The nurse is emptying an ileostomy pouch for a patient. Which assessment finding would the nurse report immediately?
Liquid consistency of stool
Unpleasant odor from the stool
Presence of blood in the stool
Continuous output from the stoma
The Correct Answer is C
Choice A For an ileostomy, liquid consistency of stool is expected as the output, and it is not an immediate concern.
Choice B Foul odor from the stool is common with ileostomy output, and while it can be unpleasant, it is not an immediate concern.
Choice C This finding should be reported immediately, as it could indicate bleeding from the stoma or intestinal mucosa, which requires prompt evaluation and intervention.
Choice D Continuous output from an ileostomy is normal and expected, so it is not a cause for immediate concern.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
No explanation
Correct Answer is B
Explanation
Choice A A bowel training schedule is not typically required for patients with an ileostomy, as they have a surgically created opening (stoma) for stool to pass directly out of the body.
Choice B Bowel training can be beneficial for patients with incontinence, as it involves establishing a regular toileting routine to help regain bowel control and prevent accidental bowel movements.
Choice C C. difficile is an infectious condition that affects the gastrointestinal tract, and bowel training may not be the primary intervention for this patient.
Choice D Crohn's disease is a chronic inflammatory bowel disease, and while bowel training may be helpful for some Crohn's patients, it is not the most common intervention for this condition.
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