A nurse is providing care for a young adult patient who has ulcerative colitis and is scheduled for an ileostomy surgery.
After a discussion with the healthcare provider, the patient expresses concern, “How will I ever be able to have a normal life after this?”
How should the nurse respond?
“Can you share how you think having the ileostomy will affect you?”
“Everyone worries about how they will manage their ileostomy at first.”.
“This will cure your disease so you don’t spend so much time in the hospital.”.
“Let’s discuss some strategies to help you adapt to life with an ileostomy.”. .
The Correct Answer is A
Choice A rationale
Asking the patient to share their concerns allows the nurse to understand the patient’s perspective and provide individualized care. It opens up a dialogue where the patient can express their fears and the nurse can provide reassurance and information.
Choice B rationale
While it’s true that many people worry about managing an ileostomy at first, this response does not address the patient’s specific concerns. It’s important to understand the patient’s individual fears and worries.
Choice C rationale
This response may be misleading. While an ileostomy can help manage the symptoms of ulcerative colitis, it does not cure the disease. It’s important to provide accurate information to the patient.
Choice D rationale
Discussing strategies to adapt to life with an ileostomy can be helpful, but it’s important to first understand the patient’s specific concerns. This response assumes what the patient needs without asking them.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
No stool noted in the collection bag is not an immediate concern as it can take several days for the bowel to start functioning after surgery.
Choice B rationale
A bluish-purplish colored stoma could indicate inadequate blood supply to the stoma, which is a medical emergency and should be reported to the provider immediately.
Choice C rationale
An edematous stoma is a common finding in the immediate postoperative period.
Choice D rationale
Slight bleeding of the stoma site can be a normal finding after colostomy placement.
Correct Answer is B
Explanation
Choice A rationale
While it’s important to ensure the feeding bag contains enough formula for the feeding period, it’s not recommended to fill the bag with more than 4-6 hours’ worth of formula at a time due to the risk of bacterial growth.
Choice B rationale
This is the correct answer. Flushing the gastrostomy tube with water every 4 hours helps maintain tube patency and hydrates the patient.
Choice C rationale
Changing the feeding bag and tubing every 72 hours is a common practice, but it’s not the most critical intervention in this scenario.
Choice D rationale
Keeping the head of the bed elevated at 30 to 45 degrees during feeding and for 1 to 2 hours afterward is recommended to minimize the risk of aspiration. However, 15 degrees may not be sufficient.
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