A nurse is reinforcing teaching with another nurse about how to change an ostomy appliance for a client who has a sigmoid colostomy.
Which of the following instructions should the nurse include in the teaching?
Create an opening on the skin barrier that is 1.27 cm (0.5 in) larger than the client's stoma
Use a moisturizing soap to clean the skin around the client's stoma
Empty the client's ostomy pouch before removing the skin barrier
Change the client's ostomy appliance 1 hr after breakfast
Correct Answer : A,B,C
Create an opening on the skin barrier that is 1.27 cm (0.5 in) larger than the client's stoma: It is important to ensure that the opening in the skin barrier is slightly larger than the stoma to prevent irritation or pressure on the stoma. This allows for proper fit and helps maintain a secure seal.
Use a mild, non-irritating soap or specifically designed ostomy cleanser to clean the skin around the client's stoma: Harsh soaps or cleansers can irritate the skin around the stoma. Using a moisturizing or gentle cleanser helps maintain the integrity of the skin and reduces the risk of irritation or breakdown.
Empty the client's ostomy pouch before removing the skin barrier: It is important to empty the ostomy pouch to prevent leakage or spillage during the appliance change. This helps maintain cleanliness and prevents potential contamination or soiling of the surrounding area.
The timing of the ostomy appliance change is not specified in the given options. The appropriate timing for changing the ostomy appliance depends on the individual client's needs and preferences. It may be helpful to consider factors such as the client's comfort, schedule, and the amount of output in determining the best time for the appliance change. This instruction is not necessary for the teaching session.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Valid and reliable health information sources should provide references or citations to support the information they present. This demonstrates that the information is based on evidence and has been reviewed by experts in the field. It allows readers to verify the accuracy and reliability of the information by referring to the cited sources.
The author's name listed without credentials does not provide information about the author's expertise or qualifications. It is important to assess the author's credentials and expertise to determine their credibility.
The website URL being listed as .com does not provide information about the accuracy or reliability of the content. Different types of websites, such as .org or .gov, can also contain credible health information.
The website being last updated 3 years ago raises concerns about the currency and relevance of the information. Health information can quickly evolve, and it is important to access up-to-date resources.
Correct Answer is ["0.25"]
Explanation
To calculate the amount of haloperidol oral concentrate the nurse should administer, we can use the following equation:
Volume (mL) = Dose (mg) / Concentration (mg/mL)
In this case, the dose is 0.5 mg and the concentration of the haloperidol oral concentrate is 2 mg/mL.
Volume (mL) = 0.5 mg / 2 mg/mL
Volume (mL) = 0.25 mL
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