, Question 1
A patient with an end ileostomy has a stoma that is flush with the skin and
located in a deep crease. The effluent is liquid and contains high levels of
proteolytic enzymes. Which pouching strategy is most appropriate to prevent
leakage and skin breakdown?
A. A one-piece flat pouch with standard skin barrier and no additional
convexity.
B. A two-piece system with a convex barrier and a belt to apply even
pressure.
C. A one-piece pouch with a large amount of skin barrier paste to fill the
crease.
D. A two-piece flat system with a pouch that has a high-output drain.
Correct Answer: B - A two-piece system with a convex barrier
and a belt to apply even pressure.
RATIONALE
A flush stoma in a crease requires convexity to push the stoma upward
and outward, and a belt helps secure the convex barrier and apply even
pressure. Flat systems (A, D) will likely leak. Paste (C) is not a
substitute for convexity and may erode.
Question 2
A patient with a urostomy presents with dark, concentrated urine and reports
inadequate output. Which assessment finding is most indicative of dehydration
requiring immediate intervention?
A. Urine pH of 6.0
B. Serum sodium of 135 mEq/L
C. Urine specific gravity of 1.035
D. Stoma output of 800 mL in 24 hours
Correct Answer: C - Urine specific gravity of 1.035
Page 2
, RATIONALE
A urine specific gravity of 1.035 indicates highly concentrated urine, a
sign of dehydration in urostomy patients. Normal specific gravity is
1.005-1.030. pH 6.0 is normal, sodium 135 is within normal limits,
and 800 mL output is adequate.
Question 3
A patient with a new colostomy has peristomal skin that is denuded with a
moist, red, painful rash extending 2 cm around the stoma. The stoma is viable.
Which is the most likely cause?
A. Candidal infection
B. Chemical irritation from effluent
C. Allergic contact dermatitis
D. Mechanical trauma from pouch removal
Correct Answer: B - Chemical irritation from effluent
RATIONALE
Chemical irritation from effluent is the most common cause of
peristomal skin breakdown, especially when the pouch opening is too
large or the barrier is not properly sealed. Candidal infection typically
presents with satellite lesions; allergic contact dermatitis is rare and
usually related to adhesive; mechanical trauma causes skin stripping.
Question 4
A patient with an ileostomy experiences high output (>1.5 L/day) and is at risk
for dehydration and electrolyte imbalance. Which intervention is most
appropriate to reduce output?
A. Increase intake of high-fiber foods.
B. Administer loperamide 30 minutes before meals.
C. Encourage liberal fluid intake with caffeine.
D. Use a bulk-forming laxative daily.
Page 3
, Correct Answer: B - Administer loperamide 30 minutes before
meals.
RATIONALE
Loperamide slows intestinal motility and reduces output; it should be
given 30 minutes before meals for maximum effect. High-fiber foods
(A) can cause blockage in ileostomies. Caffeine (C) increases output.
Bulk-forming laxatives (D) are contraindicated and can cause
obstruction.
Question 5
A patient with a continent ileostomy (Kock pouch) reports difficulty intubating
the stoma. Which action should the nurse recommend first?
A. Increase fluid intake to thin the effluent.
B. Use a smaller catheter and apply gentle pressure.
C. Apply a warm compress to the stoma before intubation.
D. Irrigate the pouch with 60 mL of tap water.
Correct Answer: C - Apply a warm compress to the stoma before
intubation.
RATIONALE
Applying a warm compress can relax the stoma and facilitate
intubation. Increasing fluids (A) does not directly aid intubation. A
smaller catheter (B) may not drain effectively and could cause trauma.
Irrigation (D) is not routinely recommended and may introduce
bacteria.
Question 6
A patient with a colostomy and a history of Crohn's disease develops a
peristomal fistula. Which pouching approach is most appropriate?
A. A standard flat pouch with a skin barrier.
B. A convex pouch with a belt.
Page 4
A patient with an end ileostomy has a stoma that is flush with the skin and
located in a deep crease. The effluent is liquid and contains high levels of
proteolytic enzymes. Which pouching strategy is most appropriate to prevent
leakage and skin breakdown?
A. A one-piece flat pouch with standard skin barrier and no additional
convexity.
B. A two-piece system with a convex barrier and a belt to apply even
pressure.
C. A one-piece pouch with a large amount of skin barrier paste to fill the
crease.
D. A two-piece flat system with a pouch that has a high-output drain.
Correct Answer: B - A two-piece system with a convex barrier
and a belt to apply even pressure.
RATIONALE
A flush stoma in a crease requires convexity to push the stoma upward
and outward, and a belt helps secure the convex barrier and apply even
pressure. Flat systems (A, D) will likely leak. Paste (C) is not a
substitute for convexity and may erode.
Question 2
A patient with a urostomy presents with dark, concentrated urine and reports
inadequate output. Which assessment finding is most indicative of dehydration
requiring immediate intervention?
A. Urine pH of 6.0
B. Serum sodium of 135 mEq/L
C. Urine specific gravity of 1.035
D. Stoma output of 800 mL in 24 hours
Correct Answer: C - Urine specific gravity of 1.035
Page 2
, RATIONALE
A urine specific gravity of 1.035 indicates highly concentrated urine, a
sign of dehydration in urostomy patients. Normal specific gravity is
1.005-1.030. pH 6.0 is normal, sodium 135 is within normal limits,
and 800 mL output is adequate.
Question 3
A patient with a new colostomy has peristomal skin that is denuded with a
moist, red, painful rash extending 2 cm around the stoma. The stoma is viable.
Which is the most likely cause?
A. Candidal infection
B. Chemical irritation from effluent
C. Allergic contact dermatitis
D. Mechanical trauma from pouch removal
Correct Answer: B - Chemical irritation from effluent
RATIONALE
Chemical irritation from effluent is the most common cause of
peristomal skin breakdown, especially when the pouch opening is too
large or the barrier is not properly sealed. Candidal infection typically
presents with satellite lesions; allergic contact dermatitis is rare and
usually related to adhesive; mechanical trauma causes skin stripping.
Question 4
A patient with an ileostomy experiences high output (>1.5 L/day) and is at risk
for dehydration and electrolyte imbalance. Which intervention is most
appropriate to reduce output?
A. Increase intake of high-fiber foods.
B. Administer loperamide 30 minutes before meals.
C. Encourage liberal fluid intake with caffeine.
D. Use a bulk-forming laxative daily.
Page 3
, Correct Answer: B - Administer loperamide 30 minutes before
meals.
RATIONALE
Loperamide slows intestinal motility and reduces output; it should be
given 30 minutes before meals for maximum effect. High-fiber foods
(A) can cause blockage in ileostomies. Caffeine (C) increases output.
Bulk-forming laxatives (D) are contraindicated and can cause
obstruction.
Question 5
A patient with a continent ileostomy (Kock pouch) reports difficulty intubating
the stoma. Which action should the nurse recommend first?
A. Increase fluid intake to thin the effluent.
B. Use a smaller catheter and apply gentle pressure.
C. Apply a warm compress to the stoma before intubation.
D. Irrigate the pouch with 60 mL of tap water.
Correct Answer: C - Apply a warm compress to the stoma before
intubation.
RATIONALE
Applying a warm compress can relax the stoma and facilitate
intubation. Increasing fluids (A) does not directly aid intubation. A
smaller catheter (B) may not drain effectively and could cause trauma.
Irrigation (D) is not routinely recommended and may introduce
bacteria.
Question 6
A patient with a colostomy and a history of Crohn's disease develops a
peristomal fistula. Which pouching approach is most appropriate?
A. A standard flat pouch with a skin barrier.
B. A convex pouch with a belt.
Page 4
