Chapter 50Lower Gastrointestinal Tract Dysfunction: Nursing Management My Nursing Test Banks

Chapter 50Lower Gastrointestinal Tract Dysfunction: Nursing Management

MULTIPLE CHOICE

1.In caring for a client diagnosed with a small bowel obstruction, what would the nurse expect to do first?

1.

Prepare to put in a nasogastric (NG) tube.

2.

Give pain medication.

3.

Draw lab work.

4.

Start an intravenous (IV) line.

ANS: 4

Starting an IV to give fluids and electrolytes would be the first step in caring for this client. Although an NG tube will be ordered, fluid balance is more important. Administering pain medication may make the problem worse. Drawing lab work would not be the first intervention needed for this client.

PTS: 1 REF: Surgery

2.The nurse, instructing a client about malabsorption syndrome, should include that food is absorbed in the:

1.

mouth.

2.

bloodstream.

3.

stomach.

4.

small intestine.

ANS: 4

The mouth and stomach are used mostly for digestion. The small intestine is where most of the absorption of food nutrients occurs. Food is not directly absorbed into the bloodstream.

PTS: 1 DIF: Apply REF: Small Intestine: Absorption of Nutrients

3.A client is diagnosed with appendicitis. One of the laboratory tests the nurse would expect to monitor would be:

1.

serum sodium.

2.

white blood cell (WBC) count.

3.

hemoglobin (Hgb) and hematocrit (Hct).

4.

bilirubin level.

ANS: 2

Infection often accompanies the inflammation of the appendix. The nurse would be looking for an elevated WBC count. Serum sodium, hemoglobin, hematocrit, and bilirubin levels are not necessarily indicated in the care of a client diagnosed with appendicitis.

PTS: 1 DIF: Analyze REF: Appendicitis: Diagnostic Tests

4.When assessing the pain in a client diagnosed with appendicitis, the nurse would expect to assess:

1.

extreme pain with slight palpation anywhere on the abdomen.

2.

pain in the upper back when the right lower quadrant is palpated.

3.

more pain when the pressure is released in the right lower quadrant.

4.

no pain when the abdomen is palpated.

ANS: 3

Typically rebound pain is associated with appendicitis. Rebound pain is described as more pain when pressure is released than when pressure is applied. Appendicitis pain is not associated with pain anywhere on the abdomen upon slight palpation. Appendicitis pain is not typically assessed in the upper back. Appendicitis is associated with pain.

PTS: 1 DIF: Apply REF: Box 50-3 Rovsings Sign for Appendicitis

5.A client is being evaluated for symptoms associated with diverticular disease. The nurse realizes that the best diagnostic test to be used to aid in this diagnosis would be:

1.

computed tomography (CT) scan.

2.

barium enema.

3.

ultrasound.

4.

x-ray study.

ANS: 1

A CT scan is the best method of detecting abscesses and complications evidenced in diverticulitis. Barium enema is contraindicated in acute diverticulitis because of the risk of contamination if there is an existing perforation. An ultrasound or x-rays would not adequately diagnose the presence of the disorder.

PTS: 1 DIF: Analyze REF: Diverticulitis: Diagnostic Tests

6.An elderly client has noted blood in her stool for the past few months. Which information in the medical history would strongly suggest colorectal cancer?

1.

Increased bouts of vomiting

2.

Change in bowel habits

3.

Recent infection in the blood

4.

Decrease in appetite

ANS: 2

Change in bowel habits is one of the seven danger signals for cancer. Changes in bowel habits and blood in the stool are common signs of colorectal cancer. Vomiting, decreased appetite, or recent blood infection could be symptoms of other health problems, but they are not necessarily colorectal cancer.

PTS:1DIF:Analyze

REF:Colorectal Cancer: Assessment with Clinical Manifestations

7.The nurse is caring for a client diagnosed with irritable bowel syndrome (IBS) who is experiencing diarrhea. What medication would the nurse expect to administer?

1.

Loperamide (Imodium)

2.

Docusate sodium (Colace)

3.

Lorazepam (Ativan)

4.

Haloperidol (Haldol)

ANS: 1

Antidiarrheal agents like Imodium can be given prophylactically or symptomatically on an as-needed basis. Docusate sodium (Colace), lorazepam (Ativan), and haloperidon (Haldol) are not indicated to treat this disorder.

PTS: 1 DIF: Apply REF: Irritable Bowel Syndrome: Pharmacology

8.A client complains of acute gastrointestinal distress. While obtaining a health history, the nurse asks about the family history. Which disorder has a familial basis?

1.

Hepatitis

2.

Ulcerative colitis

3.

Appendicitis

4.

Bowel obstructions

ANS: 2

Genetic factors have been identified as susceptibility factors for the development of ulcerative colitis. None of the other choices have a genetic predisposition for developing the disorder.

PTS: 1 DIF: Analyze REF: Inflammatory Bowel Disorders

9.A client diagnosed with appendicitis asks the nurse why this illness occurred. The nurse should respond that the most common cause of appendicitis is:

1.

ulcerative colitis.

2.

obstruction of the appendix.

3.

low-fat diet.

4.

infection.

ANS: 2

An infection may occur with appendicitis, but the most common cause of infection is an obstruction of the appendix. The obstruction could be caused by lymph tissue, a fecalith, a foreign body, or worms. Ulcerative colitis, low-fat diet, or infection does not cause appendicitis.

PTS: 1 DIF: Apply REF: Appendicitis: Pathophysiology

10.A young client is experiencing acute abdominal pain. The nurse realizes that the most common cause for this type of pain would be:

1.

appendicitis.

2.

biliary tract disease.

3.

kidney stones.

4.

urinary tract infection.

ANS: 1

The most common cause of acute abdominal pain is appendicitis. Biliary tract disease is the most common disorder in the elderly, causing pain in the right upper quadrant. Kidney stones and urinary tract infections do not necessarily cause abdominal pain.

PTS:1DIF:AnalyzeREF:Acute Abdomen

11.A client experiencing abdominal pain and diarrhea tells the nurse that he used to smoke. Which of the following gastrointestinal disturbances is this client most likely experiencing?

1.

Irritable bowel syndrome

2.

Crohns disease

3.

Acute appendicitis

4.

Small bowel obstruction

ANS: 2

Current and former smokers appear to have a greater risk of developing Crohns disease than nonsmokers. Not smoking will not cause irritable bowel syndrome, acute appendicitis, or small bowel obstruction.

PTS:1DIF:Analyze

REF:Inflammatory Bowel Disorders: Planning and Implementation

12.A client has a history of being treated for ulcerative colitis. The nurse realizes that a life-threatening complication of this disorder is:

1.

Crohns disease.

2.

small bowel obstruction.

3.

peptic ulcer disease.

4.

toxic megacolon.

ANS: 4

Toxic megacolon is a life-threatening complication of ulcerative colitis, and it requires immediate surgical intervention. Crohns disease, small bowel obstruction, and peptic ulcer disease are not life-threatening complications of ulcerative colitis.

PTS: 1 DIF: Analyze REF: Ulcerative Colitis: Pathophysiology

13.The nurse assesses no bowel sounds with occasional splashing sounds over the large intestines. Which of the following do these assessment findings suggest to the nurse?

1.

Ulcerative colitis

2.

Irritable bowel syndrome

3.

Appendicitis

4.

Bowel obstruction

ANS: 4

Obstruction can be detected with absent bowel sounds and borborygmi or a splashing sound heard over the large intestine. Absent bowel sounds and borborygmi are not associated with ulcerative colitis, irritable bowel syndrome, or appendicitis.

PTS:1DIF:Analyze

REF:Acute Abdomen: Assessment with Clinical Manifestations

14.The nurse is instructing a client on diagnostic tests used to screen for colorectal cancer. Which of the following should be included in these instructions?

1.

A digital rectal exam should be done annually.

2.

A test for fecal occult blood should be done annually.

3.

A flexible sigmoidoscopy should be done annually.

4.

A colonoscopy should be done every 5 years after age 40.

ANS: 2

The nurse should instruct the client to have a fecal occult blood test done annually. A digital rectal exam is not a recommendation for this disease process. A flexible sigmoidoscopy should be done every 5 years after age 50. A colonoscopy should be done every 10 years after age 50.

PTS: 1 DIF: Apply REF: Table 50-8: Screening and Detection: CRC

MULTIPLE RESPONSE

1.Laparoscopic surgery is scheduled for a client diagnosed with appendicitis. Which of the following may be a result of laparoscopic surgery?  (Select all that apply.)

1.

No risk of infection

2.

Less pain

3.

Faster recovery times

4.

Maybe more complications

5.

Shorter hospital stays

6.

Better visualization of the abdominal organs

ANS: 2, 3, 5

Laparoscopic surgery has less pain and faster recovery times. There are fewer complications, less bleeding, and less risk of infection so the client has a shorter hospital stay. A risk of infection is present with all surgical procedures. Laparoscopic surgery does not cause a better visualization of the abdominal organs.

PTS:1DIF:AnalyzeREF:Appendicitis: Surgery

2.The nurse is assessing a client diagnosed with diverticulitis. Which of the following are clinical manifestations associated with this disorder? (Select all that apply.)

1.

Constipation or diarrhea

2.

Left lower quadrant abdominal pain

3.

Low-grade fever

4.

Increased excitability

5.

Changes in level of consciousness

6.

Thirst

ANS: 1, 2, 3

In diverticulitis, there may be a chronic asymptomatic condition two-thirds of the time. If there are manifestations, they would likely be constipation or diarrhea, lower abdominal pain in the left lower quadrant, and low-grade fever. Increased excitability, changes in level of consciousness, and thirst are not clinical manifestations of diverticulitis.

PTS:1DIF:Analyze

REF: Diverticulitis: Assessment with Clinical Manifestations

3.The nurse is assessing a client diagnosed with irritable bowel syndrome (IBS). Which of the following characteristics are associated with this disorder? (Select all that apply.)

1.

Recurrent abdominal pain

2.

Abdominal pain that improves with defecation

3.

Pain associated with a change in stool frequency

4.

Pain associated with a change in stool appearance

5.

Pain that occurs only during defecation

6.

Pain associated with passing flatus

ANS: 1, 2, 3, 4

IBS is relatively common and is a motility disorder of the gastrointestinal tract. It is characterized by recurrent abdominal pain that improves with defecation. The pain will also appear with a change in stool frequency. The pain is also associated with a change in stool appearance. The pain of IBS does not occur only during defecation and is not associated with passing flatus.

PTS:1DIF:Analyze

REF: Irritable Bowel Syndrome: Assessment with Clinical Manifestations

4.A client, diagnosed with a vitamin B-12 deficiency, tells the nurse that she does not want to receive injections every month to treat the disorder. Which of the following should the nurse instruct the client regarding the effects of vitamin B-12 deficiency? (Select all that apply.)

1.

Paresthesias in the hands

2.

Paresthesias in the feet

3.

Ataxia

4.

Spinal cord degeneration

5.

Loss of memory

6.

Loss of the sense of smell

ANS: 1, 2, 3, 4

Vitamin B-12 deficiency produces neurological abnormalities such as symmetrical paresthesias in the hands and feet, diminished vibratory and proprioceptive sense, ataxia, and spinal cord degeneration. Vitamin B-12 deficiency does not produce memory loss or loss of smell.

PTS: 1 DIF: Apply REF: Cobalamin

5.The nurse is planning care for a client diagnosed with an acute abdomen. Which of the following nursing diagnoses would be appropriate for this client? (Select all that apply.)

1.

Fear

2.

Deficient fluid volume

3.

Ineffective coping

4.

Acute pain

5.

Risk of infection

6.

Altered self-perception

ANS: 1, 2, 4, 5

Nursing diagnoses appropriate for a client diagnosed with an acute abdomen include fear, deficient fluid volume, acute pain, and risk of infection. Ineffective coping and altered self-perception would not apply to this client.

PTS: 1 DIF: Apply REF: Acute Abdomen: Nursing Diagnoses

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