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Digestive System Disorder NCLEX Practice Quiz #1 (80 1. There is no need to change eating habits.

Questions) 2. Eat six small meals a day.


3. Eat the largest meal in the evening.
4. Restrict fluid intake.
1. A patient with chronic alcohol abuse is admitted with liver
failure. You closely monitor the patient’s blood pressure 10. Arthur has a family history of colon cancer and is
because of which change that is associated with the liver scheduled to have a sigmoidoscopy. He is crying as he tells
failure? you, “I know that I have colon cancer, too.” Which response is
1. Hypoalbuminemia most therapeutic?
2. Increased capillary permeability 1. “I know just how you feel.”
3. Abnormal peripheral vasodilation 2. “You seem upset.”
4. Excess rennin release from the kidneys 3. “Oh, don’t worry about it, everything will be just fine.”
4. “Why do you think you have cancer?”
2. You’re assessing the stoma of a patient with a healthy, well-
healed colostomy. You expect the stoma to appear: 11. You’re caring for Beth who underwent a Billroth II
1. Pale, pink and moist procedure (surgical removal of the pylorus and duodenum) for
2. Red and moist treatment of a peptic ulcer. Which findings suggest that the
3. Dark or purple colored patient is developing dumping syndrome, a complication
4. Dry and black associated with this procedure?
1. Flushed, dry skin.
3. You’re caring for a patient with a sigmoid colostomy. The 2. Headache and bradycardia.
stool from this colostomy is: 3. Dizziness and sweating.
1. Formed 4. Dyspnea and chest pain.
2. Semisolid
3. Semiliquid 12. You’re developing the plan of care for a patient
4. Watery experiencing dumping syndrome after a Billroth II procedure.
Which dietary instructions do you include?
4. You’re advising a 21 y.o. with a colostomy who reports 1. Omit fluids with meals.
problems with flatus. What food should you recommend? 2. Increase carbohydrate intake.
1. Peas 3. Decrease protein intake.
2. Cabbage 4. Decrease fat intake.
3. Broccoli
4. Yogurt 13. You’re caring for Lewis, a 67 y.o. patient with liver cirrhosis
who develops ascites and requires paracentesis. Relief of
5. You have to teach ostomy self care to a patient with a which symptom indicated that the paracentesis was effective?
colostomy. You tell the patient to measure and cut the wafer: 1. Pruritus
1. To the exact size of the stoma. 2. Dyspnea
2. About 1/16” larger than the stoma. 3. Jaundice
3. About 1/8” larger than the stoma. 4. Peripheral Neuropathy
4. About 1/4″ larger than the stoma.
14. You’re caring for Jane, a 57 y.o. patient with liver cirrhosis
6. You’re performing an abdominal assessment on Brent who who develops ascites and requires paracentesis. Before her
is 52 y.o. In which order do you proceed? paracentesis, you instruct her to:
1. Observation, percussion, palpation, auscultation 1. Empty her bladder.
2. Observation, auscultation, percussion, palpation 2. Lie supine in bed.
3. Percussion, palpation, auscultation, observation 3. Remain NPO for 4 hours.
4. Palpation, percussion, observation, auscultation 4. Clean her bowels with an enema.
7. You’re doing preoperative teaching with Gertrude who has 15. After abdominal surgery, your patient has a severe
ulcerative colitis who needs surgery to create an ileoanal coughing episode that causes wound evisceration. In addition
reservoir. Which information do you include? to calling the doctor, which intervention is most appropriate?
1. A reservoir is created that exits through the abdominal 1. Irrigate the wound & organs with Betadine.
wall. 2. Cover the wound with a saline soaked sterile
2. A second surgery is required 12 months after the first dressing.
surgery. 3. Apply a dry sterile dressing & binder.
3. A permanent ileostomy is created. 4. Push the organs back & cover with moist sterile
4. The surgery occurs in two stages. dressings.
8. You’re caring for Carin who has just had ileostomy 16. You’re caring for Betty with liver cirrhosis. Which of the
surgery. During the first 24 hours post-op, how much drainage following assessment findings leads you to suspect hepatic
can you expect from the ileostomy? encephalopathy in her?
1. 100 ml 1. Asterixis
2. 500 ml 2. Chvostek’s sign
3. 1500 ml 3. Trousseau’s sign
4. 5000 ml 4. Hepatojugular reflex
9. You’re preparing a teaching plan for a 27 y.o. named Jeff 17. You are developing a careplan on Sally, a 67 y.o. patient
who underwent surgery to close a temporary ileostomy. Which with hepatic encephalopathy. Which of the following do you
nutritional guideline do you include in this plan? include?
1. Administering a lactulose enema as ordered. 3. Fever, rebound tenderness, and abdominal rigidity
2. Encouraging a protein-rich diet. 4. Redness, warmth, and drainage at the biopsy site
3. Administering sedatives, as necessary.
4. Encouraging ambulation at least four times a day. 26. Michael, a 42 y.o. man is admitted to the med-surg floor
with a diagnosis of acute pancreatitis. His BP is 136/76, pulse
18. You have a patient with achalasia (incomplete muscle 96, Resps 22 and temp 101. His past history includes
relaxtion of the GI tract, especially sphincter muscles). Which hyperlipidemia and alcohol abuse. The doctor prescribes an
medications do you anticipate to administer? NG tube. Before inserting the tube, you explain the purpose to
1. Isosorbide dinitrate (Isordil) patient. Which of the following is a most accurate explanation?
2. Digoxin (Lanoxin) 1. “It empties the stomach of fluids and gas.”
3. Captopril (Capoten) 2. “It prevents spasms at the sphincter of Oddi.”
4. Propanolol (Inderal) 3. “It prevents air from forming in the small intestine and
large intestine.”
19. The student nurse is preparing a teaching care plan to 4. “It removes bile from the gallbladder.”
help improve nutrition in a patient with achalasia. You include
which of the following: 27. Jason, a 22 y.o. accident victim, requires an NG tube for
1. Swallow foods while leaning forward. feeding. What should you immediately do after inserting an NG
2. Omit fluids at mealtimes. tube for liquid enteral feedings?
3. Eat meals sitting upright. 1. Aspirate for gastric secretions with a syringe.
4. Avoid soft and semisoft foods. 2. Begin feeding slowly to prevent cramping.
3. Get an X-ray of the tip of the tube within 24 hours.
20. Britney, a 20 y.o. student is admitted with acute 4. Clamp off the tube until the feedings begin.
pancreatitis. Which laboratory findings do you expect to be
abnormal for this patient? 28. Stephanie, a 28 y.o. accident victim, requires TPN. The
1. Serum creatinine and BUN rationale for TPN is to provide:
2. Alanine aminotransferase (ALT) and aspartate 1. Necessary fluids and electrolytes to the body.
aminotransferase (AST) 2. Complete nutrition by the I.V. route.
3. Serum amylase and lipase 3. Tube feedings for nutritional supplementation.
4. Cardiac enzymes 4. Dietary supplementation with liquid protein given
between meals.
21. A patient with Crohn’s disease is admitted after 4 days of
diarrhea. Which of the following urine specific gravity values do 29. Type A chronic gastritis can be distinquished from type B
you expect to find in this patient? by its ability to:
1. 1.005 1. Cause atrophy of the parietal cells.
2. 1.011 2. Affect only the antrum of the stomach.
3. 1.020 3. Thin the lining of the stomach walls.
4. 1.030 4. Decrease gastric secretions.

22. Your goal is to minimize David’s risk of complications after 30. Matt is a 49 y.o. with a hiatal hernia that you are about to
a heriorrhaphy. You instruct the patient to: counsel. Health care counseling for Matt should include which
1. Avoid the use of pain medication. of the following instructions?
2. Cough and deep breathe Q2H. 1. Restrict intake of high-carbohydrate foods.
3. Splint the incision if he can’t avoid sneezing or 2. Increase fluid intake with meals.
coughing. 3. Increase fat intake.
4. Apply heat to scrotal swelling. 4. Eat three regular meals a day.

23. Janice is waiting for discharge instructions after her 31. Jerod is experiencing an acute episode of ulcerative
herniorrhaphy. Which of the following instructions do you colitis. Which is priority for this patient?
include? 1. Replace lost fluid and sodium.
1. Eat a low-fiber diet. 2. Monitor for increased serum glucose level from
2. Resume heavy lifting in 2 weeks. steroid therapy.
3. Lose weight, if obese. 3. Restrict the dietary intake of foods high in potassium.
4. Resume sexual activity once discomfort is gone. 4. Note any change in the color and consistency of
stools.
24. Develop a teaching care plan for Angie who is about to
undergo a liver biopsy. Which of the following points do you 32. A 29 y.o. patient has an acute episode of ulcerative colitis.
include? What diagnostic test confirms this diagnosis?
1. “You’ll need to lie on your stomach during the test.” 1. Barium Swallow.
2. “You’ll need to lie on your right side after the test.” 2. Stool examination.
3. “During the biopsy you’ll be asked to exhale deeply 3. Gastric analysis.
and hold it.” 4. Sigmoidoscopy.
4. “The biopsy is performed under general anesthesia.”
33. Eleanor, a 62 y.o. woman with diverticulosis is your
25. Stephen is a 62 y.o. patient that has had a liver biopsy. patient. Which interventions would you expect to include in her
Which of the following groups of signs alert you to a possible care?
pneumothorax? 1. Low-fiber diet and fluid restrictions.
1. Dyspnea and reduced or absent breath sounds over 2. Total parenteral nutrition and bed rest.
the right lung 3. High-fiber diet and administration of psyllium.
2. Tachycardia, hypotension, and cool, clammy skin 4. Administration of analgesics and antacids.
2. PPN
34. Regina is a 46 y.o. woman with ulcerative colitis. You 3. NG feeding
expect her stools to look like: 4. Oral liquid supplements
1. Watery and frothy.
2. Bloody and mucoid. 43. You’re patient is complaining of abdominal pain during
3. Firm and well-formed. assessment. What is your priority?
4. Alternating constipation and diarrhea. 1. Auscultate to determine changes in bowel sounds.
2. Observe the contour of the abdomen.
35. Donald is a 61 y.o. man with diverticulitis. Diverticulitis is 3. Palpate the abdomen for a mass.
characterized by: 4. Percuss the abdomen to determine if fluid is present.
1. Periodic rectal hemorrhage.
2. Hypertension and tachycardia. 44. Before bowel surgery, Lee is to administer enemas until
3. Vomiting and elevated temperature. clear. During administration, he complains of intestinal cramps.
4. Crampy and lower left quadrant pain and low-grade What do you do next?
fever. 1. Discontinue the procedure.
2. Lower the height of the enema container.
36. Brenda, a 36 y.o. patient is on your floor with acute 3. Complete the procedure as quickly as possible.
pancreatitis. Treatment for her includes: 4. Continue administration of the enema as ordered
1. Continuous peritoneal lavage. without making any adjustments.
2. Regular diet with increased fat.
3. Nutritional support with TPN. 45. Leigh Ann is receiving pancrelipase (Viokase) for chronic
4. Insertion of a T tube to drain the pancreas. pancreatitis. Which observation best indicates the treatment is
effective?
37. Glenda has cholelithiasis (gallstones). You expect her to 1. There is no skin breakdown.
complain of: 2. Her appetite improves.
1. Pain in the right upper quadrant, radiating to the 3. She loses more than 10 lbs.
shoulder. 4. Stools are less fatty and decreased in frequency.
2. Pain in the right lower quadrant, with rebound
tenderness. 46. Ralph has a history of alcohol abuse and has acute
3. Pain in the left upper quadrant, with shortness of pancreatitis. Which lab value is most likely to be elevated?
breath. 1. Calcium
4. Pain in the left lower quadrant, with mild cramping. 2. Glucose
3. Magnesium
38. After an abdominal resection for colon cancer, Madeline 4. Potassium
returns to her room with a Jackson-Pratt drain in place. The
purpose of the drain is to: 47. Anna is 45 y.o. and has a bleeding ulcer. Despite multiple
1. Irrigate the incision with a saline solution. blood transfusions, her HGB is 7.5g/dl and HCT is 27%. Her
2. Prevent bacterial infection of the incision. doctor determines that surgical intervention is necessary and
3. Measure the amount of fluid lost after surgery. she undergoes partial gastrectomy. Postoperative nursing care
4. Prevent accumulation of drainage in the wound. includes:
1. Giving pain medication Q6H.
39. Anthony, a 60 y.o. patient, has just undergone a bowel 2. Flushing the NG tube with sterile water.
resection with a colostomy. During the first 24 hours, which of 3. Positioning her in high Fowler’s position.
the following observations about the stoma should you report 4. Keeping her NPO until the return of peristalsis.
to the doctor?
1. Pink color. 48. Sitty, a 66 y.o. patient underwent a colostomy for ruptured
2. Light edema. diverticulum. She did well during the surgery and returned to
3. Small amount of oozing. your med-surg floor in stable condition. You assess her
4. Trickles of bright red blood. colostomy 2 days after surgery. Which finding do you report to
the doctor?
40. Your teaching Anthony how to use his new colostomy. 1. Blanched stoma
How much skin should remain exposed between the stoma 2. Edematous stoma
and the ring of the appliance? 3. Reddish-pink stoma
1. 1/16” 4. Brownish-black stoma
2. 1/4″
3. 1/2” 49. Sharon has cirrhosis of the liver and develops ascites.
4. 1” What intervention is necessary to decrease the excessive
accumulation of serous fluid in her peritoneal cavity?
41. Claire, a 33 y.o. is on your floor with a possible bowel 1. Restrict fluids
obstruction. Which intervention is priority for her? 2. Encourage ambulation
1. Obtain daily weights. 3. Increase sodium in the diet
2. Measure abdominal girth. 4. Give antacids as prescribed
3. Keep strict intake and output.
4. Encourage her to increase fluids. 50. Katrina is diagnosed with lactose intolerance. To avoid
complications with lack of calcium in the diet, which food
42. Your patient has a GI tract that is functioning, but has the should be included in the diet?
inability to swallow foods. Which is the preferred method of 1. Fruit
feeding for your patient? 2. Whole grains
1. TPN 3. Milk and cheese products
4. Dark green, leafy vegetables
58. A patient who underwent abdominal surgery now has a
51. Nathaniel has severe pruritus due to having hepatitis B. gaping incision due to delayed wound healing. Which method
What is the best intervention for his comfort? is correct when you irrigate a gaping abdominal incision with
1. Give tepid baths. sterile normal saline solution, using a piston syringe?
2. Avoid lotions and creams. 1. Rapidly instill a stream of irrigating solution into the
3. Use hot water to increase vasodilation. wound.
4. Use cold water to decrease the itching. 2. Apply a wet-to-dry dressing to the wound after the
irrigation.
52. Rob is a 46 y.o. admitted to the hospital with a suspected 3. Moisten the area around the wound with normal
diagnosis of Hepatitis B. He’s jaundiced and reports weakness. saline solution after the irrigation.
Which intervention will you include in his care? 4. Irrigate continuously until the solution becomes clear
1. Regular exercise. or all of the solution is used.
2. A low-protein diet.
3. Allow patient to select his meals. 59. Hepatic encephalopathy develops when the blood level of
4. Rest period after small, frequent meals. which substance increases?
1. Ammonia
53. You’re discharging Nathaniel with hepatitis B. Which 2. Amylase
statement suggests understanding by the patient? 3. Calcium
1. “Now I can never get hepatitis again.” 4. Potassium
2. “I can safely give blood after 3 months.”
3. “I’ll never have a problem with my liver again, even if I 60. Your patient recently had abdominal surgery and tells you
drink alcohol.” that he feels a popping sensation in his incision during a
4. “My family knows that if I get tired and start vomiting, I coughing spell, followed by severe pain. You anticipate an
may be getting sick again.” evisceration. Which supplies should you take to his room?
1. A suture kit.
54. Gail is scheduled for a cholecystectomy. After completion 2. Sterile water and a suture kit.
of preoperative teaching, Gail states,”If I lie still and avoid 3. Sterile water and sterile dressings.
turning after the operation, I’ll avoid pain. Do you think this is a 4. Sterile saline solution and sterile dressings.
good idea?” What is the best response?
1. “You’ll need to turn from side to side every 2 hours.” 61. Findings during an endoscopic exam include a
2. “It’s always a good idea to rest quietly after surgery.” cobblestone appearance of the colon in your patient. The
3. “The doctor will probably order you to lie flat for 24 findings are characteristic of which disorder?
hours.” 1. Ulcer
4. “Why don’t you decide about activity after you return 2. Crohn’s disease
from the recovery room?” 3. Chronic gastritis
4. Ulcerative colitis
55. You’re caring for a 28 y.o. woman with hepatitis B. She’s
concerned about the duration of her recovery. Which response 62. What information is correct about stomach cancer?
isn’t appropriate? 1. Stomach pain is often a late symptom.
1. Encourage her to not worry about the future. 2. Surgery is often a successful treatment.
2. Encourage her to express her feelings about the 3. Chemotherapy and radiation are often successful
illness. treatments.
3. Discuss the effects of hepatitis B on future health 4. The patient can survive for an extended time with
problems. TPN.
4. Provide avenues for financial counseling if she
expresses the need. 63. Dark, tarry stools indicate bleeding in which location of the
GI tract?
56. Elmer is scheduled for a proctoscopy and has an I.V. The 1. Upper colon.
doctor wrote an order for 5mg of I.V. diazepam(Valium). Which 2. Lower colon.
order is correct regarding diazepam? 3. Upper GI tract.
1. Give diazepam in the I.V. port closest to the vein. 4. Small intestine.
2. Mix diazepam with 50 ml of dextrose 5% in water and
give over 15 minutes. 64. A patient has an acute upper GI hemorrhage. Your
3. Give diazepam rapidly I.V. to prevent the bloodstream interventions include:
from diluting the drug mixture. 1. Treating hypovolemia.
4. Question the order because I.V. administration of 2. Treating hypervolemia.
diazepam is contraindicated. 3. Controlling the bleeding source.
4. Treating shock and diagnosing the bleeding source.
57. Annebell is being discharged with a colostomy, and you’re
teaching her about colostomy care. Which statement correctly 65. You promote hemodynamic stability in a patient with upper
describes a healthy stoma? GI bleeding by:
1. “At first, the stoma may bleed slightly when touched.” 1. Encouraging oral fluid intake.
2. “The stoma should appear dark and have a bluish 2. Monitoring central venous pressure.
hue.” 3. Monitoring laboratory test results and vital signs.
3. “A burning sensation under the stoma faceplate is 4. Giving blood, electrolyte and fluid replacement.
normal.”
4. “The stoma should remain swollen away from the 66. You’re preparing a patient with a malignant tumor for
abdomen.” colorectal surgery and subsequent colostomy. The patient tells
you he’s anxious. What should your initial step be in working 74. Your patient has a retractable gastric peptic ulcer and has
with this patient? had a gastric vagotomy. Which factor increases as a result of
1. Determine what the patient already knows about vagotomy?
colostomies. 1. Peristalsis.
2. Show the patient some pictures of colostomies. 2. Gastric acidity.
3. Arrange for someone who has a colostomy to visit the 3. Gastric motility.
patient. 4. Gastric pH.
4. Provide the patient with written material about
colostomy care. 75. Christina is receiving an enteral feeding that requires a
concentration of 80ml of supplement mixed with 20 ml of water.
67. Your patient, Christopher, has a diagnosis of ulcerative How much water do you mix with an 8 oz (240ml) can of
colitis and has severe abdominal pain aggravated by feeding?
movement, rebound tenderness, fever, nausea, and decreased 1. 60 ml.
urine output. This may indicate which complication? 2. 70 ml.
1. Fistula. 3. 80 ml.
2. Bowel perforation. 4. 90 ml.
3. Bowel obstruction.
4. Abscess. 76. Which stoma would you expect a malodorous, enzyme-
rich, caustic liquid output that is yellow, green, or brown?
68. A patient has a severe exacerbation of ulcerative colitis. 1. Ileostomy.
Long-term medications will probably include: 2. Ascending colostomy.
1. Antacids. 3. Transverse colostomy.
2. Antibiotics. 4. Descending colostomy.
3. Corticosteroids.
4. Histamine2-receptor blockers. 77. George has a T tube in place after gallbladder surgery.
Before discharge, what information or instructions should be
69. The student nurse is teaching the family of a patient with given regarding the T tube drainage?
liver failure. You instruct them to limit which foods in the 1. “If there is any drainage, notify the surgeon
patient’s diet? immediately.”
1. Meats and beans. 2. “The drainage will decrease daily until the bile duct
2. Butter and gravies. heals.”
3. Potatoes and pastas. 3. “First, the drainage is dark green; then it becomes
4. Cakes and pastries. dark yellow.”
70. An intubated patient is receiving continuous enteral 4. “If the drainage stops, milk the tube toward the
feedings through a Salem sump tube at a rate of 60ml/hr. puncture wound.”
Gastric residuals have been 30-40ml when monitored Q4H.
You check the gastric residual and aspirate 220ml. What is 78. Your patient Maria takes NSAIDS for her degenerative
your first response to this finding? joint disease, has developed peptic ulcer disease. Which drug
1. Notify the doctor immediately. is useful in preventing NSAID-induced peptic ulcer disease?
2. Stop the feeding, and clamp the NG tube. 1. Calcium carbonate (Tums)
3. Discard the 220ml, and clamp the NG tube. 2. Famotidine (Pepcid)
4. Give a prescribed GI stimulant such as 3. Misoprostol (Cytotec)
metoclopramide (Reglan). 4. Sucralfate (Carafate)

71. Your patient with peritonitis is NPO and complaining of 79. The student nurse is participating in colorectal cancer-
thirst. What is your priority? screening program. Which patient has the fewest risk factors
1. Increase the I.V. infusion rate. for colon cancer?
2. Use diversion activities. 1. Janice, a 45 y.o. with a 25-year history of ulcerative
3. Provide frequent mouth care. colitis
4. Give ice chips every 15 minutes. 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
72. Kevin has a history of peptic ulcer disease and vomits diet
coffee-ground emesis. What does this indicate? 4. Sissy, a 72 y.o. with a history of breast cancer
1. He has fresh, active upper GI bleeding.
2. He needs immediate saline gastric lavage. 80. You’re patient, post-op drainage of a pelvic abscess
3. His gastric bleeding occurred 2 hours earlier. secondary to diverticulitis, begins to cough violently after
4. He needs a transfusion of packed RBC’s. drinking water. His wound has ruptured and a small segment of
73. A 53 y.o. patient has undergone a partial gastrectomy for the bowel is protruding. What’s your priority?
adenocarcinoma of the stomach. An NG tube is in place and is 1. Ask the patient what happened, call the doctor, and
connected to low continuous suction. During the immediate cover the area with a water-soaked bedsheet.
postoperative period, you expect the gastric secretions to be 2. Obtain vital signs, call the doctor, and obtain
which color? emergency orders.
1. Brown. 3. Have a CAN hold the wound together while you
2. Clear. obtain vital signs, call the doctor and flex the patient’s
3. Red. knees.
4. Yellow. 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.
1. A Blood pressure decreases as the body is unable to 21. D The normal range of specific gravity of urine is 1.010 to
maintain normal oncotic pressure with liver failure, so 1.025; a value of 1.030 may be seen with dehydration.
patients with liver failure require close blood pressure 22. C Teach the pt to avoid activities that increase intra-
monitoring. Increased capillary permeability, abnormal abdominal pressure such as coughing, sneezing, or straining
peripheral vasodilation, and excess rennin released with a bowel movement.
from the kidney’s aren’t direct ramifications of liver 23. C Because obesity weakens the abdominal muscles,
failure. advise weight loss for the patient who has had a hernia repair.
2. B Good circulation causes tissues to be moist and 24. B After a liver biopsy, the patient is placed on the right side
red, so a healthy, well-healed stoma appears red and to compress the liver and to reduce the risk of bleeding or bile
moist. leakage.
3. A A colostomy in the sigmoid colon produces a solid, 25. A Signs and Symptoms of pneumothorax include dyspnea
formed stool. and decreased or absent breath sounds over the affected lung
4. D High-fiber foods stimulate peristalsis, and a result, (right lung).
flatus. Yogurt reduces gas formation. 26. A An NG tube is inserted into the patients stomach to drain
5. B A proper fit protects the skin, but doesn’t impair fluid and gas.
circulation. A 1/16” should be cut. 27. A Aspirating the stomach contents confirms correct
6. B Observation, auscultation, percussion, palpation placement. If an X-ray is ordered, it should be done
7. D An ileoanal reservoir is created in two stages. The immediately, not in 24 hours.
two surgeries are about 2 to 3 months apart. First, 28. B TPN is given I.V. to provide all the nutrients your patient
diseased intestines are removed and a temporary needs. TPN isn’t a tube feeding nor is it a liquid dietary
loop ileostomy is created. Second, the loop ileostomy supplement.
is closed and stool goes to the reservoir and out 29. A Type A causes changes in parietal cells.
through the anus. 30. B Increasing fluids helps empty the stomach. A high carb
8. C The large intestine absorbs large amounts of water diet isn’t restricted and fat intake shouldn’t be increased.
so the initial output from the ileostomy may be as 31. A Diarrhea d/t an acute episode of ulcerative colitis leads
much as 1500 to 2000 ml/24 hours. Gradually, the to fluid & electrolyte losses so fluid replacement takes priority.
small intestine absorbs more fluid and the output 32. D Sigmoidoscopy allows direct observation of the colon
decreases. mucosa for changes, and if needed, biopsy.
9. B To avoid overloading the small intestine, encourage 33. C She needs a high-fiber diet and a psyllium (bulk
the patient to eat six small, regularly spaced meals. laxative) to promote normal soft stools.
10. B Making observations about what you see or hear is a 34. B Stools from ulcerative colitis are often bloody and
useful therapeutic technique. This way, you acknowledge that contain mucus.
you are interested in what the patient is saying and feeling. 35. D One sign of acute diverticulitis is crampy lower left
11. C After a Billroth II procedure, a large amount of quadrant pain. A low-grade fever is another common sign.
hypertonic fluid enters the intestine. This causes extracellular 36. C With acute pancreatitis, you need to rest the GI tract by
fluid to move rapidly into the bowel, reducing circulating blood TPN as nutritional support.
volume and producing vasomotor symptoms. Vasomotor 37. A The gallbladder is located in the RUQ and a frequent
symptoms produced by dumping syndrome include dizziness sign of gallstones is pain radiating to the shoulder.
and sweating, tachycardia, syncope, pallor, and palpitations. 38. D A Jackson-Pratt drain promotes wound healing by
12. A Gastric emptying time can be delayed by omitting fluids allowing fluid to escape from the wound.
from your patient’s meal. A diet low in carbs and high in fat & 39. D After creation of a colostomy, expect to see a stoma that
protein is recommended to treat dumping syndrome. is pink, slightly edematous, with some oozing. Bright red blood,
13. B Ascites puts pressure on the diaphragm. Paracentesis is regardless of amount, indicates bleeding and should be
done to remove fluid and reducing pressure on the diaphragm. reported to the doctor.
The goal is to improve the patient’s breathing. The others are 40. A Only a small amount of skin should be exposed and
signs of cirrhosis that aren’t relieved by paracentesis. more than 1/16” of skin allows the excretement to irritate the
14. A A full bladder can interfere with paracentesis and be skin.
punctured inadvertently. 41. B Measuring abdominal girth provides quantitative
15. B Cover the organs with a sterile, nonadherent dressing information about increases or decreases in the amount of
moistened with normal saline. Do this to prevent infection and distention.
to keep the organs from drying out. 42. C Because the GI tract is functioning, feeding methods
16. A Asterixis is an early neurologic sign of hepatic involve the enteral route which bypasses the mouth but allows
encephalopathy elicited by asking the patient to hold her arms for a major portion of the GI tract to be used.
stretched out. Asterixis is present if the hands rapidly extend 43. B The first step in assessing the abdomen is to observe its
and flex. shape and contour, then auscultate, palpate, and then percuss.
17. A You may administer the laxative lactulose to reduce 44. B Lowering the height decreases the amount of flow,
ammonia levels in the colon. allowing him to tolerate more fluid.
18. A Achalasia is characterized by incomplete relaxation of 45. D Pancrelipase provides the exocrine pancreatic enzyme
the LES, dilation of the lower esophagus, and a lack of necessary for proper protein, fat, and carb digestion. With
esophageal peristalsis. Because nitrates relax the lower increased fat digestion and absorption, stools become less
esophageal sphincter, expect to give Isordil orally or frequent and normal in appearance.
sublingually. 46. B Glucose level increases and diabetes mellitus may
19. C Eating in the upright position aids in emptying the result d/t the pancreatic damage to the islets of langerhans.
esophagus. Doing the opposite of the other three also may be 47. D After surgery, she remains NPO until peristaltic activity
helpful. returns. This decreases the risk for abdominal distention and
20. C Pancreatitis involves activation of pancreatic enzymes, obstruction.
such as amylase and lipase. These levels are elevated in a 48. D A brownish-black color indicates lack of blood flow, and
patient with acute pancreatitis. maybe necrosis.
49. A Restricting fluids decrease the amount of body fluid and 73. C Normally, drainage is bloody for the first 24 hours after a
the accumulation of fluid in the peritoneal space. partial gastrectomy; then it changes to brown-tinged and then
50. D Dark green, leafy vegetables are rich in calcium. to yellow or clear.
51. A For pruritus, care should include tepid sponge baths and 74. D If the vagus nerve is cut as it enters the stomach, gastric
use of emollient creams and lotions. acid secretion is decreased, but intestinal motility is also
52. D Rest periods and small frequent meals is indicated decreased and gastric emptying is delayed. Because gastric
during the acute phase of hepatitis B. acids are decreased, gastric pH increases.
53. D Hepatitis B can recur. Patients who have had hepatitis 75. A Dosage problem. It’s 80/20 = 240/X. X=60.
are permanently barred from donating blood. Alcohol is 76. A The output from an Ileostomy is described.
metabolized by the liver and should be avoided by those who 77. B As healing occurs from the bile duct, bile drains from the
have or had hepatitis B. tube; the amount of bile should decrease. Teach the patient to
54. A To prevent venous stasis and improve muscle tone, expect dark green drainage and to notify the doctor if drainage
circulation, and respiratory function, encourage her to move stops.
after surgery. 78. C Misoprostol restores prostaglandins that protect the
55. A Telling her not to worry minimizes her feelings. stomach from NSAIDS, which diminish the prostaglandins.
56. A Diazepam is absorbed by the plastic I.V. tubing and 79. C
should be given in the port closest to the vein. 80. D
57. A For the first few days to a week, slight bleeding normally
occurs when the stoma is touched because the surgical site is
still new. She should report profuse bleeding immediately.
58. D To wash away tissue debris and drainage effectively,
irrigate the wound until the solution becomes clear or all the
solution is used.
59. A Ammonia levels increase d/t improper shunting of blood,
causing ammonia to enter systemic circulation, which carries it
to the brain.
60. D Saline solution is isotonic, or close to body fluids in
content, and is used along with sterile dressings to cover an
eviscerated wound and keep it moist.
61. B Crohn’s disease penetrates the mucosa of the colon
through all layers and destroys the colon in patches, which
creates a cobblestone appearance.
62. A Stomach pain is often a late sign of stomach cancer;
outcomes are particularly poor when the cancer reaches that
point. Surgery, chemotherapy, and radiation have minimal
positive effects. TPN may enhance the growth of the cancer.
63. C Melena is the passage of dark, tarry stools that contain
a large amount of digested blood. It occurs with bleeding from
the upper GI tract.
64. A A patient with an acute upper GI hemorrhage must be
treated for hypovolemia and hemorrhagic shock. You as a
nurse can’t diagnose the problem. Controlling the bleeding
may require surgery or intensive medical treatment.
65. D To stabilize a patient with acute bleeding, NS or LR
solution is given I.V. until BP rises and urine output returns to
30ml/hr.
66. A Initially, you should assess the patient’s knowledge
about colostomies and how it will affect his lifestyle.
67. B An inflammatory condition that affects the surface of the
colon, ulcerative colitis causes friability and erosions with
bleeding. Patients with ulcerative colitis are at increased risk
for bowel perforation, toxic megacolon, hemorrhage, cancer,
and other anorectal and systemic complications.
68. C Medications to control inflammation such as
corticosteroids are used for long-term treatment.
69. A Meats and beans are high-protein foods. In liver failure,
the liver is unable to metabolize protein adequately, causing
protein by-products to build up in the body rather than be
excreted.
70. B A gastric residual greater than 2 hours worth of feeding
or 100-150ml is considered too high. The feeding should be
stopped; NG tube clamped, and then allow time for the
stomach to empty before additional feeding is added.
71. C Frequent mouth care helps relieve dry mouth.
72. 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.