youre caring for carin who has just had ileostomy surgery during the first 24 hours post op how much drainage can you expect from the ileostomy
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Nursing Elites

ATI RN

ATI Gastrointestinal System Test

1. You’re caring for Carin who has just had ileostomy surgery. During the first 24 hours post-op, how much drainage can you expect from the ileostomy?

Correct answer: C

Rationale: During the first 24 hours post-op, you can expect about 1500 ml of drainage from the ileostomy.

2. Which stoma would you expect a malodorous, enzyme-rich, caustic liquid output that is yellow, green, or brown?

Correct answer: A

Rationale: An ileostomy would have a malodorous, enzyme-rich, caustic liquid output that is yellow, green, or brown.

3. Claire, a 33 y.o. is on your floor with a possible bowel obstruction. Which intervention is priority for her?

Correct answer: B

Rationale: For a patient with a possible bowel obstruction, measuring abdominal girth is a priority to monitor for signs of worsening obstruction or distention.

4. The nurse develops a plan of care for a client with a T tube. Which one of the following nursing interventions should be included?

Correct answer: A

Rationale: The correct nursing intervention to include in the plan of care for a client with a T tube is to inspect the skin around the T tube daily for irritation. Bile is erosive and can cause skin irritation, so it is crucial to keep the skin clean and dry. T tubes are not routinely irrigated; irrigation is done only with a physician's order. It is unnecessary to maintain the client in a supine position; instead, assist the client into a position of comfort. T tubes are not typically clamped unless ordered by a physician, and if clamped, it is usually done 1 to 2 hours before and after meals.

5. Which of the following symptoms is a client with colon cancer most likely to exhibit?

Correct answer: B

Rationale: A change in bowel habits is the most common symptom of colon cancer.

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