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A nurse is talking with a patient who is scheduled to have a hemicolectomy with the creation of a colostomy. The patient admits to being anxious and has many questions concerning the surgery, the care of a stoma, and necessary lifestyle changes. Which of the following nursing actions is most appropriate?
- A. Reassure the patient that the procedure is relatively low risk and that patients are usually successful in adjusting to an ostomy.
- B. Provide the patient with educational materials that match the patients learning style.
- C. Encourage the patient to write down these concerns and questions to bring forward to the surgeon.
- D. Maintain an open dialogue with the patient and facilitate a referral to the wound-ostomy-continence (WOC) nurse.
Correct Answer: D
Rationale: A wound-ostomy-continence (WOC) nurse is a registered nurse who has received advanced education in an accredited program to care for patients with stomas. The enterostomal nurse therapist can assist with the selection of an appropriate stoma site, teach about stoma care, and provide emotional support. The surgeon is less likely to address the patients psychosocial and learning needs. Reassurance does not address the patients questions, and education may or may not alleviate anxiety.
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A patient has been diagnosed with a small bowel obstruction and has been admitted to the medical unit. The nurses care should prioritize which of the following outcomes?
- A. Preventing infection
- B. Maintaining skin and tissue integrity
- C. Preventing nausea and vomiting
- D. Maintaining fluid and electrolyte balance
Correct Answer: D
Rationale: All of the listed focuses of care are important for the patient with a small bowel obstruction. However, the patients risk of fluid and electrolyte imbalances is an immediate threat to safety, and is a priority in nursing assessment and interventions.
A patient has been experiencing disconcerting GI symptoms that have been worsening in severity. Following medical assessment, the patient has been diagnosed with lactose intolerance. The nurse should recognize an increased need for what form of health promotion?
- A. Annual screening colonoscopies
- B. Adherence to recommended immunization schedules
- C. Regular blood pressure monitoring
- D. Frequent screening for osteoporosis
Correct Answer: D
Rationale: Persons with lactose intolerance often experience hypocalcemia and a consequent risk of osteoporosis related to malabsorption of calcium. Lactose intolerance does not create an increased need for screening for colorectal cancer, immunizations, or blood pressure monitoring.
A patient admitted with inflammatory bowel disease asks the nurse for help with menu selections. What menu selection is most likely the best choice for this patient?
- A. Spinach
- B. Tofu
- C. Multigrain bagel
- D. Blueberries
Correct Answer: B
Rationale: Nutritional management of inflammatory bowel disease requires ingestion of a diet that is bland, low-residue, high-protein, and high-vitamin. Tofu meets each of these criteria. Spinach, multigrain bagels, and blueberries are not low-residue.
A patients screening colonoscopy revealed the presence of numerous polyps in the large bowel. What principle should guide the subsequent treatment of this patients health problem?
- A. Adherence to a high-fiber diet will help the polyps resolve.
- B. The patient should be assured that these are a normal, age-related physiologic change.
- C. The patients polyps constitute a risk factor for cancer.
- D. The presence of polyps is associated with an increased risk of bowel obstruction.
Correct Answer: C
Rationale: Although most polyps do not develop into invasive neoplasms, they must be identified and followed closely. They are very common, but are not classified as a normal, age-related physiologic change. Diet will not help them resolve and they do not typically lead to obstructions.
An older adult who resides in an assisted living facility has sought care from the nurse because of recurrent episodes of constipation. Which of the following actions should the nurse first perform?
- A. Encourage the patient to take stool softener daily.
- B. Assess the patients food and fluid intake.
- C. Assess the patients surgical history.
- D. Encourage the patient to take fiber supplements.
Correct Answer: B
Rationale: The nurse should follow the nursing process and perform an assessment prior to interventions. The patients food and fluid intake is more likely to affect bowel function than surgery.