The nurse provides information about factors related to bowel elimination in the older population

School Test Banks

Potter & Perry: Fundamentals of Nursing,

7th Edition

Test Bank MULTIPLE CHOICE

1. Which of the following would the nurse expect as a normal change in the bowel elimination as a person ages?

2. Absorptive processes are increased in the intestinal mucosa.

3. Esophageal emptying time is increased.

4. Changes in nerve innervation and sensation cause diarrhea.

5. Mastication processes are less efficient.

ANS: 4 An expected change in bowel elimination is decreased chewing and decreased salivation, resulting in less efficient mastication. There is decreased nutrient absorption of the small intestine in the older adult. Esophageal emptying slows, as a result of reduced motility, especially in the lower third of the esophagus. With decreased peristalsis and weakened musculature, the older adult is more prone to constipation. Duller nerve sensations may place the older adult at increased risk for fecal incontinence. 2. An 8-month-old infant is hospitalized with severe diarrhea. The nurse knows that the major problem associated with severe diarrhea is:

1. Pain in the abdominal area

2. Electrolyte and fluid loss

3. Presence of excessive flatus

4. Irritation of the perineal and rectal area

ANS: 2 Excess loss of colonic fluid because of diarrhea can result in serious fluid and electrolyte or acid-base imbalances. Infants and older adults are particularly susceptible to associated complications. Pain from abdominal cramping may occur with diarrhea, but it is not the major problem associated with severe diarrhea. Excessive flatus is not the major problem associated with severe diarrhea. Because

repeated passage of diarrhea stools exposes the skin of the perineum and buttocks to irritating intestinal contents, meticulous skin care and containment of fecal drainage are needed to prevent skin breakdown. The greatest danger of severe diarrhea is a fluid and electrolyte or acid-base imbalance. 3. A 50-year-old male client is having a screening colonoscopy. The nurse instructs the client that:

1. No special preparation is required

2. Light sedation is normally used

3. No metallic objects are allowed

4. Swallowing of an opaque liquid is required

ANS: 2 Light sedation is required for a colonoscopy. Special preparation is required before a colonoscopy. Clear liquids are given the day before and then some form of bowel cleanser, such as GoLytely, is administered. Enemas until clear may also be ordered. There is no restriction of metallic objects for a colonoscopy, not does it require swallowing an opaque liquid. 4. A client is to have a stool test for occult blood. The nurse is instructing the nursing assistant in the correct procedure for the test. The nursing assistant is correctly informed that:

1. Sterile technique is used for collection

2. Stool should be collected over a 3-day period

3. The specimen should be kept warm

4. A 1-inch sample of formed stool is needed

ANS: 4 Tests performed by the laboratory for occult blood in the stool and stool cultures require only a small sample. The nurse uses clean technique to collect about 1 inch of formed stool or 15 to 30 mL of liquid stool. Unlike testing for occult blood, tests for measuring the output of fecal fat require a 3- to 5-day collection of stool, and tests that measure for ova and parasites require the stool to be warm. 5. A client who recently underwent surgery and now has a colostomy is correctly instructed by the nurse that for the next few weeks the clients diet will include foods such as:

1. Vegetables

2. Fresh fruit

3. The client is taking medications to promote defecation. Which of the following instructions should be included by the nurse in the teaching plan for this client?

4. Increased laxative use often causes hyperkalemia.

5. Salt tablets should be taken to increase the solute concentration of the extr

6. Emollient solutions may increase the amount of water secreted into the bo

7. Bulk-forming additives may turn the urine pink.

ANS: 3 Emollient solutions are stool softeners that may increase the amount of water secreted into the bowel. Laxative overuse can cause serious diarrhea that can lead to dehydration and hypokalemia. Salt tablets should not be taken to increase the solute concentration of extracellular fluid. Bulk-forming additives do not turn the urine pink. Phenolphthalein or danthron stimulant cathartics (e., Doxidan, Correctol, Ex-Lax) may cause pink or red urine. 9. While undergoing a soapsuds enema, the client complains of abdominal cramping. The nurse should:

1. Immediately stop the infusion

2. Lower the height of the enema container

3. Advance the enema tubing 2 to 3 inches

4. Clamp the tubing

ANS: 2 The nurse should lower the container if the client complains of abdominal cramping. Cramping may prevent the client from retaining all of the fluid, which would alter the effectiveness of the enema. If the nurse stops the infusion, the client will not receive all of the fluid, and the enema will be less effective. The nurse may slow the infusion until the abdominal cramping passes. The enema tubing should not be advanced further. The tubing may be clamped temporarily if fluid escapes around the rectal tube. The instillation should be slowed in the instance of abdominal cramping. 10. A nurse who is caring for postoperative clients on a surgical unit knows that for 24 to 48 hours postoperatively, clients who have undergone general anesthesia may experience:

1. Colitis

2. Stomatitis

3. Paralytic ileus

4. Gastrocolic reflex

ANS: 3 Any surgery that involves direct manipulation of the bowel temporarily stops peristalsis. This condition, called paralytic ileus, usually lasts about 24 to 48 hours. Colitis is inflammation of the colon. Stomatitis is inflammation of the mouth. The gastrocolic reflex is the peristaltic wave in the colon induced by entrance of food into the stomach. Colitis, stomatitis, and gastrocolic reflex are not caused by anesthetic used during surgery. 11. For clients with hypocalcemia, the nurse should implement measures to prevent:

1. Gastric upset

2. Malabsorption

3. Constipation

4. Fluid secretion

ANS: 3 Disorders of calcium metabolism contribute to difficulty with the passage of stools. The nurse should implement measures to prevent constipation in clients with hypocalcemia. Gastric upset, malabsorption, and fluid secretion are not caused by hypocalcemia. 12. The client is to receive a Kayexalate enema. The nurse recognizes that this is used to:

1. Prevent further constipation

2. Remove excess potassium from the system

3. Reduce bacteria in the colon before diagnostic testing

4. Provide direct antidiarrheal medication to the intestine

ANS: 2 Kayexalate is a type of medicated enema used to treat clients with dangerously high serum potassium levels. This drug contains a resin that exchanges sodium ions for potassium ions in the large intestine. Kayexalate enemas are not used to treat or prevent constipation, and Kayexalate is not a diarrheal medication. Neomycin enemas, not Kayexalate enemas, may be used to reduce bacteria in the colon before diagnostic testing. 13. The appropriate amount of fluid to prepare for an enema to be given to an average-size school-age child is:

1. 150 to 250 mL

be secured to the clients gown, not the bed. The tubing should not be changed daily, but it should be irrigated daily. 16. The nurse instructs the client that before the fecal occult blood test (FOBT) she may eat:

1. Whole wheat bread

2. A lean, T-bone steak

3. Veal

4. Salmon

ANS: 1 Whole wheat bread may be eaten before a fecal occult blood test. A lean, T-bone steak may cause false-positive results if eaten before a fecal occult blood test. Veal may cause false-positive results if eaten before a fecal occult blood test. Salmon may cause false-positive results if eaten before a fecal occult blood test. 17. The nurse is discussing arteriosclerosis and the effects it has on the body with an older adult client. Although the most commonly recognized effect is on the cardiovascular system, the nurse should include which of the following statements regarding its effect on the gastrointestinal system to complete the discussion?

1. Circulatory problems make getting to the bathroom easily problematic.

2. The benefit you get from your food is also decreased by this condition.

3. The aging process that causes the vascular problems also causes eliminati

4. The problem it creates with blood flow also affects blood flow to the bowels

ANS: 4 Systemic changes in the function of digestion and absorption of nutrients result from changes in older clients cardiovascular and neurological systems, rather than their gastrointestinal system. For example, arteriosclerosis causes decreased mesenteric blood flow, thus decreasing absorption from the small intestine. 18. Which of the following statements made by an older adult reflects the best understanding of the role of fiber regarding bowel patterns?

1. The more fiber I eat, the fewer problems I have with my bowels.

2. Whole grain cereal and toast for breakfast keeps my bowels moving regula

3. My wife makes whole grain muffins; they are really good and good for me to

4. I use to have trouble with constipation until I started taking a fiber supplem

ANS: 2

The bowel walls are stretched, creating peristalsis and initiating the defecation reflex. By stimulating peristalsis, bulk foods pass quickly through the intestines, keeping the stool soft. Ingestion of a high- fiber diet improves the likelihood of a normal elimination pattern if other factors are normal. The other options are not as specific about the role of fiber, or they fail to provide an example of a high-fiber food. 19. Which of the following statements made by an older adult reflects the best understanding of the role of fiber regarding good bowel health?

1. Fiber is very effective at cleaning out the bowels.

2. A high-fiber diet results in softer bowel movements.

3. Passing hard, dry stool is more uncomfortable and harder on the bowels.

4. The more fiber there is in my diet, the less risk I have of developing polyps

ANS: 4 When there is no fiber to transport waste matter through the colon, it increases the risk for polyps. Although the other options are not incorrect, they do not address the most important barrier to good bowel health. 20. The nurse is discussing food allergies with a group of mothers whose children are allergy prone. Which of the following statements made by the nurse best describes lactose intolerance?

1. If milk causes diarrhea, cramps, or gas, it might be an intolerance of lactos

2. You dont have to be allergic to dairy for it to cause you problems.

3. Allergies to milk can be very dangerous, even life threatening.

4. Many children outgrow their intolerance of dairy lactose.

ANS: 1 Food intolerance is not an allergy, but a particular food that causes the body distress within a few hours of ingestion. The result is diarrhea, cramps, or flatulence. For example, people who drink cows milk who have these symptoms are not allergic to milk but lack the enzyme needed to digest the milk sugar lactose; they are lactose intolerant**.** 21. The nurse is discussing food allergies with a group of mothers whose children are allergy prone. Which of the following statements made by a mother best describes lactose intolerance?

1. My child is allergic to milk; it makes her very gassy.

2. Your health care provider might prescribe an enema if I call.

ANS: 1 An increase in fluid intake with the use of fruit juices softens stool and increases peristalsis. The remaining interventions are not inappropriate, but they are not the initial intervention for such a complaint. 24. Which of the following statements by a client reporting constipation reflects the most informed understanding of interventions that will aid in assuming proper bowel mobility?

1. Could it be that I need to get more exercise, even here in the hospital?

2. Is it true that drinking coffee often helps stimulate the bowels to work?

3. I guess a little high-fiber cereal might help. Can you get me some from the

4. May I have a cup of decaffeinated tea in addition to my breakfast juice? Th

ANS: 4 Unless there is a medical contraindication, an adult needs to drink six to eight glasses (1500 to 2000 mL) of noncaffeinated fluid daily. An increase in fluid intake with the use of fruit juices softens stool and increases peristalsis. Poor fluid intake increases the risk for constipation because of reabsorption of fluid in the colon, resulting in hard, dry stools. Although the other options are not incorrect, the client does not seem to have past experience with these suggestions. 25. A client is caring for her husband who recently experienced a cerebral vascular accident. She tells the home care nurse that she has been very anxious lately about all the added responsibilities. She adds that she has not been sleeping well and has had several bouts of diarrhea. Which of the following statements by the nurse focuses on the most likely cause of the gastrointestinal problem?

1. Have you experienced increased gas and cramping in addition to the diarrh

2. You are under a lot of stress; that can affect your bowels and result in diarr

3. I suggest you get some over-the-counter medication and keep it on hand to

4. Have you been eating a well-balanced diet since you brought your husband

ANS: 2 During emotional stress the digestive process is accelerated, and peristalsis is increased. Side effects of increased peristalsis are diarrhea and gaseous distention. The remaining options are focused on the most likely cause of the problem, or they are focused on treatment, not cause.

1. A client is caring for her daughter, who recently suffered multiple fractures in an automobile accident. The client tells the home care nurse that she has been really down since all this happened. She adds that she has been constipated and not really interested in eating. Which of the following statements by the nurse focuses on the most likely cause of the gastrointestinal problem?

2. Actually, how long have you been constipated?

3. Are you eating fiber-rich foods like fruit and whole grains?

4. You may be depressed; emotional depression can cause constipation.

5. I suggest you get some over-the-counter mild laxative and see if that helps

ANS: 3 If a person becomes depressed, the autonomic nervous system slows impulses, and peristalsis decreases, resulting in constipation. Although the other options are not incorrect, they are not the most likely cause for this particular client. 27. A 70-year-old client is discussing his recent difficulty with having regular bowel movements while on a cross-country bus tour with a senior citizens group. Which of the following assessment questions is directed toward the most likely cause of the problem?

1. Did the bus stop frequently so you could get up and walk around?

2. Did you eat enough fiber while you were on the trip?

3. Do you find using public restrooms unsettling?

4. Do you have any chronic bowel-related problems?

ANS: 3 Attempting to eliminate in a public restroom sometimes results in a temporary inability to defecate. This embarrassment may prompt clients to ignore the urge to defecate, which begins a vicious cycle of constipation and discomfort. Although the remaining options may affect bowel elimination, the situation of the scenario strongly suggests an emotional cause. 28. The nurse is caring for a 19-year-old male client with a fractured left femur whose leg was pinned 36 hours ago and is now in traction. Which of the following stressors is mostly likely the cause of this clients difficulty related to constipation?

1. Pain related to the fracture and its repair

2. Anxiety regarding the serious nature of the injury

3. The need to defecate in an unfamiliar, awkward position

bacterial flora in the GI tract. The remaining options are not necessarily true. 31. A client is reporting that the oral medication she was prescribed for her hypothyroidism does not seem to be helping. The client goes on to report that she has been experiencing tension-related headaches and constipation. She has been self-medicating with nonsteroidal anti-inflammatory drugs (NSAIDs) and bulk laxatives. Which of the following assessment questions is most likely to provide information regarding this client concern regarding her thyroid problem?

1. How long have you taken Synthroid?

2. What other medications are you currently on?

3. How long have you been taking a bulk laxative?

4. Have you developed any other gastrointestinal symptoms?

ANS: 3 Laxatives often influence the efficacy of other medications by altering the transit time (i., the time the medication remains in the GI tract and is available for absorption). The remaining options would have little bearing on the effectiveness of the hypothyroid medication unless the medication has not been taken long enough to reach therapeutic levels. 32. The nurse is assessing a cognitively impaired older adult client and observes a leaking of liquid stool from the rectum. The nurses initial intervention for this client is to:

1. Determine if the client has been eating sufficiently, especially fiber-rich foo

2. Determine how long it has been since the client had a normal-size, formed

3. Perform a digital examination of the rectum to determine the presence of s

4. Call the health care provider to get a prescription for an antidiarrheal medi

ANS: 1 When a continuous oozing of diarrhea stool occurs, suspect impaction. The liquid portion of feces located higher in the colon seeps around the impacted mass. An obvious sign of impaction is the inability to pass a stool for several days, despite the repeated urge to defecate. The digital examination should be performed after it has been determined that the client has been without a normal bowel movement for several days. Although the remaining options are not inappropriate, they would not be the initial intervention. 33. The greatest risk for injury for a client who has fecal

incontinence is:

1. Perineal and rectal skin breakdown

2. The contamination of existing wounds

3. Falls resulting from attempts to reach the bathroom

4. Cross-contamination into the upper gastrointestinal tract

ANS: 1 Fecal incontinence is a potentially dangerous condition in terms of contamination and risk for skin ulceration. The greatest risk to the otherwise healthy individual is skin breakdown. Although the other options may be risk factors, they are not as great as that of skin breakdown. 34. The nurse is providing ancillary personnel with instructions regarding the proper methods to implement when caring for a client with a Clostridium difficile infection. Which of the following practices will have the greatest impact on containment of the bacteria and thus prevention of cross-contamination?

1. Frequent in-services on transmission modes of C. difficile

2. Practice of proper hand hygiene by all staff

3. Appropriate handling of contaminated linen

4. Stool cultures on all suspected carriers

ANS: 2 Poor hand hygiene and erratic disinfection practices result in the transmission of C. difficile. Stool cultures are useful in the diagnosis, not the prevention, of C. difficile. Although the other options are appropriate, they do not have the most impact on preventing the spread of these bacteria. 35. Which of the following clients is at greatest risk for serious complications when using the Valsalva maneuver to expel feces?

1. 25-year-old pregnant client

2. 66-year-old male with hypertrophied prostate disease

3. 44-year-old male client with glaucoma

4. 53-year-old female with stomach cancer

ANS: 3 Clients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk, such as cardiac irregularities and elevated blood pressure, with this maneuver and need to avoid straining to pass the stool. Although

extremities. Clients should be able to eat following nonbowel-related surgery whether or not they have undergone a general anesthetic or a local anesthetic. 38. A 44-year-old male client was placed on a daily low-dose aspirin regimen by his health care provider following a recent diagnosis of hypertension and periodic atrial fibrillation. The client is currently hospitalized with renal stones. As the nurse is admitting the client, he shares that he has been very tired. The nurse gathers additional data regarding his bowel habits. The client shares that he has recently had black, tarry stools. The nurse is most concerned that the client may have:

1. Colon cancer

2. A GI bleed from the aspirin therapy

3. Ongoing atrial fibrillation

4. Electrolyte imbalance

ANS: 2 Although the client could have any one of the items mentioned, it is most likely that the aspirin is causing a GI bleed. The loss of blood can cause the client to be fatigued. Aspirin is a prostaglandin inhibitor, which interferes with the formation and production of protective mucus and causes GI bleeding. 39. The nurse is counseling a 65-year-old female client on her use of mineral oil as a laxative. One of the most important things that the nurse can share with the client is how mineral oil can cause the decreased absorption of which of the following vitamins?

1. Vitamin C

2. Niacin

3. Vitamin D

4. Riboflavin

ANS: 3 Mineral oil, a common laxative, decreases fat-soluble vitamin absorption. Vitamin D is the only fat-soluble vitamin listed the others are all water-soluble. 40. An active 25-year-old female client shared with the nurse that ever since she had gone on a high-protein low-carbohydrate diet she had suffered from constipation. The client states that the diet is working for her in terms of weight loss and would like to stay on it. The best response from the nurse is that the client should try:

1. Consuming more low-carbohydrate fiber-rich foods like broccoli, raspberries

2. Taking a laxative when feeling constipated

3. Try a different diet with less tendency to cause constipation

4. Exercise more

ANS: 1 A low-fiber diet high in animal fats (e., meats, dairy products, eggs) can slow peristalsis, leading to constipation. By consuming fiber-rich low-carbohydrate foods, the client can still maintain weight loss while avoiding constipation. The client could develop a dependence on laxatives by using them on a regular basis. The client has expressed a desire to remain on the diet she is currently on, and it seems to be working to help her lose weight. Because client is already active, additional activity is not likely to have a profound effect on relieving the constipation. 41. The nurse knows that the client receiving enteral feedings is at risk for diarrhea. One of the measures that the nurse can take to minimize the risk for diarrhea in this client is:

1. Making sure to chill the canned feeding before administering

2. Using strict sanitation when administering the formula

3. Not deviating from the prescribed rate of delivery for the formula

4. Not diluting or changing the strength of the prescribed formula

ANS: 2 Interventions to prevent diarrhea include the following: administer canned formulas at room temperature, follow strict sanitation when preparing the formula, increase the rate slowly, administer the volume at a rate tolerable to your client, or if using a hypertonic solution, give the initial feeding at half strength and gradually increase the volume to allow the client to adjust to a hypertonic solution. Consult a dietitian when diarrhea occurs. 42. Upon auscultation of the clients abdomen, the nurse hears hyperactive bowel sounds (greater than 35 per minute). The nurse knows that this can indicate which of the following?

1. Paralytic ileus

2. Fecal impaction

3. Small intestine obstruction

4. Abdominal tumor

ANS: 3

certain vitamins, iron, and salt (which are absorbed in the ileum). Food is broken down in the stomach. The cecum is the beginning of the large intestine. 2. The nurse would expect the least formed stool to be present in which portion of the digestive tract?

a . Ascending

b . Descending

c . Transverse

d . Sigmoid ANS: A The path of digestion goes from the ascending, across the transverse, to the descending and finally passing into the sigmoid; therefore, the least formed stool would be in the ascending. 3. Which of the following is not a function of the large intestine? a . Absorbing nutrients

b . Absorbing water

c . Secreting bicarbonate

d . Eliminating waste ANS: A Nutrient absorption is done in the small intestine. The other options are all functions of the large intestine. 4. The nurse is caring for a patient who is confined to the bed. The nurse asks the patient if he needs to have a bowel movement 30 minutes after eating a meal because

a .

The digested food needs to make room for recently ingested food.

b .

Mastication triggers the digestive system to begin peristalsis.

c .

The smell of bowel elimination in the room would deter the patient from eating.

d More ancillary staff members are available after meal

. times. ANS: B Peristalsis occurs only a few times a day; the strongest peristaltic waves are triggered by mastication of the meal. The intestine can hold a great deal of food. A patients voiding schedule should not be based on the staffs convenience. 5. A nurse is assisting a patient in making dietary choices that promote healthy bowel elimination. Which menu option should the nurse recommend?

a .

Grape and walnut chicken salad sandwich on whole wheat bread

b . Broccoli and cheese soup with potato bread

c .

Dinner salad topped with hard-boiled eggs, cheese, and fat-free dressing

d . Turkey and mashed potatoes with brown gravy ANS: A A healthy diet for the bowel should include foods high in bulk- forming fiber. Whole grains, fresh fruit, and fresh vegetables are excellent sources. Foods without much fiber and with high levels of fat can slow down peristalsis, causing constipation. 6. A patient informs the nurse that she was using laxatives three times daily to lose weight. After stopping use of the laxative, the patient had difficulty with constipation and wonders if she needs to take laxatives again. The nurse educates the patient that

a .

Long-term laxative use causes the bowel to become less responsive to stimuli, and constipation may occur.

b .

Laxatives can cause trauma to the intestinal lining and scarring may result, leading to decreased peristalsis.

c .

Natural laxatives such as mineral oil are safer than chemical laxatives for relieving constipation.

d .

Laxatives cause the body to become malnourished, so when the patient begins eating again, the body absorbs all of the food, and no waste products are produced.

Which assessment finding does the nurse associate with a problem with bowel elimination?

What is bowel elimination in nursing?

Which question would the nurse ask first to obtain information about the patient's bowel habits?

What would the nurse recommend to promote normal bowel function?