CHAPTER 41 GI

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 need to drink 2 to 3 liters of fluids every day." "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread." "I should exercise four times per week." "I need to use laxatives regularly to prevent constipation."

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

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? D5W 0.9% NS D10W 0.45% of NS

0.9% NS The administration of several liters of an isotonic solution is immediately prescribed. Hypovolemia occurs because massive amounts of fluid and electrolytes move from the intestinal lumen into the peritoneal cavity and deplete the fluid in the vascular space

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? A change in bowel habits Frank blood in the stool Abdominal pain Abdominal distention

A change in bowel habits

After assessing a client with peritonitis, how would the nurse most likely document the client's bowel sounds? High-pitched Hyperactive Mild Absent

Absent

In women, which of the following types of cancer exceeds colorectal cancer? Breast Lung Liver Skin

Breast

A client is having a diagnostic workup for reports of frequent diarrhea, right lower abdominal pain, and weight loss. The nurse is reviewing the results of the barium study and notes the presence of "string sign." What does the nurse understand that this is significant of? Ulcerative colitis Irritable bowel syndrome Diverticulitis Crohn's disease

Crohn's disease The most conclusive diagnostic aid for Crohn's disease has classically been a barium study of the upper GI tract that shows a "string sign" on an x-ray film of the terminal ileum, indicating the constriction of a segment of intestine.

Which of the following is considered a bulk-forming laxative? Dulcolax Metamucil Mineral oil Milk of Magnesia

Metamucil

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? Duodenal ulcers Polyps Hemorrhoids Weight gain

Polyps

A nurse is caring for a client who has experienced an acute exacerbation of Crohn's disease. Which statement best indicates that the disease process is under control? The client verbalizes a manageable level of discomfort. The client exhibits signs of adequate GI perfusion. The client expresses positive feelings about himself. The client maintains skin integrity.

The client exhibits signs of adequate GI perfusion. Adequate GI perfusion can be maintained only if Crohn's disease is controlled. If the client experiences acute, uncontrolled episodes of Crohn's disease, impaired GI perfusion may lead to a bowel infarction. Positive self-image, a manageable level of discomfort, and intact skin integrity are expected client outcomes, but aren't related to control of the disease

During assessment of a client for a malabsorption disorder, the nurse notes a history of abdominal pain and weight loss, marked steatorrhea, azotorrhea, and frequent glucose intolerance. Based on these clinical features, what diagnosis will the nurse suspect? Ileal dysfunction Celiac disease pancreatic insufficiency Lactose intolerance

pancreatic insufficiency

An older adult client in a long-term care facility is concerned about bowel regularity. During a client education session, the nurse reinforces the medically acceptable definition of "regularity." What is the actual measurement of "regular"? two bowel movements daily one bowel movement every other day stool consistency and client comfort one bowel movement daily

stool consistency and client comfort

Which statement provides accurate information regarding cancer of the colon and rectum? Colorectal cancer is the third most common site of cancer in the United States. Colon cancer has no hereditary component. Rectal cancer affects more than twice as many people as colon cancer. The incidence of colon and rectal cancer decreases with age.

Colorectal cancer is the third most common site of cancer in the United States.

The nurse is preparing a client for a test that involves inserting a thick barium paste into the rectum with radiographs taken as the client expels the barium. What test will the nurse prepare the client for? Colonic transit studies Kidneys, ureters, bladder (KUB) Abdominal radiography Defecography

Defecography

Which is one of the primary symptoms of irritable bowel syndrome (IBS)? Pain Abdominal distention Bloating Diarrhea

Diarrhea The primary symptoms of IBS include constipation, diarrhea, or a combination of both. Pain, bloating, and abdominal distention often accompany changes in bowel pattern.

A client is being treated for diverticulosis. Which points should the nurse include in this client's teaching plan? Select all that apply.

Do not suppress the urge to defecate. Drink at least 8 to 10 large glasses of fluid every day. Use bulk-forming laxatives Encourage an individualized exercise program

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

Familial polyposis

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

Familial polyposis

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

Rectal bleeding

A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a: fistula. fissure. hemorrhoid. pilonidal cyst.

fissure.

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. hypokalemia. hyponatremia. hyperkalemia.

hypokalemia. The older client taking digoxin must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

Clients with inflammatory bowel disease (IBD) are at significantly increased risk for which condition?

osteoporosis

The nurse is teaching a client with constipation to increase dietary fiber intake to 25 g/day. Which recommendation would the nurse include? Limiting fluid intake to 5 to 6 glasses per day Minimizing activity levels for at least 2 months Avoiding bran cereals and beans in the diet Adding fiber-rich foods to the diet gradually

Adding fiber-rich foods to the diet gradually

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 Tenesmus Borborygmus Peristalsis

Borborygmus

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 Diverticulitis Azotorrhea Tenesmus

Borborygmus

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? Rectal fissures Bowel perforation Appendicitis Diverticulitis

Bowel perforation Megacolon is a dilated and atonic colon caused by a fecal mass that obstructs the passage of colon contents. Symptoms include constipation, liquid fecal incontinence, and abdominal distention. Megacolon can lead to perforation of the bowel.

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse? Clamp the tubing and give the patient a rest period. Replace the fluid with cooler water since it is probably too warm. Inform the patient that it will only last a minute and continue with the procedure. Stop the irrigation and remove the tube.

Clamp the tubing and give the patient a rest period.

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

Drink 8 to 10 glasses of fluid daily.

What information should the nurse include in the teaching plan for a client being treated for diverticulosis? Drink at least 8 to 10 large glasses of fluid every day Use laxatives or enemas at least once a week Avoid daily exercise; indulge only in mild activity Avoid unprocessed bran in the diet

Drink at least 8 to 10 large glasses of fluid every day

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 barrier powder Dry skin thoroughly after washing Apply triamcinolone acetonide spray Dust with nystatin powder

Dry skin thoroughly after washing

A client has been recently diagnosed with an anorectal condition. The nurse is reviewing interventions that will assist the client with managing the therapeutic regimen. What would not be included? Encourage the client to avoid exercise. Teach the client how to do sitz baths at home using warm water three to four times each day. Instruct the client to cleanse perianal area with warm water. Encourage the client to follow diet and medication instructions.

Encourage the client to avoid exercise. Activity promotes healing and normal stool patterns. Proper cleansing prevents infection and irritation. Sitz baths promote healing, decrease skin irritation, and relieve rectal spasms. Encouragement promotes compliance with therapeutic regimen and prevents complications.

A surgeon is discussing surgery with a client diagnosed with colon cancer. The client is visibly shaken over the possibility of a colostomy. Based on the client's response, the surgeon should collaborate with which health team member? Enterostomal nurse Social worker Staff nurse Clinical educator

Enterostomal nurse

A client underwent a continent ileostomy. Within which time frame should the client expect to empty the reservoir? Every 4 to 6 hours Three or four times daily At least once a day At least once every 2 days

Every 4 to 6 hours The length of time between drainage periods is gradually increased until the reservoir needs to be drained only every 4 to 6 hours and irrigated once each day. This prevents the accumulating effluent from spilling or causing infection.

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 Maintaining wrinkles in the faceplate so it doesn't irritate the skin Cutting the faceplate opening no more than 2 inches larger than the stoma Scrubbing fecal material from the skin surrounding the stoma

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

A client is reporting problems with constipation. What dietary suggestion can the nurse inform the client may help facilitate the passage of stool? Increase dietary protein such as lean meats. Increase dietary fat consumption. Increase the carbohydrate content of the diet. Increase dietary fiber.

Increase dietary fiber.

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

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

The instructor is teaching a group of students about irritable bowel syndrome (IBS) and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an antidiarrheal agent commonly administered for IBS? Lubiprostone Peppermint oil Loperamide Dicyclomine

Loperamide

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

Low residue Oral fluids and a low-residue, high-protein, high-calorie diet with supplemental vitamin therapy and iron replacement are prescribed to meet the nutritional needs, reduce inflammation, and control pain and diarrhea.

The nurse is caring for an older adult patient experiencing fecal incontinence. When planning the care of this patient, what should the nurse designate as a priority goal? Instituting a diet high in fiber and increase fluid intake Maintaining skin integrity Determining the need for surgical intervention to correct the problem Beginning a bowel program to establish continence

Maintaining skin integrity

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

Metabolic alkalosis Vomiting results in loss of hydrochloric acid (HCl) and potassium from the stomach, leading to a reduction of chlorides and potassium in the blood and to metabolic alkalosis.

Celiac disease (celiac sprue) is an example of which category of malabsorption? Luminal problems causing malabsorption Infectious diseases Mucosal disorders causing generalized malabsorption Postoperative malabsorption

Mucosal disorders causing generalized malabsorption

The nurse is admitting a client with a diagnosis of diverticulitis and assesses that the client has a board-like abdomen, no bowel sounds, and reports of severe abdominal pain. What is the nurse's first action? Administer a retention enema. Notify the health care provider. Start an IV with lactated Ringer's solution. Administer an opioid analgesic.

Notify the health care provider. Abdominal pain, a rigid board-like abdomen, loss of bowel sounds, and signs and symptoms of shock occur with peritonitis. Peritonitis is typically a life-threatening emergency that requires prompt surgical intervention, and typically involves postoperative critical care monitoring due to the risk of sepsis, organ failure, and subsequent infections; thus, the nurse should notify the health care provider.

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? The appendix may develop gangrene and rupture, especially in a middle-aged client. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. 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.

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

The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder? A loop of intestine adheres to an area that is healing slowly after surgery. The bowel protrudes through a weakened area in the abdominal wall. The bowel twists and turns itself and obstructs the intestinal lumen. One part of the intestine telescopes into another portion of the intestine.

One part of the intestine telescopes into another portion of the intestine.

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 board-like. What complication does the nurse determine may be occurring at this time? Accumulation of gas Paralytic ileus Constipation Peritonitis

Peritonitis

The nurse observes the physician palpating the abdomen of a client that is suspected of having acute appendicitis. When the abdomen is pressed in the left lower quadrant the client complains of pain on the right side. What does the nurse understand this assessment technique is referred to? Rovsing sign Rebound pain Referred pain Cremasteric reflex

Rovsing sign When an examiner deeply palpates the left lower abdominal quadrant and the client feels pain in the right lower quadrant, this is referred to as a positive Rovsing sign and suggests acute appendicitis. Referred pain indicates pain in another area but is not necessarily manipulated by the examiner. Rebound pain is indicated when the pain of palpation is worse when the pressure is off of the site. The cremasteric reflex is a superficial reflex that is present in male clients.

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

Saline agents (e.g., magnesium hydroxide) Saline agents use osmosis to stimulate peristalsis and act within 2 hours of consumption. Bulk-forming agents mix with intestinal fluids, swell, and stimulate peristalsis. Stimulants irritate the colon epithelium. Fecal softeners hydrate the stool by surfactant action on the colonic epithelium, resulting in the mixing of aqueous and fatty substances. page 1290

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

Suggest fluid intake of at least 2 L/day The nurse should suggest a fluid intake of at least 2 L/day to help the client avoid constipation. The nurse should also offer prune or apple juice because they promote elimination. The nurse should encourage the client to eat regular meals. Dieting or fasting can decrease stool volume and slow elimination. The nurse should instruct the client to keep a record of food intake in case of diarrhea, because this helps identify specific foods that irritate the gastrointestinal tract page 1287

Which is a true statement regarding regional enteritis (Crohn's disease)? It has a progressive disease pattern. It is characterized by pain in the lower left abdominal quadrant. The clusters of ulcers take on a cobblestone appearance. The lesions are in continuous contact with one another.

The clusters of ulcers take on a cobblestone appearance.

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 client is able to fully evacuate with each bowel movement 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 consistency of stool and comfort when passing stool

A client reports taking a stimulant laxative in order to be able to have a bowel movement daily. What should the nurse inform the client about taking a stimulant laxative? They can be habit forming and will require increasing doses to be effective. The laxative is safe to take with other medication the client is taking. The client should take a fiber supplement along with the stimulant laxative. If the client is drinking 8 glasses of water per day, it is all right to continue taking them.

They can be habit forming and will require increasing doses to be effective.

The nurse is conducting a gastrointestinal assessment. When the client reports the presence of mucus and pus in the stool, the nurse assesses for additional signs/symptoms of which disease/condition? Disorders of the colon Small-bowel disease Intestinal malabsorption Ulcerative colitis

Ulcerative colitis

The presence of mucus and pus in the stools suggests which condition? Ulcerative colitis Disorders of the colon Small-bowel disease Intestinal malabsorption

Ulcerative colitis

A client presents to the emergency department with complaints of acute GI distress, bloody diarrhea, weight loss, and fever. Which condition in the family history is most pertinent to the client's current health problem? Appendicitis Hypertension Ulcerative colitis Gastroesophageal reflux disease

Ulcerative colitis A family history of ulcerative colitis, particularly if the relative affected is a first-degree relative, increases the likelihood of the client having ulcerative colitis. Although hypertension has familial tendencies, the client's symptoms aren't related to hypertension. A family history of gastroesophageal reflux disease or appendicitis isn't a significant factor in the client history because these conditions aren't considered familial traits. pg 1305

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

high-fiber diet

A nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find? severe abdominal pain with direct palpation or rebound tenderness jaundice and vomiting rectal bleeding and a change in bowel habits tenderness and pain in the right upper abdominal quadrant

severe abdominal pain with direct palpation or rebound tenderness Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (i.e., appendicitis, diverticulitis, ulcerative colitis, a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.

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. activity levels. current medications.

usual pattern of elimination. Constipation has many possible reasons; assessing the client's usual pattern of elimination is the first step in identifying the cause.