Question 1

The mother of a 3-month-old infant comes to emergency department and states,"My baby has been having severe diarrhea for 4 days.She is crying all the time." In formulating the plan of care to moderate the diarrhea,the nurse focuses her intervention(s)on which of the following? Select all that apply.

Accepted Answer

Patients with diarrhea are at risk for fluid and electrolyte imbalance.Water and potassium loss are the primary concerns.Infants,young children,and the frail elderly are most vulnerable and may require hospitalization and intravenous fluid replacement therapy.Ideally,oral liquids replace the lost fluid and potassium.Priority nursing interventions,particularly for the infant,must focus on treating the diarrhea itself,fluid and electrolyte balance/imbalance,and impaired skin integrity.Although crying distresses parents,managing the infant's crying is not a priority at this time,and it will usually cease once the infant is feeling better and responding to treatment.

Question 2

Which of the following populations are considered high risk for the development of hemorrhoids? Select all that apply.

Accepted Answer

Hemorrhoids are distended blood vessels within or protruding from the anus.The anus is highly vascular.Chronic pressure on the veins within the anal canal,as with prolonged sitting,retained feces,pregnancy,and obesity,can cause hemorrhoids.In this item,pregnant women and school bus drivers (sedentary)are at risk.Marathon runners are usually thin and are not in the risk group.There is no evidence to support any nursing group is high risk for hemorrhoids unless the nurse position is sedentary.

Question 3

The nurse is performing a focused bowel assessment on an older adult.Which of the following physiological changes of aging should alert the nurse to an increased risk for problems associated with bowel elimination? Select all that apply.

Accepted Answer

The bowel pattern set in childhood normally continues into late adulthood if the patient consumes adequate fiber and fluid and engages in regular physical activity.However,peristalsis,intestinal smooth muscle tone,perineal muscle tone,and sphincter control normally decrease with aging.These physiological processes can contribute to bowel elimination problems among older adults (e.g.,bowel incontinence,constipation),especially if they decrease their activity and fiber intake.Increased intestinal muscle tone is not a normal physiological change of aging.Decreased activity level,although common in some older adults,is not a physiological change or process.In fact,some older adults may have rather high activity levels.

Question 4

Older adults are more likely to use laxatives with regularity.In advising an older adult practicing this habit,the nurse would identify which of the following factors? Select all that apply.

Accepted Answer

Laxatives are used to treat constipation.In general,laxatives work by stimulating peristalsis.They are frequently abused by people who self-medicate with OTC drugs,who may become dependent on them,thus requiring ever-increasing dosages until the intestine fails to work properly.Laxatives may cause fluid and electrolyte imbalance.Laxatives decrease,not increase,the absorption of certain vitamins.

Question 5

A patient who has been immobile since sustaining injuries in a motor vehicle accident complains of constipation.The nurse encourages him to consume 8 to 10 eight-ounce glasses of fluid daily.Which fluids should the patient avoid because of the diuretic effect? Select all that apply.

Accepted Answer

Coffee,tea,and caffeine-containing sodas should be avoided because caffeine promotes diuresis,placing the patient at further risk for constipation.Water is the preferred fluid; however,fruit juices and decaffeinated sodas are also acceptable.

Question 6

A day after abdominal surgery,a postoperative patient on a surgical unit says to the nurse,"I'm having a problem with a lot of gas.Maybe it's the food I'm eating." What is the appropriate response by the nurse? Select all that apply.

Accepted Answer

To help patients manage flatulence,the nurse should teach patients to be aware of and avoid foods that trigger flatulence and to encourage patients who have had surgery to ambulate and perform bed exercises,as this helps to stimulate peristalsis and the passage of gas.In severe cases,the nurse may need to obtain a prescription for a rectal tube.In this item,there is no indication that the patient's flatulence is severe enough to indicate a rectal tube.The patient is likely not eating gas-producing foods on day one postoperatively,but the nurse might want to teach the patient about this possibility.Some people develop flatulence after eating gas-producing foods,such as beans,cabbage,cauliflower,onion,or highly spiced foods.For others,flatulence occurs when fiber intake is increased.Constipation is often accompanied by flatulence because digestive by-products undergo prolonged fermentation in the colon.

Question 7

Which of the following tasks may be delegated to a CNA or NAP? Select all that apply.

Accepted Answer

Collecting and testing a stool sample for occult blood and placing/removing a fracture pan for an immobile patient are tasks that can be delegated to a CNA or NAP.Irrigating a newly created colostomy and digitally removing stool cannot be delegated.These tasks require ongoing assessment of the patient by the professional nurse.The nurse must monitor the patient for complications,such as bleeding and vagal nerve stimulation.Nursing judgment is necessary in determining the need to halt these procedures.

Question 8

A patient has a history of chronic constipation.Which of the following medications prescribed for the patient would alert the nurse to be especially vigilant in observing for constipation and teach the client about preventive measures? Select all that apply.

Accepted Answer

Many medications may affect peristalsis and all oral medicines have the potential to affect the function of the GI tract.Iron has an astringent effect on the bowel and is notorious for causing constipation.Pain medications,particularly opioids (narcotics),slow peristalsis and are associated with a high incidence of constipation.Antibiotics,given to combat infection,decrease the normal flora in the colon.The result is often diarrhea.Aspirin and NSAIDs irritate the stomach.Repeated use of these medicines usually leads to ulceration of the stomach or duodenum.However,antibiotics and NSAIDs are not usually associated with constipation.

Question 9

The pediatric nurse educator is teaching a group of parents about distinguishing between food allergies and food intolerance.The nurse should teach parents that which of the following is/are considered to be true food allergens? Select all that apply.

Accepted Answer

The National Institute of Allergy and Infectious Disease (NIAID)characterizes a food allergy as a true immune system reaction prompted by the presence in the body of an allergenic food.Some common food allergens include dairy products,egg whites,shellfish,gluten,peanuts and other nuts,citrus fruits,and soy.Immune responses to foods manifests as a variety of symptoms ranging from a mild rash to anaphylactic shock.Food intolerance,in contrast to a food allergy,is specifically linked to the GI system.It produces such symptoms as GI discomfort,pain,gas,bloating,diarrhea,or constipation.An example is lactose intolerance,a deficiency of the enzyme lactase.Corn is not considered a food allergen,although some people may find corn to be constipating.

Question 10

Which factors place the patient at risk for constipation? Select all that apply.

Accepted Answer

Physical activity stimulates peristalsis and bowel elimination.Therefore,those with a sedentary lifestyle commonly experience constipation.High-dose calcium therapy also predisposes a patient to constipation.Lactose intolerance and spicy food consumption are associated with a nursing diagnosis of diarrhea,not constipation.

Question 11

The nurse must administer an enema to an adult patient with constipation.Which of the following would be a safe and effective distance for the nurse to insert the tubing into the patient's rectum? Select all that apply.

Accepted Answer

When administering an enema,the nurse should insert the tubing about 3 to 4 inches into the patient's rectum.Two inches would not be effective because it would not place the fluid high enough in the rectum.Five inches is too far.

Question 12

The nurse is preparing a patient for an invasive diagnostic test that will provide direct visualization of the rectum,entire large intestine,and distal small bowel.The nurse should teach and give the patient written instructions about which of the following tests?

Accepted Answer

A colonoscopy provides direct visualization of the rectum,colon,entire large intestine,and distal small bowel.A sigmoidoscopy allows direct visualization of the anal canal,rectum,and sigmoid colon,but not of the entire large intestine.Many patients and providers choose a colonoscopy for cancer screening,as this procedure provides better visualization of the colon.A barium enema is a radiological examination of the rectum,colon,and small bowel; however,this test does not provide direct visualization.Instead,it requires the use of barium and views these organ structures via x-ray.An ultrasound detects tissue abnormalities such as masses,cysts,edema,or stones,usually through the use of a transducer that is moved externally across the skin surface of the abdomen; it is not direct visualization.

Question 13

The nurse is caring for a patient on the medical-surgical unit.The patient states,"I really don't like to talk about my bowel movements,but what is considered a normal bowel movement?" What is the best response by the nurse? Select all that apply.

Accepted Answer

Part of the confusion about bowel function is that there is a wide range of "normal." The frequency of BMs may range from several times per day to once a week.As long as the person passes stools without excessive urgency (needing to rush to the toilet),with minimal effort and no straining,without blood loss,and without the use of laxative,you can regard bowel function as normal.The best responses by the nurse are therefore the ones that provide the patient with the most information.Although telling a patient there is no such thing as normal and all people are different is not incorrect,it does not provide the patient any information regarding what constitutes "normal" as far as number of BMs,what they should look like,defecation without much straining,and so on.Moreover,that statement advises the patient not to worry about it,which is condescending and negates feelings.

Question 14

The nursing instructor is teaching students how to use a fracture pan for patients who are unable to move or turn independently.What are the most appropriate instructions for this procedure? Select all that apply.

Accepted Answer

When placing a fracture pan for a patient who has decreased mobility or is unable to move and turn independently,the instructor should instruct students to ask for help from another healthcare worker,lower the head of the bed,assist the patient to a side-lying position,and,when placing the pan,place the wide,rounded end of the pan toward the front.

Question 15

The community health nurse is preparing a teaching plan on food choices that promote normal bowel elimination.Which of the following foods should the nurse teach patients to be sure to include in their diet? Select all that apply.

Accepted Answer

Most people should have at least five servings of high-fiber foods each day.Examples are fresh fruits and berries,dried fruits,vegetables (especially raw),whole-grain cereal products,flaxseed,popcorn,and dried beans,peas,and legumes.Although they are necessary for other nutrients,low-fiber foods such as pasta,other simple carbohydrates,and lean meats slow peristalsis and may predispose to constipation.Including them in the diet is not a focus for maintaining normal elimination.

Quiz 29: Bowel Elimination