, Question 1
Which pathophysiologic mechanism most directly explains the increased risk
of hyperchloremic metabolic acidosis in a patient with a new ileostomy?
A. Excessive bicarbonate secretion from the ileal mucosa.
B. Loss of chloride-rich intestinal fluid and subsequent renal
compensation.
C. Bacterial fermentation of unabsorbed carbohydrates producing organic
acids.
D. Increased aldosterone secretion causing renal potassium wasting.
Correct Answer: B - Loss of chloride-rich intestinal fluid and
subsequent renal compensation.
RATIONALE
Ileostomy output is rich in sodium, chloride, and bicarbonate; large
losses can lead to dehydration and hyperchloremic metabolic acidosis
due to renal compensation (reabsorption of chloride and excretion of
hydrogen ions). Option A is incorrect because the ileum absorbs
bicarbonate, not secretes it. Option C describes D-lactic acidosis from
bacterial overgrowth, not typical early ileostomy. Option D relates to
potassium wasting, not acid-base status.
Question 2
A patient with a new colostomy reports the pouch leaking frequently and skin
irritation. Which intervention should the nurse implement first?
A. Apply a skin barrier powder and seal with a liquid skin protectant.
B. Change the pouching system every 24 hours to prevent leakage.
C. Assess the stoma size and shape to ensure proper fit of the skin barrier.
D. Switch to a one-piece pouching system to reduce leakage.
Correct Answer: C - Assess the stoma size and shape to ensure
proper fit of the skin barrier.
Page 2
, RATIONALE
The first step is to assess the stoma and peristomal skin to identify the
cause of leakage; improper fit is the most common reason. Option A
may be appropriate after assessment but is not the first action. Option
B may worsen skin irritation if not correctly fitted. Option D is not
evidence-based as a first-line solution without assessment.
Question 3
A patient with a colostomy presents with a dusky, edematous stoma 24 hours
postoperatively. Which action should the nurse take?
A. Apply ice packs to the stoma to reduce swelling.
B. Document the finding as a normal postoperative change.
C. Notify the surgeon immediately for evaluation of ischemia.
D. Increase the frequency of pouch changes to every 4 hours.
Correct Answer: C - Notify the surgeon immediately for
evaluation of ischemia.
RATIONALE
A dusky, edematous stoma may indicate ischemia or necrosis,
requiring immediate surgical evaluation. Option A is incorrect because
ice can further compromise perfusion. Option B is incorrect because
this is not a normal finding. Option D does not address the underlying
issue and may cause skin damage.
Question 4
Which laboratory finding is most indicative of dehydration in a patient with a
new ileostomy?
A. Serum sodium 135 mEq/L
B. Blood urea nitrogen (BUN) 28 mg/dL
C. Serum potassium 4.0 mEq/L
D. Hemoglobin 14 g/dL
Correct Answer: B - Blood urea nitrogen (BUN) 28 mg/dL
Page 3
Which pathophysiologic mechanism most directly explains the increased risk
of hyperchloremic metabolic acidosis in a patient with a new ileostomy?
A. Excessive bicarbonate secretion from the ileal mucosa.
B. Loss of chloride-rich intestinal fluid and subsequent renal
compensation.
C. Bacterial fermentation of unabsorbed carbohydrates producing organic
acids.
D. Increased aldosterone secretion causing renal potassium wasting.
Correct Answer: B - Loss of chloride-rich intestinal fluid and
subsequent renal compensation.
RATIONALE
Ileostomy output is rich in sodium, chloride, and bicarbonate; large
losses can lead to dehydration and hyperchloremic metabolic acidosis
due to renal compensation (reabsorption of chloride and excretion of
hydrogen ions). Option A is incorrect because the ileum absorbs
bicarbonate, not secretes it. Option C describes D-lactic acidosis from
bacterial overgrowth, not typical early ileostomy. Option D relates to
potassium wasting, not acid-base status.
Question 2
A patient with a new colostomy reports the pouch leaking frequently and skin
irritation. Which intervention should the nurse implement first?
A. Apply a skin barrier powder and seal with a liquid skin protectant.
B. Change the pouching system every 24 hours to prevent leakage.
C. Assess the stoma size and shape to ensure proper fit of the skin barrier.
D. Switch to a one-piece pouching system to reduce leakage.
Correct Answer: C - Assess the stoma size and shape to ensure
proper fit of the skin barrier.
Page 2
, RATIONALE
The first step is to assess the stoma and peristomal skin to identify the
cause of leakage; improper fit is the most common reason. Option A
may be appropriate after assessment but is not the first action. Option
B may worsen skin irritation if not correctly fitted. Option D is not
evidence-based as a first-line solution without assessment.
Question 3
A patient with a colostomy presents with a dusky, edematous stoma 24 hours
postoperatively. Which action should the nurse take?
A. Apply ice packs to the stoma to reduce swelling.
B. Document the finding as a normal postoperative change.
C. Notify the surgeon immediately for evaluation of ischemia.
D. Increase the frequency of pouch changes to every 4 hours.
Correct Answer: C - Notify the surgeon immediately for
evaluation of ischemia.
RATIONALE
A dusky, edematous stoma may indicate ischemia or necrosis,
requiring immediate surgical evaluation. Option A is incorrect because
ice can further compromise perfusion. Option B is incorrect because
this is not a normal finding. Option D does not address the underlying
issue and may cause skin damage.
Question 4
Which laboratory finding is most indicative of dehydration in a patient with a
new ileostomy?
A. Serum sodium 135 mEq/L
B. Blood urea nitrogen (BUN) 28 mg/dL
C. Serum potassium 4.0 mEq/L
D. Hemoglobin 14 g/dL
Correct Answer: B - Blood urea nitrogen (BUN) 28 mg/dL
Page 3
