N400 (E3) Ch 38: Bowel Elimination
The nurse is providing health teaching for four clients. Which client should consider a colonoscopy screening?
50-year-old client with a family history of polyps
A nurse is caring for a client whose primary care provider has written an order for "enemas until clear." Which explanation to the client about this procedure is correct? A. "This enema will assist in your bowel regimen when you go home." B. "I will administer enemas until the enema return is without stool." C. "I will administer up to three enemas as prescribed." D. "You will need to have enemas unless you can consume clear liquids without nausea."
B.
Which statement best explains why digital removal of stool is considered a last resort after other methods of bowel evacuation have been unsuccessful? A. Nurses find the procedure distasteful and difficult to perform. B. It often causes rebound diarrhea and electrolyte loss. C. Digital removal of stool may cause parasympathetic stimulation. D. Most clients will not consent to have digital removal of stool.
C.
Which symptom is a known side effect of antibiotics? A. Abdominal bloating B. Fecal impaction C. Diarrhea D. Constipation
C.
A student nurse studying human anatomy knows that a structure of the large intestine is the:
Cecum
A nurse is collecting a stool specimen of a client suspected of having Clostridium difficile. Which guideline is recommended for this procedure?
Collect 15 to 30 mL of the client's liquid stool.
Which factor is related to developmental changes in bowel habits for older adult clients? A. Increase in dietary fiber can decrease peristalsis. B. Milk products cause constipation in clients with lactose intolerance. C. Older adults should peel fruits before eating. D. Weakened pelvic muscles lead to constipation.
D.
A registered nurse is overseeing the care of numerous clients on an acute medicine unit. Which task should the nurse delegate to unlicensed assistive personnel (UAP)?
Emptying a client's ileostomy appliance
"Vagal response" is the voluntary increase of intra-abdominal pressure that helps expel feces.
False
After data collection on a client, the nurse suspects that the client has diarrhea. Which data collection finding, if observed by the nurse, would confirm the nurse's suspicion?
Hyperactive bowel sounds
The nurse is slowly advancing a nasogastric (NG) tube when the client begins to gasp and is unable to vocalize. Which scenario has likely occurred?
The NG tube is in the client's airway.
The nurse is teaching a client with a new ostomy about skin care to preserve tissue integrity at the stomal site. Which teaching will the nurse provide regarding cleansing the stoma?
Use H2O and Mild Soap
Which factor is related to developmental changes in bowel habits for older adult clients?
Weakened pelvic muscles lead to constipation.
The nurse is scheduling tests for a client who is experiencing bowel alterations. What is the mostlogical sequence of tests to ensure an accurate diagnosis?
fecal occult blood test, barium studies, endoscopic examination
When caring for a client with a new colostomy, which assessment finding would be considered abnormal and would need to be reported to the physician?
the stoma is prolapsed
A client has been given fecal occult blood test (FOBT) testing supplies. What teaching will the nurse provide about the purpose for this test?
"This test detects heme, an iron compound in blood within the stool."
The nurse has presented an educational in-service about caring for clients who have newly created ostomies. The nurse asks participants, "How will you know when a client begins to accept the altered body image?" Which responses by participants indicates a correct understanding of the material? Select all that apply.
- "The client is willing to look at the stoma." - "The client makes neutral or positive statements about the ostomy." - "The client expresses interest in learning self-care."
The nurse is selecting antidiarrheal medications for clients with diarrhea. Which statements accurately describe the action of specific antidiarrheal medications? Select all that apply.
- Loperamide is a nonaddictive antidiarrheal medication that has a longer duration of action than diphenoxylate/atropine. - Bismuth subsalicylate contains salicylates; a physician should be consulted before giving it to children or clients taking aspirin. - Paregoric contains morphine and may be addictive.
An older adult client has a history of constipation and currently self-treats with over-the-counter laxatives. What should the nurse educate the client regarding the use of laxatives? Select all that apply.
- Oral laxatives take longer to effect change than laxatives administered rectally. - Older adults are at particular risk for laxative misuse. - Rectal suppositories tend to work within 60 minutes of administration. - It will be helpful to increase dietary fiber and fluids.
The nurse is preparing a client for a guaiac fecal occult blood test. What medications taken by the client does the nurse identify that may cause a false-positive result in the test? Select all that apply.
- Warfarin 10 mg daily - Ferrous sulfate 325 mg daily - Prednisone 20 mg daily
The risk for developing colorectal cancer during one's lifetime is 1 in 19. Nurses play an integral role in the promotion of colorectal cancer screening. What are risk factors for colorectal cancer? Select all that apply.
- age 50 and older - a positive family history - a history of inflammatory bowel disease
In the nursing care plan for constipation, the nurse should have an intervention that addresses the number of grams of cellulose that are needed for normal bowel function. How many grams should be in the daily diet?
20-30g
The nurse is preparing to administer a large-volume enema to an adult client. How far should the nurse insert the tubing into the rectum?
3 in (7.5 cm) - 4 in (10 cm)
A client scheduled for a colonoscopy is scheduled to receive a hypertonic enema prior to the procedure. A hypertonic enema is classified as which type of enema? A. cleansing enema B. return-flow enema C. retention enema D. carminative enema
A.
A nurse is caring for a client with an abdominal injury at a health care facility. The client informs the nurse about passing blood-stained stool. Which nursing action is appropriate at this time? A. Perform a screening test on stool samples. B. Send the stool sample to the laboratory. C. Save a sample of the stool in a container. D. Inform the client to report the occurrence if it happens again.
A.
A student nurse studying human anatomy knows that a structure of the large intestine is the: A. cecum B. duodenum C. ileum D. jejunum
A.
During the inspection of a client's abdomen, the nurse notes that it is visibly distended. The nurse should proceed with the client's abdominal assessment by next performing: A. auscultation. B. percussion. C. light palpation. D. deep palpation.
A.
The nurse is educating a new colostomy client on gas-producing foods. Which food is a gas-producing food the client may choose to avoid? A. brussels sprouts B. green peppers C. rice D. lettuce
A.
The nurse is presenting a lecture on ostomy bowel elimination at a community clinic. When questioned by the clients, which food would the nurse suggest as natural intestinal deodorizers? A. Yogurt and buttermilk B. Asparagus and turnip C. Fish and dried lentils D. Onions and garlic
A.
The nurse is scheduling tests for a client who is experiencing bowel alterations. What is the most logical sequence of tests to ensure an accurate diagnosis? A. fecal occult blood test, barium studies, endoscopic examination B. barium studies, fecal occult blood test, endoscopic examination C. barium studies, endoscopic examination, fecal occult blood test D. endoscopic examination, barium studies, fecal occult blood test
A.
The nurse is slowly advancing a nasogastric (NG) tube when the client begins to gasp and is unable to vocalize. Which scenario has likely occurred? A. The NG tube is in the client's airway. B. The client is forcefully resisting the procedure. C. The NG tube is curled in the back of the client's throat. D. The client is experiencing a vasovagal reaction.
A.
When caring for a client with a new colostomy, which assessment finding would be considered abnormal and would need to be reported to the physician? A. The stoma is prolapsed. B. The stoma is pink. C. The stoma is on the abdominal surface. D. The stoma has a small amount of bleeding.
A.
Which medication causes constipation? A. Iron supplements B. Aspirin C. Bisacodyl D. Magnesium antacids
A.
The nurse has presented an educational in-service about caring for clients who have newly created ostomies. The nurse asks participants, "How will you know when a client begins to accept the altered body image?" Which responses by participants indicates a correct understanding of the material? Select all that apply. A. "The client makes neutral or positive statements about the ostomy." B. "The client expresses interest in learning self-care." C. "The client uses spray deodorant several times an hour to mask odor." D. "The client agrees to take prescribed antidepressants." E. "The client is willing to look at the stoma."
A. B. E.
A student nurse is preparing to administer a client's ordered large-volume enema. What action should the nurse perform during this skill?
Administer the solution gradually over 5 to 10 minutes.
A nurse is caring for a client with an NG tube attached to continuous suction. The nurse observes that the tube is connected to the wall suction, but it is not draining. What is the nurse's bestaction?
Attempt to irrigate the NG tube with water or normal saline.
The nurse assesses a client who underwent abdominal surgery 72 hours prior and notes that the client has developed abdominal distention. Which further physical assessment will the nurse perform to gather additional information?
Auscultate for bowel sounds.
A client is preparing for a fecal occult blood test. What teaching will the nurse provide regarding vitamin C three days before testing?
Avoid more than 250 mg
A client has been given fecal occult blood test (FOBT) testing supplies. What teaching will the nurse provide about the purpose for this test? A. "This test gives the healthcare provider a very accurate indication about whether you may have colorectal cancer." B. "This test detects heme, an iron compound in blood within the stool." C. "This will determine what foods you are allergic to that affect digestion and elimination." D. "This test will help determine whether you have an infectious process in the intestines."
B.
A client is preparing for a fecal occult blood test. What teaching will the nurse provide regarding vitamin C three days before testing? A. Consume citrus fruits B. Avoid more than 250 mg C. Take 500 mg D. Drink orange and grapefruit juice
B.
A nurse is caring for a client with an NG tube attached to continuous suction. The nurse observes that the tube is connected to the wall suction, but it is not draining. What is the nurse's best action? A. Turn off the suction for 30 minutes and then turn it on again. B. Attempt to irrigate the NG tube with water or normal saline. C. Instill digestive enzymes, as ordered. D. Remove the NG tube and replace it with a larger-bore tube, as ordered.
B.
A nurse is caring for a client with constipation. The incidence of constipation tends to be high among clients who follow which diet? A. a diet lacking in glucose and water B. a diet lacking in fruits and vegetables C. a diet consisting of whole grains, seeds, and nuts D. a diet lacking in meat and poultry products
B.
A nurse is collecting a stool specimen of a client suspected of having Clostridium difficile. Which guideline is recommended for this procedure? A. If the specimen contains barium or enema solution, document this on the container. B. Collect 15 to 30 mL of the client's liquid stool. C. Refrigerate the specimen until it is cooled before sending it to the laboratory. D. If portions of the stool include visible blood, mucus, or pus, discard the stool.
B.
A nurse is ordered to perform digital removal of stool for a client with stool impaction. Which action is an appropriate step in this procedure? A. Position the client supine, as dictated by client comfort and condition. B. Instruct the client not to bear down while extracting feces in order to prevent vagal response. C. Gently work the finger around and into the hardened mass to break it up and then remove pieces of it. D. Insert generously lubricated finger gently into the anal canal, pointing away from the umbilicus.
B.
A nurse is teaching a student nurse how to manage unexpected events during the removal of a nasogastric tube. Which action should the nurse recommend? A. If epistaxis occurs with removal of the NG tube, ensure that the client is in a supine position with an ice pack applied. B. If within 2 hours after NG tube removal, the client's abdomen is showing signs of distention, notify the health care provider. C. If the client experiences pain during removal, apply petroleum jelly to the skin near the exit site. D. Replace the NG tube if the client experiences nausea within 6 hours of removal.
B.
An older adult woman who is incontinent of stool following a cerebrovascular accident will have which nursing diagnosis? A. Constipation related to physiologic condition involving the deficit in neurologic innervation, as evidenced by fecal incontinence B. Bowel Incontinence related to loss of sphincter control, as evidenced by inability to delay the urge to defecate C. Diarrhea related to tube feedings, as evidenced by hyperactive bowel sounds and urgency D. Fecal Retention related to loss of sphincter control, and diminished spinal cord innervation related to hemiparesis
B.
Digital rectal examination confirms that a client has an impaction, and an enema solution has been ordered to lubricate the stool and intestinal mucosa without distending the intestine. What solution best meets this client's needs? A. water B. oil C. normal saline D. soap
B.
The newly hired graduate nurse is preparing to administer a cleansing enema. The nurse educator will intervene if which action is taken by the graduate nurse? A. The graduate takes this opportunity to teach about the function of the intestinal tract. B. The graduate places the client in Fowler's position. C. The graduate advises the client that the enema should not be expelled immediately. D. The graduate uses a room temperature solution.
B.
The nurse is caring for an older adult client with diarrhea. Which assessment finding requires immediate nursing intervention? A. temperature 99.9°F (37.9°C) B. skin turgor response 5 seconds C. heart rate 90 beats/min D. blood pressure 130/80 mm Hg
B.
The nurse is inserting a rectal tube to administer a large-volume enema. Which nursing action is performed correctly in this procedure? A. Position the client on his back and drape properly. B. Slowly and gently insert the enema tube 3 to 4 in (7.5 to 10 cm) for an adult. C. Encourage the client to hold the solution for at least 20 minutes. D. Introduce solution quickly over a period of 3 to 5 minutes.
B.
The nurse is providing health teaching for four clients. Which client should consider a colonoscopy screening? A. 42-year-old client with diarrhea twice weekly B. 50-year-old client with a family history of polyps C. 33-year-old client who reports painful elimination D. 67-year-old client with constipation
B.
The nurse is talking with four members of a family. Which client within the family does the nurse identify that would benefit from discussing a colonoscopy screening with their health care provider? A. 48-year old with regular bowel habits B. 47-year old whose father had polyps C. 22-year old who experiences constipation D. 18-year old who with diarrhea twice weekly
B.
The student nurse is caring for a client with a colostomy. When changing the ostomy appliance, the nurse manager would intervene if which action by the student is observed? A. Places a disposable pad on the work surface B. Starts at the bottom of the appliance, holds abdominal skin taut and gently removes the faceplate C. Empties the pouch before changing the appliance D. Applies a skin protectant to a 2-in (5-cm) radius around the stoma and allows it to dry completely
B.
The type of stool that will be expelled into the ostomy bag by a client who has undergone surgery for an ileostomy will be: A. mucus-filled. B. liquid consistency. C. soft semi-formed. D. bloody.
B.
Which client is most likely to require interventions in order to maintain regular bowel patterns? A. a woman 59 years of age who has recently begun hormone replacement therapy B. a client whose neuropathic pain requires multiple doses of opioids each day C. a client who has a history of atrial fibrillation requiring daily anticoagulants D. a client with hypertension who takes a diuretic and adrenergic blocker each morning
B.
The risk for developing colorectal cancer during one's lifetime is 1 in 19. Nurses play an integral role in the promotion of colorectal cancer screening. What are risk factors for colorectal cancer? Select all that apply. A. a diet high in fruits, vegetables, and whole grains. B. a positive family history C. a history of inflammatory bowel disease D. age 50 and older
B. C. D.
Removal of a client's NG tube has been ordered. Which action should the nurse perform during this intervention?
Before removing the tube, discontinue suction and separate the tube from suction.
A nurse prepares to insert a nasointestinal tube to provide nutrition to a client. Which guideline is recommended for this procedure?
Begin by measuring from the tip of the client's nose to the earlobe to the xiphoid process.
An older adult woman who is incontinent of stool following a cerebrovascular accident will have which nursing diagnosis?
Bowel Incontinence related to loss of sphincter control, as evidenced by inability to delay the urge to defecate
A client has received nursing teaching about proper skin care at a stomal site. The nurse's teaching has been effective when the client identifies which solution is used to clean the stoma? A. alcohol-based sanitizer B. saline C. water and mild soap D. mineral oil
C.
A nurse has auscultated the abdomen in all four quadrants for 5 minutes and has not heard any bowel sounds. How would this be documented? A. "Auscultated abdomen for bowel sounds. Bowel not functioning." B. "Bowel sounds auscultated. Client has no bowel sounds." C. "All four abdominal quadrants auscultated. Inaudible bowel sounds." D. "Client may have bowel sounds, but they can't be heard."
C.
A nurse prepares to insert a nasointestinal tube to provide nutrition to a client. Which guideline is recommended for this procedure? A. Add 16 to 18 in to the measurement obtained to ensure the tube comes to rest at the desired point. B. Administer an oral analgesia 30 to 45 minutes before attempting insertion. C. Begin by measuring from the tip of the client's nose to the earlobe to the xiphoid process. D. Position the bed flat and assist the client onto his or her left side.
C.
A registered nurse is overseeing the care of numerous clients on an acute medicine unit. Which task should the nurse delegate to unlicensed assistive personnel (UAP)? A. Irrigating a client's NG tube B. Inserting a client's NG tube C. Emptying a client's ileostomy appliance D. Assessing a client's GI system
C.
The health care provider prescribes a high-fiber diet for a client to promote bowel elimination. Which foods, selected by the client, would indicate to the nurse that the client can identify high-fiber foods? A. Soda crackers and chicken noodle soup B. Hot tea and flavored water C. Whole wheat spaghetti and broccoli D. Cream of wheat and applesauce
C.
The nurse is assisting an older adult client into position for a sigmoidoscopy. Which position would the nurse place the client in? A. Semi-Fowler's B. Prone C. Left lateral D. Right lateral
C.
The student nurse is administering a large-volume enema to a client. The client reports abdominal cramping. What should the student nurse do first? A. Stop the administration of the enema and notify the physician. B. Increase the flow of the enema for approximately 30 seconds then decrease it to the prior flow rate. C. Stop the administration of the enema momentarily. D. Increase the flow of the enema until all of the solution has been administered.
C.
While administering a cleansing enema, the client displays lightheadedness, nausea, and has clammy skin. The nurse would implement which priority action? A. Slow the infusion rate, have the client take deep breaths, then resume the enema. B. Slow the infusion rate, withdraw the tubing slightly, then resume the enema. C. Stop the procedure, monitor heart rate and blood pressure. D. Stop the procedure and reposition the client.
C.
A client with no significant medical history reports experiencing diarrhea over the past week. Which assessment question will the nurse ask? Select all that apply. A. "Are you experiencing rectal fullness?" B. "Is the stool difficult to pass?" C. "What are your normal bowel habits?" D. "Do you use laxatives?" E. "Have you started a new medication?"
C. D. E.
A client asks, "Why do some foods, like corn, come out undigested in my feces?" Which is the nurse's best response?
Corn is high in cellulose, which is an insoluble fiber that the body cannot digest.
A nurse is caring for a client with primary constipation. Which factor is responsible for primary constipation? A. high intake of fiber B. constant physical activity C. constant urges to defecate D. inadequate intake of liquid
D.
An older adult client tells the nurse, "I give myself a mineral oil enema every day." What is the appropriate nursing response? A. "Perhaps you should do this twice daily." B. "This is good to help bowels move." C. "It is important that you discontinue this type of treatment immediately." D. "Mineral oil enemas can interfere with absorption of fat-soluble vitamins."
D.
The nurse is administering a rectal suppository. How far will the nurse insert the suppository? A. until the client reports feelings of discomfort B. just past the opening of the anus C. far enough to still visualize the end of the suppository D. past the internal sphincter
D.
The nurse needs to collect a stool specimen for culture from a client. The client passed stool into the toilet instead of using the collection container. What is the next step for the nurse? A. Inform the client that the culture prescription will now be cancelled. B. Administer a PRN dose of laxative to the client to collect new sample. C. Collect stool and send to laboratory for culture per regular protocol. D. Reinstruct the client on use of collection container for next bowel movement.
D.
When reviewing a client's chart, which data related to a client experiencing diarrhea might suggest to the nurse a causative factor? A. The client repeatedly ignores the urge to defecate. B. The client has a daily fluid intake of 2,000 to 3,000 mL. C. The client consumes large qualities of fresh vegetables. D. The client returned from a foreign country 2 days ago.
D.
Which symptom is a known side effect of antibiotics?
Diarrhea
Which statement best explains why digital removal of stool is considered a last resort after other methods of bowel evacuation have been unsuccessful?
Digital removal of stool may cause parasympathetic stimulation.
a client whose neuropathic pain requires multiple doses of opioids each day The nurse is preparing to auscultate the bowel sounds of a client with a nasogastric tube in place set to low intermittent suction. How shall the nurse approach the assessment of bowel sounds and manage the nasogastric tube?
Disconnect the nasogastric tube from suction during the assessment of bowel sounds.
The nurse is caring for a client who is scheduled for an esophagogastroduodenoscopy (EGD). What action would the nurse take to prepare the client for this procedure?
Ensure that the client fasts 6 to 12 hours before the test as per policy.
The nurse provides teaching to a client experiencing constipation. Which food choice on the client's breakfast tray indicates effective teaching?
Grapefruit
A client has received nursing teaching about proper skin care at a stomal site. The nurse's teaching has been effective when the client identifies which solution is used to clean the stoma?
H2O and Mild Soap
A nurse is teaching a student nurse how to manage unexpected events during the removal of a nasogastric tube. Which action should the nurse recommend?
If within 2 hours after NG tube removal, the client's abdomen is showing signs of distention, notify the health care provider.
A nurse is assessing and documenting the eating habits of a client with repeated reports of gas who wants to include more fiber in the diet. Which suggestion should the nurse include in the teaching plan?
Increase fiber slowly over a period of time to prevent gas.
Which medication causes constipation?
Iron Supplements
The nurse is assisting an older adult client into position for a sigmoidoscopy. Which position would the nurse place the client in?
Left Lateral
The nurse is changing a client's ostomy appliance and observes that the peristomal skin is excoriated. What would be the nurse's priority intervention in this situation?
Make sure that the appliance is not cut too large.
Digital rectal examination confirms that a client has an impaction, and an enema solution has been ordered to lubricate the stool and intestinal mucosa without distending the intestine. What solution best meets this client's needs?
Oil
A nurse attempts to administer a tap water enema to a client who is dehydrated and finds that the client cannot retain the enema for the prescribed amount of time. What nursing action would be appropriate for this client?
Place the client on a bedpan in supine position while receiving the enema and elevate the head of the bed 30 degrees.
The nurse is preparing a client to receive a hypertonic enema solution. Into which position will the nurse place the client?
Sims
The nurse is caring for an older adult client with diarrhea. Which finding is most important for the nurse to report to the health care provider?
Skin turgor response of 6 seconds
The nurse is inserting a rectal tube to administer a large-volume enema. Which nursing action is performed correctly in this procedure?
Slowly and gently insert the enema tube 3 to 4 in (7.5 to 10 cm) for an adult.
The student nurse is administering a large-volume enema to a client. The client reports abdominal cramping. What should the student nurse do first?
Stop the administration of the enema momentarily.
While administering a cleansing enema, the client displays lightheadedness, nausea, and has clammy skin. The nurse would implement which priority action?
Stop the procedure, monitor heart rate and blood pressure.
The newly hired graduate nurse is preparing to administer a cleansing enema. The nurse educator will intervene if which action is taken by the graduate nurse?
The graduate places the client in Fowler's position.
The nursing student is performing a focused gastrointestinal assessment. Which action performed by the student would indicate to nurse faculty that further instruction is needed?
The student sequenced from auscultation to inspection, and percussion to palpation.
When educating a breastfeeding mother on the characteristic of the stool of her newborn, the nurse should inform her that the stool will be:
Yellow
Which client is most likely to require interventions in order to maintain regular bowel patterns?
a client whose neuropathic pain requires multiple doses of opioids each day
During the inspection of a client's abdomen, the nurse notes that it is visibly distended. The nurse should proceed with the client's abdominal assessment by next performing:
auscultation
A client scheduled for a colonoscopy is scheduled to receive a hypertonic enema prior to the procedure. A hypertonic enema is classified as which type of enema?
cleansing enema
The type of stool that will be expelled into the ostomy bag by a client who has undergone surgery for an ileostomy will be:
liquid consistency.
The nurse is administering a rectal suppository. How far will the nurse insert the suppository?
past the internal sphincter
When caring for a client with fecal incontinence, the nurse knows that fecal incontinence is the result of:
physiologic or lifestyle changes in the client.
The nurse is caring for an older adult client with diarrhea. Which assessment finding requires immediate nursing intervention?
skin turgor response 5 seconds