A nurse is giving discharge instructions to a client who has a new ileostomy. The nurse should recognize that the teaching has been effective when the client states,

"My stoma size will stay the same, even after it has healed."

"My stoma will drain liquid fluid continuously."

"I will change my pouch system every 2 weeks."

"I will ensure that my medications are enteric coated."

Answer and Explanation

The Correct Answer is B

A. "My stoma size will stay the same, even after it has healed." - This statement is incorrect.

Stoma size can change during the healing process and may continue to evolve over time due to factors such as swelling, retraction, or prolapse.

B. "My stoma will drain liquid fluid continuously." - This statement is correct. In an ileostomy, the stoma typically drains liquid stool continuously due to the absence of the colon, which is responsible for absorbing water from the feces.

C. "I will change my pouch system every 2 weeks." - This statement is incorrect. The frequency of pouch changes depends on individual factors such as stoma size, type of pouching system used, and personal preference. It is essential to teach clients to change their pouch when needed, which may vary from a few days to a week or longer.

D. "I will ensure that my medications are enteric coated." - This statement is unrelated to ileostomy care. Enteric-coated medications are designed to resist dissolution in the acidic environment of the stomach and instead dissolve in the alkaline environment of the small intestine. It is not directly relevant to stoma care.

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Correct Answer is D

Explanation

A. Herpes simplex virus 2: Herpes simplex virus infections are not typically reportable to the

Centers for Disease Control and Prevention (CDC). These infections are commonly managed at the local level.

B. Candida albicans: Candida albicans infections are not typically reportable to the CDC. Candida species are common pathogens and are usually managed at the local level.

C. Staphylococcus aureus: Staphylococcus aureus infections, including methicillin-resistant

Staphylococcus aureus (MRSA), are not typically reportable to the CDC unless part of a larger outbreak or public health concern.

D. Lyme disease: Lyme disease is a reportable infection that requires notification to public health authorities, including the Centers for Disease Control and Prevention (CDC). Lyme disease is a vector-borne illness transmitted through the bite of infected ticks.

A. " I will use my cell phone on the ear opposite of my pacemaker." B. "I can play softball with my family in 3 weeks." C. “ I should perform arm exercises daily." D. “I will go to my cardiologist's office when the battery needs to be changed."

Correct Answer is A

Explanation

A. Using a cell phone on the ear opposite to the pacemaker helps minimize the risk of electromagnetic interference with the pacemaker function.

B. Engaging in activities such as playing softball may not be appropriate immediately after pacemaker insertion. The client should follow specific activity restrictions as advised by the healthcare provider.

C. While performing arm exercises is generally beneficial for overall health, the client should avoid strenuous activities that may strain the upper body or disrupt the pacemaker leads

immediately after insertion.

D. Pacemaker battery replacement is typically scheduled based on the device's longevity and is performed in a healthcare facility, not the cardiologist's office. The client should follow up regularly with the healthcare provider for device checks and monitoring of battery status.

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A nurse is giving discharge instructions to a client who has a new ileostomy. The nurse should recognize that the teaching has been effective when the client states,

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse from the State Health Department is instructing a group of nurses regarding reportable infections. Which of the following infections should the nurse report to the Centers for Disease Control and Prevention?

Correct Answer is D

Explanation

A nurse is providing postoperative teaching to a client who has a newly inserted pacemaker.Which of the following statements by the client Indicates that the teaching has been effective?

Correct Answer is A

Explanation

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