Chapter 24: PrepU - Nursing Management: Patients With Intestinal and Rectal Disorders

A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a: 1- fissure. 2- fistula. 3- hemorrhoid. 4- pilonidal cyst.

1

Which of the following is the most common symptom of a polyp? 1- Rectal bleeding 2- Abdominal pain 3- Diarrhea 4- Anorexia

1

In women, which of the following types of cancer exceeds colorectal cancer? 1- Breast 2- Lung 3- Skin 4- Liver

1

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: 1- A small bowel disorder. 2- Intestinal malabsorption. 3- Inflammatory colitis. 4- A disorder of the large bowel.

2

The nursing educator is teaching a group of nurses about constipation and the elderly. What recommendation for this population should a nurse can make about treating chronic constipation? 1- Take a mild laxative, such as magnesium citrate, when necessary. 2- Take a stool softener, such as docusate sodium (Colace), daily. 3- Administer a tap water enema weekly. 4- Administer a phospho-soda (Fleet) enema when necessary.

2

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? 1- Peritonitis 2- Pelvic abscess 3- Ileus 4- Hemorrhage

1

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse? 1- Inform the patient that it will only last a minute and continue with the procedure. 2- Clamp the tubing and give the patient a rest period. 3- Stop the irrigation and remove the tube. 4- Replace the fluid with cooler water since it is probably too warm.

2

What would the nurse identify as a characteristic finding when assessing a client for pilonidal sinus? 1- Pain in the perianal area 2- Purulent drainage from the gluteal fold 3- Dilated pits of hair follicles in the cleft 4- Abdominal pain

3

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? 1- Social worker 2- Staff nurse 3- Clinical educator 4- Enterostomal nurse

4

A positive Rovsing's sign is indicative of appendicitis. A nurse knows to assess for this indicator by palpating the: 1- Right lower quadrant. 2- Left lower quadrant. 3- Right upper quadrant. 4- Left upper quadrant.

2

The nurse is aware that many of the diseases of the lower gastrointestinal tract can be identified by the characteristics of the patient's stool. What would voluminous, greasy stools suggest? 1- Intestinal malabsorption 2- Inflammatory colitis 3- Colon cancer 4- Small bowel obstruction

1

Which is one of the primary symptoms of irritable bowel syndrome (IBS)? 1- Diarrhea 2- Pain 3- Bloating 4- Abdominal distention

1

Which statement provides accurate information regarding cancer of the colon and rectum? 1- Colorectal cancer is the third most common site of cancer in the United States. 2- Rectal cancer affects more than twice as many people as colon cancer. 3- The incidence of colon and rectal cancer decreases with age. 4- Colon cancer has no hereditary component.

1

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. 1- A peanut butter sandwich and fruit cup 2- Broiled chicken with low-fiber pasta 3- Salami on whole grain bread and V-8 juice 4- A fruit salad with yogurt

2

When preparing a client for a hemorrhoidectomy, the nurse should take which action? 1- Administer an enema as ordered. 2- Administer oral antibiotics as ordered. 3- Administer topical antibiotics as ordered. 4- Administer analgesics as ordered.

1

After assessing a client with peritonitis, how would the nurse most likely document the client's bowel sounds? 1- Mild 2- High-pitched 3- Hyperactive 4- Absent

4

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? 1- Encourage the client to avoid exercise. 2- Instruct the client to cleanse perianal area with warm water. 3- Teach the client how to do sitz baths at home using warm water three to four times each day. 4- Encourage the client to follow diet and medication instructions.

1

After teaching a group of students about irritable bowel syndrome and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an opiate-related antidiarrheal agent? 1- Loperamide 2- Bismuth subsalicylate 3- Kaolin and pectin 4- Bisacodyl

1

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? 1- Maintaining skin integrity 2- Beginning a bowel program to establish continence 3- Instituting a diet high in fiber and increase fluid intake 4- Determining the need for surgical intervention to correct the problem

1

Which client requires immediate nursing intervention? The client who: 1- complains of epigastric pain after eating. 2- complains of anorexia and periumbilical pain. 3- presents with a rigid, boardlike abdomen. 4- presents with ribbonlike stools.

3

A man with severe ulcerative colitis has been informed by his health care provider that he will require a colectomy and an ileostomy. The patient has been told by his health care provider that he is candidate for a continent ileal reservoir (Kock pouch). The patient's nurse recognizes which of the following advantages to the use of a Kock pouch as an alternative to the creation of an ileal stoma? 1- The patient's abdominal wall will remain intact. 2- The patient will soon be able to resume normal bowel function. 3- The patient will have to make minimal dietary modifications. 4- The patient will not have to wear an external collection bag.

4

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? 1- Age younger than 40 years 2- Low-fat, low-protein, high-fiber diet 3- History of skin cancer 4- Familial polyposis

4

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? 1- Increasing fluid intake to prevent dehydration 2- Wearing an appliance pouch only at bedtime 3- Consuming a low-protein, high-fiber diet 4- Taking only enteric-coated medications

1

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? 1- Appendicitis 2- Rectal fissures 3- Bowel perforation 4- Diverticulitis

3

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? 1- Crohn's disease 2- Ulcerative colitis 3- Irritable bowel syndrome 4- Diverticulitis

1

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process? 1- Hypotension 2- Subnormal temperature 3- Bradycardia 4- Normal erythrocyte sedimentation rate (ESR)

1

A 16-year-old girl presents at the emergency department complaining of right lower quadrant pain and is diagnosed with appendicitis. When assessing this patient, what signs or symptoms should the nurse expect to find? 1- Rigid abdomen, Levine's sign, pain relief leaning forward 2- Rebound tenderness, McBurney's sign, low-grade fever 3- Right lower quadrant pain, Chvostek's sign, muscle guarding 4- Periumbilical pain, Trousseau's sign, pain relief with pressure

2

Celiac sprue is an example of which category of malabsorption? 1- Infectious diseases causing generalized malabsorption 2- Mucosal disorders causing generalized malabsorption 3- Luminal problems causing malabsorption 4- Postoperative malabsorption

2

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? 1- Hematocrit 42% 2- White blood cell (WBC) count 22.8/mm3 3- Serum potassium 4.2 mEq/L 4- Serum sodium 135 mEq/L

2

The nurse is admitting a client with a diagnosis of diverticulitis and assesses that the client has a boardlike abdomen, no bowel sounds, and reports of severe abdominal pain. What is the nurse's first action? 1- Start an IV with lactated Ringer's solution. 2- Notify the health care provider. 3- Administer a retention enema. 4- Administer an opioid analgesic.

2

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? 1- lack of free water intake 2- lack of solid food 3- lack of exercise 4- increased fiber

1

Clostridium difficile infection has been moving through an extended-care facility, and several of the elderly residents have been experiencing severe diarrhea. One particularly sick resident has told the nurse that he is now experiencing extreme fatigue and muscle cramps and that his heart feels like it occasionally "skips a beat." The nurse should facilitate a stat assessment of this resident's: 1- Potassium levels 2- Calcium levels 3- Cardiac biomarkers 4- Hemoglobin and hematocrit

1

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? 1- Dry skin thoroughly after washing 2- Apply barrier powder 3- Apply triamcinolone acetonide spray 4- Dust with nystatin powder

1

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? 1- Cutting the faceplate opening no more than 2? larger than the stoma 2- Gently washing the area surrounding the stoma using a facecloth and mild soap 3- Scrubbing fecal material from the skin surrounding the stoma 4- Maintaining wrinkles in the faceplate so it doesn't irritate the skin

2

A client informs the nurse that he has been having abdominal pain that is relieved when having a bowel movement. The client states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder? 1- Weight loss due to malabsorption 2- Blood and mucus in the stool 3- Chronic constipation with sporadic bouts of diarrhea 4- Client is awakened from sleep due to abdominal pain.

3

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 boardlike. What complication does the nurse determine may be occurring at this time? 1- Constipation 2- Paralytic ileus 3- Peritonitis 4- Accumulation of gas

3

An older adult client seeks help for chronic constipation. What factor related to aging can cause constipation in elderly clients? 1- Increased intestinal motility 2- Decreased abdominal strength 3- Increased intestinal bacteria 4- Decreased production of hydrochloric acid

2

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: 1- hyperkalemia. 2- hypokalemia. 3- hyponatremia. 4- hypernatremia.

2

A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client? 1- Suggest fluid intake of at least 2 L/day 2- Instruct the client to avoid prune or apple juice 3- Assist the client regarding the correct diet or to minimize food intake 4- Instruct the client to keep a record of food intake

2

A client with anorexia reports constipation. Which nursing measure would be most effective in helping the client reduce constipation? 1- Provide adequate quantity of food. 2- Obtain medical and allergy history. 3- Assist client to increase dietary fiber. 4- Obtain complete food history.

2

The nurse is assigned to care for a patient 2 days after an appendectomy due to a ruptured appendix with resultant peritonitis. The nurse has just assisted the patient with ambulation to the bedside commode when the patient points to the surgical site and informs the nurse that "something gave way." What does the nurse suspect may have occurred? 1- A drain may have become dislodged. 2- Wound dehiscence has occurred. 3- Infection has developed. 4- The surgical wound has begun to bleed.

2

The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder? 1- The bowel twists and turns itself and obstructs the intestinal lumen. 2- One part of the intestine telescopes into another portion of the intestine. 3- The bowel protrudes through a weakened area in the abdominal wall. 4- A loop of intestine adheres to an area that is healing slowly after surgery.

2

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? 1- Ultrasound 2- Endoscopy with mucosal biopsy 3- Stool specimen for ova and parasites 4- Pancreatic function tests

2

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? 1- Loud bowel sounds 2- Borborygmus 3- Tenesmus 4- Peristalsis

2

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? 1- Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. 2- Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. 3- The appendix may develop gangrene and rupture, especially in a middle-aged client. 4- Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

2

The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching? 1- Avoid unprocessed bran. 2- Avoid daily exercise. 3- Drink 8 to 10 glasses of fluid daily. 4- Use laxatives weekly.

3

Which is a true statement regarding regional enteritis (Crohn's disease)? 1- It has a progressive disease pattern. 2- It is characterized by pain in the lower left abdominal quadrant. 3- The clusters of ulcers take on a cobblestone appearance. 4- The lesions are in continuous contact with one another.

3

Which of the following would a nurse expect to assess in a client with peritonitis? 1- Deep slow respirations 2- Decreased pulse rate 3- Hyperactive bowel sounds 4- Board-like abdomen

4

Which drug is considered a stimulant laxative? 1- Magnesium hydroxide 2- Bisacodyl 3- Mineral oil 4- Psyllium hydrophilic mucilloid

2

Which is the most common presenting symptom of colon cancer? 1- Fatigue 2- Change in bowel habits 3- Anorexia 4- Weight loss

2

s/s of pyloric obstruction

vomiting, a feeling of fullness, gastric distention, nausea after eating, loss of appetite and weight loss

Vomiting results in which of the following acid-base imbalances? 1- Metabolic alkalosis 2- Metabolic acidosis 3- Respiratory acidosis 4- Respiratory alkalosis

1

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? 1- Borborygmus 2- Tenesmus 3- Azotorrhea 4- Diverticulitis

1

When interviewing a client with internal hemorrhoids, what would the nurse expect the client to report? 1- Rectal bleeding 2- Pain 3- Itching 4- Soreness

1

The nurse is caring for a patient who is postoperative day 3 following bowel resection and the creation of a colostomy. While changing the dressing, the nurse notes the stoma is dusky in color. How should the nurse interpret this assessment finding? 1- This is a normal color postoperatively. 2- The patient's oxygen saturation may be low. 3- Circulation to the stoma is compromised. 4- The stoma is blocked.

3

A 75-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. An emergency room nurse is obtaining assessment data from this patient. What assessment finding is characteristic of a small bowel obstruction? 1- Nausea and vomiting 2- Decrease in urine production 3- Mucus in the stool 4- Mucosal edema

1

A client is diagnosed with Zollinger-Ellison syndrome. The nurse knows to assess the client for which characteristic clinical feature of this syndrome? 1- Decreased intestinal lactose 2- Folate deficiency 3- Lymphadenopathy 4- Steatorrhea

4

A nurse caring for a client with small-bowel obstruction should plan to implement which nursing intervention first? 1- Administering pain medication 2- Obtaining a blood sample for laboratory studies 3- Preparing to insert a nasogastric (NG) tube 4- Administering I.V. fluids

4

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? 1- Duodenal ulcers 2- Hemorrhoids 3- Weight gain 4- Polyps

4

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? 1- Colonoscopy 2- Barium enema 3- Flexible sigmoidoscopy 4- CT scan

1

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: 1- caffeinated products. 2- spicy foods. 3- high-fiber diet. 4- fluids with meals.

3

The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation? 1- Alcohol consumption 2- Activity levels 3- Usual pattern of elimination 4- Current medications

3

A nurse is caring for a client who had an ileo 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? 1- Beefy red stoma site 2- Stoma site not sensitive to touch 3- Red, sensitive skin around the stoma site 4- Clear mucus mixed with yellow urine drained from the appliance bag

3

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? 1- Abdominal distention 2- Frank blood in the stool 3- A change in bowel habits 4- Abdominal pain

3

Which client would be at greatest risk for the development of an anorectal fistula? 1- A 50-year-old male with diverticulosis 2- A 35-year-old female with Crohn's disease 3- A 42-year-old female with irritable bowel syndrome 4- A 60-year-old male with polyps of the colon

2

A nurse caring for a patient with regional enteritis knows to assess for this most serious systemic complication. What is that complication? 1- Pyelonephritis 2- Megacolon 3- Small bowel obstruction 4- Nephrolithiasis

3

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? 1- Test all stools for occult blood. 2- Administer topical ointment to the rectal area to decrease bleeding. 3- Prepare the client for a gastrostomy tube placement. 4- Administer morphine (Duramorph PF) routinely, as ordered.

1

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? 1- The consistency of stool and comfort when passing stool 2- That the client has a bowel movement daily 3- That the stool is formed and soft 4- The client is able to fully evacuate with each bowel movement

1

Crohn's disease is a condition of malabsorption caused by which pathophysiological process? 1- Inflammation of all layers of intestinal mucosa 2- Infectious disease 3- Disaccharidase deficiency 4- Gastric resection

1

A 61-year-old woman presented to a scheduled appointment with her nurse practitioner, stating, "I'm having a lot of trouble with constipation over the past few months." What action should the nurse first take in response to this patient's health complaint? 1- Assess the woman's family history of constipation and bowel obstruction. 2- Assess the woman's typical bowel patterns and her expectations for bowel function. 3- Advise the woman to increase her fluid intake, activity level, and fiber intake. 4- Arrange for a barium enema or colonoscopy to assess the woman's lower bowel.

2

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? 1- "I don't understand this; I took the medication the doctor ordered and followed the diet." 2- "I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." 3- "I don't understand why this happened again; I didn't travel out of the country." 4- "I don't like oatmeal, so it doesn't matter that I can't have it."

2