Ch. 37: Bowel Elimination PrepU

A woman age 76 years has informed the nurse that she has begun using over-the-counter laxatives because her friend told her it was imperative to have at least one bowel movement daily. How should the nurse best respond to this client's statement? a) "Actually, people's bowel patterns can vary a lot and some people don't tend to go every day." b) "Your friend is correct in her assessment, but it would likely be better to exercise and drink more instead of using medications." c) "That's correct, but be sure that you don't increase your laxative doses over time." d) "Most older adults only have a bowel movement every 2 to 3 days, actually, so I'd encourage you to taper off your laxatives."

"Actually, people's bowel patterns can vary a lot and some people don't tend to go every day." Explanation: Elimination patterns vary widely among individuals, and the expectation of a daily bowel movement is not realistic for many healthy people. This client may not require pharmacologic interventions.

An older adult woman who is incontinent of stool following a cerebrovascular accident will have which nursing diagnosis? a) Constipation related to physiologic condition involving the deficit in neurologic innervation, as evidenced by fecal incontinence b) Fecal Retention related to loss of sphincter control, and diminished spinal cord innervation related to hemiparesis c) Bowel Incontinence related to loss of sphincter control, as evidenced by inability to delay the urge to defecate d) Diarrhea related to tube feedings, as evidenced by hyperactive bowel sounds and urgency

Bowel Incontinence related to loss of sphincter control, as evidenced by inability to delay the urge to defecate Explanation: The most appropriate nursing diagnosis addresses the client's fecal incontinence, related to loss of sphincter control innervation.

A nurse is assessing and documenting the eating habits of a client with repeated reports of flatus. Which food item produces gas that could lead to flatus? a) Chicken b) Fish c) Cabbage d) Apples

Cabbage Explanation: Vegetables such as cabbage, cucumbers, and onions are commonly known for producing gas. Flatulence, or flatus, results from swallowing air while eating, or sluggish peristalsis. Another cause is the gas that forms as a byproduct of bacterial fermentation in the bowel. Apples, fish, and chicken do not produce gas and lead to flatus

The nurse is doing preoperative teaching with a client who has a prescription for GoLYTELY® before undergoing intestinal surgery. For tolerance of drinking the solution, the nurse would advise the client to drink it in which manner? a) Warm b) Room temperature c) In fruit juice d) Chilled

Chilled Explanation: GoLYTELY® has a salty taste and is better tolerated if consumed cold. It is a powder that is mixed with water, not fruit juice. Serving at room temperature or warm does not enhance its taste.

A client's recent diagnosis of colorectal cancer has required a hemicolectomy (removal of part of the bowel) and the creation of a colostomy. The nurse would recognize that the client's stoma is healthy when it appears what color? a) Red and dry. b) Off-white or pale pink. c) Dark pink and moist. d) Dark or purple-blue

Dark pink and moist. Explanation: A healthy stoma is dark pink to red and moist. Pallor may suggest anemia and a dark appearance may indicate ischemia

Which symptom is a known side effect of antibiotics? a) Constipation b) Abdominal bloating c) Diarrhea d) Fecal impaction

Diarrhea Explanation: A side effect of taking antibiotics is diarrhea. Constipation, fecal impaction, and abdominal bloating are not common side effects of antibiotics.

Which medication causes constipation? a) Iron supplements b) Aspirin c) Bisacodyl d) Magnesium antacids

Iron supplements Explanation: A common side effect of iron supplements is constipation. Bisacodyl is a stool softener. Aspirin is an analgesic that does not typically cause constipation. Magnesium antacids help to decrease heartburn and do not typically cause constipation.

A client's last bowel movement was 4 days ago and oral laxatives and dietary changes have failed to prompt a bowel movement. How should the nurse position the client in anticipation of administering a cleansing enema? a) Right side-lying b) Left side-lying c) Supine d) Prone

Left side-lying Explanation: When administering a cleansing enema, the client is most often positioned in a left side-lying (Sims') position, though positioning has not been shown to appreciably alter the result of a cleansing enema

A nurse is giving an enema to a client who doubles over in pain with severe cramping. What intervention would be appropriate in this situation? a) Place the client on a bedpan in the supine position while receiving the enema. b) Lower the solution container and check the temperature and flow rate. c) Reposition the rectal tube and check for any fecal content. d) Remove the tubing and discontinue the procedure

Lower the solution container and check the temperature and flow rate. Explanation: If the client experiences severe cramping when the enema solution is introduced, the nurse should lower the solution container and check the temperature and flow rate. If the solution is too cold or the flow rate too fast, severe cramping may occur

Which enema solution lubricates the stool and intestinal mucosa without distending the intestine? a) Soap b) Water c) Normal saline d) Oil

Oil Explanation: Mineral, olive, or cottonseed oil are used to lubricate the stool and intestinal mucosa without distending the intestine.

A 5-year-old client has a gastrointestinal infection. His mother plans to send him to school tomorrow. The school nurse knows that which nursing outcome is most important to include in the care plan of the client? a) The client will demonstrate good health practices by isolating himself from others. b) The client will not return to school until he is completely symptom free for 7 days. c) The client will inform all contacts that he is ill. d) The client will demonstrate good health practices to prevent spread of infection.

The client will demonstrate good health practices to prevent spread of infection. Explanation: Children should not, but may, return to a school or daycare setting during the infectious phase of their illness. Hand washing is key to preventing the spread of infection

The health care provider prescribes a high fiber diet for a client to promote bowel elimination. Which foods, selected by the client, would indicate to the nurse that the client can identify high-fiber foods? a) Soda crackers and chicken noodle soup b) Whole wheat spaghetti and broccoli c) Cream of wheat and applesauce d) Hot tea and flavored water

Whole wheat spaghetti and broccoli Explanation: To promote bowel elimination, consume 20 to 35 g of fiber daily. Foods high in fiber include fresh fruits and vegetables, bran, and whole grains. Cream of Wheat is refined cereal and fiber has been removed from apples because of cooking. Other foods low in fiber include soda crackers, chicken noodle soup, tea, and flavored water

A student nurse studying human anatomy knows that a structure of the large intestine is the: a) ileum b) duodenum c) cecum d) jejunum

cecum Explanation: The small intestine consists of the duodenum, jejunum, and ileum. The large intestine consists of the cecum, colon (ascending, transverse, descending, and sigmoid), and rectum.

The nurse is scheduling tests for a client who is experiencing bowel alterations. What is the most logical sequence of tests to ensure an accurate diagnosis? a) endoscopic examination, barium studies, fecal occult blood test b) barium studies, endoscopic examination, fecal occult blood test c) fecal occult blood test, barium studies, endoscopic examination d) barium studies, fecal occult blood test, endoscopic examination

fecal occult blood test, barium studies, endoscopic examination Explanation: There is a specific sequence that bowel tests must be performed due to the results of certain contrasts and other preps that must be given. The nurse would verify that the tests are done in the correct order: Fecal occult blood test, barium studies, and then endoscopic examination.

A nurse is caring for a client with primary constipation. Which factor is responsible for primary constipation? a) high intake of fiber b) inadequate intake of liquid c) constant urges to defecate d) constant physical activity

inadequate intake of liquid Explanation: Primary constipation results from lifestyle factors such as insufficient fluid intake, inadequate intake of fiber, inactivity, or ignoring the urge to defecate.

A nurse is administering a prescribed solution of cottonseed oil to a client during an enema. What is the outcome of the use of cottonseed? a) distends rectum and moistens stool b) distends rectum and irritates local tissue c) lubricates and softens stool d) irritates local tissue

lubricates and softens stool Explanation: Cottonseed, olive oil, or mineral oil lubricates and softens the stool so that it can be expelled more easily during a retention enema. Tap water and normal saline solution distend the rectum and moisten the stool, whereas a soap and water solution not only distends the rectum and moistens the stool but also irritates the local tissue. A hypertonic saline solution irritates local tissue.

You are caring for a 68-year-old female patient who weighs 108 pounds. The patient has been worried about regularity of her bowel movements. You have just placed a regular bedpan under the patient and the patient states, "Please leave the bedpan in place until I have a bowel movement." Which of the following responses is most appropriate? a) "Turn your call light on when you want me to come back into the room." b) "Remember, you can also urinate into the bedpan." c) "I will check back in 10 minutes and remove the bedpan for a period of time even if you have not had a bowel movement." d) "Leaving the bedpan in place for a long period of time is unusual. Are you worried that staff will not respond in a timely manner when you need to have a bowel movement?"

"I will check back in 10 minutes and remove the bedpan for a period of time even if you have not had a bowel movement." Explanation: A bedpan should not be left in place for extended periods of time because this can result in excessive pressure and irritation to the patient's skin

Which client is most likely to require interventions in order to maintain regular bowel patterns? a) A woman 59 years of age who has recently begun hormone replacement therapy. b) A client whose neuropathic pain requires multiple doses of opioids each day. c) A client with hypertension who takes a diuretic and adrenergic blocker each morning. d) A client who has a history of atrial fibrillation requiring daily anticoagulants.

A client whose neuropathic pain requires multiple doses of opioids each day. Explanation: Opioids have a very high potential to cause constipation. Anticoagulants, hormone replacements, diuretics, and adrenergic blockers are not among the medications commonly implicated in cases of constipation.

A client scheduled for a colonoscopy is scheduled to receive a hypertonic enema prior to the procedure. A hypertonic enema is classified as which type of enema? a) Cleansing enema b) Retention enema c) Carminative enema d) Return-flow enema

Cleansing enema Explanation: The most common types of solutions used for cleansing enemas are tap water, normal saline, soap solution, and hypertonic solution. Cleansing enemas are used to relieve constipation or fecal impaction; promote visualization of the intestinal tract by radiographic or instrument examination (colonoscopy); establish regular bowel function; and prevent the involuntary escape of fecal material during surgical procedures.

Which statement best explains why digital removal of stool is considered a last resort after other methods of bowel evacuation have been unsuccessful? a) Most clients will not consent to have digital removal of stool. b) Nurses find the procedure distasteful and difficult to perform. c) Digital removal of stool may cause parasympathetic stimulation. d) It often causes rebound diarrhea and electrolyte loss.

Digital removal of stool may cause parasympathetic stimulation. Explanation: The procedure may stimulate a vagal response, which increases parasympathetic stimulation

The nurse is preparing to auscultate the bowel sounds of a client with a nasogastric tube in place set to low intermittent suction. How shall the nurse approach the assessment of bowel sounds and manage the nasogastric tube? a) Disconnect the nasogastric tube from suction during the assessment of bowel sounds. b) Apply continuous suction to the nasogastric tube during assessment of bowel sounds. c) Disconnect the nasogastric tube from the suction for 1 hour prior to the assessment of bowel sounds. d) Allow the low intermittent suction to continue during the assessment of bowel sounds.

Disconnect the nasogastric tube from suction during the assessment of bowel sounds. Explanation: If the client has a nasogastric tube in place, disconnect it from the suction during this assessment to allow for accurate interpretation of sounds.

While reading a client's history, the nurse notes that a client has a colostomy. When assessing the client, the nurse notes that the output is formed stool. What should the nurse do? a) Gvie the client the ordered laxative b) Assess for obstruction c) Contact the physician immediately d) Document the output, this is normal

Document the output, this is normal Explanation: Output from a colostomy is normally formed stool. Therefore the nurse should document the output as normal. There is no need to contact the physician at this time or to assess for an obstruction or to give a laxative

The nurse is caring for a client who is scheduled for an esophagogastroduodenoscopy (EGD). What action would the nurse take to prepare the client for this procedure? a) Ensure that the client ingests a gallon of bowel cleanser, such as polyethylene glycol electrolyte solution, in a short period of time. b) Ensure that the client fasts 6 to 12 hours before the test as per policy. c) Inform client that a chalky-tasting barium contrast mixture will be given to drink before the test. d) Provide a light meal before the test and administer two Fleet enemas.

Ensure that the client fasts 6 to 12 hours before the test as per policy. Explanation: The nurse would ensure that the client fasted 6 to 12 hours before the test as per policy. The nurse would not provide a light meal before the test, nor administer two Fleet enemas for an EGD. The client would not ingest a gallon of bowel cleanser. The nurse would not give the client a barium contrast mixture to drink

A hypertonic enema solution lubricates the stool and intestinal mucosa, making stool passage more comfortable. a) False b) True

False

After data collection on a client, the nurse suspects that the client has diarrhea. Which data collection finding, if observed by the nurse, would confirm the nurse's suspicion? a) Increased anal area pigmentation b) Hyperactive bowel sounds c) Dry, hard stool d) Visible waves of abdominal peristalsis

Hyperactive bowel sounds Explanation: Increased bowel motility, indicated by hyperactive bowel sounds, is commonly caused by diarrhea. Visible waves of abdominal peristalsis are commonly seen in intestinal obstruction. The anal area normally has increased pigmentation and some hair growth. Diarrhea stools are liquid in formation, whereas dry, hard stools are seen in constipation.

A nurse is performing an abdominal assessment of a client before administering a large-volume cleansing enema. Which assessment technique would be performed last? a) Palpation b) Percussion c) Inspection d) Auscultation

Palpation Explanation: The abdominal assessment should be performed in the following sequence: inspection, auscultation, percussion, palpation.

When caring for a client with fecal incontinence, the nurse knows that fecal incontinence is the result of which of the following reasons? a) Physiologic or lifestyle changes in client b) Nature and amount of food eaten by client c) Social and emotional setting of client d) Drinking and smoking habits of client

Physiologic or lifestyle changes in client Explanation: Fecal incontinence mainly results from physiologic or lifestyle changes that impair muscle activity and sensation of the gastrointestinal tract. Particularly in the older adult, the weakening of the intestinal walls and decreased muscle tone can lead to bowel incontinence

The nurse is inserting a rectal tube to administer a large-volume enema. Which nursing action is performed correctly in this procedure? a) Slowly and gently insert the enema tube 3 to 4 inches (7.5 to 10 cm) for an adult. b) Position the client on his back and drape properly. c) Encourage the client to hold the solution for at least 20 minutes. d) Introduce solution quickly over a period of 3 to 5 minutes.

Slowly and gently insert the enema tube 3 to 4 inches (7.5 to 10 cm) for an adult. Explanation: The nurse would slowly and gently insert the enema tube 3 to 4 inches for an adult. The nurse would not position the client in a supine position, rather on the left side in the Sims' position. This position aids in the client's ability to retain the solution. The nurse would not introduce the solution quickly, as this will result in the client cramping. The nurse would administer the solution over 5 to 10 minutes, depending on the volume. The nurse would not encourage the client to hold the solution for at least 20 minutes, rather 5 to 15 minutes when the urge to defecate becomes strong

While administering a cleansing enema, the client displays lightheadedness, nausea, and has clammy skin. The nurse would implement which priority action? a) Slow the infusion rate, withdraw the tubing slightly, then resume enema. b) Stop the procedure and reposition the client. c) Stop the procedure, monitor heart rate and blood pressure. d) Slow the infusion rate, have the client take deep breaths, then resume enema.

Stop the procedure, monitor heart rate and blood pressure. Explanation: When administering an enema, the client's vagus nerve may be stimulated causing a decrease in the heart rate. The client will exhibit nausea, lightheadedness, nausea, dizziness, and clammy skin. The procedure should be stopped, heart rate and blood pressure monitored, and the health care provider notified. The other responses are not appropriate for a client exhibiting a vagal response

When reviewing a client's chart, which data related to a client experiencing diarrhea might suggest to the nurse a causative factor? a) The client consumes large qualities of fresh vegetables. b) The client repeatedly ignores the urge to defecate. c) The client returned from a foreign country two days ago. d) The client has a daily fluid intake of 2,000 to 3,000 mL.

The client returned from a foreign country two days ago. Explanation: Eating native food and drinking water in a foreign country may cause problems with digestion and elimination, such as diarrhea. To promote normal bowel elimination, people should drink 2,000 to 3,000 mL fluids daily. Ignoring the urge to defecate and consuming large quantities of fiber, such as fresh vegetables, may lead to constipation.

When reviewing data collection on a client with constipation, which factor identified by the nurse might suggest the causative factor? a) The client takes Dulcolax every day. b) The client drinks 8 glasses of fluid daily. c) The client traveled to South America two weeks ago. d) The client eats five to six small meals per day.

The client takes Dulcolax every day. Explanation: Over usage of Dulcolax may cause lazy bowel syndrome, leading to constipation. Traveling to South America usually causes a client to develop traveler's diarrhea. Drinking 8 glasses of fluid daily promotes bowel elimination. Consuming five to six small meals per day should not contribute to constipation.

The newly hired graduate nurse is preparing to administer a cleansing enema. The nurse educator will intervene if which action is taken by the graduate nurse? a) The graduate advises the client that the enema should not be expelled immediately. b) The graduate uses a room temperature solution. c) The graduate places the client in Fowler's position. d) The graduate takes this opportunity to teach about the function of the intestinal tract.

The graduate places the client in Fowler's position. Explanation: Placing the client in Fowler's position during an enema will cause the solution to remain in the rectum and expulsion of the solutions happens rapidly with minimal cleansing to be done. The solution should be retained until the desired results are achieved. The solution should not be too hot or too cold, but administered at room temperature. Most people are uncomfortable about discussing the intestinal tract and bowel elimination, so this is an opportune time to discuss it.

A nurse is educating a client on how to change his ostomy appliance. What is an accurate step that should be incorporated into the education plan? a) Use toilet tissue to remove any excess stool from the stoma. b) Apply skin protectant to a 6-inch (15 cm) radius around the stoma, and allow it to dry completely for 30 minutes. c) Gently remove the pouch faceplate from the skin by pulling the appliance from the skin. d) If the appliance is reusable, set it aside to wash it in alcohol and allow it to air dry.

Use toilet tissue to remove any excess stool from the stoma. Explanation: Excess stool may be removed from the stoma using toilet paper. The pouch faceplate should be removed from the skin by pushing, rather than pulling, the skin from the appliance. If reusable, the appliance should be washed in lukewarm soap and water. Skin protectant should be applied to a 2-inch (5 cm) radius around the stoma and allowed to dry for about 30 seconds.

A nurse is assessing the stoma of a client with an ostomy. Which intervention should the nurse perform when providing peristomal care to the client to preserve skin integrity? a) Wash it with a mild cleanser and water. b) Avoid using commercial skin preparations. c) Clean it with a dry, cotton bandage. d) Avoid applying a barrier substance.

Wash it with a mild cleanser and water. Explanation: Washing the stoma and surrounding skin with a mild cleanser and water, and patting it dry can preserve skin integrity. When using a cleanser, it is important to rinse the area thoroughly. Any residue left on the skin can cause problems with the wafer adhering.

A nurse is caring for a client with fecal impaction. Which factors cause fecal impaction? Select all that apply. a) Insufficient mastication b) Weak abdominal muscles c) Excess intake of fibrous food d) Unrelieved constipation e) Severe dehydration

Weak abdominal muscles • Severe dehydration • Unrelieved constipation Explanation: Fecal impaction results from unrelieved constipation, retained barium from an intestinal x-ray, dehydration, and weakness of abdominal muscles. Clients with a fecal impaction usually report a frequent desire to defecate but an inability to do so. Insufficient mastication of food does not lead to fecal impaction but may sometimes lead to indigestion and temporary constipation. Excess intake of fibrous food, such as raw fruits and vegetables, does not lead to constipation; instead, adequate fiber helps facilitate bowel movement and elimination

Which factor is related to developmental changes in bowel habits for older adult clients? a) Milk products cause constipation in clients with lactose intolerance. b) Older adults should peel fruits before eating. c) Weakened pelvic muscles lead to constipation. d) Increase in dietary fiber can decrease peristalsis.

Weakened pelvic muscles lead to constipation. Explanation: Weakened pelvic muscles and decreased activity levels contribute to constipation in older adults. Increasing dietary fiber does not decrease peristalsis. Lactose intolerance is not a developmental change in older adults. Peeling fruit does not impact bowel habits in the older adults.

The nurse is presenting a lecture on ostomy bowel elimination at a community clinic. When questioned by the clients, which foods would the nurse suggest as natural intestinal deodorizers? a) Fish and dried lentils b) Asparagus and turnip c) Yogurt and buttermilk d) Onions and garlic

Yogurt and buttermilk Explanation: Buttermilk, parsley, and yogurt are foods that are natural intestinal deodorizers. Dried lentils, asparagus, turnip, fish, onions, and garlic are foods that produce odor.

A nurse is caring for a client with constipation. The incidence of constipation tends to be high among clients that follow which diet? a) a diet lacking in meat and poultry products b) a diet lacking in fruits and vegetables c) a diet consisting of whole grains, seeds, and nuts d) a diet lacking in glucose and water

a diet lacking in fruits and vegetables Explanation: The incidence of constipation tends to be high among clients whose dietary habits lack sufficient raw fruits and vegetables, whole grains, seeds, and nuts, all of which contain adequate fiber. Dietary fiber, which becomes undigested cellulose, is important because it attracts water within the bowel, resulting in bulkier stool that is more quickly and easily eliminated.

During the inspection of a client's abdomen, the nurse notes that it is visibly distended. The nurse should proceed with the client's abdominal assessment by next performing: a) deep palpation. b) percussion. c) auscultation. d) light palpation.

auscultation. Explanation: When performing an abdominal assessment, the nurse should proceed from inspection to auscultation, since performing palpation or percussion prior to auscultation may disturb normal peristalsis and confound the assessment.

When the nurse performs a Hemoccult test on a stool specimen, blood in the stool will change the color on the test paper to: a) brown. b) blue. c) green. d) red.

blue. Explanation: Blue is a positive diagnostic finding, indicating the presence of blood in the stool sample.

The type of stool that will be expelled into the ostomy bag by a client who has undergone surgery for an ileostomy will be: a) liquid consistency. b) mucus-filled. c) soft semi-formed. d) bloody.

liquid consistency. Explanation: Stool produced from an ileostomy is liquid and contains large quantities of electrolytes.

Occult blood testing has been ordered for a hospitalized client. Which meal would be acceptable for a client receiving occult blood testing? a) macaroni and cheese, corn, lettuce salad, and vanilla pudding b) tofu with peanut sauce, snow peas, broccoli, and ginger snaps c) spaghetti with meat sauce, garlic bread, and chocolate cake d) pot roast with potatoes, carrots, and gravy; applesauce; and gelatin with bananas

macaroni and cheese, corn, lettuce salad, and vanilla pudding Explanation: Certain foods and medication should be avoided when occult blood testing is performed because they can cause a false-positive result. The ingestion of red meat, animal liver and kidneys, salmon, tuna, mackerel, and sardines should be avoided for 4 days prior to testing. Clients should also avoid tomatoes, cauliflower, horseradish, turnips, melon, bananas, and soybeans.

A client has had abdominal surgery and 72 hours later develops abdominal distention and absence of bowel sounds with pain. The nurse suspects the client has: a) a wound infection. b) need of greater pain relief. c) paralytic ileus. d) increased activity

paralytic ileus. Explanation: An obstruction that blocks the passage of flatus and intestinal chime or feces is a primary cause of abdominal distention. Paralytic ileus and abdominal tumors are types of bowel obstruction that produce distention.

A nurse is caring for a 65-year-old woman who has undergone a hernia operation. The client has a morphine PCA for postoperative pain. She also receives sulfamethoxazole-trimethoprim every 12 hours to treat a urinary tract infection, and an iron supplement for anemia. The client is on mobility restrictions because of the narcotics. She explains that while she usually stools once per day, she has stooled four times today. What is most likely contributing to her diarrhea? a) iron supplement b) sulfamethoxazole-trimethaprim c) morphine d) immobility

sulfamethoxazole-trimethaprim Explanation: Antibiotics (such as sulfamethoxazole-trimethaprim), iron, and immobility can cause constipation.

The nurse has presented an educational in-service about caring for clients who have newly created ostomies. The nurse asks participants, "How will you know when a client begins to accept the altered body image?" Which responses by participants indicates a correct understanding of the material? Select all that apply. a) "The client makes neutral or positive statements about the ostomy." b) "The client expresses interest in learning self-care." c) "The client uses spray deodorant several times an hour to mask odor." d) "The client is willing to look at the stoma." e) "The client agrees to take prescribed antidepressants."

• "The client makes neutral or positive statements about the ostomy." • "The client expresses interest in learning self-care." • "The client is willing to look at the stoma."

A nurse who is planning menus for a client in a long-term care facility takes into consideration the effects of foods and fluids on bowel elimination. Which examples correctly describe these effects? Select all that apply. a) Alcohol and coffee tend to have a constipating effect on clients. b) Clients experiencing flatulence should avoid gas-producing foods such as cauliflower and onions. c) Clients with lactose intolerance may experience diarrhea or gas when consuming starchy foods. d) Clients who are constipated should eat more fruits and vegetables. e) Clients with food intolerances may experience altered bowel elimination. f) A client who is constipated should eat eggs and pasta to relieve the condition.

• Clients who are constipated should eat more fruits and vegetables. • Clients experiencing flatulence should avoid gas-producing foods such as cauliflower and onions. • Clients with food intolerances may experience altered bowel elimination. Explanation: The nurse would realize that clients who are constipated should eat more fruits and vegetables. The nurse would realize that clients experiencing flatulence should avoid gas-producing foods such as cauliflower and onions. The nurse would also realize that clients with food intolerances may experience altered bowel elimination.

The nurse is administering an oil-retention enema to a client. Which nursing actions in this procedure are performed correctly? Select all that apply. a) The nurse chooses a large rectal tube. b) The nurse administers a cleansing enema after the oil-retention enema. c) The nurse warms the oil-retention enema before administering it. d) The nurse administers a cleansing enema prior to the oil-retention enema. e) The nurse instructs the client to retain the oil for at least 30 minutes. f) The nurse administers the oil-retention enema at body temperature

• The nurse administers the oil-retention enema at body temperature. • The nurse instructs the client to retain the oil for at least 30 minutes. • The nurse administers a cleansing enema after the oil-retention enema. Explanation: The nurse would administer the oil-retention enema at body temperature. This prevents any injuries or discomfort if given at this temperature. The nurse would instruct the client to retain the enema for at least 30 minutes for best results. The nurse would administer a cleansing enema after the oil-retention enema. This would clean the colon of any oil residue after the oil-retention enema. A small rectal tube is used for the enema.

The nurse is talking to a client whose colostomy pouch frequently comes loose and falls off. Which interventions are appropriate suggestions? (Select all that apply.) a) Secure the ostomy pouch in place by wrapping an elastic bandage around the abdomen, making sure to cover the entire ostomy appliance. b) After applying the ostomy pouch, lie flat in the prone position for 10 to 15 minutes to facilitate adhesion. c) Apply a commercially available skin barrier before applying the ostomy pouch. d) Leave the ostomy pouch off and cover the stoma with an adult incontinence pad. e) Thoroughly cleanse the skin surrounding the stoma and allow it to dry completely before applying the ostomy pouch.

• Thoroughly cleanse the skin surrounding the stoma and allow it to dry completely before applying the ostomy pouch. • Apply a commercially available skin barrier before applying the ostomy pouch. Explanation: This approach allows for the use of a small covering over the colostomy between irrigations instead of a regular appliance.

The risk for developing colorectal cancer during one's lifetime is 1 in 19. Nurses play an integral role in the promotion of colorectal cancer screening. What are risk factors for colorectal cancer? Select all that apply. a) a history of inflammatory bowel disease b) a positive family history c) age 50 and older d) smoking

• a history of inflammatory bowel disease • a positive family history • age 50 and older Explanation: The risks for colorectal cancer increase after the age of 50, with a positive family history of colorectal cancer, and also with Crohn's disease. An important nursing responsibility is to teach clients about annual screening beginning at 50, encourage endoscopic exam every 5 years, or colonoscopy every 10 years for normal-risk individuals.