Question 1
A 35-year-old client with a 5-year history of ulcerative colitis reports increased diarrhea, bloody stools, and abdominal pain. The nurse knows that these symptoms indicate a possible exacerbation of their condition. Which of the following actions should the nurse take first?
A. Administer an anti-diarrheal medication.
B. Encourage the client to increase fluid intake.
C. Assess the client’s abdomen and vital signs.
D. Prepare the client for a colonoscopy.
E. Instruct the client to follow a low-residue diet.
Rationale: Initial assessment of the abdomen and vital signs is crucial in determining the severity of the exacerbation and for planning subsequent interventions. Vital signs can indicate systemic effects of the disease, such as fever or tachycardia from dehydration or anemia from bloody stools. Abdominal assessment provides information on distension, pain, and bowel sounds, which are essential for evaluating the disease’s impact and guiding further treatment. This prioritization follows the nursing process and ensures a systematic approach to care.
Question 2
A nurse is providing dietary teaching for a client with ulcerative colitis. Which of the following foods should the nurse recommend as part of a diet during remission?
A. Whole wheat bread
B. Popcorn
C. Fresh fruits and vegetables
D. Spicy foods
E. Oatmeal
Rationale: During remission, it is important for clients with ulcerative colitis to consume foods that are high in nutrients, easy to digest, and low in fiber to avoid triggering a flare-up. Oatmeal is an excellent choice because it is soothing to the digestive tract, provides energy, and is less likely to cause irritation compared to high-fiber options like whole wheat bread or popcorn, and spicy foods which can exacerbate symptoms. Fresh fruits and vegetables are healthy but might need to be limited if they are high in fiber or if the client has difficulty digesting them.
Question 3
The healthcare team is discussing the treatment plan for a client with moderate to severe ulcerative colitis who has not responded to standard treatments. Which of the following medications is most appropriate to recommend next?
A. Antibiotics
B. Antidiarrheal agents
C. Corticosteroids
D. Aminosalicylates
E. Immunomodulators
Rationale: For clients with moderate to severe ulcerative colitis who do not respond to standard treatments such as aminosalicylates, corticosteroids, or antidiarrheal agents, immunomodulators are considered an appropriate next step. These medications help reduce inflammation by altering the immune system’s response. Unlike antibiotics, which are typically used for infections, or antidiarrheals, which manage symptoms but don’t treat the underlying inflammation, immunomodulators target the disease process at a systemic level, potentially inducing and maintaining remission.
Question 4
A client with ulcerative colitis is scheduled to undergo a colonoscopy. The nurse should include which of the following instructions in the client’s pre-procedure teaching?
A. “Eat a normal diet up to the evening before the procedure.”
B. “You may have a light breakfast the day of your procedure.”
C. “You will need to follow a clear liquid diet the day before your procedure.”
D. “You can drink coffee and tea the morning of your procedure.”
E. “There are no dietary restrictions before the procedure.”
Rationale: A clear liquid diet the day before a colonoscopy is essential to ensure that the colon is free of solid food, which allows for a clear view during the examination. This diet includes broths, clear juices, and water, but excludes solid foods and substances that can’t be seen through, like milk or orange juice with pulp. This preparation is critical for a successful procedure, as it enables the healthcare provider to thoroughly examine the colon for signs of ulcerative colitis, polyps, or other abnormalities.
Question 5
A nurse is caring for a client who was recently diagnosed with ulcerative colitis. The client expresses concern about the impact of the disease on their lifestyle. Which of the following is an appropriate response by the nurse?
A. “You will need to make significant lifestyle changes to manage your condition effectively.”
B. “Most people with ulcerative colitis lead active, normal lives with proper treatment and diet.”
C. “It’s unlikely that you’ll be able to travel or participate in strenuous activities.”
D. “You should plan for frequent hospital admissions due to flare-ups.”
E. “Avoid social activities to reduce your stress levels.”
Rationale: Educating the client about the chronic nature of ulcerative colitis is important, but it’s also vital to provide hope and positive reinforcement. This response reassures the client that, with appropriate medical management and lifestyle modifications, they can maintain a high quality of life. It encourages adherence to treatment plans and dietary recommendations while dispelling fears that the condition will severely limit their daily activities or social interactions. Encouraging a positive outlook is crucial for the client’s mental and emotional well-being.
Question 6
During an education session for a client with ulcerative colitis, the nurse discusses the importance of monitoring for signs of complications. Which of the following signs or symptoms should the nurse emphasize as indicating a potential complication that requires immediate medical attention?
A. Occasional diarrhea
B. Increased appetite
C. Sudden weight gain
D. Fever and persistent vomiting
E. Mild abdominal discomfort
Rationale: Fever and persistent vomiting in a client with ulcerative colitis may indicate serious complications, such as a severe flare, infection, or even toxic megacolon, which is a medical emergency. These symptoms suggest systemic involvement beyond the typical localized symptoms of ulcerative colitis and warrant immediate evaluation to prevent further complications. Educating clients to recognize and respond quickly to such symptoms is a critical component of comprehensive care, aiming to minimize complications and optimize outcomes.
Question 7
A client with ulcerative colitis is experiencing a severe flare-up. Which of the following nursing interventions is most appropriate to include in the client’s care plan?
A. Increase the client’s dietary fiber intake immediately.
B. Encourage the client to engage in vigorous exercise.
C. Administer prescribed corticosteroids.
D. Recommend over-the-counter NSAIDs for pain.
E. Instruct the client to discontinue their immunosuppressant medications.
Rationale: In the case of a severe flare-up of ulcerative colitis, corticosteroids are often prescribed to quickly reduce inflammation and symptoms. Corticosteroids are effective in inducing remission in moderate to severe cases when other treatments might not be sufficient. Increasing dietary fiber, while generally healthy, can worsen symptoms during a flare-up. Vigorous exercise may not be appropriate during severe flare-ups due to the risk of exacerbating symptoms. NSAIDs should be avoided as they can increase gastrointestinal irritation, and discontinuing immunosuppressants without medical advice could lead to worsening of the disease.
Question 8
The nurse is preparing to administer a biologic therapy to a client with ulcerative colitis. Which of the following actions is most important for the nurse to take before administering the medication?
A. Ensure the client has not eaten for at least 6 hours.
B. Confirm the client’s allergy status.
C. Check the client’s blood pressure and heart rate.
D. Instruct the client to drink plenty of fluids post-administration.
E. Advise the client to avoid live vaccines.
Rationale: Before administering biologic therapy, it is crucial to confirm the client’s allergy status to prevent possible severe allergic reactions. Biologic therapies can cause allergic reactions in some individuals, and knowing the client’s allergy history helps to minimize the risk of an adverse event. This step is part of safe medication administration practices and prioritizes the client’s safety by ensuring that the treatment does not cause harm. Blood pressure and heart rate monitoring, hydration, and vaccination status are important but secondary to assessing allergy risk in this context.
Question 9
A client with a history of ulcerative colitis presents to the emergency department with abdominal pain and distension. The nurse suspects toxic megacolon. Which of the following assessments should the nurse prioritize? A. Checking for rebound tenderness
B. Measuring the circumference of the abdomen
C. Assessing the client’s bowel sounds
D. Obtaining a stool sample
E. Monitoring for signs of peritonitis
Rationale: In the context of suspected toxic megacolon, monitoring for signs of peritonitis is critical because it indicates a possible perforation of the colon, a life-threatening complication. Signs of peritonitis include severe abdominal pain, fever, and a rigid, board-like abdomen. While assessing bowel sounds, checking for rebound tenderness, measuring abdominal circumference, and obtaining a stool sample are important in the overall assessment, recognizing signs of peritonitis is paramount for timely intervention to prevent further complications such as sepsis and shock.
Question 10
A 22-year-old client with ulcerative colitis is being educated on self-management techniques for stress reduction, as stress can exacerbate symptoms. Which of the following strategies should the nurse include in the education plan?
A. Engaging in high-intensity interval training
B. Starting a strict ketogenic diet
C. Practicing mindfulness and meditation
D. Increasing caffeine intake to improve alertness
E. Isolating from social activities to reduce stressors
Rationale: Mindfulness and meditation are effective stress-reduction techniques that can help manage the psychological and emotional stressors that may exacerbate ulcerative colitis symptoms. These practices can improve the client’s ability to relax, reduce stress levels, and potentially lead to a decrease in flare-ups or symptom severity. High-intensity exercise may not be suitable for all clients, especially during flare-ups, and caffeine can stimulate the gut and worsen symptoms. A ketogenic diet and social isolation do not directly contribute to stress reduction in the context of ulcerative colitis and might actually have adverse effects on the client’s overall well-being and disease management.