Chapter 52: Concepts of Care for Patients
with Inflammatory Intestinal Disorders
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. The nurse is caring for a client who is prescribed sulfasalazine. Which question would
the nurse ask the client before starting this drug?
a. “Are you taking Vitamin C or B?
b. “Do you have any allergy to sulfa drugs?”
c. “Can you swallow pills pretty easily?”
d. “Do you have insurance to cover this drug?”
ANS: B
Sulfasalazine is a sulfa drug given for clients who have ulcerative colitis. However, it
should not be given to those who have an allergy to sulfa and sulfa drugs to prevent a
hypersensitivity reaction.
DIF: Understanding TOP: Integrated Process: Nursing Process: Assessment
KEY: Ulcerative colitis, Drug therapy MSC: Client Needs
Category: Physiological Integrity: Pharmacological and Parenteral Therapies
2. A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which
assessment would the nurse complete first?
a. Inspection of oral mucosa
b. Recent dietary intake
c. Heart rate and rhythm
d. Percussion of abdomen
, ANS: C
Although the client with severe diarrhea may experience skin irritation and
hypovolemia, the client is most at risk for cardiac dysrhythmias secondary to
potassium and magnesium loss from severe diarrhea. The client would have her or his
electrolyte levels monitored, and electrolyte replacement may be necessary. Oral
mucosa inspection, recent dietary intake, and abdominal percussion are important
parts of physical assessment but are lower priority for this patient than heart rate and
rhythm.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Ulcerative colitis, Assessment MSC: Client Needs
Category: Safe and Effective Care Environment: Management of Care
3. A nurse reviews the electronic health record of a client who has Crohn disease and a
draining fistula. Which documentation would alert the nurse to urgently contact the
primary health care provider for additional prescriptions?
a. Serum potassium of 2.6 mEq/L (2.6 mmol/L)
b. Client ate 20% of breakfast meal
c. White blood cell count of 8200/mm3 (8.2 109/L)
d. Client’s weight decreased by 3 lb (1.4 kg)
ANS: A
Fistulas place the patient with Crohn disease at risk for hypokalemia which can lead
to serious dysrhythmias. This potassium level is low and would cause the nurse to
intervene. The white blood cell count is normal. The other two findings are abnormal
and also warrant intervention, but the potassium level takes priority.
DIF: Applying TOP: Integrated Process: Nursing Process: Analysis
KEY: Crohn disease, Complications MSC: Client Needs
Category: Physiological Integrity: Reduction of Risk Potential
, 4. A client is preparing to have a laparoscopic restorative proctocolectomy with ileo
pouch-anal anastomosis (RCA-IPAA). Which preoperative health teaching would the
nurse include?
a. “You will have to wear an appliance for your permanent ileostomy.”
b. “You should be able to have better bowel continence after healing occurs.”
c. “You will have a large abdominal incision that will require irrigation.”
d. “This procedure can be performed under general or regional anesthesia.”
ANS: B
A RCA-IPAA can improve bowel continence although leakage may still occur for
some clients. The procedure is a 2-step process performed under general anesthesia
using a laparoscope which does not require an abdominal incision or permanent
ileostomy.
DIF: Applying TOP: Integrated Process: Teaching/Learning KEY:
Ulcerative colitis, Perioperative care MSC: Client Needs Category:
Physiological Integrity: Physiological Adaptation
5. After teaching a client who has diverticulitis, a nurse assesses the client’s
understanding. Which statement made by the client indicates a need for further
teaching?
a. “I’ll ride my bike or take a long walk at least three times a week.”
b. “I must try to include at least 25 g of fiber in my diet every day.”
c. “I will take a laxative nightly at bedtime to avoid becoming constipated.”
d. “I should use my legs rather than my back muscles when I lift heavy objects.”
ANS: C
Laxatives are not recommended for patients with diverticulitis because they can
increase pressure in the bowel, causing additional outpouching of the lumen. Exercise
and a high-fiber diet are recommended for clients with diverticulitis because they
promote regular bowel function. Using the leg muscles rather than the back for lifting
prevents abdominal straining.
with Inflammatory Intestinal Disorders
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. The nurse is caring for a client who is prescribed sulfasalazine. Which question would
the nurse ask the client before starting this drug?
a. “Are you taking Vitamin C or B?
b. “Do you have any allergy to sulfa drugs?”
c. “Can you swallow pills pretty easily?”
d. “Do you have insurance to cover this drug?”
ANS: B
Sulfasalazine is a sulfa drug given for clients who have ulcerative colitis. However, it
should not be given to those who have an allergy to sulfa and sulfa drugs to prevent a
hypersensitivity reaction.
DIF: Understanding TOP: Integrated Process: Nursing Process: Assessment
KEY: Ulcerative colitis, Drug therapy MSC: Client Needs
Category: Physiological Integrity: Pharmacological and Parenteral Therapies
2. A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which
assessment would the nurse complete first?
a. Inspection of oral mucosa
b. Recent dietary intake
c. Heart rate and rhythm
d. Percussion of abdomen
, ANS: C
Although the client with severe diarrhea may experience skin irritation and
hypovolemia, the client is most at risk for cardiac dysrhythmias secondary to
potassium and magnesium loss from severe diarrhea. The client would have her or his
electrolyte levels monitored, and electrolyte replacement may be necessary. Oral
mucosa inspection, recent dietary intake, and abdominal percussion are important
parts of physical assessment but are lower priority for this patient than heart rate and
rhythm.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Ulcerative colitis, Assessment MSC: Client Needs
Category: Safe and Effective Care Environment: Management of Care
3. A nurse reviews the electronic health record of a client who has Crohn disease and a
draining fistula. Which documentation would alert the nurse to urgently contact the
primary health care provider for additional prescriptions?
a. Serum potassium of 2.6 mEq/L (2.6 mmol/L)
b. Client ate 20% of breakfast meal
c. White blood cell count of 8200/mm3 (8.2 109/L)
d. Client’s weight decreased by 3 lb (1.4 kg)
ANS: A
Fistulas place the patient with Crohn disease at risk for hypokalemia which can lead
to serious dysrhythmias. This potassium level is low and would cause the nurse to
intervene. The white blood cell count is normal. The other two findings are abnormal
and also warrant intervention, but the potassium level takes priority.
DIF: Applying TOP: Integrated Process: Nursing Process: Analysis
KEY: Crohn disease, Complications MSC: Client Needs
Category: Physiological Integrity: Reduction of Risk Potential
, 4. A client is preparing to have a laparoscopic restorative proctocolectomy with ileo
pouch-anal anastomosis (RCA-IPAA). Which preoperative health teaching would the
nurse include?
a. “You will have to wear an appliance for your permanent ileostomy.”
b. “You should be able to have better bowel continence after healing occurs.”
c. “You will have a large abdominal incision that will require irrigation.”
d. “This procedure can be performed under general or regional anesthesia.”
ANS: B
A RCA-IPAA can improve bowel continence although leakage may still occur for
some clients. The procedure is a 2-step process performed under general anesthesia
using a laparoscope which does not require an abdominal incision or permanent
ileostomy.
DIF: Applying TOP: Integrated Process: Teaching/Learning KEY:
Ulcerative colitis, Perioperative care MSC: Client Needs Category:
Physiological Integrity: Physiological Adaptation
5. After teaching a client who has diverticulitis, a nurse assesses the client’s
understanding. Which statement made by the client indicates a need for further
teaching?
a. “I’ll ride my bike or take a long walk at least three times a week.”
b. “I must try to include at least 25 g of fiber in my diet every day.”
c. “I will take a laxative nightly at bedtime to avoid becoming constipated.”
d. “I should use my legs rather than my back muscles when I lift heavy objects.”
ANS: C
Laxatives are not recommended for patients with diverticulitis because they can
increase pressure in the bowel, causing additional outpouching of the lumen. Exercise
and a high-fiber diet are recommended for clients with diverticulitis because they
promote regular bowel function. Using the leg muscles rather than the back for lifting
prevents abdominal straining.
