BOWEL ELIMINATION

A nurse is caring for a client who reports having chronic constipation. Which of the following herbal supplements should the nurse recommend? A. Ginseng B. Coenzyme Q-10 C. Cranberry juice D. Flaxseed

Flaxseed The nurse should recommend the client use flaxseed to treat constipation, which is a high-fiber product.

A nurse is providing instructions about bowel cleansing with polyethylene glycol-electrolyte solution (PEG) for a client who is going to have a colonoscopy. Which of the following information should the nurse include? A. "To prevent dehydration, drink an additional liter of fluid during preparation time." B. "Expect bowel movements to begin 3 hr following completion of solution." C. "Abdominal bloating might occur." D. "Drink 400 mL every hour until bowel movements are clear."

"Abdominal bloating might occur." While PEG is well-tolerated, adverse effects include nausea, bloating, and abdominal discomfort.

A nurse is providing instructions for a 52 year old client who is scheduled for a colonoscopy. The client reports that he has not had the procedure before and is very anxious about feeling pain during the procedure. Which of the following responses by the nurse is appropriate? A. "Don't worry; most clients dislike the prep more than the procedure itself." B. "Before the examination, your provider will give you a sedative that will make you sleepy." C. "I know you're anxious, but this procedure is recommended for people your age." D. "After you have signed the consent form, we can talk more about this."

"Before the examination, your provider will give you a sedative that will make you sleepy." This therapeutic response appropriately addresses the client's concerns. The client is seeking information and this response provides the client with accurate information. It can also lead to further discussion about the procedure.

A nurse is caring for a client following the surgical placement of a colostomy. Which of the following statements indicates the client understands the dietary teaching? A. "Eating yogurt can help decrease the amount of gas that I have." B. "I should eliminate pasta from my diet so that I don't have as many loose stools." C. "My largest meal of the day should be in the evening." D. "Carbonated beverages can help control odor."

"Eating yogurt can help decrease the amount of gas that I have." The client who has a colostomy can include yogurt into his diet to help reduce odors and intestinal gas.

A nurse is teaching a client about which foods she should include in her low-fiber diet. Which of the following statements indicate the client understands the teaching? A. "A fresh pear would be a good snack option." B. "I can prepare refried beans for supper." C. "Bran cereal would be a good breakfast choice." D. "I should choose white rice as a side dish."

"I should choose white rice as a side dish." White rice is a refined grain and has less fiber than whole or unrefined grains. The client can include white rice as part of a low-fiber diet.

A nurse is providing teaching to a client who has a new colostomy. Which of the following information should the nurse include in the teaching? A. "You can expect fecal output within 24 hours." B. "You will need to increase your dietary intake of raw vegetables." C. "You can expect the stoma to be purplish in color for the first week." D. "You may experience a small amount of bleeding around the stoma."

"You may experience a small amount of bleeding around the stoma." A small amount of bleeding around the stoma and its stem can occur. However, the client should report an increase in bleeding to the surgeon.

A nurse is teaching a group of adults about nutrition. The nurse should include which of the following amounts as an appropriate daily intake of fiber for adult women? A. 5 to 10 g B. 10 to 15 g C. 20 to 35 g D. 40 to 50 g

20 to 35 g The Adequate Intake (AI) for total fiber for women is 20 g per day; therefore, 10 g would not be adequate.

A nurse is assisting a group of clients in an outpatient clinic. For which of the following clients should the nurse anticipate scheduling a colonoscopy? A. 56-year-old who had a colonoscopy 6 years ago B. 34-year-old who reports a new onset of constipation C. 32-year-old who has a sister who died of colon cancer D. 51-year-old who is being seen for an annual physical examination

51-year-old who is being seen for an annual physical examination Colorectal cancer (CRC) is not common prior to the age of 40 years. When an adult turns 40, the provider should begin screening the client for risk factors of CRC (e.g., family history, inflammatory bowel disease, tobacco and alcohol use, high-fat and low-fiber diet, diet high in animal fats and red meat, sedentary lifestyle). The provider also may begin fecal occult blood testing depending on the client's risk. Screening colonoscopies are recommended starting at age 50 for those clients considered to be at normal risk with no family history and repeated every 10 years. It may begin earlier and performed more often for clients at high risk.

A nurse is preparing to administer a soapsuds enema to an adult client. Which of the following actions should the nurse take? A. Put on sterile gloves. B. Assist the client to the left Sims' position. C. Hang the enema container 60 cm (24 in) above the anus. D. Insert the tubing about 15 cm (6 in) into the anus.

Assist the client to the left Sims' position. This position makes it easier for the enema solution to flow by gravity into the sigmoid and descending colon. The nurse should also have the client's right leg flexed to facilitate insertion.

A nurse is caring for a client who has a prescription for a stool test for guaiac. The nurse understands the purpose of the test is to check the stool for which of the following substances? A. Steatorrhea B. Blood C. Bacteria D. Parasites

Blood A guaiac test detects the presence of occult or hidden blood in the stool. The guaiac test is an extremely useful diagnostic screening test for the presence of colon cancer and gastrointestinal ulcers.

A nurse is preparing to administer a soap suds enema to a client who has constipation. As the nurse explains the procedure, the client states, "The doctor didn't tell me I was supposed to receive an enema." Which of the following nursing actions is appropriate at this time? A. Check the client's medical record for the provider's prescription. B. Explain to the client that the provider prescribed the procedure. C. Assure the client that enemas are commonly prescribed for constipation. D. Inform the charge nurse that the client refused the enema.

Check the client's medical record for the provider's prescription. The nurse should use the client's medical record to verify the provider prescribed an enema for the client.

A nurse is caring for a client who is about to have a colonoscopy. The client states, "I am so nervous about what the doctor might find during the test." The nurse asks the client, "Are you feeling anxious about the results of your colonoscopy?" With this question, the nurse is using which of the following communication techniques? A. Clarification B. Summarizing C. Confrontation D. Providing information

Clarification Clarifying verifies whether the sender's message is clear and accurate.

A nurse is teaching a client who has a prescription of a NG to treat a pyloric obstruction. Which of the following rationales for the use of the nasogastric tube should the nurse include in the teaching? A. Determine the pH of the gastric secretions. B. Supply nutrients via tube feedings. C. Decompress the stomach. D. Administer medications.

Decompress the stomach. A pyloric obstruction, also called gastric outlet obstruction, is caused by edema, scarring, or spasm, often the result of gastritis or peptic ulcer disease. The nurse should inform the client that because the stomach is dilated and may contain undigested food, it must be decompressed, necessitating the placement of an NG tube.

A nurse is completing dietary teaching on consuming a low fiber diet with a client who has ulcerative colitis. Which of the following foods should be eliminated in the client's diet? A. Cooked cabbage B. Dried apricots C. Ripe bananas D. Ice cream

Dried apricots A nurse should instruct a client who has ulcerative colitis to consume a diet low in fiber and should eliminate dried apricots from his diet. Dried apricots are high in fiber and may cause an exacerbation of the client's disease process.

A nurse is caring for an older adult client. The nurse informs the client that straining while defecating can cause which of the following? A. Dilated pupils B. Dysrhythmias C. Diarrhea D. Gastric ulcer

Dysrhythmias Dysrhythmias can result from straining while defecating. Pressure can be exerted with the Valsalva maneuver, when the client contracts the abdominal muscles and holds their breath while bearing down. When the client exhales, there is a sudden release of intraabdominal pressure against the closed airway, which can result in cardiac dysrhythmias and elevated blood pressure.

A nurse is teaching a client who has constipation. Which of the following should the nurse discuss as causes of constipation? SATA A. Excessive laxative use B. Ignoring the urge to defecate C. Inadequate fluid intake D. Increased fiber in the diet E. Increased activity

Excessive laxative use is correct. Chronic use of laxatives causes the large intestine to lose muscle tone and become less responsive to stimulation by laxatives. Ignoring the urge to defecate is correct. Anything that prevents the client from responding to the urge to defecate and disrupts regular habits can cause alterations in bowel habits, such as constipation. Inadequate fluid intake is correct. Reduced fluid intake slows the passage of food through the intestine and can result in hardening of stool. Increased fiber in the diet is incorrect. Increased fiber promotes more efficient bowel emptying. Increased activity is incorrect. Increased activity promotes bowel emptying.

A nurse is preparing to administer a cleansing enema to a client. Which of the following actions should the nurse take? A. Keep the container of solution at a level to maintain client comfort. B. Hold the container of solution 30 cm (12 in) above the anus. C. Hold the container of solution level with the client's upper hip. D. Hold the container of solution 15 cm (6 in) above the anus, then lower it 15 cm below the

Hold the container of solution 30 cm (12 in) above the anus. The nurse should hold the container of solution 30 to 45 cm (12 to 18 in) above the anus when administering a cleansing enema to allow for a continuous, slow instillation of solution to promote evacuation of feces in the bowel.

A nurse is teaching a client who has constipation about a high-fiber diet. Which of the following foods should be included as sources of fiber? A. Kidney beans B. Blackberries C. Refined cereals D. Whole wheat bread E. Lean turkey

Kidney beans is correct. Kidney beans should be included in the teaching as a source of fiber. Blackberries is correct. Blackberries should be included in the teaching as a source of fiber. Refined cereals is incorrect. Whole grain cereals, not refined cereals, should be included in the teaching as a source of fiber. Whole wheat bread is correct. Whole wheat bread should be included in the teaching as a source of fiber. Lean turkey is incorrect. Lean turkey is a source of complete protein, but should not be included in the teaching as a source of fiber.

A nurse is administering a tap water enema to a client who is constipated. During the administration of the enema, the client states he is having abdominal cramps. Which of the following actions should the nurse take to relieve the client's discomfort? A. Lower the height of the solution container. B. Encourage the client to bear down. C. Allow the client to expel some fluid before continuing. D. Stop the enema and document that the client did not tolerate the procedure.

Lower the height of the solution container. If nausea or cramping occurs, the flow of water should momentarily be slowed or stopped by lowering the device or clamping the tubing. This allows the intestinal spasm to pass while leaving the catheter in place. The nurse should then continue administering the enema at a slower rate once the cramping has passed.

A nurse in a PACU is assessing a client who has a newly created colostomy. Which of the following findings should the nurse report to the provider? A. Stoma oozing red drainage B. Shiny, moist stoma C. Purplish-colored stoma D. Rosebud-like stoma orifice

Purplish-colored stoma A stoma that is purplish in color indicates ischemia. The nurse should notify the provider immediately.

A nurse is caring for a client who needs a stool specimen collected. Which of the following actions should the nurse take when obtaining the specimen? A. Use a sterile swab to obtain the specimen. B. Place the specimen in a sterile container. C. Label the paper bag in which specimen container is placed. D. Send specimen container immediately to the lab.

Send specimen container immediately to the lab. The nurse should label the specimen contain and send it immediately to the laboratory. A delay in transport can result in altered laboratory findings.

A nurse is administering a cleansing enema to a client who reports mild cramping. The client asks the nurse to stop the enema and allow him to go to the bathroom. Which of the following actions should the nurse take? A. Discontinue the enema. B. Slow the flow of enema solution briefly. C. Continue the enema and reassure the client. D. Pause the enema and administer oral pain medication.

Slow the flow of enema solution briefly. Slowing the enema solution flow temporarily prevents cramping.

A nurse is teaching a group of middle adult clients about early detection of colorectal cancer. The nurse should include the American Cancer Society recommendation that men and women beginning at age 50 who are at average risk should have a fecal occult blood test (FOBT) and a colonoscopy at which of the following intervals? A. Five years B. Ten years C. One year D. Two years

Ten years Ten years is the recommended interval for colonoscopy screening for clients who have an average risk.

A nurse is assessing a client who received IV conscious sedation for a colonoscopy. Which of the following findings indicated that the client is ready for discharge? A. The client is restless. B. The client is cooperative and oriented. C. The client shows a brisk response to stimulus. D. The client shows a sluggish response to stimulus.

The client is cooperative and oriented. A client who is cooperative, oriented, and calm will have a Ramsay Sedation score of 2, which indicates the client has recovered adequately to go home with a responsible adult.

A nurse is preparing a teaching plan for a client who has chronic constipation secondary to irregular bowel habits. Which of the following should the nurse plan to include in the teaching? A. The client should drink two to three 8 oz glasses of water each day. B. The client should follow a high-fiber diet to establish bowel regularity. C. The client should try to take in all of the required dietary fiber with the morning meal. D. The client should be taught that the goal of therapy is to have a bowel movement daily.

The client should follow a high-fiber diet to establish bowel regularity. The client who has chronic constipation should consume a diet with high-fiber food sources, including bran and complex carbohydrates.

A nurse is assessing a client who has a colostomy. Which of the following findings should the nurse report to the provider? A. The stool is yellow-green. B. The ostomy is draining frequently. C. The stoma is pale in color. D. The skin around the stoma is red.

The stoma is pale in color. The stoma should be pinkish to cherry red in color, which indicates an adequate blood supply. If the stoma becomes pale, bluish, or dark, the nurse should report this finding to the provider immediately

A nurse is implementing a bowel training program for a client. For the program to be effective, the nurse should take the client to the toilet at which of the following times? A. When the client has the urge to defecate B. Every 2 hr while the client is awake C. Immediately before the client has a meal D. After the client feels abdominal cramping

When the client has the urge to defecate When on a bowel training program, the nurse should take the client to the toilet when the client recognizes the urge to defecate. A bowel training program focuses on identifying times in the client's bowel pattern to promote self-control of defecation.

A nurse is creating a plan of care to maintain the skin integrity of a client who experiences frequent diarrhea due to ulcerative colitis. Which of the following interventions should the nurse include in the plan? A. Soak in a sitz bath for 20 min after each stool. B. Administer a soap-suds enema to cleanse the colon. C. Cleanse with antimicrobial scrub and vigorously dry. D. Wipe perianal area with warm water and apply a barrier cream

Wipe perianal area with warm water and apply a barrier cream The nurse should instruct the client to wipe the perianal area and apply a barrier cream to decrease skin breakdown when in contact with fecal material.

A nurse is teaching an older adult client who reports constipation. Which of the following instructions should the nurse include in the teaching? A. Bear down hard when defecating. B. Drink four to five glasses of water daily. C. Increase dietary intake of raw vegetables. D. Limit activity.

ncrease dietary intake of raw vegetables. The client should increase dietary intake of raw vegetables to help provide fiber in the diet, which will increase stool bulk and move the stool through the colon to prevent constipation.