Chapter 26: The Patient with an Ostomy
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. Which term appropriately defines an artificial opening into a body cavity?
a.
Gastrostomy
b.
Ostomy
c.
Colonoscopy
d.
Ureterostomy
2. Why is a patient who has undergone a colostomy instructed to measure the width of the
stomas for the first 6 weeks postoperatively before applying each new pouch?
a.
The stoma will shrink during this time.
b.
A poor-fitting pouch will cause infection of the stoma.
c.
The paste will not adhere.
d.
Prolapse will result.
3. A 47-year-old patient with a permanent colostomy reports some abdominal discomfort and
rigidity 3 days after surgery. Which assessment should the nurse report and record?
a.
Vital signs are temperature, 100° F; pulse, 92 beats/min; and blood pressure,
160/98 mm Hg.
b.
Stoma is swollen and red; small amount of blood is observed at the base.
c.
Pouch has drained 110 mL of green-brown liquid, oozing from the pouch edges.
d.
Stoma is protruding.
4. A nurse is aware that many patients with ostomies have an altered self-image. What might this
cause?
a.
Self-care deficits
b.
Sexual dysfunction
c.
Nonadherence to diet
d.
Irrational anger
5. What should a nurse instruct the patient to do to ensure a good fit of the appliance to avoid
leakage?
a.
Place the pouch only when lying down.
b.
Check pouch placement to ensure a firm seal.
c.
Confirm that the pouch fits tightly to the edges of the stoma.
d.
Confirm that the pouch covers the entire abdomen.
6. What should a nurse suggest to a patient with a colostomy choose when selecting an
appropriate diet to reduce excess gas or diarrhea?
a.
Roast beef, mashed potatoes, and peeled stewed tomatoes
b.
Broiled pork chop, boiled potato, and corn on the cob
c.
Broiled trout, mashed potatoes, and spinach
d.
Barbeque pork on a white bun, coleslaw, and French fries
7. A patient who has had a temporary colostomy to rest his ulcerated bowel says, “I don’t know
how I will continue to work at my job with this thing stuck to my stomach.” Which response
by the nurse is most likely to stimulate communication?
a.
“This is only a temporary adjustment for you, and the colostomy will be
reanastomosed in less than 6 months.”
b.
“A nurse with special training will be in to help you.”
c.
“What is there about your job that you feel you cannot do?”
d.
“Many people feel as you do, but they learn to dress and act and work just like
they did before the surgery.”
8. What is the primary advantage of a J-pouch anal anastomosis procedure?
a.
No odor
b.
Easier to irrigate
c.
Near-normal bowel elimination
d.
Less problem with diarrhea
9. What should a nurse include in postoperative teaching for a patient who has undergone a
ureterostomy?
a.
The significance of the ureteral catheter for the first week
b.
Appropriate use of karaya gum products
c.
Daily schedule for changing the pouch
d.
Evening schedule for changing the pouch before bedtime
10. A patient with an ostomy asks the nurse what limitations should be observed in the immediate
postoperative period when at home. What is the most informative information that the nurse
should share?
a.
Avoid heavy lifting for at least 3 months.
b.
Limit fluid intake to no more than 1000 mL/day.
c.
Wear loose clothing without belts or elastic.
d.
Cover your appliance with plastic sheeting while showering.
11. A patient with a colostomy continues to worry about odor. What instruction should a nurse
provide to allay this concern?
a.
Pierce the top of the appliance bag with a pin to allow gas to escape.
b.
Rinse the pouch in a vinegar solution.
c.
Wear tight-fitting underwear.
d.
Improve personal hygiene.
12. A 20-year-old patient with a permanent colostomy asks whether she will be able to become
pregnant. What is the most informative response by the nurse?
a.
“No. The colostomy weakened the pelvic floor to the point that it will not support
a pregnancy.”
b.
“Yes. Pregnancy may be accomplished with artificial insemination because the
fallopian tubes are usually damaged by a colostomy.”
c.
“No. The abdominal pressure exerted by a pregnancy will cause the prolapse of the
stoma.”
d.
“Yes. The colostomy will not interfere with pregnancy or delivery.”
13. Which assessment of the stoma should a nurse caring for a 2-day postoperative colostomy
patient report immediately?
a.
Is beefy and red
b.
Has swelling
c.
Has a small amount of bleeding around it
d.
Is blue tinged
14. A baby born without a urinary bladder has a surgically created cutaneous ureterostomy. One
stoma exists. What should be discussed with the child’s family regarding the care?
a.
“This urinary diversion is permanent, and urine will drain from it continually.”
b.
“In the future, a second surgery will offer an exit for the urine from the other
kidney.”
c.
“This pouch needs to be changed only once a week.”
d.
“You should notify the surgeon if the stoma becomes paler in color.”
15. What should the initial assessment of a patient that just returned from surgery for the creation
of an Indiana pouch include?
a.
Drainage of urine from the Penrose drain at the operative site
b.
Condition and color of the stoma
c.
Appearance of mucus in the urine
d.
Copious and odorous urine drainage from the incision
16. A patient says, “I hate this yucky paste under my appliance. I think I will just tape it on.”
What is the best response by the nurse?
a.
“Taping will not work!”
b.
“Taping will not seal the wafer tight enough to prevent leakage or fill increases.”
c.
“Taping with waterproof tape is just as effective as the paste.”
d.
“Taping is far more irritating to the skin than the paste would be.”
17. A patient comes to the industrial nurse and is frantic because the stoma to the colostomy has
prolapsed 1 year after surgery. What is the best response by the nurse?
a.
“If there are still feces coming from the stoma, then it is not blocked. Contact your
surgeon for an evaluation.”
b.
“You must come in immediately because the stoma may completely retract into
your abdomen.”
c.
“This is an emergency situation because it has stenosed.”
d.
“Don’t worry about that. Coughing or sneezing might have caused the prolapse. It
will come back out in a few hours.”
18. A patient is receiving discharge instructions and shares with the nurse that he intends to do a
lot of traveling. What instruction should the nurse include?
a.
“Pack plenty of extra colostomy supplies in your checked airline luggage. Some
places you might visit do not always carry the supplies you will need.”
b.
“Exercise caution with new foods, especially local fruits and vegetables because
they may cause diarrhea or gas.”
c.
“If visiting somewhere where drinking local water is not advised, irrigating the
colostomy with the local water is still okay.”
d.
“Repeat back to me what we just talked about so that you will remember
everything you have been taught.”
19. Which assessment by a nurse caring for an immediate postoperative patient with an ileal
conduit should be reported or receive attention immediately?
a.
Lack of bowel sounds
b.
Distended abdomen
c.
Mucus present in the urine
d.
Small amount of blood in the drainage
20. A patient asks if rectal suppositories can be used to assist with constipation problems with his
colostomy. What should the nurse clarify regarding suppositories?
a.
They can be used in double-barreled colostomies.
b.
They can be used in a stoma.
c.
They should not ever be used in a colostomy.
d.
They will not penetrate well enough to relieve constipation.
21. What might the continual loss of liquid stool result in with an ileostomy patient?
a.
Acidosis
b.
Alkalosis
c.
Erosion of stoma
d.
Colitis
22. Which is the best nursing strategy for encouraging an ostomy patient to perform self-care?
a.
Plan to change the pouch when family members will be present, and have the
patient watch and listen to the procedure.
b.
Frequently tell the patient that if he or she does not learn stoma self-care, no one is
going to do it for him or her.
c.
Encourage the patient to watch the stoma care procedure, gradually encouraging
participation.
d.
Shield the patient from sight of the stoma until the patient actually asks to see it.
23. A patient asks a nurse if karaya products can be used to seal the urostomy appliance. On what
knowledge should the nurse base a response?
a.
Any adhesive is effective on a urostomy appliance.
b.
Urine breaks down karaya products.
c.
Karaya products can cause urinary infections.
d.
Formation of urine crystals is increased with the use of karaya products.
24. What is caused by some adhesive pouch material used to hold the appliance in place?
a.
Melting of the pouch
b.
Excoriation of the stoma
c.
Allergic reaction
d.
Unpleasant odor
25. What is the most effective way for a nurse to help provide support to the patient with an
ostomy who has ineffective regimen management?
a.
Ask a volunteer from the American Cancer Society or United Ostomy Association
to visit.
b.
Ask a volunteer from the Reach for Recovery Society to visit.
c.
Send a close family member for psychiatric counseling.
d.
Obtain humor books pertaining to illness, such as Anatomy of an Illness, or watch
several episodes of The Three Stooges on television.
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
MULTIPLE RESPONSE
26. A postoperative patient with an ostomy is at risk for loss of fluid volume and electrolyte
imbalance. Which assessments indicate such loss? (Select all that apply.)
a.
Changing mental status
b.
Twitching
c.
Poor skin turgor
d.
Moist mucous membranes
e.
Weakness
27. What can be caused by lack of thorough cleansing of fecal matter from around a stoma?
(Select all that apply.)
a.
Fungal infection
b.
Bacterial infection
c.
Yeast infection
d.
Deterioration of the stoma
e.
Odor
28. The 1-day postoperative ileostomy patient is concerned about the fact that no drainage has
occurred from the ileostomy. What should the nurse remind the patient? (Select all that
apply.)
a.
The drainage does not start until approximately 24 to 48 hours after surgery.
b.
The first drainage will have blood in it.
c.
Mucus will be obvious in the early drainage.
d.
The first drainage is expelled with a great deal of force.
e.
A large amount of flatus will accompany the first drainage.
29. What are complications that may occur with continent pouches (Kock and Indiana)? (Select
all that apply.)
a.
Incontinence
b.
Difficult catheterization
c.
Pyelonephritis
d.
Rupture of the pouch
e.
Peritonitis
30. What should be considered when deciding placement of a stoma? (Select all that apply.)
a.
Good seal
b.
Stabilization from the abdominal rectus
c.
Ease of self-care
d.
Inoffensive appearance
e.
Proximity to the umbilicus
COMPLETION
31. When a patient complains of urine crystals forming on the urostomy stoma, the home health
nurse recommends dissolving them with a pad saturated with _____.
