A nurse is caring for 4 patients each patient has a colostomy bag. Which patient should be seen first and made a priority?

The patient with a pale blue stoma

The patient with a continuous draining stoma

The patient with a stoma that had fecal contents all over it.

The patient with a beefy red, moist stoma

Answer and Explanation

The Correct Answer is C

Choice A A pale blue stoma may indicate a lack of blood supply (ischemia) to the stoma, which is concerning but not as immediately critical as fecal contamination.

Choice B A continuous draining stoma is normal, and there is no indication of an urgent issue in this scenario.

Choice C This patient should be seen first and made a priority as fecal contamination of the stoma can lead to skin irritation, infection, and complications. Immediate cleaning and appropriate care are necessary.

Choice D A beefy red, moist stoma is a healthy stoma appearance and does not indicate an urgent issue.

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Correct Answer is B

Explanation

The correct answer is choice b. Ascending colon.

Choice A rationale:

The sigmoid colon is the last part of the large intestine before the rectum. By this stage, the stool is usually well-formed as most water has been absorbed.

Choice B rationale:

The ascending colon is the first part of the large intestine where the stool is least formed. This is because it is the initial stage of the large intestine where water absorption begins, so the stool is still relatively liquid.

Choice C rationale:

The descending colon is further along the digestive tract, where more water has been absorbed, making the stool more formed compared to the ascending colon.

Choice D rationale:

The transverse colon is between the ascending and descending colons. While the stool here is more formed than in the ascending colon, it is less formed than in the descending and sigmoid colons.

A. Pneumonia B. Edema or Excess Fluid Volume C. Hypertension D. Diabetes Melitus

Correct Answer is B

Explanation

Choice A Pneumonia is not a contraindication for a tap water enema.

Choice B A tap water enema is not recommended for patients with edema or excess fluid volume due to the risk of further fluid overload.

Choice C Hypertension is not a contraindication for a tap water enema unless the patient has other cardiovascular conditions that could be exacerbated by the procedure.

Choice D Diabetes mellitus is not a contraindication for a tap water enema. However, patients with diabetes may need careful monitoring during the procedure due to potential glucose

fluctuations.

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A nurse is caring for 4 patients each patient has a colostomy bag. Which patient should be seen first and made a priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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Explanation

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