Question 1

The nurse is assessing a cognitively impaired older adult client and observes a leaking of liquid stool from the rectum.The nurse's initial intervention for this client is to:

Accepted Answer

When a continuous oozing of diarrhea stool occurs,suspect impaction.The liquid portion of feces located higher in the colon seeps around the impacted mass.An obvious sign of impaction is the inability to pass a stool for several days,despite the repeated urge to defecate.The digital examination should be performed after it has been determined that the client has been without a normal bowel movement for several days.Although the remaining options are not inappropriate,they would not be the initial intervention.

Question 2

A 44-year-old male client was placed on a daily low-dose aspirin regimen by his health care provider following a recent diagnosis of hypertension and periodic atrial fibrillation.The client is currently hospitalized with renal stones.As the nurse is admitting the client,he shares that he has been very tired.The nurse gathers additional data regarding his bowel habits.The client shares that he has recently had black,tarry stools.The nurse is most concerned that the client may have:

Accepted Answer

Although the client could have any one of the items mentioned,it is most likely that the aspirin is causing a GI bleed.The loss of blood can cause the client to be fatigued.Aspirin is a prostaglandin inhibitor,which interferes with the formation and production of protective mucus and causes GI bleeding.

Question 3

A client is reporting that the oral medication she was prescribed for her hypothyroidism does not seem to be helping.The client goes on to report that she has been experiencing tension-related headaches and constipation.She has been self-medicating with nonsteroidal antiinflammatory drugs (NSAIDs)and bulk laxatives.Which of the following assessment questions is most likely to provide information regarding this client's concern regarding her thyroid problem?

Accepted Answer

Laxatives often influence the efficacy of other medications by altering the transit time (i.e. ,the time the medication remains in the GI tract and is available for absorption).The remaining options would have little bearing on the effectiveness of the hypothyroid medication unless the medication has not been taken long enough to reach therapeutic levels.

Question 4

The nurse is discussing food allergies with a group of mothers whose children are allergy prone.Which of the following statements made by a mother best describes lactose intolerance?

Accepted Answer

Food intolerance is not an allergy,but a particular food that causes the body distress within a few hours of ingestion.The result is diarrhea,cramps,or flatulence.For example,people who drink cow's milk who have these symptoms are not allergic to milk but lack the enzyme needed to digest the milk sugar lactose;they are lactose intolerant.To be lactose intolerant (exhibiting the signs after ingesting dairy products)does not constitute a dairy allergy.The remaining options are not as specific as the answer.

Question 5

An active 25-year-old female client shared with the nurse that ever since she had gone on a high-protein low-carbohydrate diet she had suffered from constipation.The client states that the diet is working for her in terms of weight loss and would like to stay on it.The best response from the nurse is that the client should try:

Accepted Answer

A low-fiber diet high in animal fats (e.g. ,meats,dairy products,eggs)can slow peristalsis,leading to constipation.By consuming fiber-rich low-carbohydrate foods,the client can still maintain weight loss while avoiding constipation.The client could develop a dependence on laxatives by using them on a regular basis.The client has expressed a desire to remain on the diet she is currently on,and it seems to be working to help her lose weight.Because client is already active,additional activity is not likely to have a profound effect on relieving the constipation.

Question 6

Which of the following statements by a client reporting constipation reflects the most informed understanding of interventions that will aid in assuming proper bowel mobility?

Accepted Answer

Unless there is a medical contraindication,an adult needs to drink six to eight glasses (1500 to 2000 mL)of noncaffeinated fluid daily.An increase in fluid intake with the use of fruit juices softens stool and increases peristalsis.Poor fluid intake increases the risk for constipation because of reabsorption of fluid in the colon,resulting in hard,dry stools.Although the other options are not incorrect,the client does not seem to have past experience with these suggestions.

Question 7

The mother of an 18-month-old male client shares with the nurse that she is trying to get her child to tell her when he needs to have a bowel movement.Which of the following statements is the most appropriate response from the nurse?

Accepted Answer

Developmental changes affecting elimination occur throughout life.The infant is unable to control defecation because of a lack of neuromuscular development.This development usually does not take place until 2 to 3 years of age.

Question 8

A client is caring for her daughter,who recently suffered multiple fractures in an automobile accident.The client tells the home care nurse that she has been "really down since all this happened." She adds that she has been constipated and not really interested in eating.Which of the following statements by the nurse focuses on the most likely cause of the gastrointestinal problem?

Accepted Answer

If a person becomes depressed,the autonomic nervous system slows impulses,and peristalsis decreases,resulting in constipation.Although the other options are not incorrect,they are not the most likely cause for this particular client.

Question 9

Which of the following statements made by a nurse discussing the effect of an antibiotic on the gastrointestinal system reflects the best understanding of the possible occurrence of diarrhea?

Accepted Answer

Antibiotics inadvertently produce diarrhea by disrupting the normal bacterial flora in the GI tract.The remaining options are not necessarily true.

Question 10

An adult client reports to the nurse that she has been experiencing constipation recently and is interested in any suggestions regarding dietary changes she might make.Which of the following suggestions provided by the nurse is most likely to minimize the client's complaint?

Accepted Answer

Unless there is a medical contraindication,an adult needs to drink six to eight glasses (1500 to 2000 mL)of noncaffeinated fluid daily.An increase in fluid intake with the use of fruit juices softens stool and increases peristalsis.Poor fluid intake increases the risk for constipation because of reabsorption of fluid in the colon,resulting in hard,dry stools.Although some of the options are food related,they are not as direct;a laxative is not a dietary change.

Question 11

A client who is 2 days' postoperative reports feeling "constipated" to the nurse.The client has good bowel sounds in all four quadrants and has tolerated liquids well.Her pain is being controlled with an opioid analgesic.Which of the following interventions should the nurse try initially?

Accepted Answer

An increase in fluid intake with the use of fruit juices softens stool and increases peristalsis.The remaining interventions are not inappropriate,but they are not the initial intervention for such a complaint.

Question 12

The 35-year-old pregnant client is concerned about constipation.When weighing the advantages and disadvantages of having a local anesthetic over a general anesthetic for a caesarian section,the nurse shares with the client that the local will cause less risk for constipation following surgery.The best reason that there is less constipation following this surgery is because:

Accepted Answer

The client who receives a local or regional anesthetic is less at risk for elimination alterations because this often affects bowel activity minimally or not at all whereas general anesthetic agents used during surgery cause temporary cessation of peristalsis,which can result in constipation.The client will still need to remain NPO before a scheduled caesarian section in case she would need to receive a general anesthetic.The client will not be able to ambulate immediately after surgery because of loss of feeling in the lower extremities.Clients should be able to eat following non-bowel-related surgery whether or not they have undergone a general anesthetic or a local anesthetic.

Question 13

The greatest risk for injury for a client who has fecal incontinence is:

Accepted Answer

Fecal incontinence is a potentially dangerous condition in terms of contamination and risk for skin ulceration.The greatest risk to the otherwise healthy individual is skin breakdown.Although the other options may be risk factors,they are not as great as that of skin breakdown.

Question 14

A client is caring for her husband who recently experienced a cerebral vascular accident.She tells the home care nurse that she has been very anxious lately about all the added responsibilities.She adds that she has not been sleeping well and has had several bouts of diarrhea.Which of the following statements by the nurse focuses on the most likely cause of the gastrointestinal problem?

Accepted Answer

During emotional stress the digestive process is accelerated,and peristalsis is increased.Side effects of increased peristalsis are diarrhea and gaseous distention.The remaining options are focused on the most likely cause of the problem,or they are focused on treatment,not cause.

Question 15

The nurse is providing ancillary personnel with instructions regarding the proper methods to implement when caring for a client with a Clostridium difficile infection.Which of the following practices will have the greatest impact on containment of the bacteria and thus prevention of cross-contamination?

Accepted Answer

Poor hand hygiene and erratic disinfection practices result in the transmission of C.difficile.Stool cultures are useful in the diagnosis,not the prevention,of C.difficile.Although the other options are appropriate,they do not have the most impact on preventing the spread of these bacteria.

Question 16

Which of the following clients is at greatest risk for serious complications when using the Valsalva maneuver to expel feces?

Accepted Answer

Clients with cardiovascular disease,glaucoma,increased intracranial pressure,or a new surgical wound are at greater risk,such as cardiac irregularities and elevated blood pressure,with this maneuver and need to avoid straining to pass the stool.Although the Valsalva maneuver may contribute to hemorrhoids,this is not as serious as increasing the intraocular pressure of a client with glaucoma.The Valsalva maneuver is not contraindicated in a client with hypertrophied prostate disease or in a client with stomach cancer.

Question 17

The nurse is counseling a 65-year-old female client on her use of mineral oil as a laxative.One of the most important things that the nurse can share with the client is how mineral oil can cause the decreased absorption of which of the following vitamins?

Accepted Answer

Mineral oil,a common laxative,decreases fat-soluble vitamin absorption.Vitamin D is the only fat soluble vitamin listed-the others are all water-soluble.

Question 18

A 70-year-old client is discussing his recent difficulty with having regular bowel movements while on a cross-country bus tour with a senior citizens' group.Which of the following assessment questions is directed toward the most likely cause of the problem?

Accepted Answer

Attempting to eliminate in a public restroom sometimes results in a temporary inability to defecate.This embarrassment may prompt clients to ignore the urge to defecate,which begins a vicious cycle of constipation and discomfort.Although the remaining options may affect bowel elimination,the situation of the scenario strongly suggests an emotional cause.

Question 19

A client who was recently diagnosed with anemia and rheumatoid arthritis reports to the nurse that she has noticed that her stool is black,and she is concerned because there is a history of colon cancer in her family.Which of the following assessment questions is most likely to provide information regarding this client's bowel problem?

Accepted Answer

Ingestion of iron,commonly prescribed for certain types of anemia,causes discoloration of the stool (black),nausea,vomiting,constipation (diarrhea is less commonly reported),and abdominal cramps.The remaining options,although focusing on aspects of function that could result in constipation,are not focused on the most likely cause in this scenario.

Question 20

The nurse is caring for a 19-year-old male client with a fractured left femur whose leg was pinned 36 hours ago and is now in traction.Which of the following stressors is mostly likely the cause of this client's difficulty related to constipation?

Accepted Answer

For the client immobilized in bed,defecation is often difficult.In a supine position it is impossible to contract the muscles used during defecation.If the client's condition permits,raise the head of the bed;this assists the client to a more normal sitting position on a bedpan,enhancing the ability to defecate.Although the other options may have some effect,the primary cause is most likely the emotional stress of not being able to assume the usual position for defecation.

Quiz 46: Bowel Elimination