QUIZLET Ch. 47 (M/S) INTESTINAL AND RECTAL DISORDERS

Which is one of the primary symptoms of irritable bowel syndrome (IBS)?

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

A client reports constipation. Which nursing measure would be most effective in helping the client reduce constipation? Assist client to increase dietary fiber. Obtain medical and allergy history. Provide adequate quantity of food. Obtain complete food history.

Assist client to increase dietary fiber.

An older adult client in a long-term care facility is concerned about bowel regularity. During a client education session, the nurse reinforces the medically acceptable definition of "regularity." What is the actual measurement of "regular"? stool consistency and client comfort one bowel movement daily two bowel movements daily one bowel movement every other day

stool consistency and client comfort Rationale: - Normal bowel patterns range from three bowel movements per day to three bowel movements per week. - 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.

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." Rationale: - 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.

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

A change in bowel habits Rationale: 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.

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. An ileus. Peritonitis An abscess under the diaphragm.

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

Right lower quadrant Rationale: 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 caring for a 77-year-old patient diagnosed with Crohn's disease. What would be especially important to monitor this patient for?

Dehydration Rationale: - Elderly patients can become dehydrated quickly and develop low potassium levels (i.e., hypokalemia) as a result of diarrhea. - The nurse observes for clinical manifestations of muscle weakness, dysrhythmias, or decreased peristaltic motility that may lead to paralytic ileus. - All options would be important to monitor, but especially important is monitoring for dehydration.

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? Administer morphine (Duramorph PF) routinely, as ordered. Test all stools for occult blood. Administer topical ointment to the rectal area to decrease bleeding. Prepare the client for a gastrostomy tube placement.

Test all stools for occult blood. Rationale: 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

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? Intestinal malabsorption Ulcerative colitis Disorders of the colon Small-bowel disease

Ulcerative colitis Rationale: 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.

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 fruit salad with yogurt Salami on whole grain bread and V-8 juice A peanut butter sandwich and fruit cup Broiled chicken with low-fiber pasta

Broiled chicken with low-fiber pasta Rationale: 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 is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, what would the nurse stress the importance of? Increasing fluid intake to prevent dehydration Consuming a low-protein, high-fiber diet Taking only enteric-coated medications Wearing an appliance pouch only at bedtime

Increasing fluid intake to prevent dehydration Rationale: - 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.

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? The appendix may develop gangrene and rupture, especially in a middle-aged client. 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. 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. Rationale: - A client with appendicitis is at Risk for infection related to inflammation, perforation, and surgerybecause 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 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 client is able to fully evacuate with each bowel movement That the client has a bowel movement daily That the stool is formed and soft The consistency of stool and comfort when passing stool

The consistency of stool and comfort when passing stool Rationale: - 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.

A client informs the nurse that he is taking a stimulant laxative in order to be able to have a bowel movement daily. What should the nurse inform the client about taking a stimulant laxative?

They can be habit forming and will require increasing doses to be effective. Rationale: - The nurse should discourage self-treatment with daily or frequent enemas or laxatives. - Chronic use of such products causes natural bowel function to be sluggish. - In addition, laxatives continuing stimulants can be habit forming, requiring continued use in increasing doses. - Although the nurse should encourage the client to have adequate fluid intake, laxative use should not be encouraged. - The laxative may interact with other medications the client is taking and may cause a decrease in absorption. - A fiber supplement may be taken alone but should not be taken with a stimulant laxative.

A nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find? rectal bleeding and a change in bowel habits severe abdominal pain with direct palpation or rebound tenderness tenderness and pain in the right upper abdominal quadrant jaundice and vomiting

severe abdominal pain with direct palpation or rebound tenderness Rationale: - Peritonitis decreases intestinal motility and causes intestinal distention. - A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (i.e., appendicitis, diverticulitis, ulcerative colitis, a strangulated obstruction). - The client may also have rebound tenderness. - Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. - Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.

What information should the nurse include in the teaching plan for a client being treated for diverticulosis? Avoid daily exercise; indulge only in mild activity Avoid unprocessed bran in the diet 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 rationale: - 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? Apply triamcinolone acetonide spray Apply barrier powder Dry skin thoroughly after washing Dust with nystatin powder

Dry skin thoroughly after washing

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

Every 4 to 6 hours

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

Familial polyposis Rationale: Family history of colon cancer or familial polyposis is a risk factor for colorectal cancer. Age older than 40 years and 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.

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

Absent Rationale: 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.

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. Stop the irrigation and remove the tube. Clamp the tubing and give the patient a rest period. Replace the fluid with cooler water since it is probably too warm

Clamp the tubing and give the patient a rest period.

A client presents with an infection in the area between the internal and external sphincters. In which chronic disease is this condition commonly seen?

Crohn's disease Rationale: An anorectal abscess is common in clients with Crohn's disease.

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 disorder of the large bowel. Inflammatory colitis. Intestinal malabsorption. A small bowel disorder.

Intestinal malabsorption. Rationale: - 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 assessing a patient with appendicitis. The nurse is attempting to elicit a Rovsing's sign. Where should the nurse palpate for this indicator of acute appendicitis? Left lower quadrant Right lower quadrant Right upper quadrant Left upper quadrant

Left lower quadrant

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

Low residue Rationale: 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.

Vomiting results in which of the following acid-base imbalances?

Metabolic alkalosis Rationale: 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 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? Hemorrhage Pelvic abscess Peritonitis Ileus

Peritonitis Rationale: - 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.

The nurse is admitting a client with a diagnosis of diverticulitis and assesses that the client has a board-like abdomen, no bowel sounds, and reports of severe abdominal pain. What is the nurse's first action?

Notify the health care provider. rationale: - Abdominal pain, a rigid board-like 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 health care provider.

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. A loop of intestine adheres to an area that is healing slowly after surgery. The bowel protrudes through a weakened area in the abdominal wall.

One part of the intestine telescopes into another portion of the intestine. Rationale: - 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.

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

Rectal bleeding

The presence of mucus and pus in the stools suggests which condition? Ulcerative colitis Small-bowel disease Disorders of the colon Intestinal malabsorption

Ulcerative colitis Rationale: - The presence of mucus and pus in the stools suggests ulcerative colitis. - Watery stools are characteristic of small-bowel disease. -mLoose, 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. Which factor should the nurse review first to identify the cause of constipation?

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

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: hypokalemia. hyponatremia. hypernatremia. hyperkalemia.

hypokalemia. Rationale: - 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.

Which client requires immediate nursing intervention? The client who: complains of epigastric pain after eating. presents with ribbonlike stools. presents with a rigid, board-like abdomen. complains of anorexia and periumbilical pain.

presents with a rigid, board-like abdomen. Rationale: - A rigid, board-like abdomen is a sign of peritonitis, a possibly life-threatening condition. - Epigastric pain occurring 90 minutes to 3 hours after eating indicates a duodenal ulcer. - Anorexia and periumbilical pain are characteristic of appendicitis. - Risk of rupture is minimal within the first 24 hours, but increases significantly after 48 hours. - A client with a large-bowel obstruction may have ribbonlike stools.