WOC Ostomy Care Certification Exam Prep: 100
Practice Questions with Evidence-Based Rationales
### Practice Questions & Rationales
**1. A WOC nurse is performing preoperative stoma site marking for a patient scheduled for a
permanent sigmoid colostomy. Which location should be avoided?**
A. Left lower quadrant within the rectus muscle
B. Right lower quadrant at the anterior superior iliac spine
C. Left upper quadrant on a flat surface
D. Right upper quadrant below the costal margin
**Correct Answer: B**
**Rationale:** Stoma sites should be marked on the rectus muscle, away from bony
prominences, the umbilicus, scars, skin folds, and the belt line. The anterior superior iliac spine
(ASIS) is a bony prominence that would compromise pouch adhesion and patient comfort.
**2. A patient with a new ileostomy has an output of 1,500 mL in 24 hours. Which complication
is the patient at highest risk for?**
A. Constipation
B. Hypovolemia (dehydration)
C. Hypernatremia
D. Peristomal infection
**Correct Answer: B**
, **Rationale:** Normal ileostomy output is approximately 500–800 mL/day. Output greater
than 1,200 mL/day defines a high-output stoma, placing the patient at significant risk for fluid
and electrolyte loss, leading to dehydration and acute kidney injury.
**3. Following creation of a new ileostomy, the WOC nurse assesses the stoma on postoperative
day 1. Which finding requires immediate notification of the surgeon?**
A. The stoma mucosa is dark red to purple with bluish discoloration at the tips
B. The stoma appears edematous and is slightly larger than expected
C. A small amount of serosanguineous drainage is present on the peristomal skin
D. The stoma is flush with the skin surface with mild bruising
**Correct Answer: A**
**Rationale:** A healthy stoma is moist and beefy red. Dark red to purple or black discoloration
indicates compromised venous return or arterial blood supply (ischemia/necrosis), which is a
surgical emergency requiring immediate evaluation to prevent perforation and peritonitis.
**4. Which type of stoma is MOST likely to develop a prolapse?**
A. End colostomy
B. Loop colostomy
C. End ileal conduit
D. Loop ileostomy
**Correct Answer: B**
**Rationale:** While prolapse can occur in any stoma, it most commonly occurs in loop
colostomies, especially those involving the transverse segment. Incidence in transverse loop
colostomies is reported to be between 7% and 25%.
Practice Questions with Evidence-Based Rationales
### Practice Questions & Rationales
**1. A WOC nurse is performing preoperative stoma site marking for a patient scheduled for a
permanent sigmoid colostomy. Which location should be avoided?**
A. Left lower quadrant within the rectus muscle
B. Right lower quadrant at the anterior superior iliac spine
C. Left upper quadrant on a flat surface
D. Right upper quadrant below the costal margin
**Correct Answer: B**
**Rationale:** Stoma sites should be marked on the rectus muscle, away from bony
prominences, the umbilicus, scars, skin folds, and the belt line. The anterior superior iliac spine
(ASIS) is a bony prominence that would compromise pouch adhesion and patient comfort.
**2. A patient with a new ileostomy has an output of 1,500 mL in 24 hours. Which complication
is the patient at highest risk for?**
A. Constipation
B. Hypovolemia (dehydration)
C. Hypernatremia
D. Peristomal infection
**Correct Answer: B**
, **Rationale:** Normal ileostomy output is approximately 500–800 mL/day. Output greater
than 1,200 mL/day defines a high-output stoma, placing the patient at significant risk for fluid
and electrolyte loss, leading to dehydration and acute kidney injury.
**3. Following creation of a new ileostomy, the WOC nurse assesses the stoma on postoperative
day 1. Which finding requires immediate notification of the surgeon?**
A. The stoma mucosa is dark red to purple with bluish discoloration at the tips
B. The stoma appears edematous and is slightly larger than expected
C. A small amount of serosanguineous drainage is present on the peristomal skin
D. The stoma is flush with the skin surface with mild bruising
**Correct Answer: A**
**Rationale:** A healthy stoma is moist and beefy red. Dark red to purple or black discoloration
indicates compromised venous return or arterial blood supply (ischemia/necrosis), which is a
surgical emergency requiring immediate evaluation to prevent perforation and peritonitis.
**4. Which type of stoma is MOST likely to develop a prolapse?**
A. End colostomy
B. Loop colostomy
C. End ileal conduit
D. Loop ileostomy
**Correct Answer: B**
**Rationale:** While prolapse can occur in any stoma, it most commonly occurs in loop
colostomies, especially those involving the transverse segment. Incidence in transverse loop
colostomies is reported to be between 7% and 25%.
