IBD NCLEX 4 — Questions and Answers
Question 1: A client with ulcerative colitis is admitted with signs of toxic megacolon. Which assessment finding would the nurse most expect?
- Hyperactive bowel sounds in all quadrants
- Abdominal rigidity with absent bowel sounds (Correct answer)
- Diarrhea increasing to 20 stools/day
- Severe tenesmus with small-volume stools
Correct answer: Abdominal rigidity with absent bowel sounds
Toxic megacolon presents with colonic dilation, abdominal rigidity, absent bowel sounds, fever, and hemodynamic instability.
Question 2: A client with Crohn's disease who is receiving total parenteral nutrition (TPN) develops a fever of 38.8°C with no other source of infection. The priority nursing action is to:
- Obtain a blood culture from the TPN line and a peripheral site (Correct answer)
- Remove the TPN line immediately
- Administer antipyretics and recheck temperature in 4 hours
- Slow the TPN infusion rate by 50%
Correct answer: Obtain a blood culture from the TPN line and a peripheral site
A fever in a TPN client may indicate catheter-related bloodstream infection; paired cultures from the central line and peripheral site are required before line removal.
Question 3: A client with IBD is started on prednisone 60 mg daily. The nurse should monitor for which complication associated with this medication?
- Hypoglycemia
- Hyperglycemia (Correct answer)
- Hyponatremia
- Hyperkalemia
Correct answer: Hyperglycemia
Corticosteroids stimulate gluconeogenesis and reduce insulin sensitivity, causing hyperglycemia, especially in clients with diabetes or prediabetes.
Question 4: A client with IBD reports joint pain and swelling that worsens with IBD flares. The nurse recognizes this as which extraintestinal manifestation?
- Rheumatoid arthritis
- Peripheral arthropathy (Type 1) (Correct answer)
- Ankylosing spondylitis
- Psoriatic arthritis
Correct answer: Peripheral arthropathy (Type 1)
Type 1 peripheral arthropathy affects large joints, is pauciarticular, parallels IBD disease activity, and resolves with IBD treatment.
Question 5: A nurse is preparing to administer an enema to a client with ulcerative colitis. Which type of enema is contraindicated in this population?
- Mesalamine retention enema
- Hydrocortisone foam enema
- Soap suds enema (Correct answer)
- Normal saline enema for stool softening
Correct answer: Soap suds enema
Soap suds enemas are irritating to the already-inflamed colonic mucosa and are contraindicated in ulcerative colitis.
Question 6: A client with IBD on long-term corticosteroid therapy asks why a DEXA scan was ordered. The nurse explains that the scan monitors for:
- Liver fibrosis from steroid hepatotoxicity
- Bone density loss from steroid-induced osteoporosis (Correct answer)
- Adrenal suppression assessment
- Pulmonary changes from steroid use
Correct answer: Bone density loss from steroid-induced osteoporosis
Long-term corticosteroid use inhibits osteoblast activity and calcium absorption, leading to osteoporosis detectable by DEXA scan.
Question 7: A client with Crohn's disease has a stricture causing partial bowel obstruction. Which diet modification should the nurse teach?
- High-fiber diet to promote bowel motility
- Low-residue diet to reduce mechanical obstruction risk (Correct answer)
- Clear liquids only until the stricture resolves
- High-protein solid foods to maintain nutrition
Correct answer: Low-residue diet to reduce mechanical obstruction risk
A low-residue (low-fiber) diet reduces the bulk of intestinal contents, decreasing the risk of food getting stuck at the site of a stricture.
IBD NCLEX 4
A client with ulcerative colitis is admitted with signs of toxic megacolon.
Which assessment finding would the nurse most expect?