Chapter 45: Nursing Management: Lower Gastrointestinal Conditions:
Lewis’s Medical-Surgical Nursing, 5th Edition
1. The nurse is caring for a patient who has been taking antibiotics for several days and
develops watery diarrhea. Which of the following actions should the nurse take first?
A. Notify the health care provider.
B. Obtain a stool specimen for analysis.
C. Provide education about handwashing.
D. Place the patient on contact precautions.
Answer: D
Explanation: The history suggests possible C. difficile infection. The most immediate action
is to implement contact precautions to prevent the spread of this highly contagious organism
to other patients.
2. The nurse is caring for a patient who is incontinent of watery diarrhea and has been
diagnosed with Clostridium difficile. Which of the following actions should the nurse
include in the plan of care?
A. Order a diet with no dairy products for the patient.
B. Place the patient in a private room with contact isolation.
C. Teach the patient about why antibiotics are not being used.
D. Educate the patient about proper food handling and storage.
Answer: B
Explanation: C. difficile is highly contagious and spreads through contact with spores.
Placing the patient in a private room and implementing contact precautions are essential to
prevent transmission to other patients.
3. A patient tells the nurse, "I have problems with constipation now that I am older, so I
use a suppository every morning." Which of the following actions should the nurse take
first?
A. Encourage the patient to increase oral fluid intake.
B. Inform the patient that a daily bowel movement is unnecessary.
C. Assess the patient about individual risk factors for constipation.
D. Suggest that the patient increase dietary intake of high-fibre foods.
Answer: C
Explanation: The nurse's initial action should be to perform a thorough assessment of the
patient's risk factors, bowel habits, and current regimen before implementing any
interventions.
4. The nurse is teaching a patient who has persistent constipation, about the use of
psyllium. Which of the following information should the nurse include?
A. Absorption of fat-soluble vitamins may be reduced by fibre-containing laxatives.
B. Dietary sources of fibre 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.
Answer: D
Explanation: Bulk-forming laxatives like psyllium absorb water to create softer, bulkier
stool. Inadequate fluid intake can lead to impaction or bowel obstruction, so high fluid intake
is crucial.
5. The nurse is obtaining a history for a female patient who is being evaluated for acute
lower abdominal pain and vomiting. Which of the following questions is most useful in
determining the cause of the patient's symptoms?
A. "Is it possible that you are pregnant?"
B. "Can you tell me more about the pain?"
C. "What type of foods do you usually eat?"
D. "What is your usual elimination pattern?"
Answer: B
Explanation: A detailed description of the pain (location, quality, severity, timing, etc.)
provides the most valuable clues for diagnosing the cause of acute abdominal pain.
6. The nurse is caring for a patient who had an exploratory laparotomy with a resection
of a short segment of small bowel two days previously. The patient has gas pains and
abdominal distension. Which of the following nursing actions is best to take at this
time?
A. Give a return-flow enema.
B. Assist the patient to ambulate.
C. Administer the ordered IV morphine sulphate.
D. Insert the ordered promethazine suppository.
Answer: B
Explanation: Ambulation stimulates peristalsis, which helps to pass flatus and reduce gas
pain and distension. This is a non-invasive, first-line intervention.
7. The nurse is caring for a patient who has blunt abdominal trauma after an
automobile accident and severe pain. A peritoneal lavage returns brown drainage with
fecal material. Which of the following actions should 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.
Answer: B
Explanation: The return of fecal material indicates a bowel perforation, which is a surgical
emergency requiring immediate intervention to prevent peritonitis and sepsis.
8. The nurse is admitting a patient for evaluation of right lower quadrant abdominal
pain accompanied by nausea and vomiting. On assessment the temperature is 37.5°C,
(99.5°F) heart rate 105, respiratory rate 20 and an O2 saturation of 90%. Which of the
following actions should the nurse take?
A. Check for rebound tenderness.
,B. Assist the patient to cough and deep breathe.
C. Administer oxygen via nasal cannula.
D. Encourage the patient to take sips of clear liquids.
Answer: C
Explanation: An oxygen saturation of 90% indicates hypoxemia, which is the priority.
Administering oxygen addresses this immediate physiological need. The patient should be
kept NPO due to the potential for surgery.
9. Which of the following nursing actions should be included in the plan of care for a
male patient with bowel irregularity and a new diagnosis of irritable bowel syndrome
(IBS)?
A. Encourage the patient to express feelings and ask questions about IBS.
B. Suggest that the patient increase the intake of milk and other dairy products.
C. Educate the patient about the use of metronidazole to reduce symptoms.
D. Teach the patient to avoid using nonsteroidal anti-inflammatory drugs (NSAIDs).
Answer: A
Explanation: Psychological stress is a known trigger for IBS symptoms. Providing
emotional support and encouraging open communication is a key psychosocial intervention.
10. The nurse is caring for a patient with an acute exacerbation of ulcerative colitis
having 14--16 bloody stools a day and crampy abdominal pain associated with the
diarrhea. Which of the following actions should the nurse take?
A. Place the patient on NPO status.
B. Administer IV metoclopramide.
C. Teach the patient about total colectomy surgery.
D. Administer cobalamin injections.
Answer: A
Explanation: Placing the bowel at rest by making the patient NPO is a primary intervention
during an acute exacerbation to reduce inflammation and diarrhea. Metoclopramide increases
motility and would worsen symptoms.
11. The nurse is admitting a patient with an exacerbation of inflammatory bowel disease
(IBD). Which of the following nursing actions should the nurse include in the plan of
care?
A. Restrict oral fluid intake.
B. Monitor stools for blood.
C. Increase dietary fibre intake.
D. Ambulate four times daily.
Answer: B
Explanation: Monitoring for blood in the stool is essential as rectal bleeding is a common
symptom of IBD exacerbations and can lead to anemia. Fluids should be encouraged, fibre
may be restricted, and activity should be balanced with rest.
12. The nurse is teaching a patient with ulcerative colitis about sulphasalazine. Which of
the following patient statements indicates that the teaching has been effective?
, A. "I will need to take this medication for at least one year."
B. "I will need to avoid contact with people who are sick."
C. "The medication will need to be tapered if I need surgery."
D. "The medication will prevent infections that cause the diarrhea."
Answer: A
Explanation: Sulphasalazine is often used as a maintenance medication to keep the disease
in remission and is typically continued long-term, often for a year or more.
13. The nurse is caring for a patient with an exacerbation of ulcerative colitis who is
having 15--20 stools daily and has external hemorrhoids. Which of the following patient
behaviours indicate that teaching regarding maintenance of skin integrity has been
effective?
A. The patient uses incontinence briefs to contain loose stools.
B. The patient asks for antidiarrheal medication after each stool.
C. The patient uses witch hazel compresses to decrease anal discomfort.
D. The patient cleans the perianal area with soap and water after each stool.
Answer: C
Explanation: Witch hazel compresses can soothe irritated perianal skin and reduce
discomfort. Incontinence briefs can trap moisture, and soap can be drying and irritating; plain
water is preferred for cleansing.
14. The nurse is providing patient teaching about recommended dietary choices for a
patient with an acute exacerbation of inflammatory bowel disease (IBD). Which of the
following diet choices by the patient indicates a need for more teaching?
A. Scrambled eggs
B. White toast and jam
C. Oatmeal with cream
D. Pancakes with syrup
Answer: C
Explanation: During an acute exacerbation, a low-residue, low-fibre diet is recommended.
Oatmeal is a high-fibre food and should be avoided as it can worsen diarrhea and cramping.
15. The nurse is caring for a patient who has had a total proctocolectomy and
permanent ileostomy who tells the nurse, "I cannot bear to even look at the stoma. I do
not think I can manage all these changes." Which of the following actions is best?
A. Develop a detailed written plan for ostomy care for the patient.
B. Ask the patient more about the concerns with stoma management.
C. Reassure the patient that care for the ileostomy will become easier.
D. Postpone any patient teaching until the patient adjusts to the ileostomy.
Answer: B
Explanation: Therapeutically exploring the patient's specific fears and concerns is the most
supportive initial approach, allowing the nurse to address the underlying psychosocial
adjustment issue.
Lewis’s Medical-Surgical Nursing, 5th Edition
1. The nurse is caring for a patient who has been taking antibiotics for several days and
develops watery diarrhea. Which of the following actions should the nurse take first?
A. Notify the health care provider.
B. Obtain a stool specimen for analysis.
C. Provide education about handwashing.
D. Place the patient on contact precautions.
Answer: D
Explanation: The history suggests possible C. difficile infection. The most immediate action
is to implement contact precautions to prevent the spread of this highly contagious organism
to other patients.
2. The nurse is caring for a patient who is incontinent of watery diarrhea and has been
diagnosed with Clostridium difficile. Which of the following actions should the nurse
include in the plan of care?
A. Order a diet with no dairy products for the patient.
B. Place the patient in a private room with contact isolation.
C. Teach the patient about why antibiotics are not being used.
D. Educate the patient about proper food handling and storage.
Answer: B
Explanation: C. difficile is highly contagious and spreads through contact with spores.
Placing the patient in a private room and implementing contact precautions are essential to
prevent transmission to other patients.
3. A patient tells the nurse, "I have problems with constipation now that I am older, so I
use a suppository every morning." Which of the following actions should the nurse take
first?
A. Encourage the patient to increase oral fluid intake.
B. Inform the patient that a daily bowel movement is unnecessary.
C. Assess the patient about individual risk factors for constipation.
D. Suggest that the patient increase dietary intake of high-fibre foods.
Answer: C
Explanation: The nurse's initial action should be to perform a thorough assessment of the
patient's risk factors, bowel habits, and current regimen before implementing any
interventions.
4. The nurse is teaching a patient who has persistent constipation, about the use of
psyllium. Which of the following information should the nurse include?
A. Absorption of fat-soluble vitamins may be reduced by fibre-containing laxatives.
B. Dietary sources of fibre 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.
Answer: D
Explanation: Bulk-forming laxatives like psyllium absorb water to create softer, bulkier
stool. Inadequate fluid intake can lead to impaction or bowel obstruction, so high fluid intake
is crucial.
5. The nurse is obtaining a history for a female patient who is being evaluated for acute
lower abdominal pain and vomiting. Which of the following questions is most useful in
determining the cause of the patient's symptoms?
A. "Is it possible that you are pregnant?"
B. "Can you tell me more about the pain?"
C. "What type of foods do you usually eat?"
D. "What is your usual elimination pattern?"
Answer: B
Explanation: A detailed description of the pain (location, quality, severity, timing, etc.)
provides the most valuable clues for diagnosing the cause of acute abdominal pain.
6. The nurse is caring for a patient who had an exploratory laparotomy with a resection
of a short segment of small bowel two days previously. The patient has gas pains and
abdominal distension. Which of the following nursing actions is best to take at this
time?
A. Give a return-flow enema.
B. Assist the patient to ambulate.
C. Administer the ordered IV morphine sulphate.
D. Insert the ordered promethazine suppository.
Answer: B
Explanation: Ambulation stimulates peristalsis, which helps to pass flatus and reduce gas
pain and distension. This is a non-invasive, first-line intervention.
7. The nurse is caring for a patient who has blunt abdominal trauma after an
automobile accident and severe pain. A peritoneal lavage returns brown drainage with
fecal material. Which of the following actions should 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.
Answer: B
Explanation: The return of fecal material indicates a bowel perforation, which is a surgical
emergency requiring immediate intervention to prevent peritonitis and sepsis.
8. The nurse is admitting a patient for evaluation of right lower quadrant abdominal
pain accompanied by nausea and vomiting. On assessment the temperature is 37.5°C,
(99.5°F) heart rate 105, respiratory rate 20 and an O2 saturation of 90%. Which of the
following actions should the nurse take?
A. Check for rebound tenderness.
,B. Assist the patient to cough and deep breathe.
C. Administer oxygen via nasal cannula.
D. Encourage the patient to take sips of clear liquids.
Answer: C
Explanation: An oxygen saturation of 90% indicates hypoxemia, which is the priority.
Administering oxygen addresses this immediate physiological need. The patient should be
kept NPO due to the potential for surgery.
9. Which of the following nursing actions should be included in the plan of care for a
male patient with bowel irregularity and a new diagnosis of irritable bowel syndrome
(IBS)?
A. Encourage the patient to express feelings and ask questions about IBS.
B. Suggest that the patient increase the intake of milk and other dairy products.
C. Educate the patient about the use of metronidazole to reduce symptoms.
D. Teach the patient to avoid using nonsteroidal anti-inflammatory drugs (NSAIDs).
Answer: A
Explanation: Psychological stress is a known trigger for IBS symptoms. Providing
emotional support and encouraging open communication is a key psychosocial intervention.
10. The nurse is caring for a patient with an acute exacerbation of ulcerative colitis
having 14--16 bloody stools a day and crampy abdominal pain associated with the
diarrhea. Which of the following actions should the nurse take?
A. Place the patient on NPO status.
B. Administer IV metoclopramide.
C. Teach the patient about total colectomy surgery.
D. Administer cobalamin injections.
Answer: A
Explanation: Placing the bowel at rest by making the patient NPO is a primary intervention
during an acute exacerbation to reduce inflammation and diarrhea. Metoclopramide increases
motility and would worsen symptoms.
11. The nurse is admitting a patient with an exacerbation of inflammatory bowel disease
(IBD). Which of the following nursing actions should the nurse include in the plan of
care?
A. Restrict oral fluid intake.
B. Monitor stools for blood.
C. Increase dietary fibre intake.
D. Ambulate four times daily.
Answer: B
Explanation: Monitoring for blood in the stool is essential as rectal bleeding is a common
symptom of IBD exacerbations and can lead to anemia. Fluids should be encouraged, fibre
may be restricted, and activity should be balanced with rest.
12. The nurse is teaching a patient with ulcerative colitis about sulphasalazine. Which of
the following patient statements indicates that the teaching has been effective?
, A. "I will need to take this medication for at least one year."
B. "I will need to avoid contact with people who are sick."
C. "The medication will need to be tapered if I need surgery."
D. "The medication will prevent infections that cause the diarrhea."
Answer: A
Explanation: Sulphasalazine is often used as a maintenance medication to keep the disease
in remission and is typically continued long-term, often for a year or more.
13. The nurse is caring for a patient with an exacerbation of ulcerative colitis who is
having 15--20 stools daily and has external hemorrhoids. Which of the following patient
behaviours indicate that teaching regarding maintenance of skin integrity has been
effective?
A. The patient uses incontinence briefs to contain loose stools.
B. The patient asks for antidiarrheal medication after each stool.
C. The patient uses witch hazel compresses to decrease anal discomfort.
D. The patient cleans the perianal area with soap and water after each stool.
Answer: C
Explanation: Witch hazel compresses can soothe irritated perianal skin and reduce
discomfort. Incontinence briefs can trap moisture, and soap can be drying and irritating; plain
water is preferred for cleansing.
14. The nurse is providing patient teaching about recommended dietary choices for a
patient with an acute exacerbation of inflammatory bowel disease (IBD). Which of the
following diet choices by the patient indicates a need for more teaching?
A. Scrambled eggs
B. White toast and jam
C. Oatmeal with cream
D. Pancakes with syrup
Answer: C
Explanation: During an acute exacerbation, a low-residue, low-fibre diet is recommended.
Oatmeal is a high-fibre food and should be avoided as it can worsen diarrhea and cramping.
15. The nurse is caring for a patient who has had a total proctocolectomy and
permanent ileostomy who tells the nurse, "I cannot bear to even look at the stoma. I do
not think I can manage all these changes." Which of the following actions is best?
A. Develop a detailed written plan for ostomy care for the patient.
B. Ask the patient more about the concerns with stoma management.
C. Reassure the patient that care for the ileostomy will become easier.
D. Postpone any patient teaching until the patient adjusts to the ileostomy.
Answer: B
Explanation: Therapeutically exploring the patient's specific fears and concerns is the most
supportive initial approach, allowing the nurse to address the underlying psychosocial
adjustment issue.
