NSG 123 Medical Surgical Nursing Exam 2 - (Latest 2026/2027 Update) GI
Disorders, Cholelithiasis, IBD, Obesity & Bariatric Surgery | Q&A | Grade A |
100% Correct (Verified Answers)
Subject: Medical-Surgical Nursing / Gastrointestinal Disorders
Source: NSG 123 Exam 2 – Comprehensive Review
Format: Q&A Guide with Clinical Rationale
1: What do you give a patient receiving a TPN to prevent hypoglycemia?
Correct Answer: D5W or D10W (dextrose solutions to prevent rebound hypoglycemia when TPN is
discontinued).
1. TPN has high glucose concentration; abrupt discontinuation causes hypoglycemia.
2. Taper TPN rate or infuse D5W/D10W before discontinuing.
3. Monitor blood glucose frequently.
2: How often should 30mL of water be flushed through an NG tube for assessment of function?
Correct Answer: Every 4 hours (to maintain patency and assess function).
1. Flush q4h during continuous suction/feeding.
2. Also flush after each medication and feeding.
3. Use sterile or tap water per protocol.
3: What time of day should Famotidine (Pepcid) be administered?
Correct Answer: Bedtime (once daily dosing at HS suppresses nocturnal acid secretion).
1. H2 blockers taken at bedtime reduce nighttime acid production.
2. Also effective for GERD prevention.
3. Multiple daily doses with meals and bedtime.
4: What testing would you expect to see from a patient receiving parenteral nutrition?
Correct Answer: Blood glucose (monitor for hyperglycemia).
1. TPN has high glucose concentration (20-70% dextrose).
2. Check blood glucose q4-6h initially.
3. May require insulin coverage.
5: What medication requires a patient take A, D, E, & K supplements?
Correct Answer: Orlistat (Xenical) - lipase inhibitor that prevents fat-soluble vitamin absorption.
1. Orlistat blocks absorption of 30% of dietary fat.
2. Fat-soluble vitamins (A, D, E, K) malabsorbed.
3. Take multivitamin at least 2 hours before or after orlistat.
,6: Which weight loss drug requires a fat soluble vitamin supplement?
Correct Answer: Orlistat (Xenical).
1. Lipase inhibitor prevents fat digestion/absorption.
3. Take multivitamin containing A, D, E, K daily.
7: Purpose of Medication in Cholelithiasis
Correct Answer: Reduces hepatic production of cholesterol. Lowers cholesterol content of bile,
facilitating gradual dissolution of cholesterol gallstones. Examples: Chenodiol (Chenodal, Chenix) is a
naturally occurring bile acid.
1. Ursodeoxycholic acid (UDCA) and chenodiol.
2. Takes 6-12 months for dissolution.
3. Only for small, radiolucent cholesterol stones.
8: The disease characterized by blood stools and left lower quadrant pain
Correct Answer: Ulcerative Colitis.
1. Bloody diarrhea hallmark symptom.
2. LLQ pain common (sigmoid colon involvement).p>
3. Continuous colonic inflammation starting at rectum.
9: A patient has a NG tube placed and running suction. What lab should the nurse monitor?
Correct Answer: BMP (electrolytes, BUN, creatinine) - monitor for metabolic alkalosis and
dehydration.
1. NG suction removes gastric acid (HCl) → metabolic alkalosis.
2. Monitor potassium, sodium, chloride.
3. Risk of hypokalemia, hypochloremia.
10: A patient is experiencing diarrhea secondary to ulcerative colitis, do you treat it?
Correct Answer: No, their body is flushing out the infection (diarrhea is symptom of active disease,
treat underlying inflammation).
1. Antidiarrheals may cause toxic megacolon.
2. Treat underlying IBD with anti-inflammatories.
3. Focus on hydration and electrolyte management.
11: Main Cause of Cholelithiasis
Correct Answer: Cholesterol stones account for most of the remaining 75% of cases of gallbladder
disease in the United States.
1. Cholesterol supersaturation in bile.
2. Risk factors: female, overweight, age >40, multiparity.
3. Pigment stones (bilirubin) account for 10-25%.
, 12: Symptoms of Cholelithiasis
Correct Answer: Nausea, vomiting, right upper quadrant abdominal pain or epigastric pain that
radiates to the right shoulder especially after meals when the gallbladder is stimulated to release bile.
1. Biliary colic: pain after fatty meal.
2. Pain radiates to right shoulder (phrenic nerve referral).
3. Murphy sign: inspiratory arrest with palpation.
13: Patient Teaching for Cholelithiasis
Correct Answer: The diet immediately after an episode is usually low-fat liquids. These can include
powdered supplements high in protein and carbohydrate stirred into skim milk.
1. Avoid fatty foods (trigger gallbladder contraction).
2. Progress to low-fat solid foods as tolerated.
3. Avoid eggs, cream, pork, fried foods, cheese.
14: Purpose of Adding Fat to Emulsion to TPN
Correct Answer: Fat emulsions (lipids) are usually given to clients receiving TPN to provide
supplemental kilocalories and prevent fatty acid deficiency. Fat emulsions can also control
hyperglycemia during periods of stress.
1. Provides essential fatty acids (linoleic, linolenic).
2. Decreases glucose load, helps glycemic control.
3. Prevents essential fatty acid deficiency.
15: Carbon Dioxide in Laparoscopic Cholecystectomy
Correct Answer: Carbon dioxide is used during the procedure. Explain to the patient that they might
feel pain in the right shoulder or scapular area (from migration of the carbon dioxide used to insufflate
the abdominal cavity during the procedure).
1. CO₂ insufflation creates working space.
2. Referred shoulder pain from diaphragmatic irritation.
3. Heating pad, ambulation helps dissipate gas.
16: Laparoscopic Cholecystectomy 3 Things to do After
Correct Answer: Recommend a heating pad for 15 to 20 minutes hourly or encourage the client to
ambulate frequently to reduce the bloating. Manage nausea assess bowel sounds for further
complications.
1. Ambulation promotes gas expulsion, prevents DVT.
2. Heating pad for referred shoulder pain.
3. Monitor for fever, vomiting, distention (complications).
Disorders, Cholelithiasis, IBD, Obesity & Bariatric Surgery | Q&A | Grade A |
100% Correct (Verified Answers)
Subject: Medical-Surgical Nursing / Gastrointestinal Disorders
Source: NSG 123 Exam 2 – Comprehensive Review
Format: Q&A Guide with Clinical Rationale
1: What do you give a patient receiving a TPN to prevent hypoglycemia?
Correct Answer: D5W or D10W (dextrose solutions to prevent rebound hypoglycemia when TPN is
discontinued).
1. TPN has high glucose concentration; abrupt discontinuation causes hypoglycemia.
2. Taper TPN rate or infuse D5W/D10W before discontinuing.
3. Monitor blood glucose frequently.
2: How often should 30mL of water be flushed through an NG tube for assessment of function?
Correct Answer: Every 4 hours (to maintain patency and assess function).
1. Flush q4h during continuous suction/feeding.
2. Also flush after each medication and feeding.
3. Use sterile or tap water per protocol.
3: What time of day should Famotidine (Pepcid) be administered?
Correct Answer: Bedtime (once daily dosing at HS suppresses nocturnal acid secretion).
1. H2 blockers taken at bedtime reduce nighttime acid production.
2. Also effective for GERD prevention.
3. Multiple daily doses with meals and bedtime.
4: What testing would you expect to see from a patient receiving parenteral nutrition?
Correct Answer: Blood glucose (monitor for hyperglycemia).
1. TPN has high glucose concentration (20-70% dextrose).
2. Check blood glucose q4-6h initially.
3. May require insulin coverage.
5: What medication requires a patient take A, D, E, & K supplements?
Correct Answer: Orlistat (Xenical) - lipase inhibitor that prevents fat-soluble vitamin absorption.
1. Orlistat blocks absorption of 30% of dietary fat.
2. Fat-soluble vitamins (A, D, E, K) malabsorbed.
3. Take multivitamin at least 2 hours before or after orlistat.
,6: Which weight loss drug requires a fat soluble vitamin supplement?
Correct Answer: Orlistat (Xenical).
1. Lipase inhibitor prevents fat digestion/absorption.
3. Take multivitamin containing A, D, E, K daily.
7: Purpose of Medication in Cholelithiasis
Correct Answer: Reduces hepatic production of cholesterol. Lowers cholesterol content of bile,
facilitating gradual dissolution of cholesterol gallstones. Examples: Chenodiol (Chenodal, Chenix) is a
naturally occurring bile acid.
1. Ursodeoxycholic acid (UDCA) and chenodiol.
2. Takes 6-12 months for dissolution.
3. Only for small, radiolucent cholesterol stones.
8: The disease characterized by blood stools and left lower quadrant pain
Correct Answer: Ulcerative Colitis.
1. Bloody diarrhea hallmark symptom.
2. LLQ pain common (sigmoid colon involvement).p>
3. Continuous colonic inflammation starting at rectum.
9: A patient has a NG tube placed and running suction. What lab should the nurse monitor?
Correct Answer: BMP (electrolytes, BUN, creatinine) - monitor for metabolic alkalosis and
dehydration.
1. NG suction removes gastric acid (HCl) → metabolic alkalosis.
2. Monitor potassium, sodium, chloride.
3. Risk of hypokalemia, hypochloremia.
10: A patient is experiencing diarrhea secondary to ulcerative colitis, do you treat it?
Correct Answer: No, their body is flushing out the infection (diarrhea is symptom of active disease,
treat underlying inflammation).
1. Antidiarrheals may cause toxic megacolon.
2. Treat underlying IBD with anti-inflammatories.
3. Focus on hydration and electrolyte management.
11: Main Cause of Cholelithiasis
Correct Answer: Cholesterol stones account for most of the remaining 75% of cases of gallbladder
disease in the United States.
1. Cholesterol supersaturation in bile.
2. Risk factors: female, overweight, age >40, multiparity.
3. Pigment stones (bilirubin) account for 10-25%.
, 12: Symptoms of Cholelithiasis
Correct Answer: Nausea, vomiting, right upper quadrant abdominal pain or epigastric pain that
radiates to the right shoulder especially after meals when the gallbladder is stimulated to release bile.
1. Biliary colic: pain after fatty meal.
2. Pain radiates to right shoulder (phrenic nerve referral).
3. Murphy sign: inspiratory arrest with palpation.
13: Patient Teaching for Cholelithiasis
Correct Answer: The diet immediately after an episode is usually low-fat liquids. These can include
powdered supplements high in protein and carbohydrate stirred into skim milk.
1. Avoid fatty foods (trigger gallbladder contraction).
2. Progress to low-fat solid foods as tolerated.
3. Avoid eggs, cream, pork, fried foods, cheese.
14: Purpose of Adding Fat to Emulsion to TPN
Correct Answer: Fat emulsions (lipids) are usually given to clients receiving TPN to provide
supplemental kilocalories and prevent fatty acid deficiency. Fat emulsions can also control
hyperglycemia during periods of stress.
1. Provides essential fatty acids (linoleic, linolenic).
2. Decreases glucose load, helps glycemic control.
3. Prevents essential fatty acid deficiency.
15: Carbon Dioxide in Laparoscopic Cholecystectomy
Correct Answer: Carbon dioxide is used during the procedure. Explain to the patient that they might
feel pain in the right shoulder or scapular area (from migration of the carbon dioxide used to insufflate
the abdominal cavity during the procedure).
1. CO₂ insufflation creates working space.
2. Referred shoulder pain from diaphragmatic irritation.
3. Heating pad, ambulation helps dissipate gas.
16: Laparoscopic Cholecystectomy 3 Things to do After
Correct Answer: Recommend a heating pad for 15 to 20 minutes hourly or encourage the client to
ambulate frequently to reduce the bloating. Manage nausea assess bowel sounds for further
complications.
1. Ambulation promotes gas expulsion, prevents DVT.
2. Heating pad for referred shoulder pain.
3. Monitor for fever, vomiting, distention (complications).
