Deck 34: Nursing Care of Patients With Lower Gastrointestinal Disorders

Question 1

A patient is to be started on clear liquids after an appendectomy. Which food, if stated by a patient, indicates to the nurse correct understanding of a clear liquid?

A)"Cranberry juice."
B)"Ice cream."
C)"Oatmeal."
D)"Graham crackers."

Answer 1

"Cranberry juice."

Question 2

The nurse suspects appendicitis in a patient complaining of abdominal pain. Which of the following assessments would cause the nurse to notify the physician?

A)Tympanic, hollow sounds are heard on percussion.
B)Palpation of the abdomen is positive for rebound tenderness.
C)The patient burps after drinking a glass of water.
D)Bowel sounds are hyperactive in the upper quadrants.

Answer 2

Palpation of the abdomen is positive for rebound tenderness.

Question 3

The nurse is providing discharge teaching for a patient with diarrhea. Which of the following statements, if made by the patient, indicates that teaching has been effective?

A)"It is important that I increase fluid intake to prevent dehydration."
B)"I am at increased risk for a ruptured bowel, so I must remain on bedrest."
C)"I should tell future health-care workers that I've been diagnosed with obstipation."
D)"My risk for a urinary tract infection is very high, so I should call the doctor if I have a pain."

Answer 3

"It is important that I increase fluid intake to prevent dehydration."

Question 4

The nurse is caring for a patient who reports feeling constipated, yet passes frequent small liquid stools. Which of the following actions should the nurse take?

A)Explain that liquid stools indicate diarrhea.
B)Administer an antidiarrheal medication.
C)Check the patient for a fecal impaction.
D)Check the abdomen for rebound tenderness.

Question 5

The nurse is caring for a patient who has an exacerbation of Crohn's disease. Which nursing action is most important to recommend for inclusion in the patient's plan of care?

A)Administer antigas agents as ordered.
B)Encourage oral fluids.
C)Apply protective ointment to perianal skin.
D)Encourage frequent ambulation.

Question 6

The nurse is collecting data for a patient who is reporting pain. Which of the following patient symptoms is most indicative of appendicitis?

A)Pain in the right lower abdominal quadrant
B)Substernal pain that radiates to the back
C)Midepigastric pain
D)Suprapubic pain

Question 7

The nurse is caring for a patient who has an inflamed appendix. The nurse understands that which complication is most likely to occur if the appendix ruptures?

A)Colitis
B)Enteritis
C)Hepatitis
D)Peritonitis

Question 8

The nurse is collecting data for a newly admitted patient. Which of the following findings from a patient history would the nurse identify as a risk factor for constipation?

A)The patient had part of the stomach removed 10 years ago because of ulcers.
B)The patient does not like milk or milk products.
C)The patient has had hemorrhoids for the past 5 years.
D)The patient has a history of breast cancer treated with chemotherapy 3 years ago.

Question 9

The nurse is teaching a patient with diverticulosis how to avoid complications. Which of the following statements, if made by the patient, would indicate understanding to the nurse?

A)"I will avoid milk and milk products."
B)"I should cook vegetables thoroughly before eating."
C)"I will increase fluids and fiber in my diet."
D)"I should avoid very hot and spicy foods."

Question 10

A patient with a colostomy says, "My pouch blows up like a balloon when I pass gas." What is an appropriate response by the nurse?

A)"Make a tiny pinhole in the top of the pouch to let air out."
B)"Remove the pouch and put on a new one when it gets too full of gas."
C)"Empty the gas like you would if the pouch was full of stool."
D)"Peel back a tiny corner of the skin barrier to allow gas to escape."

Question 11

The nurse is contributing to the plan of care of a patient with gluten enteropathy (celiac disease). Which of the following should the nurse recommend be eliminated from the diet of the patient?

A)Milk and milk products
B)Fresh fruits and vegetables
C)Red meats
D)Wheat, rye, oats, and barley

Question 12

The nurse is caring for a patient who is being screened for diverticulosis. Which of these, if stated by a patient, indicates to the nurse correct understanding of conditions that predispose to diverticulosis?

A)"Chronic diarrhea."
B)"Chronic constipation."
C)"Colon cancer."
D)"Diet high in red meats."

Question 13

The nurse is reinforcing patient teaching on the best way to prevent transmission of infectious diarrhea. Which of the following statements by the patient would indicate correct understanding of the teaching?

A)Keep the perineal area clean and dry.
B)Wash hands frequently and after toileting.
C)Wear a mask and gown.
D)Avoid sharing eating utensils.

Question 14

The nurse is reinforcing teaching for a patient who has acute diarrhea on the most common causes for it. Which of the following statements by the patient would indicate a correct understanding of the teaching?

A)"Excessive fluid intake."
B)"Viral or bacterial infection."
C)"Excessive fiber in the diet."
D)"Inflammatory bowel disease."

Question 15

The nurse notes that a patient with a history of a myocardial infarction is straining during defecation. Which of the following responses by the nurse is best?

A)"It is important that you not strain because it could cause damage to your heart."
B)"Your blood pressure gets very low when you strain like that and you could faint."
C)"Chronic constipation often causes a dilated colon, so it is good that you are staying empty."
D)"Be careful, you might get a headache when you push so hard."

Question 16

A patient asks the nurse, "What is diverticulitis?" How should the nurse respond?

A)"You have little outpouchings that occur in weak areas of the colon."
B)"You have little pouches in your colon that are inflamed."
C)"The lining of your colon is irritated and inflamed."
D)"The visceral and parietal membranes in your abdomen are inflamed."

Question 17

The nurse is monitoring a patient who had an emergency appendectomy today. Which of the following findings should be reported to the physician immediately?

A)Pain at the operative site
B)Absence of bowel sounds
C)Abdomen rigid on palpation
D)3-cm spot of bloody drainage on dressing

Question 18

The nurse is caring for a patient who has diarrhea. Which of the following nursing actions is the highest priority?

A)Provide analgesics for abdominal pain.
B)Auscultate the abdomen daily.
C)Encourage oral fluid replacement.
D)Provide perineal skin care.

Question 19

A patient is scheduled for an ileostomy for Crohn's disease that has been uncontrolled with conservative treatment. The patient asks the nurse what it means to have an ileostomy. Which of the following responses by the nurse is best?

A)"Your colon will be removed, and the end of your small bowel will be brought out onto your abdomen."
B)"Your ileum will be anastomosed to your rectum, so your stools will be watery."
C)"Your ileum will be removed, and the end of your jejunum will be made into a stoma."
D)"You will have a loop of colon brought out onto your abdomen."

Question 20

The nurse is contributing to a patient's plan of care. For which of the following patients would the nursing diagnosis of Risk for Constipation be most appropriate?

A)A 37-year-old taking NSAIDs for bursitis
B)A 59-year-old taking narcotics for chronic pain control
C)A 74-year-old taking antibiotics for a urinary tract infection
D)A 67-year-old taking anticoagulant therapy for a history of deep vein thrombosis

Question 21

The nurse is caring for a patient with fecal incontinence of liquid stool and notes the patient's perianal area is excoriated. Which of the following interventions should be discussed with the RN? (Select all that apply.?

A)A low-pressure rectal tube
B)Nasogastric (NG) tube to suction
C)Stool culture
D)Protective barrier cream
E)Baby powder to peri area
F)Antibiotic therapy

Question 22

The nurse is contributing to a patient's plan of care. Which of the following foods should the nurse recommend be avoided or used with caution to reduce the possibility of ileostomy blockage? (Select all that apply.?

A)Broiled chicken
B)Apples
C)Potatoes
D)Dried fruits
E)Celery
F)Mushrooms

Question 23

The nurse is caring for a patient who is admitted with gastrointestinal bleeding and whose blood pressure is 140/80 mm Hg, pulse 72 beats/minute, respirations 14 breaths/minute, and temperature 98.8°F (37.1°C). What finding should be reported to the RN or physician immediately?

A)Pulse 78 beats/minute
B)Crampy abdominal pain
C)Blood pressure 104/68 mm Hg
D)Occult blood in the stool

Question 24

The nurse is reinforcing teaching on a patient who reports constipation and straining and has a distended abdomen and intestinal rumbling. What should be included in the teaching? (Select all that apply.?

A)Set a time for defecation every day.
B)Drink water each morning and about 2 to 3 L throughout the day.
C)Sit on the toilet with feet planted firmly on the floor.
D)Increase intake of fiber, especially bran, in the diet.
E)Use enemas and rectal suppositories if constipation persists after 2 days.
F)Increase the intake of foods containing vitamin K.

Question 25

Which statements by a patient who has been instructed on use of the medication budesonide (Entocort EC) to reduce local inflammation from Crohn's disease indicate that more teaching is needed? (Select all that apply.?

A)"I will take the pill each evening before going to bed."
B)"I should swallow the pill whole, not crushed."
C)"I can just stop taking the medication once I feel better."
D)"I should avoid grapefruit juice."
E)"I must avoid the sun while taking this drug."
F)"I might experience mood swings or weight gain on this medication."

Question 26

The nurse would evaluate a patient with an ostomy as understanding how to protect the skin if the patient cuts the skin barrier to which of the following measurements?

A)Tight to the base of the stoma
B)1/16 to 1/8 inch from the stoma
C)1/4 to 1/3 inch from the stoma
D)1/3 to 1/2 inch from the stoma

Question 27

The nurse is participating in a community health fair program on risk factors for cancer. Which of the following would be included as increasing the risk for colon cancer? (Select all that apply.?

A)Low-fiber diet
B)History of ulcerative colitis
C)Low-sodium diet
D)Family history of breast cancer
E)Low-fat diet
F)History of rectal polyps

Question 28

The nurse is reinforcing teaching for a patient about appropriate diet modifications to help prevent exacerbations of inflammatory bowel disease. The nurse evaluates teaching as effective by which of the following patient statements? (Select all that apply.?

A)"I should increase my intake of fresh fruits and vegetables."
B)"It is important to eat more whole grains and bran."
C)"I should avoid caffeine and spicy fiber foods."
D)"I should avoid concentrated sweets and starches."
E)"Milk and other dairy products should be limited in my diet."
F)"High-fiber foods should not be included in my diet."

Question 29

The nurse is caring for a patient with an ascending ostomy. The patient's wife asks if the patient will always have to wear a pouch. What response should the nurse give?

A)"No, a bag will not be needed after discharge from the hospital."
B)"A bag will be needed only to protect the stoma."
C)"A bag will be needed only during the night."
D)"A bag will be needed all of the time."
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 30

The nurse is contributing to a patient's plan of care for an ostomy. Why is it important for the nurse to recommend the use of a skin barrier product under the ostomy appliance?

A)To prevent the bag from sticking too tightly to the skin
B)To keep stool from irritating the skin
C)To prevent stool from coming in contact with the stoma
D)To ease removal of the pouch for changing

Question 31

The nurse is caring for a patient admitted with a possible bowel obstruction. The nurse would be most concerned by which of the following symptoms?

A)Flank pain
B)Watery diarrhea
C)Fecal vomiting
D)Occult blood in the stool

Question 32

The nurse is caring for a patient who has had ileostomy surgery. Which of these should be included in the plan of care and have the highest monitoring priority after the surgery?

A)Bowel sounds every 4 hours for 24 hours
B)Food intake
C)Participation in stoma care
D)Stoma condition every 8 hours

Question 33

The nurse is caring for a patient who has an ileostomy and feels crampy. The nurse notes that the stoma has become edematous and pale and suspects a blockage. What action should the nurse take?

A)Have the patient drink 2 to 3 L of water or other liquid.
B)Have the patient get into a tub full of warm water and drink warm liquids.
C)Administer a 1000-mL warm tap water enema through the stoma.
D)Administer a laxative such as milk of magnesia.

Question 34

The nurse is caring for a patient who has a bowel obstruction. The patient asks, "What term describes an obstruction caused by telescoping of the bowel, which my doctor said I have?" Which response by the nurse is appropriate?

A)"Volvulus."
B)"Ileus."
C)"Adhesions."
D)"Intussusception."

Question 35

A patient with a new ileostomy asks the nurse, "Will I have to wear a bag on my abdomen after my ileostomy?" What is the appropriate response by the nurse?

A)"Your stool will be liquid, so you will always need a bag."
B)"Your stool will be mushy, and you will need a bag most of the time."
C)"Your stool will be formed, and you may be able to regulate your bowel movements so that a bag will be optional."
D)"You will be taught to irrigate your stoma to eliminate the need for a bag."

Question 36

While receiving report from the previous shift, the nurse is informed that a nasogastric tube was placed in a patient who has a bowel obstruction. The nurse recognizes that the tube has most likely been inserted for which of the following reasons?

A)To relieve distention
B)To feed the patient
C)To administer medications
D)To break up the obstruction

Question 37

The nurse is reinforcing teaching for a patient who is being discharged after a colostomy. Which comments by the patient indicate understanding of the discharge teaching? (Select all that apply.?

A)"I will empty the pouch when it is less than half full."
B)"I always check the seal and tape around the stoma after I shower."
C)"I'm so glad I can eat all the foods I like now, including hot dogs."
D)"I can spray deodorant into the pouch after I clean it."
E)"I will not be concerned if there is no stool for several days."
F)"I should change the pouch each morning and evening to prevent infection."

Question 38

The nurse is monitoring a patient and finds a bulging area in the patient's groin. The nurse would be most concerned by which of the following findings?

A)The white blood cell count is 10,000/mm³.
B)The patient develops pain at the site and vomiting.
C)The bulging disappears at times.
D)The bulging occurs when the patient coughs or strains.

Question 39

The nurse is collecting data for a patient with a stoma. What finding would the nurse document as reflecting a healthy stoma?

A)Black and dry
B)Bluish and wet
C)Gray and dry
D)Pink and moist

Question 40

The nurse is caring for a patient who has an absorption disorder. What term would the nurse use to document fat in the patient's stool?

A)Lactorrhea
B)Lipidorrhea
C)Steatorrhea
D)Oleorrhea

Question 41

The nurse receives a call from a 45-year-old individual who reports recent development of diarrhea with five liquid stools in the past 24 hours. Which of the following additional symptoms would cause the nurse to suggest the patient seek immediate/emergent medical attention? (Select all that apply.?

A)Severe abdominal cramping
B)Oral intake of 3 L of fluid in 24 hours
C)Blood pressure 138/72 mm Hg
D)Weight loss of 1 pound in the past week
E)Fever
F)Blood in the stool
Completion
Complete each statement.

Question 42

In the normal process of digestion, the intestinal mucosa absorbs greater than ________________mL of liquid with nutrients and electrolytes into the portal bloodstream.

Question 43

Melena is the term used to describe blood that is in the genitourinary tract for greater than ________________hours which has come into contact with hydrochloric acid.