Chapter 19: Bowel Elimination and Gastric Intubation

Chapter 19: Bowel Elimination and Gastric Intubation

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The nurse determines a patient requires a fecal impaction removal. Which assessment result justifies the nurse’s finding?

a.	The patient exhibits rebound tenderness.
b.	The patient experiences hard stool that cannot be passed.
c.	The patient has a history of fecal impaction.
d.	The patient denies having a bowel movement today.

 

 

ANS:  B

The nurse determines that the patient who is unable to pass hard stool requires fecal removal after other methods, including suppositories and enemas, have been unsuccessful. Rebound tenderness is a clinical indicator consistent with peritonitis. However, normal pain and tenderness can indicate stool impaction. A patient history of fecal impaction affects prevention strategies for impaction, including exercise, fluids, high-fiber diet, and maintaining a bowel ritual and regular bowel habits. Lack of a bowel movement for a day does not necessarily indicate constipation.

 

DIF:    Cognitive Level: Apply                   REF:   Page 512

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Assessment

 

2. A patient requires digital removal of a fecal impaction. Which action should the nurse perform before beginning this procedure?

a.	Administer large-volume tap water enemas until clear.
b.	Assist the patient into the dorsal recumbent position.
c.	Check for an order from the healthcare provider.
d.	Delegate the procedure to nursing assistive personnel (NAP).

 

 

ANS:  C

The nurse obtains an order from the healthcare provider before implementing fecal impaction removal because it is an invasive procedure and can precipitate unexpected results such as bradycardia. The nurse wants the provider’s validation of the procedure to provide safe and effective nursing care. Other strategies to stimulate a bowel movement, such as suppositories and enemas, will be tried before determining that digital removal of a fecal impaction is needed. For fecal impaction removal, the nurse assists the patient to the side-lying position. The nurse cannot delegate the procedure to the NAP because it requires the clinical judgment and critical thinking skills of a nurse.

 

DIF:    Cognitive Level: Remember            REF:   Page 512

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Planning

 

3. The nurse assesses a patient during digital removal of a fecal impaction. Which patient assessment finding does the nurse determine to be unexpected?

a.	Complaints of abdominal cramping
b.	Large amount of brown, liquid stool
c.	Blood pressure 130/86 mm Hg, stable
d.	Heart monitor showing sinus bradycardia

 

 

ANS:  D

Sinus bradycardia is a heart rate less than 60 beats/min and is consistent with clinical indicators for vasovagal stimulation from digital removal of fecal impaction. This heart rate is usually too slow to maintain an adequate cardiac output; thus the patient becomes hypotensive and lightheaded and may lose consciousness. The nurse stops the procedure, assesses patient vital signs and neurological status, and calls for help in anticipation of the need for emergency interventions. Usually bradycardia from vasovagal stimulation resolves spontaneously; however, the nurse also notifies the provider to deliver safe and effective nursing care. The nurse expects abdominal cramping; he or she instructs the patient to focus on slow, even breathing and proceeds with removal slowly and gently to minimize cramping. The patient can pass a large amount of stool after some or the entire impacted stool is removed because fecal matter frequently accumulates behind the impaction in the colon. Stable blood pressure is a highly desirable finding.

 

DIF:    Cognitive Level: Comprehend          REF:   Page 513

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Assessment

 

4. A home care patient has a history of fecal impaction. Which intervention does the nurse instruct the home health aide to implement to prevent another fecal impaction?

a.	Provide the patient with low-residue foods.
b.	Notify the provider of patient abdominal pain.
c.	Administer a cleansing enema every 3 days.
d.	Encourage and assist the patient to take additional fluids daily.

 

 

ANS:  D

The nurse instructs the home health aide to assist the patient with increased daily fluids to facilitate bowel passage through the colon to prevent a fecal impaction. The nurse instructs the aide to encourage frequent sips of water and help the patient avoid dehydrating liquids with high-caffeine content. The aide should provide high-fiber foods to increase the stool bulk and facilitate stool passage through the colon. He or she should report abdominal pain, but abdominal pain is not an indicator of fecal impaction. The nurse avoids instructing the aide to administer a cleansing enema to the patient on a regular basis because frequent exogenous methods of stimulating bowel movements tend to encourage patient dependency on these measures for regular bowel movements.

 

DIF:    Cognitive Level: Apply                   REF:   Page 512

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Assessment

 

5. The nurse implements the teaching plan for a patient with chronic constipation. Which of the following outcomes indicates patient teaching has been effective?

a.	The patient passes a small liquid stool daily.
b.	The patient has a firm stool every fourth day.
c.	The patient reports less frequent abdominal cramping.
d.	The patient describes methods to prevent constipation.

 

 

ANS:  D

If the patient is able to describe three prevention strategies for constipation, the teaching plan has been effective. Patients can have a small liquid stool and still be experiencing fecal impaction. The patient who has a firm stool every fourth day or experiences abdominal cramping has clinical indicators consistent with chronic constipation. In these instances the patient should be reevaluated for understanding, and additional teaching should be implemented.

 

DIF:    Cognitive Level: Apply                   REF:   Page 519

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Evaluation