chpt 41 patients with intestinal and rectal disorders/lower GI

After undergoing a total cystectomy and urinary diversion, a client has a Kock pouch (continent internal reservoir) in place. Which statement by the client indicates a need for further teaching? "I'll have to wear an external collection pouch for the rest of my life." "I should eat foods from all the food groups." "I'll need to drink at least eight glasses of water a day." "I'll have to catheterize my pouch every 2 hours."

"I'll have to wear an external collection pouch for the rest of my life." (An internal collection pouch, such as the Kock pouch, allows the client to perform self-catheterization for ileal drainage. This pouch is an internal reservoir, eliminating the need for an external collection pouch.)

How fast do bisacodyl suppository work?

15 minutes - 1 hour

After teaching a group of students about intestinal obstruction, the instructor determines that the teaching was effective when the students identify which of the following as a cause of a functional obstruction? Volvulus Intussusception Tumor Abdominal surgery

Abdominal surgery (In functional obstruction, the intestine can become adynamic from an absence of normal nerve stimulation to intestinal muscle fibers. For example, abdominal surgery can lead to paralytic ileus.)

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? Colectomy Segmental resection Abdominoperineal resection A low colectomy

Abdominoperineal resection

A complete bowel obstruction causes what bowel sounds?

Absent bowel sounds below the obstruction and hyperactive sounds above the obstruction.

Meconium is?

Baby's first poop (sloughed-off epithelial cells, bile, and other substances)

A client presents to the emergency room with a possible diagnosis of appendicitis. The health care provider asks the nurse to assess for tenderness at McBurney's point. The nurse knows to palpate which area? Between the umbilicus and the left iliac crest Between the umbilicus and the anterior superior iliac spine In the left periumbilical area In the upper right quadrant slightly below the diaphragm

Between the umbilicus and the anterior superior iliac spine

Which drug is considered a stimulant laxative? Magnesium hydroxide Bisacodyl Mineral oil Psyllium hydrophilic mucilloid

Bisacodyl

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? Appendicitis Rectal fissures Bowel perforation Diverticulitis

Bowel perforation

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

Broiled chicken and low-fiber pasta (to reduce the size and number of stools)

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? Weight loss due to malabsorption Blood and mucus in the stool Chronic constipation with sporadic bouts of diarrhea Client is awakened from sleep due to abdominal pain.

Chronic constipation with sporadic bouts of diarrhea

Which of the following is the diagnostic of choice if the suspected diagnosis is diverticulitis? Computed tomography scan Magnetic resonance imaging Colonoscopy Barium enema

Computed tomography scan

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

Decreased abdominal strength

Which is one of the primary symptoms of irritable bowel syndrome (IBS)? Diarrhea Pain Bloating Abdominal distention

Diarrhea

A nurse is caring for a client with cardiac disease. The client asks the nurse which medication is best for help with regular bowel movements. What is the best response by the nurse? Docusate Magnesium hydroxide Bisacodyl Mineral oil

Docusate (colace, used for cardiac pts that shouldn't be straining)

A client underwent a continent ileostomy. Within which time frame should the client expect to empty the reservoir? At least once a day At least once every 2 days Two to three times daily Every 4 to 6 hours

Every 4 to 6 hours

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

It will increase peristalsis by stimulating nerves in the colon wall

The nurse is comparing Crohn's disease (regional enteritis) with ulcerative colitis. Which of the following describes Crohn's disease? Fistulas are rare Diarrhea is more severe Bleeding is common and severe Its course is prolonged and variable

Its course is prolonged and variable

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? When taking the laxatives, plenty of fluid should be taken as well. The laxatives should be taken no more than 3 times a week or laxative addiction will result. Laxatives should not be routinely taken due to destruction of nerve endings in the colon. Laxatives should never be the first response for the treatment of constipation; natural methods should be employed first.

Laxatives should not be routinely taken due to destruction of nerve endings in the colon.

he 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? Loperamide Lubiprostone Dicyclomine Peppermint oil

Loperamide (opiate-related anti-diarrheal agent)

The nurse is administering a cathartic agent to a patient with renal insufficiency. Which order will the nurse question? a. bisacodyl b. lubiprostone c. cascara sagrada d. magnesium hydroxide

Magnesium hydroxide

What laxative should not be given to patients with renal insufficiency?

Magnesium hydroxide (milk of magnesium) because it may cause hypermagnesemia in the patient with renal issues.

Which of the following is considered a bulk-forming laxative? Metamucil Milk of Magnesia Mineral oil Dulcolax

Metamucil

Which is a laxative that is a saline agent?

Milk of magnesium

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

Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

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

One part of the intestine telescopes into another portion of the intestine.

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? Lactose intolerance Celiac disease Pancreatic insufficiency Ileal dysfunction

Pancreatic insufficiency

What is paralytic ileus?

Paralysis of the bowel d/t surgery (common- especially in abd surgery)

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of: A pelvic abscess. Peritonitis An ileus. An abscess under the diaphragm.

Peritonitis

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? Peritonitis Pelvic abscess Ileus Hemorrhage

Peritonitis

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? Beefy red stoma site Stoma site not sensitive to touch Red, sensitive skin around the stoma site Clear mucus mixed with yellow urine drained from the appliance bag

Red, sensitive skin around the stoma site

A client with a cyst has been brought for care. The nurse who is contributing to the client's care knows that treatment will be chosen based on what risk? Risk for infection Risk for bowel incontinence Risk for constipation Risk for impaired tissue perfusion

Risk for infection

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 ________. Rovsing sign; acute appendicitis McBurney sign; acute appendicitis Rovsing sign; perforation McBurney sign; perforation

Rovsing sign; acute appendicitis

Which type of diarrhea is caused by increased production of water and electrolytes by the intestinal mucosa and their secretion into the intestinal lumen? Osmotic diarrhea Secretory diarrhea Mixed diarrhea Diarrheal disease

Secretory diarrhea (Secretory diarrhea is usually high-volume diarrhea caused by increased production and secretion of water and electrolytes by the intestinal mucosa into the intestinal lumen.)

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

Take each dose with a full glass of water or other liquid

A nurse is caring for a client who has experienced an acute exacerbation of Crohn's disease. Which statement best indicates that the disease process is under control? The client exhibits signs of adequate GI perfusion. The client expresses positive feelings about himself. The client verbalizes a manageable level of discomfort. The client maintains skin integrity.

The client exhibits signs of adequate GI perfusion.

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? They can be habit forming and will require increasing doses to be effective. If the client is drinking 8 glasses of water per day, it is all right to continue taking them. The laxative is safe to take with other medication the client is taking. The client should take a fiber supplement along with the stimulant laxative.

They can be habit forming and will require increasing doses to be effective.

A client is being seen in the clinic for reports of painful hemorrhoids. The nurse assesses the client and observes the hemorrhoids are prolapsed but able to be placed back in the rectum manually. The nurse documents the hemorrhoids as what degree? First degree Second degree Third degree Fourth degree

Third degree

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? Small-bowel disease Ulcerative colitis Disorders of the colon Intestinal malabsorption

Ulcerative colitis

Lubiprostone (Amitiza) is?

Used for IBS-C and chronic constipation Increases fluid secretion in intestine, promotes motility Can cause diarrhea, nausea (take w/ food)

Dycyclomine (Bentyl)

a smooth muscle antispasmodic agent, is used to treat pain accompanying IBS.

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

absent

Symptoms of paralytic ileus?

absent bowel sounds, nausea, and abdominal distention.

Hirschsprung disease (congenital aganglionic megacolon)

birth defect, missing ganglion cells in the colon (lack of peristalsis)

What clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's Disease? Select all that apply Restricted to rectum strictures are common bloody, diarrhea stools cramping abdominal pain lesions penetrate intestine

bloody, diarrhea stools cramping abdominal pain

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

c. reposition the tube and check for placement ( the tube may be resting against the stomach wall)

Which laxative is a stimulant?

dulcolax

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: fissure. fistula. hemorrhoid. pilonidal cyst.

fissure

fourth degree hemorrhoids are?

hemorrhoids prolapse to the extent that they may not be reduced.

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

high-fiber diet (fluid with meals causes abd distention so contraindicated)

Sign of first degree hemorrhoids?

in the anal canal with no prolapse

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? inflammatory bowel disease (IBD) colorectal cancer diverticulitis liver failure

inflammatory bowel disease (IBD)

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

it will reduce the amount of acid in the stomach while you are not eating

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

low residue (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.)

Which is a lubricant laxative?

mineral oil

A nurse is performing focused assessment on her clients. She expects to hear hypoactive bowel sounds in a client with: paralytic ileus. Crohn's disease. gastroenteritis. complete bowel obstruction.

paralytic ileus.

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

presents with a rigid, board-like abdomen. (possibly life-threatening condition)

Sign of second degree hemorrhoids?

prolapse outside the anal canal during defecation but reduce spontaneously

Sign of third degree prolapse?

prolapse to the extent that they require manual reduction.

How often should NG tubes be assessed?

q4

What is burborygmus?

rumbling noise caused by the movement of gas through the intestines, often associated with diarrhea.

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

steatorrhea (fatty stools) (Hyperacidity in the duodenum inactivates pancreatic enzymes causing steatorrhea and ulcer diathesis.)

A nurse is preparing to provide care for a client whose exacerbation of ulcerative colitis has required hospital admission. During an exacerbation of this health problem, the nurse would anticipate that the client's stools will have what characteristics? Watery with blood and mucus Hard and black or tarry Dry and streaked with blood Loose with visible fatty streaks

watery with blood and mucus

What foods do you avoid when you have IBD?

yogurt, fruit, salami, peanut butter