The nurse is conducting a physical examination of a child with suspected Crohn disease. Which finding would be the most suspicious of Crohn disease?
A) Normal growth patterns
B) Perianal skin tags or fissures
C) Poor growth patterns
D) Abdominal tenderness
Ans: B
Perianal skin tags and/or fissures are highly suspicious of Crohn disease. Poor growth patterns and abdominal tenderness are common to Crohn disease but are also seen with many other conditions. Normal growth patterns would not point to Crohn disease because of problems with absorbing nutrients.
You might also like to view...
In response to a patient's nausea, the nurse has mixed a dose of an antiemetic with 50 mL of sterile normal saline and will administer the dose by IV piggyback. What is the rationale for the use of IV piggyback?
A) The patient is receiving continuous IV fluids in addition to IV medications. B) The patient must be continuously monitored to gauge the effect of the medication. C) The patient has failed to adhere to the prescribed treatment regimen. D) The patient's electrolyte levels are volatile.
The nurse is caring for an alcoholic who is being treated for hypomagnesemia. When planning care, what should the nurse identify as a priority intervention for this client?
1. Frequent bathing 2. Oral care three times a day 3. Ambulation four times a day 4. Safety interventions
A nurse is caring for several clients with small-bore feeding tubes and nasogastric (NG) tubes. Which of the following activities can the nurse delegate to the unlicensed assistive personnel?
a. Assessing placement of the nasoenteric feeding tube b. Reattaching suction to a nasogastric tube after the client ambulates c. Refilling the tube-feeding bag for a small-bore gastrostomy tube d. Performing skin care at the exit site of a jejunostomy tube
A pneumothorax greater than 15% requires
a. systemic antibiotics to treat the inflammatory response. b. an occlusive dressing to equalize lung pressures. c. interventions to evacuate the air from the pleural space and facilitate re-expansion of the collapsed lung. d. mechanical ventilation to assist with re-expansion of the collapsed lung.