Lewis Chapter 42: Nursing Management Quiz

Questions and Answers

Which patient presents with the most urgent issue?

40-year-old female with a colostomy bag that is pulling away from the adhesive wafer

30-year-old female with a femoral hernia who has abdominal pain and vomiting (correct)

30-year-old male with ulcerative colitis who has severe perianal skin breakdown

40-year-old male with celiac disease who has frequent frothy diarrhea

What is the most important question for the nurse to ask a 67-year-old patient with new-onset steatorrhea?

Have you noticed a recent weight loss?

Which information will the nurse teach a 23-year-old patient with lactose intolerance?

Live-culture yogurt is usually tolerated. (correct)

Heating milk will break down the lactose.

Nonfat milk is a better choice than whole milk.

Ice cream is relatively low in lactose.

Which prescribed intervention for a 61-year-old female patient with chronic short bowel syndrome will the nurse question?

Senna (Senokot) 1 tablet every day Signup and view all the answers

Which information will the nurse include when teaching a patient how to avoid chronic constipation? (Select all that apply)

Many over-the-counter (OTC) medications can cause constipation. Signup and view all the answers

How much drainage should a patient expect after bowel adjustment to an ileostomy?

2 cups Signup and view all the answers

What should the initial plan of care be for a patient with acute diverticulitis?

Administer IV fluids Signup and view all the answers

What teaching should be provided to a patient after a herniorrhaphy?

Apply a scrotal support and ice to reduce swelling Signup and view all the answers

Which breakfast choice indicates understanding of a diet for celiac disease?

Corn tortilla with scrambled eggs Signup and view all the answers

What instruction should the nurse include in discharge teaching after a hemorrhoidectomy?

Take prescribed pain medications before a bowel movement Signup and view all the answers

What initial action should a nurse take for a patient with diarrhea for 24 hours?

Ask the patient to describe stool characteristics Signup and view all the answers

What primary intervention should be implemented for a patient with severe abdominal pain and vital signs indicating shock?

Infuse 1 liter of lactated Ringer's solution over 30 minutes Signup and view all the answers

What is the first action when a patient complains of nausea and abdominal distention after bowel resection?

Reposition the nasogastric tube and check placement Signup and view all the answers

Which initial assessment is most important for a patient with a knife handle protruding from the abdomen?

Check for circulation and tissue perfusion Signup and view all the answers

Which information is most important to communicate to a provider about a patient with blood in the stools?

The patient has blood in the stools Signup and view all the answers

What is an appropriate task to delegate to unlicensed assistive personnel for a patient with a new colostomy?

Drain and measure the output from the ostomy Signup and view all the answers

Which dietary choice is best for preventing diverticulitis in a patient with diverticulosis?

Navy bean soup and vegetable salad Signup and view all the answers

Which action will the nurse include in the plan of care for a 42-year-old patient who is being admitted with Clostridium difficile?

Place the patient in a private room on contact isolation. Signup and view all the answers

A 71-year-old male patient tells the nurse that growing old causes constipation so he has been using a suppository for constipation every morning. Which action should the nurse take first?

Assess the patient about risk factors for constipation. Signup and view all the answers

A 64-year-old woman who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in the response?

Large amounts of fluid should be taken to prevent impaction or bowel obstruction. Signup and view all the answers

A 26-year-old woman is being evaluated for vomiting and abdominal pain. Which question from the nurse will be most useful in determining the cause of the patient's symptoms?

Can you tell me more about the pain? Signup and view all the answers

A patient complains of gas pains and abdominal distention two days after a small bowel resection. Which nursing action is best to take?

Encourage the patient to ambulate. Signup and view all the answers

A 58-year-old man with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next?

Prepare the patient for surgery. Signup and view all the answers

A 27-year-old female patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action should the nurse take?

Apply an ice pack to the right lower quadrant. Signup and view all the answers

Which nursing action will be included in the plan of care for a 27-year-old male patient with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)?

Encourage the patient to express concerns and ask questions about IBS. Signup and view all the answers

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to

Discontinue the patient's oral food intake. Signup and view all the answers

Which nursing action will the nurse include in the plan of care for a 35-year-old male patient admitted with an exacerbation of inflammatory bowel disease (IBD)?

Monitor stools for blood. Signup and view all the answers

Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective?

I will need to use a sunscreen when I am outdoors. Signup and view all the answers

A 22-year-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective?

The patient uses witch hazel compresses to decrease irritation. Signup and view all the answers

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching?

Oatmeal with cream Signup and view all the answers

After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, 'I cannot manage all these changes. I don't want to look at the stoma.' What is the best action by the nurse?

Ask the patient about the concerns with stoma management. Signup and view all the answers

A 51-year-old male patient has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg) over 2 months. The nurse will plan to teach about

Medication use. Signup and view all the answers

A 24-year-old woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient?

Fistulas can form between the bowel and bladder. Signup and view all the answers

A 73-year-old patient with diverticulosis has a large bowel obstruction. The nurse will monitor for

Abdominal distention. Signup and view all the answers

The nurse preparing for the annual physical exam of a 50-year-old man will plan to teach the patient about

Colonoscopy. Signup and view all the answers

The nurse is providing preoperative teaching for a 61-year-old man scheduled for an abdominal-perineal resection. Which information will the nurse include?

The patient will drink polyethylene glycol lavage solution (GoLYTELY) preoperatively. Signup and view all the answers

A 74-year-old patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. The nurse explains that the test is used to

Monitor the tumor status after surgery. Signup and view all the answers

A 71-year-old patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery?

Assess the perineal drainage and incision. Signup and view all the answers

A 47-year-old female patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. The nurse should

Document stoma assessment findings. Signup and view all the answers

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis?

Use care when eating high-fiber foods to avoid obstruction of the ileum. Signup and view all the answers

The nurse will determine that teaching a 67-year-old man to irrigate his new colostomy has been effective if the patient

Hangs the irrigating container 18 inches above the stoma. Signup and view all the answers

Study Notes

Clostridium Difficile Management

Patients with Clostridium difficile should be placed in a private room with contact isolation due to high contagion.
No need for dietary restrictions on dairy; metronidazole (Flagyl) is commonly prescribed for treatment.

Constipation in Older Adults

Assess risk factors for constipation before making dietary suggestions.
Older patients may need to increase fluid intake and high-fiber foods to manage constipation.

Psyllium Use and Fluid Intake

When using psyllium (Metamucil), it’s essential to drink large amounts of fluid to prevent constipation or bowel obstruction.
Gradual fiber intake increase may reduce reliance on laxatives over time.

Assessing Abdominal Pain

A detailed description of abdominal pain is crucial for accurate diagnosis.
Questions about diet or pregnancy may be relevant but are secondary to understanding the pain's nature.

Post-Surgery Nursing for Bowel Resection

Encourage ambulation post small bowel resection to relieve gas pain and improve peristalsis.

Peritoneal Lavage and Bowel Perforation

Brown fecal drainage during peritoneal lavage indicates potential bowel perforation requiring immediate surgery.

Appendicitis Symptoms

Applying an ice pack to the right lower quadrant can help alleviate pain associated with possible appendicitis.

Irritable Bowel Syndrome (IBS) Education

Encourage emotional expression and questions about IBS as psychologic factors can affect symptoms.

Ulcerative Colitis Management

Patients experiencing an exacerbation should be made NPO to rest the bowel.
Monitoring for blood in stools is crucial due to potential anemia.

Sulfasalazine Patient Teaching

Patients should be warned about photosensitivity while taking sulfasalazine for ulcerative colitis.

Skin Integrity in Ulcerative Colitis

Witch hazel compresses can effectively reduce irritation for patients with excoriated perianal skin.

Dietary Considerations for IBD

Avoid high-fiber foods such as oatmeal during acute exacerbations of inflammatory bowel disease (IBD).

Stoma Care Post-Surgery

Encourage patients to express concerns about their stoma to facilitate adjustment to changes in body image.

Crohn's Disease and UTIs

Monitor for fistulas in patients with Crohn's disease, as they can contribute to urinary tract infections (UTIs).

Signs of Large Bowel Obstruction

Abdominal distention is a key indicator of large bowel obstruction; other symptoms may not apply.

Colorectal Cancer Screening

At age 50, individuals should begin screenings for colorectal cancer; colonoscopy is the gold standard.

Preoperative Patient Education

Patients should use bowel-cleansing agents like polyethylene glycol before scheduled surgeries to minimize infection risks.

Carcinoembryonic Antigen (CEA) Test

CEA levels are monitored post-surgery to check for cancer recurrence; they do not indicate metastasis.

Postoperative Care after Colostomy

Immediate focus should be on assessing the perineal wound for infection risk after abdominal-perineal resection.

Stoma Assessment

A deep pink stoma with some edema is generally normal; proper documentation is vital.

High-Fiber Foods and Ileostomy

Gradual introduction and careful chewing of high-fiber foods are necessary post-ileostomy to prevent obstruction.

Colostomy Irrigation Procedure

The irrigating container should be placed 18 to 24 inches above the stoma for effective irrigation.

Ileostomy Drainage Expectations

Average ileostomy drainage is about 500 mL daily after bowel adjustment, equating to approximately 2 cups.

Initial Care for Acute Diverticulitis

Patients should remain NPO with IV fluids as the first step in managing acute diverticulitis.

Herniorrhaphy Postoperative Education

Post-surgery care includes using scrotal support and ice to reduce swelling rather than coughing or other strenuous activities.### Celiac Disease and Dietary Choices
Gluten avoidance is crucial for managing celiac disease.
Safe food options include corn tortillas, which are gluten-free.
Other options like oatmeal, whole wheat toast, and bagels contain gluten and should be avoided.

Hemorrhoidectomy Post-Op Care

Pain management is critical; pain medications should be taken before expected bowel movements.
Low-residue diets can prevent constipation but are not necessary if pain is managed appropriately.
Use of warm sitz baths is recommended over ice packs for pain relief.

Diagnosing Acute Diarrhea

Collecting a stool specimen is essential for identifying infections or parasites causing diarrhea.
Other diagnostic tests like colonoscopy or barium enema are not immediately indicated.

Crohn's Disease and Anemia

Megaloblastic anemia in Crohn's disease often results from impaired cobalamin (B12) absorption.
Regular cobalamin injections or sprays are necessary for treatment.

Abdominal Pain Assessment

Ecchymosis around the umbilicus is known as Cullen's sign, indicative of possible serious conditions.
Rovsing's sign suggests appendicitis but should not be confused with Cullen's.

Managing Incontinence in Critically Ill Patients

Fecal management systems can effectively manage ongoing incontinence of liquid stools.
Frequent changes of incontinence briefs are necessary to prevent skin breakdown.

Irritable Bowel Syndrome (IBS)

A diagnosis considers the presence of abdominal pain for at least three months.
Inquiry about pain duration helps in identifying potential IBS.

Peritonitis Management

Initiating antibiotic therapy is the first critical action in treating peritonitis.
Other interventions can follow antibiotic administration.

Assessing Diarrhea in Adults

Initial assessment involves gathering detailed information about stool characteristics and associated symptoms.

Hypovolemic Shock Recognition

Rapid infusion of fluids is prioritized for patients exhibiting signs of shock, such as tachycardia and hypotension.

Post-Op Management for Bowel Resection

Repositioning the NG tube is often effective for managing nausea and abdominal distention after surgery.

Knife Injury Assessment

Circulation and tissue perfusion assessments are crucial for patients with penetrating abdominal injuries.

Colostomy Care Delegation

UAPs can drain and measure output from colostomies within their scope of practice.

Urgency of Symptoms

Blood in stool signifies a potential colorectal issue and requires immediate assessment.

Delegation for Paralytic Ileus

UAPs can assist with basic hygiene tasks like applying petroleum jelly to lips.

Infection Control with Diarrhea

Implementing contact precautions is vital for patients with new diarrhea to prevent C. difficile infection spread.

Assessing Post-Surgery Patients

Abdominal distention with tachycardia indicates critical condition; prioritize this patient for assessment.

Patient Education on Familial Adenomatous Polyposis

Annual colonoscopies starting at age 16 are essential for this high-risk group for colorectal cancer.

Nutrition for Diverticulosis

High-fiber diets, such as navy bean soup and vegetable salad, help prevent diverticulitis.

Management of Steatorrhea

Significant weight loss in patients with steatorrhea is crucial; it indicates potential malnutrition.

Lactose Intolerance Education

Live-culture yogurt is generally well-tolerated by those with lactose intolerance, unlike ice cream or heated milk.

Short Bowel Syndrome Care Considerations

Bulk-forming laxatives are appropriate; stimulant laxatives should be avoided due to diarrhea risk.

Chronic Constipation Prevention Strategies

Use of bulk-forming laxatives, regular exercise, and timing bowel movements after meals can prevent constipation.

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Description

This quiz focuses on nursing management strategies for lower gastrointestinal problems, specifically addressing Clostridium difficile infections. It is based on Chapter 42 from Lewis' nursing textbook and aims to test your understanding of appropriate patient care protocols.