Foundations Chapter 47 Bowel Elimination

8, 4, 7, 5, 6, 9, 1, 3, 2 Before performing the procedure, the nurse should first perform hand hygiene, pull the curtains around the bed, obtain the patient's baseline vital signs, assess the patient's level of comfort, and palpate for abdominal distention. The nurse should then position the patient on his or her left side in the Sims' position with the knees flexed and the back toward the nurse. The nurse should then drape the patient's trunk and legs with a bath blanket and place a waterproof pad under the buttocks. The nurse should apply clean gloves and lubricate the index finger of the dominant hand with a water-soluble lubricant. The nurse should then instruct the patient to take slow, deep breaths, and gently insert the index finger into the rectum. With the finger, the nurse should work the feces downward toward the end of the rectum, remove small pieces one at a time, and discard them into a bedpan. The buttocks and anal area should be washed and dried. The nurse should then remove the bedpan and inspect the feces for color and consistency. Finally, the nurse should perform hand hygiene and record the results of the procedure.

1. Wash and dry the buttocks and anal area. 2. Perform hand hygiene and record the results of the procedure. 3. Remove the bedpan and inspect the feces for color and consistency. 4. Position the patient on his or her left side in Sims' position with the knees flexed and the back toward the nurse. 5. Apply clean gloves and lubricate the index finger of the dominant hand with a water-soluble lubricant. 6. Instruct patient to take slow, deep breaths, and gently insert the index finger into the rectum. 7. Drape the trunk and legs with a bath blanket, and place a waterproof pad under the buttocks. 8. Perform hand hygiene, pull the curtains around the bed, obtain the patient's baseline vital signs, assess the patient's level of comfort, and palpate for abdominal distention. 9. With the finger, work the feces downward toward the end of the rectum, remove small pieces one at a time, and discard them into a bedpan.

4 The normal frequency of bowel evacuation for infants who are breastfed is 4 to 6 times daily; therefore, this child is normal. Maternal fiber intake does not relieve diarrhea in infants. There is no need to shift to bottle feeding. Because the infant's bowel movements are normal, antidiarrheal medication is not needed.

A mother reports that her baby passes stools five times daily. How should the nurse handle this situation? 1 Promote maternal intake of a high-fiber diet. 2 Advise the mother to shift to bottle feeding. 3 Administer a dose of antidiarrheal medication. 4 Convince the mother that this is normal for infants

2 The pubic area should not be shaved before applying the condom catheter. It should either be clipped or a hair guard should be used. Condom catheters should only be applied to intact skin. The catheter should be connected to a large-volume drainage bag or leg. There should be a space of 2.5 to 5 cm (1 to 2 inches) between the penis and the end of the catheter.

A nurse asks the nursing assistive person (NAP) to explain the skills of applying a condom catheter to a patient. Which statement by the nursing assistive person (NAP) indicates a need for further education? 1 "Condom catheters should only be applied to intact skin." 2 "The pubic area should be shaved before applying a condom catheter." 3 "The catheter should be connected to large-volume drainage bag or leg." 4 "The tip of the penis and the end of the catheter should have a space of 2.5 to 5 cm (1 to 2 inches)."

2 Hypomotility of the gastrointestinal tract is most likely to lead to an abnormally decreased frequency of defecation, or constipation. Clay-colored stools are an abnormal finding caused by absence of bile. Oily stools are caused by malabsorption syndrome, enteritis, pancreatic disease, or a surgical resection of intestine. Blood in the feces is caused by intestinal bleeding.

A nurse cares for a patient diagnosed with hypomotility disorder of the gastrointestinal tract. Which finding does the nurse anticipate? 1 Oily stool 2 Constipation 3 Blood in feces 4 Clay-colored stools

4 A saline-based agent is an osmotic laxative used for the acute emptying of the bowel, which is done before an endoscopic examination. Emollient agents are used to relieve straining on defecation, which serves to not aggravate hemorrhoids. Bulk-forming agents are laxatives that are used to relieve mild diarrhea. A saline-based agent is not used for the long-term management of constipation. Instead, bulk-forming agents are most likely to be used.

A nurse cares for a patient who has been prescribed a saline-based agent. What is the nurse most likely to infer from this? 1 The patient is suffering from hemorrhoids. 2 The patient is being treated for mild diarrhea. 3 The patient is suffering from chronic constipation. 4 The patient is scheduled for an endoscopic examination the next day

1, 3, 4 Irritated hemorrhoids cause pain during defecation. An ice pack or a warm sitz bath provides temporary relief. The primary goal of a patient who has hemorrhoids is to have soft-formed, painless bowel movements. Regular exercise improves the likelihood of stools being soft. The passage of hard stools in a patient who has hemorrhoids causes bleeding and irritation. Therefore, the nurse would not advise the patient to take an antidiarrheal agent. Drinking adequate fluids is essential for regular bowel movements, which hels prevent constipation. Therefore, the nurse would not advise the patient to restrict fluid intake.

A nurse cares for a patient who has hemorrhoids. What advice should the nurse give to the patient to relieve discomfort? Select all that apply. 1 "Using an ice pack can help you feel better for a while." 2 "Taking an antidiarrheal agent will help you if the problem persists." 3 "Using a warm sitz bath can give you temporary pain relief." 4 "Exercising regularly might help you have regular bowel movements." 5 "Restricting the amount of water you drink daily is beneficial.

4 Oily stool is associated with pancreatic disease. Pus, blood, and mucus in stools are associated with internal bleeding, infection, or inflammation.

A nurse cares for a patient who has pancreatic cancer. Which stool finding is consistent with the patient's disorder? 1 Pus 2 Blood 3 Mucus 4 Oily stool

4 Tests performed by the laboratory for occult (microscopic) blood in the stool and the stool cultures require only a small sample. If the patient passes formed stools, a 3-cm (1-in) mass of formed stool is sufficient. The patient does not need to pass only liquid stools for the test to be performed. Tests for measuring the output of fecal fat require a 3- to 5-day collection of stool. A single sample is sufficient for performing a fecal occult blood test. If the patient passes liquid stools, the amount of fecal matter required to test for fecal occult blood ranges from 15 to 30 mL.

A nurse collects a stool specimen for an ordered occult blood laboratory test. Which statement is correct about the sample collection procedure for this test? 1 Only liquid stools can be collected for performing this test. 2 The samples should be collected over a 3- to 5-day period. 3 At least 40 mL of liquid stool should be collected for performing the test. 4 A 3-cm (1-in) mass of formed stool is an adequate sample size for this test.

1, 2, 4 To reduce the risk of constipation, one should perform regular physical exercise, include high-fiber foods in the diet, and attempt to defecate at the same time each day. A regular physical exercise program promotes peristalsis, thereby easing defecation. High-fiber foods are bulk-forming foods, which help remove fats and waste products from the body efficiently. Bowel function is also influenced by personal elimination habits. Irregular bowel habits may lead to constipation. A low-fiber diet high in animal fats, such as meats and carbohydrates, may cause constipation. To reduce the risk of constipation, a person should drink at least 1.5 L of fluids per day.

A nurse educates a group of patients on the prevention of constipation. Which statements if made by a patient indicate effective understanding? Select all that apply. 1 "I'll perform regular physical exercise." 2 "I'll include high-fiber foods in my diet." 3 "I'll regularly eat meats and carbohydrates." 4 "I'll attempt to defecate at the same time each day." 5 "I'll ensure that my daily fluid intake is not less than 1 liter."

1, 2 Docusate calcium is an emollient and stool-softener that is used for short-term therapy to relieve straining on defecation. Hemorrhoids and perianal surgery can cause straining during defecation; docusate calcium can be used to treat these conditions. A low-residue diet is likely to be responsible for chronic constipation; stool softeners are of little value for the treatment of chronic constipation. Suspected poisoning and endoscopic examinations both call for the acute emptying of the bowel; saline-based agents are often used for this task.

A nurse has been assigned to care for a patient who has been prescribed docusate calcium. What conditions would warrant the issuing of this laxative? Select all that apply. 1 Hemorrhoids 2 Perianal surgery 3 Low-residue diet 4 Suspected poisoning 5 Endoscopic examination

3 Diarrhea may be associated with fever, chills, weight loss, or abdominal pain; therefore, the nurse should ask the patient about the presence of these symptoms. A bloated feeling after eating may be present in patients with indigestion. Patients with constipation may have to strain to have a bowel movement and may have abdominal or rectal pain when they have a bowel movement.

A nurse is assessing a patient with diarrhea. Which question will help determine the presence of other symptoms? 1 "Do you feel bloated after eating?" 2 "Do you have to strain to have a bowel movement?" 3 "Have you had fever, chills, weight loss, or abdominal pain recently?" 4 "Do you have abdominal or rectal pain when you have a bowel movement?"

5, 1, 6, 2, 4, 3, 8, 7 While assisting an immobilized patient with bowel elimination to use a bedpan, the nurse should first perform hand hygiene, apply clean gloves, and close the room curtain for privacy. The nurse should then raise the side rail opposite the nurse. The head of the bed should be lowered flat, and the patient should be rolled onto his or her side facing away from the nurse. The nurse should then place a bedpan firmly against the patient's buttocks. The bedpan should be pushed down into the mattress with the open rim toward the patient's feet. Then, keeping one hand against the bedpan, the nurse should place the other hand on the patient's hip. After allowing the patient to roll onto the pan and flat on the bed, the nurse should raise the head of the bed 30 degrees.

A nurse is assisting an immobilized patient with bowel elimination to use a bedpan. Arrange the steps of this process in the correct order. 1. Raise the side rail opposite the nurse. 2. Place a bedpan firmly against the buttocks. 3. Keeping one hand against the bedpan, place the other hand on the patient's hip. 4. Push bedpan down into mattress with the open rim toward the patient's feet. 5. Perform hand hygiene, apply clean gloves, and close the room curtain for privacy. 6. Lower the head of the bed flat and roll the patient onto his or her side facing away from the nurse. 7. Raise the head of the bed 30 degrees. 8. Allow the patient to roll onto the pan and flat on the bed

4 Tincture of opium is an antidiarrheal drug that is used to manage chronic severe diarrhea in patients with diseases such as Crohn's disease, ulcerative colitis, and acquired immunodeficiency syndrome. Bisacodyl and casanthranol are cathartics, and methylcellulose is a laxative; they may be used to manage constipation, not diarrhea.

A nurse is caring for a patient with Crohn's disease who has developed chronic severe diarrhea. Which medication does the nurse anticipate will help manage the patient's diarrhea? 1 Bisacodyl 2 Casanthranol 3 Methylcellulose 4 Tincture of opium

B Black or tarry stool indicates iron ingestion or gastrointestinal bleeding; therefore, patient B is most likely to be taking iron supplements. White or clay-colored stool indicates an absence of bile. Red stool may indicate gastrointestinal bleeding, hemorrhoids, or ingestion of beets. Brown stool is a normal finding.

A nurse is caring for four patients. While collecting stool specimens for laboratory examination, the nurse observes the stool colors. Which patient does the nurse suspect to be taking iron supplements? 1 A 2 B 3 C 4 D

2 When positioning an immobilized patient on a bedpan, the nurse should roll the patient onto the bedpan to ensure the patient's safety. The nurse should never try to lift the patient onto a bedpan. After a patient is positioned on a bedpan, the nurse should elevate the head of the patient's bed 30 to 45 degrees, not 15 to 25 degrees. A smaller fracture pan should be provided to patients with leg fractures, not arm fractures.

A nurse is caring for immobilized patients in a hospital setting. Which action taken by the nurse while positioning patients on a bedpan will help them evacuate bowel contents without discomfort? 1 Lifting the patient onto the bedpan 2 Rolling the patient onto the bedpan 3 Elevating the head of the patient's bed 15 to 25 degrees 4 Providing a smaller fracture pan to a patient with a humerus fracture

3 Debilitated, confused, or unconscious patients have an increased risk of fecal impaction, whereas patients with impaired cognitive function are more likely to have fecal incontinence. Diarrhea, not fecal impaction, may occur due to antibiotic therapy, whereas constipation may occur due to opiate therapy. Flatulence is the accumulation of gas in the lumen of the intestines, whereas fecal incontinence is the inability to control the passage of feces and gas from the anus. Fecal impaction is characterized by a loss of appetite, nausea and/or vomiting, and rectal pain, whereas flatulence, not fecal incontinence, is characterized by abdominal distention and severe, sharp abdominal pain.

A nurse is discussing common bowel elimination problems. Which statement indicates effective understanding of the difference between fecal impaction and fecal incontinence? 1 Fecal impaction may occur due to antibiotic therapy, whereas fecal incontinence may occur due to opiate therapy. 2 Fecal impaction is the accumulation of gas in the lumen of the intestines, whereas fecal incontinence is the inability to control the passage of feces and gas from the anus. 3 Fecal impaction is common in debilitated, confused, or unconscious patients, whereas fecal incontinence is common in patients with impaired cognitive function. 4 Fecal impaction is characterized by loss of appetite, nausea and/or vomiting, and rectal pain, whereas fecal incontinence is characterized by abdominal distention and severe, sharp abdominal pain.

4 An antegrade continence enema is a procedure in which the surgeon creates a continence valve with an opening to the intestine on the abdomen; this allows the patient or caregiver to insert a tube and administer an enema that comes out through the anus. A patient with a sigmoid colostomy will have a more formed stool. An ileoanal pouch anastomosis involves removal of the colon and creation of a pouch from the end of the small intestine attached to the anus. Patients who have undergone this procedure need to empty the pouch several times a day. Sigmoid and transverse ostomies are performed to divert stool from an area of trauma or perianal wounds.

A nurse is educating the caregiver of a patient who has undergone an antegrade continence enema procedure. Which statement if made by the caregiver indicates effective learning? 1 "After this procedure, the patient will have a more formed stool." 2 "After this procedure, I'll have to make the patient empty the pouch several times a day." 3 "After this procedure, stool will be temporarily diverted from the patient's area of trauma." 4 "After this procedure, I can easily insert a tube and give the patient an enema that comes out through the anus."

1 While performing physical assessment of a patient with bowel elimination problems, the nurse should inspect the patient's mouth, abdomen, and rectum. A bowel movement every 5 days indicates constipation, which is an abnormal finding. Abdominal distension, indicated by taut and stretched abdominal skin, may be seen in patients with altered bowel elimination. The occurrence of bowel sounds every 5 to 15 seconds and the absence of peristaltic waves on the abdomen are normal findings.

A nurse is performing a physical assessment of a patient with bowel elimination problems. Which finding does the nurse anticipate is most likely in the patient? 1 Bowel movements every 5 days 2 Abdominal skin appearing loose 3 Occurrence of bowel sounds every 5 to 15 seconds 4 Absence of peristaltic waves on the abdomen

2, 3 Pus and mucus are abnormal constituents of fecal matter that may indicate an infection or inflammation. Fat, bile pigment, and cells lining the intestinal mucosa are normal constituents of feces.

A nurse looks at the findings of a patient's stool analysis. Which findings in the report indicate an abnormality? Select all that apply. 1 Fat 2 Pus 3 Mucus 4 Bile pigment 5 Cells lining intestinal mucosa

3, 4 Peristaltic waves cannot be seen normally. So, a lack of visible peristaltic waves indicates normal functioning. Normal bowel sounds occur every 5 to 15 seconds. Therefore, bowel sounds that are audible every 10 seconds are a normal observation. Masses, tumors, and fluid are dull to percussion. High-pitched and hyperactive bowel sounds occur with small intestine obstructions and inflammatory disorders. An overall outward protuberance of the abdomen indicates intestinal gas, large tumors, or fluid in the peritoneal cavity.

A nurse performs a physical assessment of a patient. Which observations most likely indicate normal functioning? Select all that apply. 1 Dull note on percussion 2 High-pitched bowel sounds 3 Lack of visible peristaltic waves 4 Outwardly protruded abdomen 5 Bowel sounds audible every 10 seconds

1 Some tests, such as measurement for ova and parasites, require the stool to be warm. When stool specimens remain at room temperature, bacteriological changes that alter test results occur. Therefore, these specimens should be sent to a laboratory as soon as possible. After obtaining a specimen, the nurse should record the specimen collection in the patient's medical record. The nurse should use the medical aseptic technique during the collection of stool specimens.

A nursing instructor is teaching students the procedure to collect a stool sample for presence of ova and parasites. Which statement made by the nursing student indicates the need for further learning? 1 "The stool specimen should be kept at room temperature." 2 "The stool specimen should be sent to the laboratory as soon as possible." 3 "The specimen collection should be entered in the patient's medical records." 4 "A medical aseptic technique should be followed during the collection of stool specimens."

3 If there are no contraindications and the health care provider gives approval, the nurse must instruct the patient to stop taking aspirin, ibuprofen, naproxen, or other nonsteroidal antiinflammatory drugs for 7 days to avoid a false-positive test result. The guaiac fecal occult blood test (gFOBT) should be repeated at least three times on three separate bowel movements. Patients should be instructed to avoid eating red meat 3 days before testing. Patients should avoid vitamin C supplements and citrus fruits and juices 3 days before the test to avoid a false-negative result.

A nursing instructor teaches nursing students about the steps to be taken while obtaining a guaiac fecal occult blood test (gFOBT). Which statement if made by a student indicates the need for further learning? 1 "I must repeat the test at least three times on three separate bowel movements." 2 "I must instruct the patient to avoid eating red meat 3 days before the test is performed." 3 "I must instruct the patient to avoid taking nonsteroidal antiinflammatory drugs the day before the test." 4 "I must instruct the patient to avoid vitamin C supplements and citrus fruits and juices for 3 days before the test."

4 The guaiac fecal occult blood test (gFOBT) requires that the patient to follow certain dietary restrictions before testing. A patient about to undergo gFOBT has to stop taking aspirin, ibuprofen, naproxen, and any other nonsteroidal antiinflammatory drugs 7 days prior to the test because these could cause a false-positive test result. A fecal immunochemical test (FIT) requires no preparation or dietary restrictions. The FIT is a more sensitive test than gFOBT and is more expensive. Patients about to undergo the gFOBT need to avoid vitamin C supplements and citrus fruits and juices at least 3 days before testing to avoid a false-negative result. The FIT has no such restrictions. The gFOBT requires the patient to refrain from eating red meat for 3 days before testing, whereas the FIT does not.

A nursing student compares the guaiac fecal occult blood test (gFOBT) with the fecal immunochemical test (FIT) for measuring microscopic amounts of blood in the feces. Which statement if made by the nursing student is correct? 1 "The guaiac fecal occult blood test (gFOBT) is a more sensitive test than the fecal immunochemical test (FIT), but it is also more expensive." 2 "Both tests call for the patients consuming citrus fruits and juices for 3 days before testing to avoid false-negative result." 3 "The guaiac fecal occult blood test (gFOBT) has no dietary restrictions, whereas the fecal immunochemical test (FIT) requires the patient to refrain from eating red meat for 3 days before testing." 4 "Only the guaiac fecal occult blood test (gFOBT) can give a false positive result if the patient takes nonsteroidal antiinflammatory drugs right before testing; the fecal immunochemical test (FIT) has no such restrictions."

2, 3 A soapsuds enema has to be used with caution in pregnant women and older adults because it could cause electrolyte imbalance or damage to the intestinal mucosa. A soapsuds enema kit contains only pure castile soap that comes in a liquid form, which can be mixed with tap water or saline to create the effect of intestinal irritation to stimulate peristalsis. In a high-cleansing enema, the fluid is delivered from a greater height with a higher pressure to cleanse more of the colon. A low enema cleanses only the rectum and sigmoid colon. After a high enema is infused, the patient has to turn from the left lateral to the dorsal recumbent, over to the right lateral position. This position change ensures that the fluid reaches the large intestine. A patient using an oil-retention enema retains the enema for several hours, if possible, to enhance the action of the oil. This is not required for a soapsuds enema.

A nursing student is learning about administering high-cleansing soapsuds enemas to patients. Which statements if made by the nursing student indicate effective learning? Select all that apply. 1 "This enema cleanses only the sigmoid colon and the rectum." 2 "This type of enema is not recommended for pregnancy-related constipation." 3 "Liquid soap can be mixed with either tap water or saline to create this enema." 4 "The patient has to remain still in the same position for 30 minutes after the enema is applied." 5 "The patient retains the enema for several hours if possible, to enhance the action of the enema."

1 No metallic objects, including metal objects on clothes, are allowed in the room during a magnetic resonance imaging (MRI) procedure. The patient might be given light sedatives if the patient feels claustrophobic and unable to lie still while an MRI is being performed. A patient cannot have food or fluids orally 4 to 6 hours before an examination. If the patient has a pacemaker or a metal implant, he or she may not be able to have an MRI.

A nursing student is learning about the steps to be performed during a magnetic resonance imaging (MRI) procedure. Which statement if made by the nursing student indicates effective learning? 1 "The patient should be screened for metal." 2 "The patient should be instructed to not take any sedatives the day of the test." 3 "The patient should stop drinking fluids 1 to 3 hours before an examination." 4 "A patient with a pacemaker can have a magnetic resonance imaging (MRI) procedure."

2 The nurse will arrange for the patient to go to the emergency department of the local hospital if the patient is experiencing acute pain related to constipation and fecal impaction is a likely cause. When the acute pain is related to surgery, the nurse should encourage the patient to try nonopioid pain medication and decrease the use of opioid pain medication. Increasing fluid and fiber in the diet and taking a stimulant laxative and stool softeners is recommended when constipation is related to opioid medication. When the patient has impaired physical mobility related to surgery, a physical therapist may help provide exercise/ambulation at home.

A patient complains of acute pain related to constipation. In which case will the nurse recommend that the patient to go to the emergency department of the local hospital? 1 Acute pain following surgery 2 Possible fecal impaction 3 Constipation related to opioid medication 4 Impaired physical mobility related to surgery

1 Type 1 stools are separate, hard lumps that resemble nuts that are difficult to pass. Type 3 stools are like a sausage, but with cracks on the surface. Type 5 stools are soft blobs with clear-cut edges that are passed easily. Type 6 stools are fluffy pieces with ragged edges.

A patient complains of difficulty passing stools, which are small, hard lumps. According to the Bristol stool form scale, what would be the classification of these stools? 1 Type 1 2 Type 3 3 Type 5 4 Type 6

3 Because bulk-forming laxatives have high fiber content, patients may notice increased gas formation and flatus when they first start taking these laxatives. This condition will subside after 4 to 5 days. Wetting or emollient laxatives act by lowering the surface tension of feces. Osmotic laxatives increase bowel pressure and act as a stimulant for peristalsis. Stimulant cathartics act by causing local irritation to the intestinal mucosa. None of these three types of laxatives cause flatus upon initiation of the regimen that subsides after 4 to 5 days.

A patient complains of increased gas formation and flatus upon first starting a laxative regimen. The nurse assures the patient that this effect will subside after 4 to 5 days. Which laxative has the patient been prescribed? 1 Wetting 2 Osmotic 3 Bulk-forming 4 Stimulant cathartic

1 For a patient who has gastrointestinal bleeding, the health care provider would order hemoglobin and hematocrit tests to help determine if anemia from gastrointestinal bleeding is present. The health care provider orders serum lipase, serum amylase, and liver function tests to assess for hepatobiliary diseases and pancreatitis.

A patient has gastrointestinal bleeding. Which test does the nurse expect the health care provider to order to help determine whether the patient has anemia? 1 Hematocrit 2 Serum lipase 3 Serum amylase 4 Liver function tests

3 The drug of choice for managing chronic constipation in a patient who is hemodynamically stable is a bulk-forming substance such as polycarbophil. Castor oil causes cramping, as well as an imbalance in fluid and electrolytes and should be avoided for long-term use. Mineral oil causes nutritional deficiency and on aspiration causes pneumonia and should be avoided. Docusate sodium is suitable for short-term therapy.

A patient is suffering from chronic constipation but has no other symptoms. Which medication would provide the most relief for the patient's constipation? 1 Castor oil 2 Mineral oil 3 Polycarbophil 4 Docusate sodium

4 Sodium phosphate is meant for acute emptying of the bowel and is suitable for managing the patient with acute constipation. Psyllium, polycarbophil, and methyl cellulose are the drugs of choice for managing chronic constipation, rather than acute constipation, because they are bulk- forming agents.

A patient needs a bowel preparation before a procedure. Which medication is appropriate in managing this patient? 1 Psyllium 2 Polycarbophil 3 Methyl cellulose 4 Sodium phosphate

3

A patient presents with dangerously high serum potassium levels. Which enema does the nurse expect the health care provider to order for the patient? 1 MGW solution 2 Neomycin solution 3 Sodium polystyrene sulfonate 4 Enema containing steroid medication

2 Mucus will be present in the feces of patients with intestinal infection, irritation, inflammation, or injury. Constipation is characterized by hard feces. Increased peristalsis manifests in narrow, pencil-shaped feces. Malabsorption of fat is characterized by pale and oily feces.

A patient reports mucus in the feces. What is the most likely cause? 1 Constipation 2 Intestinal infection 3 Increased peristalsis 4 Malabsorption of fat

2, 5 The disorders that cause pencil-shaped stools are obstructive lesions of the gastrointestinal (GI) tract and peristaltic disorders of the GI tract. Any partial obstruction of the GI tract may lead to improper passing of stool and result in pencil-shaped stools. Conditions that affect peristalsis may also cause pencil-shaped stools. Pancreatitis does not present with pencil-shaped stools. Malabsorption presents with excess fat in the stool. Absence of bile in the stool is associated with pale stools.

A patient reports passing narrow pencil-shaped stools over the past few days. Which conditions should the patient be evaluated for? Select all that apply. 1 Pancreatitis 2 Obstructions 3 Malabsorption 4 Absence of bile 5 Rapid peristalsis

4 Bleeding is an unexpected outcome. The nurse should stop the procedure, obtain vital signs, and call the health care provider because this is a medical emergency. The nurse should not continue the procedure.

A patient starts to experience pain while receiving an enema. The nurse notes blood in the return fluid and rectal bleeding. Which action should the nurse take first? 1 Administer pain medication. 2 Slow down the rate of instillation. 3 Tell the patient to breathe slowly and relax. 4 Stop the instillation and obtain vital signs

1, 3, 4 Fats and bile salts undergo absorption in the ileum, whereas the carbohydrates and proteins undergo absorption in the jejunum. Nutrients that cross the mucosal barrier of the intestine are absorbed into the lymph fluids or blood vessels. Iron and vitamins are absorbed in the ileum and not the duodenum. Plant fiber is not digested in the small intestine; the undigested fiber is emptied into the cecum.

A patient who has malabsorption syndrome asks the nurse about the process of nutrient absorption. What response should the nurse give the patient? Select all that apply. 1 The ileum absorbs fat and bile salts. 2 The duodenum absorbs iron and vitamins. 3 The jejunum absorbs carbohydrates and proteins. 4 Nutrients are absorbed into the blood vessels. 5 Plant fiber undergoes absorption in the small intestine.

1, 2, 4 The patient's presentation is suggestive of constipation secondary to use of opioids. Management includes the use of laxatives to promote defecation. Adequate fluid intake helps to prevent the stool from becoming hard and promotes easy passage of stools. A high-fiber diet promotes bulky stool, which stimulates peristalsis and encourages the easy passage of stools. Withholding opioids will increase pain and cause discomfort in the patient. Relaxation techniques are useful for managing patients who have pain due to physical injuries.

A patient who is taking opioids to control cancer-related pain has developed constipation. On assessment, the nurse finds that the patient has abdominal distension and hypoactive bowel sounds. Which management orders should the nurse include in the patient's care plan to relieve the constipation? Select all that apply. 1 Using laxatives 2 Promoting water intake 3 Withholding the opioids 4 Encouraging high-fiber diet 5 Training for relaxation techniques

3, 4 Carcinoembryonic antigen increases in inflammatory disorders of the gastrointestinal (GI) tract and with inflammation of the hepatobiliary organs. Therefore, the patient requires evaluation for these disorders. Serum amylase is a marker for GI function. Bowel necrosis and diabetic ketoacidosis are associated with increased serum amylase, not carcinoembryonic antigen. A transfusion reaction is associated with increased serum bilirubin due to destruction of hemoglobin, not carcinoembryonic antigen.

A patient who visited the hospital for routine laboratory tests is found to have an increased serum carcinoembryonic antigen. Which conditions would be suspected in the patient and require further assessment? Select all that apply. 1 Bowel necrosis 2 Diabetic ketoacidosis 3 Inflammation of gastrointestinal (GI) tract 4 Inflammation of hepatobiliary organs 5 Transfusion reaction

2 Amylase is an enzyme produced in the pancreas. It helps in the digestion process. If the pancreas is inflamed, the amylase is released into the bloodstream, increasing the levels of the enzyme in the blood. Bilirubin indicates liver function and is not elevated in pancreatitis. Carcinoembryonic antigen is an indicator of gastrointestinal (GI) health and is not elevated in pancreatitis. Alkaline phosphatase increases with obstructive hepatobiliary diseases, hepatobiliary carcinomas, bone tumors, and healing fractures.

A patient with a history of pancreatitis reports acute pain in the abdomen. Which abnormal finding in the laboratory report of this patient indicates pancreatitis? 1 Raised bilirubin 2 Raised serum amylase 3 Elevated carcinoembryonic antigen 4 Elevated alkaline phosphatase levels

1, 4, 5 The nurse should place a waterproof pad under the patient's hips and buttocks when administering an enema. The nurse should also cover the patient with a bath blanket, exposing only the rectal area, and clearly visualizing the anus. If the patient has poor sphincter control, the nurse should position the patient on a bedpan in a comfortable dorsal recumbent position. While preparing a patient for an enema, the nurse should assist the patient into the Sims' position with the right knee flexed and the nurse should stand on the right side of the patient's bed and raise side rail on the opposite side.

A registered nurse is educating nursing students about the required interventions while administering an enema. Which statements if made by a student nurse indicate effective understanding? Select all that apply. 1 "I'll place a waterproof pad under the patient's hips and buttocks." 2 "I'll assist the patient into the supine position with the right knee flexed." 3 "I'll stand on the left side of the patient's bed and raise the side rail on the opposite side." 4 "I'll cover the patient with a bath blanket, exposing only the rectal area, and clearly visualizing the anus." 5 "If the patient has poor sphincter control, I'll position the patient on a bedpan in a comfortable dorsal recumbent position."

1 To develop and implement an individualized plan of care for patients with bowel elimination problems, the nurse should perform certain assessments that include nursing history, physical assessment, inspection of fecal characteristics, and review of relevant test results. When assessing bowel elimination issues, the nurse need not inspect the patient's teeth, tongue, and gums for poor dentition, because poor dentition or poorly fitting dentures that affect the ability to chew may interfere with nutrition, but do not necessarily lead to bowel elimination problems. During the physical assessment related to bowel elimination, the nurse should inspect the patient's abdomen and rectum. The nurse should ask the patient about a history of abdominal or anal pain. The nurse should assess the area around the anus for lesions, discoloration, and inflammation; these may indicate hemorrhoids caused by straining during defecation. The nurse should also auscultate the abdomen with a stethoscope to assess bowel sounds in each quadrant. High-pitched and hyperactive bowel sounds may indicate small intestine obstruction.

A registered nurse is teaching a licensed practical nurse about the physical assessment of body systems and functions of patients with bowel elimination problems to develop and implement an individualized plan of care. Which statement if made by the licensed practical nurse indicates a need for further teaching? 1 "I'll inspect the patient's teeth, tongue, and gums for poor dentition." 2 "I'll ask the patient about a history of abdominal or anal pain." 3 "I'll inspect the area around the anus for lesions, discoloration, and inflammation." 4 "I'll auscultate the abdomen with a stethoscope to assess bowel sounds in each quadrant.

1 Various factors such as fluid intake, stress, age, and position during defecation influence the process of bowel elimination. A fluid intake of 2.2 L/day is recommended for women. During emotional stress, the digestive process is accelerated, and peristalsis is increased; this may cause diarrhea and gaseous distension. In older adults, muscle tone in the perineal floor and anal sphincter weakens, which causes difficulty in controlling defecation. Squatting allows a person to lean forward, exert intraabdominal pressure, and contract the gluteal muscles. This position facilitates easy defecation.

A student nurse is learning about the various factors that influence the process of bowel elimination. Which statement if made by the student nurse indicates a need for further learning? 1 "A woman should drink at least 1 L of fluid to maintain normal bowel elimination." 2 "Prolonged emotional stress increases peristalsis, causing diarrhea and gaseous distension." 3 "Older adults may have difficulty in controlling defecation due to weakened muscle tone in the perineal floor and anal sphincter." 4 "A position that allows a person to lean forward exerts intraabdominal pressure, contracts the gluteal muscles, and facilitates easy defecation."

3 While performing a physical assessment of a patient with altered bowel elimination, the nurse may auscultate the patient's abdomen. High-pitched and hyperactive bowel sounds proximal to the obstruction may indicate that the patient has obstruction of the small intestine. Swelling and pain in the rectal area may indicate hemorrhoids. Intestinal gas, large tumors, or fluid in the peritoneal cavity may cause abdominal distention, which may be indicated by the abdominal skin appearing stretched. The occurrence of bowel sounds every 5 to 15 seconds on auscultation of the abdomen is a normal finding.

After performing a physical assessment of a patient with altered bowel elimination, a nurse suspects that the patient has an obstruction of the small intestine. Which finding supports the nurse's suspicion? 1 Swelling and pain in the rectal area 2 Abdominal skin appearing stretched 3 High-pitched and hyperactive bowel sounds on auscultation of the abdomen 4 The occurrence of bowel sounds every 5 to 15 seconds on auscultation of the abdomen

2 Cholecystitis causes inflammation of the gallbladder. Increased amylase levels are observed in patients with cholecystitis due to obstruction of the bile duct. Increased bilirubin levels indicate hepatobiliary disease. Increased alkaline phosphatase levels indicate hepatobiliary carcinomas and bone tumor. Increased carcinoembryonic antigen levels indicate cancer or inflammation of the gastrointestinal tract.

After reviewing a patient's laboratory reports, the nurse concludes the patient has cholecystitis. Which laboratory finding would enable the nurse to reach this conclusion? 1 Increased bilirubin levels 2 Increased amylase levels 3 Increased alkaline phosphatase levels 4 Increased carcinoembryonic antigen levels

2 Serum amylase levels increase in patients with pancreatitis and in patients with pancreatic tumors. Bilirubin is elevated in patients with hepatic disorders. Carcinoembryonic antigen becomes elevated in inflammatory disorders of the gastrointestinal tract. Alkaline phosphatase becomes elevated in bone tumors.

An alcoholic develops chronic pancreatitis. Which laboratory parameter is helpful in diagnosing pancreatitis? 1 Raised bilirubin 2 Raised serum amylase 3 Elevated carcinoembryonic antigen 4 Elevated alkaline phosphatase levels

2 Age and race are two factors that can indicate whether a patient is at an increased risk of developing colon cancer. In this case, the patient is an elderly African American. Statistics show that African Americans have a higher risk than other ethnic groups of developing colon cancer. In addition, the patient's presentation of change in bowel habits, rectal bleeding, and sense of incomplete evacuation of bowel are warning signs of colon cancer, and the nurse should evaluate the patient for this condition. Infections are usually present with diarrhea, which may be associated with blood. Irritable bowel syndrome and inflammatory bowel disorders are associated with abdominal pain.

An elderly African American reports a change in bowel habits with rectal bleeding and a sense of incomplete bowel evacuation. Which disorder would the nurse suspect in this patient? 1 Infection 2 Colon cancer 3 Irritable bowel syndrome 4 Inflammatory bowel disease

1 Emptying the urinary bladder before collecting the stool sample prevents contamination of the specimen. It is not necessary to wash the patient's perineum. A clean, dry bedpan is sufficient for containing the specimen. It is not necessary to collect the first specimen of the day.

Before collecting a stool sample for occult blood, what should the nurse instruct the nursing assistive personnel to do? 1 Ask the patient to void. 2 Wash the patient's perineum. 3 Secure a sterile specimen container. 4 Plan to collect the first specimen of the day.

3, 1, 5, 2, 6, 4 The first action should be to assess the patient's level of mobility because it helps to determine whether the patient should be treated as dependent or independent. The nurse should then explain the technique to the patient. The next priority is to perform hand hygiene and apply clean gloves. The room curtains then need to be closed to maintain privacy. The patient's bed is then raised to a comfortable working height. The top linen is then folded back to patient's knees.

Chronologically arrange the steps for assisting a patient on a bedpan? 1. Explain the technique to the patient. 2. Close the room curtain for privacy. 3. Assess the patient's level of mobility. 4. Fold back the top linen to the patient's knees. 5. Perform hand hygiene, and apply clean gloves. 6. Raise the bed to a comfortable working height.

1, 2, 3 The patient with flatulence is likely to report abdominal distension, cramping, and pain due to accumulation of gas in the intestines. Loose watery stools may occur in diarrhea and are a major cause of fecal incontinence, or the involuntary passage of stools.

During a home visit to an elderly patient, the patient expresses to the nurse that he is experiencing flatulence, which is embarrassing. Which signs and symptoms should the nurse expect the patient to report? Select all that apply. 1 Abdominal fullness 2 Pain 3 Cramping 4 Loose watery stools 5 Involuntary passage of stools

3 This patient possibly lacks the enzyme needed to digest milk sugar lactase and therefore is potentially lactose intolerant. Lactose intolerance is not a food allergy but rather a food intolerance that increases peristalsis, not decreases. Based on the circumstances of the condition, irritable bowel is not indicated.

During the nursing assessment, a patient reveals that he has diarrhea and cramping every time he has ice cream. He attributes this to the cold nature of the food. However, the nurse begins to suspect that these symptoms are associated with which condition? 1 Food allergy 2 Irritable bowel 3 Lactose intolerance 4 Decreased peristalsis

3 In a colonic transit study, the patient swallows a capsule containing radiopaque markers; an x-ray film examination is performed on the patient 4 days after ingestion. In a barium enema, barium can be swallowed or instilled through the anal opening via an enema for visualization of the upper or the lower gastrointestinal tract. Ultrasound imaging uses high-frequency sound waves to echo off body organs, creating a picture of the gastrointestinal tract. Anorectal manometry measures the pressure activity of internal and external anal sphincters and reflexes during rectal distention, relaxation during straining, and rectal sensation.

In which method of indirect visualization of the gastrointestinal tract would the patient swallow a capsule containing radiopaque markers and have an x-ray done after 4 days? 1 Barium enema 2 Ultrasound imaging 3 Colonic transit study 4 Anorectal manometry

2, 1, 4, 3, 6, 7, 5 (2) Hand hygiene prevents transmission of microorganisms; (1) removing the pouch allows for visualization of the skin and stoma; (4) cleansing the stoma removes microorganisms and allows for proper visualization; (3) assessing the stoma provides information about healing; (6) because the stoma is cleansed, a proper measurement is taken to provide an adequate opening in the pouch; (7) gently applying the pouch smoothly ensures adherence; (5) applying tape around the pectin barrier provides added strength to the seal.

List the steps in the correct order in which to apply an ostomy pouch. 1. Remove the used pouch and skin barrier. 2. Perform hand hygiene and apply clean gloves. 3. Assess the stoma for color, swelling, and healing. 4. Gently cleanse the peristomal skin with warm tap water. 5. Apply nonallergenic tape around the pectin skin barrier. 6. Cut an opening on the pouch 0.15 to 0.3 cm (1/16 to 1/8 inch) larger than the stoma. 7. Press the adhesive backing of the pouch smoothly against the skin.

2 Methylcellulose is a bulk-forming stool softener that absorbs water and increases solid intestinal bulk. It is a drug of choice for chronic constipation and is available in powder form. The nurse should instruct the patient to mix the powder with at least 250 mL of water or juice and swallow it quickly; if not, it could cause constipation. The nurse should advise patients that prescribed stimulant laxatives should only be taken occasionally to prevent dependence on the stimulus for defecation. Methylcellulose may cause the passage of stool 12 to 24 hours after taking the medication. Therefore, the patient need not report to the health care provider if he or she does not pass stool within 8 to 10 hours of taking the medication. Increased gas formation and flatus may occur when the patient first starts taking methylcellulose; this will subside after 4 or 5 days. Therefore, the nurse should not instruct the patient to stop taking the medication in such situations.

The health care provider prescribes methylcellulose to a patient with chronic constipation. Which instruction provided by the nurse will help prevent complications? 1 "Do not use the medication on a regular basis." 2 "Mix the powder with 250 mL of water or juice and swallow it quickly." 3 "Report to the health care provider if you do not pass stool within 8 to 10 hours of taking the medication." 4 "Stop taking the medication if you note increased gas formation and flatus when you first start taking it."

3 According to the Bristol stool form scale, type 2 stools are sausage shaped, but lumpy. Type 4 stools are smooth and soft and resemble a sausage or snake. Type 1 stools are separate hard lumps that resemble nuts. Type 3 stools look like a sausage, but with cracks on the surface.

The nurse categorizes a patient's stools as Type 2 according to the Bristol stool form scale. How would a patient most likely described his or her stools? 1 "They are soft, like a snake." 2 "They are separate hard lumps." 3 "They are sausage-shaped, but lumpy." 4 "They are like a sausage with a cracked surface."

1, 2, 3 The presence of excess fat is an abnormal finding and indicates liver dysfunction. The presence of blood and mucus in the stool are abnormal findings and are associated with internal bleeding, infection, and inflammation. Bile pigment and dead bacteria are normal constituents of the fecal matter.

The nurse is analyzing the fecal characteristics of a patient. Which substances indicate an abnormality? Select all that apply. 1 Excess fat 2 Blood 3 Mucus 4 Bile pigment 5 Dead bacteria

3 Guaiac fecal occult blood testing (gFOBT) is used as a diagnostic screening tool for colon cancer as recommended by the American Cancer Society. More advanced screenings, such as a colonoscopy, would be indicated for rectal bleeding, family history of polyps, and/or a palpable mass detected upon digital examination.

The nurse is assessing a 55-year-old patient who is in the clinic for a routine physical. When would the nurse instruct the patient about the need to obtain a stool specimen for guaiac fecal occult blood testing (gFOBT)? 1 If patient reports rectal bleeding 2 If there is a family history of polyps 3 As part of a routine examination for colon cancer 4 If a palpable mass is detected on digital examination

1 The Bristol stool form scale is used to classify types of feces. A fecal impaction is a dry hard stool, which may be type 1 or type 2. As per the Bristol stool form scale, sausage-shaped and lumpy stool indicates type 2. Separate and hard stool with a nutlike appearance indicates type 1 stools. Stool that appears as soft blobs with clear-cut edges is type 5 stool. Fluffy pieces with ragged edges indicate type 6 stool.

The nurse is assessing a patient who has a fecal impaction. The nurse documents type 2 stools in the patient's medical records as per the Bristol stool form scale. Which type of stool does the nurse observe? 1 Sausage-shaped but lumpy 2 Separate hard lumps like nuts 3 Soft blobs with clear-cut edges 4 Fluffy pieces with ragged edges

3 For a colonic transit study, the patient swallows a capsule containing radiopaque markers and then maintains a normal diet and fluid intake for 5 days. On the fifth day, an x-ray film examination is performed. For a colonic transit study, the patient is not given medications that affect bowel function. An enema can be given to empty out stool particles before performing a barium swallow/enema. No metallic objects, including metal objects on clothes, are allowed in the room during a magnetic resonance imaging. Contrast is used during a colonoscopy, not a colonic transit study.

The nurse is assigned to a patient who has been ordered to undergo a colonic transit study. Which statement is true about the procedure? 1 The patient may be given an enema before the test to empty out stool particles. 2 Clothes containing metallic buttons or chains are not allowed in the examination room. 3 There is a gap of a few days between the patient swallowing radiopaque markers and the x-ray film examination. 4 Intravenous contrast solution may be injected during the test and the patient has to refrain from having food or fluids for 4 to 6 hours before the examination.

1, 2 This procedure is an x-ray film examination that uses an opaque contrast medium and air to outline the colon and rectum in order to examine the lower gastrointestinal (GI) tract. The patient should fast after midnight to ensure that the stomach is empty during the procedure. Metallic objects do not interfere with the procedure. Sedation is not required, because it is not a painful procedure. There is no need for the patient to lie very still for this procedure, unlike some other imaging techniques

The nurse is attending to a patient with abdominal pain who is scheduled for a barium enema with air contrast. What information should the nurse give to the patient before this procedure? Select all that apply. 1 The procedure will help in the examination of the lower gastrointestinal (GI) tract. 2 The patient should not ingest food or liquids after midnight. 3 No metallic objects should be worn during the procedure. 4 Light sedation is required. 5 The patient needs to lie very still.

2, 3, 4 Use of antibiotics may cause diarrhea by disrupting the normal flora of the intestine. Food allergies and prolonged stress cause increased peristalsis, resulting in diarrhea. The use of opioid drugs and hypothyroidism cause constipation by decreasing peristalsis.

The nurse is caring for a patient admitted with diarrhea. What could be the possible causes of diarrhea in the patient? Select all that apply. 1 Use of opioid drugs 2 Use of antibiotics 3 Food allergies 4 Prolonged stress 5 Hypothyroidism

1, 2 A healthy stoma has adequate blood circulation and should be bright pink or brick red in color. A stoma that is blue, brown, or black in color may have compromised circulation.

The nurse is caring for a patient who has a colostomy. When assessing the color of the stoma, which color indicates the stoma is healthy? Select all that apply. 1 Bright pink 2 Brick red 3 Blue 4 Brown 5 Black

1, 2 A small-bore nasogastric tube is used for administration of medications and enteral feeding. A large-bore tube is used for gastric decompression and removal of gastric secretions. A barium enema does not require a nasogastric tube.

The nurse is caring for a patient who has undergone a surgery on the pharynx. The patient has a small-bore nasogastric tube. What are the purposes of a small-bore nasogastric tube? Select all that apply. 1 Medication administration 2 Enteral feeding 3 Gastric decompression 4 Removal of gastric secretions 5 Preparation for barium enema

1, 2, 4, 5 The tape or the fixation device used to anchor the tube may get soiled. It should be changed every day to prevent irritation. Lubricants should be applied at least every 2 hours on the nares to prevent excoriation. The nasogastric tube may cause a sore throat. Gargles with topical Xylocaine jelly can be provided to increase comfort. A glass of water can be provided to rinse the mouth, but the patient should be instructed not to swallow it. The patient with the nasogastric tube tends to breathe through the mouth. Therefore, regular mouth care at least every 2 hours is required to prevent dehydration.

The nurse is caring for a patient who has undergone surgery on the pharynx. The patient has a small-bore nasogastric tube. The nurse understands that a nasogastric tube may be very uncomfortable for the patient. Which interventions should the nurse perform to ensure patient comfort? Select all that apply. 1 Change the tape on the fixation device. 2 Apply lubricants to the nares. 3 Provide mouth care once daily. 4 Use gargles with topical Xylocaine jelly. 5 Provide cool water for rinsing.

3 According to the American Cancer Society screening guidelines for the early detection of colorectal cancer in average-risk asymptomatic people, a double-contrast barium enema should be performed every 5 years, starting at age 50. A guaiac fecal occult blood test (gFOBT) done on multiple samples at home is performed annually, starting at age 50. There is no test that is recommended to be performed biannually in this case. A colonoscopy should be performed every 10 years, starting at age 50.

The nurse is educating a 56-year-old patient about the screening guidelines for the early detection of colorectal cancer in average-risk asymptomatic people as specified by the American Cancer Society. At which frequency should the nurse advise the patient to get a double-contrast barium enema done? 1 Annual, starting at age 50 2 Biannual, starting at age 50 3 Every 5 years, starting at age 50 4 Every 10 years, starting at age 50

1, 3, 4 The functions of the stomach include storage of food and liquids, as well as secretion of intrinsic factor, which is responsible for absorption of vitamin B12. The stomach also produces hydrochloric acid, which, along with pepsin, helps in protein digestion. Reabsorption of nutrients occurs in the small intestine, not in the stomach. Mucus is secreted from the stomach, but it does not aid in protein digestion. Instead, it forms a protective barrier on stomach mucosa.

The nurse is explaining to a patient with gastritis about the various physiological functions of the stomach. Which statements pertain to the functions of the stomach? Select all that apply. 1 Storage of food 2 Reabsorption of nutrients 3 Secretion of intrinsic factor 4 Production of hydrochloric acid 5 Mucus secretion to aid protein digestion

3 Lack of a bowel movement is a sign of a bowel obstruction and is a medical emergency.

The nurse is taking a health history of a newly admitted patient with a diagnosis Rule/out bowel obstruction. Which is the priority question to ask the patient? 1 Describe your bowel movements. 2 How often do you have a bowel movement? 3 When was the last time you moved your bowels? 4 Do you routinely use stool softeners, laxatives, or enemas?

4, 3, 2, 5, 6, 1 When placing a bedpan, the patient should be positioned high in the bed. The patient's head is raised to 30 degrees to prevent hyperextension of the back and to support the torso. Then, the patient raises the hips by bending the knees and lifting the hips upwards. The nurse then places a palm under the patient's sacrum while resting the elbow on the mattress. The nurse then slips the pan under the patient.

The nurse is taking care of a patient who is immobilized. The nurse implements dietary modifications to relieve constipation. The patient requests a bedpan. Arrange the steps in the correct sequence for placing the immobilized patient on a bedpan. 1. Slip the pan under the patient. 2. Provide support to the upper torso. 3. Raise the patient's head about 30 degrees. 4. Ensure the patient is positioned high in the bed. 5. Ask the patient to raise the hips by bending the knees and lifting the hips upward. 6. Place a hand palm up under the patient's sacrum, resting the elbow on the mattress.

1 Percussion is a method of physical examination that helps the healthcare provider or nurse to listen to the sounds produced by the body. The presence of gas gives a tympanic note on percussion in the abdomen. Fluid, tumor, masses, and thick pus have a dull note on percussion of the abdomen.

The nurse observes the presence of a tympanic note when percussing the abdomen of a patient. What would be the probable cause for the presence of a tympanic note? 1 Gas 2 Fluid 3 Tumor 4 Thick pus

4 A Sengstaken-Blakemore tube is used for the compression of esophageal varices to treat an upper gastrointestinal (GI) bleed or the risk of acute GI bleeding. The Sengstaken-Blakemore tube provides internal application of pressure with an inflated balloon to avoid esophageal or GI hemorrhage. An Ewald tube is used for gastric lavage. A Dobhoff tube is used for enteral feeding. A Miller-Abbott tube is used for intestinal diagnostics.

The patient's presentation is suggestive of constipation secondary to use of opioids. Management includes the use of laxatives to promote defecation. Adequate fluid intake helps to prevent the stool from becoming hard and promotes easy passage of stools. A high-fiber diet promotes bulky stool, which stimulates peristalsis and encourages the easy passage of stools. Withholding opioids will increase pain and cause discomfort in the patient. Relaxation techniques are useful for managing patients who have pain due to physical injuries.

1, 2, 3 Bowel sounds can be assessed by auscultating the four quadrants of the abdomen. It is considered normal if the bowel sounds occur every 5-15 seconds. Each bowel sound may last one to several seconds. In bowel distention, an increase in pitch or a tinkling sound can be heard. Hypoactive sounds are less than 5 sounds per minute and may occur in paralytic ileus. Hyperactive bowel sounds or 35 or more sounds per minute occur in intestinal obstruction.

The student nurse is learning to auscultate the abdomen for bowel sounds. What should the nurse know about the bowel sounds before starting to auscultate? Select all that apply. 1 Normal bowel sounds occur every 5-15 seconds. 2 Each bowel sound lasts one to several seconds. 3 An increase in pitch or a tinkling sound indicates bowel distention. 4 Hypoactive sounds may occur in small-intestine obstruction. 5 Hyperactive sounds may occur in paralytic ileus.

3 Enemas that uses hypertonic solutions are low volume and are designed for patients who cannot tolerate a large volume of fluid. This type of enema is contraindicated in infants and dehydrated patients. A patient with a dangerously high serum potassium level may receive a medicated enema that contains sodium polystyrene sulfonate.

To which patient will the nurse most likely give a hypertonic solution enema? 1 An infant who is unable to defecate 2 A dehydrated patient who has constipation 3 A patient who cannot tolerate a large volume of fluid 4 A patient with a dangerously high serum potassium level

3, 4, 5 Bile pigment, dead bacteria, and cells lining the intestinal mucosa are normal constituents of feces. Mucus is found in feces if there is intestinal irritation, inflammation, infection, or injury. Worms can be found in feces if there is a parasite infestation.

What are the normal constituents of feces? Select all that apply. 1 Mucus 2 Worms 3 Bile pigment 4 Dead bacteria 5 Cells lining the intestinal mucosa

1

What does the nurse know to be true about a tap water enema? 1 A tap water enema should be repeated with caution. 2 A tap water enema is contraindicated for patients who are dehydrated. 3 A tap water enema should be used with caution, particularly in pregnant women. 4 A tap water enema is associated with lessened danger of excess fluid absorption.

4 The preparation required for a magnetic resonance imaging (MRI) is that no food or fluids are given to the patient orally 4 to 6 hours before the examination. A simple x-ray film of the abdomen requires no bowel preparation. A barium swallow/enema procedure may require laxatives the day before the procedure and, in some instances, an enema before the test to empty out stool particles.

What is true regarding the bowel preparation associated with magnetic resonance imaging (MRI)? 1 No bowel preparation required 2 Enema to empty out stool particles 3 Laxatives the day before the procedure 4 No food or fluids given orally 4 to 6 hours before the examination

3 A Salem sump tube has a double lumen. One lumen removes gastric contents, and the second lumen is the blue pig-tailed portion that is open to air for the purpose of equalizing the pressure outside the body to inside the stomach. This prevents the tip of the Salem sump from becoming attached to the stomach lining, thus preventing mucosal irritation and bleeding.

When comparing nasogastric tubes used for gastric decompression, what is the Salem sump specifically designed to do? 1 Minimize the risk of a bowel obstruction. 2 Ensure drainage of the intestines. 3 Remove gastric secretions and provide an air vent. 4 Promote resting the gut.

1, 3, 5 Antibiotic use, Clostridium difficile, and surgeries and diagnostic testing of the lower gastrointestinal tract may cause diarrhea. Lack of exercise and reduced fluid intake may cause constipation.

Which are causes of diarrhea? Select all that apply. 1 Antibiotic use 2 Lack of exercise 3 Clostridium difficile 4 Reduced fluid intake 5 Surgeries of the lower gastrointestinal tract

2, 4, 5 The predisposing factors for the development of hemorrhoids are pregnancy, cardiac failure, and hepatic disorder. These conditions increase intraabdominal pressure, leading to engorgement of the blood vessels of the rectum. Renal failure is not a risk factor for the development of hemorrhoids, as it does not increase intraabdominal pressure. Straining due to constipation (not diarrhea) can cause hemorrhoids.

Which are predisposing factors for the development of hemorrhoids? Select all that apply. 1 Diarrhea 2 Pregnancy 3 Renal failure 4 Cardiac failure 5 Hepatic disorders

1, 2, 3 Cathartics, laxatives, and enemas are short-term solutions to constipation. Lifestyle changes in diet and defecation schedule are long-term management solutions.

Which are short-term solutions to constipation? Select all that apply. 1 Enemas 2 Laxatives 3 Cathartics 4 Diet change 5 Change in defecation schedule

2 Flatulence may cause abdominal fullness, cramping, distention, and severe, sharp pain. Diarrhea may be associated with fever, chills, weight loss, or abdominal pain. Hemorrhoids are associated with pain in the area around the anus. Fecal incontinence is the inability to control the passage of fecal matter from the anus.

Which bowel elimination problem is associated with abdominal fullness, cramping, distention, and severe, sharp pain? 1 Diarrhea 2 Flatulence 3 Hemorrhoids 4 Fecal incontinence

1, 2, 5 Improper diet, lack of exercise, and reduced fluid intake may cause constipation. Laxatives are used to promote defecation. Antibiotics may cause diarrhea, not constipation.

Which factors may cause constipation? Select all that apply. 1 Improper diet 2 Lack of exercise 3 Use of laxatives 4 Use of antibiotics 5 Reduced fluid intake

3 An infant is not expected to defecate more than six times per day. Therefore, an infant who passes stools nine times per day has an abnormal frequency of defecation. Note that defecating less than once every 2 days is also considered abnormal.

Which is an abnormal frequency of defecation for an infant? 1 Three times per day 2 Five times per day 3 Nine times per day 4 Once every two days

3, 4 The Valsalva maneuver requires the patient to hold the breath while straining to defecate. This maneuver increases venous pressure from straining. Over time, hemorrhoids result. In addition, this maneuver increases the risk for dysrhythmias, which are often life threatening.

Which is caused by straining on defecation? Select all that apply. 1 Pain 2 Impaction 3 Hemorrhoids 4 Dysrhythmias 5 Dry stool

1 The stimulation of the rectum by digital examination may stimulate the vagus nerve, which then slows the heart rate. This is potentially hazardous, so it is done cautiously and only when allowed by agency policy. Severe cramping and fluid and electrolyte imbalance may be caused due to use of cathartics. Toxic buildup of magnesium is a concern when magnesium hydroxide (Milk of Magnesia) is used.

Which is of most concern when performing a digital rectal examination to determine the presence of fecal impaction? 1 Slowing heart rate 2 Severe cramping 3 Fluid and electrolyte imbalance 4 Toxic buildup of magnesium

4 Digital examination of the rectum may be recommended for a patient in whom fecal impaction is suspected. Gastroscopy is used to gain direct visualization of the upper gastrointestinal tract. A barium swallow is a radiographic examination using an opaque contrast medium (barium, which is swallowed) to examine the structure and motility of the upper gastrointestinal tract. The fecal occult blood test is a stool test to measure microscopic amounts of blood in the feces. These examinations may not be recommended for a patient in whom fecal impaction is suspected.

Which may be recommended for a patient in whom fecal impaction is suspected? 1 Gastroscopy 2 Barium swallow 3 Fecal occult blood test 4 Digital examination of the rectum

4 Opioid analgesics slow peristalsis and contractions, thereby causing constipation. Laxatives and cathartics are often prescribed to promote defecation in patients with constipation; they do not cause constipation. Antibiotics decrease intestinal bacterial flora, thereby causing diarrhea.

Which medication may cause constipation? 1 Laxatives 2 Antibiotics 3 Cathartics 4 Opioid analgesics

3 Constipation is a symptom, not a disease, and has many possible causes, including improper diet, reduced fluid intake, lack of exercise, and certain medications. Diarrhea is another symptom associated with disorders affecting digestion, absorption, and secretion in the gastrointestinal tract. Flatulence is caused when gas accumulates in the lumen of the intestines and the bowel stretches and distends. Incontinence is caused by physical conditions that impair anal sphincter function or large-volume liquid stools.

Which of these is the most likely result of improper diet, reduced fluid intake, and lack of exercise? 1 Diarrhea 2 Flatulence 3 Constipation 4 Incontinence

4 The main functions of the large intestine, or colon, are absorption, secretion, and elimination. Therefore, the large intestine plays a major role in bowel elimination. The small intestine is involved in digestion and absorption, but not elimination. The main functions of the stomach include storage of swallowed food and liquid, mixing of food with digestive juices into a substance, and regulated emptying of its contents into the small intestine. The esophagus is the part of the gastrointestinal tract through which food reaches the upper end of the stomach. It is not involved in elimination.

Which part of the gastrointestinal tract plays a major role in bowel elimination? 1 Stomach 2 Esophagus 3 Small intestine 4 Large intestine

3 An enema prepared with a hypertonic solution is designed to be low volume. Patients unable to tolerate large volumes of fluid benefit most from this type of enema. This type of enema is contraindicated for young infants and dehydrated patients. An enema containing steroid medication is appropriate for acute inflammation in the lower colon.

Which patient benefits the most from an enema prepared with a hypertonic solution? 1 A patient who is dehydrated 2 A patient who is a young infant 3 A patient who is unable to tolerate large volumes of fluid 4 A patient who is suffering from acute inflammation in the lower colon

2 Opioid analgesics slow peristalsis and contractions, thereby causing constipation. Therefore, a patient taking opioid analgesics has the highest risk of constipation. A patient who is taking antibiotics may have diarrhea because antibiotics decrease intestinal bacterial flora, resulting in diarrhea. Patients who have undergone diagnostic procedures that require visualization of the gastrointestinal tract may experience increased gas or loose stools, not constipation. A person should drink at least 1.5 L of fluids per day to avoid constipation.

Which patient has the highest risk of constipation? 1 A patient who is taking antibiotics 2 A patient who is taking opioid analgesics 3 A patient who has undergone endoscopy 4 A patient who drinks only 1.5 L of fluids per day

1, 3, 4 The large intestine is larger in diameter than the small intestine, but it is shorter. It is the primary organ for bowel elimination and fluid absorption. Each fold of the rectal part of the large intestine has blood vessels that become distended from pressure during straining, which results in hemorrhoid formation. The large intestine is responsible for absorption of water, sodium, and chloride from the digested food. The circular muscles are responsible for preventing regurgitation.

Which should the nursing mentor include in an explanation to nursing students about the various roles of the large intestine? Select all that apply. 1 The large intestine is shorter than the small intestine. 2 The large intestine has no absorptive role. 3 The large intestine has a role in the elimination function. 4 The large intestine can develop hemorrhoids. 5 The large intestine has longitudinal muscles that prevent regurgitation.

1 Fecal incontinence is the inability to control the passage of feces and gas from the anus. Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. Fecal impaction results when a patient has unrelieved constipation and is unable to expel the hardened feces retained in the rectum. Constipation is characterized by infrequent bowel movements (less than three per week) and hard, dry stools that are difficult to pass.

Which statement about fecal incontinence is correct? 1 It is the inability to control the passage of feces and gas from the anus. 2 It is an increase in the number of stools and the passage of liquid, unformed feces. 3 It results when a patient has unrelieved constipation and is unable to expel the hardened feces retained in the rectum. 4 It is characterized by infrequent bowel movements (less than three per week) and hard, dry stools that are difficult to pass.

3 An endoscopy involves using a lighted fiber optic tube to gain direct visualization of the upper gastrointestinal (GI) tract. Ultrasound imaging is associated with using high-frequency sound waves to echo off body organs, creating a picture of the GI tract. A colonoscopy is an endoscopic examination of the large intestine using a lighted fiber optic tube. A barium swallow involves using barium as an opaque contrast medium to examine the structure and motility of the upper GI tract, including the pharynx, esophagus, and stomach.

Which step is associated with an upper endoscopy? 1 Using high-frequency sound waves to echo off body organs 2 Using a lighted fiber optic tube to directly visualize the large intestine 3 Using a lighted fiber optic tube to gain direct visualization of the upper gastrointestinal tract 4 Using an opaque contrast medium to examine the structure and motility of the pharynx and esophagus

1

Which type of enema may cause electrolyte imbalances or damage to the intestinal mucosa in pregnant women and older adults? 1 Soapsuds enema 2 Tap water enema 3 Oil-retention enema 4 Normal saline enema

4 Before administering an enema, the nurse should inspect the patient's abdomen for distention. This provides a baseline for determining the effectiveness of the enema. To plan for appropriate teaching measures, the nurse should determine the patient's level of understanding of the purpose of the enema. The nurse should review the health care provider's order for the type of enema and the amount to be given. Before administering an enema, the nurse should review the patient's medical record for increased intracranial pressure, glaucoma, or recent abdominal, rectal, or prostate surgery because these conditions contraindicate the use of enemas.

While assessing a patient before administering an enema, the nurse inspects the patient's abdomen for distention. What is the purpose of this nursing intervention? 1 It allows the nurse to plan for appropriate teaching measures. 2 It helps determine the number and type of enemas to be given. 3 It helps determine conditions that contraindicate the use of enemas. 4 It provides a baseline for determining the effectiveness of the enema.

1, 2, 4 An inability to pass stool for several days despite the repeated urge to defecate may indicate fecal impaction. The patient may also experience loss of appetite (anorexia), rectal pain, continuous oozing of liquid stool, nausea and/or vomiting, and abdominal distention and cramping. Dark-colored urine and less frequent urination than usual are signs of dehydration, not fecal impaction.

While caring for a debilitated patient, a nurse learns that the patient has been unable to pass stool for several days, despite the repeated urge to defecate. The nurse suspects that the patient has a fecal impaction. Which other findings support the nurse's suspicion? Select all that apply. 1 Anorexia 2 Rectal pain 3 Dark-colored urine 4 Continuous oozing of liquid stool 5 Less frequent urination than usual