PrepU Chapter 35: Bowel Elimination

The nurse is caring for a client with a stoma that is pink in color and dry. Which action will the nurse take?

Apply petroleum-based ointment.

A nurse is providing home care for a middle-aged client with fecal incontinence. Friends have come to visit the client, but the client avoids meeting with them. Which action can the nurse take to best address the client's avoidance behavior?

Ask open-ended questions to elicit why the client is avoiding friends.

A client reports experiencing uncomfortable, frequent episodes of flatulence to the nurse. Which foods will the nurse recommend that the client avoid? Select all that apply.

cucumbers lentils onions cabbage

The nurse is inserting a rectal tube to administer a large-volume enema. Which nursing action is performed correctly in this procedure?

Slowly and gently insert the enema tube 3 to 4 in (7.5 to 10 cm) for an adult.

The nurse is scheduling tests for a client who is experiencing bowel alterations. What is the most logical sequence of tests to ensure an accurate diagnosis?

fecal occult blood test, barium studies, endoscopic examination

A client with no significant medical history reports experiencing diarrhea over the past week. Which assessment question(s) will the nurse ask? Select all that apply.

"Have you started a new medication?" "What are your normal bowel habits?" "Do you use laxatives?"

The nurse in an outpatient provider's office is caring for a client with persistent flatus. Which client teaching will the nurse provide as to why some foods cause flatus?

"Certain vegetables can cause flatus, as they are more difficult to digest."

A nurse is documenting the appearance of feces from a client with a permanent ileostomy. Which scenario would she document?

"Ileostomy bag half filled with liquid feces."

An older adult client tells the nurse, "I give myself a mineral oil enema every day." What is the appropriate nursing response?

"Mineral oil enemas can interfere with absorption of fat-soluble vitamins."

When caring for a client with fecal incontinence, the client shares feelings of embarrassment. Which statement will the nurse use to respond?

"Neurologic changes that impair muscle activity in your body can cause incontinence."

The nurse has presented an educational in-service about caring for clients who have newly created ostomies. The nurse asks participants, "How will you know when a client begins to accept the altered body image?" Which responses by participants indicates a correct understanding of the material? Select all that apply.

"The client is willing to look at the stoma." "The client makes neutral or positive statements about the ostomy." "The client expresses interest in learning self-care."

A hospitalized toddler, previously bowel trained, has been having incontinent stools. What would the nurse tell the parents about this behavior?

"This is normal when a child this age is hospitalized."

The nurse is teaching a client with rectal bleeding about fecal occult blood test (FOBT) testing supplies. What teaching will the nurse provide?

"This test detects heme, a type of iron compound in blood in the stool."

A client informs a nurse that he has had difficulty defecating over the past 6 months. He describes his stools as firm and pebble-like and sometimes he must strain to relieve himself. In order to diagnose this client with constipation using the Rome III criteria, what percentage of stool must be affected?

25%

The nurse is checking the placement of a nasogastric tube and aspirates for gastric contents. The nurse checks the pH of the aspirate and determines that the tube is in the stomach when she gets which pH measurement?

5

The risk for developing colorectal cancer during one's lifetime is 1 in 19. Nurses play an integral role in the promotion of colorectal cancer screening. What are risk factors for colorectal cancer? Select all that apply.

age 50 and older a positive family history a history of inflammatory bowel disease

A client is preparing for a fecal occult blood test. What teaching will the nurse provide regarding vitamin C three days before testing?

Avoid more than 250 mg

A client comes to the emergency department with severe abdominal cramping and frequent bloody stools. Food poisoning is suspected. Which assessment techniques and diagnostic studies should the nurse use?

Bowel sounds and stool sample

A group of nursing students is reviewing the common agents used to relieve constipation. The group demonstrates understanding of this information when they identify which remedies as examples of stimulant laxatives? Select all that apply.

Castor oil Bisacodyl Senna

Then nurse is preparing to apply a fecal incontinence pouch. Arrange the following steps in the correct order.

Cleanse entire perianal area and pat dry. Apply skin protectant and allow it to dry. Separate buttocks and apply the pouch to the anal area. Attach the pouch to a urinary drainage bag. Hang the drainage bag below the client.

A client asks, "Why do some foods, like corn, come out undigested in my feces?" Which is the nurse's best response?

Corn is high in cellulose, which is an insoluble fiber that the body cannot digest.

Which statement best explains why digital removal of stool is considered a last resort after other methods of bowel evacuation have been unsuccessful?

Digital removal of stool may cause parasympathetic stimulation.

A nurse is providing discharge instructions for a client with a new colostomy. Which is a recommended guideline for long-term ostomy care?

Drink at least 2 quarts (1.9 L) of fluids, preferably water, daily.

The nurse is caring for a client who is scheduled for an esophagogastroduodenoscopy (EGD). What action would the nurse take to prepare the client for this procedure?

Ensure that the client fasts 6 to 12 hours before the test as per policy.

A nurse is scheduling diagnostic studies for a client. Which test would be performed first?

Fecal occult blood test

A client tells the nurse that he takes laxatives every day but is still constipated. The nurse's response is based on which reasoning?

Habitual laxative use is the most common cause of chronic constipation.

A postoperative client is reporting abdominal distention and pressure related to intestinal gas. The nurse performs a physical assessment. What percussion sound is consistent with excess flatus trapped in the intestine?

Hyperresonance

In preparing a client to utilize fecal occult blood testing (FOBT) supplies, what teaching will the nurse provide?

If you have had a recent nose bleed, postpone using test.

A client with terminal cancer is taking high doses of an opioid for pain. Which comfort measures should the nurse teach the client's family regarding how to manage elimination care?

Increase fiber in the diet.

A nurse is assessing and documenting the eating habits of a client with repeated reports of gas who wants to include more fiber in the diet. Which suggestion should the nurse include in the teaching plan?

Increase fiber slowly over a period of time to prevent gas.

A nurse is assessing a client with constipation and severe rectal pain. Which action should the nurse perform to determine the presence of fecal impaction?

Insert a lubricated, gloved finger into the rectum.

The nurse is preparing to insert a nasogastric tube for a client needing decompression. Which method would be most appropriate for the nurse to use to determine the length of tubing to be inserted?

Measure from the tip of earlobe to tip of nose to the tip of xiphoid process.

The following foods are a part of a client's daily diet: high-fiber cereals, fruits, vegetables, ten 8-oz glasses (2,500 mL) of fluids. What would the nurse tell the client to change?

Nothing; this is a good diet.

A nurse is assisting a client when he is draining a continent ileostomy. The catheter suddenly becomes plugged with stool. Which action should the nurse take to rectify the problem?

Rotate the catheter tip inside the stoma.

The nurse is teaching a client how to change an ostomy appliance. After removing the existing pouch, which action will the nurse teach next?

Shower, bathe, or wash peristomal area with mild soapy water.

The health care provider has prescribed a hypertonic sodium solution for a client who requires immediate colonic emptying. Which client factor should the nurse notify the provider about that will prevent administration of this type of enema? Select all that apply.

The client has a history of chronic renal failure. The client has an elevated phosphorus level. The client has a history of left sided heart failure.

A nurse is preparing a client for colon surgery. Which teaching should the nurse provide first to prepare the client for what to expect after surgery?

The nurse will listen to the bowel sounds regularly.

A client is having difficulty having a bowel movement on the bedpan. What is the physiologic reason for this problem?

The position does not facilitate downward pressure.

A nurse is caring for a client with constipation. The incidence of constipation tends to be high among clients who follow which diet?

a diet lacking in fruits and vegetables

During the inspection of a client's abdomen, the nurse notes that it is visibly distended. The nurse should proceed with the client's abdominal assessment by next performing:

auscultation.

What is fecal occult blood?

blood that cannot be seen

A student nurse studying human anatomy knows that a structure of the large intestine is the:

cecum

What are two essential techniques when collecting a stool specimen?

hand hygiene and wearing gloves

A 60-year-old client is experiencing pain that can be attributed to distention of the veins in her rectum. What health problem is this client most likely experiencing?

hemorrhoids

A cleansing enema has been ordered for the client to draw water into the bowel. Which type of solution does the nurse gather?

hypertonic saline

A client's last bowel movement was 4 days ago and oral laxatives and dietary changes have failed to prompt a bowel movement. How should the nurse position the client in anticipation of administering a cleansing enema?

left side-lying

Digital rectal examination confirms that a client has an impaction, and an enema solution has been ordered to lubricate the stool and intestinal mucosa without distending the intestine. What solution best meets this client's needs?

oil

A nurse is performing an abdominal assessment of a client before administering a large-volume cleansing enema. Which assessment technique would be performed last?

palpation

The nurse is administering a rectal suppository. How far will the nurse insert the suppository?

past the internal sphincter

The nurse is caring for an older adult client with diarrhea. Which assessment finding requires immediate nursing intervention?

skin turgor response 5 seconds

The nurse prepares to administer large-volume cleansing enemas to a client scheduled for bowel surgery. For which client should the nurse stop administration of the enemas and notify the primary care provider?

the client who experiences severe abdominal pain

A client is prescribed a large volume cleansing enema and is concerned as to why the large volume is indicated. What response should the nurse give to the client? Select all that apply.

to relieve constipation to prevent involuntary escape of fecal material during surgical procedures to promote optimal visualization of the colon during a colonoscopy

A client has received nursing teaching about proper skin care at a stomal site. The nurse's teaching has been effective when the client identifies which solution is used to clean the stoma?

water and mild soap

A nurse is assessing the stools of a breast-fed baby. What is the appearance of normal stools for this baby?

yellow, loose, odorless