Question 1

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

Accepted Answer

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 client will not be able to use the commode.

Question 2

Which of the following actions should the nurse implement when initiating the initial plan of care for a client admitted with acute diverticulitis?
A)Give stool softeners.
B)Administer IV fluids.
C)Order a diet high in fibre and fluids.
D)Prepare the client for colonoscopy.

Accepted Answer

A client 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 client with acute diverticulitis will not have a colonoscopy because of the risk for perforation and peritonitis.

Question 3

A client 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 1 000 mL of lactated Ringer's solution over 30 minutes.

Accepted Answer

The priority for this client is to treat the client's hypovolemic shock with fluid infusion. The other actions should be implemented after starting the fluid infusion.

Question 4

A client with ulcerative colitis who is taking azathioprine calls the nurse in the outpatient clinic about all of these symptoms. Which of the following symptoms is most important to communicate to the health care provider?
A)Nausea
B)Joint pain
C)Frequent headaches
D)Elevated temperature

Accepted Answer

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

Question 5

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

Accepted Answer

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

Question 6

Which of the following instructions should the nurse include in discharge teaching for a client 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.

Accepted Answer

Bowel movements may be very painful, and clients 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 7

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

Accepted Answer

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 8

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

Accepted Answer

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 client may need occasional transfusions but not regularly scheduled transfusions.

Question 9

During the initial postoperative assessment of a client'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 thesefindings?
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.

Accepted Answer

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 10

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

Accepted Answer

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 client will be encouraged to assist with the colostomy, but this is not the highest priority in the immediate postoperative period.

Question 11

The nurse is providing teaching to a client with a new ileostomy. Which of the following daily drainage amounts should the nurse inform the client is expected after the bowel adjusts to the ileostomy?
A)400 mL
B)600 mL
C)800 mL
D)1 000 mL

Accepted Answer

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

Question 12

A client 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 client?
A)Collect a stool specimen.
B)Prepare for colonoscopy.
C)Schedule a barium enema.
D)Have blood cultures drawn.

Accepted Answer

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 client needs a colonoscopy, blood cultures, or a barium enema.

Question 13

The nurse is providing discharge teaching for a client with a new colostomy. Which of the following client actions indicates that the teaching has been effective?
A)Empties the colostomy bag once it is 2/3 full.
B)Drinks at least 1 000 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.

Accepted Answer

The health care provider should be contacted if there is pain or erythema in the peristomal area. If the client has a temperature, the health care provider should be contacted. The colostomy should be emptied before it becomes 1/3 full. The client should drink at least
1 500-2 000 mL per day to avoid dehydration.

Question 14

The nurse is providing discharge teaching for a client 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 client 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.

Accepted Answer

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 15

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

Accepted Answer

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

Question 16

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

Accepted Answer

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 17

The nurse is caring for a client who has ulcerative colitis and a proctocolectomy and ileostomy. Which of the following information should the nurse include in client 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.

Accepted Answer

High-fibre foods are introduced gradually and should be well chewed to avoid obstruction of the ileostomy. Clients 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 18

The nurse is interviewing a client 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?"

Accepted Answer

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 19

Which of the following actions should the nurse take first when a client calls the clinic complaining of diarrhea of 24 hours' duration?
A)Ask the client to describe the character of the stools and any associated symptoms.
B)Inform the client that laboratory testing of blood and stool specimens will be necessary.
C)Suggest that the client drink clear liquid fluids with electrolytes, such as Gatorade or Pedialyte.
D)Advise the client to use over-the-counter loperamide to slow gastrointestinal (GI) motility.

Accepted Answer

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

Question 20

The nurse is caring for a client following an exploratory laparotomy and bowel resection who has a nasogastric tube to suction and 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 client's health care provider.
C)Reposition the tube and check for placement.
D)Remove the tube and replace it with a new one.

Accepted Answer

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 client.

Quiz 45: Nursing Management Lower Gastro-intestinal Problems

The nurse is caring for a critically ill client who develops incontinence of watery stools. What of the following actions is best for the nurse to take to prevent complications associated with ongoing incontinence?

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

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

A client is brought to the emergency department with a knife impaled in the abdomen following a domestic fight. During the initial assessment of the client, which of the following actions should the nurse implement?

Which of the following instructions should the nurse include in discharge teaching for a client who has had a hemorrhoidectomy at an outpatient surgical centre?

Which of the following prescribed interventions should the nurse implement first when caring for a client who has just diagnosed with peritonitis caused by a ruptured diverticulum?

The nurse is caring for a client with Crohn's disease who has megaloblastic anemia. Which of the following medications should the nurse anticipate teaching the client about taking on an ongoing basis?

During the initial postoperative assessment of a client'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 thesefindings?

Which of the following nursing actions is most important to include in the plan of care for a client who had an abdominal-perineal resection the previous day?

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

A client 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 client?

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

The nurse is providing discharge teaching for a client who has had a herniorrhaphy to repair an incarcerated inguinal hernia. Which of the following information should be included in the teaching?

After the nurse has completed teaching a client with newly diagnosed celiac disease, which of the following breakfast choices by the client indicates good understanding of the information?

The nurse is performing an admission assessment for a client with abdominal pain and palpates the left lower quadrant and the client indicates right lower quadrant pain. Which of the following descriptors should the nurse use to document this finding?

The nurse is caring for a client who has ulcerative colitis and a proctocolectomy and ileostomy. Which of the following information should the nurse include in client teaching?

The nurse is interviewing a client with abdominal pain and possible irritable bowel syndrome. Which of the following questions is most important for the nurse to ask?

Which of the following actions should the nurse take first when a client calls the clinic complaining of diarrhea of 24 hours' duration?

The nurse is caring for a client following an exploratory laparotomy and bowel resection who has a nasogastric tube to suction and symptoms of nausea and stomach distension. Which of the following actions should the nurse take first?