The nurse is caring for a client with an exacerbation of inflammatory bowel disease: Which of the following orders would be anticipated for this patient?

NG tube placement

Low calorie and low protein diet

Stool softeners and laxatives

Barium contrast imaging studies

Answer and Explanation

The Correct Answer is A

A. NG tube placement:
In patients with an exacerbation of inflammatory bowel disease (IBD), particularly in cases of severe flare-ups, the gastrointestinal tract may need rest, and the patient may have difficulty maintaining adequate nutrition. An NG (nasogastric) tube may be used for enteral feeding if the patient is unable to tolerate oral intake, or to provide bowel rest if indicated. Nutritional support via an NG tube can help provide essential nutrients and manage symptoms during an exacerbation, especially if the patient is experiencing severe nausea, vomiting, or malabsorption.

B. Low calorie and low protein diet:
During an IBD flare, the patient typically needs a higher-calorie, higher-protein diet to support healing and immune function. A low-calorie, low-protein diet would not be appropriate, as it would not provide the necessary nutrients for recovery and tissue repair. In fact, nutritional support is often one of the key components in managing IBD exacerbations. A diet rich in calories and protein is often recommended to prevent malnutrition.

C. Stool softeners and laxatives:
Stool softeners and laxatives are generally contraindicated during an IBD flare, as they can exacerbate diarrhea and increase bowel motility, which may worsen symptoms such as abdominal pain, cramping, and diarrhea. The focus during an exacerbation of IBD is typically on controlling inflammation, rest, and reducing bowel irritation, rather than promoting bowel movements.

D. Barium contrast imaging studies:
Barium contrast imaging studies are generally not performed during an acute exacerbation of IBD because they can cause further irritation to the inflamed bowel. Imaging studies are typically used for diagnosis and assessment of disease extent in a stable or chronic phase, rather than during an acute flare. The priority during a flare is managing symptoms and controlling inflammation, not conducting procedures that could aggravate the condition.

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Correct Answer is A

Explanation

A) Obtain samples for urine culture and urinalysis:
This is the first priority. The symptoms described—urinary frequency, dysuria (painful urination), and fever—are suggestive of a urinary tract infection (UTI). To confirm the diagnosis and identify the causative organism, it is critical to obtain a urine sample for both a urinalysis and urine culture. The culture will help guide antibiotic therapy once the organism is identified. This is the foundational step before initiating any treatment. The results will also help determine whether the infection is localized or more severe, like a pyelonephritis
or systemic infection.

B) Insert a Foley catheter:
Inserting a Foley catheter may be necessary if the patient is unable to void, but it is not the first intervention in this case. A Foley catheter is generally used for urinary retention or if monitoring of urine output is necessary. In the context of suspected UTI symptoms, a Foley catheter should only be inserted if there is a clear need, not just for the convenience of obtaining a sample. Additionally, inserting a Foley catheter could introduce bacteria if the patient is not already catheterized and should therefore be avoided unless medically indicated.

C) Begin broad-spectrum IV antibiotics:
While starting antibiotics is important in treating a suspected UTI, especially in the presence of fever and potential infection, obtaining a urine sample for culture and urinalysis should be done first. This allows the healthcare team to tailor antibiotic therapy based on the culture results, reducing the risk of unnecessary or incorrect antibiotic use. If the patient is febrile and appears severely ill, broad-spectrum antibiotics may be started after obtaining the urine sample, but the culture and urinalysis must still be prioritized.

D) Prepare the client for a CT scan:
While imaging studies like a CT scan may be helpful in evaluating for complications, they are not the first step in managing the patient’s symptoms. Obtaining the urine sample and identifying whether an infection is present is essential for guiding further management. A CT scan may be ordered later if the clinical suspicion for complications remains high after the initial evaluation and lab results.

A. Pernicious anemia B. Hemolytic anemia C. Iron deficiency anemia D. Aplastic anemia

Correct Answer is A

Explanation

A) Pernicious anemia:
Vitamin B12 injections are most commonly used to treat pernicious anemia, which is caused by a deficiency in vitamin B12 due to an inability to absorb the vitamin from the gastrointestinal tract. This condition is often associated with a lack of intrinsic factor, a protein required for vitamin B12 absorption. As a result, the body cannot make enough healthy red blood cells, leading to anemia. The treatment of pernicious anemia typically involves lifelong vitamin B12 injections, making this the correct answer.

B) Hemolytic anemia:
It is not typically treated with vitamin B12 injections. Instead, hemolytic anemia may require treatments that address the underlying cause of red blood cell destruction, such as corticosteroids, immunosuppressive therapy, or splenectomy, depending on the type of hemolysis. Therefore, vitamin B12 would not be the primary treatment for this type of anemia.

C) Iron deficiency anemia:
It is typically treated with iron supplements, either orally or intravenously, rather than vitamin B12. While both conditions cause anemia, the treatment for iron deficiency anemia is not vitamin B12, so this is not the correct choice.

D) Aplastic anemia:
This condition is usually treated with treatments such as bone marrow stimulants, blood transfusions, or bone marrow transplantation, rather than vitamin B12. Vitamin B12 supplementation would not be indicated for the treatment of aplastic anemia.

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