Stromberg: deWit’s Medical-Surgical Nursing, 4th Edition
Chapter 29: Care of Patients With Disorders of the Lower Gastrointestinal System
Answer Guidelines for Think Critically
What is the difference between the signs and symptoms of diverticulitis and those of irritable
bowel syndrome?
Diverticulitis produces symptoms of diarrhea or constipation, left lower abdominal pain, fever,
and rectal bleeding. The three characteristics typical of IBS are (1) alteration in bowel
elimination—either constipation or diarrhea or both; (2) abdominal pain and bloating; and (3)
the absence of detectable organic disease. Each patient seems to have a unique pattern.
What would you say to a family member who mentions that they have a swelling in the groin
area and think they may have a hernia?
Assess the person for contributing factors in the development of a hernia: straining to lift heavy
objects, chronic cough, straining to void, straining at stool, and ascites. Assess for pain and
symptoms of obstruction. Advise the person to consult a health care provider for diagnosis
because hernias are treatable with surgery.
Describe three key differences between Crohn disease and UC.
See Table 29.2.
What do you think the psychological concerns might be for a person who is to have a colostomy?
Fear related to the prognosis of cancer or the surgical procedure. The patient may worry about
how to manage and care for the colostomy or how the colostomy will affect physical appearance
or sexual intimacy.
How does the effluent from a transverse colostomy, from a sigmoid colostomy, and from an
ileostomy differ?
The stool from a transverse colostomy is semiliquid and is discharged unpredictably.
The stool from a sigmoid colostomy is more solid and well formed and may be discharged on a
relatively regular schedule, no more often than once a day or every 2 days. The stool from an
ileostomy is liquid, and even though digestion is completed by the time the fecal material
reaches the stoma, it still contains digestive enzymes that are highly irritating to the skin.
Copyright © 2021 by Elsevier, Inc. All rights reserved.
, Answers and Rationales for Review Questions for the NCLEX® Examination
1. Correct Answer: 2
The purpose of having a patient with IBS keep a food diary is to identify foods that may cause
bloating; a diary will help establish a pattern of eating and of symptoms. The other options are
also correct and appropriate for different patients with different health conditions. (1, 4) For
example, an obese patient may keep a diary to monitor calories or to recognize that they are
overconsuming high-calorie foods. (3) Keeping a diary for food preferences might be appropriate
to identify the favorite foods of an older adult patient or of someone from a different cultural
background.
2. Correct Answer: 2
The symptoms of diarrhea and fever suggest the need for increased fluid intake. Rectal bleeding
should be further evaluated and reported. (1, 3, 4) These options are not appropriate because all
of these actions would increase bowel activity.
3. Correct Answer: 1, 3, 4, 2
(1) Increased abdominal pressure can impair the ability of the diaphragm to move and cause
problems with breathing. (3) A position with the head of bed flat and legs elevated would be best
for support of blood pressure. However, the patient may not breathe well with the head of bed
flat, so a slight elevation may be necessary. (4) You should anticipate the need for IV fluids and
medications, so a patent IV is essential. (2) The health care provider needs to be notified of the
change in patient condition.
4. Correct Answer: 2
A different body position, such as a knee-chest position, might move the blockage forward. (1)
Massage the area around the stoma, not the stoma itself. (3) A warm bath might help. (4) The
patient would be switched to a liquid diet; a high-fiber diet could make the problem worse. (See
Patient Teaching: Measures to Prevent Intestinal Blockage for Ileostomy Patients on the Evolve
website for additional information.)
5. Correct Answer: 4
A dressing is never placed over an ileal stoma; drainage must be assessed because a decrease in
output could signal a blockage, which could lead to a rupture. (1, 2, 3) The other orders are part
of the standard postoperative care for an ileostomy patient.
6. Correct Answer: 4
A drug that is to be absorbed from the intestine, as for relief of vomiting, should be inserted into
the distal stoma, where it will not be expelled. (1, 2) Ileostomy patients should not take time-
release capsules and enteric-coated tablets, as there is not enough time for adequate absorption
Copyright © 2021 by Elsevier, Inc. All rights reserved.
Chapter 29: Care of Patients With Disorders of the Lower Gastrointestinal System
Answer Guidelines for Think Critically
What is the difference between the signs and symptoms of diverticulitis and those of irritable
bowel syndrome?
Diverticulitis produces symptoms of diarrhea or constipation, left lower abdominal pain, fever,
and rectal bleeding. The three characteristics typical of IBS are (1) alteration in bowel
elimination—either constipation or diarrhea or both; (2) abdominal pain and bloating; and (3)
the absence of detectable organic disease. Each patient seems to have a unique pattern.
What would you say to a family member who mentions that they have a swelling in the groin
area and think they may have a hernia?
Assess the person for contributing factors in the development of a hernia: straining to lift heavy
objects, chronic cough, straining to void, straining at stool, and ascites. Assess for pain and
symptoms of obstruction. Advise the person to consult a health care provider for diagnosis
because hernias are treatable with surgery.
Describe three key differences between Crohn disease and UC.
See Table 29.2.
What do you think the psychological concerns might be for a person who is to have a colostomy?
Fear related to the prognosis of cancer or the surgical procedure. The patient may worry about
how to manage and care for the colostomy or how the colostomy will affect physical appearance
or sexual intimacy.
How does the effluent from a transverse colostomy, from a sigmoid colostomy, and from an
ileostomy differ?
The stool from a transverse colostomy is semiliquid and is discharged unpredictably.
The stool from a sigmoid colostomy is more solid and well formed and may be discharged on a
relatively regular schedule, no more often than once a day or every 2 days. The stool from an
ileostomy is liquid, and even though digestion is completed by the time the fecal material
reaches the stoma, it still contains digestive enzymes that are highly irritating to the skin.
Copyright © 2021 by Elsevier, Inc. All rights reserved.
, Answers and Rationales for Review Questions for the NCLEX® Examination
1. Correct Answer: 2
The purpose of having a patient with IBS keep a food diary is to identify foods that may cause
bloating; a diary will help establish a pattern of eating and of symptoms. The other options are
also correct and appropriate for different patients with different health conditions. (1, 4) For
example, an obese patient may keep a diary to monitor calories or to recognize that they are
overconsuming high-calorie foods. (3) Keeping a diary for food preferences might be appropriate
to identify the favorite foods of an older adult patient or of someone from a different cultural
background.
2. Correct Answer: 2
The symptoms of diarrhea and fever suggest the need for increased fluid intake. Rectal bleeding
should be further evaluated and reported. (1, 3, 4) These options are not appropriate because all
of these actions would increase bowel activity.
3. Correct Answer: 1, 3, 4, 2
(1) Increased abdominal pressure can impair the ability of the diaphragm to move and cause
problems with breathing. (3) A position with the head of bed flat and legs elevated would be best
for support of blood pressure. However, the patient may not breathe well with the head of bed
flat, so a slight elevation may be necessary. (4) You should anticipate the need for IV fluids and
medications, so a patent IV is essential. (2) The health care provider needs to be notified of the
change in patient condition.
4. Correct Answer: 2
A different body position, such as a knee-chest position, might move the blockage forward. (1)
Massage the area around the stoma, not the stoma itself. (3) A warm bath might help. (4) The
patient would be switched to a liquid diet; a high-fiber diet could make the problem worse. (See
Patient Teaching: Measures to Prevent Intestinal Blockage for Ileostomy Patients on the Evolve
website for additional information.)
5. Correct Answer: 4
A dressing is never placed over an ileal stoma; drainage must be assessed because a decrease in
output could signal a blockage, which could lead to a rupture. (1, 2, 3) The other orders are part
of the standard postoperative care for an ileostomy patient.
6. Correct Answer: 4
A drug that is to be absorbed from the intestine, as for relief of vomiting, should be inserted into
the distal stoma, where it will not be expelled. (1, 2) Ileostomy patients should not take time-
release capsules and enteric-coated tablets, as there is not enough time for adequate absorption
Copyright © 2021 by Elsevier, Inc. All rights reserved.
