A nurse in a PACU is assessing a client who has a newly created colostomy. Which of the following findings should the nurse report to the provider?
Shiny, moist stoma
Rosebud-like stoma orifice
Purplish-colored stoma
Stoma oozing red drainage
The Correct Answer is C
Choice A reason:
A shiny, moist stoma is generally a healthy sign, indicating good blood supply and adequate hydration of the stoma tissue. It is not a cause for concern.
Choice B reason:
A rosebud-like stoma orifice is a normal appearance for some types of stomas. It indicates a healthy stoma with good blood supply. This finding is expected and does not warrant concern.
Choice C reason:
A purplish-colored stoma may indicate compromised blood supply to the stoma, which is a serious concern and should be reported to the provider promptly. It may suggest inadequate blood flow to the stoma, which could lead to tissue necrosis.
Choice D reason:
Stoma oozing red drainage may be normal immediately postoperatively. It can be due to some oozing from the surgical site, and if it's minimal and stops after a short while, it's generally not a cause for concern.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason:
Removing the NG tube without further attempts to unclog it may not be necessary and could be an unnecessary intervention.
Choice B reason:
This statement is correct. Attempting to unclog the NG tube with warm water and an in-and-out motion is an appropriate next step.
Choice C reason:
Flicking the tube with the fingers may not be effective in dislodging the clog, and it could potentially cause harm to the patient.
Choice D reason:
Withdrawing the tube 3 to 5 cm may not effectively address the clog and could potentially lead to complications.
Correct Answer is B
Explanation
Choice A reason:
Both ulcerative colitis and Crohn's disease can require surgery in some cases, but it is not a common link that defines both conditions.
Choice B reason:
This is the correct answer. Both ulcerative colitis and Crohn's disease are types of inflammatory bowel disease (IBD). They share the common feature of chronic inflammation of the digestive tract.
Choice C reason:
Fistula formation is more commonly associated with Crohn's disease than ulcerative colitis. It is not a defining characteristic of both conditions.
Choice D reason:
Ulcerative colitis primarily affects the colon and rectum, but Crohn's disease can affect any part of the digestive tract from the mouth to the anus. Therefore, both conditions do not necessarily begin in the rectum.
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