CNA Bowel and Ostomy Care 3 — Questions and Answers
Question 1: A resident complains of abdominal cramping, bloating, and has not had a bowel movement in four days. The CNA should FIRST:
- Report the findings to the nurse (Correct answer)
- Administer an enema per standing order
- Encourage the resident to drink more water and wait
- Massage the abdomen vigorously
Correct answer: Report the findings to the nurse
Signs of constipation lasting four days with discomfort must be reported to the nurse so appropriate interventions can be ordered.
Question 2: Which dietary choice BEST supports regular bowel movements in a resident?
- High-fiber foods such as fruits, vegetables, and whole grains (Correct answer)
- White bread, cheese, and low fluid intake
- High protein shakes with minimal carbohydrates
- Soft diet limited to pudding and crackers
Correct answer: High-fiber foods such as fruits, vegetables, and whole grains
High-fiber foods add bulk to stool and promote regular peristalsis, preventing constipation.
Question 3: A resident receiving a cleansing enema reports sudden severe abdominal pain during the procedure. The CNA should:
- Stop the enema and notify the nurse immediately (Correct answer)
- Slow the flow rate and continue
- Ask the resident to take deep breaths and continue
- Remove the tubing and have the resident sit on the toilet
Correct answer: Stop the enema and notify the nurse immediately
Sudden severe pain during an enema may indicate bowel perforation or extreme cramping and requires immediate cessation and nurse notification.
Question 4: When performing digital rectal stimulation is ordered for a spinal cord-injured resident, the CNA should be most alert for:
- Signs of autonomic dysreflexia such as sudden high blood pressure and pounding headache (Correct answer)
- Mild rectal bleeding which is always expected
- The resident becoming sleepy during the procedure
- Loose stool output indicating the procedure is complete
Correct answer: Signs of autonomic dysreflexia such as sudden high blood pressure and pounding headache
Autonomic dysreflexia is a life-threatening reflex in spinal cord injury patients that can be triggered by bowel care and requires immediate intervention.
Question 5: The correct solution temperature for a cleansing enema is:
- 105°F (40.5°C) — warm but not hot (Correct answer)
- 98.6°F (37°C) — body temperature
- 120°F (49°C) — to stimulate peristalsis
- Room temperature, approximately 72°F (22°C)
Correct answer: 105°F (40.5°C) — warm but not hot
Enema solution at 105°F is warm enough to stimulate peristalsis without risking mucosal burns.
Question 6: After administering an enema, the resident should be instructed to retain the solution for:
- 5 to 10 minutes or as directed (Correct answer)
- Only 30 seconds then immediately expel
- At least 30 minutes for best effect
- Until the entire enema bag is returned
Correct answer: 5 to 10 minutes or as directed
Retaining enema solution for 5–10 minutes allows adequate time for softening and stimulating stool evacuation.
Question 7: A resident has fecal impaction. Which sign would the CNA MOST likely observe?
- Liquid stool leaking around a firm rectal mass (Correct answer)
- No stool output for one day only
- Bright red blood in the toilet
- Hard pellet stools passed with straining
Correct answer: Liquid stool leaking around a firm rectal mass
Liquid stool leaking around a hard impacted mass (paradoxical diarrhea) is the hallmark sign of fecal impaction.
CNA Bowel and Ostomy Care 3
A resident complains of abdominal cramping, bloating, and has not had a bowel movement in four days.
The CNA should FIRST: