Chapter 60: Care of Patients with Inflammatory Intestinal Disorders

Chapter 60: Care of Patients with Inflammatory Intestinal Disorders

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

 

MULTIPLE CHOICE

 

1. The nurse conducts a physical assessment for a client with abdominal pain. Which finding leads the nurse to suspect appendicitis?

a.	Severe, steady right lower quadrant (RLQ) pain
b.	Abdominal pain that started a day after vomiting began
c.	Abdominal pain that increases with knee flexion
d.	Marked peristalsis and hyperactive bowel sounds

 

 

ANS:  A

Right lower quadrant pain, specifically at McBurney’s point, is characteristic of appendicitis. Usually if nausea and vomiting begin first, the client has a gastroenteritis. Abdominal pain due to appendicitis decreases with knee flexion. Marked peristalsis and hyperactive bowel sounds are not indicative of appendicitis.

 

DIF:    Cognitive Level: Knowledge/Remembering                       REF:   p. 1267

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Assessment)

 

2. The nurse conducts a physical assessment for a client with severe right lower quadrant (RLQ) abdominal pain. The nurse notes that the abdomen is rigid and the client’s temperature is 101.1° F (38.4° C). Which laboratory value does the nurse bring to the attention of the health care provider as a priority?

a.	A “left shift” in the white blood cell count
b.	White blood cell count, 22,000/mm3
c.	Serum sodium, 149 mEq/L
d.	Serum creatinine, 0.7 mg/dL

 

 

ANS:  B

This client may have appendicitis based on RLQ pain. A white blood cell count of 22,000/mm³ is severely elevated and could indicate a perforated appendix, as could the fever. The nurse should bring these findings to the provider’s attention as soon as possible. A left shift would be expected in uncomplicated appendicitis. The sodium reading is only slightly high; this could be due to hemoconcentration from vomiting or from decreased intake. The creatinine level is normal.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Laboratory Values) MSC:           Integrated Process: Nursing Process (Analysis)

 

3. The nurse is caring for an older client with Salmonella food poisoning. Which is the priority action of the nurse?

a.	Monitor vital signs.
b.	Maintain IV fluids.
c.	Provide perineal care.
d.	Initiate Isolation Precautions.

 

 

ANS:  B

Dehydration can occur quickly in older clients with Salmonella food poisoning caused by diarrhea, so maintenance of fluid balance is a high priority. Monitoring vital signs and providing perineal care are important nursing actions, but are of lower priority than fluid replacement. Contact Isolation is not regularly instituted for Salmonella infection. Standard Precautions are usually sufficient.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Illness Management)  MSC:           Integrated Process: Nursing Process (Implementation)

 

4. The nurse is caring for a client who is having approximately 20 foul-smelling stools each day. Laboratory Gram stain testing indicates the presence of white blood cells (WBCs) and red blood cells (RBCs) in the stool. Which organism does the nurse expect to see in the culture report?

a.	Helicobacter pylori
b.	Campylobacter jejuni
c.	Clostridium botulinum
d.	Norwalk virus

 

 

ANS:  B

Campylobacter gastroenteritis causes foul-smelling diarrhea with up to 20 to 30 stools per day for 7 days. Both RBCs and WBCs are present in a Gram stain of the stools. Infection with Clostridium causes not diarrhea, but constipation, paralysis, and respiratory failure. H. pylori is a common cause of gastric ulcers, not gastroenteritis. Norwalk virus produces milder illness with diarrhea and vomiting.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Analysis)