CHAPTER 43 Nursing Management Lower Gastrointestinal Problems (9th Edition) // CHAPTER 42 Lower Gastrointestinal Problems (10th Edition) Flashcards Preview

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*** 1. The appropriate collaborative therapy for the patient with acute diarrhea caused by a viral infection is to

a. increase fluid intake.

b. administer an antibiotic.

c. administer antimotility drugs.

d. quarantine the patient to prevent spread of the virus.

a. increase fluid intake.

Acute diarrhea resulting from infectious causes (e.g., virus) is usually self-limiting. The major concerns are transmission prevention, fluid and electrolyte replacement, and resolution of the diarrhea. Antidiarrheal agents are contraindicated in the treatment of infectious diarrhea because they potentially prolong exposure to the infectious organism. Antibiotics are rarely used to treat acute diarrhea. To prevent transmission of diarrhea caused by a virus, hands should be washed before and after contact with the patient and when body fluids of any kind are handled. Vomitus and stool should be flushed down the toilet, and contaminated clothing should be washed immediately with soap and hot water.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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Ashley A.

2

2. When a 35-year-old female patient is admitted to the emergency department with acute abdominal pain, which possible diagnosis should you consider that may be the cause of her pain?
Select all that apply.

a. Gastroenteritis

b. Ectopic pregnancy

c. Gastrointestinal bleeding

d. Irritable bowel syndrome

e. Inflammatory bowel disease

a. Gastroenteritis

b. Ectopic pregnancy

c. Gastrointestinal bleeding

d. Irritable bowel syndrome

e. Inflammatory bowel disease

All these conditions could cause acute abdominal pain.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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3

*** 3. Assessment findings suggestive of peritonitis include

a. rebound abdominal pain.

b. a soft, distended abdomen.

c. dull, continuous abdominal pain.

d. observing that the patient is restless.

a. rebound abdominal pain.

With peritoneal irritation, the abdomen is hard, like a board, and the patient has severe abdominal pain that is worse with any sudden movement. The patient lies very still. Palpating the abdomen and releasing the hands suddenly causes sudden movement within the abdomen and severe pain. This is called rebound tenderness.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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Amanda Z.

4

*** 4. In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease

a. frequently results in toxic megacolon.

b. causes fewer nutritional deficiencies than ulcerative colitis.

c. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy.

d. is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis.

c. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy.

Ulcerative colitis affects only the colon and rectum; it can cause megacolon and rectal bleeding, but not nutrient malabsorption. Surgical removal of the colon and rectum cures it. Crohn’s disease usually involves the ileum, where bile salts and vitamin cobalamin are absorbed. After surgical treatment, disease recurrence at the site is common.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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Amanda Z.

5

5. The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that manifestations of an obstruction in the large intestine are:
Select all that apply.

a. persistent abdominal pain.

b. marked abdominal distention.

c. diarrhea that is loose or liquid.

d. colicky, severe, intermittent pain.

e. profuse vomiting that relieves abdominal pain.

a. persistent abdominal pain.

b. marked abdominal distention.

With lower intestinal obstructions, abdominal distention is markedly increased and pain is persistent. Onset of a large intestine obstruction is gradual, vomiting is rare, and there is usually absolute constipation, not diarrhea.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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6

*** 6. A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that

a. chemotherapy will begin after the patient recovers from the surgery.

b. both chemotherapy and radiation can be used as palliative treatments.

c. follow-up colonoscopies will be needed to ensure that the cancer does not recur.

d. a wound, ostomy, and continence nurse will visit the patient to identify an abdominal site for the ostomy.

c. follow-up colonoscopies will be needed to ensure that the cancer does not recur.

Stage 1 colorectal cancer is treated with surgical removal of the tumor and reanastomosis, and so there is no ostomy. Chemotherapy is not recommended for stage I tumors. Follow-up colonoscopy is recommended because colorectal cancer can recur.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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Kaitlin G.

7

*** 7. The nurse explains to the patient undergoing ostomy surgery that the procedure that maintains the most normal functioning of the bowel is

a. a sigmoid colostomy.

b. a transverse colostomy.

c. a descending colostomy.

d. an ascending colostomy.

a. a sigmoid colostomy.

The more distal the ostomy is, the more the intestinal contents resemble feces eliminated from an intact colon and rectum. Output from a sigmoid colostomy resembles normally formed stool, and some patients are able to regulate emptying time so they do not need to wear a collection bag.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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Leslie G.

8

*** 8. In contrast to diverticulitis, the patient with diverticulosis

a. has rectal bleeding.

b. often has no symptoms.

c. has localized cramping pain.

d. frequently develops peritonitis.

b. often has no symptoms.

Many people with diverticulosis have no symptoms. Patients with diverticulitis have symptoms of inflammation. Diverticulitis can lead to obstruction or perforation.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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Leslie G.

9

*** 9. A nursing intervention that is most appropriate to decrease postoperative edema and pain after an inguinal herniorrhaphy is

a. applying a truss to the hernia site.

b. allowing the patient to stand to void.

c. supporting the incision during coughing.

d. applying a scrotal support with ice bag.

d. applying a scrotal support with ice bag.

Scrotal edema is a painful complication after an inguinal hernia repair. Scrotal support with application of an ice bag may help relieve pain and edema.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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Leslie G.

10

*** 10. The nurse determines that the goals of dietary teaching have been met when the patient with celiac disease selects from the menu

a. scrambled eggs and sausage.

b. buckwheat pancakes with syrup.

c. oatmeal, skim milk, and orange juice.

d. yogurt, strawberries, and rye toast with butter.

a. scrambled eggs and sausage.

Celiac disease is treated with lifelong avoidance of dietary gluten. Wheat, barley, oats, and rye products must be avoided. Although pure oats do not contain gluten, oat products can become contaminated with wheat, rye, and barley during the milling process. Gluten is also found in some medications and in many food additives, preservatives, and stabilizers.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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Ashley A.

11

*** 11. What should a patient be taught after a hemorrhoidectomy?

a. Take mineral oil before bedtime.

b. Eat a low-fiber diet to rest the colon.

c. Administer oil-retention enema to empty the colon.

d. Use prescribed pain medication before a bowel movement.

d. Use prescribed pain medication before a bowel movement.

After a hemorrhoidectomy, the patient usually dreads the first bowel movement and often resists the urge to defecate. Pain medication may be given before the bowel movement to reduce discomfort. The patient should avoid constipation and straining. A high-fiber diet can reduce constipation. A stool softener such as docusate (Colace) is usually ordered for the first few postoperative days. If the patient does not have a bowel movement within 2 to 3 days, an oil-retention enema is administered.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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Leslie G.

12

*** 1. A 20-year-old man is admitted to the emergency department after a motor vehicle crash with suspected abdominal trauma. What assessment finding by the nurse is of highest priority?

a. Nausea and vomiting

b. Hyperactive bowel sounds

c. Firmly distended abdomen

d. Abrasions on all extremities

c. Firmly distended abdomen

Clinical manifestations of abdominal trauma are guarding and splinting of the abdominal wall; a hard, distended abdomen (indicating possible intraabdominal bleeding); decreased or absent bowel sounds; contusions, abrasions, or bruising over the abdomen; abdominal pain; pain over the scapula; hematemesis or hematuria; and signs of hypovolemic shock (tachycardia and decreased blood pressure).

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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Bethany M.

13

*** 2. The nurse identifies that which patient is at highest risk for developing colon cancer?

a. A 28-year-old male who has a body mass index of 27 kg/m2

b. A 32-year-old female with a 12-year history of ulcerative colitis

c. A 52-year-old male who has followed a vegetarian diet for 24 years

d. A 58-year-old female taking prescribed estrogen replacement therapy

b. A 32-year-old female with a 12-year history of ulcerative colitis

Risk for colon cancer includes personal history of inflammatory bowel disease (especially ulcerative colitis for longer than 10 years); obesity (body mass index ≥ 30 kg/m2); family (first-degree relative) or personal history of colorectal cancer, adenomatous polyposis, hereditary nonpolyposis colorectal cancer syndrome; red meat (=7 servings/week); cigarette use; and alcohol (=4 drinks/week).

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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Bethany M.

14

*** 3. A 58-year-old woman is being discharged home today after ostomy surgery for colon cancer. The nurse should assign the patient to which staff member?

a. A nursing assistant on the unit who also has hospice experience

b. A licensed practical nurse who has worked on the unit for 10 years

c. A registered nurse with 6 months of experience on the surgical unit

d. A registered nurse who has floated to the surgical unit from pediatrics

c. A registered nurse with 6 months of experience on the surgical unit

The patient needs ostomy care directions/reinforcement at discharge and should be assigned to a registered nurse with experience in providing discharge teaching for ostomy care. Teaching should not be delegated to a licensed practical/vocational nurse or unlicensed assistive personnel.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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Bethany M.

15

*** 4. The nurse is admitting a 68-year-old man with severe dehydration and frequent watery diarrhea. He just completed a 10-day outpatient course of antibiotic therapy for bacterial pneumonia. It is most important for the nurse to take which action?

a. Wear a mask to prevent transmission of infection.

b. Wipe equipment with ammonia-based disinfectant.

c. Instruct visitors to use the alcohol-based hand sanitizer.

d. Don gloves and gown before entering the patient’s room.

d. Don gloves and gown before entering the patient’s room.

Clostridium difficile is an antibiotic-associated diarrhea transmitted by contact, and the spores are extremely difficult to kill. Patients with suspected or confirmed infection with C. difficile should be placed in a private room and gloves and gowns should be worn by visitors and health care providers. Alcohol-based hand cleaners and ammonia-based disinfectants are ineffective and do not kill all of the spores. Equipment cannot be shared with other patients, and a disposable stethoscope and individual patient thermometer are kept in the room. Objects should be disinfected with a 10% solution of household bleach.

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16

*** 5. After an abdominal hysterectomy, a 45-year-old woman complains of severe gas pains. Her abdomen is distended. It is most appropriate for the nurse to administer which prescribed medication?

a. Morphine sulfate

b. Ondansetron (Zofran)

c. Acetaminophen (Tylenol)

d. Metoclopramide (Reglan)

d. Metoclopramide (Reglan)

Swallowed air and reduced peristalsis after surgery can result in abdominal distention and gas pains. Early ambulation helps restore peristalsis and eliminate flatus and gas pain. Medications used to reduce gas pain include metoclopramide (Reglan) or alvimopan (Entereg) to stimulate peristalsis.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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Bethany M.

17

*** 1. The nurse should administer an as-needed dose of magnesium hydroxide (MOM) after noting what information while reviewing a patient's medical record?

a. Abdominal pain and bloating

b. No bowel movement for 3 days

c. A decrease in appetite by 50% over 24 hours

d. Muscle tremors and other signs of hypomagnesemia

b. No bowel movement for 3 days

MOM is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days. MOM would not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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Bethany M.

18

*** 2. The nurse asks a 68-year-old patient scheduled for colectomy to sign the operative permit as directed in the physician's preoperative orders. The patient states that the physician has not really explained very well what is involved in the surgical procedure. What is the most appropriate action by the nurse?

a. Ask family members whether they have discussed the surgical procedure with the physician.

b. Have the patient sign the form and state the physician will visit to explain the procedure before surgery.

c. Explain the planned surgical procedure as well as possible and have the patient sign the consent form.

d. Delay the patient's signature on the consent and notify the physician about the conversation with the patient.

d. Delay the patient's signature on the consent and notify the physician about the conversation with the patient.

The patient should not be asked to sign a consent form unless the procedure has been explained to the satisfaction of the patient. The nurse should notify the physician, who has the responsibility for obtaining consent.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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Kaitlin G.

19

3. The wound, ostomy, and continence (WOC) nurse selects the site where the ostomy will be placed. What should be included in the consideration for the site?

a. The patient must be able to see the site.

b. Outside the rectus muscle area is the best site.

c. It is easier to seal the drainage bag to a protruding area.

d. The ostomy will need irrigation, so area should not be tender.

a. The patient must be able to see the site.

In selection of the ostomy site, the WOC nurse will want a site visible to the patient so the patient can take care of it, within the rectus muscle to avoid hernias, and on a flat surface to more easily create a good seal with the drainage bag.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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20

4. A stroke patient who primarily uses a wheelchair for mobility has diarrhea with fecal incontinence. What should the nurse assess first?

a. Fecal impaction

b. Perineal hygiene

c. Dietary fiber intake

d. Antidiarrheal agent use

a. Fecal impaction

Patients with limited mobility are at risk for fecal impactions due to constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed and considered next.

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21

5. The nurse is preparing to insert a nasogastric (NG) tube into a 68-year-old female patient who is nauseated and vomiting. She has an abdominal mass and suspected small intestinal obstruction. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate?

a. "The tube will help to drain the stomach contents and prevent further vomiting."

b. "The tube will push past the area that is blocked and thus help to stop the vomiting."

c. "The tube is just a standard procedure before many types of surgery to the abdomen."

d. "The tube will let us measure your stomach contents so that we can plan what type of IV fluid replacement would be best."

a. "The tube will help to drain the stomach contents and prevent further vomiting."

The NG tube is used to decompress the stomach by draining stomach contents and thereby prevent further vomiting. The NG tube will not push past the blocked area. Potential surgery is not currently indicated. The location of the obstruction will determine the type of fluid to use, not measure the amount of stomach contents.

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22

6. Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease?
Select all that apply.

a. Restricted to rectum

b. Strictures are common.

c. Bloody, diarrhea stools

d. Cramping abdominal pain

e. Lesions penetrate intestine.

c. Bloody, diarrhea stools

d. Cramping abdominal pain

Clinical manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's disease.

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23

*** 7. When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend?

a. White bread, cheese, and green beans

b. Fresh tomatoes, pears, and corn flakes

c. Oranges, baked potatoes, and raw carrots

d. Dried beans, All Bran (100%) cereal, and raspberries

d. Dried beans, All Bran (100%) cereal, and raspberries

A high fiber diet is recommended for diverticular disease. Dried beans, All Bran (100%) cereal, and raspberries all have higher amounts of fiber than white bread, cheese, green beans, fresh tomatoes, pears, corn flakes, oranges, baked potatoes, and raw carrots.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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Kaitlin G.

24

8. The nurse is caring for a postoperative patient with a colostomy. The nurse is preparing to administer a dose of famotidine (Pepcid) when the patient asks why the medication was ordered since the patient does not have a history of heartburn or gastroesophageal reflux disease (GERD). What response by the nurse would be the most appropriate?

a. "This will prevent air from accumulating in the stomach, causing gas pains."

b. "This will prevent the heartburn that occurs as a side effect of general anesthesia."

c. "The stress of surgery is likely to cause stomach bleeding if you do not receive it."

d. "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again."

d. "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again."

Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery. Famotidine does not prevent air from accumulating in the stomach or stop the stomach from bleeding. Heartburn is not a side effect of general anesthesia.

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25

9. What information would have the highest priority to be included in preoperative teaching for a 68-year-old patient scheduled for a colectomy?

a. How to care for the wound

b. How to deep breathe and cough

c. The location and care of drains after surgery

d. Which medications will be used during surgery

b. How to deep breathe and cough

Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed preoperatively, but done again with higher priority after surgery. Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.

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26

10. A 61-year-old patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times?

a. 7:00 AM, 10:00 AM, and 1:00 PM

b. 8:00 AM, 12:00 PM, and 4:00 PM

c. 9:00 AM and 3:00 PM

d. 9:00 AM, 12:00 PM, and 3:00 PM

b. 8:00 AM, 12:00 PM, and 4:00 PM

A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00 AM, 12:00 PM, and 4:00 PM.

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27

11. The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass, and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture?

a. Low-pitched and rumbling above the area of obstruction

b. High-pitched and hypoactive below the area of obstruction

c. Low-pitched and hyperactive below the area of obstruction

d. High-pitched and hyperactive above the area of obstruction

d. High-pitched and hyperactive above the area of obstruction

Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high-pitched, sometimes referred to as "tinkling" above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

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28

12. Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result of

a. impaired peristalsis.

b. irritation of the bowel.

c. nasogastric suctioning.

d. inflammation of the incision site.

a. impaired peristalsis.

Until peristalsis returns to normal following anesthesia, the patient may experience slowed gastrointestinal motility leading to gas pains and abdominal distention. Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention.

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29

13. The nurse is preparing to administer a dose of bisacodyl (Dulcolax). In explaining the medication to the patient, the nurse would explain that it acts in what way?

a. Increases bulk in the stool

b. Lubricates the intestinal tract to soften feces

c. Increases fluid retention in the intestinal tract

d. Increases peristalsis by stimulating nerves in the colon wall

d. Increases peristalsis by stimulating nerves in the colon wall

Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. It is available in oral and suppository forms. Fiber and bulk forming drugs increase bulk in the stool; water and stool softeners soften feces, and saline and osmotic solutions cause fluid retention in the intestinal tract.

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30

14. Following bowel resection, a patient has a nasogastric (NG) tube to suction, but complains of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse?

a. Notify the physician.

b. Auscultate for bowel sounds.

c. Reposition the tube and check for placement.

d. Remove the tube and replace it with a new one.

c. Reposition the tube and check for placement.

The tube may be resting against the stomach wall. The first action by the nurse (since this is intestinal surgery and not gastric surgery) is to reposition the tube and check it again for placement. The physician does not need to be notified unless the tube function cannot be restored by the nurse. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.

Chapter 43 Nursing Management: Lower Gastrointestinal Problems (9th Edition)
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