Deck 18: Elimination

Question 1

Which patient would be most at risk for constipation?

A) Patient taking antibiotics for an upper respiratory infection
B) Patient taking hormones for postmenopausal symptoms
C) Patient iron supplements for anemia
D) Patient taking nonsteroidal inhalants for chronic obstructive pulmonary disease (COPD)

Answer 1

Patient iron supplements for anemia

Question 2

What would be the most effective action of the nurse when assisting an 85-year-old adult with weak abdominal muscles to defecate?

A) Encourage the use of a bedpan before getting up in the morning.
B) Place a footstool under the feet of the patient when seated on the toilet.
C) Insert a finger in the patient's rectum to stimulate the urge to defecate.
D) Instruct the patient to do isometric exercises to strengthen the abdominal muscles.

Answer 2

Place a footstool under the feet of the patient when seated on the toilet.

Question 3

What can suppress the defecation reflex?

A) Frequent episodes of diarrhea
B) Long-term use of vitamin A and vitamin B complex
C) Repeatedly ignoring the urge
D) Excessive fiber and bulk in the diet

Answer 3

Repeatedly ignoring the urge

Question 4

How do Kegel exercises aid in the treatment of incontinence?

A) Increases the tone of the bladder
B) Reduces urinary retention
C) Strengthens the urinary sphincter
D) Sensitizes biofeedback

Question 5

What stool description would indicate constipation?

A) Firm stool passed without difficulty every 3 days
B) Hard stool passed without difficulty every 2 days
C) Soft brown stool passed with difficulty every 2 days
D) Hard dry stool passed with difficulty every 3 days

Question 6

What does the nurse expect will occur in a patient as a result of decreased fluid intake? (Select all that apply.)

A) Fluid will be withdrawn from the stool
B) The stool becomes hard and dry
C) Less mucus is formed in the colon
D) Lumen of bowel constricts because of smaller bulk
E) Peristalsis slows

Question 7

What can the nurse implement to reduce episodes of bowel incontinence?

A) Encourage intake of foods that cause mild constipation.
B) Use appropriate disposable garments, pads, and bed covering.
C) Establish a toileting schedule.
D) Coach the patient in Kegel exercises.

Question 8

The patient has begun taking psyllium (Metamucil). What advice should be given to the patient?

A) Eat several servings of fresh fruit and vegetables a day.
B) Avoid citrus fruit juices.
C) Reduce intake of carbonated drinks.
D) Increase his fluid intake to 3000 mL a day.

Question 9

What influences regular bowel patterns? (Select all that apply.)

A) Level of activity
B) Diet
C) Medication
D) Fluid intake
E) Lifestyle

Question 10

Which of the following complaints by the 80-year-old resident would indicate a need for the nurse to complete a focused bowel assessment on the resident?

A) The inability to have a bowel movement every day
B) Feeling pressure and fullness in the rectum but is unable to defecate
C) Having had one loose stool after breakfast
D) Ingestion and flatulence

Question 11

The patient complains of feeling the need to urinate and fullness and tenderness in the bladder area. The patient is restless and diaphoretic. What is the most appropriate initial nursing intervention?

A) Help the patient into a warm tub bath to stimulate voiding.
B) Catheterize the patient.
C) Palpate the bladder fundus.
D) Place heated towels over the bladder area.

Question 12

Which patient would need enhanced skin care precautions?

A) Patient who has one unformed stool after a bolus of tube feeding
B) Patient who has an unformed stool followed by a formed stool 3 hours later
C) Patient who reports cramping and nausea followed by an unformed stool
D) Patient who reports no abdominal discomfort but has had three unformed stools in 8 hours

Question 13

What can a nurse do to encourage a normal bowel movement in an older adult?

A) Encourage the patient to decrease fluid intake.
B) Provide a warm beverage at breakfast.
C) Administer a mild laxative at bedtime.
D) Provide a warm shower each morning.

Question 14

Which statement by the patient would indicate a need for further instruction regarding prevention of constipation?

A) "I eat bran flakes or oatmeal every day to add bulk to my diet."
B) "Since I started eating three servings of fruit a day, I haven't been constipated."
C) "I'm never constipated. I take a gentle laxative every night."
D) "My daily walks have kept my bowels working regularly."

Question 15

The nurse explains that a diet low in fiber results in a small stool that

A) moves rapidly through the intestines.
B) becomes excessively dry.
C) overstimulates the defecation reflex.
D) contributes to frequent bowel movements.

Question 16

What food provides a natural laxative effect?

A) Orange
B) Pineapple
C) Prunes
D) Raw apple

Question 17

What age-related changes are related to constipation? (Select all that apply.)

A) Diminished abdominal muscle tone
B) Reduced activity level
C) Inadequate fluid intake
D) Increased dietary fiber
E) Dependence on laxatives

Question 18

An alert, independent, 89-year-old male resident with congestive heart failure has been on Lasix for a week. Over the past 2 days he has been frequently incontinent and does not make it to the bathroom in time. He tells the nurse that he is having spasms in his lower abdomen. What diagnosis would best apply to this resident?

A) Impaired urinary elimination
B) Functional urinary incontinence
C) Stress urinary incontinence
D) Urge urinary incontinence

Question 19

Which patient would require special precautions when the nurse is performing a digital rectal exam?

A) Patient with chronic obstructive pulmonary disease (COPD)
B) Patient with diabetes
C) Patient with Parkinson disease
D) Patient with congestive heart failure

Question 20

What statement by the patient would indicate stress incontinence?

A) "Lifting my grandchild makes me wet my pants."
B) "I frequently wet myself because I just can't get to the bathroom in time."
C) "My arthritis makes me so clumsy that I can't get my pants down in time."
D) "Every time I have a urinary infection, I experience incontinence."

Question 21

What are the broad general causes of bowel incontinence? (Select all that apply.)

A) Inability to recognize defecation urge related to mental impairment
B) Inability to respond to defecation urge related to immobility
C) Inflammatory bowel disease
D) Increased fiber in the diet
E) Unexpected defecation when passing gas

Question 22

The nurse is aware that the urge to defecate is increased peristalsis stimulated by the defecation reflex and the __________ reflex.

Question 23

What are causes of bowel and bladder elimination problems in the older adult? (Select all that apply.)

A) Daily use of laxatives for defecation
B) Inability to get to adequate water
C) Fear of pain with defecation
D) Total privacy during elimination
E) Use of a bedpan for elimination

Question 24

What should be included in a plan of care for an older adult with diarrhea? (Select all that apply.)

A) Perineal care immediately after the diarrhea episode
B) Application of lotion to the buttocks
C) Maintenance of dry linens
D) Patting the anal area dry rather than wiping
E) Leaving excoriated areas open to the air

Question 25

Which of the following complaints would indicate a possible fecal impaction in an older adult? (Select all that apply.)

A) Cramping
B) Rectal pain
C) Abdominal distention
D) Anorexia
E) Passing large amounts of liquid stool

Question 26

What conditions could result in constipation related to pain? (Select all that apply.)

A) Hemorrhoids
B) Anal fissures
C) Reduction of bowel mucus
D) Diminished abdominal muscle tone
E) Slowed peristalsis

Question 27

The nurse is aware that an adult has the urge to urinate when the bladder has approximately _____ mL of urine in it.