Lewis Med-Surg, Chapter 47: Advanced Gastrointestinal, Hematologic,
and Surgical Nursing Assessment: Evidence-Based Management,
Pathophysiology, Diagnostics, Pharmacology, Patient Safety, Infection
Control, Nutrition, Fluid-Electrolyte Balance, Ostomy Care, Inflammatory
Bowel Disease, Ulcerative Colitis, Crohn’s Disease, Celiac Disease, Short
Bowel Syndrome, Clostridium difficile, Colorectal Cancer Screening,
Postoperative Care, Ileostomy Management, Perianal Skin Integrity,
Megaloblastic Anemia, Iron Deficiency, Hematopoietic Support,
Neutropenia, Transfusion Reactions, Thrombocytopenia, Polycythemia
Vera, Sickle Cell Crisis, Immunosuppressive Therapy, Patient Education, and
Critical Decision-Making Skills Exam Questions Verified and Provided with
Complete A+ Graded Rationales Latest Updated 2026
Which action will the nurse include in the plan of care for a patient who is being admitted with
Clostridium difficile?
a. Teach the patient about proper food storage.
b. Order a diet without dairy products for the patient.
c. Place the patient in a private room on contact isolation.
d. Teach the patient about why antibiotics will not be used.
ANS: C
Because C. difficile is highly contagious, the patient should be placed in a private room, and contact
precautions should be used. There is no need to restrict dairy products for this type of diarrhea.
Metronidazole (Flagyl) is frequently used to treat C. difficile infections. Improper food handling and
storage do not cause C. difficile.
,A patient complains of gas pains and abdominal distention 2 days after a small bowel resection. Which
nursing action should the nurse take?
a. Encourage the patient to ambulate.
b. Instill a mineral oil retention enema.
c. Administer the prescribed IV morphine sulfate.
d. Offer the prescribed promethazine (Phenergan).
ANS: A
Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral
oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to
relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine is used as an
antiemetic rather than to decrease gas pains or distention.
A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain
and passing 15 or more bloody stools a day. The nurse will plan to
a. administer IV metoclopramide (Reglan).
b. discontinue the patient's oral food intake.
c. administer cobalamin (vitamin B12) injections.
d. teach the patient about total colectomy surgery.
ANS: B
, An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by
making the patient NPO. Metoclopramide increases peristalsis and will worsen symptoms. Cobalamin
(vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. Although total
colectomy is needed for some patients, there is no indication that this patient is a candidate.
Which nursing action will the nurse include in the plan of care for a 35-yr-old male patient admitted with
an exacerbation of inflammatory bowel disease (IBD)?
a. Restrict oral fluid intake.
b. Monitor stools for blood.
c. Ambulate six times daily.
d. Increase dietary fiber intake.
ANS: B
Because anemia or hemorrhage may occur with IBD, stools should be assessed for the presence of
blood. The other actions would not be appropriate for the patient with IBD. Dietary fiber may increase
gastrointestinal motility and exacerbate the diarrhea, severe fatigue is common with IBD exacerbations,
and dehydration may occur.
Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine) for
ulcerative colitis has been effective?
a. "The medication will be tapered if I need surgery."
b. "I will need to use a sunscreen when I am outdoors."
c. "I will need to avoid contact with people who are sick."
and Surgical Nursing Assessment: Evidence-Based Management,
Pathophysiology, Diagnostics, Pharmacology, Patient Safety, Infection
Control, Nutrition, Fluid-Electrolyte Balance, Ostomy Care, Inflammatory
Bowel Disease, Ulcerative Colitis, Crohn’s Disease, Celiac Disease, Short
Bowel Syndrome, Clostridium difficile, Colorectal Cancer Screening,
Postoperative Care, Ileostomy Management, Perianal Skin Integrity,
Megaloblastic Anemia, Iron Deficiency, Hematopoietic Support,
Neutropenia, Transfusion Reactions, Thrombocytopenia, Polycythemia
Vera, Sickle Cell Crisis, Immunosuppressive Therapy, Patient Education, and
Critical Decision-Making Skills Exam Questions Verified and Provided with
Complete A+ Graded Rationales Latest Updated 2026
Which action will the nurse include in the plan of care for a patient who is being admitted with
Clostridium difficile?
a. Teach the patient about proper food storage.
b. Order a diet without dairy products for the patient.
c. Place the patient in a private room on contact isolation.
d. Teach the patient about why antibiotics will not be used.
ANS: C
Because C. difficile is highly contagious, the patient should be placed in a private room, and contact
precautions should be used. There is no need to restrict dairy products for this type of diarrhea.
Metronidazole (Flagyl) is frequently used to treat C. difficile infections. Improper food handling and
storage do not cause C. difficile.
,A patient complains of gas pains and abdominal distention 2 days after a small bowel resection. Which
nursing action should the nurse take?
a. Encourage the patient to ambulate.
b. Instill a mineral oil retention enema.
c. Administer the prescribed IV morphine sulfate.
d. Offer the prescribed promethazine (Phenergan).
ANS: A
Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral
oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to
relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine is used as an
antiemetic rather than to decrease gas pains or distention.
A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain
and passing 15 or more bloody stools a day. The nurse will plan to
a. administer IV metoclopramide (Reglan).
b. discontinue the patient's oral food intake.
c. administer cobalamin (vitamin B12) injections.
d. teach the patient about total colectomy surgery.
ANS: B
, An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by
making the patient NPO. Metoclopramide increases peristalsis and will worsen symptoms. Cobalamin
(vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. Although total
colectomy is needed for some patients, there is no indication that this patient is a candidate.
Which nursing action will the nurse include in the plan of care for a 35-yr-old male patient admitted with
an exacerbation of inflammatory bowel disease (IBD)?
a. Restrict oral fluid intake.
b. Monitor stools for blood.
c. Ambulate six times daily.
d. Increase dietary fiber intake.
ANS: B
Because anemia or hemorrhage may occur with IBD, stools should be assessed for the presence of
blood. The other actions would not be appropriate for the patient with IBD. Dietary fiber may increase
gastrointestinal motility and exacerbate the diarrhea, severe fatigue is common with IBD exacerbations,
and dehydration may occur.
Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine) for
ulcerative colitis has been effective?
a. "The medication will be tapered if I need surgery."
b. "I will need to use a sunscreen when I am outdoors."
c. "I will need to avoid contact with people who are sick."
