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MSN Exam for Gastrointestinal Disorders (PM)*
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Question 1
Mrs. Cruz’ body mass index (BMI) is 25. You can categorized her as:
A
normal
B
overweight
C
underweight
D
obese
Question 1 Explanation:
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.
Question 2
Signs and symptoms include pain in the RLQ of the abdomen that may be localize at McBurney’s point. To relieve pain, Mr. Liu should assume which position?
A
Prone
B
Supine, stretched out
C
Sitting
D
Lying with legs drawn up
Question 2 Explanation:
Posturing by lying with legs drawn up can relax the abdominal muscle thus relieve pain.
Question 3
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
Question 3 Explanation:
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.
Question 4
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.
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
Question 4 Explanation:
In gastric ulcer food intake aggravates pain which usually occur ½ - 1 hour before meal or immediately during or after food intake. Options a, b, c suggests duodenal ulcer.
Question 5
Four hours post – operatively, Mr. Sean complains of guarding and rigidity of the abdomen. Nurse Leonard’s initial intervention is:
A
assess for signs of peritonitis
B
call the physician
C
administer pain medication
D
ignore the client
Question 5 Explanation:
Assessment precedes intervention. Symptoms presented are signs of peritonitis. Assessment will provide you the data for prompt intervention.
Question 6
Voluminous, watery stools can deplete fluids and electrolytes. The acid base imbalance that can occur is:
A
metabolic alkalosis
B
metabolic acidosis
C
respiratory acidosis
D
respiratory alkalosis
Question 6 Explanation:
In diarrhea, metabolic acidosis is the acid – base imbalance that occurs while in vomiting, metabolic alkalosis occur. This is a metabolic disorder that’s why eliminate options c and d.
Question 7
Client education should include minimizing client discomfort due to hemorrhoids. Nursing management should include:
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
Question 7 Explanation:
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.
Question 8
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
Question 8 Explanation:
Rationale: 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 accurate.
Question 9
Once food has been placed in the mouth, both mechanical and chemical digestions begin. The six activities of the digestive process are:
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.
Question 10
Situation 8: Mr. Sean is admitted to the hospital with a bowel obstruction. He complained of colicky pain and inability to pass stool.
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
Question 10 Explanation:
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.
Question 11
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
Question 11 Explanation:
Stress is an environmental factor that is thought to cause ulcerative colitis. Test taking skill: options b, c, and d are all healthy lifestyles.
Question 12
What life threatening condition may result in persistent diarrhea?
A
hypokalemia
B
dehydration
C
cardiac dysrhytmias
D
leukocytosis
Question 12 Explanation:
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.
Question 13
How about ulcerative colitis, which of the following factors is believed to cause it?
A
Acidic die
B
Altered immunity
C
Chronic constipation
D
Emotional stress
Question 13 Explanation:
Refer to rationale for number 23. Test taking skill: which does not belong? Options a, c and d are all modifiable factors
Question 14
In order to identify areas of tenderness and swelling, Nurse Dorina must do:
A
deep palpation
B
light palpation
C
percussion
D
palpation
Question 14 Explanation:
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
Question 15
Mr. Lim verbalized pain on the right iliac region. Nurse Dorina knows that the organ affected would be the:
A
liver
B
sigmoid colon
C
appendix
D
duodenum
Question 15 Explanation:
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.
Question 16
After a few minutes, the pain suddenly stops without any intervention. Nurse Ray might suspect that:
A
the appendix is still distended
B
the appendix may have ruptured
C
an increased in intrathoracic pressure will occur
D
signs and symptoms of peritonitis occur
Question 16 Explanation:
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.
Question 17
Nasogastric tube was inserted to Mr. Sean. The NGT’s primary purpose is:
A
nutrition
B
decompression of bowel
C
passage for medication
D
aspiration of gastric contents
Question 17 Explanation:
The NGT’s primary purpose is for bowel decompression especially for clients suffering from obstruction.
Question 18
Which of the following alimentary canal is the most common location for Chron’s disease?
A
Descending colon
B
Jejunum
C
Sigmoid Colon
D
Terminal Ileum
Question 18 Explanation:
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.
Question 19
To avoid acid reflux, Nurse Yoshi should advice Mrs. Cruz to avoid which type of diet?
A
cola, coffee and tea
B
high fat, carbonated and caffeinated beverages
C
beer and green tea
D
lechon paksiw and bicol express
Question 19 Explanation:
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
Question 20
Which position would be ideal for the client in the early postoperative period after hemorrhoidectomy?
A
High Fowler’s
B
Supine
C
Side – lying
D
Trendelenburg’s
Question 20 Explanation:
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 Fowler’s or supine position will place pressure on the operative site and is not recommended. There is no need for trendelenburg’s position.
Question 21
What diagnostic test would yield good visualization of the ulcer crater?
A
Endoscopy
B
Gastroscopy
C
Barium Swallow
D
Histology
Question 21 Explanation:
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.
Question 22
Situation 10: Nurse Nico is caring to a 38-year-old female, G3P3 client who has been diagnosed with hemorrhoids.
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
Question 22 Explanation:
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.
Question 23
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
Question 23 Explanation:
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.
Question 24
Situation 6: A patient was admitted in the Medical Floor at St. Luke’s Hospital. He was asymptomatic. The doctor suspects diverticulosis.
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
Question 24 Explanation:
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.
Question 25
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
Question 25 Explanation:
Rationale: 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.
Question 26
Situation 3: Mrs. Cruz was admitted in the Medical Floor due to pyrosis, dyspepsia and difficulty of swallowing.
Based from the symptoms presented, Nurse Yoshi might suspect:
A
Esophagitis
B
Hiatal hernia
C
GERD
D
Gastric Ulcer
Question 26 Explanation:
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.
Question 27
Client education should be given in order to prevent constipation. Nurse Leonard’s health teaching should include which of the following?
A
use of natural laxatives
B
fluid intake of 6 glasses per day
C
use of OTC laxatives
D
complete bed rest
Question 27 Explanation:
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.
Question 28
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
Question 28 Explanation:
Option a are local anesthetics; c are antiseptics and d are keratolytics.
Question 29
What pancreatic enzyme aids in the digestion of carbohydrates?
A
Lipase
B
Trypsin
C
Amylase
D
Chymotrypsin
Question 29 Explanation:
Amylase aids in the digestion of carbohydrates. Trypsin/Chymotrypsin aids in the digestion of proteins. Lipase aids in the digestion of fats.
Question 30
Peptic ulcer disease particularly gastric ulcer is thought to be cause by which of the following microorgamisms?
A
E. coli
B
H. pylori
C
S. aureus
D
K. pnuemoniae
Question 30 Explanation:
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.
Question 31
Upon review of Mr. Trinidad’s 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:
A
obese
B
normal
C
overweight
D
underweight
Question 31 Explanation:
Mr. Trinidad’s BMI is 23 which is normal. 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.
Question 32
Which of the following factors is believed to be linked to Chron’s disease?
A
Diet
B
Constipation
C
Heredity
D
Lack of exercise
Question 32 Explanation:
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.
Question 33
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
Question 33 Explanation:
RInspection 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.
Question 34
Situation 5: IBD is a common inflammatory functional bowel disorder also known as spastic bowel, functional colitis and mucous colitis
The client with IBS asks Nurse June what causes the disease. Which of the following responses by Nurse June would be most appropriate?
A
“The cause of this condition is unknown”
B
“There is thinning of the intestinal mucosa caused by ingestion of gluten”
C
“This is an inflammation of the bowel caused by eating too much roughage”
D
“IBS is caused by a stressful lifestyle”
Question 34 Explanation:
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.
Question 35
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
Question 35 Explanation:
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.
Question 36
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
Question 36 Explanation:
Diarhhea is an intestinal disorder that is self – limiting. Options a, c and d are etiological factors of diarrhea.
Question 37
Mr. Lim felt pain upon release of Nurse Dorina’s hand. This can be referred as:
A
referred pain
B
rebound tenderness
C
direct tenderness
D
indirect tenderness
Question 37 Explanation:
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.
Question 38
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.
How will you position Mr. Lim prior to procedure?
A
supine with knees flexed
B
prone
C
lying on back
D
sim’s
Question 38 Explanation:
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.
Question 39
What diagnostic test would confirm the type of problem Mrs. Cruz have?
A
barium enema
B
barium swallow
C
colonoscopy
D
lower GI series
Question 39 Explanation:
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.
Question 40
Situation 7: Manny, 6 years old was admitted at Cardinal Santos Hospital due to increasing frequency of bowel movements, abdominal cramps and distension.
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
Question 41
Which of the following tests should be administered to client with diverticulosis?
A
Proctosocopy
B
Barium enema
C
Barium swallow
D
Gastroscopy
Question 41 Explanation:
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.
Question 42
To improve Mr. Trinidad’s condition, your best nursing intervention and teaching is:
A
Reduce fluid intake
B
Increase fiber in the diet
C
Administering of antibiotics
D
Exercise to increase intraabdominal pressure
Question 42 Explanation:
Mr. Trinidad’s BMI is 23 which is normal. Refer to rationale number 15.
Question 43
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 °F.
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.
B
Mr. Liu describes the pain as occurring 2 hours after eating
C
The pain subsides after eating
D
The pain is in the left lower quadrant
Question 43 Explanation:
Pain over McBurney’s point, the point halfway between the umbilicus and the iliac crest, is diagnosis for appendicitis. Options b and c are common with ulcers; option d may suggest ulcerative colitis or diverticulitis.
Question 44
Which of the following complications is thought to be the most common cause of appendicitis?
A
A fecalith
B
Internal bowel occlusion
C
Bowel kinking
D
Abdominal wall swelling
Question 44 Explanation:
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.
Question 45
Mr. Sean has undergone surgery. Post – operatively, which of the following findings is normal?
A
absent bowel sounds
B
bleeding
C
hemorrhage
D
bowel movement
Question 45 Explanation:
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.
Question 46
Situation 1: Children have a special fascination with the workings of the digestive system. To fully understand the digestive processes, Nurse Lavigña must be knowledgeable of the anatomy and physiology of the gastrointestinal system.
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
Question 46 Explanation:
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?
Question 47
Mrs. Cruz complained of pain and difficulty in swallowing. This term is referred as:
A
Odynophagia
B
Dysphagia
C
Pyrosis
D
Dyspepsia
Question 47 Explanation:
When difficulty of swallowing is accompanied with pain this is now referred as odynophagia. Dysphagia is difficulty of swallowing alone.
Question 48
She is for occult blood test, what specimen will you collect?
A
Blood
B
Urine
C
Stool
D
Gastric Juice
Question 48 Explanation:
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.
Question 49
What is the immediate home care management for diarrhea?
A
Milk
B
Imodium
C
Water
D
Oresol
Question 49 Explanation:
Oresol is the immediate home care management for diarrhea to prevent dehydration. Water may not be enough to prevent diarrhea.
Question 50
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
Question 50 Explanation:
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.
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Exam Mode – Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam.
MSN Exam for Gastrointestinal Disorders (EM)*
Choose the letter of the correct answer. You got 50 minutes to finish the exam .Good luck!
Start
Congratulations - you have completed MSN Exam for Gastrointestinal Disorders (EM)*.
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Question 1
Situation 8: Mr. Sean is admitted to the hospital with a bowel obstruction. He complained of colicky pain and inability to pass stool.
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
Question 1 Explanation:
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.
Question 2
Situation 7: Manny, 6 years old was admitted at Cardinal Santos Hospital due to increasing frequency of bowel movements, abdominal cramps and distension.
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
Question 3
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
Question 3 Explanation:
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.
Question 4
Upon review of Mr. Trinidad’s 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:
A
obese
B
normal
C
overweight
D
underweight
Question 4 Explanation:
Mr. Trinidad’s BMI is 23 which is normal. 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.
Question 5
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.
How will you position Mr. Lim prior to procedure?
A
supine with knees flexed
B
prone
C
lying on back
D
sim’s
Question 5 Explanation:
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.
Question 6
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
Question 6 Explanation:
Rationale: 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.
Question 7
To improve Mr. Trinidad’s condition, your best nursing intervention and teaching is:
A
Reduce fluid intake
B
Increase fiber in the diet
C
Administering of antibiotics
D
Exercise to increase intraabdominal pressure
Question 7 Explanation:
Mr. Trinidad’s BMI is 23 which is normal. Refer to rationale number 15.
Question 8
Nasogastric tube was inserted to Mr. Sean. The NGT’s primary purpose is:
A
nutrition
B
decompression of bowel
C
passage for medication
D
aspiration of gastric contents
Question 8 Explanation:
The NGT’s primary purpose is for bowel decompression especially for clients suffering from obstruction.
Question 9
Peptic ulcer disease particularly gastric ulcer is thought to be cause by which of the following microorgamisms?
A
E. coli
B
H. pylori
C
S. aureus
D
K. pnuemoniae
Question 9 Explanation:
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.
Question 10
Signs and symptoms include pain in the RLQ of the abdomen that may be localize at McBurney’s point. To relieve pain, Mr. Liu should assume which position?
A
Prone
B
Supine, stretched out
C
Sitting
D
Lying with legs drawn up
Question 10 Explanation:
Posturing by lying with legs drawn up can relax the abdominal muscle thus relieve pain.
Question 11
Mrs. Cruz’ body mass index (BMI) is 25. You can categorized her as:
A
normal
B
overweight
C
underweight
D
obese
Question 11 Explanation:
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.
Question 12
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
Question 12 Explanation:
Stress is an environmental factor that is thought to cause ulcerative colitis. Test taking skill: options b, c, and d are all healthy lifestyles.
Question 13
Which of the following complications is thought to be the most common cause of appendicitis?
A
A fecalith
B
Internal bowel occlusion
C
Bowel kinking
D
Abdominal wall swelling
Question 13 Explanation:
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.
Question 14
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
Question 14 Explanation:
Rationale: 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 accurate.
Question 15
What pancreatic enzyme aids in the digestion of carbohydrates?
A
Lipase
B
Trypsin
C
Amylase
D
Chymotrypsin
Question 15 Explanation:
Amylase aids in the digestion of carbohydrates. Trypsin/Chymotrypsin aids in the digestion of proteins. Lipase aids in the digestion of fats.
Question 16
Situation 1: Children have a special fascination with the workings of the digestive system. To fully understand the digestive processes, Nurse Lavigña must be knowledgeable of the anatomy and physiology of the gastrointestinal system.
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
Question 16 Explanation:
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?
Question 17
Which of the following alimentary canal is the most common location for Chron’s disease?
A
Descending colon
B
Jejunum
C
Sigmoid Colon
D
Terminal Ileum
Question 17 Explanation:
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.
Question 18
Mrs. Cruz complained of pain and difficulty in swallowing. This term is referred as:
A
Odynophagia
B
Dysphagia
C
Pyrosis
D
Dyspepsia
Question 18 Explanation:
When difficulty of swallowing is accompanied with pain this is now referred as odynophagia. Dysphagia is difficulty of swallowing alone.
Question 19
Mr. Sean has undergone surgery. Post – operatively, which of the following findings is normal?
A
absent bowel sounds
B
bleeding
C
hemorrhage
D
bowel movement
Question 19 Explanation:
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.
Question 20
How about ulcerative colitis, which of the following factors is believed to cause it?
A
Acidic die
B
Altered immunity
C
Chronic constipation
D
Emotional stress
Question 20 Explanation:
Refer to rationale for number 23. Test taking skill: which does not belong? Options a, c and d are all modifiable factors
Question 21
Once food has been placed in the mouth, both mechanical and chemical digestions begin. The six activities of the digestive process are:
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.
Question 22
She is for occult blood test, what specimen will you collect?
A
Blood
B
Urine
C
Stool
D
Gastric Juice
Question 22 Explanation:
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.
Question 23
What diagnostic test would yield good visualization of the ulcer crater?
A
Endoscopy
B
Gastroscopy
C
Barium Swallow
D
Histology
Question 23 Explanation:
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.
Question 24
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
Question 24 Explanation:
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.
Question 25
To avoid acid reflux, Nurse Yoshi should advice Mrs. Cruz to avoid which type of diet?
A
cola, coffee and tea
B
high fat, carbonated and caffeinated beverages
C
beer and green tea
D
lechon paksiw and bicol express
Question 25 Explanation:
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
Question 26
Which of the following tests should be administered to client with diverticulosis?
A
Proctosocopy
B
Barium enema
C
Barium swallow
D
Gastroscopy
Question 26 Explanation:
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.
Question 27
Mr. Lim felt pain upon release of Nurse Dorina’s hand. This can be referred as:
A
referred pain
B
rebound tenderness
C
direct tenderness
D
indirect tenderness
Question 27 Explanation:
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.
Question 28
Mr. Lim verbalized pain on the right iliac region. Nurse Dorina knows that the organ affected would be the:
A
liver
B
sigmoid colon
C
appendix
D
duodenum
Question 28 Explanation:
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.
Question 29
Four hours post – operatively, Mr. Sean complains of guarding and rigidity of the abdomen. Nurse Leonard’s initial intervention is:
A
assess for signs of peritonitis
B
call the physician
C
administer pain medication
D
ignore the client
Question 29 Explanation:
Assessment precedes intervention. Symptoms presented are signs of peritonitis. Assessment will provide you the data for prompt intervention.
Question 30
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
Question 30 Explanation:
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.
Question 31
Client education should be given in order to prevent constipation. Nurse Leonard’s health teaching should include which of the following?
A
use of natural laxatives
B
fluid intake of 6 glasses per day
C
use of OTC laxatives
D
complete bed rest
Question 31 Explanation:
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.
Question 32
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
Question 32 Explanation:
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.
Question 33
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
Question 33 Explanation:
RInspection 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.
Question 34
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.
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
Question 34 Explanation:
In gastric ulcer food intake aggravates pain which usually occur ½ - 1 hour before meal or immediately during or after food intake. Options a, b, c suggests duodenal ulcer.
Question 35
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
Question 35 Explanation:
Option a are local anesthetics; c are antiseptics and d are keratolytics.
Question 36
Situation 5: IBD is a common inflammatory functional bowel disorder also known as spastic bowel, functional colitis and mucous colitis
The client with IBS asks Nurse June what causes the disease. Which of the following responses by Nurse June would be most appropriate?
A
“The cause of this condition is unknown”
B
“There is thinning of the intestinal mucosa caused by ingestion of gluten”
C
“This is an inflammation of the bowel caused by eating too much roughage”
D
“IBS is caused by a stressful lifestyle”
Question 36 Explanation:
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.
Question 37
In order to identify areas of tenderness and swelling, Nurse Dorina must do:
A
deep palpation
B
light palpation
C
percussion
D
palpation
Question 37 Explanation:
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
Question 38
After a few minutes, the pain suddenly stops without any intervention. Nurse Ray might suspect that:
A
the appendix is still distended
B
the appendix may have ruptured
C
an increased in intrathoracic pressure will occur
D
signs and symptoms of peritonitis occur
Question 39
Which position would be ideal for the client in the early postoperative period after hemorrhoidectomy?
A
High Fowler’s
B
Supine
C
Side – lying
D
Trendelenburg’s
Question 39 Explanation:
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 Fowler’s or supine position will place pressure on the operative site and is not recommended. There is no need for trendelenburg’s position.
Question 40
What is the immediate home care management for diarrhea?
A
Milk
B
Imodium
C
Water
D
Oresol
Question 40 Explanation:
Oresol is the immediate home care management for diarrhea to prevent dehydration. Water may not be enough to prevent diarrhea.
Question 41
What life threatening condition may result in persistent diarrhea?
A
hypokalemia
B
dehydration
C
cardiac dysrhytmias
D
leukocytosis
Question 41 Explanation:
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.
Question 42
Situation 10: Nurse Nico is caring to a 38-year-old female, G3P3 client who has been diagnosed with hemorrhoids.
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
Question 42 Explanation:
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.
Question 43
Client education should include minimizing client discomfort due to hemorrhoids. Nursing management should include:
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
Question 43 Explanation:
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.
Question 44
What diagnostic test would confirm the type of problem Mrs. Cruz have?
A
barium enema
B
barium swallow
C
colonoscopy
D
lower GI series
Question 44 Explanation:
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.
Question 45
Voluminous, watery stools can deplete fluids and electrolytes. The acid base imbalance that can occur is:
A
metabolic alkalosis
B
metabolic acidosis
C
respiratory acidosis
D
respiratory alkalosis
Question 45 Explanation:
In diarrhea, metabolic acidosis is the acid – base imbalance that occurs while in vomiting, metabolic alkalosis occur. This is a metabolic disorder that’s why eliminate options c and d.
Question 46
Situation 3: Mrs. Cruz was admitted in the Medical Floor due to pyrosis, dyspepsia and difficulty of swallowing.
Based from the symptoms presented, Nurse Yoshi might suspect:
A
Esophagitis
B
Hiatal hernia
C
GERD
D
Gastric Ulcer
Question 46 Explanation:
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.
Question 47
Which of the following factors is believed to be linked to Chron’s disease?
A
Diet
B
Constipation
C
Heredity
D
Lack of exercise
Question 47 Explanation:
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.
Question 48
Situation 6: A patient was admitted in the Medical Floor at St. Luke’s Hospital. He was asymptomatic. The doctor suspects diverticulosis.
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
Question 48 Explanation:
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.
Question 49
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 °F.
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.
B
Mr. Liu describes the pain as occurring 2 hours after eating
C
The pain subsides after eating
D
The pain is in the left lower quadrant
Question 49 Explanation:
Pain over McBurney’s point, the point halfway between the umbilicus and the iliac crest, is diagnosis for appendicitis. Options b and c are common with ulcers; option d may suggest ulcerative colitis or diverticulitis.
Question 50
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
Question 50 Explanation:
Diarhhea is an intestinal disorder that is self – limiting. Options a, c and d are etiological factors of diarrhea.
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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 Lavigña 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:
liver
gall bladder
stomach
pancreas
2. Pharynx is lined with mucous membranes and mucous secreting glands to ease the passage of food. The larygngopharynx serves as passageway for:
air only
air and water
food, fluids and air
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:
4. Most digestive activity occurs in the pyloric region of the stomach. What hormone stimulates the chief cells to produce pepsinogen?
Gastrin
Pepsin
HCl
Insulin
5. What pancreatic enzyme aids in the digestion of carbohydrates?
Lipase
Trypsin
Amylase
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?
supine with knees flexed
prone
lying on back
sim’s
7. To identify any localized bulging, distention and peristaltic waves, Nurse Dorina must perform which of the following?
Auscultation
Inspection
Palpation
Percussion
8. In order to identify areas of tenderness and swelling, Nurse Dorina must do:
deep palpation
light palpation
percussion
palpation
9. Mr. Lim verbalized pain on the right iliac region. Nurse Dorina knows that the organ affected would be the:
liver
sigmoid colon
appendix
duodenum
10. Mr. Lim felt pain upon release of Nurse Dorina’s hand. This can be referred as:
referred pain
rebound tenderness
direct tenderness
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:
Esophagitis
Hiatal hernia
GERD
Gastric Ulcer
12. What diagnostic test would confirm the type of problem Mrs. Cruz have?
barium enema
barium swallow
colonoscopy
lower GI series
13. Mrs. Cruz complained of pain and difficulty in swallowing. This term is referred as:
Odynophagia
Dysphagia
Pyrosis
Dyspepsia
14. To avoid acid reflux, Nurse Yoshi should advice Mrs. Cruz to avoid which type of diet?
cola, coffee and tea
high fat, carbonated and caffeinated beverages
beer and green tea
lechon paksiw and bicol express
15. Mrs. Cruz’ body mass index (BMI) is 25. You can categorized her as:
normal
overweight
underweight
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?
right epigastric pain
pain occurs when stomach is empty
pain occurs immediately after meal
pain not relieved by vomiting
17. What diagnostic test would yield good visualization of the ulcer crater?
Endoscopy
Gastroscopy
Barium Swallow
Histology
18. Peptic ulcer disease particularly gastric ulcer is thought to be cause by which of the following microorgamisms?
E. coli
H. pylori
S. aureus
K. pnuemoniae
19. She is for occult blood test, what specimen will you collect?
Blood
Urine
Stool
Gastric Juice
20. Preparation of the client for occult blood examination is:
Fluid intake limited only to 1 liter/day
NPO for 12 hours prior to obtaining of specimen
Increase fluid intake
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?
“This is an inflammation of the bowel caused by eating too much roughage”
“IBS is caused by a stressful lifestyle”
“The cause of this condition is unknown”
“There is thinning of the intestinal mucosa caused by ingestion of gluten”
22. Which of the following alimentary canal is the most common location for Chron’s disease?
Descending colon
Jejunum
Sigmoid Colon
Terminal Ileum
23. Which of the following factors is believed to be linked to Crohn’s disease?
Diet
Constipation
Heredity
Lack of exercise
24. How about ulcerative colitis, which of the following factors is believed to cause it?
Acidic diet
Altered immunity
Chronic constipation
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 demanding and stressful job
Changing to a modified vegetarian diet
Beginning a weight training program
Walking 2 miles everyday
Situation 6: A patient was admitted in the Medical Floor at St. Luke’s Hospital. He was asymptomatic. The doctor suspects diverticulosis.
26. Which of the following definitions best describes diverticulosis?
An inflamed outpouching of the intestine
A non – inflamed outpouching of the intestine
The partial impairment of the forward flow of instestinal contents
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?
Low – fiber diet
High – fiber diet
High – protein diet
Low – carbohydrate diet
28. Which of the following tests should be administered to client with diverticulosis?
Proctosocpy
Barium enema
Barium swallow
Gastroscopy
29. To improve Mr. Trinidad’s condition, your best nursing intervention and teaching is:
Reduce fluid intake
Increase fiber in the diet
Administering of antibiotics
Exercise to increase intraabdominal pressure
30. Upon review of Mr. Trinidad’s 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:
obese
normal
obese
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:
passage of stool is more than 3 bowel movements per week
passage of stool is less than 3 bowel movements per day
passage of stool is more than 3 bowel movements per day
passage of stool is less than 3 bowel movements per week
32. Diarrhea is believed to be caused by all of the following except
increase intestinal secretions
altered immunity
decrease mucosal absorption
altered motility
33. What life threatening condition may result in persistent diarrhea?
hypokalemia
dehydration
cardiac dysrhytmias
leukocytosis
34. Voluminous, watery stools can deplete fluids and electrolytes. The acid base imbalance that can occur is:
metabolic alkalosis
metabolic acidosis
respiratory acidosis
respiratory alkalosis
35. What is the immediate home care management for diarrhea?
Milk
Imodium
Water
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?
high pitched tinkling or rumbling bowel sounds
hypoactive bowel sounds
no bowel sounds auscultated
normal bowel sounds heard in all four quadrants
37. Nasogastric tube was inserted to Mr. Sean. The NGT’s primary purpose is:
nutrition
decompression of bowel
passage for medication
aspiration of gastric contents
38. Mr. Sean has undergone surgery. Post – operatively, which of the following findings is normal?
absent bowel sounds
bleeding
hemorrhage
bowel movement
39. Client education should be given in order to prevent constipation. Nurse Leonard’s health teaching should include which of the following?
use of natural laxatives
fluid intake of 6 glasses per day
use of OTC laxatives
complete bed rest
40. Four hours post – operatively, Mr. Sean complains of guarding and rigidity of the abdomen. Nurse Leonard’s initial intervention is:
assess for signs of peritonitis
call the physician
administer pain medication
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?
The pain is localized at a position halfway between the umbilicus and the right iliac crest.
Mr. Liu describes the pain as occurring 2 hours after eating
The pain subsides after eating
The pain is in the left lower quadrant
42. Which of the following complications is thought to be the most common cause of appendicitis?
A fecalith
Internal bowel occlusion
Bowel kinking
Abdominal wall swelling
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?
RBC 5.5 x 106/mm3
Hct 44 %
WBC 13, 000/mm3
Hgb 15 g/dL
44. Signs and symptoms include pain in the RLQ of the abdomen that may be localize at McBurney’s point. To relieve pain, Mr. Liu should assume which
position?
Prone
Supine, stretched out
Sitting
Lying with legs drawn upl
45. After a few minutes, the pain suddenly stops without any intervention. Nurse Ray might suspect that:
the appendix is still distended
the appendix may have ruptured
an increased in intrathoracic pressure will occur
signs and symptoms of peritonitis occur
Situation 10: Nurse Nico is caring to a 38-year-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?
Her age
Three vaginal delivery pregnancies
Her job as a school teacher
Varicosities in the legs
47. Client education should include minimizing client discomfort due to hemorrhoids. Nursing management should include:
Suggest to eat low roughage diet
Advise to wear silk undergarments
Avoid straining during defecation
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:
temporarily relieves pain, burning, and itching by numbing the nerve endings
causes coagulation (clumping) of proteins in the cells of the perianal skin or the lining of the anal canal
inhibits the growth of bacteria and other organisms
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?
High Fowler’s
Supine
Side – lying
Trendelenburg’s
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?
Hemorrhage
Rectal Spasm
Urinary retention
Constipation
Answers and Rationales
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?
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
Answer: A. Odynophagia. When difficulty of swallowing is accompanied with pain this is now referred as odynophagia. Dysphagia is difficulty of swallowing alone.
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
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.
Answer: C. Pain occurs immediately after meal.In gastric ulcer food intake aggravates pain which usually occur ½ – 1 hour before meal or immediately during or after food intake. Options a, b, c suggests duodenal ulcer.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Answer: B. Normal. Mr. Trinidad’s BMI is 23 which is normal. Refer to rationale number 15.
Answer: C. passage of stool is more than 3 bowel movements per day
Answer: B. Altered Immunity. Diarhhea is an intestinal disorder that is self – limiting. Options a, c and d are etiological factors of diarrhea.
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.
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 that’s why eliminate options c and d.
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.
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.
Answer: B. Decompression of bowel. The NGT’s primary purpose is for bowel decompression especially for clients suffering from obstruction.
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.
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.
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.
Answer: A. The pain is localized at a position halfway between the umbilicus and the right iliac crest. Pain over McBurney’s point, the point halfway between the umbilicus and the iliac crest, is diagnosis for appendicitis. Options b and c are common with ulcers; option d may suggest ulcerative colitis or diverticulitis.
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.
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.
Answer: D. Lying with legs drawn up. Posturing by lying with legs drawn up can relax the abdominal muscle thus relieve pain.
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.
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.
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.
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.
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 Fowler’s or supine position will place pressure on the operative site and is not recommended. There is no need for trendelenburg’s position.
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.