ATI Ostomy Care | Complete Nursing Skills Guide for
Colostomy, Ileostomy & Urostomy Management, Stoma
Assessment, Pouching Systems, Peristomal Skin Protection,
Patient Education, Complication Prevention, Documentation,
NCLEX Review, and ATI Exam Success
1. A nurse is assessing a patient’s stoma on the second postoperative day.
Which finding should the nurse report to the provider immediately?
A. The stoma is moist and pink.
B. The stoma is slightly edematous.
C. The stoma is dark purple and dry.
D. The stoma has a small amount of bloody drainage.
Answer: C
Rationale: A dark purple or black stoma indicates ischemia or necrosis due to
compromised blood supply. This is an emergency. A healthy stoma should be pink
to red, moist, and slightly edematous for 4-6 weeks post-op. Small amounts of
bloody ooze are normal.
2. A nurse is teaching a patient with a new ileostomy about diet. Which food
should the patient avoid to prevent an obstruction?
A. Applesauce
B. Well-cooked potatoes
C. Raw celery stalks
D. White bread
Answer: C
Rationale: Raw celery, nuts, popcorn, and corn are high in insoluble fiber and
cellulose, which can cause a blockage (obstruction) in the ileostomy. All other
options are low-residue or soft foods that are safer.
3. A patient with a sigmoid colostomy asks the nurse about bowel irrigation.
What is the primary purpose of this procedure?
,A. To soften the stool
B. To promote regular bowel movements without a pouch
C. To clean the stoma site
D. To prevent skin breakdown
Answer: B
Rationale: Colostomy irrigation is used to stimulate a regular bowel movement by
instilling warm water into the stoma, allowing the patient to go for 24-48 hours
without wearing a pouch (often just a stoma cap).
4. A nurse is replacing a patient’s ostomy pouch. After removing the old pouch,
the nurse notes the peristomal skin is red, weeping, and pruritic. Which action
should the nurse take?
A. Apply a skin barrier powder and dust off excess.
B. Apply an alcohol-based skin prep.
C. Use a larger pouch to cover the affected skin.
D. Apply a topical steroid cream under the barrier.
Answer: A
Rationale: Red, weeping, pruritic skin indicates moisture-associated skin damage
or fungal infection. Skin barrier powder absorbs moisture and protects the skin.
Excess powder must be dusted off so the new barrier can adhere. Alcohol-based
preps are drying and irritating.
5. A nurse is teaching a patient about an extended-wear skin barrier. To ensure
maximum adherence, the nurse should instruct the patient to:
A. Apply the barrier immediately after a warm shower.
B. Press gently around the barrier for 30 to 60 seconds.
C. Cut the barrier opening 1 inch larger than the stoma.
D. Apply skin barrier wipe and let it dry for 5 minutes.
Answer: B
Rationale: The heat and pressure from the fingers activate the adhesive
properties of the extended-wear barrier. Cutting it too large exposes skin to
effluent. Skin must be completely dry before application.
,6. A nurse is caring for a patient with a urostomy. Which finding indicates the
pouching system is functioning correctly?
A. The urine is dark amber and cloudy.
B. The pouch is filled with gas and mucus.
C. The urine is clear yellow and drains continuously.
D. The patient reports a burning sensation.
Answer: C
Rationale: A urostomy (ileal conduit) continuously drains urine. Clear yellow urine
is normal. Dark/cloudy urine could indicate infection or dehydration. Mucus is
normal but should not fill the pouch with gas.
7. A patient with an ileostomy is experiencing high-output liquid stool. Which
dietary recommendation should the nurse provide?
A. Increase intake of grape juice.
B. Eat salty foods like pretzels.
C. Drink hot tea with meals.
D. Increase consumption of leafy greens.
Answer: B
Rationale: Salty foods (and foods containing pectin, like applesauce) help thicken
ileostomy output. Grape juice, hot liquids, and leafy greens tend to increase
motility and output, worsening diarrhea.
8. The nurse is assessing a patient’s stoma 4 weeks post-surgery. The stoma has
retracted below the skin level. What is the priority nursing intervention?
A. Notify the surgeon immediately for revision.
B. Apply a convex ostomy barrier/pouch system.
C. Place the patient on NPO status.
D. Apply a stoma paste to fill the crease.
Answer: B
Rationale: A retracted stoma sits below skin level, increasing the risk of leakage. A
convex barrier applies pressure around the stoma to bring it into the pouch.
Stoma paste can be used as a filler, but a convex system is the primary solution.
, 9. A nurse is providing discharge teaching to a patient with a new ostomy.
Which statement by the patient indicates a need for further teaching?
A. "I will avoid eating popcorn and nuts."
B. "I can shower with my pouch on."
C. "I will change my pouch every day."
D. "I will look at my stoma daily in a mirror."
Answer: C
Rationale: Changing the pouch every day is not necessary and can cause skin
trauma. Pouch changes should be done every 3 to 7 days for standard wear time,
or when leaking occurs. Daily washing of the pouch is fine, but changing the entire
appliance daily is excessive.
10. A patient reports a foul odor from their colostomy pouch. Which oral
medication can help reduce fecal odor?
A. Loperamide (Imodium)
B. Bismuth subgallate (Devrom)
C. Metronidazole (Flagyl)
D. Bisacodyl (Dulcolax)
Answer: B
Rationale: Bismuth subgallate is an internal deodorant specifically used to reduce
odor from colostomies and ileostomies. Loperamide reduces output,
Metronidazole treats infection, and Bisacodyl is a laxative.
11. During a pouch change, the nurse observes that the peristomal skin has a
red, raised, itchy rash that matches the exact shape of the adhesive tape. This is
most indicative of:
A. Candidiasis
B. Chemical irritation from effluent
C. Contact dermatitis (allergic reaction)
D. Folliculitis
Answer: C
Rationale: A rash matching the shape of the tape/adhesive suggests an allergic
Colostomy, Ileostomy & Urostomy Management, Stoma
Assessment, Pouching Systems, Peristomal Skin Protection,
Patient Education, Complication Prevention, Documentation,
NCLEX Review, and ATI Exam Success
1. A nurse is assessing a patient’s stoma on the second postoperative day.
Which finding should the nurse report to the provider immediately?
A. The stoma is moist and pink.
B. The stoma is slightly edematous.
C. The stoma is dark purple and dry.
D. The stoma has a small amount of bloody drainage.
Answer: C
Rationale: A dark purple or black stoma indicates ischemia or necrosis due to
compromised blood supply. This is an emergency. A healthy stoma should be pink
to red, moist, and slightly edematous for 4-6 weeks post-op. Small amounts of
bloody ooze are normal.
2. A nurse is teaching a patient with a new ileostomy about diet. Which food
should the patient avoid to prevent an obstruction?
A. Applesauce
B. Well-cooked potatoes
C. Raw celery stalks
D. White bread
Answer: C
Rationale: Raw celery, nuts, popcorn, and corn are high in insoluble fiber and
cellulose, which can cause a blockage (obstruction) in the ileostomy. All other
options are low-residue or soft foods that are safer.
3. A patient with a sigmoid colostomy asks the nurse about bowel irrigation.
What is the primary purpose of this procedure?
,A. To soften the stool
B. To promote regular bowel movements without a pouch
C. To clean the stoma site
D. To prevent skin breakdown
Answer: B
Rationale: Colostomy irrigation is used to stimulate a regular bowel movement by
instilling warm water into the stoma, allowing the patient to go for 24-48 hours
without wearing a pouch (often just a stoma cap).
4. A nurse is replacing a patient’s ostomy pouch. After removing the old pouch,
the nurse notes the peristomal skin is red, weeping, and pruritic. Which action
should the nurse take?
A. Apply a skin barrier powder and dust off excess.
B. Apply an alcohol-based skin prep.
C. Use a larger pouch to cover the affected skin.
D. Apply a topical steroid cream under the barrier.
Answer: A
Rationale: Red, weeping, pruritic skin indicates moisture-associated skin damage
or fungal infection. Skin barrier powder absorbs moisture and protects the skin.
Excess powder must be dusted off so the new barrier can adhere. Alcohol-based
preps are drying and irritating.
5. A nurse is teaching a patient about an extended-wear skin barrier. To ensure
maximum adherence, the nurse should instruct the patient to:
A. Apply the barrier immediately after a warm shower.
B. Press gently around the barrier for 30 to 60 seconds.
C. Cut the barrier opening 1 inch larger than the stoma.
D. Apply skin barrier wipe and let it dry for 5 minutes.
Answer: B
Rationale: The heat and pressure from the fingers activate the adhesive
properties of the extended-wear barrier. Cutting it too large exposes skin to
effluent. Skin must be completely dry before application.
,6. A nurse is caring for a patient with a urostomy. Which finding indicates the
pouching system is functioning correctly?
A. The urine is dark amber and cloudy.
B. The pouch is filled with gas and mucus.
C. The urine is clear yellow and drains continuously.
D. The patient reports a burning sensation.
Answer: C
Rationale: A urostomy (ileal conduit) continuously drains urine. Clear yellow urine
is normal. Dark/cloudy urine could indicate infection or dehydration. Mucus is
normal but should not fill the pouch with gas.
7. A patient with an ileostomy is experiencing high-output liquid stool. Which
dietary recommendation should the nurse provide?
A. Increase intake of grape juice.
B. Eat salty foods like pretzels.
C. Drink hot tea with meals.
D. Increase consumption of leafy greens.
Answer: B
Rationale: Salty foods (and foods containing pectin, like applesauce) help thicken
ileostomy output. Grape juice, hot liquids, and leafy greens tend to increase
motility and output, worsening diarrhea.
8. The nurse is assessing a patient’s stoma 4 weeks post-surgery. The stoma has
retracted below the skin level. What is the priority nursing intervention?
A. Notify the surgeon immediately for revision.
B. Apply a convex ostomy barrier/pouch system.
C. Place the patient on NPO status.
D. Apply a stoma paste to fill the crease.
Answer: B
Rationale: A retracted stoma sits below skin level, increasing the risk of leakage. A
convex barrier applies pressure around the stoma to bring it into the pouch.
Stoma paste can be used as a filler, but a convex system is the primary solution.
, 9. A nurse is providing discharge teaching to a patient with a new ostomy.
Which statement by the patient indicates a need for further teaching?
A. "I will avoid eating popcorn and nuts."
B. "I can shower with my pouch on."
C. "I will change my pouch every day."
D. "I will look at my stoma daily in a mirror."
Answer: C
Rationale: Changing the pouch every day is not necessary and can cause skin
trauma. Pouch changes should be done every 3 to 7 days for standard wear time,
or when leaking occurs. Daily washing of the pouch is fine, but changing the entire
appliance daily is excessive.
10. A patient reports a foul odor from their colostomy pouch. Which oral
medication can help reduce fecal odor?
A. Loperamide (Imodium)
B. Bismuth subgallate (Devrom)
C. Metronidazole (Flagyl)
D. Bisacodyl (Dulcolax)
Answer: B
Rationale: Bismuth subgallate is an internal deodorant specifically used to reduce
odor from colostomies and ileostomies. Loperamide reduces output,
Metronidazole treats infection, and Bisacodyl is a laxative.
11. During a pouch change, the nurse observes that the peristomal skin has a
red, raised, itchy rash that matches the exact shape of the adhesive tape. This is
most indicative of:
A. Candidiasis
B. Chemical irritation from effluent
C. Contact dermatitis (allergic reaction)
D. Folliculitis
Answer: C
Rationale: A rash matching the shape of the tape/adhesive suggests an allergic
