Test 6
The Client with Lower Gastrointestinal Tract Health Problems
The Client with Cancer of the Colon
1. Which of the following has been identified as a potential risk factor for the development of colon cancer?
1. Chronic constipation.
2. Long-term use of laxatives.
3. History of smoking.
Other risk factors include age (older than 40 years), history of familial polyposis, colorectal polyps, and high-fat and/or low-fiber diet.
4. History of inflammatory bowel disease.
A history of inflammatory bowel disease is a risk factor for colon cancer.
2. The nurse is preparing a teaching plan for a community presentation on the prevention and early detection of colon cancer. Which of the following would the nurse identify to the audience as the most common symptom of colon cancer?
1. Abdominal pain.
2. Diarrhea.
Other commonly seen symptoms include alternating constipation and diarrhea, narrowing of stool caliber, and a sense of incomplete evacuation.
3. Rectal bleeding.
Rectal bleeding is the most common symptom of colon cancer.
Iron-deficiency anemia and occult bleeding may also be present. Colon cancer may be asymptomatic in early stages.
4. Abdominal distention.
Abdominal pain and distention are not necessarily present in the early stages of colon cancer.
3. When teaching a client with signs and symptoms of colon cancer about the diagnostic workup, the nurse instructs the client to take which of the following types of medication after a barium enema?
1. Laxative.
After a barium enema, a laxative is ordinarily prescribed. This is done to promote elimination of the barium. Retained barium predisposes the client to constipation and fecal impaction.
2. Anticholinergic.
Anticholinergic drugs decrease gastrointestinal motility.
3. Antacid.
Antacids decrease gastric acid secretion.
4. Demulcent.
Demulcents soothe mucous membranes of the gastrointestinal tract and are used to treat diarrhea.
4. The client with colon cancer has an abdominal-perineal resection with a colostomy. Which of the following nursing interventions is most appropriate for this client in the postoperative period?
1. Maintain the client in a semi-Fowler’'s position.
The client will be more comfortable assuming a side-lying position because of the perineal incision.
2. Assist the client with warm sitz baths.
Appropriate nursing interventions after an abdominal-perineal resection with a colostomy include assisting the client with warm sitz baths three to four times a day to clean the perineal incision.
3. Administer 30 mL of milk of magnesia to stimulate colostomy activity.
It would be inappropriate to administer milk of magnesia to stimulate colostomy activity.
4. Remove the ostomy pouch as needed so the stoma can be assessed.
Stool passage will begin as peristalsis returns. It is not necessary or desirable to change the ostomy pouch daily to assess the stoma. The ostomy pouch should be transparent to allow easy observation of the stoma and drainage.
5. The nurse evaluates the client’s stoma during the initial postoperative period. Which of the following observations should be reported immediately to the physician?
1. The stoma is slightly edematous.
Mild edema and slight oozing of blood are normal in the early postoperative period.
2. The stoma is dark red to purple.
A dark red to purple stoma indicates inadequate blood supply.
3. The stoma oozes a small amount of blood.
4. The stoma does not expel stool.
The colostomy would typically not begin functioning until 2 to 4 days after surgery.
6. While changing the client’s colostomy bag and dressing, the nurse assesses that the client is ready to participate in her care by noting which of the following?
1. The client asks what time the doctor will visit that day.
2. The client asks about the supplies used during the dressing change.
A client who displays interest in the procedure and asks about supplies used for dressings may be ready to participate in self-care.
3. The client talks about something she read in the morning newspaper.
4. The client complains about the way the night nurse changed the dressing.
Inquiring about the physician’s visit, discussing news events, and complaining about a dressing change are behaviors that avoid the subject of the colostomy.
7. Which of the following skin preparations would be best to apply around the client’s colostomy?
1. Karaya.
Karaya and Stomahesive are both effective agents for protecting the skin around a colostomy. They keep the skin healthy and prevent skin irritation from stoma drainage.
2. Petrolatum.
3. Cornstarch.
4. Antiseptic cream.
Petrolatum, cornstarch, and antiseptic creams do not protect the skin adequately and may prevent an adequate seal between the skin and the colostomy bag.
8. A client is recovering from an abdominal-perineal resection. Which of the following measures would most effectively promote wound healing after the perineal drains have been removed?
1. Taking sitz baths.
Sitz baths are an effective way to clean the operative area after an abdominal-perineal resection. Sitz baths bring warmth to the area, improve circulation, and promote healing and cleanliness. Most clients find them comfortable and relaxing. Between sitz baths, the area should be kept clean and dry.
2. Taking daily showers.
A shower will not adequately clean the perineal area.
3. Applying warm, moist dressings to the area.
Moist dressings may promote wound contamination and delay healing.
4. Applying a protected heating pad to the area.
A heating pad applied to the area for longer than 20 minutes may cause excessive vasodilation, leading to congestion and discomfort.
9. When planning diet teaching for the client with a colostomy, the nurse would develop a plan that emphasizes which of the following dietary instructions?
1. Foods containing roughage should not be eaten.
Severe restriction of roughage is not recommended.
2. Liquids are best limited to prevent diarrhea.
The client is encouraged to drink 2 to 3 L of fluid per day.
3. Clients should experiment to find the diet that is best for them.
It is best to adjust the diet of a client with a colostomy in a manner that suits the client rather than trying special diets.
4. A high-fiber diet will produce a regular passage of stool.
A high-fiber diet may produce loose stools.
10. Which of the following would be an expected outcome for a client who is recovering from an abdominal-perineal resection with a colostomy?
1. The client will maintain a fluid intake of 3,000 mL/day.
An expected outcome is that the client will maintain an intake of 3,000 ml / day unless contraindicated.
2. The client will eliminate fiber from the diet.
There is no need to eliminate fiber from the diet; the client can eat whatever foods are desired, avoiding those that are bothersome.
3. The client will limit physical activity to light exercise.
Physical activity does not need to be limited to light exercise.
4. The client will accept that sexual activity will be diminished.
The client can resume normal activities as tolerated, usually within 6 to 8 weeks. The client’s sexual activity may be affected, but it does not need to be diminished. |