LWW - Ch. 47: Mgmt of Patients With Intestinal and Rectal Disorders

A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client? 1. Suggest fluid intake of at least 2 L/day 2. Instruct the client to avoid prune or apple juice 3. Assist the client regarding the correct diet or to minimize food intake 4. Instruct the client to keep a record of food intake

1

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? 1. "I need to use laxatives regularly to prevent constipation." 2. "I need to drink 2 to 3 liters of fluids every day." 3. "I should exercise four times per week." 4. "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread."

1

Crohn's disease is a condition of malabsorption caused by which pathophysiological process? 1. Inflammation of all layers of intestinal mucosa 2. Infectious disease 3. Gastric resection 4. Disaccharidase deficiency

1

The nurse caring for a client with diverticulitis is preparing to administer the client's medications. The nurse anticipates administration of which category of medication because of the client's diverticulitis? 1. Antispasmodic 2. Anti-inflammatory 3. Antianxiety 4. Antiemetic

1

A client has developed an anorectal abscess. Which client is at most risk for the development of this type of abscess? 1. A client with hemorrhoids 2. A client with Crohn's disease 3. A client with diverticulosis 4, A client with colon cancer

2

A client informs the nurse that he has been having abdominal pain that is relieved when having a bowel movement. The client states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder? 1. Blood and mucus in the stool 2. Chronic constipation with sporadic bouts of diarrhea 3. Weight loss due to malabsorption 4. Client is awakened from sleep due to abdominal pain.

2

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? 1. Prepare the client for a gastrostomy tube placement. 2. Test all stools for occult blood. 3.Administer morphine (Duramorph PF) routinely, as ordered. 4. Administer topical ointment to the rectal area to decrease bleeding.

2

A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult? 1. "I don't like oatmeal, so it doesn't matter that I can't have it." 2. "I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." 3. "I don't understand this; I took the medication the doctor ordered and followed the diet." 4. "I don't understand why this happened again; I didn't travel out of the country."

2

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"? 1. one bowel movement daily 2. stool consistency and client comfort 3. two bowel movements daily 4. one bowel movement every other day

2

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find: 1. tenderness and pain in the right upper abdominal quadrant. 2. severe abdominal pain with direct palpation or rebound tenderness. 3. jaundice and vomiting. 4. rectal bleeding and a change in bowel habits.

2

The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching? 1. Use laxatives weekly. 2. Drink 8 to 10 glasses of fluid daily. 3. Avoid daily exercise. 4. Avoid unprocessed bran.

2

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? 1. History of skin cancer 2. Familial polyposis 3. Low-fat, low-protein, high-fiber diet 4. Age younger than 40 years

2

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: 1. hemorrhoid. 2. fistula. 3. pilonidal cyst. 4. fissure.

4

A longitudinal tear or ulceration in the lining of the anal canal is termed a(n): a) Hemorrhoid b) Anorectal abscess c) Anal fistula d) Anal fissure

d

Which of the following would a nurse expect to assess in a client with peritonitis? a) Hyperactive bowel sounds. b) Decreased pulse rate (HR). c) Slow, deep respirations. d) Board-like abdomen.

d

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? 1. Tenesmus 2. Borborygmus 3. Loud bowel sounds 4. Peristalsis

2

Which statement provides accurate information regarding cancer of the colon and rectum? 1. Rectal cancer affects more than twice as many people as colon cancer. 2. Colorectal cancer is the third most common site of cancer in the United States. 3. Colon cancer has no hereditary component. 4. The incidence of colon and rectal cancer decreases with age.

2

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 boardlike. What complication does the nurse determine may be occurring at this time? 1. Constipation 2. Paralytic ileus 3. Peritonitis 4. Accumulation of gas

3

A patient with IBD would be encouraged to increase fluids, use vitamins and iron supplements, and follow a diet designed to reduce inflammation. Select the meal choice that would be recommended for a low-residue diet. 1. Salami on whole grain bread and V-8 juice 2. A peanut butter sandwich and fruit cup 3. Broiled chicken with low-fiber pasta 4. A fruit salad with yogurt

3

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process? 1. Normal erythrocyte sedimentation rate (ESR) 2. Subnormal temperature 3. Hypotension 4. Bradycardia

3

Which client requires immediate nursing intervention? The client who: 1. presents with ribbonlike stools. 2. complains of epigastric pain after eating. 3. presents with a rigid, boardlike abdomen. 4. complains of anorexia and periumbilical pain.

3

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? 1. lack of solid food 2. lack of exercise 3. increased fiber 4. lack of free water intake

4

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? 1. Calorie restriction 2. Low protein 3. Iron restriction 4. Low residue

4

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? 1. Limiting fluid intake to 5 to 6 glasses per day 2. Avoiding bran cereals and beans in the diet 3. Minimizing activity levels for at least 2 months 4. Adding fiber-rich foods to the diet gradually

4

The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation? 1. Current medications 2. Activity levels 3. Alcohol consumption 4. Usual pattern of elimination

4

The nurse is talking with a group of clients who are older than age 50 years about the recognition of colon cancer to access early intervention. What should the nurse inform the clients to report immediately to their primary care provider? 1. Abdominal cramping when having a bowel movement 2. Daily bowel movements 3. Excess gas 4. Change in bowel habits

4

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? 1. Dust with nystatin powder 2. Apply barrier powder 3. Apply triamcinolone acetonide spray 4. Dry skin thoroughly after washing

4

Which of the following is accurate regarding regional enteritis? 1. Severe diarrhea 2. Severe bleeding 3. Fistulas are common 4. Exacerbations and remissions

4

A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation? a) Assisting to increase dietary fiber. b) Providing an adequate quantity of food. c) Obtaining medications and allergy history. d) Obtain medical and food history.

a

A nurse is interviewing a client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? a) Polyps b) Hemorrhoids c) Duodenal ulcers d) Weight gain

a

The nurse in an extended-care facility reports that a resident has clinical manifestations of fecal incontinence. The health care provider orders a diagnostic study to rule out inflammation. The nurse would prepare the patient for which of the following? a) Flexible sigmoidoscopy b) X-ray studies (i.e., barium enema) c) Computed tomography (CT) scan d) Anorectal manometry and transit studies

a

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) Medications c) Allergies d) Family history of constipation/GI issues

a

What information should the nurse include in the teaching plan for a client being treated for diverticulosis? a) Drink at least 8 to 10 large glasses of fluid every day b) Do not include unprocessed bran in the diet c) Regular use of laxatives and enemas at home d) Discourage regular exercise if pt. is inactive

a

What is the MOST common cause of small-bowel obstruction? a) adhesions b) ulcers c) hernias d) tumors

a

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? a) Administering an ointment b) Testing all stools for occult blood. c) Administering an opioid pain medication. d) Preparing a client for a gastrostomy tube.

b

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) anorectal fistula b) anal fissure c) anal polyp d) hemorrhoids

b

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) Frank blood in stool b) Change in bowel habits c) Change in dietary habits d) Abdominal pain

b

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: a) Encourage caffeine and alcohol consumption at mild to moderate levels. b) Encourage a high-fiber diet daily. c) Encourage increased consumption of spicy foods, lactose, fried foods, corn, and wheat. d) Increase p.o. fluids only with/during meals.

b

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of: a) Ulcerative colitis b) Peritonitis c) Diverticulitis d) Diverticulosis

b

The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition? a) Azotorrhea b) Borborygmus c) Tenesmus d) Diverticulitis

b

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is MOST appropriate? a) Cutting the faceplate opening no more than 2" larger than the stoma b) Scrubbing the area around the stoma c) Gently washing the area surrounding the stoma using a facecloth and mild soap d) Eliminating wrinkles in the faceplate

c

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? a) Low p.o. fluids. b) Low-protein diet. c) Low residue diet. d) High-calorie diet.

c

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? a) Age under 40 years old. b) High-fat, high-protein, low-fiber diet. c) Familial polyposis (FHx of colon cancer). d) Familial history of basal cell carcinomas.

c

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) Avoid bran cereals and beans in the diet. b) Increasing intake of fluids, 3-4 glasses/day. c) Avoid a daily exercise regimen. d) Adding fiber-rich foods to the diet gradually.

d

The nurse is assessing a client for constipation. Which review should the nurse conduct FIRST to identify the cause of constipation? a) Review current medications b) Assess pain levels c) Bright red blood found in stools d) Usual pattern of elimination

d

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? a) Tell the client you are almost finished and to hold still for the next 1-2 minutes. b) Water should flow in over a 45 minute period. c) Allow only tepid fluid to enter the colon slowly. d) Clamp the tubing and give the patient a rest period.

d