Test #4 - Bowel Elimination

A nurse is obtaining health history from a young adult patient who has a colostomy. The patient reports frequent episodes of loose stools over the last month, but has no signs of infection or bowel obstruction. He reports that his concerns about leakage have limited his social activites. Which of the following should the nurse recommend?

Consume foods that are low in fiber content.

Incontinence is described as the inability to control defecation often caused by what? A. Constipation B. Flatulence C. Hemorrhoids D. Diarrhea

D. Diarrhea

A patient with the diagnosis of diverticulosis is advised to eat a diet high in fiber. What should the nurse recommend that the patient eat to best increase the bulk and fecal material? A. Whole wheat bread B. White rice C. Pasta D. Kale

D. Kale

Which enema should not be administered before a colon exam or prior to a stool specimen? A. Normal Saline B. Tap Water C. Fleet's D. Soap Suds Enema

D. Soap Suds Enema

What is likely to cause electrolyte abnormality?

High-volume effluent

Soapsuds enemas act by stimulating peristalsis through intestinal irritation. As long as pure _________ soap is used, it is considered a safe procedure.

castile

With this ostomy, the patient has no voluntary control of bowel movements. The stoma of an ______ is typically located in the right lower quadrant. This type contains digestive enzymes and acids that cause skin irritation, extra care is required to keep waste materials from contacting the abdominal surface.

ileostomy

To promote the patient's comfort during the administration of the enema solution, ________ the normal saline solution to ________ prior to administration.

preheat, lukewarm

Patient complains of black stool. What are some assessment questions that could be asked? A. Do you take Pepto-Bismol? B. How often are your bowel movements? C. Do you eat black food or dye? D. Do you drink a lot of water?

A. Do you take Pepto-Bismol?

What should not be used on stomas? A Alcohol B. Peroxide C. Lotions D. Adhesive past

A Alcohol B. Peroxide C. Lotions

_________: is typically created as an emergency procedure to relieve an intestinal obstruction or perforation. A communicating wall remains between the proximal and the distal bowel. It has two openings through the one stoma - the proximal end drains stool while the distal portion drains mucus. The bridge can be removed in 7 to 10 days; typically temporary.

A transverse loop colostomy

A nurse is preparing to administer an oil-retention enema to a patient who has constipation. The nurse explains that the patient should try to retain the instilled oil for? A. At least 30 mins, or as long as they can hold it. B. 5 mins, or as soon as possible. C. 3 hours, or until dissolved.

A. At least 30 mins, or as long as they can hold it.

Ostomies of the upper GI tract, Gastrostomy and Jejunostomy, are often used for what? A. Feedings B. Defecation C. No purpose D. Administer fluid

A. Feedings

Which enema is the safest to use for any patient? A. Isotonic; Normal Saline B. Hypotonic; Tap Water C. Hypertonic; Fleet's D. Hypotonic; Soap Suds Enema

A. Isotonic; Normal Saline

When comparing the steps of a return-flow enema with a cleansing enema, what nursing intervention is unique to return-flow? A. Lower the solution after instilling about 150 mL of solution. B. Raise the solution 12 inches above the anus. C. Lubricate 5 inches of the rectal tube. D. Insert the rectal tube 4 inches in the anus.

A. Lower the solution after instilling about 150 mL of solution.

What are some important facts to know about enemas? A. Place the enema 12-18 inches above the anus B. Warm the enema to prevent constipation C. Place client on left side with right leg flexed D. Insert 5 inches in anus E. Insert enema towards umbilicus

A. Place the enema 12-18 inches above the anus B. Warm the enema to prevent constipation C. Place client on left side with right leg flexed E. Insert enema towards umbilicus

Which physiological response would be most concerning to someone who had diarrhea? A. Excoriated Skin B. Malnutrition C. Dehydration D. Urinary Incontinence

C. Dehydration

A nurse is providing teaching to a client who has a new colostomy about proper care. Which of the following information should the nurse include in the teaching?

Cleanse the skin around the stoma with warm water.

A nurse is replacing the ostomy appliance for a patient whose newly created colostomy is functioning. After removing the pouch, which of the following should the nurse do first?

Cleanse the stoma and the peristomal skin

What type of output is first expected from an ileostomy postoperatively?

Loose, dark green liquid that may contain blood

A nurse is planning to collect a stool specimen for ova and parasites from a client who has diarrhea. Which of the following actions should the nurse take when collecting the specimen?

Place the stool specimen collection container in a biohazard bag.

A nurse is providing teaching to an older adult client who has constipation. Which of the following statements should the nurse include in the teaching?

Sit on the toilet 30 minutes after eating a meal.

________: This location is used for a temporary ostomy, with the stoma constructed as a loop. Output is liquid to semi-formed.

Transverse colon (mid-abdomen).

What are some factors than can affect bowel elimination? A. Cathartics B. Squatting C. Happiness D. Depression E. Breast Milk

A. Cathartics B. Squatting D. Depression E. Breast Milk

A nurse is talking with a client who reports constipation. When the nurse discusses dietary changes that can help prevent constipation, which of the following foods should the nurse recommend? A. Macaroni and cheese B. Fresh food and whole wheat toast C. Rice pudding and ripe bananas D. Roast chicken and white rice

B. Fresh food and whole wheat toast

A patient who has bladder cancer tells the nurse that, of the various urinary diversion options the surgeon presented, she prefers one that will allow her to have some control over urinary elimination. The nurse should explain the option that will allow is?

A Kock's pouch

A nurse is preparing to administer a cleansing enema to a patient who is prone to more fecal incontinence due to poor sphincter control and is unlikely to retain the enema solution. Which of the following interventions is appropriate for this patient? A. Place the patient on the bedpan in dorsal recumbent position on bedpan. B. Instill 200 mL of fluid every 15 mins. C. Administer the enema while the patient sits on the toilet. D. Administer an antidiarrheal medication 3 hr. prior to the enema.

A. Place the patient on the bedpan in dorsal recumbent position on bedpan.

__________: The output is typically liquid to semi-liquid and is very irritating to the surrounding skin.

Ascending colon (right abdomen).

What is the fluid amounts for large-volume enemas? A. 150 to 200 mL B. 750 to 1000 mL C. 500 to 750 mL D. 250 to 300 mL

B. 750 to 1000 mL

Which enema would be used for fecal impaction? A. SSE B. Tap water C. Mineral Oil D. Fleet

C. Mineral Oil

______ enema is to assist a client to expel flatus.

Carminative

A patient is to take a fecal occult home. During discharge instructions, you tell the patient they need to do the test how many consecutive days? A. 10 B. 1 C. 6 D. 3

D. 3

What are some foods that could cause blockage in a colostomy?

Fresh tomatoes, celery, mushrooms, popcorn, shrimp, lobster.

A nurse is caring for a client who is 48 hours postoperative following a small bowel resection. The client reports gas pains I the periumbilical area. The nurse should plan care based on which of the following factors contributing to this postoperative complication?

Impaired peristalsis of the intestines

A nurse is administering a cleansing enema to a client who is scheduled for a diagnostic procedure. Which of the following action should the nurse take?

Insert the tip of the tubing 8 cm (3.1 cm)

A nurse is caring for a client who has a fecal impaction. Before digital removal of the mass, which of the following types of enemas should the nurse plan to administer to soften the feces?

Oil retention

What should I do if my patient cannot retain the enema solution?

Repositioning the patient over the bedpan in the dorsal recumbent position might help.

________: This is the location for a permanent colostomy, particularly for cancer of the rectum. The stoma is typically located on the lower left quadrant of the abdomen, and the output is formed.

Sigmoid colon (left lower abdomen).

A nurse is providing preoperative teaching for an older adult patient who has diverticulitis and is scheduled for a creation of a double-barrel colostomy in the sigmoid colon. Which of the following instructions should the nurse include in the teaching?

Tape a dry gauze pad over the distal stoma to collect drainage

What are the contraindications for enemas?

They include increased intracranial pressure, glaucoma, and rectal or prostate surgery

Hypertonic solutions, such as sodium phosphate, pull fluid from the interstitial space into the colon. This type of enema should be avoided in ___________ and ________________.

young infants, patients who are dehydrated

A nurse is teaching a patient how to apply an extended-wear skin barrier. Which of the following strategies should the nurse instruct the patient to use for maximal adherence?

Gently pressure the barrier for 1 to 2 mins

What is the difference between a one-piece and two-piece pouching system?

- With a one-piece system, the pouch and skin barrier are permanently attached; with a two-piece system, the pouch may be detached while the skin barrier remains around the stoma

A patient comes into the ER with a colostomy. The patient states "Something just isn't right". During the assessment, the nurse notices the stoma is pale. What should the nurse do next? A. Gently massage the stoma B. Listen for bowel sounds C. Place an aspirin in the colostomy D. Notify provider

D. Notify provider

A nurse is administering an enema medicated with sodium polystyrene sulfonate (Kayexalate) to an older adult patient who has hyperkalemia. The nurse should insert the tip of the rectal tube? A. 4 to 5 in B. 1-2 in C. 6-8 in D. 1-3 in.

A. 4 to 5 in

If a fecal hemoccult came up to be positive, what color would it be? A. Red B. Green C. Yellow D. Black

B. Green

A patient is experiencing constipation. What independent nursing interventions can be performed? A. Apply lubricant to the anus B. Provide sitz bath after defecation C. Instill warm mineral oil into the rectum D. Place a warm washcloth against the perianal area E. Encourage the patient to rock back and forth while defecating

A. Apply lubricant to the anus D. Place a warm washcloth against the perianal area E. Encourage the patient to rock back and forth while defecating

What are some beverages that increased peristalsis? A. Coffee B. Prune Juice C. Milk D. Apple Juice

A. Coffee B. Prune Juice D. Apple Juice

Clients should be taught that repeatedly ignoring the sensation of needing to defecate could result in which of the following? A. Constipation B. Diarrhea C. Incontinence D. Hemorrhoids

A. Constipation

A, Fleet enema, is hypertonic. To which patient should a fleet enema NOT be administered to? A. Dehydrated B. Constipated C. Brain trauma D. Cancer

A. Dehydrated

What are some interventions used for fecal incontinence? A. Determine cause (medication, infection, impaction) B. Provide perineal care after each stool C. Use sitz bath D. Apply barrier cream

A. Determine cause (medication, infection, impaction) B. Provide perineal care after each stool D. Apply barrier cream

What assessment questions would you ask someone who has constipation? A. When was your last bowel movement? B. What color is your usual bowel? C. Do you use anything to help you defecate? D. What time of day is your normal bowel movement?

A. When was your last bowel movement?

A nurse discourages a patient from straining excessively when attempting to have a bowel movement. What physiological response primarily may be prevented by avoiding straining on defecation? A. Incontinence B. Dysrhythmias C. Fecal impaction D. Rectal hemorrhoids

B. Dysrhythmias

A nurse is caring for a patient with a intestinal stoma. Which intervention is most important? A. Wear sterile gloves B. Select a bag with an appropriate size stomal opening C. Clean stoma with alcohol D. Spray air freshener in room before and after removal

B. Select a bag with an appropriate size stomal opening

When an enema is instill what happens? A. Adds water to the bowel B. The bowel wall is stretched which stimulates peristalsis

B. The bowel wall is stretched which stimulates peristalsis

Which of the following is most likely to validate that a client is experiencing intestinal bleeding? A. Large quantities of fat mixed with pale yellow liquid stool B. Brown, formed stool C. Semi soft tar colored stools D. Narrow, Pencil shaped stool

C. Semi soft tar colored stools

Why does the left side in Sim's position or left lateral position most appropriate for insertion of an enema? A. This position is more comfortable for the patient. B. This position allow for ease of access. C. This position allows the solution to flow downward by gravity along the curve of the sigmoid colon and rectum, thus improving the effectiveness of the enema.

C. This position allows the solution to flow downward by gravity along the curve of the sigmoid colon and rectum, thus improving the effectiveness of the enema

Which nursing diagnoses is/are most applicable to a client with fecal incontinence? Select all that apply. A. Bowel incontinence B. Risk for deficient fluid volume C. Disturbed body image D. Social isolation E. Risk for impaired skin integrity

A. Bowel incontinence C. Disturbed body image D. Social isolation E. Risk for impaired skin integrity

If the patient was instructed to avoid foods that may have a laxative effect, the nurse would advise the patient to avoid which of the following foods? Select all that apply. A. Bran B. Alcohol C. Rice D. Chocolate

A. Bran B. Alcohol D. Chocolate

What important consideration should be taken when doing a fecal impaction? A. Stimulation of the vagus nerve B. Possible diarrhea C. Constipation D. Abdominal pain

A. Stimulation of the vagus nerve

While a nurse is administering a cleansing enema, the patient reports abdominal cramping. Which of the following is the appropriate intervention? A. Keep going until enema is finished B. Stop the enema C. Lower the enema fluid container D. Notify the doctor

C. Lower the enema fluid container

A nurse is about to administer a tap-water enema when a patient asks what is the purpose. The nurse responds with? A. It is used to relieve flatulence. B. It drains the bladder. C. It empties the bowel. D. It controls diarrhea.

C. It empties the bowel.

_____ enema to a client who has very high levels of potassium

Sodium polystyrene sulfate

A nurse is providing preoperative teaching for a patient who has colon cancer. The surgeon informed the patient that his entire large intestine and rectum will be removed. The nurse should explain the type of ostomy he will have is?

An ileostomy

_____ to cleanse the client's bowel; often used in preparation of surgery

Hypertonic fluid solution

Which statement provides evidence that an older adult who is prone to constipation is in need of further teaching? A. "I need to drink one and a half to 2 quarts of liquid each day" B. "I need to take a laxative such as milk of magnesia if I don't have a BM every day" C. "If my bowel pattern changes on its own, I should call you" D. "Eating my meals at regular times is likely to result in regular bowel movements"

B. "I need to take a laxative such as milk of magnesia if I don't have a BM every day"

A nurse is to administer an oil-enema, tap-water enema, and a return-enema to 3 different patients. What nursing interventions should be applied to all 3? A. Use between 500-1000 mL of solution. B. Place the client on the left side position. C. Use water-soluble jelly for lubrication. D. Pull the curtain around the patient's bed and drape the patient. E. Hold the enema solution 12 inches above the anus

B. Place the client on the left side position. C. Use water-soluble jelly for lubrication. D. Pull the curtain around the patient's bed and drape the patient.

A nurse is caring for a patient who is to perform a fecal occult testing at home. What important information should be included in the teaching?

C. The specimen can not be contaminated with urine.

A nurse is caring for a client who has major fecal incontinence and reports irritation in the perianal area. Which of the following actions should the nurse take first?

Check the client's perineum.

______: The output is semi-formed because more water is absorbed while fecal material is in the ascending and transverse colon.

Descending colon (left upper abdomen).

__________: two separate stomas are created. Both ends of the bowel are brought through the abdomen to the skin surface as two separate sections. Typically, the distal colon is not removed but bypassed. The proximal stoma, which is functional, diverts feces to the abdominal wall.

Double-barrel colostomy

A nurse is preparing to administer a cleansing enema to a client. Which of the following actions should the nurse plan to take?

Position the client on his left side.

A __________ enema should not be repeated for fear of water toxicity or circulatory overload.

tap water

A _________ is a urinary diversion that allows urine to exit the body after removal of a diseased or damaged section of the urinary tract.

urostomy

The excessive use of laxatives can take what effect on the body? A. Causes abdominal discomfort B. Weakens the muscles and the natural ability to defecate C. Causes distention of the intestines D. Reabsorbs water from the bowel

B. Weakens the muscles and the natural ability to defecate

A nurse is teaching a patient with a new ileostomy about incorporating preventive strategies at home. To prevent excoriation and breakdown of the peristomal skin, the nurse should instruct the patient to?

Empty the pouch when it is no more than half full