GASTROINTESTINAL MED-SURG TEST BANK
(ADVANCED LEVEL – 100 QUESTIONS)
Answers and rationales
1. A client with acute pancreatitis reports severe epigastric pain
radiating to the back. Which intervention is the priority?
A. Provide ice chips
B. Administer IV opioids as prescribed
C. Place the client supine
D. Encourage oral fluids
Rationale: Severe pancreatitis pain requires rapid opioid
administration to reduce sympathetic stress and metabolic demand.
2. A nurse reviews labs for a client with ulcerative colitis. Which
finding requires immediate action?
A. Hgb 12.5 g/dL
B. WBC 9,000/mm³
C. K+ 2.9 mEq/L
D. Albumin 3.4 g/dL
Rationale: Severe diarrhea in UC can cause life-threatening
hypokalemia requiring urgent correction.
3. Which assessment most strongly indicates a bowel obstruction?
A. Soft abdomen
B. High-pitched tinkling bowel sounds
C. Loose stools
,D. Bruits over the aorta
Rationale: High-pitched sounds occur early in mechanical obstruction
due to increased peristaltic activity.
4. A client with cirrhosis has a distended abdomen. The nurse suspects
ascites due to which mechanism?
A. Excess ADH
B. Decreased albumin production
C. Increased bile excretion
D. High RBC levels
Rationale: Hypoalbuminemia lowers oncotic pressure, causing fluid
leakage into the peritoneal cavity.
5. Which manifestation is most consistent with mesenteric artery
occlusion?
A. Mild cramping
B. Hypoactive bowel sounds
C. Sudden severe abdominal pain out of proportion to exam
D. Intermittent nausea
Rationale: Acute ischemia causes extreme pain despite minimal
physical exam findings.
6. A client presents with hematemesis. Which action is priority?
A. Insert NG tube
B. Assess airway and hemodynamic stability
C. Administer antacids
D. Provide oral antiemetics
,Rationale: Upper GI bleeding threatens airway and circulation,
requiring immediate stabilization.
7. Which finding indicates possible perforated peptic ulcer?
A. Gradual pain relief
B. Hyperactive bowel sounds
C. Sudden severe “board-like” abdomen
D. Bloating
Rationale: Perforation causes peritonitis with rigid abdomen and
sudden severe pain.
8. In Crohn’s disease, which complication is most characteristic?
A. Only superficial mucosal involvement
B. Continuous lesions
C. Confined to colon only
D. Fistula formation
Rationale: Crohn’s causes transmural inflammation leading to fistulas
and strictures.
9. A client with hepatic encephalopathy has increasing confusion.
Which lab is most relevant?
A. ALT
B. Bilirubin
C. PT/INR
D. Ammonia
Rationale: Elevated ammonia contributes directly to encephalopathy.
, 10. Which intervention prevents dumping syndrome after
gastrectomy?
A. Increase fluid intake with meals
B. Increase carbohydrate intake
C. Eat small, frequent, high-protein meals
D. Eat high-fiber foods
Rationale: High-protein, small meals slow gastric emptying and
reduce rapid fluid shifts.
11. A client with cirrhosis is at risk for spontaneous bacterial
peritonitis. Which symptom is most indicative?
A. Mild jaundice
B. Weight gain
C. Fever and abdominal tenderness
D. Fatigue
Rationale: Fever and tenderness suggest infection in ascitic fluid,
which is life-threatening.
12. Which lab value indicates worsening liver function in a client with
chronic hepatitis?
A. Creatinine 1.0 mg/dL
B. ALT 220 U/L
C. Hemoglobin 14 g/dL
D. Sodium 140 mEq/L
Rationale: Elevated ALT reflects hepatocellular injury, indicating
disease progression.
(ADVANCED LEVEL – 100 QUESTIONS)
Answers and rationales
1. A client with acute pancreatitis reports severe epigastric pain
radiating to the back. Which intervention is the priority?
A. Provide ice chips
B. Administer IV opioids as prescribed
C. Place the client supine
D. Encourage oral fluids
Rationale: Severe pancreatitis pain requires rapid opioid
administration to reduce sympathetic stress and metabolic demand.
2. A nurse reviews labs for a client with ulcerative colitis. Which
finding requires immediate action?
A. Hgb 12.5 g/dL
B. WBC 9,000/mm³
C. K+ 2.9 mEq/L
D. Albumin 3.4 g/dL
Rationale: Severe diarrhea in UC can cause life-threatening
hypokalemia requiring urgent correction.
3. Which assessment most strongly indicates a bowel obstruction?
A. Soft abdomen
B. High-pitched tinkling bowel sounds
C. Loose stools
,D. Bruits over the aorta
Rationale: High-pitched sounds occur early in mechanical obstruction
due to increased peristaltic activity.
4. A client with cirrhosis has a distended abdomen. The nurse suspects
ascites due to which mechanism?
A. Excess ADH
B. Decreased albumin production
C. Increased bile excretion
D. High RBC levels
Rationale: Hypoalbuminemia lowers oncotic pressure, causing fluid
leakage into the peritoneal cavity.
5. Which manifestation is most consistent with mesenteric artery
occlusion?
A. Mild cramping
B. Hypoactive bowel sounds
C. Sudden severe abdominal pain out of proportion to exam
D. Intermittent nausea
Rationale: Acute ischemia causes extreme pain despite minimal
physical exam findings.
6. A client presents with hematemesis. Which action is priority?
A. Insert NG tube
B. Assess airway and hemodynamic stability
C. Administer antacids
D. Provide oral antiemetics
,Rationale: Upper GI bleeding threatens airway and circulation,
requiring immediate stabilization.
7. Which finding indicates possible perforated peptic ulcer?
A. Gradual pain relief
B. Hyperactive bowel sounds
C. Sudden severe “board-like” abdomen
D. Bloating
Rationale: Perforation causes peritonitis with rigid abdomen and
sudden severe pain.
8. In Crohn’s disease, which complication is most characteristic?
A. Only superficial mucosal involvement
B. Continuous lesions
C. Confined to colon only
D. Fistula formation
Rationale: Crohn’s causes transmural inflammation leading to fistulas
and strictures.
9. A client with hepatic encephalopathy has increasing confusion.
Which lab is most relevant?
A. ALT
B. Bilirubin
C. PT/INR
D. Ammonia
Rationale: Elevated ammonia contributes directly to encephalopathy.
, 10. Which intervention prevents dumping syndrome after
gastrectomy?
A. Increase fluid intake with meals
B. Increase carbohydrate intake
C. Eat small, frequent, high-protein meals
D. Eat high-fiber foods
Rationale: High-protein, small meals slow gastric emptying and
reduce rapid fluid shifts.
11. A client with cirrhosis is at risk for spontaneous bacterial
peritonitis. Which symptom is most indicative?
A. Mild jaundice
B. Weight gain
C. Fever and abdominal tenderness
D. Fatigue
Rationale: Fever and tenderness suggest infection in ascitic fluid,
which is life-threatening.
12. Which lab value indicates worsening liver function in a client with
chronic hepatitis?
A. Creatinine 1.0 mg/dL
B. ALT 220 U/L
C. Hemoglobin 14 g/dL
D. Sodium 140 mEq/L
Rationale: Elevated ALT reflects hepatocellular injury, indicating
disease progression.
