HESI Intestinal Obstruction Practice Quiz

Which explanation should the nurse consider when formulating a response to a client's inquiry about intussusception of the bowel? a. Kinking of the bowel onto itself b. A band of connective tissue compressing the bowel c. Telescoping of a proximal loop of bowel into a distal loop d. A protrusion of an organ or part of an organ through the wall that contains it

Telescoping of a proximal loop of bowel into a distal loop Intussusception is the telescoping or prolapse of a segment of the bowel into the lumen of an immediately connecting segment of the bowel. Volvulus is a twisting of the bowel onto itself. Adhesions are bands of scar tissue that can compress the bowel. Herniation describes protrusion of an organ through the wall that contains it.

intussusception

telescoping of the intestines

A client has surgery for an *incarcerated hernia*. The healthcare provider returns the incarcerated tissue to the abdominal cavity and uses a mesh to reinforce the muscle wall. What specific instructions should be included in the discharge instructions? a. Reduce dietary roughage. b. Avoid lifting heavy items. c. Increase dietary potassium intake. d. Keep the head of the bed elevated.

*Avoid lifting heavy items.* Avoiding lifting helps prevent increased intraabdominal pressure that may disrupt the surgical repair. Roughage helps prevent constipation, thus avoiding straining and increased intraabdominal pressure. There is no indication for potassium supplements. The client can assume any position of comfort.

incarcerated hernia

hernia that is swollen and fixed within a sac, causing an obstruction

A possible complication of a hernia

is intestinal obstruction; if an obstruction occurs, there is no passage of flatus or regular bowel movements. Coughing is contraindicated because it places stress on the operative site.

When an intestinal obstruction is suspected, a client has a nasogastric tube inserted and attached to suction. What response should the nurse critically assess on this client? a. Edema b. Belching c. Fluid deficit d. Excessive salivation

*Fluid deficit* Dehydration is a danger because of fluid loss with gastrointestinal (GI) suction. Based on the data provided, edema, belching, and excessive salivation are not likely to occur.

A client admitted to the hospital with a small bowel obstruction is to have an intestinal tube inserted. When preparing the client for the procedure, what action should the nurse take? a. Place the client in the right side-lying position b. Instruct the client about techniques for mouth breathing c. Spray the client's oropharynx with a local anesthetic solution d. Reassure the client that the procedure will not cause discomfort

*Instruct the client about techniques for mouth breathing* Mouth breathing helps to decrease the gag reflex, thereby easing the passage of the intestinal tube. Lying on the right side does not take advantage of gravity and makes the client's naso-oral cavity less accessible to tube passage. Spraying the oropharynx with a local anesthetic solution will make it more comfortable, but it will interfere with swallowing, which is necessary during passage of an intestinal tube. Reassuring the client that passage of an intestinal tube will not cause discomfort is false reassurance; the procedure is not painful, but it is uncomfortable.

A nurse is caring for a *postoperative* client who has a *nasogastric tube attached to low continuous suction*. Which assessment findings indicate that the client may be experiencing *hypokalemia*? a. Tingling of the fingertips and toes b. Dry and sticky mucous membranes c. Abdominal cramping and irritability d. Muscle weakness and cardiac dysrhythmia

*Muscle weakness and cardiac dysrhythmia* Muscle weakness and cardiac dysrhythmias are related to potassium depletion in the skeletal and cardiac muscles; the sodium-potassium pump facilitates conduction of nerve impulses and muscle activity. Tingling of the fingertips and toes is related to hypocalcemia or hyperkalemia, not hypokalemia. Dry and sticky mucous membranes are related to hypernatremia, not hypokalemia. Abdominal cramping and irritability are related to hyperkalemia, not hypokalemia.

A client is admitted to the hospital with the diagnosis of *intestinal obstruction* and has an *intestinal tube* inserted. The plan of care includes a prescription to *instill 30 mL of normal saline into the tube as needed to maintain patency*. When considering the normal saline that is instilled, how should the nurse proceed? a. Subtract the 30 mL from the gastric output b. Record the 30 mL on the intake and output record c. Understand that the amount instilled equals insensible losses d. Consider the amount too small to document on the intake and output record

*Record the 30 mL on the intake and output record* All fluid taken in by the client, regardless of the route, should be recorded on the intake and output record; documentation indicates that the action was implemented. No amount of fluid should be considered insignificant. insensible losses through the skin and lungs generally equal approximately 800 mL daily. The healthcare provider's prescription indicates that the instillation is to be done as necessary; the total amount instilled during a 24-hour period may be significant. Intake and output records should be accurate; therefore, every instillation should be documented

A client is admitted to the hospital for the *surgical repair of an incarcerated indirect inguinal hernia*. What is the primary preoperative nursing intervention for this client? a. Placing the client in the supine position b. Observing the client's bowel movements c. Monitoring the client's serum enzyme levels d. Teaching the client about the need to cough postoperatively

*Observing the client's bowel movements* A possible complication of a hernia is intestinal obstruction; if an obstruction occurs, there is no passage of flatus or regular bowel movements. The supine position has no effect on an incarcerated hernia. Monitoring serum enzyme levels is done for all clients; it is not specific for a client with a hernia. Coughing is contraindicated because it places stress on the operative site.

A client is admitted to the hospital with a diagnosis of intestinal obstruction. The healthcare provider prescribes intestinal suction via a nasoenteric decompression tube. The loss of which constituents associated with intestinal suctioning is most important to consider when caring for this client? a. Protein enzymes b. Energy carbohydrates c. Vitamins and minerals d. Water and electrolytes

*Water and electrolytes* Fluid and electrolytes are lost through intestinal decompression; on a daily basis about 20% of the total body water is secreted into and almost completely reabsorbed by the gastrointestinal (GI) tract. Because the client is kept nothing by mouth (NPO), there is no stimulus to cause enzymes to be secreted into the GI tract. Intravenous dextrose supplies some carbohydrates as a source of energy; carbohydrates will not be drawn from storage by intestinal decompression. Because the client is being kept NPO, vitamins and minerals are not entering the GI tract and therefore are not lost.

A client is scheduled for surgery to repair an irreducible (incarcerated) hernia. What nursing intervention is of primary importance? a. Assessing the client's bowel movement b. Maintaining the client in the supine position c. Checking the client's vital signs periodically d. Monitoring the client's serum enzyme levels

Assessing the client's bowel movement A possible complication of a hernia is intestinal obstruction. If an obstruction occurs, there is no passage of flatus or bowel movements. The supine position will have no effect on an incarcerated hernia. Checking the client's vital signs periodically is done for all clients; it is not specific for a client with a hernia and is not the primary assessment. Monitoring the client's serum enzyme levels will not facilitate the identification of complications.

A client with *severe Crohn disease* develops a *small bowel obstruction*. Which clinical finding should the nurse expect the client to report? a. Bloody vomitus b. Projectile vomiting c. Bleeding with defecation d. Pain in the left lower quadrant

Projectile vomiting Nausea and vomiting, accompanied by diffuse abdominal pain, commonly occur in clients with small bowel obstruction; the vomiting may be projectile and may contain bile or fecal material. Hematemesis is associated more closely with peptic ulcer disease. Bleeding with defecation is associated with hemorrhoids and anal fissures. Pain in the left lower quadrant is associated with diverticulitis. Pain associated with a small bowel obstruction usually is more diffuse.