Deck 33: Management of Clients with Intestinal Disorders

Question 1

A client with Crohn's disease is recovering from a fourth bowel resection and is being dismissed. The nurse determines that teaching goals have been met when the client indicates that s/he will watch for manifestations of

A) chronic constipation.
B) fatigue and weakness.
C) Heberden's nodules.
D) malabsorption syndrome.

Answer 1

malabsorption syndrome.

Question 2

Until a diagnosis is made, the nurse caring for a client being evaluated for acute appendicitis should treat pain and discomfort with

A) comfort touch and reassurance.
B) frequently changing the client's position.
C) narcotic pain medication.
D) warm compresses applied to the belly.

Answer 2

comfort touch and reassurance.

Question 3

In counseling a client with ulcerative colitis for 25 years about health maintenance plans, the nurse would include the advice that the client should

A) avoid red meat.
B) obtain genetic counseling.
C) reduce physical exercise.
D) schedule regular proctoscopic examinations.

Answer 3

schedule regular proctoscopic examinations.

Question 4

A nurse is caring for a postoperative client who has developed peritonitis. An assessment finding that would require immediate action would be

A) a decrease in blood pressure of more than 15 mm Hg.
B) an increase in urine output of more than 300 ml/day.
C) pulse deficit of more than 20 beats/minute.
D) weight gain of more than 5 pounds.

Question 5

The nurse caring for a client with an intestinal malignancy assesses for bleeding, which would most likely be manifested by

A) abdominal discomfort.
B) hematemesis.
C) hematochezia.
D) hypotension.

Question 6

In caring for a client with Crohn's disease and the nursing diagnosis of Imbalanced Nutrition: Less Than Body Requirements related to diarrhea, the nurse would plan to observe for

A) bradycardia.
B) increased urine output.
C) increasing blood pressure.
D) manifestations of anemia.

Question 7

The nurse is instructing a client with a new colostomy on its care and notes that the stoma is large and dusky. The most appropriate nursing intervention at this time is to

A) assess the client's reaction to the ostomy site.
B) assist the client to irrigate the colostomy.
C) notify the surgeon immediately.
D) reassure the client that the stoma will decrease in size.

Question 8

The nurse taking the history of an 80-year-old woman diagnosed with gastroenteritis would recognize that the most significant factor in determining potential for complications in this client is

A) age.
B) family history.
C) gender.
D) prior bouts of gastroenteritis.

Question 9

A 13-year-old client with ulcerative colitis says, "I am so glad I will grow out of this disease. It's so embarrassing at school." Which action by the nurse would best address this statement?

A) Ask the client to explain what he/she means.
B) Encourage the client to become active in school activities or sports.
C) Review the pathophysiology of ulcerative colitis.
D) Tell the client about other people who live successfully with the disease.

Question 10

A client recovering from a recent colostomy is very reluctant to participate in self-care. To initiate the client's interaction, the nurse should

A) allow care to be deferred until the client will participate.
B) evaluate the level to which the client can tolerate participation.
C) insist the client become involved in self-care.
D) provide the client with a mirror to observe the stoma.

Question 11

To help a client with a new ostomy integrate its appearance into the client's body image, the home health nurse would

A) discourage the client's negative remarks about the stoma.
B) discuss clothing options that will hide the appliance.
C) limit family interaction in the client's stomal care.
D) use humor and jokes regarding the ostomy.

Question 12

A client with inflammatory bowel disease (IBD) takes sulfasalazine (Azulfadine) for management of manifestations. To counteract a side effect of this drug, the nurse would encourage the client to increase intake of

A) any citrus fruits.
B) bananas and apples.
C) fish and seafood.
D) peas and beans.

Question 13

A client with ulcerative colitis is scheduled for surgical creation of an ileoanal reservoir (J pouch). What information should the nurse include in this client's teaching plan?

A) The client will need an easily removable appliance.
B) The client will need to plan for a daily irrigation.
C) The stool will be expelled through the rectum eventually.
D) The transverse loop ostomy will be temporary.

Question 14

A client with ulcerative colitis has severe diarrhea. Further assessments by the nurse are aimed at early recognition of

A) dehydration.
B) hemorrhoids.
C) metabolic alkalosis.
D) nephrolithiasis.

Question 15

A client is admitted with dysentery caused by Clostridium difficile, or pseudomembranous colitis. To elicit the most helpful information about the cause of the dysentery, the nurse would ask the client

A) "Are you taking any antibiotics?"
B) "Do you ever go barefoot outside your home?"
C) "Does anyone else in your family have bowel problems?"
D) "Have you traveled in any foreign countries lately?"

Question 16

A client is admitted with appendicitis and is awaiting surgery. The client states, "Now instead of pain in just one spot, the pain is kind of all over my abdomen." Which action by the nurse takes priority?

A) Assess the client's abdomen.
B) Get a set of vital signs.
C) Call the physician.
D) Prepare the client for another x-ray.

Question 17

The nurse caring for a client with abdominal distention and vomiting that is fecal in nature should conduct further assessment aimed at discovering

A) a distal, small intestinal obstruction.
B) gastric ulceration.
C) gastrointestinal (GI) bleeding.
D) ulceration of the esophagus.

Question 18

When a client is admitted to the emergency department with a hernia, the classification of hernia that would represent a surgical emergency is

A) incisional.
B) inguinal.
C) reducible.
D) strangulated.

Question 19

For a client who has returned to the nursing unit after creation of a continent ileostomy (Kock pouch), the action the nurse would include in the plan of care is

A) attach the catheter to straight drainage initially for several days.
B) irrigate the pouch daily with sterile solutions only.
C) provide a permanent appliance and assist the client in application.
D) restrict oral intake until ileal drainage is profuse.

Question 20

In caring for a client with peritonitis from inflamed diverticuli, the nurse should assign priority to assessing

A) bowel sounds.
B) intake and output.
C) neurologic status.
D) vital signs.

Question 21

A client with an ostomy is irrigating it with about 500 ml of warm tap water and is holding the irrigating container about 36 inches above the stoma. Which nursing diagnosis best fits this situation?

A) Constipation
B) Effective management of therapeutic regimen
C) Enhanced individual coping
D) Knowledge deficit

Question 22

A nurse is caring for several clients. One client needs ostomy care. The nurse delegates ostomy care to the unlicensed assistive personnel for the client who

A) has had the ostomy for several years, but whose arthritis makes self-care difficult.
B) is afraid to touch the ostomy, causing the nurse to be frustrated and short-tempered.
C) underwent ostomy surgery 3 days ago and has been stable with a red stoma.
D) uses multiple brands and sizes of appliances and pouches.

Question 23

For an 83-year-old client admitted with obstruction of the large bowel, the nurse's most significant assessment during the nursing history in regard to development of an obstruction would be

A) advanced age.
B) poor appetite.
C) previously treated colon cancer.
D) well-controlled diabetes.

Question 24

In caring for a client who is vomiting fecal material, the nurse should place the highest priority on which action?

A) Administering parenteral fluids that contain electrolytes
B) Encouraging the client to take small sips of water
C) Giving the client frequent oral hygiene
D) Preparing the client for surgery

Question 25

In advising a client on the care of an anal fissure caused by chronic constipation, the home health nurse would focus on

A) avoiding long, hot baths.
B) cleansing with peroxide after each bowel movement.
C) keeping stools small by limiting fluid intake.
D) the importance of a daily bowel movement.