Deck 43: Nursing Management: Lower Gastrointestinal Problems

Question 1

The nurse identifies a nursing diagnosis of impaired skin integrity related to having 15 to 20 daily episodes of diarrhea for a patient with ulcerative colitis. The nurse recognizes that teaching regarding perianal care has been effective when the patient

A) takes a sitz bath for 40 minutes following each stool.
B) asks for antidiarrheal medication after each diarrhea stool.
C) uses witch hazel compresses to provide relief from anal irritation.
D) cleans the perianal area with soap and water after each stool.

Answer 1

uses witch hazel compresses to provide relief from anal irritation.

Question 2

A patient is admitted to the emergency department with severe abdominal pain with rebound tenderness, anorexia, and chills. The vital signs include temperature 101° F (38.3° C), pulse 130, respirations 34, and blood pressure (BP) 82/50. Of the following collaborative interventions, which one should the nurse implement first?

A) Infuse 1000 ml of lactated Ringer's solution over 30 minutes.
B) Administer IV ketorolac (Toradol) 15 mg.
C) Give IV ceftriaxone (Rocephin) 1g
D) Obtain a computed tomography (CT) scan of the abdomen with and without contrast.

Answer 2

Infuse 1000 ml of lactated Ringer's solution over 30 minutes.

Question 3

Surgery is recommended by the health care provider for a patient with severe ulcerative colitis. The patient asks the nurse for clarification about the various procedures and the associated advantages and disadvantages. In responding to the patient's concerns, the nurse explains that

A) surgery for ulcerative colitis involves the formation of a temporary ileostomy to divert fecal contents until the large bowel heals.
B) in a total proctocolectomy with a continent ileostomy, a pouch is created that holds bowel contents and is emptied once a day with the use of a catheter.
C) a total colectomy and ileal reservoir provide the most normal elimination function, but this surgery consists of two procedures, requiring a temporary ileostomy for 8 to 12 weeks.
D) any proposed surgery for treatment of ulcerative colitis should be given serious consideration because the disease often recurs in previously unaffected parts of the bowel.

Answer 3

a total colectomy and ileal reservoir provide the most normal elimination function, but this surgery consists of two procedures, requiring a temporary ileostomy for 8 to 12 weeks.

Question 4

After teaching a patient with IBD about recommended dietary modifications, the nurse identifies a need for further instruction when the patient chooses from the menu

A) spaghetti with tomato sauce.
B) poached eggs and crisp bacon.
C) boiled shrimp and white rice.
D) ham hocks and beans.

Question 5

While obtaining a nursing history from a patient with IBD, the nurse recognizes that the patient most likely has ulcerative colitis rather than Crohn's disease when the patient reports experiencing

A) weight loss.
B) bloody stools.
C) abdominal pain and cramping.
D) disease onset at age 20.

Question 6

A patient with acute diarrhea of 24 hours' duration calls the clinic to ask for directions for care. In talking with the patient, the nurse should

A) ask the patient to describe the character of the stools and any associated symptoms.
B) advise the patient to use over-the-counter loperamide (Imodium) to slow gastrointestinal (GI) motility.
C) inform the patient that laboratory testing of blood and stool specimens will be necessary.
D) advise the patient to drink clear liquid fluids with electrolytes, such as Gatorade or Pedialyte.

Question 7

Following an exploratory laparotomy and bowel resection, a patient has an NG tube to suction but complains of nausea and stomach distention. The nurse irrigates the tube PRN as ordered, but the irrigating fluid does not return. The first action by the nurse should be to

A) notify the patient's health care provider.
B) auscultate for bowel sounds.
C) reposition the tube and check for placement.
D) remove the tube and replace it with a new one.

Question 8

Psyllium (Metamucil) is prescribed for a patient with chronic constipation. In teaching the patient about the use of the drug, the nurse stresses that

A) the use of this type of laxative is safe and adverse effects are very minimal.
B) large amounts of fluid should be taken to prevent impaction or bowel obstruction.
C) dietary sources of fiber should be eliminated to prevent excessive gas formation.
D) fat-soluble vitamins must be taken because the drug blocks absorption of these vitamins.

Question 9

A patient is brought to the emergency department following an automobile accident in which blunt trauma to the abdomen occurred. The patient is splinting the abdomen and complaining of pain, and bowel sounds are decreased. Peritoneal lavage returns brown drainage. Based on the results of the lavage, the nurse plans for

A) preparation for a paracentesis.
B) administration of pain medications.
C) continued monitoring of the patient's condition.
D) immediate preparation of the patient for surgery.

Question 10

The nurse identifies the collaborative problem of potential complication: hypovolemic shock related to loss of circulatory volume for a patient with bacterial peritonitis resulting from a ruptured appendix. The nurse recognizes that the major loss of circulating fluid volume occurs as a result of

A) prolonged nasogastric (NG) suctioning.
B) increased production of stress hormones.
C) extracellular fluid shift into the peritoneal cavity.
D) loss of purulent drainage into the peritoneal cavity.

Question 11

A patient is admitted to the emergency department for evaluation of right lower-quadrant abdominal pain with nausea and vomiting. The patient has a white blood cell count (WBC) of 14,000/ml with a shift to the left. Which of these actions is appropriate for the nurse to take?

A) Encouraging the patient to take sips of clear liquids
B) Applying an ice pack to the right lower quadrant
C) Checking for rebound tenderness every 30 minutes
D) Teaching the patient how to cough and deep breathe

Question 12

Two days following an exploratory laparotomy with a resection of a short segment of small bowel, the patient complains of gas pains and abdominal distention. Which nursing action is most appropriate to take at this time?

A) Assisting the patient to ambulate
B) Administering the ordered IV morphine sulfate
C) Giving a return-flow enema
D) Inserting the ordered promethazine (Phenergan) suppository

Question 13

A patient who is hospitalized with a diagnosis of Giardia lamblia infection frequently has uncontrollable explosive diarrhea. The patient closes the eyes and will not talk to the nurse when the linens are changed and skin care is performed. To help maintain the patient's self-esteem, the nurse should

A) use incontinence briefs for the patient so that the cleaning is less cumbersome and embarrassing.
B) request an order for an antidiarrheal drug from the health care provider to help control the diarrhea episodes.
C) ensure the patient that the lack of control is temporary and will resolve after about a week of treatment.
D) acknowledge the behavior as reflective of a difficult situation and provide privacy during hygiene.

Question 14

A 23-year-old woman is being evaluated in the emergency department for acute lower abdominal pain and vomiting. During the nursing history, the most helpful question by the nurse to obtain information regarding the patient's condition is

A) "What type of foods do you usually eat?"
B) "Can you tell me about your pain?"
C) "What is your usual elimination pattern?"
D) "Is it possible that you are pregnant?"

Question 15

A patient diagnosed with irritable bowel syndrome (IBS) tells the nurse, "My friends tell me this problem is all in my head." In caring for the patient, the nurse should

A) discuss the new medications that are available to treat the condition.
B) inform the patient that IBS has a specific, identifiable cause.
C) explain that modifications to increase dietary fiber can control the symptoms.
D) encourage the patient to express feelings and ask questions about IBS.

Question 16

A 67-year-old patient tells the nurse, "I have problems with constipation now that I am older, so I use a suppository every morning." The most appropriate nursing action at this time is to

A) encourage the patient to drink at least 3000 ml of fluid a day.
B) inform the patient that a daily bowel movement is not necessary.
C) perform a focused nursing assessment to identify risk factors for constipation.
D) suggest that the patient increase dietary intake of foods that are high in fiber.

Question 17

Sulfasalazine (Azulfidine) is prescribed for a patient who has been diagnosed with ulcerative colitis. The nurse recognizes that teaching about this drug has been effective when the patient says,

A) "The medication will prevent infections that cause the diarrhea."
B) "The medication suppresses the inflammation in my large intestine."
C) "I will need lab tests to be sure that I can still fight infections."
D) "I will take the sulfasalazine as an enema or suppository."

Question 18

A patient who is hospitalized with abdominal pain and watery, incontinent diarrhea is diagnosed with Clostridium difficile. In planning care for the patient, the nurse will

A) order a diet with no dairy products for the patient.
B) place the patient in a private room with contact isolation.
C) explain to the patient why antibiotics are not being used.
D) teach the patient about proper food handling and storage.

Question 19

A patient hospitalized with an acute exacerbation of ulcerative colitis is having 14 to 16 bloody stools a day and crampy abdominal pain associated with the diarrhea. The nurse will plan to

A) place the patient on NPO status.
B) administer Cobalamin (vitamin BB₁₂) injections.
C) start bowel preparation for colonoscopy.
D) administer IV metoclopramide (Reglan).

Question 20

A patient is brought to the emergency department with a knife impaled in the abdomen following a domestic fight. During the initial assessment of the patient, it is important for the nurse to

A) assess the BP and pulse.
B) remove the knife to assess the wound.
C) determine the presence of Rovsing's sign.
D) insert a urinary catheter and assess for hematuria.

Question 21

A 26-year-old patient is diagnosed with Crohn's disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg) over 2 months. The nurse will plan to teach the patient about

A) activity restrictions.
B) fluid restriction.
C) oral corticosteroids.
D) enteral feedings.

Question 22

A patient has a newly formed ileostomy for treatment of ulcerative colitis. In teaching the patient about the care of the ileostomy, the nurse informs the patient about the need to

A) restrict fluid intake to prevent constant liquid drainage from the stoma.
B) change the pouch every day to prevent leakage of contents onto the skin.
C) use care when eating high-fiber foods to avoid obstruction of the ileum.
D) irrigate the ileostomy daily to avoid having to wear a drainage appliance.

Question 23

A patient with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, foul-smelling urine. The nurse will teach the patient

A) to clean the perianal carefully after any stools.
B) about fistula formation between the bowel and bladder.
C) to empty the bladder before and after sexual intercourse.
D) about the effects of corticosteroid use on immune function.

Question 24

A patient has a large bowel obstruction that occurred as a result of a fecal impaction. During nursing assessment of the patient, a finding by the nurse that is consistent with a large bowel obstruction includes

A) metabolic alkalosis.
B) referred pain to the back.
C) bile colored vomiting.
D) abdominal distension.

Question 25

A patient is hospitalized with severe vomiting and colicky abdominal pain that is somewhat relieved with the vomiting. The health care provider orders an IV infusion of lactated Ringer's solution and placement of an NG tube. An appropriate collaborative problem for the nurse to identify for the patient at this time is

A) potential complication: volvulus.
B) potential complication: thromboembolism.
C) potential complication: renal insufficiency.
D) potential complication: metabolic alkalosis.

Question 26

Before undergoing a colon resection for cancer of the colon, a patient has an elevated carcinoembryonic antigen (CEA) test. The nurse explains that the test is used to

A) identify the extent of cancer spread or metastasis.
B) confirm the diagnosis of colon cancer.
C) monitor the tumor status after surgery.
D) determine the need for postoperative chemotherapy.

Question 27

A 42-year-old patient recently developed abdominal distention, weight loss, steatorrhea, and flatulence. A diagnosis of adult celiac disease is made, and treatment is initiated. The nurse determines that teaching about the treatment of the disease has been effective when the patient says,

A) "I must take folic acid for the rest of my life."
B) "I will avoid dietary wheat, rye, barley, and oats."
C) "I will be sure to take all of the ordered antibiotics."
D) "I should eat only very low-fat or fat-free foods."

Question 28

A total proctocolectomy with a permanent ileostomy is performed for a patient with ulcerative colitis. The patient is very upset and tells the nurse, "I can not bear to even look at the stoma. I do not think I can manage all these changes." The nurse's best approach to the patient's remarks is to

A) reassure the patient that care for the ileostomy will become easier.
B) ask the patient if a member of an ostomy support group may visit.
C) develop a detailed written plan for ostomy care for the patient.
D) wait to intervene until the patient adjusts to the body image change.

Question 29

A patient newly diagnosed with Crohn's disease asks the nurse what to expect in the future. The best response by the nurse is,

A) "You need to know that there is the probability of lifelong, unpredictable periods of remissions and recurrences."
B) "You can expect to lead a normal life and may have long periods without episodes of diarrhea or other symptoms."
C) "Most patients with Crohn's disease require an ostomy to control the disease, but you can adjust to that."
D) "After about 10 years, patients with Crohn's disease have a high risk for colon cancer unless the colon is removed."

Question 30

A recent colonoscopy revealed an increased number of polyps in a 22-year-old patient with a history of moderately severe familial adenomatous polyposis (FAP). In planning care for the patient, the nurse recognizes that the medical recommendation for patients with familial adenomatous polyposis includes

A) a total colectomy with ileostomy.
B) annual colonoscopy until age 40.
C) routine periodic polypectomies via colonoscope to remove these abnormal growths.
D) biannual colonoscopy for life because of a 50% chance of developing colon cancer.

Question 31

During the initial postoperative assessment of a patient's stoma formed with a transverse colostomy, the nurse finds it to be red with moderate edema and a small amount of bleeding. The nurse should

A) document the stoma assessment.
B) notify the surgeon about the stoma appearance.
C) monitor the stoma every 30 minutes.
D) place an ice pack on the stoma to reduce swelling.

Question 32

During preoperative preparation for a patient scheduled for an abdominal-perineal resection, the nurse will

A) give IV antibiotics starting 24 hours before surgery to reduce the number of bowel bacteria.
B) teach the patient that activities such as sitting at the bedside will be started the first postoperative day.
C) instruct the patient that another surgery in 8 to 12 weeks will be used to create an ileal-anal reservoir.
D) administer enemas and laxatives to ensure that the bowel is empty before the surgery.

Question 33

The nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements for a patient who is hospitalized with an acute exacerbation of Crohn's disease, based on the finding of

A) complaints of fatigue and weakness.
B) hemoglobin of 10 g/dl (120 g/L).
C) weight loss of 2 pounds (0.9 kg) in 2 days.
D) a 1500-calorie intake over the last day.

Question 34

While obtaining a nursing history from a 55-year-old patient scheduled for a colonoscopy, the nurse will be most concerned about

A) lifelong constipation.
B) nausea and vomiting.
C) history of an appendectomy.
D) recent blood in the stools.

Question 35

The nurse explains to a patient with a new ileostomy that after the bowel adjusts to the ileostomy, the usual drainage will be about

A) 1 cup.
B) 2 cups.
C) 3 cups.
D) 1 quart.

Question 36

A patient returns from surgery following an abdominal-perineal resection with a sigmoid colostomy and abdominal and perineal incisions. The colostomy is dressed with petroleum jelly gauze and dry gauze dressings. The perineal incision is partially closed and has two drains attached to Jackson-Pratt suction. On the first postoperative day, the nurse gives the highest priority to

A) teaching about a low-residue diet.
B) monitoring drainage from the stoma.
C) assessing the perineal drainage and incision.
D) encouraging acceptance of the colostomy site.

Question 37

In providing discharge teaching for a patient who has undergone a hemorrhoidectomy at an outpatient surgical center, the nurse instructs the patient to

A) take prescribed pain medications before a bowel movement is expected.
B) delay having a bowel movement for several days until healing has occurred.
C) maintain a low-residue diet until the surgical area is healed.
D) use ice packs on the perianal area to relieve pain and swelling.

Question 38

After teaching a patient to irrigate a new colostomy, the nurse will determine that the teaching has been effective if the patient

A) hangs the irrigating container about 18 inches above the stoma.
B) stops the irrigation and removes the irrigating cone if cramping occurs.
C) fills the irrigating container with 1000 to 2000 ml of lukewarm tap water.
D) inserts the irrigation tubing no further than 4 to 6 inches into the stoma.

Question 39

When implementing the initial plan of care for a patient admitted with acute diverticulitis, the nurse will

A) administer IV fluids.
B) order a diet high in fiber and fluids.
C) give stool softeners.
D) prepare the patient for colonoscopy.

Question 40

The nurse identifies a nursing diagnosis of acute pain related to edema and surgical incision for a patient who has had a herniorrhaphy performed for an incarcerated inguinal hernia. An appropriate nursing intervention for this problem is to

A) administer stool softeners as ordered.
B) provide warm sitz baths several times a day.
C) apply a scrotal support with application of ice.
D) apply moist heat to the abdomen.

Question 41

A patient with Crohn's disease has a megaloblastic anemia. The nurse will anticipate teaching the patient about the ongoing need for

A) oral ferrous sulfate tablets.
B) cobalamin (BB₁₂) injections.
C) iron dextran (Imferon) injections.
D) regular blood transfusions.

Question 42

The RN and nursing assistant (NA) are caring for a patient with a paralytic ileus. Which of these nursing activities is appropriate for the nurse to delegate to the NA?

A) Irrigation of the NG tube with saline
B) Retaping the NG tube
C) Applying petroleum jelly to the lips
D) Auscultation for bowel sounds

Question 43

After a patient with IBD has had dietary teaching, which food choice by the patient indicates that the teaching has been successful?

A) Oatmeal with cream, whole wheat toast, and a banana
B) Corn tortilla taco with chicken, lettuce, tomato, and cheese
C) Roast beef, mashed potatoes, and a tossed green salad
D) Chicken sandwich with mayonnaise on white bread

Question 44

After being treated for a respiratory tract infection with a 10-day course of antibiotics, a 69-year-old patient calls the clinic and tells the nurse about developing frequent, watery diarrhea. The nurse anticipates that the patient will need to

A) prepare for colonoscopy by taking laxatives.
B) have blood drawn for blood cultures.
C) bring a stool specimen in to be tested for C. difficile.
D) schedule a barium enema to check for inflammation.

Question 45

A patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as illustrated. The nurse explains to the patient that

A) this type of colostomy is usually temporary.
B) soft, formed stool can be expected as drainage.
C) the drainage is liquid at this site but less odorous than at higher sites.
D) colostomy irrigations can help regulate the drainage from the proximal stoma.

Question 46

When performing an admission assessment for a patient with abdominal pain, the nurse palpates the left lower quadrant and the patient complains of right lower quadrant pain. The nurse will document this as

A) McBurney's point.
B) rebound pain.
C) Rovsing's sign.
D) Cullen's sign.