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1. Which action will the nurse include in the plan of care for a patient who is being admitted with Clostridium difficile?
A. Teach the patient about proper food storage.
B. Order a diet without dairy products for the patient.
C. Place the patient in a private room on contact isolation.
D. Teach the patient about why antibiotics will not be used.
ANS: C
Because C. difficile is highly contagious, the patient should be placed in a private room, and contact precautions should be used. There is no need to restrict dairy products for this type of diarrhea. Metronidazole (Flagyl) is frequently used to treat C. difficile infections. Improper food handling and storage do not cause C. difficile.
2. A 74-yr-old male patient tells the nurse that growing old causes constipation, so he has been using a suppository to prevent constipation every morning. Which action should the nurse take first?
a. Encourage the patient to increase oral fluid intake.
b. Question the patient about risk factors for constipation.
c. Suggest that the patient increase intake of high-fiber foods.
d. Teach the patient that a daily bowel movement is unnecessary.
ANS: B
The nurse's initial action should be further assessment of the patient for risk factors for constipation and for his usual bowel pattern. The other actions may be appropriate but will be based on the assessment.
3. A patient who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in the response?
a. Fiber-containing laxatives may reduce the absorption of fat-soluble vitamins.
b. Dietary sources of fiber should be eliminated to prevent excessive gas formation.
c. Use of this type of laxative to prevent constipation does not cause adverse effects.
d. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.
ANS: D
A high fluid intake is needed when patients are using bulk-forming laxatives to avoid worsening constipation. Although bulk-forming laxatives are generally safe, the nurse should emphasize the possibility of constipation or obstipation if inadequate fluid intake occurs. Although increased gas formation is likely to occur with increased dietary fiber, the patient should gradually increase dietary fiber and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool softeners and lubricants, not by bulk-forming laxatives.
4. A 26-yr-old woman is being evaluated for vomiting and abdominal pain. Which question from the nurse will be most useful in determining the cause of the patient's symptoms?
a."What type of foods do you eat?"
b. "Is it possible that you are pregnant?"
c. "Can you tell me more about the pain?"
d. "What is your usual elimination pattern?"
ANS: C
A complete description of the pain provides clues about the cause of the problem. Although the nurse should ask whether the patient is pregnant to determine whether the patient might have an ectopic pregnancy and before any radiology studies are done, this information is not the most useful in determining the cause of the pain. The usual diet and elimination patterns are less helpful in determining the reason for the patient's symptoms.
5. A patient reports gas pains and abdominal distention 2 days after a small bowel resection. Which nursing action should the nurse take?
a. Administer morphine sulfate.
b. Encourage the patient to ambulate.
c. Offer the prescribed promethazine.
d. Instill a mineral oil retention enema.
B
6. A patient with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next?
a. Auscultate the bowel sounds.
b. Prepare the patient for surgery.
c. Check the patient's oral temperature.
d. Obtain information about the accident.
b
7. A young adult patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action should the nurse take?
A. Assist the patient to cough and deep breathe.
B. Palpate the abdomen for rebound tenderness.
C. Suggest the patient lie on the side, flexing the right leg.
D. Encourage the patient to sip clear, noncarbonated liquids.
c
8. Which nursing action will be included in the plan of care for a 25-yr-old male patient with a new diagnosis of irritable bowel syndrome (IBS)?
A. Encourage the patient to express concerns and ask questions about IBS.
B. Suggest that the patient increase the intake of milk and other dairy products.
C. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs).
D. Teach the patient about the use of alosetron (Lotronex) to reduce IBS symptoms.
A
9. A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 bloody stools a day. What should the nurse include in the plan of care?
A. Administer IV metoclopramide (Reglan).
B. Discontinue the patient's oral food intake.
C. Administer cobalamin (vitamin B12) injections.
D. Teach the patient about total colectomy surgery.
B
10. Which nursing action will the nurse include in the plan of care for a patient admitted with an exacerbation of inflammatory bowel disease (IBD)?
A. Restrict oral fluid intake.
B. Monitor stools for blood.
C. Ambulate six times daily.
D. Increase dietary fiber intake.
B
11. Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective?
a. "I should apply sunscreen before going outdoors."
B. "The medication will be tapered if I need surgery."
C."I will need to avoid contact with people who are sick."
D. "The medication prevents the infections that cause diarrhea."
A
12. A 22-yr-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective?
A. The patient uses incontinence briefs to contain loose stools.
B. The patient uses witch hazel compresses to soothe irritation.
C. The patient asks for antidiarrheal medication after each stool.
D. The patient cleans the perianal area with soap after each stool.
B
13. Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching?
A. Scrambled eggs
B. White toast and jam
C. Oatmeal with cream
D. Pancakes with syrup
C
14. After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, "I cannot manage all this. I don't want to look at the stoma." What action should the nurse take?
A. Reassure the patient that ileostomy care will become easier.
B. Ask the patient about the concerns with stoma management.
c. Postpone any teaching until the patient adjusts to the ileostomy.
d. Develop a detailed written list of ostomy care tasks for the patient.
B
15. After having frequent diarrhea and a weight loss of 10 lb (4.5 kg) over 2 months, a patient has a new diagnosis of Crohn's disease. What should the nurse plan to teach the patient?
A. Medication use
B. Fluid restriction
C. Enteral nutrition
D. Activity restrictions
A
16. A young woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient?
A. Fistulas can form between the bowel and bladder.
B. Bacteria in the perianal area can enter the urethra.
C. Drink adequate fluids to maintain normal hydration.
D. Empty the bladder before and after sexual intercourse.
A
17. What is a likely finding in the nurse's assessment of a patient who has a large bowel obstruction?
A. Referred back pain
B. Metabolic alkalosis
C. Projectile vomiting
D. Abdominal distention
D
18. What should the nurse preparing for the annual physical exam of a 45-yr-old man plan to teach the patient about?
A. Endoscopy
B. Colonoscopy
C. Computerized tomography screening
D. Carcinoembryonic antigen (CEA) testing
B
19. The nurse is providing preoperative teaching for a patient scheduled for an abdominal-perineal resection. Which information will the nurse include?
A. The patient will need to remain on bedrest for three days after surgery.
B. An additional surgery in 8 to 12 weeks will be done to create an ileal-anal
reservoir.
C. IV antibiotics will be started at least 24 hours before surgery to reduce the bowel
bacteria.
D. The site where the stoma will be located will be marked on the abdomen
preoperatively.
D
20. A patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. What should the nurse explain as the reason for the test?
a. Identify any metastasis of the cancer.
b. Monitor the tumor status after surgery.
c. Confirm the diagnosis of a specific type of cancer.
d. Determine the need for postoperative chemotherapy.
B
21. A patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery?
A. Teach about a low-residue diet.
B. Monitor output from the stoma.
C. Assess the perineal drainage and incision.
D. Encourage acceptance of the colostomy stoma.
C
22. A patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. What action should the nurse take?
A. Place ice packs around the stoma.
B. Notify the surgeon about the stoma.
C. Monitor the stoma every 30 minutes.
D. Document stoma assessment findings.
D
23. Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis?
a. Restrict fluid intake to prevent constant liquid drainage from the stoma.
B. Use care when eating high-fiber foods to avoid obstruction of the ileum.
C. Irrigate the ileostomy daily to avoid having to wear a drainage appliance.
D. Change the pouch every day to prevent leakage of contents onto the skin.
B
24. A patient with a new ileostomy asks how much it will drain. How many cups of drainage per day should the nurse explain for the patient to expect?
a. 2
b. 3
c. 4
d. 5
A
25. What should the nurse admitting a patient with acute diverticulitis plan for initial care?
A. Administer IV fluids.
B. Prepare for colonoscopy.
C. Encourage a high-fiber diet.
D. Give stool softeners and enemas.
A
26. A 40-yr-old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia. Which patient teaching will the nurse provide before discharge?
A. Soak in Sitz baths several times each day.
B. Cough 5 times each hour for the next 48 hours.
C. Avoid using acetaminophen (Tylenol) for pain.
D. Apply a scrotal support and ice to reduce swelling.
D
27. Which breakfast choice indicates a patient's good understanding of information about a diet for celiac disease?
A. Wheat toast with butter
B. Oatmeal with nonfat milk
C. Bagel with low-fat cream cheese
D. Corn tortilla with scrambled eggs
D
28. After a patient has had a hemorrhoidectomy at an outpatient surgical center, which instructions will the nurse include in discharge teaching?
a. Maintain a low-residue diet until the surgical area is healed.
B. Use ice packs on the perianal area to relieve pain and swelling.
C. Take prescribed pain medications before you expect a bowel movement.
D. Delay having a bowel movement for several days until you are well healed.
C
29. A patient calls the clinic to report a new onset of severe diarrhea. What should the nurse anticipate that the patient will need to do?
A. Collect a stool specimen.
B. Prepare for colonoscopy.
C. Schedule a barium enema.
D. Have blood cultures drawn.
A
30. What should the nurse plan to teach about to a patient with Crohn's disease who has megaloblastic anemia?
A. Iron dextran infusions
B. Oral ferrous sulfate tablets
C. Routine blood transfusions
D. Cobalamin (B12) supplements
D
31. The nurse is assessing a patient with abdominal pain. How will the nurse document ecchymosis around the area of umbilicus?
A. Cullen sign
B. Rovsing sign
C. McBurney sign
D. Grey-Turner's sign
A
32. A critically ill patient with sepsis is frequently incontinent of watery stools. What action by the nurse will prevent complications associated with ongoing incontinence?
A. Apply incontinence briefs.
B. Use a fecal management system.
C. Insert a rectal tube with a drainage bag.
D. Assist the patient to a commode frequently.
B
33. Which question from the nurse would help determine if a patient's abdominal pain might
indicate irritable bowel syndrome (IBS)?
A. "Have you been passing a lot of gas?"
B. "What foods affect your bowel patterns?"
C. "Do you have any abdominal distention?"
D. "How long have you had abdominal pain?"
D
34. A patient in the emergency department has just been diagnosed with peritonitis from a ruptured diverticulum. Which prescribed intervention will the nurse implement first?
A. Send the patient for a CT scan.
B. Insert a urinary catheter to drainage.
C. Infuse metronidazole (Flagyl) 500 mg IV.
D. Place a nasogastric tube to intermittent low suction.
C
35. A 25-yr-old male patient calls the clinic reporting diarrhea for 24 hours. Which action should the nurse take first?
A. Inform the patient that testing of blood and stools will be needed.
B. Suggest that the patient drink clear liquid fluids with electrolytes.
C. Ask the patient to describe the stools and any associated symptoms.
D. Advise the patient to use over-the-counter antidiarrheal medication.
C
36. A patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102° F (38.3° C), pulse 120 beats/min, respirations 32 breaths/min, and blood pressure (BP) 82/54 mm Hg. Which prescribed intervention should the nurse implement first?
A. Administer IV ketorolac 15 mg for pain relief.
B. Send a blood sample for a complete blood count (CBC).
C. Infuse a liter of lactated Ringer's solution over 30 minutes.
D. Send the patient for an abdominaI computed tomography (CT) scan.
C
37. Four hours after a bowel resection, a 74-yr-old male patient with a nasogastric tube to suction reports nausea and abdominal distention. What should be the nurse's first action?
A. Auscultate for hypotonic bowel sounds.
B. Notify the patient's health care provider.
C. Check for tube placement and reposition it.
D. Remove the tube and replace it with a new one.
C
38. A 19-yr-old woman is brought to the emergency department with a knife handle protruding from her abdomen. What should the nurse do during the initial assessment of the patient?
A. Remove the knife and assess the wound.
B. Determine the presence of Rovsing sign.
C. Check for circulation and tissue perfusion.
D. Insert a urinary catheter and assess for hematuria.
C
39. Which activity in the care of a patient with a new colostomy could the nurse delegate to unlicensed assistive personnel (UAP)?
A. Document the appearance of the stoma.
B. Place a pouching system over the ostomy.
C. Drain and measure the output from the ostomy.
D. Check the skin around the stoma for breakdown.
C
40. Which information obtained by the nurse interviewing a 30-yr-old male patient is most important to communicate to the health care provider?
A. The patient has a history of constipation.
B. The patient has noticed blood in the stools.
C. The patient had an appendectomy at age 27.
D. The patient smokes a pack/day of cigarettes.
B
41. Which care activity for a patient with a paralytic ileus is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)?
A. Auscultating for bowel sounds
B. Brushing the teeth and tongue
C. Assessing the nares for irritation
D. Irrigating the nasogastric (NG) tube
B
42. After several days of antibiotic therapy for pneumonia, an older hospitalized patient develops watery diarrhea. Which action should the nurse take first?
A. Notify the health care provider.
B. Obtain a stool specimen for analysis.
C. Teach the patient about hand washing.
D. Place the patient on contact precautions.
D
43. Which patient should the nurse assess first after receiving change-of-shift report?
A. A 30-yr-old patient who has a distended abdomen and tachycardia
B. A 60-yr-old patient whose ileostomy has drained 800 mL over 8 hours
C. A 40-yr-old patient with ulcerative colitis who had six liquid stools in 4 hours
D. A 50-yr-old patient with familial adenomatous polyposis who has occult blood in
the stool
A
44. A patient with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. Which symptom is most important to communicate to the health care provider?
A. Fever
B. Nausea
C. Joint pain
D. Headache
A
45. A 33-yr-old male patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as shown in the accompanying figure. Which information will be included in patient teaching?
A. Stool will be expelled from both stomas.
B. This type of colostomy is usually temporary.
C. Soft, formed stool can be expected as drainage.
D. Irrigations can regulate drainage from the stomas.
B
46. A 76-yr-old patient with obstipation has a fecal impaction and is incontinent of liquid stool. Which action should the nurse take first?
A. Administer bulk-forming laxatives.
B. Assist the patient to sit on the toilet.
C. Manually remove the impacted stool.
D. Increase the patient's oral fluid intake.
C
47. A patient is awaiting surgery for acute peritonitis. Which action will the nurse plan to include in the preoperative care?
A. Position patient with the knees flexed.
B. Avoid use of opioids or sedative drugs.
C. Offer frequent small sips of clear liquids.
D. Assist patient to breathe deeply and cough.
A
48. A 72-yr-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider?
A. Skin is dry with tenting and poor turgor.
B. Patient has not voided for the last 2 hours.
C. Crackles are heard halfway up the posterior chest.
D. Patient has had 5 loose stools over the previous 6 hours.
C
49. A 19-yr-old patient has familial adenomatous polyposis (FAP). Which action will the nurse in the gastrointestinal clinic include in the plan of care?
A. Obtain blood samples for DNA analysis.
B. Schedule the patient for yearly colonoscopy.
C. Provide preoperative teaching about total colectomy.
D. Discuss lifestyle modifications to decrease cancer risk.
B
50. Which menu choice by the patient with diverticulosis is best for preventing diverticulitis?
A. Navy bean soup and vegetable salad
B. Whole grain pasta with tomato sauce
C. Baked potato with low-fat sour cream
D. Roast beef sandwich on whole wheat bread
A
51. After change-of-shift report, which patient should the nurse assess first?
A. A 40-yr-old male patient with celiac disease who has frequent frothy diarrhea
B. A 30-yr-old female patient with a femoral hernia who has abdominal pain and
vomiting
C. A 30-yr-old male patient with ulcerative colitis who has severe perianal skin
breakdown
D. A 40-yr-old female patient with a colostomy bag that is pulling away from the adhesive wafer
B
52. The nurse is admitting a 67-yr-old patient with new-onset steatorrhea. Which question is most important for the nurse to ask?
a. "How much milk do you usually drink?"
B. "Have you noticed a recent weight loss?"
C. "What time of day do your bowels move?"
D. "Do you eat meat or other animal products?"
B
53. Which information will the nurse plan to teach a patient who has lactose intolerance?
A.Ice cream is relatively low in lactose.
B.Live-culture yogurt is usually tolerated.
C.Heating milk will break down the lactose.
D.Nonfat milk is tolerated better than whole milk.
B
54. Which prescribed intervention for a patient with chronic short bowel syndrome should the nurse question?
A.Senna 1 tablet daily
B.Ferrous sulfate 325 mg daily
C.Psyllium (Metamucil) 3 times daily
D.Diphenoxylate with atropine (Lomotil) PRN loose stools
A
1. Which information will the nurse include when teaching a patient how to avoid chronic constipation? (Select all that apply.)
A. Stimulant and saline laxatives can be used regularly.
B. Bulk-forming laxatives are an excellent source of fiber.
C. Walking or cycling frequently will help bowel motility.
D. A good time for a bowel movement may be after breakfast.
E. Some over-the-counter (OTC) medications cause constipation.
B,C,D,E
