Physician order reads: Furosemide 60 mg po bid. Available: 40 mg scored tablets. What do you administer to the patient?

Choice A reason: Pulling fluid into the bowel describes osmotic laxatives (e.g., lactulose), which increase water content to soften stool and stimulate peristalsis. Bulk-forming agents work by absorbing water to increase stool volume, not by osmotically drawing fluid.

Choice B reason: Bulk-forming agents (e.g., psyllium) absorb water in the intestine, swelling to form a bulky, soft stool that stimulates peristalsis. Taken with adequate water, they promote regular bowel movements, making this the accurate description.

Choice C reason: Softening the fecal mass describes stool softeners (e.g., docusate), which reduce stool surface tension to allow water penetration. Bulk-forming agents primarily increase stool volume, not just soften it, distinguishing their mechanism.

Choice D reason: Causing local irritation describes stimulant laxatives (e.g., bisacodyl), which irritate the mucosa to enhance motility and reduce water absorption. Bulk-forming agents work mechanically by adding bulk, not through chemical irritation.

Choice A reason: Using soap and water to cleanse the stoma site risks skin irritation, as soap can disrupt the skin’s natural barrier, leading to dermatitis or poor pouch adhesion. Gentle cleansing with water or specialized products is preferred to maintain peristomal skin integrity and prevent complications.

Choice B reason: Leaving a 1/2-inch space around the stoma is excessive. The barrier should fit closely (1/16 to 1/8 inch) to protect peristomal skin from effluent, which can cause irritation or breakdown. A larger gap risks skin damage, compromising pouch adherence and patient comfort.

Choice C reason: Emptying the pouch when one-third to one-half full is appropriate. This prevents leakage, reduces pouch weight, and maintains skin integrity by minimizing effluent contact. Regular emptying supports patient comfort and prevents complications like skin irritation or pouch detachment, critical for ileostomy care.

Choice D reason: Changing the skin barrier daily is unnecessary unless leakage or skin issues occur. Barriers typically last 3-7 days, depending on output and skin condition. Daily changes risk skin trauma from frequent adhesive removal, increasing irritation and compromising peristomal skin health.