Question 1

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

Accepted Answer

The nurse should first assess the situation by asking the patient to describe the character of the stools and any associated symptoms to determine the severity and possible cause of the diarrhea before providing further advice or treatment.

Question 2

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

Accepted Answer

Assessing the BP and pulse is crucial in the initial assessment to determine the patient's hemodynamic stability and to monitor for signs of shock or hemorrhage, which are immediate life-threatening concerns.

Question 3

Psyllium (Metamucil)is prescribed for a patient with chronic constipation.In teaching the patient about chronic constipation,what should the nurse stress?

Accepted Answer

Chronic constipation can lead to impaction or bowel obstruction, so it is important for the patient to consume enough fluids to help prevent this complication. The use of bulk-forming laxatives may cause adverse effects such as bloating and gas formation. Removing dietary sources of fiber may exacerbate the constipation. Psyllium (Metamucil) does not block the absorption of fat-soluble vitamins.

Question 4

A woman diagnosed with irritable bowel syndrome (IBS)tells the nurse that her friends say her problem is "all in [her] head." In caring for the woman,what is it most important for the nurse to do?

Accepted Answer

It is important for the nurse to develop a trusting relationship with the patient to allow for the expression of her concerns. It is not helpful to dismiss her concerns or suggest that IBS has a specific cause, as the exact cause of IBS is not yet fully understood. Although dietary modifications and medications can be helpful, building a trusting relationship and addressing the patient's emotional well-being is essential in providing holistic care.

Question 5

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 which of the following?

Accepted Answer

Extracellular fluid shift into the peritoneal cavity, also known as third spacing, is a major cause of hypovolemic shock in patients with bacterial peritonitis resulting from a ruptured appendix. This is because the peritoneal cavity fills with fluid, which is not available for circulation, leading to a decrease in circulating volume and subsequent hypovolemic shock. Nasogastric suctioning and drainage of excessive fluids from the appendix can also contribute to fluid loss but are not typically the primary causes of hypovolemic shock in these patients. Increased production of stress hormones may lead to vasoconstriction and increased heart rate, but it is not a significant contributor to hypovolemic shock in this context.

Question 6

A patient is admitted to the emergency department with severe abdominal pain,anorexia,and chills.His vital signs include temperature 38.3°C,pulse 130 beats/min,respiration 34 breaths/min,and blood pressure (BP)82/50 mm Hg.His pain is more intense in the left lower quadrant but radiates throughout the entire abdomen,with rebound tenderness and abdominal rigidity.The nurse plans care for the patient based on the knowledge that management of his condition initially involves which of the following actions?

Accepted Answer

The patient's vital signs indicate hypovolemia, likely due to fluid loss from an acute abdomen. Thus, the initial management of this patient involves IV fluid resuscitation to restore hemodynamic stability. Exploratory laparotomy may be necessary depending on the underlying cause of the acute abdomen, but this decision would be made based on diagnostic testing and evaluation. Administration of IV antibiotics may be necessary if an infection is identified as the cause, but again, this would be based on diagnostic testing. Diagnostic testing with barium studies and endoscopy may be diagnostic tools, but they are not the initial management of this patient's acute abdomen.

Question 7

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.Which of the following will the nurse plan to implement?

Accepted Answer

Placing the patient on NPO (nil per os, or nothing by mouth) status is appropriate to rest the bowel during acute exacerbations of ulcerative colitis, which can help reduce symptoms and prevent further irritation of the colon.

Question 8

A patient is brought to the emergency department following an automobile accident in which she suffered blunt trauma to the abdomen.She is splinting her abdomen and complaining of pain,and bowel sounds are decreased.A peritoneal lavage returns brown drainage.Based on the results of the lavage,what should the nurse plan for?

Accepted Answer

The brown drainage from the peritoneal lavage indicates possible bowel perforation and immediate preparation for surgery is necessary to explore and repair any damage to the abdominal organs. Pain medications and monitoring the patient's condition are important, but do not address the urgent need for surgical intervention. Preparation for a paracentesis is not indicated, as this procedure involves draining fluid from the peritoneal cavity and would not address the underlying issue of possible bowel trauma.

Question 9

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

Accepted Answer

Assisting the patient to ambulate can help promote passage of flatus and relieve gas pains and abdominal distension. Administering IV morphine sulphate and inserting a promethazine suppository can cause further slowing of the bowel and worsen symptoms. A return-flow enema may be helpful if constipation or fecal impaction is suspected, but may not be the best initial intervention.

Question 10

While obtaining a nursing history from a patient with IBD,which of the following data leads the nurse to suspect that the patient most likely has ulcerative colitis rather than Crohn's disease?

Accepted Answer

Bloody diarrhea is a symptom that is more commonly associated with ulcerative colitis than Crohn's disease. Weight loss and abdominal pain and cramping can be present in both types of IBD, and the age of onset does not differentiate between the two.

Question 11

After teaching a patient with IBD about the recommended low-residue diet,the nurse identifies a need for further instruction when the patient chooses which of the following foods from the menu?

Accepted Answer

Ham hocks and beans are high in fiber and may cause increased intestinal transit time and bowel movements, which can exacerbate symptoms in patients with IBD. The other options are low in fiber and generally acceptable on a low-residue diet. The best choice(s) would be A, C, and D.

Question 12

Sulphasalazine (Salazopyrin)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 states which of the following?

Accepted Answer

Sulphasalazine is an anti-inflammatory drug that suppresses the inflammation in the large intestine, which is the reason it is prescribed for ulcerative colitis. It does not prevent infections or require lab tests to check immune function. It is taken orally and not administered as an enema or suppository.

Question 13

Which of the following is a neoplastic polyp of the large intestine?

Accepted Answer

Neoplastic polyps of the large intestine are associated with hereditary polyposis syndromes, including familial adenomatous polyposis (FAP) and Lynch syndrome. Familial juvenile polyps and pseudopolyps are non-neoplastic polyps, and leiomyomas are tumors of smooth muscle, not associated with the colon.

Question 14

A 20-year-old university student is admitted to the emergency department for evaluation of abdominal pain with nausea and vomiting.She has a white blood cell count of 14,000 cells/microlitre with a shift to the left.Which one of the following actions is appropriate for the nurse to take?

Accepted Answer

Applying an ice pack to the right lower quadrant can help reduce inflammation and pain, which is appropriate for a patient with suspected appendicitis.

Question 15

The nurse identifies a nursing diagnosis of impaired skin integrity related to diarrhea for a patient with ulcerative colitis.The nurse recognizes that teaching regarding perianal care has been effective when the patient implements which of the following actions?

Accepted Answer

Applying a barrier cream after each cleansing of the perianal area helps protect the skin from further breakdown and can promote healing. Taking a sitz bath for 40 minutes after each stool may not be practical or necessary for the patient. Asking for antidiarrheal medication after each diarrhea stool may not address the underlying issue of ulcerative colitis and its associated skin integrity problems. Cleansing the perianal area with soap and water may be appropriate, but it is important to also apply a barrier cream to protect the skin.

Question 16

An older adult man is hospitalized with a diagnosis of Giardia lamblia infection.He frequently has explosive diarrhea stools that he is unable to control.He closes his eyes and will not talk to the nurse when his linens are changed and skin care is performed.To help maintain the patient's self-esteem,what should the nurse implement?

Accepted Answer

The best choice is to acknowledge the patient's behavior as reflective of a difficult situation and provide privacy during hygiene. This will help maintain the patient's self-esteem by respecting his dignity and providing him with privacy during personal care. Using incontinence briefs without the patient's consent may further erode his self-esteem, and an antidiarrheal drug may not address the patient's emotional needs. Assuring the patient that his lack of control is temporary may be helpful but does not address the immediate emotional concerns.

Question 17

Surgery is recommended by the physician for a patient with severe ulcerative colitis who has not responded to conservative treatment.The patient tells the nurse that she does not know what decision to make about the proposed surgery or how to choose among the surgical alternatives offered by the surgeon.In responding to the patient's concerns,what should the nurse explain?

Accepted Answer

The nurse should explain that a total colectomy and ileal reservoir provide the most normal elimination function for the patient but require two procedures, including a temporary ileostomy for 8 to 12 weeks. The nurse should also provide information about the surgical alternatives offered by the surgeon, such as the risks and benefits of each option, and encourage the patient to ask questions and voice any concerns they may have.

Question 18

Which stool consistency would the nurse expect to see in a patient with a sigmoid colostomy?

Accepted Answer

A sigmoid colostomy is created on the sigmoid colon, which is responsible for controlling the final consistency of stool. Therefore, the nurse would expect the stool to be formed.

Question 19

A patient is being evaluated in the emergency department for acute lower abdominal pain with diarrhea and vomiting.During the nursing history,what is the most helpful question to obtain information regarding the patient's condition?

Accepted Answer

The most helpful question to obtain information regarding the patient's condition is "Can you tell me about your pain?". This question will help the nurse to assess the severity, location, and duration of the pain, which can provide important clues to the underlying cause.

Question 20

A 78-year-old patient is transferred to the hospital from a nursing home on developing abdominal pain and watery,incontinent diarrhea following a course of antibiotic therapy for pneumonia.Stool cultures reveal the presence of Clostridium difficile.In planning care for the patient,the nurse will do which of the following?

Accepted Answer

Placing the patient in a private room with contact isolation is important to prevent the spread of Clostridium difficile infection to other patients or healthcare workers. Choices A, C, and D may be appropriate interventions depending on the patient's specific needs, but they are not the priority for managing C. difficile infection.

Quiz 45: Nursing Management: Lower Gastrointestinal Problems