Chapter 46: Caring for Clients with Disorders of the Lower
A client's colorectal cancer has necessitated a hemicolectomy with the creation of a colostomy. In the 4 days since the surgery, the client has been unwilling to look at the ostomy or participate in any aspects of ostomy care. What is the nurse's most appropriate response to this observation?
Acknowledge the patient's reluctance and initiate discussion of the factors underlying it.
A client admitted with acute diverticulitis has experienced a sudden increase in temperature and reports a sudden onset of exquisite abdominal tenderness. The nurse's rapid assessment reveals that the client's abdomen is uncharacteristically rigid on palpation. What is the nurse's best response?
Contact the primary care provider promptly and report these signs of perforation.
A client has been diagnosed with a small bowel obstruction and has been admitted to the medical unit. The nurse's care should prioritize which of the following outcomes?
Maintaining fluid and electrolyte balance
Which of the following is considered a bulk-forming laxative?
Metamucil
A nurse is teaching an older adult client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required?
"I need to use laxatives regularly to prevent constipation."
A client's colorectal cancer has necessitated a hemicolectomy with the creation of a colostomy. In the 4 days since the surgery, the client has been unwilling to look at the ostomy or participate in any aspects of ostomy care. What is the nurse's most appropriate response to this observation?
Acknowledge the client's reluctance and initiate discussion of the factors underlying it
The nurse is conducting a community education program on colorectal cancer. Which statement should the nurse include in the program?
It is the third most common cancer in the United States.
A patient with irritable bowel syndrome has been having more frequent symptoms lately and is not sure what lifestyle changes may have occurred. What suggestion can the nurse provide to identify a trigger for the symptoms?
Keep a 1- to 2-week symptom and food diary to identify food triggers.
A nurse is caring for a client with constipation whose primary provider has recommended senna for the management of this condition. The nurse should provide which of the following education points?
"Avoid taking the drug on a long-term basis."
A nurse is caring for a client with constipation whose primary provider has recommended senna for the management of this condition. The nurse should provide which of the following education points? "Make sure to take a multivitamin with each dose." "Take this on an empty stomach to ensure maximum effect." "Limit your fluid intake temporarily so you don't get diarrhea." "Avoid taking the drug on a long-term basis."
"Avoid taking the drug on a long-term basis."
A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care?
Test all stools for occult blood.
A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care? Administer morphine (Duramorph PF) routinely, as ordered. Test all stools for occult blood. Administer topical ointment to the rectal area to decrease bleeding. Prepare the client for a gastrostomy tube placement.
Test all stools for occult blood.
Which is a true statement regarding regional enteritis (Crohn's disease)?
The clusters of ulcers take on a cobblestone appearance.
The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening?
Familial polyposis
The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? Low-fat, low-protein, high-fiber diet Familial polyposis History of skin cancer Age younger than 40 years
Familial polyposis
The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for:
hypokalemia.
A client's colorectal cancer has necessitated a hemicolectomy with the creation of a colostomy. In the 4 days since the surgery, the client has been unwilling to look at the ostomy or participate in any aspects of ostomy care. What is the nurse's most appropriate response to this observation? Arrange for the client to be seen by a social worker or spiritual advisor. Reassure the client that many people are fearful after the creation of an ostomy. Acknowledge the client's reluctance and initiate discussion of the factors underlying it. Ensure that the client knows that he or she will be responsible for care after discharge.
Acknowledge the client's reluctance and initiate discussion of the factors underlying it.
What is the most common cause of small-bowel obstruction?
Adhesions
The nurse is performing a rectal assessment and notices a longitudinal tear or ulceration in the lining of the anal canal. The nurse documents the finding as which condition?
Anal fissure
An older adult who resides in an assisted living facility has sought care from the nurse because of recurrent episodes of constipation. Which of the following actions should the nurse first perform? Assess the client's food and fluid intake. Encourage the client to take stool softener daily. Assess the client's surgical history. Encourage the client to take fiber supplements.
Assess the client's food and fluid intake.
An older adult who resides in an assisted living facility has sought care from the nurse because of recurrent episodes of constipation. Which of the following actions should the nurse first perform?
Assess the patient's food and fluid intake.
The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's notes?
Borborygmus
A patient is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling?
Colonoscopy
Which statement provides accurate information regarding cancer of the colon and rectum?
Colorectal cancer is the third most common site of cancer in the United States.
Which statement provides accurate information regarding cancer of the colon and rectum? The incidence of colon and rectal cancer decreases with age. Colon cancer has no hereditary component. Colorectal cancer is the third most common site of cancer in the United States. Rectal cancer affects more than twice as many people as colon cancer.
Colorectal cancer is the third most common site of cancer in the United States.
Which is one of the primary symptoms of irritable bowel syndrome (IBS)?
Diarrhea
The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching?
Drink 8 to 10 glasses of fluid daily.
When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?
Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication? Pelvic abscess Hemorrhage Ileus Peritonitis
Peritonitis
A client suspected of having colorectal cancer requires which diagnostic study to confirm the diagnosis?
Sigmoidoscopy
The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation? Activity levels Usual pattern of elimination Alcohol consumption Current medications
Usual pattern of elimination
Which factor could lead to the formation of a hernia?
coughing
Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes:
high-fiber diet.
Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: fluids with meals. spicy foods. caffeinated products. high-fiber diet.
high-fiber diet.
The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for: hyponatremia. hyperkalemia. hypokalemia. hypernatremia.
hypokalemia.
The nurse is admitting a patient with a diagnosis of diverticulitis and assesses that the patient has a boardlike abdomen, no bowel sounds, and complains of severe abdominal pain. What is the nurse's first action?
notify the physician
Which client requires immediate nursing intervention? The client who
presents with a rigid, boardlike abdomen.
Which client requires immediate nursing intervention? The client who:
presents with a rigid, boardlike abdomen.
A nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find?
severe abdominal pain with direct palpation or rebound tenderness.
Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find:
severe abdominal pain with direct palpation or rebound tenderness.
A client with complaints of right lower quadrant pain is admitted to the emergency department. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the physician immediately?
A client with complaints of right lower quadrant pain is admitted to the emergency department. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the physician immediately?
The nurse is performing a rectal assessment and notices a longitudinal tear or ulceration in the lining of the anal canal. The nurse documents the finding as which condition? Anal fissure Hemorrhoid Anal fistula Anorectal abscess
Anal fissure
A longitudinal tear or ulceration in the lining of the anal canal is termed a(n):
Anal fissure.
The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse? Replace the fluid with cooler water since it is probably too warm. Inform the patient that it will only last a minute and continue with the procedure. Stop the irrigation and remove the tube. Clamp the tubing and give the patient a rest period.
Clamp the tubing and give the patient a rest period.
A client admitted with acute diverticulitis has experienced a sudden increase in temperature and reports a sudden onset of exquisite abdominal tenderness. The nurse's rapid assessment reveals that the client's abdomen is uncharacteristically rigid on palpation. What is the nurse's best response? Administer a Fleet enema as prescribed and remain with the client. Contact the primary provider promptly and report these signs of perforation. Position the client supine and insert an NG tube. Page the primary provider and report that the client may be obstructed.
Contact the primary provider promptly and report these signs of perforation.
A client presents with an infection in the area between the internal and external sphincters. In which chronic disease is this condition commonly seen?
Crohn's disease
A nurse is assessing a client's stoma on postoperative day 3. The nurse notes that the stoma has a shiny appearance and a bright red color. How should the nurse best respond to this assessment finding?
Document that the stoma appears healthy and well perfused.
A nurse is assessing a client's stoma on postoperative day 3. The nurse notes that the stoma has a shiny appearance and a bright red color. How should the nurse best respond to this assessment finding? Document a nursing diagnosis of Impaired Skin Integrity. Irrigate the ostomy to clear a possible obstruction. Contact the primary provider to report this finding. Document that the stoma appears healthy and well perfused.
Document that the stoma appears healthy and well perfused.
The nurse is assessing a client who had an ileostomy created three days ago for the treatment of irritable bowel disease. The nurse observes that the client's stoma is bright red and there are scant amounts of blood on the stoma. What is the nurse's best action?
Document these expected assessment findings
A nurse caring for a patient with regional enteritis knows to assess for this most serious systemic complication. What is that complication?
Small bowel obstruction
A patient is being treated for diverticulosis. Which information should the nurse include in this patient's teaching plan? Avoid daily exercise; indulge only in mild activity. Drink at least 8 to 10 large glasses of fluid every day. Avoid unprocessed bran in the diet. Use laxatives or enemas at least once a week.
Drink at least 8 to 10 large glasses of fluid every day.
The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation?
Dry skin thoroughly after washing
Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction?
Sudden, sustained abdominal pain
A client's screening colonoscopy revealed the presence of numerous polyps in the large bowel. What principle should guide the subsequent treatment of this client's health problem?
The patient's polyps constitute a risk factor for cancer.
A client has been experiencing occasional episodes of constipation and has been unable to achieve consistent relief by increasing physical activity and improving his diet. When introducing the client to the use of laxatives, what teaching should the nurse emphasize?
The risk of becoming laxative-dependent
A longitudinal tear or ulceration in the lining of the anal canal is termed a(n): anorectal abscess. hemorrhoid. anal fistula. anal fissure.
anal fissure.
A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client?
Suggest fluid intake of at least 2 L/day
The nurse is caring for a patient who has malabsorption syndrome with an undetermined cause. What procedure will the nurse assist with that is the best diagnostic test for this illness?
Endoscopy with mucosal biopsy
A longitudinal tear or ulceration in the lining of the anal canal is termed a(n):
anal fissure.
A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a:
fissure.
A nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find? tenderness and pain in the right upper abdominal quadrant jaundice and vomiting severe abdominal pain with direct palpation or rebound tenderness rectal bleeding and a change in bowel habits
severe abdominal pain with direct palpation or rebound tenderness
The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's notes? Tenesmus Peristalsis Loud bowel sounds Borborygmus
Borborygmus
A client admitted with acute diverticulitis has experienced a sudden increase in temperature and reports a sudden onset of exquisite abdominal tenderness. The nurse's rapid assessment reveals that the client's abdomen is uncharacteristically rigid on palpation. What is the nurse's best response?
Contact the primary provider promptly and report these signs of perforation.
During a client's scheduled home visit, an older adult client has stated to the community health nurse that she has been experiencing hemorrhoids of increasing severity in recent months. The nurse should recommend which of the following?
Increased fluid and fiber intake
During a client's scheduled home visit, an older adult client has stated to the community health nurse that she has been experiencing hemorrhoids of increasing severity in recent months. The nurse should recommend which of the following? Daily use of OTC glycerin suppositories Use of an NSAID to reduce inflammation Regular application of an OTC antibiotic ointment Increased fluid and fiber intake
Increased fluid and fiber intake
Crohn's disease is a condition of malabsorption caused by which pathophysiological process?
Inflammation of all layers of intestinal mucosa
The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication?
Peritonitis
The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation?
Review the client's usual pattern of elimination.
A nurse caring for a patient with colorectal cancer is preparing the patient for upcoming surgery. The nurse administers cephalexin (Keflex) to the patient and explains what rationale? To reduce abdominal distention postoperatively To reduce bowel motility To reduce intestinal bacteria levels To treat any undiagnosed infections
To reduce intestinal bacteria levels
An older adult has a diagnosis of Alzheimer disease and has recently been experiencing fecal incontinence. However, the nurse has observed no recent change in the character of the client's stools. What is the nurse's most appropriate intervention?
Toilet the patient on a frequent, scheduled basis.
The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation?
Usual pattern of elimination
An older adult client in a long term care facility is concerned about bowel regularity. During a client education session, the nurse reinforces the medically acceptable definition of "regularity." What is the actual measurement of "regular"? stool consistency and client comfort one bowel movement every other day one bowel movement daily two bowel movements daily
stool consistency and client comfort
A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation?
lack of free water intake
A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation? lack of exercise increased fiber lack of free water intake lack of solid food
lack of free water intake
The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's:
usual pattern of elimination.
Which is the most common presenting symptom of colon cancer?
Change in bowel habits
The nurse is assessing a client who had an ileostomy created three days ago for the treatment of irritable bowel disease. The nurse observes that the client's stoma is bright red and there are scant amounts of blood on the stoma. What is the nurse's best action? Cleanse the stoma with alcohol or chlorhexidine Contact the care provider to have the client's hemoglobin and hematocrit measured Apply barrier ointment to the stoma as prescribed Document these expected assessment findings
Document these expected assessment findings
What information should the nurse include in the teaching plan for a client being treated for diverticulosis?
Drink at least 8 to 10 large glasses of fluid every day
A patient is being treated for diverticulosis. Which information should the nurse include in this patient's teaching plan?
Drink at least 8 to 10 large glasses of fluid every day.
A nurse is interviewing a client about past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?
Polyps
A nurse caring for a client with a newly created ileostomy assesses the client and notes that the client has had not ostomy output for the past 12 hours. The client also reports worsening nausea. What is the nurse's priority action? Report signs and symptoms of obstruction to the health care provider. Contact the physician and obtain a swab of the stoma for culture. Facilitate a referral to the wound-ostomy-continence (WOC) nurse. Encourage the client to mobilize in order to enhance motility.
Report signs and symptoms of obstruction to the health care provider.
Which category of laxatives draws water into the intestines by osmosis? Bulk-forming agents (e.g., psyllium) Fecal softeners (e.g., docusate) Stimulants (e.g., bisacodyl) Saline agents (e.g., magnesium hydroxide)
Saline agents (e.g., magnesium hydroxide)
A client is admitted to the emergency department with reports right lower quadrant pain. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the health care provider immediately?
White blood cell (WBC) count 22.8/mm3
The nurse is assigned to care for a patient 2 days after an appendectomy due to a ruptured appendix with resultant peritonitis. The nurse has just assisted the patient with ambulation to the bedside commode when the patient points to the surgical site and informs the nurse that "something gave way." What does the nurse suspect may have occurred?
Wound dehiscence has occurred.
A nurse is teaching a group of adults about screening and prevention of colorectal cancer. The nurse should describe which of the following as the most common sign of possible colon cancer?
Change in bowel habits
The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse?
Clamp the tubing and give the patient a rest period.
A nurse is planning discharge teaching for a 21-year-old client with a new diagnosis of ulcerative colitis. When planning family assessment, the nurse should recognize that which of the following factors will likely have the greatest impact on the client's coping after discharge? The family's ability to take care of the client's special diet needs The family's ability to monitor the client's changing health status The family's ability to provide emotional support The family's ability to manage the client's medication regimen
The family's ability to provide emotional support
The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation? Dry skin thoroughly after washing Apply barrier powder Dust with nystatin powder Apply triamcinolone acetonide spray
Dry skin thoroughly after washing
A client has been recently diagnosed with an anorectal condition. The nurse is reviewing interventions that will assist the client with managing the therapeutic regimen. What would not be included? Teach the client how to do sitz baths at home using warm water three to four times each day. Instruct the client to cleanse perianal area with warm water. Encourage the client to avoid exercise. Encourage the client to follow diet and medication instructions.
Encourage the client to avoid exercise.
