chapter 51

A nurse cares for a client who had a colostomy placed in the ascending colon 2 weeks ago. The client states, ―The stool in my pouch is still liquid.‖ How would the nurse respond? The client states, —The stool ni my pouch si still liquid.I How would the nurse respond? a."The stool will always be liquid with this type of colostomy." b."Eating additional fiber will bulk up your stool and decrease diarrhea." c. "your stool will become firmer over the next couple of weeks" d. "this is abnormal. I will contact your primary health care provider"

A

The nurse is caring for a client who has a postoperative paralytic ileus following abdominal surgery. What drug is appropriate to manage this nonmechanical bowel obstruction? a. Alosetron b. Alvimopan c. Amitiptyline d. Amlodipine

B Alvimopan is the appropriate drug to promote peristalsis for clients who have a paralytic ileus. The other drugs do not affect intestinal activity.

A nurse cares for a client who has a new colostomy. Which action would the nurse take? a. empty the pouch frequently to remove excess gas collection b. change the ostomy pouch and barrier every morning. c. allow the pouch to completely fill with stool prior to emptying it d. use surgical tape to secure the pouch and prevent leakage

a

The nurse is caring for a client who is planning to have a laparoscopic colon resection for colorectal cancer tomorrow. Which statement by the client indicates a need for further teaching? a.I should have less pain after this surgery compared to having a large incision. b.I will probably be in the hospital for 3 to 4 days after surgery c.I will be able to walk around a little on the same day as the surgery. d.I will be able to return to work in a week or two depending on how I do.

b

A client si admited with adiagnosis of possible strangulated inguinal hernia. For which complication would the nurse monitor? a. Paralytic ileus b. Bowel volvulus c. Sepsis d. Colitis

c

A nurse assessing a client with colorectal cancer auscultates high-pitched bowel sounds and 5. Anurse assessing aclient with colorectal cancer auscultates high-pitched bowel sounds and notes the presence of visible peristaltic waves. Which action would the nurse take? notes the presence of visible peristaltic waves. Which action would the nurse take? a. Ask if the client is experiencing pain in the right shoulder. b. Perform a rectal examination and assess for polyps. c. Recommend that the client have computed tomography. d. Administer a laxative to increase bowel movement activity.

C The presence of visible peristaltic waves, accompanied by high-pitched or high-pitched bowel sounds, is indicative of bowel obstruction caused by the tumor. The nurse would contact the primary health care provider with these results and recommend a computed tomography scan for further diagnostic testing. This assessment finding is not associated with right shoulder pain; peritonitis and cholecystitis are associated with referred pain to the right shoulder. The pain; peritonitis and cholecystitis are associated with referred pain to the right shoulder. The nurse generalist is not qualified to complete a rectal examination for polyps, and laxatives nurse generalist is not qualified to complete a rectal examination for polyps, and laxatives would not help this client.

A nurse cares for a client who has a family history of colorectal cancer. The client states, "My father and my brother had colon cancer. What is the chance that I will get cancer? How would the nurse respond? a. If you eat a low-fat and low-fiber diet, your chances decrease significantly b. you are safe. This is an autososmal dominant disorder that skips generations c. preemptive surgery and chemotherapy will remove cancer cells and prevent cancer d. you should have colonoscopy more frequently to identify abnormal polyps early

D

The nurse is caring for a client with a large bowel obstruction due to fecal impaction. What .9 The nurse si caring for a client with a large bowel obstruction due ot fecal impaction. What position would be appropriate for the client while in bed? position would be appropriate for the client while ni bed? a. Prone b. Supine c. Recumbent d. Semi-Fowler

D

A nurse assesses clients at a community health center. Which client is at highest risk for developing colorectal cancer? a.A 37-year-old who drinks eight cups of coffee daily. b.A 44-year-old with irritable bowel syndrome (IBS). c. A 60-year-old lawyer who works 65 hours per week. d. A 72-year-old who eats fast food frequently.

D Colon cancer is rare before the age of 40, but its incidence increases rapidly with advancing age. Fast food tends to be high in fat and low in fiber, increasing the risk for colon cancer. Coffee intake, IBS, and a heavy workload do not increase the risk for colon cancer.

A nurse cares for a client who states, "My husband is repulsed by my colostomy and refuses to be intimate with me" How would the nurse respond? Let's talk to the ostomy nurse to help you and your husband work through this. b.You could try to wear longer lingerie that will better hide the ostomy appliance c. You should empty the pouch first so it will be less noticeable for your husband. d.If you are not careful, you can hurt the stoma if you engage in sexual activity

a

A nurse assesses a client who is prescribed alosetron. Which assessment question would the nurse ask this client before starting the drug? a.Have you been experiencing any constipation? b.Are you eating a diet high in fiber and fluids? c.Do you have a history of high blood pressure? d.What vitamins and supplements are you taking?

a Ischemic colitis is a life-threatening complication of alosetron. The nurse would assess the client for constipation because it places the client at risk for this complication. The other questions do not identify the risk for complications related to alosetron

A client is preparing to have a fecal occult blood test (FOBT). A What health teaching would the nurse include prior to the test? a. This test will determine whether you have colorectal cancer. .b. You need to avoid red meat and NSAIDs for 48 hours before the test. c. You don't need to have this test because you can have a virtual colonoscopy. d. This test can determine your genetic risk for developing colorectal cancer.

B

The nurse is caring for a client who has been prescribed lubiprostone for irritable bowel syndrome (IBS-C). What health teaching will the nurse include about taking this drug? a. this drug will make you very dry because it will decrease your diarrhea b. be sure to take this drug with food and water to help manage constipation c.avoid people who have infection as this drug will supress your immune system d. include high-fiber foods in your diet to help produce more solid stools

B

After teaching a client with irritable bowel syndrome (IBS), a nurse assesses the client's understanding. Which menu selection indicates that the client correctly understands the dietary teaching? a. Ham sandwich on white bread, cup of applesauce, carbonated beverage b. Broiled chicken with brown rice, steamed broccoli, glass of apple juice c. Grilled cheese sandwich, small banana, cup of hot tea with lemon d. Baked tilapia, fresh green beans, cup of coffee with low-fat milk

b Patients with IBS are advised to eat a high-fiber diet. Chicken with brown rice, broccoli, and apple juice has the highest fiber content. Clients should avoid alcohol, caffeine, and other gastric irritants.

A nurse cares for a client with colorectal cancer who has a new colostomy. The client states,I think it would be helpful to talk with someone who has had a similar experience." How I—think it would be helpful to talk with someone who has had a similar experience. How would the nurse respond? a. "I have a good friend with a colostomy who would be willing to talk with you." b. "The ostomy nurse will be able to answer all of your questions." c. "I will make a referral to the United Ostomy Associations of America." d. "You'll find that most people with colostomies don't want to talk about them."

c

A nurse teaches a client who is at risk for colorectal cancer. Which dietary recommendation would the nurse teach the client? a. eat low-fiber and low-residual foods b. white rice and bread are easier to digest c. add vegetables such as broccoli and cauliflower to your diet d. foods high in animal fat help to protect the intestinal mucosa

c

The nurse is teaching aclient how to avoid the formation of hemorrhoids. What lifestyle change would the nurse include? a. Avoiding alcohol b. Quitting smoking c.Decreasing fluid intake d.Increasing dietary fiber

c

The nurse is caring for a client who is diagnosed with a complete small bowel obstruction. For what priority problem is this client most likely at risk? a.Abdominal distention b.Nausea c.Electrolyte imbalance d.Obstipation

c The client who has a small bowel obstruction is at the highest risk for fluid and electrolyte imbalances, especially dehydration and hypokalemia due to profuse vomiting. Nausea, abdominal distention, and obstipation are also usually present, but these problems are not as life threatening as the imbalances in electrolytes.