Ch. 35 Bowel Elimination

A nurse is documenting the appearance of feces from a client with a permanent ileostomy. Which scenario would she document? -"Ileostomy bag half filled with liquid feces." -"Ileostomy bag half filled with hard, formed feces." -"Colostomy bag intact without feces." -"Colostomy bag filled with flatus and feces."

"Ileostomy bag half filled with liquid feces."

The home care nurse visits a client and is reviewing the medications that the client uses. Which medication would the nurse identify as acting directly on the intestine to slow bowel motility, or to absorb excess fluid in the bowel? -Antiflatulence agent -Antidiarrheal agent -Laxative -Suppository

Antidiarrheal agent

A nurse is providing home care for a middle-aged client with fecal incontinence. Friends have come to visit the client, but the client avoids meeting with them. Which action can the nurse take to best address the client's avoidance behavior? -Provide adult briefs to mask the client's problem. -Ask open-ended questions to elicit why the client is avoiding friends. -Utilize air fresheners when the client's friends are present. -Have the client use the toilet before friends are scheduled to visit.

Ask open-ended questions to elicit why the client is avoiding friends.

The nurse is administering a cleansing enema when the client reports cramping. What is the appropriate nursing action? -Discontinue the administration of the enema -Remove the tubing. -Continue infusing at a faster rate to finish the enema quicker. -Clamp the tube for a brief period and resume at a slower rate.

Clamp the tube for a brief period and resume at a slower rate.

A nurse is providing care to a client who has undergone a colonoscopy. What would be most appropriate for the nurse to do after the procedure? -Avoid giving solid food. -Administer a laxative to the client. -Monitor for rectal bleeding. -Limit oral fluid intake.

Monitor for rectal bleeding.

A client has been prescribed a nasogastric tube placed to low wall suction, due to reduced peristalsis. The nurse will prepare for the procedure by measuring the nasogastric tube for the appropriate length. What is the proper way to measure length of ng tube.

The nurse will first measure from the tip of the NOSE then to the EARLOBE and then finally to the XIPHOID PROCESS.

A nurse is caring for a client with constipation. The incidence of constipation tends to be high among clients who follow which diet? -a diet lacking in fruits and vegetables -a diet lacking in glucose and water -a diet lacking in refined grains, seeds, and nuts -a diet lacking in meat and poultry products

a diet lacking in fruits and vegetables

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? -saline -mineral oil -water and mild soap -alcohol-based sanitizer

water and mild soap

A nurse is assessing the stools of a breast-fed baby. What is the appearance of normal stools for this baby? -yellow, loose, odorless -brown, paste-like, some odor -brown, formed, strong odor -black, semiformed, no odor

yellow, loose, odorless

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? -"Auscultated abdomen for bowel sounds. Bowel not functioning." -"All four abdominal quadrants auscultated. Inaudible bowel sounds." -"Bowel sounds auscultated. Client has no bowel sounds." -"Client may have bowel sounds, but they can't be heard."

"All four abdominal quadrants auscultated. Inaudible bowel sounds."

The nurse in an outpatient provider's office is caring for a client with persistent flatus. Which client teaching will the nurse provide as to why some foods cause flatus? -"Certain vegetables can cause flatus, as they are more difficult to digest." -"Parasites in your stool can cause persistent flatus." -"Drinking alcoholic beverages can cause flatus." -"Flatus is a natural action and the cause is unknown."

"Certain vegetables can cause flatus, as they are more difficult to digest."

When caring for a client with fecal incontinence, the client shares feelings of embarrassment. Which statement will the nurse use to respond? -"You can stop this by changing the nature and amount of food consumed." -"This is caused by your drinking and smoking habits." -"Neurologic changes that impair muscle activity in your body can cause incontinence." -"This is happening because you are going through a difficult time."

"Neurologic changes that impair muscle activity in your body can cause incontinence."

A hospitalized toddler, previously bowel trained, has been having incontinent stools. What would the nurse tell the parents about this behavior? -"When he does this, scold him and he will quit." -"I don't understand why this child is losing control." -"This is normal when a child this age is hospitalized." -"I will have to call the doctor and report this behavior."

"This is normal when a child this age is hospitalized."

The nurse is teaching a client with rectal bleeding about fecal occult blood test (FOBT) testing supplies. What teaching will the nurse provide? -"This test will determine whether foods are contributing to rectal bleeding." -"This test will show if you have colorectal cancer." -"This test will show if you have an infection in the bowel." -"This test detects heme, a type of iron compound in blood in the stool."

"This test detects heme, a type of iron compound in blood in the stool."

A client with no significant medical history reports experiencing diarrhea over the past week. Which assessment question(s) will the nurse ask? Select all that apply. -"Have you started a new medication?" -"What are your normal bowel habits?" -"Are you experiencing rectal fullness?" -"Do you use laxatives?" -"Is the stool difficult to pass?"

-"Have you started a new medication?" -"What are your normal bowel habits?" -"Do you use laxatives?"

The nurse is checking the placement of a nasogastric tube and aspirates for gastric contents. The nurse checks the pH of the aspirate and determines that the tube is in the stomach when she gets which pH measurement? -8 -7 -6 -5

-5

The nurse is performing digital removal of a fecal impaction. Which nursing actions follow guidelines for this procedure? Select all that apply. -Have the client lie on his stomach and pie-fold top linens over him. -Place the client in a side-lying position. -Vigorously work the finger around and into the hardened mass to break it up. -Use nonsterile gloves for the procedure because the intestinal tract is not sterile. -Use a cleansing enema if necessary. -Provide a sitz bath or tub bath after the procedure to soothe the perianal area

-Place the client in a side-lying position. -Use nonsterile gloves for the procedure because the intestinal tract is not sterile. -Provide a sitz bath or tub bath after the procedure to soothe the perianal area

A client with constipation has been instructed to increase the intake of foods high in fluid. Which food(s) will the nurse include in the client's education? Select all that apply. -Watermelon -Strawberries -Cantaloupe -Lettuce -Cucumber

-Watermelon -Strawberries -Cantaloupe -Lettuce -Cucumber

The nurse is evaluating stool characteristics of an adult client. Which of the following would describe a normal stool? Select all that apply. -dark brown -light brown -black -clay colored -yellow

-dark brown -light brown

The nurse is reviewing the care plan of a client and notes a risk for altered bowel elimination. For each assessment finding, specify which alteration in bowel function the finding is consistent with. Each finding may be consistent with more than 1 alteration. 1. AsConstipation 2. Impaction 3. Distention -reports of abdominal fullness -feelings of an inability to pass stool -straining with deficiation -inability to voluntarily evacuate stool -incontinence of liquid stool

-reports of abdominal fullness 1,2,3 -feelings of an inability to pass stool 2,3 -straining with deficiation 1 -inability to voluntarily evacuate stool 2 -incontinence of liquid stool 2

A nurse is preparing to administer a large-volume enema to a client. The client and enema have been prepared. Place the following steps in the order in which the nurse would perform them. 1. Gently insert the tube directing the tip toward the umbilicus. 2. Open the clamp on the solution tubing while holding the tube in the rectum. 3. Separate the buttocks to visualize the anus. 4. Have the client take a slow, deep breath. 5. Lubricate 2 to 3 in (5 to 8 cm) of the tip of the rectal tube with water-soluble lubricant.

5. Lubricate 2 to 3 in (5 to 8 cm) of the tip of the rectal tube with water-soluble lubricant. 3. Separate the buttocks to visualize the anus. 4. Have the client take a slow, deep breath. 1. Gently insert the tube directing the tip toward the umbilicus. 2. Open the clamp on the solution tubing while holding the tube in the rectum.

The nurse is providing health teaching for four clients. Which client should consider a colonoscopy screening? -33-year-old client who reports painful elimination -42-year-old client with diarrhea twice weekly -50-year-old client with a family history of polyps -67-year-old client with constipation

50-year-old client with a family history of polyps

The nurse is caring for a client with a stoma that is pink in color and dry. Which action will the nurse take? -Dry the stoma regularly. -Observe the stoma to prevent moistening. -Apply petroleum-based ointment. -Cleanse with alcohol-based products.

Apply petroleum-based ointment.

A client is preparing for a fecal occult blood test. What teaching will the nurse provide regarding vitamin C three days before testing? -Take 500 mg -Consume citrus fruits -Drink orange and grapefruit juice -Avoid more than 250 mg

Avoid more than 250 mg

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. -Corn is high in sucrose, which is an insoluble fiber that the body cannot digest. -Corn is high in lactose, which is an insoluble fiber that the body cannot digest. -Corn is high in galactose, which is an insoluble fiber that the body cannot digest.

Corn is high in cellulose, which is an insoluble fiber that the body cannot digest.

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. -Nurses find the procedure distasteful and difficult to perform. -Most clients will not consent to have digital removal of stool. -It often causes rebound diarrhea and electrolyte loss.

Digital removal of stool may cause parasympathetic stimulation.

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. -Apply continuous suction to the nasogastric tube during assessment of bowel sounds. -Allow the low intermittent suction to continue during the assessment of bowel sounds. -Disconnect the nasogastric tube from the suction for 1 hour prior to the assessment of bowel sounds.

Disconnect the nasogastric tube from suction during the assessment of bowel sounds.

A nurse is providing discharge instructions for a client with a new colostomy. Which is a recommended guideline for long-term ostomy care? -During the first 6 to 8 weeks after surgery, eat foods high in fiber. -Drink at least 2 quarts (1.9 L) of fluids, preferably water, daily. -Use enteric-coated or sustained-release medications if needed. -Use a mild laxative if needed.

Drink at least 2 quarts (1.9 L) of fluids, preferably water, daily.

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 ingests a gallon of bowel cleanser, such as polyethylene glycol electrolyte solution, in a short period of time. -Inform client that a chalky-tasting barium contrast mixture will be given to drink before the test. -Provide a light meal before the test and administer two Fleet enemas. -Ensure that the client fasts 6 to 12 hours before the test as per policy.

Ensure that the client fasts 6 to 12 hours before the test as per policy.

A nurse is scheduling diagnostic studies for a client. Which test would be performed first? -Fecal occult blood test -Barium study -Endoscopic exam -Upper gastrointestinal series

Fecal occult blood test

Which statement about ostomy irrigation is true? -For some clients, regularly scheduled colostomy irrigation can be used to establish a predictable pattern of elimination. -Daily irrigation is necessary to assure passage of stool from an ileostomy. -Clients who want to self-irrigate their colostomy must sign a contract and agree to use the equipment only for its intended use. -Postoperative ostomy prolapse can be avoided by twice daily irrigation for the first 4 weeks after surgery.

For some clients, regularly scheduled colostomy irrigation can be used to establish a predictable pattern of elimination.

A nurse is assessing a client with constipation and severe rectal pain. Which action should the nurse perform to determine the presence of fecal impaction? -Insert a lubricated, gloved finger into the rectum. -Obtain a sharp intestinal x-ray. -Insert a lubricated rectal tube into the rectum. -Administer an oil retention enema into the rectum.

Insert a lubricated, gloved finger into the rectum.

The following foods are a part of a client's daily diet: high-fiber cereals, fruits, vegetables, ten 8-oz glasses (2,500 mL) of fluids. What would the nurse tell the client to change? -Decrease high-fiber foods. -Decrease amount of fluids. -Omit fruits if eating vegetables. -Nothing; this is a good diet.

Nothing; this is a good diet.

A nurse is assisting a client when he is draining a continent ileostomy. The catheter suddenly becomes plugged with stool. Which action should the nurse take to rectify the problem? -Avoid milking the catheter. -Wait for 8 hours to obtain drainage. -Avoid removing the catheter. -Rotate the catheter tip inside the stoma.

Rotate the catheter tip inside the stoma.

The nurse is teaching a client how to change an ostomy appliance. After removing the existing pouch, which action will the nurse teach next? -Measure the stoma using a stomal guide. -Fold and clamp bottom of pouch. -Attach new pouch to the ring of the faceplate. -Shower, bathe, or wash peristomal area with mild soapy water.

Shower, bathe, or wash peristomal area with mild soapy water.

The nurse is inserting a rectal tube to administer a large-volume enema. Which nursing action is performed correctly in this procedure? -Position the client on his back and drape properly. -Slowly and gently insert the enema tube 3 to 4 in (7.5 to 10 cm) for an adult. -Introduce solution quickly over a period of 3 to 5 minutes. -Encourage the client to hold the solution for at least 20 minutes.

Slowly and gently insert the enema tube 3 to 4 in (7.5 to 10 cm) for an adult.

A client is having difficulty having a bowel movement on the bedpan. What is the physiologic reason for this problem? -It is painful to sit on a bedpan. -The position does not facilitate downward pressure. -The position encourages the Valsalva maneuver. -The cause is unknown and requires further study.

The position does not facilitate downward pressure.

A nurse assessing a client with an ostomy appliance documents the condition "prolapse" in the client chart and notifies the physician. Which of statement describes this condition? -The peristomal skin is excoriated or irritated because the appliance is cut too large. -The system has leaks or poor adhesion leading to noticeable odor. -The bag continues to come loose and become inverted. -The stoma is protruding into the bag and may become twisted.

The stoma is protruding into the bag and may become twisted.

While caring for an infant who is breast-fed, the nurse assesses the characteristics of the stools. The nurse is teaching the mother about infant care. What are characteristics of the stool the nurse would expect to assess and teach the mother in breast-fed infants? -The stool will be yellow to golden and loose. -The stool with be dark brown and firm in texture. -The stool will be a yellow-brown color and pasty. -The stool with be green and have much mucus present.

The stool will be yellow to golden and loose.

A nurse is teaching a client how to change his ostomy appliance. Which instructions should be incorporated into the teaching plan? -Gently remove the pouch faceplate from the skin by pulling the appliance from the skin. -If the appliance is reusable, set it aside to wash it with alcohol and allow it to air dry. -Use toilet tissue to remove any excess stool from the stoma. -Apply skin protectant to a 6-in (15-cm) radius around the stoma, and allow it to dry completely for 10 minutes.

Use toilet tissue to remove any excess stool from the stoma.

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 water only. -Use alcohol-based sanitizer. -Use water and mild soap. -Use mineral oil.

Use water and mild soap

A nurse is assessing the stoma of a client with an ostomy. Which intervention should the nurse perform when providing peristomal care to the client to preserve skin integrity? -Wash it with a mild cleanser and water. -Avoid using commercial skin preparations. -Clean it with a dry, cotton bandage. -Avoid applying a barrier substance.

Wash it with a mild cleanser and water.

Which action taken by the nurse while collecting a stool sample has the greatest impact on minimizing risk? -Using a tongue depressor to access stool -Taking sample directly from commode insert -Wearing disposable gloves -Not removing commode insert from commode

Wearing disposable gloves

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 -a client with hypertension who takes a diuretic and adrenergic blocker each morning -a client who has a history of atrial fibrillation requiring daily anticoagulants -a woman 59 years of age who has recently begun hormone replacement therapy

a client whose neuropathic pain requires multiple doses of opioids each day

What is fecal occult blood? -bright red visible blood -dark black visible blood -blood that contains mucus -blood that cannot be seen

blood that cannot be seen

A student nurse studying human anatomy knows that a structure of the large intestine is the: -duodenum -jejunum -ileum -cecum

cecum

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? -barium studies, endoscopic examination, fecal occult blood test -fecal occult blood test, barium studies, endoscopic examination -barium studies, fecal occult blood test, endoscopic examination -endoscopic examination, barium studies, fecal occult blood test

fecal occult blood test, barium studies, endoscopic examination

A 60-year-old client is experiencing pain that can be attributed to distention of the veins in her rectum. What health problem is this client most likely experiencing? -hemorrhoids -diarrhea -paralytic ileus -constipation

hemorrhoids

A client's last bowel movement was 4 days ago and oral laxatives and dietary changes have failed to prompt a bowel movement. How should the nurse position the client in anticipation of administering a cleansing enema? -left side-lying -prone -right side-lying -supine

left side-lying

A nurse is administering a prescribed solution of cottonseed oil to a client during an enema. What is the outcome of the use of cottonseed? -distends rectum and moistens stool -distends rectum and irritates local tissue -irritates local tissue -lubricates and softens stool

lubricates and softens stool

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? -water -soap -normal saline -oil

oil

A nurse is performing an abdominal assessment of a client before administering a large-volume cleansing enema. Which assessment technique would be performed last? -palpation -percussion -auscultation -inspection

palpation

When preparing to administer a large cleansing enema to a client, which solution does the nurse gather? -tap water -mineral oil -soap and water -hypertonic saline

tap water