Chapter 47: Management of Patients With Intestinal and Rectal Disorders

Usual pattern of elimination

The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation?

Borborygmus

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?

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?

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?

Dry skin thoroughly after washing

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?

Ulcerative colitis

The presence of mucus and pus in the stools suggests which condition?

Metabolic alkalosis

Vomiting results in which of the following acid-base imbalances?

Deficient fluid volume

What is the primary nursing diagnosis for a client with a bowel obstruction?

presents with a rigid, boardlike abdomen.

Which client requires immediate nursing intervention? The client who:

The clusters of ulcers take on a cobblestone appearance.

Which is a true statement regarding regional enteritis (Crohn's disease)?

Metamucil

Which of the following is considered a bulk-forming laxative?

Rectal bleeding

Which of the following is the most common symptom of a polyp?

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

Which statement provides accurate information regarding cancer of the colon and rectum?

Right lower quadrant

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location?

Rovsing's sign; acute appendicitis

A client presents to the ED with acute abdominal pain, fever, nausea, and vomiting. During the client's examination, the lower left abdominal quadrant is palpated, causing the client to report pain in the RLQ. This positive sign is referred to as ________ and suggests the client may be experiencing ________.

Broiled chicken with low-fiber pasta

A patient with IBD would be encouraged to increase fluids, use vitamins and iron supplements, and follow a diet designed to reduce inflammation. Select the meal choice that would be recommended for a low-residue diet.

stool consistency and client comfort

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"?

Mucosal disorders causing generalized malabsorption

Celiac sprue is an example of which category of malabsorption?

0.9% NS

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?

hypokalemia.

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:

Fecal incontinence

The nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be

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

The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder?

Endoscopy with mucosal biopsy

The nurse is caring for a patient who has malabsorption syndrome with an undetermined cause. What procedure will the nurse assist with that is the best diagnostic test for this illness?

Clamp the tubing and allow client to rest.

The nurse is irrigating a client's colostomy when the client begins to report cramping. What is the appropriate action by the nurse?

Clamp the tubing and give the patient a rest period.

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?

Peritonitis

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?

Familial polyposis

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening?

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

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?

water and electrolyte absorption

A client has been experiencing lower GI difficulties that have increased in severity, and the gastroenterologist is concerned that the client's bowel is not functioning properly. What function of the lower GI tract is most likely to be affected by the client's disorder?

Chronic constipation with sporadic bouts of diarrhea

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?

fissure.

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:

The consistency of stool and comfort when passing stool

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?

Suggest fluid intake of at least 2 L/day

A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client?

Peritonitis

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?

Polyps

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?

A change in bowel habits

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?

severe abdominal pain with direct palpation or rebound tenderness

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?

Intestinal malabsorption.

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:

lack of free water intake

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?

Hypokalemia

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

"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread."

A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult?

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

A client informs the nurse that he is 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?

Test all stools for occult blood.

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?

Increasing fluid intake to prevent dehydration

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?

Assist client to increase dietary fiber.

A client with anorexia reports constipation. Which nursing measure would be most effective in helping the client reduce constipation?

Low residue

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following?

Adding fiber-rich foods to the diet gradually

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?

Ulcerative colitis

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?

Computed tomography scan

Which of the following is the diagnostic of choice if the suspected diagnosis is diverticulitis?