Chapter 48 Intestinal and Rectal Disorders2
A client has a 10-year history of Crohn's disease and is seeing the physician in the GI group where you practice nursing due to increased diarrhea and fatigue. What is the recommended dietary approach to treat Crohn's disease? a) Dietary approach varies. b) Lactose-rich foods c) Low-fiber diet d) High-fiber diet
A Explanation: The dietary approach varies. A high-fiber diet may be indicated when it is desirable to add bulk to loose stools. A low-fiber diet may be indicated in cases of severe inflammation or stricture. A high-calorie and high-protein diet helps replace nutritional losses from chronic diarrhea. The client may need nutritional supplements, depending on the area of the bowel affected. When the small intestine is inflamed, some clients experience lactose intolerance, requiring avoidance of lactose-rich foods. When the small intestine is inflamed, some clients experience lactose intolerance, requiring avoidance of lactose-rich foods. (less)
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? a) This is a normal finding 1 day after surgery. b) An intestinal obstruction has occurred. c) The ostomy bag should be adjusted. d) Blood supply to the stoma has been interrupted.
Blood supply to the stoma has been interrupted. Correct Explanation: An ileostomy stoma forms as the ileum is brought through the abdominal wall to the surface skin, creating an artificial opening for waste elimination. The stoma should appear cherry red, indicating adequate arterial perfusion. A dusky stoma suggests decreased perfusion. The nurse should interpret this finding as an indication that the stoma's blood supply is interuppted, which may lead to tissue damage or necrosis. A dusky stoma isn't a normal finding 1 day after surgery. Adjusting the ostomy bag wouldn't affect stoma color, which depends on blood supply to the area. An intestinal obstruction also wouldn't change stoma color. (less)
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? a) Diverticulitis b) Appendicitis c) Bowel perforation d) Rectal fissures
Bowel perforation Correct Explanation: Megacolon is a dilated and atonic colon caused by a fecal mass that obstructs the passage of colon contents. Symptoms include constipation, liquid fecal incontinence, and abdominal distention. Megacolon can lead to perforation of the bowel. (less)
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: a) consuming a low-protein, high-fiber diet. b) increasing fluid intake to prevent dehydration. c) wearing an appliance pouch only at bedtime. d) taking only enteric-coated medications.
increasing fluid intake to prevent dehydration. Correct Explanation: 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. (less)
Which of the following will the nurse observe as symptoms of perforation in a client with an intestinal obstruction? Select all that apply. a) Sudden drop in body temperature b) Sudden, sustained abdominal pain c) Intermittent, severe pain d) Abdominal distention
• Sudden, sustained abdominal pain • Abdominal distention Explanation: 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 intestinal obstruction, the instructor determines that the teaching was effective when the students identify which of the following as a cause of a functional obstruction? a) Tumor b) Abdominal surgery c) Volvulus d) Intussusception
Abdominal surgery Correct Explanation: In functional obstruction, the intestine can become adynamic from an absence of normal nerve stimulation to intestinal muscle fibers. For example, abdominal surgery can lead to paralytic ileus. Mechanical obstructions result from a narrowing of the bowel lumen with or without a space-occupying mass. A mass may include a tumor, adhesions (fibrous bands that constrict tissue), incarcerated or strangulated hernias, volvulus (kinking of a portion of intestine), intussusception (telescoping of one part of the intestine into an adjacent part), or impacted feces or barium. (less)
A client presents to the emergency department with complaints of acute GI distress, bloody diarrhea, weight loss, and fever. Which condition in the family history is most pertinent to the client's current health problem? a) Hypertension b) Ulcerative colitis c) Gastroesophageal reflux disease d) Appendicitis
Ulcerative colitis Explanation: A family history of ulcerative colitis, particularly if the relative affected is a first-degree relative, increases the likelihood of the client having ulcerative colitis. Although hypertension has familial tendencies, the client's symptoms aren't related to hypertension. A family history of gastroesophageal reflux disease or appendicitis isn't a significant factor in the client history because these conditions aren't considered familial traits. (less)
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? a) Decreased white blood cell count b) Increased albumin levels c) Decreased erythrocyte sedimentation rate d) Stool cultures negative for microorganisms or parasite
D 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. (less)
Which of the following is a true statement regarding regional enteritis (Crohn's disease)? a) The clusters of ulcers take on a cobblestone appearance. b) It is characterized by lower left quadrant abdominal pain. c) The lesions are in continuous contact with one another. d) It has a progressive disease pattern.
A Explanation: The clusters of ulcers take on a cobblestone appearance. It is characterized by remissions and exacerbations. The pain is located in the lower right quadrant. The lesions are not in continuous contact with one another and are separated by normal tissue. (less)
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? a) "The stoma should remain swollen distal to the abdomen." b) "At first, the stoma may bleed slightly when touched." c) "The stoma should appear dark and have a bluish hue." d) "A burning sensation under the stoma faceplate is normal."
"At first, the stoma may bleed slightly when touched." Correct Explanation: The surgical site remains fresh for up to 1 week after a colostomy and touching the stoma normally causes slight bleeding. However, profuse bleeding should be reported immediately. A dark stoma with a bluish hue indicates impaired circulation; a normal stoma should appear red, similar to the buccal mucosa. Swelling should decrease in 6 weeks, leaving a stoma that protrudes slightly from the abdomen; continued swelling suggests a blockage. A burning sensation under the faceplate is abnormal and indicates skin breakdown. (less)
When planning care for a client with a small-bowel obstruction, the nurse should consider the primary goal to be: a) maintaining fluid balance. b) reporting pain relief. c) maintaining body weight. d) reestablishing a normal bowel pattern.
maintaining fluid balance. Explanation: Because a client with a small-bowel obstruction can't tolerate oral intake, fluid volume deficit may occur and can be life-threatening. Therefore, maintaining fluid balance is the primary goal. Pain relief and maintaining body weight don't reflect life-threatening conditions, and the client's normal bowel pattern can be reestablished after fluid volume is stabilized. (less)
A client has a newly created colostomy. After participating in counseling with the nurse and receiving support from the spouse, the client decides to change the colostomy pouch unaided. Which behavior suggests that the client is beginning to accept the change in body image? a) The client closes his eyes when the abdomen is exposed. b) The client asks the spouse to leave the room. c) The client avoids talking about the recent surgery. d) The client touches the altered body part.
The client touches the altered body part. Correct Explanation: By touching the altered body part, the client recognizes the body change and establishes that the change is real. Closing his eyes, not looking at the abdomen when the colostomy is exposed, or avoiding talking about the surgery reflects denial, instead of acceptance of the change. Asking the spouse to leave the room signifies that the client is ashamed of the change and not coping with it. (less)
A patient underwent a continent ileostomy. Within which timeframe should the patient expect to empty the reservoir? a) At least once every 2 days b) Three or four times daily c) At least once a day d) Every 4 to 6 hours
Every 4 to 6 hours Explanation: 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. (less)
Which of the following is the most prominent sign of inflammatory bowel disease? a) Intermittent pain b) Abdominal distention c) Increased peristalsis d) Hyperactive bowel sounds
Intermittent pain Correct Explanation: The most prominent symptom is intermittent pain that occurs with diarrhea but does not decrease after defecation. Abdominal distention, hyperactive bowel sounds, and increased peristalsis are not the most prominent signs. (less)
Which of the following is one of the primary symptoms of irritable bowel syndrome (IBS)? a) Abdominal distention b) Diarrhea c) Bloating d) Pain
Diarrhea Correct Explanation: The primary symptoms of IBS include constipation, diarrhea, or a combination of both. Pain, bloating, and abdominal distention often accompany changes in bowel pattern.
Crohn's disease is a condition of malabsorption caused by which of the following pathophysiological processes? a) Inflammation of all layers of intestinal mucosa b) Infectious disease c) Gastric resection d) Disaccharidase deficiency
A Correct Explanation: Crohn's disease, also known as regional enteritis, can occur anywhere along the GI tract, but most commonly at the distal ileum and in the colon. Infectious disease causes problems such as small bowel bacterial overgrowth leading to malabsorption. Disaccharidase deficiency leads to lactose intolerance. Postoperative malabsorption occurs after gastric or intestinal resection. (less)
A nurse is performing focused assessment on her clients. She expects to hear hypoactive bowel sounds in a client with: a) Crohn's disease. b) complete bowel obstruction. c) gastroenteritis. d) paralytic ileus.
D Correct Explanation: Bowel sounds are hypoactive or absent in a client with a paralytic ileus. Clients with Crohn's disease and gastroenteritis have hyperactive bowel sounds because of increased intestinal motility. A complete bowel obstruction causes absent bowel sounds below the obstruction and hyperactive sounds above the obstruction. (less)
A client is recently diagnosed with Crohn's disease and is beginning treatment. What first-line treatment does the nurse expect that the client will be placed on to decrease the inflammatory response? a) Ciprofloxacin (Cipro) b) Azathioprine (Imuran) c) Methotrexate (MTX) d) Sulfasalazine (Azulfidine)
D Correct Explanation: Considered first-line treatment for inflammatory bowel disease, 5-ASA drugs contain salicy late, which is bonded to a carrying agent that allows the drug to be absorbed in the intestine. These drugs work by decreasing the inflammatory response. MTX or Imuran are used when failure to maintain remission necessitates the use of an immune-modulating agent. Cipro is used as an effective adjunct to treat the disease. (less)
A patient with an ileostomy should avoid which of the following? a) Wax matrix coated products b) Nonlayered tablets c) Antacids and antibiotics d) Enteric-coated products
Enteric-coated products Explanation: Patients with an ileostomy should avoid enteric-coated products and some modified-release drugs, such as slow-release beads and layered tablets. This is because these products may pass through without being absorbed. Preparations such as slow-K (potassium chloride) leave a "ghost" of the wax matrix coating, but that does not indicate the drug has been unabsorbed. It is not essential for the patient to avoid antacids and antibiotics if they have been prescribed. (less)
A 35-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. In collaboration with the primary care provider, what intervention should the nurse prioritize? a) Insertion of a central venous catheter b) Administration of a mineral oil enema c) Insertion of a nasogastric tube d) Administration of a glycerin suppository and an oral laxative
Insertion of a nasogastric tube Correct Explanation: Decompression of the bowel through a nasogastric tube is necessary for all patients with small bowel obstruction. Peripheral IV access is normally sufficient. Enemas, suppositories, and laxatives are not indicated if an obstruction is present. (less)
After assessing a client with peritonitis, the nurse most likely would document the client's bowel sounds as: a) Mild. b) High-pitched. c) Hyperactive. d) Absent.
Absent. Explanation: 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.
What is the most common cause of small bowel obstruction? a) Hernias b) Adhesions c) Volvulus d) Neoplasms
Adhesions Explanation: 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. (less)
A nurse is caring for a patient who has been admitted to the hospital with diverticulitis. Which of the following would be appropriate nursing diagnoses for this patient? Select all that apply. a) Activity Intolerance Related to Generalized Weakness b) Impaired Urinary Elimination Related to GI Pressure on the Bladder c) Deficient Fluid Volume Related to Anorexia, Nausea, and Diarrhea d) Acute Pain Related to Increased Peristalsis and GI Inflammation e) Bowel Incontinence Related to Increased Intestinal Peristalsis
A, C, D Explanation: Patients with diverticulitis are likely to experience pain and decreased activity levels, and are at risk of fluid volume deficit. The patient is unlikely to experience fecal incontinence and urinary function is not directly influenced. (less)
The nurse is assisting a patient to drain his continent ileostomy (Kock pouch). The nurse should insert the catheter how far through the nipple/valve? a) 2 in. b) 6 in. c) 5 in. d) 3 in.
2 in. Explanation: The nurse should insert the lubricated catheter about 2 in. (5 cm) through the nipple/valve. Reference:
The nurse caring for a patient with diverticulitis is preparing to administer the patient's medications. The nurse anticipates administration of which category of medications due to the patient's diverticulitis? a) Antispasmodic b) Antianxiety c) Anti-inflammatory d) Antiemetic
Antispasmodic Explanation: The nurse anticipates administration of antispasmodic medication to decrease intestinal spasm associated with diverticulitis. The patient may also be ordered an opioid analgesic to relieve the associated pain. There is no indication that the patient needs antianxiety, antiemetic, or anti-inflammatory medications at this time. (less)
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) A peanut butter sandwich and fruit cup c) Broiled chicken with low-fiber pasta d) Salami on whole grain bread and V-8 juice
Broiled chicken with low-fiber pasta Correct Explanation: 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.
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) Stop the irrigation and remove the tube. b) Replace the fluid with cooler water since it is probably too warm. c) Inform the patient that it will only last a minute and continue with the procedure. d) Clamp the tubing and give the patient a rest period.
Clamp the tubing and give the patient a rest period. Correct 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. (less)
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? a) Start an IV of Ringer's lactate. b) Insert an intestinal tube. c) Insert a nasogastric tube. d) Notify the physician.
Notify the physician. Explanation: The physician should be notified immediately to examine the client because the client is exhibiting signs of an intestinal obstruction. Starting the IV and inserting a nasogastric tube would be interventions that the physician will order after seeing the client. The nurse does not insert intestinal tubes. (less)
In a client with enteritis and frequent diarrhea, the nurse should anticipate: a) respiratory acidosis. b) metabolic alkalosis. c) respiratory alkalosis. d) metabolic acidosis.
metabolic acidosis. Correct Explanation: Diarrhea causes a bicarbonate deficit. With loss of the relative alkalinity of the lower GI tract, the relative acidity of the upper GI tract predominates, leading to metabolic acidosis. Loss of acid, which occurs with severe vomiting, may lead to metabolic alkalosis. Diarrhea doesn't lead to respiratory acid-base imbalances, such as respiratory acidosis and respiratory alkalosis. (less)
The nurse teaches the patient whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be a) fluid. b) mushy. c) semimushy. d) solid.
solid. Correct Explanation: With a sigmoid colostomy, the feces are solid. With a descending colostomy, the feces are semimushy. With a transverse colostomy, the feces are mushy. With an ascending colostomy, the feces are fluid. (less)
Mrs. Henry has been diagnosed with cancer in the descending colon. Which of the following symptoms would you expect her to report when obtaining a history? Select all that apply. a) Constipation b) Black, tarry stools c) Tenesmus d) Narrowing of stools
• Narrowing of stools • Constipation Correct Explanation: Abdominal pain and cramping, narrowing of stools, constipation, abdominal distension, and bright red blood in stools are symptoms associated with a left-sided lesion. Black, tarry stools and tenesmus are symptoms associated with a right-sided lesion. (less)
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)
Loperamide (Imodium) Explanation: 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. (less)
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
Sigmoidoscopy Explanation: 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. (less)
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? a) Disorders of the colon b) Small-bowel disease c) Ulcerative colitis d) Intestinal malabsorption
Ulcerative colitis Correct Explanation: The presence of mucus and pus in the stools suggests ulcerative colitis. Watery stools are characteristic of small-bowel disease. Loose, semisolid stools are associated more often with disorders of the colon. Voluminous, greasy stools suggest intestinal malabsorption. (less)
Barbara Allen, a 69-year-old retired cab driver, is undergoing diagnostic testing in the hospital where you practice nursing. She has been experiencing lower GI difficulties that have increased in severity, and her gastroenterologist is concerned that her bowel is not functioning properly. What function of the lower GI tract is most likely to be affected by her disorder? a) Fat digestion b) Protein digestion c) Water and electrolyte absorption d) All options are correct.
Water and electrolyte absorption Correct Explanation: Disorders of the lower GI tract usually affect movement of feces toward the anus, absorption of water and electrolytes, and elimination of dietary wastes. Water and electrolyte absorption would most likely be affected. (less)
After undergoing a total cystectomy and urinary diversion, a client has a Kock pouch (continent internal reservoir) in place. Which statement by the client indicates a need for further teaching? a) "I'll have to catheterize my pouch every 2 hours." b) "I'll have to wear an external collection pouch for the rest of my life." c) "I'll need to drink at least eight glasses of water a day." d) "I should eat foods from all the food groups."
"I'll have to wear an external collection pouch for the rest of my life." Correct Explanation: The client requires additional teaching if he states that he'll have to wear an external collection pouch for the rest of his life. An internal collection pouch, such as the Kock pouch, allows the client to perform self-catheterization for ileal drainage. This pouch is an internal reservoir, eliminating the need for an external collection pouch. A well-balanced diet is essential for healing; the client need not include or exclude particular foods. The client should drink at least eight glasses of fluid daily to prevent calculi formation and urinary tract infection. Intervals between pouch drainings should be increased gradually until the pouch is emptied two to four times daily. (less)
A nurse is teaching a group of adults about screening and prevention of colorectal cancer. The nurse should describe which of the following as the most common sign of possible colon cancer? a) Abdominal bloating and flank pain b) Unexplained weight gain c) Change in bowel habits d) Development of new hemorrhoids
Change in bowel habits Correct Explanation: The most common presenting symptom associated with colorectal cancer is a change in bowel habits. The passage of blood is the second most common symptom. Symptoms may also include unexplained anemia, anorexia, weight loss, and fatigue. Hemorrhoids and bloating are atypical. (less)
What is the primary nursing diagnosis for a client with a bowel obstruction? a) Deficient fluid volume b) Deficient knowledge c) Acute pain d) Ineffective tissue perfusion
Deficient fluid volume Explanation: 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. (less)
A patient diagnosed with IBS is advised to eat a diet that is: a) Sodium-restricted. b) Low in residue. c) High in fiber. d) Restricted to 1,200 calories/day.
High in fiber. Correct Explanation: A high-fiber diet is prescribed to control diarrhea and constipation and is recommended for patients with IBS.
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? a) Administer an opioid analgesic. b) Administer a retention enema. c) Start an IV with lactated Ringer's solution. d) Notify the physician.
Notify the physician. Correct 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. (less)
Patients with irritable bowel disease (IBD) are at significantly increased risk for which of the following? a) Hypotension b) Deep vein thrombosis c) Osteoporosis d) Pneumonia
Osteoporosis Explanation: Patients with IBD also have a significantly increased risk of osteoporotic fractures due to decreased bone mineral density. Patients are not at increased risk of deep vein thrombosis, hypotension, or pneumonia. (less)
A client is being treated for diverticulosis. Which of the following 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) Do not suppress the urge to defecate. c) Use laxatives or enemas at least once a week. d) Drink at least 8 to 10 large glasses of fluid every day.
• Do not suppress the urge to defecate. • Drink at least 8 to 10 large glasses of fluid every day. Explanation: 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. (less)
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? a) "I'll incorporate foods rich in omega-3 fatty acids into my diet." b) "I'll increase my intake of protein during exacerbations." c) "I should increase my intake of fresh fruits and vegetables during remissions." d) "I'll snack on nuts, olives, and popcorn during flare-ups."
"I should increase my intake of fresh fruits and vegetables during remissions." Explanation: A client with diverticulitis needs to modify fiber intake to effectively manage the disease. During episodes of diverticulitis, he should follow a low-fiber diet to help minimize bulk in the stools. A client with diverticulosis should follow a high-fiber diet. Clients with diverticular disease don't need to modify their intake of protein and omega-3 fatty acids. (less)
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) D5W c) D10W d) 0.45% of NS
0.9% NS Correct Explanation: 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. (less)
Common clinical manifestations of Crohn's disease include: a) Abdominal pain and diarrhea. b) Edema and weight gain. c) Obstruction and paralytic ileus. d) Nausea and vomiting.
A Correct Explanation: The onset of symptoms is usually insidious in regional enteritis, with prominent lower right quadrant abdominal pain that is unrelieved by defecation and the presence of diarrhea.
A nurse caring for a client with small-bowel obstruction should plan to implement which nursing intervention first? a) Preparing to insert a nasogastric (NG) tube b) Obtaining a blood sample for laboratory studies c) Administering I.V. fluids d) Administering pain medication
Administering I.V. fluids Explanation: The nurse should first administer I.V. infusions containing normal saline solution and potassium to maintain fluid and electrolyte balance. For the client's comfort and to assist in bowel decompression, the nurse should prepare to insert an NG tube next. A blood sample is then obtained for laboratory studies to help diagnose bowel obstruction and guide treatment. Blood studies usually include a complete blood count, serum electrolyte levels, and blood urea nitrogen level. Pain medication commonly is withheld until obstruction is diagnosed because analgesics can decrease intestinal motility. (less)
A 50-year-old woman is brought into the ED with symptoms suggestive of peritonitis. Nursing management would include all of the following, except? a) Analgesics are limited to avoid the formation of paralytic ileus. b) Insertion of urinary retention catheter c) Insertion of nasogastric tube d) Accurate recording of input and output
Analgesics are limited to avoid the formation of paralytic ileus. Explanation: Analgesics such as meperidine or IV morphine sulfate are ordered to relieve pain and promote rest. Because hypovolemia can occur from fluids leaking into the peritoneal cavity, I & O is monitored closely to assist in determining fluid replacement. A nasogastric tube is used to relieve abdominal distention by suctioning the accumulated gas and stagnant upper GI fluids. If hypovolemia is present, renal perfusion can become decreased, requiring close monitoring. (less)
Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? a) Low residue b) Calorie restriction c) Iron restriction d) Low protein
Low residue Correct 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. (less)
The nurse is teaching a patient with an ostomy how to change the pouching system. Which of the following should the nurse include in the teaching of a patient with no peristomal skin irritation? a) Apply barrier powder b) Dry skin thoroughly after washing c) Apply Kenalog spray d) Dust with nystatin powder
Dry skin thoroughly after washing Explanation: The nurse should teach the patient without peristomal skin irritation to dry the skin thoroughly after washing. Barrier powder, Kenalog spray, and nystatin powder are used when there is peristomal skin irritation and/or fungal infection. (less)
A nurse is providing care for a patient whose recent colostomy has contributed to a nursing diagnosis of Disturbed Body Image Related to Colostomy. What intervention best addresses this diagnosis? a) Emphasize the fact that the colostomy was needed to alleviate a much more serious health problem. b) Engage the patient in the care of the ostomy to the extent that the patient is willing. c) Emphasize the fact that the colostomy is temporary measure and is not permanent. d) Encourage the patient to conduct online research into colostomies.
Engage the patient in the care of the ostomy to the extent that the patient is willing. Explanation: For some patients, becoming involved in the care of the ostomy helps to normalize it and enhance familiarity. Emphasizing the benefits of the intervention is unlikely to improve the patient's body image, since the benefits are likely already known. Online research is not likely to enhance the patient's body image and some ostomies are permanent. (less)
severe abdominal pain with direct palpation or rebound tenderness. Correct 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. (less)
Hypotension Correct Explanation: Clinical manifestations include hypotension, increased temperature, tachycardia, and elevated ESR. Reference:
The nurse is conducting a community education program on colorectal cancer. Which of the following statements should the nurse include in the program? a) There is no hereditary component to colorectal cancer. b) The incidence of colorectal cancer decreases with age. c) It is the third most common cancer in the United States. d) The lifetime risk of developing colorectal cancer is 1 in 10.
It is the third most common cancer in the United States. Correct Explanation: Colorectal cancer is the third most common type of cancer in the United States. The lifetime risk of developing colorectal cancer is 1 in 20. The incidence increases with age (the incidence is highest in people older than 85). Colorectal cancer occurrence is higher in people with a family history of colon cancer. (less)
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? a) Keep a 1- to 2-week symptom and food diary to identify food triggers. b) Document how much fluid is being taken to determine if the patient is overhydrating. c) Discontinue the use of any medication presently being taken to determine if medication is a trigger. d) 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. Correct Explanation: The nurse emphasizes and reinforces good dietary habits (e.g., avoidance of food triggers). A good way to identify problem foods is to keep a 1- to 2-week symptom and food diary.
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) Duodenal ulcers b) Polyps c) Weight gain d) Hemorrhoids
Polyps Correct 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. (less)
