Chapter 47 review questions

A patient has not had a bowel movement for 4 days. Now she has nausea and severe cramping throughout her abdomen. On the basis of these findings, what should the nurse suspect? A) An intestinal obstruction B) Irritation of the intestinal mucosa C) Gastroenteritis D) A fecal impaction

Answer: A Rational: Absence of bowel movement, nausea, cramping, and possibly vomiting are characteristic of an intestinal obstruction.

Which skills must a patient with a new colostomy be taught before discharge from the hospital? (Select all that apply.) A) How to change the pouch B) How to empty the pouch C) How to open and close the pouch D) How to irrigate the colostomy

Answer: A,B,C Rational: The patient must be able to do these tasks to successfully manage his or her colostomy when going home.

An elderly patient comes to the hospital with a complaint of severe weakness and diarrhea for several days. Of the following problems, which is the most important to assess initially? A) Malnutrition B) Dehydration C) Skin breakdown D) Incontinence

Answer: B Rational: Dehydration caused by fluid loss from the intestinal tract is an immediate and possibly dangerous consequence of diarrhea

The nurse should do which of the following when placing a bedpan under an immobilized patient? A) Lift the patient's hips off the bed and slide the bedpan under the patient B) After positioning the patient on the bedpan, elevate the head of the bed to a 45-degree angle C) Adjust the head of the bed so it is lower than the feet and use gentle but firm pressure to push the bedpan under the patient E) Have the patient stand beside the bed and then have him or her sit on the bedpan on the edge of the bed

Answer: B Rational: Elevating the head of the bed allows the patient the most normal and comfortable position for defecation on a bedpan

The nurse is caring for a patient with an ileostomy. Which intervention is most important? A) Cleansing the stoma with hot water B) Inserting a deodorant tablet in the stoma bag C) Selecting or cutting a pouch with an appropriate-size stoma opening D) Wearing sterile gloves while caring for the stoma

Answer: C Rational: A properly fitting pouch that does not leave skin exposed prevents peristomal skin breakdown.

The nurse is taking a health history of a newly admitted patient with a diagnosis of possible fecal impaction. Which of the following is the priority question to ask the patient or caregiver? A) Have you eaten more high-fiber foods lately? B) Are your bowel movements soft and formed? C) Have you experienced frequent, small liquid stools recently? D) Have you taken antibiotics recently?

Answer: C Rational: Frequent or continuous oozing of liquid stools occurs when liquid fecal matter above the impacted stool seeps around the fecal impaction

Which of the following may cause Clostridium difficile infection? (Select all that apply.) A) Chronic laxative use B) Contact with C. difficile bacteria C) Overuse of antibiotics D) Frequent episodes of diarrhea caused by food intolerance E) Inflammation of the bowel

Answer: C,D Rational: These are the two main causes of C. difficile infection.

Which of the following symptoms are warning signs of possible colorectal cancer according to the American Cancer Society guidelines? (Select all that apply.) A) Change in bowel habits B) Blood in the stool C) A larger-than-normal bowel movement D) Fecal impaction E) Muscle aches F) Incomplete emptying of the colon Food particles in the stool Unexplained abdominal or back pain

Answer: A,B,F, H Rational: According to the American Cancer Society current guidelines, anyone with these symptoms should seek medical evaluation because they may have colon cancer. Other conditions may also cause these symptoms; but, if colon cancer is present, early diagnosis is important.

Which are key points that the nurse should include in patient education for a person with complaints of chronic constipation? (Select all that apply.) A) Increase fiber and fluids in the diet B) Use a low-volume enema daily C) Avoid gluten in the diet D) Take laxatives twice a day E) Exercise for 30 minutes every day F) Schedule time to use the toilet at the same time every day G) Take probiotics 5 times a week

Answer: A,E,F Rational: These steps are the initial ones to take to resolve chronic problems with constipation before considering regular laxative or enema use.

Match the following steps for administering a prepackaged enema with the correct order in which they occur. 1. Insert enema tip gently in the rectum. 2. Help patient to bathroom when he or she feels urge to defecate. 3. Position patient on side. 4. Perform hand hygiene and apply clean gloves. 5. Squeeze contents of container into rectum. 6. Explain procedure to the patient. A) 6, 3, 4, 1, 5, 2 B) 6, 4, 1, 3, 2, 5 C) 4, 6, 3, 1, 2, 5 D) 6, 4, 3, 1, 5, 2

Answer: D Rational: These steps are used to administer a prepackaged enema.

During the nursing assessment a patient reveals that he has diarrhea and cramping every time he has ice cream. He attributes this to the cold nature of the food. However, the nurse begins to suspect that these symptoms are associated with what problem? A) Food allergy B) Irritable bowel C) Increased peristalsis D) Lactose intolerance

Answer: D Rational: These symptoms are consistent with lactose intolerance, and they occur with ingestion of dairy products.

What is the correct order for an ostomy pouch change? 1. Close the end of the pouch. 2. Measure the stoma. 3. Cut the hole in the wafer. 4. Press the pouch in place over the stoma. 5. Remove the old pouch. 6. Trace the correct measurement onto the back of the wafer. 7. Assess the stoma and the skin around it. 8. Cleanse and dry the peristomal skin. A) 5, 8, 2, 7, 3, 6, 4, 1 B) 8, 5, 6, 2, 7, 3, 4, 1 C) 8, 5, 7, 6, 2, 3, 4, 1 D) 5, 8, 7, 2, 6, 3, 4, 1

Answer: D Rational: This order of tasks describes the correct way to change an ostomy pouch.

During the administration of a warm tap-water enema, the patient complains of cramping abdominal pain that he rates 6 out of 10. What is the first thing the nurse should do? A) Stop the instillation B) Ask the patient to take deep breaths to decrease the pain C) Add soapsuds to the enema D) Tell the patient to bear down as he would when having a bowel movement

Answer:A Rational: When a patient complains of pain during an enema, the instillation should be stopped, and an assessment done before discontinuing or resuming the procedure.

When a patient has fecal incontinence as a result of cognitive impairment, it may be helpful to teach caregivers to do which of the following interventions? A) Cleanse the skin with antibacterial soap and apply talcum powder to the buttocks B) Use diapers and heavy padding on the bed C) Initiate bowel or habit training program to promote continence D) Help the patient to toilet once every hour

Answer:C Rational: A cognitively impaired patient may have forgotten how to respond to the urge to defecate and benefit from a structured program of bowel retraining.

The nurse is teaching the patient to obtain a specimen for fecal occult blood testing using fecal immunochemical (FIT) testing at home. How does the nurse instruct the patient to collect the specimen? A) Three fecal smears from one bowel movement B)One fecal smear from an early-morning bowel movement C) One fecal smear from three separate bowel movements D) Three fecal smears when blood can be seen in the bowel movement

Answer:C Rational: Samples from three separate bowel movements decrease the risk of a false-negative or a false-positive result.