NCLEX-RNBasic Care and ComfortHard
A nurse is preparing to apply a new skin barrier wafer for a client with a fresh colostomy. The stoma measures 3.2 cm in diameter. Using standard ostomy sizing guides, the nurse should cut the wafer opening to which size?
- A2.8 cm, slightly smaller than the stoma to create a tight seal
- BExactly 3.2 cm, matching the stoma diameter precisely
- C5.0 cm, to allow for stoma swelling over the following weeks
- DApproximately 3.5 cm, about 1/8 inch (0.3 cm) larger than the stoma
Show answer & explanationAnswer & explanation
Correct answer: D. Approximately 3.5 cm, about 1/8 inch (0.3 cm) larger than the stoma
The wafer opening should be cut about 1/8 inch (approximately 0.3 cm) larger than the stoma to prevent the appliance from cutting into or constricting the stoma while minimizing skin exposure to stool: 3.2 cm + 0.3 cm ≈ 3.5 cm.
Why the other options are wrong
- A. A smaller opening will strangulate the stoma, cutting off blood flow.
- B. An exact match risks constricting the stoma as it naturally moves and can cause trauma.
- C. 5.0 cm is far too large and exposes excessive skin to stool, causing breakdown.
Ostomy Wafer Sizing
Proper measurement technique for cutting a skin barrier opening to fit a stoma without constricting it or exposing excess peristomal skin.
- Cut opening about 1/8 inch (0.3 cm) larger than the stoma
- Re-measure stoma regularly, especially in the first weeks postoperatively due to swelling changes
- Opening too tight causes ischemia; too large causes skin breakdown from stool exposure
Memory trick: An eighth of an inch bigger keeps the stoma from getting stiffer.