Fundamental Ch. 38 Bowel elimination

The nurse is replacing a client's ileostomy appliance and has identified that the diameter of the stoma is 3.5 cm. The nurse has trimmed the flange of the new appliance to a diameter of 7 cm. What will be the most likely outcome of the nurse's action? A risk that the peristomal skin will become excoriated A heightened risk that the stoma will prolapse The appliance will fit securely to the client's skin. The appliance will need to be changed daily.

A risk that the peristomal skin will become excoriated

A nurse who is planning menus for a client in a long-term care facility takes into consideration the effects of foods and fluids on bowel elimination. Which examples correctly describe these effects? Select all that apply. A client who is constipated should eat eggs and pasta to relieve the condition. Clients who are constipated should eat more fruits and vegetables. Clients with food intolerances may experience altered bowel elimination. Clients experiencing flatulence should avoid gas-producing foods such as cauliflower and onions. Clients with lactose intolerance may experience diarrhea or gas when consuming starchy foods. Alcohol and coffee tend to have a constipating effect on clients.

Clients who are constipated should eat more fruits and vegetables. Clients with food intolerances may experience altered bowel elimination. Clients experiencing flatulence should avoid gas-producing foods such as cauliflower and onions.

During the inspection of a client's abdomen, the nurse notes that it is visibly distended. The nurse should proceed with the client's abdominal assessment by next performing: percussion. deep palpation. auscultation. light palpation.

auscultation.

A student nurse studying human anatomy knows that a structure of the large intestine is the: jejunum duodenum cecum ileum

cecum

The nurse is scheduling tests for a client who is experiencing bowel alterations. What is the most logical sequence of tests to ensure an accurate diagnosis? barium studies, endoscopic examination, fecal occult blood test barium studies, fecal occult blood test, endoscopic examination endoscopic examination, barium studies, fecal occult blood test fecal occult blood test, barium studies, endoscopic examination

fecal occult blood test, barium studies, endoscopic examination

Digital rectal examination confirms that a client has an impaction, and an enema solution has been ordered to lubricate the stool and intestinal mucosa without distending the intestine. What solution best meets this client's needs? soap oil water normal saline

oil

A woman age 76 years has informed the nurse that she has begun using over-the-counter laxatives because her friend told her it was imperative to have at least one bowel movement daily. How should the nurse best respond to this client's statement? "That's correct, but be sure that you don't increase your laxative doses over time." "Most older adults only have a bowel movement every 2 to 3 days, actually, so I'd encourage you to taper off your laxatives." "Actually, people's bowel patterns can vary a lot and some people don't tend to go every day." "Your friend is correct in her assessment, but it would likely be better to exercise and drink more instead of using medications."

"Actually, people's bowel patterns can vary a lot and some people don't tend to go every day."

The nurse in an outpatient provider's office is caring for a client with persistent flatus. Which client teaching will the nurse provide as to why some foods cause flatus? "Drinking alcoholic beverages can cause flatus." "Flatus is a natural action and the cause is unknown." "Parasites in your stool can cause persistent flatus." "Certain vegetables can cause flatus, as they are more difficult to digest."

"Certain vegetables can cause flatus, as they are more difficult to digest."

A client with no significant medical history reports experiencing diarrhea over the past week. Which assessment question(s) will the nurse ask? Select all that apply. "Do you use laxatives?" "Have you started a new medication?" "Are you experiencing rectal fullness?" "What are your normal bowel habits?" "Is the stool difficult to pass?"

"Do you use laxatives?" "Have you started a new medication?" "What are your normal bowel habits?"

A nurse is caring for a client whose primary care provider has written an order for "enemas until clear." Which explanation to the client about this procedure is correct? "You will need to have enemas unless you can consume clear liquids without nausea." "I will administer up to three enemas as prescribed." "I will administer enemas until the enema return is without stool." "This enema will assist in your bowel regimen when you go home."

"I will administer enemas until the enema return is without stool."

An older adult client tells the nurse, "I give myself a mineral oil enema every day." What is the appropriate nursing response? "It is important that you discontinue this type of treatment immediately." "Perhaps you should do this twice daily." "This is good to help bowels move." "Mineral oil enemas can interfere with absorption of fat-soluble vitamins."

"Mineral oil enemas can interfere with absorption of fat-soluble vitamins."

In the nursing care plan for constipation, the nurse should have an intervention that addresses the number of grams of cellulose that are needed for normal bowel function. How many grams should be in the daily diet? 20-30 g 40-50 g 60-70 g >80g

20-30 g

The nurse is preparing to administer a large-volume enema to an adult client. How far should the nurse insert the tubing into the rectum? 3 in (7.5 cm) 1 in (2.5 cm) 5 in (12.5 cm) 2 in (5.0 cm)

3 in (7.5 cm)

The nurse is talking with four members of a family. Which client within the family does the nurse identify that would benefit from discussing a colonoscopy screening with their health care provider? 48-year old with regular bowel habits 18-year old who with diarrhea twice weekly 22-year old who experiences constipation 47-year old whose father had polyps

47-year old whose father had polyps

The nurse is providing health teaching for four clients. Which client should consider a colonoscopy screening? 33-year-old client who reports painful elimination 67-year-old client with constipation 42-year-old client with diarrhea twice weekly 50-year-old client with a family history of polyps

50-year-old client with a family history of polyps

The nurse assesses the stool of clients admitted to the hospital with abdominal distress. Which statements accurately describe the normal characteristics of stool and special considerations for observation? Select all that apply. A gastrointestinal obstruction may result in a narrow, pencil-shaped stool. Antacids in the diet cause the stool to be whitish. The rapid rate of peristalsis in the breastfed infant causes the stool to be yellow. Consistently large diarrheal stools suggest a disorder of the left colon or rectum. The absence of bile may cause the stool to appear black. The odor of the stool is influenced by its pH value, which normally is slightly acidic.

A gastrointestinal obstruction may result in a narrow, pencil-shaped stool. Antacids in the diet cause the stool to be whitish. The rapid rate of peristalsis in the breastfed infant causes the stool to be yellow.

Removal of a client's NG tube has been ordered. Which action should the nurse perform during this intervention? Before removing the tube, discontinue suction and separate the tube from suction. Quickly and carefully remove tube while the client breathes out. Attach a syringe and flush with 50 mL of water or normal saline before removal. Place the client in a protective supine position to facilitate easy removal.

Before removing the tube, discontinue suction and separate the tube from suction.

A nurse prepares to insert a nasointestinal tube to provide nutrition to a client. Which guideline is recommended for this procedure? Add 16 to 18 in to the measurement obtained to ensure the tube comes to rest at the desired point. Position the bed flat and assist the client onto his or her left side. Begin by measuring from the tip of the client's nose to the earlobe to the xiphoid process. Administer an oral analgesia 30 to 45 minutes before attempting insertion.

Begin by measuring from the tip of the client's nose to the earlobe to the xiphoid process.

An older adult woman who is incontinent of stool following a cerebrovascular accident will have which nursing diagnosis? Constipation related to physiologic condition involving the deficit in neurologic innervation, as evidenced by fecal incontinence Bowel Incontinence related to loss of sphincter control, as evidenced by inability to delay the urge to defecate Fecal Retention related to loss of sphincter control, and diminished spinal cord innervation related to hemiparesis Diarrhea related to tube feedings, as evidenced by hyperactive bowel sounds and urgency

Bowel Incontinence related to loss of sphincter control, as evidenced by inability to delay the urge to defecate

A client asks, "Why do some foods, like corn, come out undigested in my feces?" Which is the nurse's best response? Corn is high in galactose, which is an insoluble fiber that the body cannot digest. Corn is high in lactose, which is an insoluble fiber that the body cannot digest. Corn is high in sucrose, which is an insoluble fiber that the body cannot digest. Corn is high in cellulose, which is an insoluble fiber that the body cannot digest.

Corn is high in cellulose, which is an insoluble fiber that the body cannot digest.

Which symptom is a known side effect of antibiotics? Diarrhea Abdominal bloating Constipation Fecal impaction

Diarrhea

Which statement best explains why digital removal of stool is considered a last resort after other methods of bowel evacuation have been unsuccessful? It often causes rebound diarrhea and electrolyte loss. Most clients will not consent to have digital removal of stool. Nurses find the procedure distasteful and difficult to perform. Digital removal of stool may cause parasympathetic stimulation.

Digital removal of stool may cause parasympathetic stimulation.

The nurse is preparing to auscultate the bowel sounds of a client with a nasogastric tube in place set to low intermittent suction. How shall the nurse approach the assessment of bowel sounds and manage the nasogastric tube? Disconnect the nasogastric tube from suction during the assessment of bowel sounds. Disconnect the nasogastric tube from the suction for 1 hour prior to the assessment of bowel sounds. Allow the low intermittent suction to continue during the assessment of bowel sounds. Apply continuous suction to the nasogastric tube during assessment of bowel sounds.

Disconnect the nasogastric tube from suction during the assessment of bowel sounds.

The nurse is caring for a client who is scheduled for an esophagogastroduodenoscopy (EGD). What action would the nurse take to prepare the client for this procedure? Inform client that a chalky-tasting barium contrast mixture will be given to drink before the test. Ensure that the client ingests a gallon of bowel cleanser, such as polyethylene glycol electrolyte solution, in a short period of time. Provide a light meal before the test and administer two Fleet enemas. Ensure that the client fasts 6 to 12 hours before the test as per policy.

Ensure that the client fasts 6 to 12 hours before the test as per policy.

The nurse provides teaching to a client experiencing constipation. Which food choice on the client's breakfast tray indicates effective teaching? Grapefruit Whole milk Bacon Eggs

Grapefruit

After data collection on a client, the nurse suspects that the client has diarrhea. Which data collection finding, if observed by the nurse, would confirm the nurse's suspicion? Hyperactive bowel sounds Increased anal area pigmentation Dry, hard stool Visible waves of abdominal peristalsis

Hyperactive bowel sounds

A nurse is assessing and documenting the eating habits of a client with repeated reports of gas who wants to include more fiber in the diet. Which suggestion should the nurse include in the teaching plan? Eat more cabbage and brussels sprouts to decrease gas and add fiber. Drink a soft drink daily to prevent gas and allow fiber to break down. Include more protein in the diet to increase fiber and decrease gas. Increase fiber slowly over a period of time to prevent gas.

Increase fiber slowly over a period of time to prevent gas.

Which medication causes constipation? Aspirin Bisacodyl Iron supplements Magnesium antacids

Iron supplements

The nurse is assisting an older adult client into position for a sigmoidoscopy. Which position would the nurse place the client in? Semi-Fowler's Left lateral Right lateral Prone

Left lateral

The nurse is preparing a client to receive a hypertonic enema solution. Into which position will the nurse place the client? Sims prone semi-Fowler's supine

Sims

The nurse is inserting a rectal tube to administer a large-volume enema. Which nursing action is performed correctly in this procedure? Encourage the client to hold the solution for at least 20 minutes. Introduce solution quickly over a period of 3 to 5 minutes. Position the client on his back and drape properly. Slowly and gently insert the enema tube 3 to 4 in (7.5 to 10 cm) for an adult.

Slowly and gently insert the enema tube 3 to 4 in (7.5 to 10 cm) for an adult.

The student nurse is administering a large-volume enema to a client. The client reports abdominal cramping. What should the student nurse do first? Increase the flow of the enema for approximately 30 seconds then decrease it to the prior flow rate. Increase the flow of the enema until all of the solution has been administered. Stop the administration of the enema and notify the physician. Stop the administration of the enema momentarily.

Stop the administration of the enema momentarily.

While administering a cleansing enema, the client displays lightheadedness, nausea, and has clammy skin. The nurse would implement which priority action? Slow the infusion rate, withdraw the tubing slightly, then resume the enema. Slow the infusion rate, have the client take deep breaths, then resume the enema. Stop the procedure and reposition the client. Stop the procedure, monitor heart rate and blood pressure.

Stop the procedure, monitor heart rate and blood pressure.

The nurse is slowly advancing a nasogastric (NG) tube when the client begins to gasp and is unable to vocalize. Which scenario has likely occurred? The NG tube is curled in the back of the client's throat. The NG tube is in the client's airway. The client is experiencing a vasovagal reaction. The client is forcefully resisting the procedure.

The NG tube is in the client's airway.

When reviewing a client's chart, which data related to a client experiencing diarrhea might suggest to the nurse a causative factor? The client repeatedly ignores the urge to defecate. The client has a daily fluid intake of 2,000 to 3,000 mL. The client returned from a foreign country 2 days ago. The client consumes large qualities of fresh vegetables.

The client returned from a foreign country 2 days ago.

The newly hired graduate nurse is preparing to administer a cleansing enema. The nurse educator will intervene if which action is taken by the graduate nurse? The graduate uses a room temperature solution. The graduate advises the client that the enema should not be expelled immediately. The graduate places the client in Fowler's position. The graduate takes this opportunity to teach about the function of the intestinal tract.

The graduate places the client in Fowler's position.

When caring for a client with a new colostomy, which assessment finding would be considered abnormal and would need to be reported to the physician? The stoma is prolapsed. The stoma has a small amount of bleeding. The stoma is on the abdominal surface. The stoma is pink.

The stoma is prolapsed.

The nursing student is performing a focused gastrointestinal assessment. Which action performed by the student would indicate to nurse faculty that further instruction is needed? The student placed the client in supine position with the abdomen exposed. The student sequenced from auscultation to inspection, and percussion to palpation. The student had the client flex the knees when performing the assessment. The student instructed the client to urinate before beginning the focused assessment.

The student sequenced from auscultation to inspection, and percussion to palpation.

The nurse is teaching a client with a new ostomy about skin care to preserve tissue integrity at the stomal site. Which teaching will the nurse provide regarding cleansing the stoma? Use water only. Use alcohol-based sanitizer. Use water and mild soap. Use mineral oil.

Use water and mild soap.

Which factor is related to developmental changes in bowel habits for older adult clients? Older adults should peel fruits before eating. Milk products cause constipation in clients with lactose intolerance. Increase in dietary fiber can decrease peristalsis. Weakened pelvic muscles lead to constipation.

Weakened pelvic muscles lead to constipation.

The nurse is presenting a lecture on ostomy bowel elimination at a community clinic. When questioned by the clients, which food would the nurse suggest as natural intestinal deodorizers? Onions and garlic Yogurt and buttermilk Fish and dried lentils Asparagus and turnip

Yogurt and buttermilk

For which client would digital removal of stool be contraindicated? a diabetic client with renal complications an older adult client who is incontinent of stool a client with a urinary tract infection a client recovering from prostate surgery

a client recovering from prostate surgery

A nurse is caring for a client with constipation. The incidence of constipation tends to be high among clients who follow which diet? a diet lacking in fruits and vegetables a diet consisting of whole grains, seeds, and nuts a diet lacking in meat and poultry products a diet lacking in glucose and water

a diet lacking in fruits and vegetables

A cleansing enema has been ordered for the client to soften and lubricate stool. Which type of solution does the nurse gather? tap water hypertonic saline soap and water mineral oil

mineral oil

A client reports experiencing uncomfortable, frequent episodes of flatulence to the nurse. Which foods will the nurse recommend that the client avoid? Select all that apply. onions shrimp cucumbers lentils pork products cabbage

onions cucumbers lentils cabbage

When caring for a client with fecal incontinence, the nurse knows that fecal incontinence is the result of: nature and amount of food eaten by the client. social and emotional setting of the client. physiologic or lifestyle changes in the client. drinking and smoking habits of the client.

physiologic or lifestyle changes in the client.

When educating a breastfeeding mother on the characteristic of the stool of her newborn, the nurse should inform her that the stool will be: green. beige. yellow. brown.

yellow.