NUR 111 UNIT 4 Bowel Elimination

Which statement by a client with diverticulosis alerts the nurse that the client needs additional health teaching? Select all that apply. 1. "I should avoid eating high-fiber cereal." 2. "I sit on the toilet for 10 minutes after breakfast every day." 3. "I am going to drink 8 glasses of water a day when I get home." 4. "I should hold my breath and bear down when having a bowel movement." 5. "I like to massage my lower abdomen when I'm trying to have a bowel movement."

1. "I should avoid eating high-fiber cereal." 4. "I should hold my breath and bear down when having a bowel movement."

A nurse is caring for a client who is experiencing diarrhea. Which physiological response to diarrhea should the nurse be most concerned about? 1. Dehydration 2. Malnutrition 3. Excoriated skin 4. Urinary incontinence

1. Dehydration

A nurse discourages a client from straining excessively when attempting to have a bowel movement. Which undesirable physiological response is the primary reason why straining on defecation should be avoided? 1. Dysrhythmia 2. Incontinence 3. Fecal impaction 4. Rectal hemorrhoid

1. Dysrhythmia

Which outcome of the options presented is most appropriate for a client with perceived constipation? 1. Have a bowel movement without the use of a laxative. 2. Explain the rationale for the use of laxatives. 3. Drink 8 glasses of water per day. 4. Defecate every day.

1. Have a bowel movement without the use of a laxative.

A nurse identifies that a client's colostomy stoma is pale. Which should the nurse do? 1. Notify the surgeon. 2. Listen for bowel sounds. 3. Wash the area with warm water. 4. Gently massage around the stoma.

1. Notify the surgeon.

A nurse is teaching a client how to irrigate a colostomy. The client asks, "Why is it necessary to use the cone attachment to the irrigation catheter?" What information should the nurse include in a response to this question? 1. Stops enema solution from flowing out of the bowel during the procedure 2. Prevents prolapse of the bowel during evacuation of the solution 3. Dilates the stoma so that the enema tube can be inserted 4. Facilitates the elimination of drainage from the colon

1. Stops enema solution from flowing out of the bowel during the procedure

A nurse identifies that a client has tarry stools. Which problem should the nurse con- clude that the client is experiencing? 1. Upper gastrointestinal bleeding 2. Pancreatic dysfunction 3. Lactulose intolerance 4. Inadequate bile salts

1. Upper gastrointestinal bleeding

A nurse is teaching a client with a history of constipation about the excessive use of laxatives. Which effect of laxatives should the nurse include as the primary reason why their use should be avoided? 1. Weakens the natural response to defecation 2. Results in distention of the intestines 3. Causes abdominal discomfort 4. Precipitates incontinence

1. Weakens the natural response to defecation

A client is experiencing constipation. Which independent nursing action facilitates defecation of a hard stool? Select all that apply. 1. _____ Applying a lubricant to the anus 2. _____ Providing a sitz bath after defecation 3. _____ Instilling warm mineral oil into the rectum 4. _____ Placing a warm, wet washcloth against the perianal area 5. _____ Encouraging the client to rock forward and back while defecating

1. _____ Applying a lubricant to the anus 4. _____ Placing a warm, wet washcloth against the perianal area 5. _____ Encouraging the client to rock forward and back while defecating

A client is attending the health clinic for treatment of hemorrhoids. The nurse reviews the client's history, interviews the client, and performs a focused assessment. Which of the following in the client's history does the nurse conclude may have influenced the development of the hemorrhoids? Select all that apply. 1. _____ Stands for long periods of time at work 2. _____ Has had multiple pregnancies 3. _____ Tends to have constipation 4. _____ Has a disease of the liver 5. _____ Is obese

1. _____ Stands for long periods of time at work 2. _____ Has had multiple pregnancies 3. _____ Tends to have constipation 4. _____ Has a disease of the liver 5. _____ Is obese

A nurse is providing dietary teaching to a client with acute diverticulitis who has a prescription for a low-fiber diet. Which food selected by the client indicates that the dietary teaching was understood? Select all that apply. 1. _____ White rice 2. _____ Split peas 3. _____ Soft tofu 4. _____ Turkey 5. _____ Pasta

1. _____ White rice 3. _____ Soft tofu 4. _____ Turkey 5. _____ Pasta

Which client statement supports the nurse's conclusion that a client understands the need to reestablish bowel flora after a week of diarrhea? 1. "I must wean myself off of the antibiotics one day after my temperature is normal." 2. "I should eat a container of yogurt every day for a few days." 3. "I have to add rice to my diet in one meal each day." 4. "I ought to drink eight glasses of water a day."

2. "I should eat a container of yogurt every day for a few days."

A nurse is collecting a bowel elimination history from a newly admitted client with a medical diagnosis of possible bowel obstruction. Which question takes priority? 1. "Do you use anything to help you move your bowels?" 2. "When was the last time you moved your bowels?" 3. "What color are your usual bowel movements?" 4. "How often do you have a bowel movement?"

2. "When was the last time you moved your bowels?"

A client is placed on a therapeutic regimen of an anticoagulant because of a history of deep vein thrombosis and an antihypertensive for an elevated blood pressure. Two weeks later, the client tells the nurse about eating a clove of garlic daily along with the prescribed medications. In addition to informing the primary health-care provider about the client's intake of garlic, what should the nurse teach the client about the client's medication regimen and the intake of garlic? Select all that apply. 1. Avoid taking garlic because it can cause excessive amounts of hemoglobin in your body. 2. Discontinue the intake of garlic two weeks before any surgery to prevent hemorrhage. 3. The risk of bruising and bleeding increases when garlic is taken concur- rently with an anticoagulant. 4. Garlic increases the antihypertensive effects of medication taken to treat an elevated blood pressure. 5. Stop taking garlic and notify the doctor immediately if you experience a rash, itching, severe dizziness, trouble breathing, or swelling of the face, tongue, or throat.

2. Discontinue the intake of garlic two weeks before any surgery to prevent hemorrhage. 3. The risk of bruising and bleeding increases when garlic is taken concur- rently with an anticoagulant. 5. Stop taking garlic and notify the doctor immediately if you experience a rash, itching, severe dizziness, trouble breathing, or swelling of the face, tongue, or throat.

Which action is important for the nurse to teach clients about the intake of bran to facilitate defecation? 1. Ingest 3 tablespoons of bran each morning. 2. Drink at least 8 glasses of fluids daily when taking bran. 3. Attempt a bowel movement right after ingesting the bran. 4. Take a cathartic daily that will supplement the action of bran.

2. Drink at least 8 glasses of fluids daily when taking bran.

A nurse determines that the teaching about a guaiac test of stool is understood when the client states that it identifies the presence of which of the following? 1. Ova and parasites 2. Hidden blood 3. Bacteria 4. Bile

2. Hidden blood

A nurse performs a physical assessment of a newly admitted client who is incontinent of stool. For which characteristic related to bowel incontinence should the nurse assess the client? 1. Frequent, soft stools 2. Involuntary passage of stool 3. Impaired anal sphincter control 4. Greenish-yellow color to the stool

2. Involuntary passage of stool

Which word is specific regarding how a soapsuds enema works on the mucosa of the bowel? 1. Dilating 2. Irritating 3. Softening 4. Lubricating

2. Irritating

A school nurse is planning a health class about bodily functions. Which information should be included regarding the purpose of mucus in the gastrointestinal tract? 1. Activates digestive enzymes 2. Protects the gastric mucosa 3. Enhances gastric acidity 4. Emulsifies fats

2. Protects the gastric mucosa

A nurse is caring for a group of clients with a variety of gastrointestinal problems. Which of the following can cause both diarrhea and constipation? Select all that apply. 1. _____ Inability to perceive bowel cues 2. _____ Cancer of the large intestines 3. _____ Side effects of medications 4. _____ High-solute tube feedings 5. _____ Increased metabolic rate

2. _____ Cancer of the large intestines 3. _____ Side effects of medications

A client had a colonoscopy with several polyps excised for biopsies. The nurse teaches the client routine post-procedure expectations. Which of the following should the nurse instruct the client to report to the primary health-care provider? Select all that apply. 1. _____ Intermittent passage of gas from the anus 2. _____ Continuous abdominal cramping 3. _____ Some abdominal bloating 4. _____ Minimal rectal bleeding 5. _____ Mild fatigue

2. _____ Continuous abdominal cramping

A nurse is to administer an oil-retention enema, a tap-water enema, and a return- flow enema to three different clients. Which of the following should be performed with all three enemas? Select all that apply. 1. _____ Use between 500 and 1,000 mL of solution. 2. _____ Place the client in the left side-lying position. 3. _____ Use water-soluble jelly to lubricate the tip of the rectal probe. 4. _____ Pull the curtain around the client's bed and drape the client. 5. _____ Hold the enema solution a minimum of 12 inches above the anus.

2. _____ Place the client in the left side-lying position. 3. _____ Use water-soluble jelly to lubricate the tip of the rectal probe. 4. _____ Pull the curtain around the client's bed and drape the client.

Which statement by a client with an ileostomy alerts the nurse to the need for further education? 1. "I don't expect to have much of a problem with fecal odor from the stoma." 2. "I will have to take special precautions to protect my skin around the stoma." 3. "I am going to have a bowel movement every morning when I irrigate the stoma." 4. "I should avoid gas-forming foods like beans to limit funny noises from the stoma."

3. "I am going to have a bowel movement every morning when I irrigate the stoma."

A primary health-care provider prescribes a tap-water enema for a client. The client asks about the purpose of the enema. Which specific information about the purpose of a tap-water enema should be included in the nurse's response? 1. "It reduces abdominal gas." 2. "It drains the urinary bladder." 3. "It empties the bowel of stool." 4. "It limits nausea and vomiting."

3. "It empties the bowel of stool."

A nurse is caring for a group of clients. Which client factor should the nurse identify as placing a client at risk for bowel incontinence? 1. Being ninety years old 2. Taking a sedative for sleep 3. Disoriented to time, place, and person 4. Receiving multiple antibiotic medications

3. Disoriented to time, place, and person

A nurse is implementing a prescribed bowel preparation for a client who is scheduled for a colonoscopy. Which is the most serious consequence that is prevented by an effective bowel preparation? 1. Psychological stress 2. Wasted expense 3. Misdiagnosis 4. Discomfort

3. Misdiagnosis

A nurse must collect a specimen for the presence of pinworms. Which action is essential to ensure accuracy of the specimen? 1. Press the sticky side of nonfrosted cellophane tape across the anus before the client goes to bed at night. 2. Insert a swab beyond the internal anal sphincter and rotate it gently while removing it from the anus. 3. Perform the procedure the first thing in the morning before the first bowel movement. 4. Wash the rectal area gently with soap and water before performing the procedure.

3. Perform the procedure the first thing in the morning before the first bowel movement.

A nurse is assisting a client with a regular bedpan. Which nursing action is essential? Select all that apply. 1. Position the client slightly off the back edge of the bedpan. 2. Fold the top linen out of the way when putting the client on the bedpan. 3. Remain outside the curtains of the bed until the client is done using the bedpan. 4. Elevate the head of the bed to the Fowler position after the client is on the bedpan. 5. Raise the side rails on both sides of the bed after the client is positioned on the bedpan.

3. Remain outside the curtains of the bed until the client is done using the bedpan. 4. Elevate the head of the bed to the Fowler position after the client is on the bedpan. 5. Raise the side rails on both sides of the bed after the client is positioned on the bedpan.

A nurse is caring for a client with an intestinal stoma. Which intervention is most important? 1. Cleansing the stoma with cool water 2. Spraying an air-freshening deodorant in the room 3. Selecting a bag with an appropriate-size stomal opening 4. Wearing sterile, nonlatex gloves when caring for the stoma

3. Selecting a bag with an appropriate-size stomal opening

A nurse should use a fracture bedpan for clients with which condition? Select all that apply. 1. _____ Below the knee amputation 2. _____ Peripheral vascular disease 3. _____ Spinal cord injury 4. _____ Dementia 5. _____ Obesity

3. _____ Spinal cord injury

Which should the nurse do before collecting a stool sample for occult blood? 1. Plan to collect the first specimen of the day. 2. Obtain a sterile specimen container. 3. Wash the client's perianal area. 4. Ask the client to void.

4. Ask the client to void.

A client is admitted with lower gastrointestinal tract bleeding. Which characteristic of the client's stool should the nurse assess for that supports this medical diagnosis? 1. Tarry stool 2. Orange stool 3. Green mucoid stool 4. Bright red-tinged stool

4. Bright red-tinged stool

A nurse is assessing a client who has a distended abdomen resulting from flatulence. The client has a prescription for a regular diet and an activity prescription for "out of bed." Which can the nurse do to promote passage of the intestinal gas? 1. Instruct the client to increase the amount of fluid intake. 2. Suggest that the client avoid cruciferous foods. 3. Obtain a prescription for a laxative. 4. Encourage the client to ambulate.

4. Encourage the client to ambulate.

While providing a health history, the client tells the nurse, "I have gastroesophageal reflux disease." Which most serious consequence associated with this disorder should the nurse anticipate this client may develop? 1. Diarrhea 2. Heartburn 3. Gastric fullness 4. Esophageal erosion

4. Esophageal erosion

A nurse is teaching a client with a cardiac condition to avoid the Valsalva maneuver. Which should the nurse teach the client to do? 1. Eat rice several times a week. 2. Take a cathartic on a regular basis. 3. Attempt to have a bowel movement every day. 4. Exhale while contracting the abdominal muscles.

4. Exhale while contracting the abdominal muscles.

A primary health-care provider prescribes a return-flow enema (Harris flush/Harris drip) for an adult client with flatulence. When preparing to administer this enema, the nurse compares the steps of a return-flow enema with those for cleansing enemas. Which nursing intervention is unique to a return-flow enema? 1. Lubricate the last 2 inches of the rectal tube. 2. Insert the rectal tube about 4 inches into the anus. 3. Raise the solution container about 12 inches above the anus. 4. Lower the solution container after instilling about 150 mL of solution.

4. Lower the solution container after instilling about 150 mL of solution.

Which should the nurse do when administering a small-volume hypertonic enema to an adult? 1. Insert the rectal tube 1 to 1.5 inches into the anal canal. 2. Position the enema bottle 12 inches above the level of the client's anus. 3. Direct the rectal tube toward the vertebrae as it is inserted into the rectum. 4. Maintain the compression of the enema container until after withdrawing the tube.

4. Maintain the compression of the enema container until after withdrawing the tube.

A nurse is performing a physical assessment of a client concerning the gastrointestinal system. Place the following interventions in the order in which they should be performed. 1. Palpate the abdomen. 2. Inspect the anus and perianal area visually. 3. Percuss the abdomen for the quality of sounds. 4. Auscultate the entire abdomen for bowel sounds. 5. Observe the contour and symmetry of the abdomen. Answer: _______________________

5. Observe the contour and symmetry of the abdomen. 2. Inspect the anus and perianal area visually. 4. Auscultate the entire abdomen for bowel sounds. 3. Percuss the abdomen for the quality of sounds. 1. Palpate the abdomen.

A primary health-care provider prescribes docusate sodium in liquid form for a client who is constipated but has difficulty swallowing tablets. The prescription is for 200 mg daily to be divided into two doses, one in the a.m. and one at hour of sleep. The package insert states that there is 50 mg/5 mL. How much solution of docusate sodium should the nurse administer per dose? Record your answer using a whole number. Answer: _______________________ mL.

50x = (100)(5) 5x = 500 x = 500/5 = 10 mL