PrepU: Chapter 47 Intestinal & Rectal Disorders

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? -Low residue -Low protein -Calorie restriction -Iron restriction

-Low residue Oral fluids and a low-residue, high-protein, high-calorie diet with supplemental vitamin therapy and iron replacement are prescribed to meet the nutritional needs, reduce inflammation, and control pain and diarrhea.

The nurse is caring for a patient who has malabsorption syndrome with an undetermined cause. What procedure will the nurse assist with that is the best diagnostic test for this illness? -Ultrasound -Endoscopy with mucosal biopsy -Stool specimen for ova and parasites -Pancreatic function tests

-Endoscopy with mucosal biopsy Endoscopy with biopsy of the mucosa is the best diagnostic tool for malabsorption syndrome.

Which of the following is considered a bulk-forming laxative? -Metamucil -Milk of Magnesia -Mineral oil -Dulcolax

-Metamucil Metamucil is a bulk-forming laxative. Milk of Magnesia is classified as a saline agent. Mineral oil is a lubricant. Dulcolax is a stimulant.

Patients diagnosed with malabsorption syndrome may have vitamin and mineral deficiency. Patient who easily bleed have which of the following deficiencies? -Vitamin K -Calcium -Iron -B12

-Vitamin K The chief result of malabsorption is malnutrition, manifested by weight loss and other signs of vitamin and mineral deficiency (e.g., easy bruising [vitamin K deficiency], osteoporosis [calcium deficiency], and anemia [iron, vitamin B12 deficiency]).

Which of the following is the most common symptom of a polyp? -Rectal bleeding -Abdominal pain -Diarrhea -Anorexia

-Rectal bleeding The most common symptom is rectal bleeding. Lower abdominal pain may also occur. Diarrhea and anorexia are clinical manifestations of ulcerative colitis.

After teaching a group of students about irritable bowel syndrome and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an opiate-related antidiarrheal agent? -Loperamide -Bismuth subsalicylate -Kaolin and pectin -Bisacodyl

-Loperamide Loperamide and diphenoxylate with atropine sulfate are examples of opiate-related antidiarrheal agents. Bismuth subsalicylate and kaolin and pectin are examples of absorbent antidiarrheal agents. Bisacodyl is a chemical stimulant laxative.

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of: -A pelvic abscess. -Peritonitis -An ileus. -An abscess under the diaphragm.

-Peritonitis Peritonitis is inflammation of the peritoneum, the serous membrane lining the abdominal cavity and covering the viscera. Peritonitis is typically a life-threatening emergency that requires prompt surgical intervention, and typically involves postoperative critical care monitoring due to the risk of sepsis, organ failure, and subsequent infections.

A 72-year-old client seeks help for chronic constipation. Constipation is a common problem for elderly clients because of several factors related to aging, including: -increased intestinal motility. -decreased abdominal strength. -increased intestinal bacteria. -decreased production of hydrochloric acid.

-decreased abdominal strength. Decreased abdominal strength, muscle tone of the intestinal wall, and motility all contribute to chronic constipation in the elderly. A decrease in hydrochloric acid causes a decrease in absorption of iron and vitamin B12, whereas an increase in intestinal bacteria actually causes diarrhea.

Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction? -Sudden, sustained abdominal pain -Decreased urine output -Decreased blood pressure -Purulent drainage from the gluteal fold

-Sudden, sustained abdominal pain Sudden, sustained pain, abdominal distention, and fever are symptoms of perforation in a client with intestinal obstruction. A decrease in blood pressure and decrease in urine output are symptoms of shock. Purulent drainage from the gluteal fold is not a symptom of perforation; it only indicates that the client has developed a condition of anorectal abscess.

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? -Age younger than 40 years -Low-fat, low-protein, high-fiber diet -History of skin cancer -Familial polyposis

-Familial polyposis Family history of colon cancer or familial polyposis is a risk factor for colorectal cancer. Age older than 40 years andd a high-fat, high-protein, low-fiber diet are risk factors for colorectal cancer. A history of skin cancer is not a recognized risk factor for colorectal cancer.

nurse expect the client to report? Select all that apply. -narrowing of stools -constipation -black, tarry stools -tenesmus

-constipation -narrowing of stools Abdominal pain and cramping, narrowing of stools, constipation, abdominal distension, and bright red blood in stools are symptoms associated with cancer in the descending colon. Black, tarry stools and tenesmus are symptoms associated with cancer in the ascending colon.

Which of the following would a nurse expect to assess in a client with peritonitis? -Deep slow respirations -Decreased pulse rate -Hyperactive bowel sounds -Board-like abdomen

-Board-like abdomen The client with peritonitis would typically exhibit a rigid, board-like abdomen, with absent bowel sounds, elevated pulse rate, and rapid, shallow respirations.

A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation? -Provide adequate quantity of food. -Obtain medical and allergy history. -Assist client to increase dietary fiber. -Obtain complete food history.

-Assist client to increase dietary fiber. The nurse should assist the client to increase the dietary fiber in her food because it helps reduce constipation. Providing an adequate quantity of food is necessary in maintaining sufficient nutrition and in sustaining normal body weight. Obtaining medical, allergy, and food history would provide valuable information, however, it would not help reduce constipation.

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process? -Hypotension -Subnormal temperature -Bradycardia -Normal erythrocyte sedimentation rate (ESR)

-Hypotension Clinical manifestations include hypotension, increased temperature, tachycardia, and elevated ESR.

Which is a true statement regarding regional enteritis (Crohn's disease)? -It has a progressive disease pattern. -It is characterized by pain in the lower left abdominal quadrant. -The clusters of ulcers take on a cobblestone appearance. -The lesions are in continuous contact with one another.

-The clusters of ulcers take on a cobblestone appearance. The clusters of ulcers take on a cobblestone appearance. It is characterized by remissions and exacerbations. The pain is located in the lower right quadrant. The lesions are not in continuous contact with one another and are separated by normal tissue.

A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult? -"I don't understand this; I took the medication the doctor ordered and followed the diet." -"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." -"I don't understand why this happened again; I didn't travel out of the country." -"I don't like oatmeal, so it doesn't matter that I can't have it."

-"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." The client stating that he ate roast beef on rye bread indicates the need for a dietary consult because rye bread contains gluten, which must be eliminated from the client's diet. The client stating that he's followed the ordered medication regimen and diet doesn't suggest that the client needs a dietary consult; a treatment regimen consisting of medications to improve symptoms and dietary modification is necessary to treat celiac disease. The client stating that he hasn't traveled outside of the country doesn't suggest that dietary concerns exist. The client saying that he can't have oatmeal shows an understanding of the dietary restrictions necessary with celiac disease.

Medical management of a patient with peritonitis includes fluid, electrolyte, and colloid replacement. The nurse knows to prepare the initial, most appropriate intravenous solution. Which of the following is the correct solution? -0.9% NS -D5W -D10W -0.45% of NS

-0.9% NS The administration of several liters of an isotonic solution is immediately prescribed. Hypovolemia occurs because massive amounts of fluid and electrolytes move from the intestinal lumen into the peritoneal cavity and deplete the fluid in the vascular space.

A patient is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling? -Colonoscopy -Barium enema -Flexible sigmoidoscopy -CT scan

-Colonoscopy Diverticulosis is typically diagnosed by colonoscopy, which permits visualization of the extent of diverticular disease and biopsy of tissue to rule out other diseases. In the past, barium enema was the preferred diagnostic test, but it is now used less frequently than colonoscopy. CT with contrast agent is the diagnostic test of choice if the suspected diagnosis is diverticulitis; it can also reveal abscesses.

A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of: -A small bowel disorder. -Intestinal malabsorption. -Inflammatory colitis. -A disorder of the large bowel.

-Intestinal malabsorption. Watery stools are characteristic of disorders of the small bowel, whereas loose, semisolid stools are associated more often with disorders of the large bowel. Large, greasy stools suggest intestinal malabsorption, and the presence of mucus and pus in the stools suggests inflammatory enteritis or colitis.

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

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

A nurse is interviewing a client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? -Duodenal ulcers -Hemorrhoids -Weight gain -Polyps

-Polyps Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: -caffeinated products. -spicy foods. -high-fiber diet. -fluids with meals.

-high-fiber diet. A high-fiber diet is prescribed to help control diarrhea and constipation. Foods that are possible irritants, such as caffeine, spicy foods, lactose, beans, fried foods, corn, wheat, and alcohol, should be avoided. Fluids should not be taken with meals because they cause abdominal distention.

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? -Cutting the faceplate opening no more than 2? larger than the stoma -Gently washing the area surrounding the stoma using a facecloth and mild soap -Scrubbing fecal material from the skin surrounding the stoma -Maintaining wrinkles in the faceplate so it doesn't irritate the skin

-Gently washing the area surrounding the stoma using a facecloth and mild soap For a client with an ostomy, maintaining skin integrity is a priority. The nurse should gently wash the area surrounding the stoma using a facecloth and mild soap. Scrubbing the area around the stoma can damage the skin and cause bleeding. The faceplate opening should be no more than 1/8? to 1/6? larger than the stoma. This size protects the skin from exposure to irritating fecal material. The nurse can create an adequate seal and prevent leakage of fecal material from under the faceplate by applying a thin layer of skin barrier and smoothing out wrinkles in the faceplate. Eliminating wrinkles in the faceplate also protects the skin surrounding the stoma from pressure.

The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation? -Alcohol consumption -Activity levels -Usual pattern of elimination -Current medications

-Usual pattern of elimination Constipation has many possible reasons and assessing the client's usual pattern of elimination is the first step in identifying the cause. The nurse should obtain a description of the bowel elimination pattern, asking about the frequency, overall appearance and consistency of stool, blood in the stool, pain, and effort necessary to pass stool. It is also essential for the nurse to review the client's current medications, diet, and activity levels.

The nurse is assigned to care for a patient 2 days after an appendectomy due to a ruptured appendix with resultant peritonitis. The nurse has just assisted the patient with ambulation to the bedside commode when the patient points to the surgical site and informs the nurse that "something gave way." What does the nurse suspect may have occurred? -A drain may have become dislodged. -Wound dehiscence has occurred. -Infection has developed. -The surgical wound has begun to bleed.

-Wound dehiscence has occurred. Any suggestion from the patient that an area of the abdomen is tender or painful or "feels as if something just gave way" must be reported. The sudden occurrence of serosanguineous wound drainage strongly suggests wound dehiscence (see Chapter 19).

A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a: -fissure. -fistula. -hemorrhoid. -pilonidal cyst.

-fissure. An anal fissure (fissure in ano) is a linear tear in the anal canal tissue. An anal fistula (fistula in ano) is a tract that forms in the anal canal. Hemorrhoids are dilated veins outside or inside the anal sphincter. A pilonidal sinus is an infection in the hair follicles in the sacrococcygeal area above the anus.

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

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

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

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

The nurse is conducting a gastrointestinal assessment. When the client reports the presence of mucus and pus in the stool, the nurse assesses for additional signs/symptoms of which disease/condition? -Small-bowel disease -Ulcerative colitis -Disorders of the colon -Intestinal malabsorption

-Ulcerative colitis The presence of mucus and pus in the stool suggests ulcerative colitis. Watery stools are characteristic of small-bowel disease. Loose, semisolid stools are associated more often with disorders of the colon. Voluminous, greasy stools suggest intestinal malabsorption.

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's: -usual pattern of elimination. -alcohol consumption. -activity levels. -current medications.

-usual pattern of elimination. Constipation has many possible reasons; assessing the client's usual pattern of elimination is the first step in identifying the cause.

When preparing a client for a hemorrhoidectomy, the nurse should take which action? -Administer an enema as ordered. -Administer oral antibiotics as ordered. -Administer topical antibiotics as ordered. -Administer analgesics as ordered.

-Administer an enema as ordered. When preparing a client for a hemorrhoidectomy, the nurse should administer an enema, as ordered, and record the results. After surgery, the client may require antibiotics and analgesics.

The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition? -Borborygmus -Tenesmus -Azotorrhea -Diverticulitis

-Borborygmus Borborygmus is the intestinal rumbling caused by the movement of gas through the intestines that accompanies diarrhea. Tenesmus refers to ineffectual straining at stool. Azotorrhea refers to excess of nitrogenous matter in the feces or urine. Diverticulitis refers to inflammation of a diverticulum from obstruction (by fecal matter) resulting in abscess formation.

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

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

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

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

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse? -Inform the patient that it will only last a minute and continue with the procedure. -Clamp the tubing and give the patient a rest period. -Stop the irrigation and remove the tube. -Replace the fluid with cooler water since it is probably too warm.

-Clamp the tubing and give the patient a rest period. When irrigating a colostomy, the nurse should allow tepid fluid to enter the colon slowly. If cramping occurs, the nurse should clamp off the tubing and allow the patient to rest before progressing. Water should flow in over a 5- to 10-minute period.

The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching? -Avoid unprocessed bran. -Avoid daily exercise. -Drink 8 to 10 glasses of fluid daily. -Use laxatives weekly.

-Drink 8 to 10 glasses of fluid daily. The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the physician. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.

The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation? -Dry skin thoroughly after washing -Apply barrier powder -Apply triamcinolone acetonide spray -Dust with nystatin powder

-Dry skin thoroughly after washing The nurse should teach the client without peristomal skin irritation to dry the skin thoroughly after washing. Barrier powder, triamcinolone acetonide spray, and nystatin powder are used when the client has peristomal skin irritation and/or fungal infection.

A client has been recently diagnosed with an anorectal condition. The nurse is reviewing interventions that will assist the client with managing the therapeutic regimen. What would not be included? -Encourage the client to avoid exercise. -Instruct the client to cleanse perianal area with warm water. -Teach the client how to do sitz baths at home using warm water three to four times each day. -Encourage the client to follow diet and medication instructions.

-Encourage the client to avoid exercise. Activity promotes healing and normal stool patterns. Proper cleansing prevents infection and irritation. Sitz baths promote healing, decrease skin irritation, and relieve rectal spasms. Encouragement promotes compliance with therapeutic regimen and prevents complications.

A client underwent a continent ileostomy. Within which time frame should the client expect to empty the reservoir? -At least once a day -At least once every 2 days -Three or four times daily -Every 4 to 6 hours

-Every 4 to 6 hours The length of time between drainage periods is gradually increased until the reservoir needs to be drained only every 4 to 6 hours and irrigated once each day. This prevents the accumulating effluent from spilling or causing infection.

The nurse in an extended-care facility reports that a resident has clinical manifestations of fecal incontinence. The health care provider orders a diagnostic study to rule out inflammation. The nurse would prepare the patient for which of the following? -Anorectal manometry -Transit study -Flexible sigmoidoscopy -Barium enema

-Flexible sigmoidoscopy The treatment of fecal incontinence depends on the cause. A rectal examination and other endoscopic examinations, such as a flexible sigmoidoscopy, are performed to rule out tumors, inflammation, or fissures. X-ray studies such as barium enema, computed tomography (CT), anorectal manometry, and transit studies may be helpful in identifying alterations in intestinal mucosa and muscle tone or in detecting other structural or functional problems.

Crohn's disease is a condition of malabsorption caused by which pathophysiological process? -Inflammation of all layers of intestinal mucosa -Infectious disease -Disaccharidase deficiency -Gastric resection

-Inflammation of all layers of intestinal mucosa Crohn's disease is also known as regional enteritis and can occur anywhere along the gastrointestinal tract, but most commonly at the distal ileum and in the colon. Infectious disease causes problems such as small-bowel bacterial overgrowth, leading to malabsorption. Disaccharidase deficiency leads to lactose intolerance. Postoperative malabsorption occurs after gastric or intestinal resection.

The nurse is conducting a community education program on colorectal cancer. Which statement should the nurse include in the program? -It is the third most common cancer in the United States. -The lifetime risk of developing colorectal cancer is 1 in 10. -The incidence of colorectal cancer decreases with age. -Colorectal cancer has no hereditary component.

-It is the third most common cancer in the United States. Colorectal cancer is the third most common type of cancer in the United States. The lifetime risk of developing colorectal cancer is 1 in 20. The incidence increases with age (the incidence is highest in people older than 85). Colorectal cancer occurrence is higher in people with a family history of colon cancer.

A patient with irritable bowel syndrome has been having more frequent symptoms lately and is not sure what lifestyle changes may have occurred. What suggestion can the nurse provide to identify a trigger for the symptoms? -Document how much fluid is being taken to determine if the patient is overhydrating. -Discontinue the use of any medication presently being taken to determine if medication is a trigger. -Begin an exercise regimen and biofeedback to determine if external stress is a trigger. -Keep a 1- to 2-week symptom and food diary to identify food triggers.

-Keep a 1- to 2-week symptom and food diary to identify food triggers. The nurse emphasizes and reinforces good dietary habits (e.g., avoidance of food triggers). A good way to identify problem foods is to keep a 1- to 2-week symptom and food diary.

The nurse is caring for an older adult patient experiencing fecal incontinence. When planning the care of this patient, what should the nurse designate as a priority goal? -Maintaining skin integrity -Beginning a bowel program to establish continence -Instituting a diet high in fiber and increase fluid intake -Determining the need for surgical intervention to correct the problem

-Maintaining skin integrity Fecal incontinence can disrupt perineal skin integrity. Maintaining skin integrity is a priority, especially in the debilitated or older adult patient.

Celiac sprue is an example of which category of malabsorption? -Infectious diseases causing generalized malabsorption -Mucosal disorders causing generalized malabsorption -Luminal problems causing malabsorption -Postoperative malabsorption

-Mucosal disorders causing generalized malabsorption In addition to celiac sprue, regional enteritis and radiation enteritis are examples of mucosal disorders. Examples of infectious diseases causing generalized malabsorption include small-bowel bacterial overgrowth, tropical sprue, and Whipple disease. Examples of luminal problems causing malabsorption include bile acid deficiency, Zollinger-Ellison syndrome, and pancreatic insufficiency. Postoperative gastric or intestinal resection can result in development of malabsorption syndromes.

The nurse is admitting a patient with a diagnosis of diverticulitis and assesses that the patient has a boardlike abdomen, no bowel sounds, and complains of severe abdominal pain. What is the nurse's first action? -Start an IV with lactated Ringer's solution. -Notify the physician. -Administer a retention enema. -Administer an opioid analgesic.

-Notify the physician. Abdominal pain, a rigid boardlike abdomen, loss of bowel sounds, and signs and symptoms of shock occur with peritonitis. Peritonitis is typically a life-threatening emergency that requires prompt surgical intervention, and typically involves postoperative critical care monitoring due to the risk of sepsis, organ failure, and subsequent infections; thus, the nurse should notify the physician.

When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? -Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. -Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. -The appendix may develop gangrene and rupture, especially in a middle-aged client. -Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

-Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. A client with appendicitis is at Risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Elderly, not middle-aged, clients are especially susceptible to appendix rupture.

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location? -Right upper quadrant -Right lower quadrant -Left upper quadrant -Left lower quadrant

-Right lower quadrant The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation? -Alcohol consumption -Activity levels -Usual pattern of elimination -Current medications

-Usual pattern of elimination Constipation has many possible causes and assessing the client's usual pattern of elimination is the first step in identifying the cause. The nurse should obtain a description of the bowel elimination pattern, asking about the frequency, overall appearance and consistency of stool, blood in the stool, pain, and effort necessary to pass stool. It is also essential for the nurse to review the client's current medications, diet, and activity levels.

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of: -increasing fluid intake to prevent dehydration. -wearing an appliance pouch only at bedtime. -consuming a low-protein, high-fiber diet. -taking only enteric-coated medications.

-increasing fluid intake to prevent dehydration. Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can't absorb them after an ileostomy.

In a client with enteritis and frequent diarrhea, the nurse should anticipate: -respiratory acidosis. -respiratory alkalosis. -metabolic acidosis. -metabolic alkalosis.

-metabolic acidosis. Diarrhea causes a bicarbonate deficit. With loss of the relative alkalinity of the lower GI tract, the relative acidity of the upper GI tract predominates, leading to metabolic acidosis. Loss of acid, which occurs with severe vomiting, may lead to metabolic alkalosis. Diarrhea doesn't lead to respiratory acid-base imbalances, such as respiratory acidosis and respiratory alkalosis.

A patient diagnosed with IBS is advised to eat a diet that is: -Sodium-restricted. -High in fiber. -Low in residue. -Restricted to 1,200 calories/day.

-High in fiber. A high-fiber diet is prescribed to control diarrhea and constipation and is recommended for patients with IBS.

An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to? -Hyperkalemia -Hypokalemia -Hyponatremia -Hypernatremia

-Hypokalemia The older client taking digitalis must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

In women, which of the following types of cancer exceeds colorectal cancer? -Breast -Lung -Skin -Liver

-Breast In women, only incidences of breast cancer exceed that of colorectal cancer. In men, only incidences of prostate cancer and lung cancer exceed that of colorectal cancer.

A nurse is reviewing the history and physical of a client admitted for a hemorrhoidectomy. Which predisposing condition does the nurse expect to see? -Hyperkalemia -Lactic acidosis -Hypoglycemia -Constipation

-Constipation Orthostatic hypertension and other conditions associated with persistently high intra-abdominal pressure (such as pregnancy) can lead to hemorrhoids. The passing of hard stools, not diarrhea, can aggravate hemorrhoids. Diverticulosis has no relationship to hemorrhoids. Rectal bleeding is a symptom of hemorrhoids, not a predisposing condition.

Vomiting results in which of the following acid-base imbalances? -Metabolic alkalosis -Metabolic acidosis -Respiratory acidosis -Respiratory alkalosis

-Metabolic alkalosis Vomiting results in loss of hydrochloric acid (HCl) and potassium from the stomach, leading to a reduction of chlorides and potassium in the blood and to metabolic alkalosis.

The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for: -hyperkalemia. -hypokalemia. -hyponatremia. -hypernatremia.

-hypokalemia. The older client taking digoxin must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

After assessing a client with peritonitis, the nurse most likely would document the client's bowel sounds as: -Mild. -High-pitched. -Hyperactive. -Absent.

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

A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation? -lack of free water intake -lack of solid food -lack of exercise -increased fiber

-lack of free water intake A client who cannot swallow food cannot drink enough water to meet daily needs. Inadequate fluid intake is a common cause of constipation.

A patient arrives in the emergency department with complaints of right lower abdominal pain that began 4 hours ago and is getting worse. The nurse assesses rebound tenderness at McBurney's point. What does this assessment data indicate to the nurse? -Crohn's disease -Ulcerative colitis -Appendicitis -Diverticulitis

-Appendicitis In up to 50% of presenting cases of appendicitis, local tenderness is elicited at McBurney's point when pressure is applied (Black & Martin, 2012) (Fig. 48-3). Rebound tenderness (i.e., production or intensification of pain when pressure is released) may be present.

Which drug is considered a stimulant laxative? -Magnesium hydroxide -Bisacodyl -Mineral oil -Psyllium hydrophilic mucilloid

-Bisacodyl Bisacodyl is a stimulant laxative. Magnesium hydroxide is a saline agent. Mineral oil is a lubricant. Psyllium hydrophilic mucilloid is a bulk-forming agent.

Which is one of the primary symptoms of irritable bowel syndrome (IBS)? -Diarrhea -Pain -Bloating -Abdominal distention

-Diarrhea The primary symptoms of IBS include constipation, diarrhea, or a combination of both. Pain, bloating, and abdominal distention often accompany changes in bowel pattern.

The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's notes? -Loud bowel sounds -Borborygmus -Tenesmus -Peristalsis

-Borborygmus Borborygmus is a rumbling noise caused by the movement of gas through the intestines, often associated with diarrhea.

When interviewing a client with internal hemorrhoids, which of the following would the nurse expect the client to report? -Rectal bleeding -Pain -Itching -Soreness

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

A nurse is assessing a client and obtains the following findings: abdominal discomfort, mild diarrhea, blood pressure of 100/80 mm Hg, pulse rate of 88 beats/minute, respiratory rate of 20 breaths/minute, temperature 100° F (37.8° C). The nurse suspects the client will be diagnosed with: -inflammatory bowel disease (IBD). -colorectal cancer. -diverticulitis. -liver failure.

-inflammatory bowel disease (IBD). IBD is a collective term for several GI inflammatory diseases with unknown causes. The most prominent sign of IBD is mild diarrhea, which sometimes is accompanied by fever and abdominal discomfort. Colorectal cancer is usually diagnosed after the client complains of bloody stools; the client will rarely have abdominal discomfort. A client with diverticulitis commonly states he has chronic constipation with occasional diarrhea, nausea, vomiting, and abdominal distention. Jaundice, coagulopathies, edema, and hepatomegaly are common signs of liver failure.

The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication? -Peritonitis -Pelvic abscess -Ileus -Hemorrhage

-Peritonitis The nurse should report to the physician that the client has signs/symptoms of peritonitis. Signs/symptoms of a pelvic abscess include anorexia, chills, fever, diaphoresis, and diarrhea. Signs/symptoms of an ileus include absent bowel sounds, nausea, and abdominal distention. Signs/symptoms of hemorrhage include tachycardia, hypotension, anxiety, and bleeding.

A patient is diagnosed with Zollinger-Ellison syndrome, a malabsorption disorder. The nurse knows to assess the patient for the characteristic clinical feature of: -Decreased intestinal lactose -Folate deficiency -Lymphadenopathy -Steatorrhea

-Steatorrhea Hyperacidity in the duodenum inactivates pancreatic enzymes causing steatorrhea and ulcer diathesis. Refer to Table 24-2 in the text.

A nurse is teaching an older adult client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required? -"I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread." -"I need to use laxatives regularly to prevent constipation." -"I need to drink 2 to 3 liters of fluids every day." -"I should exercise four times per week."

-"I need to use laxatives regularly to prevent constipation." The client requires more teaching if he states that he'll use laxatives regularly to prevent constipation. The nurse should teach this client to gradually eliminate the use of laxatives because using laxatives to promote regular bowel movements may have the opposite effect. A high-fiber diet, ample amounts of fluids, and regular exercise promote good bowel health.

The nurse is performing a rectal assessment and notices a longitudinal tear or ulceration in the lining of the anal canal. The nurse documents the finding as which condition? -Anorectal abscess -Anal fistula -Hemorrhoid -Anal fissure

-Anal fissure Fissures are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety (leading to constipation). An anorectal abscess is an infection in the pararectal spaces. An anal fistula is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus. A hemorrhoid is a dilated portion of vein in the anal canal.

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care? -Test all stools for occult blood. -Administer topical ointment to the rectal area to decrease bleeding. -Prepare the client for a gastrostomy tube placement. -Administer morphine (Duramorph PF) routinely, as ordered.

-Test all stools for occult blood. Blood in the stools is one of the warning signs of colorectal cancer. The nurse should plan on checking all stools for both frank and occult blood. The blood in the stool is coming from the colon or rectum; administering an ointment wouldn't help decrease the bleeding. Preparing a client for a gastrostomy tube isn't appropriate when diagnosing colorectal cancer. Colorectal cancer is usually painless; administering opioid pain medication isn't needed

A nurse applies an ostomy appliance to a client who is recovering from ileostomy surgery. Which intervention should the nurse utilize to prevent leakage from the appliance? -Press the adhesive faceplate from the stomal edge inward -Ask the client to remain inactive for 5 minutes. -Ensure that no air is trapped in the pouch -Ensure that there are no holes in the pouch

-Ask the client to remain inactive for 5 minutes. After applying the ostomy appliance, the nurse should ask the client to remain inactive for 5 minutes to allow body heat to strengthen the adhesive bond. The adhesive faceplate should be pressed from the stomal edge outward to prevent the formation of wrinkles. A small amount of air should also be allowed to be trapped in the pouch; liquid feces will then drain to the bottom of the pouch, placing less tension on it.

A patient is admitted to the hospital after not having had a bowel movement in several days. The nurse observes the patient is having small liquid stools, a grossly distended abdomen, and abdominal cramping. What complication can this patient develop related to this problem? -Appendicitis -Rectal fissures -Bowel perforation -Diverticulitis

-Bowel perforation Megacolon is a dilated and atonic colon caused by a fecal mass that obstructs the passage of colon contents. Symptoms include constipation, liquid fecal incontinence, and abdominal distention. Megacolon can lead to perforation of the bowel.

What information should the nurse include in the teaching plan for a client being treated for diverticulosis? -Avoid unprocessed bran in the diet -Avoid daily exercise; indulge only in mild activity -Drink at least 8 to 10 large glasses of fluid every day -Use laxatives or enemas at least once a week

-Drink at least 8 to 10 large glasses of fluid every day The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the physician. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.

A surgeon is discussing surgery with a client diagnosed with colon cancer. The client is visibly shaken over the possibility of a colostomy. Based on the client's response, the surgeon should collaborate with which health team member? -Social worker -Staff nurse -Clinical educator -Enterostomal nurse

-Enterostomal nurse The surgeon should collaborate with the enterostomal nurse, who can address the client's concerns. The enterostomal nurse may schedule a visit with a client who has a colostomy to offer support to the client. The clinical educator can provide information about the colostomy when the client is ready to learn. The staff nurse and social worker aren't specialized in colostomy care, so they aren't the best choices for this situation.

A patient with IBD would be encouraged to increase fluids, use vitamins and iron supplements, and follow a diet designed to reduce inflammation. Select the meal choice that would be recommended for a low-residue diet. -A peanut butter sandwich and fruit cup -Broiled chicken with low-fiber pasta -Salami on whole grain bread and V-8 juice -A fruit salad with yogurt

-Broiled chicken with low-fiber pasta A low-residue, high-protein, and high-calorie diet is recommended to reduce the size and number of stools. Foods to avoid include yogurt, fruit, salami, and peanut butter.

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

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

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

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