A client with type 2 diabetes who has been prescribed metformin. The client asks the nurse how the medication will affect their kidneys. What is the nurse’s most appropriate response?

Choice A reason: Colorectal cancer may cause bleeding or pain but typically presents with mass lesions or obstruction, not a continuous pattern of mucosal lesions on X-ray. Its symptoms are less likely to remit and exacerbate cyclically, unlike inflammatory bowel diseases, making it less likely than ulcerative colitis.

Choice B reason: Crohn’s disease causes patchy, transmural bowel lesions, not continuous large bowel involvement. Its skip lesions and potential for small bowel involvement distinguish it from the continuous mucosal inflammation seen in ulcerative colitis, making this an inaccurate diagnosis for the described X-ray findings.

Choice C reason: Diverticulitis involves inflamed diverticula, typically causing localized pain and fever, not continuous large bowel lesions or bloody diarrhea with remissions. X-ray may show diverticula, but not diffuse mucosal involvement. This condition is less likely than ulcerative colitis given the described symptom pattern.

Choice D reason: Ulcerative colitis causes continuous mucosal inflammation in the large bowel, leading to bloody diarrhea, abdominal pain, and periods of exacerbation and remission. X-ray showing continuous lesions aligns with its diffuse colitis pattern, making this the most accurate diagnosis for the client’s symptoms and findings.

Choice A reason: Ecchymosis, or bruising, may occur with a fracture due to soft tissue injury and bleeding but is not specific to fractures. It results from ruptured blood vessels in the skin, not bone disruption, and can occur in many trauma scenarios, making it less definitive than crepitus for fracture assessment.

Choice B reason: Crepitus, the grating sound or sensation from bone fragments rubbing together, is a hallmark of fractures. It occurs due to disrupted bone continuity, detectable during physical examination. This clinical manifestation is highly specific to fractures, making it the most accurate choice for a nurse’s assessment focus.

Choice C reason: Shock can occur with severe fractures due to blood loss or pain but is not a direct manifestation of the fracture itself. It reflects systemic response to trauma, not the localized bone injury, making it less specific than crepitus for identifying a fracture during assessment.

Choice D reason: Deformity is a common fracture sign due to bone misalignment but is not always present, especially in hairline or non-displaced fractures. Crepitus is more consistently detectable in physical exams, as it directly results from bone fragment movement, making it a more reliable clinical manifestation.