Deck 34: Nursing Care of Patients With Lower Gastrointestinal Disorders

Question 1

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 a pain."

Answer 1

"It is important that I increase fluid intake to prevent dehydration."

Question 2

The nurse is teaching a patient with diverticulosis 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."

Answer 2

"I will increase fluids and fiber in my diet."

Question 3

The nurse is caring for a patient who is being screened for diverticulosis.Which patient statement indicates understanding of conditions that predispose to diverticulosis?

A) "Colon cancer."
B) "Chronic diarrhea."
C) "Chronic constipation."
D) "Diet high in red meats."

Answer 3

"Chronic constipation."

Question 4

The nurse is caring for a patient with an inflamed appendix.Which complication is most likely to occur if the appendix ruptures?

A) Colitis
B) Enteritis
C) Hepatitis
D) Peritonitis

Question 5

The nurse is monitoring a patient recovering from an emergency appendectomy.Which finding should be reported to the physician immediately?

A) Pain at the operative site
B) Absence of bowel sounds
C) Abdomen rigid on palpation
D) 3-centimeter spot of bloody drainage on dressing

Question 6

The nurse is caring for a patient who has diarrhea.Which nursing action is the highest priority?

A) Provide perineal skin care.
B) Auscultate the abdomen daily.
C) Encourage oral fluid replacement.
D) Provide analgesics for abdominal pain.

Question 7

The nurse is contributing to the plan of care for a patient with gluten enteropathy (celiac disease).What should 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 8

A patient scheduled for an ileostomy for Crohn's disease asks the nurse to explain the procedure.What should the nurse respond?

A) "You will have a loop of colon brought out onto your abdomen."
B) "Your ileum will be anastomosed to your rectum, so your stools will be watery."
C) "Your ileum will be removed, and the end of your jejunum will be made into a stoma."
D) "Your colon will be removed, and the end of your small bowel will be brought out onto your abdomen."

Question 9

A patient with a colostomy says,"My pouch blows up like a balloon when I pass gas." What is an appropriate response by the nurse?

A) "Make a tiny pinhole in the top of the pouch to let air out."
B) "Empty the gas like you would if the pouch was full of stool."
C) "Peel back a tiny corner of the skin barrier to allow gas to escape."
D) "Remove the pouch and put on a new one when it gets too full of gas."

Question 10

The nurse is contributing to a patient's plan of care.For which patient would the nursing diagnosis of Risk for Constipation be most appropriate?

A) A 37-year-old taking NSAIDs for bursitis
B) A 59-year-old taking narcotics for chronic pain control
C) A 74-year-old taking antibiotics for a urinary tract infection
D) A 67-year-old taking anticoagulant therapy for a history of deep vein thrombosis

Question 11

The nurse is reinforcing teaching provided to a patient with acute diarrhea.Which statement indicates the patient understands the most common cause for this health problem?

A) "Excessive fluid intake."
B) "Excessive fiber in the diet."
C) "Viral or bacterial infection."
D) "Inflammatory bowel disease."

Question 12

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 13

A patient asks what causes diverticulitis.How should the nurse respond?

A) "The lining of your colon is irritated and inflamed."
B) "You have little pouches in your colon that are inflamed."
C) "You have little outpouchings that occur in weak areas of the colon."
D) "The visceral and parietal membranes in your abdomen are inflamed."

Question 14

The nurse is reinforcing patient teaching on the best way to prevent transmission of infectious diarrhea.Which patient statement indicates correct understanding of the teaching?

A) Wear a mask and gown.
B) Avoid sharing eating utensils.
C) Keep the perineal area clean and dry.
D) Wash hands frequently and after toileting.

Question 15

The nurse is collecting data from a newly admitted patient.Which finding should the nurse identify as a risk factor for constipation?

A) The patient does not like milk or milk products.
B) The patient has had hemorrhoids for the past 5 years.
C) The patient had part of the stomach removed 10 years ago because of ulcers.
D) The patient has a history of breast cancer treated with chemotherapy 3 years ago.

Question 16

The nurse is caring for a patient with an exacerbation of Crohn's disease.Which nursing action is most important to recommend for inclusion in the patient's plan of care?

A) Encourage oral fluids.
B) Encourage frequent ambulation.
C) Administer anti-gas agents as ordered.
D) Apply protective ointment to perianal skin.

Question 17

The nurse is caring for a patient who reports feeling constipated,yet passes frequent small liquid stools.Which action should the nurse take?

A) Check the patient for a fecal impaction.
B) Administer an antidiarrheal medication.
C) Explain that liquid stools indicate diarrhea.
D) Check the abdomen for rebound tenderness.

Question 18

The nurse suspects appendicitis in a patient complaining of abdominal pain.Which assessment finding should cause the nurse to notify the physician?

A) The patient burps after drinking a glass of water.
B) Tympanic, hollow sounds are heard on percussion.
C) Bowel sounds are hyperactive in the upper quadrants.
D) Palpation of the abdomen is positive for rebound tenderness.

Question 19

A patient is to be started on clear liquids after an appendectomy.Which food should the nurse identify as being a clear liquid?

A) "Oatmeal."
B) "Ice cream."
C) "Cranberry juice."
D) "Graham crackers."

Question 20

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, so it is good that you are staying empty."

Question 21

On admission,a patient with gastrointestinal bleeding had vital signs of a blood pressure of 140/80 mm Hg,pulse 72 beats/minute,respirations 14 breaths/minute,and temperature 98.8°F (37.1°C).What finding should be reported to the registered nurse (RN)or physician immediately?

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

Question 22

The nurse is reinforcing teaching provided 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'm so glad I can eat all the foods I like now, including hot dogs."
E) "I always check the seal and tape around the stoma after I shower."
F) "I should change the pouch each morning and evening to prevent infection."

Question 23

The nurse is evaluating a patient's ability to change an ostomy appliance.Which observation indicates that the patient can safely provide self-ostomy care?

A) Stoma measured prior to applying new appliance
B) Skin barrier applied tight to the base of the stoma
C) Skin barrier cut to the same size as previous barrier
D) Lotion applied to skin before application of skin barrier

Question 24

The spouse of a patient with an ascending ostomy asks if the patient will always have to wear a pouch.What response should the nurse make?

A) "A bag will be needed all of the time."
B) "A bag will be needed only during the night."
C) "A bag will be needed only to protect the stoma."
D) "No, a bag will not be needed after discharge from the hospital."

Question 25

The nurse is reviewing the process of digestion with a patient diagnosed with malabsorption syndrome.How many mL of fluid should the nurse instruct that is absorbed through the intestinal mucosa into the portal bloodstream?

A) 1000
B) 2000
C) 4000
D) 8000

Question 26

The nurse is caring for a patient recovering from ileostomy surgery.What should have the highest priority when caring for the patient after surgery?

A) Food intake
B) Participation in stoma care
C) Stoma condition every 8 hours
D) Bowel sounds every 4 hours for 24 hours

Question 27

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 28

The nurse reinforces teaching provided to a patient with constipation and straining who is experiencing abdominal distention and intestinal rumbling.What should be included in the teaching? (Select all that apply.)

A) Set a time for defecation every day.
B) Increase the intake of foods containing vitamin K.
C) Increase intake of fiber, especially bran, in the diet.
D) Sit on the toilet with feet planted firmly on the floor.
E) Drink water each morning and about 2 to 3 L throughout the day.
F) Use enemas and rectal suppositories if constipation persists after 2 days.

Question 29

The nurse is collecting data from a patient with a stoma.What should the nurse document for a health stoma?

A) Gray and dry
B) Black and dry
C) Bluish and wet
D) Pink and moist

Question 30

The nurse is participating in a community health fair program focusing on risk factors for cancer.Which should be included as increasing the risk for colon cancer? (Select all that apply.)

A) Low-fat diet
B) Low-fiber diet
C) Low-sodium diet
D) History of rectal polyps
E) History of ulcerative colitis
F) Family history of breast cancer

Question 31

The nurse is contributing to the plan of care for patient with an ostomy.Why should the nurse recommend the use of a skin barrier product under the ostomy appliance?

A) To keep stool from irritating the skin
B) To ease removal of the pouch for changing
C) To prevent the bag from sticking too tightly to the skin
D) To prevent stool from coming in contact with the stoma

Question 32

The nurse is caring for a patient with an absorption disorder.What term should the nurse use to document fat in the patient's stool?

A) Oleorrhea
B) Steatorrhea
C) Lactorrhea
D) Lipidorrhea

Question 33

A patient with a new ileostomy asks if a bag needs to be worn on the abdomen.What is the most appropriate response by the nurse?

A) "Your stool will be liquid, so you will always need a bag."
B) "Your stool will be mushy, and you will need a bag most of the time."
C) "You will be taught to irrigate your stoma to eliminate the need for a bag."
D) "Your stool will be formed, and you may be able to regulate your bowel movements so that a bag will be optional."

Question 34

A patient with a bowel obstruction asks for the term that describes telescoping of the bowel.Which should the nurse respond to this patient?

A) "Ileus."
B) "Volvulus."
C) "Adhesions."
D) "Intussusception."

Question 35

A patient is experiencing melena.What does this observation indicate to the nurse?

A) The patient has a ruptured diverticulum
B) The patient has ingested a large volume of red meat
C) Blood has begun to seep into the stomach over the last 3 hours from esophageal varices
D) Blood has been in the gastrointestinal tract for more than 8 hours after being in contact with hydrochloric acid

Question 36

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

A) The bulging disappears at times.
B) The white blood cell 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 37

While receiving report from the previous shift,the nurse is informed that a nasogastric tube was placed in a patient who has a bowel obstruction.For which reason should the nurse realize the tube was inserted?

A) To feed the patient
B) To relieve distention
C) To administer medications
D) To prevent another obstruction

Question 38

The nurse is caring for a patient who has an ileostomy and feels crampy.The nurse notes that the stoma has become edematous and pale and suspects a blockage.What action should the nurse take?

A) Administer a laxative such as milk of magnesia.
B) Have the patient drink 2 to 3 L of water or other liquid.
C) Administer a 1000-mL warm tap water enema through the stoma.
D) Have the patient get into a tub full of warm water and drink warm liquids.

Question 39

The nurse is reinforcing teaching provided to 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) "I should increase my intake of fresh fruits and vegetables."
F) "Milk and other dairy products should be limited in my diet."

Question 40

The nurse provides teaching to a patient prescribed budesonide (Entocort EC)for Crohn's disease inflammation.Which patient statements indicate that more 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 just stop taking the medication once I feel better."
F) "I might experience mood swings or weight gain on this medication."

Question 41

A patient with irritable bowel syndrome is being started on the FODMAP diet.What foods should the nurse instruct the patient to avoid when following this diet? (Select all that apply.)

A) Milk
B) Pears
C) Apples
D) Broccoli
E) Brussels sprouts

Question 42

The nurse is teaching a patient newly diagnosed with ulcerative colitis about triggers for exacerbation of the disease.What should the nurse urge the patient to do 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 43

A patient with fecal incontinence has an excoriated perianal region.Which interventions should be discussed with the RN? (Select all that apply.)

A) Stool culture
B) Antibiotic therapy
C) Protective barrier cream
D) Baby powder to peri area
E) A low-pressure rectal tube
F) Nasogastric (NG) tube to suction

Question 44

The nurse is assisting to prepare dietary teaching for a patient with diverticulosis.Which food items should the nurse suggest be added to this patient's teaching plan? (Select all that apply.)

A) Peas
B) Salad
C) Cheese
D) Prunes
E) Raisins

Question 45

A patient with Crohn's disease is scheduled for an ileoanal pouch.What should the nurse include when teaching the patient about this surgery? (Select all that apply.)

A) Stool will pass through the anus.
B) A temporary ileostomy is needed.
C) The stool is hard and brown in color.
D) An ostomy pouch will need to be worn.
E) Several bowel movements occur per day.

Question 46

A patient comes into the client after experiencing diarrhea with five liquid stools in the past 24 hours.Which additional patient symptoms should cause the nurse concern? (Select all that apply.)

A) Fever
B) Blood in the stool
C) Severe abdominal cramping
D) Blood pressure 138/72 mm Hg
E) Oral intake of 3 L of fluid in 24 hours
F) Weight loss of 1 pound in the past week

Question 47

The nurse is contributing to a patient's plan of care.Which foods should the nurse recommend to be avoided or used with caution to reduce the possibility of ileostomy blockage? (Select all that apply.)

A) Celery
B) Apples
C) Potatoes
D) Dried fruits
E) Mushrooms
F) Broiled chicken

Question 48

During a health history,the nurse learns that a patient uses laxatives every day to ensure a bowel movement.What should the nurse expect to be prescribed for this patient? (Select all that apply.)

A) Daily enema
B) Psyllium (Metamucil)
C) Daily rectal suppository
D) Docusate sodium (Colace)
E) Methylnaltrexone (Relistor)