Question 1

The nurse is caring for a patient with an ileostomy.Which assessment finding is expected when emptying the patient's ostomy appliance?

Accepted Answer

An ileostomy bypasses the entire large intestine creating frequent,liquid stools.Frequent unformed stool would be expected after removal of some of the large intestine.The patient would have a soft,formed stool after sigmoid colostomy.Infrequent hard pellets of stool is not be expected in a patient with an ostomy.

Question 2

Which actions of the nurse demonstrate correct administration of a soapsuds enema?

Accepted Answer

The enema bag is lowered when the patient complains of abdominal cramping to slow the rate and reduce discomfort.Fecal impactions should be removed before administration of soapsuds enemas.The tip of the enema tube should be lubricated with water-soluble jelly rather than petroleum jelly.Only castile soap may be used for soapsuds enemas.Liquid antibacterial soap can cause damage to the colon.The enema should be administered while the patient is in the left Sims' position.

Question 3

Which assessment finding by the nurse indicates that the patient's colonoscopy preparation is complete?

Accepted Answer

The colonoscopy preparation is complete when the patient's colon is free of stool.This is indicated by passage of watery clear yellow liquid from the colon.Passage of soft formed stool indicates that additional cleansing of the colon is required.The abdomen should not be distended and the colonoscopy preparation should not cause vomiting.

Question 4

The nurse is caring for a patient who had surgery to remove most of the large intestine.Which finding will the nurse expect to note when assessing the patient?

Accepted Answer

The large intestine is responsible for resorption of water from the stool.Removal of the large intestine results in loose stools as the water is not sufficiently removed from the stool before evacuation.Removal of the large intestine does not cause impaction or constipation.

Question 5

The nurse is caring for a patient with a new,unexpected sigmoid colostomy.The nursing diagnosis knowledge deficit related to colostomy care is included in the patient's care plan.Which is the appropriate outcome for the patient?

Accepted Answer

The appropriate outcome for the nursing diagnosis knowledge deficit related to colostomy is that the patient will empty and change the colostomy appliance.Resuming a sexual relationship,verbalizing feelings,and using clothing to conceal the ostomy do not relate to the patient's need to learn how to care for the colostomy.

Question 6

Which assessment finding leads the nurse to conclude that digital disimpaction of stool is unsafe for the patient?

Accepted Answer

Digital removal of stool from the rectum can cause lowering of the heart rate due to stimulation of the vagus nerve.Patients with bradycardia can experience dangerously low heart rates due to vagal stimulation.Presence of hard,dry stool in the rectum,use of senna,and no bowel movement for the last 6 days are not contraindications for digital removal of stool.

Question 7

Which is the appropriate nursing action after administering a bisacodyl suppository?

Accepted Answer

A bisacodyl suppository will cause the patient to have a bowel movement in approximately 30 minutes so the bedside commode should be ready next to the patient's bed.The colon should be checked for fecal impaction prior to administration of a laxative suppository.There is no need to educate the patient about methods to relieve excess gas formation.

Question 8

The nurse is caring for a patient with diarrhea caused by Clostridium difficile infection.Which are the priority interventions of the nurse?

Accepted Answer

Hand hygiene with soap and water and maintenance of contact isolation precautions are essential to prevent spread of Clostridium difficile infection.Accurate calculation of intake and output is needed to assess for fluid volume deficit from diarrhea.Skin barrier cream to the perineal area will help prevent skin breakdown.Increasing dietary fiber is not recommended as it may further irritate the colon.Antidiarrheal medication such as loperamide is not administered as it will prevent removal of the Clostridium difficile infection from the colon through the diarrhea.

Question 9

Which possible reasons does the nurse identify that contribute to the patient's black stools?

Accepted Answer

Iron supplements and upper gastrointestinal bleeding will cause black stools.Hemorrhoids will cause streaks of fresh red blood on the stool.Clostridium difficile infection will cause watery diarrhea.Incomplete small bowel obstruction will not cause black stools.

Question 10

The nurse is caring for a patient with painful hemorrhoids.Which is the appropriate recommendation of the nurse to prevent their recurrence?

Accepted Answer

Hemorrhoids are caused and aggravated by straining for defecation with constipation,pregnancy,or chronic illness.A high-fiber diet with plenty of liquids will keep stools soft and prevent straining for defecation.Low-carbohydrate ketogenic diets are often low in fiber which can lead to constipation.Bowel cleansing programs and daily stool softeners are not recommended,as they can lead to chronic constipation,and fluid-electrolyte imbalances.

Question 11

The nurse is caring for a patient who has just undergone knee-replacement surgery.The patient has incontinent of continuous oozing stool for the last few days.Which is the appropriate action of the nurse?

Accepted Answer

Continuous oozing stool for several days indicates the possibility of fecal impaction,especially as the patient has been recuperating after joint surgery.Loperamide would cause fecal impaction to worsen and should not be administered.Potential skin breakdown does not address the root cause of the oozing stool.Fluid intake,in the presence of continuous oozing stool,is less likely to help the patient versus assessing for a fecal impaction.

Question 12

Which medication does the nurse identify as most likely to cause a patient's constipation?

Accepted Answer

Ferrous sulfate (iron supplement)is known to cause constipation.Cefaclor and other antibiotics are known to cause diarrhea.Warfarin and prednisone do not cause constipation.

Question 13

The nurse is caring for a patient who relies on laxatives to ensure daily bowel movements.Which is the appropriate nursing diagnosis for this patient?

Accepted Answer

Perceived constipation is the patient's use of laxatives to ensure daily bowel movements.This leads to laxative abuse and dependence with possible damage to the colon.Risk for constipation and toileting self-care deficit are less appropriate for the patient than perceived constipation.Powerlessness is not a priority nursing diagnosis for this patient.

Question 14

The nurse is caring for a patient with a colostomy.The nursing diagnosis risk for impaired skin integrity related to leakage of effluent from appliance is included in the patient's care plan.Which is the appropriate intervention of the nurse?

Accepted Answer

The ostomy appliance is liable to leak if it becomes more than half full.Leakage of stool from the ostomy appliance puts the patient's skin at risk of breakdown.The nurse can minimize the risk of skin breakdown by emptying the effluent into the toilet before the ostomy appliance becomes half full.Application of creams to the skin under the appliance will prevent adhesion and lead to leakage around the stoma.Measurement of the stoma will not help to prevent skin breakdown.

Question 15

Which patient would benefit from a sitz bath?

Accepted Answer

A sitz bath is a shallow bath of warm water used to clean and soothe irritation of the perineum or rectum.A patient with painful hemorrhoids would benefit from soaking in a sitz bath.A sitz bath does not relieve constipation or help adhere an ostomy appliance to the skin.A patient with continuous oozing of stool should not be given a sitz bath,as bacteria from the stool could be introduced to the vaginal and/or urethral openings.

Question 16

Which is the appropriate nursing action after the patient's fecal occult blood test is positive?

Accepted Answer

Any patient with positive fecal occult blood tests should have a colonoscopy performed to check for the presence of colon cancer.Fecal occult blood is the presence of minute amounts of blood in the stool so no CBC or transfusion is needed.There is no need for the nurse to check the patient's rectum for impacted stool.

Question 17

The rehabilitation nurse is working with a patient to regain bowel continence after a stroke.Which intervention will the nurse include as part of the patient's bowel training program?

Accepted Answer

The patient's bowel training program will help the patient to set up a daily routine for defecation.Assisting the patient to the toilet every morning after breakfast is a good way to help set up this routine.Administering stool softeners,routinely checking for fecal impaction,and applying skin barrier creams will not help the patient to set up a daily routine for defecation.

Question 18

Which patient does the nurse identify that would benefit from administration of an oil-retention enema?

Accepted Answer

A patient with a fecal impaction would benefit from an oil-retention enema as the hard stool would soften and make it easier to pass.Oil-retention enemas do not benefit patients with diarrhea,positive fecal occult blood test,or a serum potassium level of 7.1 mEq/L.A sodium polystyrene sulfonate enema is administered to treat severe hyperkalemia.

Question 19

Which patient does the nurse identify that would benefit from a nasogastric tube to low intermittent suction?

Accepted Answer

A patient who is vomiting due to a complete small bowel obstruction would benefit from a nasogastric tube as it will decompress the stomach and eliminate the need for vomiting.A nasogastric tube will not be of benefit for patients with constipation,diarrhea,or leaking ostomy appliance.

Quiz 37: Bowel Elimination