Chapter 42: Lower Gastrointestinal
Problems Lewis: Medical-Surgical
Nursing, 10th Edition
A patient calls the clinic to report a new onset of severe diarrhea. The nurse anticipates that
the patient will need to
a. collect a stool specimen. .
b. prepare for colonoscopy.
c. schedule a barium enema
d. have blood cultures drawn. - ✔✔- ANS: A
Acute diarrhea is usually caused by an infectious process, and stool specimens are obtained
for culture and examined for parasites or white blood cells. There is no indication that the
patient needs a colonoscopy, blood cultures, or a barium enema.
DIF: Cognitive Level: Apply (application) REF: 931
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
Which nursing action will the nurse include in the plan of care for a 35-yr-old male patient
admitted with an exacerbation of inflammatory bowel disease (IBD)?
a. Restrict oral fluid intake.
b. Monitor stools for blood.
c. Ambulate six times daily.
d. Increase dietary fiber intake. - ✔✔- ANS: B
Because anemia or hemorrhage may occur with IBD, stools should be assessed for the
presence of blood. The other actions would not be appropriate for the patient with IBD.
Dietary fiber may increase gastrointestinal motility and exacerbate the diarrhea, severe fatigue
is common with IBD exacerbations, and dehydration may occur.
DIF: Cognitive Level: Apply (application) REF: 949
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
A patient has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight
loss of 10 lb (4.5 kg) over 2 months. The nurse will plan to teach about
a. medication use.
b. fluid restriction.
c. enteral nutrition.
d. activity restrictions. - ✔✔- ANS: A
Medications are used to induce and maintain remission in patients with inflammatory bowel
disease (IBD). Decreased activity level is indicated only if the patient has severe fatigue and
weakness. Fluids are needed to prevent dehydration. There is no advantage to enteral
feedings.
DIF: Cognitive Level: Apply (application) REF: 947
,TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
Which action will the nurse include in the plan of care for a patient who is being admitted
with Clostridium difficile?
a. Teach the patient about proper food storage.
b. Order a diet without dairy products for the patient.
c. Place the patient in a private room on contact isolation.
d. Teach the patient about why antibiotics will not be used. - ✔✔- ANS: C
Because C. difficile is highly contagious, the patient should be placed in a private room, and
contact precautions should be used. There is no need to restrict dairy products for this type of
diarrhea. Metronidazole (Flagyl) is frequently used to treat C. difficile infections. Improper
food handling and storage do not cause C. difficile.
DIF: Cognitive Level: Apply (application) REF: 932
TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment
A 74-yr-old male patient tells the nurse that growing old causes constipation so he has been
using a suppository for constipation every morning. Which action should the nurse take first?
a. Encourage the patient to increase oral fluid intake.
b. Question the patient about risk factors for constipation.
c. Suggest that the patient increase intake of high-fiber foods.
d. Teach the patient that a daily bowel movement is unnecessary. - ✔✔- ANS: B
The nurse's initial action should be further assessment of the patient for risk factors for
constipation and for his usual bowel pattern. The other actions may be appropriate but will be
based on the assessment.
DIF: Cognitive Level: Analyze (analysis) REF: 933
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
A patient who has chronic constipation asks the nurse about the use of psyllium (Metamucil).
Which information will the nurse include in the response?
a. Absorption of fat-soluble vitamins may be reduced by fiber-containing laxatives.
b. Dietary sources of fiber should be eliminated to prevent excessive gas formation.
c. Use of this type of laxative to prevent constipation does not cause adverse effects.
d. Large amounts of fluid should be taken to prevent impaction or bowel obstruction. - ✔✔-
ANS: D
A high fluid intake is needed when patients are using bulk-forming laxatives to avoid
worsening constipation. Although bulk-forming laxatives are generally safe, the nurse should
emphasize the possibility of constipation or obstipation if inadequate fluid intake occurs.
Although increased gas formation is likely to occur with increased dietary fiber, the patient
should gradually increase dietary fiber and eventually may not need the psyllium. Fat-soluble
vitamin absorption is blocked by stool softeners and lubricants, not by bulk-forming laxatives.
DIF: Cognitive Level: Apply (application) REF: 935
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
, A 26-yr-old woman is being evaluated for vomiting and abdominal pain. Which question from
the nurse will be most useful in determining the cause of the patient's symptoms?
a. "What type of foods do you eat?"
b. "Is it possible that you are pregnant?"
c. "Can you tell me more about the pain?"
d. "What is your usual elimination pattern?" - ✔✔- ANS: C
A complete description of the pain provides clues about the cause of the problem. Although
the nurse should ask whether the patient is pregnant to determine whether the patient might
have an ectopic pregnancy and before any radiology studies are done, this information is not
the most useful in determining the cause of the pain. The usual diet and elimination patterns
are less helpful in determining the reason for the patient's symptoms.
DIF: Cognitive Level: Analyze (analysis) REF: 939
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
A patient complains of gas pains and abdominal distention 2 days after a small bowel
resection. Which nursing action should the nurse take?
a. Encourage the patient to ambulate.
b. Instill a mineral oil retention enema.
c. Administer the prescribed IV morphine sulfate.
d. Offer the prescribed promethazine (Phenergan). - ✔✔- ANS: A
Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain.
A mineral oil retention enema is helpful for constipation with hard stool. A return-flow enema
might be used to relieve persistent gas pains. Morphine will further reduce peristalsis.
Promethazine is used as an antiemetic rather than to decrease gas pains or distention.
DIF: Cognitive Level: Analyze (analysis) REF: 940
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
A 58-yr-old patient with blunt abdominal trauma from a motor vehicle crash undergoes
peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan
to take next?
a. Auscultate the bowel sounds.
b. Prepare the patient for surgery.
c. Check the patient's oral temperature.
d. Obtain information about the accident. - ✔✔- ANS: B
Return of brown drainage and fecal material suggests perforation of the bowel and the need
for immediate surgery. Auscultation of bowel sounds, checking the temperature, and
obtaining information about the accident are appropriate actions, but the priority is to prepare
to send the patient for emergency surgery.
DIF: Cognitive Level: Analyze (analysis) REF: 941
OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
Problems Lewis: Medical-Surgical
Nursing, 10th Edition
A patient calls the clinic to report a new onset of severe diarrhea. The nurse anticipates that
the patient will need to
a. collect a stool specimen. .
b. prepare for colonoscopy.
c. schedule a barium enema
d. have blood cultures drawn. - ✔✔- ANS: A
Acute diarrhea is usually caused by an infectious process, and stool specimens are obtained
for culture and examined for parasites or white blood cells. There is no indication that the
patient needs a colonoscopy, blood cultures, or a barium enema.
DIF: Cognitive Level: Apply (application) REF: 931
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
Which nursing action will the nurse include in the plan of care for a 35-yr-old male patient
admitted with an exacerbation of inflammatory bowel disease (IBD)?
a. Restrict oral fluid intake.
b. Monitor stools for blood.
c. Ambulate six times daily.
d. Increase dietary fiber intake. - ✔✔- ANS: B
Because anemia or hemorrhage may occur with IBD, stools should be assessed for the
presence of blood. The other actions would not be appropriate for the patient with IBD.
Dietary fiber may increase gastrointestinal motility and exacerbate the diarrhea, severe fatigue
is common with IBD exacerbations, and dehydration may occur.
DIF: Cognitive Level: Apply (application) REF: 949
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
A patient has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight
loss of 10 lb (4.5 kg) over 2 months. The nurse will plan to teach about
a. medication use.
b. fluid restriction.
c. enteral nutrition.
d. activity restrictions. - ✔✔- ANS: A
Medications are used to induce and maintain remission in patients with inflammatory bowel
disease (IBD). Decreased activity level is indicated only if the patient has severe fatigue and
weakness. Fluids are needed to prevent dehydration. There is no advantage to enteral
feedings.
DIF: Cognitive Level: Apply (application) REF: 947
,TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
Which action will the nurse include in the plan of care for a patient who is being admitted
with Clostridium difficile?
a. Teach the patient about proper food storage.
b. Order a diet without dairy products for the patient.
c. Place the patient in a private room on contact isolation.
d. Teach the patient about why antibiotics will not be used. - ✔✔- ANS: C
Because C. difficile is highly contagious, the patient should be placed in a private room, and
contact precautions should be used. There is no need to restrict dairy products for this type of
diarrhea. Metronidazole (Flagyl) is frequently used to treat C. difficile infections. Improper
food handling and storage do not cause C. difficile.
DIF: Cognitive Level: Apply (application) REF: 932
TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment
A 74-yr-old male patient tells the nurse that growing old causes constipation so he has been
using a suppository for constipation every morning. Which action should the nurse take first?
a. Encourage the patient to increase oral fluid intake.
b. Question the patient about risk factors for constipation.
c. Suggest that the patient increase intake of high-fiber foods.
d. Teach the patient that a daily bowel movement is unnecessary. - ✔✔- ANS: B
The nurse's initial action should be further assessment of the patient for risk factors for
constipation and for his usual bowel pattern. The other actions may be appropriate but will be
based on the assessment.
DIF: Cognitive Level: Analyze (analysis) REF: 933
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
A patient who has chronic constipation asks the nurse about the use of psyllium (Metamucil).
Which information will the nurse include in the response?
a. Absorption of fat-soluble vitamins may be reduced by fiber-containing laxatives.
b. Dietary sources of fiber should be eliminated to prevent excessive gas formation.
c. Use of this type of laxative to prevent constipation does not cause adverse effects.
d. Large amounts of fluid should be taken to prevent impaction or bowel obstruction. - ✔✔-
ANS: D
A high fluid intake is needed when patients are using bulk-forming laxatives to avoid
worsening constipation. Although bulk-forming laxatives are generally safe, the nurse should
emphasize the possibility of constipation or obstipation if inadequate fluid intake occurs.
Although increased gas formation is likely to occur with increased dietary fiber, the patient
should gradually increase dietary fiber and eventually may not need the psyllium. Fat-soluble
vitamin absorption is blocked by stool softeners and lubricants, not by bulk-forming laxatives.
DIF: Cognitive Level: Apply (application) REF: 935
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
, A 26-yr-old woman is being evaluated for vomiting and abdominal pain. Which question from
the nurse will be most useful in determining the cause of the patient's symptoms?
a. "What type of foods do you eat?"
b. "Is it possible that you are pregnant?"
c. "Can you tell me more about the pain?"
d. "What is your usual elimination pattern?" - ✔✔- ANS: C
A complete description of the pain provides clues about the cause of the problem. Although
the nurse should ask whether the patient is pregnant to determine whether the patient might
have an ectopic pregnancy and before any radiology studies are done, this information is not
the most useful in determining the cause of the pain. The usual diet and elimination patterns
are less helpful in determining the reason for the patient's symptoms.
DIF: Cognitive Level: Analyze (analysis) REF: 939
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
A patient complains of gas pains and abdominal distention 2 days after a small bowel
resection. Which nursing action should the nurse take?
a. Encourage the patient to ambulate.
b. Instill a mineral oil retention enema.
c. Administer the prescribed IV morphine sulfate.
d. Offer the prescribed promethazine (Phenergan). - ✔✔- ANS: A
Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain.
A mineral oil retention enema is helpful for constipation with hard stool. A return-flow enema
might be used to relieve persistent gas pains. Morphine will further reduce peristalsis.
Promethazine is used as an antiemetic rather than to decrease gas pains or distention.
DIF: Cognitive Level: Analyze (analysis) REF: 940
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
A 58-yr-old patient with blunt abdominal trauma from a motor vehicle crash undergoes
peritoneal lavage. If the lavage returns brown fecal drainage, which action will the nurse plan
to take next?
a. Auscultate the bowel sounds.
b. Prepare the patient for surgery.
c. Check the patient's oral temperature.
d. Obtain information about the accident. - ✔✔- ANS: B
Return of brown drainage and fecal material suggests perforation of the bowel and the need
for immediate surgery. Auscultation of bowel sounds, checking the temperature, and
obtaining information about the accident are appropriate actions, but the priority is to prepare
to send the patient for emergency surgery.
DIF: Cognitive Level: Analyze (analysis) REF: 941
OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
