Chapter 24 IBS
The nurse determines that a patient taking metronidazole (Flagyl) for a protozoan infection has been drinking alcohol while taking the medication. What assessment findings did the nurse use to make this clinical decision? Standard Text: Select all that apply. 1. Bruising 2. Flushing 3. Vomiting 4. Sore throat 5. Severe headache
2. Flushing 3. Vomiting 5. Severe headache Reason: Alcohol causes an Antabuse-type reaction when taking metronidazole (Flagyl). Flushing, vomiting, and severe headache are manifestations of this response. Bruising and sore throat are adverse effects of metronidazole (Flagyl) and should be reported to the healthcare provider.
A patient with Crohn disease is recovering from a bowel resection. What does the nurse realize will most likely occur in this patient? 1. The patient will never have another recurrence of the disease. 2. The patient will possibly have a recurrence in another portion of the bowel. 3. The patient will develop ulcerative colitis. 4. The patient will experience intestinal strictures.
2. The patient will possibly have a recurrence in another portion of the bowel. Reason: The disease process for Crohn disease tends to recur in other areas following removal of affected bowel segments. The processes involving Crohn disease and ulcerative colitis are different. There is no increased risk for the development of intestinal strictures.
A 28-year-old female patient is diagnosed with inflammatory disease of the small bowel. The nurse realizes that this patient most likely is experiencing what health problem? 1. ulcerative colitis 2. chronic diarrhea 3. gastroenteritis 4. Crohn disease
4. Crohn disease Reason: In Crohn disease, a patchy pattern of involvement is seen, which affects primarily the small intestine. Ulcerative colitis affects the large intestine. A diagnosis of chronic diarrhea is not supported by the information provided. The diarrhea associated with Crohn disease is frequent, causing watery stools several times a day. Gastroenteritis results from ingesting contaminated foods or beverages. Ulcerative colitis affects the large intestine.
The nurse is instructing a patient who is experiencing diarrhea associated with a microorganism not to use an antidiarrheal medication. The patient asks, "Why can't I take something to stop the diarrhea?" How should the nurse respond to this patient? 1. "Antidiarrheal medication slows down the elimination of the microorganism causing the diarrhea." 2. "Antibiotics are always used to treat the microorganisms but antibiotics may worsen diarrhea." 3. "The potassium you are taking will help to slow down the diarrhea." 4. "Your physician does not like to use antidiarrheal medications."
1. "Antidiarrheal medication slows down the elimination of the microorganism causing the diarrhea." Reason: Antidiarrheal medications can prolong the discomfort by slowing the elimination of the bacteria from the bowel. Antibiotics may be given but the antibiotics alter the normal flora of the bowel and may worsen diarrhea. Potassium is given to achieve electrolyte balance.
A patient is being seen for a "sudden lump" in the groin after lifting a heavy box to a shelf. The nurse realizes that this patient might be experiencing which health problem? 1. an indirect inguinal hernia 2. a direct inguinal hernia 3. a femoral hernia 4. an incisional hernia
1. An indirect inguinal hernia Reason: Indirect inguinal hernias are caused by improper closure of the tract that develops as the testes descend into the scrotum before birth. A sac of abdominal contents protrudes through the internal inguinal ring into the inguinal canal. It often descends into the scrotum. Although indirect inguinal hernias are congenital defects, they often are not evident until adulthood, when increased intra-abdominal pressure and dilation of the inguinal ring allow abdominal contents to enter the channel.
The nurse is implementing a bowel training program for a patient. What should be included in this patient's plan of care? 1. Assess the patient to determine the best time of day to use the commode for defecation. 2. Keep the bedpan near the patient at all times. 3. Instruct the patient not to attempt to use the bathroom unattended. 4. Stay with the patient while defecating.
1. Asses the patients to determine the best time of day to use the commode for defecation. Reason: Placing the patient in a normal position to defecate at a consistent time of day stimulates the defecation reflex and helps reestablish a pattern of stool evacuation. Ideally, the bowel training program should focus on use of the commode or toilet. Providing the patient with assistance to the bathroom is a safety measure and does not influence the success of the bowel training program. Remaining with the patient may reduce comfort level and interfere with defecation.
Alcohol causes an Antabuse-type reaction when taking metronidazole (Flagyl). Flushing, vomiting, and severe headache are manifestations of this response. Bruising and sore throat are adverse effects of metronidazole (Flagyl) and should be reported to the healthcare provider.
1. Keep the head of the bed elevated 30 to 45 degrees 4. Measure external tube length after verifying placement with an x-ray Reason: The head of the bed should be elevated 30 to 45 degrees. The external tube length should be measured after placement has been verified with an x-ray. Flushing with normal saline is not an appropriate method to check for tube placement. Flushing the tube with club soda after medication administration is not appropriate. Tube feedings should be stopped 30 to 60 minutes before placing the patient in the supine position.
After a company barbecue three people out of a group of 12 developed signs of enteritis. Which assessment finding should the nurse use as an indication of the source of the health problem? 1. The three patients ate hamburgers. 2. Nine people ate hotdogs. 3. Most of the people drank canned soda. 4. All of the people ate ice cream.
1. The tree patient ate hamburgers Reason: The highly pathogenic E. coli serotype O157:H7 is present in the gut of infected animals. Meats from the animal may be contaminated with bowel contents. The organism is readily destroyed by heat, so cuts of meat such as steaks or roasts are less likely to cause infection, since the organism is on the outside of the meat. However, the process of grinding hamburger allows E. coli to be mixed throughout the meat. Hot dogs, canned soda, and ice cream are not associated with the bacteria.
A patient with malabsorption syndrome is prescribed vitamin B12 injections. Which manifestations of this health problem should the nurse expect to improve with this vitamin supplement? Standard Text: Select all that apply. 1. anemia 2. cheilosis 3. bone pain 4. paresthesias 5. muscle cramps
1. anemia 2. cheilosis 4. paresthesias 5. muscle cramps Reason: Systemic manifestations of malabsorption syndrome include anemia, cheilosis, paresthesias, and muscle cramps. Vitamin B12 helps with erythropoiesis, healing of cheilosis, and neuromuscular functioning. Bone pain is associated with vitamin D and calcium deficiency.
The nurse is caring for an older patient recovering from a bleeding ulcer. Which manifestations should the nurse use to determine whether the patient is experiencing peritonitis? Standard Text: Select all that apply. 1. confusion 2. bradycardia 3. restlessness 4. abdominal discomfort 5. decreased urinary output
1. confusion 3. restlessness 4. abdominal discomfort 5. decreased urinary output Reason: Patients who are older, chronically debilitated, or immunosuppressed may present with few of the classic signs of peritonitis. Increased confusion and restlessness, decreased urinary output, and vague abdominal complaints may be the only manifestations present. Bradycardia is not a manifestation of peritonitis in an older patient.
The nurse suspects that a patient with ulcerative colitis has taken a dose of diphenoxylate (Lomotil) to help with diarrhea. What did the nurse assess to make this clinical decision? Standard Text: Select all that apply. 1. fever 2. tachycardia 3. hypotension 4. low urine output 5. abdominal cramps
1. fever 2. tachycardia 3. hypotension 5. abdominal cramps Reason: Toxic megacolon may be triggered by the use of laxatives by the person with ulcerative colitis. Manifestations of toxic megacolon include fever, tachycardia, hypotension, and abdominal cramps. Low urine output is not a manifestation of toxic megacolon.
A patient with peritonitis develops a temperature of 103° F (39.4° C), is restless, has blood pressure of 85/45 and has a urinary output of 76 mL in 8 hours. The nurse should develop a plan of care related to which health problem? 1. hypovolemic shock 2. inflammation 3. third spacing 4. bowel dysfunction
1. hypovolemic shock Reason: The patient experiencing peritonitis may develop an abscess, which can lead to shock. The patient developing shock may present with oliguria, hypotension, fever, restlessness, confusion, and hypovolemia. The symptoms do not indicate inflammation, third spacing, or bowel dysfunction.
A patient with chronic diarrhea has been advised by the healthcare provider to avoid foods containing sorbitol and mannitol. What should the nurse instruct the patient to avoid consuming for this health problem? Standard Text: Select all that apply. 1. mints 2. honey 3. pear juice 4. apple juice 5. orange juice
1. mints 3. Pear juice 4. Apple juice Reason: Apple and pear juice and mints may contain sorbitol or mannitol, which are sugars that are not absorbed and can cause osmotic draw, increasing diarrhea. Orange juice is not identified as a food item that aggravates chronic diarrhea.
A patient is diagnosed with gastroenteritis. The nurse should assess which serum laboratory value first? 1. sodium 2. bicarbonate 3. calcium 4. potassium
4. potassium Reason: Electrolyte and acid‒base imbalances may result from gastroenteritis. Extensive vomiting can lead to metabolic alkalosis due to the loss of hydrochloric acid from the stomach. When diarrhea predominates, metabolic acidosis is more likely. Potassium is lost in either case, which leads to hypokalemia. Sodium, bicarbonate, and calcium are not the primary electrolyte lost with gastroenteritis.
A patient has been experiencing diarrhea for several days. What should the nurse assess to determine if adverse effects are occurring within this patient? Standard Text: Select all that apply. 1. skin turgor 2. muscle tone 3. serum potassium level 4. serum magnesium level 5. orthostatic blood pressure
1. skin turgor 3. serum potassium level 4. serum magnesium level 5. orthostatic blood pressure Reason: Diarrhea can have devastating effects. Water and electrolytes are lost in diarrheal stool. This can lead to dehydration. With severe diarrhea, potassium and magnesium are lost, potentially leading to hypokalemia and hypomagnesemia Monitor orthostatic vital signs and skin turgor to identify and respond to possible adverse effects of diarrhea. Muscle tone will not help identify possible adverse effects of diarrhea.
A patient is prescribed a low-residue diet. What foods should the nurse instruct the patient to avoid while on this diet? 1. wine, vinegar, beer, liquor 2. rice, grains, pasta 3. canned vegetables 4. chilled fruit gelatin desserts
1. wine, vinegar, beer, liquor Reason: Alcohol is not permitted on a low-residue diet. Foods allowed include rice, grains, pasta, canned vegetables, and chilled fruit gelatin desserts.
The nurse instructs a patient with irritable bowel syndrome about the newly prescribed medication sulfasalazine (Azulfidine). Which patient statements indicate that no additional teaching about this medication is required? Standard Text: Select all that apply. 1. "I should take this medication before meals." 2. "I should use sunscreen while taking this medication." 3. "I should not take any aspirin while taking this medication." 4. "I should restrict my fluid intake while taking this medication." 5. "I should not take any vitamin C while taking this medication."
2. "I should use sunscreen while taking this medication." 3. "I should not take any aspirin while taking this medication." 5. "I should not take vitamin C while taking this medication." Reason: This medication increases sensitivity to the sun so sunscreen should be used. This medication should not be taken with aspirin or vitamin C. The patient should be instructed to take this medication after meals to decrease gastric distress. The patient should be instructed to drink at least 2 quarts of fluid each day to reduce the risk of kidney damage
A patient learns that a small bowel obstruction was caused by an appendectomy five years ago. The nurse realizes that this obstruction was most likely caused by what health problem? 1. an untreated infection of the appendix 2. adhesions 3. undiagnosed femoral hernia 4. umbilical hernia
2. adhesions Reason: In adults, adhesions develop following abdominal surgery or inflammatory processes. Adhesions usually produce a simple obstruction or single blockage in one portion of the intestine. An untreated infection would have resulted in peritonitis. There is inadequate information provided to support femoral or umbilical hernias.
A patient who is newly diagnosed with short bowel syndrome asks, "Now what do I need to do? I'm so tired of being sick." How should the nurse respond to this patient? 1. "Dealing with this problem will be difficult in the beginning." 2. "Sometimes minor diet changes will alleviate the problem." 3. "I think more surgery is in your future." 4. "Short bowel syndrome is a long-term challenge."
2. "Sometimes minor diet changes will alleviate the problem." Reason: Management of short bowel syndrome focuses on alleviating symptoms. Patients often simply require frequent, small, high-kilocalorie, and high-protein feedings. Advising the patient there will initially be difficulty promotes negativity and may not be correct information. Surgery is not utilized to manage short bowel syndrome. The patient is seeking information related to the management of the condition. Advising the patient it will be a life-long challenge does not address their verbalized concerns.
The nurse teaches a patient with Crohn disease about surgery to create a continent ileostomy. Which patient statements indicate that teaching has been effective? Standard Text: Select all that apply. 1. "I will need to change my diet." 2. "Stool will collect in an internal pouch." 3. "Stool will not leak through the stoma." 4. "I will use a catheter to drain the stool." 5. "I will need to change the bag every day."
2. "Stool will collect in an internal pouch." 3. "Stool will not leak through the stoma." 4. "I will use a catheter to drain the stool." Reason: In a continent ileostomy an intra-abdominal reservoir is constructed and a nipple valve formed from the terminal ileum before it is brought to the surface of the abdominal wall. Stool collects in the internal pouch; the nipple valve prevents it from leaking through the stoma. A catheter is inserted into the pouch to drain the stool. An ostomy bag does not need to be worn with a continent ileostomy.
The nurse is providing discharge instructions to a patient who is recovering from anal-rectal surgery for repair of an anal fissure. What should be included in these instructions? Standard Text: Select all that apply. 1. Do not remove the dressing. 2. Change the dressing if it becomes soiled with urine or feces. 3. Use the sitz bath. 4. Use the antibiotic until all drainage stops. 5. Avoid bowel movements.
2. Change the dressing if it becomes soiled with urine or feces. 3. Use the sitz bath. Reason: Teach the importance of maintaining a high-fiber diet and liberal fluid intake to increase stool bulk and softness and thereby decrease discomfort with defecation. Stress the importance of responding to the urge to defecate to prevent constipation. Teach the patient to keep the perianal region clean and dry. If a dressing is in place, instruct to avoid soiling it with urine or feces during elimination. Following removal of the dressing, teach to clean the area gently with soap and water following a bowel movement. Discuss the use of sitz baths for cleaning and comfort. If an antibiotic has been prescribed, provide written and verbal instructions about its use, its desired effects, and possible adverse effects and their management.
The nurse can detect no bowel sounds on a patient recovering from bowel surgery. What should the nurse suspect is occurring in this patient? 1. borborygmi 2. paralytic ileus 3. hyperactive bowel sounds 4. atonic bowel
2. Paralytic ileus Reason: Paralytic ileus, or ileus, is defined as an impaired propulsion or forward movement of bowel contents. The patient will not have bowel sounds upon auscultation. Borborygmi are loud, hyperactive bowel sounds. Hyperactive bowel sounds are an increase in sound and frequency. Atonic is a term used to refer to the loss of muscular tone.
A patient with Crohn disease is instructed to ingest a low-residue diet. Which dietary choices indicate that the patient needs additional information about this eating plan? Standard Text: Select all that apply. 1. corn flakes 2. poppy seed roll 3. tapioca pudding 4. steamed broccoli 5. whole grain bread
2. Poppy seed roll 4. steamed broccoli 5. whole grain bread Reason: Raw or cooked seeds, cooked vegetables, and whole grain breads should be avoided on a low-residue diet. Cereals such as corn flakes and desserts such as tapioca are permitted on a low-residue diet.
A patient receiving long-term antibiotic therapy for an infected joint replacement begins to experience diarrhea, abdominal cramps, malaise, fever, and anorexia. What interventions should the nurse prepare to administer to this patient? Standard Text: Select all that apply. 1. Maintain nothing by mouth status. 2. Prepare to administer metronidazole. 3. Insert a nasogastric tube for feedings. 4. Collect all urine for a 24-hour specimen.
2. Prepare to administer metronidazole 5. Discontinue the currently prescribed antibiotic Reason: The patient is demonstrating manifestations of Clostridium difficile. Stopping the antibiotic causing the diarrhea is the first step in the treatment of this health problem. Treatment with metronidazole is specific for C. difficile. Nothing by mouth, insertion of a nasogastric tube, and 24-hour urine are not treatments for Clostridium difficile.
The nurse has instructed the patient who is experiencing diarrhea associated with irritable bowel syndrome on dietary changes to prevent diarrhea. The nurse knows the patient understands the dietary changes if the patient selects which menu choices? 1. yogurt, crackers, and sweet tea 2. salad with chicken, whole wheat crackers 3. bacon, tomato, lettuce with mayonnaise, and a soft drink 4. tuna on white bread and green grapes
2. Salad with chicken, whole wheat crackers Reason: Salad and whole wheat crackers may decrease diarrhea due to increased fiber. Bacon, tomato, lettuce with mayonnaise and soft drink is high in fat and the soft drink is hyperosmolar, both contributing to diarrhea. Dairy increases diarrhea. Foods high in carbohydrates increase diarrhea. Green grapes may increase diarrhea.
After learning that a patient has abdominal pain that occurs at least 3 days per month over the last 3 months, the nurse suspects that a patient is experiencing irritable bowel syndrome. What findings did the nurse use to make this clinical decision? Standard Text: Select all that apply. 1. abdominal pain that is relieved by eating 2. abdominal pain that improves with defecation 3. abdominal pain that is associated with a change in stool form 4. abdominal pain that is associated with a change in bowel frequency 5. abdominal pain that improves with physical activity and limiting food intake
2. abdominal pain that improves with defecation 3. abdominal pain that is associated with a change in stool form 4. abdominal pain that is associated with a change in bowel frequency Reason: Irritable bowel syndrome is diagnosed based on the presence of abdominal pain or discomfort at least 3 days per month in the past 3 months that has at least two of the following characteristics: (1) improved with defecation, (2) associated with a change in frequency of elimination, (3) or associated with a change in stool form. Abdominal pain that is relieved by eating is not a characteristic of irritable bowel syndrome. Abdominal pain that improves with physical activity and limiting food intake is not characteristic of irritable bowel syndrome.
An older patient is diagnosed with severe acute diverticulitis. What treatment should the nurse expect to be prescribed for this patient? Standard Text: Select all that apply. 1. complete bed rest 2. intravenous fluids 3. nothing by mouth 4. aspirin or NSAIDs for pain 5. intravenous cefoxitin (Mefoxin)
2. intravenous fluids 3. nothing by mouth 5. intravenous cefoxitin (Mefoxin) Reason: Severe, acute attacks of diverticulitis often necessitate hospitalization and treatment with intravenous fluids and antibiotics such as cefoxitin (Mefoxin) a second-generation cephalosporin. The patient initially may be NPO. There is no need for the patient to be on complete bed rest. There is no specific recommendation for pain medications for acute diverticulitis.
The nurse is preparing to assess a patient with diverticulitis. Which area of the patient's abdomen should the nurse expect to palpate a mass? 1. upper-right quadrant 2. lower-left quadrant 3. area of McBurney point 4. epigastric region
2. lower-left quadrant Reason: Diverticulitis can manifest as a palpable mass in the left lower quadrant as a result of the inflammatory response. A mass in the upper-right quadrant could involve a disorder of the liver or transverse colon. McBurney point is palpated to elicit rebound tenderness pain characteristic of appendicitis. A mass in the epigastric region could indicate a disorder of the stomach or pancreas.
The nurse is caring for a patient with a fecal impaction. Which type of enemas will best assist in relieving the fecal impaction? 1. normal saline 2. oil retention 3. tap water 4. soap suds
2. oil retention Reason: Oil retention enemas instill mineral or vegetable oil into the bowel to soften the fecal mass. The instilled oil is retained overnight or for several hours before evacuation. This is the most suitable choice for the patient with fecal impaction. The normal saline enema is used to soften the fecal mass and promote defecation in the least irritating manner. Tap water enemas soften the bowel and irritate the bowel to promote defecation. Soap suds provide an increased means to irritate the bowel to promote a bowel movement.
A patient is suspected as having sprue. What diet teaching does this patient need? 1. Avoid high-protein foods. 2. A vegetarian diet is the best treatment for this condition. 3. Gluten products must be eliminated from the diet. 4. All whey products must be eliminated from the diet.
3. Gluten products must eliminate from the diet Reason: The patient with celiac sprue is placed on a gluten-free diet. This treatment is generally successful, as long as the patient entirely avoids gluten. Avoiding high-protein foods, eating a vegetarian diet, and eliminating whey are not relevant for the patient with sprue.
A patient comes into the emergency department with suspected appendicitis. What should the nurse do for this patient? 1. Provide a hot water bottle to place over the abdomen. 2. Provide with clear water to drink. 3. Inspect the abdomen and assess bowel sounds. 4. Prepare to administer a biscodyl (Dulcolax) suppository.
3. Inspect the abdomen and assess bowel sounds Reason: Keep the patient with suspected appendicitis NPO, and do not administer laxatives or enemas, which may cause perforation of the appendix. No heat should be applied to the abdomen; this may increase circulation to the appendix and also cause perforation.
The nurse is providing care to a patient admitted with acute diarrhea. What intervention would assist in this patient's care? 1. Provide a normal diet as tolerated. 2. Hold all medications until the diarrhea stops. 3. Provide clear liquids in small amounts. 4. Encourage normal activities of daily living in the hospital room.
3. Provide clear liquids in small amounts Reason: Fluid replacement is of primary importance in managing the patient with diarrhea. Solid food is withheld in the first 24 hours of acute diarrhea to rest the bowel. The nurse should provide antidiarrheal medication as prescribed. Because of the potential for orthostatic hypotension, this patient should be instructed to move slowly and not engage in normal activities of daily living until the blood pressure is assessed.
An unlicensed assistive staff member says to the nurse, "I need for you to assess a patient. Something is coming out of his rectum." The nurse realizes that the assistant most likely observed which health problem? 1. internal hemorrhoids 2. colostomy 3. prolapsed hemorrhoids 4. femoral hernia
3. prolapsed hemorrhoids Reason: Prolapsed hemorrhoids will be visible from the rectum and anal area. Internal hemorrhoids are not visible by an external examination. The colostomy and femoral hernia are not located in the rectal area.
A patient with cancer of the rectum is scheduled for surgery and the placement of a permanent ostomy. Which type of ostomy will this patient most likely have performed during the surgery? 1. ileostomy 2. double-barrel 3. sigmoid 4. transverse loop
3. sigmoid Reason: A sigmoid colostomy is the most common permanent colostomy performed, particularly for cancer of the rectum. It is usually created during an abdominoperineal resection. The ileostomy, double-barrel, and transverse loop ostomies are not in the correct area to manage cancer in this location.
A patient with irritable bowel syndrome asks the nurse, "Why did the doctor order something for depression?" How should the nurse respond? 1. "Didn't the doctor tell you that you are depressed?" 2. "Depression can be caused by irritable bowel syndrome." 3. "Did the doctor not give you an opportunity to ask questions?" 4. "These medications help with the symptoms associated with your bowel problem."
4. "These medications help with the symptoms associated with your bowel problem." Reason: Antidepressant drugs, including tricyclics and selective serotonin reuptake inhibitors (SSRIs), may help relieve abdominal pain associated with IBS. There is no indication the patient is depressed. Bowel disorders do not usually cause depression. The patient is asking for clarification, and asking whether the doctor provided the opportunity to ask questions does not address the patient's concern.
A patient tells the nurse about diarrhea after eating ice cream. The nurse realizes that this patient might be experiencing which health problem? 1. disease of the colon 2. inflammation of the small intestines 3. cholera 4. lactose intolerance
4. Lactose intolerance Reason: When the lactose in milk is not broken down and absorbed, the lactose molecules exert an osmotic draw, which causes diarrhea. There is not enough information to suspect colon disease. The symptom of diarrhea after ingesting ice cream is inconsistent with small intestine inflammation. The symptom does not suggest cholera.
The nurse is providing medications to a patient with diverticular disease. Which medication should the nurse question for this patient? 1. docusate (Colace) 2. metronidazole (Flagyl) 3. trimethoprim-sulfamethoxazole (Bactrim) 4. bisacodyl (Dulcolax) suppository
4. bisacodyl (Dulcolax) sppository Reason: Although a stool softener such as docusate (Colace) may be prescribed, it is important to note that laxatives can further increase intraluminal pressure in the colon and should be avoided for the patient with diverticular disease. Systemic broad-spectrum antibiotics effective against usual bowel flora are prescribed to treat acute diverticulitis. Oral antibiotics such as metronidazole (Flagyl) or trimethoprim-sulfamethoxazole (Septra, Bactrim) may be prescribed if manifestations are mild.
A patient with Crohn disease is experiencing weight loss. What should be included in this patient's plan of care? 1. a low-calorie, high-milk diet 2. a low-calorie, low-residue diet 3. a high-calorie, low-protein diet 4. a high-calorie, low-fat diet
4. high-calorie, low-fat diet Reason: Provide a high-kilocalorie, high-protein, and low-fat diet, and restrict milk and milk products if lactose intolerance is present. The Crohn patient needs an elevation in calories related to the nutrients lost as a result of diarrhea. A high-calorie, low-protein diet (called the DASH diet) is appropriate for the patient wanting to lower elevated blood pressure