Lewis 43

A 71-year-old patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery? a. Teach about a low-residue diet. b. Monitor output from the stoma. c. Assess the perineal drainage and incision. d. Encourage acceptance of the colostomy stoma.

C

Which is the best explanation of the pathophysiology that occurs in celiac or gluten-sensitive enteropathy? A. Intestinal inflammation, especially in the duodenum B. Full-thickness ulcers throughout the small and large intestines C. Lack of enzyme necessary to digest gluten D. Irregular peristalsis with heightened sensitivity

a Rationale Tissue destruction occurs as a result of chronic inflammation, activated by gluten. Damage is most severe in the duodenum, probably because it is the site of the highest concentration of gluten. Intermittent, full-thickness ulcers are characteristic of IBD. Lack of the necessary enzyme for digestion of milk is characteristic of lactase deficiency. Irregular peristalsis with enhanced sensitivity is characteristic of irritable bowel syndrome (IBS). Reference: 1050

Which alterations occur in IBS? A. Ulceration in the gastric mucosa B. Viral infection C. Protozoal infestation D. Altered bowel motility

D Rationale The cause of IBS is unknown, but altered bowel motility, heightened visceral sensitivity, inflammation, and psychological distress are likely to be involved. Ulceration is associated with inflammatory bowel disease (IBD). IBS is not associated with infection or protozoal infestation. Reference: 1018

The nurse preparing for the annual physical exam of a 50-year-old man will plan to teach the patient about a. endoscopy. b. colonoscopy. c. computerized tomography screening. d. carcinoembryonic antigen (CEA) testing.

ANS: B At age 50, individuals with an average risk for colorectal cancer (CRC) should begin screening for CRC. Colonoscopy is the gold standard for CRC screening. The other diagnostic tests are not recommended as part of a routine annual physical exam at age 50.

Which information will the nurse teach a 23-year-old patient with lactose intolerance? a. Ice cream is relatively low in lactose. b. Live-culture yogurt is usually tolerated. c. Heating milk will break down the lactose. d. Nonfat milk is a better choice than whole milk.

ANS: B Lactose-intolerant individuals can usually eat yogurt without experiencing discomfort. Ice cream, nonfat milk, and milk that has been heated are all high in lactose

The patient with Crohn's disease has an ileostomy, with the terminal ileum removed. Absorption of what nutrient is a key concern? A. Carbohydrate B. Cobalamin C. Gluten D. Lactose

B Rationale Patients who had the terminal ileum removed have reduced absorption of cobalamin (vitamin B12). Instrinsic factor is secreted in the stomach but absorbed in the small intestine. Fat absorption is decreased because bile salts are absorbed in the terminal ileum, but not carbohydrates. Lack of absorption of gluten occurs in celiac disease. Lactose intolerance occurs because the enzyme lactase is deficient. Reference: 1045

Compared with a colostomy, which complication is a patient with an ileostomy at an increased risk for? A. Constipation B. Obstruction C. Flatus D. Polyps

B Rationale The ileostomy patient is susceptible to obstruction because the lumen is less than an inch in diameter and may narrow further at the point where the bowel passes through the fascia-muscle layer of the abdomen. Ileostomies have loose drainage because fluid is not absorbed in the large colon. Flatus can occur in patients with either an ileostomy or a colostomy. Polyps are most often found in the distal colon and rectum, which has been removed if the patient has an ileostomy. Reference: 1045

The patient with chronic gastritis is being put on a combination of medications to eradicate H. pylori. Which drugs does the nurse know will probably be used for this patient? a) Antibiotic(s), antacid, and corticosteroid b) Antibiotic(s), aspirin, and antiulcer/protectant c) Antibiotic(s), proton pump inhibitor, and bismuth d) Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)

C To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori.

The patient is brought in with a piece of wood impaled in his lower abdomen after being rescued from a collapsing building. What action should you take? A. Assess for positive rebound pressure. B. Stabilize the wood until examined by a physician. C. Remove the wood and apply direct pressure. D. Note the presence of bowel sounds.

B Rationale An impaled object should never be removed until skilled care is available. Removal may cause further injury and bleeding. Reference: 1020

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8

The appropriate collaborative therapy for the patient with acute diarrhea caused by a viral infection is to: A. increased fluid intake B. administer an antibiotic C. administer antimotility drugs D. quarantine the patient to prevent spread of the virus

A

The nurse determines that the goals of dietary teaching have been met when the patient with celiac disease selects from the menu: A. scrambled eggs and sausage B. buckwheat pancake and syrup C. oatmeal, skim milk, and OJ D. yogurt, strawberries and rye toast with butter

A

You perform a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that manifestations of an obstruction in the large intestine include (select all that apply) A. a largely distended abdomen. B. diarrhea that is loose or liquid. C. persistent, colicky abdominal pain. D. profuse vomiting that relieves abdominal pain.

A, C Rationale Persistent, colicky abdominal pain occurs with lower intestinal obstruction. Abdominal distention is markedly increased in lower intestinal obstructions. Onset of a large intestine obstruction is gradual, and vomiting is rare. Absolute constipation usually is associated with large intestine obstructions. Reference: 1033

A 51-year-old woman with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. Which symptom is most important to communicate to the health care provider? a. Fever b. Nausea c. Joint pain d. Headache

ANS: A Since infliximab suppresses the immune response, rapid treatment of infection is essential. The other patient complaints are common side effects of the medication, but they do not indicate any potentially life-threatening complications

A 33-year-old male patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as shown in the accompanying figure. Which information will be included in patient teaching? a. Stool will be expelled from both stomas. b. This type of colostomy is usually temporary. c. Soft, formed stool can be expected as drainage. d. Irrigations can regulate drainage from the stomas.

B

The nurse would increase the comfort of a patient with appendicitis by: A. having the patient lie prone B. flexing the patient's right knee C. sitting the patient upright in a chair D. turning the patient onto his left side

B

A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient?' a) Barium swallow b) Endoscopic biopsy c) Capsule endoscopy d) Endoscopic ultrasonography

B Because of this patient's history of excessive alcohol intake, smoking, hemoptysis, and the current choking episode, cancer may be present. A biopsy is necessary to make a definitive diagnosis of carcinoma, so an endoscope will be used to obtain a biopsy and observe other abnormalities as well. A barium swallow may show narrowing of the esophagus, but it is more diagnostic for achalasia. An endoscopic ultrasonography may be used to stage esophageal cancer. Capsule endoscopy can show alterations in the esophagus but is more often used for small intestine problems. A barium swallow, capsule endoscopy, and endoscopic ultrasonography cannot provide a definitive diagnosis for cancer when it is suspected.

Which is the best understanding of colon irrigation? A. It is taught to patients with ascending colostomies. B. The tip should be inside a cone to prevent perforation. C. Use cold water to promote peristalsis. D. Administer 2000 mL of sterile saline.

B Rationale The tip is inside a cone to control the depth of insertion, prevent water from leaking out, and prevent perforation. Irrigation is used only in the distal colon or rectum because the stool is solid there. The water should be warm; cold water can cause cramping. Approximately 500 to 1000 mL of tap water is administered. Reference: 1045

A nursing intervention that is most appropriate to decrease postoperative edema and pain following an inguinal herniorraphy is: A. applying a truss to the hernia site B. allowing the patient to stand to void C. supporting the incision during coughing D. applying a scrotal support with ice bag

D

A nurse is caring for a client who has had diarrhea for the past 4 days. When assessing the client, the nurse should expect which of the following findings? (Select all that apply.) ___Bradycardia ___Hypotension ___Fever ___Poor skin turgor ___Peripheral edema ___Abdominal cramping

Hypotension Fever Poor skin turgor Abdominal cramping Prolonged diarrhea leads to dehydration, which is characterized by tachycardia, hypotension, fever, lethargy, poor skin turgor, and abdominal cramping. Peripheral edema is more likely to be caused by a fluid overload rather than a fluid deficit. Chapter 45; Page 1096, Box 46-3

What causes a pilonidal cyst? A. Infection of a congenital tract under the skin between the buttocks B. Fistula formed from large intestine C. Cellulitis most often caused by methicillin-resistant Staphylococcus (MRSA) D. Complication of exudates from hemorrhoids

a Rationale A pilonidal sinus is a small tract under the skin between the buttocks in the sacrococcygeal area, and it is thought to be congenital. It is lined with epithelium and hair, and with moisture collection and movement of the hair, it becomes infected, forming an abscess. Reference: 1054

A patient is told to take replacement pancreatic enzymes to prevent malabsorption of fat. How should the enzymes be administered? A. Mixed in fruit juice B. Mixed in chocolate milk C. Enema D. IV infusion

a Rationale Pancreatic enzymes are mixed in fruit juice or applesauce. They should not be mixed with a protein. They are administered by mouth. Reference: 1093-1094

For the patient hospitalized with inflammatory bowel disease (IBD), which treatments would be used to rest the bowel (select all that apply)? a. NPO d. Sedatives b. IV fluids e. Nasogastric suction c. Bed rest f. Parenteral nutrition

a, b, e, f. With an acute exacerbation of inflammatory bowel disease (IBD), to rest the bowel the patient will be NPO, receive IV fluids and parenteral nutrition, and have nasogastric suction. Sedatives would be used to alleviate stress. Enteral nutrition will be used as soon as possible

A patient with inflammatory bowel disease has a nursing diagnosis of imbalanced nutrition: less than body requirements related to decreased nutritional intake and decreased intestinal absorption. Which assessment data support this nursing diagnosis? a. Pallor and hair loss c. Anorectal excoriation and pain b. Frequent diarrhea stools d. Hypotension and urine output below 30 mL/hr

a. Signs of malnutrition include pallor from anemia, hair loss, bleeding, cracked gingivae, and muscle weakness, which support a nursing diagnosis that identifies impaired nutrition. Diarrhea may contribute to malnutrition but is not a defining characteristic. Anorectal excoriation and pain relate to problems with skin integrity. Hypotension relates to problems with fluid deficit.

A postoperative patient has a nursing diagnosis of pain related to effects of medication and decreased GI motility as evidenced by abdominal pain and distention and inability to pass flatus. Which nursing intervention is most appropriate for this patient? a. Ambulate the patient more frequently. b. Assess the abdomen for bowel sounds. c. Place the patient in high Fowler's position. d. Withhold opioids because they decrease bowel motility.

a. The abdominal pain and distention that occur from the decreased motility of the bowel should be treated with increased ambulation and frequent position changes to increase peristalsis. If the pain is severe, cholinergic drugs, rectal tubes, or application of heat to the abdomen may be prescribed. Assessment of bowel sounds is not an intervention to relieve the pain and a high Fowler's position is not indicated. Opioids may still be necessary for pain control and motility can be increased by other means.

The patient has not voided for 6 hours after a herniorrhaphy. What action should you take? A. Document the findings. B. Have patient sit on toilet and listen to running water. C. Obtain a residual urine sample. D. Apply pressure on the suprapubic region to promote urge.

b Rationale After a hernia repair, the patient may have difficulty voiding. Voiding is expected by 6 hours after the operation. Measures to help the patient void include using the normal sitting position, pouring warm water over the perineum, and listening to running water. Because it has been 6 hours, action beyond documentation is required. The residual urine is the amount remaining after the patient has voided. The bladder can be palpated for distention, but the first nursing action for someone who does not have an atonic bladder is not manual pressure. Reference: 1048

Which is correct information about an anal fissure? A. Classic symptom is black, tarry stool. B. Defecating is described as "passing broken glass." C. Avoid bulk to present large stool that irritates the fissure. D. Typical treatment includes packing the rectum to absorb drainage.

b Rationale An anal fissure is a crack in the lining of the anal wall, producing the key symptoms of bright red rectal bleeding and severe anal pain on defecation. Black, tarry stool indicates bleeding higher in the gastrointestinal tract. Treatment of an anal fissure includes fiber supplements, adequate fluid intake, sitz baths, and topical analgesics. Rectal packing is used after a hemorrhoidectomy. Reference: 1053

Which is correct information regarding gastrointestinal stromal tumors (GISTs)? A. It is cancer of the villa cells that affect absorption of nutrients. B. It is cancer of cells controlling movement of food through stomach. C. They are usually detected by occult blood stool screening. D. Screening looks for elevation of the carcinogenic embryonic antigen (CEA) level.

b Rationale GISTs are a rare form of cancer that originates in cells found in the gastrointestinal tract wall. These cells (interstitial cells of Cajal) are part of the autonomic nervous system. They help control the movement of food and liquid through the stomach and intestines. About 65% are found in the stomach. Because initial symptoms are usually vague and similar to many other gastrointestinal problems, it is difficult to detect early. Colon cancer is usually detected by occult blood stool screening or by screening for elevation of the level of CEA. Reference: 1052

The patient has cystic fibrosis. Which finding indicates malabsorption? A. Small stature and thin B. Greasy, foul-smelling, mushy stool C. Urine specific gravity of 1.031 D. Current jelly-like stool

b Rationale People with cystic fibrosis have malabsorption because of pancreatic dysfunction. Steatorrhea is a symptom of failure to properly digest fats. Children with cystic fibrosis typically have growth issues, but small stature and being thin does not necessarily indicate malabsorption. The urine specific gravity is slightly high and indicates dehydration, not malabsorption. Current jelly-like stool is a classic symptom of intussusception. Reference: 1049

When considering the following causes of acute abdomen, the nurse should know that surgery would be indicated for (select all that apply)? a. pancreatitis c. foreign-body perforation b. acute ischemic bowel d. pelvic inflammatory disease e. ruptured ectopic pregnancy f. ruptured abdominal aneurysm

b, c, e, f. An immediate surgical consult is needed for acute ischemic bowel, foreign-body perforation, ruptured ectopic pregnancy, or ruptured abdominal aneurysm. A diagnostic laparoscopy may be done or a laparotomy may be done to repair a ruptured abdominal aneurysm or remove the appendix. Surgery is not needed for pancreatitis or pelvic inflammatory disease, as these can be diagnosed and treated without surgery.

An important nursing intervention for a patient with a small intestinal obstruction who has an NG tube is to a. offer ice chips to suck PRN. b. provide mouth care every 1 to 2 hours. c. irrigate the tube with normal saline every 8 hours. d. keep the patient supine with the head of the bed elevated 30 degrees.

b. Mouth care should be done frequently for the patient with a small intestinal obstruction who has an NG tube because of vomiting, fecal taste and odor, and mouth breathing. No ice chips are allowed when a patient is NPO because of a bowel obstruction. The NG tube should be checked for patency and irrigated as ordered. The position of the patient should be one of comfort.

Which patient is most likely to be diagnosed with short bowel syndrome? a. History of ulcerative colitis c. Diagnosed with irritable bowel syndrome b. Had extensive resection of the ileum d. Had colectomy performed for cancer of the bowel

b. Short bowel syndrome results from extensive resection of portions of the small bowel and would occur if a patient had an extensive resection of the ileum. The other conditions primarily affect the large colon and result in fewer and less severe symptoms.

How is the most common form of malabsorption syndrome treated? a. Administration of antibiotics b. Avoidance of milk and milk products c. Supplementation with pancreatic enzymes d. Avoidance of gluten found in wheat, barley, oats, and rye

b. The most common type of malabsorption syndrome is lactose intolerance and it is managed by restricting the intake of milk and milk products. Antibiotics are used in cases of bacterial infections that cause malabsorption, pancreatic enzyme supplementation is used for pancreatic insufficiency, and restriction of gluten is necessary for control of adult celiac disease (celiac sprue, gluten-induced enteropathy).

The patient has persistent and continuous pain at McBurney's point. The nursing assessment reveals rebound tenderness and muscle guarding with the patient preferring to lie still with the right leg flexed. What should the nursing interventions for this patient include? a. Laxatives to move the constipated bowel b. NPO status in preparation for possible appendectomy c. Parenteral fluids and antibiotic therapy for 6 hours before surgery d. NG tube inserted to decompress the stomach and prevent aspiration

b. The patient's manifestations are characteristic of appendicitis. After laboratory test and CT scan confirmation, the patient will have surgery. Laxatives are not used. The 6 hours of fluids and antibiotics preoperatively would be used only if the appendix was ruptured. The NG tube is more likely to be used with abdominal trauma.

Which is the best food for the patient with lactase deficiency? A. Skim milk B. Low-fat ice cream C. Live-culture yogurt D. Cheddar cheese

c Rationale Live-culture yogurt can be consumed if no milk products have been added. The other options all contain lactose. Reference: 1051

The medications prescribed for the patient with inflammatory bowel disease include cobalamin and iron injections. What is the rationale for using these drugs? a. Alleviate stress c. Correct malnutrition b. Combat infection d. Improve quality of life

c. Cobalamin and iron injections will help to correct malnutrition. Correcting malnutrition will also indirectly help to improve quality of life and fight infections.

The patient has peritonitis, which is a major complication of appendicitis. What treatment will the nurse plan to include? a. Peritoneal lavage c. IV fluid replacement b. Peritoneal dialysis d. Increased oral fluid intake

c. IV fluid replacement along with antibiotics, NG suction, analgesics, and surgery would be expected. Peritoneal lavage may be used to determine abdominal trauma. Peritoneal dialysis would not be performed. Oral fluids would be avoided with peritonitis.

The patient comes to the emergency department with intermittent crampy abdominal pain, nausea, projectile vomiting, and dehydration. The nurse suspects a GI obstruction. Based on the manifestations, what area of the bowel should the nurse suspect is obstructed? a. Large intestine c. Upper small intestine b. Esophageal sphincter d. Lower small intestine

c. Intermittent crampy abdominal pain, nausea, projectile vomiting, and dehydration are characteristics of mechanical upper small intestinal obstruction. With continued vomiting, metabolic alkalosis may occur. Large bowel obstruction is characterized by constipation, low-grade abdominal pain, and abdominal distention. Fecal vomiting is seen with lower small intestinal obstruction.

The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis? a) "You'll need to drink at least two to three glasses of milk daily." b) "It would likely be beneficial for you to eliminate drinking alcohol." c) "Many people find that a minced or pureed diet eases their symptoms of PUD." d) "Your medications should allow you to maintain your present diet while minimizing symptoms."

B Alcohol increases the amount of stomach acid produced so it should be avoided. Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. Milk may exacerbate PUD.

The nurse identifies that which patient is at highest risk for developing colon cancer? A. A 28-year-old male who has a body mass index of 27 kg/m2 B. A 32-year-old female with a 12-year history of ulcerative colitis C. A 52-year-old male who has followed a vegetarian diet for 24 years D. A 58-year-old female taking prescribed estrogen replacement therapy

B. A 32-year-old female with a 12-year history of ulcerative colitis Risk for colon cancer includes personal history of inflammatory bowel disease (especially ulcerative colitis for longer than 10 years); obesity (body mass index ≥ 30 kg/m2); family (first-degree relative) or personal history of colorectal cancer, adenomatous polyposis, hereditary nonpolyposis colorectal cancer syndrome; red meat (=7 servings/week); cigarette use; and alcohol (=4 drinks/week).

Which of the following foods should a nurse encourage for a client who is experiencing constipation?

B. Fresh fruit and whole wheat toast A high-fiber diet promotes normal bowel elimination. The choice of fruit and toast is the highest fiber option. Macaroni and cheese, beef tips and noodles, and mashed potatoes and gravy are lower-fiber options. Besides, ain't no body got time to make mac-n-cheese, fancy beef tips with noodles, and mashed potatoes and gravy. If you do, please share with Jan.

A 58-year-old woman is being discharged home today after ostomy surgery for colon cancer. The nurse should assign the patient to which staff member? A. A nursing assistant on the unit who also has hospice experience B. A licensed practical nurse who has worked on the unit for 10 years C. A registered nurse with 6 months of experience on the surgical unit D. A registered nurse who has floated to the surgical unit from pediatrics

C. A registered nurse with 6 months of experience on the surgical unit The patient needs ostomy care directions/reinforcement at discharge and should be assigned to a registered nurse with experience in providing discharge teaching for ostomy care. Teaching should not be delegated to a licensed practical/vocational nurse or unlicensed assistive personnel.

A 20-year-old man is admitted to the emergency department after a motor vehicle crash with suspected abdominal trauma. What assessment finding by the nurse is of highest priority? A. Nausea and vomiting B. Hyperactive bowel sounds C. Firmly distended abdomen D. Abrasions on all extremities

C. Firmly distended abdomen Clinical manifestations of abdominal trauma are guarding and splinting of the abdominal wall; a hard, distended abdomen (indicating possible intraabdominal bleeding); decreased or absent bowel sounds; contusions, abrasions, or bruising over the abdomen; abdominal pain; pain over the scapula; hematemesis or hematuria; and signs of hypovolemic shock (tachycardia and decreased blood pressure).

Which of the following should a patient be taught after a hemorrhoidectomy? A. take mineral oil prior to bedtime B eat a low fiber diet to rest the colon C. administer oil retention enema to empty the colon D. use prescribed pain medication before a bowel movement

D

A nurse is caring for a client who will perform fecal occult blood testing at home. Which of the following should the nurse include when explaining the procedure to the client? A. Eating more protein is recommended prior to testing. B. One stool specimen is sufficient for testing. C. A red color change indicates a positive test. D. The specimen cannot be contaminated with urine.

D. The specimen cannot be contaminated with urine. For fecal occult blood testing at home, the stool specimens cannot be contaminated with water or urine; three specimens from three different bowel movements are required; some proteins such as red meat, fish, and poultry can alter the test results; and a blue color indicates a positive guaiac or presence of fecal occult blood not red. Chapter 45; Page 1046

You determine that the goals of dietary teaching have been met when the patient with celiac disease selects from the menu A. scrambled eggs and sausage. B. buckwheat pancakes with syrup. C. oatmeal, skim milk, and orange juice. D. yogurt, strawberries, and rye toast with butter.

a Rationale Celiac disease is treated with lifelong avoidance of dietary gluten. Wheat, barley, oats, and rye products must be avoided. Although pure oats do not contain gluten, oat products can become contaminated with wheat, rye, and barley during the milling process. Gluten is also found in some medications and in many food additives, preservatives, and stabilizers. Reference: 1050

The patient with Crohn's disease has had multiple intestinal resections. Which symptom indicates that short bowel syndrome has developed? A. Steatorrhea B. Constipation C. Hypercholesteremia D. Hypercalcemia

a Rationale The predominant manifestation is diarrhea or steatorrhea. Diarrhea, not constipation, is a concern because there is decreased intestinal surface to absorb fluid and nutrients. Decreased absorption of bile salts is the issue; increased cholesterol is not related to short bowel syndrome. The risk is deficiencies of cobalamin, zinc, and calcium. Reference: 1051

The patient with lactase deficiency is at risk for which nutritional deficiency? A. Vitamin K B. Calcium C. Folic acid D. Cobalamin (vitamin B12)

b Rationale Milk products are the main source of calcium in the American diet, and a lactose-intolerant person can acquire a calcium deficiency. The other nutrients are not a concern. Reference: 1051

The nurse should teach the patient with chronic constipation that which food has the highest dietary fiber? a. Peach c. Dried beans b. Popcorn d. Shredded wheat

c. Of the foods listed, dried beans contain the highest amount of dietary fiber and are an excellent source of soluble fiber. Bran and berries also have large amounts of fiber.

A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, boardlike abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate? a) Providing IV fluids and inserting a nasogastric (NG) tube b) Administering oral bicarbonate and testing the patient's gastric pH level c) Performing a fecal occult blood test and administering IV calcium gluconate d) Starting parenteral nutrition and placing the patient in a high-Fowler's position

A A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth, and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis, and parenteral nutrition is not a priority in the short term.

A patient complains of nausea. When administering a dose of metoclopramide (Reglan), the nurse should teach the patient to report which potential adverse effect? a) Tremors b) Constipation c) Double vision d) Numbness in fingers and toes

A Extrapyramidal side effects, including tremors and tardive dyskinesias, may occur as a result of metoclopramide (Reglan) administration. Constipation, double vision, and numbness in fingers and toes are not adverse effects of metoclopramide.

The appropriate collaborative therapy for the patient with acute diarrhea caused by a viral infection is to A. increase fluid intake. B. administer an antibiotic. C. administer antimotility drugs. D. quarantine the patient to prevent spread of the virus.

A Rationale Acute diarrhea from infectious causes (e.g., a virus) is usually self-limiting. The major concerns are preventing transmission, fluid and electrolyte replacement, and resolution of the diarrhea. Antidiarrheal agents are contraindicated in the treatment of infectious diarrhea because they potentially prolong exposure to the infectious organism. Antibiotics are rarely used to treat acute diarrhea. To prevent transmission of diarrhea caused by a virus, hand washing should be performed before and after contact with the patient and when body fluids of any kind are handled. Flush vomitus and stool in the toilet, and wash contaminated clothing immediately with soap and hot water. Reference: 1008-1009

Which factor in a patient's history would make the patient at risk for constipation? A. Takes codeine daily for chronic back problem B. Runs a marathon yearly C. Takes an angiotensin-converting enzyme (ACE) inhibitor for hypertension D. Follows a vegan diet

A Rationale Common causes of constipation include insufficient dietary fiber, inadequate fluid intake, decreased physical activity, ignoring the defecation urge, and medications such as opioids. Constipation from opioids is a side effect that does not decrease with time. Training for and running a marathon would help regularity. An ACE inhibitor does not cause constipation. A vegan diet tends to have increased bulk, but it is not a factor as long as the patient has adequate fluids and fiber. Reference: 1012

The patient has a history of chronic diarrhea of three or more liquid stools for the past 4 weeks. What potential imbalance is of greatest concern? A. Hypokalemia B. Hyponatremia C. Metabolic alkalosis D. Thrombocytopenia

A Rationale Diarrhea can cause electrolyte imbalances, particularly hypokalemia. Because dehydration can result, the patient is at risk for hypernatremia. Metabolic acidosis can develop with severe diarrhea. Low platelet levels are not necessarily associated with diarrhea. Reference: 1008

You are caring for a patient in the emergency department with complaints of acute abdominal pain, nausea, and vomiting. When you palpate the patient's left lower abdominal quadrant, the patient complains of pain in the right lower quadrant. You will document this as which diagnostic sign of appendicitis? A. Rovsing sign B. Referred pain C. Chvostek's sign D. Rebound tenderness

A Rationale In patients with suspected appendicitis, the Rovsing sign may be elicited by palpation of the left lower quadrant, causing pain to be felt in the right lower quadrant. Reference: 1020

A patient is suspected of having a large intestine obstruction. What is the best indication that an obstruction is present? A. Lack of flatus B. Nausea C. Temperature of 100.4° F (38° C) D. Thirst

A Rationale Inability to pass gas or constipation is a common manifestation of a large intestinal obstruction. Reference: 1032

You are conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instruction would be most helpful to prevent further episodes of constipation? A. Maintain a high intake of fluid and fiber in the diet. B. Reduce intake of medications causing constipation. C. Eat several small meals per day to maintain bowel motility. D. Sit upright during meals to increase bowel motility by gravity.

A Rationale Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility. Reference: 1013

The elderly patient was informed that outpouches were found in the descending colon during the screening colonoscopy. The patient asks you what this finding means. What is the best explanation? A. Most people get these outpouchings as they age. B. These findings respond well to treatment with sulfa antibiotics. C. It is a precursor to colon cancer, and routine screening is essential. D. They contribute to malabsorption of cobalamin (vitamin B12) and fat.

A Rationale It is believed that 65% of people have the saccular dilations or outpouchings of the mucosa by the time they are 85 years old. It is believed to be from high intraluminal pressure on weakened areas of the bowel wall from inadequate dietary fiber. It is typically asymptomatic and not a concern unless inflamed or diverticulitis develops. Antibiotics are not required unless they are inflamed (diverticulitis). Polyps are a precursor to colon cancer; diverticula are not precancerous. Malabsorption of cobalamin (vitamin B12) and fat is seen with disease of the terminal ileum; the sigmoid colon mainly absorbs water. Reference: 1046

The patient is admitted to the hospital with a severe exacerbation of ulcerative colitis. What finding is most important for you to act on? A. Blood urea nitrogen (BUN): 50 mg/dL B. Hemoglobin (Hb): 12 g/dL C. White blood cells (WBC): 11,000/μL D. Sodium (Na+): 148 mEq/L

A Rationale Patients with severe ulcerative colitis frequently have bloody diarrhea. Dehydration is present as evidenced by the high BUN. This must be treated first before the mild anemia and mild inflammation are addressed. Hypernatremia is usually not treated until the sodium level is above 150 mEq/L, and it usually responds to fluid replacement. Reference: 1024

A 60-year-old man reports to the clinic nurse that he feels tired. The CBC count shows a hemoglobin level of 9 g/dL. What action should you advocate? A. Fecal occult blood test (FOBT) B. Consuming foods high in iron, such as red meat C. Assessing the patient's stress and sleep schedule D. Encouraging over-the-counter iron supplement

A Rationale Symptoms of colorectal cancer are nonspecific or absent until the disease is advanced. Anemia can be a symptom in an older adult. The cause of the anemia, including screening for colorectal cancer, needs to be done before advocating other treatment. Cancer assessment takes priority over lifestyle assessment. Reference: 1035-1036

What is a classic diagnostic finding in a patient with appendicitis? A. Elevated white blood cell (WBC) count B. Elevated level of lipase C. Left lower quadrant tenderness D. Positive Kernig's sign

A Rationale The WBC count is mildly to moderately elevated in about 90% of cases. The lipase level is elevated in patients with pancreatitis. Left lower quadrant tenderness is typically seen in diverticulitis. The classic location for appendicitis is McBurney's point in the right lower quadrant. Positive Kernig's sign indicates meningitis. Reference: 1020

The patient has fecal incontinence. You are working to promote bowel training. What is the best time to have the patient attempt to defecate every day? A. Thirty minutes after breakfast B. Before going to bed C. Before noon meal D. After performing exercise

A Rationale The gastrocolic reflex is strongest in most people right after breakfast. A good time for many persons to schedule elimination is within 30 minutes after breakfast. The other times are not as conducive; exercise often makes fecal incontinence worse. Reference: 1012

You explain to the patient undergoing ostomy surgery that the procedure that maintains the most normal functioning of the bowel is A. A sigmoid colostomy B. A transverse colostomy C. A descending colostomy D. An ascending colostomy

A Rationale The more distal the ostomy, the more the intestinal contents resemble feces that are eliminated from an intact colon and rectum. Output from a sigmoid colostomy resembles normally formed stool, and some patients are able to regulate emptying time so they do not need to wear a collection bag. Reference: 1039

What is important to teach a patient who is learning to manage a colostomy? A. Change the drainage bag when it is one-third full. B. Cut the skin protective wafer about 1 inch larger than the stoma. C. Poke a hole in the collection bag if it is tight and taunt. D. Maintain sterile procedure during the drainage bag change.

A Rationale The weight of drainage from the stoma pulls the wafer away from the skin so ostomy bags should be emptied when one-third full. The wafer is 1/8 to 1/16 larger than the stoma to prevent drainage on the skin that would cause irritation. Holes are not poked in the bag. A distended bag is full of flatus, which should be expelled by opening the bag. The gastrointestinal system is not sterile, and clean protocol is maintained. Reference: 1042

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation? A. Maintain a high intake of fluid and fiber in the diet. B. Reduce intake of medications causing constipation. C. Eat several small meals per day to maintain bowel motility. D. Sit upright during meals to increase bowel motility by gravity.

A Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility. Analgesics taken for lung cancer probably cannot be reduced. Other medications may decrease constipation, but it is best to avoid laxatives. Eating several small meals per day and position do not facilitate bowel motility. Defecation is easiest when the person sits on the commode with the knees higher than the hips.

A stroke patient who primarily uses a wheelchair for mobility has diarrhea with fecal incontinence. What should the nurse assess first? A. Fecal impaction B. Perineal hygiene C. Dietary fiber intake D. Antidiarrheal agent use

A Patients with limited mobility are at risk for fecal impactions due to constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed and considered next.

The nurse is preparing to insert a nasogastric (NG) tube into a 68-year-old female patient who is nauseated and vomiting. She has an abdominal mass and suspected small intestinal obstruction. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate? A. "The tube will help to drain the stomach contents and prevent further vomiting." B. "The tube will push past the area that is blocked and thus help to stop the vomiting." C. "The tube is just a standard procedure before many types of surgery to the abdomen." D. "The tube will let us measure your stomach contents so that we can plan what type of IV fluid replacement would be best."

A The NG tube is used to decompress the stomach by draining stomach contents and thereby prevent further vomiting. The NG tube will not push past the blocked area. Potential surgery is not currently indicated. The location of the obstruction will determine the type of fluid to use, not measure the amount of stomach contents

When evaluating the patient's understanding about the care of the ileostomy, what statement by the patient indicates the patient needs more teaching? A. "I will be able to regulate when I have stools." B. "I will be able to wear the pouch until it leaks." C. "Dried fruit and popcorn must be chewed very well." D. "The drainage from my stoma can damage my skin."

A The ileostomy is in the ileum and drains liquid stool frequently, unlike the colostomy which has more formed stool the further distal the ostomy is in the colon. The ileostomy pouch is usually worn 4-7 days or until it leaks. It must be changed immediately if it leaks because the drainage is very irritating to the skin. To avoid obstruction, popcorn, dried fruit, coconut, mushrooms, olives, stringy vegetables, food with skin, and meats with casings must be chewed extremely well before swallowing because of the narrow diameter of the ileostomy lumen.

A nurse is caring for a client for whom a tap water enema is prescribed, to be repeated until the return is clear. Which of the following actions should the nurse take? A. Clarify the order with the provider. B. Explain the procedure to the client. C. Ensure that the tap water is not too hot. D. Keep the amount per enema to less than 1,000 mL.

A. Clarify the order with the provider. Tap water is a hypotonic solution that can cause water toxicity. It should not be repeated. The nurse should clarify the order with the provider. Explaining the procedure to the client, ensuring that the tap water is not too hot, and keeping the amount to less than 1,000 mL are not pertinent if the enema should not be repeated. If you got this question wrong, I am judging you...just kidding :)

Which menu choice by the patient with diverticulosis is best for preventing diverticulitis? a. Navy bean soup and vegetable salad b. Whole grain pasta with tomato sauce c. Baked potato with low-fat sour cream d. Roast beef sandwich on whole wheat bread

ANS: A A diet high in fiber and low in fats and red meat is recommended to prevent diverticulitis. Although all of the choices have some fiber, the bean soup and salad will be the highest in fiber and the lowest in fat

The nurse admitting a patient with acute diverticulitis explains that the initial plan of care is to a. administer IV fluids. b. give stool softeners and enemas. c. order a diet high in fiber and fluids. d. prepare the patient for colonoscopy.

ANS: A A patient with acute diverticulitis will be NPO and given parenteral fluids. A diet high in fiber and fluids will be implemented before discharge. Bulk-forming laxatives, rather than stool softeners, are usually given, and these will be implemented later in the hospitalization. The patient with acute diverticulitis will not have enemas or a colonoscopy because of the risk for perforation and peritonitis.

A 50-year-old female patient calls the clinic to report a new onset of severe diarrhea. The nurse anticipates that the patient will need to a. collect a stool specimen. b. prepare for colonoscopy. c. schedule a barium enema. d. have blood cultures drawn.

ANS: A Acute diarrhea is usually caused by an infectious process, and stool specimens are obtained for culture and examined for parasites or white blood cells. There is no indication that the patient needs a colonoscopy, blood cultures, or a barium enema.

A 34-year-old female patient with a new ileostomy asks how much drainage to expect. The nurse explains that after the bowel adjusts to the ileostomy, the usual drainage will be about _____ cups. a. 2 b. 3 c. 4 d. 5

ANS: A After the proximal small bowel adapts to reabsorb more fluid, the average amount of ileostomy drainage is about 500 mL daily. One cup is about 240 mL.

A patient complains of gas pains and abdominal distention two days after a small bowel resection. Which nursing action is best to take? a. Encourage the patient to ambulate. b. Instill a mineral oil retention enema. c. Administer the ordered IV morphine sulfate. d. Offer the ordered promethazine (Phenergan) suppository.

ANS: A Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine (Phenergan) is used as an antiemetic rather than to decrease gas pains or distention

Which nursing action will be included in the plan of care for a 27-year-old male patient with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)? a. Encourage the patient to express concerns and ask questions about IBS. b. Suggest that the patient increase the intake of milk and other dairy products. c. Educate the patient about the use of alosetron (Lotronex) to reduce symptoms. d. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs).

ANS: A Because psychologic and emotional factors can affect the symptoms for IBS, encouraging the patient to discuss emotions and ask questions is an important intervention. Alosetron has serious side effects, and is used only for female patients who have not responded to other therapies. Although yogurt may be beneficial, milk is avoided because lactose intolerance can contribute to symptoms in some patients. NSAIDs can be used by patients with IBS.

A 51-year-old male patient has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg) over 2 months. The nurse will plan to teach about a. medication use. b. fluid restriction. c. enteral nutrition. d. activity restrictions.

ANS: A Medications are used to induce and maintain remission in patients with inflammatory bowel disease (IBD). Decreased activity level is indicated only if the patient has severe fatigue and weakness. Fluids are needed to prevent dehydration. There is no advantage to enteral feedings

A female patient is awaiting surgery for acute peritonitis. Which action will the nurse include in the plan of care? a. Position patient with the knees flexed. b. Avoid use of opioids or sedative drugs. c. Offer frequent small sips of clear liquids. d. Assist patient to breathe deeply and cough.

ANS: A There is less peritoneal irritation with the knees flexed, which will help decrease pain. Opioids and sedatives are typically given to control pain and anxiety. Preoperative patients with peritonitis are given IV fluids for hydration. Deep breathing and coughing will increase the patient's discomfort

Which information will the nurse include when teaching a patient how to avoid chronic constipation (select all that apply)? a. Many over-the-counter (OTC) medications can cause constipation. b. Stimulant and saline laxatives can be used regularly. c. Bulk-forming laxatives are an excellent source of fiber. d. Walking or cycling frequently will help bowel motility. e. A good time for a bowel movement may be after breakfast.

ANS: A, C, D, E Stimulant and saline laxatives should be used infrequently. Use of bulk-forming laxatives, regular early morning timing of defecation, regular exercise, and avoiding many OTC medications will help the patient avoid constipation

The nurse is admitting a 67-year-old patient with new-onset steatorrhea. Which question is most important for the nurse to ask? a. "How much milk do you usually drink?" b. "Have you noticed a recent weight loss?" c. "What time of day do your bowels move?" d. "Do you eat meat or other animal products?"

ANS: B Although all of the questions provide useful information, it is most important to determine if the patient has an imbalance in nutrition because of the steatorrhea

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to a. administer IV metoclopramide (Reglan). b. discontinue the patient's oral food intake. c. administer cobalamin (vitamin B12) injections. d. teach the patient about total colectomy surgery.

ANS: B An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO. Metoclopramide increases peristalsis and will worsen symptoms. Cobalamin (vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. Although total colectomy is needed for some patients, there is no indication that this patient is a candidate

Which nursing action will the nurse include in the plan of care for a 35-year-old male patient admitted with an exacerbation of inflammatory bowel disease (IBD)? a. Restrict oral fluid intake. b. Monitor stools for blood. c. Ambulate four times daily. d. Increase dietary fiber intake.

ANS: B Because anemia or hemorrhage may occur with IBD, stools should be assessed for the presence of blood. The other actions would not be appropriate for the patient with IBD. Because dietary fiber may increase gastrointestinal (GI) motility and exacerbate the diarrhea, severe fatigue is common with IBD exacerbations, and dehydration may occur.

A patient in the emergency department has just been diagnosed with peritonitis caused by a ruptured diverticulum. Which prescribed intervention will the nurse implement first? a. Insert a urinary catheter to drainage. b. Infuse metronidazole (Flagyl) 500 mg IV. c. Send the patient for a computerized tomography scan. d. Place a nasogastric (NG) tube to intermittent low suction.

ANS: B Because peritonitis can be fatal if treatment is delayed, the initial action should be to start antibiotic therapy (after any ordered cultures are obtained). The other actions can be done after antibiotic therapy is initiated

Which information obtained by the nurse interviewing a 30-year-old male patient is most important to communicate to the health care provider? a. The patient has a history of constipation. b. The patient has noticed blood in the stools. c. The patient had an appendectomy at age 27. d. The patient smokes a pack/day of cigarettes.

ANS: B Blood in the stools is a possible clinical manifestation of colorectal cancer and requires further assessment by the health care provider. The other patient information will also be communicated to the health care provider, but does not indicate an urgent need for further testing or intervention

A 74-year-old patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. The nurse explains that the test is used to a. identify any metastasis of the cancer. b. monitor the tumor status after surgery. c. confirm the diagnosis of a specific type of cancer. d. determine the need for postoperative chemotherapy.

ANS: B CEA is used to monitor for cancer recurrence after surgery. CEA levels do not help to determine whether there is metastasis of the cancer. Confirmation of the diagnosis is made on the basis of biopsy. Chemotherapy use is based on factors other than CEA

The nurse is assessing a 31-year-old female patient with abdominal pain. Th nurse,who notes that there is ecchymosis around the area of umbilicus, will document this finding as a. Cullen sign. b. Rovsing sign. c. McBurney sign. d. Grey-Turner's signt.

ANS: B Cullen sign is ecchymosis around the umbilicus. Rovsing sign occurs when palpation of the left lower quadrant causes pain in the right lower quadrant. Deep tenderness at McBurney's point (halfway between the umbilicus and the right iliac crest), known as McBurney's sign, is a sign of acute appendicitis

After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, "I cannot manage all these changes. I don't want to look at the stoma." What is the best action by the nurse? a. Reassure the patient that ileostomy care will become easier. b. Ask the patient about the concerns with stoma management. c. Develop a detailed written list of ostomy care tasks for the patient. d. Postpone any teaching until the patient adjusts to the ileostomy.

ANS: B Encouraging the patient to share concerns assists in helping the patient adjust to the body changes. Acknowledgment of the patient's feelings and concerns is important rather than offering false reassurance. Because the patient indicates that the feelings about the ostomy are the reason for the difficulty with the many changes, development of a detailed ostomy care plan will not improve the patient's ability to manage the ostomy. Although detailed ostomy teaching may be postponed, the nurse should offer teaching about some aspects of living with an ostomy.

A 54-year-old critically ill patient with sepsis is frequently incontinent of watery stools. What action by the nurse will prevent complications associated with ongoing incontinence? a. Apply incontinence briefs. b. Use a fecal management system c. Insert a rectal tube with a drainage bag. d. Assist the patient to a commode frequently.

ANS: B Fecal management systems are designed to contain loose stools and can be in place for as long as 4 weeks without causing damage to the rectum or anal sphincters. Although incontinence briefs may be helpful, unless they are changed frequently, they are likely to increase the risk for skin breakdown. Rectal tubes are avoided because of possible damage to the anal sphincter and ulceration of the rectal mucosa. A critically ill patient will not be able to tolerate getting up frequently to use the commode or bathroom.

A 24-year-old woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient? a. Bacteria in the perianal area can enter the urethra. b. Fistulas can form between the bowel and bladder. c. Drink adequate fluids to maintain normal hydration. d. Empty the bladder before and after sexual intercourse.

ANS: B Fistulas between the bowel and bladder occur in Crohn's disease and can lead to UTI. Teaching for UTI prevention in general includes good hygiene, adequate fluid intake, and voiding before and after intercourse

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis? a. Restrict fluid intake to prevent constant liquid drainage from the stoma. b. Use care when eating high-fiber foods to avoid obstruction of the ileum. c. Irrigate the ileostomy daily to avoid having to wear a drainage appliance. d. Change the pouch every day to prevent leakage of contents onto the skin.

ANS: B High-fiber foods are introduced gradually and should be well chewed to avoid obstruction of the ileostomy. Patients with ileostomies lose the absorption of water in the colon and need to take in increased amounts of fluid. The pouch should be drained frequently but is changed every 5 to 7 days. The drainage from an ileostomy is liquid and continuous, so control by irrigation is not possible

After change-of-shift report, which patient should the nurse assess first? a. 40-year-old male with celiac disease who has frequent frothy diarrhea b. 30-year-old female with a femoral hernia who has abdominal pain and vomiting c. 30-year-old male with ulcerative colitis who has severe perianal skin breakdown d. 40-year-old female with a colostomy bag that is pulling away from the adhesive wafer

ANS: B Pain and vomiting with a femoral hernia suggest possible strangulation, which will necessitate emergency surgery. The other patients have less urgent problems

Which action will the nurse in the gastrointestinal clinic include in the plan of care? a. Obtain blood samples for DNA analysis. b. Schedule the patient for yearly colonoscopy. c. Provide preoperative teaching about total colectomy. d. Discuss lifestyle modifications to decrease cancer risk.

ANS: B Patients with FAP should have annual colonoscopy starting at age 16 and usually have total colectomy by age 25 to avoid developing colorectal cancer. DNA analysis is used to make the diagnosis, but is not needed now for this patient. Lifestyle modifications will not decrease cancer risk for this patient

A new 19-year-old male patient has familial adenomatous polyposis (FAP). Which action will the nurse in the gastrointestinal clinic include in the plan of care? a. Obtain blood samples for DNA analysis. b. Schedule the patient for yearly colonoscopy. c. Provide preoperative teaching about total colectomy. d. Discuss lifestyle modifications to decrease cancer risk.

ANS: B Patients with FAP should have annual colonoscopy starting at age 16 and usually have total colectomy by age 25 to avoid developing colorectal cancer. DNA analysis is used to make the diagnosis, but is not needed now for this patient. Lifestyle modifications will not decrease cancer risk for this patient.

Which prescribed intervention for a 61-year-old female patient with chronic short bowel syndrome will the nurse question? a. Ferrous sulfate (Feosol) 325 mg daily b. Senna (Senokot) 1 tablet every day c. Psyllium (Metamucil) 2.1 grams 3 times daily d. Diphenoxylate with atropine (Lomotil) prn loose stools

ANS: B Patients with short bowel syndrome have diarrhea because of decreased nutrient and fluid absorption and would not need stimulant laxatives. Iron supplements are used to prevent iron-deficiency anemia, bulk-forming laxatives help make stools less watery, and opioid antidiarrheal drugs are helpful in slowing intestinal transit time

A 58-year-old man with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next? a. Auscultate the bowel sounds. b. Prepare the patient for surgery. c. Check the patient's oral temperature. d. Obtain information about the accident.

ANS: B Return of brown drainage and fecal material suggests perforation of the bowel and the need for immediate surgery. Auscultation of bowel sounds, checking the temperature, and obtaining information about the accident are appropriate actions, but the priority is to prepare to send the patient for emergency surgery

Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective? a. "The medication will be tapered if I need surgery." b. "I will need to use a sunscreen when I am outdoors." c. "I will need to avoid contact with people who are sick." d. "The medication will prevent infections that cause the diarrhea."

ANS: B Sulfasalazine may cause photosensitivity in some patients. It is not used to treat infections. Sulfasalazine does not reduce immune function. Unlike corticosteroids, tapering of sulfasalazine is not needed.

A 25-year-old male patient calls the clinic complaining of diarrhea for 24 hours. Which action should the nurse take first? a. Inform the patient that laboratory testing of blood and stools will be necessary. b. Ask the patient to describe the character of the stools and any associated symptoms. c. Suggest that the patient drink clear liquid fluids with electrolytes, such as Gatorade or Pedialyte. d. Advise the patient to use over-the-counter loperamide (Imodium) to slow gastrointestinal (GI) motility.

ANS: B The initial response by the nurse should be further assessment of the patient. The other responses may be appropriate, depending on what is learned in the assessment

The nurse will determine that teaching a 67-year-old man to irrigate his new colostomy has been effective if the patient a. inserts the irrigation tubing 4 to 6 inches into the stoma. b. hangs the irrigating container 18 inches above the stoma. c. stops the irrigation and removes the irrigating cone if cramping occurs. d. fills the irrigating container with 1000 to 2000 mL of lukewarm tap water.

ANS: B The irrigating container should be hung 18 to 24 inches above the stoma. If cramping occurs, the irrigation should be temporarily stopped and the cone left in place. Five hundred to 1000 mL of water should be used for irrigation. An irrigation cone, rather than tubing, should be inserted into the stoma; 4 to 6 inches would be too far for safe insertion.

A 71-year-old male patient tells the nurse that growing old causes constipation so he has been using a suppository for constipation every morning. Which action should the nurse take first? a. Encourage the patient to increase oral fluid intake. b. Assess the patient about risk factors for constipation. c. Suggest that the patient increase intake of high-fiber foods. d. Teach the patient that a daily bowel movement is unnecessary.

ANS: B The nurse's initial action should be further assessment of the patient for risk factors for constipation and for his usual bowel pattern. The other actions may be appropriate but will be based on the assessment.

The nurse is providing preoperative teaching for a 61-year-old man scheduled for an abdominal-perineal resection. Which information will the nurse include? a. Another surgery in 8 to 12 weeks will be used to create an ileal-anal reservoir. b. The patient will begin sitting in a chair at the bedside on the first postoperative day. c. The patient will drink polyethylene glycol lavage solution (GoLYTELY) preoperatively. d. IV antibiotics will be started at least 24 hours before surgery to reduce the bowel bacteria.

ANS: C A bowel-cleansing agent is used to empty the bowel before surgery to reduce the risk for infection. A permanent colostomy is created with this surgery. Sitting is contraindicated after an abdominal-perineal resection. Oral antibiotics (rather than IV antibiotics) are given to reduce colonic and rectal bacteria

A 26-year-old woman is being evaluated for vomiting and abdominal pain. Which question from the nurse will be most useful in determining the cause of the patient's symptoms? a. "What type of foods do you eat?" b. "Is it possible that you are pregnant?" c. "Can you tell me more about the pain?" d. "What is your usual elimination pattern?"

ANS: C A complete description of the pain provides clues about the cause of the problem. Although the nurse should ask whether the patient is pregnant to determine whether the patient might have an ectopic pregnancy and before any radiology studies are done, this information is not the most useful in determining the cause of the pain. The usual diet and elimination patterns are less helpful in determining the reason for the patient's symptoms

Which action will the nurse include in the plan of care for a 42-year-old patient who is being admitted with Clostridium difficile? a. Educate the patient about proper food storage. b. Order a diet with no dairy products for the patient. c. Place the patient in a private room on contact isolation. d. Teach the patient about why antibiotics will not be used.

ANS: C Because C. difficile is highly contagious, the patient should be placed in a private room and contact precautions should be used. There is no need to restrict dairy products for this type of diarrhea. Metronidazole (Flagyl) is frequently used to treat C. difficile. Improper food handling and storage do not cause C. difficile.

A 62-year-old patient has had a hemorrhoidectomy at an outpatient surgical center. Which instructions will the nurse include in discharge teaching? a. Maintain a low-residue diet until the surgical area is healed. b. Use ice packs on the perianal area to relieve pain and swelling. c. Take prescribed pain medications before a bowel movement is expected. d. Delay having a bowel movement for several days until healing has occurred.

ANS: C Bowel movements may be very painful, and patients may avoid defecation unless pain medication is taken before the bowel movement. A high-residue diet will increase stool bulk and prevent constipation. Delay of bowel movements is likely to lead to constipation. Warm sitz baths rather than ice packs are used to relieve pain and keep the surgical area clean

Which activity in the care of a 48-year-old female patient with a new colostomy could the nurse delegate to unlicensed assistive personnel (UAP)? a. Document the appearance of the stoma. b. Place a pouching system over the ostomy. c. Drain and measure the output from the ostomy. d. Check the skin around the stoma for breakdown.

ANS: C Draining and measuring the output from the ostomy is included in UAP education and scope of practice. The other actions should be implemented by LPNs or RNs.

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching? a. Scrambled eggs b. White toast and jam c. Oatmeal with cream d. Pancakes with syrup

ANS: C During acute exacerbations of IBD, the patient should avoid high-fiber foods such as whole grains. High-fat foods also may cause diarrhea in some patients. The other choices are low residue and would be appropriate for this patient.

Four hours after a bowel resection, a 74-year-old male patient with a nasogastric tube to suction complains of nausea and abdominal distention. The first action by the nurse should be to a. auscultate for hypotonic bowel sounds. b. notify the patient's health care provider. c. reposition the tube and check for placement. d. remove the tube and replace it with a new one.

ANS: C Repositioning the tube will frequently facilitate drainage. Because this is a common occurrence, it is not appropriate to notify the health care provider unless other interventions do not resolve the problem. Information about the presence or absence of bowel sounds will not be helpful in improving drainage. Removing the tube and replacing it are unnecessarily traumatic to the patient, so that would only be done if the tube was completely occluded

A 76-year-old patient with obstipation has a fecal impaction and is incontinent of liquid stool. Which action should the nurse take first? a. Administer bulk-forming laxatives. b. Assist the patient to sit on the toilet. c. Manually remove the impacted stool. d. Increase the patient's oral fluid intake.

ANS: C The initial action with a fecal impaction is manual disimpaction. The other actions will be used to prevent future constipation and impactions

A 19-year-old female is brought to the emergency department with a knife handle protruding from the abdomen. During the initial assessment of the patient, the nurse should a. remove the knife and assess the wound. b. determine the presence of Rovsing sign. c. check for circulation and tissue perfusion. d. insert a urinary catheter and assess for hematuria.

ANS: C The initial assessment is focused on determining whether the patient has hypovolemic shock. The knife should not be removed until the patient is in surgery, where bleeding can be controlled. Rovsing sign is assessed in the patient with suspected appendicitis. A patient with a knife in place will be taken to surgery and assessed for bladder trauma there

A 72-year-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider? a. Patient has not voided for the last 4 hours. b. Skin is dry with poor turgor on all extremities. c. Crackles are heard halfway up the posterior chest. d. Patient has had 5 loose stools over the last 6 hours.

ANS: C The presence of crackles in an older patient receiving IV fluids at a high rate suggests volume overload and a need to reduce the rate of the IV infusion. The other data will also be reported, but are consistent with the patient's age and diagnosis and do not require a change in the prescribed treatment

Which care activity for a patient with a paralytic ileus is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)? a. Auscultation for bowel sounds b. Nasogastric (NG) tube irrigation c. Applying petroleum jelly to the lips d. Assessment of the nares for irritation

ANS: C UAP education and scope of practice include patient hygiene such as oral care. The other actions require education and scope of practice appropriate to the RN.

A 22-year-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective? a. The patient uses incontinence briefs to contain loose stools. b. The patient asks for antidiarrheal medication after each stool. c. The patient uses witch hazel compresses to decrease irritation. d. The patient cleans the perianal area with soap after each stool.

ANS: C Witch hazel compresses are suggested to reduce anal irritation and discomfort. Incontinence briefs may trap diarrhea and increase the incidence of skin breakdown. Antidiarrheal medications are not given 15 to 20 times a day. The perianal area should be washed with plain water after each stool.

A 64-year-old woman who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in the response? a. Absorption of fat-soluble vitamins may be reduced by fiber-containing laxatives. b. Dietary sources of fiber should be eliminated to prevent excessive gas formation. c. Use of this type of laxative to prevent constipation does not cause adverse effects. d. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.

ANS: D A high fluid intake is needed when patients are using bulk-forming laxatives to avoid worsening constipation. Although bulk-forming laxatives are generally safe, the nurse should emphasize the possibility of constipation or obstipation if inadequate fluid intake occurs. Although increased gas formation is likely to occur with increased dietary fiber, the patient should gradually increase dietary fiber and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool softeners and lubricants, not by bulk-forming laxatives

A 42-year-old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia. Which patient teaching will the nurse provide before discharge? a. Soak in sitz baths several times each day. b. Cough 5 times each hour for the next 48 hours. c. Avoid use of acetaminophen (Tylenol) for pain. d. Apply a scrotal support and ice to reduce swelling.

ANS: D A scrotal support and ice are used to reduce edema and pain. Coughing will increase pressure on the incision. Sitz baths will not relieve pain and would not be of use after this surgery. Acetaminophen can be used for postoperative pain.

A 73-year-old patient with diverticulosis has a large bowel obstruction. The nurse will monitor for a. referred back pain. b. metabolic alkalosis. c. projectile vomiting. d. abdominal distention.

ANS: D Abdominal distention is seen in lower intestinal obstruction. Referred back pain is not a common clinical manifestation of intestinal obstruction. Metabolic alkalosis is common in high intestinal obstruction because of the loss of HCl acid from vomiting. Projectile vomiting is associated with higher intestinal obstruction.

Which breakfast choice indicates a patient's good understanding of information about a diet for celiac disease? a. Oatmeal with nonfat milk b. Whole wheat toast with butter c. Bagel with low-fat cream cheese d. Corn tortilla with scrambled eggs

ANS: D Avoidance of gluten-containing foods is the only treatment for celiac disease. Corn does not contain gluten, while oatmeal and wheat do

The nurse will plan to teach a patient with Crohn's disease who has megaloblastic anemia about the need for a. oral ferrous sulfate tablets. b. regular blood transfusions. c. iron dextran (Imferon) infusions. d. cobalamin (B12) spray or injections.

ANS: D Crohn's disease frequently affects the ileum, where absorption of cobalamin occurs. Cobalamin must be administered regularly by nasal spray or IM to correct the anemia. Iron deficiency does not cause megaloblastic anemia. The patient may need occasional transfusions but not regularly scheduled transfusions

Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome? a. "Have you been passing a lot of gas?" b. "What foods affect your bowel patterns?" c. "Do you have any abdominal distention?" d. "How long have you had abdominal pain?"

ANS: D One criterion for the diagnosis of irritable bowel syndrome (IBS) is the presence of abdominal discomfort or pain for at least 3 months. Abdominal distention, flatulence, and food intolerance are also associated with IBS, but are not diagnostic criteria.

Which patient should the nurse assess first after receiving change-of-shift report? a. 60-year-old patient whose new ileostomy has drained 800 mL over the previous 8 hours b. 50-year-old patient with familial adenomatous polyposis who has occult blood in the stool c. 40-year-old patient with ulcerative colitis who has had six liquid stools in the previous 4 hours d. 30-year-old patient who has abdominal distention and an apical heart rate of 136 beats/minute

ANS: D The patient's abdominal distention and tachycardia suggest hypovolemic shock caused by problems such as peritonitis or intestinal obstruction, which will require rapid intervention. The other patients should also be assessed as quickly as possible, but the data do not indicate any life-threatening complications associated with their diagnoses

A 27-year-old female patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action should the nurse take? a. Encourage the patient to sip clear liquids. b. Assess the abdomen for rebound tenderness. c. Assist the patient to cough and deep breathe. d. Apply an ice pack to the right lower quadrant.

ANS: D The patient's clinical manifestations are consistent with appendicitis, and application of an ice pack will decrease inflammation at the area. Checking for rebound tenderness frequently is unnecessary and uncomfortable for the patient. The patient should be NPO in case immediate surgery is needed. The patient will need to know how to cough and deep breathe postoperatively, but coughing will increase pain at this time

After several days of antibiotic therapy, an older hospitalized patient develops watery diarrhea. Which action should the nurse take first? a. Notify the health care provider. b. Obtain a stool specimen for analysis. c. Teach the patient about handwashing. d. Place the patient on contact precautions.

ANS: D The patient's history and new onset diarrhea suggest a C. difficile infection, which requires implementation of contact precautions to prevent spread of the infection to other patients. The other actions are also appropriate but can be accomplished after contact precautions are implemented

A 45-year-old patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102° F (38.3° C), pulse 120, respirations 32, and blood pressure (BP) 82/54. Which prescribed intervention should the nurse implement first? a. Administer IV ketorolac (Toradol) 15 mg. b. Draw blood for a complete blood count (CBC). c. Obtain a computed tomography (CT) scan of the abdomen. d. Infuse 1 liter of lactated Ringer's solution over 30 minutes.

ANS: D The priority for this patient is to treat the patient's hypovolemic shock with fluid infusion. The other actions should be implemented after starting the fluid infusion

A 47-year-old female patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. The nurse should a. place ice packs around the stoma. b. notify the surgeon about the stoma. c. monitor the stoma every 30 minutes. d. document stoma assessment findings.

ANS: D The stoma appearance indicates good circulation to the stoma. There is no indication that surgical intervention is needed or that frequent stoma monitoring is required. Swelling of the stoma is normal for 2 to 3 weeks after surgery, and an ice pack is not needed

The nurse cares for a postoperative patient who has just vomited yellow green liquid and reports nausea. Which action would be an appropriate nursing intervention? a) Offer the patient a herbal supplement such as ginseng. b) Apply a cool washcloth to the forehead and provide mouth care. c) Take the patient for a walk in the hallway to promote peristalsis. d) Discontinue any medications that may cause nausea or vomiting.

B Cleansing the face and hands with a cool washcloth and providing mouth care are appropriate comfort interventions for nausea and vomiting. Ginseng is not used to treat postoperative nausea and vomiting. Unnecessary activity should be avoided. The patient should rest in a quiet environment. Medications may be temporarily withheld until the acute phase is over, but the *medications should not be discontinued without consultation with the health care provider.*

You are planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history increases the patient's risk for colorectal cancer? A. Osteoarthritis B. History of rectal polyps C. History of lactose intolerance D. Use of herbs as dietary supplements

B Rationale A history of rectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. The other factors identified do not pose an additional risk to the patient. Reference: 1035

A woman with irritable bowel syndrome is prescribed alosetron (Lotronex). The patient should be taught to discontinue the drug if which symptom occurs? A. Diarrhea B. Constipation C. Urinary burning D. Renal calculi

B Rationale A potential complication of alosetron is severe constipation with ischemic colitis. The drug should be discontinued if constipation occurs. Diarrhea is the reason the drug is prescribed. The drug does not affect the urinary system. Reference: 1018

The patient is diagnosed with infectious diarrhea caused by E. coli. Which treatment do you anticipate? A. Antidiarrheal agent B. Pedialyte C. Antibiotic D. Stool transplantation

B Rationale Acute diarrhea from infectious causes is usually self-limiting. The major concerns are preventing transmission, fluid and electrolyte replacement, and resolution of the diarrhea. Oral solutions such as Gatorade or Pedialyte may be sufficient. Antidiarrheal agents are contraindicated in the treatment of infectious diarrhea because they potentially prolong exposure to the infectious organisms. Antibiotics are rarely used to treat acute diarrhea. Exceptions are certain infections (C. difficile) or patients who are immunosuppressed. Stool transplantation is used as a last resort for recurrent C. difficile infections. Reference: 1008

Which is correct information about the treatment of Crohn's disease? A. Surgery is the preferred treatment. B. Aminosalicylates are frequently used first. C. Corticosteroids are given for long-term therapy. D. High-fiber foods are encouraged to add bulk to diarrheal stool.

B Rationale Aminosalicylates (5-ASAs) are used first because they are less toxic, although there is a movement to using biologic and targeted therapy as first-line therapy. Drugs with 5-ASA suppress the proinflammatory cytokines and inflammatory mediators. Because there is a high rate of recurrence after surgical treatment of Crohn's disease, medication is the preferred treatment, although up to 75% of patients eventually must have surgery. Corticosteroids are given for the shortest time possible due to the complications of long-term therapy. Patients are put on a low-residue diet. Reference: 1025

The patient presents with abdominal pain. Which assessment finding should you follow-up? A. 130/80 mm Hg, 100 beats/minute, 16 breaths/minute B. Fetal posture C. Vomit × 1 green liquid D. Negative rebound tenderness

B Rationale Fetal posture is common with peritoneal irritation. It lessens the tension on the inflamed perineal area. The elevated pulse and blood pressure may be caused by pain and anxiety. Signs of shock include elevated pulse and respirations with normal or decreased blood pressure. Green emesis is likely a sign of bile, and one episode is not of major concern. Negative rebound tenderness is a normal finding. Reference: 1015

The patient with fecal incontinence has not responded to the bowel-retraining program and a medication will be used. Which is most appropriate? A. Oil retention enema B. Bisacodyl (Dulcolax) C. Diphenoxylate and atropine (Lomotil) D. Loperamide (Imodium)

B Rationale If nonpharmacologic treatments are ineffective in reestablishing bowel regularity, Dulcolax or a small phosphate enema can be administered 15 to 30 minutes before the usual evacuation time to stimulate the anorectal reflex. After a regular pattern is reestablished, the mediation is discontinued. An oil retention enema is used for impaction or constipation. Lomotil and Imodium are used for diarrhea and are not part of an incontinent program. Reference: 1012

The patient with ulcerative colitis has a total proctocolectomy with permanent ileostomy. Which instruction is most important to teach the patient? A. Contact the primary provider if there is more than 1500 mL of drainage per day. B. Monitor skin integrity. C. Irrigate to gain control of stool elimination. D. Assess for signs of cobalamin (vitamin B12) deficiency.

B Rationale If the stoma retracts, stool can contact the skin, causing loss of the epidermal layer. An ileostomy can initially drain 1500 to 2000 mL per 24 hours. It is not possible to obtain continence with an ileostomy. Cobalamin deficiency is a concern if the terminal ileus is removed because that is where this vitamin is absorbed. It is not a problem with large intestine removal. Reference: 1028

What is the main treatment for a patient with acute diverticulitis? A. Colon resection and ostomy B. Nasogastric tube and intravenous (IV) fluids C. Long-term course of oral corticosteroids D. Mechanical soft diet

B Rationale In acute diverticulitis, the goal of treatment is to allow the colon to rest and inflammation to subside. Bowel rest can be accomplished with the use of a nasogastric tube and IV fluids. Surgery is reserved for patients with complications, such as an abscess or obstruction that does not respond to medical management. The colon is reanastomosed after it has healed. Corticosteroids are not routinely used with diverticulitis; antibiotics are. During an acute attack, bowel rest is required. A mechanical soft diet is used for patients who lack the ability to adequately chew. Reference: 1047

The immunosuppressant azathioprine (Imuran) is given to maintain remission after corticosteroid induction therapy for an exacerbation of ulcerative colitis. What monitoring is required? A. Carcinogenic embryonic antigen (CEA) B. Complete blood cell count (CBC) C. Prostate-specific antigen (PSA) D. Potassium

B Rationale Regular CBC monitoring is required because the drug can suppress the bone marrow and lead to inflammation of the pancreas or gallbladder. CEA is used to monitor for recurrence of colorectal cancer. PSA is used to monitor for prostate cancer. It is not necessary to specifically monitor for potassium with this drug. Reference: 1026

How does the drug sulfasalazine (Azulfidine) work in the treatment of IBD? A. Destroys bacteria B. Suppresses inflammatory mediators C. Slows gastric motility D. Promotes electrolyte exchange across intestinal membrane

B Rationale Sulfasalazine contains sulfapyridine and 5-aminosalicylic acid (5-ASA). Although the exact action is unknown, it works by suppressing inflammatory mediators. IBD is an autoimmune inflammatory disease; no specific infectious agent has been identified, although antimicrobials (Flagyl, Cipro) occasionally are used. The last two options are not related to this drug. Reference: 1025

What is the best task to assign to nursing assistive personnel (NAP) for the care of a patient with a new ascending colostomy? A. Describe the drainage bag content. B. Empty the drainage bag. C. Observe the patient's technique when changing the bag. D. Find out if the patient has any questions.

B Rationale The NAP can perform the task of emptying the bag. The NAP should not be delegated any step of the nursing process including the responsibility of making an assessment. Observing a patient doing a new skill or asking about questions requires evaluation and potential teaching, which should be done by the RN. Reference: 1044

You would increase the comfort of the patient with appendicitis by A. having the patient lie prone. B. flexing the patient's right knee. C. sitting the patient upright in a chair. D. turning the patient onto his or her left side.

B Rationale The patient with appendicitis usually prefers to lie still, often with the right leg flexed to decrease pain. Reference: 1020

What is a key distinction between ulcerative colitis and Crohn's disease? A. Presence of intermittent constipation B. Pattern of inflammation C. Age of onset D. Prescribed diet

B Rationale The pattern of inflammation differs between Crohn's disease and ulcerative colitis. Crohn's disease involves all layers of the bowel wall anywhere in the gastrointestinal tract. Ulcerative colitis usually starts in the rectum and moves progressively toward the cecum, staying mainly located in the colon and rectum. Inflammation occurs in the mucosal layer. Intermittent diarrhea and constipation is a symptom of irritable bowel syndrome; diarrhea can occur in both diseases. Both commonly occur during the teenage years and early adulthood, with a second peak in the sixth decade. Both are treated similarly in terms of bowel rest, diet, and drugs. Reference: 1023

What screening test should you recommend to a white person with an average risk of colorectal cancer? A. Flexible sigmoidoscopy at age 21 B. Initial colonoscopy starting at age 50 C. Stool DNA every 10 years D. Carcinoembryonic antigen (CEA) yearly

B Rationale Whites with an average risk should have a colonoscopy every 10 years starting at age 50 (African Americans should have the first one at age 45). The use of a flexible sigmoidoscopy is decreasing because it evaluates only about 50% of the colon. When used, it is begun at age 50. Stool DNA is less favorable but acceptable. Stool tests must be done frequently since DNA shedding occur at intervals and may be easily missed. CEA is used to monitor disease recurrence after surgery or chemotherapy. Reference: 1036

The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history increases the patient's risk for colorectal cancer? A. Osteoarthritis B. History of colorectal polyps C. History of lactose intolerance D. Use of herbs as dietary supplements

B A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient.

A 61-year-old patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? A. 7:00 AM, 10:00 AM, and 1:00 PM B. 8:00 AM, 12:00 PM, and 4:00 PM C. 9:00 AM and 3:00 PM D. 9:00 AM, 12:00 PM, and 3:00 PM

B A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00 AM, 12:00 PM, and 4:00 PM.

What information would have the highest priority to be included in preoperative teaching for a 68-year-old patient scheduled for a colectomy? A. How to care for the wound B. How to deep breathe and cough C. The location and care of drains after surgery D. Which medications will be used during surgery

B Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed preoperatively, but done again with higher priority after surgery. Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.

A colectomy is scheduled for a 38-year-old woman with ulcerative colitis. The nurse should plan to include what prescribed measure in the preoperative preparation of this patient? A. Instruction on irrigating a colostomy B. Administration of a cleansing enema C. A high-fiber diet the day before surgery D. Administration of IV antibiotics for bowel preparation

B Preoperative preparation for bowel surgery typically includes bowel cleansing with antibiotics, such as oral neomycin and cleansing enemas, including Fleet enemas. Instructions to irrigate the colostomy will be done postoperatively. Oral antibiotics are given preoperatively, and an IV antibiotic may be used in the OR. A clear liquid diet will be used the day before surgery with the bowel cleansing.

A female patient has a sliding hiatal hernia. What nursing interventions will prevent the symptoms of heartburn and dyspepsia that she is experiencing? a) Keep the patient NPO. b) Put the bed in the Trendelenberg position. c) Have the patient eat 4 to 6 smaller meals each day. d) Give various antacids to determine which one works for the patient.

C Eating smaller meals during the day will decrease the gastric pressure and the symptoms of hiatal hernia. Keeping the patient NPO or in a Trendelenberg position are not safe or realistic for a long period of time for any patient. Varying antacids will only be done with the care provider's prescription, so this is not a nursing intervention.

Following administration of a dose of metoclopramide (Reglan) to the patient, the nurse determines that the medication has been effective when what is noted? a) Decreased blood pressure b) Absence of muscle tremors c) Relief of nausea and vomiting d) No further episodes of diarrhea

C Metoclopramide is classified as a prokinetic and antiemetic medication. If it is effective, the patient's nausea and vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea.

The patient receiving chemotherapy rings the call bell and reports the onset of nausea. The nurse should prepare an as-needed dose of which medication? a) Morphine sulfate b) Zolpidem (Ambien) c) Ondansetron (Zofran) d) Dexamethasone (Decadron)

C Ondansetron is a 5-HT3 receptor antagonist antiemetic that is especially effective in reducing cancer chemotherapy-induced nausea and vomiting. Morphine sulfate may cause nausea and vomiting. Zolpidem does not relieve nausea and vomiting. Dexamethasone is usually used in combination with ondansetron for acute and chemotherapy-induced emesis.

You are conducting a community education session. Which is the best information to provide? A. Women are at highest risk for inguinal hernia. B. Hernias are a result of a low-fiber diet. C. Hernia is not an emergency unless it cannot be reduced. D. Pulsation is commonly seen in abdominal hernias.

C Rationale A hernia is not a concern unless it cannot be reduced and an obstruction occurs in the intestine. Men are at highest risk for an inguinal hernia. Hernias are a result of an abnormal opening or a weakened area in the wall of the cavity. A pulsating abdominal mass is a symptom of an abdominal aortic aneurysm. Reference: 1048

The young adult female patient reports unilateral left lower abdominal pain. The last menstrual period was 4 weeks ago. What diagnostic test is essential? A. Orthostatic vital signs B. Hemoglobin and hematocrit C. Pregnancy test D. Appendix ultrasound

C Rationale A pregnancy test is performed in women of childbearing age with acute abdominal pain to rule out ectopic pregnancy, and it should be performed before the other tests. The appendix is on the right side. If the pregnancy test is negative, additional testing for other causes should be done. Reference: 1015

What is cause of abdominal compartment syndrome? A. Uncontrolled systemic hypertension B. Wearing restrictive clothing, decreasing venous flow C. Internal bleeding that causes pressure on organs D. Deficiency of the clotting factors

C Rationale Abdominal compartment syndrome is organ dysfunction caused by intraabdominal hypertension. Abdominal or retroperitoneal bleeding places pressure on abdominal organs located within the abdominal cavity. The other options are not causes of acute compartment syndrome. Reference: 1018

What is the best indication that the intravenous (IV) fluid replacement is adequate during the treatment of a patient with intestinal obstruction? A. Serum sodium: 155 mEq/L B. Urine specific gravity: 1.050 C. Urine output: 0.5 ml/kg/ hour D. Bowel sounds: 4 times/minute

C Rationale Adequate fluid replacement results in urine output of 0.5 mL/kg/ hour. The first two options indicate dehydration. Bowel sounds (peristalsis) are not used to determine rehydration. Reference: 1033

Which action will assist in caring for the patient with fecal incontinence? A. Assess stool consistency using the Braden scale. B. Encourage the use of a rectal tube to prevent skin breakdown. C. Assist the patient to the bathroom at a regular time daily. D. Encourage morning coffee to promote stool evacuation.

C Rationale Assisting with bowel training can help regulate evacuation. This can include assisting the patient to the bathroom at a regular time daily. Thirty minutes after breakfast is the time often recommended. The Braden Scale measures skin breakdown; the Bristol Stool Scale assesses stool consistency. Rectal tubes should be avoided because they can decrease responsiveness of the rectal sphincter and cause ulceration of the rectal mucosa. Patients with stool incontinence are taught to avoid caffeine, which worsens symptoms. Reference: 1011-1012

In planning care for the patient with Crohn's disease, you recognize that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease A. frequently results in toxic megacolon. B. causes fewer nutritional deficiencies than does ulcerative colitis. C. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy. D. is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis.

C Rationale Because there is a high recurrence rate after surgical treatment of Crohn's disease, medications are the preferred treatment. Reference: 1025

An elderly hospitalized patient, who was recently on broad-spectrum antibiotics, develops foul-smelling diarrhea. What is the most likely cause? A. Giardia lamblia B. Salmonella C. Clostridium difficile D. Lactose intolerance

C Rationale C. difficile is often a health care-acquired infection. Spores can survive up to 70 days. People at risk include elderly hospitalized patients who had antibiotics in the past 2 months. G. lamblia is a parasite found in contaminated lakes or pools. Salmonella is found in undercooked eggs or chicken. It is unusual for the patient to suddenly develop lactose intolerance and symptoms. Reference: 1007-1008

A patient with metastatic colorectal cancer is scheduled for chemotherapy and radiation therapy. Patient teaching regarding these therapies should include which explanation? A. Chemotherapy can be used to cure colorectal cancer. B. Irradiation is routinely used as adjuvant therapy after surgery. C. Both chemotherapy and irradiation can be used as palliative treatments. D. The patient should expect few or no side effects from chemotherapeutic agents.

C Rationale Chemotherapy can be used to shrink the tumor before surgery, as an adjuvant therapy after colon resection, and as palliative therapy for nonresectable colorectal cancer. Radiation therapy may be used postoperatively as an adjuvant to surgery and chemotherapy or as a palliative measure for patients with metastatic cancer. Reference: 1038

Which is the best category of food to encourage prevention of diverticulosis? A. High iron, such as organ meats B. Low gluten C. High fiber, such as raw vegetables D. No nuts or popcorn

C Rationale Foods high in fiber (bulk), such as fresh fruits and vegetables (along with decreased fat and red meat), help to prevent diverticulosis. Iron and gluten are not specific for diverticulosis. There is no evidence to support avoiding nuts and seeds to prevent diverticulitis, and they may have a protective effect. Reference: 1047

The patient has nonresectable colorectal cancer. The primary provider has recommended chemotherapy. What is the best explanation of this treatment? A. It gives the patient a sense of hope that something is being done. B. It shrinks the tumor before surgery. C. It provides palliative treatment. D. It prevents metastasis to the liver.

C Rationale Palliative treatment is done for nonresectable colorectal cancer to shrink the tumor and prevent obstruction. Telling the patient that chemotherapy may cure the cancer is not realistic and provides false information. This patient's tumor is classified as nonresectable, indicating that surgical treatment is not an option. In this situation it probably means that the tumor has already metastasized. Reference: 1038

Which food is recommended for a patient 2 weeks after having a colostomy? A. Cabbage B. Popcorn C. Applesauce D. Dried fruit

C Rationale Patients are initially on low-residue and low-fiber diets until the intestine adjusts. The eventual goal is to return to a normal presurgical diet. The patient who had an ileostomy is susceptible to obstruction. Foods such as popcorn and dried fruits must be chewed extremely well so particles are small when swallowed. Patients with ostomies are encouraged to eliminate the cabbage family foods because they cause odor. Reference: 1045

What should you teach a patient with colorectal cancer who is receiving capecitabine (Xeloda) for chemotherapy? A. Obtain weekly CBC count. B. Monitor the stool for occult blood. C. Do not get any immunizations without physician's approval. D. Take your temperature daily.

C Rationale Patients should not receive immunizations during chemotherapy because resistance is low, and they are unable to build up immunity. The other options are not specific for this drug, although the general instruction to monitor for bleeding or infection can be done. Reference: 1038

A female college student goes to the university health clinic complaining of pain that started at the umbilicus and moved to the right lower quadrant over the last 12 hours. You notice muscle guarding on examination. What action should you take? A. Administer a PRN laxative per standing orders. B. Ask about the last menstrual period. C. Make the student NPO. D. Assess bowel sounds.

C Rationale This is a classic description of appendicitis. At the very least, it is an acute abdomen, and the student should be kept NPO until a need for surgery is ruled out. The student should be referred to an emergency department. A laxative should not be given because it can increase peristalsis and cause perforation. Asking about her last menstrual cycle (possibility of a ruptured ectopic pregnancy) is important but the symptoms suggest appendicitis. Bowel sounds should be assessed, but the NPO status is a priority. Reference: 1021

The patient had an ileostomy 4 days earlier and has a daily drainage of 1800 mL. What action should you take? A. Notify the primary provider. B. Send a specimen to the laboratory. C. Document the findings. D. Test the stool for occult blood.

C Rationale With an ileostomy, the volume of drainage is high (1000 to 1800 mL/day) after peristalsis returns because the adsorptive functions provided by the colon and the delay provided by the ileocecal valve have been altered. Eventually, the amount of drainage is reduced to 500 mL daily as the proximal small bowel adapts. If the small bowel has been shortened from resections, the drainage can be greater. There is no need to do the other options. Reference: 1045

A 74-year-old female patient with gastroesophageal reflux disease (GERD) takes over-the-counter medications. For which medication, if taken long-term, should the nurse teach about an increased risk of fractures? a) Sucralfate (Carafate) b) Cimetidine (Tagamet) c) Omeprazole (Prilosec) d) Metoclopramide (Reglan)

C There is a potential link between proton pump inhibitors (PPIs) (e.g., omeprazole) use and bone metabolism. Long-term use or high doses of PPIs may increase the risk of fractures of the hip, wrist, and spine. Lower doses or shorter duration of therapy should be considered. REGLAN--> TARDIVE DYSKINESIA

The nurse receives an order for a parenteral dose of promethazine (Phenergan) and prepares to administer the medication to a 38-year-old male patient with nausea and repeated vomiting. Which action is most important for the nurse to take? a) Administer the medication subcutaneously for fast absorption. b) Administer the medication into an arterial line to prevent extravasation. c) Administer the medication deep into the muscle to prevent tissue damage. d) Administer the medication with 0.5 mL of lidocaine to decrease injection pain.

C Promethazine (Phenergan) is an antihistamine administered to relieve nausea and vomiting. Deep muscle injection is the preferred route of injection administration. This medication should not be administered into an artery or under the skin because of the risk of severe tissue injury, including gangrene. When administered IV, a risk factor is that it can leach out from the vein and cause serious damage to surrounding tissue.

Assessment findings suggestive of peritonitis include a. rebound abdominal pain. b. a soft, distended abdomen. c. dull, continuous abdominal pain. d. observing that the patient is restless.

Correct answer: a Rationale: With peritoneal irritation, the abdomen is hard, like a board, and the patient has severe abdominal pain that is worse with any sudden movement. The patient lies very still. Palpating the abdomen and releasing the hands suddenly causes sudden movement within the abdomen and severe pain. This is called rebound tenderness.

The nurse explains to the patient undergoing ostomy surgery that the procedure that maintains the most normal functioning of the bowel is a. a sigmoid colostomy. b. a transverse colostomy. c. a descending colostomy. d. an ascending colostomy.

Correct answer: a Rationale: The more distal the ostomy is, the more the intestinal contents resemble feces eliminated from an intact colon and rectum. Output from a sigmoid colostomy resembles normally formed stool, and some patients are able to regulate emptying time so they do not need to wear a collection bag.

The nurse should administer an as-needed dose of magnesium hydroxide (MOM) after noting what information while reviewing a patient's medical record? a. Abdominal pain and bloating b. No bowel movement for 3 days c. A decrease in appetite by 50% over 24 hours d. Muscle tremors and other signs of hypomagnesemia

Correct answer: b Rationale: MOM is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days. MOM would not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.

A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that a. chemotherapy will begin after the patient recovers from the surgery. b. both chemotherapy and radiation can be used as palliative treatments. c. follow-up colonoscopies will be needed to ensure that the cancer does not recur. d. a wound, ostomy, and continence nurse will visit the patient to identify an abdominal site for the ostomy.

Correct answer: c Rationale: Stage 1 colorectal cancer is treated with surgical removal of the tumor and reanastomosis, and so there is no ostomy. Chemotherapy is not recommended for stage I tumors. Follow-up colonoscopy is recommended because colorectal cancer can recur.

In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease a. frequently results in toxic megacolon. b. causes fewer nutritional deficiencies than ulcerative colitis. c. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy. d. is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis.

Correct answer: c Rationale: Ulcerative colitis affects only the colon and rectum; it can cause megacolon and rectal bleeding, but not nutrient malabsorption. Surgical removal of the colon and rectum cures it. Crohn's disease usually involves the ileum, where bile salts and vitamin cobalamin are absorbed. After surgical treatment, disease recurrence at the site is common.

The nurse is preparing to administer a dose of bisacodyl (Dulcolax). In explaining the medication to the patient, the nurse would explain that it acts in what way? a. Increases bulk in the stool b.Lubricates the intestinal tract to soften feces c. Increases fluid retention in the intestinal tract d. Increases peristalsis by stimulating nerves in the colon wall

Correct answer: d Rationale: Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. It is available in oral and suppository forms. Fiber and bulk forming drugs increase bulk in the stool; water and stool softeners soften feces, and saline and osmotic solutions cause fluid retention in the intestinal tract.

The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that manifestations of an obstruction in the large intestine are (select all that apply) a. persistent abdominal pain. b. marked abdominal distention. c. diarrhea that is loose or liquid. d. colicky, severe, intermittent pain. e. profuse vomiting that relieves abdominal pain.

Correct answers: a, b Rationale: With lower intestinal obstructions, abdominal distention is markedly increased and pain is persistent. Onset of a large intestine obstruction is gradual, vomiting is rare, and there is usually absolute constipation, not diarrhea.

When a 35-year-old female patient is admitted to the emergency department with acute abdominal pain, which possible diagnosis should you consider that may be the cause of her pain (select all that apply)? a. Gastroenteritis b. Ectopic pregnancy c. Gastrointestinal bleeding d. Irritable bowel syndrome e. Inflammatory bowel disease

Correct answers: a, b, c, d, e Rationale: All these conditions could cause acute abdominal pain.

Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease (select all that apply)? a. Restricted to rectum b. Strictures are common. c. Bloody, diarrhea stools d. Cramping abdominal pain e. Lesions penetrate intestine.

Correct answers: c, d Rationale: Clinical manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's disease.

A 72-year-old patient was admitted with epigastric pain due to a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? a) Chest pain relieved with eating or drinking water b) Back pain 3 or 4 hours after eating a meal c) Burning epigastric pain 90 minutes after breakfast d) Rigid abdomen and vomiting following indigestion

D A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain 3-4 hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain 1-2 hours after a meal is an expected manifestation of a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care.

The patient has an obstruction high in the small intestine. What patient assessment do you anticipate finding? A. No bowel sounds B. Metabolic acidosis C. Flank pain D. Vomiting

D Rationale A patient with a high small intestinal obstruction is likely to have vomiting, which can be profuse. Lower intestinal obstruction is associated with a greater risk of metabolic acidosis. In small intestinal obstructions bowel sounds can still be heard in the large intestine. Flank pain is typically related to renal calculi. Reference: 1032

Why are adenomatous polyps removed during a colonoscopy? A. They eventually cause intestinal obstruction. B. They are prone to bleeding and lead to anemia. C. They lead to familial adenomatous polyposis (FAP). D. They are closely linked to colorectal cancer.

D Rationale Adenomatous polyps are neoplastic; 85% of colorectal adenocarcinomas arise from them. Removing adenomatous polyps decreases the occurrence of colorectal cancer. All polyps are considered abnormal and should be removed. FAP is a genetic disorder that is autosomal dominant and not related to the typical appearance of adenomatous polyps. Reference: 1034

You are conducting a community education session. Which option is correct information related to diverticulosis? A. It is commonly seen in young people. B. The classic presentation is right-sided abdominal pain. C. Adequate protein can prevent its occurrence. D. It is a result of aging and decreased stool size.

D Rationale Although the exact cause is unknown, diverticulosis is thought to result from high intraluminal pressure on weakened areas of the bowel, often resulting from inadequate fiber. The decreased stool raises intraluminal pressure. Diverticular disease is common, and the incidence increases with age. In Western civilization, the classic anatomic location of diverticulum is in the sigmoid colon or left-sided abdomen. It usually is asymptomatic unless inflammation (diverticulitis) is present. Preventive measures include increasing the bulk in diet (fresh fruits and vegetables) and decreasing intake of red meats and fats. Reference: 1046

Which is the best method for evaluation and treatment of large intestine polyps? A. Sigmoidoscopy B. Barium enema C. Digital examination D. Colonoscopy

D Rationale Colonoscopy is preferred because it allows evaluation of the total colon and polyps can be immediately removed. Only polyps in the distal colon and rectum can be detected and removed during sigmoidoscopy. Polyps can be detected but not removed during barium enema and radiography. Digital examination is used for prostate evaluation but not for the diagnosis of colon polyps because it only assesses the rectal area and not the colon. Reference: 1034

You are caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass and a bowel obstruction is suspected. You are auscultating the abdomen listening for which types of bowel sounds that are consistent with the patient's clinical picture? A. Low pitched and rumbling above the area of obstruction B. High pitched and hypoactive below the area of obstruction C. Low pitched and hyperactive below the area of obstruction D. High pitched and hyperactive above the area of obstruction

D Rationale Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high pitched, sometimes referred to as "tinkling" above the level of the obstruction. This occurs because peristaltic action increases to push past the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent. Reference: 1033

Which finding is most important to monitor in a patient with Crohn's disease? A. Elevated WBC level B. Frequent diarrhea C. Abdominal cramping D. Brown discharge in urine

D Rationale Fistulas can develop between bowel and bladder. Stool in the urine and urinary tract infections (UTIs) are the signs of a fistula. The other options are expected findings during an exacerbation of the condition. Reference: 1023, 1025

During the assessment of a patient with acute abdominal pain, what should you do? A. Perform deep palpation before auscultation. B. Obtain blood pressure and pulse rate to determine hypervolemic changes. C. Auscultate bowel sounds because hyperactive bowel sounds suggest paralytic ileus. D. Measure body temperature because an elevated temperature may indicate an inflammatory or infectious process.

D Rationale For the patient complaining of acute abdominal pain, you should take vital signs immediately. Increased pulse and decreasing blood pressure are indicative of hypovolemia. An elevated temperature suggests an inflammatory or infectious process. Intake and output measurements provide essential information about the adequacy of vascular volume. Inspect the abdomen first, and then auscultate bowel sounds. Palpation is performed next and should be gentle. Reference: 1016

Which discharge teaching should you provide to a patient with a herniorrhaphy for an inguinal hernia repair? A. Wear a truss continually. B. Call the primary provider if scrotal edema occurs. C. Cough frequently to prevent atelectasis. D. Do not do heavy lifting for 6 to 8 weeks.

D Rationale Heavy lifting should be avoided for 6 to 8 weeks after repair. Preoperatively a truss is used by some people to prevent a hernia from protruding. It is not worn after surgery. Scrotal edema is a painful but not serious complication after an inguinal hernia repair. Coughing is not encouraged because it increases pressure. The patient should be encouraged to do deep breathing and turning instead. Reference: 1048

The elderly male patient reports his stool is very narrow and thin like a pencil. What action should you take? A. Encourage more bulk in the diet. B. Stress the importance of adequate fluids. C. Assess for laxative abuse. D. Initiate evaluation for colorectal cancer.

D Rationale Left-sided colon cancerous lesions can change the stool caliber. This is the priority action. Reference: 1036

What is the most common symptom of an acute abdominal problem? A. Nausea B. Flatulence C. Fever D. Pain

D Rationale Pain is the most common symptoms of an acute abdominal problem. The other symptoms may be present, along with vomiting, diarrhea, constipation, flatulence, fatigue, or increased abdominal girth, but pain is most common. Reference: 1015

For a patient with Crohn's disease which assessment finding is most important for you to follow-up? A. Bloody diarrheal stool: 4 times/day B. Abdominal cramping C. Temperature: 100.4° F (38° C) D. Positive rebound tenderness

D Rationale Positive rebound tenderness is a classic sign of peritonitis and requires emergency follow-up. The other options are expected signs or symptoms with ulcerative colitis, which has intermittent exacerbations. Reference: 1021, 1023

Which items are included in the Rome III symptom-based criteria for inflammatory bowel syndrome (IBS)? A. Positive occult blood stool specimen B. Unilateral abdominal pain C. Diarrhea 10 or more times/day D. Abdominal pain for at least 3 months

D Rationale The Rome III criteria include abdominal discomfort or pain for at least 3 months, with onset at least 6 months before that has at least two characteristics: (1) relieved with defecation, (2) onset associated with a change in stool frequency, and (3) onset associated with change in stool appearance. Positive occult blood in the stool can be an indication of colorectal cancer and that must be ruled out. Pain tends to be across the lower abdomen. While some people can have frequent diarrhea, others have constipation or intermittent diarrhea and constipation. Reference: 1018

Which is the best indication that the patient is adjusting emotionally to having a colostomy? A. Indicates his spouse will be taking care of things B. Agrees to attend a future support group meeting C. Reads a brochure about colostomy care D. Participates in changing the drainage bag

D Rationale The best indication that a patient is adjusting emotionally is involvement in his or her care. Participation is a better indication than relying on others, promises of future activity, or only reading about the care. Reference: 1042

After inserting a nasogastric tube for a 68-year-old patient with suspected bowel obstruction, you should write which priority nursing diagnosis on the patient's problem list? A. Anxiety related to nasogastric tube placement B. Abdominal pain related to nasogastric tube placement C. Risk of deficient knowledge related to nasogastric tube placement D. Altered oral mucous membrane related to nasogastric tube placement

D Rationale With nasogastric tube placement, the patient is likely to breathe through the mouth and may experience irritation in the affected nares. For this reason, you should plan preventive measures based on this nursing diagnosis. Reference: 1034

When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend? A. White bread, cheese, and green beans B. Fresh tomatoes, pears, and corn flakes C. Oranges, baked potatoes, and raw carrots D. Dried beans, All Bran (100%) cereal, and raspberries

D A high fiber diet is recommended for diverticular disease. Dried beans, All Bran (100%) cereal, and raspberries all have higher amounts of fiber than white bread, cheese, green beans, fresh tomatoes, pears, corn flakes, oranges, baked potatoes, and raw carrots.

What should the nurse instruct the patient to do to best enhance the effectiveness of a daily dose of docusate sodium (Colace)? A. Take a dose of mineral oil at the same time. B. Add extra salt to food on at least one meal tray. C. Ensure dietary intake of 10 g of fiber each day. D. Take each dose with a full glass of water or other liquid.

D Docusate lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage. The patient should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. Dietary fiber intake should be a minimum of 20 g daily to prevent constipation. Mineral oil and extra salt are not recommended.

The nurse would question the use of which cathartic agent in a patient with renal insufficiency? A. Bisacodyl (Dulcolax) B. Lubiprostone (Amitiza) C. Cascara sagrada (Senekot) D. Magnesium hydroxide (Milk of Magnesia)

D Milk of Magnesia may cause hypermagnesemia in patients with renal insufficiency. The nurse should question this order with the health care provider. Bisacodyl, lubiprostone, and cascara sagrada are safe to use in patients with renal insufficiency as long as the patient is not currently dehydrated.

The nurse is admitting a 68-year-old man with severe dehydration and frequent watery diarrhea. He just completed a 10-day outpatient course of antibiotic therapy for bacterial pneumonia. It is most important for the nurse to take which action? A. Wear a mask to prevent transmission of infection. B. Wipe equipment with ammonia-based disinfectant. C. Instruct visitors to use the alcohol-based hand sanitizer. D. Don gloves and gown before entering the patient's room.

D. Don gloves and gown before entering the patient's room. Clostridium difficile is an antibiotic-associated diarrhea transmitted by contact, and the spores are extremely difficult to kill. Patients with suspected or confirmed infection with C. difficile should be placed in a private room and gloves and gowns should be worn by visitors and health care providers. Alcohol-based hand cleaners and ammonia-based disinfectants are ineffective and do not kill all of the spores. Equipment cannot be shared with other patients, and a disposable stethoscope and individual patient thermometer are kept in the room. Objects should be disinfected with a 10% solution of household bleach.

After an abdominal hysterectomy, a 45-year-old woman complains of severe gas pains. Her abdomen is distended. It is most appropriate for the nurse to administer which prescribed medication? A. Morphine sulfate B. Ondansetron (Zofran) C. Acetaminophen (Tylenol) D. Metoclopramide (Reglan)

D. Metoclopramide (Reglan) Swallowed air and reduced peristalsis after surgery can result in abdominal distention and gas pains. Early ambulation helps restore peristalsis and eliminate flatus and gas pain. Medications used to reduce gas pain include metoclopramide (Reglan) or alvimopan (Entereg) to stimulate peristalsis.

A 20-year old patient with a history of Crohn's disease comes to the clinic with persistent diarrhea. What are characteristics of Crohn's disease (select all that apply)? a. Weight loss d. Toxic megacolon b. Rectal bleeding e. Has segmented distribution c. Abdominal pain f. Involves the entire thickness of the bowel wall

a, c, e, f. Crohn's disease may have severe weight loss, segmented distribution through the entire wall of the bowel, and crampy abdominal pain. Rectal bleeding and toxic megacolon are more often seen with ulcerative colitis.

The patient calls the clinic and describes a bump at the site of a previous incision that disappears when he lies down. The nurse suspects that this is which type of hernia (select all that apply)? a. Ventral d. Reducible b. Inguinal e. Incarcerated c. Femoral f. Strangulated

a, d. The ventral or incisional hernia is due to a weakness of the abdominal wall at the site of a previous incision. It is reducible when it returns to the abdominal cavity. Inguinal hernias are at the weak area of the abdominal wall where the spermatic cord in men or the round ligament in women emerges. A femoral hernia is a protrusion through the femoral ring into the femoral canal. Incarcerated hernias do not reduce.

When obtaining a nursing history from the patient with colorectal cancer, the nurse should specifically ask the patient about a. dietary intake. b. sports involvement. c. environmental exposure to carcinogens. d. long-term use of nonsteroidal antiinflammatory drugs (NSAIDs).

a. A diet high in red meat and low fruit and vegetable intake is associated with development of colorectal cancer (CRC), as are alcohol intake and smoking. Family and personal history of CRC also increases the risk. Other environmental agents are not known to be related to colorectal cancer. Long-term use of nonsteroidal antiinflammatory drugs (NSAIDs) is associated with reduced CRC risk.

The nurse plans teaching for the patient with a colostomy but the patient refuses to look at the nurse or the stoma, stating, "I just can't see myself with this thing." What is the best nursing intervention for this patient? a. Encourage the patient to share concerns and ask questions. b. Refer the patient to a chaplain to help cope with this situation. c. Explain that there is nothing the patient can do about it and must take care of it. d. Tell the patient that learning about it will prevent stool leaking and the sounds of flatus.

a. Encouraging the patient to share concerns and ask questions will help the patient to begin to adapt to living with the colostomy. The other options do not support the patient and do not portray the nurse's focus on helping the patient or treating the patient as an individual.

Which method is preferred for immediate treatment of an acute episode of constipation? a. An enema c. Stool softeners b. Increased fluid d. Bulk-forming medication

a. Enemas are fast acting and beneficial in the immediate treatment of acute constipation but should be limited in their use. Bulk-forming medication stimulates peristalsis but takes 24 hours to act. Stool softeners have a prolonged action, taking up to 72 hours for an effect, and fluids can help to decrease the incidence of constipation

Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms occur as a result of which of the following? a. Impaired peristalsis b. Irritation of the bowel c. Nasogastric suctioning d. Anastomosis site inflammation

a. Impaired peristalsis Until peristalsis returns to normal following anesthesia, the patient may experience slowed gastrointestinal motility leading to gas pains and abdominal distention. Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention.

A patient with ulcerative colitis has a total proctocolectomy with formation of a terminal ileum stoma. What is the most important nursing intervention for this patient postoperatively? a. Measure the ileostomy output to determine the status of the patient's fluid balance. b. Change the ileostomy appliance every 3 to 4 hours to prevent leakage of drainage onto the skin. c. Emphasize that the ostomy is temporary and the ileum will be reconnected when the large bowel heals. d. Teach the patient about the high-fiber, low-carbohydrate diet required to maintain normal ileostomy drainage.

a. Initial output from a newly formed ileostomy may be as high as 1500 to 2000 mL daily and intake and output must be accurately monitored for fluid and electrolyte imbalance. Ileostomy bags may need to be emptied every 3 to 4 hours but the appliance should not be changed for several days unless there is leakage onto the skin. A terminal ileum stoma is permanent and the entire colon has been removed. A return to a normal, presurgical diet is the goal for the patient with an ileostomy, with restrictions based only on the patient's individual tolerances.

A patient with a gunshot wound to the abdomen complains of increasing abdominal pain several hours after surgery to repair the bowel. What action should the nurse take first? a. Take the patient's vital signs. b. Notify the health care provider. c. Position the patient with the knees flexed. d. Determine the patient's IV intake since the end of surgery.

a. It is likely that the patient could be developing a peritonitis, which could be life-threatening, and assessment of vital signs for hypovolemic shock should be done to report to the health care provider. If an IV line is not in place, it should be inserted and pain may be eased by flexing the knees.

82-year-old man is admitted with an acute attack of diverticulitis. What should the nurse include in his care? a. Monitor for signs of peritonitis. b. Treat with daily medicated enemas. c. Prepare for surgery to resect the involved colon. d. Provide a heating pad to apply to the left lower quadrant.

a. The inflammation and infection of diverticula cause small perforations with spread of the inflammation to the surrounding area in the intestines. Abscesses may form or complete perforation with peritonitis may occur. Systemic antibiotic therapy is often used but medicated enemas would increase intestinal motility and increase the possibility of perforation, as would the application of heat. Surgery is only necessary to drain abscesses or to resect an obstructing inflammatory mass.

A patient is admitted to the emergency department with acute abdominal pain. What nursing intervention should the nurse implement first? a. Measurement of vital signs b. Administration of prescribed analgesics c. Assessment of the onset, location, intensity, duration, and character of the pain d. Physical assessment of the abdomen for distention, bowel sounds, and pigmentation changes

a. The patient with an acute abdomen may have significant fluid or blood loss into the abdomen and evaluation of blood pressure (BP) and heart rate (HR) should be the first intervention, followed by assessment of the abdomen and the nature of the pain. Analgesics should be used cautiously until a diagnosis can be determined so that symptoms are not masked.

Which behavior can help people with lactase deficiency to tolerate milk? A. Drink the milk on an empty stomach 30 minutes before meals. B. Add Lactaid to the consumed milk. C. Consume the milk with calcium supplement. D. Use on buttermilk.

b Rationale The lactase enzyme (Lactaid) is available as an over-the-counter product to mix with milk and break down the lactose before the milk is ingested. Some can tolerate the lactose better if lactase is taken with meals. Although lack of milk consumption can lead to a calcium deficiency, consuming it with calcium will not make a difference. The symptoms result from an inability to digest lactose, not a calcium deficiency. Buttermilk has additional fat, but it also has lactose. Reference: 1051

On examining a patient 8 hours after having surgery to create a colostomy, what should the nurse expect to find? a. Hyperactive, high-pitched bowel sounds b. A brick-red, puffy stoma that oozes blood c. A purplish stoma, shiny and moist with mucus d. A small amount of liquid fecal drainage from the stoma

b. A normal new colostomy stoma should appear bright red, have mild to moderate edema, and have a small amount of bleeding or oozing of blood when touched. A purplish stoma indicates inadequate blood supply and should be reported. The colostomy will not have any fecal drainage for 2 to 4 days but there may be some earlier mucus or serosanguineous drainage. Bowel sounds after extensive bowel surgery will be diminished or absent

The patient asks the nurse to explain what the physician meant when he said the patient had an anorectal abscess. Which description should the nurse use to explain this to the patient? a. Ulcer in anal wall c. Sacrococcygeal hairy tract b. Collection of perianal pus d. Tunnel leading from the anus or rectum

b. An anorectal abscess is a collection of perianal pus. An ulcer in the anal wall is an anal fissure. Sacrococcygeal hairy tract describes a pilonidal sinus. A tunnel leading from the anus or rectum is an anorectal fistula.

What information should be included when the nurse teaches a patient about colostomy irrigation? a. Infuse 1500 to 2000 mL of warm tap water as irrigation fluid. b. Allow 30 to 45 minutes for the solution and feces to be expelled. c. Insert a firm plastic catheter 3 to 4 inches into the stoma opening. d. Hang the irrigation bag on a hook about 36 inches above the stoma.

b. Following infusion of the fluid into the stoma, the solution and feces will take about 30 to 45 minutes to return and the patient can plan to read or perform other quiet activities during the wait time. Between 500 and 1000 mL of warm tap water should be used. A cone tip on the end of the tubing prevents bowel damage that could occur if a stiff plastic catheter is used. Fluid should be elevated about 18 to 24 inches above the stoma, or to about shoulder level, to prevent too rapid infusion of the solution and cramping.

Which of the following would be the highest priority information to include in preoperative teaching for a 68-year-old patient scheduled for a colectomy? a. How to care for the wound b. How to deep breathe and cough c. The location and care of drains after surgery d. What medications will be used during surgery

b. How to deep breathe and cough Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed preoperatively, but done again with higher priority after surgery. Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.

What is a nursing intervention that is indicated for a male patient following an inguinal herniorrhaphy? a. Applying heat to the inguinal area c. Applying a truss to support the operative site b. Elevating the scrotum with a scrotal support d. Encouraging the patient to cough and deep breathe

b. Scrotal edema is a common and painful complication after an inguinal hernia repair and can be relieved in part by application of ice and elevation of the scrotum with a scrotal support. Heat would increase the edema and the discomfort and a truss is used to keep unrepaired hernias from protruding. Coughing is discouraged postoperatively because it increases intraabdominal pressure and stress on the repair site.

A patient with ulcerative colitis undergoes the first phase of a total proctocolectomy with ileal pouch and anal anastomosis. On postoperative assessment of the patient, what should the nurse expect to find? a. A rectal tube set to low continuous suction b. A loop ileostomy with a plastic rod to hold it in place c. A colostomy stoma with an NG tube in place to provide pouch irrigations d. A permanent ileostomy stoma in the right lower quadrant of the abdomen

b. The initial procedure for a total proctocolectomy with ileal pouch and anal anastomosis includes a colectomy, rectal mucosectomy, ileal reservoir construction, ileoanal anastomosis, and a temporary ileostomy. A loop ileostomy is the most common temporary ileostomy and it may be held in place with a plastic rod for the first week. A rectal tube to suction is not indicated in any of the surgical procedures for ulcerative colitis. A colostomy is not used and an NG tube would not be used to irrigate the pouch. A permanent ileostomy stoma would be expected following a total proctocolectomy with a permanent ileostomy.

A physician just told a patient that she has a volvulus. When the patient asks the nurse what this is, what is the best description for the nurse to give her? a. Bowel folding on itself c. Emboli of arterial supply to the bowel b. Twisting of bowel on itself d. Protrusion of bowel in weak or abnormal opening

b. Volvulus is the bowel twisting on itself. The bowel folding on itself is intussusception. Emboli of arterial blood supply to the bowel is vascular obstruction. Protrusion of bowel in a weak or abnormal opening is a hernia

Which food item should a patient with celiac disease avoid? A. Steamed rice B. Yogurt C. Pancakes D. Raw pineapple

c Rationale A patient with celiac disease cannot digest wheat, rye, or barley. Pancakes are made with flour, which is made with wheat. Reference: 1049-1050

Which is a risk for developing hemorrhoids? A. Body mass index (BMI) of 17 kg/m2 B. Younger than 30 years C. Chronic constipation D. History of lactase deficiency

c Rationale Chronic constipation increases intraluminal pressure, which can predispose to hemorrhoids. Overweight is a risk, not underweight (normal BMI is 18.5 to 24.9 kg/m2). Older adults are at higher risk. Lactase deficiency is not related to hemorrhoids. Reference: 1052

The patient reports that she experiences cramping, flatulence, and abdominal cramping about an hour after consuming milk. What action should you pursue? A. Encourage patient to ensure she is not drinking milk past the expiration date. B. Assess the patient for the presence of dumping syndrome. C. Suggest a hydrogen breath test. D. Ask about recent stressors in the patient's life that could cause gastrointestinal upset.

c Rationale In lactase deficiency, the enzyme to digest lactose in milk is absent. Common symptoms include bloating, flatulence, cramping abdominal pain, and diarrhea 30 minutes to several hours after ingestion. It can be diagnosed with a lactose tolerance test, a hydrogen breath test to assess intolerance, or genetic testing using DNA. The most likely cause should be explored before assuming the food is spoiled or the reaction is a result of emotional stress. Dumping syndrome occurs when the stomach storage area has decreased from surgery and concentrated carbohydrates are consumed. Reference: 1051

Which is the most common causative organism of an anorectal abscess? A. Giardia lamblia B. Clostridium difficile C. Escherichia coli D. The organism for tuberculosis

c Rationale The most common organisms causing perianal pus are E. coli, staphylococci, and streptococci. Reference: 1054

The patient had a colon resection and a colostomy today. You should call the primary provider after noticing which finding during the patient assessment? A. No drainage in the colostomy bag B. Moderate stoma swelling C. Dusky blue stoma D. Stoma that bleeds when touched

c Rationale The stoma should be pink or red to show adequate circulation. Drainage is not expected the first 24 hours because peristalsis has not returned. Mild to moderate swelling of the stoma is expected the first 2 to 3 weeks after surgery. The raw surgical mucosa bleeds with trauma during the first postoperative day. Reference: 1041

The patient asks the nurse why she needs to have surgery for a femoral, strangulated hernia. What is the best explanation the nurse can give the patient? a. The surgery will relieve her constipation. b. The abnormal hernia must be replaced into the abdomen. c. The surgery is needed to allow intestinal flow and prevent necrosis. d. The hernia is because the umbilical opening did not close after birth as it should have.

c. A strangulated femoral hernia obstructs intestinal flow and blood supply, thus requiring emergency surgery. The other options are incorrect.

During a routine screening colonoscopy on a 56-year-old patient, a rectosigmoidal polyp was identified and removed. The patient asks the nurse if his risk for colon cancer is increased because of the polyp. What is the best response by the nurse? a. "It is very rare for polyps to become malignant but you should continue to have routine colonoscopies." b. "Individuals with polyps have a 100% lifetime risk of developing colorectal cancer and at an earlier age than those without polyps." c. "All polyps are abnormal and should be removed but the risk for cancer depends on the type and if malignant changes are present." d. "All polyps are premalignant and a source of most colon cancer. You will need to have a colonoscopy every 6 months to check for new polyps."

c. Although all polyps are abnormal growths, the most common type of polyp (hyperplastic) is non-neoplastic, as are inflammatory, lipomas, and juvenile polyps. However, adenomatous polyps are characterized by neoplastic changes in the epithelium and most colorectal cancers appear to arise from these polyps. Only patients with a family history of familial adenomatous polyposis (FAP) have close to a 100% lifetime risk of developing colorectal cancer.

What should a patient be taught after a hemorrhoidectomy? A. Do not use the Valsalva maneuver. B. Eat a low-fiber diet to rest the colon. C. Administer oil-retention enema to empty the colon. D. Use prescribed pain medication before a bowel movement.

d Rationale After a hemorrhoidectomy, the patient usually dreads the first bowel movement and often resists the urge to defecate. Pain medication may be given before the bowel movement to reduce discomfort. The patient should avoid constipation and straining. A high-fiber diet can reduce constipation. A stool softener such as docusate (Colace) is usually ordered for the first few postoperative days. If the patient does not have a bowel movement within 2 to 3 days, an oil-retention enema may be given. Reference: 1053

A patient returns to the surgical unit with a nasogastric (NG) tube to low intermittent suction, IV fluids, and a Jackson-Pratt drain at the surgical site following an exploratory laparotomy and repair of a bowel perforation. Four hours after admission, the patient experiences nausea and vomiting. What is a priority nursing intervention for the patient? a. Assess the abdomen for distention and bowel sounds. b. Inspect the surgical site and drainage in the Jackson-Pratt. c. Check the amount and character of gastric drainage and the patency of the NG tube. d. Administer prescribed prochlorperazine (Compazine) to control the nausea and vomiting.

c. An adequately functioning nasogastric (NG) tube should prevent nausea and vomiting because stomach contents are continuously being removed. The first intervention in this case is to check the amount and character of the recent drainage and check the tube for patency. Decreased or absent bowel sounds are expected after a laparotomy and the Jackson-Pratt drains only fluid from the tissue of the surgical site. Antiemetics may be given if the NG tube is patent because anesthetic agents may cause nausea.

The patient is receiving the following medications. Which one is prescribed to relieve symptoms rather than treat a disease? a. Corticosteroids c. Antidiarrheal agents b. 6-Mercaptopurine d. Sulfasalazine (Azulfidine)

c. Antidiarrheal agents only relieve symptoms. Corticosteroids, 6-mercaptopurine, and sulfasalazine (Azulfidine) are used to treat and control inflammation with various diseases.

The nurse identifies a need for additional teaching when a patient with acute infectious diarrhea makes which statement? a. "I can use A&D ointment or Vaseline jelly around the anal area to protect my skin." b. "Gatorade is a good liquid to drink because it replaces the fluid and salts I have lost." c. "I may use over-the-counter Imodium or Parepectolin when I need to control the diarrhea." d. "I must wash my hands after every bowel movement to prevent spreading the diarrhea to my family."

c. Antiperistaltic agents, such as loperamide (Imodium) and paregoric, should not be used in infectious diarrhea because of the potential of prolonging exposure to the infectious agent. Demulcent agents may be used to coat and protect mucous membranes in these cases. The other options are all appropriate measures to use in cases of infectious diarrhea.

What should the nurse teach the patient with diverticulosis to do? a. Use anticholinergic drugs routinely to prevent bowel spasm. b. Have an annual colonoscopy to detect malignant changes in the lesions. c. Maintain a high-fiber diet and use bulk laxatives to increase fecal volume. d. Exclude whole grain breads and cereals from the diet to prevent irritating the bowel.

c. Formation of diverticula is common when decreased bulk of stool, combined with a more narrowed lumen in the sigmoid colon, causes high intraluminal pressures that result in saccular dilation or outpouching of the mucosa through the muscle of the intestinal wall. To prevent the high intraluminal pressure, fecal volume should be increased with use of high-fiber diets and bulk laxatives, such as psyllium (Metamucil). Anticholinergic drugs are used only during an acute episode of diverticulitis and the lesions are not premalignant.

A 60-year-old African American patient is afraid she might have anal cancer. What assessment finding puts her at high risk for anal cancer? a. Alcohol use c. Human papillomavirus (HPV) b. Only one sexual partner d. Use of a condom with sexual intercourse

c. Human papillomavirus (HPV) is associated with about 80% of anal cancer cases. Other risk factors include multiple sexual partners, smoking, receptive anal sex, and HIV infection, as well as being female, age 60, and African American. The other options are not considered risk factors for anal cancer.

Following bowel resection, a patient has a nasogastric tube to suction, but complains of nausea and abdominal distention. The nurse irrigates the tube prn as ordered, but the irrigating fluid does not return. Which of the following should be the priority action by the nurse? a. Notify the physician. b. Auscultate for bowel sounds. c. Reposition the tube and check for placement. d. Remove the tube and replace it with a new one.

c. Reposition the tube and check for placement. The tube may be resting against the stomach wall. The first action by the nurse (since this is intestinal surgery and not gastric surgery) is to reposition the tube and check it again for placement. The physician does not need to be notified unless the tube function cannot be restored by the nurse. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.

A patient is diagnosed with celiac disease following a workup for iron-deficiency anemia and decreased bone density. The nurse identifies that additional teaching about disease management is needed when the patient makes which statement? a. "I should ask my close relatives to be screened for celiac disease." b. "If I do not follow the gluten-free diet, I might develop a lymphoma." c. "I don't need to restrict gluten intake because I don't have diarrhea or bowel symptoms." d. "It is going to be difficult to follow a gluten-free diet because it is found in so many foods."

c. The autoimmune process associated with celiac disease continues as long as the body is exposed to gluten, regardless of the symptoms it produces, and a lifelong gluten-free diet is necessary. The other statements regarding celiac disease are all true

The person with lactase deficiency is at risk for which condition? A. Colorectal cancer B. Pancreatitis C. Osteoarthritis D. Osteoporosis

d Rationale Avoidance of milk and milk products can lead to calcium deficiency, which can lead to osteoporosis. Lactase deficiency is not linked to the other options. Reference: 1051

You are answering a patient's questions about celiac or gluten-sensitive enteropathy disease. Which option is the correct information to provide? A. Celiac is also known as tropical sprue. B. Celiac is only seen in children. C. Its symptoms mimic inflammatory bowel disease (IBD). D. It is an autoimmune disease.

d Rationale Celiac is an autoimmune disease in people who have a genetic predisposition, consume gluten, and an immune-mediated response. Celiac disease is different from tropical sprue, which is a chronic disorder acquired in tropical areas and treated with folic acid and tetracycline. Celiac disease is a relatively common disease that occurs in all ages. The symptoms mimic irritable bowel syndrome (IBS). Reference: 1049

After a fistulectomy, the patient is prescribed sitz baths. What is the main rationale for a sitz bath? A. To prevent hemorrhoids B. To promote defecation C. To relieve pressure on the area D. To provide comfort

d Rationale Sitz baths are started 1 to 2 days after surgery to provide comfort and keep the anal area clean. A sponge ring may be used to relieve pressure. Reference: 1054, 1053

The RN coordinating the care for a patient who is 2 days postoperative following an anterior- posterior resection with colostomy may delegate which interventions to the licensed practical nurse (LPN) (select all that apply)? a. Irrigate the colostomy. b. Teach ostomy and skin care. c. Assess and document stoma appearance. d. Monitor and record the volume, color, and odor of the drainage. e. Empty the ostomy bag and measure and record the amount of drainage.

d, e. The licensed practical nurse (LPN) can monitor and record observations related to the drainage and can measure and record the amount. The LPN could also monitor the skin around the stoma for breakdown. LPNs can irrigate a colostomy in a stable patient but this patient is only 2 days postoperative. The other actions are responsibilities of the RN (teaching, assessing stoma, and developing a care plan).

The nurse is caring for a postoperative patient with a colostomy. The nurse is preparing to administer a dose of famotidine (Pepcid) when the patient asks why the medication was ordered since the patient does not have a history of heartburn or gastroesophageal reflux disease (GERD). Which of the following would be the most appropriate response by the nurse? a. "This will prevent air from accumulating in the stomach, causing gas pains." b. "This will prevent the heartburn that occurs as a side effect of general anesthesia." c. "The stress of surgery is likely to cause stomach bleeding if you do not receive it." d. "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed, and you can eat a regular diet again."

d. "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed, and you can eat a regular diet again." Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery. Famotidine does not prevent air from accumulating in the stomach or stop the stomach from bleeding. Heartburn is not a side effect of general anesthesia.

The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which of the following types of bowel sounds that is consistent with the patient's clinical picture? a. Low pitched and rumbling above the area of obstruction b. High pitched and hypoactive below the area of obstruction c. Low pitched and hyperactive below the area of obstruction d. High pitched and hyperactive above the area of obstruction

d. High pitched and hyperactive above the area of obstruction Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high-pitched, sometimes referred to as "tinkling" above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

A nurse is doing a nursing assessment on a patient with chronic constipation. What data obtained during the interview may be a factor contributing to the constipation? a. Taking methylcellulose (Citrucel) daily c. History of hemorrhoids and hypertension b. High dietary fiber with high fluid intake d. Suppressing the urge to defecate while at work

d. Ignoring the urge to defecate causes the muscles and mucosa in the rectal area to become insensitive to the presence of feces and drying of the stool occurs. The urge to defecate is decreased and stool becomes more difficult to expel. Taking a bulk-forming agent with fluids or highfiber diet with fluids prevent constipation. Hemorrhoids are the most common complication of chronic constipation, caused by straining to pass hardened stool. The straining may cause problems in patients with hypertension but these do not cause constipation. Other things that may cause constipation are a history of diverticulosis, which is seen in individuals with low fiber intake, small stool mass, and hard stools. Chronic laxative use and chronic dilation and loss of colonic tone may also cause chronic constipation.

A male patient who has undergone an anterior-posterior repair is worried about his sexuality. What is an appropriate nursing intervention for this patient? a. Have the patient's sexual partner reassure the patient that he is still desirable. b. Reassure the patient that sexual function will return when healing is complete. c. Remind the patient that affection can be expressed in ways other than through sexual intercourse. d. Explain that physical and emotional factors can affect sexual function but not necessarily the patient's sexuality.

d. Sexual dysfunction may result from an anterior-posterior repair but the nurse should discuss with the patient that different nerve pathways affect erection, ejaculation, and orgasm and that a dysfunction of one does not mean total sexual dysfunction and also that an alteration in sexual activity does not have to alter sexuality. Simple reassurance of desirability and ignoring concerns about sexual function do not help the patient to regain positive feelings of sexuality.

In instituting a bowel training program for a patient with fecal incontinence, what should the nurse first plan to do? a. Teach the patient to use a perianal pouch. b. Insert a rectal suppository at the same time every morning. c. Place the patient on a bedpan 30 minutes before breakfast. d. Assist the patient to the bathroom at the time of the patient's normal defecation.

d. The first intervention to establish bowel regularity includes promoting bowel evacuation at a regular time each day, preferably by placing the patient on the bedpan, using a bedside commode, or walking the patient to the bathroom. To take advantage of the gastrocolic reflex, an appropriate time is 30 minutes after the first meal of the day or at the patient's usual individual time. Perianal pouches are used to protect the skin only when regularity cannot be established and evacuation suppositories are also used only if other techniques are not successful.

The patient with a new ileostomy needs discharge teaching. What should the nurse plan to include in this teaching? a. The pouch can be worn for up to 2 weeks before changing it. b. Decrease the amount of fluid intake to decrease the amount of drainage. c. The pouch can be removed when bowel movements have been regulated. d. If leakage occurs, promptly remove the pouch, clean the skin, and apply a new pouch

d. The ileostomy drainage is extremely irritating to the skin, so the skin must be cleaned and a new solid skin barrier and pouch applied as soon as a leak occurs to prevent skin damage. The pouch is usually worn for 4 to 7 days unless there is a leak. Because the initial drainage from the ileostomy is high, the fluid intake must not be decreased. The pouch must always be worn, as the liquid drainage, not formed bowel movements, is frequent.

A 22-year-old patient calls the outpatient clinic complaining of nausea and vomiting and right lower abdominal pain. What should the nurse advise the patient to do? a. Use a heating pad to relax the muscles at the site of the pain. b. Drink at least 2 quarts of juice to replace the fluid lost in vomiting. c. Take a laxative to empty the bowel before examination at the clinic. d. Have the symptoms evaluated by a health care provider right away.

d. The patient is having symptoms of an acute abdomen and should be evaluated by a health care provider immediately. The patient's age, location of pain, and other symptoms are characteristic of appendicitis. Heat application and laxatives should not be used in patients with undiagnosed abdominal pain because they may cause perforation of the appendix or other inflammations. Fluids should not be taken until vomiting is controlled, nor should they be taken in the event that surgery may be performed.

In report, the nurse learns that the patient has a transverse colostomy. What should the nurse expect when providing care for this patient? a. Semiliquid stools with increased fluid requirements b. Liquid stools in a pouch and increased fluid requirements c. Formed stools with a pouch, needing irrigation, but no fluid needs d. Semiformed stools in a pouch with the need to monitor fluid balance

d. The patient with a transverse colostomy has semiliquid to semiformed stools needing a pouch and needs to have fluid balance monitored. The ascending colostomy has semiliquid stools needing a pouch and increased fluid. The ileostomy has liquid to semiliquid stools needing a pouch and increased fluid. The sigmoid colostomy has formed stools and may or may not need a pouch but will need irrigation.

What extraintestinal manifestations are seen in both ulcerative colitis and Crohn's disease? a. Celiac disease and gallstones c. Conjunctivitis and colonic dilation b. Peptic ulcer disease and uveitis d. Erythema nodosum and osteoporosis

d. Ulcerative colitis and Crohn's disease have many of the same extraintestinal symptoms, including erythema nodosum and osteoporosis, as well as gallstones, uveitis, and conjunctivitis. Colonic dilation and celiac disease are not extraintestinal.

Following a hemorrhoidectomy, what should the nurse advise the patient to do? a. Use daily laxatives to facilitate bowel emptying. b. Use ice packs to the perineum to prevent swelling. c. Avoid having a bowel movement for several days until healing occurs. d. Take warm sitz baths several times a day to promote comfort and cleaning.

d. Warm sitz baths provide comfort, healing, and cleansing of the area following all anorectal surgery and may be done three or four times a day for 1 to 2 weeks. Stool softeners may be prescribed for several days postoperatively to help keep stools soft for passage but laxatives may cause irritation and trauma to the anorectal area and are not used postoperatively. Early passage of a bowel movement, although painful, is encouraged to prevent drying and hardening of stool, which would result in an even more painful bowel movement.

When a patient returns to the clinical unit after an abdominal-perineal resection (APR), what should the nurse expect? a. An abdominal dressing c. A temporary colostomy and drains b. An abdominal wound and drains d. A perineal wound, drains, and a stoma

d. With an abdominal perineal-resection (APR), an abdominal incision is made and the proximal sigmoid colon is brought through the abdominal wall and formed into a permanent colostomy. The patient is repositioned, a perineal incision is made, and the distal sigmoid colon, rectum, and anus are removed through the perineal incision, which may be left open, packed, and have drains.