CHAPTER 40: Fundamentals of Nursing, 2nd Edition – Active Learning for Collaborative Practice by Yoost & Crawford

Fundamentals of Nursing, 2nd Edition – Active Learning for Collaborative Practice by Yoost & Crawford Chapter 40: Bowel Elimination Multiple Choice Questions 1. The nurse observes a patient with small streaks of fresh red blood in the stool but no abdominal pain or appetite loss. What is the most likely cause of this bleeding? A. Hemorrhoids B. Bleeding gastric ulcer C. Colon polyps D. Perforated colon Answer: A Explanation: Hemorrhoids commonly cause fresh red blood streaks due to irritation of superficial rectal veins, while other options would present with different symptoms. Why Other Options Are Wrong: B causes black tarry stools from digested blood. C typically doesn't bleed. D would cause severe pain and systemic symptoms. 2. The nurse identifies which priority nursing diagnosis for a patient with diarrhea? A. Lack of knowledge about diet modifications B. Impaired nutritional intake from poor appetite C. Diarrhea related to fluid loss D. Anxiety about incontinence Answer: C Explanation: Fluid/electrolyte imbalance from diarrhea is the immediate threat requiring intervention before addressing other concerns. Why Other Options Are Wrong: A, B, and D are secondary to restoring hydration status. 3. The nurse questions an order for diphenoxylate-atropine (Lomotil) after noting which assessment finding? A. Skin breakdown from loose stools B. No bowel movement for 3 days C. Gluten-free diet D. Painful hemorrhoids Answer: B Explanation: Antidiarrheals like Lomotil are contraindicated in constipation as they worsen impaction risks. Why Other Options Are Wrong: A, C, and D don't contraindicate antidiarrheal use. 4. An immobile patient has abdominal pain, liquid stools, and vomiting. What is the nurse's priority action? A. Provide oral care B. Apply skin barrier C. Check for fecal impaction D. Administer antiemetic Answer: C Explanation: Immobility and liquid stools suggest impaction with overflow diarrhea, requiring immediate assessment. Why Other Options Are Wrong: A, B, and D are appropriate after ruling out impaction. 5. Which finding best indicates bowel function recovery post-surgery? A. Bowel sounds and flatus B. Minimal pain/no nausea C. Hunger for soup/tea D. NG tube removal Answer: A Explanation: Auscultated bowel sounds and flatus confirm peristalsis has resumed, allowing safe oral intake. Why Other Options Are Wrong: B, C, and D don't definitively indicate functional recovery. 6. What is the priority nursing diagnosis for a patient with a new ileostomy? A. Impaired skin integrity B. Social isolation C. Knowledge deficit D. Disturbed body image Answer: A Explanation: Liquid stool from ileostomies rapidly causes skin breakdown, which must be prevented to avoid infection and poor appliance adherence. Why Other Options Are Wrong: B, C, and D are important but secondary to skin protection. 7. Which breakfast prevents constipation in a postoperative patient taking narcotics? A. Raisin bran, fruit, wheat toast B. Pancakes, bacon, coffee C. Cheese omelet, peppers D. Bagel, yogurt Answer: A Explanation: High-fiber foods (bran, fruit, whole grains) counteract narcotic-induced slowed motility. Why Other Options Are Wrong: B, C, and D lack sufficient fiber. 8. A patient hasn't had a bowel movement in 3 days. What is the nurse's priority intervention? A. Order a soap suds enema B. Teach Valsalva maneuver C. Stop constipating meds D. Assess normal bowel pattern Answer: D Explanation: Establishing the patient's baseline pattern is essential before intervening, as some individuals normally defecate every 2-3 days. Why Other Options Are Wrong: A and B are unsafe without assessment. C requires provider approval. 9. What instruction will the nurse provide about an upcoming upper GI series? A. "Your throat will be numbed." B. "Take laxatives tonight." C. "You'll drink a milky liquid." D. "Hold warfarin tonight." Answer: C Explanation: Patients ingest barium contrast for upper GI series, while throat numbing is for endoscopy. Why Other Options Are Wrong: A describes endoscopy. B and D aren't required for this test. 10. Which intervention is included in pre-colonoscopy care? A. Zinc oxide perineal cream B. Post-procedure laxative C. Swallowing assessment D. Shellfish allergy check Answer: A Explanation: Frequent liquid stools during bowel prep irritate perineal skin, requiring barrier protection. Why Other Options Are Wrong: B is unnecessary post-procedure. C and D aren't relevant to colonoscopy. 11. When testing for fecal occult blood, what does the nurse do? A. Keep NPO for 72 hours B. Send warm samples to lab C. Collect multiple specimens D. Use sterile containers Answer: C Explanation: Three samples detect intermittent bleeding that single tests might miss. Why Other Options Are Wrong: A isn't required. B applies to cultures. D isn't necessary for occult blood. 12. The nurse questions a cleansing enema order for which patient? A. Traumatic brain injury B. No BM for 3 days C. Scheduled lower GI series D. Recent upper GI series Answer: A Explanation: Enemas increase ICP, risking neurologic damage in TBI patients. Why Other Options Are Wrong: B, C, and D are appropriate indications for enemas. 13. Post-bowel surgery, the nurse notes hypoactive bowel sounds. What is the appropriate action? A. Maintain NPO status B. Give laxative suppository C. Insert NG tube D. Notify surgeon Answer: A Explanation: Hypoactive sounds are expected initially; NPO prevents vomiting until peristalsis resumes. Why Other Options Are Wrong: B and C are unnecessary without vomiting. D isn't indicated for normal findings. 14. What intervention helps a constipated patient with hard rectal stool? A. Warm prune juice B. Loperamide C. Fiber supplement D. Oil retention enema Answer: D Explanation: Oil softens impacted stool for easier passage, while other options prevent future constipation. Why Other Options Are Wrong: A and C are preventative. B worsens constipation. 15. A patient develops watery diarrhea and fever after IV antibiotics. What is the likely cause? A. C. difficile infection B. Paralytic ileus C. Fecal impaction D. Salmonella Answer: A Explanation: Antibiotic use disrupts gut flora, allowing C. difficile overgrowth, which causes colitis. Why Other Options Are Wrong: B causes absence of stool. C presents with overflow diarrhea. D follows foodborne exposure. 16. A post-colonoscopy patient complains of bloating. What should the nurse do? A. Ambulate the patient B. Insert rectal tube C. Administer enema D. Encourage high-fiber foods Answer: A Explanation: Walking stimulates peristalsis to expel retained air from insufflation during the procedure. Why Other Options Are Wrong: B and C are invasive and unnecessary. D may increase gas. 17. What is the priority intervention for a dementia patient with fecal incontinence? A. Daily laxatives B. Digital disimpaction C. Rectal tube insertion D. Prompted toileting Answer: D Explanation: Scheduled toileting re-establishes routine for patients unable to communicate needs. Why Other Options Are Wrong: A causes dependency. B and C are last-resort measures. 18. Which goal is priority for a non-weight-bearing hip surgery patient with impaired self toileting? A. Demonstrate safe transfers B. Prompt call light response C. Morning toileting schedule D. Accessible hygiene supplies Answer: A Explanation: Safe mobility prevents falls during toileting, which is the primary safety risk. Why Other Options Are Wrong: B, C, and D are staff responsibilities or secondary goals. 19. Which menu choice indicates inadequate teaching for gastroenteritis recovery? A. Applesauce B. Orange popsicle C. White toast D. Coffee with cream Answer: D Explanation: Caffeine and dairy irritate the recovering GI tract and worsen dehydration. Why Other Options Are Wrong: A, B, and C are bland, low-residue options. 20. What is the priority goal for a post-stroke patient needing toileting assistance? A. Maintain continence/skin integrity B. Express satisfaction with gait belt C. Regain clothing adjustment ability D. Ensure privacy during toileting Answer: A Explanation: Preventing incontinence complications preserves dignity and prevents skin breakdown. Why Other Options Are Wrong: B, C, and D are important but less critical than physical health outcomes. 21. A student positions a patient right side-lying for an enema. What should the preceptor do? A. Approve lubricant use B. Confirm solution warming C. Reposition left side-lying D. Validate bedpan readiness Answer: C Explanation: Left Sims position uses gravity to enhance enema flow through the descending colon. Why Other Options Are Wrong: A, B, and D are correct procedural steps. MULTIPLE RESPONSE QUESTIONS 1. Which ostomy care tasks can the nurse delegate to a nursing assistant? (Select all that apply.) A. Clean stoma with warm water B. Assess for infection/ischemia C. Gather supplies D. Teach post-discharge care E. Select appliance type F. Apply skin protectant Answer: A, C, F Explanation: Assistants may perform hygiene, supply collection, and skin protection under supervision, while assessment, teaching, and clinical decisions require nursing judgment. Why Other Options Are Wrong: B, D, and E are outside the assistant's scope. 2. Which items must be removed from a pre-colonoscopy dinner tray? (Select all that apply.) A. Cherry gelatin B. Cream of chicken soup C. Apple juice D. Coffee with cream E. Lemon Italian ice F. Ginger ale Answer: A, B, D Explanation: Red dyes (cherry gelatin) mimic blood, while cream-based foods and dairy aren't clear liquids. Why Other Options Are Wrong: C, E, and F are approved clear liquids.