The nurse identifies a client problem of impaired skin integrity related to diarrhea for a client who has ulcerative colitis. The nurse recognizes that teaching about perianal care has been effective when the client:
cleans and dries the perianal area after each diarrheal stool.
uses alcohol compresses to provide relief from anal irritation.
asks for antidiarrheal medication after each stool.
takes an hour-long Sitz bath following each stool.
The Correct Answer is A
A. Cleans and dries the perianal area after each diarrheal stool: This is the correct option. Effective perianal care for a client with diarrhea, such as ulcerative colitis, involves gentle cleansing and thorough drying of the perianal area after each stool. Proper hygiene helps prevent skin breakdown and irritation caused by prolonged contact with stool.
B. Alcohol can be irritating to the skin and may exacerbate perianal irritation and discomfort. Therefore, using alcohol compresses is not considered an appropriate perianal care practice.
C. While antidiarrheal medications may be prescribed for clients with ulcerative colitis to help manage symptoms, asking for medication after each stool is not a typical or recommended approach. The frequency and timing of antidiarrheal medication administration should be based on healthcare provider recommendations and individual symptom management plans.
D. While Sitz baths can provide relief from perianal discomfort and promote healing, taking an hour-long Sitz bath after each stool may be impractical and excessive. Sitz baths are typically recommended for shorter durations (e.g., 10-20 minutes) and may be used periodically rather than after every stool.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Teach the client to support the surgical site while deep breathing and coughing: This action is appropriate as it helps prevent complications such as atelectasis and pneumonia by promoting lung expansion and clearing secretions. Supporting the surgical site while deep breathing and coughing helps reduce pain and discomfort during these activities.
B. This is an important teaching point for clients using PCA for pain control after surgery. Opioid medications used in PCA can lead to gastrointestinal motility issues, including constipation. However, pain management is central within the first 24 hours post operation.
C. Irrigating and repositioning the NGT frequently can increase the risk of complications such as displacement or irritation of the surgical site. NGT care should be performed as needed based on institutional protocols and the client's condition.
D. The client's diet will likely be advanced gradually, starting with clear fluids and progressing to full liquids and then solid foods as tolerated. Fruit juices may be introduced gradually as part of the liquid diet once the client's gastrointestinal function has recovered sufficiently.
Correct Answer is B
Explanation
B. Childhood obesity is a significant risk factor for the development of type 2 diabetes mellitus (T2DM) in children and adolescents. Excess adiposity can lead to insulin resistance, a key underlying mechanism in the development of T2DM.
A. While ADHD is a neurodevelopmental disorder that can affect children, it is not typically considered a direct consequence or complication of childhood obesity. However, there may be associations between obesity and ADHD, such as shared genetic factors or lifestyle factors, but causality is not clearly established.
C. Rheumatoid arthritis is an autoimmune disorder characterized by inflammation of the joints. While obesity is a known risk factor for osteoarthritis, particularly in weight-bearing joints, it is not typically associated with rheumatoid arthritis.
D. Hypotension, or low blood pressure, is not typically considered a complication of childhood obesity. In fact, obesity is more commonly associated with hypertension (high blood pressure) due to the increased strain on the cardiovascular system.
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