A nurse is caring for a client who has a newly created colostomy. The client’s partner tells the nurse that the client refuses to look at the stoma. Which of the following actions should the nurse take?

Suggest the client join a support group for people who have colostomies.

Encourage the client and partner to avoid expressing negative feelings about the colostomy.

Instruct the client’s partner to assume care of the colostomy for the client.

Transfer the client to a rehabilitation facility for instruction about self-management of the colostomy.

Answer and Explanation

The Correct Answer is A

Choice A reason: Suggesting a support group helps the client address emotional resistance to the colostomy through peer support. This fosters psychological adjustment, reduces stigma, and promotes self-management by sharing experiences, aligning with evidence-based strategies to improve coping and adaptation in clients with new ostomies.
Choice B reason: Encouraging avoidance of negative feelings dismisses the client’s emotional response, hindering psychological adaptation. Accepting a colostomy requires processing grief and fear. Suppressing emotions delays coping, as psychological adjustment involves acknowledging feelings to integrate the stoma into the client’s self-image effectively.
Choice C reason: Instructing the partner to assume colostomy care undermines the client’s autonomy and delays self-management. Independence in stoma care is critical for psychological and practical adaptation. Dependency may hinder adjustment, as clients need to develop skills to manage their condition independently.
Choice D reason: Transferring to a rehabilitation facility is premature without trying in-hospital education or support groups. Most clients learn stoma care with nursing guidance. Transfer disrupts care continuity and may increase distress, failing to address emotional resistance directly, unlike peer support interventions.

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Correct Answer is D

Explanation

Choice A reason: Penicillin, an antibiotic, has no known interactions with saw palmetto, a herbal supplement used for BPH. Saw palmetto affects prostate function, not antibiotic metabolism, so this combination is safe, making it an incorrect choice for an adverse interaction.
Choice B reason: Ipratropium, used for respiratory conditions, does not interact with saw palmetto, which targets prostate health. Their mechanisms are unrelated, and no significant drug-herb interaction exists, making this medication an incorrect choice for an adverse interaction with saw palmetto.
Choice C reason: Zolpidem, a sedative, has no documented interactions with saw palmetto. Saw palmetto’s effects on prostate tissue do not influence zolpidem’s central nervous system actions, so this combination is safe, making it incorrect for an adverse interaction.
Choice D reason: Finasteride, used for BPH, may interact with saw palmetto, as both reduce prostate size via similar mechanisms (inhibiting 5-alpha-reductase). Combined use can amplify effects or cause additive side effects, making this a potential adverse interaction, thus the correct choice.

A. I cannot be a witness to your advance directives in writing. B. Your desire to have advance directives can be included in your medical record. C. Your name can be removed from your advance directives at any time. D. You must be at least 21 years old to complete advance directives.

Correct Answer is B

Explanation

Choice A reason: Nurses can witness advance directives in many settings, depending on state laws, so stating they cannot is inaccurate. This response dismisses the client’s request without providing guidance, making it incorrect and unhelpful for addressing their wishes.
Choice B reason: Including the client’s desire for advance directives in the medical record ensures their wishes are documented and respected. This aligns with the Patient Self-Determination Act, facilitating care planning, making it the correct and supportive response.
Choice C reason: Stating the client’s name can be removed from advance directives is confusing, as directives are personal and revocable, not about name removal. This response is inaccurate and irrelevant to the client’s request, making it incorrect.
Choice D reason: There is no universal age requirement of 21 for advance directives; competent adults (typically 18+) can create them. This statement is incorrect and restrictive, misinforming the client about their rights, making it inappropriate.

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A nurse is caring for a client who has a newly created colostomy. The client’s partner tells the nurse that the client refuses to look at the stoma. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the medication administration record of a client who has benign prostatic hyperplasia (BPH). The client asks the nurse about taking saw palmetto. The nurse should instruct the client that which of the following medications interacts adversely with saw palmetto?

Correct Answer is D

Explanation

A nurse is caring for a client who asks for information about advance directives and states, “I want to make sure my wishes are respected.” Which of the following responses should the nurse make?

Correct Answer is B

Explanation

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