A patient expresses concerns over having bright red stool. Which response by the nurse is most appropriate?
"Sometimes severe stress can make the stool bright red."
"This is probably nothing. Just let me know if it happens again."
"This needs to be investigated. I will need a stool sample immediately and need to notify the Charge RN."
"You should schedule a colonoscopy as soon as possible."
The Correct Answer is C
A. Stress does not cause bright red stool. Dismissing the symptom as stress could delay identification of potentially serious gastrointestinal bleeding.
B. Minimizing the patient’s concern is inappropriate because bright red stool may indicate active lower gastrointestinal bleeding, such as from hemorrhoids, diverticulosis, or other more serious causes.
C. Investigating the cause of bright red stool promptly is essential. Collecting a stool sample and notifying the charge nurse ensures timely assessment, early detection of bleeding, and appropriate interventions to prevent complications.
D. Recommending a colonoscopy may be necessary in the long-term evaluation of bright red stool, but immediate assessment and diagnostic steps should occur first. Scheduling a colonoscopy without initial evaluation is premature and does not address acute concerns.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is choice b. Ascending colon.
Choice A rationale:
The sigmoid colon is the last part of the large intestine before the rectum. By this stage, the stool is usually well-formed as most water has been absorbed.
Choice B rationale:
The ascending colon is the first part of the large intestine where the stool is least formed. This is because it is the initial stage of the large intestine where water absorption begins, so the stool is still relatively liquid.
Choice C rationale:
The descending colon is further along the digestive tract, where more water has been absorbed, making the stool more formed compared to the ascending colon.
Choice D rationale:
The transverse colon is between the ascending and descending colons. While the stool here is more formed than in the ascending colon, it is less formed than in the descending and sigmoid colons.
Correct Answer is D
Explanation
Choice A The supine position (lying flat on the back) is not suitable for administering an enema as it does not facilitate proper flow and retention of the solution.
Choice B High Fowler's position (sitting upright at a 90degree angle) is not appropriate for enema administration, as it might cause discomfort and hinder proper administration.
Choice C Semi Fowler's position (sitting at a semiupright angle) is also not the best option for enema administration, as it may not allow the solution to flow effectively.
Choice D The Sims position, with the patient lying on the left side with the right knee flexed, allows the enema solution to flow downward by gravity and improves retention. It is the best position for enema administration.
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