A nurse is assisting with evaluating a newly licensed nurse who is draining an ileostomy bag for a client. Which of the
following actions by the newly licensed nurse indicates an understanding of the procedure?
Wears sterile gloves to drain the ileostomy bag
Washes the skin surrounding the client's ileostomy with hot water
Cleans the end of the ileostomy pouch before clamping
Empties the ileostomy bag when it is three-fourths full
The Correct Answer is C
Choice A reason: Wearing sterile gloves is not necessary when draining an ileostomy bag as this is not a sterile procedure. Clean gloves are typically used.
Choice B reason: Washing the skin surrounding the ileostomy with hot water is not recommended as it can cause
irritation. Lukewarm water should be used, and the area should be patted dry.
Choice C reason: Cleaning the end of the ileostomy pouch before clamping is important to maintain hygiene and
prevent contamination when draining the bag.
Choice D reason: The ileostomy bag should be emptied when it is one-third to one-half full to prevent leakage and ensure comfort for the client.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: The small intestine is not the starting point of the digestive process. It is where most of the digestion and absorption of nutrients occurs after the food has been processed in the stomach.
Choice B reason: The rectum is the final section of the large intestine, where feces are stored before being expelled. It is not involved in the initial stages of digestion.
Choice C reason: The stomach is involved in the early stages of digestion, particularly in the breakdown of proteins, but it is not the starting point. Food enters the stomach after being ingested through the mouth.
Choice D reason: The mouth is the correct starting location for the digestive process. Here, ingestion takes place, and mechanical digestion begins with chewing, while chemical digestion starts with enzymes in the saliva breaking down carbohydrates.
Correct Answer is D
Explanation
Choice A reason: Memory loss is not typically associated with a lack of dietary fiber. Memory loss can be related to various neurological or psychological conditions.
Choice B reason: Bleeding gums are commonly associated with vitamin C deficiency, not a lack of dietary fiber.
Choice C reason: Brittle hair can be associated with poor nutrition in general, but it is not a specific indicator of inadequate fiber intake.
Choice D reason: Constipation is a well-known symptom of inadequate fiber intake. Fiber helps to bulk up the stool
and promotes regular bowel movements.
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