Nurseslabs, Quizlets, RN Pedia ( For states an intension to increase the

Quizzes) Quizlets (For Midterm Exam) intake of:

a. Pork
RNPedia NCLEX Gastro 1
b. Milk
1. Nurse Berlinda is assigned to a 41- c. Chicken
year-old client who has a diagnosis d. Broccoli
of chronic pancreatitis. The nurse
R: The client with cirrhosis needs
reviews the laboratory result,
to consume foods high in thiamine.
anticipating a laboratory report
Thiamine is present in a variety of
that indicates a serum amylase
foods of plant and animal origin.
level of:
Pork products are especially rich in
a. 45 units/L
this vitamin. Other good food
b. 100 units/L
sources include nuts, whole grain
c. 300 units/L
cereals, and legumes. Milk contains
d. 500 units/L
vitamins A, D, and B2. Poultry
R: The normal serum amylase level contains niacin. Broccoli contains
is 25 to 151 units/L. With chronic vitamins C, E, and K and folic acid
cases of pancreatitis, the rise in
4. Nurse Oliver checks for residual
serum amylase levels usually does
before administering a bolus tube
not exceed three times the normal
feeding to a client with a
value. In acute pancreatitis, the
nasogastric tube and obtains a
value may exceed five times the
residual amount of 150 mL. What is
normal value.
appropriate action for the nurse to
2. A male client who is recovering take?
from surgery has been advanced a. Hold the feeding
from a clear liquid diet to a full b. Reinstill the amount and
liquid diet. The client is looking continue with administering
forward to the diet change because the feeding
he has been “bored” with the clear c. Elevate the client’s head at
liquid diet. The nurse would offer least 45 degrees and
which full liquid item to the client? administer the feeding
a. Tea d. Discard the residual amount
b. Gelatin and proceed with
c. Custard administering the feeding
d. Popsicle
R: Unless specifically indicated,
R: Full liquid food items include residual amounts more than 100
items such as plain ice cream, mL require holding the feeding.
sherbet, breakfast drinks, milk, Therefore options B, C, and D are
pudding and custard, soups that incorrect. Additionally, the feeding
are strained, and strained is not discarded unless its contents
vegetable juices. A clear liquid diet are abnormal in color or
consists of foods that are relatively characteristics.
transparent. The food items in
5. A nurse is inserting a nasogastric
options A, B, and D are clear
tube in an adult male client. During
liquids.
the procedure, the client begins to
3. Nurse Juvy is caring for a client cough and has difficulty breathing.
with cirrhosis of the liver. To Which of the following is the
minimize the effects of the appropriate nursing action?
disorder, the nurse teaches the a. Quickly insert the tube
client about foods that are high in b. Notify the physician
thiamine. The nurse determines immediately
that the client has the best c. Remove the tube and
understanding of the dietary reinsert when the respiratory
measures to follow if the client distress subsides
 d. Pull back on the tube and nasogastric tube that is connected
wait until the respiratory to suction. To administer the
distress subsides medication, the nurse would:
a. Position the client supine to
R: During the insertion of a
assist in medication
nasogastric tube, if the client
absorption
experiences difficulty breathing or
b. Aspirate the nasogastric tube
any respiratory distress, withdraw
after medication
the tube slightly, stop the tube
administration to maintain
advancement, and wait until the
patency
distress subsides. Options B and C
c. Clamp the nasogastric tube
are unnecessary. Quickly inserting
for 30 minutes following
the tube is not an appropriate
administration of the
action because, in this situation, it
medication
may be likely that the tube has
d. Change the suction setting to
entered the bronchus.
low intermittent suction for
6. Nurse Ryan is assessing for correct
30 minutes after medication
placement of a nosogartric tube.
administration
The nurse aspirates the stomach
contents and check the contents R: If a client has a nasogastric tube
for pH. The nurse verifies correct connected to suction, the nurse
tube placement if which pH value is should wait up to 30 minutes
noted? before reconnecting the tube to
a. 3.5 the suction apparatus to allow
b. 7.0 adequate time for medication
c. 7.35 absorption. Aspirating the
d. 7.5 nasogastric tube will remove the
medication just administered. Low
R: If the nasogastric tube is in the
intermittent suction also will
stomach, the pH of the contents
remove the medication just
will be acidic. Gastric aspirates
administered. The client should not
have acidic pH values and should
be placed in the supine position
be 3.5 or lower. Option B indicates
because of the risk for aspiration.
a slightly acidic pH. Option C
indicates a neutral pH. Option D 9. A nurse is preparing to care for a
indicates an alkaline pH. female client with esophageal
varices who has just has a
7. A nurse is preparing to remove a
Sengstaken-Blakemore tube
nasogartric tube from a female
inserted. The nurse gathers
client. The nurse should instruct
supplies, knowing that which of the
the client to do which of the
following items must be kept at the
following just before the nurse
bedside at all times?
removes the tube?
a. An obturator
a. Exhale
b. Kelly clamp
b. Inhale and exhale quickly
c. An irrigation set
c. Take and hold a deep breath
d. A pair of scissors
d. Perform a Valsalva maneuver
R: When the client has a
R: When the nurse removes a
Sengstaken-Blakemore tube, a pair
nasogastric tube, the client is
of scissors must be kept at the
instructed to take and hold a deep
client’s bedside at all times. The
breath. This will close the
client needs to be observed for
epiglottis. This allows for easy
sudden respiratory distress, which
withdrawal through the esophagus
occurs if the gastric balloon
into the nose. The nurse removes
ruptures and the entire tube moves
the tube with one smooth,
upward. If this occurs, the nurse
continuous pull.
immediately cuts all balloon
8. Nurse Joy is preparing to lumens and removes the tube. An
administer medication through a obturator and a Kelly clamp are
 kept at the bedside of a client with because morphine sulfate can
a tracheostomy. An irrigation set cause spasms in the sphincter of
may be kept at the bedside, but it Oddi. Options A, B, and D are
is not the priority item. appropriate interventions for the
client with acute pancreatitis.
10. Dr. Smith has determined
13. A female client being seen in
that the client with hepatitis has
a physician’s office has just been
contracted the infection form
scheduled for a barium swallow the
contaminated food. The nurse
next day. The nurse writes down
understands that this client is most
which instruction for the client to
likely experiencing what type of
follow before the test?
hepatitis?
a. Fast for 8 hours before the
a. Hepatitis A
test
b. Hepatitis B
b. Eat a regular supper and
c. Hepatitis C
breakfast
d. Hepatitis D
c. Continue to take all oral
R: Hepatitis A is transmitted by the medications as scheduled
fecal-oral route via contaminated d. Monitor own bowel
food or infected food handlers. movement pattern for
Hepatitis B, C, and D are constipation
transmitted most commonly via
R: A barium swallow is an x-ray
infected blood or body fluids.
study that uses a substance called
11. A client is suspected of barium for contrast to highlight
having hepatitis. Which diagnostic abnormalities in the
test result will assist in confirming gastrointestinal tract. The client
this diagnosis? should fast for 8 to 12 hours before
a. Elevated hemoglobin level the test, depending on physician
b. Elevated serum bilirubin level instructions. Most oral medications
c. Elevated blood urea nitrogen also are withheld before the test.
level After the procedure, the nurse
d. Decreased erythrocycle must monitor for constipation,
sedimentation rate which can occur as a result of the
presence of barium in the
R: Laboratory indicators of
gastrointestinal tract.
hepatitis include elevated liver
14. The nurse is performing an
enzyme levels, elevated serum
abdominal assessment and
bilirubin levels, elevated
inspects the skin of the abdomen.
erythrocyte sedimentation rates,
The nurse performs which
and leukopenia. An elevated blood
assessment technique next?
urea nitrogen level may indicate
a. Palpates the abdomen for
renal dysfunction. A hemoglobin
size
level is unrelated to this diagnosis.
b. Palpates the liver at the right
rib margin
12. The nurse is reviewing the
c. Listens to bowel sounds in all
physician’s orders written for a
for quadrants
male client admitted to the hospital
d. Percusses the right lower
with acute pancreatitis. Which
abdominal quadrant
physician order should the nurse
question if noted on the client’s R: The appropriate sequence for
chart? abdominal examination is
a. NPO status inspection, auscultation,
b. Nasogastric tube inserted percussion, and palpation.
c. Morphine sulfate for pain Auscultation is performed after
d. An anticholinergic medication inspection to ensure that the
motility of the bowel and bowel
R: Meperidine (Demerol) rather
sounds are not altered by
than morphine sulfate is the
percussion or palpation. Therefore,
medication of choice to treat pain
 after inspecting the skin on the R: Indomethacin (Indocin) is a
abdomen, the nurse should listen nonsteroidal anti-inflammatory
for bowel sounds. drug and can cause ulceration of
15. Polyethylene glycol-electrlyte the esophagus, stomach, or small
solution (GoLYTELY) is prescribed intestine. Indomethacin is
for the female client scheduled for contraindicated in a client with
a colonoscopy. The client begins to gastrointestinal disorders.
experience diarrhea following Furosemide (Lasix) is a loop
administration of the solution. diuretic. Digoxin is a cardiac
What action by the nurse is medication. Propranolol (Inderal) is
appropriate? a β-adrenergic blocker.
a. Start an IV infusion Furosemide, digoxin, and
b. Administer an enema propranolol are not contraindicated
c. Cancel the diagnostic test in clients with gastric disorders.
d. Explain that diarrhea is 18. The nurse is assessing a
expected male client 24 hours following a
cholecystectomy. The nurse noted
R: The solution GoLYTELY is a
that the T tube has drained 750 mL
bowel evacuant used to prepare a
of green-brown drainage since the
client for a colonoscopy by
surgery. Which nursing
cleansing the bowel. The solution is
intervention is appropriate?
expected to cause a mild diarrhea
a. Clamp the T tube
and will clear the bowel in 4 to 5
b. Irrigate the T tube
hours. Options A, B, and C are
c. Notify the physician
inappropriate actions.
d. Document the findings
16. The nurse is caring for a male
R: Following cholecystectomy,
client with a diagnosis of chronic
drainage from the T tube is initially
gastritis. The nurse monitors the
bloody and then turns to a
client knowing that this client is at
greenish-brown color. The drainage
risk for which vitamin deficiency?
is measured as output. The amount
a. Vitamin A
of expected drainage will range
b. Vitamin B12
from 500 to 1000 mL/day. The
c. Vitamin C
nurse would document the output.
d. Vitamin E
19. The nurse is monitoring a
R: Chronic gastritis causes
female client with a diagnosis of
deterioration and atrophy of the
peptic ulcer. Which assessment
lining of the stomach, leading to
findings would most likely indicate
the loss of the function of the
perforation of the ulcer?
parietal cells. The source of the
a. Bradycardia
intrinsic factor is lost, which results
b. Numbness in the legs
in the inability to absorb vitamin
c. Nausea and vomiting
B12. This leads to the development
d. A rigid, board-like abdomen
of pernicious anemia. The client is
not at risk for vitamin A, C, or E R: Perforation of an ulcer is a
deficiency. surgical emergency and is
17. The nurse is reviewing the characterized by sudden, sharp,
medication record of a female intolerable severe pain beginning
client with acute gastritis. Which in the midepigastric area and
medication, if noted on the client’s spreading over the abdomen,
record, would the nurse question? which becomes rigid and board-
a. Digoxin (Lanoxin) like. Nausea and vomiting may
b. Furosemide (Lasix) occur. Tachycardia may occur as
c. Indomethacin (Indocin) hypovolemic shock develops.
d. Propranolol hydrochloride Numbness in the legs is not an
(Inderal) associated finding.
20. A male client with a peptic d. Sit in a high-Fowler’s position
ulcer is scheduled for a vagotomy during meals
and the client asks the nurse about
R: Dumping syndrome is a term
the purpose of this procedure.
that refers to a constellation of
Which response by the nurse best
vasomotor symptoms that occurs
describes the purpose of a
after eating, especially following a
vagotomy?
Billroth II procedure. Early
a. Halts stress reactions
manifestations usually occur within
b. Heals the gastric mucosa
30 minutes of eating and include
c. Reduces the stimulus to acid
vertigo, tachycardia, syncope,
secretions
sweating, pallor, palpitations, and
d. Decreases food absorption in
the desire to lie down. The nurse
the stomach
should instruct the client to
R: A vagotomy, or cutting of the decrease the amount of fluid taken
vagus nerve, is done to eliminate at meals and to avoid high-
parasympathetic stimulation of carbohydrate foods, including
gastric secretion. Options A, B, and fluids such as fruit nectars; to
D are incorrect descriptions of a assume a low-Fowler’s position
vagotomy. during meals; to lie down for 30
minutes after eating to delay
21. The nurse is caring for a
gastric emptying; and to take
female client following a Billroth II
antispasmodics as prescribed.
procedure. Which postoperative
order should the nurse question 23. The nurse is monitoring a
and verify? female client for the early signs
a. Leg exercises and symptoms of dumping
b. Early ambulation syndrome. Which of the following
c. Irrigating the nasogastric indicate this occurrence?
tube a. Sweating and pallor
d. Coughing and deep-breathing b. Bradycardia and indigestion
exercises c. Double vision and chest pain
d. Abdominal cramping and
R: In a Billroth II procedure, the
pain
proximal remnant of the stomach
is anastomosed to the proximal R: Early manifestations of dumping
jejunum. Patency of the syndrome occur 5 to 30 minutes
nasogastric tube is critical for after eating. Symptoms include
preventing the retention of gastric vertigo, tachycardia, syncope,
secretions. The nurse should never sweating, pallor, palpitations, and
irrigate or reposition the gastric the desire to lie down.
tube after gastric surgery, unless
24. The nurse is preparing a
specifically ordered by the
discharge teaching plan for the
physician. In this situation, the
male client who had umbilical
nurse should clarify the order.
hernia repair. What should the
Options A, B, and D are
nurse include in the plan?
appropriate postoperative
a. Irrigating the drain
interventions.
b. Avoiding coughing
22. The nurse is providing c. Maintaining bed rest
discharge instructions to a male d. Restricting pain medication
client following gastrectomy and
R: Coughing is avoided following
instructs the client to take which
umbilical hernia repair to prevent
measure to assist in preventing
disruption of tissue integrity, which
dumping syndrome?
can occur because of the location
a. Ambulate following a meal
of this surgical procedure. Bed rest
b. Eat high carbohydrate foods
is not required following this
c. Limit the fluid taken with
surgical procedure. The client
meal
should take analgesics as needed
 and as prescribed to control pain. A d. Nutrition: more than body
drain is not used in this surgical requirements, imbalanced
procedure, although the client may
R: Body image, disturbed relates to
be instructed in simple dressing
loss of bowel control, the presence
changes.
of a stoma, the release of fecal
25. The nurse is instructing the material onto the abdomen, the
male client who has an inguinal passage of flatus, odor, and the
hernia repair how to reduce need for an appliance (external
postoperative swelling following pouch). No data in the question
the procedure. What should the support options A and C. Nutrition:
nurse tell the client? less than body requirements,
a. Limit oral fluid imbalanced is the more likely
b. Elevate the scrotum nursing diagnosis.
c. Apply heat to the abdomen
28. The nurse is reviewing the
d. Remain in a low-fiber diet
record of a female client with
R: Following inguinal hernia repair, Crohn’s disease. Which stool
the client should be instructed to characteristics should the nurse
elevate the scrotum and apply ice expect to note documented in the
packs while in bed to decrease client’s record?
pain and swelling. The nurse also a. Diarrhea
should instruct the client to apply a b. Chronic constipation
scrotal support when out of bed. c. Constipation alternating with
Heat will increase swelling. diarrhea
Limiting oral fluids and a low-fiber d. Stools constantly oozing form
diet can cause constipation. the rectum

26. The nurse is caring for a R: Crohn’s disease is characterized

hospitalized female client with a by nonbloody diarrhea of usually
diagnosis of ulcerative colitis. not more than four to five stools
Which finding, if noted on daily. Over time, the diarrhea
assessment of the client, would the episodes increase in frequency,
nurse report to the physician? duration, and severity. Options B,
a. Hypotension C, and D are not characteristics of
b. Bloody diarrhea Crohn’s disease.
c. Rebound tenderness
29. The nurse is performing a
d. A hemoglobin level of 12
colostomy irrigation on a male
mg/dL
client. During the irrigation, the
R: Rebound tenderness may client begins to complain of
indicate peritonitis. Bloody abdominal cramps. What is the
diarrhea is expected to occur in appropriate nursing action?
ulcerative colitis. Because of the a. Notify the physician
blood loss, the client may be b. Stop the irrigation
hypotensive and the hemoglobin temporarily
level may be lower than normal. c. Increase the height of the
Signs of peritonitis must be irrigation
reported to the physician. d. Medicate for pain and
resume the irrigation
27. The nurse is caring for a male
client postoperatively following R: If cramping occurs during a
creation of a colostomy. Which colostomy irrigation, the irrigation
nursing diagnosis should the nurse flow is stopped temporarily and the
include in the plan of care? client is allowed to rest. Cramping
a. Sexual dysfunction may occur from an infusion that is
b. Body image, disturbed too rapid or is causing too much
c. Fear related to poor pressure. The physician does not
prognosis need to be notified. Increasing the
height of the irrigation will cause
 further discomfort. Medicating the R: Good circulation causes tissues
client for pain is not the to be moist and red, so a healthy,
appropriate action in this situation. well-healed stoma appears red and
moist.
30. The nurse is teaching a
female client how to perform a 33. You’re caring for a patient
colostomy irrigation. To enhance with a sigmoid colostomy. The stool
the effectiveness of the irrigation from this colostomy is:
and fecal returns, what measure a. Formed
should the nurse instruct the client b. Semisolid
to do? c. Semiliquid
a. Increase fluid intake d. Watery
b. Place heat on the abdomen
R: A colostomy in the sigmoid
c. Perform the irrigation in the
colon produces a solid, formed
evening
stool.
d. Reduce the amount of
irrigation solution 34. You’re advising a 21 y.o. with
a colostomy who reports problems
R: To enhance effectiveness of the
with flatus. What food should you
irrigation and fecal returns, the
recommend?
client is instructed to increase fluid
a. Peas
intake and to take other measures
b. Cabbage
to prevent constipation. Options B,
c. Broccoli
C and D will not enhance the
d. Yogurt
effectiveness of this procedure.
R: High-fiber foods stimulate
31. A patient with chronic alcohol
peristalsis, and a result, flatus.
abuse is admitted with liver failure.
Yogurt reduces gas formation.
You closely monitor the patient’s
blood pressure because of which 35. You have to teach ostomy
change that is associated with the self care to a patient with a
liver failure? colostomy. You tell the patient to
a. Hypoalbuminemia measure and cut the wafer:
b. Increased capillary a. To the exact size of the
permeability stoma.
c. Abnormal peripheral b. About 1/16” larger than the
vasodilation stoma.
d. Excess rennin release from c. About 1/8” larger than the
the kidneys stoma.
d. About 1/4″ larger than the
R: Blood pressure decreases as the
stoma.
body is unable to maintain normal
oncotic pressure with liver failure, R: A proper fit protects the skin,
so patients with liver failure require but doesn’t impair circulation. A
close blood pressure monitoring. 1/16” should be cut.
Increased capillary permeability,
36. You’re performing an
abnormal peripheral vasodilation,
abdominal assessment on Brent
and excess rennin released from
who is 52 y.o. In which order do
the kidney’s aren’t direct
you proceed?
ramifications of liver failure.
a. Inspection, percussion,
32. You’re assessing the stoma palpation, auscultation
of a patient with a healthy, well- b. Inspection, auscultation,
healed colostomy. You expect the percussion, palpation
stoma to appear: c. Percussion, palpation,
a. Pale, pink and moist auscultation, Inspection
b. Red and moist d. Palpation, percussion,
c. Dark or purple colored inspection, auscultation
d. Dry and black
37. You’re doing preoperative d. Restrict fluid intake.
teaching with Gertrude who has
ulcerative colitis who needs R: To avoid overloading the small
surgery to create an ileoanal intestine, encourage the patient to
reservoir. Which information do eat six small, regularly spaced
you include? meals.
a. A reservoir is created that
40. Arthur has a family history of
exits through the abdominal
colon cancer and is scheduled to
wall.
have a sigmoidoscopy. He is crying
b. A second surgery is required
as he tells you, “I know that I have
12 months after the first
colon cancer, too.” Which response
surgery.
is most therapeutic?
c. A permanent ileostomy is
a. “I know just how you feel.”
created.
b. “You seem upset.”
d. The surgery occurs in two
c. “Oh, don’t worry about it,
stages.
everything will be just fine.”
R: An ileoanal reservoir is created d. “Why do you think you have
in two stages. The two surgeries cancer?”
are about 2 to 3 months apart.
First, diseased intestines are R: Making observations about what
removed and a temporary loop you see or hear is a useful
ileostomy is created. Second, the therapeutic technique. This way,
loop ileostomy is closed and stool you acknowledge that you are
goes to the reservoir and out interested in what the patient is
through the anus. saying and feeling.

41. You’re caring for Beth who

underwent a Billroth II procedure
+
(surgical removal of the pylorus
38. You’re caring for Carin who and duodenum) for treatment of a
has just had ileostomy surgery. peptic ulcer. Which findings
During the first 24 hours post-op, suggest that the patient is
how much drainage can you expect developing dumping syndrome, a
from the ileostomy? complication associated with this
a. 100 ml procedure?
b. 500 ml a. Flushed, dry skin.
c. 1500 ml b. Headache and bradycardia.
d. 5000 ml c. Dizziness and sweating.
d. Dyspnea and chest pain.
R: The large intestine absorbs large
amounts of water so the initial R: After a Billroth II procedure, a
output from the ileostomy may be large amount of hypertonic fluid
as much as 1500 to 2000 ml/24 enters the intestine. This causes
hours. Gradually, the small extracellular fluid to move rapidly
intestine absorbs more fluid and into the bowel, reducing circulating
the output decreases. blood volume and producing
39. You’re preparing a teaching vasomotor symptoms. Vasomotor
plan for a 27 y.o. named Jeff who symptoms produced by dumping
underwent surgery to close a syndrome include dizziness and
temporary ileostomy. Which sweating, tachycardia, syncope,
nutritional guideline do you include pallor, and palpitations.
in this plan?
42. You’re developing the plan of
a. There is no need to change
care for a patient experiencing
eating habits.
dumping syndrome after a Billroth
b. Eat six small meals a day.
II procedure. Which dietary
c. Eat the largest meal in the
instructions do you include?
evening.
a. Omit fluids with meals.
 b. Increase carbohydrate c. Apply a dry sterile dressing &
intake. binder.
c. Decrease protein intake. d. Push the organs back & cover
d. Decrease fat intake. with moist sterile dressings.

R: Gastric emptying time can be R: Cover the organs with a sterile,

delayed by omitting fluids from nonadherent dressing moistened
your patient’s meal. A diet low in with normal saline. Do this to
carbs and high in fat & protein is prevent infection and to keep the
recommended to treat dumping organs from drying out.
syndrome.
46. You’re caring for Betty with
43. You’re caring for Lewis, a 67 liver cirrhosis. Which of the
y.o. patient with liver cirrhosis who following assessment findings
develops ascites and requires leads you to suspect hepatic
paracentesis. Relief of which encephalopathy in her?
symptom indicated that the a. Asterixis
paracentesis was effective? b. Chvostek’s sign
a. Pruritus c. Trousseau’s sign
b. Dyspnea d. Hepatojugular reflex
c. Jaundice
d. Peripheral Neuropathy R: Asterixis is an early neurologic
sign of hepatic encephalopathy
R: Ascites puts pressure on the elicited by asking the patient to
diaphragm. Paracentesis is done to hold her arms stretched out.
remove fluid and reducing Asterixis is present if the hands
pressure on the diaphragm. The rapidly extend and flex.
goal is to improve the patient’s
breathing. The others are signs of 47. You are developing a
cirrhosis that aren’t relieved by careplan on Sally, a 67 y.o. patient
paracentesis. with hepatic encephalopathy.
Which of the following do you
44. You’re caring for Jane, a 57 include?
y.o. patient with liver cirrhosis who a. Administering a lactulose
develops ascites and requires enema as ordered.
paracentesis. Before her b. Encouraging a protein-rich
paracentesis, you instruct her to: diet.
a. Empty her bladder. c. Administering sedatives, as
b. Lie supine in bed. necessary.
c. Remain NPO for 4 hours. d. Encouraging ambulation at
d. Clean her bowels with an least four times a day.
enema.
R: You may administer the laxative
R: A full bladder can interfere with lactulose to reduce ammonia levels
paracentesis and be punctured in the colon.
inadvertently.
48. You have a patient with
45. After abdominal surgery, achalasia (incomplete muscle
your patient has a severe coughing relaxtion of the GI tract, especially
episode that causes wound sphincter muscles). Which
evisceration. In addition to calling medications do you anticipate to
the doctor, which intervention is administer?
most appropriate? a. Isosorbide dinitrate (Isordil)
a. Irrigate the wound & organs b. Digoxin (Lanoxin)
with Betadine. c. Captopril (Capoten)
b. Cover the wound with a d. Propanolol (Inderal)
saline soaked sterile
dressing. R: Achalasia is characterized by
incomplete relaxation of the LES,
 dilation of the lower esophagus, heriorrhaphy. You instruct the
and a lack of esophageal patient to:
peristalsis. Because nitrates relax a. Avoid the use of pain
the lower esophageal sphincter, medication.
expect to give Isordil orally or b. Cough and deep breathe
sublingually. Q2H.
c. Splint the incision if he can’t
49. The student nurse is avoid sneezing or coughing.
preparing a teaching care plan to d. Apply heat to scrotal
help improve nutrition in a patient swelling.
with achalasia. You include which
of the following: R: Teach the pt to avoid activities
a. Swallow foods while leaning that increase intra-abdominal
forward. pressure such as coughing,
b. Omit fluids at mealtimes. sneezing, or straining with a bowel
c. Eat meals sitting upright. movement.
d. Avoid soft and semisoft
foods. 53. Janice is waiting for
discharge instructions after her
R: Eating in the upright position herniorrhaphy. Which of the
aids in emptying the esophagus. following instructions do you
Doing the opposite of the other include?
three also may be helpful. a. Eat a low-fiber diet.
b. Resume heavy lifting in 2
50. Britney, a 20 y.o. student is weeks.
admitted with acute pancreatitis. c. Lose weight, if obese.
Which laboratory findings do you d. Resume sexual activity once
expect to be abnormal for this discomfort is gone.
patient?
a. Serum creatinine and BUN R: Because obesity weakens the
b. Alanine aminotransferase abdominal muscles, advise weight
(ALT) and aspartate loss for the patient who has had a
aminotransferase (AST) hernia repair.
c. Serum amylase and lipase
d. Cardiac enzymes 54. Develop a teaching care plan
for Angie who is about to undergo a
R: Pancreatitis involves activation liver biopsy. Which of the following
of pancreatic enzymes, such as points do you include?
amylase and lipase. These levels a. “You’ll need to lie on your
are elevated in a patient with stomach during the test.”
acute pancreatitis. b. “You’ll need to lie on your
right side after the test.”
51. A patient with Crohn’s c. “During the biopsy you’ll be
disease is admitted after 4 days of asked to exhale deeply and
diarrhea. Which of the following hold it.”
urine specific gravity values do you d. “The biopsy is performed
expect to find in this patient? under general anesthesia.”
a. 1.005
b. 1.011 R: After a liver biopsy, the patient
c. 1.020 is placed on the right side to
d. 1.030 compress the liver and to reduce
the risk of bleeding or bile leakage.
R: The normal range of specific
gravity of urine is 1.010 to 1.025; a 55. Stephen is a 62 y.o. patient
value of 1.030 may be seen with that has had a liver biopsy. Which
dehydration. of the following groups of signs
alert you to a possible
52. Your goal is to minimize pneumothorax?
David’s risk of complications after a
 a. Dyspnea and reduced or X-ray is ordered, it should be done
absent breath sounds over immediately, not in 24 hours.
the right lung
b. Tachycardia, hypotension, 58. Stephanie, a 28 y.o. accident
and cool, clammy skin victim, requires TPN. The rationale
c. Fever, rebound tenderness, for TPN is to provide:
and abdominal rigidity a. Necessary fluids and
d. Redness, warmth, and electrolytes to the body.
drainage at the biopsy site b. Complete nutrition by the I.V.
route.
R: Signs and Symptoms of c. Tube feedings for nutritional
pneumothorax include dyspnea supplementation.
and decreased or absent breath d. Dietary supplementation with
sounds over the affected lung liquid protein given between
(right lung). meals.

56. Michael, a 42 y.o. man is R: TPN is given I.V. to provide all

admitted to the med-surg floor with the nutrients your patient needs.
a diagnosis of acute pancreatitis. TPN isn’t a tube feeding nor is it a
His BP is 136/76, pulse 96, Resps liquid dietary supplement.
22 and temp 101. His past history
includes hyperlipidemia and 59. Type A chronic gastritis can
alcohol abuse. The doctor be distinquished from type B by its
prescribes an NG tube. Before ability to:
inserting the tube, you explain the a. Cause atrophy of the parietal
purpose to patient. Which of the cells.
following is a most accurate b. Affect only the antrum of the
explanation? stomach.
a. “It empties the stomach of c. Thin the lining of the
fluids and gas.” stomach walls.
b. “It prevents spasms at the d. Decrease gastric secretions.
sphincter of Oddi.”
R: Type A causes changes in
c. “It prevents air from forming
parietal cells.
in the small intestine and
large intestine.” 60. Matt is a 49 y.o. with a hiatal
d. “It removes bile from the hernia that you are about to
gallbladder.” counsel. Health care counseling for
Matt should include which of the
R: An NG tube is inserted into the
following instructions?
patients stomach to drain fluid and
a. Restrict intake of high-
gas.
carbohydrate foods.
57. Jason, a 22 y.o. accident b. Increase fluid intake with
victim, requires an NG tube for meals.
feeding. What should you c. Increase fat intake.
immediately do after inserting an d. Eat three regular meals a
NG tube for liquid enteral feedings? day.
a. Aspirate for gastric
R: Increasing fluids helps empty
secretions with a syringe.
the stomach. A high carb diet isn’t
b. Begin feeding slowly to
restricted and fat intake shouldn’t
prevent cramping.
be increased.
c. Get an X-ray of the tip of the
tube within 24 hours. 61. Jerod is experiencing an
d. Clamp off the tube until the acute episode of ulcerative colitis.
feedings begin. Which is priority for this patient?
a. Replace lost fluid and
R: Aspirating the stomach contents
sodium.
confirms correct placement. If an
 b. Monitor for increased serum b. Hypertension and
glucose level from steroid tachycardia.
therapy. c. Vomiting and elevated
c. Restrict the dietary intake of temperature.
foods high in potassium. d. Crampy and lower left
d. Note any change in the color quadrant pain and low-grade
and consistency of stools. fever.
R: One sign of acute diverticulitis is
R: Diarrhea d/t an acute episode of crampy lower left quadrant pain. A
ulcerative colitis leads to fluid & low-grade fever is another common
electrolyte losses so fluid sign.
replacement takes priority. 66. Brenda, a 36 y.o. patient is
on your floor with acute
62. A 29 y.o. patient has an
pancreatitis. Treatment for her
acute episode of ulcerative colitis.
includes:
What diagnostic test confirms this
a. Continuous peritoneal
diagnosis?
lavage.
a. Barium Swallow.
b. Regular diet with increased
b. Stool examination.
fat.
c. Gastric analysis.
c. Nutritional support with TPN.
d. Sigmoidoscopy.
d. Insertion of a T tube to drain
R: Sigmoidoscopy allows direct the pancreas.
observation of the colon mucosa
R: With acute pancreatitis, you
for changes, and if needed, biopsy.
need to rest the GI tract by TPN as
63. Eleanor, a 62 y.o. woman nutritional support.
with diverticulosis is your patient.
67. Glenda has cholelithiasis
Which interventions would you
(gallstones). You expect her to
expect to include in her care?
complain of:
a. Low-fiber diet and fluid
a. Pain in the right upper
restrictions.
quadrant, radiating to the
b. Total parenteral nutrition and
shoulder.
bed rest.
b. Pain in the right lower
c. High-fiber diet and
quadrant, with rebound
administration of psyllium.
tenderness.
d. Administration of analgesics
c. Pain in the left upper
and antacids.
quadrant, with shortness of
R: She needs a high-fiber diet and breath.
a psyllium (bulk laxative) to d. Pain in the left lower
promote normal soft stools. quadrant, with mild
cramping.
64. Regina is a 46 y.o. woman
with ulcerative colitis. You expect R: The gallbladder is located in the
her stools to look like: RUQ and a frequent sign of
a. Watery and frothy. gallstones is pain radiating to the
b. Bloody and mucoid. shoulder.
c. Firm and well-formed.
68. After an abdominal resection
d. Alternating constipation and
for colon cancer, Madeline returns
diarrhea.
to her room with a Jackson-Pratt
R: Stools from ulcerative colitis are drain in place. The purpose of the
often bloody and contain mucus. drain is to:
a. Irrigate the incision with a
65. Donald is a 61 y.o. man with saline solution.
diverticulitis. Diverticulitis is b. Prevent bacterial infection of
characterized by: the incision.
a. Periodic rectal hemorrhage.
 c. Measure the amount of fluid the preferred method of feeding for
lost after surgery. your patient?
d. Prevent accumulation of a. TPN
drainage in the wound. b. PPN
R: A Jackson-Pratt drain promotes c. NG feeding
wound healing by allowing fluid to d. Oral liquid supplements
escape from the wound.
69. Anthony, a 60 y.o. patient, R: Because the GI tract is
has just undergone a bowel functioning, feeding methods
resection with a colostomy. During involve the enteral route which
the first 24 hours, which of the bypasses the mouth but allows for
following observations about the a major portion of the GI tract to
stoma should you report to the be used.
doctor?
73. Your patient is complaining of
a. Pink color.
abdominal pain during assessment.
b. Light edema.
What is your priority?
c. Small amount of oozing.
a. Auscultate to determine
d. Trickles of bright red blood.
changes in bowel sounds.
R: After creation of a colostomy,
b. Observe the contour of the
expect to see a stoma that is pink,
abdomen.
slightly edematous, with some
c. Palpate the abdomen for a
oozing. Bright red blood,
mass.
regardless of amount, indicates
d. Percuss the abdomen to
bleeding and should be reported to
determine if fluid is present.
the doctor.
70. Your teaching Anthony how R: The first step in assessing the
to use his new colostomy. How abdomen is to observe its shape
much skin should remain exposed and contour, then auscultate,
between the stoma and the ring of palpate, and then percuss.
the appliance?
a. 1/16” 74. Before bowel surgery, Lee is
b. 1/4″ to administer enemas until clear.
c. 1/2” During administration, he
d. 1” complains of intestinal cramps.
What do you do next?
R: Only a small amount of skin a. Discontinue the procedure.
should be exposed and more than b. Lower the height of the
1/16” of skin allows the enema container.
excretement to irritate the skin. c. Complete the procedure as
quickly as possible.
71. Claire, a 33 y.o. is on your
d. Continue administration of
floor with a possible bowel
the enema as ordered
obstruction. Which intervention is
without making any
priority for her?
adjustments.
a. Obtain daily weights.
b. Measure abdominal girth. R: Lowering the height decreases
c. Keep strict intake and output. the amount of flow, allowing him to
d. Encourage her to increase tolerate more fluid.
fluids.
75. Leigh Ann is receiving
R: Measuring abdominal girth pancrelipase (Viokase) for chronic
provides quantitative information pancreatitis. Which observation
about increases or decreases in best indicates the treatment is
the amount of distention. effective?
a. There is no skin breakdown.
72. Your patient has a GI tract
b. Her appetite improves.
that is functioning, but has the
c. She loses more than 10 lbs.
inability to swallow foods. Which is
 d. Stools are less fatty and c. Reddish-pink stoma
decreased in frequency. d. Brownish-black stoma

R: Pancrelipase provides the R: A brownish-black color indicates

exocrine pancreatic enzyme lack of blood flow, and maybe
necessary for proper protein, fat, necrosis.
and carb digestion. With increased
fat digestion and absorption, stools 79. Sharon has cirrhosis of the
become less frequent and normal liver and develops ascites. What
in appearance. intervention is necessary to
decrease the excessive
76. Ralph has a history of alcohol accumulation of serous fluid in her
abuse and has acute pancreatitis. peritoneal cavity?
Which lab value is most likely to be a. Restrict fluids
elevated? b. Encourage ambulation
a. Calcium c. Increase sodium in the diet
b. Glucose d. Give antacids as prescribed
c. Magnesium
d. Potassium R: Restricting fluids decrease the
amount of body fluid and the
R: Glucose level increases and accumulation of fluid in the
diabetes mellitus may result d/t the peritoneal space.
pancreatic damage to the islets of
langerhans. 80. Katrina is diagnosed with
lactose intolerance. To avoid
77. Anna is 45 y.o. and has a complications with lack of calcium
bleeding ulcer. Despite multiple in the diet, which food should be
blood transfusions, her HGB is included in the diet?
7.5g/dl and HCT is 27%. Her doctor a. Fruit
determines that surgical b. Whole grains
intervention is necessary and she c. Milk and cheese products
undergoes partial gastrectomy. d. Dark green, leafy vegetables
Postoperative nursing care
includes: R: Dark green, leafy vegetables are
a. Giving pain medication Q6H. rich in calcium.
b. Flushing the NG tube with
81. Nathaniel has severe pruritus
sterile water.
due to having hepatitis B. What is
c. Positioning her in high
the best intervention for his
Fowler’s position.
comfort?
d. Keeping her NPO until the
a. Give tepid baths.
return of peristalsis.
b. Avoid lotions and creams.
R: After surgery, she remains NPO c. Use hot water to increase
until peristaltic activity returns. vasodilation.
This decreases the risk for d. Use cold water to decrease
abdominal distention and the itching.
obstruction.
R: For pruritus, care should include
78. Sitty, a 66 y.o. patient tepid sponge baths and use of
underwent a colostomy for emollient creams and lotions.
ruptured diverticulum. She did well
82. Rob is a 46 y.o. admitted to
during the surgery and returned to
the hospital with a suspected
your med-surg floor in stable
diagnosis of Hepatitis B. He’s
condition. You assess her
jaundiced and reports weakness.
colostomy 2 days after surgery.
Which intervention will you include
Which finding do you report to the
in his care?
doctor?
a. Regular exercise.
a. Blanched stoma
b. A low-protein diet.
b. Edematous stoma
 c. Allow patient to select his her recovery. Which response isn’t
meals. appropriate?
d. Rest period after small, a. Encourage her to not worry
frequent meals. about the future.
b. Encourage her to express her
R: Rest periods and small frequent feelings about the illness.
meals is indicated during the acute c. Discuss the effects of
phase of hepatitis B. hepatitis B on future health
problems.
83. You’re discharging Nathaniel
d. Provide avenues for financial
with hepatitis B. Which statement
counseling if she expresses
suggests understanding by the
the need.
patient?
a. “Now I can never get R: Telling her not to worry
hepatitis again.” minimizes her feelings.
b. “I can safely give blood after
3 months.” 86. Elmer is scheduled for a
c. “I’ll never have a problem proctoscopy and has an I.V. The
with my liver again, even if I doctor wrote an order for 5mg of
drink alcohol.” I.V. diazepam(Valium). Which order
d. “My family knows that if I get is correct regarding diazepam?
tired and start vomiting, I a. Give diazepam in the I.V. port
may be getting sick again.” closest to the vein.
b. Mix diazepam with 50 ml of
R: Hepatitis B can recur. Patients dextrose 5% in water and
who have had hepatitis are give over 15 minutes.
permanently barred from donating c. Give diazepam rapidly I.V. to
blood. Alcohol is metabolized by prevent the bloodstream
the liver and should be avoided by from diluting the drug
those who have or had hepatitis B. mixture.
d. Question the order because
84. Gail is scheduled for a
I.V. administration of
cholecystectomy. After completion
diazepam is contraindicated.
of preoperative teaching, Gail
states,”If I lie still and avoid turning R: Diazepam is absorbed by the
after the operation, I’ll avoid pain. plastic I.V. tubing and should be
Do you think this is a good idea?” given in the port closest to the
What is the best response? vein.
a. “You’ll need to turn from side
to side every 2 hours.” 87. Annebell is being discharged
b. “It’s always a good idea to with a colostomy, and you’re
rest quietly after surgery.” teaching her about colostomy care.
c. “The doctor will probably Which statement correctly
order you to lie flat for 24 describes a healthy stoma?
hours.” a. “At first, the stoma may
d. “Why don’t you decide about bleed slightly when touched.”
activity after you return from b. “The stoma should appear
the recovery room?” dark and have a bluish hue.”
c. “A burning sensation under
R: To prevent venous stasis and the stoma faceplate is
improve muscle tone, circulation, normal.”
and respiratory function, d. “The stoma should remain
encourage her to move after swollen away from the
surgery. abdomen.”

85. You’re caring for a 28 y.o. R: For the first few days to a week,
woman with hepatitis B. She’s slight bleeding normally occurs
concerned about the duration of when the stoma is touched
because the surgical site is still
 new. She should report profuse R: Saline solution is isotonic, or
bleeding immediately. close to body fluids in content, and
is used along with sterile dressings
88. A patient who underwent to cover an eviscerated wound and
abdominal surgery now has a keep it moist.
gaping incision due to delayed
wound healing. Which method is 91. Findings during an
correct when you irrigate a gaping endoscopic exam include a
abdominal incision with sterile cobblestone appearance of the
normal saline solution, using a colon in your patient. The findings
piston syringe? are characteristic of which
a. Rapidly instill a stream of disorder?
irrigating solution into the a. Ulcer
wound. b. Crohn’s disease
b. Apply a wet-to-dry dressing c. Chronic gastritis
to the wound after the d. Ulcerative colitis
irrigation.
c. Moisten the area around the R: Crohn’s disease penetrates the
wound with normal saline mucosa of the colon through all
solution after the irrigation. layers and destroys the colon in
d. Irrigate continuously until the patches, which creates a
solution becomes clear or all cobblestone appearance.
of the solution is used.
92. What information is correct
R: To wash away tissue debris and about stomach cancer?
drainage effectively, irrigate the a. Stomach pain is often a late
wound until the solution becomes symptom.
clear or all the solution is used. b. Surgery is often a successful
treatment.
89. Hepatic encephalopathy c. Chemotherapy and radiation
develops when the blood level of are often successful
which substance increases? treatments.
a. Ammonia d. The patient can survive for
b. Amylase an extended time with TPN.
c. Calcium
d. Potassium R: Stomach pain is often a late sign
of stomach cancer; outcomes are
R: Ammonia levels increase d/t particularly poor when the cancer
improper shunting of blood, reaches that point. Surgery,
causing ammonia to enter chemotherapy, and radiation have
systemic circulation, which carries minimal positive effects. TPN may
it to the brain. enhance the growth of the cancer.

90. Your patient recently had 93. Dark, tarry stools indicate
abdominal surgery and tells you bleeding in which location of the GI
that he feels a popping sensation in tract?
his incision during a coughing spell, a. Upper colon.
followed by severe pain. You b. Lower colon.
anticipate an evisceration. Which c. Upper GI tract.
supplies should you take to his d. Small intestine.
room?
a. A suture kit. R: Melena is the passage of dark,
b. Sterile water and a suture kit. tarry stools that contain a large
c. Sterile water and sterile amount of digested blood. It occurs
dressings. with bleeding from the upper GI
d. Sterile saline solution and tract.
sterile dressings.
94. A patient has an acute upper 97. Your patient, Christopher,
GI hemorrhage. Your interventions has a diagnosis of ulcerative colitis
include: and has severe abdominal pain
a. Treating hypovolemia. aggravated by movement, rebound
b. Treating hypervolemia. tenderness, fever, nausea, and
c. Controlling the bleeding decreased urine output. This may
source. indicate which complication?
d. Treating shock and a. Fistula.
diagnosing the bleeding b. Bowel perforation.
source. c. Bowel obstruction.
d. Abscess.
R: A patient with an acute upper GI
hemorrhage must be treated for R: An inflammatory condition that
hypovolemia and hemorrhagic affects the surface of the colon,
shock. You as a nurse can’t ulcerative colitis causes friability
diagnose the problem. Controlling and erosions with bleeding.
the bleeding may require surgery Patients with ulcerative colitis are
or intensive medical treatment. at increased risk for bowel
perforation, toxic megacolon,
95. You promote hemodynamic hemorrhage, cancer, and other
stability in a patient with upper GI anorectal and systemic
bleeding by: complications.
a. Encouraging oral fluid intake.
b. Monitoring central venous 98. A patient has a severe
pressure. exacerbation of ulcerative colitis.
c. Monitoring laboratory test Long-term medications will
results and vital signs. probably include:
d. Giving blood, electrolyte and a. Antacids.
fluid replacement. b. Antibiotics.
c. Corticosteroids.
R: To stabilize a patient with acute d. Histamine2-receptor
bleeding, NS or LR solution is given blockers.
I.V. until BP rises and urine output
returns to 30ml/hr. R: Medications to control
inflammation such as
96. You’re preparing a patient corticosteroids are used for long-
with a malignant tumor for term treatment.
colorectal surgery and subsequent
colostomy. The patient tells you 99. The student nurse is teaching
he’s anxious. What should your the family of a patient with liver
initial step be in working with this failure. You instruct them to limit
patient? which foods in the patient’s diet?
a. Determine what the patient a. Meats and beans.
already knows about b. Butter and gravies.
colostomies. c. Potatoes and pastas.
b. Show the patient some d. Cakes and pastries.
pictures of colostomies.
c. Arrange for someone who R: Meats and beans are high-
has a colostomy to visit the protein foods. In liver failure, the
patient. liver is unable to metabolize
d. Provide the patient with protein adequately, causing
written material about protein by-products to build up in
colostomy care. the body rather than be excreted.

R: Initially, you should assess the 100. An intubated patient is receiving

patient’s knowledge about continuous enteral feedings through
colostomies and how it will affect a Salem sump tube at a rate of
his lifestyle. 60ml/hr. Gastric residuals have
been 30-40ml when monitored Q4H.
 You check the gastric residual and hypovolemic complications of
aspirate 220ml. What is your first pancreatitis. Hypotension can be
response to this finding? caused by a hypovolemic complication,
a. Notify the doctor but hypertension usually isn’t related to
immediately. acute pancreatitis.
b. Stop the feeding, and clamp 3. A male client with a recent history
the NG tube. of rectal bleeding is being prepared
c. Discard the 220ml, and for a colonoscopy. How should the
clamp the NG tube. nurse position the client for this
d. Give a prescribed GI test initially?
stimulant such as a. Lying on the right side with legs
metoclopramide (Reglan). straight
b. Lying on the left side with knees
R: A gastric residual greater than 2
bent
hours worth of feeding or 100-
c. Prone with the torso elevated
150ml is considered too high. The
d. Bent over with hands touching
feeding should be stopped; NG
the floor
tube clamped, and then allow time
for the stomach to empty before R: For a colonoscopy, the nurse initially
additional feeding is added. should position the client on the left side
with knees bent. Placing the client on
RNPEDIA GASTRO 2
the right side with legs straight, prone
1. During preparation for bowel with the torso elevated, or bent over
surgery, a male client receives an with hands touching the floor wouldn’t
antibiotic to reduce intestinal allow proper visualization of the large
bacteria. Antibiotic therapy may intestine.
interfere with synthesis of which 4. A male client with extreme
vitamin and may lead to weakness, pallor, weak peripheral
hypoprothrombinemia? pulses, and disorientation is
a. vitamin A admitted to the emergency
b. vitamin D department. His wife reports that
c. vitamin E he has been “spitting up blood.” A
d. vitamin K Mallory-Weiss tear is suspected,
and the nurse begins taking a
R: Intestinal bacteria synthesize such
client history from the client’s wife.
nutritional substances as vitamin K,
The question by the nurse that
thiamine, riboflavin, vitamin B12, folic
demonstrates her understanding of
acid, biotin, and nicotinic acid.
Mallory-Weiss tearing is:
Therefore, antibiotic therapy may
a. “Tell me about your
interfere with synthesis of these
husband’s alcohol usage.”
substances, including vitamin K.
b. “Is your husband being
Intestinal bacteria don’t synthesize
treated for tuberculosis?”
vitamins A, D, or E.
c. “Has your husband
2. When evaluating a male client for
recently fallen or injured
complications of acute pancreatitis,
his chest?”
the nurse would observe for:
d. “Describe spices and
a. increased intracranial pressure.
condiments your husband
b. decreased urine output.
uses on food.”
c. bradycardia.
d. Hypertension. R: A Mallory-Weiss tear is
associated with massive bleeding
R: Acute pancreatitis can cause
after a tear occurs in the mucous
decreased urine output, which results
membrane at the junction of the
from the renal failure that sometimes
esophagus and stomach. There is a
accompanies this condition. Intracranial
strong relationship between
pressure neither increases nor
ethanol usage, resultant vomiting,
decreases in a client with pancreatitis.
and a Mallory-Weiss tear. The
Tachycardia, not bradycardia, usually is
bleeding is coming from the
associated with pulmonary or
stomach, not from the lungs as 7. The nurse is caring for a male
would be true in some cases of client with cirrhosis. Which
tuberculosis. A Mallory-Weiss tear assessment findings indicate
doesn’t occur from chest injuries or that the client has deficient
falls and isn’t associated with vitamin K absorption caused by
eating spicy foods. this hepatic disease?
a. Dyspnea and fatigue
5. Which of the following nursing
b. Ascites and orthopnea
interventions should the nurse
c. Purpura and petechiae
perform for a female client
d. Gynecomastia and
receiving enteral feedings
testicular atrophy
through a gastrostomy tube?
a. Change the tube feeding R: A hepatic disorder, such as
solutions and tubing at cirrhosis, may disrupt the liver’s
least every 24 hours. normal use of vitamin K to produce
b. Maintain the head of the prothrombin (a clotting factor).
bed at a 15-degree Consequently, the nurse should
elevation continuously. monitor the client for signs of
c. Check the gastrostomy bleeding, including purpura and
tube for position every 2 petechiae. Dyspnea and fatigue
days. suggest anemia. Ascites and
d. Maintain the client on bed orthopnea are unrelated to vitamin
rest during the feedings. K absorption. Gynecomastia and
R: Tube feeding solutions and testicular atrophy result from
tubing should be changed every 24 decreased estrogen metabolism by
hours, or more frequently if the the diseased liver.
feeding requires it. Doing so
8. Which condition is most likely to
prevents contamination and
have a nursing diagnosis of fluid
bacterial growth. The head of the
volume deficit?
bed should be elevated 30 to 45
a. Appendicitis
degrees continuously to prevent
b. Pancreatitis
aspiration. Checking for
c. Cholecystitis
gastrostomy tube placement is
d. Gastric ulcer
performed before initiating the
feedings and every 4 hours during R: Hypovolemic shock from fluid
continuous feedings. Clients may shifts is a major factor in acute
ambulate during feedings. pancreatitis. The other conditions
6. A male client is recovering from are less likely to exhibit fluid
a small-bowel resection. To volume deficit.
relieve pain, the physician
9. While a female client is being
prescribes meperidine
prepared for discharge, the
(Demerol), 75 mg I.M. every 4
nasogastric (NG) feeding tube
hours. How soon after
becomes clogged. To remedy
administration should
this problem and teach the
meperidine’s onset of action
client’s family how to deal with
occur?
it at home, what should the
a. 5 to 10 minutes
nurse do?
b. 15 to 30 minutes
a. Irrigate the tube with cola.
c. 30 to 60 minutes
b. Advance the tube into the
d. 2 to 4 hours
intestine.
R: Meperidine’s onset of action is c. Apply intermittent suction
15 to 30 minutes. It peaks between to the tube.
30 and 60 minutes and has a d. Withdraw the obstruction
duration of action of 2 to 4 hours. with a 30-ml syringe.

R: The nurse should irrigate the

tube with cola because its
effervescence and acidity are b. Powerlessness
suited to the purpose, it’s c. Chronic low self esteem
inexpensive, and it’s readily d. Deficient knowledge
available in most homes.
Advancing the NG tube is R: Young women with Chronic low
inappropriate because the tube is self esteem — are at highest risk
designed to stay in the stomach for anorexia nervosa because they
and isn’t long enough to reach the perceive being thin as a way to
intestines. Applying intermittent improve their self-confidence.
suction or using a syringe for Hopelessness and Powerlessness
aspiration is unlikely to dislodge are inappropriate nursing
the material clogging the tube but diagnoses because clients with
may create excess pressure. anorexia nervosa seldom feel
Intermittent suction may even hopeless or powerless; instead,
collapse the tube. they use food to control their
desire to be thin and hope that
10. A male client with restricting food intake will achieve
pancreatitis complains of pain. this goal. Anorexia nervosa doesn’t
The nurse expects the physician result from a knowledge deficit,
to prescribe meperidine such as one regarding good
(Demerol) instead of morphine nutrition.
to relieve pain because:
a. meperidine provides a 12. Which diagnostic test would
better, more prolonged be used first to evaluate a client
analgesic effect. with upper GI bleeding?
b. morphine may cause a. Endoscopy
spasms of Oddi’s b. Upper GI series
sphincter. c. Hemoglobin (Hb) levels
c. meperidine is less and hematocrit (HCT)
addictive than morphine. d. Arteriography
d. morphine may cause
R: Endoscopy permits direct
hepatic dysfunction.
evaluation of the upper GI tract
R: For a client with pancreatitis, and can detect 90% of bleeding
the physician will probably avoid lesions. An upper GI series, or
prescribing morphine because this barium study, usually isn’t the
drug may trigger spasms of the diagnostic method of choice,
sphincter of Oddi (a sphincter at especially in a client with acute
the end of the pancreatic duct), active bleeding who’s vomiting and
causing irritation of the pancreas. unstable. An upper GI series is also
Meperidine has a somewhat less accurate than endoscopy.
shorter duration of action than Although an upper GI series might
morphine. The two drugs are confirm the presence of a lesion, it
equally addictive. Morphine isn’t wouldn’t necessarily reveal
associated with hepatic whether the lesion is bleeding. Hb
dysfunction. levels and HCT, which indicate loss
of blood volume, aren’t always
11. Mandy, an adolescent girl is reliable indicators of GI bleeding
admitted to an acute care because a decrease in these values
facility with severe malnutrition. may not be seen for several hours.
After a thorough examination, Arteriography is an invasive study
the physician diagnoses associated with life-threatening
anorexia nervosa. When complications and wouldn’t be
developing the plan of care for used for an initial evaluation.
this client, the nurse is most
likely to include which nursing 13. A female client who has just
diagnosis? been diagnosed with hepatitis A
a. Hopelessness asks, “How could I have gotten
 this disease?” What is the surgery because obstruction of the
nurse’s best response? appendix causes mucus fluid to
a. “You may have eaten build up, increasing pressure in the
contaminated restaurant appendix and compressing venous
food.” outflow drainage. The pressure
b. “You could have gotten it continues to rise with venous
by using I.V. drugs.” obstruction; arterial blood flow
c. “You must have received then decreases, leading to
an infected blood ischemia from lack of perfusion.
transfusion.” Inflammation and bacterial growth
d. “You probably got it by follow, and swelling continues to
engaging in unprotected raise pressure within the appendix,
sex.” resulting in gangrene and rupture.
Geriatric, not middle-aged, clients
R: Hepatitis A virus typically is are especially susceptible to
transmitted by the oral-fecal route appendix rupture.
— commonly by consuming food
contaminated by infected food 15. A female client with hepatitis
handlers. The virus isn’t C develops liver failure and GI
transmitted by the I.V. route, blood hemorrhage. The blood products
transfusions, or unprotected sex. that would most likely bring
Hepatitis B can be transmitted by about hemostasis in the client
I.V. drug use or blood transfusion. are:
Hepatitis C can be transmitted by a. whole blood and albumin.
unprotected sex. b. platelets and packed red
blood cells.
14. When preparing a male c. fresh frozen plasma and
client, age 51, for surgery to whole blood.
treat appendicitis, the nurse d. cryoprecipitate and fresh
formulates a nursing diagnosis frozen plasma.
of Risk for infection related to
inflammation, perforation, and R: The liver is vital in the synthesis
surgery. What is the rationale of clotting factors, so when it’s
for choosing this nursing diseased or dysfunctional, as in
diagnosis? hepatitis C, bleeding occurs.
a. Obstruction of the Treatment consists of
appendix may increase administering blood products that
venous drainage and aid clotting. These include fresh
cause the appendix to frozen plasma containing
rupture. fibrinogen and cryoprecipitate,
b. Obstruction of the which have most of the clotting
appendix reduces arterial factors. Although administering
flow, leading to ischemia, whole blood, albumin, and packed
inflammation, and rupture cells will contribute to hemostasis,
of the appendix. those products aren’t specifically
c. The appendix may used to treat hemostasis. Platelets
develop gangrene and are helpful, but the best answer is
rupture, especially in a cryoprecipitate and fresh frozen
middle-aged client. plasma.
d. Infection of the appendix
diminishes necrotic 16. To prevent gastroesophageal
arterial blood flow and reflux in a male client with hiatal
increases venous hernia, the nurse should provide
drainage. which discharge instruction?
a. “Lie down after meals to
R: A client with appendicitis is at promote digestion.”
risk for infection related to b. “Avoid coffee and
inflammation, perforation, and alcoholic beverages.”
 c. “Take antacids with b. The client is free from
meals.” esophagitis and achalasia.
d. “Limit fluid intake with c. The client reports
meals.” diminished duodenal
inflammation.
R: To prevent reflux of stomach d. The client has normal
acid into the esophagus, the nurse gastric structures.
should advise the client to avoid
foods and beverages that increase R: Dysphagia may be the reason
stomach acid, such as coffee and why a client with esophagitis or
alcohol. The nurse also should achalasia seeks treatment.
teach the client to avoid lying Dysphagia isn’t associated with
down after meals, which can rectal tenesmus, duodenal
aggravate reflux, and to take inflammation, or abnormal gastric
antacids after eating. The client structures.
need not limit fluid intake with
meals as long as the fluids aren’t 19. A male client undergoes total
gastric irritants. gastrectomy. Several hours
after surgery, the nurse notes
17. The nurse caring for a client that the client’s nasogastric
with small-bowel obstruction (NG) tube has stopped draining.
would plan to implement which How should the nurse respond?
nursing intervention first? a. Notify the physician
a. Administering pain b. Reposition the tube
medication c. Irrigate the tube
b. Obtaining a blood sample d. Increase the suction level
for laboratory studies
c. Preparing to insert a R: An NG tube that fails to drain
nasogastric (NG) tube during the postoperative period
d. Administering I.V. fluids should be reported to the physician
immediately. It may be clogged,
R: I.V. infusions containing normal which could increase pressure on
saline solution and potassium the suture site because fluid isn’t
should be given first to maintain draining adequately. Repositioning
fluid and electrolyte balance. For or irrigating an NG tube in a client
the client’s comfort and to assist in who has undergone gastric surgery
bowel decompression, the nurse can disrupt the anastomosis.
should prepare to insert an NG Increasing the level of suction may
tube next. A blood sample is then cause trauma to GI mucosa or the
obtained for laboratory studies to suture line.
aid in the diagnosis of bowel
obstruction and guide treatment. 20. What laboratory finding is the
Blood studies usually include a primary diagnostic indicator for
complete blood count, serum pancreatitis?
electrolyte levels, and blood urea a. Elevated blood urea
nitrogen level. Pain medication nitrogen (BUN)
often is withheld until obstruction b. Elevated serum lipase
is diagnosed because analgesics c. Elevated aspartate
can decrease intestinal motility. aminotransferase (AST)
d. Increased lactate
18. A female client with dehydrogenase (LD)
dysphagia is being prepared for
discharge. Which outcome R: Elevation of serum lipase is the
indicates that the client is ready most reliable indicator of
for discharge? pancreatitis because this enzyme
a. The client doesn’t exhibit is produced solely by the pancreas.
rectal tenesmus. A client’s BUN is typically elevated
in relation to renal dysfunction; the
AST, in relation to liver
dysfunction; and LD, in relation to R: The RUQ contains the liver,
damaged cardiac muscle. gallbladder, duodenum, head of
the pancreas, hepatic flexure of
21. A male client with the colon, portions of the
cholelithiasis has a gallstone ascending and transverse colon,
lodged in the common bile duct. and a portion of the right kidney.
When assessing this client, the The sigmoid colon is located in the
nurse expects to note: left lower quadrant; the appendix,
a. yellow sclerae. in the right lower quadrant; and
b. light amber urine. the spleen, in the left upper
c. circumoral pallor. quadrant.
d. black, tarry stools.
24. A male client has undergone
R: Yellow sclerae may be the first a colon resection. While turning
sign of jaundice, which occurs him, wound dehiscence with
when the common bile duct is evisceration occurs. The nurse’s
obstructed. Urine normally is light first response is to:
amber. Circumoral pallor and a. call the physician.
black, tarry stools don’t occur in b. place saline-soaked sterile
common bile duct obstruction; they dressings on the wound.
are signs of hypoxia and GI c. take a blood pressure and
bleeding, respectively. pulse.
d. pull the dehiscence
22. Nurse Hannah is teaching a
closed.
group of middle-aged men
about peptic ulcers. When R: The nurse should first place
discussing risk factors for peptic saline-soaked sterile dressings on
ulcers, the nurse should the open wound to prevent tissue
mention: drying and possible infection. Then
a. a sedentary lifestyle and the nurse should call the physician
smoking. and take the client’s vital signs.
b. a history of hemorrhoids The dehiscence needs to be
and smoking. surgically closed, so the nurse
c. alcohol abuse and a should never try to close it.
history of acute renal
failure. 25. The nurse is monitoring a
d. alcohol abuse and female client receiving
smoking. paregoric to treat diarrhea for
drug interactions. Which drugs
R: Risk factors for peptic (gastric can produce additive
and duodenal) ulcers include constipation when given with an
alcohol abuse, smoking, and opium preparation?
stress. A sedentary lifestyle and a a. Antiarrhythmic drugs
history of hemorrhoids aren’t risk b. Anticholinergic drugs
factors for peptic ulcers. Chronic c. Anticoagulant drugs
renal failure, not acute renal d. Antihypertensive drugs
failure, is associated with duodenal
ulcers. R: Paregoric has an additive effect
of constipation when used with
23. While palpating a female anticholinergic drugs.
client’s right upper quadrant Antiarrhythmics, anticoagulants,
(RUQ), the nurse would expect and antihypertensives aren’t
to find which of the following known to interact with paregoric.
structures?
a. Sigmoid colon 26. A male client is recovering
b. Appendix from an ileostomy that was
c. Spleen performed to treat inflammatory
d. Liver bowel disease. During discharge
 teaching, the nurse should a. severe abdominal pain
stress the importance of: radiating to the shoulder.
a. increasing fluid intake to b. anorexia, nausea, and
prevent dehydration. vomiting.
b. wearing an appliance c. eructation and
pouch only at bedtime. constipation.
c. consuming a low-protein, d. abdominal ascites.
high-fiber diet.
d. taking only enteric-coated R: Hallmark signs and symptoms of
medications. hepatitis A include anorexia,
nausea, vomiting, fatigue, and
R: Because stool forms in the large weakness. Abdominal pain may
intestine, an ileostomy typically occur but doesn’t radiate to the
drains liquid waste. To avoid fluid shoulder. Eructation and
loss through ileostomy drainage, constipation are common in
the nurse should instruct the client gallbladder disease, not hepatitis
to increase fluid intake. The nurse A. Abdominal ascites is a sign of
should teach the client to wear a advanced hepatic disease, not an
collection appliance at all times early sign of hepatitis A.
because ileostomy drainage is
incontinent, to avoid high-fiber 29. A female client with viral
foods because they may irritate hepatitis A is being treated in an
the intestines, and to avoid enteric- acute care facility. Because the
coated medications because the client requires enteric
body can’t absorb them after an precautions, the nurse should:
ileostomy a. place the client in a
private room.
27. The nurse is caring for a b. wear a mask when
female client with active upper handling the client’s
GI bleeding. What is the bedpan.
appropriate diet for this client c. wash the hands after
during the first 24 hours after touching the client.
admission? d. wear a gown when
a. Regular diet providing personal care
b. Skim milk for the client.
c. Nothing by mouth
d. Clear liquids R: To maintain enteric precautions,
the nurse must wash the hands
R: Shock and bleeding must be after touching the client or
controlled before oral intake, so potentially contaminated articles
the client should receive nothing and before caring for another
by mouth. A regular diet is client. A private room is warranted
incorrect. When the bleeding is only if the client has poor hygiene
controlled, the diet is gradually — for instance, if the client is
increased, starting with ice chips unlikely to wash the hands after
and then clear liquids. Skim milk touching infective material or is
shouldn’t be given because it likely to share contaminated
increases gastric acid production, articles with other clients. For
which could prolong bleeding. A enteric precautions, the nurse
liquid diet is the first diet offered need not wear a mask and must
after bleeding and shock are wear a gown only if soiling from
controlled. fecal matter is likely.

28. A male client has just been 30. Which of the following factors
diagnosed with hepatitis A. On can cause hepatitis A?
assessment, the nurse expects a. Contact with infected
to note: blood
 b. Blood transfusions with continuous suction. During the
infected blood immediate postoperative period,
c. Eating contaminated you expect the gastric
shellfish secretions to be which color?
d. Sexual contact with an a. Brown.
infected person b. Clear.
c. Red.
R: Hepatitis A can be caused by d. Yellow.
consuming contaminated water,
milk, or food — especially shellfish R: Normally, drainage is bloody for
from contaminated water. Hepatitis the first 24 hours after a partial
B is caused by blood and sexual gastrectomy; then it changes to
contact with an infected person. brown-tinged and then to yellow or
Hepatitis C is usually caused by clear.
contact with infected blood,
including receiving blood 34. Your patient has a
transfusions. retractable gastric peptic ulcer
and has had a gastric vagotomy.
31. Your patient with peritonitis Which factor increases as a
is NPO and complaining of thirst. result of vagotomy?
What is your priority? a. Peristalsis.
a. Increase the I.V. infusion b. Gastric acidity.
rate. c. Gastric motility.
b. Use diversion activities. d. Gastric pH.
c. Provide frequent mouth
care. R: If the vagus nerve is cut as it
d. Give ice chips every 15 enters the stomach, gastric acid
minutes. secretion is decreased, but
intestinal motility is also decreased
R: Frequent mouth care helps and gastric emptying is delayed.
relieve dry mouth. Because gastric acids are
decreased, gastric pH increases.
32. Kevin has a history of peptic
ulcer disease and vomits coffee- 35. Christina is receiving an
ground emesis. What does this enteral feeding that requires a
indicate? concentration of 80ml of
a. He has fresh, active upper supplement mixed with 20 ml of
GI bleeding. water. How much water do you
b. He needs immediate mix with an 8 oz (240ml) can of
saline gastric lavage. feeding?
c. His gastric bleeding a. 60 ml.
occurred 2 hours earlier. b. 70 ml.
d. He needs a transfusion of c. 80 ml.
packed RBC’s. d. 90 ml.

R: Coffee-ground emesis occurs R: Dosage problem. It’s 80/20 =

when there is upper GI bleeding 240/X. X=60.
that has undergone gastric
digestion. For blood to appear as 36. Which stoma would you
coffee-ground emesis, it would expect a malodorous, enzyme-
have to be digested for rich, caustic liquid output that is
approximately 2 hours. yellow, green, or brown?
a. Ileostomy.
33. A 53 y.o. patient has b. Ascending colostomy.
undergone a partial c. Transverse colostomy.
gastrectomy for d. Descending colostomy.
adenocarcinoma of the
stomach. An NG tube is in place R: The output from an Ileostomy is
and is connected to low described.
37. George has a T tube in place secondary to diverticulitis,
after gallbladder surgery. Before begins to cough violently after
discharge, what information or drinking water. His wound has
instructions should be given ruptured and a small segment of
regarding the T tube drainage? the bowel is protruding. What’s
a. “If there is any drainage, your priority?
notify the surgeon a. Ask the patient what
immediately.” happened, call the doctor,
b. “The drainage will and cover the area with a
decrease daily until the water-soaked bedsheet.
bile duct heals.” b. Obtain vital signs, call the
c. “First, the drainage is dark doctor, and obtain
green; then it becomes emergency orders.
dark yellow.” c. Have a CAN hold the
d. “If the drainage stops, wound together while you
milk the tube toward the obtain vital signs, call the
puncture wound.” doctor and flex the
patient’s knees.
R: As healing occurs from the bile d. Have the doctor called
duct, bile drains from the tube; the while you remain with the
amount of bile should decrease. patient, flex the patient’s
Teach the patient to expect dark knees, and cover the
green drainage and to notify the wound with sterile towels
doctor if drainage stops. soaked in sterile saline
solution.
38. Your patient Maria takes
NSAIDS for her degenerative RNPEDIA GASTRO 3
joint disease, has developed
1. Which of the following
peptic ulcer disease. Which drug
complications is thought to be
is useful in preventing NSAID-
the most common cause of
induced peptic ulcer disease?
appendicitis?
a. Calcium carbonate (Tums)
a. A fecalith
b. Famotidine (Pepcid)
b. Bowel kinking
c. Misoprostol (Cytotec)
c. Internal bowel occlusion
d. Sucralfate (Carafate)
d. Abdominal bowel swelling
R: Misoprostol restores R: A fecalith is a fecal calculus,
prostaglandins that protect the or stone, that occludes the
stomach from NSAIDS, which lumen of the appendix and is
diminish the prostaglandins. the most common cause of
appendicitis. Bowel wall
39. The student nurse is swelling, kinking of the
participating in colorectal appendix, and external
cancer-screening program. occlusion, not internal occlusion,
Which patient has the fewest of the bowel by adhesions can
risk factors for colon cancer? also be causes of appendicitis.
a. Janice, a 45 y.o. with a 25- 2. Which of the following terms
year history of ulcerative best describes the pain
colitis associated with appendicitis?
b. George, a 50 y.o. whose a. Aching
father died of colon cancer b. Fleeting
c. Herman, a 60 y.o. who c. Intermittent
follows a low-fat, high- d. Steady
fiber diet R: The pain begins in the
d. Sissy, a 72 y.o. with a epigastrium or periumbilical
history of breast cancer region, then shifts to the right
40. Your patient, post-op lower quadrant and becomes
drainage of a pelvic abscess
 steady. The pain may be 5. Which of the following
moderate to severe. substances is most likely to
3. Which of the following nursing cause gastritis?
interventions should be a. Milk
implemented to manage a client b. Bicarbonate of soda, or
with appendicitis? baking soda
a. Assessing for pain c. Enteric coated aspirin
b. Encouraging oral intake of d. Nonsteriodal anti-
clear fluids imflammatory drugs
c. Providing discharge R: NSAIDS are a common cause
teaching of gastritis because they inhibit
d. Assessing for symptoms of prostaglandin synthesis. Milk,
peritonitis once thought to help gastritis,
R: The focus of care is to assess has little effect on the stomach
for peritonitis, or inflammation mucosa. Bicarbonate of soda, or
of the peritoneal cavity. baking soda, may be used to
Peritonitis is most commonly neutralize stomach acid, but it
caused by appendix rupture and should be used cautiously
invasion of bacteria, which could because it may lead to
be lethal. The client with metabolic acidosis. ASA with
appendicitis will have pain that enteric coating shouldn’t
should be controlled with contribute significantly to
analgesia. The nurse should gastritis because the coating
discourage oral intake in limits the aspirin’s effect on the
preparation of surgery. gastric mucosa.
Discharge teaching is important; 6. Which of the following
however, in the acute phase, definitions best describes
management should focus on diverticulosis?
minimizing preoperative a. An inflamed outpouching
complications and recognizing of the intestine
when such may be occurring. b. A noninflamed
4. Which of the following outpouching of the
definitions best describes intestine
gastritis? c. The partial impairment of
a. Erosion of the gastric the forward flow of
mucosa intestinal contents
b. Inflammation of a d. An abnormal protrusion of
diverticulum an organ through the
c. Inflammation of the structure that usually
gastric mucosa holds it.
d. Reflux of stomach acid R: Diverticulosis involves a
into the esophagus noninflamed outpouching of the
R: Gastritis is an inflammation of intestine. Diverticulitis involves
the gastric mucosa that may be an inflamed outpouching. The
acute (often resulting from partial impairment of forward
exposure to local irritants) or flow of the intestine is an
chronic (associated with obstruction; abnormal
autoimmune infections or protrusion of an organ is a
atrophic disorders of the hernia.
stomach). Erosion of the mucosa 7. Which of the following types of
results in ulceration. diets is implicated in the
Inflammation of a diverticulum development of diverticulosis?
is called diverticulitis; reflux of a. Low-fiber diet
stomach acid is known as b. High-fiber diet
gastroesophageal disease. c. High-protein diet
d. Low-carbohydrate diet
 R: Low-fiber diets have been 10. Which of the following tests
implicated in the development should be administered to a
of diverticula because these client suspected of having
diets decrease the bulk in the diverticulosis?
stool and predispose the person a. Abdominal ultrasound
to the development of b. Barium enema
constipation. A high-fiber diet is c. Barium swallow
recommended to help prevent d. Gastroscopy
diverticulosis. A high-protein or R: A barium enema will cause
low-carbohydrate diet has no diverticula to fill with barium
effect on the development of and be easily seen on x-ray. An
diverticulosis. abdominal US can tell more
8. Which of the following about structures, such as the
mechanisms can facilitate the gallbladder, liver, and spleen,
development of diverticulosis than the intestine. A barium
into diverticulitis? swallow and gastroscopy view
a. Treating constipation with upper GI structures.
chronic laxative use, 11. Medical management of the
leading to dependence on client with diverticulitis should
laxatives include which of the following
b. Chronic constipation treatments?
causing an obstruction, a. Reduced fluid intake
reducing forward flow of b. Increased fiber in diet
intestinal contents c. Administration of
c. Herniation of the intestinal antibiotics
mucosa, rupturing the wall d. Exercises to increase
of the intestine intra-abdominal pressure
d. Undigested food blocking R: Antibiotics are used to reduce
the diverticulum, the inflammation. The client
predisposing the area to isn’t typically isn’t allowed
bacteria invasion. anything orally until the acute
R: Undigested food can block episode subsides. Parenteral
the diverticulum, decreasing fluids are given until the client
blood supply to the area and feels better; then it’s
predisposing the area to recommended that the client
invasion of bacteria. Chronic drink eight 8-ounce glasses of
laxative use is a common water per day and gradually
problem in elderly clients, but it increase fiber in the diet to
doesn’t cause diverticulitis. improve intestinal motility.
Chronic constipation can cause During the acute phase,
an obstruction—not activities that increase intra-
diverticulitis. Herniation of the abdominal pressure should be
intestinal mucosa causes an avoided to decrease pain and
intestinal perforation. the chance of intestinal
9. Which of the following obstruction.
symptoms indicated 12. Crohn’s disease can be
diverticulosis? described as a chronic relapsing
a. No symptoms exist disease. Which of the following
b. Change in bowel habits areas in the GI system may be
c. Anorexia with low-grade involved with this disease?
fever a. The entire length of the
d. Episodic, dull, or steady large colon
midabdominal pain b. Only the sigmoid area
R: Diverticulosis is an c. The entire large colon
asymptomatic condition. The through the layers of
other choices are signs and mucosa and submucosa
symptoms of diverticulitis.
 d. The small intestine and exacerbate the attacks but isn’t
colon; affecting the entire believed to be the primary
thickness of the bowel cause.
R: Crohn’s disease can involve 16. Fistulas are most common
any segment of the small with which of the following
intestine, the colon, or both, bowel disorders?
affecting the entire thickness of a. Crohn’s disease
the bowel. Answers A and C b. Diverticulitis
describe ulcerative colitis, c. Diverticulosis
answer B is too specific and d. Ulcerative colitis
therefore, not likely. R: The lesions of Crohn’s
13. Which area of the alimentary disease are transmural; that is,
canal is the most common they involve all thickness of the
location for Crohn’s disease? bowel. These lesions may
a. Ascending colon perforate the bowel wall,
b. Descending colon forming fistulas with adjacent
c. Sigmoid colon structures. Fistulas don’t
d. Terminal ileum develop in diverticulitis or
R: Studies have shown that the diverticulosis. The ulcers that
terminal ileum is the most occur in the submucosal and
common site for recurrence in mucosal layers of the intestine
clients with Crohn’s disease. The in ulcerative colitis usually don’t
other areas may be involved but progress to fistula formation as
aren’t as common. in Crohn’s disease.
14. Which of the following factors 17. Which of the following areas
is believed to be linked to is the most common site of
Crohn’s disease? fistulas in client’s with Crohn’s
a. Constipation disease?
b. Diet a. Anorectal
c. Hereditary b. Ileum
d. Lack of exercise c. Rectovaginal
R: Although the definite cause of d. Transverse colon
Crohn’s disease is unknown, it’s R: Fistulas occur in all these
thought to be associated with areas, but the anorectal area is
infectious, immune, or most common because of the
psychological factors. Because it relative thinness of the
has a higher incidence in intestinal wall in this area.
siblings, it may have a genetic 18. Which of the following
cause. associated disorders may a
15. Which of the following factors client with ulcerative colitis
is believed to cause ulcerative exhibit?
colitis? a. Gallstones
a. Acidic diet b. Hydronephrosis
b. Altered immunity c. Nephrolithiasis
c. Chronic constipation d. Toxic megacolon
d. Emotional stress R: Toxic megacolon is extreme
R: Several theories exist dilation of a segment of the
regarding the cause of diseased colon caused by
ulcerative colitis. One suggests paralysis of the colon, resulting
altered immunity as the cause in complete obstruction. This
based on the extraintestinal disorder is associated with both
characteristics of the disease, Crohn’s disease and ulcerative
such as peripheral arthritis and colitis. The other disorders are
cholangitis. Diet and more commonly associated with
constipation have no effect on Crohn’s disease.
the development of ulcerative 19. Which of the following
colitis. Emotional stress can associated disorders may the
 client with Crohn’s disease d. Colonoscopy with biopsy
exhibit? R: A colonoscopy with biopsy
a. Ankylosing spondylitis can be performed to determine
b. Colon cancer the state of the colon’s mucosal
c. Malabsorption layers, presence of ulcerations,
d. Lactase deficiency and level of cytologic
R: Because of the transmural development. An abdominal x-
nature of Crohn’s disease ray or CT scan wouldn’t provide
lesions, malaborption may occur the cytologic information
with Crohn’s disease. Ankylosing necessary to diagnose which
spondylitis and colon cancer are disease it is. A barium swallow
more commonly associated with doesn’t involve the intestine.
ulcerative colitis. Lactase 23. Which of the following
deficiency is caused by a interventions should be included
congenital defect in which an in the medical management of
enzyme isn’t present. Crohn’s disease?
20. Which of the following a. Increasing oral intake of
symptoms may be exhibited by fiber
a client with Crohn’s disease? b. Administering laxatives
a. Bloody diarrhea c. Using long-term steroid
b. Narrow stools therapy
c. N/V d. Increasing physical
d. Steatorrhea activity
R: Steatorrhea from R: Management of Crohn’s
malaborption can occur with disease may include long-term
Crohn’s disease. N/V, and steroid therapy to reduce the
bloody diarrhea are symptoms inflammation associated with
of ulcerative colitis. Narrow the deeper layers of the bowel
stools are associated with wall. Other management
diverticular disease. focuses on bowel rest (not
21. Which of the following increasing oral intake) and
symptoms is associated with reducing diarrhea with
ulcerative colitis? medications (not giving
a. Dumping syndrome laxatives). The pain associated
b. Rectal bleeding with Crohn’s disease may
c. Soft stools require bed rest, not an increase
d. Fistulas in physical activity.
R: In ulcerative colitis, rectal 24. In a client with Crohn’s
bleeding is the predominant disease, which of the following
symptom. Soft stools are more symptoms should not be a
commonly associated with direct result from antibiotic
Crohn’s disease, in which therapy?
malabsorption is more of a a. Decrease in bleeding
problem. Dumping syndrome b. Decrease in temperature
occurs after gastric surgeries. c. Decrease in body weight
Fistulas are associated with d. Decrease in the number of
Crohn’s disease. stools
22. If a client had irritable bowel R: A decrease in body weight
syndrome, which of the may occur during therapy due
following diagnostic tests would to inadequate dietary intake,
determine if the diagnosis is but isn’t related to antibiotic
Crohn’s disease or ulcerative therapy. Effective antibiotic
colitis? therapy will be noted by a
a. Abdominal computed decrease in temperature,
tomography (CT) scan number of stools, and bleeding.
b. Abdominal x-ray 25. Surgical management of
c. Barium swallow ulcerative colitis may be
 performed to treat which of the polposis seem to increase a
following complications? person’s chance of developing
a. Gastritis colon cancer. The other
b. Bowel herniation conditions listed have no known
c. Bowel outpouching effect on colon cancer risk.
d. Bowel perforation 29. Which of the following diets
R: Perforation, obstruction, is most commonly associated
hemorrhage, and toxic with colon cancer?
megacolon are common a. Low-fiber, high fat
complications of ulcerative b. Low-fat, high-fiber
colitis that may require surgery. c. Low-protein, high-
Herniation and gastritis aren’t carbohydrate
associated with irritable bowel d. Low carbohydrate, high
diseases, and outpouching of protein
the bowel is diverticulosis. R: A low-fiber, high-fat diet
26. Which of the following reduced motility and increases
medications is most effective for the chance of constipation. The
treating the pain associated metabolic end products of this
with irritable bowel disease? type of diet are carcinogenic. A
a. Acetaminophen low-fat, high-fiber diet is
b. Opiates recommended to prevent colon
c. Steroids cancer.
d. Stool softeners 30. Which of the following
R: The pain with irritable bowel diagnostic tests should be
disease is caused by performed annually over age 50
inflammation, which steroids to screen for colon cancer?
can reduce. Stool softeners a. Abdominal CT scan
aren’t necessary. b. Abdominal x-ray
Acetaminophen has little effect c. Colonoscopy
on the pain, and opiate d. Fecal occult blood test
narcotics won’t treat its R: Surface blood vessels of
underlying cause (I feel this is polyps and cancers are fragile
untrue—dilaudid will and often bleed with the
helpanything!) passage of stools. Abdominal x-
27. During the first few days of ray and CT scan can help
recovery from ostomy surgery establish tumor size and
for ulcerative colitis, which of metastasis. A colonoscopy can
the following aspects should be help locate a tumor as well as
the first priority of client care? polyps, which can be removed
a. Body image before they become malignant.
b. Ostomy care 31. Radiation therapy is used to
c. Sexual concerns treat colon cancer before
d. Skin care surgery for which of the
R: Although all of these are following reasons?
concerns the nurse should a. Reducing the size of the
address, being able to safely tumor
manage the ostomy is crucial b. Eliminating the malignant
for the client before discharge. cells
28. Colon cancer is most closely c. Curing the cancer
associated with which of the d. Helping the bowel heal
following conditions? after surgery
a. Appendicitis R: Radiation therapy is used to
b. Hemorrhoids treat colon cancer before
c. Hiatal hernia surgery to reduce the size of the
d. Ulcerative colitis tumor, making it easier to be
R: Chronic ulcerative colitis, resected. Radiation therapy isn’t
granulomas, and familial curative, can’t eliminate the
 malignant cells (though it helps a. Barium enema
define tumor margins), can b. Colonoscopy
could slow postoperative c. Gastroscopy
healing. d. Serum chemistry levels
32. Which of the following R: gastroscopy will allow direct
symptoms is a client with colon visualization of the tumor. A
cancer most likely to exhibit? colonoscopy or a barium enema
a. A change in appetite would help diagnose colon
b. A change in bowel habits cancer. Serum chemistry levels
c. An increase in body don’t contribute data useful to
weight the assessment of gastric
d. An increase in body cancer.
temperature 36. A client with gastric cancer
R: The most common complaint can expect to have surgery for
of the client with colon cancer is resection. Which of the following
a change in bowel habits. The should be the nursing
client may have anorexia, management priority for the
secondary abdominal distention, preoperative client with gastric
or weight loss. Fever isn’t cancer?
associated with colon cancer. a. Discharge planning
33. A client has just had surgery b. Correction of nutritional
for colon cancer. Which of the deficits
following disorders might the c. Prevention of DVT
client develop? d. Instruction regarding
a. Peritonitis radiation treatment
b. Diverticulosis R: Client’s with gastric cancer
c. Partial bowel obstruction commonly have nutritional
d. Complete bowel deficits and may be cachectic.
obstruction Discharge planning before
R: Bowel spillage could occur surgery is important, but
during surgery, resulting in correcting the nutrition deficit is
peritonitis. Complete or partial a higher priority. At present,
bowel obstruction may occur radiation therapy hasn’t been
before bowel resection. proven effective for gastric
Diverticulosis doesn’t result cancer, and teaching about it
from surgery or colon cancer. preoperatively wouldn’t be
34. A client with gastric cancer appropriate. Prevention of DVT
may exhibit which of the also isn’t a high priority to
following symptoms? surgery, though it assumes
a. Abdominal cramping greater importance after
b. Constant hunger surgery.
c. Feeling of fullness 37. Care for the postoperative
d. Weight gain client after gastric resection
R: The client with gastric cancer should focus on which of the
may report a feeling of fullness following problems?
in the stomach, but not enough a. Body image
to cause him to seek medical b. Nutritional needs
attention. Abdominal cramping c. Skin care
isn’t associated with gastric d. Spiritual needs
cancer. Anorexia and weight R: After gastric resection, a
loss (not increased hunger or client may require total
weight gain) are common parenteral nutrition or
symptoms of gastric cancer. jejunostomy tube feedings to
35. Which of the following maintain adequate nutritional
diagnostic tests may be status.
performed to determine if a 38. Which of the following
client has gastric cancer? complications of gastric
 resection should the nurse teach 41. Which of the following
the client to watch for? treatments is used for rectal
a. Constipation cancer but not for colon cancer?
b. Dumping syndrome a. Chemotherapy
c. Gastric spasm b. Colonoscopy
d. Intestinal spasms c. Radiation
R: Dumping syndrome is a d. Surgical resection
problem that occurs R: A client with rectal cancer
postprandially after gastric can expect to have radiation
resection because ingested food therapy in addition to
rapidly enters the jejunum chemotherapy and surgical
without proper mixing and resection of the tumor. A
without the normal duodenal colonoscopy is performed to
digestive processing. Diarrhea, diagnose the disease. Radiation
not constipation, may also be a therapy isn’t usually indicated in
symptom. Gastric or intestinal colon cancer.
spasms don’t occur, but 42. Which of the following
antispasmidics may be given to conditions is most likely to
slow gastric emptying. directly cause peritonitis?
39. A client with rectal cancer a. Cholelithiasis
may exhibit which of the b. Gastritis
following symptoms? c. Perforated ulcer
a. Abdominal fullness d. Incarcerated hernia
b. Gastric fullness R: The most common cause of
c. Rectal bleeding peritonitis is a perforated ulcer,
d. Right upper quadrant pain which can pour contaminates
R: Rectal bleeding is a common into the peritoneal cavity,
symptom of rectal cancer. causing inflammation and
Rectal cancer may be missed infection within the cavity. The
because other conditions such other conditions don’t by
as hemorrhoids can cause rectal themselves cause peritonitis.
bleeding. Abdominal fullness However, if cholelithiasis leads
may occur with colon cancer, to rupture of the gallbladder,
gastric fullness may occur with gastritis leads to erosion of the
gastric cancer, and right upper stomach wall, or an incarcerated
quadrant pain may occur with hernia leads to rupture of the
liver cancer. intestines, peritonitis may
40. A client with which of the develop.
following conditions may be 43. Which of the following
likely to develop rectal cancer? symptoms would a client in the
a. Adenomatous polyps early stages of peritonitis
b. Diverticulitis exhibit?
c. Hemorrhoids a. Abdominal distention
d. Peptic ulcer disease b. Abdominal pain and
R: A client with adenomatous rigidity
polyps has a higher risk for c. Hyperactive bowel sounds
developing rectal cancer than d. Right upper quadrant pain
others do. Clients with R: Abdominal pain causing
diverticulitis are more likely to rigidity of the abdominal
develop colon cancer. muscles is characteristic of
Hemorrhoids don’t increase the peritonitis. Abdominal distention
chance of any type of cancer. may occur as a late sign but not
Clients with peptic ulcer disease early on. Bowel sounds may be
have a higher incidence of normal or decreased but not
gastric cancer. increased. Right upper quadrant
pain is chatacteristic of
cholecystitis or hepatitis.
44. Which of the following may be needed periodically to
laboratory results would be ensure patency of the
expected in a client with nasogastric tube. Although pain
peritonitis? management is important for
a. Partial thromboplastin comfort and psychosocial care
time above 100 seconds will address concerns such as
b. Hemoglobin level below anxiety, focusing on fluid and
10 mg/dL electrolyte imbalance will
c. Potassium level above 5.5 maintain hemodynamic stability.
mEq/L 47. A client with irritable bowel
d. White blood cell count syndrome is being prepared for
above 15,000 discharge. Which of the
R: Because of infection, the following meal plans should the
client’s WBC count will be nurse give the client?
elevated. A hemoglobin level a. Low fiber, low-fat
below 10 mg/dl may occur from b. High fiber, low-fat
hemorrhage. A PT time longer c. Low fiber, high-fat
than 100 seconds may suggest d. High-fiber, high-fat
disseminated intravascular R: The client with irritable bowel
coagulation, a serious syndrome needs to be on a diet
complication of septic shock. A that contains at least 25 grams
potassium level above 5.5 of fiber per day. Fatty foods are
mEq/L may indicate renal to be avoided because they may
failure. precipitate symptoms.
45. Which of the following 48. A client presents to the
therapies is not included in the emergency room, reporting that
medical management of a client he has been vomiting every 30
with peritonitis? to 40 minutes for the past 8
a. Broad-spectrum hours. Frequent vomiting puts
antibiotics him at risk for which of the
b. Electrolyte replacement following?
c. I.V. fluids a. Metabolic acidosis with
d. Regular diet hyperkalemia
R: The client with peritonitis b. Metabolic acidosis with
usually isn’t allowed anything hypokalemia
orally until the source of c. Metabolic alkalosis with
peritonitis is confirmed and hyperkalemia
treated. The client also requires d. Metabolic alkalosis with
broad-spectrum antibiotics to hypokalemia
combat the infection. I.V. fluids R: Gastric acid contains large
are given to maintain hydration amounts of potassium, chloride,
and hemodynamic stability and and hydrogen ions. Excessive
to replace electrolytes. loss of these substances, such
46. Which of the following as from vomiting, can lead to
aspects is the priority focus of metabolic alkalosis and
nursing management for a client hypokalemia.
with peritonitis? 49. Five days after undergoing
a. Fluid and electrolyte surgery, a client develops a
balance small-bowel obstruction. A
b. Gastric irrigation Miller-Abbott tube is inserted for
c. Pain management bowel decompression. Which
d. Psychosocial issues nursing diagnosis takes priority?
R: Peritonitis can advance to a. Imbalanced nutrition: Less
shock and circulatory failure, so than body requirements
fluid and electrolyte balance is b. Acute pain
the priority focus of nursing c. Deficient fluid volume
management. Gastric irrigation d. Excess fluid volume
 R: Fluid shifts to the site of the excessive fluid loss in the stool.
bowel obstruction, causing a Expected outcomes include firm
fluid deficit in the intravascular skin turgor, moist mucous
spaces. If the obstruction isn’t membranes, and urine output of
resolved immediately, the client at least 30 ml/hr. The client also
may experience an imbalanced has a nursing diagnosis of
nutritional status (less than diarrhea, with expected
body requirements); however, outcomes of passage of formed
deficient fluid volume takes stools at regular intervals and a
priority. The client may also decrease in stool frequency and
experience pain, but that liquidity. The client is at risk for
nursing diagnosis is also of impaired skin integrity related
lower priority than deficient fluid to irritation from diarrhea;
volume. expected outcomes for this
50. When teaching an elderly diagnosis include absence of
client how to prevent erythema in perianal skin and
constipation, which of the mucous membranes and
following instructions should the absence of perianal tenderness
nurse include? or burning.
a. “Drink 6 glasses of fluid 52. When teaching a community
each day.” group about measures to
b. “Avoid grain products and prevent colon cancer, which
nuts.” instruction should the nurse
c. “Add at least 4 grams of include?
brain to your cereal each a. “Limit fat intake to 20% to
morning.” 25% of your total daily
d. “Be sure to get regular calories.”
exercise.” b. “Include 15 to 20 grams of
R: Exercise helps prevent fiber into your daily diet.”
constipation. Fluids and dietary c. “Get an annual rectal
fiber promote normal bowel examination after age
function. The client should drink 35.”
eight to ten glasses of fluid each d. “Undergo sigmoidoscopy
day. Although adding bran to annually after age 50.”
cereal helps prevent R: To help prevent colon cancer,
constipation by increasing fats should account for no more
dietary fiber, the client should than 20% to 25% of total daily
start with a small amount and calories and the diet should
gradually increase the amount include 25 to 30 grams of fiber
as tolerated to a maximum of 2 per day. A digital rectal
grams a day. examination isn’t recommended
51. In a client with diarrhea, as a stand-alone test for
which outcome indicates that colorectal cancer. For colorectal
fluid resuscitation is successful? cancer screening, the American
a. The client passes formed Cancer society advises clients
stools at regular intervals over age 50 to have a flexible
b. The client reports a sigmoidoscopy every 5 years,
decrease in stool yearly fecal occult blood tests,
frequency and liquidity yearly fecal occult blood tests
c. The client exhibits firm PLUS a flexible sigmoidoscopy
skin turgor every 5 years, a double-contrast
d. The client no longer barium enema every 5 years, or
experiences perianal a colonoscopy every 10 years.
burning. 53. A 30-year old client
R: A client with diarrhea has a experiences weight loss,
nursing diagnosis of Deficient abdominal distention, crampy
fluid volume related to abdominal pain, and
 intermittent diarrhea after birth a. Semi-Fowlers
of her 2nd child. Diagnostic b. Supine
tests reveal gluten-induced c. Reverse Trendelenburg
enteropathy. Which foods must d. High Fowler’s
she eliminate from her diet R: To prevent aspiration of
permanently? stomach contents, the nurse
a. Milk and dairy products should place the client in semi-
b. Protein-containing foods Fowler’s position. High Fowler’s
c. Cereal grains (except rice position isn’t necessary and
and corn) may not be tolerated as well as
d. Carbohydrates semi-Fowler’s.
R: To manage gluten-induced 56. An enema is prescribed for a
enteropathy, the client must client with suspected
eliminate gluten, which means appendicitis. Which of the
avoiding all cereal grains except following actions should the
for rice and corn. In initial nurse take?
disease management, clients a. Prepare 750 ml of
eat a high calorie, high-protein irrigating solution warmed
diet with mineral and vitamin to 100*F
supplements to help normalize b. Question the physician
nutritional status. about the order
54. After a right hemicolectomy c. Provide privacy and
for treatment of colon cancer, a explain the procedure to
57-year old client is reluctant to the client
turn while on bed rest. Which d. Assist the client to left
action by the nurse would be lateral Sim’s position
appropriate? R: Enemas are contraindicated
a. Asking a co-worker to help in an acute abdominal condition
turn the client of unknown origin as well as
b. Explaining to the client after recent colon or rectal
why turning is important. surgery or myocardial infarction.
c. Allowing the client to turn The other answers are correct
when he’s ready to do so only when enema administration
d. Telling the client that the is appropriate.
physician’s order states 57. The client being seen in a
he must turn every 2 physician’s office has just been
hours scheduled for a barium swallow
R: The appropriate action is to the next day. The nurse writes
explain the importance of down which of the following
turning to avoid postoperative instructions for the client to
complications. Asking a follow before the test?
coworker to help turn the client a. Fast for 8 hours before the
would infringe on his rights. test
Allowing him to turn when he’s b. Eat a regular supper and
ready would increase his risk for breakfast
postoperative complications. c. Continue to take all oral
Telling him he must turn medications as scheduled.
because of the physician’s d. Monitor own bowel
orders would put him on the movement pattern for
defensive and exclude him from constipation
participating in care decision. R: A barium swallow is an x-ray
55. A client has a percutaneous study that uses a substance
endoscopic gastrostomy tube called barium for contrast to
inserted for tube feedings. highlight abnormalities in the GI
Before starting a continuous tract. The client should fast for 8
feeding, the nurse should place to 12 hours before the test,
the client in which position? depending on the physician
 instructions. Most oral nurse expect to note
medications also are withheld documented on the client’s
before the test. After the record?
procedure the nurse must a. Chronic constipation
monitor for constipation, which b. Diarrhea
can occur as a result of the c. Constipation alternating
presence of barium in the GI with diarrhea
tract. d. Stool constantly oozing
58. The nurse is preparing a from the rectum
discharge teaching plan for the R: Crohn’s disease is
client who had an umbilical characterized by nonbloody
hernia repair. Which of the diarrhea of usually not more
following would the nurse than four to five stools daily.
include in the plan? Over time, the diarrhea
a. Restricting pain episodes increase in frequency,
medication duration and severity. The other
b. Maintaining bedrest option are not associated with
c. Avoiding coughing diarrhea.
d. Irrigating the drain 61. The nurse is teaching the
R: Bedrest is not required client how to perform a
following this surgical colostomy irrigation. To enhance
procedure. The client should the effectiveness of the
take analgesics as needed and irrigation and fecal returns, what
as prescribed to control pain. A measure should the nurse
drain is not used in this surgical instruct the client to do?
procedure, although the client a. Increase fluid intake
may be instructed in simple b. Reduce the amount of
dressing changes. Coughing is irrigation solution
avoided to prevent disruption of c. Perform the irrigation in
the tissue integrity, which can the evening
occur because of the location of d. Place heat on the
this surgical procedure. abdomen
59. The nurse is caring for a R: To enhance effectiveness of
hospitalized client with a the irrigation and fecal returns,
diagnosis of ulcerative colitis. the client is instructed to
Which finding, if noted on increase fluid intake and
assessment of the client, would prevent constipation.
the nurse report to the 62. The nurse is reviewing the
physician? physician’s orders written for a
a. Bloody diarrhea client admitted with acute
b. Hypotension pancreatitis. Which physician
c. A hemoglobin of 12 mg/dL order would the nurse question
d. Rebound tenderness if noted on the client’s chart?
R: Rebound tenderness may a. NPO status
indicate peritonitis. Blood b. Insert a nasogastric tube
diarrhea is expected to occur in c. An anticholinergic
ulcerative colitis. Because of the medication
blood loss, the client may be d. Morphine for pain
hypotensive and the R: Meperidine (Demerol) rather
hemoglobin level may be lower than morphine is the medication
than normal. Signs of peritonitis of choice because morphine can
must be reported to the cause spasm in the sphincter of
physician. Oddi.
60. The nurse is reviewing the 63. The nurse is doing an
record of a client with Crohn’s admission assessment on a
disease. Which of the following client with a history of duodenal
stool characteristics would the ulcer. To determine whether the
 problem is currently active, the diagnosis of Disturbed body
nurse would assess the client for image. The nurse would
which of the following most evaluate that the client is
frequent symptom(s) of making the most significant
duodenal ulcer? progress toward identified goals
a. Pain that is relieved by if the client:
food intake a. Watches the nurse empty
b. Pain that radiated down the colostomy bag
the right arm b. Looks at the ostomy site
c. N/V c. Reads the ostomy product
d. Weight loss literature
R: The most frequent symptom d. Practices cutting the
of duodenal ulcer is pain that is ostomy appliance
relieved by food intake. These R: The client is expected to have
clients generally describe the a body image disturbance after
pain as burning, heavy, sharp, colostomy. The client
or “hungry” pain that often progresses through normal
localizes in the midepigastric grieving stages to adjust to this
area. The client with duodenal change. The client demonstrates
ulcer usually does not the greatest deal of acceptance
experience weight loss or N/V. when the client participates in
These symptoms are usually the actual colostomy care. Each
more typical in the client with a of the incorrect options
gastric ulcer. represents an interest in
64. The nurse instructs the colostomy care but is a passive
ileostomy client to do which of activity. The correct option
the following as a part of shows the client is participating
essential care of the stoma? in self-care.
a. Cleanse the peristomal 66. The nurse is assessing for
skin meticulously stoma prolapse in a client with a
b. Take in high-fiber foods colostomy. The nurse would
such as nuts observe which of the following if
c. Massage the area below stoma prolapse occurred?
the stoma a. Sunken and hidden stoma
d. Limit fluid intake to b. Dark- and bluish-colored
prevent diarrhea. stoma
R: The peristomal skin must c. Narrowed and flattened
receive meticulous cleansing stoma
because the ileostomy drainage d. Protruding stoma
has more enzymes and is more R: A prolapsed stoma is one
caustic to the skin than which the bowel protruded
colostomy drainage. Foods such through the stoma. A stoma
as nuts and those with seeds retraction is characterized by
will pass through the ileostomy. sinking of the stoma. Ischemia
The client should be taught that of the stoma would be
these foods will remain associated with dusky or bluish
undigested. The area below the color. A stoma with a narrowed
ileostomy may be massaged if opening at the level of the skin
needed if the ileostomy or fascia is said to be stenosed.
becomes blocked by high fiber 67. The client with a new
foods. Fluid intake should be colostomy is concerned about
maintained to at least six to the odor from the stool in the
eight glasses of water per day to ostomy drainage bag. The nurse
prevent dehydration. teaches the client to include
65. The client who has which of the following foods in
undergone creation of a the diet to reduce odor?
colostomy has a nursing a. Yogurt
 b. Broccoli client can tolerate a diet orally.
c. Cucumbers Intestinal obstruction is a less
d. Eggs frequent complication. Fat
R: The client should be taught to malabsorption and folate
include deodorizing foods in the deficiency are complications
diet, such a beet greens, that could occur later in the
parsley, buttermilk, and yogurt. postoperative period.
Spinach also reduces odor but is 70. The nurse is doing pre-op
a gas forming food as well. teaching with the client who is
Broccoli, cucumbers, and eggs about to undergo creation of a
are gas forming foods. Kock pouch. The nurse
68. The nurse has given interprets that the client has the
instructions to the client with an best understanding of the
ileostomy about foods to eat to nature of the surgery if the
thicken the stool. The nurse client makes which of the
determines that the client needs following statements?
further instructions if the client a. “I will need to drain the
stated to eat which of the pouch regularly with a
following foods to make the catheter.”
stools less watery? b. “I will need to wear a
a. Pasta drainage bag for the rest
b. Boiled rice of my life.”
c. Bran c. “The drainage from this
d. Low-fat cheese type of ostomy will be
R: Foods that help thicken the formed.”
stool of the client with an d. “I will be able to pass stool
ileostomy include pasta, boiled from my rectum
rice, and low-fat cheese. Bran is eventually.”
high in dietary fiber and thus R: A Kock pouch is a continent
will increase output of watery ileostomy. As the ileostomy
stool by increasing propulsion begins to function, the client
through the bowel. Ileostomy drains it every 3 to 4 hours and
output is liquid. Addition or then decreases the draining to
elimination of various foods can about 3 times a day or as
help thicken or loosen this liquid needed when full. The client
drainage. does not need to wear a
69. The client has just had drainage bag but should wear
surgery to create an ileostomy. an absorbent dressing to absorb
The nurse assesses the client in mucus drainage from the stoma.
the immediate post-op period Ileostomy drainage is liquid. The
for which of the following most client would be able to pass
frequent complications of this stool only from the rectum if an
type of surgery? ileal-anal pouch or anastamosis
a. Intestinal obstruction were created. This type of
b. Fluid and electrolyte operation is a two-stage
imbalance procedure.
c. Malabsorption of fat 71. The client with a colostomy
d. Folate deficiency has an order for irrigation of the
R: A major complication that colostomy. The nurse used
occurs most frequent following which solution for irrigation?
an ileostomy is fluid and a. Distilled water
electrolyte imbalance. The client b. Tap water
requires constant monitoring of c. Sterile water
intake and output to prevent d. Lactated Ringer’s
this from happening. Losses R: Warm tap water or saline
require replacement by solution is used to irrigate a
intravenous infusion until the colostomy. If the tap water is
 not suitable for drinking, then area and radiating to the
bottled water should be used. umbilicus.
72. A nurse is monitoring a client d. Burning and aching,
admitted to the hospital with a located in the left lower
diagnosis of appendicitis. The quadrant and radiating to
client is scheduled for surgery in the hip.
2 hours. The client begins to R: The pain associated with
complain of increased acute pancreatitis is often
abdominal pain and begins to severe and unrelenting, is
vomit. On assessment the nurse located in the epigastric region,
notes that the abdomen is and radiates to the back.
distended and the bowel sounds 74. The client with Crohn’s
are diminished. Which of the disease has a nursing diagnosis
following is the most of acute pain. The nurse would
appropriate nursing teach the client to avoid which
intervention? of the following in managing this
a. Administer dilaudid problem?
b. Notify the physician a. Lying supine with the legs
c. Call and ask the operating straight
room team to perform the b. Massaging the abdomen
surgery as soon as c. Using antispasmodic
possible medication
d. Reposition the client and d. Using relaxation
apply a heating pad on a techniques
warm setting to the R: The pain associated with
client’s abdomen. Crohn’s disease is alleviated by
R: Based on the signs and the use of analgesics and
symptoms presented in the antispasmodics and also is
question, the nurse should reduced by having the client
suspect peritonitis and should practice relaxation techniques,
notify the physician. applying local cold or heat to
Administering pain medication is the abdomen, massaging the
not an appropriate intervention. abdomen, and lying with the
Heat should never be applied to legs flexed. Lying with the legs
the abdomen of a client with extended is not useful because
suspected appendicitis. it increases the muscle tension
Scheduling surgical time is not in the abdomen, which could
within the scope of nursing aggravate the inflamed
practice, although the physician intestinal tissues as the
probably would perform the abdominal muscles are
surgery earlier than the stretched.
prescheduled time. 75. A client with ulcerative colitis
73. The client has been admitted has an order to begin salicylate
with a diagnosis of acute medication to reduce
pancreatitis. The nurse would inflammation. The nurse
assess this client for pain that is: instructs the client to take the
a. Severe and unrelenting, medication:
located in the epigastric a. 30 minutes before meals
area and radiating to the b. On an empty stomach
back. c. After meals
b. Severe and unrelenting, d. On arising
located in the left lower R: Salicylate compounds act by
quadrant and radiating to inhibiting prostaglandin
the groin. synthesis and reducing
c. Burning and aching, inflammation. The nurse
located in the epigastric teaches the client to take the
medication with a full glass of
 water and to increase fluid oozing of blood are normal in
intake throughout the day. This the early post-op period. The
medication needs to be taken colostomy would typically not
after meals to reduce GI begin functioning until 2-4 days
irritation. after surgery.
76. During the assessment of a 78. When planning care for a
client’s mouth, the nurse notes client with ulcerative colitis who
the absence of saliva. The client is experiencing symptoms,
is also complaining of pain near which client care activities can
the area of the ear. The client the nurse appropriately
has been NPO for several days delegate to a unlicensed
because of the insertion of a NG assistant? Select all that apply.
tube. Based on these findings, a. Assessing the client’s
the nurse suspects that the bowel sounds
client is developing which of the b. Providing skin care
following mouth conditions? following bowel
a. Stomatitis movements
b. Oral candidiasis c. Evaluating the client’s
c. Parotitis response to antidiarrheal
d. Gingivitis medications
R: The lack of saliva, pain near d. Maintaining intake and
the area of the ear, and the output records
prolonged NPO status of the e. Obtaining the client’s
client should lead the nurse to weight.
suspect the development of R: The nurse can delegate the
parotitis, or inflammation of the following basic care activities to
parotid gland. Parotitis usually the unlicensed assistant:
develops in cases of providing skin care following
dehydration combined with poor bowel movements, maintaining
oral hygiene or when clients intake and output records, and
have been NPO for an extended obtaining the client’s weight.
period. Preventative measures Assessing the client’s bowel
include the use of sugarless sounds and evaluating the
hard candy or gum to stimulate client’s response to medication
saliva production, adequate are registered nurse activities
hydration, and frequent mouth that cannot be delegated.
care. Stomatitis (inflammation 79. Which goal of the client’s
of the mouth) produces care should take priority during
excessive salivation and a sore the first days of hospitalization
mouth. for an exacerbation of ulcerative
77. The nurse evaluates the colitis?
client’s stoma during the initial a. Promoting self-care and
post-op period. Which of the independence
following observations should be b. Managing diarrhea
reported immediately to the c. Maintaining adequate
physician? nutrition
a. The stoma is slightly d. Promoting rest and
edematous comfort
b. The stoma is dark red to R: Diarrhea is the primary
purple symptom in an exacerbation of
c. The stoma oozes a small ulcerative colitis, and
amount of blood decreasing the frequency of
d. The stoma does not expel stools is the first goal of
stool treatment. The other goals are
R: A dark red to purple stoma ongoing and will be best
indicates inadequate blood achieved by halting the
supply. Mild edema and slight exacerbation. The client may
 receive antidiarrheal are aware that if these agents
medications, antispasmodic are given simultaneously, which
agents, bulk hydrophilic agents, of the following will occur?
or anti-inflammatory drugs. a. Increased absorption of
80. A client’s ulcerative colitis digoxin
symptoms have been present b. Decreased absorption of
for longer than 1 week. The digoxin
nurse recognizes that the client c. Increased absorption of
should be assessed carefully for the absorbent
signs of which of the following d. Decreased absorption of
complications? the absorbent
a. Heart failure R:
b. DVT 83. When used with hyperacidic
c. Hypokalemia disorders of the stomach,
d. Hypocalcemia antacids are given to elevate
R: Excessive diarrhea causes the gastric pH to:
significant depletion of the a. 2.0
body’s stores of sodium and b. 4.0
potassium as well as fluid. The c. 6.0
client should be closely d. >8.0
monitored for hypokalemia and R:
hyponatremia. Ulcerative colitis 84. One of your patients is
does not place the client at risk receiving digitalis orally and is
for heart failure, DVT, or also to receive an antacid at the
hypocalcemia. same time. Your most
81. A client who has ulcerative appropriate action, based on the
colitis has persistent diarrhea. pharmacokinetics of antacids, is
He is thin and has lost 12 to:
pounds since the exacerbation a. Delay the digitalis for 1 to
of his ulcerative colitis. The 2 hours until the antacid is
nurse should anticipate that the absorbed
physician will order which of the b. Give the antacid at least 2
following treatment approaches to 4 hours before
to help the client meet his administering the digitalis
nutritional needs? c. Administer both
a. Initiate continuous enteral medications as ordered
feedings and document in nurse’s
b. Encourage a high protein, notes
high-calorie diet d. Contact the physician
c. Implement total regarding the drug
parenteral nutrition interaction and request a
d. Provide six small meals a change in the time of
day. dosing of the drugs.
R: Food will be withheld from R:
the client with severe symptoms 85. The nurse would teach
of ulcerative colitis to rest the patients that antacids are
bowel. To maintain the client’s effective in treatment of
nutritional status, the client will hyperacidity because they:
be started on TPN. Enteral a. Neutralize gastric acid
feedings or dividing the diet into b. Decrease stomach motility
6 small meals does not allow the c. Decrease gastric pH
bowel to rest. A high-calorie, d. Decrease duodenal pH
high-protein diet will worsen the R: Antacids work by neutralizing
client’s symptoms. gastric acid, which would cause
82. Digoxin preparations and an increase in pH. They do not
absorbents should not be given affect gastric motility.
simultaneously. As a nurse, you
86. The nurse would monitor for for a patient receiving
which of the following adverse famotidine (Pepcid)?
reactions to aluminum- a. Increased risk for infection
containing antacids such as due to immunosuppresion
aluminum hydroxide b. Potential risk for bleeding
(Amphojel)? related to
a. Diarrhea thrombocytopenia.
b. Constipation c. Aleration in urinary
c. GI upset elimination related to
d. Fluid retention retention
R: Aluminum- and calcium- d. Alteration in tissue
containing antacids cause perfusion related to
constipation, magnesium- hypertension
containing antacids cause R: A serious side effect of
diarrhea, and sodium-containing famotidine is thrombocytopenia,
antacids cause sodium and fluid which is manifested by a
retention. decrease in platelet count and
87. The nurse would question an an increased risk of bleeding.
order for which type of antacid 90. Histamine2-receptor
in patients with chronic renal antagonists:
failure? a. Compete with histamine
a. Aluminum-containing for binding sites on the
antacids parietal cells
b. Calcium-containing b. Irreversibly bind to
antacids H+/K+ATPase
c. Magnesium-containing c. Cause a decrease in
antacids stomach pH
d. All of the above. d. Decrease signs and
R: Magnesium-containing symptoms of allergies
antacids can cause related to histamine
hypermagnesemia in patients release
with chronic renal failure. R: Histamine receptor blocking
Aluminum-containing antacids agents decrease gastric acid by
may be used as a phosphate competing with histamine for
binder in patients with chronic binding sites on the parietal
renal failure. Calcium-containing cells.
antacids are also appropriate 91. Proton pump inhibitors:
because these patients may be a. Gastric ulcer formation
hypocalcemic. b. GERD
88. The nurse would monitor a c. Achlorhydria
patient using sodium d. Diverticulosis
bicarbonate to treat gastric R: Because the proton pump
hyperacidity for signs and inhibitors stop the final step of
symptoms of: acid secretion, they can block
a. Metabolic alkalosis up to 90% of acid secretion,
b. Metabolic acidosis leading to achlorhydria (without
c. Hyperkalemia acid).
d. Hypercalcemia 92. A patient unable to tolerate
R: Solutions containing sodium oral medications may be
bicarbonate (a base) can cause prescribed which of the
metabolic alkalosis. Serum K following proton pump inhibitors
and serum calcium would to be administered
decrease with alkalosis, not intravenously?
increase. a. lansoprazole (Prevacid)
89. Which of the following b. omeprazole (Prilosec)
nursing diagnoses is appropriate c. pantoprazole (Protonix)
d. esomeprazole (Nexium)
 R: Pantoprazole is the only a. 4
proton pump inhibitor that is b. 6
available for intravenous c. 8
administration. The other d. 10
medications in this category R: Bulk-forming laxatives must
may only be administered be given with at least 8 ounces
orally. of liquid plus additional liquid
93. When administering each day to prevent intestinal
sucralfate (Carafate) to a obstruction.
patient with a nasogastric tube, 96. Bismuth subsalicylate (Pepto-
it is important to: Bismol), as an absorbent, has
a. Crush the tablet into a fine which of the following
powder before mixing with mechanisms of action?
water a. Decreased GI motility
b. Administer with a bolus b. Decreased gastric
tube feeding secretions
c. Allow the tablet to c. Increased fluid absorption
dissolve in water before d. Binding to diarrhea-
administering causing bacteria for
d. Administer with an antacid excretion
for maximum benefit R: Absorbent antidiarrheal
R: It is important to give medications bind to diarrhea-
sucralfate on an empty stomach causing bacteria to form a
so that it may dissolve and form nonabsorbable complex, which
a protective barrier over the is then excreted in the stool.
gastric mucosa. The tablet form 97. Side effects of loperamide
will not dissolve in water when (Imodium) include all of the
crushed; it must be left whole following except?
and allowed to dissolve. a. Diarrhea
Crushing the medication so that b. epigastric pain
it will not dissolve could lead to c. Dry mouth
clogging of the nasogastric tube d. Anorexia
and decreased effectiveness of R: Side effects associated with
the drug. loperamide include CNS fatigue
94. Sucralfate (Carafate) and dizziness, epigastric pain,
achieves a therapeutic effect by: abdominal cramps, nausea, dry
a. Neutralizing gastric acid mouth, vomiting, and anorexia.
b. Enhancing gastric Diarrhea is an indication, not a
absorption side effect.
c. Forming a protective 98. The mechanism of action of
barrier around gastric diphenoxylate (Lotomil) is:
mucosa a. An increase in intestinal
d. Inhibiting gastric acid excretion of water
secretion b. An increase in intestinal
R: Sucralfate has a local effect motility
only on the gastric mucosa. It c. A decrease in peristalsis in
forms a pastelike substance in the intestinal wall
the stomach, which adheres to d. A decrease in the
the gastric lining, protecting reabsorption of water in
against adverse effects related the bowel
to gastric acid. It also stimulates R: Diphenoxylate acts on the
healing of any ulcerated areas smooth muscle of the intestinal
of the gastric mucosa. tract to inhibit GI motility and
95. To avoid fecal impaction, excessive propulsion of the GI
psyllium (Metamucil) should be tract (peristalsis).
administered with at least how 99. Milk of Magnesium alleviates
many ounces of fluid? constipation by:
 a. Increasing water following complications can cause
absorption into the colon increased abdominal pressure?
b. Lubricating the passage of
a. Obesity
stool
b. Volvulus
c. Increasing bulk within the
c. Constipation
colon
d. Intestinal obstruction
d. Stimulating nerves that
regulate defecation R: Obesity may cause increased
R: Milk of Magnesia is a saline abdominal pressure that pushes
laxative that increases osmotic the lower portion of the stomach
pressure to draw water into the into the thorax.
colon.
3. Which of the following
100. Lactulose, a hyperosmotic
symptoms is common with a hiatal
laxative, also functions to:
hernia?
a. Decrease peripheral
edema a. Left arm pain
b. Correct sodium b. Lower back pain
imbalances c. Esophageal reflux
c. Reduce ammonia levels d. Abdominal cramping
d. Alleviate galactose
R: Esophageal reflux is a common
intolerance
symptom of hiatal hernia. This
R: Lactulose reduces blood seems to be associated with
ammonia levels by forcing chronic exposure of the lower
ammonia from the blood into the esophageal sphincter to the lower
colon. It is useful in treating pressure of the thorax, making it
patients with hepatic less effective.
encephalopathy.
4. Which of the following tests
can be performed to diagnose a
hiatal hernia?
RNPEDIA Gastro 4
a. Colonoscopy
1. Which of the following conditions
b. Lower GI series
can cause a hiatal hernia?
c. Barium swallow
a. Increased intrathoracic pressure d. Abdominal x-rays
b. Weakness of the esophageal
R: A barium swallow with
muscle
fluoroscopy shows the position of
c. Increased esophageal muscle
the stomach in relation to the
pressure
diaphragm. A colonoscopy and a
d. Weakness of the diaphragmic
lower GI series show disorders of
muscle
the intestine.
R: A hiatal hernia is caused by
5. Which of the following
weakness of the diaphragmic
measures should the nurse focus
muscle and increased intra-
on for the client with esophageal
abdominal—not intrathoracic—
varices?
pressure. This weakness allows the
stomach to slide into the a. Recognizing hemorrhage
esophagus. The esophageal b. Controlling blood pressure
supports weaken, but esophageal c. Encouraging nutritional intake
muscle weakness or increased d. Teaching the client about
esophageal muscle pressure isn’t a varices
factor in hiatal hernia.
R: Recognizing the rupture of
2. Risk factors for the esophageal varices, or
development of hiatal hernias are hemorrhage, is the focus of nursing
those that lead to increased care because the client could
abdominal pressure. Which of the succumb to this quickly. Controlling
blood pressure is also important
because it helps reduce the risk of stomach. These include lying flat
variceal rupture. It is also on the back or on the stomach
important to teach the client what after a meal of lying on the right
varices are and what foods he side. The left side-lying position
should avoid such as spicy foods. with the head of the bed elevated
is most likely to give relief to the
6. Which of the following tests
client.
can be used to diagnose ulcers?
9. The nurse is caring for a client
a. Abdominal x-ray
following a Billroth II procedure. On
b. Barium swallow
review of the post-operative
c. Computed tomography (CT)
orders, which of the following, if
scan
prescribed, would the nurse
d. Esophagogastroduodenoscopy
question and verify?
(EGD)
a. Irrigating the nasogastric tube
R: The EGD can visualize the entire
b. Coughing a deep breathing
upper GI tract as well as allow for
exercises
tissue specimens and
c. Leg exercises
electrocautery if needed. The
d. Early ambulation
barium swallow could locate a
gastric ulcer. A CT scan and an R: In a Billroth II procedure the
abdominal x-ray aren’t useful in the proximal remnant of the stomach is
diagnosis of an ulcer. anastomased to the proximal
jejunum. Patency of the NG tube is
7. Which of the following best
critical for preventing the retention
describes the method of action of
of gastric secretions. The nurse
medications, such as ranitidine
should never irrigate or reposition
(Zantac), which are used in the
the gastric tube after gastric
treatment of peptic ulcer disease?
surgery, unless specifically ordered
a. Neutralize acid by the physician. In this situation,
b. Reduce acid secretions the nurse would clarify the order.
c. Stimulate gastrin release
10. The nurse is providing
d. Protect the mucosal barrier
discharge instructions to a client
R: Ranitidine is a histamine-2 following gastrectomy. Which
receptor antagonist that reduces measure will the nurse instruct the
acid secretion by inhibiting gastrin client to follow to assist in
secretion. preventing dumping syndrome?

8. The hospitalized client with a. Eat high-carbohydrate foods

GERD is complaining of chest b. Limit the fluids taken with meals
discomfort that feels like heartburn c. Ambulate following a meal
following a meal. After d. Sit in a high-Fowlers position
administering an ordered antacid, during meals
the nurse encourages the client to
R: The nurse should instruct the
lie in which of the following
client to decrease the amount of
positions?
fluid taken at meals and to avoid
a. Supine with the head of the bed high carbohydrate foods including
flat fluids such as fruit nectars; to
b. On the stomach with the head assume a low-Fowler’s position
flat during meals; to lie down for 30
c. On the left side with the head of minutes after eating to delay
the bed elevated 30 degrees gastric emptying; and to take
d. On the right side with the head antispasmidocs as prescribed.
of the bed elevated 30 degrees.
11. The nurse instructs the nursing
R: The discomfort of reflux is assistant on how to provide oral
aggravated by positions that hygiene for a client who cannot
compress the abdomen and the perform this task for himself. Which
of the following techniques should procedure, so it is expected that
the nurse tell the assistant to they will display signs of sedation
incorporate into the client’s daily after the procedure is completed. A
care? lack of appetite could be the result
of many factors, including the
a. Assess the oral cavity each time
disease process.
mouth care is given and record
observations 13. A client has been diagnosed
b. Use a soft toothbrush to brush with adenocarcinoma of the
the client’s teeth after each stomach and is scheduled to
meal undergo a subtotal gastrectomy
c. Swab the client’s tongue, gums, (Billroth II procedure). During pre-
and lips with a soft foam operative teaching, the nurse is
applicator every 2 hours. reinforcing information about the
d. Rinse the client’s mouth with procedure. Which of the following
mouthwash several times a day. explanations is most accurate?

R: A soft toothbrush should be used a. The procedure will result in

to brush the client’s teeth after enlargement of the pyloric
each meal and more often as sphincter
needed. Mechanical cleaning is b. The procedure will result in
necessary to maintain oral health, anastomosis of the gastric
simulate gingiva, and remove stump to the jejunum
plaque. Assessing the oral cavity c. The procedure will result in
and recording observations is the removal of the duodenum
responsibility of the nurse, not the d. The procedure will result in
nursing assistant. Swabbing with a repositioning of the vagus nerve
safe foam applicator does not
R: A Billroth II procedure bypasses
provide enough friction to clean the
the duodenum and connects the
mouth. Mouthwash can be a drying
gastric stump directly to the
irritant and is not recommended for
jejunum. The pyloric sphincter is
frequent use.
removed, along with some of the
12. A client with suspected gastric stomach fundus.
cancer undergoes an endoscopy of
14. After a subtotal gastrectomy,
the stomach. Which of the
the nurse should anticipate that
following assessments made after
nasogastric tube drainage will be
the procedure would indicate the
what color for about 12 to 24 hours
development of a potential
after surgery?
complication?
a. Dark brown
a. The client complains of a sore
b. Bile green
throat
c. Bright red
b. The client displays signs of
d. Cloudy white
sedation
c. The client experiences a sudden R: About 12 to 24 hours after a
increase in temperature subtotal gastrectomy, gastric
d. The client demonstrates a lack drainage is normally brown, which
of appetite indicates digested blood. Bile green
or cloudy white drainage is not
R: The most likely complication of
expected during the first 12 to 24
an endoscopic procedure is
hours after a subtotal gastrectomy.
perforation. A sudden temperature
Drainage during the first 6 to 12
spike with 1 to 2 hours after the
hours contains some bright red
procedure is indicative of a
blood, but large amounts of blood
perforation and should be reported
or excessively bloody drainage
immediately to the physician. A
should be reported to the physician
sore throat is to be anticipated
promptly.
after an endoscopy. Clients are
given sedatives during the
15. After a subtotal gastrectomy, optimal nutritional status through
care of the client’s nasogastric the use of oral feedings or total
tube and drainage system should parenteral nutrition (TPN). TPN may
include which of the following be used to supplement oral intake,
nursing interventions? or it may be used alone if the client
cannot tolerate oral feedings. The
a. Irrigate the tube with 30 ml of
client would not be expected to
sterile water every hour, if
regain lost weight within 1 month
needed.
after surgery or to tolerate a
b. Reposition the tube if it is not
normal dietary intake of three
draining well
meals per day. Nausea and
c. Monitor the client for N/V, and
vomiting would not be considered
abdominal distention
an expected outcome of gastric
d. Turn the machine to high
surgery, and regular use of
suction of the drainage is
antiemetics would not be
sluggish on low suction.
anticipated.
R: Nausea, vomiting, or abdominal
17. The client with GERD
distention indicated that gas and
complains of a chronic cough. The
secretions are accumulating within
nurse understands that in a client
the gastric pouch due to impaired
with GERD this symptom may be
peristalsis or edema at the
indicative of which of the following
operative site and may indicate
conditions?
that the drainage system is not
working properly. Saline solution is a. Development of laryngeal
used to irrigate nasogastric tubes. cancer
Hypotonic solutions such as water b. Irritation of the esophagus
increase electrolyte loss. In c. Esophageal scar tissue
addition, a physician’s order is formation
needed to irrigate the NG tube, d. Aspiration of gastric contents
because this procedure could
R: Clients with GERD can develop
disrupt the suture line. After gastric
pulmonary symptoms such as
surgery, only the surgeon
coughing, wheezing, and dyspnea
repositions the NG tube because of
that are caused by the aspiration of
the danger of rupturing or
gastric contents. GERD does not
dislodging the suture line. The
predispose the client to the
amount of suction varies with the
development of laryngeal cancer.
type of tube used and is ordered by
Irritation of the esophagus and
the physician. High suction may
esophageal scar tissue formation
create too much tension on the
can develop as a result of GERD.
gastric suture line.
However, GERD is more likely to
16. Which of the following would cause painful and difficult
be an expected nutritional outcome swallowing.
for a client who has undergone a
18. Which of the following dietary
subtotal gastrectomy for cancer?
measures would be useful in
a. Regain weight loss within 1 preventing esophageal reflux?
month after surgery
a. Eating small, frequent meals
b. Resume normal dietary intake of
b. Increasing fluid intake
three meals per day
c. Avoiding air swallowing with
c. Control nausea and vomiting
meals
through regular use of
d. Adding a bedtime snack to the
antiemetics
dietary plan
d. Achieve optimal nutritional
status through oral or parenteral R: Esophageal reflux worsens when
feedings the stomach is overdistended with
food. Therefore, an important
R: An appropriate expected
measure is to eat small, frequent
outcome is for the client to achieve
meals. Fluid intake should be pain that occurs about one hour
decreased during meals to reduce after eating. Eating frequently
abdominal distention. Avoiding air aggravates the pain. Clients with
swallowing does not prevent duodenal ulcers are more likely to
esophageal reflux. Food intake in complain about pain that occurs
the evening should be strictly during the night and is frequently
limited to reduce the incidence of relieved by eating.
nighttime reflux, so bedtime snacks
21. The nurse is caring for a client
are not recommended.
who has had a gastroscopy. Which
19. A client is admitted to the of the following symptoms may
hospital after vomiting bright red indicate that the client is
blood and is diagnosed with a developing a complication related
bleeding duodenal ulcer. The client to the procedure? Select all that
develops a sudden, sharp pain in apply.
the midepigastric area along with a
a. The client complains of a sore
rigid, boardlike abdomen. These
throat
clinical manifestations most likely
b. The client has a temperature of
indicate which of the following?
100*F
a. An intestinal obstruction has c. The client appears drowsy
developed following the procedure
b. Additional ulcers have d. The client complains of
developed epigastric pain
c. The esophagus has become e. The client experiences
inflamed hematemesis
d. The ulcer has perforated
R: Following a gastroscopy, the
R: The body reacts to perforation of nurse should monitor the client for
an ulcer by immobilizing the area complications, which include
as much as possible. This results in perforation and the potential for
boardlike muscle rigidity, usually aspiration. An elevated
with extreme pain. Perforation is a temperature, complaints of
medical emergency requiring epigastric pain, or the vomiting of
immediate surgical intervention blood (hematemesis) are all
because peritonitis develops indications of a possible perforation
quickly after perforation. An and should be reported promptly. A
intestinal obstruction would not sore throat is a common
cause midepigastric pain. occurrence following a
Esophageal inflammation or the gastroscopy. Clients are usually
development of additional ulcers sedated to decrease anxiety and
would not cause a rigid, boardlike the nurse would anticipate that the
abdomen. client will be drowsy following the
procedure.
20. When obtaining a nursing
history on a client with a suspected 22. A client with peptic ulcer
gastric ulcer, which signs and disease tells the nurse that he has
symptoms would the nurse expect black stools, which he has not
to see? Select all that apply. reported to his physician. Based on
this information, which nursing
a. Epigastric pain at night
diagnosis would be appropriate for
b. Relief of epigastric pain after
this client?
eating
c. Vomiting a. Ineffective coping related to fear
d. Weight loss of diagnosis of chronic illness
b. Deficient knowledge related to
R: Vomiting and weight loss are
unfamiliarity with significant
common with gastric ulcers. Clients
signs and symptoms
with a gastric ulcer are most likely
c. Constipation related to
to complain of a burning epigastric
decreased gastric motility
d. Imbalanced nutrition: Less than e. Reassessing the client on an
body requirements due to hour
gastric bleeding
R: The symptoms of nausea and
R: Black, tarry stools are an dizziness in a client with peptic
important warning sign of bleeding ulcer disease may be indicative of
in peptic ulcer disease. Digested hemorrhage and should not be
blood in the stomach causes it to ignored. The appropriate nursing
be black. The odor of the stool is actions at this time are for the
very stinky. Clients with peptic nurse to monitor the client’s vital
ulcer disease should be instructed signs and notify the physician of
to report the incidence of black the client’s symptoms. To
stools promptly to their physician administer an antacid hourly or to
wait one hour to reassess the client
23. A client with a peptic ulcer
would be inappropriate; prompt
reports epigastric pain that
intervention is essential in a client
frequently awakens her at night, a
who is potentially experiencing a
feeling of fullness in the abdomen,
gastrointestinal hemorrhage. The
and a feeling of anxiety about her
nurse would notify the physician of
health. Based on this information,
assessment findings and then
which nursing diagnosis would be
initiate oxygen therapy if ordered
most appropriate?
by the physician.
a. Imbalanced Nutrition: Less than
25. A client is to take one daily
Body Requirements related to
dose of ranitidine (Zantac) at home
anorexia.
to treat her peptic ulcer. The nurse
b. Disturbed Sleep Pattern related
knows that the client understands
to epigastric pain
proper drug administration of
c. Ineffective Coping related to
ranitidine when she says that she
exacerbation of duodenal ulcer
will take the drug at which of the
d. Activity Intolerance related to
following times?
abdominal pain
a. Before meals
R: Based on the data provided, the
b. With meals
most appropriate nursing diagnosis
c. At bedtime
would be Disturbed Sleep pattern.
d. When pain occurs
A client with a duodenal ulcer
commonly awakens at night with R: Ranitidine blocks secretion of
pain. The client’s feelings of hydrochloric acid. Clients who take
anxiety do not necessarily indicate only one daily dose of ranitidine
that she is coping ineffectively. are usually advised to take it at
bedtime to inhibit nocturnal
24. While caring for a client with
secretion of acid. Clients who take
peptic ulcer disease, the client
the drug twice a day are advised to
reports that he has been
take it in the morning and at
nauseated most of the day and is
bedtime.
now feeling lightheaded and dizzy.
Based upon these findings, which 26. A client has been taking
nursing actions would be most aluminum hydroxide 30 mL six
appropriate for the nurse to take? times per day at home to treat his
Select all that apply. peptic ulcer. He tells the nurse that
he has been unable to have a
a. Administering an antacid hourly
bowel movement for 3 days. Based
until nausea subsides.
on this information, the nurse
b. Monitoring the client’s vital
would determine that which of the
signs
following is the most likely cause of
c. Notifying the physician of the
the client’s constipation?
client’s symptoms
d. Initiating oxygen therapy a. The client has not been
including enough fiber in his diet
b. The client needs to increase his 28. The nurse is caring for a client
daily exercise with chronic gastritis. The nurse
c. The client is experiencing a side monitors the client, knowing that
effect of the aluminum this client is at risk for which of the
hydroxide. following vitamin deficiencies?
d. The client has developed a
a. Vitamin A
gastrointestinal obstruction.
b. Vitamin B12
R: It is most likely that the client is c. Vitamin C
experiencing a side effect of the d. Vitamin E
antacid. Antacids with aluminum
R: Chronic gastritis causes
salt products, such as aluminum
deterioration and atrophy of the
hydroxide, form insoluble salts in
lining of the stomach, leading to
the body. These precipitate and
the loss of the functioning parietal
accumulate in the intestines,
cells. The source of the intrinsic
causing constipation. Increasing
factor is lost, which results in the
dietary fiber intake or daily
inability to absorb vitamin B12.
exercise may be a beneficial
This leads to the development of
lifestyle change for the client but is
pernicious anemia.
not likely to relieve the
constipation caused by the 29. The nurse is reviewing the
aluminum hydroxide. Constipation, medication record of a client with
in isolation from other symptoms, acute gastritis. Which medication,
is not a sign of bowel obstruction. if noted on the client’s record,
would the nurse question?
27. A client is taking an antacid for
treatment of a peptic ulcer. Which a. Digoxin (Lanoxin)
of the following statements best b. Indomethacin (Indocin)
indicates that the client c. Furosemide (Lasix)
understands how to correctly take d. Propranolol hydrochloride
the antacid? (Inderal)

a. “I should take my antacid before R: Indomethacin (Indocin) is a

I take my other medications.” NSAID and can cause ulceration of
b. “I need to decrease my intake of the esophagus, stomach,
fluids so that I don’t dilute the duodenum, or small intestine.
effects of my antacid.” Indomethacin is contraindicated in
c. “My antacid will be most a client with GI disorders.
effective if I take it whenever I
31. The nurse provides medication
experience stomach pains.”
instructions to a client with peptic
d. “It is best for me to take my
ulcer disease. Which statement, if
antacid 1 to 3 hours after
made by the client, indicates the
meals.”
best understanding of the
R: Antacids are most effective if medication therapy?
taken 1 to 3 hours after meals and
a. “The cimetidine (Tagamet) will
at bedtime. When an antacid is
cause me to produce less
taken on an empty stomach, the
stomach acid.”
duration of the drug’s action is
b. “Sucralfate (Carafate) will
greatly decreased. Taking antacids
change the fluid in my
1 to 3 hours after a meal lengthens
stomach.”
the duration of action, thus
c. “Antacids will coat my
increasing the therapeutic action of
stomach.”
the drug. Antacids should be
d. “Omeprazole (Prilosec) will coat
administered about 2 hours after
the ulcer and help it heal.”
other medications to decrease the
chance of drug interactions. It is R: Cimetidine (Tagamet), a
not necessary to decrease fluid histamine H2 receptor antagonist,
intake when taking antacids. will decrease the secretion of
gastric acid. Sucralfate (Carafate) a. Upper quadrant and radiates to
promotes healing by coating the the left scapula and shoulder
ulcer. Antacids neutralize acid in b. Upper quadrant and radiates to
the stomach. Omeprazole (Prilosec) the right scapula and shoulder
inhibits gastric acid secretion. c. Lower quadrant and radiates to
the umbilicus
32. The client with peptic ulcer
d. Lower quadrant and radiates to
disease is scheduled for a
the back
pyloroplasty. The client asks the
nurse about the procedure. The R: During an acute “gallbladder
nurse plans to respond knowing attack,” the client may complain of
that a pyloroplasty involves: severe right upper quadrant pain
that radiates to the right scapula
a. Cutting the vagus nerve
and shoulder. This is governed by
b. Removing the distal portion of
the pattern on dermatones in the
the stomach
body.
c. Removal of the ulcer and a large
portion of the cells that produce 35. Which of the following tasks
hydrochloric acid should be included in the
d. An incision and resuturing of the immediate postoperative
pylorus to relax the muscle and management of a client who has
enlarge the opening from the undergone gastric resection?
stomach to the duodenum.
a. Monitoring gastric pH to detect
R: An incision and resuturing of the complications
pylorus to relax the muscle and b. Assessing for bowel sounds
enlarge the opening from the c. Providing nutritional support
stomach to the duodenum d. Monitoring for symptoms of
describes the procedure for a hemorrhage
pyloroplasty. A vagotomy involves
R: The client should be monitored
cutting the vagus nerve. A subtotal
closely for signs and symptoms of
gastrectomy involves removing the
hemorrhage, such as bright red
distal portion of the stomach. A
blood in the nasogastric tube
Billroth II procedure involves
suction, tachycardia, or a drop in
removal of the ulcer and a large
blood pressure. Gastric pH may be
portion of the tissue that produces
monitored to evaluate the need for
hydrochloric acid.
histamine-2 receptor antagonists.
33. A client with a peptic ulcer is Bowel sounds may not return for
scheduled for a vagotomy. The up to 72 hours postoperatively.
client asks the nurse about the Nutritional needs should be
purpose of this procedure. The addressed soon after surgery.
nurse tells the client that the
36. If a gastric acid perforates,
procedure:
which of the following actions
a. Decreases food absorption in should not be included in the
the stomach immediate management of the
b. Heals the gastric mucosa client?
c. Halts stress reactions
a. Blood replacement
d. Reduces the stimulus to acid
b. Antacid administration
secretions
c. Nasogastric tube suction
R: A vagotomy, or cutting the d. Fluid and electrolyte
vagus nerve, is done to eliminate replacement
parasympathetic stimulation of
R: Antacids aren’t helpful in
gastric secretion.
perforation. The client should be
34. The nurse would assess the treated with antibiotics as well as
client experiencing an acute fluid, electrolyte, and blood
episode of cholecysitis for pain that replacement. NG tube suction
is located in the right should also be performed to
prevent further spillage of stomach b. On deep palpitation and release,
contents into the peritoneal cavity. pain in elicited
c. On deep inspiration, pain is
37. Mucosal barrier fortifiers are
elicited and breathing stops
used in peptic ulcer disease
d. Abdominal muscles are
management for which of the
tightened in anticipation of
following indications?
palpation
a. To inhibit mucus production
R: Murphy’s sign is elicited when
b. To neutralize acid production
the client reacts to pain and stops
c. To stimulate mucus production
breathing. It’s a common finding in
d. To stimulate hydrogen ion
clients with cholecystitis.
diffusion back into the mucosa
Periumbilical ecchymosis, Cullen’s
R: The mucosal barrier fortifiers sign, is present in peritonitis. Pain
stimulate mucus production and on deep palpation and release is
prevent hydrogen ion diffusion rebound tenderness. Tightening up
back into the mucosa, resulting in abdominal muscles in anticipation
accelerated ulcer healing. Antacids of palpation is guarding.
neutralize acid production.
40. Which of the following tests is
38. When counseling a client in most commonly used to diagnose
ways to prevent cholecystitis, cholecystitis?
which of the following guidelines is
a. Abdominal CT scan
most important?
b. Abdominal ultrasound
a. Eat a low-protein diet c. Barium swallow
b. Eat a low-fat, low-cholesterol d. Endoscopy
diet
R: An abdominal ultrasound can
c. Limit exercise to 10 minutes/day
show if the gallbladder is enlarged,
d. Keep weight proportionate to
if gallstones are present, if the
height
gallbladder wall is thickened, or if
R: Obesity is a known cause of distention of the gallbladder lumen
gallstones, and maintaining a is present. An abdominal CT scan
recommended weight will help can be used to diagnose
protect against gallstones. cholecystitis, but it usually isn’t
Excessive dietary intake of necessary. A barium swallow looks
cholesterol is associated with the at the stomach and the duodenum.
development of gallstones in many Endoscopy looks at the esophagus,
people. Dietary protein isn’t stomach, and duodenum.
implicated in cholecystitis. Liquid
41. Which of the following factors
protein and low-calorie diets (with
should be the main focus of nursing
rapid weight loss of more than 5 lb
management for a client
[2.3kg] per week) are implicated as
hospitalized for cholecystitis?
the cause of some cases of
cholecystitis. Regular exercise (30 a. Administration of antibiotics
minutes/three times a week) may b. Assessment for complications
help reduce weight and improve fat c. Preparation for lithotripsy
metabolism. Reducing stress may d. Preparation for surgery
reduce bile production, which may
R: The client with acute
also indirectly decrease the
cholecystitis should first be
chances of developing
monitored for perforation, fever,
cholecystitis.
abscess, fistula, and sepsis. After
39. Which of the following assessment, antibiotics will be
symptoms best describes Murphy’s administered to reduce the
sign? infection. Lithotripsy is used only
for a small percentage of clients.
a. Periumbilical eccymosis exists
Surgery is usually done after the
acute infection has subsided.
42. A client being treated for b. After insertion into the nostril,
chronic cholecystitis should be instruct the client to extend his
given which of the following neck
instructions? c. Introduce the tube with the
client’s head tilted back, then
a. Increase rest
instruct him to keep his head
b. Avoid antacids
upright for final insertion
c. Increase protein in diet
d. Instruct the client to hold his
d. Use anticholinergics as
chin down, then back for
prescribed
insertion of the tube
R: Conservative therapy for chronic
R: NG insertion technique is to
cholecystitis includes weight
have the client first tilt his head
reduction by increasing physical
back for insertion into the nostril,
activity, a low-fat diet, antacid use
then to flex his neck forward and
to treat dyspepsia, and
swallow. Extension of the neck will
anticholinergic use to relax smooth
impede NG tube insertion.
muscles and reduce ductal tone
and spasm, thereby reducing pain. 46. The most important
pathophysiologic factor
43. The client with a duodenal
contributing to the formation of
ulcer may exhibit which of the
esophageal varices is:
following findings on assessment?
a. Decreased prothrombin
a. Hematemesis
formation
b. Malnourishment
b. Decreased albumin formation by
c. Melena
the liver
d. Pain with eating
c. Portal hypertension
R: The client with a duodenal ulcer d. Increased central venous
may have bleeding at the ulcer pressure
site, which shows up as melena
R: As the liver cells become fatty
(black tarry poop). The other
and degenerate, they are no longer
findings are consistent with a
able to accommodate the large
gastric ulcer.
amount of blood necessary for
44. The pain of a duodenal ulcer homeostasis. The pressure in the
can be distinguished from that of a liver increases and causes
gastric ulcer by which of the increased pressure in the venous
following characteristics? system. As the portal pressure
increases, fluid exudes into the
a. Early satiety
abdominal cavity. This is called
b. Pain on eating
ascites.
c. Dull upper epigastric pain
d. Pain on empty stomach 47. The client being treated for
esophageal varices has a
R: Pain on empty stomach is
Sengstaken-Blakemore tube
relieved by taking foods or
inserted to control the bleeding.
antacids. The other symptoms are
The most important assessment is
those of a gastric ulcer.
for the nurse to:
45. The client has orders for a
a. Check that the hemostat is on
nasogastric (NG) tube insertion.
the bedside
During the procedure, instructions
b. Monitor IV fluids for the shift
that will assist in the insertion
c. Regularly assess respiratory
would be:
status
a. Instruct the client to tilt his head d. Check that the balloon is
back for insertion in the nostril, deflated on a regular basis
then flex his neck for the final
R: The respiratory system can
insertion
become occluded if the balloon
slips and moves up the esophagus,
putting pressure on the trachea. a. Reduce gastric acid output
This would result in respiratory b. Protect the ulcer surface
distress and should be assessed c. Inhibit the production of
frequently. Scissors should be kept hydrochloric acid (HCl)
at the bedside to cut the tube if d. Inhibit vagus nerve stimulation
distress occurs. This is a safety
R: These drugs inhibit action of
intervention.
histamine on the H2 receptors of
48. A female client complains of parietal cells, thus reducing gastric
gnawing epigastric pain for a few acid output.
hours after meals. At times, when
the pain is severe, vomiting occurs.
Specific tests are indicated to rule RNPEDIA PHARMA GASTROMEDS
out:
1. Nurse Harper is evaluating the
a. Cancer of the stomach effectiveness of Omeprazole (Prilosec) in
b. Peptic ulcer disease her patient. Which statement by the
c. Chronic gastritis patient would indicate that the
d. Pylorospasm medication is achieving its therapeutic
effect?
R: Peptic ulcer disease is
A. "I've found relief from my GERD
characteristically gnawing
symptoms."
epigastric pain that may radiate to
the back. Vomiting usually reflects B. "I'm having fewer episodes of
pyloric spasm from muscular diarrhea."
spasm or obstruction. Cancer
C. "My nausea and vomiting have
would not evidence pain or
subsided."
vomiting unless the pylorus was
obstructed. D. "I'm not experiencing constipation
anymore."
49. When a client has peptic ulcer
R: Omeprazole (Prilosec) is a proton
disease, the nurse would expect a
pump inhibitor (PPI) that works by
priority intervention to be:
reducing the production of stomach acid.
a. Assisting in inserting a Miller- It is commonly prescribed for conditions
Abbott tube like gastroesophageal reflux disease
b. Assisting in inserting an arterial (GERD), peptic ulcer disease, and
pressure line Zollinger-Ellison syndrome. The primary
c. Inserting a nasogastric tube therapeutic effect of Omeprazole is to
d. Inserting an I.V. alleviate symptoms associated with
excessive stomach acid, such as
R: An NG tube insertion is the most
heartburn, acid reflux, and regurgitation.
appropriate intervention because it
will determine the presence of 2. Nurse Morgan is administering tincture
active GI bleeding. A Miller-Abbott of opium to a patient experiencing
tube is a weighted, mercury-filled severe diarrhea. Which statement about
ballooned tube used to resolve this medication is accurate?
bowel obstructions. There is no A. It increases intestinal motility and
evidence of shock or fluid overload peristalsis.
in the client; therefore, an arterial
B. Opium tincture is not classified as a
line is not appropriate at this time
controlled substance.
and an IV is optional.
C. Opium tincture can be safely used
50. A 40-year-old male client has
with medications like naltrexone and
been hospitalized with peptic ulcer
buprenorphine.
disease. He is being treated with a
histamine receptor antagonist D. It has an unpleasant taste and can be
(cimetidine), antacids, and diet. diluted with 15-30 mL of water.
The nurse doing discharge planning
R: Tincture of opium, also known as
will teach him that the action of
laudanum, is a concentrated alcoholic
cimetidine is to:
solution of opium. It is used in small prokinetic and antiemetic medication
doses to treat severe diarrhea by commonly used to treat nausea and
reducing intestinal motility. However, vomiting, especially in patients
due to its high concentration and bitter undergoing chemotherapy or radiation
taste, it can be unpleasant for patients to therapy. It works by enhancing
take. To make it more palatable, the gastrointestinal motility and accelerating
tincture can be diluted with 15-30 mL of gastric emptying, as well as by blocking
water or another liquid before dopamine receptors in the brain, which
administration. This not only helps mask helps control nausea and vomiting. For
the taste but also ensures more accurate patients undergoing radiation therapy,
dosing. Metoclopramide can help manage the
nausea and vomiting that are common
3. Nurse Carter is overseeing the care of
side effects of the treatment, making it a
a patient with Crohn's disease who is
safe and appropriate choice in this
receiving Infliximab (Remicade) infusion
scenario.
therapy. Which action should Nurse
Carter prioritize while the patient is on 5. Nurse Simmons is caring for Mr.
this medication? Reynolds, an elderly patient who has
A. Monitoring the frequency and been prescribed Cimetidine (Tagamet) to
consistency of bowel movements. manage his heartburn. As Nurse
Simmons monitors for side effects, which
B. Checking liver function tests prior to
central nervous system reaction should
the infusion.
she be most vigilant about?
C. Keeping track of vomiting episodes. A. Agitation

D. Monitoring urine output and B. Dizziness

orientation.
C. Confusion
R: Infliximab (Remicade) is a monoclonal
antibody that targets tumor necrosis D. Headache
factor-alpha (TNF-alpha), a pro- R: Cimetidine (Tagamet) is an H2
inflammatory cytokine involved in the receptor antagonist often prescribed to
inflammatory response of autoimmune manage heartburn and other acid-related
diseases like Crohn's disease. The conditions. In elderly patients, one of the
primary goal of Infliximab therapy in most significant concerns with Cimetidine
Crohn's disease is to reduce is its potential to cross the blood-brain
inflammation in the gastrointestinal tract, barrier and cause central nervous system
which should lead to a reduction in (CNS) side effects, particularly confusion.
symptoms such as diarrhea, abdominal This is especially relevant in older adults
pain, and bowel urgency. Monitoring the due to changes in drug metabolism and
frequency and consistency of bowel excretion with age, alongside the
movements is crucial because it directly likelihood of polypharmacy and pre-
indicates how well the inflammation is existing cognitive conditions.
being controlled. Improvement in these
6. Nurse Allen is caring for a patient
parameters suggests that the treatment
receiving Sulfasalazine (Azulfidine) for
is effective.
ulcerative colitis. Which assessment
4. Nurse Lewis is preparing to administer finding should be the most concerning for
Metoclopramide (Reglan). For which of Nurse Allen?
the following conditions is it safe to give A. Urine discoloration.
this medication?
B. Drowsiness.
A. A patient with pheochromocytoma.
C. Vomiting.
B. A patient with bowel obstruction.
D. Decreased urine output.
C. A patient undergoing radiation
R: Sulfasalazine (Azulfidine) is commonly
therapy.
used to treat ulcerative colitis by
D. A patient with gastrointestinal reducing inflammation in the colon.
hemorrhage. However, like many sulfa-based drugs, it
R: Metoclopramide (Reglan) is a carries the risk of nephrotoxicity, which
can lead to decreased urine output, newly prescribed medications:
signaling potential kidney dysfunction or Amoxicillin (Wymox), Pantoprazole
acute kidney injury. (Prevacid), and Clarithromycin (Biaxin).
Which statement by Nurse Laura
7. Nurse Harris is reviewing the
accurately describes the purpose of
medications for a patient admitted with
these medications?
irritable bowel syndrome (IBS) who also
A. "These medications will reduce acid
has a history of chest pain. Which of the
production and eradicate the bacteria."
following medications is least likely to be
included in the medical management B. "These medications will reduce acid
plan for this patient? and form a protective layer over the
A. Tegaserod (Zelnorm). ulcer."

B. Alosetron (Lotronex). C. "These medications will manage the

ulcer and prevent motion sickness."
C. Lubiprostone (Amitiza).
D. "The ulcer will heal as these drugs will
D. Loperamide (Imodium).
eliminate the bacteria."
R: Tegaserod (Zelnorm) is least likely to
R: This statement accurately describes
be included in the medical management
the purpose of the prescribed
plan for a patient with irritable bowel
medications for Mr. Thompson's
syndrome (IBS) who also has a history of
duodenal ulcer and H. pylori infection.
chest pain. Tegaserod is a selective
The combination of Amoxicillin,
serotonin 5-HT4 receptor agonist that is
Clarithromycin, and Pantoprazole is a
used to treat IBS with constipation (IBS-
standard treatment regimen aimed at
C) in women under the age of 65.
eradicating H. pylori bacteria and
However, Tegaserod has been associated
reducing stomach acid production to
with an increased risk of cardiovascular
promote ulcer healing.
events, including chest pain, heart
attack, and stroke, particularly in 10. Nurse Williams is providing discharge
patients with preexisting cardiovascular instructions to a patient who has been
conditions. prescribed a bulk-forming laxative for
home use. Which of the following is NOT
8. Nurse Kelly is instructing a
an example of a bulk-forming laxative?
malnourished patient with diarrhea and
A. Docusate Sodium (Colace).
frequent abdominal pain, who is about to
begin Total Parenteral Nutrition (TPN). B. Psyllium (Metamucil).
Which statement by Nurse Kelly is the
C. Methylcellulose (Citrucel).
most appropriate?
A. "It will assist in your weight loss." D. Polycarbophil (Fibercon).
R: Docusate sodium (Colace) is not a
B. "It will shorten your hospital stay."
bulk-forming laxative; rather, it is a stool
C. "It will decrease your diarrhea and softener. Stool softeners work by
allow your bowel to rest." increasing the amount of water the stool
absorbs in the gut, making the stool
D. "You will feel better after receiving
softer and easier to pass. It does not add
TPN."
bulk to the stool but rather facilitates
R: Total Parenteral Nutrition (TPN) is an
easier passage by softening it.
intravenous method of feeding that
The bulk-forming laxatives, such as
bypasses the digestive tract, delivering
methylcellulose (Citrucel), polycarbophil
essential nutrients directly into the
(Fibercon), and psyllium (Metamucil),
bloodstream. By avoiding the use of the
work differently. These agents are fiber
gastrointestinal (GI) tract for digestion,
supplements that increase the bulk and
TPN allows the bowel to rest, thereby
water content of the stool, which helps to
potentially decreasing symptoms such as
stimulate bowel movements by
diarrhea and giving the intestines time to
expanding the stool mass, making it
heal.
easier to pass through the intestines.
9. Nurse Laura is educating Mr.
11. Nurse Riley is educating Mr.
Thompson, a patient with a duodenal
Anderson on how to properly take
ulcer and H. pylori infection, about his
Cholestyramine (Prevalite). After the observation would indicate that the
session, she checks his understanding of medication is achieving its intended
the instructions. Which statement made therapeutic effect?
by Mr. Anderson suggests he needs more A. Relief from abdominal pain.
education? B. Reduction of excess fat in the stool.
A. "This medicine will assist in lowering C. Absence of constipation.
my cholesterol." D. Absence of diarrhea.
R: Pancrelipase (Pancreaze) is a
B. "I'll sip the Cholestyramine powder
pancreatic enzyme replacement therapy
slowly over time to help with faster
used in patients who have conditions like
absorption."
chronic pancreatitis, cystic fibrosis, or
C. "I'll add more high-fiber foods to my other pancreatic disorders that lead to
diet." insufficient pancreatic enzyme
production. The primary function of
D. "I'll keep taking my multivitamins as
Pancrelipase is to assist in the digestion
usual."
of fats, proteins, and carbohydrates by
R: This statement indicates that Mr.
providing the necessary enzymes (lipase,
Anderson needs more education.
protease, and amylase) that the
Cholestyramine (Prevalite) is a bile acid
pancreas would normally secrete.
sequestrant used to lower cholesterol
levels. The medication comes in powder 14. Nurse Adams is caring for a
form and must be mixed with water or postoperative patient who has been
another liquid before ingestion. However, prescribed Ondansetron (Zofran). For
it should be consumed immediately after which condition should Nurse Adams
mixing, not sipped slowly over time. administer this medication?
Sipping the mixture slowly can reduce its A. Atelectasis
effectiveness and increase the risk of B. Abdominal infection.
gastrointestinal side effects such as C. Vomiting
constipation. Furthermore, D. Incisional pain.
Cholestyramine binds with bile acids in R: Ondansetron (Zofran) is an antiemetic
the intestines, and it does not require medication primarily used to prevent and
"faster absorption" as the statement treat nausea and vomiting. It works by
implies; its primary action occurs within blocking the action of serotonin, a
the gastrointestinal tract. natural substance in the body that can
trigger vomiting. Postoperative patients
12. Nurse Parker is caring for a patient
are often at risk of nausea and vomiting
who is receiving an antiemetic. What is
due to the effects of anesthesia, opioids,
the priority nursing intervention?
and the surgical procedure itself.
A. Keep items far away from the bed.
B. Give the client privacy by letting them 15. Nurse Taylor is reviewing the
walk around the room. medication plan with Mrs. Lopez, who has
C. Monitor intake and output. been on long-term Ibuprofen therapy and
D. Keep the bed in a low position with has recently been prescribed Misoprostol
side rails up. (Cytotec). Nurse Taylor is assessing for
R: The priority nursing intervention for a the therapeutic effects of Misoprostol.
patient receiving an antiemetic is to Which outcome would indicate that the
ensure safety by keeping the bed in a medication is working effectively?
low position with side rails up. Antiemetic A. Decrease in vomiting.
medications, such as ondansetron, B. Healing of gastric ulcers.
metoclopramide, or promethazine, can C. Reduction in diarrhea.
cause drowsiness, dizziness, or sedation D. Alleviation of constipation.
as side effects. These effects increase R: Misoprostol (Cytotec) is a synthetic
the risk of falls or injuries, especially in a prostaglandin E1 analog that is primarily
hospitalized patient who may already be prescribed to prevent and treat gastric
weakened or disoriented due to illness. ulcers, particularly those induced by
nonsteroidal anti-inflammatory drugs
13. Nurse Thompson is evaluating a
(NSAIDs) like Ibuprofen. NSAIDs inhibit
patient who has been prescribed
the production of prostaglandins, which
Pancrelipase (Pancreaze). Which
protect the gastric lining by promoting effectively before food intake triggers the
the secretion of mucus and bicarbonate. release of stomach acid, which could
This inhibition can lead to gastric ulcers. otherwise dilute the medication's
Misoprostol works by replacing the protective layer.
protective prostaglandins, thereby
18. Nurse Mitchell is preparing to
reducing acid secretion and promoting
administer an osmotic laxative to a
the healing of gastric ulcers.
patient. Which of the following
medications is classified as an osmotic
16. Nurse Taylor is providing medication laxative?
instructions to a patient with A. Senna (Senokot).
hemorrhoids who has been prescribed B. Bisacodyl (Dulcolax).
mineral oil. Which statement by the C. Mineral Oil.
patient indicates a need for further D. Polyethylene glycol and electrolytes
teaching? (GoLYTELY).
A. "I can take it at least 2 hours before R: Polyethylene glycol (PEG) with
bedtime." electrolytes, commonly known as
B. "If I miss a dose of mineral oil liquid, GoLYTELY, is classified as an osmotic
I’ll take it as soon as I remember." laxative. Osmotic laxatives work by
C. "It can interfere with the absorption of drawing water into the bowel from
the vitamin E that I am taking." surrounding body tissues, which helps to
D. "I can use mineral oil liquid for an soften the stool and stimulate bowel
extended period to prevent further movements. PEG is commonly used for
damage." bowel cleansing before procedures such
R: This statement indicates a need for as colonoscopy, where rapid and
further teaching because long-term use complete evacuation of the colon is
of mineral oil is not recommended. required.
Mineral oil is a lubricant laxative that
19. Nurse Davis is assessing a patient
works by coating the stool and the inside
who has just been prescribed Loperamide
of the bowel with a waterproof film,
hydrochloride (Imodium). In which
which helps to retain moisture in the
situation is this medication most
stool, making it easier to pass. However,
appropriately indicated?
prolonged use of mineral oil can lead to
A. Cases of acute dysentery.
complications such as fat-soluble vitamin
B. Presence of bloody diarrhea.
deficiencies (e.g., vitamins A, D, E, and
C. Instances of abdominal pain.
K), lipid pneumonia from aspiration, and
D. For patients with an ileostomy.
dependence on laxatives for bowel
R: Loperamide hydrochloride (Imodium)
movements.
is an antidiarrheal medication that works
17. Nurse Evans is educating a patient by slowing down gut movement, which
who has been prescribed Sucralfate allows for more water and electrolytes to
(Carafate) for a gastric ulcer. How should be absorbed, thus reducing the
the nurse instruct the patient to take this frequency of bowel movements. It is
medication? often used to manage chronic diarrhea in
A. At lunchtime. patients with an ileostomy. These
B. 1 hour before meals. patients often experience loose stools
C. 1 hour after meals. because the colon (which absorbs water)
D. Simultaneously with an antacid. is bypassed. Loperamide can help
R: Sucralfate (Carafate) is a medication thicken the stool and decrease the
used primarily to treat gastric ulcers. It frequency of bowel movements,
works by forming a protective barrier improving the patient's quality of life.
over the ulcer site, which shields it from
20. Nurse Johnson is administering an IV
stomach acid and pepsin, thus allowing
bolus of Cimetidine (Tagamet) to her
the ulcer to heal. For optimal
patient. After the administration, which
effectiveness, Sucralfate should be taken
parameter should Nurse Johnson monitor
on an empty stomach, specifically 1 hour
most closely?
before meals. This timing ensures that
A. Patient's temperature.
the medication can coat the ulcer
B. Patient's blood pressure.
C. Patient's respiratory rate. decrease gastric acid production?
D. Patient's skin turgor. A. Metoclopramide (Reglan)
R: Cimetidine (Tagamet) is an H2 B. Magnesium Hydroxide (Maalox)
receptor antagonist primarily used to C. Omeprazole (Prilosec)
reduce stomach acid production in D. Cimetidine (Tagamet)
conditions such as ulcers and R: Cimetidine, also known as Tagamet, is
gastroesophageal reflux disease (GERD). an H2 receptor antagonist. It works by
When administered as an IV bolus, blocking histamine action on H2
Cimetidine can have cardiovascular receptors in the stomach, specifically the
effects, particularly hypotension (low parietal cells, which are responsible for
blood pressure). This is because producing gastric acid. When these H2
Cimetidine can cause vasodilation, receptors are blocked, there is a
leading to a drop in blood pressure. decrease in gastric acid secretion,
Therefore, the patient's blood pressure thereby creating a less acidic
should be closely monitored following the environment in the stomach. This helps
administration of Cimetidine to ensure in the healing of peptic ulcers.
that the patient does not develop
3. In the early hours of the morning,
hypotension, which could lead to
nurse Abby was reviewing a patient’s
dizziness, fainting, or even shock if
chart who was just admitted for
severe.
persistent abdominal pain. She pondered
RNPEDIA Digestive System on the distinguishing characteristics of
duodenal ulcers in order to develop a
1. Nurse Miranda was reviewing Mr.
more accurate care plan. Which of these
Thompson’s health history. He was a
is NOT typically attributed to duodenal
long-time sufferer of cirrhosis, and now
ulcers?
he was exhibiting signs of ascites.
A. Primarily seen in individuals younger
Miranda wondered what factors could be
than 65.
exacerbating Mr. Thompson’s condition.
B. Prevalent more in men than women.
Which of the following does not typically
C. Potential for weight increased.
contribute to ascites?
D. Non-malignant nature, but possible
A. Elevated concentrations of angiotensin
malignancy if left untreated.
I.
R: Duodenal ulcers are a type of peptic
B. High blood pressure.
ulcer disease that occurs in the first part
C. Raised levels of aldosterone.
of the small intestine, known as the
D. Decreased albumin levels.
duodenum. They are typically caused by
R: Indeed, elevated concentrations of
an infection with the bacterium
angiotensin I do not directly contribute to
Helicobacter pylori or by long-term use of
the formation of ascites. Angiotensin I is
nonsteroidal anti-inflammatory drugs
a hormone that is part of the renin-
(NSAIDs). Potential for weight increase is
angiotensin-aldosterone system (RAAS),
not a typical characteristic of duodenal
which helps regulate blood pressure and
ulcers. In fact, people with duodenal
fluid balance in the body. However, it is
ulcers often experience weight loss, not
the conversion of angiotensin I to
gain. This is because the pain associated
angiotensin II that has more direct
with eating can lead to a decrease in
implications for fluid balance.
food intake. Furthermore, the body may
Angiotensin II can lead to
not absorb nutrients as effectively when
vasoconstriction and stimulate the
the lining of the duodenum is damaged
release of aldosterone, which promotes
by an ulcer, which can also contribute to
sodium and water retention, a factor in
weight loss.
ascites formation.
4. During a medical team meeting, Nurse
2. During her evening rounds, Nurse
Williams was discussing Mr. Brown’s
Anderson was administering medications
gastroesophageal reflux disease (GERD)
to Mrs. Johnson, who had recently been
management. They were considering a
diagnosed with peptic ulcer disease.
medication that can neutralize stomach
Anderson considered the properties of
acid directly. Which of the following
each drug. Which medication among the
medications acts as an antacid?
following is known to block histamine and
A. Metoclopramide (Reglan) 7. Nurse Larson was analyzing a patient’s
B. Magnesium Hydroxide (Maalox) chart who had recently been diagnosed
C. Omeprazole (Prilosec) with parotitis. In the case history, he
D. Cimetidine (Tagamet) noticed that the patient had been
R: Magnesium Hydroxide, better known exposed to various microorganisms.
by its brand name Maalox, is classified as Which of the following has been
an antacid. Antacids work by directly associated with parotitis?
neutralizing gastric acid, thereby A. Schistosoma
decreasing the acidity in the stomach B. Wuchereria bancrofti
and providing symptomatic relief to C. Staphylococcus aureus
patients with conditions like GERD. This D. Trypanosoma cruzi
helps protect the esophageal and gastric R: Parotitis is inflammation of the parotid
lining from the corrosive effect of the gland, the largest salivary gland. It can
acid. be caused by a variety of factors,
including bacterial infections. One of the
5. During a health promotion event,
common bacteria associated with
Nurse Rodriguez was providing
parotitis is Staphylococcus aureus. In
information about Hepatitis C. She
many cases, Staphylococcus aureus
mentioned several features of this
gains entry into the salivary glands
disease but noticed a misconception in
through the salivary ducts, causing
her presentation. Which of the following
infection and subsequent inflammation.
is not a specific characteristic of Hepatitis
C? 8. During a nutrition seminar, Nurse
A. Possibility of becoming a lifetime Peters was explaining the storage sites of
carrier. different vitamins in the body. A curious
B. Availability of a preventive vaccine. participant asked about the vitamins that
C. Potential transmission through sexual are not stored in the liver. Which of the
contact. following vitamins is typically not stored
D. Causes inflammation of the liver. in the liver?
R: There is no available vaccine to A. Vitamin A
prevent Hepatitis C. Hepatitis C is a viral B. Vitamin B
infection that causes liver inflammation, C. Vitamin C
and while treatments exist to manage D. Vitamin D
and cure the infection, prevention R: Vitamin C, also known as ascorbic
primarily relies on reducing the risk of acid, is a water-soluble vitamin. It’s not
exposure to the virus rather than stored in large quantities in the body,
vaccination. particularly not in the liver, and excess
amounts are usually excreted through
6. Nurse Elliot was contemplating the
urine. The body requires a continuous
best medication for Mr. Davis who had
supply of Vitamin C through dietary
been struggling with gastroparesis. He
sources or supplements.
knew that a dopamine antagonist might
be beneficial. Which of the following 9. In the midst of a heated discussion
medications acts as a dopamine during a medical seminar, Nurse
antagonist? Thompson brought up the Whipple
A. Metoclopramide procedure. She asked the audience if
B. Cimetidine they knew another term for this
C. Magnesium Hydroxide procedure. The Whipple procedure is also
D. Omeprazole known as a ________.
R: Metoclopramide, known as Reglan, is a A. Cholangiogram
dopamine antagonist. It works by B. Pancreatoduodenectomy
blocking dopamine receptors in the gut, C. Cholecystogram
thereby enhancing gut motility and D. Cholangiopancreatography
accelerating gastric emptying. This R: The Whipple procedure, also known as
action makes it beneficial for conditions a pancreatoduodenectomy, is a complex
like gastroparesis, where there is a delay surgical procedure performed to remove
in gastric emptying. the head of the pancreas, the first part of
the small intestine (duodenum), the
gallbladder and the bile duct. This D. Cholecystogram
operation is typically performed to treat R: The Billroth I procedure, also known as
pancreatic cancer or conditions affecting gastroduodenostomy, is a surgical
the pancreas or bile ducts. procedure where the lower portion of the
stomach, or the pylorus, is removed and
10. Nurse Graham was explaining the
the remaining portion of the stomach is
intricate functions of different cell types
attached directly to the duodenum. This
in the human body to a group of nursing
procedure is commonly used to treat
students. He asked them which type of
conditions such as stomach cancer or
cell is responsible for releasing
peptic ulcer disease.
somatostatin. What type of cell releases
this hormone? 13. During a health education session,
A. D cells Nurse Richards was discussing the role of
B. A cells hormones in glucose metabolism. He
C. B cells asked the participants to identify the
D. Plasma cells type of cell that is responsible for the
R: D cells, also known as delta cells, are release of glucagon. What type of cell
a type of cell found in the pancreas and releases this hormone?
the gastrointestinal tract. They are A. Plasma cells
responsible for the secretion of B. B cells
somatostatin, a hormone that inhibits the C. D cells
release of other hormones including D. A cells
insulin and glucagon from the pancreas, R: A cells, also known as alpha cells, are
and gastrin from the stomach. found in the pancreas, specifically in the
islets of Langerhans. These cells are
11. During a diabetes management
responsible for the secretion of glucagon.
workshop, Nurse Adams was detailing
Glucagon plays a key role in glucose
the role of various cell types involved in
metabolism by stimulating the liver to
glucose regulation. She posed a question
convert stored glycogen into glucose,
about the cell type responsible for insulin
which is then released into the
production. Which type of cell releases
bloodstream. This increases blood
insulin?
glucose levels, acting as a
A. Plasma cells
counterbalance to insulin, which
B. A cells
decreases blood glucose levels.
C. B cells
D. D cells 14. During an anatomy lecture, Nurse
R: In the pancreas, B cells stand for Beta Walker was explaining the complex
cells. These cells are located in the islets vascular system supplying the digestive
of Langerhans within the pancreas, tract. He asked the students to identify
where they produce insulin. Insulin is a the artery primarily responsible for
hormone that regulates the amount of supplying blood to the midgut. Which of
glucose (sugar) in the blood. When blood the following arteries fulfills this role?
glucose levels rise, such as after eating, A. Inferior Mesenteric Artery (IMA)
beta cells release insulin to enable the B. Axillary Artery
body’s cells to absorb glucose from the C. Superior Mesenteric Artery (SMA)
bloodstream for energy or storage, D. Celiac Artery
lowering the amount of glucose in the R: The Superior Mesenteric Artery (SMA)
blood. is the primary artery supplying blood to
the midgut. The midgut consists of parts
12. While discussing various surgical
of the gastrointestinal tract including the
procedures during a training session,
distal half of the duodenum, the jejunum,
Nurse Patel mentioned the Billroth I
the ileum, the ascending colon, and the
procedure. She asked if anyone knew an
proximal two-thirds of the transverse
alternate term for this surgery. The
colon.
Billroth I procedure is also known as a
________. 15. During a surgical nursing seminar,
A. Gastroduodenostomy Nurse Harrison brought up the Billroth II
B. Cholangiogram procedure. She questioned the audience
C. Gastrojejunostomy if they knew another term for this
surgical procedure. The Billroth II a term that is not traditionally considered
procedure is also known as a ________. one of these rights. Which of the
A. Gastrojejunostomy following is not considered a ‘right’ of
B. Cholecystogram medication?
C. Cholangiogram A. Time
D. Gastroduodenostomy B. Limit
R: The Billroth II procedure, also known C. Route
as gastrojejunostomy, is a type of D. Dose
surgery where the remaining part of the R: Traditionally, “limit” is not considered
stomach (after partial gastrectomy) is one of the ‘rights’ of medication
attached directly to the jejunum, administration. The basic rights of
bypassing the duodenum. This procedure medication administration are typically
is commonly used to treat conditions listed as the right patient, right
such as stomach cancer or peptic ulcer medication, right dose, right route, right
disease. time, and more recently, right
documentation and right to refuse.
16. In an anatomy and physiology
lecture, Nurse Baxter was teaching about 19. While attending to Mrs. Arnold, who
the nervous control of the had been struggling with delayed gastric
gastrointestinal tract. She asked the emptying, Nurse Goodman contemplated
students if they knew an alternate name the most suitable medication to alleviate
for the myenteric plexus. The myenteric her symptoms. Which of the following
plexus is also known as the ________. drugs assists in promoting gastric
A. Brachial plexus emptying?
B. Auerbach’s plexus A. Ranitidine (Zantac)
C. Submucosal plexus B. Famotidine (Pepcid)
D. Lumbar plexus C. Tranylcypromine sulfate (Parnate)
R: The myenteric plexus is also known as D. Cisapride (Propulsid)
Auerbach’s plexus. It is one of the major R: Cisapride, sold under the brand name
nerve networks in the gastrointestinal Propulsid, is a medication known as a
tract and plays a crucial role in prokinetic agent. It works by enhancing
controlling gastrointestinal motility. the action of acetylcholine, a
neurotransmitter that promotes muscle
17. While discussing the digestive
contraction in the gastrointestinal tract.
process in a health education class,
This results in an increased rate of
Nurse Bennett asked which enzyme was
gastric emptying, making it a useful
responsible for breaking down starches
medication for conditions characterized
into maltose. Which of the following
by delayed gastric emptying.
enzymes fulfills this role?
A. Lipase 20. In a pharmacology lecture, Nurse
B. Amylase Webster was discussing different classes
C. Trypsinogen of drugs used to manage gastric acid
D. Pepsin disorders. She asked the students to
R: Amylase is the enzyme responsible for identify which among the listed drugs is
breaking down starches into maltose. not considered an H2 blocker. Which of
Starches are complex carbohydrates the following does not belong to this
found in foods like bread, pasta, and category?
potatoes. When you eat these foods, A. Cimetidine
your saliva and pancreatic juice release B. Sucralfate
amylase to begin the process of C. Ranitidine
carbohydrate digestion, breaking the D. Famotidine
starches down into smaller sugars like R: Sucralfate (Carafate) is not an H2
maltose. blocker. It is actually a medication
primarily used for treating active
18. During a medication administration
duodenal ulcers. It works by forming a
seminar, Nurse Matthews was discussing
protective barrier over these ulcers,
the principles of safe medication
promoting healing and preventing further
practices, including the ‘rights’ of
damage from acid and pepsin.
medication. She posed a question about
RNPEDIA LIVER CIRRHOSIS b. Postnecrotic cirrhosis
c. Biliary cirrhosis
1) The nurse is caring for a male client
d. Compensated cirrhosis
with cirrhosis. Which assessment findings
indicate that the client has deficient R: This type of cirrhosis is due to chronic
vitamin K absorption caused by this alcoholism and is the most common type
hepatic disease? of cirrhosis.

a. Dyspnea and fatigue 5) A male client with a history of cirrhosis

b. Ascites and orthopnea and alcoholism is admitted with severe
c. Purpura and petechiae dyspnea resulted to ascites. The nurse
d. Gynecomastia and testicular should be aware that the ascites is most
atrophy likely the result of increased…

R: A hepatic disorder, such as cirrhosis, a. Pressure in the portal vein

may disrupt the liver’s normal use of b. Production of serum albumin
vitamin K to produce prothrombin (a c. Secretion of bile salts
clotting factor). Consequently, the nurse d. Interstitial osmotic pressure
should monitor the client for signs of
R: Enlarged cirrhotic liver impinges the
bleeding, including purpura and
portal system causing increased
petechiae. Dyspnea and fatigue suggest
hydrostatic pressure resulting to ascites.
anemia. Ascites and orthopnea are
unrelated to vitamin K absorption. 6) A client with advanced cirrhosis of the
Gynecomastia and testicular atrophy liver is not tolerating protein well, as
result from decreased estrogen eveidenced by abnormal laboratory
metabolism by the diseased liver. values. The nurse anticipates that which
of the following medications will be
2) A man is admitted to the nursing care
prescribed for the client?
unit with a diagnosis of cirrhosis. He has
a long history of alcohol dependence. a. lactulose (Chronulac)
During the late evening following his b. ethacrynic acid (Edecrin)
admission, he becomes increasingly c. folic acid (Folvite)
disoriented and agitated. Which of the d. thiamine (Vitamin B1)
following would the client be least likely
R: The client with cirrhosis has impaired
to experience?
ability to metabolize protein because of
a. Diaphoresis and tremors. liver dysfunction. Administration of
b. Increased blood pressure and heart lactulose aids in the clearance of
rate. ammonia via the gastrointestinal (GI)
c. Illusions. tract. Ethacrynic acid is a diuretic. Folic
d. Delusions of grandeur. acid and thiamine are vitamins, which
may be used in clients with liver disease
R: Diaphoresis and tremors occur in the
as supplemental therapy.
first phase of alcohol withdrawal. The
blood pressure and heart rate increase in 7) The nurse is caring for a client with
the first phase of alcohol withdrawal. cirrhosis of the liver who has developed
Illusions are common in persons esophageal varices. The nurse
withdrawing from alcohol. Illusions occur understands that the best explanation for
most often in dim artificial lighting where development of esophageal varices is
the environment is not perceived which of the following?
accurately. Delusions of grandeur are
a. Chronic low serum protein levels
symptomatic of manic clients, not clients
result in inadequate tissue repair,
withdrawing from alcohol. The symptoms
allowing the esophageal wall to
and history of alcohol abuse suggest this
weaken.
client is in alcohol withdrawal.
b. The enlarged liver presses on the
4) Which of the following terms is used to diaphragm, which in turn presses
describe a chronic liver disease in which on the esophageal wall, causing
scar tissue surrounds the portal areas? collapse of blood vessels into the
esophageal lumen.
a. Alcoholic cirrhosis
 c. Increased portal pressure causes VII, IX, and X are not produced in
some of the blood that normally sufficient amounts.
circulates through the liver to be
9) A Sengstaken-Blakemore tube is
shunted to the esophageal vessels,
inserted in the effort to stop the bleeding
increasing their pressure and
esophageal varices in a patient with
causing varicosities.
complicated liver cirrhosis. Upon
d. The enlarged liver displaces the
insertion of the tube, the client complains
esophagus toward the left, tearing
of difficulty of breathing. The first action
the muscle layer of the esophageal
of the nurse is to:
blood vessels, which allows small
aneurysms to form along the lower a. Deflate the esophageal balloon
esophageal vessels. b. Monitor VS
c. Encourage him to take deep
R: While low serum albumin is common
breaths
with liver disease, it does not weaken the
d. Notify the MD
existing structures of the body.
Weakness of the esophageal wall is not R: When a client with a Sengstaken-
the problem. Since the esophageal Blakemore tube develops difficulty of
vessels lie close to the surface, under the breathing, it means the tube is displaced
mucous membranes, the esophageal wall and the inflated balloon is in the
does not support them at the inner oropharynx causing airway obstruction
surface. The liver is located to the right
10) A client with cirrhosis is at risk for
of the esophagus. When it enlarges, it is
developing complications. Which
more likely to compromise expansion of
condition is the most serious and
the right lung than to affect the
potentially life-threatening?
esophagus. The fibrosed liver obstructs
flow through portal vessels, which a. Esophageal varices
normally receive all blood circulating b. Ascites
from the gastrointestinal tract. The c. Peripheral edema
increased pressure in portal vessels d. Asterixis (liver flap)
shunts some of the blood into the lower
R: When a client has esophageal varices,
pressure veins around the lower
the vessels become very fragile and
esophagus. Since these veins are not
massive hemorrhage can occur. The
designed to handle the high-pressure
mortality rate is 30% – 50% after an
portal blood flow, they develop
episode of bleeding. Ascites and edema
varicosities, which often rupture and
occur when liver production of albumin
bleed. Enlargement of the liver does not
fails. Asterixis is a sign of hepatic
displace the esophagus.
encephalopathy. Focus:Prioritization
8) Nurse Cynthia is providing a discharge
11) Situation: Mr. Gonzales was admitted
teaching to a client with chronic cirrhosis.
to the hospital with ascites and jaundice.
His wife asks her to explain why there is
To rule out cirrhosis of the liver:Which
so much emphasis on bleeding
laboratory test indicates liver cirrhosis?
precautions. Which of the following
provides the most appropriate response? a. Decreased red blood cell count
b. Decreased serum acid phosphate
a. “The low protein diet will result in
level
reduced clotting.”
c. Elevated white blood cell count
b. “The increased production of bile
d. Elevated serum aminotransferase
decreases clotting factors.”
c. “The liver affected by cirrhosis is R: Hepatic cell death causes release of
unable to produce clotting factors.” liver enzymes alanine aminotransferase
d. “The required medications reduce (ALT), aspartate aminotransferase (AST)
clotting factors.” and lactate dehydrogenase (LDH) into
the circulation. Liver cirrhosis is a chronic
R: When bile production is reduced, the
and irreversible disease of the liver
body has reduced ability to absorb fat-
characterized by generalized
soluble vitamins. Without adequate
inflammation and fibrosis of the liver
Vitamin K absorption, clotting factors II,
tissues.
12) Situation: Mr. Gonzales was admitted getting larger. Which of the following is
to the hospital with ascites and jaundice. the appropriate nursing response?
To rule out cirrhosis of the liver:The
a. “How much of a difference have
biopsy of Mr. Gonzales confirms the
you noticed”
diagnosis of cirrhosis. Mr. Gonzales is at
b. “It’s part of the swelling your body
increased risk for excessive bleeding
is experiencing”
primarily because of:
c. “It’s probably because you have
a. Impaired clotting mechanism been less physically active”
b. Varix formation d. “Your liver is not destroying
c. Inadequate nutrition estrogen hormones that all men
d. Trauma of invasive procedure produce”

R: Cirrhosis of the liver results in R: This allows the client to elaborate his
decreased Vitamin K absorption and concern and provides the nurse a
formation of clotting factors resulting in baseline of assessment
impaired clotting mechanism.
16) Which of the following findings would
13) Mr. Gonzales develops hepatic strongly indicate the possibility of
encephalopathy. Which clinical cirrhosis?
manifestation is most common with this
a. dry skin
condition?
b. hepatomegaly
a. Increased urine output c. peripheral edema
b. Altered level of consciousness d. pruritus
c. Decreased tendon reflex
R: Although option D is correct, it is not a
d. Hypotension
strong indicator of cirrhosis. Pruritus can
R: Changes in behavior and level of occur for many reasons. Options A and C
consciousness are the first sins of hepatic are incorrect, fluid accumulations is
encephalopathy. Hepatic encephalopathy usually in the form of ascites in the
is caused by liver failure and develops abdomen. Hepatomegaly is an enlarged
when the liver is unable to convert liver, which is correct. The spleen may
protein metabolic product ammonia to also be enlarged.
urea. This results in accumulation of
17) Which of the following is NOT a liver
ammonia and other toxic in the blood
function?
that damages the cells.
a. conversion of excess glucose into
14) A nurse is completing an assessment
glycogen for storage
to a client with cirrhosis. Which of the
b. conversion of conjugated bilirubin
following nursing assessment is
to unconjugated bilirubin
important to notify the physician?
c. regulation blood coagulation
a. Expanding ecchymosis d. production of bile salts
b. Ascites and serum albumin of 3.2 e. conversion of ammonia to urea
g/dl
c. Slurred speech
d. Hematocrit of 37% and hemoglobin
of 12g/dl
18) What is the normal liver span?
R: Clients with cirrhosis have already
a. 8-13cm
coagulation due to thrombocytopenia
b. 2-3cm
and vitamin K deficiency. This could be a
c. 1 foot
sign of bleeding
d. 6-12cm
15) A male client with cirrhosis is
19) The left hepatic vein divides the left
complaining of belly pain, itchiness and
lobe into
his breasts are getting larger and also
the abdomen. The client is so upset a. medial and lateral lobes
because of the discomfort and asks the b. anterior and posterior halves
nurse why his breast and abdomen are c. superior and inferior halves
d. left and right parts of left lobe
20) The left lobe occupies d. subphrenic ligaments

a. right and left hypochondrium 29) The pancreas is ____ to the ____ lobe
b. epigastrium and some left of the liver.
hypochondrium
a. inferior, left
c. right hypochondrium and
b. inferior, right
epigastrium
c. superior, left
d. epigastrium and umbilicus
d. inferior, caudate
21) The right lobe of the liver occupies
30) In a female, the liver weighs about
epigastrium.
a. 1200 to 1400 g
a. True
b. 1400 to 1600 g
b. False
c. 1800 mg
22) The fundus of the stomach in d. 1000 g
relationship to the liver
31) Right Lobe length
a. posterior and superior to right lobe
a. 15-17 cm
b. anterior and lateral to left lobe
b. 20-22 cm
c. posterior and lateral to left lobe
c. 10-12.5 cm
d. inferior to left lobe
d. <15 cm
23) Ultrasound is the best modality to
32) Which diagnostic test is best to
differentiate a liver cyst from a solid
evaluate liver enlargement and ascites?
mass
a. Ultrasound
a. True
b. X-Ray
b. False
c. CT scan
24) Right hepatic vein divides right lobe d. Nuclear Medicine
of the liver into anterior and posterior e. Arteriogram
halves.
33) CT scan of the liver
a. True
a. good for evaluating small masses
b. False
<1cm
25) What separates the right lobe from b. good for differentiating cysts vs.
the left lobe? solid mass
c. evaluates function of liver
a. falciform ligament
b. right hepatic vein 34) Which is the largest lobe of liver?
c. ligament teres
a. Right
d. portal vein
b. Left
26) The right lobe of the liver is how c. Quadrate
many times larger than the left? d. Caudate

a. 2 RNPEDIA COLOSTOMY
b. 4
1) The nurse knew that the normal color
c. 6
of Michiel’s stoma should be
d. 8
a. Brick Red
27) Where is Morison’s Pouch located?
b. Gray
a. between liver and right diaphragm c. Blue
b. between liver and left diaphragm d. Pale Pink
c. between liver and right kidney
R: The stoma should be RED in color.
d. between liver and duodenum
Pale pink are common with anemic or
28) The liver is suspended from the dehydrated patients who lost a lot of
diaphragm and abdominal wall by blood after an operation. Blue stoma
indicated cyanosis or alteration in
a. falciform ligament
perfusion. Stomas are not expected to be
b. ligament teres
Gray.
c. ligament venosum
3) The nurse is caring for a client with a when the patient states he’ll contact the
colostomy. The client tells the nurse that doctor if:
he makes small pin holes in the drainage
a. He experiences abdominal
bag to help relieve gas. The nurse should
cramping while the irrigant is
teach him that this action:
infusing
a. destroys the odor-proof seal b. He has difficulty inserting the
b. wont affect the colostomy system irrigation tube into the stoma
c. is appropriate for relieving the gas c. He expels flatus while the return is
in a colostomy system running out
d. destroys the moisture barrier seal d. He’s unable to complete the
procedure in 1 hour
R: Any hole, no matter how small, will
destroy the odor-proof seal of a drainage R: The patient should notify the doctor if
bag. Removing the bag or unclamping it he has difficulty inserting the irrigation
is the only appropriate method for tube into the stoma. Difficulty with
relieving gas. insertion may indicate stenosis of the
bowel. Abdominal cramping and
4) The nurse will start to teach Michiel
expulsion of flatus may normally occur
about the techniques for colostomy
with irrigation. The procedure will often
irrigation. Which of the following should
take an hour to complete.
be included in the nurse’s teaching plan?
8) When preparing to teach a client with
a. Use 500 ml to 1,000 ml NSS
colostomy how to irrigate his colostomy,
b. Suspend the irrigant 45 cm above
the nurse should plan to perform the
the stoma
procedure:
c. Insert the cone 4 cm in the stoma
d. If cramping occurs, slow the a. When the client would have
irrigation normally had a bowel movement
b. After the client accepts he had a
R: 1 inches is equal to 2.54 cm. Convert
bowel movement
the cm if you are not familiar. 45 cm is
c. Before breakfast and morning care
around 17 inches which is ideal for
d. At least 2 hours before visitors
colostomy irrigation. Any value from 12
arrive
to 18 is accepted as the colostomy
irrigant height. Tap water is used as an R: Irrigation should be performed at the
irrigant and is infused at room time the client normally defecated before
temperature. 4 cm is a little bit short for the colostomy to maintain continuity in
the ideal 3-4 inches. If cramping occurs lifestyle and usual bowel function/habit.
STOP the irrigation and continue when is
9) The nurse teaches the patient whose
subsides.
surgery will result in a sigmoid colostomy
5) Nurse Michelle should know that the that the feces expelled through the
drainage is normal 4 days after a sigmoid colostomy will be
colostomy when the stool is:
a. solid.
a. Green liquid b. semi-mushy.
b. Solid formed c. mushy.
c. Loose, bloody d. fluid.
d. Semiformed
R: With a sigmoid colostomy, the feces
R: Normal bowel function and soft- are solid. With a descending colostomy,
formed stool usually do not occur until the feces are semi-mushy. With a
around the seventh day following transverse colostomy, the feces are
surgery. The stool consistency is related mushy. With an ascending colostomy,
to how much water is being absorbed. the feces are fluid.

6) Discharge instructions for a patient 11) Tony returns form surgery with
who has been operated on for colorectal permanent colostomy. During the first 24
cancer include irrigating the colostomy. hours the colostomy does not drain. The
The nurse knows her teaching is effective nurse should be aware that:
 a. Proper functioning of nasogastric a. Stops the flow of fluid when he
suction feels uncomfortable
b. Presurgical decrease in fluid intake b. Lubricates the tip of the catheter
c. Absence of gastrointestinal motility before inserting it into the stoma
d. Intestinal edema following surgery c. Hangs the bag on a clothes hook
on the bathroom door during fluid
R: This is primarily caused by the trauma
insertion
of intestinal manipulation and the
d. Discontinues the insertion of fluid
depressive effects anesthetics and
after only 500 ml of fluid has been
analgesics.
instilled
12) When irrigating a colostomy, the
R: The irrigation bag should be hung 12-
nurse lubricates the catheter and gently
18 inches above the level of the stoma; a
inserts it into the stoma no more than
clothes hook is too high which can create
_______ inches
increase pressure and sudden intestinal
a. 3” distention and cause abdominal
b. 2” discomfort to the patient.
c. 4”
16) A client is scheduled to undergo an
d. 5”
abdominal perineal resection with a
R: The nurse should insert the catheter permanent colostomy. Which of the
no more than 3 inches. following measures would be an
anticipated part of the client’s
13) The next day, the nurse will assess
preoperative care?
Michiel’s stoma. The nurse noticed that a
prolapsed stoma is evident if she sees a. Keep the client NPO for 24 hrs
which of the following? before surgery
b. Administer neomycin sulfate the
a. A sunken and hidden stoma
evening before surgery
b. A dusky and bluish stoma
c. Inform the client that total
c. A narrow and flattened stoma
parenteral nutrition will likely be
d. Protruding stoma with swollen
implemented after surgery
appearance
d. Advise the client to limit physical
R: A refers to a retracted stoma, B refers activity
to a stoma that is getting a very poor
17) A client with colostomy refuses to
blood supply. C is a description of
allow his wife to see the incision or stoma
stenosis of the stoma.
and ignores most of his dietary
14) Michiel asked the nurse, what foods instructions. The nurse on assessing this
will help lessen the odor of his colostomy. data, can assume that the client is
The nurse best response would be experiencing:
a. Eat eggs a. A reaction formation to his recent
b. Eat cucumbers altered body image.
c. Eat beet greens and parsley b. A difficult time accepting reality
d. Eat broccoli and spinach and is in a state of denial.
c. Impotency due to the surgery and
R: Kinchay and Pechay helps lessen the
needs sexual counseling
odor of the colostomy. Spinach, broccoli,
d. Suicide thoughts and should be
Cabbage, Cucumbers, Patola or bottle
seen by psychiatrist
gourd also help lessen the odor BUT are
gas formers. Eggs are not recommended R: As long as no one else confirms the
because they are known to cause presence of the stoma and the client
unpleasant odors in patients with does not need to adhere to a prescribed
colostomy. regimen, the client’s denial is supported
15) When observing an ostomate do a 18) The nurse should insert the
return demonstration of the colostomy colostomy tube for irrigation at
irrigation, the nurse notes that he needs approximately
more teaching if he:
a. 1-2 inches
 b. 3-4 inches a. After surgery, changes in activities
c. 6-8 inches must be made to accommodate for
d. 12-18 inches the physiologic changes caused by
the operation.
R: Remember 3-4 inches. They are both
b. Most sports activities, except for
used in the rectal tube and colostomy
swimming, can be resumed based
irrigation tube insertion. 1 to 2 inches is
on the client’s overall physical
too short and may spill out the irrigant
condition.
out of the stoma. Starting from 6 inches,
c. With counseling and medical
it would be too long already and may
guidance, a near normal lifestyle,
perforate the bowel.
including complete sexual function
19) SITUATION: Michiel, A male patient is possible.
diagnosed with colon cancer was newly d. Activities of daily living should be
put in colostomy. Michiel shows the BEST resumed as quickly as possible to
adaptation with the new colostomy if he avoid depression and further
shows which of the following? dependency.

a. Look at the ostomy site R: There are few physical restraints on

b. Participate with the nurse in his activity postoperatively, but the client
daily ostomy care may have emotional problems resulting
c. Ask for leaflets and contact from the body image changes.
numbers of ostomy support groups
22) The client who had transverse
d. Talk about his ostomy openly to
colostomy asks the nurse about the
the nurse and friends
possible effect of the surgery on future
R: Actual participation conveys positive sexual relationship. What would be the
acceptance and adjustment to the best nursing response?
altered body image. Although looking at
a. The surgery will temporarily
the ostomy site also conveys acceptance
decrease the client’s sexual
and adjustment, Participating with the
impulses.
nurse to his daily ostomy care is the
b. Sexual relationships must be
BEST adaptation a client can make
curtailed for several weeks.
during the first few days after colostomy
c. The partner should be told about
creation.
the surgery before any sexual
20) Arthur Cruz, a 45 year old artist, has activity.
recently had an abdominoperineal d. The client will be able to resume
resection and colostomy. Mr. Cruz normal sexual relationships.
accuses the nurse of being
R: Surgery on the bowel has no direct
uncomfortable during a dressing change,
anatomic or physiologic effect on sexual
because his “wound looks terrible.” The
performance. However, the nurse should
nurse recognizes that the client is using
encourage verbalization.
the defense mechanism known as:
23) The nurse plans to teach Michiel
a. Reaction Formation
about colostomy irrigation. As the nurse
b. Sublimation
prepares the materials needed, which of
c. Intellectualization
the following item indicates that the
d. Projection
nurse needs further instruction?
R: Projection is the attribution of
a. Plain NSS / Normal Saline
unacceptable feelings and emotions to
b. K-Y Jelly
others which may indicate the patients
c. Tap water
nonacceptance of his condition.
d. Irrigation sleeve
21) Before discharge, the nurse
R: The colon is not sterile, nor the
scheduled the client who had a
stomach. Tap water is used in enema
colostomy for colorectal cancer for
irrigation and not NSS. Although some
discharge instruction about resuming
clients would prefer a distilled, mineral or
activities. The nurse should plan to help
filtered water, NSS is not always
the client understands that:
necessary. KY Jelly is used as the
lubricant for the irrigation tube and is conduit created for urine diversion. While
inserted 3-4 inches into the colostomy changing this client’s pouch, the nurse
pointing towards the RIGHT. Irrigation observes that the area around the stoma
sleeve is use to direct the flow of the is red, weeping, and painful. What should
irrigated solution out of the stomach and nurse Katrina conclude?
into the bedpan or toilet.
a. The skin wasn’t lubricated before
24) A 58-year-old male client tells the the pouch was applied.
office nurse that his wife does not let him b. The pouch faceplate doesn’t fit the
change his colostomy bag himself. Which stoma.
response by the nurse indicates as c. A skin barrier was applied properly.
understanding of the situation? d. Stoma dilation wasn’t performed.

a. “Your wife’s need to help you is a R: If the pouch faceplate doesn’t fit the
reality you should accept” stoma properly, the skin around the
b. “Do you think your wife might stoma will be exposed to continuous
benefit from counseling?” urine flow from the stoma, causing
c. “You feel you need privacy when excoriation and red, weeping, and painful
changing your colostomy?” skin. A lubricant shouldn’t be used
d. “Have you discussed the situation because it would prevent the pouch from
with your doctor?” adhering to the skin. When properly
applied, a skin barrier prevents skin
25) Which of the following is TRUE in
excoriation. Stoma dilation isn’t
colostomy feeding?
performed with an ileal conduit, although
a. Hold the syringe 18 inches above it may be done with a colostomy if
the stoma and administer the ordered.
feeding slowly
28) When doing colostomy irrigation at
b. Pour 30 ml of water before and
home, a client with colostomy should be
after feeding administration
instructed to report to his physician :
c. Insert the ostomy feeding tube 1
inch towards the stoma a. Abdominal cramps during fluid
d. A Pink stoma means that inflow
circulation towards the stoma is all b. Difficulty in inserting the irrigating
well tube
c. Passage of flatus during expulsion
26) A Client is scheduled to have a
of feces
descending colostomy. He’s very anxious
d. Inability to complete the procedure
and has many questions regarding the
in half an hour
surgical procedure, care of stoma, and
lifestyle changes. It would be most R: Difficulty of inserting the irrigating
appropriate for the nurse to make a tube indicates stenosis of the stoma and
referral to which member of the health should be reported to the physician.
care team? Abdominal cramps and passage of flatus
can be expected during colostomy
a. Social worker
irrigations. The procedure may take
b. registered dietician
longer than half an hour.
c. occupational therapist
d. enterostomal nurse therapist 29) The first day after, surgery the nurse
finds no measurable fecal drainage from
R: An enterostomal nurse therapist is a
a patient’s colostomy stoma. What is the
registered nurse who has received
most appropriate nursing intervention?
advance education in an accredited
program to care for clients with stomas. a. Call the doctor immediately.
The enterostomal nurse therapist can b. Obtain an order to irrigate the
assist with selection of an appropriate stoma.
stoma site, teach about stoma care, and c. Place the patient on bed rest and
provide emotional support. call the doctor.
d. Continue the current plan of care.
27) A male client with bladder cancer has
had the bladder removed and an ileal
R: The colostomy may not function for 2 a. Is the opening on the client’s left
days or more (48 to 72 hours) after side
surgery. Therefore, the normal plan of b. Is the opening on the distal end on
care can be followed. Since no fecal the client’s left side
drainage is expected for 48 to 72 hours c. Is the opening on the client’s right
after a colostomy (only mucous and side
serosanguineous), the doctor doesn’t d. Is the opening on the distal right
have to be notified and the stoma side
shouldn’t be irrigated at this time.
R: The proximal end of the double-barrel
30) The maximum height of irrigation colostomy is the end toward the small
solution for colostomy is intestines. This end is on the client’s right
side. The distal end, as in answers A, B,
a. 5 inches
and D, is on the client’s left side.
b. 12 inches
c. 18 inches 33) Which of the following behavior of
d. 24 inches the client indicates the best initial step in
learning to care for his colostomy?
R: If you will answer in the CGFNS and
NCLEX, C will be the correct answer. a. Ask to defer colostomy care to
According to BRUNNER AND SUDDARTHS another individual
and Saunders, The height of the b. Promises he will begin to listen the
colostomy irrigation bag should be next day
hanging above the clients shoulder at c. Agrees to look at the colostomy
around 18 inches. According to MOSBY, d. States that colostomy care is the
12 inches should be the maximum function of the nurse while he is in
height. According to Lippinncots, 18 the hospital
inches is the maximum height. According
R: The client made the best initial step in
the the board of examiners, 12 inches
learning to care for his colostomy once
should be the maximum height and an
he looks at the site. This is the start of
18 inches irrigant height would cause
the client’s acceptance on his altered
rapid flow of the irrigant towards the
body image. A,B and D delays learning
colostomy. Therefore, answer in the local
and shows the client’s disintrest
board should only be at 12 inches.
regarding colostomy care.
31) The nurse would know that dietary
34) While irrigating the client’s
teaching had been effective for a client
colostomy, Michiel suddenly complains of
with colostomy when he states that he
severe cramping. Initially, the nurse
will eat:
would
a. Food low in fiber so that there is
a. Stop the irrigation by clamping the
less stool
tube
b. Everything he ate before the
b. Slow down the irrigation
operation but will avoid those foods
c. Tell the client that cramping will
that cause gas
subside and is normal
c. Bland foods so that his intestines
d. Notify the physician
do not become irritated
d. Soft foods that are more easily R: Stopping the irrigation will also stop
digested and absorbed by the large the cramping and pain. During the first
intestines few days of irrigation, The client will feel
pain and cramping as soon as the irirgant
R: There is no special diets for clients
touches the bowel. This will start to
with colostomy. These clients can eat a
lessen once the client got accustomed to
regular diet. Only gas-forming foods that
colostomy irrigation. Slowing down the
cause distention and discomfort should
irrigation will not stop the pain. Telling
be avoided
the client that it is normal and will
32) A temporary colostomy is performed subside eventually is not acceptable
on the client with colon cancer. The when a client experiences pain. Pain is all
nurse is aware that the proximal end of a encompasing and always a priority over
double barrel colostomy: anything else in most situations.
Notifying the physician will not be helpful e. Select the correct tubing and filter.
and unecessary. f. Set infusion pump at prescribed
rate.
RNPEDIA Gastrointestinal Problems
C, E, B, A, D & F
1. In preparing a client for a colonoscopy
procedure, which task is most suitable to R: The solution should not be cloudy or
delegate to the nursing assistant? turbid. Prepare the equipment by priming
the tubing and threading the pump. To
a. Explain the need for clear liquids 1
prevent infection, use aseptic technique
– 3 days prior to procedure.
when inserting the connector into the
b. Reinforce NPO status 8 hours prior
injection cap and connecting the tubing
to procedure.
to the central line. Set the pump at the
c. Administer laxatives 1 – 3 days
prescribed rate. Focus: Prioritization
prior to procedure.
d. Administer an enema the night 4. You are caring for a client with peptic
before the procedure. ulcer disease. Which assessment finding
is the most serious?
R: The nursing assistant can reinforce
dietary and fluid restrictions after the RN a. Projectile vomiting
has explained the information to the b. Burning sensation 2 hours after
client. It is also possible that the nursing eating
assistant can administer the enema; c. Coffee-grounded emesis
however, special training is required and d. Board-like abdomen with shoulder
policies may vary between institutions. pain
Medication administration should be
R: A board-like abdomen with shoulder
performed by licensed personnel. Focus:
pain is a symptom of a perforation, which
Delegation
is most lethal complication of peptic ulcer
2. You would be most concerned about disease. A burning sensation is a typical
which client having an order for TPN complaint, which can be controlled with
(total parental nutrition) fat emulsion? medications. Projectile vomiting can
signal an obstruction. Coffee-ground
a. A client with gastrointestinal
emesis is typical of slower bleeding and
obstruction
will require diagnostic testing. Focus:
b. A client with severe anorexia
Prioritization
nervosa
c. A client with chronic diarrhea and 5. You are taking an initial history for a
vomiting client seeking surgical treatment for
d. A client with a fractured femur obesity. Which of the following should be
called to the attention of the surgeon
R: A client with fractured femur is at risk
before proceeding with additional history
for fat embolism, so fat emulsion should
or physical assessment?
be used with caution. Vomiting may be a
problem if the emulsion is infused too a. Obesity for approximately 5 years
rapidly. TPN is commonly used for b. History of counseling for body
gastrointestinal obstruction, severe dysmorphic disorder
anorexia nervosa, and chronic diarrhea c. Failure to reduce weight with other
or vomiting. Focus: Prioritization forms of therapy
d. Body weight 100% above the ideal
3. You are preparing to administer TPN
for age, gender and height
through a central line. Place the steps for
administration in the correct order. R: Body dysmorphic disorder is a
preoccupation with an imagined physical
a. Use aseptic technique when
defect. Corrective surgery can
handling the injection cap.
exacerbate this disorder when the client
b. Thread the IN tubing through an
continues to feel dissatisfied with the
infusion pump.
results. The other criteria are indicators
c. Check the solution for cloudiness or
of candidacy for this treatment. Focus:
turbidity.
Prioritization
d. Connect the tubing to the central
line.
6. In educating a client with lungs. The amount of residual volume
gastroesophageal reflux disease (GERD), determines whether the amount of the
you will teach the client that the drug scheduled feeding is appropriate or
therapy is a “step-up” approach that whether the physician should be notified.
depends on the response to the Flushing the tube before and after
medication. For the drugs listed, what is feeding helps maintain tube patency.
the anticipated order that the physician Focus: Prioritization
will try in the treatment plan?
9. Care of which of these clients is most
a. Magnesium trisilicate (Gaviscon) appropriate to assign to the LPN/LVN,
and Famotidine (Pepci AC) under the supervision of an RN?
b. Ranitidine (Zantac) 150 mg
a. A client with oral cancer who is
c. Pantoprazole (Protonix)
scheduled in the morning for
A, B & C glossectomy
b. An obese client returned from
R: First, antacids and over-the-counter
surgery following a vertical banded
histamine – 2 blockers are used. In step
gastroplasty
two, prescription histamine – 2 blockers
c. A client with anorexia nervosa with
are prescribed. Finally, proton-pump
muscle weakness and decreased
inhibitors are used. Focus: Prioritization
urine output
7. In caring for a client with GERD, which d. A client with intractable nausea
task would be appropriate to assign to and vomiting related to
the nursing assistant? chemotherapy

a. Share successful strategies for R: Nausea and vomiting are common

weight reduction. after chemotherapy. Administration of
b. Encourage the client to express antiemetics and fluid monitoring can be
concerns about lifestyle done by an LPN/LVN. The RN should do
modification. the pre-operative teaching for the
c. Remind the client not to lie down glossectomy client. Clients returning
for 2 – 3 hours after eating. from surgery need extensive
d. Explain the rationale for small assessment. The client with anorexia is
frequent meals. showing signs of hypokalemia and is at
risk for cardiac dysrhythmias. Focus:
R: Reminding the client to follow through
Assignment
on advice given by the nurse is an
appropriate task for the nursing 10.In planning the post-operative care for
assistant. The RN should take a morbidly obese client, how can the
responsibility for teaching rationale and expertise of the LPN/LVN best be
discussing strategies for the treatment applied?
plan and assessing client concerns.
a. Obtain an oversized blood pressure
Focus: Delegation
cuff and a large-size bed.
8. You are preparing to give an enteral b. Set up a reinforced trapeze bar.
feeding through a nasogastric tube. Place c. Assist in the planning of bathing,
the steps in the correct order. turning, and ambulation.
d. Design alternatives for routine
a. Assess for bowel sounds.
tasks such as daily weights.
b. Auscultate tube placement and
check pH. R: The LPN/LVN can assist in the planning
c. Flush the tube with water. of interventions, but the RN should take
d. Reflush the tube with water. ultimate responsibility for planning or
e. Administer the feeding. designing. Obtaining equipment should
f. Check for residual volume. be delegated to the nursing assistant.
Contact physical therapy to set up
A, B, F, C, E & D
specialized equipment. Focus: Delegation
R: Assessment is the first step. Checking
11.A client with proctitis needs a rectal
for tube placement prevents accidentally
suppository. A senior nursing student
instilling feeding/medication into the
assigned to this client tells you that she
is afraid to insert the suppository to the skin prevents breakdown. Focus:
because she has never done it before. Prioritization
What is the most appropriate action in
13.You are caring for a client with a
supervising this student?
nasogastric (NG) tube. Which task can be
a. You give the medication and report delegated to the experienced nursing
the student to the instructor. assistant?
b. Ask the student to leave the clinical
a. Remove the NG tube per physician
area for being unprepared.
order.
c. Reassign the client to an LPN/LVN.
b. Secure the tape if the client
d. Show the student how to insert the
accidentally dislodges the tube.
suppository and talk to the
c. Disconnect the suction to allow
instructor.
ambulation to the toilet.
R: Showing the student how to insert the d. Reconnect the suction after the
suppository meets that immediate client client has ambulated.
need and the student’s learning need.
R: Disconnecting the tube from suction is
The instructor can address the student’s
an appropriate task to delegate. Suction
fears and long-term learning needs once
should be reconnected by the nurse, so
he/she is aware of the incident. It is
that correct pressure is checked. If the
preferable that students express fears
nursing assistant is permitted to
and learning needs. The other options
reconnect the tube, the RN is still
will discourage the student’s future
responsible for checking that the
disclosure of clinical limitations and
pressure setting is correct. During
need for additional training. Focus:
removal of the tube, there is a potential
Supervision/assignment
for aspiration, so the nurse should
12.You are teaching the client and family perform this task. If the tube is
how to do colostomy irrigation. Place the dislodged, the nurse should recheck
information in the correct order. placement before it is secured. Focus:
Delegation
a. Hang the container at about
shoulder height. 14.In planning a treatment and
b. Allow the solution to flow slowly prevention program of chronic fecal
and steadily for 5 – 10 minutes. incontinence for an elderly client, which
c. Put 500 – 100 mL of lukewarm intervention should you try first?
water in the container.
a. Administer a glycerin suppository
d. Allow 30 – 45 minutes for
15 minutes before evacuation time.
evacuation.
b. Insert a rectal tube at specified
e. Lubricate the stoma cone and
intervals each day.
gently insert the tubing tip into the
c. Assist the client to the bedpan or
stoma.
toilet 30 minutes after meals.
f. Clean, rinse, and dry skin, and
d. Use incontinence briefs or adult-
apply a new drainage pouch.
sized diapers.
C, A, G, E, B, D, F
R: The goal of bowel training is to
R: Prepare the warm water (cold water establish a pattern that mimics normal
can cause cramping) and hang the defecation, and many people have the
container at shoulder height (hanging the urge to defecate after a meal. If this is
container too high or too low will alter not successful, a suppository can be used
the rate of flow). Put on a pair of clean to stimulate the urge. Incontinence briefs
gloves to protect your hands from are embarrassing for the client and must
colostomy secretions. Lubricating the be changed frequently to prevent skin
stoma and gently inserting will allow the breakdown. Routine use of rectal tubes is
water t flow into the stoma. A slow and not recommended because of damage to
steady flow prevents cramps and the mucosa and sphincter tone. Focus:
spillage. Adequate time allows for Prioritization
complete evacuation. Careful attention
15.A client hospitalized with ulcerative
colitis reports 10 – 20 small diarrhea
stools per day, with abdominal pain prior popped open.” Upon examination you
to defecation. The client appears note wound evisceration. Place the
depressed and underweight and is following steps in order for handling this
uninterested in self-care or suggested complication.
therapies. What is the priority nursing
a. Cover the intestine with sterile
diagnosis?
moistened gauze
a. Diarrhea related to irritated bowel b. Stay calm and stay with the client.
b. Imbalanced Nutrition: Less Than c. Monitor the vital signs especially
Body Requirements related to BP and pulse.
nutrient loss d. Have a colleague gather supplies
c. Acute Pain related to increased GI and contact the physician.
motility e. Put the client into semi-Fowler’s
d. Ineffective Therapeutic Regimen with knees slightly flexed.
related to treatment plan f. Prepare the client for surgery as
ordered.
R: The immediate problem is controlling
the diarrhea. Addressing this problem is B, D, E, A, C & F
a step to correcting the nutritional
R: Stay calm and stay with the client. If
imbalance and decreasing the diarrheal
the client does anything to increase
cramping. Self-care and compliance with
intra-abdominal pressure, the
the treatment plan are important long-
evisceration will worsen. Have a
term goals that can be addressed when
colleague gather supplies and notify the
the client is feeling better physically.
physician. Putting the client in a semi-
Focus: Prioritization
Fowler’s position with knees flexed will
16.While transferring a dirty laundry bag, decrease the strain on the wound site.
a nursing assistant sustains a puncture Covering the site provides protection of
would to the finger from a contaminated tissue. Monitor vital signs particularly for
needle. The unit has several clients with decrease in blood pressure or increase in
hepatitis and AIDS; the source is pulse. Anticipate and prepare the client
unknown. Prioritize the instructions that for emergency surgery. Focus:
you, as charge nurse, should give to the Prioritization
assistant.
18.You are caring for a post-operative
a. Have blood test (s) drawn protocol. cholecystectomy client. What should be
b. Complete and file an incident reported immediately to the physician?
report.
a. The client cannot void 4 hours
c. Perform a thorough aseptic
post-operatively.
Handwashing.
b. The client reports shoulder pain.
d. Report to the occupational health
c. The client reports severe RUQ
nurse.
tenderness.
e. Follow up for results and
d. Output does not equal input for the
counseling.
first few hours.
f. Begin prophylactic drug therapy.
R: RUQ is a sign of hemorrhage or bile
C, D, B, A, F & E
leak. Ability to void should return within 6
R: Immediate decontamination is hours post-operatively. Right shoulder
appropriate because time can affect viral pain is related to unabsorbed CO2 and
load. Occupational health will direct the will resolve by placing the client in the
employee in filing the correct forms, Sims’ position. Output that does not
getting the appropriate laboratory tests, equal input after surgery for the first
getting appropriate prophylaxis, and several hours is expected. Focus:
following up on results. Focus: Prioritization
Prioritization
19.In caring for a client with acute viral
17.You are caring for an obese post- hepatitis, which task should be delegated
operative client who underwent surgery to the nursing assistant?
for bowel resection. As the client is
moving in bed, he states, “Something
 a. Empty the bedpan while wearing should be called immediately for which
gloves. physical assessment finding?
b. Suggest diversional activities.
a. Abdominal distention and rigidity
c. Monitor dietary preferences.
b. NG tube intentionally displaced by
d. Reports signs and symptoms of
client
jaundice.
c. Absent or hypoactive bowel sounds
R: The nursing assistant should use d. Nausea and occasional vomiting
infection control precautions for the
R: Distention and rigidity can signal
protection of self, employees, and other
hemorrhage or peritonitis. Physician may
clients. Planning and monitoring are RN
also decide that symptoms require a
responsibilities. While the nursing
medication to stimulate peristalsis.
assistants can report valuable
Absent bowel sounds are expected within
information, they should not be
the first 24 – 28 hours. Nausea and
responsible for signs and symptoms that
vomiting are not uncommon and are
can be subtle or hard to detect, such as
usually self-limiting, and a PRN order for
skin changes. Focus: Delegation
an antiemetic is usually part of the
20.A client with cirrhosis is at risk for routine post-operative orders. Assess the
developing complications. Which client’s reason for pulling tube, and
condition is the most serious and secure as necessary. Focus: Prioritization
potentially life-threatening?
23.You must rearrange the room
a. Esophageal varices assignment for several clients. Which two
b. Ascites clients would best suited to put in the
c. Peripheral edema same room?
d. Asterixis (liver flap)
a. A 35-year-old female with copious,
R: When a client has esophageal varices, intractable diarrhea and vomiting
the vessels become very fragile and b. A 43-year-old female second day
massive hemorrhage can occur. The post-operative cholecystectomy
mortality rate is 30% – 50% after an c. A 53-year-old female with pain
episode of bleeding. Ascites and edema related to alcohol-associated
occur when liver production of albumin pancreatitis
fails. Asterixis is a sign of hepatic d. A 62-year-old female with colon
encephalopathy. Focus:Prioritization cancer receiving chemotherapy
and radiation
21.For clients coming to the ambulatory
care GI clinic, which task would be most R: Both clients will need frequent pain
appropriate to assign to the LPN/LVN? assessments and medications. Clients
with copious diarrhea or vomiting will
a. Teach a client self-care measures
frequently need enteric isolation. Cancer
for hemorrhoids.
clients receiving chemotherapy are at
b. Assist the physician in incision and
risk for immunosuppression and are
drainage of a pilonidal cyst.
likely to need reverse isolation. Focus:
c. Evaluate a client’s response to sitz
Assignment
baths for an anorectal abscess.
d. Describe the basic pathophysiology 24.As nurse manager, you must select an
of an anal fistula to a client. employee to participate in a hospital
committee that will develop client
R: Assisting with procedures in stable
education brochures about common
clients with predictable outcomes is
abdominal surgeries and wound care.
within the educational scope of the
Who would be the best employee to send
LPN/LVN. Teaching the client about self-
to this committee?
care or pathophysiology and evaluating
the outcome of interventions are a. Newly graduated medical-surgical
responsibilities of the RN. Focus: RN
Delegation b. Experienced medical-surgical RN
c. Experienced surgical intensive care
22.A client underwent an exploratory
unit RN
laparotomy 2 days ago. The physician
 d. Experienced medical-surgical pink color. Washing, rinsing, drying, and
LPN/LVN application of a skin barrier help to
protect the skin. A good fit prevents
R: The experienced medical-surgical
gastric contents from spilling onto the
nurse will know the types of questions
skin. Focus: Prioritization
that clients generally ask during the pre-
operative or discharge teaching. The new
graduate may have enthusiasm and
knowledge, but will lack practical
application. SICU nurses are less involved
in pre-operative or discharge teaching.
LPN/LVNs can do teaching, but their
educational scope does not provide for
development of teaching materials and
RNPEDIA GASTRO DISORDERS
strategies. Focus: Assignment
Situation 1: Children have a special
25.A client is admitted through the
fascination with the workings of the
emergency department for a
digestive system. To fully understand the
strangulated intestinal obstruction with
digestive processes, Nurse Lavigña must
perforation. What interventions do you
be knowledgeable of the anatomy and
anticipate for this emergency condition?
physiology of the gastrointestinal
(Choose all that apply.)
system.
a. Preparation for surgery
1. The alimentary canal is a continuous,
b. Barium enema
coiled, hollow muscular tube that winds
c. NG tube insertion
through the ventral cavity and is open at
d. Abdominal x-ray
both ends. Its solid organs include all of
e. IV fluids
the following except:
R: Strangulated intestinal obstruction is a
a. liver
surgical emergency. NG tube is for
b. gall bladder
decompression of the intestine.
c. stomach
Abdominal x-ray is the most useful
d. pancreas
diagnostic aid. IV fluids are needed to
maintain fluid and electrolyte balance R: Stomach is a hollow digestive organ in
and delivery of medication. Barium the GI tract. The liver, gall baldder and
enema is not ordered if perforation is pancreas are all solid organs which are
suspected. Focus: Prioritization part of the hepato-biliary system.

26.Place the steps in correct order for 2. Pharynx is lined with mucous
performing colostomy care. membranes and mucous secreting
glands to ease the passage of food. The
a. Fit the pouch snugly around the
larygngopharynx serves as passageway
stoma.
for:
b. Assess the color and appearance of
the stoma. a. air only
c. Wash the skin with mild soap and b. air and water
rinse with warm water. c. food, fluids and air
d. Apply a skin barrier to protect the d. air and food
peristomal skin.
R: The laryngopharynx serves as
e. Dry the skin carefully.
passageway for air and food and so as
f. Don a pair of clean gloves.
with the oropharynx. Option a is
F, B, C, E, D & A nasopharynx. Answers b and c may be
correct but air and food is more accuarte.
R: Apply a pair of clean gloves before
touching the skin. (Note: Visual 3. Once food has been placed in the
assessment can be performed without mouth, both mechanical and chemical
applying gloves; however, the stoma mat digestions begin. The six activities of the
ooze or require gentle palpation.) The digestive process are:
stoma should be assessed for a healthy
 a. ingestion, mastication, digestion, 6. How will you position Mr. Lim prior to
deglutition, absorption, egestion procedure?
b. ingestion, mastication, deglutition,
a. supine with knees flexed
digestion, absorption, egestion
b. prone
c. deglutition, ingestion, mastication,
c. lying on back
egestion, absorption, defecation
d. sim’s
d. ingestion, digestion, mastication,
deglutition, absorption, defecation R: During abdominal examination,
positioning the client in supine with
R: The digestive processes involve six
knees flexed will promote relaxation of
steps. Ingestion is taking in of food in the
abdominal muscles. Options b and d are
mouth; mastication is the mechanical
inaccurate in this type of procedure.
process where food is converted into
Lying on back or supine may be correct
bolus; deglutition is the act of
but option a is the best answer.
swallowing; digestion is the chemical
breakdown of food into chime; absorption 7. To identify any localized bulging,
occurs in the small intestines (solutes) distention and peristaltic waves, Nurse
and large intestines (water) and Dorina must perform which of the
egestion/defecation where elimination of following?
feces occur.
a. Auscultation
4. Most digestive activity occurs in the b. Inspection
pyloric region of the stomach. What c. Palpation
hormone stimulates the chief cells to d. Percussion
produce pepsinogen?
R: Inspection is the first step in
a. Gastrin abdominal exam to note the contour and
b. Pepsin symmetry of abdomen as well as
c. HCl localized bulging, distention and
d. Insulin peristaltic waves. Auscultation is done to
determine the character, location and
R: Gastrin stimulates chief cells to
frequency of bowel sounds. Percussion is
produce pepsinogen when foods enter
to assess tympany or dullness. Palpation
and suppression of pepsinogen when it
is to asses areas of tenderness and
leaves and enters the small intestines; it
discomfort. Note: In abdominal exam:
is the major hormone that regulates acid
Inspection, Auscultation, Percussion and
secretion in the stomach. Pepsin; a
Palpation are the correct order.
gastric protease secreted in an inactive
form, pepsinogen, which is activated by 8. In order to identify areas of tenderness
stomach acid that acts to degrade and swelling, Nurse Dorina must do:
protein. HCl is produced by the parietal
a. deep palpation
cells. Insulin is a pancreatic hormone.
b. light palpation
5. What pancreatic enzyme aids in the c. percussion
digestion of carbohydrates? d. palpation

a. Lipase R: Light palpation is done to identify

b. Trypsin areas of tenderness and swelling. Deep
c. Amylase palpation is done to identify masses in all
d. Chymotrypsin four quadrants. Test taking skills: one of
the opposite is the correct answer
R: Amylase aids in the digestion of
carbohydrates. Trypsin/Chymotrypsin 9. Mr. Lim verbalized pain on the right
aids in the digestion of proteins. Lipase iliac region. Nurse Dorina knows that the
aids in the digestion of fats. organ affected would be the:

Situation 2: Nurse Dorina is going to a. liver

perform an abdominal examination to Mr. b. sigmoid colon
Lim who was admitted due to on and off c. appendix
pain since yesterday. d. duodenum
R: Appendix and cecum is located in the c. Pyrosis
right iliac region. Liver and gall bladder is d. Dyspepsia
at the right hypochondriac. Sigmoid
R: When difficulty of swallowing is
colon is at the left iliac. Duodenum,
accompanied with pain this is now
stomach and pancreas is in the epigastric
referred as odynophagia. Dysphagia is
region.
difficulty of swallowing alone.
10. Mr. Lim felt pain upon release of
14. To avoid acid reflux, Nurse Yoshi
Nurse Dorina’s hand. This can be referred
should advice Mrs. Cruz to avoid which
as:
type of diet?
a. referred pain
a. cola, coffee and tea
b. rebound tenderness
b. high fat, carbonated and
c. direct tenderness
caffeinated beverages
d. indirect tenderness
c. beer and green tea
R: Rebound tenderness is pain felt upon d. lechon paksiw and bicol express
sudden release of the examiners hand
R: All are correct but option b is the best
which in most cases suggest peritonitis.
answer. In patients with GERD, this type
Referred pain is pain felt in an area
of diet must be avoided to avoid
remote from the site of origin. Direct
backflow of gastric contents. Excessive
tenderness is localized pain upon
caffeine reduces the tone of lower
palpation. Indirect tenderness is pain
esophageal sphincter.
outside the area of palpation.
15. Mrs. Cruz’ body mass index (BMI) is
Situation 3: Mrs. Cruz was admitted in
25. You can categorized her as:
the Medical Floor due to pyrosis,
dyspepsia and difficulty of swallowing. a. normal
b. overweight
11. Based from the symptoms presented,
c. underweight
Nurse Yoshi might suspect:
d. obese
a. Esophagitis
R: Mr. Cruz’ BMI belongs to the
b. Hiatal hernia
overweight category (24 – 26),
c. GERD
malnourished (less than 17), underweight
d. Gastric Ulcer
(17 – 19), normal (20 – 23), obese (27–
R: GERD is the backflow of gastric or 30) and morbidly obese (greater than
duodenal contents into the esophagus 30). BMI is weight in kilograms divided by
caused by incompetent lower esophageal height in square meters.
sphincter. Pyrosis or heartburn,
Situation 4: Nurse Gloria is the staff
dyspepsia and dysphagia are cardinal
nurse assigned at the Emergency
symptoms.
Department. During her shift, a patient
12. What diagnostic test would confirm was rushed – in the ED complaining of
the type of problem Mrs. Cruz have? severe heartburn, vomiting and pain that
radiates to the flank. The doctor suspects
a. barium enema
gastric ulcer.
b. barium swallow
c. colonoscopy 16. What other symptoms will validate
d. lower GI series the diagnosis of gastric ulcer?

R: Barium swallow or upper GI series a. right epigastric pain

would confirm GERD. Endoscopy is b. pain occurs when stomach is
another diagnostic test. Options a and d empty
are the same. Option c is incorrect. c. pain occurs immediately after meal
d. pain not relieved by vomiting
13. Mrs. Cruz complained of pain and
difficulty in swallowing. This term is R: In gastric ulcer food intake aggravates
referred as: pain which usually occur ½ – 1 hour
before meal or immediately during or
a. Odynophagia
after food intake. Options a, b, c
b. Dysphagia
suggests duodenal ulcer.
17. What diagnostic test would yield technique, avoiding certain drugs, and
good visualization of the ulcer crater? observing dietary restrictions can
minimize these measurement errors.
a. Endoscopy
b. Gastroscopy Situation 5: IBD is a common
c. Barium Swallow inflammatory functional bowel disorder
d. Histology also known as spastic bowel, functional
colitis and mucous colitis.
R: Endoscopy determines bleeding, pain,
difficulty swallowing, and a change in 21. The client with IBS asks Nurse June
bowel habits. This would yield good what causes the disease. Which of the
visualization of the ulcer crater. Other following responses by Nurse June would
options are also diagnostic tests in PUD. be most appropriate?

18. Peptic ulcer disease particularly a. “This is an inflammation of the

gastric ulcer is thought to be cause by bowel caused by eating too much
which of the following microorgamisms? roughage”
b. “IBS is caused by a stressful
a. E. coli
lifestyle”
b. H. pylori
c. “The cause of this condition is
c. S. aureus
unknown”
d. K. pnuemoniae
d. “There is thinning of the intestinal
R: Helicobacter pylori (H. pylori) is a mucosa caused by ingestion of
bacteria responsible for most ulcers and gluten”
many cases of chronic gastritis
R: There is no known cause of IBS, and
(inflammation of the stomach). This
diagnosis is made by excluding all the
organism can weaken the protective
other diseases that cause the symptoms.
coating of the stomach and duodenum
There is no inflammation if the bowel.
(first part of the small intestines),
Some factors exacerbate the symptoms
allowing the damaging digestive juices to
including anxiety, fear, stress,
irritate the sensitive lining of these body
depression, some foods and drugs but
parts.
there do not cause the disease.
19. She is for occult blood test, what
22. Which of the following alimentary
specimen will you collect?
canal is the most common location for
a. Blood Chron’s disease?
b. Urine
a. Descending colon
c. Stool
b. Jejunum
d. Gastric Juice
c. Sigmoid Colon
R: Occult blood test or stool guiac test is d. Terminal Ileum
a test that detects the presence of
R: Chronic inflammatory of GI mucosa
hidden (occult) blood in the stool (bowel
occurs anywhere from the mouth to anus
movement). The stool guaiac is the most
but most often in terminal ileum.
common form of fecal occult blood test
Inflammatory lesions are local and
(FOBT) in use today. So stool specimen
involve all layers of the intestinal wall.
will be collected.
24. How about ulcerative colitis, which of
20. Preparation of the client for occult
the following factors is believed to cause
blood examination is:
it?
a. Fluid intake limited only to 1
a. Acidic diet
liter/day
b. Altered immunity
b. NPO for 12 hours prior to obtaining
c. Chronic constipation
of specimen
d. Emotional stress
c. Increase fluid intake
d. Meatless diet for 48 hours prior to R: Refer to rationale for number 23
obtaining of specimen
25. Mr. Jung, had ulcerative colitis for 5
R: Eating meat can cause false positive years and was admitted to the hospital.
test result. Using proper stool collection Which of the following factors was most
likely of greatest significance in causing contraindicated when diverticulitis is
an exacerbation of the disease? present because of the risk of rupturing
the diverticulum.
a. A demanding and stressful job
b. Changing to a modified vegetarian 29. To improve Mr. Trinidad’s condition,
diet your best nursing intervention and
c. Beginning a weight training teaching is:
program
a. Reduce fluid intake
d. Walking 2 miles everyday
b. Increase fiber in the diet
R: Stress is an environmental factor that c. Administering of antibiotics
is thought to cause ulcerative colitis. Test d. Exercise to increase
taking skill: options b, c, and d are all intraabdominal pressure
healthy lifestyles.
R: Patient with diverticulosis must be
Situation 6: A patient was admitted in the encouraged to increase roughage in diet
Medical Floor at St. Luke’s Hospital. He such as fruits and vegetables rich in
was asymptomatic. The doctor suspects fiber. Increasing fluid intake 2 – 3
diverticulosis. liters/day unless contraindicated rather
reducing. Administering antibiotics can
26. Which of the following definitions
decrease bowel flora and infection but
best describes diverticulosis?
this is a dependent function of a nurse.
a. An inflamed outpouching of the
30. Upon review of Mr. Trinidad’s chart,
intestine
Nurse Drew noticed that he weighs 121
b. A non – inflamed outpouching of
lbs and his height is 5 ft, 4 in. After
the intestine
computing for his Body Mass Index (BMI),
c. The partial impairment of the
you can categorize him as:
forward flow of instestinal contents
d. An abnormal protrusions of an a. obese
oxygen through the structure that b. normal
usually holds it c. obese
d. underweight
R: An increase intraluminal pressure
causes the outpouching of the colon wall R: Mr. Trinidad’s BMI is 23 which is
resulting to diverticulosis. Option a normal. Refer to rationale number 15.
suggests diverticulitis.
Situation 7: Manny, 6 years old was
27. Which of the following types of diet is admitted at Cardinal Santos Hospital due
implicated in the development of to increasing frequency of bowel
diverticulosis? movements, abdominal cramps and
distension.
a. Low – fiber diet
b. High – fiber diet 31. Diarrhea is said to be the leading
c. High – protein diet cause of morbidity in the Philippines.
d. Low – carbohydrate diet Nurse Harry knows that diarrhea is
present if:
R: A lack of adequate blood supply and
nutrients from the diet such as low fiber a. passage of stool is more than 3
foods may contribute to the development bowel movements per week
of the disease. b. passage of stool is less than 3
bowel movements per day
28. Which of the following tests should
c. passage of stool is more than 3
be administered to client with
bowel movements per day
diverticulosis?
d. passage of stool is less than 3
a. Proctosocpy bowel movements per week
b. Barium enema
32. Diarrhea is believed to be caused by
c. Barium swallow
all of the following except
d. Gastroscopy
a. increase intestinal secretions
R: Barium enema is used to diagnose
b. altered immunity
diverticulosis, however, this is
c. decrease mucosal absorption
 d. altered motility d. normal bowel sounds heard in all
four quadrants
R: Diarhhea is an intestinal disorder that
is self – limiting. Options a, c and d are R: Early in the bowel obstruction, the
etiological factors of diarrhea. bowel attempts to move the contents
past the obstruction and this is heard as
33. What life threatening condition may
high pitched tinkling bowel sounds. As
result in persistent diarrhea?
the obstruction progresses, bowel sounds
a. hypokalemia will diminish and may finally become
b. dehydration absent.
c. cardiac dysrhytmias
37. Nasogastric tube was inserted to Mr.
d. leukocytosis
Sean. The NGT’s primary purpose is:
R: Due to increase frequency and fluid
a. nutrition
content in the stools, diarrhea may cause
b. decompression of bowel
fluid and electrolyte imbalance such as
c. passage for medication
hypokalemia. Once potassium is
d. aspiration of gastric contents
depleted, this will affect the contractility
of the heart causing cardiac arrhythmia R: The NGT’s primary purpose is for
leading to death. bowel decompression especially for
clients suffering from obstruction.
34. Voluminous, watery stools can
deplete fluids and electrolytes. The acid 38. Mr. Sean has undergone surgery.
base imbalance that can occur is: Post – operatively, which of the following
findings is normal?
a. metabolic alkalosis
b. metabolic acidosis a. absent bowel sounds
c. respiratory acidosis b. bleeding
d. respiratory alkalosis c. hemorrhage
d. bowel movement
R: In diarrhea, metabolic acidosis is the
acid – base imbalance that occurs while R: Post – operatively, no bowel sounds
in vomiting, metabolic alkalosis occur. are present so this is a normal finding.
This is a metabolic disorder that’s why Bleeding and hemorrhage must be
eliminate options c and d. prevented to avoid complications. Bowel
movement occurs only after flatus and
bowel sounds are noted.
35. What is the immediate home care
management for diarrhea? 39. Client education should be given in
order to prevent constipation. Nurse
a. Milk
Leonard’s health teaching should include
b. Imodium
which of the following?
c. Water
d. Oresol a. use of natural laxatives
b. fluid intake of 6 glasses per day
R: In the DOH book, oresol is the
c. use of OTC laxatives
immediate home care management for
d. complete bed rest
diarrhea to prevent dehydration. Water
may not be enough to prevent diarrhea. R: The use of natural laxatives such as
foods and fruits high in fiber is still the
Situation 8: Mr. Sean is admitted to the
best way of preventing constipation
hospital with a bowel obstruction. He
Increasing fluid intake, taking laxatives
complained of colicky pain and inability
judiciously and exercise also can prevent
to pass stool.
this.
36. Which of these findings by Nurse
40. Four hours post – operatively, Mr.
Leonard, would indicate that the
Sean complains of guarding and rigidity
obstruction is in the early stages?
of the abdomen. Nurse Leonard’s initial
a. high pitched tinkling or rumbling intervention is:
bowel sounds
a. assess for signs of peritonitis
b. hypoactive bowel sounds
b. call the physician
c. no bowel sounds auscultated
 c. administer pain medication R: Posturing by lying with legs drawn up
d. ignore the client can relax the abdominal muscle thus
relieve pain.
R: Assessment precedes intervention.
Symptoms presented are signs of 45. After a few minutes, the pain
peritonitis. Assessment will provide you suddenly stops without any intervention.
the data for prompt intervention. Nurse Ray might suspect that:

Situation 9: Mr. Gerald Liu, 19 y/o, is a. the appendix is still distended

being admitted to a hospital unit b. the appendix may have ruptured
complaining of severe pain in the lower c. an increased in intrathoracic
abdomen. Admission vital signs reveal an pressure will occur
oral temperature of 101.2 0F. d. signs and symptoms of peritonitis
occur
41. Which of the following would confirm
a diagnosis of appendicitis? R: If a confirmed diagnosis is made and
the pain suddenly without any
a. The pain is localized at a position
intervention, the appendix may have
halfway between the umbilicus and
ruptured; the pain is lessened because
the right iliac crest.
the appendix is no longer distended thus
b. Mr. Liu describes the pain as
surgery is still needed.
occurring 2 hours after eating
c. The pain subsides after eating Situation 10: Nurse Nico is caring to a 38-
d. The pain is in the left lower year-old female, G3P3 client who has
quadrant been diagnosed with hemorrhoids.

R: Pain over McBurney’s point, the point 46. Which of the following factors would
halfway between the umbilicus and the most likely be a primary cause of her
iliac crest, is diagnosis for appendicitis. hemorrhoids?
Options b and c are common with ulcers;
a. Her age
option d may suggest ulcerative colitis or
b. Three vaginal delivery pregnancies
diverticulitis.
c. Her job as a school teacher
43. The doctor ordered for a complete d. Varicosities in the legs
blood count. After the test, Nurse Ray
R: Hemorrhoids are associated with
received the result from the laboratory.
prolonged sitting, or standing, portal
Which laboratory values will confirm the
hypertension, chronic constipation and
diagnosis of appendicitis?
prolonged intra abdominal pressure as
a. RBC 5.5 x 106/mm3 associated with pregnancy and the strain
b. Hct 44 % of vaginal delivery. Her job as a
c. WBC 13, 000/mm3 schoolteacher does not require prolong
d. Hgb 15 g/dL sitting or standing. Age and leg
varicosities are not related to the
R: Increase in WBC counts is suggestive
development of hemorrhoids.
of appendicitis because of bacterial
invasion and inflammation. Normal WBC 47. Client education should include
count is 5, 000 – 10, 000/mm3. Other minimizing client discomfort due to
options are normal values. hemorrhoids. Nursing management
should include:
44. Signs and symptoms include pain in
the RLQ of the abdomen that may be a. Suggest to eat low roughage diet
localize at McBurney’s point. To relieve b. Advise to wear silk undergarments
pain, Mr. Liu should assume which c. Avoid straining during defecation
position d. Use of sitz bath for 30 minutes

a. Prone R: Straining can increase intra abdominal

b. Supine, stretched out pressure. Health teachings also include:
c. Sitting suggest to eat high roughage diet,
d. Lying with legs drawn up wearing of cotton undergarments and
use of sitz bath for 15 minutes.
48. The doctor orders for Witch Hazel 5 A. The client is oriented to time, place,
%. Nurse Nico knows that the action of and person.
this astringent is:
B. The client exhibits no ecchymotic
a. temporarily relieves pain, burning, areas.
and itching by numbing the nerve
C. The client increases oral intake to
endings
2,000 calories/day.
b. causes coagulation (clumping) of
proteins in the cells of the perianal D. The client exhibits increased serum
skin or the lining of the anal canal albumin level.
c. inhibits the growth of bacteria and
R: Hepatic coma is the most advanced
other organisms
stage of hepatic encephalopathy. As
d. causes the outer layers of skin or
hepatic coma resolves, improvement in
other tissues to disintegrate
the client’s level of consciousness occurs.
R: Option a are local anesthetics; c are The client should be able to express
antiseptics and d are keratolytics. orientation to time, place, and person.
Throughout the intermediate stages,
49. Which position would be ideal for the
patients tend to experience worsening
client in the early postoperative period
levels of confusion, lethargy, and
after hemorrhoidectomy?
personality changes.
a. High Fowler’s
32. Jordin is a client with jaundice who is
b. Supine
experiencing pruritus. Which nursing
c. Side – lying
intervention would be included in the
d. Trendelenburg’s
care plan for the client?
R: Positioning in the early postoperative
A. Administering vitamin K
phase should avoid stress and pressure
subcutaneously
on the operative site. The prone and side
– lying are ideal from a comfort B. Applying pressure when giving I.M.
perspective. A high Fowler’s or supine injections
position will place pressure on the
C. Decreasing the client's dietary protein
operative site and is not recommended.
intake
There is no need for trendelenburg’s
position. D. Keeping the client's fingernails short
and smooth
50. Nurse Nico instructs her client who
has had a hemorrhoidectomy not to used R: The client with pruritus experiences
sitz bath until at least 12 hours itching, which may lead to skin
postoperatively to avoid which of the breakdown and possibly infection from
following complications? scratching. Keeping his fingernails short
and smooth helps prevent skin
a. Hemorrhage
breakdown and infection from scratching.
b. Rectal Spasm
Encourage the patient to adopt skin care
c. Urinary retention
routines to decrease skin irritation. One
d. Constipation
of the first steps in the management of
R: Applying heat during the immediate pruritus is promoting healthy skin and
postoperative period may cause healing of skin lesions.
hemorrhage at the surgical site. Moist
33. Marie, a 51-year-old woman, is
heat may relieve rectal spasms after
diagnosed with cholecystitis. Which diet,
bowel movements. Urinary retention
when selected by the client, indicates
caused by reflex spasm may also be
that the nurse’s teaching has been
relieved by moist heat. Increasing fiber
successful?
and fluid in the diet can help
constipation. A. 4-6 small meals of low-carbohydrate
foods daily
NURSESLABS 1
B. High-fat, high-carbohydrate meals
31. For a client in hepatic coma, which
outcome would be the most appropriate? C. Low-fat, high-carbohydrate meals
D. High-fat, low protein meals C. "Continue taking antacids even when
pain subsides."
34. The hospital administrator had
undergone percutaneous transhepatic D. "Weigh yourself daily when taking this
cholangiography. Which assessment medication."
finding indicates complication after the
R: Antacids neutralize gastric acid and
operation?
decrease the absorption of other
A. Fever and chills medications. The client should be
instructed to avoid taking other
B. Hypertension
medications within 2 hours of the
C. Bradycardia antacid. The antacids act by neutralizing
the acid in the stomach and by inhibiting
D. Nausea and diarrhea
pepsin, which is a proteolytic enzyme.
R: Septicemia is a common complication Each of these cationic salts has a
after a percutaneous transhepatic characteristic pharmacological property
cholangiography. Evidence of fever and that determines its clinical use.
chills, possibly indicative of septicemia, is
37. Which clinical manifestation would
important. Although PTC may be
the nurse expect a client diagnosed with
performed to treat the obstruction that is
acute cholecystitis to exhibit?
the cause of sepsis, PTC itself may also
cause sepsis. Antibiotics, IV fluids, A. Jaundice, dark urine, and steatorrhea
oxygen, and vasopressors in the setting
B. Acute right lower quadrant (RLQ) pain,
of an intensive care unit should be
diarrhea, and dehydration
considered.
C. Ecchymosis petechiae, and coffee-
35. When planning home care for a client
ground emesis
with hepatitis A, which preventive
measure should be emphasized to D. Nausea, vomiting, and anorexia
protect the client’s family?
R: Acute cholecystitis is an acute
A. Keeping the client in complete inflammation of the gallbladder
isolation commonly manifested by the following:
anorexia, nausea, and vomiting; biliary
B. Using good sanitation with dishes and
colic; tenderness and rigidity the right
shared bathrooms
upper quadrant (RUQ) elicited on
C. Avoiding contact with blood-soiled palpation (e.g., Murphy’s sign); fever; fat
clothing or dressing intolerance; and signs and symptoms of
jaundice.
D. Forbidding the sharing of needles or
syringes 38. Pierre, who is diagnosed with acute
pancreatitis, is under the care of Nurse
R: Hepatitis A is transmitted through the
Bryan. Which intervention should the
fecal-oral route or from contaminated
nurse include in the care plan for the
water or food. Measures to protect the
client?
family include good handwashing,
personal hygiene and sanitation, and the A. Administration of vasopressin and
use of standard precautions. According to insertion of a balloon tamponade
the WHO, the most effective way to
B. Preparation for a paracentesis and
prevent HAV infection is to improve
administration of diuretics
sanitation, food safety, and immunization
practices. C. Maintenance of nothing-by-mouth
status and insertion of nasogastric (NG)
36. For Jayvin who is taking antacids,
tube with low intermittent suction
which instruction would be included in
the teaching plan? D. Dietary plan of a low-fat diet and
increased fluid intake to 2,000 ml/day
A. "Take the antacids with 8 oz of water."
R: With acute pancreatitis, the client is
B. "Avoid taking other medications within
kept on nothing-by-mouth status to
2 hours of this one."
inhibit pancreatic stimulation and
secretion of pancreatic enzymes. NG
intubation with low intermittent suction is closely and documented, could place the
used to relieve nausea and vomiting, client at risk for serious fluid and
decrease painful abdominal distention, electrolyte imbalances. The most
and remove hydrochloric acid. Prolonged common adverse effect for any diuretic is
bowel rest by nothing per os (NPO) to mild hypovolemia, which can lead to
minimize pancreatic secretion was an transient dehydration and increased
important part of the therapy for any thirst. When there is an over-treatment
patient with acute pancreatitis. with a diuretic, this could lead to severe
hypovolemia, causing hypotension,
39. When teaching a client about
dizziness, and syncope.
pancreatic function, the nurse
understands that pancreatic lipase 41.Which assessment finding indicates
performs which function? that lactulose is effective in decreasing
the ammonia level in the client with
A. Transports fatty acids into the brush
hepatic encephalopathy?
border
A. Passage of two or three soft stools
B. Breaks down fat into fatty acids and
daily
glycerol
B. Evidence of watery diarrhea
C. Triggers cholecystokinin to contract
the gallbladder C. Daily deterioration in the client's
handwriting
D. Breaks down protein into dipeptides
and amino acids D. Appearance of frothy, foul-smelling
stools
R: Lipase hydrolyses or breaks down fat
into fatty acids and glycerol. Lipase is an R: Lactulose reduces serum ammonia
enzyme that breaks down triglycerides levels by inducing catharsis,
into free fatty acids and glycerol. Lipases subsequently decreasing colonic pH and
are present in pancreatic secretions and inhibiting fecal flora from producing
are responsible for fat digestion. There ammonia from urea. Ammonia is
are many different types of lipases; for removed with the stool. Two or three soft
example, hepatic lipases are in the liver, stools daily indicate the effectiveness of
hormone-sensitive lipases are in the drug. Lactulose, also known as 1,4
adipocytes, lipoprotein lipase is in the beta galactoside-fructose, is a non-
vascular endothelial surface, and absorbable synthetic disaccharide made
pancreatic lipase in the small intestine. up of galactose and fructose. The human
small intestinal mucosa does not have
40. A 52-year-old man was referred to
the enzymes to split lactulose, and hence
the clinic due to increased abdominal
lactulose reaches the large bowel
girth. He is diagnosed with ascites by the
unchanged. Lactulose is metabolized in
presence of a fluid thrill and shifting
the colon by colonic bacteria to
dullness on percussion. After
monosaccharides, and then to volatile
administering diuretic therapy, which
fatty acids, hydrogen, and methane.
nursing action would be most effective in
ensuring safe care? 42. Nurse Farrah is providing care for
Kristoff who has jaundice. Which
A. Measuring serum potassium for
statement indicates that the nurse
hyperkalemia
understands the rationale for instituting
B. Assessing the client for hypervolemia skin care measures for the client?

C. Measuring the client's weight weekly A. "Jaundice is associated with pressure

ulcer formation."
D. Documenting precise intake and
output B. "Jaundice impairs urea production,
which produces pruritus."
R: For the client with ascites receiving
diuretic therapy, careful intake and C. "Jaundice produces pruritus due to
output measurement are essential for impaired bile acid excretion."
safe diuretic therapy. Diuretics lead to
D. "Jaundice leads to decreased tissue
fluid losses, which if not monitored
perfusion and subsequent breakdown."
R: Jaundice is a symptom characterized A. Assessing the client's neurologic
by increased bilirubin concentration in status every 2 hours
the blood. Bile acid excretion is impaired,
B. Monitoring the client's hemoglobin and
increasing the bile acids in the skin and
hematocrit levels
causing pruritus. Patients with jaundice
often nominate pruritus as their most C. Evaluating the client's serum ammonia
troublesome symptom to control and the level
symptom that has the most negative
D. Monitoring the client's handwriting
influence on their quality of life. The
daily
presence of pruritus can cause severe
sleep deprivation resulting in lassitude, E. Preparing to insert an esophageal
fatigue, depression, and suicidal ideation tamponade tube

43. Which rationale supports explaining F. Making sure the client's fingernails are
the placement of an esophageal short
tamponade tube in a client who is
R: Hepatic encephalopathy results from
hemorrhaging?
an increased ammonia level due to the
A. Allowing the client to help insert the liver’s inability to convert ammonia to
tube urea, which leads to neurologic
dysfunction and possible brain damage.
B. Beginning teaching for home care
Hepatic encephalopathy (HE) is a
C. Maintaining the client's level of reversible syndrome observed in patients
anxiety and alertness with advanced liver dysfunction. The
syndrome is characterized by a spectrum
D. Obtaining cooperation and reducing
of neuropsychiatric abnormalities
fear
resulting from the accumulation of
R: An esophageal tamponade tube would neurotoxic substances in the
be inserted in critical situations. bloodstream (and ultimately in the
Typically, the client is fearful and highly brain).
anxious. The nurse, therefore, explains
46. For a client with hepatic cirrhosis who
the placement to help obtain the client’s
has altered clotting mechanisms, which
cooperation and reduce his fear.
intervention would be most important?
44. For Rico who has chronic pancreatitis,
A. Allowing complete independence of
which nursing intervention would be
mobility
most helpful?
B. Applying pressure to injection sites
A. Allowing liberalized fluid intake
C. Administering antibiotics as prescribed
B. Counseling to stop alcohol
consumption D. Increasing nutritional intake

C. Encouraging daily exercise R: The client with cirrhosis who has

altered clotting is at high risk for
D. Modifying dietary protein
hemorrhage. Prolonged application of
R: Chronic pancreatitis typically results pressure to injection or bleeding sites is
from repeated episodes of acute important. Instruct patient/SO of signs
pancreatitis. More than half of chronic and symptoms that warrant notification
pancreatitis cases are associated with of health care provider: increased
alcoholism. Counseling to stop alcohol abdominal girth; rapid weight loss/gain;
consumption would be the most helpful increased peripheral edema; increased
for the client. Explore the availability of dyspnea, fever; blood in stool or urine;
treatment programs and rehabilitation of excess bleeding of any kind; jaundice.
chemical dependency if indicated.
47. A client with advanced cirrhosis has
45.Mr. Hasakusa is in end-stage liver been diagnosed with hepatic
failure. Which interventions should the encephalopathy. The nurse expects to
nurse implement when addressing assess for:
hepatic encephalopathy? Select all that
A. Malaise
apply.
B. Stomatitis increasing blood supply and cell
regeneration. Institute bed red or chair
C. Hand tremors
rest during the toxic state. Provide a
D. Weight loss quiet environment; limit visitors as
needed. Promotes rest and relaxation.
R: Hepatic encephalopathy results from
Available energy is used for healing.
the accumulation of neurotoxins in the
Activity and an upright position are
blood, therefore the nurse wants to
believed to decrease hepatic blood flow,
assess for signs of neurological
which prevents optimal circulation to the
involvement. Flapping of the hands
liver cells.
(asterixis), changes in mentation,
agitation, and confusion are common. 50. Spironolactone (Aldactone) is
During the intermediate stages of HE, a prescribed for a client with chronic
characteristic jerking movement of the cirrhosis and ascites. The nurse should
limbs is often observed (e.g., asterixis) monitor the client for which of the
when the patient attempts to hold arms following medication-related side effects?
outstretched with hands bent upward at
A. Jaundice
the wrist.
B. Hyperkalemia
48. A client diagnosed with chronic
cirrhosis who has ascites and pitting C. Tachycardia
peripheral edema also has hepatic
D. Constipation
encephalopathy. Which of the following
nursing interventions are appropriate to R: This is a potassium-sparing diuretic so
prevent skin breakdown? Select all that clients should be monitored closely for
apply. hyperkalemia. Diarrhea, dizziness, and
headaches are other more common side
A. Range of motion every 4 hours
effects. Spironolactone is a medication
B. Turn and reposition every 2 hours used in the management and treatment
of hypertension and heart failure with
C. Abdominal and foot massages every 2
some indications aside from
hours
cardiovascular disease. It is in the
D. Alternating air pressure mattress mineralocorticoid receptor antagonist
class of drugs.
E. Sit in chair for 30 minutes each shift

R: Edematous tissue must receive

meticulous care to prevent tissue NURSESLABS Prac 9
breakdown. An air pressure mattress,
1. Which of the following laboratory
careful repositioning can prevent skin
values would be the most important to
breakdown. Inspect pressure points and
monitor for a patient with pancreatic
skin surfaces closely and routinely.
cancer?
Gently massage bony prominences or
areas of continued stress. Use of A. Serum glucose
emollient lotions and limiting use of soap
B. Radioimmunoassay (RIA)
for bathing may help.
C. Creatine phosphokinase (CPK)
49. Which of the following will the nurse
include in the care plan for a client D. Carcinoembryonic antigen (CEA)
hospitalized with viral hepatitis? R: In pancreatitis, hypersecretion of the
insulin from a tumor may affect the islets
A. Increase fluid intake to 3000 ml per
of Langerhans, resulting in
day
hyperinsulinemia, a complication of
B. Adequate bed rest pancreatic cancer. Pancreatitis damages
the cells that produce insulin and
C. Bland diet
glucagon, which are the hormones that
D. Administer antibiotics as ordered control the amount of glucose in the
blood. This can lead to an increase in
R: Treatment of hepatitis consists of bed
blood glucose levels.
rest during the acute phase to reduce
metabolic demands on the liver, thus
2. You observe changes in mentation, A. Monitor for respiratory distress.
irritability, restlessness, and decreased
B. Monitor for coagulation studies.
concentration in a patient with cancer of
the liver. Hepatic encephalopathy is C. Administer pain medications as
suspected and the patient is ordered ordered.
neomycin enemas. Which of the following
D. Administer normal saline, crystalloids
information in the patient’s history would
as ordered.
be a contraindication of this order?
R: Pain medication may mask signs and
A. Left nephrectomy
symptoms of hemorrhage, further
B. Glaucoma in both eyes decrease blood pressure, and interfere
with assessment of neurologic status and
C. Myocardial infarction
additional abdominal injury. With the
D. Peripheral neuropathy potential for hemorrhage, nonsteroidal
anti-inflammatory drugs (NSAIDs)
R: Neomycin prevents the release of
probably should be avoided.
ammonia from the intestinal bacteria
Acetaminophen with or without small
flora and from the breakdown of red
quantities of mild narcotic analgesics
blood cells. Common side-effects of this
may be all that should be prescribed
drug are nephrotoxicity and ototoxicity.
initially. Minimize use of analgesics in
Patients with renal disease or renal
patients who are admitted for
impairment should not take this drug. A
observation.
baseline serum BUN/creatinine should be
obtained with subsequent periodical 5. A male client is recovering from a
follow-up blood tests during chronic small bowel resection. To relieve pain,
therapy to monitor for effects on renal the physician prescribes meperidine
function. Prompt discontinuation of the (Demerol), 75 mg I.M. every 4 hours.
drug should occur with any signs of renal How soon after administration should
or otologic damage. meperidine onset of action occur?

3. A nursing intervention for a patient A. 5 to 10 minutes

with hepatitis B would include which of
B. 15 to 30 minutes
the following types of isolation.
C. 30 to 60 minutes
A. Universal precautions
D. 2 to 4 hours
B. Blood transfusions
R: Meperidine onset of action is 15 to 30
C. Enteric isolation
minutes. It peaks between 30 and 60
D. Strict isolation minutes and has a duration of action of 2
to 4 hours. Meperidine, also known as
R: Universal precautions are indicated for
pethidine, is in the class of
the patient with hepatitis B. Hepatitis B is
phenylpiperidine as a hydrochloride salt
contracted via blood and blood products,
synthetic form of the opioid, which is a
body secretions, and punctures from
white crystalline with a melting point of
contaminated needles. Universal
186°C. This medication has calcium
precautions apply to blood and to other
sulfate, dibasic calcium phosphate,
body fluids containing visible blood.
starch, stearic acid, and talc as inactive
Occupational transmission of HIV and
ingredients. Clinicians use meperidine for
HBV to healthcare workers by blood is
the treatment of moderate to severe
documented. Blood is the single most
pain.
important source of HIV, HBV, and other
bloodborne pathogens in the
occupational setting.
Nuseslabs Challenge Exam 2
4. A patient is admitted with lacerated
32. Peritonitis can occur as a
liver as a result of blunt abdominal
complication of:
trauma. Which of the following nursing
interventions would not be appropriate A. Septicemia
for this patient?
B. Multiple organ failure
C. Hypovolemic shock 35. The nurse would anticipate using
which medication if sclerotherapy has not
D. Peptic ulcer disease
been used?
R: Perforation is a life-threatening
A. Neomycin
complication of peptic ulcer disease and
can result in peritonitis. Since the B. Propranolol
peritoneum completely covers the
C. Vasopressin
stomach, perforation of the wall creates
a communication between the gastric D. Cimetidine
lumen and the peritoneal cavity. If the
R: Vasopressin is the drug of choice when
perforation occurs acutely, there is no
sclerotherapy is contraindicated.
time for an inflammatory reaction to wall
Vasoactive drugs stop bleeding in most
off the perforation, and the gastric
patients, and emergency sclerotherapy
content is free to enter the general
may carry risks to the patient and is
peritoneal cavity, causing chemical
more demanding on the healthcare
peritonitis.
system. Sclerotherapy did not appear to
33. A patient has become very depressed be superior to vasoactive drugs in terms
postoperatively after receiving a of control of bleeding, the number of
colostomy for GI cancer. He does not transfusions, 42?day rebleeding and
participate in his colostomy care or looks mortality, or rebleeding and mortality
at the stoma. An appropriate nursing before other elective treatments.
diagnosis for this situation is:
36. The nurse must be alert for
A. Ineffective Individual Coping complications with Sengstaken-
Blakemore intubation including:
B. Knowledge Deficit
A. Pulmonary obstruction
C. Impaired Adjustment
B. Pericardiectomy syndrome
D. Anxiety
C. Pulmonary embolization
R: The patient is dealing with a
disturbance in self-concept and difficulty D. Cor pulmonale
coping with the newly established stoma.
R: Rupture or deflation of the balloon
Encourage the patient/SO to verbalize
could result in upper airway obstruction.
feelings regarding the ostomy.
Esophageal rupture is a well-known but
Acknowledge normality of feelings of
rarely reported fatal complication of the
anger, depression and grief over a loss.
management of bleeding esophageal
Discuss daily “ups and downs” that can
varices with the Sengstaken-Blakemore
occur.
(SB) tube. The most common
34. Patients with esophageal varices complications of esophageal balloon
would reveal the following assessment: therapy for varices include aspiration,
esophageal perforation, and pressure
A. Increased blood pressure
necrosis of the mucosa. The other
B. Increased heart rate choices are not related to the tube.

C. Decreased respiratory rate 37. Peptic ulcer disease may be caused

by which of the following?
D. Increased urinary output
A. Helicobacter pylori
R: Tachycardia is an early sign of
compensation for patients with B. Clostridium difficile
esophageal varices. Since the portal
C. Candida albicans
venous system has no valves, resistance
at any level between the splanchnic D. Staphylococcus aureus
vessels and the right side of the heart
R: Helicobacter pylori is considered to be
results in retrograde flow and elevated
the major cause of ulcer formation.
pressure. The collaterals slowly enlarge
Peptic ulcer disease (PUD) has various
and connect the systemic circulation to
causes; however, Helicobacter pylori-
the portal venous system.
associated PUD and NSAID-associated
PUD account for the majority of the Diabetes mellitus is the most common
disease etiology. H. pylorus is a gram- endocrine disorder affecting multiple
negative bacillus that is found within the organs including the gastrointestinal (GI)
gastric epithelial cells. This bacterium is tract where manifestations and/or
responsible for 90% of duodenal ulcers complications relate to disordered gut
and 70% to 90% of gastric ulcers. Other motility possibly as a result of autonomic
choices are not related to ulcer neuropathy.
formation.
41. During the initial assessment of a
38. Pain control with peptic ulcer disease patient post-endoscopy, the nurse notes
includes all of the following except: absent bowel sounds, tachycardia, and
abdominal distention. The nurse would
A. Promoting physical and emotional rest.
anticipate:
B. Identifying stressful situations.
A. Ischemic bowel
C. Eating meals when desired.
B. Peritonitis
D. Administering medications that
C. Hypovolemic shock
decrease gastric acidity.
D. Perforated bowel
R: Meals should be regularly spaced in a
relaxed environment. Instruct the client R: Invasive diagnostic testing can cause
that meals should be eaten at regularly perforated bowel. Perforation is widely
spaced intervals in a relaxed setting. An recognized as one of the most serious
irregular schedule of meals may interfere complications of endoscopy of the lower
with the regular administration of gastrointestinal tract. The risk of
medications. perforation ranges from 0.027% to
0.088% for flexible sigmoidoscopy, from
39. Nitrosocarcinogen production can be
0.016% to 0.2% for diagnostic
inhibited with the intake of:
colonoscopy, and up to 5% for
A. Vitamin C therapeutic endoscopy.

B. Vitamin E 42. Which of the following tests can be

useful as a diagnostic and therapeutic
C. Carbohydrates
tool in the biliary system?
D. Fiber
A. Ultrasonography
R: Vitamin C and refrigeration of foods
B. MRI
inhibit nitroso carcinogen. Humans are
exposed to a wide range of nitrogen- C. Endoscopic retrograde
containing compounds and nitrosating cholangiopancreatography (ERCP)
agents, such as nitrite, nitrate, and
D. Computed tomography scan (CT scan)
nitrogen oxides (NOx), that can react in
vivo to form potentially carcinogenic N- R: ERCP permits direct visualization of
nitroso compounds (NOCs), as well as the pancreatic and common bile ducts.
several carcinogenic C-nitro(so) or Its therapeutic value is in retrieving
reactive diazo compounds. gallstones from the distal and common
bile ducts and dilating strictures.
40. The nurse can expect a 60-year old
Endoscopic retrograde
patient with ischemic bowel to report a
cholangiopancreatography (ERCP) is a
history of:
combined endoscopic and fluoroscopic
procedure in which an endoscope is
advanced into the second part of the
A. Diabetes mellitus
duodenum, thus allowing other tools to
B. Asthma be passed into the biliary and pancreatic
ducts via the major duodenal papilla.
C. Addison's Disease

D. Cancer of the bowel

43. To inhibit pancreatic secretions,
R: Ischemic bowel occurs in patients over which pharmacologic agent would you
50 with a history of diabetes mellitus.
anticipate administering to a patient with R: Flexion of the trunk lessens the pain
acute pancreatitis? and decreases restlessness. Promote
position of comfort on one side with
A. Nitroglycerin
knees flexed, sitting up, and leaning
B. Somatostatin forward. Reduces abdominal pressure
and tension, providing some measure of
C. Pancrelipase
comfort and pain relief. Other positions
D. Pepcid do not decrease the pain.
R: Somatostatin, a treatment for acute 46. What assessment finding of a patient
pancreatitis, inhibits the release of with acute pancreatitis would indicate a
pancreatic enzymes. Somatostatin bluish discoloration around the
produces predominantly neuroendocrine umbilicus?
inhibitory effects across multiple
A. Grey-Turner's sign
systems. It is known to inhibit GI,
endocrine, exocrine, pancreatic, and B. Homan's sign
pituitary secretions, as well as modify
C. Rovsing's sign
neurotransmission and memory
formation in the CNS. D. Cullen's sign

44. Your patient’s ABG reveals an acidic R: Cullen’s sign is associated with
pH, an acidic CO2, and a normal pancreatitis when a hemorrhage is
bicarbonate level. Which of the following suspected. Cullen’s sign is described as
indicates this acid-base disturbance? superficial edema with bruising in the
subcutaneous fatty tissue around the
A. Respiratory acidosis
periumbilical region. It is also known as
B. Respiratory alkalosis periumbilical ecchymosis. It is most often
recognized as a result of hemorrhagic
C. Metabolic acidosis
pancreatitis. The sign can take 2–3 days
D. Metabolic alkalosis before appearance and may be used as a
clinical sign to help the diagnosis of
R: A pH of 7.35 indicates acidosis, as
acute pancreatitis.
does an acidic CO2 and bicarbonate. The
primary disturbance of elevated arterial 47. A patient with severe cirrhosis of the
PCO2 is the decreased ratio of arterial liver develops hepatorenal syndrome.
bicarbonate to arterial PCO2, which leads Which of the following nursing
to a lowering of the pH. In the presence assessment data would support this?
of alveolar hypoventilation, 2 features
A. Oliguria and azotemia
commonly are seen are respiratory
acidosis and hypercapnia. To B. Metabolic alkalosis
compensate for the disturbance in the
C. Decreased urinary concentration
balance between carbon dioxide and
bicarbonate (HCO3-), the kidneys begin D. Weight gain of less than 1 lb per week
to excrete more acid in the forms of
R: Hepatorenal syndrome is a functional
hydrogen and ammonium and reabsorb
disorder resulting from a redistribution of
more base in the form of bicarbonate.
renal blood flow. Oliguria and azotemia
See also: 8-Step Guide to ABG Analysis:
occur abruptly as a result of this
Tic-Tac-Toe Method
complication. Confusion due to hepatic
45. A clinical manifestation of acute encephalopathy is likely the last and
pancreatitis is epigastric pain. Your most severe stage of liver disease as a
nursing intervention to facilitate relief of result of the liver failing to break down
pain would place the patient in a: toxic metabolites. Most importantly these
patients notice they urinate less
A. Knee-chest position
frequently in smaller and smaller
B. Semi-Fowler's position volumes as they become oliguric.

C. Recumbent position 48. Which phase of hepatitis would the

nurse incur strict precautionary
D. Low-Fowler's position
measures at?
A. Icteric when referral back to a transplant center
or hepatologist is appropriate. The most
B. Non-icteric
serious issues are problems with the
C. Post-icteric vasculature of the liver, biliary issues,
rejection, and infection. Lab
D. Pre-icteric
abnormalities—specifically elevation in
R: Pre-icteric is the infective phase and alkaline phosphatase, alanine
precautionary measures should be aminotransferase (ALT), and serum
strictly enforced. However, most patients bilirubin levels—are usually the first
are not always diagnosed during this indication of a problem in one or more of
phase. Nonspecific symptoms occur; they these areas.
include profound anorexia, malaise,
Quizlet-2
nausea and vomiting, a newly developed
distaste for cigarettes (in smokers), and 1. The health care provider schedules a
often fever or right upper quadrant patient for a colonoscopy. In preparing
abdominal pain. Urticaria and arthralgias him for this procedure, you explain that:
occasionally occur, especially in HBV
a. he will be sedated to minimize
infection.
discomfort
49. You are caring for Rona, a 35-year-
b. the procedure takes only about six
old female in a hepatic coma. Which
minutes
evaluation criteria would be the most
appropriate? c. he may have a liquid breakfast before
the procedure
A. The patient demonstrates an increase
in the level of consciousness. d. he can go back to work as soon as the
procedure is over
B. The patient exhibits improved skin
integrity. 2. The nurse is caring for several patients
with gastrointestinal problems. Which
C. The patient experiences no evident
patient is most likely to need a guaiac
signs of bleeding.
(hemooccult) test?
D. The patient verbalizes decreased
a. patient reports dark amber-colored
episodes of pain.
urine
R: Increased level of consciousness
b. patient reports black discoloration of
indicates resolving of a comatose state.
stool
Ongoing assessment of behavior and
mental status is important because of c. Patient vomits small amounts of yellow
the fluctuating nature of impending emesis
hepatic coma. Other options are
d. patient complains of right upper
important evaluations but do not
quadrant pain
evaluate a patient in a hepatic coma who
is responding to external stimuli. 3. Which healthy lifestyle choice can
decrease the risk of pancreatic cancer?
50. What is the primary nursing diagnosis
for a 4th to 10th-day postoperative liver a. Eat a well-balanced diet
transplant patient?
b. Obtain 30 minutes of exercise at least
A. Excess Fluid Volume three times a week

B. Risk for Rejection c. Refrain from drinking any alcohol

C. Impaired Skin Integrity d. refrain from smoking cigarettes

D. Decreased Cardiac Output 4. When patients undergo diagnostic

tests of the gastrointestinal system,
R: Risk for rejection is always a
elderly patients in particular must be
possibility, especially during the 4th to
closely watched for:
10th day postoperatively. LT patients are
at risk for several complications. The a. dehydration and electrolyte imbalance
primary care NP should be aware of
b. nausea and vomiting
these complications and needs to know
c. diarrhea c. Cancel the test and reschedule it for
the next day
d. constipation from contrast media
d. Notify the charge nurse and diagnostic
5. Hyperactive bowel sounds in one
technician
quadrant and absent bowel sounds in
other quadrants plus nausea and 9. A nurse hears in report that a patient
vomiting may indicate: has stomatitis. Which intervention is the
nurse most likely to initiate for this
a. pancreatitis
patient?
b. cholecystitis
a. check for tube gastric residual before
c. gastrointestinal bleeding feeding

d. intestinal obstruction b. assess for a typical 24 hour eating

pattern
6. Your patient is to have a liver biopsy.
What teaching points should be included c. offer frequent mouth care and artificial
in the instructions (SATA) saliva

a. Nothing is allowed by mouth for 4-8 d. perform a physical assessment with a

hours prior to the procedure skinfold measurement

b. local or general anesthesia will be 10. The nurse is caring for a patient with
used a gastrostomy tube. Which nursing
intervention is appropriate?
c. patient will be positioned on the right
side for the procedure a. flush the tube after each feeding

d. The procedure takes about an hour b. instruct the patient to take some
practice swallows
e. It will be necessary to lie on the right
side for 1-2 hours postprocedure c. give only thickened liquids
d. Heavy lifting or strenuous activities d. handle the tube using sterile technique
are to be avoided for 1-2 weeks
11. Prior to administering an enteral
feeding through a feeding tube, the
nurse checks for residual. What is the
7. The nurse hears in report that a
best rationale for performing this nursing
patient is suspected of having ascites.
action?
WHich action is the nurse most likely to
initiate for this specific condition? a. checking for residual is likely to be in
the procedural manual
a. Elevate the head of the bed 30-45
degrees b. the appearance of residual should be
documented
b. Assess for pain every 30-60 minutes
c. excessive volume can cause
c. Perform serial measurements of
regurgitation and aspiration
abdominal girth
d. The nutritionist bases formula
d. Slightly elevate legs and buttocks to
recommendations on residual content
help expel flatus
12. Following a stroke, a patient has
8. The patient is supposed to be NPO for
dysphagia and a nursing diagnosis of
12 hours prior to diagnostic testing. The
altered swallowing ability. What would be
nursing assistant reports that the patient
the best outcome statement?
just drank a soda and ate a sandwich.
What should the nurse do first? a. patient will receive pureed foods and
thickened liquids
a. Explain the purpose of NPO to the
patient b. patient will increase swallowing
muscle strength
b. Make an incident report that includes
all the relevant facts c. patient will control breathing while
swallowing
d. patient will not aspirate when 17. When caring for a patient with
swallowing nasogastric suction, you would test the
drainage for blood if you found:
13. A patient is second day postoperative
for GI surgery and has a nasogastric tube a. copious greenish drainage in the
attached to suction. There is little container
drainage in the suction container after
b. material resembling coffee grounds in
four hours. What should the nurse do
the tubing
first?
c. complaints of continued nausea by the
a. Check to see that the NG tube is still in
patient
the correct place by checking the mark
near the nose d. a rising BP and pulse rate.

b. try to aspirate some stomach contents

c. irrigate the tube with the ordered QUIZLET 3

amount of solution
1. Which information about an 80-year-
d. Instill 2 mL of air into the pigtail of the old man at the senior center is of most
NG tube with a dry syringe concern to the nurse?

14. A patient is suspected of having a. Decreased appetite

esophageal cancer. Which diagnostic test
b. Unintended weight loss
is the health care provider most likely to
order to make the definitive diagnosis? c. Difficulty chewing food

a. Esophageal manometry with 24 hour d. Complaints of indigestion

pH monitoring
2. When caring for a patient with a
b. Gastric analysis and serum tests for H. history of a total gastrectomy, the nurse
phylori will monitor for

c. Upper GI series and check BMI a. constipation.

d. Esophagogastroduodenoscopy with b. dehydration.

biopsy
c. elevated total serum cholesterol.
15. Proton pump inhibitors such as
d. cobalamin (vitamin B12) deficiency.
rabeprazole (AcipHex) work by:
3. The nurse will plan to monitor a
a. Increasing HCl secretion in the
patient with an obstructed common bile
stomach
duct for
b. neutralizing stomach acid
a. melena.
c. both neutralizing and suppressing
b. steatorrhea (fat in feces).
stomach acid
c. decreased serum cholesterol levels.
d. Suppressing the secretion of stomach
acid d. increased serum indirect bilirubin
levels.
16. A nursing implication for
esomeprazole (Nexium) is to: R: A common bile duct obstruction will
reduce the absorption of fat in the small
a. administer the drug only with food
intestine, leading to fatty stools
b. not to administer the drug with digoxin
4. The nurse receives the following
(lanoxin)
information about a 51-year-old woman
c. administer the drug along with an who is scheduled for a colonoscopy.
antacid Which information should be
communicated to the health care
d. Do not administer the drug along with
provider before sending the patient for
orange or grapefruit juice
the procedure?

a. The patient has a permanent

pacemaker to prevent bradycardia.
b. The patient is worried about b. "Can you tell me the food that you ate
discomfort during the examination. yesterday?"

c. The patient has had an allergic c. "Do you have any difficulty in
reaction to shellfish and iodine in the preparing or eating
past.
food?"
d. The patient refused to drink the
d. "Are you taking any medications that
ordered polyethylene glycol (GoLYTELY).
alter your taste for food?"
5. Which statement to the nurse from a
9. A 54-year-old man has just arrived in
patient with jaundice indicates a need for
the recovery area after an upper
teaching?
endoscopy. Which information collected
a. "I used cough syrup several times a by the nurse is most important to
day last week." communicate to the health care
provider?
b. "I take a baby aspirin every day to
prevent strokes." a. The patient is very drowsy.

c. "I use acetaminophen (Tylenol) every 4 b. The patient reports a sore throat.
hours for back pain."
c. The oral temperature is 101.6° F.
d. "I need to take an antacid for
d. The apical pulse is 104 beats/minute.
indigestion several times a week"
10. A 30-year-old man is being admitted
6. Which finding by the nurse during
to the hospital for elective knee surgery.
abdominal auscultation indicates a need
Which assessment finding is most
for a focused abdominal assessment?
important to report to the health care
a. Loud gurgles provider?

b. High-pitched gurgles a. Tympany on percussion of the

abdomen
c. Absent bowel sounds
b. Liver edge 3 cm below the costal
d. Frequent clicking sounds
margin
7. A 42-year-old woman is admitted to
c. Bowel sounds of 20/minute in each
the outpatient testing area for an
quadrant
ultrasound of the gallbladder. Which
information obtained by the nurse d. Aortic pulsations visible in the
indicates that the ultrasound may need epigastric area
to be rescheduled?
11. A 58-year-old woman has just
a. The patient took a laxative the returned to the nursing unit after an
previous evening. esophagogastroduodenoscopy (EGD).
Which action by unlicensed assistive
b. The patient had a high-fat meal the
personnel (UAP) requires that the
previous
registered nurse (RN) intervene?
evening.
a. Offering the patient a drink of water
c. The patient has a permanent
b. Positioning the patient on the right
gastrostomy tube in place.
side
d. The patient ate a low-fat bagel 4 hours
c. Checking the vital signs every 30
ago for
minutes
breakfast.
d. Swabbing the patient's mouth with
8. The nurse is assessing an alert and cold water
independent 78-year-old woman for
12. While interviewing a 30-year-old
malnutrition risk. The most appropriate
man, the nurse learns that the patient
initial question is which of the following?
has a family history of familial
a. "How do you get to the store to buy adenomatous polyposis (FAP). The nurse
your food?"
will plan to assess the patient's epigastric area and radiating to the
knowledge about umbilicus
4. Severe and unrelenting, located in the
a. preventing noninfectious hepatitis.
left lower quadrant and radiating to the
b. treating inflammatory bowel disease. groin

c. risk for developing colorectal cancer. Rationale: The pain associated with acute
pancreatitis is often severe and
d. using antacids and proton pump
unrelenting, is located in the epigastric
inhibitors.
region, and radiates to the back. The
other options are incorrect.
QUIZLET 4 3. The nurse is assessing a client who is
experiencing an acute episode of
1. The nurse is monitoring a client
cholecystitis. Where should the nurse
admitted to the hospital with a diagnosis
anticipate the location of the pain?
of appendicitis who is scheduled for
1. Right lower quadrant, radiating to the
surgery in 2 hours. The client begins to
back
complain of increased abdominal pain
2. Right lower quadrant, radiating to the
and begins to vomit. On assessment, the
umbilicus
nurse notes that the abdomen is
3. Right upper quadrant, radiating to the
distended and bowel sounds are
left scapula and shoulder
diminished. Which is the most
4. Right upper quadrant, radiating to the
appropriate nursing intervention?
right scapula and shoulder
1. Notify the health care provider (HCP).
Rationale: During an acute episode of
2. Administer the prescribed pain cholecystitis, the client may complain of
medication. severe right upper quadrant pain that
radiates to the right scapula and
3. Call and ask the operating room team
shoulder. This is determined by the
to perform the surgery as soon as
pattern of dermatomes in the body. The
possible.
other options are incorrect.
4. Reposition the client and apply a
4. A client is admitted to the hospital with
heating pad on the warm setting to the
viral hepatitis, complaining of "no
client's Abdomen.
appetite" and "losing my taste for food."
Rationale: On the basis of the signs and What instruction should the nurse give
symptoms presented in the question, the the client to provide adequate nutrition?
nurse should suspect peritonitis and 1. Select foods high in fat.
notify the HCP. Administering pain 2. Increase intake of fluids, including
medication is not an appropriate juices.
intervention. Heat should never be 3. Eat a good supper when anorexia is
applied to the abdomen of a client with not as severe.
suspected appendicitis because of the 4. Eat less often, preferably only three
risk of rupture. Scheduling surgical time large meals daily.
is not within the scope of nursing
Rationale: Although no special diet is
practice, although the HCP probably
required to treat viral hepatitis, it is
would perform the surgery earlier than
generally recommended that clients
the prescheduled time
consume a low-fat diet as fat may be
2. A client has been admitted to the tolerated poorly because of decreased
hospital with a diagnosis of acute bile production. Small, frequent meals
pancreatitis and the Nurse is assessing are preferable and may even prevent
the client's pain. What type of pain is nausea. Frequently, appetite is better in
consistent with this diagnosis? the morning, so it is easier to eat a good
breakfast. An adequate fluid intake of
1. Burning and aching, located in the left
2500 to 3000 mL/day that includes
lower quadrant and radiating to the hip
nutritional juices is also important.
2. Severe and unrelenting, located in the
epigastric area and radiating to the back
3. Burning and aching, located in the
5. A client has developed hepatitis A 5. Fried chicken
after eating contaminated oysters. The 6. Scrambled eggs
nurse assesses the client for which Rationale: Foods that decrease lower
expected assessment finding? esophageal sphincter (LES) pressure and
1. Malaise irritate the esophagus will increase reflux
2. Dark stools and exacerbate the symptoms of
3. Weight gain gastroesophageal reflux disease (GERD)
4. Left upper quadrant discomfort and therefore should be avoided.
Rationale: Hepatitis causes Aggravating substances include
gastrointestinal chocolate, coffee, fried or fatty foods,
symptoms such as anorexia, nausea, peppermint, carbonated beverages, and
right alcohol. Options 4 and 6 do not promote
upper quadrant discomfort, and weight this effect.
loss.
8. A client has undergone
Fatigue and malaise are common. Stools
esophagogastroduodenoscopy. The nurse
will be light- or clay-colored if conjugated
should place highest priority on which
bilirubin is unable to flow out of the liver
item as part of the client's care plan?
because of inflammation or obstruction
1. Monitoring the temperature
of the bile ducts
2. Monitoring complaints of heartburn
6. A client has just had a 3. Giving warm gargles for a sore throat
hemorrhoidectomy. Which nursing 4. Assessing for the return of the gag
interventions are appropriate for this reflex
client? Select all that apply. Rationale: The nurse places highest
1. Administer stool softeners as priority on assessing for return of the gag
prescribed. reflex. This assessment addresses the
2. Instruct the client to limit fluid intake client's airway. The nurse also monitors
to avoid urinary retention. the client's vital signs and for a sudden
3. Instruct the client to avoid activities increase in temperature, which could
that will initiate vasovagal responses. indicate perforation of the
4. Encourage a high-fiber diet to promote gastrointestinal tract. This complication
bowel movements without straining. would be accompanied by other signs as
5. Apply cold packs to the anal-rectal well, such as pain. Monitoring for sore
area over the dressing until the packing throat and heartburn are also important;
is removed. however, the client's airway is the
6. Help the client to a Fowler's position to priority
place pressure on the rectal area and
9. The nurse has taught the client about
decrease bleeding.
an upcoming endoscopic retrograde
Rationale: Nursing interventions after a
cholangiopancreatography procedure.
hemorrhoidectomy are aimed at
The nurse determines that the client
management of pain and avoidance of
needs further information if the client
bleeding and incision rupture. Stool
makes which statement?
softeners and a high-fiber diet will help
1. "I know I must sign the consent form."
the client avoid straining, thereby
2. "I hope the throat spray keeps me
reducing the chances of rupturing the
from gagging."
incision. An ice pack will increase comfort
3. "I'm glad I don't have to lie still for this
and decrease bleeding. Options 2, 3, and
procedure."
6 are incorrect interventions.
4. "I'm glad some IV medication will be
7. The nurse is planning to teach a client given to relax me."
with gastroesophageal reflux disease Rationale: The client does have to lie still
about substances to avoid. Which items for endoscopic retrograde
should the nurse include on this list? cholangiopancreatography (ERCP), which
Select all that apply. takes about 1 hour to perform. The client
1. Coffee also has to sign a consent form.
2. Chocolate Intravenous sedation is given to relax the
3. Peppermint client, and an anesthetic spray is used to
4. Nonfat milk
help keep the client from gagging as the anticholinergics may be prescribed to
endoscope is passed. suppress gastrointestinal secretions.

10. The health care provider has 18. The nurse is reviewing the record of a
determined that a client with hepatitis client with a diagnosis of cirrhosis and
has contracted the Infection from notes that there is documentation of the
contaminated food. The nurse presence of asterixis. How should the
understands that this client is most likely nurse assess for its presence?
experiencing what type of hepatitis? 1. Dorsiflex the client's foot.
1. Hepatitis A 2. Measure the abdominal girth.
2. Hepatitis B 3. Ask the client to extend the arms.
3. Hepatitis C 4. Instruct the client to lean forward.
4. Hepatitis D Rationale: Asterixis is irregular flapping
Rationale: Hepatitis A is transmitted by movements of the fingers and wrists
the fecal-oral route via contaminated when the hands and arms are
food or infected food handlers. Hepatitis outstretched, with the palms down,
B, C, and D are transmitted most wrists bent up, and fingers spread.
commonly via infected blood or body Asterixis is the most common and
fluids. reliable sign that hepatic encephalopathy
is developing. Options 1, 2, and 4 are
16. The nurse is reviewing the
incorrect.
prescription for a client admitted to the
hospital with a diagnosis of acute 19. The nurse is reviewing the laboratory
pancreatitis. Which interventions would results for a client with cirrhosis and
the nurse expect to be prescribed for the notes that The ammonia level is
client? Select all that apply. elevated. Which diet does the nurse
1. Administer antacids as prescribed. anticipate to be prescribed for This
2. Encourage coughing and deep client?
breathing. 1. Low-protein diet
3. Administer anticholinergics as 2. High-protein diet
prescribed. 3. Moderate-fat diet
4. Give small, frequent high-calorie 4. High-carbohydrate diet
feedings. Rationale: Cirrhosis is a chronic,
5. Maintain the client in a supine and flat progressive
position. disease of the liver characterized by
6. Give meperidine (Demerol) as diffuse
prescribed for pain. degeneration and destruction of
Rationale: The client with acute hepatocytes. Most of the ammonia in the
pancreatitis normally is placed on NPO body is found in the gastrointestinal
status to rest the pancreas and suppress tract.
gastrointestinal secretions. Because Protein provided by the diet is
abdominal pain is a prominent symptom transported to
of pancreatitis, pain medication such as the liver by the portal vein. The liver
meperidine is prescribed. Some clients breaks down
experience lessened pain by assuming protein, which results in the formation of
positions that flex the trunk, with the ammonia. If the client has hepatic
knees drawn up to the chest. A side-lying encephalopathy, a low-protein diet would
position with the head elevated 45 be
degrees decreases tension on the prescribed.
abdomen and may help ease the pain.
20. The nurse is doing an admission
The client is susceptible to respiratory
assessment on a client with a history of
infections because the retroperitoneal
duodenal ulcer. To determine whether
fluid raises the diaphragm, which causes
the problem is currently active, the nurse
the client to take shallow, guarded
should assess the client for which
abdominal breaths. Therefore measures
symptom(s) of duodenal ulcer
such as turning, coughing, and deep
1. Weight loss
breathing are instituted. Antacids and
2. Nausea and vomiting
3. Pain relieved by food intake
4. Pain radiating down the right arm stool via the colostomy. Options 2, 3, and
Rationale: A frequent symptom of 4 are incorrect.
duodenal ulcer is pain that is relieved by
food intake. These clients generally
describe the pain as a burning, heavy,
sharp, or "hungry" pain that often
localizes in the mid-epigastric area. The
client with duodenal ulcer usually does
not experience weight loss or nausea and
vomiting. These symptoms are more
typical in the client with a gastric ulcer.

21. A client with hiatal hernia chronically

experiences heartburn following meals.
The nurse should plan to teach the client
to avoid which action because it is
contraindicated with a hiatal hernia?
1. Lying recumbent following meals
2. Consuming small, frequent, bland
meals
3. Raising the head of the bed on 6-inch
blocks
4. Taking H2-receptor antagonist
medication
Rationale: Hiatal hernia is caused by a
protrusion of a portion of the stomach
above the
diaphragm where the esophagus usually
is positioned. The client usually
experiences pain from reflux caused by
ingestion of irritating foods, lying flat
following meals or at night, and eating
large or fatty meals. Relief is obtained
with the intake of small, frequent, and
bland meals, use of H2-receptor
antagonists and antacids, and elevation
of the thorax following meals and during
sleep.

23. A client had a new colostomy created

2 days earlier and is beginning to pass
malodorous flatus from the stoma. What
is the correct interpretation by the
nurse?
1. This is a normal, expected event.
2. The client is experiencing early signs
of ischemic bowel.
3. The client should not have the
nasogastric tube removed.
4. This indicates inadequate preoperative
bowel preparation.
Rationale: As peristalsis returns following
creation of a colostomy, the client begins
to pass malodorous flatus. This indicates
returning bowel function and is an
expected event. Within 72 hours of
surgery, the client should begin passing