A nurse is reinforcing teaching with a client who is to undergo a bone marrow aspiration. Which of the following statements should the nurse include in the teaching?

"You will need to fast for 2 hours before the procedure."

"You will have the bone marrow taken from your femur."

"You will not receive a local anesthetic agent for this procedure."

"I will hold pressure on the site after the procedure."

Answer and Explanation

The Correct Answer is D

A. "You will need to fast for 2 hours before the procedure." Bone marrow aspiration typically does not require fasting. If the procedure involves sedation, the client may be instructed to fast for a certain period, but fasting is not a standard requirement for bone marrow aspiration.
B. "You will have the bone marrow taken from your femur." While the femur (thigh bone) can be a site for bone marrow aspiration, the most common site is the posterior iliac crest (the back of the pelvis). The nurse should clarify the exact site with the healthcare provider.
C. "You will not receive a local anesthetic agent for this procedure." Bone marrow aspiration is typically performed under local anesthesia to minimize discomfort at the site. The client will feel pressure during the procedure but should not experience pain due to the anesthesia.
D. "I will hold pressure on the site after the procedure." After a bone marrow aspiration, the nurse will apply pressure to the site to control any bleeding and help prevent hematoma formation. This is an important part of post-procedure care.

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Correct Answer is B

Explanation

A. Administer a glycerin suppository: While this may help, addressing bowel hypoactivity through ambulation is less invasive and more appropriate initially.
B. Ambulate the client in the hallway. Ambulation stimulates peristalsis, which can help resolve hypoactive bowel sounds and abdominal discomfort, making it the priority action.
C. Request the client to be NPO: Making the client NPO might be necessary later if symptoms worsen or there is suspicion of ileus or obstruction, but it is not the first action.
D. Offer an analgesic medication: Pain relief is essential, but analgesics (especially opioids) can worsen bowel hypoactivity. Prioritize interventions that restore bowel function first.

A. Soft, unformed stools B. Purplish stoma C. Noticeable stool odor D. Slight bleeding around the stoma

Correct Answer is B

Explanation

A. "Soft, unformed stools.": This can be expected, depending on the location of the colostomy.
B. "Purplish stoma." A purplish stoma suggests compromised blood flow, which is a medical emergency.
C. "Noticeable stool odor.": Odor is normal with colostomies unless accompanied by infection or other symptoms.
D. "Slight bleeding around the stoma.": Minimal bleeding during cleaning is common and expected initially.

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A nurse is reinforcing teaching with a client who is to undergo a bone marrow aspiration. Which of the following statements should the nurse include in the teaching?

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