Question 1

A patient is receiving discharge instructions.He shares with the nurse that he intends to do a lot of traveling.Instructions for travel should include which one of these points?

Accepted Answer

Warning about foods in a different country is appropriate.Supplies should be placed in a carry-on bag for quick access or in the case of lost luggage.Water that is not safe to drink is not appropriate as irrigation fluid.

Question 2

A baby born without a urinary bladder has a cutaneous ureterostomy with one stoma and a cutaneous ureterostomy has been surgically created.One stoma exists.Discussion with the child's family regarding the care should include which of the following?

Accepted Answer

The baby's ureterostomy and drainage of urine are constant.This is a permanent solution because of the lack of a bladder.Both ureters are joined for the release of urine through the stoma.The pouch will be on continually and needs to be changed as needed several times a day.

Question 3

The patient asks if rectal suppositories can be used to assist with constipation problems with his colostomy.The nurse clarifies that suppositories:

Accepted Answer

Suppositories can be used effectively in double-barreled colostomies and in stomas of a single colostomy.

Question 4

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." The nurse's best response to stimulate communication would be:

Accepted Answer

Open-ended questions without prejudgment or belittling encourage the patient to identify sources of anxiety and help the patient cope with,adapt to,or problem-solve stressful events.

Question 5

The 20-year-old patient with a permanent colostomy asks whether she will be able to become pregnant.The nurse's most informative response would be:

Accepted Answer

Colostomies do not interfere with pregnancy or delivery.

Question 6

The nurse explains that an artificial opening into a body cavity is a(n):

Accepted Answer

An ostomy is an artificial opening into a body cavity.

Question 7

To ensure a good fit of the appliance to avoid leakage,the nurse would instruct the patient to:

Accepted Answer

Placement of the pouch should provide a good fit and be comfortable in all positions but not too snug on the stoma to risk laceration.The pouch need only cover enough of the abdomen to allow for a firm fit.

Question 8

A 47-year-old patient with a permanent colostomy reports some abdominal discomfort and rigidity 3 days after surgery.The assessment that the nurse should report and record is:

Accepted Answer

Vital signs,in conjunction with the complaint of abdominal discomfort,should be reported and recorded as possible signs of impending peritonitis.

Question 9

In postoperative teaching to a patient who has undergone a ureterostomy,the nurse would include information pertaining to the:

Accepted Answer

Information about the ureteral catheter,which will be in place for the first week,is important.Karaya gum products are not used for urinary appliances because urine breaks down the karaya.Pouches are changed only every 4 to 6 days to prevent skin irritation.The pouch is best changed in the morning.

Question 10

The nurse caring for a 2-day postoperative colostomy patient should report immediately if a stoma is assessed and:

Accepted Answer

A stoma should be beefy red.Blue or black coloration is an indication of poor circulation and should be reported immediately.Swelling and a small amount of blood around the stoma are normal in early postoperative days.

Question 11

The nurse explains to a preoperative patient that a J-pouch anal anastomosis procedure has the primary advantage of:

Accepted Answer

Preoperative teaching includes the expectation of near-normal bowel elimination.As with any bowel elimination,odor and possibly occasional diarrhea will occur.An irrigation is not necessary.

Question 12

Because the colostomy patient continues to worry about odor,the nurse can allay those concerns by explaining that odor can be diminished by:

Accepted Answer

The problem of odor is a frequent cause of anxiety to the colostomy patient.Rinsing the bag with a vinegar solution or putting a small amount of vinegar in the bag is helpful in odor control.Piercing the bag allows gas to escape more easily,wearing tight fitting clothing does nothing to alleviate odor.Personal hygiene is not a consideration in controlling the odor of feces.

Question 13

The initial assessment of a patient just returned from surgery for the creation of an Indiana pouch would include the:

Accepted Answer

Indiana pouches initially have a Penrose drain to drain the small amount of urine; it will have mucus in it but no odor.No stoma exists to observe.Irrigations may be necessary to remove clots and mucus.

Question 14

The patient who has undergone a colostomy is instructed to measure the width of the stomas for the first 6 weeks postoperatively before applying each new pouch because:

Accepted Answer

During the first 6 weeks,the stoma normally shrinks.The pouch needs to fit as closely to the stoma as is comfortable and safe to prevent skin irritation.

Question 15

The patient comes to the industrial nurse and is frantic because the stoma to the colostomy has prolapsed 1 year after surgery.The nurse's best counsel would be:

Accepted Answer

The prolapse of a stoma is very disturbing to a patient.The condition should be evaluated by the surgeon.However,if the stoma is still patent,emergency implementation is not necessary.Prolapse can be caused by coughing or sneezing,but the stoma will still need evaluation.

Question 16

To assist a colostomy patient in selecting an appropriate diet to reduce excess gas or diarrhea,the nurse would encourage the patient to choose:

Accepted Answer

Gas-forming or spicy foods and roughage,such as corn,fish,and cabbage,usually cause gas and diarrhea.

Question 17

An ostomate asks the nurse what limitations must be observed in the immediate postoperative period when at home.The most informative information that the nurse can share is to:

Accepted Answer

Avoiding heavy lifting for 3 months is advised.Ostomates should take in at least 2000 ml of fluid every day.They may wear ordinary clothes that do not bind the stoma.Showering is allowed,because the appliance is waterproof.

Question 18

The patient says,"I hate this yucky paste under my appliance.I think I will just tape it on." The nurse's most informative response to this remark would be which of the following?

Accepted Answer

Reminding the patient that the paste both bonds and waterproofs is the best information.

Question 19

The nurse caring for the immediate postoperative patient with an ileal conduit should report or intervene for:

Accepted Answer

The distended abdomen suggests that the gastrointestinal suction is not effective to prevent bowel distention.The nurse must check the efficiency of the suction.Lack of bowel sounds,mucus in the urine,and a small amount of blood in the drainage is to be expected as normal postoperative assessments.

Question 20

The nurse is aware that many ostomates have an altered self-image,which may cause:

Accepted Answer

A damaged self-image or body image may cause ostomates to feel unattractive and embarrassed about possible sexual activity.Open-ended questions assist the patient to talk about their feelings.

Quiz 26: The Patient With an Ostomy