SCTIMST Staff Nurse - 2015 (Set-A)
Medical & Surgical Nursing
Hard
A client who is sent home with an ileostomy requires dietary supplementation with?
Appeared in: SCTIMST Staff Nurse - 2015 (Set-A)
Explanation
- An ileostomy involves diverting the small intestine to an opening in the abdomen, which bypasses the entire large intestine (colon).
- The colon's primary physiological function is the absorption of water and electrolytes, particularly sodium.
- Due to the colon bypass, ileostomy effluent (stool) is liquid and contains high amounts of sodium and water, leading to significant and continuous losses.
- To prevent dehydration and hyponatremia (low blood sodium), clients with an ileostomy require a higher intake of sodium in their diet.
Why Other Options Were Wrong
- Option A: High-fibre foods are poorly digested and can cause a food bolus obstruction (blockage) at the stoma site, especially in the early postoperative period.
- Option C: While some potassium is lost, the loss of sodium is far more clinically significant and pronounced. Routine potassium supplementation is not indicated.
- Option D: Vitamin B12 is absorbed in the terminal ileum. An ileostomy itself does not necessitate B12 supplementation unless the absorptive site was surgically removed.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Dietary management and supplementation for a client with an ileostomy as background academic context rather than a clinical decision trigger.
- Patient education is a critical nursing role. Nurses must teach clients with a new ileostomy to recognize the signs and symptoms of dehydration, such as increased thirst, dark urine, dizziness, and fatigue.
- Nurses should instruct patients to liberally salt their food and consider using oral rehydration solutions (ORS), which contain a balanced mix of salt, sugar, and water, especially during hot weather or illness.
- Monitoring stoma output is essential. An output consistently greater than 1.5 liters per day is considered a 'high-output stoma' and requires prompt medical evaluation to manage fluid and electrolyte imbalances.
How to Approach the Question
- First, identify the key term in the question: 'ileostomy'.
- Recall the anatomy and physiology related to an ileostomy. This procedure bypasses the large intestine (colon).
- Consider the primary function of the bypassed organ. The colon's main role is to absorb water and electrolytes, especially sodium.
- Deduce the direct consequence of this bypass: The body will lose large amounts of water and sodium.
- Evaluate the options based on this physiological consequence. The need to replace lost sodium makes 'Sodium' the most logical answer.
- Eliminate the other options by recalling their specific roles: Fibre can cause blockages, potassium loss is secondary, and Vitamin B12 absorption is site-specific (terminal ileum) and not always affected.
Concept Tested & Keywords
- Concept Tested: Dietary management and supplementation for a client with an ileostomy.
- Stem keywords: ileostomy, dietary supplementation
- Lead-in keywords: requires
- Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.
Question ID
QfTW-Q79AJGwvR0TmzFtif
Reference Book
E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 45-47
E6 Nursing Fundamentals Taylor p. 636-638
Practise the full SCTIMST Staff Nurse - 2015 (Set-A)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
More Digestive and Gastrointestinal Function Questions
- Which condition is defined as the inflammation of the peritoeum?
- Which types of stools are seen in Gastric bleeding?
- A patient comes to the ED with 105°F fever and hypertension and bradycardia also having vomiting and diarrhea past one day and he also has loosening…
- A patient complains of right abdominal tenderness, pain at the right lower quadrants region, nausea, vomiting and too much restlessness. In X-ray fil…
- A postoperative patient requires which nutrient after ileostomy?
- Which of the following clinical features are seen in intestinal obstruction, except?
- A patient comes in the ED with hematemesis and mild splenomegaly. What would be the possible cause?
- Ranson score is used in which clinical finding?
- In which of the following consists with Charcot's triad, EXCEPT?
- Following a gastric resection, which of the following actions would the nurse reinforce with the client in order to alleviate the distress from dumpi…
More SCTIMST Staff Nurse - 2015 (Set-A) Questions
- The nurse who observes projectile vomiting in a newborn suspects?
- A person with Diabetes mellitus is asking you the calories obtained from one teaspoon of sugar. what is 1 tea spoon in mL?
- Which of the following food items are rich sources of vitamin A?
- The urinary output of a client for 24 hours was 350 ml. The nurse has documented the observation as?
- Which one of the following terms indicates an increase in the size of cells without an increase in the number of cells?
- When the client can breathe only in an upright position, it is termed as?
- A client with hypoventilation is prone to develop?
- A client after pneumonectomy will be positioned on?
- The hierarchy of human needs, where nurses prioritize basic physiological needs, is identified by?
- The most reliable index of the cerebral status is?