Chapter 28. Bowel Elimination My Nursing Test Banks

Chapter 28. Bowel Elimination

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. When changing a diaper, the nurse observes that a 2-day-old infant has had a green black, tarry stool. What should the nurse do?

1)

Notify the physician.

2)

Do nothing; this is normal.

3)

Give the baby sterile water until the mothers milk comes in.

4)

Apply a skin barrier cream to the buttocks to prevent irritation.

____ 2. Based on the stage of physical development at which toilet training becomes physically possible, for which age would a goal of Achieves toilet training by the end of this month be most appropriate?

1)

18 months

2)

2 1/2 years

3)

3 1/2 years

4)

4 years

____ 3. The nurse has taught a patient about the primary risk factors for irritable bowel syndrome. Which behavior by the patient would be evidence of learning? The patient:

1)

Reduces her intake of gluten-containing products.

2)

Does not consume foods that contain lactose.

3)

Consumes only 4 cups of caffeinated coffee per day.

4)

Takes measures to reduce her stress level.

____ 4. Which of the following goals is appropriate for a patient with a nursing diagnosis of Constipation? The patient increases the intake of:

1)

Milk and cheese.

2)

Bread and pasta.

3)

Fruits and vegetables.

4)

Lean meats.

____ 5. A patient is diagnosed with an intestinal infection after traveling abroad. The nurse should encourage the intake of which food to promote healing?

1)

Yogurt

2)

Pasta

3)

Oatmeal

4)

Broccoli

____ 6. A nurse is teaching wellness to a womens group. The nurse should explain the importance of consuming at least how much fluid to promote healthy bowel function (assume these are 8-ounce glasses)?

1)

2 to 4 glasses a day

2)

4 to 6 glasses a day

3)

6 to 8 glasses a day

4)

8 to 10 glasses a day

____ 7. A patient with a skin infection is prescribed cephalexin (an antibiotic) 500 mg orally q 12 hours. The patient complains that the last time he took this medication, he had frequent episodes of loose stools. Which recommendation should the nurse make to the patient?

1)

Stop taking the drug immediately if diarrhea develops.

2)

Take an antidiarrheal agent such as diphenoxylate.

3)

Consume yogurt daily while taking the antibiotic.

4)

Increase your intake of fiber until the diarrhea stops.

____ 8. Which collaborative interventions will help prevent paralytic ileus in a patient who underwent right hemicolectomy for colon cancer?

1)

Administering morphine 4 mg intravenously every 2 hours for pain

2)

Administering IV fluids at 125 ml/hr

3)

Inserting an indwelling urinary catheter to monitor I&O

4)

Keeping the patient NPO until bowel sounds return

____ 9. The nurse in a long-term care facility is teaching a group of residents about increasing fiber in their diet. Which foods should she explain are high in fiber?

1)

White bread, pasta, and white rice

2)

Oranges, raisins, and strawberries

3)

Whole milk, eggs, and bacon

4)

Peaches, orange juice, and bananas

____ 10. The nurse is assessing a patient who underwent bowel resection 2 days ago. As she auscultates the patients abdomen, she notes low-pitched, infrequent bowel sounds. How should she document this finding?

1)

Hyperactive bowel sounds

2)

Abdominal bruit sounds

3)

Normal bowel sounds

4)

Hypoactive bowel sounds

____ 11. The healthcare team suspects that a patient has an intestinal infection. Which action should the nurse take to help confirm the diagnosis?

1)

Prepare the patient for an abdominal flat plate.

2)

Collect a stool specimen that contains 20 to 30 ml of liquid stool.

3)

Administer a laxative to prepare the patient for a colonoscopy.

4)

Test the patients stool using a fecal occult test.

____ 12. The nurse is instructing a patient about performing home testing for fecal occult blood. The nurse can conclude that learning occurs if the patient says, For 3 days prior to testing, I should avoid eating

1)

Beef.

2)

Milk.

3)

Eggs.

4)

Oatmeal.

____ 13. The nurse is instructing a patient about performing home testing for fecal occult blood. The nurse should explain that ingestion of which substance may cause a false-negative fecal occult blood test?

1)

Vitamin D

2)

Iron

3)

Vitamin C

4)

Thiamine

____ 14. Which action should the nurse take to assess a 2-year-old child for pinworms?

1)

Press clear cellophane tape against the anal opening to obtain a specimen.

2)

Collect a freshly passed stool from a diaper using a wooden spatula.

3)

Place a smear of stool on a slide and add two drops of reagent.

4)

Prepare the patient for a flat plate (x-ray) of the abdomen.

____ 15. The nurse must irrigate the colostomy of a patient who is unable to move independently. How should the nurse position the patient for this procedure?

1)

Semi-Fowlers position

2)

Left sidelying position

3)

Supine with the head of the bed lowered flat

4)

Supine with the head of bed raised to 30 degrees

____ 16. A mother of a school-age child seeks healthcare because her child has had diarrhea after being ill with a viral infection. The patient states that after vomiting for 24 hours, his appetite has returned. Which recommendation should the nurse make to this mother?

1)

Consume a diet consisting of bananas, white rice, applesauce, and toast.

2)

Drink large quantities of water regularly to prevent dehydration.

3)

Take loperamide [an antidiarrheal] as needed to control diarrhea.

4)

Increase the consumption of raw fruits and vegetables.

____ 17. Which is a key treatment intervention for the patient admitted with diverticulitis?

1)

Antacid

2)

Antidiarrheal agent

3)

Antibiotic therapy

4)

NSAIDs

____ 18. The nurse assesses a patients abdomen 4 days after abdominal surgery and notes that bowel sounds are absent. This finding most likely suggest which postoperative complication?

1)

Paralytic ileus

2)

Small bowel obstruction

3)

Diarrhea

4)

Constipation

____ 19. A patient with a colostomy complains to the nurse, I am having really bad odors coming from my pouch. To help control odor, which foods should the nurse advise him to consume?

1)

White rice and toast

2)

Tomatoes and dried fruit

3)

Asparagus and melons

4)

Yogurt and parsley

____ 20. A patient with severe hemorrhoids is incontinent of liquid stool. Which of the following interventions is contraindicated?

1)

Apply an indwelling fecal drainage device.

2)

Apply an external fecal collection device.

3)

Place an incontinence garment on the patient.

4)

Place a waterproof pad under the patients buttocks.

____ 21. A patient has a colostomy in the descending (sigmoid) colon and wishes to control bowel evacuation and possibly stop wearing an ostomy pouch. To help achieve this goal, nurse should teach the patient to:

1)

Call the primary care provider if the stoma becomes pale, dusky, or black.

2)

Limit the intake of gas-forming foods such as cabbage, onions, and fish.

3)

Irrigate the stoma to produce a bowel movement on a schedule.

4)

Avoid returning to the use of an ostomy appliance if he becomes ill.

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 1. Which factor(s) place(s) the patient at risk for constipation? Choose all that apply.

1)

Sedentary lifestyle

2)

High-dose calcium therapy

3)

Lactose intolerance

4)

Consuming spicy foods

____ 2. 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 fluid(s) should the patient avoid because of the diuretic effect? Choose all that apply.

1)

Cranberry juice

2)

Water

3)

Coffee

4)

Ginger ale

5)

Tea

____ 3. 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 patients rectum? Choose all that apply.

1)

2 inches

2)

3 inches

3)

4 inches

4)

5 inches

Other

1. When performing an abdominal assessment, what sequence of assessment techniques should the nurse use? Label the steps from 1 to 4, with 1 being the first step to perform.

A. Auscultation

B. Palpation

C. Percussion

D. Inspection

2. The nurse is collecting a stool specimen. Arrange the following steps in the order the nurse should perform them. Label the steps from 1 to 4, with 1 being the first step to perform.

A. Have the patient defecate into a special container placed under the toilet seat.

B. Put on gloves and place the specimen in a specimen container.

C. Ask the patient to void to empty the bladder.

D. Place a label on the specimen container.

3. When administering an enema, list the following steps in the order in which they should be performed. Label the steps from 1 to 6, with 1 being the first step to perform.

A. Document the results of the procedure.

B. Assess the patient for cramping.

C. Insert the tubing about 3 to 4 inches into the rectum.

D. Lubricate the tip of the enema tubing generously.

E. Raise the container to the correct height and instill the solution at a slow rate.

F. Encourage the patient to hold the solution for 3 to 15 minutes, depending on the type of enema.

Chapter 28. Bowel Elimination

Answer Section

MULTIPLE CHOICE

1. ANS: 2

During the first few days of life, a term newborn passes green black, tarry stools known as meconium. Stools transition to a yellow green color over the next few days. After that, the appearance of stools depends upon the feedings the newborn receives. Sterile water does nothing to alter this progression. Meconium stools are more irritating to the buttocks than other stools because they are so sticky and the skin usually must be rubbed to cleanse it.

PTS: 1 DIF: Moderate REF: V1, p. 681

KEY: Nursing process: Interventions | Client need: HPM | Cognitive level: Application

2. ANS: 2

Between ages 2 and 3 years, a child can typically control defecation, thereby making toilet training possible. Nevertheless, some children, especially boys, may not actually be toilet trained until somewhat later.

PTS: 1 DIF: Easy REF: V1, p. 681

KEY: Nursing process: Planning | Client need: HPM | Cognitive level: Comprehension

3. ANS: 4

Stress is a primary factor in the development of irritable bowel syndrome. Other risk factors include caffeine consumption and lactose intolerance; however, they are not primary risk factors. Celiac disease is associated with gluten intake.

PTS: 1 DIF: Moderate REF: V1, p. 681

KEY: Nursing process: Evaluation | Client need: PHSI | Cognitive level: Application

4. ANS: 3

The nurse should encourage the patient to increase his intake of foods rich in fiber because they promote peristalsis and defecation, thereby relieving constipation. Low-fiber foods, such as bread, pasta, and other simple carbohydrates, as well as milk, cheese, and lean meat, slow peristalsis.

PTS: 1 DIF: Moderate REF: V1, p. 692

KEY: Nursing process: Planning | Client need: PHSI | Cognitive level: Application

5. ANS: 1

Although the patient may have diarrhea, the goal is not to stop the diarrhea, but to eliminate the pathogens from the digestive tract. The active bacteria in yogurt stimulate peristalsis and promote healing of intestinal infections. Pasta is a low-fiber food that slows peristalsis. It does not promote healing of intestinal infections. Oatmeal stimulates peristalsis, but it does not promote healing of intestinal infections. Broccoli stimulates gas production; it is ineffective against intestinal infections.

PTS: 1 DIF: Moderate REF: V1, p. 682 | V1, p. 692

KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application

6. ANS: 3

A minimum of 6 to 8 glasses of fluid should be consumed each day to promote healthy bowel function.

PTS: 1 DIF: Easy REF: V1, p. 682

KEY: Nursing process: Interventions | Client need: HPM | Cognitive level: Recall

7. ANS: 3

Antibiotics such as cephalexin, given to combat infection, decrease the normal flora in the colon that cause diarrhea. Bacterial populations can be maintained by encouraging the patient to consume yogurt daily while taking the drugs. Diarrhea is a common adverse effect of antibiotics; stopping the drug is not necessary. The patient should not be encouraged to take an antidiarrheal agent at this time. Increasing the intake of fiber combats constipation, not diarrhea.

PTS: 1 DIF: Moderate REF: V1, p. 682

KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application

8. ANS: 4

Patients who require bowel surgery typically remain NPO until peristalsis returns, helping to prevent paralytic ileus, a complication that can occur after the bowel is surgically manipulated. Administering morphine promotes comfort but may increase the risk of ileus. Administering IV fluids prevents dehydration, but does not directly prevent ileus. Inserting an indwelling urinary catheter prevents urine retention and facilitates monitoring postoperative urine output.

PTS: 1 DIF: Moderate REF: V1, p. 682; not stated directly in text

KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application

9. ANS: 2

Oranges, raisins, and strawberries are high in fiber. White bread, pasta, and white rice are carbohydrates. Whole milk, eggs, and bacon are high in cholesterol. Peaches, orange juice, and bananas are sources of potassium.

PTS: 1 DIF: Moderate REF: V1, p. 700

KEY: Nursing process: Interventions | Client need: HPM | Cognitive level: Comprehension

10. ANS: 4

Hypoactive bowel sounds are low-pitched, infrequent, and quiet. An abdominal bruit is a hollow, blowing sound found over an artery, such as the iliac artery. Normal bowel sounds are high-pitched with approximately 5 to 35 gurgles occurring every minute. Hyperactive bowel sounds are very high pitched and more frequent than normal bowel sounds.

PTS: 1 DIF: Difficult REF: V1, p. 686

KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Application

11. ANS: 2

To confirm the diagnosis of an infection, the nurse should collect a liquid stool specimen that contains 20 to 30 ml of liquid stool. An abdominal flat plate and a fecal occult blood test cannot confirm the diagnosis. Colonoscopy is not necessary to obtain a specimen to confirm the diagnosis.

PTS: 1 DIF: Moderate REF: V1, p. 688

KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Application

12. ANS: 1

The nurse should instruct the patient to avoid red meat, chicken, fish, horseradish, and certain raw fruits and vegetables for 3 days prior to fecal occult blood testing.

PTS: 1 DIF: Moderate REF: V1, p. 688 | V2, p. 650

KEY: Nursing process: Evaluation | Client need: PHSI | Cognitive level: Comprehension

13. ANS: 3

Ingestion of vitamin C can produce a false-negative fecal occult blood test; ingestion of vitamin D, iron, and thiamine does not. Iron can lead to a false-positive result.

PTS: 1 DIF: Moderate REF: V1, p. 688 | V2, p. 650

KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Comprehension

14. ANS: 1

To assess for pinworms, the nurse should press cellophane tape against the childs anal opening during the night or as soon as he awakens. Remove the tape immediately, and place it on a slide. Perineal swabs may also be necessary for microscopic study. Collecting a fresh stool specimen from a diaper describes the method for an infant or toddler. Placing a smear of stool on a slide and adding a reagent describes fecal occult blood testing. An abdominal flat plate is not a method of assessing for pinworms.

PTS: 1 DIF: Moderate REF: V1, p. 688 | V2, p. 675

KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Comprehension

15. ANS: 2

The nurse should position an immobile patient in a left sidelying position to irrigate his colostomy. Semi-Fowlers, supine with the bed lowered flat, and the supine position with the head of bed elevated to 30 degrees are not appropriate positions for colostomy irrigation.

PTS: 1 DIF: Moderate REF: V2, p. 665

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

16. ANS: 1

The nurse should encourage the patient with diarrhea who has an appetite to consume a diet that consists of bananas, white rice, applesauce, and toast. These foods are easy to digest, provide calories for energy, and help provide a source of calcium. The patient should sip liquids frequently to prevent dehydration; large quantities might worsen diarrhea. Medication, such as loperamide (Imodium), is usually reserved for chronic diarrhea. Raw fruits and vegetables may worsen diarrhea.

PTS: 1 DIF: Moderate REF: V1, p. 692

KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application

17. ANS: 3

A key treatment for diverticulitis (an infected diverticulum) is antibiotic therapy; if antibiotic therapy is ineffective, surgery may be necessary. Antacids, antidiarrheal agents, and NSAIDs are not indicated for treatment of diverticulitis.

PTS: 1 DIF: Moderate REF: V1, p. 684

KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application

18. ANS: 1

Absent bowel sounds on the fourth postoperative day suggests paralytic ileus, a complication associated with abdominal surgery. A small bowel obstruction and diarrhea produce hyperactive bowel sounds. Constipation might be associated with hypoactive bowel sounds.

PTS: 1 DIF: Moderate REF: V1, p. 682

KEY: Nursing process: Diagnosis | Client need: PHSI | Cognitive level: Analysis

19. ANS: 4

Yogurt, cranberry juice, parsley, and buttermilk may help control odor. White rice and toast (also bananas and applesauce) help control diarrhea. Asparagus, peas, melons, and fish are known to cause odor. Tomatoes, pears, and dried fruit are high-fiber foods that might cause blockage in a patient with an ostomy.

PTS: 1 DIF: Moderate REF: V1, p. 700

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

20. ANS: 1

An indwelling fecal drainage device is contraindicated for children; for more than 30 consecutive days of use; and for patients who have severe hemorrhoids, recent bowel, rectal, or anal surgery or injury; rectal or anal tumors; or stricture or stenosis. External devices are not typically used for patients who are ambulatory, agitated, or active in bed because the device may be dislodged, causing skin breakdown. External devices cannot be used effectively when the patient has Impaired Skin Integrity because they will not seal tightly. Absorbent products are not contraindicated for this patient unless Impaired Skin Integrity occurs. Even with absorbent products or an external collection device, the nurse should place a waterproof pad under the patient to protect the bed linens.

PTS: 1 DIF: Difficult REF: V1, p. 698

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

21. ANS: 3

Patients with an ostomy in the descending or sigmoid colon may use colostomy irrigation as a means to control and schedule bowel evacuation and possibly eliminate the need to wear an ostomy pouch. Limiting the intake of gas-forming foods is a good idea from a social perspective; however, it does not help achieve the goal of having regular BMs and eliminating the need to wear a pouch. When illness occurs, it may be difficult to control the output, so the patient can use an ostomy appliance. This will not make it more difficult to schedule the BMs after the illness passes.

PTS: 1 DIF: Moderate REF: V1, p. 701

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

MULTIPLE RESPONSE

1. ANS: 1, 2

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 consuming spicy foods are associated with a nursing diagnosis of Diarrhea, not Constipation.

PTS: 1 DIF: Moderate REF: V1, p. 692

KEY: Nursing process: Diagnosis | Client need: HPM | Cognitive level: Comprehension

2. ANS: 3, 5

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.

PTS: 1 DIF: Moderate REF: V1, p. 690

KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Comprehension

3. ANS: 2, 3

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

PTS: 1 DIF: Moderate REF: V2, p. 656

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Recall

OTHER

1. ANS:

D, A, C, B

When performing an abdominal assessment, the nurse should follow the sequence: inspection, auscultation, percussion, and palpation. Percussion and palpation may stimulate peristalsis, so the techniques with the least contact should be done first.

PTS: 1 DIF: Moderate REF: V2, p. 677

KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Recall

2. ANS:

C, A, B, D

The nurse should ask the patient to void and then have him defecate into a special container placed under the toilet seat. Next, the nurse should put on gloves and, using a tongue blade, place the specimen into the container. Finally, she should label the specimen and send it to the laboratory for analysis.

PTS: 1 DIF: Difficult REF: V1, p. 688 | V2, p. 650

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Analysis

3. ANS:

D, C, E, B, F, A

You must lubricate the tip before inserting the tubing. You would then begin instilling the solution before assessing for cramping that the instillation might produce. Only after the solution is instilled would you ask the patient to hold the solution. The last action is to document the results of the procedure, after the procedure is finished.

PTS: 1 DIF: Difficult REF: V2, pp. 655-657

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

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