IBD NCLEX 3 — Questions and Answers
Question 1: A client with IBD is prescribed metronidazole for a perianal fistula. The nurse should teach the client to avoid which substance?
- Grapefruit juice
- Alcohol (Correct answer)
- Aged cheese
- Green leafy vegetables
Correct answer: Alcohol
Metronidazole causes a disulfiram-like reaction with alcohol, producing flushing, nausea, vomiting, and tachycardia.
Question 2: A nurse is caring for a client with Crohn's disease experiencing a flare. The client reports 10 bloody stools per day, fever of 39.2°C, and HR of 112 bpm. These findings are consistent with which complication?
- Mild IBD exacerbation
- Toxic megacolon
- Severe colitis (Correct answer)
- Colovesical fistula
Correct answer: Severe colitis
More than 6 bloody stools per day with systemic signs (fever, tachycardia) meets criteria for severe colitis requiring aggressive inpatient management.
Question 3: Which laboratory value is the most specific marker used to monitor intestinal inflammation in IBD clients without requiring colonoscopy?
- C-reactive protein (CRP)
- Erythrocyte sedimentation rate (ESR)
- Fecal calprotectin (Correct answer)
- Serum ferritin
Correct answer: Fecal calprotectin
Fecal calprotectin is a stool-based biomarker that directly reflects intestinal mucosal inflammation and is more specific to GI inflammation than CRP or ESR.
Question 4: A postoperative client who had a colectomy for ulcerative colitis develops fever, abdominal distension, and absent bowel sounds on day 3. The nurse suspects:
- Expected postoperative ileus
- Paralytic ileus requiring intervention
- Anastomotic leak (Correct answer)
- Wound dehiscence
Correct answer: Anastomotic leak
Fever with abdominal distension after bowel surgery suggests anastomotic leak, a serious complication requiring immediate surgical evaluation.
Question 5: A client with IBD asks about the risk of colorectal cancer. The nurse correctly explains that colonoscopy surveillance should begin:
- At age 50 like the general population
- After 8–10 years of extensive colitis (Correct answer)
- Immediately at diagnosis
- Only if family history of colon cancer exists
Correct answer: After 8–10 years of extensive colitis
Clients with extensive ulcerative colitis or Crohn's colitis have increased cancer risk and should begin surveillance colonoscopy after 8–10 years of disease.
Question 6: A client with Crohn's disease develops kidney stones. The nurse understands that the most likely type of stone in this population is:
- Calcium phosphate stones
- Oxalate stones (Correct answer)
- Uric acid stones
- Struvite stones
Correct answer: Oxalate stones
Ileal Crohn's disease causes fat malabsorption, leading to increased intestinal oxalate absorption (hyperoxaluria) and calcium oxalate stone formation.
Question 7: The nurse is teaching a client with IBD about azathioprine therapy. Which instruction is most important?
- Take on an empty stomach to improve absorption
- Report any signs of infection immediately (Correct answer)
- Avoid all live and inactivated vaccines
- Expect hair loss as a common side effect
Correct answer: Report any signs of infection immediately
Azathioprine is an immunosuppressant that increases infection risk; clients must report fever, chills, or other infection signs promptly.
IBD NCLEX 3
A client with IBD is prescribed metronidazole for a perianal fistula.
The nurse should teach the client to avoid which substance?