Nokea
A nurse is caring for a newly admitted patient with a suspected GI bleed. The nurse assesses the patient's stool after a bowel movement and notes it to be a tarry-black color. This finding is suggestive of bleeding from what location?
- A. Sigmoid colon
- B. Upper GI tract
- C. Large intestine
- D. Anus or rectum
Correct Answer: B
Rationale: Blood shed in sufficient quantities in the upper GI tract will produce a tarry-black color (melena). Blood entering the lower portion of the GI tract or passing rapidly through it will appear bright or dark red. Lower rectal or anal bleeding is suspected if there is streaking of blood on the surface of the stool or if blood is noted on toilet tissue.
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A clinic patient has described recent dark-colored stools; the nurse recognizes the need for fecal occult blood testing (FOBT). What aspect of the patient's current health status would contraindicate FOBT?
- A. Gastroesophageal reflux disease (GERD)
- B. Peptic ulcers
- C. Hemorrhoids
- D. Recurrent nausea and vomiting
Correct Answer: C
Rationale: FOBT should not be performed when there is hemorrhoidal bleeding. GERD, peptic ulcers and nausea and vomiting do not contraindicate the use of FOBT as a diagnostic tool.
A patient has been brought to the emergency department with abdominal pain and is subsequently diagnosed with appendicitis. The patient is scheduled for an appendectomy but questions the nurse about how his health will be affected by the absence of an appendix. How should the nurse best respond?
- A. Your appendix doesn't play a major role, so you won't notice any difference after you recovery from surgery.
- B. The surgeon will encourage you to limit your fat intake for a few weeks after the surgery, but your body will then begin to compensate.
- C. Your body will absorb slightly fewer nutrients from the food you eat, but you won't be aware of this.
- D. Your large intestine will adapt over time to the absence of your appendix.
Correct Answer: A
Rationale: The appendix is an appendage of the cecum (not the large intestine) that has little or no physiologic function. Its absence does not affect digestion or absorption.
A patient asks the nursing assistant for a bedpan. When the patient is finished, the nursing assistant notifies the nurse that the patient has bright red streaking of blood in the stool. What is this most likely a result of?
- A. Diet high in red meat
- B. Upper GI bleed
- C. Hemorrhoids
- D. Use of iron supplements
Correct Answer: C
Rationale: Lower rectal or anal bleeding is suspected if there is streaking of blood on the surface of the stool. Hemorrhoids are often a cause of anal bleeding since they occur in the rectum. Blood from an upper GI bleed would be dark rather than frank. Iron supplements make the stool dark, but not bloody and red meat consumption would not cause frank blood.
An adult patient is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include when the patient has completed the test?
- A. Stool will be yellow for the first 24 hours postprocedure.
- B. The barium may cause diarrhea for the next 24 hours.
- C. Fluids must be increased to facilitate the evacuation of the stool.
- D. Slight anal bleeding may be noted as the barium is passed.
Correct Answer: C
Rationale: Postprocedural patient education includes information about increasing fluid intake; evaluating bowel movements for evacuation of barium; and noting increased number of bowel movements, because barium, due to its high osmolarity, may draw fluid into the bowel, thus increasing the intraluminal contents and resulting in greater output. Yellow stool, diarrhea, and anal bleeding are not expected.
The nurse is providing health education to a patient scheduled for a colonoscopy. The nurse should explain that she will be placed in what position during this diagnostic test?
- A. In a knee-chest position (lithotomy position)
- B. Lying prone with legs drawn toward the chest
- C. Lying on the left side with legs drawn toward the chest
- D. In a prone position with two pillows elevating the buttocks
Correct Answer: C
Rationale: For best visualization, colonoscopy is performed while the patient is lying on the left side with the legs drawn up toward the chest. A knee-chest position, lying on the stomach with legs drawn to the chest, and a prone position with two pillows elevating the legs do not allow for the best visualization.