Med Surg - Chapter 56 - Care of Patients with Noninflammatory Intestinal Disorders

What is a behavioral illness that is known to relate to irritable bowel syndrome (IBS)? 1 Anxiety 2 Schizophrenia 3 Bipolar disorder 4 Attention deficit-hyperactivity disorder (ADHD)

1 Anxiety Considerable evidence relates the relationship of stress and mental or behavioral illness, especially anxiety and depression, to IBS. Many patients diagnosed with IBS meet the criteria for at least one primary mental health disorder. There is no known connection between IBS and bipolar disorder, schizophrenia, or ADHD.

A patient recently diagnosed with irritable bowel syndrome (IBS) asks the nurse what dietary changes will help with IBS. What does the nurse suggest? 1 Consuming 30-40 g of fiber per day 2 Drinking 3-4 cups of fluids each day 3 Increasing consumption of dairy products 4 Consuming no more than one protein serving per day

1 Consuming 30-40 g of fiber per day Dietary changes that are helpful for those with IBS include consuming 30-40 grams of fiber per day. Limiting protein intake is not suggested for those with IBS. Other recommendations include avoiding milk and milk products and drinking 8-10 cups of fluids each day.

A patient who reports unintentional weight loss, dark or bright-colored red stools, and a family history of colorectal cancer is admitted to the hospital. Which information should the nurse obtain from this patient? Select all that apply. 1 Experiencing fatigue 2 History of appendicitis 3 History of gastroenteritis 4 Use of tobacco or alcohol 5 Experiencing abdominal fullness

1 Experiencing fatigue 4 Use of tobacco or alcohol 5 Experiencing abdominal fullness Dark or bright-colored red stools may indicate colorectal cancer (CRC) in some patients. Therefore, the nurse should assess for all the risk factors of CRC in the patients. Fatigue and abdominal fullness indicate the presence of a growth in the abdomen. Tobacco or alcohol use may increase the risk for CRC. Information about appendicitis and gastroenteritis are not important because they may not indicate the risk for colorectal cancers.

A patient has undergone a resection of the ileum. What laboratory findings of the patient indicate malabsorption of proteins? Select all that apply. 1 Low serum iron 2 Low serum calcium 3 Low serum albumin 4 Low serum vitamin A 5 Low serum cholesterol

1 Low serum iron 3 Low serum albumin In protein malabsorption, the serum iron level decreases because of insufficient gastric acid for the use of iron. Serum albumin level is also low. Malabsorption of vitamin D and amino acids causes a low serum calcium level. Low serum vitamin A indicates a bile salt deficiency and malabsorption of fat. Low serum cholesterol occurs in the malabsorption of fats.

What type of nutrition therapy is indicated for patients diagnosed with severe steatorrhea? 1 Low-fat 2 Gluten-free 3 Low-calorie 4 High-protein

1 Low-fat Patients diagnosed with steatorrhea will need a low-fat diet and should avoid high-fat foods. These patients will not have to be on a gluten-free, low-calorie, or high-protein diet.

What is an appropriate intervention for a patient with irritable bowel syndrome (IBS)? 1 Take 30 to 40 g of fiber each day. 2 Chew gum to decrease gastric acid. 3 Drink 8 to 10 glasses of prune juice. 4 Eat a light breakfast and a heavy dinner.

1 Take 30 to 40 g of fiber each day. The patient with IBS is taught to ingest 30 to 40 g of fiber each day to help regulate elimination patterns. The patient is taught to drink 8 to 10 glasses of water, not prune juice. Chewing gum is not advised as it can produce more gastric acid. The patient is taught to eat regular meals, not light and then heavy ones.

A patient with irritable bowel syndrome (IBS) has been prescribed a tricyclic antidepressant. What does the nurse teach this patient about taking this drug? 1 "Take the medication at nighttime to prevent daytime sleepiness." 2 "If pain usually occurs after eating, take the drug 30-45 minutes before meals." 3 "This medication will be useful for preventing diarrheal symptoms of IBS." 4 "Use the medication as needed for depressive symptoms associated with IBS."

2 "If pain usually occurs after eating, take the drug 30-45 minutes before meals." Tricyclic antidepressants are given to control pain associated with IBS. If pain occurs after meals, patients should be advised to take the drug 30-45 minutes before meals. In this case, it is not given at bedtime. Tricyclic antidepressants do not affect diarrheal symptoms. This drug is given to control pain, not depression.

Aside from chemotherapeutic agents, what other medications does the nurse expect to administer to a patient with advanced colorectal cancer for relief of symptoms? 1 Steroids and analgesics 2 Analgesics and antiemetics 3 Analgesics and benzodiazepines 4 Steroids and anti-inflammatory medications

2 Analgesics and antiemetics Patients with advanced colorectal cancer and metastasis also receive drugs such as analgesics and antiemetics for relief of symptoms, specifically pain and nausea. Benzodiazepines, steroids, and anti-inflammatory medications are not routinely requested for these patients.

Which factors cause malabsorption syndrome? Select all that apply. 1 Chronic diarrhea 2 Bile salt deficiencies 3 Presence of bacteria 4 Elevated enzyme values 5 Increase in gastric surface area

2 Bile salt deficiencies 3 Presence of bacteria Bile salt deficiencies and the presence of bacteria are two factors that can cause malabsorption syndrome. Chronic diarrhea is a classic symptom of malabsorption, but does not cause it. A decrease, not an increase, in gastric surface area can cause malabsorption syndrome. Enzyme deficiencies, not elevated enzymes, can cause malabsorption syndrome.

What laboratory test is indicated for a patient who is being evaluated for malabsorption disorders? 1 The Schilling test 2 Fecal fat analysis 3 Bile acid breath test 4 Lactose tolerance test

2 Fecal fat analysis Fecal fat analysis is done to diagnose malabsorption disorders. The Schilling test, lactose tolerance test, and bile acid breath test are not indicated for this diagnosis. The Schilling test is used in the diagnosis of pernicious anemia. A bile acid breath test assesses the absorption of bile salt. A lactose tolerance test is used to analyze whether or not someone has trouble digesting foods and beverages that contain lactose.

A patient is diagnosed with constipation-predominant irritable bowel syndrome. What medication does the nurse anticipate will be prescribed by the primary health care provider? 1 Rifaximin 2 Linaclotide 3 Loperamide 4 Amitriptyline

2 Linaclotide Linaclotide is selectively prescribed in cases of constipation-predominant irritable bowel syndrome. It works by stimulating receptors in the intestine to increase fluid and promote bowel transit time. Rifaximin works effectively in patients with irritable bowel syndrome having bloating abdominal distention without constipation. Diarrhea-predominate irritable bowel syndrome may be treated with loperamide. Amitriptyline is prescribed for irritable bowel syndrome when pain is the predominant symptom.

Which is a key feature of large-bowel obstruction? 1 Metabolic alkalosis 2 Minimal or no vomiting 3 Upper abdominal distention 4 Nausea and profuse vomiting

2 Minimal or no vomiting A key feature of large-bowel obstruction is minimal or no vomiting. Nausea and profuse vomiting, metabolic alkalosis, and upper abdominal distention are key features of small-bowel obstruction.

A patient underwent a colostomy formation and was discharged from the hospital. Which complications should the patient be aware of and immediately report to the primary health care provider? Select all that apply. 1 Leakage 2 Unusual bleeding 3 Edematous stoma 4 Mucocutaneous separation 5 Reddish pink and moist stoma

2 Unusual bleeding 4 Mucocutaneous separation Unusual bleeding from the stoma may be a complication of the surgical procedure. Mucocutaneous separation may be the breakdown of the suture line from the abdominal wall. These complications are considered an emergency and should be reported immediately to the primary health care provider. Signs of leakage may indicate a fitting problem of the pouching system and can be managed by the wound and ostomy nurse. During the initial postoperative period, the stoma may be slightly edematous. A healthy stoma should be reddish pink, moist, and protrude 2 cm from the abdominal wall.

A patient with malabsorption syndrome asks the nurse, "What did I do to cause this disorder to develop?" How does the nurse respond? 1 "It is inherited, so it could run in your family." 2 "It might be caused by a virus, so you could have gotten it almost anywhere." 3 "Nothing you did could have caused it; it is the result of flattening of the mucosa of your small intestine." 4 "An excessive intake of alcohol is associated with it, so your substance abuse could have contributed to its development."

3 "Nothing you did could have caused it; it is the result of flattening of the mucosa of your small intestine." Stating that the disorder is the result of flattening of the mucosa of the small intestine is the only statement that is physiologically accurate. Malabsorption syndrome is not associated with an excessive intake of alcohol. It is not inherited, although a genetic immune defect is present in the related disease, celiac sprue. It is not caused by a virus.

Which statement made by the student nurse indicates effective learning about polyps? 1 "Polyps are formed due to injuries to the internal organs." 2 "Polyps are formed due to weakness in the abdominal wall." 3 "Polyps are formed in the intestinal tracts as small growths." 4 "Polyps are formed due to inadequate healing of a surgical incision."

3 "Polyps are formed in the intestinal tracts as small growths." Polyps are formed in intestinal tracts as small growths covered with mucosa and attached to the surface of the intestine. Abdominal trauma is formed due to injuries to the internal organs. Hernias are formed due to a weakness in the abdominal wall. Incisional, or ventral, hernias are formed due to inadequate healing of a surgical incision.

The nurse is explaining postoperative care to a patient scheduled for a hemorrhoidectomy. What teaching does the nurse include? 1 "Urinary incontinence can be a complication." 2 "A high-fiber diet should be restricted for a few weeks." 3 "Sitz baths should be given three to four times each day." 4 "Stimulant laxatives should be taken to promote bowel movements."

3 "Sitz baths should be given three to four times each day." After a hemorrhoidectomy, sitz baths or other forms of moist heat are given three to four times a day to promote comfort. Rectal spasms and anorectal tenderness following the surgery may cause urinary retention rather than urinary incontinence. The patient is encouraged to consume a high-fiber diet, as it helps to promote regular bowel movements after the surgery. Stimulant laxatives can be habit forming, so the patient is advised to avoid them.

A 50-year-old patient comes to an outpatient clinic for a colonoscopy and asks how often the procedure needs to be performed. What does the nurse tell the patient? 1 Every 3 years 2 Every 5 years 3 Every 10 years 4 Every 15 years

3 Every 10 years The screening recommendation for those over the age of 50 is every 10 years for a colonoscopy or every 5 years for a double-contrast barium enema or sigmoidoscopy.

A patient's stool sample showed microscopic amounts of blood content. After assessing the patient's history, the nurse concludes that the patient may have tumors in the colon. Which finding in the patient's history enabled the nurse to reach this conclusion? 1 Anemia 2 Appendicitis 3 Abdominal pain 4 Endometrial cancer

4 Endometrial cancer A history of endometrial cancer would make the nurse suspect there may be tumors in the colon because the endometrial cancer may spread to the colon. Anemia may not confirm colorectal cancer. Appendicitis may not be a reason for colorectal cancer. Abdominal pain can happen due to many disease processes, not just cancerous tumors in the colon.

Which patients have the highest risk for diagnosis of an umbilical hernia? Select all that apply. 1 Young men 2 Older adults 3 Obese patients 4 Newborn babies 5 Pregnant women

3 Obese patients 4 Newborn babies 5 Pregnant women Newborn babies have an increased risk of having congenital umbilical hernias. Pregnant women and obese patients have an increased risk of developing umbilical hernias. Young men and older adults are not at increased risk of development of umbilical hernia.

Which statement is true regarding polyps? 1 Polyps are malignant. 2 Polyps are symptomatic. 3 Polyps may be hereditary. 4 Tubular adenomas pose a greater cancer risk than villous adenomas.

3 Polyps may be hereditary. Polyps may be genetically inherited and characterized by progressive development of colorectal adenomas. Most polyps are benign, although some have the potential to become malignant. Polyps are usually asymptomatic and are discovered during a routine colonoscopy screening. There are two types of adenomas, villous and tubular. Villous adenomas pose a greater cancer risk.

A patient is in the first postoperative day after a partial colectomy with colostomy. The nurse notes that the stoma is reddish-pink and moist with edema and a small amount of bleeding. Which nursing action is correct? 1 Report these findings to the surgeon immediately. 2 Apply an absorbent pressure dressing to the stoma. 3 Recognize these as normal, early postoperative findings. 4 Turn the patient to the unaffected side to prevent bleeding.

3 Recognize these as normal, early postoperative findings The stoma initially appears reddish-pink and may be edematous with a small amount of bleeding. This is normal and does not warrant action on the part of the nurse. It is not necessary to apply a pressure dressing, turn the patient to the unaffected side, or to report the findings to the surgeon.

Which factor increases the risk for hernia? 1 Bradycardia 2 Underweight 3 Pink-colored wounds 4 Abdominal distension

4 Abdominal distension Hernia is a weakness in the abdominal wall. Abdominal distension is one of the causes of hernia. It occurs when substances such as gas or fluid accumulate in the abdomen, causing outward expansion beyond the normal girth of the stomach and waist. Tachycardia and obesity may increase the risk for hernia. Post-operative incisions or wounds that appear pink are healthy and are not likely to increase the risk for hernia.

The nurse is caring for a patient diagnosed with malabsorption syndrome and macrocytic anemia. What lab value is consistent with this diagnosis? 1 Increased folic acid 2 Increased vitamin B 12 3 Increased serum iron 4 Increased mean corpuscular volume space (MCV)

4 Increased mean corpuscular volume space (MCV) Increased mean corpuscular volume space (MCV) is found in macrocytic anemia. Macrocytic anemia does not have increased folic acid, vitamin B 12 levels, or serum iron.

A patient has a nasogastric (NG) tube for decompression after a small bowel obstruction. What position should a patient be encouraged to use? 1 Supine 2 Side-lying 3 High-Fowler's 4 Semi-Fowler's

4 Semi-Fowler's Semi-Fowler's position will help promote emptying of the stomach and alleviation of pressure of the abdominal distention on the chest. Supine, side-lying, and high-Fowler's positions are not indicated.

The nurse is caring for a patient who is to be discharged after a bowel resection and the creation of a colostomy. Which patient statement demonstrates that additional instruction from the nurse is needed? 1 "I can drive my car in about 2 weeks." 2 "I should avoid drinking carbonated sodas." 3 "Stool softeners will help me avoid straining." 4 "It may take 6 weeks to see the effects of some foods on my bowel patterns."

1 "I can drive my car in about 2 weeks." The patient who has had a bowel resection and colostomy should avoid driving for 4 to 6 weeks. The patient should avoid drinking sodas and other carbonated drinks because of the gas they produce. He or she may not be able to see the effects of certain foods on bowel patterns for several weeks. The patient should avoid straining at stool.

Which kind of hernia is common in infants? 1 Direct 2 Ventral 3 Femoral 4 Umbilical

4 Umbilical An umbilical hernia can be acquired or congenital and is seen in infants. A direct hernia is the intestine passing through a weak point in the abdominal wall. Ventral hernia is seen in people who have undergone a surgical procedure. A femoral hernia is a protrusion of the bowel through the femoral ring and is unusual in infants.

Which patient does the medical-surgical unit charge nurse assign to an LPN/LVN? 1 41-year-old who needs assistance with choosing a site for a colostomy stoma 2 47-year-old who needs to receive "whole gut" lavage before a colon resection 3 56-year-old who has obstipation and a recent emesis of foul-smelling liquid 4 51-year-old who has recently arrived on the unit after having an open herniorrhaphy

2 47-year-old who needs to receive "whole gut" lavage before a colon resection Because administration of medications is within the LPN/LVN scope of practice, this preoperative patient can be assigned to the LPN/LVN. Assistance with choosing a site for a colostomy stoma is an intervention that should be provided by an RN. The recent postoperative patient and the critically ill patient will need assessments and interventions that can only be done by an RN.

Which of the following is a common sign of malabsorption syndrome? 1 Melena 2 Steatorrhea 3 Constipation 4 Hematochezia

2 Steatorrhea Chronic diarrhea is a classic symptom of malabsorption and steatorrhea is common because of greater than normal amounts of fat in the stool. Constipation, bloody stools, and black, tarry stools are not associated with malabsorption syndrome.

A 67-year-old male patient reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have? 1 Ventral 2 Femoral 3 Reducible 4 Strangulated

3 Reducible The hernia is reducible because its contents can be pushed back into the abdominal cavity. Femoral hernias tend to occur more frequently in obese and pregnant women. A hernia is considered to be strangulated when the blood supply to the herniated segment of the bowel is cut off. It cannot be a ventral hernia because it would have to occur at the site of a previous surgical incision.

Which describes internal hemorrhoids? 1 They are noticeable to the eye. 2 They lie below the anal sphincter. 3 They cannot be seen upon inspection. 4 They fall down and protrude through the anus.

3 They cannot be seen upon inspection. Internal hemorrhoids are located inside the body and cannot be seen upon inspection of the anal area. Prolapsed hemorrhoids fall down and protrude through the anus. External hemorrhoids are noticeable to the eye and lie below the anal sphincter.

The nurse case manager is discussing community resources with a patient who has colorectal cancer (CRC) and is scheduled for a colostomy. Which referral is of greatest value to this patient initially? 1 Hospice 2 Hospital chaplain 3 Home health nursing agency 4 Certified Wound, Ostomy, and Continence Nurse (CWOCN)

4 Certified Wound, Ostomy, and Continence Nurse (CWOCN) A CWOCN (or an enterostomal therapist) will be of greatest value to the patient because the patient is scheduled to receive a colostomy. The patient is newly diagnosed, so it is not yet known whether home health nursing will be needed. A referral to hospice may be helpful for a terminally ill patient. Referral to a chaplain may be helpful later in the process of adjusting to the disease.

Which is a functioning stoma? 1 End stoma 2 Loop stoma 3 Distal stoma 4 Proximal stoma

4 Proximal stoma The proximal stoma is a functioning stoma and eliminates stool. It is closest to the patient's head. An end stoma is constructed by severing the end of the proximal portion of the bowel and bringing it out through the abdominal wall. A loop stoma is made by bringing a loop of the colon to the skin surface, severing and everting the anterior wall, and suturing it to the abdominal wall. The distal stoma is nonfunctioning, although it may secrete mucus, and sometimes it is referred to as a mucous fistula.

What may be a cause of colon polyps? 1 Pregnancy 2 Tachycardia 3 Sports injury 4 Rectal bleeding

4 Rectal bleeding Polyps are small growths in the intestinal tract covered with mucosa. Rectal bleeding due to hemorrhoids may increase the risk of colon polyps. Pregnancy and tachycardia are the signs of hernia. A sports injury is one of the common causes of abdominal trauma.

A patient is being evaluated in the emergency department (ED) for a possible small-bowel obstruction. Which signs and/or symptoms does the nurse expect to assess? 1 Cramping intermittently, metabolic acidosis, and minimal vomiting 2 Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis 3 Metabolic acidosis, upper abdominal distention, and intermittent cramping 4 Upper abdominal distention, metabolic alkalosis, and great amount of vomiting

4 Upper abdominal distention, metabolic alkalosis, and great amount of vomiting A small-bowel obstruction is characterized by upper abdominal distention, metabolic alkalosis, and a great amount of vomiting. Intermittent lower abdominal cramping, obstipation, metabolic acidosis, and minimal vomiting are all symptoms of a large-bowel obstruction.

The advanced practice nurse is examining a patient for the presence of an inguinal hernia. In what order does the nurse perform the assessment? 1. Ask the patient to stand up for examination of the groin. 2. Observe for any bulging while the patient performs the Valsalva maneuver. 3. Gently insert a finger in the inguinal ring and ask the patient to cough. 4. Auscultate for the presence of active bowel sounds. 5. Ask the patient to lie down for inspection of the abdomen.

5, 1, 2, 4, 3 When examining a patient for a hernia, the abdominal assessment is first done while the patient is lying down and then again while the patient is standing up. First, the abdomen is inspected while the patient is lying down. On inspection, it may be seen that a reducible hernia disappears in this position. The patient is then asked to strain or perform the Valsalva maneuver and the abdomen is observed for any bulging. After that, the abdomen is auscultated for active bowel sounds. Absence of bowel sounds is a medical emergency indicating obstruction and strangulation. A finger is then gently inserted in the inguinal ring to examine the ring and its contents, and any changes that are felt when the patient coughs are then noted.

The nurse is caring for a 56-year-old patient who has no familial adenomatous polyposis (FAP) or other risk factors related to colorectal cancer. When the nurse teaches the patient about cancer screenings, what does the nurse advise? 1 "It is recommended you get a colonoscopy every 10 years." 2 "You should get a fecal occult blood test performed every 2 years." 3 "Your provider will want you to do a sigmoidoscopy annually." 4 "You should screen for this cancer by doing a double-contrast barium enema every 10 years."

1 "It is recommended you get a colonoscopy every 10 years." Men and women over 50 should follow screening recommendations for early detection of colorectal cancer. This includes getting a colonoscopy every 10 years. A sigmoidoscopy should be done every 5 years, not annually. A fecal occult blood test should be done annually, not every 2 years. A double-contrast barium enema should be done every 5 years, not every 10 years.

What are risk factors for colorectal cancer? Select all that apply. 1 Age >50 years 2 Diet high in caffeine 3 Family history of cancer 4 History of Crohn's disease 5 Heavy alcohol consumption

1 Age >50 years 3 Family history of cancer 4 History of Crohn's disease 5 Heavy alcohol consumption The major risk factors for developing colorectal cancer include being older than 50 years, having a personal or family history of cancer, having a history of Crohn's disease, and heavy alcohol consumption. A diet high in caffeine is not connected to colorectal cancer.

The nurse is planning care for a male patient who has undergone a hernia repair. The patient reports difficulty voiding. What does the nurse instruct the patient to do? 1 Allow water to run when attempting to void. 2 Drink at least 500 to 1000 mL of fluids daily. 3 Report a urine output of less than 60 mL/hour. 4 Sit in a squatting position to stimulate voiding.

1 Allow water to run when attempting to void. The patient should be advised to allow water to run when attempting to void, as such techniques tend to stimulate voiding. Male patients should be encouraged to stand, which allows a more natural position and allows gravity to facilitate voiding and bladder emptying. The patient should report to the surgeon if urine output is less than 30 mL per hour. For proper hydration and maintenance of urinary function, the patient should have a fluid intake of at least 1500 to 2500 mL per day.

What signs are consistent with strangulation of a hernia? Select all that apply. 1 Fever 2 Nausea 3 Bradycardia 4 Hypertension 5 Abdominal distention

1 Fever 2 Nausea 5 Abdominal distention Fever, nausea, and abdominal distention are found in patients with strangulated hernias. Tachycardia, not bradycardia, is found in these patients. Hypertension does not indicate strangulation of a hernia.

The primary health care provider prescribes bevacizumab for a patient who underwent surgical resection for colorectal cancer. Which is an expected outcome of this medication? 1 Block growth factors that promote cancer cell growth 2 Interrupt the DNA production of cells and destroy them 3 Control pain, hemorrhage, bowel obstruction, or metastasis to the lung 4 Reduce blood flow to the growing tumor cells, thereby depriving the nutrients for growth

4 Reduce blood flow to the growing tumor cells, thereby depriving the nutrients for growth Bevacizumab is an antiangiogenesis drug, and it is also known as a vascular endothelial growth factor inhibitor. This drug reduces blood flow to the growing tumor cells, thereby depriving them of the necessary nutrients needed for growth of cancer cells. Cetuximab, also known as epidermal growth factor receptor antagonist, is a monoclonal antibody that blocks growth factors that promote cancer cell growth. Intravenous 5-fluorouracil with leucovorin is a chemotherapeutic drug, which interrupts DNA production of cells and destroys them. Radiation therapy controls pain, hemorrhage, bowel obstruction, or metastasis to the lung in the advanced stages of the disease.

After assessing a patient who presents with abdominal pain, the nurse suspects colon cancer. Which statements by the patient may support the nurse's suspicion? Select all that apply. 1 "I have cramping gas pains." 2 "I have normal colored stools." 3 "I have increased activity levels." 4 "I have difficulty in passing stools." 5 "I have incomplete bowel movements."

1 "I have cramping gas pains." 4 "I have difficulty in passing stools." 5 "I have incomplete bowel movements." Tumors in the transverse colon and descending colon result in symptoms of gas pain, cramping, and obstruction as growth of the tumor blocks the passage of stool. As a result, the patient may experience incomplete bowel movements and difficulty in passing stools. Usually dark colored or bright red color stools are found in patients with tumors. Activity levels of the patients may be decreased due to gastrointestinal disturbances.

The nurse is teaching a patient about perineal wound care. Which patient statement indicates a need for further teaching? 1 "I should avoid sitz baths." 2 "I should use foam pads to sit." 3 "I should avoid sitting for long periods." 4 "I should sleep in a side-lying position in bed."

1 "I should avoid sitz baths." When teaching a patient about perineal wound care, it is advisable to soak the wound area in a sitz bath for 10 to 20 minutes, three to four times a day. The other statements indicate adequate understanding. The patient can use foam pads or soft pillows to sit. The patient should avoid sitting for long periods. Sleeping in a side-lying position reduces pressure on the perineal area, promoting comfort.

Which are the most common types of abdominal hernias? Select all that apply. 1 Femoral hernia 2 Umbilical hernia 3 Reducible hernia 4 Direct inguinal hernia 5 Spermatic cord hernia 6 Indirect inguinal hernia

1 Femoral hernia 2 Umbilical hernia 4 Direct inguinal hernia 6 Indirect inguinal hernia The most common types of hernias include indirect inguinal, direct inguinal, umbilical, and femoral hernias, as well as incisional hernias. Spermatic cord is not a type of hernia. A hernia is classified as reducible when the contents of the hernia sac can be placed back into the abdominal cavity with gentle pressure.

The nurse is assigned to care for a patient with a small bowel obstruction. What clinical manifestations would the nurse expect to find during the admission assessment? Select all that apply. 1 Nausea 2 Vomiting 3 Ribbon-like stools 4 Metabolic acidosis 5 Electrolyte imbalances

1 Nausea 2 Vomiting 5 Electrolyte imbalances In patients with small bowel obstruction, the nurse would expect to find nausea and vomiting due to increased pressure in the intestines. Electrolyte imbalances occur due to fluid shifts and vomiting. Ribbon-like stools and metabolic acidosis are more typical of large bowel obstructions.

What patient population is more susceptible to direct inguinal hernias? 1 Older adults 2 Obese patients 3 Newborn babies 4 Pregnant women

1 Older adults Direct inguinal hernias are more frequent in older adults. Femoral or umbilical hernias are more common in obese people and pregnant women. Indirect hernias are more frequently found in babies.

Small growths that are covered with mucosa and are attached to the surface of the intestine are known as what? 1 Polyps 2 Hernias 3 Volvulus 4 Adenocarcinomas

1 Polyps Polyps are small growths that are covered with mucosa and are attached to the surface of the intestine. Most of them are benign, but some can potentially become malignant. Hernias are weaknesses in the abdominal muscle wall through which a segment of the bowel protrudes. Volvulus is the twisting of the intestines. Adenocarcinomas are tumors that arise from the glandular epithelial tissue of the colon.

A patient with colorectal cancer (CRC) is scheduled for colostomy surgery. Which comment from the nurse is most therapeutic for this patient? 1 "Why are you so afraid of having this procedure done?" 2 "Tell me what worries you the most about this procedure." 3 "Don't worry. You will get used to the colostomy eventually." 4 "Are you afraid of what your spouse will think of the colostomy?"

2 "Tell me what worries you the most about this procedure." Asking the patient about what worries him or her is the only response that allows the patient to express fears and anxieties about the diagnosis and treatment. Asking the patient if he or she is afraid is a closed question (i.e., it requires only a "yes" or "no" answer); it closes the dialogue and is not therapeutic. Telling the patient not to worry offers reassurance and is a "pat" statement, making it nontherapeutic. "Why" questions place patients on the defensive and are not therapeutic because they close the conversation.

While assessing a patient with colorectal cancer, the primary health care provider finds some masses when palpating the abdomen. Which assessment test would be used to confirm if there are masses in the abdomen? 1 Colonoscopy 2 Sigmoidoscopy 3 Magnetic resonance imaging 4 A double contrast barium enema

3 Magnetic resonance imaging Magnetic resonance imaging of the chest, abdomen, pelvis, lungs, or liver helps confirm the existence of masses, the extent of disease, and the location of distant metastases. A colonoscopy helps in detection of colon polyps, tumors, inflammation, and bleeding in the rectum and colon. A sigmoidoscopy provides visualization of the lower colon. A double contrast barium enema test may be used to detect polyps in the colon.

A patient with colorectal cancer (CRC) was started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. A relatively new chemotherapeutic agent, oxaliplatin, has been added to the treatment regimen. What does the nurse tell the patient about the diarrhea and mouth ulcers? 1 "You have these as a result of the radiation treatment." 2 "A combination of chemotherapeutic agents has caused them." 3 "GI problems are symptoms of the advanced stage of your disease." 4 "5-FU cannot discriminate between your cancer and your healthy cells."

4 "5-FU cannot discriminate between your cancer and your healthy cells." 5-FU cannot discriminate between cancer and healthy cells; therefore, the side effects are diarrhea, mucositis, leukopenia, mouth ulcers, and skin ulcers. The 5-FU treatment, not a combination of chemotherapy drugs, radiation, or the stage of the disease, is what is causing the patient's GI problems.

Which statement is most accurate about colorectal cancer (CRC)? 1 Gross blood is common in CRC of the right side of the colon. 2 Hematochezia is common in CRC involving the transverse colon. 3 "Gas pains" and cramping are common in CRC of the rectosigmoid colon. 4 A palpable mass in the lower right quadrant is common in CRC of the ascending colon.

4 A palpable mass in the lower right quadrant is common in CRC of the ascending colon. Tumors of the ascending colon or the right side of the colon can grow quite large without causing a change in bowel patterns. This can be palpated as a mass in the lower right quadrant. Gross blood is not common when this part of the colon is affected; rather, it is common with tumors of the left side of the colon and rectum. A tumor of the transverse colon blocks the passage of stool and causes symptoms of "gas pains" or cramping. Hematochezia, or passage of red blood via the rectum, is seen in rectosigmoid CRC.

Which statement about irritable bowel syndrome (IBS) is most accurate? 1 In Asia, women are twice as likely to have IBS than men. 2 Pain is most common in the left upper quadrant of the abdomen. 3 Patients with IBS have a decreased amount of hydrogen during exhalation. 4 IBS is associated with both primary and secondary mental health disorders.

4 IBS is associated with both primary and secondary mental health disorders. Psychosocial problems such as stress may be a cause of IBS. Pain and chronic symptoms can also lead to secondary psychosocial problems such as depression. Thus, IBS is associated with both primary and secondary mental health disorders. Pain is most common in the left lower quadrant of the abdomen. In Asia, there does not seem to be any gender predominance, but in the United States, women are twice as likely to have IBS than men. Patients with IBS have an increased amount of hydrogen while exhaling, which may be due to small-intestinal bacterial overgrowth or malabsorption of nutrients.

A patient presents to the emergency department with pain in the left lower quadrant of the abdomen. The patient reports nausea after eating, diarrhea, and abdominal bloating. What diagnosis does the nurse suspect? 1 Hemorrhoids 2 Umbilical hernia 3 Intestinal obstruction 4 Irritable bowel syndrome (IBS)

4 Irritable bowel syndrome (IBS) Patients with pain in the left lower abdominal quadrant, nausea after eating, diarrhea, and bloating have symptoms that are consistent with irritable bowel syndrome (IBS). The symptoms are not consistent with hemorrhoids, umbilical hernia, or intestinal obstruction.

A patient diagnosed with irritable bowel syndrome (IBS) is discharged home with a variety of medications for IBS symptoms. Upon returning to the clinic, the patient states, "Most of my symptoms have improved, except for the diarrhea." What does the nurse anticipate will be prescribed for this patient? 1 Antidiarrheal agent 2 Serotonin antagonist 3 Tricyclic antidepressant 4 Muscarinic receptor agonist

4 Muscarinic receptor agonist A muscarinic (M 3)-receptor antagonist can also inhibit intestinal motility. Antidiarrheal agents and serotonin antagonists are not the most effective choices for this patient. A tricyclic antidepressant is not going to be effective for this patient's diarrhea.