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WOCNCB Certified Ostomy Care Nurse
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A patient with a nephrostomy tube complains of pain and tenderness at the insertion site. The nurse assesses the site and notes erythema and warmth. What is the most likely cause of these findings?
Tube dislodgement
llergic reaction to the tube material rine leakage around the tube
wer: B
anation: The most likely cause of pain, tenderness, erythema, and war nephrostomy tube insertion site is infection. Infection can occur whe
oorganisms invade the area around the tube, leading to localized mmation and signs of infection. Tube dislodgement, allergic reaction, leakage may cause different symptoms or findings but are less likely ent with the specific signs mentioned in the question.
ch of the following is a potential complication of a continent urinary sion?
Infection
A
U
Ans
Expl mth
at the n
micr
infla and
urine to
pres
Whi diver
Nephrostomy tube dysfunction
Fecal impaction
Enterocutaneous fistula
Hernia Answer: D
Explanation: Hernia refers to the protrusion of an organ or tissue through a weakened area in the abdominal wall. In the case of a continent urinary diversion, hernia can occur around the stoma site or at the site where the bowel is brought through the abdominal wall. It can lead to pain, discomfort, and potential bowel obstruction. Regular assessment and appropriate management are necessary to prevent complications associated with hernia in patients with a continent urinary diversion.
ch of the following peristomal complications is characterized by the ration of the mucocutaneous junction around the stoma?
rolapse ermatitis
yoderma gangrenosum ucocutaneous separation
wer: D
anation: Mucocutaneous separation refers to the separation of the muc from the surrounding skin at the stoma site. It can occur due to exce on, poor surgical technique, or trauma. Mucocutaneous separation can akage, skin irritation, and difficulty in maintaining a secure pouch sea mpt assessment and appropriate management are necessary to promote
ng and prevent complications.
Whi sepa
P
D
P
M
Ans
Expl osal
lining ssive
tensi lead
to le l.
Pro heali
A patient with an ileostomy is at risk for fluid and electrolyte imbalances. Which of the following electrolyte abnormalities is commonly associated with an ileostomy?
Hyperkalemia
Hypernatremia
Hypocalcemia
Hypokalemia Answer: D
eostomy. The small intestine, which is bypassed or partially bypassed tomy, is the primary site of potassium absorption. With the loss of fec er through the ileostomy, there is an increased risk of potassium deple ernatremia (high sodium level), hypocalcemia (low calcium level), an rkalemia (high potassium level) are less commonly associated with an tomy.
tient with an ostomy is taking multiple medications. The nurse recogn mportance of medication management and educates the patient about:
rushing all medications to facilitate absorption.
aking medications at the same time as ostomy appliance changes. voiding enteric-coated or extended-release formulations.
topping all medications that may cause diarrhea.
Explanation: Hypokalemia, a low potassium level, is commonly associated with an il in an
ileos al
matt tion.
Hyp d
hype ileos
A pa izes
the i
C
T
A
S
Answer: C
Explanation: When managing medications for patients with an ostomy, it is important to avoid enteric-coated or extended-release formulations. These formulations may not dissolve properly or be adequately absorbed in the altered gastrointestinal tract. Crushing medications should be done only under the guidance of a healthcare provider, as some medications should not be crushed.
Taking medications at the same time as ostomy appliance changes is not necessary unless specifically instructed by the healthcare provider. Discontinuing medications without medical supervision is not recommended and should be discussed with the healthcare provider.
tient with a colostomy reports experiencing frequent leakage of stool nd the stoma. The nurse suspects peristomal dermatitis. What is the m opriate intervention for managing this condition?
pplying a protective skin barrier around the stoma. sing absorbent dressings to absorb excess moisture. nsuring a proper fit of the ostomy pouching system. pplying topical corticosteroids to the affected area.
wer: C
anation: The most appropriate intervention for managing peristomal atitis is to ensure a proper fit of the ostomy pouching system. A prop create a secure seal around the stoma, preventing leakage of stool on urrounding skin. Applying a protective skin barrier can also be useful enting skin irritation, but it may not address the underlying cause of age. Using absorbent dressings and topical corticosteroids are not typi
A pa
arou ost
appr
A
U
E
A
Ans Expl
derm er fit
helps to
the s in
prev
leak cally
the first-line interventions for managing peristomal dermatitis.
A patient with an ileostomy reports that the stoma is protruding significantly and causing discomfort. The nurse assesses the stoma and notes that it appears to be larger than usual. What is the most likely cause of this finding?
Necrosis
Retraction
Prolapse
Hernia
anation: Prolapse refers to the protrusion of the stoma beyond the nor of the abdominal wall. It occurs when the stoma extends outward du
kened or stretched muscles around the stoma site. Prolapse can cause omfort and may require intervention or surgical correction.
tient who underwent ostomy surgery develops a wound dehiscence. W following actions should the nurse prioritize?
pplying sterile dressings to the wound. otifying the healthcare provider immediately. acing the patient in a low Fowler's position. dministering analgesics for pain management.
wer: B
Answer: C
Expl mal
level e to
wea disc
A pa hich
of the
A
N
Pl
A
Ans
Explanation: Wound dehiscence, the partial or complete separation of the wound edges, is a surgical complication that requires immediate attention. The nurse should prioritize notifying the healthcare provider immediately to ensure prompt evaluation and appropriate interventions. Applying sterile dressings to the wound may be necessary, but it is secondary to notifying the healthcare provider. Placing the patient in a low Fowler's position and administering
analgesics are not directly related to managing wound dehiscence.
Which of the following is a potential complication of a colostomy?
Prolapse
yoderma gangrenosum ephrostomy tube dysfunction
wer: A
anation: Prolapse refers to the protrusion of the colostomy stoma beyo eristomal skin. It can occur due to increased intra-abdominal pressure kened abdominal muscles. Prolapse can lead to difficulty in pouch cation, leakage, and skin irritation. Regular assessment and appropriat agement are necessary to prevent complications associated with colost pse.
tient with an ileostomy reports skin irritation and leakage of stool aro toma. The nurse suspects that the patient may benefit from using a rent containment modality. Which ofthe following options would be t
Urinary tract infection
P
N
Ans
Expl nd
the p or
wea
appli e
man omy
prola
A pa und
the s
diffe he
most appropriate alternative for managing the patient's ostomy?
Pouch with a convex shape.
Pouch with an open-ended design.
Absorptive dressing applied to the stoma.
Barrier ring placed around the stoma.
ay not address the issue of stool leakage. Barrier rings are typically u in uneven skin contours and improve pouch adhesion but may not
tly address the problem of leakage.
tient with a urostomy presents with signs of urinary tract infection, ding dysuria and cloudy urine. Which of the following actions should prioritize?
ssess the stoma for signs of infection. crease the patient's fluid intake.
ollect a urine sample for culture and sensitivity. dminister antibiotics as prescribed.
wer: C
Explanation: A pouch with a convex shape would be the most appropriate alternative for managing the patient's ostomy. A convex pouch helps create a better seal around the stoma, reducing the risk of leakage and skin irritation. An open-ended pouch design may not provide sufficient protection against leakage. Absorptive dressings are more commonly used for peristomal complications and m sed
to fill direc
A pa
inclu the
nurse
A
In
C
A
Ans
Explanation: The nurse should prioritize collecting a urine sample for culture and sensitivity to identify the specific bacteria causing the infection and determine the most appropriate antibiotic treatment. Assessing the stoma for signs of infection is important but should be done in conjunction with obtaining a urine sample. Increasing fluid intake and administering antibiotics may be appropriate interventions based on the culture results and healthcare provider's prescription.
A patient with an enterocutaneous fistula presents with persistent drainage from the wound site. Which of the following interventions is most appropriate for managing the fistula?
itiating total parenteral nutrition (TPN). dministering antibiotics as prescribed. onsulting a wound care specialist.
wer: D
anation: Managing an enterocutaneous fistula often requires a idisciplinary approach, including the involvement of a wound care alist. The specialist can provide expertise in managing complex woun istulas, including the selection and application of appropriate dressing parenteral nutrition (TPN) and antibiotics may be necessary in some hould be prescribed by the healthcare provider based on the individua nt's needs.
ch of the following is a surgical complication that can occur in a patie n ileostomy?
Applying a sterile dressing to the wound.
In
A
C
Ans Expl
mult
speci ds
and f s.
Total cases
but s l
patie
Whi nt
with a
Dermatitis
Dehiscence
Mucocutaneous separation
Pyoderma gangrenosum
Answer: B
tient with an ostomy reports crusting around the stoma site. The nurse ains that crusting can be managed by:
pplying a skin barrier wipe to the stoma. sing an adhesive remover to clean the stoma.
pplying a thin layer of petroleum jelly to the stoma.
sing warm water and a washcloth to gently cleanse the stoma. wer: D
anation: Crusting around the stoma site can be managed by using war and a washcloth to gently cleanse the stoma. This helps remove the d tions and debris that contribute to crusting. Applying a skin barrier wi elp protect the skin, but it may not effectively remove the crust. Petr
ay create a barrier but does not address the underlying cause of crus
Explanation: Dehiscence refers to the separation or opening of the surgical incision or anastomosis. In the case of an ileostomy, dehiscence can occur at the stoma site or at the site where the bowel is brought through the abdominal wall. It is a serious complication that can lead to infection, peritonitis, and the need for surgical intervention. Prompt recognition and appropriate management are crucial in preventing further complications.
A pa expl
A
U
A
U
Ans
Expl m
water ried
secre pe
can h oleum
jelly m ting.
Adhesive removers are typically used to remove adhesive residue from the skin and are not specifically indicated for managing crusting.