CH 41 Management of Patients with Intestinal and Rectal Disorders
A client is admitted to the emergency department with reports right lower quadrant pain. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the health care provider immediately? A) Hematocrit 42% B) White blood cell (WBC) count 22.8/mm3 C) Serum potassium 4.2 mEq/L D) Serum sodium 135 mEq/L
B
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 laxative is safe to take with other medication the client is taking. B) They can be habit forming and will require increasing doses to be effective. C) If the client is drinking 8 glasses of water per day, it is all right to continue taking them. D) The client should take a fiber supplement along with the stimulant laxative.
B
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 pain B) A change in bowel habits C) Frank blood in the stool D) Abdominal distention
B
A client with Crohn's disease is losing weight. For which reason will the nurse anticipate the client being prescribed parenteral nutrition? A) Unwilling to ingest nutrients orally B) Prolonged preoperative nutritional needs C) Impaired ability to absorb food D) Insufficient oral intake
C
Which of the following is the most common symptom of a polyp? A) Diarrhea B) Abdominal pain C) Rectal bleeding D) Anorexia
C
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) severe abdominal pain with direct palpation or rebound tenderness B) jaundice and vomiting C) rectal bleeding and a change in bowel habits D) tenderness and pain in the right upper abdominal quadrant
A
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) Colonoscopy B) Flexible sigmoidoscopy C) CT scan D) Barium enema
A
Which is one of the primary symptoms of irritable bowel syndrome (IBS)? A) Diarrhea B) Abdominal distention C) Bloating D) Pain
A
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 lower quadrant B) Right upper quadrant C) Left upper quadrant D) Left lower quadrant
A
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) Peritonitis B) Ileus C) Pelvic abscess D) Hemorrhage
A
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) Borborygmus B) Azotorrhea C) Tenesmus D) Diverticulitis
A
The nurse is teaching a client with constipation to increase dietary fiber intake to 25 g/day. Which recommendation would the nurse include? A) Adding fiber-rich foods to the diet gradually B) Minimizing activity levels for at least 2 months C) Avoiding bran cereals and beans in the diet D) Limiting fluid intake to 5 to 6 glasses per day
A
Which client requires immediate nursing intervention? The client who: A) presents with a rigid, board-like abdomen. B) presents with ribbonlike stools. C) complains of anorexia and periumbilical pain. D) complains of epigastric pain after eating.
A
Which of the following is considered a bulk-forming laxative? A) Metamucil B) Mineral oil C) Milk of Magnesia D) Dulcolax
A
Which of the following would a nurse expect to assess in a client with peritonitis? A) Board-like abdomen B) Deep slow respirations C) Decreased pulse rate D) Hyperactive bowel sounds
A
A patient with irritable bowel syndrome has been having more frequent symptoms lately and is not sure what lifestyle changes may have occurred. What suggestion can the nurse provide to identify a trigger for the symptoms? A) Document how much fluid is being taken to determine if the patient is overhydrating. B) Keep a 1- to 2-week symptom and food diary to identify food triggers. C) Discontinue the use of any medication presently being taken to determine if medication is a trigger. D) Begin an exercise regimen and biofeedback to determine if external stress is a trigger.A
B
A teenage client with a pilonidal cyst has been brought for care by her mother. The nurse who is contributing to the client's care knows that treatment will be chosen based on what risk? A) Risk for impaired tissue perfusion B) Risk for infection C) Risk for constipation D) Risk for bowel incontinence
B
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) Instituting a diet high in fiber and increase fluid intake D) Determining the need for surgical intervention to correct the problem
B
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) Disorders of the colon B) Ulcerative colitis C) Intestinal malabsorption D) Small-bowel disease
B
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) Loud bowel sounds B) Borborygmus C) Tenesmus D) Peristalsis
B
Vomiting results in which of the following acid-base imbalances? A) Respiratory acidosis B) Metabolic alkalosis C) Metabolic acidosis D) Respiratory alkalosis
B
A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult? A) "I don't like oatmeal, so it doesn't matter that I can't have it." B) "I don't understand why this happened again; I didn't travel out of the country." C) "I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." D) "I don't understand this; I took the medication the doctor ordered and followed the diet."
C
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) Wearing an appliance pouch only at bedtime B) Taking only enteric-coated medications C) Increasing fluid intake to prevent dehydration D) Consuming a low-protein, high-fiber diet
C
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 inflammatory bowel disease. B) The client may lose his or her appetite. C) The client's natural bowel function may become sluggish. D) The client may develop arthritis or arthralgia.
C
After assessing a client with peritonitis, how would the nurse most likely document the client's bowel sounds? A) High-pitched B) Mild C) Hyperactive D) Absent
D
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) Chronic constipation with sporadic bouts of diarrhea B) Client is awakened from sleep due to abdominal pain. C) Weight loss due to malabsorption D) Blood and mucus in the stool
A
A nurse is teaching an older adult client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required? A) "I need to use laxatives regularly to prevent constipation." B) "I need to drink 2 to 3 liters of fluids every day." C) "I should exercise four times per week." D) "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread."
A
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) stool consistency and client comfort B) one bowel movement daily C) two bowel movements daily D) one bowel movement every other day
A
An older adult client seeks help for chronic constipation. What factor related to aging can cause constipation in elderly clients? A) Decreased abdominal strength B) Increased intestinal motility C) Increased intestinal bacteria D) Decreased production of hydrochloric acid
A
Celiac disease (celiac sprue) is an example of which category of malabsorption? A) Mucosal disorders causing generalized malabsorption B) Luminal problems causing malabsorption C) Infectious diseases D) Postoperative malabsorption
A
Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: A) high-fiber diet. B) caffeinated products. C) spicy foods. D) fluids with meals.
A
The nurse is caring for a patient who has malabsorption syndrome with an undetermined cause. What procedure will the nurse assist with that is the best diagnostic test for this illness? A) Endoscopy with mucosal biopsy B) Pancreatic function tests C) Stool specimen for ova and parasites D) Ultrasound
A
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) Gently washing the area surrounding the stoma using a facecloth and mild soap C) Scrubbing fecal material from the skin surrounding the stoma D) Maintaining wrinkles in the faceplate so it doesn't irritate the skin
B
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) diverticulitis B) inflammatory bowel disease (IBD) C) liver failure D) colorectal cancer
B
Clients with inflammatory bowel disease (IBD) are at significantly increased risk for which condition? A) Pneumonia B) Osteoporosis C) Hypotension D) DVT
B
In women, which of the following types of cancer exceeds colorectal cancer? A) Liver B) Breast C) Lung D) Skin
B
The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder? A) The bowel twists and turns itself and obstructs the intestinal lumen. B) One part of the intestine telescopes into another portion of the intestine. C) The bowel protrudes through a weakened area in the abdominal wall. D) A loop of intestine adheres to an area that is healing slowly after surgery.
B
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
C
A nurse is teaching a group of adults about screening and prevention of colorectal cancer. The nurse should describe which of the following as the most common sign of possible colon cancer? A) Development of new hemorrhoids B) Abdominal bloating and flank pain C) Change in bowel habits D) Unexplained weight gain
C
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.
C
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) hyponatremia. B) hypernatremia. C) hypokalemia. D) hyperkalemia.
C
The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation? A) Activity levels B) Current medications C) Usual pattern of elimination D) Alcohol consumption
C
The nurse is performing a rectal assessment and notices a longitudinal tear or ulceration in the lining of the anal canal. The nurse documents the finding as which condition? A) Anorectal abscess B) Anal fistula C) Anal fissure D) Hemorrhoid
C
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 triamcinolone acetonide spray B) Apply barrier powder C) Dry skin thoroughly after washing D) Dust with nystatin powder
C
What information should the nurse include in the teaching plan for a client being treated for diverticulosis? A) Use laxatives or enemas at least once a week B) Avoid daily exercise; indulge only in mild activity C) Drink at least 8 to 10 large glasses of fluid every day D) Avoid unprocessed bran in the diet
C
When the nurse interviews a client with internal hemorrhoids, what would the nurse expect the client to report? A) Discharge that includes pus B) Constipation C) Rectal bleeding D) Severe pain
C
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) Encourage the client to follow diet and medication instructions. C) Instruct the client to cleanse perianal area with warm water. D) Encourage the client to avoid exercise.
D
A client is diagnosed with Zollinger-Ellison syndrome. The nurse knows to assess the client for which characteristic clinical feature of this syndrome? A) Decreased intestinal lactose B) Folate deficiency C) Lymphadenopathy D) Steatorrhea
D
A client presents to the ED with acute abdominal pain, fever, nausea, and vomiting. During the client's examination, the lower left abdominal quadrant is palpated, causing the client to report pain in the RLQ. This positive sign is referred to as ________ and suggests the client may be experiencing ________. A) McBurney sign; perforation B) McBurney sign; acute appendicitis C) Rovsing sign; perforation D) Rovsing sign; acute appendicitis
D
A client reports constipation. Which nursing measure would be most effective in helping the client reduce constipation? A) Obtain medical and allergy history. B) Obtain complete food history. C) Provide adequate quantity of food. D) Assist client to increase dietary fiber.
D
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) That the client has a bowel movement daily B) That the stool is formed and soft C) The client is able to fully evacuate with each bowel movement D) The consistency of stool and comfort when passing stool
D
A nurse is caring for a client admitted with symptoms of an anorectal infection; cultures indicate that the client has a viral infection. The nurse should anticipate the administration of what drug? A) Doxycycline B) Metronidazole C) Penicillin D) Acyclovir
D
A nurse is caring for a client with constipation whose primary provider has recommended senna for the management of this condition. The nurse should provide which of the following education points? A) "Make sure to take a multivitamin with each dose." B) "Take this on an empty stomach to ensure maximum effect." C) "Limit your fluid intake temporarily so you don't get diarrhea." D) "Avoid taking the drug on a long-term basis."
D
A patient is not having daily bowel movements and has begun taking a laxative for this problem. What should the nurse educate the patient about regarding laxative use? A) The laxatives should be taken no more than 3 times a week or laxative addiction will result. B) When taking the laxatives, plenty of fluid should be taken as well. C) Laxatives should never be the first response for the treatment of constipation; natural methods should be employed first. D) Laxatives should not be routinely taken due to destruction of nerve endings in the colon.
D
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 peanut butter sandwich and fruit cup B) A fruit salad with yogurt C) Salami on whole grain bread and V-8 juice D) Broiled chicken with low-fiber pasta
D
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) Clinical educator B) Social worker C) Staff nurse D) Enterostomal nurse
D
Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? A) Low protein B) Iron restriction C) Calorie restriction D) Low residue
D
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) D5W B) 0.45% of NS C) D10W D) 0.9% NS
D
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) Lubiprostone B) Dicyclomine C) Peppermint oil D) Loperamide
D
The nurse is comparing Crohn's disease (regional enteritis) with ulcerative colitis. Which of the following describes Crohn's disease? A) Diarrhea is more severe B) Bleeding is common and severe C) Fistulas are rare D) Its course is prolonged and variable
D
The nurse is irrigating a client's colostomy when the client begins to report cramping. What is the appropriate action by the nurse? A) Change irrigation fluid to normal saline. B) Increase the rate of administration. C) Discontinue the irrigation immediately. D) Clamp the tubing and allow client to rest.
D
Which drug is considered a stimulant laxative? A) Magnesium hydroxide B) Mineral oil C) Psyllium hydrophilic mucilloid D) Bisacodyl
D
Which is a true statement regarding regional enteritis (Crohn's disease)? A) It is characterized by pain in the lower left abdominal quadrant. B) The lesions are in continuous contact with one another. C) It has a progressive disease pattern. D) The clusters of ulcers take on a cobblestone appearance.
D