Nokea
A client who is scheduled for an ileostomy surgery says to the nurse, 'I'm afraid I won't be able to look at that stoma.' Which response by the nurse would be most therapeutic?
- A. That's something you don't have to think about now.'
- B. I'll make sure there is a familiar nurse here with you the first time.'
- C. It's okay, everybody feels this anxious about this.'
- D. Don't worry, I'm sure that you will be able to do this just fine.'
Correct Answer: B
Rationale: Telling the client that a familiar nurse will be with him the first time provides the client with reassurance that he will not be alone and will have the support of a familiar person to answer questions and provide comfort and support. Telling the client not to worry about it now, that everybody feels anxious, and that he'll do just fine discounts the client's feelings and is not therapeutic.
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The nurse is preparing to irrigate a client's single-barrel colostomy after surgery. The nurse would expect an order from the healthcare provider to irrigate the colostomy on what day after surgery?
- A. Fourth or fifth postoperative day
- B. The day after surgery
- C. The seventh postoperative day
- D. The colostomy should be irrigated immediately postop
Correct Answer: A
Rationale: Colostomy irrigation begins on the fourth or fifth postoperative day. Standard irrigation is a scheduled irrigation, using 500 to 1500 mL of tepid water.
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.
The nurse is discussing care of the client's ileostomy and is instructing the client to avoid certain medications that move through without being absorbed. What medications should the client avoid? Select all that apply.
- A. Enteric-coated products
- B. Liquid medication
- C. Slow-release beads
- D. Layered tablets
- E. Chewable tablets
Correct Answer: A,C,D
Rationale: Clients with an ileostomy should avoid enteric-coated products and some modified-release drugs, such as slow-release beads and layered tablets. These products may pass through without being absorbed. The client may take liquid and chewable tablets because they will go through the breakdown process in the stomach.
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.
A male client will be having an ileoanal anastomosis for the treatment of chronic ulcerative colitis. What is the benefit to this client of having this procedure rather than a total colectomy? Select all that apply.
- A. Maintains bowel continence
- B. Unlikely to experience bladder dysfunction
- C. Unlikely to experience erectile dysfunction
- D. Unlikely to experience infertility
- E. Able to have the procedure as an outpatient
Correct Answer: A,B,C,D
Rationale: The ileoanal reservoir, also called an ileoanal anastomosis, is a procedure that maintains bowel continence. It is performed on selected clients who have chronic ulcerative colitis or whose disease does not affect the anorectal sphincter. Besides allowing the client to control bowel elimination, this procedure, as opposed to a conventional ileostomy with total colectomy, preserves innervation to the male genitalia. Subsequently, the male client is unlikely to experience bladder dysfunction, erectile dysfunction, or infertility. The client will not be able to have this surgery done on an outpatient basis, they require postoperative care for a longer duration.