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Postoperative Ostomy Care Case Study: Miguel Flores – Adult Health II (NR 325)
100 Practice Questions with Answers and Rationales
Section 1: Assessment and Stoma Evaluation (Questions 1–20)
1. A WOC nurse assesses a new ileostomy 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
Answer: A – Dark red to purple discoloration with bluish hue at the stoma tips
Rationale: Dark red to purple discoloration with bluish or blackish hue indicates
compromised venous return or arterial blood supply, which may indicate ischemia or
necrosis. This is a surgical emergency requiring immediate notification.
2. What is the normal appearance of a healthy stoma?
A. Pale pink and dry
B. Beefy red and moist
C. Dark purple and shiny
D. Gray and flat
Answer: B – Beefy red and moist
Rationale: A healthy stoma appears beefy red to pink, moist, and shiny, reflecting good
blood supply.
3. 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
Answer: B – Hypovolemia (dehydration)
Rationale: Normal ileostomy output is approximately 500–800 mL/day. Output greater than
1200 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.
4. Miguel Flores reports increasing peristomal pain (7/10) and irritation. What is the MOST
likely cause?
, 2
A. Normal postoperative healing
B. Peristomal dermatitis from leakage
C. Stoma necrosis
D. Crohn's disease flare
Answer: B – Peristomal dermatitis from leakage
Rationale: Erythema, excoriation, and pain around the stoma are consistent with peristomal
dermatitis, often caused by leakage due to poor appliance fit.
5. What is the correct technique for measuring a stoma for pouching system fit?
A. Estimate the size visually
B. Use a stoma measuring guide/template
C. Use the same size as the previous pouch
D. Measure the peristomal skin only
Answer: B – Use a stoma measuring guide/template
Rationale: The stoma should be measured with a measuring guide/template to ensure the
flange opening is cut to the correct size, typically with 1/8-inch clearance.
6. Which laboratory value in Miguel Flores' case indicates dehydration?
A. WBC 12.9
B. Na+ 130
C. K+ 3.2
D. Creatinine 1.4
Answer: D – Creatinine 1.4
Rationale: Elevated creatinine (1.4) indicates mild dehydration and reduced renal perfusion.
Low sodium (130) and potassium (3.2) also reflect electrolyte losses, but elevated creatinine
specifically indicates dehydration.
7. What stoma characteristics influence pouching system selection?
A. Surgeon's preference
B. Stoma size, shape, location, output consistency, and peristomal skin condition
C. Hospital's available supplies
D. Patient's insurance coverage only
Answer: B – Stoma size, shape, location, output consistency, and peristomal skin condition
Rationale: Pouching system selection must be individualized based on stoma characteristics,
peristomal skin integrity, and the patient's lifestyle and dexterity.
8. Miguel Flores has a stoma with liquid/watery output and a flaccid abdomen. Which
type of pouching system is MOST appropriate?
, 3
A. Flat barrier
B. Convex barrier
C. Closed pouch
D. One-piece flat system
Answer: B – Convex barrier
Rationale: Convex barriers are indicated for loop ileostomies, stomas protruding one inch or
less, liquid/loose output, flaccid abdomen, and uneven/irregular peristomal skin.
9. What is the expected output consistency for a new ileostomy?
A. Formed stool
B. Pasty output (applesauce consistency)
C. Liquid/watery output
D. Hard, dry stool
Answer: C – Liquid/watery output
Rationale: Ileostomy output is initially liquid and gradually thickens to a pasty consistency
over weeks to months. The effluent contains digestive enzymes that are irritating to skin.
10. What is the expected output volume for a normal-functioning ileostomy?
A. 100–300 mL/day
B. 500–800 mL/day
C. 1,000–1,500 mL/day
D. 2,000–3,000 mL/day
Answer: B – 500–800 mL/day
Rationale: Normal ileostomy output is approximately 500–800 mL/day. Output greater than
1200 mL/day defines a high-output stoma.
11. Which finding indicates possible stoma retraction?
A. Stoma protrudes 2 cm above skin
B. Stoma recedes below skin level with leakage under the barrier
C. Stoma is beefy red and moist
D. Stoma is round and regular
Answer: B – Stoma recedes below skin level with leakage under the barrier
Rationale: Stomal retraction occurs when the stoma recedes below skin level, causing
leakage of discharge under the skin barrier and poor pouching adherence.
12. What is the FIRST sign of stomal necrosis?
Postoperative Ostomy Care Case Study: Miguel Flores – Adult Health II (NR 325)
100 Practice Questions with Answers and Rationales
Section 1: Assessment and Stoma Evaluation (Questions 1–20)
1. A WOC nurse assesses a new ileostomy 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
Answer: A – Dark red to purple discoloration with bluish hue at the stoma tips
Rationale: Dark red to purple discoloration with bluish or blackish hue indicates
compromised venous return or arterial blood supply, which may indicate ischemia or
necrosis. This is a surgical emergency requiring immediate notification.
2. What is the normal appearance of a healthy stoma?
A. Pale pink and dry
B. Beefy red and moist
C. Dark purple and shiny
D. Gray and flat
Answer: B – Beefy red and moist
Rationale: A healthy stoma appears beefy red to pink, moist, and shiny, reflecting good
blood supply.
3. 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
Answer: B – Hypovolemia (dehydration)
Rationale: Normal ileostomy output is approximately 500–800 mL/day. Output greater than
1200 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.
4. Miguel Flores reports increasing peristomal pain (7/10) and irritation. What is the MOST
likely cause?
, 2
A. Normal postoperative healing
B. Peristomal dermatitis from leakage
C. Stoma necrosis
D. Crohn's disease flare
Answer: B – Peristomal dermatitis from leakage
Rationale: Erythema, excoriation, and pain around the stoma are consistent with peristomal
dermatitis, often caused by leakage due to poor appliance fit.
5. What is the correct technique for measuring a stoma for pouching system fit?
A. Estimate the size visually
B. Use a stoma measuring guide/template
C. Use the same size as the previous pouch
D. Measure the peristomal skin only
Answer: B – Use a stoma measuring guide/template
Rationale: The stoma should be measured with a measuring guide/template to ensure the
flange opening is cut to the correct size, typically with 1/8-inch clearance.
6. Which laboratory value in Miguel Flores' case indicates dehydration?
A. WBC 12.9
B. Na+ 130
C. K+ 3.2
D. Creatinine 1.4
Answer: D – Creatinine 1.4
Rationale: Elevated creatinine (1.4) indicates mild dehydration and reduced renal perfusion.
Low sodium (130) and potassium (3.2) also reflect electrolyte losses, but elevated creatinine
specifically indicates dehydration.
7. What stoma characteristics influence pouching system selection?
A. Surgeon's preference
B. Stoma size, shape, location, output consistency, and peristomal skin condition
C. Hospital's available supplies
D. Patient's insurance coverage only
Answer: B – Stoma size, shape, location, output consistency, and peristomal skin condition
Rationale: Pouching system selection must be individualized based on stoma characteristics,
peristomal skin integrity, and the patient's lifestyle and dexterity.
8. Miguel Flores has a stoma with liquid/watery output and a flaccid abdomen. Which
type of pouching system is MOST appropriate?
, 3
A. Flat barrier
B. Convex barrier
C. Closed pouch
D. One-piece flat system
Answer: B – Convex barrier
Rationale: Convex barriers are indicated for loop ileostomies, stomas protruding one inch or
less, liquid/loose output, flaccid abdomen, and uneven/irregular peristomal skin.
9. What is the expected output consistency for a new ileostomy?
A. Formed stool
B. Pasty output (applesauce consistency)
C. Liquid/watery output
D. Hard, dry stool
Answer: C – Liquid/watery output
Rationale: Ileostomy output is initially liquid and gradually thickens to a pasty consistency
over weeks to months. The effluent contains digestive enzymes that are irritating to skin.
10. What is the expected output volume for a normal-functioning ileostomy?
A. 100–300 mL/day
B. 500–800 mL/day
C. 1,000–1,500 mL/day
D. 2,000–3,000 mL/day
Answer: B – 500–800 mL/day
Rationale: Normal ileostomy output is approximately 500–800 mL/day. Output greater than
1200 mL/day defines a high-output stoma.
11. Which finding indicates possible stoma retraction?
A. Stoma protrudes 2 cm above skin
B. Stoma recedes below skin level with leakage under the barrier
C. Stoma is beefy red and moist
D. Stoma is round and regular
Answer: B – Stoma recedes below skin level with leakage under the barrier
Rationale: Stomal retraction occurs when the stoma recedes below skin level, causing
leakage of discharge under the skin barrier and poor pouching adherence.
12. What is the FIRST sign of stomal necrosis?
