Chapter 34. Nursing Care of Patients With Lower Gastrointestinal Disorders
MULTIPLE CHOICE
1. The nurse is providing care for a patient diagnosed with obstipation. Which condition is the
nurse aware as being unrelated to the patient’s diagnosis?
1. History of repeatedly ignoring the urge to defecate
2. Colon and rectal tissue insensitive to presence of feces
3. Medical history of obesity and cardiovascular disorders
4. Stronger stimulation needed to produce a peristaltic rush
ANS: 3
Chapter: Chapter 34. Nursing Care of Patients With Lower Gastrointestinal Disorders
Objective: Identify the causes, signs and symptoms, and therapeutic measures of
constipation and diarrhea.
Page: 659
Heading: Constipation
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: Physiological Integrity—Physiological Adaptation
Cognitive Level: Analysis (Analyzing)
Concept: Elimination
Difficulty: Moderate
Feedback
1 Obstipation is the term for long-standing constipation. A patient history of
repeatedly ignoring the urge to defecate is a strong contributor to the condition.
2 The musculature of the bowel and rectal mucous membrane become insensitive
to the presence of feces.
3 A medical history of obesity and cardiovascular disorders are unrelated to
intermittent or long-standing constipation.
4 Once obstipation occurs, stronger stimulation is needed to produce the
peristaltic rush required for defecation.
PTS: 1 CON: Elimination
2. The nurse is providing care for a patient who reports feeling constipated, yet passes frequent
small liquid stools. The nurse suspects an impaction. Which statement by the patient causes
the nurse concern?
1. “I took some medication to stop the diarrhea.”
2. “I have strained but cannot have a good bowel movement.”
3. “When I do pass feces, they are small, hard, and dry.”
4. “My stomach is so bloated that I am uncomfortable.”
ANS: 1
Chapter: Chapter 34. Nursing Care of Patients With Lower Gastrointestinal Disorders
Objective: Identify the causes, signs and symptoms, and therapeutic measures of
constipation and diarrhea.
Page: 659
, Heading: Constipation
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: Physiological Integrity—Reduction of Risk Potential
Cognitive Level: Analysis (Analyzing)
Concept: Elimination
Difficulty: Moderate
Feedback
1 Fecal impaction results when the fecal mass is so dry it cannot be passed. Small
amounts of liquid stool ooze around the fecal mass and cause incontinence of
liquid stools. The nurse is concerned if the patient takes antidiarrheal
medication, which can make the condition worse.
2 Straining is not uncommon by a patient who has constipation or a bowel
impaction. There is no information in the question to indicate a cardiac,
neurologic, or respiratory concern.
3 The patient is describing the expected appearance of feces during constipation;
the passage of some stool does not support the presence of an impaction.
4 With constipation or impaction, the patient will frequently experience bloating
and pain.
PTS: 1 CON: Elimination
3. The nurse notes that a patient with a history of a myocardial infarction is straining during
defecation. Which response by the nurse is best?
1. “Be careful, you might get a headache when you push so hard.”
2. “It is important that you not strain because it could cause damage to your heart.”
3. “Your blood pressure gets very low when you strain like that and you could faint.”
4. “Chronic constipation often causes a dilated colon, it is good that you are staying
empty.”
ANS: 2
Chapter: Chapter 34. Nursing Care of Patients With Lower Gastrointestinal Disorders
Objective: Plan nursing care and teaching for patients with constipation or diarrhea.
Page: 659
Heading: Constipation
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: Physiological Integrity—Reduction of Risk Potential
Cognitive Level: Analysis (Analyzing)
Concept: Elimination
Difficulty: Moderate
Feedback
1 The nurse’s response does not address the greatest concern for the patient.
2 Straining to have a bowel movement (Valsalva’s maneuver) can result in
cardiac, neurologic, and respiratory complications. If the patient has a history
of heart failure, hypertension, or recent myocardial infarction, straining can
lead to cardiac rupture and death.
3 When straining, Valsalva’s maneuver can actually cause the patient’s blood
pressure to rise.
, 4 Chronic constipation can cause a dilated colon (megacolon) proximal to the dry
fecal mass and obstruct the colon. However, this is not the greatest concern for
this patient.
PTS: 1 CON: Elimination
4. The nurse is providing care for a client postoperative for the placement of a colostomy for
colon cancer. When examining the stoma, which finding causes the nurse to immediately
contact the health care provider (HCP)?
1. Large, beefy-red in color
2. Small in size and pink color
3. Large and seeping drainage
4. Dusky color, dryness noted
ANS: 4
Chapter: Chapter 34. Nursing Care of Patients With Lower Gastrointestinal Disorders
Objective: Plan nursing care and teaching for a patient with an ostomy.
Page: 679
Heading: Colostomy
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: Physiological Integrity—Reduction of Risk Potential
Cognitive Level: Analysis (Analyzing)
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 The colostomy stoma appears large and beefy-red in color after surgery and
during a period of healing.
2 The colostomy stoma will eventually appear small and pink in color.
3 The initial appearance of a colostomy stoma is large and may exhibit some
seeping drainage.
4 A dusky-colored stoma that appears dry needs to be reported immediately to
the HCP. The finding is indicative of compromised circulation to the stoma and
additional surgery may be necessary.
PTS: 1 CON: Patient-Centered Care
5. The nurse is gathering data on a patient with severe diarrhea for 3 days. The patient reports
being out of the country for 2 weeks. Laboratory results indicate the presence of red blood
cells (RBCs) and mucus in a stool sample. For which conditions does the nurse expect
further testing?
1. Cholera, typhoid, typhus, or amebiasis
2. Shigellosis, salmonellosis, or reginal enteritis
3. Large bowel cancer or intestinal tuberculosis
4. Celiac disease, or irritable bowel syndrome
ANS: 1
Chapter: Chapter 34. Nursing Care of Patients With Lower Gastrointestinal Disorders
MULTIPLE CHOICE
1. The nurse is providing care for a patient diagnosed with obstipation. Which condition is the
nurse aware as being unrelated to the patient’s diagnosis?
1. History of repeatedly ignoring the urge to defecate
2. Colon and rectal tissue insensitive to presence of feces
3. Medical history of obesity and cardiovascular disorders
4. Stronger stimulation needed to produce a peristaltic rush
ANS: 3
Chapter: Chapter 34. Nursing Care of Patients With Lower Gastrointestinal Disorders
Objective: Identify the causes, signs and symptoms, and therapeutic measures of
constipation and diarrhea.
Page: 659
Heading: Constipation
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: Physiological Integrity—Physiological Adaptation
Cognitive Level: Analysis (Analyzing)
Concept: Elimination
Difficulty: Moderate
Feedback
1 Obstipation is the term for long-standing constipation. A patient history of
repeatedly ignoring the urge to defecate is a strong contributor to the condition.
2 The musculature of the bowel and rectal mucous membrane become insensitive
to the presence of feces.
3 A medical history of obesity and cardiovascular disorders are unrelated to
intermittent or long-standing constipation.
4 Once obstipation occurs, stronger stimulation is needed to produce the
peristaltic rush required for defecation.
PTS: 1 CON: Elimination
2. The nurse is providing care for a patient who reports feeling constipated, yet passes frequent
small liquid stools. The nurse suspects an impaction. Which statement by the patient causes
the nurse concern?
1. “I took some medication to stop the diarrhea.”
2. “I have strained but cannot have a good bowel movement.”
3. “When I do pass feces, they are small, hard, and dry.”
4. “My stomach is so bloated that I am uncomfortable.”
ANS: 1
Chapter: Chapter 34. Nursing Care of Patients With Lower Gastrointestinal Disorders
Objective: Identify the causes, signs and symptoms, and therapeutic measures of
constipation and diarrhea.
Page: 659
, Heading: Constipation
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: Physiological Integrity—Reduction of Risk Potential
Cognitive Level: Analysis (Analyzing)
Concept: Elimination
Difficulty: Moderate
Feedback
1 Fecal impaction results when the fecal mass is so dry it cannot be passed. Small
amounts of liquid stool ooze around the fecal mass and cause incontinence of
liquid stools. The nurse is concerned if the patient takes antidiarrheal
medication, which can make the condition worse.
2 Straining is not uncommon by a patient who has constipation or a bowel
impaction. There is no information in the question to indicate a cardiac,
neurologic, or respiratory concern.
3 The patient is describing the expected appearance of feces during constipation;
the passage of some stool does not support the presence of an impaction.
4 With constipation or impaction, the patient will frequently experience bloating
and pain.
PTS: 1 CON: Elimination
3. The nurse notes that a patient with a history of a myocardial infarction is straining during
defecation. Which response by the nurse is best?
1. “Be careful, you might get a headache when you push so hard.”
2. “It is important that you not strain because it could cause damage to your heart.”
3. “Your blood pressure gets very low when you strain like that and you could faint.”
4. “Chronic constipation often causes a dilated colon, it is good that you are staying
empty.”
ANS: 2
Chapter: Chapter 34. Nursing Care of Patients With Lower Gastrointestinal Disorders
Objective: Plan nursing care and teaching for patients with constipation or diarrhea.
Page: 659
Heading: Constipation
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: Physiological Integrity—Reduction of Risk Potential
Cognitive Level: Analysis (Analyzing)
Concept: Elimination
Difficulty: Moderate
Feedback
1 The nurse’s response does not address the greatest concern for the patient.
2 Straining to have a bowel movement (Valsalva’s maneuver) can result in
cardiac, neurologic, and respiratory complications. If the patient has a history
of heart failure, hypertension, or recent myocardial infarction, straining can
lead to cardiac rupture and death.
3 When straining, Valsalva’s maneuver can actually cause the patient’s blood
pressure to rise.
, 4 Chronic constipation can cause a dilated colon (megacolon) proximal to the dry
fecal mass and obstruct the colon. However, this is not the greatest concern for
this patient.
PTS: 1 CON: Elimination
4. The nurse is providing care for a client postoperative for the placement of a colostomy for
colon cancer. When examining the stoma, which finding causes the nurse to immediately
contact the health care provider (HCP)?
1. Large, beefy-red in color
2. Small in size and pink color
3. Large and seeping drainage
4. Dusky color, dryness noted
ANS: 4
Chapter: Chapter 34. Nursing Care of Patients With Lower Gastrointestinal Disorders
Objective: Plan nursing care and teaching for a patient with an ostomy.
Page: 679
Heading: Colostomy
Integrated Process: Clinical Problem-Solving Process (Nursing Process)
Client Need: Physiological Integrity—Reduction of Risk Potential
Cognitive Level: Analysis (Analyzing)
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 The colostomy stoma appears large and beefy-red in color after surgery and
during a period of healing.
2 The colostomy stoma will eventually appear small and pink in color.
3 The initial appearance of a colostomy stoma is large and may exhibit some
seeping drainage.
4 A dusky-colored stoma that appears dry needs to be reported immediately to
the HCP. The finding is indicative of compromised circulation to the stoma and
additional surgery may be necessary.
PTS: 1 CON: Patient-Centered Care
5. The nurse is gathering data on a patient with severe diarrhea for 3 days. The patient reports
being out of the country for 2 weeks. Laboratory results indicate the presence of red blood
cells (RBCs) and mucus in a stool sample. For which conditions does the nurse expect
further testing?
1. Cholera, typhoid, typhus, or amebiasis
2. Shigellosis, salmonellosis, or reginal enteritis
3. Large bowel cancer or intestinal tuberculosis
4. Celiac disease, or irritable bowel syndrome
ANS: 1
Chapter: Chapter 34. Nursing Care of Patients With Lower Gastrointestinal Disorders
