Chapter 29. Bowel Elimination

A day after abdominal surgery, a postoperative patient on a surgical unit says to the nurse, "I'm having a problem with a lot of gas. Maybe it's the food I'm eating." What is the appropriate response by the nurse? Select all that apply. a)"If the problem continues after you go home, you'll need to avoid gas-producing foods such as beans." b)"Let's get you out of bed and walking more. This can help with your gas." c)"When was your last bowel movement? You may be a bit constipated." d)"I understand. I'll have to call the doctor for an insertion of a rectal tube."

A, B, C To help patients manage flatulence, the nurse should teach patients to be aware of and avoid foods that trigger flatulence and to encourage patients who have had surgery to ambulate and perform bed exercises, as this helps to stimulate peristalsis and the passage of gas. In severe cases, the nurse may need to obtain a prescription for a rectal tube. In this item, there is no indication that the patient's flatulence is severe enough to indicate a rectal tube. The patient is likely not eating gas-producing foods on day one postoperatively, but the nurse might want to teach the patient about this possibility. Some people develop flatulence after eating gas-producing foods, such as beans, cabbage, cauliflower, onion, or highly spiced foods. For others, flatulence occurs when fiber intake is increased. Constipation is often accompanied by flatulence because digestive by-products undergo prolonged fermentation in the colon.

The community health nurse is preparing a teaching plan on food choices that promote normal bowel elimination. Which of the following foods should the nurse teach patients to be sure to include in their diet? Select all that apply. a)Fresh fruits b)Lean meats c)Whole-grain cereals d)Pastas

A, C Most people should have at least five servings of high-fiber foods each day. Examples are fresh fruits and berries, dried fruits, vegetables (especially raw), whole-grain cereal products, flaxseed, popcorn, and dried beans, peas, and legumes. Although they are necessary for other nutrients, low-fiber foods such as pasta, other simple carbohydrates, and lean meats slow peristalsis and may predispose to constipation. Including them in the diet is not a focus for maintaining normal elimination.

The nursing instructor is teaching students how to use a fracture pan for patients who are unable to move or turn independently. What are the most appropriate instructions for this procedure? Select all that apply. a)Obtain help from another healthcare worker. b)Elevate the head of the bed before placing the pan under the patient. c)Place the wide, rounded end of the pan toward the front of the patient. d)Assist the patient to a side-lying position prior to placing the bedpan.

A, C, D When placing a fracture pan for a patient who has decreased mobility or is unable to move and turn independently, the instructor should instruct students to ask for help from another healthcare worker, lower the head of the bed, assist the patient to a side-lying position, and, when placing the pan, place the wide, rounded end of the pan toward the front.

Which of the following structures is considered a vestigial organ? a)Sigmoid colon b)Rectum c)Appendix d)Internal sphincter of the anus

C The appendix is a small, fingerlike appendage off the cecum. It is believed to be a vestigial organ—one whose significance has diminished over time; however, it is lined with lymphatic tissue and may play a role in immune function.

The nurse is preparing a patient for an invasive diagnostic test that will provide direct visualization of the rectum, entire large intestine, and distal small bowel. The nurse should teach and give the patient written instructions about which of the following tests? a)Barium enema b)Ultrasound of the abdomen c)Sigmoidoscopy d)Colonoscopy

D A colonoscopy provides direct visualization of the rectum, colon, entire large intestine, and distal small bowel. A sigmoidoscopy allows direct visualization of the anal canal, rectum, and sigmoid colon, but not of the entire large intestine. Many patients and providers choose a colonoscopy for cancer screening, as this procedure provides better visualization of the colon. A barium enema is a radiological examination of the rectum, colon, and small bowel; however, this test does not provide direct visualization. Instead, it requires the use of barium and views these organ structures via x-ray. An ultrasound detects tissue abnormalities such as masses, cysts, edema, or stones, usually through the use of a transducer that is moved externally across the skin surface of the abdomen; it is not direct visualization.

A nurse is teaching wellness to a women's group. The nurse should explain the importance of consuming at least how much fluid to promote healthy bowel function (assume these are 8-ounce glasses)? a)3 to 4 glasses a day b)5 to 6 glasses a day c)7 to 8 glasses a day d)9 to 10 glasses a day

C A minimum of 7 to 8 glasses of fluid should be consumed each day to promote healthy bowel function.

The nurse assesses a patient's abdomen 4 days after abdominal surgery and notes that bowel sounds are absent. This finding most likely suggest which postoperative complication? a)Paralytic ileus b)Small bowel obstruction c)Diarrhea d)Constipation

A Absent bowel sounds on the fourth postoperative day suggests paralytic ileus, a complication associated with abdominal surgery. A small bowel obstruction and diarrhea produce hyperactive bowel sounds. Constipation might be associated with hypoactive bowel sounds.

A patient is diagnosed with an intestinal infection after traveling abroad. The nurse should encourage the intake of which food to promote healing? a)Yogurt b)Pasta c)Oatmeal d)Broccoli

A Although the patient may have diarrhea, the goal is not to stop the diarrhea, but to eliminate the pathogens from the digestive tract. The active bacteria in yogurt stimulate peristalsis and promote healing of intestinal infections. Pasta is a low-fiber food that slows peristalsis. It does not promote healing of intestinal infections. Oatmeal stimulates peristalsis, but it does not promote healing of intestinal infections. Broccoli stimulates gas production; it is ineffective against intestinal infections.

A patient with severe hemorrhoids is incontinent of liquid stool. Which of the following interventions is contraindicated? a)Apply an indwelling fecal drainage device. b)Apply an external fecal collection device. c)Place an incontinence garment on the patient. d)Place a waterproof pad under the patient's buttocks.

A An indwelling fecal drainage device is contraindicated for children; for more than 30 consecutive days of use; and for patients who have severe hemorrhoids, recent bowel, rectal, or anal surgery or injury; rectal or anal tumors; or stricture or stenosis. External devices are not typically used for patients who are ambulatory, agitated, or active in bed because the device may be dislodged, causing skin breakdown. External devices cannot be used effectively when the patient has Impaired Skin Integrity because they will not seal tightly. Absorbent products are not contraindicated for this patient unless Impaired Skin Integrity occurs. Even with absorbent products or an external collection device, the nurse should place a waterproof pad under the patient to protect the bed linens.

A mother of a school-age child seeks healthcare because her child has had diarrhea after being ill with a viral infection. The patient states that after vomiting for 24 hours, his appetite has returned. Which recommendation should the nurse make to this mother? a)Consume a diet consisting of bananas, white rice, applesauce, and toast. b)Drink large quantities of water regularly to prevent dehydration. c)Take loperamide [an antidiarrheal] as needed to control diarrhea. d)Increase the consumption of raw fruits and vegetables.

A The nurse should encourage the patient with diarrhea who has an appetite to consume a diet that consists of bananas, white rice, applesauce, and toast. These foods are easy to digest, provide calories for energy, and help provide a source of calcium. The patient should sip liquids frequently to prevent dehydration; large quantities might worsen diarrhea. Medication such as loperamide (Imodium) is usually reserved for chronic diarrhea. Raw fruits and vegetables may worsen diarrhea.

Which action should the nurse take to assess a 2-year-old child for pinworms? a)Press clear cellophane tape against the anal opening at night to obtain a specimen. b)Collect a freshly passed stool from a diaper using a wooden specimen blade. c)Place a smear of stool on a slide and add two drops of reagent. d)Prepare the patient for a flat plate (x-ray) of the abdomen.

A To assess for pinworms, the nurse should press cellophane tape against the child's anal opening during the night or as soon as he awakens. Remove the tape immediately, and place it on a slide. Perineal swabs may also be necessary for microscopic study. Collecting a fresh stool specimen from a diaper describes the method for an infant or toddler. Placing a smear of stool on a slide and adding a reagent describes fecal occult blood testing. An abdominal flat plate is not a method of assessing for pinworms.

Which of the following populations are considered high risk for the development of hemorrhoids? Select all that apply. a)Pregnant women b)School bus drivers c)Marathon runners d)Intensive care unit nurses

A, B Hemorrhoids are distended blood vessels within or protruding from the anus. The anus is highly vascular. Chronic pressure on the veins within the anal canal, as with prolonged sitting, retained feces, pregnancy, and obesity, can cause hemorrhoids. In this item, pregnant women and school bus drivers (sedentary) are at risk. Marathon runners are usually thin and are not in the risk group. There is no evidence to support any nursing group is high risk for hemorrhoids unless the nurse position is sedentary.

Which factors place the patient at risk for constipation? Select all that apply. a)Sedentary lifestyle b)High-dose calcium therapy c)Lactose intolerance d)Spicy food consumption

A, B Physical activity stimulates peristalsis and bowel elimination. Therefore, those with a sedentary lifestyle commonly experience constipation. High-dose calcium therapy also predisposes a patient to constipation. Lactose intolerance and spicy food consumption are associated with a nursing diagnosis of diarrhea, not constipation.

The nurse is performing a focused bowel assessment on an older adult. Which of the following physiological changes of aging should alert the nurse to an increased risk for problems associated with bowel elimination? Select all that apply. a)Decreased sphincter control b)Decreased peristalsis c)Increased intestinal muscle tone d)Decreased physical activity

A, B The bowel pattern set in childhood normally continues into late adulthood if the patient consumes adequate fiber and fluid and engages in regular physical activity. However, peristalsis, intestinal smooth muscle tone, perineal muscle tone, and sphincter control normally decrease with aging. These physiological processes can contribute to bowel elimination problems among older adults (e.g., bowel incontinence, constipation), especially if they decrease their activity and fiber intake. Increased intestinal muscle tone is not a normal physiological change of aging. Decreased activity level, although common in some older adults, is not a physiological change or process. In fact, some older adults may have rather high activity levels.

Older adults are more likely to use laxatives with regularity. In advising an older adult practicing this habit, the nurse would identify which of the following factors? Select all that apply. a)Consistent use of laxatives inhibits natural defecation reflexes, and is thought to cause rather that cure constipation. b)Habitual use of laxatives may lead to the need for ever-increasing dosages until the intestine fails to work properly. c)Laxatives may interfere with fluid and electrolyte balance. d)Laxatives increase the absorption of certain vitamins.

A, B, C Laxatives are used to treat constipation. In general, laxatives work by stimulating peristalsis. They are frequently abused by people who self-medicate with OTC drugs, who may become dependent on them, thus requiring ever-increasing dosages until the intestine fails to work properly. Laxatives may cause fluid and electrolyte imbalance. Laxatives decrease, not increase, the absorption of certain vitamins.

The mother of a 3-month-old infant comes to emergency department and states, "My baby has been having severe diarrhea for 4 days. She is crying all the time." In formulating the plan of care to moderate the diarrhea, the nurse focuses her intervention(s) on which of the following? Select all that apply. a)Fluid management b)Electrolyte balance c)Skin integrity d)Excessive crying

A, B, C Patients with diarrhea are at risk for fluid and electrolyte imbalance. Water and potassium loss are the primary concerns. Infants, young children, and the frail elderly are most vulnerable and may require hospitalization and intravenous fluid replacement therapy. Ideally, oral liquids replace the lost fluid and potassium. Priority nursing interventions, particularly for the infant, must focus on treating the diarrhea itself, fluid and electrolyte balance/imbalance, and impaired skin integrity. Although crying distresses parents, managing the infant's crying is not a priority at this time, and it will usually cease once the infant is feeling better and responding to treatment.

The pediatric nurse educator is teaching a group of parents about distinguishing between food allergies and food intolerance. The nurse should teach parents that which of the following is/are considered to be true food allergens? Select all that apply. a)Egg whites b)Shellfish c)Peanuts d)Corn

A, B, C The National Institute of Allergy and Infectious Disease (NIAID) characterizes a food allergy as a true immune system reaction prompted by the presence in the body of an allergenic food. Some common food allergens include dairy products, egg whites, shellfish, gluten, peanuts and other nuts, citrus fruits, and soy. Immune responses to foods manifests as a variety of symptoms ranging from a mild rash to anaphylactic shock. Food intolerance, in contrast to a food allergy, is specifically linked to the GI system. It produces such symptoms as GI discomfort, pain, gas, bloating, diarrhea, or constipation. An example is lactose intolerance, a deficiency of the enzyme lactase. Corn is not considered a food allergen, although some people may find corn to be constipating.

Considering normal developmental and physical maturation in children, for which age would a goal of "Achieves bowel control by the end of this month" be most realistic? a)18 months b)3 years c)4 years d)5 years

B Between ages 2 and 3 years, a child can typically control defecation, thereby making toilet training possible. Nevertheless, some children, especially boys, may not achieve consistent bowel control until somewhat later.

The nurse is performing a colostomy irrigation on a male client. During the irrigation, the client begins to complain of abdominal cramps. What is the appropriate nursing action? a)Notify the physician. b)Stop the irrigation temporarily. c)Increase the height of the irrigation. d)Medicate for pain and resume the irrigation.

B If cramping occurs during a colostomy irrigation, the irrigation flow is stopped 15 to 30 seconds and the client is asked to take deep breaths. Cramping may occur from an infusion that is too rapid or is causing too much pressure. The physician does not need to be notified. Increasing the height of the irrigation will cause further discomfort. Medicating the client for pain is not the appropriate action in this situation.

When changing a diaper, the nurse observes that a 2-day-old infant has passed a green-black, tarry stool. What should the nurse do? a)Notify the provider immediately. b)Do nothing; this is normal. c)Give the baby sterile water until the mother's milk comes in. d)Apply a skin barrier cream to the buttocks to prevent irritation.

B The nurse should do nothing; this is normal. During the first few days of life, a term newborn passes green-black, tarry stools known as meconium. Stools transition to a yellow-green color over the next few days. After that, the appearance of stools depends on the feedings the newborn receives. Sterile water does nothing to alter this progression. Meconium stools are more irritating to the buttocks than other stools because they are so sticky and the skin usually must be rubbed to cleanse it.

The healthcare team suspects that a patient has an intestinal infection. Which action should the nurse take to help confirm the diagnosis? a)Prepare the patient for an abdominal flat plate. b)Collect a stool specimen that contains 20 to 30 mL of liquid stool. c)Administer a laxative to prepare the patient for a colonoscopy. d)Test the patient's stool using a fecal occult test.

B To confirm the diagnosis of an infection, the nurse should collect a liquid stool specimen that contains 20 to 30 mL of liquid stool. An abdominal flat plate and a fecal occult blood test cannot confirm the diagnosis. Colonoscopy is not necessary to obtain a specimen to confirm the diagnosis.

The nurse must administer an enema to an adult patient with constipation. Which of the following would be a safe and effective distance for the nurse to insert the tubing into the patient's rectum? Select all that apply. a)2 in. (5.1 cm) b)3 in. (7.6 cm) c)4 in. (10.2 cm) d)5 in. (12.7 cm)

B, C When administering an enema, the nurse should insert the tubing about 3 to 4 inches into the patient's rectum. Two inches would not be effective because it would not place the fluid high enough in the rectum. Five inches is too far.

The nurse is caring for a patient on the medical-surgical unit. The patient states, "I really don't like to talk about my bowel movements, but what is considered a normal bowel movement?" What is the best response by the nurse? Select all that apply. a)"We usually like to set an acceptable standard of at least one bowel movement per week." b)"We can say normal frequency is anything from several times a day to once per week. It depends on your normal pattern." c)"We also consider whether you have to strain with bowel movements, use laxatives, or have to rush to the toilet." d)"There is no such thing as normal. All people are different, so don't worry about it."

B, C Part of the confusion about bowel function is that there is a wide range of "normal." The frequency of BMs may range from several times per day to once a week. As long as the person passes stools without excessive urgency (needing to rush to the toilet), with minimal effort and no straining, without blood loss, and without the use of laxative, you can regard bowel function as normal. The best responses by the nurse are therefore the ones that provide the patient with the most information. Although telling a patient there is no such thing as normal and all people are different is not incorrect, it does not provide the patient any information regarding what constitutes "normal" as far as number of BMs, what they should look like, defecation without much straining, and so on. Moreover, that statement advises the patient not to worry about it, which is condescending and negates feelings

Which of the following tasks may be delegated to a CNA or NAP? Select all that apply. a)Irrigating a newly created colostomy b)Collecting and testing a stool sample for occult blood c)Digitally removing stool as a result of a fecal impaction d)Assisting with placing a fracture pan on an immobile patient

B, D Collecting and testing a stool sample for occult blood and placing/removing a fracture pan for an immobile patient are tasks that can be delegated to a CNA or NAP. Irrigating a newly created colostomy and digitally removing stool cannot be delegated. These tasks require ongoing assessment of the patient by the professional nurse. The nurse must monitor the patient for complications, such as bleeding and vagal nerve stimulation. Nursing judgment is necessary in determining the need to halt these procedures.

A patient has a history of chronic constipation. Which of the following medications prescribed for the patient would alert the nurse to be especially vigilant in observing for constipation and teach the client about preventive measures? Select all that apply. a)NSAIDs b)Iron c)Antibiotics d)Pain medications

B, D Many medications may affect peristalsis and all oral medicines have the potential to affect the function of the GI tract. Iron has an astringent effect on the bowel and is notorious for causing constipation. Pain medications, particularly opioids (narcotics), slow peristalsis and are associated with a high incidence of constipation. Antibiotics, given to combat infection, decrease the normal flora in the colon. The result is often diarrhea. Aspirin and NSAIDs irritate the stomach. Repeated use of these medicines usually leads to ulceration of the stomach or duodenum. However, antibiotics and NSAIDs are not usually associated with constipation.

The nurse is obtaining a bowel elimination history from her 80-year-old patient. The patient states, "Sometimes when I go to the bathroom I push real hard, hold my breath, and plug my nose." Which action should the nurse take first? a)Warn the patient, "You should not hold your breath while straining." b)Assure the patient, "This does seem to help some people to have a bowel movement." c)Check the patient's medical history for heart disease, glaucoma, increased intracranial pressure, or a new surgical wound. d)Notify the primary care provider that the patient has reported performing this action.

C A person can increase the pressure to expel feces by contracting the abdominal muscles (straining) while maintaining a closed airway (e.g., holding breath). This is called the Valsalva maneuver and it is what the patient is describing. Although it assists with the passage of stool, you should caution patients with heart disease, glaucoma, increased intracranial pressure, or a new surgical wound to avoid this maneuver because it increases pressure with the abdominal cavity, raises blood pressure, decreases heart rate, and is associated with an increased risk for cardiac dysrhythmias. For that reason, before deciding how to respond, the nurse should check the chart to see whether the patient has any medical conditions that contraindicate the Valsalva maneuver. Only then would it be necessary to warn the patient against the maneuver. The nurse should not reassure the patient or further encourage the action without additional information. It is not necessary at this time to inform the primary care provider, although a notation should be made in the patient record.

A patient with a skin infection is prescribed cephalexin (an antibiotic) 500 mg orally q 12 hours. The patient complains that the last time he took this medication, he had frequent episodes of loose stools. Which recommendation should the nurse make to the patient? a)Stop taking the drug immediately if diarrhea develops. b)Take an antidiarrheal agent, such as diphenoxylate. c)Consume yogurt daily while taking the antibiotic. d)Increase your intake of fiber until the diarrhea stops.

C Antibiotics such as cephalexin, given to combat infection, decrease the normal flora in the colon that cause diarrhea. The patient should avoid highly spiced, high-fat foods and large quantities of raw fruits, which tend to cause even more diarrhea. Yogurt is recommended daily, for as long as the antibiotic is being taken. Diarrhea is a common adverse effect of antibiotics; therefore, stopping the drug is not necessary or advisable. The patient should not be encouraged to take an antidiarrheal agent at this time. Increasing the intake of fiber combats constipation, not diarrhea.

The nurse is instructing a patient about performing home testing for fecal occult blood. The nurse should explain that ingestion of which substance may cause a false-negative fecal occult blood test? a)Vitamin D b)Iron c)Vitamin C d)Thiamine

C Ingestion of vitamin C can produce a false-negative fecal occult blood test; ingestion of vitamin D, iron, and thiamine does not. Iron can lead to a false-positive result.

The nurse is seeing a patient at home with a new colostomy. In formulating the plan of care, what is the priority long-term goal for this patient? The patient will: a)Adjust emotionally to the colostomy and lifestyle change b)Verbalize appropriate steps in caring for his colostomy c)Assume self-care in colostomy management d)Experience soft stool with minimal flatus

C Patients experience a variety of reactions to a bowel diversion, and each person has unique physical and psychological needs. Initially, the nurse will care for the colostomy and teach the patient how to care for it. The ultimate, priority goal is for the patient to assume self-care and a normal life. Although patient acceptance of his or her colostomy is important, the nurse cannot assume any patient will accept the lifestyle change. Some patients may never feel comfortable with a bowel diversion. However, if the patient has been sick before surgery and the ostomy leads to less pain or discomfort, the transition and acceptance may be easier. Verbalizing the steps of colostomy care and passing soft stool with minimal flatus are important short-term goals. However, they are merely small steps toward the long-term goal of self-care and management.

A patient has a colostomy in the descending (sigmoid) colon and wants to control bowel evacuation and possibly stop wearing an ostomy pouch. To help achieve this goal, the nurse should teach the patient to: a)Call the primary care provider if the stoma becomes pale, dusky, or black b)Limit the intake of gas-forming foods such as cabbage, onions, and fish c)Irrigate the stoma to produce a bowel movement on a schedule d)Avoid returning to the use of an ostomy appliance if he becomes ill

C Patients with an ostomy in the descending or sigmoid colon may use colostomy irrigation as a means to control and schedule bowel evacuation and possibly eliminate the need to wear an ostomy pouch. Limiting the intake of gas-forming foods is a good idea from a social perspective; however, it does not help achieve the goal of having regular bowel movements, thus eliminating the need to wear a pouch. When illness occurs, it may be difficult to control the output, so the patient can use an ostomy appliance. This will not make it more difficult to schedule the BMs after the illness passes.

A patient who has been immobile since sustaining injuries in a motor vehicle accident complains of constipation. The nurse encourages him to consume 8 to 10 eight-ounce glasses of fluid daily. Which fluids should the patient avoid because of the diuretic effect? Select all that apply. a)Cranberry juice b)Water c)Coffee d)Ginger ale e)Tea

C, E Coffee, tea, and caffeine-containing sodas should be avoided because caffeine promotes diuresis, placing the patient at further risk for constipation. Water is the preferred fluid; however, fruit juices and decaffeinated sodas are also acceptable.

The enterostomal nurse is conducting a teaching session for patients with new colostomies. Today's topic is self-assessment and signs and symptoms that must be immediately reported to the surgeon. Which sign/symptom should the nurse include in this teaching? a)Constipation b)Skin breakdown c)A stoma that is deep pink to red in color d)A stoma that is pale, dusky, or black in color

D A healthy stoma ranges in color from deep pink to brick red, regardless of the patient's skin color, and is shiny and moist. Pallor or a dusky blue color indicates ischemia, and a brown-black color indicates necrosis. Immediately report to the surgeon a stoma that is pale, dusky, or black in color. These indicate inadequate blood supply to the portion of the intestine that has been externalized. The patient should also pay close attention to the skin surrounding the stoma. Skin breakdown may lead to infection, pain, and leakage. The nurse will provide and further recommend the use of a barrier cream and other skin products. Skin breakdown and constipation may need to be reported to the surgeon depending on the extent of the breakdown and severity of the constipation. However, a change in stoma appearance is critical and warrants immediate attention.

Which collaborative interventions will help prevent paralytic ileus in a patient who underwent right hemicolectomy for colon cancer? a)Administer morphine 4 mg intravenously every 2 hours for pain. b)Administer IV fluids at 125 mL/hr. c)Insert an indwelling urinary catheter to monitor I&O. d)Keep the patient NPO until bowel sounds return.

D Patients who require bowel surgery typically remain NPO until peristalsis returns, helping to prevent paralytic ileus, a complication that can occur after the bowel is surgically manipulated. Administering morphine promotes comfort but may increase the risk of ileus. Administering IV fluids prevents dehydration, but does not directly prevent ileus. Inserting an indwelling urinary catheter prevents urine retention and facilitates monitoring postoperative urine output.

The nurse educates a patient about the primary risk factors for irritable bowel syndrome. Which behavior by the patient would be evidence of learning? The patient: a)Reduces her intake of gluten-containing products b)Does not consume foods that contain lactose c)Consumes only four cups of caffeinated coffee per day d)Takes measures to reduce her stress level

D Stress is a primary factor in the development of irritable bowel syndrome. Other risk factors include caffeine consumption and lactose intolerance; however, they are not primary risk factors. Celiac disease is associated with gluten intake.

A bowel prep "until clear" is prescribed for the female client scheduled for a colonoscopy. The client begins to experience diarrhea following administration of the solution. What action by the nurse is appropriate? a)Start an IV infusion. b)Administer an enema. c)Cancel the diagnostic test. d)Explain that diarrhea is expected.

D The solution administered is a bowel evacuant used to prepare a client for a colonoscopy by cleansing the bowel. The solution is expected to cause a mild diarrhea and will clear the bowel in 4 to 5 hours. The other options are inappropriate actions.