, metabolic alkalosis, and obstipation
B. Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis
C. Metabolic acidosis, upper abdominal distention, and intermittent cramping
D. Intermittent cramping, metabolic acidosis, and minimal vomiting
Mrs. Hunter is experiencing severe pain secondary to her obstruction. Which nursing intervention should be done first?
A. Position the client in a high-Fowler's position.
B. Administer morphine for pain.
C. Position the client in a semi-Fowler's position.
D. Administer Demerol for pain.
Mrs. McFarland is a 54-year-old woman admitted to the hospital with colorectal cancer. She is being prepared for colostomy surgery. Which question or statement, if made by the nurse, would be best to say to this client?
A. “Don’t worry, you will get used to the colostomy after time passes.”
B. “Why are you so afraid of this procedure?”
C. “Tell me what worries you the most about this procedure.”
D. “Are you afraid of what your husband will think of the colostomy?”
Once Mrs. Hunter's bowel obstruction is diagnosed, the emergency department physician places a nasogastric tube. Which nursing intervention, if done by a student nurse, would require further instruction by the staff?
A. Peristalsis is checked by auscultating for bowel sounds with the suction disconnected.
B. The contents of the nasogastric tube are aspirated and checked.
C. The nasogastric tube is flushed with normal saline every 4 hours.
D. Continuous suction is applied and maintained
Ralph, a new graduate nurse, is caring for Mrs. McFarland. Ralph is preparing the client for discharge after her bowel resection and colostomy. Which statement, if made by Ralph, demonstrates that further teaching is needed?
A. “You are allowed to drive 2 weeks after surgery.”
B. “A stool softener is recommended to keep stools at a soft consistency for ease of passage.”
C. “You should avoid drinking soda.”
D. “It may take 4 to 6 weeks to establish the effects of certain foods on bowel patterns.”
Robert is being prepared for a minimally invasive inguinal hernia repair (MIIHR). Which statement, if made by Robert, indicates the need for further teaching of this procedure?
A. “I should not eat from midnight the day of the surgery.”
B. “My chances of having a recurring hernia after this procedure is not likely.”
C. “I may have trouble urinating right after surgery.”
D. “I will just need to stay in the hospital overnight.”
Robert presents to his family physician with complaints of pain with coughing in his inguinal area. When he coughs or has pain in the area, he is able to gently push the bulge back in. Which type of hernia is this?
A. A ventral hernia
B. A femoral hernia
C. A reducible hernia
D. A strangulated hernia
Savannah is a home care nurse assigned to Mr. Kelly once he is released from the hospital. Savannah is teaching Mr. Kelly about caring for his new colostomy. Which statement, if made by Mr. Kelly, would demonstrate a good understating of his colostomy care?
A. “I do not need to worry if my stoma looks dark or purplish.”
B. “I should check for leakage underneath my colostomy.”
C. “If my skin is red or scratched, I know it will heal soon.”
D. “I should apply as tight a fit as I can tolerate when applying the barrier around the stoma.”