Adult 2- Lower GI Problems practice questions

The nurse formulates the nursing diagnoses of acute pain from the effects of medication and decreased GI motility for a postoperative patient with abdominal pain and distention with an inability to pass flatus. Which nursing intervention is most appropriate for this patient? a. Ambulate the patient more frequently. b. Assess the abdomen for bowel sounds. c. Place the patient in high Fowler's position. d. Withhold opioids because they decrease bowel motility.

a. Ambulate the patient more frequently. Rationale: The abdominal pain and distention that occur from the decreased motility of the bowel should be treated with increased ambulation and frequent position changes to increase peristalsis. If the pain is severe, cholinergic drugs, rectal tubes, or application of heat to the abdomen may be prescribed. Assessment of bowel sounds is not an intervention to relieve the pain and a high Fowler's position is not indicated. Opioids may still be necessary for pain control and motility can be increased by other means.

A patient is admitted to the emergency department with acute abdominal pain. What nursing intervention should the nurse implement first? a. Measurement of vital signs b. Administration of prescribed analgesics c. Anticipate orders for diagnostic studies based on manifestations d. Assessment of the onset, location, intensity, duration, and character of the pain e. Physical assessment of the abdomen for distention, bowel sounds, and pigmentation changes

1- a. Measurement of vital signs 2- e. Physical assessment of the abdomen for distention, bowel sounds, and pigmentation changes 3- d. Assessment of the onset, location, intensity, duration, and character of the pain 4- c. Anticipate orders for diagnostic studies based on manifestations 5- b. Administration of prescribed analgesics Rationale: Assessment of vital signs should be the first nursing action for the patient with an acute abdomen because there may be significant fluid or blood loss into the abdomen; followed by assessment of the abdomen and the nature of the pain. Anticipate diagnostic studies to identify the cause as soon as possible. Analgesics should be used cautiously until a diagnosis can be determined so that symptoms are not masked.

The nurse provides instructions to a client about measures to treat inflammatory bowel syndrome (IBS). Which statement by the client indicates a need for further teaching? a. "I need to limit my intake of dietary fiber." b. "I need to drink plenty, at least 8 to 10 cups daily." c. "I need to eat regular meals and chew my food well." d. "I will take the prescribed medications because they will regulate my bowel patterns."

a. "I need to limit my intake of dietary fiber." Rationale: IBS is a functional gastrointestinal disorder that causes chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating. Dietary fiber and bulk help produce bulky, soft stools and establish regular bowel elimination habits. Therefore, the client should consume a high-fiber diet. Eating regular meals, drinking 8 to 10 cups of liquid a day, and chewing food slowly help promote normal bowel function. Medication therapy depends on the main symptoms of IBS. Bulk-forming laxatives or antidiarrheal agents or other agents may be prescribed.

The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for further instruction? a. "I should increase the fiber in my diet." b. "I will need to avoid caffeinated beverages." c. "I'm going to learn some stress reduction techniques." d. "I can have exacerbations and remissions with Crohn's disease."

a. "I should increase the fiber in my diet." Rationale: Crohn's disease is an inflammatory disease that can occur anywhere in the gastrointestinal tract but most often affects the terminal ileum and leads to thickening and scarring, a narrowed lumen, fistulas, ulcerations, and abscesses. It is characterized by exacerbations and remissions. If stress increases the symptoms of the disease, the client is taught stress management techniques and may require additional counseling. The client is taught to avoid gastrointestinal stimulants containing caffeine and to follow a high-calorie and high-protein diet. A low-fiber diet may be prescribed, especially during periods of exacerbation.

The nurse determines a patient undergoing ileostomy surgery understands the procedure when the patient states a. "I should only have to change the pouch every 4 to 7 days." b. "The drainage in the pouch will look like my normal stool." c. I may not need to wear a drainage pouch if I irrigate it daily. d. Limiting my fluid intake should decrease the amount of output.

a. "I should only have to change the pouch every 4 to 7 days." Rationale: Because ileostomy drainage is a liquid to thin paste, the patient will need to wear a drainage bag at all times. The patient should use an open-ended drainable pouch. It is worn for 4 to 7 days. Output from a sigmoid colostomy resembles normally formed stool, and some patients are able to regulate emptying time so they do not need to wear an ostomy pouch.

A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate for this client? Select all that apply. a. Administer stool softeners as prescribed. b. Instruct the client to limit fluid intake to avoid urinary retention. c. Encourage a high-fiber diet to promote bowel movements without straining. d. Apply cold packs to the anal-rectal area over the dressing until the packing is removed. e. Help the client to a Fowler's position to place pressure on the rectal area and decrease bleeding.

a. Administer stool softeners as prescribed. c. Encourage a high-fiber diet to promote bowel movements without straining. d. Apply cold packs to the anal-rectal area over the dressing until the packing is removed. Rationale: Nursing interventions after a hemorrhoidectomy are aimed at management of pain and avoidance of bleeding and incision rupture. Stool softeners and a high-fiber diet will help the client avoid straining, thereby reducing the chances of rupturing the incision. An ice pack will increase comfort and decrease bleeding. Options b and e are incorrect interventions.

Which method is preferred for immediate treatment of an acute episode of constipation? a. An enema b. Increased fluid c. Stool softeners d. Bulk-forming medication

a. An enema Rationale: Enemas are fast acting and beneficial in the immediate treatment of acute constipation but should be limited in their use. Increased fluids can help decrease the incidence of constipation. Stool softeners have a prolonged action, taking up to 72 hours for an effect. Bulk-forming medication stimulates peristalsis but takes 24 hours to act.

The nurse plans teaching for the patient with a colostomy but the patient refuses to look at the nurse or the stoma, stating, "I just can't see myself with this thing." What is the best nursing intervention for this patient? a. Encourage the patient to share concerns and ask questions. b. Refer the patient to a chaplain to help cope with this situation. c. Explain that there is nothing the patient can do about it and must take care of it. d. Tell the patient that learning about it will prevent stool leaking and the sounds of flatus.

a. Encourage the patient to share concerns and ask questions. Rationale: Encouraging the patient to share concerns and ask questions will help the patient to begin to adapt to living with the colostomy. The other options do not support the patient and do not portray the nurse's focus on helping the patient or treating the patient as an individual.

A 35-year-old female patient is admitted to the emergency department with acute abdominal pain. Which medical diagnoses should you consider as possible causes of her pain (select all that apply)? a. Gastroenteritis b. Ectopic pregnancy c. Gastrointestinal bleeding d. Irritable bowel syndrome e. Inflammatory bowel disease

a. Gastroenteritis b. Ectopic pregnancy c. Gastrointestinal bleeding d. Irritable bowel syndrome e. Inflammatory bowel disease Rationale: All these conditions could cause acute abdominal pain

A patient with ulcerative colitis has a total proctocolectomy with formation of a terminal ileum stoma. What is the most important nursing intervention for this patient postoperatively? a. Measure the ileostomy output to determine the status of the patient's fluid balance. b. Change the ileostomy appliance every 3 to 4 hours to prevent leakage of drainage onto the skin. c. Emphasize that the ostomy is temporary and the ileum will be reconnected when the large bowel heals. d. Teach the patient about the high-fiber, low-carbohydrate diet required to maintain normal ileostomy drainage

a. Measure the ileostomy output to determine the status of the patient's fluid balance. Rationale: Initial output from a newly formed ileostomy may be as high as 1500 to 2000 mL daily, and intake and output must be accurately monitored for fluid and electrolyte imbalance. Ileostomy bags may need to be emptied every 3 to 4 hours but the appliance should not be changed for several days unless there is leakage onto the skin. A terminal ileum stoma is permanent and the entire colon has been removed. A return to a normal, presurgical diet is the goal for the patient with an ileostomy, with restrictions based only on the patient's individual tolerances.

82-year-old man is admitted with an acute attack of diverticulitis. What is most important for the nurse include in his care? a. Monitor for signs of peritonitis. b. Treat with daily medicated enemas. c. Prepare for surgery to resect the involved colon. d. Provide a heating pad to apply to the left lower quadrant.

a. Monitor for signs of peritonitis. Rationale: Diverticulitis can erode the bowel wall and perforate into the peritoneum. Abscesses may form to wall off the area of perforation, but complete perforation with peritonitis may occur. Systemic antibiotic therapy is often used but medicated enemas would increase intestinal motility and increase the possibility of perforation, as would the application of heat. Surgery is only necessary to drain abscesses or to resect an obstructing inflammatory mass.

For the patient hospitalized with inflammatory bowel disease (IBD), which treatments would be used to rest the bowel (select all that apply)? a. NPO b. IV fluids c. Bed rest d. Sedatives e. Nasogastric suction f. Parenteral nutrition

a. NPO b. IV fluids e. Nasogastric suction f. Parenteral nutrition Rationale: With an acute exacerbation of inflammatory bowel disease, to rest the bowel the patient will be NPO, receive IV fluids and parenteral nutrition, and have NG suction. Sedatives may be used to alleviate stress. Enteral nutrition will be used as soon as possible.

A patient with inflammatory bowel disease has a nursing diagnosis of imbalanced nutrition: less than body requirements related to decreased nutritional intake and decreased intestinal absorption. Which assessment data support this nursing diagnosis? a. Pallor and hair loss b. Frequent diarrhea stools c. Anorectal excoriation and pain d. Hypotension and urine output below 30 mL/hr

a. Pallor and hair loss Rationale: Signs of malnutrition include pallor from anemia, hair loss, bleeding, cracked gingivae, and muscle weakness, which support a nursing diagnosis that identifies impaired nutrition. Diarrhea may contribute to malnutrition but is not a defining characteristic. Anorectal excoriation and pain relate to problems with skin integrity. Hypotension relates to problems with fluid deficit.

A client had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nurse? a. This is a normal, expected event. b. The client is experiencing early signs of ischemic bowel. c. The client should not have the nasogastric tube removed. d. This indicates inadequate preoperative bowel preparation.

a. This is a normal, expected event. Rationale: As peristalsis returns following creation of a colostomy, the client begins to pass malodorous flatus. This indicates returning bowel function and is an expected event. Within 72 hours of surgery, the client should begin passing stool via the colostomy. Options b, c, and d are incorrect interpretations.

The patient calls the clinic and describes a bump at the site of a previous incision that disappears when he lies down. The nurse suspects that this is which type of hernia (select all that apply)? a. Ventral b. Inguinal c. Femoral d. Reducible e. Incarcerated f. Strangulated

a. Ventral d. Reducible Rationale: The ventral or incisional hernia is caused by a weakness of the abdominal wall at the site of a previous incision. It is reducible because it returns to the abdominal cavity. Inguinal hernias are at the weak area of the abdominal wall where the spermatic cord in men or the round ligament in women emerges. A femoral hernia is a protrusion through the femoral ring into the femoral canal. Incarcerated hernias do not reduce. Strangulation occurs when the blood supply to an irreducible hernia is compromised.

A 20-year old patient with a history of Crohn's disease comes to the clinic with persistent diarrhea. What are common characteristics of Crohn's disease (select all that apply)? a. Weight loss b. Rectal bleeding c. Abdominal pain d. Toxic megacolon e. Has segmented distribution f. Involves the entire thickness of the bowel wall

a. Weight loss c. Abdominal pain e. Has segmented distribution f. Involves the entire thickness of the bowel wall Rationale: Crohn's disease may have severe weight loss, crampy abdominal pain, and segmented distribution through the entire wall of the bowel. Rectal bleeding and toxic megacolon are more often seen with ulcerative colitis

When obtaining a nursing history from the patient with colorectal cancer, the nurse should specifically ask the patient about a. dietary intake. b. sports involvement. c. environmental exposure to carcinogens. d. long-term use of nonsteroidal antiinflammatory drugs (NSAIDs).

a. dietary intake. Rationale: A diet high in red meat and low fruit and vegetable intake is associated with development of colorectal cancer (CRC), as are alcohol intake and smoking. Family and personal history of CRC also increases the risk. Other environmental agents are not known to be related to colorectal cancer. Long-term use of nonsteroidal antiinflammatory drugs (NSAIDs) is associated with reduced CRC risk.

The most appropriate therapy for a patient with acute diarrhea caused by a viral infection is to a. increase fluid intake. b. administer an antibiotic. c. administer an antimotility drug. d. quarantine the patent to prevent spread of the virus.

a. increase fluid intake. Rationale: Acute diarrhea resulting from infectious causes (e.g., virus) is usually self-limiting. The major concerns are transmission prevention, fluid and electrolyte replacement, and resolution of the diarrhea. Antidiarrheal agents are contraindicated in the treatment of infectious diarrhea because they potentially prolong exposure to the infectious organism. Antibiotics are rarely used to treat acute diarrhea. To prevent transmission of diarrhea caused by a virus, wash your hands before and after contact with the patient and when handling body fluids of any kind. Flush vomitus and stool down the toilet, and wash contaminated clothing immediately with soap and hot water.

The nurse performs a detailed assessment of the abdomen of a patent with a possible bowel obstruction, knowing that manifestations of an obstruction in the large intestine are (select all that apply) a. persistent abdominal pain. b. marked abdominal distention. c. diarrhea that is loose or liquid. d. colicky, severe, intermittent pain. e. profuse vomiting that relieves abdominal pain.

a. persistent abdominal pain. b. marked abdominal distention. Rationale: With lower intestinal obstructions, abdominal distention is markedly increased and pain is persistent. Onset of a large intestine obstruction is gradual, vomiting is rare, and there is usually absolute constipation, not diarrhea.

Assessment findings suggestive of peritonitis include (select all that apply) a. rebound tenderness. b. a soft, distended abdomen. c. dull, intermittent abdominal pain d. shallow respirations with bradypnea e. observing that the patient is lying still.

a. rebound tenderness. e. observing that the patient is lying still. Rationale: With peritoneal irritation, the abdomen is hard, and the patient has severe continuous abdominal pain that is worse with any sudden movement. Palpating the abdomen and releasing the hands suddenly causes sudden movement within the abdomen and severe pain. This is called rebound tenderness. The patient lies very still and takes shallow breaths. Abdominal distention, tachypnea, fever, and tachycardia may occur.

The nurse determines that the goals of dietary teaching have been met when the patient with celiac disease selects from the menu a. scrambled eggs and sausage. b. buckwheat pancakes with syrup. c. oatmeal, skim milk, and orange juice. d. yogurt, strawberries, and rye toast with butter.

a. scrambled eggs and sausage. Rationale: Celiac disease is treated with lifelong avoidance of dietary gluten (wheat, barley, oats, rye products). Although pure oats do not contain gluten, oat products can become contaminated with wheat, rye, and barley during the milling process. Gluten is also found in some medications and in many food additives, preservatives, and stabilizers.

On examining a patient 8 hours after having surgery to create a colostomy, what should the nurse expect to find? a. Hyperactive, high-pitched bowel sounds b. A brick-red, puffy stoma that oozes blood c. A purplish stoma, shiny and moist with mucus d. A small amount of liquid fecal drainage from the stoma

b. A brick-red, puffy stoma that oozes blood Rationale: A normal new colostomy stoma should appear rose to brick red, have mild to moderate edema, and have a small amount of bleeding or oozing of blood when touched. A purplish stoma indicates inadequate blood supply and should be reported. Bowel sounds after extensive bowel surgery will be diminished or absent. The colostomy will not have any fecal drainage for 2 to 4 days but there may be some earlier mucus or serosanguineous drainage.

A patient with ulcerative colitis undergoes the first phase of a total proctocolectomy with ileal pouch and anal anastomosis. On postoperative assessment of the patient, what should the nurse expect to find? a. A rectal tube set to low continuous suction b. A loop ileostomy with a plastic rod to hold it in place c. A colostomy stoma with an NG tube in place to provide pouch irrigations d. A permanent ileostomy stoma in the right lower quadrant of the abdomen

b. A loop ileostomy with a plastic rod to hold it in place Rationale: The initial procedure for a total proctocolectomy with ileal pouch and anal anastomosis includes a colectomy, rectal mucosectomy, ileal reservoir construction, ileoanal anastomosis, and a temporary ileostomy. A loop ileostomy is the most common temporary ileostomy and it may beheld in place with a plastic rod for the first week. A rectal tube to suction is not indicated in any of the surgical procedures for ulcerative colitis. A colostomy is not used and an NG tube would not be used to irrigate the pouch. A permanent ileostomy stoma would be expected following a total proctocolectomy with a permanent ileostomy.

What information should be included when the nurse teaches a patient about colostomy irrigation? a. Infuse 1500 to 2000 mL of warm tap water as irrigation fluid. b. Allow 30 to 45 minutes for the solution and feces to be expelled. c. Insert a firm plastic catheter 3 to 4 inches into the stoma opening. d. Hang the irrigation bag on a hook about 36 inches above the stoma.

b. Allow 30 to 45 minutes for the solution and feces to be expelled Rationale: Following infusion of the fluid into the stoma, the solution and feces will take about 30 to 45 minutes to return and the patient can plan to read or perform other quiet activities during the wait time. Between 500 and 1000 mL of warm tap water should be used. A cone tip on the end of the tubing prevents bowel damage that could occur if a stiff plastic catheter is used. Fluid should be elevated about 18 to 24 inches above the stoma, or to about shoulder level, to prevent too rapid infusion of the solution and cramping.

A patient with a gunshot wound to the abdomen complains of increasing abdominal pain several hours after surgery to repair the bowel. What action should the nurse take first? a. Notify the HCP. b. Assess the patient's vital signs. c. Position the patient with the knees flexed. d. Determine the patient's IV intake since the end of surgery.

b. Assess the patient's vital signs. Rationale: It is likely that the patient could be developing peritonitis, which could be life-threatening, and assessment of vital signs for hypovolemic shock should be done to report to the HCP. If an IV line is not in place, it should be inserted and pain may be eased by flexing the knees.

How is the most common form of malabsorption syndrome treated? a. Administration of antibiotics b. Avoidance of milk and milk products c. Supplementation with pancreatic enzymes d. Avoidance of gluten found in wheat, barley, oats, and rye

b. Avoidance of milk and milk products Rationale: The most common type of malabsorption syndrome is lactose intolerance and it is managed by restricting the intake of milk and milk products. Antibiotics are used in cases of bacterial infections that cause malabsorption, pancreatic enzyme supplementation is used for pancreatic insufficiency, and restriction of gluten is necessary for control of adult celiac disease (celiac sprue, gluten-induced enteropathy).

The patient asks the nurse to explain what the physician meant when he said the patient had an anorectal abscess. Which description should the nurse use to explain this to the patient? a. Ulcer in anal wall b. Collection of perianal pus c. Sacrococcygeal hairy tract d. Tunnel leading from the anus or rectum

b. Collection of perianal pus Rationale: An anorectal abscess is a collection of perianal pus. An ulcer in the anal wall is an anal fissure. Sacrococcygeal hairy tract describes a pilonidal sinus. A tunnel leading from the anus or rectum is an anorectal fistula.

When caring for a patient with irritable bowel syndrome (IBS), what is most important for the nurse to do? a. Recognize that IBS is a psychogenic illness that cannot be definitively diagnosed. b. Develop a trusting relationship with the patient to provide support and symptomatic care. c. Teach the patient that a diet high in fiber will relieve the symptoms of both diarrhea and constipation. d. Inform the patient that new medications for IBS are available and effective for treatment of IBS manifested by either diarrhea or constipation.

b. Develop a trusting relationship with the patient to provide support and symptomatic care. Rationale: Because there is no definitive treatment for irritable bowel syndrome (IBS) and patients become frustrated and discouraged with uncontrolled symptoms, it is important to develop a trusting relationship that will support the patient as different treatments are implemented and evaluated. Although IBS can be precipitated and aggravated by stress and emotions, it is not a psychogenic illness. High-fiber diets may help but they might also increase the bloating and gas pains of IBS. Medications are available but use is individualized because of side effects.

What is a nursing intervention that is indicated for a male patient following an inguinal herniorrhaphy? a. Applying heat to the inguinal area b. Elevating the scrotum with a scrotal support c. Applying a truss to support the operative site d. Encouraging the patient to cough and deep breathe

b. Elevating the scrotum with a scrotal support Rationale: Scrotal edema is a common and painful complication after an inguinal hernia repair and can be relieved in part by elevation of the scrotum with a scrotal support and application of ice. Heat would increase the edema and the discomfort and a truss is used to keep unrepaired hernias from protruding. Coughing is discouraged postoperatively because it increases intraabdominal pressure and stress on the repair site.

Which patient is most likely to be diagnosed with short bowel syndrome? a. History of ulcerative colitis b. Had extensive resection of the ileum c. Diagnosed with irritable bowel syndrome d. Had colectomy performed for cancer of the bowel

b. Had extensive resection of the ileum Rationale: Short bowel syndrome results from extensive resection of portions of the small bowel and would occur if a patient had an extensive resection of the ileum. The other conditions primarily affect the large colon and result in fewer and less severe symptoms.

The patient has persistent and continuous pain at McBurney's point. The nursing assessment reveals rebound tenderness and muscle guarding with the patient preferring to lie still with the right leg flexed. What should the nursing interventions for this patient include? a. Laxatives to move the constipated bowel b. NPO status in preparation for possible appendectomy c. Parenteral fluids and antibiotic therapy for 6 hours before surgery d. NG tube inserted to decompress the stomach and prevent aspiration

b. NPO status in preparation for possible appendectomy Rationale: The patient's manifestations are characteristic of appendicitis. After laboratory test and CT scan confirmation, the patient will have surgery. Laxatives are not used. The 6 hours of fluids and antibiotics preoperatively would be used if the appendix was ruptured. The NG tube is more likely to be used with abdominal trauma.

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention? a. Administer the prescribed pain medication. b. Notify the primary health care provider (PHCP). c. Call and ask the operating room team to perform surgery as soon as possible. d. Reposition the client and apply a heating pad on the warm setting to the client's abdomen.

b. Notify the primary health care provider (PHCP). Rationale: On the basis of the signs and symptoms presented in the question, the nurse should suspect peritonitis and notify the PHCP. Administering pain medication is not an appropriate intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis because of the risk of rupture. Scheduling surgical time is not within the scope of nursing practice, although the PHCP probably would perform the surgery earlier than the prescheduled time.

The nurse is providing care for a client with a recent transverse colostomy. Which observation requires immediate notification of the primary health care provider? a. Stoma is beefy red and shiny b. Purple discoloration of the stoma c. Skin excoriation around the stoma d. Semiformed stool noted in the ostomy pouch

b. Purple discoloration of the stoma Rationale: Ischemia of the stoma would be associated with a dusky or bluish or purple color. A beefy red and shiny stoma is normal and expected. Skin excoriation needs to be addressed and treated but does not require as immediate attention as purple discoloration of the stoma. Semiformed stool is a normal finding.

An HCP just told a patient that she has a volvulus. When the patient asks the nurse what this is, what is the best description for the nurse to give her? a. Bowel folding on itself b. Twisting of bowel on itself c. Emboli of arterial supply to the bowel d. Protrusion of bowel in weak or abnormal opening

b. Twisting of bowel on itself Rationale: Volvulus is the bowel twisting on itself. The bowel folding on itself is intussusception. Emboli of arterial blood supply to the bowel is vascular obstruction. Protrusion of bowel in a weak or abnormal opening is a hernia

When considering the following causes of acute abdomen, the nurse should know that surgery would be indicated for (select all that apply)? a. pancreatitis b. acute ischemic bowel c. foreign-body perforation d. ruptured ectopic pregnancy e. pelvic inflammatory disease f. ruptured abdominal aneurysm

b. acute ischemic bowel c. foreign-body perforation d. ruptured ectopic pregnancy f. ruptured abdominal aneurysm Rationale: An immediate surgical consult is needed for acute ischemic bowel, foreign-body perforation, ruptured ectopic pregnancy, or ruptured abdominal aneurysm. A diagnostic laparoscopy may be done or a laparotomy may be done to repair a ruptured abdominal aneurysm or remove the appendix. Surgery is not needed for pancreatitis or pelvic inflammatory disease, as these can be diagnosed and treated without surgery.

In contrast to diverticulitis, the patient with diverticulosis a. has rectal bleeding. b. often has no symptoms. c. has localized cramping pain. d. frequently develops peritonitis.

b. often has no symptoms. Rationale: Many people with diverticulosis have no symptoms. Patients with diverticulitis have symptoms of inflammation. Diverticulitis can lead to obstruction or perforation.

An important nursing intervention for a patient with a small intestinal obstruction who has an NG tube is to a. offer ice chips to suck PRN. b. provide mouth care every frequently c. irrigate the tube with normal saline every 8 hours. d. keep the patient supine with the head of the bed elevated 30 degrees.

b. provide mouth care every frequently Rationale: Mouth care should be done frequently for the patient with a small intestinal obstruction who has an NG tube because of vomiting, fecal taste and odor, and mouth breathing. No ice chips are allowed when a patient is NPO because of a bowel obstruction. The NG tube should be checked for patency and irrigated as ordered. The position of the patient should be one of comfort.

During a routine screening colonoscopy on a 56-year-old patient, a rectosigmoidal polyp was identified and removed. The patient asks the nurse if his risk for colon cancer is increased because of the polyp. What is the best response by the nurse? a. "It is very rare for polyps to become malignant but you should continue to have routine colonoscopies." b. "Individuals with polyps have a 100% lifetime risk of developing colorectal cancer and at an earlier age than those without polyps." c. "All polyps are abnormal and should be removed but the risk for cancer depends on the type and if malignant changes are present." d. "All polyps are premalignant and a source of most colon cancer. You will need to have a colonoscopy every 6 months to check for new polyps."

c. "All polyps are abnormal and should be removed but the risk for cancer depends on the type and if malignant changes are present." Rationale: Although all polyps are abnormal growths, the most common type of polyp (hyperplastic) is non-neoplastic, as are inflammatory, lipomas, and juvenile polyps. However, adenomatous polyps are characterized by neoplastic changes in the epithelium and about 85% of colorectal cancers arise from these polyps. Only patients with a family history of familial adenomatous polyposis (FAP) have close to a 100% lifetime risk of developing CRC and are at a greater risk for other cancers.

A patient is diagnosed with celiac disease following a workup for iron-deficiency anemia and decreased bone density. The nurse identifies that additional teaching about disease management is needed when the patient makes which statement? a. "I should ask my close relatives to be screened for celiac disease." b. "If I do not follow the gluten-free diet, I might develop a lymphoma." c. "I don't need to restrict gluten intake because I don't have diarrhea or bowel symptoms." d. "It is going to be difficult to follow a gluten-free diet because it is found in so many foods." e. "If I do not follow the gluten-free diet, I will likely develop malnutrition

c. "I don't need to restrict gluten intake because I don't have diarrhea or bowel symptoms." Rationale: The autoimmune process associated with celiac disease continues as long as the body is exposed to gluten, regardless of the symptoms it produces, and a lifelong gluten-free diet is necessary. The other statements regarding celiac disease are all true

The nurse identifies a need for additional teaching when a patient with acute infectious diarrhea makes which statement? a. "I can use A&D ointment or Vaseline jelly around the anal area to protect my skin." b. "Gatorade is a good liquid to drink because it replaces the fluid and salts I have lost." c. "I may use over-the-counter Imodium or Parepectolin when I need to control the diarrhea." d. "I must wash my hands after every bowel movement to prevent spreading the diarrhea to my family."

c. "I may use over-the-counter Imodium or Parepectolin when I need to control the diarrhea." Rationale: Antiperistaltic agents, such as loperamide (Imodium) and paregoric, should not be used in infectious diarrhea because of the potential of prolonging exposure to the infectious agent. Demulcent agents may be used to coat and protect mucous membranes in these cases. The other options are all appropriate measures to use in cases of infectious diarrhea.

The patient is receiving the following medications. Which one is prescribed to relieve symptoms rather than treat a disease? a. Corticosteroids b. 6-Mercaptopurine c. Antidiarrheal agents d. Sulfasalazine (Azulfidine)

c. Antidiarrheal agents Rationale: Antidiarrheal agents only relieve symptoms. Corticosteroids, 6-mercaptopurine, and sulfasalazine (Azulfidine) are used to treat and control inflammation with various diseases and maintain IBD remission

A patient returns to the surgical unit with a nasogastric (NG) tube to low intermittent suction, IV fluids, and a Jackson-Pratt drain at the surgical site following an exploratory laparotomy and repair of a bowel perforation. Four hours after admission, the patient experiences nausea and vomiting. What is a priority nursing intervention for the patient? a. Assess the abdomen for distention and bowel sounds. b. Inspect the surgical site and drainage in the Jackson-Pratt. c. Check characteristics of gastric drainage and the patency of the NG tube. d. Administer prescribed ondansetron (Zofran) to control the nausea and vomiting.

c. Check characteristics of gastric drainage and the patency of the NG tube. Rationale: An adequately functioning nasogastric (NG) tube should prevent nausea and vomiting because stomach contents are continuously being removed. The first intervention in this case is to check the amount and character of the recent drainage and check the tube for patency. Decreased or absent bowel sounds are expected after a laparotomy and the Jackson-Pratt drains only fluid from the tissue of the surgical site. Antiemetics may be given if the NG tube is patent because anesthetic agents may cause nausea.

The medications prescribed for the patient with inflammatory bowel disease (IBD) include cobalamin and iron injections. What is the reasons for using these drugs? a. Alleviate stress b. Combat infection c. Correct malnutrition d. Improve quality of life

c. Correct malnutrition Rationale: Cobalamin and iron injections will help correct malnutrition. Correcting malnutrition will also indirectly help improve quality of life and fight infections.

What laboratory findings are expected in ulcerative colitis because of diarrhea and vomiting? a. Increased albumin b. Elevated white blood cells (WBCs) c. Decreased serum Na+, K+, Mg+, Cl-, and HCO3- d. Decreased hemoglobin (Hgb) and hematocrit (Hct)

c. Decreased serum Na+, K+, Mg+, Cl-, and HCO3- Rationale: In the patient with ulcerative colitis, decreased serum Na+, K+, Mg+, Cl-, and HCO3- are a result of diarrhea and vomiting. Hypoalbuminemia may be present in severe disease. Elevated WBC counts occur with toxic megacolon. Decreased hemoglobin and hematocrit occur with bloody diarrhea, leading to iron-deficiency anemia.

The nurse should teach the patient with chronic constipation that which food has the highest dietary fiber? a. Peach b. Popcorn c. Dried beans d. Shredded wheat

c. Dried beans Rationale: Of the foods listed, dried beans contain the highest amount of dietary fiber and are an excellent source of soluble fiber. Bran and berries also have large amounts of fiber.

A 60-year-old African American patient is afraid she might have anal cancer. What assessment finding puts her at high risk for anal cancer? a. Alcohol use b. Only one sexual partner c. Human papillomavirus (HPV) d. Use of a condom with sexual intercourse

c. Human papillomavirus (HPV) Rationale: Human papillomavirus (HPV) is associated with about 80% of anal cancer cases. Other risk factors include smoking, receptive anal sex, women with cervical or vulvar cancer or precancerous lesions, immunosuppression, and HIV infection. The other options are not considered risk factors for anal cancer.

The patient has peritonitis, which is a major complication of ruptured appendix. What treatment should the nurse plan to include? a. Peritoneal lavage b. Peritoneal dialysis c. IV fluid replacement d. Increased oral fluid intake

c. IV fluid replacement Rationale: IV fluid replacement along with antibiotics, NG suction, analgesics, and surgery would be expected. Peritoneal lavage may be used to determine abdominal trauma. Peritoneal dialysis would not be performed. Oral fluids would be avoided with peritonitis.

What should the nurse teach the patient with diverticulosis to do? a. Use anticholinergic drugs routinely to prevent bowel spasm. b. Have an annual colonoscopy to detect malignant changes in the lesions. c. Maintain a high-fiber diet and encourage fluid intake of at least 2 L daily. Can also use bulk laxatives to increase fecal volume. d. Exclude whole grain breads and cereals from the diet to prevent irritating the bowel. e. Use antibiotics routinely to prevent future inflammation.

c. Maintain a high-fiber diet and encourage fluid intake of at least 2 L daily. Can also use bulk laxatives to increase fecal volume. Rationale: Formation of diverticula is common when decreased bulk of stool, combined with a more narrowed lumen in the sigmoid colon, causes high intraluminal pressures that result in saccular dilation or outpouching of the mucosa through the muscle of the intestinal wall. To prevent the diverticula, fecal volume and passage is increased with use of high-fiber diets and at least 2 L of fluid each day. Bulk laxatives, such as psyllium (Metamucil), may also be used. Anticholinergic drugs are used only during an acute episode of diverticulitis and the lesions are not premalignant. Antibiotics are used during an acute episode of diverticulitis with infection. Colonoscopies are done to detect problems, but not yearly.

The patient asks the nurse why she needs to have surgery for a femoral, strangulated hernia. What is the best explanation the nurse can give the patient? a. The surgery will relieve her constipation. b. The abnormal hernia must be replaced into the abdomen. c. The surgery is needed to allow intestinal flow and prevent necrosis. d. The hernia is because the umbilical opening did not close after birth as it should have.

c. The surgery is needed to allow intestinal flow and prevent necrosis Rationale: A strangulated femoral hernia obstructs intestinal flow and blood supply, thus requiring emergency surgery. The other options are incorrect.

What is the most important thing the nurse should do when caring for a patient who has contracted Clostridium difficile? a. Clean the entire room with ammonia. b. Feed the patient yogurt with probiotics. c. Wear gloves and wash hands with soap and water. d. Teach the family to use alcohol-based hand cleaners.

c. Wear gloves and wash hands with soap and water. Rationale: Wearing gloves will avoid hand contamination and washing hands with soap and water will remove more Clostridium difficile spores than alcohol-based hand cleaners and ammonia-based disinfectants. The entire room will need to be disinfected with a 10% solution of household bleach. Probiotics may help to prevent diarrhea in the patient on antibiotics by replacing normal intestinal bacteria.

A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would included an explanation that a. chemotherapy will begin after the patient recovers from the surgery. b. both chemotherapy and radiation can be used as palliative treatments. c. follow-up colonoscopies will be needed to ensure that the cancer does not recur. d. a wound, ostomy, and continence nurse will visit the patient to identify an abdominal site for the ostomy.

c. follow-up colonoscopies will be needed to ensure that the cancer does not recur. Rationale: Stage I colorectal cancer is treated with surgical removal of the tumor and reanastomosis, and so there is no ostomy. Chemotherapy is not recommended for stage I tumors. Follow-up colonoscopy is recommended because colorectal cancer can recur.

In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease a. frequently results in toxic megacolon. b. causes fewer nutritional deficiencies than ulcerative colitis. c. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy d. is manifested by rectal bleeding and anemia more often than is ulcerative colitis.

c. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy Rationale: Ulcerative colitis affects only the colon and rectum; it can cause megacolon and rectal bleeding, but not nutrient malabsorption. Surgical removal of the colon and rectum cures it. Crohn's disease usually involves the ileum, where bile salts and vitamin cobalamin are absorbed. After surgical treatment, disease recurrence at the site is common.

When a patient returns to the clinical unit after an abdominal-perineal resection (APR), what should the nurse expect? a. An abdominal dressing b. An abdominal wound and drains c. A temporary colostomy and drains d. A perineal wound, drains, and a stoma

d. A perineal wound, drains, and a stoma Rationale: With an abdominal perineal-resection (APR), an abdominal incision is made and the proximal sigmoid colon is brought through the abdominal wall and formed into a permanent colostomy. The patient is repositioned, a perineal incision is made, and the distal sigmoid colon, rectum, and anus are removed through the perineal incision, which may be closed or open, packed, and have drains.

In instituting a bowel training program for a patient with fecal incontinence, what should the nurse first plan to do? a. Teach the patient to use a perianal pouch. b. Insert a rectal suppository at the same time every morning. c. Place the patient on a bedpan 30 minutes before breakfast. d. Assist the patient to the bathroom at the time of the patient's normal defecation.

d. Assist the patient to the bathroom at the time of the patient's normal defecation. Rationale: The first intervention to establish bowel regularity includes promoting bowel evacuation at a regular time each day, preferably by placing the patient on the bedpan, using a bedside commode, or walking the patient to the bathroom. To take advantage of the gastrocolic reflex, an appropriate time is 30 minutes after the first meal of the day or at the patient's usual individual time. Perianal pouches are used to protect the skin only when regularity cannot be established and evacuation suppositories are also used only if other techniques are not successful.

What extraintestinal manifestations are seen in both ulcerative colitis and Crohn's disease? a. Celiac disease and gallstones b. Peptic ulcer disease and uveitis c. Conjunctivitis and colonic dilation d. Erythema nodosum and osteoporosis

d. Erythema nodosum and osteoporosis Rationale: Ulcerative colitis and Crohn's disease have many of the same extraintestinal symptoms, including erythema nodosum and osteoporosis, as well as gallstones, uveitis, and conjunctivitis. Celiac disease, peptic ulcer disease, and colonic dilation are not extraintestinal.

A male patient who is scheduled for an abdominal-perineal resection (APR) is worried about his sexuality. What is the best nursing intervention for this patient? a. Have the patient's sexual partner reassure the patient that he is still desirable. b. Reassure the patient that sexual function will return when healing is complete. c. Remind the patient that affection can be expressed in ways other than through sexual intercourse. d. Explain that physical and emotional factors can affect sexual function but not necessarily the patient's sexuality.

d. Explain that physical and emotional factors can affect sexual function but not necessarily the patient's sexuality. Rationale: Sexual dysfunction may result from an APR but the nurse should discuss with the patient that different nerve pathways affect erection, ejaculation, and orgasm and that a dysfunction of one does not mean total sexual dysfunction and also that an alteration in sexual activity does not have to alter sexuality. Referral to a wound, ostomy, and continence nurse (WOCN) would also be helpful. Simple reassurance of desirability and ignoring concerns about sexual function do not help the patient to regain positive feelings of sexuality.

A client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which most frequent complication of this type of surgery? a. Folate deficiency b. Malabsorption of fat c. Intestinal obstruction d. Fluid and electrolyte imbalance

d. Fluid and electrolyte imbalance Rationale: A frequent complication that occurs following ileostomy is fluid and electrolyte imbalance. The client requires constant monitoring of intake and output to prevent this from occurring. Losses require replacement by intravenous infusion until the client can tolerate a diet orally. Intestinal obstruction is a less frequent complication. Fat malabsorption and folate deficiency are complications that could occur later in the postoperative period.

A 22-year-old patient calls the outpatient clinic complaining of nausea and vomiting and right lower abdominal pain. What should the nurse advise the patient to do? a. Use a heating pad to relax the muscles at the site of the pain. b. Drink at least 2 quarts of juice to replace the fluid lost in vomiting. c. Take a laxative to empty the bowel before examination at the clinic. d. Have the symptoms evaluated right away by a health care provider at a hospital's ED.

d. Have the symptoms evaluated right away by a health care provider at a hospital's ED. Rationale: The patient is having symptoms of an acute abdomen and should be evaluated by a health care provider immediately. The patient's age, location of pain, and other symptoms are characteristic of appendicitis. Heat application and laxatives should not be used in patients with undiagnosed abdominal pain because they may cause perforation of the appendix or other inflammations. Fluids should not be taken until vomiting is controlled, nor should they be taken in the event that surgery may be performed.

The patient with a new ileostomy needs discharge teaching. What should the nurse plan to include in this teaching? a. The pouch can be worn for up to 2 weeks before changing it. b. Decrease the amount of fluid intake to decrease the amount of drainage. c. The pouch can be removed when bowel movements have been regulated. d. If leakage occurs, promptly remove the pouch, clean the skin, and apply a new pouch

d. If leakage occurs, promptly remove the pouch, clean the skin, and apply a new pouch Rationale: The ileostomy drainage is extremely irritating to the skin, so the skin must be cleaned and a new solid skin barrier and pouch applied as soon as a leak occurs to prevent skin damage. The pouch is usually worn for 4 to 7 days unless there is a leak. Because the initial drainage from the ileostomy is high, the fluid intake must be increased. The pouch must always be worn, as the liquid drainage, not formed bowel movements, is frequent.

The RN coordinating the care for a patient who is 2 days postoperative following an abdominal -perineal resection (APR) with colostomy may delegate which interventions to the licensed practical nurse (LPN) (select all that apply)? a. Irrigate the colostomy. b. Teach ostomy and skin care. c. Assess and document stoma appearance. d. Monitor and record the volume, color, and odor of the drainage. e. Empty the ostomy bag and measure and record the amount of drainage.

d. Monitor and record the volume, color, and odor of the drainage. e. Empty the ostomy bag and measure and record the amount of drainage. Rationale: The (LPN) can monitor and record observations related to the drainage and can measure and record the amount. The LPN could also monitor the skin around the stoma for breakdown. LPNs can irrigate a colostomy in a stable patient but this patient is only 2 days postoperative. The other actions are responsibilities of the RN (teaching, assessing stoma, and developing a care plan).

In report, the nurse learns that the patient has a transverse colostomy. What should the nurse expect when providing care for this patient? a. Semiliquid stools with increased fluid requirements b. Liquid stools in a pouch and increased fluid requirements c. Formed stools with a pouch, needing irrigation, but no fluid needs d. Semiformed stools in a pouch with the need to monitor fluid balance

d. Semiformed stools in a pouch with the need to monitor fluid balance Rationale: The patient with a transverse colostomy has semiliquid to semiformed stools needing a pouch and needs to have fluid balance monitored. The ascending colostomy has semiliquid stools needing a pouch and increased fluid. The ileostomy has liquid to semiliquid stools needing a pouch and increased fluid. The sigmoid colostomy has formed stools and may or may not need a pouch but will need irrigation, and no changes in fluid needs

A nurse is doing a nursing assessment on a patient with chronic constipation. What data obtained during the interview may be a factor contributing to the constipation? a. Taking methylcellulose (Citrucel) daily b. High dietary fiber with high fluid intake c. History of hemorrhoids and hypertension d. Suppressing the urge to defecate while at work

d. Suppressing the urge to defecate while at work Rationale: Ignoring the urge to defecate causes the muscles and mucosa in the rectal area to become insensitive to the presence of feces and drying of the stool occurs. The urge to defecate is decreased and stool becomes more difficult to expel. Taking a bulk-forming agent with fluids or high fiber diet with fluids prevent constipation. Hemorrhoids are the most common complication of chronic constipation, caused by straining to pass hardened stool. The straining may cause problems in patients with hypertension but these do not cause constipation. Other things that may cause constipation are a history of diverticulosis, which is seen in individuals with low fiber intake, small stool mass, and hard stools. Chronic laxative use and chronic dilation and loss of colonic tone may also cause chronic constipation.

Following a hemorrhoidectomy, what should the nurse advise the patient to do? a. Use daily laxatives to facilitate bowel emptying. b. Use ice packs to the perineum to prevent swelling. c. Avoid having a bowel movement for several days until healing occurs. d. Take warm sitz baths several times a day to promote comfort and cleaning.

d. Take warm sitz baths several times a day to promote comfort and cleaning. Rationale: Warm sitz baths provide comfort, healing, and cleansing of the area following all anorectal surgery and may be done 3 or 4 times a day for 1 to 2 weeks. Stool softeners and bulking agents help form a soft bulky stool that is easier to pass, but laxatives may cause irritation and trauma to the anorectal area and are not used postoperatively. Early passage of a bowel movement, although painful, is encouraged to prevent drying and hardening of stool, which would result in an even more painful bowel movement.

What should a patient be taught after a hemorrhoidectomy? a. Take mineral oil before bedtime. b. Eat a low-fiber diet to rest the colon. c. Administer oil-retention enema to empty the colon. d. Use prescribed pain medication before a bowel movement.

d. Use prescribed pain medication before a bowel movement. Rationale: After a hemorrhoidectomy, the patient usually dreads the first bowel movement and often resists the urge to defecate. Give pain medication before the bowel movement to reduce discomfort. The patient should avoid constipation and straining. A high-fiber diet can reduce constipation. A stool softener such as docusate (Colace) is usually ordered for the first few postoperative days. If the patient does not have a bowel movement within 2 to 3 days, an oil-retention enema is administered.

A nursing intervention that is most appropriate to decrease postoperative edema and pain after an inguinal herniorrhaphy is a. applying a truss to the hernia site. b. allowing the patient to stand to void. c. supporting the incision during coughing. d. applying a scrotal support with an ice bag.

d. applying a scrotal support with an ice bag. Rationale: Scrotal edema is a painful complication after an inguinal hernia repair. Scrotal support with application of an ice bag may help relieve pain and edema.

The patient comes to the emergency department with intermittent crampy abdominal pain, nausea, projectile vomiting, and dehydration. The nurse suspects a GI obstruction. Based on the manifestations, what area of the bowel should the nurse suspect is obstructed? a. Large intestine b. Esophageal sphincter c. distal small intestine d. proximal small intestine

d. proximal small intestine Rationale: Intermittent crampy abdominal pain, nausea, projectile vomiting, and dehydration are characteristics of proximal small intestinal obstruction. With continued vomiting, metabolic alkalosis may occur. Large bowel obstruction is characterized by constipation, low-grade abdominal pain, and abdominal distention. Esophageal sphincter blockage or achalasia feels like food is stuck in the chest. Fecal vomiting is seen with distal small intestinal obstruction.