A surgical opening in the stomach for feeding

A device inserted to relieve constipation

A tube placed in the rectum for enemas

CNA Bowel and Ostomy Care 1 — Questions and Answers

Question 1: What is a colostomy?

A surgical opening in the stomach for feeding
A surgically created opening in the colon that allows stool to exit through the abdominal wall (Correct answer)
A device inserted to relieve constipation
A tube placed in the rectum for enemas

Correct answer: A surgically created opening in the colon that allows stool to exit through the abdominal wall

A colostomy is a surgical procedure that creates a stoma (opening) in the colon on the abdominal wall, through which feces are expelled into an external pouching system.

Question 2: What is an ileostomy?

A surgically created opening in the ileum (small intestine) that allows liquid stool to exit the abdomen (Correct answer)
A surgically created opening in the large intestine
A catheter for urinary drainage
A feeding tube placed in the stomach

Correct answer: A surgically created opening in the ileum (small intestine) that allows liquid stool to exit the abdomen

An ileostomy is a surgical opening in the ileum (end of the small intestine). Output is liquid to semi-liquid and contains digestive enzymes that are very irritating to skin.

Question 3: A healthy stoma should appear:

Pale, dry, and flat against the abdomen
Bright red or pink, moist, and slightly raised above the skin (Correct answer)
Dark purple or black
Sunken into the abdominal skin

Correct answer: Bright red or pink, moist, and slightly raised above the skin

A normal stoma is pink to red, moist, and protrudes slightly above the abdominal surface. Discoloration (purple, black, or very pale) or retraction indicates problems requiring immediate nurse notification.

Question 4: Which observation of a stoma requires IMMEDIATE reporting?

The stoma is pink and moist
The stoma is dark purple or black (Correct answer)
Output from the stoma is present
The stoma protrudes slightly above skin level

Correct answer: The stoma is dark purple or black

Dark purple or black color indicates the stoma may be losing its blood supply (ischemia or necrosis). This is a surgical emergency and must be reported to the nurse immediately.

Question 5: The skin around the stoma is called the:

Peristomal skin (Correct answer)
Mucocutaneous junction
Abdominal fascia
Peritoneal wall

Correct answer: Peristomal skin

Peristomal skin is the skin surrounding the stoma. It must be kept clean, dry, and protected from effluent because continuous contact with stool or urine causes severe skin breakdown.

Question 6: Why is it especially important to protect the peristomal skin of an ileostomy?

Because the output is solid and dry
Because ileostomy output contains active digestive enzymes that rapidly damage skin (Correct answer)
Because the stoma is located near a joint
Because ileostomy stomas are always infected

Correct answer: Because ileostomy output contains active digestive enzymes that rapidly damage skin

Ileostomy output is liquid and contains proteolytic enzymes (digestive enzymes) that rapidly break down and erode the peristomal skin if they are allowed to contact it.

Question 7: When should a CNA change an ostomy pouch?

Every hour to prevent leakage
When it is one-third to one-half full, or when there is a leak (Correct answer)
Only when the nurse directs them to
At the same time every day regardless of fill level

Correct answer: When it is one-third to one-half full, or when there is a leak

The pouch should be emptied when one-third to one-half full to prevent the weight from breaking the seal. It should also be changed immediately if a leak is detected to protect the peristomal skin.

Question 8: The CORRECT technique when removing an ostomy barrier (wafer) is to:

Pull it off quickly to minimize discomfort
Gently peel it away from skin while supporting surrounding skin to prevent tearing (Correct answer)
Soak the wafer in water first, then scrub it off
Use scissors to cut it away from the skin

Correct answer: Gently peel it away from skin while supporting surrounding skin to prevent tearing

The barrier should be gently peeled while using one hand to support and protect the surrounding skin. Rapid removal or pulling can cause skin tears, especially in elderly or fragile patients.

Question 9: When cleaning a stoma during a pouch change, the CNA should use:

Alcohol wipes to disinfect the area
Mild soap or prescribed skin cleanser and warm water, then dry thoroughly (Correct answer)
Hydrogen peroxide to clean around the stoma
Antiseptic solution poured directly on the stoma

Correct answer: Mild soap or prescribed skin cleanser and warm water, then dry thoroughly

Mild soap or prescribed cleansers with warm water are used to gently clean the stoma and peristomal skin. Alcohol, hydrogen peroxide, and strong antiseptics damage stoma tissue and peristomal skin.

Question 10: It is normal for the stoma to bleed slightly when cleaned because:

It indicates an infection
The stoma tissue has many blood vessels near the surface and is similar to mucous membrane (Correct answer)
The resident has a clotting disorder
Cleaning should be stopped immediately

Correct answer: The stoma tissue has many blood vessels near the surface and is similar to mucous membrane

Stoma tissue is mucous membrane with a rich blood supply close to the surface. Minor bleeding with gentle cleaning is normal. Persistent or heavy bleeding should be reported.

Question 11: When does the CNA apply the new ostomy pouching system?

While the peristomal skin is still wet to prevent drying
After the peristomal skin is thoroughly clean and completely dry (Correct answer)
Before cleaning the stoma
Only after the nurse approves the skin condition

Correct answer: After the peristomal skin is thoroughly clean and completely dry

The new pouching system must be applied only after the skin is completely dry. Moisture under the barrier prevents proper adhesion, causing leaks and skin breakdown.

Question 12: Constipation is BEST described as:

Passing stool more than 3 times per day
Infrequent, difficult, or incomplete passage of hard, dry stool (Correct answer)
Watery stool passed frequently
Normal variation in bowel habits

Correct answer: Infrequent, difficult, or incomplete passage of hard, dry stool

Constipation is characterized by infrequent bowel movements (less than 3 per week), hard or dry stool, straining, and a feeling of incomplete evacuation.

Question 13: Which of the following BEST prevents constipation in residents?

Restricting fluid intake to reduce stool bulk
Encouraging adequate fluid intake, dietary fiber, and regular ambulation (Correct answer)
Administering a laxative daily
Keeping the resident on bedrest

Correct answer: Encouraging adequate fluid intake, dietary fiber, and regular ambulation

Adequate hydration, dietary fiber (whole grains, fruits, vegetables), and physical activity (ambulation) stimulate bowel motility and soften stool, reducing constipation risk.

Question 14: Diarrhea in a resident can be dangerous because it:

Increases potassium levels in the blood
Causes dehydration and electrolyte imbalances (Correct answer)
Only affects nutritional status
Is always caused by poor hand hygiene by staff

Correct answer: Causes dehydration and electrolyte imbalances

Diarrhea causes rapid fluid and electrolyte loss, leading to dehydration, hyponatremia, hypokalemia, and acid-base imbalances, which can be life-threatening in elderly residents.

Question 15: A resident has had 5 episodes of liquid stool in 4 hours. What should the CNA do?

Offer the resident a snack and increase fluid intake
Report immediately to the nurse and continue monitoring (Correct answer)
Apply a diaper and check at the next scheduled care time
Wait to report until the end of the shift

Correct answer: Report immediately to the nurse and continue monitoring

Frequent liquid stools can cause rapid dehydration and may indicate infection (including C. difficile). Immediate reporting allows the nurse to assess, implement interventions, and consider isolation if needed.

Question 16: Fecal impaction is BEST described as:

Frequent, watery stools
A hard mass of stool stuck in the rectum that cannot be expelled normally (Correct answer)
Blood in the stool
A rectal hernia

Correct answer: A hard mass of stool stuck in the rectum that cannot be expelled normally

Fecal impaction is an accumulation of hardened stool in the rectum that cannot be evacuated normally. It can cause extreme discomfort, bowel obstruction, and paradoxical liquid stool leaking around the impaction.

Question 17: A sign of fecal impaction that a CNA might observe is:

Formed, soft brown stools every day
Liquid stool oozing around a hard stool mass in the rectum (Correct answer)
Increased appetite
Absent bowel sounds

Correct answer: Liquid stool oozing around a hard stool mass in the rectum

Liquid stool seeping around an impacted mass (overflow incontinence), combined with no normal bowel movement for days and complaints of rectal pressure, are key signs of fecal impaction.

Question 18: When assisting a resident with a bedpan, the CNA should:

Leave the resident alone with the call light for privacy
Raise the head of the bed to a semi-sitting position if medically allowed, for comfort and effectiveness (Correct answer)
Always keep the bed flat to prevent falls
Ask the resident to hold it in until the commode is available

Correct answer: Raise the head of the bed to a semi-sitting position if medically allowed, for comfort and effectiveness

Elevating the head of the bed to a semi-sitting position (30–45 degrees or more if allowed) uses gravity to assist defecation and is more physiologically natural, increasing comfort and effectiveness.

Question 19: What should the CNA document regarding a resident's bowel movement?

Only the time
Time, frequency, amount, color, consistency, and any abnormalities (Correct answer)
Amount only in milliliters
Nothing — bowel movements are not routinely documented

Correct answer: Time, frequency, amount, color, consistency, and any abnormalities

Bowel movement documentation must include time, frequency, amount (small/moderate/large), color, consistency (formed, loose, liquid), and any unusual characteristics such as blood, mucus, or odor.

Question 20: Bright red blood in the stool most likely indicates bleeding:

From the stomach
From the upper small intestine
From the lower colon or rectum (Correct answer)
From the liver

Correct answer: From the lower colon or rectum

Bright red blood in the stool (hematochezia) indicates fresh bleeding from the lower colon or rectum, such as hemorrhoids, rectal tears, or colorectal lesions. It must always be reported immediately.

Question 21: Black, tarry stools (melena) indicate:

Normal iron supplement effect
Bleeding in the upper gastrointestinal tract (stomach or upper intestine) (Correct answer)
Eating large amounts of spinach only
A benign variation in stool color

Correct answer: Bleeding in the upper gastrointestinal tract (stomach or upper intestine)

Melena (black, tarry stool) is caused by digested blood from upper GI bleeding (stomach, esophagus, or duodenum). It has a characteristic foul odor and is a medical emergency requiring immediate reporting.

Question 22: Which of the following is MOST appropriate when a resident has an ostomy?

Avoid discussing the ostomy with the resident to prevent embarrassment
Provide emotional support and maintain the resident's dignity during ostomy care (Correct answer)
Perform ostomy care only when the resident is asleep to avoid embarrassment
Ignore complaints about odor, as it is expected with an ostomy

Correct answer: Provide emotional support and maintain the resident's dignity during ostomy care

Ostomy care has a significant emotional and psychological impact. CNAs should perform care matter-of-factly, provide privacy, and offer emotional support while maintaining the resident's dignity.

Question 23: How should a CNA dispose of ostomy pouch contents?

In a regular waste bin without precautions
Empty contents into the toilet, rinse the pouch if reusable, and dispose of disposable pouches in a lined trash container (Correct answer)
Pour directly down the hallway sink
Seal the full pouch in a biohazard bag only

Correct answer: Empty contents into the toilet, rinse the pouch if reusable, and dispose of disposable pouches in a lined trash container

Pouch contents (stool/effluent) should be emptied into the toilet. Disposable pouches are wrapped and discarded in a lined trash container per facility policy. Follow standard precautions throughout.

Question 24: Which factor can INCREASE the risk of bowel incontinence?

Regular physical exercise
High dietary fiber intake
Cognitive impairment or dementia (Correct answer)
Maintaining a regular toileting schedule

Correct answer: Cognitive impairment or dementia

Cognitive impairment (dementia) reduces awareness of the need to defecate and the ability to initiate independent toileting, significantly increasing the risk of bowel incontinence.

Question 25: A resident with a new colostomy tells the CNA they feel disgusted and do not want to look at the stoma. The BEST response is:

"You will get used to it — just look at it now."
"I understand, and I will always handle your care with privacy and respect." (Correct answer)
"This is a normal part of life — you shouldn't feel that way."
"Ask the doctor to reverse the colostomy if you feel that way."

Correct answer: "I understand, and I will always handle your care with privacy and respect."

Acknowledging the resident's feelings without dismissing or minimizing them, and reassuring them of respectful, private care, is the therapeutic and person-centered response.

Question 26: After applying a new ostomy wafer, the CNA should hold it firmly against the skin for 1–2 minutes because:

It prevents the stoma from prolapsing
Body heat and pressure activate the adhesive for a better seal (Correct answer)
It allows the barrier to dry completely
It prevents the resident from feeling pain

Correct answer: Body heat and pressure activate the adhesive for a better seal

Applying firm pressure with a warm hand for 1–2 minutes activates the skin barrier adhesive, creates a better seal against effluent, and reduces leakage.

Question 27: Which ostomy typically produces the most formed (solid) stool?

Ileostomy
Ascending colostomy
Transverse colostomy
Sigmoid colostomy (Correct answer)

Correct answer: Sigmoid colostomy

A sigmoid colostomy is located in the lower left colon, where most water has been reabsorbed from the stool, resulting in the most formed, solid fecal output. Ileostomy output is the most liquid.

Question 28: A resident with an ileostomy is at risk for:

Hyperkalemia (too much potassium)
Dehydration and electrolyte imbalances due to liquid output (Correct answer)
Chronic constipation
Formed stool that is easy to manage

Correct answer: Dehydration and electrolyte imbalances due to liquid output

Ileostomy output is liquid and high volume, with significant electrolyte content. Residents are at risk for dehydration, hyponatremia, and hypokalemia if fluid intake is inadequate.

Question 29: What does it mean if a stoma prolapses?

The stoma shrinks below abdominal skin level
The bowel telescopes or protrudes out through the stoma, extending farther than normal (Correct answer)
The stoma site becomes infected
The stoma output stops completely

Correct answer: The bowel telescopes or protrudes out through the stoma, extending farther than normal

Stoma prolapse occurs when the bowel protrudes excessively through the stomal opening, extending abnormally. It should be reported to the nurse immediately as it may compromise circulation.

Question 30: What does stoma retraction mean?

The stoma protrudes excessively
The stoma recedes below skin level, making pouching difficult and increasing leak risk (Correct answer)
The stoma output increases significantly
The stoma skin becomes bright red

Correct answer: The stoma recedes below skin level, making pouching difficult and increasing leak risk

Stoma retraction is when the stoma sinks below skin level, making it very difficult to achieve a proper pouch seal and greatly increasing the risk of effluent contacting the peristomal skin.

Question 31: Which of the following is a normal finding when caring for a stoma?

Black, dry, hard stoma tissue
Slight redness or minor bleeding when the stoma is gently wiped during cleaning (Correct answer)
Purple discoloration extending 2 cm around the stoma
Stoma that is completely flat with the abdomen

Correct answer: Slight redness or minor bleeding when the stoma is gently wiped during cleaning

Minor surface redness and slight bleeding when gently wiped during cleaning are normal due to the stoma's rich mucosal blood supply. Heavy or continuous bleeding is not normal.

Question 32: What is the BEST way to control ostomy odor?

Leave the pouch open to air out
Use a well-fitting, closed pouching system and empty regularly (Correct answer)
Apply cologne or perfume around the stoma
Increase the resident's dairy intake

Correct answer: Use a well-fitting, closed pouching system and empty regularly

A properly fitting closed pouching system and regular emptying are the most effective odor control methods. Deodorant drops or pouches with built-in charcoal filters are also used per facility policy.

Question 33: Before performing ostomy care, the CNA should:

Read the care plan, gather all supplies, explain the procedure to the resident, and provide privacy (Correct answer)
Perform the procedure without explanation to avoid causing the resident distress
Gather supplies after starting the procedure
Ask another CNA to complete ostomy care to avoid discomfort

Correct answer: Read the care plan, gather all supplies, explain the procedure to the resident, and provide privacy

Before any procedure, review the care plan, gather all needed supplies, explain what you will do to the resident, and ensure privacy. This promotes dignity, safety, and cooperation.

CNA Bowel and Ostomy Care 1

What is a colostomy?

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