The nurse is caring for a client with an exacerbation of inflammatory bowel disease: Which of the following orders would be anticipated for this patient?

NG tube placement

Low calorie and low protein diet

Stool softeners and laxatives

Barium contrast imaging studies

Answer and Explanation

The Correct Answer is A

A. NG tube placement:
In patients with an exacerbation of inflammatory bowel disease (IBD), particularly in cases of severe flare-ups, the gastrointestinal tract may need rest, and the patient may have difficulty maintaining adequate nutrition. An NG (nasogastric) tube may be used for enteral feeding if the patient is unable to tolerate oral intake, or to provide bowel rest if indicated. Nutritional support via an NG tube can help provide essential nutrients and manage symptoms during an exacerbation, especially if the patient is experiencing severe nausea, vomiting, or malabsorption.

B. Low calorie and low protein diet:
During an IBD flare, the patient typically needs a higher-calorie, higher-protein diet to support healing and immune function. A low-calorie, low-protein diet would not be appropriate, as it would not provide the necessary nutrients for recovery and tissue repair. In fact, nutritional support is often one of the key components in managing IBD exacerbations. A diet rich in calories and protein is often recommended to prevent malnutrition.

C. Stool softeners and laxatives:
Stool softeners and laxatives are generally contraindicated during an IBD flare, as they can exacerbate diarrhea and increase bowel motility, which may worsen symptoms such as abdominal pain, cramping, and diarrhea. The focus during an exacerbation of IBD is typically on controlling inflammation, rest, and reducing bowel irritation, rather than promoting bowel movements.

D. Barium contrast imaging studies:
Barium contrast imaging studies are generally not performed during an acute exacerbation of IBD because they can cause further irritation to the inflamed bowel. Imaging studies are typically used for diagnosis and assessment of disease extent in a stable or chronic phase, rather than during an acute flare. The priority during a flare is managing symptoms and controlling inflammation, not conducting procedures that could aggravate the condition.

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Correct Answer is B

Explanation

A. Impaired perineal skin integrity:
While impaired perineal skin integrity is a concern for clients with severe diarrhea, it is not the priority risk in this case. Diarrhea can lead to irritation and breakdown of the skin, especially in the perineal area, but this can generally be managed with proper skin care and barrier creams. While important, this is not the most critical issue at the moment.

B. Fluid and electrolyte imbalances:
The priority risk for a client with an acute exacerbation of Crohn's disease and severe diarrhea is fluid and electrolyte imbalances. Diarrhea causes significant fluid loss, which can lead to dehydration and imbalances in electrolytes such as sodium, potassium, and chloride. These imbalances can result in life-threatening complications like hypovolemic shock, arrhythmias, and kidney failure. Therefore, ensuring adequate fluid and electrolyte replacement is the top priority in this situation.

C. Pain related to abdominal cramping:
While pain due to abdominal cramping is common in Crohn's disease, it is not the most immediate risk in this scenario. Pain management is important for comfort, but the risk of dehydration, electrolyte imbalances, and potential shock due to fluid loss takes precedence. Pain relief can be addressed after managing the more critical issues.

D. Protein-calorie malnutrition:
Protein-calorie malnutrition is a concern for patients with Crohn's disease, especially with chronic disease or malabsorption. However, in the context of an acute exacerbation with severe diarrhea, the immediate concern is fluid and electrolyte imbalance. Nutritional concerns, including malnutrition, are important for long-term management, but the priority in this acute phase is stabilizing the client’s fluid status to prevent further complications.

A. Having 2 RNs ensure the blood product is properly labeled and matches the client’s identification B. Ensuring that the client signed a consent form for receiving blood transfusions beforehand C. Preparing a primary and secondary IV tubing D. Obtaining a bag of 0.9% sodium chloride

Correct Answer is C

Explanation

A) Having 2 RNs ensure the blood product is properly labeled and matches the client’s identification:
Two registered nurses must independently verify that the blood product matches the patient's identification and that it is properly labeled. This is a critical safety measure to prevent errors, such as mismatched blood transfusions, which can lead to severe complications like hemolytic reactions. Proper verification before administration is a standard safety protocol in blood transfusion procedures.

B) Ensuring that the client signed a consent form for receiving blood transfusions beforehand:
Obtaining informed consent is a vital legal and ethical step before administering a blood transfusion. The nurse must ensure that the patient understands the potential risks and benefits of the procedure and has signed a consent form prior to transfusion. Without consent, the transfusion cannot legally be performed. This is a key part of patient rights and nursing responsibilities.

C) Preparing a primary and secondary IV tubing:
For blood transfusions, only blood administration tubing should be used, which typically includes a filter to prevent the infusion of any debris or clots. Using regular IV tubing (primary and secondary) for blood administration is not recommended, as it may not have the necessary filter and could potentially introduce contaminants. Blood should always be administered with tubing specifically designed for that purpose.

D) Obtaining a bag of 0.9% sodium chloride:
Normal saline is typically used as the solution to flush the IV line before and after the transfusion. It is compatible with blood products and helps to prevent clotting or reactions in the line. This is an essential step to ensure safe and effective blood administration.

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The nurse is caring for a client with an exacerbation of inflammatory bowel disease: Which of the following orders would be anticipated for this patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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