Nokea
The nurse is interviewing a client with internal hemorrhoids. What would the nurse expect the client to report?
- A. Rectal bleeding
- B. Pain
- C. Itching
- D. Soreness
Correct Answer: A
Rationale: Internal hemorrhoids cause bleeding but are less likely to cause pain, unless they protrude through the anus. External hemorrhoids may cause few symptoms, or they can produce pain, itching, and soreness of the anal area.
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A client reports taking a stimulant laxative in order to be able to have a bowel movement daily. What should the nurse inform the client about taking a stimulant laxative?
- A. They can be habit forming and will require increasing doses to be effective.
- B. If the client is drinking 8 glasses of water per day, it is all right to continue taking them.
- C. The laxative is safe to take with other medication the client is taking.
- D. The client should take a fiber supplement along with the stimulant laxative.
Correct Answer: A
Rationale: The nurse should discourage self-treatment with daily or frequent enemas or laxatives. Chronic use of such products causes natural bowel function to be sluggish. In addition, laxatives containing stimulants can be habit forming, requiring continued use in increasing doses. Although the nurse should encourage the client to have adequate fluid intake, laxative use should not be encouraged. The laxative may interact with other medications the client is taking and may cause a decrease in absorption. A fiber supplement may be taken alone but should not be taken with a stimulant laxative.
The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder?
- A. The bowel twists and turns itself and obstructs the intestinal lumen.
- B. One part of the intestine telescopes into another portion of the intestine.
- C. The bowel protrudes through a weakened area in the abdominal wall.
- D. A loop of intestine adheres to an area that is healing slowly after surgery.
Correct Answer: B
Rationale: In intussusception of the bowel, one part of the intestine telescopes into another portion of the intestine. When the bowel twists and turns itself and obstructs the intestinal lumen, this is known as a volvulus. A hernia is when the bowel protrudes through a weakened area in the abdominal wall. An adhesion is a loop of intestine that adheres to an area that is healing slowly after surgery.
A nurse is preparing a presentation for a local community group of older adults about colon cancer. What would the nurse include as the primary characteristic associated with this disorder?
- A. Abdominal distention
- B. Frank blood in the stool
- C. A change in bowel habits
- D. Abdominal pain
Correct Answer: C
Rationale: Although abdominal distention and blood in the stool (frank or occult) may be present, the chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Abdominal pain is a late sign.
The nurse is caring for a client who has had diarrhea for 3 days. What major problem(s) associated with severe or prolonged diarrhea should the nurse monitor for when caring for this client? Select all that apply.
- A. Oral candidiasis
- B. Dehydration
- C. Electrolyte imbalances
- D. Vitamin deficiencies
- E. Rectal fissures
Correct Answer: B,C,D
Rationale: Three major problems associated with severe or prolonged diarrhea include dehydration, electrolyte imbalances, and vitamin deficiencies.
A client realizes that regular use of laxatives has led to bowel pattern improvement. However, the nurse cautions this client against the prolonged use of laxatives for which reason?
- A. The client may develop inflammatory bowel disease.
- B. The client may develop arthritis or arthralgia.
- C. The client's natural bowel function may become sluggish.
- D. The client's appetite may be depleted.
Correct Answer: C
Rationale: It is essential for the nurse to caution the client against the prolonged use of laxatives because it decreases muscle tone in the large intestine. Prolonged use of laxatives may cause the client's natural bowel function to become sluggish. Laxatives do not increase the risk of developing inflammatory bowel disease, arthritis, or arthralgia, nor do they cause a loss in appetite.