Chapter 34 Bowel Elimination and Gastric Intubation

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Chapter 34 Bowel Elimination and Gastric Intubation

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

MULTIPLE CHOICE

1. The nurse is caring for a patient who has been on bed rest for several weeks. The nurse notes that the patient is continually seeping liquid stool rectally. The nurse should take which action?
a.
Hold the patient’s antibiotics.
b.
Put the patient on a bran diet.
c.
Perform a digital rectal examination.
d.
Increase the dosage of the patient’s antibiotics.

ANS: C
Continual seepage of diarrhea may occur with an impaction, and a digital rectal examination can verify its presence. Diarrhea is often due to diet or antibiotic use, which alters the normal flora in the gastrointestinal tract. However, a physician’s order is required to change these, and continual seepage of stool is more likely the result of impaction; this should be ruled out first.

DIF: Cognitive Level: Application REF: Text reference: p. 849
OBJ: Discuss methods used to relieve constipation or impaction.
TOP: Digital Rectal Examination KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

2. The patient is a 74-year-old man who has been in the hospital for 4 days following an orthopedic surgical procedure. He is concerned because he has not moved his bowels every day as he did before surgery, but every other day. Which response made by the nurse is appropriate?
a.
Tells the patient to put himself on over-the-counter laxatives
b.
Tells the patient that daily bowel movements are not always necessary
c.
Tells the patient that with increasing age, his bowel movements should increase in frequency
d.
Tells the patient that she will call to get a laxative to get him back on track

ANS: B
Reinforce with older adult patients that as long as the consistency of the stool remains normal and bowel movements occur with regularity. As long as he is able to move his bowels at least 3 times a week, he shouldn’t worry about not having a daily movement. Since there is no indication of constipation the patient should not place himself on laxatives. However, since the patient is most likely less mobile and receiving strong pain medication following his orthopedic surgery (both likely to cause constipation) the nurse should monitor the situation.

DIF: Cognitive Level: Application REF: Text reference: pp. 842-843
OBJ: Discuss methods used to relieve constipation or impaction.
TOP: Gerontological Considerations KEY: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity

3. The nurse assesses that a patient has a severe fecal impaction. Which action taken by the nurse addresses this problem?
a.
Administering laxatives
b.
Providing a high-fiber diet
c.
Performing a digital removal
d.
Administering an enema

ANS: C
Prevention is the key to fecal impaction. However, once it occurs, digital removal of stool is the only alternative. Once the impaction is cleared, a high-fiber diet, increased activity, and adequate hydration may all reduce the likelihood of recurrence.

DIF: Cognitive Level: Application REF: Text reference: p. 849
OBJ: Describe factors that promote and impede normal bowel elimination.
TOP: Digital Removal of Fecal Impaction
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

4. The nurse prepares to exercise a digital removal of feces. To detect an untoward effect of this procedure, the nurse should assess the patient history for which condition?
a.
Heart disease
b.
Abdominal pain
c.
Urinary infection
d.
Diabetes mellitus

ANS: A
Because of the potential to stimulate the vagus nerve, patients with a history of dysrhythmia or heart disease are at greater risk for changes in heart rhythm. Be sure to monitor the patient’s pulse before and during the procedure. This procedure may be contraindicated in cardiac patients; if in doubt, verify with the physician. Symptoms of fecal impaction include constipation, rectal discomfort, anorexia, nausea, vomiting, abdominal pain, diarrhea (around the impacted stool), and urinary frequency. Abdominal pain by itself is not indicative of the need for extra caution. Symptoms of fecal impaction include urinary frequency, not infection. There is no correlation between the two.

DIF: Cognitive Level: Analysis REF: Text reference: pp. 849-850
OBJ: Describe factors that promote and impede normal bowel elimination.
TOP: Digital Removal of Fecal Impaction
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

5. When evaluating a health care team member’s ability to digitally remove feces, the nurse determined that further teaching is required in which of the following situations?
a.
Staff member provides perianal skin care.
b.
Staff member continues the procedure if bleeding starts.
c.
Staff member follows the procedure by offering the patient the bedpan.
d.
Staff member discontinues the procedure in the presence of bradycardia.

ANS: B
If the patient experiences bleeding from the rectum, the anal and perianal regions should be assessed to locate the source of the bleeding. Observe for the presence of perianal skin irritation. The presence of such indicates the need for postprocedure skin care to the perianal region to reduce pain during subsequent bowel elimination. After the procedure, assist the patient to the toilet or onto a clean bedpan. Removal of impaction stimulates the defecation reflex. The sacral branch of the vagus nerve is stimulated during digital stimulation; this may result in reflex slowing of the heart rate. Stop the procedure and retake vital signs.

DIF: Cognitive Level: Analysis REF: Text reference: p. 851
OBJ: Implement the following skills: digital removal of stool.
TOP: Digital Removal of Fecal Impaction
KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

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