Professional Documents
Culture Documents
1. A fecalith
2. Bowel kinking
3. Internal bowel occlusion
4. Abdominal bowel swelling
2. Which of the following terms best describes the pain associated with appendicitis?
1. Aching
2. Fleeting
3. Intermittent
4. Steady
1. Low-fiber diet
2. High-fiber diet
3. High-protein diet
4. Low-carbohydrate diet
1. No symptoms exist
2. Change in bowel habits
3. Anorexia with low-grade fever
4. Episodic, dull, or steady midabdominal pain
1. Abdominal ultrasound
2. Barium enema
3. Barium swallow
4. Gastroscopy
11. Medical management of the client with diverticulitis should include which of the
following treatments?
12. Crohn’s disease can be described as a chronic relapsing disease. Which of the
following areas in the GI system may be involved with this disease?
13. Which area of the alimentary canal is the most common location for Crohn’s
disease?
1. Ascending colon
2. Descending colon
3. Sigmoid colon
4. Terminal ileum
1. Constipation
2. Diet
3. Hereditary
4. Lack of exercise
1. Acidic diet
2. Altered immunity
3. Chronic constipation
4. Emotional stress
16. Fistulas are most common with which of the following bowel disorders?
1. Crohn’s disease
2. Diverticulitis
3. Diverticulosis
4. Ulcerative colitis
17. Which of the following areas is the most common site of fistulas in client’s with
Crohn’s disease?
1. Anorectal
2. Ileum
3. Rectovaginal
4. Transverse colon
18. Which of the following associated disorders may a client with ulcerative colitis
exhibit?
1. Gallstones
2. Hydronephrosis
3. Nephrolithiasis
4. Toxic megacolon
19. Which of the following associated disorders may the client with Crohn’s disease
exhibit?
1. Ankylosing spondylitis
2. Colon cancer
3. Malabsorption
4. Lactase deficiency
20. Which of the following symptoms may be exhibited by a client with Crohn’s
disease?
1. Bloody diarrhea
2. Narrow stools
3. N/V
4. Steatorrhea
1. Dumping syndrome
2. Rectal bleeding
3. Soft stools
4. Fistulas
22. If a client had irritable bowel syndrome, which of the following diagnostic tests
would determine if the diagnosis is Crohn’s disease or ulcerative colitis?
1. Abdominal computed tomography (CT) scan
2. Abdominal x-ray
3. Barium swallow
4. Colonoscopy with biopsy
24. In a client with Crohn’s disease, which of the following symptoms should not be a
direct result of antibiotic therapy?
1. Decrease in bleeding
2. Decrease in temperature
3. Decrease in body weight
4. Decrease in the number of stools
25. Surgical management of ulcerative colitis may be performed to treat which of the
following complications?
1. Gastritis
2. Bowel herniation
3. Bowel outpouching
4. Bowel perforation
26. Which of the following medications is most effective for treating the pain
associated with irritable bowel disease?
1. Acetaminophen
2. Opiates
3. Steroids
4. Stool softeners
27. During the first few days of recovery from ostomy surgery for ulcerative colitis,
which of the following aspects should be the first priority of client care?
1. Body image
2. Ostomy care
3. Sexual concerns
4. Skin care
28. Colon cancer is most closely associated with which of the following conditions?
1. Appendicitis
2. Hemorrhoids
3. Hiatal hernia
4. Ulcerative colitis
29. Which of the following diets is most commonly associated with colon cancer?
30. Which of the following diagnostic tests should be performed annually over age 50
to screen for colon cancer?
1. Abdominal CT scan
2. Abdominal x-ray
3. Colonoscopy
4. Fecal occult blood test
31. Radiation therapy is used to treat colon cancer before surgery for which of the
following reasons?
32. Which of the following symptoms is a client with colon cancer most likely to
exhibit?
1. A change in appetite
2. A change in bowel habits
3. An increase in body weight
4. An increase in body temperature
33. A client has just had surgery for colon cancer. Which of the following disorders
might the client develop?
1. Peritonitis
2. Diverticulosis
3. Partial bowel obstruction
4. Complete bowel obstruction
34. A client with gastric cancer may exhibit which of the following symptoms?
1. Abdominal cramping
2. Constant hunger
3. Feeling of fullness
4. Weight gain
35. Which of the following diagnostic tests may be performed to determine if a client
has gastric cancer?
1. Barium enema
2. Colonoscopy
3. Gastroscopy
4. Serum chemistry levels
36. A client with gastric cancer can expect to have surgery for resection. Which of the
following should be the nursing management priority for the preoperative client with
gastric cancer?
1. Discharge planning
2. Correction of nutritional deficits
3. Prevention of DVT
4. Instruction regarding radiation treatment
37. Care for the postoperative client after gastric resection should focus on which of
the following problems?
1. Body image
2. Nutritional needs
3. Skin care
4. Spiritual needs
38. Which of the following complications of gastric resection should the nurse teach
the client to watch for?
1. Constipation
2. Dumping syndrome
3. Gastric spasm
4. Intestinal spasms
39. A client with rectal cancer may exhibit which of the following symptoms?
1. Abdominal fullness
2. Gastric fullness
3. Rectal bleeding
4. Right upper quadrant pain
40. A client with which of the following conditions may be likely to develop rectal
cancer?
1. Adenomatous polyps
2. Diverticulitis
3. Hemorrhoids
4. Peptic ulcer disease
41. Which of the following treatments is used for rectal cancer but not for colon
cancer?
1. Chemotherapy
2. Colonoscopy
3. Radiation
4. Surgical resection
42. Which of the following conditions is most likely to directly cause peritonitis?
1. Cholelithiasis
2. Gastritis
3. Perforated ulcer
4. Incarcerated hernia
43. Which of the following symptoms would a client in the early stages of peritonitis
exhibit?
1. Abdominal distention
2. Abdominal pain and rigidity
3. Hyperactive bowel sounds
4. Right upper quadrant pain
44. Which of the following laboratory results would be expected in a client with
peritonitis?
45. Which of the following therapies is not included in the medical management of a
client with peritonitis?
1. Broad-spectrum antibiotics
2. Electrolyte replacement
3. I.V. fluids
4. Regular diet
46. Which of the following aspects is the priority focus of nursing management for a
client with peritonitis?
47. A client with irritable bowel syndrome is being prepared for discharge. Which of
the following meal plans should the nurse give the client?
1. Low fiber, low-fat
2. High fiber, low-fat
3. Low fiber, high-fat
4. High-fiber, high-fat
48. A client presents to the emergency room, reporting that he has been vomiting
every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts him at risk for
which of the following?
49. Five days after undergoing surgery, a client develops a small-bowel obstruction.
A Miller-Abbott tube is inserted for bowel decompression. Which nursing
diagnosistakes priority?
52. When teaching a community group about measures to prevent colon cancer,
which instruction should the nurse include?
53. A 30-year old client experiences weight loss, abdominal distention, crampy
abdominal pain, and intermittent diarrhea after birth of her 2nd child. Diagnostic tests
reveal gluten-induced enteropathy. Which foods must she eliminate from her diet
permanently?
54. After a right hemicolectomy for treatment of colon cancer, a 57-year old client is
reluctant to turn while on bed rest. Which action by the nurse would be appropriate?
1. Semi-Fowlers
2. Supine
3. Reverse Trendelenburg
4. High Fowler’s
56. An enema is prescribed for a client with suspected appendicitis. Which of the
following actions should the nurse take?
57. The client being seen in a physician’s office has just been scheduled for a barium
swallow the next day. The nurse writes down which of the following instructions for
the client to follow before the test?
58. The nurse is monitoring a client for the early signs of dumping syndrome. Which
symptom indicates this occurrence?
1. Restricting pain medication
2. Maintaining bedrest
3. Avoiding coughing
4. Irrigating the drain
60. The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis.
Which finding, if noted on assessment of the client, would the nurse report to the
physician?
1. Bloody diarrhea
2. Hypotension
3. A hemoglobin of 12 mg/dL
4. Rebound tenderness
61. The nurse is reviewing the record of a client with Crohn’s disease. Which of the
following stool characteristics would the nurse expect to note documented on the
client’s record?
1. Chronic constipation
2. Diarrhea
3. Constipation alternating with diarrhea
4. Stool constantly oozing from the rectum
62. The nurse is performing a colostomy irrigation on a client. During the irrigation, a
client begins to complain of abdominal cramps. Which of the following is the most
appropriate nursing action?
63. The nurse is teaching the client how to perform a colostomy irrigation. To
enhance the effectiveness of the irrigation and fecal returns, what measure should
the nurse instruct the client to do?
64. The nurse is reviewing the physician’s orders written for a client admitted with
acute pancreatitis. Which physician order would the nurse question if noted on the
client’s chart?
1. NPO status
2. Insert a nasogastric tube
3. An anticholinergic medication
4. Morphine for pain
66. The nurse instructs the ileostomy client to do which of the following as a part of
essential care of the stoma?
1. Cleanse the peristomal skin meticulously
2. Take in high-fiber foods such as nuts
3. Massage the area below the stoma
4. Limit fluid intake to prevent diarrhea.
67. The client who has undergone creation of a colostomy has a nursing diagnosis
of Disturbed body image. The nurse would evaluate that the client is making the most
significant progress toward identified goals if the client:
68. The nurse is assessing for stoma prolapse in a client with a colostomy. The nurse
would observe which of the following if stoma prolapse occurred?
69. The client with a new colostomy is concerned about the odor from the stool in the
ostomy drainage bag. The nurse teaches the client to include which of the following
foods in the diet to reduce odor?
1. Yogurt
2. Broccoli
3. Cucumbers
4. Eggs
70. The nurse has given instructions to the client with an ileostomy about foods to
eat to thicken the stool. The nurse determines that the client needs further
instructions if the client stated to eat which of the following foods to make the stools
less watery?
1. Pasta
2. Boiled rice
3. Bran
4. Low-fat cheese
71. The client has just had surgery to create an ileostomy. The nurse assesses the
client in the immediate post-op period for which of the following most frequent
complications of this type of surgery?
1. Intestinal obstruction
2. Fluid and electrolyte imbalance
3. Malabsorption of fat
4. Folate deficiency
72. The nurse is doing pre-op teaching with the client who is about to undergo
creation of a Kock pouch. The nurse interprets that the client has the best
understanding of the nature of the surgery if the client makes which of the following
statements?
73. The client with a colostomy has an order for irrigation of the colostomy. The
nurse used which solution for irrigation?
1. Distilled water
2. Tap water
3. Sterile water
4. Lactated Ringer’s
1. Administer dilaudid
2. Notify the physician
3. Call and ask the operating room team to perform the surgery as soon as possible
4. Reposition the client and apply a heating pad on a warm setting to the client’s abdomen.
75. The client has been admitted with a diagnosis of acute pancreatitis. The nurse
would assess this client for pain that is:
1. Severe and unrelenting, located in the epigastric area and radiating to the back.
2. Severe and unrelenting, located in the left lower quadrant and radiating to the groin.
3. Burning and aching, located in the epigastric area and radiating to the umbilicus.
4. Burning and aching, located in the left lower quadrant and radiating to the hip.
76. The client with Crohn’s disease has a nursing diagnosis of acute pain. The nurse
would teach the client to avoid which of the following in managing this problem?
77. A client with ulcerative colitis has an order to begin salicylate medication to
reduce inflammation. The nurse instructs the client to take the medication:
1. 30 minutes before meals
2. On an empty stomach
3. After meals
4. On arising
78. During the assessment of a client’s mouth, the nurse notes the absence of saliva.
The client is also complaining of pain near the area of the ear. The client has been
NPO for several days because of the insertion of a NG tube. Based on these findings,
the nurse suspects that the client is developing which of the following mouth
conditions?
1. Stomatitis
2. Oral candidiasis
3. Parotitis
4. Gingivitis
79. The nurse evaluates the client’s stoma during the initial post-op period. Which of
the following observations should be reported immediately to the physician?
80. When planning care for a client with ulcerative colitis who is experiencing
symptoms, which client care activities can the nurse appropriately delegate to a
unlicensed assistant? Select all that apply.
1. Promoting self-care and independence
2. Managing diarrhea
3. Maintaining adequate nutrition
4. Promoting rest and comfort
82. A client’s ulcerative colitis symptoms have been present for longer than 1 week.
The nurse recognizes that the client should be assessed carefully for signs of which
of the following complications?
1. Heart failure
2. DVT
3. Hypokalemia
4. Hypocalcemia
83. A client who has ulcerative colitis has persistent diarrhea. He is thin and has lost
12 pounds since the exacerbation of his ulcerative colitis. The nurse should
anticipate that the physician will order which of the following treatment approaches
to help the client meet his nutritional needs?
85. When used with hyperacidic disorders of the stomach, antacids are given to
elevate the gastric pH to:
1. 2.0
2. 4.0
3. 6.0
4. >8.0
86. One of your patients is receiving digitalis orally and is also to receive
an antacid at the same time. Your most appropriate action, based on the
pharmacokinetics of antacids, is to:
87. The nurse would teach patients that antacids are effective in treatment of
hyperacidity because they:
88. The nurse would monitor for which of the following adverse reactions to
aluminum-containing antacids such as aluminum hydroxide (Amphojel)?
1. Diarrhea
2. Constipation
3. GI upset
4. Fluid retention
89. The nurse would question an order for which type of antacid in patients
with chronic renal failure?
1. Aluminum-containing antacids
2. Calcium-containing antacids
3. Magnesium-containing antacids
4. All of the above.
90. The nurse would monitor a patient using sodium bicarbonate to treat gastric
hyperacidity for signs and symptoms of:
1. Metabolic alkalosis
2. Metabolic acidosis
3. Hyperkalemia
4. Hypercalcemia
91. Which of the following nursing diagnoses is appropriate for a patient receiving
famotidine (Pepcid)?
94. A patient unable to tolerate oral medications may be prescribed which of the
following proton pump inhibitors to be administered intravenously?
1. lansoprazole (Prevacid)
2. omeprazole (Prilosec)
3. pantoprazole (Protonix)
4. esomeprazole (Nexium)
1. Crush the tablet into a fine powder before mixing with water
2. Administer with a bolus tube feeding
3. Allow the tablet to dissolve in water before administering
4. Administer with an antacid for maximum benefit
1. 4
2. 6
3. 8
4. 10
1. Decreased GI motility
2. Decreased gastric secretions
3. Increased fluid absorption
4. Binding to diarrhea-causing bacteria for excretion
99. Side effects of loperamide (Imodium) include all of the following except?
1. Diarrhea
2. epigastric pain
3. Dry mouth
4. Anorexia
2. Answer: 4. Steady
The pain begins in the epigastrium or periumbilical region, then shifts to the right lower
quadrant and becomes steady. The pain may be moderate to severe.
The focus of care is to assess for peritonitis, or inflammation of the peritoneal cavity.
Peritonitis is most commonly caused by appendix rupture and invasion of bacteria, which
could be lethal. The client with appendicitis will have pain that should be controlled with
analgesia. The nurse should discourage oral intake in preparation for surgery. Discharge
teaching is important; however, in the acute phase, management should focus on
minimizing preoperative complications and recognizing when such may be occurring.
Gastritis is an inflammation of the gastric mucosa that may be acute (often resulting from
exposure to local irritants) or chronic (associated with autoimmune infections or atrophic
disorders of the stomach). Erosion of the mucosa results in ulceration. Inflammation of a
diverticulum is called diverticulitis; reflux of stomach acid is known as gastroesophageal
disease.
NSAIDS are a common cause of gastritis because they inhibit prostaglandin synthesis. Milk,
once thought to help gastritis, has little effect on the stomach mucosa. Bicarbonate of soda,
or baking soda, may be used to neutralize stomach acid, but it should be used cautiously
because it may lead to metabolic acidosis. ASA with enteric coating shouldn’t contribute
significantly to gastritis because the coating limits the aspirin’s effect on the gastric mucosa.
Low-fiber diets have been implicated in the development of diverticula because these diets
decrease the bulk in the stool and predispose the person to the development of
constipation. A high-fiber diet is recommended to help prevent diverticulosis. A high-protein
or low-carbohydrate diet has no effect on the development of diverticulosis.
Undigested food can block the diverticulum, decreasing blood supply to the area and
predisposing the area to invasion of bacteria. Chronic laxative use is a common problem in
elderly clients, but it doesn’t cause diverticulitis. Chronic constipation can cause an
obstruction—not diverticulitis. Herniation of the intestinal mucosa causes an intestinal
perforation.
Diverticulosis is an asymptomatic condition. The other choices are signs and symptoms of
diverticulitis.
Antibiotics are used to reduce the inflammation. The client isn’t typically isn’t allowed
anything orally until the acute episode subsides. Parenteral fluids are given until the client
feels better; then it’s recommended that the client drink eight 8-ounce glasses of water per
day and gradually increase fiber in the diet to improve intestinal motility. During the acute
phase, activities that increase intra-abdominal pressure should be avoided to decrease pain
and the chance of intestinal obstruction.
12. Answer: 4. The small intestine and colon; affecting the entire thickness of the
bowel
Crohn’s disease can involve any segment of the small intestine, the colon, or both, affecting
the entire thickness of the bowel. Answers 1 and 3 describe ulcerative colitis, answer 2 is
too specific and therefore, not likely.
Studies have shown that the terminal ileum is the most common site for recurrence in
clients with Crohn’s disease. The other areas may be involved but aren’t as common.
Although the definite cause of Crohn’s disease is unknown, it’s thought to be associated
with infectious, immune, or psychological factors. Because it has a higher incidence in
siblings, it may have a genetic cause.
The lesions of Crohn’s disease are transmural; that is, they involve all thickness of the
bowel. These lesions may perforate the bowel wall, forming fistulas with adjacent structures.
Fistulas don’t develop in diverticulitis or diverticulosis. The ulcers that occur in the
submucosal and mucosal layers of the intestine in ulcerative colitis usually don’t progress to
fistula formation as in Crohn’s disease.
Fistulas occur in all these areas, but the anorectal area is most common because of the
relative thinness of the intestinal wall in this area.
Because of the transmural nature of Crohn’s disease lesions, malabsorption may occur with
Crohn’s disease. Ankylosing spondylitis and colon cancer are more commonly associated
with ulcerative colitis. Lactase deficiency is caused by a congenital defect in which an
enzyme isn’t present.
20. Answer: 4. Steatorrhea
Steatorrhea from malabsorption can occur with Crohn’s disease. N/V, and bloody diarrhea
are symptoms of ulcerative colitis. Narrow stools are associated with diverticular disease.
In ulcerative colitis, rectal bleeding is the predominant symptom. Soft stools are more
commonly associated with Crohn’s disease, in which malabsorption is more of a problem.
Dumping syndrome occurs after gastric surgeries. Fistulas are associated with Crohn’s
disease.
A colonoscopy with biopsy can be performed to determine the state of the colon’s mucosal
layers, presence of ulcerations, and level of cytologic development. An abdominal x-ray or
CT scan wouldn’t provide the cytologic information necessary to diagnose which disease it
is. A barium swallow doesn’t involve the intestine.
Management of Crohn’s disease may include long-term steroid therapy to reduce the
inflammation associated with the deeper layers of the bowel wall. Other management
focuses on bowel rest (not increasing oral intake) and reducing diarrhea with medications
(not giving laxatives). The pain associated with Crohn’s disease may require bed rest, not
an increase in physical activity.
A decrease in body weight may occur during therapy due to inadequate dietary intake, but
isn’t related to antibiotic therapy. Effective antibiotic therapy will be noted by a decrease in
temperature, number of stools, and bleeding.
25. Answer: 4. Bowel perforation
The pain with irritable bowel disease is caused by inflammation, which steroids can reduce.
Stool softeners aren’t necessary. Acetaminophen has little effect on the pain, and
opiate narcotics won’t treat its underlying cause.
Although all of these are concerns the nurse should address, being able to safely manage
the ostomy is crucial for the client before discharge.
Chronic ulcerative colitis, granulomas, and familial polyposis seem to increase a person’s
chance of developing colon cancer. The other conditions listed have no known effect on
colon cancer risk.
A low-fiber, high-fat diet reduced motility and increases the chance of constipation. The
metabolic end products of this type of diet are carcinogenic. A low-fat, high-fiber diet is
recommended to prevent colon cancer.
Surface blood vessels of polyps and cancers are fragile and often bleed with the passage of
stools. Abdominal x-ray and CT scan can help establish tumor size and metastasis. A
colonoscopy can help locate a tumor as well as polyps, which can be removed before they
become malignant.
Radiation therapy is used to treat colon cancer before surgery to reduce the size of the
tumor, making it easier to be resected. Radiation therapy isn’t curative, can’t eliminate the
malignant cells (though it helps define tumor margins), can could slow postoperative
healing.
The most common complaint of the client with colon cancer is a change in bowel habits.
The client may have anorexia, secondary abdominal distention, or weight loss. Fever isn’t
associated with colon cancer.
Bowel spillage could occur during surgery, resulting in peritonitis. Complete or partial bowel
obstruction may occur before bowel resection. Diverticulosis doesn’t result from surgery or
colon cancer.
The client with gastric cancer may report a feeling of fullness in the stomach, but not
enough to cause him to seek medical attention. Abdominal cramping isn’t associated with
gastric cancer. Anorexia and weight loss (not increased hunger or weight gain) are common
symptoms of gastric cancer.
Client’s with gastric cancer commonly have nutritional deficits and may be cachectic.
Discharge planning before surgery is important, but correcting the nutrition deficit is a higher
priority. At present, radiation therapy hasn’t been proven effective for gastric cancer, and
teaching about it preoperatively wouldn’t be appropriate. Prevention of DVT also isn’t a high
priority to surgery, though it assumes greater importance after surgery.
After gastric resection, a client may require total parenteral nutrition or jejunostomy tube
feedings to maintain adequate nutritional status.
Dumping syndrome is a problem that occurs postprandially after gastric resection because
ingested food rapidly enters the jejunum without proper mixing and without the normal
duodenal digestive processing. Diarrhea, not constipation, may also be a symptom. Gastric
or intestinal spasms don’t occur, but antispasmodics may be given to slow gastric emptying.
Rectal bleeding is a common symptom of rectal cancer. Rectal cancer may be missed
because other conditions such as hemorrhoids can cause rectal bleeding. Abdominal
fullness may occur with colon cancer, gastric fullness may occur with gastric cancer, and
right upper quadrant pain may occur with liver cancer.
A client with rectal cancer can expect to have radiation therapy in addition to chemotherapy
and surgical resection of the tumor. A colonoscopy is performed to diagnose the disease.
Radiation therapy isn’t usually indicated in colon cancer.
The most common cause of peritonitis is a perforated ulcer, which can pour contaminates
into the peritoneal cavity, causing inflammation and infection within the cavity. The other
conditions don’t by themselves cause peritonitis. However, if cholelithiasis leads to rupture
of the gallbladder, gastritis leads to erosion of the stomach wall, or an incarcerated hernia
leads to rupture of the intestines, peritonitis may develop.
Because of infection, the client’s WBC count will be elevated. A hemoglobin level below 10
mg/dl may occur from hemorrhage. A PT time longer than 100 seconds may
suggest disseminated intravascular coagulation, a serious complication of septic shock. A
potassium level above 5.5 mEq/L may indicate renal failure.
45. Answer: 4. Regular diet
The client with peritonitis usually isn’t allowed anything orally until the source of peritonitis is
confirmed and treated. The client also requires broad-spectrum antibiotics to combat the
infection. I.V. fluids are given to maintain hydration and hemodynamic stability and to
replace electrolytes.
Peritonitis can advance to shock and circulatory failure, so fluid and electrolyte balance is
the priority focus of nursing management. Gastric irrigation may be needed periodically to
ensure patency of the nasogastric tube. Although pain management is important for comfort
and psychosocial care will address concerns such as anxiety, focusing on fluid and
electrolyte imbalance will maintain hemodynamic stability.
The client with irritable bowel syndrome needs to be on a diet that contains at least 25
grams of fiber per day. Fatty foods are to be avoided because they may precipitate
symptoms.
Gastric acid contains large amounts of potassium, chloride, and hydrogen ions. Excessive
loss of these substances, such as from vomiting, can lead to metabolic alkalosis and
hypokalemia.
Fluid shifts to the site of the bowel obstruction, causing a fluid deficit in the intravascular
spaces. If the obstruction isn’t resolved immediately, the client may experience an
imbalanced nutritional status (less than body requirements); however, deficient fluid volume
takes priority. The client may also experience pain, but that nursing diagnosis is also of
lower priority than deficient fluid volume.
Exercise helps prevent constipation. Fluids and dietary fiber promote normal bowel function.
The client should drink eight to ten glasses of fluid each day. Although adding bran to cereal
helps prevent constipation by increasing dietary fiber, the client should start with a small
amount and gradually increase the amount as tolerated to a maximum of 2 grams a day.
A client with diarrhea has a nursing diagnosis of Deficient fluid volume related to excessive
fluid loss in the stool. Expected outcomes include firm skin turgor, moist mucous
membranes, and urine output of at least 30 ml/hr. The client also has a nursing diagnosis
of diarrhea, with expected outcomes of passage of formed stools at regular intervals and a
decrease in stool frequency and liquidity. The client is at risk for impaired skin
integrity related to irritation from diarrhea; expected outcomes for this diagnosis include
absence of erythema in perianal skin and mucous membranes and absence of perianal
tenderness or burning.
52. Answer: 1. “Limit fat intake to 20% to 25% of your total daily calories.”
To help prevent colon cancer, fats should account for no more than 20% to 25% of total
daily calories and the diet should include 25 to 30 grams of fiber per day. A digital rectal
examination isn’t recommended as a stand-alone test for colorectal cancer. For colorectal
cancer screening, the American Cancer society advises clients over age 50 to have a
flexible sigmoidoscopy every 5 years, yearly fecal occult blood tests, yearly fecal occult
blood tests PLUS a flexible sigmoidoscopy every 5 years, a double-contrast barium enema
every 5 years, or a colonoscopy every 10 years.
To prevent aspiration of stomach contents, the nurse should place the client in semi-
Fowler’s position. High Fowler’s position isn’t necessary and may not be tolerated as well as
semi-Fowler’s.
A barium swallow is an x-ray study that uses a substance called barium for contrast to
highlight abnormalities in the GI tract. The client should fast for 8 to 12 hours before the
test, depending on the physician instructions. Most oral medications also are withheld
before the test. After the procedure the nurse must monitor for constipation, which can
occur as a result of the presence of barium in the GI tract.
58. Answer: 3. Sweating and pallor
Bedrest is not required following this surgical procedure. The client should take analgesics
as needed and as prescribed to control pain. A drain is not used in this surgical procedure,
although the client may be instructed in simple dressing changes. Coughing is avoided to
prevent disruption of the tissue integrity, which can occur because of the location of this
surgical procedure.
Crohn’s disease is characterized by nonbloody diarrhea of usually not more than four to five
stools daily. Over time, the diarrhea episodes increase in frequency, duration and severity.
The other options are not associated with diarrhea.
If cramping occurs during a colostomy irrigation, the irrigation flow is stopped temporarily
and the client is allowed to rest. Cramping may occur from an infusion that is too rapid or is
causing too much pressure. Increasing the height of the irrigation will cause further
discomfort. The physician does not need to be notified. Medicating the client for pain is not
the most appropriate action.
To enhance effectiveness of the irrigation and fecal returns, the client is instructed to
increase fluid intake and prevent constipation.
Meperidine (Demerol) rather than morphine is the medication of choice because morphine
can cause spasm in the sphincter of Oddi.
The most frequent symptom of duodenal ulcer is pain that is relieved by food intake. These
clients generally describe the pain as burning, heavy, sharp, or “hungry” pain that often
localizes in the midepigastric area. The client with duodenal ulcer usually does not
experience weight loss or N/V. These symptoms are usually more typical in the client with a
gastric ulcer.
The peristomal skin must receive meticulous cleansing because the ileostomy drainage has
more enzymes and is more caustic to the skin than colostomy drainage. Foods such as nuts
and those with seeds will pass through the ileostomy. The client should be taught that these
foods will remain undigested. The area below the ileostomy may be massaged if needed if
the ileostomy becomes blocked by high fiber foods. Fluid intake should be maintained to at
least six to eight glasses of water per day to prevent dehydration.
A prolapsed stoma is one which the bowel protruded through the stoma. A stoma retraction
is characterized by sinking of the stoma. Ischemia of the stoma would be associated with
dusky or bluish color. A stoma with a narrowed opening at the level of the skin or fascia is
said to be stenosed.
The client should be taught to include deodorizing foods in the diet, such a beet greens,
parsley, buttermilk, and yogurt. Spinach also reduces odor but is a gas forming food as well.
Broccoli, cucumbers, and eggs are gas forming foods.
Foods that help thicken the stool of the client with an ileostomy include pasta, boiled rice,
and low-fat cheese. Bran is high in dietary fiber and thus will increase output of watery stool
by increasing propulsion through the bowel. Ileostomy output is liquid. Addition or
elimination of various foods can help thicken or loosen this liquid drainage.
72. Answer: 1. “I will need to drain the pouch regularly with a catheter.”
A Kock pouch is a continent ileostomy. As the ileostomy begins to function, the client drains
it every 3 to 4 hours and then decreases the draining to about 3 times a day or as needed
when full. The client does not need to wear a drainage bag but should wear an absorbent
dressing to absorb mucus drainage from the stoma. Ileostomy drainage is liquid. The client
would be able to pass stool only from the rectum if an ileal-anal pouch or anastomosis were
created. This type of operation is a two-stage procedure.
Warm tap water or saline solution is used to irrigate a colostomy. If the tap water is not
suitable for drinking, then bottled water should be used.
Based on the signs and symptoms presented in the question, the nurse should suspect
peritonitis and should notify the physician. Administering pain medication is not an
appropriate intervention. Heat should never be applied to the abdomen of a client with
suspected appendicitis. Scheduling surgical time is not within the scope of nursing practice,
although the physician probably would perform the surgery earlier than the prescheduled
time.
75. Answer: 1. Severe and unrelenting, located in the epigastric area and radiating to
the back.
The pain associated with acute pancreatitis is often severe and unrelenting, is located in the
epigastric region, and radiates to the back.
The lack of saliva, pain near the area of the ear, and the prolonged NPO status of the client
should lead the nurse to suspect the development of parotitis, or inflammation of the parotid
gland. Parotitis usually develops in cases of dehydration combined with poor oral hygiene or
when clients have been NPO for an extended period. Preventative measures include the
use of sugarless hard candy or gum to stimulate saliva production, adequate hydration, and
frequent mouth care. Stomatitis (inflammation of the mouth) produces excessive salivation
and a sore mouth.
A dark red to purple stoma indicates inadequate blood supply. Mild edema and slight oozing
of blood are normal in the early post-op period. The colostomy would typically not begin
functioning until 2-4 days after surgery.
Diarrhea is the primary symptom in an exacerbation of ulcerative colitis, and decreasing the
frequency of stools is the first goal of treatment. The other goals are ongoing and will be
best achieved by halting the exacerbation. The client may receive antidiarrheal medications,
antispasmodic agents, bulk hydrophilic agents, or anti-inflammatory drugs.
Excessive diarrhea causes significant depletion of the body’s stores of sodium and
potassium as well as fluid. The client should be closely monitored for hypokalemia and
hyponatremia. Ulcerative colitis does not place the client at risk for heart failure, DVT, or
hypocalcemia.
Food will be withheld from the client with severe symptoms of ulcerative colitis to rest the
bowel. To maintain the client’s nutritional status, the client will be started on TPN. Enteral
feedings or dividing the diet into 6 small meals does not allow the bowel to rest. A high-
calorie, high-protein diet will worsen the client’s symptoms.
86. Answer: 4. Contact the physician regarding the drug interaction and request a
change in the time of dosing of the drugs.
87. Answer: 1. Neutralize gastric acid
Antacids work by neutralizing gastric acid, which would cause an increase in pH. They do
not affect gastric motility.
Solutions containing sodium bicarbonate (a base) can cause metabolic alkalosis. Serum K
and serum calcium would decrease with alkalosis, not increase.
92. Answer: 1. Compete with histamine for binding sites on the parietal cells
Histamine receptor blocking agents decrease gastric acid by competing with histamine for
binding sites on the parietal cells.
Pantoprazole is the only proton pump inhibitor that is available for intravenous
administration. The other medications in this category may only be administered orally.
It is important to give sucralfate on an empty stomach so that it may dissolve and form a
protective barrier over the gastric mucosa. The tablet form will not dissolve in water when
crushed; it must be left whole and allowed to dissolve. Crushing the medication so that it will
not dissolve could lead to clogging of the nasogastric tube and decreased effectiveness of
the drug.
Sucralfate has a local effect only on the gastric mucosa. It forms a paste-like substance in
the stomach, which adheres to the gastric lining, protecting against adverse effects related
to gastric acid. It also stimulates healing of any ulcerated areas of the gastric mucosa.
97. Answer: 3. 8
Bulk-forming laxatives must be given with at least 8 ounces of liquid plus additional liquid
each day to prevent intestinal obstruction.
Diphenoxylate acts on the smooth muscle of the intestinal tract to inhibit GI motility and
excessive propulsion of the GI tract (peristalsis).