You're preparing a patient with a malignant tumor for colorectal surgery and subsequent colostomy. The patient tells you he's anxious. What should your initial step be in working with this patient?

Correct Answer: A

Rationale: In preparing a patient with a malignant tumor for colorectal surgery and subsequent colostomy, the initial step should be to determine what the patient already knows about colostomies (Option A). This is crucial for assessing the patient's baseline knowledge, addressing any misconceptions, and tailoring education to meet their specific needs and concerns. Option B, showing pictures of colostomies, may be overwhelming for a patient experiencing anxiety and could potentially increase their distress. Option C, arranging for someone with a colostomy to visit the patient, may not always be feasible and might not address the patient's individual questions and fears. Option D, providing written material, may not be effective if the patient is too anxious to read or comprehend the information. In an educational context, effective patient education involves assessing the patient's knowledge, addressing their concerns, and providing information in a way that is tailored to their needs and preferences. By starting with what the patient already knows, healthcare providers can build upon existing knowledge, correct misunderstandings, and ensure that the patient is well-prepared and supported for the upcoming surgery and colostomy.

Correct Answer: C

Rationale: In the context of a severe exacerbation of ulcerative colitis, the correct long-term medication choice is corticosteroids (Option C). Here's a detailed rationale: Corticosteroids are commonly used in ulcerative colitis to reduce inflammation and suppress the immune response in the colon. They help in inducing and maintaining remission in patients with severe disease activity. Antacids (Option A) are primarily used for conditions such as acid reflux and peptic ulcers, not for ulcerative colitis. Antibiotics (Option B) may be used in cases of infection but are not the mainstay of treatment for ulcerative colitis. Histamine2-receptor blockers (Option D) are used for conditions like GERD and peptic ulcers, not for inflammatory bowel diseases like ulcerative colitis. In an educational context, it's crucial for nursing students to understand the rationale behind medication choices in gastrointestinal disorders like ulcerative colitis. Knowing the appropriate pharmacological interventions based on the underlying pathophysiology and severity of the condition is essential for providing safe and effective patient care. This question highlights the importance of selecting the right medications tailored to the specific disease process.

Correct Answer: A

Rationale: In the context of a patient with liver failure, limiting meats and beans (Option A) in the diet is crucial due to their high protein content. The liver is responsible for metabolizing proteins, and in liver failure, the organ's ability to process protein is compromised, leading to ammonia buildup and potential encephalopathy. By reducing protein intake, the workload on the liver is decreased, helping to manage symptoms and prevent further damage. Butter and gravies (Option B) are high in fats, which can worsen liver function as the liver struggles to process them. Excessive fat consumption can lead to fatty liver disease and exacerbate the patient's condition. Potatoes and pastas (Option C) are sources of carbohydrates and are generally acceptable in moderation for a patient with liver failure unless they have other comorbid conditions like diabetes or obesity. Carbohydrates provide energy and are not as directly taxing on the liver as proteins and fats. Cakes and pastries (Option D) are high in sugars and unhealthy fats, which can contribute to weight gain and fatty liver disease. These should be limited in a patient with liver failure to prevent further stress on the liver. Educationally, understanding dietary restrictions in liver failure is essential for patient care. Teaching families about appropriate food choices helps them support the patient's health and recovery. It also highlights the importance of individualized care based on the patient's specific condition to optimize outcomes.

Correct Answer: B

Rationale: The correct response, B) Stop the feeding, and clamp the NG tube, is based on the principle of patient safety and preventing complications. Aspirating 220ml of gastric residual suggests poor gastric emptying and potential risk for aspiration, which can lead to respiratory compromise. By stopping the feeding and clamping the NG tube, you are preventing the patient from receiving more feedings that could potentially exacerbate the situation. Option A) Notify the doctor immediately is not the first response because immediate action is needed to address the risk of aspiration. Waiting for a physician's response could delay necessary interventions. Option C) Discard the 220ml, and clamp the NG tube is incorrect because discarding the aspirate without taking action to prevent further feeding could still lead to complications. Option D) Give a prescribed GI stimulant such as metoclopramide (Reglan) is not appropriate in this situation as the priority is to address the immediate risk of aspiration rather than promoting gastric motility. In an educational context, understanding the significance of gastric residuals in enteral feedings is crucial for nurses caring for patients with NG tubes. Prompt recognition of abnormal findings and appropriate actions can prevent serious complications and promote patient safety in medical-surgical settings.

Correct Answer: D

Rationale: Delegating tasks such as providing skin care, maintaining intake and output records, and obtaining the client's weight are within the scope of practice for an unlicensed assistant. Assessing bowel sounds and evaluating the response to medications require nursing judgment and should not be delegated.