NUR 202 Adult Health II Exam 2 Prep: Master
Gastrointestinal Disorders Practice Questions & Detailed
Explanations
Subject: Adult Health II – Gastrointestinal Disorders
Question 1: A client with severe acute pancreatitis is receiving aggressive fluid resuscitation.
Which assessment finding provides the most definitive evidence of therapeutic success in
preventing systemic complications?
A) Serum amylase levels returning to within normal limits.
B) Urine output maintained at 0.5 mL/kg/hr with a stable Mean Arterial Pressure (MAP) of 70
mmHg.
C) Pain level reduction from 9/10 to 3/10 following PCA administration.
D) Normalization of serum calcium and magnesium levels.
Correct Answer: B) Urine output maintained at 0.5 mL/kg/hr with a stable Mean Arterial
Pressure (MAP) of 70 mmHg.
Explanation: Acute pancreatitis is often complicated by severe third-spacing and systemic
inflammatory response syndrome (SIRS). Fluid resuscitation is critical to prevent hypovolemic
shock and acute tubular necrosis. Hemodynamic stability and adequate end-organ perfusion,
reflected by urine output, are the primary clinical markers for success. Amylase levels are non-
specific and do not correlate with systemic stability.
Question 2: A client with chronic liver cirrhosis presents with hepatic encephalopathy. The nurse
administers lactulose. How does the nurse evaluate the effectiveness of this intervention?
A) The client maintains a minimum of three soft bowel movements per day.
B) A decrease in serum ammonia levels to within the therapeutic reference range.
C) Improvement in the client's ability to perform the "asterixis test" (writing a sentence or
holding arms extended).
D) An increase in serum albumin levels.
Correct Answer: C) Improvement in the client's ability to perform the "asterixis test"
(writing a sentence or holding arms extended).
Explanation: While lactulose works by trapping ammonia in the gut to be excreted, the clinical
gold standard for assessing the resolution of hepatic encephalopathy is the improvement of
,neurological status, specifically the reduction of asterixis (flapping tremor). Ammonia levels can
be misleading and do not always correlate perfectly with the severity of mental status changes.
Question 3: A client is diagnosed with a duodenal ulcer secondary to Helicobacter pylori
infection. The nurse is educating the client on the triple therapy regimen. Which statement by the
client indicates an understanding of the treatment goals?
A) "I will take my antacids 30 minutes after every meal to neutralize excess acid."
B) "I must complete the full course of antibiotics and the proton pump inhibitor to eradicate the
bacteria."
C) "I can stop the medications once my epigastric pain subsides, as this indicates the ulcer has
healed."
D) "The antibiotics will prevent the ulcer from recurring by strengthening the mucosal lining."
Correct Answer: B) "I must complete the full course of antibiotics and the proton pump
inhibitor to eradicate the bacteria."
Explanation: Eradication of H. pylori requires a strict regimen of antibiotics (usually
clarithromycin and amoxicillin/metronidazole) combined with a PPI to raise gastric pH,
allowing for effective antibiotic action. Stopping early fosters resistance and relapse. Antacids
provide symptom relief but do not address the causative pathogen.
Question 4: A client post-esophagogastroduodenoscopy (EGD) suddenly complains of severe
chest pain and displays signs of tachycardia. Which complication does the nurse suspect?
A) Vasovagal response from sedation.
B) Esophageal perforation.
C) Aspiration pneumonia.
D) Reaction to the topical anesthetic.
Correct Answer: B) Esophageal perforation.
Explanation: Severe chest pain, tachycardia, and potentially subcutaneous emphysema following
an EGD are hallmark indicators of an esophageal perforation, a life-threatening complication.
This requires immediate notification of the provider and NPO status for potential surgical
intervention.
Question 5: A client with ulcerative colitis is experiencing a severe exacerbation characterized
by bloody diarrhea. Which diagnostic finding is most concerning to the nurse?
,A) Serum potassium of 3.2 mEq/L.
B) Hemoglobin of 10.5 g/dL.
C) Presence of fever and tachycardia.
D) Evidence of "toxic megacolon" on abdominal X-ray.
Correct Answer: D) Evidence of "toxic megacolon" on abdominal X-ray.
Explanation: Toxic megacolon is a devastating complication of inflammatory bowel disease
where the colon dilates rapidly, leading to potential rupture and peritonitis. It is a surgical
emergency. While hypokalemia and anemia are common in UC, toxic megacolon poses the most
immediate threat to life.
Question 6: A client with a new colostomy for colorectal cancer expresses anxiety about the
appearance of the stoma. Which assessment finding would the nurse document as normal?
A) A stoma that is pale and cool to the touch.
B) A stoma that is moist, beefy red, and slightly edematous.
C) A stoma that has small areas of dark purple discoloration.
D) A stoma that shows minimal serosanguinous drainage from the edges.
Correct Answer: B) A stoma that is moist, beefy red, and slightly edematous.
Explanation: A healthy, viable stoma should be pink to beefy red, moist, and slightly edematous
immediately post-op. A pale or purple stoma indicates poor perfusion and is a clinical
emergency.
Question 7: A client with Crohn’s disease is at high risk for which specific nutritional deficiency
due to the location of the disease process?
A) Vitamin B12 and folate deficiency.
B) Vitamin C and Vitamin K deficiency.
C) Iron and calcium deficiency.
D) Thiamine and riboflavin deficiency.
Correct Answer: A) Vitamin B12 and folate deficiency.
, Explanation: Crohn’s disease frequently affects the terminal ileum. Since Vitamin B12 is
absorbed exclusively in the terminal ileum, Crohn’s patients are highly susceptible to pernicious
anemia and folate deficiency, requiring long-term monitoring and potential replacement.
Question 8: A client with cirrhosis is being evaluated for esophageal varices. Which medication
would the nurse anticipate to reduce the risk of bleeding?
A) Propranolol (Inderal).
B) Furosemide (Lasix).
C) Lactulose.
D) Vitamin K (Phytonadione).
Correct Answer: A) Propranolol (Inderal).
Explanation: Non-selective beta-blockers like propranolol are the standard prophylactic
treatment for esophageal varices. They decrease portal venous pressure by reducing cardiac
output and causing vasoconstriction in the splanchnic circulation.
Question 9: A client is diagnosed with cholecystitis. Which clinical presentation would the nurse
expect to find?
A) Pain in the left lower quadrant radiating to the back.
B) Right upper quadrant (RUQ) pain radiating to the right shoulder after a high-fat meal.
C) Rebound tenderness in the epigastrium that improves with eating.
D) Burning pain that occurs 2 hours after meals.
Correct Answer: B) Right upper quadrant (RUQ) pain radiating to the right shoulder after
a high-fat meal.
Explanation: Cholecystitis typically presents with biliary colic in the RUQ, triggered by fat
ingestion. The radiation to the right scapula or shoulder (Boas' sign) is a classic referred pain
pattern due to phrenic nerve irritation.
Question 10: During the assessment of a client with peritonitis, the nurse expects to observe:
A) A soft, non-tender abdomen.
B) Hyperactive bowel sounds.
C) A "board-like" rigid abdomen.
Gastrointestinal Disorders Practice Questions & Detailed
Explanations
Subject: Adult Health II – Gastrointestinal Disorders
Question 1: A client with severe acute pancreatitis is receiving aggressive fluid resuscitation.
Which assessment finding provides the most definitive evidence of therapeutic success in
preventing systemic complications?
A) Serum amylase levels returning to within normal limits.
B) Urine output maintained at 0.5 mL/kg/hr with a stable Mean Arterial Pressure (MAP) of 70
mmHg.
C) Pain level reduction from 9/10 to 3/10 following PCA administration.
D) Normalization of serum calcium and magnesium levels.
Correct Answer: B) Urine output maintained at 0.5 mL/kg/hr with a stable Mean Arterial
Pressure (MAP) of 70 mmHg.
Explanation: Acute pancreatitis is often complicated by severe third-spacing and systemic
inflammatory response syndrome (SIRS). Fluid resuscitation is critical to prevent hypovolemic
shock and acute tubular necrosis. Hemodynamic stability and adequate end-organ perfusion,
reflected by urine output, are the primary clinical markers for success. Amylase levels are non-
specific and do not correlate with systemic stability.
Question 2: A client with chronic liver cirrhosis presents with hepatic encephalopathy. The nurse
administers lactulose. How does the nurse evaluate the effectiveness of this intervention?
A) The client maintains a minimum of three soft bowel movements per day.
B) A decrease in serum ammonia levels to within the therapeutic reference range.
C) Improvement in the client's ability to perform the "asterixis test" (writing a sentence or
holding arms extended).
D) An increase in serum albumin levels.
Correct Answer: C) Improvement in the client's ability to perform the "asterixis test"
(writing a sentence or holding arms extended).
Explanation: While lactulose works by trapping ammonia in the gut to be excreted, the clinical
gold standard for assessing the resolution of hepatic encephalopathy is the improvement of
,neurological status, specifically the reduction of asterixis (flapping tremor). Ammonia levels can
be misleading and do not always correlate perfectly with the severity of mental status changes.
Question 3: A client is diagnosed with a duodenal ulcer secondary to Helicobacter pylori
infection. The nurse is educating the client on the triple therapy regimen. Which statement by the
client indicates an understanding of the treatment goals?
A) "I will take my antacids 30 minutes after every meal to neutralize excess acid."
B) "I must complete the full course of antibiotics and the proton pump inhibitor to eradicate the
bacteria."
C) "I can stop the medications once my epigastric pain subsides, as this indicates the ulcer has
healed."
D) "The antibiotics will prevent the ulcer from recurring by strengthening the mucosal lining."
Correct Answer: B) "I must complete the full course of antibiotics and the proton pump
inhibitor to eradicate the bacteria."
Explanation: Eradication of H. pylori requires a strict regimen of antibiotics (usually
clarithromycin and amoxicillin/metronidazole) combined with a PPI to raise gastric pH,
allowing for effective antibiotic action. Stopping early fosters resistance and relapse. Antacids
provide symptom relief but do not address the causative pathogen.
Question 4: A client post-esophagogastroduodenoscopy (EGD) suddenly complains of severe
chest pain and displays signs of tachycardia. Which complication does the nurse suspect?
A) Vasovagal response from sedation.
B) Esophageal perforation.
C) Aspiration pneumonia.
D) Reaction to the topical anesthetic.
Correct Answer: B) Esophageal perforation.
Explanation: Severe chest pain, tachycardia, and potentially subcutaneous emphysema following
an EGD are hallmark indicators of an esophageal perforation, a life-threatening complication.
This requires immediate notification of the provider and NPO status for potential surgical
intervention.
Question 5: A client with ulcerative colitis is experiencing a severe exacerbation characterized
by bloody diarrhea. Which diagnostic finding is most concerning to the nurse?
,A) Serum potassium of 3.2 mEq/L.
B) Hemoglobin of 10.5 g/dL.
C) Presence of fever and tachycardia.
D) Evidence of "toxic megacolon" on abdominal X-ray.
Correct Answer: D) Evidence of "toxic megacolon" on abdominal X-ray.
Explanation: Toxic megacolon is a devastating complication of inflammatory bowel disease
where the colon dilates rapidly, leading to potential rupture and peritonitis. It is a surgical
emergency. While hypokalemia and anemia are common in UC, toxic megacolon poses the most
immediate threat to life.
Question 6: A client with a new colostomy for colorectal cancer expresses anxiety about the
appearance of the stoma. Which assessment finding would the nurse document as normal?
A) A stoma that is pale and cool to the touch.
B) A stoma that is moist, beefy red, and slightly edematous.
C) A stoma that has small areas of dark purple discoloration.
D) A stoma that shows minimal serosanguinous drainage from the edges.
Correct Answer: B) A stoma that is moist, beefy red, and slightly edematous.
Explanation: A healthy, viable stoma should be pink to beefy red, moist, and slightly edematous
immediately post-op. A pale or purple stoma indicates poor perfusion and is a clinical
emergency.
Question 7: A client with Crohn’s disease is at high risk for which specific nutritional deficiency
due to the location of the disease process?
A) Vitamin B12 and folate deficiency.
B) Vitamin C and Vitamin K deficiency.
C) Iron and calcium deficiency.
D) Thiamine and riboflavin deficiency.
Correct Answer: A) Vitamin B12 and folate deficiency.
, Explanation: Crohn’s disease frequently affects the terminal ileum. Since Vitamin B12 is
absorbed exclusively in the terminal ileum, Crohn’s patients are highly susceptible to pernicious
anemia and folate deficiency, requiring long-term monitoring and potential replacement.
Question 8: A client with cirrhosis is being evaluated for esophageal varices. Which medication
would the nurse anticipate to reduce the risk of bleeding?
A) Propranolol (Inderal).
B) Furosemide (Lasix).
C) Lactulose.
D) Vitamin K (Phytonadione).
Correct Answer: A) Propranolol (Inderal).
Explanation: Non-selective beta-blockers like propranolol are the standard prophylactic
treatment for esophageal varices. They decrease portal venous pressure by reducing cardiac
output and causing vasoconstriction in the splanchnic circulation.
Question 9: A client is diagnosed with cholecystitis. Which clinical presentation would the nurse
expect to find?
A) Pain in the left lower quadrant radiating to the back.
B) Right upper quadrant (RUQ) pain radiating to the right shoulder after a high-fat meal.
C) Rebound tenderness in the epigastrium that improves with eating.
D) Burning pain that occurs 2 hours after meals.
Correct Answer: B) Right upper quadrant (RUQ) pain radiating to the right shoulder after
a high-fat meal.
Explanation: Cholecystitis typically presents with biliary colic in the RUQ, triggered by fat
ingestion. The radiation to the right scapula or shoulder (Boas' sign) is a classic referred pain
pattern due to phrenic nerve irritation.
Question 10: During the assessment of a client with peritonitis, the nurse expects to observe:
A) A soft, non-tender abdomen.
B) Hyperactive bowel sounds.
C) A "board-like" rigid abdomen.
