Deck 46: Bowel Elimination

Question 1

The client asks the nurse to recommend bulk-forming foods that may be included in the diet.Which of the following should be recommended by the nurse?
1) Whole grains
2) Fruit juice
3) Rare meats
4) Milk products

Answer 1

1
Bulk-forming foods,such as grains,fruits,and vegetables,absorb fluids and increase stool mass.Fruit juice,rare meats,and milk products are not bulk-forming foods.

Question 2

The client has been admitted to an acute care unit with a diagnosis of biliary disease.The nurse suspects that the feces will appear:
1) Bloody
2) Pus filled
3) Black and tarry
4) White or clay colored

Answer 2

4
Stool that is white or clay colored indicates an absence of bile.Bloody feces is not an indication of biliary disease.Pus-filled feces indicate infection.Black or tarry feces may indicate upper gastrointestinal (GI)bleeding or iron ingestion.

Question 3

A client has undergone intestinal surgery and now has an incontinent ostomy.The use of which of the following products by the client indicates that the discharge learning goals have been achieved?
1) A powder for a yeast infection
2) Peroxide to toughen the peristomal skin
3) A commercial deodorant around the stoma
4) Alcohol to cleanse the stoma

Answer 3

1
If a yeast infection occurs,thorough cleansing should be performed,followed by patting the area dry and applying a prescribed topical agent,such as triamcinolone acetonide (Kenalog)spray or nystatin (Mycostatin),to the affected region.The peristomal skin should be cleansed gently with warm tap water using gauze pads or a clean washcloth.An ostomy deodorant may be placed into the pouch,not around the stoma.Alcohol should not be used to clean the stoma.The area may be cleaned with warm tap water.

Question 4

The nurse is discussing food allergies with a group of mothers whose children are allergy prone.Which of the following statements made by the nurse best describes lactose intolerance?
1) "If milk causes diarrhea,cramps,or gas,it might be an intolerance of lactose."
2) "You don't have to be allergic to dairy for it to cause you problems."
3) "Allergies to milk can be very dangerous,even life threatening."
4) "Many children outgrow their intolerance of dairy lactose."

Question 5

Which of the following statements made by an older adult reflects the best understanding of the role of fiber regarding good bowel health?
1) "Fiber is very effective at cleaning out the bowels."
2) "A high-fiber diet results in softer bowel movements."
3) "Passing hard,dry stool is more uncomfortable and harder on the bowels."
4) "The more fiber there is in my diet,the less risk I have of developing polyps."

Question 6

The client is taking medications to promote defecation.Which of the following instructions should be included by the nurse in the teaching plan for this client?
1) Increased laxative use often causes hyperkalemia.
2) Salt tablets should be taken to increase the solute concentration of the extracellular fluid.
3) Emollient solutions may increase the amount of water secreted into the bowel.
4) Bulk-forming additives may turn the urine pink.

Question 7

A client is to have a stool test for occult blood.The nurse is instructing the nursing assistant in the correct procedure for the test.The nursing assistant is correctly informed that:
1) Sterile technique is used for collection
2) Stool should be collected over a 3-day period
3) The specimen should be kept warm
4) A 1-inch sample of formed stool is needed

Question 8

A client who recently underwent surgery and now has a colostomy is correctly instructed by the nurse that for the next few weeks the client's diet will include foods such as:
1) Vegetables
2) Fresh fruit
3) Whole grain breads
4) Poached eggs and rice

Question 9

The nurse is discussing arteriosclerosis and the effects it has on the body with an older adult client.Although the most commonly recognized effect is on the cardiovascular system,the nurse should include which of the following statements regarding its effect on the gastrointestinal system to complete the discussion?
1) "Circulatory problems make getting to the bathroom easily problematic."
2) "The benefit you get from your food is also decreased by this condition."
3) "The aging process that causes the vascular problems also causes elimination problems."
4) "The problem it creates with blood flow also affects blood flow to the bowels and so affects elimination."

Question 10

Which of the following statements made by an older adult reflects the best understanding of the role of fiber regarding bowel patterns?
1) "The more fiber I eat,the fewer problems I have with my bowels."
2) "Whole grain cereal and toast for breakfast keeps my bowels moving regularly."
3) "My wife makes whole grain muffins;they are really good and good for me too."
4) "I use to have trouble with constipation until I started taking a fiber supplement."

Question 11

While undergoing a soapsuds enema,the client complains of abdominal cramping.The nurse should:
1) Immediately stop the infusion
2) Lower the height of the enema container
3) Advance the enema tubing 2 to 3 inches
4) Clamp the tubing

Question 12

A nurse who is caring for postoperative clients on a surgical unit knows that for 24 to 48 hours postoperatively,clients who have undergone general anesthesia may experience:
1) Colitis
2) Stomatitis
3) Paralytic ileus
4) Gastrocolic reflex

Question 13

Which of the following would the nurse expect as a normal change in the bowel elimination as a person ages?
1) Absorptive processes are increased in the intestinal mucosa.
2) Esophageal emptying time is increased.
3) Changes in nerve innervation and sensation cause diarrhea.
4) Mastication processes are less efficient.

Question 14

An 8-month-old infant is hospitalized with severe diarrhea.The nurse knows that the major problem associated with severe diarrhea is:
1) Pain in the abdominal area
2) Electrolyte and fluid loss
3) Presence of excessive flatus
4) Irritation of the perineal and rectal area

Question 15

The client is to receive a Kayexalate enema.The nurse recognizes that this is used to:
1) Prevent further constipation
2) Remove excess potassium from the system
3) Reduce bacteria in the colon before diagnostic testing
4) Provide direct antidiarrheal medication to the intestine

Question 16

Which of the following is an appropriate nursing intervention for a client with a nasogastric tube in place?
1) Tape the tube up and around the ear on the side of insertion.
2) Secure the tubing to the bed by the client's head.
3) Mark the tube where it exits the nose.
4) Change the tubing daily.

Question 17

The appropriate amount of fluid to prepare for an enema to be given to an average-size school-age child is:
1) 150 to 250 mL
2) 250 to 350 mL
3) 300 to 500 mL
4) 500 to 750 mL

Question 18

The nurse instructs the client that before the fecal occult blood test (FOBT)she may eat:
1) Whole wheat bread
2) A lean,T-bone steak
3) Veal
4) Salmon

Question 19

A 50-year-old male client is having a screening colonoscopy.The nurse instructs the client that:
1) No special preparation is required
2) Light sedation is normally used
3) No metallic objects are allowed
4) Swallowing of an opaque liquid is required

Question 20

For clients with hypocalcemia,the nurse should implement measures to prevent:
1) Gastric upset
2) Malabsorption
3) Constipation
4) Fluid secretion

Question 21

The nurse is assessing a cognitively impaired older adult client and observes a leaking of liquid stool from the rectum.The nurse's initial intervention for this client is to:
1) Determine if the client has been eating sufficiently,especially fiber-rich foods
2) Determine how long it has been since the client had a normal-size,formed stool
3) Perform a digital examination of the rectum to determine the presence of stool
4) Call the health care provider to get a prescription for an antidiarrheal medication

Question 22

A 44-year-old male client was placed on a daily low-dose aspirin regimen by his health care provider following a recent diagnosis of hypertension and periodic atrial fibrillation.The client is currently hospitalized with renal stones.As the nurse is admitting the client,he shares that he has been very tired.The nurse gathers additional data regarding his bowel habits.The client shares that he has recently had black,tarry stools.The nurse is most concerned that the client may have:
1) Colon cancer
2) A GI bleed from the aspirin therapy
3) Ongoing atrial fibrillation
4) Electrolyte imbalance

Question 23

A client is reporting that the oral medication she was prescribed for her hypothyroidism does not seem to be helping.The client goes on to report that she has been experiencing tension-related headaches and constipation.She has been self-medicating with nonsteroidal antiinflammatory drugs (NSAIDs)and bulk laxatives.Which of the following assessment questions is most likely to provide information regarding this client's concern regarding her thyroid problem?
1) "How long have you taken Synthroid?"
2) "What other medications are you currently on?"
3) "How long have you been taking a bulk laxative?"
4) "Have you developed any other gastrointestinal symptoms?"

Question 24

The nurse is discussing food allergies with a group of mothers whose children are allergy prone.Which of the following statements made by a mother best describes lactose intolerance?
1) "My child is allergic to milk;it makes her very gassy."
2) "Dairy products require a special enzyme to be digested properly."
3) "Being lactose intolerant means my child can't tolerate dairy products."
4) "My child gets diarrhea from dairy products because she can't digest lactose."

Question 25

An active 25-year-old female client shared with the nurse that ever since she had gone on a high-protein low-carbohydrate diet she had suffered from constipation.The client states that the diet is working for her in terms of weight loss and would like to stay on it.The best response from the nurse is that the client should try:
1) Consuming more low-carbohydrate fiber-rich foods like broccoli,raspberries,blackberries,and asparagus
2) Taking a laxative when feeling constipated
3) Try a different diet with less tendency to cause constipation
4) Exercise more

Question 26

Which of the following statements by a client reporting constipation reflects the most informed understanding of interventions that will aid in assuming proper bowel mobility?
1) "Could it be that I need to get more exercise,even here in the hospital?"
2) "Is it true that drinking coffee often helps stimulate the bowels to work?"
3) "I guess a little high-fiber cereal might help.Can you get me some from the cafeteria?"
4) "May I have a cup of decaffeinated tea in addition to my breakfast juice? That usually helps."

Question 27

The mother of an 18-month-old male client shares with the nurse that she is trying to get her child to tell her when he needs to have a bowel movement.Which of the following statements is the most appropriate response from the nurse?
1) "I'm sure that you will be glad to have your son out of diapers."
2) "I once heard of a child who was totally potty-trained by the time he was a year old."
3) "Development of neuromuscular control of the bowels doesn't normally occur until a child is between 2 and 3 year of age."
4) "You will have to really be persistent about taking him to the bathroom frequently in order to be successful."

Question 28

A client is caring for her daughter,who recently suffered multiple fractures in an automobile accident.The client tells the home care nurse that she has been "really down since all this happened." She adds that she has been constipated and not really interested in eating.Which of the following statements by the nurse focuses on the most likely cause of the gastrointestinal problem?
1) "Actually,how long have you been constipated?"
2) "Are you eating fiber-rich foods like fruit and whole grains?"
3) "You may be depressed;emotional depression can cause constipation."
4) "I suggest you get some over-the-counter mild laxative and see if that helps."

Question 29

Which of the following statements made by a nurse discussing the effect of an antibiotic on the gastrointestinal system reflects the best understanding of the possible occurrence of diarrhea?
1) "The GI tract naturally rids itself of bacterial toxins by increasing peristalsis,and that causes diarrhea."
2) "The antibiotic is responsible for killing off the GI tract's normal bacterial,and diarrhea is the result."
3) "For some,antibiotics irritate the mucous lining of the intestines,causing decreased absorption and diarrhea."
4) "When you are taking an antibiotic,your body is fighting off an infection,and peristalsis is faster and so diarrhea occurs."

Question 30

An adult client reports to the nurse that she has been experiencing constipation recently and is interested in any suggestions regarding dietary changes she might make.Which of the following suggestions provided by the nurse is most likely to minimize the client's complaint?
1) "Have you tried foods like prunes and bran?"
2) "You might find the new flavored bulk laxatives helpful."
3) "What have you tried in the past that hasn't been helpful?"
4) "Increase your fluid intake;have some juice with breakfast."

Question 31

A client who is 2 days' postoperative reports feeling "constipated" to the nurse.The client has good bowel sounds in all four quadrants and has tolerated liquids well.Her pain is being controlled with an opioid analgesic.Which of the following interventions should the nurse try initially?
1) "Let me get you some apple juice."
2) "Ambulating may get your bowels moving."
3) "I'll see about getting a different pain medication."
4) "Your health care provider might prescribe an enema if I call."

Question 32

The 35-year-old pregnant client is concerned about constipation.When weighing the advantages and disadvantages of having a local anesthetic over a general anesthetic for a caesarian section,the nurse shares with the client that the local will cause less risk for constipation following surgery.The best reason that there is less constipation following this surgery is because:
1) The client will not have to be allowed nothing by mouth (NPO)before surgery
2) The client will be able to ambulate immediately following surgery
3) The client will be able to eat following surgery
4) Local or regional anesthetic often has little or no effect on bowel activity

Question 33

The greatest risk for injury for a client who has fecal incontinence is:
1) Perineal and rectal skin breakdown
2) The contamination of existing wounds
3) Falls resulting from attempts to reach the bathroom
4) Cross-contamination into the upper gastrointestinal tract

Question 34

A client is caring for her husband who recently experienced a cerebral vascular accident.She tells the home care nurse that she has been very anxious lately about all the added responsibilities.She adds that she has not been sleeping well and has had several bouts of diarrhea.Which of the following statements by the nurse focuses on the most likely cause of the gastrointestinal problem?
1) "Have you experienced increased gas and cramping in addition to the diarrhea?"
2) "You are under a lot of stress;that can affect your bowels and result in diarrhea."
3) "I suggest you get some over-the-counter medication and keep it on hand to manage those bouts."
4) "Have you been eating a well-balanced diet since you brought your husband home?"

Question 35

The nurse is providing ancillary personnel with instructions regarding the proper methods to implement when caring for a client with a Clostridium difficile infection.Which of the following practices will have the greatest impact on containment of the bacteria and thus prevention of cross-contamination?
1) Frequent in-services on transmission modes of C.difficile
2) Practice of proper hand hygiene by all staff
3) Appropriate handling of contaminated linen
4) Stool cultures on all suspected carriers

Question 36

Which of the following clients is at greatest risk for serious complications when using the Valsalva maneuver to expel feces?
1) 25-year-old pregnant client
2) 66-year-old male with hypertrophied prostate disease
3) 44-year-old male client with glaucoma
4) 53-year-old female with stomach cancer

Question 37

The nurse is counseling a 65-year-old female client on her use of mineral oil as a laxative.One of the most important things that the nurse can share with the client is how mineral oil can cause the decreased absorption of which of the following vitamins?
1) Vitamin C
2) Niacin
3) Vitamin D
4) Riboflavin

Question 38

A 70-year-old client is discussing his recent difficulty with having regular bowel movements while on a cross-country bus tour with a senior citizens' group.Which of the following assessment questions is directed toward the most likely cause of the problem?
1) "Did the bus stop frequently so you could get up and walk around?"
2) "Did you eat enough fiber while you were on the trip?"
3) "Do you find using public restrooms unsettling?"
4) "Do you have any chronic bowel-related problems?"

Question 39

A client who was recently diagnosed with anemia and rheumatoid arthritis reports to the nurse that she has noticed that her stool is black,and she is concerned because there is a history of colon cancer in her family.Which of the following assessment questions is most likely to provide information regarding this client's bowel problem?
1) "What medications are you currently on?"
2) "When did you have your last colonoscopy?"
3) "Does the arthritis severely impair your mobility?"
4) "Would you like to have the stool tested for occult blood?"

Question 40

The nurse is caring for a 19-year-old male client with a fractured left femur whose leg was pinned 36 hours ago and is now in traction.Which of the following stressors is mostly likely the cause of this client's difficulty related to constipation?
1) Pain related to the fracture and its repair
2) Anxiety regarding the serious nature of the injury
3) The need to defecate in an unfamiliar,awkward position
4) Poor fluid intake after the accident and ensuing surgery

Question 41

The health care provider has ordered a stool specimen for ova and parasites from the 43-year-old male client.The nurse knows that when collecting the specimen the stool must be:
1) Kept on ice
2) Kept warm
3) Collected using sterile technique
4) Free from urine

Question 42

The nurse knows that the client receiving enteral feedings is at risk for diarrhea.One of the measures that the nurse can take to minimize the risk for diarrhea in this client is:
1) Making sure to chill the canned feeding before administering
2) Using strict sanitation when administering the formula
3) Not deviating from the prescribed rate of delivery for the formula
4) Not diluting or changing the strength of the prescribed formula

Question 43

Upon auscultation of the client's abdomen,the nurse hears hyperactive bowel sounds (greater than 35 per minute).The nurse knows that this can indicate which of the following?
1) Paralytic ileus
2) Fecal impaction
3) Small intestine obstruction
4) Abdominal tumor