Honan-Chapter 24: Nursing Management: Patients With Intestinal and Rectal Disorders

A client is scheduled to undergo rhinoplasty in the morning, and reports medications used on a daily basis, which the nurse records on the client's chart. Which daily medications have the potential to result in constipation? A. laxative B. multivitamin without iron C. NSAIDs D. acetaminophen

A. laxative RATIONALE Constipation may also result from chronic use of laxatives ("cathartic colon")because such use can cause a loss of normal colonic motility and intestinal tone. Laxatives also dull the gastrocolic reflex.

A patient complains of abdominal pain unrelieved by defecation, that typically occurs after meals along with diarrhea. What does the nurse recognize as the most likely diagnosis? A. Ulcerative colitis B. Regional enteritis C. Cholecystitis D. Diverticulosis

B. Regional enteritis RATIONALE Regional enteritis, or Crohn's disease, typically presents with cramp/spasm-type abdominal pain that worsens after meals. It often also presents with diarrhea.

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

B. White blood cell (WBC) count 22.8/mm3 RATIONALE The nurse should report the elevated WBC count. This finding, which is a sign of infection, indicates that the client's appendix might have ruptured. Hematocrit of 42%, serum potassium of 4.2 mEq/L, and serum sodium of 135 mEq/L are within normal limits. Alterations in these levels don't indicate appendicitis.

What is the most common cause of small-bowel obstruction? A. Hernias B. Neoplasms C. Adhesions D. Volvulus

C. Adhesions RATIONALE Adhesions are scar tissue that forms as a result of inflammation and infection. Adhesions are the most common cause of small-bowel obstruction, followed by tumors, Crohn's disease, and hernias. Other causes include intussusception, volvulus, and paralytic ileus.

A patient returns to his room following a diagnostic colonoscopy after radiologic evidence of diverticulosis. He reports an increase in abdominal pain, fever, and chills. Which clinical condition is most concerning to the nurse? A. Colon cancer B. Hemorrhoids C. Bowel perforation D. Anal fissure

C. Bowel perforation RATIONALE During a colonoscopy, manipulation of the bowel occurs, which can cause peritonitis or bowel perforation. Signs and symptoms of a perforated bowel include abdominal pain, fever, and chills. The patient may have guarding (not allowing palpation of the abdomen), rigidity, and firmness of the abdomen, or rebound tenderness (an increase of pain upon releasing pressure on the abdomen).

A patient complains of abdominal pain and distention, fever, tachycardia, and diaphoresis. An abdominal x-ray shows free air under the diaphragm. The emergency department nurse should suspect which condition? A. Intestinal obstruction B. Malabsorption C. Intestinal perforation D. Acute cholelithiasis

C. Intestinal perforation RATIONALE Free air in the abdomen may result from a perforation of the abdominal organ or any part of the bowel, a tumor, or trauma.

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. As long as the client is drinking 8 glasses of water per day, he can continue to take them. B. The laxative is safe to take with other medication the client is taking. C. The client should take a fiber supplement along with the stimulant laxative. D. They can be habit forming and will require increasing doses to be effective.

D. They can be habit forming and will require increasing doses to be effective. RATIONALE The nurse should discourage self-treatment with daily or frequent enemas or laxatives. Chronic use of such products causes natural bowel function to be sluggish. In addition, laxatives continuing stimulants can be habit forming, requiring continued use in increasing doses. Although the nurse should encourage the client to have adequate fluid intake, laxative use should not be encouraged. The laxative may interact with other medications the client is taking and may cause a decrease in absorption. A fiber supplement may be taken alone but should not be taken with a stimulant laxative.

A 75-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. An emergency room nurse is obtaining assessment data from this patient. What assessment finding is characteristic of a small bowel obstruction? A. Nausea and vomiting B. Decrease in urine production C. Mucus in the stool D. Mucosal edema

A. Nausea and vomiting RATIONALE Nausea and vomiting are symptoms of a small bowel obstruction. Decrease in urine production and mucosal edema are not symptoms of a bowel obstruction. The patient may defecate mucus, but this is not accompanied by stool.

A patient is complaining of right lower quadrant pain, fever, and decreased appetite. What does the nurse suspect is the most likely cause? A. Diverticulitis B. Appendicitis C. Small bowel obstruction D. Sigmoid colon cancer

B. Appendicitis RATIONALE The signs and symptoms of appendicitis include right lower quadrant pain, increased fever and WBC counts, and a decreased appetite. The patient may also complain of nausea and vomiting, and the pain may radiate into the umbilical area.

A 61-year-old woman presented to a scheduled appointment with her nurse practitioner, stating, "I'm having a lot of trouble with constipation over the past few months." What action should the nurse first take in response to this patient's health complaint? A.Assess the woman's family history of constipation and bowel obstruction. B. Assess the woman's typical bowel patterns and her expectations for bowel function. C. Advise the woman to increase her fluid intake, activity level, and fiber intake. D. Arrange for a barium enema or colonoscopy to assess the woman's lower bowel.

B. Assess the woman's typical bowel patterns and her expectations for bowel function. RATIONALE Before recommending interventions, it is important to ascertain the patient's current bowel habits and her expectations surrounding these. This should precede invasive diagnostic testing and would be prioritized over the woman's family history.

A patient has a bowel perforation from a recent surgery and now has been diagnosed with peritonitis. The patient has hypoactive bowel sounds, a temperature of 100.5°F, and an elevated WBC count. What is the most serious potential complication of peritonitis for which the nurse should monitor? A. Nausea B. Diarrhea C. Sepsis D. Abdominal tenderness

C. Sepsis RATIONALE Sepsis is the major cause of death from peritonitis. Shock may result from septicemia or hypovolemia. The inflammatory process may cause intestinal obstruction, primarily from the development of bowel adhesions, and care must be made to closely monitor the patient's nasogastric tube drainage and input and output. Diarrhea would normally not occur due to intestinal obstruction, which causes decreased peristalsis and decreased bowel movements. Nausea and abdominal tenderness are expected as clinical manifestations of peritonitis.

A community health nurse is performing a home visit to a 53-year-old patient who requires twice-weekly wound care on her foot. The patient mentions that she is currently having hemorrhoids, a problem that she has not previously experienced. What treatment measure should the nurse recommend to this patient? A. Daily application of topical antibiotics B. Decreased fluid intake C. Bathing, rather than showering, once per day D. A high-fiber diet with increased fruit intake

D. A high-fiber diet with increased fruit intake RATIONALE Hemorrhoid symptoms and discomfort can be relieved by good personal hygiene and by avoiding excessive straining during defecation. A high-residue diet that contains fruit and bran along with an increased fluid intake may be all the treatment necessary to promote the passage of soft, bulky stools to prevent straining. It is unnecessary to avoid showering, and antibiotics are not an effective treatment.

An 81-year-old patient of a subacute geriatric medical unit has become incontinent of stool over the past several days. This development has coincided with a decline in the patient's cognition as a result of severe Alzheimer's disease. In light of the patient's fecal incontinence, what nursing diagnosis should the nurse prioritize when planning this patient's care? A. Altered role performance related to fecal incontinence B. Altered nutrition, less than body requirements related to fecal incontinence C. Situational low self-esteem related to fecal incontinence D. Impaired skin integrity related to fecal incontinence

D. Impaired skin integrity related to fecal incontinence RATIONALE Fecal incontinence creates a significant risk of skin breakdown, especially when combined with decreased cognition. Role performance and self-esteem are likely to be impacted by the patient's Alzheimer's disease more than by fecal incontinence. Incontinence does not necessarily cause a nutritional deficit.