Fundamentals of Nursing

Nursing

Quiz 49 :

Fecal Elimination

Quiz 49 :

Fecal Elimination

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The nurse assesses a client's abdomen several days after abdominal surgery. It is firm, distended, and painful to palpate. The client reports feeling "bloated." The nurse consults with the surgeon, who orders an enema. The nurse prepares to give what kind of enema? 1) Soapsuds 2) Retention 3) Return flow 4) Oil retention
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Soap suds are the solution that irritates the mucosa and enhances distention of the colon. Retention enema involves the introduction of oil into the rectum and colon. This liquid stays for a long period of time.
An oil retention enema softens the hard stool. It also lubricates the rectum and anal canal and hence facilitates the passage of feces. These solutions help in managing constipation, but they do not provide relief to the client against flatus.
Hence, the options 1, 2 and 4 are incorrect.
The client's abdomen is observed to be distended, firm, and is painful to palpate. The client also reports of feeling bloated. In such condition, return flow enema is the most appropriate for the client.
Return flow enema is helpful in expelling the flatus. This process involves flowing of the fluid in and out of the rectum and sigmoid colon in order to stimulate peristalsis. Hence, this will provide relief to the client of postoperative flatus and will also enhance bowel motility.
Hence, the correct answer is option
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Which of the following is most likely to validate that a client is experiencing intestinal bleeding? 1) Large quantities of fat mixed with pale yellow liquid stool 2) Brown, formed stools 3) Semisoft black-colored stools 4) Narrow, pencil-shaped stool
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Fat mixed with pale yellow liquid stool signifies a condition of malabsorption of fats. It can also occur due to high content of milk and milk products and low content of meat in the diet. Brown stool appears in normal conditions and signifies that the client is healthy.
It does not indicate any abnormality in elimination. The shape of stool of a client appears narrow and pencil like when he or she is suffering from obstructive condition of the rectum. All these observations do not indicate a condition of intestinal bleeding.
Hence, the options 1, 2 and 4 are incorrect.
Intestinal bleeding in a client can be identified by the appearance of semisoft black colored stool. Black or tarry colored stool appears in case of intestinal bleeding because the blood in the upper gastrointestinal tract is tarry and black.
Hence, the correct answer is option
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A client with a new stoma who has not had a bowel movement since surgery last week reports feeling nauseous. What is the appropriate nursing action? 1) Prepare to irrigate the colostomy. 2) After assessing the stoma and surrounding skin, notify the surgeon. 3) Assess bowel sounds and administer antiemetic. 4) Administer a bulk-forming laxative, and encourage increased fluids and exercise.
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Irrigation of colostomy requires appropriate assessment and should not be done without any assessment. Also, it is a dependent nursing action. Assessment of bowel sounds is an independent action and can be performed by the nurse.
Administration of antiemetics is generally suggested immediately after the surgery and not many days after the surgery, as in this case. It requires proper assessment. Administration of a bulk forming laxatives, is contraindicated in patients suffering from nausea after a surgery.
Hence, the options 1, 3 and 4 are incorrect.
When a client having a new stoma is complaining about the absence of bowel movement since the surgery, which occurred one week ago and also reports of feeling nauseous, the nurse should notify this to the surgeon after assessing the stoma and the surrounding skin.
Hence, the correct answer is option
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Which statement provides evidence that an older adult who is prone to constipation is in need of further teaching? 1) "I need to drink one and a half to two quarts of liquid each day." 2) "I need to take a laxative such as Milk of Magnesia if I don't have a BM every day." 3) "If my bowel pattern changes on its own, I should call you." 4) "Eating my meals at regular times is likely to result in regular bowel movements."
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A student nurse is assigned to care for a client with a sigmoidostomy. The student will assess which ostomy site? img
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The nurse is most likely to report which finding to the primary care provider for a client who has an established colostomy? 1) The stoma extends 1/2 in. above the abdomen. 2) The skin under the appliance looks red briefly after removing the appliance. 3) The stoma color is a deep red-purple. 4) The ascending colostomy delivers liquid feces.
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What nursing intervention is most appropriate Before making suggestions to correct or prevent the problem she is experiencing?
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Which goal is the most appropriate for clients with diarrhea related to ingestion of an antibiotic for an upper respiratory infection? 1) The client will wear a medical alert bracelet for antibiotic allergy. 2) The client will return to his or her previous fecal elimination pattern. 3) The client will verbalize the need to take an antidiarrheal medication pm. 4) The client will increase intake of insoluble fiber such as grains, rice, and cereals.
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You learn that Mrs. Brown's stools have been liquid, in very small amounts, and at infrequent intervals, generally occurring when She feels the urge to defecate. What additional data are important to obtain from her?
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A client is scheduled for a colonoscopy. The nurse will provide information to the
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Which nursing diagnoses is/are most applicable to a client fecal incontinence? Select all that apply. 1) Bowel Incontinence 2) Risk for Deficient Fluid Volume 3) Disturbed Body Image 4) Social Isolation 5) Risk for Impaired Skin Integrity
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Explain why cathartics and laxatives are generally contraindicated for people in Mrs. Brown's situation?
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What suggestions can you give her about maintaining a regular bowel pattern?
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Clients should be taught that repeatedly ignoring the sensation of needing to defecate could result in which of the following? 1) Constipation 2) Diarrhea 3) Incontinence 4) Hemorrhoids
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