TEST 7: Chapter 47 Mastering (Fundamentals of Nursing)

Which assessment finding would the nurse associate with a problem with bowel elimination?

*A. A bowel movement every 5 days B. Loose appearing abdominal skin C. Bowel sounds every 5 to 15 seconds D. Absence of peristaltic waves on the abdomen RATIONALE: A bowel movement every 5 days indicates constipation, which is an abnormal finding, thus a problem with bowel elimination. Abdominal distension, indicated by taut and stretched abdominal skin, may be seen in patients with altered bowel elimination, as opposed to loose appearing abdominal skin. The occurrence of bowel sounds every 5 to 15 seconds and the absence of peristaltic waves on the abdomen are expected/normal findings and therefore not indicative of a problem with bowel elimination.

What does the nurse know to be true about a tap water enema?

*A. A tap water enema should be repeated with caution. B. A tap water enema is contraindicated for patients who are dehydrated. C. A tap water enema should be used with caution, particularly in pregnant women. D. A tap water enema is associated with lessened danger of excess fluid absorption. RATIONALE: Tap water enemas should be used with caution if they need to be repeated, because water toxicity or circulatory overload develops if the body absorbs large amounts of water. A hypertonic solution enema is contraindicated for patients who are dehydrated. Tap water enemas are not associated with any particular advisory that they should be used with caution in pregnant women. A normal saline enema is associated with lessened danger of excess fluid absorption.

Which are causes of diarrhea? Select all that apply.

*A. Antibiotic use B. Lack of exercise *C. Clostridium difficile D. Reduced fluid intake *E. Surgeries of the lower gastrointestinal tract RATIONALE: Antibiotic use, Clostridium difficile, and surgeries and diagnostic testing of the lower gastrointestinal tract may cause diarrhea. Lack of exercise and reduced fluid intake may cause constipation.

Which medication could increase a patient's risk of gastric bleeding?

*A. Aspirin B. Glycopyrrolate C. Dicyclomine HCl D. Iron supplements RATIONALE: Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain. It is a prostaglandin inhibitor. Aspirin interferes with the secretion of protective mucus and thereby increases the risk of gastric bleeding. Glycopyrrolate inhibits gastric acid secretion and depresses gastrointestinal motility; it does not increase the risk of gastric bleeding. Dicyclomine HCl suppresses peristalsis and decreases gastric emptying; it does not increase the risk of gastric bleeding. Iron supplements cause discoloration of the stool, nausea, constipation, and abdominal cramps as side effects.

Which medication is used to treat hyperactive bowel disorder?

*A. Atropine B. Polycarbophil C. Casanthranol D. Docusate calcium RATIONALE: Atropine is an anticholinergic drug that inhibits gastric acid secretion and depresses gastrointestinal motility. It is used to treat patients with hyperactive bowel disorder. Polycarbophil is used to treat constipation. Docusate calcium is a stool softener and is used as a short-term therapy to relieve straining on defecation. Casanthranol is used to cleanse and prepare the bowel for diagnostic procedures.

A patient reports a noxious change in odor while defecating. What is most likely to be the cause of this?

*A. Blood in feces B. Ingestion of beets C. Absence of bile in feces D. Malabsorption syndrome RATIONALE: Blood in the feces can cause a noxious change in the odor of feces. The ingestion of beets may cause the feces to appear red. The absence of bile in feces causes the feces to become white or clay-like in color. Malabsorption syndrome causes oily stools. TEST-TAKING TIP: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers.

Which is an example of a diagnostic test that uses direct visualization of the gastrointestinal tract?

*A. Endoscopy B. Barium enema C. Colonic transit study D. Anorectal manometry RATIONALE: An endoscopy uses direct visualization of the gastrointestinal tract. A barium enema, a colonic transit study, and an anorectal manometry all use indirect visualization. TEST-TAKING TIP: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question.

The nurse observes the presence of a tympanic note when percussing the abdomen of a patient. What would be the probable cause for the presence of a tympanic note?

*A. Gas B. Fluid C. Tumor D. Thick pus RATIONALE: Percussion is a method of physical examination that helps the healthcare provider or nurse to listen to the sounds produced by the body. The presence of gas gives a tympanic note on percussion in the abdomen. Fluid, tumor, masses, and thick pus have a dull note on percussion of the abdomen. TEST-TAKING TIP: Think of a timpani drum (filled with air) when you need to recall that a tympanic note reflects gas in the intestines. Search for images of a timpani drum online to help your visual memory.

Which statement about fecal incontinence is correct?

*A. It is the inability to control the passage of feces and gas from the anus. B. It is an increase in the number of stools and the passage of liquid, unformed feces. C. It results when a patient has unrelieved constipation and is unable to expel the hardened feces retained in the rectum. D. It is characterized by infrequent bowel movements (less than three per week) and hard, dry stools that are difficult to pass. RATIONALE: Fecal incontinence is the inability to control the passage of feces and gas from the anus. Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. Fecal impaction results when a patient has unrelieved constipation and is unable to expel the hardened feces retained in the rectum. Constipation is characterized by infrequent bowel movements (less than three per week) and hard, dry stools that are difficult to pass.

A patient is admitted for lower gastrointestinal (GI) bleeding. What color of stool would the nurse anticipate the patient to have?

*A. Red B. Black C. Green D. Orange RATIONALE: Red-colored stool indicates lower gastrointestinal (GI) bleeding. Upper GI bleeding would result in black stools. Green and orange stools are not an indicator of bleeding.

A patient is admitted to the hospital with constipation. Which could be a possible reason?

*A. Reduced fluid intake B. Vigorous exercise C. Antibiotic use via any route D. Food allergies RATIONALE: A reduced fluid intake may make the stool hard and difficult to pass, causing constipation. A lack of exercise usually results in constipation due to slow peristalsis. Antibiotic use destroys the intestinal flora and causes diarrhea. Food allergies also tend to induce diarrhea by increasing the peristalsis.

Upon auscultating the abdomen of a patient with a stethoscope, the nurse hears high-pitched and hyperactive bowel sounds. What might this indicate?

*A. Small intestine obstruction B. Normal bowel activity C. Fluid or gas within the abdomen D. Effects of abdominal surgery RATIONALE: High-pitched and hyperactive bowel sounds are heard on auscultation in cases of small intestine obstruction and inflammatory disorders. Normal bowel sounds do not sound like this and occur every 5 to 15 seconds and last a second to several seconds. Percussion, not auscultation, is used to identify fluid or gas within the abdomen. Absent (no auscultated bowel sounds), or hypoactive, sounds occur with an ileus, such as after abdominal surgery.

Which statement by a patient with an ileostomy indicates the need for additional teaching?

A. "I'll change the pouch before it begins to leak." B. "I can eat dairy products after I recover from my surgery." *C. "I won't drink too much so the amount of stool is less." D. "I won't need to buy new clothing that better accommodates the pouch." RATIONALE: A patient with an ileostomy should maintain a daily fluid intake of at least 3 L to prevent blockage. Limiting fluid intake can lead to complications. If the patient makes this statement, additional teaching is needed. The pouch needs to be changed before it starts leaking, because leakage can irritate the surrounding skin. The patient can eat anything, including dairy products, once the conduit matures. The patient can wear normal clothes with the conduit; there is no need to buy new clothes to accommodate the ileostomy.

A nursing student is learning about laxatives and cathartics. Which statement if made by the nursing student indicates effective learning?

A. "Laxatives have a stronger effect than cathartics." B. "Oral laxatives are faster acting than suppositories." C. "A suppository should be given immediately before a meal." *D. "Suppositories usually start acting within 30 minutes of application." RATIONALE: Suppositories such as bisacodyl act within 30 minutes. Although the terms laxative and cathartic are often used interchangeably, cathartics generally have a stronger and more rapid effect on the intestines. Laxatives prepared as suppositories may act more quickly than oral laxatives because of their stimulant effect on the rectal mucosa. A suppository should be given shortly before a patient's usual time to defecate or immediately after a meal.

Which time interval between consecutive bowel sounds is a normal finding?

A. 3 seconds *B. 12 seconds C. 18 seconds D. 23 seconds RATIONALE: Normal bowel sounds occur every 5 to 15 seconds. Therefore, a gap of 12 seconds between consecutive bowel sounds is a normal finding.

A patient starts to experience pain while receiving an enema. The nurse notes blood in the return fluid and rectal bleeding. Which action should the nurse take first?

A. Administer pain medication. B. Slow down the rate of instillation. C. Tell the patient to breathe slowly and relax. *D. Stop the instillation and obtain vital signs. RATIONALE: Bleeding is an unexpected outcome. The nurse should stop the procedure, obtain vital signs, and call the health care provider because this is a medical emergency. The nurse should not continue the procedure.

A patient has been diagnosed with malabsorption of fat from the intestine. What would be the color of the patient's stool?

A. Black B. Clay-colored *C. Pale and oily D. White-colored RATIONALE: Malabsorption of fat can lead to pale and oily stools. Black-colored stools indicate iron ingestion or gastrointestinal (GI) bleeding. White or clay-colored stools indicate the absence of bile.

Which substance may cause complications for a patient who has kidney dysfunction?

A. Castor oil B. Mineral oil C. Docusate sodium *D. Magnesium hydroxide RATIONALE: Magnesium hydroxide produces an osmotic effect by pulling water into the bowel. As water moves into the bowel, it increases the pressure in the bowel and increases peristalsis. Magnesium hydroxide is contraindicated in patients with kidney dysfunction because it causes a toxic buildup of magnesium in the body. Castor oil is a stimulant cathartic but does not result in magnesium toxicity. Mineral oil and docusate sodium are not contraindicated for patients with kidney dysfunction, because they do not cause magnesium toxicity.

Which medication may be used to promote defecation?

A. Codeine *B. Laxatives C. Loperamide D. Opium tincture RATIONALE: Laxatives are often prescribed to promote defecation in patients with constipation. Codeine and opium tincture may be used to manage chronic severe diarrhea in patients with Crohn's disease, ulcerative colitis, or acquired immunodeficiency syndrome. Loperamide is also an antidiarrheal agent.

Which is the most commonly used antidiarrheal agent?

A. Codeine B. Polycarbophil C. Tincture of opium *D. Diphenoxylate with atropine RATIONALE: The most commonly used antidiarrheal agents are loperamide or diphenoxylate with atropine. Codeine or tincture of opium may be used to manage chronic severe diarrhea in patients with diseases such as Crohn's disease, ulcerative colitis, and acquired immunodeficiency syndrome (AIDS). Polycarbophil is a bulk-forming laxative that is used to relieve mild diarrhea.

The nurse is taking a health history of a newly admitted patient with a diagnosis Rule/out bowel obstruction. Which is the priority question to ask the patient?

A. Describe your bowel movements. B. How often do you have a bowel movement? *C. When was the last time you had a bowel movement? D. Do you routinely use stool softeners, laxatives, or enemas? RATIONALE: Lack of a bowel movement is a sign of a bowel obstruction and is a medical emergency.

Which of these is the most likely result of improper diet, reduced fluid intake, and lack of exercise?

A. Diarrhea B. Flatulence C. Constipation D. Incontinence RATIONALE: Constipation is a symptom, not a disease, and has many possible causes, including improper diet, reduced fluid intake, lack of exercise, and certain medications. Diarrhea is another symptom associated with disorders affecting digestion, absorption, and secretion in the gastrointestinal tract. Flatulence is caused when gas accumulates in the lumen of the intestines and the bowel stretches and distends. Incontinence is caused by physical conditions that impair anal sphincter function or large-volume liquid stools. TEST-TAKING TIP: The most reliable way to ensure that you select the correct response to a multiple choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and based on this what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look right, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question.

During the nursing assessment, a patient reveals that he has diarrhea and cramping every time he has ice cream. He attributes this to the cold nature of the food. However, the nurse begins to suspect that these symptoms are associated with which condition?

A. Food allergy B. Irritable bowel *C. Lactose intolerance D. Decreased peristalsis RATIONALE: This patient possibly lacks the enzyme needed to digest milk sugar lactase and therefore is potentially lactose intolerant. Lactose intolerance is not a food allergy but rather a food intolerance that increases peristalsis, not decreases. Based on the circumstances of the condition, irritable bowel is not indicated. TEST-TAKING TIP: Remember that lact- means milk, as in lactation. Milk-containing products may produce diarrhea in lactose-intolerant patients. Lactose is the sugar (- ose is the suffix indicating sugar), and lactase (- ase indicates enzyme) is the enzyme that breaks down lactose.

Which may be recommended for a patient in whom fecal impaction is suspected?

A. Gastroscopy B. Barium swallow C. Fecal occult blood test *D. Digital examination of the rectum RATIONALE: Digital examination of the rectum may be recommended for a patient in whom fecal impaction is suspected. Gastroscopy is used to gain direct visualization of the upper gastrointestinal tract. A barium swallow is a radiographic examination using an opaque contrast medium (barium, which is swallowed) to examine the structure and motility of the upper gastrointestinal tract. The fecal occult blood test is a stool test to measure microscopic amounts of blood in the feces. These examinations may not be recommended for a patient in whom fecal impaction is suspected. TEST-TAKING TIP: Identify option components as correct or incorrect. This may help you identify a wrong answer.

What is the mode of action of emollient laxatives?

A. Increasing pressure in the bowel *B. Lowering the surface tension of feces C. Causing local irritation to the intestinal mucosa D. Inhibiting reabsorption of water in the large intestine RATIONALE: Emollient laxatives or stool softeners are detergents that lower surface tension of feces, allowing water and fat to penetrate. Saline-based laxatives have an osmotic effect that increases pressure in bowel to act as stimulant for peristalsis. Stimulant cathartics cause local irritation to the intestinal mucosa, increase intestinal motility, and inhibit reabsorption of water in the large intestine. RATIONALE:

Which medication may cause constipation?

A. Laxatives B. Antibiotics C. Cathartics *D. Opioid analgesics RATIONALE: Opioid analgesics slow peristalsis and contractions, thereby causing constipation. Laxatives and cathartics are often prescribed to promote defecation in patients with constipation; they do not cause constipation. Antibiotics decrease intestinal bacterial flora, thereby causing diarrhea.

The nurse is teaching a patient healthy bowel habits. Which information should be included in the teaching? Select all that apply.

A. Laxatives should be used regularly. *B. Dietary fibers should be an essential component of the diet. *C. Fluid intake should be at least 6 to 8 glasses of water per day. D. Physical exercises should be avoided to prevent constipation. *E. Stress management techniques should be practiced. RATIONALE: Consuming dietary fiber increases the bulk of stool and helps in better bowel elimination. Maintaining adequate fluid intake increases the water content of the stool, prevents it from hardening, and permits easy passage through the rectum and anus. Stress can cause constipation; therefore, the patient should be instructed to practice stress management techniques. Laxatives should not be used regularly, because the bowel becomes habituated to laxative use. Physical activity helps prevent constipation by facilitating bowel movements. TEST-TAKING TIP: Reread the question if the answers do not seem to make sense, because you may have missed key words in the statement. One of the choices includes the word, "avoided," which is key to not choosing that response.

A nurse is caring for immobilized patients in a hospital setting. Which action taken by the nurse while positioning patients on a bedpan will help them evacuate bowel contents without discomfort?

A. Lifting the patient onto the bedpan *B. Rolling the patient onto the bedpan C. Elevating the head of the patient's bed 15 to 25 degrees D. Providing a smaller fracture pan to a patient with a humerus fracture RATIONALE: When positioning an immobilized patient on a bedpan, the nurse should roll the patient onto the bedpan to ensure the patient's safety. The nurse should never try to lift the patient onto a bedpan. After a patient is positioned on a bedpan, the nurse should elevate the head of the patient's bed 30 to 45 degrees, not 15 to 25 degrees. A smaller fracture pan should be provided to patients with leg fractures, not arm fractures.

The nurse is caring for a 78-year-old man with diarrhea. Which problem is the most important to consider?

A. Malnutrition *B. Dehydration C. Skin breakdown D. Incontinence RATIONALE: Diarrhea interferes with absorption time of digestive juices. With frequent loose, watery stools, dehydration becomes a major problem in the older adult. Skin breakdown is another outcome of diarrhea that should be prevented with meticulous hygiene, though it is not the most important factor to consider. Malnutrition and incontinence are not the most important factors to consider in this case.

A patient presents with abdominal discomfort, and the nurse auscultates 40 bowel sounds in 1 minute. Which pattern of bowel sounds would the nurse document?

A. Normal B. Hypoactive *C. Hyperactive D. Tympanic note RATIONALE: Bowel activity of more than 35 sounds per minute is considered hyperactive. Normal bowel sounds occur every 5 to 15 seconds, and each sound lasts for one to a few seconds. Hypoactivity is defined as less than 5 bowel sounds per minute. A tympanic note is not an auscultation finding, it is a percussion finding. STUDY TIP: Practice listening to the bowel sounds of a family member or classmate and counting them for one minute. Compare the counts you obtain to the ranges of hypoactive, normal, and hyperactive bowel sounds. Do this at different times of the day and before and after meals until you are certain you have the ranges memorized.

A nurse collects a stool specimen for an ordered occult blood laboratory test. Which statement is correct about the sample collection procedure for this test?

A. Only liquid stools can be collected for performing this test. B. The samples should be collected over a 3- to 5-day period. C. At least 40 mL of liquid stool should be collected for performing the test. *D. A 3-cm (1-in) mass of formed stool is an adequate sample size for this test. RATIONALE: Tests performed by the laboratory for occult (microscopic) blood in the stool and the stool cultures require only a small sample. If the patient passes formed stools, a 3-cm (1-in) mass of formed stool is sufficient. The patient does not need to pass only liquid stools for the test to be performed. Tests for measuring the output of fecal fat require a 3- to 5-day collection of stool. A single sample is sufficient for performing a fecal occult blood test. If the patient passes liquid stools, the amount of fecal matter required to test for fecal occult blood ranges from 15 to 30 mL.

Which is an osmotic agent used to treat constipation?

A. Polycarbophil B. Casanthranol C. Docusate potassium *D. Sodium phosphate RATIONALE: Sodium phosphate is an osmotic agent used to treat constipation. Polycarbophil is a bulk-forming agent. Casanthranol is a stimulant cathartic. Docusate potassium is an emollient.

A mother reports that her baby passes stools five times daily. How should the nurse handle this situation?

A. Promote maternal intake of a high-fiber diet. B. Advise the mother to shift to bottle feeding. C. Administer a dose of antidiarrheal medication. *D. Convince the mother that this is normal for infants. RATIONALE: The normal frequency of bowel evacuation for infants who are breastfed is 4 to 6 times daily; therefore, this child is normal. Maternal fiber intake does not relieve diarrhea in infants. There is no need to shift to bottle feeding. Because the infant's bowel movements are normal, antidiarrheal medication is not needed.

Which patient needs to use a fracture pan for a bowel movement?

A. The patient who is obese B. The patient experiencing confusion C. The patient on bed rest *D. A patient recovering from hip surgery RATIONALE: A fracture pan is used for a patient with back or lower-extremity health issues. Because a fracture pan is shallow in comparison to a regular bedpan, the fracture pan prevents disturbing the patient's body alignment.

The nurse gives a patient an enema using a prepackaged disposable container. Why would the nurse expel air from the enema container before inserting the tip into the patient's rectum?

A. To promote defecation B. To prevent trauma to the rectal mucosa *C. To minimize distention and discomfort in the colon D. To promote relaxation of the external rectal sphincter RATIONALE: The nurse expels air from the enema container before inserting the tip of the bottle into the rectum to minimize the introduction of air into the colon. Introducing air into the colon causes distention and discomfort. To promote defecation after applying the enema, the patient should maintain a normal sitting position. For this, the nurse helps the patient to the bathroom or helps to position the patient on the bedpan. To prevent trauma to the rectal mucosa, the nurse inserts the tip of the container gently into the rectum toward the umbilicus. To promote relaxation of the external rectal sphincter, the nurse instructs the patient to relax by breathing out slowly through mouth while inserting the tipoff the bottle into the rectum.