QUESTIONS AND ANSWERS 2026
- 2027
The nurse should instruct the client to empty the pouch when it is
between 1/3 to 1/2 full because waiting to empty the pouch until it is
more than 1/2 full increases the risk of leakage. Leakage of Ileostomy
effluent is irritating to peristomal skin.
A nurse is replacing the ostomy appliance for a client whose newly
created colostomy is functioning. After removing the pouch, which of
the following actions should the nurse take first?
Measure the stoma.
Cover the stoma with gauze.
Remove the backing on the skin barrier.
Cleanse the stoma and the peristomal skin. - ANSWERS-Cleanse the
stoma and the peristomal skin.
The first action the nurse should take is to remove any effluent
adhering to the stoma and the peristomal skin to facilitate the
assessment of the area.
, A nurse is teaching a client about extended-wear skin barriers. Which
of the following strategies should the nurse instruct the client to use
for maximal adherence?
Use an oil-based lotion on the peristomal area.
Apply the skin barrier while the skin is slightly moist.
Leave the residue from the previous appliance on the skin.
Press gently around the barrier for 30 seconds to 1 min. - ANSWERS-
Press gently around the barrier for 30 seconds to 1 min.
The nurse should instruct the client to press gently around to barrier
for 30 seconds to 1 min because the pressure-sensitive tackifiers and
heat-sensitive polymers of the skin barrier require adequate pressure
and warmth (from the fingers) to ensure adherence.
A nurse is reinforcing teaching with a client about replacing an
ostomy pouching system. The client reports that they occasionally
experience pain when removing the skin barrier. Which of the
following techniques should the nurse suggest?
Lift up on both sides of the skin barrier simultaneously.
Release one corner of the barrier and pull it quickly over the stoma.
Push the skin away from the barrier while removing it.
Gently roll the barrier end-over-end across the stoma. - ANSWERS-
Push the skin away from the barrier while removing it.