Med Surg Chapter 48: Management of Patients With Intestinal and Rectal Disorders
A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation?
Assist client to increase dietary fiber.
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 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
The presence of mucus and pus in the stools suggests which of the following conditions?
Ulcerative colitis
A client has symptoms suggestive of peritonitis. Nursing management would not include:
limiting analgesics to avoid the formation of paralytic ileus.
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.
Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following?
Low residue
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?
Ulcerative colitis
The nurse is assessing a patient for constipation. Which of the following is the first factor the nurse should review to identify the cause of constipation?
Usual pattern of elimination
A 72-year-old client seeks help for chronic constipation. Constipation is a common problem for elderly clients because of several factors related to aging, including:
decreased abdominal strength.
The nurse is performing a community screening for colorectal cancer. Which of the following characteristics should the nurse include in the screening?
Familial polyposis
Diet therapy for patients diagnosed with IBS include which of the following?
High-fiber diet
A client comes to the clinic complaining of not having a bowel movement in several days, abdominal cramping, and nausea. When the nurse puts the client on the stretcher, he vomits a large amount of fecal material. What should the first action by the nurse be?
Notify the physician.
A nurse is helping to plan a teaching session for a client who will be discharged with a colostomy. Which statement describes a healthy stoma?
"At first, the stoma may bleed slightly when touched."
A nurse is teaching an elderly 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."
Which of the follow statements provide accurate information regarding cancer of the colon and rectum?
Cancer of the colon and rectum is the second most common type of internal cancer in the United States.
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.
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?
0.9% NS
Perforation of the appendix generally occurs within which timeframe of the onset of pain if no intervention is done?
24 hours
The nurse is caring for four clients with diarrhea. Which client is most likely to be diagnosed with Crohn's disease?
A 24 year-old Caucasian eastern European Jewish female
After teaching a group of students about intestinal obstruction, the instructor determines that the teaching was effective when the students identify which of the following as a cause of a functional obstruction?
Abdominal surgery
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?
Adding fiber-rich foods to the diet gradually
A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's stoma appears dusky. How should the nurse interpret this finding?
Blood supply to the stoma has been interrupted.
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
The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the patient then experiences diarrhea, the nurse documents the presence of which of the following?
Borborygmus
The nurse is talking with a group of clients that 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?
Change in bowel habits
Which of the following is the most common presenting symptom of colon cancer?
Change in bowel habits
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?
Chronic constipation with sporadic bouts of diarrhea
A client is being treated for diverticulosis. Which points should the nurse include in this client's teaching plan? Select all that apply.
Drink at least 8 to 10 large glasses of fluid every day. Do not suppress the urge to defecate.
The nurse is teaching a patient with an ostomy how to change the pouching system. Which of the following should the nurse include in the teaching of a patient with no peristomal skin irritation?
Dry skin thoroughly after washing
A patient with an ileostomy should avoid which of the following?
Enteric-coated products
Crohn's disease is a condition of malabsorption caused by which of the following pathophysiological processes?
Inflammation of all layers of intestinal mucosa
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:
Intestinal malabsorption.
Vomiting results in which of the following acid-base imbalances?
Metabolic alkalosis
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?
Peritonitis
The nurse is monitoring a patient's postoperative course after an appendectomy. The nurse's assessment reveals that the patient has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse's report to the physician is that the patient has signs/symptoms of which of the following complications?
Peritonitis
When interviewing a client with internal hemorrhoids, which of the following would the nurse expect the client to report?
Rectal bleeding
Which of the following is the most common symptom of a polyp?
Rectal bleeding
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?
Right lower quadrant
Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction?
Sudden, sustained abdominal pain
A patient who has undergone colostomy surgery is experiencing constipation. Which of the following interventions should a nurse consider for such a patient?
Suggest fluid intake of at least 2 L per day
Which of the following is a true statement regarding regional enteritis (Crohn's disease)?
The clusters of ulcers take on a cobblestone appearance.
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?
White blood cell (WBC) count 22.8/mm3
A longitudinal tear or ulceration in the lining of the anal canal is termed a (an)
anal fissure.
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 nurse is reviewing lab results for a client with an intestinal obstruction, and infection is suspected. What would be an expected finding?
leukocytosis; elevated hematocrit; low sodium, potassium, and chloride
An elderly 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
A client with appendicitis is experiencing excruciating abdominal pain. An abdominal X-ray film reveals intraperitoneal air. The nurse should prepare the client for:
surgery
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.
