chapter 45

Question 1

1. The nurse is caring for a client who has watery, incontinent diarrhea and has diagnosed with Clostridium difficile. Which of the following actions should the nurse include in the plan of care?
   a. Order a diet with no dairy products for the client.
   b. Place the client in a private room with contact isolation.
   c. Teach the client about why antibiotics are not being used.
   d. Educate the client about proper food handling and storage.

Answer 1

b. Place the client in a private room with contact isolation.

Question 2

A client tells the nurse, “I have problems with constipation now that I am older, so I use a suppository every morning.” Which of the following actions should the nurse take first?
a. Encourage the client to increase oral fluid intake.
b. Inform the client that a daily bowel movement is unnecessary.
c. Assess the client about individual risk factors for constipation.
d. Suggest that the client increase dietary intake of high-fibre foods.

Answer 2

c. Assess the client about individual risk factors for constipation.

Question 3

The nurse is teaching a client who has chronic constipation about the use of psyllium. Which of the following information should the nurse include?
a. Absorption of fat-soluble vitamins may be reduced by fibre-containing laxatives.
b. Dietary sources of fibre 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.

Answer 3

d. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.

Question 4

The nurse is obtaining a history for a female client who is being evaluated for acute lower abdominal pain and vomiting. Which of the following questions is most useful in determining the cause of the client’s symptoms?
a. “Is it possible that you are pregnant?”
b. “Can you tell me more about the pain?”
c. “What type of foods do you usually eat?”
d. “What is your usual elimination pattern?”

Answer 4

b. “Can you tell me more about the pain?”

Question 5

The nurse is caring for a client who had an exploratory laparotomy with a resection of a short segment of small bowel two days previously. The client has gas pains and abdominal
distension. Which of the following nursing actions is best to take at this time?
a. Give a return-flow enema.
b. Assist the client to ambulate.
c. Administer the ordered IV morphine sulphate.
d. Insert the ordered promethazine suppository.

Answer 5

b. Assist the client to ambulate.

Question 6

The nurse is caring for a client who has blunt abdominal trauma after an automobile accident and severe pain. A peritoneal lavage returns brown drainage with fecal material. Which of the following actions should the nurse plan to take next?
a. Auscultate the bowel sounds.
b. Prepare the client for surgery.
c. Check the client’s oral temperature.
d. Obtain information about the accident.

Answer 6

b. Prepare the client for surgery.

Question 7

The nurse is admitting a client for evaluation of right lower quadrant abdominal pain with nausea and vomiting and an O2 saturation of 90%. Which of the following actions should
the nurse take?
a. Check for rebound tenderness.
b. Assist the client to cough and deep breathe.
c. Administer oxygen via nasal cannula.
d. Encourage the client to take sips of clear liquids.

Answer 7

c. Administer oxygen via nasal cannula.

Question 8

Which of the following nursing actions should be included in the plan of care for a male client with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)?
a. Encourage the client to express feelings and ask questions about IBS.
b. Suggest that the client increase the intake of milk and other dairy products.
c. Educate the client about the use of Tegaserod to reduce symptoms.
d. Teach the client to avoid using nonsteroidal anti-inflammatory drugs (NSAIDs).

Answer 8

a. Encourage the client to express feelings and ask questions about IBS.

Question 9

The nurse is caring for a client with an acute exacerbation of ulcerative colitis having 14–16 bloody stools a day and crampy abdominal pain associated with the diarrhea. Which of the following actions should the nurse take?
a. Place the client on NPO status.
b. Administer IV metoclopramide.
c. Teach the client about total colectomy surgery.
d. Administer cobalamin injections.

Answer 9

a. Place the client on NPO status.

Question 10

The nurse is admitting a client with an exacerbation of inflammatory bowel disease (IBD). Which of the following nursing actions should the nurse include in the plan of care?
a. Restrict oral fluid intake.
b. Monitor stools for blood.
c. Increase dietary fibre intake.
d. Ambulate four times daily.

Answer 10

b. Monitor stools for blood.

Question 11

The nurse is teaching a client with ulcerative colitis about sulphasalazine. Which of the following client statements indicates that the teaching has been effective?
a. “I will need to take this medication for at least one year.”
b. “I will need to avoid contact with people who are sick.”
c. “The medication will need to be tapered if I need surgery.”
d. “The medication will prevent infections that cause the diarrhea.”

Answer 11

a. “I will need to take this medication for at least one year.”

Question 12

The nurse is caring for a client with an exacerbation of ulcerative colitis who is having 15–20 stools daily and has external hemorrhoids. Which of the following client behaviours indicate that teaching regarding maintenance of skin integrity has been effective?
a. The client uses incontinence briefs to contain loose stools.
b. The client asks for antidiarrheal medication after each stool.
c. The client uses witch hazel compresses to decrease anal discomfort.
d. The client cleans the perianal area with soap and water after each stool.

Answer 12

c. The client uses witch hazel compresses to decrease anal discomfort.

Question 13

The nurse is providing client teaching about recommended dietary choices for a client with an acute exacerbation of inflammatory bowel disease (IBD). Which of the following diet
choices by the client indicates a need for more teaching?
a. Scrambled eggs
b. White toast and jam
c. Oatmeal with cream
d. Pancakes with syrup

Answer 13

c. Oatmeal with cream

Question 14

The nurse is caring for a client who has had a total proctocolectomy and permanent ileostomy who tells the nurse, “I cannot bear to even look at the stoma. I do not think I can
manage all these changes.” Which of the following actions is best?
a. Develop a detailed written plan for ostomy care for the client.
b. Ask the client more about the concerns with stoma management.
c. Reassure the client that care for the ileostomy will become easier.
d. Postpone any client teaching until the client adjusts to the ileostomy.

Answer 14

b. Ask the client more about the concerns with stoma management.

Question 15

The nurse is caring for a client who has a new diagnosis of Crohn’s disease after having frequent diarrhea and a weight loss of 4.5 kg over 2 months. Which of the following topics
should the nurse plan to include in the teaching plan?
a. Medication use
b. Fluid restriction
c. Enteral nutrition
d. Activity restrictions

Answer 15

a. Medication use

Question 16

The nurse is caring for a client with Crohn’s disease who develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. Which of the following
information should the nurse teach the client?
a. To clean the perianal area carefully after any stools
b. About fistula formation between the bowel and bladder
c. To empty the bladder before and after sexual intercourse
d. About the effects of corticosteroid use on immune function

Answer 16

b. About fistula formation between the bowel and bladder

Question 17

The nurse is caring for a client who has a large bowel obstruction that occurred as a result of diverticulosis. Which of the following symptoms should the nurse monitor for when assessing the client?
a. Referred back pain
b. Metabolic alkalosis
c. Projectile vomiting
d. Abdominal distension

Answer 17

d. Abdominal distension

Question 18

The nurse is preparing a 50-year-old client for an annual physical examination. Which of the following diagnostic tests should the nurse teach to the client?
a. Endoscopy
b. Fecal occult blood test
c. Computerized tomography screening
d. Carcinoembryonic antigen (CEA) testing

Answer 18

b. Fecal occult blood test

Question 19

The nurse is conducting preoperative preparation for a client scheduled for an abdominal-perineal resection. Which of the following actions should the nurse implement?
a. Give IV antibiotics starting 24 hours before surgery to reduce the number of bowel bacteria.
b. Teach the client that activities such as sitting at the bedside will be started the first postoperative day.
c. Instruct the client that another surgery in 8–12 weeks will be used to create an ileal-anal reservoir.
d. Administer polyethylene glycol lavage solution (GoLYTELY) to ensure that the bowel is empty before the surgery.

Answer 19

d. Administer polyethylene glycol lavage solution (GoLYTELY) to ensure that the bowel is empty before the surgery.

Question 20

Before undergoing a colon resection for cancer of the colon, a client has an elevated carcinoembryonic antigen (CEA) test. Which of the following explanations should the nurse provide to the client about this test?
a. It confirms the diagnosis of colon cancer.
b. It monitors the tumour status after surgery.
c. It identifies the extent of cancer spread or metastasis.
d. It determines the need for postoperative chemotherapy.

Answer 20

b. It monitors the tumour status after surgery.

Question 21

Which of the following nursing actions is most important to include in the plan of care for a client who had an abdominal-perineal resection the previous day?
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.

Answer 21

c. Assess the perineal drainage and incision.

Question 22

During the initial postoperative assessment of a client’s stoma formed from a transverse colostomy, the nurse finds it to be deep pink with moderate edema and a small amount of bleeding. Which of the following actions should the nurse take based upon these findings?
a. Document the stoma assessment.
b. Monitor the stoma every 30 minutes.
c. Notify the surgeon about the stoma appearance.
d. Place an ice pack on the stoma to reduce swelling.

Answer 22

a. Document the stoma assessment.

Question 23

The nurse is caring for a client who has ulcerative colitis and a proctocolectomy and ileostomy. Which of the following information should the nurse include in client teaching?
a. Restrict fluid intake to prevent constant liquid drainage from the stoma.
b. Use care when eating high-fibre foods to avoid obstruction of the ileum.
c. Irrigate the ileostomy daily to avoid having to wear a drainage appliance.
d. Change the pouch every day to prevent leakage of contents onto the skin.

Answer 23

b. Use care when eating high-fibre foods to avoid obstruction of the ileum.

Question 24

The nurse is providing discharge teaching for a client with a new colostomy. Which of the following client actions indicates that the teaching has been effective?
a. Empties the colostomy bag once it is 2/3 full.
b. Drinks at least 1 000 mL of fluid a day.
c. Contacts the health care provider if there is pain or erythema in the peristomal area.
d. Takes acetaminophen when a temperature of 38.3°C (100.9°F) occurs.

Answer 24

c. Contacts the health care provider if there is pain or erythema in the peristomal area.

Question 25

The nurse is providing teaching to a client with a new ileostomy. Which of the following daily drainage amounts should the nurse inform the client is expected after the bowel adjusts to the ileostomy?
a. 400 mL
b. 600 mL
c. 800 mL
d. 1 000 mL

Answer 25

c. 800 mL

Question 26

Which of the following actions should the nurse implement when initiating the initial plan of care for a client admitted with acute diverticulitis?
a. Give stool softeners.
b. Administer IV fluids.
c. Order a diet high in fibre and fluids.
d. Prepare the client for colonoscopy.

Answer 26

b. Administer IV fluids.

Question 27

The nurse is providing discharge teaching for a client who has had a herniorrhaphy to repair an incarcerated inguinal hernia. Which of the following information should be included in the teaching?
a. Encourage the client to cough.
b. Provide sitz baths several times daily.
c. Avoid use of acetaminophen for pain.
d. Apply a scrotal support and encourage deep breathing.

Answer 27

d. Apply a scrotal support and encourage deep breathing.

Question 28

After the nurse has completed teaching a client with newly diagnosed celiac disease, which of the following breakfast choices by the client indicates good understanding of the
information?
a. Corn tortilla with eggs
b. Bagel with cream cheese
c. Oatmeal with non-fat milk
d. Whole wheat toast with butter

Answer 28

a. Corn tortilla with eggs

Question 29

Which of the following instructions should the nurse include in discharge teaching for a client who has had a hemorrhoidectomy at an outpatient surgical centre?
a. Maintain a low-residue diet until the surgical area is healed.
b. Use ice packs on the perianal area to relieve pain and swelling.
c. Take prescribed pain medications before a bowel movement is expected.
d. Delay having a bowel movement for several days until healing has occurred.

Answer 29

c. Take prescribed pain medications before a bowel movement is expected.

Question 30

A client calls the clinic and tells the nurse about a new onset of severe and frequent, diarrhea. Which of the following actions should the nurse anticipate for this client?
a. Collect a stool specimen.
b. Prepare for colonoscopy.
c. Schedule a barium enema.
d. Have blood cultures drawn.

Answer 30

a. Collect a stool specimen.

Question 31

The nurse is caring for a client with Crohn’s disease who has megaloblastic anemia. Which of the following medications should the nurse anticipate teaching the client about taking on an ongoing basis?
a. Oral ferrous sulphate tablets
b. Regular blood transfusions
c. Iron dextran (Imferon) infusion
d. Cobalamin (B12) nasal spray or injections

Answer 31

d. Cobalamin (B12) nasal spray or injections

Question 32

The nurse is performing an admission assessment for a client with abdominal pain and palpates the left lower quadrant and the client indicates right lower quadrant pain. Which of the following descriptors should the nurse use to document this finding?
a. Rebound pain
b. Cullen sign
c. Rovsing sign
d. McBurney point

Answer 32

c. Rovsing sign

Question 33

The nurse is caring for a critically ill client who develops incontinence of watery stools. What of the following actions is best for the nurse to take to prevent complications associated with ongoing incontinence?
a. Insert a rectal tube.
b. Use incontinence briefs.
c. Apply a perianal pouch.
d. Assist the client to a bedside commode at frequent intervals.

Answer 33

c. Apply a perianal pouch.

Question 34

The nurse is interviewing a client with abdominal pain and possible irritable bowel syndrome. Which of the following questions is most important for the nurse to ask?
a. “Have you been passing a lot of gas?”
b. “What foods affect your bowel patterns?”
c. “Do you have any abdominal distension?”
d. “How long have you had abdominal pain?”

Answer 34

d. “How long have you had abdominal pain?”

Question 35

Which of the following prescribed interventions should the nurse implement first when caring for a client who has just diagnosed with peritonitis caused by a ruptured diverticulum?
a. Administer morphine sulphate 4 mg IV.
b. Infuse metronidazole 500 mg IV.
c. Send the client for a computerized tomography scan.
d. Insert a nasogastric (NG) tube and connect it to intermittent low suction.

Answer 35

b. Infuse metronidazole 500 mg IV.

Question 36

Which of the following actions should the nurse take first when a client calls the clinic complaining of diarrhea of 24 hours’ duration?
a. Ask the client to describe the character of the stools and any associated symptoms.
b. Inform the client that laboratory testing of blood and stool specimens will be necessary.
c. Suggest that the client drink clear liquid fluids with electrolytes, such as Gatorade or Pedialyte.
d. Advise the client to use over-the-counter loperamide to slow gastrointestinal (GI) motility.

Answer 36

a. Ask the client to describe the character of the stools and any associated symptoms.

Question 37

A client is admitted to the emergency department with severe abdominal pain with rebound tenderness. The vital signs include temperature 38.3°C (100.9°F), pulse 130, respirations 34, and blood pressure (BP) 84/50. Which of the following interventions
should the nurse implement first?
a. Administer IV ketorolac 5 mg.
b. Draw blood for a complete blood count (CBC).
c. Obtain a computed tomography (CT) scan of the abdomen.
d. Infuse 1 000 mL of lactated Ringer’s solution over 30 minutes.

Answer 37

d. Infuse 1 000 mL of lactated Ringer’s solution over 30 minutes.

Question 38

The nurse is caring for a client following an exploratory laparotomy and bowel resection who has a nasogastric tube to suction and symptoms of nausea and stomach distension. Which of the following actions should the nurse take first?
a. Auscultate for hypotonic bowel sounds.
b. Notify the client’s health care provider.
c. Reposition the tube and check for placement.
d. Remove the tube and replace it with a new one.

Answer 38

c. Reposition the tube and check for placement.

Question 39

A client is brought to the emergency department with a knife impaled in the abdomen following a domestic fight. During the initial assessment of the client, which of the following actions should the nurse implement?
a. Assess the BP and pulse.
b. Remove the knife to assess the wound.
c. Determine the presence of Rovsing sign.
d. Insert a urinary catheter and assess for hematuria.

Answer 39

a. Assess the BP and pulse.

Question 40

A client with ulcerative colitis who is taking azathioprine calls the nurse in the outpatient clinic about all of these symptoms. Which of the following symptoms is most important to communicate to the health care provider?
a. Nausea
b. Joint pain
c. Frequent headaches
d. Elevated temperature

Answer 40

d. Elevated temperature

Question 41

The nurse is interviewing a 40-year-old client and obtains information about the following client problems. Which of the following information is most important to communicate to
the health care provider?
a. The client had an appendectomy at age 17.
b. The client smokes a pack/day of cigarettes.
c. The client has a history of frequent constipation.
d. The client has recently noticed blood in the stools.

Answer 41

d. The client has recently noticed blood in the stools.

Question 42

When assessing the colour of a new stoma in the postoperative period, which of the following findings should cause the nurse to suspect anemia?
a. Light red to rose
b. Pale pink
c. Blanching, dark red to purple
d. Dark red

Answer 42

b. Pale pink

Question 43

The nurse is caring for a client who has been taking antibiotics for several days and develops watery diarrhea. Which of the following actions should the nurse take first?
a. Notify the health care provider.
b. Obtain a stool specimen for analysis.
c. Provide education about handwashing.
d. Place the client on contact precautions.

Answer 43

d. Place the client on contact precautions.

Question 44

After receiving change-of-shift report, which of the following clients should the nurse assess first?
a. A client whose new ileostomy has drained 800 mL over the previous 8 hours
b. A client with familial adenomatous polyposis who has occult blood in the stool
c. A client with ulcerative colitis who has had six liquid stools in the previous 4 hours
d. A client who has abdominal distension and an apical heart rate of 136 beats/minute

Answer 44

d. A client who has abdominal distension and an apical heart rate of 136 beats/minute

Question 45

A client with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as illustrated. Which of the following information should the nurse include in client teaching?
a. This type of colostomy is usually temporary.
b. Soft, formed stool can be expected as drainage.
c. Stool will be expelled from both ostomy stomas.
d. Irrigations can regulate drainage from the stomas.

Answer 45

a. This type of colostomy is usually temporary.