Deck 30: Bowel Elimination and Care

Question 1

A 68-year-old male has been admitted to the hospital for nutritional deficiencies. Approximately 6 months ago, he had part of his duodenum surgically removed following a bowel obstruction. The nurse understands that the patient's nutritional deficiencies are occurring because

A) His diet is low in minerals and vitamins.
B) Enzymes produced in the duodenum are not available.
C) Removal of the duodenum made the colon too short for proper absorption.
D) His ability to absorb nutrients is decreased.

Answer 1

His ability to absorb nutrients is decreased.

Question 2

A patient's admission assessment includes pertinent information about bowel elimination. Which subjective information collected by the nurse will be documented?

A) Distention of abdomen
B) Shape of abdomen
C) Abdominal cramping
D) Bowel sounds

Answer 2

Abdominal cramping

Question 3

While providing care for an elderly patient, a nurse learns that the patient has had only small, watery stools for several days. The nurse understands that the first priority in providing care for this patient is to

A) Assess the patient for an impaction.
B) Call the primary care physician and get an order for a laxative.
C) Administer medication to slow the diarrhea.
D) Collect a stool specimen for analysis.

Answer 3

Assess the patient for an impaction.

Question 4

In response to a nurse's question about bowel elimination habits, a patient says, "Sometimes my bowel movements are greenish black. Is that normal?" The nurse replies:

A) "Large amounts of dairy products can cause your stools to turn green."
B) "If you take iron tablets, your stools can become greenish black."
C) "Typically our diet has very little to do with the color of our stools, so tell your physician about it."
D) "Eating green foods such as spinach can cause your stools to have greenish black streaks."

Question 5

A nurse educator explains to staff nurses that diarrhea can quickly become life-threatening in elderly patients because

A) The elderly patient's total body water percentage increases, making it easier to become dehydrated.
B) Their decreased ability to concentrate on many daily functions makes them forget to drink fluids, particularly when they are ill.
C) Thirst is already diminished, and their percentage of body water is decreased, making them more susceptible to dehydration.
D) Their decreased stature and weight increases the likelihood that they will become dehydrated.

Question 6

A patient states, "Sometimes I have trouble with constipation and have to take a laxative." Discussing ways to help avoid constipation, the nurse replies, "Because an individual commonly gets the urge to have a bowel movement about 30 minutes after eating, it is important to

A) Not ignore the defecation reflex."
B) Not skip meals when having a bowel movement."
C) Decrease fluids when you increase the amount of fiber in your meal."
D) Notify your physician if you do not experience that urge after every meal."

Question 7

A patient with a known history of diverticulosis, who is experiencing severe cramping and diarrhea, was admitted to the hospital during the night with diverticulitis. The patient's pain continues to increase and the abdomen is now very distended and hard. The patient has spiked a fever of 102.4°F. A nurse notifies the primary care physician that the patient may be developing a complication from diverticulosis that is life-threatening. This complication is

A) Crohn disease.
B) Irritable bowel syndrome (IBS).
C) Fecal incontinence.
D) Peritonitis.

Question 8

A nurse suspects a patient is developing a bowel obstruction a few days postoperatively. Auscultation of the abdomen finds

A) Low-pitched, hypoactive bowel sounds in all quads.
B) Hypoactive bowel sounds in all four quads.
C) Bowel sounds are high pitched and hyperactive in right lower quad (RLQ) and right upper quad (RUQ), and hypoactive in left upper quad (LUQ) and left lower quad (LLQ).
D) Bowel sounds are hypoactive in RUQ and active in RLQ, LUQ, and LLQ.

Question 9

When questioned on admission about bowel habits, a patient tells a nurse that he frequently has loose stools three or four times a day and that his warning is a feeling of urgency. The nurse most correctly document the patient's statement as:

A) "Has three to four liquid stools/day accompanied by flatus."
B) "Has multiple bouts of diarrhea and cramping."
C) "Has a few loose stools every day with loss of continence."
D) "Has three to four episodes of tenesmus with watery stools per day."

Question 10

A patient who is disoriented, debilitated, and/or elderly may be unable to drink an adequate amount of fluids to prevent dehydration, thus increasing the risk for constipation. To help prevent constipation, a nurse will

A) Call the physician and get an order for intravenous (IV) therapy.
B) Call a family member and ask if someone can stay with the patient and offer fluids.
C) Enlist the help of the nurse aide or unlicensed assistive personnel to offer sips of fluids every 20 minutes.
D) Force an extra glass of fluid on the patient with meals.

Question 11

After an initial assessment, a nurse documents that a patient, admitted for abdominal pain, has hyperactive bowel sounds. As a result, the nurse could expect the patient's bowel movements to be

A) Hard and shaped in small balls.
B) Fluffy, with a tendency to float in the toilet.
C) Ribbon-shaped and soft.
D) Liquid or semi-liquid.

Question 12

An adult patient has orders for an enema. A nurse will

A) Warm the water to a temperature between 115°F and 125°F.
B) Insert the tip of the enema tube approximately 3 to 4 inches into the rectum.
C) Give the enema to the patient while he or she sits on the toilet.
D) Have the patient lie on the right side to facilitate the instillation of water.

Question 13

After assisting a patient to the bathroom, a nurse notices that the patient's stool is clay colored. Upon questioning, the patient tells the nurse that this has been a problem off and on for the last month or two. The nurse suspects the patient

A) Is not eating a well-balanced diet.
B) May have gallstones or liver problems.
C) Has a history of gastrointestinal (GI) bleeding.
D) Is not drinking an adequate amount of fluids.

Question 14

Following diagnostic tests of the gastrointestinal (GI) system, a patient with chronic constipation asks the nurse, "What is peristalsis, and why it is important?" The nurse explains:

A) "Peristalsis works against gravity to swiftly propel food through the GI tract to decrease problems with constipation."
B) "Peristalsis releases enzymes that break food down and aids in the propulsion of food through the GI tract. These enzymes work hard to prevent constipation."
C) "Peristalsis is the contraction of circular and longitudinal muscles that propels food through the GI tract. If peristalsis slows, it can cause problems with constipation."
D) "Peristalsis is stimulated by a food bolus, which results in the contraction of the pyloric sphincter to help keep food down. If unable to keep food down, constipation can be the result."

Question 15

A nurse teaches a patient on antibiotic therapy that to prevent an opportunistic infection, he or she should

A) Eat yogurt that contains active bacteria.
B) Increase daily fluid intake.
C) Eat bananas, applesauce, and apple pectin.
D) Increase daily physical activity levels.

Question 16

A female patient has been admitted with ulcerative colitis. The nurse knows that when the condition exacerbates, the patient's stools will most likely

A) Be black, tarry, and odiferous.
B) Float, and be odorless and bloody.
C) Contain pus, mucus, and blood.
D) Be soft, but ribbon shaped.

Question 17

A middle-aged patient who has had diarrhea for the past 2 days is being admitted to the hospital. A nurse expects the treatment plan to include

A) A clear liquid diet to allow the gastrointestinal (GI) tract to recover.
B) Drinking fluids that are at room temperature to prevent increasing peristalsis.
C) An assessment to rule out a fecal impaction.
D) A full liquid diet plus cooked vegetables and fruits.

Question 18

The day after surgery, a patient asks a nurse, "Why do the nurses keep listening to my abdomen? That's not where I had surgery." Which of the following responses best answers the patient's question?

A) "General anesthesia puts everything to sleep, including the bowel, so it is important to determine when bowel sounds have returned. When your bowel sounds return, your surgeon will allow you to begin to eat and drink."
B) "Listening to your bowel sounds is just part of the physical assessment, so it's nothing you need to worry about. It will only take me a few minutes to listen; then I'll let you rest."
C) "We listen so we can let your surgeon know your gastrointestinal system wasn't damaged by the anesthesia."
D) "Your surgeon has written orders to assess your abdomen every 4 hours. I'm sorry if it worries you, but I must do my job."

Question 19

During an admission physical assessment, a nurse questions a patient about bowel elimination habits. The nurse's goal is

A) To assess the need for a laxative.
B) To maintain the patient's normal elimination habit.
C) To collect all pertinent patient data.
D) To determine whether further gastrointestinal testing is necessary.

Question 20

A patient is voicing concerns about the increased amount of flatus he has been having over the last couple weeks and asks the nurse what causes flatus. In response to the patient's question, the nurse explains that flatus normally

A) Is created as a result of peristalsis.
B) Occurs as a result of eating an imbalanced diet.
C) Is the result of normal flora's interaction with chyme.
D) Occurs when normal flora numbers in the colon are reduced.

Question 21

While inspecting a patient's stool, a nurse notices a small amount of black, tarry blood with a distinctive old-blood odor that appears to have been partially digested. The nurse identifies this type of blood as

A) Melena.
B) Occult blood.
C) Frank blood.
D) Steatorrhea.

Question 22

After having an enema tube inserted into the rectum, a patient begins to exhibit symptoms of a vagal response. A nurse should immediately do which of the following?

A) Place the patient in the supine position.
B) Remove the enema tube from the rectum.
C) Flush the colon with Kayexalate.
D) Administer a small dose of atropine.
E) Assess pulse rate, skin color, and whether the patient is diaphoretic.

Question 23

A primary care physician has ordered a high enema for a patient admitted for constipation. When administering the high enema, a nurse will

A) Insert the tip of the tubing a minimum of 8 inches to make certain that feces contained above the sigmoid colon will be removed.
B) Instill at least 1000 mL normal saline heated to 120°F to promote peristalsis but decrease the discomfort of cramping.
C) Insert the tip of the tubing 4 inches while the patient sits on the toilet to aid elimination by use of gravity.
D) Instill half of the ordered solution while the patient lies on the left side, then reposition the patient to supine and then right lateral side-lying position to instill the rest of the solution.

Question 24

After having an enema tube inserted into the rectum, a patient begins to complain of dizziness, shortness of breath, and chest pain. A nurse identifies that these symptoms indicate

A) A vagal response.
B) Perforation of the colon.
C) An impaction.
D) Steatorrhea.

Question 25

A patient is admitted for a bowel diversion caused by colon cancer. A nurse explains to a certified nursing assistant that another name for fecal material collected in an ostomy appliance is ____________________.

Question 26

A male patient has told a nurse that he occasionally fights constipation. Teaching the patient how to prevent constipation and promote normal elimination, the nurse instructs him to

A) Eat a minimum of 50 g fiber every day and quickly increase the amount until normal defecation becomes routine.
B) Drink at least 2000 mL fluid every day, but limit the amount of caffeine to 300 mg.
C) Take a stool softener or laxative every day until a normal elimination pattern has been reestablished.
D) Eat small amounts at meals so less waste will need to be expelled.

Question 27

Following a patient's surgery, a nurse will initiate which of the following implementations to stimulate peristalsis?

A) Ambulate four times a day in the hall.
B) Encourage the patient to drink 8 ounces of water four times a day.
C) Get the patient up in a chair for meals.
D) Administer a laxative at bedtime.
E) Encourage fiber intake as allowed by the patient's diet.

Question 28

A patient with Crohn disease underwent a bowel diversion. The distal portion of the colon was not removed, allowing it time to rest and heal. A nurse identifies that this type of bowel diversion is known as an

A) Ileostomy.
B) Colostomy.
C) Kock pouch.
D) Continent ostomy.

Question 29

A nurse stops administering an enema because the patient develops bradycardia. The nurse understands the patient has had a(n) ____________________ response as a result of stimulating a specific nerve.

Question 30

A patient with a new colostomy has many needs. The care that a nurse plans for the patient will include which of the following?

A) Administering pain medication as ordered and needed
B) Emptying the appliance bag when half full to limit skin excoriation
C) Being careful to avoid eye contact while providing ostomy care
D) Giving the patient a list of foods that are known to increase flatus
E) Determining educational needs of the patient and family members who will be involved in the patient's care

Question 31

A patient was seen in the clinic for removal of a fecal impaction. A nurse provides patient teaching to help prevent recurrent constipation and impaction. Which of the following instructions might the nurse include in the teaching?

A) "Try not to delay toileting when the urge to defecate occurs."
B) "Increase the fiber in your diet."
C) "Limit the amount of fluids you drink prior to eating."
D) "Increase the amount of sugar in your daily diet."
E) "Get some form of exercise daily."

Question 32

An instructor is discussing the various types of solutions used for enemas. A student shows the need for additional instruction by saying:

A) "Only pure castile soap or a soap designated by facility policy should be used for a soapsuds enema."
B) "I should only use tap water when giving an enema to children."
C) "Hypertonic solutions may be used in small volumes for adults."
D) "Normal saline is the only solution that should be used on patients with congestive heart failure."

Question 33

A doctor orders a guaiac test on a patient's stool sample. A nurse identifies that this type of test is used to detect the presence of

A) Frank blood
B) Melena
C) Pancreatitis
D) Occult blood

Question 34

Before the removal of an impaction, a nurse is instructed to give a patient an enema to soften the hard stool. The nurse determines that the correct type of enema in this situation is a(n)

A) Kayexalate enema.
B) Oil retention enema.
C) Return flow enema.
D) Harris flush.

Question 35

An older adult patient admitted for diarrhea caused by gastroenteritis states, "My stools are much less frequent and aren't as watery today." The nurse determines that the antibiotic treatment is therapeutically effective. The nurse understands that the symptoms of gastroenteritis are the result of

A) Chemical changes in the bowel with resulting rapid transit time.
B) Structural changes in the bowel.
C) Normal changes due to the aging process.
D) Decreases in the patient's activity level.

Question 36

A patient with dementia is confused, unable to provide self-care, and drinks only a few sips at a time. It is the responsibility of the nurse to ensure that the patient receives adequate amounts of fluid to prevent dehydration. The nurse should

A) Offer the patient a drink every hour.
B) Offer the patient a drink of water or other beverage every 4 hours.
C) Provide the patient with a drink of water or other beverage every 15 minutes.
D) Insist that a family member stay with the patient and give fluids frequently.

Question 37

A patient requires the removal of flatus, but not the removal of stool as with other types of enemas. A nurse identifies that this may be accomplished by using

A) A Harris flush.
B) A return flow enema.
C) A siphon enema.
D) All of the above.

Question 38

A nurse explains to a patient that it is wise to avoid taking a laxative every day because of the problems it can cause. The patient demonstrates understanding by saying laxative abuse can result in which of the following?

A) Fluid and electrolyte imbalances
B) The need for increasing dosages of laxative
C) Loss of natural contractility in the bowel
D) Increased risk for an impaction
E) Development of irritable bowel syndrome

Question 39

While inspecting a patient's stool, a nurse notices that the stool appears fluffy, is floating on the water, and has a foul odor. The nurse identifies this type of stool as

A) Tenesmus.
B) Steatorrhea.
C) Effluence.
D) Melena.

Question 40

A nurse can expect that which of the following patients are likely to suffer from fecal incontinence?

A) An 84-year-old with dementia
B) A 39-year-old paraplegic
C) A 26-year-old with mental challenges
D) A 54-year-old with diverticulosis
E) A 75-year-old with voluntary control

Question 41

A nurse explains to a patient that when a bowel diversion is brought to the outside of the body through the abdominal wall, the new opening is called an ostomy, and the mouth of the ostomy is called a(n) ____________________.