Patient Care Chapter 18

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1

A tap water enema is also called a:

soapsuds enema

hypertonic enema

hypotonic enema

saline enema

hypotonic enema

2

A patient should increase his or her fluid intake for several days after a barium enema.

false

true

true

3

A hypotonic enema should not be repeated because of the potential for water toxicity.

false

true

true

4

Nasogastric (NG) tubes are inserted with the patient in the _____ position.

Trendelenburg

High Fowler’s

recumbent, prone

Sims’

High Fowler’s

5

In preparation for a barium examination of a colostomy patient, it is important to:

irrigate the stoma the night before and morning of the examination.

tell the patient to not take his or her bismuth antiodor tablets before the examination.

understand the sensitivity of these patients to their condition and lifestyle change.

do all of the above.

do all of the above.

6

Which of the following is a TRUE statement regarding cleansing enemas?

An enema consisting of salt with approximately 500 mL of water is harmful to infants and should never be performed.

A hypertonic or Fleet enema is used for patients unable to handle large fluid enema volumes.

Hypotonic enemas can be performed repeatedly until the stool is clear.

Oil retention enemas are used to “harden” stool material for more complete evacuation.

A hypertonic or Fleet enema is used for patients unable to handle large fluid enema volumes.

7

When a barium examination of an ostomy patient is performed:

glucagon is never given to such patients.

it is important to prevent leakage of the barium around the stoma site.

the patient is imaged in the prone position.

a larger volume of barium is used than in a conventional barium enema.

it is important to prevent leakage of the barium around the stoma site.

8

To confirm the placement of an NG tube in its proper position, a physician may use:

fluoroscopy or radiography for visualization.

a syringe to remove gastric contents as proof.

feedback from the patient by asking if he or she can feel it in the stomach.

both a and b.

both a and b.

9

When performing a barium enema examination:

show the patient the entire volume of enema solution to prepare them for the study.

encourage the patient to use short breaths or gasps and to tighten abdominal movements, similar to a bowel movement.

suspend the enema bag above the table at a height no greater than 30 inches.

continue emptying the barium solution as the patient cramps to encourage peristalsis.

suspend the enema bag above the table at a height no greater than 30 inches.

10

A cleansing enema is used to promote:

urination

digestion

defecation

none of the above

defecation

11

For insertion of the NG tube, the patient is placed in the Trendelenburg position.

false

true

false

12

A hypertonic enema may be prescribed to prepare the colon for a barium enema.

true

false

true

13

A double contrast barium enema is indicated for:

polyps

intussusception

volvulus

none of the above

polyps

14

When transporting a patient with a nasogastric (NG) tube to medical imaging:

confirm the allowable time for suction interruption.

confirm the suction pressure before disconnecting the tube.

make sure the NG tube is secured to the patient’s nose.

do all of the above.

do all of the above.

15

Bowel preparation for a barium enema may include each of the following except:

a cleansing enema the morning of the examination

NPO after midnight

clear liquids the day before

breakfast the morning of the examination

breakfast the morning of the examination

16

When working with a nonambulatory male patient who needs to void:

ask the patient how much assistance he feels he needs, and allow him to use a urinal.

dispose of the urine in the toilet and rinse the urinal with cold water.

after the patient has voided, record the volume of urine in the patient’s chart if documentation is required.

remove your disposable gloves, wash your hands, and place the soiled urinal in a receptacle for resterilization.

do all of the above

do all of the above

17

Sterile gloves must be worn while assisting a patient with a bedpan.

true

false

false

18

To facilitate removal of a nasogastric tube, the patient is:

in the Trendelenburg position.

encouraged to take a deep breath.

sedated heavily.

all of the above.

encouraged to take a deep breath.

19

Placement of the NG tube can be verified by:

fluoroscopy

auscultation

aspiration of gastric contents

all of the above

all of the above

20

Postprocedural care for patients who have had a colon examination should include:

an awareness of the change in stool color to an ashen, gray color and the importance of eliminating the barium during defecation.

an increase in fluid intake and dietary fiber for a few days after the examination.

instructions for maintaining hydration.

all of the above.

all of the above.

21

The two contrast media used for a barium enema are:

barium and blood

barium and water

barium and air

barium and saline

barium and air

22

Male urinals and female urinals are identical.

true

false

false

23

The use of a water-soluble contrast agent such as Gastrografin for a colon examination is warranted for patients with:

a possible bowel perforation.

pancreatitis.

diverticulosis.

polyps.

a possible bowel perforation.

24

A bedpan may be used for:

defecation

ovulation

urination

more than one of the above

more than one of the above

25

An NG tube should be lubricated with water-soluble lubricating jelly just before insertion.

true

false

true

26

There is no discomfort associated with a nasogastric tube.

true

false

false

27

Giving cleansing enemas “until clear” involves:

giving two or three enemas until the bowel contents are free of fecal material.

asking the patient to hold the enema contents until the fluoroscopy schedule is open for the examination.

administering enemas until the patient’s state of hydration is at risk.

giving the patient cleansing enemas until his or her sinuses have drained.

giving two or three enemas until the bowel contents are free of fecal material.

28

For a single-contrast barium enema:

a postevacuation film image is unnecessary.

air or carbon dioxide is used as a contrast agent.

approximately 500 mL of barium are used for an adult.

spot images of the cecum, hepatic flexure, splenic flexure, and sigmoid are taken.

spot images of the cecum, hepatic flexure, splenic flexure, and sigmoid are taken.

29

After bedpan use, hygiene of the female patient's perineum is important. Proper cleansing of this region requires using gloves and several folded tissues to wipe the region:

from the mons pubis to the anus.

transversely between gluteal folds.

from the anus to the mons pubis.

in circular motions.

from the mons pubis to the anus.

30

A common misunderstanding of patients regarding barium enemas is that:

they will be asked to drink a chalky “milkshake” for the examination.

the barium enema is all that is needed as a cleansing enema.

the actual barium enema examination is “just another cleansing enema.”

they will be expected to defecate during the examination for filming.

the actual barium enema examination is “just another cleansing enema.”

31

The smooth muscle relaxant given to a patient before a double contrast barium enema is:

barium

Valium

glucagon

aspirin

glucagon

32

The administration of glucagon shortly before a double-contrast barium enema is intended to:

cause the gallbladder to empty.

relieve bowel spasm.

increase peristalsis to improve bowel motility.

increase liver function and the release of glycogen.

relieve bowel spasm.

33

In many instances cleansing enemas are self-administered by the patient before the examination. Instructions for a self-administered enema include:
1. eating fruits and vegetables within 24 hours of the examination.
2. limiting water intake to prevent hydration.
3. using purgation mixtures.
4. eating a low-residue diet.
5. a clear liquid diet including carbonated beverages, clear gelatin, clear broth, and coffee and tea with sugar.
6. administering a cleansing clear water enema.

3, 4, 5, and 6 only

2, 3, 5, and 6 only

1, 2, 4, 5, and 6 only

1, 3, 4, and 6 only

3, 4, 5, and 6 only

34

Which of these is not an example of an NG tube?

Salem-sump

Levin

Foley

Cantor

Foley

35

A barium enema is used to diagnose pathologic conditions of the:

nasopharynx

small intestine

colon

stomach

colon

36

Nondisposable bedpans must be sterilized between uses.

true

false

true

37

As you begin to perform a hip examination on an elderly female patient who has undergone hip surgery, the patient states that she “needs to go to the bathroom.” Which of the following should be done?
1. Use a standard bedpan.
2. Provide for the patient’s privacy and locate a fracture bedpan.
3. Be sure to wear gloves and wash your hands.
4. If the bedpan is metallic, run it under warm water for patient comfort and throw it away after each use.
5. You and an assistant should assist the patient with movement onto the bedpan.
6. Return the patient to the nursing floor for cleanup and patient hygiene.

2, 3, 5, and 6 only

1, 5, and 6 only

1, 3, 4, 5, and 6 only

2, 3, and 5 only

2, 3, and 5 only

38

As you arrive into a patient’s room for transport to radiology, you notice that the patient has an NG tube in place with a syringe upright and pinned to the gown. You should know that this patient:
has a double-lumen NG tube in place.
has a Levine line that is single lumen.
must have the line clamped before transport.
Both a and c are correct.

has a Levine line that is single lumen.

39

The most common type of nasogastric tube used for stomach decompression is the:

single-lumen Levin tube.

central venous pressure line.

peripherally inserted central venous catheter (PICC).

Swan-Ganz catheter.

single-lumen Levin tube.

40

A primary purpose of the NG tube is:

reinflating the lung

removing flatus from the stomach

gastric lavage (washing)

none of the above

removing flatus from the stomach

41

When performing a cleansing enema on an adult patient:

after the bowel is filled with liquid, generally more than 500 mL, the patient should rest quietly to allow the liquids to work.

the patient is placed in the Sims’ position for enema tip insertion.

lukewarm water just above body temperature is used.

all of the above are appropriate.

all of the above are appropriate.

42

A colostomy is an opening made from the bowel to the outside of the body.

true

false

true

43

Urinals are provided to patients who are not ambulatory.

true

false

true

44

All of the following are true of cleansing enemas EXCEPT:

they are complete when bowel contents are clear and free of fecal matter.

there are several types of enemas, each with its own strengths and weaknesses.

they are intended for the administration of enteric medications.

they promote the defecation reflex and discharge.

they are intended for the administration of enteric medications.

45

In order to allow tissue healing from a partial colon resection:

an external stoma is created to allow for defecation.

the patient’s colon will be clamped off distal to the resection site.

the patient is kept bedridden for the entire recovery period.

the patient will be kept on a liquid diet for the entire recovery period.

an external stoma is created to allow for defecation.

46

The most common complication of a barium enema is:

ulceration

venous emboli

damage to the rectal wall from overinflation of the balloon catheter

tearing of the GI mucosa

damage to the rectal wall from overinflation of the balloon catheter

47

A radiographer would not need to wear gloves while assisting a patient with a urinal.

true

false

false

48

Nasogastric (NG) tubes are inserted through the patient’s _____ with the end of the tube placed in the _____.

nasopharynx; stomach

oropharynx; stomach

mouth; ileum

mouth; duodenum

nasopharynx; stomach

49

A nasogastric (NG) tube is placed through the nasopharynx into the:

stomach

lungs

small intestine

large intestine

stomach

50

All colostomies are permanent.

false

true

false