Chapter 46: Bowel Elimination

An active 25-year-old female client shared with the nurse that ever since she had gone on a high-protein low-carbohydrate diet she had suffered from constipation. The client states that the diet is working for her in terms of weight loss and would like to stay on it. The best response from the nurse is that the client should try: 1. Consuming more low-carbohydrate fiber-rich foods like broccoli, raspberries, blackberries, and asparagus 2. Taking a laxative when feeling constipated 3. Try a different diet with less tendency to cause constipation 4. Exercise more

ANS: 1 A low-fiber diet high in animal fats (e.g., meats, dairy products, eggs) can slow peristalsis, leading to constipation. By consuming fiber-rich low-carbohydrate foods, the client can still maintain weight loss while avoiding constipation. The client could develop a dependence on laxatives by using them on a regular basis. The client has expressed a desire to remain on the diet she is currently on, and it seems to be working to help her lose weight. Because client is already active, additional activity is not likely to have a profound effect on relieving the constipation.

The client asks the nurse to recommend bulk-forming foods that may be included in the diet. Which of the following should be recommended by the nurse? 1. Whole grains 2. Fruit juice 3. Rare meats 4. Milk products

ANS: 1 Bulk-forming foods, such as grains, fruits, and vegetables, absorb fluids and increase stool mass. Fruit juice, rare meats, and milk products are not bulk-forming foods.

The nurse is discussing food allergies with a group of mothers whose children are allergy prone. Which of the following statements made by the nurse best describes lactose intolerance? 1. "If milk causes diarrhea, cramps, or gas, it might be an intolerance of lactose." 2. "You don't have to be allergic to dairy for it to cause you problems." 3. "Allergies to milk can be very dangerous, even life threatening." 4. "Many children outgrow their intolerance of dairy lactose."

ANS: 1 Food intolerance is not an allergy, but a particular food that causes the body distress within a few hours of ingestion. The result is diarrhea, cramps, or flatulence. For example, people who drink cow's milk who have these symptoms are not allergic to milk but lack the enzyme needed to digest the milk sugar lactose; they are lactose intolerant.

A client has undergone intestinal surgery and now has an incontinent ostomy. The use of which of the following products by the client indicates that the discharge learning goals have been achieved? 1. A powder for a yeast infection 2. Peroxide to toughen the peristomal skin 3. A commercial deodorant around the stoma 4. Alcohol to cleanse the stoma

ANS: 1 If a yeast infection occurs, thorough cleansing should be performed, followed by patting the area dry and applying a prescribed topical agent, such as triamcinolone acetonide (Kenalog) spray or nystatin (Mycostatin), to the affected region. The peristomal skin should be cleansed gently with warm tap water using gauze pads or a clean washcloth. An ostomy deodorant may be placed into the pouch, not around the stoma. Alcohol should not be used to clean the stoma. The area may be cleaned with warm tap water.

The nurse is assessing a cognitively impaired older adult client and observes a leaking of liquid stool from the rectum. The nurse's initial intervention for this client is to: 1. Determine if the client has been eating sufficiently, especially fiber-rich foods 2. Determine how long it has been since the client had a normal-size, formed stool 3. Perform a digital examination of the rectum to determine the presence of stool 4. Call the health care provider to get a prescription for an antidiarrheal medication

ANS: 1 When a continuous oozing of diarrhea stool occurs, suspect impaction. The liquid portion of feces located higher in the colon seeps around the impacted mass. An obvious sign of impaction is the inability to pass a stool for several days, despite the repeated urge to defecate. The digital examination should be performed after it has been determined that the client has been without a normal bowel movement for several days. Although the remaining options are not inappropriate, they would not be the initial intervention.

The nurse instructs the client that before the fecal occult blood test (FOBT) she may eat: 1. Whole wheat bread 2. A lean, T-bone steak 3. Veal 4. Salmon

ANS: 1 Whole wheat bread may be eaten before a fecal occult blood test. A lean, T-bone steak may cause false-positive results if eaten before a fecal occult blood test. Veal may cause false-positive results if eaten before a fecal occult blood test. Salmon may cause false-positive results if eaten before a fecal occult blood test.

A 44-year-old male client was placed on a daily low-dose aspirin regimen by his health care provider following a recent diagnosis of hypertension and periodic atrial fibrillation. The client is currently hospitalized with renal stones. As the nurse is admitting the client, he shares that he has been very tired. The nurse gathers additional data regarding his bowel habits. The client shares that he has recently had black, tarry stools. The nurse is most concerned that the client may have: 1. Colon cancer 2. A GI bleed from the aspirin therapy 3. Ongoing atrial fibrillation 4. Electrolyte imbalance

ANS: 2 Although the client could have any one of the items mentioned, it is most likely that the aspirin is causing a GI bleed. The loss of blood can cause the client to be fatigued. Aspirin is a prostaglandin inhibitor, which interferes with the formation and production of protective mucus and causes GI bleeding.

A 50-year-old male client is having a screening colonoscopy. The nurse instructs the client that: 1. No special preparation is required 2. Light sedation is normally used 3. No metallic objects are allowed 4. Swallowing of an opaque liquid is required

ANS: 2 Light sedation is required for a colonoscopy. Special preparation is required before a colonoscopy. Clear liquids are given the day before and then some form of bowel cleanser, such as GoLytely, is administered. Enemas until clear may also be ordered. There is no restriction of metallic objects for a colonoscopy, not does it require swallowing an opaque liquid.

Upon auscultation of the client's abdomen, the nurse hears hyperactive bowel sounds (greater than 35 per minute). The nurse knows that this can indicate which of the following? 1. Paralytic ileus 2. Fecal impaction 3. Small intestine obstruction 4. Abdominal tumor

ANS: 3 Absent (no auscultated bowel sounds) or hypoactive sounds (less than five sounds per minute) occur with paralytic ileus, such as after abdominal surgery. High-pitched and hyperactive bowel sounds (35 or more sounds per minute) occur with small intestine obstruction and inflammatory disorders.

A nurse who is caring for postoperative clients on a surgical unit knows that for 24 to 48 hours postoperatively, clients who have undergone general anesthesia may experience: 1. Colitis 2. Stomatitis 3. Paralytic ileus 4. Gastrocolic reflex

ANS: 3 Any surgery that involves direct manipulation of the bowel temporarily stops peristalsis. This condition, called paralytic ileus, usually lasts about 24 to 48 hours. Colitis is inflammation of the colon. Stomatitis is inflammation of the mouth. The gastrocolic reflex is the peristaltic wave in the colon induced by entrance of food into the stomach. Colitis, stomatitis, and gastrocolic reflex are not caused by anesthetic used during surgery.

Which of the following clients is at greatest risk for serious complications when using the Valsalva maneuver to expel feces? 1. 25-year-old pregnant client 2. 66-year-old male with hypertrophied prostate disease 3. 44-year-old male client with glaucoma 4. 53-year-old female with stomach cancer

ANS: 3 Clients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk, such as cardiac irregularities and elevated blood pressure, with this maneuver and need to avoid straining to pass the stool. Although the Valsalva maneuver may contribute to hemorrhoids, this is not as serious as increasing the intraocular pressure of a client with glaucoma. The Valsalva maneuver is not contraindicated in a client with hypertrophied prostate disease or in a client with stomach cancer.

The client is taking medications to promote defecation. Which of the following instructions should be included by the nurse in the teaching plan for this client? 1. Increased laxative use often causes hyperkalemia. 2. Salt tablets should be taken to increase the solute concentration of the extracellular fluid. 3. Emollient solutions may increase the amount of water secreted into the bowel. 4. Bulk-forming additives may turn the urine pink.

ANS: 3 Emollient solutions are stool softeners that may increase the amount of water secreted into the bowel. Laxative overuse can cause serious diarrhea that can lead to dehydration and hypokalemia. Salt tablets should not be taken to increase the solute concentration of extracellular fluid. Bulk-forming additives do not turn the urine pink. Phenolphthalein or danthron stimulant cathartics (e.g., Doxidan, Correctol, Ex-Lax) may cause pink or red urine.

A client is reporting that the oral medication she was prescribed for her hypothyroidism does not seem to be helping. The client goes on to report that she has been experiencing tension-related headaches and constipation. She has been self-medicating with nonsteroidal antiinflammatory drugs (NSAIDs) and bulk laxatives. Which of the following assessment questions is most likely to provide information regarding this client's concern regarding her thyroid problem? 1. "How long have you taken Synthroid?" 2. "What other medications are you currently on?" 3. "How long have you been taking a bulk laxative?" 4. "Have you developed any other gastrointestinal symptoms?"

ANS: 3 Laxatives often influence the efficacy of other medications by altering the transit time (i.e., the time the medication remains in the GI tract and is available for absorption). The remaining options would have little bearing on the effectiveness of the hypothyroid medication unless the medication has not been taken long enough to reach therapeutic levels.

The nurse is counseling a 65-year-old female client on her use of mineral oil as a laxative. One of the most important things that the nurse can share with the client is how mineral oil can cause the decreased absorption of which of the following vitamins? 1. Vitamin C 2. Niacin 3. Vitamin D 4. Riboflavin.

ANS: 3 Mineral oil, a common laxative, decreases fat-soluble vitamin absorption. Vitamin D is the only fat soluble vitamin listed—the others are all water-soluble

A client who recently underwent surgery and now has a colostomy is correctly instructed by the nurse that for the next few weeks the client's diet will include foods such as: 1. Vegetables 2. Fresh fruit 3. Whole grain breads 4. Poached eggs and rice

ANS: 4 During the first weeks after surgery, many health care providers recommend low-fiber diets because the bowel requires time to adapt to the diversion. Low-fiber foods include bread, noodles, rice, cream cheese, eggs (not fried), strained fruit juices, lean meats, fish, and poultry. Poached eggs and rice would be appropriate for this client. After the ostomy heals, the client is allowed to eat whole grains, fruits, and vegetables. High-fiber foods such as fresh fruits and vegetables help ensure a more solid stool needed to achieve success at irrigation. Ostomy clients may benefit from avoiding foods that cause gas and odor, including broccoli, cauliflower, dried beans, and Brussels sprouts.

The nurse is discussing food allergies with a group of mothers whose children are allergy prone. Which of the following statements made by a mother best describes lactose intolerance? 1. "My child is allergic to milk; it makes her very gassy." 2. "Dairy products require a special enzyme to be digested properly." 3. "Being lactose intolerant means my child can't tolerate dairy products." 4. "My child gets diarrhea from dairy products because she can't digest lactose."

ANS: 4 Food intolerance is not an allergy, but a particular food that causes the body distress within a few hours of ingestion. The result is diarrhea, cramps, or flatulence. For example, people who drink cow's milk who have these symptoms are not allergic to milk but lack the enzyme needed to digest the milk sugar lactose; they are lactose intolerant. To be lactose intolerant (exhibiting the signs after ingesting dairy products) does not constitute a dairy allergy. The remaining options are not as specific as the answer.

The client has been admitted to an acute care unit with a diagnosis of biliary disease. The nurse suspects that the feces will appear: 1. Bloody 2. Pus filled 3. Black and tarry 4. White or clay colored

ANS: 4 Stool that is white or clay colored indicates an absence of bile. Bloody feces is not an indication of biliary disease. Pus-filled feces indicate infection. Black or tarry feces may indicate upper gastrointestinal (GI) bleeding or iron ingestion.

A client is to have a stool test for occult blood. The nurse is instructing the nursing assistant in the correct procedure for the test. The nursing assistant is correctly informed that: 1. Sterile technique is used for collection 2. Stool should be collected over a 3-day period 3. The specimen should be kept warm 4. A 1-inch sample of formed stool is needed

ANS: 4 Tests performed by the laboratory for occult blood in the stool and stool cultures require only a small sample. The nurse uses clean technique to collect about 1 inch of formed stool or 15 to 30 mL of liquid stool. Unlike testing for occult blood, tests for measuring the output of fecal fat require a 3- to 5-day collection of stool, and tests that measure for ova and parasites require the stool to be warm.