Deck 39: Nursing Management: Lower Gastrointestinal Problems

Question 1

A 58-year-old man with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage.If the lavage returns brown fecal drainage,which action will the nurse plan to take next?

A) Auscultate the bowel sounds.
B) Prepare the patient for surgery.
C) Check the patient's oral temperature.
D) Obtain information about the accident.

Answer 1

Prepare the patient for surgery.

Question 2

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD)indicates a need for more teaching?

A) Scrambled eggs
B) White toast and jam
C) Oatmeal with cream
D) Pancakes with syrup

Answer 2

Oatmeal with cream

Question 3

A 71-year-old male patient tells the nurse that growing old causes constipation so he has been using a suppository for constipation every morning.Which action should the nurse take first?

A) Encourage the patient to increase oral fluid intake.
B) Assess the patient about risk factors for constipation.
C) Suggest that the patient increase intake of high-fiber foods.
D) Teach the patient that a daily bowel movement is unnecessary.

Answer 3

Assess the patient about risk factors for constipation.

Question 4

A 24-year-old woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI)with tan,fecal-smelling urine.What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient?

A) Bacteria in the perianal area can enter the urethra.
B) Fistulas can form between the bowel and bladder.
C) Drink adequate fluids to maintain normal hydration.
D) Empty the bladder before and after sexual intercourse.

Question 5

A 51-year-old male patient has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg)over 2 months.The nurse will plan to teach about

A) medication use.
B) fluid restriction.
C) enteral nutrition.
D) activity restrictions.

Question 6

A 64-year-old woman who has chronic constipation asks the nurse about the use of psyllium (Metamucil).Which information will the nurse include in the response?

A) Absorption of fat-soluble vitamins may be reduced by fiber-containing laxatives.
B) Dietary sources of fiber should be eliminated to prevent excessive gas formation.
C) Use of this type of laxative to prevent constipation does not cause adverse effects.
D) Large amounts of fluid should be taken to prevent impaction or bowel obstruction.

Question 7

The nurse is providing preoperative teaching for a 61-year-old man scheduled for an abdominal-perineal resection.Which information will the nurse include?

A) Another surgery in 8 to 12 weeks will be used to create an ileal-anal reservoir.
B) The patient will begin sitting in a chair at the bedside on the first postoperative day.
C) The patient will drink polyethylene glycol lavage solution (GoLYTELY) preoperatively.
D) IV antibiotics will be started at least 24 hours before surgery to reduce the bowel bacteria.

Question 8

Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine)for ulcerative colitis has been effective?

A) "The medication will be tapered if I need surgery."
B) "I will need to use a sunscreen when I am outdoors."
C) "I will need to avoid contact with people who are sick."
D) "The medication will prevent infections that cause the diarrhea."

Question 9

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day.The nurse will plan to

A) administer IV metoclopramide (Reglan).
B) discontinue the patient's oral food intake.
C) administer cobalamin (vitamin B??) injections.
D) teach the patient about total colectomy surgery.

Question 10

Which nursing action will be included in the plan of care for a 27-year-old male patient with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)?

A) Encourage the patient to express concerns and ask questions about IBS.
B) Suggest that the patient increase the intake of milk and other dairy products.
C) Educate the patient about the use of alosetron (Lotronex) to reduce symptoms.
D) Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs).

Question 11

A 73-year-old patient with diverticulosis has a large bowel obstruction.The nurse will monitor for

A) referred back pain.
B) metabolic alkalosis.
C) projectile vomiting.
D) abdominal distention.

Question 12

Which nursing action will the nurse include in the plan of care for a 35-year-old male patient admitted with an exacerbation of inflammatory bowel disease (IBD)?

A) Restrict oral fluid intake.
B) Monitor stools for blood.
C) Ambulate four times daily.
D) Increase dietary fiber intake.

Question 13

A 27-year-old female patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting.Which action should the nurse take?

A) Encourage the patient to sip clear liquids.
B) Assess the abdomen for rebound tenderness.
C) Assist the patient to cough and deep breathe.
D) Apply an ice pack to the right lower quadrant.

Question 14

The nurse preparing for the annual physical exam of a 50-year-old man will plan to teach the patient about

A) endoscopy.
B) colonoscopy.
C) computerized tomography screening.
D) carcinoembryonic antigen (CEA) testing.

Question 15

After a total proctocolectomy and permanent ileostomy,the patient tells the nurse,"I cannot manage all these changes.I don't want to look at the stoma." What is the best action by the nurse?

A) Reassure the patient that ileostomy care will become easier.
B) Ask the patient about the concerns with stoma management.
C) Develop a detailed written list of ostomy care tasks for the patient.
D) Postpone any teaching until the patient adjusts to the ileostomy.

Question 16

A 22-year-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin.Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective?

A) The patient uses incontinence briefs to contain loose stools.
B) The patient asks for antidiarrheal medication after each stool.
C) The patient uses witch hazel compresses to decrease irritation.
D) The patient cleans the perianal area with soap after each stool.

Question 17

A 74-year-old patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA)test result.The nurse explains that the test is used to

A) identify any metastasis of the cancer.
B) monitor the tumor status after surgery.
C) confirm the diagnosis of a specific type of cancer.
D) determine the need for postoperative chemotherapy.

Question 18

A 26-year-old woman is being evaluated for vomiting and abdominal pain.Which question from the nurse will be most useful in determining the cause of the patient's symptoms?

A) "What type of foods do you eat?"
B) "Is it possible that you are pregnant?"
C) "Can you tell me more about the pain?"
D) "What is your usual elimination pattern?"

Question 19

Which action will the nurse include in the plan of care for a 42-year-old patient who is being admitted with Clostridium difficile?

A) Educate the patient about proper food storage.
B) Order a diet with no dairy products for the patient.
C) Place the patient in a private room on contact isolation.
D) Teach the patient about why antibiotics will not be used.

Question 20

A patient complains of gas pains and abdominal distention two days after a small bowel resection.Which nursing action is best to take?

A) Encourage the patient to ambulate.
B) Instill a mineral oil retention enema.
C) Administer the ordered IV morphine sulfate.
D) Offer the ordered promethazine (Phenergan) suppository.

Question 21

The nurse is assessing a 31-year-old female patient with abdominal pain.Th nurse,who notes that there is ecchymosis around the area of umbilicus,will document this finding as

A) Cullen sign.
B) Rovsing sign.
C) McBurney sign.
D) Grey-Turner's signt.

Question 22

A 62-year-old patient has had a hemorrhoidectomy at an outpatient surgical center.Which instructions will the nurse include in discharge teaching?

A) Maintain a low-residue diet until the surgical area is healed.
B) Use ice packs on the perianal area to relieve pain and swelling.
C) Take prescribed pain medications before a bowel movement is expected.
D) Delay having a bowel movement for several days until healing has occurred.

Question 23

Which activity in the care of a 48-year-old female patient with a new colostomy could the nurse delegate to unlicensed assistive personnel (UAP)?

A) Document the appearance of the stoma.
B) Place a pouching system over the ostomy.
C) Drain and measure the output from the ostomy.
D) Check the skin around the stoma for breakdown.

Question 24

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis?

A) Restrict fluid intake to prevent constant liquid drainage from the stoma.
B) Use care when eating high-fiber foods to avoid obstruction of the ileum.
C) Irrigate the ileostomy daily to avoid having to wear a drainage appliance.
D) Change the pouch every day to prevent leakage of contents onto the skin.

Question 25

The nurse admitting a patient with acute diverticulitis explains that the initial plan of care is to

A) administer IV fluids.
B) give stool softeners and enemas.
C) order a diet high in fiber and fluids.
D) prepare the patient for colonoscopy.

Question 26

Four hours after a bowel resection,a 74-year-old male patient with a nasogastric tube to suction complains of nausea and abdominal distention.The first action by the nurse should be to

A) auscultate for hypotonic bowel sounds.
B) notify the patient's health care provider.
C) reposition the tube and check for placement.
D) remove the tube and replace it with a new one.

Question 27

A 54-year-old critically ill patient with sepsis is frequently incontinent of watery stools.What action by the nurse will prevent complications associated with ongoing incontinence?

A) Apply incontinence briefs.
B) Use a fecal management system
C) Insert a rectal tube with a drainage bag.
D) Assist the patient to a commode frequently.

Question 28

A 45-year-old patient is admitted to the emergency department with severe abdominal pain and rebound tenderness.Vital signs include temperature 102° F (38.3° C),pulse 120,respirations 32,and blood pressure (BP)82/54.Which prescribed intervention should the nurse implement first?

A) Administer IV ketorolac (Toradol) 15 mg.
B) Draw blood for a complete blood count (CBC).
C) Obtain a computed tomography (CT) scan of the abdomen.
D) Infuse 1 liter of lactated Ringer's solution over 30 minutes.

Question 29

A 42-year-old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia.Which patient teaching will the nurse provide before discharge?

A) Soak in sitz baths several times each day.
B) Cough 5 times each hour for the next 48 hours.
C) Avoid use of acetaminophen (Tylenol) for pain.
D) Apply a scrotal support and ice to reduce swelling.

Question 30

Which breakfast choice indicates a patient's good understanding of information about a diet for celiac disease?

A) Oatmeal with nonfat milk
B) Whole wheat toast with butter
C) Bagel with low-fat cream cheese
D) Corn tortilla with scrambled eggs

Question 31

A 71-year-old patient had an abdominal-perineal resection for colon cancer.Which nursing action is most important to include in the plan of care for the day after surgery?

A) Teach about a low-residue diet.
B) Monitor output from the stoma.
C) Assess the perineal drainage and incision.
D) Encourage acceptance of the colostomy stoma.

Question 32

A 47-year-old female patient is transferred from the recovery room to a surgical unit after a transverse colostomy.The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage.The nurse should

A) place ice packs around the stoma.
B) notify the surgeon about the stoma.
C) monitor the stoma every 30 minutes.
D) document stoma assessment findings.

Question 33

A 50-year-old female patient calls the clinic to report a new onset of severe diarrhea.The nurse anticipates that the patient will need to

A) collect a stool specimen.
B) prepare for colonoscopy.
C) schedule a barium enema.
D) have blood cultures drawn.

Question 34

The nurse will determine that teaching a 67-year-old man to irrigate his new colostomy has been effective if the patient

A) inserts the irrigation tubing 4 to 6 inches into the stoma.
B) hangs the irrigating container 18 inches above the stoma.
C) stops the irrigation and removes the irrigating cone if cramping occurs.
D) fills the irrigating container with 1000 to 2000 mL of lukewarm tap water.

Question 35

A patient in the emergency department has just been diagnosed with peritonitis caused by a ruptured diverticulum.Which prescribed intervention will the nurse implement first?

A) Insert a urinary catheter to drainage.
B) Infuse metronidazole (Flagyl) 500 mg IV.
C) Send the patient for a computerized tomography scan.
D) Place a nasogastric (NG) tube to intermittent low suction.

Question 36

A 34-year-old female patient with a new ileostomy asks how much drainage to expect.The nurse explains that after the bowel adjusts to the ileostomy,the usual drainage will be about _____ cups.

A) 2
B) 3
C) 4
D) 5

Question 37

A 25-year-old male patient calls the clinic complaining of diarrhea for 24 hours.Which action should the nurse take first?

A) Inform the patient that laboratory testing of blood and stools will be necessary.
B) Ask the patient to describe the character of the stools and any associated symptoms.
C) Suggest that the patient drink clear liquid fluids with electrolytes, such as Gatorade or Pedialyte.
D) Advise the patient to use over-the-counter loperamide (Imodium) to slow gastrointestinal (GI) motility.

Question 38

A 19-year-old female is brought to the emergency department with a knife handle protruding from the abdomen.During the initial assessment of the patient,the nurse should

A) remove the knife and assess the wound.
B) determine the presence of Rovsing sign.
C) check for circulation and tissue perfusion.
D) insert a urinary catheter and assess for hematuria.

Question 39

Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome?

A) "Have you been passing a lot of gas?"
B) "What foods affect your bowel patterns?"
C) "Do you have any abdominal distention?"
D) "How long have you had abdominal pain?"

Question 40

The nurse will plan to teach a patient with Crohn's disease who has megaloblastic anemia about the need for

A) oral ferrous sulfate tablets.
B) regular blood transfusions.
C) iron dextran (Imferon) infusions.
D) cobalamin (B₁₂) spray or injections.

Question 41

Which menu choice by the patient with diverticulosis is best for preventing diverticulitis?

A) Navy bean soup and vegetable salad
B) Whole grain pasta with tomato sauce
C) Baked potato with low-fat sour cream
D) Roast beef sandwich on whole wheat bread

Question 42

Which care activity for a patient with a paralytic ileus is appropriate for the registered nurse (RN)to delegate to unlicensed assistive personnel (UAP)?

A) Auscultation for bowel sounds
B) Nasogastric (NG) tube irrigation
C) Applying petroleum jelly to the lips
D) Assessment of the nares for irritation

Question 43

Which patient should the nurse assess first after receiving change-of-shift report?

A) 60-year-old patient whose new ileostomy has drained 800 mL over the previous 8 hours
B) 50-year-old patient with familial adenomatous polyposis who has occult blood in the stool
C) 40-year-old patient with ulcerative colitis who has had six liquid stools in the previous 4 hours
D) 30-year-old patient who has abdominal distention and an apical heart rate of 136 beats/minute

Question 44

After several days of antibiotic therapy,an older hospitalized patient develops watery diarrhea.Which action should the nurse take first?

A) Notify the health care provider.
B) Obtain a stool specimen for analysis.
C) Teach the patient about handwashing.
D) Place the patient on contact precautions.

Question 45

The nurse is admitting a 67-year-old patient with new-onset steatorrhea.Which question is most important for the nurse to ask?

A) "How much milk do you usually drink?"
B) "Have you noticed a recent weight loss?"
C) "What time of day do your bowels move?"
D) "Do you eat meat or other animal products?"

Question 46

A 51-year-old woman with Crohn's disease who is taking infliximab (Remicade)calls the nurse in the outpatient clinic about new symptoms.Which symptom is most important to communicate to the health care provider?

A) Fever
B) Nausea
C) Joint pain
D) Headache

Question 47

Which information will the nurse include when teaching a patient how to avoid chronic constipation (select all that apply)? 2.

A) Many over-the-counter (OTC) medications can cause constipation.
B) Stimulant and saline laxatives can be used regularly.
C) Bulk-forming laxatives are an excellent source of fiber.
D) Walking or cycling frequently will help bowel motility.
E) A good time for a bowel movement may be after breakfast.

Question 48

A female patient is awaiting surgery for acute peritonitis.Which action will the nurse include in the plan of care?

A) Position patient with the knees flexed.
B) Avoid use of opioids or sedative drugs.
C) Offer frequent small sips of clear liquids.
D) Assist patient to breathe deeply and cough.

Question 49

Which information will the nurse teach a 23-year-old patient with lactose intolerance?

A) Ice cream is relatively low in lactose.
B) Live-culture yogurt is usually tolerated.
C) Heating milk will break down the lactose.
D) Nonfat milk is a better choice than whole milk.

Question 50

A 76-year-old patient with obstipation has a fecal impaction and is incontinent of liquid stool.Which action should the nurse take first?

A) Administer bulk-forming laxatives.
B) Assist the patient to sit on the toilet.
C) Manually remove the impacted stool.
D) Increase the patient's oral fluid intake.

Question 51

A new 19-year-old male patient has familial adenomatous polyposis (FAP).Which action will the nurse in the gastrointestinal clinic include in the plan of care?

A) Obtain blood samples for DNA analysis.
B) Schedule the patient for yearly colonoscopy.
C) Provide preoperative teaching about total colectomy.
D) Discuss lifestyle modifications to decrease cancer risk.

Question 52

A 33-year-old male patient with a gunshot wound to the abdomen undergoes surgery,and a colostomy is formed as shown in the accompanying figure.Which information will be included in patient teaching?

A) Stool will be expelled from both stomas.
B) This type of colostomy is usually temporary.
C) Soft, formed stool can be expected as drainage.
D) Irrigations can regulate drainage from the stomas.

Question 53

After change-of-shift report,which patient should the nurse assess first?

A) 40-year-old male with celiac disease who has frequent frothy diarrhea
B) 30-year-old female with a femoral hernia who has abdominal pain and vomiting
C) 30-year-old male with ulcerative colitis who has severe perianal skin breakdown
D) 40-year-old female with a colostomy bag that is pulling away from the adhesive wafer

Question 54

A 72-year-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour.Which assessment finding by the nurse is most important to report to the health care provider?

A) Patient has not voided for the last 4 hours.
B) Skin is dry with poor turgor on all extremities.
C) Crackles are heard halfway up the posterior chest.
D) Patient has had 5 loose stools over the last 6 hours.

Question 55

Which information obtained by the nurse interviewing a 30-year-old male patient is most important to communicate to the health care provider?

A) The patient has a history of constipation.
B) The patient has noticed blood in the stools.
C) The patient had an appendectomy at age 27.
D) The patient smokes a pack/day of cigarettes.

Question 56

Which prescribed intervention for a 61-year-old female patient with chronic short bowel syndrome will the nurse question?

A) Ferrous sulfate (Feosol) 325 mg daily
B) Senna (Senokot) 1 tablet every day
C) Psyllium (Metamucil) 2.1 grams 3 times daily
D) Diphenoxylate with atropine (Lomotil) prn loose stools