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Which is one of the primary symptoms of irritable bowel syndrome (IBS)? A. Pain B. Diarrhea C. Bloating D. Abdominal distention

Answer: B The primary symptoms of IBS include constipation, diarrhea, or a combination of both. Pain, bloating, and abdominal distention often accompany changes in bowel pattern.

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? A. Peristalsis B. Borborygmus C. Loud bowel sounds D. Tenesmus

Answer: B Borborygmus is a rumbling noise caused by the movement of gas through the intestines, often associated with diarrhea.

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? A. Age younger than 40 years B. Low-fat, low-protein, high-fiber diet C. Familial polyposis D. History of skin cancer

Answer: C Family history of colon cancer or familial polyposis is a risk factor for colorectal cancer. Age older than 40 years and a high-fat, high-protein, low-fiber diet are risk factors for colorectal cancer. A history of skin cancer is not a recognized risk factor for colorectal cancer.

The presence of mucus and pus in the stools suggests which condition? A. Intestinal malabsorption B. Disorders of the colon C. Small-bowel disease D. Ulcerative colitis

Answer: D 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.

Which of the following is considered a bulk-forming laxative? A. Metamucil B. Dulcolax C. Mineral oil D. Milk of Magnesia

Answer: A Metamucil is a bulk-forming laxative. Milk of Magnesia is classified as a saline agent. Mineral oil is a lubricant. Dulcolax is a stimulant.

An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to? A. Hyperkalemia B. Hyponatremia C. Hypokalemia D. Hypernatremia

Answer: C The older client taking digitalis must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

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? A. Right upper quadrant B. Left upper quadrant C. Right lower quadrant D. Left lower quadrant

Answer: C The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

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

Answer: D 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.

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? A. Iron restriction B. Low residue C. Low protein D. Calorie restriction

Answer: B 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.

A client is diagnosed with Zollinger-Ellison syndrome. The nurse knows to assess the client for which characteristic clinical feature of this syndrome? A. Lymphadenopathy B. Folate deficiency C. Steatorrhea D. Decreased intestinal lactose

Answer: C Hyperacidity in the duodenum inactivates pancreatic enzymes causing steatorrhea and ulcer diathesis.

A nurse is caring for a client who had an ileal conduit 3 days earlier. The nurse examines the stoma site and determines that she should consult with the ostomy nurse. Which assessment finding indicates the need for further consultation? A. Clear mucus mixed with yellow urine drained from the appliance bag B. Beefy red stoma site C. Red, sensitive skin around the stoma site D. Stoma site not sensitive to touch

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

Which term refers to intestinal rumbling? A. Azotorrhea B. Diverticulitis C. Tenesmus D. Borborygmus

Answer: D Borborygmus is the intestinal rumbling caused by gas moving through the intestines that accompanies diarrhea. Tenesmus refers to ineffectual straining upon evacuation of stool. Azotorrhea refers to excess nitrogenous matter in the feces or urine. Diverticulitis refers to inflammation of a diverticulum from obstruction (by fecal matter), resulting in abscess formation.

A nurse is interviewing a client about past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? A. Hemorrhoids B. Duodenal ulcers C. Polyps D. Weight gain

Answer: C 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.

The nurse is irrigating a client's colostomy when the client begins to report cramping. What is the appropriate action by the nurse? A. Discontinue the irrigation immediately. B. Increase the rate of administration. C. Clamp the tubing and allow client to rest. D. Change irrigation fluid to normal saline.

Answer: C The nurse should clamp the tubing and allow the client to rest when the client begins to report cramping during colostomy irrigation. Once the cramping has stopped, the nurse can resume the irrigation.

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

Answer: A 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.

The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching? A. Use laxatives weekly. B. Avoid daily exercise. C. Avoid unprocessed bran. D. Drink 8 to 10 glasses of fluid daily.

Answer: D The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the physician. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.

A client reports constipation. Which nursing measure would be most effective in helping the client reduce constipation? A. Obtain complete food history. B. Assist client to increase dietary fiber. C. Obtain medical and allergy history. D. Provide adequate quantity of food.

Answer: B The nurse should assist the client to increase the dietary fiber in food because it helps reduce constipation. Providing an adequate quantity of food is necessary in maintaining sufficient nutrition and in sustaining normal body weight. Obtaining medical, allergy, and food history would provide valuable information, however, it would not help reduce constipation.

The nurse is conducting a gastrointestinal assessment. When the client reports the presence of mucus and pus in the stool, the nurse assesses for additional signs/symptoms of which disease/condition? A. Ulcerative colitis B. Intestinal malabsorption C. Disorders of the colon D. Small-bowel disease

Answer: A The presence of mucus and pus in the stool 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.

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

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

Which of the following is the most common symptom of a polyp? A. Diarrhea B. Abdominal pain C. Rectal bleeding D. Anorexia

Answer: C The most common symptom is rectal bleeding. Lower abdominal pain may also occur. Diarrhea and anorexia are clinical manifestations of ulcerative colitis.

A nurse is reviewing the history and physical of a client admitted for a hemorrhoidectomy. Which predisposing condition does the nurse expect to see? A. Lactic acidosis B. Constipation C. Hyperkalemia D. Hypoglycemia

Answer: B Orthostatic hypertension and other conditions associated with persistently high intra-abdominal pressure (such as pregnancy) can lead to hemorrhoids. The passing of hard stools, not diarrhea, can aggravate hemorrhoids. Diverticulosis has no relationship to hemorrhoids. Rectal bleeding is a symptom of hemorrhoids, not a predisposing condition.

Celiac disease (celiac sprue) is an example of which category of malabsorption? A. Mucosal disorders causing generalized malabsorption B. Luminal problems causing malabsorption C. Postoperative malabsorption D. Infectious diseases

Answer: A Celiac disease (celiac sprue, gluten-sensitive enteropathy) results from a toxic response to the gliadin component of gluten by the surface epithelium of the intestine; eventually, the mucosal villi of the small intestine become denuded and cannot function. Crohn's disease (regional enteritis) and radiation enteritis are other examples of mucosal disorders. Examples of infectious diseases causing generalized malabsorption include small-bowel bacterial overgrowth, tropical sprue, and Whipple disease. Examples of luminal problems causing malabsorption include bile acid deficiency, Zollinger-Ellison syndrome, and pancreatic insufficiency. Postoperative gastric or intestinal resection and cancer can result in development of a lymphatic malabsorption syndrome, in which there is interference with the transport of the fat by-products of digestion into the systemic circulation.

A client tells the nurse, "I am not having normal bowel movements." When differentiating between what are normal and abnormal bowel habits, what indicators are the most important? A. The consistency of stool and comfort when passing stool B. That the stool is formed and soft C. That the client has a bowel movement daily D. The client is able to fully evacuate with each bowel movement

Answer: A In differentiating normal from abnormal, the consistency of stools and the comfort with which a person passes them are more reliable indicators than is the frequency of bowel elimination. People differ greatly in their bowel habits and normal bowel patterns range from three bowel movements per day to three bowel movements per week. It is important for the stool to be soft to pass without pain. The client may not be able to fully evacuate with a bowel movement; it may take time.

A client is having a diagnostic workup for reports of frequent diarrhea, right lower abdominal pain, and weight loss. The nurse is reviewing the results of the barium study and notes the presence of "string sign." What does the nurse understand that this is significant of? A. Crohn's disease B. Irritable bowel syndrome C. Ulcerative colitis D. Diverticulitis

Answer: A The most conclusive diagnostic aid for Crohn's disease has classically been a barium study of the upper GI tract that shows a "string sign" on an x-ray film of the terminal ileum, indicating the constriction of a segment of intestine.

What information should the nurse include in the teaching plan for a client being treated for diverticulosis? A. Drink at least 8 to 10 large glasses of fluid every day B. Use laxatives or enemas at least once a week C. Avoid daily exercise; indulge only in mild activity D. Avoid unprocessed bran in the diet

Answer: A The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the physician. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.

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? A. A low colectomy B. Abdominoperineal resection C. Colectomy D. Segmental resection

Answer: B A cancerous mass in the lower third of the rectum will result in an abdominoperineal resection with a wide excision of the rectum and the creation of a sigmoid colostomy. An encapsulated colorectal tumor may be removed without taking away surrounding healthy tissue. This type of tumor, however, may call for partial or complete surgical removal of the colon (colectomy). Occasionally, the tumor causes a partial or complete bowel obstruction. If the tumor is in the colon and upper third of the rectum, a segmental resection is performed. In this procedure, the surgeon removes the cancerous portion of the colon and rejoins the remaining portions of the GI tract to restore normal intestinal continuity.

Which statement provides accurate information regarding cancer of the colon and rectum? A. Colon cancer has no hereditary component. B. Colorectal cancer is the third most common site of cancer in the United States. C. The incidence of colon and rectal cancer decreases with age. D. Rectal cancer affects more than twice as many people as colon cancer.

Answer: B Cancer of the colon and rectum is the third most common site of new cancer cases in the United States. Colon cancer affects more than twice as many people as does rectal cancer (94,700 for colon, 34,700 for rectum). The incidence increases with age (the incidence is highest in people older than 85). Colon cancer occurrence is higher in people with a family history of colon cancer.

A patient is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling? A. Barium enema B. Colonoscopy C. Flexible sigmoidoscopy D. CT scan

Answer: B Diverticulosis is typically diagnosed by colonoscopy, which permits visualization of the extent of diverticular disease and biopsy of tissue to rule out other diseases. In the past, barium enema was the preferred diagnostic test, but it is now used less frequently than colonoscopy. CT with contrast agent is the diagnostic test of choice if the suspected diagnosis is diverticulitis; it can also reveal abscesses.

The nurse is preparing a client for a test that involves inserting a thick barium paste into the rectum with radiographs taken as the client expels the barium. What test will the nurse prepare the client for? A. Abdominal radiography B. Defecography C. Colonic transit studies D. Kidneys, ureters, bladder (KUB)

Answer: B In defecography, a thick barium paste is inserted into the rectum. Radiographs are taken as the client expels the barium to determine whether there are any anatomic abnormalities or problems with the muscles surrounding the anal sphincter. A KUB will not determine this. Colonic transit studies are used to determine how long it takes for food to travel through the intestines. Abdominal radiography will show the structure but does not determine the muscle ability surrounding the anal sphincter.

When the nurse interviews a client with internal hemorrhoids, what would the nurse expect the client to report? A. Discharge that includes pus B. Rectal bleeding C. Constipation D. Severe pain

Answer: B Internal hemorrhoids often cause bleeding but are usually not painful. Severe pain is associated with external hemorrhoids, due to the inflammation and edema caused by thrombosis. Pus is associated with an anorectal abscess or anal fistula. While straining against hard stools due to constipation is one potential cause of hemorrhoids, there are many other causes including chronic diarrhea, pregnancy, prolonged sitting, and others.

A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of: A. A small bowel disorder. B. A disorder of the large bowel. C. Intestinal malabsorption. D. Inflammatory colitis.

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

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

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

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. Bowel perforation C. Appendicitis D. Rectal fissures

Answer: B 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.

The nurse in an extended-care facility reports that a resident has clinical manifestations of fecal incontinence. The health care provider orders a diagnostic study to rule out inflammation. Which study will the nurse prepare the client for? A. Flexible sigmoidoscopy B. Anorectal manometry C. Barium enema D. Transit study

Answer: A The treatment of fecal incontinence depends on the cause. A rectal examination and other endoscopic examinations, such as a flexible sigmoidoscopy, are performed to rule out tumors, inflammation, or fissures. X-ray studies such as barium enema, computed tomography (CT), anorectal manometry, and transit studies may be helpful in identifying alterations in intestinal mucosa and muscle tone or in detecting other structural or functional problems.

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

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

When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? A. The appendix may develop gangrene and rupture, especially in a middle-aged client. B. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. C. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. D. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

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

The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition? A. Tenesmus B. Borborygmus C. Azotorrhea D. Diverticulitis

Answer: B Borborygmus is the intestinal rumbling caused by the movement of gas through the intestines that accompanies diarrhea. Tenesmus refers to ineffectual straining at stool. Azotorrhea refers to excess of nitrogenous matter in the feces or urine. Diverticulitis refers to inflammation of a diverticulum from obstruction (by fecal matter) resulting in abscess formation.

A client realizes that regular use of laxatives has greatly improved bowel patterns. However, the nurse cautions this client against the prolonged use of laxatives for which reason? A. The client may develop arthritis or arthralgia. B. The client's natural bowel function may become sluggish. C. The client may lose his or her appetite. D. The client may develop inflammatory bowel disease.

Answer: B It is essential for the nurse to caution the client against the prolonged use of laxatives because it decreases muscle tone in the large intestine. Prolonged use of laxatives may cause the client's natural bowel function to become sluggish. Laxatives do not increase the risk of developing inflammatory bowel disease, arthritis, or arthralgia, nor do they cause a loss in appetite.

The instructor is teaching a group of students about irritable bowel syndrome (IBS) and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an antidiarrheal agent commonly administered for IBS? A. Peppermint oil B. Loperamide C. Lubiprostone D. Dicyclomine

Answer: B Loperamide is an opiate-related antidiarrheal agent. Lubiprostone is used to treat constipation; it activates chloride channels in the gastrointestinal tract to increase gastrointestinal transit. Dicyclomine, a smooth muscle antispasmodic agent, is used to treat pain accompanying IBS. Peppermint oil may also be taken to ease discomfort.

Which category of laxatives draws water into the intestines by osmosis? A. Fecal softeners (e.g., docusate) B. Saline agents (e.g., magnesium hydroxide) C. Stimulants (e.g., bisacodyl) D. Bulk-forming agents (e.g., psyllium)

Answer: B Saline agents use osmosis to stimulate peristalsis and act within 2 hours of consumption. Bulk-forming agents mix with intestinal fluids, swell, and stimulate peristalsis. Stimulants irritate the colon epithelium. Fecal softeners hydrate the stool by surfactant action on the colonic epithelium, resulting in the mixing of aqueous and fatty substances.

Which outcome indicates effective client teaching to prevent constipation? A. The client verbalizes consumption of low-fiber foods. B. The client reports engaging in a regular exercise regimen. C. The client maintains a sedentary lifestyle. D. The client limits water intake to three glasses per day.

Answer: B The client having a regular exercise program indicates effective teaching. A regular exercise regimen promotes peristalsis and contributes to regular bowel elimination patterns. A low-fiber diet, a sedentary lifestyle, and limited water intake would predispose the client to constipation.

The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication? A. Hemorrhage B. Peritonitis C. Pelvic abscess D. Ileus

Answer: B The nurse should report to the physician that the client has signs/symptoms of peritonitis. Signs/symptoms of a pelvic abscess include anorexia, chills, fever, diaphoresis, and diarrhea. Signs/symptoms of an ileus include absent bowel sounds, nausea, and abdominal distention. Signs/symptoms of hemorrhage include tachycardia, hypotension, anxiety, and bleeding.

A surgeon is discussing surgery with a client diagnosed with colon cancer. The client is visibly shaken over the possibility of a colostomy. Based on the client's response, the surgeon should collaborate with which health team member? A. Social worker B. Enterostomal nurse C. Clinical educator D. Staff nurse

Answer: B The surgeon should collaborate with the enterostomal nurse, who can address the client's concerns. The enterostomal nurse may schedule a visit with a client who has a colostomy to offer support to the client. The clinical educator can provide information about the colostomy when the client is ready to learn. The staff nurse and social worker aren't specialized in colostomy care, so they aren't the best choices for this situation.

During assessment of a client for a malabsorption disorder, the nurse notes a history of abdominal pain and weight loss, marked steatorrhea, azotorrhea, and frequent glucose intolerance. Based on these clinical features, what diagnosis will the nurse suspect? A. Ileal dysfunction B. Pancreatic insufficiency C. Celiac disease D. Lactose intolerance

Answer: B These symptoms are consistent with a diagnosis of pancreatic insufficiency. Loss of ileal absorbing surface results in ileal dysfunction. A toxic response to gluten is characteristic of celiac disease, and a deficiency of intestinal lactase results in lactose intolerance.

Which symptom characterizes regional enteritis? A. Rectal bleeding B. Transmural thickening C. Diffuse involvement D. Severe diarrhea

Answer: B Transmural thickening is an early pathologic change of Crohn's disease. Later pathology results in deep, penetrating granulomas. Regional enteritis is characterized by regional discontinuous lesions. Severe diarrhea is characteristic of ulcerative colitis, whereas diarrhea in regional enteritis is less severe. Rectal bleeding is one of the predominant symptoms of ulcerative colitis.

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: A. caffeinated products. B. spicy foods. C. high-fiber diet. D. fluids with meals.

Answer: C A high-fiber diet is prescribed to help control constipation. Individuals experiencing diarrhea may be advised to eat a low-fiber diet. Foods that are possible irritants, such as caffeine, spicy foods, lactose, beans, fried foods, corn, wheat, and alcohol, should be avoided. Fluids should not be taken with meals because they cause abdominal distention.

A nurse is preparing a presentation for a local community group of older adults about colon cancer. What would the nurse include as the primary characteristic associated with this disorder? A. Abdominal distention B. Abdominal pain C. A change in bowel habits D. Frank blood in the stool

Answer: C Although abdominal distention and blood in the stool (frank or occult) may be present, the chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Abdominal pain is a late sign.

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? A. Cutting the faceplate opening no more than 2 inches larger than the stoma B. Scrubbing fecal material from the skin surrounding the stoma C. Gently washing the area surrounding the stoma using a facecloth and mild soap D. Maintaining wrinkles in the faceplate so it doesn't irritate the skin

Answer: C For a client with an ostomy, maintaining skin integrity is a priority. The nurse should gently wash the area surrounding the stoma using a facecloth and mild soap. Scrubbing the area around the stoma can damage the skin and cause bleeding. The faceplate opening should be no more than 1/8-inch to 1/6-inch larger than the stoma. This size protects the skin from exposure to irritating fecal material. The nurse can create an adequate seal and prevent leakage of fecal material from under the faceplate by applying a thin layer of skin barrier and smoothing out wrinkles in the faceplate. Eliminating wrinkles in the faceplate also protects the skin surrounding the stoma from pressure.

A client with a diagnosis of acute appendicitis is awaiting surgical intervention. The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and board-like. What complication does the nurse determine may be occurring at this time? A. Accumulation of gas B. Constipation C. Peritonitis D. Paralytic ileus

Answer: C Lack of bowel motility typically accompanies peritonitis. The abdomen feels rigid and board-like as it distends with gas and intestinal contents. Bowel sounds typically are absent. The diagnosis of acute appendicitis correlates with the symptoms of rupture of the appendix and peritonitis. A paralytic ileus and gas alone do not produce these symptoms.

A client informs the nurse of having abdominal pain that is relieved when having a bowel movement. The health care provider diagnosed the client with irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder? A. Weight loss due to malabsorption B. Blood and mucus in the stool C. Chronic constipation with sporadic bouts of diarrhea D. Client is awakened from sleep due to abdominal pain.

Answer: C Most clients with irritable bowel syndrome (IBS) describe having chronic constipation with sporadic bouts of diarrhea. Some report the opposite pattern, although less commonly. Most clients experience various degrees of abdominal pain that defecation may relieve. Weight usually remains stable, indicating that when diarrhea occurs, malabsorption of nutrients does not accompany it. Stools may have mucus, but blood is not usually found because the bowel is not locally inflamed. The sleep is not disturbed from abdominal pain.

An older adult client in a long-term care facility is concerned about bowel regularity. During a client education session, the nurse reinforces the medically acceptable definition of "regularity." What is the actual measurement of "regular"? A. two bowel movements daily B. one bowel movement every other day C. stool consistency and client comfort D. one bowel movement daily

Answer: C Normal bowel patterns range from three bowel movements per day to three bowel movements per week. In differentiating normal from abnormal, the consistency of stools and the comfort with which a person passes them are more reliable indicators than is the frequency of bowel elimination.

Which is a true statement regarding regional enteritis (Crohn's disease)? A. It has a progressive disease pattern. B. It is characterized by pain in the lower left abdominal quadrant. C. The clusters of ulcers take on a cobblestone appearance. D. The lesions are in continuous contact with one another.

Answer: C 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.

A client reports taking a stimulant laxative in order to be able to have a bowel movement daily. What should the nurse inform the client about taking a stimulant laxative? A. The client should take a fiber supplement along with the stimulant laxative. B. The laxative is safe to take with other medication the client is taking. C. They can be habit forming and will require increasing doses to be effective. D. If the client is drinking 8 glasses of water per day, it is all right to continue taking them.

Answer: C The nurse should discourage self-treatment with daily or frequent enemas or laxatives. Chronic use of such products causes natural bowel function to be sluggish. In addition, laxatives continuing stimulants can be habit forming, requiring continued use in increasing doses. Although the nurse should encourage the client to have adequate fluid intake, laxative use should not be encouraged. The laxative may interact with other medications the client is taking and may cause a decrease in absorption. A fiber supplement may be taken alone but should not be taken with a stimulant laxative.

A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation? A. increased fiber B. lack of solid food C. lack of exercise D. lack of free water intake

Answer: D A client who cannot swallow food cannot drink enough water to meet daily needs. Inadequate fluid intake is a common cause of constipation.

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. Salami on whole grain bread and V-8 juice D. Broiled chicken with low-fiber pasta

Answer: D 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.

Which client requires immediate nursing intervention? The client who: A. presents with ribbonlike stools. B. complains of anorexia and periumbilical pain. C. complains of epigastric pain after eating. D. presents with a rigid, board-like abdomen.

Answer: D A rigid, board-like abdomen is a sign of peritonitis, a possibly life-threatening condition. Epigastric pain occurring 90 minutes to 3 hours after eating indicates a duodenal ulcer. Anorexia and periumbilical pain are characteristic of appendicitis. Risk of rupture is minimal within the first 24 hours, but increases significantly after 48 hours. A client with a large-bowel obstruction may have ribbonlike stools.

A client has been recently diagnosed with an anorectal condition. The nurse is reviewing interventions that will assist the client with managing the therapeutic regimen. What would not be included? A. Teach the client how to do sitz baths at home using warm water three to four times each day. B. Instruct the client to cleanse perianal area with warm water. C. Encourage the client to follow diet and medication instructions. D. Encourage the client to avoid exercise.

Answer: D Activity promotes healing and normal stool patterns. Proper cleansing prevents infection and irritation. Sitz baths promote healing, decrease skin irritation, and relieve rectal spasms. Encouragement promotes compliance with therapeutic regimen and prevents complications.

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

Answer: D 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 tumors, Crohn's disease, and hernias. Other causes include intussusception, volvulus, and paralytic ileus.

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, what would the nurse stress the importance of? A. Taking only enteric-coated medications B. Consuming a low-protein, high-fiber diet C. Wearing an appliance pouch only at bedtime D. Increasing fluid intake to prevent dehydration

Answer: D 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.

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care? A. Administer topical ointment to the rectal area to decrease bleeding. B. Prepare the client for a gastrostomy tube placement. C. Administer morphine (Duramorph PF) routinely, as ordered. D. Test all stools for occult blood.

Answer: D Blood in the stools is one of the warning signs of colorectal cancer. The nurse should plan on checking all stools for both frank and occult blood. The blood in the stool is coming from the colon or rectum; administering an ointment wouldn't help decrease the bleeding. Preparing a client for a gastrostomy tube isn't appropriate when diagnosing colorectal cancer. Colorectal cancer is usually painless; administering opioid pain medication isn't needed

The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation? A. Current medications B. Alcohol consumption C. Activity levels D. Usual pattern of elimination

Answer: D Constipation has many possible reasons and assessing the client's usual pattern of elimination is the first step in identifying the cause. The nurse should obtain a description of the bowel elimination pattern, asking about the frequency, overall appearance and consistency of stool, blood in the stool, pain, and effort necessary to pass stool. It is also essential for the nurse to review the client's current medications, diet, and activity levels.

A client with enteritis reports frequent diarrhea. What assessment should the nurse should anticipate? A. metabolic alkalosis B. respiratory alkalosis C. respiratory acidosis D. metabolic acidosis

Answer: D 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.

A nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find? A. tenderness and pain in the right upper abdominal quadrant B. jaundice and vomiting C. rectal bleeding and a change in bowel habits D. severe abdominal pain with direct palpation or rebound tenderness

Answer: D 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 (i.e., appendicitis, diverticulitis, ulcerative colitis, 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.

The nurse is talking with a group of clients who are older than age 50 years about the recognition of colon cancer to access early intervention. What should the nurse inform the clients to report immediately to their primary care provider? A. Abdominal cramping when having a bowel movement B. Excess gas C. Daily bowel movements D. Change in bowel habits

Answer: D The chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Excess gas, daily bowel movements, and abdominal cramping when having a bowel movement are not indicators of colon cancer.

The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation? A. Apply barrier powder B. Dust with nystatin powder C. Apply triamcinolone acetonide spray D. Dry skin thoroughly after washing

Answer: D The nurse should teach the client without peristomal skin irritation to dry the skin thoroughly after washing. Barrier powder, triamcinolone acetonide spray, and nystatin powder are used when the client has peristomal skin irritation and/or fungal infection.

The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for: A. hypernatremia. B. hyponatremia. C. hyperkalemia. D. hypokalemia.

Answer: D The older client taking digoxin must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.