Ch 47- Mgmt of Pt with intestinal and rectal disorders, MedSurg Chapter 47: PrepU, Intestinal and Rectal Disorders Prep U, prep chapter 48, LWW - Ch. 47: Mgmt of Patients With Intestinal and Rectal Disorders, Chapter 48 Management of Patients with In…

A nurse is helping to plan a teaching session for a client who will be discharged with a colostomy. Which statement describes a healthy stoma?

"At first, the stoma may bleed slightly when touched."

A client with Crohn's disease is to receive prednisone as part of the treatment plan. Which of the following instructions would be appropriate?

"Avoid contact with other people who might have an infection."

A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult?

"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread."

A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult?

"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." Explanation: The client stating that he ate roast beef on rye bread indicates the need for a dietary consult because rye bread contains gluten, which must be eliminated from the client's diet. The client stating that he's followed the ordered medication regimen and diet doesn't suggest that the client needs a dietary consult; a treatment regimen consisting of medications to improve symptoms and dietary modification is necessary to treat celiac disease. The client stating that he hasn't traveled outside of the country doesn't suggest that dietary concerns exist. The client saying that he can't have oatmeal shows an understanding of the dietary restrictions necessary with celiac disease.

A nurse is teaching an elderly client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required?

"I need to use laxatives regularly to prevent constipation."

A home health nurse who sees a client with diverticulitis is evaluating teaching about dietary modifications necessary to prevent future episodes. Which statement by the client indicates effective teaching?

"I should increase my intake of fresh fruits and vegetables during remissions."

A nurse is teaching an older adult client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required? - "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread." - "I need to use laxatives regularly to prevent constipation." - "I should exercise four times per week." - "I need to drink 2 to 3 liters of fluids every day."

- "I need to use laxatives regularly to prevent constipation."

Medical management of a patient with peritonitis includes fluid, electrolyte, and colloid replacement. The nurse knows to prepare the initial, most appropriate intravenous solution. Which of the following is the correct solution? - 0.9% NS - D5W - D10W - 0.45% of NS

- 0.9% NS

A nurse is preparing a presentation for a local community group of older adults about colon cancer. What would the nurse include as the primary characteristic associated with this disorder? - Frank blood in the stool - A change in bowel habits - Abdominal distention - Abdominal pain

- A change in bowel habits

In addition to teaching a client with constipation to increase dietary fiber intake to 25 g/day, which of the following would the nurse include as important? - Avoiding bran cereals and beans in the diet - Adding fiber-rich foods to the diet gradually - Limiting fluid intake to 5 to 6 glasses per day - Minimizing activity levels for at least 2 months

- Adding fiber-rich foods to the diet gradually

The nurse is performing a rectal assessment and notices a longitudinal tear or ulceration in the lining of the anal canal. The nurse documents the finding as which condition? - Anal fistula - Anorectal abscess - Hemorrhoid - Anal fissure

- Anal fissure

A patient arrives in the emergency department with complaints of right lower abdominal pain that began 4 hours ago and is getting worse. The nurse assesses rebound tenderness at McBurney's point. What does this assessment data indicate to the nurse? - Diverticulitis - Ulcerative colitis - Appendicitis - Crohn's disease

- Appendicitis

A client with anorexia reports constipation. Which nursing measure would be most effective in helping the client reduce constipation? - Assist client to increase dietary fiber. - Obtain medical and allergy history. - Provide adequate quantity of food. - Obtain complete food history.

- Assist client to increase dietary fiber.

A client with anorexia reports constipation. Which nursing measure would be most effective in helping the client reduce constipation? - Obtain medical and allergy history. - Assist client to increase dietary fiber. - Obtain complete food history. - Provide adequate quantity of food.

- Assist client to increase dietary fiber.

Which of the following would a nurse expect to assess in a client with peritonitis? - Board-like abdomen - Deep slow respirations - Decreased pulse rate - Hyperactive bowel sounds

- Board-like abdomen

Which of the following would a nurse expect to assess in a client with peritonitis? - Decreased pulse rate - Deep slow respirations - Board-like abdomen - Hyperactive bowel sounds

- Board-like abdomen

The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's notes? - Loud bowel sounds - Borborygmus - Tenesmus - Peristalsis

- Borborygmus

The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition? - Borborygmus - Tenesmus - Azotorrhea - Diverticulitis

- Borborygmus

Which term refers to intestinal rumbling? - Tenesmus - Azotorrhea - Borborygmus - Diverticulitis

- Borborygmus

A patient is admitted to the hospital after not having had a bowel movement in several days. The nurse observes the patient is having small liquid stools, a grossly distended abdomen, and abdominal cramping. What complication can this patient develop related to this problem? - Appendicitis - Rectal fissures - Bowel perforation - Diverticulitis

- Bowel perforation

The nurse is talking with a group of clients who are older than age 50 years about the recognition of colon cancer to access early intervention. What should the nurse inform the clients to report immediately to their primary care provider? - Excess gas - Daily bowel movements - Abdominal cramping when having a bowel movement - Change in bowel habits

- Change in bowel habits

Which is the most common presenting symptom of colon cancer? - Fatigue - Change in bowel habits - Anorexia - Weight loss

- Change in bowel habits

A client informs the nurse that he has been having abdominal pain that is relieved when having a bowel movement. The client states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder? - Chronic constipation with sporadic bouts of diarrhea - Weight loss due to malabsorption - Blood and mucus in the stool - Client is awakened from sleep due to abdominal pain.

- Chronic constipation with sporadic bouts of diarrhea

A client informs the nurse that he has been having abdominal pain that is relieved when having a bowel movement. The client states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder? - Weight loss due to malabsorption - Blood and mucus in the stool - Chronic constipation with sporadic bouts of diarrhea - Client is awakened from sleep due to abdominal pain.

- Chronic constipation with sporadic bouts of diarrhea

A client is being treated for diverticulosis. Which points should the nurse include in this client's teaching plan? Select all that apply.

- Do not suppress the urge to defecate. - Drink at least 8 to 10 large glasses of fluid every day.

The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching? - Avoid daily exercise. - Use laxatives weekly. - Avoid unprocessed bran. - Drink 8 to 10 glasses of fluid daily.

- Drink 8 to 10 glasses of fluid daily.

The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation? - Apply triamcinolone acetonide spray - Apply barrier powder - Dust with nystatin powder - Dry skin thoroughly after washing

- Dry skin thoroughly after washing

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? - Age younger than 40 years - Low-fat, low-protein, high-fiber diet - History of skin cancer - Familial polyposis

- Familial polyposis

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? - Familial polyposis - Age younger than 40 years - History of skin cancer - Low-fat, low-protein, high-fiber diet

- Familial polyposis

Which characteristic is a risk factor for colorectal cancer? - Familial polyposis - Low-fat, low-protein, high-fiber diet - Age younger than 40 years - History of skin cancer

- Familial polyposis

The nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be - Diarrhea - Fecal incontinence - Dark, tarry stools - Hemorrhoids

- Fecal incontinence

The nurse in an extended-care facility reports that a resident has clinical manifestations of fecal incontinence. The health care provider orders a diagnostic study to rule out inflammation. Which study will the nurse prepare the client for? - Anorectal manometry - Barium enema - Transit study - Flexible sigmoidoscopy

- Flexible sigmoidoscopy

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? - Gently washing the area surrounding the stoma using a facecloth and mild soap - Scrubbing fecal material from the skin surrounding the stoma - Maintaining wrinkles in the faceplate so it doesn't irritate the skin - Cutting the faceplate opening no more than 2? larger than the stoma

- Gently washing the area surrounding the stoma using a facecloth and mild soap

Which term refers to a protrusion of the intestine through a weakened area in the abdominal wall? - Tumor - Hernia - Volvulus - Adhesion

- Hernia

A patient diagnosed with IBS is advised to eat a diet that is: - Restricted to 1,200 calories/day. - Sodium-restricted. - High in fiber. - Low in residue.

- High in fiber.

An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to? - Hyponatremia - Hypernatremia - Hyperkalemia - Hypokalemia

- Hypokalemia

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process? - Normal erythrocyte sedimentation rate (ESR) - Hypotension - Bradycardia - Subnormal temperature

- Hypotension

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, what would the nurse stress the importance of? - Increasing fluid intake to prevent dehydration - Consuming a low-protein, high-fiber diet - Taking only enteric-coated medications - Wearing an appliance pouch only at bedtime

- Increasing fluid intake to prevent dehydration

Crohn's disease is a condition of malabsorption caused by which pathophysiological process? - Gastric resection - Infectious disease - Disaccharidase deficiency - Inflammation of all layers of intestinal mucosa

- Inflammation of all layers of intestinal mucosa

A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of: - A small bowel disorder. - Intestinal malabsorption. - Inflammatory colitis. - A disorder of the large bowel.

- Intestinal malabsorption.

The nurse is conducting a community education program on colorectal cancer. Which statement should the nurse include in the program? - It is the third most common cancer in the United States. - The lifetime risk of developing colorectal cancer is 1 in 10. - The incidence of colorectal cancer decreases with age. - Colorectal cancer has no hereditary component.

- It is the third most common cancer in the United States.

A patient with irritable bowel syndrome has been having more frequent symptoms lately and is not sure what lifestyle changes may have occurred. What suggestion can the nurse provide to identify a trigger for the symptoms? - Discontinue the use of any medication presently being taken to determine if medication is a trigger. - Keep a 1- to 2-week symptom and food diary to identify food triggers. - Document how much fluid is being taken to determine if the patient is overhydrating. - Begin an exercise regimen and biofeedback to determine if external stress is a trigger.

- Keep a 1- to 2-week symptom and food diary to identify food triggers.

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? - Calorie restriction - Low residue - Iron restriction - Low protein

- Low residue

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? - Iron restriction - Low protein - Calorie restriction - Low residue

- Low residue

As part of the management of constipation, the client is instructed to take 30 mL of mineral oil orally. How does mineral oil facilitate bowel evacuation? - Irritates nerve endings in the intestinal mucosa - Lubricates and softens fecal matter - Increases the volume of intestinal contents - Decreases water retention of stool

- Lubricates and softens fecal matter

Vomiting results in which of the following acid-base imbalances? - Metabolic acidosis - Metabolic alkalosis - Respiratory alkalosis - Respiratory acidosis

- Metabolic alkalosis

When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? - Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. - Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. - The appendix may develop gangrene and rupture, especially in a middle-aged client. - Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

- Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

A client with a diagnosis of acute appendicitis is awaiting surgical intervention. The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and boardlike. What complication does the nurse determine may be occurring at this time? - Accumulation of gas - Constipation - Paralytic ileus - Peritonitis

- Peritonitis

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of: - An ileus. - A pelvic abscess. - Peritonitis - An abscess under the diaphragm.

- Peritonitis

The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication? - Peritonitis - Pelvic abscess - Ileus - Hemorrhage

- Peritonitis

A nurse is interviewing a client about past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? - Hemorrhoids - Weight gain - Duodenal ulcers - Polyps

- Polyps

Which of the following is the most common symptom of a polyp? - Abdominal pain - Rectal bleeding - Anorexia - Diarrhea

- Rectal bleeding

A nurse is caring for a client who had an ileo conduit 3 days earlier. The nurse examines the stoma site and determines that she should consult with the ostomy nurse. Which assessment finding indicates the need for further consultation? - Stoma site not sensitive to touch - Beefy red stoma site - Clear mucus mixed with yellow urine drained from the appliance bag - Red, sensitive skin around the stoma site

- Red, sensitive skin around the stoma site

Which category of laxatives draws water into the intestines by osmosis? - Bulk-forming agents (e.g., psyllium) - Saline agents (e.g., magnesium hydroxide) - Stimulants (e.g., bisacodyl) - Fecal softeners (e.g., docusate)

- Saline agents (e.g., magnesium hydroxide)

Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction? - Purulent drainage from the gluteal fold - Decreased blood pressure - Sudden, sustained abdominal pain - Decreased urine output

- Sudden, sustained abdominal pain

A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client? - Suggest fluid intake of at least 2 L/day - Instruct the client to keep a record of food intake - Assist the client regarding the correct diet or to minimize food intake - Instruct the client to avoid prune or apple juice

- Suggest fluid intake of at least 2 L/day

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care? - Prepare the client for a gastrostomy tube placement. - Administer topical ointment to the rectal area to decrease bleeding. - Administer morphine (Duramorph PF) routinely, as ordered. - Test all stools for occult blood.

- Test all stools for occult blood.

A client realizes that regular use of laxatives has greatly improved bowel patterns. However, the nurse cautions this client against the prolonged use of laxatives for which reason? - The client may develop arthritis or arthralgia. - The client's natural bowel function may become sluggish. - The client may lose his or her appetite. - The client may develop inflammatory bowel disease.

- The client's natural bowel function may become sluggish.

A client tells the nurse, "I am not having normal bowel movements." When differentiating between what are normal and abnormal bowel habits, what indicators are the most important? - That the client has a bowel movement daily - That the stool is formed and soft - The client is able to fully evacuate with each bowel movement - The consistency of stool and comfort when passing stool

- The consistency of stool and comfort when passing stool

A client tells the nurse, "I am not having normal bowel movements." When differentiating between what are normal and abnormal bowel habits, what indicators are the most important? - The consistency of stool and comfort when passing stool - That the client has a bowel movement daily - That the stool is formed and soft - The client is able to fully evacuate with each bowel movement

- The consistency of stool and comfort when passing stool

The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation? - Alcohol consumption - Activity levels - Usual pattern of elimination - Current medications

- Usual pattern of elimination

A client is admitted to the emergency department with reports right lower quadrant pain. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the health care provider immediately? - White blood cell (WBC) count 22.8/mm3 - Hematocrit 42% - Serum sodium 135 mEq/L - Serum potassium 4.2 mEq/L

- White blood cell (WBC) count 22.8/mm3

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: - caffeinated products. - spicy foods. - high-fiber diet. - fluids with meals.

- high-fiber diet.

The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for: - hyperkalemia. - hypokalemia. - hyponatremia. - hypernatremia.

- hypokalemia.

The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for: - hypernatremia. - hyponatremia. - hyperkalemia. - hypokalemia.

- hypokalemia.

A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation? - lack of free water intake - lack of solid food - lack of exercise - increased fiber

- lack of free water intake

Which client requires immediate nursing intervention? The client who: - complains of epigastric pain after eating. - complains of anorexia and periumbilical pain. - presents with a rigid, boardlike abdomen. - presents with ribbonlike stools.

- presents with a rigid, boardlike abdomen.

A client is admitted from the emergency department with complaints of severe abdominal pain and an elevated white blood cell count. The physician diagnoses appendicitis. The nurse knows the client is at greatest risk for: - rupture of the appendix. - emotional distress related to the pain. - inflammation of the gallbladder. - ulceration of the appendix.

- rupture of the appendix.

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's: - alcohol consumption. - usual pattern of elimination. - current medications. - activity levels.

- usual pattern of elimination.

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's: - usual pattern of elimination. - alcohol consumption. - activity levels. - current medications.

- usual pattern of elimination.

The nurse is caring for four clients with diarrhea. Which client is most likely to be diagnosed with Crohn's disease?

A 24 year-old Caucasian eastern European Jewish female

A nurse is preparing a presentation for a local community group of older adults about colon cancer. Which of the following would the nurse include as the primary characteristic associated with this disorder?

A change in bowel habits

A nurse is preparing a presentation for a local community group of older adults about colon cancer. Which of the following would the nurse include as the primary characteristic associated with this disorder?

A change in bowel habits Explanation: Although abdominal distention and blood in the stool (frank or occult) may be present, the chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Abdominal pain is a late sign.

2

A client has developed an anorectal abscess. Which client is at most risk for the development of this type of abscess? 1. A client with hemorrhoids 2. A client with Crohn's disease 3. A client with diverticulosis 4, A client with colon cancer

2

A client informs the nurse that he has been having abdominal pain that is relieved when having a bowel movement. The client states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder? 1. Blood and mucus in the stool 2. Chronic constipation with sporadic bouts of diarrhea 3. Weight loss due to malabsorption 4. Client is awakened from sleep due to abdominal pain.

Test all stools for occult blood.

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care?

2

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care? 1. Prepare the client for a gastrostomy tube placement. 2. Test all stools for occult blood. 3.Administer morphine (Duramorph PF) routinely, as ordered. 4. Administer topical ointment to the rectal area to decrease bleeding.

b

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care? a) Administering an ointment b) Testing all stools for occult blood. c) Administering an opioid pain medication. d) Preparing a client for a gastrostomy tube.

Right lower quadrant

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location?

Drink at least 8-10 large glasses of fluid every day.

A client is being treated for diverticulosis. Which information should the nurse include in the client's teaching plan?

Drink at least 8 to 10 large glasses of fluid every day

A client is being treated for diverticulosis. Which information should the nurse include in this client's teaching plan?

"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread."

A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult?

2

A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult? 1. "I don't like oatmeal, so it doesn't matter that I can't have it." 2. "I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." 3. "I don't understand this; I took the medication the doctor ordered and followed the diet." 4. "I don't understand why this happened again; I didn't travel out of the country."

The client's natural bowel function may become sluggish.

A client realizes that regular use of laxatives has greatly improved his bowel pattern. However, the nurse cautions this client against the prolonged use of laxatives for which reason?

Fissure

A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a:

4

A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a: 1. hemorrhoid. 2. fistula. 3. pilonidal cyst. 4. fissure.

b

A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a: a) anorectal fistula b) anal fissure c) anal polyp d) hemorrhoids

every 4-6 hours

A client underwent a continent ileostomy. Within which time frame should the client expect to empty the reservoir?

Suggest fluid intake of atleast 2L/day

A client who has undergone colostomy surgery is experience constipation. Which intervention should a nurse consider for such a client?

Suggest fluid intake of at least 2 L/day

A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client?

1

A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client? 1. Suggest fluid intake of at least 2 L/day 2. Instruct the client to avoid prune or apple juice 3. Assist the client regarding the correct diet or to minimize food intake 4. Instruct the client to keep a record of food intake

A client has developed an anorectal abscess. Which client is at most risk for the development of this type of abscess?

A client with Crohn's disease

3

A client with a diagnosis of acute appendicitis is awaiting surgical intervention. The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and boardlike. What complication does the nurse determine may be occurring at this time? 1. Constipation 2. Paralytic ileus 3. Peritonitis 4. Accumulation of gas

Assist client to increase dietary fiber.

A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation?

a

A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation? a) Assisting to increase dietary fiber. b) Providing an adequate quantity of food. c) Obtaining medications and allergy history. d) Obtain medical and food history.

d

A longitudinal tear or ulceration in the lining of the anal canal is termed a(n): a) Hemorrhoid b) Anorectal abscess c) Anal fistula d) Anal fissure

Anal fissure

A longitudinal tear or ulceration in the lining of the anal canal is termed an

c

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is MOST appropriate? a) Cutting the faceplate opening no more than 2" larger than the stoma b) Scrubbing the area around the stoma c) Gently washing the area surrounding the stoma using a facecloth and mild soap d) Eliminating wrinkles in the faceplate

Gently washing the area surrounding the stoma using a facecloth and mild soap

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate?

a

A nurse is interviewing a client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? a) Polyps b) Hemorrhoids c) Duodenal ulcers d) Weight gain

A change in bowel habits

A nurse is preparing a presentation for a local community group of older adults about colon cancer. Which of the following would the nurse include as the primary characteristic associated with this disorder?

b

A nurse is preparing a presentation for a local community group of older adults about colon cancer. Which of the following would the nurse include as the primary characteristic associated with this disorder? a) Frank blood in stool b) Change in bowel habits c) Change in dietary habits d) Abdominal pain

"I need to use laxatives regularly to prevent constipation."

A nurse is teaching an older adult client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required?

1

A nurse is teaching an older adult client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required? 1. "I need to use laxatives regularly to prevent constipation." 2. "I need to drink 2 to 3 liters of fluids every day." 3. "I should exercise four times per week." 4. "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread."

Appendicitis

A patient arrives in the emergency department with complaints of right lower abdominal pain that began 4 hours ago and is getting worse. The nurse assesses rebound tenderness at McBurney's point. What does this assessment data indicate to the nurse?

High in fiber.

A patient diagnosed with IBS is advised to eat a diet that is:

3

A patient with IBD would be encouraged to increase fluids, use vitamins and iron supplements, and follow a diet designed to reduce inflammation. Select the meal choice that would be recommended for a low-residue diet. 1. Salami on whole grain bread and V-8 juice 2. A peanut butter sandwich and fruit cup 3. Broiled chicken with low-fiber pasta 4. A fruit salad with yogurt

Keep a 1- to 2-week symptom and food diary to identify food triggers.

A patient with irritable bowel syndrome has been having more frequent symptoms lately and is not sure what lifestyle changes may have occurred. What suggestion can the nurse provide to identify a trigger for the symptoms?

4

A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation? 1. lack of solid food 2. lack of exercise 3. increased fiber 4. lack of free water intake

Nausea

A typical sign of appendicitis is

Common clinical manifestations of Crohn's disease include:

Abdominal pain and diarrhea.

A client is diagnosed with colon cancer, located in the lower third of the rectum. What does the nurse understand will be the surgical treatment option for this client?

Abdominoperineal resection

A nurse is caring for a client immediately following an appendectomy. The nurse should assign which nursing diagnosis the highest priority?

Acute pain

In addition to teaching a client with constipation to increase dietary fiber intake to 25 g/day, which of the following would the nurse include as important?

Adding fiber-rich foods to the diet gradually.

What is the most common cause of small bowel obstruction? Hernias Neoplasms Adhesions Volvulus

Adhesions are scar tissue that forms as a result of inflammation and infection. Adhesions are the most common cause of small bowel obstruction, followed by hernias and neoplasms. Other causes include intussusceptions, volvulus, and paralytics ileus.

Hypokalemia

An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to?

2

An older adult client in a long term care facility is concerned about bowel regularity. During a client education session, the nurse reinforces the medically acceptable definition of "regularity." What is the actual measurement of "regular"? 1. one bowel movement daily 2. stool consistency and client comfort 3. two bowel movements daily 4. one bowel movement every other day

The American Cancer Society recommends routine screening to detect colorectal cancer. Which screening test for colorectal cancer should a nurse recommend?

Annual digital examination after age 40

A patient arrives in the emergency department with complaints of right lower abdominal pain that began 4 hours ago and is getting worse. The nurse assesses rebound tenderness at McBurney's point. What does this assessment data indicate to the nurse?

Appendicitis

A patient arrives in the emergency department with complaints of right lower abdominal pain that began 4 hours ago and is getting worse. The nurse assesses rebound tenderness at McBurney's point. What does this assessment data indicate to the nurse?

Appendicitis Explanation: In up to 50% of presenting cases of appendicitis, local tenderness is elicited at McBurney's point when pressure is applied (Black & Martin, 2012) (Fig. 48-3). Rebound tenderness (i.e., production or intensification of pain when pressure is released) may be present.

A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation?

Assist client to increase dietary fiber.

A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation?

Assist client to increase dietary fiber. Explanation: The nurse should assist the client to increase the dietary fiber in her food because it helps reduce constipation. Providing an adequate quantity of food is necessary in maintaining sufficient nutrition and in sustaining normal body weight. Obtaining medical, allergy, and food history would provide valuable information, however, it would not help reduce constipation.

Which drug is considered a stimulant laxative?

Bisacodyl

A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's stoma appears dusky. How should the nurse interpret this finding?

Blood supply to the stoma has been interrupted.

Which of the following would a nurse expect to assess in a client with peritonitis?

Board-like abdomen

The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition?

Borborygmus

Which of the following is a term used to describe intestinal rumbling?

Borborygmus Explanation: Borborygmus is intestinal rumbling. Ineffective straining is tenesmus. Malabsorption is the inability of the digestive system to absorb one or more of the major vitamins, minerals, and nutrients. Decreased muscle tone that occur with aging.

The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition?

Borborygmus Explanation: Borborygmus is the intestinal rumbling caused by the movement of gas through the intestines that accompanies diarrhea. Tenesmus refers to ineffectual straining at stool. Azotorrhea refers to excess of nitrogenous matter in the feces or urine. Diverticulitis refers to inflammation of a diverticulum from obstruction (by fecal matter) resulting in abscess formation.

In women, which of the following types of cancer exceeds colorectal cancer?

Breast

In women, which of the following types of cancer exceeds colorectal cancer?

Breast Explanation: In women, only incidences of breast cancer exceed that of colorectal cancer. In men, only incidences of prostate cancer and lung cancer exceed that of colorectal cancer.

The nurse is talking with a group of clients that are older than age 50 years about the recognition of colon cancer to access early intervention. What should the nurse inform the clients to report immediately to their primary care provider?

Change in bowel habits

The nurse is talking with a group of clients who are older than age 50 years about the recognition of colon cancer to access early intervention. What should the nurse inform the clients to report immediately to their primary care provider?

Change in bowel habits Explanation: The chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Excess gas, daily bowel movements, and abdominal cramping when having a bowel movement are not indicators of colon cancer.

A patient informs the nurse that he has been having abdominal pain that is relieved when having a bowel movement. The patient states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder?

Chronic constipation with sporadic bouts of diarrhea

The nurse is irrigating a client's colostomy when the client begins to report cramping. What is the appropriate action by the nurse?

Clamp the tubing and allow client to rest.

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse?

Clamp the tubing and give the patient a rest period.

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse?

Clamp the tubing and give the patient a rest period. Explanation: When irrigating a colostomy, the nurse should allow tepid fluid to enter the colon slowly. If cramping occurs, the nurse should clamp off the tubing and allow the patient to rest before progressing. Water should flow in over a 5- to 10-minute period.

Which statement provides accurate information regarding cancer of the colon and rectum?

Colorectal cancer is the third most common site of cancer in the United States. Explanation: Cancer of the colon and rectum is the third most common site of new cancer cases in the United States. Colon cancer affects more than twice as many people as does rectal cancer (94,700 for colon, 34,700 for rectum). The incidence increases with age (the incidence is highest in people older than 85). Colon cancer occurrence is higher in people with a family history of colon cancer.

A nurse is reviewing the history and physical of a client admitted for a hemorrhoidectomy. Which predisposing condition does the nurse expect to see?

Constipation

Inflammation of all layers on intestinal mucosa

Crohn's disease is a condition of malabsorption caused by which pathophysiological process?

1

Crohn's disease is a condition of malabsorption caused by which pathophysiological process? 1. Inflammation of all layers of intestinal mucosa 2. Infectious disease 3. Gastric resection 4. Disaccharidase deficiency

The nurse is caring for a 77-year-old patient diagnosed with Crohn's disease. What would be especially important to monitor this patient for?

Dehydration Explanation: Elderly patients can become dehydrated quickly and develop low potassium levels (ie, hypokalemia) as a result of diarrhea. The nurse observes for clinical manifestations of muscle weakness, dysrhythmias, or decreased peristaltic motility that may lead to paralytic ileus. All options would be important to monitor, but especially important is monitoring for dehydration.

Which is one of the primary symptoms of irritable bowel syndrome (IBS)?

Diarrhea

4

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? 1. Calorie restriction 2. Low protein 3. Iron restriction 4. Low residue

c

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? a) Low p.o. fluids. b) Low-protein diet. c) Low residue diet. d) High-calorie diet.

high fiber diet

Diet therapy for clients diagnosed with IBS includes

high-fiber diet.

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes:

b

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: a) Encourage caffeine and alcohol consumption at mild to moderate levels. b) Encourage a high-fiber diet daily. c) Encourage increased consumption of spicy foods, lactose, fried foods, corn, and wheat. d) Increase p.o. fluids only with/during meals.

Which of the following would the nurse identify as a characteristic finding when assessing a client for pilonidal sinus?

Dilated pits of hair follicles in the cleft

A client is being treated for diverticulosis. Which information should the nurse include in this client's teaching plan?

Drink at least 8 to 10 large glasses of fluid every day Explanation: The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the physician. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.

The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation?

Dry skin thoroughly after washing

The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation?

Dry skin thoroughly after washing Explanation: The nurse should teach the client without peristomal skin irritation to dry the skin thoroughly after washing. Barrier powder, triamcinolone acetonide spray, and nystatin powder are used when the client has peristomal skin irritation and/or fungal infection.

A client has been recently diagnosed with an anorectal condition. The nurse is reviewing interventions that will assist the client with managing the therapeutic regimen. What would not be included?

Encourage the client to avoid exercise. Explanation: Activity promotes healing and normal stool patterns. Proper cleansing prevents infection and irritation. Sitz baths promote healing, decrease skin irritation, and relieve rectal spasms. Encouragement promotes compliance with therapeutic regimen and prevents complications.

A patient with an ileostomy should avoid which of the following?

Enteric-coated products

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening?

Familial polyposis

An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to?

Hypokalemia

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process?

Hypotension

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process?

Hypotension Explanation: Clinical manifestations include hypotension, increased temperature, tachycardia, and elevated ESR.

4

In addition to teaching a client with constipation to increase dietary fiber intake to 25 g/day, which of the following would the nurse include as important? 1. Limiting fluid intake to 5 to 6 glasses per day 2. Avoiding bran cereals and beans in the diet 3. Minimizing activity levels for at least 2 months 4. Adding fiber-rich foods to the diet gradually

d

In addition to teaching a client with constipation to increase dietary fiber intake to 25 g/day, which of the following would the nurse include as important? a) Avoid bran cereals and beans in the diet. b) Increasing intake of fluids, 3-4 glasses/day. c) Avoid a daily exercise regimen. d) Adding fiber-rich foods to the diet gradually.

Breast

In women, which of the following types of cancer exceeds colorectal cancer?

Crohn's disease is a condition of malabsorption caused by which pathophysiological process?

Inflammation of all layers of intestinal mucosa

When describing abdominal hernias to a group of nursing students, the instructor would identify which type as most common?

Inguinal

A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of:

Intestinal malabsorption.

The nurse is conducting a community education program on colorectal cancer. Which statement should the nurse include in the program?

It is the third most common cancer in the United States.

A patient is not having daily bowel movements and has begun taking a laxative for this problem. What should the nurse educate the patient about regarding laxative use?

Laxatives should not be routinely taken due to destruction of nerve endings in the colon. Explanation: Laxative abuse, particularly the anthracene derivatives such as senna and cascara, can lead to destruction of the nerves of the colon that are essential for normal peristalsis (Apau, 2010a).

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following?

Low residue Explanation: Oral fluids and a low-residue, high-protein, high-calorie diet with supplemental vitamin therapy and iron replacement are prescribed to meet the nutritional needs, reduce inflammation, and control pain and diarrhea.

As part of the management of constipation, the client is instructed to take 30 ml of mineral oil orally. Mineral oil facilitates bowel evacuation by

Lubricating and softening fecal matter

Vomiting results in which of the following acid-base imbalances?

Metabolic alkalosis

Which of the following is considered a bulk-forming laxative?

Metamucil

When a nurse recommends the following laxative, she emphasizes that it should not be taken with meals. Choose the laxative. Colace Dulcolax Mineral Oil Metamucil

Mineral oil should never be taken with meals because it can impair the absorption of fat-soluble vitamins and delay gastric emptying. Refer to Table 24-1 in the text.

Celiac sprue is an example of which category of malabsorption?

Mucosal disorders causing generalized malabsorption

Celiac sprue is an example of which category of malabsorption?

Mucosal disorders causing generalized malabsorption Explanation: In addition to celiac sprue, regional enteritis and radiation enteritis are examples of mucosal disorders. Examples of infectious diseases causing generalized malabsorption include small-bowel bacterial overgrowth, tropical sprue, and Whipple disease. Examples of luminal problems causing malabsorption include bile acid deficiency, Zollinger-Ellison syndrome, and pancreatic insufficiency. Postoperative gastric or intestinal resection can result in development of malabsorption syndromes.

A 75-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. An emergency room nurse is obtaining assessment data from this patient. What assessment finding is characteristic of a small bowel obstruction?

Nausea and vomiting

A 75-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. An emergency room nurse is obtaining assessment data from this patient. What assessment finding is characteristic of a small bowel obstruction?

Nausea and vomiting Explanation: Nausea and vomiting are symptoms of a small bowel obstruction. Decrease in urine production and mucosal edema are not symptoms of a bowel obstruction. The patient may defecate mucus, but this is not accompanied by stool.

The nurse is reviewing the laboratory test results of a client with Crohn's disease. Which of the following would the nurse most likely find?

Negative stool cultures Explanation: Stool cultures fail to reveal an etiologic microorganism or parasite, but occult blood and white blood cells (WBCs) often are found in the stool. Results of blood studies indicate anemia from chronic blood loss and nutritional deficiencies. The WBC count and erythrocyte sedimentation rate may be elevated, confirming an inflammatory disorder. Serum protein and albumin levels may be low because of malnutrition.

A client comes to the clinic complaining of not having a bowel movement in several days, abdominal cramping, and nausea. When the nurse puts the client on the stretcher, he vomits a large amount of fecal material. What should the first action by the nurse be?

Notify the physician.

The nurse is admitting a patient with a diagnosis of diverticulitis and assesses that the patient has a boardlike abdomen, no bowel sounds, and complains of severe abdominal pain. What is the nurse's first action?

Notify the physician. Explanation: Abdominal pain, a rigid boardlike abdomen, loss of bowel sounds, and signs and symptoms of shock occur with peritonitis. Peritonitis is typically a life-threatening emergency that requires prompt surgical intervention, and typically involves postoperative critical care monitoring due to the risk of sepsis, organ failure, and subsequent infections; thus, the nurse should notify the physician.

severe abdominal pain with direct palpation or rebound tenderness.

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find:

2

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find: 1. tenderness and pain in the right upper abdominal quadrant. 2. severe abdominal pain with direct palpation or rebound tenderness. 3. jaundice and vomiting. 4. rectal bleeding and a change in bowel habits.

When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?

Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication?

Peritonitis

A client with a diagnosis of acute appendicitis is awaiting surgical intervention. The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and boardlike. What complication does the nurse determine may be occurring at this time?

Peritonitis Explanation: Lack of bowel motility typically accompanies peritonitis. The abdomen feels rigid and boardlike as it distends with gas and intestinal contents. Bowel sounds typically are absent. The diagnosis of acute appendicitis correlates with the symptoms of rupture of the appendix and peritonitis. A paralytic ileus and gas alone do not produce these symptoms.

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of:

Peritonitis Explanation: Peritonitis is inflammation of the peritoneum, the serous membrane lining the abdominal cavity and covering the viscera. Peritonitis is typically a life-threatening emergency that requires prompt surgical intervention, and typically involves postoperative critical care monitoring due to the risk of sepsis, organ failure, and subsequent infections.

A nurse is interviewing a client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?

Polyps Explanation: Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.

b

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of: a) Ulcerative colitis b) Peritonitis c) Diverticulitis d) Diverticulosis

Which of the following is the most common symptom of a polyp?

Rectal bleeding

Which of the following is the most common symptom of a polyp?

Rectal bleeding Explanation: The most common symptom is rectal bleeding. Lower abdominal pain may also occur. Diarrhea and anorexia are clinical manifestations of ulcerative colitis.

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location?

Right lower quadrant

Which category of laxatives draws water into the intestines by osmosis?

Saline agents (e.g., magnesium hydroxide)

Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction?

Sudden, sustained abdominal pain

Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction?

Sudden, sustained abdominal pain Explanation: Sudden, sustained pain, abdominal distention, and fever are symptoms of perforation in a client with intestinal obstruction. A decrease in blood pressure and decrease in urine output are symptoms of shock. Purulent drainage from the gluteal fold is not a symptom of perforation; it only indicates that the client has developed a condition of anorectal abscess.

A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client?

Suggest fluid intake of at least 2 L/day

An elderly client asks the nurse how to treat chronic constipation. What is the best recommendation the nurse can make?

Take a stool softener such as docusate sodium (Colace) daily.

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care?

Test all stools for occult blood.

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care?

Test all stools for occult blood. Explanation: Blood in the stools is one of the warning signs of colorectal cancer. The nurse should plan on checking all stools for both frank and occult blood. The blood in the stool is coming from the colon or rectum; administering an ointment wouldn't help decrease the bleeding. Preparing a client for a gastrostomy tube isn't appropriate when diagnosing colorectal cancer. Colorectal cancer is usually painless; administering opioid pain medication isn't needed

A nurse is caring for a client who has experienced an acute exacerbation of Crohn's disease. Which statement best indicates that the disease process is under control?

The client exhibits signs of adequate GI perfusion. Explanation: Adequate GI perfusion can be maintained only if Crohn's disease is controlled. If the client experiences acute, uncontrolled episodes of Crohn's disease, impaired GI perfusion may lead to a bowel infarction. Positive self-image, a manageable level of discomfort, and intact skin integrity are expected client outcomes, but aren't related to control of the disease.

Which outcome indicates effective client teaching to prevent constipation?

The client reports engaging in a regular exercise regimen.

Which is a true statement regarding regional enteritis (Crohn's disease)?

The clusters of ulcers take on a cobblestone appearance.

Which of the following is a true statement regarding regional enteritis (Crohn's disease)? It has a progressive disease pattern. It is characterized by lower left quadrant abdominal pain. The clusters of ulcers take on a cobblestone appearance. The lesions are in continuous contact with one another.

The clusters of ulcers take on a cobblestone appearance.

A client tells the nurse, "I am not having normal bowel movements." When differentiating between what are normal and abnormal bowel habits, what indicators are the most important?

The consistency of stool and comfort when passing stool Explanation: In differentiating normal from abnormal, the consistency of stools and the comfort with which a person passes them are more reliable indicators than is the frequency of bowel elimination. People differ greatly in their bowel habits and normal bowel patterns range from three bowel movements per day to three bowel movements per week. It is important for the stool to be soft to pass without pain. The client may not be able to fully evacuate with a bowel movement; it may take time.

Antispasmodic

The nurse caring for a client with a client with diverticulitis is preparing to administer the clients medications. The nurse anticipates administration of which category of medication?

1

The nurse caring for a client with diverticulitis is preparing to administer the client's medications. The nurse anticipates administration of which category of medication because of the client's diverticulitis? 1. Antispasmodic 2. Anti-inflammatory 3. Antianxiety 4. Antiemetic

hypokalemia.

The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for:

a

The nurse in an extended-care facility reports that a resident has clinical manifestations of fecal incontinence. The health care provider orders a diagnostic study to rule out inflammation. The nurse would prepare the patient for which of the following? a) Flexible sigmoidoscopy b) X-ray studies (i.e., barium enema) c) Computed tomography (CT) scan d) Anorectal manometry and transit studies

Notify the physician.

The nurse is admitting a patient with a diagnosis of diverticulitis and assesses that the patient has a boardlike abdomen, no bowel sounds, and complains of severe abdominal pain. What is the nurse's first action?

usual pattern of elimination.

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's:

a

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's: a) Usual pattern of elimination b) Medications c) Allergies d) Family history of constipation/GI issues

4

The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation? 1. Current medications 2. Activity levels 3. Alcohol consumption 4. Usual pattern of elimination

d

The nurse is assessing a client for constipation. Which review should the nurse conduct FIRST to identify the cause of constipation? a) Review current medications b) Assess pain levels c) Bright red blood found in stools d) Usual pattern of elimination

usual pattern of elimination

The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation?

2 inches

The nurse is assisting a client to drain his Kock pouch. The nurse should insert the catheter how far through the nipple/valve? (interesting word choice in the question lol)

Fecal incontinence

The nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be

Hypotension

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process?

3

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process? 1. Normal erythrocyte sedimentation rate (ESR) 2. Subnormal temperature 3. Hypotension 4. Bradycardia

2

The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching? 1. Use laxatives weekly. 2. Drink 8 to 10 glasses of fluid daily. 3. Avoid daily exercise. 4. Avoid unprocessed bran.

Clamp the tubing and give the patient a rest period.

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse?

d

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse? a) Tell the client you are almost finished and to hold still for the next 1-2 minutes. b) Water should flow in over a 45 minute period. c) Allow only tepid fluid to enter the colon slowly. d) Clamp the tubing and give the patient a rest period.

Clamp the tubing and allow client to rest

The nurse is irrigating the client's colostomy when the client begins to report cramping. what is the appropriate action by the nurse?

Peritonitis

The nurse is monitoring a client post-op after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and tachycardia. The nurse reports to the physician that the client has signs and symptoms of which complication?

Peritonitis

The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication?

Familial polyposis

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening?

2

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? 1. History of skin cancer 2. Familial polyposis 3. Low-fat, low-protein, high-fiber diet 4. Age younger than 40 years

c

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? a) Age under 40 years old. b) High-fat, high-protein, low-fiber diet. c) Familial polyposis (FHx of colon cancer). d) Familial history of basal cell carcinomas.

2

The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's notes? 1. Tenesmus 2. Borborygmus 3. Loud bowel sounds 4. Peristalsis

b

The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition? a) Azotorrhea b) Borborygmus c) Tenesmus d) Diverticulitis

4

The nurse is talking with a group of clients who are older than age 50 years about the recognition of colon cancer to access early intervention. What should the nurse inform the clients to report immediately to their primary care provider? 1. Abdominal cramping when having a bowel movement 2. Daily bowel movements 3. Excess gas 4. Change in bowel habits

4

The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation? 1. Dust with nystatin powder 2. Apply barrier powder 3. Apply triamcinolone acetonide spray 4. Dry skin thoroughly after washing

Dry skin thoroughly after washing

The nurse is teaching a client with an ostomy how to change the pouching system. what information should the nurse include when teaching a client with no peristomal skin irritation?

Solid

The nurse teaches the client whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location? Right upper quadrant Right lower quadrant Left upper quadrant Left lower quadrant

The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

UlcerativeColitis

The presence of mucus and pus in the stools suggest which condition?

During assessment of a patient for a malabsorption disorder, the nurse notes a history of abdominal pain and weight loss, marked steatorrhea, azotorrhea, and frequent glucose intolerance. Based on these clinical features, the nurse suspects a diagnosis of: Lactose intolerance. Celiac disease. Pancreatic insufficiency. Ileal dysfunction.

These symptoms are consistent with a diagnosis of pancreatic insufficiency. Loss of ileal absorbing surface results in ileal dysfunction. A toxic response to gluten is characteristic of celiac disease, and a deficiency of intestinal lactase results in lactose intolerance. Refer to Table 24-2 in the text.

The nurse is conducting a gastrointestinal assessment. When the client reports the presence of mucus and pus in the stool, the nurse assesses for additional signs/symptoms of which disease/condition?

Ulcerative colitis

The presence of mucus and pus in the stools suggests which condition?

Ulcerative colitis

The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation?

Usual pattern of elimination

The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation?

Usual pattern of elimination Explanation: Constipation has many possible causes and assessing the client's usual pattern of elimination is the first step in identifying the cause. The nurse should obtain a description of the bowel elimination pattern, asking about the frequency, overall appearance and consistency of stool, blood in the stool, pain, and effort necessary to pass stool. It is also essential for the nurse to review the client's current medications, diet, and activity levels.

Patients diagnosed with malabsorption syndrome may have vitamin and mineral deficiency. Patient who easily bleed have which of the following deficiencies?

Vitamin K

Vomiting results in which of the following acid-base imbalances? Metabolic alkalosis Metabolic acidosis Respiratory acidosis Respiratory alkalosis

Vomiting results in loss of hydrochloric acid (HCl) and potassium from the stomach, leading to a reduction of chlorides and potassium in the blood and to metabolic alkalosis.

a

What information should the nurse include in the teaching plan for a client being treated for diverticulosis? a) Drink at least 8 to 10 large glasses of fluid every day b) Do not include unprocessed bran in the diet c) Regular use of laxatives and enemas at home d) Discourage regular exercise if pt. is inactive

a

What is the MOST common cause of small-bowel obstruction? a) adhesions b) ulcers c) hernias d) tumors

Adhesion

What is the most common cause of small-bowel obstruction?

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse? Inform the patient that it will only last a minute and continue with the procedure. Clamp the tubing and give the patient a rest period. Stop the irrigation and remove the tube. Replace the fluid with cooler water since it is probably too warm.

When irrigating a colostomy, the nurse should allow tepid fluid to enter the colon slowly. If cramping occurs, the nurse should clamp off the tubing and allow the patient to rest before progressing. Water should flow in over a 5- to 10-minute period.

Familial polyposis

Which characteristic is a risk factor for Colorectal cancer?

presents with a rigid, boardlike abdomen.

Which client requires immediate nursing intervention? The client who:

3

Which client requires immediate nursing intervention? The client who: 1. presents with ribbonlike stools. 2. complains of epigastric pain after eating. 3. presents with a rigid, boardlike abdomen. 4. complains of anorexia and periumbilical pain.

The clusters of ulcers take on a cobblestone apperance

Which is a true statement regarding Crohn's disease?

Diarrhea

Which is one of the primary symptoms of IBS?

Change in bowel habits

Which is the most common presenting symptom of colon cancer?

Intermittent pain

Which is the most prominent sign of inflammatory bowel disease?

A 35-year-old female with Crohn's disease

Which of the following clients would be at greatest risk for the development of an anorectal fistula?

4

Which of the following is accurate regarding regional enteritis? 1. Severe diarrhea 2. Severe bleeding 3. Fistulas are common 4. Exacerbations and remissions

d

Which of the following would a nurse expect to assess in a client with peritonitis? a) Hyperactive bowel sounds. b) Decreased pulse rate (HR). c) Slow, deep respirations. d) Board-like abdomen.

Colorectal cancer is the third most common site of cancer in the United States.

Which statement provides accurate information regarding cancer of the colon and rectum?

2

Which statement provides accurate information regarding cancer of the colon and rectum? 1. Rectal cancer affects more than twice as many people as colon cancer. 2. Colorectal cancer is the third most common site of cancer in the United States. 3. Colon cancer has no hereditary component. 4. The incidence of colon and rectal cancer decreases with age.

Hernia

Which term refers to a protrusion of the intestine through a weakened area in the abdominal wall?

Borborygmus

Which term refers to intestinal rumbling?

The nurse is assigned to care for a patient 2 days after an appendectomy due to a ruptured appendix with resultant peritonitis. The nurse has just assisted the patient with ambulation to the bedside commode when the patient points to the surgical site and informs the nurse that "something gave way." What does the nurse suspect may have occurred?

Wound dehiscence has occurred. Explanation: Any suggestion from the patient that an area of the abdomen is tender or painful or "feels as if something just gave way" must be reported. The sudden occurrence of serosanguineous wound drainage strongly suggests wound dehiscence (see Chapter 19).

constipation

a condition in which stool becomes dry, compact, and difficult and painful to pass. may result from insufficient dietary fiber and water, ignoring or resisting the urge to defecate, emotional stress, use of drugs that tend to slow intestinal motility, or inactivity (nerves).

fructose

a natural laxative recommended for constipation

Ask the client to remain inactive for 5 minutes

a nurse applies an ostomy appliance to a client who is recovering from surgery. Which intervention should the nurse utilize to prevent leakage from the appliance?

intestinal decompression

accomplished by suctioning large amounts of accumulated secretions and gas through a nasogastric tube or longer intestinal tube, which may or may not be weighted

pilonidal sinus

an infection in the hair follicles in the sacrococcygeal area above the anus.

A longitudinal tear or ulceration in the lining of the anal canal is termed a(n)

anal fissure.

A longitudinal tear or ulceration in the lining of the anal canal is termed a(n):

anal fissure. Explanation: Fissures are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety (leading to constipation). An anorectal abscess is an infection in the pararectal spaces. An anal fistula is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus. A hemorrhoid is a dilated portion of vein in the anal canal.

Which of the following is considered a stimulant laxative? Magnesium hydroxide (milk of Magnesia) Bisacodyl (Dulcolax) Mineral oil Psyllium hydrophilic mucilloid (Metamucil)

bisacodyl

5-ASA drugs containing salicylate

bonded to a carrying agent that allows the drug to be absorbed in the intestine. considered first-line treatment for IBD. work by decreasing the inflammatory response. (*Azulfidine, Dipentum, Asacol, Pentasa*)

symptoms of IBS

chronic constipation with sporadic bouts of diarrhea.

inflammatory bowel disease

chronic illness characterized by exacerbations and remission. several chronic digestive disorders believed to result from the immune system attacking the bowel. does not resolve without medical intervention.

ulcerative colitis

chronic inflammation usually limited to the mucosal and submucosal layers of the colon and rectum. most common in young and middle-aged adults but can occur at any age.

Crohn's disease

chronic inflammatory condition that can occur in any portion of the GI tract but predominantly affect the bowel in the terminal portion of the ileum. extends transmurally through all the layers of the bowel, but the submucosa layer is most involved. *regional enteritis* ("cobblestone" appearance). occult blood and white blood cells are often found in stool when present.

What is the primary nursing diagnosis for a client with a bowel obstruction? Deficient fluid volume Deficient knowledge Acute pain Ineffective tissue perfusion

deficit fluid volume Feces, fluid, and gas accumulate above a bowel obstruction. Then the absorption of fluids decreases and gastric secretions increase. This process leads to a loss of fluids and electrolytes in circulation. Therefore, Deficient fluid volume is the primary diagnosis. Deficient knowledge, Acute pain, and Ineffective tissue perfusion are applicable but not the primary nursing diagnosis.

hemorrhoids

dilated veins outside or inside the anal sphincter

A patient with an ileostomy should avoid which of the following? Enteric-coated products Antacids and antibiotics Wax matrix coated products Nonlayered tablets

enteric coated

A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the healthcare provider notes a linear tear in the anal canal tissue. The client is diagnosed with a:

fissure.

emollients and lubricants

form a slippery coat on intestinal contents, decreasing the loss of water out of the contents and preventing the contents from becoming hard or impacted (*Colace, Sani-Supp, Agoral Plain*).

A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult? "I don't understand this; I took the medication the doctor ordered and followed the diet." "I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." "I don't understand why this happened again; I didn't travel out of the country." "I don't like oatmeal, so it doesn't matter that I can't have it."

he client stating that he ate roast beef on rye bread indicates the need for a dietary consult because rye bread contains gluten, which must be eliminated from the client's diet. The client stating that he's followed the ordered medication regimen and diet doesn't suggest that the client needs a dietary consult; a treatment regimen consisting of medications to improve symptoms and dietary modification is necessary to treat celiac disease. The client stating that he hasn't traveled outside of the country doesn't suggest that dietary concerns exist. The client saying that he can't have oatmeal shows an understanding of the dietary restrictions necessary with celiac disease.

high-calorie and high-protein diet

helps replace nutritional losses from chronic diarrhea

An elderly patient diagnosed with diarrhea is taking digoxin (Lanoxin). Which of the following electrolyte imbalances should the nurse be alert to? Hyperkalemia Hypokalemia Hyponatremia Hypernatremia

hypokalemia

The nurse caring for an elderly client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for

hypokalemia.

The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for:

hypokalemia. Explanation: The older client taking digoxin must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of:

increasing fluid intake to prevent dehydration.

anorectal abscess

infection with a collection of pus in an area between the internal and external sphincters

appendicitis

inflammation of a narrow, blind protrusion called the vermiform appendix located at the tip of the cecum in the right lower quadrant of the abdomen.

Crohn's disease is a condition of malabsorption caused by which of the following pathophysiological processes? Inflammation of all layers of intestinal mucosa Infectious disease Disaccharidase deficiency Gastric resection

inflammation of all layeers of intestinal mucosa

peritonitis

inflammation of the peritoneum

fistula

inflammatory channel containing blood, mucus, pus, or stool.

A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of: A small bowel disorder. Intestinal malabsorption. Inflammatory colitis. A disorder of the large bowel.

intestinal malabsorption

paralytic ileus

intestine lacks peristalsis

volvulus

kinking of a portion of intestine

A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation?

lack of free water intake

anal fissure

linear tear in the anal canal tissue

NPO, IV fluids with electrolytes, antibiotics, intestinal decompression with NG tubes

medical management for intestinal obstructions

Crohn's disease and ulcerative colitis

most common inflammatory disease that include IBD. grouped together because of their similar symptoms and treatments.

Celiac sprue is an example of which category of malabsorption? Infectious diseases causing generalized malabsorption Mucosal disorders causing generalized malabsorption Luminal problems causing malabsorption Postoperative malabsorption

mucosal disordere scausing generalized malabosrption

pilonidal

nest of hair

routine stool cultures

obtained to identify bacterial infections as the cause for infectious diarrhea

rebound tenderness

pain is worse when manual pressure near the region is suddenly released

A nurse is performing focused assessment on her clients. She expects to hear hypoactive bowel sounds in a client with:

paralytic ileus.

encopresis

passing liquid stool around an obstructive stool mass. sometimes misinterpreted as diarrhea.

The nurse is monitoring a patient's postoperative course after an appendectomy. The nurse's assessment reveals that the patient has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse's report to the physician is that the patient has signs/symptoms of which of the following complications? Peritonitis Pelvic abscess Ileus Hemorrhage

peritonitis

A client is being treated for prolonged diarrhea. Which of the following foods should the nurse encourage the client to consume? Protein-rich foods Potassium-rich foods High-fiber foods High-fat foods

potassium rich

Which client requires immediate nursing intervention? The client who:

presents with a rigid, boardlike abdomen.

hernia

protrusion of any organ from the cavity that normally confines it.

colorectal cancer

ranks as the third most common cancer among men and women in the U.S. and second among causes of cancer deaths

major goals of nursing management for constipation

restoring normal bowel function, relieving rectal discomfort and anxiety, and helping the client understand how to maintain normal bowel function.

Mechanical obstructions

result from a narrowing of the bowel lumen with or without a space-occupying mass.

A client is admitted from the emergency department with complaints of severe abdominal pain and an elevated white blood cell count. The physician diagnoses appendicitis. The nurse knows the client is at greatest risk for:

rupture of the appendix.

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find:

severe abdominal pain with direct palpation or rebound tenderness.

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find:

severe abdominal pain with direct palpation or rebound tenderness. Explanation: Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (such as appendicitis, diverticulitis, ulcerative colitis, or a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.

irritable bowel syndrome

spastic bowel. functional motility disorder primarily affecting the colon. cluster of symptoms that occur despite the absence of an identifiable disease process.

An elderly client in a long term care facility is concerned about bowel regularity. During a client education session, the nurse reinforces the medically acceptable definition of "regularity." What is the actual measurement of "regular"?

stool consistency and client comfort

An elderly client in a long term care facility is concerned about bowel regularity. During a client education session, the nurse reinforces the medically acceptable definition of "regularity." What is the actual measurement of "regular"? stool consistency and client comfort one bowel movement daily one bowel movement every other day two bowel movements daily

stool consistency and client comfort

A client with appendicitis is experiencing excruciating abdominal pain. An abdominal X-ray film reveals intraperitoneal air. The nurse should prepare the client for:

surgery.

herniorrhaphy

surgical repair of a hernia, recommended treatment. protruding intestine is repositioned in the abdominal cavity and the defect in the abdominal wall is repaired.

intussusception

telescoping of a part of the intestine into an adjacent part

treating the cause

the best relief for constipation

A client realizes that regular use of laxatives has greatly improved his bowel pattern. However, the nurse cautions this client against the prolonged use of laxatives for which reason? The client may develop inflammatory bowel disease. The client may develop arthritis or arthralgia. The client's natural bowel function may become sluggish. The client may lose his appetite.

the clients natural bowel function may become sluggish

diarrhea

the frequent passage of larger-than-normal amounts of liquid or semiliquid stool (more than 3 bowel movements a day).

functional obstruction

the intestine can become adynamic from an absence of normal nerve stimulation to intestinal muscle givers.

anal fistula

tract that forms in the anal canal that occurs when an anorectal abscess is inadequate, an inflamed tunnel develops, connecting the area of the original abscess with perianal skin.

The nurse is conducting a gastrointestinal assessment. When the patient complains of the presence of mucus and pus in his stools, the nurse assesses for additional signs/symptoms of which of the following disease/conditions? Small-bowel disease Ulcerative colitis Disorders of the colon Intestinal malabsorption

ulcerative colitits

tenesmus

urgency

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's:

usual pattern of elimination.

hernioplasty

weakened area of protrusion is reinforced with wire, fascia, or mesh.

dehydration, electrolyte imbalances, and vitamin deficiencies

what are the 3 major problems associated with severe or prolonged diarrhea?

abdominal pain is first generalized through the abdomen and around the umbilicus then localizes in the RLQ at *McBurney's point*, an area midway between the umbilicus and the right iliac crest

what are the assessment findings with appendicitis?

anorexia, weight loss, dehydration, and signs of nutritional deficiencies occur

what happens as Crohn's disease progresses?

rectal distention, difficulty passing stool, or anal tears

what is acute pain related to in those with constipation?

immobility or inadequate fluid intake as evidenced by infrequent passage of stool and abdominal distention

what is constipation related to?

unknown

what is the cause of Crohn's disease?

change in bowel habits, such as alternating constipation and diarrhea

what is the chief characteristic of cancer of the colon?

packing is inserted into the cavity, and the wound heals by secondary intention

what is the management for pilonidal sinus?

infection by bacterial, parasitic, or viral agents

what is the most common cause of diarrhea?

intestinal obstruction

when a blockage interferes with the normal progression of intestinal contents through the intestinal tract.

after meals

when is the gastrocolic reflex most active?

sigmoid colon

where does obstruction in the large intestine generally occur?

Saline agents (magnesium hydroxide)

which category of laxatives draws water into the intestines by osmosis?

inadequate intake of dietary fiber, lack of exercise, and decreased fluid intake, decrease in the peristaltic action of the GI tract, narcotic pain relievers, time frame

why is constipation a common problem in older adults?