Examination: Bowel Diversion & Patient
Care (Miguel Flores) Practice Exam
Questions And Correct Answers (Verified
Answers) Plus Rationales
Section 1: Fundamentals & Indications (Questions 1-15)
1. A nurse is reviewing the medical record of Miguel Flores. Which diagnosis most commonly
necessitates a permanent end colostomy?
a) Crohn’s disease affecting the ileum
b) Ulcerative colitis refractory to medication
c) Abdominal perineal resection for rectal cancer
d) Diverticulitis with abscess formation
Correct Answer: c) Abdominal perineal resection for rectal cancer
Rationale: An abdominal perineal resection (APR) involves removal of the rectum and anus, resulting in
a permanent end colostomy. While UC and Crohn’s may require ostomies, they are often temporary or
involve ileostomies. Diverticulitis usually results in a temporary colostomy.
2. Miguel asks the nurse why his colostomy output is thick and formed, whereas his neighbor’s
ileostomy output is liquid. What is the correct physiological rationale?
a) The small intestine has a shorter transit time but more water absorption.
b) The colon reabsorbs water and electrolytes, forming solid stool.
c) Ileostomies are always located higher in the GI tract, preventing enzymatic breakdown.
d) Miguel is eating more fiber than his neighbor.
Correct Answer: b) The colon reabsorbs water and electrolytes, forming solid stool.
Rationale: The primary function of the colon is water absorption. A colostomy (large bowel) produces
semi-formed to formed stool. An ileostomy (small bowel) produces continuous liquid/porridge-like
output because the colon is not present to absorb water.
,3. Which laboratory value is most critical to monitor in a patient with a new ileostomy (like Miguel if
he had an ileostomy) during the first 48 hours post-op?
a) Hemoglobin
b) White blood cell count
c) Urine specific gravity
d) Serum potassium
Correct Answer: d) Serum potassium
Rationale: High-volume liquid output from an ileostomy leads to significant loss of water, sodium, and
potassium. Hypokalemia is a life-threatening risk due to the loss of electrolytes in the effluent.
4. During morning assessment, the nurse notes Miguel’s stoma is dark purple and dry. What is the
priority nursing action?
a) Apply a barrier paste to the stoma.
b) Notify the surgeon immediately.
c) Increase the frequency of pouch changes.
d) Measure the abdominal girth.
Correct Answer: b) Notify the surgeon immediately.
Rationale: A dark purple/blue or black stoma indicates ischemia or necrosis due to compromised blood
supply. This is a surgical emergency requiring immediate intervention.
5. Miguel reports that his stoma has decreased in size from 3 cm to 2.5 cm over the last 3 weeks. How
should the nurse respond?
a) “This is a sign of infection; we need to start antibiotics.”
b) “This is normal as post-operative edema subsides.”
c) “We need to refer you to a wound care specialist immediately.”
d) “You should increase your fluid intake to plump up the stoma.”
Correct Answer: b) “This is normal as post-operative edema subsides.”
Rationale: Stomas shrink significantly during the first 6-8 weeks post-op as surgical swelling decreases.
The patient must be taught to measure the stoma regularly to ensure the wafer is cut to the correct size
to prevent skin breakdown.
6. Select All That Apply (SATA): The nurse is preparing Miguel for discharge. Which findings indicate
the patient is ready for self-care?
, a) Miguel demonstrates cutting the wafer to the correct size using a tracing mechanism.
b) Miguel states he will only change the pouch when it leaks to save money.
c) Miguel verbalizes the difference between signs of skin irritation versus allergic reaction.
d) Miguel’s spouse states, “I refuse to look at it or help.”
e) Miguel empties the pouch when it is one-third to one-half full.
Correct Answers: a, c, e
Rationale:
a: Correct cutting prevents peristomal skin breakdown.
c: Understanding skin complications is vital.
e: Emptying when 1/3 to 1/2 full prevents leakage due to weight and seal breakdown.
b: Waiting for leaks causes skin damage and is not cost-effective.
d: Lack of family support does not indicate readiness; however, this answer is incorrect because
the question asks for findings indicating readiness. This indicates a barrier to discharge.
7. Miguel has a sigmoid colostomy. What is the expected consistency of his stool?
a) Liquid
b) Semi-liquid
c) Semi-formed to formed
d) Pelleted
Correct Answer: c) Semi-formed to formed
Rationale: The sigmoid colon is the final segment of the large intestine. Output here is typically semi-
formed to formed because most water has been absorbed.
8. A nurse is teaching Miguel about dietary management. Which food is most likely to cause a
blockage in an ileostomy?
a) Applesauce
b) White bread
c) Raw celery
d) Yogurt
Correct Answer: c) Raw celery
Rationale: High-fiber foods, raw vegetables, nuts, and seeds can cause a bolus obstruction (blockage) in
Care (Miguel Flores) Practice Exam
Questions And Correct Answers (Verified
Answers) Plus Rationales
Section 1: Fundamentals & Indications (Questions 1-15)
1. A nurse is reviewing the medical record of Miguel Flores. Which diagnosis most commonly
necessitates a permanent end colostomy?
a) Crohn’s disease affecting the ileum
b) Ulcerative colitis refractory to medication
c) Abdominal perineal resection for rectal cancer
d) Diverticulitis with abscess formation
Correct Answer: c) Abdominal perineal resection for rectal cancer
Rationale: An abdominal perineal resection (APR) involves removal of the rectum and anus, resulting in
a permanent end colostomy. While UC and Crohn’s may require ostomies, they are often temporary or
involve ileostomies. Diverticulitis usually results in a temporary colostomy.
2. Miguel asks the nurse why his colostomy output is thick and formed, whereas his neighbor’s
ileostomy output is liquid. What is the correct physiological rationale?
a) The small intestine has a shorter transit time but more water absorption.
b) The colon reabsorbs water and electrolytes, forming solid stool.
c) Ileostomies are always located higher in the GI tract, preventing enzymatic breakdown.
d) Miguel is eating more fiber than his neighbor.
Correct Answer: b) The colon reabsorbs water and electrolytes, forming solid stool.
Rationale: The primary function of the colon is water absorption. A colostomy (large bowel) produces
semi-formed to formed stool. An ileostomy (small bowel) produces continuous liquid/porridge-like
output because the colon is not present to absorb water.
,3. Which laboratory value is most critical to monitor in a patient with a new ileostomy (like Miguel if
he had an ileostomy) during the first 48 hours post-op?
a) Hemoglobin
b) White blood cell count
c) Urine specific gravity
d) Serum potassium
Correct Answer: d) Serum potassium
Rationale: High-volume liquid output from an ileostomy leads to significant loss of water, sodium, and
potassium. Hypokalemia is a life-threatening risk due to the loss of electrolytes in the effluent.
4. During morning assessment, the nurse notes Miguel’s stoma is dark purple and dry. What is the
priority nursing action?
a) Apply a barrier paste to the stoma.
b) Notify the surgeon immediately.
c) Increase the frequency of pouch changes.
d) Measure the abdominal girth.
Correct Answer: b) Notify the surgeon immediately.
Rationale: A dark purple/blue or black stoma indicates ischemia or necrosis due to compromised blood
supply. This is a surgical emergency requiring immediate intervention.
5. Miguel reports that his stoma has decreased in size from 3 cm to 2.5 cm over the last 3 weeks. How
should the nurse respond?
a) “This is a sign of infection; we need to start antibiotics.”
b) “This is normal as post-operative edema subsides.”
c) “We need to refer you to a wound care specialist immediately.”
d) “You should increase your fluid intake to plump up the stoma.”
Correct Answer: b) “This is normal as post-operative edema subsides.”
Rationale: Stomas shrink significantly during the first 6-8 weeks post-op as surgical swelling decreases.
The patient must be taught to measure the stoma regularly to ensure the wafer is cut to the correct size
to prevent skin breakdown.
6. Select All That Apply (SATA): The nurse is preparing Miguel for discharge. Which findings indicate
the patient is ready for self-care?
, a) Miguel demonstrates cutting the wafer to the correct size using a tracing mechanism.
b) Miguel states he will only change the pouch when it leaks to save money.
c) Miguel verbalizes the difference between signs of skin irritation versus allergic reaction.
d) Miguel’s spouse states, “I refuse to look at it or help.”
e) Miguel empties the pouch when it is one-third to one-half full.
Correct Answers: a, c, e
Rationale:
a: Correct cutting prevents peristomal skin breakdown.
c: Understanding skin complications is vital.
e: Emptying when 1/3 to 1/2 full prevents leakage due to weight and seal breakdown.
b: Waiting for leaks causes skin damage and is not cost-effective.
d: Lack of family support does not indicate readiness; however, this answer is incorrect because
the question asks for findings indicating readiness. This indicates a barrier to discharge.
7. Miguel has a sigmoid colostomy. What is the expected consistency of his stool?
a) Liquid
b) Semi-liquid
c) Semi-formed to formed
d) Pelleted
Correct Answer: c) Semi-formed to formed
Rationale: The sigmoid colon is the final segment of the large intestine. Output here is typically semi-
formed to formed because most water has been absorbed.
8. A nurse is teaching Miguel about dietary management. Which food is most likely to cause a
blockage in an ileostomy?
a) Applesauce
b) White bread
c) Raw celery
d) Yogurt
Correct Answer: c) Raw celery
Rationale: High-fiber foods, raw vegetables, nuts, and seeds can cause a bolus obstruction (blockage) in
