Ulcerative Colitis (10 Questions)

1. M. Jacques Tremblay, 28 years old, presents to the clinic complaining of recurrent diarrhea for the past 3 weeks.

Assessment:
*Stool: 15-20 liquid stools per day, containing blood and mucus.
*Pain: Cramping in the Left Lower Quadrant (LLQ) relieved by defecation.
*General: Weight loss of 4 kg, fatigue, and pallor.

Medical Orders:
*Colonoscopy.
*Stool culture.

Question:
Which assessment finding is most specific to Ulcerative Colitis (compared to Crohn’s Disease)? *

Right Lower Quadrant pain.

Bloody diarrhea with mucus.

Fistulas and anal fissures.

Skip lesions (patchy inflammation) on endoscopy.

2. Mme. Ginette Roy, 35 years old, is admitted with a severe exacerbation of UC.

Assessment:
*Abdomen: Markedly distended, rigid, and tender.
*Vital Signs: Temp 39.5°C, HR 120, BP 90/60.
*Bowel Sounds: Absent.
*Patient Status: Lethargic.

Medical Orders:
*Abdominal X-ray STAT.
*NPO.
*IV fluids and Antibiotics.

Question:
What life-threatening complication do these signs suggest? *

Bowel Obstruction due to stricture.

Toxic Megacolon.

Appendicitis.

Diverticulitis.

3. M. Pierre Gagnon, 40 years old, is recovering from an acute flare-up of UC. The nurse is reviewing his lunch menu choices to minimize bowel irritation.

Medical Orders:
*Low Residue Diet.

Question:
Which meal choice indicates that the patient needs further teaching? *

Roasted chicken with white rice.

Scrambled eggs and white toast.

Canned peaches and cottage cheese.

Whole grain bread sandwich with raw vegetables and a side of popcorn.

4. Mme. Claire Bouchard, 29 years old, is prescribed Sulfasalazine for maintenance therapy of her UC.

Medical Orders:
*Sulfasalazine 500 mg PO QID.
*Folic Acid 1 mg PO daily.

Question:
What is the nurse’s priority assessment before administering the first dose? *

Check blood pressure.

Assess for allergy to Sulfa drugs or Aspirin (Salicylates).

Assess for a history of asthma.

Check blood glucose levels.

5. M. Robert Fortin, 45 years old, has refractory UC that is not responding to high-dose steroids and biologics. The surgeon recommends a Total Proctocolectomy with Permanent Ileostomy. M. Fortin asks, "Will I still have the disease after they take my colon out?"

Question:
What is the correct nursing response? *

"Yes, the disease can come back in your small intestine."

"Since Ulcerative Colitis only affects the colon and rectum, removing them is considered a curative procedure."

"You will still need to take medication to prevent it from attacking your stomach."

"The surgery only treats the symptoms, not the disease."

6. M. Sylvain Cote, 32 years old, is 1 day post-op from the creation of an ileostomy. The nurse assesses the stoma and the drainage pouch.

Assessment:
*Stoma: Beefy red and moist.
*Output: 1200 mL of dark green liquid stool in the last 24 hours.

Medical Orders:
*Monitor stoma and output.
*IV fluids Lactated Ringer's.

Question:
What is the nurse’s interpretation of these findings? *

The stoma is infected (too red).

The findings are normal; high-volume liquid output is expected initially.

The patient has diarrhea and needs Imodium immediately.

The stoma is ischemic (dark green output).

7. Mme. Sophie Lemieux, 24 years old, is being discharged on a tapering dose of Prednisone after a severe flare. She tells the nurse, "I stopped taking them yesterday because my face is getting puffy and I feel moody."

Medical Orders:
*Prednisone taper schedule.

Question:
What is the priority nursing warning? *

"You can stop if you don't like the side effects."

"Take the pills at night to reduce the facial swelling."

"Switch to Tylenol if the mood swings get bad."

"You must never stop steroids abruptly; it can cause an adrenal crisis."

8. M. Michel Desjardins, 50 years old, has severe diarrhea (20 stools/day). He complains of intense burning and pain around the anus.

Assessment:
*Perianal skin is red, excoriated, and raw.

Medical Orders:
*Routine skin care.

Question:
Which intervention is most appropriate? *

Scrub the area vigorously with soap and water after each movement.

Apply a heating pad to the area.

Cleanse gently with peri-wash, pat dry, and apply a barrier cream.

Restrict fluids to stop the diarrhea.

9. Mme. Valérie Turcotte, 38 years old, with a history of UC, reports feeling constantly tired and short of breath when walking.

Lab Results:
*Hemoglobin: 85 g/L (Low).
*Hematocrit: 0.28.
*Ferritin: Low.

Medical Orders:
*Iron Sucrose IV infusion.

Question:
What is the primary cause of this anemia in UC? *

Vitamin B12 malabsorption.

Bone marrow suppression from Sulfasalazine.

Chronic blood loss from the ulcerated colon.

Hemolysis.

10. M. André Lemieux, 22 years old, is scheduled for permanent ileostomy surgery tomorrow. He is quiet, withdrawn, and refuses to look at the stoma marking on his abdomen.

Medical Orders:
*Pre-op teaching.

Question:
What is the most appropriate nursing intervention? *

Force him to look at pictures of stomas so he is prepared.

Cancel the surgery until he is psychologically ready.

Arrange for a visit from a peer support person (Ostomy Visitor) who is his age.

Tell him that a bag is better than dying of cancer.