46 & 48

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

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

When interviewing a client with internal hemorrhoids, which of the following would the nurse expect the client to report? A) Rectal bleeding B) Pain C) Itching D) Soreness

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

After teaching a group of students about irritable bowel syndrome and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an opiate-related antidiarrheal agent? A) Loperamide (Imodium) B) Bismuth subsalicylate (Pepto-Bismol) C) Kaolin and pectin (Kaopectate) D) Bisacodyl (Dulcolax)

Ans: A Feedback:Loperamide (Imodium) and diphenoxylate with atropine sulfate (Lomotil) are examples of opiate-related antidiarrheal agents. Bismuth subsalicylate (Pepto-Bismol) and kaolin and pectin (Kaopectate) are examples of absorbent antidiarrheal agents. Bisacodyl (Dulcolax) is a chemical stimulant laxative.

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

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

The nurse is assessing a client for fecal impaction, and when inserting a lubricated, gloved finger, the stool feels like small rocks. What does the nurse document this finding as? A) Scybala B) Hard stool C) Fecal Impaction D) Obstruction

Ans: A Feedback:When a practitioner inserts a gloved and lubricated finger in the rectum, the stool may feel like small rocks, a condition referred to as scybala. The client may have hard stool or be impacted but the correct terminology to be documented is scybala. A fecal obstruction is not always able to be determined on digital examination and will require an x-ray.

18. The nurse is caring for a patient who has had diarrhea for 3 days. What major problems associated with severe or prolonged diarrhea should the nurse monitor for when caring for this patient? Select all that apply. A) Oral candidiasis B) Dehydration C) Electrolyte imbalances D) Vitamin deficiencies E) Rectal fissures

Ans: B, C, D Feedback:Three major problems associated with severe or prolonged diarrhea include dehydration, electrolyte imbalances, and vitamin deficiencies.

The nurse is preparing a patient for a test that involves inserting a thick barium paste into the rectum with radiographs taken as the client expels the barium. What test will the nurse prepare the patient for? A) Kidneys, ureters, bladder (KUB) B) Colonic transit studies C) Defecography D) Abdominal radiography

Ans: C Feedback: In defecography, a thick barium paste is inserted into the rectum. Radiographs are taken as the client expels the barium to determine whether there are any anatomic abnormalities or problems with the muscles surrounding the anal sphincter. A KUB will not determine this. Colonic transit studies are used to determine how long it takes for food to travel through the intestines. Abdominal radiography will show the structure but does not determine the muscle ability surrounding the anal sphincter.

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

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

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

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

The nurse is reviewing the laboratory test results of a client with Crohn's disease. Which of the following would the nurse most likely find? A) Decreased white blood cell count B) Increased albumin levels C) Stool cultures negative for microorganisms or parasite D) Decreased erythrocyte sedimentation rate

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

After teaching a group of students about intestinal obstruction, the instructor determines that the teaching was effective when the students identify which of the following as a cause of a functional obstruction? A) V olvulus B) Intussusception C) Tumor D) Abdominal surgery

Ans: D Feedback:In functional obstruction, the intestine can become adynamic from an absence of normal nerve stimulation to intestinal muscle fibers. For example, abdominal surgery can lead to paralytic ileus. Mechanical obstructions result from a narrowing of the bowel lumen with or without a space-occupying mass. A mass may include a tumor, adhesions (fibrous bands that constrict tissue), incarcerated or strangulated hernias, volvulus (kinking of a portion of intestine), intussusception (telescoping of one part of the intestine into an adjacent part), or impacted feces or barium.

A client at a long-term care facility informs the nurse that he is having cramping when trying to have a bowel movement, and all that is coming out is liquid. When the nurse reviews the client's last bowel movement history, it is determined that the client has not had a bowel movement in 7 days. What does the nurse understand is most likely occurring with this client? A) Scybala B) The history is incorrect of the last bowel movement. C) Diarrhea D) Encopresis

Ans: D Feedback:Sometimes, if a client has been constipated for a long time, the client may begin passing liquid stool around an obstructive stool mass called encopresis, a phenomenon sometimes misinterpreted as diarrhea. The liquid stool results from dry stool stimulating nerve endings in the lower colon and rectum, which increases peristalsis. Scybala is hard, rocklike stool. The nurse cannot make a judgment about the correctness of the last bowel movement if it is not documented. Encopresis will mimic diarrhea, but there is an obstructive mass above where the liquid stool is leaking around.

A client is complaining of problems with constipation. What dietary suggestion can the nurse inform the client may help facilitate the passage of stool? A) Increase the carbohydrate content of the diet. B) Increase dietary fat consumption. C) Increase dietary protein such as lean meats. D) Increase dietary fiber.

Ans: D Feedback: Constipation may result from insufficient dietary fiber and water. A diet low in fiber predisposes people to constipation because the stools produced are small in volume and dry. Increasing the carbohydrate, fat, and protein content will not facilitate the passage of stool.

A client with a hernia decides to manage the herniation with a truss. The nurse would emphasize which of the following? A) Using laxatives to ensure regular bowel movement B) Wearing warm, woolen clothes to avoid dryness C) Applying a sunscreen to prevent exposure to direct sunlight D) Using cornstarch to absorb moisture in the area

Ans: D Feedback: When a client is managing herniation with a truss, the nurse informs the client to keep the skin clean and dry or to use cornstarch to absorb moisture. This minimizes the risk for infection. Use of warm, woolen clothes will not help reduce moisture; it may increase the moisture and increase the risk of infections. If the client's bowel movements are regular, laxatives would not be necessary. However, the client would need teaching to prevent constipation. Applying sunscreen is a general recommendation for any client to reduce the risk of exposure to ultraviolet radiation from the sun.