A nurse is educating a patient who recently had a colostomy. What information should the nurse include in the teaching?
The stoma may appear purplish during the first week.
A small amount of bleeding around the stoma is normal.
Fecal output can be expected within 24 hours.
An increase in the intake of raw vegetables is necessary.
The Correct Answer is B
Choice A rationale
A stoma may appear red and moist immediately after surgery, similar to the inside of the mouth. A purplish color could indicate a lack of blood supply to the stoma, which is a medical emergency.
Choice B rationale
A small amount of bleeding around the stoma is normal, especially when cleaning the area or changing the ostomy appliance. This is because the stoma contains blood vessels and has a rich blood supply.
Choice C rationale
Fecal output from a colostomy can be expected within 2 to 4 days after surgery. It is not typical to see output within 24 hours.
Choice D rationale
An increase in the intake of raw vegetables is not necessary after a colostomy. In fact, some people may find certain raw vegetables difficult to digest and they may cause gas or odor.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Excessive thirst and urination are symptoms of hyperglycemia, not hypoglycemia. Hyperglycemia could occur if the TPN solution was infusing too quickly, but it would not be a result of the infusion pump not working.
Choice B rationale
Shakiness and diaphoresis are manifestations of hypoglycemia. When a sudden interruption in the infusion of TPN occurs, the patient is at risk for hypoglycemia.
Choice C rationale
Fever and chills are symptoms of infection, not a direct result of the TPN infusion stopping.
Choice D rationale
Hypertension and crackles in the lungs are signs of fluid overload, not hypoglycemia. These symptoms would not be expected if the TPN infusion stopped.
Correct Answer is C
Explanation
Choice A rationale
Sterile gloves are not necessary when checking a patient’s pulse. They are typically used for procedures that require aseptic technique, such as wound dressing changes or insertion of a central venous catheter.
Choice B rationale
Protective eyewear is used to protect the healthcare provider from splashes or sprays of blood, body fluids, secretions, or excretions. It is not necessary when checking a patient’s pulse.
Choice C rationale
Clean gloves should be worn when touching blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin. This includes when caring for a patient with MRSA in an abdominal wound.
Choice D rationale
An N95 respirator mask is used to protect the healthcare provider from airborne pathogens, such as tuberculosis. It is not necessary when checking a patient’s pulse.
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