Question 1

A patient who is hospitalized with abdominal pain and watery, incontinent diarrhea is diagnosed with Clostridium difficile. In planning care for the patient, the nurse will

Accepted Answer

A)  order a diet with no dairy products for the patient. 
B)  place the patient in a private room with contact isolation. 
C)  explain to the patient why antibiotics are not being used. 
D)  teach the patient about proper food handling and storage.

Question 2

Surgery is recommended by the health care provider for a patient with severe ulcerative colitis. The patient asks the nurse for clarification about the various procedures and the associated advantages and disadvantages. In responding to the patient's concerns, the nurse explains that

Accepted Answer

A)  surgery for ulcerative colitis involves the formation of a temporary ileostomy to divert fecal contents until the large bowel heals. 
B)  in a total proctocolectomy with a continent ileostomy, a pouch is created that holds bowel contents and is emptied once a day with the use of a catheter. 
C)  a total colectomy and ileal reservoir provide the most normal elimination function, but this surgery consists of two procedures, requiring a temporary ileostomy for 8 to 12 weeks. 
D)  any proposed surgery for treatment of ulcerative colitis should be given serious consideration because the disease often recurs in previously unaffected parts of the bowel.

Question 3

A recent colonoscopy revealed an increased number of polyps in a 22-year-old patient with a history of moderately severe familial adenomatous polyposis (FAP). In planning care for the patient, the nurse recognizes that the medical recommendation for patients with familial adenomatous polyposis includes

Accepted Answer

A)  a total colectomy with ileostomy. 
B)  annual colonoscopy until age 40. 
C)  routine periodic polypectomies via colonoscope to remove these abnormal growths. 
D)  biannual colonoscopy for life because of a 50% chance of developing colon cancer.

Question 4

The nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements for a patient who is hospitalized with an acute exacerbation of Crohn's disease, based on the finding of

Accepted Answer

A)  complaints of fatigue and weakness. 
B)  hemoglobin of 10 g/dl (120 g/L). 
C)  weight loss of 2 pounds (0.9 kg) in 2 days. 
D)  a 1500-calorie intake over the last day.

Question 5

A patient is brought to the emergency department following an automobile accident in which blunt trauma to the abdomen occurred. The patient is splinting the abdomen and complaining of pain, and bowel sounds are decreased. Peritoneal lavage returns brown drainage. Based on the results of the lavage, the nurse plans for

Accepted Answer

A)  preparation for a paracentesis. 
B)  administration of pain medications. 
C)  continued monitoring of the patient's condition. 
D)  immediate preparation of the patient for surgery.

Question 6

A 26-year-old patient is diagnosed with Crohn's disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg) over 2 months. The nurse will plan to teach the patient about

Accepted Answer

A)  activity restrictions. 
B)  fluid restriction. 
C)  oral corticosteroids. 
D)  enteral feedings.

Question 7

While obtaining a nursing history from a patient with IBD, the nurse recognizes that the patient most likely has ulcerative colitis rather than Crohn's disease when the patient reports experiencing

Accepted Answer

A)  weight loss. 
B)  bloody stools. 
C)  abdominal pain and cramping. 
D)  disease onset at age 20.

Question 8

Following an exploratory laparotomy and bowel resection, a patient has an NG tube to suction but complains of nausea and stomach distention. The nurse irrigates the tube PRN as ordered, but the irrigating fluid does not return. The first action by the nurse should be to

Accepted Answer

A)  notify the patient's health care provider. 
B)  auscultate for bowel sounds. 
C)  reposition the tube and check for placement. 
D)  remove the tube and replace it with a new one.

Question 9

The RN and nursing assistant (NA) are caring for a patient with a paralytic ileus. Which of these nursing activities is appropriate for the nurse to delegate to the NA?

Accepted Answer

A)  Irrigation of the NG tube with saline 
B)  Retaping the NG tube 
C)  Applying petroleum jelly to the lips 
D)  Auscultation for bowel sounds

Question 10

A patient is admitted to the emergency department with severe abdominal pain with rebound tenderness, anorexia, and chills. The vital signs include temperature 101° F (38.3° C), pulse 130, respirations 34, and blood pressure (BP) 82/50. Of the following collaborative interventions, which one should the nurse implement first?

Accepted Answer

A)  Infuse 1000 ml of lactated Ringer's solution over 30 minutes. 
B)  Administer IV ketorolac (Toradol) 15 mg. 
C)  Give IV ceftriaxone (Rocephin) 1g 
D)  Obtain a computed tomography (CT) scan of the abdomen with and without contrast.

Question 11

The nurse identifies a nursing diagnosis of acute pain related to edema and surgical incision for a patient who has had a herniorrhaphy performed for an incarcerated inguinal hernia. An appropriate nursing intervention for this problem is to

Accepted Answer

A)  administer stool softeners as ordered. 
B)  provide warm sitz baths several times a day. 
C)  apply a scrotal support with application of ice. 
D)  apply moist heat to the abdomen.

Question 12

A 42-year-old patient recently developed abdominal distention, weight loss, steatorrhea, and flatulence. A diagnosis of adult celiac disease is made, and treatment is initiated. The nurse determines that teaching about the treatment of the disease has been effective when the patient says,

Accepted Answer

A)  "I must take folic acid for the rest of my life." 
B)  "I will avoid dietary wheat, rye, barley, and oats." 
C)  "I will be sure to take all of the ordered antibiotics." 
D)  "I should eat only very low-fat or fat-free foods."

Question 13

After teaching a patient with IBD about recommended dietary modifications, the nurse identifies a need for further instruction when the patient chooses from the menu

Accepted Answer

A)  spaghetti with tomato sauce. 
B)  poached eggs and crisp bacon. 
C)  boiled shrimp and white rice. 
D)  ham hocks and beans.

Question 14

After a patient with IBD has had dietary teaching, which food choice by the patient indicates that the teaching has been successful?

Accepted Answer

A)  Oatmeal with cream, whole wheat toast, and a banana 
B)  Corn tortilla taco with chicken, lettuce, tomato, and cheese 
C)  Roast beef, mashed potatoes, and a tossed green salad 
D)  Chicken sandwich with mayonnaise on white bread

Question 15

A total proctocolectomy with a permanent ileostomy is performed for a patient with ulcerative colitis. The patient is very upset and tells the nurse, "I can not bear to even look at the stoma. I do not think I can manage all these changes." The nurse's best approach to the patient's remarks is to

Accepted Answer

A)  reassure the patient that care for the ileostomy will become easier. 
B)  ask the patient if a member of an ostomy support group may visit. 
C)  develop a detailed written plan for ostomy care for the patient. 
D)  wait to intervene until the patient adjusts to the body image change.

Question 16

While obtaining a nursing history from a 55-year-old patient scheduled for a colonoscopy, the nurse will be most concerned about

Accepted Answer

A)  lifelong constipation. 
B)  nausea and vomiting. 
C)  history of an appendectomy. 
D)  recent blood in the stools.

Question 17

A patient with Crohn's disease has a megaloblastic anemia. The nurse will anticipate teaching the patient about the ongoing need for

Accepted Answer

A)  oral ferrous sulfate tablets. 
B)  cobalamin (BB12) injections. 
C)  iron dextran (Imferon) injections. 
D)  regular blood transfusions.

Question 18

When implementing the initial plan of care for a patient admitted with acute diverticulitis, the nurse will

Accepted Answer

A)  administer IV fluids. 
B)  order a diet high in fiber and fluids. 
C)  give stool softeners. 
D)  prepare the patient for colonoscopy.

Question 19

A patient has a large bowel obstruction that occurred as a result of a fecal impaction. During nursing assessment of the patient, a finding by the nurse that is consistent with a large bowel obstruction includes

Accepted Answer

A)  metabolic alkalosis. 
B)  referred pain to the back. 
C)  bile colored vomiting. 
D)  abdominal distension.

Question 20

A patient is brought to the emergency department with a knife impaled in the abdomen following a domestic fight. During the initial assessment of the patient, it is important for the nurse to

Accepted Answer

A)  assess the BP and pulse. 
B)  remove the knife to assess the wound. 
C)  determine the presence of Rovsing's sign. 
D)  insert a urinary catheter and assess for hematuria.

Exam 43: Nursing Management: Lower Gastrointestinal Problems