Transcript
Clinical Manifestations 1. The nurse anticipates that Loren will describe her diarrhea as: A) Bloody. Feedback: CORRECT Clients with ulcerative colitis may experience as many as 10-20 liquid, bloody stools per day. B) Green and frothy. Feedback: INCORRECT This description is not associated with the diarrhea of ulcerative colitis. C) Gray with observable fat. Feedback: INCORRECT This describes stool often seen in pancreatitis. D) Clay-colored. Feedback: INCORRECT Clay-colored stool indicates the absence of bile in the stool, which may be seen in clients with cirrhosis or cholecystitis. Points Earned: 0.0/1.0 Correct Answer(s): A 2. Because rectal bleeding is a common finding in ulcerative colitis, which additional question is important for the nurse to ask Loren? A) "Do you ever hear ringing in your ears?" Feedback: INCORRECT This is not a manifestation related to bleeding, although aspirin is associated with GI distress and bleeding, and ringing in the ears is associated with aspirin toxicity. B) "Do you feel fatigued or light-headed?" Feedback: CORRECT Continuous rectal bleeding will result in anemia, causing the client to feel fatigued, dizzy, light-headed, and weak. C) "Do you experience tremors or headaches?" Feedback: INCORRECT These are not typical manifestations associated with rectal bleeding or resultant anemia. D) "Do you have trouble remembering recent events?" Feedback: INCORRECT This is not a typical manifestation associated with rectal bleeding or resultant anemia. Points Earned: 1.0/1.0 Correct Answer(s): B Loren has no other GI symptoms at the present time. She does report that she has developed a sore in her mouth. 3. What is the nurse's best response to this information? A) "That may indicate that the colitis has spread throughout the GI tract." Feedback: INCORRECT Extraintestinal symptoms may occur, but they do not indicate spread throughout the GI tract. B) "Ulcerative colitis can cause problems in areas other than the colon." Feedback: CORRECT Ulcerative colitis can cause extraintestinal complications such as mouth and skin lesions, vision problems, and arthritis. C) "It is probably related to the stress you are experiencing, not the colitis." Feedback: INCORRECT Although Loren may indeed be experiencing stress, mouth and skin sores may be manifestations of extraintestinal effects of the ulcerative colitis. D) "That has no bearing on your current problems related to the colitis." Feedback: INCORRECT Ulcerative colitis can cause extraintestinal problems, including mouth lesions. Points Earned: 1.0/1.0 Correct Answer(s): B Diagnostic Studies The nurse provides a stool specimen container and instructs Loren to obtain three specimens, one each on three consecutive days. 4. Which instruction is important for the nurse to provide Loren regarding food and fluid intake during the stool specimen collection? A) Avoid caffeine. Feedback: INCORRECT Caffeine does not alter the findings of this test. B) Avoid red meat. Feedback: CORRECT The ingestion of hemoglobin found in red meats may cause a false-positive test result. Therefore, it should be avoided for three days before starting the specimen collection. Other food products, vigorous exercise, and a variety of medications may also affect the test results. C) Increase fluid intake. Feedback: INCORRECT The client only needs to drink the amount of fluids regularly consumed. D) Remain NPO after midnight. Feedback: INCORRECT Clients should be allowed to eat and drink as instructed by the nurse to ensure continued regular bowel movements. Points Earned: 1.0/1.0 Correct Answer(s): B Loren is scheduled for a flexible sigmoidoscopy and a barium enema. 5. Which explanation of the procedure for the barium enema should the nurse provide Loren? A) X-ray is used to visualize the large intestine after barium is instilled. Feedback: CORRECT A barium enema involves a series of x-rays taken to visualize the colon. These x-rays are taken after barium is instilled into the colon through a rectal catheter. B) Movement of barium in the colon is observed through a scope. Feedback: INCORRECT A scope is not used to visualize the colon during a barium enema. C) A barium-based dye is injected intravenously, followed by abdominal scanning. Feedback: INCORRECT Barium is not injected via the intravenous route, and scanning is not part of the procedure. D) A digital exam is performed after the barium is removed by an enema. Feedback: INCORRECT A barium enema does not involve removal of this substance. Points Earned: 0.0/1.0 Correct Answer(s): A 6. What instruction should the nurse provide to a client who just completed a barium enema? A) Remain NPO for 24 hours. Feedback: INCORRECT Unless the client has another reason to remain NPO, fluid intake following this procedure is important. B) Limit fluid intake. Feedback: INCORRECT Limiting fluid intake will increase the client's risk for post-procedure constipation. C) Resume normal fluid intake. Feedback: INCORRECT There is a better choice to prevent post-procedure constipation. D) Drink extra fluids. Feedback: CORRECT Extra fluids are important to help flush out the barium and prevent constipation and bowel obstruction. Points Earned: 1.0/1.0 Correct Answer(s): D 7. Immediately following the sigmoidoscopy, it is important for the nurse to assess for which manifestation? A) Headache. Feedback: INCORRECT There is no reason to anticipate a headache following a sigmoidoscopy. B) Abdominal guarding. Feedback: CORRECT Abdominal distention, tenderness, or guarding may indicate perforation of the intestine. C) Concentrated urine. Feedback: INCORRECT Concentrated urine might be an indicator of dehydration secondary to hemorrhage following the procedure, but it is not likely to occur immediately post-procedure. D) Inelastic skin turgor. Feedback: INCORRECT Inelastic skin turgor might be an indicator of dehydration secondary to hemorrhage, but it is not likely to occur immediately post-procedure. Points Earned: 0.0/1.0 Correct Answer(s): B Therapeutic Communication The diagnostic test results confirm that Loren has acute ulcerative colitis. During the acute phase, edema and ulceration of the bowel mucosa are seen, with resultant hemorrhage. Further changes in the colon occur as the disease progresses and becomes chronic. After the healthcare provider explains to Loren her diagnosis and the necessary treatment, the nurse observes that she is visibly upset and trying to refrain from crying. When the nurse sits down next to her, Loren says, "My life is over. I'll have to quit college and move home with my parents to let them take care of me. My boyfriend won't want to spend time with someone who has diarrhea all the time." 8. In responding to Loren, the nurse recognizes that Loren's remarks reflect which of Erikson's developmental stages? A) Ego integrity versus despair. Feedback: INCORRECT This developmental task is recognized as being a priority of the older adult, typically over the age of 65, as the individual reflects on satisfaction with one's life. B) Generativity versus self-absorption. Feedback: INCORRECT This developmental task is generally the priority of the middle-aged adult, when the individual considers the need for changes in life goals and direction. C) Intimacy versus isolation. Feedback: CORRECT Young adulthood, between the ages of 18 and 35 years, is seen by Erikson as the developmental stage in which a priority concern is the maturing relationship of oneself to surrounding social systems. A major life event can greatly impact how a young adult relates to others. D) Identity versus inferiority. Feedback: INCORRECT This stage is typically seen in the school-aged child who is learning self-worth through the mastery of behavioral skills. Points Earned: 1.0/1.0 Correct Answer(s): C 9. What is the nurse's best response to Loren? A) "This all seems very overwhelming right now." Feedback: CORRECT This is an open-ended statement that acknowledges Loren's expressed feelings, leaving an opportunity for her to continue to share her feelings and concerns. B) "I know you are feeling very angry about this." Feedback: INCORRECT Loren is not necessarily demonstrating anger, so this may be an incorrect assumption by the nurse. C) "You won't have to quit college or move home." Feedback: INCORRECT This statement may or may not be true, and it does not encourage further communication by Loren. D) "You are beginning to cope with a new situation." Feedback: INCORRECT This statement is making a judgment about Loren's feelings, and it is not supportive. It is appropriate and healthy for Loren to verbalize her concerns, and the nurse's role is to encourage this verbalization. Points Earned: 1.0/1.0 Correct Answer(s): A Diet and Medications The nurse identifies that priority outcomes for Loren include control of her pain and her diarrhea. Loren receives prescriptions for diphenoxylate (Lomotil) PRN, prednisone (Deltasone), sulfasalazine (Azulfidine), and azathioprine (Imuran). Loren's prescription for sulfasalazine reads, "Take 1 gram three times a day." Loren takes the medication at 0800, 1200, and 1800, which are her mealtimes. After two weeks of this regimen, she reports that her diarrhea has worsened and that she vomits frequently. 10. What instruction should the nurse provide Loren? A) "Stop the medication immediately. You are experiencing an allergic reaction." Feedback: INCORRECT These symptoms are not indicative of an allergic reaction. B) "You need to increase the length of time between each dose of the medication." Feedback: CORRECT Adverse GI manifestations can increase if the dose of Azulfidine is too large or if taken too close together. Loren should be instructed to take the dose as close to an every-eight-hours dosing schedule as possible. C) "You should take the medication on an empty stomach to avoid these problems." Feedback: INCORRECT Azulfidine should be taken with, or after meals, if possible. D) "Your symptoms are worsening, so you will probably need a higher dose." Feedback: INCORRECT These manifestations are most likely related to the current dosing regimen. Points Earned: 1.0/1.0 Correct Answer(s): B 11. Which assessment finding indicates that the Lomotil is having the desired effect? A) Reported decrease in abdominal pain. Feedback: INCORRECT This is not the best finding to demonstrate that the Lomotil is having the desired effect. B) No evidence of blood in the stool. Feedback: INCORRECT This is not the best finding to demonstrate that the Lomotil is having the desired effect. C) Increase in bowel sound activity. Feedback: INCORRECT Lomotil should result in decreased bowel sound activity. D) Decreased number of bowel movements. Feedback: CORRECT Lomotil is an antidiarrheal medication. Therefore, the best measure of the effectiveness of the medication is assessment of the number of bowel movements. Lomotil should be used with extreme caution for clients with ulcerative colitis, since excessive use may result in colonic dilatation, causing additional problems such as toxic megacolon. Points Earned: 1.0/1.0 Correct Answer(s): D The nurse reviews the instructions for each of these medications with Loren. 12. What instruction is most important to include when teaching Loren about the prednisone? A) Urine may appear concentrated or reddish-orange in color. Feedback: INCORRECT Corticosteroids do not cause a change in urine color. Some medications, such as Macrodantin, a urinary tract antiinfective, and rifampin, an antibacterial agent, may turn the urine reddish-orange or brown. Clients taking Macrodantin or rifampin may develop CHF with resultant fluid overload and edema, but they are not likely to exhibit concentrated urine. B) Take the daily dose at bedtime to avoid daytime drowsiness. Feedback: INCORRECT Prednisone does not cause daytime drowsiness, although it can cause insomnia. Therefore, it is best taken in the morning. C) Cover exposed skin when spending time in direct sunlight. Feedback: INCORRECT These instructions are appropriate for medications that cause photosensitivity, such as the prescribed sulfasalazine (Azulfidine). D) Monitor mouth sores for white patches or increased discomfort. Feedback: CORRECT Corticosteroids, such as prednisone, have antiinflammatory and immunosuppressive effects that increase the risk for infection and may also mask signs of infection. Since Loren already has mouth sores, she is at risk for the development of an oral Candida infection and should, therefore, be instructed to report any signs of infection, including white patches or increased discomfort. Points Earned: 0.0/1.0 Correct Answer(s): D Loren initially follows a low-fiber, low-lactose diet. 13. To maintain this diet, which snack choice is best for Loren? A) Butter-free popcorn and a cola. Feedback: INCORRECT Popcorn is considered a high-fiber food. Additionally, the cola is a GI stimulant that may be irritating. B) An apple and flavored water. Feedback: INCORRECT Raw fruits are high in fiber. Cooked or canned apples, without the skin, would be allowed. C) Nachos and light beer. Feedback: INCORRECT The chips are high in fiber, and the cheese contains lactose. Alcoholic beverages should be avoided on a low-fiber diet. D) Angel food cake and cranberry juice. Feedback: CORRECT Juices are acceptable on a low-fiber diet, as long as they are strained or pulp-free. Points Earned: 0.0/1.0 Correct Answer(s): D Malabsorption: Management of Total Parenteral Nutrition Loren's symptoms are managed for the next year, and she is able to gradually add many foods to her diet, finding that only alcohol, fresh fruits and vegetables, excessively greasy and spicy foods, and caffeine produce significant diarrhea. However, during her senior year in college, a number of stressful life events occur, including the death of her father and her application to graduate school. Following graduation, she reports severe, uncontrolled diarrhea that has been ongoing for the last two months. She is pale, dyspneic with mild exertion, and reports constant fatigue and abdominal discomfort. She is hospitalized for an acute exacerbation of the ulcerative colitis. Loren's hemoglobin and hematocrit are low. 14. Which additional serum lab value best reflects nutritional malabsorption? A) Albumin 1.5 g/dl. Feedback: CORRECT This value is significantly lower than normal values (3.5 – 5.0 g/dl in an adult), which is most likely the result of malnutrition. B) Calcium 8.5 mg/dl. Feedback: INCORRECT This value is slightly low (normal adult value is 9.0 – 10.5 mg/dl), which may reflect some diminished absorption, but it is not the best indicator of altered nutrition. Additionally, the serum calcium level may be falsely low because Loren's albumin level is low. C) BUN 20.0 mg/dl. Feedback: INCORRECT This value is normal (normal adult value is 10 – 20 mg/dl). Altered BUN values may reflect Loren's state of protein intake, as well as her state of hydration. D) Sodium 148.0 mEq/L. Feedback: INCORRECT This value is slightly high (normal adult value is 136 – 145 mEq/L), which may reflect slight dehydration, but it is not the best indicator of altered nutrition. Points Earned: 1.0/1.0 Correct Answer(s): A Loren is placed on bowel rest, and she agrees that total parenteral nutrition (TPN) should be started. 15. Since the course of TPN treatment will last about ten days, the nurse plans to prepare Loren for the insertion of which access device? A) Percutaneous endoscopic gastrostomy. Feedback: INCORRECT A gastrostomy (surgical opening into the stomach) is made percutaneously (through the skin) using an endoscope to put the tube in place. Enteral nutrition provided through a gastrostomy tube will not provide bowel rest. B) Implanted port below the clavicle. Feedback: INCORRECT Ports are implanted surgically and are not generally used for short-term IV access. C) Peripheral IV in the antecubital fossa. Feedback: INCORRECT A peripheral IV does not provide access to a vein large enough to tolerate the hyperosmotic solution provided in TPN. Partial solutions, such as lipid emulsions, may be administered peripherally. D) Multi-lumen subclavian catheter. Feedback: CORRECT A subclavian catheter provides access to a large, central vein, which will tolerate the hyperosmotic solution of TPN. These catheters are appropriate for short-term use, such as the ten-day course of treatment anticipated for Loren. Points Earned: 1.0/1.0 Correct Answer(s): D After insertion of the venous access device, Loren is started on a TPN solution containing 50% dextrose, amino acids, lipids, vitamins, and minerals at 60 ml/hour. The nurse obtains a fingerstick glucose level six hours after the TPN was started. Loren's blood glucose level is 215 mg/dl. 16. What action should the nurse take? A) Slow down the rate of infusion to 30 ml/hour. Feedback: INCORRECT This is not the best solution, especially since the blood glucose level is not dangerously elevated. B) Call the lab to obtain a stat glucose via venipuncture. Feedback: INCORRECT This is not necessary since there is no reason to suspect that the fingerstick glucose level is inaccurate. C) Add regular insulin to the infusing TPN solution. Feedback: INCORRECT Medication should never be added to the TPN solution at the bedside, since this may introduce infectious organisms. D) Administer insulin using a sliding scale protocol. Feedback: CORRECT Because of the high dextrose content, blood glucose levels should be monitored routinely, and insulin administered per sliding scale. To reduce the likelihood of hyperglycemia, insulin may also be added to the TPN solution in the pharmacy. Points Earned: 1.0/1.0 Correct Answer(s): D 17. Which medication that Loren is receiving is most likely to contribute to her increased blood glucose level? A) Azathioprine (Imuran). Feedback: INCORRECT Imuran is an immunosuppressive agent, and it does not cause hyperglycemia. B) Diphenoxylate (Lomotil). Feedback: INCORRECT Lomotil is an antidiarrheal agent, and it does not cause hyperglycemia. C) Prednisone (Deltasone). Feedback: CORRECT Prednisone is a glucocorticoid, which may increase serum glucose. D) Sulfasalazine (Azulfidine). Feedback: INCORRECT Azulfidine is a salicylate with immunosuppressive and antiinflammatory properties, and it does not cause hyperglycemia. Points Earned: 1.0/1.0 Correct Answer(s): C The next day, the nurse enters Loren's room and notes that only 30 ml of the TPN solution is remaining. The nurse contacts the pharmacy and learns that the next bag of TPN will not be available for two hours. 18. What action should the nurse take after the remaining TPN has infused? A) Apply a lock and flush the line with a heparin sodium flush solution. Feedback: INCORRECT It is important to infuse an IV solution as similar to the TPN as possible. B) Hang a 500 ml bag of normal saline at a KVO rate. Feedback: INCORRECT It is most important to infuse an IV solution at as similar a rate to the TPN infusion as possible to avoid fluid imbalances. C) Hang a liter of 10% dextrose in water at the same rate of infusion. Feedback: CORRECT This IV solution contains a dextrose concentration most similar to the TPN solution, which will help reduce the risk of hypoglycemia. D) Hang a liter of Lactated Ringer's solution at the same rate of infusion. Feedback: INCORRECT Ringer's solutions contain electrolytes. It is most important in this situation to provide a solution with a dextrose concentration most like the TPN solution. Points Earned: 0.0/1.0 Correct Answer(s): C Management: Delegation of Tasks In developing Loren's plan of care, the nurse recognizes that a priority problem is, "High risk for infection." 19. To ensure that Loren remains infection free, which responsibility is best to delegate to an unlicensed assistive personnel (UAP)? A) Teach Loren about signs of infection, which should be reported. Feedback: INCORRECT Teaching the client is the responsibility of the nurse, since it requires a high level of expertise. B) Observe the catheter insertion site for inflammation. Feedback: INCORRECT Assessment of the catheter insertion site is the responsibility of the nurse, since it requires a high level of expertise. Remember, UAP responsibilities do not include assessment! C) Obtain and record vital signs every four hours. Feedback: CORRECT This is a task that falls within the responsibilities of the UAP. Remember, it is the responsibility of the nurse to analyze the vital signs! UAP responsibilities are limited to those within the implementation phase of the nursing process. D) Clean the catheter insertion site every 72 hours. Feedback: INCORRECT This is a task that requires the expertise of the nurse. Points Earned: 1.0/1.0 Correct Answer(s): C After ten days of TPN, the catheter site becomes infected. The healthcare provider decides that the subclavian catheter should be removed and the tip sent to the lab for culture. IV antibiotics are prescribed, and they are to be administered through a peripheral IV. 20. In providing the care, which division of tasks is best for the nurse to assign? A) The LPN removes the subclavian catheter, with the RN supervising to ensure that sterile procedure is followed. Feedback: INCORRECT Removal of the subclavian catheter is a skill that requires the expertise of the RN, since a number of complications can result. B) After the healthcare provider removes the sublclavian catheter, the LPN updates the plan of care, and the RN starts the new IV and antibiotics. Feedback: INCORRECT Although the healthcare provider may choose to remove the subclavian catheter, this can also be performed by the RN. The RN should update the plan of care, since this falls outside the scope of practice of the LPN. C) After the RN removes the subclavian catheter, the UAP applies pressure to the site and covers the area with a dressing. Feedback: INCORRECT The RN should complete this entire procedure, since it requires a high level of skilled intervention and expertise. D) After the RN removes the subclavian catheter, the LPN obtains vital signs, and the UAP transports the tip to the lab. Feedback: CORRECT This is the best use of all available nursing staff. Points Earned: 1.0/1.0 Correct Answer(s): D A Complication Occurs Loren develops a fever and tachycardia. She complains of abdominal cramping, and the nurse palpates an abdominal mass over the area of the transverse colon. Loren seems restless and confused. 21. The nurse recognizes this complication of ulcerative colitis as: A) Tenesmus. Feedback: INCORRECT Tenesmus, or spastic contractions of the rectum, that is accompanied by the desire to empty the bowel, is a symptom of ulcerative colitis, but it does not cause these symptoms. B) Toxic megacolon. Feedback: CORRECT This massive dilatation of the colon can result in intestinal perforation and peritonitis if untreated. C) Carcinoma. Feedback: INCORRECT Chronic ulcerative colitis does increase the risk for colorectal cancer and tumor development, but this is not the most likely explanation for this finding. D) Rectal fistula. Feedback: INCORRECT Fistulas are a complication of ulcerative colitis, but they are unlikely to produce this combination of symptoms. Points Earned: 1.0/1.0 Correct Answer(s): B 22. The nurse expects to alter Loren's oral intake in what way? A) Loren should be NPO. Feedback: CORRECT Toxic megacolon may result in bowel obstruction and intestinal perforation. Therefore, the nurse should keep Loren NPO and expect to insert a nasogastric tube. B) Loren should be given clear liquids only. Feedback: INCORRECT Toxic megacolon may result in bowel obstruction and intestinal perforation. Therefore, clear liquid intake is not safe at this time. C) Loren should be given full liquids only. Feedback: INCORRECT Toxic megacolon may result in bowel obstruction and intestinal perforation. Therefore, full liquid intake is not safe at this time. D) Loren should be encouraged to eat any foods she can tolerate. Feedback: INCORRECT Toxic megacolon may result in bowel obstruction and intestinal perforation. Therefore, food intake is not safe at this time. Points Earned: 1.0/1.0 Correct Answer(s): A The nurse notifies the healthcare provider of Loren's obstruction, and inserts a nasogastric tube and a urinary catheter. The current IV fluid, D5 ¼ NS, is increased to 125 ml/hour through the peripheral IV. Loren's next dose of IV antibiotic, which is compatible with the current IV solution, is now due to be administered. 23. What action should the nurse take? A) Administer the dose as scheduled concurrently with the IV fluids. Feedback: CORRECT The administration of fluids and broad-spectrum antibiotics is important at this time to prevent fluid volume depletion and peritonitis. B) Stop the IV fluids until the dose of antibiotics is administered. Feedback: INCORRECT There is no reason to stop the IV fluids while the antibiotic is administered. C) Give the dose after the first liter of IV fluids is infused. Feedback: INCORRECT There is no reason why the IV fluids and the antibiotic cannot be given concurrently. D) Hold the dose until the healthcare provider arrives to evaluate Loren. Feedback: INCORRECT There is no reason to hold the dose of antibiotic. Administration of antibiotics at regularly scheduled times (to maintain a blood level) is important in preventing peritonitis. Points Earned: 1.0/1.0 Correct Answer(s): A Ethical-legal Issues: Workplace Harassment Despite effective treatment of the toxic megacolon, diagnostic tests indicate that Loren's ulcerative colitis has spread and worsened very rapidly. It becomes necessary for Loren to undergo a total colectomy with the formation of an ileal reservoir and a temporary ileostomy. In the immediate postoperative period, Loren is monitored in the Surgical Intensive Care Unit. After her condition stabilizes, Loren is transferred to a nursing unit where she can learn about ostomy care. The female unlicensed assistive personnel (UAP) assisting with Loren's care confides to the nurse on the unit that another hospital employee has made numerous sexual advances to her despite being asked to stop. 24. The nurse recognizes that the UAP is protected under what legal statute? A) Civil Rights Legislation. Feedback: CORRECT Workplace harassment is a violation of the UAP's civil rights. B) State Nurse Practice Act. Feedback: INCORRECT State Nurse Practice Acts govern the practice of nursing, not the individual rights of employees. C) Joint Commission Accreditation Standards. Feedback: INCORRECT These standards provide direction for the accreditation of healthcare organizations. D) Health Information Privacy Protection Act. Feedback: INCORRECT This act safeguards the client's right to privacy related to health information. Points Earned: 1.0/1.0 Correct Answer(s): A 25. What action should the nurse take? A) Verbally warn the other members of the nursing staff to avoid the alleged offender. Feedback: INCORRECT This will not resolve the problem, and it could be construed as slander. B) Assist the UAP to confront the offender with tape-recorded proof of the harassment. Feedback: INCORRECT This is not the best solution to solve the problem. C) Instruct the UAP to document all the alleged offenses in writing and submit a copy to the supervisor. Feedback: CORRECT Written documentation should be submitted to an individual with the authority to take further action. Information should include the conversation and action of the offender, any witnesses to the event, and the action and the response of the UAP. D) Advise the UAP to request a transfer to a different area of the hospital to avoid further confrontation. Feedback: INCORRECT This will not resolve the problem. Points Earned: 1.0/1.0 Correct Answer(s): C The UAP submits a complaint to the supervisor, who belittles her and refuses to take action. The UAP again confides to the nurse that she believes she is being "pulled" to other units more frequently because of her complaint. The UAP states she can't afford to quit work because she is the sole provider for herself and her two children. 26. With whom should the nurse advise the UAP to collaborate? A) The local women's crisis center. Feedback: INCORRECT This is not the best choice to resolve this violation of the UAP's rights in the workplace. B) A hospital social worker. Feedback: INCORRECT This is not the best choice to resolve this violation of the UAP's rights. C) The hospital medical director. Feedback: INCORRECT This is not the best choice to resolve this violation of the UAP's rights. D) A legal aid clinic attorney. Feedback: CORRECT An attorney is the best choice to help the UAP regarding this violation of civil rights. Other possible resources include a hospital administrator or the state board of nursing. Points Earned: 0.0/1.0 Correct Answer(s): D Discharge Teaching: Stoma Management The nurse begins to prepare Loren for discharge and self-management of her ileostomy for the next two months until the next stage of surgery is performed. The stoma drainage is currently a dark green liquid. Loren asks if this is the normal drainage she should expect. 27. How should the nurse respond? A) "Yes, this is the appearance of the drainage you will always experience." Feedback: INCORRECT As the small intestine adapts, the stool will change in both consistency and color. B) "Your bowel movements will remain green, but they will become solid." Feedback: INCORRECT As the small intestine adapts, the stool will change in both consistency and color, but is unlikely to drain solid stool. C) "The drainage will become thicker and appear more yellow or yellow-brown." Feedback: CORRECT Once the small intestine begins to absorb increased water and sodium, the stool will become pastelike in consistency and will appear more yellow-green or yellow-brown in color. D) "Eventually you will experience normal-looking, soft brown bowel movements." Feedback: INCORRECT The drainage from an ileostomy is unlikely to appear like a normal soft brown bowel movement. Points Earned: 1.0/1.0 Correct Answer(s): C 28. To ensure the best skin protection around the stoma, the nurse should instruct Loren to use what type of product? A) Hydrogel dressing. Feedback: INCORRECT This will not provide adequate barrier protection from the irritating drainage. B) Skin foam with Vitamins A and E. Feedback: INCORRECT This will not provide adequate barrier protection from the irritating drainage. C) Transparent film dressing. Feedback: INCORRECT This will not provide adequate barrier protection from the irritating drainage. D) Pectin-based solid skin barrier. Feedback: CORRECT Ileostomy drainage contains enzymes which can be very damaging to the skin, so a solid skin barrier should be used at all times to protect the skin around the stoma. Points Earned: 0.0/1.0 Correct Answer(s): D 29. When should Loren expect to empty her pouch? A) Anytime she has any drainage. Feedback: INCORRECT It is not necessary to empty the pouch every time any drainage occurs, as this would be very disruptive to normal activity. B) When the pouch is 1/3 to 1/2 full. Feedback: CORRECT This will prevent excessive pull and pressure on the pouch system, preventing leakage. C) When the pouch is almost 75% full. Feedback: INCORRECT This may result in excessive pull and pressure on the pouch system, causing leakage. D) Only when the pouch is completely full. Feedback: INCORRECT This may result in excessive pull and pressure on the pouch system, causing leakage. Points Earned: 1.0/1.0 Correct Answer(s): B Case Outcome Reanastomosis of the bowel is completed two months later. Gradual reintroduction of food is begun.
