Ch. 47: Lower GI Problems TEST BANK QUESTIONS
Which action would the nurse include in the plan of care for a patient who is being admitted with a C.
difficile infection?
a. Teach the patient about proper food storage.
b. Order a diet without dairy products for the patient.
c. Place the patient in a private room on contact isolation.
d. Teach the patient about why antibiotics will not be used. - (correct Answer) - ANS: C
Because C. difficile is highly contagious, the patient would be placed in a private room, and contact
precautions would be used. There is no need to restrict dairy products for this type of diarrhea.
Metronidazole (Flagyl) is frequently used to treat C. difficile infections. Improper food handling and
storage do not cause C. difficile.
2. A 74-yr-old male patient tells the nurse that growing old causes constipation, so he has been using a
suppository to prevent constipation every morning. Which action would the nurse take first?
a. Encourage the patient to increase oral fluid intake.
b. Question the patient about risk factors for constipation.
c. Suggest that the patient increase intake of high-fiber foods.
d. Teach the patient that a daily bowel movement is unnecessary. - (correct Answer) - ANS: B
The nurse's initial action should be further assessment of the patient for risk factors for constipation and
for his usual bowel pattern. The other actions may be appropriate but will be based on the assessment.
3. A patient who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which
information would the nurse provide?
a. Fiber-containing laxatives may reduce the absorption of fat-soluble vitamins.
b. Dietary sources of fiber should be eliminated to prevent excessive gas formation.
c. Use of this type of laxative to prevent constipation does not cause adverse effects.
d. Large amounts of fluid should be taken to prevent impaction or bowel obstruction. - (correct Answer) -
ANS: D
A high fluid intake is needed when patients are using bulk-forming laxatives to avoid worsening
constipation. Although bulk-forming laxatives are generally safe, the nurse should emphasize the
possibility of constipation or obstipation if inadequate fluid intake occurs. Although increased gas
formation is likely to occur with increased dietary fiber, the patient should gradually increase dietary
fiber and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool
softeners and lubricants, not by bulk-forming laxatives.
4. A 26-yr-old woman is being evaluated for vomiting and abdominal pain. Which question from the
,nurse will be most useful in determining the cause of the patient's symptoms?
a. "What type of foods do you eat?"
b. "Is it possible that you are pregnant?"
c. "Can you tell me more about the pain?"
d. "What is your usual elimination pattern?" - (correct Answer) - ANS: C
A complete description of the pain provides clues about the cause of the problem. Although the nurse
should ask whether the patient is pregnant to determine whether the patient might have an ectopic
pregnancy and before any radiology studies are done, this information is not the most useful in
determining the cause of the pain. The usual diet and elimination patterns are less helpful in
determining the reason for the patient's symptoms.
5. A patient reports gas pains and abdominal distention 2 days after a small bowel resection. Which
action would the nurse take?
a. Administer morphine sulfate.
b. Encourage the patient to ambulate.
c. Offer the prescribed promethazine.
d. Instill a mineral oil retention enema. - (correct Answer) - ANS: B
Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral
oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to
relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine is used as an
antiemetic rather than to decrease gas pains or distention.
6. A patient with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the
lavage returns brown fecal drainage, which action will the nurse plan to take next?
a. Auscultate the bowel sounds.
b. Prepare the patient for surgery.
c. Check the patient's oral temperature.
d. Obtain information about the accident. - (correct Answer) - ANS: B
Return of brown drainage and fecal material suggests perforation of the bowel and the need for
immediate surgery. Auscultation of bowel sounds, checking the temperature, and obtaining information
about the accident are appropriate actions, but the priority is to prepare to send the patient for
emergency surgery.
7. A young adult patient is admitted to the hospital for evaluation of right lower quadrant abdominal
pain with nausea and vomiting. Which action would the nurse take?
a. Assist the patient to cough and deep breathe.
, b. Palpate the abdomen for rebound tenderness.
c. Suggest the patient lie on the side, flexing the right leg.
d. Encourage the patient to sip clear, noncarbonated liquids. - (correct Answer) - ANS: C
The patient's clinical manifestations are consistent with appendicitis. Lying still with the right leg flexed is
often the most comfortable position. Checking for rebound tenderness frequently is unnecessary and
uncomfortable for the patient. The patient should be NPO in case immediate surgery is needed. The
patient will need to know how to cough and deep breathe postoperatively, but coughing will increase
pain at this time.
8. Which action will the nurse include in the plan of care for a 25-yr-old male patient with a new
diagnosis of irritable bowel syndrome (IBS)?
a. Encourage the patient to express concerns and ask questions about IBS.
b. Suggest that the patient increase the intake of milk and other dairy products.
c. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs).
d. Teach the patient about the use of alosetron (Lotronex) to reduce IBS symptoms. - (correct Answer) -
ANS: A
Because psychologic and emotional factors can affect the symptoms for IBS, encouraging the patient to
discuss emotions and ask questions is an important intervention. Alosetron has serious side effects and
is used only for female patients who have not responded to other therapies. Although yogurt may be
beneficial, milk is avoided because lactose intolerance can contribute to symptoms in some patients.
NSAIDs can be used by patients with IBS.
9. A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal
pain and passing 15 bloody stools a day. Which intervention would the nurse include in the patient's plan
of care?
a. Administer oral metoclopramide.
b. Instruct the patient not to eat or drink.
c. Administer cobalamin (vitamin B12) injections.
d. Teach the patient about total colectomy surgery. - (correct Answer) - ANS: B
An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by
making the patient NPO. Metoclopramide increases peristalsis and will worsen symptoms. Cobalamin
(vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. Although total
colectomy is needed for some patients, there is no indication that this patient is a candidate during this
acute phase.
10. Which nursing action will the nurse include in the plan of care for a patient admitted with an
exacerbation of inflammatory bowel disease (IBD)?
Which action would the nurse include in the plan of care for a patient who is being admitted with a C.
difficile infection?
a. Teach the patient about proper food storage.
b. Order a diet without dairy products for the patient.
c. Place the patient in a private room on contact isolation.
d. Teach the patient about why antibiotics will not be used. - (correct Answer) - ANS: C
Because C. difficile is highly contagious, the patient would be placed in a private room, and contact
precautions would be used. There is no need to restrict dairy products for this type of diarrhea.
Metronidazole (Flagyl) is frequently used to treat C. difficile infections. Improper food handling and
storage do not cause C. difficile.
2. A 74-yr-old male patient tells the nurse that growing old causes constipation, so he has been using a
suppository to prevent constipation every morning. Which action would the nurse take first?
a. Encourage the patient to increase oral fluid intake.
b. Question the patient about risk factors for constipation.
c. Suggest that the patient increase intake of high-fiber foods.
d. Teach the patient that a daily bowel movement is unnecessary. - (correct Answer) - ANS: B
The nurse's initial action should be further assessment of the patient for risk factors for constipation and
for his usual bowel pattern. The other actions may be appropriate but will be based on the assessment.
3. A patient who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which
information would the nurse provide?
a. Fiber-containing laxatives may reduce the absorption of fat-soluble vitamins.
b. Dietary sources of fiber should be eliminated to prevent excessive gas formation.
c. Use of this type of laxative to prevent constipation does not cause adverse effects.
d. Large amounts of fluid should be taken to prevent impaction or bowel obstruction. - (correct Answer) -
ANS: D
A high fluid intake is needed when patients are using bulk-forming laxatives to avoid worsening
constipation. Although bulk-forming laxatives are generally safe, the nurse should emphasize the
possibility of constipation or obstipation if inadequate fluid intake occurs. Although increased gas
formation is likely to occur with increased dietary fiber, the patient should gradually increase dietary
fiber and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool
softeners and lubricants, not by bulk-forming laxatives.
4. A 26-yr-old woman is being evaluated for vomiting and abdominal pain. Which question from the
,nurse will be most useful in determining the cause of the patient's symptoms?
a. "What type of foods do you eat?"
b. "Is it possible that you are pregnant?"
c. "Can you tell me more about the pain?"
d. "What is your usual elimination pattern?" - (correct Answer) - ANS: C
A complete description of the pain provides clues about the cause of the problem. Although the nurse
should ask whether the patient is pregnant to determine whether the patient might have an ectopic
pregnancy and before any radiology studies are done, this information is not the most useful in
determining the cause of the pain. The usual diet and elimination patterns are less helpful in
determining the reason for the patient's symptoms.
5. A patient reports gas pains and abdominal distention 2 days after a small bowel resection. Which
action would the nurse take?
a. Administer morphine sulfate.
b. Encourage the patient to ambulate.
c. Offer the prescribed promethazine.
d. Instill a mineral oil retention enema. - (correct Answer) - ANS: B
Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral
oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to
relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine is used as an
antiemetic rather than to decrease gas pains or distention.
6. A patient with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the
lavage returns brown fecal drainage, which action will the nurse plan to take next?
a. Auscultate the bowel sounds.
b. Prepare the patient for surgery.
c. Check the patient's oral temperature.
d. Obtain information about the accident. - (correct Answer) - ANS: B
Return of brown drainage and fecal material suggests perforation of the bowel and the need for
immediate surgery. Auscultation of bowel sounds, checking the temperature, and obtaining information
about the accident are appropriate actions, but the priority is to prepare to send the patient for
emergency surgery.
7. A young adult patient is admitted to the hospital for evaluation of right lower quadrant abdominal
pain with nausea and vomiting. Which action would the nurse take?
a. Assist the patient to cough and deep breathe.
, b. Palpate the abdomen for rebound tenderness.
c. Suggest the patient lie on the side, flexing the right leg.
d. Encourage the patient to sip clear, noncarbonated liquids. - (correct Answer) - ANS: C
The patient's clinical manifestations are consistent with appendicitis. Lying still with the right leg flexed is
often the most comfortable position. Checking for rebound tenderness frequently is unnecessary and
uncomfortable for the patient. The patient should be NPO in case immediate surgery is needed. The
patient will need to know how to cough and deep breathe postoperatively, but coughing will increase
pain at this time.
8. Which action will the nurse include in the plan of care for a 25-yr-old male patient with a new
diagnosis of irritable bowel syndrome (IBS)?
a. Encourage the patient to express concerns and ask questions about IBS.
b. Suggest that the patient increase the intake of milk and other dairy products.
c. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs).
d. Teach the patient about the use of alosetron (Lotronex) to reduce IBS symptoms. - (correct Answer) -
ANS: A
Because psychologic and emotional factors can affect the symptoms for IBS, encouraging the patient to
discuss emotions and ask questions is an important intervention. Alosetron has serious side effects and
is used only for female patients who have not responded to other therapies. Although yogurt may be
beneficial, milk is avoided because lactose intolerance can contribute to symptoms in some patients.
NSAIDs can be used by patients with IBS.
9. A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal
pain and passing 15 bloody stools a day. Which intervention would the nurse include in the patient's plan
of care?
a. Administer oral metoclopramide.
b. Instruct the patient not to eat or drink.
c. Administer cobalamin (vitamin B12) injections.
d. Teach the patient about total colectomy surgery. - (correct Answer) - ANS: B
An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by
making the patient NPO. Metoclopramide increases peristalsis and will worsen symptoms. Cobalamin
(vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. Although total
colectomy is needed for some patients, there is no indication that this patient is a candidate during this
acute phase.
10. Which nursing action will the nurse include in the plan of care for a patient admitted with an
exacerbation of inflammatory bowel disease (IBD)?
