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A nurse is providing preprocedure education for a patient who will undergo a lower GI tract study the following week. What should the nurse teach the patient about bowel preparation?
- A. You'll need to fast for at least 18 hours prior to your test.
- B. Starting today, take over-the-counter stool softeners twice daily.
- C. You'll need to have enemas the day before the test.
- D. For 24 hours before the test, insert a glycerin suppository every 4 hours.
Correct Answer: C
Rationale: Preparation of the patient includes emptying and cleansing the lower bowel. This often necessitates a low-residue diet 1 to 2 days before the test; a clear liquid diet and a laxative the evening before; NPO after midnight; and cleansing enemas until returns are clear the following morning.
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The nurse is caring for a patient who has a diagnosis of AIDS. Inspection of the patient's mouth reveals the new presence of white lesions on the patient's oral mucosa. What is the nurse's most appropriate response?
- A. Encourage the patient to gargle with salt water twice daily.
- B. Attempt to remove the lesions with a tongue depressor.
- C. Make a referral to the unit's dietitian.
- D. Inform the primary care provider of this finding.
Correct Answer: D
Rationale: The nurse should inform the primary care provider of this abnormal finding in the patient's oral cavity, since it necessitates medical treatment. It would be inappropriate to try to remove skin lesions from a patient's mouth and salt water will not resolve this problem, which is likely due to candidiasis. A dietitian referral is unnecessary.
A nurse is assessing the abdomen of a patient just admitted to the unit with a suspected GI disease. Inspection reveals several diverse lesions on the patient's abdomen. How should the nurse best interpret this assessment finding?
- A. Abdominal lesions are usually due to age-related skin changes.
- B. Integumentary diseases often cause GI disorders.
- C. GI diseases often produce skin changes.
- D. The patient needs to be assessed for self-harm.
Correct Answer: C
Rationale: Abdominal lesions are of particular importance, because GI diseases often produce skin changes. Skin problems do not normally cause GI disorders. Age-related skin changes do not have a pronounced effect on the skin of the abdomen when compared to other skin surfaces. Self-harm is a less likely explanation for skin lesions on the abdomen.
A patient has been experiencing significant psychosocial stress in recent weeks. The nurse is aware of the hormonal effects of stress, including norepinephrine release. Release of this substance would have what effect on the patient's gastrointestinal function?
- A. Decreased motility
- B. Increased sphincter tone
- C. Increased enzyme release
- D. Inhibition of secretions
- E. Increased peristalsis
Correct Answer: A,B,D
Rationale: Norepinephrine generally decreases GI motility and secretions, but increases muscle tone of sphincters. Norepinephrine does not increase the release of enzymes.
A patient has come to the clinic complaining of blood in his stool. A FOBT test is performed but is negative. Based on the patient's history, the physician suggests a colonoscopy, but the patient refuses, citing a strong aversion to the invasive nature of the test. What other test might the physician order to check for blood in the stool?
- A. A laparoscopic intestinal mucosa biopsy
- B. A quantitative fecal immunochemical test
- C. Computed tomography (CT)
- D. Magnetic resonance imagery (MRI)
Correct Answer: B
Rationale: Quantitative fecal immunochemical tests may be more accurate than guaiac testing and useful for patients who refuse invasive testing. CT or MRI cannot detect blood in stool. Laparoscopic intestinal mucosa biopsy is not performed.
An inpatient has returned to the medical unit after a barium enema. When assessing the patient's subsequent bowel patterns and stools, what finding should the nurse report to the physician?
- A. Large, wide stools
- B. Milky white stools
- C. Three stools during an 8-hour period of time
- D. Streaks of blood present in the stool
Correct Answer: D
Rationale: Barium has a high osmolarity and may draw fluid into the bowel, thus increasing the intraluminal contents and resulting in greater output (large stools). The barium will give the stools a milky white appearance, and it is not uncommon for the patient to experience an increase in the number of bowel movements. Blood in fecal matter is not an expected finding and the nurse should notify the physician.