lOMoARcPSD|44532475
Gastrointestinal
ewis Medical-Surgical
ChapterProblems
42 Lower
Nursing,
Lewis
Gastrointestinal
10th
Medical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@@@@@@@@@
ProblemsNursing,
Lewis10thMedical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@
Nursing, 10th Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@
Chapter 42: Lower Gastrointestinal Problems
Lewis: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. 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
2. 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
3. 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
Gastrointestinal
ewis Medical-Surgical
ChapterProblems
42 Lower
Nursing,
Lewis
Gastrointestinal
10th Downloaded
Medical-Surgical Lewisby madiba South Africa stuvia ()
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@@@@@@@@@
ProblemsNursing, 10th
Medical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@
Nursing, 10th Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@
, lOMoARcPSD|44532475
Gastrointestinal
ewis Medical-Surgical
ChapterProblems
42 Lower
Nursing,
Lewis
Gastrointestinal
10th
Medical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@@@@@@@@@
ProblemsNursing,
Lewis10thMedical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@
Nursing, 10th Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@
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
4. 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
5. 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
6. 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
Gastrointestinal
ewis Medical-Surgical
ChapterProblems
42 Lower
Nursing,
Lewis
Gastrointestinal
10th Downloaded
Medical-Surgical Lewisby madiba South Africa stuvia ()
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@@@@@@@@@
ProblemsNursing, 10th
Medical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@
Nursing, 10th Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@
, lOMoARcPSD|44532475
Gastrointestinal
ewis Medical-Surgical
ChapterProblems
42 Lower
Nursing,
Lewis
Gastrointestinal
10th
Medical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@@@@@@@@@
ProblemsNursing,
Lewis10thMedical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@
Nursing, 10th Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@
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
7. A young adult patient is admitted to the hospital for evaluation of right lower quadrant
abdominal pain with nausea and vomiting. Which action should the nurse take?
a. Assist the patient to cough and deep breathe.
b. Palpate the abdomen for rebound tenderness.
c. Suggest the patient lie on the side, flexing the right leg.
d. Encourage the patient to sip clear, noncarbonated liquids.
ANS: C
The patient’s clinical manifestations are consistent with appendicitis. Lying still with the right
leg flexed is often the most comfortable position. Checking for rebound tenderness frequently
is unnecessary and uncomfortable for the patient. The patient should be NPO in case
immediate surgery is needed. The patient will need to know how to cough and deep breathe
postoperatively, but coughing will increase pain at this time.
DIF: Cognitive Level: Apply (application) REF: 942
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
8. Which nursing action will be included in the plan of care for a 25-yr-old male patient with a
new diagnosis of irritable bowel syndrome (IBS)?
a. Encourage the patient to express concerns and ask questions about IBS.
b. Suggest that the patient increase the intake of milk and other dairy products.
c. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs).
d. Teach the patient about the use of alosetron (Lotronex) to reduce IBS symptoms.
ANS: A
Because psychologic and emotional factors can affect the symptoms for IBS, encouraging the
patient to discuss emotions and ask questions is an important intervention. Alosetron has
serious side effects and is used only for female patients who have not responded to other
therapies. Although yogurt may be beneficial, milk is avoided because lactose intolerance can
contribute to symptoms in some patients. NSAIDs can be used by patients with IBS.
DIF: Cognitive Level: Apply (application) REF: 940
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
9. A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy
abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to
a. administer IV metoclopramide (Reglan).
b. discontinue the patient’s oral food intake.
c. administer cobalamin (vitamin B12) injections.
d. teach the patient about total colectomy surgery.
ANS: B
Gastrointestinal
ewis Medical-Surgical
ChapterProblems
42 Lower
Nursing,
Lewis
Gastrointestinal
10th Downloaded
Medical-Surgical Lewisby madiba South Africa stuvia ()
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@@@@@@@@@
ProblemsNursing, 10th
Medical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@
Nursing, 10th Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@
Gastrointestinal
ewis Medical-Surgical
ChapterProblems
42 Lower
Nursing,
Lewis
Gastrointestinal
10th
Medical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@@@@@@@@@
ProblemsNursing,
Lewis10thMedical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@
Nursing, 10th Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@
Chapter 42: Lower Gastrointestinal Problems
Lewis: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. 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
2. 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
3. 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
Gastrointestinal
ewis Medical-Surgical
ChapterProblems
42 Lower
Nursing,
Lewis
Gastrointestinal
10th Downloaded
Medical-Surgical Lewisby madiba South Africa stuvia ()
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@@@@@@@@@
ProblemsNursing, 10th
Medical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@
Nursing, 10th Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@
, lOMoARcPSD|44532475
Gastrointestinal
ewis Medical-Surgical
ChapterProblems
42 Lower
Nursing,
Lewis
Gastrointestinal
10th
Medical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@@@@@@@@@
ProblemsNursing,
Lewis10thMedical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@
Nursing, 10th Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@
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
4. 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
5. 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
6. 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
Gastrointestinal
ewis Medical-Surgical
ChapterProblems
42 Lower
Nursing,
Lewis
Gastrointestinal
10th Downloaded
Medical-Surgical Lewisby madiba South Africa stuvia ()
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@@@@@@@@@
ProblemsNursing, 10th
Medical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@
Nursing, 10th Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@
, lOMoARcPSD|44532475
Gastrointestinal
ewis Medical-Surgical
ChapterProblems
42 Lower
Nursing,
Lewis
Gastrointestinal
10th
Medical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@@@@@@@@@
ProblemsNursing,
Lewis10thMedical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@
Nursing, 10th Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@
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
7. A young adult patient is admitted to the hospital for evaluation of right lower quadrant
abdominal pain with nausea and vomiting. Which action should the nurse take?
a. Assist the patient to cough and deep breathe.
b. Palpate the abdomen for rebound tenderness.
c. Suggest the patient lie on the side, flexing the right leg.
d. Encourage the patient to sip clear, noncarbonated liquids.
ANS: C
The patient’s clinical manifestations are consistent with appendicitis. Lying still with the right
leg flexed is often the most comfortable position. Checking for rebound tenderness frequently
is unnecessary and uncomfortable for the patient. The patient should be NPO in case
immediate surgery is needed. The patient will need to know how to cough and deep breathe
postoperatively, but coughing will increase pain at this time.
DIF: Cognitive Level: Apply (application) REF: 942
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
8. Which nursing action will be included in the plan of care for a 25-yr-old male patient with a
new diagnosis of irritable bowel syndrome (IBS)?
a. Encourage the patient to express concerns and ask questions about IBS.
b. Suggest that the patient increase the intake of milk and other dairy products.
c. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs).
d. Teach the patient about the use of alosetron (Lotronex) to reduce IBS symptoms.
ANS: A
Because psychologic and emotional factors can affect the symptoms for IBS, encouraging the
patient to discuss emotions and ask questions is an important intervention. Alosetron has
serious side effects and is used only for female patients who have not responded to other
therapies. Although yogurt may be beneficial, milk is avoided because lactose intolerance can
contribute to symptoms in some patients. NSAIDs can be used by patients with IBS.
DIF: Cognitive Level: Apply (application) REF: 940
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
9. A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy
abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to
a. administer IV metoclopramide (Reglan).
b. discontinue the patient’s oral food intake.
c. administer cobalamin (vitamin B12) injections.
d. teach the patient about total colectomy surgery.
ANS: B
Gastrointestinal
ewis Medical-Surgical
ChapterProblems
42 Lower
Nursing,
Lewis
Gastrointestinal
10th Downloaded
Medical-Surgical Lewisby madiba South Africa stuvia ()
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@@@@@@@@@
ProblemsNursing, 10th
Medical-Surgical
Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@@@@@@@@@@@@@
Nursing, 10th Edition.pdf!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~@@@@
