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A nurse is working with a patient who has chronic constipation. What should be included in patient teaching to promote normal bowel function?
- A. Use glycerin suppositories on a regular basis.
- B. Limit physical activity to promote bowel peristalsis.
- C. Consume high-residue, high-fiber foods.
- D. Resist the urge to defecate until the urge becomes intense.
Correct Answer: C
Rationale: Goals for the patient include restoring or maintaining a regular pattern of elimination by responding to the urge to defecate, ensuring adequate intake of fluids and high-fiber foods, learning about methods to avoid constipation, relieving anxiety about bowel elimination patterns, and avoiding complications. Ongoing use of soaps or pharmacologic aids should not be promoted, due to the risk of dependence. Increased mobility helps to maintain a regular pattern of elimination. The urge to defecate should be heeded.
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An adult patient has been diagnosed with diverticular disease after ongoing challenges with constipation. The patient will be treated on an outpatient basis. What components of treatment should the nurse anticipate?
- A. Anticholinergic medications
- B. Increased fiber intake
- C. Enemas on alternating days
- D. Reduced fat intake
- E. Fluid reduction
Correct Answer: B,D
Rationale: Patients whose diverticular disease does not warrant hospital treatment often benefit from a high-fiber, low-fat diet. Neither enemas nor anticholinergics are indicated, and fluid intake is encouraged.
A patients health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohns disease, rather than ulcerative colitis, as the cause of the patients signs and symptoms?
- A. A pattern of distinct exacerbations and remissions
- B. Severe diarrhea
- C. An absence of blood in stool
- D. Involvement of the rectal mucosa
Correct Answer: C
Rationale: Bloody stool is far more common in cases of UC than in Crohns. Rectal involvement is nearly 100% in cases of UC (versus 20% in Crohns) and patients with UC typically experience severe diarrhea. UC is also characterized by a pattern of remissions and exacerbations, while Crohns often has a more prolonged and variable course.
A patient has been diagnosed with a small bowel obstruction and has been admitted to the medical unit. The nurses care should prioritize which of the following outcomes?
- A. Preventing infection
- B. Maintaining skin and tissue integrity
- C. Preventing nausea and vomiting
- D. Maintaining fluid and electrolyte balance
Correct Answer: D
Rationale: All of the listed focuses of care are important for the patient with a small bowel obstruction. However, the patients risk of fluid and electrolyte imbalances is an immediate threat to safety, and is a priority in nursing assessment and interventions.
A nurse caring for a patient with a newly created ileostomy assesses the patient and notes that the patient has had no ostomy output for the past 12 hours. The patient also complains of worsening nausea. What is the nurses priority action?
- A. Facilitate a referral to the wound-ostomy-continence (WOC) nurse.
- B. Report signs and symptoms of obstruction to the physician.
- C. Encourage the patient to mobilize to enhance motility.
- D. Contact the physician and obtain a swab of the stoma for culture.
Correct Answer: B
Rationale: It is important to report nausea and abdominal distention, which may indicate intestinal obstruction. This requires prompt medical intervention. Referral to the WOC nurse is not an appropriate short-term response, since medical treatment is necessary. Physical mobility will not normally resolve an obstruction. There is no need to collect a culture from the stoma, because infection is unrelated to this problem.
During a patients scheduled home visit, an older adult patient has stated to the community health nurse that she has been experiencing hemorrhoids of increasing severity in recent months. The nurse should recommend which of the following?
- A. Regular application of an OTC antibiotic ointment
- B. Increased fluid and fiber intake
- C. Daily use of OTC glycerin suppositories
- D. Use of an NSAID to reduce inflammation
Correct Answer: B
Rationale: Hemorrhoid symptoms and discomfort can be relieved by good personal hygiene and by avoiding excessive straining during defecation. A high-residue diet that contains fruit and bran along with an increased fluid intake may be all the treatment that is necessary to promote the passage of soft, bulky stools to prevent straining. Antibiotics, regular use of suppositories, and NSAIDs are not recommended, as they do not address the etiology of the health problem.