Deck 44: Bowel Elimination

Question 1

The patient has been admitted to an acute care unit with a diagnosis of obstructive jaundice.Which of the following best describes the appearance that the nurse should expect this patient's feces to have?

A) Bloody
B) Pus-filled
C) Black and tarry
D) White or clay-coloured

Answer 1

D

Question 2

Which of the following physiological changes is an age-related change in the gastrointestinal tract?

A) Increased salivation
B) Decreased incidence of acid reflux
C) Increased acid secretions
D) Decreased nutrient absorption

Answer 2

D

Question 3

When planning nursing care to promote normal elimination,what is the best time for the nurse to assist an elderly patient to the bathroom?

A) Immediately after breakfast
B) Just before dinner
C) 30 minutes after dinner
D) 15 minutes after breakfast

Answer 3

D

Question 4

What is the recommended daily maximum fluid intake for a healthy adult?

A) 1000 mL
B) 1500 mL
C) 2000 mL
D) 3000 mL

Question 5

The nurse is caring for patients on a postoperative unit in the medical centre.The nurse is alert to the possibility that for 24 to 48 hours of the postoperative period,patients may experience which of the following symptoms as a result of the anaesthetic used during the surgery?

A) Colitis
B) Stomatitis
C) Paralytic ileus
D) Gastrocolic reflex

Question 6

Which of the following patients is at greatest risk for serious complications when using the Valsalva manoeuvre to expel feces?

A) A 25-year-old pregnant patient
B) A 66-year-old male patient with hypertrophied prostate disease
C) A 44-year-old male patient with glaucoma
D) A 53-year-old female patient with stomach cancer

Question 7

The nurse is providing ancillary personnel with instructions regarding the proper methods to implement when caring for a patient with a Clostridium difficile infection.Which of the following practices will have the greatest impact on containment of the bacteria,and thus on prevention of cross-contamination?

A) Frequent in-service programs on transmission modes of C. difficile
B) The practising of proper hand hygiene by all staff
C) Appropriate handling of contaminated linen
D) Stool cultures on all suspected carriers

Question 8

Which part of the small intestine is the longest,measuring about 3.7 m?

A) Ileum
B) Jejunum
C) Duodenum
D) Descending colon

Question 9

A 6-month-old infant has severe diarrhea.Which of the following is the major problem associated with severe diarrhea?

A) Pain in the abdominal area
B) Electrolyte and fluid loss
C) Presence of excessive flatus
D) Irritation of the perineal and rectal area

Question 10

To decrease diarrhea in patients with Clostridium difficile infection,which of the following medications does the nurse know the patient may be advised to take?

A) Antibiotics
B) Ibuprofen
C) Probiotic acidophilus supplements
D) Iron supplements

Question 11

Which of the following does the nurse instruct the patient that she may eat before the fecal occult blood test (FOBT)?

A) Whole-wheat bread
B) A lean T-bone steak
C) Veal
D) Salmon

Question 12

While undergoing a soapsuds enema,the patient complains of abdominal cramping.Which of the following should be the nurse's first action?

A) Immediately stop the infusion.
B) Slow the rate of infusion.
C) Advance the enema tubing 5 to 8 cm.
D) Clamp the tubing.

Question 13

A patient has just had intestinal surgery with the creation of a colostomy.For the first few weeks,which of the following will the nutritional therapy for this patient include?

A) Vegetables
B) Fresh fruit
C) Cauliflower and broccoli
D) Poached eggs and rice

Question 14

A patient who was recently diagnosed with anemia and rheumatoid arthritis reports to the nurse that she has noticed her stool is black,and she is concerned because there is a history of colon cancer in her family.Which of the following assessment questions is most likely to provide information regarding this patient's bowel problem?

A) "What medications are you currently taking?"
B) "When did you have your last colonoscopy?"
C) "Does the arthritis severely impair your mobility?"
D) "Would you like to have the stool tested for occult blood?"

Question 15

A patient is to have a stool test for occult blood.The nurse is instructing the nursing assistant in the correct procedure for the test.The nursing assistant is correctly informed when the nurse explains which one of the following?

A) Sterile technique is used for collection.
B) Stool should be collected over a three-day period.
C) The specimen should be kept warm.
D) A 2.5-cm sample of formed stool is needed.

Question 16

What causes food to enter the stomach once it has reached the esophagus?

A) Gravity
B) Peristaltic contractions
C) Contraction of the cricopharyngeal muscle
D) The release of somatostatin, which causes the stomach to contract and accept food

Question 17

The patient is taking medication to promote defecation.Which of the following instructions should the nurse include in the teaching plan for this patient?

A) Increased laxative use often causes hyperkalemia.
B) Salt tablets should be taken to increase the solute concentration of the extracellular fluid.
C) Emollient laxatives may increase the amount of water secreted into the bowel.
D) Bulk-forming additives may turn the urine pink.

Question 18

The patient is to receive a sodium polystyrene sulphonate (Kayexalate)enema.For which of the following purposes does the nurse recognize this is used?

A) To prevent further constipation
B) To remove excess potassium from the system
C) To reduce bacteria in the colon before diagnostic testing
D) To provide direct antidiarrheal medication to the intestine

Question 19

Which of the following is the appropriate amount of fluid to prepare for a cleansing enema to be given to an adult patient?

A) 150 to 250 mL
B) 250 to 350 mL
C) 750 to 1000 mL
D) 500 to 750 mL

Question 20

The patient is seen in the gastroenterology clinic after having experienced changes in his bowel elimination.A colonoscopy is ordered,and the patient has questions about the examination.What information should the nurse give the patient before the colonoscopy?

A) No special preparation is required.
B) Light sedation is normally used.
C) No metallic objects are allowed.
D) Swallowing of an opaque liquid is required.

Question 21

If obstructed,which component of the urination system would cause peristaltic waves?

A) Kidney
B) Ureters
C) Bladder
D) Urethra

Question 22

When establishing a diagnosis of altered urinary elimination,the nurse should first

A) Establish normal voiding patterns for the patient.
B) Encourage the patient to flush kidneys by drinking excessive fluids.
C) Monitor patients' voiding attempts by assisting them with every attempt.
D) Discuss causes and solutions to problems related to micturition.

Question 23

Which assessment question should the nurse ask if stress incontinence is suspected?

A) "Does your bladder feel distended?"
B) "Do you empty your bladder completely when you void?"
C) "Do you experience urine leakage when you cough or sneeze?"
D) "Do your symptoms increase with consumption of alcohol or caffeine?"

Question 24

A patient has fallen several times in the past week when attempting to get to the bathroom.The patient informs the nurse that he gets up 3 or 4 times a night to urinate.Which recommendation by the nurse is most appropriate in correcting this urinary problem?

A) Clear the path to the bathroom of all obstacles before bed.
B) Leave the bathroom light on to illuminate a pathway.
C) Limit fluid and caffeine intake before bed.
D) Practice Kegel exercises to strengthen bladder muscles.

Question 25

To obtain a clean-voided urine specimen for a female patient,the nurse should teach the patient to

A) Cleanse the urethral meatus from the area of most contamination to least.
B) Initiate the first part of the urine stream directly into the collection cup.
C) Hold the labia apart while voiding into the specimen cup.
D) Drink fluids 5 minutes before collecting the urine specimen.

Question 26

A patient is experiencing oliguria.Which action should the nurse perform first?

A) Increase the patient's intravenous fluid rate.
B) Encourage the patient to drink caffeinated beverages.
C) Assess for bladder distention.
D) Request an order for diuretics.

Question 27

Which nursing diagnosis related to alternations in urinary function in an older adult should be a nurse's first priority?

A) Self-care deficit related to decreased mobility
B) Risk of infection
C) Anxiety related to urinary frequency
D) Impaired self-esteem related to lack of independence

Question 28

Which of the following is the primary function of the kidney?

A) Metabolizing and excreting medications
B) Maintaining fluid and electrolyte balance
C) Storing and excreting urine
D) Filtering blood cells and proteins

Question 29

Upon palpation,the nurse notices that the bladder is firm and distended; the patient expresses an urge to urinate.The nurse should follow up by asking

A) "When was the last time you voided?"
B) "Do you lose urine when you cough or sneeze?"
C) "Have you noticed any change in your urination patterns?"
D) "Do you have a fever or chills?"

Question 30

The nurse suspects that a urinary tract infection has progressed to cystitis when the patient complains of which symptom?

A) Dysuria
B) Flank pain
C) Frequency
D) Fever and chills

Question 31

When viewing a urine specimen under a microscope,what would the nurse expect to see in a patient with a urinary tract infection?

A) Bacteria
B) Casts
C) Crystals
D) Protein

Question 32

The nurse knows that urinary tract infection (UTI)is the most common health care-associated infection because

A) Catheterization procedures are performed more frequently than indicated.
B) Escherichia coli pathogens are transmitted during surgical or catheterization procedures.
C) Perineal care is often neglected by nursing staff.
D) Bedpans and urinals are not stored properly and transmit infection.

Question 33

When caring for a patient with urinary retention,the nurse would anticipate an order for

A) Limited fluid intake.
B) A urinary catheter.
C) Diuretic medication.
D) A renal angiogram.

Question 34

While receiving a shift report on a patient,the nurse is informed that the patient has urinary incontinence.Upon assessment,the nurse would expect to find

A) An indwelling Foley catheter.
B) Reddened irritated skin on the buttocks.
C) Tiny blood clots in the patient's urine.
D) Foul-smelling discharge indicative of a UTI.

Question 35

A patient requests the nurse's assistance to the bedside commode and becomes frustrated when unable to void in front of the nurse.The nurse understands the patient's inability to void because

A) Anxiety can make it difficult for abdominal and perineal muscles to relax enough to void.
B) The patient does not recognize the physiological signals that indicate a need to void.
C) The patient is lonely, and calling the nurse in under false pretenses is a way to get attention.
D) The patient is not drinking enough fluids to produce adequate urine output.

Question 36

When reviewing laboratory results,the nurse should immediately notify the health care provider about which finding?

A) Glomerular filtration rate of 20 mL/min
B) Urine output of 80 mL/hr
C) pH of 6.4
D) Protein level of 2 mg/100 mL

Question 37

An 86-year-old patient tells the nurse that she is experiencing uncontrollable leakage of urine.Which nursing diagnosis should the nurse include in the patient's plan of care?

A) Urinary retention
B) Hesitancy
C) Urgency
D) Urinary incontinence

Question 38

The nurse knows that indwelling catheters are placed before a cesarean because

A) The patient may void uncontrollably during the procedure.
B) A full bladder can cause the mother's heart rate to drop.
C) Spinal anesthetics can temporarily disable urethral sphincters.
D) The patient will not interrupt the procedure by asking to go to the bathroom.

Question 39

A patient asks about treatment for urge urinary incontinence.The nurse's best response is to advise the patient to

A) Perform pelvic floor exercises.
B) Drink cranberry juice.
C) Avoid voiding frequently.
D) Wear an adult diaper.

Question 40

The nurse would expect the urine of a patient with uncontrolled diabetes mellitus to be

A) Cloudy.
B) Discolored.
C) Sweet smelling.
D) Painful.

Question 41

A nurse is caring for a patient who just underwent intravenous pyelography that revealed a renal calculus obstructing the left ureter.What is the nurse's first priority in caring for this patient?

A) Turn the patient on the right side to alleviate pressure on the left kidney.
B) Encourage the patient to increase fluid intake to flush the obstruction.
C) Administer narcotic medications to alleviate pain.
D) Monitor the patient for fever, rash, and difficulty breathing.

Question 42

Many individuals have difficulty voiding in a bedpan or urinal while lying in bed because they

A) Are embarrassed that they will urinate on the bedding.
B) Would feel more comfortable assuming a normal voiding position.
C) Feel they are losing their independence by asking the nursing staff to help.
D) Are worried about acquiring a urinary tract infection.

Question 43

What signs and symptoms would the nurse expect to observe in a patient with excessive white blood cells present in the urine?

A) Fever and chills
B) Difficulty holding in urine
C) Increased blood pressure
D) Abnormal blood sugar

Question 44

The nurse anticipates preparing a patient who is allergic to shellfish for an arteriogram by

A) Obtaining baseline vital signs after the start of the procedure.
B) Monitoring the extremity for neurocirculatory function.
C) Keeping the patient on bed rest for the prescribed time.
D) Administering an antihistamine medication to the patient.

Question 45

To reduce patient discomfort during closed catheter irrigation,the nurse should

A) Use room temperature irrigation solution.
B) Administer the solution as quickly as possible.
C) Allow the solution to sit in the bladder for at least 1 hour.
D) Raise the bag of irrigation solution at least 12 inches above the bladder.

Question 46

The nurse would anticipate inserting a Coudé catheter for which patient?

A) An 8-year-old male undergoing anesthesia for a tonsillectomy
B) A 24-year-old female who is going into labor
C) A 56-year-old male admitted for bladder irrigation
D) An 86-year-old female admitted for a urinary tract infection.

Question 47

The nurse anticipates urinary diversion from the kidneys to a site other than the bladder for which patient?

A) A 12-year-old female with severe abdominal trauma
B) A 24-year-old male with severe genital warts around the urethra
C) A 50-year-old male with recent prostatectomy
D) A 75-year-old female with end-stage renal disease

Question 48

A nurse notifies the provider immediately if a patient with an indwelling catheter

A) Complains of discomfort upon insertion of the catheter.
B) Places the drainage bag higher than the waist while ambulating.
C) Has not collected any urine in the drainage bag for 2 hours.
D) Is incontinent of stool and contaminates the external portion of the catheter.

Question 49

Which observation by the nurse best indicates that bladder irrigation for urinary retention has been effective?

A) Recording an output that is larger than the amount instilled
B) Presence of blood clots or sediment in the drainage bag
C) Reduction in discomfort from bladder distention
D) Visualizing clear urinary catheter tubing

Question 50

The nurse would question an order to insert a urinary catheter on which patient?

A) A 26-year-old patient with a recent spinal cord injury at T2
B) A 30-year-old patient requiring drug screening for employment
C) A 40-year-old patient undergoing bladder repair surgery
D) An 86-year-old patient requiring monitoring of urinary output for renal failure

Question 51

The nurse knows that which indwelling catheter procedure places the patient at greatest risk for acquiring a urinary tract infection?

A) Emptying the drainage bag every 8 hours or when half full
B) Kinking the catheter tubing to obtain a urine specimen
C) Placing the drainage bag on the side rail of the patient's bed
D) Failing to secure the catheter tubing to the patient's thigh

Question 52

A nurse is caring for an 8-year-old patient who is embarrassed about urinating in his bed at night.Which intervention should the nurse suggest to reduce the frequency of this occurrence?

A) "Drink your nightly glass of milk earlier in the evening."
B) "Set your alarm clock to wake you every 2 hours, so you can get up to void."
C) "Line your bedding with plastic sheets to protect your mattress."
D) "Empty your bladder completely before going to bed."

Question 53

The nurse would anticipate an order for which diagnostic test for a patient who has severe flank pain and calcium phosphate crystals revealed on urinalysis?

A) Renal ultrasound
B) Bladder scan
C) KUB x-ray
D) Intravenous pyelogram

Question 54

A nurse is providing education to a patient being treated for a urinary tract infection.Which of the following statements by the patient indicates an understanding?

A) "Since I'm taking medication, I do not need to worry about proper hygiene."
B) "I should drink 15 to 20 glasses of fluid a day to help flush the bacteria out."
C) "My medication may discolor my urine; this should resolve once the medication is stopped."
D) "I should not have sexual intercourse until the infection has resolved."

Question 55

Which statement by the patient about an upcoming computed tomography (CT)scan indicates a need for further teaching?

A) "I'm allergic to shrimp, so I should monitor myself for an allergic reaction."
B) "I will complete my bowel prep program the night before the scan."
C) "I will be anesthetized so that I lie perfectly still during the procedure."
D) "I will ask the technician to play music to ease my anxiety."

Question 56

A patient is having difficulty voiding in a bedpan but states that she feels her bladder is full.To stimulation micturition,which nursing intervention should the nurse try first?

A) Exiting the room and informing the patient that the nurse will return in 30 minutes to check on the patient's progress
B) Utilizing the power of suggestion by turning on the faucet and letting the water run
C) Obtaining an order for a Foley catheter
D) Administering diuretic medication

Question 57

An 86-year-old patient asks the nurse what lifestyle changes will reduce the chance of a urinary tract infection.Which response is accurate?

A) Urinary tract infections are unavoidable in the elderly because of a weakened immune system.
B) Decreasing fluid intake will decrease the amount of urine with bacteria produced.
C) Making sure to cleanse the perineal area from back to front after voiding will reduce the chance of infection.
D) Increasing consumption of acidic foods such as cranberry juice will reduce the chance of infection.

Question 58

A nurse anticipates urodynamic testing for a patient with which symptom?

A) Involuntary urine leakage
B) Severe flank pain
C) Presence of blood in urine
D) Dysuria

Question 59

When caring for a hospitalized patient with a urinary catheter,which nursing action best prevents the patient from acquiring an infection?

A) Inserting the catheter using strict clean technique
B) Performing hand hygiene before and after providing perineal care
C) Fully inflating the catheter's balloon according to the manufacturer's recommendation
D) Disconnecting and replacing the catheter drainage bag once per shift

Question 60

Which of the following are indications for irrigating a urinary catheter?

A) Sediment occluding within the tubing
B) Blood clots in the bladder following surgery
C) Rupture of the catheter balloon
D) Bladder infection
E) Presence of renal calculi

Question 61

The nurse properly obtains a 24-hour urine specimen collection by

A) Asking the patient to void and to discard the first sample.
B) Keeping the urine collection container on ice.
C) Withholding all patient medications for the day.
D) Asking the patient to notify the staff before and after every void.

Question 62

Which of the following symptoms are most closely associated with uremic syndrome?

A) Fever
B) Nausea and vomiting
C) Headache
D) Altered mental status
E) Dysuria

Question 63

The nurse understands that peritoneal dialysis and hemodialysis use which processes to clean the patient's blood?

A) Gravity
B) Osmosis
C) Diffusion
D) Filtration

Question 64

Which nursing actions are acceptable when collecting a urine specimen?

A) Growing urine cultures for up to 12 hours
B) Labeling all specimens with date, time, and initials
C) Wearing gown, gloves, and mask for all specimen handling
D) Allowing the patient adequate time and privacy to void
E) Squeezing urine from diapers into a urine specimen cup
F) Transporting specimens to the laboratory in a timely fashion
G) Placing a plastic bag over the child's urethra to catch urine