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WOCNCB® Exams: The Multiple Choice Testing Method – Focus on Ostomy

Thompson, Donna L.; Richbourg, Leanne

Journal of Wound, Ostomy and Continence Nursing: July/August 2012 - Volume 39 - Issue 4 - p 440–442
doi: 10.1097/WON.0b013e31825d34ad

Donna L. Thompson, MSN, CRNP, FNP-BC, CCCN, Continence Specialist/Nurse Practitioner, Urology Health Specialists, LLC, Drexel Hill, Pennsylvania.

Leanne Richbourg, MSN, APRN-BC, CWON-AP, GCNS-BC, Wound and Ostomy Clinical Nurse Specialist, Duke University Hospital, Durham, North Carolina.

Correspondence: Donna L. Thompson, MSN, CRNP, FNP-BC, CCCN, WOCNCB Office, 555 East Wells St, 1100, Milwaukee, WI 53202 (

The authors declare no conflict of interest.

To be successful on the WOCNCB certification examinations, the test taker needs to have a basic mastery of WOC specialty nursing practice and the ability to apply basic test-taking skills. Unfortunately, some candidates have lost many of those test-taking skills used when in nursing schools.

Testing at the specialty nursing level uses multiple-choice questions. Multiple-choice testing in and of itself does enhance learning the material but can have a detrimental effect because incorrect options in a multiple-choice question can cause the learner to remember false rather than correct data.

One study looked at a strategy to improve the positive effects and reduce the negative effects of taking multiple-choice tests1 by giving the test taker the feedback about the correct and incorrect choices. By understanding why a choice was incorrect, the test taker will remember more correct information. Thus, by practicing certification testing, you can enhance your learning.

In every issue of this journal is a section devoted to preparing for WOCNCB certification examinations. Each article includes a sampling of questions from the examination content outline. The questions are carefully chosen to help you practice, and feedback about correct and incorrect answers is included to help enhance your learning. When working through the questions in this issue, cover the answers and see how you do. Then read through the rationales for each question and use the feedback to boost your learning.

In the next columns of Getting Ready for Certification, we will offer strategies related to either study or test taking.


1. Butler AC, Roediger HL III. Feedback enhances the positive effects and reduces the negative effects of multiple-choice testing. Memory Cogn. 2008;36(3):604–617.

Sample Questions

  1. Which type of stoma is MOST likely to develop a prolapse?
    1. End colostomy
    2. Loop colostomy
    3. End ileal conduit
    4. Loop ileostomy
  2. A patient presents to the ostomy clinic with complaints of shortness of breath during exercise and general fatigue. Medical and surgical history includes a diagnosis of Crohn disease and a resection of the terminal ileum 3 years ago. Current vitals signs include pulse 80 beats per minute, blood pressure 120/60 mmHg, and temperature 98.6°F. The patient is not currently taking any medications.
  3. The MOST LIKELY cause for these symptoms is
    1. Vitamin B12 deficiency
    2. Chronic dehydration
    3. Crohn disease flare
    4. Upper respiratory infection
  4. A patient has been given the choice by his urologist of an ileal conduit, a continent urostomy, or an orthotopic neobladder as treatment for his bladder cancer. When providing preoperative counseling, which of the following factors is MOST important for the ostomy nurse to consider?:
    1. The patient's preferences
    2. The patient's gender
    3. The patient's body weight
    4. The patient's finances

Question 1 Answer: B. This recall question is designed to measure the ability to recall or recognize specific information. A prolapse is a telescoping of the bowel through the stoma. While prolapsing of end ileostomy, ileal conduit, or loop ileostomy stomas is possible, this complication most commonly occurs in loop colostomies, especially those involving the transverse segment. A review of the literature by Shabbir and Britton1 found that the incidence of prolapse in transverse loop colostomies was 7% to 25%, for end colostomies it was 12%, and for loop ileostomies it was 11%. Cheung2 reported the prolapse rate for end sigmoid colostomies and ileal conduits to be 4%.


1. Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal Dis. 2010;12:958–964.

2. Cheung MT. Complications of an abdominal stoma: an analysis of 322 stomas. Aust N Z J Surg. 1995;65:808–811. As quoted by Colwell JC. Stomal and peristomal complications. In: Colwell J, Goldberg M, Carmel J, eds. Fecal and Urinary Diversions Management Principles. St Louis, MO: Mosby; 2004:310.

3. Colwell JC. Stomal and peristomal complications. In: Colwell J, Goldberg M, Carmel J, eds. Fecal and Urinary Diversions Management Principles. St Louis, MO: Mosby; 2004:310–311.

4. Wound Ostomy Continence Nurses Society. Stoma Complications: Best Practice for Clinicians. Mt Laurel, NJ: Wound Ostomy Continence Nurses Society; 2005:5.

5. Wound Ostomy Continence Nurses Society. Management of the Patient With a Fecal Ostomy: Best Practice Guideline for Clinicians. Mt Laurel, NJ: Wound Ostomy Continence Nurses Society; 2010:20.

Content outline location: A-2-d

Cognitive Level: Recall

Question 2 Answer: A. An analysis question requires the ability to identify, analyze, and synthesize information, determine solutions, or evaluate the usefulness of a solution. The best answer to this question is Vitamin B12 deficiency. This vitamin is absorbed only from the terminal ileum, which this patient has had removed. Liver stores of vitamin B12 last up to 2 years. Since this patient is 3 years postoperation, this vitamin store will be depleted. Common signs of vitamin B12 deficiency (pernicious anemia) are fatigue and shortness of breath. Chronic dehydration is not a good option because patients who are dehydrated may have fatigue but will also have tachycardia and low blood pressure. Patients with an ileostomy can have a Crohn disease flare, but the symptoms listed in the stem do not support this diagnosis. The symptoms of a flare include abdominal cramping, fever, and weight loss. Patients with an ileostomy in the postoperative period are at risk for URI due to the stress of surgery, but symptoms listed in the stem do not lead us to that conclusion.


A.D.A.M. Medical Encyclopedia. Pernicious anemia. PubMed Health. 2010. Accessed February 29, 2012.

Gray M. Anatomy and physiology of the urinary system. In: Colwell J, Goldberg M, Carmel J, eds. Fecal and Urinary Diversions Management Principles. St Louis, MO: Mosby; 2004:181.

Crentsil V, Hanauer SB. Inflammatory bowel disease: medical management. In: Colwell J, Goldberg M, Carmel J, eds. Fecal and Urinary Diversions Management Principles. St Louis, MO: Mosby; 2004:67.

MedlinePlus. Common cold. U. S. National Library of Medicine/National Institutes of Health. 2012. Accessed February 29, 2012.

Content Outline Location: C-2-f—Fecal and urinary diversions: ileostomy: teach patient about changes in absorption following ileostomy.

Cognitive Level: Analysis

Question 3 Answer: A. This question requires the ability to comprehend, relate, or apply physiological/psychological facts and educational principles to new or changing situations. Questioning the patient about his or her own preferences is an essential aspect of preoperative education. It will assist the WOC nurse in determining the patients' expectations of what is perceived as ideal or possible after surgery, factors that affect a patient's postoperative health-related quality of life. Patients' beliefs about the impact surgery will have on their lives impacts their psychological health. Improved surgical techniques that preserve the bladder neck and the entire urethra in women and the membranous distal urethra in men allow all 3 urinary diversion options to be available to persons of either gender, depending on the extent of their disease process. Body weight and finances are lesser but still important considerations. The neobladder can be advantageous for the obese patient since the thickness of the abdominal wall can make creation and management of a stoma challenging. Distress about obtaining supplies is associated with poorer psychosocial adjustment to an incontinent ostomy.


Gray M, Beitz J. Counseling patients undergoing urinary diversion. J Wound Ostomy Continence Nurs. 2005;32(1):7–15.

Haugen V, Bliss DZ, Savik K. Perioperative factors that affect long-term adjustment to an incontinent ostomy. J Wound Ostomy Continence Nurs. 2006;33(5):525–535.

Tomaselli N, McGinnis DE. Urinary diversions: surgical interventions. In: Colwell J, Goldberg M, Carmel J, eds. Fecal and Urinary Diversions Management Principles. St Louis, MO: Mosby; 2004:184–203.

White CA. Ostomy adjustment. In: Colwell J, Goldberg M, Carmel J, eds. Fecal and Urinary Diversions Management Principles. St Louis, MO: Mosby; 2004:327.

Content Outline Location: B-4

Cognitive Level: Application

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The Quest for Knowledge—A Lifelong Journey

Diana L. Gallagher, MS, RN, CWOCN, CFCN

In many African cultures, lifelong learning refers to an individual's continuous acquisition of knowledge and skills and the ability to pass those knowledge and skills on to others. The ability to share this learning from one person to another is critical; it keeps the learning cycle in motion and extends it on to future generations.

This concept is transcultural and one that WOCNCB-certified nurses have always embraced. The process of certification and recertification prompts nurses interested in earning and maintaining wound, ostomy, continence, or foot care practices to expand their didactic and clinical skills.

While the process of certification and recertification provides an external structure to drive ongoing learning, WOCNCB-certified nurses are driven by an internal quest for knowledge. The idea that specialty nurses would not continue to build their knowledge and expertise is unthinkable. We learn from every journal read, in-service attended, course taken, lectures prepared, research reviewed, and conducted and from every patient encountered. Learning is ubiquitous. Every experience is another opportunity to learn.

When nurses reach their goal of becoming specialty nurses, they may begin with basic or advanced preparation. From that point, they continue to learn and advance within the role. Some will continue their formal education and move to the next level; others may choose to grow within the specialties with informal learning. However, knowledge is gained; there is so much these individuals can contribute because of lifelong learning.


WOC advanced practice certification exam for eligible NP and CNS nurses.

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