Chapter 40: Lower Digestive Tract Disorders Nursing School Test Banks

Chapter 40: Lower Digestive Tract Disorders
Linton: Introduction to Medical-Surgical Nursing, 6th Edition

MULTIPLE CHOICE

1. What is the most current endoscopic procedure for examining the small intestine?
a. Capsule camera
b. Fiberoptic light probe
c. Rigid lighted tubes
d. Flat plate
ANS: A
The capsule camera is swallowed and transmits information about the small bowel to a receiver on a belt around the patients waist.

DIF: Cognitive Level: Knowledge REF: p. 823 OBJ: 1
TOP: Endoscopy KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. Which instruction given to a patient with irritable bowel syndrome (IBS) should lessen discomfort?
a. Eat only whole grains.
b. Take small bites and chew well.
c. Include dietary fiber in at least two meals per day.
d. Drink herbal teas and low-calorie cola drinks.
ANS: B
Taking small bites, chewing food well, and eating slowly will reduce some of the discomfort associated with IBS. Caffeine and high-fiber foods should be avoided.

DIF: Cognitive Level: Comprehension REF: p. 839 OBJ: 3 | 4
TOP: IBS KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

3. A nurse has collected several stool specimens for ova and parasites that are to be sent to the laboratory. What action is most appropriate for the nurse to implement?
a. Immediately take the specimens to the laboratory to be tested for parasites and ova.
b. Take the specimens to the laboratory to be tested for culture and sensitivity and leave them for later pickup.
c. Take the specimens to the refrigerator to be tested later for parasites and ova.
d. Leave the specimens in a warm place until convenient time to deliver to the laboratory.
ANS: A
Parasite and ova specimens should be immediately taken to the laboratory while the parasites are still alive. Specimens for evaluating pathogenic organisms should be kept cool.

DIF: Cognitive Level: Application REF: p. 823 OBJ: 1
TOP: Care of Stool Specimens KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

4. A nurse is caring for a 34-year-old patient admitted with severe diarrhea that has been going on for 2 weeks. What assessment should the nurse anticipate?
a. Edema of lower legs and feet
b. Hypotension and fatigue
c. Hypertension and hunger
d. Metabolic alkalosis
ANS: B
Diarrhea of long-standing duration will cause dehydration and fatigue with accompanying hypotension. The patient will most likely be in metabolic acidosis as a result of the loss of the essentially basic bowel contents.

DIF: Cognitive Level: Application REF: p. 829 OBJ: 3
TOP: Diarrhea KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. Stool softeners are prescribed to promote normal elimination of feces. What is the most appropriate way to ensure effectiveness of this type of drug?
a. Mouth care
b. Ambulation
c. Adequate fluid intake
d. High-fiber diet
ANS: C
Adequate fluids must be maintained to ensure the liquid is available; otherwise, the fecal mass will remain hard.

DIF: Cognitive Level: Comprehension REF: p. 831 OBJ: 3
TOP: Constipation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

6. Which set of findings best indicates that a patient with intestinal obstruction has achieved normal hydration?
a. Pulse and blood pressure are within the patients norms, mucous membranes are moist, and fluid intake and output are equal.
b. Pulse rate is strong (at least 60 beats/min), bowel sounds are normal, and a respiratory rate of 22 breaths/min is recorded.
c. Blood pressure is within the patients norm, the temperature is below normal, and adequate tissue turgor is observed.
d. Mucous membranes are moist, the 24-hour fluid intake is higher than the 24-hour output, and the pulse rate is elevated.
ANS: A
Vital sign within normal limits, moist mucous membranes, and equal fluid intake and output are indicative of normal hydration.

DIF: Cognitive Level: Comprehension REF: p. 833 OBJ: 4
TOP: Hydration KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. After abdominal surgery, a patient must cough and take deep breaths. How can the nurse best achieve this with this patient?
a. Withhold analgesics until the patient performs this task.
b. Help the patient splint the incision with a pillow.
c. Explain that pneumonia occurs if deep breathing is not carried out every 4 hours.
d. Ambulate the patient 40 feet to increase his need for oxygen.
ANS: B
Splinting decreases pain by supporting the muscles, thereby allowing for better lung expansion.

DIF: Cognitive Level: Application REF: p. 834 OBJ: 3 | 4
TOP: Abdominal Surgery KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

8. A nurse describes a patient as morbidly obese because the patient has a weight of 387 lb and a height of 2 meters. What is the patients body mass index (BMI)?
a. 58.4
b. 52.8
c. 43.9
d. 31.6
ANS: C
Body mass index is calculated by dividing the weight in kilograms by the height in meters squared. Anyone weighing more than 30 kg is considered obese; 387 lb 2.2 lb/kg = 176 kg; 176 kg 4 m = BMI of 43.9.

DIF: Cognitive Level: Analysis REF: p. 825 OBJ: 4
TOP: Inguinal Hernia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

9. Which statement by a patient with an ileostomy as a remedy for ulcerative colitis indicates the need for further teaching?
a. I will avoid milk products.
b. I should select food with less dietary fiber.
c. Ill miss my martini before dinner.
d. I will be glad when the surgeon closes this ileostomy.
ANS: D
The ileostomy is permanent. The diet of a person prone to ulcerative colitis is low roughage, no milk products, and no alcohol.

DIF: Cognitive Level: Comprehension REF: p. 838 OBJ: 4
TOP: Inflammatory Bowel Disease KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

10. A nurse identifies a risk factor in an older man that places him at risk for developing diverticulosis. What patient information indicates such a risk factor?
a. Eats a low-fiber diet
b. Chronic diarrhea
c. History of using nonsteroidal antiinflammatory drugs (NSAIDs)
d. Family history of colon cancer
ANS: A
A low-fiber diet increases the risk for diverticulitis.

DIF: Cognitive Level: Comprehension REF: p. 841 OBJ: 4
TOP: Diverticulitis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

11. Which foods should an individual with diverticulosis avoid?
a. Peanuts and raspberries
b. Apples and pears
c. Red meat and dairy products
d. Bran and whole grains
ANS: A
Foods containing seeds or small hard particles could become lodged in small pouches.

DIF: Cognitive Level: Application REF: p. 841 OBJ: 3 | 4
TOP: Diverticulosis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

12. Colonoscopy results indicate the diagnosis of irritable bowel disease (IBD) in a patient admitted to the hospital with diarrhea. What information should the nurse include when preparing patient education regarding diet?
a. Dairy products are encouraged.
b. No added salt is required.
c. Low roughage should be followed.
d. Protein foods are restricted.
ANS: C
A low-roughage diet without milk products is prescribed for mild to moderate IBD.

DIF: Cognitive Level: Comprehension REF: p. 838 OBJ: 3 | 4
TOP: IBD KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

13. A nurse is caring for a patient diagnosed with diverticulosis and assesses a temperature of 102.4 F and abdominal rigidity. What should the nurse be aware is the most likely cause of these signs and symptoms?
a. Infection
b. Constipation
c. Perforation
d. Obstruction
ANS: C
The nurse caring for a patient diagnosed with diverticulosis should be alert for signs of perforation including fever, abdominal distention, and rigidity.

DIF: Cognitive Level: Application REF: p. 841 OBJ: 3 | 4
TOP: Diverticulosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

14. A patient is diagnosed with cancer of the large intestine. What is the most likely initial recommended medical intervention?
a. Repeat colonoscopy
b. Surgery
c. Radiation therapy
d. Chemotherapy
ANS: B
Colorectal cancers are usually initially treated surgically.

DIF: Cognitive Level: Knowledge REF: p. 842 OBJ: 3 | 4
TOP: Colorectal Cancer KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

15. A nurse is performing an assessment of a patient after an abdominoperineal resection. How many incision sites will be present?
a. Two
b. Three
c. Four
d. Five
ANS: B
After an abdominoperineal resection, the patient will have three incisions: one on the abdomen, a second for the colostomy, and a third on the perineum.

DIF: Cognitive Level: Knowledge REF: p. 842 OBJ: 3 | 4
TOP: Abdominoperineal resection KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

16. A patient reports severe pain after an abdominoperineal resection. What position should the nurse assist this patient into in order to promote comfort?
a. Side-lying
b. Supine
c. Prone
d. Semi-Fowler
ANS: A
Pain is severe for several days after an abdominoperineal resection. At first, the patient will be most comfortable in a side-lying position.

DIF: Cognitive Level: Application REF: p. 842 OBJ: 3 | 4
TOP: Abdominoperineal resection KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

17. A nurse provides education to a patient after a hemorrhoidectomy. Which statement by the patient demonstrates the need for further instruction?
a. Sitz baths are ordered to soothe the area.
b. Imagery may help control pain.
c. Bleeding should be reported.
d. Fluids are restricted.
ANS: D
After hemorrhoidectomy, the patient should be encouraged to ingest a high-fiber diet and drink plenty of fluids to promote regular, soft stools.

DIF: Cognitive Level: Comprehension REF: p. 844 OBJ: 3 | 4
TOP: Hemorrhoidectomy KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

18. A nurse notes a diagnosis of pilonidal cyst on a patients admission assessment. What anatomical location should the nurse expect to assess this cyst?
a. Rectum
b. Sacrococcygeal area
c. Abdomen
d. Anus
ANS: B
A pilonidal cyst is located in the sacrococcygeal area.

DIF: Cognitive Level: Knowledge REF: p. 845 OBJ: 3
TOP: Pilonidal Cyst KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

19. A patient is being seen for the first time at a physicians office. When assisting with the assessment, a nurse notices abdominal striae. What alternative term should the nurse use when the patient asks what it is all over her abdomen?
a. Scarring
b. Lesions
c. Rashes
d. Stretch marks
ANS: D
Striae is the medical term for stretch marks.

DIF: Cognitive Level: Knowledge REF: p. 822 OBJ: 3
TOP: Inspection KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

MULTIPLE RESPONSE

20. A home health nurse is instructing an older adult patient regarding dietary changes to help prevent constipation. What changes should the nurse indicate when providing this education? (Select all that apply.)
a. Addition of whole-grain cereal
b. Cessation of laxative use
c. Increase in liquid intake
d. Increase in sugar intake
e. Eating fresh vegetables
ANS: A, B, C, E
A decrease in sugar intake will help stem diarrhea.

DIF: Cognitive Level: Comprehension REF: p. 831 OBJ: 3 | 4
TOP: Nutrition to Avoid Constipation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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