Assessment findings for a client following a colectomy for familial polyposis include an ileostomy bag that contains a large amount of fecal liquid and an IV infusion of dextrose 5% in lactated Ringer's infusing at a rate of 100 mL/hour. Which assessment is most

Urinary output.

Serum electrolytes.

Peristomal skin integrity.

Skin turgor.

Answer and Explanation

The Correct Answer is B

A.   While monitoring urinary output is important, it is not the most critical assessment in this context.
B.   Monitoring serum electrolytes is crucial because the large amount of fecal liquid output from the ileostomy can lead to significant electrolyte imbalances.
C.   Peristomal skin integrity is important but is secondary to the immediate risk of electrolyte imbalances.
D.   Skin turgor is important for assessing hydration status, but monitoring electrolytes is more directly related to the immediate postoperative care.

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Correct Answer is A

Explanation

A. Diarrhea can lead to significant fluid and electrolyte imbalances, especially in older adults. Prioritizing hydration and electrolyte management is essential to prevent severe complications like renal failure or shock.
B. While caregiver stress is significant and must be addressed, it is not as immediately life-threatening as a fluid volume deficit.
C. This is an ongoing management issue but does not pose an immediate threat to the client's life compared to fluid and electrolyte imbalances.
D. Although important for overall care and prevention of complications such as pressure ulcers, it is not as critical as managing fluid volume deficit in this scenario.

A. Plain, air-popped popcorn. B. Cheddar cheese cubes. C. Lightly salted potato chips. D. Natural whole almonds. E. Canned fruit in heavy syrup.

Correct Answer is ["A","D"]

Explanation

A. Plain, air-popped popcorn is a low-calorie, low-sodium snack that is suitable for clients with heart failure.
B. Cheddar cheese cubes are high in fat and sodium, which is not ideal for heart failure management.

C. Lightly salted potato chips still contain significant sodium, which should be limited in heart failure diets.
D. Natural whole almonds are a good source of healthy fats and protein, making them a suitable option.
E. Canned fruit in heavy syrup contains added sugars and unnecessary calories, which should be avoided.

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Assessment findings for a client following a colectomy for familial polyposis include an ileostomy bag that contains a large amount of fecal liquid and an IV infusion of dextrose 5% in lactated Ringer's infusing at a rate of 100 mL/hour. Which assessment is most

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Naxlex Comprehensive Predictor Exams

The nurse identifies several problems for an older adult client experiencing diarrhea and fecal incontinence who is confined to bed and being cared for by a primary caregiver. In planning care, the nurse should determine which nursing problem is the highest priority?

Correct Answer is A

Explanation

During discharge teaching, an overweight client with heart failure (HF) is asked to make a grocery list for the nurse to review. What food choice(s) included on the client's list should the nurse encourage? Select all that apply.

Correct Answer is ["A","D"]

Explanation

When assessing a client with an ionized calcium level of 17 mg/dL (4.25 mmol/L), which intervention is most important for the nurse to implement? Reference Range lonized Calcium [Adult 4.6 to 5.1 mg/dL (1.15 to 1.35 mmol/L)]

What 2 orders should the nurse complete first?

Patient Data Exhibits Which assessment findings indicate that the client has stabilized? Select all that apply.

The nurse is assigned to care for four surgical clients. After receiving report, which client should the nurse see first?

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An older client is being admitted to a rehabilitation unit from a medical-surgical unit following a left hip replacement. When reviewing the client's prescribed medications, which intervention should the nurse implement first?

Patient Data Exhibits Click to select the 5 most important nursing interventions for postoperative client care.

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