NSG 4100 EXAM 1 CH 48, 49, 39, 40, 41, 42(TB)
WITH COMPLETE SOLUTIONS 100% VERIFIED
2025-2026!!
The client is admitted to the medical unit with a diagnosis of intestinal obstruction. In
developing this client's plan of care, which of the following nursing diagnoses should be
the priority?
A. Ineffective tissue perfusion related to bowel ischemia
B. Imbalanced nutrition: Less than body requirements related to impaired absorption
C. Anxiety related to bowel obstruction and subsequent hospitalization
D. Impaired skin integrity related to bowel obstruction - ANSWER>>A. Ineffective
Tissue Perfusion Related to Bowel Ischemia
A nurse is providing an educational program to a community group. When discussing
colorectal cancer the nurse should include which of the following as a risk factor?
A. High level of alcohol consumption
B. History of bowel obstruction
C. History of diverticulitis
D. Long-standing psychosocial stress - ANSWER>>A. High level of alcohol
consumption
A client undergoes a screening colonoscopy and is discovered to have multiple polyps
of the large bowel. What principle should guide the treatment of this client's health
problem?
A. The client should be advised that adherence to a high-fiber diet will help resolve the
polyps.
,B. The client can be reassured that this is a normal, age-related physiologic change.
C. The client's polyps constitute a risk factor for cancer.
D. The risk of bowel obstruction is increased because of the polyps. - ANSWER>>C.
The client has a risk factor related to his polyps for cancer.
The nurse is implementing health screening with a group of clients from many different
backgrounds. Which client has the greatest number of risk factors for hemorrhoids?
A. A 45-year-old teacher who stands in the classroom 6 hours a day
B. A client who is pregnant and at 28 weeks' gestation
C. A 37-year-old construction worker who does heavy lifting
D. A 60 year old professional who is under stress - ANSWER>>B. A pregnant woman at
28 weeks gestation
A nurse is providing care for an older adult who resides in an assisted living facility and
has come to the nurse because of repeated bouts of constipation. What would be the
nurse's first action?
A. Instruct the client to take daily stool softener.
B. Assess the client's food and fluid intake.
C. Assess the client's surgical history.
D. Encourage the client to take fiber supplements. - ANSWER>>B. Assess the client's
food and fluid intake.
A 16-year-old comes to the emergency department with a complaint of right lower
quadrant pain and is diagnosed with appendicitis. While developing this client's nursing
care plan, the nurse should identify which nursing diagnosis as a priority?
A. Imbalanced nutrition: Less than body requirements related to decreased oral intake
B. Risk for infection related to possible rupture of appendix
C. Constipation related to decreased bowel motility and decreased fluid intake
,D. Chronic pain related to appendicitis - ANSWER>>B. Risk for Infection Related to
Possible Rupture of Appendix
A nurse is discussing a plan of care with a client scheduled for a hemicolectomy with the
creation of a colostomy. The client relates anxiety and multiple questions regarding the
surgery, care of a stoma, and lifestyle adjustments required. What is the most
appropriate nursing action?
A. Instruct the client that surgery can be considered low risk and most clients adapt
fairly well to living with an ostomy.
B. The nurse should provide the client with educational materials that match the client's
learning style.
C. Encourage the client to write down these concerns and questions to bring forward to
the surgeon.
D. Keep open dialogue with the client and facilitate a referral to the WOC nurse. -
ANSWER>>D. Keep open dialogue with the client and facilitate a referral to the WOC
nurse.
The nurse is caring for a client who is undergoing diagnostic testing for suspected
malabsorption. When taking this client's health history and performing the physical
assessment, the nurse should identify what finding as most consistent with this
diagnosis?
A. Recurrent constipation coupled with weight loss
B. Foul-smelling diarrhea that contains fat
C. Fever accompanied by a rigid, tender abdomen
D. Bloody bowel movements accompanied by fecal incontinence - ANSWER>>B.
Foul-smelling diarrhea that contains fat
A nurse is providing care for a client with a newly formed ileostomy. During an
assessment, the nurse discovers that the client has not produced ostomy output for the
previous 12 hours. The client also reports nausea that has been worsening. What is the
nurse's priority action?
A. Facilitate a consultation with the WOC nurse.
B. Report signs and symptoms of obstruction to the health care provider.
, C. Encourage the client to ambulate to improve motility.
D. Notify the health care provider and prepare a swab of the stoma for culture. -
ANSWER>>B. Report signs and symptoms of obstruction to the health care provider.
A nurse is caring for a client who has been diagnosed with irritable bowel syndrome.
When creating this client's plan of care, the nurse should work with the client and focus
on which of the following goals as the priority?
A. The client will identify those foods that precipitate his symptoms correctly.
B. The client will manage his ileostomy appropriately.
C. The client will use standard infection control precautions appropriately.
D. Client will follow guidelines for mobility and activity. - ANSWER>>A. Client will
correctly identify precipitating foods.
A client has been experiencing distressing GI symptoms that have become increasingly
severe. After medical evaluation, the client is found to have lactose intolerance. The
nurse should identify an increased need for health promotion related to which of the
following?
Annual screening colonoscopies
Following recommended immunization schedules
C. Regular blood pressure monitoring
D. Frequent screening for osteoporosis - ANSWER>>D. Frequent screening for
osteoporosis
A client is an older adult who has been diagnosed with Alzheimer disease and who is
now experiencing fecal incontinence. The nurse, however, has noted no recent
alteration in the character of the client's stools. What is the nurse's best response?
A. Maintain a food diary to identify those foods that precipitate the client's symptoms.
B. Provide the client with a bland, low-residue diet.
C. Toilet the client on a frequent, scheduled basis.
D. Liaise with the primary provider to obtain an order for loperamide. - ANSWER>>C.
Toilet the client on a frequent, scheduled basis.
WITH COMPLETE SOLUTIONS 100% VERIFIED
2025-2026!!
The client is admitted to the medical unit with a diagnosis of intestinal obstruction. In
developing this client's plan of care, which of the following nursing diagnoses should be
the priority?
A. Ineffective tissue perfusion related to bowel ischemia
B. Imbalanced nutrition: Less than body requirements related to impaired absorption
C. Anxiety related to bowel obstruction and subsequent hospitalization
D. Impaired skin integrity related to bowel obstruction - ANSWER>>A. Ineffective
Tissue Perfusion Related to Bowel Ischemia
A nurse is providing an educational program to a community group. When discussing
colorectal cancer the nurse should include which of the following as a risk factor?
A. High level of alcohol consumption
B. History of bowel obstruction
C. History of diverticulitis
D. Long-standing psychosocial stress - ANSWER>>A. High level of alcohol
consumption
A client undergoes a screening colonoscopy and is discovered to have multiple polyps
of the large bowel. What principle should guide the treatment of this client's health
problem?
A. The client should be advised that adherence to a high-fiber diet will help resolve the
polyps.
,B. The client can be reassured that this is a normal, age-related physiologic change.
C. The client's polyps constitute a risk factor for cancer.
D. The risk of bowel obstruction is increased because of the polyps. - ANSWER>>C.
The client has a risk factor related to his polyps for cancer.
The nurse is implementing health screening with a group of clients from many different
backgrounds. Which client has the greatest number of risk factors for hemorrhoids?
A. A 45-year-old teacher who stands in the classroom 6 hours a day
B. A client who is pregnant and at 28 weeks' gestation
C. A 37-year-old construction worker who does heavy lifting
D. A 60 year old professional who is under stress - ANSWER>>B. A pregnant woman at
28 weeks gestation
A nurse is providing care for an older adult who resides in an assisted living facility and
has come to the nurse because of repeated bouts of constipation. What would be the
nurse's first action?
A. Instruct the client to take daily stool softener.
B. Assess the client's food and fluid intake.
C. Assess the client's surgical history.
D. Encourage the client to take fiber supplements. - ANSWER>>B. Assess the client's
food and fluid intake.
A 16-year-old comes to the emergency department with a complaint of right lower
quadrant pain and is diagnosed with appendicitis. While developing this client's nursing
care plan, the nurse should identify which nursing diagnosis as a priority?
A. Imbalanced nutrition: Less than body requirements related to decreased oral intake
B. Risk for infection related to possible rupture of appendix
C. Constipation related to decreased bowel motility and decreased fluid intake
,D. Chronic pain related to appendicitis - ANSWER>>B. Risk for Infection Related to
Possible Rupture of Appendix
A nurse is discussing a plan of care with a client scheduled for a hemicolectomy with the
creation of a colostomy. The client relates anxiety and multiple questions regarding the
surgery, care of a stoma, and lifestyle adjustments required. What is the most
appropriate nursing action?
A. Instruct the client that surgery can be considered low risk and most clients adapt
fairly well to living with an ostomy.
B. The nurse should provide the client with educational materials that match the client's
learning style.
C. Encourage the client to write down these concerns and questions to bring forward to
the surgeon.
D. Keep open dialogue with the client and facilitate a referral to the WOC nurse. -
ANSWER>>D. Keep open dialogue with the client and facilitate a referral to the WOC
nurse.
The nurse is caring for a client who is undergoing diagnostic testing for suspected
malabsorption. When taking this client's health history and performing the physical
assessment, the nurse should identify what finding as most consistent with this
diagnosis?
A. Recurrent constipation coupled with weight loss
B. Foul-smelling diarrhea that contains fat
C. Fever accompanied by a rigid, tender abdomen
D. Bloody bowel movements accompanied by fecal incontinence - ANSWER>>B.
Foul-smelling diarrhea that contains fat
A nurse is providing care for a client with a newly formed ileostomy. During an
assessment, the nurse discovers that the client has not produced ostomy output for the
previous 12 hours. The client also reports nausea that has been worsening. What is the
nurse's priority action?
A. Facilitate a consultation with the WOC nurse.
B. Report signs and symptoms of obstruction to the health care provider.
, C. Encourage the client to ambulate to improve motility.
D. Notify the health care provider and prepare a swab of the stoma for culture. -
ANSWER>>B. Report signs and symptoms of obstruction to the health care provider.
A nurse is caring for a client who has been diagnosed with irritable bowel syndrome.
When creating this client's plan of care, the nurse should work with the client and focus
on which of the following goals as the priority?
A. The client will identify those foods that precipitate his symptoms correctly.
B. The client will manage his ileostomy appropriately.
C. The client will use standard infection control precautions appropriately.
D. Client will follow guidelines for mobility and activity. - ANSWER>>A. Client will
correctly identify precipitating foods.
A client has been experiencing distressing GI symptoms that have become increasingly
severe. After medical evaluation, the client is found to have lactose intolerance. The
nurse should identify an increased need for health promotion related to which of the
following?
Annual screening colonoscopies
Following recommended immunization schedules
C. Regular blood pressure monitoring
D. Frequent screening for osteoporosis - ANSWER>>D. Frequent screening for
osteoporosis
A client is an older adult who has been diagnosed with Alzheimer disease and who is
now experiencing fecal incontinence. The nurse, however, has noted no recent
alteration in the character of the client's stools. What is the nurse's best response?
A. Maintain a food diary to identify those foods that precipitate the client's symptoms.
B. Provide the client with a bland, low-residue diet.
C. Toilet the client on a frequent, scheduled basis.
D. Liaise with the primary provider to obtain an order for loperamide. - ANSWER>>C.
Toilet the client on a frequent, scheduled basis.
