Chapter 29 Bowel Elimination PDF

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Ch 29 – Bowel Elimination Normal flora contained in the colon aid digestion and produce which nutrients? Select all that apply. 1) Vitamin A 2) Vitamin B 3) Vitamin C 4) Vitamin K 5) Iron 6) Zinc Answer 2) Vitamin B; 4) Vitamin K Rationale: The normal flora in the colon produce vitamin K and several of the B vitamins. They are not responsible for production of vitamins A and C, iron, and zinc. When a patient with heartburn takes antacids, for which problem is he especially at risk? 1) Diarrhea 2) Constipation 3) Stomach ulceration 4) Flatulence Answer 2) Constipation. Rationale: Antacids slow peristalsis, placing the patient at risk for constipation. Antibiotics increase the risk for diarrhea. Stomach ulceration is an adverse effect associated with NSAIDs. Iron supplementation may cause flatulence. Which type of bowel diversion allows the patient to be free from an appliance? 1) Colostomy in the transverse colon 2) Double-barreled colostomy 3) Ileostomy 4) Kock pouch Answer 4) Kock pouch. Rationale: A Kock pouch, also known as a continent ileostomy, creates an internal pouch to collect ileal drainage. To drain the pouch, the patient inserts a tube through the external stoma into a pouch several times a day. This allows the patient to be free from an appliance. A colostomy, double-barreled colostomy, and ileostomy all require an appliance. The nurse has taught a client how to manage constipation. Which action by the client would provide evidence of learning? The patient: (Select all that apply.) 1) increases his intake of high-fiber foods. 2) drinks at least four 8-ounce glasses of water a day. 3) goes to the bathroom to evacuate after meals. 4) takes a daily laxative. Answer 1) increases his intake of high-fiber foods.; 3) goes to the bathroom to evacuate after meals. Rationale: The urge to defecate typically comes after eating; the nurse can help manage the patient's constipation by assisting the patient to the bathroom after meals. The nurse should also encourage the patient to increase his intake of high-fiber food and drink at least eight glasses of water a day (not four). Laxatives should be administered or taken only when absolutely necessary. The nurse in a long-term care facility is teaching a group of residents about increasing dietary fiber. Which foods should she explain are high in fiber? 1) White bread, pasta, and white rice 2) Oranges, raisins, and strawberries 3) Whole milk, eggs, and bacon

4) Peaches, orange juice and bananas Answer 2) Oranges, raisins, and strawberries. Rationale: Oranges, raisins, and strawberries are high in fiber. White bread, pasta, and white rice are carbohydrates. Whole milk, eggs, and bacon are high in cholesterol. Peaches, orange juice, and bananas are sources of potassium. A patient is admitted to the hospital with severe diarrhea. The patient should be monitored for which complication associated with diarrhea? 1) Hypokalemia 2) Hypocalcemia 3) Hyperglycemia 4) Thrombocytopenia Answer 1) Hypokalemia. Rationale: Diarrhea causes fluid loss and hypokalemia, not hypocalcemia, hyperglycemia, or thrombocytopenia. The nurse is assessing a patient who underwent bowel resection 2 days ago. As she auscultates the patient's abdomen, she notes low-pitched, infrequent bowel sounds. How should she document this finding? 1) Hyperactive bowel sounds 2) Abdominal bruit sounds 3) Normal bowel sounds 4) Hypoactive bowel sounds Answer 4) Hypoactive bowel sounds. Rationale: Hypoactive bowel sounds are low pitched, infrequent, and quiet. An abdominal bruit is a hollow, blowing sound found over an artery, such as the iliac artery. Normal bowel sounds are high pitched, with approximately 5 to 35 gurgles occurring every minute. Hyperactive bowel sounds are very high pitched and more frequent than normal bowel sounds. For a patient with a newly fractured pelvis, not yet in a cast, which of the following actions is appropriate when placing the patient on a bedpan? 1) Place the patient in semi-Fowler's position to defecate. 2) Ask the patient to push up with his feet to lift his hips while you place the bedpan. 3) Place a fracture pan under the buttocks, small end toward the feet. 4) Raise the siderail on the opposite side from where you are working. Answer 4) Raise the siderail on the opposite side from where you are working. Rationale: The nurse should always raise the siderail on the opposite side from where he is working to protect the patient from falls. Placing the patient in semi-Fowler's position or asking the patient to push up with his feet would cause pain and possible dislocation of the fracture. A fracture pan should be used, but the large end is pointed toward the feet. The nurse is instructing a patient about performing home testing for fecal occult blood. The nurse can conclude that learning occurs if the patient says, "For 3 days prior to testing, I should avoid eating 1) beef. 2) milk. 3) eggs. 4) oatmeal. Answer 1) beef. Rationale: The nurse should instruct the patient to avoid red meat, chicken, fish, horseradish, and certain raw fruits and vegetables for 3 days prior to fecal occult blood testing.

Which of the following goals is appropriate for a patient with a nursing diagnosis of Constipation? The patient increases the intake of: 1) milk and cheese. 2) bread and pasta. 3) fruits and vegetables. 4) lean meats. Answer 3) fruits and vegetables. Rationale: The nurse should encourage the patient to increase his intake of foods rich in fiber because they promote peristalsis and defecation, thereby relieving constipation. Low-fiber foods, such as bread, pasta, and other simple carbohydrates, as well as milk, cheese, and lean meat, slow peristalsis. The nurse must irrigate the colostomy of a patient who is unable to move independently. How should the nurse position the patient for this procedure? 1) Semi-Fowler's position 2) Left side-lying position 3) Supine, with the head of the bed lowered flat 4) Supine, with the head of bed raised to 30 degrees Answer 2) Left side-lying position. Rationale: The nurse should position an immobile patient in a left side-lying position to irrigate his colostomy. Semi-Fowler's, supine with the bed lowered flat, and the supine position with the head of bed elevated to 30 degrees are not appropriate positions for colostomy irrigation. Which is a key treatment intervention for the patient admitted with diverticulitis? 1) Antacid 2) Antidiarrheal agent 3) Antibiotic therapy 4) NSAIDs Answer 3) Antibiotic therapy. Rationale: A key treatment for diverticulitis (an infected diverticulum) is antibiotic therapy; if antibiotic therapy is ineffective, surgery may be necessary. Antacids, antidiarrheal agents, and NSAIDs are not indicated for treatment of diverticulitis. A patient with a colostomy complains to the nurse, "I am having really bad odors coming from my pouch." To help control odor, which foods should the nurse advise him to consume? 1) White rice and toast 2) Tomatoes and dried fruit 3) Asparagus and melons 4) Yogurt and parsley Answer 4) Yogurt and parsley. Rationale: Yogurt, cranberry juice, parsley, and buttermilk may help control odor. White rice and toast (also bananas and applesauce) help control diarrhea. Asparagus, peas, melons, and fish are known to cause odor. Tomatoes, pears, and dried fruit are high-fiber foods that might cause blockage in a patient with an ostomy....