How it Works
Try Naxlex NCLEX-RN (Free-Trial)

A nurse is preparing to receive a client from surgery following a transverse colon resection with colostomy placement. The nurse should expect to assess the stoma at which of the following locations? (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.)
Answer and Explanation

The Correct Answer is "{\"xRanges\":[53.828125,93.828125],\"yRanges\":[164,204]}"

A. The stoma from a transverse colon resection with colostomy placement is typically located in the right iliac fossa, which is the lower right quadrant of the abdomen. This is where the transverse colon is most often brought to the surface for colostomy placement. It allows for easier access and drainage postoperatively.

B. The epigastric area, which is located above the umbilicus, is not a typical location for a colostomy stoma. This area is more commonly associated with upper abdominal organs such as the stomach and liver.

C. The left iliac fossa is generally where a descending or sigmoid colostomy would be placed, rather than a transverse colon resection. This location would be expected for colostomies created from the descending colon, not the transverse colon.


Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Free Nursing Study Resources

Related Questions

Correct Answer is D

Explanation

A. Dry brown eschar is a sign of necrotic tissue, which indicates that the wound is not healing properly. Eschar needs to be removed for proper healing to occur.

B. Wound tissue firm to palpation is not a typical sign of healing. Healing tissue tends to be softer, while firm tissue could indicate fibrosis or an abnormal healing process.

C. Light yellow exudate can indicate the presence of infection or the early stages of healing, but it is not as specific a sign of healing as granulation tissue. Granulation tissue is a more definitive sign of healing.

D. Dark red granulation tissue is a sign of healthy healing tissue. It consists of new blood vessels and is an indication that the wound is in the proliferative phase of healing, which is a positive sign.

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A,B"},"C":{"answers":"A,B"},"D":{"answers":"A,B"},"E":{"answers":"A"}}

Explanation

Rationale

Interpretation of Assessment Findings:

  • Urine ketones:
    • DKA
      The presence of urine ketones is a hallmark of diabetic ketoacidosis (DKA), as it indicates the body is breaking down fat for energy due to insufficient insulin. Ketones are typically not present in hyperglycemic-hyperosmolar state (HHS).
  • Blood glucose greater than expected reference range:
    • DKA
    • HHS
      Elevated blood glucose levels are consistent with both DKA and HHS. However, blood glucose levels tend to be higher in HHS than in DKA, often exceeding 600 mg/dL in HHS.
  • Skin turgor:
    • DKA
    • HHS
      Decreased skin turgor indicates dehydration, which is a common feature in both DKA and HHS due to osmotic diuresis caused by hyperglycemia.
  • Creatinine greater than expected reference range:
    • DKA
    • HHS
      Elevated creatinine reflects impaired renal function, often due to dehydration or acute kidney injury, which can occur in both DKA and HHS.
  • Blood pH:
    • DKA
      A blood pH of 7.30 indicates metabolic acidosis, a defining feature of DKA. Blood pH is typically normal in HHS because it does not involve significant ketoacidosis.

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Register