A client with rheumatoid arthritis and psoriasis has been prescribed adalimumab, a biologic agent that blocks tumor necrosis factor alpha (TNF-alpha). Which of the following statements by the client indicates a need for further teaching?

Choice A reason: MRI is not a diagnostic procedure for Barrett esophagus. MRI is a type of imaging test that uses magnetic fields and radio waves to create detailed pictures of the internal organs and tissues. It is mainly used to diagnose problems in the brain, spine, joints, and blood vessels.

Choice B reason: EGD is a diagnostic procedure for Barrett esophagus. EGD is a type of endoscopy that uses a flexible tube with a light and a camera to examine the esophagus, stomach, and duodenum. It can detect changes in the lining of the esophagus that may indicate Barrett esophagus, a condition where the normal squamous cells are replaced by columnar cells due to chronic acid exposure.

Choice C reason: Colonoscopy is not a diagnostic procedure for Barrett esophagus. Colonoscopy is a type of endoscopy that uses a flexible tube with a light and a camera to examine the colon and rectum. It is mainly used to screen for colorectal cancer and polyps, as well as to diagnose inflammatory bowel disease and other conditions affecting the lower gastrointestinal tract.

Choice D reason: CT scan is not a diagnostic procedure for Barrett esophagus. CT scan is a type of imaging test that uses X-rays and a computer to create cross-sectional pictures of the body. It is mainly used to diagnose problems in the chest, abdomen, pelvis, and bones.

Choice A reason: Guarding and rebound tenderness are signs of peritonitis, which is a serious complication of colonoscopy. Peritonitis is an inflammation of the peritoneum, the membrane that lines the abdominal cavity. It can be caused by perforation or puncture of the colon during the colonoscopy, which allows bacteria and fecal matter to enter the peritoneal space. The nurse should monitor the client for signs of peritonitis, such as abdominal pain, rigidity, fever, and leukocytosis.

Choice B reason: Nausea and vomiting are not specific signs of a complication of colonoscopy. They may be caused by other factors, such as the sedation, the bowel preparation, or the ingestion of food or fluids after the procedure. Nausea and vomiting may also be symptoms of other conditions, such as gastroenteritis, food poisoning, or pregnancy.

Choice C reason: Diarrhea is not a sign of a complication of colonoscopy. Diarrhea may be a normal consequence of the bowel preparation, which involves taking laxatives or enemas to clear the colon before the procedure. Diarrhea may also be caused by other factors, such as the ingestion of food or fluids after the procedure, or the presence of an underlying bowel disorder, such as irritable bowel syndrome or inflammatory bowel disease.

Choice D reason: Hyperactive bowel sounds are not a sign of a complication of colonoscopy. Hyperactive bowel sounds may indicate increased peristalsis, which is the movement of the digestive tract. Hyperactive bowel sounds may be a normal response to the bowel preparation, the ingestion of food or fluids after the procedure, or the stimulation of the colon during the colonoscopy. Hyperactive bowel sounds may also be present in conditions such as diarrhea, gastroenteritis, or intestinal obstruction.