GNRS 558, Intermediate Medical-Surgical Care of the Adult
GNRS 558 EXAM 2 2025 ACTUAL EXAM WITH DETAILED
ANSWERS/MULTIPLE CHOICE QUESTIONS (ALL 2025
SESSIONS)
1. Which action will the nurse include in the plan of care for a 42-year-old patient who is being admitted
with Clostridium difficile?
a.
Educate the patient about proper food storage.
b.
Order a diet with no dairy products for the patient.
c.
Place the patient in a private room on contact isolation.
d.
Teach the patient about why antibiotics will not be used.
ANS: C
Because C. difficile is highly contagious, the patient should be placed in a private room and contact
precautions should be used. There is no need to restrict dairy products for this type of diarrhea.
Metronidazole (Flagyl) is frequently used to treat C. difficile. Improper food handling and storage do not
cause C. difficile.
2. A 71-year-old male patient tells the nurse that growing old causes constipation so he has been using a
suppository for constipation every morning. Which action should the nurse take first?
a.
Encourage the patient to increase oral fluid intake.
b.
,GNRS 558, Intermediate Medical-Surgical Care of the Adult
Assess the patient about risk factors for constipation.
c.
Suggest that the patient increase intake of high-fiber foods.
d.
Teach the patient that a daily bowel movement is unnecessary.
ANS: B
The nurse's initial action should be further assessment of the patient for risk factors for constipation and
for his usual bowel pattern. The other actions may be appropriate but will be based on the assessment.
3. A 64-year-old woman who has chronic constipation asks the nurse about the use of psyllium
(Metamucil). Which information will the nurse include in the response?
a.
Absorption of fat-soluble vitamins may be reduced by fiber-containing laxatives.
b.
Dietary sources of fiber should be eliminated to prevent excessive gas formation.
c.
Use of this type of laxative to prevent constipation does not cause adverse effects.
d.
Large amounts of fluid should be taken to prevent impaction or bowel obstruction.
ANS: D
A high fluid intake is needed when patients are using bulk-forming laxatives to avoid worsening
constipation. Although bulk-forming laxatives are generally safe, the nurse should emphasize the
possibility of constipation or obstipation if inadequate fluid intake occurs. Although increased gas
formation is likely to occur with increased dietary fiber, the patient should gradually increase dietary
fiber and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool
softeners and lubricants, not by bulk-forming laxatives.
,GNRS 558, Intermediate Medical-Surgical Care of the Adult
4. A 26-year-old woman is being evaluated for vomiting and abdominal pain. Which question from the
nurse will be most useful in determining the cause of the patient's symptoms?
a.
"What type of foods do you eat?"
b.
"Is it possible that you are pregnant?"
c.
"Can you tell me more about the pain?"
d.
"What is your usual elimination pattern?"
ANS: C
A complete description of the pain provides clues about the cause of the problem. Although the nurse
should ask whether the patient is pregnant to determine whether the patient might have an ectopic
pregnancy and before any radiology studies are done, this information is not the most useful in
determining the cause of the pain. The usual diet and elimination patterns are less helpful in
determining the reason for the patient's symptoms.
5. A patient complains of gas pains and abdominal distention two days after a small bowel resection.
Which nursing action is best to take?
a.
Encourage the patient to ambulate.
b.
Instill a mineral oil retention enema.
c.
, GNRS 558, Intermediate Medical-Surgical Care of the Adult
Administer the ordered IV morphine sulfate.
d.
Offer the ordered promethazine (Phenergan) suppository.
ANS: A
Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral
oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to
relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine (Phenergan) is used
as an antiemetic rather than to decrease gas pains or distention.
6. A 58-year-old man with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal
lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next?
a.
Auscultate the bowel sounds.
b.
Prepare the patient for surgery.
c.
Check the patient's oral temperature.
d.
Obtain information about the accident.
ANS: B
Return of brown drainage and fecal material suggests perforation of the bowel and the need for
immediate surgery. Auscultation of bowel sounds, checking the temperature, and obtaining information
about the accident are appropriate actions, but the priority is to prepare to send the patient for
emergency surgery.
GNRS 558 EXAM 2 2025 ACTUAL EXAM WITH DETAILED
ANSWERS/MULTIPLE CHOICE QUESTIONS (ALL 2025
SESSIONS)
1. Which action will the nurse include in the plan of care for a 42-year-old patient who is being admitted
with Clostridium difficile?
a.
Educate the patient about proper food storage.
b.
Order a diet with no dairy products for the patient.
c.
Place the patient in a private room on contact isolation.
d.
Teach the patient about why antibiotics will not be used.
ANS: C
Because C. difficile is highly contagious, the patient should be placed in a private room and contact
precautions should be used. There is no need to restrict dairy products for this type of diarrhea.
Metronidazole (Flagyl) is frequently used to treat C. difficile. Improper food handling and storage do not
cause C. difficile.
2. A 71-year-old male patient tells the nurse that growing old causes constipation so he has been using a
suppository for constipation every morning. Which action should the nurse take first?
a.
Encourage the patient to increase oral fluid intake.
b.
,GNRS 558, Intermediate Medical-Surgical Care of the Adult
Assess the patient about risk factors for constipation.
c.
Suggest that the patient increase intake of high-fiber foods.
d.
Teach the patient that a daily bowel movement is unnecessary.
ANS: B
The nurse's initial action should be further assessment of the patient for risk factors for constipation and
for his usual bowel pattern. The other actions may be appropriate but will be based on the assessment.
3. A 64-year-old woman who has chronic constipation asks the nurse about the use of psyllium
(Metamucil). Which information will the nurse include in the response?
a.
Absorption of fat-soluble vitamins may be reduced by fiber-containing laxatives.
b.
Dietary sources of fiber should be eliminated to prevent excessive gas formation.
c.
Use of this type of laxative to prevent constipation does not cause adverse effects.
d.
Large amounts of fluid should be taken to prevent impaction or bowel obstruction.
ANS: D
A high fluid intake is needed when patients are using bulk-forming laxatives to avoid worsening
constipation. Although bulk-forming laxatives are generally safe, the nurse should emphasize the
possibility of constipation or obstipation if inadequate fluid intake occurs. Although increased gas
formation is likely to occur with increased dietary fiber, the patient should gradually increase dietary
fiber and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool
softeners and lubricants, not by bulk-forming laxatives.
,GNRS 558, Intermediate Medical-Surgical Care of the Adult
4. A 26-year-old woman is being evaluated for vomiting and abdominal pain. Which question from the
nurse will be most useful in determining the cause of the patient's symptoms?
a.
"What type of foods do you eat?"
b.
"Is it possible that you are pregnant?"
c.
"Can you tell me more about the pain?"
d.
"What is your usual elimination pattern?"
ANS: C
A complete description of the pain provides clues about the cause of the problem. Although the nurse
should ask whether the patient is pregnant to determine whether the patient might have an ectopic
pregnancy and before any radiology studies are done, this information is not the most useful in
determining the cause of the pain. The usual diet and elimination patterns are less helpful in
determining the reason for the patient's symptoms.
5. A patient complains of gas pains and abdominal distention two days after a small bowel resection.
Which nursing action is best to take?
a.
Encourage the patient to ambulate.
b.
Instill a mineral oil retention enema.
c.
, GNRS 558, Intermediate Medical-Surgical Care of the Adult
Administer the ordered IV morphine sulfate.
d.
Offer the ordered promethazine (Phenergan) suppository.
ANS: A
Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral
oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to
relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine (Phenergan) is used
as an antiemetic rather than to decrease gas pains or distention.
6. A 58-year-old man with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal
lavage. If the lavage returns brown fecal drainage, which action will the nurse plan to take next?
a.
Auscultate the bowel sounds.
b.
Prepare the patient for surgery.
c.
Check the patient's oral temperature.
d.
Obtain information about the accident.
ANS: B
Return of brown drainage and fecal material suggests perforation of the bowel and the need for
immediate surgery. Auscultation of bowel sounds, checking the temperature, and obtaining information
about the accident are appropriate actions, but the priority is to prepare to send the patient for
emergency surgery.
