Adult Nursing - Chapter 47: Management of Patients with Intestinal and Rectal Disorders - PrepU

A patient diagnosed with IBS is advised to eat a diet that is: - Restricted to 1,200 calories/day. - Sodium-restricted. - High in fiber. - Low in residue.

- High in fiber.

An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to? - Hyponatremia - Hypernatremia - Hyperkalemia - Hypokalemia

- Hypokalemia

Vomiting results in which of the following acid-base imbalances? - Metabolic acidosis - Metabolic alkalosis - Respiratory alkalosis - Respiratory acidosis

- Metabolic alkalosis

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's: - alcohol consumption. - usual pattern of elimination. - current medications. - activity levels.

- usual pattern of elimination.

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's: - usual pattern of elimination. - alcohol consumption. - activity levels. - current medications.

- usual pattern of elimination.

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of: - An ileus. - A pelvic abscess. - Peritonitis - An abscess under the diaphragm.

- Peritonitis

A nurse is teaching an older adult client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required? - "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread." - "I need to use laxatives regularly to prevent constipation." - "I should exercise four times per week." - "I need to drink 2 to 3 liters of fluids every day."

- "I need to use laxatives regularly to prevent constipation."

In addition to teaching a client with constipation to increase dietary fiber intake to 25 g/day, which of the following would the nurse include as important? - Avoiding bran cereals and beans in the diet - Adding fiber-rich foods to the diet gradually - Limiting fluid intake to 5 to 6 glasses per day - Minimizing activity levels for at least 2 months

- Adding fiber-rich foods to the diet gradually

Which is the most common presenting symptom of colon cancer? - Fatigue - Change in bowel habits - Anorexia - Weight loss

- Change in bowel habits

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

- Change in bowel habits

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

- Chronic constipation with sporadic bouts of diarrhea

The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation? - Apply triamcinolone acetonide spray - Apply barrier powder - Dust with nystatin powder - Dry skin thoroughly after washing

- Dry skin thoroughly after washing

Which term refers to a protrusion of the intestine through a weakened area in the abdominal wall? - Tumor - Hernia - Volvulus - Adhesion

- Hernia

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

- Hypotension

The nurse is conducting a community education program on colorectal cancer. Which statement should the nurse include in the program? - It is the third most common cancer in the United States. - The lifetime risk of developing colorectal cancer is 1 in 10. - The incidence of colorectal cancer decreases with age. - Colorectal cancer has no hereditary component.

- It is the third most common cancer in the United States.

As part of the management of constipation, the client is instructed to take 30 mL of mineral oil orally. How does mineral oil facilitate bowel evacuation? - Irritates nerve endings in the intestinal mucosa - Lubricates and softens fecal matter - Increases the volume of intestinal contents - Decreases water retention of stool

- Lubricates and softens fecal matter

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

- presents with a rigid, boardlike abdomen.

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? - Calorie restriction - Low residue - Iron restriction - Low protein

- Low residue

A client with a diagnosis of acute appendicitis is awaiting surgical intervention. The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and boardlike. What complication does the nurse determine may be occurring at this time? - Accumulation of gas - Constipation - Paralytic ileus - Peritonitis

- Peritonitis

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

- Polyps

Which category of laxatives draws water into the intestines by osmosis? - Bulk-forming agents (e.g., psyllium) - Saline agents (e.g., magnesium hydroxide) - Stimulants (e.g., bisacodyl) - Fecal softeners (e.g., docusate)

- Saline agents (e.g., magnesium hydroxide)

The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's notes? - Loud bowel sounds - Borborygmus - Tenesmus - Peristalsis

- Borborygmus

A nurse is caring for a client who had an ileo conduit 3 days earlier. The nurse examines the stoma site and determines that she should consult with the ostomy nurse. Which assessment finding indicates the need for further consultation? - Stoma site not sensitive to touch - Beefy red stoma site - Clear mucus mixed with yellow urine drained from the appliance bag - Red, sensitive skin around the stoma site

- Red, sensitive skin around the stoma site

A client realizes that regular use of laxatives has greatly improved bowel patterns. However, the nurse cautions this client against the prolonged use of laxatives for which reason? - The client may develop arthritis or arthralgia. - The client's natural bowel function may become sluggish. - The client may lose his or her appetite. - The client may develop inflammatory bowel disease.

- The client's natural bowel function may become sluggish.

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

- Inflammation of all layers of intestinal mucosa

A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation? - lack of free water intake - lack of solid food - lack of exercise - increased fiber

- lack of free water intake

A client with anorexia reports constipation. Which nursing measure would be most effective in helping the client reduce constipation? - Obtain medical and allergy history. - Assist client to increase dietary fiber. - Obtain complete food history. - Provide adequate quantity of food.

- Assist client to increase dietary fiber.

A patient is admitted to the hospital after not having had a bowel movement in several days. The nurse observes the patient is having small liquid stools, a grossly distended abdomen, and abdominal cramping. What complication can this patient develop related to this problem? - Appendicitis - Rectal fissures - Bowel perforation - Diverticulitis

- Bowel perforation

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

- Chronic constipation with sporadic bouts of diarrhea

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

- Familial polyposis

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? - Gently washing the area surrounding the stoma using a facecloth and mild soap - Scrubbing fecal material from the skin surrounding the stoma - Maintaining wrinkles in the faceplate so it doesn't irritate the skin - Cutting the faceplate opening no more than 2? larger than the stoma

- Gently washing the area surrounding the stoma using a facecloth and mild soap

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, what would the nurse stress the importance of? - Increasing fluid intake to prevent dehydration - Consuming a low-protein, high-fiber diet - Taking only enteric-coated medications - Wearing an appliance pouch only at bedtime

- Increasing fluid intake to prevent dehydration

The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication? - Peritonitis - Pelvic abscess - Ileus - Hemorrhage

- Peritonitis

A client tells the nurse, "I am not having normal bowel movements." When differentiating between what are normal and abnormal bowel habits, what indicators are the most important? - The consistency of stool and comfort when passing stool - That the client has a bowel movement daily - That the stool is formed and soft - The client is able to fully evacuate with each bowel movement

- The consistency of stool and comfort when passing stool

The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for: - hyperkalemia. - hypokalemia. - hyponatremia. - hypernatremia.

- hypokalemia.

Which of the following would a nurse expect to assess in a client with peritonitis? - Board-like abdomen - Deep slow respirations - Decreased pulse rate - Hyperactive bowel sounds

- Board-like abdomen

Which of the following would a nurse expect to assess in a client with peritonitis? - Decreased pulse rate - Deep slow respirations - Board-like abdomen - Hyperactive bowel sounds

- Board-like abdomen

Medical management of a patient with peritonitis includes fluid, electrolyte, and colloid replacement. The nurse knows to prepare the initial, most appropriate intravenous solution. Which of the following is the correct solution? - 0.9% NS - D5W - D10W - 0.45% of NS

- 0.9% NS

Which term refers to intestinal rumbling? - Tenesmus - Azotorrhea - Borborygmus - Diverticulitis

- Borborygmus

A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of: - A small bowel disorder. - Intestinal malabsorption. - Inflammatory colitis. - A disorder of the large bowel.

- Intestinal malabsorption.

The nurse is performing a rectal assessment and notices a longitudinal tear or ulceration in the lining of the anal canal. The nurse documents the finding as which condition? - Anal fistula - Anorectal abscess - Hemorrhoid - Anal fissure

- Anal fissure

A patient arrives in the emergency department with complaints of right lower abdominal pain that began 4 hours ago and is getting worse. The nurse assesses rebound tenderness at McBurney's point. What does this assessment data indicate to the nurse? - Diverticulitis - Ulcerative colitis - Appendicitis - Crohn's disease

- Appendicitis

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: - caffeinated products. - spicy foods. - high-fiber diet. - fluids with meals.

- high-fiber diet.

Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction? - Purulent drainage from the gluteal fold - Decreased blood pressure - Sudden, sustained abdominal pain - Decreased urine output

- Sudden, sustained abdominal pain

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

- Suggest fluid intake of at least 2 L/day

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care? - Prepare the client for a gastrostomy tube placement. - Administer topical ointment to the rectal area to decrease bleeding. - Administer morphine (Duramorph PF) routinely, as ordered. - Test all stools for occult blood.

- Test all stools for occult blood.

A nurse is preparing a presentation for a local community group of older adults about colon cancer. What would the nurse include as the primary characteristic associated with this disorder? - Frank blood in the stool - A change in bowel habits - Abdominal distention - Abdominal pain

- A change in bowel habits

A client with anorexia reports constipation. Which nursing measure would be most effective in helping the client reduce constipation? - Assist client to increase dietary fiber. - Obtain medical and allergy history. - Provide adequate quantity of food. - Obtain complete food history.

- Assist client to increase dietary fiber.

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

- Borborygmus

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

- Drink 8 to 10 glasses of fluid daily.

Which of the following is the most common symptom of a polyp? - Abdominal pain - Rectal bleeding - Anorexia - Diarrhea

- Rectal bleeding

A client is admitted from the emergency department with complaints of severe abdominal pain and an elevated white blood cell count. The physician diagnoses appendicitis. The nurse knows the client is at greatest risk for: - rupture of the appendix. - emotional distress related to the pain. - inflammation of the gallbladder. - ulceration of the appendix.

- rupture of the appendix.

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

- Usual pattern of elimination

A client is admitted to the emergency department with reports right lower quadrant pain. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the health care provider immediately? - White blood cell (WBC) count 22.8/mm3 - Hematocrit 42% - Serum sodium 135 mEq/L - Serum potassium 4.2 mEq/L

- White blood cell (WBC) count 22.8/mm3

The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for: - hypernatremia. - hyponatremia. - hyperkalemia. - hypokalemia.

- hypokalemia.

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

- Familial polyposis

Which characteristic is a risk factor for colorectal cancer? - Familial polyposis - Low-fat, low-protein, high-fiber diet - Age younger than 40 years - History of skin cancer

- Familial polyposis

The nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be - Diarrhea - Fecal incontinence - Dark, tarry stools - Hemorrhoids

- Fecal incontinence

The nurse in an extended-care facility reports that a resident has clinical manifestations of fecal incontinence. The health care provider orders a diagnostic study to rule out inflammation. Which study will the nurse prepare the client for? - Anorectal manometry - Barium enema - Transit study - Flexible sigmoidoscopy

- Flexible sigmoidoscopy

A patient with irritable bowel syndrome has been having more frequent symptoms lately and is not sure what lifestyle changes may have occurred. What suggestion can the nurse provide to identify a trigger for the symptoms? - Discontinue the use of any medication presently being taken to determine if medication is a trigger. - Keep a 1- to 2-week symptom and food diary to identify food triggers. - Document how much fluid is being taken to determine if the patient is overhydrating. - Begin an exercise regimen and biofeedback to determine if external stress is a trigger.

- Keep a 1- to 2-week symptom and food diary to identify food triggers.

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? - Iron restriction - Low protein - Calorie restriction - Low residue

- Low residue

When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? - Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. - Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. - The appendix may develop gangrene and rupture, especially in a middle-aged client. - Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

- Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

A client tells the nurse, "I am not having normal bowel movements." When differentiating between what are normal and abnormal bowel habits, what indicators are the most important? - That the client has a bowel movement daily - That the stool is formed and soft - The client is able to fully evacuate with each bowel movement - The consistency of stool and comfort when passing stool

- The consistency of stool and comfort when passing stool