Deck 46: Bowel Elimination

Question 1

A nurse is preparing a patient for a magnetic resonance imaging scan.Which nursing action is most important?

A) Ensuring that the patient does not eat or drink 2 hours before the examination
B) Removing all of the patient's metallic jewelry
C) Administering a colon cleansing product 12 hours before the examination
D) Obtaining an order for a pain medication before the test is performed

Answer 1

Removing all of the patient's metallic jewelry

Question 2

A patient informs the nurse that she was using laxatives three times daily to lose weight.After stopping use of the laxative,the patient had difficulty with constipation and wonders if she needs to take laxatives again.The nurse educates the patient that

A) Long-term laxative use causes the bowel to become less responsive to stimuli, and constipation may occur.
B) Laxatives can cause trauma to the intestinal lining and scarring may result, leading to decreased peristalsis.
C) Natural laxatives such as mineral oil are safer than chemical laxatives for relieving constipation.
D) Laxatives cause the body to become malnourished, so when the patient begins eating again, the body absorbs all of the food, and no waste products are produced.

Answer 2

Long-term laxative use causes the bowel to become less responsive to stimuli, and constipation may occur.

Question 3

Which nursing intervention is most effective in promoting normal defecation for a patient who has muscle weakness in the legs that prevents ambulation?

A) Elevate the head of the bed 45 degrees 60 minutes after breakfast.
B) Use a mobility device to place the patient on a bedside commode.
C) Give the patient a pillow to brace against the abdomen while bearing down.
D) Administer a soap suds enema every 2 hours.

Answer 3

Use a mobility device to place the patient on a bedside commode.

Question 4

A nurse is assisting a patient in making dietary choices that promote healthy bowel elimination.Which menu option should the nurse recommend?

A) Grape and walnut chicken salad sandwich on whole wheat bread
B) Broccoli and cheese soup with potato bread
C) Dinner salad topped with hard-boiled eggs, cheese, and fat-free dressing
D) Turkey and mashed potatoes with brown gravy

Question 5

The nurse is emptying an ileostomy pouch for a patient.Which assessment finding would the nurse report immediately?

A) Liquid consistency of stool
B) Presence of blood in the stool
C) Noxious odor from the stool
D) Continuous output from the stoma

Question 6

The nurse has attempted to administer a tap water enema for a patient with fecal impaction with no success.What is the next priority nursing action?

A) Preparing the patient for a second tap water enema
B) Donning gloves for digital removal of the stool
C) Positioning the patient on the left side
D) Inserting a rectal tube

Question 7

The nurse provides knows that a bowel elimination schedule would be most beneficial in the plan of care for which patient?

A) A 40-year-old patient with an ileostomy
B) A 25-year-old patient with Crohn's disease
C) A 30-year-old patient with C. difficile
D) A 70-year-old patient with stool incontinence

Question 8

Fecal impactions occur in which portion of the colon?

A) Ascending
B) Descending
C) Transverse
D) Rectum

Question 9

The nurse would expect the least formed stool to be present in which portion of the digestive tract?

A) Ascending
B) Descending
C) Transverse
D) Sigmoid

Question 10

The nurse knows that most nutrients are absorbed in which portion of the digestive tract?

A) Stomach
B) Duodenum
C) Ileum
D) Cecum

Question 11

A patient with a hip fracture is having difficulty defecating into a bed pan while lying in bed.Which action by the nurse would assist the patient in having a successful bowel movement?

A) Administering laxatives to the patient
B) Raising the head of the bed
C) Preparing to administer a barium enema
D) Withholding narcotic pain medication

Question 12

A patient expresses concerns over having black stool.The fecal occult test is negative.Which response by the nurse is most appropriate?

A) "This is probably a false negative; we should rerun the test."
B) "Do you take iron supplements?"
C) "You should schedule a colonoscopy as soon as possible."
D) "Sometimes severe stress can alter stool color."

Question 13

The nurse is devising a plan of care for a patient with the nursing diagnosis of Constipation related to opioid use.Which of the following outcomes would the nurse evaluate as successful for the patient to establish normal defecation?

A) The patient reports eliminating a soft, formed stool.
B) The patient has quit taking opioid pain medication.
C) The patient's lower left quadrant is tender to the touch.
D) The nurse hears bowel sounds present in all four quadrants.

Question 14

Which of the following is not a function of the large intestine?

A) Absorbing nutrients
B) Absorbing water
C) Secreting bicarbonate
D) Eliminating waste

Question 15

Which physiological change can cause a paralytic ileus?

A) Chronic cathartic abuse
B) Surgery for Crohn's disease and anesthesia
C) Suppression of hydrochloric acid from medication
D) Fecal impaction

Question 16

The nurse should question which order?

A) A normal saline enema to be repeated every 4 hours until stool is produced
B) A hypertonic solution enema with a patient with fluid volume excess
C) A Kayexalate enema for a patient with hypokalemia
D) An oil retention enema for a patient using mineral oil laxatives

Question 17

The nurse is preparing to perform a fecal occult blood test.The nurse plans to properly perform the examination by

A) Applying liberal amounts of stool to the guaiac paper.
B) Testing the quality control section before collecting the specimen section.
C) Reporting any abnormal findings to the provider.
D) Applying sterile disposable gloves.

Question 18

The nurse is caring for a patient who is confined to the bed.The nurse asks the patient if he needs to have a bowel movement 30 minutes after eating a meal because

A) The digested food needs to make room for recently ingested food.
B) Mastication triggers the digestive system to begin peristalsis.
C) The smell of bowel elimination in the room would deter the patient from eating.
D) More ancillary staff members are available after meal times.

Question 19

Which patient is most at risk for increased peristalsis?

A) A 5-year-old child who ignores the urge to defecate owing to embarrassment
B) A 21-year-old patient with three final examinations on the same day
C) A 40-year-old woman with major depressive disorder
D) An 80-year-old man in an assisted-living environment

Question 20

The nurse would anticipate which diagnostic examination for a patient with black tarry stools?

A) Ultrasound
B) Barium enema
C) Upper endoscopy
D) Flexible sigmoidoscopy

Question 21

The nurse administers a cathartic to a patient.The nurse determines that the cathartic has had a therapeutic effect when the patient

A) Has a decreased level of anxiety.
B) Experiences pain relief.
C) Has a bowel movement.
D) Passes flatulence.

Question 22

A nurse is educating a patient on how to irrigate an ostomy bag.Which statement by the patient indicates the need for further instruction?

A) "I can use a fleet enema to save money because it contains the same irrigation solution."
B) "Sitting on the toilet lets the irrigation sleeve eliminate into the bowl."
C) "I should never attempt to reach into my stoma to remove fecal material."
D) "Using warm tap water will reduce cramping and discomfort during the procedure."

Question 23

A nurse is caring for an older adult patient with fecal incontinence due to cathartic use.The nurse is most concerned about which complication that has the greatest risk for severe injury?

A) Rectal skin breakdown
B) Contamination of existing wounds
C) Falls from attempts to reach the bathroom
D) Cross-contamination into the upper GI tract

Question 24

A nurse is performing an assessment on a patient who has not had a bowel movement in 3 days.The nurse would expect which other assessment finding?

A) Hypoactive bowel sounds
B) Jaundice in sclera
C) Decreased skin turgor
D) Soft tender abdomen

Question 25

While a cleansing enema is administered to an 80-year-old patient,the patient expresses the urge to defecate.What is the next priority nursing action?

A) Positioning the patient in the dorsal recumbent position with a bed pan
B) Assisting the patient to the bedside commode
C) Stopping the enema cleansing and rolling the patient into right-lying Sims' position
D) Inserting a rectal plug to contain the enema solution

Question 26

An older adult's perineal skin appears to be dry and thin with mild excoriation.When providing hygiene after a bowel movement,the nurse should

A) Thoroughly scrub the skin with a wash cloth and hypoallergenic soap.
B) Apply a skin protective lotion after perineal care.
C) Tape an occlusive moisture barrier pad to the patient's skin.
D) Massage the skin with deep kneading pressure.

Question 27

A nurse is providing discharge teaching for a patient who is going home with a guaiac test.Which statement by the patient indicates the need for further education?

A) "If I get a positive result, I have gastrointestinal bleeding."
B) "I should not eat red meat before my examination."
C) "I should schedule to perform the examination when I am not menstruating."
D) "I will need to perform this test three times if I have a positive result."

Question 28

A guaiac test has been ordered.The nurse knows that this is a test for

A) Bright red blood.
B) Dark black blood.
C) Blood that contains mucus.
D) Blood that cannot be seen.

Question 29

A patient has constipation and hypernatremia.The nurse prepares to administer which type of enema?

A) Oil retention
B) Carminative
C) Saline
D) Tap water

Question 30

A patient had an ileostomy surgically placed 2 days ago.Which diet would the nurse recommend to the patient to ease the transition of the new ostomy?

A) Eggs over easy, whole wheat toast, and orange juice with pulp
B) Chicken fried rice with stir fried vegetables and iced tea
C) Turkey meatloaf with white rice and apple juice
D) Fish sticks with macaroni and cheese and soda

Question 31

The nurse knows that the ideal time to change an ostomy pouch is

A) Before eating a meal, when the patient is comfortable.
B) When the patient feels that he needs to have a bowel movement.
C) When ordered in the patient's chart.
D) After the patient has ambulated the length of the hallway.

Question 32

A nurse is pouching an ostomy on a patient with an ileostomy.Which action by the nurse is most appropriate?

A) Changing the skin barrier portion of the ostomy pouch daily
B) Selecting a pouch that is able to hold excess output to reduce the frequency of pouch emptying
C) Thoroughly scrubbing the skin around the stoma to remove excess stool and adhesive
D) Measuring the correct size for the barrier device while leaving a 1/8-inch space around the stoma

Question 33

A nurse is caring for a patient who has had diarrhea for the past week.Which additional assessment finding would the nurse expect?

A) Increased energy levels
B) Distended abdomen
C) Decreased serum bicarbonate
D) Increased blood pressure

Question 34

The nurse should place the patient in which position when preparing to administer an enema?

A) Left Sims' position
B) Fowler's
C) Supine
D) Semi-Fowler's

Question 35

After a patient returns from a barium swallow,the nurse's priority is to

A) Encourage the patient to increase fluids to flush out the barium.
B) Monitor stools closely for bright red blood or mucus, which indicates trauma from the procedure.
C) Inform the patient that his bowel movements are radioactive, and that he should be sure to flush the toilet three times.
D) Thicken all patient drinks to prevent aspiration.

Question 36

Which nursing action best reduces risk of excoriation to the mucosal lining of the nose from a nasogastric tube?

A) Lubricating the nares with water-soluble lubricant
B) Applying a small ice bag to the nose for 5 minutes every 4 hours
C) Instilling Xylocaine into the nares once a shift
D) Changing the tape holding the tube in place once a shift

Question 37

The nurse is assessing a patient 2 hours after a colonoscopy.Based on the procedure done,what focused assessment will the nurse include?

A) Bowel sounds
B) Presence of flatulence
C) Bowel movements
D) Nausea

Question 38

The nurse is caring for a patient with Clostridium difficile.Which of the following nursing actions will have the greatest impact in preventing the spread of bacteria?

A) Monthly in-services about contact precautions
B) Placing all contaminated items in biohazard bags
C) Mandatory cultures on all patients
D) Proper hand hygiene techniques

Question 39

The nurse is caring for a patient who had a colostomy placed yesterday.The nurse should report which assessment finding immediately?

A) Stoma is protruding from the abdomen.
B) Stoma is moist.
C) Stool is discharging from the stoma.
D) Stoma is purple.

Question 40

A patient is diagnosed with a bowel obstruction.The nurse chooses which type of tube for gastric decompression?

A) Salem sump
B) Dobhoff
C) Sengstaken-Blakemore
D) Small bore