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 C

Explanation

A) "5% Dextrose in water (D5W)":
. D5W is an isotonic solution that, once metabolized by the body, becomes hypotonic because the glucose is rapidly utilized, leaving water. It is typically used to provide free water for hydration or for patients who need a small amount of calories or fluid, but it is not the best choice for this client. The client's low blood pressure and symptoms of dehydration (nausea, vomiting, dizziness, and weakness) suggest that normal saline (0.9% sodium chloride) is the more appropriate choice to help restore circulatory volume and improve blood pressure.

B) "10% Dextrose in water (D10W)":
. D10W is a hypertonic solution with a higher concentration of glucose, used in specific situations such as severe hypoglycemia or for patients requiring a high amount of glucose. It is not appropriate for this patient, whose primary issue seems to be volume depletion due to nausea and vomiting. The focus should be on replenishing circulatory volume and addressing the hypotension, which normal saline (0.9% sodium chloride) would do more effectively than D10W.

C) "0.9% Sodium Chloride":
. 0.9% Sodium Chloride (normal saline) is an isotonic solution and is the most appropriate choice for fluid resuscitation in a client with low blood pressure (hypotension) and signs of dehydration (nausea, vomiting, dizziness). This solution will help restore circulatory volume, correct hypovolemia, and improve blood pressure. It is commonly used for initial fluid resuscitation in clients who are hypotensive and experiencing fluid loss due to vomiting.

D) "0.45% Sodium Chloride (half-normal saline)":
. 0.45% Sodium Chloride is a hypotonic solution, which is more appropriate for treating patients who have conditions like hypernatremia or require gradual hydration. However, in this case, the patient is presenting with hypotension, dizziness, and weakness, which are signs of fluid depletion. A hypotonic solution would not be appropriate in this context, as it could potentially worsen the patient's hypotension or lead to further fluid shifts. The focus should be on using normal saline (0.9% sodium chloride) to help restore circulatory volume and improve the low blood pressure.

A. Intramuscular epinephrine B. Intravenous corticosteroids C. High volume IV fluids D. PO diphenhydramine

Correct Answer is C

Explanation

A. Intramuscular epinephrine:
Intramuscular epinephrine is typically used in cases of anaphylactic reactions, which present with symptoms such as difficulty breathing, swelling, hives, and hypotension. Flank and lower back pain are not typical signs of an anaphylactic reaction during a blood transfusion. Instead, flank pain may suggest a hemolytic reaction, which involves the destruction of red blood cells, not an allergic or anaphylactic response. Thus, epinephrine would not be the first-line treatment for this situation.

B. Intravenous corticosteroids:
Intravenous corticosteroids are often used for inflammatory reactions, such as in cases of autoimmune diseases or severe allergic reactions. While corticosteroids might be used for certain types of transfusion reactions, they are not the primary treatment for hemolytic reactions (which could cause flank and lower back pain). The primary goal in a transfusion reaction with flank pain is to manage potential hemolysis and prevent kidney damage, which would be addressed through hydration and other supportive measures.

C. High volume IV fluids:
High-volume IV fluids are the most appropriate immediate intervention for a client who is experiencing flank and lower back pain during a blood transfusion, which are signs of a potential hemolytic reaction. Hemolysis, or the breakdown of red blood cells, can lead to kidney injury, so increasing fluid volume helps flush the kidneys, promote diuresis, and reduce the risk of kidney damage. The fluids also help to dilute any hemoglobin that is released into the bloodstream, supporting the kidneys' ability to filter it out. This is the priority intervention in this scenario.

D. PO diphenhydramine:
Oral diphenhydramine is used for allergic reactions, such as mild reactions involving itching, rashes, or hives, but it is not appropriate for managing more severe transfusion reactions, such as hemolytic reactions, that cause flank and lower back pain. Diphenhydramine would not address the underlying issue of potential hemolysis and kidney injury. Therefore, it is not the correct intervention for this situation.

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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?

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Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

A client is receiving a blood transfusion, The nurse observes that the client is experiencing flank and lower back pain. Which of the following orders does the nurse anticipate receiving?

Correct Answer is C

Explanation

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