Hank Smith, a 36-year-old bartender, was admitted for a total cystectomy with creation of an ileal conduit. Hank was diagnosed with a bladder tumor six months ago. While emptying and cleaning the stoma, the nurse is incorrect when she does which of the following?

  1. Maintains an aseptic technique all throughout the procedure
  2. Changes the urine collection appliance on a timely schedule
  3. Instructs the client to sit upright on the bed
  4. Changes the appliance during early morning
Explanation

Answer: C - The nurse is incorrect when she instructs the client to sit upright on the bed. Ideally, the client is placed in a low Fowler's position to keep the abdomen flat. This position prevents skin folding, which can cause the appliance to slip. A low Fowler's position allows the client to observe the procedure and encourages interest in performing the procedure themself. The nurse should maintain asepsis to avoid the transmission of harmful microorganisms. Timing is important; the appliance is changed during a period of low fluid intake (i.e., early morning).

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