Which of the following instructions should a nurse

Question 1 of 5

Which of the following instructions should a nurse provide a client with an ileostomy when using the catheter?

A. Avoid warming the catheter before inserting it into the ileal pouch. B. Report if there is resistance when the catheter reaches the nipple valve. C. Avoid coughing when the catheter is being inserted into the ileal pouch. D. Clean catheter with soapy water and store it in a plastic bag after use.

Correct Answer: B

Rationale: Resistance at the nipple valve may indicate blockage, and the client should report it to avoid complications.

Question 2 of 5

Priority Decision: A patient with ulcerative colitis has a total proctocolectomy with formation of a terminal ileum stom What is the most important nursing intervention for this patient postoperatively?

A. Measure the ileostomy output to determine the status of the patient's fluid balance. B. Change the ileostomy appliance every 3 to 4 hours to prevent leakage of drainage onto the skin. C. Emphasize that the ostomy is temporary and the ileum will be reconnected when the large bowel heals. D. Teach the patient about the high-fiber, low-carbohydrate diet required to maintain normal ileostomy drainage.

Correct Answer: A

Rationale: Measuring ileostomy output is crucial to assess fluid balance and prevent dehydration in the patient postoperatively.

Question 3 of 5

Priority Decision: Following auscultation of the abdomen, what should the nurse's next action be?

A. Lightly percuss over all four quadrants B. Have the patient empty his or her bladder C. Inspect perianal and anal areas for color masses and scars D. Perform deep palpation to delineate abdominal organs and masses

Correct Answer: A

Rationale: After auscultation percussing the abdomen helps assess for fluid gas or organ enlargement.

Question 4 of 5

What is a risk factor associated with cancer of the pancreas?

A. Alcohol intake B. Cigarette smoking C. Exposure to asbestos D. Increased dietary intake of spoiled milk products

Correct Answer: B

Rationale: Cigarette smoking is a well-established risk factor for pancreatic cancer.

Question 5 of 5

Which of the following instructions should a nurse provide a client with an ileostomy when using the catheter?

A. Avoid warming the catheter before inserting it into the ileal pouch. B. Report if there is resistance when the catheter reaches the nipple valve. C. Avoid coughing when the catheter is being inserted into the ileal pouch. D. Clean catheter with soapy water and store it in a plastic bag after use.

Correct Answer: B

Rationale: Resistance at the nipple valve may indicate blockage, and the client should report it to avoid complications.

Which of the following instructions should a nurse provide a client with an ileostomy when using the catheter?

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