Bowel elmination

Question 1

Normal and abnormal

Color

Answer 1

Normal
Infant- yellow
Adult-brown

Abnormal
White or clay- the absence of bile
Black- Iron ingestion, GI bleeding
Red-GI bleeding
pale and oily-Malabsorption of fat

Question 2

Normal and abnormal

Odor

Answer 2

Normal-may be affected by food

Abnormal-Noxious changes
foul-smelling

Question 3

Normal and abnormal

Consistency

Answer 3

Normal-Soft, formed

Abnormal-Liquid(diarrhea)
　　 Hard(constipation)

Question 4

Normal and abnormal

Frequency

Answer 4

Normal-Infant 4-6/day
Adult-twice daily and 3 times a week

Abnormal-Infant more than 6 times or less than once every 1-2days

Adult more than 3 times a day or less than once a week

Question 5

Normal and abnormal

Shape

Answer 5

Normal-resembles diameter of the rectum
似ている

Abnormal-Narrow, pencil-shaped
Obstruction, increase peristalsis

Question 6

Normal and abnormal

Constituents/構成要素

Answer 6

Normal-Undigested food, dead bacteria, fat, bile, pigment

Abnormal-Blood, foreign bodies, oily stool
GI bleeding, infection

Question 7

The nurse is about educating the client about age-related changes that affect bowel elimination.

These include?

A. Increased absorption of nutrients in the intestine
B. Increased peristalsis, resulting in softer stools.
C. Weaking of intestinal smooth muscle tone.
D. Increased risk of developing ulcerative colitis.

Answer 7

C

Question 8

Which is most important when caring for a patient with a colostomy stoma?

1) Cleansing the stoma with cool water
2) Spraying an air freshener in the room
3) Selecting a bag with an appropriate sized stomal opening
4) Wearing sterile gloves when caring for the stoma

Answer 8

3

Question 9

Which statement should the nurse use when teaching the patient to avoid foods that have a laxative effect? “You should avoid:

1) Applesauce
2) Chocolate
3) Coffee
4) Pasta

Answer 9

3

Question 10

Which question would take priority when collecting a bowel elimination history for a newly admitted patient with a medical diagnosis of possible bowel obstruction?

1) “Do you use anything to help you move your bowels?”
2) “When was the last time you moved your bowels?”
3) “What color are your usual bowel movements?”
4) “How often do you have a bowel movement?”

Answer 10

2

Question 11

Which independent nursing action facilitates defecation of a hard stool?

1) Applying a lubricant to the anus
2) Encouraging a sitz bath after defecation
3) Instilling warm mineral oil into the rectum
4) Placing a cold compress against the anus

Answer 11

1

Question 12

Which adaptation is most significant in indicating the presence of a fecal impaction?

1) Odorous flatus
2) Marble-sized, hard, dry stools
3) Liquid, fecal seepage, with no passage of stool
4) Bright, red blood with the passage of stool

Answer 12

3

Question 13

Which is the most appropriate outcome for a hospitalized patient with the nursing diagnosis Diarrhea? “The patient will:

1) have no more than two bowel movements a day.”
2) avoid foods that are high in water-soluble fiber.”
3) take Imodium after each bowel movement.”
4) drink at least 8 glasses of water per day.”

Answer 13

1

Question 14

Which is detected in a guaiac test of stool?

1) Bile
2) Bacteria
3) Occult blood
4) Ova and parasites

Answer 14

3

Question 15

The nurse discourages straining on defecation primarily because if performed by the patient it could precipitate:

1) Incontinence
2) Dysrhythmias
3) Fecal Impaction
4) Rectal hemorrhoids

Answer 15

2

Question 16

Which food works best to increase the bulk in fecal material?

1) Whole wheat bread
2) White rice
3) Pasta
4) Kale

Answer 16

4

Question 17

The excessive use of laxatives should be avoided primarily because it:

1) Weakens the natural response to defecation
2) Results in distention of the intestines
3) Causes abdominal discomfort
4) Causes incontinence

Answer 17

1

Question 18

Which of the following is not a function of the large intestine?

a. Absorbing nutrients
b. Absorbing water
c. Secreting bicarbonate
d. Eliminating waste

Answer 18

ANS: A
Nutrient absorption is done in the small intestine. The other options are all functions of the large intestine.

Question 19

A patient informs the nurse that she was using laxatives three times daily to lose weight. After
stopping use of the laxative, the patient had difficulty with constipation and wonders if she needs to take laxatives again. The nurse educates the patient that
a. Long-term laxative use causes the bowel to become less responsive to stimuli, and constipation may occur.
b. Laxatives can cause trauma to the intestinal lining and scarring may result, leading to decreased peristalsis.
c. Natural laxatives such as mineral oil are safer than chemical laxatives for relieving constipation.
d. Laxatives cause the body to become malnourished, so when the patient begins eating again, the body absorbs all of the food, and no waste products are produced

Answer 19

ANS: A
Long-term laxative use can lead to constipation. Increasing fluid and fiber intake can help with this problem

Question 20

A patient with a hip fracture is having difficulty defecating into a bed pan while lying in bed. Which action by the nurse would assist the patient in having a successful bowel movement?

a. Administering laxatives to the patient
b. Raising the head of the bed
c. Preparing to administer a barium enema
d. Withholding narcotic pain medication

Answer 20

ANS: B
Lying in bed is an unnatural position; raising the head of the bed assists the patient into a more normal position that allows proper contraction of muscles for elimination.

Question 21

Which patient is most at risk for increased peristalsis?

a. A 5-year-old child who ignores the urge to defecate owing to embarrassment
b. A 21-year-old patient with three final examinations on the same day
c. A 40-year-old woman with major depressive disorder
d. An 80-year-old man in an assisted-living environment

Answer 21

ANS: B
Stress can stimulate digestion and increase peristalsis. Ignoring the urge to defecate, depression, and age-related changes of the elderly are causes of constipation

Question 22

A patient expresses concerns over having black stool. The fecal occult test is negative. Which response by the nurse is most appropriate?

a. “This is probably a false negative; we should rerun the test.”
b. “Do you take iron supplements?”
c. “You should schedule a colonoscopy as soon as possible.”
d. “Sometimes severe stress can alter stool color.”

Answer 22

ANS: B
Certain medications and supplements, such as iron, can alter the color of stool.

Question 23

The nurse is assessing a patient 2 hours after a colonoscopy. Based on the procedure done, what focused assessment will the nurse include?

a. Bowel sounds
b. Presence of flatulence
c. Bowel movements
d. Nausea

Answer 23

ANS: A
The nurse does want to hear the presence of bowel sounds; absent bowel sounds may indicate a complication from the surgery.

Answer 24

ANS: A
The nurse does want to hear the presence of bowel sounds; absent bowel sounds may indicate a complication from the surgery.

Question 25

The nurse should place the patient in which position when preparing to administer an enema?

a. Left Sims’ position
b. Fowler’s
c. Supine
d. Semi-Fowler’s

Answer 25

ANS: A
Side-lying Sims’ position allows the enema solution to flow downward by gravity along the natural curve of the sigmoid colon.

Question 26

A guaiac test has been ordered. The nurse knows that this is a test for

a. Bright red blood.
b. Dark black blood.
c. Blood that contains mucus.
d. Blood that cannot be seen.

Answer 26

ANS: D
Fecal occult blood tests are used to test for blood that may be present in stool that cannot be seen by the naked eye. This is usually indicative of a GI bleed.

Question 27

A patient has constipation and hypernatremia. The nurse prepares to administer which type of
enema?
a. Oil retention
b. Carminative
c. Saline
d. Tap water

Answer 27

ANS: D
Tap water enema would draw fluid into the system and would help flush out excess sodium

Question 28

The nurse is caring for a patient who had a colostomy placed yesterday. The nurse should
report which assessment finding immediately?
a. Stoma is protruding from the abdomen.
b. Stoma is moist.
c. Stool is discharging from the stoma.
d. Stoma is purple.

Answer 28

ANS: D
A purple stoma may indicate strangulation or poor circulation to the stoma and may require surgical intervention.

A stoma should be reddish-pink and moist in appearance

Question 29

A nurse is caring for a patient who has had diarrhea for the past week. Which additional assessment finding would the nurse expect?

a. Increased energy levels
b. Distended abdomen
c. Decreased serum bicarbonate
d. Increased blood pressure

Answer 29

ANS: C
Chronic diarrhea can result in metabolic acidosis, which is diagnostic of low serum bicarbonate.

bicarbonate
-is an alkali the opposite of acid, and can balance acid. It keeps our blood from becoming too acidic.

Question 30

A nurse is performing an assessment on a patient who has not had a bowel movement in 3 days. The nurse would expect which other assessment finding?

a. Hypoactive bowel sounds
b. Jaundice in sclera
c. Decreased skin turgor
d. Soft tender abdomen

Answer 30

ANS: A
Three or more days with no bowel movement indicates hypomotility of the GI tract

Question 31

The nurse is caring for a patient with Clostridium difficile. Which of the following nursing actions will have the greatest impact in preventing the spread of bacteria?

a. Monthly in-services about contact precautions
b. Placing all contaminated items in biohazard bags
c. Mandatory cultures on all patients
d. Proper hand hygiene techniques

Answer 31

ANS: D
Proper hand hygiene is the best way to prevent the spread of bacteria.

C. Diff.

Question 32

A nurse is providing discharge teaching for a patient who is going home with a guaiac test. Which statement by the patient indicates the need for further education?

a. “If I get a positive result, I have gastrointestinal bleeding.”
b. “I should not eat red meat before my examination.”
c. “I should schedule to perform the examination when I am not menstruating.”
d. “I will need to perform this test three times if I have a positive result.”

Answer 32

ANS: A
A positive result does not mean GI bleeding; it could be a false positive from consuming red meat, some raw vegetables, or NSAIDs.

Proper patient education is important for viable results. The patient needs to avoid certain foods to rule out a false positive. If the test is
positive, the patient will need to repeat the test at least three times

Question 33

The nurse knows that the ideal time to change an ostomy pouch is

a. Before eating a meal, when the patient is comfortable.
b. When the patient feels that he needs to have a bowel movement.
c. When ordered in the patient’s chart.
d. After the patient has ambulated the length of the hallway

Answer 33

ANS: A
The nurse wants to change the ostomy appliance when as little output as necessary ensures a smooth procedure.

Question 34

A nurse is pouching an ostomy on a patient with an ileostomy. Which action by the nurse is most appropriate?

a. Changing the skin barrier portion of the ostomy pouch daily
b. Selecting a pouch that is able to hold excess output to reduce the frequency of pouch emptying
c. Thoroughly scrubbing the skin around the stoma to remove excess stool and adhesive
d. Measuring the correct size for the barrier device while leaving a 1/8-inch space around the stoma

Answer 35

ANS: B
Selecting a pouch that holds a large volume of output will decrease the frequency of emptying the pouch and may ease patient anxiety about pouch overflow

Question 36

A registered nurse is educating nursing students about the required interventions while administering an enema. Which statements if made by a student nurse indicate effective understanding? Select all that apply.
1
“I’ll place a waterproof pad under the patient’s hips and buttocks.”
2
“I’ll assist the patient into the supine position with the right knee flexed.”
3
“I’ll stand on the left side of the patient’s bed and raise the side rail on the opposite side.”
4
“I’ll cover the patient with a bath blanket, exposing only the rectal area, and clearly visualizing the anus.”
5
“If the patient has poor sphincter control, I’ll position the patient on a bedpan in a comfortable dorsal recumbent position.”

Answer 36

1,4,5

Question 37

While assessing a patient before administering an enema, the nurse inspects the patient’s abdomen for distention. What is the purpose of this nursing intervention?
1
It allows the nurse to plan for appropriate teaching measures.
2
It helps determine the number and type of enemas to be given.
3
It helps determine conditions that contraindicate the use of enemas.
4
It provides a baseline for determining the effectiveness of the enema.

Answer 37

4

Question 38

A nurse is discussing common bowel elimination problems. Which statement indicates effective understanding of the difference between fecal impaction and fecal incontinence?
1
Fecal impaction may occur due to antibiotic therapy, whereas fecal incontinence may occur due to opiate therapy.
2
Fecal impaction is the accumulation of gas in the lumen of the intestines, whereas fecal incontinence is the inability to control the passage of feces and gas from the anus.
3
Fecal impaction is common in debilitated, confused, or unconscious patients, whereas fecal incontinence is common in patients with impaired cognitive function.
4
Fecal impaction is characterized by loss of appetite, nausea and/or vomiting, and rectal pain, whereas fecal incontinence is characterized by abdominal distention and severe, sharp abdominal pain.

Answer 38

3

Question 39

Which statement about fecal incontinence is correct?
1
It is the inability to control the passage of feces and gas from the anus.
2
It is an increase in the number of stools and the passage of liquid, unformed feces.
3
It results when a patient has unrelieved constipation and is unable to expel the hardened feces retained in the rectum.
4
It is characterized by infrequent bowel movements (less than three per week) and hard, dry stools that are difficult to pass.

Answer 39

1

Question 40

Which bowel elimination problem is associated with abdominal fullness, cramping, distention, and severe, sharp pain?
1
Diarrhea
2
Flatulence
3
Hemorrhoids
4
Fecal incontinence

Answer 40

2

Question 41

Which are causes of diarrhea? Select all that apply.
1
Antibiotic use
2
Lack of exercise
3
Clostridium difficile
4
Reduced fluid intake
5
Surgeries of the lower gastrointestinal tract

Answer 41

1,3,5

Question 42

A nurse educates a group of patients on the prevention of constipation. Which statements if made by a patient indicate effective understanding? Select all that apply.
1
“I’ll perform regular physical exercise.”
2
“I’ll include high-fiber foods in my diet.”
3
“I’ll regularly eat meats and carbohydrates.”
4
“I’ll attempt to defecate at the same time each day.”
5
“I’ll ensure that my daily fluid intake is not less than 1 liter.”

Answer 42

1,2,4

Question 43

The nurse is caring for a patient admitted with diarrhea. What could be the possible causes of diarrhea in the patient? Select all that apply.
1
Use of opioid drugs
2
Use of antibiotics
3
Food allergies
4
Prolonged stress
5
Hypothyroidism

Answer 43

2,3,4

Question 44

Which patient has the highest risk of constipation?
1
A patient who is taking antibiotics
2
A patient who is taking opioid analgesics
3
A patient who has undergone endoscopy
4
A patient who drinks only 1.5 L of fluids per day

Answer 44

2

Question 45

Which factors may cause constipation? Select all that apply.
1
Improper diet
2
Lack of exercise
3
Use of laxatives
4
Use of antibiotics
5
Reduced fluid intake

Answer 45

1.2.5

Question 46

Purpose of Guaiac fecal occult blood test

FOBT

Answer 46

Qualitative method for detecting occult blood in the stool

It may be indicative of asymptomatic GI diseases such as:

• Colorectal cancer
• Polyps
• Colitis(An inflammatory reaction in the colon)

Answer 47

guaiac slide test

designed to assess presence of blood in stool specimens collected from three bowel movements on three different days

Question 47

Guaiac slide test result

Answer 47

Blue is positive on right

Designed to assess the presence of blood in stool specimens collected from three bowel movements on three different days

Question 48

Which of the following is not a digestive change associated with age?

A. Increased hydrochloric acid secretion

B. Decreased salivation

C. Decreased motility

D. Increased pouching of the intestinal wall.

Answer 48

A

Question 49

A a)__________ irritates the mucosal lining of the intestinal wall which then prompts increased intestinal motility
to evacuate the bowel.

evacuate　立ち退く

Answer 49

Cathartic