Chapter 42 Lower GI Problems

A 22-year-old patient calls the outpatient clinic reporting 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 right away by a health care provider (HCP) at a hospital's ED.

D

A male patient who is scheduled for an abdominal-perineal resection (APR) is worried about his sexuality. What is the best 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

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 b. High dietary fiber with high fluid intake c. History of hemorrhoids and hypertension d. Suppressing the urge to defecate while at work

D

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

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

Priority Decision: In instituting a bowel training program for a patient with fecal incontinence, what should the nurse plan to do first? 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 patient comes to the ED 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 b. Esophageal sphincter c. Distal small intestine d. Proximal small intestine

D

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

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

D

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

D

The patient asks the nurse to explain what the HCP 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 b. Collection of perianal pus c. Sacrococcygeal hairy tract d. Tunnel leading from the anus or rectum

B

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

A

A patient with inflammatory bowel disease has a nursing diagnosis of impaired nutritional status; etiology: decreased nutritional intake and decreased intestinal absorption. Which assessment data support this nursing diagnosis? a. Pallor and hair loss b. Frequent diarrhea stools c. Anorectal excoriation and pain d. Hypotension and urine output below 30 mL/hr

A

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 as needed. b. provide mouth care frequently. c. irrigate the tube with normal saline every 8 hours. d. keep the patient supine with the head of the bed elevated 30 degrees.

A

Patient-Centered Care: The nurse formulates the nursing diagnosis of acute pain from the effects of medication and decreased GI motility for a postoperative patient with abdominal pain and distension with an 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

Priority Decision: 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

Priority Decision: An 82-year-old man is admitted with an acute attack of diverticulitis. What is most important for the nurse to 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 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

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

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

A

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

A,B,E,F

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

A,C,E,F

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 b. Inguinal c. Femoral d. Reducible e. Incarcerated f. Strangulated

A,D

What should the nurse teach the patient with diverticulosis to do? a. Use antibiotics routinely to prevent future inflammation. b. Have an annual colonoscopy to detect malignant changes in the lesions. c. Maintain a high-fiber diet and encourage fluid intake of at least 2 L daily. d. Exclude whole grain breads and cereals from the diet to prevent irritating the bowel.

C

A patient with ulcerative colitis undergoes the first phase of a total proctocolectomy with ileal pouch and anal anastomosis. On initial 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

An HCP 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 in on itself b. Twisting of bowel on itself c. Emboli of arterial supply to the bowel d. Protrusion of bowel in weak or abnormal opening

B

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

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

Priority Decision: A patient with a gunshot wound to the abdomen reports increasing abdominal pain several hours after surgery to repair the bowel. What action should the nurse take first? a. Notify the HCP. b. Assess the patient's vital signs. c. Position the patient with the knees flexed. d. Determine the patient's IV intake since the end of surgery.

B

Priority Decision: When caring for a patient with irritable bowel syndrome (IBS), what is most important for the nurse to do? a. Recognize that IBS is a psychogenic illness that cannot be definitively diagnosed. b. Develop a trusting relationship with the patient to provide support and symptomatic care. c. Teach the patient that a diet high in fiber will relieve the symptoms of both diarrhea and constipation. d. Inform the patient that new medications are available and effective for treatment of IBS manifested by either diarrhea or constipation.

B

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

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

B

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

B

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

B,C,D,F

A 60-year-old black woman is afraid she may have anal cancer. What assessment finding puts her at high risk for anal cancer? a. Alcohol use b. Only 1 sexual partner c. Human papillomavirus (HPV) d. Use of a condom with sexual intercourse

C

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 will likely develop malnutrition." c. "I don't need to restrict gluten intake because I don't have diarrhea or bowel symptoms." d. "It is going to be hard to follow a gluten-free diet because it is found in so many foods."

C

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

Priority Decision: 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 characteristics of gastric drainage and the patency of the NG tube. d. Administer prescribed ondansetron (Zofran) to control the nausea and vomiting.

C

Priority Decision: What is the most important thing the nurse should do when caring for a patient who has contracted Clostridium difficile? a. Clean the entire room with ammonia. b. Feed the patient yogurt with probiotics. c. Wear gloves and wash hands with soap and water. d. Teach the family to use alcohol-based hand cleaners.

C

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

C

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 loperamide or paregoric 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

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 your 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

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

C

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

C

What laboratory findings are expected in ulcerative colitis because of diarrhea and vomiting? a. Increased albumin b. Elevated white blood cells (WBCs) c. Decreased serum Na+, K+, Mg+, Cl-, and HCO3- d. Decreased hemoglobin (Hgb) and hematocrit (Hct)

C

Collaboration: The registered nurse (RN) coordinating the care for a patient who is 2 days postoperative following an abdominal-perineal resection (APR) 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