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“I need to drink one and a half to two quarts of liquid each day.” Adequate hydration, roughly 1,500–2,000 Ml, is essential for keeping stool soft. Since the client understands this, no further teaching is required.

“If my bowel pattern changes on its own, I should call you.” A sudden, unexplained change in bowel habits-especially in older adults-can be a warning sign of underlying issues like colorectal cancer or bowel obstructions. The client demonstrates good judgment here.

“Eating my meals at regular times is likely to result in regular bowel movements.” The gastrocolic reflex is stimulated by eating. Consistent meal times help establish a predictable rhythm for the bowels, encouraging regularity.

The stoma extends 1/2 in. above the abdomen: This is a normal, healthy finding. A “budded” stoma ensures that effluent (waste) empties directly into the pouch rather than sitting on the skin.

The skin looks red briefly after removing the appliance: This is normal reactive hyperemia. Just like taking off a band-aid, the skin may be pink for a few minutes. As long as the skin isn't broken or persistently painful, it is not an emergency.

The ascending colostomy delivers liquid feces: This is physiologically normal. In the ascending colon, the stool hasn't reached the parts of the bowel that reabsorb water, so the output is expected to be liquid.

The client will wear a medical alert bracelet: Diarrhea is a common side effect of antibiotics due to the disruption of normal intestinal flora, not necessarily an allergic reaction. Unless the client shows signs of an allergy, a medical alert bracelet is inappropriate and unnecessary.

The client will verbalize the need to take an antidiarrheal medication prn: Antidiarrheal medications are often contraindicated in antibiotic-associated diarrhea (such as C. diff), as they can slow down the clearance of toxins from the gut.

The client will increase intake of insoluble fiber: Insoluble fiber like bran or raw veggies acts as a laxative and speeds up GI transit time, which would likely worsen diarrhea. While soluble fiber like rice or bananas can help bulk up stool, increasing insoluble fiber is the wrong dietary intervention for this client.

Ileostomy (Site 1): This site is located at the end of the small intestine (ileum). It typically produces constant, liquid, and highly acidic drainage.

Ascending Colostomy (Site 2): Located in the ascending colon on the right side of the abdomen. The output here is liquid to semi-liquid because water has not yet been reabsorbed.

Transverse Colostomy (Site 3): Located in the transverse colon across the upper abdomen. This usually results in malodorous, mushy, or semi-formed stool.

Descending Colostomy (Site 4): Located in the descending colon on the left side of the abdomen. The stool is becoming more solid as it moves toward the rectum.

Cheese: This food is generally known to have a constipating effect. Dairy products like cheese can slow down intestinal motility in many individuals.

Eggs: Like cheese, eggs are low-fiber, high-protein foods that are more likely to cause constipation or have a neutralizing effect on bowel patterns rather than a laxative one.

Pasta: Refined carbohydrates such as white pasta are low in fiber and are traditionally associated with constipation or binding the stool, making them inappropriate for a client trying to avoid laxative effects.

Administering a large volume of solution (500–1,000 mL): These are small-volume enemas (usually 90–120 mL). Large volumes (500–1,000 mL) are used for cleansing enemas to distend the bowel.

Mixing milk and molasses in equal parts: A milk and molasses enema is a specific type of carminative enema used to help expel gas. Oil-retention enemas use mineral or vegetable oil.

Administering the enema while the client is sitting on the toilet: Enemas should be administered in the left Sims' position (lying on the left side with the right knee flexed). Sitting on a toilet makes it difficult for the fluid to flow into the sigmoid colon and increases the risk of immediate expulsion before the oil can work.

Emollient: Also known as stool softeners like docusate sodium, these work by lowering the surface tension of the stool, allowing water and fats to penetrate the fecal mass. They make the stool slippery rather than making it swell.

Lubricant: Lubricant laxatives like mineral oil coat the surface of the stool and the intestinal tract. This prevents water from being absorbed out of the stool and allows the mass to slide through the colon more easily.

Stimulant: Stimulant laxatives like senna or bisacodyl work by chemically irritating the intestinal mucosa or stimulating the nerve endings in the gut wall to force contractions. They do not work by changing the volume of the stool through water absorption.

Visual examination of the esophagus and stomach: This describes an Esophagogastroduodenoscopy (EGD) or Upper Endoscopy. While it uses a similar camera tool, it focuses on the upper GI tract, not the colon.

Radiographic examination of the large intestine: This describes a barium enema. This is an X-ray (radiographic) procedure where contrast dye is inserted into the rectum to visualize the colon on a screen; it does not involve a camera for a direct visual view.

Fluoroscopic examination of the small intestine: This describes a small bowel follow-through. It involves swallowing contrast and using real-time X-rays (fluoroscopy) to watch the material move through the small intestine.

Using a diet that is low in bulk: A successful bowel training program requires a high-fiber (high-bulk) diet. Fiber adds weight and volume to the stool, which stretches the colon wall and stimulates the necessary peristalsis for a bowel movement.

Decreasing fluid intake to 1,000 mL: Adequate hydration is essential for bowel training; typically, 2,000–3,000 mL of fluid per day is recommended. Low fluid intake leads to hard, dry stools that are difficult to pass, defeating the purpose of the program.

Administering an enema once a day: While a suppository may be used to initiate a schedule, daily enemas are avoided in training programs because they can lead to dependency and can cause fluid and electrolyte imbalances.

Barium can cause lower gastrointestinal bleeding: This is incorrect. Barium is an inert substance and does not cause bleeding. Its primary risk is impaction/constipation if it is not flushed out of the system with fluids.

The physician’s orders are in that sequence: While orders are followed, this does not explain the rationale behind the sequencing. Nursing exams require you to understand the underlying physiological or diagnostic reason.

Barium is absorbed readily in the lower intestine: Barium is not absorbed by the body; it is meant to stay in the lumen of the gut to coat the walls for X-ray visualization and is eventually excreted in the stool.

They will cause a fecal impaction: While untreated constipation can lead to impaction, laxatives are designed to prevent it. However, the overuse of laxatives makes the bowel less likely to function on its own, which may eventually lead to an impaction if the laxative is suddenly stopped.

They change the pH of the gastrointestinal tract: While some osmotic laxatives may slightly alter the local environment, the primary reason nurses discourage habitual use is the physiological loss of bowel function and muscle tone, not pH shifts.

They inhibit the intestinal enzymes: Laxatives generally work through irritation, osmosis, or lubrication; they do not typically interfere with the digestive enzymes responsible for breaking down food in the small intestine.

Bowel mucosa irritation: While some enemas like soapsuds work through irritation to stimulate peristalsis, hypertonic enemas like Fleet enemas work primarily through fluid shift.

Diffusion of water out of colon: Diffusion out of the colon would dehydrate the stool and make it harder to pass. Hypertonic solutions pull water into the space they occupy.

Softening of fecal contents: This is a secondary effect. While the influx of water does soften the stool, the primary action that characterizes a hypertonic enema is the osmotic fluid shift.

Constipation: This is almost never a diagnosis for an ileostomy. Because an ileostomy bypasses the entire large intestine where water is absorbed, the output is constant and liquid. Constipation is a concern for colostomies, not ileostomies.

Delayed Growth and Development: Unless the client is a child or adolescent whose physical or social milestones are being missed due to chronic illness, this is not a common or standard diagnosis for an adult with an ileostomy.

Excess Fluid Volume: The opposite is actually true. Because the colon is bypassed, the client loses large amounts of fluid and electrolytes in their liquid stool. They are at high risk for Deficient Fluid Volume, not excess.

Encouraging the client to avoid moving his bowels until a certain time: Clients should be encouraged to heed the defecation reflex as soon as it occurs. Ignoring the urge leads to water reabsorption and constipation.

Encouraging the client to avoid excess fluid intake and fiber: To promote regularity, a nurse should encourage the opposite: an increase in fiber to add bulk and an increase in fluids (2,000–3,000 mL) to keep the stool soft.

Avoiding strenuous exercise: Physical activity and exercise like walking actually promote peristalsis and help move waste through the colon. Sedentary behavior is a leading cause of constipation.