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Lewis: Medical-Surgical Nursing, 9 Edition

chapter 43 questions

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184 views

Lewis: Medical-Surgical Nursing, 9 Edition

chapter 43 questions

Uploaded by

SL
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Lewis: Medical-Surgical Nursing, 9th Edition

Chapter 43

Rationales for Bridge to NCLEX® Examination questions

1. Correct answer: a
Rationale: Acute diarrhea resulting from infectious causes (e.g., virus) is usually self-limiting.
The major concerns are transmission prevention, fluid and electrolyte replacement, and
resolution of the diarrhea. Antidiarrheal agents are contraindicated in the treatment of infectious
diarrhea because they potentially prolong exposure to the infectious organism. Antibiotics are
rarely used to treat acute diarrhea. To prevent transmission of diarrhea caused by a virus, hands
should be washed before and after contact with the patient and when body fluids of any kind are
handled. Vomitus and stool should be flushed down the toilet, and contaminated clothing should
be washed immediately with soap and hot water.

2. Correct answers: a, b, c, d, e
Rationale: All these conditions could cause acute abdominal pain.

3. Correct answer: a
Rationale: With peritoneal irritation, the abdomen is hard, like a board, and the patient has
severe abdominal pain that is worse with any sudden movement. The patient lies very still.
Palpating the abdomen and releasing the hands suddenly causes sudden movement within the
abdomen and severe pain. This is called rebound tenderness.

4. Correct answer: c
Rationale: Ulcerative colitis affects only the colon and rectum; it can cause megacolon and
rectal bleeding, but not nutrient malabsorption. Surgical removal of the colon and rectum cures
it. Crohn’s disease usually involves the ileum, where bile salts and vitamin cobalamin are
absorbed. After surgical treatment, disease recurrence at the site is common.

5. Correct answers: a, b
Rationale: With lower intestinal obstructions, abdominal distention is markedly increased and
pain is persistent. Onset of a large intestine obstruction is gradual, vomiting is rare, and there is
usually absolute constipation, not diarrhea.

6. Correct answer: c
Rationale: Stage 1 colorectal cancer is treated with surgical removal of the tumor and
reanastomosis, and so there is no ostomy. Chemotherapy is not recommended for stage I tumors.
Follow-up colonoscopy is recommended because colorectal cancer can recur.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.


Rationales for Bridge to NCLEX® Examination questions 2

7. Correct answer: a
Rationale: The more distal the ostomy is, the more the intestinal contents resemble feces
eliminated from an intact colon and rectum. Output from a sigmoid colostomy resembles
normally formed stool, and some patients are able to regulate emptying time so they do not need
to wear a collection bag.

8. Correct answer: b
Rationale: Many people with diverticulosis have no symptoms. Patients with diverticulitis have
symptoms of inflammation. Diverticulitis can lead to obstruction or perforation.

9. Correct answer: d
Rationale: Scrotal edema is a painful complication after an inguinal hernia repair. Scrotal
support with application of an ice bag may help relieve pain and edema.

10. Correct answer: a


Rationale: Celiac disease is treated with lifelong avoidance of dietary gluten. Wheat, barley,
oats, and rye products must be avoided. Although pure oats do not contain gluten, oat products
can become contaminated with wheat, rye, and barley during the milling process. Gluten is also
found in some medications and in many food additives, preservatives, and stabilizers.

11. Correct answer: d


Rationale: After a hemorrhoidectomy, the patient usually dreads the first bowel movement and
often resists the urge to defecate. Pain medication may be given before the bowel movement to
reduce discomfort. The patient should avoid constipation and straining. A high-fiber diet can
reduce constipation. A stool softener such as docusate (Colace) is usually ordered for the first
few postoperative days. If the patient does not have a bowel movement within 2 to 3 days, an oil-
retention enema is administered.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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