IBD NCLEX 2 — Questions and Answers
Question 1: A client with Crohn's disease develops a fistula between the bowel and bladder. Which symptom should the nurse expect to assess?
- Hematuria with clots
- Pneumaturia (air in urine) (Correct answer)
- Proteinuria >3g/day
- Oliguria with flank pain
Correct answer: Pneumaturia (air in urine)
An enterovesical fistula allows bowel gas and bacteria to enter the bladder, causing pneumaturia and recurrent UTIs.
Question 2: A nurse is reviewing labs for a client with IBD who is on long-term sulfasalazine therapy. Which finding requires the most immediate follow-up?
- Folate level 2.8 ng/mL (low) (Correct answer)
- WBC 11,000/mm³
- Serum creatinine 0.9 mg/dL
- ESR 35 mm/hr
Correct answer: Folate level 2.8 ng/mL (low)
Sulfasalazine inhibits folate absorption; a low folate level requires supplementation to prevent megaloblastic anemia and neural tube defects in pregnancy.
Question 3: A client with ulcerative colitis undergoes a total proctocolectomy with ileostomy. On postoperative day 2, the nurse notes the stoma output is 1,800 mL in 8 hours. The priority nursing action is to:
- Reassure the client this is expected
- Notify the provider and prepare to give IV fluids (Correct answer)
- Encourage oral fluid intake only
- Apply a larger ostomy appliance
Correct answer: Notify the provider and prepare to give IV fluids
High-output ileostomy (>1,200–1,500 mL/day) risks dehydration and electrolyte imbalance; IV replacement and provider notification are the priority.
Question 4: Which dietary modification should the nurse teach a client with Crohn's disease affecting the terminal ileum?
- Increase raw vegetables for fiber
- Take B12 injections or supplements (Correct answer)
- Follow a high-fat diet for caloric needs
- Restrict all dairy to prevent lactase issues
Correct answer: Take B12 injections or supplements
The terminal ileum is the only site that absorbs vitamin B12, so Crohn's disease in that region impairs absorption and supplementation is necessary.
Question 5: A nurse administers infliximab to a client with Crohn's disease. Thirty minutes into the infusion the client reports chest tightness and develops urticaria. The first action is to:
- Slow the infusion rate and reassess
- Stop the infusion and call the provider (Correct answer)
- Administer diphenhydramine and continue
- Document and monitor for 15 more minutes
Correct answer: Stop the infusion and call the provider
Chest tightness and urticaria during a biologic infusion indicate an infusion reaction or anaphylaxis; the infusion must be stopped immediately and the provider notified.
Question 6: A client with IBD has a serum albumin of 2.1 g/dL. What is the most likely clinical consequence the nurse should monitor for?
- Hypertension from fluid retention
- Peripheral edema from decreased oncotic pressure (Correct answer)
- Hypercalcemia from bone resorption
- Polycythemia from erythropoietin elevation
Correct answer: Peripheral edema from decreased oncotic pressure
Low serum albumin reduces plasma oncotic pressure, allowing fluid to shift into interstitial spaces and causing edema.
Question 7: A client with ulcerative colitis is taking mesalamine suppositories. The client asks why suppositories are used instead of oral tablets. The nurse's best response is:
- Suppositories have fewer systemic side effects than oral forms
- Suppositories deliver medication directly to the rectal mucosa where disease is active (Correct answer)
- Oral mesalamine is not absorbed in the gastrointestinal tract
- Suppositories work faster because they bypass liver metabolism
Correct answer: Suppositories deliver medication directly to the rectal mucosa where disease is active
Mesalamine suppositories deliver topical anti-inflammatory medication directly to the rectal mucosa, which is the primary site of disease in proctitis.
IBD NCLEX 2
A client with Crohn's disease develops a fistula between the bowel and bladder.
Which symptom should the nurse expect to assess?