A nurse is reinforcing teaching about ostomy supplies with a client who has a new colostomy. Which of the following information should the nurse include?

Empty the pouch when it is 1/3 to 1/2 full.

Use a standard enema set to irrigate the colostomy.

Cleanse the skin surrounding the stoma with moisturizing soap.

Cut the opening in the skin barrier 1/4 inch larger than the stoma.

Answer and Explanation

The Correct Answer is A

A. Empty the pouch when it is 1/3 to 1/2 full: This prevents the weight of the pouch from causing leaks or pulling on the stoma.
B. Use a standard enema set to irrigate the colostomy: This is incorrect as a standard enema set is not typically used. Colostomy irrigation requires specific equipment and is not performed routinely.
C. Cleanse the skin surrounding the stoma with moisturizing soap: Moisturizing soap can leave a residue that interferes with adhesive barriers. Mild, non-moisturizing soap or just water should be used.
D. Cut the opening in the skin barrier 1/4 inch larger than the stoma: The opening should fit closely to the stoma to protect the surrounding skin from irritation and leakage.

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Correct Answer is D

Explanation

A. "I will lie down for 30 minutes after each meal.": Lying down after meals increases reflux risk; clients should remain upright for 2–3 hours after eating.
B. "I will increase vitamin C intake by drinking orange juice.": Citrus juices are acidic and can aggravate GERD symptoms.
C. "I will sleep flat on my back at night.": Sleeping flat increases reflux; elevating the head of the bed is recommended.
D. "I will eat six small meals each day.": Smaller, more frequent meals reduce gastric distension and lower the risk of reflux.

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

Explanation

The first action the nurse should take is to assess neurovascular status followed by notify the provider.

Assess neurovascular status first: The diminished pulses and coolness of the right foot indicate compromised circulation, requiring immediate evaluation to confirm the severity.
Notify the provider: Once the critical assessment findings are confirmed, notifying the provider for prompt intervention is essential to prevent further complications.

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A nurse is reinforcing teaching about ostomy supplies with a client who has a new colostomy. Which of the following information should the nurse include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching with a client who has gastroesophageal reflux (GERD). Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer is D

Explanation

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

Explanation

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