Easier

STUDY MIDTERM

ANATOMY

Week 1:
Intro to Anatomy and Physiology Medica terminology Tissues and Body Systems

Introduction to anatomy and physiology● Introduction to medical terminology● Types of tissues in the human body
cavities● Functions of Thorgan systems● Homeostasis

Week 2: The Skeletal System

Basic bone anatomy and physiology

o Bone cells Bones of the skeleton
o Types of joints
o Joint movements
● Disorders of the skeletal system
o arthritis, osteoporosis
● Changes related to the disease and aging process make a new bone osteoclasts

Platelets: crack, break

Clasts: cell break down damage bone to make a new one

Blasts: bone builder

Week 3: The muscular system

● Skeletal muscles
o Structure and function
● Muscle actions
● Movements:
o agonist,
o antagonist
o synergist muscles
● Disorders of the muscular system
o Tendonitis
o Myalgia,
o Strains
o Sprains

Voluntary muscle and striated = skeletal (blood, vessel, respiratory)

Cardiac : involuntary muscles striated

Smooth: involuntary- nonstriated

Week 4: The nervous system

Nervous tissue
● Spinal cord and spinal nerves
o Structure and function
● Peripheral nervous system
● Anatomy of the brain, structure, and function

Nervous system send message for body activies

Neuroglia (Glial Cells): support neurons, keep neurvous tissue together, tế bào thần kinh đệm

Neurons: unique structure They can be sensory, motor or interneurons

The axon (send)and dendrites( receive signals) : sợi trục và nhánh cây•

Neurons are connected by SYNAPSES. These chemicals (neutrostranmitter) can either EXCITE or CALM (inhibit)
the

neuron that receives the chemicals.

Peripheral Nervous System ( somatic-autonomic)

sensory • Gathers information about changes occurring

within and around the body.
• Send signals (nerve impulses) to the CNS.
• The INPUT signal is sent via SENSORY
NEURONS
Processing and
Interpreting
• Information is "brought together," interpreted, to
create sensations, create thoughts, add to
memory, make decisions, etc.
Motor • Is the response to the signals (impulses).
• The goal is usually to maintain stable conditions -
>Homeostasis.
• The OUTPUT signal is sent via MOTOR
NEURONS
The Somatic Nervous System is the Motor System and
is part of the Peripheral Nervous System
This is the OUTPUT side of the nervous
system.
• Motor neurons are what send the signals to MOVE!
• The Autonomic Nervous System (ANS) controls the motor
function of internal organs and glands ( control unvoluntary muscle, glands that release hocmon-cac Tuyen tiet ra
hoocmon

• Glands that release hormones are also controlled by the

autonomic nervous system.

The branches of the PNS

: Autonomatic –

PARAsympathetic &sympsthetic-

Resting, Digesting & Fight,flightmaintenance

of our

bodies: “resting and

digesting”

• This means that we will

maintain homeostasis.
he pho giao cam (parasympathetic) nervous system controls
normal body functioning.

The sympathetic nervous system controls the “fight or

flight” response.• This is also known as a stress response

Week 5:

The nervous system: Somatic sensory system and motor

system
● Autonomic nervous system
● Disorders of the nervous system:
o Paralysis
o Stroke
o Spinal cord injury
● Changes related to a disease antiaging process

Cerebum
longitudinal fissure and divided from the cerebellum by the
transverse fissure.
External brain anatomy and lobes.
Cerebellum is inferior to the cerebrum

Cerebrum: The Four

Lobes• It is divided into the right and left, and there are four major
areas, called lobes.
• The lobes are named for the skull bones that cover them
and occur in pairs, one in each hemisphere.
1. Frontal Lobe: •
• is responsible for motor activities, behaviour and
emotions, memory storage, thinking (conscious
thought), smell and speech.
• contains the area responsible for “executive function”,
making sound decisions based on reason and
judgment. also contains Broca’s area, which
controls motor output for speech.

2. Occipital Lobe is responsible for vision.

3. Parietal Lobe• are involved with body sense perception and

language comprehension. In the parietal lobe is Wernicke’s area. Wernicke’s area
was long thought to control sensory aspects of language,
including understanding.
4. Temporal Lobe responsible for hearing, speech and language and
integration of emotions

In most people, Broca’s and Wernicke’s areas are in the

left hemisphere.
External brain anatomy and lobes.
Precentral gyrus is anterior to the central
sulcus and is responsible for motor activity
(movement

Postcentral gyrus is posterior to the

central sulcus and is responsible
for sensory integration (sensation).
Movement and sensory area
Cerebral Cortex : vo nao
• Much of the information coming into your brain is
contralateral
• • From its external appearance it is easy to see
why the cerebellum is called the “little brain”.

Week 6: Internal and external anatomy of the eye and the ear
● Sense of vision, hearing and equilibrium
● Sensory receptor and sensation
● Sense of taste and smell Somatic Senses
● touch, pain, pressure
● Disorders

that affect senses

● Changes related to the aging process
Lecture:
● Functions of the integumentary system
● Description and function of the layers of the skin
● Skin healing
● Role in temperature regulation
● Common disorders of the integumentary system
o Melanoma
o Skin lesions
● Changes
● Structure
and function of
the heart
● Cardiac
cycle
o Structure
amputated =phantom pain ( bị cắt cụt là cơn đau ảo
Practice questions:

Reinforce

Amplifies khuyech dai

Ligament connective tissue attaches muscle to bone

Cerument : ear wax

Cochlea: nail shape structure

Pinal nerves adult human body 12

Servical 8

4 warning signs of stroke

Dizzy, blur, speech, headache, face drooping, arm weakness, lot of sweaty, loss of visions

main symptoms are:

 Paralysis or numbness or inability to move parts of The face, arm, or leg - particularly on one side of The body
 Confusion- including trouble with speaking
 Headache with vomiting
 Trouble seeing in one or both eyes
 Metallic taste in mouth
  Difficulty in swallowing
 Trouble in walking (impaired coordination)
 Dystonia
 Alexia
 Agnosia
 Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
 Sudden confusion, trouble speaking, or difficulty understanding speech.
 Sudden trouble seeing in one or both eyes.
 Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
 Sudden severe headache with no known cause.
speech slurred or strange

4 senses: smells, taste, hearing, signs, touch

 Ears (hearing)
 Skin and hair (touch)
 Eyes (sight)
 Tongue (taste)
 Nose (smell)
2 generals senses

5 types of states :bitter, sour, umami, sweet, salty ( đắng chua chát ngọt mặn)

Short duration experiences Acute pain

Referred pain?

Chronic pain?

Key information and midterm

Vision

The midbrain is a

pathway to relay visual

and auditory impulses and

other information to the

cerebrum.

• The pons plays a role in

respiration.

• Medulla oblongata is

responsible for control of

heartbeat, respiration, and

blood vessel diameter

 pons: Contains nuclei that relay signals from the forebrain to the cerebellum,
along with nuclei that deal primarily with sleep, respiration, swallowing, bladder
 control, hearing, equilibrium, taste, eye movement, facial expressions, facial
sensation, and posture.
 midbrain: Associated with vision, hearing, motor control, sleep and wake cycles,
alertness, and temperature regulation.
 medulla: The lower half of the brainstem that contains the cardiac, respiratory,
vomiting, and vasomotor centers and regulates autonomic, involuntary functions
such as breathing, heart rate, and blood pressure.

The brain stem The four main parts of the diencephalon are:

1. Thalamus

2. Hypothalamus

3. Pineal body

4. Pituitary gland Corpus

Callossum

Thick, white band of nerve fibers that

connects the two hemispheres Each spinal nerve is

covered with
connective tissue and
contains axon
bundles and blood
vessels.
Each spinal nerve
carries both sensory
and motor
information

PSW 1022

There are 31 pairs of spinal nerves. Each

pair is named for the spinal cord
segment they are coming from. All these different nerves
innervate specific areas of the
body.
◦ This means they carry information to
and from that specific area.

Spinal
8 cervical nerves
(C1- C8)
12 thoracic
nerves (T1-T12)
5 lumbar nerves
(L1- L5)
5 sacral nerves (S1-
S5)
1 coccygeal nerve
(Co1) PSW 1022
For example, the T1 spinal nerve
comes out BELOW the T1 vertebra. *One exception is in the cervical
region.
Remember there are only 7 cervical
vertebrae, but there are 8 cervical
spinal nerves.
In the cervical region, the spinal nerves
come out ABOVE the vertebrae
starting at C1.
Therefore we have a C8, it comes
out BELOW C7. **

Phan xa:
The spinal cord is protected by many
structures (vertebrae and meninges),
however trauma can cause damage to
the nervous tissue of the spinal cord.

3 layers of the Meninges:
1. Dura mater = hard
mother
2. Arachnoid = spider
3. Pia mater = tender
mother

Spinal cord injury results in paralysis

(plegia) of the area that is related to
and below the location of the spinal
cord injury.

This means that there is N O sensory

input and N O motor output below
the level of injury of the spinal
cord.This means they can’t feel and
can’t move whatever was innervated
by the injured nerve and all the nerves
below it.
juries

For example, a spinal cord injury in the

cervical region would result in paralysis
of ALL four limbs.This is called
quadriplegia.

Injuries in the thoracic region and

below result in paraplegia, paralysis of
the lower extremity.
Reflexes developed as a protective
mechanism, to keep us safe.
A stroke is when there is a disruption
in the blood flow to a portion of the
brain
This disruption can either be due to
a blockage (blood clot) or
hemorrhage (bleeding).
When the blood stops flowing to the
part of the brain, this area no longer
receives oxygen and the brain tissue will
die.
Weakness – sudden loss of strength
 Trouble speaking – sudden
difficulty speaking or sudden
confusion
 Vision problems – sudden trouble
with vision
 Headache – sudden sever and
unusual headache
 Dizziness – sudden loss of balance
*especially with any of the above
signs
Changes with Aging
Process
PSW 1022

connective tissue
A body tissue that provides support for the body and connects all of its parts
muscle tissue
movement
nervous tissue
A body tissue that carries electrical messages back and forth between the brain and every other part of the body.
epithelial tissue
A body tissue that covers the surfaces of the body, inside and out
prefix
beginning of a word
Suffixes
letters added at the end of a base word that alters the meaning
Homeostasis
A tendency to maintain a balanced or constant internal state; the regulation of any aspect of body chemistry, such as
blood glucose, around a particular level
Microscopic Anatomy
examines cells and molecules
Macroscopic Anatomy
study of large body structures visible to the naked eye
negative feedback
A type of regulation that responds to a change in conditions by initiating responses that will counteract the change.
Maintains a steady state.
Anatomy
The study of body structure
Physiology
The study of body function
Pathology
study of disease
Anterior
front of the body
Posterior
back of body
Distal
away from the point of attachment
Proximal
Nearer to the trunk of the body
Medial
toward the midline
Lateral
away from the midline
Superior
toward the head
Inferior
Lower on the body, farther from the head
external
Located outside the body
internal
inside
superficial
near the surface
deep
Away from the body surface; more internal
Central
located in the center of a thing or place
peripheral
away from the center
transverse plane
divides the body into superior and inferior parts
median or midsagittal plane
divides the body in two equal left and right sides along the midline
frontal or coronal plane
divides the body into anterior and posterior sections
thoracic cavity
contains heart and lungs
pericardial cavity
contains the heart

abdominopelvic cavity
contains both the abdominal and pelvic cavities

cranical cavity
contains the brain

spinal cavity
spinal cord

skeletal system
gives our bodies structure and protects major organs like the heart, lungs, and brain

Muscles system
Function: help in movement of: bones; contraction of heart and other organs. E.g stomach

integumentary system
Consists of the skin, mucous membranes, hair, and nail

nervous system
the body's speedy, electrochemical communication network, consisting of all the nerve cells of the peripheral and
central nervous systems

endocrine system
the body's "slow" chemical communication system; a set of glands that secrete hormones into the bloodstream

cardiovascular system
The transport system of the body responsible for carrying oxygen and nutrients to the body and carrying away carbon
dioxide and other wastes; composed of the heart, blood vessels, and blood.

respiratory system
Brings oxygen into the body. Gets rid of carbon dioxide.

Lymphatic/Immune System
Main function is to protect the body from disease by developing immunities

gastrointestinal system
the body's system for digesting food; includes the digestive tract, salivary glands, pancreas, liver, and gallbladder

urinary system
Cleanses the blood. Rids the body of wastes. Maintains salt and water balance.
reproductive system
Reproduce offspring- produce male sex cells (sperm) and female sex cells (oocytes)

long bones
bones that are longer than they are wide
long bones
Are hard and dense bone that provide strength, structure and mobility.
00:1103:06
short bones
bones of the wrist and ankles
flat bones
These bones are thin, flat, and curved. They form the ribs, breastbone, and skull.
irregular bones
vertebrae and facial bones

Cartilage
A connective tissue that is more flexible than bone and that protects the ends of bones and keeps them from rubbing
together.

synovial fluid
The small amount of liquid within a joint used as lubrication. ( chất bôi trơn )

nervous system
the network of nerve cells and fibers that transmits nerve impulses between parts of the body.

Periosteum ,màng xương

a dense layer of vascular connective tissue enveloping the bones except at the surfaces of the joints.

Epiphysis
End of a long bone

Diaphysis trục xương

shaft of bone

Osteoporosis loãng xương

A condition in which the body's bones become weak and break easily.
00:0803:06
Osteoblasts tạo tế bào xương
bone forming cells

Osteocytes
mature bone cells
Osteoclasts
Bone-destroying cells

trabeculae
supporting bundles of bony fibers in cancellous bone bó sợi xương
arthritis viêm khớp
inflammation of a joint
glinding joints trật khớp
joint in which bones slide along eachother (wrists and ankles)
hinge joint ( khớp xương)

Joint between bones (as at the elbow or knee) that permits motion in only one plane

saddle joint ( khớp ngón tay )

type of joint found at the base of each thumb; allows grasping and rotation

Ellipsoid/Condyloid Joint
wrist and knuckles
pivot joint
Allows for rotation around the length of a bone, and only allows for rotation. E.G neck
ball and socket joint
hip and shoulder joints

Flexion
bending a joint

extension
Straightening of a joint

plantar flexion
bends the foot downward at the ankle

Dorsiflexion
bending of the foot or the toes upward

Abduction
Movement away from the midline of the body

Adduction
Movement toward the midline of the body

Inversion
Turning the sole of the foot inward

Eversion
turning the sole of the foot outward
Protraction
Moving a part forward
Retraction
moving a part backward
Rotation
The spinning motion of a planet on its axis
Circumduction
circular movement of a limb at the far end
thorax
pleural cavity, chest

Ribs
12 pairs
Cervical vertebrae
7
thoracic vertebrae
the second set of 12 vertebrae; form the outward curve of the spine and are known as T1 through T12
lumbar vertebrae
L1-L5 lower back
https://quizlet.com/search?query=psw-1022&type=sets&useOriginal=
Structure
Framework
Protect organs
Make blood cells
Minerals reserve

What are the functions of the skeletal system?

Bones & Cartilage

What makes up the skeletal system?

00:0203:06

Axial Skeleton
The following bones are part of the
Axial or Appendicular skeleton?

Skull
Vertebrae
Ribs
Sternum

Appendicular Skeleton

The following bones are part of the Axial or Appendicular skeleton?

Humerus
Femur
Ulna
Radius
Tibia
Fibula

Sutures

immovable joints that unite cranial bones

Fontanel/Fontanelle

the soft spot on top of the skull

Cervical
Thoracic
Lumbar
Sacral
Coccygeal

What are the 5 regions of the Vertebral Column (in order)?

Cervical

7 vertebrates in the neck in all mammals

Axis

C2: "NO"

Atlas

C1: "YES"

Lumbar

Vertebrate section in the lower body region, Carnivores have more for flexibility, Herbivores have less for support

Thoracic

Vertebrate section in the body region with the ribs attached to it.

00:0203:06

Sacral

Vertebrate section in the pelvis region. Carnivores have less for flexibility, Herbivores have more for support

Sternum

Also known as the breastbone

Coccygeal

Vertebrate section that consists of the tail

Scapula

Also known as the shoulder blade

Clavicle

Also known as the collarbone- Cats are the only domestic animal with a collarbone

Humerus

Also known as the upper arm bone

Ulna

larger and longer bone of the forearm

Radius

smaller bone of the forearm

Carpus

known as the knee in horses or the wrist in dogs and humans

Metacarpus

Bones of the palm of the hand. Known as the cannon region in horses.

Phalanges

Also known as fingers or digits

Pelvis or Hip Bone

ilium, ischium, and pubis fuse to form it

Ilium

part of the hip bone; part of the pelvis

Ischium

the lower, posterior portions of the pelvis

Pubis

smallest and most medial portion of the 3 pelvic bones

Femur

A heavy, long bone that forms the leg above the knee

Acetabulum

hip socket
Patella

Known as the kneecap in humans. Largest sesamoid bone.

Tibia

Medial, main weight bearing bone of the lower leg.

Fibula

thin bone that runs parallel to the other lower leg bone.

Tarsals

Called the "hock" in animals, "ankle" in humans

Metatarsals

Cannon region in the hind limb, number depends on the species.

Short bones

cube shaped, equal widths and lengths; carpals and tarsals

Flat bones

thin plate of bone; scapula, rib, skull, pelvis

Irregular bones

complex shaped; vertebrae

Sesamoid bones

small, seed shaped bones; Patella, Navicular bone

Long bones

bone is longer than it is wide; femur, tibia, humerus

Diaphysis

shaft of a long bone

Metaphysis

Flared portion of a long bone, between the diaphysis (shaft) of the bone and the epiphyseal plate at the end of the bone.

Epiphysis

Large ends of a long bone

Periosteum

thin, outer protective layer covering the outside of the bone (growth, development and repair of bone takes place in it)

Endosteum

thin, inner protective layer lining the medullary cavity

Medullary Cavity

space within the bone filled with bone marrow

Ossification

Process is when tissue and cartilage turns into bone

Simple Fracture

Fracture that does not break the skin

Complete Fracture

Fracture that goes completely across the bone

Compound Fracture

Fracture that breaks through the skin (much more serious)

Incomplete Fracture

Fracture that doesn't go completely across the bone

Fissure Fracture

Break along the long axis of a bone

Greenstick Fracture

one in which the bone is bent and only partially broken

Transverse Fracture

occurs straight across the bone

Comminuted Fracture

bone shatters into many pieces

Skeletal System
Muscular System

What 2 systems make the musculoskeletal system?

Declaw

Term for removal of the claws

Dew Claw

A claw that serves no purpose on dogs and is commonly removed so that it doesn't catch on anything and tear off causing
injury.

Frontal

Front or Cranial part of the skull.

Parietal

Paired bones on the roof of the cranial part.

Occipital
Back part of the cranial part, has a hole for the spinal cord.

Temporal

Paired bones on the side of the cranium.

Sphenoid

Paired bones that form base of skull and around the bony eye socket.

Zygomatic Arch

Forms the cheekbones

Incisive

Nose part by the nostrils & hard palate

Nasal

Bridge of the nose

Maxilla

Upper jaw

Mandible

Lower jaw

Brachycephalic

Dog skulls with short, wide heads (ex. pugs, Pekingese)

Dolichocephalic

Dog skulls with long, narrow heads (ex. collies, greyhounds)

Mesocephalic

Dog skulls with average heads (ex. Labrador retrievers)

Intervertebral Disc Disease

Condition where the space between the vertebrates start to protrude into the spinal cord causing paralysis.

Dachshund, Pekingese, Cocker Spaniel

Dog breeds prone to getting Intervertebral disc disease?

26% minerals
50% water
20% protein
4% fat

What are bones made of?

Spongy Bone

Soft bone with holes and tunnels in it; that fills the ends of hollow bones

Yellow Marrow

Which marrow (Red or Yellow) is located in the hollow part of a bone and stores fat cells and energy and makes cell
membranes?

Red Marrow

Which marrow (Red or Yellow) is located in the spongy bone and makes red blood cells?

Compact Bone

2nd strongest material in your body that is hard mineral matter beneath the periosteum.

Enamel

What's the strongest material in our body?

96% fat
Build immunity
Repair wounds
Help with digestion & kidney function
Fight cancer
Build & clot blood

What are the benefits and components of bone marrow?

Osteoblasts

Cells that make bone tissue

Osteocytes

Cells that maintain bone tissue

Osteoclasts
Cells that eat bone tissue

Synovial Joints

Joints that allow us to move freely

Synovial Fluid

Lubricates your joints to make your joints to move more freely so that the cartilage doesn't wear out

Hinge Joint

What type of joint is the knee and elbow?

Ball and Socket Joint

What type of joint is the shoulder and hip?

Gliding Joint

What type of joint is the carpals, tarsals, and vertebrates?

Fixed (Immovable) Joint

What type of joint is the skull (sutures)?

Stunted Growth of the Bone

What happens if you break the growth plate of a bone?

Hip Dysplasia

When the acetabulum doesn't fit nicely into the socket of the hip? Seen commonly in large and over weight dogs.

Rickets

Vitamin D deficiency causes deformity of the legs causing them to be curved and weakened.

Arthritis

Inflammation of a joint

1 in every 5

How many dogs are affected by arthritis?

Osteoarthritis

Degenerative Joint Disease is commonly found in older animals - what's another name for DJD?

Ligaments appear as crisscross bands that attach bone to bone and help
stabilize joints.
Tendons, located at each end of a muscle, attach muscle to bone.

The cerebellum is involved in

sensory and
motor coordination and balance.
• why the cerebellum is called the
“little brain”.
Corpus
Callossum• Thick, white band
of nerve fibers that
connects the two hemispheres of
the
cerebrum and allows them to
communicate
and coordinate their activities.
• A collection of white matter
surrounding the
lateral ventricles, connecting the
left and
right hemispheres. Sclera – the
outer layer that is the protective
layer. This
is what we call “the whites of our
eyes”.
• The sclera has a special part
that is transparent called the
cornea.
Choroid – the middle layer that
contains many blood
vessels.
• This layer contains the iris and
the pupil.
• The last part of this layer is the
lens
Retina - is the inside layer that
contains nervous tissue
containing sensors.
• These sensors are called rods
and cones. Choroid
 This layer contains the iris and
the pupil. Choroid
 This layer contains the iris and
the pupil. The middle ear is a space
that holds the smallest
bones of your body called
ossicles.
 These bones are joined so
that they can increase the
sound waves that hit the
tympanic membrane.
 Also part of the middle ear
is the Eustachian tube
that helps to equalize the
pressure in the ear.
 Going from the outside in,
the bones are the malleus,
incus and stapes.
 The stapes connects to an
internal membrane that
transmits the amplified
sound waves into the inner
ear.

PSW 1022 11
WEEK 7: (7) Heart 101 | National Geographic - YouTube

Nirmal vs for an adult

Blood pressure: Check whats their normal

Fever 38 and up ( check 0.5-1hr)

Mouth check under tongue

Wait half an hour check patient temperature after eat or drink, smoke

Ear direction toward your front

Pulse with 2 fingers, radio..

Respiration best position seating them up

30s times 2, adult 12-20

Woman lower than man

Heart rate- pain.. heart rate go up, blood,.. up.

What is going on w my patient, do I recognize anything going on

Best is left close to your heart

1inch -1finger fit

Review quiz:

At least every 3-day bowel, can’t be more than 3 days, requently

Sofr formed and brown (chart)

Types number BRISTOL STOOL CHART

Factorts affecting bm. Amount, color, consistency, older.

Fibre, activities, nutrition fluid, bets

Best time promote is morning after breakfast (30mins)

Key things: privacy, give them time.

No more than 20 mins in toilet (uncomfortable, skin, heart) don’t strain

Give them call bell.

Peri care

Bowel routine, schedule, helps patient

Preven better than treating.

Fecal impaction, pink liquid not okay,

Fecal incontinence: bowel routine is so important,

Diarrhea, huge problem, dehydration, and skin.. offer them small nutrition good fluid no tea, coffee. More water “sip
sip..”

Isolate them, spread to the whole unit.

Flatulence+gas : acvtivies, reposition them, left side position, no spicy food, vegies

Enema: sim position (200cc) work 5-10 mins.. blue pad ready, gentle way (left side)

Ostomy+ created opening +stoma( wash skin around, dry , observe any break down, make sure stoma pink and
wide, healthy, dusky= death) cut the whole to fit the stoma, cut nicely and fit

Colostomy is lowest

Ileostomy empty

URINARY

Waste from blood,

Clear, light, yellow, nothing on it

Incontinence 100ml every time

COMMON URINARY ELIMINATION PROBLEMS CHART

Pee passes the prostate for old man

Bedpans

Urinals only for males w penis, doesn’t go to bed table, hang it on the rail, measure after, no handle,

Commodes, (patient cant walk far to the washroom)

(basic types of incontinence are)

Stress and functional ( mixed)

Skin clean and dry

Continence products

Risks with Brief

Catheters you have to make sure (UTI) 3 key principles ( has to be below bladder,, never on the bed rails, and empty
alcohol swap, paper towl0

Turn your patient, always bring the bag toward turn patient first and bring the bag) 2000

Leg bag 600ml

empty every shift or whenever it fill up

Accidental Disconnection , clams/ 2 alcohol swap

Condom catheter, wrap penis,

Urine Specimens

The nurse knows that most nutrients are absorbed in which portion of the digestive
tract?
a. Stomach
b. Duodenum
c. Ileum
d. Cecum
ANS: B
Most nutrients are absorbed in the duodenum with the exception of certain vitamins,
iron, and salt (which are absorbed in the ileum). Food is broken down in the stomach.
The cecum is the beginning of the large intestine
The nurse would expect the least formed stool to be present in which portion of the
digestive tract?
a. Ascending
b. Descending
c. Transverse
d. Sigmoid
ANS: A
The path of digestion goes from the ascending, across the transverse, to the
descending and finally passing into the sigmoid; therefore, the least formed stool would
be in the ascending
00:0803:49
Which of the following is not a function of the large intestine?
a. Absorbing nutrients
b. Absorbing water
c. Secreting bicarbonate
d. Eliminating waste
ANS: A
Nutrient absorption is done in the small intestine. The other options are all functions of
the large intestine.
The nurse is caring for a patient who is confined to the bed. The nurse asks the patient
if he needs to have a bowel movement 30 minutes after eating a meal because
a. The digested food needs to make room for recently ingested food.
b. Mastication triggers the digestive system to begin peristalsis.
c. The smell of bowel elimination in the room would deter the patient from eating.
d. More ancillary staff members are available after meal times.
ANS: B
Peristalsis occurs only a few times a day; the strongest peristaltic waves are triggered
by mastication of the meal. The intestine can hold a great deal of food. A patient's
voiding schedule should not be based on the staff's convenience
A nurse is assisting a patient in making dietary choices that promote healthy bowel
elimination. Which menu option should the nurse recommend?
a. Grape and walnut chicken salad sandwich on whole wheat bread
b. Broccoli and cheese soup with potato bread
c. Dinner salad topped with hard-boiled eggs, cheese, and fat-free dressing
d. Turkey and mashed potatoes with brown gravy
ANS: A
A healthy diet for the bowel should include foods high in bulk-forming fiber. Whole
grains, fresh fruit, and fresh vegetables are excellent sources. Foods without much fiber
and with high levels of fat can slow down peristalsis, causing constipation
A patient informs the nurse that she was using laxatives three times daily to lose weight.
After
stopping use of the laxative, the patient had difficulty with constipation and wonders if
she needs to take laxatives again. The nurse educates the patient that
a. Long-term laxative use causes the bowel to become less responsive to stimuli, and
constipation may occur.
b. Laxatives can cause trauma to the intestinal lining and scarring may result, leading to
decreased peristalsis.
c. Natural laxatives such as mineral oil are safer than chemical laxatives for relieving
constipation.
d. Laxatives cause the body to become malnourished, so when the patient begins
eating again, the body absorbs all of the food, and no waste products are produced
ANS: A
Long-term laxative use can lead to constipation. Increasing fluid and fiber intake can
help with this problem. Laxatives do not cause scarring. Natural laxatives like mineral oil
come with their own set of risks, such as inability to absorb fat-soluble vitamins. Even if
malnourished, the body will produce waste if substance is consumed
A patient with a hip fracture is having difficulty defecating into a bed pan while lying in
bed. Which action by the nurse would assist the patient in having a successful bowel
movement?
a. Administering laxatives to the patient
b. Raising the head of the bed
c. Preparing to administer a barium enema
d. Withholding narcotic pain medication
ANS: B
Lying in bed is an unnatural position; raising the head of the bed assists the patient into
a more normal position that allows proper contraction of muscles for elimination.
Laxatives would not give the patient control over bowel movements. A barium enema is
a diagnostic test, not an intervention to promote defecation. Pain relief measures should
be given; however, preventative action should be taken to prevent constipation.
Which patient is most at risk for increased peristalsis?
a. A 5-year-old child who ignores the urge to defecate owing to embarrassment
b. A 21-year-old patient with three final examinations on the same day
c. A 40-year-old woman with major depressive disorder
d. An 80-year-old man in an assisted-living environment
ANS: B
Stress can stimulate digestion and increase peristalsis. Ignoring the urge to defecate,
depression, and age-related changes of the elderly are causes of constipation
A patient expresses concerns over having black stool. The fecal occult test is negative.
Which response by the nurse is most appropriate?
a. "This is probably a false negative; we should rerun the test."
b. "Do you take iron supplements?"
c. "You should schedule a colonoscopy as soon as possible."
d. "Sometimes severe stress can alter stool color."
ANS: B
Certain medications and supplements, such as iron, can alter the color of stool. The
fecal occult test takes three separate samples over a period of time and is a fairly
reliable test. A colonoscopy is health prevention screening that should be done every 5
to 10 years; it is not the nurse's initial priority. Stress alters GI motility and stool
consistency, not color
Which physiological change can cause a paralytic ileus?
a. Chronic cathartic abuse
b. Surgery for Crohn's disease and anesthesia
c. Suppression of hydrochloric acid from medication
d. Fecal impaction
ANS: B
Surgical manipulation of the bowel can cause a paralytic ileus. The other options are
incorrect
Fecal impactions occur in which portion of the colon?
a. Ascending
b. Descending
c. Transverse
d. Rectum
ANS: D
A fecal impaction is a collection of hardened feces wedged in the rectum that cannot be
expelled. It results from unrelieved constipation. Feces at this point in the colon contain
the least amount of moisture. Feces found in the ascending, transverse, and
descending colon still consist mostly of liquid and do not form a hardened mass.
The nurse provides knows that a bowel elimination schedule would be most beneficial in
the plan of care for which patient?
a. A 40-year-old patient with an ileostomy
b. A 25-year-old patient with Crohn's disease
c. A 30-year-old patient with C. difficile
d. A 70-year-old patient with stool incontinence
ANS: D
A bowel elimination program is helpful for a patient with incontinence. It helps the
person who still has neuromuscular control defecate normally. An ileostomy, Crohn's
disease, and C. difficile all relate to uncontrollable bowel movements, for which no
method can be used to set
up a schedule of elimination
00:0203:49
Which nursing intervention is most effective in promoting normal defecation for a patient
who
has muscle weakness in the legs that prevents ambulation?
a. Elevate the head of the bed 45 degrees 60 minutes after breakfast.
b. Use a mobility device to place the patient on a bedside commode.
c. Give the patient a pillow to brace against the abdomen while bearing down.
d. Administer a soap suds enema every 2 hours
ANS: B
The best way to promote normal defecation is to assist the patient into a posture that is
as normal as possible while defecating. Using a mobility device promotes nurse and
patient safety. Elevating the head of the bed would be appropriate if the patient were to
void with a bed pan. However, the patient's condition does not require use of a bed pan.
Giving the patient a pillow may reduce discomfort, but this is not the best way to
promote defecation. A soaps suds enema is indicated for a patient who needs
assistance to stimulate peristalsis. It promotes non-natural defecation
The nurse is devising a plan of care for a patient with the nursing diagnosis of
Constipation related to opioid use. Which of the following outcomes would the nurse
evaluate as successful for the patient to establish normal defecation?
a. The patient reports eliminating a soft, formed stool.
b. The patient has quit taking opioid pain medication.
c. The patient's lower left quadrant is tender to the touch.
d. The nurse hears bowel sounds present in all four quadrants
ANS: A
The nurse's goal is for the patient to be on opioid medication and to have normal bowel
elimination. Normal stools are soft and formed. Ceasing pain medication is not a desired
outcome for the patient. Tenderness in the left lower quadrant indicates constipation
and does not further address bowel elimination. Present bowel sounds indicate that the
bowels are moving; however, they are not an indication of defecation.
The nurse is emptying an ileostomy pouch for a patient. Which assessment finding
would the nurse report immediately?
a. Liquid consistency of stool
b. Presence of blood in the stool
c. Noxious odor from the stool
d. Continuous output from the stoma
ANS: B
Blood in the stool may indicate a problem with the surgical procedure, and the physician
should be notified. All other options are expected findings for an ileostomy
The nurse would anticipate which diagnostic examination for a patient with black tarry
stools?
a. Ultrasound
b. Barium enema
c. Upper endoscopy
d. Flexible sigmoidoscopy
ANS: C
Black tarry stools are an indication of ulceration or bleeding in the upper portion of the
GI tract; upper endoscopy would allow visualization of the bleeding. No other option
would allow upper GI visualization
The nurse has attempted to administer a tap water enema for a patient with fecal
impaction
with no success. What is the next priority nursing action?
a. Preparing the patient for a second tap water enema
b. Donning gloves for digital removal of the stool
c. Positioning the patient on the left side
d. Inserting a rectal tube
ANS: B
When enemas are not successful, digital removal of the stool may be necessary
occasionally to break up pieces of the stool or to stimulate the anus to defecate. Tap
water enemas should not be repeated because of risk of fluid imbalance. Positioning the
patient on the left side does
not promote defecation. A rectal tube is indicated for a patient with liquid stool
incontinence but would not be applicable or effective for this patient
The nurse should question which order?
a. A normal saline enema to be repeated every 4 hours until stool is produced
b. A hypertonic solution enema with a patient with fluid volume excess
c. A Kayexalate enema for a patient with hypokalemia
d. An oil retention enema for a patient using mineral oil laxatives
ANS: C
Kayexalate binds to and helps excrete potassium, so it would be contraindicated in
patients who are hypokalemic (have low potassium). Normal saline enemas can be
repeated without risk of fluid or electrolyte imbalance. Hypertonic solutions are intended
for patients who cannot handle large fluid volume and are contraindicated for
dehydrated patients. Because mineral oil laxatives and an oil retention enema have the
same intended effect of lubricating the colon and rectum, an oil retention enema is not
needed
The nurse is preparing to perform a fecal occult blood test. The nurse plans to properly
perform the examination by
a. Applying liberal amounts of stool to the guaiac paper.
b. Testing the quality control section before collecting the specimen section.
c. Reporting any abnormal findings to the provider.
d. Applying sterile disposable gloves
ANS: C
Abnormal findings such as a positive test should be reported to the provider. A fecal
occult blood test is a clean procedure; sterile gloves are not needed. A thin specimen
smear is all that is required. The quality control section should be developed after it is
determined whether the sample is positive or negative
A nurse is preparing a patient for a magnetic resonance imaging scan. Which nursing
action is
most important?
a. Ensuring that the patient does not eat or drink 2 hours before the examination
b. Removing all of the patient's metallic jewelry
c. Administering a colon cleansing product 12 hours before the examination
d. Obtaining an order for a pain medication before the test is performed
ANS: B
No jewelry or metal products should be in the same room as an MRI machine because
of the high-power magnet used in the machine. The patient needs to be NPO 4 to 6
hours before the examination. Colon cleansing products are not necessary for MRIs.
Pain medication is not needed before the examination is performed
After a patient returns from a barium swallow, the nurse's priority is to
a. Encourage the patient to increase fluids to flush out the barium.
b. Monitor stools closely for bright red blood or mucus, which indicates trauma from the
procedure.
c. Inform the patient that his bowel movements are radioactive, and that he should be
sure to flush the toilet three times.
d. Thicken all patient drinks to prevent aspiration
ANS: A
Encourage the patient to increase fluid intake to flush and remove excess barium from
the body. Barium swallow is a noninvasive procedure for which no trauma would
produce blood or mucus or increase aspiration risk. Barium is not a radioactive
substance, so multiple flushes are not needed.
While a cleansing enema is administered to an 80-year-old patient, the patient
expresses the
urge to defecate. What is the next priority nursing action?
a. Positioning the patient in the dorsal recumbent position with a bed pan
b. Assisting the patient to the bedside commode
c. Stopping the enema cleansing and rolling the patient into right-lying Sims' position
d. Inserting a rectal plug to contain the enema solution
ANS: A
Patients with poor sphincter control may not be able to hold in all of an enema solution.
Positioning the patient on a bed pan in dorsal recumbent position will allow the nurse to
continue to administer the enema. Having the patient get up to toilet is unsafe because
the rectal tube can damage the mucosal lining. The purpose of the enema is to promote
defecation; stopping it early may inhibit its effectiveness. Use of a rectal plug to contain
the solution is
inappropriate
A nurse is educating a patient on how to irrigate an ostomy bag. Which statement by the
patient indicates the need for further instruction?
a. "I can use a fleet enema to save money because it contains the same irrigation
solution."
b. "Sitting on the toilet lets the irrigation sleeve eliminate into the bowl."
c. "I should never attempt to reach into my stoma to remove fecal material."
d. "Using warm tap water will reduce cramping and discomfort during the procedure."
ANS: A
Enema applicators should never be used in the stoma because they can cause
damage. A special coned irrigation device is used for ostomies. Irrigating a stoma into
the toilet is an effective management technique. Fingers and other objects should not
be placed into the stoma because they may cause trauma to the intestinal wall. Warm
tap water will reduce cramping during irrigation.
A patient is diagnosed with a bowel obstruction. The nurse chooses which type of tube
for gastric decompression?
a. Salem sump
b. Dobhoff
c. Sengstaken-Blakemore
d. Small bore
ANS: A
A bowel obstruction causes a backup into the gastric area; a nasogastric tube may be
inserted to decompress secretions and gases from the gastrointestinal tract. The Salem
sump has the width and functionality needed to both feed and suction, and it is ideal for
a bowel obstruction. A Dobhoff tube is used for instillation of feedings. A Sengstaken-
Blakemore tube is used to
compress stomach contents to prevent hemorrhage. A small bore is intended for
nutritional feedings only and does not have suction capacity
A patient had an ileostomy surgically placed 2 days ago. Which diet would the nurse
recommend to the patient to ease the transition of the new ostomy?
a. Eggs over easy, whole wheat toast, and orange juice with pulp
b. Chicken fried rice with stir fried vegetables and iced tea
c. Turkey meatloaf with white rice and apple juice
d. Fish sticks with macaroni and cheese and soda
ANS: C
During the first week or so after ostomy placement, the patient should consume easy-to-
digest low-fiber foods such as poultry, rice and noodles, and strained fruit juices. Fried
foods can irritate digestion and can cause blockage. Foods high in fiber will be useful
later in the recovery process but can cause blockage if the GI tract is not accustomed to
digesting with an ileostomy
A nurse is pouching an ostomy on a patient with an ileostomy. Which action by the
nurse is most appropriate?
a. Changing the skin barrier portion of the ostomy pouch daily
b. Selecting a pouch that is able to hold excess output to reduce the frequency of pouch
emptying
c. Thoroughly scrubbing the skin around the stoma to remove excess stool and
adhesive
d. Measuring the correct size for the barrier device while leaving a 1/8-inch space
around the stoma
ANS: B
Selecting a pouch that holds a large volume of output will decrease the frequency of
emptying the pouch and may ease patient anxiety about pouch overflow. The barrier
device should be changed every few days unless it is leaking or is no longer effective.
Peristomal skin should
be gently cleansed; vigorous rubbing can cause further irritation or skin breakdown.
Approximately 1/16 of an inch is present between the barrier device and the stoma.
Excess space allows fecal matter to have prolonged exposure to skin, resulting in skin
breakdown
The nurse knows that the ideal time to change an ostomy pouch is
a. Before eating a meal, when the patient is comfortable.
b. When the patient feels that he needs to have a bowel movement.
c. When ordered in the patient's chart.
d. After the patient has ambulated the length of the hallway
ANS: A
The nurse wants to change the ostomy appliance when as little output as necessary
ensures a smooth procedure. Patients with ostomies do not feel the urge to defecate
because the sensory portion of the anus is not stimulated. Changing the ostomy pouch
is a nursing judgment decision. After a patient ambulates, stool output is increased
The nurse administers a cathartic to a patient. The nurse determines that the cathartic
has had
a therapeutic effect when the patient
a. Has a decreased level of anxiety.
b. Experiences pain relief.
c. Has a bowel movement.
d. Passes flatulence
ANS: C
A cathartic is a laxative that stimulates a bowel movement. It would be effective if the
patient experiences a bowel movement. The other options are not outcomes of
administration of a cathartic.
An older adult's perineal skin appears to be dry and thin with mild excoriation. When
providing hygiene after a bowel movement, the nurse should
a. Thoroughly scrub the skin with a wash cloth and hypoallergenic soap.
b. Apply a skin protective lotion after perineal care.
c. Tape an occlusive moisture barrier pad to the patient's skin.
d. Massage the skin with deep kneading pressure
ANS: B
Proper skin care and perineal cleaning require that the nurse gently clean the skin and
apply a moistening barrier cream. Tape and occlusive dressings can damage skin.
Excessive pressure and force are inappropriate and may cause skin breakdown
Which nursing action best reduces risk of excoriation to the mucosal lining of the nose
from a nasogastric tube?
a. Lubricating the nares with water-soluble lubricant
b. Applying a small ice bag to the nose for 5 minutes every 4 hours
c. Instilling Xylocaine into the nares once a shift
d. Changing the tape holding the tube in place once a shift
ANS: A
The tube constantly irritates the nasal mucosa, increasing the risk of excoriation.
Frequent lubrication with a water-soluble lubricant decreases the likelihood of
excoriation. Ice is not applied to the nose. Ice may be applied externally to the throat if
the patient reports a sore throat. Xylocaine requires a physician order and is used to
treat sore throat, not nasal mucosal excoriation. Changing the tape should be done
daily, not every shift
A nurse is providing discharge teaching for a patient who is going home with a guaiac
test. Which statement by the patient indicates the need for further education?
a. "If I get a positive result, I have gastrointestinal bleeding."
b. "I should not eat red meat before my examination."
c. "I should schedule to perform the examination when I am not menstruating."
d. "I will need to perform this test three times if I have a positive result."
ANS: A
A positive result does not mean GI bleeding; it could be a false positive from consuming
red meat, some raw vegetables, or NSAIDs. Proper patient education is important for
viable results. The patient needs to avoid certain foods to rule out a false positive. If the
test is
positive, the patient will need to repeat the test at least three times. Menses and
hemorrhoids can also lead to false positives
A nurse is caring for an older adult patient with fecal incontinence due to cathartic use.
The
nurse is most concerned about which complication that has the greatest risk for severe
injury?
a. Rectal skin breakdown
b. Contamination of existing wounds
c. Falls from attempts to reach the bathroom
d. Cross-contamination into the upper GI tract
ANS: C
The nurse is most concerned about the worst injury the patient could receive, which
involves falling while attempting to get to the bathroom. To reduce injury, the nurse
should clear the path and reinforce use of the call light. The question is asking for the
greatest risk of injury,
not the most frequent occurrence or the event most likely to occur
The nurse is caring for a patient with Clostridium difficile. Which of the following nursing
actions will have the greatest impact in preventing the spread of bacteria?
a. Monthly in-services about contact precautions
b. Placing all contaminated items in biohazard bags
c. Mandatory cultures on all patients
d. Proper hand hygiene techniques
ANS: D
Proper hand hygiene is the best way to prevent the spread of bacteria. Monthly in-
services place emphasis on education, not on action. Biohazard bags are appropriate
but cannot be used on every item that C. difficile comes in contact with, such as a
human. Mandatory cultures are expensive and unnecessary and would not prevent the
spread of bacteria
A nurse is performing an assessment on a patient who has not had a bowel movement
in 3 days. The nurse would expect which other assessment finding?
a. Hypoactive bowel sounds
b. Jaundice in sclera
c. Decreased skin turgor
d. Soft tender abdomen
ANS: A
Three or more days with no bowel movement indicates hypomotility of the GI tract.
Assessment findings would include hypoactive bowel sounds, a firm distended
abdomen, and pain or discomfort upon palpation
A nurse is caring for a patient who has had diarrhea for the past week. Which additional
assessment finding would the nurse expect?
a. Increased energy levels
b. Distended abdomen
c. Decreased serum bicarbonate
d. Increased blood pressure
ANS: C
Chronic diarrhea can result in metabolic acidosis, which is diagnostic of low serum
bicarbonate. Patients with chronic diarrhea are dehydrated with decreased blood
pressure.
Diarrhea also causes loss of electrolytes, nutrients, and fluid, which decreases energy
levels. A distended abdomen would indicate constipation
The nurse is caring for a patient who had a colostomy placed yesterday. The nurse
should
report which assessment finding immediately?
a. Stoma is protruding from the abdomen.
b. Stoma is moist.
c. Stool is discharging from the stoma.
d. Stoma is purple.
ANS: D
A purple stoma may indicate strangulation or poor circulation to the stoma and may
require surgical intervention. A stoma should be reddish-pink and moist in appearance.
It can be flush with the skin, or it can protrude. Stool is an expected outcome of stoma
placement
A patient has constipation and hypernatremia. The nurse prepares to administer which
type of
enema?
a. Oil retention
b. Carminative
c. Saline
d. Tap water
ANS: D
Tap water enema would draw fluid into the system and would help flush out excess
sodium. Oil retention would not address sodium problems. Carminative enemas are
used to provide relief from distention caused by gas. A saline enema would worsen
hypernatremia
A guaiac test has been ordered. The nurse knows that this is a test for
a. Bright red blood.
b. Dark black blood.
c. Blood that contains mucus.
d. Blood that cannot be seen.
ANS: D
Fecal occult blood tests are used to test for blood that may be present in stool that
cannot be seen by the naked eye. This is usually indicative of a GI bleed. All other
options are incorrect
The nurse should place the patient in which position when preparing to administer an
enema?
a. Left Sims' position
b. Fowler's
c. Supine
d. Semi-Fowler's
ANS: A
Side-lying Sims' position allows the enema solution to flow downward by gravity along
the natural curve of the sigmoid colon. This helps to improve retention of the enema.
Administering an enema in a sitting position may allow the curved rectal tube to scrape
the rectal wall.
The nurse is assessing a patient 2 hours after a colonoscopy. Based on the procedure
done, what focused assessment will the nurse include?
a. Bowel sounds
b. Presence of flatulence
c. Bowel movements
d. Nausea
ANS: A
The nurse does want to hear the presence of bowel sounds; absent bowel sounds may
indicate a complication from the surgery. Bowel movements and flatulence are not
expected in the hours after surgery. The nurse does want to hear the presence of bowel
movements. Nausea is not a problem following colonoscopy.

ADVERTISEMENT

Normal flora contained in the colon aid digestion and produce which nutrients? Select
all that apply.

1) Vitamin A
2) Vitamin B
3) Vitamin C
4) Vitamin K
5) Iron
6) Zinc
Answer:
2) Vitamin B
4) Vitamin K
Rationale:
The normal flora in the colon produce vitamin K and several of the B vitamins. They are
not responsible for production of vitamins A and C, iron, and zinc.
When a patient with heartburn takes antacids, for which problem is he especially at
risk?

1) Diarrhea
2) Constipation
3) Stomach ulceration
4) Flatulence
Answer:
2) Constipation

Rationale:
Antacids slow peristalsis, placing the patient at risk for constipation. Antibiotics increase
the risk for diarrhea. Stomach ulceration is an adverse effect associated with NSAIDs.
Iron supplementation may cause flatulence.
00:0203:49
Which type of bowel diversion allows the patient to be free from an appliance?

1) Colostomy in the transverse colon

2) Double-barreled colostomy
3) Ileostomy
4) Kock pouch
Answer:
4) Kock pouch

Rationale:
A Kock pouch, also known as a continent ileostomy, creates an internal pouch to collect
ileal drainage. To drain the pouch, the patient inserts a tube through the external stoma
into a pouch several times a day. This allows the patient to be free from an appliance. A
colostomy, double-barreled colostomy, and ileostomy all require an appliance.
The nurse has taught a client how to manage constipation. Which action by the client
would provide evidence of learning? (Select all that apply.) The patient:

1) increases his intake of high-fiber foods.

2) drinks at least four 8-ounce glasses of water a day.
3) goes to the bathroom to evacuate after meals.
4) takes a daily laxative.
Answer:
1) increases his intake of high-fiber foods.
3) goes to the bathroom to evacuate after meals.

Rationale:
The urge to defecate typically comes after eating; the nurse can help manage the
patient's constipation by assisting the patient to the bathroom after meals. The nurse
should also encourage the patient to increase his intake of high-fiber food and drink at
least eight glasses of water a day (not four). Laxatives should be administered or taken
only when absolutely necessary.
The nurse in a long-term care facility is teaching a group of residents about increasing
dietary fiber. Which foods should she explain are high in fiber?

1) White bread, pasta, and white rice

2) Oranges, raisins, and strawberries
3) Whole milk, eggs, and bacon
4) Peaches, orange juice and bananas
Answer:
2) Oranges, raisins, and strawberries

Rationale:
Oranges, raisins, and strawberries are high in fiber. White bread, pasta, and white rice
are carbohydrates. Whole milk, eggs, and bacon are high in cholesterol. Peaches,
orange juice, and bananas are sources of potassium.
A patient is admitted to the hospital with severe diarrhea. The patient should be
monitored for which complication associated with diarrhea?

1) Hypokalemia
2) Hypocalcemia
3) Hyperglycemia
4) Thrombocytopenia
Answer:
1) Hypokalemia

Rationale:
Diarrhea causes fluid loss and hypokalemia, not hypocalcemia, hyperglycemia, or
thrombocytopenia.
The nurse is assessing a patient who underwent bowel resection 2 days ago. As she
auscultates the patient's abdomen, she notes low-pitched, infrequent bowel sounds.
How should she document this finding?

1) Hyperactive bowel sounds

2) Abdominal bruit sounds
3) Normal bowel sounds
4) Hypoactive bowel sounds
Answer:
4) Hypoactive bowel sounds

Rationale:
Hypoactive bowel sounds are low pitched, infrequent, and quiet. An abdominal bruit is a
hollow, blowing sound found over an artery, such as the iliac artery. Normal bowel
sounds are high pitched, with approximately 5 to 35 gurgles occurring every minute.
Hyperactive bowel sounds are very high pitched and more frequent than normal bowel
sounds.
For a patient with a newly fractured pelvis, not yet in a cast, which of the following
actions is appropriate when placing the patient on a bedpan?

1) Place the patient in semi-Fowler's position to defecate.

2) Ask the patient to push up with his feet to lift his hips while you place the bedpan.
3) Place a fracture pan under the buttocks, small end toward the feet.
4) Raise the siderail on the opposite side from where you are working.
Answer:
4) Raise the siderail on the opposite side from where you are working.

Rationale:
The nurse should always raise the siderail on the opposite side from where he is
working to protect the patient from falls. Placing the patient in semi-Fowler's position or
asking the patient to push up with his feet would cause pain and possible dislocation of
the fracture. A fracture pan should be used, but the large end is pointed toward the feet.
The nurse is instructing a patient about performing home testing for fecal occult blood.
The nurse can conclude that learning occurs if the patient says, "For 3 days prior to
testing, I should avoid eating

1) beef.
2) milk.
3) eggs.
4) oatmeal.
Answer:
1) beef.

Rationale:
The nurse should instruct the patient to avoid red meat, chicken, fish, horseradish, and
certain raw fruits and vegetables for 3 days prior to fecal occult blood testing.
Which of the following goals is appropriate for a patient with a nursing diagnosis of
Constipation? The patient increases the intake of:

1) milk and cheese.

2) bread and pasta.
3) fruits and vegetables.
4) lean meats.
Answer:
3) fruits and vegetables.

Rationale:
The nurse should encourage the patient to increase his intake of foods rich in fiber
because they promote peristalsis and defecation, thereby relieving constipation. Low-
fiber foods, such as bread, pasta, and other simple carbohydrates, as well as milk,
cheese, and lean meat, slow peristalsis.
The nurse must irrigate the colostomy of a patient who is unable to move independently.
How should the nurse position the patient for this procedure?

1) Semi-Fowler's position
2) Left side-lying position
3) Supine, with the head of the bed lowered flat
4) Supine, with the head of bed raised to 30 degrees
Answer:
2) Left side-lying position

Rationale:
The nurse should position an immobile patient in a left side-lying position to irrigate his
colostomy. Semi-Fowler's, supine with the bed lowered flat, and the supine position with
the head of bed elevated to 30 degrees are not appropriate positions for colostomy
irrigation.
Which is a key treatment intervention for the patient admitted with diverticulitis?

1) Antacid
2) Antidiarrheal agent
3) Antibiotic therapy
4) NSAIDs
Answer:
3) Antibiotic therapy

Rationale:
A key treatment for diverticulitis (an infected diverticulum) is antibiotic therapy; if
antibiotic therapy is ineffective, surgery may be necessary. Antacids, antidiarrheal
agents, and NSAIDs are not indicated for treatment of diverticulitis.
A patient with a colostomy complains to the nurse, "I am having really bad odors coming
from my pouch." To help control odor, which foods should the nurse advise him to
consume?

1) White rice and toast

2) Tomatoes and dried fruit
3) Asparagus and melons
4) Yogurt and parsley
Answer:
4) Yogurt and parsley

Rationale:
Yogurt, cranberry juice, parsley, and buttermilk may help control odor. White rice and
toast (also bananas and applesauce) help control diarrhea. Asparagus, peas, melons,
and fish are known to cause odor. Tomatoes, pears, and dried fruit are high-fiber foods
that might cause blockage in a patient with an ostomy.
 ADVERTISEMENT

Concepts of bowel elimination: structure and function of GI tract

Organs of bowel elimination, formation of feces, defecation
Problems of bowel elimination
Occult blood (hidden) in stool
Diarrhea
Bowel incontinence
Flatulence
Constipation
Fecal impaction
00:1403:49
Peristaltic waves move the feces into the sigmoid colon and the rectum
Senrsory nerves in rectum are stimulated
Individuals becomes aware of need to defecate
Feces move into the anal canal when the internal and external sphincter relax
External anal sphincter is relaxed voluntarily if timing is appropriate
Expulsion of the feces assisted b contraction of the abdominal muscles and the
diaphragm
Moves the feces through the anal canal and expelled through anus
Facilitated by thigh flexing and a sitting position
Physiology of defecation
1.Visualize abdomen (see any bumps or masses), 2. Auscultate for bowel sounds
(listening to bowel sounds; peristalsis; gurgling; hearing something every 15-30
seconds), 3. Percussion of abdomen (tap abdomen and listen to low and high pitch
sounds; high is gas sounds and low is organ or stool), 4. Palpation of abdomen (take
hand and slowly press down into abdomen to feel for masses, any kind of tortion, or
areas of collection of stool, or patient complaining of pain)
Physical examination
Why does auscultation precede percussion or palpating of the abdomen?
It alters peristalsis
Physical examination continued
Inspection of feces for color, consistency, shape, amount, odor, abnormal constituents,
blood
What test is used for occult blood?
Guaiac test
Guaiac test for occult blood
A stool specimen that they will take and put on paper slide. Blue means slide is still
working, without color to make sure its working
On left, negative test; green or yellow
On right, positive test; cobalt blue color
Factors affecting bowel elimination
Lifestyle factors, cultural factors, developmental factors, psychosocial factors,
psychological factors
Lifestyle factors?
Personal habits, nutrition, fluids, enough fiber, exercise, etc
Cultural factors
Difficulty talking about private matters
Developmental factors
Age
00:0203:49
Psychological factors
Person who is pregnant, motor sensory disturbances, bowel diversion
Ileostomy
Going through small intestine, liquid stool, pouch or stoma comes out through abdomen
to bag
Colostomy
On descending colon, pouch goes over stoma, solid or soft stool
Diarrhea
Passage of liquid feces and increases frequency of defecation
Spasmodic cramps, increased bowel sounds
Fatigue, weakness, malaise, emaciation
Causes: stress, medications, allergies, disease of colon, etc.
What can diarrhea cause?
Decreased water absorption, nutrients and electrolytes, dehydration
Bowel incontience
Loss of voluntary ability to control fecal and gaseous discharges
Observe for skin breakdown frequently
Causes: impaired functioning of anal sphincter, paralysis, spinal trauma, tumors, etc
Can lead to UTIs
Fecal incontience pouch
A bag that foes over anal sphincter right at opening of anus
Use for liquid stool
Helps protect skin
Flatulence
Excessive flatus (gas) in intestines
Leads to stretching and inflation of intestines
Causes: different foods such as greens, nuts, abdominal surgery, etc
Uncomfortable
Rectal tube with or without pouch
Helps expel gas
Have on left side
Consitpation
Decreased frequency of defecation
Hard, dry, formed stools
Straining
Painful defecation
Causes: insufficient fiber and fluid intake, insufficient activity, etc.
common among older adults
Common enema solutions
soapsuds (castile), hypertonic, hypotonic
Soapsuds (castile)
Large volume
Irritates the mucosa
Distends the colon
Hypertonic (fleet phosphate)
Small volume (240 ml), draws water into colon which softens stool
Hypotonic (tap water)
Large volume
Distends the colon
Stimulates peristalsis
Softens feces
Administering large volume enema
Fluid is about 105 degrees
Hold container 12-18 inches above rectum
Fecal impaction
Mass or collection of hardened feces in folds of rectum
Passage of liquid fecal seepage and no normal stool
Causes: all the reasons that happens with constipation, except that ther is no passing
stool for days
Top, the high back or regular bedpan; bottom, the slipper or fracture pan
Front part goes toward patient
Slipper can be used for people who have had surgery such as hip
What position should patient be in when placing a fracture or slipper plan?
High or semi fowlers
Evaluation
Assess whether the problem is resolving and what interventions are necessary for care
Encourage clients participation in care
Assess skin integrity
While assessing a patient before administering an enema, the nurse inspects the patient's
abdomen for distention. What is the purpose of this nursing intervention?
A. It allows the nurse to plan for appropriate teaching measures.
B. It helps determine the number and type of enemas to be given.
C. It helps determine conditions that contraindicate the use of enemas.
D. It provides a baseline for determining the effectiveness of the enema.
D
Before administering an enema, the nurse should inspect the patient's abdomen for distention.
This provides a baseline for determining the effectiveness of the enema. To plan for appropriate
teaching measures, the nurse should determine the patient's level of understanding of the
purpose of the enema. The nurse should review the health care provider's order for the type of
enema and the amount to be given. Before administering an enema, the nurse should review
the patient's medical record for increased intracranial pressure, glaucoma, or recent abdominal,
rectal, or prostate surgery because these conditions contraindicate the use of enemas.
A nurse is preparing to administer an enema to a patient who is scheduled for a colonoscopy.
Which action taken by the nurse may lead to a complication?
A. Giving the enema with the patient sitting on the toilet
B. Giving the enema with the patient positioned on a bedpan
C. Refraining from sterile technique while administering the enema
D. Asking the patient to retain the enema solution for a specific length of time
A
The nurse should not give an enema to a patient sitting on the toilet because the position of the
rectal tubing could injure the rectal wall. When giving an enema to an immobilized patient, it is
always recommended that the patient be positioned on a bedpan. The use of sterile technique is
not necessary when administering an enema, because the colon already contains bacteria.
However, the nurse should wear gloves to prevent the transmission of fecal microorganisms. It
is appropriate to ask the patient to retain the enema solution for a specific length of time before
defecation.
The health care provider prescribes methylcellulose to a patient with chronic constipation.
Which instruction provided by the nurse will help prevent complications?
A. "Do not use the medication on a regular basis."
B. "Mix the powder with 250 mL of water or juice and swallow it quickly."
C. "Report to the health care provider if you do not pass stool within 8 to 10 hours of taking the
medication."
D. "Stop taking the medication if you note increased gas formation and flatus when you first
start taking it."
B
Methylcellulose is a bulk-forming stool softener that absorbs water and increases solid intestinal
bulk. It is a drug of choice for chronic constipation and is available in powder form. The nurse
should instruct the patient to mix the powder with at least 250 mL of water or juice and swallow
it quickly; if not, it could cause constipation. The nurse should advise patients that prescribed
stimulant laxatives should only be taken occasionally to prevent dependence on the stimulus for
defecation. Methylcellulose may cause the passage of stool 12 to 24 hours after taking the
medication. Therefore, the patient need not report to the health care provider if he or she does
not pass stool within 8 to 10 hours of taking the medication. Increased gas formation and flatus
may occur when the patient first starts taking methylcellulose; this will subside after 4 or 5 days.
Therefore, the nurse should not instruct the patient to stop taking the medication in such
situations.
Which part of the gastrointestinal tract plays a major role in bowel elimination?
A. Stomach
B. Esophagus
C. Small intestine
D. Large intestine
D
The main functions of the large intestine, or colon, are absorption, secretion, and elimination.
Therefore, the large intestine plays a major role in bowel elimination. The small intestine is
involved in digestion and absorption, but not elimination. The main functions of the stomach
include storage of swallowed food and liquid, mixing of food with digestive juices into a
substance, and regulated emptying of its contents into the small intestine. The esophagus is the
part of the gastrointestinal tract through which food reaches the upper end of the stomach. It is
not involved in elimination.
To which patient will the nurse most likely give a hypertonic solution enema?
A. An infant who is unable to defecate
B. A dehydrated patient who has constipation
C. A patient who cannot tolerate a large volume of fluid
D. A patient with a dangerously high serum potassium level
C
Enemas that uses hypertonic solutions are low volume and are designed for patients who
cannot tolerate a large volume of fluid. This type of enema is contraindicated in infants and
dehydrated patients. A patient with a dangerously high serum potassium level may receive a
medicated enema that contains sodium polystyrene sulfonate.
While assessing a patient with a bowel elimination problem, the nurse asks the patient, "Do you
feel as though your bowel movements are incomplete?" Which condition is the nurse trying to
determine in the patient?
A. Diarrhea
B. Indigestion
C. Constipation
D. Hemorrhoids
C
To determine constipation, the nurse should ask the patient about feelings of having incomplete
bowel movements. To determine indigestion, the nurse should ask the patient about a bloated
feeling after eating. To determine diarrhea, the nurse may ask whether the patient has taken
any antibiotics recently. Pain in the area around the anus may indicate hemorrhoids.
Which patient has the highest risk of constipation?
A. A patient who is taking antibiotics
B. A patient who is taking opioid analgesics
C. A patient who has undergone endoscopy
D. A patient who drinks only 1.5 L of fluids per day
B
Opioid analgesics slow peristalsis and contractions, thereby causing constipation. Therefore, a
patient taking opioid analgesics has the highest risk of constipation. A patient who is taking
antibiotics may have diarrhea because antibiotics decrease intestinal bacterial flora, resulting in
diarrhea. Patients who have undergone diagnostic procedures that require visualization of the
gastrointestinal tract may experience increased gas or loose stools, not constipation. A person
should drink at least 1.5 L of fluids per day to avoid constipation.
Which bowel elimination problem is associated with abdominal fullness, cramping, distention,
and severe, sharp pain?
A. Diarrhea
B. Flatulence
C. Hemorrhoids
D. Fecal incontinence
B
Flatulence may cause abdominal fullness, cramping, distention, and severe, sharp pain.
Diarrhea may be associated with fever, chills, weight loss, or abdominal pain. Hemorrhoids are
associated with pain in the area around the anus. Fecal incontinence is the inability to control
the passage of fecal matter from the anus.
During a home visit to an elderly patient, the patient expresses to the nurse that he is
experiencing flatulence, which is embarrassing. Which signs and symptoms should the nurse
expect the patient to report? Select all that apply.
A. Abdominal fullness
B. Pain
C. Cramping
D. Loose watery stools
E. Involuntary passage of stools
The patient with flatulence is likely to report abdominal distension, cramping, and pain due to
accumulation of gas in the intestines. Loose watery stools may occur in diarrhea and are a
major cause of fecal incontinence, or the involuntary passage of stools.
Which enema is used in infants and children?
A. Soapsuds enema
B. Tap water enema
C. Normal saline enema
D. Hypertonic solution enema
C
Normal saline enemas are used in infants and children because they are at greater risk for fluid
imbalances. Soapsuds enemas and tap water enemas should not be used in infants and
children. Hypertonic solution enemas are contraindicated in infants.
A nurse is discussing common bowel elimination problems. Which statement indicates effective
understanding of the difference between fecal impaction and fecal incontinence?
A. Fecal impaction may occur due to antibiotic therapy, whereas fecal incontinence may occur
due to opiate therapy.
B. Fecal impaction is the accumulation of gas in the lumen of the intestines, whereas fecal
incontinence is the inability to control the passage of feces and gas from the anus.
C. Fecal impaction is common in debilitated, confused, or unconscious patients, whereas fecal
incontinence is common in patients with impaired cognitive function.
D. Fecal impaction is characterized by loss of appetite, nausea and/or vomiting, and rectal pain,
whereas fecal incontinence is characterized by abdominal distention and severe, sharp
abdominal pain.
C
Debilitated, confused, or unconscious patients have an increased risk of fecal impaction,
whereas patients with impaired cognitive function are more likely to have fecal incontinence.
Diarrhea, not fecal impaction, may occur due to antibiotic therapy, whereas constipation may
occur due to opiate therapy. Flatulence is the accumulation of gas in the lumen of the intestines,
whereas fecal incontinence is the inability to control the passage of feces and gas from the
anus. Fecal impaction is characterized by a loss of appetite, nausea and/or vomiting, and rectal
pain, whereas flatulence, not fecal incontinence, is characterized by abdominal distention and
severe, sharp abdominal pain.
The nurse is caring for a patient admitted with diarrhea. What could be the possible causes of
diarrhea in the patient? Select all that apply.
A. Use of opioid drugs
B. Use of antibiotics
C. Food allergies
D. Prolonged stress
E. Hypothyroidism
B, C, E
Use of antibiotics may cause diarrhea by disrupting the normal flora of the intestine. Food
allergies and prolonged stress cause increased peristalsis, resulting in diarrhea. The use of
opioid drugs and hypothyroidism cause constipation by decreasing peristalsis.
After reviewing a patient's laboratory reports, the nurse concludes the patient has cholecystitis.
Which laboratory finding would enable the nurse to reach this conclusion?
A. Increased bilirubin levels
B. Increased amylase levels
C. Increased alkaline phosphatase levels
D. Increased carcinoembryonic antigen levels
B
Cholecystitis causes inflammation of the gallbladder. Increased amylase levels are observed in
patients with cholecystitis due to obstruction of the bile duct. Increased bilirubin levels indicate
hepatobiliary disease. Increased alkaline phosphatase levels indicate hepatobiliary carcinomas
and bone tumor. Increased carcinoembryonic antigen levels indicate cancer or inflammation of
the gastrointestinal tract.
A patient is scheduled for a plain film x-ray of the kidney, ureter, and bladder. Which preliminary
preparations should this patient take?
A. No preparation is required in plain film.
B. Bowel preparation is done with magnesium citrate.
C. Light sedatives are provided the previous night.
D. Fasting is required after midnight before examination.
A
No specific preliminary preparation is needed for getting a plain film of kidney, ureter, and
bladder. Bowel preparation with magnesium citrate is required for barium enema, colonoscopy,
and flexible sigmoidoscopy. Light sedation is required for upper endoscopy, colonoscopy,
sigmoidoscopy, and for computerized tomography scan. The patient must fast from midnight the
night before the examination for certain procedures. Such procedures include barium swallow,
upper endoscopy, barium enema, ultrasound, computerized tomography, and magnetic
resonance imaging.
The nurse is analyzing the fecal characteristics of a patient. Which substances indicate an
abnormality? Select all that apply.
A. Excess fat
B. Blood
C. Mucus
D. Bile pigment
E. Dead bacteria
A, B, C
The presence of excess fat is an abnormal finding and indicates liver dysfunction. The presence
of blood and mucus in the stool are abnormal findings and are associated with internal bleeding,
infection, and inflammation. Bile pigment and dead bacteria are normal constituents of the fecal
matter.
A cleansing enema is ordered for a 55-year-old patient before intestinal surgery. What is the
maximum amount of fluid the nurse should give?
A. 150 to 200 mL.
B. 200 to 400 mL.
C. 400 to 750 mL.
D. 750 to 1000 mL.
D
More than 1000 mL of fluid causes distention to the point of rupturing the bowel.
What signs manifest in infants and young children who are dehydrated? Select all that apply.
A. Dizziness
B. High fever
C. Sunken eyes
D. Light-headedness
E. Dry eyes when crying
F. Listlessness or irritability
B, C, E, F
In infants and young children, dehydration manifests in high fever, sunken eyes or cheeks, an
absence of tears when crying, and listlessness or irritability. In contrast, dizziness and light-
headedness are characteristic of dehydration in adults.

Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type,
you are asked to select all options that apply to a given situation or patient. All options likely
relate to the situation, but only some of the options may relate directly to the situation.
The nurse is assessing a 55-year-old patient who is in the clinic for a routine physical. When
would the nurse instruct the patient about the need to obtain a stool specimen for guaiac fecal
occult blood testing (gFOBT)?
A. If patient reports rectal bleeding
B. If there is a family history of polyps
C. As part of a routine examination for colon cancer
D. If a palpable mass is detected on digital examination
C
Guaiac fecal occult blood testing (gFOBT) is used as a diagnostic screening tool for colon
cancer as recommended by the American Cancer Society. More advanced screenings, such as
a colonoscopy, would be indicated for rectal bleeding, family history of polyps, and/or a palpable
mass detected upon digital examination.
An elderly African American reports a change in bowel habits with rectal bleeding and a sense
of incomplete bowel evacuation. Which disorder would the nurse suspect in this patient?
A. Infection
B. Colon cancer
C. Irritable bowel syndrome
D. Inflammatory bowel disease
B
Age and race are two factors that can indicate whether a patient is at an increased risk of
developing colon cancer. In this case, the patient is an elderly African American. Statistics show
that African Americans have a higher risk than other ethnic groups of developing colon cancer.
In addition, the patient's presentation of change in bowel habits, rectal bleeding, and sense of
incomplete evacuation of bowel are warning signs of colon cancer, and the nurse should
evaluate the patient for this condition. Infections are usually present with diarrhea, which may be
associated with blood. Irritable bowel syndrome and inflammatory bowel disorders are
associated with abdominal pain.
Before collecting a stool sample for occult blood, what should the nurse instruct the nursing
assistive personnel to do?
A. Ask the patient to void.
B. Wash the patient's perineum.
C. Secure a sterile specimen container.
D. Plan to collect the first specimen of the day.
A
Emptying the urinary bladder before collecting the stool sample prevents contamination of the
specimen. It is not necessary to wash the patient's perineum. A clean, dry bedpan is sufficient
for containing the specimen. It is not necessary to collect the first specimen of the day.
Which complication may result from a patient who regularly ingests castor oil to relieve
constipation? Select all that apply.
A. Abdominal cramping
B. Constipation
C. Fluid and electrolyte imbalance
D. Damage to the intestinal mucosa
E. Toxic buildup of magnesium
A, C
Castor oil can cause severe cramping, and chronic use can cause fluid and electrolyte
imbalances. Saline-based agents can cause toxic buildup of magnesium. Powder-form agents
can cause constipation if not mixed with liquids. Use of soapsuds enemas may damage the
intestinal mucosa.
An alcoholic develops chronic pancreatitis. Which laboratory parameter is helpful in diagnosing
pancreatitis?
A. Raised bilirubin
B. Raised serum amylase
C. Elevated carcinoembryonic antigen
D. Elevated alkaline phosphatase levels
B
Serum amylase levels increase in patients with pancreatitis and in patients with pancreatic
tumors. Bilirubin is elevated in patients with hepatic disorders. Carcinoembryonic antigen
becomes elevated in inflammatory disorders of the gastrointestinal tract. Alkaline phosphatase
becomes elevated in bone tumors.
When caring for patients of varying ages with disorders of bowel elimination, what should the
nurse consider?
A. Adolescents have a decreased metabolic rate.
B. The ability to control defecation is absent until 2 to 3 years of age.
C. Peristalsis is enhanced and esophageal emptying is accelerated in older adults.
D. Infants have little secretion of digestive enzymes and slow intestinal peristalsis.
B
Until 2 to 3 years of age, one cannot control defecation. Adolescents experience rapid growth
and an increased, not decreased, metabolic rate. In older adults, partially chewed food is not
digested as easily, so peristalsis declines and esophageal emptying slows. Infants have less
secretion of digestive enzymes and rapid, not slow, intestinal peristalsis.
Which is of most concern when performing a digital rectal examination to determine the
presence of fecal impaction?
A. Slowing heart rate
B. Severe cramping
C. Fluid and electrolyte imbalance
D. Toxic buildup of magnesium
A
The stimulation of the rectum by digital examination may stimulate the vagus nerve, which then
slows the heart rate. This is potentially hazardous, so it is done cautiously and only when
allowed by agency policy. Severe cramping and fluid and electrolyte imbalance may be caused
due to use of cathartics. Toxic buildup of magnesium is a concern when magnesium hydroxide
(Milk of Magnesia) is used.
Which patient benefits the most from an enema prepared with a hypertonic solution?
A. A patient who is dehydrated
B. A patient who is a young infant
C. A patient who is unable to tolerate large volumes of fluid
D. A patient who is suffering from acute inflammation in the lower colon
C
An enema prepared with a hypertonic solution is designed to be low volume. Patients unable to
tolerate large volumes of fluid benefit most from this type of enema. This type of enema is
contraindicated for young infants and dehydrated patients. An enema containing steroid
medication is appropriate for acute inflammation in the lower colon.
A nursing student compares the guaiac fecal occult blood test (gFOBT) with the fecal
immunochemical test (FIT) for measuring microscopic amounts of blood in the feces. Which
statement if made by the nursing student is correct?
A. "The guaiac fecal occult blood test (gFOBT) is a more sensitive test than the fecal
immunochemical test (FIT), but it is also more expensive."
B. "Both tests call for the patients consuming citrus fruits and juices for 3 days before testing to
avoid false-negative result."
C. "The guaiac fecal occult blood test (gFOBT) has no dietary restrictions, whereas the fecal
immunochemical test (FIT) requires the patient to refrain from eating red meat for 3 days before
testing."
D. "Only the guaiac fecal occult blood test (gFOBT) can give a false positive result if the patient
takes nonsteroidal antiinflammatory drugs right before testing; the fecal immunochemical test
(FIT) has no such restrictions."
D
The guaiac fecal occult blood test (gFOBT) requires that the patient to follow certain dietary
restrictions before testing. A patient about to undergo gFOBT has to stop taking aspirin,
ibuprofen, naproxen, and any other nonsteroidal antiinflammatory drugs 7 days prior to the test
because these could cause a false-positive test result. A fecal immunochemical test (FIT)
requires no preparation or dietary restrictions. The FIT is a more sensitive test than gFOBT and
is more expensive. Patients about to undergo the gFOBT need to avoid vitamin C supplements
and citrus fruits and juices at least 3 days before testing to avoid a false-negative result. The FIT
has no such restrictions. The gFOBT requires the patient to refrain from eating red meat for 3
days before testing, whereas the FIT does not.
Which procedure measures the pressure activity of the internal and external anal sphincters and
reflexes during rectal distention?
A. Barium enema
B. Ultrasound imaging
C. Anorectal manometry
D. Computed tomography scan
C
An anorectal manometry measures the pressure activity of internal and external anal sphincters
and reflexes during rectal distention, relaxation during straining, and rectal sensation. Barium
enemas use barium as an opaque contrast medium to visualize the upper and lower
gastrointestinal tract. Ultrasound imaging uses high-frequency sound waves to echo off body
organs, creating a picture of the gastrointestinal tract. A computed tomography scan is an x-ray
examination of the body from many angles using a scanner analyzed by a computer.
A nursing instructor is teaching students the procedure to collect a stool sample for presence of
ova and parasites. Which statement made by the nursing student indicates the need for further
learning?
A. "The stool specimen should be kept at room temperature."
B. "The stool specimen should be sent to the laboratory as soon as possible."
C. "The specimen collection should be entered in the patient's medical records."
D. "A medical aseptic technique should be followed during the collection of stool specimens."
A
Some tests, such as measurement for ova and parasites, require the stool to be warm. When
stool specimens remain at room temperature, bacteriological changes that alter test results
occur. Therefore, these specimens should be sent to a laboratory as soon as possible. After
obtaining a specimen, the nurse should record the specimen collection in the patient's medical
record. The nurse should use the medical aseptic technique during the collection of stool
specimens.
A nurse cares for a patient who has been advised by the health care provider to get a guaiac
fecal occult blood test (gFOBT) done. Which step would the nurse instruct the patient to follow
in order to minimize the possibility of getting a false-negative test result?
A. Take vitamin C supplements for 7 days before the test.
B. Refrain from consuming red meat on the day of testing.
C. Refrain from consuming citrus fruits and juices 3 days before the test.
D. Refrain from taking nonsteroidal antiinflammatory drugs 7 days before the test.
C
The nurse advises the patient to avoid citrus fruits and juices 3 days before the test because
they can cause a false-negative result. Patients also need to avoid vitamin C supplements to
avoid a false-negative result; taking vitamin C supplements 7 days before the test would
increase the possibility of getting a false-negative result. Patients should be instructed to avoid
eating red meat 3 days before testing. Patients should be instructed to not take nonsteroidal
antiinflammatory drugs 7 days before the test to minimize the possibility of a false-positive (not a
false-negative) result.
A nurse is performing nasogastric intubation on a patient for gastric decompression. Which step
taken by the nurse promotes the patient's ability to swallow during the procedure?
A. Having the patient blow his or her nose
B. Raising the patient's bed to a horizontal level that is comfortable for nurse
C. Positioning the patient in high-Fowler's position with pillows behind the head and shoulders
D. Curving 10 to 15 cm (4 to 6 in) of the end of the tube tightly around the index finger before
releasing
C
Positioning the patient in high-Fowler's position with pillows behind the head and shoulders
promotes the patient's ability to swallow during the procedure. Having the patient blow his or her
nose removes existing nasal secretions. Raising the bed to a horizontal level that is comfortable
for the nurse prevents strain on the nurse. Curving 10 to 15 cm (4 to 6 in) of the end of the tube
tightly around the nurse's index finger and releasing it aids in insertion and decreases tube
stiffness.
Which medication is considered to be a bulk-forming laxative?
A. Bisacodyl
B. Methylcellulose
C. Docusate sodium
D. Magnesium hydroxide
B
Methylcellulose is a bulk-forming agent. Bisacodyl is a stimulant cathartic. Docusate sodium is a
stool softener. Magnesium hydroxide is an osmotic agent.
Which laxative is most likely to be used in a patient who is suffering from constipation due to
frequent opioid use?
A. Psyllium
B. Castor oil
C. Lactulose
D. Magnesium hydroxide
B
Castor oil is a stimulant cathartic prescribed to patients suffering from constipation from frequent
opioid use. Psyllium is a bulk-forming agent, and lactulose and magnesium hydroxide are
saline-based agents. Neither bulk-forming agents nor saline-based agents are specifically
recommended for people suffering from constipation due to frequent opioid use.
A nurse cares for a patient who has been prescribed a saline-based agent. What is the nurse
most likely to infer from this?
A. The patient is suffering from hemorrhoids.
B. The patient is being treated for mild diarrhea.
C. The patient is suffering from chronic constipation.
D. The patient is scheduled for an endoscopic examination the next day.
D
A saline-based agent is an osmotic laxative used for the acute emptying of the bowel, which is
done before an endoscopic examination. Emollient agents are used to relieve straining on
defecation, which serves to not aggravate hemorrhoids. Bulk-forming agents are laxatives that
are used to relieve mild diarrhea. A saline-based agent is not used for the long-term
management of constipation. Instead, bulk-forming agents are most likely to be used.
In which method of indirect visualization of the gastrointestinal tract would the patient swallow a
capsule containing radiopaque markers and have an x-ray done after 4 days?
A. Barium enema
B. Ultrasound imaging
C. Colonic transit study
D. Anorectal manometry
C
In a colonic transit study, the patient swallows a capsule containing radiopaque markers; an x-
ray film examination is performed on the patient 4 days after ingestion. In a barium enema,
barium can be swallowed or instilled through the anal opening via an enema for visualization of
the upper or the lower gastrointestinal tract. Ultrasound imaging uses high-frequency sound
waves to echo off body organs, creating a picture of the gastrointestinal tract. Anorectal
manometry measures the pressure activity of internal and external anal sphincters and reflexes
during rectal distention, relaxation during straining, and rectal sensation.
Which is an abnormal frequency of defecation for an infant?
A. Three times per day
B. Five times per day
C. Nine times per day
D. Once every two days
C
An infant is not expected to defecate more than six times per day. Therefore, an infant who
passes stools nine times per day has an abnormal frequency of defecation. Note that defecating
less than once every 2 days is also considered abnormal.
The nurse is assessing a patient who has a fecal impaction. The nurse documents type 2 stools
in the patient's medical records as per the Bristol stool form scale. Which type of stool does the
nurse observe?
A. Sausage-shaped but lumpy
B. Separate hard lumps like nuts
C. Soft blobs with clear-cut edges
D. Fluffy pieces with ragged edges
B
The Bristol stool form scale is used to classify types of feces. A fecal impaction is a dry hard
stool, which may be type 1 or type 2. As per the Bristol stool form scale, sausage-shaped and
lumpy stool indicates type 2. Separate and hard stool with a nutlike appearance indicates type 1
stools. Stool that appears as soft blobs with clear-cut edges is type 5 stool. Fluffy pieces with
ragged edges indicate type 6 stool.
A nursing student compares the guaiac fecal occult blood test (gFOBT) with the fecal
immunochemical test (FIT) for measuring microscopic amounts of blood in the feces. Which
statement if made by the nursing student is correct?
A. "The guaiac fecal occult blood test (gFOBT) is a more sensitive test than the fecal
immunochemical test (FIT), but it is also more expensive."
B. "Both tests call for the patients consuming citrus fruits and juices for 3 days before testing to
avoid false-negative result."
C. "The guaiac fecal occult blood test (gFOBT) has no dietary restrictions, whereas the fecal
immunochemical test (FIT) requires the patient to refrain from eating red meat for 3 days before
testing."
D. "Only the guaiac fecal occult blood test (gFOBT) can give a false positive result if the patient
takes nonsteroidal antiinflammatory drugs right before testing; the fecal immunochemical test
(FIT) has no such restrictions."
D
A nurse is preparing to administer an enema to a patient who is scheduled for a colonoscopy.
Which action taken by the nurse may lead to a complication?
A patient with an indwelling catheter carries the collection bag at waist level when ambulating.
The patient is at risk for what? Select all that apply.
A. Infection
B. Retention
C. Stagnant urine
D. Reflux of urine
E. Hypotension
A, D
Urine in the bag and tubing becomes a medium for bacteria; infection is likely to develop if urine
flows back into the bladder.
What are the roles of the nurse when caring for a patient with urinary diversions? Select all that
apply.
A. Refer the patient to an ostomy nurse.
B. Train the patient on management of urinary diversions.
C. Refer the patient to ostomy associations for further support.
D. Check the patency of the nephrostomy tube by trying to pull it out.
E. Refer the patient to the United Ostomy Associations of America.
A, B, C, E
Patients with urinary diversions require special care and should be referred to an ostomy nurse.
The ostomy nurse provides all the information about ostomy care and educates the patient
about ostomy care. The patient must be trained to properly manage the diversion and become
independent, because it is a long-term condition. In addition, these patients should be referred
to the United Ostomy Associations of America for more information about support groups to
enhance coping and adaptation to lifestyle and body image changes. The ostomy nurse assists
the patient and family members with matters pertaining to all aspects of care. Care must be
taken not to pull on tubing, especially in a nephrostomy, because it can cause tissue and organ
damage and infection.
In which order do the steps occur in the control of blood pressure by the kidneys through the
renin-angiotensin system?
A. Angiotensin II is formed in the lungs.
B. The blood supply decreases in the kidneys.
C. Renin is released from the juxtaglomerular cells.
D. Angiotensinogen is converted into angiotensin I.
E. The blood volume increases due to retention of water.
F. Aldosterone release from the adrenal cortex is stimulated.
B, C, D, A, F, E
In times of renal ischemia or decreased blood supply to the kidneys, renin is released from the
juxtaglomerular cells. Renin functions as an enzyme to convert angiotensinogen into
angiotensin I. Angiotensin I is converted to angiotensin II in the lungs. Angiotensin II causes
vasoconstriction and stimulates aldosterone release from the adrenal cortex. Aldosterone
causes water retention, which increases blood volume. This mechanism, along with the
mechanism of vasodilation through prostaglandin E2 and prostacyclin produced by the kidneys,
helps in the control of blood pressure through the renin-angiotensin system.
The nurse understands that urinary tract infections (UTIs) in women are eight times more
common than in men. What are the reasons for this? Select all that apply.
A. Urination is infrequent.
B. The urethra is shorter than it is in males.
C. The urethra lies closer to the anus than it does in males.
D. Failure to wipe from front to back after voiding or defecating.
E. Lack of antibacterial substances in vaginal secretions.
B, C, D, E
The anatomical makeup of females includes a short urethra and close proximity of the urethra to
the anus, which are conducive to the development of urinary tract infections (UTIs). The risk of
infections also increases if females fail to wipe from front to back after voiding and defecating. It
can cause the bacteria from the anal area to gain access to the urinary tract. Urination is not
infrequent in females. In males, the prostatic secretions have an antibacterial substance that
helps to prevent infection. This antibacterial substance is lacking in vaginal secretions.
An elderly patient who has dementia is suffering from cognitive deficit and an overactive
bladder. Which type of urinary incontinence is this patient likely to suffer?
A. Stress incontinence
B. Functional incontinence
C. Low risk of incontinence
D. Urge incontinence
D
Elderly patients with cognitive deficits such as dementia may have overactive bladder (OAB).
These patients are at risk of developing urge incontinence due to involuntary bladder
contraction. Stress incontinence is common among elderly women with weakened pelvic
musculature. Functional incontinence due to urinary infection is common among younger
women with urinary infections. Incontinence risk is not lowered in patients with dementia; it is
increased.
Which substance secreted by the kidneys helps to control blood pressure via vasodilation?
A. Renin
B. Aldosterone
C. Angiostenin II
D. Prostaglandin E2
D
Prostaglandin E2 , which, along with prostacyclin, helps maintain renal blood flow via
vasodilation, is produced by the kidneys. Renin functions as an enzyme to convert
angiotensinogen into angiotensin I. Aldosterone causes retention of water, which increases the
blood volume. Angiotensin II causes vasoconstriction and stimulates aldosterone release from
the adrenal cortex.
The nurse is teaching a group of licensed vocational nurses (LVNs) and licensed practical
nurses (LPNs) about the pathogenesis of urinary infections. Which information pertaining to
catheter-associated urinary tract infection (CAUTI) should the nurse include in the teaching?
Select all that apply.
A. Bacteria inhabit the vagina.
B. CAUTI are mostly caused by a descending infection.
C. Colonic flora do not cause urinary infections.
D. Bacteria inhabit the distal urethra in men and women.
E. Escherichia coli is the common causative organism.
A, D, E
Catheter-associated urinary infection is caused by bacteria that inhabit the vagina in women and
by bacteria that inhabit the distal urethra in men and women. The common organism
responsible for CAUTI is Escherichia coli. The infection is ascending in nature, because bacteria
cause infection as they ascend the urinary tract. Bacteria from the colon are the main causes of
urinary infections.
What characteristics are associated with urge urinary incontinence? Select all that apply.
A. Urgency
B. Frequency
C. Leakage of urine without awareness
D. Diminished awareness of the urge to void
E. Difficulty holding urine once the urge to void occurs
A, B, E
The characteristics associated with urge urinary incontinence are urgency, frequency, and
difficulty holding urine once the urge to void occurs. Leakage of urine without awareness and
diminished awareness of the urge to void are associated with reflex urinary incontinence.
The nurse is teaching a group of nursing students about kidney function. Which statements
apply to kidney function? Select all that apply.
A. The kidneys produce several substances vital for maintenance of blood pressure.
B. The kidneys produce several substances vital to bone mineralization.
C. A nephron is a functional unit of the kidney and helps in urine formation.
D. The kidneys filter waste products of metabolism and excrete them in the urine.
E. The kidneys produce several substances vital to white blood cell (WBC) production.
A, B, C, D, E
The kidneys produce several substances vital to blood pressure and bone mineralization.
Nephron is the functional unit of the kidney and helps in urine formation. Kidneys filter waste
products of metabolism and excrete them in urine. Kidneys produce substances vital for
production of red blood cells (RBC), not white blood cells (WBC).
The nurse is caring for a patient who sustained a spinal cord injury. The patient has urinary
incontinence. Which aspects of care should the nurse include when teaching the patient to
perform self-catheterization? Select all that apply.
A. The structures of the urinary tract
B. The technique of catheterization
C. The importance of adequate fluid intake
D. The frequency of self-catheterization
E. The technique of applying a condom catheter
A, B, C, D
Self-catheterization can be useful for patients who are physically able to manipulate the catheter
and position themselves upright. Knowledge of the structures of the urinary tract is important for
accurate catheter insertion and preventing complications. Learning the technique of
catheterization helps the patient to minimize infections during the procedure. Adequate fluid
intake is necessary to flush out microorganisms in the urine and prevent complications. The
frequency of catheterization is important to ensure complete emptying of the bladder. Generally,
the catheterization is done every 4 to 6 hours. The patient is not on a condom catheter;
therefore, this technique does not need to be taught.
The nurse understands that hypertension can be caused by an impaired renin-angiotensin
mechanism. Which statements accurately describe the renin-angiotensin mechanism? Select all
that apply.
A. Angiotensinogen is synthesized in the lungs.
B. Renin is secreted by the juxtaglomerular apparatus.
C. Angiotensin II causes peripheral vasoconstriction.
D. Angiotensin II causes aldosterone secretion in the adrenal cortex.
E. Converting enzyme in the liver converts angiotensin I to angiotensin II.
B, C, D
The juxtaglomerular apparatus of the kidneys secretes renin in response to a drop in blood
pressure. Angiotensin II has two functions. It causes peripheral vasoconstriction, which in turn
increases blood pressure. It is also involved in secreting aldosterone from the adrenal cortex of
the adrenal gland. Aldosterone also raises the blood pressure by causing water retention.
Angiotensinogen is produced in the liver, not the lungs, in response to renin production. The
converting enzyme responsible for conversion of angiotensin I to angiotensin II is present in the
lungs, not in the liver.
The patient is to have an intravenous pyelogram (IVP). Which action applies to this procedure?
Select all that apply.
A. Note any allergies.
B. Monitor intake and output.
C. Provide for perineal hygiene.
D. Assess vital signs.
E. Encourage fluids after the procedure.
A, E
The dye used in the procedure is iodine based. Assessing for history of any allergies can predict
allergy to the dye used. Fluid intake dilutes and flushes the dye from the patient.
A male patient returned from the operating room 6 hours ago with a cast on his right arm. He
has not yet voided. Which action would be most beneficial in assisting the patient to void?
A. Suggest he stand at the bedside.
B. Stay with the patient.
C. Give him the urinal to use in bed.
D. Tell him that, if he doesn't urinate, he will be catheterized.
A
A man voids more easily in the standing position.
The nurse assesses that the patient has a full bladder, and the patient states that he or she is
having difficulty voiding. What should the nurse teach the patient to do?
A. Use the double-voiding technique.
B. Perform Kegel exercises.
C. Use the Credé method.
D. Keep a voiding diary
C
With the Credé method, pressure is put on the suprapubic area with each attempted void. The
maneuver promotes bladder emptying by relaxing the urethral sphincter.
A 70-year-old woman complains of involuntary passage of urine. The leakage of urine occurs in
small amounts and is more frequent when she coughs. The nursing assessment reveals that the
patient is obese, has had three pregnancies, and has already gone through menopause. The
nurse understands that the patient is at increased risk of developing urinary tract infection.
Which nursing interventions are helpful to prevent a urinary tract infection in the patient? Select
all that apply.
Emphasize reduced fluid intake.
Emphasize wearing cotton underwear.
Emphasize the need for continuous bladder catheterization.
Promote complete emptying of bladder by double voiding.
Emphasize the importance of perineal hygiene.
B, D, E
Cotton underwear absorbs moisture and helps to keep the skin on the perineal area dry.
Residual urine in bladder promotes bacterial growth. Complete voiding reduces the risk of
developing a urinary tract infection and may be achieved by double voiding. Perineal hygiene is
important in preventing a urinary tract infection. The urethral meatus should be cleaned after
each void or bowel movement. Adequate fluid intake helps to flush the microorganisms from the
urinary tract and prevent infection. Catheterization increases the risk of bladder infections and
should be avoided.
A 55-year-old man is admitted to the hospital with urinary retention. The health care provider
orders catheterization for the patient. When setting up the supplies for catheterization, which
size catheter should the nurse select for this patient?
A. 8 Fr
B. 10 Fr
C. 14 Fr
D. 18 Fr
C
Selecting a catheter depends on many factors. One of the factors is the size of the patient's
urethral canal. Most adults with an indwelling catheter should use a size 14 to 16 Fr to minimize
trauma and risk for infection. Smaller sizes are needed for children, such as a 5 to 6 Fr for
infants, 8 to 10 Fr for children, and 12 Fr for young girls.
The nurse is reviewing the lab report of a patient. The presence of which substance in the urine
hints at the possibility of an abnormality?
A. Protein, 6
B. Glucose, ++
C. Red blood cells, 2
D. White blood cells, 4
B
A normal urinalysis should not be positive for glucose, because glucose undergoes complete
reabsorption. The presence of protein in the urine is acceptable under 8 mg/100 mL. The
presence of 2 red cells is acceptable, but there should not be any more than this. A white cell of
count 4 is acceptable and does not indicate abnormality.
A nurse is caring for a patient with a spinal cord injury who reports an absence of awareness of
bladder filling and the urge to void. A family member adds that the patient also sometimes has
leakage of urine without awareness. Which nursing intervention is most important for the
patient?
A. Placing an indwelling catheter
B. Monitoring for autonomic dysreflexia
C. Encouraging the patient to perform pelvic muscle exercises
D. Monitoring the postvoid residual volume according to the health care provider's direction
B
Reflex urinary incontinence occurs in patients who have spinal cord injuries and, it is
characterized by diminished or absent awareness of bladder filling and the urge to void. The
patient may also have leakage of urine without awareness. Patients with reflex urinary
incontinence have an increased risk of autonomic dysreflexia, which is a life-threatening
condition. This is a medical emergency that requires immediate intervention, so the nurse's
most important intervention is to monitor the patient for autonomic dysreflexia and notify the
health care provider immediately. Patients with overflow urinary incontinence may require the
use of an indwelling catheter. Patients with stress urinary incontinence should be encouraged to
perform pelvic muscle exercises. Monitoring the postvoid residual volume according to the
health care provider's direction is important when caring for a patient with mild urinary retention
associated with overflow urinary incontinence.
A postoperative patient has difficulty voiding after surgery and is feeling "uncomfortable" in the
lower abdomen. Which action should the nurse implement first?
A. Encourage fluid intake.
B. Administer pain medication.
C. Catheterize the patient.
D. Turn on the bathroom faucet as the patient tries to void.
D
The sound of running water helps many patients to void through the power of suggestion.
The patient's urine specific gravity is 1.05. The urine tests positive for ketone bodies. Which
could be possible causes? Select all that apply.
A. Starvation
B. Dilute urine
C. Dehydration
D. Overhydration
E. Diabetes mellitus
A, C, E
Presence of ketone bodies supports the possibility of starvation. Specific gravity would be
increased if the patient were dehydrated. Increased specific gravity and ketone bodies in the
urine also support the possibility of diabetes mellitus. A high specific gravity and the presence of
ketone bodies do not indicate urine dilution or overhydration.
A 70-year-old woman complains of involuntary passage of urine. The leakage of urine occurs in
small amounts and is more frequent when she coughs. The nursing assessment reveals that the
patient is obese, has had three pregnancies, and has already gone through menopause. Which
nursing interventions would be helpful to this patient in reducing incontinence? Select all that
apply.
A. Advise the patient to suppress coughs.
B. Teach the patient Kegel exercises.
C. Advise the patient to avoid caffeinated drinks.
D. Stress the importance of losing weight.
E. Encourage lifting heavy weights to increase muscle strength.
B, C, D
Kegel exercises increase the strength of muscles around the urethra and help to reduce stress
incontinence. Losing weight helps to reduce stress incontinence. Cough is a reflex activity and
is difficult to control voluntarily. Caffeinated drinks have a diuretic effect and increase stress
incontinence. Lifting heavy weights increases abdominal pressure and thus increases
incontinence; therefore, this activity should be avoided.
A patient reports having the urge to void, but urine starts leaking before the patient reaches the
bathroom. Which treatment strategies would be helpful for this patient? Select all that apply.
A. Scheduled toileting
B. Absorbent products
C. Electrical stimulation
D. Clothing modification
E. Antimuscarinic agents
A, B, D
Functional incontinence is characterized by the inability to reach the bathroom in time.
Scheduled toileting involves teaching the patient to void at specified times so that there is no
urgency. Use of absorbent products helps prevent soiling of clothes. Clothing can be modified to
make it easier to remove when there is an urgency to void. Electrical stimulation is helpful for
patients with stress incontinence. Antimuscarinic agents are helpful for patients with urge
incontinence.
Which patients should the nurse anticipate to require the use of a short- or long-term urinary
catheter? Select all that apply.
A. A patient who has chronic urinary retention
B. A patient who has reflex urinary incontinence
C. A patient who has stress urinary incontinence
D. A patient who needs accurate monitoring of urine output after a gynecologic procedure
E. A patient who is unable to completely empty the bladder due to a neurological condition
D, E
Indwelling catheterization may be short-term (two weeks or less) or long-term. A short- or long-
term urinary catheter may be used in patients who require accurate monitoring of urine output
after a gynecologic procedure and patients who are unable to completely empty the bladder due
to a neurological condition. Patients with chronic urinary retention and reflex urinary
incontinence may require intermittent catheterization (one-time catheterization for bladder
emptying). Patients with stress urinary incontinence require pelvic floor strengthening exercises
and no catheterization.
The nurse is reviewing laboratory results for a patient and notices the urine tested positive for
ketones. Which underlying factors may lead to the presence of urinary ketone bodies? Select all
that apply.
A. Epilepsy
B. Starvation
C. Dehydration
D. Hyperthyroidism
E. Uncontrolled diabetes mellitus
B, C, E
Ketones are produced as a by-product when the body uses fat for energy production. When a
patient is not taking in adequate amounts of carbohydrate, such as in starvation, the body uses
other sources for energy. Dehydration can also lead to ketonuria. A patient with uncontrolled
diabetes mellitus breaks down fatty acids for energy. Epilepsy and hyperthyroidism are not
associated with the presence of ketone bodies in urine. Epilepsy is a disease that affects the
nervous system, and hyperthyroidism affects the endocrine system.
What size urinary catheter should the nurse use for a 7-year-old child?
A. 5 to 6 Fr
B. 8 to 10 Fr
C. 12 Fr
D. 14 to 16 Fr
B
The size of a urinary catheter is based on the French (Fr) scale, which reflects the internal
diameter of the catheter. The catheter size to be used for children is 8-10 Fr.

We have an expert-written solution to this problem!

A nursing instructor asks the nursing students about the function of the kidneys. Which
statement by a student indicates the need for further learning?
A. "The kidneys play a major role in blood pressure control via the renin-angiotensin system."
B. "The kidneys produce erythropoietin, which decelerates red blood cell production in and the
maturation of bone marrow."
C. "The kidneys remove waste products from the blood and play a major role in the regulation of
fluid and electrolyte balance."
D. "The kidneys affect calcium and phosphate regulation by producing a substance that
converts vitamin D into its active form."
B
The kidneys produce erythropoietin, which stimulates (not decelerates) the production of red
blood cells and their maturation in the bone marrow. The kidneys affect blood pressure control
via the renin-angiotensin system, remove waste products from blood, and affect calcium and
phosphate regulation by producing a substance that converts vitamin D into its active form,
thereby regulating fluid and electrolyte balance.
A patient has bladder overactivity. What does the nurse expect to be the most likely cause?
A. Spinal cord injury
B. Anesthetic agents
C. Prostatic enlargement
D. Chronic pain syndromes
A
A spinal cord injury or intervertebral disk disease can cause the loss of urine control because of
bladder overactivity. Anesthetic agents given during surgery can decrease bladder contractility,
which causes urinary retention. Prostatic enlargement can cause obstruction of the bladder
outlet, which causes urinary retention. Chronic pain syndromes can interfere with the timely
access to a toilet.
A patient's urinary report suggests microscopic hematuria. What is the most likely cause for
this?
A. Tumors
B. Infection
C. Urinary tract calculi
D. Trauma to urinary tract
D
Microscopic hematuria (blood not visualized but measured on urinalysis) is caused by trauma to
the urinary tract. Tumors of the kidney, bladder, or other parts of the urinary tract are
characterized by the presence of blood in the urine, which is visible to the eyes. In cases of
infection or urinary tract calculi, gross hematuria (blood easily seen in urine) is present.
A nurse reviews a patient's urinary examination report. The presence of which component in the
urine leads the nurse to suspect glomerular injury?
A. Glucose
B. Creatinine
C. Large proteins
D. Major electrolyte
C
Because large proteins do not normally get filtered through the glomerulus, the presence of
these molecules indicates a possible glomerular injury. The glomerulus filters glucose,
creatinine, and major electrolytes. Therefore, these are normally found in the urine.
What should the nurse do during the planning phase of the nursing process when caring for a
patient who has altered urinary elimination?
A. Inspect the character of the patient's urine.
B. Reinforce adherence to good hygiene practices.
C. Gather relevant laboratory and diagnostic test data.
D. Have the patient and family demonstrate self-care skills.
B
Reinforcing adherence to good hygiene practices forms a part of the planning phase of nursing
process for urinary elimination. Inspecting the character of the patient's urine is part of the
evaluation phase. During the assessment phase of the nursing process for urinary elimination,
relevant laboratory and diagnostic test data is gathered. The patient and family may be asked to
demonstrate self-care skills during the evaluation phase of the nursing process for urinary
elimination.
After a transurethral prostatectomy, a patient returns to his room with a triple-lumen indwelling
catheter and continuous bladder irrigation. The irrigation is normal saline at 150 mL/hr. The
nurse empties the drainage bag for a total of 2520 mL after an 8-hour period. In mL, how much
of the total is urine output? Record your answer using a whole number and please note that no
comma is needed. ___________ mL
1320 ML
The output is determined by calculating the amount of irrigation solution and subtracting that
from the total output: 150 × 8 = 1200. Total output is 2520. 2520 - 1200 = 1320 urine output.
A patient complains of urinary alterations along with pain and discomfort at the time of voiding.
What is the exact terminology that the nurse should know for this condition?
A. Dysuria
B. Oliguria
C. Urgency
D. Polyuria
A
Dysuria is a condition where patients have pain and discomfort associated with voiding. Oliguria
refers to reduced urinary output with regard to fluid intake. Urgency refers to an instant and
strong desire to void that is not easily delayed. In polyuria, there is a voiding of excessive
amounts of urine.
A patient is diagnosed with transient incontinence. What does the nurse explain to the patient
about the cause of this type of urinary incontinence?
A. "Transient incontinence is the loss of continence because of causes outside the urinary
tract."
B. "Transient incontinence is caused by medical conditions that are mostly treatable and
reversible."
C. "Transient incontinence is caused by urethral hypermobility or an incompetent urinary
sphincter."
D. "Transient incontinence is caused by an overdistended bladder; it is often related to bladder
outlet obstruction."
B
Transient incontinence is defined as incontinence caused by medical conditions that are
generally treatable and reversible. Functional incontinence is continence due to causes outside
the urinary tract. Stress urinary incontinence is defined as involuntary leakage of small volumes
of urine associated with increased intraabdominal pressure related to either urethral
hypermobility or an incompetent urinary sphincter. Urinary incontinence associated with the
chronic retention of urine is the involuntary loss of urine caused by an overdistended bladder,
which is often related to bladder outlet obstruction or poor bladder emptying due to weak or
absent bladder contractions.
What is the use of double-lumen catheters?
A. Straight catheterization
B. Intermittent catheterization
C. Continuous bladder irrigation
D. Urinary drainage and inflation of a balloon
D
Double-lumen catheters are designed specifically for indwelling catheters, in which one lumen
provides urinary drainage and the other inflates a balloon that keeps the catheter in place.
Single-lumen catheters are used for straight catheterization. Additionally, single-lumen catheters
are also used for intermittent catheterization. Triple-lumen catheters are used for continuous
bladder irrigation.
What suggestion does the nurse give to a patient who asks for advice on how to prevent urinary
tract infections?
A. "Drink enough water to pass pale yellow urine."
B. "Avoid straining when voiding or moving the bowels."
C. "Take enough time to empty the bladder completely."
D. "Avoid or limit drinking beverages that contain caffeine."
A
The nurse should suggest that the patient drink enough water to pass pale yellow urine in order
to prevent urinary tract infections. Avoidance of straining when voiding or moving the bowels
and taking enough time to empty the bladder completely, indicate good voiding habits. Avoiding
or limiting the consumption of beverages that contain caffeine sustains adequate hydration.
What strategy should the nurse use to teach a patient to perform pelvic muscle exercises such
as Kegel exercises?
A. Use open-ended questions to determine the level of learning.
B. Ask the patient to describe how to correctly identify the pelvic floor muscles.
C. Use pictures to explain the pelvic anatomy and the location of the pelvic muscles.
D. Ask the patient to demonstrate and/or explain how to perform pelvic muscle exercises.
C
The nurse should use pictures and plain language to teach the patient pelvic anatomy and the
location of the pelvic muscles. A nurse uses open-ended questions to determine the level of
learning during the evaluation of patient teaching. The nurse also asks thepatient to describe
the correct identification of pelvic floor muscles and demonstrate the pelvic muscle exercises by
performing as part of the evaluation of patient teaching.

A nurse is preparing to administer the first of 2 large-volume, cleansing enemas

prescribed for a client in preparation for a diagnostic procedure. Which of the follwing
actions should the nurse take?
Warm the enema solution prior to instillation.
- It is important to warm the enema solution because cold fluid can cause abdominal
cramping. The solution should not be too hot, though, because hot fluid can injure the
intestinal mucosa.
WHile a nurse is administering a cleansing enema, the clint reports abdominal cramping
. Which of the following actions should the nurse take?
Lower the enema fluid container.
- Some abdominal cramping is to be expected during enema administration. To ease
the client's discomfort, the nurse should slow the rate of instillation by reducing the
height of the enema fluid container.
00:0203:49
A nurse is administering an enema medicated with sodium polystyrene sulfonate to an
adult client who has hyperkalemia. To which of the following lengths should the nurse
inser the rectal tube?
7.5 cm to 10 cm (3 to 4 in)
- This is the appropriate length of insertion for an adult client.
A nurse is administering a returning-flow anema to a client. After instilling 100 mL of
enema fluid, which of the folling actions should the nurse take?
Lower the container to allow the solution to flow back out.
- Return-flow enemas involve moving 100 to 200 mL of fluid into and out of the rectum.
After instilling the solution, the nurse lowers the container to allow the solution to flow
back into the container and then repeats the process several times.
A client who is postoperative is experiencing abdominal distention and is having
difficulty expelling flatus. The nurse should expect the provider to prescribe which of the
following types of enemas?
Return-flow
- Return-flow, or flush, enemas are used to expel flatus, stimulate peristalsis, and
relieve abdominal distention.
A nurse is preparing an adult client for an enema. The nurse should assist the client into
which of the following positions?
Left lateral with the right leg flexed
- This position makes it easier for the enema solution to flow by gravity into the sigmoid
and descending colon. The flexed leg promotes exposure of the anus for insertion of the
rectal tube.
A nurse is preparing to administer an oil retention enema to a cliet who has
constipation. The nurse should instruct the client to retain the solution for which of the
following duration
At least 30 min
- The enema will be most effective in softening the stool and lubricating its passageway
if the client retains the oil for a minimum of 30 min.
A nurse is preparing to administer a cleansing enema to a client who has poor sphincter
control. Which of the following actions should the nurse take?
Place the client in the dorsal recumbent position on a bedpan.
- A client who has poor sphincter control might not be able to retain the enema solution
at all. Repositioning the client over the bedpan in the dorsal recumbent position after
insertion of the rectal tube will help contain the fluid that is likely to be expelled.

ADVERTISEMENT

chyme
semi liquid product of digestion that travels from the stomach through the intestine
peristalsis
the mechanism of progressive contraction and relaxation of the walls of the intestine,
forces chyme into the large intestine through the ileocecal valve, which prevents
regurgitation of chyme
hemerroids
swollen and inflamed veins in the anus or lower rectum
defication
elimination of feces
diarrhea
an intestinal disorder that is characterized by an abnormal frequency and fluidity of
bowel movement
clostridium difficile (c. diff)
a bacterium that causes diarrhea and inflammation of the colon
incontinence
refers to the loss of voluntary control of fecal and gaseous discharge through the anus
constipation
having in frequent or difficult bell movements, as well as having fewer than 3 bowel
movements per week
valsalva maneuver
consists of "bearing down" while holding the breath
impaction
refers to the presence of a hard fecal mass in the rectum or colon that the patient is in
capable of expelling
flatulence
the production of a mixture of gases in the intestine, by products of the digestive
process; belching or passing gas
ostomy
surgically created opening in the G.I., urinary, or respiratory organ that is exited out to
the skin
stoma
any body opening but usually refers to the actual exit point for a GI surgical ostomy,
which forms a slight protuberance of mucosa through the skin
colostomy
surgically created when a portion of the colon or the rectum is removed and the
remaining colon is brought through the abdominal wall
ileostomy
surgically created opening in the small intestine, usually at the end of the ileum
paralytic ileus
the stoppage of peristalsis
laxatives
ease defecation, often by stimulating bowel activity
cathartics
strong laxatives that stimulate evacuation of the bowel by causing a change in GI transit
time
fecal occult blood test
testing for the presence of blood in the feces
polyps
benign or malignant tissue growth in the colon
colonoscopy
a procedure performed to visualize inflamed tissue, ulcers, and abnormal growth in the
anus, rectum, and colon
lavage
irrigation of the stomach
suppository
a drug delivery system that is inserted into the rectum, where it dissolves for medication
absorption by coming into contact with rectal mucosa
enema
the introduction of solutions into the rectum and sigmoid colon via the anus
he nurse is teaching a health class about the gastrointestinal tract. The nurse will explain that
which portion of the digestive tract absorbs most of the nutrients?
a. Ileum
b. Cecum
c. Stomach
d. Duodenum
ANS: D
The duodenum and jejunum absorb most nutrients and electrolytes in the small intestine. The
ileum absorbs certain vitamins, iron, and bile salts. Food is broken down in the stomach. The
cecum is the beginning of the large intestine.
2. The nurse is caring for patients with ostomies. In which ostomy location will the nurse expect
very liquid stool to be present?
a. Sigmoid
b. Transverse
c. Ascending
d. Descending
ANS: C
The path of digestion goes from the ascending, across the transverse, to the descending and
finally passing into the sigmoid; therefore, the least formed stool (very liquid) would be in the
ascending.
00:0203:49
3. A nurse is teaching a patient about the large intestine in elimination. In which order will the
nurse list the structures, starting with the first portion?
a. Cecum, ascending, transverse, descending, sigmoid, and rectum
b. Ascending, transverse, descending, sigmoid, rectum, and cecum
c. Cecum, sigmoid, ascending, transverse, descending, and rectum
d. Ascending, transverse, descending, rectum, sigmoid, and cecum
ANS: A
The large intestine is divided into the cecum, ascending colon, transverse colon, descending
colon, sigmoid colon, and rectum. The large intestine is the primary organ of bowel elimination.
4. The nurse is planning care for a group of patients. Which task will the nurse assign to the
nursing assistive personnel (NAP)?
a. Performing the first postoperative pouch change
b. Maintaining a nasogastric tube
c. Administering an enema
d. Digitally removing stool
ANS: C
The skill of administering an enema can be delegated to an NAP. The skill of inserting and
maintaining a nasogastric (NG) tube cannot be delegated to an NAP. The nurse should do the
first postoperative pouch change. Digitally removing stool cannot be delegated to nursing
assistive personnel.
5. A nurse is assisting a patient in making dietary choices that promote healthy bowel
elimination. Which menu option should the nurse recommend?
a. Broccoli and cheese soup with potato bread
b. Turkey and mashed potatoes with brown gravy
c. Grape and walnut chicken salad sandwich on whole wheat bread
d. Dinner salad topped with hard-boiled eggs, cheese, and fat-free dressing
ANS: C
Grapes and whole wheat bread are high fiber and should be chosen. Cheese, eggs, potato
bread, and mashed potatoes do not contain as much fiber as whole wheat bread. A healthy diet
for the bowel should include foods high in bulk-forming fiber. Whole grains, fresh fruit, and fresh
vegetables are excellent sources. Foods without much fiber and with high levels of fat can slow
down peristalsis, causing constipation.
6. A patient is using laxatives three times daily to lose weight. After stopping laxative use, the
patient has difficulty with constipation and wonders if laxatives should be taken again. Which
information will the nurse share with the patient?
a. Long-term laxative use causes the bowel to become less responsive to stimuli, and
constipation may occur.
b. Laxatives can cause trauma to the intestinal lining and scarring may result, leading to
decreased peristalsis.
c. Long-term use of emollient laxatives is effective for treatment of chronic constipation and may
be useful in certain situations.
d. Laxatives cause the body to become malnourished, so when the patient begins eating again,
the body absorbs all of the food, and no waste products are produced.
ANS: A
Teach patients about the potential harmful effects of overuse of laxatives, such as impaired
bowel motility and decreased response to sensory stimulus. Make sure the patient understands
that laxatives are not to be used long term for maintenance of bowel function. Increasing fluid
and fiber intake can help with this problem. Laxatives do not cause scarring. Even if
malnourished, the body will produce waste if any substance is consumed.
7. A patient with a hip fracture is having difficulty defecating into a bedpan while lying in bed.
Which action by the nurse will assist the patient in having a successful bowel movement?
a. Preparing to administer a barium enema
b. Withholding narcotic pain medication
c. Administering laxatives to the patient
d. Raising the head of the bed
ANS: D
Lying in bed is an unnatural position; raising the head of the bed assists the patient into a more
normal position that allows proper contraction of muscles for elimination. Laxatives would not
give the patient control over bowel movements. A barium enema is a diagnostic test, not an
intervention to promote defecation. Pain relief measures should be given; however, preventative
action should be taken to prevent constipation.
8. Which patient is most at risk for increased peristalsis?
a. A 5-year-old child who ignores the urge to defecate owing to embarrassment
b. A 21-year-old female with three final examinations on the same day
c. A 40-year-old female with major depressive disorder
d. An 80-year-old male in an assisted-living environment
ANS: B
Stress can stimulate digestion and increase peristalsis, resulting in diarrhea; three finals on the
same day is stressful. Ignoring the urge to defecate, depression, and age-related changes of the
older adult (80-year-old man) are causes of constipation, which is from slowed peristalsis.
9. A patient expresses concerns over having black stool. The fecal occult test is negative. Which
response by the nurse is most appropriate?
a. "This is probably a false negative; we should rerun the test."
b. "You should schedule a colonoscopy as soon as possible."
c. "Are you under a lot of stress?"
d. "Do you take iron supplements?"
ANS: D
Certain medications and supplements, such as iron, can alter the color of stool (black or tarry).
Since the fecal occult test is negative, bleeding is not occurring. The fecal occult test takes three
separate samples over a period of time and is a fairly reliable test. A colonoscopy is health
prevention screening that should be done every 5 to 10 years; it is not the nurse's initial priority.
Stress alters GI motility and stool consistency, not color.
10. Which patient will the nurse assess most closely for an ileus?
a. A patient with a fecal impaction
b. A patient with chronic cathartic abuse
c. A patient with surgery for bowel disease and anesthesia
d. A patient with suppression of hydrochloric acid from medication
ANS: C
Any surgery that involves direct manipulation of the bowel temporarily stops peristalsis.
Anesthesia can also cause cessation of peristalsis. This condition, called an ileus, usually lasts
about 24 to 48 hours. Fecal impaction, cathartic abuse, and medication to suppress hydrochloric
acid will have bowel sounds, but they may be hypoactive or hyperactive.

We have an expert-written solution to this problem!

11. A patient has a fecal impaction. Which portion of the colon will the nurse assess?
a. Descending
b. Transverse
c. Ascending
d. Rectum
ANS: D
A fecal impaction is a collection of hardened feces wedged in the rectum that cannot be
expelled. It results from unrelieved constipation. Feces at this point in the colon contain the least
amount of moisture. Feces found in the ascending, transverse, and descending colon still
consist mostly of liquid and do not form a hardened mass.
12. The nurse is managing bowel training for a patient. To which patient is the nurse most likely
providing care?
a. A 25-year-old patient with diarrhea
b. A 30-year-old patient with Clostridium difficile
c. A 40-year-old patient with an ileostomy
d. A 70-year-old patient with stool incontinence
ANS: D
The patient with chronic constipation or fecal incontinence secondary to cognitive impairment
may benefit from bowel training, also called habit training. An ileostomy, diarrhea, and C. difficile
all relate to uncontrollable bowel movements, for which no method can be used to set up a
schedule of elimination.
00:0203:49
13. Which nursing intervention is most effective in promoting normal defecation for a patient
who has muscle weakness in the legs?
a. Administer a soapsuds enema every 2 hours.
b. Use a mobility device to place the patient on a bedside commode.
c. Give the patient a pillow to brace against the abdomen while bearing down.
d. Elevate the head of the bed 20 degrees 60 minutes after breakfast while on bedpan.
ANS: B
The best way to promote normal defecation is to assist the patient into a posture that is as
normal as possible for defecation. Using a mobility device promotes nurse and patient safety.
Elevating the head of the bed is appropriate but is not the most effective; closer to 30 to 45
degrees is the proper position for the patient on a bedpan, and the patient is not on bed rest so
a bedside commode is the best choice. Giving the patient a pillow may reduce discomfort, but
this is not the best way to promote defecation. A soapsuds enema is indicated for a patient who
needs assistance to stimulate peristalsis. It promotes non-natural defecation.
14. The nurse is devising a plan of care for a patient with the nursing diagnosis of Constipation
related to opioid use. Which outcome will the nurse evaluate as successful for the patient to
establish normal defecation?
a. The patient reports eliminating a soft, formed stool.
b. The patient has quit taking opioid pain medication.
c. The patient's lower left quadrant is tender to the touch.
d. The nurse hears bowel sounds in all four quadrants.
ANS: A
The nurse's goal is for the patient to take opioid medication and to have normal bowel
elimination. Normal stools are soft and formed. Ceasing pain medication is not a desired
outcome for the patient. Tenderness in the left lower quadrant indicates constipation and does
not indicate success. Bowel sounds indicate that the bowels are moving; however, they are not
an indication of defecation.
15. The nurse is emptying an ileostomy pouch for a patient. Which assessment finding will the
nurse report immediately?
a. Liquid consistency of stool
b. Presence of blood in the stool
c. Malodorous stool
d. Continuous output from the stoma
ANS: B
Blood in the stool indicates a problem, and the health care provider should be notified. All other
options are expected findings for an ileostomy. The stool should be liquid, there should be an
odor, and the output should be continuous.
16. The nurse will anticipate which diagnostic examination for a patient with black tarry stools?
a. Ultrasound
b. Barium enema
c. Endoscopy
d. Anorectal manometry
ANS: C
Black tarry stools are an indication of bleeding in the GI tract; endoscopy would allow
visualization of the bleeding. No other option (ultrasound, barium enema, and anorectal
manometry) would allow GI visualization.
17. The nurse has attempted to administer a tap water enema for a patient with fecal impaction
with no success. The fecal mass is too large for the patient to pass voluntarily. Which is the
nextpriority nursing action?
a. Preparing the patient for a second tap water enema
b. Obtaining an order for digital removal of stool
c. Positioning the patient on the left side
d. Inserting a rectal tube
ANS: B
When enemas are not successful, digital removal of the stool may be necessary to break up
pieces of the stool or to stimulate the anus to defecate. Tap water enemas should not be
repeated because of risk of fluid imbalance. Positioning the patient on the left side does not
promote defecation. A rectal tube is indicated for a patient with liquid stool incontinence or flatus
but would not be applicable or effective for this patient.
18. A nurse is checking orders. Which order should the nurse question?
a. A normal saline enema to be repeated every 4 hours until stool is produced
b. A hypertonic solution enema for a patient with fluid volume excess
c. A Kayexalate enema for a patient with severe hypokalemia
d. An oil retention enema for a patient with constipation
ANS: C
Kayexalate binds to and helps excrete potassium, so it would be contraindicated in patients who
are hypokalemic (have low potassium). Normal saline enemas can be repeated without risk of
fluid or electrolyte imbalance. Hypertonic solutions are intended for patients who cannot handle
large fluid volume and are contraindicated for dehydrated patients. Oil retention enemas
lubricate the feces in the rectum and colon and are used for constipation.
19. The nurse is performing a fecal occult blood test. Which action should the nurse take?
a. Test the quality control section before testing the stool specimens.
b. Apply liberal amounts of stool to the guaiac paper.
c. Report a positive finding to the provider.
d. Don sterile disposable gloves.
ANS: C
Abnormal findings such as a positive test (turns blue) should be reported to the provider. A fecal
occult blood test is a clean procedure; sterile gloves are not needed. A thin specimen smear is
all that is required. The quality control section should be developed after it is determined
whether the sample is positive or negative.
20. A nurse is preparing a patient for a magnetic resonance imaging (MRI) scan. Which nursing
action is most important?
a. Ensuring that the patient does not eat or drink 2 hours before the examination.
b. Administering a colon cleansing product 6 hours before the examination.
c. Obtaining an order for a pain medication before the test is performed.
d. Removing all of the patient's metallic jewelry.
ANS: D
No jewelry or metal products should be in the same room as an MRI machine because of the
high-power magnet used in the machine. The patient needs to be NPO 4 to 6 hours before the
examination. Colon cleansing products are not necessary for MRIs. Pain medication is not
needed before the examination is performed.
21. A patient with a fecal impaction has an order to remove stool digitally. In which order will the
nurse perform the steps, starting with the first one?
1. Obtain baseline vital signs.
2. Apply clean gloves and lubricate.
3. Insert index finger into the rectum.
4. Identify patient using two identifiers.
5. Place patient on left side in Sims' position.
6. Massage around the feces and work down to remove.
a. 4, 1, 5, 2, 3, 6
b. 1, 4, 2, 5, 3, 6
c. 4, 1, 2, 5, 3, 6
d. 1, 4, 5, 2, 3, 6
ANS: A
The steps for removing a fecal impaction are as follows: identify patient using two identifiers;
obtain baseline vital signs; place on left side in Sims' position; apply clean gloves and lubricate;
insert index finger into the rectum; and gently loosen the fecal mass by massaging around it and
work the feces downward toward the end of the rectum.
22. Before administering a cleansing enema to an 80-year-old patient, the patient says "I don't
think I will be able to hold the enema." Which is the next priority nursing action?
a. Rolling the patient into right-lying Sims' position
b. Positioning the patient in the dorsal recumbent position on a bedpan
c. Inserting a rectal plug to contain the enema solution after administering
d. Assisting the patient to the bedside commode and administering the enema
ANS: B
If you suspect the patient of having poor sphincter control, position on bedpan in a comfortable
dorsal recumbent position. Patients with poor sphincter control are unable to retain all of the
enema solution. Administering an enema with the patient sitting on the toilet is unsafe because
it is impossible to safely guide the tubing into the rectum, and it will be difficult for the patient to
retain the fluid as he or she is in the position used for emptying the bowel. Rolling the patient
into right-lying Sims' position will not help the patient retain the enema. Use of a rectal plug to
contain the solution is inappropriate and unsafe.
23. A nurse is providing care to a group of patients. Which patient will the nurse see first?
a. A child about to receive a normal saline enema
b. A teenager about to receive loperamide for diarrhea
c. An older patient with glaucoma about to receive an enema
d. A middle-aged patient with myocardial infarction about to receive docusate sodium
ANS: C
An enema is contradicted in a patient with glaucoma; this patient should be seen first. All the
rest are expected. A child can receive normal saline enemas since they are isotonic.
Loperamide, an antidiarrheal, is given for diarrhea. Docusate sodium is given to soften stool for
patients with myocardial infarction to prevent straining.
24. A patient is diagnosed with a bowel obstruction. Which type of tube is the best for the nurse
to obtain for gastric decompression?
a. Salem sump
b. Small bore
c. Levin
d. 8 Fr
ANS: A
The Salem sump tube is preferable for stomach decompression. The Salem sump tube has two
lumina: one for removal of gastric contents and one to provide an air vent. When the main
lumen of the sump tube is connected to suction, the air vent permits free, continuous drainage
of secretions. While the Levin tube can be used for decompression, it is only a single-lumen
tube with holes near the tip. Large-bore tubes, 12 Fr and above, are usually used for gastric
decompression or removal of gastric secretions. Fine- or small-bore tubes are frequently used
for medication administration and enteral feedings.
25. A patient had an ileostomy surgically placed 2 days ago. Which diet will the nurse
recommend to the patient to ease the transition of the new ostomy?
a. Eggs over easy, whole wheat toast, and orange juice with pulp
b. Chicken fried rice with fresh pineapple and iced tea
c. Turkey meatloaf with white rice and apple juice
d. Fish sticks with sweet corn and soda
ANS: C
During the first few days after ostomy placement, the patient should consume easy-to-digest
soft foods such as poultry, rice, and noodles. Fried foods can irritate digestion. Foods high in
fiber will be useful later in the recovery process but can cause food blockage if the GI tract is not
accustomed to digesting with an ileostomy. Foods with indigestible fiber such as sweet corn,
popcorn, raw mushrooms, fresh pineapple, and Chinese cabbage could cause this problem.
26. A nurse is pouching an ostomy on a patient with an ileostomy. Which action by the nurse is
most appropriate?
a. Changing the skin barrier portion of the ostomy pouch daily
b. Emptying the pouch if it is more than one-third to one-half full
c. Thoroughly cleansing the skin around the stoma with soap and water to remove excess stool
and adhesive
d. Measuring the correct size for the barrier device while leaving a 1/2-inch space around the
stoma
ANS: B
Pouches must be emptied when they are one-third to one-half full because the weight of the
pouch may disrupt the seal of the adhesive on the skin. The barrier device should be changed
every 3 to 7 days unless it is leaking or is no longer effective. Peristomal skin should be gently
cleansed; vigorous rubbing can cause further irritation or skin breakdown. Avoid soap. It leaves
a residue on skin, which may irritate the skin. The pouch opening should fit around the stoma
and cover the peristomal skin to prevent contact with the effluent. Excess space, like 1/2 inch,
allows fecal matter to have prolonged exposure to skin, resulting in skin breakdown.
27. The nurse will irrigate a patient's nasogastric (NG) tube. Which action should the nurse
take?
a. Instill solution into pigtail slowly.
b. Check placement after instillation of solution.
c. Immediately aspirate after instilling fluid.
d. Prepare 60 mL of tap water into Asepto syringe.
ANS: C
After instilling saline, immediately aspirate or pull back slowly on syringe to withdraw fluid. Do
not introduce saline through blue "pigtail" air vent of Salem sump tube. Checking placement
before instillation of normal saline prevents accidental entrance of irrigating solution into lungs.
Draw up 30 mL of normal saline into Asepto syringe to minimize loss of electrolytes from
stomach fluids.
28. The nurse administers a cathartic to a patient. Which finding helps the nurse determine that
the cathartic has a therapeutic effect?
a. Reports decreased diarrhea.
b. Experiences pain relief.
c. Has a bowel movement.
d. Passes flatulence.
ANS: C
A cathartic is a laxative that stimulates a bowel movement. It would be effective if the patient
experiences a bowel movement. The other options are not outcomes of administration of a
cathartic. An antidiarrheal will provide relief from diarrhea. Pain medications will provide pain
relief. Carminative enemas provide relief from gaseous distention (flatulence).
29. An older adult's perineal skin is dry and thin with mild excoriation. When providing hygiene
care after episodes of diarrhea, what should the nurse do?
a. Thoroughly scrub the skin with a washcloth and hypoallergenic soap.
b. Tape an occlusive moisture barrier pad to the patient's skin.
c. Apply a skin protective ointment after perineal care.
d. Massage the skin with light kneading pressure.
ANS: C
Cleansing with a no-rinse cleanser and application of a barrier ointment should be done after
each episode of diarrhea. Tape and occlusive dressings can damage skin. Excessive pressure
and massage are inappropriate and may cause skin breakdown.
30. Which action will the nurse take to reduce the risk of excoriation to the mucosal lining of the
patient's nose from a nasogastric tube?
a. Instill Xylocaine into the nares once a shift.
b. Tape tube securely with light pressure on nare.
c. Lubricate the nares with water-soluble lubricant.
d. Apply a small ice bag to the nose for 5 minutes every 4 hours.
ANS: C
The tube constantly irritates the nasal mucosa, increasing the risk of excoriation. Frequent
lubrication with a water-soluble lubricant decreases the likelihood of excoriation and is less toxic
than oil-based if aspirated. Xylocaine is used to treat sore throat, not nasal mucosal excoriation.
While the tape should be secure, pressure will increase excoriation. Ice is not applied to the
nose.
31. A nurse is providing discharge teaching for a patient who is going home with a guaiac test.
Which statement by the patient indicates the need for further education?
a. "If I get a blue color that means the test is negative."
b. "I should not get any urine on the stool I am testing."
c. "If I eat red meat before my test, it could give me false results."
d. "I should check with my doctor to stop taking aspirin before the test."
ANS: A
A blue color indicates a positive guaiac, or presence of fecal occult blood; the patient needs
more teaching to correct this misconception. Proper patient education is important for viable
results. Be sure specimen is free of toilet paper and not contaminated with urine. The patient
needs to avoid certain foods, like red meat, to rule out a false positive. While the health care
provider should be consulted before asking a patient to stop any medication, if there are no
contraindications, the patient should be instructed to stop taking aspirin, ibuprofen, naproxen or
other nonsteroidal antiinflammatory drugs for 7 days because these could cause a false-positive
test result.
32. A nurse is preparing to lavage a patient in the emergency department for an overdose.
Which tube should the nurse obtain?
a. Ewald
b. Dobhoff
c. Miller-Abbott
d. Sengstaken-Blakemore
ANS: A
Lavage is irrigation of the stomach in cases of active bleeding, poisoning, or gastric dilation. The
types of tubes include Levin, Ewald, and Salem sump. Sengstaken-Blakemore is used for
compression by internal application of pressure by means of inflated balloon to prevent internal
esophageal or GI hemorrhage. Dobhoff is used for enteral feeding. Miller-Abbott is used for
gastric decompression.
33. The nurse is caring for a patient with Clostridium difficile. Which nursing actions will have the
greatest impact in preventing the spread of the bacteria?
a. Appropriate disposal of contaminated items in biohazard bags
b. Monthly in-services about contact precautions
c. Mandatory cultures on all patients
d. Proper hand hygiene techniques
ANS: D
Proper hand hygiene is the best way to prevent the spread of bacteria. Soap and water are
mandatory. Monthly in-services place emphasis on education, not on action. Biohazard bags
are appropriate but cannot be used on every item that C. difficile comes in contact with, such as
a human. Mandatory cultures are expensive and unnecessary and would not prevent the spread
of bacteria.
34. A nurse is performing an assessment on a patient who has not had a bowel movement in 3
days. The nurse will expect which other assessment finding?
a. Hypoactive bowel sounds
b. Increased fluid intake
c. Soft tender abdomen
d. Jaundice in sclera
ANS: A
Three or more days with no bowel movement indicates hypomotility of the GI tract. Assessment
findings would include hypoactive bowel sounds, a firm distended abdomen, and pain or
discomfort upon palpation. Increased fluid intake would help the problem; a decreased intake
can lead to constipation. Jaundice does not occur with constipation but can occur with liver
disease.

35. A nurse is caring for a patient who has had diarrhea for the past week. Which
additional assessment finding will the nurse expect?
a. Distended abdomen
b. Decreased skin turgor
c. Increased energy levels
d. Elevated blood pressure
ANS: B
Chronic diarrhea can result in dehydration. Patients with chronic diarrhea are
dehydrated with decreased skin turgor and blood pressure. Diarrhea also causes loss of
electrolytes, nutrients, and fluid, which decreases energy levels. A distended abdomen
could indicate constipation.
36. The nurse is caring for a patient who had a colostomy placed yesterday. The nurse
should report which assessment finding immediately?
a. Stoma is protruding from the abdomen.
b. Stoma is flush with the skin.
c. Stoma is purple.
d. Stoma is moist.
ANS: C
A purple stoma may indicate strangulation/necrosis or poor circulation to the stoma and
may require surgical intervention. A stoma should be reddish-pink and moist in
appearance. It can be flush with the skin, or it can protrude.
37. A patient is receiving a neomycin solution enema. Which primary goal is the nurse
trying to achieve?
a. Prevent gaseous distention
b. Prevent constipation
c. Prevent colon infection
d. Prevent lower bowel inflammation
ANS: C
A medicated enema is a neomycin solution, i.e., an antibiotic used to reduce bacteria in
the colon before bowel surgery. Carminative enemas provide relief from gaseous
distention. Bulk forming, emollient (wetting), and osmotic laxatives and cathartics help
prevent constipation or treat constipation. An enema containing steroid medication may
be used for acute inflammation in the lower colon.
38. A guaiac test is ordered for a patient. Which type of blood is the nurse checking for
in this patient's stool?
a. Bright red blood
b. Dark black blood
c. Microscopic
d. Mucoid
ANS: C
Fecal occult blood tests are used to test for blood that may be present in stool but
cannot be seen by the naked eye (microscopic). This is usually indicative of a
gastrointestinal bleed. All other options are incorrect. Detecting bright red blood, dark
black blood, and blood that contains mucus (mucoid) is not the purpose of a guaiac test.
39. A patient is receiving opioids for pain. Which bowel assessment is a priority?
a. Clostridium difficile
b. Constipation
c. Hemorrhoids
d. Diarrhea
ANS: B
Patients receiving opiates for pain after surgery often require a stool softener or laxative
to prevent constipation. C. difficile occurs from antibiotics, not opioids. Hemorrhoids are
caused by conditions other than opioids. Diarrhea does not occur as frequently as
constipation.
40. Which nutritional instruction is a priority for the nurse to advise a patient about with
an ileostomy?
a. Keep fiber low.
b. Eat large meals.
c. Increase fluid intake.
d. Chew food thoroughly.
ANS: C
Patients with ileostomies will digest their food completely but will lose both fluid and salt
through their stoma and will need to be sure to replace this to avoid dehydration. A good
reminder for patients is to encourage drinking an 8-ounce glass of fluid when they
empty their pouch. This helps patients to remember that they have greater fluid needs
than they did before having an ileostomy. A low-fiber diet is not necessary. Eating large
meals is not advised. While chewing food thoroughly is correct, it is not the priority;
liquid is the priority.
41. A nurse is preparing a bowel training program for a patient. Which actions will the
nurse take? (Select all that apply.)
a. Record times when the patient is incontinent.
b. Help the patient to the toilet at the designated time.
c. Lean backward on the hips while sitting on the toilet.
d. Maintain normal exercise within the patient's physical ability.
e. Apply pressure with hands over the abdomen, and strain while pushing.
f. Choose a time based on the patient's pattern to initiate defecation-control measures.
ANS: A, B, D, F
A successful program includes the following: Assessing the normal elimination pattern
and recording times when the patient is incontinent. Choosing a time based on the
patient's pattern to initiate defecation-control measures. Maintaining normal exercise
within the patient's physical ability. Helping the patient to the toilet at the designated
time. Offering a hot drink (hot tea) or fruit juice (prune juice) (or whatever fluids normally
stimulate peristalsis for the patient) before the defecation time. Instructing the patient to
lean forward at the hips while sitting on the toilet, apply manual pressure with the hands
over the abdomen, and bear down but do not strain to stimulate colon emptying.
42. A nurse is teaching a health class about colorectal cancer. Which information should
the nurse include in the teaching session? (Select all that apply.)
a. A risk factor is smoking.
b. A risk factor is high intake of animal fats or red meat.
c. A warning sign is rectal bleeding.
d. A warning sign is a sense of incomplete evacuation.
e. Screening with a colonoscopy is every 5 years, starting at age 50.
f. Screening with flexible sigmoidoscopy is every 10 years, starting at age 50.
ANS: A, B, C, D
Risk factors for colorectal cancer are a diet high in animal fats or red meat and low
intake of fruits and vegetables; smoking and heavy alcohol consumption are also risk
factors. Warning signs are change in bowel habits, rectal bleeding, a sensation of
incomplete evacuation, and unexplained abdominal or back pain. A flexible
sigmoidoscopy is every 5 years, starting at age 50, while a colonoscopy is every 10
years, starting at age 50.

ADVERTISEMENT
 ADVERTISEMENT

Tuesday, November 14, 2023 Oxygen needs,

Homonstatic= balance your body

Red: blood from heart

Blue: clean blood to heart