Lewis: Medical Surgical Nursing 11th Edition test Bank Quizlet

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A patient with acute diarrhea of 24 hours' duration calls the clinic to ask for directions for care. In talking with the patient, what should the nurse do?

a. Ask the patient to describe the character of the stools and any associated symptoms.
b. Advise the patient to use over-the-counter loperamide (Imodium) to slow gastrointestinal motility.
c. Inform the patient that laboratory testing of blood and stool specimens will be necessary.
d. Advise the patient to drink clear liquid fluids with electrolytes, such as Gatorade or Pedialyte.

ANS: A
The nurse's initial response should be further assessment of the patient. The other responses may be appropriate, depending on what is learned in the assessment.

A 78-year-old patient is transferred to the hospital from a nursing home on developing abdominal pain and watery, incontinent diarrhea following a course of antibiotic therapy for pneumonia. Stool cultures reveal the presence of Clostridium difficile. In planning care for the patient, the nurse will do which of the following?

a. Order a diet with no dairy products for the patient.
b. Place the patient in a private room with contact isolation.
c. Explain to the patient why antibiotics are not being used.
d. Teach the patient about proper food handling and storage.

ANS: B
Because C. difficile is highly contagious, the patient should be placed in a private room and contact precautions should be used.

Psyllium (Metamucil) is prescribed for a patient with chronic constipation. In teaching the patient about chronic constipation, what should the nurse stress?

a.The use of bulk-forming laxatives is safe, and they do not cause any adverse effects.
b.At least 3000 mL of fluid daily must be taken to prevent impaction or bowel obstruction.
c.Dietary sources of fibre should be eliminated from the diet to prevent excessive gas formation.
d.Supplemental fat-soluble vitamins must be taken because the medication blocks absorption of these vitamins.

ANS: B
A high fluid intake is needed to prevent hardened stools leading to impaction or bowel obstruction. Although bulk-forming laxatives are generally safe, the nurse should emphasize the possibility of constipation or obstipation if inadequate fluid intake occurs.

A patient is admitted to the emergency department with severe abdominal pain, anorexia, and chills. His vital signs include temperature 38.3°C, pulse 130 beats/min, respiration 34 breaths/min, and blood pressure (BP) 82/50 mm Hg. His pain is more intense in the left lower quadrant but radiates throughout the entire abdomen, with rebound tenderness and abdominal rigidity. The nurse plans care for the patient based on the knowledge that management of his condition initially involves which of the following actions?

a.Intravenous (IV) fluid resuscitation
b.Exploratory laparotomy
c.Administration of IV antibiotics
d.Diagnostic testing with barium studies and endoscopy

ANS: A
The priority for this patient is to treat the patient's hypovolemic shock with fluid infusion. The other actions should be implemented after starting the fluid infusion.

A patient is being evaluated in the emergency department for acute lower abdominal pain with diarrhea and vomiting. During the nursing history, what is the most helpful question to obtain information regarding the patient's condition?

a."What do you usually eat?"
b."Can you tell me about your pain?"
c."What is your usual elimination pattern?"
d."When did the diarrhea and vomiting start?"

ANS: B
A complete description of the pain provides clues about the cause of the problem.

Which stool consistency would the nurse expect to see in a patient with a sigmoid colostomy?

a. Semiliquid
b.Semiformed
c.Formed
d.Pasty

ANS: C
A patient with a sigmoid colostomy would be expected to have a formed soot consistency. A semiliquid or semiformed stool consistency would be expected with a transverse colostomy. A pasty stool consistency would be expected with an ileostomy.

A 20-year-old university student is admitted to the emergency department for evaluation of abdominal pain with nausea and vomiting. She has a white blood cell count of 14,000 cells/microlitre with a shift to the left. Which one of the following actions is appropriate for the nurse to take?

a.Encourage the patient to take sips of clear liquids.
b.Apply an ice pack to the right lower quadrant.
c.Check for rebound tenderness every 30 minutes.
d.Teach the patient how to cough and breathe deeply.

ANS: B
The patient's clinical manifestations are consistent with appendicitis, and application of an ice pack will decrease inflammation at the area. Heat is never to be applied to the area because it may cause the appendix to rupture.

A patient hospitalized with an acute exacerbation of ulcerative colitis is having 14 to 16 bloody stools a day and crampy abdominal pain associated with the diarrhea. Which of the following will the nurse plan to implement?

a.Place the patient on NPO status.
b.Administer cobalamin (vitamin B12) injections.
c.Start bowel preparation for colonoscopy.
d.Administer IV metoclopramide.

ANS: A
An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO status.

While obtaining a nursing history from a patient with IBD, which of the following data leads the nurse to suspect that the patient most likely has ulcerative colitis rather than Crohn's disease?
a.Weight loss
b.Bloody diarrhea
c.Abdominal pain and cramping
d.Onset of the disease at age 20

ANS: B
Because ulcerative colitis affects the colon, blood in the stools is more common with this form of IBD.

Sulphasalazine (Salazopyrin) is prescribed for a patient who has been diagnosed with ulcerative colitis. The nurse recognizes that teaching about this drug has been effective when the patient states which of the following?

a."The medication will prevent infections that cause the diarrhea."
b. "The medication suppresses the inflammation in my large intestine."
c. "I will need lab tests to be sure that I can still fight infections."
d. "I will take the sulphasalazine as an enema or suppository."

ANS: B
Sulphasalazine suppresses the inflammatory process that causes the symptoms of ulcerative colitis.

The nurse identifies a nursing diagnosis of impaired skin integrity related to diarrhea for a patient with ulcerative colitis. The nurse recognizes that teaching regarding perianal care has been effective when the patient implements which of the following actions?

a.Takes a sitz bath for 40 minutes following each stool
b.Asks for antidiarrheal medication after each diarrhea stool
c.Applies barrier cream after each cleansing of the perianal area
d.Cleans her perianal area with soap and water after each diarrhea stool

ANS: C
The patient should apply barrier cream after cleansing, to protect skin and promote healing.

After teaching a patient with IBD about the recommended low-residue diet, the nurse identifies a need for further instruction when the patient chooses which of the following foods from the menu?

a. Boiled shrimp
b. Ham hocks and beans
c. Spaghetti with tomato sauce
d. Poached eggs and crisp bacon

ANS: B
The patient is taught to avoid high-fibre foods such as beans.

The nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements for a patient who is hospitalized with an acute exacerbation of Crohn's disease based on which of the following findings?

a.Fatigue and weakness
b.A hemoglobin of 6.2 mmol/L (10 g/dL)
c.A weight loss of 0.9 kg in 2 days
d.A 24-hour diet history that reveals a 1500-calorie intake

ANS: B
A hemoglobin count of 6.2 mmol/L (10 g/dL) indicates that the patient's iron is low; anemia is a common complication of Crohn's disease.

A 26-year-old woman is diagnosed with Crohn's disease after having frequent diarrhea and a weight loss of 4.5 kg over 2 months. When the patient asks what will happen, the nurse explains that initial therapy usually includes which of the following treatments?

a.Bed rest
b.Fluid restriction
c.Use of corticosteroids
d.Small, frequent feedings of a high-calorie diet

ANS: C
Corticosteroids are used to achieve remission in IBD, and systemic corticosteroids will be used in Crohn's disease to affect the small intestine.

A patient newly diagnosed with Crohn's disease asks the nurse what to expect in the future. What is the best response?

a."You need to know that lifelong, unpredictable periods of remissions and recurrences are probable."
b."You can expect to lead a normal life and may have long periods without episodes of diarrhea or other symptoms."
c."Most patients with Crohn's disease require an ostomy to control the disease, but you can adjust to that."
d."After about 10 years, patients with Crohn's disease have a high risk for colon cancer unless the colon is removed."

ANS: A
Crohn's disease has recurrent acute exacerbations that occur at unpredictable intervals.

A patient with Crohn's disease develops a fever and symptoms of a urinary tract infection. The nurse recognizes that this complication may occur as a result of which of the following events?

a. Perianal irritation from frequent diarrhea
b. Fistula formation between the bowel and the bladder
c. Extraintestinal manifestations of the bowel disease
d. Impaired immunological response to infectious microorganisms

ANS: B
Fistulas between the bowel and the bladder occur in Crohn's disease and can lead to urinary tract infection.

While obtaining a nursing history from a patient scheduled for a colonoscopy, what would the nurse be most concerned about?
a. Lifelong constipation
b. Nausea and vomiting
c. History of an appendectomy
d. Recent blood in the stools

ANS: D
Rectal bleeding is associated with colorectal cancer. Recent changes in bowel patterns are a clinical manifestation of colorectal cancer, but lifelong constipation is not an indication.

During the initial postoperative assessment of a patient's stoma formed with a transverse colostomy, the nurse finds it to be red with moderate edema and a small amount of bleeding. What is the most appropriate nursing action?

a.Document the stoma assessment.
b.Notify the surgeon about the stoma appearance.
c.Monitor the stoma every 30 minutes.
d. Place an ice pack on the stoma to reduce swelling.

ANS: A
The stoma appearance indicates good circulation to the stoma.

A patient has a newly formed ileostomy for treatment of ulcerative colitis. In teaching the patient about the care of her ileostomy, what should the nurse advise the patient to do?

a. Restrict fluid intake to prevent constant liquid drainage from the stoma.
b. Change the pouch every day to prevent leakage of contents onto the skin.
c. Use care when eating high-fibre foods to avoid obstruction of the ileum.
d. Irrigate the ileostomy daily to avoid having to wear a drainage appliance.

ANS: C
High-fibre foods are introduced gradually and should be well chewed to avoid obstruction of the ileostomy.

When teaching a patient to irrigate a new colostomy, the nurse recognizes that additional teaching is needed when the patient indicates which of the following?

a. "I should hang the irrigating container about 46 to 60 cm above the stoma."
b."Irrigation will help control and train my bowel."
c."I should use a hard plastic catheter for irrigating."
d."If resistance is met, force is not to be used."

ANS: C
A hard plastic catheter is not recommended because of the risk of intestinal perforation.

The nurse explains to a patient with a new ileostomy that after her system adjusts to the ileostomy, the usual drainage will be about which following amount?
a. 250 mL
b. 500 mL
c. 800 mL
d. 1400 mL

ANS: C
After the proximal small bowel adapts to reabsorb more fluid, the average amount of ileostomy drainage is about 800 mL daily.

A 42-year-old patient recently developed abdominal distension, weight loss, steatorrhea, and flatulence. A diagnosis of adult celiac disease is made, and treatment is initiated. The nurse identifies that teaching about the treatment of the disease has been effective when the patient makes which of the following statements?

a."I must take maintenance folic acid for the rest of my life."
b. "I must avoid all sources of wheat, rye, and oats in my diet."
c. "A course of antibiotics is usually effective in treating this disorder."
d. "To control the fatty, greasy stools, I should eat only very low-fat or fat-free foods."

ANS: B
Avoidance of gluten-containing foods is the only treatment for celiac disease.

After being treated for a respiratory tract infection with a 10-day course of antibiotics, a 69-year-old patient calls the clinic and tells the nurse about developing frequent, watery diarrhea. What will the nurse anticipate that the patient will need to do?

a. Prepare for colonoscopy by taking laxatives.
b. Have blood drawn for blood cultures.
c. Bring a stool specimen in to be tested for C. difficile.
d. Schedule a barium enema to check for inflammation.

ANS: C
The patient's age and history of antibiotic use suggest a C. difficile infection. There is no indication that the patient needs a colonoscopy, blood cultures, or a barium enema.

Which of the following is a clinical manifestation of an obstruction in the small intestine as opposed to the large intestine?

a. Gradual onset
b. Immediate and frequent vomiting
c. Low-grade cramping abdominal pain
d. Complete constipation

ANS: B
Clinical manifestations of a small intestine obstruction include a rapid onset, frequent and copious vomiting, colicky, cramplike, intermittent pain, feces for a short time, and minimal abdominal distension.