Chapter 31: Bowel Elimination
Fundamental Nursing Skills and Concepts 12th Edition, Timby
MULTIPLE CHOICE
1. A nurse is reinforcing teaching with a patient who will begin a bowel training program.
An intervention this program does not include is:
a. regularly scheduled time for toileting.
b. fluid intake of at least 2500 mL daily.
c. use of a suppository.
d. use of an enema.
ANS: D
Enemas and stronger laxatives are not considered a part of the program.
DIF: Cognitive Level: Comprehension REF: m 579, Box 30-3
OBJ: Theory #2 TOP: Bowel Training KEY: Nursing
Process Step: Implementation MSC: NCLEX: Physiological
Integrity: basic care and comfort
2. A nurse is assisting a patient with a new continent ileostomy to catheterize the internal
reservoir to drain the ileostomy. When the catheter meets resistance from the internal
valve, the nurse should:
a. have the patient take a deep breath and apply gentle pressure over the area.
b. withdraw the catheter and start again with a new one.
c. ask the patient to bear down and hold her breath.
d. coat the opening with petroleum jelly or a water-soluble lubricant.
ANS: A
For some patients the taking of a deep breath relaxes muscles and allows passage of
the catheter.
DIF: Cognitive Level: Application REF: m 581, Steps 30-2 OBJ:
Clinical Practice #7 TOP: Ileostomy KEY: Nursing Process
Step: Implementation MSC: NCLEX: Physiological Integrity
3. A nurse is caring for a patient who had bowel surgery 3 days ago and is now beginning to
have a well-functioning ostomy. The ostomy drainage bag should be emptied whenever it
is:
a. one-fourth full.
b. one-half full.
c. three-fourths full.
d. full.
ANS: B
The ostomy bag should be changed when it is one-third to one-half full so that the
weight of the bag will not detach it.
DIF: Cognitive Level: Knowledge REF: m 584, Skill 30-2 OBJ:
Clinical Practice #8 TOP: Ostomy Bag KEY: Nursing Process
Step: Planning MSC: NCLEX: Physiological Integrity: basic
care and comfort
,4. A patient with a colostomy asks about foods that can be eaten that will reduce odor in the
ostomy drainage bag. The most informative response by the nurse is to say that ostomy
odor can be decreased with the intake of:
a. buttermilk.
b. eggs.
c. cucumbers.
d. beans.
ANS: A
Buttermilk is among the suggested foods that decrease ostomy bag odor.
DIF: Cognitive Level: Comprehension REF: m 582 OBJ: Clinical
Practice #8 TOP: Ostomy Bag KEY: Nursing Process Step:
Planning MSC: NCLEX: Physiological Integrity: basic care and comfort
5. The nurse is caring for an anxious patient who is scheduled for surgery for colostomy
placement. While the nurse is talking to the patient, the patient states, I am so scared. The
nurses most supportive response would be:
a. Surgeries like yours are very safe.
b. What about your colostomy scares you?
c. Why are you scared?
d. Sounds like someone has been telling you horror stories.
ANS: B
The nurse needs to address the patients anxiety and fear first by use of open-ended
questioning, because the patient might be focused on a variety of things, including
poor body image or the prospect of death. Asking a Why question is not therapeutic
and makes the patient defensive.
DIF: Cognitive Level: Application REF: m 580 OBJ: Theory #5
TOP: Preoperative Colostomy KEY: Nursing Process
Step: Implementation MSC: NCLEX: Psychosocial Integrity:
coping and adaptation
6. The nurse reminds the patient that digestion of food is a complex process with much of
the food breaking down in intestines. The small intestine functions to:
a. reabsorb sodium and chlorides.
b. propel waste material toward the anus.
c. absorb food substances from the bloodstream.
d. return water from the waste material to the bloodstream.
ANS: C
The small intestine processes the chyme into a more liquid state and absorbs food
substances into the bloodstream. All other listed functions are those of the large
intestine.
DIF: Cognitive Level: Knowledge REF: m 568 OBJ: Theory #5
TOP: Intestinal Digestion KEY: Nursing Process Step:
Implementation MSC: NCLEX: Physiological Integrity: physiological
adaptation
7. The nurse caring for a patient who had a colostomy 2 days ago assesses slight bleeding
, around the stoma when the area is cleansed, colostomy bag filled with gas, pale stoma,
and a reddened area under the adhesive of the appliance. The assessment that should be
reported immediately is the assessment pertaining to the:
a. skin irritation.
b. bleeding around the stoma.
c. amount of gas in the bag.
d. pale stoma.
ANS: D
The pale stoma indicates a compromised blood supply and should be reported
immediately to the physician.
DIF: Cognitive Level: Analysis REF: m 582, Clinical Cues OBJ:
Clinical Practice #8 TOP: Colostomy Stoma KEY: Nursing Process
Step: Implementation MSC: NCLEX: Safe Effective Care
Environment: safety and early detection of disease
8. The patient asks the nurse how an ileostomy differs from a colostomy. The most
informative response by the nurse would be that a(n):
a. ileostomy is performed to remove stool from the colon, whereas a colostomy is
the removal of lower diverting intestinal contents.
b. ileostomy has effluent that is more formed, whereas a colostomy has effluent that
is liquid.
c. colostomy is an opening into the colon, whereas an ileostomy is an opening at the
ileum.
d. ileostomy requires irrigating, whereas a colostomy requires catheterizing.
ANS: C
The colostomy is an opening into the colon, with formed effluent requiring irrigation,
whereas the ileostomy is an opening in the ileum, with liquid effluent requiring
catheterizing.
DIF: Cognitive Level: Comprehension REF: m 582 OBJ: Theory #7
TOP: Intestinal Diversions KEY: Nursing Process Step:
Implementation MSC: NCLEX: Physiological Integrity: basic care and
comfort
9. The patient with the new colostomy is concerned about how to control diarrhea of the
effluent. The nurse suggests that diarrhea can be controlled by the intake of:
a. cheese.
b. apple juice.
c. raw vegetables.
d. beams.
ANS: A
Cheese can control or decrease the incidence of diarrhea in a colostomy.
DIF: Cognitive Level: Comprehension REF: m 582 OBJ: Clinical
Practice #1 TOP: Control of Diarrhea KEY: Nursing Process
Step: Implementation MSC: NCLEX: Physiological Integrity:
basic care and comfort
10. The nurse caring for a patient with lactose intolerance would anticipate the need to offer
, interventions for:
a. diarrhea.
b. steatorrhea.
c. constipation.
d. hemorrhoid discomfort.
ANS: A
Lactose intolerance is the name for the condition in which diarrhea occurs after
consuming milk products.
DIF: Cognitive Level: Knowledge REF: m 572 OBJ: Theory #2
TOP: Abnormal Characteristics of Stool KEY: Nursing Process
Step: Assessment MSC: NCLEX: Physiological Integrity:
basic care and comfort
11. A nurse has performed abdominal assessments on four patients. After reviewing the
findings, the nurse is least concerned about problems with bowel elimination for the
patient with abdomen _____ bowel sounds in all four quadrants.
a. nondistended, firm, with hypoactive
b. nondistended, soft, with active
c. distended, firm, with hypoactive
d. distended, soft, with hyperactive
ANS: B
Normal abdominal assessment data are an abdomen that is soft and nondistended and
that has active bowel sounds in all four quadrants.
DIF: Cognitive Level: Comprehension REF: m 572, Clinical Cues
OBJ: Clinical Practice #3 TOP: Assessment: Bowels KEY:
Nursing Process Step: Assessment MSC: NCLEX: Physiological
Integrity: basic care and comfort
12. A nurse is monitoring bowel elimination of a patient who has a history of constipation.
The nurse implements measures to assist with bowel elimination if the patient has not had
a bowel movement within how many days?
a. 5
b. 3
c. 2
d. 1
ANS: B
If bowel evacuation has not occurred within 3 days, measures should be taken to
assist the patient.
DIF: Cognitive Level: Comprehension REF: m 573 OBJ: Theory #2
TOP: Abnormal Characteristics of Stool KEY: Nursing Process
Step: Assessment MSC: NCLEX: Physiological Integrity: basic
care and comfort
13. The nurse has assessed that a patients stool has changed from brown to dark black and
sticky. The nurse suspects:
a. blockage of the bile duct.
b. blockage of the pancreatic duct.
Fundamental Nursing Skills and Concepts 12th Edition, Timby
MULTIPLE CHOICE
1. A nurse is reinforcing teaching with a patient who will begin a bowel training program.
An intervention this program does not include is:
a. regularly scheduled time for toileting.
b. fluid intake of at least 2500 mL daily.
c. use of a suppository.
d. use of an enema.
ANS: D
Enemas and stronger laxatives are not considered a part of the program.
DIF: Cognitive Level: Comprehension REF: m 579, Box 30-3
OBJ: Theory #2 TOP: Bowel Training KEY: Nursing
Process Step: Implementation MSC: NCLEX: Physiological
Integrity: basic care and comfort
2. A nurse is assisting a patient with a new continent ileostomy to catheterize the internal
reservoir to drain the ileostomy. When the catheter meets resistance from the internal
valve, the nurse should:
a. have the patient take a deep breath and apply gentle pressure over the area.
b. withdraw the catheter and start again with a new one.
c. ask the patient to bear down and hold her breath.
d. coat the opening with petroleum jelly or a water-soluble lubricant.
ANS: A
For some patients the taking of a deep breath relaxes muscles and allows passage of
the catheter.
DIF: Cognitive Level: Application REF: m 581, Steps 30-2 OBJ:
Clinical Practice #7 TOP: Ileostomy KEY: Nursing Process
Step: Implementation MSC: NCLEX: Physiological Integrity
3. A nurse is caring for a patient who had bowel surgery 3 days ago and is now beginning to
have a well-functioning ostomy. The ostomy drainage bag should be emptied whenever it
is:
a. one-fourth full.
b. one-half full.
c. three-fourths full.
d. full.
ANS: B
The ostomy bag should be changed when it is one-third to one-half full so that the
weight of the bag will not detach it.
DIF: Cognitive Level: Knowledge REF: m 584, Skill 30-2 OBJ:
Clinical Practice #8 TOP: Ostomy Bag KEY: Nursing Process
Step: Planning MSC: NCLEX: Physiological Integrity: basic
care and comfort
,4. A patient with a colostomy asks about foods that can be eaten that will reduce odor in the
ostomy drainage bag. The most informative response by the nurse is to say that ostomy
odor can be decreased with the intake of:
a. buttermilk.
b. eggs.
c. cucumbers.
d. beans.
ANS: A
Buttermilk is among the suggested foods that decrease ostomy bag odor.
DIF: Cognitive Level: Comprehension REF: m 582 OBJ: Clinical
Practice #8 TOP: Ostomy Bag KEY: Nursing Process Step:
Planning MSC: NCLEX: Physiological Integrity: basic care and comfort
5. The nurse is caring for an anxious patient who is scheduled for surgery for colostomy
placement. While the nurse is talking to the patient, the patient states, I am so scared. The
nurses most supportive response would be:
a. Surgeries like yours are very safe.
b. What about your colostomy scares you?
c. Why are you scared?
d. Sounds like someone has been telling you horror stories.
ANS: B
The nurse needs to address the patients anxiety and fear first by use of open-ended
questioning, because the patient might be focused on a variety of things, including
poor body image or the prospect of death. Asking a Why question is not therapeutic
and makes the patient defensive.
DIF: Cognitive Level: Application REF: m 580 OBJ: Theory #5
TOP: Preoperative Colostomy KEY: Nursing Process
Step: Implementation MSC: NCLEX: Psychosocial Integrity:
coping and adaptation
6. The nurse reminds the patient that digestion of food is a complex process with much of
the food breaking down in intestines. The small intestine functions to:
a. reabsorb sodium and chlorides.
b. propel waste material toward the anus.
c. absorb food substances from the bloodstream.
d. return water from the waste material to the bloodstream.
ANS: C
The small intestine processes the chyme into a more liquid state and absorbs food
substances into the bloodstream. All other listed functions are those of the large
intestine.
DIF: Cognitive Level: Knowledge REF: m 568 OBJ: Theory #5
TOP: Intestinal Digestion KEY: Nursing Process Step:
Implementation MSC: NCLEX: Physiological Integrity: physiological
adaptation
7. The nurse caring for a patient who had a colostomy 2 days ago assesses slight bleeding
, around the stoma when the area is cleansed, colostomy bag filled with gas, pale stoma,
and a reddened area under the adhesive of the appliance. The assessment that should be
reported immediately is the assessment pertaining to the:
a. skin irritation.
b. bleeding around the stoma.
c. amount of gas in the bag.
d. pale stoma.
ANS: D
The pale stoma indicates a compromised blood supply and should be reported
immediately to the physician.
DIF: Cognitive Level: Analysis REF: m 582, Clinical Cues OBJ:
Clinical Practice #8 TOP: Colostomy Stoma KEY: Nursing Process
Step: Implementation MSC: NCLEX: Safe Effective Care
Environment: safety and early detection of disease
8. The patient asks the nurse how an ileostomy differs from a colostomy. The most
informative response by the nurse would be that a(n):
a. ileostomy is performed to remove stool from the colon, whereas a colostomy is
the removal of lower diverting intestinal contents.
b. ileostomy has effluent that is more formed, whereas a colostomy has effluent that
is liquid.
c. colostomy is an opening into the colon, whereas an ileostomy is an opening at the
ileum.
d. ileostomy requires irrigating, whereas a colostomy requires catheterizing.
ANS: C
The colostomy is an opening into the colon, with formed effluent requiring irrigation,
whereas the ileostomy is an opening in the ileum, with liquid effluent requiring
catheterizing.
DIF: Cognitive Level: Comprehension REF: m 582 OBJ: Theory #7
TOP: Intestinal Diversions KEY: Nursing Process Step:
Implementation MSC: NCLEX: Physiological Integrity: basic care and
comfort
9. The patient with the new colostomy is concerned about how to control diarrhea of the
effluent. The nurse suggests that diarrhea can be controlled by the intake of:
a. cheese.
b. apple juice.
c. raw vegetables.
d. beams.
ANS: A
Cheese can control or decrease the incidence of diarrhea in a colostomy.
DIF: Cognitive Level: Comprehension REF: m 582 OBJ: Clinical
Practice #1 TOP: Control of Diarrhea KEY: Nursing Process
Step: Implementation MSC: NCLEX: Physiological Integrity:
basic care and comfort
10. The nurse caring for a patient with lactose intolerance would anticipate the need to offer
, interventions for:
a. diarrhea.
b. steatorrhea.
c. constipation.
d. hemorrhoid discomfort.
ANS: A
Lactose intolerance is the name for the condition in which diarrhea occurs after
consuming milk products.
DIF: Cognitive Level: Knowledge REF: m 572 OBJ: Theory #2
TOP: Abnormal Characteristics of Stool KEY: Nursing Process
Step: Assessment MSC: NCLEX: Physiological Integrity:
basic care and comfort
11. A nurse has performed abdominal assessments on four patients. After reviewing the
findings, the nurse is least concerned about problems with bowel elimination for the
patient with abdomen _____ bowel sounds in all four quadrants.
a. nondistended, firm, with hypoactive
b. nondistended, soft, with active
c. distended, firm, with hypoactive
d. distended, soft, with hyperactive
ANS: B
Normal abdominal assessment data are an abdomen that is soft and nondistended and
that has active bowel sounds in all four quadrants.
DIF: Cognitive Level: Comprehension REF: m 572, Clinical Cues
OBJ: Clinical Practice #3 TOP: Assessment: Bowels KEY:
Nursing Process Step: Assessment MSC: NCLEX: Physiological
Integrity: basic care and comfort
12. A nurse is monitoring bowel elimination of a patient who has a history of constipation.
The nurse implements measures to assist with bowel elimination if the patient has not had
a bowel movement within how many days?
a. 5
b. 3
c. 2
d. 1
ANS: B
If bowel evacuation has not occurred within 3 days, measures should be taken to
assist the patient.
DIF: Cognitive Level: Comprehension REF: m 573 OBJ: Theory #2
TOP: Abnormal Characteristics of Stool KEY: Nursing Process
Step: Assessment MSC: NCLEX: Physiological Integrity: basic
care and comfort
13. The nurse has assessed that a patients stool has changed from brown to dark black and
sticky. The nurse suspects:
a. blockage of the bile duct.
b. blockage of the pancreatic duct.
