Which autoantigens are responsible for the development of Crohn disease?
1. Crypt epithelial cells
2. Thyroid cell surface
3. Basement membranes of the lungs
4. Basement membranes of the glomeruli - Answers1. Crypt epithelial cells
Rationale:
Crypt epithelial cells are considered the autoantigens responsible for Crohn disease. Thyroid
cell surfaces are autoantigens responsible for Hashimoto thyroiditis. The pulmonary and
glomerular basement membranes act as autoantigens responsible for Goodpasture syndrome.
Parenteral vitamins are prescribed for the client with Crohn disease. The client asks why the
vitamins have to be given intravenously (IV) rather than by mouth. Which rationales will the
nurse provide? Select all that apply. One, some, or all responses may be correct.
1. "They provide more rapid action results."
2. "They decrease colon irritability."
3. "Oral vitamins are less effective."
4. "Intestinal absorption may be inadequate."
,5. "Allergic responses are less likely to occur." - AnswersANS: 1, 3, 4
Rationale:
Absorption through the gastrointestinal (GI) tract is impaired, and parenteral administration
goes directly into the intravascular compartment. Disease of the GI tract hampers absorption.
Because the mucosa of the intestinal tract is damaged, its ability to absorb vitamins taken orally
is greatly impaired. IV vitamins do not decrease colonic irritability. Route of administration does
not affect allergic response.
While awaiting surgery, a client with a history of Crohn disease is receiving total parenteral
nutrition (TPN) on an outpatient basis. The nurse teaches the client that TPN helps prepare for
surgery by which process?
1. Decreasing fecal bulk
2. Preventing bowel infection
3. Providing stimulation of secretions
4. Maintaining negative nitrogen balance - Answers1. Decreasing fecal bulk
Rationale:
By decreasing fecal bulk and bowel stimulation, TPN provides rest for the bowel while the client
awaits surgery. TPN does not prevent a bowel infection. TPN does not stimulate
gastrointestinal secretions. TPN promotes positive nitrogen balance.
A client is admitted to the hospital with a diagnosis of Crohn disease. Which is important for the
nurse to include in the teaching plan for the client?
1. Controlling constipation
,2. Meeting nutritional needs
3. Preventing increased weakness
4. Anticipating a sexual alteration - Answers2. Meeting nutritional needs
Rationale:
To avoid gastrointestinal pain and diarrhea, these clients often refuse to eat and become
malnourished. The consumption of a high-calorie, high-protein diet is advised. Diarrhea, not
constipation, is a problem with Crohn disease. Preventing an increase in weakness is a
secondary concern that results from malnutrition; correcting the malnutrition will increase
strength. Anticipating a sexual alteration generally is not a problem with Crohn disease.
A client with Crohn disease is admitted to the hospital with a history of chronic, bloody diarrhea,
weight loss, and signs of general malnutrition. The client has anemia, a low serum albumin level,
and signs of negative nitrogen balance. The nurse concludes that the client's health status is
related to which major deficiency?
1. Ferrous sulfate
2. Protein
3. Ascorbic acid
4. Linoleic acid - Answers2. Protein
Rationale:
Protein deficiency causes a low serum albumin level, which permits fluid shifts from the
intravascular to the interstitial compartment, resulting in edema. Decreased protein also causes
anemia; protein intake must be increased. Although a deficiency of ferrous sulfate will result in
, anemia, it will not cause the other adaptations. Ascorbic acid is unrelated to these adaptations.
Linoleic acid is unrelated to these adaptations.
A client with the diagnosis of Crohn disease tells the nurse, "My partner dates other people. I
believe that behavior has caused an increase in my symptoms." Which is an appropriate initial
nursing response?
1. Help the client explore personal attitudes.
2. Educate the partner about the illness and events that affect the client's symptoms.
3. Suggest the client should not date the partner to determine if symptoms change.
4. Schedule the client and the partner for a counseling session. - Answers1. Help the client
explore personal attitudes.
Rationale:
Because emotional stress can influence the progress of Crohn disease, initially the nurse should
help the client explore self-attitudes to aid in better understanding the feelings engendered by
the partner dating others. Initially, the nurse should help the client explore the situation and the
feelings it engenders rather than involve the partner. The client should make the decision about
continuing to date the partner. Scheduling the client and the partner for a counseling session is
premature; the client is not ready for a joint counseling session.
A client with severe Crohn disease develops a small bowel obstruction. Which clinical finding
would the nurse expect the client to report?
1. Bloody vomitus
2. Projectile vomiting