Christ the King College

College of Nursing and IHAP Department

PRELIM EXAMINATION
NCM 103: METABOLISM AND ENDOCRINE

NAME: ________________________________________________DATE: _______________

YEAR/COURSE: _____________________________ SCORE: _______________

I.MULTIPLE CHOICE. Select the best answer by encircling the letter of your choice.

1. The middle layer of digestive system 6. Which of the following nursing

which is responsible for segmental interventions should the nurse perform
contractions. for a female client receiving enteral
a. Inner epithelial layer feedings through a gastrostomy tube?
b. Serous layer a. Maintain the client on bed rest
c. Sub mucosa during feedings.
d. Mascular layer b. Check the gastrostomy tube
position every 2 days.
2. The result of the evagination of large c. Maintain the head of the bed at 15
intestine: degree elevation continuously
a. Appendix d. Change the tube feeding solution
b. Cecum and tubing at least every 24 hours
c. Columnar epithelium
d. Peritoneum 7. While a female client is being prepared
for discharge, the nasogastric tube
3. Drumlike sound produced by feeding becomes clogged. To remedy
percussing the air filled stomach. this problem and teach client’s family
a. Hyperrosance how to deal with it at home, what
b. Tympany should the nurse do?
c. Resonance a. Irrigate the tube with cola
d. Dull sound b. Advance the tube into the intestine
c. Apply intermittent suction to the
4. During preparation for bowel surgery, tube
a male client receives an antibiotic to d. Withdraw the obstruction with a 30
reduce intestinal bacteria. Antibiotic ml syringe
therapy may interfere with synthesis of
which vitamin and may lead to 8. Mandy an adolescent girl is admitted
hypoprothrombinemia? to an acute care facility with severe
a. Vitamin A malnutrition. After a thorough
b. Vitamin D examination, the physician diagnose
c. Vitamin E anorexia nervosa. When developing
d. Vitamin K plan of care for this client, the nurse is
most likely to include which nursing
5. A male client with a recent history of diagnosis?
rectal bleeding is being prepared for a a. Hopelessness
colonoscopy. How should the nurse b. Chronic low self esteem
position the client for this test initially? c. Powerlessness
a. Lying on the left side with knees d. Deficient Knowledge
bent
b. Lying on the right side with legs 9. Which diagnostic test would be used
straight first to evaluate a client with upper GI
c. Prone with the torso elevated bleeding?
d. Bent over with hands touching the a. Barium Swallow
floor b. Arteriography
c. Hemoglobin and hematocrit
d. Endoscopy
10. To prevent gastroesophageal reflux in 15. A male client has undergone a colon
a male client with hiatal hernia, the resection. While turning him, wound
nurse should provide which discharge dehiscence with evisceration occurs.
instruction? The nurse’s first response is to:
a. Limit fluid intake with meals a. Call the physician
b. Take antacids with meals b. Pull the dehiscence closed
c. Lie down after meals to promote c. Take BP and pulse
digestion d. Place saline soaked sterile dressings
d. Avoid coffee and alcoholic on the wound
beverages
16. A male client is recovering from
11. A female client with dysphagia is being ileostomy. This is the opening in the
prepared for discharge. Which belly brought through to form a stoma.
outcome indicates that the client is During discharge teaching, the nurse
ready for discharge. should stress the importance of:
a. The client is free from esophagitis a. Increase fluid intake to prevent
and achalasia dehydration
b. The client doesn’t exhibit rectal b. Wearing an appliance pouch only at
tenesmus bedtime
c. The client diminished duodenal c. Consuming a low protein, high fiber
inflammation diet
d. The client has normal gastric d. Taking only enteric coated
structures medications

12. A male client undergoes total 17. The nurse is caring for a female client
gastrectomy. Several hours after with active upper GI bleeding. What is
surgery, the nurse note that the the appropriate diet for this client
client’s nasogastric tube has stopped during the first 24 hours after
draining. How should the nurse admission?
respond? a. Regular diet
a. Reposition the tube b. Nothing by mouth
b. Notify the physician c. Skim milk
c. Irrigate the tube d. Clear liquids
d. Increase the suction level
18. The alimentary canal is a continuous,
13. Nurse Lyka is teaching a group of colied, hollow muscular tube that
middle-aged men about peptic ulcers. winds through ventral cavity and is
When discussing risk factors for peptic open at both ends. Its solid organs
ulcer, the nurse should mention: include all of the following except;
a. Sedentary lifestyle and smoking a. Liver
b. History of hemorrhoids and b. Gall bladder
smoking c. Pancreas
c. Alcohol abuse and history of acute d. Stomach
renal failure
d. Alcohol abuse and smoking 19. Nurse Lia is going to perform an
abdominal examination to Mr. Lim who
14. While palpating a female client’s right was admitted due to on and off pain
upper quadrant (RUQ), the nurse since yesterday. How will you position
would expect to find which of the Mr. Lim prior to procedure.
following structures? a. Supine with knees flexed
a. Liver b. Prone
b. Sigmoid colon c. Lying on back
c. Appendix d. Sims
d. Spleen
20. To identify any localized bulging, 27. Nurse Trishia is the staff nurse assigned
distention and peristaltic waves, Nurse at the Emergency Department. During
Mia must perform which of the her shift, a patient was rushed
following? complaining of severe heartburn,
a. Ausculattion vomiting and pain that radiates to the
b. Palpation flank. The doctor suspects gastric ulcer.
c. Percussion What other symptoms will validate the
d. Inspection diagnosis of gastric ulcer.
a. Right epigastric pain
21. In order to identify areas of tenderness b. Pain occurs an hour after meal
and swelling, Nurse Mia must do: c. Pain not relieved by vomiting
a. Light palpation d. Pain occurs when stomach is empty
b. Deep palpation
c. Percussion 28. What diagnostic test would yield good
d. Palpation visualization of the ulcer crater?
a. Histology
22. Mr. Lim verbalized pain on the right b. Barium swallow
iliac region. Nurse Chona knows the c. Gastroscopy
organ affected would be the: d. Endoscopy
a. Liver
b. Appendix 29. Peptic ulcer particularly gastric ulcer is
c. Sigmoid colon thought to be cause by which of the
d. Duodenum following microorganisms?
a. H. pylori
23. Mr. Lim felt pain upon release of Nurse b. E. coli
Chona’s hand. This can be referred as: c. S. aureus
a. Referred pain d. K. pneumonia
b. Direct tenderness
c. Indirect tenderness 30. The patient is for occult blood test.
d. Rebound tenderness What specimen will you collect.
a. Blood
24. Mrs. Cruz was admitted in the Medical b. Urine
ward due to dyspepsia and difficulty c. Gastric juice
swallowing. What diagnostic test d. Stool
would confirm the type of problem
Mrs. Cruz have? 31. Preparation for the client for occult
a. Barium swallow blood examination is:
b. Barium enema a. Meatless diet for 48 hours prior to
c. Colonoscopy obtaining of specimen
d. Lower GI series b. Fluid intake limited only to 1 L per
day
25. Mrs. Cruz complained of pain and c. NPO for 12 hours prior to
difficulty in swallowing. This term is procedure
referred as: d. Increase fluid intake
a. Dyspepsia
b. Pyrosis 32. Mr. Bean is admitted to the hospital
c. Dysphagia with a bowel obstruction. He
d. Odynophagia complained of colicky pain and inability
to pass stool. Which of these findings
26. To avoid acid reflux, Nurse Ruby should by Nurse Leonard would indicate the
advise Mrs. Cruz to avoid which type of obstruction is in early stage.?
diet? a. Normal bowel sounds in all four
a. High fat, carbonated and quadrants
caffeinated beverages b. Hypoactive bowel sounds
b. Cola, coffee and tea c. No bowel sounds auscultated
c. Beer and green tea d. High pitched tinkling or rumbling
d. Lechon paksiw and bicol express bowel sounds
33. Nasogastric tube was inserted to Mr. 40. The most common site of peptic ulcer:
Bean. The primary purpose is to: a. Gastro-duodenal
a. Decompression of bowel b. Gastric
b. Nutrition c. Esophageal
c. Passage of medication d. Jejunal
d. Aspiration of gastric contents
41. Gastric initiation which is initiated by a
34. Client education should be given in stimuli such as sight and smell:
order to prevent constipation. Nurse a. Intestinal phase
Ricardo’s health teaching should b. Gastric phase
include which of the following? c. Enzymatic phase
a. Complete bed rest d. Cephalic phase
b. Use of natural laxatives
c. Use of OTC laxatives 42. A client has been diagnosed with
d. Fluid intake of 6 glasses per day adenocarcinoma of the stomach and is
scheduled to undergo a subtotal
35. Four hours postoperatively, Mr. Bean gastrectomy. During pre operative
complains of guarding and rigidity of teaching, the nurse is reinforcing
the abdomen. Nurse Ricardo’s initial information about the procedure.
intervention is: Which of the following explanation is
a. Ignore the client most accurate?
b. Administer pain medication a. The procedure will result in
c. Call the physician enlargement of the pyloric
d. Assess for signs of peritonitis sphincter
b. The procedure will result in
36. Pernicious anemia is a decrease in red anastomosis (connection) of gastric
blood cells that occurs when intestines stump to jejunum
cannot properly absorbed vitamin B12. c. The procedure will result in removal
To be able to absorb Vitamin B12, a of the duodenum
special protein is needed for proper d. The procedure will result in
absorption. This protein is: repositioning of the vagus nerve
a. Extrinsic Factor
b. Gastric acids 43. A client with peptic ulcer disease tells
c. Iron the nurse that he has black stools
d. Intrinsic factor which he has not reported to his
physician. Based on the information,
37. Type B gastric analysis indicates: which nursing diagnosis would be
a. High level of HCL appropriate for this client?
b. Low level of HCL a. Imbalanced nutrition: less than
c. Absence of HCL body requirements due to gastric
d. Hypochlorhydria bleeding
b. Ineffective coping related to fear of
38. Non surgical management in chronic diagnosis of chronic illness
gastritis is a drug therapy which c. Constipation related to decrease
includes antacids. What is the purpose gastric motility
of these drugs? d. Deficient knowledge related to
a. Mucosal barrier unfamiliarity with significant signs
b. Buffering agents and symptoms
c. H2 receptors antagonist
d. Anti inflammatory 44. The client with a duodenal ulcer may
exhibit which of the following findings
39. The following are complications of on assessment?
Chronic gastritis except: a. Melena
a. Gastric ulcer b. Hematemesis
b. Gastric cancer c. Pain with eating
c. Anemia d. Malnourishemnt
d. Dehiscence and evisceration
 45. The following are the purpose of 50. Which of the following complications
gastric intubation EXCEPT? of gastric resection should the nurse
a. Decompress the stomach teach the client to watch out for?
b. To lavage the stomach and remove a. Constipation
harmful materials b. Gastric spasm
c. Administer medications and feedings c. Intestinal spasm
d. Instillation of gastric contents for d. Dumping syndrome
analysis

46. Before inserting gastric tube, the nurse 51. Which of the following condition is
determines the length that will be most likely to directly cause
needed to reach the stomach or the peritonitis?
small intestine. The length is a. Perforated ulcer
traditionally determined by? b. Cholelithiasis
a. Measuring the distance from the tip c. Hernia
of the nose to the earlobe and from d. Gastritis
earlobe to the xiphoid process
b. Measure the height of the patient 52. Which of the following symptoms
then subtract the length of the tube would a client in early stage of
c. Measure the distance from the peritonitis exhibit?
xiphoid process to the earlobe and a. Abdominal distention
from earlobe to the nose b. Abdominal pain and rigidity
d. Measure the distance from the c. Hyperactive bowel sounds
earlobe to the nose and from the d. Right upper quadrant pain
nose to the xiphoid process
53. Which of the following laboratory
47. To ensure patient safety, it is essential results would be expected in client
to confirm that the tube has been with peritonitis?
placed correctly. One of the methods is a. Partial thromboplastin time above
the ph measurement of aspirate. The 100 seconds
ph of gastric content of 4.5 indicates? b. Hemoglobin level below 10mg/dl
a. Alkaline c. Potassium level above 5.5 meq/L
b. Acidic d. WBC above 15,000
c. Base
d. Neutral 54. Which of the following therapies is not
included in the medical management
48. A client with gastric cancer can expect of a client with peritonitis?
to have surgery for resection. Which of a. Regular diet
the following should be the nursing b. Broad spectrum antibiotics
management priority for the pre- c. Electrolyte replacement
operative client with gastric cancer? d. IV fluids
a. Correction of nutritional deficit
b. Discharge planning 55. Bariatric surgery requires preliminary
c. Prevention of DVT process, evaluation by multidisciplinary
d. Instruction regarding radiation team including social workers and
treatment psychologist because of the drastic
change in the functioning. Which of the
49. Care for the postoperative client after following the patient may necessitate?
gastric resection should focus on which a. Pharmacologic management
of the following problems? b. Nutritional status
a. Body image c. Laboratory work up
b. Skin care d. Counseling
c. Nutritional needs
d. Spiritual needs
e.
56. The nurse is planning to teach the b. Eat high carbohydrate foods
client with gastroesophageal reflux c. Limit the fluids taken with meals
disease about substances that will d. Sit in High fowler’s position during
increase the lower esophageal meals
sphincter pressure. Which item should
the nurse include on this list? 62. The nurse is monitoring a client for the
a. Coffee early signs and symptoms of dumping
b. Chocolate syndrome. Which of the following
c. Fatty foods indicate this occurrence?
d. Nonfat milk a. Sweating and pallor
b. Bradycardia and indigestion
57. The client has undergone c. Double vision and chest pain
esophagogastroduodenoscopy . The d. Abdominal cramping and pain
nurse places highest priority on which
item as part of the client’s care plan? 63. The nurse is doing an admission
a. Monitoring the temperature assessment on a client with a history of
b. Monitoring complaints of duodenal ulcer. To determine whether
heartburn the problem is currently active, the
c. Giving warm gargles for a sore nurse should assess the client for
throat which symptom of duodenal ulcer?
d. Assessing for the return for the gag a. Weight loss
reflex b. Nausea and vomiting
c. Pain relieved by food intake
58. The nurse is caring for a client with d. Pain radiating down the right
diagnosis of chronic gastritis. The nurse
monitors the client knowing that this 64. The client with hiatal hernia chronically
client is at risk for which vitamin experiences heartburn following meals.
deficiency? The nurse plans to teach the client to
a. Vitamin A avoid which action because it is
b. Vitamin B12 contraindicated with hiatal hernia?
c. Vitamin C a. Lying recumbent following meals
d. Vitamin E b. Taking small, frequent, bland meals
c. Raising the head of bed on 6 inch
59. The nurse is monitoring a client with a blocks
diagnosis of peptic ulcer. Which d. Taking H2 receptor antagonist
assessment finding would most likely medication
indicate perforation of the ulcer?
a. Bradycardia 65. An older client recently has been
b. Numbness in the legs taking cimetidine (Tagamet). The nurse
c. Nausea and vomiting monitors the client for which most
d. A rigid, board like abdomen frequent CNS side effect of this
medication?
60. The nurse is caring for a client a. Tremors
following a Billroth II procedure. Which b. Dizziness
postoperative prescription should the c. Confusion
nurse question and verify? d. Hallucinations
a. Leg exercises
b. Early ambulation 66. The client who chronically uses non
c. Irrigating the nasogastric tube steroidal anti-inflammatory drugs
d. Coughing and deep breathing (NSAIDS) has been taking misoprostol
exercises (Cytotec). The nurse determines that
the medication is having the intended
61. The nurse is providing discharge therapeutic effect if which of the
instructions to a client following following is noted?
gastrectomy and instructs the client to a. Resolved diarrhea
take which measure to assist in b. Relief of epigastric pain
preventing dumping syndrome? c. Decreased platelet count
a. Ambulate following a meal d. Decreased WBC count
 d. “These medication will coat the
67. The client has been taking Omeprazole ulcer and decrease the acid
for 4 weeks. The nurse evaluates that production in my stomach”.
the client is receiving optimal intended
effect of the medication if the client 69. The client has new prescription for
reports the absence of which metoclopramide. On review of the
symptoms? chart, the nurse identifies that this
a. Diarrhea medication can be safely administered
b. Heartburn with which condition?
c. Flatulence a. Intestinal obstruction
d. Constipation b. Peptic Ulcer with melena
c. Diverticulitis with perforation
68. A client with a peptic ulcer is diagnosed d. Vomiting following cancer
with a Helicobacter pylori infection. chemotherapy
The nurse is teaching the client about
the medication prescribed including 70. The nurse has given instruction to a
Clarithromycin, Esomeprazole and client who has just been prescribed
Amoxicillin. Which statement by the cholestyramine (Questran). Which
client indicates the best understanding statement by the client indicates need
of the medication regimen? for further instruction?
a. “My ulcer will heal because these a. I will continue taking vitamin
medications will kill the bacteria” supplements
b. “These medications are only taken b. This medication will help lower my
when I have pain from my ulcer” cholesterol
c. “The medications will kill the c. This medication should only be
bacteria and stop acid production” taken with water
d. A high fiber diet is important while
taking this medication

II. MATCHING TYPE. Match column A with the correct answer on column B. Write only the letter of the
answer on the blank provided.

_________1. SSRI a. fecal fat, parasites

_________2. Tympany b. Flouroscopy
_________3. Stool test c. Gastric analysis
_________4. Endoscopic Ultrasound d. dry mouth
_________5. Barium swallow e. neuromascular defect
_________6. Biopsy f. esophageal motility
_________7. Zollinger Ellison g. weight gain
_________8. Xerostomia h. outpouching
_________9. Mumps i. gastric tissue
_________10. Achalasia j. stomach content
_________11. Manometer k. air filled stomach
_________12. Diverticula l. jejunum anastomosis to new pouch stomach
_________13. Residual volume m. Parotitis
_________14. Roux en Y n. use of prosthetic device
_________15. Gastric banding o. Enteroscopic procedure
_________16. Sister Mary joseph p. hyperresonace
_________17. Steatorrhea q. cytology
_________18. Adenocarcinoma r. halitosis
_________19. Orlistat s. Basal conditions
_________20. Pylorus t. GI malignancy
u. fat content in stool
v. metastasis
w. obesity
x. gastric oulet
III. ESSAY. Discuss briefly. (5 points each)

1. Identify 1 priority problem (Nursing Diagnosis) for patient with achalasia and include the nursing
interventions.

2. Differentiate sliding and rolling/paraesophageal hernia. Compare and contrast its manifestations.