Question

While obtaining a nursing history from a client with inflammatory bowel disease, the nurse recognizes that the client most likely has ulcerative colitis rather than Crohn's disease when the client reports experiencing:

Answer 1

Correct Answers:

bloody diarrhea 15-20 times per day.

Rationale :

🔹Ulcerative colitis (UC) primarily affects the colon and rectum, leading to continuous mucosal inflammation.

🔹A hallmark symptom is frequent bloody diarrhea, often up to 15–20 stools per day, accompanied by urgency and tenesmus.

🔹This differs from Crohn’s disease, which can affect any part of the GI tract and often presents with patchy inflammation, abdominal cramping, and weight loss but less frequent bloody stools.

🔹The intense rectal bleeding in UC is due to superficial ulcerations of the colonic mucosa, making bloody diarrhea a distinguishing feature.

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Answer 2

Correct Answers:

Join a support group
Keep a food diary

Rationale :

🔹Join a support group:

Behavioral and social support are essential for long-term adherence to weight loss efforts.
A support group provides accountability, motivation, and shared strategies, which have been shown to increase weight loss success and maintenance.

🔹Keep a food diary:

Self-monitoring, such as keeping a food diary, increases awareness of eating habits and helps identify caloric intake patterns and emotional triggers.
It supports goal setting and reflection, both critical for sustained behavior change.

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Answer 3

Correct Answers:

Bowel sounds change from normoactive to absent

Rationale :

A sudden change from normoactive to absent bowel sounds in a client with diverticulitis indicates intestinal paralysis or potential perforation, which is a surgical emergency.
This finding suggests that the inflammation may have progressed to peritonitis or ileus, both of which compromise bowel motility and can quickly escalate to sepsis or shock.
Unlike mild fever or localized pain, an absence of bowel sounds signifies that peristalsis has ceased, often due to serious intra-abdominal pathology.
Immediate provider notification is required to facilitate further imaging, surgical consult, and possible emergent intervention.

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Answer 4

Correct Answers:

3

Rationale :

🔹McBurney's point, the classic site of tenderness in acute appendicitis, is located in the right lower quadrant, about one-third the distance from the anterior superior iliac spine to the umbilicus.

🔹Point 3 on the illustration corresponds anatomically with this region.

🔹Tenderness at McBurney’s point is due to irritation of the peritoneum overlying the inflamed appendix and is used clinically as a diagnostic indicator.

🔹Localization of this pain helps differentiate appendicitis from other causes of abdominal discomfort and supports further imaging or surgical consultation.

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Answer 5

Correct Answers:

take the antibiotic for the full 7 days, even if symptoms improve in a few days

Rationale :

Completing the entire 7-day course of antibiotics is essential in treating a urinary tract infection (UTI) caused by E. coli to ensure complete bacterial eradication and to prevent resistance development.
Even if symptoms improve early, residual bacteria may persist and multiply if the full course is not completed, leading to recurrence or a more severe infection.
Trimethoprim-sulfamethoxazole is effective against most E. coli strains, but adherence to the full treatment schedule is necessary to maintain its effectiveness.
This is a cornerstone of antimicrobial stewardship.👍

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Answer 6

Correct Answers:

"Have you made an appointment for your annual colonoscopy?"

Rationale :

🔹Clients with ulcerative colitis (UC) for over 8–10 years are at an increased risk of developing colorectal cancer, especially if the disease involves extensive colonic segments.

🔹As a result, annual or biennial colonoscopy with biopsies is recommended to detect dysplasia or early malignancy.

🔹Surveillance colonoscopy is a key part of long-term UC management and is vital for early intervention and cancer prevention.

🔹While medication adherence and stress management are important, the greatest long-term risk is neoplastic transformation, making cancer screening the priority discussion point at this stage.

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Answer 7

Correct Answers:

Loops of large bowel become visibly outlined through the abdominal wall

Rationale :

In late-stage large bowel obstruction, gas and fluid accumulate behind the obstruction, causing significant distention.
This pressure leads to stretching of the bowel loops, which can become so pronounced that they are visible externally through the abdominal wall.
This indicates a severe and advanced obstruction, with increased risk of perforation, ischemia, or peritonitis.
This physical sign warrants urgent evaluation and intervention, typically involving imaging, decompression, and surgical consultation.
It reflects a transition from a manageable obstruction to a potentially life-threatening emergency.

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Answer 8

Correct Answers:

Sit the client up and provide supplemental oxygen

Rationale :

Following bariatric surgery, new-onset chest pain and shortness of breath must be treated as a possible pulmonary embolism (PE) or atelectasis, both of which can compromise gas exchange.
The priority intervention is to elevate the head of the bed and administer oxygen, which immediately supports ventilation and oxygenation.
These actions improve lung expansion, reduce the work of breathing, and buy time for further diagnostic steps such as ABG, imaging, or physician evaluation.
Delay in supportive measures while waiting for diagnostic tests can result in rapid clinical deterioration.

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Answer 9

Correct Answers:

Large amounts of IV saline solution

Rationale :

In hyperglycemic hyperosmolar nonketotic coma (HHNK), the most urgent concern is severe dehydration, resulting from osmotic diuresis caused by extremely elevated glucose levels.
This condition leads to intravascular volume depletion, impaired tissue perfusion, and altered mental status.
The first-line treatment is aggressive IV fluid replacement with isotonic saline to restore volume and stabilize blood pressure and perfusion.
Once fluid status improves, insulin therapy is initiated carefully to avoid rapid shifts in serum osmolality.
Fluids are always prioritized over insulin in the acute phase of HHNK to correct hypovolemia and support renal function.👍

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Answer 10

Correct Answers:

Provide all of the client's nutritional needs in a hypertonic solution

Rationale :

Total parenteral nutrition (TPN) is a method of providing complete nutritional support via a central venous catheter in clients who cannot use their GI tract due to surgery, obstruction, or malabsorption.
TPN solutions are hypertonic and contain essential nutrients, including carbohydrates, amino acids, fats, electrolytes, vitamins, and trace elements, in concentrations that meet the full daily requirements.
TPN bypasses the digestive system entirely and supports anabolism, tissue healing, and immune function, especially in severely ill or post-operative clients.
It requires close monitoring of glucose, electrolytes, and fluid balance due to the risk of complications such as hyperglycemia, infection, and electrolyte imbalances.

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RN Medsurg~200 Exam

No.

1 : While obtaining a nursing history from a client with inflammatory bowel disease, the nurse recognizes that the client most likely has ulcerative colitis rather than Crohn's disease when the client reports experiencing:

2 : The nurse is teaching the client about successful strategies for weight loss. Which would the nurse include? (SELECT ALL THAT APPLY)

3 : The nurse assesses a client admitted four hours ago with a diagnosis of diverticulitis. Which clinical manifestation must be reported immediately to the physician?

4 : The client has a possible diagnosis of appendicitis. On physical examination, the nurse should assess for tenderness on palpation at McBurney's point, located at which pictured site?

5 : Trimethoprim and sulfamethoxazole BID for 7 days is prescribed for a client who has a UTI caused by E.coli. The nurse instructs the client to:

6 : The client has lived with ulcerative colitis for close to 15 years and has learned to manage it very well. At this point in time, the nurse's discussion with the client about this disease should have a primary focus on which question?

7 : The nurse is assessing a client who has a large bowel obstruction. Which late clinical finding would the nurse expect?

8 : The nurse is assessing a client after bariatric surgery. The client complains of chest pain and shortness of breath. What is the priority nursing intervention at this time?

9 : A client with Type 2 diabetes is brought into the emergency room in an unresponsive state. A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNK) is made. The nurse prepares for the administration of which initial therapy?

10 : The nurse is caring for a client receiving total parenteral nutrition (TPN). The nurse understands that the best explanation for utilizing TPN is to:

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