Nokea
An adult patient has been diagnosed with diverticular disease after ongoing challenges with constipation. The patient will be treated on an outpatient basis. What components of treatment should the nurse anticipate?
- A. Anticholinergic medications
- B. Increased fiber intake
- C. Enemas on alternating days
- D. Reduced fat intake
- E. Fluid reduction
Correct Answer: B,D
Rationale: Patients whose diverticular disease does not warrant hospital treatment often benefit from a high-fiber, low-fat diet. Neither enemas nor anticholinergics are indicated, and fluid intake is encouraged.
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A nurse is providing care for a patient who has a diagnosis of irritable bowel syndrome (IBS). When planning this patients care, the nurse should collaborate with the patient and prioritize what goal?
- A. Patient will accurately identify foods that trigger symptoms.
- B. Patient will demonstrate appropriate care of his ileostomy.
- C. Patient will demonstrate appropriate use of standard infection control precautions.
- D. Patient will adhere to recommended guidelines for mobility and activity.
Correct Answer: A
Rationale: A major focus of nursing care for the patient with IBS is to identify factors that exacerbate symptoms. Surgery is not used to treat this health problem and infection control is not a concern that is specific to this diagnosis. Establishing causation likely is more important to the patient than managing physical activity.
A nurse is assessing a patients stoma on postoperative day 3. The nurse notes that the stoma has a shiny appearance and a bright red color. How should the nurse best respond to this assessment finding?
- A. Irrigate the ostomy to clear a possible obstruction.
- B. Contact the primary care provider to report this finding.
- C. Document that the stoma appears healthy and well perfused.
- D. Document a nursing diagnosis of Impaired Skin Integrity.
Correct Answer: C
Rationale: A healthy, viable stoma should be shiny and pink to bright red. This finding does not indicate that the stoma is blocked or that skin integrity is compromised.
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.
A 35-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. In collaboration with the primary care provider, what intervention should the nurse prioritize?
- A. Insertion of a nasogastric tube
- B. Insertion of a central venous catheter
- C. Administration of a mineral oil enema
- D. Administration of a glycerin suppository and an oral laxative
Correct Answer: A
Rationale: Decompression of the bowel through a nasogastric tube is necessary for all patients with small bowel obstruction. Peripheral IV access is normally sufficient. Enemas, suppositories, and laxatives are not indicated if an obstruction is present.
A nurse is providing care for a patient whose recent colostomy has contributed to a nursing diagnosis of Disturbed Body Image Related to Colostomy. What intervention best addresses this diagnosis?
- A. Encourage the patient to conduct online research into colostomies.
- B. Engage the patient in the care of the ostomy to the extent that the patient is willing.
- C. Emphasize the fact that the colostomy was needed to alleviate a much more serious health problem.
- D. Emphasize the fact that the colostomy is temporary measure and is not permanent.
Correct Answer: B
Rationale: For some patients, becoming involved in the care of the ostomy helps to normalize it and enhance familiarity. Emphasizing the benefits of the intervention is unlikely to improve the patients body image, since the benefits are likely already known. Online research is not likely to enhance the patients body image and some ostomies are permanent.