Question 1

Which assessment by a nurse caring for an immediate postoperative patient with an ileal conduit should be reported or receive attention immediately?&#10;A) Lack of bowel sounds&#10;B) Distended abdomen&#10;C) Mucus present in the urine&#10;D) Small amount of blood in the drainage

Accepted Answer

A distended abdomen could indicate a possible bowel obstruction or urinary tract obstruction and should be reported immediately to the healthcare provider. Lack of bowel sounds is common in the immediate postoperative period and may not require immediate attention. Mucus present in the urine and a small amount of blood in the drainage are expected findings in a patient with an ileal conduit.

Question 2

Which term appropriately defines an artificial opening into a body cavity?&#10;A) Gastrostomy&#10;B) Ostomy&#10;C) Colonoscopy&#10;D) Ureterostomy

Accepted Answer

'Ostomy' is the term that appropriately defines an artificial opening into a body cavity. 'Gastrostomy' refers to the surgical creation of an opening into the stomach, 'colonoscopy' is a diagnostic procedure to examine the colon, and 'ureterostomy' is a surgical procedure to create a new opening for the ureter.

Question 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?&#10;A) Vital signs are temperature, 100$\degree$ F; pulse, 92 beats/min; and blood pressure, 160/98 mm Hg.&#10;B) Stoma is swollen and red; small amount of blood is observed at the base.&#10;C) Pouch has drained 110 mL of green-brown liquid, oozing from the pouch edges.&#10;D) Stoma is protruding.

Accepted Answer

CA) Elevated temperature and blood pressure may indicate an infection or other postoperative complications, which should be reported and recorded. C) Drainage of green-brown liquid oozing from the pouch edges could indicate a leak or infection, which is also significant and should be reported and recorded.

Question 4

A nurse is aware that many patients with ostomies have an altered self-image.What might this cause?&#10;A) Inadequate self-care&#10;B) Altered sexual function&#10;C) Nonadherence to diet&#10;D) Irrational anger

Accepted Answer

An altered self-image due to an ostomy can lead to concerns about body image and intimacy, potentially affecting sexual function.

Question 5

A patient asks if rectal suppositories can be used to assist with constipation problems with his colostomy.What should the nurse clarify regarding suppositories?&#10;A) They can be used in double-barreled colostomies.&#10;B) They can be used in a stoma.&#10;C) They should not ever be used in a colostomy.&#10;D) They will not penetrate well enough to relieve constipation.

Accepted Answer

Suppositories can be used in a stoma, but should not be used in a colostomy. Double-barreled colostomies do not typically require suppositories for constipation relief. It is possible that suppositories may not penetrate well enough to relieve constipation, but this is not always the case and may vary depending on the individual's specific situation.

Question 6

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?&#10;A) &#34;If there are still feces coming from the stoma, then it is not blocked.Contact your surgeon for an evaluation.&#34;&#10;B) &#34;You must come in immediately because the stoma may completely retract into your abdomen.&#34;&#10;C) &#34;This is an emergency situation because it has stenosed.&#34;&#10;D) &#34;Don't worry about that.Coughing or sneezing might have caused the prolapse.It will come back out in a few hours.&#34;

Accepted Answer

The best response is to reassure the patient that if feces are still coming from the stoma, then it is not blocked and suggest that they contact their surgeon for further evaluation. While a prolapsed stoma can be concerning and uncomfortable for the patient, it is not necessarily an emergency or a sign of stenosis, and it may resolve on its own or with intervention from the surgeon. Option B is incorrect because a prolapsed stoma does not necessarily retract completely into the abdomen, and this can create unnecessary anxiety for the patient. Option C is incorrect because a prolapsed stoma does not always indicate stenosis. Option D is incorrect because coughing or sneezing did not cause the prolapse, and this response does not address the patient's concerns or provide helpful information.

Question 7

A patient says, &#34;I hate this yucky paste under my appliance.I think I will just tape it on.&#34; What is the best response by the nurse?&#10;A) &#34;Taping will not work!&#34;&#10;B) &#34;Taping will not seal the wafer tight enough to prevent leakage or fill increases.&#34;&#10;C) &#34;Taping with waterproof tape is just as effective as the paste.&#34;&#10;D) &#34;Taping is far more irritating to the skin than the paste would be.&#34;

Accepted Answer

Taping will not seal the wafer tight enough to prevent leakage or fill increases.

Question 8

What should the initial assessment of a patient that just returned from surgery for the creation of an Indiana pouch include?&#10;A) Drainage of urine from the Penrose drain at the operative site&#10;B) Condition and color of the stoma&#10;C) Appearance of mucus in the urine&#10;D) Copious and odorous urine drainage from the incision

Accepted Answer

The answer of What should the initial assessment of a...

Question 9

What might the continual loss of liquid stool result in with an ileostomy patient?&#10;A) Acidosis&#10;B) Alkalosis&#10;C) Erosion of stoma&#10;D) Colitis

Accepted Answer

The continual loss of liquid stool in an ileostomy patient can lead to acidosis due to the loss of bicarbonate in the stool, which is necessary to neutralize acids in the body.

Question 10

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?&#10;A) The stoma will shrink during this time.&#10;B) A poor-fitting pouch will cause infection of the stoma.&#10;C) The paste will not adhere.&#10;D) Prolapse will result.

Accepted Answer

After surgery, swelling and edema may cause the stoma size to decrease. It is important to measure the stoma regularly during the first 6 weeks to ensure a proper fit for the pouching system. A poorly fitting pouch can cause irritation and infection of the stoma.

Question 11

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?&#10;A) &#34;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.&#34;&#10;B) &#34;Exercise caution with new foods, especially local fruits and vegetables because they may cause diarrhea or gas.&#34;&#10;C) &#34;If visiting somewhere where drinking local water is not advised, irrigating the colostomy with the local water is still okay.&#34;&#10;D) &#34;Repeat back to me what we just talked about so that you will remember everything you have been taught.&#34;

Accepted Answer

The answer of A patient is receiving discharge instructions and...

Question 12

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?&#10;A) &#34;This urinary diversion is permanent, and urine will drain from it continually.&#34;&#10;B) &#34;In the future, a second surgery will offer an exit for the urine from the other kidney.&#34;&#10;C) &#34;This pouch needs to be changed only once a week.&#34;&#10;D) &#34;You should notify the surgeon if the stoma becomes paler in color.&#34;

Accepted Answer

The answer of A baby born without a urinary bladder...

Question 13

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?&#10;A) &#34;No.The colostomy weakened the pelvic floor to the point that it will not support a pregnancy.&#34;&#10;B) &#34;Yes.Pregnancy may be accomplished with artificial insemination because the fallopian tubes are usually damaged by a colostomy.&#34;&#10;C) &#34;No.The abdominal pressure exerted by a pregnancy will cause the prolapse of the stoma.&#34;&#10;D) &#34;Yes.The colostomy will not interfere with pregnancy or delivery.&#34;

Accepted Answer

The answer of A 20-year-old patient with a permanent colostomy...

Question 14

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?&#10;A) Avoid heavy lifting for at least 3 months.&#10;B) Limit fluid intake to no more than 1000 mL/day.&#10;C) Wear loose clothing without belts or elastic.&#10;D) Cover your appliance with plastic sheeting while showering.

Accepted Answer

The answer of A patient with an ostomy asks the...

Question 15

What should a nurse suggest to a patient with a colostomy choose when selecting an appropriate diet to reduce excess gas or diarrhea?&#10;A) Roast beef, mashed potatoes, and peeled stewed tomatoes&#10;B) Broiled pork chop, boiled potato, and corn on the cob&#10;C) Broiled trout, mashed potatoes, and spinach&#10;D) Barbeque pork on a white bun, coleslaw, and French fries

Accepted Answer

The answer of What should a nurse suggest to a...

Question 16

What is the primary advantage of a J-pouch anal anastomosis procedure?&#10;A) No odor&#10;B) Easier to irrigate&#10;C) Near-normal bowel elimination&#10;D) Less problem with diarrhea

Accepted Answer

The answer of What is the primary advantage of a...

Question 17

A patient with a colostomy continues to worry about odor.What instruction should a nurse provide to allay this concern?&#10;A) Pierce the top of the appliance bag with a pin to allow gas to escape.&#10;B) Rinse the pouch in a vinegar solution.&#10;C) Wear tight-fitting underwear.&#10;D) Improve personal hygiene.

Accepted Answer

The answer of A patient with a colostomy continues to...

Question 18

Which is the best nursing strategy for encouraging an ostomy patient to perform self-care?&#10;A) Plan to change the pouch when family members will be present, and have the patient watch and listen to the procedure.&#10;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.&#10;C) Encourage the patient to watch the stoma care procedure, gradually encouraging participation.&#10;D) Shield the patient from sight of the stoma until the patient actually asks to see it.

Accepted Answer

The answer of Which is the best nursing strategy for...

Question 19

What should a nurse instruct the patient to do to ensure a good fit of the appliance to avoid leakage?&#10;A) Place the pouch only when lying down.&#10;B) Check pouch placement to ensure a firm seal.&#10;C) Confirm that the pouch fits tightly to the edges of the stoma.&#10;D) Confirm that the pouch covers the entire abdomen.

Accepted Answer

The answer of What should a nurse instruct the patient...

Question 20

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."

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Accepted Answer

The answer of A patient who has had a temporary...

Question 21

What should be considered when deciding placement of a stoma? (Select all that apply.)&#10;A) Good seal&#10;B) Stabilization from the abdominal rectus&#10;C) Ease of self-care&#10;D) Inoffensive appearance&#10;E) Proximity to the umbilicus

Accepted Answer

The answer of What should be considered when deciding placement...

Question 22

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?&#10;A) Any adhesive is effective on a urostomy appliance.&#10;B) Urine breaks down karaya products.&#10;C) Karaya products can cause urinary infections.&#10;D) Formation of urine crystals is increased with the use of karaya products.

Accepted Answer

The answer of A patient asks a nurse if karaya...

Question 23

What are complications that may occur with continent pouches (Kock and Indiana)? (Select all that apply.)&#10;A) Incontinence&#10;B) Difficult catheterization&#10;C) Pyelonephritis&#10;D) Rupture of the pouch&#10;E) Peritonitis

Accepted Answer

The answer of What are complications that may occur with...

Question 24

What can be caused by lack of thorough cleansing of fecal matter from around a stoma? (Select all that apply.)&#10;A) Fungal infection&#10;B) Bacterial infection&#10;C) Yeast infection&#10;D) Deterioration of the stoma&#10;E) Odor

Accepted Answer

The answer of What can be caused by lack of...

Question 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?&#10;A) Ask a volunteer from the American Cancer Society or United Ostomy Association to visit.&#10;B) Ask a volunteer from the Reach for Recovery Society to visit.&#10;C) Send a close family member for psychiatric counseling.&#10;D) Obtain humor books pertaining to illness, such as Anatomy of an Illness, or watch several episodes of The Three Stooges on television.

Accepted Answer

The answer of What is the most effective way for...

Question 26

What is caused by some adhesive pouch material used to hold the appliance in place?&#10;A) Melting of the pouch&#10;B) Excoriation of the stoma&#10;C) Allergic reaction&#10;D) Unpleasant odor

Accepted Answer

The answer of What is caused by some adhesive pouch...

Question 27

A postoperative patient with an ostomy has the potential for loss of fluid volume and electrolyte imbalance.Which assessments indicate such loss? (Select all that apply.)&#10;A) Changing mental status&#10;B) Twitching&#10;C) Poor skin turgor&#10;D) Moist mucous membranes&#10;E) Weakness

Accepted Answer

The answer of A postoperative patient with an ostomy has...

Question 28

When a patient complains of urine crystals forming on the urostomy stoma, the home health nurse recommends dissolving them with a pad saturated with ______.

Accepted Answer

The answer of When a patient complains of urine crystals...

Deck 18: The Patient With an Ostomy