Question 1

The nurse identifies a nursing diagnosis of impaired skin integrity related to having 15 to 20 daily episodes of diarrhea for a patient with ulcerative colitis. The nurse recognizes that teaching regarding perianal care has been effective when the patient

Accepted Answer

Witch hazel compresses are suggested to reduce anal irritation and discomfort. Sitz baths may be helpful but should be limited to 15 or 20 minutes. Antidiarrheal medications are not given 15 to 20 times a day. The perianal area should be washed with water after each stool.

Question 2

A patient is admitted to the emergency department with severe abdominal pain with rebound tenderness, anorexia, and chills. The vital signs include temperature 101° F (38.3° C), pulse 130, respirations 34, and blood pressure (BP) 82/50. Of the following collaborative interventions, which one should the nurse implement first?

Accepted Answer

The priority for this patient is to treat the patient's hypovolemic shock with fluid infusion. The other actions should be implemented after starting the fluid infusion.

Question 3

Surgery is recommended by the health care provider for a patient with severe ulcerative colitis. The patient asks the nurse for clarification about the various procedures and the associated advantages and disadvantages. In responding to the patient's concerns, the nurse explains that

Accepted Answer

The total colectomy and ileal reservoir enable the patient to pass stool rectally but require two procedures 8 to 12 weeks apart. Although a temporary ileostomy may be needed, the large bowel is removed rather than being allowed to heal. The pouch formed during total proctocolectomy with continent ileostomy is drained more often than once daily. Surgical treatment for ulcerative colitis is curative because the colon is removed.

Question 4

After teaching a patient with IBD about recommended dietary modifications, the nurse identifies a need for further instruction when the patient chooses from the menu

Accepted Answer

The patient is taught to avoid high-fiber foods such as beans. In addition, high-fat foods such as ham may trigger diarrhea in some patients. The other choices are appropriate for a patient with IBD.

Question 5

While obtaining a nursing history from a patient with IBD, the nurse recognizes that the patient most likely has ulcerative colitis rather than Crohn's disease when the patient reports experiencing

Accepted Answer

Because ulcerative colitis affects the colon, blood in the stools is more common with this form of IBD. Weight loss, abdominal pain and cramping, and onset at age 20 are consistent with both Crohn's disease and ulcerative colitis.

Question 6

A patient with acute diarrhea of 24 hours' duration calls the clinic to ask for directions for care. In talking with the patient, the nurse should

Accepted Answer

The initial response by the nurse should be further assessment of the patient. The other responses may be appropriate, depending on what is learned in the assessment.

Question 7

Following an exploratory laparotomy and bowel resection, a patient has an NG tube to suction but complains of nausea and stomach distention. The nurse irrigates the tube PRN as ordered, but the irrigating fluid does not return. The first action by the nurse should be to

Accepted Answer

Repositioning the tube will frequently facilitate drainage. Because this is a common occurrence, it is not appropriate to notify the health care provider. Information about the presence of absence of bowel tones will not be helpful in improving drainage. Removing the tube and replacing it are unnecessarily traumatic to the patient.

Question 8

Psyllium (Metamucil) is prescribed for a patient with chronic constipation. In teaching the patient about the use of the drug, the nurse stresses that

Accepted Answer

A high fluid intake is needed when patients are using bulk-forming laxatives to avoid worsening constipation. Although bulk-forming laxatives are generally safe, the nurse should emphasize the possibility of constipation or obstipation if inadequate fluid intake occurs. Although increased gas formation is likely to occur with increased dietary fiber, the patient should increase dietary fiber and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool softeners and lubricants, not by bulk-forming laxatives.

Question 9

A patient is brought to the emergency department following an automobile accident in which blunt trauma to the abdomen occurred. The patient is splinting the abdomen and complaining of pain, and bowel sounds are decreased. Peritoneal lavage returns brown drainage. Based on the results of the lavage, the nurse plans for

Accepted Answer

Return of brown drainage suggests perforation of the bowel and the need for immediate surgery. Paracentesis is not a treatment for abdominal trauma and may spread infection. Administration of pain medication and/or continued monitoring may be indicated for a negative finding with peritoneal lavage.

Question 10

The nurse identifies the collaborative problem of potential complication: hypovolemic shock related to loss of circulatory volume for a patient with bacterial peritonitis resulting from a ruptured appendix. The nurse recognizes that the major loss of circulating fluid volume occurs as a result of

Accepted Answer

The inflammatory process causes the shift of fluids into the peritoneal space. Patients with NG suctioning receive IV fluids to compensate for fluid loss. Stress hormone production causes retention of fluids. Purulent drainage is not usually a significant source of fluid loss.

Question 11

A patient is admitted to the emergency department for evaluation of right lower-quadrant abdominal pain with nausea and vomiting. The patient has a white blood cell count (WBC) of 14,000/ml with a shift to the left. Which of these actions is appropriate for the nurse to take?

Accepted Answer

The patient's clinical manifestations are consistent appendicitis, and application of an ice pack will decrease inflammation at the area. The patient should be NPO in case immediate surgery is needed. Checking for rebound tenderness frequently is unnecessary and uncomfortable for the patient. The patient will need to know how to cough and deep breathe postoperatively, but coughing will increase pain and the patient is not likely to retain information at this point.

Question 12

Two days following an exploratory laparotomy with a resection of a short segment of small bowel, the patient complains of gas pains and abdominal distention. Which nursing action is most appropriate to take at this time?

Accepted Answer

Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. Morphine will further reduce peristalsis. A return-flow enema may decrease the patient's symptoms, but ambulation is less invasive and should be tried first. Promethazine (Phenergan) is used as an antiemetic rather than to decrease gas pains or distention.

Question 13

A patient who is hospitalized with a diagnosis of Giardia lamblia infection frequently has uncontrollable explosive diarrhea. The patient closes the eyes and will not talk to the nurse when the linens are changed and skin care is performed. To help maintain the patient's self-esteem, the nurse should

Accepted Answer

Acknowledging the difficulty of the situation and providing privacy will decrease the patient's embarrassment about the incontinence. Incontinence briefs are usually perceived as humiliating for patients. Use of antidiarrheal medications prolongs the exposure to the Giardia by slowing GI motility. Giardia may take several months to resolve.

Question 14

A 23-year-old woman is being evaluated in the emergency department for acute lower abdominal pain and vomiting. During the nursing history, the most helpful question by the nurse to obtain information regarding the patient's condition is

Accepted Answer

A complete description of the pain provides clues about the cause of the problem. The usual diet and elimination patterns are less helpful in determining the reason for the patient's symptoms. Although the nurse should ask whether the patient is pregnant to determine whether the patient might have an ectopic pregnancy and before any radiology studies are done, this information is not the most.

Question 15

A patient diagnosed with irritable bowel syndrome (IBS) tells the nurse, "My friends tell me this problem is all in my head." In caring for the patient, the nurse should

Accepted Answer

Because psychologic and emotional factors can impact on the symptoms for IBS, encouraging the patient to discuss emotions and ask questions is an important intervention. Although new medications are available, discussion of these medications does not address the patient's concerns with what friends think or say. There is no specific cause for IBS. Modifications in fiber intake may help some patients but might also increase bloating and gas pain. In addition, discussion of fiber does not address the patient's feelings.

Question 16

A 67-year-old patient tells the nurse, "I have problems with constipation now that I am older, so I use a suppository every morning." The most appropriate nursing action at this time is to

Accepted Answer

The nurse's initial action should be further assessment of the patient for risk factors for constipation and for usual bowel pattern. The other actions may be appropriate but will be based on the assessment.

Question 17

Sulfasalazine (Azulfidine) is prescribed for a patient who has been diagnosed with ulcerative colitis. The nurse recognizes that teaching about this drug has been effective when the patient says,

Accepted Answer

Sulfasalazine suppresses the inflammatory process that causes the symptoms of ulcerative colitis. It is not used to treat infections. Laboratory tests for immune suppression are needed for the immunosuppressant medications used for ulcerative colitis. Sulfasalazine is an oral medication, although the active portion of the medication (5-ASA) may be given rectally.

Question 18

A patient who is hospitalized with abdominal pain and watery, incontinent diarrhea is diagnosed with Clostridium difficile. In planning care for the patient, the nurse will

Accepted Answer

Because C. difficile is highly contagious, the patient should be placed in a private room and contact precautions should be used. There is no need to restrict dairy products for this type of diarrhea. Metronidazole (Flagyl) is frequently used to treat C. difficile. Improper food handling and storage do not cause C. difficile.

Question 19

A patient hospitalized with an acute exacerbation of ulcerative colitis is having 14 to 16 bloody stools a day and crampy abdominal pain associated with the diarrhea. The nurse will plan to

Accepted Answer

An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO. Cobalamin (vitamin BB₁₂) is absorbed in the ileum, which is not affected by ulcerative colitis. It is not appropriate to administer laxatives needed for colonoscopy to a patient with diarrhea. Metoclopramide increases peristalsis and will worsen symptoms.

Question 20

A patient is brought to the emergency department with a knife impaled in the abdomen following a domestic fight. During the initial assessment of the patient, it is important for the nurse to

Accepted Answer

The initial assessment is focused on determining whether the patient has hypovolemic shock. The knife should not be removed until the patient is in surgery, where bleeding can be controlled. Rovsing's sign is assessed in the patient with suspected appendicitis. A patient with a knife in place will be taken to surgery and assessed for bladder trauma there.

Quiz 43: Nursing Management: Lower Gastrointestinal Problems