A client passes black, tarry stools. the nurse recognizes that this may be an indication of:

The nurse is obtaining a health history from an older adult client. The client tells the nurse that a bowel movement occurs about every 2 to 3 days. Which question should the nurse ask to determine if this is normal functioning for the client?
1.
What is the consistency of your stool?
2.
Do you take laxatives to go more often?
3.
What is a normal daily diet for you?
4.
How do you feel if you don't go every day?

1

A client has undergone diagnostic tests of the gastrointestinal (GI) system. The client, who has chronic constipation, tells the nurse the physician is concerned about peristalsis, and asks why it is important. Which information will the nurse include?
1.
Peristalsis counteracts gravity to prevent food from being propelled through the GI tract too swiftly.
2.
Peristalsis is movement triggered by enzymes causing food to digest quickly and prevent constipation.
3.
Peristalsis is contractions of circular and longitudinal muscles that propels food through the GI tract.
4.
Peristalsis is an abnormal movement of the bowel which causes intractable nausea and vomiting.

3

An older adult client is admitted to the hospital for a bowel obstruction, and part of the client's duodenum was surgically removed. Which condition does the nurse recognize as a potential problem for the client?
1.
Limited stomach capacity
2.
Duodenum-produced enzymes are not available
3.
Poor absorption from shortening of the colon
4.
A decreased ability to absorb nutrients

4

During an admission physical assessment, a nurse questions a client about bowel elimination habits. Which client care goal is the nurse attempting to identify?
1.
Assessment about the need for a laxative.
2.
Maintain the client's normal elimination habit.
3.
Complete collection of all pertinent client data.
4.
Determine if further gastrointestinal testing is necessary.

2

The nurse is discussing ways to help prevent constipation. Which information is most important for the nurse to share?
1.
Do not ignore the defecation reflex.
2.
Plan to defecate prior to the next meal.
3.
Decrease fluids if fiber is increased.
4.
Use laxatives to better time defecation.

1

In response to a nurse's question about bowel function, a client shares that sometimes the feces are greenish black in color. Which answer by the nurse is correct?
1.
"Large amounts of dairy products can cause your stools to turn green."
2.
"If you take iron tablets, your stools can become greenish black."
3.
"Typically our diet has very little to do with the color of our stools."
4.
"Eating green foods, such as spinach, can cause your stools to have greenish black streaks."

4

After an initial assessment, a nurse documents that a client, admitted for abdominal pain, has hyperactive bowel sounds. Which type of bowel movement will the nurse expect this client to have?
1.
Hard and shaped in small balls
2.
Fluffy, with a tendency to float in the toilet
3.
Ribbon-shaped and soft
4.
Liquid or semi-liquid

4

A female client has been admitted with ulcerative colitis. Which appearance of the client's stools will the nurse expect with the exacerbation of this condition?
1.
Be black, tarry, and odiferous
2.
Float, and be odorless and bloody
3.
Contain pus, mucus, and blood
4.
Be soft, but ribbon shaped

3

The nurse assists a client to the bathroom, and notices that the client's stool is clay colored. The client tells the nurse that this has occurred off and on for the last month or two. Which condition does the nurse suspect?
1.
Poorly balanced diet
2.
Gallstones or liver problems
3.
History of gastrointestinal (GI) bleeding
4.
Poor fluid intake

2

The nurse is admitting a client and performs a focused assessment. Which techniques will result in the nurse acquiring objective data related to bowel function?
1.
Ask when the client last had a bowel movement.
2.
Use the diaphragm of a stethoscope to hear bowel sounds.
3.
Inquire about the characteristics of feces.
4.
Ask the client to describe past abdominal pain.

2

The nurse is assigned to provide client care to multiple clients. Which client does the nurse recognize as being at greatest risk for a fecal impaction?
1.
An older adult client with poor fluid intake and a history of laxative abuse.
2.
A client who is four days postoperative receiving an opioid drug for pain.
3.
A client admitted for dehydration related to vomiting, receiving IV therapy.
4.
A client ordered on bedrest for a pulmonary embolus who eats a regular diet.

1

While providing care for an older adult client, the nurse learns that the client has had only small, watery stools for several days. Which is the nurse's priority in providing care for this client?
1.
Assess the client for an impaction.
2.
Call the primary care physician and get an order for a laxative.
3.
Administer medication to slow the diarrhea.
4.
Collect a stool specimen for analysis.

1

The nurse is caring for a client who has fecal incontinence. The symptoms include intermittent periods when small amounts of liquid stool are passed, followed by periods of severe constipation requiring the use of enemas to resolve. Which intervention should the nurse perform first?
1.
Assess for readiness to participate in a bowel training program.
2.
Teach the client about increasing fiber and fluids in the daily diet.
3.
Examine the client and check for the possibility of fecal impaction.
4.
Inform the client of the multiple types of incontinence products available.

3

The nurse is preparing to collect a stool specimen ordered by the physician. Which client and reason defines the need for the specimen?
1.
A client traveled outside the country and has lost weight since returning.
2.
A client experiences bloating and flatus after consuming dairy products.
3.
A client with hemorrhoids notices streaks of blood on the toilet paper.
4.
A client is on iron therapy for anemia and the stools are dark in color.

1

The nurse is caring for multiple clients with a variety of bowel conditions. Which client does the nurse consider at greatest risk for surgery to place a colostomy?
1.
A client with traumatic injury to the abdomen
2.
A client with a portion of bowel without circulation
3.
A client with a cancerous tumor in the transverse colon
4.
A client who has experienced a ruptured diverticulum

2

The nurse is preparing to administer an ordered enema to a client. Which intervention by the nurse is correct for this procedure?
1.
Warm the water to a temperature between 115°F and 125°F.
2.
Insert the tip of the enema tube approximately 3 to 4 inches into the rectum.
3.
Give the enema while the client is in a sitting position on the toilet.
4.
Have the client lie on the right side to facilitate the instillation of fluid.

2

A client with a known history of diverticulosis who is experiencing severe cramping and diarrhea is admitted to the hospital during the night with a diagnosis of diverticulitis. The client's pain increases, and the abdomen is distended and hard. The client has spiked a fever of 102.4°F. The nurse concludes the client may be developing a life-threatening complication and notifies the physician. Which possible complication concerns the nurse?
1.
Crohn disease
2.
Irritable bowel syndrome (IBS)
3.
Fecal incontinence
4.
Peritonitis

4

While inspecting a client's stool, a nurse notices a small amount of black, tarry blood with a distinctive old-blood odor that appears to have been partially digested. Which term does the nurses use to describe the client's stool?
1.
Melena
2.
Occult blood
3.
Frank blood
4.
Steatorrhea

1

The nurse is assessing a client immediately after the placement of a colostomy. Which assessment finding does the nurse expect to see?
1.
The presence of effluence in the colostomy appliance
2.
A stoma that is red, shiny, moist, and beefy in appearance
3.
A slight skin irritation found under the appliance wafer
4.
Drainage of mucus and purulent liquid from the stoma

2

A nurse explains to a client that it is wise to avoid taking a laxative every day because of the problems it can cause. The client demonstrates understanding by saying laxative abuse can result in which condition? Select all that apply.
1.
Fluid and electrolyte imbalances
2.
The need for increasing dosages of laxative
3.
Loss of natural contractility in the bowel
4.
Increased risk for an impaction
5.
Development of irritable bowel syndrome

1 2 3 4

Feedback:
1
This is correct. Laxative abuse can result in diarrhea, thus increasing the risk for fluid and electrolyte imbalances.
2
This is correct. Laxative abuse leads to the need for increasing dosages of laxatives.
3
This is correct. Dependence on laxative-induced bowel movements results in the loss of natural contractility of the bowel, which can increase the risk for development of an impaction.
4
This is correct. Dependence on laxative-induced bowel movements results in the loss of natural contractility of the bowel, which can increase the risk for development of an impaction.
5
This is incorrect. Irritable bowel disease is caused by the inflammatory process rather than laxative abuse.

The nurse is providing care for a client with a newly placed ileostomy. Which comment by the client indicates a lack of acceptance for the alteration in body function? Select all that apply.
1.
"I don't want to look at anything right now while it is so fresh."
2.
"I know that you know what to do, so I will be quiet during care."
3.
"I am still having some intense pain; I think that I need medication."
4.
"I guess that I will need to ask about any dietary changes I need to make."
5.
"Please teach my spouse how to perform all the care; I don't need to know."

1 2 5

Feedback:
1
This is correct. The client is showing a lack of acceptance by refusing to look at the stoma. The delay until healing occurs is a sign of an unhealthy attitude; there is much for the client to learn in regards to healing.
2
This is correct. The client's willingness to allow the nurse to perform care without any participation is an indication that the client lacks acceptance.
3
This is incorrect. It is not unusual for the client to be aware of and seek relief from pain related to a surgery. This comment does not indicate a lack of acceptance.
4
This is incorrect. Stating that the client understands that dietary changes may be needed indicates acceptance.
5
This is correct. Deferring all teaching and care to the spouse indicates that the client has a lack of acceptance.

The nurse is caring for a client who is postoperative for abdominal surgery. On assessment, the nurse notes the presence of hypoactive bowel sounds. Which nursing intervention does the nurse need to include on the client's plan of care? Select all that apply.
1.
Ambulation four times a day in the hall
2.
Intake of 8 ounces of water four times a day
3.
Movement to a chair for meals
4.
Laxative administration at bedtime
5.
Encouragement to pass flatus

1 3 5

Feedback:
1
This is correct. Physical activity, such as getting up in a chair and ambulating, stimulates peristalsis and helps the client regain bowel function.
2
This is incorrect. Eight ounces of fluid four times a day is inadequate fluid intake.
3
This is correct. Physical activity, such as getting up in a chair and ambulating, stimulates peristalsis and helps the client regain bowel function.
4
This is incorrect. A laxative is contraindicated for the client after bowel surgery.
5
This is correct. The client is likely to have flatus following bowel surgery and passing the flatus will promote normal bowel peristalsis. The nurse knows that clients often need to be encouraged to pass flatus.

The nurse is administering a cleansing enema to a client in preparation for a diagnostic test. After inserting the rectal tube, the client becomes quiet and does not respond to verbal stimulus. The nurse stops the enema and discovers a pulse rate of 30 beats/minute. The nurse recognizes that the client is exhibiting a ________ response.

vagal

Feedback: Stimulation of the vagus nerve, known as vagal stimulation, results in bradycardia, which requires that the nurse immediately stop the administration of the enema and place the client in the supine position

The nurse is providing care for a client after the surgical removal of the colon. The nurse is aware that the client has a procedure in which the ____________________ does not drain into an external appliance.

effluent

Feedback: Fecal material that empties into an ostomy appliance is termed effluent.

A ____________________ flush removes flatus, but not stool as with other types of enemas.

harris

Feedback: A return flow enema, also known as a Harris flush, is administered for the purpose of removing flatus, or gas, and not specifically for the removal of stool as with other types of enemas.

When should I be concerned about black stool?

What causes black stool after surgery?

Which of the following clients are at highest risk for fecal impaction?

Is dark brown stool normal?