Chapter 48: Management of Patients With Intestinal and Rectal Disorders

The nurse is assessing a patient with appendicitis. The nurse is attempting to elicit a Rovsing's sign. Where should the nurse palpate for this indicator of acute appendicitis? a) Left lower quadrant b) Right lower quadrant c) Left upper quadrant d) Right upper quadrant

a) Left lower quadrant Rovsing's sign may be elicited by palpating the left lower quadrant; this paradoxically causes pain to be felt in the right lower quadrant (see Fig. 48-3).

A patient underwent a continent ileostomy. Within which timeframe should the patient expect to empty the reservoir? a) Every 4 to 6 hours b) Three or four times daily c) At least once every 2 days d) At least once a day

a) Every 4 to 6 hours The length of time between drainage perionds is gradually increased until the reservoir needs to be drained only every 4 to 6 hours and irrigated once each day. This prevents the accumulating effluent from spilling or causing infections.

A client has been recently diagnosed with an anorectal condition. The nurse is reviewing interventions that will assist the client with managing his therapeutic regimen. Which of the following would not be included? a) Instruct client to cleanse perianal area with warm water. b) Encourage client to avoid exercise. c) Encourage client to follow diet and medication instructions. d) Teach client how to do sitz baths at home using warm water three to four times each day.

b) Encourage client to avoid exercise. Activity promotes healing and normal stool patterns. These measures prevent infection and irritation. Sitz baths promote healing, decrease skin irritation, and relieve rectal spasms. Encouragement promotes compliance with therapeutic regimen and prevents complications.

A client is recently diagnosed with Crohn's disease and is beginning treatment. What first-line treatment does the nurse expect that the client will be placed on to decrease the inflammatory response? a) Ciprofloxacin (Cipro) b) Sulfasalazine (Azulfidine) c) Azathioprine (Imuran) d) Methotrexate (MTX)

b) Sulfasalazine (Azulfidine) Considered first-line treatment for inflammatory bowel disease, 5-ASA drugs contain salicy late, which is bonded to a carrying agent that allows the drug to be absorbed in the intestine. These drugs work by decreasing the inflammatory response. MTX or Imuran are used when failure to maintain remission necessitates the use of an immune-modulating agent. Cipro is used as an effective adjunct to treat the disease.

A client has a 10-year history of Crohn's disease and is seeing the physician in the GI group where you practice nursing due to increased diarrhea and fatigue. What is the recommended dietary approach to treat Crohn's disease? a) High-fiber diet b) Lactose-rich foods c) Dietary approach varies. d) Low-fiber diet

c) Dietary approach varies. The dietary approach varies. A high-fiber diet may be indicated when it is desirable to add bulk to loose stools. A low-fiber diet may be indicated in cases of severe inflammation or stricture. A high-calorie and high-protein diet helps replace nutritional losses from chronic diarrhea. The client may need nutritional supplements, depending on the area of the bowel affected. When the small intestine is inflamed, some clients experience lactose intolerance, requiring avoidance of lactose-rich foods. When the small intestine is inflamed, some clients experience lactose intolerance, requiring avoidance of lactose-rich foods.

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) Barium enema b) Flexible sigmoidoscopy c) CT scan d) Colonoscopy

d) Colonoscopy Diverticulosis is typically diagnosed by colonoscopy, which permits visualization of the extent of diverticular disease and biopsy of tissue to rule out other diseases. In the past, barium enema was the preferred diagnostic test, but it is now used less frequently than colonoscopy. CT with contrast agent is the diagnostic test of choice if the suspected diagnosis is diverticulitis; it can also reveal abscesses.

A home health nurse who sees a client with diverticulitis is evaluating teaching about dietary modifications necessary to prevent future episodes. Which statement by the client indicates effective teaching? a) "I'll incorporate foods rich in omega-3 fatty acids into my diet." b) "I'll snack on nuts, olives, and popcorn during flare-ups." c) "I should increase my intake of fresh fruits and vegetables during remissions." d) "I'll increase my intake of protein during exacerbations."

c) "I should increase my intake of fresh fruits and vegetables during remissions." A client with diverticulitis needs to modify fiber intake to effectively manage the disease. During episodes of diverticulitis, he should follow a low-fiber diet to help minimize bulk in the stools. A client with diverticulosis should follow a high-fiber diet. Clients with diverticular disease don't need to modify their intake of protein and omega-3 fatty acids.

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) D10W c) D5W d) 0.45% of NS

a) 0.9% NS The administration of several liters of an isotonic solution is immediately prescribed. Hypovolemia occurs because massive amounts of fluid and electrolytes move from the intestinal lumen into the peritoneal cavity and deplete the fluid in the vascular space.

A patient diagnosed with IBS is advised to eat a diet that is: a) Low in residue. b) High in fiber. c) Sodium-restricted. d) Restricted to 1,200 calories/day.

b) High in fiber. A high-fiber diet is prescribed to control diarrhea and constipation and is recommended for patients with IBS.

When interviewing a client with internal hemorrhoids, which of the following would the nurse expect the client to report? a) Itching b) Pain c) Rectal bleeding d) Soreness

c) Rectal bleeding Internal hemorrhoids cause bleeding but are less likely to cause pain, unless they protrude through the anus. External hemorrhoids may cause few symptoms, or they can produce pain, itching, and soreness of the anal area.

A patient is diagnosed with Zollinger-Ellison syndrome, a malabsorption disorder. The nurse knows to assess the patient for the characteristic clinical feature of: a) Folate deficiency b) Decreased intestinal lactose c) Steatorrhea d) Lymphadenopathy

c) Steatorrhea Hyperacidity in the duodenum inactivates pancreatic enzymes causing steatorrhea and ulcer diathesis. Refer to Table 24-2 in the text.

The nurse is conducting a gastrointestinal assessment. When the patient complains of the presence of mucus and pus in his stools, the nurse assesses for additional signs/symptoms of which of the following disease/conditions? a) Small-bowel disease b) Disorders of the colon c) Intestinal malabsorption d) Ulcerative colitis

d) Ulcerative colitis The presence of mucus and pus in the stools suggests ulcerative colitis. Watery stools are characteristic of small-bowel disease. Loose, semisolid stools are associated more often with disorders of the colon. Voluminous, greasy stools suggest intestinal malabsorption.

A patient informs the nurse that he has been having abdominal pain that is relieved when having a bowel movement. The patient states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder? a) Chronic constipation with sporadic bouts of diarrhea b) Blood and mucus in the stool c) Client is awakened from sleep due to abdominal pain. d) Weight loss due to malabsorption

a) Chronic constipation with sporadic bouts of diarrhea Most clients with IBS describe having chronic constipation with sporadic bouts of diarrhea. Some report the opposite pattern, although less commonly. Most clients experience various degrees of abdominal pain that defecation may relieve. Weight usually remains stable, indicating that when diarrhea occurs, malabsorption of nutrients does not accompany it. Stools may have mucus, but blood is not usually found because the bowel is not locally inflamed. The sleep is not disturbed from abdominal pain.

A patient with an ileostomy should avoid which of the following? a) Enteric-coated products b) Wax matrix coated products c) Antacids and antibiotics d) Nonlayered tablets

a) Enteric-coated products Patients with an ileostomy should avoid enteric-coated products and some modified-release drugs, such as slow-release beads and layered tablets. This is because these products may pass through without being absorbed. Preparations such as slow-K (potassium chloride) leave a "ghost" of the wax matrix coating, but that does not indicate the drug has been unabsorbed. It is not essential for the patient to avoid antacids and antibiotics if they have been prescribed.

A nurse is caring for a client who had an ileo conduit 3 days earlier. The nurse examines the stoma site and determines that she should consult with the ostomy nurse. Which assessment finding indicates the need for further consultation? a) Red, sensitive skin around the stoma site b) Beefy red stoma site c) Stoma site not sensitive to touch d) Clear mucus mixed with yellow urine drained from the appliance bag

a) Red, sensitive skin around the stoma site Red, sensitive skin around the stoma site may indicate an ill-fitting appliance Beefy redness at a stoma site that isn't sensitive to touch is a normal assessment finding. Urine mixed with mucus is also a normal finding.

A client suspected of having colorectal cancer requires which diagnostic study to confirm the diagnosis? a) Sigmoidoscopy b) Abdominal computed tomography (CT) scan c) Carcinoembryonic antigen (CEA) d) Stool Hematest

a) Sigmoidoscopy Used to visualize the lower GI tract, sigmoidoscopy and proctoscopy aid in the detection of two-thirds of all colorectal cancers. Stool Hematest detects blood, which is a sign of colorectal cancer; however, the test doesn't confirm the diagnosis. CEA may be elevated in colorectal cancer but isn't considered a confirming test. An abdominal CT scan is used to stage the presence of colorectal cancer.

In a client with enteritis and frequent diarrhea, the nurse should anticipate: a) respiratory alkalosis. b) metabolic acidosis. c) respiratory acidosis. d) metabolic alkalosis.

b) metabolic acidosis. Diarrhea causes a bicarbonate deficit. With loss of the relative alkalinity of the lower GI tract, the relative acidity of the upper GI tract predominates, leading to metabolic acidosis. Loss of acid, which occurs with severe vomiting, may lead to metabolic alkalosis. Diarrhea doesn't lead to respiratory acid-base imbalances, such as respiratory acidosis and respiratory alkalosis.

A 50-year-old woman is brought into the ED with symptoms suggestive of peritonitis. Nursing management would include all of the following, except? a) Insertion of urinary retention catheter b) Accurate recording of input and output c) Analgesics are limited to avoid the formation of paralytic ileus. d) Insertion of nasogastric tube

c) Analgesics are limited to avoid the formation of paralytic ileus. Analgesics such as meperidine or IV morphine sulfate are ordered to relieve pain and promote rest. Because hypovolemia can occur from fluids leaking into the peritoneal cavity, I & O is monitored closely to assist in determining fluid replacement. A nasogastric tube is used to relieve abdominal distention by suctioning the accumulated gas and stagnant upper GI fluids. If hypovolemia is present, renal perfusion can become decreased, requiring close monitoring.

The nurse is reinforcing diet teaching for a patient s diagnosed with IBS. The nurse instructs the patient to include which of the following in his diet? a) Caffeinated products b) Spicy foods c) High-fiber diet d) Fluids with meals

c) High-fiber diet A high-fiber diet is prescribed to help control diarrhea and constipation. Foods that are possible irritants, such as caffeine, spicy foods, lactose, beans, fried foods, corn, wheat, and alcohol, should be avoided. Fluids should not be taken with meals because this results in abdominal distention.

Typical signs and symptoms of appendicitis include a) left lower quadrant pain. b) pain when pressure is applied to the right lower quadrant of the abdomen. c) nausea. d) high fever.

c) nausea. Nausea is typically associated with appendicitis with or without vomiting. Pain is generally felt in the right lower quadrant. Rebound tenderness, or pain felt with release of pressure applied to the abdomen, may be present with appendicitis. Low-grade fever is associated with appendicitis.

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

d) A change in bowel habits Although abdominal distention and blood in the stool (frank or occult) may be present, the chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Abdominal pain is a late sign.

A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of: a) Inflammatory colitis. b) A disorder of the large bowel. c) A small bowel disorder. d) Intestinal malabsorption.

d) Intestinal malabsorption. Watery stools are characteristic of disorders of the small bowel, whereas loose, semisolid stools are associated more often with disorders of the large bowel. Large, greasy stools suggest intestinal malabsorption, and the presence of mucus and pus in the stools suggests inflammatory enteritis or colitis.

A nurse is caring for a client who has experienced an acute exacerbation of Crohn's disease. Which statement best indicates that the disease process is under control? a) The client maintains skin integrity. b) The client expresses positive feelings about himself. c) The client verbalizes a manageable level of discomfort. d) The client exhibits signs of adequate GI perfusion.

d) The client exhibits signs of adequate GI perfusion. Adequate GI perfusion can be maintained only if Crohn's disease is controlled. If the client experiences acute, uncontrolled episodes of Crohn's disease, impaired GI perfusion may lead to a bowel infarction. Positive self-image, a manageable level of discomfort, and intact skin integrity are expected client outcomes, but aren't related to control of the disease.

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? a) Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. b) The appendix may develop gangrene and rupture, especially in a middle-aged client. c) Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. d) Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

c) Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. A client with appendicitis is at Risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Elderly, not middle-aged, clients are especially susceptible to appendix rupture.

Perforation of the appendix generally occurs within which timeframe of the onset of pain if no intervention is done? a) 24 hours b) 36 hour c) 48 hours d) 12 hours

a) 24 hours The major complication of appendicitis is perforation of the appendix. Perforation generally occurs 24 hours after the onset of pain if no intervention has occurred.