A nurse is providing discharge teaching for a client who had a partial colectomy 2 days ago. Which of the following information should the nurse include in the teaching?

"Place an aspirin in your ostomy pouch to control odor."

"Your ostomy should start functioning in five days."

"Empty your ostomy pouch when it becomes a third to halfway full."

"Notify your provider if your stoma becomes dark red:"

Answer and Explanation

The Correct Answer is C

A. "Place an aspirin in your ostomy pouch to control odor.": Aspirin should never be placed in an ostomy pouch, as it can damage the pouch material and irritate the stoma. Deodorizers or dietary adjustments are safer alternatives for odor control.

B. "Your ostomy should start functioning in five days.": An ostomy typically begins functioning within 2 to 4 days postoperatively, depending on bowel motility. Waiting five days without output could indicate an obstruction or ileus, requiring medical evaluation.

C. "Empty your ostomy pouch when it becomes a third to halfway full.": Keeping the pouch from becoming too full prevents leaks, discomfort, and excessive pressure on the stoma. This practice helps maintain skin integrity and ostomy function.

D. "Notify your provider if your stoma becomes dark red.": A dark red stoma is normal and indicates good blood supply. However, a stoma that turns pale, dusky, or black requires immediate medical attention, as it suggests compromised circulation and possible necrosis.

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Correct Answer is C

Explanation

A. Constipation: Radiation therapy to the neck does not typically affect the gastrointestinal system directly. Constipation is more commonly associated with opioid pain management or radiation targeting the abdominal or pelvic region rather than the head and neck area.

B. Peripheral neuropathy: Nerve damage leading to peripheral neuropathy is more often linked to chemotherapy, particularly agents like vincristine or cisplatin, rather than radiation therapy. Radiation to the neck primarily affects tissues in the irradiated field, such as the oral mucosa.

C. Mouth ulcers: Radiation to the neck frequently causes mucositis, leading to painful mouth ulcers due to the direct impact on rapidly dividing mucosal cells. Clients may experience pain, difficulty swallowing, and increased risk of infection as a result of mucosal breakdown.

D. Decreased tear production: Radiation therapy to the neck is unlikely to directly affect the lacrimal glands. While radiation near the eyes can cause dry eyes, treatment focused on the neck primarily impacts the oral mucosa, salivary glands, and throat rather than tear production.

Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}

Explanation

Infection: Poor glycemic control, indicated by an elevated hemoglobin A1c of 9.5%, leads to impaired immune function, delayed wound healing, and increased risk of postoperative infections. Chronic hyperglycemia promotes bacterial growth, reduces leukocyte function, and compromises vascular integrity, further predisposing the client to infections.
Deep vein thrombosis (DVT): Postoperative immobility, increased coagulation, and endothelial injury increase DVT risk. However, BUN of 15 mg/dL is within the normal range and does not indicate dehydration or hemoconcentration, which would contribute to thrombus formation.
Hypovolemia: Reduced blood volume typically presents with signs such as hypotension, tachycardia, and elevated BUN/creatinine ratio. Preoperative hypertension does not indicate hypovolemia and is more commonly associated with chronic vascular resistance rather than acute fluid loss.
BUN of 15 mg/dL: A BUN level within the normal range does not suggest an increased risk for DVT or fluid imbalance. It primarily reflects renal function and hydration status, neither of which are significantly altered in this case.
Preoperative hypertension: While chronic hypertension is a cardiovascular risk factor, it does not indicate hypovolemia, which would present with dehydration-related signs such as orthostatic hypotension, tachycardia, and decreased urine output.
Hemoglobin A1c: A value of 9.5% indicates poor long-term glycemic control, which impairs immune function and slows wound healing. Elevated glucose levels reduce neutrophil function, impair macrophage activity, and increase oxidative stress, all of which contribute to a heightened infection risk.

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A nurse is providing discharge teaching for a client who had a partial colectomy 2 days ago. Which of the following information should the nurse include in the teaching?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}

Explanation

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