Which of the following is not a component of saliva?

Correct Answer: D

Rationale: The correct answer is D: Hydrochloric acid. Saliva is composed mainly of water, amylase (an enzyme that breaks down starch), and mucus. Hydrochloric acid is not a component of saliva; instead, it is a component of gastric juice produced in the stomach. It plays a role in the digestion of food in the stomach by lowering the pH level. Therefore, choice D is the correct answer as it does not belong to the components of saliva. Choices A, B, and C are incorrect as they are all components found in saliva.

Correct Answer: B

Rationale: The correct answer is B: The patient uses witch hazel compresses to soothe irritation. Witch hazel has astringent and anti-inflammatory properties, which can help reduce inflammation and soothe irritated skin. By using witch hazel compresses, the patient is actively taking steps to alleviate discomfort and promote skin healing. A: The patient using incontinence briefs to contain loose stools does not address the issue of skin integrity maintenance and may lead to prolonged exposure of the skin to stool, exacerbating the problem. C: Asking for antidiarrheal medication after each stool does not directly address the need for skin integrity maintenance. While it may help reduce stool frequency, it does not specifically target skin healing. D: Cleaning the perianal area with soap after each stool can be harsh on the already excoriated skin and may further irritate it. Using soap can strip the skin of its natural oils and hinder the healing process.

Correct Answer: D

Rationale: The correct answer is D: Document stoma assessment findings. The rationale for this choice is that documentation is crucial in providing a clear and accurate record of the stoma's condition for ongoing monitoring and evaluation. By documenting the stoma assessment findings, the nurse can track any changes in color, edema, or drainage over time, which helps in identifying any potential issues or improvements. Choice A is incorrect because placing ice packs around the stoma can cause vasoconstriction and worsen the edema. Choice B is unnecessary at this point as the nurse can first assess and document the stoma before escalating to the surgeon if needed. Choice C is not the best action as monitoring every 30 minutes may be excessive and not practical, especially if the patient is stable.

Correct Answer: A

Rationale: The correct answer is A because parasympathetic impulses do not lead to the secretion of somatostatin. Somatostatin is released in response to low pH in the stomach to inhibit further acid secretion. Parasympathetic impulses stimulate the secretion of gastrin, promote histamine release, and inhibit somatostatin secretion. This is important for enhancing gastric acid secretion and promoting digestion. Therefore, choices B, C, and D are incorrect as they are effects of parasympathetic stomach impulses.

Correct Answer: B

Rationale: The correct answer is B: obstructive jaundice. Gallstones can obstruct the bile duct, leading to the buildup of bile pigment in tissues, causing jaundice. This results in the characteristic yellowing of the skin and eyes. Hyperbilirubinemia (A) refers to elevated levels of bilirubin in the blood, which can occur in various liver conditions. Hepatitis (C) is inflammation of the liver, which can also lead to jaundice but is not directly caused by gallstones. Hepatocellular jaundice (D) is due to liver cell damage, not bile duct obstruction.