Chapter 26: The Patient with an Ostomy Nursing School Test Banks

Chapter 26: The Patient with an Ostomy
Linton: Introduction to Medical-Surgical Nursing, 6th Edition

MULTIPLE CHOICE

1. Which term appropriately defines an artificial opening into a body cavity?
a. Gastrostomy
b. Ostomy
c. Colonoscopy
d. Ureterostomy
ANS: B
An ostomy is an artificial opening into a body cavity.

DIF: Cognitive Level: Knowledge REF: p. 414 OBJ: 3
TOP: Terminology KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

2. Why is a patient who has undergone a colostomy instructed to measure the width of the stomas for the first 6 weeks postoperatively before applying each new pouch?
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.
ANS: A
During the first 6 weeks, the stoma normally shrinks. The pouch needs to fit as closely to the stoma as is comfortable and safe to prevent skin irritation.

DIF: Cognitive Level: Comprehension REF: p. 427 OBJ: 4 | 7
TOP: Pouch Fit KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. A 47-year-old patient with a permanent colostomy reports some abdominal discomfort and rigidity 3 days after surgery. Which assessment should the nurse report and record?
a. Vital signs are temperature, 100 F; pulse, 92 beats/min; and blood pressure, 160/98 mm Hg.
b. Stoma is swollen and red; small amount of blood is observed at the base.
c. Pouch has drained 110 mL of green-brown liquid, oozing from the pouch edges.
d. Stoma is protruding.
ANS: A
Vital signs, in conjunction with the complaint of abdominal discomfort, should be reported and recorded as possible signs of impending peritonitis.

DIF: Cognitive Level: Application REF: p. 423 OBJ: 4
TOP: Signs of Peritonitis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

4. A nurse is aware that many patients with ostomies have an altered self-image. What might this cause?
a. Self-care deficits
b. Sexual dysfunction
c. Nonadherence to diet
d. Irrational anger
ANS: B
A damaged self-image or body image may cause patients with ostomies to feel unattractive and embarrassed about possible sexual activity. Open-ended questions assist the patient to talk about their feelings.

DIF: Cognitive Level: Comprehension REF: p. 420 OBJ: 4 | 7
TOP: Self-Concept Issues in an Ostomate
KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

5. What should a nurse instruct the patient to do to ensure a good fit of the appliance to avoid leakage?
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.
ANS: B
Placement of the pouch should provide a good fit and be comfortable in all positions but not too snug on the stoma to risk laceration. The pouch needs to only cover enough of the abdomen to allow for a firm fit.

DIF: Cognitive Level: Application REF: p. 415 OBJ: 4 | 7
TOP: Placement of the Stoma KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

6. What should a nurse suggest to a patient with a colostomy choose when selecting an appropriate diet to reduce excess gas or diarrhea?
a. Roast beef, mashed potatoes, and peeled stewed tomatoes
b. Broiled pork chop, boiled potato, and corn on the cob
c. Broiled trout, mashed potatoes, and spinach
d. Barbeque pork on a white bun, coleslaw, and French fries
ANS: A
Gas-forming or spicy foods and roughage, such as corn, fish, and cabbage, usually cause gas and diarrhea.

DIF: Cognitive Level: Application REF: p. 420 OBJ: 7
TOP: Ostomy Nutrition Teaching KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

7. A patient who has had a temporary colostomy to rest his ulcerated bowel says, I dont know how I will continue to work at my job with this thing stuck to my stomach. Which response by the nurse is most likely to stimulate communication?
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.
ANS: C
Open-ended questions without prejudgment or belittling encourage the patient to identify sources of anxiety and help the patient cope with, adapt to, or problem solve stressful events.

DIF: Cognitive Level: Application REF: p. 415 OBJ: 2
TOP: Interpersonal Communication Skills
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

8. What is the primary advantage of a J-pouch anal anastomosis procedure?
a. No odor
b. Easier to irrigate
c. Near-normal bowel elimination
d. Less problem with diarrhea
ANS: C
Preoperative teaching includes the expectation of near-normal bowel elimination. As with any bowel elimination, odor and possibly occasional diarrhea will occur. An irrigation is not necessary.

DIF: Cognitive Level: Comprehension REF: p. 416 OBJ: 3
TOP: Preoperative Teaching for J-pouch KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

9. What should a nurse include in postoperative teaching for a patient who has undergone a ureterostomy?
a. The 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
ANS: A
Information about the ureteral catheter, which will be in place for the first week, is important. Karaya gum products are not used for urinary appliances because urine breaks down the karaya. Pouches are changed only every 4 to 6 days to prevent skin irritation. The pouch is best changed in the morning.

DIF: Cognitive Level: Comprehension REF: p. 429-430 OBJ: 7
TOP: Postoperative Urostomy Teaching KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

10. A patient with an ostomy asks the nurse what limitations should be observed in the immediate postoperative period when at home. What is the most informative information that the nurse should share?
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.
ANS: A
Avoiding heavy lifting for 3 months is advised. People with ostomies should take in at least 2000 mL of fluid every day. They may wear ordinary clothes that do not bind the stoma. Showering is allowed because the appliance is waterproof.

DIF: Cognitive Level: Comprehension REF: p. 421 OBJ: 7
TOP: Postoperative Limitations for Ostomates
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

11. A patient with a colostomy continues to worry about odor. What instruction should a nurse provide to allay this concern?
a. Pierce the top of the appliance bag with a pin to allow gas to escape.
b. Rinse the pouch in a vinegar solution.
c. Wear tight-fitting underwear.
d. Improve personal hygiene.
ANS: B
The problem of odor is a frequent cause of anxiety to patients with colostomies. Rinsing the bag with a vinegar solution or putting a small amount of vinegar in the bag is helpful in odor control. Piercing the bag allows gas to escape more easily, and wearing tight fitting clothing does nothing to alleviate odor. Personal hygiene is not a consideration in controlling the odor of feces.

DIF: Cognitive Level: Application REF: p. 420 OBJ: 7
TOP: Controlling Odor from a Colostomy
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

12. A 20-year-old patient with a permanent colostomy asks whether she will be able to become pregnant. What is the most informative response by the nurse?
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.
ANS: D
Colostomies do not interfere with pregnancy or delivery.

DIF: Cognitive Level: Comprehension REF: p. 421 OBJ: 6
TOP: Pregnancy KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. Which assessment of the stoma should a nurse caring for a 2-day postoperative colostomy patient report immediately?
a. Is beefy and red
b. Has swelling
c. Has a small amount of bleeding around it
d. Is blue tinged
ANS: D
A stoma should be beefy red. Blue or black coloration is an indication of poor circulation and should be reported immediately. Swelling and a small amount of blood around the stoma are normal in early postoperative days.

DIF: Cognitive Level: Comprehension REF: p. 418 OBJ: 4
TOP: Stoma Assessment in Colostomy KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

14. A baby born without a urinary bladder has a surgically created cutaneous ureterostomy. One stoma exists. What should be discussed with the childs family regarding the care?
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.
ANS: A
The babys ureterostomy and drainage of urine are constant. This is a permanent solution because of the lack of a bladder. Both ureters are joined for the release of urine through the stoma. The pouch will be on continually and needs to be changed as needed several times a day.

DIF: Cognitive Level: Application REF: p. 427-428 OBJ: 5 | 7
TOP: Cutaneous Ureterostomy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

15. What should the initial assessment of a patient that just returned from surgery for the creation of an Indiana pouch include?
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
ANS: A
Indiana pouches initially have a Penrose drain to drain the small amount of urine; it will have mucus in it but no odor. No stoma exists to observe. Irrigations may be necessary to remove clots and mucus.

DIF: Cognitive Level: Application REF: p. 429 OBJ: 3 | 6
TOP: Assessment of New Postoperative Patient
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

16. A patient says, I hate this yucky paste under my appliance. I think I will just tape it on. What is the best response by the nurse?
a. Taping will not work!
b. Taping will not seal the wafer tight enough to prevent leakage or fill increases.
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.
ANS: B
Reminding the patient that the paste both bonds and waterproofs is the best information.

DIF: Cognitive Level: Application REF: p. 419 OBJ: 6 | 7
TOP: Function of Paste on Ostomy Appliance
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

17. A patient comes to the industrial nurse and is frantic because the stoma to the colostomy has prolapsed 1 year after surgery. What is the best response by the nurse?
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. Dont worry about that. Coughing or sneezing might have caused the prolapse. It will come back out in a few hours.
ANS: A
The prolapse of a stoma is very disturbing to a patient. The condition should be evaluated by the surgeon. However, if the stoma is still patent, emergency implementation is not necessary. Prolapse can be caused by coughing or sneezing, but the stoma will still need evaluation.

DIF: Cognitive Level: Application REF: p. 424 OBJ: 7
TOP: Stomal Prolapse KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

18. A patient is receiving discharge instructions and shares with the nurse that he intends to do a lot of traveling. What instruction should the nurse include?
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.
ANS: B
Warning about foods in a different country is appropriate. Supplies should be placed in a carry-on bag for quick access or in the case of lost luggage. Water that is not safe to drink is not appropriate as irrigation fluid.

DIF: Cognitive Level: Application REF: p. 421 OBJ: 7
TOP: Discharge Instructions KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

19. Which assessment by a nurse caring for an immediate postoperative patient with an ileal conduit should be reported or receive attention immediately?
a. Lack of bowel sounds
b. Distended abdomen
c. Mucus present in the urine
d. Small amount of blood in the drainage
ANS: B
The distended abdomen suggests that the gastrointestinal suction is not effective to prevent bowel distention. The nurse must check the efficiency of the suction. Lack of bowel sounds, mucus in the urine, and a small amount of blood in the drainage is to be expected as normal postoperative assessments.

DIF: Cognitive Level: Application REF: p. 428 OBJ: 3
TOP: Postoperative Care of Ileal Conduit
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

20. A patient asks if rectal suppositories can be used to assist with constipation problems with his colostomy. What should the nurse clarify regarding suppositories?
a. They can be used in double-barreled colostomies.
b. They can be used in a stoma.
c. They should not ever be used in a colostomy.
d. They will not penetrate well enough to relieve constipation.
ANS: B
Suppositories can be used effectively in double-barreled colostomies and in stomas of a single colostomy.

DIF: Cognitive Level: Application REF: p. 427 OBJ: 7
TOP: Use of Rectal Suppositories KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

21. What might the continual loss of liquid stool result in with an ileostomy patient?
a. Acidosis
b. Alkalosis
c. Erosion of stoma
d. Colitis
ANS: A
Metabolic acidosis can result from a loss of bicarbonates in the stool.

DIF: Cognitive Level: Comprehension REF: p. 418-419 OBJ: 6
TOP: Signs of Electrolyte Imbalance KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

22. Which is the best nursing strategy for encouraging an ostomy patient to perform self-care?
a. Plan to change the pouch when family members will be present, and 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 him or her.
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.
ANS: C
The goal for teaching patients with ostomies is to assist them to care for themselves without pressure or forcing.

DIF: Cognitive Level: Application REF: p. 421 OBJ: 4
TOP: Encourage Self-Care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

23. A patient asks a nurse if karaya products can be used to seal the urostomy appliance. On what knowledge should the nurse base a response?
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 is increased with the use of karaya products.
ANS: B
Urine breaks down karaya products and should not be used as a paste with urinary diversion appliances.

DIF: Cognitive Level: Comprehension REF: p. 430 OBJ: 4
TOP: Karaya Products KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

24. What is caused by some adhesive pouch material used to hold the appliance in place?
a. Melting of the pouch
b. Excoriation of the stoma
c. Allergic reaction
d. Unpleasant odor
ANS: C
Pouch adhesives can cause allergic reactions, but they do not melt the pouch or cause odor. Because the paste is not in contact with the stoma, it does not affect it.

DIF: Cognitive Level: Comprehension REF: p. 419 OBJ: 7
TOP: Pouch Materials KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

25. What is the most effective way for a nurse to help provide support to the patient with an ostomy who has ineffective regimen management?
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.
ANS: A
Contact with persons who have coped with all the aspects of ostomies are excellent resources for individuals with new ostomies. Every effort is made to send a volunteer of the same age and gender.

DIF: Cognitive Level: Comprehension REF: p. 431 OBJ: 4 | 6
TOP: Support for Ostomy Patients KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

MULTIPLE RESPONSE

26. A postoperative patient with an ostomy is at risk for loss of fluid volume and electrolyte imbalance. Which assessments indicate such loss? (Select all that apply.)
a. Changing mental status
b. Twitching
c. Poor skin turgor
d. Moist mucous membranes
e. Weakness
ANS: A, B, C, E
The loss of base products from the bowel that allow for metabolic acidosis can be a very serious postoperative complication. Signs and symptoms include changing mental status, muscular twitching, poor skin turgor, dry mucous membranes, and weakness.

DIF: Cognitive Level: Comprehension REF: p. 419 OBJ: 4
TOP: Assessments for Fluid and Electrolyte Loss
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

27. What can be caused by lack of thorough cleansing of fecal matter from around a stoma? (Select all that apply.)
a. Fungal infection
b. Bacterial infection
c. Yeast infection
d. Deterioration of the stoma
e. Odor
ANS: A, B, C, E
Fecal matter left on the skin and trapped under the pouch can cause fungal, bacterial, and yeast infections, as well as odor.

DIF: Cognitive Level: Comprehension REF: p. 419 OBJ: 4
TOP: Cleaning Stoma of Fecal Matter KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

28. The 1-day postoperative ileostomy patient is concerned about the fact that no drainage has occurred from the ileostomy. What should the nurse remind the patient? (Select all that apply.)
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.
ANS: A, B, C
Drainage does not begin because of the empty bowel before surgery. The first drainage appears 24 to 48 hours after surgery and is accompanied by small amounts of blood and mucus from the bowel. The first drainage is expelled with low pressure and very little, if any, gas.

DIF: Cognitive Level: Application REF: p. 417-418 OBJ: 4 | 7
TOP: Expected Drainage from an Ileostomy
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

29. What are complications that may occur with continent pouches (Kock and Indiana)? (Select all that apply.)
a. Incontinence
b. Difficult catheterization
c. Pyelonephritis
d. Rupture of the pouch
e. Peritonitis
ANS: A, B, C
The most frequent complications are incontinence, difficult catheterization, and reflux pyelonephritis. Rupture and peritonitis are not threats to the patient from this surgery.

DIF: Cognitive Level: Knowledge REF: p. 428 OBJ: 3
TOP: Complication of Kock and Indiana Continent Pouches
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

30. What should be considered when deciding placement of a stoma? (Select all that apply.)
a. Good seal
b. Stabilization from the abdominal rectus
c. Ease of self-care
d. Inoffensive appearance
e. Proximity to the umbilicus
ANS: A, C
The two major considerations for the placement of the stoma are that the placement allows for a good seal and ease in self-care. Stabilization is nice but not necessary. The placement should not be near the umbilicus.

DIF: Cognitive Level: Comprehension REF: p. 415 OBJ: 3
TOP: Stoma Placement KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

COMPLETION

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

ANS:
vinegar
A pad soaked in vinegar with dissolve urine crystals that may form on the stoma of a urostomy.

DIF: Cognitive Level: Comprehension REF: p. 430 OBJ: 7
TOP: Urine Crystals KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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