GASTROINTESTINAL SYSTEM
DISORDERS Challenge Exam #1
- QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
2023/2024
GRADED A+ NEW
1. Question
Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic
pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory
report that indicates a serum amylase level of:
A. 45 units/L
B. 100 units/L
C. 300 units/L
D. 500 units/L
Correct Answer: C. 300 units/L
The normal serum amylase level is 25 to 151 units/L. With chronic cases of pancreatitis,
the rise in serum amylase levels usually does not exceed three times the normal value.
In acute pancreatitis, the value may exceed five times the normal value. Basic lab
studies for chronic pancreatitis can include a CBC, BMP, LFTs, lipase, amylase, lipid
panel, and a fecal-elastase-1 value. Lipase and amylase levels can be elevated, but
they are usually normal secondary to significant pancreatic scarring and fibrosis. Of
note, amylase and lipase values should not be considered diagnostic or prognostic.
Option A: 45 units/L is within normal limits. Serum amylase and lipase levels may be
slightly elevated in chronic pancreatitis; high levels are found only during acute attacks
of pancreatitis. In the later stages of chronic pancreatitis, atrophy of the pancreatic
,parenchyma can result in normal serum enzyme levels because of significant fibrosis of
the pancreas, resulting in decreased concentrations of these enzymes within the
pancreas.
Option B: 100 units/L is within normal limits. When pancreatic tissue damage (eg.
pancreatitis) or pancreatic duct is blocked, serum amylase levels increased. In acute
pancreatitis, lipase levels are often very high; 10.5 times the normal level can be
increased
Option D: 500 units/L is an extremely elevated level seen in acute pancreatitis. In acute
pancreatitis, blood amylase increased. Sometimes up to 4-6 times the highest normal
level rises.
2. Question
A male client who is recovering from surgery has been advanced from a clear
liquid diet to a full liquid diet. The client is looking forward to the diet change
because he has been “bored” with the clear liquid diet. The nurse would offer
which full liquid item to the client?
A. Tea
B. Gelatin
C. Custard
D. Popsicle
Correct Answer: C. Custard
Full liquid food items include items such as plain ice cream, sherbet, breakfast drinks,
milk, pudding, and custard, soups that are strained, and strained vegetable juices. A
clear liquid diet consists of foods that are relatively transparent. A patient prescribed a
full liquid diet follows a specific diet type requiring all liquids and semi-liquids but no
forms of solid intake.
Option A: Tea is included in the clear liquid diet. Unlike a clear liquid diet, which includes
only liquids and semi-liquids that are non-opaque, a full liquid diet is more inclusive, as it
allows all types of liquids.
Option B: A clear liquid diet is a specific dietary plan that only includes liquids that are
fully transparent at room temperature. Some items that may be allowed include water,
ice, fruit juices without pulp, sports drinks, carbonated drinks, gelatin, tea, coffee, clear
broths, and clear ice pops.
Option D: A popsicle is included in the clear liquid diet. The clear liquid diet assists in
maintaining hydration, it provides electrolytes and calories, and offers some level of
,satiety when a full diet is not appropriate, but may struggle to provide adequate caloric
needs if employed for more than five days.
3. Question
Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects
of the disorder, the nurse teaches the client about foods that are high in thiamine.
The nurse determines that the client has the best understanding of the dietary
measures to follow if the client states an intention to increase the intake of:
A. Pork
B. Milk
C. Chicken
D. Broccoli
Correct Answer: A. Pork
The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present
in a variety of foods of plant and animal origin. Pork products are especially rich in this
vitamin. Other good food sources include nuts, whole grain cereals, and legumes.
Thiamine helps turn carbohydrates into energy. It is required for the metabolism of
glucose, amino acids, and lipids.
Option B: Milk contains vitamins A, D, and B2. Milk and dairy foods provide the right
amount of bone-building nutrients, specifically calcium, vitamin D, protein, phosphorus,
magnesium, potassium, vitamin B12, and zinc.
Option C: Poultry contains niacin. Meat represents an excellent source of the majority of
hydrophilic vitamins, and it is the ideal dietary source of vitamin B12. The amounts of
B-group vitamins (e.g. niacin, vitamin B6, and pantothenic acid) in poultry are very
similar to those of other meats and do not significantly diminish during cooking.
Option D: Broccoli contains vitamins C, E, and K, and folic acid. Broccoli is a rich source
of multiple vitamins, minerals, and fiber. Different cooking methods may affect the
vegetable’s nutrient composition, but broccoli is a healthy addition to the diet whether
cooked or raw.
4. Question
Nurse Oliver checks for residual before administering a bolus tube feeding to a
client with a nasogastric tube and obtains a residual amount of 150 mL. What is
the appropriate action for the nurse to take?
A. Hold the feeding
, B. Reinstill the amount and continue with administering the feeding
C. Elevate the client’s head at least 45 degrees and administer the feeding
D. Discard the residual amount and proceed with administering the feeding
Correct Answer: A. Hold the feeding
Unless specifically indicated, residual amounts more than 100 mL require holding the
feeding. Gastric residual refers to the volume of fluid remaining in the stomach at a point
in time during enteral nutrition feeding. Nurses withdraw this fluid via the feeding tube by
pulling back on the plunger of a large (usually 60 mL) syringe at intervals typically
ranging from four to eight hours.
Option B: When interpreting GRV, clinicians must keep in mind that the stomach has a
reservoir function and that the stomach fluid is a mixture of both the infused EN formula
and normal gastric secretions.
Option C: Patients at risk for delayed gastric emptying include those with gastroparesis,
poorly controlled diabetes mellitus, gastric outlet obstruction, ileus, recent surgery,
trauma, or sepsis, and those using a large amount of narcotic pain medication. Efforts to
prevent aspiration of gastric contents are important in these patients.
Option D: The feeding is not discarded unless its contents are abnormal in color or
characteristics. In a review article, “Measurement of Gastric Residual Volume: State of
the Science,” published in 2000 in MEDSURG Nursing, Edwards and Metheny reported
that the literature contained a variety of recommendations for what is considered a high
GRV, ranging from 100 to 500 mL.
5. Question
A nurse is inserting a nasogastric tube in an adult male client. During the
procedure, the client begins to cough and has difficulty breathing. Which of the
following is the appropriate nursing action?
A. Quickly insert the tube
B. Notify the physician immediately
C. Remove the tube and reinsert when the respiratory distress subsides
D. Pull back on the tube and wait until the respiratory distress subsides
Correct Answer: D. Pull back on the tube and wait until the respiratory distress subsides
During the insertion of a nasogastric tube, if the client experiences difficulty breathing or
any respiratory distress, withdraw the tube slightly, stop the tubing advancement, and
wait until the distress subsides. The most common indication for placement of a
DISORDERS Challenge Exam #1
- QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
2023/2024
GRADED A+ NEW
1. Question
Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic
pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory
report that indicates a serum amylase level of:
A. 45 units/L
B. 100 units/L
C. 300 units/L
D. 500 units/L
Correct Answer: C. 300 units/L
The normal serum amylase level is 25 to 151 units/L. With chronic cases of pancreatitis,
the rise in serum amylase levels usually does not exceed three times the normal value.
In acute pancreatitis, the value may exceed five times the normal value. Basic lab
studies for chronic pancreatitis can include a CBC, BMP, LFTs, lipase, amylase, lipid
panel, and a fecal-elastase-1 value. Lipase and amylase levels can be elevated, but
they are usually normal secondary to significant pancreatic scarring and fibrosis. Of
note, amylase and lipase values should not be considered diagnostic or prognostic.
Option A: 45 units/L is within normal limits. Serum amylase and lipase levels may be
slightly elevated in chronic pancreatitis; high levels are found only during acute attacks
of pancreatitis. In the later stages of chronic pancreatitis, atrophy of the pancreatic
,parenchyma can result in normal serum enzyme levels because of significant fibrosis of
the pancreas, resulting in decreased concentrations of these enzymes within the
pancreas.
Option B: 100 units/L is within normal limits. When pancreatic tissue damage (eg.
pancreatitis) or pancreatic duct is blocked, serum amylase levels increased. In acute
pancreatitis, lipase levels are often very high; 10.5 times the normal level can be
increased
Option D: 500 units/L is an extremely elevated level seen in acute pancreatitis. In acute
pancreatitis, blood amylase increased. Sometimes up to 4-6 times the highest normal
level rises.
2. Question
A male client who is recovering from surgery has been advanced from a clear
liquid diet to a full liquid diet. The client is looking forward to the diet change
because he has been “bored” with the clear liquid diet. The nurse would offer
which full liquid item to the client?
A. Tea
B. Gelatin
C. Custard
D. Popsicle
Correct Answer: C. Custard
Full liquid food items include items such as plain ice cream, sherbet, breakfast drinks,
milk, pudding, and custard, soups that are strained, and strained vegetable juices. A
clear liquid diet consists of foods that are relatively transparent. A patient prescribed a
full liquid diet follows a specific diet type requiring all liquids and semi-liquids but no
forms of solid intake.
Option A: Tea is included in the clear liquid diet. Unlike a clear liquid diet, which includes
only liquids and semi-liquids that are non-opaque, a full liquid diet is more inclusive, as it
allows all types of liquids.
Option B: A clear liquid diet is a specific dietary plan that only includes liquids that are
fully transparent at room temperature. Some items that may be allowed include water,
ice, fruit juices without pulp, sports drinks, carbonated drinks, gelatin, tea, coffee, clear
broths, and clear ice pops.
Option D: A popsicle is included in the clear liquid diet. The clear liquid diet assists in
maintaining hydration, it provides electrolytes and calories, and offers some level of
,satiety when a full diet is not appropriate, but may struggle to provide adequate caloric
needs if employed for more than five days.
3. Question
Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects
of the disorder, the nurse teaches the client about foods that are high in thiamine.
The nurse determines that the client has the best understanding of the dietary
measures to follow if the client states an intention to increase the intake of:
A. Pork
B. Milk
C. Chicken
D. Broccoli
Correct Answer: A. Pork
The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present
in a variety of foods of plant and animal origin. Pork products are especially rich in this
vitamin. Other good food sources include nuts, whole grain cereals, and legumes.
Thiamine helps turn carbohydrates into energy. It is required for the metabolism of
glucose, amino acids, and lipids.
Option B: Milk contains vitamins A, D, and B2. Milk and dairy foods provide the right
amount of bone-building nutrients, specifically calcium, vitamin D, protein, phosphorus,
magnesium, potassium, vitamin B12, and zinc.
Option C: Poultry contains niacin. Meat represents an excellent source of the majority of
hydrophilic vitamins, and it is the ideal dietary source of vitamin B12. The amounts of
B-group vitamins (e.g. niacin, vitamin B6, and pantothenic acid) in poultry are very
similar to those of other meats and do not significantly diminish during cooking.
Option D: Broccoli contains vitamins C, E, and K, and folic acid. Broccoli is a rich source
of multiple vitamins, minerals, and fiber. Different cooking methods may affect the
vegetable’s nutrient composition, but broccoli is a healthy addition to the diet whether
cooked or raw.
4. Question
Nurse Oliver checks for residual before administering a bolus tube feeding to a
client with a nasogastric tube and obtains a residual amount of 150 mL. What is
the appropriate action for the nurse to take?
A. Hold the feeding
, B. Reinstill the amount and continue with administering the feeding
C. Elevate the client’s head at least 45 degrees and administer the feeding
D. Discard the residual amount and proceed with administering the feeding
Correct Answer: A. Hold the feeding
Unless specifically indicated, residual amounts more than 100 mL require holding the
feeding. Gastric residual refers to the volume of fluid remaining in the stomach at a point
in time during enteral nutrition feeding. Nurses withdraw this fluid via the feeding tube by
pulling back on the plunger of a large (usually 60 mL) syringe at intervals typically
ranging from four to eight hours.
Option B: When interpreting GRV, clinicians must keep in mind that the stomach has a
reservoir function and that the stomach fluid is a mixture of both the infused EN formula
and normal gastric secretions.
Option C: Patients at risk for delayed gastric emptying include those with gastroparesis,
poorly controlled diabetes mellitus, gastric outlet obstruction, ileus, recent surgery,
trauma, or sepsis, and those using a large amount of narcotic pain medication. Efforts to
prevent aspiration of gastric contents are important in these patients.
Option D: The feeding is not discarded unless its contents are abnormal in color or
characteristics. In a review article, “Measurement of Gastric Residual Volume: State of
the Science,” published in 2000 in MEDSURG Nursing, Edwards and Metheny reported
that the literature contained a variety of recommendations for what is considered a high
GRV, ranging from 100 to 500 mL.
5. Question
A nurse is inserting a nasogastric tube in an adult male client. During the
procedure, the client begins to cough and has difficulty breathing. Which of the
following is the appropriate nursing action?
A. Quickly insert the tube
B. Notify the physician immediately
C. Remove the tube and reinsert when the respiratory distress subsides
D. Pull back on the tube and wait until the respiratory distress subsides
Correct Answer: D. Pull back on the tube and wait until the respiratory distress subsides
During the insertion of a nasogastric tube, if the client experiences difficulty breathing or
any respiratory distress, withdraw the tube slightly, stop the tubing advancement, and
wait until the distress subsides. The most common indication for placement of a
