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A patients colorectal cancer has necessitated a hemicolectomy with the creation of a colostomy. In the 4 days since the surgery, the patient has been unwilling to look at the ostomy or participate in any aspects of ostomy care. What is the nurses most appropriate response to this observation?
- A. Ensure that the patient knows that he or she will be responsible for care after discharge.
- B. Reassure the patient that many people are fearful after the creation of an ostomy.
- C. Acknowledge the patients reluctance and initiate discussion of the factors underlying it.
- D. Arrange for the patient to be seen by a social worker or spiritual advisor.
Correct Answer: C
Rationale: If the patient is reluctant to participate in ostomy care, the nurse should attempt to dialogue about this with the patient and explore the factors that underlie it. It is presumptive to assume that the patients behavior is motivated by fear. Assessment must precede referrals and emphasizing the patients responsibilities may or may not motivate the patient.
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A nurse is caring for an older adult who has been experiencing severe Clostridium difficile-related diarrhea. When reviewing the patients most recent laboratory tests, the nurse should prioritize which of the following?
- A. White blood cell level
- B. Creatinine level
- C. Hemoglobin level
- D. Potassium level
Correct Answer: D
Rationale: In elderly patients, it is important to monitor the patients serum electrolyte levels closely. Diarrhea is less likely to cause an alteration in white blood cell, creatinine, and hemoglobin levels.
An older adult has a diagnosis of Alzheimers disease and has recently been experiencing fecal incontinence. However, the nurse has observed no recent change in the character of the patients stools. What is the nurses most appropriate intervention?
- A. Keep a food diary to determine the foods that exacerbate the patients symptoms.
- B. Provide the patient with a bland, low-residue diet.
- C. Toilet the patient on a frequent, scheduled basis.
- D. Liaise with the primary care provider to obtain an order for loperamide.
Correct Answer: C
Rationale: Because the patients fecal incontinence is most likely attributable to cognitive decline, frequent toileting is an appropriate intervention. Loperamide is unnecessary in the absence of diarrhea. Specific foods are not likely to be a cause of, or solution to, this patients health problem.
A nurse is presenting an educational event to a local community group. When speaking about colorectal cancer, what risk factor should the nurse cite?
- A. High levels of alcohol consumption
- B. History of bowel obstruction
- C. History of diverticulitis
- D. Longstanding psychosocial stress
Correct Answer: A
Rationale: Risk factors include high alcohol intake; cigarette smoking; and high-fat, high-protein, low-fiber diet. Diverticulitis, obstruction, and stress are not noted as risk factors for colorectal cancer.
The nurse is providing care for a patient whose inflammatory bowel disease has necessitated hospital treatment. Which of the following would most likely be included in the patients medication regimen?
- A. Anticholinergic medications 30 minutes before a meal
- B. Antiemetics on a PRN basis
- C. Vitamin B12 injections to prevent pernicious anemia
- D. Beta adrenergic blockers to reduce bowel motility
Correct Answer: A
Rationale: The nurse administers anticholinergic medications 30 minutes before a meal as prescribed to decrease intestinal motility and administers analgesics as prescribed for pain. Antiemetics, vitamin B12 injections, and beta blockers do not address the signs, symptoms, or etiology of inflammatory bowel disease.
Which of the following is the most plausible nursing diagnosis for a patient whose treatment for colon cancer has necessitated a colonostomy?
- A. Risk for Unstable Blood Glucose Due to Changes in Digestion and Absorption
- B. Unilateral Neglect Related to Decreased Physical Mobility
- C. Risk for Excess Fluid Volume Related to Dietary Changes and Changes In Absorption
- D. Ineffective Sexuality Patterns Related to Changes in Self-Concept
Correct Answer: D
Rationale: The presence of an ostomy frequently has an effect on sexuality; this should be addressed thoughtfully in nursing care. None of the other listed diagnoses reflects the physiologic changes that result from colorectal surgery.