Chapter 43: Nursing Management: Lower Gastrointestinal Problems Flashcards
- Which action will the nurse include in the plan of care for a 42-year-old patient who is being admitted with Clostridium difficile?
a.
Educate the patient about proper food storage.
b.
Order a diet with no dairy products for the patient.
c.
Place the patient in a private room on contact isolation.
d.
Teach the patient about why antibiotics will not be used.
ANS: C
Because C. difficile is highly contagious, the patient should be placed in a private room and contact precautions should be used. There is no need to restrict dairy products for this type of diarrhea. Metronidazole (Flagyl) is frequently used to treat C. difficile. Improper food handling and storage do not cause C. difficile.
- A 71-year-old male patient tells the nurse that growing old causes constipation so he has been using a suppository for constipation every morning. Which action should the nurse take first?
a.
Encourage the patient to increase oral fluid intake.
b.
Assess the patient about risk factors for constipation.
c.
Suggest that the patient increase intake of high-fiber foods.
d.
Teach the patient that a daily bowel movement is unnecessary.
ANS: B
The nurses initial action should be further assessment of the patient for risk factors for constipation and for his usual bowel pattern. The other actions may be appropriate but will be based on the assessment.
- A 64-year-old woman who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in the response?
a.
Absorption of fat-soluble vitamins may be reduced by fiber-containing laxatives.
b.
Dietary sources of fiber should be eliminated to prevent excessive gas formation.
c.
Use of this type of laxative to prevent constipation does not cause adverse effects.
d.
Large amounts of fluid should be taken to prevent impaction or bowel obstruction.
ANS: D
A high fluid intake is needed when patients are using bulk-forming laxatives to avoid worsening constipation. Although bulk-forming laxatives are generally safe, the nurse should emphasize the possibility of constipation or obstipation if inadequate fluid intake occurs. Although increased gas formation is likely to occur with increased dietary fiber, the patient should gradually increase dietary fiber and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool softeners and lubricants, not by bulk-forming laxatives.
- A 26-year-old woman is being evaluated for vomiting and abdominal pain. Which question from the nurse will be most useful in determining the cause of the patients symptoms?
a.
What type of foods do you eat?
b.
Is it possible that you are pregnant?
c.
Can you tell me more about the pain?
d.
What is your usual elimination pattern?
ANS: C
A complete description of the pain provides clues about the cause of the problem. Although the nurse should ask whether the patient is pregnant to determine whether the patient might have an ectopic pregnancy and before any radiology studies are done, this information is not the most useful in determining the cause of the pain. The usual diet and elimination patterns are less helpful in determining the reason for the patients symptoms.
- A patient complains of gas pains and abdominal distention two days after a small bowel resection. Which nursing action is best to take?
a.
Encourage the patient to ambulate.
b.
Instill a mineral oil retention enema.
c.
Administer the ordered IV morphine sulfate.
d.
Offer the ordered promethazine (Phenergan) suppository.
ANS: A
Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine (Phenergan) is used as an antiemetic rather than to decrease gas pains or distention.
- A 58-year-old man with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next?
a.
Auscultate the bowel sounds.
b.
Prepare the patient for surgery.
c.
Check the patients oral temperature.
d.
Obtain information about the accident.
ANS: B
Return of brown drainage and fecal material suggests perforation of the bowel and the need for immediate surgery. Auscultation of bowel sounds, checking the temperature, and obtaining information about the accident are appropriate actions, but the priority is to prepare to send the patient for emergency surgery.
- A 27-year-old female patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action should the nurse take?
a.
Encourage the patient to sip clear liquids.
b.
Assess the abdomen for rebound tenderness.
c.
Assist the patient to cough and deep breathe.
d.
Apply an ice pack to the right lower quadrant.
ANS: D
The patients clinical manifestations are consistent with appendicitis, and application of an ice pack will decrease inflammation at the area. Checking for rebound tenderness frequently is unnecessary and uncomfortable for the patient. The patient should be NPO in case immediate surgery is needed. The patient will need to know how to cough and deep breathe postoperatively, but coughing will increase pain at this time.
- Which nursing action will be included in the plan of care for a 27-year-old male patient with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)?
a.
Encourage the patient to express concerns and ask questions about IBS.
b.
Suggest that the patient increase the intake of milk and other dairy products.
c.
Educate the patient about the use of alosetron (Lotronex) to reduce symptoms.
d.
Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs).
ANS: A
Because psychologic and emotional factors can affect the symptoms for IBS, encouraging the patient to discuss emotions and ask questions is an important intervention. Alosetron has serious side effects, and is used only for female patients who have not responded to other therapies. Although yogurt may be beneficial, milk is avoided because lactose intolerance can contribute to symptoms in some patients. NSAIDs can be used by patients with IBS.
- A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to
a.
administer IV metoclopramide (Reglan).
b.
discontinue the patients oral food intake.
c.
administer cobalamin (vitamin B12) injections.
d.
teach the patient about total colectomy surgery.
ANS: B
An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO. Metoclopramide increases peristalsis and will worsen symptoms. Cobalamin (vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. Although total colectomy is needed for some patients, there is no indication that this patient is a candidate.
- Which nursing action will the nurse include in the plan of care for a 35-year-old male patient admitted with an exacerbation of inflammatory bowel disease (IBD)?
a.
Restrict oral fluid intake.
b.
Monitor stools for blood.
c.
Ambulate four times daily.
d.
Increase dietary fiber intake.
ANS: B
Because anemia or hemorrhage may occur with IBD, stools should be assessed for the presence of blood. The other actions would not be appropriate for the patient with IBD. Because dietary fiber may increase gastrointestinal (GI) motility and exacerbate the diarrhea, severe fatigue is common with IBD exacerbations, and dehydration may occur.
- Which patient statement indicates that the nurses teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective?
a.
The medication will be tapered if I need surgery.
b.
I will need to use a sunscreen when I am outdoors.
c.
I will need to avoid contact with people who are sick.
d.
The medication will prevent infections that cause the diarrhea.
ANS: B
Sulfasalazine may cause photosensitivity in some patients. It is not used to treat infections. Sulfasalazine does not reduce immune function. Unlike corticosteroids, tapering of sulfasalazine is not needed.
- A 22-year-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective?
a.
The patient uses incontinence briefs to contain loose stools.
b.
The patient asks for antidiarrheal medication after each stool.
c.
The patient uses witch hazel compresses to decrease irritation.
d.
The patient cleans the perianal area with soap after each stool.
ANS: C
Witch hazel compresses are suggested to reduce anal irritation and discomfort. Incontinence briefs may trap diarrhea and increase the incidence of skin breakdown. Antidiarrheal medications are not given 15 to 20 times a day. The perianal area should be washed with plain water after each stool.
- Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching?
a.
Scrambled eggs
b.
White toast and jam
c.
Oatmeal with cream
d.
Pancakes with syrup
ANS: C
During acute exacerbations of IBD, the patient should avoid high-fiber foods such as whole grains. High-fat foods also may cause diarrhea in some patients. The other choices are low residue and would be appropriate for this patient.
- After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, I cannot manage all these changes. I dont want to look at the stoma. What is the best action by the nurse?
a.
Reassure the patient that ileostomy care will become easier.
b.
Ask the patient about the concerns with stoma management.
c.
Develop a detailed written list of ostomy care tasks for the patient.
d.
Postpone any teaching until the patient adjusts to the ileostomy.
ANS: B
Encouraging the patient to share concerns assists in helping the patient adjust to the body changes. Acknowledgment of the patients feelings and concerns is important rather than offering false reassurance. Because the patient indicates that the feelings about the ostomy are the reason for the difficulty with the many changes, development of a detailed ostomy care plan will not improve the patients ability to manage the ostomy. Although detailed ostomy teaching may be postponed, the nurse should offer teaching about some aspects of living with an ostomy.
- A 51-year-old male patient has a new diagnosis of Crohns disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg) over 2 months. The nurse will plan to teach about
a.
medication use.
b.
fluid restriction.
c.
enteral nutrition.
d.
activity restrictions.
ANS: A
Medications are used to induce and maintain remission in patients with inflammatory bowel disease (IBD). Decreased activity level is indicated only if the patient has severe fatigue and weakness. Fluids are needed to prevent dehydration. There is no advantage to enteral feedings.
- A 24-year-old woman with Crohns disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient?
a.
Bacteria in the perianal area can enter the urethra.
b.
Fistulas can form between the bowel and bladder.
c.
Drink adequate fluids to maintain normal hydration.
d.
Empty the bladder before and after sexual intercourse.
ANS: B
Fistulas between the bowel and bladder occur in Crohns disease and can lead to UTI. Teaching for UTI prevention in general includes good hygiene, adequate fluid intake, and voiding before and after intercourse.
- A 73-year-old patient with diverticulosis has a large bowel obstruction. The nurse will monitor for
a.
referred back pain.
b.
metabolic alkalosis.
c.
projectile vomiting.
d.
abdominal distention.
ANS: D
Abdominal distention is seen in lower intestinal obstruction. Referred back pain is not a common clinical manifestation of intestinal obstruction. Metabolic alkalosis is common in high intestinal obstruction because of the loss of HCl acid from vomiting. Projectile vomiting is associated with higher intestinal obstruction.
- The nurse preparing for the annual physical exam of a 50-year-old man will plan to teach the patient about
a.
endoscopy.
b.
colonoscopy.
c.
computerized tomography screening.
d.
carcinoembryonic antigen (CEA) testing.
ANS: B
At age 50, individuals with an average risk for colorectal cancer (CRC) should begin screening for CRC. Colonoscopy is the gold standard for CRC screening. The other diagnostic tests are not recommended as part of a routine annual physical exam at age 50.
- The nurse is providing preoperative teaching for a 61-year-old man scheduled for an abdominal-perineal resection. Which information will the nurse include?
a.
Another surgery in 8 to 12 weeks will be used to create an ileal-anal reservoir.
b.
The patient will begin sitting in a chair at the bedside on the first postoperative day.
c.
The patient will drink polyethylene glycol lavage solution (GoLYTELY) preoperatively.
d.
IV antibiotics will be started at least 24 hours before surgery to reduce the bowel bacteria.
ANS: C
A bowel-cleansing agent is used to empty the bowel before surgery to reduce the risk for infection. A permanent colostomy is created with this surgery. Sitting is contraindicated after an abdominal-perineal resection. Oral antibiotics (rather than IV antibiotics) are given to reduce colonic and rectal bacteria.
- A 74-year-old patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. The nurse explains that the test is used to
a.
identify any metastasis of the cancer.
b.
monitor the tumor status after surgery.
c.
confirm the diagnosis of a specific type of cancer.
d.
determine the need for postoperative chemotherapy.
ANS: B
CEA is used to monitor for cancer recurrence after surgery. CEA levels do not help to determine whether there is metastasis of the cancer. Confirmation of the diagnosis is made on the basis of biopsy. Chemotherapy use is based on factors other than CEA.
- A 71-year-old patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery?
a.
Teach about a low-residue diet.
b.
Monitor output from the stoma.
c.
Assess the perineal drainage and incision.
d.
Encourage acceptance of the colostomy stoma.
ANS: C
Because the perineal wound is at high risk for infection, the initial care is focused on assessment and care of this wound. Teaching about diet is best done closer to discharge from the hospital. There will be very little drainage into the colostomy until peristalsis returns. The patient will be encouraged to assist with the colostomy, but this is not the highest priority in the immediate postoperative period.
- A 47-year-old female patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. The nurse should
a.
place ice packs around the stoma.
b.
notify the surgeon about the stoma.
c.
monitor the stoma every 30 minutes.
d.
document stoma assessment findings.
ANS: D
The stoma appearance indicates good circulation to the stoma. There is no indication that surgical intervention is needed or that frequent stoma monitoring is required. Swelling of the stoma is normal for 2 to 3 weeks after surgery, and an ice pack is not needed.
