Chapter 32- Bowel Elimination Nursing School Test Banks

 

1.

In the nursing care plan for constipation, the nurse should have an intervention that addresses the number of grams of cellulose that are needed for normal bowel function. How many grams should be in the daily diet?

A)

2030 g

B)

4050 g

C)

6070 g

D)

>80g

Ans:

A

Feedback:

A person who consumes approximately 20 g to 30 g of dietary fiber from fruits, vegetables, and grains will most likely have sufficient bulk in the stools to allow for easy defecation.

2.

A patient reports constipation. Which of the following assessment questions should the nurse initially ask when completing the patients health history, including bowel habits?

A)

Do you have a daily bowel movement?

B)

How do you handle stress?

C)

Do you eat fiber foods every day?

D)

What medicines do you take?

Ans:

B

Feedback:

This represents a broad opening statement that allows for greater subjective information. Chronic exposure to stress can slow bowel activity, resulting in decreased frequency of bowel movements.

3.

The student nurse has completed a presentation to a group of senior citizens on colorectal screening. Which statement by a participant suggests a need for further education?

A)

I will need yearly screenings for colon cancer.

B)

I will have a fecal occult blood test done every 5 years.

C)

I will have a flexible endoscopic exam done every 5 years.

D)

My mother had colon cancer so I am at a greater risk for also developing colon cancer.

Ans:

B

Feedback:

Yearly screenings, including a fecal occult blood test, should be done on all patients over the age of 50. A flexible endoscopic exam should be done every 5 years. A family history of colorectal cancer increases the risk of developing colorectal cancer.

4.

A patient is complaining of increased flatulence. Which of the following may be a cause of his flatulence? Select all that apply.

A)

Carbonated beverages

B)

Caffeinated beverages

C)

Smoking

D)

Drinking straws

E)

Rapid ingestion of food

Ans:

A, C, D, E

Feedback:

Rapid ingestion of food, improper use of straws, smoking, and excessive carbonated beverages may all be causes of flatulence. Caffeinated beverages typically do not cause flatulence.

5.

A nurse is providing education to an elderly patient concerning ways to prevent constipation. Which diet choices would support that the education was successful? Select all that apply

A)

Hot tea with meals

B)

A turkey sandwich with whole-grain bread

C)

Prune juice with breakfast

D)

Ice cream with lunch and dinner

E)

Diet soda with lemon

Ans:

A, B, C

Feedback:

A glass of prune juice is equivalent to more than one serving of the dried fruit, has high magnesium content, and is an excellent source of fluid to promote bowel elimination. Hot fluids, such as coffee, tea, or hot water with lemon juice, may also increase intestinal motility. High fiber foods such as whole-grain bread provide bulk for the stool. Ice cream and diet soda do not provide any preventative measures for constipation.

6.

The student nurse is preparing a presentation on bowel elimination. Which of the following would be a potential cause of diarrhea that the student should include? Select all that apply.

A)

Opioids

B)

Antibiotics

C)

Acute stress

D)

Depression

E)

Increased physical activity

Ans:

B, C

Feedback:

Acute stress, anxiety, and antibiotic use can all cause diarrhea. Opioid use and depression can cause constipation. Increased physical activity can increase peristalsis but this does not necessarily cause diarrhea.

7.

The nurse is assisting an elderly patient into position for a sigmoidoscopy. Which position would the nurse place the patient in?

A)

Right lateral

B)

Left lateral

C)

Prone

D)

Semi-Fowlers

Ans:

B

Feedback:

The left lateral or knee to chest position is the most common position for sigmoidoscopies or colonoscopies. If the patient is not able to tolerate this position, Sims position may also be used. The right lateral, prone or semi-Fowlers positions are not routinely used for this procedure.

8.

The student nurse is administering a large-volume enema to a patient. The patient complains of abdominal cramping. What should the student nurse do first?

A)

Increase the flow of the enema for approximately 30 seconds then decrease it to the prior flow rate.

B)

Stop the administration of the enema and notify the physician.

C)

Stop the administration of the enema momentarily .

D)

Increase the flow of the enema until all of the solution has been administered.

Ans:

C

Feedback:

If the patient complains of abdominal discomfort or cramping, the nurse should momentarily stop the flow of solution. Increasing the flow of the enema may cause more cramping and discomfort. Cramping and discomfort are common complaints during enema administration so there is no need to notify the physician.

9.

When caring for a patient with a new colostomy, which assessment finding would be considered abnormal and need to be reported to the physician?

A)

The stoma is pink.

B)

The stoma has a small amount of bleeding.

C)

The stoma is prolapsed.

D)

The stoma is on the abdominal surface.

Ans:

C

Feedback:

The stoma should be pink and remain on the abdominal surface. The mucosal tissue is fragile, so a small amount of bleeding may be normal. If the stoma is found to be prolapsed, the surgeon must be notified immediately.

10.

An elderly woman who is incontinent of stool following a cerebrovascular accident will have the following nursing diagnosis

A)

Bowel incontinence related to loss of sphincter control as evidenced by inability to delay the urge to defecate

B)

Diarrhea related to tube feedings as evidenced by hyperactive bowel sounds and urgency

C)

Constipation related to physiologic condition involving the deficit in neurologic innervation as evidenced by fecal incontinence

D)

Fecal retention related to loss of sphincter control and diminished spinal cord innervation related to hemiparesis

Ans:

A

Feedback:

The most appropriate nursing diagnosis addresses the patients fecal incontinence related to loss of sphincter control innervation.

11.

When the nurse performs a Hemoccult test on a stool specimen, blood in the stool will change the color on the test paper to

A)

Blue

B)

Brown

C)

Green

D)

Red

Ans:

A

Feedback:

Blue is a positive diagnostic finding, indicating the presence of blood in the stool sample.

12.

A patient has had abdominal surgery and in 72 hours develops abdominal distention and absence of bowel sounds with pain. The nurse suspects the patient has

A)

A wound infection

B)

Need of greater pain relief

C)

Increased activity

D)

Paralytic ileus

Ans:

D

Feedback:

An obstruction that blocks the passage of flatus and intestinal chime or feces is a primary cause of abdominal distention. Paralytic ileus and abdominal tumors are types of bowel obstruction that produce distention.

13.

You are educating a new colostomy patient on gas-producing foods. Which of the following are gas-producing foods the patient may choose to avoid?

A)

Lettuce

B)

Rice

C)

Brussels sprouts

D)

Green peppers

Ans:

C

Feedback:

Certain foods (e.g., cabbage, onions, legumes) often increase the amount of flatus produced in the intestine.

14.

The proliferation of Clostridium difficile causes

A)

Antibiotic-associated diarrhea

B)

Escherichia coli diarrhea

C)

Urinary Clostridium infection

D)

Anal yeast infection

Ans:

A

Feedback:

Normal intestinal flora inhibit the growth of Clostridium difficile. When broad-spectrum antibiotics, especially third-generation cephalosporins, are administered, normal flora is altered and C. difficile can proliferate and release toxins that cause antibiotic-associated diarrhea.

15.

An elderly patient who is wheelchair bound following a cerebrovascular accident is being assessed by the nurse. The nurse notes the patient has seepage of stool from the anus. The nurse knows this is indicative of

A)

Constipation

B)

Diarrhea

C)

Fecal impaction

D)

Intestinal infection

Ans:

C

Feedback:

Suspect a fecal impaction when there is a history of absence of a regular bowel movement for several days (35 days or more) followed by the passage of liquid or semi-liquid stool.

16.

Which of the following diversions is considered a continent ostomy?

A)

Colostomy

B)

Ileostomy

C)

Ileoconduit

D)

Ileoanal

Ans:

D

Feedback:

A continent fecal diversion is the ileoanal diversion. With this type of diversion, feces can be drained at the patients convenience rather than having it continually draining into an external pouch, as occurs in the traditional ileostomy or colostomy.

17.

The type of stool that will be expelled into the ostomy bag by a patient who has undergone surgery for an ileostomy will be

A)

Bloody

B)

Mucus filled

C)

Soft semi-formed

D)

Liquid consistency

Ans:

D

Feedback:

Stool produced from an ileostomy is liquid and contains large quantities of electrolytes.

18.

A patient has completed an upper gastrointestinal x-ray, small bowel series, and lower gastrointestinal x-ray. Following these x-rays, the nurse will need to administer

A)

A low-residue diet

B)

An antibiotic

C)

A laxative

D)

High-fiber diet

Ans:

C

Feedback:

Barium is ingested during these exams. Barium can cause constipation. Therefore, laxatives are commonly ordered after the diagnostic test to facilitate barium removal.

19.

Which of the following symptoms is a known side effect of antibiotics?

A)

Diarrhea

B)

Constipation

C)

Fecal impaction

D)

Abdominal bloating

Ans:

A

Feedback:

A side effect of taking antibiotics is diarrhea. Constipation, fecal impaction and abdominal bloating are not common side effects of antibiotics.

20.

Which of the following medications causes constipation?

A)

Magnesium antacids

B)

Dulcolax

C)

Aspirin

D)

Iron supplements

Ans:

D

Feedback:

A common side effect of iron supplements is constipation. Dulcolax is a stool softener. Aspirin is an analgesic that does not typically cause constipation. Magnesium antacids help to decrease heartburn and do not typically cause constipation.

21.

The nurse needs to assess the patients elimination patterns. Which of the following patients will most likely deny the urge to defecate?

A)

Patient with anxiety and depression

B)

Patient who consumes >30 g of fiber

C)

Patient who has a colostomy

D)

Patient 3 days post-vaginal delivery

Ans:

D

Feedback:

People who experience pain during defecation may choose to deny the urge to defecate, which can lead to constipation. The patient with anxiety and depression typically does not have pain upon defecation. The patient with a colostomy will also typically not have pain upon defecation. The patient consuming >30 g of fiber will typically not be constipated.

22.

Ignoring the urge to defecate on a continual basis leads to

A)

Sudden increase in stool with mucus

B)

Constipation and hard stool

C)

Need to increase milk intake

D)

Total loss of bowel control

Ans:

B

Feedback:

The longer feces remain in the large intestine, the more water is absorbed; the result is harder, drier stool.

23.

A young woman has just consumed a serving of ice cream pie and develops severe cramping and diarrhea. The school nurse suspects the woman is

A)

Allergic to sugar

B)

Lactose intolerant

C)

Experiencing infectious diarrhea

D)

Deficit in fiber

Ans:

B

Feedback:

Many people have difficulty digesting lactose (the sugar contained in milk products). The breakdown of lactose into its component sugars, glucose and galactose, requires a sufficient quantity of the enzyme lactase in the small intestine. If a person is lactose-deficient, alterations of bowel elimination, including formation of gas, abdominal cramping, and diarrhea, can occur after ingestion of milk products.

24.

When educating an elderly patient on the prevention of constipation, the nurse should provide which of the following educational interventions?

A)

Drink three glasses of milk per day

B)

Eat six servings of bread or pasta

C)

Consume antacids to decrease reflux

D)

Increase intake of fresh vegetables

Ans:

D

Feedback:

Educate older persons to recognize that decreased frequency of bowel movements is usually a normal result of aging. Nurses should encourage a change in dietary habits to increase the amount of fluids and high-fiber foods in the diet and to increase activity to prevent constipation.

25.

Which of the following factors is related to developmental changes in bowel habits for elderly patients?

A)

Increase in dietary fiber can decrease peristalsis

B)

Milk products cause constipation in lactose intolerance patients

C)

Weakened pelvic muscles lead to constipation

D)

The elderly should peel fruits before eating

Ans:

C

Feedback:

Weakened pelvic muscles and decreased activity levels contribute to constipation in older adults. Increasing dietary fiber does not decrease peristalsis. Lactose intolerance is not a developmental change in the elderly. Peeling fruit does not impact bowel habits in the elderly.

26.

In a toddler, a good indication of spinal cord maturation and ultimate bowel control is

A)

Use of the flexor and extensor

B)

The ability to walk

C)

Parallel play

D)

Recognition of peristalsis

Ans:

B

Feedback:

Myelinization of the sacral spinal cord segments, which control the anus, becomes complete between 12 and 18 months. When this occurs, toddlers can recognize that stool is present in the rectum. A good indicator of spinal cord maturation is the ability to walk independently.

27.

The postpartum nurse is instructing a new mother that her infant will pass meconium for

A)

1 day

B)

2 days

C)

3 days

D)

4 days

Ans:

C

Feedback:

By the 3rd day after birth, the stools characteristics begin to reflect the type of milk in the diet.

28.

When educating a breast-feeding mother on the characteristics of the stool of her newborn, the nurse should inform her that the stool will be

A)

Dark yellow

B)

Bright yellow

C)

Beige

D)

Brown

Ans:

B

Feedback:

If newborns are fed breast milk, the stools will be bright yellow, soft, and unformed with an unobjectionable odor.

29.

What is meconium?

A)

Semi-digested food

B)

Soft brown stool

C)

Secreted liquid mucus

D)

Dry intestinal secretions

Ans:

D

Feedback:

Meconium is the partially dried intestinal secretions that accumulate in the large intestine before birth.

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