Five gastrointestinal questions with answers
Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
The patient is admitted to the unit with the diagnosis of rhabdomyolysis. The patient is started on intravenous (IV) fluids and IV mannitol. What action by the nurse is best?
- A. Assess the patient's hearing.
- B. Assess the patient's lungs.
- C. Decrease IV fluids once the diuretic has been administered.
- D. Give extra doses before giving radiological contrast agents.
Show answer and rationale
Correct answer: B — Assess the patient's lungs.
The correct answer is B: Assess the patient's lungs. In rhabdomyolysis, muscle breakdown leads to the release of myoglobin which can cause renal damage. IV fluids and mannitol are given to prevent kidney injury. Assessing the patient's lungs is important to monitor for potential complications such as pulmonary edema, a serious side effect of mannitol therapy. This assessment will help the nurse detect any signs of respiratory distress early on, allowing for prompt intervention.
Choices A, C, and D are incorrect:
A: Assess the patient's hearing - This is not directly related to the treatment of rhabdomyolysis and mannitol administration.
C: Decrease IV fluids once the diuretic has been administered - Decreasing IV fluids prematurely can lead to inadequate hydration and worsen kidney function.
D: Give extra doses before giving radiological contrast agents - This is not indicated in the treatment of rhabdomyolysis and can potentially harm the patient.
Question 2
A 47-year-old web designer has a 14-year history of ulcerative colitis. He recently moved to your area and presents to your office for continued management of his ulcerative colitis. He has been asymptomatic for the past two years and off all medications for one year with no rectal bleeding, diarrhea, abdominal pain, tenesmus, or fever. Before that he had very active colitis requiring steroids and immunosuppressants. He brings records from his previous physician that include his last three colonoscopy and pathology reports. The reports from 6 and 12 years ago documented active colitis with friable mucosa from the mid-transverse colon to the rectum, superficial ulcerations, crypt abscesses and crypt distortion, and acute and chronic inflammation. The most recent report, from almost three years ago, was fairly unremarkable endoscopically. Numerous random biopsies had been obtained. They showed mucosal changes on histology also consistent with a history of ulcerative colitis, but there was no evidence of active disease. What do you recommend?
- A. Initiate steroids; if stools are heme-occult positive, then refer for colonoscopy
- B. Do not start steroids; if stools are heme-occult positive, then refer for colonoscopy
- C. Start steroids; refer for colonoscopy
- D. Do not start steroids; refer for colonoscopy
Show answer and rationale
Correct answer: D — Do not start steroids; refer for colonoscopy
The patient has not had active disease for several years and remains well despite being off medications for the past year. Steroids are indicated for active disease only, and steroids do not prevent recurrence. Ulcerative colitis is a chronic disease with recurrence expected. An argument can be made for azulfidine or mesalamine; 5-ASA agents have been documented to decrease flares and appear to decrease the risk of dysplasia and eventual colon cancer. Patients with ulcerative colitis for more than eight years should undergo colonoscopy every two years with random biopsies taken every $10 \mathrm{~cm}$ to rule out dysplasia; then more frequently after 20 years of disease. Definitive evidence of dysplasia requires referral for colectomy to avoid the extremely high risk of colon cancer. Presence of occult blood in the stool will not change endoscopic management because this patient needs to be on a regular screening protocol regardless of heme-occult status.
Question 3
The nurse has provided home care instructions to a client who had a subtotal gastrectomy. The nurse instructs the client regarding the signs and symptoms associated with dumping syndrome. Which of the following signs and symptoms, if identified by the client, indicates an understanding of this potential complication following gastrointestinal surgery?
- A. Hiccups and diarrhea
- B. Fatigue and abdominal pain
- C. Constipation and fever
- D. Diaphoresis and diarrhea
Show answer and rationale
Correct answer: D — Diaphoresis and diarrhea
The correct answer is D: Diaphoresis and diarrhea. Diaphoresis (excessive sweating) and diarrhea are classic signs of dumping syndrome, a common complication after gastrectomy. Diaphoresis occurs due to the rapid movement of food into the intestines, triggering the release of hormones leading to sweating. Diarrhea results from the rapid emptying of undigested food into the intestines. These symptoms typically occur within 30 minutes to 3 hours after eating in dumping syndrome.
Explanation for why the other choices are incorrect:
A: Hiccups and diarrhea - Hiccups are not typically associated with dumping syndrome.
B: Fatigue and abdominal pain - Fatigue and abdominal pain are not specific symptoms of dumping syndrome.
C: Constipation and fever - Constipation and fever are not typical signs of dumping syndrome.
In summary, diaphoresis and diarrhea are classic symptoms of dumping syndrome due to rapid emptying of food into the intestines, making
Question 4
The nurse recognizes that teaching a patient following a laparoscopic cholecystectomy has been effective when the patient makes which statement?
- A. "I can take a shower and walk around the house tomorrow."Â
- B. "I need to limit my activities and not return to work for 4 weeks."Â
- C. "I can expect yellowish drainage from the incision for a few days."Â
- D. "I will follow a low-fat diet for life because I do not have a gallbladder."Â
Show answer and rationale
Correct answer: A — "I can take a shower and walk around the house tomorrow."Â
Rationale for Correct Answer (A): The statement "I can take a shower and walk around the house tomorrow" indicates an understanding of post-operative activity expectations. After a laparoscopic cholecystectomy, early ambulation is encouraged to prevent complications like blood clots. Additionally, showering promotes wound healing and hygiene.
Incorrect Choices:
B: "I need to limit my activities and not return to work for 4 weeks" - This choice is incorrect as it overestimates the recovery time for a laparoscopic cholecystectomy, which typically allows for a quicker return to normal activities.
C: "I can expect yellowish drainage from the incision for a few days" - While drainage is common after surgery, the color and duration mentioned are not typical for this procedure.
D: "I will follow a low-fat diet for life because I do not have a gallbladder" - Following a low-fat diet is recommended after surgery, but the statement is too extreme as dietary
Question 5
A 22-yr-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?
- A. The patient uses incontinence briefs to contain loose stools.
- B. The patient uses witch hazel compresses to soothe irritation.
- C. The patient asks for antidiarrheal medication after each stool.
- D. The patient cleans the perianal area with soap after each stool.
Show answer and rationale
Correct answer: B — The patient uses witch hazel compresses to soothe irritation.
The correct answer is B: The patient uses witch hazel compresses to soothe irritation. Witch hazel has astringent and anti-inflammatory properties, which can help reduce inflammation and soothe irritated skin. By using witch hazel compresses, the patient is actively taking steps to alleviate discomfort and promote skin healing.
A: The patient using incontinence briefs to contain loose stools does not address the issue of skin integrity maintenance and may lead to prolonged exposure of the skin to stool, exacerbating the problem.
C: Asking for antidiarrheal medication after each stool does not directly address the need for skin integrity maintenance. While it may help reduce stool frequency, it does not specifically target skin healing.
D: Cleaning the perianal area with soap after each stool can be harsh on the already excoriated skin and may further irritate it. Using soap can strip the skin of its natural oils and hinder the healing process.