IGGY CH56 Noninflammatory Intestinal Disorders

22. 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 need to avoid drinking carbonated sodas." C. "It may take 6 weeks to see the effects of some foods on my bowel patterns." D. "Stool softeners will help me avoid straining."

ANS. A "I can drive my car in about 2 weeks." Additional instruction is needed from the nurse when the patient who is about to be discharged after a bowel resection and colostomy says, "I can drive my car in about 2 weeks." The patient who has had a bowel resection and colostomy would avoid driving for 4 to 6 weeks.The patient needs to 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 must avoid straining at stool.

15. 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. Analgesics and antiemetics B. Analgesics and benzodiazepines C. Steroids and analgesics D. Steroids and anti-inflammatory medications

ANS. A Analgesics and antiemetics Besides chemotherapeutic agents, the nurse expects to administer analgesics and antiemetics to a patient with advanced colorectal cancer for relief of symptoms related to pain and nausea.Benzodiazepines, steroids, and anti-inflammatory medications are not routinely requested for these patients.

4. What does the nurse advice a patient diagnosed with irritable bowel syndrome (IBS) to take during periods of constipation? A. Bulk-forming laxatives B. Saline laxatives C. Stimulant laxatives D. Stool-softening agents

ANS. A Bulk-forming laxatives The nurse advises the patient diagnosed with IBS to take bulk-forming laxatives during periods of constipation. For treatment of constipation-predominant IBS, bulk-forming laxatives are generally taken at mealtimes with a glass of water.Saline and stimulant laxatives are not used for the treatment of constipation-predominant IBS. Stool-softening agents are not effective.

2. A patient who has colorectal cancer is scheduled for a colostomy. Which referral is initially of greatest value to this patient? A. Certified Wound, Ostomy, and Continence Nurse (CWOCN) B. Home health nursing agency C. Hospice D. Hospital chaplain

ANS. A Certified Wound, Ostomy, and Continence Nurse (CWOCN) A CWOCN (or an enterostomal therapist) will be of greatest value to the patient with colorectal cancer 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.

20. A patient with colorectal cancer had colostomy surgery performed yesterday. The patient is very anxious about caring for the colostomy and states that the primary health care provider's instructions "seem overwhelming." What does the nurse do first for this patient? A. Encourage the patient to look at and touch the colostomy stoma B. Instruct the patient about complete care of the colostomy C. Schedule a visit from a patient who has a colostomy and is successfully caring for it D. Suggest that the patient involve family members in the care of the colostomy

ANS. A Encourage the patient to look at and touch the colostomy stoma The first action the nurse does for the postoperative colostomy patient who is very anxious about caring for the colostomy is to encourage the patient to look at and touch the colostomy stoma. The initial intervention is to get the patient comfortable looking at and touching the stoma before providing instructions on its care.Instructing the patient about colostomy care will be much more effective after the patient's anxiety level has stabilized. Talking with someone who has gone through a similar experience may be helpful to the patient only after his or her anxiety level has stabilized. The patient has begun to express feelings regarding the colostomy and its care. It is too soon to involve others. The patient must get comfortable with this body image change before attempting to involve family members in colostomy care.

24. The nurse is teaching a group of patients with irritable bowel syndrome (IBS) about complementary and alternative therapies. What does the nurse suggest as possible treatment modalities? Select all that apply. A. Acupuncture B. Decreasing physical activities C. Meditation D. Peppermint oil capsules E. Yoga

ANS. A, C, D E Possible treatment modalities the nurse suggests for a patient with IBS include: acupuncture, meditation, peppermint oil capsules, and yoga. Acupuncture is recommended as a complementary therapy for IBS. Meditation, yoga, and other relaxation techniques help many patients manage stress and their IBS symptoms. Research has shown that peppermint oil capsules may be effective in reducing symptoms of IBS. Regular exercise is important for managing stress and promoting bowel elimination.The nurse would not suggest decreasing physical activity. Regular exercise is important for managing stress and promoting bowel elimination.

1. The nurse is teaching a patient with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods are included? Select all that apply. A. Broccoli B. Buttermilk C. Mushrooms D. Onions E. Peas F. Yogurt

ANS. A, C, D, E Foods the patient with a newly created colostomy needs to limit or avoid because of flatulence or odors include: Broccoli, mushrooms, onions, and peas.Buttermilk will help prevent odors. Yogurt can help prevent flatus.

21. 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. "A cup (236 mL) of caffeinated coffee with cream & sugar at dinner is OK for me." B. "I need to go for a walk every evening." C. "Maintaining a low-fiber diet will manage my constipation." D. "Limiting the amount of fluid that I drink with meals is very important."

ANS. B "I need to go for a walk every evening." The patient statement, "I need to go for a walk every evening," shows that the patient accurately understands the nurse's management plan to treat IBS. Walking every day is an excellent exercise for promoting intestinal motility. 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 need to 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 (2 to 2.5 liters) of fluid need to be consumed daily to promote normal bowel function.

25. The nurse is teaching a patient who has undergone a hemorrhoidectomy about a follow-up plan of care. Which patient statement demonstrates a correct understanding of the nurse's instructions? A. "I would take Ex-Lax after the surgery to 'keep things moving'." B. "I will need to eat a diet high in fiber." C. "Limiting my fluids will help me with constipation." D. "To help with the pain, I'll apply ice to the surgical area."

ANS. B "I will need to eat a diet high in fiber." The statement that shows that the hemorrhoidectomy patient correctly understands the nurse's instruction is, "I will need to eat a diet high in fiber." A diet high in fiber serves as a natural stool softener and will prevent irritation to hemorrhoids caused by painful bowel movements.Ex-lax is a stimulant laxative. Stimulant laxatives are discouraged because they are habit-forming. Increased amounts of fluids are needed to prevent constipation. Moist heat (sitz baths) will be more effective with postoperative discomfort than cold applications. Cold therapy is sometimes recommended and useful before surgery for inflamed hemorrhoids.

5. 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 may have trouble urinating immediately after the surgery." B. "I will need to stay in the hospital overnight." C. "I will not eat after midnight the day of the surgery." D. "My chances of having complications after this procedure are slim."

ANS. B "I will need to stay in the hospital overnight." A need for further teaching about MIIHR is when the patient says, "I will need to stay in the hospital overnight." Usually, the patient is discharged 3 to 5 hours after MIIHR surgery.Male patientswho have difficulty urinating after the procedure would 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.

11. A patient suspected of having irritable bowel syndrome (IBS) is scheduled for a hydrogen breath test. What does the nurse tell the patient about this test? A. "During the test, you will drink small amounts of an antacid as directed by the technician." B. "If you have IBS, hydrogen levels may be increased in your breath samples and can be an indication that you have IBS." C. "The test will take between 30 and 45 minutes to complete." D. "You must have nothing to drink (except water) for 24 hours before the test."

ANS. B "If you have IBS, hydrogen levels may be increased in your breath samples and can be an indication that you have IBS." The nurse tells the patient with IBS who has a hydrogen breath test prescribed that "hydrogen levels may be increased in your breath samples and can indicate that you have IBS." Excess hydrogen levels in patients with IBS are due to bacterial overgrowth in the small intestine that accompanies the disease. The hydrogen travels to the lungs to be excreted.The patient will ingest small amounts of sugar during the test, not an antacid. The test takes longer than 45 minutes to complete. The patient has breath samples taken every 15 minutes for 1 to 2 hours. The patient needs to be NPO (except for water) for 12 hours before the test.

13. The RN on the medical-surgical unit receives a shift report about four patients. Which patient does the nurse assess first? A. A 34-year-old who has returned to the unit after a colon resection with a new colostomy stoma, which is pink and moist. B. A 36-year-old admitted after a motor vehicle collision (MVC) with areas of ecchymosis on the abdomen in a "lap-belt" pattern C. A 40-year-old with a reducible inguinal hernia asking questions about surgery. D. A 51-year-old with familial adenomatous polyposis (FAP) who is scheduled for a colonoscopy

ANS. B A 36-year-old admitted after a motor vehicle collision (MVC) with areas of ecchymosis on the abdomen in a "lap-belt" pattern After the shift-report, the RN first assesses the 36-year-old admitted after a MVC with areas of ecchymosis on the area in a "lap-belt" pattern. Ecchymosis in the abdominal area may indicate intraperitoneal or intraabdominal bleeding. This patient requires rapid assessment and interventions.The patient who is post colon resection, the patient with preoperative questions, and the patient with FAP do not have an urgent need for further assessment or intervention.

17. A male patient in a long-term care facility is 2 days postoperative after an open repair of an indirect inguinal hernia. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)? A. Assessing the patient's incision for signs of infection B. Assisting the patient to stand to void C. Instructing the patient in how to deep-breathe D. Monitoring the patient's pain level

ANS. B Assisting the patient to stand to void The RN delegates the UAP to assist the 2 day postoperative open repair of an indirect inguinal hernia patient to stand and void. Assisting the patient with activities is part of the UAP role.Assessment of the patient's incision and monitoring the patient's pain level requires broader education and scope of practice than a UAP and would be performed by licensed nursing personnel. Patient teaching—even about something as fundamental as taking "deep breaths"—likewise requires broader education and scope of practice and would be done by licensed nursing personnel.

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

ANS. B Elevated carcinoembryonic antigen 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.

12. A 67-year-old male patient, with no surgical history, reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have? A. Femoral B. Reducible C. Strangulated D. Incarcerated

ANS. B Reducible The hernia is reducible because its contents can be pushed back into the abdominal cavity.Femoral hernias tend to occur more frequently in obese and pregnant women. A hernia is considered to be strangulated when the blood supply to the herniated segment of the bowel is cut off. An incarcerated or irreducible hernia cannot be reduced or placed back into the abdominal cavity. Any hernia that is not reducible requires immediate surgical evaluation.

28. A patient is diagnosed with irritable bowel syndrome (IBS). What factors does the nurse suspect as possibly contributing to the patient's condition? Select all that apply. A. Antihistamines B. Caffeinated drinks C. Stress D. Sleeping pills E. Combinations of genetic, immunological, and hormonal factors

ANS. B, C, E The factors that the nurse suspects may contribute to IBS include: caffeinated drinks, stress, and combinations of genetic, immunological and hormonal factors. The etiology of IBS remains unclear. Research suggests that a combination of environmental, immunologic, genetic, hormonal, and stress factors play a role in the development and course of the disorder. Examples of environmental factors include foods and fluids like caffeinated or carbonated beverages and dairy products. Infectious agents have also been identified. Several studies have found that patients with IBS often have small-bowel bacterial overgrowth, which causes bloating and abdominal distention.Antihistamines and sleeping pills are not suspected of causing IBS.

10. A patient with colorectal cancer was started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. What does the nurse tell the patient about the cause of diarrhea and mouth ulcers? A. "A combination of chemotherapeutic agents has caused them." B. "GI problems are symptoms of the advanced stage of your disease." C. "5-FU cannot discriminate between your cancer and your healthy cells and is causing your ulcers and diarrhea." D. "You have these as a result of the radiation treatment."

ANS. C "5-FU cannot discriminate between your cancer and your healthy cells and is causing your ulcers and diarrhea." The nurse tells the patient with colorectal cancer who is taking 5-fluorouracil and is having fatigue, diarrhea, and mouth ulcers that 5-FU cannot discriminate between cancer and healthy cells. Therefore, the side effects of 5-FU 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.

19. 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. "A dark or purplish-looking stoma is normal and would not concern me." B. "If the skin around the stoma is red or scratched, it will heal soon." C. "I need to check for leakage underneath my colostomy." D. "I need to strive for a very tight fit when applying the barrier around the stoma."

ANS. C "I need to check for leakage underneath my colostomy." The patient's statement, "I need to check for leakage underneath my colostomy" shows that the patient correctly understands the instructions about how to care for a new colostomy. The pouch system must 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 must be reported to prevent it from beginning to break down. An overly tight fit may lead to necrosis of the stoma.

26. A patient with colorectal cancer is scheduled for colostomy surgery. Which comment from the nurse is most therapeutic for this patient? A. "Are you afraid of what your spouse will think of the colostomy?" B. "Don't worry. You will get used to the colostomy eventually." C. "Tell me what worries you the most about this procedure." D. "Why are you so afraid of having this procedure done?"

ANS. C "Tell me what worries you the most about this procedure." The most therapeutic comment by the nurse to a patient scheduled for colostomy surgery is "Tell me what worries you the most about this procedure." Asking the patient about what worries him or her is the only question that allows the patient to express fears and anxieties about the diagnosis and treatment.Asking the patient if he or she is afraid is a closed question (i.e., it requires only a "yes" or "no" response). It closes the dialogue and is not therapeutic. Telling the patient not to worry offers reassurance and is a "pat" statement, making it nontherapeutic. "Why" questions place patients on the defense and are not therapeutic because they close the conversation.

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

ANS. C Connecting the tube to low continuous suction Most patients with an obstruction have an NGT unless the obstruction is mild. A Salem sump tube is inserted through the nose and placed into the stomach. It is attached to low continuous suction unless otherwise requested by the primary health care provider. This tube has a vent (pigtail) that prevents the stomach mucosa from being pulled away during suctioning. This tube does not require intermittent suctionLevin tubes (no pigtail) do not have a vent and therefore should only be connected to low intermittent suction. They are used much less often than the Salem sump tubes. Bowel sounds would not be auscultated with suction on and running. After appropriate placement is established, the contents are aspirated and the tube is irrigated with 30 mL of normal saline every 4 hours or as requested by the primary health care provider.

14. A patient at risk for colorectal cancer asks the nurse, "Can you tell me some foods to include in my diet so that I can reduce my chances of getting this disease?" Which dietary selection does the nurse suggest? A. Steak with pasta B. Spaghetti with tomato sauce C. Steamed broccoli with turkey D. Tuna salad with wheat crackers

ANS. C Steamed broccoli with turkey The nurse suggests steamed broccoli and turkey to the patient who wants to know what foods to include in his/her diet to reduce the chance of getting colorectal cancer.Animal fat from red meats is carcinogenic, and pasta is high in refined carbohydrates, which are known to contribute to colon cancer. Spaghetti and wheat crackers also contain large amounts of refined carbohydrates.

7. The Certified Wound, Ostomy, and Continence Nurse 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. "I will have my spouse change the bag for me." B. "If I have any leakage, I'll put a towel over it." C. "I can put aspirin tablets in the pouch in order to reduce odor" D. "I will apply a non-alcoholic skin sealant around the stoma and allow it to dry prior to applying the bag."

ANS. D "I will apply a non-alcoholic skin sealant around the stoma and allow it to dry prior to applying the bag." The patient statement that reflects a correct understanding of necessary self-management skills to care for a newly created colostomy is, "I will apply a non-alcoholic sealant around the stoma and allow it to dry prior to putting the bag on." Teach the patient and family to apply a skin sealant (preferably without alcohol) and allow it to dry before application of the appliance (colostomy bag) to facilitate less painful removal of the tape or adhesive.It is not realistic that the spouse will always change the patient's bag and does not reflect correct understanding of self-management skills. A towel is not an acceptable or effective way to cope with leakage. Putting an aspirin in the pouch will not reduce odor and can lead to ulcers in the stoma.

6. A male patient's sister was recently diagnosed with colorectal cancer (CRC), and his brother died of CRC 5 years ago. The patient asks the nurse whether he will inherit the disease too. How does the nurse respond? A. "Have you asked your primary health care provider what he or she thinks your chances are?" B. "It is hard to know what can predispose a person to develop a certain disease." C. "No. Just because they both had CRC doesn't mean that you will have it, too." D. "The only way to know whether you are predisposed to CRC is by genetic testing."

ANS. D "The only way to know whether you are predisposed to CRC is by genetic testing." The nurse's response to the patient who asks if he will inherit CRC is "the only way to know whether you are predisposed to CRC is by genetic testing." Genetic testing is the only definitive way to determine whether the patient has a predisposition to develop CRC.Asking the patient what the primary health care provider thinks is an evasive response by the nurse and does not address the patient's concerns. A higher incidence of the disease has been noted in families who have a history of CRC. It is not, however, the responsibility of the nurse to engage in genetic counseling. This patient might not be predisposed to developing CRC.

23. A patient with malabsorption syndrome asks the nurse, "What did I do to cause this disorder to develop?" How does the nurse respond? A. "An excessive intake of alcohol is associated with it, so your substance abuse could have contributed to its development." B. "It is inherited, so it could run in your family." C. "It might be caused by a virus, so you could have gotten it almost anywhere." D. "There are a variety of things that can cause malabsorption syndrome to occur. You may have a deficiency is certain enzymes, a bacteria or changes in the lining of your intestines."

ANS. D "There are a variety of things that can cause malabsorption syndrome to occur. You may have a deficiency is certain enzymes, a bacteria or changes in the lining of your intestines." The nurse responds to the patient with malabsorption syndrome who asks, "What did I do to cause this?", that there are many things that can cause this disorder. Malabsorption is a syndrome associated with a variety of disorders and intestinal surgical procedures. This syndrome can be caused by inflammation, intrinsic disease, or injury to the lining of the intestine.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 but can be caused by some bacterias.

27. What is the mechanism of action for the chemotherapeutic drug cetuximab (Erbitux)? A. It destroys the cancer's cell wall, which will kill the cell. B. It decreases blood flow to rapidly dividing cancer cells. C. It stimulates the body's immune system and stunts cancer growth. D. It blocks factors that promote cancer cell growth.

ANS. D It blocks factors that promote cancer cell growth. The mechanism of action for the chemotherapeutic drug cetuximab is that it blocks factors that promote cancer cell growth. 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.Cetuximab does not destroy the cancer's cell walls and does not stimulate the body's immune system or stunt cancer growth in that manner. Cetuximab also does not decrease blood flow to rapidly dividing cancer cells.

3. 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. Changes the nasogastric suction level from "intermittent" to "constant" C. Positions the patient in high-Fowler's position D. Prepares the patient for emergency surgery

ANS. D Prepares the patient for emergency surgery The first action the nurse takes for a patient with intestinal obstruction whose pain changes from "colicky" intermittent type to constant discomfort is to prepare the patient for emergency surgery. 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.

18. A 21-year-old with a stab wound to the abdomen has come to the emergency department (ED). Once stabilized, the patient is admitted to the medical-surgical unit. What does the admitting nurse do first for this patient? A. Administer pain medication. B. Assess skin temperature and color. C. Check on the amount of urine output. D. Take vital signs.

ANS. D Take vital signs. The admitting nurse needs to first take the vital signs of a patient who was just transferred from the ED with a stab wound to the abdomen. Assessment of vital signs must be done first to determine the adequacy of the airway and circulation. Vital signs initially reveal the most about the patient's condition.The patient would not be medicated for pain until his or her alertness level is determined. Skin temperature and color are not specifically indicative of the patient's overall condition. If the patient is in shock, urine output will be scant and will not be an accurate assessment variable.

9. A patient is being evaluated in the emergency department (ED) for a possible small bowel obstruction. Which signs/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 a great amount of vomiting

ANS. D Upper abdominal distention, metabolic alkalosis, and a great amount of vomiting A small bowel obstruction is characterized by upper or epigastric abdominal distention, metabolic alkalosis, and a great amount of vomiting.Intermittent lower abdominal cramping and metabolic acidosis are all symptoms of a large bowel obstruction.