Chapter 24 Nursing Care of Patients with Bowel Disorders

A patient is prescribed a low-residue diet. What foods should the nurse instruct the patient to avoid while on this diet? 1. Wine, vinegar, beer, liquor 2. Rice, grains, pasta 3. Canned vegetables 4. Chilled fruit gelatin desserts

Answer: 1 Explanation: 1. Alcohol is not permitted on a low-residue diet. 2. Foods allowed on a low-residue diet include rice, grains, and pasta. 3. Foods allowed on a low-residue diet include canned vegetables. 4. Foods allowed on a low-residue diet include chilled fruit gelatin desserts. Page Ref: 774

A patient who is experiencing diarrhea associated with a microorganism asks why antidiarrheal medication is not to be used. What should the nurse respond to this patient? 1. "Antidiarrheal medication slows down the elimination of the microorganism causing the diarrhea." 2. "Antibiotics are always used to treat the microorganisms but antibiotics may worsen diarrhea." 3. "The potassium you are taking will help to slow down the diarrhea." 4. "Your physician does not like to use antidiarrheal medications."

Answer: 1 Explanation: 1. Antidiarrheal medications can prolong the discomfort by slowing the elimination of the bacteria from the bowel. 2. Antibiotics may be given but the antibiotics alter the normal flora of the bowel and may worsen diarrhea. 3. Potassium is given to achieve electrolyte balance. 4. This response does not address the patient's question. Page Ref: 737

A patient is being seen for a "sudden lump" in the groin after lifting a heavy box to a shelf. Which health problem should the nurse suspect is occurring with this patient? 1. Indirect inguinal hernia 2. Direct inguinal hernia 3. Femoral hernia 4. Incisional hernia

Answer: 1 Explanation: 1. Indirect inguinal hernias are caused by improper closure of the tract that develops as the testes descend into the scrotum before birth. A sac of abdominal contents protrudes through the internal inguinal ring into the inguinal canal. It often descends into the scrotum. Although indirect inguinal hernias are congenital defects, they often are not evident until adulthood, when increased intra-abdominal pressure and dilation of the inguinal ring allow abdominal contents to enter the channel. 2. Direct inguinal hernias are acquired defects that result from weakness of the posterior inguinal wall and a palpable mass may be present in the groin. Direct inguinal hernias usually affect older adults. 3. Femoral hernias are also acquired defects in which a peritoneal sac protrudes through the femoral ring. 4. Inadequate information is provided to support the presence of an incisional hernia. Page Ref: 795

The nurse is implementing a bowel training program for a patient. What should be included in this patient's plan of care? 1. Assess the patient to determine the best time of day to use the commode for defecation. 2. Keep the bedpan near the patient at all times. 3. Instruct the patient not to attempt to use the bathroom unattended. 4. Stay with the patient while defecating.

Answer: 1 Explanation: 1. Placing the patient in a normal position to defecate at a consistent time of day stimulates the defecation reflex and helps reestablish a pattern of stool evacuation. Ideally, the bowel training program should focus on use of the commode or toilet. 2. Ideally, the bowel training program should focus on use of the commode or toilet. 3. Providing the patient with assistance to the bathroom is a safety measure and does not influence the success of the bowel training program. 4. Remaining with the patient may reduce comfort level and interfere with defecation. Page Ref: 748

After a company barbecue three people out of a group of 12 developed signs of enteritis. Which assessment finding should the nurse use as an indication of the source of the health problem? 1. The three patients ate hamburgers. 2. Nine people ate hotdogs. 3. Most of the people drank canned soda. 4. All of the people ate ice cream.

Answer: 1 Explanation: 1. The highly pathogenic E. coli serotype O157:H7 is present in the gut of infected animals. Meats from the animal may be contaminated with bowel contents. The organism is readily destroyed by heat, so cuts of meat such as steaks or roasts are less likely to cause infection, since the organism is on the outside of the meat. However, the process of grinding hamburger allows E. coli to be mixed throughout the meat. 2. Hotdogs are not associated with the bacteria. 3. Canned soda is not associated with the bacteria. 4. Ice cream is not associated with the bacteria. Page Ref: 761

A patient with peritonitis develops a temperature of 103°F (39.4°C), is restless, has blood pressure of 85/45 mmHg and has a urinary output of 76 mL in 8 hours. For which health problem should the nurse plan care for this patient? 1. Hypovolemic shock 2. Inflammation 3. Third spacing 4. Bowel dysfunction

Answer: 1 Explanation: 1. The patient experiencing peritonitis may develop an abscess, which can lead to shock. The patient developing shock may present with oliguria, hypotension, fever, restlessness, confusion, and hypovolemia. 2. The symptoms do not indicate inflammation. 3. The symptoms do not indicate third spacing. 4. The symptoms do not indicate bowel dysfunction. Page Ref: 754

The nurse suspects that a patient with ulcerative colitis has taken a dose of diphenoxylate (Lomotil) to help with diarrhea. What did the nurse assess to make this clinical decision? Select all that apply. 1. Fever 2. Tachycardia 3. Hypotension 4. Low urine output 5. Abdominal cramps

Answer: 1, 2, 3, 5 Explanation: 1. Toxic megacolon may be triggered by the use of laxatives by the person with ulcerative colitis. Manifestations of toxic megacolon include fever. 2. Toxic megacolon may be triggered by the use of laxatives by the person with ulcerative colitis. Manifestations of toxic megacolon include tachycardia. 3. Toxic megacolon may be triggered by the use of laxatives by the person with ulcerative colitis. Manifestations of toxic megacolon include hypotension. 4. Low urine output is not a manifestation of toxic megacolon. 5. Toxic megacolon may be triggered by the use of laxatives by the person with ulcerative colitis. Manifestations of toxic megacolon include abdominal cramps. Page Ref: 774

A patient with malabsorption syndrome is prescribed vitamin B12 injections. Which manifestation of this health problem should the nurse expect to improve with this vitamin supplement? Select all that apply. 1. Anemia 2. Cheilosis 3. Bone pain 4. Paresthesias 5. Muscle cramps

Answer: 1, 2, 4, 5 Explanation: 1. One systemic manifestation of malabsorption syndrome is anemia. Vitamin B12 will help with erythropoiesis. 2. One systemic manifestation of malabsorption syndrome is cheilosis. Vitamin B12 will help with this manifestation. 3. Bone pain is associated with vitamin D and calcium deficiency. 4. One systemic manifestation of malabsorption syndrome is paresthesias. Vitamin B12 will help with neurologic functioning. 5. One systemic manifestation of malabsorption syndrome is muscle cramps. Vitamin B12 will help with muscular functioning. Page Ref: 781

A patient with chronic diarrhea has been advised by the healthcare provider to avoid foods containing sorbitol and mannitol. What should the nurse instruct the patient to avoid consuming for this health problem? Select all that apply. 1. Mints 2. Honey 3. Pear juice 4. Apple juice 5. Orange juice

Answer: 1, 3, 4 Explanation: 1. Mints may contain sorbitol or mannitol, which are sugars that are not absorbed and can cause osmotic draw, increasing diarrhea. 2. Honey contains fructose. 3. Pear juice may contain sorbitol or mannitol, which are sugars that are not absorbed and can cause osmotic draw, increasing diarrhea. 4. Apple juice may contain sorbitol or mannitol, which are sugars that are not absorbed and can cause osmotic draw, increasing diarrhea. 5. Orange juice is not identified as a food item that aggravates chronic diarrhea. Page Ref: 738

The nurse is caring for an older patient recovering from a bleeding ulcer. Which manifestation should the nurse use to determine whether the patient is experiencing peritonitis? Select all that apply. 1. Confusion 2. Bradycardia 3. Restlessness 4. Abdominal discomfort 5. Decreased urinary output

Answer: 1, 3, 4, 5 Explanation: 1. Patients who are older, chronically debilitated, or immunosuppressed may present with few of the classic signs of peritonitis. Increased confusion may be the only manifestation present. 2. Bradycardia is not a manifestation of peritonitis in an older patient. 3. Patients who are older, chronically debilitated, or immunosuppressed may present with few of the classic signs of peritonitis. Restlessness may be the only manifestation present. 4. Patients who are older, chronically debilitated, or immunosuppressed may present with few of the classic signs of peritonitis. Vague abdominal complaints may be the only manifestation present. 5. Patients who are older, chronically debilitated, or immunosuppressed may present with few of the classic signs of peritonitis. Decreased urinary output may be the only manifestation present. Page Ref: 754

A patient has been experiencing diarrhea for several days. What should the nurse assess to determine if adverse effects are occurring within this patient? Select all that apply. 1. Skin turgor 2. Muscle tone 3. Serum potassium level 4. Serum magnesium level 5. Orthostatic blood pressure

Answer: 1, 3, 4, 5 Explanation: 1. The nurse should monitor skin turgor to identify and respond to possible adverse effects of diarrhea. 2. Muscle tone will not help identify possible adverse effects of diarrhea. 3. Water and electrolytes are lost in diarrheal stool. The nurse should monitor serum potassium level to help identify a possible adverse effect of diarrhea. 4. Water and electrolytes are lost in diarrheal stool. The nurse should monitor serum magnesium level to help identify a possible adverse effect of diarrhea. 5. Water is lost in the stool which can lead to dehydration. The nurse should monitor orthostatic vital signs to identify possible adverse effects of diarrhea. Page Ref: 736

A patient recovering from surgery for a small bowel obstruction is prescribed enteral feedings. Which action should the nurse take to ensure the feedings are provided safely to the patient? Select all that apply. 1. Keep the head of the bed elevated 30 to 45 degrees. 2. Check for tube placement by flushing with normal saline. 3. Flush the tube with club soda after administering medications. 4. Measure external tube length after verifying placement with an x-ray. 5. Stop the tube feeding 10 minutes before changing the position to supine.

Answer: 1, 4 Explanation: 1. The head of the bed should be elevated 30 to 45 degrees. 2. Flushing with normal saline is not an appropriate method to check for tube placement. 3. Flushing the tube with club soda after medication administration is not appropriate. 4. The external tube length should be measured after placement has been verified with an x-ray. 5. Tube feedings should be stopped 30 to 60 minutes before placing the patient in the supine position. Page Ref: 755

The nurse is preparing to assess a patient with diverticulitis. Which area of the patient's abdomen should the nurse expect to palpate a mass? 1. Upper-right quadrant 2. Lower-left quadrant 3. Area of McBurney point 4. Epigastric region

Answer: 2 Explanation: 1. A mass in the upper-right quadrant could involve a disorder of the liver or transverse colon. 2. Diverticulitis can manifest as a palpable mass in the lower-left quadrant as a result of the inflammatory response. 3. McBurney point is palpated to elicit rebound tenderness pain characteristic of appendicitis. 4. A mass in the epigastric region could indicate a disorder of the stomach or pancreas. Page Ref: 778

A patient who is newly diagnosed with short bowel syndrome asks what can be done to help the problem. How should the nurse respond to this patient? 1. "Dealing with this problem will be difficult in the beginning." 2. "Sometimes minor diet changes will alleviate the problem." 3. "I think more surgery is in your future." 4. "Short bowel syndrome is a long-term challenge."

Answer: 2 Explanation: 1. Advising the patient there will initially be difficulty promotes negativity and may not be correct information. 2. Management of short bowel syndrome focuses on alleviating symptoms. Patients often simply require frequent, small, high-kilocalorie, and high-protein feedings. 3. Surgery is not utilized to manage short bowel syndrome. 4. Advising the patient it will be a lifelong challenge does not address the verbalized concerns. Page Ref: 784

A patient learns that a small bowel obstruction was caused by an appendectomy five years ago. Which health problem most likely is causing the obstruction? 1. An untreated infection of the appendix 2. Adhesions 3. Undiagnosed femoral hernia 4. Umbilical hernia

Answer: 2 Explanation: 1. An untreated infection would have resulted in peritonitis. 2. In adults, adhesions develop following abdominal surgery or inflammatory processes. Adhesions usually produce a simple obstruction or single blockage in one portion of the intestine. 3. There is inadequate information provided to support a femoral hernia. 4. There is inadequate information provided to support an umbilical hernia. Page Ref: 797

The nurse can detect no bowel sounds on a patient recovering from bowel surgery. What should the nurse suspect is occurring in this patient? 1. Borborygmi 2. Paralytic ileus 3. Hyperactive bowel sounds 4. Atonic bowel

Answer: 2 Explanation: 1. Borborygmi are loud, hyperactive bowel sounds. 2. Paralytic ileus, or ileus, is defined as an impaired propulsion or forward movement of bowel contents. The patient will not have bowel sounds upon auscultation. 3. Hyperactive bowel sounds are an increase in sound and frequency. 4. Atonic is a term used to refer to the loss of muscular tone. Page Ref: 754

The nurse has instructed the patient who is experiencing diarrhea associated with irritable bowel syndrome on dietary changes to prevent diarrhea. Which menu selection indicates that patient teaching was effective? 1. Yogurt, crackers, and sweet tea 2. Salad with chicken, whole wheat crackers 3. Bacon, tomato, lettuce with mayonnaise, and a soft drink 4. Tuna on white bread and green grapes

Answer: 2 Explanation: 1. Dairy increases diarrhea. Foods high in carbohydrates increase diarrhea. 2. Salad and whole wheat crackers may decrease diarrhea due to increased fiber. 3. Bacon, tomato, lettuce with mayonnaise and soft drink is high in fat and the soft drink is hyperosmolar, both contributing to diarrhea. 4. Foods high in carbohydrates increase diarrhea. Green grapes may increase diarrhea. Page Ref: 738

A patient with Crohn disease is recovering from a bowel resection. What does the nurse realize will most likely occur in this patient? 1. The patient will never have another recurrence of the disease. 2. The patient will possibly have a recurrence in another portion of the bowel. 3. The patient will develop ulcerative colitis. 4. The patient will experience intestinal strictures.

Answer: 2 Explanation: 1. The disease process for Crohn disease tends to recur in other areas following removal of affected bowel segments. 2. The disease process for Crohn disease tends to recur in other areas following removal of affected bowel segments. 3. The processes involving Crohn disease and ulcerative colitis are different. 4. There is no increased risk for the development of intestinal strictures. Page Ref: 771

The nurse is caring for a patient with a fecal impaction. Which type of enema will best assist in relieving the fecal impaction? 1. Normal saline 2. Oil retention 3. Tap water 4. Soap suds

Answer: 2 Explanation: 1. The normal saline enema is used to soften the fecal mass and promote defecation in the least irritating manner. 2. Oil retention enemas instill mineral or vegetable oil into the bowel to soften the fecal mass. The instilled oil is retained overnight or for several hours before evacuation. This is the most suitable choice for the patient with fecal impaction. 3. Tap water enemas soften the bowel and irritate the bowel to promote defecation. 4. Soap suds provide an increased means to irritate the bowel to promote a bowel movement. Page Ref: 743

The nurse is providing discharge instructions to a patient who is recovering from anal-rectal surgery for repair of an anal fissure. What should be included in these instructions? Select all that apply. 1. Do not remove the dressing. 2. Change the dressing if it becomes soiled with urine or feces. 3. Use the sitz bath. 4. Use the antibiotic until all drainage stops. 5. Avoid bowel movements.

Answer: 2, 3 Explanation: 1. Teach the patient to keep the perianal region clean and dry. If a dressing is in place, instruct to avoid soiling it with urine or feces during elimination. 2. Teach the patient to keep the perianal region clean and dry. If a dressing is in place, instruct to avoid soiling it with urine or feces during elimination. 3. Discuss the use of sitz baths for cleaning and comfort. 4. If an antibiotic has been prescribed, provide written and verbal instructions about its use, its desired effects, and possible adverse effects and their management. 5. Teach the importance of maintaining a high-fiber diet and liberal fluid intake to increase stool bulk and softness and thereby decrease discomfort with defecation. Stress the importance of responding to the urge to defecate to prevent constipation. Page Ref: 804

After learning that a patient has abdominal pain that occurs at least 3 days per month over the last 3 months, the nurse suspects that a patient is experiencing irritable bowel syndrome. Which characteristic of the patient's abdominal pain did the nurse use to make this clinical decision? Select all that apply. 1. Relieved by eating 2. Improves with defecation 3. Associated with a change in stool form 4. Associated with a change in bowel frequency 5. Improves with physical activity and limiting food intake.

Answer: 2, 3, 4 Explanation: 1. Abdominal pain that is relieved by eating is not a characteristic of irritable bowel syndrome. 2. Improvement of abdominal pain with defection is one characteristic used to diagnose irritable bowel syndrome in a patient who has had abdominal pain or discomfort 3 days per month in the past 3 months. 3. A change in stool form is one characteristic used to diagnose irritable bowel syndrome in a patient who has had abdominal pain or discomfort 3 days per month in the past 3 months. 4. A change in bowel frequency is one characteristic used to diagnose irritable bowel syndrome in a patient who has had abdominal pain or discomfort 3 days per month in the past 3 months. 5. Abdominal pain that improves with physical activity and limiting food intake is not characteristic of irritable bowel syndrome. Page Ref: 745

A patient with a new descending colostomy is concerned because the stool is runny. Which food item should the nurse suggest to the patient to help thicken the stool? Select all that apply. 1. Peas 2. Pasta 3. Cheese 4. Bananas 5. Broccoli

Answer: 2, 3, 4 Explanation: 1. Peas will not thicken the stool but will increase intestinal gas. 2. Pasta will thicken the stool. 3. Cheese will thicken the stool. 4. Bananas will thicken the stool. 5. Broccoli will not thicken the stool but will increase intestinal gas. Page Ref: 791

The nurse teaches a patient with Crohn disease about surgery to create a continent ileostomy. Which patient statement indicates that teaching has been effective? Select all that apply. 1. "I will need to change my diet." 2. "Stool will collect in an internal pouch." 3. "Stool will not leak through the stoma." 4. "I will use a catheter to drain the stool." 5. "I will need to change the bag every day."

Answer: 2, 3, 4 Explanation: 1. There is no evidence that the patient will need to change the diet for a continent ileostomy. 2. In a continent ileostomy, an intra-abdominal reservoir is constructed and a nipple valve formed from the terminal ileum before it is brought to the surface of the abdominal wall. Stool collects in the internal pouch. 3. In a continent ileostomy, an intra-abdominal reservoir is constructed and a nipple valve formed from the terminal ileum before it is brought to the surface of the abdominal wall. A nipple valve prevents stool from leaking through the stoma. 4. In a continent ileostomy, an intra-abdominal reservoir is constructed and a nipple valve formed from the terminal ileum before it is brought to the surface of the abdominal wall. A catheter is inserted into the pouch to drain the stool. 5. An ostomy bag does not need to be worn with a continent ileostomy. Page Ref: 772

The nurse determines that a patient taking metronidazole (Flagyl) for a protozoan infection has been drinking alcohol while taking the medication. What assessment finding did the nurse use to make this clinical decision? Select all that apply. 1. Bruising 2. Flushing 3. Vomiting 4. Sore throat 5. Severe headache

Answer: 2, 3, 5 Explanation: 1. Bruising is an adverse effect of metronidazole (Flagyl) and should be reported to the healthcare provider. 2. Alcohol causes an Antabuse-type reaction when taking metronidazole (Flagyl). Flushing is one manifestation of this response. 3. Alcohol causes an Antabuse-type reaction when taking metronidazole (Flagyl). Vomiting is one manifestation of this response. 4. Sore throat is an adverse effect of metronidazole (Flagyl) and should be reported to the healthcare provider. 5. Alcohol causes an Antabuse-type reaction when taking metronidazole (Flagyl). Severe headache is one manifestation of this response. Page Ref: 762

The nurse instructs a patient with irritable bowel syndrome about the newly prescribed medication sulfasalazine (Azulfidine). Which patient statement indicates that teaching has been effective? Select all that apply. 1. "I should take this medication before meals." 2. "I should use sunscreen while taking this medication." 3. "I should not take any aspirin while taking this medication." 4. "I should restrict my fluid intake while taking this medication." 5. "I should not take any vitamin C while taking this medication."

Answer: 2, 3, 5 Explanation: 1. The patient should be instructed to take this medication after meals to decrease gastric distress. 2. This medication increases sensitivity to the sun, so sunscreen should be used. 3. This medication should not be taken with aspirin. 4. The patient should be instructed to drink at least 2 quarts of fluid each day to reduce the risk of kidney damage. 5. This medication should not be taken with vitamin C. Page Ref: 770

An older patient is diagnosed with severe acute diverticulitis. What treatment should the nurse expect to be prescribed for this patient? Select all that apply. 1. Complete bed rest 2. Intravenous fluids 3. Nothing by mouth 4. Aspirin or NSAIDs for pain 5. Intravenous cefoxitin (Mefoxin)

Answer: 2, 3, 5 Explanation: 1. There is no need for this patient to be on complete bed rest. 2. Severe, acute attacks of diverticulitis often necessitate hospitalization and treatment with intravenous fluids. 3. The patient initially may be NPO. 4. There is no specific recommendation for pain medications for acute diverticulitis. 5. Severe, acute attacks of diverticulitis often necessitate hospitalization and treatment with a second-generation cephalosporin such as cefoxitin (Mefoxin). Page Ref: 778

A patient with Crohn disease is instructed to ingest a low-residue diet. Which dietary choice indicates that the patient needs additional information about this eating plan? Select all that apply. 1. Corn flakes 2. Poppy seed roll 3. Tapioca pudding 4. Steamed broccoli 5. Whole grain bread

Answer: 2, 4, 5 Explanation: 1. Cereals made from refined flours such as corn flakes are permitted on a low-residue diet. 2. Raw or cooked seeds should be avoided on a low-residue diet. 3. Desserts such as tapioca are permitted on a low-residue diet. 4. Cooked vegetables are to be avoided on a low-residue diet. 5. Whole grain breads are to be avoided on a low-residue diet. Page Ref: 774

A patient receiving long-term antibiotic therapy for an infected joint replacement begins to experience diarrhea, abdominal cramps, malaise, fever, and anorexia. What intervention should the nurse prepare to administer to this patient? Select all that apply. 1. Maintain nothing by mouth status. 2. Prepare to administer metronidazole. 3. Insert a nasogastric tube for feedings. 4. Collect all urine for a 24-hour specimen. 5. Discontinue the currently prescribed antibiotic.

Answer: 2, 5 Explanation: 1. Nothing by mouth status is not a treatment for Clostridium difficile. 2. The patient is demonstrating manifestations of Clostridium difficile. Treatment with metronidazole is specific for C. difficile. 3. A nasogastric tube for feedings is not a treatment for Clostridium difficile. 4. Collecting 24-hour urine is not indicated for Clostridium difficile. 5. The patient is demonstrating manifestations of Clostridium difficile. Stopping the antibiotic causing the diarrhea is the first step in the treatment of this health problem. Page Ref: 758

A patient is suspected as having sprue. What diet teaching does this patient need? 1. Avoid high-protein foods. 2. A vegetarian diet is the best treatment for this condition. 3. Gluten products must be eliminated from the diet. 4. All whey products must be eliminated from the diet.

Answer: 3 Explanation: 1. Avoiding high-protein foods is not relevant for the patient with sprue. 2. A vegetarian diet is not relevant for the patient with sprue. 3. The patient with celiac sprue is placed on a gluten-free diet. This treatment is generally successful, as long as the patient entirely avoids gluten. 4. The elimination of whey is not relevant for the patient with sprue. Page Ref: 782

The nurse is asked to "look at" a patient because "something is coming out" of the rectum. Which health problem is the patient most likely experiencing? 1. Internal hemorrhoids 2. Colostomy 3. Prolapsed hemorrhoids 4. Femoral hernia

Answer: 3 Explanation: 1. Internal hemorrhoids are not visible by an external examination. 2. The colostomy and femoral hernia are not located in the rectal area. 3. Prolapsed hemorrhoids will be visible from the rectum and anal area. 4. The colostomy and femoral hernia are not located in the rectal area. Page Ref: 801

A patient comes into the emergency department with suspected appendicitis. What should the nurse do for this patient? 1. Provide a hot water bottle to place over the abdomen. 2. Provide with clear water to drink. 3. Inspect the abdomen and assess bowel sounds. 4. Prepare to administer a biscodyl (Dulcolax) suppository.

Answer: 3 Explanation: 1. No heat should be applied to the abdomen; this may increase circulation to the appendix and also cause perforation. 2. Keep the patient with suspected appendicitis NPO. 3. Assessing the abdomen and bowel sounds is the priority action for the nurse to take. 4. Do not administer laxatives or enemas, which may cause perforation of the appendix. Page Ref: 752

A patient with cancer of the rectum is scheduled for surgery and the placement of a permanent ostomy. Which type of ostomy will this patient most likely have performed during the surgery? 1. Ileostomy 2. Double-barrel 3. Sigmoid 4. Transverse loop

Answer: 3 Explanation: 1. The ileostomy is not in the correct area to manage cancer in this location. 2. The double-barrel ostomy is not in the correct area to manage cancer in this location. 3. A sigmoid colostomy is the most common permanent colostomy performed, particularly for cancer of the rectum. It is usually created during an abdominoperineal resection. 4. The transverse loop ostomy is not in the correct area to manage cancer in this location. Page Ref: 788

The nurse is providing care to a patient admitted with acute diarrhea. What intervention would assist in this patient's care? 1. Provide a normal diet as tolerated. 2. Hold all medications until the diarrhea stops. 3. Provide clear liquids in small amounts. 4. Encourage normal activities of daily living in the hospital room.

Answer: 3 Explanation: 1. This patient should have limited food intake, reintroducing solid foods slowly. 2. The nurse should provide antidiarrheal medication as prescribed. 3. Fluid replacement is of primary importance in managing the patient with diarrhea. Solid food is withheld in the first 24 hours of acute diarrhea to rest the bowel. 4. Because of the potential for orthostatic hypotension, this patient should be instructed to move slowly and not engage in normal activities of daily living until the blood pressure is assessed. Page Ref: 738

The nurse is providing medications to a patient with diverticular disease. Which medication should the nurse question for this patient? 1. Docusate (Colace) 2. Metronidazole (Flagyl) 3. Trimethoprim-sulfamethoxazole (Bactrim) 4. Bisacodyl (Dulcolax) suppository

Answer: 4 Explanation: 1. Although a stool softener such as docusate (Colace) may be prescribed, it is important to note that laxatives can further increase intraluminal pressure in the colon and should be avoided for the patient with diverticular disease. 2. Systemic broad-spectrum antibiotics effective against usual bowel flora are prescribed to treat acute diverticulitis. Oral antibiotics such as metronidazole (Flagyl) may be prescribed if manifestations are mild. 3. Systemic broad-spectrum antibiotics effective against usual bowel flora are prescribed to treat acute diverticulitis. Oral antibiotics such as trimethoprim-sulfamethoxazole (Septra, Bactrim) may be prescribed if manifestations are mild. 4. Although a stool softener such as docusate (Colace) may be prescribed, it is important to note that laxatives can further increase intraluminal pressure in the colon and should be avoided for the patient with diverticular disease. Page Ref: 778

A patient is diagnosed with gastroenteritis. The nurse should assess which serum laboratory value first? 1. Sodium 2. Bicarbonate 3. Calcium 4. Potassium

Answer: 4 Explanation: 1. Although electrolyte and acid‒base imbalances may result from gastroenteritis and extensive vomiting can lead to metabolic alkalosis due to the loss of hydrochloric acid from the stomach, sodium would not be the first lab value assessed by the nurse. 2. Although electrolyte and acid‒base imbalances may result from gastroenteritis and extensive vomiting can lead to metabolic alkalosis due to the loss of hydrochloric acid from the stomach, bicarbonate would not be the first lab value assessed by the nurse. 3. Although electrolyte and acid‒base imbalances may result from gastroenteritis and extensive vomiting can lead to metabolic alkalosis due to the loss of hydrochloric acid from the stomach, calcium would not be the first lab value assessed by the nurse. 4. Electrolyte and acid‒base imbalances may result from gastroenteritis. Extensive vomiting can lead to metabolic alkalosis due to the loss of hydrochloric acid from the stomach. When diarrhea predominates, metabolic acidosis is more likely. Potassium is lost in either case, which leads to hypokalemia. Page Ref: 758 Cognitive Level: Applying

A patient with Crohn disease is experiencing weight loss. What should be included in this patient's plan of care? 1. A low-calorie, high-milk diet 2. A low-calorie, low-residue diet 3. A high-calorie, low-protein diet 4. A high-calorie, low-fat diet

Answer: 4 Explanation: 1. Provide a high-kilocalorie, high-protein, and low-fat diet and restrict milk and milk products if lactose intolerance is present. 2. The Crohn patient needs an elevation in calories related to the nutrients lost as a result of diarrhea. 3. The DASH diet is appropriate for the patient wanting to lower elevated blood pressure. 4. Provide a high-kilocalorie, high-protein, and low-fat diet, and restrict milk and milk products if lactose intolerance is present. The Crohn patient needs an elevation in calories related to the nutrients lost as a result of diarrhea. Page Ref: 775

A patient with irritable bowel syndrome (IBS) asks why medication was prescribed to treat depression. Which response should the nurse make? 1. "Didn't the doctor tell you that you are depressed?" 2. "Depression can be caused by irritable bowel syndrome." 3. "Did the doctor not give you an opportunity to ask questions?" 4. "These medications help with the symptoms associated with your bowel problem."

Answer: 4 Explanation: 1. There is no indication the patient is depressed. 2. Bowel disorders do not usually cause depression. 3. The patient is asking for clarification, and this response does not address the patient's concern. 4. Antidepressant drugs, including tricyclics and selective serotonin reuptake inhibitors (SSRIs), may help relieve abdominal pain associated with IBS. Page Ref: 745

A patient tells the nurse about diarrhea after eating ice cream. Which health problem should the nurse suspect this patient is experiencing? 1. Disease of the colon 2. Inflammation of the small intestines 3. Cholera 4. Lactose intolerance

Answer: 4 Explanation: 1. There is not enough information to suspect colon disease. 2. The symptom of diarrhea after ingesting ice cream is inconsistent with small intestine inflammation. 3. The symptom does not suggest cholera. 4. When the lactose in milk is not broken down and absorbed, the lactose molecules exert an osmotic draw, which causes diarrhea. Page Ref: 783

A young adult female patient is diagnosed with inflammatory disease of the small bowel. Which health problem is this patient most likely experiencing? 1. Ulcerative colitis 2. Chronic diarrhea 3. Gastroenteritis 4. Crohn disease

Answer: 4 Explanation: 1. Ulcerative colitis affects the large intestine. 2. A diagnosis of chronic diarrhea is not supported by the information provided. The diarrhea associated with Crohn disease is frequent, causing watery stools several times a day. 3. Gastroenteritis results from ingesting contaminated foods or beverages. 4. In Crohn disease, a patchy pattern of involvement is seen, which affects primarily the small intestine. The peak incidence is in adolescents and young adults between the ages of 15 and 30 years. Page Ref: 764