Chapter 40- Bowel Elimination
Question 1 of 23
The nurse is caring for a patient who periodically has small streaks of fresh red blood in the stool. The patient denies abdominal pain
or loss of appetite. The nurse identifies what to be the most likely cause of this patient’s bleeding?
Perforated colon
Hemorrhoids
Bleeding gastric ulcer
Colon polyps
Bleeding hemorrhoids can lead to small streaks of fresh red blood in the stool. Bleeding gastric ulcer would lead to black, tarry stools
as the blood is digested. Colon polyps do not cause bleeding.
Question 2 of 23
The nurse is caring for a patient who has diarrhea and identifies which priority nursing diagnosis for this patient?
Lack of knowledge related to prescribed diet modifications.
Anxiety related to incontinence with loose stools and need for clothing change.
Impaired nutritional intake related to poor appetite.
Diarrhea related to excessive loss of fluid through stool.
Dehydration is the priority nursing problem for this patient, so diarrhea is the most important nursing diagnosis. Impaired nutritional
intake, lack of knowledge, and anxiety can be addressed once fluid balance is restored.
Question 3 of 23
The nurse is caring for a patient who is prescribed diphenoxylate-atropine (Lomotil). Which assessment finding by the nurse
indicates a need to contact the prescriber and question the order?
The patient is constipated with last BM 3 days ago.
The patient is on a low-fiber, gluten-free diet.
The patient has skin breakdown from loose stools.
The patient has painful bleeding hemorrhoids.
Diphenoxylate-atropine is an antidiarrheal medication. It should not be given to patients who are constipated until the patient is
checked for impaction. The other assessment findings are not contraindications.
Question 4 of 23
The nurse is caring for an immobile patient who has abdominal pain and frequent small, liquid stools. The patient vomited his
breakfast and is still nauseated. Which action by the nurse is the highest priority?
Check the patient for a fecal impaction.
Apply a skin barrier to the patient’s perineal area.
Administer antiemetic medication with a sip of water.
Provide oral care after each episode of emesis.
The patient who has abdominal pain and frequent small liquid stools should be checked for fecal impaction, especially since the
patient is vomiting. Immobility is a risk factor for the development of fecal impaction. The other actions can be performed once fecal
impaction is ruled out.
Question 5 of 23
The nurse is caring for a patient who is recovering from bowel surgery. Which assessment finding best indicates that the bowel is
starting to resume function and the patient will be able to resume oral intake soon?
, The patient has bowel sounds × 4 quadrants and is passing gas.
The patient’s nasogastric tube was discontinued the previous day.
The patient feels hungry for chicken soup and hot tea.
The patient has no nausea, and abdominal pain is minimal.
The presence of bowel sounds and passage of flatus indicate that the patient’s bowels are starting to resume function and the patient
will be able to resume oral intake soon. Hunger, discontinuation of the NG tube, or absence of nausea are not definite indicators of
readiness to resume oral feedings.
Question 6 of 23
The nurse is caring for a patient who has an ileostomy. Which nursing diagnosis has the highest priority for the patient?
Lack of knowledge r/t care and maintenance of ostomy appliance.
Social isolation r/t potential leakage of stool from ostomy appliance.
Impaired skin integrity r/t localized skin irritation from liquid stool.
Disturbed body image r/t presence of stoma and altered elimination.
The highest priority nursing diagnosis for this patient is impaired skin integrity because stools from an ileostomy are frequent and
liquid and cannot be regulated. Drainage contains digestive enzymes, which can be damaging to the skin; therefore patients with
ileostomies wear an appliance continuously and take special precautions to prevent skin breakdown. In addition, ostomy appliances do
not adhere well to open wounds, increasing the risk for continuing skin break down. The other nursing diagnoses are appropriate for
this patient but are not the highest priority.
Question 7 of 23
The nurse is caring for a patient who is taking narcotic pain medication after surgery. Which breakfast choices will help prevent
constipation and promote return to regular bowel function?
Omelet with cheddar cheese, green pepper, and onions.
Pancakes with maple syrup, bacon, and coffee with cream.
Bagel with cream cheese, and strawberry nonfat yogurt.
Raisin bran with skim milk, fresh fruit, and wheat toast.
The postoperative patient taking narcotic pain medications is at risk for developing constipation. A high-fiber diet with plenty of
liquids will help prevent this from occurring. Raisin bran, fruit, and wheat bread are all good sources of fiber.
Question 8 of 23
The nurse is caring for a patient who has not had a bowel movement for 2 days. Which is the priority nursing intervention for this
patient?
Discontinue medications that can cause constipation.
Obtain an order to administer a soap suds cleansing enema.
Teach the patient how to use the Valsalva maneuver.
Assess the patient’s usual pattern of bowel movements.
Frequency and amount of defecation will vary and differs from person to person, ranging from two or three times per week to several
times per day. The nurse should assess the patient’s usual pattern of bowel movements to determine if it is normal for the patient to
have a bowel movement every 2 to 3 days. Patients should be taught not to use the Valsalva maneuver because it can lead to
bradycardia or death. Medications are not independently discontinued by the nurse and this would require a conversation with the
provider.
Question 9 of 23
The nurse is caring for a patient who will be undergoing upper GI series testing the next day. Which instruction will the nurse provide
to the patient about the upcoming exam?
“You will need to have a clear liquid diet and take a laxative tonight.”
Question 1 of 23
The nurse is caring for a patient who periodically has small streaks of fresh red blood in the stool. The patient denies abdominal pain
or loss of appetite. The nurse identifies what to be the most likely cause of this patient’s bleeding?
Perforated colon
Hemorrhoids
Bleeding gastric ulcer
Colon polyps
Bleeding hemorrhoids can lead to small streaks of fresh red blood in the stool. Bleeding gastric ulcer would lead to black, tarry stools
as the blood is digested. Colon polyps do not cause bleeding.
Question 2 of 23
The nurse is caring for a patient who has diarrhea and identifies which priority nursing diagnosis for this patient?
Lack of knowledge related to prescribed diet modifications.
Anxiety related to incontinence with loose stools and need for clothing change.
Impaired nutritional intake related to poor appetite.
Diarrhea related to excessive loss of fluid through stool.
Dehydration is the priority nursing problem for this patient, so diarrhea is the most important nursing diagnosis. Impaired nutritional
intake, lack of knowledge, and anxiety can be addressed once fluid balance is restored.
Question 3 of 23
The nurse is caring for a patient who is prescribed diphenoxylate-atropine (Lomotil). Which assessment finding by the nurse
indicates a need to contact the prescriber and question the order?
The patient is constipated with last BM 3 days ago.
The patient is on a low-fiber, gluten-free diet.
The patient has skin breakdown from loose stools.
The patient has painful bleeding hemorrhoids.
Diphenoxylate-atropine is an antidiarrheal medication. It should not be given to patients who are constipated until the patient is
checked for impaction. The other assessment findings are not contraindications.
Question 4 of 23
The nurse is caring for an immobile patient who has abdominal pain and frequent small, liquid stools. The patient vomited his
breakfast and is still nauseated. Which action by the nurse is the highest priority?
Check the patient for a fecal impaction.
Apply a skin barrier to the patient’s perineal area.
Administer antiemetic medication with a sip of water.
Provide oral care after each episode of emesis.
The patient who has abdominal pain and frequent small liquid stools should be checked for fecal impaction, especially since the
patient is vomiting. Immobility is a risk factor for the development of fecal impaction. The other actions can be performed once fecal
impaction is ruled out.
Question 5 of 23
The nurse is caring for a patient who is recovering from bowel surgery. Which assessment finding best indicates that the bowel is
starting to resume function and the patient will be able to resume oral intake soon?
, The patient has bowel sounds × 4 quadrants and is passing gas.
The patient’s nasogastric tube was discontinued the previous day.
The patient feels hungry for chicken soup and hot tea.
The patient has no nausea, and abdominal pain is minimal.
The presence of bowel sounds and passage of flatus indicate that the patient’s bowels are starting to resume function and the patient
will be able to resume oral intake soon. Hunger, discontinuation of the NG tube, or absence of nausea are not definite indicators of
readiness to resume oral feedings.
Question 6 of 23
The nurse is caring for a patient who has an ileostomy. Which nursing diagnosis has the highest priority for the patient?
Lack of knowledge r/t care and maintenance of ostomy appliance.
Social isolation r/t potential leakage of stool from ostomy appliance.
Impaired skin integrity r/t localized skin irritation from liquid stool.
Disturbed body image r/t presence of stoma and altered elimination.
The highest priority nursing diagnosis for this patient is impaired skin integrity because stools from an ileostomy are frequent and
liquid and cannot be regulated. Drainage contains digestive enzymes, which can be damaging to the skin; therefore patients with
ileostomies wear an appliance continuously and take special precautions to prevent skin breakdown. In addition, ostomy appliances do
not adhere well to open wounds, increasing the risk for continuing skin break down. The other nursing diagnoses are appropriate for
this patient but are not the highest priority.
Question 7 of 23
The nurse is caring for a patient who is taking narcotic pain medication after surgery. Which breakfast choices will help prevent
constipation and promote return to regular bowel function?
Omelet with cheddar cheese, green pepper, and onions.
Pancakes with maple syrup, bacon, and coffee with cream.
Bagel with cream cheese, and strawberry nonfat yogurt.
Raisin bran with skim milk, fresh fruit, and wheat toast.
The postoperative patient taking narcotic pain medications is at risk for developing constipation. A high-fiber diet with plenty of
liquids will help prevent this from occurring. Raisin bran, fruit, and wheat bread are all good sources of fiber.
Question 8 of 23
The nurse is caring for a patient who has not had a bowel movement for 2 days. Which is the priority nursing intervention for this
patient?
Discontinue medications that can cause constipation.
Obtain an order to administer a soap suds cleansing enema.
Teach the patient how to use the Valsalva maneuver.
Assess the patient’s usual pattern of bowel movements.
Frequency and amount of defecation will vary and differs from person to person, ranging from two or three times per week to several
times per day. The nurse should assess the patient’s usual pattern of bowel movements to determine if it is normal for the patient to
have a bowel movement every 2 to 3 days. Patients should be taught not to use the Valsalva maneuver because it can lead to
bradycardia or death. Medications are not independently discontinued by the nurse and this would require a conversation with the
provider.
Question 9 of 23
The nurse is caring for a patient who will be undergoing upper GI series testing the next day. Which instruction will the nurse provide
to the patient about the upcoming exam?
“You will need to have a clear liquid diet and take a laxative tonight.”
