A nurse is using the domains of learning to provide teaching to a client who has diabetes mellitus. Which of the following actions should the nurse take to utilize psychomotor learning?

Rationale

A. "Empty the ostomy pouch when it becomes one-third full of contents.": Emptying the pouch before it becomes too full prevents leakage, skin irritation, and discomfort. Regular emptying supports hygiene and maintains appliance adherence, which is essential for stoma care.

B. "Expect the stoma to turn a purple-blue color as it heals.": A healthy stoma should be pink to red, indicating good perfusion. Purple-blue discoloration may indicate ischemia or compromised blood flow, which requires immediate provider notification.

C. "Place a piece of gauze over the stoma while changing the pouch.": Gauze is not necessary and may interfere with proper pouch application. Direct handling with clean technique and using the appliance as designed is sufficient for maintaining hygiene and protecting the stoma.

D. "Cut the opening of the pouch 1/8 of an inch larger than the stoma.": Ensuring the pouch opening is slightly larger than the stoma protects peristomal skin from contact with effluent while maintaining a secure fit. Accurate sizing is critical for preventing skin breakdown and leakage.

E. "Use povidone-iodine to clean around the stoma.": Povidone-iodine is harsh and can irritate peristomal skin. Gentle washing with warm water and mild soap is recommended to preserve skin integrity and prevent irritation.

Rationale

A. Ensure the client wears a surgical mask when they are outside of their room: The client has no current respiratory symptoms and no evidence of an active infection requiring droplet or airborne precautions. The previous pneumonia noted in the history is resolved. Standard precautions are therefore adequate at this time.

B. Place the client on contact precautions: The sudden onset of abdominal cramping and multiple loose stools after antibiotic therapy raises concern for possible C. difficile infection. Initiating contact precautions promptly helps prevent the spread of spores, which can contaminate surfaces and infect other clients. Early isolation is critical when diarrhea develops in a client receiving broad-spectrum antibiotics.

C. Clarify the prescription for amoxicillin with the provider: The client’s documented penicillin allergy places them at risk for hypersensitivity reactions when given amoxicillin, a penicillin-class antibiotic. Even if doses have been tolerated so far, the risk of an allergic event remains significant.

D. Hold the dose of levothyroxine: Levothyroxine should be administered consistently to maintain stable thyroid hormone levels, and the client shows no findings indicating the need to withhold it. Vital signs and clinical status do not suggest complications related to thyroid therapy or excess dosing. Disrupting routine thyroid management could worsen metabolic balance.

E. Recommend increasing the dose of metoprolol: Vital signs demonstrate stable blood pressure and heart rate, showing no evidence of inadequate control of hypertension. Increasing the dose without indication could result in hypotension or bradycardia, which may compromise perfusion. No assessment data support changing this medication at this time.

F. Request a prescription for an antiemetic medication: The client continues to experience persistent nausea and has demonstrated reduced dietary intake for several days, which may impair hydration and oral medication tolerance. Addressing nausea helps support nutritional intake and overall recovery.