Chapter 36 Bowel Elimination Nclex style questions with Rationales 2025
A nurse is caring for a patient experiencing frequent diarrhea. The
Answer: c. Inspect the abdomen for masses, scars, or distention.
nurse should first:
Rationale: The sequence for abdominal assessment proceeds
a. Auscultate the abdomen in a clockwise manner.
b. Lightly palpate the abdomen to check for areas of pain. from inspection (first), then auscultation, percussion, and palpa-
tion. Inspection is the first step to identify any masses, scars, or
c. Inspect the abdomen for masses, scars, or distention
areas of distention before moving on to further assessment.
.d. Percuss the abdomen to identify fluid or air.
A patient reports severe cramping after a large-volume cleansing
enema. What should the nurse do next?
Answer: c. Lowering the solution container and checking the tem-
a. Elevating the head of the bed 30 degrees and repositioning the
rectal tube perature and flow rate
b. Placing the patient in a supine position and modifying the
Rationale: Severe cramping may occur if the solution is too cold
amount of solution
or the flow rate is too fast. Lowering the solution container and
c. Lowering the solution container and checking the temperature
adjusting the flow rate will help alleviate the cramping.
and flow rate
d. Removing the rectal tube and notifying the primary care
provider
After listening for bowel sounds for 2 minutes, a nurse notes
decreased or absent sounds. Which condition is most likely to Answer: c. Postoperative paralytic ileus
cause this finding?
Rationale: A paralytic ileus, commonly seen postoperatively, is as-
a. Diarrhea sociated with decreased or absent bowel sounds. Other conditions
b. Gastroenteritisc. Postoperative paralyti like peritonitis or prolonged immobility can also result in absent
c Postoperative paralytic ileus bowel sounds.
d. Early bowel obstruction
A nurse is assessing patients in a long-term care facility. Which
patient would be at the highest risk for diarrhea? Answer: e. A patient taking amoxicillin clavulanate for infection
a. A patient on opioid pain medication Rationale: Antibiotic therapy, particularly with broad-spectrum an-
b. A patient taking metformin for diabetes tibiotics like amoxicillin clavulanate, increases the risk of diarrhea
c. A patient taking diuretics by disrupting normal gut flora and promoting overgrowth of path-
d. A patient with dehydration ogenic organisms.
e. A patient taking amoxicillin clavulanate for infection
When administering a retention enema, which nursing action is
Answer: b. Instructing the patient to retain the enema for at least
appropriate?
30 minutes
a. Administering a large-volume solution Rationale: Retention enemas require the solution to be retained
b. Instructing the patient to retain the enema for at least 30 minutes
for a specified time (usually 30 minutes) for effective results. This
c. Administering the enema while the patient is seated on the toilet
helps to soften stool or lubricate the intestine for easier passage.
d. Using a carminative solution to help expel gas
After listening for bowel sounds for 2 minutes, a nurse notes
decreased or absent sounds. Which condition is most likely to Answer: a. Peritonitis, b. Prolonged bedrest, f. Postoperative par-
cause this finding? Select all that apply. alytic ileus
a. Peritonitis
b. Prolonged bedrest Rationale: Absent bowel sounds may indicate peritonitis, paralytic
c. Diarrhea ileus, or prolonged bedrest. These conditions decrease or halt
d. Gastroenteritise. Early bowel obstruction bowel motility, leading to absent bowel sounds.
f. Postoperative paralytic ileus
The nurse is teaching a patient with a new ileostomy. Which Answer: a. "The stool from an ileostomy is typically liquid," d. "Eat
statement should the nurse include? Select all that apply. dark-green vegetables to control the odor of the stool," e. "You may
have a tendency to develop food blockages."
a. "The stool from an ileostomy is typically liquid.
"b. "The size of the stoma will stabilize within 2 weeks." Rationale: Ileostomies produce liquid stool due to the bypassing of
c. "Keep the skin around the stoma site clean and moist." the large intestine. Eating dark-green vegetables can help deodor-
d. "Eat dark-green vegetables to control the odor of the stool. ize stool. Patients with ileostomies are at risk of food blockages,
e. "You may have a tendency to develop food blockages." particularly from high-fiber foods.
A nurse is preparing a patient for a colonoscopy. Which action is
Answer: b. Having the patient take bisacodyl and ingest a gallon
part of the recommended preparation?
oral polyethylene glycol solution (PEG)
1/5
, Chapter 36 Bowel Elimination Nclex style questions with Rationales 2025
a. Having the patient consume a low-fiber diet several days before
the testb. Having the patient take bisacodyl and ingest a gallon oral Rationale: Bowel preparation for a colonoscopy typically includes
polyethylene glycol solution (PEG)c. Preparing the patient for the bisacodyl and PEG solution. General anesthesia is not typically
use of general anesthesia during the testd. Explaining that barium used for colonoscopies, and barium contrast is used for upper GI
contrast mixture will be given to drink before the test studies, not colonoscopies.
During digital stool removal, the patient feels dizzy and nauseous.
What is the nurse's next step?
Answer: c. Stopping the procedure, assessing vital signs, and
a. Reassuring the patient that this is a normal reaction to the notifying the health care provider
procedure
b. Stopping the procedure, preparing to administer CPR, and Rationale: These symptoms suggest vagus nerve stimulation,
notifying the primary care provider which can affect heart rate and blood pressure. The procedure
c. Stopping the procedure, assessing vital signs, and notifying the should be stopped immediately, and the nurse should assess the
health care provider patient's vital signs and inform the healthcare provider.
d. Pausing the procedure, waiting 5 minutes, and then resuming
the procedure
Which order should the nurse follow when scheduling diagnostic
tests for a patient with epigastric pain?
Answer: a. Fecal occult blood test, barium enema, upper GI series,
a. Fecal occult blood test, barium enema, upper GI series, endo-
endoscopic studies
scopic studies
b. Barium enema, fecal occult blood test, endoscopic studies,
Rationale: Noninvasive tests should be performed first, and inva-
upper GI series
sive tests like endoscopy should be performed last. A fecal occult
c. Fecal occult blood test, upper GI series, barium enema, endo-
blood test is usually the first step to identify GI bleeding.
scopic studies
d. Barium enema, upper GI series, fecal occult blood test, endo-
scopic studies
A nurse is caring for a patient with a nasogastric tube for gastric
Answer: b. Confirming tube placement with pH testing of gastric
decompression. Which action is most important when caring for
aspirate
this patient?
Rationale: It is critical to confirm the placement of the NG tube
a. Irrigating the tube with 30-mL normal saline solutionb. Confirm-
before administering any fluids or medications to avoid aspiration.
ing tube placement with pH testing of gastric aspiratec. Position-
pH testing of gastric aspirate is a common and effective method
ing the air vent at the level of the patient's umbilicusd. Instilling
for confirming placement.
irrigation via the blue air vent
The nurse is planning a bowel program for a patient with consti-
pation after a spinal cord injury. What is the first step? Answer: d. Assessing the patient's bowel patterns
a. Offering a diet that is low in residue Rationale: The first step in planning a bowel program is assessing
b. Increasing fluid intake to 3,000 mL daily the patient's bowel patterns to determine the most effective inter-
c. Administering daily enemas to stimulate peristalsis ventions based on the individual's condition.
d. Assessing the patient's bowel patterns
Which of the following is a common sign of colon cancer?
Answer: a. Blood in the stool, d. Unintentional weight loss
a. Blood in the stool
Rationale: Blood in the stool and unintentional weight loss are
b. Previous colonoscopy
c. Passing two large bowel movements daily hallmark signs of colon cancer. Other symptoms may include
changes in bowel habits and abdominal discomfort.
d. Unintentional weight loss
For a patient with a left-sided end colostomy in the sigmoid colon,
what is the most appropriate intervention? Answer: a. Irrigating the colostomy
a. Irrigating the colostomy Rationale: Colostomy irrigation is appropriate for patients with
b. Applying an ostomy appliance a left-sided colostomy in the sigmoid colon to regulate bowel
c. Managing the ostomy diet movements.
d. Administering medication
The nurse notes that a patient's stoma is protruding into the
Answer: c. Having the patient rest for 30 minutes to see if the
ostomy bag. What is the nurse's first action?
prolapse resolves
a. Reassuring the patient that this is a normal with a new ostomy
Rationale: Stoma prolapse may resolve with rest. If the stoma does
b. Notifying the health care provider that the stoma is prolapsed
2/5
A nurse is caring for a patient experiencing frequent diarrhea. The
Answer: c. Inspect the abdomen for masses, scars, or distention.
nurse should first:
Rationale: The sequence for abdominal assessment proceeds
a. Auscultate the abdomen in a clockwise manner.
b. Lightly palpate the abdomen to check for areas of pain. from inspection (first), then auscultation, percussion, and palpa-
tion. Inspection is the first step to identify any masses, scars, or
c. Inspect the abdomen for masses, scars, or distention
areas of distention before moving on to further assessment.
.d. Percuss the abdomen to identify fluid or air.
A patient reports severe cramping after a large-volume cleansing
enema. What should the nurse do next?
Answer: c. Lowering the solution container and checking the tem-
a. Elevating the head of the bed 30 degrees and repositioning the
rectal tube perature and flow rate
b. Placing the patient in a supine position and modifying the
Rationale: Severe cramping may occur if the solution is too cold
amount of solution
or the flow rate is too fast. Lowering the solution container and
c. Lowering the solution container and checking the temperature
adjusting the flow rate will help alleviate the cramping.
and flow rate
d. Removing the rectal tube and notifying the primary care
provider
After listening for bowel sounds for 2 minutes, a nurse notes
decreased or absent sounds. Which condition is most likely to Answer: c. Postoperative paralytic ileus
cause this finding?
Rationale: A paralytic ileus, commonly seen postoperatively, is as-
a. Diarrhea sociated with decreased or absent bowel sounds. Other conditions
b. Gastroenteritisc. Postoperative paralyti like peritonitis or prolonged immobility can also result in absent
c Postoperative paralytic ileus bowel sounds.
d. Early bowel obstruction
A nurse is assessing patients in a long-term care facility. Which
patient would be at the highest risk for diarrhea? Answer: e. A patient taking amoxicillin clavulanate for infection
a. A patient on opioid pain medication Rationale: Antibiotic therapy, particularly with broad-spectrum an-
b. A patient taking metformin for diabetes tibiotics like amoxicillin clavulanate, increases the risk of diarrhea
c. A patient taking diuretics by disrupting normal gut flora and promoting overgrowth of path-
d. A patient with dehydration ogenic organisms.
e. A patient taking amoxicillin clavulanate for infection
When administering a retention enema, which nursing action is
Answer: b. Instructing the patient to retain the enema for at least
appropriate?
30 minutes
a. Administering a large-volume solution Rationale: Retention enemas require the solution to be retained
b. Instructing the patient to retain the enema for at least 30 minutes
for a specified time (usually 30 minutes) for effective results. This
c. Administering the enema while the patient is seated on the toilet
helps to soften stool or lubricate the intestine for easier passage.
d. Using a carminative solution to help expel gas
After listening for bowel sounds for 2 minutes, a nurse notes
decreased or absent sounds. Which condition is most likely to Answer: a. Peritonitis, b. Prolonged bedrest, f. Postoperative par-
cause this finding? Select all that apply. alytic ileus
a. Peritonitis
b. Prolonged bedrest Rationale: Absent bowel sounds may indicate peritonitis, paralytic
c. Diarrhea ileus, or prolonged bedrest. These conditions decrease or halt
d. Gastroenteritise. Early bowel obstruction bowel motility, leading to absent bowel sounds.
f. Postoperative paralytic ileus
The nurse is teaching a patient with a new ileostomy. Which Answer: a. "The stool from an ileostomy is typically liquid," d. "Eat
statement should the nurse include? Select all that apply. dark-green vegetables to control the odor of the stool," e. "You may
have a tendency to develop food blockages."
a. "The stool from an ileostomy is typically liquid.
"b. "The size of the stoma will stabilize within 2 weeks." Rationale: Ileostomies produce liquid stool due to the bypassing of
c. "Keep the skin around the stoma site clean and moist." the large intestine. Eating dark-green vegetables can help deodor-
d. "Eat dark-green vegetables to control the odor of the stool. ize stool. Patients with ileostomies are at risk of food blockages,
e. "You may have a tendency to develop food blockages." particularly from high-fiber foods.
A nurse is preparing a patient for a colonoscopy. Which action is
Answer: b. Having the patient take bisacodyl and ingest a gallon
part of the recommended preparation?
oral polyethylene glycol solution (PEG)
1/5
, Chapter 36 Bowel Elimination Nclex style questions with Rationales 2025
a. Having the patient consume a low-fiber diet several days before
the testb. Having the patient take bisacodyl and ingest a gallon oral Rationale: Bowel preparation for a colonoscopy typically includes
polyethylene glycol solution (PEG)c. Preparing the patient for the bisacodyl and PEG solution. General anesthesia is not typically
use of general anesthesia during the testd. Explaining that barium used for colonoscopies, and barium contrast is used for upper GI
contrast mixture will be given to drink before the test studies, not colonoscopies.
During digital stool removal, the patient feels dizzy and nauseous.
What is the nurse's next step?
Answer: c. Stopping the procedure, assessing vital signs, and
a. Reassuring the patient that this is a normal reaction to the notifying the health care provider
procedure
b. Stopping the procedure, preparing to administer CPR, and Rationale: These symptoms suggest vagus nerve stimulation,
notifying the primary care provider which can affect heart rate and blood pressure. The procedure
c. Stopping the procedure, assessing vital signs, and notifying the should be stopped immediately, and the nurse should assess the
health care provider patient's vital signs and inform the healthcare provider.
d. Pausing the procedure, waiting 5 minutes, and then resuming
the procedure
Which order should the nurse follow when scheduling diagnostic
tests for a patient with epigastric pain?
Answer: a. Fecal occult blood test, barium enema, upper GI series,
a. Fecal occult blood test, barium enema, upper GI series, endo-
endoscopic studies
scopic studies
b. Barium enema, fecal occult blood test, endoscopic studies,
Rationale: Noninvasive tests should be performed first, and inva-
upper GI series
sive tests like endoscopy should be performed last. A fecal occult
c. Fecal occult blood test, upper GI series, barium enema, endo-
blood test is usually the first step to identify GI bleeding.
scopic studies
d. Barium enema, upper GI series, fecal occult blood test, endo-
scopic studies
A nurse is caring for a patient with a nasogastric tube for gastric
Answer: b. Confirming tube placement with pH testing of gastric
decompression. Which action is most important when caring for
aspirate
this patient?
Rationale: It is critical to confirm the placement of the NG tube
a. Irrigating the tube with 30-mL normal saline solutionb. Confirm-
before administering any fluids or medications to avoid aspiration.
ing tube placement with pH testing of gastric aspiratec. Position-
pH testing of gastric aspirate is a common and effective method
ing the air vent at the level of the patient's umbilicusd. Instilling
for confirming placement.
irrigation via the blue air vent
The nurse is planning a bowel program for a patient with consti-
pation after a spinal cord injury. What is the first step? Answer: d. Assessing the patient's bowel patterns
a. Offering a diet that is low in residue Rationale: The first step in planning a bowel program is assessing
b. Increasing fluid intake to 3,000 mL daily the patient's bowel patterns to determine the most effective inter-
c. Administering daily enemas to stimulate peristalsis ventions based on the individual's condition.
d. Assessing the patient's bowel patterns
Which of the following is a common sign of colon cancer?
Answer: a. Blood in the stool, d. Unintentional weight loss
a. Blood in the stool
Rationale: Blood in the stool and unintentional weight loss are
b. Previous colonoscopy
c. Passing two large bowel movements daily hallmark signs of colon cancer. Other symptoms may include
changes in bowel habits and abdominal discomfort.
d. Unintentional weight loss
For a patient with a left-sided end colostomy in the sigmoid colon,
what is the most appropriate intervention? Answer: a. Irrigating the colostomy
a. Irrigating the colostomy Rationale: Colostomy irrigation is appropriate for patients with
b. Applying an ostomy appliance a left-sided colostomy in the sigmoid colon to regulate bowel
c. Managing the ostomy diet movements.
d. Administering medication
The nurse notes that a patient's stoma is protruding into the
Answer: c. Having the patient rest for 30 minutes to see if the
ostomy bag. What is the nurse's first action?
prolapse resolves
a. Reassuring the patient that this is a normal with a new ostomy
Rationale: Stoma prolapse may resolve with rest. If the stoma does
b. Notifying the health care provider that the stoma is prolapsed
2/5
