Intestinal

Which statement made by a nursing student regarding hemorrhoids indicates a need for further learning? 1. "External hemorrhoids lie above the anal sphincter." 2. "Hemorrhoids are varicose veins of the rectum." 3. "Hemorrhoids are a common disorder that affects both men and women." 4. "Hemorrhoids may be caused or precipitated by straining during defecation or prolonged constipation."

1. "External hemorrhoids lie above the anal sphincter." Rationales Option 1: Internal hemorrhoids lie above the anal sphincter, and external hemorrhoids lie below the anal sphincter. Option 2: Hemorrhoids are swollen or dilated veins in the anorectal area, or in other words, they are varicose veins of the rectum. Option 3: Both men and women can be affected by hemorrhoids. Option 4: Straining during defecation and prolonged constipation are two of the major causes of hemorrhoids. [Page reference: 1270]

Which type of fistula occurs between the two parts of the intestines? 1. Enteroenteral 2. Enterovaginal 3. Enterovesicular 4. Enterocutaneous

1. Enteroenteral Rationales Option 1: In enteroenteral the fistula occurs between intestines. Option 2: In enterovaginal the fistula occurs between bowel and vagina. Option 3: In enterovesicular the fistula occurs between bowel and bladder. Option 4: In enterocutaneous the fistula occurs between skin and intestine. [Page reference: 1280]

Which instruction provided by a student nurse for a client with hemorrhoids may lead to further complications? 1. "Wash the surgical area gently and pat to keep it dry." 2. "Strain in order to have a regular bowel movement." 3. "Apply cold packs and use sitz baths to reduce pain." 4. "Include good sources of fluids and fiber in the diet."

2. "Strain in order to have a regular bowel movement." Rationales Option 1: The surgical area should be kept free from contaminants that may cause infection and should be washed gently and patted dry. Option 2: The client should avoid straining to have a bowel movement because it may increase inflammation and pain associated with hemorrhoids. Option 3: Nonpharmacological methods, such as cold packs and sitz baths, may be used to alleviate some pain associated with hemorrhoids. Option 4: The client should have good sources of fluids and fiber including whole grains, raw vegetables, and fruit in the diet to prevent constipation. [Page reference: 1272]

In which way are external hemorrhoids diagnosed? 1. Anoscopy 2. Visual inspection 3. Digital examination 4. Sigmoidoscopy

2. Visual inspection Rationales Option 1: Internal hemorrhoids are diagnosed by anoscopy. Option 2: External hemorrhoids are diagnosed by visual inspection. Option 3: Internal hemorrhoids are diagnosed by digital examination. Option 4: Internal hemorrhoids are diagnosed by sigmoidoscopy. [Page reference: 1270]

In which diagnostic study does the client swallow a pill to capture the image of the gastrointestinal tract to assess for colorectal cancer? 1. Lower gastrointestinal (GI) Series 2. Wireless capsule endoscopy 3. Virtual colonoscopy 4. Sigmoidoscopy

2. Wireless capsule endoscopy Rationales Option 1: A lower GI series is a diagnostic study in which a tube is inserted into the rectum and the large intestine is filled with barium. Option 2: Wireless capsule endoscopy is known as the pill camera; the client needs to swallow the pill to capture the image of the gastrointestinal tract. It takes 8 hours to pass through the gastrointestinal tract and then the photos are documented on a portable device. Option 3: A virtual colonoscopy is performed using either computerized tomography scanning or magnetic resonance imaging by using a tube inserted into the rectum. Option 4: A sigmoidoscopy is a diagnostic study in which a flexible tube with a light and camera is inserted in the rectum and colon up to the transverse colon. [Page reference: 1289]

Which statement made by a nursing student regarding a colonoscopy indicates a need for further learning? 1. "Biopsies can be taken and polyps can be removed during a colonoscopy." 2. "A colonoscopy is the gold standard for colorectal cancer screening." 3. "A colonoscopy involves taking x-ray images after performing a barium enema." 4. "A colonoscopy is an invasive procedure."

3. "A colonoscopy involves taking x-ray images after performing a barium enema." Rationales Option 1: By using a colonoscopy, biopsies can be taken and polyps can be removed during the procedure. Option 2: A colonoscopy is the gold standard for screening of colorectal cancer. Option 3: A colonoscopy does not involve the use of barium. X-ray images of the intestine are taken after a double-contrast barium enema. Option 4: Since a long, flexible tube with a light and camera on the end is inserted into the full length of the colon, a colonoscopy is an invasive procedure. [Page reference: 1289]

A client underwent a surgical procedure for grade 3 hemorrhoids. The RN is teaching the nursing student about the interventions that must be followed while caring for a client after surgery. Which statements made by the nursing student indicate effective understanding? Select all that apply. 1. "I will administer narcotic analgesics when pain is severe." 2. "I will apply local, moist heat immediately after surgically." 3. "I will administer docusate sodium for softening the stool." 4. "I will administer an analgesic before the first bowel movement." 5. "I will advise the client to reduce the fluid intake while on bulk laxatives."

3. "I will administer docusate sodium for softening the stool." 4. "I will administer an analgesic before the first bowel movement." Rationales Option 1: The nurse must not administer narcotic analgesics to the client since it may cause constipation that may further cause pain while defecating. Option 2: Local, moist heat can be applied to the site for soothing effect but it must not be applied immediately after the surgical procedure because it may lead to bleeding. Option 3: The nurse must administer over-the-counter medications such as docusate sodium, a stool softener. Option 4: The nurse must administer an analgesic before the first bowel movement because the first bowel movement may cause intense pain in the client. Option 5: While administering bulk laxatives such as hydrophilic psyllium. The nurse must advise the client to increase the fluid intake to avoid constipation. [Page reference: 1272]

Which statement made by a nursing student regarding toxic megacolon indicates a need for further learning? 1. "It occurs more commonly in ulcerative colitis and requires an emergency colectomy." 2. "It is colonic dilatation greater than 5 cm." 3. "It usually occurs during an acute exacerbation." 4. "Bacterial infection does not play any role in toxic megacolon."

4. "Bacterial infection does not play any role in toxic megacolon." Rationales Option 1: Toxic megacolon occurs more commonly in ulcerative colitis than in Crohn"s disease and requires an emergency colectomy. Option 2: Toxic megacolon is colonic dilatation greater than 5 cm. Option 3: Toxic megacolon occurs during an acute exacerbation of inflammatory bowel disease. Option 4: Bacterial overgrowth contributes to toxic megacolon. [Page reference: 1280]

A nurse is teaching a client with irritable bowel syndrome (IBS) about a precautionary measure that he or she needs to take in order to prevent further complications. Which statement made by the client indicates the need for further training? 1. "I should consume 10 grams of fiber each day." 2. "I should drink 8 to 10 cups of liquid per day." 3. "I should avoid drinking beverages that contain sorbitol or fructose." 4. "I should sleep at least 7 to 8 hours each night."

1. "I should consume 10 grams of fiber each day." Rationales Option 1: It is necessary to eat fiber rich foods because it helps in producing bulky, soft stools and prevents constipation and diarrhea. A client should consume 30 to 40 grams of fiber each day. Option 2: It is necessary to drink 8 to 10 cups of liquid per day to normalize stool consistency and frequency. Option 3: Beverages that contain sorbitol or fructose should be avoided because these trigger the symptoms of IBS. Option 4: To manage stress and anxiety and to ensure regular bowel habits, it is necessary to have adequate amounts of sleep. Therefore, a client should ensure at least 7 to 8 hours of sleep each night. [Page reference: 1276]

A nurse is assigned to teach a client with hemorrhoids. Which teachings of the nurse will help to facilitate fast recovery of the client? Select all that apply. 1. Advising the client to take a sitz bath to reduce the pain 2. Advising the client to avoid sitting for a long period of time 3. Advising the client to take docusate sodium if constipation is experienced 4. Advising the client to decrease fiber intake since it may increase bowel movements 5. Advising the client that urinary retention is normal and is caused by spasms

1. Advising the client to take a sitz bath to reduce the pain 2. Advising the client to avoid sitting for a long period of time 3. Advising the client to take docusate sodium if constipation is experienced Rationales Option 1: A sitz bath helps to reduce pain and provide comfort to the client. Option 2: Sitting for longer periods may increase inflammation and pain. Option 3: Docusate sodium is a stool softener that can be taken if constipation is experienced. Option 4: The client should increase the intake of fiber, which helps in easy bowel movements. Option 5: The client should report to a primary health-care provider if urinary retention is seen. [Page reference: 1272]

Which are appropriate measures for a nurse when caring for a client who has undergone a surgery for inguinal hernia? Select all that apply. 1. Advising the client to use splints when coughing 2. Instructing the client to avoid heavy lifting for a few days 3. Encouraging the client to do deep-breathing exercises 4. Advising the client to take medication when redness and swelling is observed 5. Instructing the client to avoid driving and operating machinery when pain medications are taken

1. Advising the client to use splints when coughing 3. Encouraging the client to do deep-breathing exercises 5. Instructing the client to avoid driving and operating machinery when pain medications are taken Rationales Option 1: The client should learn the use of splints when coughing since it promotes comfort and minimizes pain. Option 2: The client should not lift heavy weights for several weeks. Option 3: Deep-breathing exercises promote lung expansion. Option 4: The client should report to the primary health-care provider if redness and swelling are present. Option 5: The client should avoid driving and operating machinery since the drugs may cause dizziness. [Page reference: 1269]

The diagnostic report of a client with inflammatory bowel disease shows an increase in lymphocytes and mast cells. Which condition most likely is reflected by these findings? 1. Intestinal inflammation 2. Gastrointestinal motility 3. Visceral hypersensitivity 4. Psychosocial dysfunction

1. Intestinal inflammation Rationales Option 1: Intestinal inflammation is reflected by an increased number of lymphocytes and mast cells. Option 2: Gastrointestinal motility is not indicated by increased lymphocytes and mast cells. Option 3: Visceral hypersensitivity is not indicated by increased lymphocytes and mast cells. Option 4: Psychosocial dysfunction is not indicated by increased lymphocytes and mast cells. [Page reference: 1273]

Which intestinal disorder is diagnosed with the help of Manning criteria? 1. Irritable bowel syndrome 2. Hemorrhoids 3. Appendicitis 4. Colorectal cancer

1. Irritable bowel syndrome Rationales Option 1: Manning criteria is a diagnostic tool for diagnosing irritable bowel syndrome. Option 2: External hemorrhoids are diagnosed by visual inspection, and internal hemorrhoids are diagnosed by digital examination, anoscopy, and sigmoidoscopy. Irritable bowel syndrome is diagnosed by Manning criteria. Option 3: Appendicitis may be diagnosed by an ultrasound or a computerized tomography scan test. Manning criteria is used to diagnose irritable bowel syndrome. Option 4: Colonoscopy is used to diagnose colorectal cancer. Manning criteria is used for diagnosing irritable bowel syndrome. [Page reference: 1273]

A client with hemorrhoids is advised to have conservative therapy. Which methods are appropriate for the client? 1. Sitz bath 2. Sclerotherapy 3. Intravenous pain killers 4. Rubber band ligation

1. Sitz bath Rationales Option 1: A sitz bath is a conservative therapy that helps to reduce pain and provide comfort to the client. Option 2: Sclerotherapy is a surgery that involves the injection of a sclerosing agent into the hemorrhoid. Option 3: The client should contact a health-care provider when pain increases, and oral analgesics are considered conservative methods of treatment. Option 4: Rubber band ligation is a surgery in which a rubber band helps to constrict the circulation, causing the hemorrhoid to slough off. [Page reference: 1270]

A client who reports pain in the rectal area and blood in stools is diagnosed with hemorrhoids. Which nonpharmacological therapy is most appropriate to alleviate the symptoms? 1. Sitz bath 2. Use of suppositories 3. Rubber band ligation 4. Minimal weight lifting exercise

1. Sitz bath Rationales Option 1: A sitz bath is a warm bath that covers the hips and buttocks and that may relieve symptoms. Option 2: Suppositories can be used to treat hemorrhoids but are a pharmacological therapy. Option 3: Rubber band ligation is a surgery in which a rubber band helps to constrict the circulation, causing the hemorrhoid to slough off. Option 4: Lifting heavy weights may exacerbate the condition. [Page reference: 1270]

Which is applicable to a client with diverticulitis? Select all that apply. 1. The client needs gastric compression. 2. The client needs treatment with a sitz bath. 3. The client would require intravenous antibiotics. 4. The client must be prepared for the surgical procedure. 5. The client will require a mesh material to avoid recurrence.

1. The client needs gastric compression. 3. The client would require intravenous antibiotics. Rationales Option 1: Diverticulitis is the inflammation of diverticula, which are small pouch-like herniations in the colon. Treatment involves inpatient care requiring gastric compression. Option 2: Conservative treatment options, such as a sitz bath, oral analgesics, and application of ointments are used in hemorrhoids. Option 3: The client with diverticulitis, depending on the severity, may require outpatient or inpatient treatment by intravenous antibiotics. Option 4: The client who has appendicitis is immediately referred for surgical removal of the organ. Option 5: Clients who undergo surgical interventions require mesh-like material, which aids in the prevention of recurrence of hernia. [Page reference: 1299]

Which is true regarding umbilical hernias? Select all that apply. 1. They can be congenital and appear in infancy. 2. They may be caused by the intake of immunosuppressive medications. 3. They are more frequently seen in women than in men. 4. They are usually omentum or peritoneal fat that detains blood flow into the hernia. 5. They form from a previous abdominal surgical incision.

1. They can be congenital and appear in infancy. 3. They are more frequently seen in women than in men. 4. They are usually omentum or peritoneal fat that detains blood flow into the hernia. Rationales Option 1: Umbilical hernias can be congenital and appear in infancy. Congenital umbilical hernias can be closed in the first 12 to 18 months of life. Option 2: Umbilical hernias are caused by obesity or multiparity. Option 3: Umbilical hernias are more frequently seen in women than in men because of increased abdominal pressure. Option 4: Umbilical hernias are usually omentum or peritoneal fat, which may detain blood flow into the hernia. Option 5: Ventral hernias may form from a previous abdominal surgical incision. [Page reference: 1268]

The primary health-care provider suspects a hernia in a client who is on immunosuppressive medications after a kidney transplantation. Which type of hernia would the nurse expect in the client? 1. Ventral hernia 2. Femoral hernia 3. Umbilical hernia 4. Direct inguinal hernia

1. Ventral hernia Rationales Option 1: Ventral hernias may also be drug induced; administration of medications such as immunosuppressants would be a risk factor for ventral hernias. Option 2: Femoral hernias are more common in females than males. They are typically present below the inguinal ligament. Option 3: Umbilical hernias are caused by increased abdominal pressure, and it can also be caused by obesity or multiparity. Option 4: Direct inguinal hernia is caused by connective tissue degeneration that causes weakened muscles in adulthood. [Page reference: 1267, 1268]

The nurse is preparing a client with ulcerative colitis for colectomy. Which part of the digestive tract is removed during this procedure? 1. 1 2. 2 3. 3 4. 4

1. 1 Rationales Option 1: A client with ulcerative colitis for a long period of time may develop colon cancer. Colectomy is the removal of the large intestine. It helps to cure ulcerative colitis but does not cure the extraintestinal manifestations associated with ulcerative colitis. Option 2: Colectomy does not involve the removal of the small intestine. Option 3: An appendectomy is the surgical removal of the appendix. It helps in the management of appendicitis. Option 4: Colectomy does not involve removal of the rectum. A proctocolectomy is the surgical removal of the rectum and colon. [Page reference: 1277]

Which surgical technique uses liquid nitrogen to freeze the hemorrhoid? 1. Rubber band ligation 2. Cryosurgery 3. Sclerotherapy 4. Bipolar, infrared, and laser coagulation

2. Cryosurgery Rationales Option 1: Rubber band ligation is a surgical technique that places a rubber band around the base of the hemorrhoid to constrict circulation, causing the hemorrhoid to slough off in 2 to 4 days. Option 2: Cryosurgery is a surgical technique that uses liquid nitrogen to freeze hemorrhoids. Option 3: Sclerotherapy is a surgical technique that involves injecting a sclerosing agent directly into a hemorrhoid. Option 4: Bipolar, infrared, and laser coagulation is a surgical technique that uses bipolar current or infrared or laser light, which causes coagulation and necrosis of the hemorrhoid. [Page reference: 1271]

Which type of fistula occurs between the bowel and bladder? 1. Enterocutaneous fistula 2. Enterovesicular fistula 3. Enteroenteral fistula 4. Enterovaginal fistula

2. Enterovesicular fistula Rationales Option 1: Enterocutaneous fistula may occur between the skin and intestine. Option 2: Enterovesicular fistula may occur between the bowel and bladder. Option 3: Enteroenteral fistula may occur between the intestine and intestine. Option 4: Enterovaginal fistula may occur between the bowel and vagina. [Page reference: 1280]

Which is the typical stool consistency in a client with a sigmoid colostomy? 1. Semi-liquid 2. Formed 3. Semi-liquid to semi-formed 4. Liquid to semi-liquid

2. Formed Rationales Option 1: In an ascending colostomy, the stool is semi-liquid. A client with a sigmoid colostomy generally passes stools, which are formed. Option 2: A client with a sigmoid colostomy passes formed stools. Option 3: In a transverse colostomy, the stool is semi-liquid to semi-formed. Formed stools are associated with a sigmoid colostomy. Option 4: In an ileostomy, the stool is liquid to semi-liquid. The texture of stool in a sigmoid colostomy is formed. [Page reference: 1295-1296]

Which grade, according to the standard grading system, is given to an internal hemorrhoid that prolapses upon defecation but reduces spontaneously? 1. Grade 1 2. Grade 2 3. Grade 3 4. Grade 4

2. Grade 2 Rationales Option 1: In grade 1 the hemorrhoids do not prolapse. Option 2: In grade 2 the hemorrhoids prolapse upon defecation but reduce spontaneously. Option 3: In grade 3 the hemorrhoids prolapse upon defecation but reduce manually. Option 4: In grade 4 the hemorrhoids are prolapsed and cannot be reduced manually. [Page reference: 1270]

Which interventions should a nurse implement for a client after colorectal surgery? Select all that apply. 1. Take vital signs of the client every 48 hours. 2. Monitor white blood cell count every day for the first few days. 3. Check if the urine output is at least 10 mL/hour during the first 24 hours. 4. Check if the stoma is reddish pink and moist. 5. Ensure that the client does not receive food and water per order.

2. Monitor white blood cell count every day for the first few days. 4. Check if the stoma is reddish pink and moist. 5. Ensure that the client does not receive food and water per order. Rationales Option 1: To measure physiologic functioning, the nurse should take vital signs every 4 hours. Option 2: The nurse should monitor the white blood cell count of the client every day because an increase in the level may indicate infection and other complications. Option 3: Although it is quite normal to have a low urine output compared with intake in the first 24 hours, it should be at least 30 mL/hour. Option 4: The nurse should check if the stoma is reddish pink and moist because any discoloration might indicate necrosis and should be reported to the primary health-care provider. Option 5: To prevent nausea and vomiting, the client should be not be given anything by mouth postsurgery until bowel function returns. [Page reference: 1293]

The nurse is assisting the primary health-care provider (PHP) while performing a surgery for a client with grade 4 hemorrhoids. The PHP injects an agent into the hemorrhoid for its disintegration. Which surgical technique could be used? 1. Cryosurgery 2. Sclerotherapy 3. Hemorrhoidectomy 4. Laser coagulation

2. Sclerotherapy Rationales Option 1: Cryosurgery uses liquid nitrogen to freeze the hemorrhoid. Sclerosing agents are not injected. Option 2: Surgical intervention is beneficial for clients who are diagnosed with grade 4 hemorrhoids. In sclerotherapy a sclerosing agent is injected directly into the hemorrhoid; this causes an inflammatory reaction leading to the vessel disintegration. Option 3: In hemorrhoidectomy an excision is made near the vein and is sutured or left open to heal. Option 4: Laser coagulation therapy uses bipolar current or infrared or laser light that causes coagulation and necrosis of the hemorrhoid. [Page reference: 1271]

A client reports pain in the abdomen and fever. Which other symptoms of the client will help to diagnose the condition as diverticulitis? Select all that apply. 1. Vomiting 2. Tachycardia 3. Blood in stools 4. Elevated red blood cell count 5. Elevated white blood cell count

2. Tachycardia 3. Blood in stools 5. Elevated white blood cell count Rationales Option 1: Vomiting is not a symptom of diverticulitis. Option 2: Tachycardia can accompany fever, which can is a clinical manifestation of diverticulitis. Option 3: Blood in the stool is a clinical manifestation of diverticulitis. Option 4: The red blood cell count typically decreases as the blood is lost in the stools. Option 5: The white blood cells may be elevated because of the presence of infection. [Page reference: 1284]

Which is true regarding a client who has undergone an appendectomy with no complications? 1. The client requires a laparotomy. 2. The client must not administer any laxatives. 3. The client requires parenteral antibiotics. 4. The client can be discharged after 2 days.

2. The client must not administer any laxatives. Rationales Option 1: A laparotomy is required in clients who have complications such as rupture of the appendix or peritonitis. Option 2: The nurse must not administer laxatives and enemas that lead to the perforation of the appendix. Option 3: The client who has complications such as peritonitis requires parenteral antibiotic therapy. Option 4: The client who has no complications can be discharged the same day or the following day. [Page reference: 1286]

Which is true regarding a direct inguinal hernia? 1. It is more common in women than in men. 2. The incidence is higher in men. 3. It is known as congenital hernia. 4. It is usually related to obesity or multiparity in women.

2. The incidence is higher in men. Rationales Option 1: Femoral hernias are more common in women than in men. Direct inguinal hernias usually occur in men. Option 2: Direct inguinal hernias only occur in men. Option 3: Indirect inguinal hernias, which are also known as congenital hernias, develop in the womb. Option 4: Umbilical hernias are caused by increased abdominal pressure and are usually related to obesity or multiparity (given birth to more than one child) in women. [Page reference: 1268]

Which section of the digestive tract has villi to aid in the digestion process? 1. 1 2. 2 3. 3 4. 4

3. 3 Rationales Option 1: The esophagus is a hollow muscular tube. The mucosa of the esophagus consists of nonkeratinized stratified squamous epithelium. Option 2: The stomach has three glands, gastric, pyloric and cardiac. These glands consist of specialized cells which secrete several chemicals essential to the digestive functions of the stomach. Option 3: Villi are finger like projections in the lining of the small intestine. Each villus has goblet cells which secrete mucus and enterocytes which aid in absorption. Option 4: The large intestine receives only indigestible fibers after the villi in the small intestine has absorbed the nutrients. [Page reference: 1202]

Which symptoms are commonly seen in elderly adult clients with diverticulitis? 1. High fever 2. Decreased white blood cell (WBC) count 3. Altered mental status 4. Severe abdominal tenderness

3. Altered mental status Rationales Option 1: An elderly adult client with diverticulitis may have a normal body temperature. Option 2: An elderly adult client with diverticulitis may have a normal WBC count. Option 3: An elderly adult client with diverticulitis may have altered mental status. Option 4: An elderly adult client with diverticulitis may have a minimal amount of abdominal tenderness. [Page reference: 1283, 1285]

Which intervention is considered a conservative treatment for hemorrhoids? 1. Bipolar, infrared, and laser coagulation 2. Sclerotherapy 3. Sitz bath 4. Hemorrhoidectomy

3. Sitz bath Rationales Option 1: Bipolar, infrared, and laser coagulation are surgical methods that use bipolar current or infrared or laser light to treat hemorrhoids. Option 2: Sclerotherapy is a surgical method that involves injecting a sclerosing agent directly into the hemorrhoid. Option 3: A sitz bath is a conservative treatment in which a warm water bath covering the hips and buttocks is used 3 to 4 times a day to reduce swelling and pain. Option 4: A hemorrhoidectomy is a surgical method for treating hemorrhoids that involves excision of the vein. [Page reference: 1270]

Which serotonergic agent used for the treatment of inflammatory bowel disease was withdrawn from the market because of a risk of heart attack? 1. Paroxetine 2. Alosetron 3. Tegaserod 4. Lubiprostone

3. Tegaserod Rationales Option 1: Paroxetine is a selective serotonin reuptake inhibitor, which decreases the pain. Option 2: Alosetron was withdrawn from the market since it caused ischemic colitis and severe pain. Option 3: Tegaserod was withdrawn from the market since it had a risk of causing heart attack. Option 4: Lubiprostone is a selective type 2 chloride channel activator for constipation associated with IBD in females. [Page reference: 1275]

A client who is a mother of two children reports pain and bulging in the abdominal region and is diagnosed with a hernia. Which type of hernia is most likely present in the client based on the symptoms and history? 1. Femoral hernia 2. Inguinal hernia 3. Umbilical hernia 4. Incisional hernia

3. Umbilical hernia Rationales Option 1: Femoral hernia is more common in females. The fat present in the femoral canal pulls the contents from peritoneum into the hernia sac. Option 2: Inguinal hernia is more common in males. It occurs in the groin between the abdomen and thigh. Option 3: Umbilical hernia occurs frequently in females because of an increase in abdominal pressure and multiparity. Option 4: Incisional hernia may be caused by previous surgical incision and by inadequate healing or nutritional deficiency. [Page reference: 1268]

Which type of hernia is seen in infancy? 1. Ventral hernia 2. Femoral hernia 3. Umbilical hernia 4. Direct inguinal hernia

3. Umbilical hernia Rationales Option 1: Ventral hernias occur in adults and are caused by connective tissue disorders, smoking, or obesity. Option 2: Femoral hernias are not confined to infancy. They occur in adulthood and need emergency treatment. Option 3: Umbilical hernias can also be congenital, like indirect inguinal hernias. These hernias appear in infancy and close up in the first 12 to 18 months of life. Option 4: Direct inguinal hernias occur in adulthood because of connective tissue degeneration and cause muscle weakness [Page reference: 1268]

A client with Crohn's disease has had an ileal resection. Which noninvasive monthly treatment is this client most likely to require? 1. Gastric decompression 2. Inpatient care for bowel rest 3. Vitamin B12 injections 4. Total parenteral nutrition (TPN)

3. Vitamin B12 injections Rationales Option 1: Gastric decompression is a procedure performed in the clients with inflammatory bowel disease, however it is not noninvasive and is not necessarily related to the ileum. Option 2: A client with inflammatory bowel disease may need hospitalization for providing bowel rest; however it is unlikely that it is a monthly treatment. Option 3: A client with Crohn's disease who has had an ileal resection may require monthly B12 injections, due to the body's inability to absorb the nutrient properly. Option 4: A client with severe inflammatory bowel disease may require TPN to properly sustain the body; however it is unlikely that it is required on a monthly basis. [Page reference: 1279]

Which point made by a nursing student regarding ulcerative colitis indicates a need for further learning? 1. "It can be cured by a total colectomy." 2. "It affects the large intestine and involves only the mucosa and submucosa." 3. "It involves abdominal pain and tenderness that is worse in the left lower quadrant." 4. "It is rarely associated with diarrhea, and bloody stool is uncommon."

4. "It is rarely associated with diarrhea, and bloody stool is uncommon." Rationales Option 1: A total colectomy is a surgical cure for ulcerative colitis. Option 2: Ulcerative colitis affects the large intestine and involves only the mucosa and submucosa. Option 3: In ulcerative colitis, abdominal pain and tenderness are worse in the left lower quadrant. Option 4: Diarrhea is common and severe in ulcerative colitis, and a client may pass more than 20 stools per day. Blood, mucus, and pus are common with ulcerative colitis. [Page reference: 1278]

Which nursing action taken may lead to further complications in the client with diverticulitis? 1. Administering antibiotics 2. Administering IV fluids 3. Administering opiates 4. Administering laxatives

4. Administering laxatives Rationales Option 1: Antibiotics are administered to relieve pain, inflammation, infection, and fever. Option 2: IV fluids are administered to maintain the fluid balance. Option 3: Opiates should be administered per order to relieve pain. Option 4: Laxatives should not be administered because they may increase intestinal motility. [Page reference: 1284]

Which is the primary goal of treatment in the client diagnosed with ulcerative colitis? 1. Combating stress 2. Combating infection 3. Correcting malnutrition 4. Controlling inflammation

4. Controlling inflammation Rationales Option 1: The reduction in inflammation may reduce the symptoms, which may result in reduction in the stress. Option 2: Inflammation should be reduced to prevent complications, and then infection can be reduced. Option 3: Malnutrition can be corrected after reducing the inflammation. Option 4: Controlling inflammation is the primary goal for the treatment of ulcerative colitis. [Page reference: 1278]

Which part of the colon lies on the left side of the abdomen from the splenic flexure? 1. Sigmoid colon 2. Ascending colon 3. Transverse colon 4. Descending colon

4. Descending colon Rationales Option 1: Sigmoid colon is the lower S-shaped curve extending to the rectum. Option 2: Ascending colon is on the right side of the abdomen extending upward. Option 3: Transverse colon is horizontally across the abdomen from the hepatic flexure to the splenic flexure. Option 4: Descending colon is on the left side of the abdomen from the splenic flexure and extends downward to the sigmoid colon. [Page reference: 1267]

An LPN is talking with a student nurse about the symptoms of a client diagnosed with irritable bowel syndrome (IBS). Which symptom listed by the student nurse indicates a need for further discussion? 1. Sensation of incomplete evacuation 2. More frequent stools at the onset of pain 3. Visible abdominal distension 4. Hard stools at the onset of pain

4. Hard stools at the onset of pain Rationales Option 1: A sensation of incomplete evacuation is a symptom of IBS. Option 2: More frequent stools at the onset of pain are a symptom of IBS. Option 3: Visible abdominal distension is a symptom of IBS. Option 4: Looser stools at the onset of pain are a symptom of IBS. [Page reference: 1273]

Which statement is true regarding the direct inguinal hernia? 1. It develops in the womb. 2. It occurs in males and females. 3. It is also called as congenital hernia. 4. It causes weakness of muscles in adulthood.

4. It causes weakness of muscles in adulthood. Rationales Option 1: Indirect inguinal hernias develop in the womb. Option 2: Direct inguinal hernia occurs only in males and is caused by connective tissue degeneration that causes weakened muscles in adulthood. Option 3: Indirect inguinal hernia, also called congenital hernia, develops in the womb. Option 4: Direct inguinal hernia causes weakened muscles in adulthood caused by connective tissue degeneration. [Page reference: 1268]

Which commonly used surgical technique allows the hemorrhoid to slough off in 2 to 4 days? 1. Cryosurgery 2. Sclerotherapy 3. Bipolar coagulation 4. Rubber band ligation

4. Rubber band ligation Rationales Option 1: In cryosurgery the hemorrhoid is frozen with the help of liquid nitrogen. The procedure is associated with intense pain and is not the most widely preferred method. Option 2: In sclerotherapy the hemorrhoid usually dries up or disintegrates. Option 3: In bipolar coagulation a bipolar current causes coagulation and necrosis of the hemorrhoid, leaving fibrosis in the submucosal layer. Option 4: Rubber band ligation is a commonly used surgical technique. A rubber band is placed around the base of the hemorrhoid, constricting the blood circulation to the hemorrhoid and sloughing it off in 2 to 4 days. [Page reference: 1271]

Which is true regarding diverticulitis? 1. This occurs frequently in the jejunum. 2. This can be seen more frequently in vegetarians. 3. This is more common in newborns. 4. This occurs more in Western industrialized societies

4. This occurs more in Western industrialized societies. Rationales Option 1: Diverticulitis mostly occurs in the gastrointestinal tract, mainly the colon. Option 2: Vegetarians are less affected by diverticulitis. Option 3: Elderly adults are more affected than other age groups. Option 4: Diverticulitis can be found more in Western industrialized societies than in Asian and African populations. [Page reference: 1283]