Chapter 42- Lower GI Problems Practice Questions

A 26-yr-old woman is being evaluated for vomiting and abdominal pain. Which question from the nurse will be most useful in determining the cause of the patient's symptoms?

"Can you tell me more about the pain?"

The nurse is admitting a 67-yr-old patient with new-onset steatorrhea. Which question is most important for the nurse to ask?

"Have you noticed a recent weight loss?" (Although all the questions provide useful information, it is most important to determine if the patient has an imbalance in nutrition because of the steatorrhea.)

Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome (IBS)?

"How long have you had abdominal pain?"

Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective?

"I should apply sunscreen before going outdoors." (Sulfasalazine may cause photosensitivity in some patients. It is not used to treat infections. Sulfasalazine does not reduce immune function.)

A patient with a new ileostomy asks how much it will drain. How many cups of drainage per day should the nurse explain for the patient to expect?

2 (After the proximal small bowel adapts to reabsorb more fluid, the average amount of ileostomy drainage is about 500 mL daily. One cup is about 240 mL.)

After change-of-shift report, which patient should the nurse assess first?

A 30-yr-old female patient with a femoral hernia who has abdominal pain and vomiting (Pain and vomiting with a femoral hernia suggest strangulation, which will require emergency surgery)

Which patient should the nurse assess first after receiving change-of-shift report?

A 30-yr-old patient who has a distended abdomen and tachycardia (The patient's abdominal distention and tachycardia suggest hypovolemic shock caused by problems such as peritonitis or intestinal obstruction, which will require rapid intervention.)

What is a likely finding in the nurse's assessment of a patient who has a large bowel obstruction?

Abdominal distention

What should the nurse admitting a patient with acute diverticulitis plan for initial care?

Administer IV fluids. (A patient with acute diverticulitis will be NPO and given parenteral fluids.)

A 40-yr-old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia. Which patient teaching will the nurse provide before discharge?

Apply a scrotal support and ice to reduce swelling. (To reduce edema and pain.)

After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, "I cannot manage all this. I don't want to look at the stoma." What action should the nurse take?

Ask the patient about the concerns with stoma management.

A 25-yr-old male patient calls the clinic reporting diarrhea for 24 hours. Which action should the nurse take first?

Ask the patient to describe the stools and any associated symptoms. (The initial response by the nurse should be further assessment of the patient.)

A patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery?

Assess the perineal drainage and incision. (Because the perineal wound is at high risk for infection, the initial care is focused on assessment and care of this wound.)

Which care activity for a patient with a paralytic ileus is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)?

Brushing the teeth and tongue

A 19-yr-old woman is brought to the emergency department with a knife handle protruding from her abdomen. What should the nurse do during the initial assessment of the patient?

Check for circulation and tissue perfusion. (The initial assessment is focused on determining whether the patient has hypovolemic shock.)

Four hours after a bowel resection, a 74-yr-old male patient with a nasogastric tube to suction reports nausea and abdominal distention. What should be the nurse's first action?

Check for tube placement and reposition it.

What should the nurse plan to teach about to a patient with Crohn's disease who has megaloblastic anemia?

Cobalamin (B12) supplements

A patient calls the clinic to report a new onset of severe diarrhea. What should the nurse anticipate that the patient will need to do?

Collect a stool specimen. (Acute diarrhea is usually caused by an infectious process, so stool specimens are obtained for culture and examined for parasites or white blood cells.)

What should the nurse preparing for the annual physical exam of a 45-yr-old man plan to teach the patient about?

Colonoscopy (Colonoscopy is the gold standard for CRC screening.)

Which breakfast choice indicates a patient's good understanding of information about a diet for celiac disease?

Corn tortilla with scrambled eggs (Avoidance of gluten-containing foods is the only treatment for celiac disease. Corn does not contain gluten, but oatmeal and wheat do.)

A 72-yr-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider?

Crackles are heard halfway up the posterior chest. (The presence of crackles in an older patient receiving IV fluids at a high rate suggests volume overload and a need to reduce the rate of the IV infusion.)

The nurse is assessing a patient with abdominal pain. How will the nurse document ecchymosis around the area of umbilicus?

Cullen sign (Cullen sign is ecchymosis around the umbilicus.)

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 bloody stools a day. What should the nurse include in the plan of care?

Discontinue the patient's oral food intake. (An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO.)

A patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. What action should the nurse take?

Document stoma assessment findings. (The stoma appearance indicates good circulation to the stoma. There is no indication that surgical intervention is needed or that frequent stoma monitoring is required. Swelling of the stoma is normal for 2 to 3 weeks after surgery. An ice pack is not needed.)

Which activity in the care of a patient with a new colostomy could the nurse delegate to unlicensed assistive personnel (UAP)?

Drain and measure the output from the ostomy.

A patient reports gas pains and abdominal distention 2 days after a small bowel resection. Which nursing action should the nurse take?

Encourage the patient to ambulate. (Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain.)

Which nursing action will be included in the plan of care for a 25-yr-old male patient with a new diagnosis of irritable bowel syndrome (IBS)?

Encourage the patient to express concerns and ask questions about IBS.

A patient with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. Which symptom is most important to communicate to the health care provider?

Fever

A young woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient?

Fistulas can form between the bowel and bladder. (Fistulas between the bowel and bladder occur in Crohn's disease and can lead to UTI.)

A patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102° F (38.3° C), pulse 120 beats/min, respirations 32 breaths/min, and blood pressure (BP) 82/54 mm Hg. Which prescribed intervention should the nurse implement first?

Infuse a liter of lactated Ringer's solution over 30 minutes.

A patient in the emergency department has just been diagnosed with peritonitis from a ruptured diverticulum. Which prescribed intervention will the nurse implement first?

Infuse metronidazole (Flagyl) 500 mg IV. (Because peritonitis can be fatal if treatment is delayed, the initial action should be to start antibiotic therapy (after any ordered cultures are obtained).)

Which information will the nurse plan to teach a patient who has lactose intolerance?

Live-culture yogurt is usually tolerated.

A 76-yr-old patient with obstipation has a fecal impaction and is incontinent of liquid stool. Which action should the nurse take first?

Manually remove the impacted stool. (The initial action with a fecal impaction is manual disimpaction.)

After having frequent diarrhea and a weight loss of 10 lb (4.5 kg) over 2 months, a patient has a new diagnosis of Crohn's disease. What should the nurse plan to teach the patient?

Medication use

Which nursing action will the nurse include in the plan of care for a patient admitted with an exacerbation of inflammatory bowel disease (IBD)?

Monitor stools for blood. (Because anemia or hemorrhage may occur with IBD, stools should be assessed for the presence of blood.)

A patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. What should the nurse explain as the reason for the test?

Monitor the tumor status after surgery (CEA is used to monitor for cancer recurrence after surgery.)

Which menu choice by the patient with diverticulosis is best for preventing diverticulitis?

Navy bean soup and vegetable salad. (A diet high in fiber and low in fats and red meat is recommended to prevent diverticulitis.)

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching?

Oatmeal with cream (During acute exacerbations of IBD, the patient should avoid high-fiber foods such as whole grains.)

Which action will the nurse include in the plan of care for a patient who is being admitted with Clostridium difficile?

Place the patient in a private room on contact isolation.

After several days of antibiotic therapy for pneumonia, an older hospitalized patient develops watery diarrhea. Which action should the nurse take first?

Place the patient on contact precautions. (The patient's history and new onset diarrhea suggest a C. difficile infection, which requires implementation of contact precautions to prevent spread of the infection to other patients.)

A patient is awaiting surgery for acute peritonitis. Which action will the nurse plan to include in the preoperative care?

Position patient with the knees flexed. (There is less peritoneal irritation with the knees flexed, which will help decrease pain.)

A patient with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next?

Prepare the patient for surgery. (Return of brown drainage and fecal material suggests perforation of the bowel and the need for immediate surgery.)

A 74-yr-old male patient tells the nurse that growing old causes constipation, so he has been using a suppository to prevent constipation every morning. Which action should the nurse take first?

Question the patient about risk factors for constipation.

A 19-yr-old patient has familial adenomatous polyposis (FAP). Which action will the nurse in the gastrointestinal clinic include in the plan of care?

Schedule the patient for yearly colonoscopy. (Patients with FAP should have annual colonoscopy starting at age 16 years and usually have total colectomy by age 25 years to avoid developing colorectal cancer.)

Which prescribed intervention for a patient with chronic short bowel syndrome should the nurse question?

Senna 1 tablet daily. (Patients with short bowel syndrome have diarrhea because of decreased nutrient and fluid absorption and would not need stimulant laxatives.)

A young adult patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action should the nurse take?

Suggest the patient lie on the side, flexing the right leg. (The patient's clinical manifestations are consistent with appendicitis. Lying still with the right leg flexed is often the most comfortable position.)

After a patient has had a hemorrhoidectomy at an outpatient surgical center, which instructions will the nurse include in discharge teaching?

Take prescribed pain medications before you expect a bowel movement. (Bowel movements may be very painful, and patients may avoid defecation unless pain medication is taken before the bowel movement.)

Which information obtained by the nurse interviewing a 30-yr-old male patient is most important to communicate to the health care provider?

The patient has noticed blood in the stools. (Blood in the stools is a possible clinical manifestation of colorectal cancer and requires further assessment by the health care provider.)

A 22-yr-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective?

The patient uses witch hazel compresses to soothe irritation.

The nurse is providing preoperative teaching for a patient scheduled for an abdominal-perineal resection. Which information will the nurse include?

The site where the stoma will be located will be marked on the abdomen preoperatively.

A 33-yr-old male patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as shown in the accompanying figure. Which information will be included in patient teaching?

This type of colostomy is usually temporary. (A loop, or double-barrel stoma, is usually temporary. Stool will be expelled from the proximal stoma only.)

A critically ill patient with sepsis is frequently incontinent of watery stools. What action by the nurse will prevent complications associated with ongoing incontinence?

Use a fecal management system.

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis?

Use care when eating high-fiber foods to avoid obstruction of the ileum.

Which information will the nurse include when teaching a patient how to avoid chronic constipation? (Select all that apply.)

b. Bulk-forming laxatives are an excellent source of fiber. c. Walking or cycling frequently will help bowel motility. d. A good time for a bowel movement may be after breakfast. e. Some over-the-counter (OTC) medications cause constipation.