Concepts of Care for Patients With Noninflammatory/Inflammatory Intestinal Disorders

Question 1

After teaching a client with irritable bowel syndrome (IBS), a nurse assesses the client’s understanding. Which menu selection indicates that the client correctly understands the dietary teaching?

a. Ham sandwich on white bread, cup of applesauce, carbonated beverage

b. Broiled chicken with brown rice, steamed broccoli, glass of apple juice

c. Grilled cheese sandwich, small banana, cup of hot tea with lemon

d. Baked tilapia, fresh green beans, cup of coffee with low-fat milk

Answer 1

b. Broiled chicken with brown rice, steamed broccoli, glass of apple juice

Patients with IBS are advised to eat a high-fiber diet. Chicken with brown rice, broccoli, and apple juice has the highest fiber content. Clients should avoid alcohol, caffeine, and other gastric irritants.

Question 2

The nurse is caring for a client who is diagnosed with a complete small bowel obstruction. For what priority problem is this client most likely at risk?

a. Abdominal distention
b. Nausea
c. Electrolyte imbalance
d. Obstipation

Answer 2

c. Electrolyte imbalance

The client who has a small bowel obstruction is at the highest risk for fluid and electrolyte imbalances, especially dehydration and hypokalemia due to profuse vomiting. Nausea, abdominal distention, and obstipation are also usually present, but these problems are not as life threatening as the imbalances in electrolytes.

Question 3

A nurse assesses clients at a community health center. Which client is at highest risk for developing colorectal cancer?

a. A 37-year-old who drinks eight cups of coffee daily.
b. A 44-year-old with irritable bowel syndrome (IBS).
c. A 60-year-old lawyer who works 65 hours per week.
d. A 72-year-old who eats fast food frequently

Answer 3

d. A 72-year-old who eats fast food frequently

Colon cancer is rare before the age of 40, but its incidence increases rapidly with advancing age. Fast food tends to be high in fat and low in fiber, increasing the risk for colon cancer. Coffee intake, IBS, and a heavy workload do not increase the risk for colon cancer.

Question 4

A nurse assessing a client with colorectal cancer auscultates high-pitched bowel sounds and notes the presence of visible peristaltic waves. Which action would the nurse take?

a. Ask if the client is experiencing pain in the right shoulder.

b. Perform a rectal examination and assess for polyps.

c. Recommend that the client have computed tomography.

d. Administer a laxative to increase bowel movement activity.

Answer 4

c. Recommend that the client have computed tomography.

The presence of visible peristaltic waves, accompanied by high-pitched or high-pitched bowel sounds, is indicative of bowel obstruction caused by the tumor. The nurse would contact the primary health care provider with these results and recommend a computed tomography scan for further diagnostic testing. This assessment finding is not associated with right shoulder pain; peritonitis and cholecystitis are associated with referred pain to the right shoulder. The nurse generalist is not qualified to complete a rectal examination for polyps, and laxatives would not help this client.

Question 5

The nurse is caring for a client with a large bowel obstruction due to fecal impaction. What position would be appropriate for the client while in bed?

a. Prone
b. Supine
c. Recumbent
d. Semi-Fowler

Answer 5

d. Semi-Fowler

Having the client in a semi-sitting position helps to decrease the pressure caused by abdominal distention and promotes thoracic expansion to facilitate breathing.

Question 6

A nurse cares for a client who had a colostomy placed in the ascending colon 2 weeks ago. The client states, “The stool in my pouch is still liquid.” How would the nurse respond?

a. “The stool will always be liquid with this type of colostomy.”
b. “Eating additional fiber will bulk up your stool and decrease diarrhea.”
c. “Your stool will become firmer over the next couple of weeks.”
d. “This is abnormal. I will contact your primary health care provider.”

Answer 6

a. “The stool will always be liquid with this type of colostomy.”

Question 7

A nurse teaches a client who is at risk for colorectal cancer. Which dietary recommendation would the nurse teach the client?

a. “Eat low-fiber and low-residual foods.”
b. “White rice and bread are easier to digest.”
c. “Add vegetables such as broccoli and cauliflower to your diet.”
d. “Foods high in animal fat help to protect the intestinal mucosa.”

Answer 7

c. “Add vegetables such as broccoli and cauliflower to your diet.”

The client would be taught to modify his or her diet to decrease animal fat and refined carbohydrates. The client should also increase high-fiber foods and Brassica vegetables, including broccoli and cauliflower, which help to protect the intestinal mucosa from colon cancer.

Question 8

A nurse cares for a client who has a new colostomy. Which action would the nurse take?

a. Empty the pouch frequently to remove excess gas collection.
b. Change the ostomy pouch and barrier every morning.
c. Allow the pouch to completely fill with stool prior to emptying it.
d. Use surgical tape to secure the pouch and prevent leakage.

Answer 8

a. Empty the pouch frequently to remove excess gas collection.

The nurse would empty the new ostomy pouch frequently because of excess gas collection, and empty the pouch when it is one-third to one-half full of stool. The ostomy pouch does not need to be changed every morning. Ostomy barriers would be used to secure and seal the ostomy appliance; surgical tape would not be used.

Question 9

A nurse cares for a client who has a family history of colorectal cancer. The client states, “My father and my brother had colon cancer. What is the chance that I will get cancer?” How would the nurse respond?

a. “If you eat a low-fat and low-fiber diet, your chances decrease significantly.”

b. “You are safe. This is an autosomal dominant disorder that skips generations.”

c. “Preemptive surgery and chemotherapy will remove cancer cells and prevent cancer.”

d. “You should have a colonoscopy more frequently to identify abnormal polyps early.”

Answer 9

d. “You should have a colonoscopy more frequently to identify abnormal polyps early.”

The nurse would encourage the patient to have frequent colonoscopies to identify abnormal polyps and cancerous cells early. The abnormal gene associated with colon cancer is an autosomal dominant gene mutation that does not skip a generation and places the client at high risk for cancer. Changing the client’s diet to more high-fiber (not low-fiber) and preemptive chemotherapy may decrease the client’s risk of colon cancer but will not prevent it.

Question 10

A client is preparing to have a fecal occult blood test (FOBT). What health teaching would the nurse include prior to the test?

a. “This test will determine whether you have colorectal cancer.”
b. “You need to avoid red meat and NSAIDs for 48 hours before the test.”
c. “You don’t need to have this test because you can have a virtual colonoscopy.”
d. “This test can determine your genetic risk for developing colorectal cancer.”

Answer 10

b. “You need to avoid red meat and NSAIDs for 48 hours before the test.”

The FOBT is a screening test that is sometimes used to assess for microscopic lower GI bleeding. To help prevent false positive results, the client needs to avoid red meat, Vitamin C, and NSAIDs. The test is not diagnostic nor does it determine a client’s genetic risk for colorectal cancer.

Question 11

The nurse is caring for a client who is planning to have a laparoscopic colon resection for colorectal cancer tomorrow. Which statement by the client indicates a need for further teaching?

a. “I should have less pain after this surgery compared to having a large incision.”
b. “I will probably be in the hospital for 3 to 4 days after surgery.”
c. “I will be able to walk around a little on the same day as the surgery.”
d. “I will be able to return to work in a week or two depending on how I do.”
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Answer 11

b. “I will probably be in the hospital for 3 to 4 days after surgery.”

All of these statements are correct about having minimally invasive laparoscopic surgery except that the hospital stay will likely be only 1 or 2 days.

Question 12

The nurse is teaching a client how to avoid the formation of hemorrhoids. What lifestyle change would the nurse include?
a. Avoiding alcohol
b. Quitting smoking
c. Decreasing fluid intake
d. Increasing dietary fiber

Answer 12

c. Decreasing fluid intake

The major cause of hemorrhoid formation is constipation. Therefore, the nurse teaches the client ways to prevent constipation, which include increasing dietary fiber, increasing exercise and fluid intake, and avoiding straining when have a stool.

Question 13

The nurse is caring for a client with probable colorectal cancer (CRC). What assessment findings would the nurse expect? (Select all that apply.)

a. Weight gain
b. Rectal bleeding
c. Anemia
d. Change in stool shape
e. Electrolyte imbalances
f. Abdominal discomfort

Answer 13

b. Rectal bleeding
c. Anemia
d. Change in stool shape
f. Abdominal discomfort

The client who has CRC usually experiences unintentional weight loss and rectal bleeding, either gross or occult. As a result of bleeding, the client has anemia and fatigue. Electrolyte imbalances are not common, but the client may note that the shape or consistency of stool has changed.

Question 14

A nurse assesses a client with irritable bowel syndrome (IBS). Which questions would the nurse include in this client’s assessment? (Select all that apply.)

a. “Which food types cause an exacerbation of symptoms?”
b. “Where is your pain or discomfort and what does it feel like?”
c. “Have you lost a significant amount of weight lately?”
d. “Are your stools soft, watery, and black?”
e. “Do you often experience nausea and vomiting”

Answer 14

a. “Which food types cause an exacerbation of symptoms?”
b. “Where is your pain or discomfort and what does it feel like?”

The nurse would ask the client about factors that may cause exacerbations of symptoms, including food, stress, and anxiety. The nurse would also assess the location, intensity, and quality of the patient’s pain or discomfort. Clients who have IBS do not usually lose weight, have nausea and vomiting, or have stools that are black.

Question 15

A nurse is caring for a client who has been diagnosed with a small bowel obstruction. Which assessment findings would the nurse correlate with this diagnosis? (Select all that apply.)

a. Serum potassium of 2.8 mEq/L (2.8 mmol/L)
b. Loss of 15 lb (6.8 kg) without dieting
c. Abdominal pain in upper quadrants
d. Low-pitched bowel sounds
e. Serum sodium of 121 mEq/L (121 mmol/L)

Answer 15

a. Serum potassium of 2.8 mEq/L (2.8 mmol/L)
c. Abdominal pain in upper quadrants
e. Serum sodium of 121 mEq/L (121 mmol/L)

Question 16

**Concepts of Care for Patients With Inflammatory Intestinal Disorders

The nurse assesses a client who has appendicitis. Which assessment finding would the nurse expect?

a. Severe, steady right lower quadrant pain
b. Abdominal pain associated with nausea and vomiting
c. Marked peristalsis and hyperactive bowel sounds
d. Abdominal pain that increases with knee flexion

Answer 16

a. Severe, steady right lower quadrant pain

Question 17

The nurse teaches a client who has viral gastroenteritis. Which dietary instruction would the nurse include in the health teaching?

a. “Drink plenty of fluids to prevent dehydration.”
b. “You should only drink 1 L of fluids daily.”
c. “Increase your protein intake by drinking more milk.”
d. “Sips of cola or tea may help to relieve your nausea

Answer 17

a. “Drink plenty of fluids to prevent dehydration.”

The client should drink plenty of fluids to prevent dehydration. Milk products may not be tolerated. Caffeinated beverages increase intestinal motility and should be avoided.

Question 18

The nurse assesses a client with gastroenteritis. What risk factor would the nurse consider as the most likely cause of this disorder?

a. Consuming too much fruit
b. Consuming fried or pickled foods
c. Consuming dairy products
d. Consuming raw seafood

Answer 18

d. Consuming raw seafood

Raw seafood is often contaminated and unless cooked can would most likely cause gastroenteritis. Any of the other food can also become contaminated if not stored properly or contaminated by workers/cooks who contaminate these foods.

Question 19

The nurse assesses a client who is hospitalized with an exacerbation of Crohn disease. Which assessment finding would the nurse expect?

a. Positive Murphy sign with rebound tenderness to palpitation

b. Dull, hypoactive bowel sounds in the lower abdominal quadrants

c. High-pitched, rushing bowel sounds in the right lower quadrant

d. Reports of abdominal cramping that is worse at night

Answer 19

c. High-pitched, rushing bowel sounds in the right lower quadrant

The nurse expects high-pitched, rushing bowel sounds due to narrowing of the bowel lumen in Crohn disease. A positive Murphy sign is indicative of gallbladder disease, and rebound tenderness often indicates peritonitis. Dullness in the lower abdominal quadrants and hypoactive bowel sounds is not commonly found with Crohn disease. Nightly worsening of abdominal cramping is not consistent with Crohn disease.

Question 20

After teaching a patient with diverticular disease, a nurse assesses the client’s understanding. Which menu selection indicates the client correctly understood the teaching?

a. Roasted chicken with rice pilaf and a cup of coffee with cream

b. Spaghetti with meat sauce, a fresh fruit cup, and hot tea

c. Garden salad with a cup of bean soup and a glass of low-fat milk

d. Baked fish with steamed carrots and a glass of apple juice

Answer 20

d. Baked fish with steamed carrots and a glass of apple juice

Clients who have diverticular disease are prescribed a low-residue diet. Whole grains (rice pilaf), uncooked fruits and vegetables (salad, fresh fruit cup), and high-fiber foods (cup [240 mL] of bean soup) would be avoided with a low-residue diet. Canned or cooked vegetables are appropriate. Apple juice does not contain fiber and is acceptable for a low-residue diet.

Question 21

A nurse cares for a young client with a new ileostomy. The client states, “I cannot go to prom with an ostomy.” How would the nurse respond?
a. “Sure you can. Purchase a prom dress one size larger to hide the ostomy
appliance.”
b. “The pouch won’t be as noticeable if you avoid broccoli and carbonated drinks
prior to the prom.”
c. “Let’s talk to the ostomy nurse about options for ostomy supplies and dress
styles.”
d. “You can remove the pouch from

Answer 21

c. “Let’s talk to the ostomy nurse about options for ostomy supplies and dress
styles.”

The ostomy nurse is a valuable resource for patients, providing suggestions for supplies and methods to manage the ostomy. A larger dress size will not necessarily help hide the ostomy appliance. Avoiding broccoli and carbonated drinks does not offer reassurance for the client. Ileostomies have an almost constant liquid effluent, so pouch removal during the prom is not feasible.

Question 22

The nurse teaches a client about how to prevent transmission of gastroenteritis. Which statement by the nurse indicates a need for further teaching?
a. “I won’t let anyone use my dishes or glasses.”
b. “I’ll wash my hands with antibacterial soap.”
c. “I’ll keep my bathroom extra clean.”
d. “I’ll cook all the meals for my family.”

Answer 22

d. “I’ll cook all the meals for my family.”

All of these statements are correct except for that the client should not prepare meals for others to help prevent transmission of gastroenteritis.

Question 23

After teaching a client who is prescribed adalimumab for severe ulcerative colitis (UC), the nurse assesses the client’s understanding. Which statement made by the client indicates a need for further teaching?

a. “I will avoid large crowds and people who are sick.”
b. “I will take this medication with my breakfast each morning.”
c. “Nausea and vomiting are common side effects of this drug.”
d. “I should wash my hands after I play with my dog.”

Answer 23

b. “I will take this medication with my breakfast each morning.”

Adalimumab is an immune modulator that is given via subcutaneous injection. It does not need to be given with food or milk. Nausea and vomiting are two common side effects. Adalimumab can cause immune suppression, so clients receiving the medication should avoid large crowds and people who are sick, and should practice good handwashing.

Question 24

The nurse is caring for a client who is prescribed sulfasalazine. Which question would the nurse ask the client before starting this drug?

a. “Are you taking Vitamin C or B?
b. “Do you have any allergy to sulfa drugs?”
c. “Can you swallow pills pretty easily?”
d. “Do you have insurance to cover this drug?”

Answer 24

b. “Do you have any allergy to sulfa drugs?”

Sulfasalazine is a sulfa drug given for clients who have ulcerative colitis. However, it should not be given to those who have an allergy to sulfa and sulfa drugs to prevent a hypersensitivity reaction.

Question 25

A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which assessment would the nurse complete first?

a. Inspection of oral mucosa
b. Recent dietary intake
c. Heart rate and rhythm
d. Percussion of abdomen

Answer 25

c. Heart rate and rhythm

Although the client with severe diarrhea may experience skin irritation and hypovolemia, the client is most at risk for cardiac dysrhythmias secondary to potassium and magnesium loss from severe diarrhea. The client would have her or his electrolyte levels monitored, and electrolyte replacement may be necessary. Oral mucosa inspection, recent dietary intake, and abdominal percussion are important parts of physical assessment but are lower priority for this patient than heart rate and rhythm.

Question 26

A nurse reviews the electronic health record of a client who has Crohn disease and a draining fistula. Which documentation would alert the nurse to urgently contact the primary health care provider for additional prescriptions?

a. Serum potassium of 2.6 mEq/L (2.6 mmol/L)
b. Client ate 20% of breakfast meal
c. White blood cell count of 8200/mm3 (8.2 × 109/L)
d. Client’s weight decreased by 3 lb (1.4 kg)

Answer 26

a. Serum potassium of 2.6 mEq/L (2.6 mmol/L)

Fistulas place the patient with Crohn disease at risk for hypokalemia which can lead to serious dysrhythmias. This potassium level is low and would cause the nurse to intervene. The white blood cell count is normal. The other two findings are abnormal and also warrant intervention, but the potassium level takes priority.

Question 27

A client is preparing to have a laparoscopic restorative proctocolectomy with ileo pouch-anal anastomosis (RCA-IPAA). Which preoperative health teaching would the nurse include?

a. “You will have to wear an appliance for your permanent ileostomy.”

b. “You should be able to have better bowel continence after healing occurs.”

c. “You will have a large abdominal incision that will require irrigation.”
d. “This procedure can be performed under general or regional anesthesia.”

Answer 27

b. “You should be able to have better bowel continence after healing occurs.”

Question 28

After teaching a client who has diverticulitis, a nurse assesses the client’s understanding. Which statement made by the client indicates a need for further teaching?

a. “I’ll ride my bike or take a long walk at least three times a week.”

b. “I must try to include at least 25 g of fiber in my diet every day.”

c. “I will take a laxative nightly at bedtime to avoid becoming constipated.”

d. “I should use my legs rather than my back muscles when I lift heavy objects.”

Answer 28

c. “I will take a laxative nightly at bedtime to avoid becoming constipated.”

Laxatives are not recommended for patients with diverticulitis because they can increase pressure in the bowel, causing additional outpouching of the lumen. Exercise and a high-fiber diet are recommended for clients with diverticulitis because they promote regular bowel function. Using the leg muscles rather than the back for lifting prevents abdominal straining.

Question 29

The nurse plans care for a client with Crohn disease who has a heavily draining fistula. Which intervention would be the nurse’s priority action?

a. Low-fiber diet
b. Skin protection
c. Antibiotic administration
d. Intravenous glucocorticoids

Answer 29

b. Skin protection

Protecting the client’s skin is the priority action for a patient who has a heavily draining fistula. Intestinal fluid enzymes are caustic and can cause skin breakdown or fungal infections if the skin is not protected. The plan of care for a client who has Crohn disease also includes adequate nutrition

Question 30

A nurse cares for an older adult who is admitted to the hospital with complications of diverticulitis. Which actions would the nurse include in the client’s plan of care? (Select all that apply.)

a. Administer pain medications as prescribed.
b. Palpate the abdomen for distention.
c. Assess for sudden changes in mental status.
d. Provide the client with a high-fiber diet.
e. Evaluate stools for occult blood.

Answer 30

a. Administer pain medications as prescribed.
b. Palpate the abdomen for distention.
c. Assess for sudden changes in mental status.
e. Evaluate stools for occult blood.

When caring for an older adult who has diverticulitis, the nurse would administer analgesics as prescribed, palpate the abdomen for distention and tenderness, assess for confusion and sudden changes in mental status, and check stools for occult or frank blee

Question 31

A nurse prepares to discharge a client who is newly diagnosed with a chronic inflammatory bowel disease. Which questions would the nurse ask in preparation for discharge? (Select all that apply.)

a. Does your gym provide yoga classes?
b. When should you contact your provider?
c. What do you plan to eat for dinner?
d. Do you have a scale for daily weights?
e. How many bathrooms are in your home?

Answer 31

a. Does your gym provide yoga classes?
b. When should you contact your provider?
c. What do you plan to eat for dinner?
e. How many bathrooms are in your home?

Question 32

A nurse cares for a patient who has a chronic inflammatory bowel disease. Which actions would the nurse take to prevent skin excoriation? (Select all that apply.)

a. Cleanse the perineum with an antibacterial soap.
b. Use medicated wipes instead of toilet paper.
c. Identify foods that decrease constipation.
d. Apply a thin coat of aloe cream to the perineum.
e. Gently pat the perineum dry after cleansing.

Answer 32

b. Use medicated wipes instead of toilet paper.
d. Apply a thin coat of aloe cream to the perineum.
e. Gently pat the perineum dry after cleansing.

Question 33

The nurse is caring for a client with peritonitis. What assessment findings would the nurse expect? (Select all that apply.)
a. Nausea and vomiting
b. Distended rigid abdomen
c. Abdominal pain
d. Bradycardia
e. Decreased urinary output
f. Fever

Answer 33

a. Nausea and vomiting
c. Abdominal pain
d. Bradycardia
e. Decreased urinary output
f. Fever