Chapter 48 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

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Chapter 48  Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

1. A nurse is working with a patient who has chronic constipation. What should be included in patient teaching to promote normal bowel function?

  1. A)  Use glycerin suppositories on a regular basis.
  2. B)  Limit physical activity in order to promote bowel peristalsis.
  3. C)  Consume high-residue, high-fiber foods.
  4. D)  Resist the urge to defecate until the urge becomes intense.

Ans: C

Feedback:

Goals for the patient include restoring or maintaining a regular pattern of elimination by responding to the urge to defecate, ensuring adequate intake of fluids and high-fiber foods, learning about methods to avoid constipation, relieving anxiety about bowel elimination patterns, and avoiding complications. Ongoing use of pharmacologic aids should not be promoted, due to the risk of dependence. Increased mobility helps to maintain a regular pattern of elimination. The urge to defecate should be heeded.

2. A nurse is preparing to provide care for a patient whose exacerbation of ulcerative colitis has required hospital admission. During an exacerbation of this health problem, the nurse would anticipate that the patient’s stools will have what characteristics?

  1. A)  Watery with blood and mucus
  2. B)  Hard and black or tarry
  3. C)  Dry and streaked with blood
  4. D)  Loose with visible fatty streaks

Ans: A

Feedback:

The predominant symptoms of ulcerative colitis are diarrhea and abdominal pain. Stools may be bloody and contain mucus. Stools are not hard, dry, tarry, black or fatty in patients who have ulcerative colitis.

3. A patient has had an ileostomy created for the treatment of irritable bowel disease and the patient is now preparing for discharge. What should the patient be taught about changing this device in the home setting?

  1. A)  Apply antibiotic ointment as ordered after cleaning the stoma.
  2. B)  Apply a skin barrier to the peristomal skin prior to applying the pouch.
  3. C)  Dispose of the clamp with each bag change.
  4. D)  Cleanse the area surrounding the stoma with alcohol or chlorhexidine.

Ans: B

Feedback:

Guidelines for changing an ileostomy appliance are as follows. Skin should be washed with soap and water, and dried. A skin barrier should be applied to the peristomal skin prior to applying the pouch. Clamps are supplied one per box and should be reused with each bag change. Topical antibiotics are not utilized, but an antifungal spray or powder may be used.

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4. A patient admitted with acute diverticulitis has experienced a sudden increase in temperature and complains of a sudden onset of exquisite abdominal tenderness. The nurse’s rapid assessment reveals that the patient’s abdomen is uncharacteristically rigid on palpation. What is the nurse’s best response?

  1. A)  Administer a Fleet enema as ordered and remain with the patient.
  2. B)  Contact the primary care provider promptly and report these signs of perforation.
  3. C)  Position the patient supine and insert an NG tube.
  4. D)  Page the primary care provider and report that the patient may be obstructed.

Ans: B

Feedback:

The patient’s change in status is suggestive of perforation, which is a surgical emergency. Obstruction does not have this presentation involving fever and abdominal rigidity. An enema would be strongly contraindicated. An order is needed for NG insertion and repositioning is not a priority.

5. A 35-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. In collaboration with the primary care provider, what intervention should the nurse prioritize?

  1. A)  Insertion of a nasogastric tube
  2. B)  Insertion of a central venous catheter
  3. C)  Administration of a mineral oil enema
  4. D)  Administration of a glycerin suppository and an oral laxative

Ans: A

Feedback:

Decompression of the bowel through a nasogastric tube is necessary for all patients with small bowel obstruction. Peripheral IV access is normally sufficient. Enemas, suppositories, and laxatives are not indicated if an obstruction is present.

6. A patient admitted with inflammatory bowel disease asks the nurse for help with menu selections. What menu selection is most likely the best choice for this patient?

  1. A)  Spinach
  2. B)  Tofu
  3. C)  Multigrain bagel
  4. D)  Blueberries

Ans: B

Feedback:

Nutritional management of inflammatory bowel disease requires ingestion of a diet that is bland, low-residue, high-protein, and high-vitamin. Tofu meets each of the criteria. Spinach, multigrain bagels, and blueberries are not low-residue.

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