MED/SURG2: Chapter 42

Which complication does the nurse monitor for in a patient who has a colonic J-pouch?

Difficulty evacuating stool A patient with a colonic J-pouch may have difficulty evacuating stools even after years of the surgery. Diarrhea, incontinence, and osteoporosis are not complications of the colonic J-pouch. p. 956

The nurse is caring for a patient who has undergone ostomy surgery. Which finding alerts the nurse to the possibility of an ischemic bowel?

Dusky blue stoma Dusky blue stoma indicates ischemia. Ischemia occurs due to an inadequate blood supply to the stoma. Pale stoma indicates anemia. Dark pink stoma is a normal finding. Brown-black stoma indicates necrosis. p. 960

The student nurse is providing postoperative care to a patient who underwent ostomy surgery. Which action of the student nurse indicates the need for correction?

Emptying collecting bags when filled completely The weight of drainage from the stoma pulls the skin barrier away from the skin and loosens the seal. Therefore, the nurse should empty the ostomy bag when it is one-third full, instead of when it is completely full. Using open-ended and transparent pouches helps the nurse to observe the stoma and collect the drainage. Placing a pouch on irritated skin using a skin barrier is done to prevent harm to the area. Expelling flatus from the bag with a charcoal filter helps to control odor. p. 960

Which test is used to determine the extent of the tumor in a patient with gastrointestinal stromal tumors?

Endoscopic ultrasound Endoscopic ultrasound is a diagnostic test used to determine the extent of the tumor in a patient with gastrointestinal stromal tumors. The D-xylose test and the lactose tolerance test are used to test malabsorption of carbohydrates. Histologic examination of biopsied tissue is used to diagnose gastrointestinal stromal tumors. p. 968

A patient reports foul smelling diarrhea and flatulence to the nurse. The nurse also finds abdominal distention, steatorrhea, and rheumatoid arthritis. Which food should the nurse include in the patient's diet plan?

Gluten-free food Celiac disease is an autoimmune disease in which patients suffer damage to the small intestinal mucosa. Celiac disease is characterized by symptoms of foul smelling diarrhea, flatulence, abdominal distension, and steatorrhea. Patients with rheumatoid arthritis are at an increased risk for celiac disease. The symptoms will increase if the patient consumes foods containing gluten. Therefore, the nurse will include gluten-free foods in the patient's diet plan. Fat-free food is recommended for patients with short bowel syndrome. Lactose-free food is recommended for a patient with lactose deficiency. Carbohydrate-free food will be recommended for a patient who is obese. pp. 966-967

Which condition is a common manifestation associated with protein deficiency?

Hair thinning Hair thinning and muscle wasting are common manifestations associated with protein deficiency because a strand of hair or muscle is composed mostly of protein. Paresthesia is a manifestation associated with cobalamin deficiency. Hypotension is a manifestation associated with dehydration. Peripheral neuropathy is also associated with cobalamin deficiency. p. 966

The nurse is caring for a patient experiencing diarrhea caused by clostridium difficile. What action should the nurse take?

Handwashing Clostridium difficile is a highly contagious infection. Meticulous handwashing is crucially important to prevent the transmission to other patients. Antidiarrheal medications will prolong the exposure to this pathogen. Mineral oil enemas are not used to treat this pathogen. Patients with clostridium difficile will be placed on contact, not airborne, isolation. p. 932

A patient's colostomy stoma is scheduled to be irrigated on the fifth postoperative day. What does the nurse understand to be the main purpose of the irrigation?

Help regulate the colon A new colostomy may require irrigation to train, or regulate, the colon for its modified function. The patient should also be instructed to contract abdominal muscles and to massage the abdomen from right to left to stimulate peristalsis. Although colostomy irrigation may act as an enema to facilitate a bowel movement, its greater purpose is the regulation of the colon. Blood clots should not be present, and an irrigation is never used to test the patency of the colostomy. p. 961

A patient on alosetron therapy reports abdominal pain and constipation. What instruction does the nurse anticipate providing to the patient?

"Discontinue alosetron." Alosetron therapy should be discontinued if constipation occurs. Hydrocil and methylcellulose are laxatives and can be administered after receiving an instruction from the primary health care provider. Reducing the frequency of alosetron administration would not resolve the constipation. p. 941

A patient has developed a complication after colostomy surgery. What statement made by the patient to the nurse indicates that further instruction is needed?

"I am including cooked split and black beans in my diet." After a colostomy, the patient should maintain a low-fiber diet initially, to maintain digestion. A high-fiber meal of cooked split and black beans can cause diarrhea. The patient can eat fish because it is not a rich source of fiber. A fluid intake of 3000 mL per day keeps the body hydrated. The patient should ingest additional sodium to compensate for excess sodium loss in feces. pp. 960-961

The nurse is discussing postoperative care with a patient who had inguinal hernia repair the previous day. Which statement by the patient reflects a need for additional education?

"I can go back to my job at the moving company in four weeks." The statement about returning to work at the moving company does not reflect an adequate understanding of instructions. The patient may be restricted from heavy lifting for six to eight weeks. After a hernia repair, encourage deep breathing, but not coughing. Teach patients to splint the incision and keep their mouths open when coughing or sneezing is unavoidable. Scrotal edema is a painful complication and scrotal support with application of an ice bag may help relieve pain and edema. pp. 964-965

When a patient reports diarrhea, abdominal cramps, and nausea, the nurse suspects an infection from Giardia lamblia. Which statement of the patient supports the nurse's suspicion?

"I have started going to a swimming pool recently." Giardia lamblia is a parasitic organism that is mostly found in contaminated lakes and pools. If a patient has been to a contaminated lake or pool and ingested the water, he or she could be infected by the Giardia lamblia organism and will experience diarrhea, abdominal cramps, and nausea. Clostridium difficile infection is suspected in a patient who is on clindamycin therapy because this organism is an antibiotic-associated diarrhea. Giardia lamblia infection is not suspected if the patient has low-fat foods in the diet. A patient who has diarrhea after eating chicken most likely has the Salmonella organism because it is seen in uncooked eggs and chicken. pp. 929, 930

The nurse is preparing education regarding ostomy self-care for a patient with a new colostomy. What statement by the patient is most indicative that the patient is ready to learn?

"I need more information about the procedure to change the bag." The patient is expressing indirect but definite interest when the nurse is providing colostomy care. The patient indicates that he or she is willing to watch, which is the first step in self-care. Indicating that he or she has no questions, asking for the spouse to be taught first, and asking for a visiting nurse reflect difficulty accepting and providing self-care for the new colostomy. pp. 960-961

Which statement of the nurse providing dietary instructions to a patient with irritable bowel syndrome (IBS) needs correction?

"You should eat cabbage." Cabbage is a gas producing food and should be avoided in patients with IBS. The patient may include yogurt in his or her diet because it does not aggravate IBS. Broccoli is a gas-producing food and should be avoided. Milk products may aggravate the patient's condition. pp. 940-941

When evaluating the patient's understanding about the care of the ileostomy, what statement by the patient indicates the patient needs more teaching?

"I will be able to regulate when I have stools." The ileostomy is in the ileum and drains liquid stool frequently, unlike the colostomy, which has more formed stool the further distal the ostomy is in the colon. The ileostomy pouch is usually worn for four to seven days or until it leaks. It must be changed immediately if it leaks because the drainage is very irritating to the skin. To avoid obstruction, popcorn, dried fruit, coconut, mushrooms, olives, stringy vegetables, food with skin, and meats with casings must be chewed extremely well before swallowing because of the narrow diameter of the ileostomy lumen. pp. 961-962

The nurse has provided teaching to a patient who has diverticular disease but is not experiencing an acute episode at this time. Which statement by the patient reflects an adequate understanding of the teaching?

"I will decrease my intake of fat and red meat." A high-fiber diet, mainly from fruits and vegetables, and decreased intake of fat and red meat are recommended for preventing diverticular disease. High levels of physical activity also seem to decrease the risk. A high-fiber diet also is recommended once diverticular disease is present. Currently there is no evidence to support the theory that diverticulitis can be prevented by avoiding nuts and seeds. A patient with diverticular disease should avoid increased intraabdominal pressure because it may precipitate an attack. Factors that increase intraabdominal pressure are straining at stool, vomiting, bending, lifting, and wearing tight restrictive clothing. pp. 963-964

The patient asks the nurse how bisacodyl exerts its effects. Which reply by the nurse is most appropriate?

"It directly stimulates the smooth muscle in the bowel." Bisacodyl has a stimulant effect on the colon, increasing peristalsis, leading to soft but formed stools within 12 hours. Water content of the stool is not affected, and there is no oil in the medication to lubricate the stool. p. 936

A 28-year-old woman calls the office nurse and states, "I am having the worst abdominal pain! It just started this afternoon. Is there anything I can take to get relief?" Which answer by the nurse is appropriate?

"Please have someone bring you to the office today so that we can do an examination." Encourage the patient with abdominal pain to see a health care provider and to avoid self-treatment. Laxatives and enemas are especially dangerous because the resulting increased peristalsis may cause perforation of an inflamed appendix. Taking pain medication is not an appropriate action for abdominal pain of unknown origin. pp. 938-939

A patient is diagnosed with irritable bowel syndrome (IBS) and asked what could have led to this development. What is the best response by the nurse?

"Sleep disturbances may be a factor." Sleep disturbance may increase the risk for irritable bowel syndrome due to chronic alterations in the bowel function. Pelvic inflammatory disease, ruptured ectopic pregnancy, and abdominal compartment syndrome may cause acute abdominal pain. p. 940

A patient with abdominal pain, severe diarrhea, bloating, and flatulence complaining of constipation is prescribed alosetron. What statement by the nurse would be most beneficial?

"Stop the medication immediately." Alosetron is used to treat irritable bowel syndrome with severe diarrhea; it can cause severe constipation and ischemic colitis. Alosetron should be stopped immediately if the patient has constipation because continuing the medication can aggravate the condition. Increasing physical activity can also alleviate constipation by enhancing bowel movements. Drinking plenty of water in the morning will enhance bowel movements and helps in evacuation. High-fiber foods can help relieve constipation. p. 941

The nurse is preparing to insert a nasogastric (NG) tube into a 68-year-old female patient who is nauseated and vomiting. The patient has an abdominal mass and suspected small intestinal obstruction. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate?

"The tube will help to drain the stomach contents and prevent further vomiting." The NG tube is used to decompress the stomach by draining stomach contents, and thereby prevent further vomiting. The NG tube will not push past the blocked area. Potential surgery is not indicated currently. The location of the obstruction will determine the type of fluid to use, not measuring the amount of stomach contents. pp. 952-953

A patient with abdominal pain, constipation, bloating, sleep disturbance, and flatulence is prescribed alosetron. Which questions should the nurse ask the patient to ensure the safety of the medication?

-"Do you have abdominal pain?" -"Do you have blood in your stools?" -"Are you experiencing severe constipation?" Abdominal pain, constipation, bloating, sleep disturbance, and flatulence indicate irritable bowel syndrome, which is treated with alosetron. Side effects of alosetron include abdominal pain, blood in the stool, and severe constipation. To ensure safety, the nurse should ask questions about abdominal pain, blood in stools, and severe constipation. The nurse will ask the patient about blood in the urine during assessment of acute abdominal pain. Alosetron does not cause blood vomiting. p. 941

The nurse is teaching measures about how to adapt with an ostomy. Which statements made by the patient indicate effective learning?

-"I can wear clothes that will hide the stoma." -"I should avoid heavy lifting for 8 weeks after surgery." -"I should maintain contact with the local support services." The patient is able to wear clothing that will hide the stoma. The patient should avoid heavy lifting for 8 weeks after the surgery to prevent the risk of heavy bleeding. The nurse should recommend support services to the patient that can help him or her to manage the stoma. The patient can go swimming with or without the pouching system in place because water does not harm the stoma. The patient's sexual activity may be affected after surgery, but it need not be avoided for 1 year after the surgery. pp. 960-962

A patient arrives in the emergency department reporting abdominal pain. When assessing the patient, for what conditions should the nurse monitor?

-Acute pancreatitis -Bowel obstruction -Pelvic inflammatory disease Acute pancreatitis, bowel obstruction, and pelvic inflammatory disease can lead to acute abdominal pain. Diabetes mellitus and Parkinson's disease can lead to constipation by slowing the gastrointestinal tract and hampering the neurologic function. p. 938

After assessing a patient with ulcerative colitis, the nurse concludes that the patient has moderate disease. Which patient symptoms support the nurse's conclusion?

-Anorexia -Increased bleeding The primary manifestations of ulcerative colitis are abdominal pain and diarrhea. Moderate disease associated with ulcerative colitis involves anorexia and increased bleeding. Tachycardia is observed in patients with severe disease. Muscular rigidity and abdominal distension are signs of peritonitis. pp. 945-946

A patient reports fever, abdominal pain, nausea, and vomiting. The patient's heart rate is 150 beats/minute and the respiratory rate is 20 breaths/minute. Which treatment strategies does the nurse identify will benefit the patient?

-Antibiotic therapy -Nasogastric suction A heart rate of 150 beats/minute indicates tachycardia and a respiratory rate of 20 breaths/minute indicates tachypnea. Fever, abdominal pain, nausea, vomiting, tachypnea, and tachycardia indicate peritonitis, which is localized or generalized inflammation of the peritoneum. Peritonitis can be managed with the use of antibiotics and nasogastric suction. Colectomy is used to treat ulcerative colitis. Antimicrobial therapy, and biologic and targeted therapy are used to treat inflammatory bowel disease. pp. 943-944

The nurse is caring for a patient who has undergone an abdominoperineal resection; the nurse suspects infection. Which findings support the nurse's conclusion?

-Body temperature of 100.4° F -Edematous and erythematous stoma -White blood cell count of 15,000 cells/mL An elevated body temperature of 100.4° F indicates a fever, which is a sign of infection. Edema, erythema, and drainage around the suture line indicate infection. An elevated white blood cell count of 15,000 cells/mL in the patient also indicates infection. pp. 956-958

Which changes in vital signs may accompany an inflamed and swollen structure around the anus and difficulty in defecating?

-Decreased venous return -Decreased arterial pressure -Increased intrathoracic pressure Inflamed and swollen structures around the anus and difficulty in defecating indicate hemorrhoids, possibly due to chronic constipation. Patients with chronic constipation inspire deeply while straining and hold the breath while contracting abdominal muscles. This results in reduced venous return, decreased arterial pressure, and increased intrathoracic pressure. During straining, heart rate and cardiac output decrease. pp. 968-969

Which symptoms support the nurse's conclusion that a patient has malabsorption syndrome?

-Diarrhea -Steatorrhea Malabsorption syndrome is a condition that is caused by impaired absorption of fats, carbohydrates, proteins, minerals, and vitamins. This impaired absorption causes diarrhea and steatorrhea. Malabsorption can result in weight loss, but not weight gain. Malabsorption syndrome does not reduce bowel movements; therefore, it does not result in constipation. Malabsorption syndrome can result in hypocalcemia, but not hypercalcemia. pp. 965-966

A patient was the unrestrained driver in a motor vehicle crash and the nurse suspects that the patient has abdominal trauma. What clinical manifestations assessed by the nurse would indicate abdominal trauma?

-Distended abdomen -Decreased bowel sounds -Guarding and splinting of the abdominal wall Abdominal trauma is injury in the abdominal area due to blunt trauma or penetrating injuries. A patient with abdominal trauma will have a distended abdomen, decreased bowel sounds, guarding and splinting of the abdominal wall, abdominal pain, and hematemesis or hematuria. Blood in the stool is a sign of ischemic colitis. Pain in the right lower quadrant is an indication of appendicitis. p. 939

When teaching a patient about ways to prevent constipation, what instructions should the nurse include?

-Eat a high-fiber diet. -Increase fluid intake. -Do not suppress the urge to defecate. To prevent constipation, it is important to have a high-fiber diet, increase fluid intake, and not suppress the urge to defecate. Dietary fibers are bulking agents and help in easy defecation. Adequate fluid intake prevents the stool from hardening and prevents constipation. The urge to defecate should not be suppressed because this can lead to the absorption of water from the digestive tract, resulting in hardened stools. Laxatives should not be used regularly because they can cause the patient to become reliant on them. Exercising regularly aids in peristalsis and helps to prevent constipation. p. 936

The nurse is caring for a patient with colorectal cancer who has a partially closed wound. Which parameters associated with the condition should the nurse monitor?

-Edema -Erythema -Elevated leukocyte count If a patient with colorectal cancer has a partially closed wound, the nurse should monitor for edema, erythema, fever, and an elevated leukocyte (white blood cell) count. Hypoalbuminemia and elevated C-reactive protein levels are observed in patients with inflammatory bowel disease (IBD). pp. 957-958

The nurse is giving discharge instructions to a patient who has been treated for severe constipation. Which statement(s) would the nurse include in the instruction of the patient?

-Establish a regular time to defecate. -Defecate on commode with knees higher than hips -Consume a high-fiber diet, increase fluid intake, and exercise regularly. Establishing a regular time to defecate is an important part of bowel training. Defecation is easier when the knees are higher than the hips. A high-fiber diet, increased fluid intake, and regular exercise help prevent constipation. Encourage patients to exercise abdominal muscles and to contract abdominal muscles several times a day to increase abdominal muscle tone. This assists with elimination. A clear liquid diet is not helpful to avoid constipation. pp. 936-937

Which laboratory parameters does the nurse need to assess in a patient who has recently undergone ileostomy?

-Fluid deficits -Sodium levels -Potassium levels A patient who has undergone an ileostomy has a high-volume colonic output, which leads to an excessive loss of fluids and electrolytes from the body. This results in fluid deficits and electrolyte imbalances. Sodium and potassium levels in the body need to be closely monitored because those levels can get dangerously low. Although red blood and white blood cell counts are important to monitor, they are not the most important parameters to be assessed. pp. 961-962

Which complications does the nurse expect due to progression of Clostridium difficile infection in a patient?

-Fulminant colitis -Intestinal perforation Clostridium difficile is a bacterium that causes diarrhea. It colonizes the gastrointestinal tract after the alteration of normal gut flora by antibiotics and causes fulminant colitis . Clostridium difficile also causes intestinal (bowel) perforation. Hemorrhoids and diverticulosis are complications of chronic constipation. Toxic megacolon occurs in patients with irritable bowel syndrome due to antidiarrheal therapy. p. 932

Which statements are true regarding lactase deficiency and malabsorption?

-Lactase deficiency can cause calcium deficiency. -Lactase deficiency is associated with genetic factors. -Lactase deficiency is a condition in which the lactase enzyme is deficient or absent. Patients with lactase deficiency are instructed not to drink milk and may develop calcium deficiency. Lactase deficiency is a result of genetic factors. Deficiency in the lactase enzyme results in lactose intolerance. Lactase deficiency does not cause steatorrhea. Lactase deficiency is more common in people of Asian or African ancestry. p. 967

When a patient with a history of duodenal ulcers reports abdominal tenderness, the nurse suspects peritonitis. The nurse identifies that the patient is at risk for what complications?

-Paralytic ileus -Hypovolemic shock -Acute respiratory distress syndrome (ARDS) Abdominal pain with tenderness caused due to duodenal ulcer indicates peritonitis. Peritonitis restricts the peristalsis that blocks bowels, causing paralytic ileus. Peritonitis depletes the body fluids, resulting in hypovolemic shock. Peritonitis is caused by both bacteria and fungi, and causes severe infection of the lungs, precipitating respiratory distress. Hemorrhage and colonic dilation are complications associated with inflammatory bowel disease. p. 943

A patient comes to the clinic reporting frequent abdominal pain for over 6 months. What conditions does the nurse recognize may contribute to the patient's symptoms?

-Peptic ulcer disease -Chronic pancreatitis -Irritable bowel syndrome Peptic ulcer disease, chronic pancreatitis, and irritable bowel syndrome are common causes of chronic abdominal pain. Bowel obstruction and ruptured ectopic pregnancy are conditions that cause acute abdominal pain. pp. 938-939

The student nurse is preparing a patient for an ostomy surgery under the supervision of the registered nurse. Which interventions by the student nurse indicate effective learning?

-Selects the rectus muscle site for placing the stomas -Prepares the patient psychologically for the ostomy -Selects a stoma site that will be clearly visible to the patient The patient's body image may change after ostomy surgery and the patient may lose bowel control. Psychologic and emotional support are necessary for the patient. The nurse should select a stoma site that will be clearly visible to the patient—such as a rectal muscle site—so that the patient can clean it properly. Dibucaine is used to reduce irritation and discomfort of the anus. The nurse should not administer allopurinol to the patient because it may cause inflammation of the colon as a side effect. pp. 960-961

The nurse is preparing a nutritional plan for a patient with short bowel syndrome. What will the nurse include in the nutritional plan?

-Soluble-fiber diet -Calcium supplements -Glutamine Short bowel syndrome is a condition in which the small intestine does not have adequate surface area to absorb enough nutrients. A soluble-fiber diet, calcium supplements, and the amino acid glutamine reduce the risk for short bowel syndrome. A low-fat diet and a high-carbohydrate diet are recommended to the patient with short bowel syndrome. pp. 967-968

The nurse is teaching a patient about what medications can be used to prevent constipation. These medications include which of the following?

-Stool softeners, such as Ducosate -Bulk-forming preparations, such as psyllium Daily bulk-forming preparations are used to prevent constipation because they work like dietary fiber and do not cause dependence; stool softeners also are used to prevent constipation. Stimulant laxatives, saline laxatives, and osmotic laxatives are not used to prevent constipation; instead, they act more rapidly and are used to relieve constipation. p. 936

After reviewing the medical history of a malnourished patient, the nurse suspects celiac disease to be the cause of malabsorption. Which conditions in the patient's medical history would support the nurse's suspicion?

-Thyroid disease -Rheumatoid arthritis -Type I diabetes mellitus Celiac disease is an autoimmune disease that generally occurs in genetically gluten-susceptible individuals. Patients with autoimmune diseases are at more risk for developing celiac disease. Therefore, the nurse will suspect celiac disease in the patient who has autoimmune diseases such as thyroid disease, rheumatoid arthritis, and type I diabetes mellitus. A patient with Crohn's disease is at risk for short bowel syndrome. Patients with congenital lactase deficiency may develop malabsorption due to lactase deficiency. pp. 966-967

The nurse recognizes that a patient with acute abdominal pain is experiencing hypovolemic shock. Which finding supports the nurse's conclusion?

-Urine output of 0.2 mL/kg/hr -Pulse rate of 58 beats/minute -Blood pressure of 90/60 mm Hg Hypovolemic shock manifests as urine output less than 0.5 mL/kg/hr, decreased pulse rate, decreased blood pressure, and a decreased level of consciousness. Urine output of 0.2 mL/kg/hr, a pulse rate of 58 beats/minute, and blood pressure of 90/60 mm Hg indicate hypovolemic shock. A fluid intake of 2 L per day and a respiratory rate of 18 breaths per minute are normal findings. p. 942

When teaching a patient with celiac disease about dietary changes, which food items should the nurse instruct this patient to restrict?

-Wheat -Rye -Barley -Oatmeal Patients with celiac disease are allergic to gluten and are advised to follow a gluten-free diet. Wheat, rye, barley, and oatmeal contain gluten and should be avoided by people who have celiac disease. Rice and lentils are gluten-free and are permitted in this diet. pp. 966-967

A 55-year-old patient with suspected bowel obstruction has had a nasogastric tube inserted at 8:00 AM. The tube should be checked routinely at which times?

12:00 PM and 4:00 PM A nasogastric tube should be checked routinely at four-hour intervals. Therefore, if the tube were inserted at 8:00 AM, it would be due to be checked at 12:00 PM and 4:00 PM. The other time intervals are not consistent with appropriate times to monitor the nasogastric tube. pp. 952-953

A patient is scheduled to receive "docusate sodium 100 mg by mouth (PO)." The patient asks to take the medication in liquid form, and the nurse obtains a prescription for the interchange. Available is a syrup that contains 175 mg/15 mL. How many milliliters does the nurse administer?

8.6 Ml Using ratio and proportion, multiply 175 by x and multiply 100 × 15 to yield 175x = 1500. Divide 1500 by 175 to yield 8.6 mL. p. 936

A 61-year-old patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times?

8:00 AM, 12:00 PM, and 4:00 PM A nasogastric tube should be checked for patency routinely at four-hour intervals. Thus, if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00 AM, 12:00 PM, and 4:00 PM. p. 953

The nurse is caring for a patient with colorectal cancer who had a polypectomy during a colonoscopy. Which finding indicates a positive outcome?

Absence of malignancy at the resected margin of the polyp The absence of cancer at the resected margin of the polyp is a positive outcome after a polypectomy during colonoscopy. Clear yellow liquid stool indicates that the colon is cleaned. Normal control over defecation is not an indicator of a successful resection. An increased white blood cell count indicates infection. p. 956

A patient taking a medication for irritable bowel syndrome (IBS) has developed severe constipation with abdominal pain and has bloody stools. Which medication does the nurse suspect to be responsible?

Alosetron A patient with IBS taking alosetron may have severe constipation, abdominal pain, and blood in the stools due to reduced blood flow to the intestine. Linaclotide can be given with IBS and constipation. Loperamide is used to treat diarrhea in the patient with IBS. Lubiprostone can be used in the treatment of IBS with constipation in women. pp. 940-941

A female patient with irritable bowel syndrome (IBS) and diarrhea is prescribed treatment. What medication will the nurse discuss with the patient?

Alosetron Alosetron is used to treat IBS with diarrhea in women. Linaclotide is used in the treatment of IBS with constipation in men and women. Lubiprostone is the medication used in the treatment IBS with constipation in women. Trimethobenzamide is used in the treatment of nausea and vomiting. pp. 940-941

Which manifestation will be suspected in a patient who has folic acid deficiency?

Anemia Folic acid is a vitamin needed for red blood cells to form and grow; therefore, deficiency of folic acid causes anemia. Tetany is caused by the deficiency of calcium. Night blindness is caused by the deficiency of vitamin A. Muscle wasting is caused by protein malabsorption. p. 966

The nurse finds the presence of a pale stoma in a patient who has undergone ostomy surgery. What does the nurse suspect to have occurred?

Anemia The stoma should be dark pink to red in normal conditions. Anemia causes deficiency of red blood cells and results in pallor, which leads to a pale stoma. Allergic reaction to food results in edematous stoma. Coagulation factor deficiency results in bleeding from the stoma. Inadequate blood supply to the stoma causes ischemia, which is manifested by a blanching dark red to purple stoma. p. 960

Which type of colon diversion is illustrated in the image?

Ascending colostomy This picture illustrates a colostomy that is in the ascending portion of the colon; therefore it is an ascending colostomy. An ileostomy is an ostomy in the ileum. A gastrostomy is an opening into the stomach to insert a tube to provide nutrition. A transverse colostomy would be at the transverse portion of the colon. p. 959

The nurse receives a prescription from the health care provider to administer a sodium phosphate enema for constipation. What nursing action should the nurse perform first?

Ask the patient about a past history of renal disease. Sodium phosphate enemas may cause an electrolyte imbalance in patients with renal and cardiac disease; therefore, the nurse should review the patient's past medical history. The enema should be administered after knowing the patient's renal status. Water intoxication is not a side effect of a sodium phosphate enema. Checking the vital signs should be done after administering the enema. p. 936

The nurse is assessing a patient following a bowel resection with a permanent colostomy. The patient says, "How am I supposed to care for a colostomy? I can't look at my scars." What is the nurse's priority action?

Ask the patient to discuss fears or concerns about the colostomy. A permanent colostomy is a major change for a patient. It includes body image concerns and learning ostomy care. The priority at this time is discussing the patient's fears and concerns to facilitate patient teaching, learning, and acceptance of the body changes. It is important to provide information about support groups, but the priority is to speak with the patient directly about his or her concerns. Administration of antianxiety medications or requesting a psychiatric evaluation may not be necessary for this patient; the nurse can determine if these measures are necessary once he or she has asked first about the patient's fears and concerns. pp. 959-960

A patient who is reestablishing bowel regularity reports fecal incontinence. Which medication may be beneficial to the patient, as per the nurse's understanding?

Bisacodyl glycerin suppository Fecal incontinence is the involuntary passage of stools that occurs when the structures that maintain continence are disrupted. Administering a bisacodyl glycerin suppository will stimulate the anorectal reflex and help in defecation. Administering senna stimulants will increase the peristalsis by irritating the colon wall and stimulate the enteric nerves; therefore, it is used in the treatment of constipation. Bismuth subsalicylate is used in treating diarrhea; this medication is especially helpful for patients who have traveler's diarrhea. Methylcellulose laxative is used in the treatment of constipation. p. 934

A patient states, "I always get diarrhea when I am traveling." Which medication does the nurse expect will be beneficial to the patient?

Bismuth subsalicylate Traveler's diarrhea is common when traveling to areas with poor sanitation. Bismuth subsalicylate is an anti-diarrheal drug that decreases the secretions, has weak antibacterial activity, and is beneficial for traveler's diarrhea. Dextranomer is used in the treatment of fecal incontinence. Metronidazole is beneficial for a patient who has diarrhea because of antibiotics. Methylcellulose is a bulk-forming laxative and is beneficial for a patient with constipation; this medication does not help relieve traveler's diarrhea. p. 931

A patient with abdominal trauma is at risk for the development of hypovolemic shock. What assessment finding by the nurse would indicate that the patient is developing this condition?

Blood pressure of 80/42 mm Hg Hypovolemic shock is a life-threatening condition that results from excessive bleeding and abdominal trauma. The assessment findings of a patient with hypovolemic shock are decreased blood pressure, rapid breathing, and increased heart rate, and pulse pressure. p. 942

The nurse would incorporate what activities in implementing a plan of care for a patient experiencing fecal incontinence?

Bowel training Regardless of the cause of fecal incontinence, bowel training is an effective strategy for many patients. Exercising after meals can aggravate symptoms of incontinence. Use of stool softeners is considered to stimulate anorectal reflex if bowel training is ineffective. Patients with fecal incontinence should avoid foods such as caffeine that worsen symptoms. p. 934

A patient involved in a motor vehicle crash reports severe abdominal pain and is suspected to have sustained arterial damage. What assessment finding by the nurse would support this conclusion?

Bruit auscultated Bruit is an audible sound produced due to turbulent blood flow in arteries. Arterial damage does not affect the rhythm of the heart. Arterial damage results in hypertension due to vasoconstriction. Prominent S 1and S 2sounds indicate normal functioning of the heart. p. 941

Which diagnostic study is used to assess alterations in mucosal integrity and inflammation in the small intestine?

Capsule endoscopy Capsule endoscopy is used to assess the small intestine for alterations in mucosal integrity and inflammation because it records images of the digestive tract. The D-xylose test is used to test carbohydrate malabsorption in patients. A bowel barium enema is used to identify abnormal mucosal patterns in patients. A lactose tolerance test is used to test carbohydrate malabsorption in patients. p. 966

The patient's laboratory reports revels melanosis coli. About which medication does the nurse expect to educate the patient?

Cascara sagrada Cascara sagrada increases peristalsis by irritating the colon wall and stimulating enteric nerves. It is used to treat constipation and causes melanosis coli (black pigmentation of colon) as an adverse effect. Docusate may cause bleeding as a side effect. Prednisolone causes osteoporosis as an adverse effect. Sulfasalazine causes folic acid deficiency as a side effect. p. 936

While assessing a patient with constipation, the nurse finds that the patient is a chronic user of bisacodyl. Which complication does the nurse expect?

Cathartic colon syndrome. Bisacodyl is a laxative and is used to treat constipation. Cathartic colon syndrome occurs because of laxative abuse; the nerves of the colon are damaged, causing dilation of the colon, making it atonic. Obstipation is a severe form of constipation in which no gas or stool is expelled; it does not occur due to chronic use of bisacodyl. Toxic megacolon is colonic dilation greater than 5 cm. It is seen in patients with irritable bowel syndrome who are on antidiarrheal therapy. Idiopathic constipation is the presence of chronic constipation symptoms, which does not occur due to use of bisacodyl. pp. 934-935

Which condition is suspected in a malnourished patient with pruritic, vesicular skin lesions on the face and altered thyroxin levels?

Celiac disease A patient with celiac disease may have pruritic, vesicular skin lesions. Autoimmune diseases such as thyroid disease and rheumatoid arthritis are associated with celiac disease. Therefore, the nurse anticipates celiac disease. Congenital lactase deficiency is associated with lactase deficiency. Crohn's disease is associated with short bowel syndrome. Gastrointestinal stromal tumors do not result in pruritic, vesicular skin lesion on the patient's face or altered thyroxin levels. p. 966

The nurse recalls that which medication blocks epidermal growth factor in patients with colorectal cancer?

Cetuximab Cetuximab is an epidermal growth factor inhibitor given to patients with colorectal cancer. Regorafenib is a multi-kinase inhibitor that blocks several enzymes that promote cancer growth. Bevacizumab and ziv-aflibercept are angiogenesis inhibitors that inhibit blood supply to tumors. p. 957

The nurse is preparing to administer a scheduled dose of docusate sodium when the patient reports an episode of loose stool and does not want to take the medication. What is the appropriate action by the nurse?

Chart the dose as not given on the medical record and explain in the nursing progress notes. Whenever a patient refuses medication, the dose should be charted as not given with an explanation of the reason documented in the nursing progress notes. In this instance, the refusal indicates good judgment by the patient and the patient should not be encouraged to take it today. The nurse should not have the family convince the patient to take the magnesium hydroxide. An incident report is not necessary in this instance. If the patient is having loose stools, he or she will likely not need the docusate sodium later during the day. p. 936

Which manifestation should be suspected in a patient with riboflavin deficiency?

Cheilosis Riboflavin is a water-soluble vitamin that lowers the risk of cheilosis. Therefore, deficiency of riboflavin causes cheilosis. Cheilosis is a painful inflammation and cracking in the corners of the mouth. Anemia is caused by folic acid deficiency. Paresthesia and peripheral neuropathy are caused by cobalamin deficiency. p. 966

Which medication will the nurse expect the primary health care provider to prescribe to a patient with malabsorption who has diarrhea and steatorrhea as well as limited ileal resection of 90 cm?

Cholestyramine Short bowel syndrome (SBS) is a condition in which the small intestine does not have adequate surface area to absorb enough nutrients. The predominant manifestations of SBS are diarrhea and steatorrhea. Short bowel syndrome can cause limited ileal resection. Cholestyramine treats the limited ileal resections in the patients effectively. It reduces diarrhea due to unabsorbed bile acids by increasing their excretion in feces. Teduglutide will be prescribed if the patient needs additional nutrition along with parenteral nutrition. Imatinib mesylate will be prescribed by the health care provider if the patient has gastrointestinal stromal tumors. Atropine loperamide will be prescribed if the patient has increased intestinal motility. pp. 968

What is a cause of primary peritonitis?

Cirrhosis with ascites Cirrhosis causes a large amount of fluid to build up in the abdominal cavity; this is known as ascites. Ascites is susceptible to bacterial infection, which can cause primary peritonitis. Pancreatitis, appendicitis with rupture, and ischemic bowel disorders are causes of secondary peritonitis. p. 943

The nurse is caring for a patient whose terminal ileum has been removed. What medication will the nurse administer to the patient?

Cobalamin supplement Cobalamin is absorbed in the terminal ileum; thus, the patient may have a cobalamin deficiency after the ileum's removal. Cobalamin supplements should be prescribed for the patient. Iron supplements are recommended for a patient with iron-deficiency anemia. Zinc and folic acid supplements do not need to be prescribed for a patient whose terminal ileum is removed. pp. 961-962

A patient who has a family history of colon cancer asks the nurse about tests for colon cancer. Which of these is considered the best method for colorectal cancer (CRC) screening?

Colonoscopy Colonoscopy is the gold standard for CRC screening because the entire colon is examined (only 50 percent of CRCs are detected by sigmoidoscopy), biopsies can be obtained, and polyps can be removed immediately and sent to the laboratory for examination. A less favorable, but acceptable, screening method includes testing the stool for fecal blood. The FOBT and fecal immunochemical test (FIT) look for blood in the stool. Stool tests must be done frequently because tumor bleeding occurs at intervals and easily may be missed if only a single test is done. p. 955

The nurse would administer magnesium hydroxide medication if the patient reported which symptom?

Constipation Milk of magnesia is an osmotic type of laxative that should produce a semifluid stool within 6 to 12 hours of administration. It is indicated for the treatment of constipation. This medication would not be effective in the treatment of indigestion or nausea and would worsen diarrhea. p. 936

Which condition involves inflammation of all layers of the bowel wall?

Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD). Crohn's disease can occur in any segment of the gastrointestinal tract and involves inflammation of all layers of the bowel wall. Peritonitis is inflammation of the peritoneum. Gastroenteritis involves inflammation of the mucosa of the small intestine and stomach. Ulcerative colitis involves inflammation starting from the rectum that moves towards the cecum. p. 944

The nurse is assessing a patient who has undergone a total proctocolectomy with ileal pouch/anal anastomosis 6 months ago. Which finding indicates a positive outcome of surgery?

Decreased number of bowel movements An ileal pouch is created in total proctocolectomy with the ileal pouch/anal anastomosis surgical procedure. Patients usually require 3 to 6 months to adapt to the pouch. A decreased number of bowel movements indicates that the patient has adapted. Clear yellow liquid stool indicates that the colon is cleaned. An increased blood urea nitrogen level indicates acute kidney injury. The absence of cancer at the resected margin of the polyp during a colonoscopy is a positive outcome of a polypectomy. pp. 948-950

A patient is scheduled for surgery to have a permanent ostomy created. What does the nurse remember is the preferred site for the ostomy?

Descending colon The descending colon is the preferred site for a permanent ostomy. Because the colon absorbs water in large quantities, the preferred site is as close to the end of the colon as possible, where stools will be of a more normal consistency. A permanent ostomy may be required in the terminal ileum or the ascending or transverse colon. However, the farther down in the colon that the ostomy is performed, the better the possibility of regulating the stools. An ostomy located at the terminal ileum is known as an ileostomy. An ostomy in the large intestine is known as a colostomy. pp. 958-959

For which clinical manifestation that occurs in both ulcerative colitis and Crohn's disease should the nurse monitor the patient?

Diarrhea

The nurse assesses Grey Turner's sign for a patient exhibiting signs of acute pancreatitis. What observation made by the nurse led to this assessment?

Discoloration of skin in the flank region The flank is the region below the last rib and the hip. Discoloration of skin in the flank region is a characteristic of Grey Turner's sign. Blood in the vomitus is called hematemesis. Splinting of the abdominal wall is a characteristic of peritonitis. Discoloration of skin around the umbilicus is a manifestation of Cullen's sign. p. 941

What is the cause of malabsorption in the patient who has lymphangiectasia?

Disturbed lymphatic circulation Lymphangiectasia is a pathologic dilation of lymph vessels. A patient with lymphangiectasia may develop malabsorption because of the reduced lymph flow. Therefore, the nurse will suspect the cause of malabsorption to be disturbed lymphatic circulation. Loss of surface area of absorption causes malabsorption with short bowel syndrome. Bacterial proliferation is the cause of malabsorption if the patient has tropical sprue. Small intestinal mucosal disruption is the cause of malabsorption if the patient has celiac disease. p. 965

A patient informs the nurse that he or she is chronically constipated. When educating the patient about the effects of complications related to chronic constipation, what should the nurse include?

Diverticulosis Chronic constipation causes diverticula formation in the intestine without inflammation, resulting in diverticulosis. Placing stomas over the rectus muscle causes hernia. Terminal ileum disease reduces absorption of cobalamin and increases the risk of anemia. Prolonged use of corticosteroids can cause hypokalemia as a side effect. p. 935

A patient who is on anticoagulant therapy reports hard stools, abdominal distention, and increased flatulence. Which medication is contraindicated for the patient?

Docusate. Constipation is infrequent bowel movements, characterized by absent or hard, dry stools, abdominal distention, bloating, and increased flatulence. Docusate is a stool softener that lubricates the intestinal tract and softens the feces, making the hard stools easier to pass. This medication blocks the absorption of fat-soluble vitamins, such as vitamin K, and increases the risk of bleeding. This medication is contraindicated for patients using anticoagulants to minimize the risk of bleeding. Linaclotide is an intestinal secretagogue that increases the fluid secretion and accelerates the intestinal tract. This medication does not produce any adverse reaction when used along with anticoagulation. Lubiprostone is a selective chloride channel activator that increases the intestinal fluid secretions and motility. This medication does not interact with anticoagulants, and is, therefore, not contraindicated in a patient using anticoagulants. Methylcellulose is a bulk-forming laxative used in the treatment of constipation. This medication does not pose any risk when used along with anticoagulants and is not contraindicated for a patient using anticoagulants. p. 936

The nurse is educating a patient about dietary fiber and the ways to incorporate it into the daily diet. What information should the nurse include while teaching this patient about fiber intake?

Drink at least 2 liters of water daily. Dietary fiber absorbs water. Therefore, when adding dietary fiber to a diet, it is important to maintain a good fluid intake. Prunes and prune juices are high in dietary fiber and should be included in this diet. Initially, fiber may increase the production of gas but that effect decreases with time. Milk and milk products do not have a high-fiber content. p. 937

Which test is performed on the patient who has malabsorption to confirm a diagnosis of pancreatic insufficiency?

Fecal elastase testing Fecal elastase testing is performed to determine pancreatic insufficiency and subsequent malabsorption syndrome. This test measures the amount of elastase, an enzyme produced by the pancreas, and therefore determines pancreatic insufficiency. Sudan III stain is the test that performs qualitative examination of stool for fat. Serologic testing is performed to confirm celiac disease. Near infrared reflectance analysis is a test performed to determine fecal fat and is available at some centers in the United States. pp. 965-966

The nurse is teaching a patient with diverticulosis about nutritional changes to avoid exacerbations. Which meal selection indicates the patient understands the nurse's instructions?

Fish, green beans, baked potato Diverticulosis is a condition in which the bowel has pouches that can become inflamed and pocket food. Fish, green beans, and a baked potato would be the most appropriate meal choice because they are less likely to irritate the bowel pouches. Foods to be avoided would be nuts, seeds, corn, popcorn, and diets high in fat and red meats. These foods can exacerbate the condition, so the sundae with nuts, hamburger, French fries, steak, and corn should all be avoided. pp. 937, 962-964

The nurse observes altered skin integrity in a patient who has undergone an ileostomy. What does the nurse attribute as the reason for the skin breakdown?

Flat stoma A flat stoma causes continuous drainage, which is extremely irritating to the skin and alters skin integrity. The consumption of olives and mushrooms does not interfere with skin integrity. Cobalamin treatment is recommended for a patient with a removed terminal ileum; this treatment does not cause skin irritation. p. 961

Which gastrointestinal manifestation is seen due to bacterial fermentation of unabsorbed carbohydrates?

Flatulence Flatulence results from the state of having excessive stomach or intestinal gas. Bacterial fermentation of unabsorbed carbohydrates releases gaseous products such as hydrogen and methane, referred to as flatulence. Glossitis is caused by a deficiency of riboflavin. Diarrhea is caused by impaired absorption of water. Weight loss is caused by malabsorption of carbohydrates. p. 966

Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result of:

Impaired peristalsis Until peristalsis returns to normal following anesthesia, the patient may experience slowed gastrointestinal motility, leading to gas pains and abdominal distention. Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention. p. 940

The nurse collaborates with an enterostomal therapist to create a teaching plan for a patient with Crohn's disease who has a new ileostomy. Which lifestyle change would be appropriate for inclusion in the plan?

Increased fluid intake to 2 to 3 L/day The enterostomal therapist is a nurse who is expert in caring for ostomies and wounds. Appropriate instructions regarding Crohn's disease are to increase fluids to 2 to 3 L/day. Patients with Crohn's disease should decrease intake of high-fiber foods, increase sodium through sport drinks to account for losses, and limit daily exercise during acute exacerbations. pp. 961-962

A hospitalized patient has just been diagnosed with diarrhea due to Clostridium difficile. Which is the highest priority nursing intervention that should be included in the patient's plan of care?

Initiate the contact isolation precautions. Initiation of contact isolation precautions must be done immediately with a patient with C. difficile. Visitors need to be taught to wear gloves and gowns and wash hands as soon as the isolation supplies are at the patient's room, but it is not the highest priority. Eating live yogurt cultures for snacks may not help the patient but will not hurt the patient, and it is not the highest priority. The room will be disinfected with 10% bleach solution when the patient is dismissed and may be done periodically during the patient's stay, depending on the agency policy, but it is not the highest priority. p. 932

The nurse is presenting information about gastroenteritis to a group of nursing students. What is appropriate for the nurse to include in the education?

It is caused by a norovirus Viruses such as noroviruses are the leading cause of gastroenteritis. Inflammatory bowel disease (IBD) is treated with sulfasalazine; this disease is classified as an ulcerative colitis. Gastroenteritis is the inflammation of the mucosa of the small intestine and stomach. p. 944

The nurse is caring for a patient who has undergone an ileostomy. What is the appropriate nursing action for this patient?

Instructing the patient to wear a drainable collecting pouch constantly for 4 to 7 days before changing Because an ileostomy drains continuously, the patient should constantly wear the bag for 4 to 7 days to collect the drainage. The patient should not take sumatriptan because it may cause colitis as a side effect. Limiting fluid intake may cause dehydration because high-volume output from the stoma is common. p. 961

The nurse finds transient incontinence of mucus in a patient who has recently undergone ileostomy. What reason does the nurse suspect for this finding?

Intraoperative manipulation of the anal canal Transient rectal incontinence of mucus is a result of intraoperative manipulation of the anal canal. Kegel exercises performed immediately after surgery may increase the risk of bleeding. Iron dextran treatment is used to treat anemia; this treatment does not affect the bowel function. Corticosteroid treatments may cause hypokalemia and osteoporosis as side effects. pp. 948-949

For what reason does the nurse suspect a patient may have inflammation of the mouth and lips as well as oral ulcers?

Iron deficiency Stomatitis is an inflammation of the mouth and lips that later results in oral ulcers. Iron is necessary for the upregulation of transcriptional elements for cell replication and repair. Iron deficiency leads to genetic downregulation of these elements, causing ineffective repair and regeneration of epithelial cells, especially in the mouth and lips, resulting in stomatitis. Protein deficiency causes hair loss and thinning. Fatty acid deficiency causes dermatitis. Cobalamin deficiency causes paresthesia. p. 966

A patient with abdominal trauma has a urinalysis that indicates there is blood in the urine. For what condition does the nurse monitor this patient?

Kidney damage Blood in the urine of a patient with abdominal trauma indicates kidney damage. Loss of bowel sounds indicates peritonitis. The presence of bowel sounds near the chest indicates diaphragm rupture. Abdominal hypertension indicates abdominal compartment syndrome. pp. 940-941

After reviewing a patient's medical record the nurse finds that the patient has a stage I tumor in the left colon. For which treatment does the nurse prepare the patient?

Laparoscopic surgery Laparoscopic surgery is recommended for a patient with a stage I tumor in the left colon. This surgery involves the removal of the tumor, 5 centimeters of intestine on either side of the tumor, and any nearby lymph nodes. Wide resectioning and reanastomosis are recommended for low-risk stage II tumors in the colon. Stage III tumors are treated with chemotherapy and surgery. p. 956

The nurse recognizes that which treatment strategy is beneficial for patients with stage I colorectal tumors?

Laparoscopic surgery Laparoscopic surgery is used to treat stage I colorectal tumors. Stage II colorectal tumors are treated with resection and reanastomosis. Chemotherapy is used to treat high-risk stage II, stage III, and stage IV colorectal tumors. p. 956

Which treatment is contraindicated for a patient complaining of constipation?

Laxative use Laxative use is not recommended as a treatment for constipation because it can lead to dependence. Many patients who overuse laxatives become unable to defecate without them. Regular exercise and increased fluid and dietary fiber intake are recommended for the management of constipation. pp. 934-935

A male patient is being treated for irritable bowel syndrome (IBS) with constipation. About what medication used for treatment does the nurse educate the patient?

Linaclotide Linaclotide is used in men to treat IBS with constipation. Alosetron and loperamide are medications used in the treatment of diarrhea. Lubiprostone is used in the treatment of IBS with constipation in women. p. 941

The nurse would question the use of which cathartic agent in a patient with renal insufficiency?

Magnesium hydroxide

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation?

Maintain a high intake of fluid and fiber in the diet. Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility. Analgesics taken for lung cancer probably cannot be reduced. Other medications may decrease constipation, but it is best to avoid laxatives. Eating several small meals per day and one's position while eating do not facilitate bowel motility. Defecation is easiest when the person sits on the commode with the knees higher than the hips. p. 936

In planning care for a patient with fecal incontinence, the goal the nurse is likely to establish is that the patient will:

Maintain perianal skin integrity The overall goals are that the patient with fecal incontinence will have predictable bowel elimination, maintain perianal skin integrity, participate in work and social activities, and avoid self-esteem problems related to bowel control. Elimination could occur more than once a day as long as it is predictable. Stool and moisture from stool left on the skin can cause impairment to the skin's integrity. pp. 932-933

Which medication does the nurse expect will be beneficial for the patient on paregoric therapy to treat diarrhea who, on a follow-up visit, reports hard stools, abdominal distension, and increased flatulence?

Methylnaltrexone Paregoric is an opioid antidiarrheal medication that decreases peristalsis and intestinal motility. Hard stools, abdominal distension, and increased flatulence indicate constipation. Opioid use results in constipation. Methylnaltrexone is a selective µ-opiate receptor antagonist indicated for the treatment of opioid-induced constipation. It binds to the peripheral µ-receptor, which decreases constipation without affecting the opioid actions of the central nervous system, brain, and spinal cord. Linaclotide is used in the treatment of idiopathic constipation and irritable bowel syndrome with constipation. Lubiprostone is a selective chloride channel activator used in women only for the treatment of idiopathic constipation and irritable bowel syndrome with constipation. Methylcellulose is a bulk-forming agent used to treat constipation, but not opioid-induced constipation. p. 936

The nurse is assessing a child with malabsorption and, after reviewing the previous medical reports, the nurse suspects celiac disease in the child. Which complication in the previous medical reports of the child supports the nurse's suspicion?

Migraine Celiac disease is an autoimmune disease characterized by damage to the small intestinal mucosa in gluten-sensitive individuals. A patient who suffers migraines is at an increased risk for developing celiac disease. Therefore, the nurse will suspect celiac disease. A patient with Crohn's disease is at risk for short bowel syndrome. A patient with a history of premature birth or congenital lactase deficiency is at more risk for developing malabsorption. p. 966

A patient is brought to the emergency department with signs of blunt trauma. What may have caused the patient's injuries?

Motor vehicle accident A motor vehicle accident may result in blunt trauma. Gunshot, stabbing, or shrapnel wounds are penetrating injuries. p. 941

The nurse recalls that which medication prevents migration of leukocytes from the bloodstream to inflamed tissues in inflammatory bowel disease (IBD)?

Natalizumab Natalizumab is an immunomodulator that blocks leukocyte migration from the blood vessels to sites of inflammation in inflammatory bowel disease. Balsalazide is a 5-aminosalicylate that decreases inflammation through direct contact with bowel mucosa. Budesonide is a corticosteroid that decreases inflammation. Metronidazole is an antimicrobial medication used in the prevention and treatment of secondary infection. p. 947

The nurse finds that a patient who has undergone laparotomy surgery has fever, vomiting, pain, weight loss, and incisional drainage. What should be the immediate nursing action in this situation?

Notifying the healthcare provider Fever, vomiting, pain, weight loss, and incisional drainage are symptoms of a laparotomy surgery complication. The nurse should immediately notify the primary health care provider to prevent further complications. Linaclotide is used to treat inflammatory bowel disease. Prednisolone is used to achieve remission in inflammatory bowel disease. A sterile pressure dressing is used to control bleeding. p. 940

Which antidiarrheal medication suppresses serotonin secretion?

Octreotide acetate Octreotide acetate is a long-acting octapeptide analog of somatostatin that binds to somatostatin receptors, inhibiting serotonin secretion to control diarrhea. Paregoric is an opioid that decreases peristalsis and intestinal motility. Bismuth subsalicylate helps decrease secretions. Calcium polycarbophil is a bulk-forming agent that absorbs excess fluid from diarrhea to form a gel. p. 931

Which medication can decrease intestinal motility?

Opioid antidiarrheals Opioid antidiarrheals effectively decrease intestinal motility and treat diarrhea. Corticosteroids are used concomitantly with gluten-free foods for the treatment of celiac disease. Bile acid sequestrants are used if the patient has limited ileal resections. Tyrosine kinase inhibitors are used if the patient has gastrointestinal stromal tumors. p. 968

Which statement is true regarding the enzyme lactase?

Over-the-counter lactase breaks down the lactose in milk. Lactase deficiency is a condition in which the enzyme lactase is deficient or absent. The over-the-counter lactase enzyme is mixed with milk to break down the lactose in milk. The lactase enzyme will not act as a calcium supplement, an analgesic, or an antidiarrheal medication. p. 967

When assessing a patient with a gastrointestinal disorder, the nurse finds an absence of bowel sounds and peristalsis. The assessment findings are indicative of what condition?

Paralytic ileus Lack of intestinal peristalsis and an absence of bowel sounds indicate paralytic ileus, which occurs due to paralysis of intestinal muscles. Volvulus is an intestinal obstruction that occurs by the bowel twisting around a focal point. Borborygmi are audible abdominal sounds due to hyperactive intestinal motility. Pseudopolyps are tongue-like projections into the bowel lumen. p. 950

The nurse is reviewing the medical records of four patients. Which patient will the nurse prepare for an ileostomy surgery?

Patient A Crohn's disease causes inflammation of the small intestine in the patient. Ileostomy surgery would be recommended for a patient with Crohn's disease to remove the diseased bowel and divert feces out of the body and away from the surgical site during healing. An ascending colostomy is recommended to treat rectovaginal fistulas. A sigmoid colostomy is recommended for a perforating diverticulum or a rectovaginal fistula. A transverse colostomy is recommended to treat inoperable colon tumors. pp. 958, 959

The primary health care provider is reviewing the laboratory reports of four patients. Which patient does the nurse prepare for a wide resection and reanastomosis?

Patient B Patient B, with a stage II colonic tumor, needs a wide resection and reanastomosis. Patient A has a stage I tumor in the left colon that requires laparoscopic surgery. Patient B, with stage III colonic tumor, would need surgery and chemotherapy. Patient D has had metastasis of colon cancer to distant sites, which is a sign of stage IV cancer. This patient would require surgery, chemotherapy, and radiation therapy. p. 956

The nurse is examining four patients. Which patient requires a permanent ostomy?

Patient C The treatment of rectal cancer tumors involves the removal of the bowel distal to the ostomy. Therefore, the patient with rectal cancer needs a permanent ostomy. A patient with a draining fistula requires a temporary ostomy to prevent the contact of stool with the diseased area. A patient with a stabbing injury in the thigh would not need an ostomy. A patient with gunshot wound may require a temporary ostomy. pp. 955-956

Which diagnostic test does the nurse anticipate will be prescribed for a patient to diagnose appendicitis without ascites?

Peritoneoscopy Peritoneoscopy is a test used to diagnose appendicitis without ascites. X-rays are used to show dilated loops of the bowel consistent with paralytic ileus. Ultrasound and computerized tomography are used to identify ascites and abscesses. p. 943

The nurse reviews the medical record of a patient with inflammatory bowel disease (IBD) and notes hypoalbuminemia. The nurse recognizes that the finding is indicative of what condition?

Poor nutrition Hypoalbuminemia is a condition in which blood levels of albumin are abnormally low. Hypoalbuminemia occurs due to poor nutrition or protein loss. Elevated white blood count indicates perforation and toxic megacolon. Elevated C-reactive protein, erythrocyte sedimentation rate, and leukocytes indicate inflammation. pp. 945-946

For what complication should the nurse assess a patient after total proctocolectomy with an ileal pouch/anal anastomosis surgery?

Pouchitis Pouchitis may occur in a patient after total proctocolectomy with ileal pouch/anal anastomosis surgery. Pouchitis is an inflammation of the pouch that occurs due to irritation. Hemorrhoids occur due to increased anal pressure. The overuse of antidiarrheal drugs will increase the risk of constipation. Hypokalemia occurs due to prolonged treatment with diuretics. p. 948

The nurse is caring for a patient with inflammatory bowel disease (IBD). To maintain remission, the nurse expects that the patient will receive a prescription for what medication?

Prednisone Corticosteroids, such as prednisone, are used to maintain remission in inflammatory bowel disease. Mesalamine is an aminosalicylate; this medication is a first-line therapy for Crohn's disease. Azathioprine is an immunosuppressant given to maintain remission after corticosteroid induction therapy. Methotrexate is used to treat Crohn's disease. p. 947

A 32-year-old female patient is admitted to the emergency department with acute abdominal pain. In addition to a complete blood count, urinalysis, and abdominal x-ray, the nurse will expect to see a prescription for which diagnostic test?

Pregnancy test A pregnancy test is performed in women of childbearing age with acute abdominal pain to rule out ectopic pregnancy. Cardiac enzymes are prescribed if a patient is experiencing chest pain or signs of a myocardial infarction. Liver function studies or renal function studies are not prescribed on a routine basis. p. 938

A patient had taken a broad spectrum oral antibiotic for 10 days for a wound infection. Soon after the infection subsides, the patient develops diarrhea. The nurse expects that what medication will be prescribed?

Probiotic The patient should be advised to take probiotics because the diarrhea is most likely related to antibiotic use. Antibiotics themselves are a cause of diarrhea; therefore, antibiotics should not be given unless necessary. Antiviral and antifungal drugs may not be useful because the diarrhea is not caused by any virus or fungus. p. 931

Which test indicates whether or not a patient has adequate absorption of vitamin K?

Prothrombin time Vitamin K aids in the formation of clotting factors, and deficiency of or inadequate absorption of vitamin K can cause prolonged bleeding in a patient. Prothrombin time indicates the time taken to clot the blood after an injury. Therefore, measuring prothrombin time indicates whether or not there is a vitamin K deficiency. Fecal elastase testing is used to determine pancreatic insufficiency. Bowel barium enema is used to identify abnormal mucosal patterns. A lactose tolerance test is used to determine carbohydrate malabsorption. p. 966

Which type of intestinal obstruction does the nurse recall is observed in a patient with collagen vascular disease?

Pseudo-obstruction Pseudo-obstruction is a type of intestinal obstruction caused by collagen vascular disease. Vascular obstruction occurs due to emboli and atherosclerosis of the mesenteric arteries. Hernias and strictures due to Crohn's disease cause mechanical obstruction. Neuromuscular and vascular diseases cause nonmechanical obstruction. pp. 950-951

The nurse is assessing a malnourished patient who has dental enamel hypoplasia along with iron and folate deficiencies. The nurse instructs the patient to consume a gluten-free diet. What additional symptoms will the nurse observe?

Rash on the scalp Celiac disease is an autoimmune disease characterized by damage to the small intestinal mucosa due to ingestion of gluten-containing foods in genetically susceptible individuals. Clinical manifestations of celiac disease include dental enamel hypoplasia and iron and folate deficiencies. Rash on the buttocks, scalp, and knees are the other symptoms of celiac disease. Early satiety is a symptom of gastrointestinal stromal tumors. Cramping abdominal pain is a symptom of lactase deficiency. Gastrointestinal bleeding is a symptom of gastrointestinal stromal tumors. p. 966

Which cause of fecal incontinence is related to pelvic floor dysfunction?

Rectal prolapse Rectal prolapse is a pelvic floor dysfunction that increases the risk for fecal incontinence. Infection related to inflammatory changes may cause fecal incontinence. Pelvic fracture is an atraumatic risk factor that leads to fecal incontinence. Rectal surgery is a neurologic risk factor that leads to the development of fecal incontinence. pp. 948-949

While reviewing the medical reports of a patient with constipation, the nurse finds that the primary health care provider has disallowed magnesium salts. What could be the reason for this action?

Renal insufficiency The gut poorly absorbs magnesium salts, such as magnesium citrate and milk of magnesia. Magnesium-containing laxatives are contraindicated in patients with renal insufficiency because they are at high risk of developing electrolyte imbalances resulting in hypermagnesemia. If the patient has appendicitis, acute hepatitis, or biliary tract obstruction, then bulk-forming agents are contraindicated. p. 936

The nurse assesses a patient with ecchymosis around the umbilicus and flanks. What does the nurse suspect that this indicates?

Retroperitoneal hemorrhage

Which medication does the nurse expect will be beneficial for the patient diagnosed with traveler's diarrhea caused by Escherichia coli?

Rifaximin Rifaximin is a nonabsorbable antibiotic that is used in the treatment of traveler's diarrhea caused by Escherichia coli . Rifaximin binds to the beta subunit of the bacterial deoxyribonucleic acid (DNA)-dependent ribonucleic acid (RNA) polymerase and inhibits bacterial RNA synthesis. Fidaxomicin is reserved for patients who are at risk for recurrent Clostridium difficile infections. Vancomycin and metronidazole are medications used in the treatment of diarrhea caused by Clostridium difficile. p. 932

While auscultating a patient with abdominal trauma, the nurse hears bowel sounds in the chest. Which complication does the nurse immediately report to the primary health care provider?

Rupture of diaphragm Rupture of the diaphragm will result in bowel sounds in the chest. Auscultation of bruits results in damage to arteries. Retroperitoneal hemorrhage will result in the formation of ecchymosis around the umbilicus. Irritation of the phrenic nerve by free blood in the abdomen causes pain over the scapula. p. 941

A 71-year-old patient with metastatic liver cancer is experiencing constipation. The nurse would plan to administer which medication?

Senna Senna is a laxative that can be used to help treat constipation. Morphine would worsen constipation. Metoclopramide and ondansetron would be used for nausea/vomiting and will not impact constipation. p. 936

A patient experiences watery and bloody diarrhea. Which laboratory parameter does the nurse find to be decreased in the patient?

Sodium A patient who has watery and bloody diarrhea will experience a loss of blood and fluids, resulting in severe dehydration. When there is severe dehydration in the body due to diarrhea, electrolytes, such as sodium concentration, decrease. Creatinine and blood urea nitrogen increase when the body is severely dehydrated. Hematocrit is increased when the patient has watery diarrhea due to an increase in the concentration of blood. p. 930

What is the main manifestation of short bowel syndrome?

Steatorrhea Short bowel syndrome is a condition in which the small intestine does not have adequate surface area to absorb enough nutrients. The predominant manifestations of short bowel syndrome are diarrhea and steatorrhea, which occur because of unabsorbed fat in the stool. Short bowel syndrome is not associated with nocturia, polyphagia, and urinary retention. pp. 967-968

In which programs should the nurse instruct a patient with Crohn's disease to participate during an exacerbation of the disease

Stress management Exacerbation of Crohn's disease may be partly related to stress and involves symptoms that are psychologically stressful. For this reason, stress management may be helpful. Aerobic exercise, smoking cessation, and weight reduction are all part a healthy lifestyle that may support reduction of stress; however, a formal stress-management program is still the best intervention for a patient with Crohn's disease during an exacerbation. p. 950

The nurse reviews the medication profile of a patient with inflammatory bowel disease (IBD) who presents with yellow-orange discoloration of the skin. Which medication does the nurse suspect is responsible for the patient's symptoms?

Sulfasalazine Sulfasalazine is a 5-aminosalicylate that suppresses pro-inflammatory cytokines and other mediators of inflammation. Sulfasalazine causes yellow discoloration of the skin and urine. Adalimumab is a tumor necrosis factor agent that causes upper respiratory and urinary tract infections, headache, nausea, joint pain, and abdominal pain. Azathioprine is an immunosuppressant that suppresses bone marrow and causes inflammation of the pancreas. Methotrexate is an immunosuppressant that causes flu-like symptoms, liver dysfunction, and bone marrow depression. p. 947

Which outcome indicates effective treatment in a patient with a bowel control problem who is on dextranomer/hyaluronic acid gel injection?

The patient does not experience involuntary passage of stools. A dextranomer/hyaluronic acid gel injection narrows the anal canal, which allows for better sphincter control. Therefore, when the patient does not experience involuntary passage of stools, it indicates effective treatment. The absence of hard stools indicates the effectiveness of treatment for constipation. The absence of watery and bloody stools indicates the effectiveness of antidiarrheal drugs. p. 934

The nurse is assessing a patient who shows signs of severe malnutrition and anticipates that intestinal transplantation will be performed. Which condition supports the nurse's conclusion?

The patient has intestinal failure and life-threatening complications. Short bowel syndrome is a condition in which the small intestine does not have adequate surface area to absorb enough nutrients. Intestinal transplantation should be performed only in a patient who has intestinal failure and life-threatening complications because intestinal transplantation is the last-resort treatment. Opioid antidiarrheal drugs are given if the patient has increased intestinal motility. Proton pump inhibitors are given if the patient has increased gastric acid secretion. Teduglutide is given if the patient needs additional nutrition along with parenteral nutrition. pp. 967-968

What cause of malabsorption will the nurse suspect in a patient with diarrhea and steatorrhea and whose medical history indicates Crohn's disease?

The patient has short bowel syndrome. Short bowel syndrome (SBS) is a condition in which the small intestine does not have adequate surface area to absorb enough nutrients. The predominant manifestations of SBS are diarrhea and steatorrhea. SBS is primarily seen in patients with Crohn's disease. Therefore, the nurse will suspect that the cause of malabsorption is SBS. Celiac disease will be suspected if the patient has migraines and myocarditis. Steatorrhea is not a symptom of lactase deficiency or gastrointestinal stromal tumors. pp. 967-968

The wound, ostomy, and continence (WOC) nurse selects the site where the ostomy will be placed. What should be included in the consideration for the site?

The patient must be able to see the site. In selection of the ostomy site, the WOC nurse will want a site visible to the patient so the patient can take care of it, within the rectus muscle to avoid hernias, and on a flat surface to more easily create a good seal with the drainage bag. The ostomy should not need irrigation. p. 960

After reviewing the diagnostic reports of a patient with colorectal cancer, the nurse concludes that the patient has a T 2 type of primary tumor based on the growth of the tumor into what area?

Through the submucosa into the muscularis propria According to TNM classification, T 2 indicates that the primary tumor has grown through submucosa into the muscularis propria. Tumors that have grown beyond mucosa into the submucosa indicate a T 1 Type of primary tumor. T 3 indicates that the tumor has grown through the muscularis propria into the subserosa. A tumor that have grown completely through the colon or rectal wall and into nearby tissues or organs indicates a T 4 type of primary tumor. p. 956

The nurse schedules a pregnancy test and an ultrasound for a pregnant patient reporting severe abdominal pain with nausea. What does the nurse explain to the patient to be the reason for the testing?

To check the location of the fetus A pregnancy test along with ultrasound is ordered in women of childbearing age to rule out ectopic pregnancy. Ectopic pregnancy is the development of the fetus outside the womb. Therefore, the primary health care provider ordered the pregnancy test and ultrasound to check the location of the fetus. The health care provider does not order the pregnancy test and ultrasound to determine the sex of the fetus, the trimester of pregnancy, or uterine changes. p. 938

A patient sustained abdominal trauma in a motor vehicle crash and the nurse is administering volume expanders as ordered. What rationale does the nurse provide to the patient for this action?

To increase the blood pressure Volume expanders are used to increase the blood volume and stabilize blood pressure. A patient with abdominal trauma will be in a hypotensive state and should be administered volume expanders to increase the blood pressure. A nasogastric tube will be inserted to prevent aspiration. Patent airway is established by clearing the vomitus. A nasogastric tube will be inserted to decompress the stomach. pp. 941-942

The nurse encourages a patient after abdominal surgery to ambulate. What is the rationale provided to the patient by the nurse for the importance of early ambulation?

To restore peristalsis Decreased mobility will result in reduced peristalsis. Early ambulation in the patient after abdominal surgery will help to restore peristalsis. Using a nasogastric tube in postoperative patients with acute abdominal pain will prevent aspiration, decompress the stomach, and prevent gastric dilation. p. 940

The nurse is educating a patient about performing colostomy irrigation. What rationale does the nurse give the patient for the importance of doing the procedure?

To stimulate emptying of the colon Colostomy irrigation helps stimulate emptying of the colon. The use of gas filters and diet modifications helps to reduce odor. Using skin barriers and avoiding placing the pouch on irritated skin prevents skin irritation. Modifying the diet plan reduces the risk of diarrhea. p. 961

Which abnormal nutritional condition is treated with folic acid and tetracycline?

Tropical sprue Tropical sprue is a chronic disorder that is characterized by progressive disruption of jejunal and ileal tissue, resulting in nutritional difficulties. A patient with tropical sprue can have anemia and pathologic villous blunting. Therefore, it is treated with folic acid and tetracycline. Celiac disease is treated with corticosteroids and a gluten-free diet. Lactase deficiency is treated with lactase. Short bowel syndrome is treated with teduglutide. p. 966

The nurse is caring for a patient in the initial postoperative period after having an ileostomy. What is a priority nursing action for this patient?

Using transparent pouches for the patien The nurse should use transparent pouches in the initial postoperative period of a patient who has undergone ileostomy to aid in the assessment of stoma viability. The nurse should give additional sodium in the patient's diet to prevent sodium deficiency. The nurse can use opaque pouches a few days after an ileostomy. Offering high-fiber food during the initial postoperative period of ileostomy leads to diarrhea. pp. 960-962

What pathophysiology will the nurse suspect in a patient who reports night blindness?

Vitamin A deficiency

Which type of intestinal obstruction is depicted in the figure?

Volvulus The given figure depicts volvulus, which is an intestinal obstruction that occurs by the bowel twisting around itself. Paralytic ileus is a condition in which bowel sounds and intestinal peristalsis are absent. Pseudopolyps are tongue-like projections into the bowel lumen. Intestinal strangulation is a condition in which the bowel becomes so distended that blood stops flowing, resulting in edema, cyanosis, and gangrene of the bowel. pp. 950-951

The primary health care provider orders a D-xylose test for a patient. Which manifestation would lead the provider to prescribe this test?

Weight loss Weight loss is a manifestation caused by malabsorption of carbohydrates. The D-xylose test is performed to test for malabsorption of carbohydrates. Therefore, the nurse will suspect that the patient has had weight loss. Tetany may be suspected if calcium levels are measured. Anemia will be suspected if iron levels are measured. Muscle wasting will be suspected if the protein levels are measured. pp. 965-966

Which food should the nurse encourage for a patient with abdominal cramps associated with irritable bowel syndrome (IBS)?

Yogurt A patient with IBS may have abdominal cramps with altered bowel patterns. Probiotics such as those in yogurt may be well tolerated and they may alter intestinal bacteria balance to improve the condition. Fruits with peels may induce diarrhea and gastric discomfort from gas. Wheat contains fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) that may contribute to the IBS. Foods such as broccoli and cabbage may lead to abdominal distention and flatulence. p. 940

The patient has a prescription for daily docusate. The nurse would include which information when teaching the patient about this medication?

You should notice an effect from this medication within 72 hours. Colace is indicated for constipation and should achieve an effect within 72 hours. Constipation is not an effect of this medication. Fluid intake should be increased; anticoagulant medication may need to be decreased. p. 936