Your Answer:
Provide a regular bedpan
Rationale:
The nurse should place the patient on a fracture bedpan, which has a lower front and back than a regular bedpan and is designed for patients restricted from raising their hips. The high front and back on a regular bedpan make it more difficult to place it underneath a patient whose motion is restricted. A rectal bag and adult diaper are more extreme measures for incontinent patients and are not appropriate for patients who have had a hip replacement.
Question 2
How can the nurse assist a postoperative patient who is complaining of extreme difficulty with defecating after being placed on the bedpan?
Your Answer:
Administer a sodium phosphate (Fleet®) enema
Rationale:
Raising the patient’s head so that he or she assumes a sitting position (30 to 60 degrees) prevents hyperextension of the back, and a sitting position promotes defecation. An enema can be administered only if it is ordered by a practitioner. Raising the patient’s knees and straightening the patient into alignment help to make the patient more comfortable, but they do not actually promote defecation.
Question 3
Which of the following is appropriate when the nurse is preparing to place the bedpan underneath a patient who has had a hip replacement?
Your Answer:
Keep the abduction pillow in place while placing the patient on the bedpan, and then remove it while the patient defecates
Rationale:
If a patient has had a total hip replacement, the abduction pillow must remain in place between the patient’s knees to prevent dislocation of the new joint. Therefore, the abduction pillow must remain in place when placing the patient on the bedpan, when the patient defecates, and when removing the bedpan.
Question 4
An older adult patient who cannot get out of bed reports diarrhea and burning and irritation of the perineal area. On assessment, the nurse notes that the perineal area is very reddened and irritated. Which is the most appropriate FIRST nursing intervention?
Your Answer:
Keep the perineal area meticulously clean of the liquid stool
Rationale:
Liquid stool predisposes a patient to skin breakdown; therefore, it is vital for the perineal area to be kept clean. A stool collection device is not used except as a final step in prevention or treatment. Protective skin cream and medications to treat the diarrhea are options that could be used if keeping the skin clean does not decrease the irritation. The primary treatment to prevent skin breakdown, however, is keeping the area clean of the liquid stool.
Question 5
To educate a female patient on appropriate perineal care, what should the nurse emphasize?
Your Answer:
Using medicated pads or wipes to cleanse the perineal area
Rationale:
Female patients should cleanse from the area of lesser contamination to that of greater contamination (i.e., wiping from front to back). This reduces the transmission of anal bacteria to the urinary meatus and reduces the risk of urinary tract infections. Wiping from the back toward the front of the perineal area and dabbing the perineal area dry after the rectal area are all methods of contamination, from the area of greater contamination to the area of lesser contamination. Whether the patient uses medicated pads or tissue, the main factor is the method of cleansing.
Question 6
An 80-year-old patient with fragile skin is requesting to use the bedpan. What is an appropriate nursing intervention to prevent skin tears for this patient?
Your Answer:
Raising the patient’s knee gatch before placing the bedpan under the buttocks
Rationale:
The nurse either assists the patient by raising the patient’s hips or by rolling the patient to the side to place the bedpan to prevent injury and skin tearing. The nurse does not pull or push the bedpan under the patient’s hips, because this action can pull the skin and cause tissue injury. Raising the knee gatch and elevating the patient’s head into a sitting position are appropriate steps to enhance comfort after the bedpan has been placed properly.
Your Answer: Provide a regular bedpan Rationale: The nurse should place the patient on a fracture bedpan, which has a lower front and back than a regular bedpan and is designed for patients restricted from raising their hips. The high front and back on a regular bedpan make it more difficult to place it underneath a patient whose motion is restricted. A rectal bag and adult diaper are more extreme measures for incontinent patients and are not appropriate for patients who have had a hip replacement. Question 2 How can the nurse assist a postoperative patient who is complaining of extreme difficulty with defecating after being placed on the bedpan? Your Answer: Administer a sodium phosphate (Fleet®) enema Rationale: Raising the patient’s head so that he or she assumes a sitting position (30 to 60 degrees) prevents hyperextension of the back, and a sitting position promotes defecation. An enema can be administered only if it is ordered by a practitioner. Raising the patient’s knees and straightening the patient into alignment help to make the patient more comfortable, but they do not actually promote defecation. Question 3 Which of the following is appropriate when the nurse is preparing to place the bedpan underneath a patient who has had a hip replacement? Your Answer: Keep the abduction pillow in place while placing the patient on the bedpan, and then remove it while the patient defecates Rationale: If a patient has had a total hip replacement, the abduction pillow must remain in place between the patient’s knees to prevent dislocation of the new joint. Therefore, the abduction pillow must remain in place when placing the patient on the bedpan, when the patient defecates, and when removing the bedpan. Question 4 An older adult patient who cannot get out of bed reports diarrhea and burning and irritation of the perineal area. On assessment, the nurse notes that the perineal area is very reddened and irritated. Which is the most appropriate FIRST nursing intervention? Your Answer: Keep the perineal area meticulously clean of the liquid stool Rationale: Liquid stool predisposes a patient to skin breakdown; therefore, it is vital for the perineal area to be kept clean. A stool collection device is not used except as a final step in prevention or treatment. Protective skin cream and medications to treat the diarrhea are options that could be used if keeping the skin clean does not decrease the irritation. The primary treatment to prevent skin breakdown, however, is keeping the area clean of the liquid stool. Question 5 To educate a female patient on appropriate perineal care, what should the nurse emphasize? Your Answer: Using medicated pads or wipes to cleanse the perineal area Rationale: Female patients should cleanse from the area of lesser contamination to that of greater contamination (i.e., wiping from front to back). This reduces the transmission of anal bacteria to the urinary meatus and reduces the risk of urinary tract infections. Wiping from the back toward the front of the perineal area and dabbing the perineal area dry after the rectal area are all methods of contamination, from the area of greater contamination to the area of lesser contamination. Whether the patient uses medicated pads or tissue, the main factor is the method of cleansing. Question 6 An 80-year-old patient with fragile skin is requesting to use the bedpan. What is an appropriate nursing intervention to prevent skin tears for this patient? Your Answer: Raising the patient’s knee gatch before placing the bedpan under the buttocks Rationale: The nurse either assists the patient by raising the patient’s hips or by rolling the patient to the side to place the bedpan to prevent injury and skin tearing. The nurse does not pull or push the bedpan under the patient’s hips, because this action can pull the skin and cause tissue injury. Raising the knee gatch and elevating the patient’s head into a sitting position are appropriate steps to enhance comfort after the bedpan has been placed properly.
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