Deck 26: The Patient With an Ostomy

Question 1

A patient is receiving discharge instructions.He shares with the nurse that he intends to do a lot of traveling.Instructions for travel should include which one of these points?

A) "Pack plenty of extra colostomy supplies in your checked airline luggage. Some places you might visit do not always carry the supplies you will need."
B) "Exercise caution with new foods, especially local fruits and vegetables, because they may cause diarrhea or gas."
C) "If visiting somewhere where drinking local water is not advised, irrigating the colostomy with the local water is still okay."
D) "Repeat back to me what we just talked about so that you will remember everything you have been taught."

Answer 1

"Exercise caution with new foods, especially local fruits and vegetables, because they may cause diarrhea or gas."

Question 2

A baby born without a urinary bladder has a cutaneous ureterostomy with one stoma and a cutaneous ureterostomy has been surgically created.One stoma exists.Discussion with the child's family regarding the care should include which of the following?

A) "This urinary diversion is permanent, and urine will drain from it continually."
B) "In the future, a second surgery will offer an exit for the urine from the other kidney."
C) "This pouch needs to be changed only once a week."
D) "You should notify the surgeon if the stoma becomes paler in color."

Answer 2

"This urinary diversion is permanent, and urine will drain from it continually."

Question 3

The patient asks if rectal suppositories can be used to assist with constipation problems with his colostomy.The nurse clarifies that suppositories:

A) Can be used in double-barreled colostomies
B) Can be used in a stoma.
C) Should not ever be used in a colostomy
D) Will not penetrate well enough to relieve constipation

Answer 3

Can be used in a stoma.

Question 4

A patient who has had a temporary colostomy to rest his ulcerated bowel says,"I don't know how I will continue to work at my job with this thing stuck to my stomach." The nurse's best response to stimulate communication would be:

A) "This is only a temporary adjustment for you, and the colostomy will be reanastomosed in less than 6 months."
B) "A nurse with special training will be in to help you."
C) "What is there about your job that you feel you cannot do?"
D) "Many people feel as you do, but they learn to dress and act and work just like they did before the surgery."

Question 5

The 20-year-old patient with a permanent colostomy asks whether she will be able to become pregnant.The nurse's most informative response would be:

A) "No. The colostomy weakened the pelvic floor to the point that it will not support a pregnancy."
B) "Yes. Pregnancy may be accomplished with artificial insemination because the fallopian tubes are usually damaged by a colostomy."
C) "No. The abdominal pressure exerted by a pregnancy will cause the prolapse of the stoma.
D) "Yes. The colostomy will not interfere with pregnancy or delivery.

Question 6

The nurse explains that an artificial opening into a body cavity is a(n):

A) Gastrostomy
B) Ostomy
C) Colonoscopy
D) Ureterostomy

Question 7

To ensure a good fit of the appliance to avoid leakage,the nurse would instruct the patient to:

A) Place the pouch only when lying down.
B) Check pouch placement to ensure a firm seal.
C) Confirm that the pouch fits tightly to the edges of the stoma.
D) Confirm that the pouch covers the entire abdomen.

Question 8

A 47-year-old patient with a permanent colostomy reports some abdominal discomfort and rigidity 3 days after surgery.The assessment that the nurse should report and record is:

A) Vital signs are: temperature, 100° F; pulse, 92 bpm; blood pressure, 160/98 mm Hg.
B) Stoma is swollen and red; small amount of blood are observed at the base.
C) Pouch has drained 110 ml of green-brown liquid, oozing from the pouch edges.
D) Stoma is protruding.

Question 9

In postoperative teaching to a patient who has undergone a ureterostomy,the nurse would include information pertaining to the:

A) Significance of the ureteral catheter for the first week.
B) Appropriate use of karaya gum products.
C) Daily schedule for changing the pouch.
D) Evening schedule for changing the pouch before bedtime.

Question 10

The nurse caring for a 2-day postoperative colostomy patient should report immediately if a stoma is assessed and:

A) Is beefy and red
B) Has swelling
C) Has a small amount of bleeding around it
D) Is blue-tinged.

Question 11

The nurse explains to a preoperative patient that a J-pouch anal anastomosis procedure has the primary advantage of:

A) No odor
B) Easier to irrigate
C) Near-normal bowel elimination
D) Less problem with diarrhea

Question 12

Because the colostomy patient continues to worry about odor,the nurse can allay those concerns by explaining that odor can be diminished by:

A) Piercing the top of the appliance bag with a pin to allow gas to escape
B) Rinsing the pouch in a vinegar solution
C) Wearing tight-fitting underwear
D) Improving personal hygiene

Question 13

The initial assessment of a patient just returned from surgery for the creation of an Indiana pouch would include the:

A) Drainage of urine from the Penrose drain at the operative site
B) Condition and color of the stoma
C) Appearance of mucus in the urine
D) Copious and odorous urine drainage from the incision

Question 14

The patient who has undergone a colostomy is instructed to measure the width of the stomas for the first 6 weeks postoperatively before applying each new pouch because:

A) The stoma will shrink during this time.
B) A poor-fitting pouch will cause infection of the stoma.
C) The paste will not adhere.
D) Prolapse will result.

Question 15

The patient comes to the industrial nurse and is frantic because the stoma to the colostomy has prolapsed 1 year after surgery.The nurse's best counsel would be:

A) "If there are still feces coming from the stoma, then it is not blocked. Contact your surgeon for an evaluation."
B) "You must come in immediately, because the stoma may completely retract into your abdomen."
C) "This is an emergency situation, because it has stenosed."
D) "Don't worry about that. Coughing or sneezing might have caused the prolapse. It will come back out in a few hours."

Question 16

To assist a colostomy patient in selecting an appropriate diet to reduce excess gas or diarrhea,the nurse would encourage the patient to choose:

A) Roast beef, mashed potatoes, peeled stewed tomatoes
B) Broiled pork chop, boiled potato, corn on the cob
C) Broiled trout, mashed potatoes, spinach
D) Barbeque pork on a white bun, coleslaw, French fries

Question 17

An ostomate asks the nurse what limitations must be observed in the immediate postoperative period when at home.The most informative information that the nurse can share is to:

A) Avoid heavy lifting for at least 3 months.
B) Limit fluid intake to no more than 1000 ml/day.
C) Wear loose clothing without belts or elastic.
D) Cover your appliance with plastic sheeting while showering.

Question 18

The patient says,"I hate this yucky paste under my appliance.I think I will just tape it on." The nurse's most informative response to this remark would be which of the following?

A) "Taping will not work!"
B) "Taping will not seal the wafer tight enough to prevent leakage or fill in creases."
C) "Taping with waterproof tape is just as effective as the paste."
D) "Taping is far more irritating to the skin than the paste would be."

Question 19

The nurse caring for the immediate postoperative patient with an ileal conduit should report or intervene for:

A) Lack of bowel sounds
B) Distended abdomen
C) Mucus present in the urine
D) Small amount of blood in the drainage

Question 20

The nurse is aware that many ostomates have an altered self-image,which may cause:

A) Self-care deficits
B) Sexual dysfunction
C) Nonadherence to diet
D) Irrational anger

Question 21

When the patient complains of urine crystals forming on the urostomy stoma,the home health nurse recommends dissolving them with a pad saturated with _________.

Question 22

The patient asks the nurse if karaya products can be used to seal the urostomy appliance.The nurse's response is based on the knowledge that:

A) Any adhesive is effective on a urostomy appliance.
B) Urine breaks down karaya products.
C) Karaya products can cause urinary infections.
D) Formation of urine crystals in increased with the use of karaya products.

Question 23

The nurse cautions that some adhesive pouch material used to hold the appliance in place may cause:

A) Melting of the pouch
B) Excoriation of the stoma
C) Allergic reaction
D) Unpleasant odor

Question 24

The most effective way for a nurse to help provide support to the ostomate who has ineffective regimen management is to:

A) Ask a volunteer from the American Cancer Society or United Ostomy Association to visit.
B) Ask a volunteer from the Reach for Recovery Society to visit.
C) Send a close family member for psychiatric counseling.
D) Obtain humor books pertaining to illness, such as Anatomy of an Illness, or watch several episodes of the Three Stooges on television.

Question 25

The 1-day postoperative ileostomy patient is concerned about the fact that no drainage has occurred from the ileostomy.The nurse reminds the patient that:

A) The drainage does not start until approximately 24 to 48 hours after surgery.
B) The first drainage will have blood in it.
C) Mucus will be obvious in the early drainage.
D) The first drainage is expelled with a great deal of force.
E) A large amount of flatus will accompany the first drainage.

Question 26

The major considerations for placement of a stoma are to provide:

A) Good seal
B) Stabilization from the abdominal rectus
C) Ease of self-care
D) Inoffensive appearance
E) Proximity to the umbilicus

Question 27

The nurse instructs the patient to be diligent in cleaning fecal matter from around the stoma because the fecal matter can cause:

A) Fungal infection
B) Bacterial infection
C) Yeast infection
D) Deterioration of the stoma
E) Odor

Question 28

The best nursing strategy for encouraging ostomy patient self-care would be to:

A) Plan to change the pouch when family members will be present, have the patient watch, and listen to the procedure.
B) Frequently tell the patient that if he or she does not learn stoma self-care, no one is going to do it for them.
C) Encourage the patient to watch the stoma care procedure, gradually encouraging participation.
D) Shield the patient from sight of the stoma until the patient actually asks to see it.

Question 29

The nurse counsels that complications of the continent pouches (Kock and Indiana)may be:

A) Incontinence
B) Difficult catheterization
C) Pyelonephritis
D) Rupture of the pouch
E) Peritonitis

Question 30

The nurse who is caring for a patient with an ileostomy is aware that the continual loss of liquid stool may result in:

A) Acidosis
B) Alkalosis
C) Erosion of stoma
D) Colitis

Question 31

The postoperative ostomate is at risk for loss of fluid volume and electrolyte imbalance.The assessments that indicate such loss are:

A) Changing mental status
B) Twitching
C) Poor skin turgor
D) Moist mucous membranes
E) Weakness