Deck 34: Nursing Care of Patients With Lower Gastrointestinal Disorders

Question 1

The nurse is providing care for a client postoperative for the placement of a colostomy for colon cancer. When examining the stoma, which finding causes the nurse to immediately contact the health care provider (HCP)?

A)Large, beefy-red in color
B)Small in size and pink color
C)Large and seeping drainage
D)Dusky color, dryness noted

Answer 1

Dusky color, dryness noted

Question 2

The nurse is monitoring a patient recovering from an emergency appendectomy. Which finding does the nurse report immediately to the HCP?

A)Pain at the operative site
B)Absence of bowel sounds
C)Abdomen rigid on palpation 4.3-cm spot of bloody drainage on dressing

Answer 2

Abdomen rigid on palpation 4.3-cm spot of bloody drainage on dressing

Question 3

The nurse is providing care for a patient diagnosed with celiac disease. The patient initially presented with a skin rash with severe pruritus and blistering. Which additional manifestation is the nurse unlikely to associate with the patient's condition?

A)Gas and abdominal bloating
B)Frequent loose bulky stools
C)Moderate amount of weight gain
D)Foul-smelling, gray-colored stool

Answer 3

Moderate amount of weight gain

Question 4

The nurse is monitoring a patient and finds a bulging area in the patient's groin. Which additional finding causes the nurse the most concern?

A)The bulging disappears at times.
B)The WBC count is 10,000/mm³.
C)The patient develops pain at the site and vomiting.
D)The bulging occurs when the patient coughs or strains.

Question 5

A patient with ulcerative colitis is scheduled for a colectomy with formation of an ileoanal pouch. The patient is reviewing information presented by the HCP regarding possible surgical complications. Which statement by the patient causes the nurse to report a misunderstanding to the HCP?

A)"I will defecate in a normal manner after healing with the pouch."
B)"I will still need to watch for obstruction or pouch inflammation."
C)"The placement of an ileostomy is temporary until healing is complete."
D)"Formation of the pouch is part of the cure of my condition."

Question 6

The nurse notes that a patient with a history of a myocardial infarction is straining during defecation. Which response by the nurse is best?

A)"Be careful, you might get a headache when you push so hard."
B)"It is important that you not strain because it could cause damage to your heart."
C)"Your blood pressure gets very low when you strain like that and you could faint."
D)"Chronic constipation often causes a dilated colon, it is good that you are staying empty."

Question 7

A patient receives a diagnosis of Crohn disease and states, "I don't understand anything about this disease." Which information provided by the nurse is most helpful at this time?

A)The condition is an autoimmune inflammatory bowel disease.
B)Treatment will focus on symptom management and medications.
C)Inflamed areas are not continuous lesions along the intestine.
D)Connections between organs called fistulas and fissures may develop.

Question 8

The nurse is providing discharge teaching to a patient with diarrhea. Which patient statement indicates that teaching has been effective?

A)"It is important that I increase fluid intake to prevent dehydration."
B)"I am at increased risk for a ruptured bowel, so I must remain on bedrest."
C)"I should tell future health care workers that I've been diagnosed with obstipation."
D)"My risk for a urinary tract infection is very high, so I should call the doctor if I have pain."

Question 9

The nurse is reinforcing teaching to a patient with diverticulosis about how to avoid complications. Which patient statement indicates that teaching has been effective?

A)"I will avoid milk and milk products."
B)"I should avoid very hot and spicy foods."
C)"I will increase fluids and fiber in my diet."
D)"I should cook vegetables thoroughly before eating."

Question 10

The nurse is providing care for a patient who reports feeling constipated, yet passes frequent small liquid stools. The nurse suspects an impaction. Which statement by the patient causes the nurse concern?

A)"I took some medication to stop the diarrhea."
B)"I have strained but cannot have a good bowel movement."
C)"When I do pass feces, they are small, hard, and dry."
D)"My stomach is so bloated that I am uncomfortable."

Question 11

The nurse is providing care for a patient admitted with a complete, nonmechanical small bowel obstruction. Which manifestation indicates to the nurse that the patient's condition is improving?

A)Flatus and feces are passed.
B)Peristaltic waves are visible.
C)Patient verbally reports thirst.
D)Abdominal circumference decreases.

Question 12

The spouse of a patient with an ascending ostomy asks if the patient will always have to wear an ostomy bag. Which is the correct response by the nurse?

A)"An ostomy bag will be needed all of the time."
B)"An ostomy bag will be needed only during the night."
C)"An ostomy bag will be needed only to protect the stoma."
D)"An ostomy bag will be needed until discharge from the hospital."

Question 13

The nurse is caring for a patient admitted with a possible bowel obstruction. Which patient symptom should cause the nurse the most concern?

A)Flank pain
B)Fecal vomiting
C)Watery diarrhea
D)Occult blood in the stool

Question 14

The nurse is contributing to the plan of care for a patient with gluten enteropathy (celiac disease). Which food(s) does the nurse recommend be eliminated from the diet of the patient?

A)Red meats
B)Milk and milk products
C)Fresh fruits and vegetables
D)Wheat, rye, oats, and barley

Question 15

The nurse is gathering data on a patient with severe diarrhea for 3 days. The patient reports being out of the country for 2 weeks. Laboratory results indicate the presence of red blood cells (RBCs) and mucus in a stool sample. For which conditions does the nurse expect further testing?

A)Cholera, typhoid, typhus, or amebiasis
B)Shigellosis, salmonellosis, or reginal enteritis
C)Large bowel cancer or intestinal tuberculosis
D)Celiac disease, or irritable bowel syndrome

Question 16

The nurse is collecting data from a patient who is reporting abdominal pain. Which symptom suggests that the patient is experiencing appendicitis?

A)Suprapubic pain
B)Midepigastric pain
C)Substernal pain that radiates to the back
D)Pain in the right lower abdominal quadrant

Question 17

On admission, a patient with gastrointestinal bleeding had the following vital signs: blood pressure (BP) 140/80 mm Hg, pulse 72 beats/min, respirations 14 breaths/min, and temperature 98.8°F (37.1°C) orally. Which finding does the licensed practical nurse/licensed vocational nurse (LPN/LVN) report immediately to the registered nurse (RN) or HCP?

A)Pulse 78 beats/min
B)Crampy abdominal pain
C)Occult blood in the stool
D)BP 104/68 mm Hg

Question 18

The nurse is providing care for a client with advanced Crohn disease who has developed multiple complications of the disease and no longer responds to treatment. The HCP is recommending surgery. Which detail about the patient's surgery does the nurse comprehend?

A)The patient is not a candidate for a Kock pouch.
B)The patient will be considered cured after the surgery.
C)The narrowed parts of the colon will be removed.
D)The formation of a colostomy is the surgical goal.

Question 19

A patient is informed, after a colonoscopy, of diverticulosis. The patient asks the nurse about the causes and management of the condition. Which information shared by the nurse is inaccurate?

A)Chronic constipation is a common precursor to the condition.
B)A major management intervention is an increase in dietary fiber.
C)Nuts and foods with seeds and hulls are avoided to prevent infection.
D)Weight control, a healthy diet, and exercise are good management interventions.

Question 20

The nurse is providing care for a patient diagnosed with obstipation. Which condition is the nurse aware as being unrelated to the patient's diagnosis?

A)History of repeatedly ignoring the urge to defecate
B)Colon and rectal tissue insensitive to presence of feces
C)Medical history of obesity and cardiovascular disorders
D)Stronger stimulation needed to produce a peristaltic rush

Question 21

The nurse is reviewing teaching with a patient scheduled for an ileostomy and placement of a continent ostomy reservoir. Which teaching is most important for the nurse to review?

A)The selected surgery takes longer than conventional surgery.
B)The pouch must be emptied regularly to prevent rupture.
C)The management of a continent pouch requires extra teaching.
D)Valve slipping or leakage will require additional surgery.

Question 22

A patient is scheduled for colon surgery that will require the placement of a colostomy. The wound, ostomy, and continence nurse (WOCN) will evaluate the patient for correct stoma placement. Which consideration by the nurse will directly impact skin integrity?

A)The placement that will prevent interference with clothing
B)The placement that promotes visibility and easy care
C)The placement that will prevent leaking or poor appliance fit
D)The placement that promotes comfort when sitting

Question 23

The nurse is gathering data on a patient who was recently treated for colon cancer with the endoscopic removal of a small tumor. Which data will the nurse determine most important to relay to the HCP?

A)Ecchymosis and tenderness in the groin
B)Mild discomfort during palpation of the abdomen
C)A 4-pound weight loss over a period of a month
D)Auscultation of active bowel sounds in all quadrants

Question 24

The nurse reinforces teaching to a patient prescribed budesonide for Crohn disease inflammation. Which patient statements indicate that additional teaching is necessary? (Select all that apply.)

A)"I should avoid grapefruit juice."
B)"I must avoid the sun while taking this drug."
C)"I should swallow the pill whole, not crushed."
D)"I will take the pill each evening before going to bed."
E)"I can stop taking the medication once I feel better."

Question 25

The nurse is reinforcing teaching to a patient newly diagnosed with ulcerative colitis about triggers for exacerbation of the disease. Which recommendation does the nurse make to the patient to prevent a future exacerbation? (Select all that apply.)

A)Do not use tobacco.
B)Reduce exposure to stress.
C)Restrict fluids to 2 liters per day.
D)Read food labels to avoid food additives.
E)Avoid ingesting foods sprayed with pesticides.

Question 26

The nurse is reinforcing teaching to a patient who is being discharged with a new colostomy. Which comments by the patient indicate understanding of the discharge teaching? (Select all that apply.)

A)"I will empty the pouch when it is less than half full."
B)"I can spray deodorant into the pouch after I clean it."
C)"I will not be concerned if there is no stool for several days."
D)"I always check the seal and tape around the stoma after I shower."
E)"I should change the pouch each morning and evening to prevent infection."

Question 27

The nurse is gathering information from a patient who reports anal pain. Which finding upon physical examination supports the presence of an anal abscess?

A)Thrombosed vessels
B)Pain with defecation
C)Fever and drainage
D)Pain-induced constipation

Question 28

The nurse is reinforcing teaching with a patient about appropriate diet modifications to help prevent exacerbations of inflammatory bowel disease. Which patient statements indicate that teaching has been effective? (Select all that apply.)

A)"I should avoid caffeine and spicy fiber foods."
B)"I should avoid concentrated sweets and starches."
C)"It is important to eat more whole grains and bran."
D)"High-fiber foods should not be included in my diet."
E)"Milk and other dairy products should be limited in my diet."

Question 29

The nurse is providing care for a patient diagnosed with an obstructed colon related to colon cancer. The client receives endoscopic treatment prior to surgical intervention to remove the obstructing tumor. Which observation will the nurse expect?

A)Decrease in pain level
B)Increased rectal bleeding
C)Rectal passage of stool
D)Improved dietary intake

Question 30

The nurse provides care to older adult residents in an extended-care facility. One resident is experiencing diarrhea. The resident reports loss of appetite, weakness, and drowsiness. Which body system is most important for the nurse examine?

A)Respiratory system
B)Skin condition
C)Cardiovascular system
D)Gastrointestinal system