Chapter 45: Bowel Elimination Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 6th Edition

MULTIPLE CHOICE

1. The nurse recognizes that changes in elimination occur with the aging process. An expected change in bowel elimination is which of the following?

a.

Absorptive processes are increased in the intestinal mucosa.

b.

Esophageal emptying time is increased.

c.

Changes in nerve innervation and sensation cause diarrhea.

d.

Mastication processes are less efficient.

ANS: d

d. An expected change in bowel elimination is decreased chewing and decreased salivation, resulting in less efficient mastication.

a. Decreased nutrient absorption of the small intestine occurs in the older adult.

b. Esophageal emptying slows,as a result of reduced motility especially in the lower third, of the esophagus.

c. With decreased peristalsis and weakened musculature, the older adult is more prone to constipation. Duller nerve sensations may place the older adult at increased risk for fecal incontinence.

REF: Text Reference: p. 1377

2. A 6-month-old infant has severe diarrhea. The major problem associated with severe diarrhea is:

a.

Pain in the abdominal area

b.

Electrolyte and fluid loss

c.

Presence of excessive flatus

d.

Irritation of the perineal and rectal area

ANS: b

b. Excess loss of colonic fluid due to diarrhea can result in serious fluid and electrolyte or acid-base imbalances. Infants and older adults are particularly susceptible to associated complications.

a. Pain from abdominal cramping may occur with diarrhea, but it is not the major problem associated with severe diarrhea.

c. Excessive flatus is not the major problem associated with severe diarrhea.

d. Because repeated passage of diarrhea stools exposes the skin of the perineum and buttocks to irritating intestinal contents, meticulous skin care and containment of fecal drainage is needed to prevent skin breakdown. The greatest danger of severe diarrhea is a fluid and electrolyte or acid-base imbalance.

REF: Text Reference: p. 1379

3. The client is seen in the gastroenterology clinic after having experienced changes in his bowel elimination. A colonoscopy is ordered and the client has questions about the examination. Before the colonoscopy, the nurse teaches the client that:

a.

No special preparation is required

b.

Light sedation is normally used

c.

No metallic objects are allowed

d.

Swallowing of an opaque liquid is required

ANS: b

b. Light sedation is required for a colonoscopy.

a. Special preparation is required before a colonoscopy. Clear liquids are given the day before, and then some form of bowel cleanser, such as Golytely. Enemas until clear also may be ordered.

c. No restriction of metallic objects is made for a colonoscopy.

d. A colonoscopy does not require swallowing an opaque liquid.

REF: Text Reference: p. 1389

4. A client is to have a stool test for occult blood. The nurse is instructing the nursing assistant in the correct procedure for the test. The nursing assistant is correctly informed that:

a.

Sterile technique is used for collection

b.

Stool should be collected over a 3-day period

c.

The specimen should be kept warm

d.

A 1-inch sample of formed stool is needed

ANS: d

d. Tests performed by the laboratory for occult blood in the stool and stool cultures require only a small sample. The nurse collects about an inch of formed stool or 15 to 30 ml of liquid stool.

a. Clean technique is used for collection.

b. Tests for measuring the output of fecal fat require a 3- to 5-day collection of stool, not for testing for occult blood.

c. The specimen does not have to be kept warm for an occult blood test. Tests that measure for ova and parasites require the stool to be warm.

REF: Text Reference: p. 1386

5. A client has just had intestinal surgery with the creation of a colostomy. For the first few weeks, the nutritional therapy for this client will include:

a.

Vegetables

b.

Fresh fruit

c.

Whole-grain breads

d.

Poached eggs and rice

ANS: d

d. During the first weeks after surgery, many physicians recommend low-fiber diets, because the bowel requires time to adapt to the diversion. Low-fiber foods include bread, noodles, rice, cream cheese, eggs (not fried), strained fruit juices, lean meats, fish, and poultry. Poached eggs and rice would be appropriate for this client.

a. After the ostomy heals, the client is allowed to eat fruits and vegetables. High-fiber foods such as fresh fruits and vegetables help ensure a more-solid stool needed to achieve success at irrigation. Ostomy clients may benefit from avoiding foods that cause gas and odor, including broccoli, cauliflower, dried beans, and brussel sprouts.

b. After the ostomy heals, the client is allowed to eat fruits and vegetables. High-fiber foods such as fresh fruits and vegetables help ensure a more-solid stool needed to achieve success at irrigation.

c. Whole-grain breads are high in fiber and are not recommended until the ostomy has had time to heal.

REF: Text Reference: p. 1410

6. The client has been admitted to an acute care unit with a diagnosis of biliary disease. The nurse suspects that the feces will appear:

a.

Bloody

b.

Pus filled

c.

Black and tarry

d.

White or clay colored

ANS: d

d. Stool that is white or clay-colored indicates an absence of bile.

a. Bloody feces are not an indication of biliary disease.

b. Pus-filled feces indicate infection.

c. Black or tarry feces may indicate upper GI bleeding or iron ingestion.

REF: Text Reference: p. 1389

7. The client asks the nurse recommend bulk-forming foods that may be included in the diet. Which of the following should be recommended by the nurse?

a.

Whole grains

b.

Fruit juice

c.

Rare meats

d.

Milk products

ANS: a

a. Bulk-forming foods, such as grains, fruits, and vegetables, absorb fluids and increase stool mass.

b. Fruit juice is not a bulk-forming food.

c. Rare meats are not bulk-forming foods.

d. Milk products are not bulk-forming foods.

REF: Text Reference: p. 1377

8. The client is taking medications to promote defecation. Which of the following instructions should be included by the nurse in the teaching plan for this client?

a.

Increased laxative use often causes hyperkalemia.

b.

Salt tablets should be taken to increase the solute concentration of the extracellular fluid.

c.

Emollient solutions may increase the amount of water secreted into the bowel.

d.

Bulk-forming additives may turn the urine pink.

ANS: c

c. Emollient solutions are stool softeners that may increase the amount of water secreted into the bowel.

a. Laxative overuse can cause serious diarrhea that can lead to dehydration and hypokalemia.

b. Salt tablets should not be taken to increase the solute concentration of extracellular fluid.

d. Bulk-forming additives do not turn the urine pink. Phenolphthalein or danthron stimulant cathartics (e.g., Doxidan, Correctol, Ex-Lax) may cause pink or red urine.

REF: Text Reference: p. 1397

9. While undergoing a soapsuds enema, the client complains of abdominal cramping. The nurse should:

a.

Immediately stop the infusion

b.

Lower the height of the enema container

c.

Advance the enema tubing 2 to 3 inches

d.

Clamp the tubing

ANS: b

b. The nurse should lower the container if the client complains of abdominal cramping. Cramping may prevent the client from retaining all of the fluid, which would alter the effectiveness of the enema.

a. If the nurse stops the infusion, the client will not receive all of the fluid, and the enema will be less effective. The nurse may slow the infusion until the abdominal cramping passes.

c. The enema tubing should not be advanced farther.

d. The tubing may be clamped temporarily if fluid escapes around the rectal tube. The instillation should be slowed in the instance of abdominal cramping.

REF: Text Reference: p. 1401

10. The nurse is caring for clients on a postoperative unit in the medical center. The nurse is alert to the possibility that for 24 to 48 hours of the postoperative period, clients may experience the following as a result of the anesthetic used during the surgery:

a.

Colitis

b.

Stomatitis

c.

Paralytic ileus

d.

Gastrocolic reflex

ANS: c

c. Any surgery that involves direct manipulation of the bowel temporarily stops peristalsis. This condition, called paralytic ileus, usually lasts about 24 to 48 hours.

a. Colitis is inflammation of the colon. It is not a result of anesthetic used during surgery.

b. Stomatitis is inflammation of the mouth. It is not caused by anesthetic used during surgery.

d. The gastrocolic reflex is the peristaltic wave in the colon induced by entrance of food into the stomach. It is not a result of anesthetic used during surgery.

REF: Text Reference: p. 1378

11. For clients with hypocalcemia, the nurse should implement measures to prevent:

a.

Gastric upset

b.

Malabsorption

c.

Constipation

d.

Fluid secretion

ANS: c

c. Disorders of calcium metabolism contribute to difficulty with the passage of stools. The nurse should implement measures to prevent constipation in clients with hypocalcemia.

a. Hypocalcemia does not cause gastric upset.

b. Hypocalcemia does not cause malabsorption.

d. Hypocalcemia does not cause fluid secretion.

REF: Text Reference: p. 1376

12. The client is to receive a sodium polystyrene sulfonate (Kayexelate) enema. The nurse recognizes that this is used to:

a.

Prevent further constipation

b.

Remove excess potassium from the system

c.

Reduce bacteria in the colon before diagnostic testing

d.

Provide direct antidiarrheal medication to the intestine

ANS: b

b. Kayexalate is a type of medicated enema used to treat clients with dangerously high serum potassium levels. This drug contains a resin that exchanges sodium ions for potassium ions in the large intestine.

a. Kayexalate enemas are not used to treat or prevent constipation.

c. Neomycin enemas, not kayexalate enemas, may be used to reduce bacteria in the colon before diagnostic testing.

d. Kayexalate is not an antidiarrheal medication.

REF: Text Reference: p. 1398

13. The appropriate amount of fluid to prepare for an enema to be given to an average size school-age child is:

a.

150 to 250 ml

b.

250 to 350 ml

c.

300 to 500 ml

d.

500 to 750 ml

ANS: c

c. The appropriate amount of fluid to prepare for an enema to be given to an average-size school-age child is 300 to 500 ml.

a. This is the appropriate amount of fluid to prepare for an enema to be given to an infant.

b. This is the appropriate amount of fluid to prepare for an enema to be given to a toddler.

d. This is the appropriate amount of fluid to prepare for an enema to be given to an adolescent.

REF: Text Reference: p. 1399

14. The nurse is instructing the client in stomal care for an incontinent ostomy. The nurse evaluates achievement of learning goals if the client uses:

a.

Triamcinolone acetamide (Kenalog) spray for a yeast infection

b.

Peroxide to toughen the periostomal skin

c.

A commercial deodorant around the stoma

d.

Alcohol to cleanse the stoma

ANS: a

a. If a yeast infection occurs, thorough cleansing should be performed, followed by patting the area dry and applying a prescribed topical agent, such as triamcinolone acetonide (Kenalog) spray or nystatin (Mycostatin), to the affected region.

b. The peristomal skin should be cleansed gently with warm tap water by using gauze pads or a clean washcloth.

c. An ostomy deodorant may be placed into the pouch, not around the stoma.

d. Alcohol should not be used to clean the stoma. The area may be cleaned with warm tap water.

REF: Text Reference: p. 1409

15. An appropriate measure for the nurse to implement for the client with a nasogastric tube in place is to:

a.

Tape the tube up and around the ear on the side of insertion

b.

Secure the tubing to the bed by the clients head

c.

Mark the tube where it exits the nose

d.

Change the tubing daily

ANS: c

c. Once placement is confirmed, a mark should be placed, either by making a red mark or using tape, on the tube to indicate where the tube exits the nose. The mark or tube length is to be used as a guide to indicate whether displacement may have occurred.

a. The tube should be taped to the nose, not to the ear.

b. The tubing should be secured to the clients gown, not to the bed.

d. The tubing should not be changed daily; it may be irrigated daily.

REF: Text Reference: p. 1407

16. The nurse instructs the client that,before the fecal occult blood test (FOBT), she may eat:

a.

Whole wheat bread

b.

A lean, T-bone steak

c.

Veal

d.

Salmon

ANS: a

a. Whole-wheat bread may be eaten before a fecal occult blood test.

b. A lean, T-bone steak may cause false-positive results if eaten before a fecal occult blood test.

c. Veal may cause false-positive results if eaten before a fecal occult blood test.

d. Salmon may cause false-positive results if eaten before a fecal occult blood test.

REF: Text Reference: p. 1387

Copyright 2005 by Mosby, Inc. All rights reserved.

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