You have to teach ostomy self care to a patient with a colostomy. You tell the patient to measure and cut the wafer:

Correct Answer: C

Rationale: In teaching ostomy self-care to a patient with a colostomy, it is crucial to ensure the correct sizing of the wafer to promote proper ostomy function and skin integrity. Option C, cutting the wafer about 1/8" larger than the stoma, is the correct choice. This additional space allows for a secure fit around the stoma without putting pressure on it, reducing the risk of leakage and skin irritation. Option A, cutting to the exact size of the stoma, can lead to the wafer being too tight, causing pressure on the stoma and potentially leading to necrosis or skin breakdown. Option B, cutting slightly smaller than the stoma, may not provide enough coverage, leading to leakage issues. Option D, cutting significantly larger than the stoma, can result in poor adhesion, leakage, and skin irritation due to exposed skin. Educationally, understanding the rationale behind correct ostomy wafer sizing is essential for nurses to effectively educate patients on self-care practices. It ensures optimal patient outcomes, promotes independence in managing their ostomy, and prevents complications. Providing clear and accurate instructions empowers patients to maintain their ostomy effectively, improving their quality of life and overall well-being.

Correct Answer: D

Rationale: In this scenario, the correct answer is option D: The surgery occurs in two stages. The rationale behind this is that creating an ileoanal reservoir involves a two-stage surgical procedure. In the first stage, the colon is removed, and the ileoanal reservoir is created, allowing for the storage of stool. A temporary ileostomy may be created to allow healing. In the second stage, the ileostomy is closed, and the patient is then able to pass stool through the newly created reservoir. Option A: A reservoir is created that exits through the abdominal wall is incorrect because the ileoanal reservoir is typically internal and does not exit through the abdominal wall. Option B: A second surgery is required 12 months after the first surgery is incorrect because the two-stage surgery typically occurs within a few months of each other, not 12 months apart. Option C: A permanent ileostomy is created is incorrect because the goal of the ileoanal reservoir surgery is to avoid the need for a permanent ileostomy by creating a new storage area for stool. Educationally, understanding the two-stage process of creating an ileoanal reservoir is crucial for nurses caring for patients with ulcerative colitis undergoing this surgery. This knowledge allows nurses to provide accurate preoperative teaching, prepare patients for what to expect during the surgical process, and support them through their recovery journey.

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 this scenario where a client with ulcerative colitis has symptoms for over a week, the nurse should carefully assess for signs of hypokalemia, making option C the correct choice. Ulcerative colitis can lead to electrolyte imbalances due to chronic inflammation and diarrhea, resulting in potassium loss. Hypokalemia can lead to serious complications like cardiac dysrhythmias and muscle weakness. Option A, heart failure, is not directly associated with ulcerative colitis unless there are underlying cardiovascular conditions. Option B, DVT (deep vein thrombosis), is more commonly associated with immobility and hypercoagulability rather than ulcerative colitis. Option D, hypocalcemia, is less likely in this context as it is not a common complication of ulcerative colitis compared to electrolyte imbalances like hypokalemia. Educationally, understanding the complications of ulcerative colitis is crucial for nurses to provide comprehensive care and early intervention. Recognizing the signs and symptoms of hypokalemia in this case can prevent serious adverse outcomes for the client. Integrating pathophysiology knowledge with clinical assessment skills is essential in medical-surgical 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.