47 bowel elimination

Question 1

1. Which nursing actions do you take when placing a bedpan under an immobilized patient? (Select all that apply.)

Answer 1

2. After positioning the patient on the bedpan, elevate the head of the bed to a 45-degree angle.
3. Make sure the patient has a nurse call system in reach to notify the nurse when he or she is ready to have the bedpan removed.

Question 2

2. During the administration of a warm tap-water enema, a patient complains of cramping abdominal pain that he rates 6 out of 10. What nursing intervention should the nurse do first?

Answer 2

1. Stop the instillation.

Question 3

3. Which instructions do you include when educating a person with chronic constipation? (Select all that apply.)

Answer 3

1. Increase fiber and fluids in the diet.
2. Exercise for 30 minutes every day.
3. Schedule time to use the toilet at the same time every day.

Question 4

4. Which skills does the nurse teach a patient with a new colostomy before discharge from the hospital? (Select all that apply.)

Answer 4

1. How to change the pouch
2. How to empty the pouch
3. How to open and close the pouch
4. How to determine whether the ostomy is healing appropriately

Question 5

5. Place the steps for an ileostomy pouch change in the correct order

Answer 5

5. Remove the old pouch.
6. Cleanse and dry the peristomal skin.
7. Assess the stoma and the skin around it.
8. Measure the stoma.
9. Trace the correct measurement onto the back of the wafer.
10. Cut the hole in the wafer to fit around the stoma and not leave skin exposed to the effluent.
11. Press the pouch in place over the stoma.
12. Close the end of the pouch.

Question 6

6. Which symptoms are warning signs of possible colorectal cancer according to the American Cancer Society guidelines? (Select all that apply.)

Answer 6

1. Change in bowel habits
2. Blood in the stool
3. Incomplete emptying of the colon
4. Unexplained abdominal or back pain

Question 7

7. A nurse is teaching a patient to obtain a specimen for fecal occult blood testing using fecal immunochemical testing (FIT) at home. How does the nurse instruct the patient to collect the specimen?

Answer 7

3. Collect one fecal smear from three separate bowel movements.

Question 8

8. What should the nurse teach family caregivers when a patient has fecal incontinence because of cognitive impairment?

Answer 8

2. Initiate bowel or habit training program to promote continence.

Question 9

9. The patient states, “I have diarrhea and cramping every time I have ice cream. I am sure this is because the food is cold.” Based on this assessment data, which health problem does the nurse suspect?

Answer 9

4. Lactose intolerance

Question 10

10. A nurse is taking a health history of a newly admitted patient with a diagnosis of possible fecal impaction. Which question is the priority to ask the patient or caregiver?

Answer 10

4. Have you experienced frequent, small liquid stools recently?

Question 11

Place in order the segments of the small and large intestines.

Answer 11

Duodenum  
Jejunum
Ileum    
Cecum  
Colon  
Rectum 
The sequence is the small intestine segments followed by the large intestine segments in the following order: duodenum, jejunum, ileum, cecum, colon, and then rectum.

Question 12

Which processes are functions of the large intestine?

Answer 12

Secretion
Secretion is a function of the large intestine. The large intestine secretes bicarbonate in exchange for chloride.
Correct

Elimination
Elimination is a function of the large intestine. The large intestine eliminates potassium, feces, and flatus.

Absorption
Absorption is a function of the large intestine. The large intestine absorbs water continually from chyme, converting it to solid feces/stool.

Question 13

Which medications would increase the patient’s risk for constipation?

Answer 13

Opioids
Opioids increase the likelihood of constipation.
Correct

Antacids
Antacids increase the likelihood of constipation.

Iron supplements
Iron supplements increase the likelihood of constipation.

Question 14

Which information would the nurse share with a patient who has a loop colostomy?

Answer 14

“After your bowels heal, they will be reattached.”

With a temporary colostomy, the bowels will be reattached after healing occurs.

Question 15

Which type of procedure creates no stoma on the patient‘s abdomen?

Answer 15

Ileoanal pouch
An ileoanal pouch is a reservoir in the abdomen that collects stool. It does not have a stoma because it is connected to the anus.

Question 16

Which characteristics are typical of a loop colostomy?

Answer 16

Has one stoma with two openings
This is a characteristic of a loop colostomy. A loop colostomy has one stoma with two openings.
Correct

Has mucus drain from the distal end of the stoma
This is a characteristic of a loop colostomy. The distal end discharges mucus in a loop colostomy.
Correct

Has stool drain from the proximal end of the stoma
This is a characteristic of a loop colostomy. Stool drains from the proximal end in a loop colostomy.

Is usually created in an emergency
This is a characteristic of a loop colostomy. A loop colostomy is usually created in an emergency.

Question 17

From which area would the nurse observe stool draining in a double-barrel colostomy?

Answer 17

Proximal end

The functional proximal end, closest to the small intestine, drains feces/stool.

Question 18

Place the organs of the gastrointestinal tract in the sequence through which a food item travels.

Answer 18

Mouth  
Esophagus  
Stomach  
Intestines  
Rectum  
Anus 
The food item travels in the following sequence: mouth, esophagus, stomach, intestines, rectum, and anus. This sequence is the normal anatomy of the gastrointestinal tract.

Question 19

The gastrointestinal tract has which function?

Answer 19

Absorption of nutrients and fluids

The gastrointestinal tract absorbs nutrients and fluids.

Question 20

Which structure is the primary organ that aids in defecation?

Answer 20

Large intestine

The large intestine is the principal organ of bowel elimination and aids in defecation.

Question 21

Which function does defecation serve?

Answer 21

Expels feces
Defecation expels feces/stool from the body. The ultimate function of the large intestine and the final act of digestion to produce feces and expel it from the body. In nursing this is called a bowel movement or stool.

Question 22

Which information is accurate regarding the structure and function of the esophagus?

Answer 22

Is a collapsible tube that transports a food bolus
The esophagus is a collapsible tube that transports a food bolus.

Connects the pharynx to the stomach
The esophagus connects the pharynx to the stomach.

Question 23

Which factors can affect a patient’s bowel movements?

Answer 23

Dietary intake
Dietary intake can affect a person’s bowel movements by affecting the consistency (hard, soft) of stools.
Correct

Medication use
Medication use can affect a person’s bowel movements by either causing diarrhea or constipation.

Pain
Pain can affect a person’s bowel movements by suppressing the urge to defecate.
Correct

Recent surgery
Recent surgery can affect a person’s bowel movements by slowing peristalsis.

Question 24

Which information regarding the frequency of bowel movements is accurate?

Answer 24

Varies from person to person

The frequency of defecation, along with the characteristics of feces, will vary and differs from person to person

Question 25

Which amount of fluid (in ounces) is recommended for an adult to maintain healthy bowel elimination?

Answer 25

64

An adult needs to consume at least 64 ounces of fluid daily to maintain healthy bowel elimination.

Question 26

Which question addresses psychological factors that can affect a patient’s bowel elimination?

Answer 26

Is the patient experiencing stress?

Stress is a psychological condition that can affect elimination. Stress can lead to diarrhea.

Question 27

Which type of intestinal movement would a patient with a paralytic ileus have?

Answer 27

None

If the intestines are manipulated during surgery, intestinal movement stops (none), causing a paralytic ileus.

Question 28

Place the types of ostomies in order based on the consistency of stool formed (from least formed/liquid to most formed/solid).

Answer 28

Ileostomy  
Ascending colostomy  
Transverse colostomy  
Descending colostomy  
Sigmoid colostomy 
The sequence for the most unregulated, liquid ostomy stool to the most regulated, solid ostomy stool is as follows: ileostomy, ascending colostomy, transverse colostomy, descending colostomy, and sigmoid colostomy. The longer the stool is in the lower gastrointestinal tract, the more regulated and solid the feces/stool becomes.

Question 29

Stool drainage from a sigmoid colostomy has which characteristics?

Answer 29

Well-formed
Well-formed stools are indicative of a sigmoid colostomy. The location of the sigmoid colon allows the stool to stay in the intestine longer and has a more normal consistency.

Well-regulated
The stools can be well regulated in a sigmoid colostomy.

Question 30

Which type of ostomy causes the patient to lose a large amount of water, electrolytes, and digestive enzymes through a stoma?

Answer 30

Ileostomy

The patient with an ileostomy loses a high volume of water, electrolytes, and digestive enzymes through a stoma.

Question 31

Which type of ostomy is the nurse describing when using this image?

Answer 31

Ileoanal pouch
The image is an ileoanal pouch, a type of alternative procedure in which the pouch attaches to the anus so the patient can defecate through the anus.

Question 32

Which question would the nurse ask to gather cues about drug-related issues for bowel elimination?

Answer 32

“Are you using any herbal supplements?”

Asking about herbal supplements is a drug-related question for bowel elimination.

Question 33

Which information would the nurse include in a teaching session about a lower gastrointestinal (GI) series?

Answer 33

It is a type of radiographic (x-ray) study.
A lower GI series is a type of radiographic (x-ray) study, so the nurse would include this information in the teaching session.

Question 34

Which findings would cause the nurse to document “active” bowel sounds?

Answer 34

Gurgling
Active bowel sounds are gurgling.
Correct

Soft
Active bowel sounds are soft.

Sounds every 5 to 15 seconds
Active bowel sounds occur every 5 to 15 seconds.
Correct

Irregular pattern
Active bowel sounds have an irregular pattern.

Question 35

Place in the correct order the steps to perform a complete assessment of bowel function.

Answer 35

Interview 
Inspection  
Auscultation  
Palpation  
To assess a patient’s bowel function, the nurse starts with interview, then inspection, followed by auscultation, and palpation last. Palpation is last because pressing on the abdomen can alter the bowel sounds and give an inaccurate result.

Question 36

Which patient requires immediate medical attention?

Answer 36

A patient with a hard, boardlike abdomen

A patient with a hard, boardlike abdomen requires immediate medical attention because it can be life threatening.

Question 37

Which location in the medical record would the nurse check to determine the date of the patient’s last bowel movement?

Answer 37

Graphic chart

The graphic chart is the best place for the nurse to check for the patient’s last bowel movement.

Question 38

Which characteristic describes bowel sounds auscultated in a patient with constipation?

Answer 38

Fewer than five per minute

The patient with constipation has hypoactive bowel sounds, fewer than five per minute.

Question 39

Which factors could be potential sources of a patient’s flatus?

Answer 39

History of recent abdominal surgery
Abdominal surgery can be a cause of flatus.
Correct

Use of bran for fiber
Bran is a source of a patient’s flatus.

Presence of milk intolerance
Certain conditions, such as lactose intolerance, are a source of flatus.
Correct

Current diet
Certain foods in the current diet, such as cabbage and onions, are a source of flatus.

Question 40

The nurse understands that patients may experience diarrhea due to which causes?

Answer 40

Psychological stress
Psychological stress is one cause of diarrhea.

Antibiotic use
Antibiotic use can lead to diarrhea.
Correct

Enteral nutrition
Enteral nutrition can cause diarrhea.

Question 41

Which patients are immediate concerns?

Answer 41

A teenager with absent bowel sounds
Absent bowel sounds are an immediate concern.

A young child with diarrhea who develops dehydration
A young child with diarrhea who develops dehydration is an immediate concern.
Correct

An older adult who is positive for Clostridium difficile (C. diff) stool culture
Diarrhea from C. diff is an immediate concern.

Question 42

Which finding would the nurse categorize as an expected finding for an abdominal assessment?

Answer 42

Nonprotruding midline umbilicus

A nonprotruding midline umbilicus is an expected finding.

Question 43

Which information would the nurse share with the patient about how blood can be detected in a guaiac test?

Answer 43

The stool sample is exposed to a special chemical that changes color when blood is present.
A guaiac test uses a stool sample exposed to a special chemical that changes color when blood is present

Question 44

Which action by the new nurse while performing an abdominal assessment would cause the charge nurse to intervene?

Answer 44

Palpates a pulsating midline mass
The charge nurse would intervene because this is an incorrect action by the new nurse. If a pulsating midline mass is observed, the nurse would not palpate. This could be an aneurysm (weak, bulging area in an artery). Palpating this mass may cause the aneurysm to burst, causing bleeding.

Question 45

Which action would the nurse take when performing an abdominal assessment?

Answer 45

Palpates the area of pain last
The nurse palpates the area of pain last to prevent discomfort of the patient and to prevent the abdomen from tightening.

Question 46

Which expected assessment cue would the nurse find upon palpation of the abdomen?

Answer 46

Painless

Painless is an expected assessment cue; an expected assessment cue for an abdomen will have no pain upon palpation.

Question 47

Which diagnostic study would help determine whether there is bleeding in the patient’s stomach?

Answer 47

Esophagogastroduodenoscopy
The esophagogastroduodenoscopy would help determine bleeding because it visualizes the stomach, as well as the mouth, throat, and part of the small intestine.

Question 48

Which cues would be anticipated in a patient with flatulence and bloating?

Answer 48

Abdominal tenseness on palpation
Abdominal tenseness on palpation is a cue for flatulence and bloating.

Reports passing excessive gas through the rectum
Passing excessive gas through the rectum is a common cue for flatulence and bloating.
Correct

Reports of abdominal pressure
A common cue for flatulence and bloating is reports of pressure in the abdomen.

Question 49

Which bowel assessment findings would the nurse report as unexpected?

Answer 49

Rebound tenderness present
Rebound tenderness is unexpected; it indicates possible appendicitis.

Steatorrhea
Steatorrhea is unexpected; steatorrhea indicates oily stool and fat malabsorption.
Correct

Clay-colored, round stool
Clay-colored, round stool is unexpected; clay-colored stools indicate no bile in the stool.

Question 50

How long would the nurse auscultate the abdomen before documenting no or absent bowel sounds? Record answer as a whole number. __ minutes

Answer 50

5

Question 51

Which cue is irrelevant for a patient with a bowel alteration?

Answer 51

Type of hypertension
Type of hypertension is an irrelevant cue for a bowel alteration because this has no bearing on bowel elimination functioning.

Question 52

The nurse caring for a patient suffering from chronic constipation must be aware of which potential complication?

Answer 52

Fecal impaction

Chronic constipation can lead to fecal impaction.

Question 53

Which cause is the likely reason a patient on long-term antibiotic therapy is experiencing frequent, foul-smelling diarrhea?

Answer 53

clostridium difficile

Clostridium difficile is a common cause of diarrhea with a foul odor in patients treated with long-term antibiotics

Question 54

Which cues suggest bowel alteration due to impaction?

Answer 54

Has not had a bowel movement in 4 days
Not having a bowel movement in several days is a cue for a fecal impaction.

Has palpable hard fecal mass
Having a palpable hard fecal mass is a cue for an impaction.
Correct

Has continuous leakage of liquid stool
Having continuous leakage of liquid stool is a cue for an impaction.

Question 55

Match each bowel alteration to its cause.

Answer 55

Prolonged constipation  
Impaction 
Paralyzed rectum muscles 
 Incontinence 
Slowed peristalsis 
 Constipation 
Increased peristalsis 
 Diarrhea