A nurse is doing discharge teaching on a client with a colostomy. What would the nurse convey to the client regarding when is the best time to perform irrigation?

Correct Answer: D

Rationale: The correct answer is D: Two hours before a meal. This timing allows for the colon to be relatively empty, making irrigation more effective. Irrigating two hours before a meal helps to prevent interference with digestion and absorption processes. Irrigating after a meal (choice A) or during a meal (choice C) may lead to discomfort, bloating, or potential leakage. Irrigating after a bowel movement (choice B) may not provide enough time for the colon to be adequately empty for effective irrigation.

Correct Answer: B

Rationale: The correct answer is B: History of untreated depression. Before proceeding with further patient preparation for bariatric surgery, it is crucial to address untreated depression as it can significantly impact the patient's mental and emotional well-being post-operatively. Untreated depression can lead to poor compliance with post-operative instructions, medication management issues, and potentially increase the risk of complications. It is essential to involve the surgeon to assess the patient's psychological readiness for surgery and ensure appropriate support and resources are in place. Incorrect choices: A: History of hypertension - While hypertension should be managed pre-operatively, it is not a critical factor that would require immediate attention before further preparation. C: History of multiple attempts at weight loss - This is a common issue in patients undergoing bariatric surgery and does not pose an immediate risk that needs urgent attention. D: History of sleep apnea treated with CPAP - While sleep apnea is a relevant consideration for bariatric surgery, the fact that it is being treated with

Correct Answer: A

Rationale: The correct answer is A because a 55-year-old female who is a smoker and experiencing symptoms of nausea and vomiting has multiple risk factors for developing a gastric ulcer. Smoking and older age are established risk factors for gastric ulcers. Nausea and vomiting can be indicative of underlying gastrointestinal issues. Choice B is less likely as illicit drug use typically does not directly increase the risk of gastric ulcers. Choice C is less likely as the male falling while looking for a job does not directly relate to gastric ulcer development. Choice D is less likely as divorce and back pain are not direct risk factors for gastric ulcers.

Correct Answer: C

Rationale: The correct answer is C. Assessing the onset, location, intensity, duration, and character of the pain is the priority because it helps determine the potential cause of the abdominal pain. This information guides further interventions and informs the healthcare team about the urgency of the situation. Choice A (Measurement of vital signs) can be important but assessing the pain characteristics takes precedence as it directly informs the urgency of the situation. Choice B (Administration of prescribed analgesics) should be delayed until the cause of the pain is identified to prevent masking symptoms that could aid in diagnosis. Choice D (Physical assessment of the abdomen) is important but assessing the pain characteristics comes first to guide the physical assessment and subsequent interventions.

Correct Answer: D

Rationale: The correct answer is D because in the event of leakage from the pouch, it is important to promptly remove it, clean the skin, and apply a new pouch to prevent skin irritation and infection. This step is crucial for maintaining skin integrity and preventing complications. Choice A is incorrect as ileostomy pouches typically need to be changed more frequently, usually every 3-7 days, to prevent skin breakdown and odor. Choice B is incorrect because decreasing fluid intake can lead to dehydration and electrolyte imbalances, which are especially risky for ileostomy patients who have increased fluid losses. Choice C is incorrect because the pouch should not be removed until the stoma and bowel movements have been evaluated and regulated to ensure proper functioning.