Ignatavicius Ch 56: Care of Patients with Noninflammatory Intestinal Disorders Flashcards
After teaching a client with irritable bowel syndrome (IBS), a nurse assesses the clients understanding. Which menu selection indicates that the client correctly understands the dietary teaching?
a. Ham sandwich on white bread, cup of applesauce, glass of diet cola
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
b. Broiled chicken with brown rice, steamed broccoli, glass of apple juice
Clients with IBS are advised to eat a high-fiber diet (30 to 40 g/day), with 8 to 10 cups of liquid daily. Chicken with brown rice, broccoli, and apple juice has the highest fiber content. They should avoid alcohol, caffeine, and other gastric irritants.
A nurse assesses a client who is prescribed alosetron (Lotronex). Which assessment question should the nurse ask this client?
a. Have you been experiencing any constipation?
b. Are you eating a diet high in fiber and fluids?
c. Do you have a history of high blood pressure?
d. What vitamins and supplements are you taking?
a. Have you been experiencing any constipation?
Ischemic colitis is a life-threatening complication of alosetron. The nurse should assess the client for constipation. The other questions do not identify complications related to alosetron.
After teaching a client who has a femoral hernia, the nurse assesses the clients understanding. Which statement indicates the client needs additional teaching related to the proper use of a truss?
a. I will put on the truss before I go to bed each night.
b. Ill put some powder under the truss to avoid skin irritation.
c. The truss will help my hernia because I cant have surgery.
d. If I have abdominal pain, Ill let my health care provider know right away.
a. I will put on the truss before I go to bed each night.
The client should be instructed to apply the truss before arising, not before going to bed at night. The other statements show an accurate understanding of using a truss.
A nurse assesses a client who is recovering from a hemorrhoidectomy that was done the day before. The nurse notes that the client has lower abdominal distention accompanied by dullness to percussion over the distended area. Which action should the nurse take?
a. Assess the clients heart rate and blood pressure.
b. Determine when the client last voided.
c. Ask if the client is experiencing flatus.
d. Auscultate all quadrants of the clients abdomen.
b. Determine when the client last voided.
Assessment findings indicate that the client may have an over-full bladder. In the immediate postoperative period, the client may experience difficulty voiding due to urinary retention. The nurse should assess when the client last voided. The clients vital signs may be checked after the nurse determines the clients last void. Asking about flatus and auscultating bowel sounds are not related to a hemorrhoidectomy.
A nurse assesses clients at a community health center. Which client is at highest risk for the development of 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
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.
A nurse assessing a client with colorectal cancer auscultates high-pitched bowel sounds and notes the presence of visible peristaltic waves. Which action should 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. Contact the provider and recommend computed tomography.
d. Administer a laxative to increase bowel movement activity.
c. Contact the provider and recommend computed tomography.
The presence of visible peristaltic waves, accompanied by high-pitched or tingling bowel sounds, is indicative of partial obstruction caused by the tumor. The nurse should contact the 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 registered nurse is not qualified to complete a rectal examination for polyps, and laxatives would not help this client.
- A nurse prepares a client for a colonoscopy scheduled for tomorrow. The client states, My doctor told me that the fecal occult blood test was negative for colon cancer. I dont think I need the colonoscopy and would like to cancel it. How should the nurse respond?
a. Your doctor should not have given you that information prior to the colonoscopy.
b. The colonoscopy is required due to the high percentage of false negatives with the blood test.
c. A negative fecal occult blood test does not rule out the possibility of colon cancer.
d. I will contact your doctor so that you can discuss your concerns about the procedure.
c. A negative fecal occult blood test does not rule out the possibility of colon cancer.
A negative result from a fecal occult blood test does not completely rule out the possibility of colon cancer. To determine whether the client has colon cancer, a colonoscopy should be performed so the entire colon can be visualized and a tissue sample taken for biopsy. The client may want to speak with the provider, but the nurse should address the clients concerns prior to contacting the provider.
A nurse cares for a client newly diagnosed with colon cancer who has become withdrawn from family members. Which action should the nurse take?
a. Contact the provider and recommend a psychiatric consult for the client.
b. Encourage the client to verbalize feelings about the diagnosis.
c. Provide education about new treatment options with successful outcomes.
d. Ask family and friends to visit the client and provide emotional support.
b. Encourage the client to verbalize feelings about the diagnosis.
The nurse recognizes that the client may be expressing feelings of grief. The nurse should encourage the client to verbalize feelings and identify fears to move the client through the phases of the grief process. A psychiatric consult is not appropriate for the client. The nurse should not brush aside the clients feelings with discussions related to cancer prognosis and treatment. The nurse should not assume that the client desires family or friends to visit or provide emotional support.
A nurse cares for a client with colon cancer who has a new colostomy. The client states, I think it would be helpful to talk with someone who has had a similar experience. How should the nurse respond?
a. I have a good friend with a colostomy who would be willing to talk with you.
b. The enterostomal therapist will be able to answer all of your questions.
c. I will make a referral to the United Ostomy Associations of America.
d. Youll find that most people with colostomies dont want to talk about them.
c. I will make a referral to the United Ostomy Associations of America.
Nurses need to become familiar with community-based resources to better assist clients. The local chapter of the United Ostomy Associations of America has resources for clients and their families, including Ostomates (specially trained visitors who also have ostomies). The nurse should not suggest that the client speak with a personal contact of the nurse. Although the enterostomal therapist is an expert in ostomy care, talking with him or her is not the same as talking with someone who actually has had a colostomy. The nurse should not brush aside the clients request by saying that most people with colostomies do not want to talk about them. Many people are willing to share their ostomy experience in the hope of helping others.
An emergency room nurse assesses a client after a motor vehicle crash and notes ecchymotic areas across the clients lower abdomen. Which action should the nurse take first?
a. Measure the clients abdominal girth.
b. Assess for abdominal guarding or rigidity.
c. Check the clients hemoglobin and hematocrit.
d. Obtain the clients complete health history.
b. Assess for abdominal guarding or rigidity.
On noticing the ecchymotic areas, the nurse should check to see if abdominal guarding or rigidity is present, because this could indicate major organ injury. The nurse should then notify the provider. Measuring abdominal girth or obtaining a complete health history is not appropriate at this time. Laboratory test results can be checked after assessment for abdominal guarding or rigidity.
A nurse cares for a client who states, My husband is repulsed by my colostomy and refuses to be intimate with me. How should the nurse respond?
a. Lets talk to the ostomy nurse to help you and your husband work through this.
b. You could try to wear longer lingerie that will better hide the ostomy appliance.
c. You should empty the pouch first so it will be less noticeable for your husband.
d. If you are not careful, you can hurt the stoma if you engage in sexual activity.
a. Lets talk to the ostomy nurse to help you and your husband work through this.
The nurse should collaborate with the ostomy nurse to help the client and her husband work through intimacy issues. The nurse should not minimize the clients concern about her husband with ways to hide the ostomy. The client will not hurt the stoma by engaging in sexual activity.
A nurse cares for a client who is recovering from a hemorrhoidectomy. The client states, I need to have a bowel movement. Which action should the nurse take?
a. Obtain a bedside commode for the client to use.
b. Stay with the client while providing privacy.
c. Make sure the call light is in reach to signal completion.
d. Gather supplies to collect a stool sample for the laboratory.
b. Stay with the client while providing privacy.
The first bowel movement after hemorrhoidectomy can be painful enough to induce syncope. The nurse should stay with the client. The nurse should instruct clients who are discharged the same day to have someone nearby when they have their first postoperative bowel movement. Making sure the call light is within reach is an important nursing action too, but it does not take priority over client safety. Obtaining a bedside commode and taking a stool sample are not needed in this situation.
An emergency room nurse cares for a client who has been shot in the abdomen and is hemorrhaging heavily. Which action should the nurse take first?
a. Send a blood sample for a type and crossmatch.
b. Insert a large intravenous line for fluid resuscitation.
c. Obtain the heart rate and blood pressure.
d. Assess and maintain a patent airway.
d. Assess and maintain a patent airway.
All of the options are important nursing actions in the care of a trauma client. However, airway always comes first. The client must have a patent airway, or other interventions will not be helpful.
A nurse assesses a client with a mechanical bowel obstruction who reports intermittent abdominal pain. An hour later the client reports constant abdominal pain. Which action should the nurse take next?
a. Administer intravenous opioid medications.
b. Position the client with knees to chest.
c. Insert a nasogastric tube for decompression.
d. Assess the clients bowel sounds.
d. Assess the clients bowel sounds.
A change in the nature and timing of abdominal pain in a client with a bowel obstruction can signal peritonitis or perforation. The nurse should immediately check for rebound tenderness and the absence of bowel sounds. The nurse should not medicate the client until the provider has been notified of the change in his or her condition. The nurse may help the client to the knee-chest position for comfort, but this is not the priority action. The nurse need not insert a nasogastric tube for decompression.
A nurse assesses a client who is prescribed 5-fluorouracil (5-FU) chemotherapy intravenously for the treatment of colon cancer. Which assessment finding should alert the nurse to contact the health care provider?
a. White blood cell (WBC) count of 1500/mm3
b. Fatigue
c. Nausea and diarrhea
d. Mucositis and oral ulcers
a. White blood cell (WBC) count of 1500/mm3
Common side effects of 5-FU include fatigue, leukopenia, diarrhea, mucositis and mouth ulcers, and peripheral neuropathy. However, the clients WBC count is very low (normal range is 5000 to 10,000/mm3), so the provider should be notified. He or she may want to delay chemotherapy by a day or two. Certainly the client is at high risk for infection. The other assessment findings are consistent with common side effects of 5-FU that would not need to be reported immediately.
