Chapter 29: Bowel Elimination

The nurse is instructing a patient about performing home testing for fecal occult blood. What food should the patient state to avoid eating for 3 days before the test? 1) Beef 2) Milk 3) Eggs 4) Oatmeal

1

The nurse notes that a client has a loop colostomy. What should the nurse ensure when providing care to this client? 1) Plastic rod is in place. 2) Irrigations occur every day. 3) Ostomy appliance is changed every 6 hours. 4) Bedside commode is in place for bowel evacuation.

1

The nurse prepares an educational program on irritable bowel syndrome for a group of clients. What should the nurse emphasize as the role of the small intestine? Select all that apply. 1) Digests lipids 2) Secretes mucus 3) Absorbs vitamins 4) Processes chyme 5) Absorbs carbohydrates

1 3 4 5

The nurse in a long-term care facility is teaching a group of residents about increasing dietary fiber. Which foods should the nurse explain are high in fiber? 1) White bread, pasta, and white rice 2) Oranges, raisins, and strawberries 3) Whole milk, eggs, and bacon 4) Peaches, orange juice, and bananas

2

The nurse must irrigate the colostomy of a patient who is unable to move independently. How should the nurse position the patient for this procedure? 1) Semi-Fowler's position 2) Left side-lying position 3) Supine with the head of the bed lowered flat 4) Supine with the head of bed raised to 30 degrees

2

A client with sluggish bowel movements asks what causes evacuation to occur. What muscle activity should the nurse explain to this client? Select all that apply. 1) Flatus 2) Peristalsis 3) Mass peristalsis 4) Haustral churning 5) Valsalva maneuver

2 3 4

A nurse is teaching wellness to a women's group. The nurse should explain the importance of consuming at least how many 8-ounce servings of fluid to promote healthy bowel function? 1) 2 to 3 2) 4 to 5 3) 6 to 8 4) 9 to 10

3

The nurse plans care for a client who is bedridden. Which laxative should be avoided to treat constipation in this client? 1) Osmotic 2) Stimulant 3) Mineral oil 4) Stool softener

3

The nurse prepares teaching material for a client scheduled for an ileostomy. What information is essential to include when teaching this client? 1) It is usually temporary. 2) Irrigation can control bowel movements. 3) An ostomy device must be worn at all times. 4) Changing the diet can control bowel movements.

3

Which food item should the nurse instruct the patient to consume to prevent or treat constipation? 1) Milk and cheese 2) Bread and pasta 3) Fruits and vegetables 4) Lean meats

3

Which is a key treatment intervention for the patient admitted with diverticulitis? 1) Antacid 2) Antidiarrheal agent 3) Antibiotic therapy 4) NSAIDs

3

A client is scheduled for surgery to create a temporary ostomy. What should the nurse emphasize when teaching about this bowel diversion? 1) Produces solid feces 2) Creates two separate stomas 3) Bypasses the large intestine 4) Permits the bowel to rest and heal

4

A patient with a colostomy complains to the nurse, "I am noticing really bad odors coming from my pouch." To help control odor, which foods should the nurse advise the patient to consume? 1) White rice and toast 2) Tomatoes and dried fruit 3) Asparagus and melons 4) Yogurt and parsley

4

The nurse auscultates low-pitched infrequent bowel sounds in a patient recovering from a bowel resection. How should this finding be documented? 1) Hyperactive bowel sounds 2) Abdominal bruit sounds 3) Normal bowel sounds 4) Hypoactive bowel sounds

4

A mother of a school-age child seeks healthcare because her child has had diarrhea after being ill with a viral infection. The patient states that after vomiting for 24 hours, his appetite has returned. Which recommendation should the nurse make to this mother? a) Consume a diet consisting of bananas, white rice, applesauce, and toast. b) Drink large quantities of water regularly to prevent dehydration. c) Take loperamide [an antidiarrheal] as needed to control diarrhea. d) Increase the consumption of raw fruits and vegetables.

a

A patient is diagnosed with an intestinal infection after traveling abroad. The nurse should encourage the intake of which food to promote healing? a) Yogurt b) Pasta c) Oatmeal d) Broccoli

a

A patient with severe hemorrhoids is incontinent of liquid stool. Which of the following interventions is contraindicated? a) Apply an indwelling fecal drainage device. b) Apply an external fecal collection device. c) Place an incontinence garment on the patient. d) Place a waterproof pad under the patient's buttocks.

a

The nurse assesses a patient's abdomen 4 days after abdominal surgery and notes that bowel sounds are absent. This finding most likely suggest which postoperative complication? a) Paralytic ileus b) Small bowel obstruction c) Diarrhea d) Constipation

a

Which action should the nurse take to assess a 2-year-old child for pinworms? a) Press clear cellophane tape against the anal opening at night to obtain a specimen. b) Collect a freshly passed stool from a diaper using a wooden specimen blade. c) Place a smear of stool on a slide and add two drops of reagent. d) Prepare the patient for a flat plate (x-ray) of the abdomen.

a

The nurse is performing a focused bowel assessment on an older adult. Which of the following physiological changes of aging should alert the nurse to an increased risk for problems associated with bowel elimination? Select all that apply. a) Decreased sphincter control b) Decreased peristalsis c) Increased intestinal muscle tone d) Decreased physical activity

a b

Which factors place the patient at risk for constipation? Select all that apply. a) Sedentary lifestyle b) High-dose calcium therapy c) Lactose intolerance d) Spicy food consumption

a b

Which of the following populations are considered high risk for the development of hemorrhoids? Select all that apply. a) Pregnant women b) School bus drivers c) Marathon runners d) Intensive care unit nurses

a b

A day after abdominal surgery, a postoperative patient on a surgical unit says to the nurse, "I'm having a problem with a lot of gas. Maybe it's the food I'm eating." What is the appropriate response by the nurse? Select all that apply. a) "If the problem continues after you go home, you'll need to avoid gas-producing foods such as beans." b) "Let's get you out of bed and walking more. This can help with your gas." c) "When was your last bowel movement? You may be a bit constipated." d) "I understand. I'll have to call the doctor for an insertion of a rectal tube."

a b c

Older adults are more likely to use laxatives with regularity. In advising an older adult practicing this habit, the nurse would identify which of the following factors? Select all that apply. a) Consistent use of laxatives inhibits natural defecation reflexes, and is thought to cause rather that cure constipation. b) Habitual use of laxatives may lead to the need for ever-increasing dosages until the intestine fails to work properly. c) Laxatives may interfere with fluid and electrolyte balance. d) Laxatives increase the absorption of certain vitamins.

a b c

The mother of a 3-month-old infant comes to emergency department and states, "My baby has been having severe diarrhea for 4 days. She is crying all the time." In formulating the plan of care to moderate the diarrhea, the nurse focuses her intervention(s) on which of the following? Select all that apply. a) Fluid management b) Electrolyte balance c) Skin integrity d) Excessive crying

a b c

The pediatric nurse educator is teaching a group of parents about distinguishing between food allergies and food intolerance. The nurse should teach parents that which of the following is/are considered to be true food allergens? Select all that apply. a) Egg whites b) Shellfish c) Peanuts d) Corn

a b c

The community health nurse is preparing a teaching plan on food choices that promote normal bowel elimination. Which of the following foods should the nurse teach patients to be sure to include in their diet? Select all that apply. a) Fresh fruits b) Lean meats c) Whole-grain cereals

a c

The nursing instructor is teaching students how to use a fracture pan for patients who are unable to move or turn independently. What are the most appropriate instructions for this procedure? Select all that apply. a) Obtain help from another healthcare worker. b) Elevate the head of the bed before placing the pan under the patient. c) Place the wide, rounded end of the pan toward the front of the patient. d) Assist the patient to a side-lying position prior to placing the bedpan

a c d

Considering normal developmental and physical maturation in children, for which age would a goal of "Achieves bowel control by the end of this month" be most realistic? a) 18 months b) 3 years c) 4 years d) 5 years

b

The healthcare team suspects that a patient has an intestinal infection. Which action should the nurse take to help confirm the diagnosis? a) Prepare the patient for an abdominal flat plate. b) Collect a stool specimen that contains 20 to 30 mL of liquid stool. c) Administer a laxative to prepare the patient for a colonoscopy. d) Test the patient's stool using a fecal occult test.

b

The nurse is performing a colostomy irrigation on a male client. During the irrigation, the client begins to complain of abdominal cramps. What is the appropriate nursing action? a) Notify the physician. b) Stop the irrigation temporarily. c) Increase the height of the irrigation. d) Medicate for pain and resume the irrigation.

b

When changing a diaper, the nurse observes that a 2-day-old infant has passed a green-black, tarry stool. What should the nurse do? a) Notify the provider immediately. b) Do nothing; this is normal. c) Give the baby sterile water until the mother's milk comes in. d) Apply a skin barrier cream to the buttocks to prevent irritation.

b

The nurse is caring for a patient on the medical-surgical unit. The patient states, "I really don't like to talk about my bowel movements, but what is considered a normal bowel movement?" What is the best response by the nurse? Select all that apply. a) "We usually like to set an acceptable standard of at least one bowel movement per week." b) "We can say normal frequency is anything from several times a day to once per week. It depends on your normal pattern." c) "We also consider whether you have to strain with bowel movements, use laxatives, or have to rush to the toilet." d) "There is no such thing as normal. All people are different, so don't worry about it."

b c

The nurse must administer an enema to an adult patient with constipation. Which of the following would be a safe and effective distance for the nurse to insert the tubing into the patient's rectum? Select all that apply. a) 2 in. (5.1 cm) b) 3 in. (7.6 cm) c) 4 in. (10.2 cm) d) 5 in. (12.7 cm)

b c

A patient has a history of chronic constipation. Which of the following medications prescribed for the patient would alert the nurse to be especially vigilant in observing for constipation and teach the client about preventive measures? Select all that apply. a) NSAIDs b) Iron c) Antibiotics d) Pain medications

b d

Which of the following tasks may be delegated to a CNA or NAP? Select all that apply. a) Irrigating a newly created colostomy b) Collecting and testing a stool sample for occult blood c) Digitally removing stool as a result of a fecal impaction d) Assisting with placing a fracture pan on an immobile patient

b d

A nurse is teaching wellness to a women's group. The nurse should explain the importance of consuming at least how much fluid to promote healthy bowel function (assume these are 8-ounce glasses)? a) 3 to 4 glasses a day b) 5 to 6 glasses a day c) 7 to 8 glasses a day d) 9 to 10 glasses a day

c

A patient has a colostomy in the descending (sigmoid) colon and wants to control bowel evacuation and possibly stop wearing an ostomy pouch. To help achieve this goal, the nurse should teach the patient to: a) Call the primary care provider if the stoma becomes pale, dusky, or black b) Limit the intake of gas-forming foods such as cabbage, onions, and fish c) Irrigate the stoma to produce a bowel movement on a schedule d) Avoid returning to the use of an ostomy appliance if he becomes ill

c

A patient with a skin infection is prescribed cephalexin (an antibiotic) 500 mg orally q 12 hours. The patient complains that the last time he took this medication, he had frequent episodes of loose stools. Which recommendation should the nurse make to the patient? a) Stop taking the drug immediately if diarrhea develops. b) Take an antidiarrheal agent, such as diphenoxylate. c) Consume yogurt daily while taking the antibiotic. d) Increase your intake of fiber until the diarrhea stops.

c

The nurse is instructing a patient about performing home testing for fecal occult blood. The nurse should explain that ingestion of which substance may cause a false-negative fecal occult blood test? a) Vitamin D b) Iron c) Vitamin C d) Thiamine

c

The nurse is obtaining a bowel elimination history from her 80-year-old patient. The patient states, "Sometimes when I go to the bathroom I push real hard, hold my breath, and plug my nose." Which action should the nurse take first? a) Warn the patient, "You should not hold your breath while straining." b) Assure the patient, "This does seem to help some people to have a bowel movement." c) Check the patient's medical history for heart disease, glaucoma, increased intracranial pressure, or a new surgical wound. d) Notify the primary care provider that the patient has reported performing this action.

c

The nurse is seeing a patient at home with a new colostomy. In formulating the plan of care, what is the priority long-term goal for this patient? The patient will: a) Adjust emotionally to the colostomy and lifestyle change b) Verbalize appropriate steps in caring for his colostomy c) Assume self-care in colostomy management d) Experience soft stool with minimal flatus

c

Which of the following structures is considered a vestigial organ? a) Sigmoid colon b) Rectum c) Appendix d) Internal sphincter of the anus

c

A patient who has been immobile since sustaining injuries in a motor vehicle accident complains of constipation. The nurse encourages him to consume 8 to 10 eight-ounce glasses of fluid daily. Which fluids should the patient avoid because of the diuretic effect? Select all that apply. a) Cranberry juice b) Water c) Coffee d) Ginger ale e) Tea

c e

A bowel prep "until clear" is prescribed for the female client scheduled for a colonoscopy. The client begins to experience diarrhea following administration of the solution. What action by the nurse is appropriate? a) Start an IV infusion. b) Administer an enema. c) Cancel the diagnostic test. d) Explain that diarrhea is expected.

d

The enterostomal nurse is conducting a teaching session for patients with new colostomies. Today's topic is self-assessment and signs and symptoms that must be immediately reported to the surgeon. Which sign/symptom should the nurse include in this teaching? a) Constipation b) Skin breakdown c) A stoma that is deep pink to red in color d) A stoma that is pale, dusky, or black in color

d

The nurse educates a patient about the primary risk factors for irritable bowel syndrome. Which behavior by the patient would be evidence of learning? The patient: a) Reduces her intake of gluten-containing products b) Does not consume foods that contain lactose c) Consumes only four cups of caffeinated coffee per day d) Takes measures to reduce her stress level

d

The nurse is preparing a patient for an invasive diagnostic test that will provide direct visualization of the rectum, entire large intestine, and distal small bowel. The nurse should teach and give the patient written instructions about which of the following tests? a) Barium enema b) Ultrasound of the abdomen c) Sigmoidoscopy d) Colonoscopy

d

Which collaborative interventions will help prevent paralytic ileus in a patient who underwent right hemicolectomy for colon cancer? a) Administer morphine 4 mg intravenously every 2 hours for pain. b) Administer IV fluids at 125 mL/hr. c) Insert an indwelling urinary catheter to monitor I&O. d) Keep the patient NPO until bowel sounds return.

d