After undergoing abdominal perineal excision for a colon tumor, a 55-year-old male patient is admitted for colostomy placement. The nurse will evaluate the newly inserted colostomy. Which of the following assessments indicates a functional colostomy?

Correct Answer: C

Rationale: Presence of flatus indicates a functional colostomy, showing bowel activity. Absent sounds suggest ileus, bloody drainage early post-op, food tolerance later. Nurses, per NCLEX, expect flatus as a sign of function, making C correct.

Correct Answer: B

Rationale: In end-of-life care, the primary goal shifts from curing to ensuring comfort and dignity, which involves managing pain and providing emotional support to both the patient and their family. Pain management addresses physical suffering, while emotional support helps alleviate fear, anxiety, or spiritual distress, aligning with holistic comfort principles. Choice A, aggressive treatment, contradicts this goal, as it may prolong suffering rather than enhance comfort. Choice C, limiting family visits, is inappropriate because family presence often provides emotional solace and supports the patient's psychosocial needs. Choice D, focusing only on physical symptoms, neglects the emotional, spiritual, and social dimensions critical in end-of-life care. Choice B stands out as the most appropriate, integrating comprehensive pain relief with emotional care to promote peace and comfort during this sensitive phase.

Correct Answer: B

Rationale: Physical or emotional stress is a common trigger for fibromyalgia pain, exacerbating the widespread musculoskeletal discomfort characteristic of the condition. Stress, whether from injury, overexertion, or psychological strain like anxiety, disrupts the central nervous system's pain processing, a key factor in fibromyalgia's pathology. Choice A, warm weather, might actually ease symptoms for some, as cold often worsens stiffness and pain. Choice C, regular exercise, while beneficial in moderation to maintain mobility, isn't a triggeroverdoing it might be, but that's distinct. Choice D, adequate rest, typically helps manage symptoms, not provoke them, though poor sleep can worsen pain. Choice B correctly identifies stress as a primary trigger, aligning with clinical observations that fibromyalgia patients experience flare-ups during stressful periods, making stress management a critical nursing focus.

Correct Answer: B

Rationale: The nurse anticipates widespread pain in a client with fibromyalgia reporting disturbed sleep and fatigue, as it's a hallmark symptom of the condition. Fibromyalgia involves chronic, diffuse musculoskeletal pain across multiple body regions, often exacerbated by poor sleep and fatigue, which disrupt pain modulation in the central nervous system. Increased appetite (Choice A) isn't typicalfatigue might reduce appetite due to low energy, not increase it. Headache (Choice C) can occur but isn't a core feature; fibromyalgia's pain is broader, not localized to the head. Bradycardia (Choice D), a slow heart rate, has no direct link to fibromyalgia, which doesn't typically affect cardiac rhythm. Widespread pain (Choice B) aligns with diagnostic criteria, making it the expected finding. Nurses assess this to tailor interventions like pain management, sleep aids, or stress reduction, addressing the triad of pain, sleep issues, and fatigue that defines fibromyalgia's impact on quality of life.

Correct Answer: B

Rationale: The nurse bases opioid analgesic dosage and timing on the client's weight and pain level, ensuring safe, effective relief tailored to body mass (for metabolism) and pain severity (for efficacy). Guidelines like mg/kg and pain scales (0-10) inform this, preventing under- or overdosing. Choice A, nurse's convenience, is unethicalcare prioritizes client need, not staff schedule. Choice C, time of day, might influence sleep-related dosing but isn't primarypain dictates timing (e.g., PRN). Choice D, drug availability, affects options but not dosage; nurses adjust within what's accessible, not arbitrarily. Choice B is correct, reflecting pharmacology principles nurses apply, balancing therapeutic effect with safety (e.g., monitoring respiratory depression), ensuring individualized care for acute or chronic pain management.