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 ["A","B"]
Explanation
Choice A reason:
Anticholinergic medications: These are not a component of treatment for diverticular disease. Anticholinergic medications can reduce intestinal motility and cause dry mouth, constipation, and urinary retention, which can aggravate the diverticula and increase the risk of complications. The patient should avoid these medications unless prescribed by a doctor for another condition.
Choice B reason:
Increasing fiber intake is a common component of treatment for diverticular disease as it can help prevent constipation and reduce the risk of diverticulitis.
Choice C reason:
Reducing fat intake is also important in the treatment of diverticular disease, as a low-fat diet can help prevent further irritation of the colon.
Choice D reason:
This is not a component of treatment for diverticular disease. On the contrary, adequate fluid intake is essential to prevent dehydration and constipation, which can worsen the condition. The patient should drink at least eight glasses of water per day or more if they have a high-fiber diet.
Choice E reason:
These are not a component of treatment for diverticular disease. Enemas can irritate the colon and increase the pressure in the diverticula, which can lead to perforation or bleeding. The patient should avoid enemas unless instructed by a doctor for a specific reason.
Correct Answer is ["3.6"]
Explanation
- To calculate the dose of Ceclor in mg, multiply the weight in kg by the dosage in mg/kg/day and divide by the number of doses per day.
- To convert pounds to kg, divide by 2.2.
- To calculate the volume of Ceclor in mL, divide the dose in mg by the concentration in mg/mL.
- Convert 66 pounds to kg: 66 / 2.2 = 30 kg
- Calculate the dose of Ceclor in mg: 30 x 45 / 3 = 450 mg
- Calculate the volume of Ceclor in mL: 450 / 125 = 3.6 mL
- The nurse would administer 3.6 mL per dose.
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