Chapter 47: Management of Patients With Intestinal and Rectal Disorders, Prep U--Ch. 47: Mgmt of Patients With Intestinal and Rectal Disorders

A longitudinal tear or ulceration in the lining of the anal canal is termed a(n): a) Hemorrhoid b) Anorectal abscess c) Anal fistula d) Anal fissure

Anal fissure

Hypotension Clinical manifestations include hypotension, increased temperature, tachycardia, and elevated ESR.

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process?

Borborygmus Borborygmus is a rumbling noise caused by the movement of gas through the intestines, often associated with diarrhea.

The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's notes?

The clusters of ulcers take on a cobblestone appearance.

Which is a true statement regarding regional enteritis (Crohn's disease)?

Steatorrhea Hyperacidity in the duodenum inactivates pancreatic enzymes causing steatorrhea and ulcer diathesis. Refer to Table 24-2 in the text.

A patient is diagnosed with Zollinger-Ellison syndrome, a malabsorption disorder. The nurse knows to assess the patient for the characteristic clinical feature of:

Third degree

A patient is being seen in the clinic for complaints of painful hemorrhoids. The nurse assesses the patient and observes the hemorrhoids are prolapsed but able to be placed back in the rectum manually. The nurse documents the hemorrhoids as what degree?

Bisacodyl Bisacodyl is a stimulant laxative. Magnesium hydroxide is a saline agent. Mineral oil is a lubricant. Psyllium hydrophilic mucilloid is a bulk-forming agent.

Which drug is considered a stimulant laxative?

Diarrhea The primary symptoms of IBS include constipation, diarrhea, or a combination of both. Pain, bloating, and abdominal distention often accompany changes in bowel pattern.

Which is one of the primary symptoms of irritable bowel syndrome (IBS)?

constipation, diarrhea, or a combination of both

Which is one of the primary symptoms of irritable bowel syndrome (IBS)?

Metamucil Metamucil is a bulk-forming laxative. Milk of Magnesia is classified as a saline agent. Mineral oil is a lubricant. Dulcolax is a stimulant.

Which of the following is considered a bulk-forming laxative?

• Do not suppress the urge to defecate. • Drink at least 8 to 10 large glasses of fluid every day. Avoid constipation. Do not suppress the urge to defecate. Consume at least 2 L/day (within limits of the client's cardiac and renal reserve) and include foods that are soft but have increased fiber, such as prepared cereals or soft-cooked vegetables, to increase the bulk of the stool and facilitate peristalsis, thereby promoting defecation. Avoid the use of laxatives or enemas except when recommended by the physician. Exercise regularly if the current lifestyle is somewhat inactive.

A client is being treated for diverticulosis. Which points should the nurse include in this client's teaching plan? Select all that apply.

Loperamide (Imodium) Loperamide and diphenoxylate with atropine sulfate are examples of opiate-related antidiarrheal agents. Bismuth subsalicylate and kaolin and pectin are examples of absorbent antidiarrheal agents. Bisacodyl is a chemical stimulant laxative.

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?

Fecal incontinence The nurse should anticipate fecal incontinence as one of the assessment findings. Other possible assessment findings include constipation and abdominal distention.

The nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be

It is the third most common cancer in the United States. Colorectal cancer is the third most common type of cancer in the United States. The lifetime risk of developing colorectal cancer is 1 in 20. The incidence increases with age (the incidence is highest in people older than 85). Colorectal cancer occurrence is higher in people with a family history of colon cancer.

The nurse is conducting a community education program on colorectal cancer. Which statement should the nurse include in the program?

Ulcerative colitis The presence of mucus and pus in the stool suggests ulcerative colitis. Watery stools are characteristic of small-bowel disease. Loose, semisolid stools are associated more often with disorders of the colon. Voluminous, greasy stools suggest intestinal malabsorption.

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?

solid. With a sigmoid colostomy, the feces are solid. With a descending colostomy, the feces are semimushy. With a transverse colostomy, the feces are mushy. With an ascending colostomy, the feces are fluid.

The nurse teaches the client whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be

Nausea Nausea, with or without vomiting, is typically associated with appendicitis. Pain is generally felt in the right lower quadrant. Rebound tenderness, or pain felt upon the release of pressure applied to the abdomen, may be present with appendicitis. Low-grade fever is associated with appendicitis.

The nurse working in the ED is evaluating a client for signs and symptoms of appendicitis. Which of the client's signs/symptoms should the nurse report to the physician?

The clusters of ulcers take on a cobblestone appearance. The clusters of ulcers take on a cobblestone appearance. It is characterized by remissions and exacerbations. The pain is located in the lower right quadrant. The lesions are not in continuous contact with one another and are separated by normal tissue.

Which is a true statement regarding regional enteritis (Crohn's disease)?

An apartment fire spreads to seven apartment units. Victims suffer burns, minor injuries, and broken bones from jumping from windows. Which client should be transported first? a) a 20-year-old with first-degree burns on her hands and forearms b) a middle-aged man with no injuries who has rapid respirations and coughs c) a 10-year-old with a simple fracture of the humerus who is in severe pain d) a woman who is 5 months pregnant with no apparent injuries

a middle-aged man with no injuries who has rapid respirations and coughs

Broiled chicken with low-fiber pasta A low-residue, high-protein, and high-calorie diet is recommended to reduce the size and number of stools. Foods to avoid include yogurt, fruit, salami, and peanut butter.

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.

One part of the intestine telescopes into another portion of the intestine. In intussusception of the bowel, one part of the intestine telescopes into another portion of the intestine. When the bowel twists and turns itself and obstructs the intestinal lumen, this is known as a volvulus. A hernia is when the bowel protrudes through a weakened area in the abdominal wall. An adhesion is a loop of intestine that adheres to an area that is healing slowly after surgery.

The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder?

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. 1. Salami on whole grain bread and V-8 juice 2. A peanut butter sandwich and fruit cup 3. Broiled chicken with low-fiber pasta 4. A fruit salad with yogurt

Broiled chicken with low-fiber pasta

Bowel perforation Megacolon is a dilated and atonic colon caused by a fecal mass that obstructs the passage of colon contents. Symptoms include constipation, liquid fecal incontinence, and abdominal distention. Megacolon can lead to perforation of the bowel.

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?

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

Increase dietary fiber

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? 1. "I need to use laxatives regularly to prevent constipation." 2. "I need to drink 2 to 3 liters of fluids every day." 3. "I should exercise four times per week." 4. "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread."

"I need to use laxatives regularly to prevent constipation."

Encourage the client to avoid exercise. Activity promotes healing and normal stool patterns. Proper cleansing prevents infection and irritation. Sitz baths promote healing, decrease skin irritation, and relieve rectal spasms. Encouragement promotes compliance with therapeutic regimen and prevents complications.

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?

Every 4 to 6 hours The length of time between drainage periods is gradually increased until the reservoir needs to be drained only every 4 to 6 hours and irrigated once each day. This prevents the accumulating effluent from spilling or causing infection.

A client underwent a continent ileostomy. Within which time frame should the client expect to empty the reservoir?

A client develops chronic pancreatitis. What would be the appropriate home diet for a client with chronic pancreatitis? a) A high-calcium, soft diet distributed over three meals and an evening snack daily b) A low-fat, bland diet distributed over five to six small meals daily c) a low-protein, high-fiber diet distributed over four to five moderate-sized meals daily d) A diabetic exchange diet distributed over three meals and two snacks daily

A low-fat, bland diet distributed over five to six small meals daily

Small bowel obstruction Small bowel obstruction is a serious systemic complication of regional enteritis. The other clinical signs are associated with ulcerative colitis. Refer to Table 24-4 in the text.

A nurse caring for a patient with regional enteritis knows to assess for this most serious systemic complication. What is that complication?

Red, sensitive skin around the stoma site Red, sensitive skin around the stoma site may indicate an ill-fitting appliance beefy redness at a stoma site that isn't sensitive to touch is a normal assessment finding. Urine mixed with mucus is also a normal finding.

A nurse is caring for a client who had an ileo 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?

The client exhibits signs of adequate GI perfusion. Adequate GI perfusion can be maintained only if Crohn's disease is controlled. If the client experiences acute, uncontrolled episodes of Crohn's disease, impaired GI perfusion may lead to a bowel infarction. Positive self-image, a manageable level of discomfort, and intact skin integrity are expected client outcomes, but aren't related to control of the disease.

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?

paralytic ileus Bowel sounds are hypoactive or absent in a client with a paralytic ileus. Clients with Crohn's disease and gastroenteritis have hyperactive bowel sounds because of increased intestinal motility. A complete bowel obstruction causes absent bowel sounds below the obstruction and hyperactive sounds above the obstruction.

A nurse is performing focused assessment on her clients. She expects to hear hypoactive bowel sounds in a client with:

enterostomal nurse The surgeon should collaborate with the enterostomal nurse who can address the client's concerns. The enterostomal nurse may schedule a visit with a client who has a colostomy to offer support to the client

A surgeon is discussing surgery with a client diagnosed with colon cancer. The client is visibly shaken over the possibility of a colostomy. Based on the client's response, the surgeon should collaborate with which health team member?

In addition to teaching a client with constipation to increase dietary fiber intake to 25 g/day, which of the following would the nurse include as important? a) Avoid bran cereals and beans in the diet. b) Increasing intake of fluids, 3-4 glasses/day. c) Avoid a daily exercise regimen. d) Adding fiber-rich foods to the diet gradually.

Adding fiber-rich foods to the diet gradually.

Absent. Since lack of bowel motility typically accompanies peritonitis, bowel sounds are absent. Therefore, the nurse will not observe mild, high-pitched, or hyperactive bowel sounds.

After assessing a client with peritonitis, the nurse most likely would document the client's bowel sounds as:

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? a) Azotorrhea b) Borborygmus c) Tenesmus d) Diverticulitis

Borborygmus

The American Cancer Society recommends routine screening to detect colorectal cancer. Which screening test for colorectal cancer should a nurse recommend? Carcinoembryonic antigen (CEA) test after age 50 Proctosigmoidoscopy after age 30 Annual digital examination after age 40 Barium enema after age 20

Annual digital examination after age 40

A nurse is interviewing a client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? a) Polyps b) Hemorrhoids c) Duodenal ulcers d) Weight gain

Polyps

The nurse caring for a client with diverticulitis is preparing to administer the client's medications. The nurse anticipates administration of which category of medication because of the client's diverticulitis? 1. Antispasmodic 2. Anti-inflammatory 3. Antianxiety 4. Antiemetic

Antispasmodic

A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation? a) Assisting to increase dietary fiber. b) Providing an adequate quantity of food. c) Obtaining medications and allergy history. d) Obtain medical and food history.

Assisting to increase dietary fiber.

Which of the following would a nurse expect to assess in a client with peritonitis? a) Hyperactive bowel sounds. b) Decreased pulse rate (HR). c) Slow, deep respirations. d) Board-like abdomen.

Board-like abdomen.

The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's notes? Loud bowel sounds Borborygmus Tenesmus Peristalsis

Borborygmus

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) Frank blood in stool b) Change in bowel habits c) Change in dietary habits d) Abdominal pain

Change in bowel habits

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? 1. Abdominal cramping when having a bowel movement 2. Daily bowel movements 3. Excess gas 4. Change in bowel habits

Change in bowel habits

Which is the most common presenting symptom of colon cancer? Fatigue Change in bowel habits Anorexia Weight loss

Change in bowel habits

While listening to a client's chest, the nurse notes a rub during inspiration and expiration with a grating sound. When communicating to the health care provider, what should the nurse request in the SBAR communication? a) Chest x-ray b) Arterial blood gasses c) Broncodialator small volume nebulizer treatments d) Narcotic pain medications

Chest x-ray

A client informs the nurse that he has been having abdominal pain that is relieved when having a bowel movement. The client states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder? 1. Blood and mucus in the stool 2. Chronic constipation with sporadic bouts of diarrhea 3. Weight loss due to malabsorption 4. Client is awakened from sleep due to abdominal pain.

Chronic constipation with sporadic bouts of diarrhea

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? a) Tell the client you are almost finished and to hold still for the next 1-2 minutes. b) Water should flow in over a 45 minute period. c) Allow only tepid fluid to enter the colon slowly. d) Clamp the tubing and give the patient a rest period.

Clamp the tubing and give the patient a rest period.

A nurse should expect to administer which medication to a client with gout? a) Aspirin b) Calcium gluconate c) Colchicine d) Furosemide

Colchicine

A 13-year-old girl is being evaluated for possible Crohn's disease. The nurse expects to prepare her for which diagnostic study? a) Genetic testing b) Myelography c) Cystoscopy d) Colonoscopy with biopsy

Colonoscopy with biopsy

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? Kidneys, ureters, bladder (KUB) Colonic transit studies Defecography Abdominal radiography

Defecography

What is the most appropriate nursing diagnosis for the client with acute pancreatitis? a) Excess fluid volume b) Decreased cardiac output c) Ineffective gastrointestinal tissue perfusion d) Deficient fluid volume

Deficient fluid volume

The nurse is caring for a 77-year-old patient diagnosed with Crohn's disease. What would be especially important to monitor this patient for? Pain Fluid overload Fatigue Dehydration

Dehydration

The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching? 1. Use laxatives weekly. 2. Drink 8 to 10 glasses of fluid daily. 3. Avoid daily exercise. 4. Avoid unprocessed bran.

Drink 8 to 10 glasses of fluid daily.

What information should the nurse include in the teaching plan for a client being treated for diverticulosis? a) Drink at least 8 to 10 large glasses of fluid every day b) Do not include unprocessed bran in the diet c) Regular use of laxatives and enemas at home d) Discourage regular exercise if pt. is inactive

Drink at least 8 to 10 large glasses of fluid every day

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: a) Encourage caffeine and alcohol consumption at mild to moderate levels. b) Encourage a high-fiber diet daily. c) Encourage increased consumption of spicy foods, lactose, fried foods, corn, and wheat. d) Increase p.o. fluids only with/during meals.

Encourage a high-fiber diet daily.

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? a) Age under 40 years old. b) High-fat, high-protein, low-fiber diet. c) Familial polyposis (FHx of colon cancer). d) Familial history of basal cell carcinomas.

Familial polyposis (FHx of colon cancer).

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. The nurse would prepare the patient for which of the following? a) Flexible sigmoidoscopy b) X-ray studies (i.e., barium enema) c) Computed tomography (CT) scan d) Anorectal manometry and transit studies

Flexible sigmoidoscopy

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is MOST appropriate? a) Cutting the faceplate opening no more than 2" larger than the stoma b) Scrubbing the area around the stoma c) Gently washing the area surrounding the stoma using a facecloth and mild soap d) Eliminating wrinkles in the faceplate

Gently washing the area surrounding the stoma using a facecloth and mild soap

When providing discharge teaching for a client with uric acid calculi, the nurse would include an instruction to avoid which type of diet? a) Low calcium b) High purine c) Low oxalate d) High oxalate

High purine

An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to? Hyperkalemia Hypokalemia Hyponatremia Hypernatremia

Hypokalemia

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process? 1. Normal erythrocyte sedimentation rate (ESR) 2. Subnormal temperature 3. Hypotension 4. Bradycardia

Hypotension

metabolic acidosis

In a client with enteritis and frequent diarrhea, the nurse should anticipate:

Breast In women, only incidences of breast cancer exceed that of colorectal cancer. In men, only incidences of prostate cancer and lung cancer exceed that of colorectal cancer.

In women, which of the following types of cancer exceeds colorectal cancer?

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 Wearing an appliance pouch only at bedtime Consuming a low-protein, high-fiber diet Taking only enteric-coated medications

Increasing fluid intake to prevent dehydration

A client is diagnosed with deep vein thrombosis (DVT). Which nursing diagnosis should receive highest priority at this time? a) Impaired gas exchange related to increased blood flow b) Excess fluid volume related to peripheral vascular disease c) Ineffective peripheral tissue perfusion related to venous congestion d) Risk for injury related to edema

Ineffective peripheral tissue perfusion related to venous congestion

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? Low residue Low protein Calorie restriction Iron restriction

Low residue

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? a) Low p.o. fluids. b) Low-protein diet. c) Low residue diet. d) High-calorie diet.

Low residue diet.

A client has an allergy to latex. What intervention would be of importance? a) Maintain standard precautions with powder free gloves. b) Use allergy free lotion to prevent skin breakdown. c) Determine if client is also allergic to kiwi and strawberries. d) Keep an epinephrine pen at the bedside.

Maintain standard precautions with powder free gloves.

Vomiting results in which of the following acid-base imbalances? Metabolic alkalosis Metabolic acidosis Respiratory acidosis Respiratory alkalosis

Metabolic alkalosis

A client with pancreatitis has been receiving total parenteral nutrition (TPN) for the past week. Which nursing intervention helps determine if TPN is providing adequate nutrition? a) Recording fluid intake and output b) Monitoring the client's weight every day c) Accelerating the infusion if it falls behind schedule d) Ensuring that the TPN tubing has an in-line filter

Monitoring the client's weight every day

Clients with inflammatory bowel disease (IBD) are at significantly increased risk for which condition? Osteoporosis DVT Hypotension Pneumonia

Osteoporosis

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of: a) Ulcerative colitis b) Peritonitis c) Diverticulitis d) Diverticulosis

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 Pelvic abscess Ileus Hemorrhage

Peritonitis

Peritonitis Peritonitis is inflammation of the peritoneum, the serous membrane lining the abdominal cavity and covering the viscera. Peritonitis is typically a life-threatening emergency that requires prompt surgical intervention, and typically involves postoperative critical care monitoring due to the risk of sepsis, organ failure, and subsequent infections.

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of:

A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm his diagnosis? a) Recent weight loss and temperature elevation b) Presence of blood in the client's stool and recent hypertension c) Adventitious breath sounds and hypertension d) Presence of easy bruising and bradycardia

Recent weight loss and temperature elevation

Which of the following is the most common symptom of a polyp? Rectal bleeding Abdominal pain Diarrhea Anorexia

Rectal bleeding

A woman at 22 weeks' gestation has right upper quadrant pain radiating to her back. She rates the pain as 9 on a scale of 1 to 10 and says that it has occurred 2 times in the last week for about 4 hours at a time. She does not associate the pain with food. Which nursing measure is the highest priority for this client? a) Educate the client concerning changes occurring in the gallbladder as a result of pregnancy. b) Discuss nutritional strategies to decrease the possibility of heartburn. c) Support the client's use of acetaminophen to relieve pain. d) Refer the client to her health care provider for evaluation and treatment of the pain

Refer the client to her health care provider for evaluation and treatment of the pain

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 upper quadrant Right lower quadrant Left upper quadrant Left lower quadrant

Right lower quadrant

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 Instruct the client to avoid prune or apple juice Assist the client regarding the correct diet or to minimize food intake Instruct the client to keep a record of food intake

Suggest fluid intake of at least 2 L/day

The health care provider prescribes sulfasalazine for the client with ulcerative colitis. Which instruction should the nurse give the client about taking this medication? a) Take the total dose at bedtime. b) Avoid taking it with food. c) Take it with a full glass (240 mL) of water. d) Stop taking it if urine turns orange-yellow.

Take it with a full glass (240 mL) of water.

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? a) Administering an ointment b) Testing all stools for occult blood. c) Administering an opioid pain medication. d) Preparing a client for a gastrostomy tube.

Testing all stools for occult blood.

The nurse notes that a client with acute pancreatitis occasionally experiences muscle twitching and jerking. How should the nurse interpret the significance of these symptoms? a) The client is experiencing a reaction to meperidine. b) The client needs a muscle relaxant to promote rest. c) The client has a nutritional imbalance. d) The client may be developing hypocalcemia.

The client may be developing hypocalcemia.

Flexible sigmoidoscopy The treatment of fecal incontinence depends on the cause. A rectal examination and other endoscopic examinations, such as a flexible sigmoidoscopy, are performed to rule out tumors, inflammation, or fissures. X-ray studies such as barium enema, computed tomography (CT), anorectal manometry, and transit studies may be helpful in identifying alterations in intestinal mucosa and muscle tone or in detecting other structural or functional problems.

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. The nurse would prepare the patient for which of the following?

Notify the physician. Abdominal pain, a rigid board-like abdomen, loss of bowel sounds, and signs and symptoms of shock occur with peritonitis. Peritonitis is typically a life-threatening emergency that requires prompt surgical intervention, and typically involves postoperative critical care monitoring due to the risk of sepsis, organ failure, and subsequent infections; thus, the nurse should notify the physician.

The nurse is admitting a patient with a diagnosis of diverticulitis and assesses that the patient has a boardlike abdomen, no bowel sounds, and complains of severe abdominal pain. What is the nurse's first action?

Borborygmus Borborygmus is the intestinal rumbling caused by the movement of gas through the intestines that accompanies diarrhea. Tenesmus refers to ineffectual straining at stool. Azotorrhea refers to excess of nitrogenous matter in the feces or urine. Diverticulitis refers to inflammation of a diverticulum from obstruction (by fecal matter) resulting in abscess formation.

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?

A 45-year-old client is admitted to the facility with excruciating paroxysmal facial pain. He reports that the episodes occur most often after feeling cold drafts and drinking cold beverages. Based on these findings, the nurse determines that the client is most likely suffering from which neurologic disorder? A. Trigeminal neuralgia B. Angina Pectoris C. Migraine Headache D. Bells Palsy

Trigeminal neuralgia

A client presents to the emergency department with reports of acute GI distress, bloody diarrhea, weight loss, and fever. A family history of which of the following would be significant to this client's diagnosis? a) Peptic ulcers b) Crohn's disease c) Ulcerative colitis d) Appendicitis

Ulcerative colitis

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's: a) Usual pattern of elimination b) Medications c) Allergies d) Family history of constipation/GI issues

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? Alcohol consumption Activity levels Usual pattern of elimination Current medications

Usual pattern of elimination

Computed tomography scan A computed tomography scan is the diagnostic of choice if the suspected diagnosis is diverticulitis; it can also reveal one or more abscesses. A barium enema or colonoscopy may be used to diagnosis diverticulosis. Magnetic resonance imaging would not be used to diagnose diverticulitis.

Which of the following is the diagnostic of choice if the suspected diagnosis is diverticulitis?

Mineral Oil Mineral oil should never be taken with meals because it can impair the absorption of fat-soluble vitamins and delay gastric emptying. Refer to Table 24-1 in the text.

When a nurse recommends the following laxative, she emphasizes that it should not be taken with meals. Choose the laxative.

When a client has an acute attack of diverticulitis, the nurse should first: a) encourage the client to drink a glass of water every 2 hr. b) prepare the client for a colonoscopy. c) assess the client for signs of peritonitis. d) encourage the client to eat a high-fiber diet.

assess the client for signs of peritonitis.

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. fistula. hemorrhoid. pilonidal cyst.

fissure

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: caffeinated products. spicy foods. high-fiber diet. fluids with meals.

high-fiber diet

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: hyperkalemia. hypokalemia. hyponatremia. hypernatremia.

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? 1. lack of solid food 2. lack of exercise 3. increased fiber 4. lack of free water intake

lack of free water intake

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 lack of solid food lack of exercise increased fiber

lack of free water intake

Which symptom would the nurse most likely observe in a client with cholecystitis from cholelithiasis? a) nausea after ingestion of high-fat foods b) black stools c) elevated temperature of 103°F (39.4°C) d) decreased white blood cell count

nausea after ingestion of high-fat foods

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? Constipation Paralytic ileus Peritonitis Accumulation of gas

peritonitis

Which client requires immediate nursing intervention? The client who: complains of epigastric pain after eating. complains of anorexia and periumbilical pain. presents with a rigid, board-like abdomen. presents with ribbonlike stools.

presents with a rigid, board-like abdomen

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: a. rupture of the appendix. b. ulceration of the appendix. c. inflammation of the gallbladder. d. emotional distress related to the pain.

rupture of the appendix.

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find: 1. tenderness and pain in the right upper abdominal quadrant. 2. severe abdominal pain with direct palpation or rebound tenderness. 3. jaundice and vomiting. 4. rectal bleeding and a change in bowel habits.

severe abdominal pain with direct palpation or rebound tenderness.

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 one bowel movement daily one bowel movement every other day two bowel movements daily

stool consistency and client comfort

A client is recovering from an abdominal-perineal resection. To promote wound healing after the perineal drains have been removed the nurse should encourage the client to: a) use a heating pad on the area. b) take sitz baths. c) shower daily. d) apply moist dressings to the area.

take sitz baths

The mother of a 16-year-old girl calls the emergency department, suspecting her daughter's abdominal pain may be appendicitis. In addition to pain, her daughter has a temperature of 100° F (37.7° C) and has vomited twice. What should the nurse tell the mother? a) "It's most likely the flu because your daughter is too young to have appendicitis." b) "Give your daughter a laxative to rule out the possibility that constipation is causing the pain." c) "Gently press on the lower left quadrant of your daughter's abdomen to test for rebound tenderness." d) "Bring your daughter into the emergency department immediately before her appendix has a chance to rupture."

"Bring your daughter into the emergency department immediately before her appendix has a chance to rupture."

A child is admitted to the emergency department and diagnosed with a suspected ruptured appendix. The parents are anxious about the child's condition and ask the nurse what to expect for immediate treatment. What is the best response by the nurse? a) "We will place a referral to the social worker to help you through this." b) "We will modify pain management strategies to control the situation." c) "We will be preparing your child for emergency surgery." d) "The focus of treatment is the initiation of antibiotic therapy."

"We will be preparing your child for emergency surgery."

Rovsing's sign; acute appendicitis When an examiner deeply palpates the left lower abdominal quadrant and the client feels pain in the RLQ, this is referred to as a positive Rovsing's sign and suggests acute appendicitis.

A client presents to the ED with acute abdominal pain, fever, nausea, and vomiting. During the client's examination, the lower left abdominal quadrant is palpated, causing the client to report pain in the RLQ. This positive sign is referred to as ________ and suggests the client may be experiencing ________.

Mucosal disorders causing generalized malabsorption In addition to celiac sprue, regional enteritis and radiation enteritis are examples of mucosal disorders. Examples of infectious diseases causing generalized malabsorption include small-bowel bacterial overgrowth, tropical sprue, and Whipple disease. Examples of luminal problems causing malabsorption include bile acid deficiency, Zollinger-Ellison syndrome, and pancreatic insufficiency. Postoperative gastric or intestinal resection can result in development of malabsorption syndromes.

Celiac sprue is an example of which category of malabsorption?

severe abdominal pain with direct palpation or rebound tenderness. Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (such as appendicitis, diverticulitis, ulcerative colitis, or a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find:

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? a) Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. b) Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage. c) Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. d) The appendix may develop gangrene and rupture, especially in a middle-aged client.

Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

An adult with appendicitis has severe abdominal pain. Which action will be the most effective to assist the client to manage pain prior to surgery? a) Apply moist heat to the abdomen. b) Teach client to massage the painful area. c) Provide distraction with music. d) Place the client in semi-Fowler's position with the knees to the chest.

Place the client in semi-Fowler's position with the knees to the chest

A client with rheumatoid arthritis tells the nurse that she feels "quite alone" in adjusting to changes in her lifestyle. The nurse should respond by: a) telling the client about her community's arthritis support group. b) referring the client and her husband for counseling to decrease her sense of isolation. c) suggesting that the client develop a hobby to occupy her time. d) suggesting that the client discuss her feelings with her minister.

telling the client about her community's arthritis support group.

Which is an appropriate nursing goal for the client who has ulcerative colitis? The client: a) uses a heating pad to decrease abdominal cramping. b) maintains a daily record of intake and output. c) accepts that a colostomy is inevitable at some time in his life. d) verbalizes the importance of small, frequent feedings.

verbalizes the importance of small, frequent feedings.

Which statement indicates the client understands the lifestyle modifications required when managing ulcerative colitis? a) "I am allowed to have alcohol as long as I only drink wine." b) "I can eat popcorn for an evening snack." c) "I may have coffee with my meals." d) "I will have to stop smoking."

"I will have to stop smoking."

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. Based on the diagnosis of acute pancreatitis the nurse will provide which explanation for the prescribed interventions? a) "I will be starting antibiotic therapy once the blood cultures are obtained." b) "I can offer you ibuprofen for pain with a small sip of water." c) "Activity is important, so you will be scheduled for physical therapy." d) "You are not allowed anything by mouth so that your pancreas can rest"

"You are not allowed anything by mouth so that your pancreas can rest"

A client is admitted for a transurethral resection of the prostate (TURP). Preoperative teaching will include which of the following information? a) "You will need to keep your abdominal incision clean and dry and cannot shower until the sutures are removed." b) "You will return from surgery and have a suprapubic catheter for 48 hours." c) "You will need to use a urinal and remain on bed rest for 24 hours after surgery." d) "You will return from surgery with a catheter in your bladder and fluid flowing into and out of it continuously."

"You will return from surgery with a catheter in your bladder and fluid flowing into and out of it continuously."

White blood cell (WBC) count 22.8/mm3 The nurse should report the elevated WBC count. This finding, which is a sign of infection, indicates that the client's appendix might have ruptured. Hematocrit of 42%, serum potassium of 4.2 mEq/L, and serum sodium of 135 mEq/L are within normal limits. Alterations in these levels don't indicate appendicitis.

A client with complaints of right lower quadrant pain is admitted to the emergency department. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the physician immediately?

Which statement provides accurate information regarding cancer of the colon and rectum? 1. Rectal cancer affects more than twice as many people as colon cancer. 2. Colorectal cancer is the third most common site of cancer in the United States. 3. Colon cancer has no hereditary component. 4. The incidence of colon and rectal cancer decreases with age.

Colorectal cancer is the third most common site of cancer in the United States.

The nurse administers theophylline to a client. When evaluating the effectiveness of this medication, the nurse should assess the client for: a) suppression of the client's respiratory infection. b) decrease in bronchial secretions. c) thinning of tenacious, purulent sputum. d) less difficulty breathing

less difficulty breathing

Insufficient fiber Emotional stress Inactivity

A client reports having increased incidence of constipation. What can cause constipation?

What is the MOST common cause of small-bowel obstruction? a) adhesions b) ulcers c) hernias d) tumors

adhesions

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 don't understand this; I took the medication the doctor ordered and followed the diet." "I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." "I don't understand why this happened again; I didn't travel out of the country." "I don't like oatmeal, so it doesn't matter that I can't have it."

"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread."

A community health nurse is performing a home visit to a 53-year-old patient who requires twice-weekly wound care on her foot. The patient mentions that she is currently having hemorrhoids, a problem that she has not previously experienced. What treatment measure should the nurse recommend to this patient? Daily application of topical antibiotics Decreased fluid intake Bathing, rather than showering, once per day A high-fiber diet with increased fruit intake

A high-fiber diet with increased fruit intake

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 Apply barrier powder Apply triamcinolone acetonide spray Dust with nystatin powder

Dry skin thoroughly after washing

Which of the following is accurate regarding regional enteritis? Fistulas are common Severe diarrhea Severe bleeding Exacerbations and remissions

Exacerbations and remissions

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? Age younger than 40 years Low-fat, low-protein, high-fiber diet History of skin cancer Familial polyposis

Familial polyposis

Crohn's disease is a condition of malabsorption caused by which pathophysiological process? 1. Inflammation of all layers of intestinal mucosa 2. Infectious disease 3. Gastric resection 4. Disaccharidase deficiency

Inflammation of all layers of intestinal mucosa

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? Start an IV with lactated Ringer's solution. Notify the health care provider. Administer a retention enema. Administer an opioid analgesic.

Notify the health care provider.

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 That the client has a bowel movement daily That the stool is formed and soft The client is able to fully evacuate with each bowel movement

The consistency of stool and comfort when passing stool

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: a) anorectal fistula b) anal fissure c) anal polyp d) hemorrhoids

anal fissure

Pancreatic enzyme replacements are prescribed for the client with chronic pancreatitis. When should the nurse instruct the client to take them to obtain the most therapeutic effect? a) with each meal and snack b) every 4 hours, at specified times c) in the morning and at bedtime d) three times daily between meals

with each meal and snack

An adolescent client scheduled for an emergency appendectomy is to be transferred directly from the emergency department to the operating room. Which statement by the client should the nurse interpret as most significant? a) "It hurts when you press on my stomach." b) "I feel like I am going to throw up." c) "All of a sudden it does not hurt at all." d) "The pain is centered around my navel."

"All of a sudden it does not hurt at all."

A client newly diagnosed with ulcerative colitis who has been placed on steroids asks the nurse why steroids are prescribed. The nurse shuld tell the client: a) "The side effects of steroids outweigh their benefits to clients with ulcerative colitis." b) "Ulcerative colitis can be cured by the use of steroids." c) "Steroids are used in severe flare-ups because they can decrease the incidence of bleeding." d) "Long-term use of steroids will prolong periods of remission."

"Steroids are used in severe flare-ups because they can decrease the incidence of bleeding."

A client has developed an anorectal abscess. Which client is at most risk for the development of this type of abscess? 1. A client with hemorrhoids 2. A client with Crohn's disease 3. A client with diverticulosis 4, A client with colon cancer

A client with Crohn's disease

The client's natural bowel function may become sluggish. Explanation: 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.

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 nurse is providing dietary instructions to a client with a history of pancreatitis. Which of the following instructions would be most appropriate? a) Maintain a low-carbohydrate, low-fat diet. b) Maintain a high-fat, high-carbohydrate diet. c) Maintain a high-carbohydrate, low-fat diet. d) Maintain a high-fat, low-carbohydrate diet.

Maintain a high-carbohydrate, low-fat diet.

An adolescent, age 14, is hospitalized for nutritional management and drug therapy after experiencing an acute episode of ulcerative colitis. Which nursing intervention is appropriate? a) Providing small, frequent meals b) Providing high-fiber snacks c) Administering digestive enzymes before meals as ordered d) Administering antibiotics with meals as ordered

Providing small, frequent meals

A client is admitted with acute pancreatitis. The nurse should monitor which laboratory values? a) decreased urine amylase level b) increased serum amylase and lipase levels c) increased calcium level d) decreased glucose level

increased serum amylase and lipase levels

Ask the client to remain inactive for 5 minutes. Explanation: After applying the ostomy appliance, the nurse should ask the client to remain inactive for 5 minutes to allow body heat to strengthen the adhesive bond. The adhesive faceplate should be pressed from the stomal edge outward to prevent the formation of wrinkles. A small amount of air should also be allowed to be trapped in the pouch; liquid feces will then drain to the bottom of the pouch, placing less tension on it.

A nurse applies an ostomy appliance to a client who is recovering from ileostomy surgery. Which intervention should the nurse utilize to prevent leakage from the appliance?

inflammatory bowel disease (IBD)

A nurse is assessing a client and obtains the following findings: abdominal discomfort, mild diarrhea, blood pressure of 100/80 mm Hg, pulse rate of 88 beats/minute, respiratory rate of 20 breaths/minute, temperature 100° F (37.8° C). The nurse suspects the client will be diagnosed with:

Colonoscopy Diverticulosis is typically diagnosed by colonoscopy, which permits visualization of the extent of diverticular disease and biopsy of tissue to rule out other diseases. In the past, barium enema was the preferred diagnostic test, but it is now used less frequently than colonoscopy. CT with contrast agent is the diagnostic test of choice if the suspected diagnosis is diverticulitis; it can also reveal abscesses.

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?

Endoscopy with mucosal biopsy Endoscopy with biopsy of the mucosa is the best diagnostic tool for malabsorption syndrome.

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?

Drink at least 8 to 10 large glasses of fluid every day The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the physician. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.

What information should the nurse include in the teaching plan for a client being treated for diverticulosis?

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.

When interviewing a client with internal hemorrhoids, which of the following would the nurse expect the client to report?

Colace Colace can be used safely by patients who should avoid straining such as cardiac patients and those with anorectal disorders. Milk of Magnesia is a saline agent. Dulcolax is a stimulant. Mineral oil is a lubricant.

Which of the following laxatives should be used by a cardiac patient who should avoid straining?

Sudden, sustained abdominal pain Sudden, sustained pain, abdominal distention, and fever are symptoms of perforation in a client with intestinal obstruction. A decrease in blood pressure and decrease in urine output are symptoms of shock. Purulent drainage from the gluteal fold is not a symptom of perforation; it only indicates that the client has developed a condition of anorectal abscess.

Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction?

0.9% NS The administration of several liters of an isotonic solution is immediately prescribed. Hypovolemia occurs because massive amounts of fluid and electrolytes move from the intestinal lumen into the peritoneal cavity and deplete the fluid in the vascular space.

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?

During the first few weeks after a cholecystectomy, the client should follow a diet that includes: a) a decreased intake of fruits, vegetables, whole grains, and nuts, to minimize pressure within the small intestine. b) ingestion of pancreatic enzymes with meals to replace the normal enzyme secretion that has been surgically altered. c) at least four servings daily of meat, cheese, and peanut butter to increase protein intake that aids incisional healing. d) a limited intake of fat distributed throughout the day so there is not an excessive amount in the intestine at any one time.

a limited intake of fat distributed throughout the day so there is not an excessive amount in the intestine at any one time.

Which is a priority assessment for the client in shock who is receiving an IV infusion of packed red blood cells and normal saline solution? a) pain b) fluid balance c) altered level of consciousness d) anaphylactic reaction

anaphylactic reaction

After receiving a dose of penicillin, a client develops dyspnea and hypotension. The nurse suspects the client is experiencing anaphylactic shock. What should the nurse do first? a) Administer epinephrine, as ordered, and prepare to intubate the client, if necessary. b) Administer the antidote for penicillin, as ordered, and continue to monitor the client's vital signs. c) Insert an indwelling urinary catheter and begin to infuse I.V. fluids, as ordered. d) Prepare to administer a corticosteroid IV.

Administer epinephrine, as ordered, and prepare to intubate the client, if necessary.

A 4-year-old child who has been ill for 4 hours is admitted to the hospital with difficulty swallowing, a sore throat, and severe substernal retractions. The child's temperature is 104° F (40° C), and the apical pulse is 140 bpm. The white blood cell count is 16,000/mm3 (16,000 X 109/L). What is priority for nursing intervention? a) difficulty breathing b) potential for aspiration c) airway obstruction d) infection

airway obstruction