Chapter 24- Lower GI MCQs

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: A. high-fiber diet. B. caffeinated products. C. fluids with meals. D. spicy foods.

A A high-fiber diet is prescribed to help control constipation. Individuals experiencing diarrhea may be advised to eat a low-fiber diet. Foods that are possible irritants, such as caffeine, spicy foods, lactose, beans, fried foods, corn, wheat, and alcohol, should be avoided. Fluids should not be taken with meals because they cause abdominal distention.

A 61-year-old woman presented to a scheduled appointment with her nurse practitioner, stating, "I'm having a lot of trouble with constipation over the past few months." What action should the nurse first take in response to this patient's health complaint? A. Assess the woman's typical bowel patterns and her expectations for bowel function. B. Arrange for a barium enema or colonoscopy to assess the woman's lower bowel. C. Assess the woman's family history of constipation and bowel obstruction. D. Advise the woman to increase her fluid intake, activity level, and fiber intake.

A Before recommending interventions, it is important to ascertain the patient's current bowel habits and her expectations surrounding these. This should precede invasive diagnostic testing and would be prioritized over the woman's family history.

Which statement provides accurate information regarding cancer of the colon and rectum? A. Colorectal cancer is the third most common site of cancer in the United States. B. Colon cancer has no hereditary component. C. The incidence of colon and rectal cancer decreases with age. D. Rectal cancer affects more than twice as many people as colon cancer.

A Cancer of the colon and rectum is the third most common site of new cancer cases in the United States. Colon cancer affects more than twice as many people as does rectal cancer (94,700 for colon, 34,700 for rectum). The incidence increases with age (the incidence is highest in people older than 85). Colon cancer occurrence is higher in people with a family history of colon cancer.

A patient is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling? Colonoscopy Barium enema Flexible sigmoidoscopy CT scan

A Diverticulosis is typically diagnosed by colonoscopy, which permits visualization of the extent of diverticular disease and biopsy of tissue to rule out other diseases.

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? A. Gently washing the area surrounding the stoma using a facecloth and mild soap B. Maintaining wrinkles in the faceplate so it doesn't irritate the skin C. Cutting the faceplate opening no more than 2 inches larger than the stoma D. Scrubbing fecal material from the skin surrounding the stoma

A For a client with an ostomy, maintaining skin integrity is a priority. The nurse should gently wash the area surrounding the stoma using a facecloth and mild soap. Scrubbing the area around the stoma can damage the skin and cause bleeding. The faceplate opening should be no more than 1/8-inch to 1/6-inch larger than the stoma. This size protects the skin from exposure to irritating fecal material. The nurse can create an adequate seal and prevent leakage of fecal material from under the faceplate by applying a thin layer of skin barrier and smoothing out wrinkles in the faceplate. Eliminating wrinkles in the faceplate also protects the skin surrounding the stoma from pressure.

A nurse is assessing a client and obtains the following findings: abdominal discomfort, mild diarrhea, blood pressure of 100/80 mm Hg, pulse rate of 88 beats/minute, respiratory rate of 20 breaths/minute, temperature 100° F (37.8° C). What diagnosis will the nurse suspect for this client? inflammatory bowel disease (IBD) colorectal cancer diverticulitis liver failure

A IBD is a collective term for several GI inflammatory diseases with unknown causes. The most prominent sign of IBD is mild diarrhea, which sometimes is accompanied by fever and abdominal discomfort.

A 75-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. An emergency room nurse is obtaining assessment data from this patient. What assessment finding is characteristic of a small bowel obstruction? A. Nausea and vomiting B. Decrease in urine production C. Mucus in the stool D. Mucosal edema

A Nausea and vomiting are symptoms of a small bowel obstruction. Decrease in urine production and mucosal edema are not symptoms of a bowel obstruction. The patient may defecate mucus, but this is not accompanied by stool.

A 16-year-old girl presents at the emergency department complaining of right lower quadrant pain and is diagnosed with appendicitis. When assessing this patient, what signs or symptoms should the nurse expect to find? A. Rebound tenderness, McBurney's sign, low-grade fever B. Periumbilical pain, Trousseau's sign, pain relief with pressure C. Rigid abdomen, Levine's sign, pain relief leaning forward D. Right lower quadrant pain, Chvostek's sign, muscle guarding

A Rebound tenderness, McBurney's sign (pain midway between umbilicus and right iliac crest), and a low-grade fever are all signs of appendicitis. Other clinical findings include a rigid abdomen, a preference to lie still with right leg flexed, right lower quadrant pain, muscle guarding, periumbilical pain, anorexia, nausea, and vomiting. The other findings are not signs of appendicitis. A patient with appendicitis would not have Levine's sign, Chvostek's sign (tetany), or Trousseau's sign (tetany).

A nurse is teaching an older adult client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required? A. "I need to use laxatives regularly to prevent constipation." B. "I should exercise four times per week." C. "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread." D. "I need to drink 2 to 3 liters of fluids every day."

A The client requires more teaching if he states that he'll use laxatives regularly to prevent constipation. The nurse should teach this client to gradually eliminate the use of laxatives because using laxatives to promote regular bowel movements may have the opposite effect. A high-fiber diet, ample amounts of fluids, and regular exercise promote good bowel health.

Which is the most common presenting symptom of colon cancer? A. Change in bowel habits B. Anorexia C. Fatigue D. Weight loss

A The most common presenting symptom is a change in bowel habits. Fatigue, anorexia, and weight loss may occur but are not the most common presenting symptoms.

A client reports taking a stimulant laxative in order to be able to have a bowel movement daily. What should the nurse inform the client about taking a stimulant laxative? A. They can be habit forming and will require increasing doses to be effective. B. If the client is drinking 8 glasses of water per day, it is all right to continue taking them. C. The laxative is safe to take with other medication the client is taking. D. The client should take a fiber supplement along with the stimulant laxative.

A The nurse should discourage self-treatment with daily or frequent enemas or laxatives. Chronic use of such products causes natural bowel function to be sluggish. In addition, laxatives continuing stimulants can be habit forming, requiring continued use in increasing doses. Although the nurse should encourage the client to have adequate fluid intake, laxative use should not be encouraged. The laxative may interact with other medications the client is taking and may cause a decrease in absorption. A fiber supplement may be taken alone but should not be taken with a stimulant laxative.

What information should the nurse include in the teaching plan for a client being treated for diverticulosis? A. Drink at least 8 to 10 large glasses of fluid every day B. Avoid daily exercise; indulge only in mild activity C. Use laxatives or enemas at least once a week D. Avoid unprocessed bran in the diet

A The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the physician. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.

The nurse is aware that many of the diseases of the lower gastrointestinal tract can be identified by the characteristics of the patient's stool. What would voluminous, greasy stools suggest? A. Intestinal malabsorption B. Inflammatory colitis C. Colon cancer D. Small bowel obstruction

A Voluminous, greasy stools suggest intestinal malabsorption, and the presence of blood, mucus, and pus in the stools suggests inflammatory enteritis or colitis. Watery stools are characteristic of disorders of the small bowel, whereas loose, semisolid stools are associated more often with disorders of the large bowel.

A nurse is interviewing a client about past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? A. Hemorrhoids B. Polyps C. Weight gain D. Duodenal ulcers

B Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.

The nurse is caring for a 77-year-old patient diagnosed with Crohn's disease. What would be especially important to monitor this patient for? A. Pain B. Dehydration C. Fatigue D. Fluid overload

B Elderly patients can become dehydrated quickly and develop low potassium levels (i.e., hypokalemia) as a result of diarrhea. The nurse observes for clinical manifestations of muscle weakness, dysrhythmias, or decreased peristaltic motility that may lead to paralytic ileus. All options would be important to monitor, but especially important is monitoring for dehydration.

A client realizes that regular use of laxatives has greatly improved bowel patterns. However, the nurse cautions this client against the prolonged use of laxatives for which reason? A. The client may lose his or her appetite. B. The client's natural bowel function may become sluggish. C. The client may develop inflammatory bowel disease. D. The client may develop arthritis or arthralgia.

B It is essential for the nurse to caution the client against the prolonged use of laxatives because it decreases muscle tone in the large intestine. Prolonged use of laxatives may cause the client's natural bowel function to become sluggish. Laxatives do not increase the risk of developing inflammatory bowel disease, arthritis, or arthralgia, nor do they cause a loss in appetite.

Which type of diarrhea is caused by increased production of water and electrolytes by the intestinal mucosa and their secretion into the intestinal lumen? A. Osmotic diarrhea B. Secretory diarrhea C. Mixed diarrhea D. Diarrheal disease

B Secretory diarrhea is usually high-volume diarrhea caused by increased production and secretion of water and electrolytes by the intestinal mucosa into the intestinal lumen. Osmotic diarrhea occurs when water is pulled into the intestines by the osmotic pressure of nonabsorbed particles, slowing the reabsorption of water. Mixed diarrhea is caused by increased peristalsis (usually from inflammatory bowel disease) and a combination of increased secretion and decreased absorption in the bowel. The most common cause of diarrheal disease is contaminated food.

Which of the following would a nurse expect to assess in a client with peritonitis? A. Decreased pulse rate B. Board-like abdomen C. Hyperactive bowel sounds D. Deep slow respirations

B The client with peritonitis would typically exhibit a rigid, board-like abdomen, with absent bowel sounds, elevated pulse rate, and rapid, shallow respirations.

A man with severe ulcerative colitis has been informed by his health care provider that he will require a colectomy and an ileostomy. The patient has been told by his health care provider that he is candidate for a continent ileal reservoir (Kock pouch). The patient's nurse recognizes which of the following advantages to the use of a Kock pouch as an alternative to the creation of an ileal stoma? A. The patient will soon be able to resume normal bowel function. B. The patient will not have to wear an external collection bag. C. The patient's abdominal wall will remain intact. D. The patient will have to make minimal dietary modifications.

B The creation of a continent ileal reservoir (i.e., Kock pouch) involves diverting a portion of the distal ileum to the abdominal wall and creating a stoma. This procedure eliminates the need for an external fecal collection bag. Approximately 30 cm of the distal ileum is reconstructed to form a reservoir with a nipple valve that is created by pulling a portion of the terminal ileal loop back into the ileum. Dietary modifications are still necessary, and bowel function is still heavily modified.

The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication? A. Pelvic abscess B. Peritonitis C. Hemorrhage D. Ileus

B The nurse should report to the physician that the client has signs/symptoms of peritonitis. Signs/symptoms of a pelvic abscess include anorexia, chills, fever, diaphoresis, and diarrhea. Signs/symptoms of an ileus include absent bowel sounds, nausea, and abdominal distention. Signs/symptoms of hemorrhage include tachycardia, hypotension, anxiety, and bleeding.

The nurse is conducting a gastrointestinal assessment. When the client reports the presence of mucus and pus in the stool, the nurse assesses for additional signs/symptoms of which disease/condition? A. Small-bowel disease B. Ulcerative colitis C. Disorders of the colon D. Intestinal malabsorption

B The presence of mucus and pus in the stool suggests ulcerative colitis (due to inflammation). Watery stools are characteristic of small-bowel disease. Loose, semisolid stools are associated more often with disorders of the colon. Voluminous, greasy stools suggest intestinal malabsorption.

Which of the following is the most common symptom of a polyp? A. Diarrhea B. Rectal bleeding C. Abdominal pain D. Anorexia

B The most common symptom is rectal bleeding. Lower abdominal pain may also occur. Diarrhea and anorexia are clinical manifestations of ulcerative colitis.

When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? A. The appendix may develop gangrene and rupture, especially in a middle-aged client. B. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. C. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. D. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

C A client with appendicitis is at Risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Elderly, not middle-aged, clients are especially susceptible to appendix rupture.

A client presents to the emergency department with complaints of acute GI distress, bloody diarrhea, weight loss, and fever. Which condition in the family history is most pertinent to the client's current health problem? A. Hypertension B. Appendicitis C. Ulcerative colitis D. Gastroesophageal reflux disease

C A family history of ulcerative colitis, particularly if the relative affected is a first-degree relative, increases the likelihood of the client having ulcerative colitis. Although hypertension has familial tendencies, the client's symptoms aren't related to hypertension. A family history of gastroesophageal reflux disease or appendicitis isn't a significant factor in the client history because these conditions aren't considered familial traits.

The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation? A. Current medications B. Alcohol consumption C. Usual pattern of elimination D. Activity levels

C Constipation has many possible causes and assessing the client's usual pattern of elimination is the first step in identifying the cause. The nurse should obtain a description of the bowel elimination pattern, asking about the frequency, overall appearance and consistency of stool, blood in the stool, pain, and effort necessary to pass stool. It is also essential for the nurse to review the client's current medications, diet, and activity levels.

Clostridium difficile infection has been moving through an extended-care facility, and several of the elderly residents have been experiencing severe diarrhea. One particularly sick resident has told the nurse that he is now experiencing extreme fatigue and muscle cramps and that his heart feels like it occasionally "skips a beat." The nurse should facilitate a stat assessment of this resident's: A. Hemoglobin and hematocrit B. Cardiac biomarkers C. Potassium levels D. Calcium levels

C Elderly patients can become dehydrated quickly and develop low potassium levels (i.e., hypokalemia) as a result of diarrhea. The nurse observes for clinical manifestations of muscle weakness, arrhythmias, or decreased peristaltic motility that may lead to paralytic ileus.

A client is being seen in the clinic for reports of painful hemorrhoids. The nurse assesses the client and observes the hemorrhoids are prolapsed but able to be placed back in the rectum manually. The nurse documents the hemorrhoids as what degree? A. Second degree B. First degree C. Third degree D. Fourth degree

C First degree hemorrhoids do not prolapse and protrude into the anal canal. Second degree hemorrhoids prolapse outside the anal canal during defecation but reduce spontaneously. Third degree hemorrhoids prolapse to the extent that they require manual reduction. Fourth degree hemorrhoids prolapse to the extent that they may not be reduced.

The instructor is teaching a group of students about irritable bowel syndrome (IBS) and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an antidiarrheal agent commonly administered for IBS? A. Dicyclomine B. Lubiprostone C. Loperamide D. Peppermint oil

C Loperamide is an opiate-related antidiarrheal agent. Lubiprostone is used to treat constipation; it activates chloride channels in the gastrointestinal tract to increase gastrointestinal transit. Dicyclomine, a smooth muscle antispasmodic agent, is used to treat pain accompanying IBS. Peppermint oil may also be taken to ease discomfort.

A typical sign/symptom of appendicitis is: A. high fever. B. left lower quadrant pain. C. nausea. D. pain when pressure is applied to the right upper quadrant.

C Nausea, with or without vomiting, is typically associated with appendicitis. Pain is generally felt in the right lower quadrant. Rebound tenderness, or pain felt upon the release of pressure applied to the abdomen, may be present with appendicitis. Low-grade fever is associated with appendicitis.

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? A. Low protein B. Iron restriction C. Low residue D. Calorie restriction

C Oral fluids and a low-residue (limit high fiber foods), high-protein, high-calorie diet with supplemental vitamin therapy and iron replacement are prescribed to meet the nutritional needs, reduce inflammation, and control pain and diarrhea.

A nurse is reviewing the history and physical of a client admitted for a hemorrhoidectomy. Which predisposing condition does the nurse expect to see? A. Hyperkalemia B. Hypoglycemia C. Constipation D. Lactic acidosis

C Orthostatic hypertension and other conditions associated with persistently high intra-abdominal pressure (such as pregnancy) can lead to hemorrhoids. The passing of hard stools, not diarrhea, can aggravate hemorrhoids. Diverticulosis has no relationship to hemorrhoids. Rectal bleeding is a symptom of hemorrhoids, not a predisposing condition.

A nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find? A. rectal bleeding and a change in bowel habits B. jaundice and vomiting C. severe abdominal pain with direct palpation or rebound tenderness D. tenderness and pain in the right upper abdominal quadrant

C Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (i.e., appendicitis, diverticulitis, ulcerative colitis, a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.

The nurse is caring for a patient who is postoperative day 3 following bowel resection and the creation of a colostomy. While changing the dressing, the nurse notes the stoma is dusky in color. How should the nurse interpret this assessment finding? A. The stoma is blocked. B. This is a normal color postoperatively. C. Circulation to the stoma is compromised. D. The patient's oxygen saturation may be low.

C Postoperative complications following colon resection may include hemorrhage, infection, and anastomosis. A healthy viable stoma should be pink. This does not indicate that the patient's oxygen saturation is low or that the stoma is blocked.

A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult? A. "I don't like oatmeal, so it doesn't matter that I can't have it." B. "I don't understand why this happened again; I didn't travel out of the country." C. "I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." D. "I don't understand this; I took the medication the doctor ordered and followed the diet."

C The client stating that he ate roast beef on rye bread indicates the need for a dietary consult because rye bread contains gluten, which must be eliminated from the client's diet. The client stating that he's followed the ordered medication regimen and diet doesn't suggest that the client needs a dietary consult; a treatment regimen consisting of medications to improve symptoms and dietary modification is necessary to treat celiac disease. The client stating that he hasn't traveled outside of the country doesn't suggest that dietary concerns exist. The client saying that he can't have oatmeal shows an understanding of the dietary restrictions necessary with celiac disease.

The nurse is teaching a client with constipation to increase dietary fiber intake to 25 g/day. Which recommendation would the nurse include? A. Limiting fluid intake to 5 to 6 glasses per day B. Avoiding bran cereals and beans in the diet C. Adding fiber-rich foods to the diet gradually D. Minimizing activity levels for at least 2 months

C The nurse instructs the client to add fiber-rich foods to the diet gradually to avoid bloating, gas, and diarrhea. It is essential for a client to include bran cereals and beans in the diet because they ease defecation. The nurse also instructs the client to increase fluids to 6 to 8 glasses per day to prevent hard, dry stools. The client should also develop a regular exercise program to increase peristalsis and promote bowel elimination.

The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation? A. Apply triamcinolone acetonide spray B. Dust with nystatin powder C. Dry skin thoroughly after washing D. Apply barrier powder

C The nurse should teach the client without peristomal skin irritation to dry the skin thoroughly after washing. Barrier powder, triamcinolone acetonide spray, and nystatin powder are used when the client has peristomal skin irritation and/or fungal infection.

Which is one of the primary symptoms of irritable bowel syndrome (IBS)? A. Pain B. Abdominal distention C. Diarrhea D. Bloating

C The primary symptoms of IBS include constipation, diarrhea, or a combination of both. Pain, bloating, and abdominal distention often accompany changes in bowel pattern.

A nurse is providing dietary teaching to a client who has diverticulitis about preventing acute attacks. Which of the following foods should the nurse recommend? A. Foods high in Vit C B. Foods low in fat C. Foods high in fiber D. Foods low in calories

C The result of long term, low fiber eating habits along with increased intracolonic pressure lead to straining during bowel movements, causing the development of diverticula. High-fiber foods help strengthen and maintain active motility of the GI tract.

A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a: A. fistula. B. pilonidal cyst. C. hemorrhoid. D. fissure.

D An anal fissure (fissure in ano) is a linear tear in the anal canal tissue. An anal fistula (fistula in ano) is a tract that forms in the anal canal. Hemorrhoids are dilated veins outside or inside the anal sphincter. A pilonidal sinus is an infection in the hair follicles in the sacrococcygeal area above the anus.

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, what would the nurse stress the importance of? A. Consuming a low-protein, high-fiber diet B. Taking only enteric-coated medications C. Wearing an appliance pouch only at bedtime D. Increasing fluid intake to prevent dehydration

D Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can't absorb them after an ileostomy.

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care? A. Prepare the client for a gastrostomy tube placement. B. Administer morphine (Duramorph PF) routinely, as ordered. C. Administer topical ointment to the rectal area to decrease bleeding. D. Test all stools for occult blood.

D Blood in the stools is one of the warning signs of colorectal cancer. The nurse should plan on checking all stools for both frank and occult blood. The blood in the stool is coming from the colon or rectum Administering an ointment wouldn't help decrease the bleeding. Preparing a client for a gastrostomy tube isn't appropriate when diagnosing colorectal cancer. Colorectal cancer is usually painless; administering opioid pain medication isn't needed

The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's notes? A. Peristalsis B. Tenesmus C. Loud bowel sounds D. Borborygmus

D Borborygmus is a rumbling noise caused by the movement of gas through the intestines, often associated with diarrhea.

A client tells the nurse, "I am not having normal bowel movements." When differentiating between what are normal and abnormal bowel habits, what indicators are the most important? A. The client is able to fully evacuate with each bowel movement B. That the client has a bowel movement daily C. That the stool is formed and soft D. The consistency of stool and comfort when passing stool

D In differentiating normal from abnormal, the consistency of stools and the comfort with which a person passes them are more reliable indicators than is the frequency of bowel elimination. People differ greatly in their bowel habits and normal bowel patterns range from three bowel movements per day to three bowel movements per week. It is important for the stool to be soft to pass without pain. The client may not be able to fully evacuate with a bowel movement; it may take time.

The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder? A. A loop of intestine adheres to an area that is healing slowly after surgery. B. The bowel twists and turns itself and obstructs the intestinal lumen. C. The bowel protrudes through a weakened area in the abdominal wall. D. One part of the intestine telescopes into another portion of the intestine.

D In intussusception of the bowel, one part of the intestine telescopes into another portion of the intestine. When the bowel twists and turns itself and obstructs the intestinal lumen, this is known as a volvulus. A hernia is when the bowel protrudes through a weakened area in the abdominal wall. An adhesion is a loop of intestine that adheres to an area that is healing slowly after surgery.

Which of the following is considered a bulk-forming laxative? A. Milk of Magnesia B. Mineral oil C. Dulcolax D. Metamucil

D Metamucil is a bulk-forming laxative. Milk of Magnesia is classified as a saline agent. Mineral oil is a lubricant. Dulcolax is a stimulant.

The nursing educator is teaching a group of nurses about constipation and the elderly. What recommendation for this population should a nurse can make about treating chronic constipation? A. Administer a phospho-soda (Fleet) enema when necessary. B. Take a mild laxative, such as magnesium citrate, when necessary. C. Administer a tap water enema weekly. D. Take a stool softener, such as docusate sodium (Colace), daily.

D Stool softeners taken daily promote absorption of liquid into the stool, creating a softer mass. They may be taken on a daily basis without developing dependence. Dependence is an adverse effect of daily laxative use. Enemas used daily or on a frequent basis can also lead to dependence of the bowel on an external source of stimulation.

Medical management of a patient with peritonitis includes fluid, electrolyte, and colloid replacement. The nurse knows to prepare the initial, most appropriate intravenous solution. Which of the following is the correct solution? A. D10W B. D5W C. 0.45% of NS D. 0.9% NS

D The administration of several liters of an isotonic solution is immediately prescribed. Hypovolemia occurs because massive amounts of fluid and electrolytes move from the intestinal lumen into the peritoneal cavity and deplete the fluid in the vascular space.

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse? A. Inform the patient that it will only last a minute and continue with the procedure. B. Stop the irrigation and remove the tube. C. Replace the fluid with cooler water since it is probably too warm. D. Clamp the tubing and give the patient a rest period.

D When irrigating a colostomy, the nurse should allow tepid fluid to enter the colon slowly. If cramping occurs, the nurse should clamp off the tubing and allow the patient to rest before progressing. Water should flow in over a 5- to 10-minute period.