Nokea
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.
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The nurse is caring for a patient who has blunt abdominal trauma after an automobile accident and severe pain. A peritoneal lavage returns brown drainage with fecal material. Which of the following actions should the nurse plan to take next?
- A. Auscultate the bowel sounds.
- B. Prepare the patient for surgery.
- C. Check the patient's oral temperature.
- D. Obtain information about the accident.
Correct Answer: B
Rationale: Return of brown drainage and fecal material suggests perforation of the bowel and the need for immediate surgery. Auscultation of bowel sounds, checking the temperature, and obtaining information about the accident are appropriate actions, but the priority is to prepare to send the patient for emergency surgery.
The nurse is caring for a patient who has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight loss of 4.5 kg over 2 months. Which of the following topics should the nurse plan to include in the teaching plan?
- A. Medication use
- B. Fluid restriction
- C. Enteral nutrition
- D. Activity restrictions
Correct Answer: A
Rationale: Medications are used to induce and maintain remission in patients with inflammatory bowel disease (IBD). Decreased activity level is indicated only if the patient has severe fatigue and weakness. Fluids are needed to prevent dehydration. There is no advantage to enteral feedings.
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 providing discharge teaching for a patient with a new colostomy. Which of the following patient actions indicates that the teaching has been effective?
- A. Empties the colostomy bag once it is one-third full.
- B. Drinks at least 1000 mL of fluid a day.
- C. Contacts the health care provider if there is pain or erythema in the peristomal area.
- D. Takes acetaminophen when a temperature of 38.3°C is present.
Correct Answer: C
Rationale: The health care provider should be contacted if there is pain or erythema in the peristomal area. If the patient has a temperature, the health care provider should be contacted. The colostomy should be emptied before it becomes one-third full. The patient should drink at least 1500-2000 mL per day to avoid dehydration.
The nurse is caring for a patient who had an exploratory laparotomy with a resection of a short segment of small bowel two days previously. The patient has gas pains and abdominal distension. Which of the following nursing actions is best to take at this time?
- A. Give a return-flow enema.
- B. Assist the patient to ambulate.
- C. Administer the ordered IV morphine sulphate.
- D. Insert the ordered promethazine suppository.
Correct Answer: B
Rationale: Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. Morphine will further reduce peristalsis. A return-flow enema may decrease the patient's symptoms, but ambulation is less invasive and should be tried first. Promethazine is used as an antiemetic rather than to decrease gas pains or distension.