Fecal Elimination

Question 1

Elimination of the waste products of digestion from the body is essential to health. The excreted waste products are referred to as _ or _.

Answer 1

feces or stool

Question 2

The longitudinal muscles are shorter than the colon and therefore cause the large intestine to form pouches, or _.

Answer 2

haustra

Question 3

The contents of the colon normally represent foods ingested over the previous _, although most of the waste products are excreted within 48 hours of ingestion (the act of taking in food).

Answer 3

4 days

Question 4

The waste products leaving the stomach through the small intestine and then passing through the ileocecal valve are called _.

Answer 4

chyme

Question 5

_ is largely air and the by-products of the digestion of carbohydrates.

Answer 5

Flatus

Question 6

_ involves movement of the chyme back and forth within the haustra.

Answer 6

Haustral churning

Question 7

_ is wavelike movement produced by the circular and longitudinal muscle fibers of the intestinal walls; it propels the intestinal contents forward.

Answer 7

Peristalsis

Question 8

_, the third type of colonic movement, involves a wave of powerful muscular contraction that moves over large areas of the colon.

Answer 8

Mass peristalsis

Question 9

When the veins become distended, as can occur with repeated pressure, a condition known as _ occurs.

Answer 9

hemorrhoids

Question 10

_ is the expulsion of feces from the anus and rectum. It is also called a _.

Answer 10

Defecation
bowel movement

Question 11

_ are made of about 75% water and 25% solid materials.

Answer 11

Normal feces

Question 12

FACTORS THAT AFFECT DEFECATION

Answer 12

Development
Diet
Fluid Intake and Output
Activity
Psychological Factors
Defecation Habits
Medications
Diagnostic Procedures
Anesthesia and Surgery
Pathologic Conditions
Pain

Question 13

_ is the first fecal material passed by the newborn, normally up to 24 hours after birth.

Answer 13

Meconium

Question 14

Responding to the _ (increased peristalsis of the colon after food has entered the stomach) is also an important consideration. For example, toileting is recommended 30 minutes after meals, especially after breakfast when the _ is strongest (Toner & Claros, 2012).

Answer 14

gastrocolic reflex

Question 15

_ are medications that stimulate bowel activity and so assist fecal elimination.

Answer 15

Laxatives

Question 16

Four common problems are related to fecal elimination:

Answer 16

constipation, diarrhea, bowel incontinence, and flatulence.

Question 17

_ may be defined as fewer than three bowel movements per week. This infers the passage of dry, hard stool or the passage of no stool.

Answer 17

Constipation

Question 18

_ is a mass or collection of hardened feces in the folds of the rectum. _ results from prolonged retention and accumulation of fecal material.

Answer 18

Fecal impaction
Impaction

Question 19

_ refers to the passage of liquid feces and an increased frequency of defecation. It is the opposite of constipation and results from rapid movement of fecal contents through the large intestine.

Answer 19

Diarrhea

Question 20

_, also called _, refers to the loss of voluntary ability to control fecal and gaseous discharges through the anal sphincter.

Answer 20

Bowel incontinence
fecal incontinence

Question 21

_ is the presence of excessive flatus in the intestines and leads to stretching and inflation of the intestines (intestinal distention).

Answer 21

Flatulence

Question 22

An _ is an opening for the gastrointestinal, urinary, or respiratory tract onto the skin.

Answer 22

ostomy

Question 23

A _ opens through the abdominal wall into the jejunum, an ileostomy opens into the ileum (small bowel), and a colostomy opens into the colon (large bowel).

Answer 23

jejunostomy

Question 24

A _ is an opening through the abdominal wall into the stomach.

Answer 24

gastrostomy

Question 25

Surgery to reconnect the ends of the bowel of a temporary ostomy may be called a _.

Answer 25

take-down

Question 26

Bowel diversion ostomies are often classified according to:

Answer 26

(a) their status as permanent or temporary, (b) their anatomic location, and (c) the construction of the stoma

Question 27

_, the opening created in the abdominal wall by the ostomy.

Answer 27

stoma

Question 28

_ are generally performed for traumatic injuries or inflammatory conditions of the bowel. They allow the distal diseased portion of the bowel to rest and heal.

Answer 28

Temporary colostomies

Question 29

_ are performed to provide a means of elimination when the rectum or anus is nonfunctional as a result of a birth defect or a disease such as cancer of the bowel.

Answer 29

Permanent colostomies

Question 30

_ are drugs that induce defecation. They can have a strong, purgative effect. A _ is mild in comparison to a _, and it produces soft or liquid stools that are sometimes accompanied by abdominal cramps.

Answer 30

Cathartics laxative

Question 31

_ are herbal oils known to act as agents that help expel gas from the stomach and intestines.

Answer 31

Carminatives

Question 32

An _ is a solution introduced into the rectum and large intestine.

Answer 32

enema

Question 33

Enemas are classified into four groups:

Answer 33

cleansing, carminative, retention, and return-flow enemas.

Question 34

_ are intended to remove feces.

Answer 34

Cleansing enemas

Question 35

A _ is given primarily to expel flatus.

Answer 35

carminative enema

Question 36

A _ introduces oil or medication into the rectum and sigmoid colon.

Answer 36

retention enema

Question 37

A _, also called a Harris flush, is occasionally used to expel flatus.

Answer 37

return-flow enema

Question 38

Clients should be taught that repeatedly ignoring the sensation of needing to defecate could result in which of the following? 1. Constipation 2. Diarrhea 3. Incontinence 4. Hemorrhoids

Answer 38

1. Answer: 1. Rationale: Habitually ignoring the urge to defecate can lead to constipation through loss of the natural urge and the accumulation of feces. Diarrhea will not result—if anything, there is increased opportunity for water reabsorption because the stool remains in the colon, leading to firmer stool (option 2). Ignoring the urge shows a strong voluntary sphincter, not a weak one that could result in incontinence (option 3). Hemorrhoids would occur only if severe drying out of the stool occurs and, thus, repeated need to strain to pass stool (option 4). Cognitive Level: Understanding. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 49-1.

Question 39

Which statement provides evidence that an older adult who is prone to constipation is in need of further teaching? 1. “I need to drink one and a half to two quarts of liquid each day.” 2. “I need to take a laxative such as Milk of Magnesia if I don’t have a BM every day.” 3. “If my bowel pattern changes on its own, I should call you.” 4. “Eating my meals at regular times is likely to result in regular bowel movements.”

Answer 39

2. Answer: 2. Rationale: The standard of practice in assisting older adults to maintain normal function of the gastrointestinal tract is regular ingestion of a well-balanced diet, adequate fluid intake, and regular exercise. If the bowel pattern is not regular with these activities, this abnormality should be reported. Stimulant laxatives can be very irritating and are not the preferred treatment for occasional constipation in older adults (option 2). In addition, a normal stool pattern for an older adult may not be daily elimination. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Evaluation. Learning Outcome: 49-3.

Question 40

A client is scheduled for a colonoscopy. The nurse will provide information to the client about which type of enema? 1. Oil retention 2. Return flow 3. High, large volume 4. Low, small volume

Answer 40

3. Answer: 4. Rationale: Small-volume enemas along with other preparations are used to prepare the client for this procedure. An oil retention enema is used to soften hard stool (option 1). Return flow enemas help expel flatus (option 2). Because of the risk of loss of fluid and electrolytes, high, large-volume enemas are seldom used (option 3). Cognitive Level: Analyzing. Client Need: Health Promotion and Maintenance. Nursing Process: Planning. Learning Outcome: 49-8.

Question 41

The nurse is most likely to report which finding to the primary care provider for a client who has an established colostomy? 1. The stoma extends 1/2 in. above the abdomen. 2. The skin under the appliance looks red briefly after removing the appliance. 3. The stoma color is a deep red-purple. 4. The ascending colostomy delivers liquid feces.

Answer 41

4. Answer: 3. Rationale: An established stoma should be dark pink like the color of the buccal mucosa and is slightly raised above the abdomen. The skin under the appliance may remain pink/red for a while after the adhesive is pulled off. Feces from an ascending ostomy are very liquid, less so from a transverse ostomy, and more solid from a descending or sigmoid stoma. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcome: 49-9.

Question 42

Which goal is the most appropriate for clients with diarrhea related to ingestion of an antibiotic for an upper respiratory infection? 1. The client will wear a medical alert bracelet for antibiotic allergy. 2. The client will return to his or her previous fecal elimination pattern. 3. The client will verbalize the need to take an antidiarrheal medication prn. 4. The client will increase intake of insoluble fiber such as grains, rice, and cereals.

Answer 42

5. Answer: 2. Rationale: Once the cause of diarrhea has been identified and corrected, the client should return to his or her previous elimination pattern. This is not an example of an allergy to the antibiotic but a common consequence of overgrowth of bowel organisms not killed by the drug (option 1). Antidiarrheal medications are usually prescribed according to the number of stools, not routinely around the clock (option 3). Increasing intake of soluble fiber such as oatmeal or potatoes may help absorb excess liquid and decrease the diarrhea, but insoluble fiber will not (option 4). Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Planning. Learning Outcome: 49-6.

Question 43

A client with a new stoma who has not had a bowel movement since surgery last week reports feeling nauseous. What is the appropriate nursing action? 1. Prepare to irrigate the colostomy. 2. After assessing the stoma and surrounding skin, notify the surgeon. 3. Assess bowel sounds and administer antiemetic. 4. Administer a bulk-forming laxative, and encourage increased fluids and exercise.

Answer 43

6. Answer: 2. Rationale: The client has assessment findings consistent with complications of surgery. Option 1: Irrigating the stoma is a dependent nursing action, and is also intervention without appropriate assessment. Option 3: Assessing the peristomal skin area is an independent action, but administering an antiemetic is an intervention without appropriate assessment. Antiemetics are generally ordered to treat immediate postoperative nausea, not several days postoperative. Option 4: Administering a bulk-forming laxative to a nauseated postoperative client is contraindicated. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 49-6.

Question 44

The nurse assesses a client’s abdomen several days after abdominal surgery. It is firm, distended, and painful to palpate. The client reports feeling “bloated.” The nurse consults with the surgeon, who orders an enema. The nurse prepares to give what kind of enema? 1. Soapsuds 2. Retention 3. Return flow 4. Oil retention

Answer 44

7. Answer: 3. Rationale: This provides relief of postoperative flatus, stimulating bowel motility. Options 1, 2, and 4 manage constipation and do not provide flatus relief. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 49-8.

Question 45

Which of the following is most likely to validate that a client is experiencing intestinal bleeding? 1. Large quantities of fat mixed with pale yellow liquid stool 2. Brown, formed stools 3. Semisoft black-colored stools 4. Narrow, pencil-shaped stool

Answer 45

8. Answer: 3. Rationale: Blood in the upper GI tract is black and tarry. Option 1 can be a sign of malabsorption in an infant, option 2 is normal stool, and option 4 is characteristic of an obstructive condition of the rectum. Cognitive Level: Analyzing. Client Need: Health Promotion and Maintenance. Nursing Process: Assessment. Learning Outcome: 49-2.

Question 46

Which nursing diagnoses is/are most applicable to a client with fecal incontinence? Select all that apply. 1. Bowel Incontinence 2. Risk for Deficient Fluid Volume 3. Disturbed Body Image 4. Social Isolation 5. Risk for Impaired Skin Integrity

Answer 46

9. Answer: 1, 3, 4, and 5. Rationale: Option 1 is the most appropriate. The client is unable to decide when stool evacuation will occur. In option 3, client thoughts about self may be altered if unable to control stool evacuation. In option 4, client may not feel as comfortable around others. In option 5, increased tissue contact with fecal material may result in impairment. Option 2 is more appropriate for a client with diarrhea. Incontinence is the inability to control feces of normal consistency. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Diagnosis. Learning Outcome: 49-6.

Question 47

A student nurse is assigned to care for a client with a sigmoidostomy. The student will assess which ostomy site?

Answer 47

10. Answer: 5. Rationale: Option 5 is a sigmoidostomy site. Option 1 is an ileostomy site, option 2 is ascending colostomy, option 3 is transverse colostomy, and option 4 is descending colostomy. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcome: 49-9.