CARE OFCLIENTS WITH PROBLEM IN

NUTRITION, AND GASTRO-INTERNAL,

METABOLISM AND ENDOCRINE,
PERCEPTION AND COORDINATION, (ACUTE
AND CHRONIC)
STUDENT’S ACTIVITY SHEET BS NURSING / THIRD YEAR Session # 4 (2 hours and
30 minutes)

Materials:
LESSON TITLE: CONSTIPATION, DIARRHEA, AND FECAL
INCONTINENCE Book, pen and notebook, projector

References:
LEARNING OUTCOMES:
Upon completion of this lesson, the nursing student can: Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K.
1. Identify the risk factors of the disorders. (2008). Brunner &Suddarth’s Textbook of 2. Determine the pharmacologic
therapy of the disorders. Medical-Surgical Nursing 11th Edition.
3. Enumerate nursing interventions of the disorders. Lippincott Williams &Wilkins

CHECK FOR UNDERSTANDING (15 minutes)

The instructor will prepare 10-15 questions that can enhance critical thinking skills. Students will work by themselves to
answer these questions and write the rationale for each question.
Multiple Choice

(For 1-10 items, please refer to the questions in the Rationalization Activity)

RATIONALIZATION ACTIVITY (DURING THE FACE TO FACE INTERACTION WITH THE STUDENTS)
The instructor will now rationalize the answers to the students and will encourage them to ask questions and to discuss
among their classmates for 20 minutes.

1. You’re performing an abdominal assessment on Brent who is 52 y.o. In which order do you proceed?
A. Observation, percussion, palpation, auscultation
B. Observation, auscultation, percussion, palpation
C. Percussion, palpation, auscultation, observation
D. Palpation, percussion, observation, auscultation
ANSWER: B, Observation, auscultation, percussion, palpation
RATIO: Observation, auscultation, percussion, palpation is the correct order

2. When teaching an elderly client how to prevent constipation, which of the following instructions should the nurse include?
A. “Drink 6 glasses of fluid each day.”
B. “Avoid grain products and nuts.”
C. “Add at least 4 grams of bran to your cereal each morning.”
D. “Be sure to get regular exercise.”
ANSWER:D, “Be sure to get regular exercise.”
RATIO: Make sure to add 30 minutes of exercise to your daily routine at least 4 times a week

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 3. The nurse would monitor for which of the following adverse reactions to aluminum-containing antacids such as aluminum
hydroxide (Amphojel)?
A. Diarrhea
B. Constipation
C. GI upset
D. Fluid retention
ANSWER: B, Constipation
RATIO: Aluminum- and calcium-containing antacids cause constipation, magnesium-containing antacids cause diarrhea,
and sodium-containing antacids cause sodium and fluid retention.

4. Nursing suggestions to help a person break the constipation habit include all of the following except:
A. A low-residue, bland diet.
B. A fluid intake of at least 2 L/day.
C. Establishing a regular schedule of exercise.
D. Establishing a regular time for daily elimination.
ANSWER: A, B, C, D
RATIO: All of the above

5. All of the following are considered complications of constipation except:

A. Hemorrhoids
B. Fecal impaction
C. Hypokalemia
D. Hypertension
ANSWER: C, Hypokalemia
RATIO: Hypokalemia is not considered complications of constipation

6. In a client with diarrhea, which outcome indicates that fluid resuscitation is successful?
A. The client passes formed stools at regular intervals
B. The client reports a decrease in stool frequency and liquidity
C. The client exhibits firm skin turgor
D. The client no longer experiences perianal burning.
ANSWER:C, The client exhibits firm skin turgor
RATIO: A client with diarrhea has a nursing diagnosis of Deficient fluid volume related to excessive fluid loss in the stool.
Expected outcomes include firm skin turgor, moist mucous membranes, and urine output of at least 30 ml/hr. The client also
has a nursing diagnosis of diarrhea, with expected outcomes of passage of formed stools at regular intervals and a decrease
in stool frequency and liquidity.

7. The mechanism of action of diphenoxylate (Lotomil) is:

A. An increase in intestinal excretion of water
B. An increase in intestinal motility
C. A decrease in peristalsis in the intestinal wall
D. A decrease in the reabsorption of water in the bowel
ANSWER: C, An decrease in peristalsis in the intestinal wall
RATIO: It helps to decrease the number and frequency of bowel movements. It works by slowing the movement of the
intestines. Diphenoxylate is similar to opioid pain relievers, but it acts mainly to slow the gut.

8. Which of the following statements best describes fecal incontinence?

A. It is a common disorder that affects the large intestine characterized by cramping, abdominal pain, bloating, gas, and
diarrhea or constipation, or both.

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 B. It is the involuntary passage of stool from the rectum.
C. It is an infrequent bowel movements or difficult passage of stools that persists for several weeks or longer.
D. It is condition with loose and watery stools during a bowel movement.
ANSWER: B, It is the involuntary passage of stool from the rectum.
RATIO: Fecal incontinence describes the involuntary passage of stool from the rectum. Factors that influence fecal
continence include the ability of the rectum to sense and accommodate stool, the amount and consistency of stool,
the integrity of the anal sphincters and musculature, and rectal motility.

9. Which of the following drugs may be administered to patient with diarrhea?

A. Loperamide (Imodium)
B. Bisacodyl (Dulcolax)
C. Senna Concentrate (Senokot)
D. Docusate (Colace)
ANSWER: A, Loperamide (Imodium)
RATIO: Imodium (loperamide hydrochloride) is an antidiarrheal used to treat diarrhea.

10. Which of the following measures helps control fecal incontinence?

A. Increase fiber in the diet during episodes of diarrhea.
B. Initiate a bowel-training program.
C. Encourage use of laxatives 3 times a day.
D. Use incontinence brief/adult diaper.
ANSWER: Initiate a bowel-training program.
RATIO: This will help you to control fecal incontinence

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