Ch.41 Management of Pts w/ Intestinal & Rectal Disorders

The instructor is teaching a group of students about irritable bowel syndrome (IBS) and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an antidiarrheal agent commonly administered for IBS?

A. Dicyclomine

B. Lubiprostone

C. Loperamide

D. Peppermint oil

C. Loperamide

Rationale: Loperamide is an opiate-related antidiarrheal agent. Lubiprostone is used to treat constipation; it activates chloride channels in the gastrointestinal tract to increase gastrointestinal transit. Dicyclomine, a smooth muscle antispasmodic agent, is used to treat pain accompanying IBS. Peppermint oil may also be taken to ease discomfort.

The nurse is performing an abdominal assessment for a client with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's notes?

A. Peristalsis

B. Tenesmus

C. Borborygmus

D. Loud bowel sounds

C. Borborygmus

Rationale: Borborygmus is a rumbling noise caused by the movement of gas through the intestines, often associated with diarrhea.

A client is admitted to the emergency department with reports right lower quadrant pain. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the health care provider immediately?

A. White blood cell (WBC) count 22.8/mm3

B. Serum potassium 4.2 mEq/L

C. Serum sodium 135 mEq/L

D. Hematocrit 42%

A. White blood cell (WBC) count 22.8/mm3

Rationale: The nurse should report the elevated WBC count. This finding, which is a sign of infection, indicates that the client's appendix might have ruptured. Hematocrit of 42%, serum potassium of 4.2 mEq/L, and serum sodium of 135 mEq/L are within normal limits. Alterations in these levels don't indicate appendicitis.

A client informs the nurse of having abdominal pain that is relieved when having a bowel movement. The health care provider diagnosed the client with irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder?

A. Client is awakened from sleep due to abdominal pain.

B. Chronic constipation with sporadic bouts of diarrhea

C. Blood and mucus in the stool

D. Weight loss due to malabsorption

B. Chronic constipation with sporadic bouts of diarrhea

Rationale:

Most clients with irritable bowel syndrome (IBS) describe having chronic constipation with sporadic bouts of diarrhea. Some report the opposite pattern, although less commonly. Most clients experience various degrees of abdominal pain that defecation may relieve. Weight usually remains stable, indicating that when diarrhea occurs, malabsorption of nutrients does not accompany it. Stools may have mucus, but blood is not usually found because the bowel is not locally inflamed. The sleep is not disturbed from abdominal pain.

A client is being treated for diverticulosis. Which points should the nurse include in this client's teaching plan? Select all that apply.

A. Limit high-fiber foods

B. Limit high-fat meat and dairy products

C. Drink fluids, especially water and fluids that are sugar-free

D. Engage in regular physical activity

E. Do not suppress the urge to defecate.

A. Limit high-fiber foods

B. Limit high-fat meat and dairy products

C. Drink fluids, especially water and fluids that are sugar-free

E. Do not suppress the urge to defecate.

Rationale: The nurse should instruct the client tto avoid constipation, and therefore not to suppress or ignore the urge to defecate. The client should consume plenty of fluids, especially water and sugar-free fluids (within limits of the client's cardiac and renal reserve). They should eat a diet that limits high-fat meats and dairy products and includes fruits and vegetables, to increase the bulk of the stool and facilitate peristalsis, thereby promoting defecation. The nurse should encourage the client to engage in regular physical activity, including exercises that involve toning abdominal muscles.

A nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find?

A. severe abdominal pain with direct palpation or rebound tenderness

B. jaundice and vomiting

C. rectal bleeding and a change in bowel habits

D. tenderness and pain in the right upper abdominal quadrant

A. severe abdominal pain with direct palpation or rebound tenderness

Rationale: Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (i.e., appendicitis, diverticulitis, ulcerative colitis, a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.

The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation?

A. Usual pattern of elimination

B. Activity levels

C. Current medications

D. Alcohol consumption

A. Usual pattern of elimination

Rationale:

Constipation has many possible reasons; assessing the client's usual pattern of elimination is the first step in identifying the cause.

A community health nurse is performing a home visit to a 53-year-old client who requires twice-weekly wound care on their foot. The client mentions that they are currently having hemorrhoids, a problem that they have not previously experienced. What treatment measure should the nurse recommend to this client?

A. Daily application of topical antibiotics

B. Decreased fluid intake

C. A high-fiber diet with increased fruit intake

D. Bathing, rather than showering, once per day

C. A high-fiber diet with increased fruit intake

Rationale: Hemorrhoid symptoms and discomfort can be relieved by good personal hygiene and by avoiding excessive straining during defecation. A high-residue diet that contains fruit and bran along with an increased fluid intake may be all the treatment necessary to promote the passage of soft, bulky stools to prevent straining. It is unnecessary to avoid showering, and antibiotics are not an effective treatment.

Which is the most common presenting symptom of colon cancer?

A. Anorexia

B. Change in bowel habits

C. Fatigue

D. Weight loss

B. Change in bowel habits

Rationale: The most common presenting symptom is a change in bowel habits. Fatigue, anorexia, and weight loss may occur but are not the most common presenting symptoms.

When describing abdominal hernias to a group of nursing students, the instructor would identify which type as most common?

A. Incisional

B. Inguinal

C. Femoral

D. Umbilical

B. Inguinal

Rationale: The common abdominal hernias are inguinal, umbilical, femoral, and incisional, with inguinal hernias the most common type.

The nurse is performing a rectal assessment and notices a longitudinal tear or ulceration in the lining of the anal canal. The nurse documents the finding as which condition?

A. Anorectal abscess

B. Hemorrhoid

C. Anal fistula

D. Anal fissure

D. Anal fissure

Rationale:

Fissures are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety (leading to constipation). An anorectal abscess is an infection in the pararectal spaces. An anal fistula is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus. A hemorrhoid is a dilated portion of vein in the anal canal.

The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching?

A. Avoid unprocessed bran.

B. Avoid daily exercise.

C. Drink 8 to 10 glasses of fluid daily.

D. Use laxatives weekly

C. Drink 8 to 10 glasses of fluid daily.

Rationale: The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the health care provider. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.

A client has been brought into the ED via ambulance, reporting acute generalized abdominal pain, nausea, fever, and constipation. The health care provider suspects appendicitis, but testing has not been performed yet to make a definitive diagnosis. What will the nurse most likely do while initially caring for this client?

A. Perform the test for rebound tenderness.

B. Administer a laxative to relieve the client's constipation.

C. Explain to the client why analgesics are being withheld.

D. Frequently palpate the abdomen to assess for changes that might indicate the onset of a perforation.

C. Explain to the client why analgesics are being withheld.

Rationale:

Analgesics may be withheld initially to avoid masking symptoms that may affect the diagnosis. Avoid multiple or frequent palpation of the abdomen; there is danger of causing the appendix to rupture. Perform the test for rebound tenderness at the end of the examination because a positive response causes pain and muscle spasm and makes it difficult to complete the rest of the assessment. Do not administer laxatives or enemas to a client who is experiencing fever, nausea, and abdominal pain, even though the client may report feeling constipated. Laxatives and cathartics may cause the appendix to rupture.

A client is being treated for diverticulosis. Which points should the nurse include in this client's teaching plan? Select all that apply.

A. Engage in regular physical activity

B. Limit high-fiber foods

C. Do not suppress the urge to defecate.

D. Limit high-fat meat and dairy products

E. Drink fluids, especially water and fluids that are sugar-free

A. Engage in regular physical activity

C. Do not suppress the urge to defecate.

D. Limit high-fat meat and dairy products

E. Drink fluids, especially water and fluids that are sugar-free

Rationale: The nurse should instruct the client tto avoid constipation, and therefore not to suppress or ignore the urge to defecate. The client should consume plenty of fluids, especially water and sugar-free fluids (within limits of the client's cardiac and renal reserve). They should eat a diet that limits high-fat meats and dairy products and includes fruits and vegetables, to increase the bulk of the stool and facilitate peristalsis, thereby promoting defecation. The nurse should encourage the client to engage in regular physical activity, including exercises that involve toning abdominal muscles.

A client reports constipation. Which nursing measure would be most effective in helping the client reduce constipation?

A. Assist client to increase dietary fiber.

B. Obtain complete food history.

C. Provide adequate quantity of food.

D. Obtain medical and allergy history.

A. Assist client to increase dietary fiber.

Rationale:

The nurse should assist the client to increase the dietary fiber in food because it helps reduce constipation. Providing an adequate quantity of food is necessary in maintaining sufficient nutrition and in sustaining normal body weight. Obtaining medical, allergy, and food history would provide valuable information, however, it would not help reduce constipation.

What information should the nurse include in the teaching plan for a client being treated for diverticulosis?

A. Avoid unprocessed bran in the diet

B. Drink at least 8 to 10 large glasses of fluid every day

C. Avoid daily exercise; indulge only in mild activity

D. Use laxatives or enemas at least once a week

B. Drink at least 8 to 10 large glasses of fluid every day

Rationale:

The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the health care provider. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's:

A. alcohol consumption.

B. current medications.

C. usual pattern of elimination.

D. activity levels.

C. usual pattern of elimination.

Rationale:

Constipation has many possible reasons; assessing the client's usual pattern of elimination is the first step in identifying the cause.

A nurse is preparing to provide care for a client whose exacerbation of ulcerative colitis has required hospital admission. During an exacerbation of this health problem, the nurse would anticipate that the client's stools will have what characteristics?

A. Watery with blood and mucus

B. Hard and black or tarry

C. Dry and streaked with blood

D. Loose with visible fatty streaks

A. Watery with blood and mucus

Rationale: The predominant symptoms of ulcerative colitis are diarrhea and abdominal pain. Stools may be bloody and contain mucus. Stools are not hard, dry, tarry, black or fatty in clients who have ulcerative colitis.

The nurse working in the emergency department is caring for a client with signs and symptoms of appendicitis. Which order from the health care provider should the nurse question?

A. intravenous antibiotic therapy

B. complete blood count

C. nothing by mouth (NPO)

D. administer an enema

D. administer an enema

Rationale: An enema is not administered in clients with symptoms associated with appendicitis because it can lead to perforation. Monitoring the complete blood cell count is necessary to identify infection. The client should receive nothing by mouth as surgery is required. Intravenous antibiotics may be ordered to prevent infection.

A 75-year-old male client presents at the emergency department with symptoms of a small bowel obstruction. An emergency room nurse is obtaining assessment data from this client. What assessment finding is characteristic of a small bowel obstruction?

A. Nausea and vomiting

B. Decrease in urine production

C. Mucus in the stool

D. Mucosal edema

A. Nausea and vomiting

Rationale: Nausea and vomiting are symptoms of a small bowel obstruction. Decrease in urine production and mucosal edema are not symptoms of a bowel obstruction. The client may defecate mucus, but this is not accompanied by stool.

A client's screening colonoscopy revealed the presence of numerous polyps in the large bowel. What principle should guide the subsequent treatment of this client's health problem?

A. The client's polyps constitute a risk factor for cancer.

B. Adherence to a high-fiber diet will help the polyps resolve.

C. The client should be assured that this is a normal, age-related physiologic change.

D. The presence of polyps is associated with an increased risk of bowel obstruction.

A. The client's polyps constitute a risk factor for cancer.

Rationale: Although most polyps do not develop into invasive neoplasms, they must be identified and followed closely. They are very common, but are not classified as a normal, age-related physiologic change. Diet will not help them resolve and they do not typically lead to obstructions.

The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for:

A. hyponatremia.

B. hypokalemia.

C. hypernatremia.

D. hyperkalemia.

B. hypokalemia.

Rationale: The older client taking digoxin must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

Which of the following is the most common symptom of a polyp?

A. Abdominal pain

B. Anorexia

C. Rectal bleeding

D. Diarrhea

C. Rectal bleeding

Rationale: The most common symptom is rectal bleeding. Lower abdominal pain may also occur. Diarrhea and anorexia are clinical manifestations of ulcerative colitis.

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes:

A. caffeinated products.

B. high-fiber diet.

C. fluids with meals.

D. spicy foods.

B. high-fiber diet.

Rationale: The most common symptom is rectal bleeding. Lower abdominal pain may also occur. Diarrhea and anorexia are clinical manifestations of ulcerative colitis.

A client with a pilonidal sinus undergoes surgery. Which of the following would the nurse include in the client's postoperative plan of care?

A. Administering prescribed antibiotics

B. Maintaining nothing by mouth (NPO) status

C. Repacking the surgical wound

D. Caring for the intact suture line

C. Repacking the surgical wound

Rationale:

A high-fiber diet is prescribed to help control constipation. Individuals experiencing diarrhea may be advised to eat a low-fiber diet. Foods that are possible irritants, such as caffeine, spicy foods, lactose, beans, fried foods, corn, wheat, and alcohol, should be avoided. Fluids should not be taken with meals because they cause abdominal distention.

A client with Crohn's disease is losing weight. For which reason will the nurse anticipate the client being prescribed parenteral nutrition?

A. Impaired ability to absorb food

B. Prolonged preoperative nutritional needs

C. Insufficient oral intake

D. Unwilling to ingest nutrients orally

A. Impaired ability to absorb food

Rationale:

A client with Crohn's disease will have an impaired ability to ingest or absorb food orally or enterally. Clients with severe burns, malnutrition, short-bowel syndrome, AIDS, sepsis, and cancer would need parenteral nutrition because of insufficient oral intake. Unwillingness to ingest nutrients orally would cause a client with a major psychiatric illness to need parenteral nutrition. Prolonged surgical nutritional needs such as what occurs after extensive bowel surgery or acute pancreatitis would necessitate the need for parenteral nutrition.

A client informs the nurse of having abdominal pain that is relieved when having a bowel movement. The health care provider diagnosed the client with irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder?

A. Blood and mucus in the stool

B. Weight loss due to malabsorption

C. Client is awakened from sleep due to abdominal pain.

D. Chronic constipation with sporadic bouts of diarrhea

D. Chronic constipation with sporadic bouts of diarrhea

Rationale:

Most clients with irritable bowel syndrome (IBS) describe having chronic constipation with sporadic bouts of diarrhea. Some report the opposite pattern, although less commonly. Most clients experience various degrees of abdominal pain that defecation may relieve. Weight usually remains stable, indicating that when diarrhea occurs, malabsorption of nutrients does not accompany it. Stools may have mucus, but blood is not usually found because the bowel is not locally inflamed. The sleep is not disturbed from abdominal pain.

Which category of laxatives draws water into the intestines by osmosis?

A. Fecal softeners (e.g., docusate)

B. Saline agents (e.g., magnesium hydroxide)

C. Stimulants (e.g., bisacodyl)

D. Bulk-forming agents (e.g., psyllium)

B. Saline agents (e.g., magnesium hydroxide)

Rationale: Saline agents use osmosis to stimulate peristalsis and act within 2 hours of consumption. Bulk-forming agents mix with intestinal fluids, swell, and stimulate peristalsis. Stimulants irritate the colon epithelium. Fecal softeners hydrate the stool by surfactant action on the colonic epithelium, resulting in the mixing of aqueous and fatty substances.

A nurse is preparing a presentation for a local community group of older adults about colon cancer. What would the nurse include as the primary characteristic associated with this disorder?

A. A change in bowel habits

B. Abdominal pain

C. Abdominal distention

D. Frank blood in the stool

A. A change in bowel habits

Rationale:

Although abdominal distention and blood in the stool (frank or occult) may be present, the chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Abdominal pain is a late sign.

The nurse is reviewing the laboratory test results of a client with Crohn's disease. Which of the following would the nurse most likely find?

A. Increased albumin levels

B. Decreased white blood cell count

C. Negative stool cultures

D. Decreased erythrocyte sedimentation rate

C. Negative stool cultures

Rationale: Stool cultures fail to reveal an etiologic microorganism or parasite, but occult blood and white blood cells (WBCs) often are found in the stool. Results of blood studies indicate anemia from chronic blood loss and nutritional deficiencies. The WBC count and erythrocyte sedimentation rate may be elevated, confirming an inflammatory disorder. Serum protein and albumin levels may be low because of malnutrition.

The nurse is conducting a gastrointestinal assessment. When the client reports the presence of mucus and pus in the stool, the nurse assesses for additional signs/symptoms of which disease/condition?

A. Disorders of the colon

B. Intestinal malabsorption

C. Small-bowel disease

D. Ulcerative colitis

D. Ulcerative colitis

Rationale: The presence of mucus and pus in the stool suggests ulcerative colitis. Watery stools are characteristic of small-bowel disease. Loose, semisolid stools are associated more often with disorders of the colon. Voluminous, greasy stools suggest intestinal malabsorption.

When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?

A. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.

B. The appendix may develop gangrene and rupture, especially in a middle-aged client.

C. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

D. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

D. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

Rationale: A client with appendicitis is at Risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Older, not middle-aged, clients are especially susceptible to appendix rupture.

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, what would the nurse stress the importance of?

A. Taking only enteric-coated medications

B. Wearing an appliance pouch only at bedtime

C. Consuming a low-protein, high-fiber diet

D. Increasing fluid intake to prevent dehydration

D. Increasing fluid intake to prevent dehydration

Rationale: Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can't absorb them after an ileostomy.

A client is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the client about prior to scheduling?

A. CT scan

B. Barium enema

C. Colonoscopy

D. Flexible sigmoidoscopy

C. Colonoscopy

Rationale: Diverticulosis is typically diagnosed by colonoscopy, which permits visualization of the extent of diverticular disease and biopsy of tissue to rule out other diseases. In the past, barium enema was the preferred diagnostic test, but it is now used less frequently than colonoscopy. CT with contrast agent is the diagnostic test of choice if the suspected diagnosis is diverticulitis; it can also reveal abscesses.

After assessing a client with peritonitis, how would the nurse most likely document the client's bowel sounds?

A. Hyperactive

B. Mild

C. High-pitched

D. Absent

D. Absent

Rationale: Since lack of bowel motility typically accompanies peritonitis, bowel sounds are absent. Therefore, the nurse will not observe mild, high-pitched, or hyperactive bowel sounds.

The nurse is irrigating a client's colostomy when the client begins to report cramping. What is the appropriate action by the nurse?

A. Clamp the tubing and allow client to rest.

B. Increase the rate of administration.

C. Change irrigation fluid to normal saline.

D. Discontinue the irrigation immediately.

A. Clamp the tubing and allow client to rest.

Rationale: The nurse should clamp the tubing and allow the client to rest when the client begins to report cramping during colostomy irrigation. Once the cramping has stopped, the nurse can resume the irrigation.

The nurse is caring for an older adult client experiencing fecal incontinence. When planning the care of this client, what should the nurse designate as a priority goal?

A. Determining the need for surgical intervention to correct the problem

B. Instituting a diet high in fiber and increase fluid intake

C. Beginning a bowel program to establish continence

D. Maintaining skin integrity

D. Maintaining skin integrity

Rationale:

Fecal incontinence can disrupt perineal skin integrity. Maintaining skin integrity is a priority, especially in the debilitated or older adult client.

A client has been experiencing occasional episodes of constipation and has been unable to achieve consistent relief by increasing physical activity and improving the client's diet. When introducing the client to the use of laxatives, what teaching should the nurse emphasize?

A. The risk of fecal incontinence

B. The risk of becoming laxative-dependent

C. The effect of laxatives on electrolyte levels

D. The underlying causes of constipation

B. The risk of becoming laxative-dependent

Rationale: Laxatives should not normally be used on an ongoing basis because of the risk of dependence. In most cases they have a minimal effect on electrolyte levels. A client who has increased activity and improved diet likely has an understanding of the usual causes of constipation. Excessive laxative use could lead to diarrhea or fecal incontinence, but for most clients the risk of dependence is more significant.

A client presents to the emergency room with a possible diagnosis of appendicitis. The health care provider asks the nurse to assess for tenderness at McBurney's point. The nurse knows to palpate which area?

A. Between the umbilicus and the left iliac crest

B. In the left periumbilical area

C. In the upper right quadrant slightly below the diaphragm

D. Between the umbilicus and the anterior superior iliac spine

D. Between the umbilicus and the anterior superior iliac spine

Rationale: Local tenderness in the right lower quadrant is elicited at McBurney's point when pressure is applied between the umbilicus and the anterior superior iliac spine.

A client has been recently diagnosed with an anorectal condition. The nurse is reviewing interventions that will assist the client with managing the therapeutic regimen. What would not be included?

A. Encourage the client to follow diet and medication instructions.

B. Teach the client how to do sitz baths at home using warm water three to four times each day.

C. Instruct the client to cleanse perianal area with warm water.

D. Encourage the client to avoid exercise.

D. Encourage the client to avoid exercise.

Rationale: Activity promotes healing and normal stool patterns. Proper cleansing prevents infection and irritation. Sitz baths promote healing, decrease skin irritation, and relieve rectal spasms. Encouragement promotes compliance with therapeutic regimen and prevents complications.

A client has been diagnosed with a small bowel obstruction and has been admitted to the medical unit. The nurse's care should prioritize which of the following outcomes?

A. Maintaining fluid and electrolyte balance

B. Preventing infection

C. Maintaining skin and tissue integrity

D. Preventing nausea and vomiting

A. Maintaining fluid and electrolyte balance

Rationale: All of the listed focuses of care are important for the client with a small bowel obstruction. However, the client's risk of fluid and electrolyte imbalances is an immediate threat to safety, and is a priority in nursing assessment and interventions.

A client visited a nurse practitioner because they had diarrhea for 2 weeks. The client described their stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of:

A. A small bowel disorder.

B. A disorder of the large bowel.

C. Intestinal malabsorption.

D. Inflammatory colitis.

C. Intestinal malabsorption.

Rationale: Watery stools are characteristic of disorders of the small bowel, whereas loose, semisolid stools are associated more often with disorders of the large bowel. Large, greasy stools suggest intestinal malabsorption, and the presence of mucus and pus in the stools suggests inflammatory enteritis or colitis.

A client is having a diagnostic workup for reports of frequent diarrhea, right lower abdominal pain, and weight loss. The nurse is reviewing the results of the barium study and notes the presence of "string sign." What does the nurse understand that this is significant of?

A. Diverticulitis

B. Crohn's disease

C. Ulcerative colitis

D. Irritable bowel syndrome

B. Crohn's disease

Rationale: The most conclusive diagnostic aid for Crohn's disease has classically been a barium study of the upper GI tract that shows a "string sign" on an x-ray film of the terminal ileum, indicating the constriction of a segment of intestine.

The nurse is comparing Crohn's disease (regional enteritis) with ulcerative colitis. Which of the following describes Crohn's disease?

A. Diarrhea is more severe

B. Fistulas are rare

C. Bleeding is common and severe

D. Its course is prolonged and variable

D. Its course is prolonged and variable

Rationale: The course of Crohn's disease is prolonged and variable whereas ulcerative colitis follows a pattern of exacerbations and remissions. In Crohn's disease, bleeding usually does not occur but tends to be mild when it does occur; fistulas are common, and diarrhea is less severe than it is with ulcerative colitis.

The nurse is caring for a client who has malabsorption syndrome with an undetermined cause. What procedure will the nurse assist with that is the best diagnostic test for this illness?

A. Endoscopy with mucosal biopsy

B. Pancreatic function tests

C. Ultrasound

D. Stool specimen for ova and parasites

A. Endoscopy with mucosal biopsy

Rationale: Endoscopy with biopsy of the mucosa is the best diagnostic tool for malabsorption syndrome.

When preparing a client for a hemorrhoidectomy, the nurse should take which action?

A. Administer an enema as ordered.

B. Administer oral antibiotics as ordered.

C. Administer analgesics as ordered.

D. Administer topical antibiotics as ordered.

A. Administer an enema as ordered.

Rationale: When preparing a client for a hemorrhoidectomy, the nurse should administer an enema, as ordered, and record the results. After surgery, the client may require antibiotics and analgesics.

An adult client diagnosed with diverticular disease will be treated on an outpatient basis. What components of treatment should the nurse anticipate? Select all that apply.

A. Fluid reduction

B. Increased fiber intake

C. Anticholinergic medications

D. Enemas on alternating days

E. Reduced fat intake

B. Increased fiber intake

E. Reduced fat intake

Rationale:

Clients whose diverticular disease does not warrant hospital treatment often benefit from a high-fiber, low-fat diet. Neither enemas nor anticholinergics are indicated, and fluid intake is encouraged.

When providing care for a client who has a diagnosis of irritable bowel syndrome (IBS), the nurse should collaborate with the client and prioritize what goal?

A. Demonstration of appropriate care of the ileostomy

B. Accurate identification of foods that trigger symptoms

C. Accurate adherence to recommended guidelines for mobility and activity

D. Demonstration of appropriate use of standard infection control precautions

B. Accurate identification of foods that trigger symptoms

Rationale: A major focus of nursing care for the client with IBS is to identify factors that exacerbate symptoms. Surgery is not used to treat this health problem and infection control is not a concern that is specific to this diagnosis. Establishing causation likely is more important to the client than managing physical activity.

A nurse is caring for a client with cardiac disease. The client asks the nurse which medication is best for help with regular bowel movements. What is the best response by the nurse?

A. Magnesium hydroxide

B. Mineral oil

C. Docusate

D. Bisacodyl

C. Docusate

Rationale: Docusate (Colace) can be used safely by clients who should avoid straining, such as cardiac clients. Magnesium hydroxide (Milk of Magnesia) is a saline agent. Bisacodyl (Dulcolax) is a stimulant laxative. Mineral oil is a lubricant laxative.

Which drug is considered a stimulant laxative?

A. Mineral oil

B. Magnesium hydroxide

C. Bisacodyl

D. Psyllium hydrophilic mucilloid

C. Bisacodyl

Rationale: Bisacodyl is a stimulant laxative. Magnesium hydroxide is a saline agent. Mineral oil is a lubricant. Psyllium hydrophilic mucilloid is a bulk-forming agent.

A nurse is caring for a client who had an ileal conduit 3 days earlier. The nurse examines the stoma site and determines that they should consult with the ostomy nurse. Which assessment finding indicates the need for further consultation?

A. Beefy red stoma site

B. Red, sensitive skin around the stoma site

C. Clear mucus mixed with yellow urine drained from the appliance bag

D. Stoma site not sensitive to touch

B. Red, sensitive skin around the stoma site

Rationale: Red, sensitive skin around the stoma site may indicate an ill-fitting appliance beefy redness at a stoma site that isn't sensitive to touch is a normal assessment finding. Urine mixed with mucus is also a normal finding.

A client is diagnosed with Zollinger-Ellison syndrome. The nurse knows to assess the client for which characteristic clinical feature of this syndrome?

A. Decreased intestinal lactose

B. Folate deficiency

C. Steatorrhea

D. Lymphadenopathy

C. Steatorrhea

Rationale: Hyperacidity in the duodenum inactivates pancreatic enzymes causing steatorrhea and ulcer diathesis.

The nurse is assisting a client to drain a continent ileostomy (Kock pouch). The nurse should insert the catheter how far through the nipple/valve?

A. 2 in.

B. 3 in.

C. 4 in.

D. 5 in.

A. 2 in.

Rationale: The nurse should insert the lubricated catheter about 2 inches (5 cm) through the nipple/valve. Please refer to the section on care of ileostomy.

Which is a true statement regarding regional enteritis (Crohn's disease)?

A. It has a progressive disease pattern.

B. It is characterized by pain in the lower left abdominal quadrant.

C. The lesions are in continuous contact with one another.

D. The clusters of ulcers take on a cobblestone appearance.

D. The clusters of ulcers take on a cobblestone appearance.

Rationale: The clusters of ulcers take on a cobblestone appearance. It is characterized by remissions and exacerbations. The pain is located in the lower right quadrant. The lesions are not in continuous contact with one another and are separated by normal tissue.

A nurse is caring for a client who has been admitted to the hospital with diverticulitis. What would be appropriate nursing diagnoses for this client? Select all that apply.

A. Bowel Incontinence Related to Increased Intestinal Peristalsis

B. Activity Intolerance Related to Generalized Weakness

C. Impaired Urinary Elimination Related to GI Pressure on the Bladder

D. Deficient Fluid Volume Related to Anorexia, Nausea, and Diarrhea

E.. Acute Pain Related to Increased Peristalsis and GI Inflammation

B. Activity Intolerance Related to Generalized Weakness

D. Deficient Fluid Volume Related to Anorexia, Nausea, and Diarrhea

E.. Acute Pain Related to Increased Peristalsis and GI Inflammation

Rationale:

Clients with diverticulitis are likely to experience pain and decreased activity levels, and are at risk of fluid volume deficit. The client is unlikely to experience fecal incontinence and urinary function is not directly influenced.

A nurse is planning discharge teaching for a 21-year-old client with a new diagnosis of ulcerative colitis. When planning family assessment, the nurse should recognize that which of the following factors will likely have the greatest impact on the client's coping after discharge?

A. The family's ability to take care of the client's special diet needs

B. The family's ability to provide emotional support

C. The family's ability to manage the client's medication regimen

D. The family's ability to monitor the client's changing health status

B. The family's ability to provide emotional support

Rationale: Emotional support from the family is key to the client's coping after discharge. A 21-year-old would be expected to self-manage the prescribed medication regimen and the family would not be primarily responsible for monitoring the client's health status. It is highly beneficial if the family is willing and able to accommodate the client's dietary needs, but emotional support is paramount and cannot be solely provided by the client alone.

A nurse is assessing a client and obtains the following findings: abdominal discomfort, mild diarrhea, blood pressure of 100/80 mm Hg, pulse rate of 88 beats/minute, respiratory rate of 20 breaths/minute, temperature 100° F (37.8° C). What diagnosis will the nurse suspect for this client?

A. diverticulitis

B. colorectal cancer

C. liver failure

D. inflammatory bowel disease (IBD)

D. inflammatory bowel disease (IBD)

Rationale:

IBD is a collective term for several GI inflammatory diseases with unknown causes. The most prominent sign of IBD is mild diarrhea, which sometimes is accompanied by fever and abdominal discomfort. Colorectal cancer is usually diagnosed after the client reports of bloody stools; the client will rarely have abdominal discomfort. A client with diverticulitis commonly states they have chronic constipation with occasional diarrhea, nausea, vomiting, and abdominal distention. Jaundice, coagulopathies, edema, and hepatomegaly are common signs of liver failure.

It is important for the nurse to monitor serum electrolytes in a client with acute diarrhea. Select the electrolyte result that should be immediately reported.

A. Sodium of 136 mEq/L

B. Potassium of 2.8 mEq/L

C. Chloride of 100 mEq/L

D. Calcium of 9 mg/dL

B. Potassium of 2.8 mEq/L

Rationale: The normal serum potassium level is 3.5 to 5 mEq/L. Hypokalemia can be severe if less than 2.5 mEq/L. A potassium result of 2.8 should be reported because it is significantly lower than normal. The other choices are normal levels.

A client has developed an anorectal abscess. Which client is likely at risk for the development of this type of abscess?

A. A client with hemorrhoids

B. A client with diverticulosis

C. A client with colon cancer

D. A client with Crohn's disease

D. A client with Crohn's disease

Rationale: An anorectal abscess is common in clients with Crohn's disease. The other disorders do not predispose the client to risk for anorectal abscess.