Digestive & Gastrointestinal System Disorders | NCLEX Quiz 72

1. The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active. the nurse would assess the client for which of the following most frequent symptom(s) of duodenal ulcer?

Pain that is relieved by food intake

Pain that radiated down the right arm

N/V

Weight loss

The most frequent symptom of duodenal ulcer is pain that is relieved by food intake. These clients generally describe the pain as burning. heavy. sharp. or “hungry” pain that often localizes in the midepigastric area. The client with duodenal ulcer usually does not experience weight loss or N/V. These symptoms are usually more typical in the client with a gastric ulcer.

Explanation

The most frequent symptom of duodenal ulcer is pain that is relieved by food intake. These clients generally describe the pain as burning. heavy. sharp. or “hungry” pain that often localizes in the midepigastric area. The client with duodenal ulcer usually does not experience weight loss or N/V. These symptoms are usually more typical in the client with a gastric ulcer.

2. The nurse instructs the ileostomy client to do which of the following as a part of essential care of the stoma?

Cleanse the peristomal skin meticulously

Take in high-fiber foods such as nuts

Massage the area below the stoma

Limit fluid intake to prevent diarrhea.

The peristomal skin must receive meticulous cleansing because the ileostomy drainage has more enzymes and is more caustic to the skin than colostomy drainage. Foods such as nuts and those with seeds will pass through the ileostomy. The client should be taught that these foods will remain undigested. The area below the ileostomy may be massaged if needed if the ileostomy becomes blocked by high fiber foods. Fluid intake should be maintained to at least six to eight glasses of water per day to prevent dehydration.

Explanation

The peristomal skin must receive meticulous cleansing because the ileostomy drainage has more enzymes and is more caustic to the skin than colostomy drainage. Foods such as nuts and those with seeds will pass through the ileostomy. The client should be taught that these foods will remain undigested. The area below the ileostomy may be massaged if needed if the ileostomy becomes blocked by high fiber foods. Fluid intake should be maintained to at least six to eight glasses of water per day to prevent dehydration.

3. The nurse is performing a colostomy irrigation on a client. During the irrigation. a client begins to complain of abdominal cramps. Which of the following is the most appropriate nursing action?

Notify the physician

Increase the height of the irrigation

Stop the irrigation temporarily.

Medicate with dilaudid and resume the irrigation

If cramping occurs during a colostomy irrigation. the irrigation flow is stopped temporarily and the client is allowed to rest. Cramping may occur from an infusion that is too rapid or is causing too much pressure. Increasing the height of the irrigation will cause further discomfort. The physician does not need to be notified. Medicating the client for pain is not the most appropriate action.

Explanation

If cramping occurs during a colostomy irrigation. the irrigation flow is stopped temporarily and the client is allowed to rest. Cramping may occur from an infusion that is too rapid or is causing too much pressure. Increasing the height of the irrigation will cause further discomfort. The physician does not need to be notified. Medicating the client for pain is not the most appropriate action.

4. The nurse is teaching the client how to perform a colostomy irrigation. To enhance the effectiveness of the irrigation and fecal returns. what measure should the nurse instruct the client to do?

Increase fluid intake

Reduce the amount of irrigation solution

Perform the irrigation in the evening

Place heat on the abdomen

To enhance effectiveness of the irrigation and fecal returns. the client is instructed to increase fluid intake and prevent constipation.

Explanation

To enhance effectiveness of the irrigation and fecal returns. the client is instructed to increase fluid intake and prevent constipation.

5. The client with a new colostomy is concerned about the odor from the stool in the ostomy drainage bag. The nurse teaches the client to include which of the following foods in the diet to reduce odor?

Yogurt

Broccoli

Cucumbers

Eggs

The client should be taught to include deodorizing foods in the diet. such a beet greens. parsley. buttermilk. and yogurt. Spinach also reduces odor but is a gas forming food as well. Broccoli. cucumbers. and eggs are gas forming foods.

Explanation

The client should be taught to include deodorizing foods in the diet. such a beet greens. parsley. buttermilk. and yogurt. Spinach also reduces odor but is a gas forming food as well. Broccoli. cucumbers. and eggs are gas forming foods.

6. The nurse is reviewing the record of a client with Crohn's disease. Which of the following stool characteristics would the nurse expect to note documented on the client's record?

Chronic constipation

Diarrhea

Constipation alternating with diarrhea

Stool constantly oozing from the rectum

Crohn’s disease is characterized by nonbloody diarrhea of usually not more than four to five stools daily. Over time. the diarrhea episodes increase in frequency. duration and severity. The other options are not associated with diarrhea.

Explanation

Crohn’s disease is characterized by nonbloody diarrhea of usually not more than four to five stools daily. Over time. the diarrhea episodes increase in frequency. duration and severity. The other options are not associated with diarrhea.

7. The nurse is assessing for stoma prolapse in a client with a colostomy. The nurse would observe which of the following if stoma prolapse occurred?

Sunken and hidden stoma

Dark- and bluish-colored stoma

Narrowed and flattened stoma

Protruding stoma

A prolapsed stoma is one which the bowel protruded through the stoma. A stoma retraction is characterized by sinking of the stoma. Ischemia of the stoma would be associated with dusky or bluish color. A stoma with a narrowed opening at the level of the skin or fascia is said to be stenosed.

Explanation

A prolapsed stoma is one which the bowel protruded through the stoma. A stoma retraction is characterized by sinking of the stoma. Ischemia of the stoma would be associated with dusky or bluish color. A stoma with a narrowed opening at the level of the skin or fascia is said to be stenosed.

8. The nurse is reviewing the physician's orders written for a client admitted with acute pancreatitis. Which physician order would the nurse question if noted on the client's chart?

NPO status

Insert a nasogastric tube

An anticholinergic medication

Morphine for pain

Meperidine (Demerol) rather than morphine is the medication of choice because morphine can cause spasm in the sphincter of Oddi.

Explanation

Meperidine (Demerol) rather than morphine is the medication of choice because morphine can cause spasm in the sphincter of Oddi.

9. The client who has undergone creation of a colostomy has a nursing diagnosis of Disturbed body image. The nurse would evaluate that the client is making the most significant progress toward identified goals if the client:

Watches the nurse empty the colostomy bag

Looks at the ostomy site

Reads the ostomy product literature

Practices cutting the ostomy appliance

The client is expected to have a body image disturbance after colostomy. The client progresses through normal grieving stages to adjust to this change. The client demonstrates the greatest deal of acceptance when the client participates in the actual colostomy care. Each of the incorrect options represents an interest in colostomy care but is a passive activity. The correct option shows the client is participating in self-care.

Explanation

The client is expected to have a body image disturbance after colostomy. The client progresses through normal grieving stages to adjust to this change. The client demonstrates the greatest deal of acceptance when the client participates in the actual colostomy care. Each of the incorrect options represents an interest in colostomy care but is a passive activity. The correct option shows the client is participating in self-care.

10. The nurse has given instructions to the client with an ileostomy about foods to eat to thicken the stool. The nurse determines that the client needs further instructions if the client stated to eat which of the following foods to make the stools less watery?

Pasta

Boiled rice

Bran

Low-fat cheese

Foods that help thicken the stool of the client with an ileostomy include pasta. boiled rice. and low-fat cheese. Bran is high in dietary fiber and thus will increase output of watery stool by increasing propulsion through the bowel. Ileostomy output is liquid. Addition or elimination of various foods can help thicken or loosen this liquid drainage.

Explanation

Foods that help thicken the stool of the client with an ileostomy include pasta. boiled rice. and low-fat cheese. Bran is high in dietary fiber and thus will increase output of watery stool by increasing propulsion through the bowel. Ileostomy output is liquid. Addition or elimination of various foods can help thicken or loosen this liquid drainage.