The nurse is caring for a patient with inflammatory bowel disease who has been discharged with an ileostomy. The patient expresses reluctance to participate in aspects of ostomy care.

What is the nurse's most appropriate response to this observation?

Remind the patient that they will be responsible for caring for the ileostomy after discharge.

Reassure the patient that this procedure will be reversed in a few months.

Acknowledge the patient's reluctance and initiate discussion to explore their feelings.

Discuss with the medical team during interdisciplinary rounds the need for a psychiatric referral.

Answer and Explanation

The Correct Answer is C

Choice A reason: Reminding the patient that they will be responsible for caring for the ileostomy after discharge may increase their anxiety and reluctance. It does not address the underlying concerns or feelings.

Choice B reason: Reassuring the patient that the procedure will be reversed in a few months is not always accurate and may provide false hope. Each patient's situation is unique, and not all ileostomies are temporary.

Choice C reason: Acknowledging the patient's reluctance and initiating a discussion to explore their feelings is the most appropriate response. This approach allows the nurse to understand the patient's concerns, provide emotional support, and offer practical solutions to help the patient feel more comfortable with ostomy care.

Choice D reason: Discussing the need for a psychiatric referral during interdisciplinary rounds is not the immediate step. The nurse should first address the patient's feelings and concerns directly and provide support.

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Correct Answer is B

Explanation

Choice A reason: While acute pain is a possibility in peripheral neuropathy, infection poses a more serious risk. The sensory deficits in peripheral neuropathy can lead to unnoticed injuries and subsequent infections, especially in the lower extremities.

Choice B reason: Infection is a major risk in patients with peripheral neuropathy due to the loss of sensation, which can result in unnoticed injuries that can become infected. Additionally, high blood sugar levels in diabetes can impair the immune response, making infections more likely and harder to heal.

A. Arterial pH less than 7.3 B. Altered mental status C. Presence of ketones in urine D. Serum bicarbonate less than 15 mEq/L

Correct Answer is B

Explanation

Choice A reason: An arterial pH less than 7.3 indicates acidosis, which is common in diabetic ketoacidosis but not typical in hyperglycemic hyperosmolar syndrome. Patients with hyperglycemic hyperosmolar syndrome typically have a near-normal pH.

Choice B reason: Altered mental status is a significant clinical manifestation in hyperglycemic hyperosmolar syndrome due to severe hyperglycemia and the hyperosmolar state, which can lead to dehydration and impaired brain function.

Choice C reason: The presence of ketones in urine is more commonly associated with diabetic ketoacidosis rather than hyperglycemic hyperosmolar syndrome. The absence of significant ketonemia differentiates hyperglycemic hyperosmolar syndrome from diabetic ketoacidosis.

Choice D reason: Serum bicarbonate less than 15 mEq/L is indicative of metabolic acidosis, typically seen in diabetic ketoacidosis rather than hyperglycemic hyperosmolar syndrome, where bicarbonate levels are usually normal or slightly decreased.

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The nurse is caring for a patient with inflammatory bowel disease who has been discharged with an ileostomy. The patient expresses reluctance to participate in aspects of ostomy care. What is the nurse's most appropriate response to this observation?

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Correct Answer is B

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The nurse is caring for a patient with inflammatory bowel disease who has been discharged with an ileostomy. The patient expresses reluctance to participate in aspects of ostomy care.

What is the nurse's most appropriate response to this observation?