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A male client, age 32 years, was recently married, and he and his wife would like to have children. The client is scheduled to have a total colectomy and is concerned with being able to have children. What is the best answer given by the nurse related to the client's concern?
- A. There is no risk of you not being able to father children after this surgery.'
- B. Certainly understand your concern, but there are other options such as artificial insemination with a donor.'
- C. You may want to consider collection and storing of sperm for later use if you are planning to have children.'
- D. Infertility is a side effect of this surgery and should be considered carefully.'
Correct Answer: C
Rationale: Young male clients may wish to collect and store sperm for later use if they plan to have children. Sexual dysfunction in men after a total colectomy is unusual but sometimes occurs. If such dysfunction persists after a colectomy, operative and nonoperative options are available to facilitate erection.
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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.
What potentially life-threatening complication can the client have if corticosteroids are abruptly withdrawn or the client has significant stress due to the impending surgical procedure?
- A. Cushing's disease
- B. Myxedema coma
- C. Thyroid storm
- D. Adrenal crisis
Correct Answer: D
Rationale: Adrenal crisis is potentially life-threatening and can result from the abrupt withdrawal of corticosteroids or significant stress after the client has been treated with corticosteroids. Cushing's disease is a condition caused by increased levels of cortisol. Myxedema coma is a result of dangerously decreased levels of thyroid hormone. Thyroid storm is a life-threatening condition caused by excessive thyroid hormone.
The nurse is caring for a client in the immediate postoperative phase after having a colostomy created. What type of appliance should the nurse use at this time?
- A. A reusable pouch appliance should be used.
- B. A disposable or temporary appliance should be used.
- C. A dry sterile dressing should be used over the stoma.
- D. A wet to dry dressing should be used over the stoma to keep it moist.
Correct Answer: B
Rationale: A disposable, or temporary, appliance is preferred in the immediate postoperative phase because the size of the stoma changes over time as a result of swelling from the procedure itself. The size of the stoma may change rapidly and differ from one appliance change to the next. After the stoma heals and reaches its final size and shape, a permanent appliance (reusable) may be used. A dry sterile dressing or wet to dry dressing should not be placed over the stoma due to the saturation of stool, which may cause maceration of the skin around the stoma.
A client has been discharged from the acute care facility with an ileostomy. The client comes to the clinic for a follow-up visit and informs the nurse that the wound has been draining and they are having abdominal pain and running a fever. What does the nurse suspect is occurring with the client?
- A. The client is having an allergic reaction to the appliance.
- B. The client has developed anemia from blood loss.
- C. The client has developed a wound infection.
- D. The client is not emptying the pouch correctly.
Correct Answer: C
Rationale: Signs of wound infection are wound drainage, abdominal pain, and elevated temperature. These symptoms do not indicate an allergic reaction, anemia, or not emptying the pouch correctly.
A client scheduled for a total colectomy has been taking the immunosuppressive agent, azathioprine. As part of the nurse's preoperative teaching, when should the client be told to discontinue the medication to prevent negative effects on tissue healing?
- A. 3 days before surgery
- B. 1 week before surgery
- C. 1 month before surgery
- D. 3 months before surgery
Correct Answer: C
Rationale: Immunosuppressive agents such as azathioprine, 6-mercaptopurine, and cyclosporine should be discontinued 3 to 4 weeks before surgery to prevent negative effects on tissue healing. Aspirin-containing compounds are discontinued at least 1 week before surgery to decrease the risk of bleeding.