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Chapter 38- Management of Patients With Intestinal and Rectal Disorders

1. Which of the following should be included in patient teaching to prevent constipation? Establish a bowel routine based upon the fact that the best time for defecation is after dinner. B) Exercise may prolong a bowel movement. C) Consume high-residue, high-fiber foods. D) Resist the urge to defecate until the scheduled time. Ans: C Difficulty: Moderate A) 2. The patient arrives in the clinic with a complaint of altered bowel habits and has a family history of ulcerative colitis. The stools of these patients are characteristically: A) Watery with blood and mucus C) Long and cylinder shaped B) Hard and black D) Loose and fatty Ans: A Difficulty: Moderate 3. The nurse is providing teaching to a patient with a new ileostomy in preparation for the patient's discharge to her home. The patient should be taught which of the following when changing her ileostomy? A) Apply moisturizing lotion after cleaning the stoma. B) Apply a skin barrier to the peristomal skin prior to applying the pouch. C) Dispose of the clamp with each bag change. D) Cleanse the area surrounding the stoma with alcohol. Ans: B Difficulty: Easy 4. The nurse monitors a patient admitted with acute diverticulitis for indicators of perforation. What assessment finding may be an indicator of bowel perforation? A) Decreased sedimentation rate C) Bradycardia B) Elevated white cell count D) Hypertension Ans: B Difficulty: Moderate 5. An emergency room nurse is obtaining assessment data from a patient presenting with a small-bowel obstruction. Which assessment finding is characteristic of a small-bowel obstruction? A) Nausea and vomiting C) Mucus in the stool B) Decrease in urine production D) Mucosal edema Ans: A Difficulty: Moderate 6. The nurse is assisting a patient admitted with inflammatory bowel disease with menu selections. Which of the following menu selections is the best choice for this patient? A) Taco B) Tofu C) Multigrain bagel D) Blueberries Ans: B Difficulty: Moderate
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7. Which of the following terms will the nurse expect to see documented on the patient's chart to describe intestinal obstruction caused by a telescoped shortening of the intestine? A) Intussusception B) Volvulus C) Herniation D) Adhesion Ans: A Difficulty: Difficult 8. The nurse reviewing a patient's chart is asking questions related to risk factors for colorectal cancer. Which of the following does the nurse identify as a risk factor associated with colorectal cancer? A) Age greater than 50 C) Family history of stomach cancer B) History of bowel obstruction D) Low-fat, low-protein, low-fiber diet Ans: A Difficulty: Moderate 9. The patient is postoperative day three following a colostomy. The nurse is changing the dressing and notes the stoma is dusky in color. What might this indicate? A) This is a normal color postoperatively. B) The patient's oxygen saturation may be low. C) Circulation to the stoma is compromised. D) The stoma is blocked. Ans: C Difficulty: Moderate 10. The nurse caring for a patient with a permanent sigmoid colostomy expects which type of fecal discharge? A) Solid feces B) Semi-mushy feces C) Mushy feces D) Liquid feces Ans: A Difficulty: Moderate 11. Which of the following should be included in the teaching about dietary management for a patient who has a colostomy? A) Experiment with an irritating food several times before eliminating it. B) Fluid intake should be decreased to prevent diarrhea. C) Diet should be high in fiber. D) Cabbage should be included to aid in digestion. Ans: A Difficulty: Moderate 12. A 57-year-old CEO of a large corporation has complaints of rectal bleeding and occasional lower abdominal pain. The patient may have which of the following? A) Ulcer B) Crohn's disease C) Rectal polyps D) Inflammatory bowel disease Ans: C Difficulty: Moderate

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13. Which of the following patients would be more likely to develop hemorrhoids? A) A 45-year-old teacher B) A pregnant woman at 38 weeks' gestation C) A 37-year-old construction worker D) A 12-year-old student Ans: B Difficulty: Easy 14. The nurse is assessing a 71-year-old female patient with ulcerative colitis. Which assessment finding related to the family will have the greatest impact on the patient's rehabilitation after discharge? A) The family's ability to take care of the patient's special diet needs B) The family's expectation that the patient will resume responsibilities and rolerelated activities C) Emotional support from the family D) The family's ability to understand the ups and downs of the illness Ans: C Difficulty: Difficult 15. The nurse is interviewing a patient about his past medical history. Which preexisting condition may lead the nurse to suspect that a patient has colorectal cancer? A) Duodenal ulcers B) Hemorrhoids C) Weight gain D) Polyps Ans: D Difficulty: Moderate 16. A patient suspected of having colorectal cancer will require which diagnostic study to confirm the diagnosis? A) Stool Hematest B) Carcinoembryonic antigen (CEA) C) Colonoscopy D) Abdominal computed tomography (CT) scan Ans: C Difficulty: Moderate 17. The nurse is conducting a screening for colorectal cancer. The patient with the highest risk of colorectal cancer is a: A) 52-year-old man with a family history of polyposis B) 32-year-old woman with a history of skin cancer C) 61-year-old man with a history of gastric ulcers D) 42-year-old man following a low-fat, 1800-calorie diet Ans: A Difficulty: Moderate 18. An elderly patient asks the nurse how to treat chronic constipation. What is the best recommendation the nurse can make? A) Take a mild laxative, such as magnesium citrate, when necessary.

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B) C) D)

Take a stool softener, such as docusate sodium (Colace), daily. Administer a tap-water enema weekly. Administer a phospho-soda (Fleet) enema when necessary. Ans: B Difficulty: Moderate

19. The nurse is assessing a patient diagnosed with appendicitis. Which of the following signs or symptoms should the nurse expect to find? A) Rigid abdomen, Levine's sign, pain relief leaning forward B) Rebound tenderness, McBurney's sign, low-grade fever C) Right lower-quadrant pain, Chvostek's sign, muscle guarding D) Periumbilical pain, Trousseau's sign, pain relief with pressure Ans: B Difficulty: Moderate 20. A patient is scheduled to have a descending colostomy. He's anxious, and has many questions concerning the surgery, the care of a stoma, and lifestyle changes. It would be most appropriate for the nurse to refer the patient to which member of the health care team? A) Social worker C) Occupational therapist B) Registered dietitian D) Enterostomal nurse therapist Ans: D Difficulty: Moderate 21. A patient with constipation has been prescribed bisacodyl (Dulcolax) for the management of this condition. The nurse is providing teaching related to this medication and properly instructs the patient to follow which of the following guidelines when taking this medication? A) Drink 8 oz of water before and after taking the medication. B) Swallow the tablets without crushing or chewing. C) Take the medication with milk to avoid stomach upset. D) Avoid taking with meals due to impairment of fat-soluble vitamin absorption. Ans: B Difficulty: Moderate 22. Which of the following instructions will the nurse provide to a patient with inflammatory bowel disease regarding nutritional management of this condition? A) Consume a bland, high-residue, high-protein, and high-vitamin diet. B) Consume a bland, low-residue, low-protein and low-vitamin diet. C) Consume a bland, low-residue, high-protein, and high-vitamin diet. D) Consume a bland, high-residue, low-protein, and low-vitamin diet. Ans: C Difficulty: Difficult 23. The nurse is interpreting the results of a biopsy from a patient with colorectal cancer. The biopsy results indicate positive nodes and tumor involvement that is limited to the

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bowel wall. The nurse recognizes that the patient has which class of colorectal cancer based upon Dukes' Classification-Modified Staging System? A) Class A B) Class B1 C) Class C1 D) Class D Ans: C Difficulty: Moderate 24. The home care nurse assisting the patient in establishing a schedule for irrigation of his colostomy informs the patient that the irrigation should occur: A) At the same time each day B) Immediately prior to the largest meal of the day C) Prior to any physical activity D) 2 to 3 times a week Ans: A Difficulty: Easy 25. The nurse is caring for a patient with a mechanical intestinal obstruction. Diagnostic studies indicate that the bowel is twisted and turned on itself. The nurse is aware that this condition is a(n): A) Intussusception B) Volvulus C) Hernia D) Tumor Ans: B Difficulty: Moderate 26. The nurse is assessing an older adult admitted with pancreatic insufficiency. While assessing for the presence of malabsorption, the nurse recalls that malabsorption may be extraintestinal in the older adult and may include the symptoms of: A) Shortness of breath and hypervolemia B) Fatigue and confusion C) Pruritus and muscle rigidity D) Darkening of skin pigmentation and tremors Ans: B Difficulty: Difficult 27. The nurse receives a patient back onto the unit after an appendectomy. What is the best positioning for this patient after surgery to reduce pain? A) Supine position C) Trendelenburg position B) Lithotomy position D) High-Fowler's position Ans: D Difficulty: Moderate 28. A patient admitted with diverticulitis is being prepared for discharge from the hospital. The nurse is providing patient teaching related to dietary considerations. The nurse will instruct the patient to consume a diet that is: A) High in fiber and low in fat C) Low in fiber and low in fat B) High in fiber and high in fat D) Low in fiber and high in fat Ans: A Difficulty: Moderate

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29. Upon assessment of a patient with regional enteritis, the nurse will expect to elicit pain when she palpates the patient's: A) Left lower quadrant C) Left upper quadrant B) Right lower quadrant D) Right upper quadrant Ans: B Difficulty: Moderate 30. A patient with a newly created ileostomy reports symptoms to the nurse that may be indicative of an intestinal obstruction. The nurse reports the symptoms to the physician immediately. What symptoms may indicate an intestinal obstruction in a patient with an ileostomy? A) Continuous flow of liquid stools and belching B) Hypervolemia and hyperkalemia C) Muscle spasms and numbness of the extremities D) Nausea and abdominal distention Ans: D Difficulty: Moderate 31. When teaching a group of patients about colorectal cancer, the nurse informs the group that the most common symptom is: A) Passage of blood in the stools C) Anorexia B) Fatigue D) A change in bowel habits Ans: D Difficulty: Moderate 32. A patient with colorectal cancer is being prepared for surgery that will occur on the following day. The nurse prepares to administer cephalexin (Keflex) to the patient and informs the patient that the goal of antibiotic administration prior to surgery is to: A) Treat any undiagnosed infections C) Assist in digestion after surgery B) Reduce the intestinal bacteria D) Reduce abdominal distention Ans: B Difficulty: Difficult 33. A patient with an anal fistula is admitted to the medical-surgical unit. In preparing a plan of care for this patient, the nurse incorporates the most common treatment for this condition, which focuses on: A) Surgery B) Dietary modification C) Sitz baths D) Stool bulking agents Ans: A Difficulty: Moderate 34. The nurse is providing dietary instruction to a patient with hemorrhoids. Which of the following breakfast options is the best option for a patient with hemorrhoids? A) Cheese omelet and coffee B) Raisin bran cereal and an apple C) A bagel with cream cheese and hot tea

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D)

Blueberry pancakes and milk Ans: B Difficulty: Easy

35. Cultures obtained from a rectal swab indicate that a patient with symptoms of an anorectal infection has an infection caused by a virus. Which of the following antibiotics will the nurse anticipate the physician to order for this viral anorectal infection? A) Acyclovir (Zovirax) C) Penicillin (Penicillin G) B) Doxycycline (Vibramycin) D) Metronidazole (Flagyl) Ans: A Difficulty: Moderate

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