Nokea
A client is to have a total colectomy and has been on prednisone for 6 months for the treatment of Crohn disease. What medication does the nurse anticipate administering in the preoperative phase to prevent adrenal crisis?
- A. Intravenous hydrocortisone
- B. Intravenous antibiotics
- C. Blood transfusion
- D. A low-molecular-weight heparin
Correct Answer: A
Rationale: A preoperative 'stress' IV steroid (e.g., hydrocortisone) is given to clients who have been on prednisone within the previous 6 months to prevent adrenal crisis. Antibiotics, blood transfusions, and low-molecular-weight heparin are not typically used to prevent adrenal crisis in this context.
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The nurse is preparing a client for surgery and observes on the operative permit that the client will be having a double-barrel colostomy. The nurse explains to the client's spouse that this is performed on what portion of the large intestine?
- A. Descending
- B. Ascending
- C. Transverse
- D. Sigmoid
Correct Answer: C
Rationale: A double-barrel colostomy, which is performed most often in the transverse section of the large intestine, contains both a proximal and distal stoma.
A nurse is preparing to administer the prescribed vitamin B12 to a client who has had most of his ileum removed. The nurse understands that this is necessary for which reason?
- A. Prevents thrombosis
- B. Prevents deficiencies
- C. Aids proper digestion
- D. Prevents constipation
Correct Answer: B
Rationale: Parenteral injections or intranasal administrations of vitamin B12 are used to prevent deficiencies in clients who have had most or all of the ileum removed because this area is responsible for B12 absorption. Vitamin B12 does not prevent thrombosis or constipation or aid digestion.
A client has had surgery to create an ileoanal reservoir. Which instruction would the nurse give to reduce the risk for bowel incontinence?
- A. Avoid high-protein food.
- B. Take frequent brisk walks.
- C. Perform perineal exercises.
- D. Perform warm water soaks.
Correct Answer: C
Rationale: To reduce the risk for bowel incontinence, the nurse should instruct a client who has undergone ileoanal reservoir surgery to perform perineal exercises. The client need not avoid high-protein food, take walks, or perform warm water soaks because these do not minimize the risk of bowel incontinence.
The nurse is providing ostomy care to the client with an ileostomy. What can the nurse use to promote adhesion of the ostomy appliance?
- A. Adhesive glue
- B. Tincture of Benzoin
- C. Vaseline
- D. Karaya paste
Correct Answer: D
Rationale: Karaya paste, which becomes gelatinous when in contact with moisture, is commonly used in place of an adhesive. Karaya paste promotes adhesion of the ostomy appliance.
The nurse is caring for a client about to have the first stage of an ileoanal anastomosis. What should the nurse inform the client they will experience?
- A. Solid stool from the anus
- B. Very little discharge from the anus
- C. Control of the fecal material from the anus
- D. Continuous discharge of mucus from the anus
Correct Answer: D
Rationale: After the first stage of surgery, clients experience an almost continuous discharge of mucus from the anus and a frequent discharge of fecal material from the ileostomy. Initially, clients cannot control the frequent watery discharge.