Chapter 43: Nursing Management: Lower Gastrointestinal Problems

Chapter 43: Nursing Management: Lower Gastrointestinal Problems Test Bank

MULTIPLE CHOICE

• A patient who is hospitalized with watery, incontinent diarrhea is diagnosed with Clostridium

difficile. Which action will the nurse include in the plan of care?

• Order a diet with no dairy products for the patient.
• Place the patient in a private room with contact isolation.
• Teach the patient about why antibiotics are not being used.
• Educate the patient about proper food handling and storage.

ANS: B

Because C. difficile is highly contagious, the patient 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 (Flagyl) is frequently used to treat C. difficile. Improper food handling and storage do not cause C. difficile.

• A 67-year-old patient tells the nurse, “I have problems with constipation now that I am older,

so I use a suppository every morning.” Which action should the nurse take first?

• Encourage the patient to increase oral fluid intake.
• Inform the patient that a daily bowel movement is unnecessary.
• Assess the patient about individual risk factors for constipation.
• Suggest that the patient increase dietary intake of high-fiber foods.

ANS: C

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

• In teaching a patient who has chronic constipation about the use of psyllium (Metamucil),

which information will the nurse include?

• Absorption of fat-soluble vitamins may be reduced by fiber-containing laxatives.
• Dietary sources of fiber should be eliminated to prevent excessive gas formation.
• Use of this type of laxative to prevent constipation does not cause adverse effects.
• Large amounts of fluid should be taken to prevent impaction or bowel obstruction.

ANS: D

A high fluid intake is needed when patients 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 fiber, the patient should gradually increase dietary fiber and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool softeners and lubricants, not by bulk-forming laxatives.

• The nurse is obtaining a history for a 23-year-old woman who is being evaluated for acute

lower abdominal pain and vomiting. Which question will be most useful in determining the cause of the patient’s symptoms?

• “Is it possible that you are pregnant?”
• “Can you tell me more about the pain?”

• “What type of foods do you usually eat?”
• “What is your usual elimination pattern?”

ANS: B

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 patient’s symptoms. Although the nurse should ask whether the patient is pregnant to determine whether the patient 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.

• Two days after an exploratory laparotomy with a resection of a short segment of small bowel,

a patient complains of gas pains and abdominal distention. Which nursing action is best to take at this time?

• Give a return-flow enema.
• Assist the patient to ambulate.
• Administer the ordered IV morphine sulfate.
• Insert the ordered promethazine (Phenergan) suppository.

ANS: B

Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain.Morphine will further reduce peristalsis. A return-flow enema may decrease the patient’s symptoms, but ambulation is less invasive and should be tried first. Promethazine (Phenergan) is used as an antiemetic rather than to decrease gas pains or distention.

• A patient who has blunt abdominal trauma after an automobile accident is complaining of

severe pain. A peritoneal lavage returns brown drainage with fecal material. Which action will the nurse plan to take next?

• Auscultate the bowel sounds.
• Prepare the patient for surgery.
• Check the patient’s oral temperature.
• Obtain information about the accident.

ANS: B

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 patient for emergency surgery.

• A patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain

with nausea and vomiting. Which action should the nurse take?

• Check for rebound tenderness.
• Assist the patient to cough and deep breathe.
• Apply an ice pack to the right lower quadrant.
• Encourage the patient to take sips of clear liquids.

ANS: C

The patient’s clinical manifestations are consistent with appendicitis, and application of an ice pack will decrease inflammation at the area. The patient should be NPO in case immediate surgery is needed. Checking for rebound tenderness frequently is unnecessary and uncomfortable for the patient. The patient will need to know how to cough and deep breathe postoperatively, but coughing will increase pain at this time.

• Which nursing action will be included in the plan of care for a patient with bowel irregularity

and a new diagnosis of irritable bowel syndrome (IBS)?

• Encourage the patient to express feelings and ask questions about IBS.
• Suggest that the patient increase the intake of milk and other dairy products.
• Educate the patient about the use of alosetron (Lotronex) to reduce symptoms.
• Teach the patient to avoid using nonsteroidal anti-inflammatory drugs (NSAIDs).

ANS: A

Because psychologic and emotional factors can affect the symptoms for IBS, encouraging the patient to discuss emotions and ask questions is an important intervention. Alosetron has serious side effects and is used only for female patients who have not responded to other therapies. Although yogurt may be beneficial, milk is avoided because lactose intolerance can contribute to symptoms in some patients. NSAIDs can be used by patients with IBS.

• A patient hospitalized with an acute exacerbation of ulcerative colitis is having 14 to 16

bloody stools a day and crampy abdominal pain associated with the diarrhea. The nurse will plan to

• place the patient on NPO status.
• administer IV metoclopramide (Reglan).
• teach the patient about total colectomy surgery.
• administer cobalamin (vitamin B12) injections.

ANS: A

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

• Which nursing action will the nurse include in the plan of care when admitting a patient with

an exacerbation of inflammatory bowel disease (IBD)?

• Restrict oral fluid intake.
• Monitor stools for blood.
• Increase dietary fiber intake.
• Ambulate four times daily.

ANS: B

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 patient with IBD. Because dietary fiber may increase gastrointestinal (GI) motility and exacerbate the diarrhea, severe fatigue is common with IBD exacerbations, and dehydration may occur.

• After the nurse has finished teaching a patient with ulcerative colitis about sulfasalazine

(Azulfidine), which patient statement indicates that the teaching has been effective?

• “I will need to use a sunscreen when I am outdoors.”
• “I will need to avoid contact with people who are sick.”
• “The medication will need to be tapered if I need surgery.”
• “The medication will prevent infections that cause the diarrhea.”

ANS: A

Sulfasalazine may cause photosensitivity in some patients. It is not used to treat infections.Sulfasalazine does not reduce immune function. Unlike corticosteroids, tapering of sulfasalazine is not needed.

• A patient who has an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has

excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective?

• The patient uses incontinence briefs to contain loose stools.
• The patient asks for antidiarrheal medication after each stool.
• The patient uses witch hazel compresses to decrease anal irritation.
• The patient cleans the perianal area with soap and water after each stool.

ANS: C

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 to 20 times a day. The perianal area should be washed with plain water after each stool.

• After the nurse has provided patient teaching about recommended dietary choices for a patient

with an acute exacerbation of inflammatory bowel disease (IBD), which diet choice by the patient indicates a need for more teaching?

• Scrambled eggs
• White toast and jam
• Oatmeal with cream
• Pancakes with syrup

ANS: C

During acute exacerbations of IBD, the patient should avoid high-fiber foods such as whole grains. High-fat foods also may cause diarrhea in some patients. The other choices are low residue and would be appropriate for this patient.

• A patient who has had a total proctocolectomy and permanent ileostomy tells the nurse, “I

cannot bear to even look at the stoma. I do not think I can manage all these changes.” Which is the best action by the nurse?

• Develop a detailed written plan for ostomy care for the patient.
• Ask the patient more about the concerns with stoma management.
• Reassure the patient that care for the ileostomy will become easier.
• Postpone any patient teaching until the patient adjusts to the ileostomy.

ANS: B

Encouraging the patient to share concerns assists in helping the patient adjust to the body changes. Acknowledgment of the patient’s feelings and concerns is important rather than offering false reassurance. Because the patient 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 patient’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.