MSN Exam for Hemorrhoids

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1) The nurse is interviewing a male client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?

  1. Duodenal ulcers
  2. Hemorrhoids
  3. Weight gain
  4. Polyps

2) Client education should include minimizing client discomfort due to hemorrhoids. Nursing management should include:

  1. Suggest to eat low roughage diet
  2. Advise to wear silk undergarments
  3. Avoid straining during defecation
  4. Use of sitz bath for 30 minutes

3) Which of the following factors would most likely be a primary cause of her hemorrhoids?

  1. Her age
  2. Three vaginal delivery pregnancies
  3. Her job as a school teacher
  4. Varicosities in the legs

4) Which position would be ideal for the client in the early postoperative period after hemorrhoidectomy?

  1. High Fowler’s
  2. Supine
  3. Side – lying
  4. Trendelenburg’s

5) The doctor orders for Witch Hazel 5 %. Nurse Nico knows that the action of this astringent is:

  1. temporarily relieves pain, burning, and itching by numbing the nerve endings
  2. causes coagulation (clumping) of proteins in the cells of the perianal skin or the lining of the anal canal
  3. inhibits the growth of bacteria and other organisms
  4. causes the outer layers of skin or other tissues to disintegrate

6) Nurse Nico instructs her client who has had a hemorrhoidectomy not to used sitz bath until at least 12 hours postoperatively to avoid which of the following complications?

  1. Hemorrhage
  2. Rectal Spasm
  3. Urinary retention
  4. Constipation
Answers and Rationales
  1. D. Polyps . Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren’t preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.
  2. C. Avoid straining during defecation. Straining can increase intra abdominal pressure. Health teachings also include: suggest to eat high roughage diet, wearing of cotton undergarments and use of sitz bath for 15 minutes.
  3. B. Three vaginal delivery pregnancies. Hemorrhoids are associated with prolonged sitting, or standing, portal hypertension, chronic constipation and prolonged intra abdominal pressure as associated with pregnancy and the strain of vaginal delivery. Her job as a schoolteacher does not require prolong sitting or standing. Age and leg varicosities are not related to the development of hemorrhoids.
  4. C. Side – lying . Positioning in the early postoperative phase should avoid stress and pressure on the operative site. The prone and side – lying are ideal from a comfort perspective. A high Fowler’s or supine position will place pressure on the operative site and is not recommended. There is no need for trendelenburg’s position.
  5. B. causes coagulation (clumping) of proteins in the cells of the perianal skin or the lining of the anal canal . Option a are local anesthetics; c are antiseptics and d are keratolytics.
  6. A. Hemorrhage. Applying heat during the immediate postoperative period may cause hemorrhage at the surgical site. Moist heat may relieve rectal spasms after bowel movements. Urinary retention caused by reflex spasm may also be relieved by moist heat. Increasing fiber and fluid in the diet can help constipation.

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