Nokea
The nurse is conducting preoperative preparation for a patient scheduled for an abdominal-perineal resection. Which of the following actions should the nurse implement?
- A. Give IV antibiotics starting 24 hours before surgery to reduce the number of bowel bacteria.
- B. Teach the patient that activities such as sitting at the bedside will be started the first postoperative day.
- C. Instruct the patient that another surgery in 8-12 weeks will be used to create an ileal-anal reservoir.
- D. Administer polyethylene glycol lavage solution (GOLYTELY) to ensure that the bowel is empty before the surgery.
Correct Answer: D
Rationale: A bowel-cleansing agent is used to empty the bowel before surgery to reduce the risk for infection. Oral antibiotics (rather than IV antibiotics) are given to reduce colonic and rectal bacteria. Sitting is contraindicated after an abdominal-perineal resection. A permanent colostomy is created with this surgery.
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The nurse is preparing a 50-year-old patient for an annual physical examination. Which of the following diagnostic tests should the nurse teach to the patient?
- A. Endoscopy
- B. Fecal occult blood test
- C. Computerized tomography screening
- D. Carcinoembryonic antigen (CEA) testing
Correct Answer: B
Rationale: At age 50, individuals with an average risk for colorectal cancer (CRC) should begin screening for CRC, including a fecal occult blood test (FOBT). Colonoscopy is the gold standard for CRC screening. The other diagnostic tests are not recommended as part of a routine annual physical examination at age 50.
The nurse is teaching a patient who has persistent constipation, about the use of psyllium. Which of the following information should the nurse include?
- A. Absorption of fat-soluble vitamins may be reduced by fibre-containing laxatives.
- B. Dietary sources of fibre should be eliminated to prevent excessive gas formation.
- C. Use of this type of laxative to prevent constipation does not cause adverse effects.
- D. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.
Correct Answer: D
Rationale: A high fluid intake is needed when patients are using bulk-forming laxatives to avoid worsening constipation. Although bulk-forming laxatives are generally safe, the nurse should emphasize the possibility of constipation or obstipation if inadequate fluid intake occurs. Although increased gas formation is likely to occur with increased dietary fibre, the patient should gradually increase dietary fibre and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool softeners and lubricants, not by bulk-forming laxatives.
A patient tells the nurse, 'I have problems with constipation now that I am older, so I use a suppository every morning.' Which of the following actions should the nurse take first?
- A. Encourage the patient to increase oral fluid intake
- B. Inform the patient that a daily bowel movement is unnecessary.
- C. Assess the patient about individual risk factors for constipation.
- D. Suggest that the patient increase dietary intake of high-fibre foods.
Correct Answer: C
Rationale: The nurse's initial action should be further assessment of the patient for risk factors for constipation and for usual bowel pattern. The other actions may be appropriate but will be based on the assessment.
The nurse is caring for a patient who has a large bowel obstruction that occurred as a result of diverticulosis. Which of the following symptoms should the nurse monitor for when assessing the patient?
- A. Referred back pain
- B. Metabolic alkalosis
- C. Projectile vomiting
- D. Abdominal distension
Correct Answer: D
Rationale: Abdominal distension is seen in lower intestinal obstruction. Metabolic alkalosis is common in high intestinal obstruction because of the loss of HCl acid from vomiting. Referred back pain is not a common clinical manifestation of intestinal obstruction. Bile-coloured vomit is associated with higher intestinal obstruction.
Which of the following nursing actions is most important to include in the plan of care for a patient who had an abdominal-perineal resection the previous day?
- A. Teach about a low-residue diet.
- B. Monitor output from the stoma.
- C. Assess the perineal drainage and incision.
- D. Encourage acceptance of the colostomy stoma.
Correct Answer: C
Rationale: Because the perineal wound is at high risk for infection, the initial care is focused on assessment and care of this wound. Teaching about diet is best done closer to discharge from the hospital. There will be very little drainage into the colostomy until peristalsis returns. The patient will be encouraged to assist with the colostomy, but this is not the highest priority in the immediate postoperative period.