A nurse assesses a patient who has celiac disease. Which signs and symptoms would the nurse expect? Select all that apply

Bloating

Flatulence

Anal fistula

Abdominal pain

Weight gain

Answer and Explanation

Correct Answer : A,B,D

Celiac disease is an autoimmune enteropathy triggered by the ingestion of gluten in genetically predisposed individuals. The immune response causes villous atrophy in the small intestine, leading to significant malabsorption of macro and micronutrients. Clinical presentation typically involves gastrointestinal distress and systemic signs of nutrient deficiency, as the damaged mucosa cannot effectively absorb fats or carbohydrates.

Rationale:

A. Bloating is a common symptom of celiac disease caused by the fermentation of unabsorbed carbohydrates by colonic bacteria. When the small intestine fails to break down nutrients due to villous atrophy, the remaining food matter undergoes bacterial degradation in the lower gut. This process releases gases that cause significant abdominal distension and discomfort for the patient.

B. Flatulence occurs alongside bloating as a direct result of malabsorption. Excess gas is produced when undigested sugars and fats reach the large intestine. This is a classic hallmark of the gastrointestinal upset associated with gluten-induced mucosal damage. Patients often report this as a persistent and distressing symptom until gluten is removed from their diet.

C. Anal fistula is not a characteristic finding of celiac disease. Fistulas are common in Crohn disease due to its transmural (full-thickness) inflammatory nature. Celiac disease is limited to the mucosal layer of the small intestine and does not typically create abnormal passages between the bowel and other structures or the external skin surface.

D. Abdominal pain is frequently reported by patients with celiac disease. The inflammation of the intestinal lining and the pressure from gas and unabsorbed bulk cause cramping and generalized distress. This pain is often exacerbated after consuming gluten-containing foods, reflecting the acute inflammatory and autoimmune response occurring within the small bowel mucosa.

E. Weight gain is atypical for untreated celiac disease; instead, patients usually experience weight loss. Because the intestinal villi are destroyed, the body cannot absorb enough calories to maintain weight. Many patients present with unintended weight loss or, in the case of children, a failure to thrive and meet growth milestones.

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Correct Answer is D

Explanation

Irritable bowel syndrome(IBS) is a functional gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits. Management of the constipation-predominant subtype (IBS-C) focuses on enhancing colonic motilityand improving stool consistency through lifestyle modifications. Physical activityand dietary fiber intake are foundational to reducing intestinal transit time.

Rationale:

A.Maintaining a low-fiber diet is contraindicated for managing constipation in IBS. Low fiber intake contributes to hard, infrequent stools and prolonged colonic transit time. Increasing soluble fiber to 25 to 35 grams daily is recommended to increase stool bulk and facilitate easier passage through the gastrointestinal tract.

B.Limiting fluid intake is counterproductive for a patient with constipation. Adequate hydration is essential for fiber to function effectively within the intestinal lumen. Restricting fluids can lead to excessively dry fecal matter, worsening the straining and discomfort associated with IBS-C, whereas 2 liters of water daily is usually advised.

C.Caffeine, cream, and sugar are common triggers that can exacerbate IBS symptoms. Caffeine acts as a chemical stimulant that can cause irregular peristaltic contractions and abdominal cramping. High-fat dairy products like cream and refined sugars may lead to increased gas production and bloating, making this an inappropriate dinner choice.

D.Walking every day is an effective non-pharmacological intervention for IBS-C because it stimulates natural peristalsis. Regular aerobic exercise helps regulate autonomic nervous system activity within the gut, promoting more consistent bowel movements. This statement confirms the client understands the importance of physical activity in maintaining healthy gastrointestinal motility and reducing symptoms.

A. White blood cell count of 8200/mm3 (8.2 x 109/L) B. Client ate 20% of breakfast meal C. Client's weight decreased by 3 lb (1.4 kg) D. Serum potassium of 2.6 mEq/L (2.6 mmol/L)

Correct Answer is D

Explanation

Crohn diseaseis a transmural inflammatory condition that often leads to fistula formation. Draining fistulas cause the loss of nutrient-rich fluids and electrolytes through abnormal tracts. Potassiumis the primary intracellular cation, and its depletion can lead to fatal myocardial irritabilityand paralysis of the respiratory muscles, requiring emergent pharmacological replacement and monitoring.

Rationale:

A.A white blood cell count of 8200/mm3 is within the normal reference range of 5000 to 10000/mm3. While patients with fistulas are at risk for infection, this specific value does not indicate an acute inflammatory process or sepsis. Therefore, this data point is stable and does not necessitate an immediate or emergent nursing intervention.

B.Eating only 20% of a meal is concerning for a patient with a chronic inflammatory condition, but it is not an acute emergency. Poor oral intake is common in Crohn disease due to abdominal pain and anorexia. While nutritional support is necessary, it is a long-term management goal rather than an immediate life-saving priority.

C.A weight decrease of 3 lb is significant and indicates a negative fluid or nutritional balance. In a patient with a draining fistula, this weight loss likely reflects fluid loss or malabsorption. However, compared to the immediate risk of cardiac arrest from electrolyte imbalance, weight changes are addressed over a longer clinical timeframe.

D.A serum potassium of 2.6 mEq/L requires immediate intervention because it represents severe hypokalemia. The normal range is 3.5 to 5.0 mEq/L; levels below 2.5 to 3.0 mEq/L are associated with life-threatening ventricular dysrhythmias and cardiac arrest. The nurse must notify the provider immediately to begin intravenous potassium replacement under continuous cardiac monitoring.

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A nurse assesses a patient who has celiac disease. Which signs and symptoms would the nurse expect? Select all that apply

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is teaching a client with irritable bowel syndrome (IBS) who has frequent constipation. Which statement by the client shows an accurate understanding of the nurse's teaching?

Correct Answer is D

Explanation

A nurse reviews the electronic health record of a client who has Crohn disease and a draining fistula. What data requires immediate intervention?

Correct Answer is D

Explanation

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