GI EXAM 1 egestion 7.

To identify any localized bulging, distention and

Situation 1: Children have a special fascination with the c. deglutition, ingestion, mastication, egestion, absorption, peristaltic waves, Nurse Dorina must perform which of
workings of the digestive system. To fully understand the defecation the following?
digestive processes, Nurse Lavigña must d. ingestion, digestion, mastication, deglutition, absorption, a. Auscultation
be knowledgeable of the anatomy and physiology of defecation b. Inspection
the gastrointestinal system. 4. Most digestive activity occurs in the pyloric region of c. Palpation
1. The alimentary canal is a continuous, coiled, hollow the stomach. What hormone stimulates the chief cells d. Percussion
muscular tube that winds through the ventral cavity to produce pepsinogen? 8. In order to identify areas of tenderness and swelling,
and is open at both ends. Its solid organs include all of a. Gastrin Nurse Dorina must do:
the following except: b. Pepsin a. deep palpation
a. liver c. HCl b. light palpation
b. gall bladder d. Insulin c. percussion
c. stomach 5. What pancreatic enzyme aids in the digestion of d. palpation
d. pancreas carbohydrates? 9. Mr. Lim verbalized pain on the right iliac region.
2. Pharynx is lined with mucous membranes and a. Lipase Nurse Dorina knows that the organ affected would be
mucous secreting glands to ease the passage of food. b. Trypsin the:
The laryngopharynx serves as passageway for: c. Amylase a. liver
a. air only d. Chymotrypsin b. sigmoid colon
b. air and water Situation 2: Nurse Dorina is going to perform an abdominal c. appendix
c. food, fluids and air examination to Mr. Lim who was admitted due to on and d. duodenum
d. air and food off pain since yesterday. 10. Mr. Lim felt pain upon release of Nurse Dorina’s
3. Once food has been placed in the mouth, both 6. How will you position Mr. Lim prior to procedure? hand. This can be referred as:
mechanical and chemical digestions begin. The six a. supine with knees flexed a. referred pain
activities of the digestive process are: b. prone b. rebound tenderness
a. ingestion, mastication, digestion, deglutition, absorption, c. lying on back c. direct tenderness
egestion d. sim’s d. indirect tenderness
b. ingestion, mastication, deglutition, digestion, absorption,
Situation 3: Mrs. Cruz was admitted in the Medical Floor 15. Mrs. Cruz’ body mass index (BMI) is 25. You can a. E. coli
due to pyrosis, dyspepsia and difficulty of swallowing. categorized her as: b. H. pylori
11. Based from the symptoms presented, Nurse Yoshi a. normal c. S. aureus
might suspect: b. overweight d. K. pneumoniae
a. Esophagitis c. underweight 19. She is for occult blood test, what specimen will you
b. Hiatal hernia d. obese collect?
c. GERD Situation 4: Nurse Gloria is the staff nurse assigned at the a. Blood
d. Gastric Ulcer Emergency Department. During her shift, a patient was b. Urine
12. What diagnostic test would confirm the type of rushed – in the ED complaining of severe heartburn, c. Stool
problem Mrs. Cruz have? vomiting and pain that radiates to the flank. The doctor d. Gastric Juice
a. barium enema suspects gastric ulcer. 20. Preparation of the client for
b. barium swallow 16. What other symptoms will validate the diagnosis occult blood examination is:
c. colonoscopy of gastric ulcer? a. Fluid intake limited only to 1 liter/day
d. lower GI series a. right epigastric pain b. NPO for 12 hours prior to obtaining of specimen
13. Mrs. Cruz complained of pain and difficulty in b. pain occurs when stomach is empty c. Increase fluid intake
swallowing. This term is referred as: c. pain occurs immediately after meal d. Meatless diet for 48 hours prior to obtaining of specimen
a. Odynophagia d. pain not relieved by vomiting Situation 5: IBD is a common inflammatory functional bowel
b. Dysphagia 17. What diagnostic test would yield good visualization disorder also known as spastic bowel, functional colitis and
c. Pyrosis of the ulcer crater? mucous colitis.
d. Dyspepsia a. Endoscopy 21. The client with IBS asks Nurse June what causes
14. To avoid acid reflux, Nurse Yoshi b. Gastroscopy the disease. Which of the following responses by
should advise Mrs. Cruz to avoid which type of diet? c. Barium Swallow Nurse June would be most appropriate?
a. cola, coffee and tea d. Histology a. “This is an inflammation of the bowel caused by eating
b. high fat, carbonated and caffeinated beverages 18. Peptic ulcer disease particularly gastric ulcer is too much roughage”
c. beer and green tea thought to be cause by which of the b. “IBS is caused by a stressful lifestyle”
d. lechon paksiw and bicol express following microorganisms? c. “The cause of this condition is unknown”
d. “There is thinning of the intestinal mucosa caused by c. Beginning a weight training program a. Reduce fluid intake
ingestion of gluten” d. Walking 2 miles everyday b. Increase fiber in the diet
22. Which of the following alimentary canal is the most Situation 6: A patient was admitted in the Medical Floor at c. Administration of antibiotics
common location for Chron’s disease? St. Luke’s Hospital. He was asymptomatic. The doctor d. Exercise to increase intra abdominal pressure
a. Descending colon suspects diverticulosis. 30. Upon review of Mr. Trinidad’s chart, Nurse Drew
b. Jejunum 26. Which of the following definitions best describes noticed that he weighs 121 lbs and his height is 5 ft, 4
c. Sigmoid Colon diverticulosis? in. After computing for his Body Mass Index (BMI), you
d. Terminal Ileum a. An inflamed outpouching of the intestine can categorize him as:
23. Which of the following factors is believed to be b. A non – inflamed outpouching of the intestine a. obese
linked to Crohn’s disease? c. The partial impairment of the forward flow of intestinal b. normal
a. Diet contents c. obese
b. Constipation d. An abnormal protrusions of an oxygen through the d. underweight
c. Heredity structure that usually holds it Situation 7: Manny, 6 years old was admitted at Cardinal
d. Lack of exercise 27. Which of the following types of diet is implicated in Santos Hospital due to increasing frequency of bowel
24. How about ulcerative colitis, which of the following the development of diverticulosis? movements, abdominal cramps and distension.
factors is believed to cause it? a. Low – fiber diet 31. Diarrhea is said to be the leading cause of
a. Acidic diet b. High – fiber diet morbidity in the Philippines. Nurse Harry knows
b. Altered immunity c. High – protein diet that diarrhea is present if:
c. Chronic constipation d. Low – carbohydrate diet a. passage of stool is more than 3 bowel movements per
d. Emotional stress 28. Which of the following tests should be week
25. Mr. Jung, had ulcerative colitis for 5 years and was administered to client with diverticulosis? b. passage of stool is less than 3 bowel movements per
admitted to the hospital. Which of the following factors a. Proctoscopy day
was most likely of greatest significance in causing an b. Barium enema c. passage of stool is more than 3 bowel movements per
exacerbation of the disease? c. Barium swallow day
a. A demanding and stressful job d. Gastroscopy d. passage of stool is less than 3 bowel movements per
b. Changing to a modified vegetarian diet 29. To improve Mr. Trinidad’s condition, your best week
nursing intervention and teaching is:
32. Diarrhea is believed to be caused by all of the Situation 8: Mr. Sean is admitted to the hospital with a c. use of OTC laxatives
following except bowel obstruction. He complained of colicky pain and d. complete bed rest
a. increase intestinal secretions inability to pass stool. 40. Four hours postoperatively, Mr. Sean complains of
b. altered immunity 36. Which of these findings by Nurse Leonard, would guarding and rigidity of the abdomen. Nurse Leonard’s
c. decrease mucosal absorption indicate that the obstruction is in the early stages? initial intervention is:
d. altered motility a. high pitched tinkling or rumbling bowel sounds a. assess for signs of peritonitis
33. What life threatening condition may result in b. hypoactive bowel sounds b. call the physician
persistent diarrhea? c. no bowel sounds auscultated c. administer pain medication
a. hypokalemia d. normal bowel sounds heard in all four quadrants d. ignore the client
b. dehydration 37. Nasogastric tube was inserted to Mr. Sean. The Situation 9: Mr. Gerald Liu, 19 y/o, is being admitted to a
c. cardiac dysrhythmias NGT’s primary purpose is: hospital unit complaining of severe pain in the lower
d. leukocytosis a. nutrition abdomen. Admission vital signs reveal an oral temperature
34. Voluminous, watery stools can deplete fluids and b. decompression of bowel of 101.2 0F.
electrolytes. The acid base imbalance that can occur c. passage for medication 41. Which of the following would confirm a diagnosis
is: d. aspiration of gastric contents of appendicitis?
a. metabolic alkalosis 38. Mr. Sean has undergone surgery. Postoperatively, a. The pain is localized at a position halfway between the
b. metabolic acidosis which of the following findings is normal? umbilicus and the right iliac crest.
c. respiratory acidosis a. absent bowel sounds b. Mr. Liu describes the pain as occurring 2 hours after
d. respiratory alkalosis b. bleeding eating
35. What is the immediate home care management for c. hemorrhage c. The pain subsides after eating
diarrhea? d. bowel movement d. The pain is in the left lower quadrant
a. Milk 39. Client education should be given in order to 42. Which of the following complications is thought to
b. Imodium prevent constipation. Nurse Leonard’s health teaching be the most common cause of appendicitis?
c. Water should include which of the following? a. A fecalith
d. Oresol a. use of natural laxatives b. Internal bowel occlusion
b. fluid intake of 6 glasses per day c. Bowel kinking
d. Abdominal wall swelling
43. The doctor ordered for a complete blood count.
After the test, Nurse Ray received the result from the
laboratory. Which laboratory values will confirm the
diagnosis of appendicitis?
a. RBC 5.5 x 106/mm3
b. Hct 44 %
c. WBC 13, 000/mm3
d. Hgb 15 g/dL
44. Signs and symptoms include pain in the RLQ of the
abdomen that may be localize at McBurney’s point. To
relieve pain, Mr. Liu should assume which position?
a. Prone
b. Supine, stretched out
c. Sitting
d. Lying with legs drawn up
45. After a few minutes, the pain suddenly stops
without any intervention. Nurse Ray might suspect
that:
a. the appendix is still distended
b. the appendix may have ruptured
c. an increased in intrathoracic pressure will occur
d. signs and symptoms of peritonitis occur
Situation 10: Nurse Nico is caring to a 38-year-old female,
G3P3 client who has been diagnosed with hemorrhoids.
46. Which of the following factors would most likely be
a primary cause of her hemorrhoids?
a. Her age
b. Three vaginal delivery pregnancies
c. Her job as a school teacher
d. Varicosities in the legs
47. Client education should include minimizing client
discomfort due to hemorrhoids. Nursing management
should include:
a. Suggest to eat low roughage diet
b. Advise to wear silk undergarments
c. Avoid straining during defecation
d. Use of sitz bath for 30 minutes
48. The doctor orders for Witch Hazel 5 %. Nurse Nico
knows that the action of this astringent is:
a. temporarily relieves pain, burning, and itching by
numbing the nerve endings
b. causes coagulation (clumping) of proteins in the cells of
the perianal skin or the lining of the anal canal
c. inhibits the growth of bacteria and other organisms
d. causes the outer layers of skin or other tissues to
disintegrate
49. Which position would be ideal for the client in the
early postoperative period after hemorrhoidectomy?
a. High Fowler’s
b. Supine
c. Side – lying
d. Trendelenburg’s
50. Nurse Nico instructs her client who has had a
hemorrhoidectomy not to used sitz bath until at least
12 hours postoperatively to avoid which of the
following complications?
a. Hemorrhage
b. Rectal Spasm
c. Urinary retention
d. Constipation
Answers and Rationale
1. Answer: C. stomach
Rationale: Stomach is a hollow digestive organ in the GI
tract. The liver, gallbladderand pancreas are all solid
organs which are part of the hepatobiliary system. Test
taking skills: which does not belong to the group?
2. Answer: D. air and food
Rationale: The laryngopharynx serves as passageway for
air and food and so as with the oropharynx. Option a is
nasopharynx. Answers b and c may be correct but air and
food is more accurate.
3. Answer: B. ingestion, mastication, deglutition,
digestion, absorption, egestion
Rationale: The digestive processes involve six steps.
Ingestion is taking in of food in the mouth; mastication is
the mechanical process where food is converted into bolus;
deglutition is the act of swallowing; digestion is the
chemical breakdown of food into chyme; absorption occurs
in the small intestines (solutes) and large intestines (water)
and egestion/defecation where elimination of feces occur.
4. Answer: A. Gastrin
Rationale: Gastrin stimulates chief cells to produce
pepsinogen when foods enter and suppression of
pepsinogen when it leaves and enters the small intestines;
it is the major hormone that regulates acid secretion in the
stomach. Pepsin; a gastric protease secreted in an inactive
form, pepsinogen, which is activated by stomach acid that
acts to degrade protein. HCl is produced by the parietal
cells. Insulin is a pancreatic hormone.
5. Answer: C. Amylase
Rationale: Amylase aids in the digestion of carbohydrates.
Trypsin/Chymotrypsin aids in the digestion of proteins.
Lipase aids in the digestion of fats.
6. Answers: A. supine with knees flexed
Rationale: During abdominal examination, positioning the
client in supine with knees flexed will promote relaxation of
abdominal muscles. Options b and d are inaccurate in this
type of procedure. Lying on back or supine may be correct
but option a is the best answer.
7. Answer: B. Inspection
Rationale: Inspection is the first step in abdominal exam to
note the contour and symmetry of abdomen as well as
localized bulging, distention and peristaltic waves.
Auscultation is done to determine the character, location
and frequency of bowel sounds. Percussion is to assess
tympany or dullness. Palpation is to asses areas of
tenderness and discomfort. Note: In abdominal exam:
Inspection, Auscultation, Percussion and Palpation are the
correct order.
8.Answer: B. Light palpation
Rationale: Light palpation is done to identify areas of
tenderness and swelling. Deep palpation is done to identify
masses in all four quadrants. Test taking skills: one of the
opposite is the correct answer
9. Answer: C. Appendix
Rationale: Appendix and cecum is located in the right iliac
region. Liver and gall bladder is at the right hypochondriac.
Sigmoid colon is at the left iliac. Duodenum, stomach
and pancreas is in the epigastric region.
10. Answer: B. Rebound Tenderness
Rationale: Rebound tenderness is pain felt upon sudden
release of the examiners hand which in most cases
suggest peritonitis. Referred pain is pain felt in an area
remote from the site of origin. Direct tenderness is localized
pain upon palpation. Indirect tenderness is pain outside the
area of palpation.
11. Answer: C. Gastroesophageal Reflux Disease
(GERD)
Rationale: GERD is the backflow of gastric or duodenal
contents into the esophaguscaused by incompetent lower
esophageal sphincter. Pyrosis or
heartburn, dyspepsia and dysphagia are cardinal
symptoms.
12. Answer: B. Barium swallow
Rationale: Barium swallow or upper GI series would
confirm GERD. Endoscopy is another diagnostic test.
Options a and d are the same. Option c is incorrect.
13. Answer: A. Odynophagia
Rationale: When difficulty of swallowing is accompanied
with pain this is now referred as odynophagia. Dysphagia is
difficulty of swallowing alone.
14. Answer: B. High fat, carbonated and caffeinated
beverages
Rationale: All are correct but option b is the best answer. In
patients with GERD, this type of diet must be avoided to
avoid backflow of gastric contents. Excessive caffeine
reduces the tone of lower esophageal sphincter. Test
Taking Skills: look for the umbrella effect.
15. Answer: B. Overweight
Rationale: Mr. Cruz’ BMI belongs to the overweight
category (24 – 26), malnourished (less than 17),
underweight (17 – 19), normal (20 – 23), obese (27
– 30) and morbidly obese (greater than 30). BMI is weight
in kilograms divided by height in square meters.
16. Answer: C. Pain occurs immediately after meal.
Rationale: In gastric ulcer food intake aggravates pain
which usually occur ½ – 1 hour before meal or immediately
during or after food intake. Options a, b, c
suggests duodenal ulcer.
17.Answer: A. Endoscopy
Rationale: Endoscopy determines bleeding, pain, difficulty
swallowing, and a change in bowel habits. This would yield
good visualization of the ulcer crater. Other options are
also diagnostic tests in PUD.
18. Answer: B. H. pylori
Rationale: Helicobacter pylori (H. pylori) is a bacteria
responsible for most ulcers and many cases of chronic
gastritis (inflammation of the stomach). This organism can
weaken the protective coating of the stomach and
duodenum (first part of the small intestines), allowing the
damaging digestive juices to irritate the sensitive lining of
these body parts.
19. Answer: C. Stool
Rationale: Occult blood test or stool guaiac test is a test
that detects the presence of hidden (occult) blood in the
stool (bowel movement). The stool guaiac is the most
common form of fecal occult blood test (FOBT) in use
today. So stool specimen will be collected.
20. Answer: D. Meatless diet for 48 hours prior to
obtaining of specimen
Rationale: Eating meat can cause false positive test result.
Using proper stool collection technique, avoiding certain
drugs, and observing dietary restrictions can minimize
these measurement errors.
21. Answer: C. “The cause of this condition is
unknown”
Rationale: There is no known cause of IBS, and diagnosis
is made by excluding all the other diseases that cause the
symptoms. There is no inflammation if the bowel. Some
factors exacerbate the symptoms including anxiety,
fear, stress, depression, some foods and drugs but there
do not cause the disease.
22. Answer: d. Terminal Ileum
Rationale: Chronic inflammatory of GI mucosa occurs
anywhere from the mouth to anus but most often in
terminal ileum. Inflammatory lesions are local and involve
all layers of the intestinal wall.
23. Answer: C. Heredity
Rationale: The cause is unknown but is thought to be
multifactorial. Heredity, infectious agents, altered immunity
or autoimmune and environmental are factors to be
considered. Test taking skill: which does not belong?
Options a, b, and d are all modifiable factors.
24. Answer: B. Altered immunity
Rationale: refer to rationale for number 23. Test taking skill:
which does not belong? Options a, c and d are all
modifiable factors.
25. Answer: A. A demanding and stressful job.
Rationale: Stress is an environmental factor that is thought
to cause ulcerative colitis. Test taking skill: options b, c,
and d are all healthy lifestyles.
26. Answer: B. A non – inflamed outpouching of
the intestine.
Rationale: An increase intraluminal pressure causes the
outpouching of the colon wall resulting to diverticulosis.
Option a suggests diverticulitis. Test taking skill: one of the
opposite is the correct answer.
27. Answer: A. Low – Fiber Diet
Rationale: A lack of adequate blood supply and nutrients
from the diet such as low fiber foods may contribute to the
development of the disease. Test taking skill: one of the
opposite is the correct answer.
28. Answer: B. Barium enema
Rationale: Barium enema is used to diagnose
diverticulosis, however, this is contraindicated when
diverticulitis is present because of the risk of rupturing the
diverticulum. Test taking skill: options b and c are opposite;
one may be the correct answer.
29. Answer: B. Increase fiber in the diet.
Rationale: Patient with diverticulosis must be encouraged
to increase roughage in diet such as fruits and vegetables
rich in fiber. Increasing fluid intake 2 to 3 liters/day unless
contraindicated rather reducing.
Administering antibiotics can decrease bowel flora
and infection but this is a dependent function of a nurse.
30. Answer: B. Normal
Rationale: Mr. Trinidad’s BMI is 23 which is normal. Refer
to rational number 15.
31. Answer: C. passage of stool is more than 3 bowel
movements per day (thanks to Budek for the
correction)
32. Answer: B. Altered Immunity
Rationale: Diarrhea is an intestinal disorder that is self –
limiting. Options a, c and d are etiological factors of
diarrhea.
33. Answer: C. Cardiac dysrhythmias
Rationale: Due to increase frequency and fluid content in
the stools, diarrhea may cause fluid and electrolyte
imbalance such as hypokalemia. Once potassium is
depleted, this will affect the contractility of the heart
causing cardiac arrhythmia leading to death.
34. Answer: B. Metabolic acidosis
Rationale: In diarrhea, metabolic acidosis is the acid – base
imbalance that occurs while in vomiting, metabolic alkalosis
occur. This is a metabolic disorder that’s why eliminate
options c and d.
35. Answer: D. Oresol
Rationale: In the DOH book, oresol is the immediate home
care management for diarrhea to prevent dehydration.
Water may not be enough to prevent diarrhea.
36. Answer: A. High pitched tinkling or rumbling bowel
sounds
Rationale: Early in the bowel obstruction, the bowel
attempts to move the contents past the obstruction and this
is heard as high pitched tinkling bowel
sounds. As the obstruction progresses, bowel sounds will
diminish and may finally become absent.
37. Answer: B. Decompression of bowel
Rationale: The NGT’s primary purpose is for bowel
decompression especially for clients suffering from
obstruction.
38. Answer: A. Absent bowel sounds
Rationale: Postoperatively, no bowel sounds are present so
this is a normal finding. Bleeding and hemorrhage must be
prevented to avoid complications. Bowel movement occurs
only after flatus and bowel sounds are noted.
39. Answer: A. Use of natural laxatives
Rationale: The use of natural laxatives such as foods and
fruits high in fiber is still the best way of
preventing constipation Increasing fluid intake, taking
laxatives judiciously and exercise also can prevent this.
40. Answer: A. Assess for signs of peritonitis
Rationale: Assessment precedes intervention. Symptoms
presented are signs of peritonitis. Assessment will provide
you the data for prompt intervention.
41. Answer: A. The pain is localized at a position
halfway between the umbilicus and the right iliac
crest.
Rationale: Pain over McBurney’s point, the point halfway
between the umbilicus and the iliac crest, is diagnosis
for appendicitis. Options b and c are common with ulcers;
option d may suggest ulcerative colitis or diverticulitis.
42. Answer: A. A fecalith
Rationale: A fecalith is a hard piece of stool which is stone
like that commonly obstructs the lumen. Due to obstruction,
inflammation and bacterial invasion can occur. Tumors or
foreign bodies may also cause obstruction.
43. Answer: C. WBC 13, 000/mm3
Rationale: Increase in WBC counts is suggestive
of appendicitis because of bacterial invasion and
inflammation. Normal WBC count is 5, 000 – 10, 000/mm3.
Other options are normal values.
44. Answer: D. Lying with legs drawn up
Rationale: Posturing by lying with legs drawn up can relax
the abdominal muscle thus relieve pain.
45. Answer: B. The appendix may have ruptured
Rationale: If a confirmed diagnosis is made and the pain
suddenly without any intervention, the appendix may have
ruptured; the pain is lessened because the appendix is no
longer distended thus surgery is still needed.
46. Answer: B. Three vaginal delivery pregnancies
Rationale: Hemorrhoids are associated with prolonged
sitting, or standing, portal hypertension,
chronic constipation and prolonged intra abdominal
pressure as associated with pregnancy and the strain of
vaginal delivery. Her job as a schoolteacher does not
require prolonged sitting or standing. Age and leg
varicosities are not related to the development of
hemorrhoids.
47. Answer: C. Avoid straining during defecation
Rationale: Straining can increase intra abdominal pressure.
Health teachings also include: suggest to eat high
roughage diet, wearing of cotton undergarments and use of
sitz bath for 15 minutes.
48. Answer: B. causes coagulation(clumping) of
proteins in the cells of the perianal skin or the lining of
the anal canal
Rationale: Option a are local anesthetics; c are antiseptics
and d are keratolytics.
49. Answer: C. Side – lying
Rationale: Positioning in the early postoperative phase
should avoid stress and pressure on the operative site.
The prone and side – lying are ideal from a comfort
perspective. A high Fowler’s or supine position will place
pressure on the operative site and is not recommended.
There is no need for trendelenburg’s position.
50. Answer: A. Hemorrhage
Rationale: Applying heat during the immediate
postoperative period may cause hemorrhage at the surgical
site. Moist heat may relieve rectal spasms after bowel
movements. Urinary retention caused by reflex spasm may
also be relieved by moist heat. Increasing fiber and fluid in
the diet can help constipation.
GI EXAM 2
1. During preparation for bowel surgery, a male client
receives an antibioticto reduce intestinal
bacteria. Antibiotic therapy may interfere with
synthesis of which vitamin and may lead to
hypoprothrombinemia?
A. vitamin A
B. vitamin D
C. vitamin E
D. vitamin K
2. When evaluating a male client for complications of
acute pancreatitis, the nurse would observe for:
A. increased intracranial pressure.
B. decreased urine output.
C. bradycardia.
D. 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?
A. Lying on the right side with legs straight
B. Lying on the left side with knees bent
C. Prone with the torso elevated
D. 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:
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.”
5. 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. Maintain the head of the bed at a 15-degree elevation
continuously.
C. Check the gastrostomy tube for position every 2 days.
D. 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 onset of action occur?
A. 5 to 10 minutes
B. 15 to 30 minutes
C. 30 to 60 minutes
D. 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?
A. Dyspnea and fatigue
B. Ascites and orthopnea
C. Purpura and petechiae
D. Gynecomastia and testicular atrophy
8. Which condition is most likely to have a nursing
diagnosis of fluid volume deficit?
A. Appendicitis
B. Pancreatitis
C. Cholecystitis
D. 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?
A. Irrigate the tube with cola.
B. Advance the tube into the intestine.
C. Apply intermittent suction to the tube.
D. 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:
A. meperidine provides a better, more prolonged analgesic
effect.
B. morphine may cause spasms of Oddi’s sphincter.
C. meperidine is less addictive than morphine.
D. 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?
A. Hopelessness
B. Powerlessness
C. Chronic low self-esteem
D. Deficient knowledge
12. Which diagnostic test would be used first to
evaluate a client with upper GI bleeding?
A. Endoscopy
B. Upper GI series
C. Hemoglobin (Hb) levels and hematocrit (HCT)
D. 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?
A. “You may have eaten contaminated restaurant food.”
B. “You could have gotten it by using I.V. drugs.”
C. “You must have received an infected blood transfusion.”
D. “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?
A. Obstruction of the appendix may increase venous
drainage and cause the appendixto rupture.
B. Obstruction of the appendix reduces arterial flow,
leading to ischemia, inflammation, and rupture of
the appendix.
C. The appendix may develop gangrene and rupture,
especially in a middle-aged client.
D. 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:
A. whole blood and albumin.
B. platelets and packed red blood cells.
C. fresh frozen plasma and whole blood.
D. cryoprecipitate and fresh frozen plasma.
16. To prevent gastroesophageal reflux in a male client
with hiatal hernia, the nurse should provide which
discharge instruction?
A. “Lie down after meals to promote digestion.”
B. “Avoid coffee and alcoholic beverages.”
C. “Take antacids with meals.”
D. “Limit fluid intake with meals.”
17. The nurse caring for a client with small-bowel
obstruction would plan to implement which nursing
intervention first?
A. Administering pain medication
B. Obtaining a blood sample for laboratory studies
C. Preparing to insert a nasogastric (NG) tube
D. 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?
A. The client doesn’t exhibit rectal tenesmus.
B. The client is free from esophagitis and achalasia.
C. The client reports diminished duodenal inflammation.
D. 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?
A. Notify the physician
B. Reposition the tube
C. Irrigate the tube
D. Increase the suction level
20. What laboratory finding is the primary diagnostic
indicator for pancreatitis?
A. Elevated blood urea nitrogen (BUN)
B. Elevated serum lipase
C. Elevated aspartate aminotransferase (AST)
D. 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:
A. yellow sclera.
B. light amber urine.
C. circumoral pallor.
D. 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. a sedentary lifestyle and smoking.
B. a history of hemorrhoids and smoking.
C. alcohol abuse and a history of acute renal failure.
D. 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?
A. Sigmoid colon
B. Appendix
C. Spleen
D. 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:
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.
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?
A. Antiarrhythmic drugs
B. Anticholinergic drugs
C. Anticoagulant drugs
D. 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:
A. increasing fluid intake to prevent dehydration.
B. wearing an appliance pouch only at bedtime.
C. consuming a low-protein, high-fiber diet.
D. 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?
A. Regular diet
B. Skim milk
C. Nothing by mouth
D. Clear liquids
28. 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. anorexia, nausea, and vomiting.
C. eructation and constipation.
D. 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:
A. place the client in a private room.
B. wear a mask when handling the client’s bedpan.
C. wash the hands after touching the client.
D. wear a gown when providing personal care for the client.
30. Which of the following factors can cause hepatitis
A?
A. Contact with infected blood
B. Blood transfusions with infected blood
C. Eating contaminated shellfish
D. Sexual contact with an infected person
Answers and Rationale
1. Answer: D. vitamin K
Intestinal bacteria synthesize such nutritional substances
as vitamin K, thiamine, riboflavin, vitamin B12, folic acid,
biotin, and nicotinic acid. Therefore, antibiotictherapy may
interfere with synthesis of these substances, including
vitamin K. Intestinal bacteria don’t synthesize vitamins A,
D, or E.
2. Answer: B. decreased urine output.
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. Lying on the left side with knees bent
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. “Tell me about your husband’s alcohol
usage.”
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. Change the tube feeding solutions and
tubing at least every 24 hours.
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. 15 to 30 minutes
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. Purpura and petechiae
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 fatiguesuggest 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. Pancreatitis
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. Irrigate the tube with cola.
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. morphine may cause spasms of Oddi’s
sphincter.
For a client with pancreatitis, the physician will probably
avoid prescribing morphinebecause 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. Chronic low self-esteem
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
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. “You may have eaten contaminated
restaurant food.”
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. Obstruction of the appendix reduces
arterial flow, leading to ischemia, inflammation, and
rupture of the appendix.
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. cryoprecipitate and fresh frozen plasma.
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. “Avoid coffee and alcoholic beverages.”
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. Administering I.V. fluids
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. The client is free from esophagitis and
achalasia.
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. Notify the physician
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. Elevated serum lipase
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 sclera.
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. alcohol abuse and smoking.
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. Liver
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. place saline-soaked sterile dressings on
the wound.
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. Anticholinergic drugs
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. increasing fluid intake to
prevent dehydration.
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. Nothing by mouth
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. anorexia, nausea, and vomiting.
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. wash the hands after touching the
client.
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. Eating contaminated shellfish
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.