A nurse is teaching a client who is preoperative for a sigmoid colostomy. Which of the following statements should the nurse include?

"Your colostomy will not produce formed stool."

"You should expect your stoma to be a purple color."

"The end of the stoma will be painful after this procedure."

"You will have a stoma in your left lower abdomen."

Answer and Explanation

The Correct Answer is D

A. "Your colostomy will not produce formed stool." A sigmoid colostomy is located in the lower part of the large intestine where stool is typically more formed. Therefore, this statement is incorrect and should not be included in the teaching.

B. "You should expect your stoma to be a purple color." A healthy stoma should be pink or red and moist. A purple, dusky, or dark color may indicate compromised blood flow to the stoma and is a sign of a medical emergency. This statement is incorrect.

C. "The end of the stoma will be painful after this procedure." The stoma itself does not have nerve endings, so it should not be painful. Pain around the incision site may occur, but the stoma itself should not be painful. This statement is incorrect.

D. "You will have a stoma in your left lower abdomen." The sigmoid colon is located on the lower left side of the abdomen, so the stoma for a sigmoid colostomy is typically placed in this area. This statement is correct.

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Correct Answer is A

Explanation

A. Have the client breathe into a paper bag. Breathing into a paper bag helps retain CO₂, which can correct respiratory alkalosis caused by hyperventilation.

B. Plan to administer insulin to the client. Insulin is used to manage hyperglycemia or diabetic ketoacidosis, not respiratory alkalosis.

C. Plan to administer sodium bicarbonate to the client. Sodium bicarbonate is used to treat metabolic acidosis, not respiratory alkalosis.

D. Have the client place their head between their knees. This position is not a standard intervention for respiratory alkalosis or hyperventilation.

A. "Small electrodes are placed on my scalp." B. "I will wear earphones during this test." C. "A tuning fork is placed on my head." D. "A small probe is placed inside my ear."

Correct Answer is C

Explanation

A. "Small electrodes are placed on my scalp." This statement describes an EEG, not the Rinne test. The Rinne test involves a tuning fork, not electrodes. This statement is incorrect.

B. "I will wear earphones during this test." This statement describes an audiometry test, not the Rinne test. The Rinne test uses a tuning fork, not earphones. This statement is incorrect.

C. "A tuning fork is placed on my head." The Rinne test is a hearing test that involves placing a vibrating tuning fork on the mastoid process behind the ear and then comparing the sound conducted through bone to the sound conducted through air.

D. "A small probe is placed inside my ear." This statement describes tympanometry or other tests that involve probes in the ear, not the Rinne test. The Rinne test uses a tuning fork placed on the mastoid bone and near the ear canal. This statement is incorrect.

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A nurse is teaching a client who is preoperative for a sigmoid colostomy. Which of the following statements should the nurse include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has respiratory alkalosis and is hyperventilating. Which of the following actions should the nurse take?

Correct Answer is A

Explanation

A nurse is teaching a client about the Rinne test. Which of the following client statements indicates an understanding of the teaching?

Correct Answer is C

Explanation

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