The patient who is NPO for several days is at risk for atrophy of which of the following structures in the mucosal surface of the small bowel?
Select one:
a. Ligament of Treitz.
b. Villi.
c. Ampulla of Vater.
d. Sphincter of Oddi.
b. Villi.
A bowel prep preoperatively for ostomy surgery is routinely utilized to decrease bacteria in the bowel. The section of the bowel with the greatest level of bacteria is:
Select one:
a. Distal portion of the colon.
b. Proximal portion of the colon.
c. Distal portion of the small bowel.
d. Proximal portion of the small bowel.
a. Distal portion of the colon.
An Ileal pouch anal anastomosis (IPAA) which is also referred to as the ileoanal reservoir is indicated for which of the following disease processes?
Select one:
a. Irritable bowel syndrome and Crohn’s Disease.
b. Colorectal cancer and chronic ulcerative colitis.
c. Crohn’s Disease and chronic ulcerative colitis.
d. Ulcerative colitis and familial adenomatous polyposis.
d. Ulcerative colitis and familial adenomatous polyposis.
The preferred abdominal location for an ileostomy in the adult is the:
Select one:
a. LLQ.
b. LUQ.
c. RLQ.
d. RUQ.
c. RLQ.
Gary is experiencing a recurrence of his Crohn’s Disease. Which of the following symptoms is Gary most likely experiencing?
Select one:
a. Obstructive abdominal pain.
b. Absence of perianal disease.
c. Bloody stools with proctitis.
d. Vomiting.
a. Obstructive abdominal pain.
The patient with ulcerative colitis will commonly exhibit:
Select one:
a. Oral ulcerations.
b. Significant abdominal pain.
c. Superficial mucosal involvement.
d. Fistula formation.
c. Superficial mucosal involvement.
When you read in the postoperative surgical report that the stoma was primarily matured, you can expect which of the following?
Select one:
a. The stoma will be opened at the bedside with electrocautery.
b. The stoma has been present for at least 3 months.
c. The stoma is ready for sutures at the mucocutaneous junction to be removed.
d. The bowel was everted and sutured to the dermal surface during surgery.
d. The bowel was everted and sutured to the dermal surface during surgery.
Which of the following groups of medications is used in the medical management of Crohn’s disease?
Select one:
a. Corticosteroids and immune suppressants.
b. Anticholinergics and anti-emetics.
c. Antidepressants and antibiotics.
d. Immune suppressants and antidepressants.
a. Corticosteroids and immune suppressants.
Which of the following statements about Crohn’s disease and/or ulcerative colitis is true?
Select one:
a. Both Crohn’s Disease and ulcerative colitis are characterized by patchy mucosal involvement and skip lesions.
b. Crohn’s Disease is limited to the colon and rectum.
c. Ulcerative colitis is characterized by transmural involvement of the bowel wall.
d. Ulcerative colitis begins in the rectal area and progresses backward toward the ileocecal valve.
d. Ulcerative colitis begins in the rectal area and progresses backward toward the ileocecal valve.
You are consulted to see a patient who has just been diagnosed with low rectal cancer located distal to the dentate line. You will prepare teaching materials to cover content areas related to which of the following surgical procedures?
Select one:
a. Low anterior resection (LAR).
b. Abdominoperineal resection (APR).
c. Total proctocolectomy (TPC).
d. Ileal Pouch Anal Anastomosis (IPAA or IAR).
b. Abdominoperineal resection (APR).
Pneumatosis is a radiologic finding associated with:
Select one:
a. Hirschsprung’s disease.
b. Gut Malrotation.
c. Diverticulitis.
d. Necrotizing Enterocolitis (NEC).
d. Necrotizing Enterocolitis (NEC).
When preparing a 35-year-old male for colon resection with a temporary ileostomy due to refractory Crohn’s disease, he asks about sexual function after surgery. You explain that this procedure involves:
Select one:
a. Removal of the rectum only.
b. Moderate incidence of premature ejaculation.
c. Do not anticipate any sexual dysfunction.
d. High incidence of erectile dysfunction.
c. Do not anticipate any sexual dysfunction.
You receive a referral for a patient scheduled for an abdominoperineal resection. Prior to reviewing the chart and interviewing the patient you can anticipate his diagnosis to be:
Select one:
a. Transitional cell carcinoma of the bladder.
b. Adenocarcinoma of the rectum.
c. Familial Adenomatous polyposis. (FAP)
d. Diverticulitis.
b. Adenocarcinoma of the rectum.
Anorectal malformation in the neonate is also known as:
Select one:
a. Hirschsprung’s disease.
b. Imperforate anus.
c. Turcot syndrome.
d. Volvulus.
b. Imperforate anus.
Which of the following types of stoma construction methods is NOT completely diverting?
Select one:
a. End stoma.
b. Loop stoma.
c. Separated double barrel stoma.
d. Brooke ileostomy.
b. Loop stoma.
A Hartmann’s Procedure (Pouch) is constructed when the:
Select one:
a. Proximal edges of the rectal segment are over sewn and left in the pelvis following colon resection.
b. Entire colon is removed, and an ileal pouch is constructed in the pelvis.
c. A reservoir is constructed in the abdomen for small bowel disease.
d. The cecal reservoir is constructed and effluent is emptied with a catheter.
a. Proximal edges of the rectal segment are over sewn and left in the pelvis following colon resection.
Which of the following statements is true for the Kock continent ileostomy?
Select one:
a. It is the preferred surgical procedure for Crohn’s Disease.
b. Nipple valve of ileum proximal to the stoma is the continence mechanism.
c. The preferred stoma site is in the left lower quadrant of the abdomen.
d. It is a surgical procedure that is done more often than the IPAA (ileal pouch anal anastomosis).
b. Nipple valve of ileum proximal to the stoma is the continence mechanism.
Based on what you know about absorption and digestion within the small bowel and colon, which of the following types of stomas would you expect to produce the most corrosive effluent?
Select one:
a. Descending colostomy.
b. Ileostomy.
c. Loop transverse colostomy.
d. Sigmoid colostomy.
b. Ileostomy.
A 21-year-old woman is on her 5th day on the orthopedic unit following a motor vehicle accident. She suddenly develops ischemic colitis from a blood clot in the inferior mesenteric artery. Which type of stoma will she most likely have following surgery?
Select one:
a. Ileostomy
b. Jejunostomy
c. Descending Colostomy
d. Sigmoid Colostomy
a. Ileostomy
During a preoperative consultation for EMERGENCY ostomy surgery, the two PRIMARY objectives for the WOC Nurse are stoma site selection and:
Select one:
a. Explanation of how to empty the pouch.
b. Demonstration of ostomy equipment.
c. Decrease patient’s anxiety about the ostomy surgery.
d. Identification of discharge plans.
c. Decrease patient’s anxiety about the ostomy surgery.
When selecting an abdominal stoma site, evidence-based practice states that the stoma should be located:
Select one:
a. lateral to the rectus muscle.
b. above the beltline.
c. on the apex of the infraumbilical bulge.
d. near the umbilicus.
c. on the apex of the infraumbilical bulge.
You are selecting a stoma site pre-op for a patient having an ileal pouch anal anastomosis (IPAA) and temporary loop ileostomy. The patient has no abdominal scars but you notice the abdomen to be soft and slightly protruding. With the patient in the supine position, you palpate for the rectus muscle, make an indelible ink mark in the RLQ, confirm they can see the site while lying down and cover the mark with a transparent dressing. What step have you omitted?
Select one:
a. To check the potential stoma site with the patient in a sitting and standing position.
b. To ask the patient if they prefer the right side or the left side.
c. To consult with the surgeon to verify the site selected would be appropriate.
d. To apply a sample pouch to confirm the site is away from scars and the umbilicus.
a. To check the potential stoma site with the patient in a sitting and standing position.
Mr. Moore is having surgery for a low rectal cancer located below the dentate line. During your pre-op visit you utilize the PLISSIT model to introduce the topic of sexuality. What might you say to the patient that is an example of giving Permission to the patient to discuss this topic?
Select one:
a. Most people have questions about routine issues of living prior to surgery: diet, exercise, sexual activity, clothing, etc.
b. Most patients wonder about sexual function after APR and there are numerous things for us to discuss that could happen to impact your sexual function.
c. Counseling the patient to see a counselor for sexual dysfunction issues.
d. The stoma should not be used for sexual intimacy as it may be damaged and has no feeling.
a. Most people have questions about routine issues of living prior to surgery: diet, exercise, sexual activity, clothing, etc.
Which of the following surgical procedures involves a wide resection of the sigmoid colon, rectum and anus?
Select one:
a. Abdominoperineal Resection (APR)
b. Total Proctocolectomy (TPC)
c. Ileal Pouch Anal Anastomosis (IPAA)
d. Low Anterior Resection (LAR)
a. Abdominoperineal Resection (APR)
Preoperative care of the neonate undergoing ostomy surgery is best described by saying that:
Select one:
a. Teaching parents about the ostomy and what is to occur helps with family adaptation.
b. 75% of stomas are performed when the neonate is under 1 year of life. Preop care is minimal for the WOC nurse in pediatrics.
c. The WOC Nurse will be marking stomas in surgery as pediatric surgeons determine the stoma is necessary.
d. Abdominal assessment in pediatrics will be more difficult than in the adult as the abdomen is smaller.
b. 75% of stomas are performed when the neonate is under 1 year of life. Preop care is minimal for the WOC nurse in pediatrics.
You are providing a preoperative visit for a patient about to undergo a temporary loop stoma and low anterior resection (LAR). Why is a temporary loop stoma usually utilized in these procedures?
Select one:
a. To decrease the incidence of bleeding.
b. Decrease the potential of diarrhea within the gut following this procedure.
c. To divert stool away from the distal anastomosis while it heals.
d. Enhance perfusion to the proximal colon.
c. To divert stool away from the distal anastomosis while it heals.
The surgical treatment of choice for the patient with a carcinoma in the upper and middle third of the rectum is:
Select one:
a. Abdominoperineal resection (APR)
b. Low anterior resection (LAR)
c. Total proctocolectomy with ileostomy (TPC)
d. Ileal pouch anal anastomosis (IPAA)
b. Low anterior resection (LAR)
Your patient with diverticulosis is concerned about infection and the need for surgery. However, through patient teaching you can to correct misinformation and tell him that diverticulosis is very common and not an indication for surgery. Diverticulosis differs from diverticulitis in that diverticulitis may require surgery because it involves:
Select one:
a. Formation of herniations in the intestinal wall.
b. High intraluminal pressures in the intestinal wall.
c. Inflammation or infection of sac-like pouches.
d. Low intraluminal pressures of the bowel wall.
c. Inflammation or infection of sac-like pouches.
Which of the following signs or symptoms are associated with diverticulitis?
Select one:
a. Fever, malaise, RUQ pain.
b. Nausea/vomiting, RLQ pain.
c. LLQ pain, fever, nausea/vomiting.
d. Dysuria, bowel obstruction.
c. LLQ pain, fever, nausea/vomiting.
A complication of diverticular disease that almost always requires surgical intervention.
Select one:
a. Intestinal inflammation.
b. Micro-perforation.
c. Diverticulum formation.
d. Bowel perforation.
d. Bowel perforation.
You are caring for a 7-month-old infant experiencing repeated bouts of constipation. The abdomen is quite distended and the surgeon suspects Hirschsprung’s disease. What type of surgery is most likely to occur following a positive rectal suction biopsy for Hirschsprung’s?
Select one:
a. Classic pull-through procedure.
b. Diverting colostomy to decompress the bowel.
c. End ileostomy.
d. Loop ileostomy.
b. Diverting colostomy to decompress the bowel.
Patients with acute radiation-induced enteritis would likely demonstrate the following symptom:
Select one:
a. Constipation
b. Temperature above 101F
c. Lack of appetite
d. Diarrhea
d. Diarrhea
Your myelomeningocele or spina bifida patient has problems with constipation because of a neurogenic bowel. It has been managed with oral laxatives, suppositories, and/or enemas but the problem is not resolved. Which of the following surgical procedures may be indicated for this patient?
Select one:
a. Loop ileostomy with IPAA.
b. Permanent ileostomy.
c. ACE Procedure.
d. Mitrofanoff procedure.
c. ACE Procedure.
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A patient with a low rectal cancer who had preoperative radiation followed by a low anterior resection with subsequent stoma takedown is at risk for what complication over the long term:
Select one:
a. Bloody diarrhea and low rectal pain.
b. Urgency, clustering of stooling, frequency, incontinence.
c. Problems with scar formation and obstruction from the previous stoma site.
d. Recurrence of the cancer and need for additional therapy.
b. Urgency, clustering of stooling, frequency, incontinence.
As an Ostomy Nurse Specialist, you know that Crohn’s Disease (CD) typically originates at the terminal ileum, is a recurring disease and not cured by surgery. However, your Crohn’s Disease patient may need surgical management because the disease is not responding to medical therapy. What is the most common surgical procedure for Crohn’s Disease?
Select one:
a. Anoplasty.
b. Segmental intestinal resection.
c. Temporary ileostomy and mucus fistula.
d. Sphincteroplasty.
b. Segmental intestinal resection.
During the first routine pouch change after an ileal conduit has been created, which of the following observations is considered normal?
Select one:
a. The stoma is dusky at the mucocutaneous junction.
b. The stoma is edematous and pink.
c. The stoma has no output.
d. A constant trickle of blood from the mucocutaneous junction is present.
b. The stoma is edematous and pink.
Which of the following foods is known to cause considerable odor for the patient with a urinary diversion?
Select one:
a. Beets.
b. Cheese.
c. Greasy, French fries.
d. Fish.
d. Fish.
The primary rationale for using a skin barrier paste is to:
Select one:
a. Fill or “caulk” irregular surfaces at the base of the stoma.
b. Increase the tack of the adhesive surface of the abdomen.
c. Protect the stoma from mechanical trauma.
d. Reduce the burning sensation associated with the use of skin barrier powders.
a. Fill or “caulk” irregular surfaces at the base of the stoma.
The patient who has a soft abdomen and a budded ileal conduit stoma will require what characteristic in the skin barrier surface of pouching system?
Select one:
a. Flexibility – all flexible pouching system.
b. Firm surface to provide support.
c. Can be either flexible or firm pouching system.
d. Need more information.
b. Firm surface to provide support.
The presence of mucus shreds in the urine after an Indiana pouch is:
Select one:
a. Indicative of a urinary tract infection.
b. Considered normal.
c. Typical of dehydration.
d. Associated with an anastomotic leak.
b. Considered normal.
Which of the statements about ostomy equipment is correct?
Select one:
a. Skin barrier and pouch should be applied before the skin sealant (also known as a liquid skin barrier) dries.
b. A skin barrier paste is essential to use for urinary and fecal ostomy care.
c. A skin barrier powder should be applied liberally to the peristomal skin to prevent moisture buildup.
d. A flexible skin barrier surface is usually indicated when the abdomen is firm.
d. A flexible skin barrier surface is usually indicated when the abdomen is firm.
Two of the MOST important assessments to make when determining the pouching procedure and equipment to use postoperatively are:
Select one:
a. The size of the stoma (height, size) and the softness or firmness of the abdomen in the peristomal field.
b. Whether it is a permanent or temporary type of stoma construction and odor.
c. Pouching equipment most familiar to the patient and their manual dexterity.
d. Patient’s hand preference (right versus left) and stoma size.
a. The size of the stoma (height, size) and the softness or firmness of the abdomen in the peristomal field.
Stomal protrusion is an important assessment in ostomy management because:
Select one:
a. A protruding stoma will not develop a prolapse.
b. Flush stomas usually require convexity because effluent is exiting the stoma at skin level.
c. A protruding stoma on the abdomen can always be seen by the patient wherever it is placed.
d. A protruding stoma assures adequate vascularity is present.
b. Flush stomas usually require convexity because effluent is exiting the stoma at skin level.
The patient at greatest risk for dehydration and electrolyte imbalance is the patient with a/an:
Select one:
a. Loop ileostomy and IPAA (ileal pouch anal anastomosis).
b. Ileal conduit.
c. Perforated bowel and loop ileostomy.
d. Orthotopic neobladder.
a. Loop ileostomy and IPAA (ileal pouch anal anastomosis).
Six months postoperatively, you can expect the patient with which of the following urinary diversions to be using bedside drainage at night?
Select one:
a. Indiana pouch
b. Mitrofanoff procedure
c. Koch pouch
d. Ileal conduit
d. Ileal conduit
When can a patient with an Indiana pouch expect to begin catheterizing the stoma for emptying?
Select one:
a. When the reservoir attains a 500 mL capacity.
b. After a pouch-o-gram indicates the suture line is healed.
c.The Indiana pouch does not require catheterization to empty.
d. On the 5th day postop.
b. After a pouch-o-gram indicates the suture line is healed.
Immediately after surgery, the patient with an orthotopic neobladder can expect to have:
Select one:
a. Every two-hour catheterizations of the reservoir to prevent mucus plug.
b. A “band-aid” type of dressing placed over the abdominal stoma.
c. A urethral catheter and a suprapubic catheter.
d. Normal sensations of the need to empty the bladder.
c. A urethral catheter and a suprapubic catheter.
An essential feature of a urinary pouch during the IMMEDIATE postoperative period is:
Select one:
a. An opaque pouch film.
b. A pouching adhesive surface that provides convexity.
c. A one-piece pouch with an attached skin barrier.
d. A sizeable (cut-to-fit) stoma opening.
d. A sizeable (cut-to-fit) stoma opening.
Which of the following urinary diversions (continent or incontinent) will usually require a diaper or pouching to contain the urine?
Select one:
a. Indiana Pouch.
b. Orthotopic Neobladder.
c. Vesicostomy.
d. Mitrofanoff procedure.
c. Vesicostomy.
Janet is a 19 y/o female with paraplegia due to a car accident. She has a Mitrofanoff diversion due to neurogenic bladder for 2 years. She complains of leakage from her urethra since she has been away at college. What is the MOST likely cause for the urethra urine leakage?
Select one:
a. Infrequent catheterization of the stoma.
b. Poor pelvic muscle strength.
c. Pouchitis.
d. Too little fluid intake.
a. Infrequent catheterization of the stoma.
Which of the following statements about bladder cancer is TRUE?
Select one:
a. A radical cystectomy and ileal conduit is the treatment of choice for most bladder cancers.
b. The most common type of bladder cancer is urothelial cell.
c. The earliest symptom of bladder cancer is difficulty in urinating.
d. Sexual dysfunction is a rare complication following removal of the bladder.
b. The most common type of bladder cancer is urothelial cell.
The procedure in which the bladder can remains intact and the appendix is used as a channel for the urine to exit through the abdomen is known as:
Select one:
a. Indiana pouch.
b. Orthotopic neobladder.
c. Vesicostomy.
d. Mitrofanoff procedure.
d. Mitrofanoff procedure.
Which of the following statements is TRUE of the orthotopic neobladder?
Select one:
a. It is located in the abdomen.
b. It is most often created from jejunum.
c. It uses the native urethra as the outlet passageway.
d. It is designed to hold a maximum of 150-250 cc urine.
c. It uses the native urethra as the outlet passageway.
Mrs. Rose has an Indiana Pouch created for bladder cancer. She comes to your outpatient clinic and complains of increase mucus production with some increase odor, difficulty with catheterizations that are painful along with back pain. What should you do?
Select one:
a. Tell her to drink more fluids, change positions, and rotate catheter while inserting.
b. Tell her to increase the size of the catheter and irrigate catheter with 30 ml of normal saline.
c. Notify her surgeon and obtain a urine sample and send off for analysis, culture & sensitivity.
d. Increase time between catheterizations and rinse catheter with hot water prior to use.
c. Notify her surgeon and obtain a urine sample and send off for analysis, culture & sensitivity.
John is 15-year-old with a new loop ileostomy with an IPAA for refractory chronic ulcerative colitis. This is your first post-operative teaching session. What assumptions can you make about John’s primary concerns regarding is new ostomy based upon Erikson’s psychosocial phases?
Select one:
a. Poor self-esteem and less autonomy
b. Fear of loss of occupation and role changes
c. Limited activities and inhibition
d. Limited peer relationships and poor body image
d. Limited peer relationships and poor body image
Wearing a Medic alert bracelet is critical for which of the following patients?
Select one:
a. A 5-year-old with a nephrostomy tube.
b. A 1-year-old with a vesicostomy.
c. A 65-year-old with an ileal conduit.
d. A 35-year-old with an Indiana pouch.
d. A 35-year-old with an Indiana pouch.
The typical site to mark for the Indiana Pouch is:
Select one:
a. RUQ.
b. RLQ.
c. Umbilicus.
d. LLQ.
b. RLQ.
Later in the postop recovery process it is important to provide instructions on pelvic muscle exercises to the patient with which of the following surgical procedures?
Select one:
a. Indiana pouch.
b. Mitrofanoff procedure.
c. Vesicostomy.
d. Orthotopic neobladder.
d. Orthotopic neobladder.
Of the following urinary diversions, which procedure is always considered permanent?
Select one:
a. Pyelostomy.
b. Ileal conduit.
c. Vesicostomy.
d. Ureterostomy.
b. Ileal conduit.
Following the surgical construction of the Indiana Pouch, the nurse should expect:
Select one:
a. To begin teaching intermittent catheterization of the pouch on Day 3 or 4.
b. The placement of ureteral stents in the renal pelvis that exit through the skin.
c. The need for an external ostomy pouch for the first 3-4 weeks to contain urine while the nipple valve heals.
d. Irrigation of the percutaneous urinary drainage tube every 3-4 hours to remove mucus and ensure free flow of urine.
d. Irrigation of the percutaneous urinary drainage tube every 3-4 hours to remove mucus and ensure free flow of urine.
A 60-year-old male is 6 weeks postop following a sigmoid colostomy for rectal cancer. During a follow-up visit, he states that he has read about colostomy irrigation and is eager to start. What should your NEXT step be?
Select one:
a. Ask the patient if chemotherapy or radiation therapy is planned.
b. Set up an appointment to begin teaching the irrigation technique as soon as possible.
c. Instruct the patient to ask again at his 6 months postop visit.
d. Ask him if he prefers using a cone tip or a catheter for the procedure.
a. Ask the patient if chemotherapy or radiation therapy is planned.
Mr. Rooke worked in a rubber plant for over 30 years. He was found to have bladder cancer involving the muscle layer and peri-vesical fat of his bladder. What type of treatment will he MOST likely have for this invasive carcinoma?
Select one:
a. Radical cystectomy and urinary diversion
b. Intravesical treatment
c. Radiation therapy
d. Watchful waiting
a. Radical cystectomy and urinary diversion
Several of these surgical urinary diversions are permanent. Which urinary diversion is usually TEMPORARY?
Select one:
a. Nephrostomy.
b. Orthotopic neobladder.
c. Ileal conduit.
d. Indiana pouch.
a. Nephrostomy.
Which type of pouching system would be appropriate to recommend for a blind person with an ileostomy?
Select one:
a. 1-piece.
b. 2-piece.
c. Closed end pouch.
d. Non-adhesive pouch.
b. 2-piece.
The absence of urine flow from a newly created urostomy is considered:
Select one:
a. Normal.
b. A temporary issue that will resolve with additional intravenous fluids.
c. Related to the stents.
d. Abnormal… a medical emergency.
d. Abnormal… a medical emergency.
The skin around the stoma should be:
Select one:
a. Denuded because of the shaving and surgical scrub.
b. Pale as compared with the rest of the abdomen.
c. Erythematous because of the pouch adhesive.
d. Intact and healthy.
d. Intact and healthy.
For the patient with a urinary or fecal diversion, a well-constructed stoma and a good location, the normal wear time for an adult would be:
Select one:
a. 1-2 days.
b. 3-4 days.
c. No schedule, change when suspected leakage.
d. Depends on the patient’s schedule.
b. 3-4 days.
What is the purpose of the support bridge that may be placed under the loop stoma?
Select one:
a. It assists the surgeon to know where both ends of the bowel are located in anticipation for stoma takedown.
b. It takes pouching the stoma easier.
c. It provides an easy access to the stoma for irrigation.
d. It supports the bowel until the stoma heals to the abdominal skin.
d. It supports the bowel until the stoma heals to the abdominal skin.
Three (3) primary concerns of the ostomy patient include:
Select one:
a. Independence, self-care and returning to previous lifestyle.
b. Work, returning to social activities and finding someone to assist with ostomy care.
c. Family issues, work and independence in care.
d. Sexuality, management of noise and odor and locating ostomy suppliers when traveling.
a. Independence, self-care and returning to previous lifestyle.
Mr. Moore had an APR (abdominoperineal resection) for colorectal cancer 3 days ago. He is on a low-residue diet and taking pain medication for postoperative surgical pain. The WOC nurse notes that his stool is formed. What would be MOST appropriate to recommend for this patient?
Select one:
a. Dried fruit i.e. Prunes
b. Stool softeners i.e. Colace
c. Bulking agents i.e. Metamucil
d. Stimulants i.e. Senna
b. Stool softeners i.e. Colace
When the ostomy patient is taking corticosteroids and immunosuppressive agents, they are at risk for developing which of the following peristomal skin complications?
Select one:
a. Pyoderma gangrenosum.
b. Pseudoverrucous lesions.
c. Peristomal candidiasis.
d. Caput medusae.
c. Peristomal candidiasis.
Spontaneous closure of an enterocutaneous fistula is unlikely to occur when:
Select one:
a. The patient’s albumin level is 3.4.
b. A distal bowel obstruction exists.
c. The fistula output is less than 100 mL.
d. The patient is on antibiotics.
b. A distal bowel obstruction exists.
You have applied a liquid skin barrier under the adhesive surface of a fistula pouch. You indicate to the nursing staff that the rationale for this intervention is to protect the skin from:
Select one:
a. Chemical injury.
b. Allergy to adhesives.
c. Contact with skin barrier pastes.
d. Mechanical injury.
d. Mechanical injury.
In general, the infant is so small in weight that they have more skin surface through which to absorb chemicals placed on the skin (transepidermal absorption). Which of the following nursing interventions demonstrates an understanding of that information?
Select one:
a. Generous use of liquid skin barrier products to reduce the risk of epidermal stripping.
b. Avoiding the use of solvents on the skin.
c. Minimal use of solid wafer skin barriers.
d. Using EMLA or lidocaine topically to reduce the discomfort of perineal dermatitis.
b. Avoiding the use of solvents on the skin.
A patient has a high output enterocutaneous fistula with a pouch seal that has no leakage between changes (every 3-4 days). Removing the pouch skin barrier you notice a solid patch of raised erythematous skin that matches the size of the skin barrier. The patient is complaining of itching. What is the most likely etiology of this skin condition?
Select one:
a. Sensitivity or Allergy to the skin barrier.
b. Mechanical irritation during removal of adhesive.
c. Irritant dermatitis.
d. Folliculitis.
a. Sensitivity or Allergy to the skin barrier.
The PRIMARY intervention for the treatment and prevention of pseudoverrucous lesions is:
Select one:
a. Resize the pouching system to the size of the base of the stoma to cover up the lesions.
b. Apply an antifungal powder to the lesions.
c. Cauterize the lesions with silver nitrate.
d. Alkalinize the urine.
a. Resize the pouching system to the size of the base of the stoma to cover up the lesions.
A fistula between the colon and skin is known as a/an:
Select one:
a. Colocutaneous fistula.
b. Colovesicle fistula.
c. Rectovaginal fistula.
d. Internal fistula.
a. Colocutaneous fistula.
Which of the following patients is at risk for fistula formation after a surgical procedure? A patient who has:
Select one:
a. Experienced intraoperative hypothermia.
b. Had preoperative hyponatremia.
c. Undergone radiation therapy in the surgical area 20 years ago.
d. A preoperative serum prealbumin level of 18.0.
c. Undergone radiation therapy in the surgical area 20 years ago.
Which of the following complications is a contributing factor to the high mortality rate associated with the patient who has a fistula?
Select one:
a. Sepsis
b. Dehydration
c. Thrombophlebitis
d. Pulmonary embolism
a. Sepsis
In which of the following situations would you normally expect to see intermittent, brief episodes where the stoma becomes dusky, then “pinks up” again?
Select one:
a. 25-year-old with a loop temporary ileostomy who is dehydrated.
b. Infant with a transverse colostomy during crying episodes.
c. 50-year-old with a sigmoid colostomy and has had history of laxative abuse.
d. 55-year-old woman with an ileostomy and recurrence of Crohn’s disease.
b. Infant with a transverse colostomy during crying episodes.
When selecting a pouching system for a patient who has an enterocutaneous fistula, the PRIMARY feature of the system that should guide your selection is:
Select one:
a. A sizeable surface for cutting.
b. An opaque pouch film.
c. Built in convexity.
d. Anti-reflux valve.
a. A sizeable surface for cutting.
Mr. Smith has had a sigmoid colostomy that he irrigates every day with regular results. Lately, he has noticed a bulging around the stoma and consistently poor returns of the irrigation fluid and feces. What complication is Mr. Smith likely experiencing?
Select one:
a. Stoma prolapse.
b. Pseudoverucous lesions.
c. Stoma necrosis.
d. Peristomal hernia.
d. Peristomal hernia.
Your outpatient presents with pseudoverrucous lesions. His stoma size is 1″ and he is wearing a 1 ¼” presized pouch. He is complaining of burning and itching. What is your next step?
Select one:
a. Refit the pouch size opening to cover the lesions.
b. Apply alcohol to dry out the lesions on the peristomal skin.
c. Check the pH of the effluent.
d. Apply powder and paste to cover the lesions.
a. Refit the pouch size opening to cover the lesions.
You have a patient with a sigmoid colostomy who developed stomal stenosis 8 weeks postoperatively. What is the key factor that increased your patient’s risk for developing this complication?
Select one:
a. A stomal necrosis.
b. A stomal prolapse.
c. A significant recent weight loss.
d. Performing sit-ups.
a. A stomal necrosis.
You have a 4-year-old child that needs his low-profile gastrostomy tube replaced. What step would be MOST important when performing this procedure?
Select one:
a. Have parents give pain medication prior to procedure.
b. Cleanse the skin with soap & water.
c. Measure the length of the stoma tract with a measuring device.
d. Use sterile gloves.
c. Measure the length of the stoma tract with a measuring device.
Mrs. Owens arrives in your Ostomy Clinic complaining that the pouch leaks within a few hours even though she puts it on exactly how she was instructed. The stoma protrudes 2 cm and her abdomen is soft; she is slightly overweight. Which of the following steps is essential to assure proper fitting of her ostomy pouch?
Select one:
a. Use a skin cement to increase the adherence of the pouch.
b. Assess her abdominal topography and stoma with her in the sitting position and standing position.
c. Trim the skin barrier to be 1/4 inch larger than the stoma.
d. Instruct her to begin using a belt.
b. Assess her abdominal topography and stoma with her in the sitting position and standing position.
Vinegar soaks to the stoma is an appropriate intervention to reduce or remove:
Select one:
a. Peyer’s patches on the mucosa.
b. Urine odor.
c. Encrustations.
d. Caput Medusa.
c. Encrustations.
Of the following individuals, who is MOST at risk for developing a stomal prolapse?
Select one:
a. Infant with a loop transverse colostomy.
b. 20-year-old male with a temporary loop ileostomy.
c. 65-year-old male with an end sigmoid colostomy and significant ascites.
d. 55-year-old female with a transverse double barrel colostomy.
a. Infant with a loop transverse colostomy.
Ms. Anderson has a diagnosis of Caput Medusae in the WOC Nursing chart. You would expect to see protuberant veins in the peristomal field which are caused by:
Select one:
a. Chronic exposure to effluent.
b. Portal hypertension.
c. Stomal prolapse.
d. Parastomal hernia.
b. Portal hypertension.
An incarcerated bowel is an emergent complication associated with:
Select one:
a. Mucocutaneous separation.
b. Stomal stenosis.
c. Parastomal hernia.
d. Peristomal pyoderma granulosum.
c. Parastomal hernia.
A 28-year-old female has a permanent ileostomy and you notice ulceration at 9 o’clock in the peristomal area 7 mm from the base of the stoma. The ulcer is producing fecal material. Without knowing her history, what is this describing?
Select one:
a. Candidiasis due to steroids.
b. Familial adenomatous polyposis.
c. Peristomal pyoderma gangrenosum.
d. Enterocutaneous fistula
d. Enterocutaneous fistula
The most effective pouching technique for the patient with an ileostomy and a small fistula open on the skin about 5mm from the base of the stoma is to:
Select one:
a. Cover the fistula opening with a skin barrier paste and pouch over the fistula opening.
b. Apply a skin barrier powder into the fistula track to absorb drainage and pouch over the fistula opening.
c. Resize the stoma opening in the pouch to include the fistula opening.
d. Place a catheter into the fistula opening, feed the catheter through the stoma opening on the pouch and anchor the catheter to the front of the pouch.
c. Resize the stoma opening in the pouch to include the fistula opening.
Mr. Hanson has an enterocutaneous fistula that you plan to pouch. What 4 criteria will be essential when selecting a pouching system for him?
Select one:
a. Volume, consistency, need for access and pH of effluent.
b. Need for access, volume, odor, pH of effluent.
c. Size of fistula opening on the skin, odor, consistency of effluent and opaque pouch.
d. Volume of effluent, size of fistula opening on the skin, odor and need for access
d. Volume of effluent, size of fistula opening on the skin, odor and need for access
Moisture associated skin damage is a leading cause of peristomal skin breakdown. Which is the best description of MASD in the peristomal area?
Select one:
a. Inflammation and erosion of the skin adjacent to the stoma.
b. Macular lesions in the presence of pruritus and pain.
c. Skin erythema in the pattern of the skin barrier.
d. Patches of skin loss under the adhesive of a pouching surface upon pouch removal.
a. Inflammation and erosion of the skin adjacent to the stoma.
Eighteen hours after the creation of an end stoma, the nurse notes that the stoma mucosa is black and flaccid. What would be the appropriate assessments and interventions?
Select one:
a. Check the hydration level of the patient and provide hydration, because the flaccid stoma may be the result of dehydration.
b. Remove the stoma pouch and gently rub the stoma to note any surface bleeding. Notify the surgical service and prepare to examine the stoma using a small, lubricated, glass tube and flashlight.
c. Encourage the patient to ambulate since this activity may precipitate bowel function.
d. Remove the ostomy pouching system, cut a larger opening in the new pouching system and place a gauze pad into the pouch to prevent that plastic from contacting the stoma.
b. Remove the stoma pouch and gently rub the stoma to note any surface bleeding. Notify the surgical service and prepare to examine the stoma using a small, lubricated, glass tube and flashlight.
The nurse is changing a pouching system and doing a teaching session for a new patient on the 4th postoperative day. Upon pouch removal, a separation of the mucocutaneous juncture is observed. What would you tell the nurse about why this complication may occur?
Select one:
a. The sutures were not completely circumferential at the stoma base.
b. This most likely occurs because this patient has been on corticosteroids preoperatively.
c. The presence of liquid effluent in the pouch may disrupt the sutures.
d. Removal of the pouching system causes a mechanical force that can dislodge sutures.
b. This most likely occurs because this patient has been on corticosteroids preoperatively.
Your outpatient is seen for follow-up and complaining of pouch leakage and extreme pain in the peristomal area. Upon exam, you see a reddish-purple (violaceous) discoloration with painful open lesions around the stoma. What are you looking at?
Select one:
a. Pseudoverrucous lesions
b. Pyoderma gangrenosum (PG)
c. Mucosal transplantation
d. Encrustations
b. Pyoderma gangrenosum (PG)
You observe a peristomal skin breakdown where there are small erythematous areas located at the hair follicle that progress from pustules to papules and may become encrusted. What is this complication and a causative organism?
Select one:
a. Candidiasis – fungus.
b. Folliculitis – staphylococcus aureus.
c. Candidiasis – Streptococcus pyogenes.
d. Encrustations – Corynebacterium.
b. Folliculitis – staphylococcus aureus.
An important fact to teach nurses who care for a patient with a gastrostomy tube is to:
Select one:
a. Stabilize the tube.
b. Change the tube every 2 weeks.
c. Flush the tube daily with saline.
d. Flush the tube daily with water.
a. Stabilize the tube.
Which of the following interventions would prevent a gastrostomy tube from clogging?
Select one:
a. Irrigate the tube daily with 10 ml of saline.
b. Irrigate before medication administration.
c. Only give liquid form of medications.
d. Crush pills and dissolve in 10mL of Diet Pepsi.
c. Only give liquid form of medications.
You are teaching a patient with a gastrostomy tube that has a balloon. You instruct the patient to do which of the following?
Select one:
a. Check the balloon volume daily.
b. Check the balloon volume once a week.
c. Replace the gastrostomy tube every two weeks.
d. Replace the gastrostomy tube once a week.
b. Check the balloon volume once a week.
A patient is having large amounts of leakage around a Penrose drain with saturation of gauze twice a shift. The surgeon asks you to evaluate and treat the red skin. The BEST action by the WOC nurse is to:
Select one:
a. Irrigate the drain.
b. Apply an ostomy pouch with an integrated skin barrier.
c. Discontinue the drain.
d. Apply a barrier ointment around the drain.
b. Apply an ostomy pouch with an integrated skin barrier.
What is the name of the radiographic study done when investigating the origin of an enterocutaneous fistula?
Select one:
a. Abdominal X-ray.
b. Fistulogram.
c. Barium enema.
d. Colonoscopy.
b. Fistulogram.
Which of the following products can be used to protect the skin around a fistula?
Select one:
a. Skin barrier powder or wafer.
b. Thick layers of cornstarch or Maalox.
c. Transparent dressing and tape.
d. Gauze dressing saturated in hydrogel.
a. Skin barrier powder or wafer.
One of the important features of an endoscopy gastrostomy procedure, compared to a surgically placed gastrostomy, is that the endoscopy gastrostomy procedure allows feeding to occur:
Select one:
a. Within 8-12 hours.
b. Within 24 hours.
c. After 48 hours.
d. Immediately.
d. Immediately.