Lewis Chapter 45 - Lower GI Conditions

Question 1

The nurse is providing discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction due to constipation. Which of the following instructions is most helpful to prevent further episodes of constipation?

A. Maintain a high intake of fluid and fibre in the diet.
B. Reduce intake of medications causing constipation.
C. Eat several small meals per day to maintain bowel motility.
D. Sit upright during meals to increase bowel motility by gravity.

Answer 1

A. Maintain a high intake of fluid and fibre in the diet.

Increased fluid intake and a high-fibre diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fibre provide bulk that in turn increases peristalsis and bowel motility.

Question 2

The nurse should administer a prn dose of magnesium hydroxide after noting which of the following findings while reviewing a patient’s medical record?

A. Abdominal pain and bloating
B. No bowel movement for 3 days
C. A decrease in appetite by 50% over 24 hours
D. Muscle tremors and other signs of hypomagnesemia

Answer 2

B. No bowel movement for 3 days

Magnesium hydroxide (milk of magnesia) is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days

Question 3

The nurse is preparing to administer a dose of bisacodyl. While providing education about the medication to the patient, the nurse would state that it acts in which of the following ways?

A. Increases bulk in the stool
B. Lubricates the intestinal tract to soften feces
C. Increases fluid retention in the intestinal tract
D. Increases peristalsis by stimulating nerves in the colon wall

Answer 3

D. Increases peristalsis by stimulating nerves in the colon wall

Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. It is available in oral and suppository forms.

Question 4

The nurse is preparing to administer a scheduled dose of docusate sodium when the patient indicates an episode of loose stool and does not want to take the medication. Which of the following is the best action by the nurse?

A. Write an incident report about this untoward event.
B. Attempt to have the family convince the patient to take the ordered dose.
C. Withhold the medication at this time and try to administer it later in the day.
D. Chart the dose as not given on the medication record and explain the reason why in the nursing progress notes.

Answer 4

D. Chart the dose as not given on the medication record and explain the reason why in the nursing progress notes.

Whenever a patient refuses medication, the dose should be charted as not given. An explanation of the reason should then be documented in the nursing progress notes. In this instance, the refusal indicates good judgement by the patient.

Question 5

A patient is prescribed docusate (Colace) 100 mg po. The patient asks to take the medication in liquid form, and the nurse obtains an order for the interchange. Available is a syrup that contains 150 mg/15 mL. How many millilitres does the nurse administer?

A. 3 mL
B. 5 mL
C. 10 mL
D. 12 mL

Answer 5

C. 10 mL

The concentration of the syrup is 150 mg/15 mL. 100 mg divided by 150 mg multiplied by 15 mL = 10 mL.

Question 6

The nurse should instruct the patient to do which of the following to best enhance the effectiveness of a daily dose of docusate sodium?

A. Take a dose of mineral oil at the same time.
B. Add extra salt to food on at least one meal tray.
C. Ensure dietary intake of 10 g of fibre each day.
D. Take each dose with a full glass of water or other liquid.

Answer 6

D. Take each dose with a full glass of water or other liquid.

Docusate sodium (Colace) lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage, and must be taken with adequate fluids. The patient should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. Dietary fibre intake should be a minimum of 20 g daily to prevent constipation.

Question 7

Which of the following cathartic agents in a patient with renal insufficiency should the nurse question?

A. disacodyl
B. senna
C. cascara sagrada
D. magnesium hydroxide

Answer 7

D. magnesium hydroxide

Magnesium hydroxide (milk of magnesia) may cause hypermagnesemia in patients with renal insufficiency. The nurse should question this order with the health care provider before administration.

Question 8

A patient who is administering a bisacodyl suppository asks the nurse how long it will take to work. The nurse replies that the patient will probably need to use the bedpan or commode within which of the following time frames after administration?

A. 2–5 minutes
B. 15–60 minutes
C. 2–4 hours
D. 6–8 hours

Answer 8

B. 15–60 minutes

Bisacodyl suppositories usually are effective within 15–60 minutes of administration, so the nurse should plan accordingly to assist the patient to use the bedpan or commode.

Question 9

The nurse is caring for a patient in the emergency department with symptoms of acute abdominal pain, nausea, and vomiting. When the nurse palpates the patient’s left lower quadrant, the patient feels pain in the right lower quadrant. The nurse will document this as which of the following diagnostic signs of appendicitis?

A. The Rovsing sign
B. Referred pain
C. Chvostek’s sign
D. Rebound tenderness

Answer 9

A. The Rovsing sign

In patients with suspected appendicitis, the Rovsing sign may be elicited by palpation of the left lower quadrant, causing pain to be felt in the right lower quadrant.

Question 10

The nurse is caring for an admitted patient with abdominal pain, nausea, and vomiting. The patient has an abdominal mass and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which of the following types of bowel sounds that is consistent with the patient’s clinical picture?

A. Low pitched and rumbling above the area of obstruction
B. High pitched and hypoactive below the area of obstruction
C. Low pitched and hyperactive below the area of obstruction
D. High pitched and hyperactive above the area of obstruction

Answer 10

D. High pitched and hyperactive above the area of obstruction

Early in intestinal obstruction, the patient’s bowel sounds are hyperactive and high pitched, sometimes referred to as “tinkling” above the level of the obstruction. This occurs because peristaltic action increases to “push past” the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

Question 11

Which of the following factors in a patient’s history increases the patient’s risk for colorectal cancer?

A. Osteoarthritis
B. History of rectal polyps
C. History of lactose intolerance
D. Use of herbs as dietary supplements

Answer 11

B. History of rectal polyps

A history of rectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. The other factors identified do not pose additional risk to the patient.

Question 12

The nurse is preparing to insert a nasogastric (NG) tube into a patient with an abdominal mass and suspected bowel obstruction. The patient asks the nurse why this procedure is necessary. Which of the following responses is best?

A. “The tube will help to drain the stomach contents and prevent further vomiting.”
B. “The tube will push past the area that is blocked, and thus help to stop the vomiting.”
C. “The tube is just a standard procedure before many types of surgery to the abdomen.”
D. “The tube will let us measure your stomach contents so that we can plan what type of IV fluid replacement would be best.”

Answer 12

A. “The tube will help to drain the stomach contents and prevent further vomiting.”

The nasogastric (NG) tube is used to decompress the stomach by draining stomach contents, and thereby prevent further vomiting.

Question 13

The nurse is caring for a patient with a suspected bowel obstruction who had a nasogastric (NG) tube inserted at 0400 hours. The nurse shares in the morning report that the day shift (0700–1500 hours) staff should check the tube for patency at which of the following times?

A. 0700, 1000, and 1300 hours
B. 0800 and 1200 hours
C. 0900 and 1500 hours
D. 0900, 1200, and 1500 hours

Answer 13

B. 0800 and 1200 hours

A nasogastric (NG) tube should be checked for patency routinely at 4-hour intervals. Thus, if the tube was inserted at 0400 hours, it would be due to be checked at 0800 hours and 1200 hours.

Question 14

The nurse who inserted a nasogastric (NG) tube for a patient with suspected bowel obstruction should write which of the following priority nursing diagnoses on the patient’s problem list?

A. Anxiety related to nasogastric (NG) tube placement
B. Abdominal pain related to nasogastric (NG) tube placement
C. Risk for deficient knowledge related to nasogastric (NG) tube placement
D. Altered oral mucous membrane related to nasogastric (NG) tube placement

Answer 14

D. Altered oral mucous membrane related to nasogastric (NG) tube placement

With nasogastric (NG) tube placement, the patient is likely to breathe through the mouth and may experience irritation in the affected nares. For this reason, the nurse should plan preventive measures based on this nursing diagnosis.

Question 15

A colectomy is scheduled for a patient with an abdominal mass, possible bowel obstruction, and a history of rectal polyps. The nurse should plan to include which of the following prescribed measures in the preoperative preparation of this patient?

A. Instruction on irrigating a colostomy
B. Administration of an oral osmotic lavage
C. A high-fibre diet the day before surgery
D. Administration of IV antibiotics for bowel preparation

Answer 15

B. Administration of an oral osmotic lavage

Bowel preparation before surgery includes orally administered osmotic lavages (e.g., GoLYTELY). This has shortened the classic 72-hour preparation with clear liquids, cathartics, and enemas.

Question 16

Which of the following information should be the highest priority to include in a preoperative teaching plan for a patient scheduled for a colectomy?

A. How to care for the wound
B. How to deep-breathe and cough
C. The location and care of drains after surgery
D. What medications will be used during surgery

Answer 16

B. How to deep-breathe and cough

Because anaesthesia, an abdominal incision, and pain can impair the patient’s respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep-breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge.

Question 17

The nurse asks a patient who is scheduled for a colectomy to sign the operative consent as directed in the health care provider’s preoperative orders. The patient states that the health care provider has not really explained well what is involved in the surgical procedure. Which of the following is the best action by the nurse?

A. Ask family members whether they have discussed the surgical procedure with the health care provider.
B. Have the patient sign the form and state that the health care provider will visit to explain the procedure before surgery.
C. Explain the planned surgical procedure as well as possible, and have the patient sign the consent form.
D.D. Delay the patient’s signature on the consent and notify the health care provider about the conversation with the patient.

Answer 17

D. Delay the patient’s signature on the consent and notify the health care provider about the conversation with the patient.

The patient should not be asked to sign a consent form unless the procedure has been explained to the satisfaction of the patient. The nurse should notify the health care provider, who has the responsibility for obtaining consent.

Question 18

Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distension. The nurse plans care for the patient based on the knowledge that the symptoms occur as a result of which of the following?

A. Impaired peristalsis
B. Irritation of the bowel
C. Nasogastric suctioning
D. Anastomosis site inflammation

Answer 18

A. Impaired peristalsis

Until peristalsis returns to normal following anaesthesia, the patient may experience slowed gastrointestinal (GI) motility leading to gas pains and abdominal distension.

Question 19

The nurse is caring for a patient following bowel resection and has a nasogastric (NG) tube to suction. The patient is experiencing symptoms of nausea and abdominal distension. The nurse irrigates the tube prn as prescribed, but the irrigating fluid does not return. Which of the following actions is priority?

A. Notify the health care provider.
B. Auscultate for bowel sounds.
C. Reposition the tube and check for placement.
D. Remove the tube and replace it with a new one.

Answer 19

C. Reposition the tube and check for placement.

The tube may be resting against the stomach wall. The first action by the nurse, since this is intestinal surgery (not gastric surgery), is to reposition the tube and check it again for placement.

Question 20

The nurse is caring for a postoperative patient with a colostomy. The patient has a nasogastric (NG) tube in situ until bowel function returns. The nurse is preparing to administer a dose of famotidine when the patient asks why the medication was prescribed since the patient does not have a history of heartburn or gastroesophageal reflux disease (GERD). Which of the following statements is the best response by the nurse?

A. “This will prevent air from accumulating in the stomach, causing gas pains.”
B. “This will prevent the heartburn that occurs as an adverse effect of general anaesthesia.”
C. “The stress of surgery is likely to cause stomach bleeding if you do not receive it.”
D. “This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again.”

Answer 20

D. “This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again.”

Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery.

Question 21

The appropriate interprofessional therapy for the client with acute diarrhea caused by a viral infection is to do which of the following?

a. Increase fluid intake.

b. Administer an antibiotic.

c. Administer antimotility medications.

d. Quarantine the client to prevent spread of the virus.

Answer 21

A.

Question 22

Assessment findings suggestive of peritonitis include which of the following?

a. Rebound abdominal pain

b. A soft, distended abdomen

c. Dull, continuous abdominal pain

d. Restlessness

Answer 22

A.

Question 23

In planning care for the client with Crohn’s disease, the nurse recognizes which major factor about Crohn’s disease that differentiates it from ulcerative colitis?

a. It frequently results in toxic megacolon.

b. It causes fewer nutritional deficiencies than ulcerative colitis.

c. It often recurs after surgery, whereas ulcerative colitis is curable with a colectomy.

d. It is manifested by rectal bleeding and anemia more frequently than ulcerative colitis is.

Answer 23

C.

Question 24

A client with stage I colorectal cancer is scheduled for surgery. Teaching for this client would include an explanation of which of the following?

a. That chemotherapy will begin after recovery from the surgery

b. That both chemotherapy and radiation can be used as palliative treatments

c. That follow-up colonoscopies will be needed to ensure that the cancer does not recur

d. That a wound nurse, ostomy nurse, and continence nurse will visit to identify an abdominal site for the ostomy

Answer 24

C.

Question 25

The nurse explains to the client undergoing ostomy surgery that the procedure that maintains the most normal functioning of the bowel is which of the following?

a. A sigmoid colostomy

b. A transverse colostomy

c. A descending colostomy

d. An ascending colostomy

Answer 25

A.

Question 26

In contrast to the client with diverticulitis, which of the following is true for the client with diverticulosis?

a. Has rectal bleeding

b. Often has no symptoms

c. Has localized cramping pain

d. Frequently develops peritonitis

Answer 26

B.

Question 27

Which of the following is a nursing intervention that is most appropriate to decrease postoperative edema and pain after an inguinal herniorrhaphy?

a. Applying a truss to the hernia site

b. Allowing the client to stand to void

c. Supporting the incision during coughing

d. Applying a scrotal support with ice bag

Answer 27

D.

Question 28

The nurse determines that the goals of dietary teaching have been met when the client with celiac disease selects which of the following from the menu?

a. Scrambled eggs and sausage

b. Buckwheat pancakes with syrup

c. Oatmeal, skim milk, and orange juice

d. Yogourt, strawberries, and rye toast with butter

Answer 28

A.

Question 29

What should a client be taught after a hemorrhoidectomy?

a. Take mineral oil before bedtime.

b. Eat a low-fibre diet to rest the colon.

c. Administer oil-retention enema to empty the colon.

d. Use prescribed pain medication before a bowel movement.

Answer 29

D.

Question 30

Which characteristic of vomitus is associated with upper intestinal obstructions?

A. Bile-tinged

B. Foul-smelling

C. Orange-brown in color

D. Vomitus contains fecal material

Answer 30

A. Bile-tinged

Bile-tinged vomitus is common in high bowel obstructions where the common bile duct has excreted bile into the small intestine, which has not yet been mixed with the intestinal contents.

Foul-smelling
Orange-brown in color
Vomitus contains fecal material
are characteristic of low intestinal blockage.

Question 31

Which laboratory value is expected to be decreased with small bowel obstruction?

A. White blood count (WBC)

B. Blood urea nitrogen (BUN)

C. Electrolytes

D. Hematocrit

Answer 31

C. Electrolytes

Serum chloride, sodium, and potassium levels are low due to abundant vomiting seen in patients experiencing small bowel obstructions.

Question 32

Which type of bowel sounds are expected for a patient with abdominal pain, nausea, and vomiting with an abdominal mass and suspected bowel obstruction?

A. Low-pitched and rumbling above the area of obstruction

B. High-pitched and hypoactive below the area of obstruction

C. Low-pitched and hyperactive below the area of obstruction

D. High-pitched and hyperactive above the area of obstruction

Answer 32

D. High-pitched and hyperactive above the area of obstruction

Early in intestinal obstruction, the patient’s bowel sounds are hyperactive and high pitched, sometimes referred to as “tinkling” above the level of the obstruction. This occurs because peristaltic action increases to “push past” the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

Question 33

Which factor in a patient’s history increases the patient’s risk for colorectal cancer?

A. Osteoarthritis

B. History of rectal polyps

C. History of lactose intolerance

D. Use of herbs as dietary supplements

Answer 33

B. History of rectal polyps

A history of rectal polyps is a risk factor for colorectal cancer. Most colorectal cancers begin as adenomatous polyps that arise from the mucosa lining the lumen of the colon and the rectum.

Question 34

Which surgical procedure would likely be scheduled for a patient with a tumour located 4 cm above the anus?

A. Left hemicolectomy

B. Right hemicolectomy

C. Abdominal–perineal resection

D. Low anterior resection

Answer 34

C. Abdominal–perineal resection

Abdominal–perineal resection is most often performed when the rectal cancer is located within 5 cm above the anus.

Question 35

Which explanation concerning treatment for colorectal cancer should be provided to a patient with stage IA colorectal cancer who is scheduled for surgery the next day?

A. “Chemotherapy will begin after recovery from the surgery.”

B. “Both chemotherapy and radiation can be used as palliative treatments.”

C. “Follow-up colonoscopies will be needed to ensure that the cancer does not recur.”

D. “A wound nurse, ostomy nurse, and continence nurse will visit to identify an abdominal site for the ostomy.”

Answer 35

C. “Follow-up colonoscopies will be needed to ensure that the cancer does not recur.”

Colorectal cancer does recur, and continued surveillance is critical for long term survival.

Question 36

Which action would the nurse take first when caring for a patient with abdominal distention, diarrhea, pain level of 4/10, hemoglobin level of 9.8 g/dL, white blood cell (WBC) count of 12.0 cells/µL, and serum potassium 4.1 mEq/L?

A. Administer a dose of kayexalate.

B. Administer a dose of acetaminophen.

C. Obtain a stool sample for occult blood.

D. Administer an antidiarrheal medication.

Answer 36

C. Obtain a stool sample for occult blood.

The patient is exhibiting signs of colorectal cancer with abdominal distention, diarrhea, and pain along with a decreased hemoglobin level. All other laboratory values are within normal range, so the nurse will obtain a stool sample for occult blood to determine the source of the gastrointestinal blood loss.

Question 37

Which statement about physical activity limitations should be made when discharging a patient with a new ostomy?

A. “You can gradually increase your activities of daily living over the next 2-3 weeks.”

B. “You can resume playing sports when you can walk up two flights of stairs without getting winded.”

C. “You should abstain from sexual intercourse for 8 weeks.”

D. “You will not be able to swim at your community swimming pool.”

Answer 37

A. “You can gradually increase your activities of daily living over the next 2-3 weeks.”

This is an appropriate timeframe for achieving resuming activities such as toileting, hygiene, meal preparation, etc.

Question 38

Which location of a stoma facilitates the patient’s long-term adaptation?

A. At the beltline

B. Within the patient’s visual field

C. Outside of the rectus muscle

D. Aligned with the middle of a skin fold

Answer 38

B. Within the patient’s visual field

In order for the patient to be able to provide self-care, they must be able to see the stoma.

The stoma should be placed either above or below the line at which a belt would be worn so that the belt does not traumatize the stoma.
The stoma is placed within the rectus muscle for stability of the stoma.
The stoma should be aligned away from obvious creases and skin folds. If placed near a skin fold, the stoma should be placed above the fold, not below the fold.

Question 39

Which measure would the nurse anticipate in the preoperative preparation of a patient with a history of rectal polyps and a possible bowel obstruction who is scheduled for a colectomy?

A. Instruction on irrigating a colostomy

B. Administration of an oral osmotic lavage

C. A high fibre diet the day before surgery

D. Administration of IV antibiotics for bowel preparation

Answer 39

B. Administration of an oral osmotic lavage

Bowel preparation before surgery includes orally administered osmotic lavages (e.g., GoLYTELY). This has shortened the once-standard 72-hour preparation with clear liquids, cathartics, and enemas.