Chapter 47: Management of Patients With Intestinal and Rectal Disorders

Medical management of a patient with peritonitis includes fluid, electrolyte, and colloid replacement. The nurse knows to prepare the initial, most appropriate intravenous solution. Which of the following is the correct solution? A.) 0.9% NS B.) D5W C.) D10W D.) 0.45% of NS

Answer: A.) 0.9% NS

Which of the following is considered a bulk-forming laxative? A.) Metamucil B.) Milk of Magnesia C.) Mineral oil D.) Dulcolax

Answer: A.) Metamucil

Which of the following is the most common symptom of a polyp? A.) Rectal bleeding B.) Abdominal pain C.) Diarrhea D.) Anorexia

Answer: A.) Rectal bleeding

In addition to teaching a client with constipation to increase dietary fiber intake to 25 g/day, which of the following would the nurse include as important? A.) Avoiding bran cereals and beans in the diet B.) Adding fiber-rich foods to the diet gradually C.) Limiting fluid intake to 5 to 6 glasses per day D.) Minimizing activity levels for at least 2 months

Answer: B.) Adding fiber-rich foods to the diet gradually

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? A.) Cutting the faceplate opening no more than 2 inches larger than the stoma B.) Gently washing the area surrounding the stoma using a facecloth and mild soap C.) Scrubbing fecal material from the skin surrounding the stoma D.) Maintaining wrinkles in the faceplate so it doesn't irritate the skin

Answer: B.) Gently washing the area surrounding the stoma using a facecloth and mild soap

An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to? A.) Hyperkalemia B.) Hypokalemia C.) Hyponatremia D.) Hypernatremia

Answer: B.) Hypokalemia

Celiac disease (celiac sprue) is an example of which category of malabsorption? A.) Infectious diseases B.) Mucosal disorders causing generalized malabsorption C.) Luminal problems causing malabsorption D.) Postoperative malabsorption

Answer: B.) Mucosal disorders causing generalized malabsorption

A nurse is preparing a presentation for a local community group of older adults about colon cancer. What would the nurse include as the primary characteristic associated with this disorder? A.) Abdominal distention B.) Frank blood in the stool C.) A change in bowel habits D.) Abdominal pain

Answer: C.) A change in bowel habits

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? A.) Age younger than 40 years B.) Low-fat, low-protein, high-fiber diet C.) History of skin cancer D.) Familial polyposis

Answer: D.) Familial polyposis

A longitudinal tear or ulceration in the lining of the anal canal is termed a(n): A.) anorectal abscess. B.) anal fistula. C.) hemorrhoid. D.) anal fissure.

Answer: D.) anal fissure.

The nurse teaches the client whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be A.) semi mushy. B.) mushy. C.) fluid. D.) solid.

Answer: D.) solid. Rationale: With a sigmoid colostomy, the feces are solid. With a descending colostomy, the feces are semi mushy. With a transverse colostomy, the feces are mushy. With an ascending colostomy, the feces are fluid.

A client informs the nurse that he is taking a stimulant laxative in order to be able to have a bowel movement daily. What should the nurse inform the client about taking a stimulant laxative? A.) They can be habit forming and will require increasing doses to be effective. B.) As long as the client is drinking 8 glasses of water per day, he can continue to take them. C.) The laxative is safe to take with other medication the client is taking. D.) The client should take a fiber supplement along with the stimulant laxative.

Answer; A.) They can be habit forming and will require increasing doses to be effective.

Vomiting results in which of the following acid-base imbalances? A.) Metabolic alkalosis B.) Metabolic acidosis C.) Respiratory acidosis D.) Respiratory alkalosis

Answer: A.) Metabolic alkalosis

Patients with irritable bowel disease (IBD) are at significantly increased risk for which of the following? A.) Osteoporosis B.) Deep vein thrombosis C.) Hypotension D.) Pneumonia

Answer: A.) Osteoporosis

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? A.) lack of free water intake B.) lack of solid food C.) lack of exercise D.) increased fiber

Answer: A.) lack of free water intake Rationale: A client who cannot swallow food cannot drink enough water to meet daily needs. Inadequate fluid intake is a common cause of constipation.

Crohn's disease is a condition of malabsorption caused by which pathophysiological process? A.) Inflammation of all layers of intestinal mucosa B.) Infectious disease C.) Disaccharidase deficiency D.) Gastric resection

Answer; A.) 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? A.) Peritonitis B.) Pelvic abscess C.) Ileus D.) Hemorrhage

Answer: A.) Peritonitis

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: A.) fissure. B.) fistula. C.) hemorrhoid. D.) pilonidal cyst.

Answer: A.) fissure.

A client has symptoms suggestive of peritonitis. Nursing management would not include: A.) limiting analgesics to avoid the formation of paralytic ileus. B.) accurate recording of input and output. C.) inserting a nasogastric tube. D.) inserting a urinary retention catheter.

Answer: A.) limiting analgesics to avoid the formation of paralytic ileus.

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's: A.) usual pattern of elimination. B.) alcohol consumption. C.) activity levels. D.) current medications.

Answer: A.) usual pattern of elimination.

The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder? A.) The bowel twists and turns itself and obstructs the intestinal lumen. B.) One part of the intestine telescopes into another portion of the intestine. C.) The bowel protrudes through a weakened area in the abdominal wall. D.) A loop of intestine adheres to an area that is healing slowly after surgery.

Answer: B.) One part of the intestine telescopes into another portion of the intestine.

The nurse is irrigating a client's colostomy when the client begins to report cramping. What is the appropriate action by the nurse? A.) Increase the rate of administration. B.) Discontinue the irrigation immediately. C.) Clamp the tubing and allow client to rest. D.) Change irrigation fluid to normal saline.

Answer: C.) Clamp the tubing and allow client to rest.

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? A.) tenderness and pain in the right upper abdominal quadrant B.) jaundice and vomiting C.) severe abdominal pain with direct palpation or rebound tenderness D.) rectal bleeding and a change in bowel habits

Answer: C.) severe abdominal pain with direct palpation or rebound tenderness Rationale: Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (i.e., appendicitis, diverticulitis, ulcerative colitis, a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.

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"? A.) stool consistency and client comfort B.) one bowel movement daily C.) one bowel movement every other day D.) two bowel movements daily

Answer; A.) stool consistency and client comfort Rationale: Normal bowel patterns range from three bowel movements per day to three bowel movements per week. In differentiating normal from abnormal, the consistency of stools and the comfort with which a person passes them are more reliable indicators than is the frequency of bowel elimination.

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? A.) Low residue B.) Low protein C.) Calorie restriction D.) Iron restriction

Answer: A.) Low residue

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? A.) Hematocrit 42% B.) White blood cell (WBC) count 22.8/mm3 C.) Serum potassium 4.2 mEq/L D.) Serum sodium 135 mEq/L

Answer: B.) White blood cell (WBC) count 22.8/mm3

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? A.) Duodenal ulcers B.) Hemorrhoids C.) Weight gain D.) Polyps

Answer; D.) Polyps Rationale: Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.

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? A.) Loud bowel sounds B.) Borborygmus C.) Tenesmus D.) Peristalsis

Answer: B.) Borborygmus

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location? A.) Right upper quadrant B.) Right lower quadrant C.) Left upper quadrant D.) Left lower quadrant

Answer: B.) Right lower quadrant Rationale: The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

A client is being treated for diverticulosis. Which points should the nurse include in this client's teaching plan? Select all that apply. - Do not suppress the urge to defecate. - Drink at least 8 to 10 large glasses of fluid every day. - Use bulk-forming laxatives - Encourage an individualized exercise program - Avoid high-fiber foods

Answer: - Do not suppress the urge to defecate. - Drink at least 8 to 10 large glasses of fluid every day. - Use bulk-forming laxatives - Encourage an individualized exercise program

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? A.) Colonoscopy B.) Barium enema C.) Flexible sigmoidoscopy D.) CT scan

Answer: A.) Colonoscopy

The nurse is conducting a community education program on colorectal cancer. Which statement should the nurse include in the program? A.) It is the third most common cancer in the United States. B.) The lifetime risk of developing colorectal cancer is 1 in 10. C.) The incidence of colorectal cancer decreases with age. D.) Colorectal cancer has no hereditary component.

Answer: A.) It is the third most common cancer in the United States.

After teaching a group of students about irritable bowel syndrome (IBS) and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an antidiarrheal agent commonly administered for IBS? A.) Loperamide B.) Lubiprostone C.) Dicyclomine D.) Peppermint oil

Answer: A.) Loperamide

The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching? A.) Avoid unprocessed bran. B.) Avoid daily exercise. C.) Drink 8 to 10 glasses of fluid daily. D.) Use laxatives weekly.

Answer: C.) Drink 8 to 10 glasses of fluid daily.

A client with a diagnosis of acute appendicitis is awaiting surgical intervention. The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and board-like. What complication does the nurse determine may be occurring at this time? A.) Constipation B.) Paralytic ileus C.) Peritonitis D.) Accumulation of gas

Answer: C.) Peritonitis Rationale: Lack of bowel motility typically accompanies peritonitis. The abdomen feels rigid and board-like as it distends with gas and intestinal contents. Bowel sounds typically are absent. The diagnosis of acute appendicitis correlates with the symptoms of rupture of the appendix and peritonitis. A paralytic ileus and gas alone do not produce these symptoms.

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: A.) caffeinated products. B.) spicy foods. C.) high-fiber diet. D.) fluids with meals.

Answer: C.) high-fiber diet.