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Ch 37 Bowel Elimination

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1

A nurse has auscultated the abdomen in all four quadrants for 5 minutes and has not heard any bowel sounds. How would this be documented?
a)“All four abdominal quadrants auscultated. Inaudible bowel sounds.”
b)“Bowel sounds auscultated. Client has no bowel sounds.”
c)“Client may have bowel sounds, but they can't be heard.”
d)“Auscultated abdomen for bowel sounds. Bowel not functioning.”

“All four abdominal quadrants auscultated. Inaudible bowel sounds.”

In the correct response, the nurse has documented what was done during the assessment and has noted that bowel sounds are inaudible.

2

Which factor is related to developmental changes in bowel habits for older adult clients?
a)Weakened pelvic muscles lead to constipation.
b)Increase in dietary fiber can decrease peristalsis.
c)Older adults should peel fruits before eating.
d)Milk products cause constipation in clients with lactose intolerance.

Weakened pelvic muscles lead to constipation.

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 older adults. Peeling fruit does not impact bowel habits in the older adults.

3

While administering a cleansing enema, the client displays lightheadedness, nausea, and has clammy skin. The nurse would implement which priority action?
a)Stop the procedure, monitor heart rate and blood pressure.
b)Slow the infusion rate, withdraw the tubing slightly, then resume enema.
c)Slow the infusion rate, have the client take deep breaths, then resume enema.
d)Stop the procedure and reposition the client.

Stop the procedure, monitor heart rate and blood pressure.

When administering an enema, the client’s vagus nerve may be stimulated causing a decrease in the heart rate. The client will exhibit nausea, lightheadedness, nausea, dizziness, and clammy skin. The procedure should be stopped, heart rate and blood pressure monitored, and the health care provider notified. The other responses are not appropriate for a client exhibiting a vagal response.

4

After data collection on a client, the nurse suspects that the client has diarrhea. Which data collection finding, if observed by the nurse, would confirm the nurse's suspicion?
a)Dry, hard stool
b)Hyperactive bowel sounds
c)Visible waves of abdominal peristalsis
d)Increased anal area pigmentation

Hyperactive bowel sounds

Increased bowel motility, indicated by hyperactive bowel sounds, is commonly caused by diarrhea. Visible waves of abdominal peristalsis are commonly seen in intestinal obstruction. The anal area normally has increased pigmentation and some hair growth. Diarrhea stools are liquid in formation, whereas dry, hard stools are seen in constipation.

5

During the inspection of a client's abdomen, the nurse notes that it is visibly distended. The nurse should proceed with the client's abdominal assessment by next performing:
a)light palpation.
b)auscultation.
c)deep palpation.
d)percussion.

auscultation.

When performing an abdominal assessment, the nurse should proceed from inspection to auscultation, since performing palpation or percussion prior to auscultation may disturb normal peristalsis and confound the assessment.

6

The type of stool that will be expelled into the ostomy bag by a client who has undergone surgery for an ileostomy will be:
a)bloody.
b)soft semi-formed.
c)mucus-filled.
d)liquid consistency.

liquid consistency.

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

7

The nurse is changing a patient’s ostomy appliance and observes that the peristomal skin is excoriated. What would be the nurse’s priority intervention in this situation?
a)Make sure that the appliance is not cut too large.
b)Clean outside of bag thoroughly when emptying.
c)Suspect ischemia and notify the primary care provider immediately.
d)Notify the primary care provider.

Make sure that the appliance is not cut too large.

The nurse would make sure that the appliance is not cut too large. Skin that is exposed inside of the ostomy appliance will become excoriated from the acidity of the stool. The nurse would not need to clean the outside of the bag because the peristomal skin is around the stoma and not exposed to the outside of the bag. The nurse would not suspect ischemia if the stoma was the normal color of pinkish-red. Excoriated peristomal skin does not indicate ischemia. The nurse could possibly notify the primary care provider of the situation, but this is not the best answer.

8

An older adult woman who is incontinent of stool following a cerebrovascular accident will have which nursing diagnosis?
a)Bowel Incontinence related to loss of sphincter control, as evidenced by inability to delay the urge to defecate
b)Fecal Retention related to loss of sphincter control, and diminished spinal cord innervation related to hemiparesis
c)Constipation related to physiologic condition involving the deficit in neurologic innervation, as evidenced by fecal incontinence
d)Diarrhea related to tube feedings, as evidenced by hyperactive bowel sounds and urgency

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

The most appropriate nursing diagnosis addresses the client's fecal incontinence, related to loss of sphincter control innervation.

9

The nurse is presenting a lecture on ostomy bowel elimination at a community clinic. When questioned by the clients, which foods would the nurse suggest as natural intestinal deodorizers?
a)Yogurt and buttermilk
b)Asparagus and turnip
c)Fish and dried lentils
d)Onions and garlic

Yogurt and buttermilk

Buttermilk, parsley, and yogurt are foods that are natural intestinal deodorizers. Dried lentils, asparagus, turnip, fish, onions, and garlic are foods that produce odor

10

A nurse is caring for a client with primary constipation. Which factor is responsible for primary constipation?
a)high intake of fiber
b)inadequate intake of liquid
c)constant urges to defecate
d)constant physical activity

inadequate intake of liquid

Primary constipation results from lifestyle factors such as insufficient fluid intake, inadequate intake of fiber, inactivity, or ignoring the urge to defecate.

11

A nurse is administering a prescribed solution of cottonseed oil to a client during an enema. What is the outcome of the use of cottonseed?
a)irritates local tissue
b)distends rectum and moistens stool
c)distends rectum and irritates local tissue
d)lubricates and softens stool

lubricates and softens stool

Cottonseed, olive oil, or mineral oil lubricates and softens the stool so that it can be expelled more easily during a retention enema. Tap water and normal saline solution distend the rectum and moisten the stool, whereas a soap and water solution not only distends the rectum and moistens the stool but also irritates the local tissue. A hypertonic saline solution irritates local tissue.

12

The nurse is scheduling tests for a client who is experiencing bowel alterations. What is the most logical sequence of tests to ensure an accurate diagnosis?
a)fecal occult blood test, barium studies, endoscopic examination
b)barium studies, fecal occult blood test, endoscopic examination
c)endoscopic examination, barium studies, fecal occult blood test
d)barium studies, endoscopic examination, fecal occult blood test

fecal occult blood test, barium studies, endoscopic examination

There is a specific sequence that bowel tests must be performed due to the results of certain contrasts and other preps that must be given. The nurse would verify that the tests are done in the correct order: Fecal occult blood test, barium studies, and then endoscopic examination.

13

The student nurse is caring for a client with a colostomy. When changing the ostomy appliance, the nurse faculty would intervene if which action by the student is observed?
a)Empties the pouch before changing the appliance
b)Applies a skin protectant to a 2-inch (5-cm) radius around the stoma and allows it to dry completely
c)Starts at the bottom of the appliance, holding abdominal skin taut gently removes the faceplate
d)Places a disposable pad on the work surface

Starts at the bottom of the appliance, holding abdominal skin taut gently removes the faceplate

When removing the appliance, the nurse should start at the top, not bottom, to prevent spillage of intestinal content. The disposal pad protects the work surface. Emptying the appliance before removal prevents spillage of fecal material. The skin should dry completely to provide good adherence of the appliance; protectant to a 2-inch radius provides protect to the skin and prevents breakdown.

14

A client's last bowel movement was 4 days ago and oral laxatives and dietary changes have failed to prompt a bowel movement. How should the nurse position the client in anticipation of administering a cleansing enema?
a)Prone
b)Right side-lying
c)Supine
d)Left side-lying

Left side-lying

When administering a cleansing enema, the client is most often positioned in a left side-lying (Sims') position, though positioning has not been shown to appreciably alter the result of a cleansing enema.

15

When caring for a client with fecal incontinence, the nurse knows that fecal incontinence is the result of which of the following reasons?
a)Nature and amount of food eaten by client
b)Social and emotional setting of client
c)Physiologic or lifestyle changes in client
d)Drinking and smoking habits of client

Physiologic or lifestyle changes in client

Fecal incontinence mainly results from physiologic or lifestyle changes that impair muscle activity and sensation of the gastrointestinal tract. Particularly in the older adult, the weakening of the intestinal walls and decreased muscle tone can lead to bowel incontinence

16

Which statement accurately describes the act of defecation?
a)Rectal distention leads to a decrease in intrarectal pressure, causing the muscles to stretch and thereby stimulating the defecation reflex.
b)Centers in the medulla and the spinal cord govern the reflex to defecate.
c)Defecation refers to the emptying of the small intestine.
d)When sympathetic stimulation occurs, the internal anal sphincter relaxes and the colon contracts, sending fecal content to the rectum.

Centers in the medulla and the spinal cord govern the reflex to defecate.

Two centers govern the reflex to defecate, one in the medulla and a subsidiary one in the spinal cord. Defecation refers to the emptying of the large intestine. When parasympathetic stimulation occurs, the internal anal sphincter relaxes and the colon contracts. Rectal distention leads to an increase in intrarectal pressure, causing the muscles to stretch and thereby stimulating the defecation reflex

17

A student nurse studying human anatomy knows that a structure of the large intestine is the:
a)jejunum
b)cecum
c)duodenum
d)ileum

cecum

The small intestine consists of the duodenum, jejunum, and ileum. The large intestine consists of the cecum, colon (ascending, transverse, descending, and sigmoid), and rectum.

18

The nurse is inserting a rectal tube to administer a large-volume enema. Which nursing action is performed correctly in this procedure?
a)Introduce solution quickly over a period of 3 to 5 minutes.
b)Encourage the client to hold the solution for at least 20 minutes.
c)Position the client on his back and drape properly.
d)Slowly and gently insert the enema tube 3 to 4 inches (7.5 to 10 cm) for an adult.

Slowly and gently insert the enema tube 3 to 4 inches (7.5 to 10 cm) for an adult.

The nurse would slowly and gently insert the enema tube 3 to 4 inches for an adult. The nurse would not position the client in a supine position, rather on the left side in the Sims’ position. This position aids in the client’s ability to retain the solution. The nurse would not introduce the solution quickly, as this will result in the client cramping. The nurse would administer the solution over 5 to 10 minutes, depending on the volume. The nurse would not encourage the client to hold the solution for at least 20 minutes, rather 5 to 15 minutes when the urge to defecate becomes strong.

19

The health care provider prescribes a high fiber diet for a client to promote bowel elimination. Which foods, selected by the client, would indicate to the nurse that the client can identify high-fiber foods?
a)Hot tea and flavored water
b)Soda crackers and chicken noodle soup
c)Cream of wheat and applesauce
d)Whole wheat spaghetti and broccoli

Whole wheat spaghetti and broccoli

To promote bowel elimination, consume 20 to 35 g of fiber daily. Foods high in fiber include fresh fruits and vegetables, bran, and whole grains. Cream of Wheat is refined cereal and fiber has been removed from apples because of cooking. Other foods low in fiber include soda crackers, chicken noodle soup, tea, and flavored water.

20

A nurse is caring for a client who has a large, hardened mass of stool interfering with defecation, making it impossible for the client to pass feces voluntarily. How should the nurse document this condition?
a)Fecal impaction
b)Fecal incontinence
c)Iatrogenic constipation
d)Secondary constipation

Fecal impaction

The client has fecal impaction because the large, hardened mass of stool is interfering with defecation. Iatrogenic constipation occurs as a consequence of other medical treatment. Secondary constipation is a consequence of a pathologic disorder. Fecal incontinence is the inability to control the elimination of stool

21

Which symptom is a known side effect of antibiotics?
a)Diarrhea
b)Abdominal bloating
c)Fecal impaction
d)Constipation

Diarrhea

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

22

While reading a client's history, the nurse notes that a client has a colostomy. When assessing the client, the nurse notes that the output is formed stool. What should the nurse do?
a)Contact the physician immediately
b)Assess for obstruction
c)Document the output, this is normal
d)Gvie the client the ordered laxative

Document the output, this is normal

Output from a colostomy is normally formed stool. Therefore the nurse should document the output as normal. There is no need to contact the physician at this time or to assess for an obstruction or to give a laxative

23

The nurse has presented an educational in-service about caring for clients who have newly created ostomies. The nurse asks participants, "How will you know when a client begins to accept the altered body image?" Which responses by participants indicates a correct understanding of the material? Select all that apply.
a)"The client is willing to look at the stoma."
b)"The client uses spray deodorant several times an hour to mask odor."
c)"The client agrees to take prescribed antidepressants."
d)"The client expresses interest in learning self-care."
e)"The client makes neutral or positive statements about the ostomy."

• "The client is willing to look at the stoma."
• "The client expresses interest in learning self-care."
• "The client makes neutral or positive statements about the ostomy."

24

A client scheduled for a colonoscopy is scheduled to receive a hypertonic enema prior to the procedure. A hypertonic enema is classified as which type of enema?
a)Return-flow enema
b)Retention enema
c)Cleansing enema
d)Carminative enema

Cleansing enema

The most common types of solutions used for cleansing enemas are tap water, normal saline, soap solution, and hypertonic solution. Cleansing enemas are used to relieve constipation or fecal impaction; promote visualization of the intestinal tract by radiographic or instrument examination (colonoscopy); establish regular bowel function; and prevent the involuntary escape of fecal material during surgical procedures. Carminative enemas are classified as retention enemas and are used to expel flatus from the rectum and provide relief from gaseous distention. Return-flow enemas are also occasionally prescribed to expel flatus.

25

Which enema solution lubricates the stool and intestinal mucosa without distending the intestine?
a)Water
b)Normal saline
c)Soap
d)Oil

Oil

Mineral, olive, or cottonseed oil are used to lubricate the stool and intestinal mucosa without distending the intestine.

26

A nurse is caring for a client with constipation. The incidence of constipation tends to be high among clients that follow which diet?
a)a diet lacking in meat and poultry products
b)a diet lacking in fruits and vegetables
c)a diet lacking in glucose and water
d)a diet consisting of whole grains, seeds, and nuts

a diet lacking in fruits and vegetables

The incidence of constipation tends to be high among clients whose dietary habits lack sufficient raw fruits and vegetables, whole grains, seeds, and nuts, all of which contain adequate fiber. Dietary fiber, which becomes undigested cellulose, is important because it attracts water within the bowel, resulting in bulkier stool that is more quickly and easily eliminated. A diet lacking in glucose and water will cause dehydration first and then constipation, depending on other constituents of the diet. Diets consisting of whole grains, seeds, and nuts provide fiber, which helps in bowel movement. A diet lacking in meat and poultry products need not necessarily lead to constipation.

27

Which statement best explains why digital removal of stool is considered a last resort after other methods of bowel evacuation have been unsuccessful?
a)Digital removal of stool may cause parasympathetic stimulation.
b)Nurses find the procedure distasteful and difficult to perform.
c)Most clients will not consent to have digital removal of stool.
d)It often causes rebound diarrhea and electrolyte loss.

Digital removal of stool may cause parasympathetic stimulation.

The procedure may stimulate a vagal response, which increases parasympathetic stimulation.

28

When reviewing a client’s chart, which data related to a client experiencing diarrhea might suggest to the nurse a causative factor?
a)The client has a daily fluid intake of 2,000 to 3,000 mL.
b)The client consumes large qualities of fresh vegetables.
c)The client returned from a foreign country two days ago.
d)The client repeatedly ignores the urge to defecate.

The client returned from a foreign country two days ago.

Eating native food and drinking water in a foreign country may cause problems with digestion and elimination, such as diarrhea. To promote normal bowel elimination, people should drink 2,000 to 3,000 mL fluids daily. Ignoring the urge to defecate and consuming large quantities of fiber, such as fresh vegetables, may lead to constipation.

29

For which one of the following patients would a hypertonic solution enema be contraindicated?
a)A patient who has cancer
b)A patient who is constipated
c)A patient with renal impairment
d)A patient who has diarrhea

A patient with renal impairment

Hypertonic solutions are contraindicated for patients with renal impairment or reduced renal clearance, because these patients have compromised ability to excrete phosphate adequately, with resulting hyperphosphatemia.

30

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)red.
b)brown.
c)blue.
d)green.

blue.

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

31

A 5-year-old client has a gastrointestinal infection. His mother plans to send him to school tomorrow. The school nurse knows that which nursing outcome is most important to include in the care plan of the client?
a)The client will not return to school until he is completely symptom free for 7 days.
b)The client will inform all contacts that he is ill.
c)The client will demonstrate good health practices by isolating himself from others.
d)The client will demonstrate good health practices to prevent spread of infection.

The client will demonstrate good health practices to prevent spread of infection.

Children should not, but may, return to a school or daycare setting during the infectious phase of their illness. Hand washing is key to preventing the spread of infection.

32

The nurse is preparing to auscultate the bowel sounds of a client with a nasogastric tube in place set to low intermittent suction. How shall the nurse approach the assessment of bowel sounds and manage the nasogastric tube?
a)Apply continuous suction to the nasogastric tube during assessment of bowel sounds.
b)Allow the low intermittent suction to continue during the assessment of bowel sounds.
c)Disconnect the nasogastric tube from suction during the assessment of bowel sounds.
d)Disconnect the nasogastric tube from the suction for 1 hour prior to the assessment of bowel sounds.

Disconnect the nasogastric tube from suction during the assessment of bowel sounds.

If the client has a nasogastric tube in place, disconnect it from the suction during this assessment to allow for accurate interpretation of sounds.

33

Which does not occur with the Valsalva maneuver?
a)contracting abdominal muscles
b)taking a deep breath against a closed glottis
c)contracting pelvic floor muscles
d)contraction of the external sphincter

contraction of the external sphincter

Contraction of the external sphincter is a voluntary reflex in response to the defecation reflex.

34

A client with constipation has been instructed to increase his fluid intake. The client is unsure what type of fluid he should consume. The nurse's best response is that the client should increase his intake of:
a)iced tea.
b)sports drinks.
c)water.
d)grape juice.

water.

Recommendations to promote regular defecation include a fluid intake of 2,000 to 3,000 mL. Water is recommended as the fluid of choice because fluids containing large amounts of caffeine and sugar may have a diuretic effect.

35

A nurse is assessing the stoma of a client with an ostomy. Which intervention should the nurse perform when providing peristomal care to the client to preserve skin integrity?
a)Clean it with a dry, cotton bandage.
b)Wash it with a mild cleanser and water.
c)Avoid using commercial skin preparations.
d)Avoid applying a barrier substance.

Wash it with a mild cleanser and water.

Washing the stoma and surrounding skin with a mild cleanser and water, and patting it dry can preserve skin integrity. When using a cleanser, it is important to rinse the area thoroughly. Any residue left on the skin can cause problems with the wafer adhering. Another way to protect the skin is to apply barrier substances such as karaya, a plant substance that becomes gelatinous when moistened, and commercial skin preparations around the stoma. Cleaning the stoma with just a dry, cotton bandage is not the correct way of preserving skin integrity

36

A nurse is caring for a 65-year-old woman who has undergone a hernia operation. The client has a morphine PCA for postoperative pain. She also receives sulfamethoxazole-trimethoprim every 12 hours to treat a urinary tract infection, and an iron supplement for anemia. The client is on mobility restrictions because of the narcotics. She explains that while she usually stools once per day, she has stooled four times today. What is most likely contributing to her diarrhea?
a)sulfamethoxazole-trimethaprim
b)immobility
c)iron supplement
d)morphine

sulfamethoxazole-trimethaprim

Antibiotics (such as sulfamethoxazole-trimethaprim), iron, and immobility can cause constipation.

37

A client admitted with cellulitis of the leg has been prescribed amoxicillin-clavulanate potassium. After 3 days of antibiotic therapy, the client develops severe diarrhea, and the nurse notifies the physician. The nurse would anticipate which course of action in response to the client's diarrhea?
a)discontinuation of the amoxicillin and the administration of an antidiarrheal drug
b)discontinuation of the amoxicillin and the administration of a different antibiotic
c)administration of an antidiarrheal drug and continuance of the amoxicillin
d)increase in the client's dietary fiber and continued administration of amoxicillin

discontinuation of the amoxicillin and the administration of a different antibiotic

The use of antidiarrheal drugs is not recommended for diarrhea related to the administration of amoxicillin-clavulanate potassium because it will prolong the exposure of the intestinal mucosa to the irritating effects of the antibiotic and toxin. If the diarrhea is severe, the drug may need to be discontinued.

38

During data collection of a client with bowel elimination concerns, which appropriate questions would the nurse ask? Select all that apply.
a)“Where do you do your grocery shopping?”
b)“How often do you move your bowels?”
c)“How often do you go out to eat?"
d)“Do you prefer hot foods or cold foods?”
e)“Do you use anything to help move your bowels?”

• “Do you use anything to help move your bowels?”
• “How often do you move your bowels?”
To determine the usual patterns of bowel elimination, the nurse asks, “How often do you move your bowels?” To determine if the client needs assistance in bowel elimination, the nurse asks, “Do you use anything to help move your bowels?” The client’s social appetite, preference for hot or cold foods, or shopping arena are not questions to ask for bowel elimination.

39

A client informs a nurse that he has had difficulty defecating over the past 6 months. He describes his stools as firm and pebble-like and sometimes he must strain to relieve himself. In order to diagnose this client with constipation using the Rome III criteria, what percentage of stool must be affected?
a)50%
b)75%
c)5%
d)25%

25% According to the Rome III criteria, symptoms must be present for 12 nonconsecutive weeks in the last 12 months for 25% of bowel movements.

40

Occult blood testing has been ordered for a hospitalized client. Which meal would be acceptable for a client receiving occult blood testing?
a)pot roast with potatoes, carrots, and gravy; applesauce; and gelatin with bananas
b)spaghetti with meat sauce, garlic bread, and chocolate cake
c)tofu with peanut sauce, snow peas, broccoli, and ginger snaps
d)macaroni and cheese, corn, lettuce salad, and vanilla pudding

macaroni and cheese, corn, lettuce salad, and vanilla pudding

Certain foods and medication should be avoided when occult blood testing is performed because they can cause a false-positive result. The ingestion of red meat, animal liver and kidneys, salmon, tuna, mackerel, and sardines should be avoided for 4 days prior to testing. Clients should also avoid tomatoes, cauliflower, horseradish, turnips, melon, bananas, and soybeans

41

A client who is postoperative Day 1 has rung the call light twice during the nurse's shift in order to request assistance transferring to a bedside commode. In both cases, however, the client has been unable to defecate. In light of the fact that the client's last bowel movement was the morning of surgery, what action should the nurse first take?
a)Position the client on his side and administer a glycerin suppository.
b)Facilitate a more private setting, such as assisting the client to a bathroom.
c)Administer a normal saline enema after obtaining the relevant order.
d)Obtain a diet change order to increase the amount of fiber in the client's meals.

Facilitate a more private setting, such as assisting the client to a bathroom.

The client's last bowel movement was one day earlier, so pharmacologic interventions such as suppositories or enemas are not likely warranted at this time. A change in diet may prove helpful, but the nurse's first action should be to provide a setting that is more conducive to having a bowel movement.

42

A hypertonic enema solution lubricates the stool and intestinal mucosa, making stool passage more comfortable.

a)True
b)False

false

43

A woman age 76 years has informed the nurse that she has begun using over-the-counter laxatives because her friend told her it was imperative to have at least one bowel movement daily. How should the nurse best respond to this client's statement?
a)"That's correct, but be sure that you don't increase your laxative doses over time."
b)"Actually, people's bowel patterns can vary a lot and some people don't tend to go every day."
c)"Your friend is correct in her assessment, but it would likely be better to exercise and drink more instead of using medications."
d)"Most older adults only have a bowel movement every 2 to 3 days, actually, so I'd encourage you to taper off your laxatives."

"Actually, people's bowel patterns can vary a lot and some people don't tend to go every day.

Elimination patterns vary widely among individuals, and the expectation of a daily bowel movement is not realistic for many healthy people. This client may not require pharmacologic interventions


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