Question 1

The nurse is caring for a client who has watery, incontinent diarrhea and has 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 client.
B)Place the client in a private room with contact isolation.
C)Teach the client about why antibiotics are not being used.
D)Educate the client about proper food handling and storage.

Accepted Answer

Because C. difficile is highly contagious, the client 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

The nurse is conducting preoperative preparation for a client scheduled for an abdominal-perineal 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 client that activities such as sitting at the bedside will be started the first postoperative day.
C)Instruct the client 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.

Accepted Answer

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 3

The nurse is caring for a client 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 client for surgery.
C)Check the client's oral temperature.
D)Obtain information about the accident.

Accepted Answer

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 client for emergency surgery.

Question 4

The nurse is caring for a client 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 client.
B)Ask the client more about the concerns with stoma management.
C)Reassure the client that care for the ileostomy will become easier.
D)Postpone any client teaching until the client adjusts to the ileostomy.

Accepted Answer

Encouraging the client to share concerns assists in helping the client adjust to the body changes. Acknowledgement of the client's feelings and concerns is important rather than offering false reassurance. Because the client 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 client'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 5

The nurse is caring for a client 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 client?
A)Referred back pain
B)Metabolic alkalosis
C)Projectile vomiting
D)Abdominal distension

Accepted Answer

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 6

The nurse is providing client teaching about recommended dietary choices for a client with an acute exacerbation of inflammatory bowel disease (IBD). Which of the following diet choices by the client indicates a need for more teaching?
A)Scrambled eggs
B)White toast and jam
C)Oatmeal with cream
D)Pancakes with syrup

Accepted Answer

During acute exacerbations of IBD, the client 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 clients. The other choices are low residue and would be appropriate for this client.

Question 7

Aclient 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 client to increase oral fluid intake.
B)Inform the client that a daily bowel movement is unnecessary.
C)Assess the client about individual risk factors for constipation.
D)Suggest that the client increase dietary intake of high-fibre foods.

Accepted Answer

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

Question 8

The nurse is teaching a client who has chronic 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.

Accepted Answer

A high fluid intake is needed when clients 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 client 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 9

The nurse is caring for a client 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 client?
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

Accepted Answer

Fistulas between the bowel and bladder occur in Crohn's disease and can lead to UTI. There is no information indicating that the client'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 client's urine indicate that a fistula has occurred.

Question 10

The nurse is admitting a client for evaluation of right lower quadrant abdominal pain with nausea and vomiting and an O2 saturation of 90%. Which of the following actions should the nurse take?
A)Check for rebound tenderness.
B)Assist the client to cough and deep breathe.
C)Administer oxygen via nasal cannula.
D)Encourage the client to take sips of clear liquids.

Accepted Answer

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

Question 11

The nurse is obtaining a history for a female client 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 client'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?"

Accepted Answer

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 client's symptoms. Although the nurse should ask whether the client is pregnant to determine whether the client 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 12

Which of the following nursing actions should be included in the plan of care for a male client with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)?
A)Encourage the client to express feelings and ask questions about IBS.
B)Suggest that the client increase the intake of milk and other dairy products.
C)Educate the client about the use of Tegaserod to reduce symptoms.
D)Teach the client to avoid using nonsteroidal anti-inflammatory drugs (NSAIDs).

Accepted Answer

Because psychological and emotional factors can affect the symptoms for IBS, encouraging the client to discuss emotions and ask questions is an important intervention. Tegaserod (Zelnorm) has been recently used to treat women with IBS whose primary bowel symptom is constipation however this question is asking about a male client.
Although yogourt may be beneficial, milk is avoided because lactose intolerance can contribute to symptoms in some clients. NSAIDs can be used by clients with IBS.

Question 13

The nurse is preparing a 50-year-old client for an annual physical examination. Which of the following diagnostic tests should the nurse teach to the client?
A)Endoscopy
B)Fecal occult blood test
C)Computerized tomography screening
D)Carcinoembryonic antigen (CEA) testing

Accepted Answer

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 14

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

Accepted Answer

Sulphasalazine usually has a maintenance dose that the client 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 15

The nurse is caring for a client with an exacerbation of ulcerative colitis who is having 15-20 stools daily and has external hemorrhoids. Which of the following client behaviours indicate that teaching regarding maintenance of skin integrity has been effective?
A)The client uses incontinence briefs to contain loose stools.
B)The client asks for antidiarrheal medication after each stool.
C)The client uses witch hazel compresses to decrease anal discomfort.
D)The client cleans the perianal area with soap and water after each stool.

Accepted Answer

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 16

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

Accepted Answer

Ambulation will improve peristalsis and help the client eliminate flatus and reduce gas pain. Morphine will further reduce peristalsis. A return-flow enema may decrease the client'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 17

The nurse is caring for a client 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 client on NPO status.
B)Administer IV metoclopramide.
C)Teach the client about total colectomy surgery.
D)Administer cobalamin injections.

Accepted Answer

An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the client NPO. Cobalamin (vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. Although total colectomy is needed for some clients, there is no indication that this client is a candidate. Metoclopramide increases peristalsis and will worsen symptoms.

Question 18

The nurse is caring for a client 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

Accepted Answer

Medications are used to induce and maintain remission in clients with inflammatory bowel disease (IBD). Decreased activity level is indicated only if the client has severe fatigue and weakness. Fluids are needed to prevent dehydration. There is no advantage to enteral feedings.

Question 19

The nurse is admitting a client 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.

Accepted Answer

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 client 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 20

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

Accepted Answer

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.

Quiz 45: Nursing Management Lower Gastro-intestinal Problems

The nurse is caring for a client who has watery, incontinent diarrhea and has diagnosed with Clostridium difficile. Which of the following actions should the nurse include in the plan of care?

The nurse is conducting preoperative preparation for a client scheduled for an abdominal-perineal resection. Which of the following actions should the nurse implement?

The nurse is caring for a client 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?

The nurse is caring for a client 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?

The nurse is caring for a client 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 client?

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

Aclient 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?

The nurse is teaching a client who has chronic constipation about the use of psyllium. Which of the following information should the nurse include?

The nurse is caring for a client 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 client?

The nurse is admitting a client for evaluation of right lower quadrant abdominal pain with nausea and vomiting and an O2 saturation of 90%. Which of the following actions should the nurse take?

The nurse is obtaining a history for a female client 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 client's symptoms?

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

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

The nurse is teaching a client with ulcerative colitis about sulphasalazine. Which of the following client statements indicates that the teaching has been effective?

The nurse is caring for a client with an exacerbation of ulcerative colitis who is having 15-20 stools daily and has external hemorrhoids. Which of the following client behaviours indicate that teaching regarding maintenance of skin integrity has been effective?

The nurse is caring for a client who had an exploratory laparotomy with a resection of a short segment of small bowel two days previously. The client has gas pains and abdominal distension. Which of the following nursing actions is best to take at this time?

The nurse is caring for a client 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?

The nurse is caring for a client 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?

The nurse is admitting a client with an exacerbation of inflammatory bowel disease (IBD) . Which of the following nursing actions should the nurse include in the plan of care?

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