Disorders of the Lower GI

When interviewing a client with internal hemorrhoids, which of the following would the nurse expect the client to report? A) Rectal bleeding B) Pain C) Itching D) Soreness

A Internal hemorrhoids cause bleeding but are less likely to cause pain, unless they protrude through the anus. External hemorrhoids may cause few symptoms, or they can produce pain, itching, and soreness of the anal area.

The nurse is talking with a group of clients that are older than age 50 years about the recognition of colon cancer to access early intervention. What should the nurse inform the clients to report immediately to their primary care provider? A) Change in bowel habits B) Excess gas C) Daily bowel movements D) Abdominal cramping when having a bowel movement

A The chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Excess gas, daily bowel movements, and abdominal cramping when having a bowel movement are not indicators of colon cancer.

A client tells the nurse, "I am not having normal bowel movements." When differentiating between what are normal and abnormal bowel habits, what indicators are the most important? A) The consistency of stool and comfort when passing stool B) That the client has a bowel movement daily C) That the stool is formed and soft D) The client is able to fully evacuate with each bowel movement

A In differentiating normal from abnormal, the consistency of stools and the comfort with which a person passes them are more reliable indicators than is the frequency of bowel elimination. People differ greatly in their bowel habits and normal bowel patterns range from three bowel movements per day to three bowel movements per week. It is important for the stool to be soft to pass without pain. The client may not be able to fully evacuate with a bowel movement; it may take time.

The nurse would instruct a client who has an appendectomy to avoid which of the following? A) Heavy lifting B) Harsh sunlight C) Dairy products D) Purine-rich foods

A It is essential for clients who have undergone appendectomy to avoid heavy lifting or unusual exertion for several months to minimize the risk of postoperative complications. However, the client need not avoid sunlight because there is no risk of photosensitivity. It is not essential for the client to avoid dairy products or purine-rich foods because these food products have no implications on the client's recovery.

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? A) Loperamide (Imodium) B) Bismuth subsalicylate (Pepto-Bismol) C) Kaolin and pectin (Kaopectate) D) Bisacodyl (Dulcolax)

A Loperamide (Imodium) and diphenoxylate with atropine sulfate (Lomotil) are examples of opiate-related antidiarrheal agents. Bismuth subsalicylate (Pepto-Bismol) and kaolin and pectin (Kaopectate) are examples of absorbent antidiarrheal agents. Bisacodyl (Dulcolax) is a chemical stimulant laxative.

The nurse is obtaining data from an older adult client who is being seen in the clinic for a checkup. The client informs the nurse that he is taking a daily dose of Epsom salts to have a daily bowel movement. What priority intervention should the nurse anticipate doing to detect the changes that can occur from prolonged use? A) Obtaining an ECG B) Obtaining blood for a complete blood count C) Listening to the patient's bowel sounds D) Administering an oil retention enema

A Magnesium products may cause ECG changes with prolonged use. The nurse should perform an ECG and compare it to the last one performed. A CBC would not establish a specific problem for the overuse of magnesium products, nor would listening to bowel sounds. Administering an oil retention enema would not be indicated at this time because the patient is not complaining of constipation and may overstimulate peristalsis.

A client informs the nurse that he is taking a stimulant laxative in order to be able to have a bowel movement daily. What should the nurse inform the client about the taking a stimulant laxative? A) They can be habit forming and will require increasing doses to be effective. B) As long as the client is drinking 8 glasses of water per day, he can continue to take them. C) The laxative is safe to take with other medication the client is taking. D) The client should take a fiber supplement along with the stimulant laxative.

A The nurse should discourage self-treatment with daily or frequent enemas or laxatives. Chronic use of such products causes natural bowel function to be sluggish. In addition, laxatives continuing stimulants can be habit forming, requiring continued use in increasing doses. Although the nurse should encourage the client to have adequate fluid intake, laxative use should not be encouraged. The laxative may interact with other medications the client is taking and may cause a decrease in absorption. A fiber supplement may be taken alone but should not be taken with a stimulant laxative

A client comes to the clinic complaining of not having a bowel movement in several days, abdominal cramping, and nausea. When the nurse puts the client on the stretcher, he vomits a large amount of fecal material. What should the first action by the nurse be? A) Notify the physician. B) Start an IV of Ringer's lactate. C) Insert an intestinal tube. D) Insert a nasogastric tube.

A The physician should be notified immediately to examine the client because the client is exhibiting signs of an intestinal obstruction. Starting the IV and inserting a nasogastric tube would be interventions that the physician will order after seeing the client. The nurse does not insert intestinal tubes.

The nurse is assessing a client for fecal impaction, and when inserting a lubricated, gloved finger, the stool feels like small rocks. What does the nurse document this finding as? A) Scybala B) Hard stool C) Fecal Impaction D) Obstruction

A When a practitioner inserts a gloved and lubricated finger in the rectum, the stool may feel like small rocks, a condition referred to as scybala. The client may have hard stool or be impacted but the correct terminology to be documented is scybala. A fecal obstruction is not always able to be determined on digital examination and will require an x-ray

A client with Crohn's disease informs the nurse that he is allergic to aspirin. What medication ordered for the treatment of Crohn's does the nurse know is contraindicated when a client is allergic to aspirin? A) Prednisone B) Sulfasalazine (Pentasa) C) Azathioprine (Imuran) D) Cyclosporine (Sandimmune)

B Drugs that contain sulfasalazine are contraindicated in patients with aspirin allergies. The other medications listed do not contain aspirin

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

B In intussusception of the bowel, one part of the intestine telescopes into another portion of the intestine. When the bowel twists and turns itself and obstructs the intestinal lumen, this is known as a volvulus. A hernia is when the bowel protrudes through a weakened area in the abdominal wall. An adhesion is a loop of intestine that adheres to an area that is healing slowly after surgery

A nurse is preparing a presentation for a local community group of older adults about colon cancer. Which of the following would the nurse include as the primary characteristic associated with this disorder? A) Abdominal distention B) Frank blood in the stool C) A change in bowel habits D) Abdominal pain

C Although abdominal distention and blood in the stool (frank or occult) may be present, the chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Abdominal pain is a late sign.

The nurse is preparing a patient for a test that involves inserting a thick barium paste into the rectum with radiographs taken as the client expels the barium. What test will the nurse prepare the patient for? A) Kidneys, ureters, bladder (KUB) B) Colonic transit studies C) Defecography D) Abdominal radiography

C In defecography, a thick barium paste is inserted into the rectum. Radiographs are taken as the client expels the barium to determine whether there are any anatomic abnormalities or problems with the muscles surrounding the anal sphincter. A KUB will not determine this. Colonic transit studies are used to determine how long it takes for food to travel through the intestines. Abdominal radiography will show the structure but does not determine the muscle ability surrounding the anal sphincter.

A client realizes that regular use of laxatives has greatly improved his bowel pattern. However, the nurse cautions this client against the prolonged use of laxatives for which reason? A) The client may develop inflammatory bowel disease. B) The client may develop arthritis or arthralgia. C) The client's natural bowel function may become sluggish. D) The client may lose his appetite

C It is essential for the nurse to caution the client against the prolonged use of laxatives because it decreases muscle tone in the large intestine. Prolonged use of laxatives may cause the client's natural bowel function to become sluggish. Laxatives do not increase the risk of developing inflammatory bowel disease, arthritis, or arthralgia, nor do they cause a loss in appetite.

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

C Most clients with IBS describe having chronic constipation with sporadic bouts of diarrhea. Some report the opposite pattern, although less commonly. Most clients experience various degrees of abdominal pain that defecation may relieve. Weight usually remains stable, indicating that when diarrhea occurs, malabsorption of nutrients does not accompany it. Stools may have mucus, but blood is not usually found because the bowel is not locally inflamed. The sleep is not disturbed from abdominal pain.

The nurse is reviewing the laboratory test results of a client with Crohn's disease. Which of the following would the nurse most likely find? A) Decreased white blood cell count B) Increased albumin levels C) Stool cultures negative for microorganisms or parasite D) Decreased erythrocyte sedimentation rate

C Stool cultures fail to reveal an etiologic microorganism or parasite, but occult blood and white blood cells (WBCs) often are found in the stool. Results of blood studies indicate anemia from chronic blood loss and nutritional deficiencies. The WBC count and erythrocyte sedimentation rate may be elevated, confirming an inflammatory disorder. Serum protein and albumin levels may be low because of malnutrition.

The nurse observes the physician palpating the abdomen of a client that is suspected of having acute appendicitis. When the abdomen is pressed in the left lower quadrant the client complains of pain on the right side. What does the nurse understand this assessment technique is referred to? A) Referred pain B) Rebound pain C) Rovsing's sign D) Cremasteric reflex

C When an examiner deeply palpates the left lower abdominal quadrant and the client feels pain in the RLQ, this is referred to as a positive Rovsing's sign and suggests acute appendicitis. Referred pain indicates pain in another area but is not necessarily manipulated by the examiner. Rebound pain is indicated when the pain of palpation is worse when the pressure is off of the site. The cremasteric reflex is a superficial reflex that is present in male patients.

A client is complaining of problems with constipation. What dietary suggestion can the nurse inform the client may help facilitate the passage of stool? A) Increase the carbohydrate content of the diet. B) Increase dietary fat consumption. C) Increase dietary protein such as lean meats. D) Increase dietary fiber.

D Constipation may result from insufficient dietary fiber and water. A diet low in fiber predisposes people to constipation because the stools produced are small in volume and dry. Increasing the carbohydrate, fat, and protein content will not facilitate the passage of stool.

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? A) Volvulus B) Intussusception C) Tumor D) Abdominal surgery

D 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. Mechanical obstructions result from a narrowing of the bowel lumen with or without a space-occupying mass. A mass may include a tumor, adhesions (fibrous bands that constrict tissue), incarcerated or strangulated hernias, volvulus (kinking of a portion of intestine), intussusception (telescoping of one part of the intestine into an adjacent part), or impacted feces or barium.

The nurse is observing the mucous membranes of a client's mouth and notices that they are darkly discolored. The client has been taking medication for diarrhea. What medication should the nurse ask the client if he has been taking? A) Diphenoxylate with atropine sulfate (Lomotil) B) Loperamide (Imodium) C) Kaopectate D) Pepto-Bismol

D Pepto-Bismol may cause the mucus membranes of the mouth to become darkly discolored. The other medications do not cause this problem.

A client at a long-term care facility informs the nurse that he is having cramping when trying to have a bowel movement, and all that is coming out is liquid. When the nurse reviews the client's last bowel movement history, it is determined that the client has not had a bowel movement in 7 days. What does the nurse understand is most likely occurring with this client? A) Scybala B) The history is incorrect of the last bowel movement. C) Diarrhea D) Encopresis

D Sometimes, if a client has been constipated for a long time, the client may begin passing liquid stool around an obstructive stool mass called encopresis, a phenomenon sometimes misinterpreted as diarrhea. The liquid stool results from dry stool stimulating nerve endings in the lower colon and rectum, which increases peristalsis. Scybala is hard, rocklike stool. The nurse cannot make a judgment about the correctness of the last bowel movement if it is not documented. Encopresis will mimic diarrhea, but there is an obstructive mass above where the liquid stool is leaking around.

A client with a hernia decides to manage the herniation with a truss. The nurse would emphasize which of the following? A) Using laxatives to ensure regular bowel movement B) Wearing warm, woolen clothes to avoid dryness C) Applying a sunscreen to prevent exposure to direct sunlight D) Using cornstarch to absorb moisture in the area

D When a client is managing herniation with a truss, the nurse informs the client to keep the skin clean and dry or to use cornstarch to absorb moisture. This minimizes the risk for infection. Use of warm, woolen clothes will not help reduce moisture; it may increase the moisture and increase the risk of infections. If the client's bowel movements are regular, laxatives would not be necessary. However, the client would need teaching to prevent constipation. Applying sunscreen is a general recommendation for any client to reduce the risk of exposure to ultraviolet radiation from the sun.

A client has developed an anorectal abscess. Which client is at most risk for the development of this type of abscess? A) A client with Crohn's disease B) A client with hemorrhoids C) A client with colon cancer D) A client with diverticulosis

A An anorectal abscess is common in clients with Crohn's disease. The other disorders do not predispose the client to risk for anorectal abscess.

The nurse is caring for four clients with diarrhea. Which client is most likely to be diagnosed with Crohn's disease? A) A 24 year-old Caucasian eastern European Jewish female B) A 46 year-old African American male C) A 32 year-old female from Vietnam D) A 63 year-old Hispanic female with a history of cancer of the vulva

A Clients who are more prone to this disorder include those with a family history of the disease, those who are white with a European and/or Jewish ancestry, and those who smoke. The other client's listed do not have these risk factors.

A client is being discharged from the outpatient care center after having an inguinal hernia reduced nonsurgically. What can the nurse instruct the client to do to decrease the incidence of recurrence? Select all that apply. A) Avoid heavy lifting and strenuous exercise. B) Avoid constipation. C) How to wear a truss. D) Take analgesics for pain. E) Bend at the waist.

A, B, C The nurse educates the client about ways to avoid constipation, control a cough, and perform proper body mechanics—how to wear and care for skin under a truss. Analgesics are not required for the prevention of a hernia. The client should bend at the knees not at the waist.

The nurse is preparing discharge instructions for the client with diverticulosis. When instructing the client to increase dietary fiber, what should the nurse inform the patient is the amount that should be taken in daily? A) 10 to 20 g B) 20 to 35 g C) 35 to 45 g D) 45 to 60 g

B A high-fiber diet supplemented with bran or prescription of a bulk-forming agent (e.g., Metamucil) helps avoid constipation. The goal is for clients to consume 20 to 35 g of fiber daily. The other amounts are not correct.

The nurse is following an order to collect a stool specimen from a patient who is having diarrhea for ova and parasites. What does the nurse understand may be required when obtaining this specimen? A) The nurse will be testing for blood in the stool. B) The nurse may have to obtain several samples. C) The test is routine and may be placed in a regular stool specimen cup. D) The stool must be placed on a slide prior to bringing it to the lab.

B Stool specimens obtained to identify parasites and their ova are placed in special preservatives and analyzed separately by the microbiology department. Several samples may be needed because parasites are not typically shed with each stool. The nurse would obtain a Hemoccult card to obtain testing for blood in the stool. The specimen will not be placed on a slide by the nurse but taken to the lab for testing

In addition to teaching a client with constipation to increase dietary fiber intake to 25 g/day, which of the following would the nurse include as important? A) Avoiding bran cereals and beans in the diet B) Adding fiber-rich foods to the diet gradually C) Limiting fluid intake to 5 to 6 glasses per day D) Minimizing activity levels for at least 2 months

B The nurse instructs the client to add fiber-rich foods to the diet gradually to avoid bloating, gas, and diarrhea. It is essential for a client to include bran cereals and beans in the diet because they ease defecation. The nurse also instructs the client to increase fluids to 6 to 8 glasses per day to prevent hard, dry stools. The client should also develop a regular exercise program to increase peristalsis and promote bowel elimination.

The nurse is caring for a patient who has had diarrhea for 3 days. What major problems associated with severe or prolonged diarrhea should the nurse monitor for when caring for this patient? Select all that apply. A) Oral candidiasis B) Dehydration C) Electrolyte imbalances D) Vitamin deficiencies E) Rectal fissures

B, C, D Three major problems associated with severe or prolonged diarrhea include dehydration, electrolyte imbalances, and vitamin deficiencies.

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? A) Colectomy B) Segmental resection C) Abdominoperineal resection D) A low colectomy

C A cancerous mass in the lower third of the rectum will result in a abdominoperineal resection with a wide excision of the rectum and the creation of a sigmoid colostomy. An encapsulated colorectal tumor may be removed without taking away surrounding healthy tissue. This type of tumor, however, may call for partial or complete surgical removal of the colon (colectomy). Occasionally, the tumor causes a partial or complete bowel obstruction. If the tumor is in the colon and upper third of the rectum, a segmental resection is performed. In this procedure, the surgeon removes the cancerous portion of the colon and rejoins the remaining portions of the GI tract to restore normal intestinal continuity.

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? A) Constipation B) Paralytic ileus C) Peritonitis D) Accumulation of gas

C Lack of bowel motility typically accompanies peritonitis. The abdomen feels rigid and boardlike as it distends with gas and intestinal contents. Bowel sounds typically are absent. The diagnosis of acute appendicitis correlates with the symptoms of rupture of the appendix and peritonitis. A paralytic ileus and gas alone do not produce these symptoms.

After assessing a client with peritonitis, the nurse likely would document the client's bowel sounds as? A) Mild B) High-pitched C) Hyperactive D) Absent

D Because lack of bowel motility typically accompanies peritonitis, bowel sounds are absent. Therefore, the nurse will not observe mild, high-pitched, or hyperactive bowel sounds.

A client is recently diagnosed with Crohn's disease and is beginning treatment. What first-line treatment does the nurse expect that the client will be placed on to decrease the inflammatory response? A) Ciprofloxacin (Cipro) B) Methotrexate (MTX) C) Azathioprine (Imuran) D) Sulfasalazine (Azulfidine)

D Considered first-line treatment for inflammatory bowel disease, 5-ASA drugs contain salicylate, which is bonded to a carrying agent that allows the drug to be absorbed in the intestine. These drugs work by decreasing the inflammatory response. MTX or Imuran are used when failure to maintain remission necessitates the use of an immune-modulating agent. Cipro is used as an effective adjunct to treat the disease.

The nurse is admitting a client to the acute care facility with abdominal pain related to an umbilical hernia. The nurse is palpating the protrusion, and the client states that it suddenly feels better. What type of hernia does the nurse understand this client has? A) Strangulated B) Incarcerated C) Irreducible D) Reducible

D If the protruding structures can be replaced in the abdominal cavity, it is a reducible hernia. An irreducible or incarcerated hernia is one in which the intestine cannot be replaced in the abdominal cavity because of edema of the protruding segment and constriction of the muscle opening through which it has emerged. If the process continues without treatment, the blood supply to the trapped segment of bowel can be cut off, leading to gangrene. This development is referred to as a strangulated hernia.