Fundamentals EAQ's Chapter 47

A student nurse is learning about the various factors that influence the process of bowel elimination. Which statement if made by the student nurse indicates a need for further learning?

"A woman should drink at least 1 L of fluid to maintain normal bowel elimination." Rationale Various factors such as fluid intake, stress, age, and position during defecation influence the process of bowel elimination. A fluid intake of 2.2 L/day is recommended for women.

A nurse is educating the caregiver of a patient who has undergone an antegrade continence enema procedure. Which statement if made by the caregiver indicates effective learning?

"After this procedure, I can easily insert a tube and give the patient an enema that comes out through the anus." Rationale An antegrade continence enema is a procedure in which the surgeon creates a continence valve with an opening to the intestine on the abdomen; this allows the patient or caregiver to insert a tube and administer an enema that comes out through the anus.

A patient is admitted with diarrhea caused by Clostridium difficile (C. difficile). Which question should the nurse ask to obtain the most helpful information about the cause of the dysentery?

"Are you taking any antibiotics?" Rationale Infection with C. difficile is bacterial dysentery. It often occurs in patients who have been receiving large doses of antibiotics or who have taken antibiotics over a long period of time.

The primary health care provider prescribes guaiac fecal occult blood testing for a patient who reports constipation and a family history of colon cancer. Which instruction should be provided to the patient?

"Avoid eating red meat for 3 days before testing." Rationale A patient who is scheduled for guaiac fecal occult blood testing should be instructed to avoid eating red meat for 3 days before testing to prevent altered test results. This test should be repeated at least three times on three separate bowel movements. The patient should also avoid vitamin C supplements and citrus fruits and juices for 3 days before the test to prevent a false-negative result. The nurse should also instruct the patient to stop taking aspirin, ibuprofen, naproxen, or other nonsteroidal antiinflammatory drugs for 7 days, not 4 days, before the test to prevent a false-positive test result.

A nurse is assessing a patient with diarrhea. Which question will help determine the presence of other symptoms?

"Have you had fever, chills, weight loss, or abdominal pain recently?" Rationale Diarrhea may be associated with fever, chills, weight loss, or abdominal pain; therefore, the nurse should ask the patient about the presence of these symptoms.

A registered nurse is teaching a licensed practical nurse about the physical assessment of body systems and functions of patients with bowel elimination problems to develop and implement an individualized plan of care. Which statement if made by the licensed practical nurse indicates a need for further teaching?

"I'll inspect the patient's teeth, tongue, and gums for poor dentition." Rationale To develop and implement an individualized plan of care for patients with bowel elimination problems, the nurse should perform certain assessments that include nursing history, physical assessment, inspection of fecal characteristics, and review of relevant test results. When assessing bowel elimination issues, the nurse need not inspect the patient's teeth, tongue, and gums for poor dentition, because poor dentition or poorly fitting dentures that affect the ability to chew may interfere with nutrition, but do not necessarily lead to bowel elimination problems.

A nurse educates a group of patients on the prevention of constipation. Which statements if made by a patient indicate effective understanding?

"I'll perform regular physical exercise." "I'll include high-fiber foods in my diet." "I'll attempt to defecate at the same time each day." Rationale To reduce the risk of constipation, one should perform regular physical exercise, include high-fiber foods in the diet, and attempt to defecate at the same time each day. A regular physical exercise program promotes peristalsis, thereby easing defecation. High-fiber foods are bulk-forming foods, which help remove fats and waste products from the body efficiently. Bowel function is also influenced by personal elimination habits. Irregular bowel habits may lead to constipation.

A registered nurse is educating nursing students about the required interventions while administering an enema. Which statements if made by a student nurse indicate effective understanding?

"I'll place a waterproof pad under the patient's hips and buttocks." "I'll cover the patient with a bath blanket, exposing only the rectal area, and clearly visualizing the anus." "If the patient has poor sphincter control, I'll position the patient on a bedpan in a comfortable dorsal recumbent position." Rationale The nurse should place a waterproof pad under the patient's hips and buttocks when administering an enema. The nurse should also cover the patient with a bath blanket, exposing only the rectal area, and clearly visualizing the anus. If the patient has poor sphincter control, the nurse should position the patient on a bedpan in a comfortable dorsal recumbent position.

A patient reports no bowel movements for 3 days and a feeling of abdominal fullness. Upon palpating the patient's abdomen, the nurse finds that the left lower quadrant is firm. Which instructions given by the nurse will be beneficial for the patient?

"Include high-fiber foods in your diet." "Try to defecate at the same time every day." "Ensure that your daily fluid intake is at least 1.5 liters." Rationale A patient with constipation may report having no bowel movements for 3 days and a feeling of abdominal fullness. The patient's left lower abdominal quadrant may also be firm on palpation. These are defining characteristics of constipation; therefore, the nurse should instruct the patient to eat high-fiber foods, which help remove fats and waste products from the body efficiently. Bowel function is also influenced by personal elimination habits. Therefore, the nurse should instruct the patient to try to defecate at the same time every day to encourage normal bowel function. The patient should be instructed to drink at least 1.5 L of fluid per day to help soften the stool.

A nurse is caring for a pregnant patient who is prescribed a stool softener that increases the secretion of water by the intestine. Which statements if made by the nurse about the prescribed medication are correct?

"It is a short-term therapy to relieve straining on defecation." "It lowers the surface tension of feces, allowing water and fat to penetrate." Rationale Docusate sodium laxative is a stool softener that increases the secretion of water by the intestine. It is a short-term therapy that may be prescribed to a pregnant patient to relieve straining on defecation. It lowers the surface tension of feces, allowing water and fat to penetrate.

The health care provider prescribes methylcellulose to a patient with chronic constipation. Which instruction provided by the nurse will help prevent complications?

"Mix the powder with 250 mL of water or juice and swallow it quickly." Rationale Methylcellulose is a bulk-forming stool softener that absorbs water and increases solid intestinal bulk. It is a drug of choice for chronic constipation and is available in powder form. The nurse should instruct the patient to mix the powder with at least 250 mL of water or juice and swallow it quickly; if not, it could cause constipation.

While inspecting the area around a patient's anus, the nurse notices lesions, discoloration, inflammation, and dilated, engorged veins in the rectum. Which instruction provided by the nurse will help manage the patient's condition?

"Take warm sitz baths frequently." "Perform regular exercise and drink at least 1.5 L of fluid per day." Rationale Lesions, discoloration, and inflammation of the area around the rectum and dilated, engorged veins in the rectum indicate hemorrhoids. The primary goal for the treatment of hemorrhoids is passage of soft-formed stool. This may be facilitated by regular exercise and proper fluid intake of least 1.5 L per day. The nurse should instruct patients with hemorrhoids to take warm sitz baths frequently because they provide temporary relief to swollen hemorrhoids

Which assessment finding would the nurse associate with a problem with bowel elimination?

A bowel movement every 5 days Rationale A bowel movement every 5 days indicates constipation, which is an abnormal finding, thus a problem with bowel elimination.

To which patient will the nurse most likely give a hypertonic solution enema?

A patient who cannot tolerate a large volume of fluid Rationale Enemas that uses hypertonic solutions are low volume and are designed for patients who cannot tolerate a large volume of fluid. This type of enema is contraindicated in infants and dehydrated patients.

Which patient has the highest risk of constipation?

A patient who is taking opioid analgesics Rationale Opioid analgesics slow peristalsis and contractions, thereby causing constipation. Therefore, a patient taking opioid analgesics has the highest risk of constipation.

During a home visit to an elderly patient, the patient expresses to the nurse that he is experiencing flatulence, which is embarrassing. Which signs and symptoms should the nurse expect the patient to report?

Abdominal fullness Pain Cramping Rationale The patient with flatulence is likely to report abdominal distension, cramping, and pain due to accumulation of gas in the intestines.

While caring for a debilitated patient, a nurse learns that the patient has been unable to pass stool for several days, despite the repeated urge to defecate. The nurse suspects that the patient has a fecal impaction. Which other findings support the nurse's suspicion?

Anorexia Rectal pain Continuous oozing of liquid stool Rationale An inability to pass stool for several days despite the repeated urge to defecate may indicate fecal impaction. The patient may also experience loss of appetite (anorexia), rectal pain, continuous oozing of liquid stool, nausea and/or vomiting, and abdominal distention and cramping

Which are causes of diarrhea?

Antibiotic use Clostridium difficile Surgeries of the lower gastrointestinal tract Rationale Antibiotic use, Clostridium difficile, and surgeries and diagnostic testing of the lower gastrointestinal tract may cause diarrhea.

Which medication could increase a patient's risk of gastric bleeding?

Aspirin Rationale Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain. It is a prostaglandin inhibitor. Aspirin interferes with the secretion of protective mucus and thereby increases the risk of gastric bleeding.

Which medication is used to treat hyperactive bowel disorder?

Atropine Rationale Atropine is an anticholinergic drug that inhibits gastric acid secretion and depresses gastrointestinal motility. It is used to treat patients with hyperactive bowel disorder.

Where does normal defecation begin?

Colon Rationale Normal defecation begins with movement in the left colon, moving stool toward the anus. It does not begin in the anus, stomach, or small intestine.

Which procedures require the patient to undergo a bowel-cleansing program before they can be performed?

Colonoscopy Computerized tomographic colonography Rationale Patients who are prescribed colonoscopy or computerized tomographic colonography should undergo a bowel-cleansing program before the test.

While assessing a patient with a bowel elimination problem, the nurse asks the patient, "Do you feel as though your bowel movements are incomplete?" Which condition is the nurse trying to determine in the patient?

Constipation Rationale To determine constipation, the nurse should ask the patient about feelings of having incomplete bowel movements.

The nurse is caring for a 78-year-old man with diarrhea. Which problem is the most important to consider?

Dehydration Rationale Diarrhea interferes with absorption time of digestive juices. With frequent loose, watery stools, dehydration becomes a major problem in the older adult.

The nurse is teaching a patient healthy bowel habits. Which information should be included in the teaching?

Dietary fibers should be an essential component of the diet. Fluid intake should be at least 6 to 8 glasses of water per day. Stress management techniques should be practiced. Rationale Consuming dietary fiber increases the bulk of stool and helps in better bowel elimination. Maintaining adequate fluid intake increases the water content of the stool, prevents it from hardening, and permits easy passage through the rectum and anus. Stress can cause constipation; therefore, the patient should be instructed to practice stress management techniques.

Which may be recommended for a patient in whom fecal impaction is suspected?

Digital examination of the rectum Rationale Digital examination of the rectum may be recommended for a patient in whom fecal impaction is suspected.

A nurse is caring for a patient who recently underwent abdominal surgery. Which actions taken by the nurse will help prevent constipation in this patient?

Encouraging ambulation as early as possible Increasing the amount of fluids in the patient's diet Establishing a regular defecation schedule for the patient Rationale To reduce the risk of constipation in a patient who recently underwent abdominal surgery, the nurse should encourage the patient to ambulate as early as possible. The nurse should also increase the amount of fluids in the patient's diet and establish a regular defecation schedule for the patient. These interventions will help to promote normal defecation.

Which are short-term solutions to constipation?

Enemas Laxatives Cathartics Rationale Cathartics, laxatives, and enemas are short-term solutions to constipation.

A nurse is discussing common bowel elimination problems. Which statement indicates effective understanding of the difference between fecal impaction and fecal incontinence?

Fecal impaction is common in debilitated, confused, or unconscious patients, whereas fecal incontinence is common in patients with impaired cognitive function. Rationale Debilitated, confused, or unconscious patients have an increased risk of fecal impaction, whereas patients with impaired cognitive function are more likely to have fecal incontinence.

Which are defining characteristics of constipation?

Firm left abdominal quadrant Feeling of abdominal fullness No bowel movement for 4 days Rationale A firm left abdominal quadrant, feeling of abdominal fullness, and no bowel movement for 4 days are defining characteristics of constipation.

Which bowel elimination problem is associated with abdominal fullness, cramping, distention, and severe, sharp pain?

Flatulence Rationale Flatulence may cause abdominal fullness, cramping, distention, and severe, sharp pain.

The nurse is taking care of a patient who is bedridden. The patient complains of constipation. Which food items should the nurse include in the patient's diet to relieve constipation?

Fresh fruits Broccoli Cauliflower Beans Rationale Bulk-forming foods should be included in the diet to relieve constipation. Fresh fruits and vegetables are sources of dietary fibers, which add bulk to the stool. The increased bulk in the stool stretches the intestinal wall and increases peristalsis. Vegetables such as broccoli, cauliflower, and beans are gas-producing foods. The gas causes distention of the intestinal wall and stimulates peristalsis.

A nurse is preparing to administer an enema to a patient who is scheduled for a colonoscopy. Which action taken by the nurse may lead to a complication?

Giving the enema with the patient sitting on the toilet Rationale The nurse should not give an enema to a patient sitting on the toilet because the position of the rectal tubing could injure the rectal wall. When giving an enema to an immobilized patient, it is always recommended that the patient be positioned on a bedpan.

Which condition may be caused by frequent straining during defecation?

Hemorrhoids Rationale Increased venous pressure from straining at defecation, pregnancy, heart failure, and chronic liver disease cause hemorrhoids.

Which is caused by straining on defecation?

Hemorrhoids Dysrhythmias Rationale The Valsalva maneuver requires the patient to hold the breath while straining to defecate. This maneuver increases venous pressure from straining. Over time, hemorrhoids result. In addition, this maneuver increases the risk for dysrhythmias, which are often life threatening.

After performing a physical assessment of a patient with altered bowel elimination, a nurse suspects that the patient has an obstruction of the small intestine. Which finding supports the nurse's suspicion?

High-pitched and hyperactive bowel sounds on auscultation of the abdomen Rationale While performing a physical assessment of a patient with altered bowel elimination, the nurse may auscultate the patient's abdomen. High-pitched and hyperactive bowel sounds proximal to the obstruction may indicate that the patient has obstruction of the small intestine.

What are the uses of an enema?

Immediate relief of constipation Beginning a program of bowel training Emptying the bowel before diagnostic tests or surgery Rationale Enemas are used for the immediate relief of constipation, to begin a program of bowel training, and to empty the bowel before a diagnostic test or surgery.

Which factors may cause constipation?

Improper diet Lack of exercise Reduced fluid intake Rationale Improper diet, lack of exercise, and reduced fluid intake may cause constipation.

Which statement about fecal incontinence is correct?

It is the inability to control the passage of feces and gas from the anus. Rationale Fecal incontinence is the inability to control the passage of feces and gas from the anus.

While assessing a patient before administering an enema, the nurse inspects the patient's abdomen for distention. What is the purpose of this nursing intervention?

It provides a baseline for determining the effectiveness of the enema. Rationale Before administering an enema, the nurse should inspect the patient's abdomen for distention. This provides a baseline for determining the effectiveness of the enema.

During the nursing assessment, a patient reveals that he has diarrhea and cramping every time he has ice cream. He attributes this to the cold nature of the food. However, the nurse begins to suspect that these symptoms are associated with which condition?

Lactose intolerance Rationale This patient possibly lacks the enzyme needed to digest milk sugar lactase and therefore is potentially lactose intolerant. Lactose intolerance is not a food allergy but rather a food intolerance that increases peristalsis, not decreases.

Which part of the gastrointestinal tract plays a major role in bowel elimination?

Large intestine Rationale The main functions of the large intestine, or colon, are absorption, secretion, and elimination. Therefore, the large intestine plays a major role in bowel elimination.

Which medication may be used to promote defecation?

Laxatives Rationale Laxatives are often prescribed to promote defecation in patients with constipation.

The nurse is reviewing the records of a patient who has chronic constipation. The record states that the patient has type 3 stools according to the Bristol stool form scale. What would be the characteristic of the stool?

Like a sausage but with cracks on the surface Rationale Type 3 stools are like a sausage but with cracks on the surface.

While collecting a patient's stool specimen for laboratory examination, a nurse observes the stool specimen and finds it to be oily. What should the nurse anticipate to be the cause of this finding?

Malabsorption syndrome Rationale Malabsorption syndrome may lead to oily stool.

Which enema is used in infants and children?

Normal saline enema Rationale Normal saline enemas are used in infants and children because they are at greater risk for fluid imbalances.

Which medication may cause constipation?

Opioid analgesics Rationale Opioid analgesics slow peristalsis and contractions, thereby causing constipation.

A nurse is caring for four patients. While collecting stool specimens for laboratory examination, the nurse observes the stool colors. Which patient does the nurse suspect to be taking iron supplements?

Patient B - Black stool Rationale Black or tarry stool indicates iron ingestion or gastrointestinal bleeding; therefore, patient B is most likely to be taking iron supplements.

Which are predisposing factors for the development of hemorrhoids?

Pregnancy Cardiac failure Hepatic disorders Rationale The predisposing factors for the development of hemorrhoids are pregnancy, cardiac failure, and hepatic disorder. These conditions increase intraabdominal pressure, leading to engorgement of the blood vessels of the rectum.

A patient is admitted to the hospital with constipation. Which could be a possible reason?

Reduced fluid intake Rationale A reduced fluid intake may make the stool hard and difficult to pass, causing constipation.

A nurse is caring for immobilized patients in a hospital setting. Which action taken by the nurse while positioning patients on a bedpan will help them evacuate bowel contents without discomfort?

Rolling the patient onto the bedpan Rationale When positioning an immobilized patient on a bedpan, the nurse should roll the patient onto the bedpan to ensure the patient's safety.

The nurse is caring for a patient with a colostomy. Which intervention is most important?

Selecting a bag with an appropriate-size stoma opening Rationale The opening of the appliance should be no larger than 0.15 to 0.3 cm (1/16 to 1/8 in) surrounding the stoma to ensure that the skin around the stoma is protected from the enzymes present in the effluent without impinging the stoma.

Which type of enema may cause electrolyte imbalances or damage to the intestinal mucosa in pregnant women and older adults?

Soapsuds enema Rationale Soapsuds enemas may cause electrolyte imbalances or damage to the intestinal mucosa in pregnant women and older adults.

Which laxative used to treat chronic constipation is contraindicated in patients with fluid restrictions?

Sodium phosphate laxative Rationale Sodium phosphate laxative is used to treat chronic constipation; however, it is contraindicated in patients with fluid restrictions.

The nurse is explaining to a patient with gastritis about the various physiological functions of the stomach. Which statements pertain to the functions of the stomach?

Storage of food Secretion of intrinsic factor Production of hydrochloric acid Rationale The functions of the stomach include storage of food and liquids, as well as secretion of intrinsic factor, which is responsible for absorption of vitamin B 12. The stomach also produces hydrochloric acid, which, along with pepsin, helps in protein digestion.

A patient who has malabsorption syndrome asks the nurse about the process of nutrient absorption. What response should the nurse give the patient?

The ileum absorbs fat and bile salts. The jejunum absorbs carbohydrates and proteins. Nutrients are absorbed into the blood vessels. Rationale Fats and bile salts undergo absorption in the ileum, whereas the carbohydrates and proteins undergo absorption in the jejunum. Nutrients that cross the mucosal barrier of the intestine are absorbed into the lymph fluids or blood vessels.

Which should the nursing mentor include in an explanation to nursing students about the various roles of the large intestine?

The large intestine is shorter than the small intestine. The large intestine has a role in the elimination function. The large intestine can develop hemorrhoids. The large intestine is larger in diameter than the small intestine, but it is shorter. It is the primary organ for bowel elimination and fluid absorption. Each fold of the rectal part of the large intestine has blood vessels that become distended from pressure during straining, which results in hemorrhoid formation.

A nurse is caring for a patient with Crohn's disease who has developed chronic severe diarrhea. Which medication does the nurse anticipate will help manage the patient's diarrhea?

Tincture of opium Rationale Tincture of opium is an antidiarrheal drug that is used to manage chronic severe diarrhea in patients with diseases such as Crohn's disease, ulcerative colitis, and acquired immunodeficiency syndrome.

The nurse is caring for a patient admitted with diarrhea. What could be the possible causes of diarrhea in the patient?

Use of antibiotics Food allergies Prolonged stress Rationale Use of antibiotics may cause diarrhea by disrupting the normal flora of the intestine. Food allergies and prolonged stress cause increased peristalsis, resulting in diarrhea.