Quiz 9: GERD, Peptic Ulcer, Ulcerative Colitis, Crohn's Disease - PDF

Here is the converted text from the images provided: ### Quiz 9. Gerd, peptic Ulcer, Ulcerative Colitis, Crohn's Disease Name: Section: Date: **Multiple Choice** 1. The nurse explains to the patient with gastroesophageal reflux disease thatthis disorder: * A. Results in acid erosion and u...

Here is the converted text from the images provided: ### Quiz 9. Gerd, peptic Ulcer, Ulcerative Colitis, Crohn's Disease Name: Section: Date: **Multiple Choice** 1. The nurse explains to the patient with gastroesophageal reflux disease thatthis disorder: * A. Results in acid erosion and ulceration of the esophagus caused by frequent vomiting * B. Will require surgical wrapping or repair of the pyloric sphincter to control the symptoms * C. Is the protrusion of a portion of the stomach into to esophagus through an opening in the diaphragm * D. **Often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the esophagus.** **Rationale:** D. The acidic contents of the stomach touching the inside of the esophagus are responsible for the physical sensation known as "heartburn" that is a cardinal symptom of GERD. 2. A patient is admitted with ulcerative colitis. In the physician's notes, it is stated that the patient's barium enema results showed the patient has colitis that starts in the rectum and extends into the sigmoid and descending colon. As the nurse, you know that this is what type of ulcerative colitis? * A. Right-sided colitis * B. Proctosigmoiditis * C. Ulcerative procotitis * D. **Left-sided colitis** **Rationale:** D. Left-sided colitis (distal colitis) starts in the rectum and goes to the sigmoid and descending colon. Ulcerative proctitis affects the rectum only. Proctosigmoiditis affects the rectum and sigmoid colon. Right-sided colitis is NOT a type of ulcerative colitis. 3. The client is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? * A. **Starting a large-bore intravenous (IV)** * B. Administering intravenous (IV) pain medication * C. Preparing equipment for intubation * D. Monitoring the client's anxiety level **Rationale:** A. A large-bore IV should be placed as requested, so that blood products can be administered. 4. Which of the following types of gastritis is associated with *Helicobacter pylori* and duodenal ulcers? * A. Erosive (hemorrhagic) gastritis * B. Fundic gland gastritis (type A) * C. **Antral gland gastritis (type B)** * D. Aspiring-induced gastric ulcer **Rationale:** C. Erosive (hemorrhagic) gastritis can be caused by ingestion of substances that irritate the gastric mucosa. Fundic gland gastritis (type A) is associated with diffuse severe mucosal atrophy and the presence of pernicious anemia. Antral gland gastritis (type B) is the most common form of gastritis, and is associated with Helicobacter pylori and duodenal ulcers. 5. A patient diagnosed with pancolitis is experiencing extreme abdominal distension, pain 10 on 1-10 scale in the abdomen, temperature of 103.6º F, HR 120, and profuse diarrhea. What complication do you suspect the pain is experiencing? * A. Fistulae * B. Stricture * C. Bowel obstruction * D. **Toxic megacolon** **Rationale:** D. Pancolitis affects all the colon and is a very severe form of ulcerative colon. The patient is at risk for toxic megacolon. In toxic megacolon, the large intestine dilates due to the overwhelming inflammation. The large intestine is unable to function properly and becomes paralyzed. Typical signs and symptoms of toxic megacolon include: abdominal distention, fever, diarrhea, abdominal pain, dehydration, and tachycardia. 6. Gastroesophageal reflux disease (GERD) weakens the lower esophageal sphincter, predisposing older persons to risk for impaired swallowing. In managing the symptoms associated with GERD, the nurse should assign the highest priority to which of the following interventions? * A. Decrease daily intake of vegetables and water, and ambulate frequently * B. Drink coffee diluted with milk at each meal, and remain in an upright position for 30 minutes * C. **Eat small, frequent meals, and remain in an upright position for at least 30 minutes after eating** * D. Avoid over-the-counter drugs that have antacids in them **Rationale:** C. Eating small and frequent meals requires less release of hydrochloric acid. Remaining in an upright position for 30 minutes after meals prevents reflux into the esophagus which is often exacerbated when lying down, expecially after a large meal which makes the patient tired. 7. A patient is newly diagnosed with mild ulcerative colitis. What type of anti-inflammatory medication is typically prescribed as first-line treatment for this condition? * A. **5-Aminosalicylates (Sulfasalazine)** * B. Immunomodulators (Adalimumab) * C. Corticosteroids (Prednisone) * D. Immunosuppressors (Azathioprine) **Rationale:** A. 5-Aminosalicylates (Sulfasalazine) are usually prescribed for mild to moderate cases of ulcerative colitis as first-line treatment. If Aminosalicylates are not working (or the patient is allergic to sulfa) corticosteroids are prescribed. Corticosteroids may be used in combination with immunosupressors. Immunosupressors and immunomodulators are used in severe cases of ulcerative colitis when other medications have not worked. 8. The nurse is reviewing the laboratory results of a client with Crohn's disease. Which of the following would the nurse most likely find? * A. Decreased white blood cell count * B. Increased albumin levels * C. **Stool cultures negative for microorganisms or parasite** * D. Decrease erythrocyte sedimentation rate **Rationale:** C. Stool cultures fail to reveal an etiologic microorganism or parasite, but occult blood and occult blood and white blood cells (WBCS) often are found in the stool. Results of blood studies indicate anemia from chronic blood loss and nutritional deficiencies. The WBC count and erythrocyte sedimentation rate may be elevated, confirming an inflammatory disorder. Serum protein and albumin levels may be low because of malnutrition. 9. The client with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? * A. "No, they probably won't be useful. You should use only prescription medications in your treatment plan." * B. **"These herbs could be helpful. However, you should talk with your physician before adding them to your treatment regimen.”** * C. "Yes, these are known to be effective in managing this disease, but make sure you research the herbs thoroughly before taking them." * D. "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe." 10. A patient is receiving treatment for ulcerative colitis by taking Azathioprine. Which physician's order would the nurse question if received? * A. Ambulate the patient twice day * B. Low-fiber and high-protein diet * C. **Administer varicella vaccine intramuscularly** * D. Administer calcium carbonate by mouth daily **Rationale:** C. Azathioprine is an immunosuppression medication that decreases the immune system. Therefore, the patient should never receive a live vaccine, such as Varicella. Other vaccinations that are live include: MMR, Shingles, Nasal influenza mist etc. 11. Crohn's disease is a condition of malabsorption caused by which pathophysiological process? * A. **Inflammation of all layers of intestinal mucosa** * B. Infectious disease * C. Disaccharidase deficiency * D. Gastric Resection **Rationale:** A. Crohn's disease is also known as regional enteritis and can occur anywhere along the gastrointestinal tract, but most commonly at the distal ileum and in the colon. Infectious disease causes problems such as small-bowel bacterial overgrowth, leading to malabsorption. Disaccharidase deficiency leads to lactose intolerance. Postoperative malabsorption occurs after gastric or intestinal resection. 12. The client with a hiatal hernia chronically experiences heartburn following meals. The nurse plans to teach the client to avoid which action because it is contraindicated with hiatal hernia? * A. **Lying recumbent following meals** * B. Taking in small, frequent, bland meals * C. Raising the head of the bed on 6-inch blocks * D. Taking $H_2$-receptor antagonist medication **Rationale:** A. Laying recumbant following meals or at night will cause reflux and pain. Relief is usually achieved with the intake of small, bland meals, use of $H_2$ receptor antagonists and antacids, and elevation of the thorax after meals and during sleep. 13. What response should a nurse offer to a client who asks why he's having a vagotomy to treat his ulcer? * A. To repair a hole in the stomach * B. **To reduce the ability of the stomach to produce acid** * C. To prevent the stomach from sliding into the chest * D. To remove a potentially malignant lesion in the stomach **Rationale:** B. A vagotomy is performed to eliminate the acid-secreting stimulus to gastric cells. a perforation would be repaired with a gastric resection. Repair of hiatal hernia (fundoplication) prevents the stomach from sliding through the diaphragm. Removal of a potentially malignant tumor wouldn't reduce the entire acid-producing mechanism. 14. A nurse is completing discharge teaching with a client who has Crohn's disease. Which of the following instructions should the nurse include in the teaching? * A. Decrease intake of calorie-dense foods * B. **Drink canned protein supplements** * C. Increase intake of high fiber foods * D. Take a bulk-forming laxative daily **Rationale:** B. A high-protein diet is recommended for the client who has Crohn's disease. Canned protein supplements are encouraged 15. Which of the following factors is believed to cause ulcerative colitis? * A. Acidic diet * B. **Altered immunity** * C. Chronic constipation * D. Emotional stress **Rationale:** B. Several theories exist regarding the cause of ulcerative colitis. One suggests altered immunity as the cause based on the extra intestinal characteristics of the disease, such as peripheral arthritis and cholangitis. Diet and constipation have no effect on the development of ulcerative colitis. Emotional stress can exacerbate the attacks but isn't believed to be the primary cause. 16. Fistulas are most common with which of the following bowel disorders? * A. **Crohn's disease** * B. Diverticulitis * C. Diverticulosis * D. Ulcerative colitis **Rationale:** A. The lesions of Crohn's disease are transmural; that is, they involve all thickness of the bowel. These lesions may perforate the bowel wall, forming fistulas with adjacent structures. Fistulas don't develop in diverticulitis or diverticulosis. The ulcers that occur in the submucosal and mucosal layers of the intestine in ulcerative colitis usually don't progress to fistula formation as in Crohn's disease. 17. Which assessment data support the client's diagnosis of gastric ulcer? * A. Presence of blood in the client's stool for the past month * B. Complaints of a burning sensation that moves like a wave * C. Sharp pain in the upper abdomen after eating a heavy meal * D. **Comparison of complaints of pain with ingestion of food and sleep** **Rationale:** A. The presence of blood does not specifically indicate diagnosis of an ulcer. The client could have hemorrhoids or cancer that would result in the presence of blood. B. A wavelike burning sensation is a symptom of gastroesophageal reflux. C. Sharp pain in the upper abdomen after eating a heavy meal is a symptom of gallbladder disease. D. (CORRECT) In a client diagnosed with a gastric ulcer, pain usually occurs 30-60 minutes after eating, but not at night. In contrast, a client with duodenal ulcer has pain during the night that is often relieved by eating food. Pain occurs 1-3 hours after meals. 18. Which of the following associated disorders may a client with ulcerative colitis exhibit? * A. Gallstones * B. Hydronephrosis * C. Nephrolithiasis * D. **Toxic megacolon** **Rationale:** D. Toxic megacolon is extreme dilation of a segment of the diseased colon caused by paralysis of the colon, resulting in complete obstruction. This disorder is associated with both Crohn's disease and ulcerative colitis. The other disorders are more commonly associated with Crohn's disease. 19. The nurse is teaching the client with peptic ulcer disease (PUD) about the prescribed drug regimen. Which statement made by the client indicates a need for further teaching before discharge? * A. *"Nizatidine (Axid) needs to be taken three times a day to be effective."* * B. *"Taking ranitidine (Zantac) at bedtime should decrease acid production at night"* * C. *"Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals"* * D. *"Omeprazole (Prilosec) should be swallowed whole and not crushed."* 20. * A. **Nizatidine (Axid) is most effective if administered twice daily.** Which of the following symptoms is associated with ulcerative colitis? * A. Dumping syndrome * B. **Rectal bleeding** * C. Soft stools * D. Fistulas **Rationale:** B. In ulcerative colitis, rectal bleeding is the predominant symptom. Soft stools are more commonly associated with Crohn's disease, in which malabsorption is more of a problem. Dumping syndrome occurs after gastric surgeries. Fistulas are associated with Crohn's disease. 21. The nurse is caring for an older adult male client who reports stomach pain and heartburn. Which syndrome is most significant in determining whether the client's ulceration is gastric or duodenal in origin? * A. **Pain occurs 1 1/2 to 3 hours after a meal, usually at night.** * B. Pain is worsened by the ingestion of food * C. The client has a malnourished appearance * D. The client is a man older than 50 years **Rationale:** A. A key symptom characteristic of duodenal ulcers is that pain usually awakens the client between 1 AM and 2 AM, occurring 1 1/2 to 3 hours after a meal. 22. If a client had irritable bowel syndrome, which of the following diagnostic tests would determine if the diagnosis is Crohn's disease or ulcerative colitis? * A. Abdominal computed tomography (CT) scan * B. Abdominal x-ray * C. Barium swallow * D. **Colonoscopy with biopsy** **Rationale:** D. A colonoscopy with biopsy can be performed to determine the state of the colon's mucosal layers, presence of ulcerations, and level of cytologic development. An abdominal x-ray or CT scan wouldn't provide the cytologic information necessary to diagnose which disease it is. A barium swallow doesn't involve the intestine. 23. In planning the care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease: * A. Frequently results in toxic megacolon * B. Causes fewer nutritional deficiencies than does ulcerative colitis * C. **Often recurs after surgery, whereas ulcerative colitis is curable with a colectomy.** * D. Is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis. **Rationale:** C. Because there is a high recurrence rate after surgical treatment of Crohn's disease, medications are the preferred treatment. 24. When assessing the client with the diagnosis of peptic ulcer disease, which physical examination should the nurse implement first? * A. **Auscultate the client's bowel sounds in all four quadrants** * B. Palpate the abdominal area for tenderness * C. Percuss the abdominal borders to identify organs * D. Assess the tender area progressing to nontender **Rationale:** A. Auscultation should be used prior to palpa-tion or percussion when assessing the abdomen. If the nurse manipulates the abdomen, the bowel sounds can be altered and give false information. 25. The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? * A. Bradycardia * B. Numbness in the legs * C. Nausea and vomiting * D. **A rigid, board-like abdomen** **Rationale:** D. Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding. 26. The nurse is monitoring the client with gastric cancer for signs and symptoms of upper GI bleeding. Which change in vital signs is most indicative of bleeding related to cancer? * A. Respiratory rate from 24 to 20 breaths/min * B. Apical pulse from 80 to 72 beats/min * C. Temperature from 98.9° F to 97.9° F * D. **Blood pressure from 140/90 to 110/70 mm Hg** **Rationale:** D. A decrease in blood pressure is the most indicative sign of bleeding. 27. Surgical management of ulcerative colitis may be performed to treat which of the following complications? * A. Gastritis * B. Bowel herniation * C. Bowel outpouching * D. **Bowel perforation** **Rationale:** D. Perforation, obstruction, hemorrhage, and toxic megacolon are common complications of ulcerative colitis that may require surgery. Herniation and gastritis aren't associated with irritable bowel diseases, and outpouching of the bowel is diverticulosis 1. Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube? * A. **Change the tube feeding solutions and tubing at least every 24 hours** * B. Maintain the head of the bed at a 15-degree elevation continuously * C. Check the gastrostomy tube for position every 2 days * D. Maintain the client on bed rest during the feedings **Rationale:** A. Tube feeding solutions and tubing should be changed every 24 hours, or more frequently if the feeding requires it. Doing so prevents contamination and bacterial growth. The head of the bed should be elevated 30 to 45 degrees continuously to prevent aspiration. Checking for gastrostomy tube placement is performed before initiating the feedings and every 4 hours during continuous feedings. Clients may ambulate during feedings. 2. In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease: * A. Frequently results in toxic megacolon * B. Causes fewer nutritional deficiencies than does ulcerative colitis * C. **Often recurs after surgery, whereas ulcerative colitis is curable with a colectomy** * D. Is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis **Rationale:** C. Because there is a high recurrence rate after surgical treatment of Crohn's disease, medications are the preferred treatment 3. Colon cancer is most closely associated with which of the following conditions? * A. Appendicitis * B. Hemorrhoids * C. Hiatal hernia * D. **Ulcerative colitis** **Rationale:** D. Chronic ulcerative colitis, granulomas,and familial polyposis seem to increase a person's chance of developing colon cancer. The other conditions listed have no known effect on colon cancer risk.The client with Crohn's disease, also known as regional enteritis. Which statement by the client would support this diagnosis? 4. The client is diagnosed with Crohn's disease, also known as regional enteritis. Which statement by the client would support this diagnosis? * A. *"My pain goes away when I have a bowel movement"* * B. *"I have bright red blood in my stool all the time"* * C. **"I hav episodes of diarrhea and constipation"** * D. *"My abdomen is hard and rigid and I have a fever"* **Rationale:** A. The terminal ileum is the most common site for regional enteritis and causes right lower quadrant pain that is relieved by defecation. Stools are liquid or somi-formed and usually do not contain blood. Episodes of diarrhea and constipation may be a sign/symptom of colon cancer, not Crohn's disease 4. A fever and hard rigid abdomen are signs/symptoms of peritonitis, a complication of Crohn's disease 5. The client is diagnosed The nurse is teaching the patient a client with a peptic ulcer discharge instructions. The client asks the nurse which type of analgesic he may take. Which of the following responses by the nurse woul be most accurate? * A. Aspirin * B. **Acetaminophen** * C. Naproxen * D. Ibuprofen **Rationale:** B. Acetaminophen is recommended for pain relief because it does no promote irritation of the mucosa. Aspirin, and nonsteroidal anti-inflammatory drugs such as naproxen and ibuprofen, may cause irritation of the mucosa and subsequent bleeding. 6. Which associated disorder might a client with Crohn's disease exhibit most often? * A. Ankylosing spondylitis * B. Colon cancer * C. **Malabsorption** * D. Lactase deficiency **Rationale:** C. Malabsorption Because of the transmural nature of Crohn's disease lesions, malabsorption may occur with Crohn's disease. Although ankylosing spondylitis and colon cancer are more commonly associated with ulcerative colitis, they may seen in clients with Crohn's disease, Lactase deficiency is caused by a congenital defect in with an enzyme isn't present. 7. The nurse finds a client vomiting coffee ground-type material. On assessment, the client has blood pressure of 100/74 mm Hg are acutely confused, and has a weak and thready pulse. Which intervention will be the nurse's first priority? * A. Administering an $H_2$ antagonist * B. Initiating enteral nutrition * C. **Administering intravenous (IV) fluids** * D. Administering antianxiety medication **Rationale:** C. Administration of IV fluids is necessary to treat the hypovolemia caused by acute GI bleeding 8. Which of the following instructions should the nurse include in the teaching plan for a client who is experiencing gastroesophageal reflux disease (GERD)? * A. Limit caffeine intake to two cups of coffee per day * B. **Do not lie down for 2 hours after eating** * C. Follow a low-protein diet * D. Take medications with milk to decrease irritation **Rationale** B. The nurse should instruct the client to not lie down for about 2 hours after eatin to prevent efflux. 9. The nurse is caring for a client diagnosed with rule out peptic ulcer disease. Which test confirms this diagnosis? * A. **Esophagogastroduodenoscopy** * B. Magnetic resonance imaging * C. Occult blood test * D. Gastric acid stimulation. **Rationale** A. The esophagogastroduodenoscopy (EGD) is an vasive diagnostic test which visualizes the esophagus, stomach, and duodenum to accurately diagnose an ulcer and evaluate the effectiveness of the clients treatment. 1. The client is scheduled to have an upper GI tract series of x-rays. Following the x-rays, the nurse should instruct the client to: * A. **Take a laxative** * B. Follow a clear liquid diet * C. Administer an enema * D. Take an antiemetic **Rationale:** A. The client should take a laxative after an upper GI series to stimulate a bowel movement. This examination involves the administration of barium, which must be promptly eliminated from the body because it may harden and cause an obstruction. 2. A client who has been diagnosed with GERD has heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which of the following items from the diet? * A. Lean beef * B. Air-popped popcorn * C. **Hot chocolate** * D. Raw vegetables **Rationale:** C. With GERD, eating substances that decrease lower esophageal sphincter pressure causes heartburn. A decrease in the lower esophageal sphincter pressure allows gastric contents to reflux into the lower end of the esophagus. Foods that can cause a decrease in esophageal sphincter pressure include fatty foods, chocolate, caffeinated beverages, peppermint, and alcohol 3. Which physical examination should the nurse implement first assessing the client diagnosed with peptic ulcer disease? * A. **Auscultate the clients bowel sounds in all four quadrants** * B. Palpate the abdominal are for tenderness * C. Percuss the abdominal borders to identify organs * D. Assess the tender are progressing to nontender **Rationale:** A. Auscultation should be used prior to palpitation or percussion when assessing the abdomen .Manipulation of the abdomen can alter bowel sounds and give false information 4. The client with GERD has a chronic cough. This symptom may be indicative of which of the following? * A. Development of laryngeal cancer * B. Irritation of the esophagus * C. Esophageal scar tissue formation * D. **Aspiration of gastric contents** **Rationale** D. Clients with GERD can develop pulmonary symptoms such as coughing, wheezing, and dyspnea, that are caused by the aspiration of gastric contents 5. in planning the care the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is Crohn's disease" * A. Frequently results in toxic megacolon * B. Causes sewer nutritional deficiencies than does ulcerative colitis * C. **Often recurs after surgery, whereas ulcerative colitis is curable with a colectomy** * D. Is manifested by rectal bleeding anemia more frequently than is ulcerative colitis **Rationale: C. Because there is a high recurrence rate after surgical treatment of Crohn's disease, medications are the preferred treatment** 6. The nurse has been assigned care for a client diagnosed. With peptic ulcer disease. Which assessment data require further intervention? * A. Bowel sounds auscultated is 15 tones in 1min * B. Belching after eating a Heavy and fatty meal late at night * C. **A decrease in systolic BP of 20mmHg from lying to sitting-** * D. A decreased frequency distress in the epigastric region **Rationale: C. A decrease in systolic BP of 20 mmHg in pressure after changing position of standing is orthostatic hypotension. This could indicate that the client is bleeding** 7. Bethanacol(Urecholine) has been prescribed for a client with GERD. The nurse should access the lient for which of the following adverse effects? * A. Constipation * B. **Urinary urgency** * C. Hypertension * D. Dry oral mucosa **Rationale**B.This is a cholinergic that could be used in GERD to increase L.E.S pressure and facilitate .Chilinergic adverse effects could include:abdomisla cramps(diarrhea),urinary agency, Hypotension.Increase saviation. 8. The client attends two testions with the dietitian to learn about about diet modifcations to minimize GERD. The teaching would be considered successful if the client decreases the intake of which of the following foods" * A. **Fatts** * B. High sodium foods * C. Carbohydrates * D. igh calcium foods **Rationale: A, Fats,are asosiated for decreased esophageal sphincter tone** 1. Which oral medication should the nurse question before administering the client with peptic ulcer disease? * A. **E-mycin, an antibiotic** * B. Prilosec, a proton pump inhibitor * C. Flagyl, an antimicrobial agent * D. Tylenol, a nonnarcotic analgesic **Rationale:** A. E-mycin is irritating to stomach and its use in a client with peptic ulcers should be questioned 2. The nurse is reviewing the record of a female client with Chron's disease, Which stool characteristics should the nurse expect to note document in the client's record * A. **Diarrhea** * B. Chronic constipation * C. Constipation alternating with diarrheaa * D. Stools Constantly oozing form the rectum **Rationale: A. Diarrhea. Crohn’s disease is characterized with nonbloody diarrhea and around 4 or 5 stools perday. Over time, episodes of diarrhea increases in frequency and duration, and severity** 3. Nurse is caring for a patient with a diagnosis of ULCERATIVE COLITIS. Which finding, if noted on assession of the client, would the nurse report to the Dr? * A. Hypotension * B. Bloody diarrhea * C. **Rebound tenderness** * D. Hemoglobin 12mg/Dl. **Rationale=C, Rebound tenderness becasue this could indicate peritonitis** 4. .Which of the following dietary measures would useful in preventing Esophageal influx? * A. **Eating small, frequent meals** * B. increasing fluid intake * C.Avoding air swallowing with meals * D. adding a bedtime snack to the dietary plan. **Rationale** Esophogeal reflux worsens When the stomach is over-distended with food, therefore, an important measure is to small freaquent meals. 5. The client has a ong -term history of Chron's Disease and has recently. The client asks the nurse whether Chron's disease was a direct causethe Gastritis . WHAT IS THE NURSE’S BEST RESPPONSE: * A Yes, chronn’s DISEASE IS NOT CAUSEDEVELOPMEMT CHRONIC Gastritis * B. **“We know that there can be an association betweens and gastritis but doesn’t cause Chronis acute gastritis to develop”** * C.WHAT HAS THE DOCTOR TOLD YOU ABOUT HAS THE GASTRITIS DEVELOPED * D HAS SAID HAS CROHS AND GAS BEEN REPORTED. **Rationale: B This is accuarte statement . The client** 6. the is diagnosed with an acute exacerbaton of ulcerative colitis WHICH INTERVENTION SHOULD THE NURSE IMPLEMENT * A. Provide a Low residue diet . * B. **Monitor intravenous diet** * C Assess vital signs duty * D. Administer antacids orally **Rationale= B. the client requries fluids to help prevent dehydration from diarrhea and replace fuid lost through normal body functions. “Not all angels have wigs scrubs” -Unknown Prepared by: Dhonnifer A. Abarao DHCM, MA, USRN, LP, DHA**