IBD NCLEX 5 — Questions and Answers
Question 1: A client with ulcerative colitis develops a painful, raised, violaceous skin lesion on the lower leg that has necrotic edges. The nurse documents this extraintestinal manifestation as:
- Erythema nodosum
- Pyoderma gangrenosum (Correct answer)
- Psoriasis
- Sweet's syndrome
Correct answer: Pyoderma gangrenosum
Pyoderma gangrenosum presents as a painful ulcerating skin lesion with violaceous, undermined edges and is a classic extraintestinal manifestation of IBD.
Question 2: A client with IBD is being discharged on 6-mercaptopurine (6-MP). The nurse emphasizes that therapeutic effect typically takes how long?
- 3–5 days
- 1–2 weeks
- 3–6 months (Correct answer)
- 12–18 months
Correct answer: 3–6 months
Thiopurines like 6-MP have a delayed onset of action of 3–6 months, so corticosteroids are often used as a bridge therapy during this period.
Question 3: A nurse caring for a client with IBD notes the client is jaundiced with elevated alkaline phosphatase and a beaded biliary tree on MRCP. The nurse recognizes this as which IBD-associated hepatobiliary complication?
- Primary biliary cholangitis
- Primary sclerosing cholangitis (PSC) (Correct answer)
- Autoimmune hepatitis
- Cholelithiasis from ileal disease
Correct answer: Primary sclerosing cholangitis (PSC)
Primary sclerosing cholangitis (PSC) causes multifocal bile duct strictures producing a beaded appearance on MRCP and is strongly associated with ulcerative colitis.
Question 4: A client with a newly created ileostomy reports that the output is green and liquid. The nurse should tell the client:
- This indicates bowel infection — call the provider
- This is normal ileostomy output that may become more formed over time (Correct answer)
- Increase dietary fat to solidify the stool
- This means the ileostomy is not functioning properly
Correct answer: This is normal ileostomy output that may become more formed over time
Green, liquid output is normal immediately after ileostomy creation as the small bowel adapts; output typically becomes more yellow and paste-like over weeks.
Question 5: A nurse is assessing a client with Crohn's disease for signs of short bowel syndrome following extensive resection. Which complication is the nurse most likely to find?
- Constipation and abdominal bloating
- Chronic diarrhea with malabsorption and weight loss (Correct answer)
- Increased appetite with weight gain
- Bile acid diarrhea only, no nutritional deficits
Correct answer: Chronic diarrhea with malabsorption and weight loss
Extensive small bowel resection reduces absorptive surface area, causing chronic diarrhea, malabsorption of macronutrients and micronutrients, and progressive weight loss.
Question 6: A client with ulcerative colitis asks whether their disease can spread to the small intestine like Crohn's disease. The nurse's most accurate response is:
- Yes, UC frequently involves the terminal ileum
- No, UC is limited to the colon and rectum, though backwash ileitis can occur (Correct answer)
- Yes, UC can affect any part of the GI tract
- No, UC is limited to the sigmoid colon only
Correct answer: No, UC is limited to the colon and rectum, though backwash ileitis can occur
Ulcerative colitis involves the colon and rectum in a continuous pattern; in pancolitis, 'backwash ileitis' from reflux into the terminal ileum may occur but is not true small bowel involvement.
Question 7: A client with Crohn's disease is prescribed vedolizumab (Entyvio). The nurse explains that this biologic differs from anti-TNF agents because it:
- Suppresses systemic immune function globally
- Acts selectively on the gut by blocking leukocyte migration into the intestinal mucosa (Correct answer)
- Increases regulatory T-cell production in the liver
- Blocks interleukin-23 production in the colon
Correct answer: Acts selectively on the gut by blocking leukocyte migration into the intestinal mucosa
Vedolizumab is a gut-selective integrin antagonist that blocks α4β7 integrin, preventing T-lymphocyte trafficking specifically into intestinal tissue without broad systemic immunosuppression.
IBD NCLEX 5
A client with ulcerative colitis develops a painful, raised, violaceous skin lesion on the lower leg that has necrotic edges.
The nurse documents this extraintestinal manifestation as: