N123 PrepU Ch. 47: Management of Patients With Intestinal and Rectal Disorders - ML6

14. A nurse is teaching an older adult client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required? "I need to drink 2 to 3 liters of fluids every day." "I need to use laxatives regularly to prevent constipation." "I should exercise four times per week." "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." Explanation: The client requires more teaching if he states that he'll use laxatives regularly to prevent constipation. The nurse should teach this client to gradually eliminate the use of laxatives because using laxatives to promote regular bowel movements may have the opposite effect. A high-fiber diet, ample amounts of fluids, and regular exercise promote good bowel health

4. Medical management of a patient with peritonitis includes fluid, electrolyte, and colloid replacement. The nurse knows to prepare the initial, most appropriate intravenous solution. Which of the following is the correct solution? 0.45% of NS 0.9% NS D10W D5W

0.9% NS Explanation: 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.

18. Which of the following is considered a bulk-forming laxative? Milk of Magnesia Metamucil Dulcolax Mineral oil

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

11. After teaching a group of students about intestinal obstruction, the instructor determines that the teaching was effective when the students identify which of the following as a cause of a functional obstruction? Tumor Abdominal surgery Intussusception Volvulus

Abdominal surgery Explanation: In functional obstruction, the intestine can become adynamic from an absence of normal nerve stimulation to intestinal muscle fibers. For example, abdominal surgery can lead to paralytic ileus. Mechanical obstructions result from a narrowing of the bowel lumen with or without a space-occupying mass. A mass may include a tumor, adhesions (fibrous bands that constrict tissue), incarcerated or strangulated hernias, volvulus (kinking of a portion of intestine), intussusception (telescoping of one part of the intestine into an adjacent part), or impacted feces or barium.

8. A client is diagnosed with colon cancer, located in the lower third of the rectum. What does the nurse understand will be the surgical treatment option for this client? Abdominoperineal resection Colectomy Segmental resection A low colectomy

Abdominoperineal resection Explanation: A cancerous mass in the lower third of the rectum will result in an abdominoperineal resection with a wide excision of the rectum and the creation of a sigmoid colostomy. An encapsulated colorectal tumor may be removed without taking away surrounding healthy tissue. This type of tumor, however, may call for partial or complete surgical removal of the colon (colectomy). Occasionally, the tumor causes a partial or complete bowel obstruction. If the tumor is in the colon and upper third of the rectum, a segmental resection is performed. In this procedure, the surgeon removes the cancerous portion of the colon and rejoins the remaining portions of the GI tract to restore normal intestinal continuity.

20. A client reports constipation. Which nursing measure would be most effective in helping the client reduce constipation? Provide adequate quantity of food. Obtain medical and allergy history. Obtain complete food history. Assist client to increase dietary fiber.

Assist client to increase dietary fiber. Explanation: The nurse should assist the client to increase the dietary fiber in food because it helps reduce constipation. Providing an adequate quantity of food is necessary in maintaining sufficient nutrition and in sustaining normal body weight. Obtaining medical, allergy, and food history would provide valuable information, however, it would not help reduce constipation.

20. Which drug is considered a stimulant laxative? Magnesium hydroxide Psyllium hydrophilic mucilloid Bisacodyl Mineral oil

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

12. 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? Borborygmus Tenesmus Peristalsis Loud bowel sounds

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

19. In women, which of the following types of cancer exceeds colorectal cancer? Skin Lung Liver Breast

Breast Explanation: 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.

4. A client informs the nurse of having abdominal pain that is relieved when having a bowel movement. The health care provider diagnosed the client with irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder? Client is awakened from sleep due to abdominal pain. Blood and mucus in the stool Weight loss due to malabsorption Chronic constipation with sporadic bouts of diarrhea SUBMIT ANSWER

Chronic constipation with sporadic bouts of diarrhea Explanation: Most clients with irritable bowel syndrome (IBS) describe having chronic constipation with sporadic bouts of diarrhea. Some report the opposite pattern, although less commonly. Most clients experience various degrees of abdominal pain that defecation may relieve. Weight usually remains stable, indicating that when diarrhea occurs, malabsorption of nutrients does not accompany it. Stools may have mucus, but blood is not usually found because the bowel is not locally inflamed. The sleep is not disturbed from abdominal pain.

15. A client presents with an infection in the area between the internal and external sphincters. In which chronic disease is this condition commonly seen? ulcerative colitis irritable bowel syndrome Crohn's disease diverticulosis

Crohn's disease Explanation: An anorectal abscess is common in clients with Crohn's disease.

20. The nurse is caring for a patient who has malabsorption syndrome with an undetermined cause. What procedure will the nurse assist with that is the best diagnostic test for this illness? Endoscopy with mucosal biopsy Pancreatic function tests Ultrasound Stool specimen for ova and parasites

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

7. A client with a diagnosis of acute appendicitis is awaiting surgical intervention. The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and board-like. What complication does the nurse determine may be occurring at this time? Peritonitis Paralytic ileus Accumulation of gas Constipation

Peritonitis Explanation: Lack of bowel motility typically accompanies peritonitis. The abdomen feels rigid and board-like as it distends with gas and intestinal contents. Bowel sounds typically are absent. The diagnosis of acute appendicitis correlates with the symptoms of rupture of the appendix and peritonitis. A paralytic ileus and gas alone do not produce these symptoms.

14. It is important for the nurse to monitor serum electrolytes in a patient with acute diarrhea. Select the electrolyte result that should be immediately reported. Calcium of 9 mg/dL Chloride of 100 mEq/L Sodium of 136 mEq/L Potassium of 2.8 mEq/L

Potassium of 2.8 mEq/L Explanation: The normal serum potassium level is 3.5 to 5 mEq/L. Hypokalemia can be severe if less than 2.5 mEq/L. A potassium result of 2.8 should be reported because it is significantly lower than normal. The other choices are normal levels.

3. 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? Administer morphine (Duramorph PF) routinely, as ordered. Test all stools for occult blood. Prepare the client for a gastrostomy tube placement. Administer topical ointment to the rectal area to decrease bleeding.

Test all stools for occult blood. Explanation: Blood in the stools is one of the warning signs of colorectal cancer. The nurse should plan on checking all stools for both frank and occult blood. The blood in the stool is coming from the colon or rectum; administering an ointment wouldn't help decrease the bleeding. Preparing a client for a gastrostomy tube isn't appropriate when diagnosing colorectal cancer. Colorectal cancer is usually painless; administering opioid pain medication isn't needed

11. Which is a true statement regarding regional enteritis (Crohn's disease)? It has a progressive disease pattern. The clusters of ulcers take on a cobblestone appearance. It is characterized by pain in the lower left abdominal quadrant. The lesions are in continuous contact with one another.

The clusters of ulcers take on a cobblestone appearance. Explanation: 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.

14. The presence of mucus and pus in the stools suggests which condition? Small-bowel disease Disorders of the colon Intestinal malabsorption Ulcerative colitis

Ulcerative colitis Explanation: The presence of mucus and pus in the stools 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.

18. The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation? Usual pattern of elimination Current medications Alcohol consumption Activity levels

Usual pattern of elimination Explanation: Constipation has many possible causes and assessing the client's usual pattern of elimination is the first step in identifying the cause. The nurse should obtain a description of the bowel elimination pattern, asking about the frequency, overall appearance and consistency of stool, blood in the stool, pain, and effort necessary to pass stool. It is also essential for the nurse to review the client's current medications, diet, and activity levels.

18. A longitudinal tear or ulceration in the lining of the anal canal is termed a(n): hemorrhoid. anal fissure. anal fistula. anorectal abscess.

anal fissure. Explanation: Fissures are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety (leading to constipation). An anorectal abscess is an infection in the pararectal spaces. An anal fistula is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus. A hemorrhoid is a dilated portion of vein in the anal canal.

17. 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 solid food increased fiber lack of exercise lack of free water intake

lack of free water intake Explanation: A client who cannot swallow food cannot drink enough water to meet daily needs. Inadequate fluid intake is a common cause of constipation.

16. A client with enteritis reports frequent diarrhea. What assessment should the nurse should anticipate? respiratory alkalosis respiratory acidosis metabolic alkalosis metabolic acidosis

metabolic acidosis Explanation: Diarrhea causes a bicarbonate deficit. With loss of the relative alkalinity of the lower GI tract, the relative acidity of the upper GI tract predominates, leading to metabolic acidosis. Loss of acid, which occurs with severe vomiting, may lead to metabolic alkalosis. Diarrhea doesn't lead to respiratory acid-base imbalances, such as respiratory acidosis and respiratory alkalosis.

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5. A typical sign/symptom of appendicitis is: nausea. left lower quadrant pain. high fever. pain when pressure is applied to the right upper quadrant.

nausea. Explanation: 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.

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

stool consistency and client comfort Explanation: Normal bowel patterns range from three bowel movements per day to three bowel movements per week. In differentiating normal from abnormal, the consistency of stools and the comfort with which a person passes them are more reliable indicators than is the frequency of bowel elimination.

20. The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition? Borborygmus Tenesmus Azotorrhea Diverticulitis

Borborygmus Explanation: 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.

19. 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? Appendicitis Diverticulitis Bowel perforation Rectal fissures

Bowel perforation Explanation: 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.

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

Broiled chicken with low-fiber pasta Explanation: 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.

19. The nurse is irrigating a client's colostomy when the client begins to report cramping. What is the appropriate action by the nurse? Increase the rate of administration. Clamp the tubing and allow client to rest. Discontinue the irrigation immediately. Change irrigation fluid to normal saline.

Clamp the tubing and allow client to rest. Explanation: The nurse should clamp the tubing and allow the client to rest when the client begins to report cramping during colostomy irrigation. Once the cramping has stopped, the nurse can resume the irrigation.

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

Colorectal cancer is the third most common site of cancer in the United States. Explanation: Cancer of the colon and rectum is the third most common site of new cancer cases in the United States. Colon cancer affects more than twice as many people as does rectal cancer (94,700 for colon, 34,700 for rectum). The incidence increases with age (the incidence is highest in people older than 85). Colon cancer occurrence is higher in people with a family history of colon cancer.

1. A client is having a diagnostic workup for reports of frequent diarrhea, right lower abdominal pain, and weight loss. The nurse is reviewing the results of the barium study and notes the presence of "string sign." What does the nurse understand that this is significant of? Crohn's disease Irritable bowel syndrome Ulcerative colitis Diverticulitis

Crohn's disease Explanation: The most conclusive diagnostic aid for Crohn's disease has classically been a barium study of the upper GI tract that shows a "string sign" on an x-ray film of the terminal ileum, indicating the constriction of a segment of intestine.

18. An older adult client seeks help for chronic constipation. What factor related to aging can cause constipation in elderly clients? Increased intestinal motility Decreased production of hydrochloric acid Increased intestinal bacteria Decreased abdominal strength

Decreased abdominal strength Explanation: Decreased abdominal strength, muscle tone of the intestinal wall, and motility all contribute to chronic constipation in the elderly. A decrease in hydrochloric acid causes a decrease in absorption of iron and vitamin B12, whereas an increase in intestinal bacteria actually causes diarrhea.

8. Which is one of the primary symptoms of irritable bowel syndrome (IBS)? Abdominal distention Bloating Diarrhea Pain

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

16. 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? Dust with nystatin powder Apply barrier powder Apply triamcinolone acetonide spray Dry skin thoroughly after washing

Dry skin thoroughly after washing Explanation: The nurse should teach the client without peristomal skin irritation to dry the skin thoroughly after washing. Barrier powder, triamcinolone acetonide spray, and nystatin powder are used when the client has peristomal skin irritation and/or fungal infection

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

Familial polyposis Explanation: Family history of colon cancer or familial polyposis is a risk factor for colorectal cancer. Age older than 40 years and a high-fat, high-protein, low-fiber diet are risk factors for colorectal cancer. A history of skin cancer is not a recognized risk factor for colorectal cancer.

10. The nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be Dark, tarry stools Fecal incontinence Hemorrhoids Diarrhea

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

12. Which of the following is accurate regarding regional enteritis? Severe diarrhea Fistulas are common Severe bleeding No narrowing of the colon

Fistulas are common Explanation: Fistulas are common with regional enteritis. There is narrowing of the colon, mild bleeding, and diarrhea is less severe than ulcerative colitis.

10. A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? Cutting the faceplate opening no more than 2 inches larger than the stoma Maintaining wrinkles in the faceplate so it doesn't irritate the skin Gently washing the area surrounding the stoma using a facecloth and mild soap Scrubbing fecal material from the skin surrounding the stoma

Gently washing the area surrounding the stoma using a facecloth and mild soap Explanation: For a client with an ostomy, maintaining skin integrity is a priority. The nurse should gently wash the area surrounding the stoma using a facecloth and mild soap. Scrubbing the area around the stoma can damage the skin and cause bleeding. The faceplate opening should be no more than 1/8-inch to 1/6-inch larger than the stoma. This size protects the skin from exposure to irritating fecal material. The nurse can create an adequate seal and prevent leakage of fecal material from under the faceplate by applying a thin layer of skin barrier and smoothing out wrinkles in the faceplate. Eliminating wrinkles in the faceplate also protects the skin surrounding the stoma from pressure.

20. A patient diagnosed with IBS is advised to eat a diet that is: Restricted to 1,200 calories/day. Sodium-restricted. Low in residue. High in fiber.

High in fiber. Explanation: A high-fiber diet is prescribed to control diarrhea and constipation and is recommended for patients with IBS.

16. 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? Taking only enteric-coated medications Wearing an appliance pouch only at bedtime Increasing fluid intake to prevent dehydration Consuming a low-protein, high-fiber diet

Increasing fluid intake to prevent dehydration Explanation: Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can't absorb them after an ileostomy.

6. A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of: Inflammatory colitis. A disorder of the large bowel. A small bowel disorder. Intestinal malabsorption.

Intestinal malabsorption. Explanation: Watery stools are characteristic of disorders of the small bowel, whereas loose, semisolid stools are associated more often with disorders of the large bowel. Large, greasy stools suggest intestinal malabsorption, and the presence of mucus and pus in the stools suggests inflammatory enteritis or colitis.

15. The nurse is comparing Crohn's disease (regional enteritis) with ulcerative colitis. Which of the following describes Crohn's disease? Diarrhea is more severe Fistulas are rare Bleeding is common and severe Its course is prolonged and variable

Its course is prolonged and variable Explanation: The course of Crohn's disease is prolonged and variable whereas ulcerative colitis follows a pattern of exacerbations and remissions. In Crohn's disease, bleeding usually does not occur but tends to be mild when it does occur; fistulas are common, and diarrhea is less severe than it is with ulcerative colitis.

7. The instructor is teaching a group of students about irritable bowel syndrome (IBS) and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an antidiarrheal agent commonly administered for IBS? Loperamide Dicyclomine Lubiprostone Peppermint oil

Loperamide Explanation: Loperamide is an opiate-related antidiarrheal agent. Lubiprostone is used to treat constipation; it activates chloride channels in the gastrointestinal tract to increase gastrointestinal transit. Dicyclomine, a smooth muscle antispasmodic agent, is used to treat pain accompanying IBS. Peppermint oil may also be taken to ease discomfort.

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

Low residue Explanation: Oral fluids and a low-residue, high-protein, high-calorie diet with supplemental vitamin therapy and iron replacement are prescribed to meet the nutritional needs, reduce inflammation, and control pain and diarrhea.

3. The nurse is caring for an older adult patient experiencing fecal incontinence. When planning the care of this patient, what should the nurse designate as a priority goal? Determining the need for surgical intervention to correct the problem Maintaining skin integrity Beginning a bowel program to establish continence Instituting a diet high in fiber and increase fluid intake

Maintaining skin integrity Explanation: Fecal incontinence can disrupt perineal skin integrity. Maintaining skin integrity is a priority, especially in the debilitated or older adult patient.

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

Metabolic alkalosis Explanation: Vomiting results in loss of hydrochloric acid (HCl) and potassium from the stomach, leading to a reduction of chlorides and potassium in the blood and to metabolic alkalosis.

12. Celiac disease (celiac sprue) is an example of which category of malabsorption? Postoperative malabsorption Infectious diseases Luminal problems causing malabsorption Mucosal disorders causing generalized malabsorption

Mucosal disorders causing generalized malabsorption Explanation: Celiac disease (celiac sprue, gluten-sensitive enteropathy) results from a toxic response to the gliadin component of gluten by the surface epithelium of the intestine; eventually, the mucosal villi of the small intestine become denuded and cannot function. Crohn's disease (regional enteritis) and radiation enteritis are other 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 and cancer can result in development of a lymphatic malabsorption syndrome, in which there is interference with the transport of the fat by-products of digestion into the systemic circulation.

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

Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. Explanation: A client with appendicitis is at Risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Elderly, not middle-aged, clients are especially susceptible to appendix rupture.

5. The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder? One part of the intestine telescopes into another portion of the intestine. The bowel twists and turns itself and obstructs the intestinal lumen. The bowel protrudes through a weakened area in the abdominal wall. A loop of intestine adheres to an area that is healing slowly after surgery.

One part of the intestine telescopes into another portion of the intestine. Explanation: 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.

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

Rectal bleeding Explanation: The most common symptom is rectal bleeding. Lower abdominal pain may also occur. Diarrhea and anorexia are clinical manifestations of ulcerative colitis.

11. 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? Left upper quadrant Right upper quadrant Left lower quadrant Right lower quadrant

Right lower quadrant Explanation: The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

17. 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 ________. Rovsing's sign; perforation Rovsing's sign; acute appendicitis McBurney's sign; acute appendicitis McBurney's sign; perforation

Rovsing's sign; acute appendicitis Explanation: 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.

1. A client is diagnosed with Zollinger-Ellison syndrome. The nurse knows to assess the client for which characteristic clinical feature of this syndrome? Decreased intestinal lactose Folate deficiency Steatorrhea Lymphadenopathy

Steatorrhea Explanation: Hyperacidity in the duodenum inactivates pancreatic enzymes causing steatorrhea and ulcer diathesis.

9. A nurse is caring for a client who has experienced an acute exacerbation of Crohn's disease. Which statement best indicates that the disease process is under control? The client maintains skin integrity. The client verbalizes a manageable level of discomfort. The client exhibits signs of adequate GI perfusion. The client expresses positive feelings about himself.

The client exhibits signs of adequate GI perfusion. Explanation: 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.

1. A client realizes that regular use of laxatives has greatly improved bowel patterns. However, the nurse cautions this client against the prolonged use of laxatives for which reason? The client may develop inflammatory bowel disease. The client's natural bowel function may become sluggish. The client may develop arthritis or arthralgia. The client may lose his or her appetite.

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.

4. A client realizes that regular use of laxatives has lead to bowel pattern improvement. However, the nurse cautions this client against the prolonged use of laxatives for which reason? The client may develop inflammatory bowel disease. The client's natural bowel function may become sluggish. The client may develop arthritis or arthralgia. The client may lose their appetite.

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.

6. 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 The client is able to fully evacuate with each bowel movement That the stool is formed and soft

The consistency of stool and comfort when passing stool Explanation: In differentiating normal from abnormal, the consistency of stools and the comfort with which a person passes them are more reliable indicators than is the frequency of bowel elimination. People differ greatly in their bowel habits and normal bowel patterns range from three bowel movements per day to three bowel movements per week. It is important for the stool to be soft to pass without pain. The client may not be able to fully evacuate with a bowel movement; it may take time.

9. A client reports taking a stimulant laxative in order to be able to have a bowel movement daily. What should the nurse inform the client about taking a stimulant laxative? The laxative is safe to take with other medication the client is taking. If the client is drinking 8 glasses of water per day, it is all right to continue taking them. They can be habit forming and will require increasing doses to be effective. The client should take a fiber supplement along with the stimulant laxative.

They can be habit forming and will require increasing doses to be effective. Explanation: The nurse should discourage self-treatment with daily or frequent enemas or laxatives. Chronic use of such products causes natural bowel function to be sluggish. In addition, laxatives continuing stimulants can be habit forming, requiring continued use in increasing doses. Although the nurse should encourage the client to have adequate fluid intake, laxative use should not be encouraged. The laxative may interact with other medications the client is taking and may cause a decrease in absorption. A fiber supplement may be taken alone but should not be taken with a stimulant laxative.

3. A client presents to the emergency department with complaints of acute GI distress, bloody diarrhea, weight loss, and fever. Which condition in the family history is most pertinent to the client's current health problem? Gastroesophageal reflux disease Hypertension Appendicitis Ulcerative colitis

Ulcerative colitis Explanation: A family history of ulcerative colitis, particularly if the relative affected is a first-degree relative, increases the likelihood of the client having ulcerative colitis. Although hypertension has familial tendencies, the client's symptoms aren't related to hypertension. A family history of gastroesophageal reflux disease or appendicitis isn't a significant factor in the client history because these conditions aren't considered familial traits.

5. 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? Small-bowel disease Ulcerative colitis Disorders of the colon Intestinal malabsorption

Ulcerative colitis Explanation: 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.

17. The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation? Usual pattern of elimination Alcohol consumption Current medications Activity levels

Usual pattern of elimination Explanation: Constipation has many possible reasons and assessing the client's usual pattern of elimination is the first step in identifying the cause. The nurse should obtain a description of the bowel elimination pattern, asking about the frequency, overall appearance and consistency of stool, blood in the stool, pain, and effort necessary to pass stool. It is also essential for the nurse to review the client's current medications, diet, and activity levels.

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

high-fiber diet. Explanation: A high-fiber diet is prescribed to help control constipation. Individuals experiencing diarrhea may be advised to eat a low-fiber diet. Foods that are possible irritants, such as caffeine, spicy foods, lactose, beans, fried foods, corn, wheat, and alcohol, should be avoided. Fluids should not be taken with meals because they cause abdominal distention.

13. 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: hypernatremia. hyponatremia. hyperkalemia. hypokalemia.

hypokalemia. Explanation: The older client taking digoxin must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

7. 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). What diagnosis will the nurse suspect for this client? inflammatory bowel disease (IBD) diverticulitis colorectal cancer liver failure

inflammatory bowel disease (IBD) Explanation: IBD is a collective term for several GI inflammatory diseases with unknown causes. The most prominent sign of IBD is mild diarrhea, which sometimes is accompanied by fever and abdominal discomfort. Colorectal cancer is usually diagnosed after the client complains of bloody stools; the client will rarely have abdominal discomfort. A client with diverticulitis commonly states he has chronic constipation with occasional diarrhea, nausea, vomiting, and abdominal distention. Jaundice, coagulopathies, edema, and hepatomegaly are common signs of liver failure.

10. A nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find? rectal bleeding and a change in bowel habits jaundice and vomiting severe abdominal pain with direct palpation or rebound tenderness tenderness and pain in the right upper abdominal quadrant

severe abdominal pain with direct palpation or rebound tenderness Explanation: 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 (i.e., appendicitis, diverticulitis, ulcerative colitis, 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.