Lower Gastrointestinal Problems Harding: Lewis's Medical-Surgical Nursing

When evaluating the patient's understanding about the care of the ileostomy, which statement by the patient indicates the patient needs more teaching? "I will be able to regulate when I have stools." "I will be able to wear a pouch until it leaks." "The drainage from my stoma can damage my skin." "Dried fruit and popcorn must be chewed very well."

"I will be able to regulate when I have stools." Rationale: An ileostomy is in the ileum and drains liquid stool frequently, unlike a colostomy, which has more formed stool the farther distal the ostomy is in the colon. The ileostomy pouch is usually worn for 4 to 7 days or until it leaks. It must be changed immediately if it leaks because the drainage is very irritating to the skin. To avoid obstruction, popcorn, dried fruit, coconut, mushrooms, olives, stringy vegetables, food with skin, and meats with casings must be chewed extremely well before swallowing because of the narrow diameter of the ileostomy lumen.

The nurse is preparing to administer a dose of bisacodyl to a patient with constipation and the patient asks how it will work. What is the best response by the nurse? "It will increase bulk in the stool." "It will lubricate the intestinal tract to soften feces." "It will increase fluid retention in the intestinal tract." "It will increase peristalsis by stimulating nerves in the colon wall."

"It will increase peristalsis by stimulating nerves in the colon wall." Rationale: Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. Fiber and bulk-forming drugs increase bulk in the stool. Water and stool softeners soften feces, and saline and osmotic solutions cause fluid retention in the intestinal tract.

The nurse is preparing to administer famotidine to a patient after a laparotomy. The patient states they do not have heartburn. What response by the nurse would be the most appropriate? "It will prevent air from accumulating in the stomach, causing gas pains." "It will reduce the amount of acid in the stomach while you are not eating." "It will prevent the heartburn that occurs as a side effect of general anesthesia." "The stress of surgery is likely to cause stomach bleeding if you do not receive it."

"It will reduce the amount of acid in the stomach while you are not eating." Rationale: Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery. Famotidine does not prevent air from accumulating in the stomach or stop the stomach from bleeding. Heartburn is not a side effect of general anesthesia.

The nurse is preparing to insert a nasogastric (NG) tube into a patient with a suspected small intestinal obstruction that is vomiting. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate? "The tube will help to drain the stomach contents and prevent further vomiting." "The tube will push past the area that is blocked and help to stop the vomiting." "The tube is just a standard procedure before many types of surgery to the abdomen." "The tube will let us measure your stomach contents so we can give you the right IV fluid replacement."

"The tube will help to drain the stomach contents and prevent further vomiting." Rationale: The NG tube is used to decompress the stomach by draining stomach contents and thereby prevent further vomiting. The NG tube will not push past the blocked area. Potential surgery is not currently indicated. The location of the obstruction will determine the type of fluid to use, not measure the amount of stomach contents.

A patient is given a bisacodyl suppository and asks the nurse how long it will take to work. What is the best response by the nurse? 2 to 5 minutes 15 to 60 minutes 2 to 4 hours 6 to 8 hours

15 to 60 minutes Rationale: Bisacodyl suppositories usually are effective within 15 to 60 minutes of administration, so the nurse should plan accordingly to assist the patient to use the bedpan or commode.

A patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? 7:00 AM, 10:00 AM, and 1:00 PM 8:00 AM, 12:00 PM, and 4:00 PM 9:00 AM and 3:00 PM 9:00 AM, 12:00 PM, and 3:00 PM

8:00 AM, 12:00 PM, and 4:00 PM Rationale: A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00 AM, 12:00 PM, and 4:00 PM.

A young woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. Which information will the nurse add to a teaching plan about UTIs for this patient that goes beyond a general teaching plan for UTIs? a. Fistulas can form between the bowel and bladder. b. Bacteria in the perianal area can enter the urethra. c. Drink adequate fluids to maintain normal hydration. d. Empty the bladder before and after sexual intercourse.

ANS: A Fistulas between the bowel and bladder occur in Crohn's disease and can lead to UTI. Teaching for UTI prevention in general includes good hygiene, adequate fluid intake, and voiding before and after intercourse. DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

Which menu choice by the patient with diverticulosis is best for preventing diverticulitis? a. Navy bean soup and vegetable salad b. Whole grain pasta with tomato sauce c. Baked potato with low-fat sour cream d. Roast beef sandwich on whole wheat bread

ANS: A A diet high in fiber and low in fats and red meat is recommended to prevent diverticulitis. Although all the choices have some fiber, the bean soup and salad will be the highest in fiber and the lowest in fat. DIF:CognitiveLevel: Analyze (Analysis) MSC:NCLEX: Health Promotion and Maintenance TOP: NursingProcess: Evaluation

Which action would the nurse plan when admitting a patient with acute diverticulitis plan for initial care? a. Administer IV fluids. b. Prepare for colonoscopy. c. Encourage a high-fiber diet. d. Give stool softeners and enemas.

ANS: A A patient with acute diverticulitis will be NPO and given parenteral fluids. A diet high in fiber and fluids will be implemented before discharge. Bulk-forming laxatives, rather than stool softeners, are usually given. These will be implemented later in the hospitalization. The patient with acute diverticulitis will not have enemas or a colonoscopy because of the risk for perforation and peritonitis.

A patient calls the clinic to report a severe diarrhea lasting 4 days. What would the nurse anticipate that the patient will need to do? a. Collect a stool specimen. b. Prepare for colonoscopy. c. Schedule a barium enema. d. Have blood cultures drawn.

ANS: A Acute diarrhea is often caused by an infectious process, so stool specimens are obtained for culture and examined for parasites or white blood cells. There is no indication that the patient needs a colonoscopy, blood cultures, or a barium enema. DIF:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess: Planning

A patient with a new ileostomy asks how much it will drain after the bowel has adapted in a few months. How many cups of drainage per day would the nurse tell the patient to expect? a. 2 b. 3 c. 4 d. 5

ANS: A 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. DIF:CognitiveLevel: Understand (Comprehension) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

Which action will the nurse include in the plan of care for a 25-yr-old male patient with a new diagnosis of irritable bowel syndrome (IBS)? a. Encourage the patient to express concerns and ask questions about IBS. b. Suggest that the patient increase the intake of milk and other dairy products. c. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs). d. Teach the patient about the use of alosetron (Lotronex) to reduce IBS symptoms.

ANS: A Because psychologic and emotional factors can affect the symptoms for IBS, encouraging the patient to discuss emotions and ask questions is an important intervention. Alosetron has serious side effects and is used only for female patients who have not responded to other therapies. Although yogurt may be beneficial, milk is avoided because lactose intolerance can contribute to symptoms in some patients. NSAIDs can be used by patients with IBS. DIF:CognitiveLevel: Apply (Application) MSC:NCLEX: Psychosocial Integrity TOP: NursingProcess: Planning

Which information obtained by the nurse interviewing a patient is most important to communicate to the health care provider? a. Blood in the stool b. History of constipation c. Appendectomy 3 years ago d. Smokes a pack/day of cigarettes

ANS: A Blood in the stool is a possible clinical manifestation of colorectal cancer and requires further assessment by the health care provider. The other patient information will also be communicated to the health care provider but does not indicate an urgent need for further testing or intervention. DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

The nurse is assessing a patient with abdominal pain. How will the nurse document ecchymosis around the area of umbilicus? a. Cullen's sign b. Rovsing sign c. McBurney's sign d. Grey-Turner's sign

ANS: A Cullen's sign is ecchymosis around the umbilicus. Rovsing sign occurs when palpation of the left lower quadrant causes pain in the right lower quadrant. Grey Turner's sign is bruising over the flanks. Deep tenderness at McBurney's point (halfway between the umbilicus and the right iliac crest), known as McBurney's sign, is a sign of acute appendicitis. DIF:CognitiveLevel: Understand (Comprehension) TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

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 would the nurse plan to teach the patient? a. Medication use b. Fluid restriction c. Enteral nutrition d. Activity restrictions

ANS: A Medications are used to induce and maintain remission in patients with inflammatory bowel disease (IBD). Decreased activity level is indicated only if the patient has severe fatigue and weakness. Fluids are needed to prevent dehydration. There is no advantage to enteral feedings if the patient is able to eat. DIF:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess: Planning

Which prescribed intervention for a patient with chronic short bowel syndrome would the nurse question? a. Senna 1 tablet daily b. Ferrous sulfate 325 mg daily c. Psyllium (Metamucil) 3 times daily d. Diphenoxylate with atropine (Lomotil) PRN loose stools

ANS: A Patients with short bowel syndrome have diarrhea because of decreased nutrient and fluid absorption and would not need stimulant laxatives. Iron supplements are used to prevent iron-deficiency anemia, bulk-forming laxatives help make stools less watery, and opioid antidiarrheal drugs are helpful in slowing intestinal transit time. DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

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? a. Fever b. Nausea c. Joint pain d. Headache

ANS: A Since infliximab suppresses the immune response, rapid treatment of infection is essential. Nausea, joint pain, and headache are common side effects of the medication, but they do not indicate any potentially life-threatening complications. DIF:CognitiveLevel: Analyze (Analysis) MSC:NCLEX: Safe and Effective Care Environment TOP: NursingProcess: Evaluation

Which patient would the nurse assess first after receiving change-of-shift report? a. A 40-yr-old patient who has a distended abdomen and tachycardia b. A 60-yr-old patient whose ileostomy has drained 800 mL over 8 hours c. A 30-yr-old patient with ulcerative colitis who had six liquid stools in 4 hours d. A 50-yr-old patient with familial adenomatous polyposis who has occult blood in the stool

ANS: A The patient's abdominal distention and tachycardia suggest hypovolemic shock caused by problems such as peritonitis or intestinal obstruction, which will require rapid intervention. The other patients would be assessed as quickly as possible, but the data do not indicate any life-threatening complications associated with their diagnoses. DIF:CognitiveLevel: Analyze (Analysis) MSC:NCLEX: Safe and Effective Care Environment TOP: NursingProcess: Planning

A patient is awaiting surgery for acute peritonitis. Which action will the nurse plan to include in the preoperative care? a. Position patient with the knees flexed. b. Avoid use of opioids or sedative drugs. c. Offer frequent small sips of clear liquids. d. Assist patient to breathe deeply and cough.

ANS: A There is less peritoneal irritation with the knees flexed, which will help decrease pain. Opioids and sedatives are typically given to control pain and anxiety. Preoperative patients with peritonitis are given IV fluids for hydration. Deep breathing and coughing will increase the patient's discomfort. DIF:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess: Planning

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 the nurse include in patient teaching? a. Stool will be expelled from both stomas. b. This type of colostomy is usually temporary. c. Soft, formed stool can be expected as drainage. d. Irrigations can regulate drainage from the stomas.

ANS: B A loop, or double-barrel stoma, is usually temporary. Stool will be expelled from the proximal stoma only. The stool from the transverse colon will be liquid and regulation through irrigations will not be possible. DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

Which care activity for a patient with a paralytic ileus is appropriate for the registered nurse (RN) to delegate to assistive personnel (AP)? a. Auscultating for bowel sounds b. Brushing the teeth and tongue c. Assessing the nares for irritation d. Irrigating the nasogastric (NG) tube

ANS: B AP education and scope of practice include patient hygiene such as oral care. The other actions require education and scope of practice appropriate to the RN. DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX: Safe and Effective Care Environment

The nurse is admitting a patient with new-onset steatorrhea. Which question is most important for the nurse to ask? a. "How much milk do you drink?" b. "Have you had a recent weight loss?" c. "What time of day do your bowels move?" d. "Do you eat meat or other animal products?"

ANS: B 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. DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

A patient reports gas pains and abdominal distention 2 days after a small bowel resection. Which action would the nurse take? a. Administer morphine sulfate. b. Encourage the patient to ambulate. c. Offer the prescribed promethazine. d. Instill a mineral oil retention enema

ANS: B Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine is used as an antiemetic rather than to decrease gas pains or distention. DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 bloody stools a day. Which intervention would the nurse include in the patient's plan of care? a. Administer oral metoclopramide. b. Instruct the patient not to eat or drink. c. Administer cobalamin (vitamin B12) injections. d. Teach the patient about total colectomy surgery.

ANS: B An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO. Metoclopramide increases peristalsis and will worsen symptoms. Cobalamin (vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. Although total colectomy is needed for some patients, there is no indication that this patient is a candidate during this acute phase. DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

Which screening test would the nurse plan to teach a 45-yr-old male about during an annual wellness exam? a. Endoscopy b. Colonoscopy c. Computerized tomography d. Carcinoembryonic antigen (CEA)

ANS: B At age 45 years, persons with an average risk for colorectal cancer (CRC) would begin screening for CRC. Colonoscopy is the gold standard for CRC screening. The other diagnostic tests are not recommended as part of a routine annual physical exam at age 45 years. DIF:CognitiveLevel: Apply (Application) MSC:NCLEX: Health Promotion and Maintenance TOP: NursingProcess: Planning

Which nursing action will the nurse include in the plan of care for a patient admitted with an exacerbation of inflammatory bowel disease (IBD)? a. Restrict IV fluid intake. b. Monitor stools for blood. c. Ambulate six times daily. d. Increase dietary fiber intake.

ANS: B Because anemia or hemorrhage may occur with IBD, stools should be assessed for the presence of blood. The other actions would not be appropriate for the patient with IBD. Dietary fiber may increase gastrointestinal motility and exacerbate the diarrhea, severe fatigue is common with IBD exacerbations, and dehydration may occur. DIF:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess: Planning

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." Which action would the nurse take? a. Reassure the patient that ileostomy care will become easier. b. Ask the patient about the concerns with stoma management. c. Postpone any teaching until the patient adjusts to the ileostomy. d. Develop a detailed written list of ostomy care tasks for the patient.

ANS: B Encouraging the patient to share concerns assists in helping the patient adjust to the body changes. Acknowledgment of the patient's feelings and concerns is important rather than offering false reassurance. Because the patient indicates that the feelings about the ostomy are the reason for the difficulty with the many changes, development of a detailed ostomy care plan will not improve the patient's ability to manage the ostomy. Although detailed ostomy teaching could be postponed, the nurse should begin to offer teaching about some aspects of living with an ostomy. DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX: Psychosocial Integrity

A critically ill patient with sepsis is frequently incontinent of watery stools. Which action by the nurse will prevent complications associated with ongoing incontinence? a. Apply incontinence briefs. b. Use a fecal management system. c. Insert a rectal tube with a drainage bag. d. Assist the patient to a commode frequently.

ANS: B Fecal management systems are designed to contain loose stools and can be in place for as long as 4 weeks without causing damage to the rectum or anal sphincters. Although incontinence briefs may be helpful, unless they are changed frequently, they are likely to increase the risk for skin breakdown. Rectal tubes are avoided because of possible damage to the anal sphincter and ulceration of the rectal mucosa. A critically ill patient will not be able to tolerate getting up frequently to use the commode or bathroom. DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis? a. Restrict fluid intake to prevent constant liquid drainage from the stoma. b. Use care when eating high-fiber foods to avoid obstruction of the ileum. c. Irrigate the ileostomy daily to avoid having to wear a drainage appliance. d. Change the pouch every day to prevent leakage of contents onto the skin.

ANS: B High-fiber foods are introduced gradually and should be well chewed to avoid obstruction of the ileostomy. Patients with ileostomies do not have a colon for the absorption of water; they need to take in increased amounts of fluid. The pouch should be drained frequently but is changed every 5 to 7 days. The drainage from an ileostomy is liquid and continuous, so control by irrigation is not possible. DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

Which information will the nurse plan to teach a patient who has lactose intolerance? a. Ice cream is relatively low in lactose. b. Live-culture yogurt is usually tolerated. c. Heating milk will break down the lactose. d. Nonfat milk is tolerated better than whole milk

ANS: B Lactose-intolerant persons can usually eat yogurt without experiencing discomfort. Ice cream, nonfat milk, and milk that have been heated are all high in lactose. DIF:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess: Planning

After change-of-shift report, which patient would the nurse assess first? a. A 40-yr-old male patient with celiac disease who has frequent frothy diarrhea b. A 30-yr-old female patient with a femoral hernia who has abdominal pain and vomiting c. A 30-yr-old male patient with ulcerative colitis who has severe perianal skin breakdown d. A 40-yr-old female patient with a colostomy bag that is pulling away from the adhesive wafer

ANS: B Pain and vomiting with a femoral hernia suggest strangulation, which will require emergency surgery. All the other patients require assessment or care but have less urgent problems.

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? a. Obtain blood samples for DNA analysis. b. Schedule the patient for yearly colonoscopy. c. Provide preoperative teaching about total colectomy. d. Discuss lifestyle modifications to decrease cancer risk.

ANS: B 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. DNA analysis is used to make the diagnosis but is not needed now for this patient. Lifestyle modifications will not decrease cancer risk for this patient. DIF:CognitiveLevel: Apply (Application) MSC:NCLEX: Health Promotion and Maintenance TOP: NursingProcess: Planning

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? a. Auscultate the bowel sounds. b. Prepare the patient for surgery. c. Check the patient's oral temperature. d. Obtain information about the accident.

ANS: B Return of brown drainage and fecal material suggests perforation of the bowel and the need for immediate surgery. Auscultation of bowel sounds, checking the temperature, and obtaining information about the accident are appropriate actions, but the priority is to prepare to send the patient for emergency surgery. DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Planning

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 would the nurse take first? a. Encourage the patient to increase oral fluid intake. b. Question the patient about risk factors for constipation. c. Suggest that the patient increase intake of high-fiber foods. d. Teach the patient that a daily bowel movement is unnecessary

ANS: B The nurse's initial action should be further assessment of the patient for risk factors for constipation and for his usual bowel pattern. The other actions may be appropriate but will be based on the assessment. DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

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 the nurse's teaching about skin integrity has been effective? a. The patient uses incontinence briefs to contain loose stools. b. The patient uses witch hazel compresses to soothe irritation. c. The patient asks for antidiarrheal medication after each stool. d. The patient cleans the perianal area with soap after each stool.

ANS: B Witch hazel compresses are suggested to reduce anal irritation and discomfort. Incontinence briefs may trap diarrhea and increase the incidence of skin breakdown. Antidiarrheal medications cannot be given 15 to 20 times a day. The perianal area should be washed with plain water or pH balanced cleanser after each stool. DIF:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess: Evaluation

Which information will the nurse include when teaching a patient how to avoid chronic constipation? (Select all that apply.) a. Stimulant and saline laxatives can be used regularly. 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.

ANS: B, C, D, E Stimulant and saline laxatives should be used infrequently. Use of bulk-forming laxatives, regular early morning timing of defecation, regular exercise, and avoiding many OTC medications will help the patient avoid constipation.

A 19-yr-old woman is brought to the emergency department with a knife handle protruding from her abdomen. Which action would the nurse take during the initial assessment of the patient? a. Remove the knife and assess the wound. b. Determine the presence of Rovsing sign. c. Check for circulation and tissue perfusion. d. Insert a urinary catheter and assess for hematuria.

ANS: C The initial assessment is focused on determining whether the patient has hypovolemic shock. The knife should not be removed until the patient is in surgery, where bleeding can be controlled. Rovsing sign is assessed in the patient with suspected appendicitis. Assessment for bladder trauma is not part of the initial assessment. DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

A patient calls the clinic reporting diarrhea for 24 hours. Which action would the nurse take first? a. Inform the patient that testing of blood and stools will be needed. b. Suggest that the patient drink clear liquid fluids with electrolytes. c. Ask the patient to describe the stools and any associated symptoms. d. Advise the patient to use over-the-counter antidiarrheal medication.

ANS: C The initial response by the nurse should be further assessment of the patient. The other responses may be appropriate, depending on what is learned in the assessment. DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

A 72-yr-old 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? a. Skin is dry with tenting and poor turgor. b. Patient has not voided for the last 2 hours. c. Crackles are heard halfway up the posterior chest. d. Patient has had 5 loose stools over the previous 6 hours.

ANS: C 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 other data will be reported but are consistent with the patient's age and diagnosis and do not require a change in the prescribed treatment. DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

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? a. "What type of foods do you eat?" b. "Is it possible that you are pregnant?" c. "Can you tell me more about the pain?" d. "What is your usual elimination pattern?"

ANS: C A complete description of the pain provides clues about the cause of the problem. Although the nurse should ask whether the patient is pregnant to determine whether the patient might have an ectopic pregnancy and before any radiology studies are done, this information is not the most useful in determining the cause of the pain. The usual diet and elimination patterns are less helpful in determining the reason for the patient's symptoms. DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

Which action would the nurse include in the plan of care for a patient who is being admitted with a C. difficile infection? a. Teach the patient about proper food storage. b. Order a diet without dairy products for the patient. c. Place the patient in a private room on contact isolation. d. Teach the patient about why antibiotics will not be used.

ANS: C Because C. difficile is highly contagious, the patient would be placed in a private room, and contact precautions would be used. There is no need to restrict dairy products for this type of diarrhea. Metronidazole (Flagyl) is frequently used to treat C. difficile infections. Improper food handling and storage do not cause C. difficile. DIF:CognitiveLevel: Apply (Application) TOP: MSC:NCLEX: Safe and Effective Care Environment NursingProcess: Planning

A patient in the emergency department has just been diagnosed with peritonitis from a ruptured diverticulum. Which prescribed intervention will the nurse implement first? a. Send the patient for a CT scan. b. Insert a urinary catheter to drainage. c. Infuse metronidazole (Flagyl) 500 mg IV. d. Place a nasogastric tube to intermittent low suction

ANS: C Because peritonitis can be fatal if treatment is delayed, the initial action would be to start antibiotic therapy (after any ordered cultures are obtained). The other actions can be done after antibiotic therapy is initiated. DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

After a patient has had a hemorrhoidectomy at an outpatient surgical center, which instructions will the nurse include in discharge teaching? a. Maintain a low-residue diet until the area is healed. b. Avoid using any topical preparations on the surgical area. c. Take prescribed pain medications before you expect a bowel movement. d. Delay having a bowel movement for several days until you are well healed.

ANS: C Bowel movements may be very painful, and patients may avoid defecation unless pain medication is taken before the bowel movement. A high-residue diet will increase stool bulk and prevent constipation. Delay of bowel movements is likely to lead to constipation. Topical preparations that provide anesthesia or reduce internal sphincter spasms such as topical lidocaine, 2% diltiazem, and glyceryl trinitrate may be used. Warm Sitz baths are used to relieve pain and keep the surgical area clean. DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

Which activity in the care of a patient with a new colostomy could the nurse delegate to assistive personnel (AP)? a. Document the appearance of the stoma. b. Place a pouching system over the ostomy. c. Drain and measure the output from the ostomy. d. Check the skin around the stoma for breakdown.

ANS: C Draining and measuring the output from the ostomy is included in AP education and scope of practice. The other actions should be implemented by LPNs or RNs. DIF:CognitiveLevel: Apply (Application) TOP: MSC:NCLEX: Safe and Effective Care Environment NursingProcess: Planning

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching? a. Scrambled eggs b. White toast and jam c. Oatmeal with cream d. Pancakes with syrup

ANS: C During acute exacerbations of IBD, the patient would avoid high-fiber foods such as whole grains. High-fat foods also may cause diarrhea in some patients. The other choices are low residue and would be appropriate for this patient. DIF:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess: Evaluation

Four hours after a bowel resection, a 74-yr-old male patient with a nasogastric tube to suction reports nausea and abdominal distention. Which action would the nurse take first? a. Auscultate for hypotonic bowel sounds. b. Notify the patient's health care provider. c. Check for tube placement and reposition it. d. Remove the tube and replace it with a new one

ANS: C Repositioning the tube will frequently facilitate drainage. Because this is a common occurrence, it is not appropriate to notify the health care provider unless other interventions do not resolve the problem. Information about the presence or absence of bowel sounds will not be helpful in improving drainage. Removing the tube and replacing it are unnecessarily traumatic to the patient, so that would only be done if the tube was completely occluded. DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

A 76-yr-old patient with obstipation has a fecal impaction and is incontinent of liquid stool. Which action would the nurse take first? a. Administer bulk-forming laxatives. b. Assist the patient to sit on the toilet. c. Manually remove the hard stool. d. Increase the patient's oral fluid intake.

ANS: C The initial action with a fecal impaction is manual disimpaction. The other actions will be used to prevent future constipation and impactions. DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

A young adult patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action would the nurse take? a. Assist the patient to cough and deep breathe. b. Palpate the abdomen for rebound tenderness. c. Suggest the patient lie on the side, flexing the right leg. d. Encourage the patient to sip clear, noncarbonated liquids.

ANS: C The patient's clinical manifestations are consistent with appendicitis. Lying still with the right leg flexed is often the most comfortable position. Checking for rebound tenderness frequently is unnecessary and uncomfortable for the patient. The patient should be NPO in case immediate surgery is needed. The patient will need to know how to cough and deep breathe postoperatively, but coughing will increase pain at this time. DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

A patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102F (38.3C), pulse 120 beats/min, respirations 32 breaths/min, and blood pressure (BP) 82/54 mm Hg. Which prescribed intervention would the nurse implement first? a. Administer IV ketorolac 15 mg for pain relief. b. Send a blood sample for a complete blood count (CBC). c. Infuse a liter of lactated Ringer's solution over 30 minutes. d. Send the patient for an abdominal computed tomography (CT) scan.

ANS: C The priority for this patient is to treat the patient's hypovolemic shock with fluid infusion. The other actions should be implemented after starting the fluid infusion. DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

A patient who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information would the nurse provide? a. Fiber-containing laxatives may reduce the absorption of fat-soluble vitamins. b. Dietary sources of fiber should be eliminated to prevent excessive gas formation. c. Use of this type of laxative to prevent constipation does not cause adverse effects. d. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.

ANS: D A high fluid intake is needed when patients are using bulk-forming laxatives to avoid worsening constipation. Although bulk-forming laxatives are generally safe, the nurse should emphasize the possibility of constipation or obstipation if inadequate fluid intake occurs. Although increased gas formation is likely to occur with increased dietary fiber, the patient should gradually increase dietary fiber and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool softeners and lubricants, not by bulk-forming laxatives.

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? a. Soak in Sitz baths several times each day. b. Cough 5 times each hour for the next 48 hours. c. Avoid using acetaminophen (Tylenol) for pain. d. Apply a scrotal support and ice to reduce swelling.

ANS: D A scrotal support and ice are used to reduce edema and pain. Coughing will increase pressure on the incision. Sitz baths will not relieve pain and would not be of use after this surgery. Acetaminophen can be used for postoperative pain. DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

The nurse is providing preoperative teaching for a patient scheduled for an abdominal-perineal resection. Which information will the nurse include? a. The patient will need to be on bedrest for three days after surgery. b. An ileal-anal reservoir will be surgically created in 8 to 12 weeks. c. The patient will have a temporary colostomy for 6-12 months. d. The site for the stoma will be marked on the abdomen before surgery.

ANS: D A wound, ostomy, continence nurse (WOCN) would select the site where the ostomy will be positioned and mark the abdomen preoperatively. The site would be within the rectus muscle, on a flat surface, and in a place that the patient is able to see. A permanent colostomy is created with this surgery and no further surgery would be planned. The patient will be encouraged to walk the day after surgery. DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

Which finding is likely in the nurse's assessment of a patient who has a large bowel obstruction? a. Referred back pain b. Metabolic alkalosis c. Projectile vomiting d. Abdominal distention

ANS: D Abdominal distention is seen in lower intestinal obstruction. Referred back pain is not a common clinical manifestation of intestinal obstruction. Metabolic alkalosis is common in high intestinal obstruction because of the loss of HCl acid from vomiting. Projectile vomiting is associated with higher intestinal obstruction. DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

Which breakfast choice indicates a patient's good understanding of information about a diet for celiac disease? a. Wheat toast with butter b. Oatmeal with nonfat milk c. Bagel with low-fat cream cheese d. Corn tortilla with scrambled eggs

ANS: D Avoidance of gluten-containing foods is the only treatment for celiac disease. Corn does not contain gluten, but oatmeal and wheat do. DIF:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess: Evaluation

Which topic would the nurse plan to teach to a patient with Crohn's disease who has megaloblastic anemia? a. Iron dextran infusions b. Oral ferrous sulfate tablets c. Routine blood transfusions d. Cobalamin (B12) supplements

ANS: D Crohn's disease frequently affects the ileum, where absorption of cobalamin occurs. Cobalamin must be administered regularly by nasal spray or IM to correct the anemia. Iron deficiency does not cause megaloblastic anemia. The patient may need occasional transfusions but not regularly scheduled transfusions. DIF:CognitiveLevel: Apply (Application) MSC:NCLEX: PhysiologicalIntegrity TOP: NursingProcess: Planning

Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome (IBS)? a. "Have you been passing a lot of gas?" b. "What foods affect your bowel patterns?" c. "Do you have any abdominal distention?" d. "How long have you had abdominal pain?"

ANS: D One criterion for the diagnosis of irritable bowel syndrome is the presence of abdominal discomfort or pain for at least 3 months. Abdominal distention, flatulence, and food intolerance are associated with IBS but are not diagnostic criteria. DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

After several days of antibiotic therapy for pneumonia, an older hospitalized patient develops watery diarrhea. Which action would the nurse take first? a. Notify the health care provider. b. Obtain a stool specimen for analysis. c. Teach the patient about hand washing. d. Place the patient on contact precautions.

ANS: D 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. The other actions are also appropriate but can be accomplished after contact precautions are implemented. DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Implementation MSC:NCLEX: Safe and Effective Care Environment

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. Which action would the nurse take? a. Place ice packs around the stoma. b. Notify the surgeon about the stoma. c. Monitor the stoma every 30 minutes. d. Document stoma assessment findings.

ANS: D \ 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. DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

A patient is planned for discharge home today after ostomy surgery for colon cancer. The nurse should assign the patient to which staff member? An UAP on the unit who has hospice experience An LPN that has worked on the unit for 10 years An RN with 6 months of experience on the surgical unit An RN who has floated to the surgical unit from pediatrics

An RN with 6 months of experience on the surgical unit Rationale: The patient needs ostomy care directions and reinforcement at discharge and should be assigned to a registered nurse with experience in providing discharge teaching for ostomy care. Teaching should not be delegated to a LPN/VN or UAP.

Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease? (Select all that apply) Restricted to rectum Strictures are common Bloody, diarrhea stools Cramping abdominal pain Lesions penetrate intestine

Bloody, diarrhea stools Cramping abdominal pain Rationale: Manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's disease.

The nurse is preparing to administer a scheduled dose of docusate sodium when the patient reports an episode of loose stool and does not want to take the medication. What is the appropriate action by the nurse? Write an incident report about this untoward event. Attempt to have the family convince the patient to take the ordered dose. Withhold the medication at this time and try to administer it later in the day. Chart the dose as not given on the medical record and explain in the nursing progress notes.

Chart the dose as not given on the medical record and explain in the nursing progress notes. Rationale: Whenever a patient refuses medication, the dose should be charted as not given with an explanation of the reason documented in the nursing progress notes. In this instance, the refusal indicates good judgment by the patient, and the patient should not be encouraged to take it today.

The nurse asks a patient scheduled for colectomy to sign the operative permit as directed in the provider's preoperative orders. The patient states that the provider has not explained very well what is involved in the surgical procedure. What is the most appropriate action by the nurse? Ask family members whether they have discussed the surgical procedure with the provider. Explain the planned surgical procedure as well as possible and have the patient sign the consent form. Have the patient sign the form and state the provider will visit to explain the procedure before surgery. Delay the patient's signature on the consent and notify the provider about the conversation with the patient.

Delay the patient's signature on the consent and notify the provider about the conversation with the patient. Rationale: The patient should not be asked to sign a consent form unless the procedure has been explained to the satisfaction of the patient. The nurse should notify the provider, who has the responsibility for obtaining consent.

The nurse is admitting a patient with severe dehydration and frequent watery diarrhea. A 10-day outpatient course of antibiotic therapy for bacterial pneumonia has just been completed. What is the most important for the nurse to take which action? Wear a mask to prevent transmission of infection. Have visitors use the alcohol-based hand sanitizer. Wipe down equipment with ammonia-based disinfectant. Don gloves and gown before entering the patient's room.

Don gloves and gown before entering the patient's room. Rationale: Clostridium difficile is an antibiotic-associated diarrhea transmitted by contact, and the spores are extremely difficult to kill. Patients with suspected or confirmed infection with C. difficile should be placed in a private room, and gloves and gowns should be worn by visitors and health care providers. Alcohol-based hand cleaners and ammonia-based disinfectants are ineffective and do not kill all the spores. Equipment cannot be shared with other patients, and a disposable stethoscope and individual patient thermometer are kept in the room. Objects should be disinfected with a 10% solution of household bleach.

When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend? White bread, cheese, and green beans Fresh tomatoes, pears, and corn flakes Oranges, baked potatoes, and raw carrots Dried beans, All Bran (100%) cereal, and raspberries

Dried beans, All Bran (100%) cereal, and raspberries Rationale: A high-fiber diet is recommended for diverticular disease. Dried beans, All Bran (100%) cereal, and raspberries all have higher amounts of fiber than white bread, cheese, green beans, fresh tomatoes, pears, corn flakes, oranges, baked potatoes, and raw carrots.

After an exploratory laparotomy, a patient on a clear liquid diet reports severe gas pains and abdominal distention. Which action by the nurse is most appropriate? Return the patient to NPO status. Place cool compresses on the abdomen. Encourage the patient to ambulate as ordered. Administer an as-needed dose of IV morphine sulfate.

Encourage the patient to ambulate as ordered. Rationale: Swallowed air and reduced peristalsis after surgery can result in abdominal distention and gas pains. Early ambulation helps restore peristalsis and eliminate flatus and gas pain. Medications used to reduce gas pain include metoclopramide, which stimulates peristalsis. A heating pad can help to alleviate some of the pain and help make the patient more comfortable. There is no need for the patient to return to NPO status. Drinking ginger ale may be helpful.

A patient after a stroke who primarily uses a wheelchair for mobility has developed diarrhea with fecal incontinence. What is a priority assessment by the nurse? Fecal impaction Perineal hygiene Dietary fiber intake Antidiarrheal agent use

Fecal impaction Rationale: Patients with limited mobility are at risk for fecal impactions caused by constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed and considered next.

A patient is admitted to the emergency department after a motor vehicle crash with suspected abdominal trauma. What assessment finding by the nurse is of highest priority? Nausea and vomiting Hyperactive bowel sounds Firmly distended abdomen Abrasions on all extremities

Firmly distended abdomen Rationale: Manifestations of abdominal trauma are guarding and splinting of the abdominal wall; a hard, distended abdomen (indicating possible intraabdominal bleeding); decreased or absent bowel sounds; contusions, abrasions, or bruising over the abdomen; abdominal pain; pain over the scapula; hematemesis or hematuria; and signs of hypovolemic shock (tachycardia and decreased blood pressure).

The nurse is caring for a patient admitted with a suspected bowel obstruction. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? Low-pitched and rumbling above the area of obstruction High-pitched and hypoactive below the area of obstruction Low-pitched and hyperactive below the area of obstruction High-pitched and hyperactive above the area of obstruction

High-pitched and hyperactive above the area of obstruction Rationale: Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high pitched, sometimes referred to as "tinkling," above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

The nurse is developing a plan of care for a patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history does the nurse recognize as increasing the patient's risk for colorectal cancer? Osteoarthritis History of colorectal polyps History of lactose intolerance Use of herbs as dietary supplements

History of colorectal polyps Rationale: A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient.

What information would have the highest priority for the nurse to include in preoperative teaching for a patient scheduled for an exploratory laparotomy? How to care for the wound How to deep breathe and cough The location and care of drains after surgery Which medications will be used during surgery

How to deep breathe and cough Rationale: Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed preoperatively but will be done again with higher priority after surgery. Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.

Two days after a bowel resection for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result what event? Impaired peristalsis Irritation of the bowel Nasogastric suctioning Inflammation of the incision site

Impaired peristalsis Rationale: Until peristalsis returns to normal after anesthesia, the patient may experience slowed gastrointestinal motility, leading to gas pains and abdominal distention. Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention.

A hospitalized patient has just been diagnosed with diarrhea due to C. difficile. Which nursing interventions should be included in the patient's plan of care? (Select all that apply.) Initiate contact isolation precautions. Place the patient on a clear liquid diet. Teach any visitors to wear gloves and gowns. Disinfect the room with 10% bleach solution as needed. Use hand sanitizer before and after any bodily fluid contact.

Initiate contact isolation precautions. Teach any visitors to wear gloves and gowns. Disinfect the room with 10% bleach solution as needed. Rationale: Initiation of contact isolation precautions must be done immediately with a patient with C. difficile, which includes washing hands with soap and water before and after patient or bodily fluid contact. Alcohol-based sanitizers are ineffective. Visitors need to be taught to wear gloves and gowns and wash hands. A clear liquid diet is not necessary. The room will be disinfected with 10% bleach solution when the patient is dismissed and may be done periodically during the patient's stay, depending on the agency policy.

The nurse is administering a cathartic agent to a patient with renal insufficiency. Which order will the nurse question? Bisacodyl Lubiprostone Cascara sagrada Magnesium hydroxide

Magnesium hydroxide Rationale: Milk of magnesia may cause hypermagnesemia in patients with renal insufficiency. The nurse should question this order with the health care provider. Bisacodyl, lubiprostone, and cascara sagrada are safe to use in patients with renal insufficiency as long as the patient is not currently dehydrated.

The nurse should administer an as-needed dose of magnesium citrate after noting what information when reviewing a patient's medical record? Abdominal pain and bloating No bowel movement for 3 days A decrease in appetite by 50% over 24 hours Muscle tremors and other signs of hypomagnesemia

No bowel movement for 3 days Rationale: Magnesium citrate is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days. It would not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.

A patient with an intestinal obstruction has a nasogastric (NG) tube to suction but reports of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse? Notify the provider. Auscultate for bowel sounds. Reposition the tube and check for placement. Remove the tube and replace it with a new one.

Reposition the tube and check for placement. Rationale: The tube may be resting against the stomach wall. The first action by the nurse is to reposition the tube and check it again for placement. The provider does not need to be notified unless the nurse cannot restore the tube function. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.

A patient with ulcerative colitis is scheduled for a colon resection with placement of an ostomy. The nurse should plan to include which prescribed measure in the preoperative preparation? Selecting the stoma site Where to purchase ostomy supplies Teaching about how to irrigate a colostomy Following a high-fiber diet the day before surgery

Selecting the stoma site Rationale: Care that is unique to ostomy surgery includes selecting the best site for the stoma. Instructions to irrigate the colostomy and where to purchase ostomy supplies will be done postoperatively. A clear liquid diet will be used the day before surgery with the bowel cleansing.

The nurse is preparing to administer a daily dose of docusate sodium to a patient that will continue taking it after discharge. What information should the nurse provide to the patient to optimize the outcome of the medication? Take a dose of mineral oil at the same time. Add extra salt to food on at least one meal tray. Ensure a dietary intake of 10 g of fiber each day. Take each dose with a full glass of water or other liquid.

Take each dose with a full glass of water or other liquid. Rationale: Docusate lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage. The patient should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. Dietary fiber intake should be a minimum of 20 g daily to prevent constipation. Mineral oil and extra salt are not recommended.

A patient with ulcerative colitis is scheduled for a total proctocolectomy with permanent ileostomy. The wound, ostomy, and continence nurse is selecting the site where the ostomy will be placed. What should be included in site consideration? Protruding areas make the best sites. The patient must be able to see the site. The site should be outside the rectus muscle area. The appliance will need to be placed at the waist line.

The patient must be able to see the site. Rationale: In selection of the ostomy site, the WOC nurse will want a site visible to the patient so the patient can take care of it, within the rectus muscle to avoid hernias, and on a flat surface to more easily create a good seal with the drainage bag. Care should be taken to avoid skin creases, scars, and belt lines, which can interfere with the adherence of the appliance.