Chapter 56 Noninflammatory intestinal disease

A client with colorectal cancer was started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. A relatively new chemotherapeutic agent, oxaliplatin (Eloxatin), has been added to the treatment regimen. What does the nurse tell the client about the diarrhea and mouth ulcers? A. "A combination of chemotherapeutic agents has caused them." B. "GI problems are symptoms of the advanced stage of your disease." C. "5-FU cannot discriminate between your cancer and your healthy cells." D. "You have these as a result of the radiation treatment."

"5-FU cannot discriminate between your cancer and your healthy cells." 5-FU cannot discriminate between cancer and healthy cells; therefore, the side effects are diarrhea, mucositis, leukopenia, mouth ulcers, and skin ulcers. The 5-FU treatment, not a combination of chemotherapy drugs, radiation, or the stage of the disease, is what is causing the client's GI problems.

A client suspected of having irritable bowel syndrome (IBS) is scheduled for a hydrogen breath test. What does the nurse tell the client about this test? A. "During the test, you will drink small amounts of an antacid as directed by the technician." B. "If you have IBS, hydrogen levels may be increased in your breath samples." C. "The test will take between 30 and 45 minutes to complete." D. "You must have nothing to drink (except water) for 24 hours before the test."

"If you have IBS, hydrogen levels may be increased in your breath samples." Excess hydrogen levels are produced in clients with IBS. This is due to bacterial overgrowth in the small intestine that accompanies the disease. The hydrogen travels to the lungs to be excreted. The client will ingest small amounts of sugar during the test, not an antacid. The test takes longer than 45 minutes. The client has breath samples taken every 15 minutes for 1 to 2 hours. The client needs to be NPO (except for water) for 12 hours before the test.

A client with malabsorption syndrome asks the nurse, "What did I do to cause this disorder to develop?" How does the nurse respond? A. "An excessive intake of alcohol is associated with it, so your substance abuse could have contributed to its development." B. "It is inherited, so it could run in your family." C. "It might be caused by a virus, so you could have gotten it almost anywhere." D. "Nothing you did could have caused it; it is the result of flattening of the mucosa of your large intestine."

"Nothing you did could have caused it; it is the result of flattening of the mucosa of your large intestine." Stating that the disorder is the result of flattening of the mucosa of the large intestine is the only statement that is physiologically accurate. Malabsorption syndrome is not associated with an excessive intake of alcohol. It is not inherited, although a genetic immune defect is present in the related disease, celiac sprue. It is not caused by a virus.

Aside from chemotherapeutic agents, what other medications does the nurse expect to administer to a client with advanced colorectal cancer for relief of symptoms? A. Analgesics and antiemetics B. Analgesics and benzodiazepines C. Steroids and analgesics D. Steroids and anti-inflammatory medications

Analgesics and antiemetics Clients with advanced colorectal cancer and metastasis also receive drugs such as analgesics and antiemetics for relief of symptoms, specifically pain and nausea. Benzodiazepines, steroids, and anti-inflammatory medications are not routinely requested for these clients.

A nurse prepares to administer 12 mg/kg of 5-fluorouracil chemotherapy intravenously to a client who has colon cancer. The client weights 132 lb. How many milligrams should the nurse administer? (Record your answer using a whole number.) _____ mg

Answer: 720 mg

A nurse assesses a client who is prescribed 5-fluorouracil chemotherapy intravenously for the treatment of colon cancer. Which assessment finding should alert the nurse to contact the health care provider? A. White blood cell count of 1500/mm3 B. Fatigue C. Nausea and diarrhea D. Mucositis and oral ulcers

Answer: A

A nurse cares for a client who states, "My husband is repulsed by my colostomy and refuses to be intimate with me." How should the nurse respond? A. "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 your engage in sexual activity."

Answer: A

A nurse plans care for a client who has chronic diarrhea. Which actions should the nurse include in this client's plan of care? (Select all that apply.) a. Using premoistened disposable wipes for perineal care b. Turning the client from right to left every 2 hours c. Using an antibacterial soap to clean after each stool d. Applying a barrier cream to the skin after cleaning e. Keeping broken skin areas open to air to promote healing

Answer: A, B, D

A nurse plans care for a client who is recovering from an inguinal hernia repair. Which interventions should the nurse include in this client's plan of care? (Select all that apply.) a. Encouraging ambulation three times a day b. Encouraging normal urination c. Encouraging deep breathing and coughing d. Providing ice bags and scrotal support e. Forcibly reducing the hernia

Answer: A, B, D

A nurse inserts a nasogastric (NG) tube for an adult client who has a bowel obstruction. Which actions does the nurse perform correctly? (Select all that apply.) a. Performs hand hygiene and positions the client in high-Fowler's position, with pillows behind the head and shoulders b. Instructs the client to extend the neck against the pillow once the NG tube has reached the oropharynx c. Checks for correct placement by checking the pH of the fluid aspirated from the tube d. Secures the NG tube by taping it to the client's nose and pinning the end to the pillowcase e. Connects the NG tube to intermittent medium suction with an anti-reflux valve on the air vent

Answer: A, C, E

A nurse assesses a client with a mechanical bowel obstruction who reports intermittent abdominal pain. An hour later the client reports constant abdominal pain. Which action should the nurse take next? A. Administer intravenous opioid medications B. Position the client with knees to chest C. Insert a nasogastric tube for decompression D. Assess the client's bowel sounds

Answer: D

A nurse cares for a client who has a family history of colon cancer. The client states, "My father and my brother had colon cancer. What is the chance that I will get cancer?" How should 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 autosomal dominant disorder that skips generations." C. "Preemptive surgery and chemotherapy will remove cancer cells and prevent cancer." D. "You should have a colonoscopy more frequently to identify abnormal polyps early."

Answer: D

An emergency room nurse cares for a client who has been shot in the abdomen and is hemorrhaging heavily. Which action should the nurse take first? A. Send a blood sample for a type and crossmatch B. Insert a large intravenous line for fluid resuscitation C. Obtain the heart rate and blood pressure D. Assess and maintain a patent airway

Answer: D

A client is diagnosed with irritable bowel syndrome (IBS). What factors does the nurse suspect as possible causes of the client's problem? (Select all that apply.) Antihistamines Caffeinated drinks Correct Stress Correct Sleeping pills Anxiety Correct

Caffeinated drinks Correct Stress Correct Anxiety Correct Factors such as ingestion of coffee or other gastric stimulants, stress, anxiety, and milk allergy are being investigated as possible causes of IBS. Antihistamines and sleeping pills are not suspected as causing IBS.

After an abdominoperineal resection, a 75-year-old client is referred to a home health agency. Which staff member does the nurse manager assign to perform the initial assessment on this client? LPN/LVN who has worked with many home health clients after colostomy surgeries LPN/LVN with 20 years of experience in the home health agency RN who is new to the agency with 5 years experience in the emergency department Social worker who is experienced with case management of older clients

RN who is new to the agency with 5 years experience in the emergency department Clients with medical or surgical diagnoses have complex physiologic needs that should be assessed by an RN. For this reason, Medicare requires that the initial assessment must be done by an RN, although LPN/LVNs and social workers are likely to be part of the health care team.

The emergency department nurse is assessing a client with a known inguinal hernia. Which assessment finding indicates that the hernia may have strangulated? (Select all that apply.) a. Fever b. Tachycardia c. Abdominal distention d. Mild abdominal pain e. Nausea and vomiting

a, b, c, and e

The nurse is teaching a group of patients with irritable bowel syndrome (IBS) about complementary and alternative therapies. What does the nurse suggest as possible treatment modalities? Select all that apply. a. Acupuncture b. Decreasing physical activities c. Meditation d. Peppermint oil capsules e. Yoga

a, c, d, and e

The nurse is teaching a patient with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods are included? Select all that apply. a. Broccoli b. Buttermilk c. Mushrooms d. Onions e. Peas f. Yogurt

a, c, d, and e

The nurse is caring for a patient who is to be discharged after a bowel resection and the creation of a colostomy. Which patient statement demonstrates that additional instruction from the nurse is needed? a. "I can drive my car in about 2 weeks." b. "I need to avoid drinking carbonated sodas." c. "It may take 6 weeks to see the effects of some foods on my bowel patterns." d. "Stool softeners will help me avoid straining."

a. "I can drive my car in about 2 weeks."

Aside from chemotherapeutic agents, what other medications does the nurse expect to administer to a patient with advanced colorectal cancer for relief of symptoms? a. Analgesics and antiemetics b. Analgesics and benzodiazepines c. Steroids and analgesics d. Steroids and anti-inflammatory medications

a. Analgesics and antiemetics

What does the nurse advice a patient diagnosed with irritable bowel syndrome (IBS) to take during periods of constipation? a. Bulk-forming laxatives b. Saline laxatives c. Stimulant laxatives d. Stool-softening agents

a. Bulk-forming laxatives

A patient who has colorectal cancer is scheduled for a colostomy. Which referral is initially of greatest value to this patient? a. Certified Wound, Ostomy, and Continence Nurse (CWOCN) b. Home health nursing agency c. Hospice d. Hospital chaplain

a. Certified Wound, Ostomy, and Continence Nurse (CWOCN)

A patient with colorectal cancer had colostomy surgery performed yesterday. The patient is very anxious about caring for the colostomy and states that the primary health care provider's instructions "seem overwhelming." What does the nurse do first for this patient? a. Encourage the patient to look at and touch the colostomy stoma b. Instruct the patient about complete care of the colostomy c. Schedule a visit from a patient who has a colostomy and is successfully caring for it d. Suggest that the patient involve family members in the care of the colostomy

a. Encourage the patient to look at and touch the colostomy stoma

A client had an open partial colectomy and ascending colostomy 3 days ago. What assessment findings does the nurse expect? (Select all that apply.) a. Black, moist stoma b. Gas inside the pouch c. Pain controlled with analgesics d. Small amount of formed stool from the colostomy e. Serosanguineous fluid draining from 2 Jackson-Pratt drains.

b, c, and e

A patient is diagnosed with irritable bowel syndrome (IBS). What factors does the nurse suspect as possibly contributing to the patient's condition? Select all that apply. a. Antihistamines b. Caffeinated drinks c. Stress d. Sleeping pills e. Combinations of genetic, immunological, and hormonal factors

b, c, and e

A patient with irritable bowel syndrome (IBS) is constipated. The nurse instructs the patient about a management plan. Which patient statement shows an accurate understanding of the nurse's teaching? a. "A cup (236 mL) of caffeinated coffee with cream & sugar at dinner is OK for me." b. "I need to go for a walk every evening." c. "Maintaining a low-fiber diet will manage my constipation." d. "Limiting the amount of fluid that I drink with meals is very important."

b. "I need to go for a walk every evening."

The nurse is teaching a patient who has undergone a hemorrhoidectomy about a follow-up plan of care. Which patient statement demonstrates a correct understanding of the nurse's instructions? a. "I would take Ex-Lax after the surgery to 'keep things moving'." b. "I will need to eat a diet high in fiber." c. "Limiting my fluids will help me with constipation." d. "To help with the pain, I'll apply ice to the surgical area."

b. "I will need to eat a diet high in fiber."

A 24-year-old male is scheduled for a minimally invasive inguinal hernia repair (MIIHR). Which patient statement indicates a need for further teaching about this procedure? a. "I may have trouble urinating immediately after the surgery." b. "I will need to stay in the hospital overnight." c. "I will not eat after midnight the day of the surgery." d. "My chances of having complications after this procedure are slim."

b. "I will need to stay in the hospital overnight."

A patient suspected of having irritable bowel syndrome (IBS) is scheduled for a hydrogen breath test. What does the nurse tell the patient about this test? a. "During the test, you will drink small amounts of an antacid as directed by the technician." b. "If you have IBS, hydrogen levels may be increased in your breath samples and can be an indication that you have IBS." c. "The test will take between 30 and 45 minutes to complete." d. "You must have nothing to drink (except water) for 24 hours before the test."

b. "If you have IBS, hydrogen levels may be increased in your breath samples and can be an indication that you have IBS."

The community nurse is talking with a group of individuals about colorectal cancer (CRC) risk factors. Which community participant is at the highest risk for development of CRC? a. 23-year-old vegetarian b. 30-year old with Crohn's disease c. 39-year old with no family history of cancer d. 46-year old with genetic predisposition to cancer

b. 30-year old with Crohn's disease

The RN on the medical-surgical unit receives a shift report about four patients. Which patient does the nurse assess first? a. A 34-year-old who has returned to the unit after a colon resection with a new colostomy stoma, which is pink and moist. b. A 36-year-old admitted after a motor vehicle collision (MVC) with areas of ecchymosis on the abdomen in a "lap-belt" pattern c. A 40-year-old with a reducible inguinal hernia asking questions about surgery. d. A 51-year-old with familial adenomatous polyposis (FAP) who is scheduled for a colonoscopy

b. A 36-year-old admitted after a motor vehicle collision (MVC) with areas of ecchymosis on the abdomen in a "lap-belt" pattern

A male patient in a long-term care facility is 2 days postoperative after an open repair of an indirect inguinal hernia. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)? a. Assessing the patient's incision for signs of infection b. Assisting the patient to stand to void c. Instructing the patient in how to deep-breathe d. Monitoring the patient's pain level

b. Assisting the patient to stand to void

A patient with a family history of colorectal cancer (CRC) regularly sees a primary health care provider for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this patient? a. Decrease in liver function test results b. Elevated carcinoembryonic antigen c. Elevated hemoglobin levels d. Negative test for occult blood

b. Elevated carcinoembryonic antigen

. The client is diagnosed with irritable bowel syndrome (IBS). The client is discharged home with a variety of medications for the symptoms of IBS. Upon returning to the clinic, the client states, "Most of my symptoms have improved-except for the diarrhea." What does the health care provider prescribe for this client? Antidiarrheal agent Muscarinic receptor antagonist Correct Serotonin antagonist Tricyclic antidepressant

b. Muscarinic-receptor agonist A muscarinic (M3) receptor antagonist can also inhibit intestinal motility. Antidiarrheal agents and serotonin antagonists are not the most effective choices for this client. A tricyclic antidepressant is not going to be effective for this client's diarrhea.

A 67-year-old male patient, with no surgical history, reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have? a. Femoral b. Reducible c. Strangulated d. Incarcerated

b. Reducible

A patient with colorectal cancer was started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. What does the nurse tell the patient about the cause of diarrhea and mouth ulcers? a. "A combination of chemotherapeutic agents has caused them." b. "GI problems are symptoms of the advanced stage of your disease." c. "5-FU cannot discriminate between your cancer and your healthy cells and is causing your ulcers and diarrhea." d. "You have these as a result of the radiation treatment."

c. "5-FU cannot discriminate between your cancer and your healthy cells and is causing your ulcers and diarrhea."

The home health nurse is teaching a patient about the care of a new colostomy. Which patient statement demonstrates a correct understanding of the instructions? a. "A dark or purplish-looking stoma is normal and would not concern me." b. "If the skin around the stoma is red or scratched, it will heal soon." c. "I need to check for leakage underneath my colostomy." d. "I need to strive for a very tight fit when applying the barrier around the stoma."

c. "I need to check for leakage underneath my colostomy."

A patient with colorectal cancer is scheduled for colostomy surgery. Which comment from the nurse is most therapeutic for this patient? a. "Are you afraid of what your spouse will think of the colostomy?" b. "Don't worry. You will get used to the colostomy eventually." c. "Tell me what worries you the most about this procedure." d. "Why are you so afraid of having this procedure done?"

c. "Tell me what worries you the most about this procedure."

A patient with a bowel obstruction is ordered a Salem sump nasogastric tube (NGT). After the nurse inserts the tube, which nursing intervention is the highest priority for this patient? a. Attaching the tube to low intermittent suction b. Auscultating for bowel sounds and peristalsis while the suction runs c. Connecting the tube to low continuous suction d. Flushing the tube with 30 mL of normal saline every 24 hours

c. Connecting the tube to low continuous suction

A patient at risk for colorectal cancer asks the nurse, "Can you tell me some foods to include in my diet so that I can reduce my chances of getting this disease?" Which dietary selection does the nurse suggest? a. Steak with pasta b. Spaghetti with tomato sauce c. Steamed broccoli with turkey d. Tuna salad with wheat crackers

c. Steamed broccoli with turkey

The Certified Wound, Ostomy, and Continence Nurse is teaching a patient with colorectal cancer how to care for a newly created colostomy. Which patient statement reflects a correct understanding of the necessary self-management skills? a. "I will have my spouse change the bag for me." b. "If I have any leakage, I'll put a towel over it." c. "I can put aspirin tablets in the pouch in order to reduce odor" d. "I will apply a non-alcoholic skin sealant around the stoma and allow it to dry prior to applying the bag.

d. "I will apply a non-alcoholic skin sealant around the stoma and allow it to dry prior to applying the bag.

A client with rectal bleeding who is preparing to undergo a colonoscopy tells the nurse, "I am very afraid of having polyps and cancer." What is the appropriate nursing response? a. "Let's worry about that after the procedure." b. "Polyps are never cancerous, so you do not need to worry." c. "Unfortunately all polyps are malignant, so you may already have cancer." d. "It is understandable that you are fearful. Tell me what frightens you most."

d. "It is understandable that you are fearful. Tell me what frightens you most."

A male patient's sister was recently diagnosed with colorectal cancer (CRC), and his brother died of CRC 5 years ago. The patient asks the nurse whether he will inherit the disease too. How does the nurse respond? a. "Have you asked your primary health care provider what he or she thinks your chances are?" b. "It is hard to know what can predispose a person to develop a certain disease." c. "No. Just because they both had CRC doesn't mean that you will have it, too." d. "The only way to know whether you are predisposed to CRC is by genetic testing."

d. "The only way to know whether you are predisposed to CRC is by genetic testing."

A patient with malabsorption syndrome asks the nurse, "What did I do to cause this disorder to develop?" How does the nurse respond? a. "An excessive intake of alcohol is associated with it, so your substance abuse could have contributed to its development." b. "It is inherited, so it could run in your family." c. "It might be caused by a virus, so you could have gotten it almost anywhere." d. "There are a variety of things that can cause malabsorption syndrome to occur. You may have a deficiency is certain enzymes, a bacteria or changes in the lining of your intestines."

d. "There are a variety of things that can cause malabsorption syndrome to occur. You may have a deficiency is certain enzymes, a bacteria or changes in the lining of your intestines."

What is the mechanism of action for the chemotherapeutic drug cetuximab (Erbitux)? a. It destroys the cancer's cell wall, which will kill the cell. b. It decreases blood flow to rapidly dividing cancer cells. c. It stimulates the body's immune system and stunts cancer growth. d. It blocks factors that promote cancer cell growth.

d. It blocks factors that promote cancer cell growth.

A patient with an intestinal obstruction has pain that changes from a "colicky" intermittent type to constant discomfort. What does the nurse do first? a. Administers medication for pain b. Changes the nasogastric suction level from "intermittent" to "constant" c. Positions the patient in high-Fowler's position d. Prepares the patient for emergency surgery

d. Prepares the patient for emergency surgery

A 21-year-old with a stab wound to the abdomen has come to the emergency department (ED). Once stabilized, the patient is admitted to the medical-surgical unit. What does the admitting nurse do first for this patient? a. Administer pain medication. b. Assess skin temperature and color. c. Check on the amount of urine output. d. Take vital signs.

d. Take vital signs.

A patient is being evaluated in the emergency department (ED) for a possible small bowel obstruction. Which signs/symptoms does the nurse expect to assess? a. Cramping intermittently, metabolic acidosis, and minimal vomiting b. Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis c. Metabolic acidosis, upper abdominal distention, and intermittent cramping d. Upper abdominal distention, metabolic alkalosis, and a great amount of vomiting

d. Upper abdominal distention, metabolic alkalosis, and a great amount of vomiting

The nurse is caring for a client who is to be discharged after a bowel resection and the creation of a colostomy. Which client statement demonstrates that additional instruction from the nurse is needed? A. "I can drive my car in about 2 weeks." B. "I should avoid drinking carbonated sodas." C. "It may take 6 weeks to see the effects of some foods on my bowel patterns." D. "Stool softeners will help me avoid straining."

"I can drive my car in about 2 weeks." The client who has had a bowel resection and colostomy should avoid driving for 4 to 6 weeks. The client should avoid drinking sodas and other carbonated drinks because of the gas they produce. He or she may not be able to see the effects of certain foods on bowel patterns for several weeks. The client should avoid straining at stool.

The RN on the medical-surgical unit receives a shift report about four clients. Which client does the nurse assess first? A. A 34-year-old who has returned to the unit after a colon resection with a new colostomy stoma, which is dark pink B. A 36-year-old admitted after a motor vehicle crash with areas of ecchymoses on the abdomen in a "lap-belt" pattern C. A 40-year-old with pneumonia who has abdominal distention and decreased bowel sounds in all quadrants D. A 51-year-old with familial adenomatous polyposis (FAP) who is scheduled for a colonoscopy

A 36-year-old admitted after a motor vehicle crash with areas of ecchymoses on the abdomen in a "lap-belt" pattern Ecchymoses in the abdominal area may indicate intraperitoneal or intra-abdominal bleeding; this client requires rapid assessment and interventions. The client who is post colon resection, the client with pneumonia, and the client with FAP do not have an urgent need for further assessment or intervention.

The nurse is teaching a client with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods are included? (Select all that apply.) A. Broccoli B. Buttermilk C. Mushrooms D. Onions E. Peas F. Yogurt

A. Broccoli C. Mushrooms D. Onions E. Peas Broccoli, mushrooms, onions, and peas often cause flatus. Buttermilk will help prevent odors. Yogurt can help prevent flatus.

A nurse cares for a client who has a nasogastric (NG) tube. Which actions should the nurse take? (Select all that apply.) a. Assess for proper placement of the tube every 4 hours. b. Flush the tube with water every hour to ensure patency. c. Secure the NG tube to the client's upper lip. d. Disconnect suction when auscultating bowel peristalsis. e. Monitor the client's skin around the tube site for irritation.

Answer: A, D, E

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 should 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 health care provider."

Answer: A

A nurse cares for a client who has a new colostomy. Which action should the nurse take? A. Empty the pouch frequently to remove excess gas collection B. Change the ostomy pouch and wafer every morning C. Allow the pouch to completely fill with stool prior to empty D. Use surgical tape to secure the pouch and prevent leakage

Answer: A

After teaching a client who has a femoral hernia, the nurse assesses the client's understanding. Which statement indicates the client needs additional teaching related to the proper use of a truss? A. "I will put on the truss before I go to bed each night." B. "I'll put some powder under the truss to avoid skin irritation." C. "The truss will help my hernia because I can't have surgery." D. "If I have abdominal pain, I'll let my health care provider know right away."

Answer: A

A nurse assesses a client with irritable bowel syndrome (IBS). Which questions should the nurse include in this client's assessment? (Select all that apply.) a. "Which food types cause an exacerbation of symptoms?" b. "Where is your pain and what does it feel like?" c. "Have you lost a significant amount of weight lately?" d. "Are your stools soft, watery, and black in color?" e. "Do you experience nausea associated with defecation?"

Answer: A, B, E

A nurse cares for a client who has been diagnosed with a small bowel obstruction. Which assessment findings should the nurse correlate with this diagnosis? (Select all that apply.) a. Serum potassium of 2.8 mEq/L b. Loss of 15 pounds without dieting c. Abdominal pain in upper quadrants d. Low-pitched bowel sounds e. Serum sodium of 121 mEq/L

Answer: A, C, E

A nurse assesses a client who is prescribed alosetron (Lotronex). Which assessment question should the nurse ask this client? 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?"

Answer: A

A male client in a long-term care facility is 2 days postoperative after an open repair of an indirect inguinal hernia. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)? A. Assessing the client's incision for signs of infection B. Assisting the client to stand to void C. Instructing the client in how to deep-breathe D. Monitoring the client's pain level

Assisting the client to stand to void Assisting the client with activities is part of the UAP role. Assessment of the client's incision and pain level requires broader education and scope of practice and should be done by licensed nursing personnel. Client teaching—even about something as fundamental as taking "deep breaths"—likewise requires broader education and scope of practice and should be done by licensed nursing personnel.

A client is diagnosed with irritable bowel syndrome (IBS). What factors does the nurse suspect as possible causes of the client's problem? (Select all that apply.) A. Antihistamines B. Caffeinated drinks C. Stress D. Sleeping pills E. Anxiety

B. Caffeinated drinks C. Stress E. Anxiety Factors such as ingestion of coffee or other gastric stimulants, stress, anxiety, and milk allergy are being investigated as possible causes of IBS. Antihistamines and sleeping pills are not suspected as causing IBS.

What does the nurse advise a client diagnosed with irritable bowel syndrome (IBS) to take during periods of constipation? A. Bulk-forming laxatives B. Saline laxatives C. Stimulant laxatives D. Stool-softening agents

Bulk-forming laxatives For treatment of constipation-predominant IBS, bulk-forming laxatives are generally taken at mealtimes with a glass of water. Saline and stimulant laxatives are not used for the treatment of constipation-predominant IBS. Stool-softening agents are not effective.

The nurse case manager is discussing community resources with a client who has colorectal cancer and is scheduled for a colostomy. Which referral is of greatest value to this client initially? A. Certified Wound, Ostomy, and Continence Nurse (CWOCN) B. Home health nursing agency C. Hospice D. Hospital chaplain

Certified Wound, Ostomy, and Continence Nurse (CWOCN) A CWOCN (or an enterostomal therapist) will be of greatest value to the client because the client is scheduled to receive a colostomy. The client is newly diagnosed, so it is not yet known whether home health nursing will be needed. A referral to hospice may be helpful for a terminally ill client. Referral to a chaplain may be helpful later in the process of adjusting to the disease.

A 67-year-old male client reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have? A. Femoral B. Reducible C. Strangulated D. Ventral

Reducible The hernia is reducible because its contents can be pushed back into the abdominal cavity. Femoral hernias tend to occur more frequently in obese and pregnant women. A hernia is considered to be strangulated when the blood supply to the herniated segment of the bowel is cut off. It cannot be a ventral hernia because it would have to occur at the site of a previous surgical incision.

A nurse is caring for a client who is to be discharged after a bowel resection and the creation of a colostomy. Which client statement demonstrates that additional instruction from the nurse is needed? "I can drive my car in about 2 weeks." Correct "I should avoid drinking carbonated sodas." "It may take 6 weeks to see the effects of some foods on my bowel patterns." "Stool softeners will help me avoid straining.

a. "I can drive my car in about 2 weeks." The client who has had a bowel resection and colostomy should avoid driving for 4 to 6 weeks. The client should avoid drinking sodas and other carbonated drinks because of the gas they produce. He or she may not be able to see the effects of certain foods on bowel patterns for several weeks. The client should avoid straining at stool.

A nurse is teaching a client who has undergone a hemorrhoidectomy about a follow-up plan of care. Which client statement demonstrates correct understanding of the nurse's instructions? "I should take Ex-Lax after the surgery to 'keep things moving'." "I will need to eat a diet high in fiber." Correct "Limiting my fluids will help me with constipation." "To help with the pain, I'll apply ice to the surgical area.

a. "I will need to eat a diet high in fiber." A diet high in fiber serves as a natural stool softener and will prevent irritation to hemorrhoids caused by painful bowel movements. Stimulant laxatives are discouraged because they are habit-forming. Increased amounts of fluids are needed to prevent constipation. Moist heat (sitz baths) will be more effective with postoperative discomfort than cold applications; cold therapy is sometimes recommended and useful before surgery for inflamed hemorrhoids.

A nurse is teaching a group of clients with irritable bowel syndrome (IBS) about complementary and alternative therapies. What does the nurse suggest as possible treatment modalities? Select all that apply. Acupuncture Correct Decreasing physical activities Herbs (moxibustion) Correct Meditation Correct Peppermint oil capsules Correct Yoga Correct

a. Acupuncture c. Herbs (moxibuction) d. Meditation e. Peppermint oil capsules f. Yoga Acupuncture is recommended as a complementary therapy for IBS. Moxibustion is helpful for some clients with IBS. Meditation, yoga, and other relaxation techniques help many clients manage stress and their IBS symptoms. Research has shown that peppermint oil capsules may be effective in reducing symptoms of IBS. Regular exercise is important for managing stress and promoting bowel elimination.

A client with irritable bowel syndrome (IBS) is constipated. The nurse instructs the client about a management plan. Which client statement shows an accurate understanding of the nurse's teaching? "A drink of diet soda with dinner is OK for me." "I need to go for a walk every evening." Correct "Maintaining a low-fiber diet will manage my constipation." "Watching the amount of fluid that I drink with meals is very important."

b. "I need to go for a walk every evening." Increased ambulation is part of the management plan for IBS, along with increased fluids and fiber and avoiding caffeinated beverages. Caffeinated beverages can cause bloating or diarrhea and should be avoided in clients with IBS. Fiber is encouraged in clients with IBS because it produces a bulky soft stool and aids in establishing regular bowel habits. At least 8 to 10 cups of fluid should be consumed daily to promote normal bowel function.

A client with a family history of colorectal cancer (CRC) regularly sees a health care provider for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this client? Decrease in liver function test results Elevated carcinoembryonic antigen Correct Elevated hemoglobin levels Negative test for occult blood

b. Elevated carcinoembryonic antigen Carcinoembryonic antigen may be elevated in many clients diagnosed with CRC. Liver involvement may or may not occur in CRC. Hemoglobin will likely be decreased with CRC, not increased. An occult blood test is not reliable to affirm or rule out CRC.

The client is a 66-year-old man with colorectal cancer (CRC). He was started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. A relatively new chemotherapeutic agent, oxaliplatin (Eloxatin), has been added to his treatment regimen. He also reports peripheral sensory neuropathy. What does the nurse tell him about his diarrhea and mouth ulcers? "A combination of chemotherapeutic agents has caused them." "GI problems are symptoms of the advanced stage of your disease." "5-FU cannot discriminate between your cancer and your healthy cells." Correct "You have these as a result of the radiation treatment."

c. "5-FU cannot discriminate from your cancer cells and your healthy cells." therefore, the side effects are diarrhea, mucositis, leukopenia, mouth ulcers, and skin ulcers. The 5-FU treatment, not a combination of chemotherapy drugs, radiation, or the stage of the disease, is what is causing the client's GI problems.

After an abdominoperineal resection, a 75-year-old client is referred to a home health agency. Which staff member does the nurse manager assign to perform the initial assessment on this client? LPN/LVN who has worked with many home health clients after colostomy surgeries LPN/LVN with 20 years of experience in the home health agency RN who is new to the agency with 5 years experience in the emergency department Correct Social worker who is experienced with case management of older clients

c. RN who is new to the agency w/5yrs ED experience Clients with medical or surgical diagnoses have complex physiologic needs that should be assessed by an RN. For this reason, Medicare requires that the initial assessment must be done by an RN, although LPN/LVNs and social workers are likely to be part of the health care team.

After an automobile crash, a client is admitted to the emergency department with possible abdominal trauma. Which health care provider request does the nurse implement first? A. Insert a nasogastric tube and connect it to intermittent suction. B. Obtain a complete blood count and coagulation panel. C. Start an IV line and infuse normal saline at 200 mL/hr. D. Arrange for a computed tomography (CT) scan of the abdomen.

Start an IV line and infuse normal saline at 200 mL/hr. After the initial airway, breathing, and circulation assessment is completed, the most immediate concerns are the high risks for hemorrhage and shock. To rapidly treat for these possible complications, IV access and infusion of fluids are necessary as the priority intervention. Inserting a nasogastric tube, laboratory studies, and arranging a CT scan are secondary to establishing IV access and instilling fluids.

The nurse is teaching a group of clients with irritable bowel syndrome (IBS) about complementary and alternative therapies. What does the nurse suggest as possible treatment modalities? (Select all that apply.) A. Acupuncture B. Decreasing physical activities C. Herbs (moxibustion) D. Meditation E. Peppermint oil capsules F. Yoga

A. Acupuncture C. Herbs (moxibustion) D. Meditation E. Peppermint oil capsules F. Yoga Acupuncture is recommended as a complementary therapy for IBS. Moxibustion is helpful for some clients with IBS. Meditation, yoga, and other relaxation techniques help many clients manage stress and their IBS symptoms. Research has shown that peppermint oil capsules may be effective in reducing symptoms of IBS. Regular exercise is important for managing stress and promoting bowel elimination.

A nurse cares for a client who is recovering from a hemorrhoidectomy. The client states, "I need to have a bowel movement." Which action should the nurse take? A. Obtain a bedside commode for the client to use B. Stay with the client while providing privacy C. Make sure the call light is in reach to signal completion D. Gather supplies to collect a stool sample for the laboratory

Answer: B

A nurse cares for a middle-aged male client who has irritable bowel syndrome. The client states, "I have changed my diet and take bulk-forming laxatives, but my symptoms have not gotten better. I heard about a drug called Amitiza. Do you think it might help?" How should the nurse respond? A. "This drug is still in the research phase and is not available for public use yet." B. "Unfortunately, lubiprostone is approved only for use in women." C. "Lubiprostone works well. I will recommend this prescription to your provider." D. "This drug should not be used with bulk-forming laxatives."

Answer: B

After teaching a client with irritable bowel syndrome, 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, glass of diet cola 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

Answer: B

A nurse teaches a client who is at risk for colon cancer. Which dietary recommendation should the nurse teach this 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 new diet." D. "Foods high in animal fat help to protect the intestinal mucosa."

Answer: C

A nurse teaches a client who is recovering from a colon resection. Which statement should the nurse include in this client's plan of care? A. "You may experience nausea and vomiting for the first few weeks." B. Carbonated beverages can help decrease acid reflux from anatomosis sites." C. "Take a stool softener to promote softer stools for ease of defecation." D. "You may return to your normal workout schedule, including weight lifting."

Answer: C

A nurse assesses a male client with an abdominal hernia. Which abdominal hernias are correctly paired with their physiologic processes? (Select all that apply.) a. Indirect inguinal hernia - An enlarged plug of fat eventually pulls the peritoneum and often the bladder into a sac b. Femoral hernia - A peritoneum sac pushes downward and may descend into the scrotum c. Direct inguinal hernia - A peritoneum sac passes through a weak point in the abdominal wall d. Ventral hernia - Results from inadequate healing of an incision e. Incarcerated hernia - Contents of the hernia sac cannot be reduced back into the abdominal cavity

Answer: C, D, E

A nurse assesses clients at a community health center. Which client is at highest risk for the development of colorectal cancer? A. a 37-year-old who drinks eight cups of coffee daily B. a 44-year-old with irritable bowel syndrome C. a 60-year-old lawyer who works 65 hours per week D. a 72-year-old who eats fast food frequently

Answer: D

A client with a family history of colorectal cancer (CRC) regularly sees a health care provider for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this client? A. Decrease in liver function test results B. Elevated carcinoembryonic antigen C. Elevated hemoglobin levels D. Negative test for occult blood

Elevated carcinoembryonic antigen Carcinoembryonic antigen may be elevated in many clients diagnosed with CRC. Liver involvement may or may not occur in CRC. Hemoglobin will likely be decreased with CRC, not increased. An occult blood test is not reliable to affirm or rule out CRC.

A client asks the nurse, "Can you tell me some foods to include in my diet so that I can reduce my chances of getting colorectal cancer?" Which dietary selection does the nurse suggest? A. Steak with pasta B. Spaghetti with tomato sauce C. Steamed broccoli with turkey D. Tuna salad with wheat crackers

Steamed broccoli with turkey Steamed broccoli with turkey contains low-fat meat and no refined carbohydrates. Animal fat from red meats is carcinogenic, and pasta is high in refined carbohydrates, which are known to contribute to colon cancer. Spaghetti and wheat crackers also contain large amounts of refined carbohydrates.

A 21-year-old with a stab wound to the abdomen has come to the emergency department. Once stabilized, the client is admitted to the medical-surgical unit. What does the admitting nurse do first for this client? A. Administer pain medication. B. Assess skin temperature and color. C. Check on the amount of urine output. D. Take vital signs.

Take vital signs. Assessment of vital signs should be done first to determine the adequacy of the airway and circulation. Vital signs initially reveal the most about the client's condition. The client should not be medicated for pain until his or her alertness level is determined. Skin temperature and color are not specifically indicative of the client's overall condition. If the client is in shock, urine output will be scant and will not be an accurate assessment variable.

What does the nurse advise a client diagnosed with irritable bowel syndrome (IBS) to take during periods of constipation? Bulk-forming laxatives Correct Saline laxatives Stimulant laxatives Stool-softening agents

a. Bulk-forming laxitives For treatment of constipation-predominant IBS, bulk-forming laxatives are generally taken at mealtimes with a glass of water. Saline and stimulant laxatives are not used for the treatment of constipation-predominant IBS. Stool-softening agents are not effective.

A nurse case manager is discussing community resources with a client who has colorectal cancer (CRC) and is scheduled for a colostomy. Which referral is of greatest value to this client initially? Certified Wound, Ostomy, and Continence Nurse (CWOCN) Correct Home health nursing agency Hospice Hospital chaplai

a. Certified Wound, Ostomy, Continence Nurse (CWOCN) A CWOCN (or an enterostomal therapist) will be of greatest value to the client because the client is scheduled to receive a colostomy. The client is newly diagnosed, so it is not yet known whether home health nursing will be needed. A referral to hospice may be helpful for a terminally ill client. Referral to a chaplain may be helpful later in the process of adjusting to the disease.

A male client in a long-term care facility is 2 days postoperative after an open repair of an indirect inguinal hernia. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)? Assessing the client's incision for signs of infection Assisting the client to stand to void Correct Instructing the client in how to deep-breathe Monitoring the client's pain level

b. Assisting the client to stand to void Assisting the client with activities is part of the UAP role. Assessment of the client's incision and pain level requires broader education and scope of practice and should be done by licensed nursing personnel. Client teaching—even about something as fundamental as taking "deep breaths"—likewise requires broader education and scope of practice and should be done by licensed nursing personnel.

A 67-year-old male client reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have? Femoral Reducible Correct Strangulated Ventral

b. Reducible The hernia is reducible because its contents can be pushed back into the abdominal cavity. Femoral hernias tend to occur more frequently in obese and pregnant women. A hernia is considered to be strangulated when the blood supply to the herniated segment of the bowel is cut off. It cannot be a ventral hernia because it would have to occur at the site of a previous surgical incision.

A client with malabsorption syndrome asks the nurse, "What did I do to cause this disorder to develop?" How does the nurse respond? "An excessive intake of alcohol is associated with it, so your substance abuse could have contributed to its development." "It is inherited, so it could run in your family." "It might be caused by a virus, so you could have gotten it almost anywhere." "Nothing you did could have caused it; it is the result of flattening of the mucosa of your large intestine."

d. "Nothing you did could've caused it. it is the result of flattening of the mucosa of your large intestine." Stating that the disorder is the result of flattening of the mucosa of the large intestine is the only statement that is physiologically accurate. Malabsorption syndrome is not associated with an excessive intake of alcohol. It is not inherited, although a genetic immune defect is present in the related disease, celiac sprue. It is not caused by a virus.

A male client's sister was recently diagnosed with colorectal cancer (CRC), and his brother died of CRC 5 years ago. He asks the nurse whether he will inherit the disease too. How does the nurse respond? "Have you asked your health care provider what he or she thinks your chances are?" "It is hard to know what can predispose a person to develop a certain disease." "No. Just because they both had CRC doesn't mean that you will have it, too." "The only way to know whether you are predisposed to CRC is by genetic testing.

d. "The only way to if you have a predisposition to CRC is by genetic testing." Genetic testing is the only definitive way to determine whether the client has a predisposition to develop CRC. A higher incidence of the disease has been noted in families who have a history; however, it is not the responsibility of the nurse to engage in genetic counseling, and this client might not be predisposed to developing CRC. Asking the client what the health care provider thinks is an evasive response by the nurse and does not address the client's concerns.

A 21-year-old with a stab wound to the abdomen has come to the emergency department (ED). Once stabilized, the client is admitted to a medical-surgical unit. What does the admitting nurse do first for this client? Administer pain medication. Assess skin temperature and color. Check on the amount of urine output. Take vital signs. Correct

d. Take vital signs Assessment of vital signs should be done first to determine the adequacy of the airway and circulation. Vital signs initially reveal the most about the client's condition. The client should not be medicated for pain until his or her alertness level is determined. Skin temperature and color are not specifically indicative of the client's overall condition. If the client is in shock, urine output will be scant and will not be an accurate assessment variable.

The home health nurse is teaching a client about the care of a new colostomy. Which client statement demonstrates a correct understanding of the instructions? A. "A dark or purplish-looking stoma is normal and should not concern me." B. "If the skin around the stoma is red or scratched, it will heal soon." C. "I need to check for leakage underneath my colostomy." D. "I should strive for a very tight fit when applying the barrier around the stoma."

"I need to check for leakage underneath my colostomy." The pouch system should be checked frequently for evidence of leakage to prevent excoriation. A purplish stoma is indicative of ischemia and necrosis. Redness or scratched skin around the stoma should be reported to prevent it from beginning to break down. An overly tight fit may lead to necrosis of the stoma.

A client with irritable bowel syndrome (IBS) is constipated. The nurse instructs the client about a management plan. Which client statement shows an accurate understanding of the nurse's teaching? A. "A drink of diet soda with dinner is OK for me." B. "I need to go for a walk every evening." C. "Maintaining a low-fiber diet will manage my constipation." D. "Watching the amount of fluid that I drink with meals is very important."

"I need to go for a walk every evening." Increased ambulation is part of the management plan for IBS, along with increased fluids and fiber and avoiding caffeinated beverages. Caffeinated beverages can cause bloating or diarrhea and should be avoided in clients with IBS. Fiber is encouraged in clients with IBS because it produces a bulky soft stool and aids in establishing regular bowel habits. At least 8 to 10 cups of fluid should be consumed daily to promote normal bowel function.

The Certified Wound, Ostomy, and Continence Nurse is teaching a client with colorectal cancer how to care for a newly created colostomy. Which client statement reflects a correct understanding of the necessary self-management skills? A. "I will have my spouse change the bag for me." B. "If I have any leakage, I'll put a towel over it." C. "I need to call my home health nurse to come out if I have any problems." D. "I will make certain that I always have an extra bag available."

"I will make certain that I always have an extra bag available." The statement that the client will be certain to bring an extra bag is the only statement illustrating that the client is taking responsibility to care for the colostomy. Using a towel is not an acceptable or effective way to cope with leakage. It is not realistic that the home health nurse can make frequent visits for the purpose of colostomy care.

The nurse is teaching a client who has undergone a hemorrhoidectomy about a follow-up plan of care. Which client statement demonstrates a correct understanding of the nurse's instructions? A. "I should take Ex-Lax after the surgery to 'keep things moving'." B. "I will need to eat a diet high in fiber." C. "Limiting my fluids will help me with constipation." D. "To help with the pain, I'll apply ice to the surgical area."

"I will need to eat a diet high in fiber." A diet high in fiber serves as a natural stool softener and will prevent irritation to hemorrhoids caused by painful bowel movements. Stimulant laxatives are discouraged because they are habit-forming. Increased amounts of fluids are needed to prevent constipation. Moist heat (sitz baths) will be more effective with postoperative discomfort than cold applications; cold therapy is sometimes recommended and useful before surgery for inflamed hemorrhoids.

A 24-year-old male is scheduled for a minimally invasive inguinal hernia repair (MIIHR). Which client statement indicates a need for further teaching about this procedure? A. "I may have trouble urinating immediately after the surgery." B. "I will need to stay in the hospital overnight." C. "I should not eat after midnight the day of the surgery." D. "My chances of having complications after this procedure are slim."

"I will need to stay in the hospital overnight." Usually, the client is discharged 3 to 5 hours after MIIHR surgery. Male clients who have difficulty urinating after the procedure should be encouraged to force fluids and to assume a natural position when voiding. Clients undergoing MIIHR surgery must be NPO after midnight before the surgery. Most clients who have MIIHR surgery have an uneventful recovery.

A client with colorectal cancer is scheduled for colostomy surgery. Which comment from the nurse is most therapeutic for this client? A. "Are you afraid of what your spouse will think of the colostomy?" B. "Don't worry. You will get used to the colostomy eventually." C. "Tell me what worries you the most about this procedure." D. "Why are you so afraid of having this procedure done?"

"Tell me what worries you the most about this procedure." Asking the client about what worries him or her is the only question that allows the client to express fears and anxieties about the diagnosis and treatment. Asking the client if he or she is afraid is a closed question (i.e., it requires only a "yes" or "no" response); it closes the dialogue and is not therapeutic. Telling the client not to worry offers reassurance and is a "pat" statement, making it nontherapeutic. "Why" questions place clients on the defense and are not therapeutic because they close the conversation.

A male client's sister was recently diagnosed with colorectal cancer (CRC), and his brother died of CRC 5 years ago. He asks the nurse whether he will inherit the disease too. How does the nurse respond? A. "Have you asked your health care provider what he or she thinks your chances are?" B. "It is hard to know what can predispose a person to develop a certain disease." C. "No. Just because they both had CRC doesn't mean that you will have it, too." D. "The only way to know whether you are predisposed to CRC is by genetic testing."

"The only way to know whether you are predisposed to CRC is by genetic testing." Genetic testing is the only definitive way to determine whether the client has a predisposition to develop CRC. A higher incidence of the disease has been noted in families who have a history; however, it is not the responsibility of the nurse to engage in genetic counseling, and this client might not be predisposed to developing CRC. Asking the client what the health care provider thinks is an evasive response by the nurse and does not address the client's concerns.

Which client does the medical-surgical unit charge nurse assign to an LPN/LVN? A. A 41-year-old who needs assistance with choosing a site for a colostomy stoma B. A 47-year-old who needs to receive "whole gut" lavage before a colon resection C. A 51-year-old who has recently arrived on the unit after having an open herniorrhaphy D. A 56-year-old who has obstipation and a recent emesis of foul-smelling liquid

A 47-year-old who needs to receive "whole gut" lavage before a colon resection Because administration of medications is within the LPN/LVN scope of practice, this preoperative client can be assigned to the LPN/LVN. Assistance with choosing a site for a colostomy stoma is an intervention that should be provided by an RN. The recent postoperative client and the critically ill client will need assessments and interventions that can only be done by an RN.

A nurse assesses a client who is recovering from a hemorrhoidectomy that was done the day before. The nurse notes that the client has lower abdominal distention accompanied by dullness to percussion over the distended area. Which action should the nurse take? A. Assess the client's heart rate and blood pressure B. Determine when the client last voided C. Ask if the client is experiencing flatus D. Auscultate all quadrants of the client's abdomen

Answer: B

A nurse cares for a client newly diagnosed with colon cancer who has become withdrawn from family members. Which action should the nurse take? A. Contact the provider and recommend a psychiatric consult for the client B. Encourage the client to verbalize feelings about the diagnosis C. Provide education about new treatment options with successful outcomes D. Ask family and friends to visit the client and provide emotional support

Answer: B

An emergency room nurse assesses a client after a motor vehicle crash and notes ecchymotic areas across the client's lower abdomen. Which action should the nurse take first? A. Measure the client's abdominal girth B. Assess for abdominal guarding or rigidity C. Check the client's hemoglobin and hematocrit D. Obtain the client's complete health history

Answer: B

After teaching a client who is recovering from a colon resection, the nurse assesses the client's understanding. Which statements by the client indicate a correct understanding of the teaching? (Select all that apply.) a. "I must change the ostomy appliance daily and as needed." b. "I will use warm water and a soft washcloth to clean around the stoma." c. "I might start bicycling and swimming again once my incision has healed." d. "Cutting the flange will help it fit snugly around the stoma to avoid skin breakdown." e. "I will check the stoma regularly to make sure that it stays a deep red color." f. "I must avoid dairy products to reduce gas and odor in the pouch."

Answer: B, C, D

A nurse assessing a client with colorectal cancer auscultates high-pitched bowel sounds and notes the presence of visible peristaltic waves. Which action should 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. Contact the provider and recommend computed tomography D. Administer a laxative to increase bowel movements activity

Answer: C

A nurse cares for a client with colon 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 should the nurse respond? A. "I have a good friend with a colostomy who would be willing to talk with you." B. The enterostomal therapist 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."

Answer: C

A nurse prepares a client for a colonoscopy scheduled for tomorrow. The client states, "My doctor told me that the fecal occult blood test was negative for colon cancer. I don't think I need the colonoscopy and would like to cancel it." How should the nurse respond? A. "Your doctor should not have given you that information prior to the colonoscopy" B. "The colonoscopy is required due to the high percentage of false negatives with the blood test." C. "A negative fecal occult blood test does not rule out the possibility of colon cancer." D. "I will contact your doctor so that you can discuss your concerns about the procedure."

Answer: C

A client with a bowel obstruction is ordered a nasogastric (NG) tube. After the nurse inserts the tube, which nursing intervention is the highest priority for this client? A. Attaching the tube to high continuous suction B. Auscultating for bowel sounds and peristalsis while the suction runs C. Connecting the tube to low intermittent suction D. Flushing the tube with 30 mL of normal saline every 24 hours

Connecting the tube to low intermittent suction The NG tube should be attached to intermittent low suction unless otherwise requested by the health care provider. Continuous suction is rarely used because it can injure the gastric mucosa of the client's stomach. Bowel sounds should not be auscultated with suction on and running. The tube should be flushed every 4 hours, minimally.

A client with colorectal cancer had colostomy surgery performed yesterday. The client is very anxious about caring for the colostomy and states that the health care provider's instructions "seem overwhelming." What does the nurse do first for this client? A. Encourages the client to look at and touch the colostomy stoma B. Instructs the client about complete care of the colostomy C. Schedules a visit from a client who has a colostomy and is successfully caring for it D. Suggests that the client involve family members in the care of the colostomy

Encourages the client to look at and touch the colostomy stoma The initial intervention is to get the client comfortable looking at and touching the stoma before providing instructions on its care. Instructing the client about colostomy care will be much more effective after the client's anxiety level has stabilized. Talking with someone who has gone through a similar experience may be helpful to the client only after his or her anxiety level has stabilized. The client has begun to express feelings regarding the colostomy and its care; it is too soon to involve others. The client must get comfortable with this body image change first.

What is the mechanism of action for the chemotherapeutic drug cetuximab (Erbitux)? It destroys the cancer's cell wall, which will kill the cell. It decreases blood flow to rapidly dividing cancer cells. It stimulates the body's immune system and stunts cancer growth. It blocks factors that promote cancer cell growth

It blocks factors that promote cancer cell growth Cetuximab, a monoclonal antibody, may be given for advanced disease. This drug works by binding to a protein (epidermal growth factor receptor) to slow cell growth. The medication does not destroy the cancer's cell walls and does not stimulate the body's immune system or stunt cancer growth in that manner. The treatment does not decrease blood flow to rapidly dividing cancer cells.

.What is the mechanism of action for the chemotherapeutic drug cetuximab (Erbitux)? A. It destroys the cancer's cell wall, which will kill the cell. B. It decreases blood flow to rapidly dividing cancer cells. C. It stimulates the body's immune system and stunts cancer growth. D. It blocks factors that promote cancer cell growth.

It blocks factors that promote cancer cell growth. Cetuximab, a monoclonal antibody, may be given for advanced disease. This drug works by binding to a protein (epidermal growth factor receptor) to slow cell growth. The medication does not destroy the cancer's cell walls and does not stimulate the body's immune system or stunt cancer growth in that manner. The treatment does not decrease blood flow to rapidly dividing cancer cells.

A client diagnosed with irritable bowel syndrome (IBS) is discharged home with a variety of medications for IBS symptoms. Upon returning to the clinic, the client states, "Most of my symptoms have improved, except for the diarrhea." What does the nurse anticipate will be prescribed for this client? A. Antidiarrheal agent B. Muscarinic receptor antagonist C. Serotonin antagonist D. Tricyclic antidepressant

Muscarinic receptor antagonist A muscarinic (M3) receptor antagonist can also inhibit intestinal motility. Antidiarrheal agents and serotonin antagonists are not the most effective choices for this client. A tricyclic antidepressant is not going to be effective for this client's diarrhea.

A client with an intestinal obstruction has pain that changes from a "colicky" intermittent type to constant discomfort. What does the nurse do first? A. Administers medication for pain B. Changes the nasogastric suction level from "intermittent" to "constant" C. Positions the client in high-Fowler's position D. Prepares the client for emergency surgery

Prepares the client for emergency surgery The change in pain type could be indicative of perforation or peritonitis and will require immediate surgical intervention. Pain medication may mask the client's symptoms but will not address the root cause. A change in the nasogastric suction rate will not resolve the cause of the client's pain and could be particularly ineffective if a nonvented tube is in use. A high-Fowler's position will have no effect on an intestinal perforation or peritonitis, which this client is likely experiencing.

After an abdominoperineal resection, a 75-year-old client is referred to a home health agency. Which staff member does the nurse manager assign to perform the initial assessment on this client? A. LPN/LVN who has worked with many home health clients after colostomy surgeries B. LPN/LVN with 20 years of experience in the home health agency C. RN who is new to the agency with 5 years experience in the emergency department D. Social worker who is experienced with case management of older clients

RN who is new to the agency with 5 years experience in the emergency department Clients with medical or surgical diagnoses have complex physiologic needs that should be assessed by an RN. For this reason, Medicare requires that the initial assessment must be done by an RN, although LPN/LVNs and social workers are likely to be part of the health care team.

A client is being evaluated in the emergency department for a possible small bowel obstruction. Which signs and/or symptoms does the nurse expect to assess? A. Cramping intermittently, metabolic acidosis, and minimal vomiting B. Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis C. Metabolic acidosis, upper abdominal distention, and intermittent cramping D. Upper abdominal distention, metabolic alkalosis, and great amount of vomiting

Upper abdominal distention, metabolic alkalosis, and great amount of vomiting A small bowel obstruction is characterized by upper or epigastric abdominal distention, metabolic alkalosis, and a great amount of vomiting. Intermittent lower abdominal cramping, metabolic acidosis, and minimal vomiting are all symptoms of a large bowel obstruction.

Aside from chemotherapeutic agents, what other medications does the nurse expect to administer to a client with advanced colorectal cancer for relief of symptoms? Analgesics and antiemetics Correct Analgesics and benzodiazepines Steroids and analgesics Steroids and anti-inflammatory medications

a. Analgesics & antiemetics Clients with advanced colorectal cancer and metastasis also receive drugs such as analgesics and antiemetics for relief of symptoms, specifically pain and nausea. Benzodiazepines, steroids, and anti-inflammatory medications are not routinely requested for these clients.

A nurse is teaching a client with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods are included? Select all that apply. Broccoli Correct Buttermilk Mushrooms Correct Onions Correct Peas Correct Yogurt

a. Broccoli c. Mushrooms d. Onions e. Peas Broccoli, mushrooms, onions, and peas often cause flatus. Buttermilk will help prevent odors. Yogurt can help prevent flatus.

A client with CRC had colostomy surgery performed yesterday. The client is very anxious about caring for the colostomy and states that the health care provider's instructions "seem to be overwhelming." What does the nurse do first for this client? Encourages the client to look at and touch the colostomy stoma Correct Instructs the client about complete care of the colostomy Schedules a visit from a client who has a colostomy and is successfully caring for it Suggests that the client involve family members in the care of the colostomy

a. Encourages the client to look at & touch the colostomy stoma The initial intervention is to get the client comfortable looking at and touching the stoma before providing instructions on its care. Instructing the client about colostomy care will be much more effective after the client's anxiety level has stabilized. Talking with someone who has gone through a similar experience may be helpful to the client only after his or her anxiety level has stabilized. The client has begun to express feelings regarding the colostomy and its care; it is too soon to involve others. The client must get comfortable with this body image change first.

A 24-year-old male is scheduled for a minimally invasive inguinal hernia repair (MIIHR). Which client statement indicates a need for further teaching about this procedure? "I may have trouble urinating immediately after the surgery." "I will need to stay in the hospital overnight." Correct "I should not eat after midnight the day of the surgery." "My chances of having complications after this procedure are slim.

b. "I will need to stay in the hospital overnight." Usually, the client is discharged 3 to 5 hours after MIIHR surgery. Male clients who have difficulty urinating after the procedure should be encouraged to force fluids and to assume a natural position when voiding. Clients undergoing MIIHR surgery must be NPO after midnight before the surgery. Most clients who have MIIHR surgery have an uneventful recovery.

A client suspected of having irritable bowel syndrome (IBS) is scheduled for a hydrogen breath test. What does the nurse tell the client about this test? "During the test, you will drink small amounts of an antacid as directed by the technician." "If you have IBS, hydrogen levels may be increased in your breath samples." Correct "The test will take between 30 and 45 minutes to complete." "You must have nothing to drink (except water) for 24 hours before the test.

b. "If you have IBS, hydrogen levels will be increased in your breath samples." Excess hydrogen levels are produced in clients with IBS. This is due to bacterial overgrowth in the small intestine that accompanies the disease. The hydrogen travels to the lungs to be excreted. The client will ingest small amounts of sugar during the test, not an antacid. The test takes longer than 45 minutes. The client has breath samples taken every 15 minutes for 1 to 2 hours. The client needs to be NPO (except for water) for 12 hours before the test.

An RN on the medical-surgical unit receives shift report about four clients. Which client does the nurse assess first? A 34-year-old who has returned to the unit after a colon resection with a new colostomy stoma, which is dark pink A 36-year-old admitted after a motor vehicle crash with areas of ecchymoses on the abdomen in a "lap-belt" pattern Correct A 40-year-old with pneumonia who has abdominal distention and decreased bowel sounds in all quadrants A 51-year-old with familial adenomatous polyposis (FAP) who is scheduled for a colonoscopy

b. 36yo recently admitted after a motor vehicle accident w/areas of ecchymoses on the abdomen in a "lap belt" pattern. Ecchymoses in the abdominal area may indicate intraperitoneal or intra-abdominal bleeding; this client requires rapid assessment and interventions. The client who is post colon resection, the client with pneumonia, and the client with FAP do not have an urgent need for further assessment or intervention.

Which client does the medical-surgical unit charge nurse assign to an LPN/LVN? A 41-year-old who needs assistance with choosing a site for a colostomy stoma A 47-year-old who needs to receive "whole gut" lavage before a colon resection Correct A 51-year-old who has recently arrived on the unit after having an open herniorrhaphy A 56-year-old who has obstipation and a recent emesis of foul-smelling liquid

b. 47yo who needs to receive "whole gut" lavage before a colon resection Because administration of medications is within the LPN/LVN scope of practice, this preoperative client can be assigned to the LPN/LVN. Assistance with choosing a site for a colostomy stoma is an intervention that should be provided by an RN. The recent postoperative client and the critically ill client will need assessments and interventions that can only be done by an RN.

A home health nurse is teaching a client about the care of a new colostomy. Which client statement demonstrates correct understanding of the instructions? "A dark or purplish-looking stoma is normal and should not concern me." "If the skin around the stoma is red or scratched, it will heal soon." "I need to check for leakage underneath my colostomy." Correct "I should strive for a very tight fit when applying the barrier around the stoma."

c. "I need to check for leakage underneath my colostomy." The pouch system should be checked frequently for evidence of leakage to prevent excoriation. A purplish stoma is indicative of ischemia and necrosis. Redness or scratched skin around the stoma should be reported to prevent it from beginning to break down. An overly tight fit may lead to necrosis of the stoma.

A client with colorectal cancer (CRC) is scheduled for colostomy surgery. Which comment from the nurse is most therapeutic for this client? "Are you afraid of what your spouse will think of the colostomy?" "Don't worry. You will get used to the colostomy eventually." "Tell me what worries you the most about this procedure." Correct "Why are you so afraid of having this procedure done?"

c. "Tell me what worries you the most about this procedure." Asking the client about what worries him or her is the only question that allows the client to express fears and anxieties about the diagnosis and treatment. Asking the client if he or she is afraid is a closed question (i.e., it requires only a "yes" or "no" response); it closes the dialogue and is not therapeutic. Telling the client not to worry offers reassurance and is a "pat" statement, making it nontherapeutic. "Why" questions place clients on the defense and are not therapeutic because they close the conversation.

A client with a bowel obstruction is requested a nasogastric (NG) tube. After the nurse inserts the tube, which nursing intervention is the highest priority for this client? Attaching the tube to high continuous suction Auscultating for bowel sounds and peristalsis while the suction runs Connecting the tube to low intermittent suction Correct Flushing the tube with 30 mL of normal saline every 24 hours

c. Connecting the tube to low intermittent suction The NG tube should be attached to intermittent low suction unless otherwise requested by the health care provider. Continuous suction is rarely used because it can injure the gastric mucosa of the client's stomach. Bowel sounds should not be auscultated with suction on and running. The tube should be flushed every 4 hours, minimally.

A 28-year-old comes to the clinic with a history of recurrent episodes of diarrhea or constipation and reports of abdominal pain and bloating. The client is diagnosed with irritable bowel syndrome (IBS). What OTC medications does a nurse suspect as a possible cause of the client's problem?

c. NSAIDs

After an automobile accident, a client is admitted to the emergency department (ED) with possible abdominal trauma. Which health care provider request does the nurse implement first? Insert a nasogastric tube and connect it to intermittent suction. Obtain a complete blood count and coagulation panel. Start an IV line and infuse normal saline at 200 mL/hr. Correct Arrange for a computed tomography (CT) scan of the abdomen.

c. Start an IV line & infuses normal saline @ 200mL/hr After the initial airway, breathing, and circulation assessment is completed, the most immediate concerns are the high risks for hemorrhage and shock. To rapidly treat for these possible complications, IV access and infusion of fluids are necessary as the priority intervention. Inserting a nasogastric tube, laboratory studies, and arranging a CT scan are secondary to establishing IV access and instilling fluids.

A client asks a nurse, "Can you tell me some foods to include in my diet so that I can reduce my chances of getting colorectal cancer?" Which dietary selection does the nurse suggest? Steak with pasta Spaghetti with tomato sauce Steamed broccoli with turkey Correct Tuna salad with wheat crackers

c. Steamed broccoli w/turkey Steamed broccoli with turkey contains low-fat meat and no refined carbohydrates. Animal fat from red meats is carcinogenic, and pasta is high in refined carbohydrates, which are known to contribute to colon cancer. Spaghetti and wheat crackers also contain large amounts of refined carbohydrates.

A Certified Wound, Ostomy, Continence Nurse (CWOCN) is teaching a client with colorectal cancer how to care for a newly created colostomy. Which client statement reflects correct understanding of the necessary self-management skills? "I will have my spouse change the bag for me." "If I have any leakage, I'll put a towel over it." "I need to call my home health nurse to come out if I have any problems." "I will make certain that I always have an extra bag available." Correct

d. "I will make certain that I always have an extra bag available." The statement that the client will be certain to bring an extra bag is the only statement illustrating that the client is taking responsibility to care for the colostomy. Using a towel is not an acceptable or effective way to cope with leakage. It is not realistic that the home health nurse can make frequent visits for the purpose of colostomy care.

A client with an intestinal obstruction has pain that changes from a "colicky" intermittent type to constant discomfort. What does the nurse do first? Administers medication for pain Changes the nasogastric suction level from "intermittent" to "constant" Positions the client in high-Fowler's position Prepares the client for emergency surgery

d. Prepares the client for emergency surgery The change in pain type could be indicative of perforation or peritonitis and will require immediate surgical intervention. Pain medication may mask the client's symptoms but will not address the root cause. A change in the nasogastric suction rate will not resolve the cause of the client's pain and could be particularly ineffective if a nonvented tube is in use. A high-Fowler's position will have no effect on an intestinal perforation or peritonitis, which this client is likely experiencing.

A client is being evaluated in the emergency department (ED) for a possible small bowel obstruction. Which symptoms does the nurse expect to assess? Cramping intermittently, metabolic acidosis, and minimal vomiting Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis Metabolic acidosis, upper abdominal distention, and intermittent cramping Upper abdominal distention, metabolic alkalosis, and great amount of vomiting

d. Upper abdominal distention, metabolic alkalosis, and great amount of vomiting A small bowel obstruction is characterized by upper or epigastric abdominal distention, metabolic alkalosis, and a great amount of vomiting. Intermittent lower abdominal cramping, metabolic acidosis, and minimal vomiting are all symptoms of a large bowel obstruction.