You are providing care for a patient who had an ileostomy placed one week ago after a bowel resection. You note the following findings during your assessment (see chart below):
|
Stoma Assessment |
Stoma is protruding 2cm, is red and moist. Peristomal area is clean and intact. |
|
Output |
Liquid stool that is malodorous. Gas present in the appliance. |
|
General Status |
Patient is avoiding looking at the ileostomy during care. |
|
Laboratory Data |
Potassium 3.6 mEq/L (normal 3.5 to 5 mEq/L) Sodium 137 mEq/L (normal 135 to 145 mEq/L) Creatinine 0.9 mg/dL (normal 0.6 to 1.2 mg/dL) |
What finding is most concerning to the nurse?
Output assessment
General Status
Stoma assessment
Laboratory data
The Correct Answer is B
A. Output assessment: Liquid stool and gas output are expected findings for an ileostomy.
B. General status: The patient’s avoidance of looking at the ileostomy suggests poor adaptation and possible psychological distress, which may require intervention.
C. Stoma assessment: A red, moist, and protruding stoma is a normal finding.
D. Laboratory data: The patient’s potassium level is on the lower end but still within normal limits. There are no critical abnormalities.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Transient incontinence and increased urine production: While increased urine production is expected, transient incontinence is not a typical finding with furosemide unless the client has preexisting bladder control issues.
B. Increased urine concentration: Furosemide is a loop diuretic that promotes the excretion of sodium and water, leading to dilute urine rather than concentrated urine.
C. Increased output of dilute urine: Furosemide blocks sodium reabsorption in the loop of Henle, resulting in increased urine production that is dilute due to excessive water excretion.
D. A risk of urinary tract infections: Furosemide does not directly increase the risk of urinary tract infections (UTIs). UTIs are more common with urinary retention rather than increased urine flow.
Correct Answer is A
Explanation
A. Better Clinical Outcomes: Meaningful Use ensures that healthcare providers adopt EHRs to improve quality, safety, and efficiency in patient care, leading to better treatment decisions and improved outcomes. Increased Transparency and Efficiency: EHRs promote real-time data sharing and streamlined workflows, reducing errors and redundant tests while enhancing communication between providers. Empowered Individuals: Patients have better access to their health records, leading to increased engagement, self-management of conditions, and informed decision-making.
B. More Robust Research Data on Health Systems: While EHR data can be used for research, this is not a direct goal of Meaningful Use. Improve Safety: This is a correct statement, but "Decrease Functionality" contradicts the purpose of Meaningful Use. Decrease Functionality: Meaningful Use aims to enhance, not reduce, the functionality of EHR systems.
C. Improved Population Health Outcomes: This is a correct benefit of Meaningful Use, as data-driven approaches help manage public health issues more effectively. Complicate Care Coordination: This is incorrect because Meaningful Use promotes interoperability, which enhances rather than complicates coordination. Interoperability: While interoperability is a goal of meaningful Use, this option presents a mix of correct and incorrect statements.
D. Improved Population Health Outcomes: This is a correct benefit of Meaningful Use. Increase Health Disparities: This is incorrect because Meaningful Use is designed to reduce disparities by improving access to digital health records and quality care. Engage Patients and Families: This is a correct statement, as patient portals and EHR access encourage active participation in health management. However, the inclusion of "Increase Health Disparities" makes this answer incorrect.
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