Chapter 28 - Bowel Elimination (Week 6 Quiz) Flashcards Preview

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Flashcards in Chapter 28 - Bowel Elimination (Week 6 Quiz) Deck (86):
1

T or F: Normal flora in the colon aid in the digestive process and produce vitamins such as K and B's.

True.

2

What are the major functions of the small intestine and large intestine?

Answer:
The intestine has the following major functions:
● Small intestine. The major function of the small intestine is the digestion and absorption of carbohydrates, fat, and protein.
● Large intestine. The major function of the large intestine is the absorption of water, vitamins, and minerals.

3

How do the rectum and anus control elimination of feces from the body?

Answer:
Normally, the rectum is free of waste products until just before defecation. Feces and flatus (gas) are expelled from the rectum through the anus. The anus has two ringlike muscles that function as sphincters. The internal sphincter relaxes and opens when feces is present in the rectum. This is an involuntary reaction. The external sphincter is under voluntary control. Relaxation of the external sphincter allows feces, or stool, to be expelled from the body.

4

Feces are usually brown in color because of _____ _____.

Bile Salts

5

Feces are usually brown in color because of _____ _____.

Bile Salts.

golden yellow Bile + bacteria = brown

6

What is considered "normal" when it comes to bowel function?

Answer:
There is a wide range of “normal.” The frequency of BMs may range from several times per day to once per week. Bowel function may be regarded as normal as long as stools are passed without excessive urgency (needing to rush to the toilet), with minimal effort and no straining, without blood loss, and without the use of laxatives.

7

Identify the factors that affect bowel elimination.

Answer:
The following factors affect bowel elimination:
● Age
● Stress
● Dietary intake
● Fluid intake
● Activity
● Medications
● Surgery
● Anesthesia
● Pregnancy
● Pathological conditions (e.g., food allergies and intolerances, diverticulosis, diverticulitis)

8

What is the process of bowel elimination?

Fecal material reaches rectum
Stretch receptors initiate contraction of sigmoid colon/rectal muscles
Internal anal sphincter relaxes
Sensory impulses cause voluntary “bearing down”
External sphincter relaxes

9

Identify the factors that affect bowel elimination.

Answer:
The following factors affect bowel elimination:
● Age:
-infants=newborns pass meconium
● Stress
● Dietary intake
● Fluid intake
● Activity
● Medications
● Surgery
● Anesthesia
● Pregnancy
● Pathological conditions (e.g., food allergies and intolerances, diverticulosis, diverticulitis)

10

What is meconium?

newborn passes meconium through the anus. It is green-black, tarry, and sticky and is formed by swallowed mucous, hair and amniotic fluid. It is odorless. Stool transition to yellow-green color over the next few days.

11

Identify the factors that affect bowel elimination.

Answer:
The following factors affect bowel elimination:
● Age:
-INFANTS=newborns pass meconium; transitions to yellow-green. Bottle fed becomes tan, breastfed is yellow. As normal flora develop it becomes firm and less frequent.
-CHILDREN=toilet training
ADULT = childhood habits are set and continue
● Stress
● Dietary intake
● Fluid intake
● Activity
● Medications
● Surgery
● Anesthesia
● Pregnancy
● Pathological conditions (e.g., food allergies and intolerances, diverticulosis, diverticulitis)

12

What is meconium?

newborn passes meconium through the anus. It is green-black, tarry, and sticky and is formed by swallowed mucous, hair and amniotic fluid. It is odorless. Stool transition to yellow-green color over the next few days.

13

Why do we wait until 2-3 years of age to toilet train?

Ability to control defecation develops around this age.
Toilet training requires neural and muscular control as well as conscious effort. Child must be aware of the urge to go, able to maintain closure of external sphincter while getting to toilet and removing clothing.

14

T or F: Peristalsis, intestinal smooth muscle tone, perineal muscle tone, and sphincter control normally decrease with aging.

True.

Decreased fiber and activity can make it even worse.

15

Identify the factors that affect bowel elimination.

Answer:
The following factors affect bowel elimination:
● Age:
-INFANTS=newborns pass meconium; transitions to yellow-green. Bottle fed becomes tan, breastfed is yellow. As normal flora develop it becomes firm and less frequent.
-CHILDREN=toilet training
ADULT = childhood habits are set and continue
● Stress - can lead to IBS
● Dietary intake - regular pattern of eating = regular pattern of defection; fiber promotes peristalsis; fluids; supplements
● Fluid intake
● Activity
● Medications
● Surgery
● Anesthesia
● Pregnancy
● Pathological conditions (e.g., food allergies and intolerances, diverticulosis, diverticulitis)

16

What foods promote peristalsis?

Fibrous foods! They bulk the stool and initiate peristalsis.

Good sources are: fruit, berries, dried fruits, vegetables (raw esp), whole grain cereal, flaxseed, popcorn, dried beans/peas/legumes.

17

How much water should you drink in a day for healthful bowel function?

6-8 8oz glasses per day

18

Identify the factors that affect bowel elimination.

Answer:
The following factors affect bowel elimination:
● Age:
-INFANTS=newborns pass meconium; transitions to yellow-green. Bottle fed becomes tan, breastfed is yellow. As normal flora develop it becomes firm and less frequent.
-CHILDREN=toilet training
ADULT = childhood habits are set and continue
● Stress - can lead to IBS
● Dietary intake - regular pattern of eating = regular pattern of defection; fiber promotes peristalsis; fluids; supplements
● Fluid intake
● Activity
● Medications-antacids, NSAIDs,
● Surgery
● Anesthesia
● Pregnancy
● Pathological conditions (e.g., food allergies and intolerances, diverticulosis, diverticulitis)

19

Identify the factors that affect bowel elimination.

Answer:
The following factors affect bowel elimination:
● Age:
-INFANTS=newborns pass meconium; transitions to yellow-green. Bottle fed becomes tan, breastfed is yellow. As normal flora develop it becomes firm and less frequent.
-CHILDREN=toilet training
ADULT = childhood habits are set and continue
● Stress - can lead to IBS
● Dietary intake - regular pattern of eating = regular pattern of defection; fiber promotes peristalsis; fluids; supplements
● Fluid intake
● Activity
● Medications-antacids, NSAIDs, antibiotics, iron, opioids, laxatives
● Surgery
● Anesthesia
● Pregnancy
● Pathological conditions (e.g., food allergies and intolerances, diverticulosis, diverticulitis)

20

If someone takes Iron, what might you expect to happen to their bowel movements? Feces?

causes constipation
stool comes out back
causes nausea if not food was eaten with it

21

Why do antibiotics cause constipation?

They decrease the normal flora in the colon.

Patients should take probiotics or eat yogurt daily while taking them to prevent this problem

22

Identify the factors that affect bowel elimination.

Answer:
The following factors affect bowel elimination:
● Age:
-INFANTS=newborns pass meconium; transitions to yellow-green. Bottle fed becomes tan, breastfed is yellow. As normal flora develop it becomes firm and less frequent.
-CHILDREN=toilet training
ADULT = childhood habits are set and continue
● Stress - can lead to IBS
● Dietary intake - regular pattern of eating = regular pattern of defection; fiber promotes peristalsis; fluids; supplements
● Fluid intake
● Activity
● Medications-antacids, NSAIDs, antibiotics, iron, opioids, laxatives
● Surgery - anesthesia, stress, manipulation of bowel during surgery
● Anesthesia
● Pregnancy
● Pathological conditions (e.g., food allergies and intolerances, diverticulosis, diverticulitis)

23

What is a paralytic ileus?

a cessation of bowel peristalsis. Bowel continues to produce secretions, but without peristalsis, secretions are stagnant.

NG tube with intermittent or constant suction is used until peristalsis returns.

24

Identify the factors that affect bowel elimination.

Answer:
The following factors affect bowel elimination:
● Age:
-INFANTS=newborns pass meconium; transitions to yellow-green. Bottle fed becomes tan, breastfed is yellow. As normal flora develop it becomes firm and less frequent.
-CHILDREN=toilet training
ADULT = childhood habits are set and continue
● Stress - can lead to IBS
● Dietary intake - regular pattern of eating = regular pattern of defection; fiber promotes peristalsis; fluids; supplements
● Fluid intake
● Activity - decreased mobility, perineal surgery, anal sphincter surgery
● Medications-antacids, NSAIDs, antibiotics, iron, opioids, laxatives
● Surgery - anesthesia, stress, manipulation of bowel during surgery
● Anesthesia
● Pregnancy - fluid loss from morning sickness
● Pathological conditions (e.g., food allergies and intolerances, diverticulosis, diverticulitis)

25

What is the BRAT diet?

bananas rice applesauce toast.

These foods are used for people who have experienced stomach upset due to IBS, food poisoning, etc. Easy on the tummy. They are also calorie dense help offset potassium loss, and are easy to digest

26

What is the BRAT diet?

bananas rice applesauce toast.

These foods are used for people who have experienced stomach upset due to IBS, food poisoning, etc. Easy on the tummy.

27

What is the BRAT diet?

bananas rice applesauce toast.

These foods are used for people who have experienced stomach upset due to IBS, food poisoning, etc. Easy on the tummy.

28

Identify the factors that affect bowel elimination.

Answer:
The following factors affect bowel elimination:
● Age:
-INFANTS=newborns pass meconium; transitions to yellow-green. Bottle fed becomes tan, breastfed is yellow. As normal flora develop it becomes firm and less frequent.
-CHILDREN=toilet training
ADULT = childhood habits are set and continue

● Stress - can lead to IBS

● Dietary intake - regular pattern of eating = regular pattern of defection; fiber promotes peristalsis; fluids; supplements - calcium constipates but magnesium loosens stools.

● Fluid intake - 6 to 8 8-ounce glasses

● Activity - decreased mobility, perineal surgery, anal sphincter surgery

● Medications-antacids, NSAIDs, antibiotics, iron, opioids, laxatives

● Surgery - anesthesia, stress, manipulation of bowel during surgery

● Anesthesia

● Pregnancy - fluid loss from morning sickness

● Pathological conditions (e.g., food allergies and intolerances, diverticulosis, diverticulitis)


29

What foods promote peristalsis?

Fibrous foods! They bulk the stool and initiate peristalsis.

Good sources are: fruit, berries, dried fruits, vegetables (raw esp), whole grain cereal, flaxseed, popcorn, dried beans/peas/legumes.

Bacteria in yogurt stimulate peristalsis and promote healing of intestinal infection (good to eat after some intestinal issues)

30

What are symptoms of food allergies?

-rash
-anaphylactic shock
-bloating
-constipation/diarrhea
-red, blistering rash around the anus
-abdominal discomfort
-excessive gas
-intestinal bleeding

31

What are symptoms of food allergies?

-rash
-anaphylactic shock

Common GI symptoms suggesting food allergy are:
-bloating
-constipation/diarrhea
-red, blistering rash around the anus
-abdominal discomfort
-excessive gas
-intestinal bleeding

32

What is the difference between food intolerance and food allergy?

Same symptoms but allergy is immune response based, whereas intolerance is not immune related. It could be enzyme related ie lactose intolerance


symptoms
-bloating
-constipation/diarrhea
-pain
-abdominal discomfort
-gas

33

What is the difference between diverticulosis and diverticulitis?

Diverticulosis is when the colon must repeatedly move highly compacted fecal material, over time the longitudinal and circular muscles enlarge.

34

What is the difference between diverticulosis and diverticulitis?

Diverticulosis is when the colon must repeatedly move highly compacted fecal material, over time the longitudinal and circular muscles enlarge. pouches are created. Diverticula are present in the intestine WITHOUT signs of inflammation.

Diverticulitis is when these said pouches become infected. (Say good bye to sesame seeds, strawberries, etc.)

caused by diets low in fiber or consist of mainly refined foods

35

What changes in bowel elimination are associated with constipation? With diarrhea?


Answer:
The following changes in bowel elimination are associated with these conditions:
● Constipation is a decrease in frequency of BMs. As the length of time between BMs increases, more water is reabsorbed from the feces. As a result, constipation is also associated with passage of dry, hard stool that requires more effort to pass.
● Diarrhea is an increase in the frequency of BMs. As transit time through the colon decreases, less water is reabsorbed and stools are often watery.

36

Why are bowel diversions performed?


Answer:
A bowel diversion is a surgically created opening for elimination of digestive waste products from the bowel. This procedure is performed for clients with a variety of conditions, including cancer, ulcerations, trauma, or inadequate blood supply. Temporary diversions are performed to allow healing of the distal portion of the bowel; permanent diversions are performed in instances of severe disease or trauma when the bowel is necrotic or cannot be salvaged.

37

What is the difference between a bowel diversion close to the ileocecal valve versus one near the rectum?

the ileocecal valve: constant flow of liquid effluent (flows out)

the rectum: effluent resembles feces

38

what does reanastomosis mean?

reconnection of the bowel after temporary bowel diversion

39

What is the difference in the effluent seen in a bowel diversion close to the ileocecal valve versus one near the rectum?

the ileocecal valve: constant flow of liquid effluent (flows out)

the rectum: effluent resembles feces



The effluent may range from liquid to solid depending on the part of the bowel that is being diverted. The lower in the bowel the colostomy is placed (i.e., the closer to the rectum and anus), the more solid the effluent. Because the fecal matter stays in the bowel longer, more water can be absorbed from it, and it becomes more solid.

40

An _______ brings a portin of the ileum through a surgical opening in the abdomen, bypassing the large intestine completely.

ileostomy

41

An _______ brings a portin of the ileum through a surgical opening in the abdomen, bypassing the large intestine completely.

ileostomy

constant wear of appliance to collect drainage

42

What is the benefit to Kock Pouch and illeoanal reservoir?

Free from ostomy appliance. POuch can be emptied manually, ileoanal a person uses commode although stool will be liquid since it skips the large intestine (aka reabsorption of water).

43

What is the benefit to Kock Pouch and ileoanal reservoir?

Free from ostomy appliance. POuch can be emptied manually, ileoanal a person uses commode although stool will be liquid since it skips the large intestine (aka reabsorption of water).

44

What should you discuss with your client when performing a nursing history focused on bowel elimination?

(Watch reactions, the pt may be embarassed)


Answer:
The following items should be part of a nursing history focused on bowel elimination:
● Normal bowel pattern
● Appearance of stool
● Changes in bowel habits or stool appearance
● History of elimination problems
● Use of bowel elimination aids, including diet, exercise, medications, and remedies

45

Read p.687 table 28-1

normal characteristics of feces and variations

46

____ bowel sounds are high pitched with approx 5 to 15 gurgles every minute

normal

47

______ bowel sounds are very high pitched and more frequent than normal.

hyperactive

48

_____ bowel sounds are low-pitched, infrequent, and quiet.

hypoactive

49

_____ bowel sounds = no bowel sounds after 3-5 minutes of listening.

absent (could be caused by lack of intestine activity of paralytic ileus).

50

Describe the physical assessment you would perform for a client with constipation.

Answer:
Physical assessment for bowel elimination includes examination of the abdomen, rectum, and anus.
● Recall that in abdominal assessment, the order of the exam is inspection, auscultation, percussion, and palpation.
● Observe the size, shape, and contour of the abdomen, and listen to bowel sounds.
● Percuss and palpate the abdomen for tenderness, presence of air or solid, and presence of masses.
● Inspect the anus for signs of hemorrhoids.
● Depending on the policies of your institution as well as your skill with assessment, you might also palpate the anus and rectum for the presence of stool or masses.

51

White or clay colored stool may indicate absence of?

bile (could also be caused by use of antacids...ask your patient!)

52

Common Diagnostic Tests include:

Direct visualization (long tube into the rectum, has camera):
Colonoscopy (colon) 50+
Sigmoidoscopy (sigmoid colon)


Radiographic views:
Flat plate of the abdomen – Anterior Posterior Lateral (AP Lateral)


Laboratory studies (of feces):
Stool for occult blood
Stool for fecal fat -
Stool for ova and parasites

53

Common Diagnostic Tests include:

Direct visualization (long tube into the rectum, has camera): INVASIVE!! Can see directly into colon.
Colonoscopy (colon) 50+
Sigmoidoscopy (sigmoid colon)


(indirect) Radiographic views:
Flat plate of the abdomen – Anterior Posterior Lateral (AP Lateral) used to detect gallstones, fecal impaction and distended bowel.


Laboratory studies (of feces):
(typically need 1 inch or 20-30mL)
Stool for occult blood
Stool for fecal fat -
Stool for ova and parasites

54

What foods should be avoided for three days before a blood occult test?

Can cause false positive!


Food: red meat, chicken, fish, horseradish, and some raw fruits/veggies such as radishes.

55

Besides food, what Can cause false test results for an occult blood test?

False positive
+bleeding gums
+menstruation


False negative
-ingestion of a large amount of vitamin C

56

The nurse knows that the results of a fecal occult blood test can be inaccurate if

a. the client has had an excessive intake of red meat
b. the female client is menstruating
c. the client takes high doses of vitamin C
d. all of the above

Correct answer: D

57

Identify at least five independent nursing actions that you could take to encourage regular elimination in a well client.


Answer:
The following nursing actions encourage regular elimination in a well client:
● Provide privacy when using the bathroom
● Allow for uninterrupted time to defecate, especially after meals
● Teach the client to do the following:
● Assume a seated or squatting position when attempting to have a BM
● Drink at least 1,500 mL (preferably 8 to 10 glasses, or 2,000 to 2,400 mL) of fluid per day
● Exercise 3 to 5 times per week

58

How do you assess for pinworms?

Pinworms deposit eggs in the anus during the night. To assess the child, use tape. In the early morning, press clear cellophane tape against the anal opening. You can tape to slide. They will be visible.

59

T or F: You should consider a person's "normal" for BMs before creating goals for the patient during the nursing process.

True

60

T or F: passive range of motion can promote peristalsis.

truep. 690

61

When should a patient see a dr about bowel issues?

when symptoms last longer than three weeks:

blood in stool
severe stomach pain
change in bowel habits
unintended weight loss
constipation is not relieved

62

What are primary concerns for someone who has diarrhea?

loss of water and potassium

63

T or F: You should use antidiarrheals to treat acute diarrhea.

False, it is not recommended to use antidiarrheals for acute diarrhea that is a response to infection. In this case, diarrhea is attempting to ride itself of the pathogens

64

Cleansing enemas are either hypotonic or hypertonic. How do they work?

hypotonic introduces large volume of fluid into the rectum leading to intestinal distention and rapid evacuation of stool.

hypertonic are smaller in volume. They attract water into the colon causing distension and stimulation of persistalsis / defecation.

65

T or F: You need a prescription from the primary care provider to perform a digital removal of stool.

True.

The pressure generated in the rectum may stimulate the vagus nerve, slowing the heart rate.

p.695 safety

66

What is most important before inserting rectal tube?

lubrication. keep from damaging sensitive tissues inside the rectum.

67

Review p.695

critical aspects of procedures 28:1-28:8B

68

Identify the types of enemas available for use.

Answer:
Enemas may be classified as follows:
● Cleansing
● Retention
● Return-flow (Harris flush)

69

● How do hypotonic and isotonic enemas differ from hypertonic enemas?

Answer:
The enemas have the following differences:
● Hypotonic and isotonic enemas are large-volume enemas. The volume causes intestinal distention and leads to rapid evacuation of stool.
● Hypertonic enemas are usually smaller volume (2.5–4 ounces or 70–120 mL). The hypertonic solution attracts water into the colon, causing distention and stimulating peristalsis and defecation. Patients are usually able to retain hypotonic and isotonic longer than hypertonic solutions. Hypertonic solutions are more irritating to the mucosa.

70

What actions can you take to make the patient more comfortable when he receives an enema?

Answer:
The following actions make the patient more comfortable when receiving an enema:
● Explain the purpose of the enema and what the patient can expect.
● Always provide privacy when administering an enema.
● Reassure the patient that you will be immediately available to help the patient to the restroom or onto the bedpan.
● Lubricate the tip of the enema and administer the solution slowly.
● Have the patient breathe slowly through the mouth.

71

What are the major patient care concerns associated with bowel incontinence?


Answer:
Major concerns associated with bowel incontinence include patient embarrassment, anxiety, social isolation, and lowered self-concept. In addition, clients with bowel incontinence are at risk for skin breakdown.

72


● What are the elements of a bowel training program?


Answer:
A bowel training program includes the following elements:
● Planning the program with the patient and caregiver
● Gradually increasing fluid, fiber, and activity to promote regular bowel movements
● Initiating a designated uninterrupted time, in private, to defecate
● Developing a staged treatment plan when constipation develops
● Regularly modifying the plan based on the patient’s response

73

How do hypotonic and isotonic enemas differ from hypertonic enemas?

Answer:
The enemas have the following differences:
● Hypotonic and isotonic enemas are large-volume enemas. The volume causes intestinal distention and leads to rapid evacuation of stool.
● Hypertonic enemas are usually smaller volume (2.5–4 ounces or 70–120 mL). The hypertonic solution attracts water into the colon, causing distention and stimulating peristalsis and defecation. Patients are usually able to retain hypotonic and isotonic longer than hypertonic solutions. Hypertonic solutions are more irritating to the mucosa.

74


What are the elements of a bowel training program?


Answer:
A bowel training program includes the following elements:
● Planning the program with the patient and caregiver
● Gradually increasing fluid, fiber, and activity to promote regular bowel movements
● Initiating a designated uninterrupted time, in private, to defecate
● Developing a staged treatment plan when constipation develops
● Regularly modifying the plan based on the patient’s response

75

What does a healthy stoma look like?


Answer:
A healthy stoma is colored from deep pink to brick red regardless of skin color and is shiny and moist at all times. The stoma will protrude above the level of the abdomen by approximately 0.5 to 1.0 inches.

Unhealthy stoma:
Blue = ischemia
black = necrosis

76

Why is skin care around a stoma so important?

Answer:
Skin care around a stoma is essential to prevent skin breakdown, which may lead to infection, discomfort, and leakage of ostomy output from around the appliance.

77

How can you help a patient adapt psychologically to living with a bowel diversion?


Answer:
The following nursing interventions help a patient adapt psychologically to a bowel diversion (other answers are possible):
● Being willing to talk with a patient about his reaction to the stoma and concerns about living with an ostomy
● Taking a caring approach when providing stoma care
● Allowing adequate time for the patient to learn about self-care
● Coordinating a visit by a volunteer from the United Ostomy Association
● Providing information about a community support group of people living with an ostomy or other bowel diversion

78

How can you help a patient adapt to living with a bowel diversion?


Answer:
The following nursing interventions help a patient adapt psychologically to a bowel diversion (other answers are possible):
● Being willing to talk with a patient about his reaction to the stoma and concerns about living with an ostomy
● Show acceptance when working with the pt
● Taking a caring approach when providing stoma care
● Allowing adequate time for the patient to learn about self-care
● provide adequate ventilation and odor control
● teach about diet alterations
● Coordinating a visit by a volunteer from the United Ostomy Association
● Providing information about a community support group of people living with an ostomy or other bowel diversion

79

If you notice a stoma is pale, dusky, or black in color, dry; or with sloughing tissues, what do you do?

Immediately report to the surgeon. These are signs of inadequate blood supply to the portion of the intestine that has been externalized.

p.701 patient safety

80

Normal flora contained in the colon aid digestion and produce which nutrients?

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.

81

hen 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 nonsteroidal anti-inflammatory drugs (NSAIDs). Iron supplementation may cause flatulence.

82

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.

83

The nurse has taught a client how to manage constipation. Which action by the client would provide evidence of learning? (Select all that apply.) The patient:

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.

84

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.

85

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 side rail on the opposite side from where you are working.

Answer:
4) Raise the side rail on the opposite side from where you are working.

Rationale:
The nurse should always raise the side rail 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.

86

Mrs. Addie is 70 years old. While the nurse is gathering admission assessment data, the patient states, “I’ve taken a tablespoon of Milk of Magnesia every day for 3 years.” Which nursing diagnosis is most appropriate for the nurse to use in her plan of care?
a. Diarrheab. Constipationc. Risk for Ineffective Therapeutic Regimend. Perceived Constipation

Correct answer: D

Daily laxative use by the patient might suggest that she perceives she is constipated, and the nurse would gather further assessment data related to the client’s bowel pattern. There is not enough data to infer actual constipation.