Davis Quiz Unit 3- Nutritional support, Bowel Elimination, Urinary Elimination

The nurse is preparing to change a suprapubic catheter. Which principles will the nurse use during this process? Select all that apply. 1. The area around the suprapubic tract is cleaned with sterile swabs. 2. The new catheter is inserted 4 to 6 inches into the suprapubic tract. 3. Hold the new catheter at a 90-degree angle for insertion into the suprapubic tract. 4. Note the amount drained from the balloon so that the same amount can be replaced. 5. The new catheter is tugged gently after the balloon is filled.

Option 1: After the catheter is removed, the area around the suprapubic tract is cleaned with sterile swabs from the catheter kit. Option 2: The new catheter is inserted 1 to 3 inches into the suprapubic tract after the tip is lubricated. Option 3: The new suprapubic catheter is inserted into the suprapubic tract at an angle of 10 to 30 degrees. Option 4: The balloon for a suprapubic catheter is filled with 3 to 5 mL of sterile water. Exact volume measurement and replacement are not necessary. Option 5: A slight tug on the new suprapubic catheter will seat the catheter in the bladder opening. (1 & 5)

Which type of nurses are caring for patients that are most prone to dehydration from diarrhea? 1. Long-term care facility 2. Pediatric unit 3. Adolescent unit 4. Assisted-living facility

Option 1: Although the elderly are at greater risk from a reduced sense of thirst and body weight being 55% to 60% water, they are not the most prone. Option 2: Infants and small children will dehydrate from diarrhea the fastest of any age group because of their small size. Even though their percentage of body-water weight is higher than that of adults, their small size and weight cause even small losses of fluid to have a greater impact. Option 3: Adolescents are not the most prone to dehydration from diarrhea. Option 4: Most of the population in an assisted-living facility are elderly. However, they are not the most prone to dehydration from diarrhea. (2)

The nurse works in a long-term care facility and is caring for a patient who is continuously incontinent. The patient is a debilitated older adult male with a diagnosis of diabetes mellitus. The nurse notes the presence of reddened skin on the perineum and buttocks. Which recommendation will the nurse make to the health-care provider? 1. The patient be given an indwelling catheter 2. Prescribed ointment for the patient's skin 3. A condom catheter be applied to the patient 4. The patient be placed on preventive care for skin damage

Option 1: An indwelling catheter requires an order from the health-care provider. However, the nurse is aware that an indwelling catheter places the patient at risk for an infection, compounded by diabetes mellitus. Option 2: Prescribed ointment would need a health-care provider's order; however it is not the recommendation that will meet the patient's broader need. Option 3: The use of a condom catheter is the best recommendation the nurse can make to the health-care provider. An order may or may not be required; however, given the patient's diagnosis and risk for poor circulation or infection, at least consultation is appropriate. Option 4: Care to prevent skin damage related to incontinence is a nursing intervention; making a recommendation to the health-care provider is not necessary. (3)

A patient is obtaining a stool specimen for occult blood from home. The nurse is reinforcing dietary restrictions for this test. Which items should the nurse tell the patient to avoid? Select all that apply. 1. Cherry limeade 2. Broiled steak 3. Vitamin D supplements 4. Steamed broccoli 5. Cooked carrots

Option 1: Anything containing red dye or food coloring should be avoided 2 to 3 days before the specimen collection. Option 2: Red meats should be avoided 2 to 3 days before the specimen collection. Option 3: Vitamin C supplements, not D, should be avoided 2 to 3 days before the specimen collection. Option 4: Two to three days before the specimen collection, vegetables and fruits high in peroxidase, an enzyme found in apples, bananas, grapes, and broccoli, should be avoided. Option 5: Carrots can be consumed before a test for occult blood and do not have to be avoided. (1,2 &4)

The nurse works in a long-term care facility and is caring for a patient with urinary incontinence. The nurse and patient decide together that the patient may benefit from a bladder training program. Which action by the nurse is unnecessary? 1. Make arrangements that someone assist the patient to the bathroom at set times. 2. Offer fluids to the patient throughout the day to assure good urinary tract health. 3. Notify the health-care provider of the patient's wishes and obtain an order for the program. 4. Teach the patient to avoid caffeinated beverages and to drink more fluids during the day.

Option 1: Bladder training will involve scheduled times to assist the patient to the bathroom, even if the urge is absent. Typically, a 2-hour span is initiated. Option 2: All patients need adequate fluid intake to assure good urinary tract health. Fluids should not be limited because of incontinence. Option 3: Bladder training is a nursing intervention and does not require a health-care provider's order. Option 4: Caffeinated fluids will increase the need to void. Fluid intake should be heavier during the day and less in the evening to help avoid nighttime incontinence. (3)

The nurse is collecting data from several patients. Which findings would cause the nurse to monitor closely for constipation? Select all that apply. 1. Is immobile due to skeletal traction 2. Eats three daily meals a day at 7 a.m., noon, and 5 p.m. 3. Is postoperative from a hip surgery 4. Takes hydrocodone to help with back pain 5. Is dehydrated from working out in the sun

Option 1: Decreased activity results in slower peristalsis, leading to constipation. Option 2: Eating at irregular times tends to lead to irregularity of bowel movements and constipation, whereas individuals who eat three meals daily at regular intervals tend to have more regular patterns of bowel elimination. Option 3: Surgery, especially surgery on the gastrointestinal (GI) tract, will decrease peristalsis and increase the risk for constipation. Anesthesia drugs can slow or completely halt peristalsis. All postoperative patients should be assessed for adequate bowel elimination to prevent constipation. Option 4: Narcotic pain medications that contain opioids, such as codeine, hydrocodone, and oxycodone, cause severe slowing of peristalsis. Option 5: Too little fluid leads to harder stools as the body absorbs the majority of the fluid intake in an attempt to maintain fluid and electrolyte balance, leaving inadequate fluid in the colon to keep the stool soft. (1,3,4 & 5)

The nurse is preparing a nutrition review session for patients who seek health care at a clinic. The topic requested by patients is about dietary fats and cholesterol in particular. Which information will help the patients remember facts about dietary fats? 1. High-density lipoprotein (HDL) carries cholesterol from the liver to the cells. 2. Normal laboratory values for HDL are lower than the values for the LDL. 3. Triglycerides are stored in the body and ingested through food. 4. Low-density lipoprotein (LDL) takes cholesterol from the cells back to the liver.

Option 1: High-density lipoprotein (HDL) carries cholesterol from the cells back to the liver. When HDL is low, the transport of cholesterol back to the liver is low. Option 2: HDL should be high, and LDL should be low. More HDL is needed to move cholesterol back to the liver, and less LDL is needed to carry it to the cells. Option 3: Triglycerides are made from a combination of three fatty acids. When excess fats are ingested, the extra fat is stored as triglyceride in fat cells. An excessive high level will contribute to heart disease and other metabolic disorders. Option 4: Low-density lipoprotein (LDL) is the carrier of cholesterol from the liver to the cells. High LDL levels results in too much cholesterol reaching the cells. (3)

The nurse in a long-term care facility is monitoring a patient who is recovering from an intestinal virus. The nurse needs to consider if the patient is ready to be advanced from a liquid to a regular diet. Which findings will cause the nurse to keep the patient on liquids? Select all that apply. 1. The patient has firm stool. 2. The patient has nausea and vomiting. 3. The patient's abdomen is distended. 4. The patient has hypoactive bowel sounds. 5. The patient is experiencing cramping.

Option 1: If the patient continues to have diarrhea, the liquid diet should be maintained. Option 2: With nausea and vomiting, the nurse will keep the patient on a liquid diet. Option 3: When the patient has a distended abdomen, a regular diet is not likely to be well tolerated. Option 4: With hypoactive bowel sounds, the nurse will decide to keep the patient on a liquid diet. Option 5: If the patient continues to experience cramping, the nurse will keep the patient on a liquid diet. (2,3,4 & 5)

The nurse is administering an enema to a patient. Which action should the nurse take? 1. Lubricate tube with petroleum-based lubricant. 2. Gradually raise the container 12 to 18 inches (30.5 to 45.7 cm) above the patient's hip level. 3. If resistance is felt, open the tubing to allow a large amount of fluid to flow. 4. Elevate the container if the patient reports cramping.

Option 1: Lubricate 4 to 6 inches of the distal end of the tubing with a water-soluble lubricant such as K-Y jelly to facilitate easy insertion into the rectum. Option 2: Gradually raise the container to a height of 12 to 18 inches (30.5 to 45.7 cm) above the patient's hip level. Option 3: If the tube does not pass easily into the rectum, allow a small amount of fluid to flow through the tubing for additional lubrication and try again. Do not force the entry. Option 4: If the patient complains of cramping, clamp the tubing for 15 to 30 seconds and instruct the patient to take slow, deep breaths through pursed lips or lower the container to decrease the flow. This will help the patient be more comfortable and be able to retain the solution longer. (2)

The nurse understands that older adult patients need the same nutrients as younger adults. However, the nurse is aware that good nutrition is a challenge for many older adults. Which patient comment will cause the nurse to suggest a referral? 1. "I have problems drinking milk, but I still eat cheese." 2. "I can't afford groceries or to go out to eat meals." 3. "I love to cook and will make several meals at a time." 4. "Meat and is so expensive that I hardly buy it anymore."

Option 1: Many older adults become lactose intolerant with age. The nurse should also remind the patient that calcium and vitamin D supplements, along with sunlight exposure will help prevent a calcium deficiency. This comment does not necessarily warrant a referral. Option 2: Older adults may be in a financial situation that makes the cost of food a deterrent to eating a nutritionally adequate diet. This patient would benefit from a referral that can help the patient access a food pantry, Meals on Wheels, and other resources. Option 3: It is sometimes difficult to prepare a meal for one person. As long as the patient practices safe food storage and is not exhibiting signs of foodborne illness, this statement does not warrant a referral. Option 4: This comment will prompt the nurse to discuss alternate sources of protein, which is needed to fight infection and restore muscle mass. However, this comment does not warrant a referral. (2)

A patient has a fecal impaction that requires digital removal and an oil retention enema. Which actions should the nurse take? Select all that apply. 1. Assign fecal impaction removal to the unlicensed assistive personnel (UAP). 2. Administer pain medication before the digital removal. 3. Monitor for vagal nerve stimulation. 4. Administer the oil retention enema after digital removal. 5. Check for heart problems before the digital removal.

Option 1: Most hospitals do not allow delegation of this procedure to a UAP. Option 2: This procedure may be embarrassing as well as painful for the patient. Some patients may even require mild pain medication to better tolerate the procedure. Option 3: Remember to monitor for signs of vagal nerve stimulation, just as with enema administration. Option 4: To make the procedure less uncomfortable, it is helpful to instill an oil retention enema about 1 hour before digital removal. Option 5: The same conditions that may contraindicate an enema may also contraindicate digital removal of impaction by the nurse. (2,3 & 5)

The nurse works in a clinic with patients diagnosed as having an eating disorder. Which sign of a bulimia nervosa will the nurse recognize? 1. Muscle wasting 2. Absence of dental decay 3. Increasing weight or obesity 4. Regurgitation of gastric juices

Option 1: Muscle wasting is a sign of anorexia nervosa. Option 2: With multiple episodes of vomiting, the teeth are exposed to gastric acids that decay the teeth. This is a sign of a binging and purging disorder known as bulimia nervosa. Option 3: Increasing weight or obesity is a sign of binge eating without purging. This is recognized as the most common eating disorder in the United States. Option 4: Also known as gastric reflux, this is a common sign of bulimia nervosa. The frequent vomiting and weakening of cardiac sphincter causes gastric juice reflex. (4)

The nurse works in a health-care provider's office where reagent testing on a urine sample is performed on every new patient. The nurse is aware that which result is unavailable with this testing? 1. The presence of dehydration based on specific gravity 2. The presence of glucose and ketones 3. The presence and level of protein 4. The presence of a sexually transmitted infection

Option 1: Reagent testing can indicate specific gravity of urine. A high reading can be indicative of dehydration. Option 2: Reagent testing is used to detect the presence and levels of glucose and ketones in the urine. Option 3: Reagent testing can detect the presence and level of protein in the urine. Option 4: Reagent testing is not specific to the presence of a sexually transmitted infection. (4)

The nurse is caring for a patient admitted with extreme urinary retention. The health-care provider has ordered that an indwelling urinary catheter be placed for bladder decompression. Which action will the nurse take based on recent research? 1. The bladder will be decompressed at a rate of 100 mL every 15 minutes. 2. The catheter will be clamped after the first 1000 mL of urine is removed. 3. The bladder will be decompressed rapidly. 4. The urine will be removed at a rate of 1 liter per hour.

Option 1: Recent research supports rapid decompression of the bladder with extreme urinary retention. Option 2: Clamping the catheter after the first 1000 mL is drained is an old standard. Recent research supports rapid decompression. Option 3: Rapid decompression is supported by recent research. Option 4: Recent research supports rapid decompression of the bladder with extreme urinary retention. (3)

The nurse would monitor which patients for diarrhea? Select all that apply. 1. One who eats ice cream and has lactose intolerance 2.One who has Clostridium difficile 3.One who has inflamed diverticula 4.One who is stressed about an upcoming surgery 5.One who is allergic to strawberries and does not eat strawberries

Option 1: Some people are unable to digest lactose, a sugar found in milk and other dairy products. If they do ingest lactose-containing foods, it will usually cause them to have diarrhea. Option 2: One of the more severe opportunistic infections is Clostridium difficile, otherwise known as C. diff., which causes diarrhea. Option 3: Diverticulitis, inflammation of colon pouches, can cause diarrhea and severe cramping sufficient to force a visit to a health-care provider. Option 4: High levels of stress or anxiety, as well as other emotional problems, can cause increased peristalsis and intestinal mucus production, which may result in diarrhea. Option 5: If the patient ate the strawberries, then diarrhea could occur; but because the patient did not eat them, diarrhea will not occur. (1,2,3 &4)

The nurse is preparing to reinforce teaching with a patient who is prescribed an anticoagulant drug. The patient needs to limit vitamin K intake. Which foods will the nurse share as being a high source of vitamin K? Select all that apply. 1. Spinach 2. Asparagus 3. Beans 4. Rice 5. Blueberries

Option 1: Spinach is a high source of vitamin K. Option 2: Asparagus is a high source of vitamin K. Option 3: Beans are a high source of vitamin K. Option 4: Rice is a grain, and is not a high source of vitamin K. Option 5: Strawberries, rather than blueberries, are a high source of vitamin K. (1,2,3,4 & 5)

Which information would the nurse share with a patient who wants to increase fiber in the diet? 1. Eat 35 to 40 g/day of fiber. 2. Slowly increase fiber intake over 7 to 10 days. 3. Increase caffeine intake with the fiber. 4. Decrease intake of fluid when eating fiber.

Option 1: Teach the patient to increase the fiber in his or her diet to a minimum of 25 to 30 g/day. Option 2: Explain that the amount of fiber should be increased slowly over 7 to 10 days and that taking too much too quickly will cause excessive flatus. Option 3: Too much caffeine may also increase peristalsis and cramping, as well as production of excessive flatus. It is recommended that caffeine intake be limited to 300 mg daily. Option 4: Too much fiber without adequate fluids can contribute to constipation. (2)

The nurse works in an acute care facility and is assigned to care for multiple patients. Which patient will the nurse place on strict intake and output (I&0) monitoring? 1. The patient with 1000-mL intake and a 550-mL output in an 8-hour shift 2. The patient with an intake of 1800 mL and an output of 1050 mL in 24 hours 3. The patient with a daily intake of 3000 mL and an output of 2750 mL 4. The patient who is restricted to a 24-hour fluid intake of 1000 mL with an output of 550 mL

Option 1: The difference between I&O is 450 mL, which is considered balanced. The patient's hourly intake and output is within normal limits. There is no need to place this patient on strict I&O monitoring. Option 2: The difference in the patient's I&O is 750 mL In order to be balanced, the difference of output should fall between 300 and 500 mL less than intake. The nurse will place this patient on I&O for strict monitoring. Option 3: The patient's I&O is nearly balanced, and the nurse does not need to place the patient on strict I&O monitoring. Option 4: This patient's I&O is indicative of renal failure, and the patient will already be on strict I&O monitoring. The nurse does not need to place this patient on I&O, but it does need to be maintained. (2)

The nurse is monitoring a patient who had surgery for an enlarged prostate. Treatment involves the maintenance of a continuous bladder irrigation system. Which finding would support an increase in the rate of irrigation fluid? 1. Red-colored drainage and clots in the tubing 2. A decrease in the amount of draining fluid 3. Bladder drainage that is pink in color 4. A report about painful bladder spasms

Option 1: The irrigation is intended to prevent blood clots from forming in the bladder and blocking the drainage of urine and irrigation fluid. This finding will support an increase in the rate of irrigation. Option 2: A decrease in the amount of draining fluid is most commonly associated with tubing blocked by a clot. Continuation of the irrigation fluid and the collection of urine can cause a bladder rupture. Option 3: When a patient has bladder irrigation after a transurethral resection of the prostate (TURP), the goal is to keep the drainage pink and free of clots. Option 4: Bladder spasms are common after prostate surgery. There is no reason to increase the rate of irrigation; however, the patient is medicated for pain. (1)

A patient presents to the clinic with unexplained diarrhea. Which question should the nurse ask to help determine the cause of the diarrhea? 1. "How much fluid do you drink?" 2. "Have you taken an antibiotic recently?" 3. "How often do your bowels normally move?" 4. "Does your mother have diverticulosis?"

Option 1: This will not help determine the cause of the unexplained diarrhea. It could help with determining the cause of constipation. Option 2: Antibiotics administered to treat infection can also kill some of the good bacteria that the body needs to stay healthy, specifically the normal flora found in the bowel. When the level of normal flora decreases, other microorganisms such as fungi are allowed to grow disproportionately, causing what is called an opportunistic infection. Opportunistic infections grow in the bowel, causing diarrhea. Option 3: Although this is a question the nurse could ask, it does not help in determining the cause of the diarrhea. Option 4: Diverticulosis could lead to diarrhea if the pouches become inflamed, but the patient would have to have the diverticulosis, not the mother. (2)

The nurse is checking the intake and output record for several patients. Which finding would alert the nurse to a potential problem? 1. Intake 2500 mL and output 2300 mL 2. Intake 1500 mL and output 1800 mL 3. Had three bowel movements on Tuesday and two bowel movements on Wednesday 4. Had last bowel movement on Monday and it is now Thursday

Option 1: This would not alert the nurse to a potential problem. Intake should be equal or within 500 mL of output. Option 2: This is not a problem. Intake should be within 300 to 500 mL of output. Option 3: Some patients will normally have one bowel movement daily, whereas others may go several days between movements, and yet others may have several bowel movements each day. Option 4: The nurse must make certain the patient has a bowel movement at least every 3 days to prevent constipation. (4)

The nurse in a health-care provider's office is instructing a patient on the benefit of Kegel exercises to decrease stress incontinence. Which instructions will the nurse present to the patient? Select all that apply. 1. Have the patient place the hands on the lower abdomen and monitor for muscle tension. 2. Instruct the patient to tighten the muscles used to stop the flow of urine. 3. Explain that tightening thigh muscles at the same time will enhance tightening of the pelvic floor. 4. Tell the patient to attempt to stop voiding to check for correct exercise techniques. 5. Encourage the patient to hold muscle tension for a minimum of 15 seconds.

Option 1: While in a supine position, the patient can place the hands on the lower abdomen and feel the muscles. The muscles need to remain relaxed during Kegel exercises. Option 2: The pelvic muscles are used to stop the flow of urine or flatus. The tightening of these muscles will strengthen the pelvic floor and help decrease stress incontinence. Option 3: Kegel exercises are correctly performed when only the pelvic muscles are tightened. Tightening the thigh or abdominal muscles is not effective. Option 4: The patient should be instructed to not attempt to stop the flow of urine; doing so can cause urinary retention. Option 5: The patient should hold muscle tension for 5 to 10 seconds and perform the exercise 40 to 60 times throughout the day. (1 & 2)

The nurse is completing an education program focused on urinary catheter placement for female patients. Which statement on the program review is incorrect? 1. Older females may have a urethral meatus inside the vagina. 2. The expected location of the female urinary meatus is between the clitoris and vaginal opening. 3. Patients with long-term placement of a urinary catheter have an obvious urethral meatus. 4. Young, healthy females have an obvious urethral meatus.

Option 1: Due to tissue atrophy, the urinary meatus may migrate to the edge of or inside the vagina of older female patients. Option 2: The female urinary meatus is commonly located halfway between the clitoris and vaginal opening. Option 3: The most obvious urethral meatus is found in females who have had an indwelling urinary catheter for a prolonged period. Option 4: Young, healthy females have an unobvious urethral meatus that looks like a dimple or a tiny slit or crease. (4)

The nurse is collecting data from several patients who have diarrhea. Which patient would the nurse monitor most closely for dehydration? 1. Teenager 2. Young adult 3. Middle-aged adult 4. Older adult patient

Option 1: A teenager is not the most prone to dehydration. Option 2:Young adults can usually tolerate diarrhea better than older adults. Option 3:Middle-aged adults are not the most vulnerable to dehydration compared with the elderly. Option 4:Elderly patients, infants, and small children dehydrate much quicker than do young or middle-aged adults, so it is important to assess these patients with diarrhea for dehydration often. (4)

The well-baby clinic nurse is reinforcing teaching to a new breastfeeding mother about her infant's stool. The nurse should share which information about the infant's stools? 1. The stools will be meconium. 2. The stools will be bright yellow and seedy. 3. The stools will be tan-colored and firm. 4. The stools will be very dark brown and sticky.

Option 1: Normally newborns have black, shiny, sticky stools called meconium. Option 2: Infants who are breastfed usually will have a bright yellow, pasty, seedy-appearing stool. Option 3: Babies who receive formula or cow's milk will have a darker yellowish-brown or tan-colored stool that is much firmer and formed. Option 4: Dark brown usually occurs in older children and adults, and sticky usually occurs with the meconium stool. (2)