A nurse is assisting with the care of a client who is receiving an IV infusion of dextrose 10% in water. The nurse should monitor the client for which of the following adverse effects?

Choice A reason: To calculate BMI, the nurse needs the client's height and weight. BMI is calculated by dividing the weight in kilograms by the square of height in meters.

Choice B reason: Skinfold thickness is used to estimate body fat percentage, not BMI.

Choice C reason: Waist circumference is used as a measure of abdominal obesity, not for calculating BMI.

Choice D reason: Daily calorie intake is not required for BMI calculation; it is more relevant for dietary assessments
and weight management plans.

Answer: B

Rationale:

A. "You should expect your stoma to be a purple color": A healthy stoma should be pink or red in color. A purple or dark-colored stoma may indicate poor blood flow and could be a sign of complications requiring immediate medical attention.

B. "You will have a stoma in your left lower abdomen": For a sigmoid colostomy, the stoma is typically located in the left lower quadrant of the abdomen. This placement is consistent with the nature of the procedure and is a correct and important piece of information for preoperative teaching.

C. "Your colostomy will not produce formed stool": A sigmoid colostomy usually results in the production of more formed stool because it is located closer to the rectum, where most of the water has been absorbed. Expecting unformed stool is more typical of a colostomy in the ascending or transverse colon.

D. "The end of the stoma will be painful after this procedure": While some discomfort is normal postoperatively, the stoma itself should not be persistently painful. Pain management and proper care should be addressed, but ongoing severe pain could indicate complications.