Chapter 41: Management of Patients with Intestinal and Rectal Disorders
Which of the following is the diagnostic of choice if the suspected diagnosis is diverticulitis?
Computed tomography scan
A nurse is caring for a client with cardiac disease. The client asks the nurse which medication is best for help with regular bowel movements. What is the best response by the nurse?
Docusate
The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching?
Drink 8 to 10 glasses of fluid daily.
Which term refers to a protrusion of the intestine through a weakened area in the abdominal wall?
Hernia
A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, what would the nurse stress the importance of?
Increasing fluid intake to prevent dehydration
A nurse is initiating parenteral nutrition (PN) to a postoperative client who has developed complications. The nurse should initiate therapy by performing which of the following actions?
Initiating the infusion slowly and monitoring the client's fluid and glucose tolerance
Which of the following is considered a bulk-forming laxative?
Metamucil
Celiac disease (celiac sprue) is an example of which category of malabsorption?
Mucosal disorders causing generalized malabsorption
The nurse is admitting a client with a diagnosis of diverticulitis and assesses that the client has a board-like abdomen, no bowel sounds, and reports of severe abdominal pain. What is the nurse's first action?
Notify the health care provider.
A nurse is interviewing a client about past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?
Polyps
A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location?
Right lower quadrant
Which outcome indicates effective client teaching to prevent constipation?
The client reports engaging in a regular exercise regimen.
A client is being seen in the clinic for reports of painful hemorrhoids. The nurse assesses the client and observes the hemorrhoids are prolapsed but able to be placed back in the rectum manually. The nurse documents the hemorrhoids as what degree?
Third degree
The presence of mucus and pus in the stools suggests which condition?
Ulcerative colitis
A nurse is preparing to provide care for a client whose exacerbation of ulcerative colitis has required hospital admission. During an exacerbation of this health problem, the nurse would anticipate that the client's stools will have what characteristics?
Watery with blood and mucus
The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for:
hypokalemia.
A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation?
lack of free water intake
A client has symptoms suggestive of peritonitis. Nursing management would not include:
limiting analgesics to avoid the formation of paralytic ileus.
The nurse is caring for an older adult client with enteritis who reports frequent diarrhea. Which assessment finding should the nurse anticipate?
metabolic acidosis
A typical sign/symptom of appendicitis is:
nausea.
A client is admitted from the emergency department with complaints of severe abdominal pain and an elevated white blood cell count. The physician diagnoses appendicitis. The nurse knows the client is at greatest risk for:
rupture of the appendix.
A nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find?
severe abdominal pain with direct palpation or rebound tenderness
A nurse is caring for a client taking a laxative daily containing senna to manage "my constipation." Which education will the nurse provide to the client to prevent complications?
"Avoid taking the laxative on a long-term basis."
A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult?
"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread."
A nurse is teaching an older adult client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required?
"I need to use laxatives regularly to prevent constipation."
Medical management of a patient with peritonitis includes fluid, electrolyte, and colloid replacement. The nurse knows to prepare the initial, most appropriate intravenous solution. Which of the following is the correct solution?
0.9% NS
Which client would be at greatest risk for the development of an anorectal fistula?
A 35-year-old female with Crohn's disease
A nurse is preparing a presentation for a local community group of older adults about colon cancer. What would the nurse include as the primary characteristic associated with this disorder?
A change in bowel habits
After assessing a client with peritonitis, how would the nurse most likely document the client's bowel sounds?
Absent
A nurse is caring for a client admitted with symptoms of an anorectal infection; cultures indicate that the client has a viral infection. The nurse should anticipate the administration of what drug?
Acyclovir
The nurse is teaching a client with constipation to increase dietary fiber intake to 25 g/day. Which recommendation would the nurse include?
Adding fiber-rich foods to the diet gradually
The American Cancer Society recommends routine screening to detect colorectal cancer. Which screening test for colorectal cancer should a nurse recommend?
Annual digital examination after age 40
A client reports constipation. Which nursing measure would be most effective in helping the client reduce constipation?
Assist client to increase dietary fiber.
Which drug is considered a stimulant laxative?
Bisacodyl
The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition?
Borborygmus
Which term refers to intestinal rumbling?
Borborygmus
A patient is admitted to the hospital after not having had a bowel movement in several days. The nurse observes the patient is having small liquid stools, a grossly distended abdomen, and abdominal cramping. What complication can this patient develop related to this problem?
Bowel perforation
A patient with IBD would be encouraged to increase fluids, use vitamins and iron supplements, and follow a diet designed to reduce inflammation. Select the meal choice that would be recommended for a low-residue diet.
Broiled chicken with low-fiber pasta
The nurse is talking with a group of clients who are older than age 50 years about the recognition of colon cancer to access early intervention. What should the nurse inform the clients to report immediately to their primary care provider?
Change in bowel habits
Which is the most common presenting symptom of colon cancer?
Change in bowel habits
A client informs the nurse of having abdominal pain that is relieved when having a bowel movement. The health care provider diagnosed the client with irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder?
Chronic constipation with sporadic bouts of diarrhea
The nurse is irrigating a client's colostomy when the client begins to report cramping. What is the appropriate action by the nurse?
Clamp the tubing and allow client to rest.
The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse?
Clamp the tubing and give the patient a rest period.
A patient is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling?
Colonoscopy
Which statement provides accurate information regarding cancer of the colon and rectum?
Colorectal cancer is the third most common site of cancer in the United States.
An older adult client seeks help for chronic constipation. What factor related to aging can cause constipation in elderly clients?
Decreased abdominal strength
The nurse is preparing a client 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 client for?
Defecography
A client is being treated for diverticulosis. Which points should the nurse include in this client's teaching plan? Select all that apply.
Do not suppress the urge to defecate. Drink at least 8 to 10 large glasses of fluid every day. Use bulk-forming laxatives Encourage an individualized exercise program
The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation?
Dry skin thoroughly after washing
A client has been recently diagnosed with an anorectal condition. The nurse is reviewing interventions that will assist the client with managing the therapeutic regimen. What would not be included?
Encourage the client to avoid exercise.
The nurse is caring for a patient who has malabsorption syndrome with an undetermined cause. What procedure will the nurse assist with that is the best diagnostic test for this illness?
Endoscopy with mucosal biopsy
The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening?
Familial polyposis
Which characteristic is a risk factor for colorectal cancer?
Familial polyposis
Which of the following is accurate regarding regional enteritis?
Fistulas are common
The nurse in an extended-care facility reports that a resident has clinical manifestations of fecal incontinence. The health care provider orders a diagnostic study to rule out inflammation. Which study will the nurse prepare the client for?
Flexible sigmoidoscopy
A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate?
Gently washing the area surrounding the stoma using a facecloth and mild soap
An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to?
Hypokalemia
A client with Crohn's disease is losing weight. For which reason will the nurse anticipate the client being prescribed parenteral nutrition?
Impaired ability to absorb food
A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of:
Intestinal malabsorption.
The nurse is conducting a community education program on colorectal cancer. Which statement should the nurse include in the program?
It is the third most common cancer in the United States.
The nurse is comparing Crohn's disease (regional enteritis) with ulcerative colitis. Which of the following describes Crohn's disease?
Its course is prolonged and variable
A patient with irritable bowel syndrome has been having more frequent symptoms lately and is not sure what lifestyle changes may have occurred. What suggestion can the nurse provide to identify a trigger for the symptoms?
Keep a 1- to 2-week symptom and food diary to identify food triggers.
The instructor is teaching a group of students about irritable bowel syndrome (IBS) and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an antidiarrheal agent commonly administered for IBS?
Loperamide
Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following?
Low residue
The nurse is caring for an older adult patient experiencing fecal incontinence. When planning the care of this patient, what should the nurse designate as a priority goal?
Maintaining skin integrity
When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?
Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
The nurse is caring for a client with diarrhea. For which finding will the nurse suspect the diarrhea is caused by pancreatic insufficiency?
Oil droplets on the toilet water
The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder?
One part of the intestine telescopes into another portion of the intestine.
A client with a diagnosis of acute appendicitis is awaiting surgical intervention. The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and board-like. What complication does the nurse determine may be occurring at this time?
Peritonitis
Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of:
Peritonitis
The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication?
Peritonitis
A client's large bowel obstruction has failed to resolve spontaneously and the client's worsening condition has warranted admission to the medical unit. Which of the following aspect of nursing care is most appropriate for this client?
Preparing the client for surgical bowel resection
When the nurse interviews a client with internal hemorrhoids, what would the nurse expect the client to report?
Rectal bleeding
Which of the following is the most common symptom of a polyp?
Rectal bleeding
A nurse is caring for a client who had an ileal conduit 3 days earlier. The nurse examines the stoma site and determines that she should consult with the ostomy nurse. Which assessment finding indicates the need for further consultation?
Red, sensitive skin around the stoma site
A client with a cyst has been brought for care. The nurse who is contributing to the client's care knows that treatment will be chosen based on what risk?
Risk for infection
The nurse observes the physician palpating the abdomen of a client that is suspected of having acute appendicitis. When the abdomen is pressed in the left lower quadrant the client complains of pain on the right side. What does the nurse understand this assessment technique is referred to?
Rovsing sign
Which type of diarrhea is caused by increased production of water and electrolytes by the intestinal mucosa and their secretion into the intestinal lumen?
Secretory diarrhea
A client suspected of having colorectal cancer requires which diagnostic study to confirm the diagnosis?
Sigmoidoscopy
A client is diagnosed with Zollinger-Ellison syndrome. The nurse knows to assess the client for which characteristic clinical feature of this syndrome?
Steatorrhea
The nurse is reviewing the laboratory test results of a client with Crohn disease. Which of the following would the nurse most likely find?
Stool cultures negative for microorganisms or parasite
A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client?
Suggest fluid intake of at least 2 L/day
A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care?
Test all stools for occult blood.
A nurse is caring for a client who has experienced an acute exacerbation of Crohn's disease. Which statement best indicates that the disease process is under control?
The client exhibits signs of adequate GI perfusion.
A client realizes that regular use of laxatives has greatly improved bowel patterns. However, the nurse cautions this client against the prolonged use of laxatives for which reason?
The client's natural bowel function may become sluggish.
A client realizes that regular use of laxatives has lead to bowel pattern improvement. However, the nurse cautions this client against the prolonged use of laxatives for which reason?
The client's natural bowel function may become sluggish.
Which is a true statement regarding regional enteritis (Crohn's disease)?
The clusters of ulcers take on a cobblestone appearance.
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?
The consistency of stool and comfort when passing stool
A client reports taking a stimulant laxative in order to be able to have a bowel movement daily. What should the nurse inform the client about taking a stimulant laxative?
They can be habit forming and will require increasing doses to be effective.
The nurse is conducting a gastrointestinal assessment. When the client reports the presence of mucus and pus in the stool, the nurse assesses for additional signs/symptoms of which disease/condition?
Ulcerative colitis
The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation?
Usual pattern of elimination
The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation?
Usual pattern of elimination
The nurse working in the emergency department is caring for a client with signs and symptoms of appendicitis. Which order from the health care provider should the nurse question?
administer an enema
A longitudinal tear or ulceration in the lining of the anal canal is termed a(n):
anal fissure.
A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a:
fissure
Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes:
high-fiber diet.
A nurse is performing focused assessment on her clients. She expects to hear hypoactive bowel sounds in a client with:
paralytic ileus.
An older adult client in a long-term care facility is concerned about bowel regularity. During a client education session, the nurse reinforces the medically acceptable definition of "regularity." What is the actual measurement of "regular"?
stool consistency and client comfort
The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's:
usual pattern of elimination.
