NCLEX Practice Exam for Gastrointestinal Diseases 1

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Text Mode

Text Mode – Text version of the exam

1. Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level of:

  1. 45 units/L
  2. 100 units/L
  3. 300 units/L
  4. 500 units/L

2. A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking forward to the diet change because he has been “bored” with the clear liquid diet. The nurse would offer which full liquid item to the client?

  1. Tea
  2. Gelatin
  3. Custard
  4. Popsicle

3. Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intension to increase the intake of:

  1. Pork
  2. Milk
  3. Chicken
  4. Broccoli

4. Nurse Oliver checks for residual before administering a bolus tube feeding to a client with a nasogastric tube and obtains a residual amount of 150 mL. What is appropriate action for the nurse to take?

  1. Hold the feeding
  2. Reinstill the amount and continue with administering the feeding
  3. Elevate the client’s head at least 45 degrees and administer the feeding
  4. Discard the residual amount and proceed with administering the feeding

5. A nurse is inserting a nasogastric
tube in an adult male client. During the procedure, the client begins to cough and has difficulty breathing. Which of the following is the appropriate nursing action?

  1. Quickly insert the tube
  2. Notify the physician immediately
  3. Remove the tube and reinsert when the respiratory distress subsides
  4. Pull back on the tube and wait until the respiratory distress subsides

6. Nurse Ryan is assessing for correct placement of a nosogartric tube. The nurse aspirates the stomach contents and check the contents for pH. The nurse verifies correct tube placement if which pH value is noted?

  1. 3.5
  2. 7.0
  3. 7.35
  4. 7.5

7. A nurse is preparing to remove a nasogartric tube from a female client. The nurse should instruct the client to do which of the following just before the nurse removes the tube?

  1. Exhale
  2. Inhale and exhale quickly
  3. Take and hold a deep breath
  4. Perform a Valsalva maneuver

8. Nurse Joy is preparing to administer medication through a nasogastric tube that is connected to suction. To administer the medication, the nurse would:

  1. Position the client supine to assist in medication absorption
  2. Aspirate the nasogastric tube after medication administration to maintain patency
  3. Clamp the nasogastric tube for 30 minutes following administration of the medication
  4. Change the suction setting to low intermittent suction for 30 minutes after medication administration

9. A nurse is preparing to care for a female client with esophageal varices who has just has a Sengstaken-Blakemore tube inserted. The nurse gathers supplies, knowing that which of the following items must be kept at the bedside at all times?

  1. An obturator
  2. Kelly clamp
  3. An irrigation set
  4. A pair of scissors

10. Dr. Smith has determined that the client with hepatitis has contracted the infection form contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis?

  1. Hepatitis A
  2. Hepatitis B
  3. Hepatitis C
  4. Hepatitis D

11. A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis?

  1. Elevated hemoglobin level
  2. Elevated serum bilirubin level
  3. Elevated blood urea nitrogen level
  4. Decreased erythrocycle sedimentation rate

12. The nurse is reviewing the physician’s orders written for a male client admitted to the hospital with acute pancreatitis. Which physician order should the nurse question if noted on the client’s chart?

  1. NPO status
  2. Nasogastric tube inserted
  3. Morphine sulfate for pain
  4. An anticholinergic medication

13. A female client being seen in a physician’s office has just been scheduled for a barium swallow the next day. The nurse writes down which instruction for the client to follow before the test?

  1. Fast for 8 hours before the test
  2. Eat a regular supper and breakfast
  3. Continue to take all oral medications as scheduled
  4. Monitor own bowel movement pattern for constipation

14. The nurse is performing an abdominal assessment and inspects the skin of the abdomen. The nurse performs which assessment technique next?

  1. Palpates the abdomen for size
  2. Palpates the liver at the right rib margin
  3. Listens to bowel sounds in all for quadrants
  4. Percusses the right lower abdominal quadrant

15. Polyethylene glycol-electrlyte solution (GoLYTELY) is prescribed for the female client scheduled for a colonoscopy. The client begins to experience diarrhea following administration of the solution. What action by the nurse is appropriate?

  1. Start an IV infusion
  2. Administer an enema
  3. Cancel the diagnostic test
  4. Explain that diarrhea is expected

16. The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency?

  1. Vitamin A
  2. Vitamin B12
  3. Vitamin C
  4. Vitamin E

17. The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the client’s record, would the nurse question?

  1. Digoxin (Lanoxin)
  2. Furosemide (Lasix)
  3. Indomethacin (Indocin)
  4. Propranolol hydrochloride (Inderal)

18. The nurse is assessing a male client 24 hours following a cholecystectomy. The nurse noted that the T tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is appropriate?

  1. Clamp the T tube
  2. Irrigate the T tube
  3. Notify the physician
  4. Document the findings

19. The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment findings would most likely indicate perforation of the ulcer?

  1. Bradycardia
  2. Numbness in the legs
  3. Nausea and vomiting
  4. A rigid, board-like abdomen

20. A male client with a peptic ulcer is scheduled for a vagotomy and the client asks the nurse about the purpose of this procedure. Which response by the nurse best describes the purpose of a vagotomy?

  1. Halts stress reactions
  2. Heals the gastric mucosa
  3. Reduces the stimulus to acid secretions
  4. Decreases food absorption in the stomach

21. The nurse is caring for a female client following a Billroth II procedure. Which postoperative order should the nurse question and verify?

  1. Leg exercises
  2. Early ambulation
  3. Irrigating the nasogastric tube
  4. Coughing and deep-breathing exercises

22. The nurse is providing discharge instructions to a male client following gastrectomy and instructs the client to take which measure to assist in preventing dumping syndrome?

  1. Ambulate following a meal
  2. Eat high carbohydrate foods
  3. Limit the fluid taken with meal
  4. Sit in a high-Fowler’s position during meals

23. The nurse is monitoring a female client for the early signs and symptoms of dumping syndrome. Which of the following indicate this occurrence?

  1. Sweating and pallor
  2. Bradycardia and indigestion
  3. Double vision and chest pain
  4. Abdominal cramping and pain

24. The nurse is preparing a discharge teaching plan for the male client who had umbilical hernia repair. What should the nurse include in the plan?

  1. Irrigating the drain
  2. Avoiding coughing
  3. Maintaining bed rest
  4. Restricting pain medication

25. The nurse is instructing the male client who has an inguinal hernia repair how to reduce postoperative swelling following the procedure. What should the nurse tell the client?

  1. Limit oral fluid
  2. Elevate the scrotum
  3. Apply heat to the abdomen
  4. Remain in a low-fiber diet

26. The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician?

  1. Hypotension
  2. Bloody diarrhea
  3. Rebound tenderness
  4. A hemoglobin level of 12 mg/dL

27. The nurse is caring for a male client postoperatively following creation of a colostomy. Which nursing diagnosis should the nurse include in the plan of care?

  1. Sexual dysfunction
  2. Body image, disturbed
  3. Fear related to poor prognosis
  4. Nutrition: more than body requirements, imbalanced

28. The nurse is reviewing the record of a female client with Crohn’s disease. Which stool characteristics should the nurse expect to note documented in the client’s record?

  1. Diarrhea
  2. Chronic constipation
  3. Constipation alternating with diarrhea
  4. Stools constantly oozing form the rectum

29. The nurse is performing a colostomy irrigation on a male client. During the irrigation, the client begins to complain of abdominal cramps. What is the appropriate nursing action?

  1. Notify the physician
  2. Stop the irrigation temporarily
  3. Increase the height of the irrigation
  4. Medicate for pain and resume the irrigation

30. The nurse is teaching a female client how to perform a colostomy irrigation. To enhance the effectiveness of the irrigation and fecal returns, what measure should the nurse instruct the client to do?

  1. Increase fluid intake
  2. Place heat on the abdomen
  3. Perform the irrigation in the evening
  4. Reduce the amount of irrigation solution

31. A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor the patient’s blood pressure because of which change that is associated with the liver failure?

  1. Hypoalbuminemia
  2. Increased capillary permeability
  3. Abnormal peripheral vasodilation
  4. Excess rennin release from the kidneys

32.  You’re assessing the stoma of a patient with a healthy, well-healed colostomy. You expect the stoma to appear:

  1. Pale, pink and moist
  2. Red and moist
  3. Dark or purple colored
  4. Dry and black

33.   You’re caring for a patient with a sigmoid colostomy. The stool from this colostomy is:

  1. Formed
  2. Semisolid
  3. Semiliquid
  4. Watery

34.    You’re advising a 21 y.o. with a colostomy who reports problems with flatus. What food should you recommend?

  1. Peas
  2. Cabbage
  3. Broccoli
  4. Yogurt

35.    You have to teach ostomy self care to a patient with a colostomy. You tell the patient to measure and cut the wafer:

  1. To the exact size of the stoma.
  2. About 1/16” larger than the stoma.
  3. About 1/8” larger than the stoma.
  4. About 1/4″ larger than the stoma.

36.    You’re performing an abdominal assessment on Brent who is 52 y.o. In which order do you proceed?

  1. Observation, percussion, palpation, auscultation
  2. Observation, auscultation, percussion, palpation
  3. Percussion, palpation, auscultation, observation
  4. Palpation, percussion, observation, auscultation

37.    You’re doing preoperative teaching with Gertrude who has ulcerative colitis who needs surgery to create an ileoanal reservoir. Which information do you include?

  1. A reservoir is created that exits through the abdominal wall.
  2. A second surgery is required 12 months after the first surgery.
  3. A permanent ileostomy is created.
  4. The surgery occurs in two stages.

38.    You’re caring for Carin who has just had ileostomy surgery. During the first 24 hours post-op, how much drainage can you expect from the ileostomy?

  1. 100 ml
  2. 500 ml
  3. 1500 ml
  4. 5000 ml

39. You’re preparing a teaching plan for a 27 y.o. named Jeff who underwent surgery to close a temporary ileostomy. Which nutritional guideline do you include in this plan?

  1. There is no need to change eating habits.
  2. Eat six small meals a day.
  3. Eat the largest meal in the evening.
  4. Restrict fluid intake.

40.  Arthur has a family history of colon cancer and is scheduled to have a sigmoidoscopy. He is crying as he tells you, “I know that I have colon cancer, too.” Which response is most therapeutic?

  1. “I know just how you feel.”
  2. “You seem upset.”
  3. “Oh, don’t worry about it, everything will be just fine.”
  4. “Why do you think you have cancer?”

41.  You’re caring for Beth who underwent a Billroth II procedure (surgical removal of the pylorus and duodenum) for treatment of a peptic ulcer. Which findings suggest that the patient is developing dumping syndrome, a complication associated with this procedure?

  1. Flushed, dry skin.
  2. Headache and bradycardia.
  3. Dizziness and sweating.
  4. Dyspnea and chest pain.

42.  You’re developing the plan of care for a patient experiencing dumping syndrome after a Billroth II procedure. Which dietary instructions do you include?

  1. Omit fluids with meals.
  2. Increase carbohydrate intake.
  3. Decrease protein intake.
  4. Decrease fat intake.

43.  You’re caring for Lewis, a 67 y.o. patient with liver cirrhosis who develops ascites and requires paracentesis. Relief of which symptom indicated that the paracentesis was effective?

  1. Pruritus
  2. Dyspnea
  3. Jaundice
  4. Peripheral Neuropathy

44.  You’re caring for Jane, a 57 y.o. patient with liver cirrhosis who develops ascites and requires paracentesis. Before her paracentesis, you instruct her to:

  1. Empty her bladder.
  2. Lie supine in bed.
  3. Remain NPO for 4 hours.
  4. Clean her bowels with an enema.

45.  After abdominal surgery, your patient has a severe coughing episode that causes wound evisceration. In addition to calling the doctor, which intervention is most appropriate?

  1. Irrigate the wound & organs with Betadine.
  2. Cover the wound with a saline soaked sterile dressing.
  3. Apply a dry sterile dressing & binder.
  4. Push the organs back & cover with moist sterile dressings.

46.  You’re caring for Betty with liver cirrhosis. Which of the following assessment findings leads you to suspect hepatic encephalopathy in her?

  1. Asterixis
  2. Chvostek’s sign
  3. Trousseau’s sign
  4. Hepatojugular reflex

47.  You are developing a careplan on Sally, a 67 y.o. patient with hepatic encephalopathy. Which of the following do you include?

  1. Administering a lactulose enema as ordered.
  2. Encouraging a protein-rich diet.
  3. Administering sedatives, as necessary.
  4. Encouraging ambulation at least four times a day.

48.  You have a patient with achalasia (incomplete muscle relaxtion of the GI tract, especially sphincter muscles). Which medications do you anticipate to administer?

  1. Isosorbide dinitrate (Isordil)
  2. Digoxin (Lanoxin)
  3. Captopril (Capoten)
  4. Propanolol (Inderal)

49.  The student nurse is preparing a teaching care plan to help improve nutrition in a patient with achalasia. You include which of the following:

  1. Swallow foods while leaning forward.
  2. Omit fluids at mealtimes.
  3. Eat meals sitting upright.
  4. Avoid soft and semisoft foods.

50.  Britney, a 20 y.o. student is admitted with acute pancreatitis. Which laboratory findings do you expect to be abnormal for this patient?

  1. Serum creatinine and BUN
  2. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
  3. Serum amylase and lipase
  4. Cardiac enzymes

51.  A patient with Crohn’s disease is admitted after 4 days of diarrhea. Which of the following urine specific gravity values do you expect to find in this patient?

  1. 1.005
  2. 1.011
  3. 1.020
  4. 1.030

52.  Your goal is to minimize David’s risk of complications after a heriorrhaphy. You instruct the patient to:

  1. Avoid the use of pain medication.
  2. Cough and deep breathe Q2H.
  3. Splint the incision if he can’t avoid sneezing or coughing.
  4. Apply heat to scrotal swelling.

53.  Janice is waiting for discharge instructions after her herniorrhaphy. Which of the following instructions do you include?

  1. Eat a low-fiber diet.
  2. Resume heavy lifting in 2 weeks.
  3. Lose weight, if obese.
  4. Resume sexual activity once discomfort is gone.

54.  Develop a teaching care plan for Angie who is about to undergo a liver biopsy. Which of the following points do you include?

  1. “You’ll need to lie on your stomach during the test.”
  2. “You’ll need to lie on your right side after the test.”
  3. “During the biopsy you’ll be asked to exhale deeply and hold it.”
  4. “The biopsy is performed under general anesthesia.”

55.  Stephen is a 62 y.o. patient that has had a liver biopsy. Which of the following groups of signs alert you to a possible pneumothorax?

  1. Dyspnea and reduced or absent breath sounds over the right lung
  2. Tachycardia, hypotension, and cool, clammy skin
  3. Fever, rebound tenderness, and abdominal rigidity
  4. Redness, warmth, and drainage at the biopsy site

56.  Michael, a 42 y.o. man is admitted to the med-surg floor with a diagnosis of acute pancreatitis. His BP is 136/76, pulse 96, Resps 22 and temp 101. His past history includes hyperlipidemia and alcohol abuse. The doctor prescribes an NG tube. Before inserting the tube, you explain the purpose to patient. Which of the following is a most accurate explanation?

  1. “It empties the stomach of fluids and gas.”
  2. “It prevents spasms at the sphincter of Oddi.”
  3. “It prevents air from forming in the small intestine and large intestine.”
  4. “It removes bile from the gallbladder.”

57.  Jason, a 22 y.o. accident victim, requires an NG tube for feeding. What should you immediately do after inserting an NG tube for liquid enteral feedings?

  1. Aspirate for gastric secretions with a syringe.
  2. Begin feeding slowly to prevent cramping.
  3. Get an X-ray of the tip of the tube within 24 hours.
  4. Clamp off the tube until the feedings begin.

58.  Stephanie, a 28 y.o. accident victim, requires TPN. The rationale for TPN is to provide:

  1. Necessary fluids and electrolytes to the body.
  2. Complete nutrition by the I.V. route.
  3. Tube feedings for nutritional supplementation.
  4. Dietary supplementation with liquid protein given between meals.

59.  Type A chronic gastritis can be distinquished from type B by its ability to:

  1. Cause atrophy of the parietal cells.
  2. Affect only the antrum of the stomach.
  3. Thin the lining of the stomach walls.
  4. Decrease gastric secretions.

60.  Matt is a 49 y.o. with a hiatal hernia that you are about to counsel. Health care counseling for Matt should include which of the following instructions?

  1. Restrict intake of high-carbohydrate foods.
  2. Increase fluid intake with meals.
  3. Increase fat intake.
  4. Eat three regular meals a day.

61.  Jerod is experiencing an acute episode of ulcerative colitis. Which is priority for this patient?

  1. Replace lost fluid and sodium.
  2. Monitor for increased serum glucose level from steroid therapy.
  3. Restrict the dietary intake of foods high in potassium.
  4. Note any change in the color and consistency of stools.

62.  A 29 y.o. patient has an acute episode of ulcerative colitis. What diagnostic test confirms this diagnosis?

  1. Barium Swallow.
  2. Stool examination.
  3. Gastric analysis.
  4. Sigmoidoscopy.

63.  Eleanor, a 62 y.o. woman with diverticulosis is your patient. Which interventions would you expect to include in her care?

  1. Low-fiber diet and fluid restrictions.
  2. Total parenteral nutrition and bed rest.
  3. High-fiber diet and administration of psyllium.
  4. Administration of analgesics and antacids.

64.  Regina is a 46 y.o. woman with ulcerative colitis. You expect her stools to look like:

  1. Watery and frothy.
  2. Bloody and mucoid.
  3. Firm and well-formed.
  4. Alternating constipation and diarrhea.

65.  Donald is a 61 y.o. man with diverticulitis. Diverticulitis is characterized by:

  1. Periodic rectal hemorrhage.
  2. Hypertension and tachycardia.
  3. Vomiting and elevated temperature.
  4. Crampy and lower left quadrant pain and low-grade fever.

66.  Brenda, a 36 y.o. patient is on your floor with acute pancreatitis. Treatment for her includes:

  1. Continuous peritoneal lavage.
  2. Regular diet with increased fat.
  3. Nutritional support with TPN.
  4. Insertion of a T tube to drain the pancreas.

67.  Glenda has cholelithiasis (gallstones). You expect her to complain of:

  1. Pain in the right upper quadrant, radiating to the shoulder.
  2. Pain in the right lower quadrant, with rebound tenderness.
  3. Pain in the left upper quadrant, with shortness of breath.
  4. Pain in the left lower quadrant, with mild cramping.

68.  After an abdominal resection for colon cancer, Madeline returns to her room with a Jackson-Pratt drain in place. The purpose of the drain is to:

  1. Irrigate the incision with a saline solution.
  2. Prevent bacterial infection of the incision.
  3. Measure the amount of fluid lost after surgery.
  4. Prevent accumulation of drainage in the wound.

69.  Anthony, a 60 y.o. patient, has just undergone a bowel resection with a colostomy. During the first 24 hours, which of the following observations about the stoma should you report to the doctor?

  1. Pink color.
  2. Light edema.
  3. Small amount of oozing.
  4. Trickles of bright red blood.

70.  Your teaching Anthony how to use his new colostomy. How much skin should remain exposed between the stoma and the ring of the appliance?

  1. 1/16”
  2. 1/4″
  3. 1/2”
  4. 1”

71.  Claire, a 33 y.o. is on your floor with a possible bowel obstruction. Which intervention is priority for her?

  1. Obtain daily weights.
  2. Measure abdominal girth.
  3. Keep strict intake and output.
  4. Encourage her to increase fluids.

72.  Your patient has a GI tract that is functioning, but has the inability to swallow foods. Which is the preferred method of feeding for your patient?

  1. TPN
  2. PPN
  3. NG feeding
  4. Oral liquid supplements

73.  You’re patient is complaining of abdominal pain during assessment. What is your priority?

  1. Auscultate to determine changes in bowel sounds.
  2. Observe the contour of the abdomen.
  3. Palpate the abdomen for a mass.
  4. Percuss the abdomen to determine if fluid is present.

74.  Before bowel surgery, Lee is to administer enemas until clear. During administration, he complains of intestinal cramps. What do you do next?

  1. Discontinue the procedure.
  2. Lower the height of the enema container.
  3. Complete the procedure as quickly as possible.
  4. Continue administration of the enema as ordered without making any adjustments.

75.  Leigh Ann is receiving pancrelipase (Viokase) for chronic pancreatitis. Which observation best indicates the treatment is effective?

  1. There is no skin breakdown.
  2. Her appetite improves.
  3. She loses more than 10 lbs.
  4. Stools are less fatty and decreased in frequency.

76.  Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab value is most likely to be elevated?

  1. Calcium
  2. Glucose
  3. Magnesium
  4. Potassium

77.  Anna is 45 y.o. and has a bleeding ulcer. Despite multiple blood transfusions, her HGB is 7.5g/dl and HCT is 27%. Her doctor determines that surgical intervention is necessary and she undergoes partial gastrectomy. Postoperative nursing care includes:

  1. Giving pain medication Q6H.
  2. Flushing the NG tube with sterile water.
  3. Positioning her in high Fowler’s position.
  4. Keeping her NPO until the return of peristalsis.

78.  Sitty, a 66 y.o. patient underwent a colostomy for ruptured diverticulum. She did well during the surgery and returned to your med-surg floor in stable condition. You assess her colostomy 2 days after surgery. Which finding do you report to the doctor?

  1. Blanched stoma
  2. Edematous stoma
  3. Reddish-pink stoma
  4. Brownish-black stoma

79.  Sharon has cirrhosis of the liver and develops ascites. What intervention is necessary to decrease the excessive accumulation of serous fluid in her peritoneal cavity?

  1. Restrict fluids
  2. Encourage ambulation
  3. Increase sodium in the diet
  4. Give antacids as prescribed

80.  Katrina is diagnosed with lactose intolerance. To avoid complications with lack of calcium in the diet, which food should be included in the diet?

  1. Fruit
  2. Whole grains
  3. Milk and cheese products
  4. Dark green, leafy vegetables

81.  Nathaniel has severe pruritus due to having hepatitis B. What is the best intervention for his comfort?

  1. Give tepid baths.
  2. Avoid lotions and creams.
  3. Use hot water to increase vasodilation.
  4. Use cold water to decrease the itching.

82.  Rob is a 46 y.o. admitted to the hospital with a suspected diagnosis of Hepatitis B. He’s jaundiced and reports weakness. Which intervention will you include in his care?

  1. Regular exercise.
  2. A low-protein diet.
  3. Allow patient to select his meals.
  4. Rest period after small, frequent meals.

83.  You’re discharging Nathaniel with hepatitis B. Which statement suggests understanding by the patient?

  1. “Now I can never get hepatitis again.”
  2. “I can safely give blood after 3 months.”
  3. “I’ll never have a problem with my liver again, even if I drink alcohol.”
  4. “My family knows that if I get tired and start vomiting, I may be getting sick again.”

84.  Gail is scheduled for a cholecystectomy. After completion of preoperative teaching, Gail states,”If I lie still and avoid turning after the operation, I’ll avoid pain. Do you think this is a good idea?” What is the best response?

  1. “You’ll need to turn from side to side every 2 hours.”
  2. “It’s always a good idea to rest quietly after surgery.”
  3. “The doctor will probably order you to lie flat for 24 hours.”
  4. “Why don’t you decide about activity after you return from the recovery room?”

85.  You’re caring for a 28 y.o. woman with hepatitis B. She’s concerned about the duration of her recovery. Which response isn’t appropriate?

  1. Encourage her to not worry about the future.
  2. Encourage her to express her feelings about the illness.
  3. Discuss the effects of hepatitis B on future health problems.
  4. Provide avenues for financial counseling if she expresses the need.

86.  Elmer is scheduled for a proctoscopy and has an I.V. The doctor wrote an order for 5mg of I.V. diazepam(Valium). Which order is correct regarding diazepam?

  1. Give diazepam in the I.V. port closest to the vein.
  2. Mix diazepam with 50 ml of dextrose 5% in water and give over 15 minutes.
  3. Give diazepam rapidly I.V. to prevent the bloodstream from diluting the drug mixture.
  4. Question the order because I.V. administration of diazepam is contraindicated.

87.  Annebell is being discharged with a colostomy, and you’re teaching her about colostomy care. Which statement correctly describes a healthy stoma?

  1. “At first, the stoma may bleed slightly when touched.”
  2. “The stoma should appear dark and have a bluish hue.”
  3. “A burning sensation under the stoma faceplate is normal.”
  4. “The stoma should remain swollen away from the abdomen.”

88.  A patient who underwent abdominal surgery now has a gaping incision due to delayed wound healing. Which method is correct when you irrigate a gaping abdominal incision with sterile normal saline solution, using a piston syringe?

  1. Rapidly instill a stream of irrigating solution into the wound.
  2. Apply a wet-to-dry dressing to the wound after the irrigation.
  3. Moisten the area around the wound with normal saline solution after the irrigation.
  4. Irrigate continuously until the solution becomes clear or all of the solution is used.

89.  Hepatic encephalopathy develops when the blood level of which substance increases?

  1. Ammonia
  2. Amylase
  3. Calcium
  4. Potassium

90.  Your patient recently had abdominal surgery and tells you that he feels a popping sensation in his incision during a coughing spell, followed by severe pain. You anticipate an evisceration. Which supplies should you take to his room?

  1. A suture kit.
  2. Sterile water and a suture kit.
  3. Sterile water and sterile dressings.
  4. Sterile saline solution and sterile dressings.

91.  Findings during an endoscopic exam include a cobblestone appearance of the colon in your patient. The findings are characteristic of which disorder?

  1. Ulcer
  2. Crohn’s disease
  3. Chronic gastritis
  4. Ulcerative colitis

92.  What information is correct about stomach cancer?

  1. Stomach pain is often a late symptom.
  2. Surgery is often a successful treatment.
  3. Chemotherapy and radiation are often successful treatments.
  4. The patient can survive for an extended time with TPN.

93.  Dark, tarry stools indicate bleeding in which location of the GI tract?

  1. Upper colon.
  2. Lower colon.
  3. Upper GI tract.
  4. Small intestine.

94.  A patient has an acute upper GI hemorrhage. Your interventions include:

  1. Treating hypovolemia.
  2. Treating hypervolemia.
  3. Controlling the bleeding source.
  4. Treating shock and diagnosing the bleeding source.

95.  You promote hemodynamic stability in a patient with upper GI bleeding by:

  1. Encouraging oral fluid intake.
  2. Monitoring central venous pressure.
  3. Monitoring laboratory test results and vital signs.
  4. Giving blood, electrolyte and fluid replacement.

96.  You’re preparing a patient with a malignant tumor for colorectal surgery and subsequent colostomy. The patient tells you he’s anxious. What should your initial step be in working with this patient?

  1. Determine what the patient already knows about colostomies.
  2. Show the patient some pictures of colostomies.
  3. Arrange for someone who has a colostomy to visit the patient.
  4. Provide the patient with written material about colostomy care.

97.  Your patient, Christopher, has a diagnosis of ulcerative colitis and has severe abdominal pain aggravated by movement, rebound tenderness, fever, nausea, and decreased urine output. This may indicate which complication?

  1. Fistula.
  2. Bowel perforation.
  3. Bowel obstruction.
  4. Abscess.

98.  A patient has a severe exacerbation of ulcerative colitis. Long-term medications will probably include:

  1. Antacids.
  2. Antibiotics.
  3. Corticosteroids.
  4. Histamine2-receptor blockers.

99.  The student nurse is teaching the family of a patient with liver failure. You instruct them to limit which foods in the patient’s diet?

  1. Meats and beans.
  2. Butter and gravies.
  3. Potatoes and pastas.
  4. Cakes and pastries.

100.  An intubated patient is receiving continuous enteral feedings through a Salem sump tube at a rate of 60ml/hr. Gastric residuals have been 30-40ml when monitored Q4H. You check the gastric residual and aspirate 220ml. What is your first response to this finding?

  1. Notify the doctor immediately.
  2. Stop the feeding, and clamp the NG tube.
  3. Discard the 220ml, and clamp the NG tube.
  4. Give a prescribed GI stimulant such as metoclopramide (Reglan).
Answers and Rationales
  1. Answer C. The normal serum amylase level is 25 to 151 units/L. With chronic cases of pancreatitis, the rise in serum amylase levels usually does not exceed three times the normal value. In acute pancreatitis, the value may exceed five times the normal value. Options A and B are within normal limits. Option D is an extremely elevated level seen in acute pancreatitis.
  2. Answer C. Full liquid food items include items such as plain ice cream, sherbet, breakfast drinks, milk, pudding and custard, soups that are strained, and strained vegetable juices. A clear liquid diet consists of foods that are relatively transparent. The food items in options A, B, and D are clear liquids.
  3. Answer A. The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a variety of foods of plant and animal origin. Pork products are especially rich in this vitamin. Other good food sources include nuts, whole grain cereals, and legumes. Milk contains vitamins A, D, and B2. Poultry contains niacin. Broccoli contains vitamins C, E, and K and folic acid
  4. Answer A. Unless specifically indicated, residual amounts more than 100 mL require holding the feeding. Therefore options B, C, and D are incorrect. Additionally, the feeding is not discarded unless its contents are abnormal in color or characteristics.
  5. Answer D. During the insertion of a nasogastric tube, if the client experiences difficulty breathing or any respiratory distress, withdraw the tube slightly, stop the tube advancement, and wait until the distress subsides. Options B and C are unnecessary. Quickly inserting the tube is not an appropriate action because, in this situation, it may be likely that the tube has entered the bronchus.
  6. Answer A. If the nasogastric tube is in the stomach, the pH of the contents will be acidic. Gastric aspirates have acidic pH values and should be 3.5 or lower. Option B indicates a slightly acidic pH. Option C indicates a neutral pH. Option D indicates an alkaline pH.
  7. Answer C. When the nurse removes a nasogastric tube, the client is instructed to take and hold a deep breath. This will close the epiglottis. This allows for easy withdrawal through the esophagus into the nose. The nurse removes the tube with one smooth, continuous pull.
  8. Answer C. If a client has a nasogastric tube connected to suction, the nurse should wait up to 30 minutes before reconnecting the tube to the suction apparatus to allow adequate time for medication absorption. Aspirating the nasogastric tube will remove the medication just administered. Low intermittent suction also will remove the medication just administered. The client should not be placed in the supine position because of the risk for aspiration.
  9. Answer D. When the client has a Sengstaken-Blakemore tube, a pair of scissors must be kept at the client’s bedside at all times. The client needs to be observed for sudden respiratory distress, which occurs if the gastric balloon ruptures and the entire tube moves upward. If this occurs, the nurse immediately cuts all balloon lumens and removes the tube. An obturator and a Kelly clamp are kept at the bedside of a client with a tracheostomy. An irrigation set may be kept at the bedside, but it is not the priority item.
  10. Answer A. Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.
  11. Answer B. Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis.
  12. Answer C.  Meperidine (Demerol) rather than morphine sulfate is the medication of choice to treat pain because morphine sulfate can cause spasms in the sphincter of Oddi. Options A, B, and D are appropriate interventions for the client with acute pancreatitis.
  13. Answer A. A barium swallow is an x-ray study that uses a substance called barium for contrast to highlight abnormalities in the gastrointestinal tract. The client should fast for 8 to 12 hours before the test, depending on physician instructions. Most oral medications also are withheld before the test. After the procedure, the nurse must monitor for constipation, which can occur as a result of the presence of barium in the gastrointestinal tract.
  14. Answer C. The appropriate sequence for abdominal examination is inspection, auscultation, percussion, and palpation. Auscultation is performed after inspection to ensure that the motility of the bowel and bowel sounds are not altered by percussion or palpation. Therefore, after inspecting the skin on the abdomen, the nurse should listen for bowel sounds.
  15. Answer D. The solution GoLYTELY is a bowel evacuant used to prepare a client for a colonoscopy by cleansing the bowel. The solution is expected to cause a mild diarrhea and will clear the bowel in 4 to 5 hours. Options A, B, and C are inappropriate actions.
  16. Answer B. Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of the function of the parietal cells. The source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12. This leads to the development of pernicious anemia. The client is not at risk for vitamin A, C, or E deficiency.
  17. Answer C. Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can cause ulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal disorders. Furosemide (Lasix) is a loop diuretic. Digoxin is a cardiac medication. Propranolol (Inderal) is a β-adrenergic blocker. Furosemide, digoxin, and propranolol are not contraindicated in clients with gastric disorders.
  18. Answer D. Following cholecystectomy, drainage from the T tube is initially bloody and then turns to a greenish-brown color. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 mL/day. The nurse would document the output.
  19. Answer D. Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding.
  20. Answer C. A vagotomy, or cutting of the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion. Options A, B, and D are incorrect descriptions of a vagotomy.
  21. Answer C. In a Billroth II procedure, the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically ordered by the physician. In this situation, the nurse should clarify the order. Options A, B, and D are appropriate postoperative interventions.
  22. Answer C. Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after eating, especially following a Billroth II procedure. Early manifestations usually occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high-carbohydrate foods, including fluids such as fruit nectars; to assume a low-Fowler’s position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmodics as prescribed.
  23. Answer A. Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.
  24. Answer B. Coughing is avoided following umbilical hernia repair to prevent disruption of tissue integrity, which can occur because of the location of this surgical procedure. Bed rest is not required following this surgical procedure. The client should take analgesics as needed and as prescribed to control pain. A drain is not used in this surgical procedure, although the client may be instructed in simple dressing changes.
  25. Answer B. Following inguinal hernia repair, the client should be instructed to elevate the scrotum and apply ice packs while in bed to decrease pain and swelling. The nurse also should instruct the client to apply a scrotal support when out of bed. Heat will increase swelling. Limiting oral fluids and a low-fiber diet can cause constipation.
  26. Answer C. Rebound tenderness may indicate peritonitis. Bloody diarrhea is expected to occur in ulcerative colitis. Because of the blood loss, the client may be hypotensive and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to the physician.
  27. Answer B. Body image, disturbed relates to loss of bowel control, the presence of a stoma, the release of fecal material onto the abdomen, the passage of flatus, odor, and the need for an appliance (external pouch). No data in the question support options A and C. Nutrition: less than body requirements, imbalanced is the more likely nursing diagnosis.
  28. Answer A. Crohn’s disease is characterized by nonbloody diarrhea of usually not more than four to five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity. Options B, C, and D are not characteristics of Crohn’s disease.
  29. Answer B. If cramping occurs during a colostomy irrigation, the irrigation flow is stopped temporarily and the client is allowed to rest. Cramping may occur from an infusion that is too rapid or is causing too much pressure. The physician does not need to be notified. Increasing the height of the irrigation will cause further discomfort. Medicating the client for pain is not the appropriate action in this situation.
  30. Answer A. To enhance effectiveness of the irrigation and fecal returns, the client is instructed to increase fluid intake and to take other measures to prevent constipation. Options B, C and D will not enhance the effectiveness of this procedure.
  31. Answer A. Blood pressure decreases as the body is unable to maintain normal oncotic pressure with liver failure, so patients with liver failure require close blood pressure monitoring. Increased capillary permeability, abnormal peripheral vasodilation, and excess rennin released from the kidney’s aren’t direct ramifications of liver failure.
  32. Answer B. Good circulation causes tissues to be moist and red, so a healthy, well-healed stoma appears red and moist.
  33. Answer A. A colostomy in the sigmoid colon produces a solid, formed stool.
  34. Answer D. High-fiber foods stimulate peristalsis, and a result, flatus. Yogurt reduces gas formation.
  35. Answer B. A proper fit protects the skin, but doesn’t impair circulation. A 1/16” should be cut.
  36. Answer B. Observation, auscultation, percussion, palpation
  37. Answer D. An ileoanal reservoir is created in two stages. The two surgeries are about 2 to 3 months apart. First, diseased intestines are removed and a temporary loop ileostomy is created. Second, the loop ileostomy is closed and stool goes to the reservoir and out through the anus.
  38. Answer C. The large intestine absorbs large amounts of water so the initial output from the ileostomy may be as much as 1500 to 2000 ml/24 hours. Gradually, the small intestine absorbs more fluid and the output decreases.
  39. Answer B. To avoid overloading the small intestine, encourage the patient to eat six small, regularly spaced meals.
  40. Answer B. Making observations about what you see or hear is a useful therapeutic technique. This way, you acknowledge that you are interested in what the patient is saying and feeling.
  41. Answer C. After a Billroth II procedure, a large amount of hypertonic fluid enters the intestine. This causes extracellular fluid to move rapidly into the bowel, reducing circulating blood volume and producing vasomotor symptoms. Vasomotor symptoms produced by dumping syndrome include dizziness and sweating, tachycardia, syncope, pallor, and palpitations.
  42. Answer A. Gastric emptying time can be delayed by omitting fluids from your patient’s meal. A diet low in carbs and high in fat & protein is recommended to treat dumping syndrome.
  43. Answer B. Ascites puts pressure on the diaphragm. Paracentesis is done to remove fluid and reducing pressure on the diaphragm. The goal is to improve the patient’s breathing. The others are signs of cirrhosis that aren’t relieved by paracentesis.
  44. Answer A. A full bladder can interfere with paracentesis and be punctured inadvertently.
  45. Answer B. Cover the organs with a sterile, nonadherent dressing moistened with normal saline. Do this to prevent infection and to keep the organs from drying out.
  46. Answer A. Asterixis is an early neurologic sign of hepatic encephalopathy elicited by asking the patient to hold her arms stretched out. Asterixis is present if the hands rapidly extend and flex.
  47. Answer A. You may administer the laxative lactulose to reduce ammonia levels in the colon.
  48. Answer A. Achalasia is characterized by incomplete relaxation of the LES, dilation of the lower esophagus, and a lack of esophageal peristalsis. Because nitrates relax the lower esophageal sphincter, expect to give Isordil orally or sublingually.
  49. Answer C. Eating in the upright position aids in emptying the esophagus. Doing the opposite of the other three also may be helpful.
  50. Answer C. Pancreatitis involves activation of pancreatic enzymes, such as amylase and lipase. These levels are elevated in a patient with acute pancreatitis.
  51. Answer D. The normal range of specific gravity of urine is 1.010 to 1.025; a value of 1.030 may be seen with dehydration.
  52. Answer C. Teach the pt to avoid activities that increase intra-abdominal pressure such as coughing, sneezing, or straining with a bowel movement.
  53. Answer C. Because obesity weakens the abdominal muscles, advise weight loss for the patient who has had a hernia repair.
  54. Answer B. After a liver biopsy, the patient is placed on the right side to compress the liver and to reduce the risk of bleeding or bile leakage.
  55. Answer A. Signs and Symptoms of pneumothorax include dyspnea and decreased or absent breath sounds over the affected lung (right lung).
  56. Answer A. An NG tube is inserted into the patients stomach to drain fluid and gas.
  57. Answer A. Aspirating the stomach contents confirms correct placement. If an X-ray is ordered, it should be done immediately, not in 24 hours.
  58. Answer B. TPN is given I.V. to provide all the nutrients your patient needs. TPN isn’t a tube feeding nor is it a liquid dietary supplement.
  59. Answer A. Type A causes changes in parietal cells.
  60. Answer B. Increasing fluids helps empty the stomach. A high carb diet isn’t restricted and fat intake shouldn’t be increased.
  61. Answer A. Diarrhea d/t an acute episode of ulcerative colitis leads to fluid & electrolyte losses so fluid replacement takes priority.
  62. Answer D. Sigmoidoscopy allows direct observation of the colon mucosa for changes, and if needed, biopsy.
  63. Answer C. She needs a high-fiber diet and a psyllium (bulk laxative) to promote normal soft stools.
  64. Answer B. Stools from ulcerative colitis are often bloody and contain mucus.
  65. Answer D. One sign of acute diverticulitis is crampy lower left quadrant pain. A low-grade fever is another common sign.
  66. Answer C. With acute pancreatitis, you need to rest the GI tract by TPN as nutritional support.
  67. Answer A. The gallbladder is located in the RUQ and a frequent sign of gallstones is pain radiating to the shoulder.
  68. Answer D. A Jackson-Pratt drain promotes wound healing by allowing fluid to escape from the wound.
  69. Answer D. After creation of a colostomy, expect to see a stoma that is pink, slightly edematous, with some oozing. Bright red blood, regardless of amount, indicates bleeding and should be reported to the doctor.
  70. Answer A. Only a small amount of skin should be exposed and more than 1/16” of skin allows the excretement to irritate the skin.
  71. Answer B. Measuring abdominal girth provides quantitative information about increases or decreases in the amount of distention.
  72. Answer C. Because the GI tract is functioning, feeding methods involve the enteral route which bypasses the mouth but allows for a major portion of the GI tract to be used.
  73. Answer B. The first step in assessing the abdomen is to observe its shape and contour, then auscultate, palpate, and then percuss.
  74. Answer B. Lowering the height decreases the amount of flow, allowing him to tolerate more fluid.
  75. Answer D. Pancrelipase provides the exocrine pancreatic enzyme necessary for proper protein, fat, and carb digestion. With increased fat digestion and absorption, stools become less frequent and normal in appearance.
  76. Answer B. Glucose level increases and diabetes mellitus may result d/t the pancreatic damage to the islets of langerhans.
  77. Answer D. After surgery, she remains NPO until peristaltic activity returns. This decreases the risk for abdominal distention and obstruction.
  78. Answer D. A brownish-black color indicates lack of blood flow, and maybe necrosis.
  79. Answer A. Restricting fluids decrease the amount of body fluid and the accumulation of fluid in the peritoneal space.
  80. Answer D. Dark green, leafy vegetables are rich in calcium.
  81. Answer A. For pruritus, care should include tepid sponge baths and use of emollient creams and lotions.
  82. Answer D. Rest periods and small frequent meals is indicated during the acute phase of hepatitis B.
  83. Answer D. Hepatitis B can recur. Patients who have had hepatitis are permanently barred from donating blood. Alcohol is metabolized by the liver and should be avoided by those who have or had hepatitis B.
  84. Answer A. To prevent venous stasis and improve muscle tone, circulation, and respiratory function, encourage her to move after surgery.
  85. Answer A. Telling her not to worry minimizes her feelings.
  86. Answer A. Diazepam is absorbed by the plastic I.V. tubing and should be given in the port closest to the vein.
  87. Answer A. For the first few days to a week, slight bleeding normally occurs when the stoma is touched because the surgical site is still new. She should report profuse bleeding immediately.
  88. Answer D. To wash away tissue debris and drainage effectively, irrigate the wound until the solution becomes clear or all the solution is used.
  89. Answer A. Ammonia levels increase d/t improper shunting of blood, causing ammonia to enter systemic circulation, which carries it to the brain.
  90. Answer D. Saline solution is isotonic, or close to body fluids in content, and is used along with sterile dressings to cover an eviscerated wound and keep it moist.
  91. Answer B. Crohn’s disease penetrates the mucosa of the colon through all layers and destroys the colon in patches, which creates a cobblestone appearance.
  92. Answer A. Stomach pain is often a late sign of stomach cancer; outcomes are particularly poor when the cancer reaches that point. Surgery, chemotherapy, and radiation have minimal positive effects. TPN may enhance the growth of the cancer.
  93. Answer C. Melena is the passage of dark, tarry stools that contain a large amount of digested blood. It occurs with bleeding from the upper GI tract.
  94. Answer A. A patient with an acute upper GI hemorrhage must be treated for hypovolemia and hemorrhagic shock. You as a nurse can’t diagnose the problem. Controlling the bleeding may require surgery or intensive medical treatment.
  95. Answer D. To stabilize a patient with acute bleeding, NS or LR solution is given I.V. until BP rises and urine output returns to 30ml/hr.
  96. Answer A. Initially, you should assess the patient’s knowledge about colostomies and how it will affect his lifestyle.
  97. Answer B. An inflammatory condition that affects the surface of the colon, ulcerative colitis causes friability and erosions with bleeding. Patients with ulcerative colitis are at increased risk for bowel perforation, toxic megacolon, hemorrhage, cancer, and other anorectal and systemic complications.
  98. Answer C. Medications to control inflammation such as corticosteroids are used for long-term treatment.
  99. Answer A. Meats and beans are high-protein foods. In liver failure, the liver is unable to metabolize protein adequately, causing protein by-products to build up in the body rather than be excreted.
  100. Answer B. A gastric residual greater than 2 hours worth of feeding or 100-150ml is considered too high. The feeding should be stopped; NG tube clamped, and then allow time for the stomach to empty before additional feeding is added.