Brunner and Suddarth's Textbook of
Medical-surgical Nursing- Chapter 38, 39,
40, 41, 43&44
Chapter 38: Assessment of Digestive and Gastrointestinal Function
1. A nurse is caring for a client who is scheduled for a colonoscopy and whose preparation will include
polyethylene glycol electrolyte lavage prior to the procedure. The presence of what health problem
would contraindicate the use of this form of bowel preparation?
A. Inflammatory bowel disease
B. Intestinal polyps
C. Diverticulitis
D. Colon cancer - correct answerA
Rationale: The use of a lavage solution is contraindicated in clients with intestinal obstruction or
inflammatory bowel disease. It can safely be used with clients who have polyps, colon cancer, or
diverticulitis.
PTS: 1 REF: p. 1219
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
Multiple Choice
Chapter 41: Management of Patients with Intestinal and Rectal Disorders
1. A nurse is working with a client who has chronic constipation. What should be included in client
teaching to promote normal bowel function?
A. Use glycerin suppositories on a regular basis.
,B. Limit physical activity in order to promote bowel peristalsis.
C. Consume high-residue, high-fiber foods.
D. Resist the urge to defecate until the urge becomes intense. - correct answerC
Rationale: Goals for the client include restoring or maintaining a regular pattern of elimination by
responding to the urge to defecate, ensuring adequate intake of fluids and high-fiber foods, learning
about methods to avoid constipation, relieving anxiety about bowel elimination patterns, and avoiding
complications. Ongoing use of pharmacologic aids should not be promoted, due to the risk of
dependence. Increased mobility helps to maintain a regular pattern of elimination. The urge to defecate
should be heeded.
PTS: 1 REF: p. 1289 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders
KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply
Multiple Choice
10. A 16-year-old presents at the emergency department reporting right lower quadrant pain and is
subsequently diagnosed with appendicitis. When planning this client's nursing care, the nurse should
prioritize what nursing diagnosis?
A. Imbalanced nutrition: Less than body requirements related to decreased oral intake
B. Risk for infection related to possible rupture of appendix
C. Constipation related to decreased bowel motility and decreased fluid intake
D. Chronic pain related to appendicitis - correct answerB
Rationale: The client with a diagnosis of appendicitis has an acute risk of infection related to the
possibility of rupture. This immediate physiologic risk is a priority over nutrition and constipation,
though each of these concerns should be addressed by the nurse. The pain associated with appendicitis
is acute, not chronic.
PTS: 1 REF: p. 1299
NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control
,TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
Multiple Choice
10. A client has undergone a laparoscopic cholecystectomy and is being prepared for discharge home.
When providing health education, the nurse should prioritize what topic?
A. Management of fluid balance in the home setting
B. The need for blood glucose monitoring for the next week
C. Signs and symptoms of intra-abdominal complications
D. Appropriate use of prescribed pancreatic enzymes - correct answerC
Rationale: Because of the early discharge following laparoscopic cholecystectomy, the client needs
thorough education in the signs and symptoms of complications. Fluid balance is not typically a problem
in the recovery period after laparoscopic cholecystectomy. There is no need for blood glucose
monitoring or pancreatic enzymes.
PTS: 1 REF: p. 1425
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders
KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply
Multiple Choice
10. A client was treated in the emergency department and critical care unit after ingesting bleach. What
possible complication of the resulting gastritis should the nurse recognize?
A. Esophageal or pyloric obstruction related to scarring
B. Uncontrolled proliferation of H. pylori
C. Gastric hyperacidity related to excessive gastrin secretion
D. Chronic referred pain in the lower abdomen - correct answerA
, Rationale: A severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may
cause the mucosa to become gangrenous or to perforate. Scarring can occur, resulting in pyloric stenosis
(narrowing or tightening) or obstruction. Chronic referred pain to the lower abdomen is a symptom of
peptic ulcer disease, but would not be an expected finding for a client who has ingested a corrosive
substance. Bacterial proliferation and hyperacidity would not occur.
PTS: 1 REF: p. 1272
NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
Multiple Choice
10. A nurse is addressing the prevention of esophageal cancer in response to a question posed by a
participant in a health promotion workshop. What action should the nurse recommend as having the
greatest potential to prevent esophageal cancer?
A. Promotion of a nutrient-dense, low-fat diet
B. Annual screening endoscopy for clients over 50 with a family history of esophageal cancer
C. Early diagnosis and treatment of gastroesophageal reflux disease
D. Adequate fluid intake and avoidance of spicy foods - correct answerC
Rationale: There are numerous risk factors for esophageal cancer but chronic esophageal irritation or
GERD is among the most significant. This is a more significant risk factor than dietary habits. Screening
endoscopies are not recommended solely on the basis of family history.
PTS: 1 REF: p. 1257
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders
KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply
Multiple Choice
Medical-surgical Nursing- Chapter 38, 39,
40, 41, 43&44
Chapter 38: Assessment of Digestive and Gastrointestinal Function
1. A nurse is caring for a client who is scheduled for a colonoscopy and whose preparation will include
polyethylene glycol electrolyte lavage prior to the procedure. The presence of what health problem
would contraindicate the use of this form of bowel preparation?
A. Inflammatory bowel disease
B. Intestinal polyps
C. Diverticulitis
D. Colon cancer - correct answerA
Rationale: The use of a lavage solution is contraindicated in clients with intestinal obstruction or
inflammatory bowel disease. It can safely be used with clients who have polyps, colon cancer, or
diverticulitis.
PTS: 1 REF: p. 1219
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 38: Assessment of Digestive and Gastrointestinal Function
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
Multiple Choice
Chapter 41: Management of Patients with Intestinal and Rectal Disorders
1. A nurse is working with a client who has chronic constipation. What should be included in client
teaching to promote normal bowel function?
A. Use glycerin suppositories on a regular basis.
,B. Limit physical activity in order to promote bowel peristalsis.
C. Consume high-residue, high-fiber foods.
D. Resist the urge to defecate until the urge becomes intense. - correct answerC
Rationale: Goals for the client include restoring or maintaining a regular pattern of elimination by
responding to the urge to defecate, ensuring adequate intake of fluids and high-fiber foods, learning
about methods to avoid constipation, relieving anxiety about bowel elimination patterns, and avoiding
complications. Ongoing use of pharmacologic aids should not be promoted, due to the risk of
dependence. Increased mobility helps to maintain a regular pattern of elimination. The urge to defecate
should be heeded.
PTS: 1 REF: p. 1289 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders
KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply
Multiple Choice
10. A 16-year-old presents at the emergency department reporting right lower quadrant pain and is
subsequently diagnosed with appendicitis. When planning this client's nursing care, the nurse should
prioritize what nursing diagnosis?
A. Imbalanced nutrition: Less than body requirements related to decreased oral intake
B. Risk for infection related to possible rupture of appendix
C. Constipation related to decreased bowel motility and decreased fluid intake
D. Chronic pain related to appendicitis - correct answerB
Rationale: The client with a diagnosis of appendicitis has an acute risk of infection related to the
possibility of rupture. This immediate physiologic risk is a priority over nutrition and constipation,
though each of these concerns should be addressed by the nurse. The pain associated with appendicitis
is acute, not chronic.
PTS: 1 REF: p. 1299
NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control
,TOP: Chapter 41: Management of Clients with Intestinal and Rectal Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
Multiple Choice
10. A client has undergone a laparoscopic cholecystectomy and is being prepared for discharge home.
When providing health education, the nurse should prioritize what topic?
A. Management of fluid balance in the home setting
B. The need for blood glucose monitoring for the next week
C. Signs and symptoms of intra-abdominal complications
D. Appropriate use of prescribed pancreatic enzymes - correct answerC
Rationale: Because of the early discharge following laparoscopic cholecystectomy, the client needs
thorough education in the signs and symptoms of complications. Fluid balance is not typically a problem
in the recovery period after laparoscopic cholecystectomy. There is no need for blood glucose
monitoring or pancreatic enzymes.
PTS: 1 REF: p. 1425
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders
KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply
Multiple Choice
10. A client was treated in the emergency department and critical care unit after ingesting bleach. What
possible complication of the resulting gastritis should the nurse recognize?
A. Esophageal or pyloric obstruction related to scarring
B. Uncontrolled proliferation of H. pylori
C. Gastric hyperacidity related to excessive gastrin secretion
D. Chronic referred pain in the lower abdomen - correct answerA
, Rationale: A severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may
cause the mucosa to become gangrenous or to perforate. Scarring can occur, resulting in pyloric stenosis
(narrowing or tightening) or obstruction. Chronic referred pain to the lower abdomen is a symptom of
peptic ulcer disease, but would not be an expected finding for a client who has ingested a corrosive
substance. Bacterial proliferation and hyperacidity would not occur.
PTS: 1 REF: p. 1272
NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 40: Management of Clients With Gastric and Duodenal Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
Multiple Choice
10. A nurse is addressing the prevention of esophageal cancer in response to a question posed by a
participant in a health promotion workshop. What action should the nurse recommend as having the
greatest potential to prevent esophageal cancer?
A. Promotion of a nutrient-dense, low-fat diet
B. Annual screening endoscopy for clients over 50 with a family history of esophageal cancer
C. Early diagnosis and treatment of gastroesophageal reflux disease
D. Adequate fluid intake and avoidance of spicy foods - correct answerC
Rationale: There are numerous risk factors for esophageal cancer but chronic esophageal irritation or
GERD is among the most significant. This is a more significant risk factor than dietary habits. Screening
endoscopies are not recommended solely on the basis of family history.
PTS: 1 REF: p. 1257
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 39: Management of Clients with Oral and Esophageal Disorders
KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply
Multiple Choice
