Deck 21: Assisting With Fecal Elimination

Question 1

The parent of a 1-year-old client is frustrated because the child will not use the toilet for bowel movements. Which response by the nurse is the most appropriate?

A) "I would suggest you consult the pediatrician for further testing."
B) "I would suggest you consult a pediatric psychologist."
C) "The child won't be able to control defecation until age 2½."
D) "Try using a reward when using the toilet."

Answer 1

C
Explanation:1. Children generally do not gain control of defecation until 18-24 months of age, so there is no need for further testing or psychological counseling. Behavior modification in a child of this age is unlikely to be successful, and continued incontinence could increase the mother's frustration if she doesn't understand normal development.
2. Children generally do not gain control of defecation until 18-24 months of age, so there is no need for further testing or psychological counseling. Behavior modification in a child of this age is unlikely to be successful, and continued incontinence could increase the mother's frustration if she doesn't understand normal development.
3. Children generally do not gain control of defecation until 18-24 months of age, so there is no need for further testing or psychological counseling. Behavior modification in a child of this age is unlikely to be successful, and continued incontinence could increase the mother's frustration if she doesn't understand normal development.
4. Children generally do not gain control of defecation until 18-24 months of age, so there is no need for further testing or psychological counseling. Behavior modification in a child of this age is unlikely to be successful, and continued incontinence could increase the mother's frustration if she doesn't understand normal development.

Question 2

An older adult client with an ileostomy and hemiplegia has ulcerated and edematous skin under the barrier because the pouch is not emptied until it is completely full. Which action should the nurse make a priority?

A) Apply a two-piece ostomy appliance.
B) Treat the damaged skin and replace the one-piece pouch.
C) Keep the skin open to air to allow time for healing and replace the ostomy appliance in a few days.
D) Call the health care provider to report the damaged skin.

Answer 2

A
Explanation:1. The client who requires emptying of the pouch one or more times per day will benefit from a drainable pouch. However, when the client lacks dexterity, a drainable two-piece pouch should be used instead of a drainable pouch.
2. A one-piece pouch needing to be changed daily requires the client to remove both the pouch and the skin barrier, which could be the cause of the skin trauma.
3. Because the client has an ileostomy, leaving the appliance off is not an option, because the ostomy will drain continuously.
4. There is no need to call the health care provider, because the nurse can provide skin care without an order.

Question 3

Which actions could the nurse safely assign to the assistive personnel (AP)? Select all that apply.

A) Assist the client to use the bedpan for bowel elimination.
B) Change the ostomy appliance for the new ostomy.
C) Administer a cleansing enema.
D) Remove a fecal impaction.
E) Determine effectiveness of cleansing enema.

Answer 3

A, C
Explanation:1. The AP can be entrusted with assisting the client to use a bedpan.
2. Only the nurse can change a new ostomy appliance, because of the need to assess the drainage and the site.
3. The AP can administer most types of enemas.
4. Because of the risk of vagal nerve stimulation, the nurse should remove fecal impactions.
5. Assessing the effectiveness of any treatment should be performed by the nurse.

Question 4

The nurse is working with assistive personnel (AP) in a long-term care facility. Which tasks can the nurse delegate to the AP? Select all that apply.

A) Administering an enema to a stable client
B) Removing a fecal impaction for an unstable client
C) Assisting a client to perform ostomy care after hand surgery
D) Helping a client onto a bedpan
E) Assessing skin during an ostomy appliance change

Question 5

A client is using a high-back bedpan. In which way should the nurse care for this bedpan after being used?

A) Place the bedpan on a chair to be emptied at a later time
B) Carry the bedpan with both hands to the bathroom for cleansing before storing
C) Place the bedpan on the floor until assistive personnel are available to empty it
D) Carry the bedpan by the handle to the bathroom and cleanse it with soapy water