Question 1

The nurse is caring for an older adult patient diagnosed with diverticulitis.Which medication is the best choice to manage the patient's pain?

Accepted Answer

Morphine is acceptable for pain management and has fewer side effects than meperidine (Demerol).In earlier recommendations,Demerol was the drug of choice based on a theoretical risk not shown in studies.A metabolite of meperidine (Demerol)is toxic,and the older adult has difficulty metabolizing and eliminating it.The buildup of the toxin in the blood can cause seizures and other mental status changes such as acute confusion.Ask for an alternate analgesic for these patients.

Question 2

The nurse is educating a patient with diverticulitis.Which statement indicates that the nurse's teaching about the importance of seeking treatment has been successful?

Accepted Answer

The term diverticulum refers to a small,blind pouch resulting from a protrusion of the mucous membranes of a hollow organ through weakened areas of the organ's muscular wall.Diverticula occur most often in the intestinal tract,especially in the esophagus and colon.The infected diverticula can perforate through the bowel wall and cause peritonitis.Diverticulitis does not result in ulcers or appendicitis.

Question 3

The nurse explains which advantage benefits patients with a Kock pouch ileostomy?

Accepted Answer

The major advantage of the Kock pouch is that the patient does not have to wear a collection device.The feces are collected in the pouch and emptied by the patient inserting a catheter into the pouch every 3 or 4 hours.

Question 4

The nurse caring for the patient who is immediately postoperative with a new ileostomy.Which intervention is most important for the nurse to implement at this time?

Accepted Answer

Helping the patient adjust to the new ostomy is one of the highest priorities in the immediate postoperative period.In the immediate postoperative period,the pouch should not be changed any more than is necessary to avoid trauma to the skin.A stool softener is not indicated since stools are usually softer and more watery when coming from a stoma.Diet advancement is a gradual process that must coordinate with returning bowel function,and the patient may be NPO for a short time while bowl motility returns.

Question 5

The nurse is caring for a patient who has been diagnosed with Crohn disease.When providing education concerning dietary recommendations,which statement indicates that the nurse's teaching has been successful?

Accepted Answer

The recommended diet in Crohn disease consists of low-fat,low-fiber foods that are high in protein and calories.Small frequent feedings are best.Lactose avoidance helps some patients.

Question 6

A 36-year-old woman who had an ascending colostomy angrily declares,"I don't want this hateful thing on my body! This nasty thing is not me." Which response is most appropriate for the nurse to make?

Accepted Answer

Asking the patient to name the specific concerns helps to conceptualize where the adjustment problem lies.All other options negate the patient's feelings,reinforce the patient's negative feelings,and do not offer any therapeutic response.

Question 7

The nurse explains that a hernioplasty is a surgery that involves which process?

Accepted Answer

Hernioplasty is a surgical intervention in which the hernia is reduced and a synthetic mesh is sewn over the defect in the wall to prevent reoccurrence.

Question 8

The nurse is educating a patient with inflammatory bowel disease (IBD)about recommended nutritional choices.Which statement indicates that the nurse's teaching has been successful?

Accepted Answer

A low-fat,low-fiber,high-protein,high-calorie diet is recommended for the patient with IBD to make up for the loss of fluid and nutrients in the frequent stools.Low-fat,low-fiber,high-protein,high-calorie foods include foods like white grains or starches and lean,tender meats.Whole grains are extremely high in fiber and should be avoided.A soft diet is not indicated.Green leafy vegetables are a rich source not only of vitamin K,but also of fiber.

Question 9

Which type of hernia can lead to necrosis?

Accepted Answer

The incarcerated hernia may become strangulated,which cuts off the blood supply and can lead to necrosis of the trapped bowel loop.Hernias are classified as reducible,which means the protruding organ can be returned to its proper place by pressing on the organ,and irreducible,which means that the protruding part of the organ is tightly wedged outside the cavity and cannot be pushed back through the opening.Another name for an irreducible hernia is incarcerated hernia.An indirect hernia protrudes through the inguinal ring.A direct hernia protrudes through the posterior inguinal wall.

Question 10

The nurse is aware that the person with ulcerative colitis is a risk factor for developing which disorder?

Accepted Answer

Ulcerative colitis is an inflammation,with the formation of ulcers,of the mucosa of the colon.It is often a chronic disease,and the patient is usually free from symptoms between acute flare-ups.The person with ulcerative colitis is 10 to 15 times more likely to develop colon cancer than those who do not have the disease.

Question 11

The nurse is aware that an unresolved intestinal obstruction can lead to which complications?

Accepted Answer

An unresolved intestinal obstruction can lead to rupture of the intestine,peritonitis,shock,and death.

Question 12

The nurse is caring for patient with a history of a chronic incarcerated hernia.The patient suddenly complains of abdominal pain and vomits dark material with a fecal odor.The nurse recognizes these signs as indications of which complication?

Accepted Answer

The symptoms of intestinal obstruction vary according to the location of the obstruction.Fecal odor or material in the emesis suggests a complete intestinal obstruction.In this case,the incarcerated hernia has blocked the flow of bowel content.If there is a defect in the muscular wall of the abdomen,the intestine may break through the defect; his protrusion is called a hernia or a rupture.Gastroenteritis is inflammation of the stomach and intestines.A duodenal ulcer occurs in the small intestine (the duodenum).

Question 13

The nurse caring for a patient admitted with peritonitis who has developed a paralytic ileus.While auscultating bowel sounds,the nurse assesses flatus.What is the significance of this finding?

Accepted Answer

Paralytic ileum is a common complication of peritonitis.The nurse should auscultate at least once a shift for the return of bowel sounds.If the patient passes flatus or feces rectally,it indicates return of peristalsis.

Question 14

The nurse explains to the patient receiving bevacizumab (Avastin)for a tumor in the colon that the drug slows cancer cell growth by which process?

Accepted Answer

Bevacizumab (Avastin)is an antiangiogenesis medication that reduces blood flow to the growing tumor cells,depriving them of nutrients needed for replication.

Question 15

The nurse is teaching a group of patients about the process of a mechanical bowel obstruction.Which example should the nurse include in the teaching?

Accepted Answer

Mechanical obstruction results in blockage of the lumen of the bowel.Examples include tumors,adhesions,strangulated hernia,twisting of the bowel (volvulus),telescoping of one part of the bowel into itself (intussusception),gallstones,barium impaction,and intestinal parasites.

Question 16

The nurse is caring for a patient with a 4-day-old ileostomy.The patient complains of cramping,the nurse notes a drop in the effluent for the ileostomy,and the bowel sounds are rapid with a "tinkling" sound.What action should the nurse take?

Accepted Answer

Cramping and reduced effluent from a new ileostomy should be reported immediately as these are signs of obstruction,which could lead to perforation.Ileostomies are not irrigated except by the physician or an enterostomal therapist.

Question 17

The nurse is caring for a patient whose home medications include bismuth subsalicylate (Pepto Bismol).The nurse should educate the patient about which side effect of this medication?

Accepted Answer

This medication often turns the stool black.It does not cause a rash,or stain the urine or teeth.

Question 18

The nurse is caring for a patient 1-day postoperative after a transverse colostomy.When assessing the stoma,which finding requires the nurse's immediate action?

Accepted Answer

The purple hue in the new stoma is an indication of reduced perfusion to the stoma and should be reported immediately.A new stoma should have a pink or beefy red color,be slightly edematous,and have some small bleeding around the stoma.

Question 19

Which age-related change predisposes older adult patients to diverticula?

Accepted Answer

Most diverticula are asymptomatic,uncommon in people under age 50,and almost universal in those over 90.Increases in intra-abdominal pressure from constipation and straining to defecate causes herniation of the mucosa through the bowel wall,causing a small pocket in the colon.

Question 20

The nurse is educating a group of patients about high-fiber dietary selections.Which patient menu selection indicates that the nurse's teaching has been successful?

Accepted Answer

A high-fiber diet is encouraged for the patient with diverticular disease.Eating whole-grain cereals and breads,as well as fruits such as apples,seedless berries,peaches,and pears adds fiber.High-fiber vegetables-squash,broccoli,cabbage,and spinach-and legumes,including dried beans,peas,and lentils,provide bulk that decreases constipation and speeds the transit time in the intestine.The meal with a turkey sandwich on whole wheat bread and pears is the only meal choice with multiple high-fiber foods (bread and pears).

Quiz 29: Care of Patients with Disorders of the Lower Gastrointestinal System