Deck 3: Gastrointestinal

Question 1

Ruby, a college student, was admitted due to persistent abdominal pain, nausea, vomiting, and difficulty in swallowing. The doctor orders for an upper GI series. Nursing preparation for this procedure includes:

A)NPO for 24 hours before the procedure
B)Administering an enema or cathartic to enhance visualization
C)Discouraging the client from smoking the morning of the procedure because smoking can stimulate gastric motility
D)Instructing the client that the test involves insertion of a rubber gastroscopy tube

Answer 1

Discouraging the client from smoking the morning of the procedure because smoking can stimulate gastric motility

Question 2

HP recently undergone a colostomy. During his first day post-operative, the nurse does not find any measurable fecal drainage from the colostomy. What should the nurse do?

A)Continue the current plan of care
B)Call the doctor immediately
C)Irrigate the stoma
D)Encourage the patient to increase fluid intake

Answer 2

Continue the current plan of care

Question 3

The nurse demonstrates to Mr. HP the correct way of cutting the appliance by making the opening how much larger than that of the client's stoma?

A)½ inch
B)1/8 inch
C)¼ inch
D)1/16 inch

Answer 3

1/8 inch

Question 4

Edna, 28 years old, has been complaining of excruciating epigastric pain and belching for the last few months since she started working as a stock broker. The physician orders for an esophagogastroduodenoscopy (EGD) immediately. After the procedure, which of the following assessments should the nurse perform?

A)Auscultate for bowel sounds
B)Check for gag reflex
C)Monitor salivary pH
D)Measure abdominal girth

Question 5

Miller, with a history of cholecystitis, is now being admitted to the hospital for possible surgical intervention. The orders include NPO, IV therapy, and bed rest. In addition to assessing for nausea, vomiting, and anorexia, the nurse should observe for pain __________.

A)In the right lower quadrant
B)After ingesting food
C)Radiating to the left shoulder
D)In the right upper quadrant

Question 6

Jackman underwent a laparoscopic cholecystectomy this morning. She is now complaining of right shoulder pain. The nurse would explain to the client this symptom is __________.

A)Common following this operation
B)Expected after general anesthesia
C)Unusual and will be reported to the surgeon
D)Indicative of a need to use the incentive spirometer

Question 7

Tom, 45 years old and a known alcoholic, came into the Emergency Department complaining of constant epigastric abdominal pain that radiates to the back and flank areas. He further states that the pain is more intense when he lies down. After a thorough examination, the doctor wrote in the client's chart his admitting diagnosis as acute pancreatitis. The nurse is aware that she should report immediately if Tom develops __________.

A)Nausea and vomiting
B)Abdominal pain
C)Decreased bowel sounds
D)Shortness of breath

Question 8

Julie Julie Johnson is receiving total parenteral nutrition (TPN). The nurse reviews the following lab values:
Glucose = 72 mg/dL
Chloride = 98 mg/dL
Sodium = 138 mEq/L
Potassium = 3.0 mEq/L
Based on the nurse's review of the lab values, which nursing action is appropriate?

A)Discontinue the TPN administration
B)Notify the physician and discuss the need for potassium replacement
C)Administer 50% dextrose immediately
D)Assess the patient's vital signs and perform a physical assessment

Question 9

Which menu selection would be most appropriate for a client with cholelithiasis?

A)Two eggs, two slices of toast with margarine, and a glass of whole milk
B)Grilled cheese sandwich, steamed vegetables with butter, and a cup of coffee
C)Roasted chicken breast, baked potato with margarine and chives, and skim milk
D)Baked fish, steamed broccoli with salt and pepper, and a glass of iced tea

Question 10

Joe, a known alcoholic for several years, is now in a hepatic coma. He is jaundiced, edematous, and with bleeding esophageal varices. The nurse reviewed his blood ammonia levels to be increased as well. Which of the following actions should the nurse perform in order to reduce ammonia intoxication?

A)Active and passive range-of-motion exercises to prevent venous stasis
B)Tap-water enemas to remove blood that may still be in the gut from the bleeding esophageal varices
C)Administration of insulin and glucagon to reduce serum-potassium levels
D)Holding all antibiotic medications so that the action of the intestinal bacteria on protein is enhanced

Question 11

Which statement by the nurse accurately describes the Miller-Abbott tube?

A)A double-lumen tube, with one lumen leading to the inflatable balloon and the other lumen used for aspiration
B)A plastic or rubber tube with holes near its tip facilitating withdrawal of fluids from the stomach
C)A single-lumen, saline-, air-, or water-weighted tube approximately 6 feet long
D)A 10-foot-long rubber tube with a saline, air, or water bag at its end

Question 12

Margaret Shawn, a 45-year-old librarian, was ordered by her physician to undergo an oral cholecystography. Which nursing action is inappropriate in preparing Ms. Shawn for this procedure?

A)Administering a fat-free diet the evening before the test
B)Administering Telepaque (iopanoic acid) tablets in 5-minute intervals 1 hour after supper
C)Administering at least 6 oz. of water with each Telepaque (iopanoic acid) tablet
D)Allowing the client, after ingesting the tablets, to drink water until midnight, then NPO

Question 13

Tuxen, a 66-year-old black American, was brought by his wife to the Emergency Department because he is increasingly confused and is coughing blood. His medical diagnosis is cirrhosis of the liver. While assessing Mr. Tuxen, the nurse understands that the correct technique when doing abdominal assessment is:

A)Palpate the most painful area progressing to the least painful parts
B)Begin with inspection and end with palpation
C)Follow the sequence of auscultation, inspection, percussion, and palpation
D)Auscultate the bowel sound first then perform palpation and percussion

Question 14

Tuxen's esophageal varices ruptured and he was having hematemesis. A Sengstaken-Blakemore tube is inserted in an effort to stop the bleeding. After the Sengstaken-Blakemore tube is inserted, the client has difficulty in breathing. Based on this information, the first action the nurse should take is to:

A)Deflate the esophageal balloon
B)Encourage him to take deep breaths
C)Monitor his vital signs
D)Notify the physician

Question 15

Paralytic ileus is described by the nurse as:

A)Edema of the intestinal mucosa
B)Acute dilation of the colon
C)Absent, diminished, or uncoordinated autonomic stimulation of peristalsis
D)High, tinkling bowel sounds over the area of obstruction

Question 16

The nurse explains to a client that a vagotomy is done in conjunction with a subtotal gastrectomy because the function of the vagus nerve is to:

A)Stimulate increased gastric motility
B)Decrease gastric motility, thereby preventing the movement of HCl out of the stomach
C)Stimulate both increased gastric secretion and gastric motility
D)Stimulate decreased gastric secretion, thereby increasing nausea and vomiting

Question 17

Raj, age 45 years old, is diagnosed with cirrhosis and has been placed on a moderate protein, high carbohydrate, high calorie, low salt diet. Which statement would the nurse select as the best rationale for this diet?

A)Because the liver may not be able to detoxify proteins, carbohydrates are substituted to meet metabolic and nutritional needs
B)Proteins are given in insufficient amount to facilitate tissue repair. High carbohydrate diet prevents further weight loss and spares proteins from energy metabolism. Sodium restriction facilitates management of fluid imbalances.
C)High protein foods are harder to digest and also have a high sodium content. Carbohydrates are more palatable and will more quickly correct the client's weight loss.
D)High carbohydrate diets, particularly if they contain adequate fiber, are more likely to decrease dyspepsia and diarrhea. Sodium is always restricted when the client is edematous.

Question 18

Paracentesis is part of the treatment plan for Mr. Raj, who was diagnosed with cirrhosis, to remove ascitic fluid. After explaining the procedure to the client, the next nursing action would be to:

A)Position the client in a chair or in high-Fowler's position
B)Instruct the client to void
C)Take vital signs
D)Drape the abdomen with sterile towels

Question 19

What nursing action best facilitates the passage of the nasoenteric tube from the stomach through the pylorus and into the duodenum?

A)Gently advancing the tube 1-4 inches at regular time intervals
B)Positioning the client on the right side for 2 hours after insertion
C)Maintaining strict bed rest and avoiding all unnecessary movement
D)Positioning the client in a flat supine position

Question 20

The mouth care measure that should be used with caution by the nurse when a client has a nasogastric tube is:

A)Regularly brushing teeth and tongue with soft brush
B)Sucking on ice chips to relieve dryness
C)Occasionally rinsing mouth with a non-astringent substance and massaging gums
D)Application of lemon juice and glycerine swabs to the lips

Question 21

After her gastrectomy, actress Sandra Newton asks the nurse when the nasogastric tube will be removed. The nurse responds ______________.

A)"According to standard procedures only, it will be removed on the fourth postoperative day."
B)"When bowel sounds are established and you have passed flatus or stool."
C)"Thirty-six hours after the cessation of bloody drainage."
D)"After two days of alternate clamping and unclamping of the tube."

Question 22

Following gastrectomy, the nurse must observe for signs of pernicious anemia because:

A)The extrinsic factor is produced in the stomach
B)The extrinsic factor is absorbed in the antral portion of the stomach
C)The intrinsic factor is produced in the stomach
D)Decreased hydrochloride acid production inhibits vitamin B12 reabsorption

Question 23

Teddy, 37 years old, is diagnosed with obstructive jaundice. The nurse should ask the client about which of these manifestations?

A)Clear, pale urine
B)Clay-colored stools
C)Lactose intolerance
D)Ankle edema

Question 24

Seuss, a music teacher, is diagnosed with chronic pancreatitis and pancrelipase (Lipancreatin) is prescribed. Which of the following instructions should the nurse give to this client about the administration of this medication?

A)"Take the drug with meals."
B)"Take the drug with a large glass of milk."
C)"Take the drug between meals."
D)"Take the drug after it is crushed and mixed with ice cream."

Question 25

The client has just had a liver biopsy. Which of the following nursing actions would be the priority after the biopsy?

A)Monitor pulse and blood pressure every 30 minutes until stable and then hourly for up to 24 hours.
B)Ambulate every 4 hours for the first day as long as client can tolerate this.
C)Measure urine specific gravity every 8 hours for the next 48 hours.
D)Maintain NPO status for 24 hours post-biopsy.

Question 26

Lanie, the new day-shift nurse, is developing a health promotion program for intestinal health. Which of the following pieces of information should the nurse include in the program?

A)The addition of dietary fiber can reduce the risk of diverticulosis
B)A diet high in fat increases the risk of developing Crohn's disease
C)Irritable bowel syndrome is caused by a deficiency in soluble fiber
D)Laxatives can improve motility and bowel health

Question 27

A client is to have an intestinal tube placed to decompress the bowel. Which of the following explanations should the nurse give to the client about what to expect?

A)"You will need to remain on bed rest until the tube is removed."
B)"While the tube is in place you will need to lie on your right side."
C)"Walking in the hall will help move the tube forward."
D)"Keeping the bed flat should make you more comfortable."

Question 28

Gwen Marshall, a 28-year-old law student with Crohn's disease, was prescribed to take sulfasalazine (Azulfidine). She asked the nurse why this medication is necessary. Which information should the nurse include in the response?

A)The drug decreases abdominal cramping by slowing peristalsis.
B)The drug decreases prostaglandin production in the bowel so it decreases inflammation.
C)The drug inhibits neurotransmission of pain impulses.
D)The drug stimulates the release of endorphins so pain is relieved.

Question 29

A client who had a Billroth I procedure is beginning to eat solid foods. The nurse should assess the client for the development of dumping syndrome by determining the presence of which of the following?

A)Bradycardia
B)Diarrhea
C)Fever
D)Tumor formation

Question 30

A client who has liver disease asks the nurse why he bruises so easily. Which of the following statements should the nurse include in the response?

A)"Your liver is unable to make the proteins that are needed to make clotting factors."
B)"Your liver can no longer metabolize drugs and render them inactive."
C)"Your liver is breaking down blood cells too rapidly."
D)"Your liver can't store vitamin C any longer."

Question 31

Simpson is scheduled for extracorporeal shock wave lithotripsy for her cholelithiasis. The nurse should tell Mrs. Simpson about which of these symptoms that may occur after this procedure?

A)Colic-type pain
B)Headache
C)Diarrhea
D)Hiccups

Question 32

Georgette, a 31-year-old research assistant, is seen in the clinic for a routine physical examination and the laboratory test results indicate an elevated HBsAg. In order to plan teaching for this client, the nurse interprets this lab result to mean:

A)The client has immunity to hepatitis B
B)The client has active hepatitis B.
C)The client is resolving hepatitis B.
D)The client has had the hepatitis B vaccine.

Question 33

Samantha Hawkins, RN, is doing discharge teaching for a client who has cirrhosis and ascites in her unit. Which of the following foods should Ms. Hawkins instruct the client to avoid?

A)Whole wheat bread
B)Cookies
C)Potato chips
D)Hard candy

Question 34

During a postoperative period following cholecystectomy, the client has a T-tube connected to gravity drainage. The nurse knows that the purpose of the T-tube is to:

A)Maintain patency of the common bile duct
B)Reduce the occurrence of postoperative bleeding
C)Prevent infection
D)Reduce bile flow into the duodenum

Question 35

The physician has left orders to deflate a client's Sengstaken-Blakemore tube, used to stop esophageal bleeding, for 5 minutes every 12 hours to prevent esophageal erosion. Two hours following second re-inflation, the client suddenly becomes severely dyspneic and dusky. The nurse should:

A)Call a code blue (cardiac arrest)
B)Deflate the balloons
C)Decrease the traction on the tube where it enters the nose
D)Irrigate the tube with ice-cold saline to facilitate movement of the balloons into the stomach

Question 36

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis, who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the appropriate nursing intervention?

A)Notify the physician
B)Administer the prescribed pain medication
C)Call and ask the operating room team to perform the surgery as soon as possible
D)Reposition the client and apply a heating pad on warm setting to the client's abdomen

Question 37

Franklin, age 57 years old, has been admitted to the hospital with a diagnosis of acute pancreatitis and the nurse is assessing the client's pain. What type of pain is consistent with this diagnosis?

A)Burning and aching located in the left lower quadrant and radiating to the hip
B)Severe and unrelenting pain located in the epigastric area and radiating to the back
C)Burning and aching located in the epigastric area and radiating to the umbilicus
D)Severe and unrelenting pain located in the left lower quadrant and radiating to the groin

Question 38

A client is admitted with a diagnosis of acute diverticulitis. What nursing intervention is appropriate for this client?

A)Instruct the client to remain NPO
B)Encourage ambulation at least four times daily
C)Administer cholinergic medications to reduce pain
D)Encourage coughing and deep breathing every 2 hours

Question 39

The client with a colostomy has an order for irrigation of the colostomy. The nurse uses which solution for the irrigation?

A)Tap water
B)Sterile water
C)Sterile distilled water
D)Sterile lactated Ringer's

Question 40

The nurse can quickly assess volume depletion in a client with ulcerative colitis by:

A)Measuring the quantity and specific gravity of the client's urine output
B)Taking the client's blood pressure first supine, then sitting, noting any changes
C)Comparing the client's present weight with weight on a previous admission
D)Administering the oral water test

Question 41

William Radcliffe, a 30-year-old truck driver scheduled for repair of bilateral inguinal hernias, has history of obesity, smoker's cough, and heavy lifting following a previous inguinal hernia repair. The most likely cause for the herniation is:

A)Intestinal obstruction
B)Failure of resected muscles in previous operations to heal properly
C)Chronic cough and vigorous exercise
D)Obesity

Question 42

After discharge following ileostomy surgery, Tess Hughes calls the nurse at the hospital to report the sudden onset of abdominal cramps, vomiting, and watery discharge from the ileostomy. What should the nurse advise?

A)Call the physician is symptoms persist for 24 hours
B)Take 30 ml of Milk of Magnesia
C)NPO until vomiting stops
D)Call the physician immediately

Question 43

Which description of pain would be most characteristic of a duodenal ulcer?

A)Gnawing, dull, aching, hunger-like pain in the epigastric area that is relieved by food intake
B)RUQ pain that increases after meal
C)Sharp pain in the epigastric area that radiates to the right shoulder
D)A sensation of painful pressure in the midsternal area

Question 44

The laboratory of a male patient with a peptic ulcer revealed an elevated titer of Helicobacter pylori. Which of the following statements indicates an understanding of this data?

A)Treatment will include Ranitidine and Antibiotics
B)No treatment is necessary at this time
C)This result indicates gastric cancer caused by the organism
D)Surgical treatment is necessary

Question 45

Which of the following is the drug of choice for pain control in the patient with acute pancreatitis?

A)Morphine
B)NSAIDS
C)Meperidine
D)Codeine

Question 46

A client with multiple injuries following a vehicular accident is transferred to the critical care unit. He begins to complain of increased abdominal pain in the left upper quadrant. A ruptured spleen is diagnosed and he is scheduled for emergency splenectomy. In preparing the client for surgery, the nurse should emphasize in his teaching plan the:

A)Complete safety of the procedure
B)Expectation of postoperative bleeding
C)Risk of the procedure with his other injuries
D)Presence of abdominal drains for several days after surgery

Question 47

Jude develops GI bleeding and is admitted to the hospital. An important etiologic clue for the nurse to explore while taking his history would be:

A)The medications he has been taking
B)Any recent foreign travel
C)His usual dietary pattern
D)His working patterns

Question 48

A client with a history of recurrent GI bleeding is admitted to the hospital for a gastrectomy. Following surgery, the client has a nasogastric tube to low continuous suction. He begins to hyperventilate. The nurse should be aware that this pattern will alter his arterial blood gases by:

A)Increasing HCO₃
B)Decreasing PCO₂
C)Decreasing pH
D)Decreasing PO₂

Question 49

A client is being evaluated for cancer of the colon. In preparing the client for a barium enema, the nurse should:

A)Give laxatives the night before and a cleansing enema in the morning before the test
B)Render an oil retention enema and give laxatives the night before
C)Instruct the client to swallow 6 radiopaque tablets the evening before the study
D)Place the client on CBR a day before the study

Question 50

Days after abdominal surgery, the client's wound dehisces. The safest nursing intervention when this occurs is to _________________.

A)Cover the wound with sterile, moist saline dressing
B)Approximate the wound edges with tape
C)Irrigate the wound with sterile saline
D)Hold the abdominal contents in place with a sterile gloved hand