A nurse is providing preoperative teaching about stool consistency to a client who will undergo a colectomy with the placement of an ileostomy. Which of the following information about stool consistency should the nurse include in the teaching?

The stool will have a tarry color.

The stool will have a high volume of liquid.

The stool will be solid and well-formed.

The stool will appear bloody with clots.

Answer and Explanation

The Correct Answer is B

Rationale:
A. The stool will have a tarry color: Tarry stools typically indicate the presence of digested blood from upper gastrointestinal bleeding. This is not expected after an ileostomy, which involves the small intestine, not the upper GI tract.

B. The stool will have a high volume of liquid: After a colectomy with ileostomy placement, stool bypasses the colon, where most water reabsorption occurs. As a result, the output from an ileostomy is typically frequent and liquid or semi-liquid in consistency.

C. The stool will be solid and well-formed: Solid, well-formed stools are characteristic of a functioning colon. Because the colon is removed in a colectomy with ileostomy, stool will not be solid due to the lack of water absorption.

D. The stool will appear bloody with clots: Bloody stools with clots suggest active bleeding, which is not expected in normal postoperative ileostomy output. This would be an abnormal finding and should be reported immediately.

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Correct Answer is A

Explanation

Rationale:
A. Maintain scheduled daily routines for the client: A consistent daily routine helps reduce confusion and anxiety in clients with Alzheimer’s disease by providing structure and familiarity. Predictability supports cognitive function and enhances a sense of security.

B. Use long sentences when speaking with the client: Long or complex sentences can overwhelm clients with moderate Alzheimer’s disease. Simple, short sentences with clear instructions are more effective for promoting understanding and cooperation.

C. Provide the client with increased environmental stimuli: Too much environmental stimulation can lead to agitation, confusion, or sensory overload in individuals with Alzheimer’s disease. A calm, quiet environment is more appropriate to help maintain focus and comfort.

D. Ensure all siderails are up on the client's bed when they are sleeping: Raising all side rails can pose a safety risk by increasing the likelihood of injury from attempts to climb over them. Alternatives like using a low bed and ensuring supervision are safer and more appropriate.

A. Place the swab in the culture container. B. Ensure the container is labeled with the date and time of collection. C. Apply clean gloves. D. Swab the wound in a zig-zag manner.

Correct Answer is C,D,A,B

Explanation

Rationale:

Apply clean gloves: Wearing clean gloves is the first step to maintain standard precautions and prevent contamination during specimen collection.
Swab the wound in a zig-zag manner: This technique ensures that the swab collects cells and fluid from multiple areas of the wound, increasing the likelihood of detecting any microorganisms present.
Place the swab in the culture container: Immediately inserting the swab into the sterile container maintains the integrity of the specimen and prevents contamination.
Ensure the container is labeled with the date and time of collection: Labeling the specimen is critical for accurate identification and processing by the lab. It must be done after collection to ensure the label reflects the correct time and date.

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A nurse is providing preoperative teaching about stool consistency to a client who will undergo a colectomy with the placement of an ileostomy. Which of the following information about stool consistency should the nurse include in the teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning care for an older adult client who has moderate Alzheimer's disease. Which of the following interventions should the nurse implement in the client's plan of care?

Correct Answer is A

Explanation

80. A nurse is preparing to obtain a wound drainage specimen for culture from a client who has a nonhealing burn injury. In what order should the nurse collect this specimen? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Correct Answer is C,D,A,B

Explanation

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