Chapter 30. Bowel Elimination and Care
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. The day after surgery, a patient asks a nurse, “Why do the nurses keep
listening to my abdomen? That’s not where I had surgery.” Which of the
following responses best answers the patient’s question?
1. “General anesthesia puts everything
to sleep, including the bowel, so it is
important to determine when bowel
sounds have returned. When your
bowel sounds return, your surgeon
will allow you to begin to eat and
drink.”
2. “Listening to your bowel sounds is
just part of the physical assessment,
so it’s nothing you need to worry
about. It will only take me a few
minutes to listen; then I’ll let you
rest.”
3. “We listen so we can let your
surgeon know your gastrointestinal
system wasn’t damaged by the
anesthesia.”
4. “Your surgeon has written orders to
assess your abdomen every 4 hours.
I’m sorry if it worries you, but I must
do my job.”
2. Following diagnostic tests of the gastrointestinal (GI) system, a patient with
chronic constipation asks the nurse, “What is peristalsis, and why it is
important?” The nurse explains:
1. “Peristalsis works against gravity to
swiftly propel food through the GI
tract to decrease problems with
constipation.”
2. “Peristalsis releases enzymes that
break food down and aids in the
propulsion of food through the GI
tract. These enzymes work hard to
prevent constipation.”
3. “Peristalsis is the contraction of
circular and longitudinal muscles
that propels food through the GI
tract. If peristalsis slows, it can
cause problems with constipation.”
4. “Peristalsis is stimulated by a food
bolus, which results in the
, contraction of the pyloric sphincter
to help keep food down. If unable to
keep food down, constipation can be
the result.”
3. A 68-year-old male has been admitted to the hospital for nutritional
deficiencies. Approximately 6 months ago, he had part of his duodenum
surgically removed following a bowel obstruction. The nurse understands that
the patient’s nutritional deficiencies are occurring because
1. His diet is low in minerals and
vitamins.
2. Enzymes produced in the duodenum
are not available.
3. Removal of the duodenum made the
colon too short for proper
absorption.
4. His ability to absorb nutrients is
decreased.
4. During an admission physical assessment, a nurse questions a patient about
bowel elimination habits. The nurse’s goal is
1. To assess the need for a laxative.
2. To maintain the patient’s normal
elimination habit.
3. To collect all pertinent patient data.
4. To determine whether further
gastrointestinal testing is necessary.
5. A patient states, “Sometimes I have trouble with constipation and have to
take a laxative.” Discussing ways to help avoid constipation, the nurse
replies, “Because an individual commonly gets the urge to have a bowel
movement about 30 minutes after eating, it is important to
1. Not ignore the defecation reflex.”
2. Not skip meals when having a bowel
movement.”
3. Decrease fluids when you increase
the amount of fiber in your meal.”
4. Notify your physician if you do not
experience that urge after every
meal.”
6. In response to a nurse’s question about bowel elimination habits, a patient
says, “Sometimes my bowel movements are greenish black. Is that normal?”
The nurse replies:
1. “Large amounts of dairy products
can cause your stools to turn
green.”
2. “If you take iron tablets, your stools
can become greenish black.”
3. “Typically our diet has very little to
, do with the color of our stools, so
tell your physician about it.”
4. “Eating green foods such as spinach
can cause your stools to have
greenish black streaks.”
7. After an initial assessment, a nurse documents that a patient, admitted for
abdominal pain, has hyperactive bowel sounds. As a result, the nurse could
expect the patient’s bowel movements to be
1. Hard and shaped in small balls.
2. Fluffy, with a tendency to float in
the toilet.
3. Ribbon-shaped and soft.
4. Liquid or semi-liquid.
8. A female patient has been admitted with ulcerative colitis. The nurse knows
that when the condition exacerbates, the patient’s stools will most likely
1. Be black, tarry, and odiferous.
2. Float, and be odorless and bloody.
3. Contain pus, mucus, and blood.
4. Be soft, but ribbon shaped.
9. After assisting a patient to the bathroom, a nurse notices that the patient’s
stool is clay colored. Upon questioning, the patient tells the nurse that this
has been a problem off and on for the last month or two. The nurse suspects
the patient
1. Is not eating a well-balanced diet.
2. May have gallstones or liver
problems.
3. Has a history of gastrointestinal (GI)
bleeding.
4. Is not drinking an adequate amount
of fluids.
10. When questioned on admission about bowel habits, a patient tells a nurse
that he frequently has loose stools three or four times a day and that his
warning is a feeling of urgency. The nurse most correctly document the
patient’s statement as:
1. “Has three to four liquid stools/day
accompanied by flatus.”
2. “Has multiple bouts of diarrhea and
cramping.”
3. “Has a few loose stools every day
with loss of continence.”
4. “Has three to four episodes of
tenesmus with watery stools per
day.”
11. A nurse educator explains to staff nurses that diarrhea can quickly become
life-threatening in elderly patients because
, 1. The elderly patient’s total body
water percentage increases, making
it easier to become dehydrated.
2. Their decreased ability to
concentrate on many daily functions
makes them forget to drink fluids,
particularly when they are ill.
3. Thirst is already diminished, and
their percentage of body water is
decreased, making them more
susceptible to dehydration.
4. Their decreased stature and weight
increases the likelihood that they
will become dehydrated.
12. While providing care for an elderly patient, a nurse learns that the patient has
had only small, watery stools for several days. The nurse understands that
the first priority in providing care for this patient is to
1. Assess the patient for an impaction.
2. Call the primary care physician and
get an order for a laxative.
3. Administer medication to slow the
diarrhea.
4. Collect a stool specimen for
analysis.
13. A patient’s admission assessment includes pertinent information about bowel
elimination. Which subjective information collected by the nurse will be
documented?
1. Distention of abdomen
2. Shape of abdomen
3. Abdominal cramping
4. Bowel sounds
14. A nurse suspects a patient is developing a bowel obstruction a few days
postoperatively. Auscultation of the abdomen finds
1. Low-pitched, hypoactive bowel
sounds in all quads.
2. Hypoactive bowel sounds in all four
quads.
3. Bowel sounds are high pitched and
hyperactive in right lower quad
(RLQ) and right upper quad (RUQ),
and hypoactive in left upper quad
(LUQ) and left lower quad (LLQ).
4. Bowel sounds are hypoactive in RUQ
and active in RLQ, LUQ, and LLQ.
15. A nurse teaches a patient on antibiotic therapy that to prevent an
opportunistic infection, he or she should
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. The day after surgery, a patient asks a nurse, “Why do the nurses keep
listening to my abdomen? That’s not where I had surgery.” Which of the
following responses best answers the patient’s question?
1. “General anesthesia puts everything
to sleep, including the bowel, so it is
important to determine when bowel
sounds have returned. When your
bowel sounds return, your surgeon
will allow you to begin to eat and
drink.”
2. “Listening to your bowel sounds is
just part of the physical assessment,
so it’s nothing you need to worry
about. It will only take me a few
minutes to listen; then I’ll let you
rest.”
3. “We listen so we can let your
surgeon know your gastrointestinal
system wasn’t damaged by the
anesthesia.”
4. “Your surgeon has written orders to
assess your abdomen every 4 hours.
I’m sorry if it worries you, but I must
do my job.”
2. Following diagnostic tests of the gastrointestinal (GI) system, a patient with
chronic constipation asks the nurse, “What is peristalsis, and why it is
important?” The nurse explains:
1. “Peristalsis works against gravity to
swiftly propel food through the GI
tract to decrease problems with
constipation.”
2. “Peristalsis releases enzymes that
break food down and aids in the
propulsion of food through the GI
tract. These enzymes work hard to
prevent constipation.”
3. “Peristalsis is the contraction of
circular and longitudinal muscles
that propels food through the GI
tract. If peristalsis slows, it can
cause problems with constipation.”
4. “Peristalsis is stimulated by a food
bolus, which results in the
, contraction of the pyloric sphincter
to help keep food down. If unable to
keep food down, constipation can be
the result.”
3. A 68-year-old male has been admitted to the hospital for nutritional
deficiencies. Approximately 6 months ago, he had part of his duodenum
surgically removed following a bowel obstruction. The nurse understands that
the patient’s nutritional deficiencies are occurring because
1. His diet is low in minerals and
vitamins.
2. Enzymes produced in the duodenum
are not available.
3. Removal of the duodenum made the
colon too short for proper
absorption.
4. His ability to absorb nutrients is
decreased.
4. During an admission physical assessment, a nurse questions a patient about
bowel elimination habits. The nurse’s goal is
1. To assess the need for a laxative.
2. To maintain the patient’s normal
elimination habit.
3. To collect all pertinent patient data.
4. To determine whether further
gastrointestinal testing is necessary.
5. A patient states, “Sometimes I have trouble with constipation and have to
take a laxative.” Discussing ways to help avoid constipation, the nurse
replies, “Because an individual commonly gets the urge to have a bowel
movement about 30 minutes after eating, it is important to
1. Not ignore the defecation reflex.”
2. Not skip meals when having a bowel
movement.”
3. Decrease fluids when you increase
the amount of fiber in your meal.”
4. Notify your physician if you do not
experience that urge after every
meal.”
6. In response to a nurse’s question about bowel elimination habits, a patient
says, “Sometimes my bowel movements are greenish black. Is that normal?”
The nurse replies:
1. “Large amounts of dairy products
can cause your stools to turn
green.”
2. “If you take iron tablets, your stools
can become greenish black.”
3. “Typically our diet has very little to
, do with the color of our stools, so
tell your physician about it.”
4. “Eating green foods such as spinach
can cause your stools to have
greenish black streaks.”
7. After an initial assessment, a nurse documents that a patient, admitted for
abdominal pain, has hyperactive bowel sounds. As a result, the nurse could
expect the patient’s bowel movements to be
1. Hard and shaped in small balls.
2. Fluffy, with a tendency to float in
the toilet.
3. Ribbon-shaped and soft.
4. Liquid or semi-liquid.
8. A female patient has been admitted with ulcerative colitis. The nurse knows
that when the condition exacerbates, the patient’s stools will most likely
1. Be black, tarry, and odiferous.
2. Float, and be odorless and bloody.
3. Contain pus, mucus, and blood.
4. Be soft, but ribbon shaped.
9. After assisting a patient to the bathroom, a nurse notices that the patient’s
stool is clay colored. Upon questioning, the patient tells the nurse that this
has been a problem off and on for the last month or two. The nurse suspects
the patient
1. Is not eating a well-balanced diet.
2. May have gallstones or liver
problems.
3. Has a history of gastrointestinal (GI)
bleeding.
4. Is not drinking an adequate amount
of fluids.
10. When questioned on admission about bowel habits, a patient tells a nurse
that he frequently has loose stools three or four times a day and that his
warning is a feeling of urgency. The nurse most correctly document the
patient’s statement as:
1. “Has three to four liquid stools/day
accompanied by flatus.”
2. “Has multiple bouts of diarrhea and
cramping.”
3. “Has a few loose stools every day
with loss of continence.”
4. “Has three to four episodes of
tenesmus with watery stools per
day.”
11. A nurse educator explains to staff nurses that diarrhea can quickly become
life-threatening in elderly patients because
, 1. The elderly patient’s total body
water percentage increases, making
it easier to become dehydrated.
2. Their decreased ability to
concentrate on many daily functions
makes them forget to drink fluids,
particularly when they are ill.
3. Thirst is already diminished, and
their percentage of body water is
decreased, making them more
susceptible to dehydration.
4. Their decreased stature and weight
increases the likelihood that they
will become dehydrated.
12. While providing care for an elderly patient, a nurse learns that the patient has
had only small, watery stools for several days. The nurse understands that
the first priority in providing care for this patient is to
1. Assess the patient for an impaction.
2. Call the primary care physician and
get an order for a laxative.
3. Administer medication to slow the
diarrhea.
4. Collect a stool specimen for
analysis.
13. A patient’s admission assessment includes pertinent information about bowel
elimination. Which subjective information collected by the nurse will be
documented?
1. Distention of abdomen
2. Shape of abdomen
3. Abdominal cramping
4. Bowel sounds
14. A nurse suspects a patient is developing a bowel obstruction a few days
postoperatively. Auscultation of the abdomen finds
1. Low-pitched, hypoactive bowel
sounds in all quads.
2. Hypoactive bowel sounds in all four
quads.
3. Bowel sounds are high pitched and
hyperactive in right lower quad
(RLQ) and right upper quad (RUQ),
and hypoactive in left upper quad
(LUQ) and left lower quad (LLQ).
4. Bowel sounds are hypoactive in RUQ
and active in RLQ, LUQ, and LLQ.
15. A nurse teaches a patient on antibiotic therapy that to prevent an
opportunistic infection, he or she should
