A nurse is assisting with evaluating a newly licensed nurse who is draining an ileostomy bag for a client. Which of the
following actions by the newly licensed nurse indicates an understanding of the procedure?
Wears sterile gloves to drain the ileostomy bag
Washes the skin surrounding the client's ileostomy with hot water
Cleans the end of the ileostomy pouch before clamping
Empties the ileostomy bag when it is three-fourths full
The Correct Answer is C
Choice A reason: Wearing sterile gloves is not necessary when draining an ileostomy bag as this is not a sterile procedure. Clean gloves are typically used.
Choice B reason: Washing the skin surrounding the ileostomy with hot water is not recommended as it can cause
irritation. Lukewarm water should be used, and the area should be patted dry.
Choice C reason: Cleaning the end of the ileostomy pouch before clamping is important to maintain hygiene and
prevent contamination when draining the bag.
Choice D reason: The ileostomy bag should be emptied when it is one-third to one-half full to prevent leakage and ensure comfort for the client.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Magnesium is important for many processes in the body, including nerve transmission and the regulation of muscle contractions, but it is not primarily used for oxygen transport.
Choice B reason: Iron is a key component of hemoglobin, the protein in red blood cells that carries oxygen from the lungs to the rest of the body. The normal range for iron in the blood is typically 50 to 170 micrograms per deciliter for men and 65 to 165 micrograms per deciliter for women.
Choice C reason: Potassium is crucial for heart function and plays a key role in skeletal and smooth muscle contraction, making it important for normal digestive and muscular function, but not directly for oxygen transport.
Choice D reason: Phosphorus helps form bones and teeth and is involved in the body's utilization of carbohydrates and fats, as well as the synthesis of protein for the growth, maintenance, and repair of cells and tissues, but it does not transport oxygen.
Correct Answer is B
Explanation
Choice A reason: Granola may contain ingredients like nuts and dried fruits that are high in potassium, which is not
suitable for a low potassium diet.
Choice B reason: Many salt substitutes contain potassium chloride instead of sodium chloride, and using them can increase potassium intake, which is not recommended for a client on a low potassium diet.
Choice C reason: Molasses is high in potassium, so replacing sugar with molasses when baking would not be
appropriate for someone on a low potassium diet.
Choice D reason: Orange juice is high in potassium compared to apple juice, making it an unsuitable choice for
someone on a low potassium diet.
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