Lewis Chapter 45 - Lower GI Conditions TEST BANK

Question 1

The nurse is caring for a patient who is incontinent of watery diarrhea and has been 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 patient.
b. Place the patient in a private room with contact isolation.
c. Teach the patient about why antibiotics are not being used.
d. Educate the patient about proper food handling and storage.

Answer 1

ANS: B
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 is frequently used to treat C. difficile. Improper food handling and
storage do not cause C. difficile.

Question 2

A patient 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 patient to increase oral fluid intake.
b. Inform the patient that a daily bowel movement is unnecessary.
c. Assess the patient about individual risk factors for constipation.
d. Suggest that the patient increase dietary intake of high-fibre foods.

Answer 2

ANS: C
The nurse’s initial action should be further assessment of the patient for risk factors for
constipation and for usual bowel pattern. The other actions may be appropriate but will be
based on the assessment.

Question 3

The nurse is teaching a patient who has persistent 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

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 fibre, the patient
should gradually increase dietary fibre and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool softeners and lubricants, not by bulk-forming laxatives.

Question 4

The nurse is obtaining a history for a female patient 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 patient’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

ANS: B
A complete description of the pain provides clues about the cause of the problem. The usual
diet and elimination patterns are less helpful in determining the reason for the patient’s
symptoms. 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.

Question 5

The nurse is caring for a patient who had an exploratory laparotomy with a resection of a short segment of small bowel two days previously. The patient 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 patient to ambulate.
c. Administer the ordered IV morphine sulphate.
d. Insert the ordered promethazine suppository.

Answer 5

ANS: B
Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain.
Morphine will further reduce peristalsis. A return-flow enema may decrease the patient’s
symptoms, but ambulation is less invasive and should be tried first. Promethazine is used as
an antiemetic rather than to decrease gas pains or distension

Question 6

The nurse is caring for a patient 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 patient for surgery.
c. Check the patient’s oral temperature.
d. Obtain information about the accident.

Answer 6

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.

Question 7

The nurse is admitting a patient for evaluation of right lower quadrant abdominal pain
accompanied by nausea and vomiting. On assessment the temperature is 37.5°C, (99.5°F)
heart rate 105, respiratory rate 20 and an O2 saturation of 90%. Which of the following actions should the nurse take?

a. Check for rebound tenderness.
b. Assist the patient to cough and deep breathe.
c. Administer oxygen via nasal cannula.
d. Encourage the patient to take sips of clear liquids.

Answer 7

ANS: C
The patient’s clinical manifestations are consistent with appendicitis but the main priority is to administer oxygen as the O2 saturation is only 90%. The patient should be NPO in case immediate surgery is needed. Checking for rebound tenderness frequently is unnecessary and uncomfortable for the patient. The patient will need to know how to cough and deep breathe postoperatively, but coughing will increase pain at this time.

Question 8

Which of the following nursing actions should be included in the plan of care for a male
patient with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)?

a. Encourage the patient to express feelings 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 metronidazole to reduce symptoms.
d. Teach the patient to avoid using nonsteroidal anti-inflammatory drugs (NSAIDs).

Answer 8

ANS: A
Because psychological and emotional factors can affect the symptoms for IBS, encouraging
the patient to discuss emotions and ask questions is an important intervention. Metronidazole is a antimicrobial used for IBS which is not indicated at the present time. 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.

Question 9

The nurse is caring for a patient 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 patient on NPO status.
b. Administer IV metoclopramide.
c. Teach the patient about total colectomy surgery.
d. Administer cobalamin injections.

Answer 9

ANS: A
An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the
bowel by making the patient NPO. 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. Metoclopramide increases peristalsis and will
worsen symptoms.

Question 10

The nurse is admitting a patient 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

ANS: B
Since 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 fibre may increase gastrointestinal (GI) motility and exacerbate the diarrhea, severe fatigue is common with IBD exacerbations, and dehydration may occur.

Question 11

The nurse is teaching a patient with ulcerative colitis about sulphasalazine. Which of the
following patient 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

ANS: A
Sulphasalazine usually has a maintenance dose that the patient takes for one year. It is not
used to treat infections. Sulphasalazine does not reduce immune function. Unlike
corticosteroids, tapering of sulphasalazine is not needed.

Question 12

The nurse is caring for a patient with an exacerbation of ulcerative colitis who is having 15–20 stools daily and has external hemorrhoids. Which of the following patient behaviours indicate 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 anal discomfort.
d. The patient cleans the perianal area with soap and water after each stool.

Answer 12

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 15–20 times a day. The perianal area should be washed with plain
water after each stool.

Question 13

The nurse is providing patient teaching about recommended dietary choices for a patient with
an acute exacerbation of inflammatory bowel disease (IBD). Which of the following diet
choices by the patient indicates a need for more teaching?

a. Scrambled eggs
b. White toast and jam
c. Oatmeal with cream
d. Pancakes with syrup

Answer 13

ANS: C
During acute exacerbations of IBD, the patient should be on a low-residue diet and avoid
high-fibre 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.

Question 14

The nurse is caring for a patient 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 patient.
b. Ask the patient more about the concerns with stoma management.
c. Reassure the patient that care for the ileostomy will become easier.
d. Postpone any patient teaching until the patient adjusts to the ileostomy.

Answer 14

ANS: B
Encouraging the patient to share concerns assists in helping the patient adjust to the body
changes. Acknowledgement of the patient’s 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 patient’s 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.

Question 15

The nurse is caring for a patient 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

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.

Question 16

The nurse is caring for a patient 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 patient?

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

ANS: B
Fistulas between the bowel and bladder occur in Crohn’s disease and can lead to UTI. There is
no information indicating that the patient’s risk for UTI is caused by poor cleaning or not
voiding before and after intercourse. Steroid use may increase the risk for infection, but the
characteristics of the patient’s urine indicate that a fistula has occurred

Question 17

The nurse is caring for a patient 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 patient?

a. Referred back pain
b. Metabolic alkalosis
c. Projectile vomiting
d. Abdominal distension

Answer 17

ANS: D
Abdominal distension is seen in lower intestinal obstruction. Metabolic alkalosis is common
in high intestinal obstruction because of the loss of HCl acid from vomiting. Referred back
pain is not a common clinical manifestation of intestinal obstruction. Bile-coloured vomit is
associated with higher intestinal obstruction.

Question 18

The nurse is preparing a 50-year-old patient for an annual physical examination. Which of the
following diagnostic tests should the nurse teach to the patient?

a. Endoscopy
b. Fecal occult blood test
c. Computerized tomography screening
d. Carcinoembryonic antigen (CEA) testing

Answer 18

ANS: B
At age 50, individuals with an average risk for colorectal cancer (CRC) should begin
screening for CRC, including a fecal occult blood test (FOBT). Colonoscopy is the gold
standard for CRC screening. The other diagnostic tests are not recommended as part of a routine annual physical examination at age 50

Question 19

he nurse is conducting preoperative preparation for a patient scheduled for an abdominalperineal 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 patient that activities such as sitting at the bedside will be started the first
postoperative day.
c. Instruct the patient 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

ANS: D
A bowel-cleansing agent is used to empty the bowel before surgery to reduce the risk for
infection. Oral antibiotics (rather than IV antibiotics) are given to reduce colonic and rectal bacteria. Sitting is contraindicated after an abdominal-perineal resection. A permanent
colostomy is created with this surgery.

Question 20

Before undergoing a colon resection for cancer of the colon, a patient has an elevated
carcinoembryonic antigen (CEA) test. Which of the following explanations should the nurse
provide to the patient 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

ANS: B
CEA is used to monitor for cancer recurrence after surgery. CEA levels do not help 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.

Question 21

Which of the following nursing actions is most important to include in the plan of care for a
patient 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

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

Question 22

During the initial postoperative assessment of a patient’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

ANS: A
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 2–3 weeks after surgery, and an ice pack is not needed.

Question 23

The nurse is caring for a patient with ulcerative colitis who underwent a proctocolectomy with
an ileostomy. Which of the following information should the nurse include in patient
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

ANS: B
High-fibre foods are introduced gradually and should be well chewed to avoid obstruction of
the ileostomy. Patients with ileostomies lose the absorption of water in the colon and need to
take in increased amounts of fluid. The pouch should be drained frequently but is changed
every 5–7 days. The drainage from an ileostomy is liquid and continuous, so control by
irrigation is not possible.

Question 24

The nurse is providing discharge teaching for a patient with a new colostomy. Which of the
following patient actions indicates that the teaching has been effective?

a. Empties the colostomy bag once it is 2/3 full.
b. Drinks at least 1000 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

ANS: C
The health care provider should be contacted if there is pain or erythema in the peristomal
area. If the patient has a temperature, the health care provider should be contacted. The
colostomy should be emptied before it becomes 1/3 full. The patient should drink at least
1500–2000 mL per day to avoid dehydration

Question 25

The nurse is providing teaching to a patient with a new ileostomy. Which of the following
daily drainage amounts should the nurse inform the patient is expected after the bowel adjusts to the ileostomy?

a. 400 mL
b. 600 mL
c. 800 mL
d. 1000 mL

Answer 25

ANS: C
After the proximal small bowel adapts to reabsorb more fluid, the average amount of
ileostomy drainage is about 800 mL daily.

Question 26

Which of the following actions should the nurse implement when initiating the initial plan of
care for a patient admitted with acute diverticulitis?

a. Give stool softeners.
b. Administer IV fluids.
c. Order a diet high in fibre and fluids.
d. Prepare the patient for colonoscopy.

Answer 26

ANS: B
A patient with acute diverticulitis will be NPO and given parenteral fluids. A diet high in fibre
and fluids will be implemented before discharge. Bulk-forming laxatives, rather than stool
softeners, are usually given, and these will be implemented later in the hospitalization. The
patient with acute diverticulitis will not have a colonoscopy because of the risk for perforation
and peritonitis.

Question 27

The nurse is providing discharge teaching for a patient 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 patient 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

ANS: D
A scrotal support is used to reduce discomfort and deep breathing, but coughing is not
encouraged. Coughing will increase pressure on the incision. Sitz baths will not relieve pain
and would not be of use after this surgery. Acetaminophen can be used for postoperative pain.

Question 28

Which of the following instructions should the nurse include in discharge teaching for a
patient 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 28

ANS: C
Bowel movements may be very painful, and patients may avoid defecation unless pain
medication is taken before the bowel movement. Delay of bowel movements is likely to lead to constipation. A high-residue diet will increase stool bulk and prevent constipation. Sitz baths are used to relieve pain and keep the surgical area clean.

Question 29

A patient 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 patient?

a. Collect a stool specimen.
b. Prepare for colonoscopy.
c. Schedule a barium enema.
d. Have blood cultures drawn.

Answer 29

ANS: A
Acute diarrhea is usually caused by an infectious process and stool specimens are obtained for
culture and examined for parasites or white blood cells. There is no indication that the patient needs a colonoscopy, blood cultures, or a barium enema.

Question 30

The nurse is caring for a patient with Crohn’s disease who has megaloblastic anemia. Which
of the following medications should the nurse anticipate teaching the patient 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 30

ANS: D
Crohn’s disease frequently affects the ileum, where absorption of cobalamin occurs, and it
must be administered regularly by nasal spray or IM to correct the anemia. Iron deficiency
does not cause megaloblastic anemia. The patient may need occasional transfusions but not regularly scheduled transfusions.

Question 31

The nurse is performing an admission assessment for a patient with abdominal pain and palpates the left lower quadrant and the patient 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 31

ANS: C
Rovsing sign occurs when palpation of the left lower quadrant causes pain in the right lower
quadrant. McBurney point, rebound pain, and Cullen sign are used to describe other aspects of
the abdominal assessment.

Question 32

The nurse is caring for a critically ill patient who develops incontinence of watery stools.
Which 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 patient to a bedside commode at frequent intervals.

Answer 32

ANS: C
Perianal pouching is an alternative in the management of fecal incontinence. Rectal tubes are avoided because of possible damage to the anal sphincter and ulceration of the rectal mucosa. Incontinence briefs may be helpful but, unless they are changed frequently, are likely to
increase the risk for skin breakdown. A critically ill patient will not be able to use the
commode.

Question 33

The nurse is interviewing a patient 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 33

ANS: D
One criterion for the diagnosis of irritable bowel syndrome (IBS) is the presence of abdominal
discomfort or pain for at least 3 months. Abdominal distension, flatulence, and food
intolerance also are associated with IBS, but are not diagnostic criteria.

Question 34

Which of the following prescribed interventions should the nurse implement first when caring
for a patient 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 patient for a computerized tomography scan.
d. Insert a nasogastric (NG) tube and connect it to intermittent low suction.

Answer 34

ANS: B
Since peritonitis can be fatal if treatment is delayed, the initial action should be to start
antibiotic therapy (after any ordered cultures are obtained). The other actions can be done
after antibiotic therapy is initiated.

Question 35

Which of the following actions should the nurse take first when a patient calls the clinic
reporting diarrhea of 24 hours’ duration?

a. Ask the patient to describe the character of the stools and any associated
symptoms.
b. Inform the patient that laboratory testing of blood and stool specimens will be
necessary.
c. Suggest that the patient drink clear liquid fluids with electrolytes, such as Gatorade
or Pedialyte.
d. Advise the patient to use over-the-counter loperamide to slow gastrointestinal (GI)
motility.

Answer 35

ANS: A
The initial response by the nurse should be further assessment of the patient. The other
responses may be appropriate, depending on what is learned in the assessment.

Question 36

A patient 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 1000 mL of lactated Ringer’s solution over 30 minutes

Answer 36

ANS: D
The priority for this patient is to treat the patient’s hypovolemic shock with fluid infusion. The other actions should be implemented after starting the fluid infusion.

Question 37

The nurse is caring for a patient following an exploratory laparotomy and bowel resection
with a nasogastric tube to low suction in situ. The patient reports 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 patient’s health care provider.
c. Reposition the tube and check for placement.
d. Remove the tube and replace it with a new one.

Answer 37

ANS: C
Repositioning the tube will frequently facilitate drainage. Because this is a common
occurrence, it is not appropriate to notify the health care provider. Information about the
presence or absence of bowel tones will not be helpful in improving drainage. Removing the
tube and replacing it are unnecessarily traumatic to the patient.

Question 38

A patient is brought to the emergency department with a knife impaled in the abdomen following a domestic fight. During the initial assessment of the patient, 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 38

ANS: A
The initial assessment is focused on determining whether the patient has hypovolemic shock.
The knife should not be removed until the patient is in surgery, where bleeding can be
controlled. Rovsing sign is assessed in the patient with suspected appendicitis. A patient with a knife in place will be taken to surgery and assessed for bladder trauma there.

Question 39

A patient with ulcerative colitis who is taking azathioprine calls the nurse in the outpatient
clinic about the following symptoms. Which be most important to communicate to the health
care provider?

a. Nausea
b. Joint pain
c. Frequent headaches
d. Elevated temperature

Answer 39

ANS: D
Since azathioprine suppresses immune function, rapid treatment of infection is essential. The
other patient complaints are common adverse effects of the medication, but do not indicate
any potentially life-threatening complications.

Question 40

The nurse is interviewing a 40-year-old patient and obtains information about the following
patient problems. Which of the following information is most important to communicate to the health care provider?

a. The patient had an appendectomy at age 17.
b. The patient smokes a pack/day of cigarettes.
c. The patient has a history of frequent constipation.
d. The patient has recently noticed blood in the stools.

Answer 40

ANS: D
Blood in the stools is a possible clinical manifestation of colorectal cancer and requires further testing by the health care provider. The other patient information also will be communicated to the health care provider but does not indicate an urgent need for further testing or intervention.

Question 41

When assessing the colour of a new stoma in the postoperative period, which of the following
would cause the nurse to suspect anemia?

a. Light red to rose
b. Pale pink
c. Blanching, dark red to purple
d. Dark red

Answer 41

ANS: B
A pale pink stoma indicates anemia. A light red rose or dark red brick colour indicates a viable
stoma mucosa. A blanching dark red to purple stoma may indicate inadequate blood supply to
the stoma, low flow state, excessive tension on the bowel mesentery at the time of
construction, or venous congestion; usually occurs in the first 72 hour after surgery.

Question 42

The nurse is caring for a patient 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 patient on contact precautions.

Answer 42

ANS: D
The patient’s history and new onset diarrhea suggest a C. difficile infection, which requires
implementation of contact precautions to prevent spread of the infection to other patients. The other actions also are appropriate but can be accomplished after contact precautions are
implemented

Question 43

After receiving change-of-shift report, which of the following patients should the nurse assess
first?

a. A patient whose new ileostomy has drained 800 mL over the previous 8 hours
b. A patient with familial adenomatous polyposis who has occult blood in the stool
c. A patient with ulcerative colitis who has had six liquid stools in the previous 4
hours
d. A patient who has abdominal distension and an apical heart rate of 136
beats/minute

Answer 43

ANS: D
The patient’s abdominal distension and tachycardia suggest hypovolemic shock caused by problems such as peritonitis or intestinal obstruction, which will require rapid intervention. The other patients also should be assessed as quickly as possible, but the data do not indicate any life-threatening complications associated with their diagnoses.

Question 44

A patient 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 patient
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 44

ANS: A
A loop, or double-barrel stoma, is usually temporary. Stool will be expelled from the proximal stoma only. The stool from the transverse colon will be liquid and regulation through irrigations will not be possible.

Question 45

After the nurse has completed teaching a patient with newly diagnosed celiac disease, which of the following breakfast choices by the patient 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 45

ANS: A
Avoidance of gluten-containing foods is the only treatment for celiac disease. Corn does not
contain gluten, while oatmeal and wheat do.