WOC Ostomy Nursing – Full Practice Exam
(50+ Questions)
SECTION 1: Assessment (Domain I)
Q1. A patient is scheduled for an abdominoperineal resection (APR) for
rectal cancer. What type of ostomy will this patient require?
• A) Temporary ileostomy
• B) Permanent colostomy
• C) Temporary colostomy
• D) Permanent ileostomy
Answer: B – An abdominoperineal resection involves the removal of the
rectum, anus, and sphincter mechanism with formation of a permanent
end colostomy. A permanent ileostomy is unnecessary as the remainder of
the colon above the rectum is intact allowing for the formation of a sigmoid
colostomy. Temporary ostomies are not possible when the anus and
sphincter have been removed.
Q2. In stoma site marking prior to surgery, which factor is MOST
important to consider?
• A) The style of clothing the patient wears
• B) The patient's abdominal contours
• C) The patient's ability to learn to care for the ostomy
• D) Where the patient would like to have the stoma
Answer: B – Abdominal contours are most important because if a stoma is
placed in a crease or fold, or in an area that is not easy for a person to
visualize, it may be difficult to obtain an adequate seal for the pouching
system. This will negatively affect the person's quality of life for as long as
they have a stoma.
,Q3. A patient with an ileostomy reports frequent leakage from the
pouching system, usually from the bottom edge of the wafer. The
peristomal skin below the stoma is denuded, raw, and painful. The
most likely etiology of this skin breakdown is:
• A) Suture granulomas
• B) Allergic dermatitis
• C) Peristomal candidiasis
• D) Irritant dermatitis
Answer: D – Irritant dermatitis is caused by skin contact with an irritant
such as fecal effluent. Since there is a recent history of leakage from the
area where the skin is raw, this is the most likely cause. Suture granulomas
occur at the mucocutaneous junction. Allergic dermatitis presents as small
vesicles and involves the entire area covered by the skin barrier. Peristomal
candidiasis presents as a cluster of pustules with satellite lesions.
Q4. What is the usual frequency of intubation 6 months following
continent ileostomy (Kock pouch) surgery?
• A) Once daily
• B) Every 2 hours
• C) 3 to 4 times in 24 hours
• D) 8 to 10 times in 24 hours
Answer: C – Following continent ileostomy surgery, the pouch is typically
intubated 3 to 4 times in 24 hours to drain the effluent. This schedule allows
for adequate pouch emptying while maintaining continence between
intubations.
Q5. A patient with an ileal pouch-anal anastomosis (IPAA) exhibits
symptoms of pouchitis for the first time 3 months after surgery to close
, the diverting ileostomy. Which medication would be MOST appropriate
to recommend/prescribe?
• A) Amoxicillin/clavulanic acid
• B) Ciprofloxacin
• C) Sulfamethoxazole/trimethoprim
• D) Infliximab
Answer: B – Antibiotic therapy is the primary treatment for acute pouchitis,
and the first line of therapy is metronidazole or ciprofloxacin. Studies
suggest that ciprofloxacin has a lower side effect incidence.
Amoxicillin/clavulanic acid may be used if allergic to ciprofloxacin.
Infliximab is a TNF-α inhibitor used for inflammatory bowel disease, not
first-line for acute pouchitis.
Q6. In site marking a patient with rectal adenocarcinoma prior to
surgery, where should the WOC nurse mark for a stoma?
• A) Right lower quadrant only
• B) Left lower quadrant only
• C) Right and left lower quadrants
• D) All 4 quadrants
Answer: C – For rectal adenocarcinoma, the WOC nurse should consider
possible surgical options. If tumor location is too low for sphincter
preservation, a permanent colostomy (left lower quadrant) is needed. If
sphincter function can be preserved, a low anterior resection with diverting
loop ileostomy (right lower quadrant) may be done. Marking both quadrants
allows the surgeon to choose the appropriate site.
Q7. A patient with a colostomy has a soft abdomen with a shallow
crease on either side of a flush stoma. The pouching system leaks
(50+ Questions)
SECTION 1: Assessment (Domain I)
Q1. A patient is scheduled for an abdominoperineal resection (APR) for
rectal cancer. What type of ostomy will this patient require?
• A) Temporary ileostomy
• B) Permanent colostomy
• C) Temporary colostomy
• D) Permanent ileostomy
Answer: B – An abdominoperineal resection involves the removal of the
rectum, anus, and sphincter mechanism with formation of a permanent
end colostomy. A permanent ileostomy is unnecessary as the remainder of
the colon above the rectum is intact allowing for the formation of a sigmoid
colostomy. Temporary ostomies are not possible when the anus and
sphincter have been removed.
Q2. In stoma site marking prior to surgery, which factor is MOST
important to consider?
• A) The style of clothing the patient wears
• B) The patient's abdominal contours
• C) The patient's ability to learn to care for the ostomy
• D) Where the patient would like to have the stoma
Answer: B – Abdominal contours are most important because if a stoma is
placed in a crease or fold, or in an area that is not easy for a person to
visualize, it may be difficult to obtain an adequate seal for the pouching
system. This will negatively affect the person's quality of life for as long as
they have a stoma.
,Q3. A patient with an ileostomy reports frequent leakage from the
pouching system, usually from the bottom edge of the wafer. The
peristomal skin below the stoma is denuded, raw, and painful. The
most likely etiology of this skin breakdown is:
• A) Suture granulomas
• B) Allergic dermatitis
• C) Peristomal candidiasis
• D) Irritant dermatitis
Answer: D – Irritant dermatitis is caused by skin contact with an irritant
such as fecal effluent. Since there is a recent history of leakage from the
area where the skin is raw, this is the most likely cause. Suture granulomas
occur at the mucocutaneous junction. Allergic dermatitis presents as small
vesicles and involves the entire area covered by the skin barrier. Peristomal
candidiasis presents as a cluster of pustules with satellite lesions.
Q4. What is the usual frequency of intubation 6 months following
continent ileostomy (Kock pouch) surgery?
• A) Once daily
• B) Every 2 hours
• C) 3 to 4 times in 24 hours
• D) 8 to 10 times in 24 hours
Answer: C – Following continent ileostomy surgery, the pouch is typically
intubated 3 to 4 times in 24 hours to drain the effluent. This schedule allows
for adequate pouch emptying while maintaining continence between
intubations.
Q5. A patient with an ileal pouch-anal anastomosis (IPAA) exhibits
symptoms of pouchitis for the first time 3 months after surgery to close
, the diverting ileostomy. Which medication would be MOST appropriate
to recommend/prescribe?
• A) Amoxicillin/clavulanic acid
• B) Ciprofloxacin
• C) Sulfamethoxazole/trimethoprim
• D) Infliximab
Answer: B – Antibiotic therapy is the primary treatment for acute pouchitis,
and the first line of therapy is metronidazole or ciprofloxacin. Studies
suggest that ciprofloxacin has a lower side effect incidence.
Amoxicillin/clavulanic acid may be used if allergic to ciprofloxacin.
Infliximab is a TNF-α inhibitor used for inflammatory bowel disease, not
first-line for acute pouchitis.
Q6. In site marking a patient with rectal adenocarcinoma prior to
surgery, where should the WOC nurse mark for a stoma?
• A) Right lower quadrant only
• B) Left lower quadrant only
• C) Right and left lower quadrants
• D) All 4 quadrants
Answer: C – For rectal adenocarcinoma, the WOC nurse should consider
possible surgical options. If tumor location is too low for sphincter
preservation, a permanent colostomy (left lower quadrant) is needed. If
sphincter function can be preserved, a low anterior resection with diverting
loop ileostomy (right lower quadrant) may be done. Marking both quadrants
allows the surgeon to choose the appropriate site.
Q7. A patient with a colostomy has a soft abdomen with a shallow
crease on either side of a flush stoma. The pouching system leaks
