Ch 39 Bowel Elimination PrepU

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." Explanation: Flatus is gas in or from the stomach or intestines that is passed through the anus. Foods that contain high amounts of fiber, such as vegetables, commonly produce flatus due to being harder to digest. Flatus is not likely related to a parasitic infection or drinking alcoholic beverages.

The nurse needs to collect stool for occult blood testing from an 8-month-old client. The parent asks if the specimen for testing can be collected from the child's diaper. What is the best response by the nurse? "Stool cannot be collect from a child's diaper." "Stool can be collected only from a cloth diaper." "It depends on which testing developer is used." "Only if the stool has not been contaminated by urine."

"Only if the stool has not been contaminated by urine." Explanation: Stool can be collected from a diaper for occult blood testing only if the stool has not been contaminated by urine. It does not matter whether the diaper is disposable or cloth. The type of developer does not make a difference as all are used to test for occult blood.

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 will determine what foods you are allergic to that affect digestion and elimination." "This test gives the healthcare provider a very accurate indication about whether you may have colorectal cancer." "This test detects heme, an iron compound in blood within the stool." "This test will help determine whether you have an infectious process in the intestines."

"This test detects heme, an iron compound in blood within the stool." Explanation: The nurse will teach that the FOBT detects heme. It does not test for allergic foods, nor does it test for infection. The fecal immunochemical test (FIT) test results have a high rate of specificity for colorectal cancer.

A nurse is following a health care provider's order to irrigate a client's NG tube. Which guideline is recommended in this procedure? Assist the client to a 30- to 45-degree position, unless this is contraindicated. Draw up 60 mL of saline solution (or amount indicated in the order or policy) into syringe. If Salem Sump or double-lumen tube is used, make sure that syringe tip is placed in the blue air vent. If unable to irrigate the tube, remove it and obtain an order for replacement.

Assist the client to a 30- to 45-degree position, unless this is contraindicated. Explanation: To irrigate an NG tube, assist the client to 30- to 45-degree position, unless this is contraindicated. Pour the irrigating solution into the container and draw up 30 mL of saline solution (or amount indicated in the order or policy) into the syringe. If a Salem Sump or double-lumen tube is used, make sure that syringe tip is placed in the drainage port and not in the blue air vent. If unable to irrigate the tube, reposition the client and attempt irrigation again. Inject 10 to 20 mL of air and aspirate again.

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? Turn off the suction for 30 minutes and then turn it on again. Attempt to irrigate the NG tube with water or normal saline. Instill digestive enzymes, as ordered. Remove the NG tube and replace it with a larger-bore tube, as ordered.

Attempt to irrigate the NG tube with water or normal saline. Explanation: An NG tube that is not draining should normally be irrigated. Turning the suction off and on is less likely to be effective, and it may be unsafe to leave the suction turned off for half an hour. Digestive enzymes are not used on NG tubes that are used for suction. Removing the NG tube would be an action of last resort.

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 Explanation: The nurse will teach the client to avoid taking more than 250 mg of vitamin C two to three days before testing, and not to consume citrus fruits or juices. Therefore, the other answers are incorrect.

Removal of a client's NG tube has been ordered. Which action should the nurse perform during this intervention? Place the client in a protective supine position to facilitate easy removal. Before removing the tube, discontinue suction and separate the tube from suction. Attach a syringe and flush with 50 mL of water or normal saline before removal. Quickly and carefully remove tube while the client breathes out.

Before removing the tube, discontinue suction and separate the tube from suction. Explanation: When removing the tube, the nurse should discontinue the suction and separate the tube from suction to allow for its unrestricted removal. The client should be placed in a 30- to 45-degree position. The tube should be flushed with 10 mL of water or normal saline solution and should be removed as the client holds his or her breath.

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. Explanation: Cramping can occur with the administration of a cleansing enema. The nurse will clamp the tube for a brief period while the client takes deep breaths, and then resume the infusion, possibly at a slower rate. Other choices are incorrect, as these do not facilitate administration of the enema while providing comfort measures.

Which client will the nurse monitor most closely for signs and symptoms of constipation? Client who takes antihyperglycemics daily for type 2 diabetes Client whose hypertension is treated with an ACE inhibitor and diuretic Client with coronary artery disease who takes 81 mg ASA daily Client with anemia who is prescribed iron supplements

Client with anemia who is prescribed iron supplements Explanation: A common side effect of iron supplements is constipation. ASA, ACE inhibitors, diuretics and diabetes medications do not typically cause constipation.

A nurse is collecting a stool specimen of a client suspected of having Clostridioides difficile. Which guideline is recommended for this procedure? Collect 15 to 30 mL of the client's liquid stool. If portions of the stool include visible blood, mucus, or pus, discard the stool. If the specimen contains barium or enema solution, document this on the container. Refrigerate the specimen until it is cooled before sending it to the laboratory.

Collect 15 to 30 mL of the client's liquid stool. Explanation: Usually, 1 in (2.5 cm) of formed stool or 15 to 30 mL of liquid stool is sufficient; this client is more likely to have liquid stool. If portions of the stool include visible blood, mucus, or pus, include these with the specimen. Also be sure that the specimen is free of any barium or enema solution. Because a fresh specimen produces the most accurate results, send the specimen to the laboratory immediately.

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

cecum Explanation: The small intestine consists of the duodenum, jejunum, and ileum. The large intestine consists of the cecum, colon (ascending, transverse, descending, and sigmoid), and rectum.

A client has been diagnosed with a dental infection and been prescribed a course of clindamycin. The nurse will monitor for what potential change in bowel function? Diarrhea Constipation Fecal impaction Abdominal bloating

Diarrhea Explanation: A side effect of taking antibiotics such as clindamycin is diarrhea. Constipation, fecal impaction, and abdominal bloating are not common side effects of antibiotics.

A paraplegic man receives care in the rehabilitation facility. He confides in a nurse that he has trouble controlling his bowel movements. He tends to normally stool 6 to 8 times per day. This has caused the skin around his rectum to become irritated. Which is not an appropriate NANDA-I diagnosis for this client? Fecal Incontinence r/t decreased muscle tone and sphincter control Risk for Impaired Skin Integrity r/t fecal incontinence Risk for Disturbed Body Image r/t fecal incontinence Diarrhea r/t decreased muscle tone and sphincter control

Diarrhea r/t decreased muscle tone and sphincter control Explanation: This client is not currently experiencing diarrhea. He does not describe his stools as watery or loose. Rather, this client's problem is with control of the bowel.

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. Explanation: The procedure may stimulate a vagal response, which increases parasympathetic stimulation. The nurse does use digital removal as a last resort. It is an uncomfortable but necessary procedure for the client. Because clients are uncomfortable with fecal impaction, the client will consent for the procedure. Digital removal does not cause rebound diarrhea nor electrolyte loss.

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. Explanation: If the client has a nasogastric tube in place, disconnect it from the suction during this assessment to allow for accurate interpretation of sounds. Allowing the low intermittent to continue during the assessment will interfere with the auscultation of the sounds. Disconnect of the tube can occur immediately and not for 1 hour prior to the assessment.

The nurse is administering magnesium citrate to a client with constipation. What mechanism of action would the nurse expect from this drug? Chemical stimulation of peristalsis Softening of the fecal material Increasing intestinal bulk to enhance mechanical stimulation of the intestine Drawing water into the intestines to stimulate peristalsis

Drawing water into the intestines to stimulate peristalsis Explanation: Magnesium citrate increases intestinal bulk by drawing water into the intestine and stimulating peristalsis. Chemical stimulation of peristalsis is promoted by stimulants such as bisacodyl. The stimulant promotes peristalsis by irritating the intestinal mucosa or stimulating nerve endings in the intestinal wall. Emollients such as mineral oil lubricate the intestinal tract and retard colonic absorption of water, softening the stool, and making it easier to pass. Bulk forming agents, such as psyllium husk, increase intestinal bulk to enhance mechanical stimulation of the intestine.

A nurse is caring for a client recovering from abdominal surgery who is experiencing paralytic ileus. The client has a nasogastric tube connected to suction. How often should the nurse irrigate this tube? Every 8 to 10 hours Every 1 to 2 hours Nasogastric tubes should not be irrigated. Every 4 to 8 hours

Every 4 to 8 hours Explanation: The tube must be kept free from obstruction or clogging and is usually irrigated every 4 to 8 hours.

The nurse provides teaching to a client experiencing constipation. Which food choice on the client's breakfast tray indicates effective teaching? Lean ham Eggs Whole milk Grapefruit

Grapefruit Explanation: Constipation may be avoided, minimized, or eliminated with proper food selection. Citrus fruits, such as grapefruit, are good choices for a client with constipation as they are rich in soluble fiber pectin, which increases gastrointestinal motility. Meat and eggs are low in fiber. Fat in whole milk may be constipating.

Which principle should guide the nurse's collection of a fecal occult blood test? The nurse must assess the client's food and medication intake for the 2 weeks prior to the test. If the client is menstruating, the nurse should postpone the test until 3 days after the end of her period. Recent use of over-the-counter stool softeners can cause a false-positive result. The results of the test will preliminarily indicate the site of a client's bleeding.

If the client is menstruating, the nurse should postpone the test until 3 days after the end of her period. Explanation: In a woman who is menstruating, the test should be postponed until 3 days after her period has ended. Before stool testing, the client should avoid the foods (for 4 days) and drugs (for 7 days) that may alter test results; there is no need to assess for a 2-week window. Stool softeners do not confound the results of testing. Results indicate the presence of blood, but not its source.

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? Eat more cabbage and Brussel sprouts to decrease gas and add fiber. Drink a soft drink daily to prevent gas and allow fiber to break down. Increase fiber slowly over a period of time to prevent gas. Include more protein in the diet to increase fiber and decrease gas.

Increase fiber slowly over a period of time to prevent gas. Explanation: Vegetables such as cabbage, cucumbers, and onions are commonly known for producing gas. By introducing fiber over a period of time, the client can get used to fiber intake and note which foods cause more gas. Flatulence, or flatus, results from swallowing air while eating or sluggish peristalsis. Drinking soft drinks can increase gas and have no effect on fiber breakdown in the body. Another cause is the gas that forms as a byproduct of bacterial fermentation in the bowel. Protein does not produce gas that leads to flatus.

The nurse is assisting an older adult client into position for a sigmoidoscopy. In which position will the nurse place the client? Right lateral Left lateral Prone Semi-Fowler's

Left lateral Explanation: The left lateral or knee to chest position is the most common position for sigmoidoscopies or colonoscopies. If the client is not able to tolerate this position, Sims' position may also be used. The right lateral, prone or semi-Fowler's positions are not routinely used for this procedure.

The nurse is administering a large-volume enema to a client as prescribed. The client reports abdominal cramping. What should the nurse do first? Increase the flow of the enema for approximately 30 seconds then decrease it to the prior flow rate. Stop the administration of the enema and notify the health care provider. Pause the administration of the enema momentarily. Gently increase the flow of the enema until all of the solution has been administered.

Pause the administration of the enema momentarily. Explanation: If the client reports abdominal discomfort or cramping, the nurse should momentarily stop the flow of solution. Increasing the flow of the enema may cause more cramping and discomfort. Cramping and discomfort are common complaints during enema administration so there is no need to notify the health care provider.

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? Do not attempt to re-administer the enema because part of the solution has already been absorbed; notify the health care provider. Place the client in a sitting position on the toilet and lower the enema solution. Stop the enema and reposition the rectal tube or remove it to check for any fecal contents. Place the client on a bedpan in supine position while receiving the enema and elevate the head of the bed 30 degrees.

Place the client on a bedpan in supine position while receiving the enema and elevate the head of the bed 30 degrees. Explanation: If the client cannot retain the enema solution for an adequate amount of time, place the client on the bedpan in a supine position while receiving the enema. Elevate the head of the bed 30 degrees for the client's comfort. If still unable to retain the solution, notify the health care provider. The nurse does not need to reposition the rectal tube but needs to assist the client by repeating the procedure with a slight variation.

A nurse is documenting the eating habits of a client who wants to include more fiber in the diet. Which is the best statement to include? Plans to eat 4 ounces of protein 3 times per day. Will includes a pat of butter with eggs for breakfast. Plans to eat a snack of fruit twice per day. Will include fish one to two times per week.

Plans to eat a snack of fruit twice per day. Explanation: By snacking on fruits and vegetables, the client can increase fiber in the diet. The amount of fish, protein, and fat do not relate to increasing or absorbing fiber in the diet.

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 NG tube is curled in the back of the client's throat. The client is experiencing a vasovagal reaction. The client is forcefully resisting the procedure.

The NG tube is in the client's airway. Explanation: The tube is in the airway if the client shows signs of distress and cannot speak or hum. Excessive coughing and gagging may occur if the tube has curled in the back of throat. A vasovagal reaction is typically manifested by lightheadedness and fainting, not by gasping and an inability to vocalize. There is no indication that the client is forcefully resisting the procedure.

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 had the client flex the knees when performing the assessment. The student sequenced from auscultation to inspection, and percussion to palpation. The student placed the client in supine position with the abdomen exposed. The student instructed the client to urinate before beginning the focused assessment.

The student sequenced from auscultation to inspection, and percussion to palpation. Explanation: The correct sequence for an abdominal assessment is inspection, then auscultation (done before palpation because palpation may disturb normal peristalsis and bowel motility), followed by percussion and palpation. The client should urinate before assessment and the knees should be flexed with the abdomen during the examination.

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. Explanation: Washing the stoma and surrounding skin with a mild cleanser and water and patting it dry can preserve skin integrity. When using a cleanser, it is important to rinse the area thoroughly. Any residue left on the skin can cause problems with the wafer adhering. Another way to protect the skin is to apply barrier substances such as karaya, a plant substance that becomes gelatinous when moistened, and commercial skin preparations around the stoma. Cleaning the stoma with just a dry, cotton bandage is not the correct way of preserving skin integrity.

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 retention enema carminative enema return-flow enema

cleansing enema Explanation: The most common types of solutions used for cleansing enemas are tap water, normal saline, soap solution, and hypertonic solution. Cleansing enemas are used to relieve constipation or fecal impaction, promote visualization of the intestinal tract by radiographic or instrument examination (colonoscopy), establish regular bowel function, and prevent the involuntary escape of fecal material during surgical procedures. Carminative enemas are classified as retention enemas and are used to expel flatus from the rectum and provide relief from gaseous distention. Return-flow enemas are also occasionally prescribed to expel flatus.

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 Explanation: There is a specific sequence that bowel tests must be performed due to the results of certain contrasts and other preps that must be given. The nurse would verify that the tests are done in the correct order: Fecal occult blood test, barium studies, and then endoscopic examination.

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 Explanation: When administering a cleansing enema, the client is most often positioned in a left side-lying (Sims') position. Prone is lying flat, especially face downward. Visualization of the rectum is acceptable but insertion of the enema is difficult. The supine position means lying horizontally with the face and torso facing up, and this is not helpful for inserting an enema as a nurse cannot visualize the rectum. The right side-lying position is used for positioning of a client, not for an enema.

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 Explanation: The abdominal assessment should be performed in the following sequence: inspection, auscultation, percussion, palpation.