# Situation: A 63-year-old man has had steady left lower quadrant (LLQ) pain for 2 days, a temperature of 38.2 °C, and a white blood cell (WBC) count of 14,000/mm³ (normal 4,500–11,000/mm³). A computed tomography (CT) scan shows uncomplicated sigmoid diverticulitis. He is admitted for oral antibiotics and observation because he lives alone. Before discharge, the nurse teaches prevention of future attacks. Which statement shows that he understood?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630385  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 63-year-old man has had steady left lower quadrant (LLQ) pain for 2 days, a temperature of 38.2 °C, and a white blood cell (WBC) count of 14,000/mm³ (normal 4,500–11,000/mm³). A computed tomography (CT) scan shows uncomplicated sigmoid diverticulitis. He is admitted for oral antibiotics and observation because he lives alone.

Before discharge, the nurse teaches prevention of future attacks. Which statement shows that he understood?

## 보기

1. "I will add fiber slowly and drink more fluids daily." **✔ 정답**
2. "I will take ibuprofen early whenever the cramps return."
3. "I will take mesalamine daily to prevent another attack."
4. "I will stop eating seeds, nuts, corn, and popcorn."

**정답: 1**

## 해설

Prevention relies on a high-fiber diet increased gradually with adequate fluids, regular activity, weight control, and avoiding routine NSAID use. Nuts, seeds, corn, and popcorn do not need to be avoided, and mesalamine does not prevent recurrence.

## 심화 해설

The statement that shows understanding
Before discharge, the goal is to prevent future attacks of diverticulitis. Prevention relies on a high-fiber diet increased gradually with adequate fluids, regular physical activity, weight control, and avoiding routine use of nonsteroidal anti-inflammatory drugs (NSAIDs). The client who says he will add fiber slowly and drink more fluids daily has understood the core message. Gradual increase limits bloating and gas, and fluids allow the fiber to form soft stool rather than a hard mass.

How fiber and fluids prevent attacks
Diverticula form at weak points of the colonic wall when the bowel must generate high pressure to move small, hard stool. Fiber absorbs water and increases stool bulk, so the colon can propel it with lower pressure and less straining. Constipation and straining fall, and so does the stress on existing diverticula. Without adequate fluid, however, extra fiber can worsen constipation, which is why both parts of the statement matter. Regular exercise and a healthy weight are also associated with fewer attacks.

Why the other statements need correction
Taking ibuprofen whenever cramps return is unsafe: NSAIDs raise the risk of diverticulitis complications, including perforation and bleeding, so routine use is avoided. Mesalamine does not prevent recurrence and is not recommended for that purpose. Avoiding seeds, nuts, corn, and popcorn reflects an old belief that particles lodge in diverticula; current evidence shows these foods do not raise diverticulitis risk and need not be avoided. Telling clients to avoid them may also reduce their overall fiber intake.

| Statement | Correct? | Reason |
| --- | --- | --- |
| Add fiber slowly and drink more fluids | Yes | Lowers colonic pressure and constipation |
| Ibuprofen whenever cramps return | No | NSAIDs raise risk of complications and bleeding |
| Daily mesalamine | No | Not recommended to prevent recurrence |
| Stop seeds, nuts, corn, popcorn | No | These foods do not raise risk |

Teaching points for discharge
The nurse teaches the client to increase fiber over several weeks, choose fruits, vegetables, legumes, and whole grains, drink fluids generously unless restricted, stay active, and report fever, worsening abdominal pain, rectal bleeding, or changes in urine such as gas or cloudiness, which could indicate a complication.

Exam takeaway
Key point The modern prevention package for diverticular disease is gradual fiber, fluids, activity, weight control, and avoiding routine NSAIDs. Restricting seeds and nuts is an outdated distractor.

## 임상 시나리오

Preventing Recurrent DiverticulitisDischarge teaching that works
Prevention centers on a high-fiber diet increased gradually with adequate fluids, which produces soft, bulky stool and lowers intracolonic pressure. Regular activity and weight control add benefit.

Routine NSAID use is avoided because it raises the risk of complications and bleeding. Mesalamine does not prevent recurrence, and seeds, nuts, corn, and popcorn need not be avoided.

CautionTeach the client to report fever, worsening abdominal pain, rectal bleeding, or air or cloudiness in the urine, which may signal a complication.

## 핵심 개념

- **Dietary fiber** — Plant material that resists digestion, adds bulk to stool, and eases its passage through the colon.
- **NSAID** — Nonsteroidal anti-inflammatory drug such as ibuprofen; routine use raises diverticular bleeding and complication risk.
- **Mesalamine** — An aminosalicylate used in inflammatory bowel disease; not recommended to prevent diverticulitis recurrence.
- **Diverticulosis** — The presence of colonic diverticula without inflammation.

## 같은 주제 문제

- [Situation: A 52-year-old man with alcohol use disorder is admitted for poor oral intake. H…](https://mymerci.kr/pages/nclex_q.php?qn_id=630266)
- [Situation: A 52-year-old man with alcohol use disorder is admitted for poor oral intake. H…](https://mymerci.kr/pages/nclex_q.php?qn_id=630267)
- [Situation: A 52-year-old man with alcohol use disorder is admitted for poor oral intake. H…](https://mymerci.kr/pages/nclex_q.php?qn_id=630268)
- [Situation: A 52-year-old man with alcohol use disorder is admitted for poor oral intake. H…](https://mymerci.kr/pages/nclex_q.php?qn_id=630269)
- [Situation: A 46-year-old woman has had heartburn and regurgitation after meals for 6 month…](https://mymerci.kr/pages/nclex_q.php?qn_id=630270)
- [Situation: A 46-year-old woman has had heartburn and regurgitation after meals for 6 month…](https://mymerci.kr/pages/nclex_q.php?qn_id=630271)
- [Situation: A 46-year-old woman has had heartburn and regurgitation after meals for 6 month…](https://mymerci.kr/pages/nclex_q.php?qn_id=630272)
- [Situation: A 38-year-old man comes to the outpatient clinic with epigastric pain for the p…](https://mymerci.kr/pages/nclex_q.php?qn_id=630273)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._