NMNC 3210 EXAM 2 CHAPTER QUIZZES QUESTIONS
Which clinical manifestations of inflammatory bowel disease are common to both
patients with ulcerative colitis (UC) and Crohn's disease? (Select all that apply)
-Restricted to rectum
-Strictures are common
-Bloody, diarrhea stools
-Cramping abdominal pain
-Lesions penetrate intestine - Answers - -Bloody, diarrhea stools
-Cramping abdominal pain
Rationale:
Manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal
pain, and nutritional disorders. Intestinal lesions associated with UC are usually
restricted to the rectum before moving into the colon. Lesions that penetrate the
intestine or cause strictures are characteristic of Crohn's disease.
A patient after a stroke who primarily uses a wheelchair for mobility has developed
diarrhea with fecal incontinence. What is a priority assessment by the nurse?
-Fecal impaction
-Perineal hygiene
-Dietary fiber intake
-Antidiarrheal agent use - Answers - -Fecal impaction
Rationale:
Patients with limited mobility are at risk for fecal impactions caused by constipation that
may lead to liquid stool leaking around the hardened impacted feces, so assessing for
fecal impaction is the priority. Perineal hygiene can be assessed at the same time.
Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed
and considered next.
A patient is given a bisacodyl suppository and asks the nurse how long it will take to
work. What is the best response by the nurse?
-2 to 5 minutes
-15 to 60 minutes
-2 to 4 hours
-6 to 8 hours - Answers - -15 to 60 minutes
Rationale:
Bisacodyl suppositories usually are effective within 15 to 60 minutes of administration,
so the nurse should plan accordingly to assist the patient to use the bedpan or
commode.
,The nurse is developing a plan of care for a patient with an abdominal mass and
suspected bowel obstruction. Which factor in the patient's history does the nurse
recognize as increasing the patient's risk for colorectal cancer?
-Osteoarthritis
-History of colorectal polyps
-History of lactose intolerance
-Use of herbs as dietary supplements - Answers - -History of colorectal polyps
Rationale:
A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue
can degenerate over time and become malignant. Osteoarthritis, lactose intolerance,
and the use of herbs do not pose additional risk to the patient.
The nurse identifies that which patient is at highest risk for developing colon cancer?
-A 28-yr-old man who has a body mass index of 27 kg/m2
-A 32-yr-old woman with a 12-year history of ulcerative colitis
-A 52-yr-old man who has followed a vegetarian diet for 24 years
-A 58-yr-old woman taking prescribed estrogen replacement therapy - Answers - -A
32-yr-old woman with a 12-year history of ulcerative colitis
Rationale:
Risk for colon cancer includes personal history of inflammatory bowel disease
(especially ulcerative colitis for longer than 10 years); obesity; family (first-degree
relative) or personal history of colorectal cancer, adenomatous polyposis, or hereditary
nonpolyposis colorectal cancer syndrome; eating red meat; cigarette use; and drinking
alcohol.
The nurse is preparing to administer famotidine to a patient after a laparotomy. The
patient states they do not have heartburn. What response by the nurse would be the
most appropriate?
-"It will prevent air from accumulating in the stomach, causing gas pains."
-"It will reduce the amount of acid in the stomach while you are not eating."
-"It will prevent the heartburn that occurs as a side effect of general anesthesia."
-"The stress of surgery is likely to cause stomach bleeding if you do not receive it." -
Answers - -"It will reduce the amount of acid in the stomach while you are not eating."
Rationale:
Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus
minimizes damage to gastric mucosa while the patient is not eating a regular diet after
surgery. Famotidine does not prevent air from accumulating in the stomach or stop the
stomach from bleeding. Heartburn is not a side effect of general anesthesia.
The nurse is conducting discharge teaching for a patient with metastatic lung cancer
who was admitted with a bowel impaction. Which instructions would be most helpful to
prevent further episodes of constipation?
-Maintain a high intake of fluid and fiber in the diet.
-Discontinue intake of medications causing constipation.
-Eat several small meals per day to maintain bowel motility.
,-Sit upright during meals to increase bowel motility by gravity. - Answers - -Maintain a
high intake of fluid and fiber in the diet.
Rationale:
Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused
by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn
increases peristalsis and bowel motility. Analgesics taken for lung cancer probably
cannot be discontinued. Eating several small meals per day and position do not
facilitate bowel motility.
The nurse is administering a cathartic agent to a patient with renal insufficiency. Which
order will the nurse question?
-Bisacodyl
-Lubiprostone
-Cascara sagrada
-Magnesium hydroxide - Answers - -Magnesium hydroxide
Rationale:
Milk of magnesia may cause hypermagnesemia in patients with renal insufficiency. The
nurse should question this order with the health care provider. Bisacodyl, lubiprostone,
and cascara sagrada are safe to use in patients with renal insufficiency as long as the
patient is not currently dehydrated.
Two days after a bowel resection for an abdominal mass, a patient reports gas pains
and abdominal distention. The nurse plans care for the patient based on the knowledge
that the symptoms are occurring as a result what event?
-Impaired peristalsis
-Irritation of the bowel
-Nasogastric suctioning
-Inflammation of the incision site - Answers - -Impaired peristalsis
Rationale:
Until peristalsis returns to normal after anesthesia, the patient may experience slowed
gastrointestinal motility, leading to gas pains and abdominal distention. Irritation of the
bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas
pains or abdominal distention.
The nurse is preparing to insert a nasogastric (NG) tube into a patient with a suspected
small intestinal obstruction that is vomiting. The patient asks the nurse why this
procedure is necessary. What response by the nurse is most appropriate?
-"The tube will help to drain the stomach contents and prevent further vomiting."
-"The tube will push past the area that is blocked and help to stop the vomiting."
-"The tube is just a standard procedure before many types of surgery to the abdomen."
-"The tube will let us measure your stomach contents so we can give you the right IV
fluid replacement." - Answers - -"The tube will help to drain the stomach contents and
prevent further vomiting."
Rationale:
The NG tube is used to decompress the stomach by draining stomach contents and
thereby prevent further vomiting. The NG tube will not push past the blocked area.
, Potential surgery is not currently indicated. The location of the obstruction will determine
the type of fluid to use, not measure the amount of stomach contents.
The nurse is preparing to administer a scheduled dose of docusate sodium when the
patient reports an episode of loose stool and does not want to take the medication.
What is the appropriate action by the nurse?
-Write an incident report about this untoward event.
-Attempt to have the family convince the patient to take the ordered dose.
-Withhold the medication at this time and try to administer it later in the day.
-Chart the dose as not given on the medical record and explain in the nursing progress
notes. - Answers - -Chart the dose as not given on the medical record and explain in
the nursing progress notes.
Rationale:
Whenever a patient refuses medication, the dose should be charted as not given with
an explanation of the reason documented in the nursing progress notes. In this
instance, the refusal indicates good judgment by the patient, and the patient should not
be encouraged to take it today.
A patient with an intestinal obstruction has a nasogastric (NG) tube to suction but
reports of nausea and abdominal distention. The nurse irrigates the tube as necessary
as ordered, but the irrigating fluid does not return. What should be the priority action by
the nurse?
-Notify the provider.
-Auscultate for bowel sounds.
-Reposition the tube and check for placement.
-Remove the tube and replace it with a new one. - Answers - -Reposition the tube and
check for placement.
Rationale:
The tube may be resting against the stomach wall. The first action by the nurse is to
reposition the tube and check it again for placement. The provider does not need to be
notified unless the nurse cannot restore the tube function. The patient does not have
bowel sounds, which is why the NG tube is in place. The NG tube would not be
removed and replaced unless it was no longer in the stomach or the obstruction of the
tube could not be relieved.
When evaluating the patient's understanding about the care of the ileostomy, which
statement by the patient indicates the patient needs more teaching?
-"I will be able to regulate when I have stools."
-"I will be able to wear a pouch until it leaks."
-"The drainage from my stoma can damage my skin."
-"Dried fruit and popcorn must be chewed very well." - Answers - -"I will be able to
regulate when I have stools."
Rationale:
An ileostomy is in the ileum and drains liquid stool frequently, unlike a colostomy, which
has more formed stool the farther distal the ostomy is in the colon. The ileostomy pouch
is usually worn for 4 to 7 days or until it leaks. It must be changed immediately if it leaks
Which clinical manifestations of inflammatory bowel disease are common to both
patients with ulcerative colitis (UC) and Crohn's disease? (Select all that apply)
-Restricted to rectum
-Strictures are common
-Bloody, diarrhea stools
-Cramping abdominal pain
-Lesions penetrate intestine - Answers - -Bloody, diarrhea stools
-Cramping abdominal pain
Rationale:
Manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal
pain, and nutritional disorders. Intestinal lesions associated with UC are usually
restricted to the rectum before moving into the colon. Lesions that penetrate the
intestine or cause strictures are characteristic of Crohn's disease.
A patient after a stroke who primarily uses a wheelchair for mobility has developed
diarrhea with fecal incontinence. What is a priority assessment by the nurse?
-Fecal impaction
-Perineal hygiene
-Dietary fiber intake
-Antidiarrheal agent use - Answers - -Fecal impaction
Rationale:
Patients with limited mobility are at risk for fecal impactions caused by constipation that
may lead to liquid stool leaking around the hardened impacted feces, so assessing for
fecal impaction is the priority. Perineal hygiene can be assessed at the same time.
Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed
and considered next.
A patient is given a bisacodyl suppository and asks the nurse how long it will take to
work. What is the best response by the nurse?
-2 to 5 minutes
-15 to 60 minutes
-2 to 4 hours
-6 to 8 hours - Answers - -15 to 60 minutes
Rationale:
Bisacodyl suppositories usually are effective within 15 to 60 minutes of administration,
so the nurse should plan accordingly to assist the patient to use the bedpan or
commode.
,The nurse is developing a plan of care for a patient with an abdominal mass and
suspected bowel obstruction. Which factor in the patient's history does the nurse
recognize as increasing the patient's risk for colorectal cancer?
-Osteoarthritis
-History of colorectal polyps
-History of lactose intolerance
-Use of herbs as dietary supplements - Answers - -History of colorectal polyps
Rationale:
A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue
can degenerate over time and become malignant. Osteoarthritis, lactose intolerance,
and the use of herbs do not pose additional risk to the patient.
The nurse identifies that which patient is at highest risk for developing colon cancer?
-A 28-yr-old man who has a body mass index of 27 kg/m2
-A 32-yr-old woman with a 12-year history of ulcerative colitis
-A 52-yr-old man who has followed a vegetarian diet for 24 years
-A 58-yr-old woman taking prescribed estrogen replacement therapy - Answers - -A
32-yr-old woman with a 12-year history of ulcerative colitis
Rationale:
Risk for colon cancer includes personal history of inflammatory bowel disease
(especially ulcerative colitis for longer than 10 years); obesity; family (first-degree
relative) or personal history of colorectal cancer, adenomatous polyposis, or hereditary
nonpolyposis colorectal cancer syndrome; eating red meat; cigarette use; and drinking
alcohol.
The nurse is preparing to administer famotidine to a patient after a laparotomy. The
patient states they do not have heartburn. What response by the nurse would be the
most appropriate?
-"It will prevent air from accumulating in the stomach, causing gas pains."
-"It will reduce the amount of acid in the stomach while you are not eating."
-"It will prevent the heartburn that occurs as a side effect of general anesthesia."
-"The stress of surgery is likely to cause stomach bleeding if you do not receive it." -
Answers - -"It will reduce the amount of acid in the stomach while you are not eating."
Rationale:
Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus
minimizes damage to gastric mucosa while the patient is not eating a regular diet after
surgery. Famotidine does not prevent air from accumulating in the stomach or stop the
stomach from bleeding. Heartburn is not a side effect of general anesthesia.
The nurse is conducting discharge teaching for a patient with metastatic lung cancer
who was admitted with a bowel impaction. Which instructions would be most helpful to
prevent further episodes of constipation?
-Maintain a high intake of fluid and fiber in the diet.
-Discontinue intake of medications causing constipation.
-Eat several small meals per day to maintain bowel motility.
,-Sit upright during meals to increase bowel motility by gravity. - Answers - -Maintain a
high intake of fluid and fiber in the diet.
Rationale:
Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused
by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn
increases peristalsis and bowel motility. Analgesics taken for lung cancer probably
cannot be discontinued. Eating several small meals per day and position do not
facilitate bowel motility.
The nurse is administering a cathartic agent to a patient with renal insufficiency. Which
order will the nurse question?
-Bisacodyl
-Lubiprostone
-Cascara sagrada
-Magnesium hydroxide - Answers - -Magnesium hydroxide
Rationale:
Milk of magnesia may cause hypermagnesemia in patients with renal insufficiency. The
nurse should question this order with the health care provider. Bisacodyl, lubiprostone,
and cascara sagrada are safe to use in patients with renal insufficiency as long as the
patient is not currently dehydrated.
Two days after a bowel resection for an abdominal mass, a patient reports gas pains
and abdominal distention. The nurse plans care for the patient based on the knowledge
that the symptoms are occurring as a result what event?
-Impaired peristalsis
-Irritation of the bowel
-Nasogastric suctioning
-Inflammation of the incision site - Answers - -Impaired peristalsis
Rationale:
Until peristalsis returns to normal after anesthesia, the patient may experience slowed
gastrointestinal motility, leading to gas pains and abdominal distention. Irritation of the
bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas
pains or abdominal distention.
The nurse is preparing to insert a nasogastric (NG) tube into a patient with a suspected
small intestinal obstruction that is vomiting. The patient asks the nurse why this
procedure is necessary. What response by the nurse is most appropriate?
-"The tube will help to drain the stomach contents and prevent further vomiting."
-"The tube will push past the area that is blocked and help to stop the vomiting."
-"The tube is just a standard procedure before many types of surgery to the abdomen."
-"The tube will let us measure your stomach contents so we can give you the right IV
fluid replacement." - Answers - -"The tube will help to drain the stomach contents and
prevent further vomiting."
Rationale:
The NG tube is used to decompress the stomach by draining stomach contents and
thereby prevent further vomiting. The NG tube will not push past the blocked area.
, Potential surgery is not currently indicated. The location of the obstruction will determine
the type of fluid to use, not measure the amount of stomach contents.
The nurse is preparing to administer a scheduled dose of docusate sodium when the
patient reports an episode of loose stool and does not want to take the medication.
What is the appropriate action by the nurse?
-Write an incident report about this untoward event.
-Attempt to have the family convince the patient to take the ordered dose.
-Withhold the medication at this time and try to administer it later in the day.
-Chart the dose as not given on the medical record and explain in the nursing progress
notes. - Answers - -Chart the dose as not given on the medical record and explain in
the nursing progress notes.
Rationale:
Whenever a patient refuses medication, the dose should be charted as not given with
an explanation of the reason documented in the nursing progress notes. In this
instance, the refusal indicates good judgment by the patient, and the patient should not
be encouraged to take it today.
A patient with an intestinal obstruction has a nasogastric (NG) tube to suction but
reports of nausea and abdominal distention. The nurse irrigates the tube as necessary
as ordered, but the irrigating fluid does not return. What should be the priority action by
the nurse?
-Notify the provider.
-Auscultate for bowel sounds.
-Reposition the tube and check for placement.
-Remove the tube and replace it with a new one. - Answers - -Reposition the tube and
check for placement.
Rationale:
The tube may be resting against the stomach wall. The first action by the nurse is to
reposition the tube and check it again for placement. The provider does not need to be
notified unless the nurse cannot restore the tube function. The patient does not have
bowel sounds, which is why the NG tube is in place. The NG tube would not be
removed and replaced unless it was no longer in the stomach or the obstruction of the
tube could not be relieved.
When evaluating the patient's understanding about the care of the ileostomy, which
statement by the patient indicates the patient needs more teaching?
-"I will be able to regulate when I have stools."
-"I will be able to wear a pouch until it leaks."
-"The drainage from my stoma can damage my skin."
-"Dried fruit and popcorn must be chewed very well." - Answers - -"I will be able to
regulate when I have stools."
Rationale:
An ileostomy is in the ileum and drains liquid stool frequently, unlike a colostomy, which
has more formed stool the farther distal the ostomy is in the colon. The ileostomy pouch
is usually worn for 4 to 7 days or until it leaks. It must be changed immediately if it leaks
