NCWO Ostomy Management 2 — Questions and Answers
Question 1: Pre-operative stoma site marking is performed by the WOC nurse to:
- Determine the type of surgical procedure needed
- Identify an optimal site avoiding bony prominences, skin folds, scars, and the belt line (Correct answer)
- Select the brand of pouching system postoperatively
- Document baseline abdominal assessment
Correct answer: Identify an optimal site avoiding bony prominences, skin folds, scars, and the belt line
Optimal stoma site marking identifies a flat, visible location away from bony prominences, skin creases, scars, and waistbands to ensure a good pouching seal and patient self-care ability.
Question 2: A urostomy (ileal conduit) patient is at increased risk for which long-term complication?
- Constipation and bowel obstruction
- Urinary tract infections and ureteral strictures (Correct answer)
- Severe dehydration from liquid output
- Vitamin B12 deficiency exclusively
Correct answer: Urinary tract infections and ureteral strictures
Urostomy patients are at ongoing risk for ascending urinary tract infections and ureteral stricture at the conduit anastomosis due to urinary reflux and altered anatomy.
Question 3: The recommended frequency for routine pouch change in a stable ostomy patient is:
- Daily to prevent any odor
- Every 3–7 days based on pouching system manufacturer guidelines (Correct answer)
- Only when the pouch leaks
- Every 12 hours to assess stoma health
Correct answer: Every 3–7 days based on pouching system manufacturer guidelines
Most ostomy pouching systems are designed for 3–7 days of wear, and changing within this window maintains peristomal skin integrity and prevents premature adhesive failure.
Question 4: Parastomal hernia management includes all of the following EXCEPT:
- Wearing a supportive hernia belt or ostomy support garment
- Avoiding heavy lifting and straining
- Using a convex pouching system to improve seal
- Immediate surgical repair in all asymptomatic cases (Correct answer)
Correct answer: Immediate surgical repair in all asymptomatic cases
Asymptomatic parastomal hernias are managed conservatively with support garments and activity modification; surgical repair is reserved for symptomatic, complicated, or enlarging hernias.
Question 5: Convex pouching systems are indicated for patients with:
- Prominent, budded stomas with minimal peristomal skin folds
- Retracted or flush stomas and peristomal skin folds causing leakage (Correct answer)
- High-output ileostomies requiring extra capacity
- Patients with extremely large stoma diameter
Correct answer: Retracted or flush stomas and peristomal skin folds causing leakage
Convexity presses inward on the peristomal skin to push a retracted or flush stoma outward, improving the seal and reducing leakage in patients with folds or depressions.
Question 6: Which dietary recommendation is most important for a new ileostomy patient to prevent dehydration?
- Restrict fluid intake to reduce high-output ileostomy
- Increase fluid and electrolyte intake, especially sodium, to compensate for output losses (Correct answer)
- Follow a high-fiber diet to add bulk to the output
- Avoid all dairy products indefinitely
Correct answer: Increase fluid and electrolyte intake, especially sodium, to compensate for output losses
Ileostomy patients lose large volumes of fluid and sodium-rich output, making increased fluid and electrolyte intake—especially sodium and potassium—essential to prevent dehydration.
NCWO Ostomy Management 2
Pre-operative stoma site marking is performed by the WOC nurse to: