IGGY - Ch. 56: IBS and Colorectal Cancer

The nurse is performing discharge teaching with a patient with hemorrhoids. Which instructions does the nurse include in the teaching plan? Select all that apply. a. Avoid caffeine. b. Exercise regularly. c. Take laxatives daily. d. Increase fiber intake. e. Drink plenty of water.

b, d, e.

A patient has been admitted with a large-bowel obstruction. What assessment finding is consistent with a diagnosis of large-bowel obstruction? a. Metabolic alkalosis b. Lower abdominal distention c. Severe electrolyte imbalance d. Nausea and profuse vomiting

b. Lower abdominal distention is seen in those with a large-bowel obstruction. Metabolic alkalosis, severe electrolyte imbalance, and nausea and profuse vomiting are seen with small-bowel obstructions.

A 50-year-old patient comes to an outpatient clinic for a colonoscopy and asks how often the procedure needs to be performed. What does the nurse tell the patient? a. Every 3 years b. Every 5 years c . Every 10 years d. Every 15 years

c. The screening recommendation for those over the age of 50 is every 10 years for a colonoscopy or every 5 years for a double-contrast barium enema or sigmoidoscopy.

Which symptoms are consistent with a diagnosis of irritable bowel syndrome (IBS)? Select all that apply. a. Fatigue b. Insomnia c. Vomiting d. Abdominal pain e. Weight changes

a, d, e. Patients with IBS may have a history of weight changes, fatigue, malaise, abdominal pain, and changes in bowel patterns. Insomnia and vomiting are not symptoms associated with IBS.

What is an appropriate intervention for a patient with irritable bowel syndrome (IBS)? a. Take 30 to 40 g of fiber each day. b. Chew gum to decrease gastric acid. c. Drink 8 to 10 glasses of prune juice. d. Eat a light breakfast and a heavy dinner.

a. The patient with IBS is taught to ingest 30 to 40 g of fiber each day to help regulate elimination patterns. The patient is taught to drink 8 to 10 glasses of water, not prune juice. Chewing gum is not advised as it can produce more gastric acid. The patient is taught to eat regular meals, not light and then heavy ones.

A 24-year-old male is scheduled for a minimally invasive inguinal hernia repair (MIIHR). Which patient statement indicates a need for further teaching about this procedure? a. "I will need to stay in the hospital overnight." b. "I should not eat after midnight the day of the surgery." c. "I may have trouble urinating immediately after the surgery." d. "My chances of having complications after this procedure are slim."

a. Usually, the patient is discharged 3-5 hours after MIIHR surgery. Male patients who have difficulty urinating after the procedure should be encouraged to force fluids and to assume a natural position when voiding. Patients undergoing MIIHR surgery must be NPO after midnight before the surgery. Most patients who have MIIHR surgery have an uneventful recovery.

The patient is prescribed amitriptyline for irritable bowel syndrome (IBS). What should the patient be told when taking this medication? a. Take it with plenty of water. b. Take it 30 minutes before a meal. c. Avoid taking it with antihistamines. d. Notify your health care provider if your urine is dark amber.

b. Take it 30 minutes before a meal.

A patient is prescribed alosetron for irritable bowel syndrome (IBS). Which statement by the patient indicates a need for further teaching? a. "It will decrease my constipation." b. "It should help with my pain and cramping." c. "I should take it 30 minutes before breakfast." d. "I should not take antihistamines while I'm on this medicine."

d. Antihistamines are not contraindicated when taking losetron. The medicine will decrease constipation, will help with pain and cramping, and should be taken 30 minutes before breakfast.

What symptoms should a patient prescribed alosetron for irritable bowel syndrome (IBS) report immediately? Select all that apply. a. Fever b. Pyrosis c. Flatulence d. Odynophagia e. Darkened urine

a, e. Fever and darkened urine in a patient taking alosetron should be reported to the health care provider immediately, and the patient should stop taking the medication. Pyrosis, flatulence, and odynophagia are not symptoms that need to be reported for this medication.

The nurse is caring for a patient diagnosed with familial adenomatous polyposis. What procedure should the nurse prepare the patient for? a. Colectomy b. Colonoscopy c. Polypectomy d. Sigmoidoscopy

a. A patient with familial adenomatous polyposis often requires a colectomy. A polypectomy will not remove the chance of the cancer spreading anywhere else in the colon. A sigmoidoscopy and colonoscopy are not indicated because the cancer has already been diagnosed.

The nurse is caring for a patient who has experienced two days of obstipation. What does the nurse understand about this patient? a. The patient has not passed stool in two days. b. The patient has not been able to eat in two days. c. The patient has been vomiting for two days in a row. d. The patient has been having diarrhea for the past two days.

a. Obstipation means no passage of stool, a sign of elimination concerns. Therefore, the nurse understands that the patient has not passed stool in two days. Obstipation does not refer to diarrhea, vomiting, or lack of appetite.

What teaching should be included for a patient who has prescribed lubiprostone for irritable bowel syndrome (IBS)? a. Report darkened urine. b. Do not take if constipated. c. Take medication with food. d. Medication may increase fatigue.

c. Lubiprostone should be taken with food. The medication does not have a side effect of darkened urine, and it is used to treat constipation. Lubiprostone does not increase fatigue.

What symptoms are consistent with hemorrhoids? Select all that apply. a. Pain b. Polyps c. Itching d. Mucus discharge e. Dark maroon blood

a, c, d. Pain, itching, and mucus discharge are all findings consistent with hemorrhoids. Blood from hemorrhoids is not dark maroon; it is usually bright red. Polyps are not associated with hemorrhoids.

A patient has undergone a resection of the ileum. What laboratory findings of the patient indicate malabsorption of proteins? Select all that apply. a. Low serum iron b. Low serum calcium c. Low serum albumin d. Low serum vitamin A e. Low serum cholesterol

a, c. In protein malabsorption, the serum iron level decreases because of insufficient gastric acid for the use of iron. Serum albumin level is also low. Malabsorption of vitamin D and amino acids causes a low serum calcium level. Low serum vitamin A indicates a bile salt deficiency and malabsorption of fat. Low serum cholesterol occurs in the malabsorption of fats.

The nurse is assessing a patient in the outpatient clinic. Which assessments will the nurse perform if he or she suspects the patient has malabsorption syndrome? Select all that apply. a. Asking if the patient feels bloated b. Requesting to check the patient's iron levels c. Having the patient explain sudden weight gain d. Discussing the many bruises on the patient's skin e. Asking the patient if there have been any changes in sexual activity or interest lately

a, b, d, e. S/s of malabsorption syndrome include bloating, purpura, anemia, and decreased libido. Therefore, the nurse asks the patient if the patient feels bloated, has the patient discuss any bruising of the skin (purpura), requests to check the patient's iron levels, and asks the patient about any changes in sexual activity or interest. Patients with malabsorption syndrome have unintentional weight loss, not weight gain.

A patient with a history of polyps is preparing to undergo a colonoscopy. The patient tells the nurse, "I'm really scared that I could have colorectal cancer." What is the most appropriate response by the nurse? a. "You have nothing to be worried about." b. "Polyps are never cancerous, so you should not be worried." c. "It is understandable to be scared. Tell me what worries you the most." d. "You could already have the cancer, so isn't it better to know than to not know?"

c.

The primary health care provider prescribes alosetron to a patient with irritable bowel syndrome. What complications should the nurse instruct the patient to report immediately? Select all that apply. a. Rectal bleeding b. Darkened urine c. Bloody diarrhea d. Decrease in fatigue e. Decrease in abdominal pain

a, b, c. Alosetron interacts with many drugs in a variety of cases. Psychoactive drugs and antihistamines should not be taken with alosetron. Drug interactions may occur and cause rectal bleeding, darkened urine, and bloody diarrhea. If these complications occur, the patient should stop taking the medication and report to the primary health care provider. Increasing fatigue and abdominal pain occur in cases of drug interactions.

What instruction should be included for a patient who has undergone inguinal hernia repair? Select all that apply. a. Stand to void. b. Ambulate early. c. Report signs of infection. d. Fluid intake of 1000 to 1200 mL daily e. Perform coughing and deep-breathing exercises

a, b, c. Patients who have had hernia repair should stand to void to promote urinary flow, ambulate early, and report signs of infection. Fluid intake should be 1500 to 2500 mL daily. Patients should not cough after having the surgery.

The nurse is teaching a male patient about proper perineal wound care and comfort measures. What does the nurse include in the teaching? Select all that apply. a. Sitting on soft pillows or foam pads b. Assuming a side-lying position in bed c. Avoiding sitting for long periods of time d. Using air rings and rubber donut devices e. Wearing boxer briefs instead of jockey-type shorts f. Applying ice packs to the area three to four times a day

a, b, c. The nurse teaches the patient to avoid sitting for long periods of time, assume a side-lying position when in bed, and use soft pillows or foam pads for sitting. The patient should be told to wear jockey-type shorts instead of boxer briefs. The patient should be told to apply warm compresses to the area, not ice packs. The patient should be told to avoid the use of air rings and rubber donut devices.

Which are the most common types of abdominal hernias? Select all that apply. a. Femoral hernia b. Umbilical hernia c. Reducible hernia d. Direct inguinal hernia e. Spermatic cord hernia f. Indirect inguinal hernia

a, b, d, f. The most common types of hernias include indirect inguinal, direct inguinal, umbilical, and femoral hernias, as well as incisional hernias. Spermatic cord is not a type of hernia. A hernia is classified as reducible when the contents of the hernia sac can be placed back into the abdominal cavity with gentle pressure.

Which of the following is a common sign of malabsorption syndrome? a. Melena b. Steatorrhea c. Constipation d. Hematochezia

b.Chronic diarrhea is a classic symptom of malabsorption and steatorrhea is common because of greater than normal amounts of fat in the stool. Constipation, bloody stools, and black, tarry stools are not associated with malabsorption syndrome.

Which describes internal hemorrhoids? a. They are noticeable to the eye. b. They lie below the anal sphincter. c. They cannot be seen upon inspection. d. They fall down and protrude through the anus.

c. Internal hemorrhoids are located inside the body and cannot be seen upon inspection of the anal area. Prolapsed hemorrhoids fall down and protrude through the anus. External hemorrhoids are noticeable to the eye and lie below the anal sphincter.

A patient with a rectal tumor is scheduled for surgery. Which surgical procedure does the nurse anticipate the surgeon will perform? a. Cecostomy b. Sigmoid colectomy c. Left descending colostomy d. Resection with anastomosis

d. Rectal tumors can be removed by resecting the colon with anastomosis or pull-through procedure, which preserves the anal sphincter and normal elimination pattern. A cecostomy is done for right-sided colon tumors and involves accessing an opening into the cecum to provide intubation to decompress the bowel. A sigmoid colectomy is done for sigmoid colon tumors for small lesions. A left descending colostomy is done for left-sided colon tumors for larger lesions.

A patient has a nasogastric (NG) tube for decompression after a small bowel obstruction. What position should a patient be encouraged to use? a. Supine b. Side-lying c. High-Fowler's d. Semi-Fowler's

d. Semi-Fowler's position will help promote emptying of the stomach and alleviation of pressure of the abdominal distention on the chest. Supine, side-lying, and high-Fowler's positions are not indicated.

The nurse case manager is discussing community resources with a patient who has colorectal cancer (CRC) and is scheduled for a colostomy. Which referral is of greatest value to this patient initially? a. Hospice b. Hospital chaplain c. Home health nursing agency d. Certified Wound, Ostomy, and Continence Nurse (CWOCN)

d. A CWOCN (or an enterostomal therapist) will be of greatest value to the patient because the patient is scheduled to receive a colostomy. The patient is newly diagnosed, so it is not yet known whether home health nursing will be needed. A referral to hospice may be helpful for a terminally ill patient. Referral to a chaplain may be helpful later in the process of adjusting to the disease.

A patient with colorectal cancer (CRC) was started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. A relatively new chemotherapeutic agent, oxaliplatin, has been added to the treatment regimen. What does the nurse tell the patient about the diarrhea and mouth ulcers? a. "You have these as a result of the radiation treatment." b. "A combination of chemotherapeutic agents has caused them." c. "GI problems are symptoms of the advanced stage of your disease." d. "5-FU cannot discriminate between your cancer and your healthy cells."

d. 5-FU cannot discriminate between cancer and healthy cells; therefore, the side effects are diarrhea, mucositis, leukopenia, mouth ulcers, and skin ulcers. The 5-FU treatment, not a combination of chemotherapy drugs, radiation, or the stage of the disease, is what is causing the patient's GI problems.

What findings are consistent with the diagnosis of irritable bowel syndrome (IBS)? Select all that apply. a. Belching b. Diarrhea c. Recent weight loss d. Positive occult blood e. Increase in white blood cell (WBC) count

a, b. Diarrhea and belching are common findings in patients with irritable bowel syndrome (IBS). Patients with IBS do not tend to have weight loss. Patients do not usually have positive occult blood with IBS. The white blood cell (WBC) count should be normal in patients with IBS.

Which interventions should the nurse provide during the postoperative care of a patient who underwent a colostomy formation? Select all that apply. a. Place a colostomy pouch over the stoma. b. Establish and maintain an intravenous line. c. Advance the diet slowly from solids to liquids. d. Assess the color and integrity of the stoma frequently. e. Assess for a dry stoma during initial postoperative period.

a, b, d. A colostomy pouch, called an appliance, should be placed over the stoma for collection of stools. After the surgery, the intravenous (IV) line should be maintained so that the patient can receive pain medication through the IV line for 24 to 36 hours. Color and integrity of the stoma should be assessed frequently. A healthy stoma should be reddish pink, moist, and protrude 2 cm from the abdominal wall. The diet should slowly progress from liquids to solids for easy bowel formation and elimination. During the initial postoperative period, the stoma may be slightly edematous. A small amount of bleeding at the stoma site is common.

What symptoms are consistent with a large-bowel obstruction? Select all that apply. a. Ribbon-like stool b. Metabolic acidosis c. Visible peristaltic waves d. Lower abdominal distention e. Upper epigastric abdominal pain

a, b, d. Ribbon-like stool, metabolic acidosis, and lower abdominal distention are common findings in large-bowel obstructions. Visible peristaltic waves and upper epigastric pain are common findings in small-bowel obstructions, not large-bowel obstructions.

A patient is diagnosed with irritable bowel syndrome (IBS). What factors does the nurse suspect as possible causes of the patient's problem? Select all that apply. a. Stress b. Anxiety c. Sleeping pills d. Antihistamines e. Caffeinated drinks

a, b, e. Factors such as ingestion of coffee or other gastric stimulants, stress, and anxiety are being investigated as possible causes of IBS. Antihistamines and sleeping pills are not suspected of causing IBS.

Which symptoms reported by a patient are consistent with irritable bowel syndrome (IBS)? Select all that apply. a. Bloating b. Anorexia c. Weight loss d. Hypotension e. Left lower quadrant pain

a, b, e. Patients with IBS will have bloating, anorexia, and left lower quadrant pain. Patients will not likely have weight loss or hypotension; these symptoms are not directly associated with IBS.

What are risk factors for colorectal cancer? Select all that apply. a. Age >50 years b. Diet high in caffeine c. Family history of cancer d. History of Crohn's disease d. Heavy alcohol consumption

a, c, d, e. The major risk factors for developing colorectal cancer include being older than 50 years, having a personal or family history of cancer, having a history of Crohn's disease, and heavy alcohol consumption. A diet high in caffeine is not connected to colorectal cancer.

What are the priority assessments a primary health care provider should perform for a patient who complains about a protrusion in the abdominal region? Select all that apply. a. Examining the ring and its contents b. Examining the abdomen while lying c. Auscultating for active bowel sounds d. Asking the patient to perform the Valsalva maneuver e. Asking the patient to sit continuously for a few minutes

a, c, d. To palpate an inguinal hernia, the primary health care provider gently examines the ring and its contents by inserting a finger into the ring and noting any changes when the patient coughs. The primary health care provider auscultates for active bowel sounds because an absence of bowel sounds may indicate obstruction and strangulation. The primary health care provider asks the patient to perform the Valsalva maneuver and observes for bulging. The primary health care provider inspects the abdomen when the patient is lying and standing because the lump may disappear when the patient is lying flat. The health care provider asks the patient to perform strenuous activity in order to check for intra-abdominal pressure. Asking the patient to sit would not be appropriate to assess the intra-abdominal pressure.

What instructions should the nurse provide when educating a group of people about risk factors for preventing colorectal cancer? Select all that apply. a. Modify your dietary habits. b. Refrain from eating brassica vegetables. c. Undergo colorectal diagnostic testing regularly. d. Initiate screening at 60 years of age if there is a family history of the disease. e. Be informed about the hazards of smoking, excessive alcohol, and physical inactivity.

a, c, e. To decrease the risk of colorectal cancer, people need to modify their diets regardless of their risk factors. Fats, refined carbohydrates, and low-fiber foods should be decreased in the diet. Baked or broiled foods should be added, especially those high in fiber and low in animal fat. Screening may help to identify symptoms early on, leading to prompt treatment. Smoking and excessive alcohol may increase the risk of cancer. People should increase the amount of brassica vegetables in their diet, including broccoli, cabbage, cauliflower, and sprouts. Diagnostic testing should begin at 40 years of age when there is a family history of colorectal cancer and at 50 years of age when there is no other risk.

What medications are used in patients diagnosed with diarrhea-predominant irritable bowel syndrome (IBS-D)? Select all that apply. a. Rifaximin b. Linaclotide c. Loperamide d. Lubiprostone d. Psyllium hydrophilic mucilloid

a, c. Rifaximin is an antibiotic that works locally and with little systemic absorption. Loperamide is an antidiarrheal agent. Both are used in patients with diarrhea-predominate irritable bowel syndrome (IBS-D). Linaclotide, lubiprostone, and psyllium hydrophilic mucilloid are used in treating constipation-predominant IBS (IBS-C).

A patient who reports unintentional weight loss, dark or bright-colored red stools, and a family history of colorectal cancer is admitted to the hospital. Which information should the nurse obtain from this patient? Select all that apply. a. Experiencing fatigue b. History of appendicitis c. History of gastroenteritis d. Use of tobacco or alcohol e. Experiencing abdominal fullness

a, d, e. Dark or bright-colored red stools may indicate colorectal cancer (CRC) in some patients. Therefore, the nurse should assess for all the risk factors of CRC in the patients. Fatigue and abdominal fullness indicate the presence of a growth in the abdomen. Tobacco or alcohol use may increase the risk for CRC. Information about appendicitis and gastroenteritis are not important because they may not indicate the risk for colorectal cancers.

What key points should the nurse specialist consider during a psychosocial assessment of a patient prior to ostomy surgery? Select all that apply. a. Patient's employment b. Ostomy location in the rectus muscle c. Ostomy location that is easily visible to the patient d. Financial concerns regarding purchase of ostomy supplies e. Presence of skinfolds, creases, bony prominences, and scars

a, d. The patient's employment and financial concerns regarding purchase of ostomy supplies should be assessed by the nurse specialist during psychosocial assessment of a patient prior to ostomy surgery. The ostomy location in the rectus muscle, a location that is easily visible to the patient, and the presence of skinfolds, creases, bony prominences, and scars are parts of the physical, not psychosocial, assessment.

A patient with colorectal cancer is scheduled for a double-barrel colostomy. What is the most accurate statement about this type of ostomy? a. Double-barrel stomas are the least common. b. An external rod is used to provide support during healing. c. The proximal stoma is also referred to as a mucous fistula. d. The distal stoma is the functioning stoma and eliminates stool.

a. A double-barrel stomach is the least common type of colostomy. The bowel is dissected and both the proximal and the distal portions are brought to the surface of the abdomen through two stomas. The distal stoma is the nonfunctioning stoma. The proximal stoma eliminates stool. The distal stoma may secrete some mucous and may be referred to as a mucous fistula. An external rod is used to provide support during healing with loop colostomies.

Which treatment would be beneficial to an 85-year-old patient with an inguinal hernia? a. A truss b. Hernioplasty c. Herniorrhaphy d. Minimally invasive inguinal hernia repair

a. A truss is beneficial for older patients in whom surgery is risky. A truss is a pad that is placed over the hernia with a belt to help keep the abdominal contents from protruding into the hernia sac. Hernioplasty involves the reinforcement of the weakened outside abdominal muscle wall with a mesh patch. Herniorrhaphy refers to the minimally invasive inguinal hernia repair (MIIHR) through a laparoscope. During this procedure, the surgeon makes small incisions to observe for any defects. An 85-year-old patient is most likely not a good candidate for hernioplasty or herniorrhaphy.

A patient is admitted to the hospital for hernia repair. Which assessment finding does the nurse report immediately to the health care provider? a. Absent bowel sounds b. A lower abdominal mass c. Abdominal tenderness upon palpation d. Tympany over the intestines upon percussion

a. Absent bowel sounds in a patient with a hernia may indicate obstruction and strangulation of the intestines and should be reported immediately. While abdominal tenderness should also be reported, it is not as emergent a finding as absent bowel sounds. A patient with a hernia may have an abdominal mass due to the herniation. Tympany is normally heard over the intestines.

What is the mechanism of action for the chemotherapeutic drug cetuximab? a. It blocks factors that promote cancer cell growth. b. It destroys the cancer's cell wall, which will kill the cell. c. It decreases blood flow to rapidly dividing cancer cells. d. It stimulates the body's immune system and stunts cancer growth.

a. Cetuximab, a monoclonal antibody, may be given for advanced disease. This drug works by binding to a protein (epidermal growth factor receptor) to slow cell growth. The medication does not destroy the cancer's cell walls and does not stimulate the body's immune system or stunt cancer growth in that manner. The treatment does not decrease blood flow to rapidly dividing cancer cells.

The nurse is working at a community health fair and speaks with a group of individuals about the risk factors for colorectal cancer (CRC). Which individual does the nurse identify as most at risk for developing CRC? a. 33-year-old who has Crohn disease b. 28-year-old who has type 2 diabetes c. 19-year-old who maintains a vegetarian diet d. 41-year-old who does not have a family history of cancer

a. Crohn disease is a condition that predisposes patients to CRC. A vegetarian diet and being 19 are not risk factors. Type 2 diabetes and being 28 are not risk factors. Being 41 and not having a family history of cancer are not risk factors.

A patient with irritable bowel syndrome (IBS) is constipated. The nurse instructs the patient about a management plan. Which patient statement shows an accurate understanding of the nurse's teaching? a. "I need to go for a walk every evening." b. "A drink of diet soda with dinner is OK for me." c. "Maintaining a low-fiber diet will manage my constipation." d. "Watching the amount of fluid that I drink with meals is very important."

a. Increased ambulation is part of the management plan for IBS, along with increased fluids and fiber and avoiding caffeinated beverages. Caffeinated beverages can cause bloating or diarrhea and should be avoided in patients with IBS. Fiber is encouraged in patients with IBS because it produces a bulky soft stool and aids in establishing regular bowel habits. At least 8 to 10 cups of fluid should be consumed daily to promote normal bowel function.

A patient complains of diarrhea, abdominal distention, and bloating that gets worse and then goes away. What response by the nurse is most appropriate? a. "Do you have any pain in the left lower abdomen?" b. "It looks like you might have irritable bowel disease (IBS)." c. "Does anyone else in your family have symptoms similar to these?" d. "You will need to start eating healthier to get rid of these symptoms."

a. It is important to ask if the patient has other signs and symptoms of irritable bowel disease (IBS). Left lower quadrant pain is one of the most common symptoms of IBS; therefore, it is important to assess the patient for that. It is not within the scope of practice for the nurse to diagnose a patient and tell that patient what the symptoms sound like. There's no indication that this is something that would be inherited or familial. Telling the patient that the patient needs to eat healthier when the diagnosis is not known is not an appropriate response.

A 51-year-old female patient receives an annual wellness check. The patient does not have a personal or family history of colorectal cancer, but the nurse plans to discuss screening recommendations with the patient. What will the nurse include in the teaching? a. Get a colonoscopy every 10 years. b. Get a sigmoidoscopy every 7 years. c. Get a fecal occult blood test every 2 years. d. Get a double-contrast barium enema every 15 years.

a. Screening recommendations for women who are at least 50 years of age and have average risk for colorectal cancer include getting a colonoscopy every 10 years. Fecal occult blood tests should be done annually. Sigmoidoscopies should be done every five years. Double-contrast barium enemas should be done every 5 years.

The nurse is caring for a patient with a suspected diagnosis of pernicious anemia. What test does the nurse anticipate being ordered for this patient? a. The Schilling test b. Ultrasonography c. Bile acid breath test d. Lactose tolerance test

a. The Schilling test is used in the diagnosis of pernicious anemia. An ultrasonography, bile acid breath test, and lactose tolerance tests are not indicated for this diagnosis. Ultrasonography is used to diagnose pancreatic tumors and tumors in the small intestine. A bile acid breath test assesses the absorption of bile salt. A lactose tolerance test is used to analyze whether or not someone has trouble digesting foods and beverages that contain lactose.

A patient is scheduled for a hydrogen breath test to rule out irritable bowel syndrome (IBS). Which statement by the patient indicates a need for further teaching? a. "The test will take about 3 to 4 hours." b. "I will have to blow into something every 15 minutes." c. "They're going to give me sugar to ingest during the test." d. "I won't have anything to eat or drink for 12 hours before the test."

a. The hydrogen breath test usually takes about 1 hour to 1 and ½ hours. The patient will need to blow into a device every 15 minutes for an hour. The patient will be given small amounts of sugar during the test to test the hydrogen afterwards. The patient shouldn't have anything to eat or drink for 12 hours before the test.

What is the most accurate statement about the incidence of intestinal regions affected by colorectal cancer (CRC)? a. Incidence in the sigmoid colon is 25%. b. Incidence in the rectal portion of the colon is around 22%. c. Incidence in the descending colon is higher than in any other part of the colon. d. Incidence in the transverse colon is more than in the ascending colon and cecum.

a. The incidence of CRC in the sigmoid colon is 25%. Incidence in the descending colon is 6%, which is lower than in any other part of the colon. Incidence in the transverse colon is half that in the ascending colon and cecum. It is 30% in the rectum.

A nurse is developing a plan of care for a patient who is admitted for surgery immediately. The patient has a history of malabsorption syndrome related to a Whipple procedure for cancer in the duodenum 2 years ago. Which order from the health care provider should the nurse question? a. Pancreatic enzymes QID b. Total parenteral nutrition c. Nothing by mouth after midnight d. Intravenous fluids of D 5 0.9 percent normal saline

a. The nurse would question the order for the pancreatic enzymes QID. The patient is undergoing surgery immediately and should have nothing by mouth to eat or drink. The patient may need total parenteral nutrition. An order to have nothing by mouth after midnight is appropriate. The patient may need intravenous fluids for nutrition and hydration.

The nurse is planning care for a male patient who has undergone a hernia repair. The patient reports difficulty voiding. What does the nurse instruct the patient to do? a. Allow water to run when attempting to void. b. Drink at least 500 to 1000 mL of fluids daily. c. Report a urine output of less than 60 mL/hour. d. Sit in a squatting position to stimulate voiding.

a. The patient should be advised to allow water to run when attempting to void, as such techniques tend to stimulate voiding. Male patients should be encouraged to stand, which allows a more natural position and allows gravity to facilitate voiding and bladder emptying. The patient should report to the surgeon if urine output is less than 30 mL per hour. For proper hydration and maintenance of urinary function, the patient should have a fluid intake of at least 1500 to 2500 mL per day.

A patient presents to the emergency department with a protrusion from the umbilicus, abdominal distention, nausea, and pain. The patient's vital signs are: blood pressure 140/80, pulse 112, temperature 100.8°F. What action by the nurse is priority? a. Keep the patient NPO. b. Administer pain medication. c. Keep the head of the bed elevated 30°. d. Administer acetaminophen for the fever.

a. The patient should have nothing by mouth because this is a medical emergency and will likely need immediate surgery. Keeping the head of the bed at 30° is not indicated for this patient. Pain medication and acetaminophen can be administered via an alternate route after the patient has maintained an NPO status.

The nurse is caring for a patient who is to be discharged after a bowel resection and the creation of a colostomy. Which patient statement demonstrates that additional instruction from the nurse is needed? a. "I can drive my car in about 2 weeks." b. "I should avoid drinking carbonated sodas." c. "Stool softeners will help me avoid straining." d. "It may take 6 weeks to see the effects of some foods on my bowel patterns."

a. The patient who has had a bowel resection and colostomy should avoid driving for 4 to 6 weeks. The patient should avoid drinking sodas and other carbonated drinks because of the gas they produce. He or she may not be able to see the effects of certain foods on bowel patterns for several weeks. The patient should avoid straining at stool.

The home health nurse is teaching a patient about the care of a new colostomy. Which patient statement demonstrates a correct understanding of the instructions? a. "I need to check for leakage underneath my colostomy." b. "If the skin around the stoma is red or scratched, it will heal soon." c. "A dark or purplish-looking stoma is normal and should not concern me." d. "I should strive for a very tight fit when applying the barrier around the stoma."

a. The pouch system should be checked frequently for evidence of leakage to prevent excoriation. A purplish stoma is indicative of ischemia and necrosis. Redness or scratched skin around the stoma should be reported to prevent it from beginning to break down. An overly tight fit may lead to necrosis of the stoma.

A nurse is educating people at a health fair regarding colorectal cancer screening. Which statement made by a participant indicates a need for further teaching? a. "I should get a colonoscopy every year after the age of 40." b. "I should undergo a double-barrel contrast enema every 5 years." c. "I should have a fecal occult blood test performed annually after the age of 50." d. "I should have more frequent screening if a family member has had colorectal cancer."

a. The recommendation for colonoscopies is every 10 years after the age of 50, so it is not necessary to get a colonoscopy every year after turning 40. The remaining statements are correct. Patients should be instructed to either undergo a double-barrel contrast enema every 5 years or an annual fecal occult blood test after turning 50. Screening should be done more frequently for people who have a family history of colorectal cancer

Which chemotherapy medications may be prescribed to a patient after surgery for colorectal cancer? Select all that apply. a. Alosetron b. Oxaliplatin c. Leucovorin d. Capecitabine e. Lubiprostone

b, c, d. Oxaliplatin, leucovorin, and capecitabine are the drugs recommended after adjuvant chemotherapy. They are prescribed for patients with stage II or stage III disease. These drugs interrupt the DNA production of cells and destroy them. Alosetron and lubiprostone are prescribed for patients with constipation-predominant irritable bowel syndrome.

A patient has been educated about nutrition and colorectal cancer. What selections by the patient demonstrate an understanding of the importance of brassica vegetables? Select all that apply. a. Sprouts b. Broccoli c. Cabbage d. Cucumber e. Green beans

b, c, d. Sprouts, broccoli, and cabbage are all brassica vegetables; they help protect intestinal mucosa from colon cancer. Cucumbers and green beans are not brassica vegetables.

Which statements are true regarding a hernia? Select all that apply. a. It is not observed in obese patients. b. It is caused by acquired muscle weakness. c. It is a weakness in the abdominal muscle wall. d. It is caused by increased intra-abdominal pressure. e. It does not penetrate through other structures in the abdominal cavity.

b, c, d. The most important elements in the development of a hernia are congenital or acquired muscle weakness. Hernia is a weakness in the abdominal muscle wall through which a segment of the bowel or other abdominal structures protrude. Hernia is also caused by an increase in intra-abdominal pressure. Obesity is one of the factors contributing to an increase intra-abdominal pressure. Hernia can penetrate through the diaphragm and other structures in the abdominal cavity.

Which factors cause malabsorption syndrome? Select all that apply. a. Chronic diarrhea b. Bile salt deficiencies c. Presence of bacteria d. Elevated enzyme values e. Increase in gastric surface area

b, c. Bile salt deficiencies and the presence of bacteria are two factors that can cause malabsorption syndrome. Chronic diarrhea is a classic symptom of malabsorption, but does not cause it. A decrease, not an increase, in gastric surface area can cause malabsorption syndrome. Enzyme deficiencies, not elevated enzymes, can cause malabsorption syndrome.

A male patient tells the primary health care provider, "I think I have a hernia in my groin." What are the steps of the assessment the primary health care provider will follow in the correct order? a. Push the loose scrotal skin using the index finger. b. Ask the patient to stand for the examination. c. Ask the patient to cough and note any palpable herniation. d. Use the right hand for the patient's right side and left hand for the patient's left side. e. Push the spermatic cord upward to the external inguinal canal.

b, d, a, e, c. While assessing a patient for a hernia in the groin region, the HCP asks the patient to stand for the examination. The HCP uses the right hand for the patient's right side and left hand for the patient's left side. The HCP pushes the loose scrotal skin using the index finger. After this, the spermatic cord is pushed upward to the external inguinal canal. Then the HCP asks the patient to cough and notes any palpable herniation.

What medications are used in patients diagnosed with constipation-predominant irritable bowel syndrome (IBS-C)? Select all that apply. a. Rifaximin b. Linaclotide c. Loperamide d. Lubiprostone e. Psyllium hydrophilic mucilloid

b, d, e. Linaclotide stimulates receptors in the intestine to increase fluid and promote bowel transit time. Lubiprostone is an oral laxative approved for women with constipation-predominant irritable bowel syndrome (IBS-C). Psyllium hydrophilic mucilloid is a bulk-forming laxative used for patients with IBS. Rifaximin and loperamide are used in diarrhea-predominant IBS (IBS-D).

A patient underwent a colostomy formation. What instructions should the nurse provide to the patient and family members about home care management? Select all that apply. a. Use aspirin tablets in the pouch. b. Measure the size of the stoma regularly. c. Use moisturizing soap for cleaning the area. d. Refrain from eating asparagus, broccoli, eggs, fish, and garlic. e. Include buttermilk, cranberry juice, parsley, and yogurt in the diet.

b, d, e. Measurement of the stoma is necessary to determine the correct size of the stomal opening on the appliance. Asparagus, broccoli, eggs, fish, and garlic contribute to odor when the pouch is open, so they should not be consumed. Buttermilk, cranberry juice, parsley, and yogurt may help prevent odor from the pouch, so patients are encouraged to eat these foods. Aspirin tablets in the pouch may cause ulceration to the stoma, so they should be not be used. Charcoal tablets or breath mints can be placed in the pouch to prevent odor. Lubricants used in the moisturizing soaps may interfere with adhesion of the appliance.

Which behavior would be beneficial for a patient with constipation-predominant irritable bowel syndrome (IBS-C)? Select all that apply. a. Chewing food minimally b. Consuming regularly scheduled meals c. Reducing the fiber content in the diet d. Drinking 8 to 10 cups of liquid daily e. Practicing meditation and yoga regularly

b, d, e. The instructions for a patient with IBS should include health teaching and stress reduction. The nurse would teach the patient to eat meals regularly. Drinking 8 to 10 cups of liquid every day helps promote normal bowel function. Stress reduction techniques such as meditation and yoga help in reducing GI symptoms. The nurse would advise the patient to chew slowly and thoroughly since it helps improve digestion. The nurse asks the patient to consume foods with high fiber content since it helps in promoting normal bowel function.

A patient underwent a colostomy formation and was discharged from the hospital. Which complications should the patient be aware of and immediately report to the primary health care provider? Select all that apply. a. Leakage b. Unusual bleeding c. Edematous stoma d. Mucocutaneous separation e. Reddish pink and moist stoma

b, d. Unusual bleeding from the stoma may be a complication of the surgical procedure. Mucocutaneous separation may be the breakdown of the suture line from the abdominal wall. These complications are considered an emergency and should be reported immediately to the primary health care provider. Signs of leakage may indicate a fitting problem of the pouching system and can be managed by the wound and ostomy nurse. During the initial postoperative period, the stoma may be slightly edematous. A healthy stoma should be reddish pink, moist, and protrude 2 cm from the abdominal wall.

The nurse is planning the care of a female patient with severe diarrhea-predominant irritable bowel syndrome (IBS-D). Which nursing invention is most appropriate for the patient? a. Avoid psyllium hydrophilic mucilloid. b. Report symptoms of constipation early if taking alosetron. c. Avoid calcium-rich foods if the patient is lactose intolerant. d. Take lubiprostone on an empty stomach to control diarrhea.

b. Alosetron is administered only as a last resort in women with IBS-D. It can cause potentially life-threatening bowel complications, so the patient should report symptoms of constipation early. Psyllium hydrophilic mucilloid is a bulk-forming agent used in both IBS-D and constipation-predominant IBS (IBS-C). Lactose intolerant patients are given calcium-rich foods as they are prone to osteoporosis. Lubiprostone is effective only in women, but it is taken with food and water to control IBS-C rather than IBS-D.

The nurse is teaching a patient who is undergoing screening for colorectal cancer. What statement by the patient indicates that the teaching has been effective? a. "I should avoid high-fiber foods." b. "I will have to have a colonoscopy every 5 years." c. "They will check my stool for blood every 10 years." d. "I will need to have a double contrast barium enema every 10 years."

b. Every 10 years a patient will need a colonoscopy and their stool should be checked for blood. Patients should be encouraged to eat high-fiber foods. Patients will need a colonoscopy every 10 years, not every 5. Patients who do not have a colonoscopy will need a barium enema every 5 years.

The nurse receives a call from a patient who underwent an abdominoperineal resection five weeks ago. The patient reports drainage from the perineal wound that is serosanguineous. What action by the nurse is appropriate? a. Notify the health care provider. b. Inform the patient this is a normal finding. c. Encourage the patient to take prescribed antibiotics. d. Encourage the patient to go to the emergency room.

b. It is normal to have serosanguineous drainage for 1 to 2 months after an abdominoperineal resection. The nurse does not need to notify the health care provider. Antibiotics are not indicated for this. The patient does not need to go to the emergency room.

A patient is diagnosed with constipation-predominant irritable bowel syndrome. What medication does the nurse anticipate will be prescribed by the primary health care provider? a. Rifaximin b. Linaclotide c. Loperamide d. Amitriptyline

b. Linaclotide is selectively prescribed in cases of constipation-predominant irritable bowel syndrome. It works by stimulating receptors in the intestine to increase fluid and promote bowel transit time. Rifaximin works effectively in patients with irritable bowel syndrome having bloating abdominal distention without constipation. Diarrhea-predominate irritable bowel syndrome may be treated with loperamide. Amitriptyline is prescribed for irritable bowel syndrome when pain is the predominant symptom.

Aside from chemotherapeutic agents, what other medications does the nurse expect to administer to a patient with advanced colorectal cancer for relief of symptoms? a. Steroids and analgesics b. Analgesics and antiemetics c. Analgesics and benzodiazepines d. Steroids and anti-inflammatory medications

b. Patients with advanced colorectal cancer and metastasis also receive drugs such as analgesics and antiemetics for relief of symptoms, specifically pain and nausea. Benzodiazepines, steroids, and anti-inflammatory medications are not routinely requested for these patients.

The nurse is explaining preoperative and postoperative care to a patient scheduled for a conventional open herniorrhaphy. Which statement made by the patient demonstrates a correct understanding of the instructions given? a. "I will wake up with several small incisions." b. "I need to avoid coughing after the procedure." c. "I will be discharged within 5 hours of the procedure." d. "I can have food and drinks up until an hour before my surgery."

b. Postoperative care of patients undergoing an open herniorrhaphy is the same as other surgeries except that patients should avoid coughing to prevent pressure on the abdominal muscles. Nothing is given to the patient by mouth for a number of hours prior to the surgery. Several small incisions may be made during minimally invasive inguinal hernia repair ( MIIHR) (which uses a laparoscope) to identify the defect and place the intestine back into the abdomen. When a patient undergoes an open herniorrhaphy, the patient will have one abdominal incision. The patient is discharged within 3 to 5 hours following an MIIHR rather than after an open herniorrhaphy.

A patient with a bowel obstruction is ordered a nasogastric (NG) tube. After the nurse inserts the tube, which nursing intervention is the highest priority for this patient? a. Attaching the tube to high continuous suction b. Connecting the tube to intermittent low suction c. Flushing the tube with 30 mL of normal saline every 24 hours d. Auscultating for bowel sounds and peristalsis while the suction runs

b. The NG tube should be attached to intermittent low suction unless otherwise requested by the health care provider. Continuous suction is rarely used because it can injure the gastric mucosa of the patient's stomach. Bowel sounds should not be auscultated with suction on and running. The tube should be flushed every 4 hours, minimally.

A patient with an intestinal obstruction has pain that changes from a "colicky" intermittent type to constant discomfort. What does the nurse do first? a. Administers medication for pain b. Prepares the patient for emergency surgery c. Positions the patient in high Fowler's position d. Changes the nasogastric suction level from "intermittent" to "constant"

b. The change in pain type could be indicative of perforation or peritonitis and will require immediate surgical intervention. Pain medication may mask the patient's symptoms but will not address the root cause. A change in the nasogastric suction rate will not resolve the cause of the patient's pain and could be particularly ineffective if a nonvented tube is in use. A high Fowler's position will have no effect on an intestinal perforation or peritonitis, which this patient is likely experiencing.

The nurse sees a note in a patient's medical record that the patient has IBS-M. What does this mean? a. The patient has IBS with mostly diarrhea. b. The patient has IBS with mainly constipation. c. The patient has IBS with a mix of diarrhea and constipation. d. The patient has IBS with motility changes of alternating diarrhea and constipation.

c. "IBS-M" means the patient has irritable bowel syndrome (IBS) with a mix of diarrhea and constipation. A patient who has mostly diarrhea would have a classification of IBS-D. A patient with mainly constipation would have a classification of IBS-C. A patient with alternating diarrhea and constipation would have a classification of IBS-A.

The nurse is explaining postoperative care to a patient scheduled for a hemorrhoidectomy. What teaching does the nurse include? a. "Urinary incontinence can be a complication." b. "A high-fiber diet should be restricted for a few weeks." c. "Sitz baths should be given three to four times each day." d. "Stimulant laxatives should be taken to promote bowel movements."

c. After a hemorrhoidectomy, sitz baths or other forms of moist heat are given three to four times a day to promote comfort. Rectal spasms and anorectal tenderness following the surgery may cause urinary retention rather than urinary incontinence. The patient is encouraged to consume a high-fiber diet, as it helps to promote regular bowel movements after the surgery. Stimulant laxatives can be habit forming, so the patient is advised to avoid them.

How does the nurse provide special skin care for the patient with chronic diarrhea? a. Have the patient soak in a cool bathtub. b. Clean the perineal area with cold water. c. Apply a thin coat of aloe vera after each stool. d. Wipe with toilet tissue to clean the perineal area.

c. After each stool, the nurse can provide relief and comfort to the patient by applying a thin coat of aloe vera to the area. The nurse can have the patient soak in a sitz bath several times per day with the health care provider's permission. The nurse should clean the perineal area with warm water, not cold water. The nurse should use medicated wipes or premoistened disposable wipes rather than toilet tissue.

A patient with a family history of colorectal cancer (CRC) regularly sees a health care provider for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this patient? a. Elevated hemoglobin levels b. Negative test for occult blood c. Elevated carcinoembryonic antigen d. Decrease in liver function test results

c. Carcinoembryonic antigen may be elevated in many patients diagnosed with CRC. Liver involvement may or may not occur in CRC. Hemoglobin will likely be decreased with CRC, not increased. An occult blood test is not reliable to affirm or rule out CRC.

Which surgery may be performed on a patient with regional lymph node involvement in colon cancer? a. Colostomy b. Colectomy c. Colon resection d. Abdominoperineal resection

c. Colon resection is performed to remove tumors and regional lymph nodes. A colostomy is the creation of an opening of the colon onto the surface of the abdomen. A colectomy is the removal of the colon. An abdominoperineal resection removes the sigmoid colon, rectum, and anus.

A patient who is taking alosetron reports dark amber urine. What action by the nurse is priority? a. Notify the health care provider. b. Inform the patient that this is a normal finding. c. Tell the patient not to take the medication again. d. Instruct the patient to go to the emergency department.

c. Dark urine may be a sign of bleeding and is a severe side effect of alosetron; the medication should be stopped immediately. After telling the patient to stop taking the medication, the nurse should then notify the health care provider. Dark amber urine is not a normal finding when using alosetron. The patient will need to be seen, if not in the office, then in the emergency department.

While assessing a patient with colorectal cancer, the primary health care provider finds some masses when palpating the abdomen. Which assessment test would be used to confirm if there are masses in the abdomen? a. Colonoscopy b. Sigmoidoscopy c. Magnetic resonance imaging d. A double contrast barium enema

c. Magnetic resonance imaging of the chest, abdomen, pelvis, lungs, or liver helps confirm the existence of masses, the extent of disease, and the location of distant metastases. A colonoscopy helps in detection of colon polyps, tumors, inflammation, and bleeding in the rectum and colon. A sigmoidoscopy provides visualization of the lower colon. A double contrast barium enema test may be used to detect polyps in the colon.

Which statement made by the student nurse indicates effective learning about polyps? a. "Polyps are formed due to injuries to the internal organs." b. "Polyps are formed due to weakness in the abdominal wall." c. "Polyps are formed in the intestinal tracts as small growths." d. "Polyps are formed due to inadequate healing of a surgical incision."

c. Polyps are formed in intestinal tracts as small growths covered with mucosa and attached to the surface of the intestine. Abdominal trauma is formed due to injuries to the internal organs. Hernias are formed due to a weakness in the abdominal wall. Incisional, or ventral, hernias are formed due to inadequate healing of a surgical incision.

Which statement is true regarding polyps? a. Polyps are malignant. b. Polyps are symptomatic. c. Polyps may be hereditary. d. Tubular adenomas pose a greater cancer risk than villous adenomas.

c. Polyps may be genetically inherited and characterized by progressive development of colorectal adenomas. Most polyps are benign, although some have the potential to become malignant. Polyps are usually asymptomatic and are discovered during a routine colonoscopy screening. There are two types of adenomas, villous and tubular. Villous adenomas pose a greater cancer risk.

The nurse is teaching a patient ways to prevent fecal impaction with a heathy diet. Which menu selection made by the patient indicates to the nurse that teaching was effective? a. Mac and cheese with a hot dog and a soda b. Slice of vegetable pizza with a glass of milk c. Turkey sandwich on whole wheat bread with an apple d. Hamburger on a white bun with French fries and an orange

c. Preventing fecal impaction can be successfully managed with healthy dietary choices. The nurse teaches the patient to eat high-fiber foods that include raw fruits and vegetables, as well as whole-grain products. The turkey sandwich on whole wheat bread with an apple fulfills the need for fiber. Mac and cheese with a hot dog and a soda offers little nutritional value and does not offer fiber. The hamburger on a white bun with French fries does not offer the patient valuable fiber content, although the orange does. A slice of vegetable pizza with a glass of milk offers little nutritional value or fiber.

A patient who reports several days of abdominal pain has abdominal distention with visible peristaltic waves in the mid-abdomen. The patient has nausea and vomiting and has been unable to pass stool. Laboratory studies reveal fluid and electrolyte imbalances and metabolic alkalosis. Which condition does the nurse suspect in this patient? a. Paralytic ileus b. Intussusception c. Small-bowel obstruction d. Large-bowel obstruction

c. Small-bowel obstruction is characterized by obstipation, metabolic alkalosis, severe fluid and electrolyte imbalances, and visible peristaltic waves. Intussusception is a large-bowel obstruction, which is characterized by occasional metabolic acidosis and minimal or no vomiting. Paralytic ileus is a nonmechanical obstruction.

A patient with malabsorption syndrome asks the nurse, "What did I do to cause this disorder to develop?" How does the nurse respond? a. "It is inherited, so it could run in your family." b. "It might be caused by a virus, so you could have gotten it almost anywhere." c. "Nothing you did could have caused it; it is the result of flattening of the mucosa of your small intestine." d. "An excessive intake of alcohol is associated with it, so your substance abuse could have contributed to its development."

c. Stating that the disorder is the result of flattening of the mucosa of the small intestine is the only statement that is physiologically accurate. Malabsorption syndrome is not associated with an excessive intake of alcohol. It is not inherited, although a genetic immune defect is present in the related disease, celiac sprue. It is not caused by a virus.

The nurse is assessing a patient diagnosed with a paralytic ileus. The patient has a nasogastric (NG) tube in place, is complaining of nausea, and has increased abdominal distention. What action by the nurse is priority? a. Request a stat x-ray. b. Contact the health care provider. c. Reposition the nasogastric (NG) tube. d. Flush the nasogastric (NG) tube 30 mL of normal saline.

c. The NG tube should be repositioned first. After that, an x-ray should be taken prior to aspirating for stomach contents or flushing the NG tube. It is not indicated to contact the health care provider.

Which statement made by the patient who has undergone minimally invasive inguinal hernia repair (MIIHR) indicates a need for further teaching? a. "I can lift 9 pounds of weight." b. "I should eat high-fiber foods." c. "I can remove the Steri-Strips." d. "I can take a shower after 24 hours."

c. The patient should not remove the Steri-Strips because they provide support to the incision and will fall off in about a week. The patient should not lift more than 10 pounds until allowed by the surgeon. The patient should eat high-fiber foods to avoid constipation. The patient can take a shower after 24 to 36 hours after removing the surgical dressing covering the Steri-Strips.

The Certified Wound, Ostomy, and Continence Nurse (CWOCN) is teaching a patient with colorectal cancer how to care for a newly created colostomy. Which patient statement reflects a correct understanding of the necessary self-management skills? a. "If I have any leakage, I'll put a towel over it." b. "I can get my spouse to change the bag for me." c. "I will make certain that I always have an extra bag available." d. "I need to call my home health nurse to come out if I have any problems."

c. The statement that the patient will be certain to bring an extra bag is the only statement illustrating that the patient is taking responsibility to care for the colostomy. Using a towel is not an acceptable or effective way to cope with leakage. It is not realistic that the home health nurse can make frequent visits for the purpose of colostomy care.

Which laboratory test may be used to identify bacterial overgrowth and malabsorption of nutrients in the small intestine? a. Occult blood test b. Serum albumin test c. Hydrogen breath test d. Complete blood count test

c. When small-intestinal bacterial overgrowth or malabsorption of nutrients is present, excess hydrogen is produced. Some of this hydrogen is absorbed into the blood stream and travels to the lungs where it is exhaled. Patients with irritable bowel syndrome often exhale an increased amount of hydrogen. Therefore, a hydrogen breath test may be used to identify bacterial overgrowth and malabsorption of nutrients in the small intestine. An occult blood test may be used to find the presence of microscopic or invisible blood in the stool. A serum albumin test measures the amount of albumin protein in the plasma of the blood. A complete blood count test is used to evaluate overall health and detect a wide range of disorders, including anemia, infection, and leukemia.

A patient's stool sample showed microscopic amounts of blood content. After assessing the patient's history, the nurse concludes that the patient may have tumors in the colon. Which finding in the patient's history enabled the nurse to reach this conclusion? a. Anemia b. Appendicitis c. Abdominal pain d. Endometrial cancer

d. A history of endometrial cancer would make the nurse suspect there may be tumors in the colon because the endometrial cancer may spread to the colon. Anemia may not confirm colorectal cancer. Appendicitis may not be a reason for colorectal cancer. Abdominal pain can happen due to many disease processes, not just cancerous tumors in the colon.

A patient diagnosed with irritable bowel syndrome (IBS) is discharged home with a variety of medications for IBS symptoms. Upon returning to the clinic, the patient states, "Most of my symptoms have improved, except for the diarrhea." What does the nurse anticipate will be prescribed for this patient? a. Antidiarrheal agent b. Serotonin antagonist c. Tricyclic antidepressant d. Muscarinic receptor agonist

d. A muscarinic (M 3)-receptor antagonist can also inhibit intestinal motility. Antidiarrheal agents and serotonin antagonists are not the most effective choices for this patient. A tricyclic antidepressant is not going to be effective for this patient's diarrhea.

A patient is being evaluated in the emergency department (ED) for a possible small-bowel obstruction. Which signs and/or symptoms does the nurse expect to assess? a. Cramping intermittently, metabolic acidosis, and minimal vomiting b. Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis c. Metabolic acidosis, upper abdominal distention, and intermittent cramping d. Upper abdominal distention, metabolic alkalosis, and great amount of vomiting

d. A small-bowel obstruction is characterized by upper abdominal distention, metabolic alkalosis, and a great amount of vomiting. Intermittent lower abdominal cramping, obstipation, metabolic acidosis, and minimal vomiting are all symptoms of a large-bowel obstruction.

The primary health care provider prescribes bevacizumab for a patient who underwent surgical resection for colorectal cancer. Which is an expected outcome of this medication? a. Block growth factors that promote cancer cell growth b. Interrupt the DNA production of cells and destroy them c. Control pain, hemorrhage, bowel obstruction, or metastasis to the lung d. Reduce blood flow to the growing tumor cells, thereby depriving the nutrients for growth

d. Bevacizumab is an antiangiogenesis drug, and it is also known as a vascular endothelial growth factor inhibitor. This drug reduces blood flow to the growing tumor cells, thereby depriving them of the necessary nutrients needed for growth of cancer cells. Cetuximab, also known as epidermal growth factor receptor antagonist, is a monoclonal antibody that blocks growth factors that promote cancer cell growth. Intravenous 5-fluorouracil with leucovorin is a chemotherapeutic drug, which interrupts DNA production of cells and destroys them. Radiation therapy controls pain, hemorrhage, bowel obstruction, or metastasis to the lung in the advanced stages of the disease.

The nurse is caring for a patient diagnosed with malabsorption syndrome and macrocytic anemia. What lab value is consistent with this diagnosis? a. Increased folic acid b. Increased vitamin B 12 c. Increased serum iron d. Increased mean corpuscular volume space (MCV)

d. Increased mean corpuscular volume space (MCV) is found in macrocytic anemia. Macrocytic anemia does not have increased folic acid, vitamin B 12 levels, or serum iron.

Which complication occurs due to increasing growth of the colorectal tumor in a patient? a. Fistula formation in the colon b. Abscesses formation in the mouth c. Tumor spreading to two layers of the bowel wall d. Bowel obstruction or perforation with resultant peritonitis

d. Increasing growth of the tumor locally or through metastatic speed can result in bowel obstruction or perforation with resultant peritonitis. Fistula formation occurs in the urinary bladder or vagina. Abscesses are formed in the colon. Tumors spread to the four layers of the bowel wall.

Which statement about irritable bowel syndrome (IBS) is most accurate? a. In Asia, women are twice as likely to have IBS than men. b. Pain is most common in the left upper quadrant of the abdomen. c. Patients with IBS have a decreased amount of hydrogen during exhalation. d. IBS is associated with both primary and secondary mental health disorders.

d. Psychosocial problems such as stress may be a cause of IBS. Pain and chronic symptoms can also lead to secondary psychosocial problems such as depression. Thus, IBS is associated with both primary and secondary mental health disorders. Pain is most common in the left lower quadrant of the abdomen. In Asia, there does not seem to be any gender predominance, but in the United States, women are twice as likely to have IBS than men. Patients with IBS have an increased amount of hydrogen while exhaling, which may be due to small-intestinal bacterial overgrowth or malabsorption of nutrients.

The nurse is providing discharge instructions to a patient who has just had a hemorrhoidectomy. Which statement by the patient indicates the teaching was effective? a. "I will avoid the use of stool softeners until I see the doctor." b. "I will take a mild laxative until I'm able to go to the bathroom." c. "I will avoid sitz baths and warm compresses for the next 3 to 4 days." d. "I will make sure someone is with me the first time I have a bowel movement."

d. Someone should be with the patient the first time the patient has a bowel movement after a hemorrhoidectomy because it can be extremely painful and the patient might become light-headed or pass out. The patient can take stool softeners. The patient should not use mild laxatives unless there is constipation and the doctor recommends them. The patient can use sitz baths and warm compresses 3 to 4 times a day.

In home colostomy care, what is the purpose of stoma paste? a. To enhance adherence of the appliance b. To facilitate less painful removal of the adhesive c. To prevent fungal infection around the stoma site d. To prevent the adjacent skin from becoming raw

d. Stoma paste or powder is often used to prevent rawness of the adjacent skin. Skin sealants are used to facilitate the removal of adhesive. If fungal infection occurs, powder (not paste) is recommended. Stoma paste is not used as an adherent.

Which is a functioning stoma? a. End stoma b. Loop stoma c. Distal stoma d. Proximal stoma

d. The proximal stoma is a functioning stoma and eliminates stool. It is closest to the patient's head. An end stoma is constructed by severing the end of the proximal portion of the bowel and bringing it out through the abdominal wall. A loop stoma is made by bringing a loop of the colon to the skin surface, severing and everting the anterior wall, and suturing it to the abdominal wall. The distal stoma is nonfunctioning, although it may secrete mucus, and sometimes it is referred to as a mucous fistula.

Which statement is most accurate about colorectal cancer (CRC)? a. Gross blood is common in CRC of the right side of the colon. b. Hematochezia is common in CRC involving the transverse colon. c. "Gas pains" and cramping are common in CRC of the rectosigmoid colon. d. A palpable mass in the lower right quadrant is common in CRC of the ascending colon.

d. Tumors of the ascending colon or the right side of the colon can grow quite large without causing a change in bowel patterns. This can be palpated as a mass in the lower right quadrant. Gross blood is not common when this part of the colon is affected; rather, it is common with tumors of the left side of the colon and rectum. A tumor of the transverse colon blocks the passage of stool and causes symptoms of "gas pains" or cramping. Hematochezia, or passage of red blood via the rectum, is seen in rectosigmoid CRC.