Chapter 47: Management of Patients With Intestinal and Rectal Disorders

The nurse is reviewing the laboratory test results of a client with Crohn's disease. Which of the following would the nurse most likely find? Decreased white blood cell count Negative stool cultures Decreased erythrocyte sedimentation rate Increased albumin levels

Negative stool cultures Stool cultures fail to reveal an etiologic microorganism or parasite, but occult blood and white blood cells (WBCs) often are found in the stool. Results of blood studies indicate anemia from chronic blood loss and nutritional deficiencies. The WBC count and erythrocyte sedimentation rate may be elevated, confirming an inflammatory disorder. Serum protein and albumin levels may be low because of malnutrition.

A client has a 10-year history of Crohn's disease and is seeing the physician due to increased diarrhea and fatigue. What is the recommended dietary approach to treat Crohn's disease? low-fiber diet dietary approach varies. lactose-rich foods high-fiber diet

dietary approach varies. The dietary approach varies. A high-fiber diet may be indicated when it is desirable to add bulk to loose stools. A low-fiber diet may be indicated in cases of severe inflammation or stricture. A high-calorie and high-protein diet helps replace nutritional losses from chronic diarrhea. The client may need nutritional supplements, depending on the area of the bowel affected. When the small intestine is inflamed, some clients experience lactose intolerance, requiring avoidance of lactose-rich foods.

Which is one of the primary symptoms of irritable bowel syndrome (IBS)? Bloating Pain Diarrhea Abdominal distention

Diarrhea 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 resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation? increased fiber lack of exercise lack of free water intake lack of solid food

lack of free water intake A client who cannot swallow food cannot drink enough water to meet daily needs. Inadequate fluid intake is a common cause of constipation.

A client with enteritis reports frequent diarrhea. What assessment should the nurse should anticipate? metabolic acidosis respiratory acidosis respiratory alkalosis metabolic alkalosis

metabolic acidosis Diarrhea causes a bicarbonate deficit. With loss of the relative alkalinity of the lower GI tract, the relative acidity of the upper GI tract predominates, leading to metabolic acidosis. Loss of acid, which occurs with severe vomiting, may lead to metabolic alkalosis. Diarrhea doesn't lead to respiratory acid-base imbalances, such as respiratory acidosis and respiratory alkalosis.

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? Wearing an appliance pouch only at bedtime Increasing fluid intake to prevent dehydration Taking only enteric-coated medications Consuming a low-protein, high-fiber diet

Increasing fluid intake to prevent dehydration 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.

The presence of mucus and pus in the stools suggests which condition? Small-bowel disease Intestinal malabsorption Ulcerative colitis Disorders of the colon

Ulcerative colitis The presence of mucus and pus in the stools suggests ulcerative colitis. 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.

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? "I need to use laxatives regularly to prevent constipation." "I should exercise four times per week." "I need to drink 2 to 3 liters of fluids every day." "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread."

"I need to use laxatives regularly to prevent constipation." 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 of the following would a nurse expect to assess in a client with peritonitis? Hyperactive bowel sounds Board-like abdomen Decreased pulse rate Deep slow respirations

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

In women, which of the following types of cancer exceeds colorectal cancer? Breast Skin Liver Lung

Breast In women, only incidences of breast cancer exceed that of colorectal cancer. In men, only incidences of prostate cancer and lung cancer exceed that of colorectal cancer.

A client has been recently diagnosed with an anorectal condition. The nurse is reviewing interventions that will assist the client with managing the therapeutic regimen. What would not be included? Encourage the client to follow diet and medication instructions. Encourage the client to avoid exercise. Instruct the client to cleanse perianal area with warm water. Teach the client how to do sitz baths at home using warm water three to four times each day.

Encourage the client to avoid exercise. Activity promotes healing and normal stool patterns. Proper cleansing prevents infection and irritation. Sitz baths promote healing, decrease skin irritation, and relieve rectal spasms. Encouragement promotes compliance with therapeutic regimen and prevents complications.

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? Familial polyposis Low-fat, low-protein, high-fiber diet Age younger than 40 years History of skin cancer

Familial polyposis Family history of colon cancer or familial polyposis is a risk factor for colorectal cancer. Age older than 40 years and a high-fat, high-protein, low-fiber diet are risk factors for colorectal cancer. A history of skin cancer is not a recognized risk factor for colorectal cancer.

Crohn's disease is a condition of malabsorption caused by which pathophysiological process? Gastric resection Inflammation of all layers of intestinal mucosa Infectious disease Disaccharidase deficiency

Inflammation of all layers of intestinal mucosa Crohn's disease, also known as regional enteritis, can occur anywhere along the gastrointestinal tract but most commonly at the distal ileum and in the colon. Infectious disease causes problems such as small-bowel bacterial overgrowth, leading to malabsorption. Disaccharidase deficiency leads to lactose intolerance. Postoperative malabsorption occurs after gastric or intestinal resection.

A client with a diagnosis of acute appendicitis is awaiting surgical intervention. The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and board-like. What complication does the nurse determine may be occurring at this time? Peritonitis Constipation Accumulation of gas Paralytic ileus

Peritonitis Lack of bowel motility typically accompanies peritonitis. The abdomen feels rigid and board-like as it distends with gas and intestinal contents. Bowel sounds typically are absent. The diagnosis of acute appendicitis correlates with the symptoms of rupture of the appendix and peritonitis. A paralytic ileus and gas alone do not produce these symptoms.

Which of the following is the most common symptom of a polyp? Rectal bleeding Anorexia Abdominal pain Diarrhea

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

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: fissure. fistula. pilonidal cyst. hemorrhoid.

fissure 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 nurse is preparing a presentation for a local community group of older adults about colon cancer. What would the nurse include as the primary characteristic associated with this disorder? Abdominal distention Abdominal pain Frank blood in the stool A change in bowel habits

A change in bowel habits Although abdominal distention and blood in the stool (frank or occult) may be present, the chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Abdominal pain is a late sign.

A client has developed an anorectal abscess. Which client is at most risk for the development of this type of abscess? A client with diverticulosis A client with hemorrhoids A client with Crohn's disease A client with colon cancer

A client with Crohn's disease An anorectal abscess is common in clients with Crohn's disease. The other disorders do not predispose the client to risk for anorectal abscess.

After assessing a client with peritonitis, how would the nurse most likely document the client's bowel sounds? Mild High-pitched Hyperactive Absent

Absent Since lack of bowel motility typically accompanies peritonitis, bowel sounds are absent. Therefore, the nurse will not observe mild, high-pitched, or hyperactive bowel sounds.

The nurse is performing a rectal assessment and notices a longitudinal tear or ulceration in the lining of the anal canal. The nurse documents the finding as which condition? Anal fistula Anorectal abscess Hemorrhoid Anal fissure

Anal fissure Fissures are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety (leading to constipation). An anorectal abscess is an infection in the pararectal spaces. An anal fistula is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus. A hemorrhoid is a dilated portion of vein in the anal canal.

A client with anorexia reports constipation. Which nursing measure would be most effective in helping the client reduce constipation? Assist client to increase dietary fiber. Obtain complete food history. Provide adequate quantity of food. Obtain medical and allergy history.

Assist client to increase dietary fiber. The nurse should assist the client to increase the dietary fiber in food because it helps reduce constipation. Providing an adequate quantity of food is necessary in maintaining sufficient nutrition and in sustaining normal body weight. Obtaining medical, allergy, and food history would provide valuable information, however, it would not help reduce constipation.

The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition? Borborygmus Azotorrhea Diverticulitis Tenesmus

Borborygmus Borborygmus is the intestinal rumbling caused by the movement of gas through the intestines that accompanies diarrhea. Tenesmus refers to ineffectual straining at stool. Azotorrhea refers to excess of nitrogenous matter in the feces or urine. Diverticulitis refers to inflammation of a diverticulum from obstruction (by fecal matter) resulting in abscess formation.

A patient with IBD would be encouraged to increase fluids, use vitamins and iron supplements, and follow a diet designed to reduce inflammation. Select the meal choice that would be recommended for a low-residue diet. A peanut butter sandwich and fruit cup A fruit salad with yogurt Broiled chicken with low-fiber pasta Salami on whole grain bread and V-8 juice

Broiled chicken with low-fiber pasta A low-residue, high-protein, and high-calorie diet is recommended to reduce the size and number of stools. Foods to avoid include yogurt, fruit, salami, and peanut butter.

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? Clamp the tubing and give the patient a rest period. Inform the patient that it will only last a minute and continue with the procedure. Stop the irrigation and remove the tube. Replace the fluid with cooler water since it is probably too warm.

Clamp the tubing and give the patient a rest period. 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.

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? Flexible sigmoidoscopy CT scan Barium enema Colonoscopy

Colonoscopy Diverticulosis is typically diagnosed by colonoscopy, which permits visualization of the extent of diverticular disease and biopsy of tissue to rule out other diseases. In the past, barium enema was the preferred diagnostic test, but it is now used less frequently than colonoscopy. CT with contrast agent is the diagnostic test of choice if the suspected diagnosis is diverticulitis; it can also reveal abscesses.

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

Constipation 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.

An older adult client seeks help for chronic constipation. What factor related to aging can cause constipation in elderly clients? Decreased production of hydrochloric acid Increased intestinal motility Decreased abdominal strength Increased intestinal bacteria

Decreased abdominal strength Decreased abdominal strength, muscle tone of the intestinal wall, and motility all contribute to chronic constipation in the elderly. A decrease in hydrochloric acid causes a decrease in absorption of iron and vitamin B12, whereas an increase in intestinal bacteria actually causes diarrhea.

A client underwent a continent ileostomy. Within which time frame should the client expect to empty the reservoir? At least once every 2 days Every 4 to 6 hours Three or four times daily At least once a day

Every 4 to 6 hours The length of time between drainage periods is gradually increased until the reservoir needs to be drained only every 4 to 6 hours and irrigated once each day. This prevents the accumulating effluent from spilling or causing infection.

An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to? Hypernatremia Hyponatremia Hypokalemia Hyperkalemia

Hypokalemia The older client taking digitalis must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

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

Low residue Oral fluids and a low-residue, 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.

Vomiting results in which of the following acid-base imbalances? Metabolic alkalosis Respiratory acidosis Metabolic acidosis Respiratory alkalosis

Metabolic alkalosis Vomiting results in loss of hydrochloric acid (HCl) and potassium from the stomach, leading to a reduction of chlorides and potassium in the blood and to metabolic alkalosis.

Which of the following is considered a bulk-forming laxative? Dulcolax Mineral oil Milk of Magnesia Metamucil

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

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? Nausea and vomiting Decrease in urine production Mucosal edema Mucus in the stool

Nausea and vomiting 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.

The nurse is admitting a client with a diagnosis of diverticulitis and assesses that the client has a board-like abdomen, no bowel sounds, and reports of severe abdominal pain. What is the nurse's first action? Start an IV with lactated Ringer's solution. Notify the health care provider. Administer a retention enema. Administer an opioid analgesic.

Notify the health care provider. Abdominal pain, a rigid board-like abdomen, loss of bowel sounds, and signs and symptoms of shock occur with peritonitis. Peritonitis is typically a life-threatening emergency that requires prompt surgical intervention, and typically involves postoperative critical care monitoring due to the risk of sepsis, organ failure, and subsequent infections; thus, the nurse should notify the health care provider.

When interviewing a client with internal hemorrhoids, what would the nurse expect the client to report? Itching Soreness Rectal bleeding Pain

Rectal bleeding Internal hemorrhoids cause bleeding but are less likely to cause pain, unless they protrude through the anus. External hemorrhoids may cause few symptoms, or they can produce pain, itching, and soreness of the anal area.

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location? Right upper quadrant Right lower quadrant Left lower quadrant Left upper quadrant

Right lower quadrant The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

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? Prepare the client for a gastrostomy tube placement. Test all stools for occult blood. Administer morphine (Duramorph PF) routinely, as ordered. Administer topical ointment to the rectal area to decrease bleeding.

Test all stools for occult blood. 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

Which is a true statement regarding regional enteritis (Crohn's disease)? It is characterized by pain in the lower left abdominal quadrant. The clusters of ulcers take on a cobblestone appearance. The lesions are in continuous contact with one another. It has a progressive disease pattern.

The clusters of ulcers take on a cobblestone appearance. The clusters of ulcers take on a cobblestone appearance. It is characterized by remissions and exacerbations. The pain is located in the lower right quadrant. The lesions are not in continuous contact with one another and are separated by normal tissue.

A client describes being constipated, but also experiencing abdominal cramping, pain, and urgent diarrhea. These symptoms occur more often when the client is nearing a deadline or is under emotional stress. What would be recommended to treat these symptoms? Select all that apply. cholinergic low-residue diet psyllium high-fiber diet

high-fiber diet psyllium Dietary changes reduce flatulence and abdominal discomfort. A high-fiber diet (30 to 40 g/day) or a bulk-forming agent, such as products containing psyllium, is prescribed to regulate bowel elimination. The fiber draws water into constipated stool and adds bulk to watery stool. An anticholinergic, such as dicyclomine (Bentyl), has an antispasmodic effect if taken before meals.

A client is scheduled to undergo rhinoplasty in the morning, and reports medications used on a daily basis, which the nurse records on the client's chart. Which daily medications have the potential to result in constipation? NSAIDs multivitamin without iron acetaminophen laxative

laxative Constipation may also result from chronic use of laxatives ("cathartic colon")because such use can cause a loss of normal colonic motility and intestinal tone. Laxatives also dull the gastrocolic reflex.

An older adult client in a long term care facility is concerned about bowel regularity. During a client education session, the nurse reinforces the medically acceptable definition of "regularity." What is the actual measurement of "regular"? one bowel movement every other day one bowel movement daily two bowel movements daily stool consistency and client comfort

stool consistency and client comfort Normal bowel patterns range from three bowel movements per day to three bowel movements per week. 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.

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's: current medications. activity levels. alcohol consumption. usual pattern of elimination.

usual pattern of elimination. Constipation has many possible reasons; assessing the client's usual pattern of elimination is the first step in identifying the cause.

A client with Crohn's disease is to receive prednisone as part of the treatment plan. Which of the following instructions would be appropriate? "Avoid contact with other people who might have an infection." "Make sure to increase your salt intake to compensate for the loss of fluid." "Once your symptoms improve, you can stop taking the drug." "Take the drug on an empty stomach to avoid upsetting your stomach."

"Avoid contact with other people who might have an infection." Clients taking corticosteroids may not experience a normal immune response to infection. The client needs to monitor himself or herself for signs and symptoms of infection and to avoid situations where they may be exposed to infection, such as others who might be ill. The drug should be taken with meals to decrease gastrointestinal irritation and should be withdrawn or tapered slowly to prevent Addisonian crisis. Clients also need to limit their sodium intake or follow a low-sodium diet to minimize water retention associated with this drug.

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? "I don't understand why this happened again; I didn't travel out of the country." "I don't understand this; I took the medication the doctor ordered and followed the diet." "I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." "I don't like oatmeal, so it doesn't matter that I can't have it."

"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." 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.

A community health nurse is performing a home visit to a 53-year-old patient who requires twice-weekly wound care on her foot. The patient mentions that she is currently having hemorrhoids, a problem that she has not previously experienced. What treatment measure should the nurse recommend to this patient? Daily application of topical antibiotics Decreased fluid intake A high-fiber diet with increased fruit intake Bathing, rather than showering, once per day

A high-fiber diet with increased fruit intake Hemorrhoid symptoms and discomfort can be relieved by good personal hygiene and by avoiding excessive straining during defecation. A high-residue diet that contains fruit and bran along with an increased fluid intake may be all the treatment necessary to promote the passage of soft, bulky stools to prevent straining. It is unnecessary to avoid showering, and antibiotics are not an effective treatment.

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? Tenesmus Borborygmus Peristalsis Loud bowel sounds

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

A client informs the nurse that he has been having abdominal pain that is relieved when having a bowel movement. The client states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder? Blood and mucus in the stool Client is awakened from sleep due to abdominal pain. Weight loss due to malabsorption Chronic constipation with sporadic bouts of diarrhea

Chronic constipation with sporadic bouts of diarrhea Most clients with irritable bowel syndrome (IBS) describe having chronic constipation with sporadic bouts of diarrhea. Some report the opposite pattern, although less commonly. Most clients experience various degrees of abdominal pain that defecation may relieve. Weight usually remains stable, indicating that when diarrhea occurs, malabsorption of nutrients does not accompany it. Stools may have mucus, but blood is not usually found because the bowel is not locally inflamed. The sleep is not disturbed from abdominal pain.

A client is having a diagnostic workup for reports of frequent diarrhea, right lower abdominal pain, and weight loss. The nurse is reviewing the results of the barium study and notes the presence of "string sign." What does the nurse understand that this is significant of? Crohn's disease Diverticulitis Ulcerative colitis Irritable bowel syndrome

Crohn's disease The most conclusive diagnostic aid for Crohn's disease has classically been a barium study of the upper GI tract that shows a "string sign" on an x-ray film of the terminal ileum, indicating the constriction of a segment of intestine.

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? Pain Dehydration Fluid overload Fatigue

Dehydration 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.

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? Dry skin thoroughly after washing Apply triamcinolone acetonide spray Apply barrier powder Dust with nystatin powder

Dry skin thoroughly after washing 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.

A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of: Inflammatory colitis. A small bowel disorder. Intestinal malabsorption. A disorder of the large bowel.

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

Celiac sprue is an example of which category of malabsorption? Postoperative malabsorption Mucosal disorders causing generalized malabsorption Infectious diseases causing generalized malabsorption Luminal problems causing malabsorption

Mucosal disorders causing generalized malabsorption In addition to celiac sprue, regional enteritis and radiation enteritis are examples of mucosal disorders. Examples of infectious diseases causing generalized malabsorption include small-bowel bacterial overgrowth, tropical sprue, and Whipple disease. Examples of luminal problems causing malabsorption include bile acid deficiency, Zollinger-Ellison syndrome, and pancreatic insufficiency. Postoperative gastric or intestinal resection can result in development of malabsorption syndromes.

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? Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage. The appendix may develop gangrene and rupture, especially in a middle-aged client. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. 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.

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? Pelvic abscess Peritonitis Ileus Hemorrhage

Peritonitis 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.

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? The client's natural bowel function may become sluggish. The client may develop inflammatory bowel disease. The client may lose his or her appetite. The client may develop arthritis or arthralgia.

The client's natural bowel function may become sluggish. 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.

A client informs the nurse that he is 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? The laxative is safe to take with other medication the client is taking. The client should take a fiber supplement along with the stimulant laxative. They can be habit forming and will require increasing doses to be effective. As long as the client is drinking 8 glasses of water per day, he can continue to take them.

They can be habit forming and will require increasing doses to be effective. 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.

A client is admitted to the emergency department with reports right lower quadrant pain. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the health care provider immediately? Hematocrit 42% White blood cell (WBC) count 22.8/mm3 Serum potassium 4.2 mEq/L Serum sodium 135 mEq/L

White blood cell (WBC) count 22.8/mm3 The nurse should report the elevated WBC count. This finding, which is a sign of infection, indicates that the client's appendix might have ruptured. Hematocrit of 42%, serum potassium of 4.2 mEq/L, and serum sodium of 135 mEq/L are within normal limits. Alterations in these levels don't indicate appendicitis.

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

high-fiber diet. A high-fiber diet is prescribed to help control diarrhea and constipation. 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 nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find? jaundice and vomiting rectal bleeding and a change in bowel habits severe abdominal pain with direct palpation or rebound tenderness tenderness and pain in the right upper abdominal quadrant

severe abdominal pain with direct palpation or rebound tenderness 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.