MED SURG GASTROINTESTINAL NCLEX QUESTIONS
AND ANSWERS LATEST VERSION VERIFIED
RATIONALE GRADED A+
A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain, and appendicitis is
suspected. Laboratory tests are performed, and the nurse notes that the client's white blood cell (WBC) count is elevated. On the
basis of these findings, the nurse should question which health care provider (HCP) prescription documented in the client's medical
record?
A. Apply a cold pack to the abdomen.
B. Administer 30 mL of milk of magnesia (MOM).
C. Maintain nothing by mouth (nil per os [NPO]) status.
D. Initiate an intravenous (IV) line for the administration of IV fluids. - ansB. Administer 30 mL of milk of magnesia (MOM).
Rationale:
Appendicitis should be suspected in a client with an elevated WBC count complaining of acute right lower abdominal quadrant pain.
Laxatives are never prescribed because if appendicitis is present, the effect of the laxative may cause a rupture with resultant
peritonitis. Cold packs may be prescribed for comfort. The client would be NPO and given IV fluids in preparation for possible
surgery.
A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain. Appendicitis is
suspected, and appropriate laboratory tests are performed. The emergency department nurse reviews the test results and notes that
the client's white blood cell (WBC) count is elevated. The nurse also reviews the prescriptions from the health care provider (HCP).
The nurse should contact the HCP to question which prescription if noted in the client's record?
A. Maintain a semi Fowler's position.
B. Maintain on NPO (nothing by mouth) status.
C.Apply a heating pad to the lower abdomen for comfort.
D. Initiate an intravenous (IV) line with the administration of IV fluids. - ansC.Apply a heating pad to the lower abdomen for comfort.
Rationale:
Appendicitis should be suspected in a client with an elevated WBC count who is complaining of acute right lower quadrant
abdominal pain. A semi Fowler's position is maintained for comfort. The client would be on NPO status and given IV fluids in
preparation for possible surgery. Heat should never be applied to the abdomen because this may increase circulation to the
appendix, potentially leading to increased inflammation and perforation.
A client experiencing chronic dumping syndrome makes the following comments to the nurse. Which one indicates the need for
further teaching?
A. "I eat at least 3 large meals each day."
B. "I eat while lying in a semirecumbent position."
C. "I have eliminated taking liquids with my meals."
D. "I eat a high-protein, low- to moderate-carbohydrate diet." - ansA. "I eat at least 3 large meals each day."
,MED SURG GASTROINTESTINAL NCLEX QUESTIONS
AND ANSWERS LATEST VERSION VERIFIED
RATIONALE GRADED A+
Rationale:
Dumping syndrome describes a group of symptoms that occur after eating. It is believed to result from rapid dumping of gastric
contents into the small intestine, which causes fluid to shift into the intestine. Signs and symptoms of dumping syndrome include
diarrhea, abdominal distention, sweating, pallor, palpitations, and syncope. To manage this syndrome, clients are encouraged to
decrease the amount of food taken at each sitting, eat in a semirecumbent position, eliminate ingesting fluids with meals, and avoid
consumption of high-carbohydrate meals.
A client had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct
interpretation by the nurse?
A. This is a normal, expected event.
B. The client is experiencing early signs of ischemic bowel.
C. The client should not have the nasogastric tube removed.
D. This indicates inadequate preoperative bowel preparation. - ansA. This is a normal, expected event.
Rationale:
As peristalsis returns following creation of a colostomy, the client begins to pass malodorous flatus. This indicates returning bowel
function and is an expected event. Within 72 hours of surgery, the client should begin passing stool via the colostomy. Options 2, 3,
and 4 are incorrect interpretations.
A client has a large, deep duodenal ulcer diagnosed by endoscopy. Which sign or symptom indicative of a complication should the
nurse look for during the client's postprocedure assessment?
A. Bradycardia
B. Nausea and vomiting
C. Numbness in the legs
D. A rigid, boardlike abdomen - ansD. A rigid, boardlike abdomen
Rationale:
The client with a large, deep duodenal ulcer is at risk for perforation of the ulcer. If this occurs, the client will experience sudden,
sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which then becomes rigid and
boardlike. Tachycardia, not bradycardia, may occur as hypovolemic shock develops. Nausea and vomiting may not occur if the
pyloric sphincter is intact. Numbness in the legs is not an associated finding.
A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate for this client? Select all that apply.
A. Administer stool softeners as prescribed.
B. Instruct the client to limit fluid intake to avoid urinary retention.
C. Encourage a high-fiber diet to promote bowel movements without straining.
,MED SURG GASTROINTESTINAL NCLEX QUESTIONS
AND ANSWERS LATEST VERSION VERIFIED
RATIONALE GRADED A+
D. Apply cold packs to the anal-rectal area over the dressing until the packing is removed.
E. Help the client to a Fowler's position to place pressure on the rectal area and decrease bleeding. - ansA. Administer stool
softeners as prescribed.
C. Encourage a high-fiber diet to promote bowel movements without straining.
D. Apply cold packs to the anal-rectal area over the dressing until the packing is removed.
Rationale:
Nursing interventions after a hemorrhoidectomy are aimed at management of pain and avoidance of bleeding and incision rupture.
Stool softeners and a high-fiber diet will help the client to avoid straining, thereby reducing the chances of rupturing the incision. An
ice pack will increase comfort and decrease bleeding. Options 2 and 5 are incorrect interventions.
A client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which
most frequent complication of this type of surgery?
A. Folate deficiency
B. Malabsorption of fat
C. Intestinal obstruction
D. Fluid and electrolyte imbalance - ansD. Fluid and electrolyte imbalance
Rationale:
A frequent complication that occurs following ileostomy is fluid and electrolyte imbalance. The client requires constant monitoring of
intake and output to prevent this from occurring. Losses require replacement by intravenous infusion until the client can tolerate a
diet orally. Intestinal obstruction is a less frequent complication. Fat malabsorption and folate deficiency are complications that could
occur later in the postoperative period.
A client has undergone esophagogastroduodenoscopy. The nurse should place highest priority on which item as part of the client's
care plan?
1. Monitoring the temperature
2. Monitoring complaints of heartburn
3. Giving warm gargles for a sore throat
4. Assessing for the return of the gag reflex - ans4. Assessing for the return of the gag reflex
Rationale:
The nurse places highest priority on assessing for return of the gag reflex. This assessment addresses the client's airway. The nurse
also monitors the client's vital signs and for a sudden increase in temperature, which could indicate perforation of the
gastrointestinal tract. This complication would be accompanied by other signs as well, such as pain. Monitoring for sore throat and
heartburn are also important; however, the client's airway is the priority.
, MED SURG GASTROINTESTINAL NCLEX QUESTIONS
AND ANSWERS LATEST VERSION VERIFIED
RATIONALE GRADED A+
A client in a long-term care facility is being prepared to be discharged to home in 2 days. The client has been eating a regular diet
for a week; however, he is still receiving intermittent enteral tube feedings and will need to receive these feedings at home. The
client states concern that he will not be able to continue the tube feedings at home. Which nursing response is most appropriate at
this time?
A. "Do you want to stay here in this facility for a few more days?"
B. "Have you discussed your feelings with your health care provider?"
C. "You need to talk to your health care provider about these concerns."
D. "Tell me more about your concerns with your diet after going home." - ansD. "Tell me more about your concerns with your diet
after going home."
Rationale:
A client often has fears about leaving the secure, cared-for environment of the health care facility. This client has a fear about not
being able to care for himself at home and of not being able to handle the tube feedings at home. A therapeutic communication
statement such as "Tell me more about . . ." often leads to valuable information about the client and his concerns. The statements in
the remaining options are nontherapeutic.
A client is admitted to the hospital with a diagnosis of acute diverticulitis. What should the nurse expect to be prescribed for this
client?
A. NPO (nothing by mouth) status
B. Ambulation at least 4 times daily
C. Cholinergic medications to reduce pain
D. Coughing and deep breathing every 2 hours - ansA. NPO (nothing by mouth) status
Rationale:
During the acute phase of diverticulitis, the goal of treatment is to rest the bowel and allow the inflammation to subside. The client
remains NPO and is placed on bed rest. Pain occurs from bowel spasms, and increased intra-abdominal pressure (coughing and
deep breathing) may precipitate an attack. Ambulation and cholinergics will increase peristalsis.
A client is readmitted to the hospital with dehydration after surgery for creation of an ileostomy. The nurse assesses that the client
has lost 3 lb of weight, has poor skin turgor, and has concentrated urine. The nurse interprets the client's clinical picture as
correlating most closely with recent intake of which medication, which is contraindicated for the ileostomy client?
A. Folate
B. Biscodyl
C. Ferrous sulfate
D. Cyanocobalamin - ansB. Biscodyl
AND ANSWERS LATEST VERSION VERIFIED
RATIONALE GRADED A+
A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain, and appendicitis is
suspected. Laboratory tests are performed, and the nurse notes that the client's white blood cell (WBC) count is elevated. On the
basis of these findings, the nurse should question which health care provider (HCP) prescription documented in the client's medical
record?
A. Apply a cold pack to the abdomen.
B. Administer 30 mL of milk of magnesia (MOM).
C. Maintain nothing by mouth (nil per os [NPO]) status.
D. Initiate an intravenous (IV) line for the administration of IV fluids. - ansB. Administer 30 mL of milk of magnesia (MOM).
Rationale:
Appendicitis should be suspected in a client with an elevated WBC count complaining of acute right lower abdominal quadrant pain.
Laxatives are never prescribed because if appendicitis is present, the effect of the laxative may cause a rupture with resultant
peritonitis. Cold packs may be prescribed for comfort. The client would be NPO and given IV fluids in preparation for possible
surgery.
A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain. Appendicitis is
suspected, and appropriate laboratory tests are performed. The emergency department nurse reviews the test results and notes that
the client's white blood cell (WBC) count is elevated. The nurse also reviews the prescriptions from the health care provider (HCP).
The nurse should contact the HCP to question which prescription if noted in the client's record?
A. Maintain a semi Fowler's position.
B. Maintain on NPO (nothing by mouth) status.
C.Apply a heating pad to the lower abdomen for comfort.
D. Initiate an intravenous (IV) line with the administration of IV fluids. - ansC.Apply a heating pad to the lower abdomen for comfort.
Rationale:
Appendicitis should be suspected in a client with an elevated WBC count who is complaining of acute right lower quadrant
abdominal pain. A semi Fowler's position is maintained for comfort. The client would be on NPO status and given IV fluids in
preparation for possible surgery. Heat should never be applied to the abdomen because this may increase circulation to the
appendix, potentially leading to increased inflammation and perforation.
A client experiencing chronic dumping syndrome makes the following comments to the nurse. Which one indicates the need for
further teaching?
A. "I eat at least 3 large meals each day."
B. "I eat while lying in a semirecumbent position."
C. "I have eliminated taking liquids with my meals."
D. "I eat a high-protein, low- to moderate-carbohydrate diet." - ansA. "I eat at least 3 large meals each day."
,MED SURG GASTROINTESTINAL NCLEX QUESTIONS
AND ANSWERS LATEST VERSION VERIFIED
RATIONALE GRADED A+
Rationale:
Dumping syndrome describes a group of symptoms that occur after eating. It is believed to result from rapid dumping of gastric
contents into the small intestine, which causes fluid to shift into the intestine. Signs and symptoms of dumping syndrome include
diarrhea, abdominal distention, sweating, pallor, palpitations, and syncope. To manage this syndrome, clients are encouraged to
decrease the amount of food taken at each sitting, eat in a semirecumbent position, eliminate ingesting fluids with meals, and avoid
consumption of high-carbohydrate meals.
A client had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct
interpretation by the nurse?
A. This is a normal, expected event.
B. The client is experiencing early signs of ischemic bowel.
C. The client should not have the nasogastric tube removed.
D. This indicates inadequate preoperative bowel preparation. - ansA. This is a normal, expected event.
Rationale:
As peristalsis returns following creation of a colostomy, the client begins to pass malodorous flatus. This indicates returning bowel
function and is an expected event. Within 72 hours of surgery, the client should begin passing stool via the colostomy. Options 2, 3,
and 4 are incorrect interpretations.
A client has a large, deep duodenal ulcer diagnosed by endoscopy. Which sign or symptom indicative of a complication should the
nurse look for during the client's postprocedure assessment?
A. Bradycardia
B. Nausea and vomiting
C. Numbness in the legs
D. A rigid, boardlike abdomen - ansD. A rigid, boardlike abdomen
Rationale:
The client with a large, deep duodenal ulcer is at risk for perforation of the ulcer. If this occurs, the client will experience sudden,
sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which then becomes rigid and
boardlike. Tachycardia, not bradycardia, may occur as hypovolemic shock develops. Nausea and vomiting may not occur if the
pyloric sphincter is intact. Numbness in the legs is not an associated finding.
A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate for this client? Select all that apply.
A. Administer stool softeners as prescribed.
B. Instruct the client to limit fluid intake to avoid urinary retention.
C. Encourage a high-fiber diet to promote bowel movements without straining.
,MED SURG GASTROINTESTINAL NCLEX QUESTIONS
AND ANSWERS LATEST VERSION VERIFIED
RATIONALE GRADED A+
D. Apply cold packs to the anal-rectal area over the dressing until the packing is removed.
E. Help the client to a Fowler's position to place pressure on the rectal area and decrease bleeding. - ansA. Administer stool
softeners as prescribed.
C. Encourage a high-fiber diet to promote bowel movements without straining.
D. Apply cold packs to the anal-rectal area over the dressing until the packing is removed.
Rationale:
Nursing interventions after a hemorrhoidectomy are aimed at management of pain and avoidance of bleeding and incision rupture.
Stool softeners and a high-fiber diet will help the client to avoid straining, thereby reducing the chances of rupturing the incision. An
ice pack will increase comfort and decrease bleeding. Options 2 and 5 are incorrect interventions.
A client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which
most frequent complication of this type of surgery?
A. Folate deficiency
B. Malabsorption of fat
C. Intestinal obstruction
D. Fluid and electrolyte imbalance - ansD. Fluid and electrolyte imbalance
Rationale:
A frequent complication that occurs following ileostomy is fluid and electrolyte imbalance. The client requires constant monitoring of
intake and output to prevent this from occurring. Losses require replacement by intravenous infusion until the client can tolerate a
diet orally. Intestinal obstruction is a less frequent complication. Fat malabsorption and folate deficiency are complications that could
occur later in the postoperative period.
A client has undergone esophagogastroduodenoscopy. The nurse should place highest priority on which item as part of the client's
care plan?
1. Monitoring the temperature
2. Monitoring complaints of heartburn
3. Giving warm gargles for a sore throat
4. Assessing for the return of the gag reflex - ans4. Assessing for the return of the gag reflex
Rationale:
The nurse places highest priority on assessing for return of the gag reflex. This assessment addresses the client's airway. The nurse
also monitors the client's vital signs and for a sudden increase in temperature, which could indicate perforation of the
gastrointestinal tract. This complication would be accompanied by other signs as well, such as pain. Monitoring for sore throat and
heartburn are also important; however, the client's airway is the priority.
, MED SURG GASTROINTESTINAL NCLEX QUESTIONS
AND ANSWERS LATEST VERSION VERIFIED
RATIONALE GRADED A+
A client in a long-term care facility is being prepared to be discharged to home in 2 days. The client has been eating a regular diet
for a week; however, he is still receiving intermittent enteral tube feedings and will need to receive these feedings at home. The
client states concern that he will not be able to continue the tube feedings at home. Which nursing response is most appropriate at
this time?
A. "Do you want to stay here in this facility for a few more days?"
B. "Have you discussed your feelings with your health care provider?"
C. "You need to talk to your health care provider about these concerns."
D. "Tell me more about your concerns with your diet after going home." - ansD. "Tell me more about your concerns with your diet
after going home."
Rationale:
A client often has fears about leaving the secure, cared-for environment of the health care facility. This client has a fear about not
being able to care for himself at home and of not being able to handle the tube feedings at home. A therapeutic communication
statement such as "Tell me more about . . ." often leads to valuable information about the client and his concerns. The statements in
the remaining options are nontherapeutic.
A client is admitted to the hospital with a diagnosis of acute diverticulitis. What should the nurse expect to be prescribed for this
client?
A. NPO (nothing by mouth) status
B. Ambulation at least 4 times daily
C. Cholinergic medications to reduce pain
D. Coughing and deep breathing every 2 hours - ansA. NPO (nothing by mouth) status
Rationale:
During the acute phase of diverticulitis, the goal of treatment is to rest the bowel and allow the inflammation to subside. The client
remains NPO and is placed on bed rest. Pain occurs from bowel spasms, and increased intra-abdominal pressure (coughing and
deep breathing) may precipitate an attack. Ambulation and cholinergics will increase peristalsis.
A client is readmitted to the hospital with dehydration after surgery for creation of an ileostomy. The nurse assesses that the client
has lost 3 lb of weight, has poor skin turgor, and has concentrated urine. The nurse interprets the client's clinical picture as
correlating most closely with recent intake of which medication, which is contraindicated for the ileostomy client?
A. Folate
B. Biscodyl
C. Ferrous sulfate
D. Cyanocobalamin - ansB. Biscodyl
