OST 580 - FINAL REVIEW STUDY
GUIDE 3 QUESTIONS AND ANSWERS
WITH COMPLETE SOLUTIONS 100%
CORRECT RATED A+
Question 1: Indications for a Fecal Stoma with a Mucous Fistula
The creation of a fecal stoma with a mucous fistula may be indicated in which
of the following conditions?
✔✔ Answer: Toxic megacolon
Clinical Rationale: Toxic megacolon (a life-threatening complication of severe
ulcerative colitis or C. difficile colitis) often requires emergency subtotal or total
colectomy. To minimize surgical time and avoid pelvic dissection in a critically ill
patient, the proximal end of the transected bowel is brought out as a functioning
stoma (e.g., ileostomy or colostomy), and the distal closed rectum/sigmoid is
brought out as a non-functioning mucous fistula to allow for safe decompression
and drainage of remaining distal secretions.
Question 2: Complications Associated with Ureteroscopy
What complication would the WOC nurse assess for in a patient undergoing a
ureteroscopy?
✔✔ Answer: Hydronephrosis
Clinical Rationale: Post-procedure edema, mucosal trauma, blood clots, or
retained stone fragments in the ureter following ureteroscopy can obstruct urine
outflow from the kidney. This backpressure causes acute renal pelvic dilation,
leading to hydronephrosis and flank pain.
Question 3: Most Common Urinary Diversion
Which procedure is the most common urinary diversion?
✔✔ Answer: Ileal conduit
Clinical Rationale: The ileal conduit (an incontinent, non-contineous urinary
diversion using an isolated 15–20 cm segment of the terminal ileum) remains the
gold-standard and most widely performed urinary diversion following radical
,cystectomy, due to its low technical complexity and predictable long-term
outcomes compared to continent cutaneous diversions or neobladder
reconstructions.
Question 4: Surgical Steps of an Ileal Conduit Construction
The WOC nurse is explaining the procedure for constructing an ileal conduit
to a patient scheduled for surgery. Which statement by the nurse adequately
describes a step in this procedure?
✔✔ Answer: Gastrointestinal continuity is restored through ileal-to-ileal
anastomosis.
Clinical Rationale: During the construction of an ileal conduit, a segment of
terminal ileum is isolated with its mesentery intact to serve as the urinary conduit.
To restore small bowel continuity, the proximal and distal remaining ends of the
ileum are reconnected via an ileal-to-ileal anastomosis. The ureters are then
implanted into the isolated ileal segment, and the distal end of the segment is
brought through the abdominal wall as the stoma.
Question 5: Purpose of a Support Rod in Loop Stomas
A support rod is placed under a loop stoma to prevent which of the following
stoma complications?
✔✔ Answer: Retraction
Clinical Rationale: A loop stoma is created by bringing a loop of bowel above the
abdominal wall skin level and supported temporarily (typically 3–7 days) with a
support rod or bridge. This prevents tension from pulling the bowel loop back
down into the abdominal cavity (retraction) before the mesentery and serosal
surfaces form inflammatory adhesions to the abdominal wall.
A patient is scheduled for surgery for an abdominal perineal resection (APR).
What type of stoma will be created during this procedure?
Permanent end colostomy
3 multiple choice options
, The WOC nurse can help patients with their fears and concerns as they face
surgery for an ostomy by
Providing the opportunity for a visit with a trained ostomy visitor
3 multiple choice options
The WOC nurse is teaching a patient with a new stoma about pouching systems.
Which teaching point accurately describes an important aspect of using a pouching
system?
The usual wear time for a pouch is 4 days.
3 multiple choice options
If the surgeon is siting the stoma during the case in the OR, what advice would you
give for general information for stoma site marking?
Ideally, the stoma should be placed on the apex of the abdominal infra-umbilical
bulge.
3 multiple choice options
The patient with ulcerative colitis who is being prepared for a surgical procedure to
create a permanent end ileostomy should receive preoperative education that
includes the following:
Help the patient to understand that they can live a full life without a colon and a
rectum.
3 multiple choice options
GUIDE 3 QUESTIONS AND ANSWERS
WITH COMPLETE SOLUTIONS 100%
CORRECT RATED A+
Question 1: Indications for a Fecal Stoma with a Mucous Fistula
The creation of a fecal stoma with a mucous fistula may be indicated in which
of the following conditions?
✔✔ Answer: Toxic megacolon
Clinical Rationale: Toxic megacolon (a life-threatening complication of severe
ulcerative colitis or C. difficile colitis) often requires emergency subtotal or total
colectomy. To minimize surgical time and avoid pelvic dissection in a critically ill
patient, the proximal end of the transected bowel is brought out as a functioning
stoma (e.g., ileostomy or colostomy), and the distal closed rectum/sigmoid is
brought out as a non-functioning mucous fistula to allow for safe decompression
and drainage of remaining distal secretions.
Question 2: Complications Associated with Ureteroscopy
What complication would the WOC nurse assess for in a patient undergoing a
ureteroscopy?
✔✔ Answer: Hydronephrosis
Clinical Rationale: Post-procedure edema, mucosal trauma, blood clots, or
retained stone fragments in the ureter following ureteroscopy can obstruct urine
outflow from the kidney. This backpressure causes acute renal pelvic dilation,
leading to hydronephrosis and flank pain.
Question 3: Most Common Urinary Diversion
Which procedure is the most common urinary diversion?
✔✔ Answer: Ileal conduit
Clinical Rationale: The ileal conduit (an incontinent, non-contineous urinary
diversion using an isolated 15–20 cm segment of the terminal ileum) remains the
gold-standard and most widely performed urinary diversion following radical
,cystectomy, due to its low technical complexity and predictable long-term
outcomes compared to continent cutaneous diversions or neobladder
reconstructions.
Question 4: Surgical Steps of an Ileal Conduit Construction
The WOC nurse is explaining the procedure for constructing an ileal conduit
to a patient scheduled for surgery. Which statement by the nurse adequately
describes a step in this procedure?
✔✔ Answer: Gastrointestinal continuity is restored through ileal-to-ileal
anastomosis.
Clinical Rationale: During the construction of an ileal conduit, a segment of
terminal ileum is isolated with its mesentery intact to serve as the urinary conduit.
To restore small bowel continuity, the proximal and distal remaining ends of the
ileum are reconnected via an ileal-to-ileal anastomosis. The ureters are then
implanted into the isolated ileal segment, and the distal end of the segment is
brought through the abdominal wall as the stoma.
Question 5: Purpose of a Support Rod in Loop Stomas
A support rod is placed under a loop stoma to prevent which of the following
stoma complications?
✔✔ Answer: Retraction
Clinical Rationale: A loop stoma is created by bringing a loop of bowel above the
abdominal wall skin level and supported temporarily (typically 3–7 days) with a
support rod or bridge. This prevents tension from pulling the bowel loop back
down into the abdominal cavity (retraction) before the mesentery and serosal
surfaces form inflammatory adhesions to the abdominal wall.
A patient is scheduled for surgery for an abdominal perineal resection (APR).
What type of stoma will be created during this procedure?
Permanent end colostomy
3 multiple choice options
, The WOC nurse can help patients with their fears and concerns as they face
surgery for an ostomy by
Providing the opportunity for a visit with a trained ostomy visitor
3 multiple choice options
The WOC nurse is teaching a patient with a new stoma about pouching systems.
Which teaching point accurately describes an important aspect of using a pouching
system?
The usual wear time for a pouch is 4 days.
3 multiple choice options
If the surgeon is siting the stoma during the case in the OR, what advice would you
give for general information for stoma site marking?
Ideally, the stoma should be placed on the apex of the abdominal infra-umbilical
bulge.
3 multiple choice options
The patient with ulcerative colitis who is being prepared for a surgical procedure to
create a permanent end ileostomy should receive preoperative education that
includes the following:
Help the patient to understand that they can live a full life without a colon and a
rectum.
3 multiple choice options
