Question 1

A 58-year-old man with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage.If the lavage returns brown fecal drainage,which action will the nurse plan to take next?

Accepted Answer

Return of brown drainage and fecal material suggests perforation of the bowel and the need for immediate surgery.Auscultation of bowel sounds,checking the temperature,and obtaining information about the accident are appropriate actions,but the priority is to prepare to send the patient for emergency surgery.

Question 2

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD)indicates a need for more teaching?

Accepted Answer

During acute exacerbations of IBD,the patient should avoid high-fiber foods such as whole grains.High-fat foods also may cause diarrhea in some patients.The other choices are low residue and would be appropriate for this patient.

Question 3

A 71-year-old male patient tells the nurse that growing old causes constipation so he has been using a suppository for constipation every morning.Which action should the nurse take first?

Accepted Answer

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

Question 4

A 24-year-old woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI)with tan,fecal-smelling urine.What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient?

Accepted Answer

Fistulas between the bowel and bladder occur in Crohn's disease and can lead to UTI.Teaching for UTI prevention in general includes good hygiene,adequate fluid intake,and voiding before and after intercourse.

Question 5

A 51-year-old male patient has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg)over 2 months.The nurse will plan to teach about

Accepted Answer

Medications are used to induce and maintain remission in patients with inflammatory bowel disease (IBD).Decreased activity level is indicated only if the patient has severe fatigue and weakness.Fluids are needed to prevent dehydration.There is no advantage to enteral feedings.

Question 6

A 64-year-old woman who has chronic constipation asks the nurse about the use of psyllium (Metamucil).Which information will the nurse include in the response?

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 gradually 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 7

The nurse is providing preoperative teaching for a 61-year-old man scheduled for an abdominal-perineal resection.Which information will the nurse include?

Accepted Answer

A bowel-cleansing agent is used to empty the bowel before surgery to reduce the risk for infection.A permanent colostomy is created with this surgery.Sitting is contraindicated after an abdominal-perineal resection.Oral antibiotics (rather than IV antibiotics)are given to reduce colonic and rectal bacteria.

Question 8

Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine)for ulcerative colitis has been effective?

Accepted Answer

Sulfasalazine may cause photosensitivity in some patients.It is not used to treat infections.Sulfasalazine does not reduce immune function.Unlike corticosteroids,tapering of sulfasalazine is not needed.

Question 9

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day.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.Metoclopramide increases peristalsis and will worsen symptoms.Cobalamin (vitamin B??)is absorbed in the ileum,which is not affected by ulcerative colitis.Although total colectomy is needed for some patients,there is no indication that this patient is a candidate.

Question 10

Which nursing action will be included in the plan of care for a 27-year-old male patient with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)?

Accepted Answer

Because psychologic and emotional factors can affect the symptoms for IBS,encouraging the patient to discuss emotions and ask questions is an important intervention.Alosetron has serious side effects,and is used only for female patients who have not responded to other therapies.Although yogurt may be beneficial,milk is avoided because lactose intolerance can contribute to symptoms in some patients.NSAIDs can be used by patients with IBS.

Question 11

A 73-year-old patient with diverticulosis has a large bowel obstruction.The nurse will monitor for

Accepted Answer

Abdominal distention is seen in lower intestinal obstruction.Referred back pain is not a common clinical manifestation of intestinal obstruction.Metabolic alkalosis is common in high intestinal obstruction because of the loss of HCl acid from vomiting.Projectile vomiting is associated with higher intestinal obstruction.

Question 12

Which nursing action will the nurse include in the plan of care for a 35-year-old male patient admitted with an exacerbation of inflammatory bowel disease (IBD)?

Accepted Answer

Because anemia or hemorrhage may occur with IBD,stools should be assessed for the presence of blood.The other actions would not be appropriate for the patient with IBD.Because dietary fiber may increase gastrointestinal (GI)motility and exacerbate the diarrhea,severe fatigue is common with IBD exacerbations,and dehydration may occur.

Question 13

A 27-year-old female patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting.Which action should the nurse take?

Accepted Answer

The patient's clinical manifestations are consistent with appendicitis,and application of an ice pack will decrease inflammation at the area.Checking for rebound tenderness frequently is unnecessary and uncomfortable for the patient.The patient should be NPO in case immediate surgery is needed.The patient will need to know how to cough and deep breathe postoperatively,but coughing will increase pain at this time.

Question 14

The nurse preparing for the annual physical exam of a 50-year-old man will plan to teach the patient about

Accepted Answer

At age 50,individuals with an average risk for colorectal cancer (CRC)should begin screening for CRC.Colonoscopy is the gold standard for CRC screening.The other diagnostic tests are not recommended as part of a routine annual physical exam at age 50.

Question 15

After a total proctocolectomy and permanent ileostomy,the patient tells the nurse,"I cannot manage all these changes.I don't want to look at the stoma." What is the best action by the nurse?

Accepted Answer

Encouraging the patient to share concerns assists in helping the patient adjust to the body changes.Acknowledgment of the patient's feelings and concerns is important rather than offering false reassurance.Because the patient indicates that the feelings about the ostomy are the reason for the difficulty with the many changes,development of a detailed ostomy care plan will not improve the patient's ability to manage the ostomy.Although detailed ostomy teaching may be postponed,the nurse should offer teaching about some aspects of living with an ostomy.

Question 16

A 22-year-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin.Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective?

Accepted Answer

Witch hazel compresses are suggested to reduce anal irritation and discomfort.Incontinence briefs may trap diarrhea and increase the incidence of skin breakdown.Antidiarrheal medications are not given 15 to 20 times a day.The perianal area should be washed with plain water after each stool.

Question 17

A 74-year-old patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA)test result.The nurse explains that the test is used to

Accepted Answer

CEA is used to monitor for cancer recurrence after surgery.CEA levels do not help to determine whether there is metastasis of the cancer.Confirmation of the diagnosis is made on the basis of biopsy.Chemotherapy use is based on factors other than CEA.

Question 18

A 26-year-old woman is being evaluated for vomiting and abdominal pain.Which question from the nurse will be most useful in determining the cause of the patient's symptoms?

Accepted Answer

A complete description of the pain provides clues about the cause of the problem.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 useful in determining the cause of the pain.The usual diet and elimination patterns are less helpful in determining the reason for the patient's symptoms.

Question 19

Which action will the nurse include in the plan of care for a 42-year-old patient who is being admitted with Clostridium difficile?

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 20

A patient complains of gas pains and abdominal distention two days after a small bowel resection.Which nursing action is best to take?

Accepted Answer

Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain.A mineral oil retention enema is helpful for constipation with hard stool.A return-flow enema might be used to relieve persistent gas pains.Morphine will further reduce peristalsis.Promethazine (Phenergan)is used as an antiemetic rather than to decrease gas pains or distention.

Quiz 39: Nursing Management: Lower Gastrointestinal Problems

A 58-year-old man with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage.If the lavage returns brown fecal drainage,which action will the nurse plan to take next?

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching?

A 71-year-old male patient tells the nurse that growing old causes constipation so he has been using a suppository for constipation every morning.Which action should the nurse take first?

A 24-year-old woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan,fecal-smelling urine.What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient?

A 51-year-old male patient has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg) over 2 months.The nurse will plan to teach about

A 64-year-old woman who has chronic constipation asks the nurse about the use of psyllium (Metamucil) .Which information will the nurse include in the response?