Chapter 48 (hard)

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. A small bowel disorder. B. A disorder of the large bowel. C. Inflammatory colitis. D. Intestinal malabsorption.

D R: Watery stools are characteristic of disorders of the small bowel, whereas loose, semisolid stools are associated more often with disorders of the large bowel. Large, greasy stools suggest intestinal malabsorption, and the presence of mucus and pus in the stools suggests inflammatory enteritis or colitis.

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? A. The consistency of stool and comfort when passing stool B. The client is able to fully evacuate with each bowel movement C. That the stool is formed and soft D. That the client has a bowel movement daily

A R: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.

The nurse is caring for a patient who has malabsorption syndrome with an undetermined cause. What procedure will the nurse assist with that is the best diagnostic test for this illness? A. Stool specimen for ova and parasites B. Ultrasound C. Pancreatic function tests D. Endoscopy with mucosal biopsy

D R: Endoscopy with biopsy of the mucosa is the best diagnostic tool for malabsorption syndrome.

A nurse caring for a patient with regional enteritis knows to assess for this most serious systemic complication. What is that complication? A. Megacolon B. Pyelonephritis C. Nephrolithiasis D. Small bowel obstruction

D R: Small bowel obstruction is a serious systemic complication of regional enteritis. The other clinical signs are associated with ulcerative colitis. Refer to Table 24-4 in the text.

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 R:Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can't absorb them after an ileostomy.

The nurse is caring for four clients with diarrhea. Which client is most likely to be diagnosed with Crohn's disease? A. A 63 year-old Hispanic female with a history of cancer of the vulva B. A 24 year-old Caucasian eastern European Jewish female C. A 46 year-old African American male D. A 32 year-old female from Vietnam

B R: Clients who are more prone to this disorder include those with a family history of the disease, those who are white with a European and/or Jewish ancestry, and those who smoke. The other client's listed do not have these risk factors.

A patient diagnosed with colon cancer presents with the characteristic symptoms of a left-sided lesion. Which of the following symptoms are indicative of this disorder? Select all that apply. A. Abdominal distention B. Constipation C. Narrowing stools D. Black, tarry stools E. Dull abdominal pain

A,B,C R:Melena and dull abdominal pain are associated with right-sided lesions. The other symptoms are found with left-sided lesions.

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: A. Pancreatic insufficiency. B. Ileal dysfunction. C. Celiac disease. D. Lactose intolerance.

A R: 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.

A client with appendicitis is experiencing excruciating abdominal pain. An abdominal X-ray film reveals intraperitoneal air. The nurse should prepare the client for: A. surgery. B. nasogastric (NG) tube insertion. C. barium enema. D. colonoscopy.

A R: The client should be prepared for surgery because his signs and symptoms indicate bowel perforation. Appendicitis is the most common cause of bowel perforation in the United States. Because perforation can lead to peritonitis and sepsis, surgery wouldn't be delayed to perform other interventions, such as colonoscopy, NG tube insertion, or a barium enema. These procedures aren't necessary at this point.

A patient underwent a continent ileostomy. Within which timeframe should the patient expect to empty the reservoir? A. Every 4 to 6 hours B. At least once a day C. At least once every 2 days D. Three or four times daily

A R: The length of time between drainage perionds is gradually increased until the reservoir needs to be drained only every 4 to 6 hours and irrigated once each day. This prevents the accumulating effluent from spilling or causing infections.

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? A. 0.9% NS B. 0.45% of NS C. D5W D. D10W

A R: The administration of several liters of an isotonic solution is immediately prescribed. Hypovolemia occurs because massive amounts of fluid and electrolytes move from the intestinal lumen into the peritoneal cavity and deplete the fluid in the vascular space.

The nurse is caring for an older adult patient experiencing fecal incontinence. When planning the care of this patient, what should the nurse designate as a priority goal? A. Determining the need for surgical intervention to correct the problem B. Maintaining skin integrity C. Instituting a diet high in fiber and increase fluid intake D. Beginning a bowel program to establish continence

B R: Fecal incontinence can disrupt perineal skin integrity. Maintaining skin integrity is a priority, especially in the debilitated or older adult patient.

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? A. Beefy red stoma site B. Stoma site not sensitive to touch C. Red, sensitive skin around the stoma site D. Clear mucus mixed with yellow urine drained from the appliance bag

C R:Red, sensitive skin around the stoma site may indicate an ill-fitting appliance Beefy redness at a stoma site that isn't sensitive to touch is a normal assessment finding. Urine mixed with mucus is also a normal finding.

What symptoms of perforation might the nurse observe in a client with an intestinal obstruction? Select all that apply. A. abdominal distention B. sudden drop in body temperature C. sudden, sustained abdominal pain D. intermittent, severe pain

A,C R: Abdominal distention, fever, and sudden, sustained abdominal pain are the symptoms of perforation in a client with intestinal obstruction.

After teaching a group of students about irritable bowel syndrome and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an opiate-related antidiarrheal agent? A. Loperamide (Imodium) B. Bisacodyl (Dulcolax) C. Kaolin and pectin (Kaopectate) D. Bismuth subsalicylate (Pepto-Bismol)

A R: Loperamide (Imodium) and diphenoxylate with atropine sulfate (Lomotil) are examples of opiate-related antidiarrheal agents. Bismuth subsalicylate (Pepto-Bismol) and kaolin and pectin (Kaopectate) are examples of absorbent antidiarrheal agents. Biscodyl (Dulcolax) is a chemical stimulant laxative.

A client describes being constipated, but also experiencing abdominal cramping, pain, and urgent diarrhea. These symptoms occur more often when the client is nearing a deadline or is under emotional stress. What would be recommended to treat these symptoms? Select all that apply. A. psyllium B. low-residue diet C. high-fiber diet D. cholinergic

A,C R: Dietary changes reduce flatulence and abdominal discomfort. A high-fiber diet (30 to 40 g/day) or a bulk-forming agent, such as products containing psyllium, is prescribed to regulate bowel elimination. The fiber draws water into constipated stool and adds bulk to watery stool. An anticholinergic, such as dicyclomine (Bentyl), has an antispasmodic effect if taken before meals.

Which of the following is considered a stimulant laxative? A. Psyllium hydrophilic mucilloid (Metamucil) B. Bisacodyl (Dulcolax) C. Mineral oil D. Magnesium hydroxide (Milk of Magnesia)

B R: Dulcolax is a stimulant laxative. Milk of Magnesia is a saline agent. Mineral oil is a lubricant. Metamucil is a bulk-forming agent.

What is the most common cause of small-bowel obstruction? A. Neoplasms B. Adhesions C. Hernias D. Volvulus

B R: 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 paralytic ileus.

A client is being treated for diverticulosis. Which points should the nurse include in this client's teaching plan? Select all that apply. A. Avoid daily exercise; indulge only in mild activity. B. Drink at least 8 to 10 large glasses of fluid every day. C. Use laxatives or enemas at least once a week. D. Do not suppress the urge to defecate.

B,D R: Avoid constipation; do not suppress the urge to defecate. Consume at least 2 L/day (within limits of the client's cardiac and renal reserve) and include foods that are soft but have increased fiber, such as prepared cereals or soft-cooked vegetables, to increase the bulk of the stool and facilitate peristalsis, thereby promoting defecation. Avoid the use of laxatives or enemas except when recommended by the physician. Exercise regularly if the current lifestyle is somewhat inactive.

A client reports having increased incidence of constipation. What can cause constipation? A. emotional stress B. inactivity C. All options are correct. D. insufficient fiber

C R: Constipation 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. It may stem from several disorders, either in the GI tract or systemically.

Patients diagnosed with malabsorption syndrome may have vitamin and mineral deficiency. Patient who easily bleed have which of the following deficiencies? A. B12 B. Iron C. Vitamin K D. Calcium

C R: The chief result of malabsorption is malnutrition, manifested by weight loss and other signs of vitamin and mineral deficiency (e.g., easy bruising [vitamin K deficiency], osteoporosis [calcium deficiency], and anemia [iron, vitamin B12 deficiency]).

A client suspected of having colorectal cancer requires which diagnostic study to confirm the diagnosis? A. Abdominal computed tomography (CT) scan B. Stool Hematest C. Carcinoembryonic antigen (CEA) D. Sigmoidoscopy

D R: Used to visualize the lower GI tract, sigmoidoscopy and proctoscopy aid in the detection of two-thirds of all colorectal cancers. Stool Hematest detects blood, which is a sign of colorectal cancer; however, the test doesn't confirm the diagnosis. CEA may be elevated in colorectal cancer but isn't considered a confirming test. An abdominal CT scan is used to stage the presence of colorectal cancer.

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?

Dehiscence R: 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

A nurse is assessing a client and obtains the following findings: abdominal discomfort, mild diarrhea, blood pressure of 100/80 mm Hg, pulse rate of 88 beats/minute, respiratory rate of 20 breaths/minute, temperature 100° F (37.8° C). The nurse suspects the client will be diagnosed with: A. inflammatory bowel disease (IBD). B. colorectal cancer. C. diverticulitis. D. liver failure.

A R: IBD is a collective term for several GI inflammatory diseases with unknown causes. The most prominent sign of IBD is mild diarrhea, which sometimes is accompanied by fever and abdominal discomfort. Colorectal cancer is usually diagnosed after the client complains of bloody stools; the client will rarely have abdominal discomfort. A client with diverticulitis commonly states he has chronic constipation with occasional diarrhea, nausea, vomiting, and abdominal distention. Jaundice, coagulopathies, edema, and hepatomegaly are common signs of liver failure.

After assessing a client with peritonitis, the nurse most likely would document the client's bowel sounds as: A. Absent. B. Hyperactive. C. Mild. D. High-pitched.

A R: Since lack of bowel motility typically accompanies peritonitis, bowel sounds are absent. Therefore, the nurse will not observe mild, high-pitched, or hyperactive bowel sounds.

Which of the following is accurate regarding regional enteritis? A. Exacerbations and remissions B. Fistulas are common C. Severe bleeding D. Severe diarrhea

A R: The course of regional enteritis is prolonged and variable. There is mild bleeding, fistulas are rare, and diarrhea is less severe than ulcerative colitis.

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. A. A fruit salad with yogurt B. Broiled chicken with low-fiber pasta C. Salami on whole grain bread and V-8 juice D. A peanut butter sandwich and fruit cup

B R: A low-residue, high-protein, and high-calorie diet is recommended to reduce the size and number of stools. Foods to avoid include yogurt, fruit, salami, and peanut butter.

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? A. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. B. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. C. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage. D. The appendix may develop gangrene and rupture, especially in a middle-aged client.

B R: A client with appendicitis is at Risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Elderly, not middle-aged, clients are especially susceptible to appendix rupture.