Question 1

When a resident reports being "uncomfortable and gassy," the nursing assistant offers to:

Accepted Answer

Like feces, flatus is a natural by-product of digestion. Flatulence can result from a lack of activity or certain diagnostic and surgical procedures. Getting out of bed and walking might be all that is needed to help the person pass the gas and should be tried first unless the resident is unable or not permitted to walk. Constipation does not generally cause a "gassy" feeling. The remaining options should not be done without first discussing them with a nurse.

Question 2

The nursing assistant is caring for a mobile, older adult client who is experiencing diarrhea. What is the priority action for the nursing assistant to take?

Accepted Answer

The first thing for the nursing assistant to do is to make sure the client knows to replace fluids with noncaffeinated drinks, as the watery stools may lead to dehydration if not treated. The nursing assistant can then inform the nurse about the frequent bouts of diarrhea and report the measures the nursing assistant has taken. The client is mobile and there is no indication that the client has had difficulty making it to the bathroom, so there is no need to ask the nurse about adding a bedside commode or employing the use of adult incontinence briefs.

Question 3

On inspection of a client's stool, the nursing assistant notices that it is very black and has a tar-like appearance. The nursing assistant will:

Accepted Answer

The nursing assistant should note the color, amount, and quality of the urine or feces before emptying the contents of the bedpan into the toilet. If anything unusual is observed, the nursing assistant should not empty the bedpan until the nurse has had the chance to look at its contents. A specimen should be collected only when the nurse directs the nursing assistant to do so. The resident may not be able to provide a reliable description.

Question 4

A fecal impaction is relieved by:

Accepted Answer

Fecal impactions are often treated by giving the person an oil retention enema, followed by digital removal of the impaction. Fluids and fiber help prevent constipation. A rectal tube helps relieve intestinal gas. A soapsuds enema increases intestinal peristalsis.

Question 5

What will the nursing assistant do when a resident receiving an enema begins to report abdominal pain and cramping?

Accepted Answer

If the person reports of pain or cramping, slow the rate of flow by tightening the clamp a bit. If the pain or cramping does not stop after slowing the rate of flow, stop the procedure and call the nurse.

Question 6

The nursing assistant in orientation is administering a soap suds enema to a client. Which action indicates the nursing assistant requires intervention?

Accepted Answer

The nurse should intervene when the nursing assistant hangs the enema bag 20 inches above the anus because anything higher than 18 inches will lead to abdominal pain and anything lower than 12 inches will not permit the fluid to enter the rectum. The other actions are proper procedure when administering the soap suds enema.

Question 7

Why is it important to ensure that the temperature of the enema solution is correct?

Accepted Answer

Enema solutions that are too cool can cause abdominal cramping and pain, whereas solutions that are too hot can cause serious injury and, possibly, even death.

Question 8

The nursing assistant prepares to administer the soap suds enema and asks the resident to take a deep breath and exhale slowly before inserting the lubricated enema tip. A bleeding loop of bowel prolapses (protrudes) outside the rectum. What is the priority action for the nursing assistant to take?

Accepted Answer

The nursing assistant should stop immediately and inform the nurse about the observation. The other actions are all those that the nursing assistant would take if the resident had no contraindications for the soap suds enema.

Question 9

The nursing assistant is caring for a resident with dementia after the nurse administers the laxative suppository. After using the bedside commode, the resident has a greasy, clay-colored stool and abdominal cramping. What is the appropriate action for the nursing assistant to take?

Accepted Answer

Clay-colored stool and abdominal cramping should be reported to the nurse right away because these could signal a serious problem with the biliary tract or pancreas. The laxative suppository will not cause this type of stool when dissolving. The client has dementia so will not be able to report reliably what a normal bowel movement is like. It is never normal to have abdominal cramping. Without an order from the prescriber and permission from the nurse, a stool sample should not be collected and sent to the lab. The nursing assistant should leave the stool for the nurse to observe.

Question 10

In an older person, the movement of food through the digestive tract may be slower. This can put the older person at risk for:

Accepted Answer

In an older person, the movement of food through the digestive tract may be slower. This can put the older person at risk for constipation. The chyme spends more time in the large intestine, which allows more water to be reabsorbed into the bloodstream. As a result, by the time the chyme reaches the end of the large intestine, almost all the water has been removed and the resulting feces are hard, dry, and difficult to pass. There is no research to support a connection between a slow digestive tract and the other options.

Question 11

Which nursing intervention is helpful to prevent an older person's risk for constipation?

Accepted Answer

Drinking ample amounts of liquids helps prevent constipation by keeping the feces from drying out and becoming hard and difficult to move through the bowels. In an older person, the movement of food through the digestive tract may be slower, which is called slow peristalsis. This can put the older person at risk for constipation. Certain medications (such as prescription pain relievers) and immobility can also increase a person's risk for constipation.

Question 12

The nursing assistant prepares to perform the delegated task of caring for a client's ostomy and observes that there is stool seeping around the ostomy appliance. The nursing assistant examines the supplies and is not familiar with them. What is the appropriate action for the nursing assistant to take?

Accepted Answer

In the event that the nursing assistant is unfamiliar with the client's supplies, the best action to take is to ask the delegating nurse to help the nursing assistant change the ostomy appliance and perform ostomy care according to the procedure. Emptying the contents into a graduate container does not address the leaking ostomy appliance, which can lead to skin breakdown. Cleaning the skin and applying paper tape will most likely not work for long. The nurse delegated the ostomy care to the nursing assistant to perform because the client may not be ready or able to perform independent care, so it is not reasonable to ask the client to do it.

Question 13

The feces would be more liquid when the colostomy is in what portion of the intestines?

Accepted Answer

If the portion of the intestine that was removed was near the beginning of the large intestine, then the feces will be more liquid because the chyme will spend less time in the large intestine. The small intestine is not responsible for feces formation.

Question 14

When providing stoma care, the skin around the stoma is cleaned with:

Accepted Answer

Because the skin around the ostomy comes into contact with feces, to prevent irritation, it must be kept clean using warm water and soap (or another cleansing agent, per facility policy). Neither the deodorant powder nor the adhesive solvent will help manage odors and dissolve the glue used to keep the bag in place, but neither will a cleaning agent. The gauze pad is best used for absorbing drainage.

Question 15

The nursing assistant administers a soap suds enema to a client and, during the administration, observes that the liquid is seeping out of the anus and the client complains of discomfort. What action should the nursing assistant take?

Accepted Answer

If the nursing assistant administers a soap suds enema and observes that fluid is seeping from the anus, to the best action is to clamp or lower the enema temporarily and ask the client to take some deep breaths before continuing with the enema. Decreasing the rate and asking the client to take deep breaths help relieve the cramping and promote absorption of the enema. Removing it and having the client use the restroom makes the enema less effective in cleansing the bowels. Raising the bag and increasing the force would cause more liquid seeping from the anus. Continuing the administration will result in the liquid leaking onto the pad below the client.

Question 16

When the nursing assistant finds a client who has recently had a surgical ostomy created for intestinal cancer crying, the proper action is to:

Accepted Answer

If the nursing assistant thinks that a client or resident is having trouble adjusting to the ostomy, suggested by the crying, the assistant should share those concerns with the nurse. The other options do nothing to help manage the problem.

Question 17

The nursing assistant has collected a stool sample inappropriately when:

Accepted Answer

Avoid touching the outside of the transport bag with the glove, since that will contaminate the outside of the bag that others will touch. The other options are correct.

Question 18

Why is it necessary for the nursing assistant to collect the stool sample correctly?

Accepted Answer

A stool sample is often requested for analysis. Proper collection and handling of the stool sample helps to ensure that the test results are accurate. The other options are true statements, but not as directly related to the need for proper sample collection.

Question 19

What is the primary purpose for performing stoma care?

Accepted Answer

If the skin around the stoma comes in contact with feces, it can become irritated, so it must be kept clean to prevent irritation. Although the other options are correct, they do not protect the person as the correct option does.

Question 20

The nursing assistant is caring for a client after surgery who has received pain medications for several days. The nursing assistant helps the client to use a bedpan for a bowel movement (BM) and observes liquid stool seeping from the anus. The nursing assistant cleans the client and changes the incontinence pad. What action should the nursing assistant take?

Accepted Answer

The nursing assistant observes the signs of an impaction, which include liquid stool seeping from the anus and no BM. The nursing assistant should report this to the nurse so the nurse may provide measures to remove the impaction. Charting that it is incontinence of stool and providing pericare will allow the impaction to worsen. Applying an incontinence brief will increase the risk for skin breakdown. Providing more fluids will increase the liquid stool and abdominal bloating because the bowel is blocked with hard stool.

Quiz 26: Assisting With Bowel Elimination