A nurse is reinforcing teaching about lleostomy care with a client. The nurse should recognize which of the following statements by the client Indicates a need for further teaching?

"I will use caution when eating high fiber foods."

"I will empty my pouch when it becomes one third full."

"I will be certain to take enteric-coated medications."

"I will change my entire pouch system at least weekly."

Answer and Explanation

The Correct Answer is C

A. "I will use caution when eating high fiber foods." Clients with an ileostomy should be cautious with high-fiber foods as they can cause blockages.

B. "I will empty my pouch when it becomes one third full."
This statement is correct. Regularly emptying the pouch prevents it from becoming too heavy and ensures comfort for the client.

C. "I will be certain to take enteric-coated medications."This statement indicates a need for further teaching. Enteric-coated medications are designed to dissolve in the intestine, but with an ileostomy, the medication may pass through the digestive system too quickly to be absorbed effectively. Clients should be advised to consult their healthcare provider about medication forms, as liquid or non-enteric-coated medications may be more appropriate.

D. "I will change my entire pouch system at least weekly."
This statement is correct. Changing the pouch system regularly helps maintain hygiene and prevents skin irritation.

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Correct Answer is D

Explanation

A. Obtain the client's vital signs:
Vital signs are essential for assessing the client's overall condition and can provide crucial information about the client's stability. However, in this scenario, there's a higher priority nursing action that needs immediate attention.

B. Weigh the client:
Daily weight measurement is important, especially in postoperative patients, to monitor for fluid retention or loss. However, this is not the most urgent action in this situation.

C. Change the client's dressing:
Changing the dressing involves maintaining the surgical site's cleanliness and preventing infections. While this is important, it's not the highest priority in this situation.

D. Administer pain medication:
Correct Choice. Addressing the client's pain is a priority to ensure their comfort and well-being, especially postoperatively. Managing pain effectively is crucial for the client's recovery and can facilitate other necessary activities, such as changing the dressing or weighing the client.

Correct Answer is ["10"]

Explanation

To calculate the number of milliliters (mL) of the hydroxyzine oral suspension to administer, you can use the following formula:

Dose (mL) = Ordered Dose (mg)/ Stock Concentration (mg/mL)

In this case:

- Ordered Dose = 50 mg

- Stock Concentration = 25 mg/5 mL

First, calculate the mg per mL from the stock concentration:

mg per mL = 25 mg/ 5 mL= 5 mg/mL

Now, use the formula to find the mL to administer:

Dose (mL) = 50 mg/ 5 mg/mL = 10 mL

So, the nurse should administer 10 mL of hydroxyzine oral suspension.

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A nurse is reinforcing teaching about lleostomy care with a client. The nurse should recognize which of the following statements by the client Indicates a need for further teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

A nurse is preparing to administer hydroxyzine HCL 50 mg PO. Available is hydroxyzine oral suspension 25 mg/5 mL. How many ml. should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["10"]

Explanation

A nurse is reviewing the plan of care for a client experiencing an acute exacerbation of ulcerative colitis. Which of the following treatments should the nurse expect to administer?

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A nurse is reinforcing teaching about lleostomy care with a client. The nurse should recognize which of the following statements by the client Indicates a need for further teaching?

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