Question 1

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?

Accepted Answer

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 client's 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.

Question 2

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?

Accepted Answer

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.

Question 3

A nurse assesses clients at a community health center.Which client is at highest risk for the development of colorectal cancer?

Accepted Answer

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.

Question 4

After teaching a client who has a femoral hernia,the nurse assesses the client's understanding.Which statement indicates the client needs additional teaching related to the proper use of a truss?

Accepted Answer

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.

Question 5

A nurse teaches a client who is recovering from a colon resection.Which statement should the nurse include in this client's plan of care?

Accepted Answer

Clients recovering from a colon resection should take a stool softener as prescribed to keep stools a soft consistency for ease of passage.Nausea and vomiting are symptoms of intestinal obstruction and perforation and should be reported to the provider immediately.The client should be advised to avoid gas-producing foods and carbonated beverages,and avoid lifting heavy objects or straining on defecation.

Question 6

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?

Accepted Answer

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.

Question 7

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?

Accepted Answer

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 client's concern about her husband with ways to hide the ostomy.The client will not hurt the stoma by engaging in sexual activity.

Question 8

A nurse teaches a client who is at risk for colon cancer.Which dietary recommendation should the nurse teach this client?

Accepted Answer

The client should be taught to modify his or her diet to decrease animal fat and refined carbohydrates.The client should also increase high-fiber foods and Brassica vegetables,including broccoli and cauliflower,which help to protect the intestinal mucosa from colon cancer.

Question 9

After teaching a client with irritable bowel syndrome (IBS),a nurse assesses the client's understanding.Which menu selection indicates that the client correctly understands the dietary teaching?

Accepted Answer

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.

Question 10

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?

Accepted Answer

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 client's vital signs may be checked after the nurse determines the client's last void.Asking about flatus and auscultating bowel sounds are not related to a hemorrhoidectomy.

Question 11

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?

Accepted Answer

Common side effects of 5-FU include fatigue,leukopenia,diarrhea,mucositis and mouth ulcers,and peripheral neuropathy.However,the client's 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.

Question 12

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?

Accepted Answer

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.

Question 13

A nurse cares for a middle-aged male client who has irritable bowel syndrome (IBS).The client states,"I have changed my diet and take bulk-forming laxatives,but my symptoms have not gotten better.I heard about a drug called Amitiza.Do you think it might help?" How should the nurse respond?

Accepted Answer

Lubiprostone (Amitiza)is a new drug for IBS with constipation that works by simulating receptors in the intestines to increase fluid and promote bowel transit time.Lubiprostone is currently approved only for use in women.Trials with increased numbers of male participants are needed prior to Food and Drug Administration approval for men.

Question 14

An emergency room nurse assesses a client after a motor vehicle crash and notes ecchymotic areas across the client's lower abdomen.Which action should the nurse take first?

Accepted Answer

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.

Question 15

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 don't think I need the colonoscopy and would like to cancel it." How should the nurse respond?

Accepted Answer

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 client's concerns prior to contacting the provider.

Question 16

A nurse assesses a client who is prescribed alosetron (Lotronex).Which assessment question should the nurse ask this client?

Accepted Answer

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.

Question 17

A nurse cares for a client who has a new colostomy.Which action should the nurse take?

Accepted Answer

The nurse should empty the new ostomy pouch frequently because of excess gas collection,and empty the pouch when it is one-third to one-half full of stool.The ostomy pouch does not need to be changed every morning.Ostomy wafers with paste should be used to secure and seal the ostomy appliance; surgical tape should not be used.

Question 18

A nurse cares for a client who had a colostomy placed in the ascending colon 2 weeks ago.The client states,"The stool in my pouch is still liquid." How should the nurse respond?

Accepted Answer

The stool from an ascending colostomy can be expected to remain liquid because little large bowel is available to reabsorb the liquid from the stool.This finding is not abnormal.Liquid stool from an ascending colostomy will not become firmer with the addition of fiber to the client's diet or with the passage of time.

Question 19

A nurse cares for a client newly diagnosed with colon cancer who has become withdrawn from family members.Which action should the nurse take?

Accepted Answer

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 client's 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.

Question 20

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?

Accepted Answer

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.

Quiz 56: Care of Patients with Noninflammatory Intestinal Disorders