Text Mode Text version of the exam

Situation 1: Children have a special

fascination with the workings of the
digestive system. To fully understand the
digestive processes, Nurse Laviga must
be knowledgeable of the anatomy and
physiology of the gastrointestinal system.
1. The alimentary canal is a continuous,
coiled, hollow muscular tube that winds
through the ventral cavity and is open at
both ends. Its solid organs include all of
the following except:
A. liver
B. gall bladder
C. stomach
D. pancreas
2. Pharynx is lined with mucous
membranes and mucous secreting glands
to ease the passage of food. The
larygngopharynx serves as passageway
for:
A. air only
B. air and water
C. food, fluids and air
D. air and food
3. Once food has been placed in the
mouth, both mechanical and chemical
digestions begin. The six activities of the
digestive process are:
A. ingestion, mastication, digestion,
deglutition, absorption, egestion
B. ingestion, mastication, deglutition,
digestion, absorption, egestion
C. deglutition, ingestion, mastication,
egestion, absorption, defecation
D. ingestion, digestion, mastication,
deglutition, absorption, defecation
4. Most digestive activity occurs in the
pyloric region of the stomach. What

hormone stimulates the chief cells to

produce pepsinogen?
A. Gastrin
B. Pepsin
C. HCl
D. Insulin
5. What pancreatic enzyme aids in the
digestion of carbohydrates?
A. Lipase
B. Trypsin
C. Amylase
D. Chymotrypsin
Situation 2: Nurse Dorina is going to
perform an abdominal examination to Mr.
Lim who was admitted due to on and off
pain since yesterday.
6. How will you position Mr. Lim prior to
procedure?
A. supine with knees flexed
B. prone
C. lying on back
D. sims
7. To identify any localized bulging,
distention and peristaltic waves, Nurse
Dorina must perform which of the
following?
A. Auscultation
B. Inspection
C. Palpation
D. Percussion
8. In order to identify areas of tenderness
and swelling, Nurse Dorina must do:
A. deep palpation
B. light palpation
C. percussion

D. palpation
9. Mr. Lim verbalized pain on the right iliac
region. Nurse Dorina knows that the organ
affected would be the:

D. Dyspepsia
14. To avoid acid reflux, Nurse Yoshi
should advice Mrs. Cruz to avoid which
type of diet?

A. liver

A. cola, coffee and tea

B. sigmoid colon

B. high fat, carbonated and

caffeinated beverages

C. appendix
D. duodenum
10. Mr. Lim felt pain upon release of Nurse
Dorinas hand. This can be referred as:
A. referred pain
B. rebound tenderness
C. direct tenderness
D. indirect tenderness
Situation 3: Mrs. Cruz was admitted in the
Medical Floor due to pyrosis, dyspepsia
and difficulty of swallowing.
11. Based from the symptoms presented,
Nurse Yoshi might suspect:
A. Esophagitis
B. Hiatal hernia
C. GERD
D. Gastric Ulcer
12. What diagnostic test would confirm the
type of problem Mrs. Cruz have?
A. barium enema
B. barium swallow
C. colonoscopy
D. lower GI series
13. Mrs. Cruz complained of pain and
difficulty in swallowing. This term is
referred as:
A. Odynophagia
B. Dysphagia
C. Pyrosis

C. beer and green tea

D. lechon paksiw and bicol express
15. Mrs. Cruz body mass index (BMI) is
25. You can categorized her as:
A. normal
B. overweight
C. underweight
D. obese
Situation 4: Nurse Gloria is the staff nurse
assigned at the Emergency Department.
During her shift, a patient was rushed in
the ED complaining of severe heartburn,
vomiting and pain that radiates to the
flank. The doctor suspects gastric ulcer.
16. What other symptoms will validate the
diagnosis of gastric ulcer?
A. right epigastric pain
B. pain occurs when stomach is
empty
C. pain occurs immediately after meal
D. pain not relieved by vomiting
17. What diagnostic test would yield good
visualization of the ulcer crater?
A. Endoscopy
B. Gastroscopy
C. Barium Swallow
D. Histology
18. Peptic ulcer disease particularly gastric
ulcer is thought to be cause by which of
the following microorgamisms?

A. E. coli
B. H. pylori

22. Which of the following alimentary

canal is the most common location for
Chrons disease?

C. S. aureus

A. Descending colon

D. K. pnuemoniae

B. Jejunum

19. She is for occult blood test, what

specimen will you collect?
A. Blood
B. Urine

C. Sigmoid Colon
D. Terminal Ileum
23. Which of the following factors is
believed to be linked to Crohns disease?

C. Stool

A. Diet

D. Gastric Juice

B. Constipation

20. Preparation of the client for occult

blood examination is:
A. Fluid intake limited only to 1
liter/day
B. NPO for 12 hours prior to obtaining
of specimen
C. Increase fluid intake
D. Meatless diet for 48 hours prior to
obtaining of specimen
Situation 5: IBD is a common
inflammatory functional bowel disorder
also known as spastic bowel, functional
colitis and mucous colitis.
21. The client with IBS asks Nurse June
what causes the disease. Which of the
following responses by Nurse June would
be most appropriate?
A. This is an inflammation of the
bowel caused by eating too much
roughage
B. IBS is caused by a stressful
lifestyle
C. The cause of this condition is
unknown
D. There is thinning of the intestinal
mucosa caused by ingestion of
gluten

C. Heredity
D. Lack of exercise
24. How about ulcerative colitis, which of
the following factors is believed to cause
it?
A. Acidic diet
B. Altered immunity
C. Chronic constipation
D. Emotional stress
25. Mr. Jung, had ulcerative colitis for 5
years and was admitted to the hospital.
Which of the following factors was most
likely of greatest significance in causing an
exacerbation of the disease?
A. A demanding and stressful job
B. Changing to a modified vegetarian
diet
C. Beginning a weight training
program
D. Walking 2 miles everyday
Situation 6: A patient was admitted in the
Medical Floor at St. Lukes Hospital. He
was asymptomatic. The doctor suspects
diverticulosis.
26. Which of the following definitions best
describes diverticulosis?

A. An inflamed outpouching of the

intestine
B. A non inflamed outpouching of
the intestine
C. The partial impairment of the
forward flow of instestinal contents
D. An abnormal protrusions of an
oxygen through the structure that
usually holds it
27. Which of the following types of diet is
implicated in the development of
diverticulosis?
A. Low fiber diet
B. High fiber diet
C. High protein diet
D. Low carbohydrate diet
28. Which of the following tests should be
administered to client with diverticulosis?
A. Proctosocpy
B. Barium enema
C. Barium swallow
D. Gastroscopy
29. To improve Mr. Trinidads condition,
your best nursing intervention and
teaching is:
A. Reduce fluid intake

C. obese
D. underweight
Situation 7: Manny, 6 years old was
admitted at Cardinal Santos Hospital due
to increasing frequency of bowel
movements, abdominal cramps and
distension.
31. Diarrhea is said to be the leading
cause of morbidity in the Philippines.
Nurse Harry knows that diarrhea is present
if:
A. passage of stool is more than 3
bowel movements per week
B. passage of stool is less than 3
bowel movements per day
C. passage of stool is more than 3
bowel movements per day
D. passage of stool is less than 3
bowel movements per week
32. Diarrhea is believed to be caused by
all of the following except
A. increase intestinal secretions
B. altered immunity
C. decrease mucosal absorption
D. altered motility
33. What life threatening condition may
result in persistent diarrhea?

B. Increase fiber in the diet

A. hypokalemia

C. Administering of antibiotics

B. dehydration

D. Exercise to increase intraabdominal

pressure

C. cardiac dysrhytmias

30. Upon review of Mr. Trinidads chart,

Nurse Drew noticed that he weighs 121 lbs
and his height is 5 ft, 4 in. After computing
for his Body Mass Index (BMI), you can
categorize him as:

D. leukocytosis
34. Voluminous, watery stools can deplete
fluids and electrolytes. The acid base
imbalance that can occur is:
A. metabolic alkalosis

A. obese

B. metabolic acidosis

B. normal

C. respiratory acidosis

D. respiratory alkalosis
35. What is the immediate home care
management for diarrhea?
A. Milk
B. Imodium
C. Water
D. Oresol
Situation 8: Mr. Sean is admitted to the
hospital with a bowel obstruction. He
complained of colicky pain and inability to
pass stool.
36. Which of these findings by Nurse
Leonard, would indicate that the
obstruction is in the early stages?
A. high pitched tinkling or rumbling
bowel sounds
B. hypoactive bowel sounds
C. no bowel sounds auscultated
D. normal bowel sounds heard in all
four quadrants
37. Nasogastric tube was inserted to Mr.
Sean. The NGTs primary purpose is:

A. use of natural laxatives

B. fluid intake of 6 glasses per day
C. use of OTC laxatives
D. complete bed rest
40. Four hours post operatively, Mr. Sean
complains of guarding and rigidity of the
abdomen. Nurse Leonards initial
intervention is:
A. assess for signs of peritonitis
B. call the physician
C. administer pain medication
D. ignore the client
Situation 9: Mr. Gerald Liu, 19 y/o, is being
admitted to a hospital unit complaining of
severe pain in the lower abdomen.
Admission vital signs reveal an oral
temperature of 101.2 0F.
41. Which of the following would confirm a
diagnosis of appendicitis?
A. The pain is localized at a position
halfway between the umbilicus and
the right iliac crest.

A. nutrition

B. Mr. Liu describes the pain as

occurring 2 hours after eating

B. decompression of bowel

C. The pain subsides after eating

C. passage for medication

D. The pain is in the left lower

quadrant

D. aspiration of gastric contents

38. Mr. Sean has undergone surgery. Post
operatively, which of the following findings
is normal?

42. Which of the following complications is

thought to be the most common cause of
appendicitis?

A. absent bowel sounds

A. A fecalith

B. bleeding

B. Internal bowel occlusion

C. hemorrhage

C. Bowel kinking

D. bowel movement

D. Abdominal wall swelling

39. Client education should be given in

order to prevent constipation. Nurse
Leonards health teaching should include
which of the following?

43. The doctor ordered for a complete

blood count. After the test, Nurse Ray
received the result from the laboratory.

Which laboratory values will confirm the

diagnosis of appendicitis?
A. RBC 5.5 x 106/mm3
B. Hct 44 %
C. WBC 13, 000/mm3
D. Hgb 15 g/dL
44. Signs and symptoms include pain in
the RLQ of the abdomen that may be
localize at McBurneys point. To relieve
pain, Mr. Liu should assume which
position?
A. Prone
B. Supine, stretched out
C. Sitting
D. Lying with legs drawn upl
45. After a few minutes, the pain suddenly
stops without any intervention. Nurse Ray
might suspect that:
A. the appendix is still distended

A. Suggest to eat low roughage diet

B. Advise to wear silk undergarments
C. Avoid straining during defecation
D. Use of sitz bath for 30 minutes
48. The doctor orders for Witch Hazel 5 %.
Nurse Nico knows that the action of this
astringent is:
A. temporarily relieves pain, burning,
and itching by numbing the nerve
endings
B. causes coagulation (clumping) of
proteins in the cells of the perianal
skin or the lining of the anal canal
C. inhibits the growth of bacteria and
other organisms
D. causes the outer layers of skin or
other tissues to disintegrate
49. Which position would be ideal for the
client in the early postoperative period
after hemorrhoidectomy?

B. the appendix may have ruptured

A. High Fowlers

C. an increased in intrathoracic
pressure will occur

B. Supine

D. signs and symptoms of peritonitis

occur

D. Trendelenburgs

Situation 10: Nurse Nico is caring to a 38year-old female, G3P3 client who has been
diagnosed with hemorrhoids.
46. Which of the following factors would
most likely be a primary cause of her
hemorrhoids?
A. Her age
B. Three vaginal delivery pregnancies
C. Her job as a school teacher
D. Varicosities in the legs
47. Client education should include
minimizing client discomfort due to
hemorrhoids. Nursing management should
include:

C. Side lying

50. Nurse Nico instructs her client who has

had a hemorrhoidectomy not to used sitz
bath until at least 12 hours
postoperatively to avoid which of the
following complications?
A. Hemorrhage
B. Rectal Spasm
C. Urinary retention
D. Constipation
Answers and Rationales
1. Answer: C. stomach. Stomach is
a hollow digestive organ in the GI
tract. The liver, gall baldder and
pancreas are all solid organs which

are part of the hepato-biliary

system. Test taking skills: which
does not belong to the group?
2. Answer: D. air and food. The
laryngopharynx serves as
passageway for air and food and so
as with the oropharynx. Option a is
nasopharynx. Answers b and c may
be correct but air and food is more
accuarte.
3. Answer: B. ingestion,
mastication, deglutition,
digestion, absorption,
egestion. The digestive processes
involve six steps. Ingestion is
taking in of food in the mouth;
mastication is the mechanical
process where food is converted
into bolus; deglutition is the act of
swallowing; digestion is the
chemical breakdown of food into
chime; absorption occurs in the
small intestines (solutes) and large
intestines (water) and
egestion/defecation where
elimination of feces occur.
4. Answer: A. Gastrin. Gastrin
stimulates chief cells to produce
pepsinogen when foods enter and
suppression of pepsinogen when it
leaves and enters the small
intestines; it is the major hormone
that regulates acid secretion in the
stomach. Pepsin; a gastric protease
secreted in an inactive form,
pepsinogen, which is activated by
stomach acid that acts to degrade
protein. HCl is produced by the
parietal cells. Insulin is a pancreatic
hormone.
5. Answer: C. Amylase. Amylase
aids in the digestion of
carbohydrates.
Trypsin/Chymotrypsin aids in the
digestion of proteins. Lipase aids in
the digestion of fats.
6. Answers: A. supine with knees
flexed. During abdominal

examination, positioning the client

in supine with knees flexed will
promote relaxation of abdominal
muscles. Options b and d are
inaccurate in this type of
procedure. Lying on back or supine
may be correct but option a is the
best answer.
7. Answer: B.
Inspection. Inspection is the first
step in abdominal exam to note the
contour and symmetry of abdomen
as well as localized bulging,
distention and peristaltic waves.
Auscultation is done to determine
the character, location and
frequency of bowel sounds.
Percussion is to assess tympany or
dullness. Palpation is to asses areas
of tenderness and discomfort.
Note: In abdominal exam:
Inspection, Auscultation, Percussion
and Palpation are the correct order.
8. Answer: B. Light
palpation. Light palpation is done
to identify areas of tenderness and
swelling. Deep palpation is done to
identify masses in all four
quadrants. Test taking skills: one of
the opposite is the correct answer
9. Answer: C. Appendix. Appendix
and cecum is located in the right
iliac region. Liver and gall bladder
is at the right hypochondriac.
Sigmoid colon is at the left iliac.
Duodenum, stomach and pancreas
is in the epigastric region.
10. Answer: B. Rebound
Tenderness. Rebound tenderness
is pain felt upon sudden release of
the examiners hand which in most
cases suggest peritonitis. Referred
pain is pain felt in an area remote
from the site of origin. Direct
tenderness is localized pain upon
palpation. Indirect tenderness is
pain outside the area of palpation.

11. Answer: C. Gastroesophageal

Reflux Disease (GERD). GERD is
the backflow of gastric or duodenal
contents into the esophagus
caused by incompetent lower
esophageal sphincter. Pyrosis
or heartburn, dyspepsia and
dysphagia are cardinal symptoms.

17. Answer: A.
Endoscopy. Endoscopy
determines bleeding, pain,
difficulty swallowing, and a change
in bowel habits. This would yield
good visualization of the ulcer
crater. Other options are also
diagnostic tests in PUD.

12. Answer: B. Barium

swallow. Barium swallow or upper
GI series would confirm GERD.
Endoscopy is another diagnostic
test. Options a and d are the same.
Option c is incorrect.

18. Answer: B. H.
pylori. Helicobacter pylori (H.
pylori) is a bacteria responsible for
most ulcers and many cases of
chronic gastritis (inflammation of
the stomach). This organism can
weaken the protective coating of
the stomach and duodenum (first
part of the small intestines),
allowing the damaging digestive
juices to irritate the sensitive lining
of these body parts.

13. Answer: A. Odynophagia. When

difficulty of swallowing is
accompanied with pain this is now
referred as odynophagia.
Dysphagia is difficulty of
swallowing alone.
14. Answer: B. High fat,
carbonated and caffeinated
beverages. All are correct but
option b is the best answer. In
patients with GERD, this type of
diet must be avoided to avoid
backflow of gastric contents.
Excessive caffeine reduces the
tone of lower esophageal sphincter.
Test Taking Skills: look for the
umbrella effect
15. Answer: B. Overweight. Mr.
Cruz BMI belongs to the
overweight category (24 26),
malnourished (less than 17),
underweight (17 19), normal (20
23), obese (27 30) and morbidly
obese (greater than 30). BMI is
weight in kilograms divided by
height in square meters.
16. Answer: C. Pain occurs
immediately after meal.In
gastric ulcer food intake
aggravates pain which usually
occur 1 hour before meal or
immediately during or after food
intake. Options a, b, c suggests
duodenal ulcer.

19. Answer: C. Stool. Occult blood

test or stool guiac test is a test that
detects the presence of hidden
(occult) blood in the stool (bowel
movement). The stool guaiac is the
most common form of fecal occult
blood test (FOBT) in use today. So
stool specimen will be collected.
20. Answer: D. Meatless diet for 48
hours prior to obtaining of
specimen. Eating meat can cause
false positive test result. Using
proper stool collection technique,
avoiding certain drugs, and
observing dietary restrictions can
minimize these measurement
errors.
21. Answer: C. The cause of this
condition is unknown. There is
no known cause of IBS, and
diagnosis is made by excluding all
the other diseases that cause the
symptoms. There is no
inflammation if the bowel. Some
factors exacerbate the symptoms
including anxiety, fear, stress,
depression, some foods and drugs
but there do not cause the disease.

22. Answer: d. Terminal

Ileum. Chronic inflammatory of GI
mucosa occurs anywhere from the
mouth to anus but most often in
terminal ileum. Inflammatory
lesions are local and involve all
layers of the intestinal wall.
23. Answer: C. Heredity. The cause
is unknown but is thought to be
multifactorial. Heredity, infectious
agents, altered immunity or
autoimmune and environmental
are factors to be considered. Test
taking skill: which does not belong?
Options a, b, and d are all
modifiable factors.
24. Answer: B. Altered
immunity. Refer to rationale for
number 23. Test taking skill: which
does not belong? Options a, c and
d are all modifiable factors.
25. Answer: A. A demanding and
stressful job. Stress is an
environmental factor that is
thought to cause ulcerative colitis.
Test taking skill: options b, c, and d
are all healthy lifestyles.
26. Answer: B. A non inflamed
outpouching of the
intestine. An increase intraluminal
pressure causes the outpouching of
the colon wall resulting to
diverticulosis. Option a suggests
diverticulitis. Test taking skill: one
of the opposite is the correct
answer.
27. Answer: A. Low Fiber Diet. A
lack of adequate blood supply and
nutrients from the diet such as low
fiber foods may contribute to the
development of the disease. Test
taking skill: one of the opposite is
the correct answer.
28. Answer: B. Barium
enema. Barium enema is used to
diagnose diverticulosis, however,
this is contraindicated when

diverticulitis is present because of

the risk of rupturing the
diverticulum. Test taking skill:
options b and c are opposite; one
may be the correct answer.
29. Answer: B. Increase fiber in the
diet. Patient with diverticulosis
must be encouraged to increase
roughage in diet such as fruits and
vegetables rich in fiber. Increasing
fluid intake 2 3 liters/day unless
contraindicated rather reducing.
Administering antibiotics can
decrease bowel flora and infection
but this is a dependent function of
a nurse.
30. Answer: B. Normal. Mr. Trinidads
BMI is 23 which is normal. Refer to
rationale number 15.
31. Answer: C. passage of stool is
more than 3 bowel movements
per day
32. Answer: B. Altered
Immunity. Diarhhea is an
intestinal disorder that is self
limiting. Options a, c and d are
etiological factors of diarrhea.
33. Answer: C. Cardiac
dysrhytmias. Due to increase
frequency and fluid content in the
stools, diarrhea may cause fluid
and electrolyte imbalance such as
hypokalemia. Once potassium is
depleted, this will affect the
contractility of the heart causing
cardiac arrhythmia leading to
death.
34. Answer: B. Metabolic
acidosis. In diarrhea, metabolic
acidosis is the acid base
imbalance that occurs while in
vomiting, metabolic alkalosis occur.
This is a metabolic disorder thats
why eliminate options c and d.
35. Answer: D. Oresol. In the DOH
book, oresol is the immediate
home care management for

diarrhea to prevent dehydration.

Water may not be enough to
prevent diarrhea.

b and c are common with ulcers;

option d may suggest ulcerative
colitis or diverticulitis.

36. Answer: A. High pitched

tinkling or rumbling bowel
sounds. Early in the bowel
obstruction, the bowel attempts to
move the contents past the
obstruction and this is heard as
high pitched tinkling bowel sounds.
As the obstruction progresses,
bowel sounds will diminish and
may finally become absent.

42. Answer: A. A fecalith. A fecalith

is a hard piece of stool which is
stone like that commonly obstructs
the lumen. Due to obstruction,
inflammation and bacterial
invasion can occur. Tumors or
foreign bodies may also cause
obstruction.

37. Answer: B. Decompression of

bowel. The NGTs primary purpose
is for bowel decompression
especially for clients suffering from
obstruction.
38. Answer: A. Absent bowel
sounds. Post operatively, no
bowel sounds are present so this is
a normal finding. Bleeding and
hemorrhage must be prevented to
avoid complications. Bowel
movement occurs only after flatus
and bowel sounds are noted.
39. Answer: A. Use of natural
laxatives. The use of natural
laxatives such as foods and fruits
high in fiber is still the best way of
preventing constipation Increasing
fluid intake, taking laxatives
judiciously and exercise also can
prevent this.
40. Answer: A. Assess for signs of
peritonitis. Assessment precedes
intervention. Symptoms presented
are signs of peritonitis. Assessment
will provide you the data for
prompt intervention.
41. Answer: A. The pain is localized
at a position halfway between
the umbilicus and the right
iliac crest. Pain over McBurneys
point, the point halfway between
the umbilicus and the iliac crest, is
diagnosis for appendicitis. Options

43. Answer: C. WBC 13,

000/mm3. Increase in WBC counts
is suggestive of appendicitis
because of bacterial invasion and
inflammation. Normal WBC count is
5, 000 10, 000/mm3. Other
options are normal values.
44. Answer: D. Lying with legs
drawn up. Posturing by lying with
legs drawn up can relax the
abdominal muscle thus relieve
pain.
45. Answer: B. The appendix may
have ruptured. If a confirmed
diagnosis is made and the pain
suddenly without any intervention,
the appendix may have ruptured;
the pain is lessened because the
appendix is no longer distended
thus surgery is still needed.
46. Answer: B. Three vaginal
delivery
pregnancies. Hemorrhoids are
associated with prolonged sitting,
or standing, portal hypertension,
chronic constipation and prolonged
intra abdominal pressure as
associated with pregnancy and the
strain of vaginal delivery. Her job as
a schoolteacher does not require
prolong sitting or standing. Age
and leg varicosities are not related
to the development of
hemorrhoids.
47. Answer: C. Avoid strainining
during defecation. Straining can

increase intra abdominal pressure.

Health teachings also include:
suggest to eat high roughage diet,
wearing of cotton undergarments
and use of sitz bath for 15 minutes.
48. Answer: B. causes
coagulation(clumping) of
proteins in the cells of the
perianal skin or the lining of
the anal canal. Option a are local
anesthetics; c are antiseptics and d
are keratolytics.
49. Answer: C. Side
lying. Positioning in the early
postoperative phase should avoid
stress and pressure on the
operative site. The prone and side
lying are ideal from a comfort

perspective. A high Fowlers or

supine position will place pressure
on the operative site and is not
recommended. There is no need for
trendelenburgs position.
50. Answer: A.
Hemorrhage. Applying heat
during the immediate
postoperative period may cause
hemorrhage at the surgical site.
Moist heat may relieve rectal
spasms after bowel movements.
Urinary retention caused by reflex
spasm may also be relieved by
moist heat. Increasing fiber and
fluid in the diet can help
constipation.