Question 1

A patient with a diagnosis of colon cancer is 2 days postoperative following bowel resection and anastomosis. The nurse has planned the patients care in the knowledge of potential complications. What assessment should the nurse prioritize?

Accepted Answer

A)  Close monitoring of temperature 
B)  Frequent abdominal auscultation 
C)  Assessment of hemoglobin, hematocrit, and red blood cell levels 
D)  Palpation of peripheral pulses and leg girth

Question 2

A nurse is providing care for a patient whose recent colostomy has contributed to a nursing diagnosis of Disturbed Body Image Related to Colostomy. What intervention best addresses this diagnosis?

Accepted Answer

A)  Encourage the patient to conduct online research into colostomies. 
B)  Engage the patient in the care of the ostomy to the extent that the patient is willing. 
C)  Emphasize the fact that the colostomy was needed to alleviate a much more serious health problem. 
D)  Emphasize the fact that the colostomy is temporary measure and is not permanent.

Question 3

A nurse caring for a patient with colorectal cancer is preparing the patient for upcoming surgery. The nurse administers cephalexin (Keflex) to the patient and explains what rationale?

Accepted Answer

A)  To treat any undiagnosed infections 
B)  To reduce intestinal bacteria levels 
C)  To reduce bowel motility 
D)  To reduce abdominal distention postoperatively

Question 4

A nurse is teaching a group of adults about screening and prevention of colorectal cancer. The nurse should describe which of the following as the most common sign of possible colon cancer?

Accepted Answer

A)  Development of new hemorrhoids 
B)  Abdominal bloating and flank pain 
C)  Unexplained weight gain 
D)  Change in bowel habits

Question 5

A patient has been experiencing disconcerting GI symptoms that have been worsening in severity. Following medical assessment, the patient has been diagnosed with lactose intolerance. The nurse should recognize an increased need for what form of health promotion?

Accepted Answer

A)  Annual screening colonoscopies 
B)  Adherence to recommended immunization schedules 
C)  Regular blood pressure monitoring 
D)  Frequent screening for osteoporosis

Question 6

Which of the following is the most plausible nursing diagnosis for a patient whose treatment for colon cancer has necessitated a colonostomy?

Accepted Answer

A)  Risk for Unstable Blood Glucose Due to Changes in Digestion and Absorption 
B)  Unilateral Neglect Related to Decreased Physical Mobility 
C)  Risk for Excess Fluid Volume Related to Dietary Changes and Changes In Absorption 
D)  Ineffective Sexuality Patterns Related to Changes in Self-Concept

Question 7

An older adult who resides in an assisted living facility has sought care from the nurse because of recurrent episodes of constipation. Which of the following actions should the nurse first perform?

Accepted Answer

A)  Encourage the patient to take stool softener daily. 
B)  Assess the patients food and fluid intake. 
C)  Assess the patients surgical history. 
D)  Encourage the patient to take fiber supplements.

Question 8

A nurse is caring for a patient who has been admitted to the hospital with diverticulitis. Which of the following would be appropriate nursing diagnoses for this patient? Select all that apply.

Accepted Answer

A)  Acute Pain Related to Increased Peristalsis and GI Inflammation 
B)  Activity Intolerance Related to Generalized Weakness 
C)  Bowel Incontinence Related to Increased Intestinal Peristalsis 
D)  Deficient Fluid Volume Related to Anorexia, Nausea, and Diarrhea 
E)  Impaired Urinary Elimination Related to GI Pressure on the Bladder

Question 9

A nurse is presenting an educational event to a local community group. When speaking about colorectal cancer, what risk factor should the nurse cite?

Accepted Answer

A)  High levels of alcohol consumption 
B)  History of bowel obstruction 
C)  History of diverticulitis 
D)  Longstanding psychosocial stress

Question 10

A nurse is working with a patient who has chronic constipation. What should be included in patient teaching to promote normal bowel function?

Accepted Answer

A)  Use glycerin suppositories on a regular basis. 
B)  Limit physical activity in order to promote bowel peristalsis. 
C)  Consume high-residue, high-fiber foods. 
D)  Resist the urge to defecate until the urge becomes intense.

Question 11

A patient has had an ileostomy created for the treatment of irritable bowel disease and the patient is now preparing for discharge. What should the patient be taught about changing this device in the home
Setting?

Accepted Answer

A)  Apply antibiotic ointment as ordered after cleaning the stoma. 
B)  Apply a skin barrier to the peristomal skin prior to applying the pouch. 
C)  Dispose of the clamp with each bag change. 
D)  Cleanse the area surrounding the stoma with alcohol or chlorhexidine.

Question 12

A nursing instructor is discussing hemorrhoids with the nursing class. Which patients would the nursing instructor identify as most likely to develop hemorrhoids?

Accepted Answer

A)  A 45-year-old teacher who stands for 6 hours per day 
B)  A pregnant woman at 28 weeks gestation 
C)  A 37-year-old construction worker who does heavy lifting 
D)  A 60-year-old professional who is under stress

Question 13

A nurse is assessing a patients stoma on postoperative day 3 . The nurse notes that the stoma has a shiny appearance and a bright red color. How should the nurse best respond to this assessment finding?

Accepted Answer

A)  Irrigate the ostomy to clear a possible obstruction. 
B)  Contact the primary care provider to report this finding. 
C)  Document that the stoma appears healthy and well perfused. 
D)  Document a nursing diagnosis of Impaired Skin Integrity.

Question 14

The nurse is providing care for a patient whose inflammatory bowel disease has necessitated hospital treatment. Which of the following would most likely be included in the patients medication regimen?

Accepted Answer

A)  Anticholinergic medications 30 minutes before a meal 
B)  Antiemetics on a PRN basis 
C)  Vitamin $\mathrm{B}_{12}$ injections to prevent pernicious anemia 
D)  Beta adrenergic blockers to reduce bowel motility

Question 15

A nurse is caring for a patient admitted with symptoms of an anorectal infection; cultures indicate that the patient has a viral infection. The nurse should anticipate the administration of what drug?

Accepted Answer

A)  Acyclovir (Zovirax) 
B)  Doxycycline (Vibramycin) 
C)  Penicillin (penicillin 
D)  Metronidazole (Flagyl)

Question 16

A patients large bowel obstruction has failed to resolve spontaneously and the patients worsening condition has warranted admission to the medical unit. Which of the following aspects of nursing care is most appropriate for this patient?

Accepted Answer

A)  Administering bowel stimulants as ordered 
B)  Administering bulk-forming laxatives as ordered 
C)  Performing deep palpation as ordered to promote peristalsis 
D)  Preparing the patient for surgical bowel resection

Question 17

A patient is admitted to the medical unit with a diagnosis of intestinal obstruction. When planning this patients care, which of the following nursing diagnoses should the nurse prioritize?

Accepted Answer

A)  Ineffective Tissue Perfusion Related to Bowel Ischemia 
B)  Imbalanced Nutrition: Less Than Body Requirements Related to Impaired Absorption 
C)  Anxiety Related to Bowel Obstruction and Subsequent Hospitalization 
D)  Impaired Skin Integrity Related to Bowel Obstruction

Question 18

A patients health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohns disease, rather that ulcerative colitis, as the cause of the patients signs and symptoms?

Accepted Answer

A)  A pattern of distinct exacerbations and remissions 
B)  Severe diarrhea 
C)  An absence of blood in stool 
D)  Involvement of the rectal mucosa

Question 19

A nurse is preparing to provide care for a patient whose exacerbation of ulcerative colitis has required hospital admission. During an exacerbation of this health problem, the nurse would anticipate that the patients stools will have what characteristics?

Accepted Answer

A)  Watery with blood and mucus 
B)  Hard and black or tarry 
C)  Dry and streaked with blood 
D)  Loose with visible fatty streaks

Question 20

A patient admitted with acute diverticulitis has experienced a sudden increase in temperature and complains of a sudden onset of exquisite abdominal tenderness. The nurses rapid assessment reveals that the patients abdomen is uncharacteristically rigid on palpation. What is the nurses best response?

Accepted Answer

A)  Administer a Fleet enema as ordered and remain with the patient. 
B)  Contact the primary care provider promptly and report these signs of perforation. 
C)  Position the patient supine and insert an NG tube. 
D)  Page the primary care provider and report that the patient may be obstructed.

Exam 47: Management of Patients With Intestinal and Rectal Disorders