The nurse provides discharge instructions to a patient with hepatitis B. Which of the following statements, if made by the patient, would indicate the need for further instruction?

Correct Answer: D

Rationale: Rationale for Correct Answer (D): The patient should avoid drugs and alcohol to prevent further damage to the liver affected by hepatitis B. Substance abuse can exacerbate liver disease. This statement indicates understanding of the importance of liver health. Summary of Other Choices: A: This statement is correct because individuals with hepatitis B should not donate blood to prevent transmission. B: This statement is correct because unprotected sex can transmit hepatitis B to sexual partners. C: This statement is correct because sharing needles can spread hepatitis B through blood-to-blood contact.

Correct Answer: B

Rationale: The correct answer is B because discussing concerns about sexual functioning is an appropriate expected outcome at this point. After an abdominal perineal resection with a colostomy, it is important for the client to address any concerns related to sexual functioning as it can impact their quality of life. A: The client maintaining a high-fiber diet is not the most appropriate expected outcome at this point as it may be too soon after surgery to focus solely on dietary adjustments. C: The client maintaining bedrest is not appropriate as early mobilization is usually encouraged after surgery to prevent complications. D: Limiting fluid intake to 1000 ml/day is not recommended as adequate hydration is crucial for recovery post-surgery.

Correct Answer: D

Rationale: Rationale for Correct Answer (D): By assessing for gastric residual before administering another feeding through the nasogastric tube, the nurse can evaluate absorption of the last feeding. If there is a significant amount of residual, it may indicate poor absorption, which could lead to complications such as aspiration. This assessment helps in determining the appropriate timing and amount of the next feeding to prevent complications. Summary of Incorrect Choices: A: Confirming proper nasogastric tube placement is typically done using other methods like pH testing or X-ray. This assessment does not directly relate to evaluating absorption. B: Observing gastric contents may provide information about the patient's gastric secretions but does not specifically help in evaluating the absorption of the last feeding. C: Assessing fluid and electrolyte status is important but not the primary purpose of checking gastric residual before administering a feeding. This assessment is more focused on monitoring the patient's overall hydration and electrolyte balance.

Correct Answer: B

Rationale: The correct answer is B: The client verbalizes the importance of small, frequent feedings. This is appropriate for a client with ulcerative colitis because small, frequent feedings help reduce gastrointestinal distress and maintain proper nutrition. Clients with ulcerative colitis often have difficulty tolerating large meals, so small, frequent feedings can help prevent exacerbation of symptoms. A: Recording intake and output is important for certain conditions but not specifically for ulcerative colitis. C: Using a heating pad may provide temporary relief for abdominal cramping but does not address the underlying issue of ulcerative colitis. D: Accepting a colostomy is not an expected outcome for ulcerative colitis treatment unless all other options have failed.

Correct Answer: A

Rationale: The correct answer is A: Vitamin B12 injections. Pernicious anemia results from a lack of intrinsic factor, which is needed for Vitamin B12 absorption. Since the stomach lining produces less intrinsic factor after gastric surgery, the client cannot absorb B12 orally. Therefore, B12 injections are necessary to bypass the need for intrinsic factor. Vitamin B6 injections (B) are not indicated for pernicious anemia. Antibiotics (C) and antacids (D) are not relevant to the treatment of pernicious anemia.