A nurse is collecting data from a client who has a newly placed colostomy.
Which of the following findings should indicate to the nurse the client has accepted their new altered body image?

Prefers not to look at the stoma site.

Accepts that sexual activity will decrease.

Participates in performing ostomy care.

Denies feelings of sadness about the ostomy.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Preferring not to look at the stoma site indicates difficulty accepting the altered body image and is often associated with feelings of denial or embarrassment. Acceptance is typically demonstrated through engagement in self-care activities.

Choice B rationale

Associating acceptance with decreased sexual activity is inaccurate, as altered body image does not directly predict changes in sexual behavior. Acceptance is better indicated by the client’s emotional adjustment and active participation in care.

Choice C rationale

Participating in ostomy care demonstrates acceptance by showing the client is willing to engage in managing their new body function. This indicates an understanding and integration of the change into their daily life.

Choice D rationale

Denying feelings of sadness about the ostomy may reflect emotional suppression rather than true acceptance. Acceptance involves acknowledging emotions and adapting positively to the new situation. .

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Correct Answer is D

Explanation

Choice A rationale

Peak expiratory flow volume measurement assesses airway obstruction in conditions like asthma but is unrelated to postoperative tonsillectomy care or oxygenation improvement.

Choice B rationale

Using straws post-tonsillectomy increases suction pressure, risking clot disruption at the surgical site. This can lead to bleeding complications and delayed healing.

Choice C rationale

Encouraging coughing post-tonsillectomy may disturb surgical site healing and increase bleeding risk due to heightened pressure on the tissue and clot displacement.

Choice D rationale

Semi-Fowler position improves oxygenation and reduces edema in the throat by promoting adequate drainage and minimizing swelling, benefiting postoperative tonsillectomy patients. .

A. Remove personal protective equipment immediately after leaving the client's room. B. Wear an N95 mask when entering the room. C. Use an alcohol swab to clean the temperature probe before removing it from the room. D. Keep a stethoscope at the client's bedside for the duration of her hospital stay.

Correct Answer is D

Explanation

Choice A rationale

Removing personal protective equipment outside the client’s room increases the risk of environmental contamination with pathogens. Contact precautions require careful containment of contaminants within the room to prevent the spread of infectious agents to other areas of the healthcare facility, thus making this action inappropriate.

Choice B rationale

An N95 mask is not required for contact precautions but is designated for airborne precautions, such as for tuberculosis or measles. Contact precautions focus on minimizing the spread of infections via touch or contact with bodily fluids, requiring gowns and gloves rather than high-filtration masks.

Choice C rationale

Using an alcohol swab to clean the temperature probe before removing it from the room may not eliminate all pathogens. Probes that contact mucous membranes or bodily fluids should undergo high-level disinfection or sterilization. Ensuring single-patient use of equipment is more effective in preventing cross-contamination in this context.

Choice D rationale

Assigning a dedicated stethoscope for the client during their hospital stay minimizes the risk of transmitting pathogens to other clients. Equipment designated for single-client use remains in the client’s room, reducing the chance of contamination and maintaining infection control measures effectively, aligning with best practices for contact precautions.

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A nurse is collecting data from a client who has a newly placed colostomy.Which of the following findings should indicate to the nurse the client has accepted their new altered body image?

Nursing Test Bank

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A nurse is collecting data from a client who has a newly placed colostomy.
Which of the following findings should indicate to the nurse the client has accepted their new altered body image?