Patient Care Rounds: Bowel Diversion Results -
Comprehensive Examination
Miguel Flores Case Study 2026!!!! summary
,Question 1
A patient with a newly created ileostomy asks the nurse about the expected appearance of their stoma.
Which response by the nurse is most accurate?
A) "The stoma will be pale and bluish in color initially, but this will improve over time"
B) "A healthy stoma should appear dark red and moist, similar to the inside of your mouth"
C) "The stoma will be brownish and dry, like the surrounding skin"
D) "The stoma should be bright red and dry to prevent infection"
ANSWER: B
Rationale:
Option A (Incorrect): Pale or bluish coloration indicates compromised blood supply and is abnormal. A
healthy stoma should be pink to dark red, not pale or blue.
Option B (Correct): A healthy stoma appears dark red or pink, moist, and shiny, resembling the mucosal
tissue of the mouth. This indicates adequate blood perfusion.
Option C (Incorrect): Brownish coloration or dryness indicates ischemia or necrosis and requires
immediate intervention.
Option D (Incorrect): While bright red can be normal, the stoma should be moist, not dry. Dryness may
indicate dehydration or poor stoma care.
,Question 2
Which nursing intervention is most important immediately following ileostomy surgery to prevent
complications?
A) Applying a new ostomy pouch every 4 hours
B) Measuring stoma size daily with a measuring guide
C) Cutting the ostomy wafer 1/8 inch larger than the stoma size
D) Keeping the stoma site uncovered to allow air circulation
ANSWER: C
Rationale:
Option A (Incorrect): Pouch changes should be done every 3-7 days or when leaking, not every 4 hours.
Frequent changes can traumatize the peristomal skin.
Option B (Incorrect): While measuring stoma size is important, it should be done at each pouch change,
which is typically every few days, not daily.
Option C (Correct): Cutting the wafer 1/8 inch larger than the stoma prevents trauma to the stoma from
friction while allowing proper adhesion to the skin. This prevents skin breakdown and stoma damage.
Option D (Incorrect): The stoma site should be covered with an ostomy appliance to contain effluent and
protect the skin from irritation.
Question 3
The nurse is assessing a patient's colostomy stoma 24 hours postoperatively. Which finding requires
immediate intervention?
A) Stoma measuring 2.5 cm in diameter
B) Slight edema of the stoma tissue
, C) Dark purple discoloration of the stoma
D) Small amount of bloody drainage on the dressing
ANSWER: C
Rationale:
Option A (Incorrect): A stoma measuring 2.5 cm is within normal range (typically 2-5 cm diameter).
Option B (Incorrect): Slight edema is expected in the first 24-48 hours postoperatively and will gradually
resolve.
Option C (Correct): Dark purple or black discoloration indicates ischemia and potential necrosis of the
stoma tissue. This requires immediate surgical evaluation as it may indicate compromised blood supply.
Option D (Incorrect): A small amount of bloody drainage on the dressing is expected postoperatively and
is not concerning unless it is excessive.
Question 4
A patient with a new colostomy asks about dietary restrictions. Which response demonstrates the
nurse's accurate understanding of postoperative ostomy care?
A) "You should avoid all high-fiber foods permanently to prevent blockages"
B) "Carbonated beverages should be avoided permanently as they cause excessive gas"
C) "You should introduce new foods one at a time to evaluate tolerance"
D) "A low-protein diet is recommended to reduce odor from the stoma"
ANSWER: C
Rationale:
Comprehensive Examination
Miguel Flores Case Study 2026!!!! summary
,Question 1
A patient with a newly created ileostomy asks the nurse about the expected appearance of their stoma.
Which response by the nurse is most accurate?
A) "The stoma will be pale and bluish in color initially, but this will improve over time"
B) "A healthy stoma should appear dark red and moist, similar to the inside of your mouth"
C) "The stoma will be brownish and dry, like the surrounding skin"
D) "The stoma should be bright red and dry to prevent infection"
ANSWER: B
Rationale:
Option A (Incorrect): Pale or bluish coloration indicates compromised blood supply and is abnormal. A
healthy stoma should be pink to dark red, not pale or blue.
Option B (Correct): A healthy stoma appears dark red or pink, moist, and shiny, resembling the mucosal
tissue of the mouth. This indicates adequate blood perfusion.
Option C (Incorrect): Brownish coloration or dryness indicates ischemia or necrosis and requires
immediate intervention.
Option D (Incorrect): While bright red can be normal, the stoma should be moist, not dry. Dryness may
indicate dehydration or poor stoma care.
,Question 2
Which nursing intervention is most important immediately following ileostomy surgery to prevent
complications?
A) Applying a new ostomy pouch every 4 hours
B) Measuring stoma size daily with a measuring guide
C) Cutting the ostomy wafer 1/8 inch larger than the stoma size
D) Keeping the stoma site uncovered to allow air circulation
ANSWER: C
Rationale:
Option A (Incorrect): Pouch changes should be done every 3-7 days or when leaking, not every 4 hours.
Frequent changes can traumatize the peristomal skin.
Option B (Incorrect): While measuring stoma size is important, it should be done at each pouch change,
which is typically every few days, not daily.
Option C (Correct): Cutting the wafer 1/8 inch larger than the stoma prevents trauma to the stoma from
friction while allowing proper adhesion to the skin. This prevents skin breakdown and stoma damage.
Option D (Incorrect): The stoma site should be covered with an ostomy appliance to contain effluent and
protect the skin from irritation.
Question 3
The nurse is assessing a patient's colostomy stoma 24 hours postoperatively. Which finding requires
immediate intervention?
A) Stoma measuring 2.5 cm in diameter
B) Slight edema of the stoma tissue
, C) Dark purple discoloration of the stoma
D) Small amount of bloody drainage on the dressing
ANSWER: C
Rationale:
Option A (Incorrect): A stoma measuring 2.5 cm is within normal range (typically 2-5 cm diameter).
Option B (Incorrect): Slight edema is expected in the first 24-48 hours postoperatively and will gradually
resolve.
Option C (Correct): Dark purple or black discoloration indicates ischemia and potential necrosis of the
stoma tissue. This requires immediate surgical evaluation as it may indicate compromised blood supply.
Option D (Incorrect): A small amount of bloody drainage on the dressing is expected postoperatively and
is not concerning unless it is excessive.
Question 4
A patient with a new colostomy asks about dietary restrictions. Which response demonstrates the
nurse's accurate understanding of postoperative ostomy care?
A) "You should avoid all high-fiber foods permanently to prevent blockages"
B) "Carbonated beverages should be avoided permanently as they cause excessive gas"
C) "You should introduce new foods one at a time to evaluate tolerance"
D) "A low-protein diet is recommended to reduce odor from the stoma"
ANSWER: C
Rationale:
