Chapter 42 Assessment and Management of Patients With Obesity
1. A nurse is working with a patient who has chronic constipation. What should be included in
patient teaching to promote normal bowel function?
A) Use glycerin suppositories on a regular basis.
B) Limit physical activity in order to promote bowel peristalsis.
C) Consume high-residue, high-fiber foods.
D) Resist the urge to defecate until the urge becomes intense.
Ans: C
Feedback:
Goals for the patient include restoring or maintaining a regular pattern of elimination by
responding to the urge to defecate, ensuring adequate intake of fluids and high-fiber foods,
learning about methods to avoid constipation, relieving anxiety about bowel elimination
patterns, and avoiding complications. Ongoing use of pharmacologic aids should not be
promoted, due to the risk of dependence. Increased mobility helps to maintain a regular
pattern of elimination. The urge to defecate should be heeded.
2. A nurse is preparing to provide care for a patient whose exacerbation of ulcerative colitis has
required hospital admission. During an exacerbation of this health problem, the nurse would
anticipate that the patient's stools will have what characteristics?
A) Watery with blood and mucus
B) Hard and black or tarry
C) Dry and streaked with blood
D) Loose with visible fatty streaks
Ans: A
Feedback:
The predominant symptoms of ulcerative colitis are diarrhea and abdominal pain.
, Stools may be bloody and contain mucus. Stools are not hard, dry, tarry, black or fatty in
patients who have ulcerative colitis.
3. A patient has had an ileostomy created for the treatment of irritable bowel disease and the
patient is now preparing for discharge. What should the patient be taught about changing this
device in the home setting?
A) Apply antibiotic ointment as ordered 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 or chlorhexidine. Ans: B
Feedback:
Guidelines for changing an ileostomy appliance are as follows. Skin should be washed
with soap and water, and dried. A skin barrier should be applied to the peristomal skin prior to
applying the pouch. Clamps are supplied one per box and should be reused with each bag
change. Topical antibiotics are not utilized, but an antifungal spray or powder may be used.
, 4. A patient admitted with acute diverticulitis has experienced a sudden increase in temperature
and complains of a sudden onset of exquisite abdominal tenderness. The nurse's rapid
assessment reveals that the patient's abdomen is uncharacteristically rigid on palpation. What
is the nurse's best response?
A) Administer a Fleet enema as ordered and remain with the patient.
B) Contact the primary care provider promptly and report these signs of perforation.
C) Position the patient supine and insert an NG tube.
D) Page the primary care provider and report that the patient may be obstructed.
Ans: B
Feedback:
The patient's change in status is suggestive of perforation, which is a surgical emergency.
Obstruction does not have this presentation involving fever and abdominal rigidity. An enema
would be strongly contraindicated. An order is needed for NG insertion and repositioning is not
a priority.
5. A 35-year-old male patient presents at the emergency department with symptoms of a small
bowel obstruction. In collaboration with the primary care provider, what intervention should
the nurse prioritize?
A) Insertion of a nasogastric tube
B) Insertion of a central venous catheter
C) Administration of a mineral oil enema
D) Administration of a glycerin suppository and an oral laxative
Ans: A
Feedback:
Decompression of the bowel through a nasogastric tube is necessary for all patients
with small bowel obstruction. Peripheral IV access is normally sufficient. Enemas, suppositories,
and laxatives are not indicated if an obstruction is present.
1. A nurse is working with a patient who has chronic constipation. What should be included in
patient teaching to promote normal bowel function?
A) Use glycerin suppositories on a regular basis.
B) Limit physical activity in order to promote bowel peristalsis.
C) Consume high-residue, high-fiber foods.
D) Resist the urge to defecate until the urge becomes intense.
Ans: C
Feedback:
Goals for the patient include restoring or maintaining a regular pattern of elimination by
responding to the urge to defecate, ensuring adequate intake of fluids and high-fiber foods,
learning about methods to avoid constipation, relieving anxiety about bowel elimination
patterns, and avoiding complications. Ongoing use of pharmacologic aids should not be
promoted, due to the risk of dependence. Increased mobility helps to maintain a regular
pattern of elimination. The urge to defecate should be heeded.
2. A nurse is preparing to provide care for a patient whose exacerbation of ulcerative colitis has
required hospital admission. During an exacerbation of this health problem, the nurse would
anticipate that the patient's stools will have what characteristics?
A) Watery with blood and mucus
B) Hard and black or tarry
C) Dry and streaked with blood
D) Loose with visible fatty streaks
Ans: A
Feedback:
The predominant symptoms of ulcerative colitis are diarrhea and abdominal pain.
, Stools may be bloody and contain mucus. Stools are not hard, dry, tarry, black or fatty in
patients who have ulcerative colitis.
3. A patient has had an ileostomy created for the treatment of irritable bowel disease and the
patient is now preparing for discharge. What should the patient be taught about changing this
device in the home setting?
A) Apply antibiotic ointment as ordered 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 or chlorhexidine. Ans: B
Feedback:
Guidelines for changing an ileostomy appliance are as follows. Skin should be washed
with soap and water, and dried. A skin barrier should be applied to the peristomal skin prior to
applying the pouch. Clamps are supplied one per box and should be reused with each bag
change. Topical antibiotics are not utilized, but an antifungal spray or powder may be used.
, 4. A patient admitted with acute diverticulitis has experienced a sudden increase in temperature
and complains of a sudden onset of exquisite abdominal tenderness. The nurse's rapid
assessment reveals that the patient's abdomen is uncharacteristically rigid on palpation. What
is the nurse's best response?
A) Administer a Fleet enema as ordered and remain with the patient.
B) Contact the primary care provider promptly and report these signs of perforation.
C) Position the patient supine and insert an NG tube.
D) Page the primary care provider and report that the patient may be obstructed.
Ans: B
Feedback:
The patient's change in status is suggestive of perforation, which is a surgical emergency.
Obstruction does not have this presentation involving fever and abdominal rigidity. An enema
would be strongly contraindicated. An order is needed for NG insertion and repositioning is not
a priority.
5. A 35-year-old male patient presents at the emergency department with symptoms of a small
bowel obstruction. In collaboration with the primary care provider, what intervention should
the nurse prioritize?
A) Insertion of a nasogastric tube
B) Insertion of a central venous catheter
C) Administration of a mineral oil enema
D) Administration of a glycerin suppository and an oral laxative
Ans: A
Feedback:
Decompression of the bowel through a nasogastric tube is necessary for all patients
with small bowel obstruction. Peripheral IV access is normally sufficient. Enemas, suppositories,
and laxatives are not indicated if an obstruction is present.
