NCLEX Practice Exam for Gastrointestinal Diseases 2

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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?

  1. vitamin A
  2. vitamin D
  3. vitamin E
  4. vitamin K

2. When evaluating a male client for complications of acute pancreatitis, the nurse would observe for:

  1. increased intracranial pressure.
  2. decreased urine output.
  3. bradycardia.
  4. 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?

  1. Lying on the right side with legs straight
  2. Lying on the left side with knees bent
  3. Prone with the torso elevated
  4. 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:

  1.  “Tell me about your husband’s alcohol usage.”
  2. “Is your husband being treated for tuberculosis?”
  3.  “Has your husband recently fallen or injured his chest?”
  4.  “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?

  1. Change the tube feeding solutions and tubing at least every 24 hours.
  2. Maintain the head of the bed at a 15-degree elevation continuously.
  3. Check the gastrostomy tube for position every 2 days.
  4. 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?

  1. 5 to 10 minutes
  2. 15 to 30 minutes
  3. 30 to 60 minutes
  4. 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?

  1. Dyspnea and fatigue
  2. Ascites and orthopnea
  3. Purpura and petechiae
  4. Gynecomastia and testicular atrophy

8. Which condition is most likely to have a nursing diagnosis of fluid volume deficit?

  1. Appendicitis
  2. Pancreatitis
  3. Cholecystitis
  4. 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?

  1. Irrigate the tube with cola.
  2. Advance the tube into the intestine.
  3. Apply intermittent suction to the tube.
  4. 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:

  1. meperidine provides a better, more prolonged analgesic effect.
  2. morphine may cause spasms of Oddi’s sphincter.
  3. meperidine is less addictive than morphine.
  4. 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?

  1. Hopelessness
  2. Powerlessness
  3. Chronic low self esteem
  4. Deficient knowledge

12. Which diagnostic test would be used first to evaluate a client with upper GI bleeding?

  1. Endoscopy
  2. Upper GI series
  3. Hemoglobin (Hb) levels and hematocrit (HCT)
  4. 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?

  1. “You may have eaten contaminated restaurant food.”
  2. “You could have gotten it by using I.V. drugs.”
  3. “You must have received an infected blood transfusion.”
  4. “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?

  1. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.
  2. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
  3. The appendix may develop gangrene and rupture, especially in a middle-aged client.
  4. 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:

  1. whole blood and albumin.
  2. platelets and packed red blood cells.
  3. fresh frozen plasma and whole blood.
  4. cryoprecipitate and fresh frozen plasma.

16. To prevent gastroesophageal reflux in a male client with hiatal hernia, the nurse should provide which discharge instruction?

  1. “Lie down after meals to promote digestion.”
  2. “Avoid coffee and alcoholic beverages.”
  3. “Take antacids with meals.”
  4. “Limit fluid intake with meals.”

17. The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first?

  1. Administering pain medication
  2. Obtaining a blood sample for laboratory studies
  3. Preparing to insert a nasogastric (NG) tube
  4. 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?

  1. The client doesn’t exhibit rectal tenesmus.
  2. The client is free from esophagitis and achalasia.
  3. The client reports diminished duodenal inflammation.
  4. 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?

  1. Notify the physician
  2. Reposition the tube
  3. Irrigate the tube
  4. Increase the suction level

20. What laboratory finding is the primary diagnostic indicator for pancreatitis?

  1. Elevated blood urea nitrogen (BUN)
  2. Elevated serum lipase
  3. Elevated aspartate aminotransferase (AST)
  4. 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:

  1. yellow sclerae.
  2. light amber urine.
  3. circumoral pallor.
  4. 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:

  1. a sedentary lifestyle and smoking.
  2. a history of hemorrhoids and smoking.
  3. alcohol abuse and a history of acute renal failure.
  4. 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?

  1. Sigmoid colon
  2. Appendix
  3. Spleen
  4. 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:

  1. call the physician.
  2. place saline-soaked sterile dressings on the wound.
  3. take a blood pressure and pulse.
  4. 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?

  1. Antiarrhythmic drugs
  2. Anticholinergic drugs
  3. Anticoagulant drugs
  4. 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:

  1. increasing fluid intake to prevent dehydration.
  2. wearing an appliance pouch only at bedtime.
  3. consuming a low-protein, high-fiber diet.
  4. 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?

  1. Regular diet
  2. Skim milk
  3. Nothing by mouth
  4. Clear liquids

28. A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:

  1. severe abdominal pain radiating to the shoulder.
  2. anorexia, nausea, and vomiting.
  3. eructation and constipation.
  4. 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:

  1. place the client in a private room.
  2. wear a mask when handling the client’s bedpan.
  3. wash the hands after touching the client.
  4. wear a gown when providing personal care for the client.

30. Which of the following factors can cause hepatitis A?

  1. Contact with infected blood
  2. Blood transfusions with infected blood
  3. Eating contaminated shellfish
  4. Sexual contact with an infected person

31.  Your patient with peritonitis is NPO and complaining of thirst. What is your priority?

  1. Increase the I.V. infusion rate.
  2. Use diversion activities.
  3. Provide frequent mouth care.
  4. Give ice chips every 15 minutes.

32.  Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate?

  1. He has fresh, active upper GI bleeding.
  2. He needs immediate saline gastric lavage.
  3. His gastric bleeding occurred 2 hours earlier.
  4. 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?

  1. Brown.
  2. Clear.
  3. Red.
  4. Yellow.

34.  Your patient has a retractable gastric peptic ulcer and has had a gastric vagotomy. Which factor increases as a result of vagotomy?

  1. Peristalsis.
  2. Gastric acidity.
  3. Gastric motility.
  4. 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?

  1. 60 ml.
  2. 70 ml.
  3. 80 ml.
  4. 90 ml.

36.  Which stoma would you expect a malodorous, enzyme-rich, caustic liquid output that is yellow, green, or brown?

  1. Ileostomy.
  2. Ascending colostomy.
  3. Transverse colostomy.
  4. 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?

  1. “If there is any drainage, notify the surgeon immediately.”
  2. “The drainage will decrease daily until the bile duct heals.”
  3. “First, the drainage is dark green; then it becomes dark yellow.”
  4. “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?

  1. Calcium carbonate (Tums)
  2. Famotidine (Pepcid)
  3. Misoprostol (Cytotec)
  4. Sucralfate (Carafate)

39.  The student nurse is participating in colorectal cancer-screening program. Which patient has the fewest risk factors for colon cancer?

  1. Janice, a 45 y.o. with a 25-year history of ulcerative colitis
  2. George, a 50 y.o. whose father died of colon cancer
  3. Herman, a 60 y.o. who follows a low-fat, high-fiber diet
  4. 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?

  1. Ask the patient what happened, call the doctor, and cover the area with a water-soaked bedsheet.
  2. Obtain vital signs, call the doctor, and obtain emergency orders.
  3. Have a CAN hold the wound together while you obtain vital signs, call the doctor and flex the patient’s knees.
  4. 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
  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  15. 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.
  16. 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.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. 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.
  25. 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.
  26. 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
  27. 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.
  28. 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.
  29. 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.
  30. 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.
  31. Answer C. Frequent mouth care helps relieve dry mouth.
  32. 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.
  33. 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.
  34. 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.
  35. Answer A. Dosage problem. It’s 80/20 = 240/X. X=60.
  36. Answer A. The output from an Ileostomy is described.
  37. 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.
  38. Answer C. Misoprostol restores prostaglandins that protect the stomach from NSAIDS, which diminish the prostaglandins.
  39. Answer C.
  40. Answer D.

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