Which goal of the client's care should take priority during the first days of hospitalization for an exacerbation of ulcerative colitis?

Correct Answer: B

Rationale: In the context of caring for a client hospitalized for an exacerbation of ulcerative colitis, the priority goal during the first days would be managing diarrhea, making option B the correct answer. This is because diarrhea is a common symptom of ulcerative colitis exacerbation and can lead to dehydration, electrolyte imbalances, and worsening of the condition. By effectively managing diarrhea, the healthcare team can help stabilize the client's condition and prevent further complications. Promoting self-care and independence (option A) is important in the long term but may not be the immediate priority during the acute phase of exacerbation when the client may require more intensive nursing care. Maintaining adequate nutrition (option C) is crucial in managing ulcerative colitis, but addressing diarrhea takes precedence in the initial phase. Promoting rest and comfort (option D) is also important but may not directly address the urgent physiological needs associated with diarrhea management. In an educational context, understanding the prioritization of care goals in different phases of a client's condition is essential for nurses. By recognizing the most critical needs of the client at any given time, nurses can provide effective and timely care to improve patient outcomes and prevent complications. This case highlights the significance of clinical judgment and critical thinking in nursing practice.

Correct Answer: C

Rationale: In the case of a client with ulcerative colitis experiencing persistent diarrhea and significant weight loss, the correct approach to help meet their nutritional needs is to implement total parenteral nutrition (TPN) as indicated by option C. TPN provides complete nutrition intravenously, bypassing the gastrointestinal tract to allow rest and healing, which is crucial in severe cases where oral or enteral feedings may not be tolerated or absorbed adequately. Option A, continuous enteral feedings, may not be effective if the client's gut is inflamed and unable to absorb nutrients efficiently. Option B, encouraging a high protein, high-calorie diet, may exacerbate diarrhea and worsen the client's condition. Option D, providing six small meals a day, may not provide the necessary nutrients and calories needed for a client with significant weight loss and malnutrition. Educationally, understanding the rationale behind TPN use in gastrointestinal disorders like ulcerative colitis is essential for nurses caring for such patients. It highlights the importance of tailored nutritional support based on the individual's condition and the need to consider alternative routes of administration when the gastrointestinal system is compromised.

Correct Answer: C

Rationale: In the context of caring for a patient who has just undergone ileostomy surgery, it is crucial for nurses to understand the expected drainage from the ileostomy in the immediate postoperative period. The correct answer, option C (1500 ml), is the most appropriate choice. Post-ileostomy surgery, the ileostomy will initially produce a significant amount of drainage due to the presence of residual fluids and secretions in the gastrointestinal tract. This drainage consists of digestive enzymes, bile, mucus, and other fluids. It is essential for nurses to monitor the output closely to assess the patient's hydration status and prevent complications such as electrolyte imbalances or dehydration. Options A, B, and D are incorrect because they do not reflect the typical range of drainage seen in the first 24 hours post-ileostomy surgery. A drainage of 100 ml (option A) would be too low, while 500 ml (option B) falls below the expected amount. A drainage of 5000 ml (option D) is excessively high and would raise concerns about fluid and electrolyte imbalances. Educationally, this question highlights the importance of accurate postoperative assessment and management of patients undergoing gastrointestinal surgery. It emphasizes the need for nurses to have a comprehensive understanding of expected postoperative outcomes to provide safe and effective care to patients with an ileostomy. Monitoring ileostomy drainage is a critical nursing intervention to ensure optimal patient outcomes and prevent complications.

Correct Answer: B

Rationale: In preparing a teaching plan for Jeff, who underwent surgery to close a temporary ileostomy, the inclusion of the nutritional guideline to eat six small meals a day (Option B) is crucial. This recommendation is based on the physiological changes following ileostomy closure. Eating smaller, more frequent meals helps in managing the reduced capacity of the gastrointestinal tract to handle large meals post-surgery. It aids in better digestion, absorption of nutrients, and reduces the risk of bowel obstruction or discomfort. Option A, stating there is no need to change eating habits, is incorrect as post-ileostomy closure, dietary adjustments are necessary to support the healing process and optimize nutrient absorption. Option C, advising to eat the largest meal in the evening, is incorrect as spreading food intake throughout the day is more beneficial for Jeff's gastrointestinal health. Option D, suggesting to restrict fluid intake, is also incorrect as maintaining adequate hydration is essential post-surgery to prevent dehydration and support optimal gastrointestinal function. In an educational context, it is important to teach patients undergoing ileostomy closure about the importance of dietary modifications to promote successful recovery and prevent complications. Providing evidence-based guidelines empowers patients like Jeff to actively participate in their care and make informed decisions regarding their health and well-being.

Correct Answer: B

Rationale: The most therapeutic response in this scenario is option B, "You seem upset." This response demonstrates active listening and empathy towards Arthur's emotional state without making assumptions or providing false reassurance. By acknowledging his emotions, the nurse opens up a safe space for Arthur to express his concerns and fears, which can help build trust and facilitate effective communication. Option A, "I know just how you feel," is not the best response because it invalidates Arthur's unique experience by assuming the nurse knows exactly how he feels. This can come across as dismissive and may hinder open dialogue. Option C, "Oh, don't worry about it, everything will be just fine," is not appropriate as it provides false reassurance and minimizes Arthur's emotional distress. It fails to address his concerns and can lead to a breakdown in the therapeutic nurse-patient relationship. Option D, "Why do you think you have cancer?" is not the most therapeutic response as it may come off as confrontational and could make Arthur feel defensive. This question puts the onus on Arthur to justify his feelings rather than focusing on addressing his emotional needs during this vulnerable moment. In an educational context, it is essential for nursing students to understand the importance of therapeutic communication in building rapport with patients. Active listening, empathy, and validation of emotions are crucial skills that nurses must develop to provide holistic and patient-centered care. By choosing the most appropriate responses in challenging situations like this, nurses can support patients effectively through their emotional and physical health journeys.