The nurse is caring for an anxious patient who is scheduled for surgery for colostomy placement. While the nurse is talking to the patient, the patient states, "I am so scared." It is a priority for the nurse to focus on addressing the

Cause of the patient's anxiety and fear.

Patient's bowel sounds and presence of gas.

Family's questions about the procedure.

Patient's lung sounds and respiratory rate.

Answer and Explanation

The Correct Answer is A

Choice A Addressing the cause of the patient's anxiety and fear is the priority to provide

emotional support and comfort. The nurse should actively listen to the patient's concerns and offer appropriate reassurance and information.

Choice B While assessing the patient's bowel sounds and gas is important for the overall care, it is not the priority at this moment when the patient is expressing fear and anxiety.

Choice C Addressing the family's questions is important, but the patient's emotional wellbeing should be the immediate focus.

Choice D Respiratory assessment is essential but is not the priority when the patient is expressing fear and anxiety about the upcoming surgery.

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Correct Answer is B

Explanation

ChoiceA: This volume might be insufficient for a large volume, cleansing enema, as it may not effectively cleanse the colon.

Choice: This range is the appropriate volume for a large volume, cleansing enema, as it provides enough fluid to cleanse the colon effectively without causing excessive distension.

Choice C: This volume is too low for a large volume, cleansing enema, and it may not be enough to achieve the desired effect.

Choice D: This volume is too low for a large volume, cleansing enema, and it may not effectively cleanse the colon.

A. full. B. 1/2 full C. 1/4 full. D. 3/4 full.

Correct Answer is B

Explanation

The correct answer is Choice B.

Choice A rationale: Waiting until the ostomy drainage bag is full increases the risk of leakage and can put undue pressure on the stoma, leading to potential skin irritation or damage. Regular emptying is crucial for maintaining stoma health and preventing complications.

Choice B rationale: Emptying the ostomy drainage bag when it is 1/2 full is recommended to prevent leaks and reduce pressure on the stoma. This practice helps maintain skin integrity around the stoma and ensures the drainage bag functions effectively.

Choice C rationale: Emptying the ostomy drainage bag when it is only 1/4 full may be too frequent and unnecessary, leading to increased use of supplies and potential irritation from frequent manipulation. It is more practical to aim for 1/2 full for routine care.

Choice D rationale: Waiting until the ostomy drainage bag is 3/4 full increases the risk of leakage and pressure on the stoma, similar to waiting until it is full. It is essential to empty the bag more regularly to maintain optimal stoma health and prevent issues

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The nurse is caring for an anxious patient who is scheduled for surgery for colostomy placement. While the nurse is talking to the patient, the patient states, "I am so scared." It is a priority for the nurse to focus on addressing the

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

There is an order to administer a large volume, cleansing enema to an adult patient. The enema bag is filled with how many milliliters of fluid for this procedure?

Correct Answer is B

Explanation

A nurse is caring for a patient with a colostomy. The ostomy drainage bag should be emptied whenever it is

Correct Answer is B

Explanation

A patient expresses concerns over having bright red stool. Which response by the nurse is most appropriate?

A patient with a colostomy asks how often the faceplate (wafer) of the ostomy appliance should be changed. The most appropriate response by the nurse is that it is usually changed every

A patient has stools that are foulsmelling and that float on water. The nurse documents that this patient is having

The nurse is caring for a patient with complaints of constant diarrhea for 3 days. The patient is exhibiting signs and symptoms of dehydration. The best fluid source for this patient to drink small amounts of is

Your patient complains of excessive flatus. When reviewing the patient's dietary intake, which food, if eaten regularly, would you identify as possibly responsible?

A nurse can expect that which of the following patients are most likely to suffer from fecal incontinence? Select all that apply.

During an admission physical assessment, a nurse questions a patient about their bowel elimination pattern. The nurse may say, "Can you tell me your bowel regimen? Do you have a regular, bowel movement every day? What is the approximate time that you have a bowel movement?" The nurse's goal is

A male patient has told a nurse that he occasionally fights constipation. Teaching the patient how to prevent constipation and promote normal elimination, the nurse instructs him to