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NCLEX Practice Exam for Gastrointestinal Diseases 2 (PM)
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Question 1
A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been “spitting up blood.” A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the client’s wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is:
A
“Is your husband being treated for tuberculosis?”
B
“Describe spices and condiments your husband uses on food.”
C
“Tell me about your husband’s alcohol usage.”
D
“Has your husband recently fallen or injured his chest?”
Question 1 Explanation:
A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the mucous membrane at the junction of the esophagus and stomach. There is a strong relationship between ethanol usage, resultant vomiting, and a Mallory-Weiss tear. The bleeding is coming from the stomach, not from the lungs as would be true in some cases of tuberculosis. A Mallory-Weiss tear doesn’t occur from chest injuries or falls and isn’t associated with eating spicy foods.
Question 2
Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate?
A
He needs immediate saline gastric lavage.
B
His gastric bleeding occurred 2 hours earlier.
C
He has fresh, active upper GI bleeding.
D
He needs a transfusion of packed RBC’s.
Question 2 Explanation:
Coffee-ground emesis occurs when there is upper GI bleeding that has undergone gastric digestion. For blood to appear as coffee-ground emesis, it would have to be digested for approximately 2 hours.
Question 3
A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:
A
severe abdominal pain radiating to the shoulder.
B
abdominal ascites
C
anorexia, nausea, and vomiting.
D
eructation and constipation.
Question 3 Explanation:
Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn’t radiate to the shoulder. Eructation and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A.
Question 4
Which of the following factors can cause hepatitis A?
A
Sexual contact with an infected person
B
Eating contaminated shellfish
C
Blood transfusions with infected blood
D
Contact with infected blood
Question 4 Explanation:
Hepatitis A can be caused by consuming contaminated water, milk, or food — especially shellfish from contaminated water. Hepatitis B is caused by blood and sexual contact with an infected person. Hepatitis C is usually caused by contact with infected blood, including receiving blood transfusions.
Question 5
Mandy, an adolescent girl is admitted to an acute care facility with severe malnutrition. After a thorough examination, the physician diagnoses anorexia nervosa. When developing the plan of care for this client, the nurse is most likely to include which nursing diagnosis?
A
Deficient knowledge
B
Hopelessness
C
Powerlessness
D
Chronic low self esteem
Question 5 Explanation:
Young women with Chronic low self esteem — are at highest risk for anorexia nervosa because they perceive being thin as a way to improve their self-confidence. Hopelessness and Powerlessness are inappropriate nursing diagnoses because clients with anorexia nervosa seldom feel hopeless or powerless; instead, they use food to control their desire to be thin and hope that restricting food intake will achieve this goal. Anorexia nervosa doesn’t result from a knowledge deficit, such as one regarding good nutrition.
Question 6
A male client is recovering from a small-bowel resection. To relieve pain, the physician prescribes meperidine (Demerol), 75 mg I.M. every 4 hours. How soon after administration should meperidine’s onset of action occur?
A
5 to 10 minutes
B
15 to 30 minutes
C
2 to 4 hours
D
30 to 60 minutes
Question 6 Explanation:
Meperidine’s onset of action is 15 to 30 minutes. It peaks between 30 and 60 minutes and has a duration of action of 2 to 4 hours.
Question 7
The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first?
A
Obtaining a blood sample for laboratory studies
B
Administering I.V. fluids
C
Preparing to insert a nasogastric (NG) tube
D
Administering pain medication
Question 7 Explanation:
I.V. infusions containing normal saline solution and potassium should be given first to maintain fluid and electrolyte balance. For the client’s comfort and to assist in bowel decompression, the nurse should prepare to insert an NG tube next. A blood sample is then obtained for laboratory studies to aid in the diagnosis of bowel obstruction and guide treatment. Blood studies usually include a complete blood count, serum electrolyte levels, and blood urea nitrogen level. Pain medication often is withheld until obstruction is diagnosed because analgesics can decrease intestinal motility.
Question 8
Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention:
A
alcohol abuse and smoking
B
alcohol abuse and a history of acute renal failure.
C
a sedentary lifestyle and smoking.
D
a history of hemorrhoids and smoking
Question 8 Explanation:
Risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren’t risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.
Question 9
To prevent gastroesophageal reflux in a male client with hiatal hernia, the nurse should provide which discharge instruction?
A
“Limit fluid intake with meals.”
B
“Lie down after meals to promote digestion.”
C
“Take antacids with meals.”
D
“Avoid coffee and alcoholic beverages.”
Question 9 Explanation:
To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren’t gastric irritants.
Question 10
While palpating a female client’s right upper quadrant (RUQ), the nurse would expect to find which of the following structures?
A
Appendix
B
Sigmoid colon
C
Spleen
D
Liver
Question 10 Explanation:
The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney. The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and the spleen, in the left upper quadrant.
Question 11
During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia?
A
vitamin A
B
vitamin E
C
vitamin K
D
vitamin D
Question 11 Explanation:
Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Therefore, antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don’t synthesize vitamins A, D, or E.
Question 12
When evaluating a male client for complications of acute pancreatitis, the nurse would observe for:
A
increased intracranial pressure.
B
hypertension
C
bradycardia
D
decreased urine output.
Question 12 Explanation:
Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia, not bradycardia, usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication, but hypertension usually isn’t related to acute pancreatitis.
Question 13
Your patient Maria takes NSAIDS for her degenerative joint disease, has developed peptic ulcer disease. Which drug is useful in preventing NSAID-induced peptic ulcer disease?
A
Famotidine (Pepcid)
B
Misoprostol (Cytotec)
C
Sucralfate (Carafate)
D
Calcium carbonate (Tums)
Question 13 Explanation:
Misoprostol restores prostaglandins that protect the stomach from NSAIDS, which diminish the prostaglandins.
Question 14
Your patient with peritonitis is NPO and complaining of thirst. What is your priority?
A
Give ice chips every 15 minutes.
B
Provide frequent mouth care.
C
Use diversion activities.
D
Increase the I.V. infusion rate.
Question 14 Explanation:
Frequent mouth care helps relieve dry mouth.
Question 15
A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of:
A
increasing fluid intake to prevent dehydration.
B
consuming a low-protein, high-fiber diet.
C
taking only enteric-coated medications
D
wearing an appliance pouch only at bedtime.
Question 15 Explanation:
Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can’t absorb them after an ileostomy
Question 16
The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation?
A
Anticholinergic drugs
B
Anticoagulant drugs
C
Antihypertensive drugs
D
Antiarrhythmic drugs
Question 16 Explanation:
Paregoric has an additive effect of constipation when used with anticholinergic drugs. Antiarrhythmics, anticoagulants, and antihypertensives aren’t known to interact with paregoric.
Question 17
You’re patient, post-op drainage of a pelvic abscess secondary to diverticulitis, begins to cough violently after drinking water. His wound has ruptured and a small segment of the bowel is protruding. What’s your priority?
A
Ask the patient what happened, call the doctor, and cover the area with a water-soaked bedsheet.
B
Obtain vital signs, call the doctor, and obtain emergency orders.
C
Have a CAN hold the wound together while you obtain vital signs, call the doctor and flex the patient’s knees.
D
Have the doctor called while you remain with the patient, flex the patient’s knees, and cover the wound with sterile towels soaked in sterile saline solution.
Question 18
A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:
A
yellow sclerae.
B
circumoral pallor.
C
light amber urine.
D
black, tarry stools.
Question 18 Explanation:
Yellow sclerae may be the first sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don’t occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.
Question 19
A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because:
A
meperidine is less addictive than morphine.
B
meperidine provides a better, more prolonged analgesic effect.
C
morphine may cause hepatic dysfunction.
D
morphine may cause spasms of Oddi’s sphincter.
Question 19 Explanation:
For a client with pancreatitis, the physician will probably avoid prescribing morphine because this drug may trigger spasms of the sphincter of Oddi (a sphincter at the end of the pancreatic duct), causing irritation of the pancreas. Meperidine has a somewhat shorter duration of action than morphine. The two drugs are equally addictive. Morphine isn’t associated with hepatic dysfunction.
Question 20
A male client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client’s nasogastric (NG) tube has stopped draining. How should the nurse respond?
A
Reposition the tube
B
Irrigate the tube
C
Increase the suction level
D
Notify the physician
Question 20 Explanation:
An NG tube that fails to drain during the postoperative period should be reported to the physician immediately. It may be clogged, which could increase pressure on the suture site because fluid isn’t draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.
Question 21
A female client who has just been diagnosed with hepatitis A asks, “How could I have gotten this disease?” What is the nurse’s best response?
A
“You probably got it by engaging in unprotected sex.”
B
“You could have gotten it by using I.V. drugs.”
C
“You must have received an infected blood transfusion.”
D
“You may have eaten contaminated restaurant food.”
Question 21 Explanation:
Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers. The virus isn’t transmitted by the I.V. route, blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion. Hepatitis C can be transmitted by unprotected sex.
Question 22
Which stoma would you expect a malodorous, enzyme-rich, caustic liquid output that is yellow, green, or brown?
A
Ascending colostomy.
B
Transverse colostomy.
C
Ileostomy.
D
Descending colostomy.
Question 22 Explanation:
The output from an Ileostomy is described.
Question 23
A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse’s first response is to:
A
take a blood pressure and pulse.
B
pull the dehiscence closed.
C
call the physician.
D
place saline-soaked sterile dressings on the wound.
Question 23 Explanation:
The nurse should first place saline-soaked sterile dressings on the open wound to prevent tissue drying and possible infection. Then the nurse should call the physician and take the client’s vital signs. The dehiscence needs to be surgically closed, so the nurse should never try to close it.
Question 24
Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube?
A
Change the tube feeding solutions and tubing at least every 24 hours.
B
Check the gastrostomy tube for position every 2 days.
C
Maintain the head of the bed at a 15-degree elevation continuously.
D
Maintain the client on bed rest during the feedings.
Question 24 Explanation:
Tube feeding solutions and tubing should be changed every 24 hours, or more frequently if the feeding requires it. Doing so prevents contamination and bacterial growth. The head of the bed should be elevated 30 to 45 degrees continuously to prevent aspiration. Checking for gastrostomy tube placement is performed before initiating the feedings and every 4 hours during continuous feedings. Clients may ambulate during feedings.
Question 25
George has a T tube in place after gallbladder surgery. Before discharge, what information or instructions should be given regarding the T tube drainage?
A
“If there is any drainage, notify the surgeon immediately.”
B
“The drainage will decrease daily until the bile duct heals.”
C
“First, the drainage is dark green; then it becomes dark yellow.”
D
“If the drainage stops, milk the tube toward the puncture wound.”
Question 25 Explanation:
As healing occurs from the bile duct, bile drains from the tube; the amount of bile should decrease. Teach the patient to expect dark green drainage and to notify the doctor if drainage stops.
Question 26
A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should:
A
wear a gown when providing personal care for the client.
B
wash the hands after touching the client.
C
wear a mask when handling the client’s bedpan
D
place the client in a private room.
Question 26 Explanation:
To maintain enteric precautions, the nurse must wash the hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients. For enteric precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is likely.
Question 27
A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are:
A
cryoprecipitate and fresh frozen plasma
B
whole blood and albumin.
C
fresh frozen plasma and whole blood.
D
platelets and packed red blood cells.
Question 27 Explanation:
The liver is vital in the synthesis of clotting factors, so when it’s diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, those products aren’t specifically used to treat hemostasis. Platelets are helpful, but the best answer is cryoprecipitate and fresh frozen plasma.
Question 28
The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?
A
Ascites and orthopnea
B
Purpura and petechiae
C
Gynecomastia and testicular atrophy
D
Dyspnea and fatigue
Question 28 Explanation:
A hepatic disorder, such as cirrhosis, may disrupt the liver’s normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.
Question 29
When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?
A
Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.
B
The appendix may develop gangrene and rupture, especially in a middle-aged client.
C
Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.
D
Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
Question 29 Explanation:
A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.
Question 30
Which diagnostic test would be used first to evaluate a client with upper GI bleeding?
A
Upper GI series
B
Endoscopy
C
Hemoglobin (Hb) levels and hematocrit (HCT)
D
Arteriography
Question 30 Explanation:
Endoscopy permits direct evaluation of the upper GI tract and can detect 90% of bleeding lesions. An upper GI series, or barium study, usually isn’t the diagnostic method of choice, especially in a client with acute active bleeding who’s vomiting and unstable. An upper GI series is also less accurate than endoscopy. Although an upper GI series might confirm the presence of a lesion, it wouldn’t necessarily reveal whether the lesion is bleeding. Hb levels and HCT, which indicate loss of blood volume, aren’t always reliable indicators of GI bleeding because a decrease in these values may not be seen for several hours. Arteriography is an invasive study associated with life-threatening complications and wouldn’t be used for an initial evaluation.
Question 31
A 53 y.o. patient has undergone a partial gastrectomy for adenocarcinoma of the stomach. An NG tube is in place and is connected to low continuous suction. During the immediate postoperative period, you expect the gastric secretions to be which color?
A
Clear.
B
Red.
C
Yellow.
D
Brown.
Question 31 Explanation:
Normally, drainage is bloody for the first 24 hours after a partial gastrectomy; then it changes to brown-tinged and then to yellow or clear.
Question 32
A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially?
A
Prone with the torso elevated
B
Bent over with hands touching the floor
C
Lying on the left side with knees bent
D
Lying on the right side with legs straight
Question 32 Explanation:
For a colonoscopy, the nurse initially should position the client on the left side with knees bent. Placing the client on the right side with legs straight, prone with the torso elevated, or bent over with hands touching the floor wouldn’t allow proper visualization of the large intestine.
Question 33
Christina is receiving an enteral feeding that requires a concentration of 80ml of supplement mixed with 20 ml of water. How much water do you mix with an 8 oz (240ml) can of feeding?
A
90 ml.
B
60 ml.
C
80 ml.
D
70 ml.
Question 33 Explanation:
Dosage problem. It’s 80/20 = 240/X. X=60.
Question 34
Your patient has a retractable gastric peptic ulcer and has had a gastric vagotomy. Which factor increases as a result of vagotomy?
A
Gastric acidity.
B
Gastric motility.
C
Gastric pH.
D
Peristalsis.
Question 34 Explanation:
If the vagus nerve is cut as it enters the stomach, gastric acid secretion is decreased, but intestinal motility is also decreased and gastric emptying is delayed. Because gastric acids are decreased, gastric pH increases.
Question 35
What laboratory finding is the primary diagnostic indicator for pancreatitis?
A
Elevated serum lipase
B
Elevated aspartate aminotransferase (AST)
C
Elevated blood urea nitrogen (BUN)
D
Increased lactate dehydrogenase (LD)
Question 35 Explanation:
Elevation of serum lipase is the most reliable indicator of pancreatitis because this enzyme is produced solely by the pancreas. A client’s BUN is typically elevated in relation to renal dysfunction; the AST, in relation to liver dysfunction; and LD, in relation to damaged cardiac muscle.
Question 36
The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission?
A
Skim milk
B
Nothing by mouth
C
Clear liquids
D
Regular diet
Question 36 Explanation:
Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. A regular diet is incorrect. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn’t be given because it increases gastric acid production, which could prolong bleeding. A liquid diet is the first diet offered after bleeding and shock are controlled.
Question 37
While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes clogged. To remedy this problem and teach the client’s family how to deal with it at home, what should the nurse do?
A
Withdraw the obstruction with a 30-ml syringe.
B
Advance the tube into the intestine.
C
Apply intermittent suction to the tube.
D
Irrigate the tube with cola.
Question 37 Explanation:
The nurse should irrigate the tube with cola because its effervescence and acidity are suited to the purpose, it’s inexpensive, and it’s readily available in most homes. Advancing the NG tube is inappropriate because the tube is designed to stay in the stomach and isn’t long enough to reach the intestines. Applying intermittent suction or using a syringe for aspiration is unlikely to dislodge the material clogging the tube but may create excess pressure. Intermittent suction may even collapse the tube.
Question 38
The student nurse is participating in colorectal cancer-screening program. Which patient has the fewest risk factors for colon cancer?
A
George, a 50 y.o. whose father died of colon cancer
B
Janice, a 45 y.o. with a 25-year history of ulcerative colitis
C
Herman, a 60 y.o. who follows a low-fat, high-fiber diet
D
Sissy, a 72 y.o. with a history of breast cancer
Question 39
Which condition is most likely to have a nursing diagnosis of fluid volume deficit?
A
Gastric ulcer
B
Cholecystitis
C
Appendicitis
D
Pancreatitis
Question 39 Explanation:
Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit.
Question 40
A female client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge?
A
The client reports diminished duodenal inflammation.
B
The client doesn’t exhibit rectal tenesmus.
C
The client is free from esophagitis and achalasia.
D
The client has normal gastric structures.
Question 40 Explanation:
Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Dysphagia isn’t associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.
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NCLEX Practice Exam for Gastrointestinal Diseases 2 (EM)
Choose the letter of the correct answer. You got 40 minutes to finish the exam .Good luck!
Start
Congratulations - you have completed NCLEX Practice Exam for Gastrointestinal Diseases 2 (EM).
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Question 1
A female client who has just been diagnosed with hepatitis A asks, “How could I have gotten this disease?” What is the nurse’s best response?
A
“You may have eaten contaminated restaurant food.”
B
“You could have gotten it by using I.V. drugs.”
C
“You probably got it by engaging in unprotected sex.”
D
“You must have received an infected blood transfusion.”
Question 1 Explanation:
Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers. The virus isn’t transmitted by the I.V. route, blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion. Hepatitis C can be transmitted by unprotected sex.
Question 2
You’re patient, post-op drainage of a pelvic abscess secondary to diverticulitis, begins to cough violently after drinking water. His wound has ruptured and a small segment of the bowel is protruding. What’s your priority?
A
Ask the patient what happened, call the doctor, and cover the area with a water-soaked bedsheet.
B
Have the doctor called while you remain with the patient, flex the patient’s knees, and cover the wound with sterile towels soaked in sterile saline solution.
C
Have a CAN hold the wound together while you obtain vital signs, call the doctor and flex the patient’s knees.
D
Obtain vital signs, call the doctor, and obtain emergency orders.
Question 3
Your patient with peritonitis is NPO and complaining of thirst. What is your priority?
A
Give ice chips every 15 minutes.
B
Increase the I.V. infusion rate.
C
Provide frequent mouth care.
D
Use diversion activities.
Question 3 Explanation:
Frequent mouth care helps relieve dry mouth.
Question 4
The student nurse is participating in colorectal cancer-screening program. Which patient has the fewest risk factors for colon cancer?
A
Sissy, a 72 y.o. with a history of breast cancer
B
George, a 50 y.o. whose father died of colon cancer
C
Herman, a 60 y.o. who follows a low-fat, high-fiber diet
D
Janice, a 45 y.o. with a 25-year history of ulcerative colitis
Question 5
The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?
A
Ascites and orthopnea
B
Gynecomastia and testicular atrophy
C
Purpura and petechiae
D
Dyspnea and fatigue
Question 5 Explanation:
A hepatic disorder, such as cirrhosis, may disrupt the liver’s normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.
Question 6
Your patient Maria takes NSAIDS for her degenerative joint disease, has developed peptic ulcer disease. Which drug is useful in preventing NSAID-induced peptic ulcer disease?
A
Famotidine (Pepcid)
B
Misoprostol (Cytotec)
C
Sucralfate (Carafate)
D
Calcium carbonate (Tums)
Question 6 Explanation:
Misoprostol restores prostaglandins that protect the stomach from NSAIDS, which diminish the prostaglandins.
Question 7
Which diagnostic test would be used first to evaluate a client with upper GI bleeding?
A
Upper GI series
B
Hemoglobin (Hb) levels and hematocrit (HCT)
C
Endoscopy
D
Arteriography
Question 7 Explanation:
Endoscopy permits direct evaluation of the upper GI tract and can detect 90% of bleeding lesions. An upper GI series, or barium study, usually isn’t the diagnostic method of choice, especially in a client with acute active bleeding who’s vomiting and unstable. An upper GI series is also less accurate than endoscopy. Although an upper GI series might confirm the presence of a lesion, it wouldn’t necessarily reveal whether the lesion is bleeding. Hb levels and HCT, which indicate loss of blood volume, aren’t always reliable indicators of GI bleeding because a decrease in these values may not be seen for several hours. Arteriography is an invasive study associated with life-threatening complications and wouldn’t be used for an initial evaluation.
Question 8
Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube?
A
Maintain the client on bed rest during the feedings.
B
Maintain the head of the bed at a 15-degree elevation continuously.
C
Change the tube feeding solutions and tubing at least every 24 hours.
D
Check the gastrostomy tube for position every 2 days.
Question 8 Explanation:
Tube feeding solutions and tubing should be changed every 24 hours, or more frequently if the feeding requires it. Doing so prevents contamination and bacterial growth. The head of the bed should be elevated 30 to 45 degrees continuously to prevent aspiration. Checking for gastrostomy tube placement is performed before initiating the feedings and every 4 hours during continuous feedings. Clients may ambulate during feedings.
Question 9
George has a T tube in place after gallbladder surgery. Before discharge, what information or instructions should be given regarding the T tube drainage?
A
“The drainage will decrease daily until the bile duct heals.”
B
“If there is any drainage, notify the surgeon immediately.”
C
“First, the drainage is dark green; then it becomes dark yellow.”
D
“If the drainage stops, milk the tube toward the puncture wound.”
Question 9 Explanation:
As healing occurs from the bile duct, bile drains from the tube; the amount of bile should decrease. Teach the patient to expect dark green drainage and to notify the doctor if drainage stops.
Question 10
A 53 y.o. patient has undergone a partial gastrectomy for adenocarcinoma of the stomach. An NG tube is in place and is connected to low continuous suction. During the immediate postoperative period, you expect the gastric secretions to be which color?
A
Brown.
B
Clear.
C
Red.
D
Yellow.
Question 10 Explanation:
Normally, drainage is bloody for the first 24 hours after a partial gastrectomy; then it changes to brown-tinged and then to yellow or clear.
Question 11
A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:
A
yellow sclerae.
B
circumoral pallor.
C
black, tarry stools.
D
light amber urine.
Question 11 Explanation:
Yellow sclerae may be the first sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don’t occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.
Question 12
Christina is receiving an enteral feeding that requires a concentration of 80ml of supplement mixed with 20 ml of water. How much water do you mix with an 8 oz (240ml) can of feeding?
A
70 ml.
B
90 ml.
C
80 ml.
D
60 ml.
Question 12 Explanation:
Dosage problem. It’s 80/20 = 240/X. X=60.
Question 13
To prevent gastroesophageal reflux in a male client with hiatal hernia, the nurse should provide which discharge instruction?
A
“Limit fluid intake with meals.”
B
“Lie down after meals to promote digestion.”
C
“Take antacids with meals.”
D
“Avoid coffee and alcoholic beverages.”
Question 13 Explanation:
To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren’t gastric irritants.
Question 14
Which condition is most likely to have a nursing diagnosis of fluid volume deficit?
A
Gastric ulcer
B
Appendicitis
C
Pancreatitis
D
Cholecystitis
Question 14 Explanation:
Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit.
Question 15
The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation?
A
Antihypertensive drugs
B
Anticoagulant drugs
C
Antiarrhythmic drugs
D
Anticholinergic drugs
Question 15 Explanation:
Paregoric has an additive effect of constipation when used with anticholinergic drugs. Antiarrhythmics, anticoagulants, and antihypertensives aren’t known to interact with paregoric.
Question 16
A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because:
A
meperidine provides a better, more prolonged analgesic effect.
B
morphine may cause hepatic dysfunction.
C
meperidine is less addictive than morphine.
D
morphine may cause spasms of Oddi’s sphincter.
Question 16 Explanation:
For a client with pancreatitis, the physician will probably avoid prescribing morphine because this drug may trigger spasms of the sphincter of Oddi (a sphincter at the end of the pancreatic duct), causing irritation of the pancreas. Meperidine has a somewhat shorter duration of action than morphine. The two drugs are equally addictive. Morphine isn’t associated with hepatic dysfunction.
Question 17
A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse’s first response is to:
A
call the physician.
B
place saline-soaked sterile dressings on the wound.
C
take a blood pressure and pulse.
D
pull the dehiscence closed.
Question 17 Explanation:
The nurse should first place saline-soaked sterile dressings on the open wound to prevent tissue drying and possible infection. Then the nurse should call the physician and take the client’s vital signs. The dehiscence needs to be surgically closed, so the nurse should never try to close it.
Question 18
Your patient has a retractable gastric peptic ulcer and has had a gastric vagotomy. Which factor increases as a result of vagotomy?
A
Gastric acidity.
B
Gastric motility.
C
Peristalsis.
D
Gastric pH.
Question 18 Explanation:
If the vagus nerve is cut as it enters the stomach, gastric acid secretion is decreased, but intestinal motility is also decreased and gastric emptying is delayed. Because gastric acids are decreased, gastric pH increases.
Question 19
Which stoma would you expect a malodorous, enzyme-rich, caustic liquid output that is yellow, green, or brown?
A
Descending colostomy.
B
Ascending colostomy.
C
Ileostomy.
D
Transverse colostomy.
Question 19 Explanation:
The output from an Ileostomy is described.
Question 20
While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes clogged. To remedy this problem and teach the client’s family how to deal with it at home, what should the nurse do?
A
Withdraw the obstruction with a 30-ml syringe.
B
Advance the tube into the intestine.
C
Apply intermittent suction to the tube.
D
Irrigate the tube with cola.
Question 20 Explanation:
The nurse should irrigate the tube with cola because its effervescence and acidity are suited to the purpose, it’s inexpensive, and it’s readily available in most homes. Advancing the NG tube is inappropriate because the tube is designed to stay in the stomach and isn’t long enough to reach the intestines. Applying intermittent suction or using a syringe for aspiration is unlikely to dislodge the material clogging the tube but may create excess pressure. Intermittent suction may even collapse the tube.
Question 21
A female client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge?
A
The client doesn’t exhibit rectal tenesmus.
B
The client reports diminished duodenal inflammation.
C
The client has normal gastric structures.
D
The client is free from esophagitis and achalasia.
Question 21 Explanation:
Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Dysphagia isn’t associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.
Question 22
The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission?
A
Regular diet
B
Skim milk
C
Clear liquids
D
Nothing by mouth
Question 22 Explanation:
Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. A regular diet is incorrect. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn’t be given because it increases gastric acid production, which could prolong bleeding. A liquid diet is the first diet offered after bleeding and shock are controlled.
Question 23
During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia?
A
vitamin K
B
vitamin E
C
vitamin D
D
vitamin A
Question 23 Explanation:
Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Therefore, antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don’t synthesize vitamins A, D, or E.
Question 24
What laboratory finding is the primary diagnostic indicator for pancreatitis?
A
Increased lactate dehydrogenase (LD)
B
Elevated blood urea nitrogen (BUN)
C
Elevated serum lipase
D
Elevated aspartate aminotransferase (AST)
Question 24 Explanation:
Elevation of serum lipase is the most reliable indicator of pancreatitis because this enzyme is produced solely by the pancreas. A client’s BUN is typically elevated in relation to renal dysfunction; the AST, in relation to liver dysfunction; and LD, in relation to damaged cardiac muscle.
Question 25
Which of the following factors can cause hepatitis A?
A
Eating contaminated shellfish
B
Contact with infected blood
C
Blood transfusions with infected blood
D
Sexual contact with an infected person
Question 25 Explanation:
Hepatitis A can be caused by consuming contaminated water, milk, or food — especially shellfish from contaminated water. Hepatitis B is caused by blood and sexual contact with an infected person. Hepatitis C is usually caused by contact with infected blood, including receiving blood transfusions.
Question 26
A male client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client’s nasogastric (NG) tube has stopped draining. How should the nurse respond?
A
Irrigate the tube
B
Notify the physician
C
Increase the suction level
D
Reposition the tube
Question 26 Explanation:
An NG tube that fails to drain during the postoperative period should be reported to the physician immediately. It may be clogged, which could increase pressure on the suture site because fluid isn’t draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.
Question 27
A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:
A
abdominal ascites
B
anorexia, nausea, and vomiting.
C
severe abdominal pain radiating to the shoulder.
D
eructation and constipation.
Question 27 Explanation:
Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn’t radiate to the shoulder. Eructation and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A.
Question 28
Mandy, an adolescent girl is admitted to an acute care facility with severe malnutrition. After a thorough examination, the physician diagnoses anorexia nervosa. When developing the plan of care for this client, the nurse is most likely to include which nursing diagnosis?
A
Hopelessness
B
Chronic low self esteem
C
Deficient knowledge
D
Powerlessness
Question 28 Explanation:
Young women with Chronic low self esteem — are at highest risk for anorexia nervosa because they perceive being thin as a way to improve their self-confidence. Hopelessness and Powerlessness are inappropriate nursing diagnoses because clients with anorexia nervosa seldom feel hopeless or powerless; instead, they use food to control their desire to be thin and hope that restricting food intake will achieve this goal. Anorexia nervosa doesn’t result from a knowledge deficit, such as one regarding good nutrition.
Question 29
When evaluating a male client for complications of acute pancreatitis, the nurse would observe for:
A
increased intracranial pressure.
B
bradycardia
C
decreased urine output.
D
hypertension
Question 29 Explanation:
Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia, not bradycardia, usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication, but hypertension usually isn’t related to acute pancreatitis.
Question 30
The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first?
A
Administering I.V. fluids
B
Administering pain medication
C
Preparing to insert a nasogastric (NG) tube
D
Obtaining a blood sample for laboratory studies
Question 30 Explanation:
I.V. infusions containing normal saline solution and potassium should be given first to maintain fluid and electrolyte balance. For the client’s comfort and to assist in bowel decompression, the nurse should prepare to insert an NG tube next. A blood sample is then obtained for laboratory studies to aid in the diagnosis of bowel obstruction and guide treatment. Blood studies usually include a complete blood count, serum electrolyte levels, and blood urea nitrogen level. Pain medication often is withheld until obstruction is diagnosed because analgesics can decrease intestinal motility.
Question 31
A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should:
A
wear a mask when handling the client’s bedpan
B
wear a gown when providing personal care for the client.
C
wash the hands after touching the client.
D
place the client in a private room.
Question 31 Explanation:
To maintain enteric precautions, the nurse must wash the hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients. For enteric precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is likely.
Question 32
Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate?
A
He needs immediate saline gastric lavage.
B
He needs a transfusion of packed RBC’s.
C
His gastric bleeding occurred 2 hours earlier.
D
He has fresh, active upper GI bleeding.
Question 32 Explanation:
Coffee-ground emesis occurs when there is upper GI bleeding that has undergone gastric digestion. For blood to appear as coffee-ground emesis, it would have to be digested for approximately 2 hours.
Question 33
A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are:
A
cryoprecipitate and fresh frozen plasma
B
platelets and packed red blood cells.
C
whole blood and albumin.
D
fresh frozen plasma and whole blood.
Question 33 Explanation:
The liver is vital in the synthesis of clotting factors, so when it’s diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, those products aren’t specifically used to treat hemostasis. Platelets are helpful, but the best answer is cryoprecipitate and fresh frozen plasma.
Question 34
A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of:
A
wearing an appliance pouch only at bedtime.
B
increasing fluid intake to prevent dehydration.
C
consuming a low-protein, high-fiber diet.
D
taking only enteric-coated medications
Question 34 Explanation:
Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can’t absorb them after an ileostomy
Question 35
Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention:
A
alcohol abuse and smoking
B
a history of hemorrhoids and smoking
C
alcohol abuse and a history of acute renal failure.
D
a sedentary lifestyle and smoking.
Question 35 Explanation:
Risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren’t risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.
Question 36
When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?
A
Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.
B
Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
C
Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.
D
The appendix may develop gangrene and rupture, especially in a middle-aged client.
Question 36 Explanation:
A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.
Question 37
A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially?
A
Bent over with hands touching the floor
B
Lying on the left side with knees bent
C
Prone with the torso elevated
D
Lying on the right side with legs straight
Question 37 Explanation:
For a colonoscopy, the nurse initially should position the client on the left side with knees bent. Placing the client on the right side with legs straight, prone with the torso elevated, or bent over with hands touching the floor wouldn’t allow proper visualization of the large intestine.
Question 38
A male client is recovering from a small-bowel resection. To relieve pain, the physician prescribes meperidine (Demerol), 75 mg I.M. every 4 hours. How soon after administration should meperidine’s onset of action occur?
A
15 to 30 minutes
B
5 to 10 minutes
C
30 to 60 minutes
D
2 to 4 hours
Question 38 Explanation:
Meperidine’s onset of action is 15 to 30 minutes. It peaks between 30 and 60 minutes and has a duration of action of 2 to 4 hours.
Question 39
A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been “spitting up blood.” A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the client’s wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is:
A
“Tell me about your husband’s alcohol usage.”
B
“Is your husband being treated for tuberculosis?”
C
“Has your husband recently fallen or injured his chest?”
D
“Describe spices and condiments your husband uses on food.”
Question 39 Explanation:
A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the mucous membrane at the junction of the esophagus and stomach. There is a strong relationship between ethanol usage, resultant vomiting, and a Mallory-Weiss tear. The bleeding is coming from the stomach, not from the lungs as would be true in some cases of tuberculosis. A Mallory-Weiss tear doesn’t occur from chest injuries or falls and isn’t associated with eating spicy foods.
Question 40
While palpating a female client’s right upper quadrant (RUQ), the nurse would expect to find which of the following structures?
A
Spleen
B
Sigmoid colon
C
Appendix
D
Liver
Question 40 Explanation:
The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney. The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and the spleen, in the left upper quadrant.
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1. During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia?
vitamin A
vitamin D
vitamin E
vitamin K
2. When evaluating a male client for complications of acute pancreatitis, the nurse would observe for:
increased intracranial pressure.
decreased urine output.
bradycardia.
hypertension.
3. A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially?
Lying on the right side with legs straight
Lying on the left side with knees bent
Prone with the torso elevated
Bent over with hands touching the floor
4. A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been “spitting up blood.” A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the client’s wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is:
“Tell me about your husband’s alcohol usage.”
“Is your husband being treated for tuberculosis?”
“Has your husband recently fallen or injured his chest?”
“Describe spices and condiments your husband uses on food.”
5. Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube?
Change the tube feeding solutions and tubing at least every 24 hours.
Maintain the head of the bed at a 15-degree elevation continuously.
Check the gastrostomy tube for position every 2 days.
Maintain the client on bed rest during the feedings.
6. A male client is recovering from a small-bowel resection. To relieve pain, the physician prescribes meperidine (Demerol), 75 mg I.M. every 4 hours. How soon after administration should meperidine’s onset of action occur?
5 to 10 minutes
15 to 30 minutes
30 to 60 minutes
2 to 4 hours
7. The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?
Dyspnea and fatigue
Ascites and orthopnea
Purpura and petechiae
Gynecomastia and testicular atrophy
8. Which condition is most likely to have a nursing diagnosis of fluid volume deficit?
Appendicitis
Pancreatitis
Cholecystitis
Gastric ulcer
9. While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes clogged. To remedy this problem and teach the client’s family how to deal with it at home, what should the nurse do?
Irrigate the tube with cola.
Advance the tube into the intestine.
Apply intermittent suction to the tube.
Withdraw the obstruction with a 30-ml syringe.
10. A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because:
meperidine provides a better, more prolonged analgesic effect.
morphine may cause spasms of Oddi’s sphincter.
meperidine is less addictive than morphine.
morphine may cause hepatic dysfunction.
11. Mandy, an adolescent girl is admitted to an acute care facility with severe malnutrition. After a thorough examination, the physician diagnoses anorexia nervosa. When developing the plan of care for this client, the nurse is most likely to include which nursing diagnosis?
Hopelessness
Powerlessness
Chronic low self esteem
Deficient knowledge
12. Which diagnostic test would be used first to evaluate a client with upper GI bleeding?
Endoscopy
Upper GI series
Hemoglobin (Hb) levels and hematocrit (HCT)
Arteriography
13. A female client who has just been diagnosed with hepatitis A asks, “How could I have gotten this disease?” What is the nurse’s best response?
“You may have eaten contaminated restaurant food.”
“You could have gotten it by using I.V. drugs.”
“You must have received an infected blood transfusion.”
“You probably got it by engaging in unprotected sex.”
14. When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?
Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.
Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
The appendix may develop gangrene and rupture, especially in a middle-aged client.
Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.
15. A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are:
whole blood and albumin.
platelets and packed red blood cells.
fresh frozen plasma and whole blood.
cryoprecipitate and fresh frozen plasma.
16. To prevent gastroesophageal reflux in a male client with hiatal hernia, the nurse should provide which discharge instruction?
“Lie down after meals to promote digestion.”
“Avoid coffee and alcoholic beverages.”
“Take antacids with meals.”
“Limit fluid intake with meals.”
17. The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first?
Administering pain medication
Obtaining a blood sample for laboratory studies
Preparing to insert a nasogastric (NG) tube
Administering I.V. fluids
18. A female client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge?
The client doesn’t exhibit rectal tenesmus.
The client is free from esophagitis and achalasia.
The client reports diminished duodenal inflammation.
The client has normal gastric structures.
19. A male client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client’s nasogastric (NG) tube has stopped draining. How should the nurse respond?
Notify the physician
Reposition the tube
Irrigate the tube
Increase the suction level
20. What laboratory finding is the primary diagnostic indicator for pancreatitis?
Elevated blood urea nitrogen (BUN)
Elevated serum lipase
Elevated aspartate aminotransferase (AST)
Increased lactate dehydrogenase (LD)
21. A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:
yellow sclerae.
light amber urine.
circumoral pallor.
black, tarry stools.
22. Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention:
a sedentary lifestyle and smoking.
a history of hemorrhoids and smoking.
alcohol abuse and a history of acute renal failure.
alcohol abuse and smoking.
23. While palpating a female client’s right upper quadrant (RUQ), the nurse would expect to find which of the following structures?
Sigmoid colon
Appendix
Spleen
Liver
24. A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse’s first response is to:
call the physician.
place saline-soaked sterile dressings on the wound.
take a blood pressure and pulse.
pull the dehiscence closed.
25. The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation?
Antiarrhythmic drugs
Anticholinergic drugs
Anticoagulant drugs
Antihypertensive drugs
26. A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of:
increasing fluid intake to prevent dehydration.
wearing an appliance pouch only at bedtime.
consuming a low-protein, high-fiber diet.
taking only enteric-coated medications.
27. The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission?
Regular diet
Skim milk
Nothing by mouth
Clear liquids
28. A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:
severe abdominal pain radiating to the shoulder.
anorexia, nausea, and vomiting.
eructation and constipation.
abdominal ascites.
29. A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should:
place the client in a private room.
wear a mask when handling the client’s bedpan.
wash the hands after touching the client.
wear a gown when providing personal care for the client.
30. Which of the following factors can cause hepatitis A?
Contact with infected blood
Blood transfusions with infected blood
Eating contaminated shellfish
Sexual contact with an infected person
31. Your patient with peritonitis is NPO and complaining of thirst. What is your priority?
Increase the I.V. infusion rate.
Use diversion activities.
Provide frequent mouth care.
Give ice chips every 15 minutes.
32. Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate?
He has fresh, active upper GI bleeding.
He needs immediate saline gastric lavage.
His gastric bleeding occurred 2 hours earlier.
He needs a transfusion of packed RBC’s.
33. A 53 y.o. patient has undergone a partial gastrectomy for adenocarcinoma of the stomach. An NG tube is in place and is connected to low continuous suction. During the immediate postoperative period, you expect the gastric secretions to be which color?
Brown.
Clear.
Red.
Yellow.
34. Your patient has a retractable gastric peptic ulcer and has had a gastric vagotomy. Which factor increases as a result of vagotomy?
Peristalsis.
Gastric acidity.
Gastric motility.
Gastric pH.
35. Christina is receiving an enteral feeding that requires a concentration of 80ml of supplement mixed with 20 ml of water. How much water do you mix with an 8 oz (240ml) can of feeding?
60 ml.
70 ml.
80 ml.
90 ml.
36. Which stoma would you expect a malodorous, enzyme-rich, caustic liquid output that is yellow, green, or brown?
Ileostomy.
Ascending colostomy.
Transverse colostomy.
Descending colostomy.
37. George has a T tube in place after gallbladder surgery. Before discharge, what information or instructions should be given regarding the T tube drainage?
“If there is any drainage, notify the surgeon immediately.”
“The drainage will decrease daily until the bile duct heals.”
“First, the drainage is dark green; then it becomes dark yellow.”
“If the drainage stops, milk the tube toward the puncture wound.”
38. Your patient Maria takes NSAIDS for her degenerative joint disease, has developed peptic ulcer disease. Which drug is useful in preventing NSAID-induced peptic ulcer disease?
Calcium carbonate (Tums)
Famotidine (Pepcid)
Misoprostol (Cytotec)
Sucralfate (Carafate)
39. The student nurse is participating in colorectal cancer-screening program. Which patient has the fewest risk factors for colon cancer?
Janice, a 45 y.o. with a 25-year history of ulcerative colitis
George, a 50 y.o. whose father died of colon cancer
Herman, a 60 y.o. who follows a low-fat, high-fiber diet
Sissy, a 72 y.o. with a history of breast cancer
40. You’re patient, post-op drainage of a pelvic abscess secondary to diverticulitis, begins to cough violently after drinking water. His wound has ruptured and a small segment of the bowel is protruding. What’s your priority?
Ask the patient what happened, call the doctor, and cover the area with a water-soaked bedsheet.
Obtain vital signs, call the doctor, and obtain emergency orders.
Have a CAN hold the wound together while you obtain vital signs, call the doctor and flex the patient’s knees.
Have the doctor called while you remain with the patient, flex the patient’s knees, and cover the wound with sterile towels soaked in sterile saline solution.
Answers and Rationales
Answer D. Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Therefore, antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don’t synthesize vitamins A, D, or E.
Answer B. Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia, not bradycardia, usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication, but hypertension usually isn’t related to acute pancreatitis.
Answer B. For a colonoscopy, the nurse initially should position the client on the left side with knees bent. Placing the client on the right side with legs straight, prone with the torso elevated, or bent over with hands touching the floor wouldn’t allow proper visualization of the large intestine.
Answer A. A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the mucous membrane at the junction of the esophagus and stomach. There is a strong relationship between ethanol usage, resultant vomiting, and a Mallory-Weiss tear. The bleeding is coming from the stomach, not from the lungs as would be true in some cases of tuberculosis. A Mallory-Weiss tear doesn’t occur from chest injuries or falls and isn’t associated with eating spicy foods.
Answer A. Tube feeding solutions and tubing should be changed every 24 hours, or more frequently if the feeding requires it. Doing so prevents contamination and bacterial growth. The head of the bed should be elevated 30 to 45 degrees continuously to prevent aspiration. Checking for gastrostomy tube placement is performed before initiating the feedings and every 4 hours during continuous feedings. Clients may ambulate during feedings.
Answer B. Meperidine’s onset of action is 15 to 30 minutes. It peaks between 30 and 60 minutes and has a duration of action of 2 to 4 hours.
Answer C. A hepatic disorder, such as cirrhosis, may disrupt the liver’s normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.
Answer B. Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit.
Answer A. The nurse should irrigate the tube with cola because its effervescence and acidity are suited to the purpose, it’s inexpensive, and it’s readily available in most homes. Advancing the NG tube is inappropriate because the tube is designed to stay in the stomach and isn’t long enough to reach the intestines. Applying intermittent suction or using a syringe for aspiration is unlikely to dislodge the material clogging the tube but may create excess pressure. Intermittent suction may even collapse the tube.
Answer B. For a client with pancreatitis, the physician will probably avoid prescribing morphine because this drug may trigger spasms of the sphincter of Oddi (a sphincter at the end of the pancreatic duct), causing irritation of the pancreas. Meperidine has a somewhat shorter duration of action than morphine. The two drugs are equally addictive. Morphine isn’t associated with hepatic dysfunction.
Answer C. Young women with Chronic low self esteem — are at highest risk for anorexia nervosa because they perceive being thin as a way to improve their self-confidence. Hopelessness and Powerlessness are inappropriate nursing diagnoses because clients with anorexia nervosa seldom feel hopeless or powerless; instead, they use food to control their desire to be thin and hope that restricting food intake will achieve this goal. Anorexia nervosa doesn’t result from a knowledge deficit, such as one regarding good nutrition.
Answer A. Endoscopy permits direct evaluation of the upper GI tract and can detect 90% of bleeding lesions. An upper GI series, or barium study, usually isn’t the diagnostic method of choice, especially in a client with acute active bleeding who’s vomiting and unstable. An upper GI series is also less accurate than endoscopy. Although an upper GI series might confirm the presence of a lesion, it wouldn’t necessarily reveal whether the lesion is bleeding. Hb levels and HCT, which indicate loss of blood volume, aren’t always reliable indicators of GI bleeding because a decrease in these values may not be seen for several hours. Arteriography is an invasive study associated with life-threatening complications and wouldn’t be used for an initial evaluation.
Answer A. Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers. The virus isn’t transmitted by the I.V. route, blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion. Hepatitis C can be transmitted by unprotected sex.
Answer B. A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.
Answer D. The liver is vital in the synthesis of clotting factors, so when it’s diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, those products aren’t specifically used to treat hemostasis. Platelets are helpful, but the best answer is cryoprecipitate and fresh frozen plasma.
Answer B. To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren’t gastric irritants.
Answer D. I.V. infusions containing normal saline solution and potassium should be given first to maintain fluid and electrolyte balance. For the client’s comfort and to assist in bowel decompression, the nurse should prepare to insert an NG tube next. A blood sample is then obtained for laboratory studies to aid in the diagnosis of bowel obstruction and guide treatment. Blood studies usually include a complete blood count, serum electrolyte levels, and blood urea nitrogen level. Pain medication often is withheld until obstruction is diagnosed because analgesics can decrease intestinal motility.
Answer B. Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment. Dysphagia isn’t associated with rectal tenesmus, duodenal inflammation, or abnormal gastric structures.
Answer A. An NG tube that fails to drain during the postoperative period should be reported to the physician immediately. It may be clogged, which could increase pressure on the suture site because fluid isn’t draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.
Answer B. Elevation of serum lipase is the most reliable indicator of pancreatitis because this enzyme is produced solely by the pancreas. A client’s BUN is typically elevated in relation to renal dysfunction; the AST, in relation to liver dysfunction; and LD, in relation to damaged cardiac muscle.
Answer A. Yellow sclerae may be the first sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don’t occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.
Answer D. Risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren’t risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.
Answer D. The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney. The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and the spleen, in the left upper quadrant.
Answer B. The nurse should first place saline-soaked sterile dressings on the open wound to prevent tissue drying and possible infection. Then the nurse should call the physician and take the client’s vital signs. The dehiscence needs to be surgically closed, so the nurse should never try to close it.
Answer B. Paregoric has an additive effect of constipation when used with anticholinergic drugs. Antiarrhythmics, anticoagulants, and antihypertensives aren’t known to interact with paregoric.
Answer A. Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can’t absorb them after an ileostomy
Answer C. Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. A regular diet is incorrect. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn’t be given because it increases gastric acid production, which could prolong bleeding. A liquid diet is the first diet offered after bleeding and shock are controlled.
Answer B. Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn’t radiate to the shoulder. Eructation and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A.
Answer C. To maintain enteric precautions, the nurse must wash the hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients. For enteric precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is likely.
Answer C. Hepatitis A can be caused by consuming contaminated water, milk, or food — especially shellfish from contaminated water. Hepatitis B is caused by blood and sexual contact with an infected person. Hepatitis C is usually caused by contact with infected blood, including receiving blood transfusions.
Answer C. Frequent mouth care helps relieve dry mouth.
Answer C. Coffee-ground emesis occurs when there is upper GI bleeding that has undergone gastric digestion. For blood to appear as coffee-ground emesis, it would have to be digested for approximately 2 hours.
Answer C. Normally, drainage is bloody for the first 24 hours after a partial gastrectomy; then it changes to brown-tinged and then to yellow or clear.
Answer D. If the vagus nerve is cut as it enters the stomach, gastric acid secretion is decreased, but intestinal motility is also decreased and gastric emptying is delayed. Because gastric acids are decreased, gastric pH increases.
Answer A. Dosage problem. It’s 80/20 = 240/X. X=60.
Answer A. The output from an Ileostomy is described.
Answer B. As healing occurs from the bile duct, bile drains from the tube; the amount of bile should decrease. Teach the patient to expect dark green drainage and to notify the doctor if drainage stops.
Answer C. Misoprostol restores prostaglandins that protect the stomach from NSAIDS, which diminish the prostaglandins.