Lower GI-Chapter 45 (evolve, NCLEX prep & notes)

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which of the following instructions would be most helpful to prevent further episodes of constipation?

A. Maintain a high intake of fluid and fibre in the diet.

B. Reduce intake of medications causing constipation.

C. Eat several small meals per day to maintain bowel motility.

D. Sit upright during meals to increase bowel motility by gravity.

ANS: A. Increased fluid intake and a high-fibre diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fibre provide bulk that in turn increases peristalsis and bowel motility.

The nurse should administer a prn dose of magnesium hydroxide (milk of magnesia) after noting which of the following while reviewing a patient's medical record?

A. Abdominal pain and bloating

B. No bowel movement for three days

C. A decrease in appetite by 50% over 24 hours

D. Muscle tremors and other signs of hypomagnesemia

Ans: B. Magnesium hydroxide (milk of magnesia) is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for three days.

The nurse is preparing to administer a dose of bisacodyl (Dulcolax). In explaining the medication to the patient, the nurse would state that it acts in which of the following ways?

A. Increases bulk in the stool

B. Lubricates the intestinal tract to soften feces

C. Increases fluid retention in the intestinal tract

D. Increases peristalsis by stimulating nerves in the colon wall

Ans: D. Bisacodyl (Dulcolax) is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. It is available in oral and suppository forms.

The nurse is preparing to administer a scheduled dose of docusate sodium (Colace) when the patient complains of an episode of loose stool and does not want to take the medication. Which of the following is the appropriate action by the nurse?

A. Write an incident report about this untoward event.

B. Attempt to have the family convince the patient to take the ordered dose.

C. Withhold the medication at this time and try to administer it later in the day.

D. Chart the dose as not given on the medical record and explain in the nursing progress notes.

ANS: D. Whenever a patient refuses medication, the dose should be charted as not given. An explanation of the reason should then be documented in the nursing progress notes. In this instance, the refusal indicates good judgement by the patient.

A patient is scheduled to receive "Colace 100 mg PO." The patient asks to take the medication in liquid form, and the nurse obtains an order for the interchange. Available is a syrup that contains 150 mg/15 mL. How many millilitres does the nurse administer?

A. 3 mL

B. 5 mL

C. 10 mL

D. 12 mL

ANS: C. The concentration of the syrup is 10 mg/mL. Therefore, a 100-mg dose necessitates 10 mL.

The nurse would instruct the patient to do which of the following to best enhance the effectiveness of a daily dose of docusate sodium (Colace)?

A. Take a dose of mineral oil at the same time.

B. Add extra salt to food on at least one meal tray.

C. Ensure dietary intake of 10 g of fibre each day.

D. Take each dose with a full glass of water or other liquid.

ANS: D. Docusate sodium (Colace) lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage. The patient should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. Dietary fibre intake should be a minimum of 20 g daily to prevent constipation

The nurse would question the use of which of the following cathartic agents in a patient with renal insufficiency?

A. Bisacodyl (Ducolax)

B. Senna (Senokot)

C. Cascara sagrada

D. Magnesium hydroxide (milk of magnesia)

ANS: D. Magnesium hydroxide (milk of magnesia) may cause hypermagnesemia in patients with renal insufficiency. The nurse should question this order with the health care provider before administration.

A patient who is administering a bisacodyl (Dulcolax) suppository asks the nurse how long it will take to work. The nurse replies that the patient will probably need to use the bedpan or commode within which of the following time frames after administration?

A. 2-5 minutes

B. 15-60 minutes

C. 2-4 hours

D. 6-8 hours

ANS: B. Bisacodyl (Dulcolax) suppositories usually are effective within 15 to 60 minutes of administration, so the nurse should plan accordingly to assist the patient to use the bedpan or commode

The nurse is caring for a patient in the emergency department with complaints of acute abdominal pain, nausea, and vomiting. When the nurse palpates the patient's left lower abdominal quadrant, the patient complains of pain in the right lower quadrant. The nurse will document this as which of the following diagnostic signs of appendicitis?

A. Rovsing sign

B. Referred pain

C. Chvostek's sign

D. Rebound tenderness

ANS: A. In patients with suspected appendicitis, Rovsing sign may be elicited by palpation of the left lower quadrant, causing pain to be felt in the right lower quadrant.

The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which of the following types of bowel sounds that is consistent with the patient's clinical picture?

A. Low pitched and rumbling above the area of obstruction

B. High pitched and hypoactive below the area of obstruction

C. Low pitched and hyperactive below the area of obstruction

D. High pitched and hyperactive above the area of obstruction

ANS: D. Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high pitched, sometimes referred to as "tinkling" above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which of the following factors in the patient's history increases the patient's risk for colorectal cancer?

A. Osteoarthritis

B. History of rectal polyps

C. History of lactose intolerance

D. Use of herbs as dietary supplements

ANS: B. A history of rectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. The other factors identified do not pose additional risk to the patient.

The nurse is preparing to insert a nasogastric tube into a 68-year-old patient with an abdominal mass and suspected bowel obstruction. The patient asks the nurse why this procedure is necessary. Which of the following responses is most appropriate?

A. "The tube will help to drain the stomach contents and prevent further vomiting."

B. "The tube will push past the area that is blocked, and thus help to stop the vomiting."

C. "The tube is just a standard procedure before many types of surgery to the abdomen."

D. "The tube will let us measure your stomach contents, so that we can plan what type of IV fluid replacement would be best."

ANS: A. The nasogastric tube is used to decompress the stomach by draining stomach contents, and thereby prevent further vomiting.

A 61-year-old patient with suspected bowel obstruction has had a nasogastric tube inserted at 0400 hrs. The nurse shares in the morning report that the day shift staff should check the tube for patency at which of the following times?

A. 0700 hrs, 1000 hrs, and 1300 hrs

B. 0800 hrs and 1200 hrs

C. 0900 hrs and 1500 hrs

D. 0900 hrs, 1200 hrs, and 1500 hrs

ANS: B. A nasogastric tube should be checked for patency routinely at four-hour intervals. Thus if the tube were inserted at 0400 hrs, it would be due to be checked at 0800 hrs and 1200 hrs.

The nurse who inserted a nasogastric tube for a 68-year-old patient with suspected bowel obstruction should write which of the following priority nursing diagnoses on the patient's problem list?

A. Anxiety related to nasogastric tube placement

B. Abdominal pain related to nasogastric tube placement

C. Risk for deficient knowledge related to nasogastric tube placement

D. Altered oral mucous membrane related to nasogastric tube placement

ANS: D. With nasogastric tube placement, the patient is likely to breathe through the mouth and may experience irritation in the affected nares. For this reason, the nurse should plan preventive measures based on this nursing diagnosis.

A colectomy is scheduled for a 68-year-old woman with an abdominal mass, possible bowel obstruction, and a history of rectal polyps. The nurse should plan to include which of the following prescribed measures in the preoperative preparation of this patient?

A. Instruction on irrigating a colostomy

B. Administration of a cleansing enema

C. A high-fibre diet the day before surgery

D. Administration of IV antibiotics for bowel preparation

ANS: B. Preoperative preparation for bowel surgery typically includes bowel cleansing with antibiotics, such as oral neomycin and cleansing enemas, including Fleet enemas.

Which of the following would be the highest priority information to include in preoperative teaching for a 68-year-old patient scheduled for a colectomy?

A. How to care for the wound

B. How to deep-breathe and cough

C. The location and care of drains after surgery

D. What medications will be used during surgery

ANS: B. Because anaesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep-breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge.

The nurse asks a 68-year-old patient scheduled for colectomy to sign the operative permit as directed in the physician's preoperative orders. The patient states that the physician has not really explained well what is involved in the surgical procedure. Which of the following is the most appropriate action by the nurse?

A. Ask family members whether they have discussed the surgical procedure with the physician.

B. Have the patient sign the form and state that the physician will visit to explain the procedure before surgery.

C. Explain the planned surgical procedure as well as possible, and have the patient sign the consent form.

D. Delay the patient's signature on the consent and notify the physician about the conversation with the patient.

ANS: D. The patient should not be asked to sign a consent form unless the procedure has been explained to the satisfaction of the patient. The nurse should notify the physician, who has the responsibility for obtaining consent.

Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distension. The nurse plans care for the patient based on the knowledge that the symptoms occur as a result of which of the following?

A. Impaired peristalsis

B. Irritation of the bowel

C. Nasogastric suctioning

D. Anastomosis site inflammation

ANS: A. Until peristalsis returns to normal following anaesthesia, the patient may experience slowed gastrointestinal motility leading to gas pains and abdominal distension.

Following bowel resection, a patient has a nasogastric tube to suction, but complains of nausea and abdominal distension. The nurse irrigates the tube prn as ordered, but the irrigating fluid does not return. Which of the following should be the priority action by the nurse?

A. Notify the physician.

B. Auscultate for bowel sounds.

C. Reposition the tube and check for placement.

D. Remove the tube and replace it with a new one.

ANS: C. The tube may be resting against the stomach wall. The first action by the nurse, since this is intestinal surgery (not gastric surgery), is to reposition the tube and check it again for placement.

The nurse is caring for a postoperative patient with a colostomy. The nurse is preparing to administer a dose of famotidine (Pepcid) when the patient asks why the medication was ordered since the patient does not have a history of heartburn or gastroesophageal reflux disease (GERD). Which of the following would be the most appropriate response by the nurse?

A. "This will prevent air from accumulating in the stomach, causing gas pains."

B. "This will prevent the heartburn that occurs as a side effect of general anaesthesia."

C. "The stress of surgery is likely to cause stomach bleeding if you do not receive it."

D. "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again."

ANS: D. Famotidine (Pepcid) is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery.

All of the following are complications of diarrhea except:

A. Anorexia

B. Muscle weakness

C. Increased potassium level

D. Hypotension

C. diarrhea and vomiting cause potassium levels to decrease

Which is the following is considered a stimulant laxative?

A. Milk of Magnesia

B. Colace

C. Metamucil

D. Dulcolax

D.

Which of the following is the diagnostic of choice if diverticulitis is suspected?

A. Colonoscopy

B. Barium enema

C. CT

D. Abdominal x-ray

C. (according to Lewis)

TRUE OR FALSE:

The colorectal area is the third most common site of new cancer cases

True (according to Lewis)

A client who is administering a bisacodyl (Dulcolax) suppository asks the nurse how long it will take to work. The nurse replies that the client will probably need to use the bedpan or commode within which of the following timeframes after administration?

A. 2-5 minutes

B. 15-60 minutes

C. 2-4 hours

D. 6-8 hours

B. Dulcolax is a stimulant laxative

In assessing a 55 year old client who is in the clinic for a routine physical, under which of the following circumstances would the nurse instruct the client about the need to provide a stool specimen for guaiac fecal occult blood testing?

A. If a client notices rectal bleeding

B. If the client has a family history of intestinal polyps

C. As part of a routine screening for colon cancer

D. If a palpable mass is detected on digital examination

C. This is considered part of annual screening for anyone over 50 years old, or 40 years old if there is a family history.

Diarrhea that occurs with a fecal impaction is the result of which of the following?

A. A clear liquid diet

B. Irritation of the intestinal mucosa

C. Inability of the client to form a stool

D. Seepage of stool around the impaction

D

The client receiving chemotherapy rings the call bell and reports onset of nausea. The nurse should prepare a p.r.n. dose of which of the following medications?

A. Dexamethasone (Decadron)

B. Morphine Sulphate

C. Ondansetron (Zofran)

D. Zolpidem (Ambien)

C

A cleansing enema is ordered for a 55 year old client before intestinal surgery. What is the maximum amount of fluid used?

A. 150-200 mL

B. 200-400 mL

C. 400-750 mL

D. 750-1000 mL

D

A client with a bowel resection and anastomosis returns to his room with an NG tube attached to intermittent suction. Which of the following observations indicated that the nasogastric suction is working properly?

A. The client's abdomen is soft

B. The client is able to swallow

C. The client has active bowel sounds

D. The client's abdominal dressing is dry and intact

A. purpose of the NG tube is to decompress

A client with diverticulitis is admitted with nausea, vomiting and dehydration. Which finding suggests a complication of diverticulitis?

A. Pain in the left lower quadrant

B. Boardlike abdomen

C. Low grade fever

D. Abdominal distension

B. this is a sign of peritonitis, which is a complication of diverticulitis

Through experience and knowledge, the nurse knows that the client will commonly experience the most severe postoperative pain at what time?

A. The third postop day

B. The fourth postop day

C. Immediately after the surgery

D. The first 12-36 hours after surgery

D

A 2 year old is hospitalized with suspected intussusception. Which finding is associated with intussusception?

A. "current jelly" stools

B. projectile vomiting

C. "ribbonlike" stools

D. palpable mass over the flank

A

The doctor has ordered Percocet (oxycodone) for a client following abdominal surgery. The primary objective of nursing care for the client receiving an opiate analgesic is to:

A. Prevent addiction

B. Alleviate pain

C. Facilitate mobility

D. Prevent nausea

B

The nurse is preparing to administer a dose of bisacodyl (Dulcolax). In explaining the medication to the client, the nurse would state that it acts in which of the following ways?

A. increases bulk in the stool

B. Lubricates the intestinal tract to soften feces

C. Increases fluid retention in the intestinal tract

D. Increases peristalsis by stimulating enteric nerves

D

A client who had abdominal surgery 2 days ago has orders for IV morphine sulphate 4 mg every 2 hours and a clear liquid diet. If the client feels distended and has sharp, cramping gas pains, which following intervention is the most appropriate?

A. Obtain an order for a laxative

B. Withhold all oral fluid and food

C. Assist the client to ambulate in the hall

D. Administer the prescribed morphine sulphate

C. Getting the client up and moving with help them to pass gas, thus alleviating the pains caused by gas

Mr. Feyes has a nasogastric tube which has been draining a bile-coloured liquid and now contains coffee ground material. What should the practical nurse do?

A. Continue to observe the drainage

B. Check the suction tubing for patency

C. Report the findings to the physician

D. Increase the power on the suction

C. This is a sign of old blood

Before changing the IV container, which action should be taken by the practical nurse first?

A. Review the client's intake/output for the shift

B. Check the physician's order

C. Gather the necessary equipment

D. Explain the procedure to the client

B

Mr. Hatmacher, 67 years old, received teaching regarding changing his colostomy appliance. How could the practical nurse best assess Mr. Hutmacher's learning?

A. Ask what problems he has had with the appliance

B. Watch him change his appliance

C. Check if the appliance is properly attached

D. Look at his appliance site

B

A client with a history of GI bleeding has a platelet count of 300,000 cells/mL. Which action by the nurse is most appropriate after reading this finding?

A. Report the abnormally low count

B. Report the abnormally high count

C. Place the client on bleeding precautions

D. Place the normal report in the clients medical record

D. A normal platelet count ranges from 150,000 to 400,000 cells/mm3. The nurse should place the report that contains the normal lab value into the client's medical record.

A client was diagnosed with acute pancreatitis 10 days ago. The nurse interprets that the episode of acute pancreatitis is fully resolved if the serum lipase level drops to which value?

A. 135 units/L

B. 175 units/L

C. 200 units/L

D. 250 units/L

A. The normal serum lipase level is 10 to 140 units/L. The client who is recovering from acute pancreatitis usually has elevated lipase levels for approximately 10 days after the onset of symptoms. This makes lipase a valuable test for monitoring the client's pancreatic function. The serum lipase level of 135 units/L indicates resolution of the acute pancreatitis because it is a normal value.

The nurse is reinforcing teaching to a client about an upcoming colonoscopy procedure. The nurse should include in the instructions that the client will be places in which position for the procedure?

A. Left Sims' position

B. Lithotomy position

C. Knee-chest position

D. Right Sims' position

A. the client is placed in the left Sims' position for the procedure. This position takes the best advantage of the clients' anatomy for ease in introducing the colonoscope.

The nurse is preparing to perform an abdominal examination. The initial step should be which?

A. palpation

B. inspection

C. Percussion

D. Auscultation

B

The nurse is caring for a client with a diagnosis of chronic gastritis. The nurse anticipates that the client is at risk for which vitamin deficiency?

A. Vitamin A

B. Vitamin C

C. Vitamin E

D. Vitamin B12

D. Deterioration and atrophy of the lining of the stomach lead to a loss of function of the parietal cells. When the acid secretion decreases, the source of the intrinsic factor is lost, which results in the inability to absorb vitamin b12. This leads to the development of pernicious anemia.

The nurse is caring for a client after a Billroth II (gastrojejunostomy) procedure. On review of the postoperative prescriptions, which should the nurse clarify?

A. Leg exercises

B. Early ambulation

C. Irrigating the NG tube

D. Coughing and deep-breathing exercises

C. In a Billroth II resection, the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the NG tube is critical for preventing the retention of gastric secretions. The nurse, however, should never irrigate or reposition the gastic tube after gastric surgery unless specifically prescribed by the HCP. In this situation, the nurse should clarify the prescription

The nurse is reinforcing discharge instructions to a client after a gastrectomy. Which measure should the nurse include in client teaching to help prevent dumping syndrome?

A. Ambulate after a meal

B. Eat high-carb foods

C. Limit the fluids taken with a meal

D. Sit in a high Fowler's position during meals

C. The client should be instructed to decrease the amount of fluid taken at meals. The client should also be instructed to avoid high carb foods, including fluids such as fruit nectars; assume the low-Fowler's position during meals; lie down for 30 minutes after eating to delay gastric emptying and take antispasmodics as prescribed

The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic should the nurse expect to see documented in the record?

A. Diarrhea

B. Constipation

C. Bloody stools

D. Stool constantly oozing from the rectum

A. Chron's disease is characterized by nonbloody diarrhea of usually not more than four or five stools daily. Over time, the diarrhea episodes increase in frequency, duration and severity.

The nurse is monitoring for stoma prolapse in a client with a colostomy. Which stoma observation should indicate that a prolapse has occurred?

A. Dark and bluish

B. Sunken and hidden

C. Narrowed and flattened

D. Protruding and swollen

D. A prolapsed stoma is one in which bowel protrudes through the stoma, with an elongated and swollen appearance. A stoma retraction is characterized by sinking of the stoma. Ischemia of the stoma would be associated with dusky or bluish color. A stoma with a narrowed opening, either at the level of the skin or fascia, is said to be stenosed.

TRUE OR FALSE

The level of glucose in the blood regulates the rate of insulin secretion from the pancreas

True

TRUE OR FALSE

Women who use oral contraceptives are at increased risk for gallstone formation

True

TRUE OR FALSE

The patient with acute pancreatitis should be offered small frequent meals high in protein and fibre

False

TRUE OR FALSE

The patient who has undergone a laparoscopic cholecystectomy is more likely to experience paralytic ileus than a patient whose gallbladder has been removed using an abdominal surgical procedure

False

The secretions of the exocrine pancreas include the ____ enzymes amylase, trypsin and lipase

digestive

The patient who is jaundiced due to obstruction of the common bile duct often complains of severe ___ of the skin

itching

The patient with chronic pancreatitis often has frequent, foul smelling stools, a condition known as ____

statorrhea