Ostomy Final Exam foreals!

A client is undergoing radiation therapy after cystoprostatectomy and ileal conduit construction. He says to you, "They marked me today for my radiation and my pouch is right in that area. Will it matter?" Which of the following is the best response? "You should avoid using any metal-containing pouches or tapes and do not rub your skin or use soap." "You should routinely massage the peristomal skin with a bland ointment such as A & D." "Radiation does not affect the skin and there is no need to change your pouching care." "You should remove your pouch each time so that it will not "block" the radiation."

"You should avoid using any metal-containing pouches or tapes and do not rub your skin or use soap."

A client with a new ileostomy tells the ostomy nurse, "I am a bit nervous about having sex with my partner after this surgery." The best response from the ostomy nurse is: "You may need to protect the bed sheet with disposable underpads, just in case." "You need to explore other forms of sexual intimacy besides intercourse." "You may need to connect the pouch to a leg-bag before having intercourse." "You should empty the pouch before engaging in sexual activity."

"You should empty the pouch before engaging in sexual activity."

The ideal length of the stoma should be 1 to 3 cm above skin level. greater than 4 cm above skin level. at skin level. 1 cm below the skin level.

1 to 3 cm above skin level.

The following food choices are recommended for thickening the stool following J-pouch surgery: Fatty and greasy foods Fresh vegetables and legumes Bananas and starches Fresh fruits and juices

Bananas and starches

An infant is diagnosed with prune belly syndrome. Which symptom is not characteristic of this disorder? Absence of abdominal muscles Dilation of the upper urinary tract Clubfeet Blood in the stool

Blood in the stool

The cause of pseudoverrucous lesions in ileal conduit is: Alkaline enzymes Staphylococcal infection Chronic moisture Candida albicans

Chronic moisture

Which client would the ostomy nurse consider at higher risk for development of peristomal varices? Client with cirrhosis of the liver Client with latex allergies Client with diabetes Client with hypertension

Client with cirrhosis of the liver

The client has an ascending colostomy after a traumatic abdominal injury 4 days ago. When changing the appliance, the nurse notes that the client keeps the eyes closed. The nurse's next action is based on knowledge that: Clients will often need someone to perform this procedure for life. Clients must be checked for vision problems first in traumatic injuries. Clients need to learn self-care as soon as possible after surgery. Clients often need time to adjust to a dramatic change in body image.

Clients often need time to adjust to a dramatic change in body image.

Spontaneous closure of fistula may not occur in the following condition: Formation of pseudoverrucous lesions on the skin A significant decrease in output after two weeks of NPWT A daily output of 100 ml Formation of pseudostoma

Formation of pseudostoma

Which modification in the treatment of colorectal cancer has significantly reduced the number of clients who require a permanent colostomy? Radiation beam therapy The effectiveness of chemotherapeutic agents The use of laparoscopic techniques in surgery Guidelines for curative resection of rectal cancer revised to require a 2-cm distal margin

Guidelines for curative resection of rectal cancer revised to require a 2-cm distal margin

Refer to the above question, to assess baby Juan's condition, you will ask the mother the following : Changes in the type of feeding and exercises Circumference of the peristomal bulging and color of the stoma Any external trauma on the stoma and the type of diaper used Length of the protrusion and changes in stomal outpout

Length of the protrusion and changes in stomal outpout

Which of the following diseases may result in intestinal failure requiring surgical resection ? Necrotizing enterocolitis Prune Belly Syndrome Colorectal Cancer Ulcerative Colitis

Necrotizing enterocolitis

A treatment plan for pyoderma gangrenosum (PG) lesions should include which of the following? Negative pressure wound therapy (NPWT) dressing Oral corticosteroids Serial debridement Whirlpool therapy

Oral corticosteroids

Which of the following assessment findings indicates that the client will require surgical closure of the fistula? History indicates fistula has been present > 14 days Output exceeding 750 ml/24 hr Evidence of mucosal eversion/pseudostoma formation Hypertrophic granulation tissue in wound bed

Output exceeding 750 ml/24 hr

A client has an enterocutaneous fistula draining 600 ml of fluid in 24 hours. Which of the following is not an appropriate intervention? TPN to maintain positive nitrogen balance High output pouch and suction system to contain drainage Place white foam inside the fistula tract to enhance NPWT pressure Sandostatin (Octreotide) injection to control watery output

Place white foam inside the fistula tract to enhance NPWT pressure

You are caring for a client who has recently undergone the final stage of Ileal Pouch Anal Anastomosis (IPAA) for management of ulcerative colitis. It is important to educate the client to expect frequent episodes of stooling. Further instruction should include: Use of an alcohol-based skin sealant to prevent infection Protect peristomal skin with an antifungal powder and barrier film Proper pouching and emptying technique Protect the perianal skin with a protective barrier cream

Protect the perianal skin with a protective barrier cream

Which of the following will be an effective way to increase client's confidence in learning ostomy care? Provide a teaching booklet. Provide simple, small steps in emptying and changing the pouch. Provide a teaching video. Provide different products to practice with.

Provide simple, small steps in emptying and changing the pouch.

A client is diagnosed with colorectal cancer manifested by a tumor that invades to the submucosa. What stage of cancer would be documented? Stage 3 Stage 1 Stage 0 Stage 2

Stage 1

A client is diagnosed with pancolitis. What part of the colon is involved? The entire colon the cecum and ascending colon the transverse colon the descending colon and rectum

The entire colon

One of the major differences in care of a client with a colostomy and one with an ileostomy is? The stool of the ileostomy is liquid to mushy which requires increased fluid intake. The ileostomy is usually able to be reversed when the disease process heals. Only the client with an ileostomy will require the use of a colostomy bag. There are usually no dietary restrictions with either client.

The stool of the ileostomy is liquid to mushy which requires increased fluid intake.

The ostomy nurse instructs the client with an ileal conduit to notify the physician if The urine drains continuously from the stoma. The urine is cloudy and has a foul odor. The stoma becomes slightly smaller over time. Many mucus shreds are noted in the urine.

The urine is cloudy and has a foul odor.

A client has a nephrostomy tube that has stopped draining. Which assessment finding would warrant correction before patency can be regained? The tube is positioned below the insertion site. The skin around the tube is irritated. The tube is connected to a drainage bag. Tubing that is unsecured and kinked.

Tubing that is unsecured and kinked.

The lack of urine flow from a newly created urostomy is indicating the need to change the pouch. a medical emergency. normal after surgery. requiring catheterization.

a medical emergency.

The mother of baby Juan calls and says the stoma is "sticking out a lot, especially when baby cries". The condition is probably: normal condition a myelomeningocele parastomal hernia a prolapsed stoma

a prolapsed stoma

A client with an ileal reservoir is diagnosed with pouchitis. The client is presenting with the following symptoms: Abdominal distention, food blockage, nausea and vomiting, chills. abdominal cramps, increased stool frequency, watery diarrhea, urgency, and fatigue. Fever, prolapse, increased urination, increased odor of urine. Fever, constipation, nausea and vomiting.

abdominal cramps, increased stool frequency, watery diarrhea, urgency, and fatigue.

The primary defect in Hirschsprung's disease is: ischemia of bowel wall leading to necrosis and perforation. absence of continuity along GI tract with proximal obstruction. absence of normal ganglion cells and hypertrophic nerves of the bowel leading to collapse of involved segment and dilation of proximal segment. twisting of bowel leading to ischemia and obstruction.

absence of normal ganglion cells and hypertrophic nerves of the bowel leading to collapse of involved segment and dilation of proximal segment.

A client has had difficulty maintaining adequate wear time. There is seeding of viable intestinal mucosa along the mucoscutaneous suture line and onto the peristomal skin. The only definitive treatment of this peristomal complication is to: ask the surgeon to evaluate for excision. apply an extended wear barrier with convexity. cauterize the lesions using silver nitrate. apply skin barrier powder and alcohol-free skin sealant.

apply skin barrier powder and alcohol-free skin sealant.

Ms. G, a competitive swimmer, has a new ileal conduit. She expresses fear that with an ostomy, her career may be over. You instruct her to empty the pouch prior to swimming. In addition, you will advise her to: apply water-proof tape to all four sides as needed. compete in other sports since urine leakage could be a problem. change the pouching system before and after each race. intubate the stoma to ensure that urine is mostly drained.

apply water-proof tape to all four sides as needed.

A client 6 weeks after a continent ileostomy (Kock Pouch) asks how to manage the mucus and moisture created by the stoma. Teaching should include: covering the stoma with a simple, dry, absorptive pad. wiping the stoma with petroleum jelly daily. wearing an ostomy pouch to catch the mucus. leaving the stoma open to air to keep it dry.

covering the stoma with a simple, dry, absorptive pad.

The Barnett Continent Ileal Reservoir (BCIR) construction improved upon the Kock continent ileostomy by: Correct! encircling the intussuscepted bowel with a "living collar" to better support the continence mechanism. connecting the reservoir to the anal canal to allow better control of bowel movement. using additional length of small bowel to create the internal pouch that allowed larger capacity. providing a way for the client to only need to intubate the internal pouch once or twice a day.

encircling the intussuscepted bowel with a "living collar" to better support the continence mechanism.

Management of a superficial, partial mucocutaneous separation include: leave the defect open to air, cut the skin barrier of the pouching system bigger to accommodate the defect. cut the opening of the pouching system to fit around the stoma so that the defect will be covered. fill the defect with a wound filler, cover the defect with the skin barrier of the pouching system. fill the defect with a wound filler, cut the opening of the skin barrier of the pouching system bigger to accommodate the defect.

fill the defect with a wound filler, cover the defect with the skin barrier of the pouching system.

Hernia belts should be used when there is parastomal hernia. The goal is to: give support circumfrentially to hold the pouch in place. reduce the prolapsed stoma. reduce the peristomal hernia. give support to the overhanging obese pannus.

give support circumfrentially to hold the pouch in place.

A client with an ileostomy has a denuded area of skin below the stoma. Upon removal of the barrier wafer, you noticed that an area from the barrier opening at 6 o'clock to the edge on the barrier wafer was softer and with a lighter color than the rest of barrier. The most likely etiology of this skin breakdown is allergic dermatitis suture granulomas irritant dermatitis peristomal candidiasis

irritant dermatitis

Selection of the type of barrier wafers, such as flat, convexity, flexible, or rigid, is determined by: location of the os and peristomal skin contours. disease etiology and prognosis. type and frequency of output. patient and caregiver preferences.

location of the os and peristomal skin contours.

A closed-end pouch is suitable for a client with the following bowel pattern: intermittent constipation and diarrhea. large volume of liquid stool per day. large amount of semi-liquid stool per day. one to two formed stools per day.

one to two formed stools per day.

If a budded stoma is inside a deep crease, it will be best to use a one-piece flexible pouch. a two-piece pouch with convexity.

one-piece flexible pouch.

Clients with peristomal hernias are usually instructed not to irrigate their colostomies. If you are required to irrigate a client with a peristomal hernia, you should: place the client in a supine position so that the hernia is reduced. use a large-bored catheter to promote fluid entry. suction the fluid out from the stoma. press onto the hernia to ensure a good return of fluid.

place the client in a supine position so that the hernia is reduced.

When there is an identified stomatized fistua inside a draining wound bed, you will: use negative-pressure wound therapy on the fistula and protect the wound bed from getting intestinal fluid on it. never use negative-pressure wound therapy. pouch the fistula and use negative-pressure wound therapy on the rest of the wound bed. pack the wound as frequently as needed and wait for the fistula to close spontaneously

pouch the fistula and use negative-pressure wound therapy on the rest of the wound bed.

Major complications after ileal pouch anal anastomosis (IPAA) include: stomal stenosis and stricture, pyelonephritis, and leakage at anstomosis. hernia, prolapse, necrosis, mucocutaneous separation, retraction, and folliculitis. pouchitis, fistulas, sexual dysfunction, and dysplasia or cancer in ileorectal anastomosis. fluid and electrolyte imbalance, food blockage, and dehydration.

pouchitis, fistulas, sexual dysfunction, and dysplasia or cancer in ileorectal anastomosis.

The ideal candidate for colostomy irrigation is someone who has had a: protocolectomy with descending colostomy. left hemi-colectomy with ascending colostomy. total protocolectomy with a Koch pouch. sigmoid colostomy and undergoing chemotherapy.

protocolectomy with descending colostomy.

A client presents with full-thickness ulcers to his peristomal skin. The ulcers have irregular, ragged, undermined edges and are extremely painful. The surrounding skin is purple. The ulcer is most likely to be a: suture granulomas folliculitis mucosal transplantation pyoderma gangrenosum

pyoderma gangrenosum

The main purpose of colostomy irrigation is to: relieve food blockage. prevent constipation. prevent pouchitis. regulate bowel movement.

regulate bowel movement.

The mother has just been told that her baby has necrotizing enterocolitis and will need surgery. You do pre-op teaching based on the knowledge that this surgery may involve: resection of involved bowel with end-to-end anastomosis. resection of involved bowel with ileostomy and mucous fistula. diverting colostomy to be followed later by pull-through procedure. loop jejunostomy to establish bile flow.

resection of involved bowel with ileostomy and mucous fistula.

The ostomy nurse determines the type of ostomy by visualization and nursing experience. noting the stoma location on the abdomen. assessing the type and consistency of the output. reviewing the medical record.

reviewing the medical record.

How could baby Juan's condition be managed? Choose the best three interventions (points will be deducted if choosing more than three answers). gently push the stoma in place when baby is in supine position sprinkle sugar to temporarily shrink the stoma monitor for changes in output use a different pouching system to accommodate the stoma apply an abdominal binder apply silver nitrate to reduce the stoma

sprinkle sugar to temporarily shrink the stoma monitor for changes in output use a different pouching system to accommodate the stoma

A client with a stoma reports pain with stoma evacuation and small, ribbon-like stools. What stomal complication may be present? necrosis stenosis prolapse trauma

stenosis

The major factors that determine a secure seal in ostomy pouching are: the types of ostomy. stomal os location and peristomal skin contours. brand name and cost of the pouching system. volume and consistency of output.

stomal os location and peristomal skin contours.

The major difference of a Barnett Continent Intestinal Reservoir (BCIR) from other continent diversions is: using the ileocecal valve to create the continent mechanism. the construction of a loop of bowel fashioned as a collar around the intussuscepted segment of bowel connecting the reservoir and the abdominal stoma. tunneling the ureters along tenia to provide antireflux protection. the removal of the colon and upper rectum but leaving the anal canal.

the construction of a loop of bowel fashioned as a collar around the intussuscepted segment of bowel connecting the reservoir and the abdominal stoma.

A client with colon cancer is receiving chemotherapy as a neoadjuvant treatment. The ostomy nurse explains to the client that this treatment is: the treatment given after surgery to eradicate remaining cancer cells. the primary treatment for the cancer. the treatment given before surgery. the treatment aimed at limited effects of a cancer that cannot be cured

the treatment given before surgery.

A client is considering to have the orthotopic bladder. He says he has difficulty in understanding what the surgeon told him. You will explain that: the cecum and first part of the large intestine is used to make the bladder. the end of a small piece of ileum is used to make a stoma. the ureters will be sewn to the top part of the reservoir. the last 15 cm of the ileum and the one-way valve at the end of the small intestine will be used to make the reservoir.

the ureters will be sewn to the top part of the reservoir.

An overgrowth of granulation tissue is seen at the percutaneous tube exit site. To determine the underlying cause of hyperplasia, the ostomy nurse must assess: nutritional deficit allergic reaction to tape tube patency tube mobility and moisture

tube mobility and moisture