Question 1

The nurse is caring for a client who is to receive 5-fluorouracil (5-FU)chemotherapy IV for the treatment of colon cancer.Which assessment finding leads the nurse to contact the health care provider?

Accepted Answer

Common side effects of 5-FU include fatigue,leukopenia,diarrhea,mucositis and mouth ulcers,and peripheral neuropathy.However,the client's WBC count is very low (normal range,5000 to 10,000/mm³),so the provider should be notified.He or she may want to delay chemotherapy by a day or two.Certainly the client is at high risk for infection.The other assessment findings are consistent with common side effects of 5-FU that would not need to be reported immediately.

Question 2

The nurse is helping a student prepare to insert a nasogastric tube for an adult client with a bowel obstruction.Which actions by the student indicate to the nurse that a review of the procedure is needed?

Accepted Answer

An 8 Fr nasogastric tube is too small for drainage of thick stomach contents.Sterile gloves are not needed for the procedure.The tube should be secured to the client's gown,not to the pillowcase,because it could become dislodged easily.The client's head should be flexed forward once the tube has reached the oropharynx.All the other actions are appropriate.A 60-mL irrigation syringe should be attached to the end of the tube before insertion so that gastric fluid does not erupt from the tube when it enters the stomach.

Question 3

The nurse is teaching self-care measures for a client who has hemorrhoids.Which nursing intervention does the nurse include in the plan of care for the client?

Accepted Answer

The client should be instructed to use wet wipes and dab the anal area after defecating to avoid further irritation.Dibucaine can be used only for short periods of time because long-term use can mask worsening symptoms.Clients with hemorrhoids require high-fiber foods.The client should not be encouraged to strain at stool or to spend long periods of time on the toilet,because this increases pressure in the rectal area,which can make hemorrhoids worse.

Question 4

A middle-aged male client has irritable bowel syndrome that has not responded well to diet changes and bulk-forming laxatives.He asks the nurse about the new drug lubiprostone (Amitiza).What information does the nurse provide him?

Accepted Answer

Lubiprostone (Amitiza)is approved only for use in women.The other statements are not accurate.

Question 5

A client is to receive 12 mg/kg of 5-fluorouracil (5-FU)chemotherapy IV for treatment of colon cancer.The client weighs 132 lb.The client will receive ______ milligrams of 5-FU.

Accepted Answer

The answer of A client is to receive 12 mg/kg...

Question 6

A client with a mechanical bowel obstruction reports that abdominal pain,which was previously intermittent and colicky,is now more constant.Which is the priority action of the nurse?

Accepted Answer

A change in the nature and timing of abdominal pain in a client with a bowel obstruction can signal peritonitis or perforation.The nurse should immediately check for rebound tenderness and the absence of bowel sounds.The nurse need not measure abdominal girth.The nurse may help the client to the knee-chest position for comfort,but this is not the priority action.The nurse should not medicate the client until the physician has been notified of the change in his or her condition.

Question 7

The nurse is providing discharge teaching for a client who has undergone colon resection surgery with a colostomy.Which statements by the client indicate that the instruction was understood?

Accepted Answer

The client should avoid using soap to clean around the stoma because it might prevent effective adhesive of the ostomy appliance.The client should use warm water and a soft washcloth instead.The stoma should remain a soft pink color.A deep red or purple hue indicates ischemia and should be reported to the surgeon right away.The tissue of the stoma is very fragile,and scant bleeding may occur when the stoma is cleaned.Yogurt and buttermilk can help reduce gas in the pouch,so the client need not avoid dairy products.Exercise (other than some contact sports)is important for clients with an ostomy.

Question 8

A client who has had a colostomy placed in the ascending colon expresses concern that the effluent collected in the colostomy pouch has remained liquid for 2 weeks after surgery.Which is the nurse's best response?

Accepted Answer

The stool from an ascending colostomy can be expected to remain liquid because little large bowel is available to reabsorb the liquid from the stool.The provider may be notified,but this is not the best response from the nurse.Liquid stool from an ascending colostomy will not become firmer with the addition of fiber to the client's diet or with the passage of time.

Question 9

The nurse is caring for a client who has undergone removal of a benign colonic polyp.The client asks the nurse why a follow-up colonoscopy is necessary.Which is the nurse's best response?

Accepted Answer

Once a person has developed a polyp,risk for occurrence of multiple polyps is present.The physician usually can remove all visible polyps during the colonoscopy procedure.Follow-up colonoscopy is not done to ensure that healing occurred where a polyp was removed,or to check for cancerous lesions that were not visible during the first procedure.

Quiz 59: Care of Patients With Noninflammatory Intestinal Disorders

The nurse is caring for a client who is to receive 5-fluorouracil (5-FU) chemotherapy IV for the treatment of colon cancer.Which assessment finding leads the nurse to contact the health care provider?