Chapter 48- Management of Patients With Intestinal and Rectal Disorders

The nurse caring for an elderly patient diagnosed with diarrhea is administering and monitoring the patient's medications. Because one of the patient's medications is digitalis (digoxin [Lanoxin]), the nurse monitors the patient closely for which of the following?

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

*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*

*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.*

Perforation of the appendix generally occurs within which timeframe of the onset of pain if no intervention is done?

24 hours

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

Review the client's usual pattern of elimination.

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

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

*Usual pattern of elimination*

*The nurse is assessing a patient for constipation. Which of the following is the first review that the nurse should conduct in order to identify the cause of constipation?*

*Usual pattern of elimination*

*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.*

*A 43-year-old man is seen in the office where you work with complaints of severe pain and bleeding while having a bowel movement. Upon inspection, his healthcare provider notes a linear tear in the anal canal tissue. While reviewing with him the medical management for his condition, he asks you to repeat the name of the condition. The nurse will most likely tell him that he has been diagnosed with a ________.*

*fissure*

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 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 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 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 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."*

*The nurse is conducting a community education program on colorectal cancer. Which of the following statements should the nurse include in the program?*

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

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

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

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?

Borborygmus

Which of the following terms is used to refer to intestinal rumbling?

Borborygmus

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

Breast

Which of the following is the most common presenting symptom of colon cancer?

Change in bowel habits

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 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.

Which of the following is one of the primary symptoms of Irritable Bowel Syndrome (IBS)?

Diarrhea

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 of the following characteristics should the nurse include in the screening?

Familial polyposis

Which of the following characteristics are risk factors for colorectal cancer?

Familial polyposis

Diet therapy for patients diagnosed with IBS include which of the following?

High-fiber diet

The nurse is reinforcing diet teaching for a patient s diagnosed with IBS. The nurse instructs the patient to include which of the following in his diet?

High-fiber diet

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

Hypokalemia

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.

A 68-year-old resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. She receives nutrition via a PEG tube. The client remains physically and socially active and has adapted well to the tube feedings. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. Which of the following is the most likely cause of this client's constipation?

Lack of free water intake

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

Low residue

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

Metabolic alkalosis

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

Mineral Oil

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.

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 caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder?

One part of the intestine telescopes into another portion of the intestine.

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

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

When interviewing a client with internal hemorrhoids, which of the following would the nurse expect the client to report?

Rectal bleeding

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

Rectal bleeding

Effie Geitgey, a 93-year-old retired waitress, obsesses about the regularity of her bowel movements, which is a common complaint among the residents of the long-term care facility where you practice nursing. During one of your education sessions, you reinforce the medically acceptable definition of "regularity." What is the actual measurement of "regular"?

Stool consistency and client comfort are the proper measurements.

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?

Stool cultures negative for microorganisms or parasite

A patient who has undergone colostomy surgery is experiencing constipation. Which of the following interventions should a nurse consider for such a patient?

Suggest fluid intake of at least 2 L per day

Which outcome indicates effective client teaching to prevent constipation?

The client reports engaging in a regular exercise regimen.

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's natural bowel function may become sluggish.

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

A client informs the nurse that he is taking a stimulant laxative in order to be able to have a bowel movement daily. What should the nurse inform the client about the taking a stimulant laxative?

They can be habit forming and will require increasing doses to be effective.

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

Vitamin K

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.

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

anal fissure.

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

paralytic ileus.

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

sudden, sustained abdominal pain

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.

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