Nokea
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.
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The nurse is caring for a client who has undergone colostomy. Which of the following instructions should the nurse include in the teaching plan?
- A. Restrict traveling by air.
- B. Limit outdoor activities.
- C. Avoid light clothing.
- D. Chew food well.
Correct Answer: D
Rationale: The nurse should instruct a client who has undergone colostomy to chew food properly. This helps decrease gas that results chiefly from swallowing air rather than from digestion. The client need not limit or avoid travel or outdoor activities. If traveling by air, the nurse should instruct the client to take ostomy supplies in carry-on luggage to prevent their loss if luggage is misdirected or lost. If the client requires firm, light support, he or she should find a stoma shield to help prevent irritation or undue pressure on the stoma.
A client will be having a total colectomy in 4 days. The client does not have an obstruction. What does the nurse anticipate instructing the client about doing prior to the surgery to prepare the bowel?
- A. Instructing the client about dietary restrictions and lavage agents
- B. Making sure the client drinks 2 L of fluids prior to the procedure
- C. Instructing the client to have no food except clear liquids for 4 days
- D. There will be no special preparation, and the client may eat until midnight the night prior to surgery.
Correct Answer: A
Rationale: Cleansing of the bowel before surgery is carried out using dietary restriction in combination with laxative or lavage agents, depending on the client's condition (i.e., presence or absence of obstruction) and according to the surgeon's preference. There are no benefits to the client drinking 2 L of fluids prior to the procedure or taking in only clear liquids for 4 days.
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.
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.
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.