Chapter 30: Care of Patients with Disorders of the Lower Gastrointestinal System My Nursing Test Banks

Chapter 30: Care of Patients with Disorders of the Lower Gastrointestinal System

MULTIPLE CHOICE

1. The patient with an incarcerated hernia is at risk for the hernia to become:

a.

strangulated.

b.

indirect.

c.

direct.

d.

irreducible.

ANS: A

The incarcerated hernia may become strangulated, which cuts off the blood supply and can lead to necrosis of the trapped bowel loop. Hernias are classified as reducible, which means the protruding organ can be returned to its proper place by pressing on the organ, and irreducible, which means that the protruding part of the organ is tightly wedged outside the cavity and cannot be pushed back through the opening. Another name for an irreducible hernia is incarcerated hernia. An indirect hernia protrudes through the inguinal ring. A direct hernia protrudes through the posterior inguinal wall.

DIF: Cognitive Level: Comprehension REF: 663 OBJ: 1 (theory)

TOP: Incarcerated Hernia: Complications

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. The patient who has had an incarcerated hernia for many years begins to experience abdominal pain and vomit dark material with a fecal odor. The nurse recognizes these signs as indications of:

a.

intestinal obstruction.

b.

ruptured bowel.

c.

gastroenteritis.

d.

duodenal ulcer.

ANS: A

Flow of bowel content is blocked by incarceration, causing bowel obstruction with its attendant signs and symptoms of vomiting fecal contents and pain from ischemia and distention of the bowel.

DIF: Cognitive Level: Comprehension REF: 663-664 OBJ: 1 (theory)

TOP: Incarcerated Hernia: Obstructions KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

3. The nurse explains that a hernioplasty involves:

a.

reducing the hernia by manual pressure.

b.

sewing synthetic mesh over the abdominal wall defect to reduce the hernia.

c.

applying an individualized truss for the reduction of the hernia.

d.

reducing the hernia and suturing the defect in the abdominal wall.

ANS: B

Hernioplasty is a surgical intervention in which the hernia is reduced and a synthetic mesh is sewn over the defect in the wall to prevent reoccurrence.

DIF: Cognitive Level: Application REF: 664 OBJ: 1 (theory)

TOP: Hernia Repair: Hernioplasty KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

4. Instruction to a patient who self-medicates with bismuth subsalicylate (Pepto Bismol) tablets should include that the tablets:

a.

may cause aspirin toxicity.

b.

should be swallowed whole.

c.

may stain teeth.

d.

will cause the stool to be black.

ANS: A

The drug may cause aspirin toxicity if taken excessively. The patient should not take other medication containing aspirin while taking this drug. The drug should be chewed well. This medication often turns the stool black. It does not affect the teeth.

DIF: Cognitive Level: Application REF: 666 OBJ: 2 (theory)

TOP: Bismuth Subsalicylate: Side Effects

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

5. The nurse explains that diverticula occur in the older adult because:

a.

loss of bowel tone reduces motility.

b.

changes in bowel wall allow herniation.

c.

the diet may be deficient in bulk.

d.

multipharmacy has altered bowel mucosa.

ANS: B

The bowel wall in the older adult becomes thickened and rigid. Intra-abdominal pressure causes herniation of the mucosa through the bowel wall, causing a small pocket in the colon.

DIF: Cognitive Level: Comprehension REF: 668 OBJ: 3 (theory)

TOP: Diverticula: Etiology KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

6. The nurse urges the patient with diverticulitis to seek treatment because the inflamed bowel wall may:

a.

extend the inflammation to the entire bowel.

b.

progress into ulcerative colitis.

c.

perforate and cause peritonitis.

d.

cause appendicitis.

ANS: C

The term diverticulum refers to a small, blind pouch resulting from a protrusion of the mucous membranes of a hollow organ through weakened areas of the organs muscular wall. Diverticula occur most often in the intestinal tract, especially in the esophagus and colon. The infected diverticula can perforate through the bowel wall and cause peritonitis. Diverticulitis does not result in ulcerative colitis or appendicitis.

DIF: Cognitive Level: Comprehension REF: 668 OBJ: 3 (theory)

TOP: Diverticulitis: Complication KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

7. The nurse uses a visual aid to demonstrate the process of a mechanical bowel obstruction that occurs when:

a.

a tumor obstructs the lumen of the bowel.

b.

a paralytic ileus causes cessation of peristalsis.

c.

the bowel is inflamed by diverticulitis.

d.

the bowel motility is slowed by antidiarrheal drugs.

ANS: A

Obstruction of the bowel may be mechanical or nonmechanical. Mechanical obstruction results in blockage of the lumen of the bowel. Nonmechanical obstruction results from the absence of peristalsis (movement of contents through the bowel stops). Mechanical obstructions include tumors, adhesions, strangulated hernia, twisting of the bowel (volvulus), telescoping of one part of the bowel into another (intussusception), gallstones, barium impaction, and intestinal parasites.

DIF: Cognitive Level: Comprehension REF: 687 OBJ: 4 (theory)

TOP: Bowel Obstruction: Mechanical KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

8. The nurse is aware that an unresolved bowel obstruction can lead to:

a.

systemic infection and fever.

b.

bowel rupture and shock.

c.

adhesions and pain.

d.

bloating and expelling gas.

ANS: B

An unresolved obstruction can cause bowel rupture, peritonitis, shock, and death.

DIF: Cognitive Level: Comprehension REF: 668 OBJ: 4 (theory)

TOP: Bowel Obstruction: Complications KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. The nurse is aware that the person with ulcerative colitis is at risk for:

a.

cancer of the colon.

b.

chronic urinary infections.

c.

intussusception.

d.

volvulus.

ANS: A

Ulcerative colitis is an inflammation, with the formation of ulcers, of the mucosa of the colon. It often is a chronic disease, and the patient usually is free from symptoms between acute flare-ups. The person with ulcerative colitis is 10 to 15 times more likely to develop colon cancer than those who do not have the disease.

DIF: Cognitive Level: Comprehension REF: 670-671 OBJ: 5 (theory)

TOP: Ulcerative Colitis: Risks KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. The nurse explains that the most beneficial diet for a person with inflammatory bowel disease (IBD) is a _____ diet.

a.

low-fat, low-fiber.

b.

high-fiber, low-protein.

c.

mechanical soft, low-sodium.

d.

low-protein, low-calorie.

ANS: A

A low-fat, low-fiber, high-protein, high-calorie diet is recommended for the patient with IBD to make up for the loss of fluid and nutrients in the frequent stools.

DIF: Cognitive Level: Application REF: 671 OBJ: 6 (theory)

TOP: IBD: Diet KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

11. The nurse caring for a patient who has peritonitis and has developed a paralytic ileus assesses that the patient is passing gas. The assessment is an indication of:

a.

gas forming in bowel contents.

b.

the result of forceful vomiting.

c.

returned peristalsis.

d.

inadequate decompression.

ANS: C

The passing of gas or stool in the patient who has a paralytic ileus is an indication that peristalsis has returned.

DIF: Cognitive Level: Comprehension REF: 673 OBJ: 7 (theory)

TOP: Peritonitis: Complication KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

12. The nurse explains to the patient receiving bevacizumab (Avastin) for a tumor in the colon that the drug slows cancer cell growth by the process of:

a.

changing the pH of the cell environment.

b.

reducing blood flow to the tumor.

c.

overhydrating cells of the tumor, causing them to burst.

d.

interfering with DNA of tumor cells.

ANS: B

Avastin reduces the blood flow to the tumor cells, depriving them of nutrients.

DIF: Cognitive Level: Application REF: 675 OBJ: 1 (clinical)

TOP: Cancer: Treatment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

13. The nurse caring for the patient with an ileostomy will include special interventions to prevent skin breakdown and irritation at the stomal site because the:

a.

large adhesive patch for the collection bag is irritating.

b.

ileostomy stoma is very large and difficult to cover completely with the adhesive faceplate.

c.

liquid stool from the ileum contains digestive enzymes that are especially harmful to the skin.

d.

soft stool is difficult to remove from the skin without abrading the skin.

ANS: C

The liquid stool from the ileum has many digestive enzymes, unlike stool that is expelled from the colon.

DIF: Cognitive Level: Application REF: 680 OBJ: 2 (clinical)

TOP: Ileostomy: Skin Protection KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

14. The nurse explains that the advantage of the Kock pouch ileostomy is that the patient:

a.

can expel feces from the rectum in the normal fashion.

b.

does not have to wear a collection device.

c.

only has to evacuate the pouch once a day.

d.

can have the pouch reanastomosed to the colon at a later time.

ANS: B

The major advantage of the Kock pouch is that the patient does not have to wear a collection device. The feces are collected in the pouch and emptied by the patient inserting a catheter into the pouch every 3 or 4 hours.

DIF: Cognitive Level: Application REF: 680 OBJ: 3 (clinical)

TOP: Ileostomy: Kock Pouch KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

15. The nurse assessing the stoma of a patient 1 day after a transverse colostomy will immediately report the finding of a(n):

a.

wet, glistening stoma.

b.

stoma with slight bleeding around the margin.

c.

edematous stoma.

d.

purplish-red stoma.

ANS: D

The purple hue in the new stoma is an indication of reduced perfusion to the stoma and should be reported immediately. A new stoma should have a pink or beefy red color, be slightly edematous, and have some small bleeding around the stoma.

DIF: Cognitive Level: Application REF: 682 OBJ: 2 (clinical)

TOP: Stoma: Assessment KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

16. The patient with a 4-day-old ileostomy complains of cramping. The nurse notes a drop in the effluent for the ileostomy. The bowel sounds are rapid with a tinkling sound. The nurse should:

a.

ambulate the patient to help expel gas.

b.

irrigate the ileostomy with 500 mL of warm water.

c.

notify the charge nurse immediately of possible obstruction.

d.

turn the patient on the left side to help drain the ileostomy.

ANS: C

Cramping and reduced effluent from a new ileostomy should be reported immediately as these are signs of obstruction, which could lead to perforation. Ileostomies are not irrigated except by the physician or an enterostomal therapist.

DIF: Cognitive Level: Application REF: 669 OBJ: 10 (theory)

TOP: Ileostomy: Obstruction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

17. A 36-year-old woman who had an ascending colostomy angrily declares, I dont want this hateful thing on my body! This nasty thing is not me. The nurses most therapeutic response would be:

a.

The colostomy is part of you now.

b.

Let me change the collection bag so you wont feel so nasty.

c.

All ostomates feel this way at first. Ill go get a list of support groups you may want to join.

d.

What about this colostomy concerns you the most?

ANS: D

Asking the patient to name the specific concerns helps to conceptualize where the adjustment problem lies. All other options negate the patients feelings, reinforce the patients negative feelings, and do not offer any therapeutic response.

DIF: Cognitive Level: Analysis REF: 684 OBJ: 4 (clinical)

TOP: Altered Body Image: Intervention KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

18. The nurse is caring for a patient diagnosed with diverticulitis. In response to the patients complaints of pain, the most likely medication to be used is:

a.

meperidine (Demerol).

b.

morphine.

c.

nalbuphine hydrochloride (Nubain).

d.

naloxone (Narcan).

ANS: A

Meperidine (Demerol) is the most likely selection to be prescribed for pain. Morphine increases intraluminal pressure and is likely to be avoided for this patient. Nubain is an analgesic but is not likely to reflect the strength and actions needed for the patient with diverticulitis. Narcan is used as an antagonist for narcotics.

DIF: Cognitive Level: Application REF: 668 OBJ: 3 (theory)

TOP: Diverticulitis: Treatment and Nursing Management

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19. The nurse is discussing high-fiber dietary selections with a patient. Later, the patient makes his menu selection. When reviewing the patients selections, what is most reflective of understanding the teaching provided?

a.

Turkey sandwich on whole wheat toast, pears, and water

b.

Fried chicken, corn, and diet soda

c.

Cheese pizza, salad, and cola

d.

Bacon, lettuce, and tomato sandwich, blackberry compote, and orange juice

ANS: A

A high-fiber diet is encouraged for the patient with diverticular disease. Eating whole-grain cereals and breads, as well as fruits such as apples, seedless berries, peaches, and pears adds fiber. High-fiber vegetablessquash, broccoli, cabbage, and spinachand legumes, including dried beans, peas, and lentils, provide bulk that decreases constipation and speeds the transit time in the intestine. Drinking plenty of fluids and water helps regularity.

DIF: Cognitive Level: Application REF: 668 OBJ: 4 (clinical)

TOP: Diverticulitis: Nutrition Considerations

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

20. The nurse is caring for a patient who has been diagnosed with Crohns disease. When providing education concerning dietary recommendations, which statement by the patient indicates an understanding of the teaching?

a.

I should try to eat as much fiber daily as I can.

b.

Reducing dietary fat and fiber will be helpful in managing my condition.

c.

I should not have lactose-containing products.

d.

Eating a larger breakfast and smaller lunch and dinner portions is recommended.

ANS: B

A diet of low-fat, low-fiber foods that have a high protein and caloric content is instituted. Small frequent feedings are best. Lactose avoidance helps some patients but is not a global recommendation.

DIF: Cognitive Level: Application REF: 671 OBJ: 5 (theory)

TOP: Crohns Disease: Treatment KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

MULTIPLE RESPONSE

21. The nurse lists the contributing factors to developing a hernia, which include: (Select all that apply.)

a.

heavy lifting.

b.

chronic cough.

c.

straining with defecation.

d.

ascites.

e.

strenuous sexual activity.

ANS: A, B, C, D

The most common locations for a hernia are in areas where the abdominal wall is normally weaker and more likely to allow a segment of intestine to protrude. These include the center of the abdomen at the site of the umbilicus and the lower abdomen at the points where the inguinal ring and the femoral canal begin. The most common contributing factors in the development of a hernia are straining to lift heavy objects, chronic cough, straining to void, straining at stool, and ascites. Sexual activity is not usually a cause for herniation.

DIF: Cognitive Level: Comprehension REF: 663 OBJ: 1 (theory)

TOP: Hernia: Etiology KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

22. The nurse lists foods and beverages that may trigger an attack of irritable bowel syndromes (IBS), which include: (Select all that apply.)

a.

caffeine.

b.

dairy products.

c.

specific food allergies.

d.

wheat products.

e.

alcohol.

ANS: A, B, C, D

Irritable bowel syndrome (IBS) is a functional disorder of gastrointestinal motility. The cause of IBS is unknown, but it is thought to be due to a hypersensitivity of the bowel wall leading to disruption of the normal function of the intestinal muscles. An altered bowel pattern and abdominal pain with bloating are caused by altered motility of the small and large intestines. It is thought that with IBS there is an abnormality of nerve function in the intestine. Stress, caffeine, and sensitivity to certain foods such as dairy and wheat products seem to trigger IBS in some people. Alcohol is not considered a trigger for IBS.

DIF: Cognitive Level: Comprehension REF: 664 OBJ: 2 (theory)

TOP: IBS: Triggers KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

23. The nurse is aware that the diagnostic criteria for the confirmation of irritable bowel syndrome include: (Select all that apply.)

a.

pain increased by defecation.

b.

pain associated with stool frequency.

c.

mucorrhea.

d.

abdominal tenderness.

e.

bloating.

ANS: B, C, D, E

Diagnosis of IBS is based on clinical manifestations and ruling out the presence of organic bowel disease. Defecation typically decreases pain. All other options are confirmation of the diagnosis of IBS.

DIF: Cognitive Level: Comprehension REF: 664-665 OBJ: 2 (clinical)

TOP: IBS: Diagnostic Criteria KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

24. The nurse explains that conservative treatment of diverticulosis includes: (Select all that apply.)

a.

low-fiber diet.

b.

increased fluids.

c.

stool softeners.

d.

NSAIDs for discomfort.

e.

bulk laxatives.

ANS: B, C, D, E

A high-fiber diet is indicated for the treatment of diverticulosis. All other options would be part of a conservative, nonsurgical approach to treatment.

DIF: Cognitive Level: Comprehension REF: 668 OBJ: 3 (theory)

TOP: Diverticulosis: Treatment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

25. The nurse preparing a teaching plan for a 20-year-old woman who is taking sulfasalazine (Azulfidine) for Crohns disease will include that this drug will: (Select all that apply.)

a.

make the patient photosensitive.

b.

interfere with effectiveness of oral contraceptives.

c.

decrease the effect of hypoglycemic agents.

d.

turn the urine orange.

e.

cause GI upset.

ANS: A, B, D, E

This drug increases the effect of hypoglycemic agents. All other options are significant points of information pertinent to the drug.

DIF: Cognitive Level: Application REF: 666 OBJ: 5 (theory)

TOP: Crohns Disease: Treatment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

26. The nursing care of a patient with an acute exacerbation of inflammatory bowel disease (IBS) will include: (Select all that apply.)

a.

measuring intake and output.

b.

assessing bowel sounds.

c.

documenting the patients weekly weight.

d.

encouraging periods of rest.

e.

assessing for internal bleeding.

ANS: A, B, C, D, E

The patient should be weighed on a daily basis during an acute exacerbation of IBS. All other options reflect nursing interventions that are significant in the care of a patient with IBS.

DIF: Cognitive Level: Application REF: 665 OBJ: 6 (theory)

TOP: NCP: IBS KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

27. The nurses instruction to the patient for peristomal skin care should include: (Select all that apply.)

a.

gently removing the faceplate of the appliance to avoid skin irritation.

b.

washing the peristomal area vigorously to rid the skin of fecal waste.

c.

rinsing the area thoroughly.

d.

applying a skin barrier to the peristomal area.

e.

cutting the faceplate to allow a 1/2-inch opening around the stoma.

ANS: A, C, D

The faceplate should be removed gently to avoid skin damage; rinsing and drying, and application of a skin barrier, is essential. The skin is gently washed and the faceplate should allow a 1/8-inch opening around the stoma.

DIF: Cognitive Level: Application REF: 683-684 OBJ: 2 (clinical)

TOP: Peristomal Skin Care KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

COMPLETION

28. The mechanical bowel obstruction caused when the bowel twists on itself is _________.

ANS:

volvulus

Volvulus, the bowel twisting on itself, causes a mechanical bowel obstruction that must be reduced immediately to prevent necrosis to the bowel from ischemia.

DIF: Cognitive Level: Knowledge REF: 668 OBJ: 4 (theory)

TOP: Bowel Obstruction: Volvulus KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

MATCHING

Match the types of ostomies with the expected type of effluent.

a.

Ascending colostomy

b.

Transverse colostomy

c.

Descending colostomy

d.

Ileostomy

e.

Continent ileostomy

29. Formed stool on relatively regular basis

30. Semiliquid stool at unpredictable times

31. Liquid and unformed stool

32. Extremely watery stool with concentrations of digestive enzymes

33. No effluent

29. ANS: C DIF: Cognitive Level: Application REF: 680

OBJ: 2 (clinical) TOP: Ostomies: Effluents

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

30. ANS: B DIF: Cognitive Level: Analysis REF: 680

OBJ: 2 (clinical) TOP: Ostomies: Effluents

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

31. ANS: A DIF: Cognitive Level: Analysis REF: 679

OBJ: 2 (clinical) TOP: Ostomies: Effluents

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

32. ANS: D DIF: Cognitive Level: Analysis REF: 680

OBJ: 2 (clinical) TOP: Ostomies: Effluents

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

33. ANS: E DIF: Cognitive Level: Analysis REF: 683

OBJ: 2 (clinical) TOP: Ostomies: Effluents

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

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