During a preoperative assessment phone call, a client reports taking several “pills” every day. Which response should the office nurse provide?

Choice A reason: A purple stoma mucosa indicates ischemia or necrosis, a surgical emergency post-colostomy. Poor blood supply risks stoma failure, infection, or perforation, requiring immediate surgical evaluation. This finding is critical, as it threatens the colostomy’s viability, making it the priority to report.

Choice B reason: Brown, solid fecal matter is normal 24 hours post-colostomy, indicating bowel function. This does not suggest complications like ischemia or obstruction, requiring no immediate reporting, as it aligns with expected postoperative outcomes, making this finding benign.

Choice C reason: Streaks of bright red blood from the stoma suggest minor trauma or irritation, common post-colostomy. This is less urgent than purple mucosa, which indicates ischemia, a life-threatening issue, making bleeding a secondary concern requiring monitoring but not immediate surgical intervention.

Choice D reason: Absent bowel sounds in the left lower quadrant are expected post-bowel surgery due to ileus. This is less urgent than purple stoma mucosa, which signals necrosis, requiring immediate action, making bowel sounds a normal postoperative finding not warranting urgent reporting.

Choice A reason: Avoiding wine, beer, and coffee is critical, as alcohol and purine-rich beverages increase uric acid, triggering gout attacks. These exacerbate hyperuricemia, worsening toe inflammation. This dietary restriction prevents recurrent flares, making it a key instruction for managing gouty arthritis effectively.

Choice B reason: Taking pain medication after exercising joints is incorrect, as exercise during a gout attack worsens inflammation. Pain relief should precede activity, and rest is advised during flares, making this instruction harmful, as it risks exacerbating the client’s toe pain.

Choice C reason: Replacing table salt with substitutes is irrelevant to gout, as salt does not affect uric acid metabolism. Gout management focuses on reducing purines and alcohol, and salt substitutes may contain potassium, unrelated to inflammation, making this instruction ineffective.

Choice D reason: Encouraging active range of motion during a gout attack increases joint stress, worsening inflammation. Rest is recommended during acute flares, and mobility is introduced later, making this instruction counterproductive, as it risks prolonging pain and delaying recovery.