NUR 242 Exam 3 (2) – Medical-Surgical Nursing Concepts | Complete Questions, Answers & Rationales | Galen College | Updated 2026–2027.

Galen NUR 242 (NUR242) Medical-Surgical Nursing Concepts – Exam 3 | Questions & Answers with Rationales | Latest 2026–2027 1. An older adult client is being prepared for flu prevention teaching. When instructing on the differences between live and killed virus vaccines, which guideline is correct for immunocompromised individuals? A. They should receive a half-dose of the live virus vaccine with prophylactic antivirals. B. They should receive the live virus vaccine to ensure active immunity. C. They should only receive the killed virus vaccine. D. They are contraindicated from receiving any form of the flu vaccine. 2. A client is diagnosed with empyema. The nurse understands that this condition is most commonly caused by which underlying respiratory disorder? A. Asthma B. Pneumonia C. Chronic Obstructive Pulmonary Disease (COPD) D. Obstructive Sleep Apnea (OSA) 3. The nurse is providing dietary teaching to a client with Chronic Obstructive Pulmonary Disease (COPD). Which nutritional instruction should be included? A. Consume three large meals daily to minimize preparation energy. B. Restrict fluid intake to prevent fluid volume excess. C. Maintain a high-carbohydrate diet to sustain quick energy levels. D. Increase high-protein food intake and consume frequent meals. 4. During physical assessment of a client with COPD, the nurse expects to observe which classic sign and symptom? A. Pectus excavatum and rapid, shallow inspirations with rapid expirations. B. Asymmetrical chest expansion with a long inspiration phase. C. Barrel chest and a short inspiration with a long expiration phase. D. Sunken chest and equal inspiration and expiration times. 5. A client experiencing a COPD exacerbation has arterial blood gas (ABG) results drawn. Which typical ABG alteration does the nurse anticipate? A. Decreased PaO2 and decreased PaCO2. B. Increased PaO2 and decreased PaCO2. C. Increased pH and decreased PaCO2. D. Decreased PaO2 and increased PaCO2. 6. An asthma client is discussing triggers with the nurse. Which of the following substances should the nurse instruct the client to avoid? A. Organic cotton bedding and low-sodium salts. B. Monosodium glutamate (MSG) and dust mites. C. High-protein dairy items and tap water. D. Purified bottled water and citrus fruits. 7. The nurse is caring for an asthmatic client who has been wheezing continuously. Suddenly, the wheezing stops. What is the nurse's priority action? A. Encourage the client to use a spacer for their maintenance corticosteroid. B. Document the finding as a sign of bronchospasm resolution. C. Place the client in a supine position and re-assess in 15 minutes. D. Intervene immediately as this indicates a complete airway occlusion. 8. A client is prescribed Ipratropium (Atrovent) for bronchodilation. Which common side effect should the nurse include in the teaching plan? A. Dry mouth; instruct the client to increase fluid intake. B. Bradycardia; instruct the client to monitor their pulse daily. C. Excessive salivation; instruct the client to spit out excess saliva. D. Diarrhea; instruct the client to follow a low-fiber diet. 9. When assessing an older adult client for acute respiratory illness, which clinical finding requires immediate intervention by the nurse? A. An elevated temperature of 100.4°F. B. Mild fatigue after physical activity. C. A sudden change in level of consciousness (LOC). D. A productive cough with clear mucus. 10. The nurse is teaching a client with obstructive sleep apnea about continuous positive airway pressure (CPAP) therapy. Which statement should be included? A. The CPAP machine directly treats the underlying metabolic cause of sleep apnea. B. The CPAP mask should be fitted loosely to allow air to escape easily. C. Ensure a proper mask fit and use the CPAP machine every night. D. Use the CPAP machine only during periods of severe daytime sleepiness. 11. What is considered a classic behavioral symptom or sign of obstructive sleep apnea (OSA)? A. Increased concentration B. Auditory hallucinations C. Irritability D. Euphoria 12. A client with active pulmonary tuberculosis (TB) is admitted to the hospital. Which transmission-based precaution is mandatory for this client? A. Airborne precautions, utilizing an N95 respirator for health care workers. B. Contact precautions, requiring gown and gloves only. C. Protective isolation, requiring a positive-pressure room. D. Droplet precautions, requiring a standard surgical mask. 13. A hospital client on airborne precautions for TB needs to be transported to the radiology department. Which action is correct? A. No mask is needed for the client; the transport staff must wear N95 masks. B. Have the client wear a protective face shield and a disposable gown. C. Place a surgical mask on the client during transport. D. Place an N95 respirator on the client during transport. 14. The nurse is teaching a client who has been prescribed Pyrazinamide for tuberculosis. Which self-care instruction is a priority? A. Avoid eating red meat to prevent acute gouty arthritis. B. Take the medication with an antacid to prevent severe gastric erosion. C. Expect your skin and urine to turn an orange-red color. D. Wear protective clothing and sunscreen when outdoors due to photosensitivity. 15. A client taking Rifampin for tuberculosis reports that their skin and urine have turned an orange color. What is the nurse's best response? A. Notify the healthcare provider immediately to obtain a renal function panel. B. Administer a dose of vitamin K to correct potential coagulation failure. C. Reassure the client that this is an expected, harmless side effect of the drug. D. Instruct the client to stop the drug immediately as this indicates hepatotoxicity. 16. The nurse is monitoring a client on oxygen therapy via a non-rebreather mask. To ensure safe oxygen delivery, what must the nurse verify? A. The humidification bottle must be continuously bubbling. B. The reservoir bag should stay fully inflated with each breath. C. The reservoir bag must completely deflate on each inspiration. D. The oxygen flow meter must be set between 2 and 4 liters per minute. 17. The nurse is assessing a closed-chest drainage system (chest tube). Which finding regarding the water-seal chamber is correct? A. The water level in the seal chamber should remain perfectly static with breathing. B. Continuous, vigorous bubbling is expected and indicates proper function. C. The water-seal chamber should not exhibit continuous bubbling. D. The water-seal chamber must be suctioned every 8 hours. 18. When managing a client's chest tube, which action should the nurse avoid to prevent lung trauma and high intrathoracic pressure? A. Keeping the drainage system below the level of the client's chest. B. Squeezing or stripping the tubing down to prevent clots. C. Assessing the volume and color of drainage every shift. D. Taping the connections securely to prevent accidental disconnection. 19. A client has a chest tube placed for a pneumothorax. Within the first 24 hours post-insertion, the chest tube suddenly stops draining. What is the nurse's first action? A. Notify the healthcare provider immediately. B. Irrigate the chest tube with 50 mL of sterile normal saline. C. Administer a dose of pain medication and reposition the client. D. Clamp the chest tube and wait 30 minutes to see if drainage resumes. 20. A nurse is monitoring a client post-thoracentesis. Which group of signs and symptoms indicates the development of a pneumothorax? A. Deep, slow respirations with prolonged expirations. B. Shallow breathing and an increased respiratory rate. C. A sudden decrease in blood pressure with bradycardia. D. Bilateral vesicular breath sounds and a decreased heart rate. 21. The nurse is teaching a client with pulmonary emphysema how to perform pursed-lip breathing. Which instruction is correct? A. Exhale rapidly through the nose while holding the mouth completely open. B. Puff out the cheeks fully and blow out hard and fast during inspiration. C. Breathe out slowly through pursed lips without puffing out the cheeks, especially during physical activity. D. Inhale deeply through pursed lips and hold the breath for 10 seconds. 22. During auscultation of the lungs, the nurse hears hollow, tubular, high-pitched sounds over the trachea. How should the nurse document these sounds? A. Normal vesicular breath sounds B. Normal bronchial breath sounds C. Bronchovesicular breath sounds D. Adventitious wheezing sounds 23. The nurse auscultates a client's chest and hears soft, low-pitched sounds with a rustling quality during inspiration, which are softer during expiration. These are heard over most of the lung field. What are these sounds? A. Bronchial breath sounds B. Bronchovesicular breath sounds C. Rhonchi D. Vesicular breath sounds 24. A client's lung sounds are described as continuous, musical, and high-pitched with a squeaking quality. The nurse recognizes these as which type of adventitious sound? A. Rhonchi B. Coarse crackles C. Wheezes D. Fine crackles 25. The nurse is suctioning a client with a tracheostomy. Which technique is correct to prevent mucosal damage and hypoxia? A. Hyperoxygenate for 1 to 5 minutes beforehand, insert without suction, and apply suction in a twirling motion while withdrawing for no more than 10 seconds. B. Apply continuous suction while inserting the catheter, and limit suction to 30 seconds. C. Apply intermittent suction while inserting, and twist the catheter continuously for 20 seconds. D. Aspirate continuously during insertion and withdrawal, keeping suction active for 15 seconds. 26. The nurse is performing tracheostomy care and needs to change the soiled ties. To prevent accidental decannulation, what is the best nursing action? A. Apply the new ties prior to removing the old soiled ties, preferably with the assistance of a co-worker. B. Loosen the old ties, clean the stoma, and apply the new ties allowing three fingers of slack. C. Keep the client in a supine position and hold the flange down firmly with one hand while tying the new ties. D. Cut the old ties first, clean the neck, and then tie the new ones tightly around the neck. 27. Which of the following emergency equipment must the nurse keep available at the bedside of a client with a tracheostomy at all times? A. A second (emergency) tracheostomy tube and an obturator. B. A high-flow non-rebreather mask and a spare oxygen tank. C. A laryngeal mask airway (LMA) and a scalpel. D. An extra-large sterile chest tube kit. 28. The nurse is preparing to administer an albuterol metered-dose inhaler (MDI) with a spacer to an asthmatic client. What instruction is correct? A. Tell the client to hold the spacer 3 inches away from the open mouth during medication release. B. Instruct the client to breathe out quickly and forcefully immediately after medication release. C. Instruct the client to breathe in slowly and deeply after releasing the medication into the spacer. D. Instruct the client to rinse their mouth with water before taking the inhalation. 29. An asthmatic client is performing peak flow monitoring at home. The client's peak expiratory flow is in the red zone. The nurse understands this is defined as what percentage of their personal best? A. Between 50% and 80% B. Less than 50% C. Exactly 100% D. Greater than 80% 30. A client is admitted with suspected Severe Acute Respiratory Syndrome (SARS). Which infection control measure is correct? A. Restrict the client to standard precautions with no mask requirement during transport. B. Place the client in a positive-pressure room with standard contact precautions. C. Place the client in a negative-pressure room and strictly follow droplet and standard precautions. D. Maintain the client in a semi-private room with a portable HEPA filter. 31. The nurse is assessing a client with suspected Gastroesophageal Reflux Disease (GERD). Which of the following foods should the client be instructed to avoid? A. Lean poultry, white rice, oatmeal, and clear broths. B. Eggs, whole wheat bread, bananas, and green beans. C. Chocolate, tomatoes, caffeine, and spicy or fried foods. D. Cottage cheese, applesauce, melons, and carrots. 32. A client with severe GERD complains of substernal burning pain that radiates to the neck and jaw. What is an important clinical implication of this symptom? A. This indicates the immediate development of an esophageal stricture. B. The client may mistake severe heartburn for a myocardial infarction (MI). C. The pain suggests the client has a strangulated diaphragmatic hernia. D. This confirms the presence of active duodenal ulceration. 33. Which positional change should the nurse instruct a GERD client to avoid, particularly after eating? A. Sitting upright in a firm chair. B. Walking slowly around the room. C. Standing with the head slightly elevated. D. Lying down flat or bending over. 34. The nurse is teaching a client with a hiatal hernia how to manage their condition. Which instruction should be included? A. Wear a tight-fitting abdominal binder at all times. B. Elevate the head of the bed during sleep and remain upright after meals. C. Consume two to three large meals daily instead of multiple small meals. D. Engage in vigorous physical exercise immediately after eating. 35. A client is scheduled for an Esophagogastroduodenoscopy (EGD). Which medication-related teaching should the nurse perform pre-procedure? A. Double the daily dose of oral anticoagulants on the day prior to the procedure. B. Increase the dose of aspirin the morning of the procedure to prevent clotting. C. Discontinue aspirin, anticoagulants, and NSAIDs at least 5 to 7 days before the procedure. D. Take all prescribed NSAIDs with a small sip of water 1 hour before the EGD. 36. A client has just returned to the unit after undergoing an EGD. What is the nurse's priority assessment? A. Encourage the client to drink a large glass of iced water. B. Auscultate for bowel sounds in all four quadrants for 5 minutes. C. Measure the client's abdominal girth immediately. D. Assess for the return of the gag reflex before allowing the client to eat or drink. 37. The nurse is planning care for a client admitted with acute gastritis. What is the priority nursing diagnosis or focus? A. Impaired physical mobility related to abdominal splinting. B. Ineffective airway clearance related to gastric hyperacidity. C. Imbalanced nutrition: more than body requirements. D. Risk for deficient fluid volume, requiring hydration and intake & output assessment. 38. A client is diagnosed with a duodenal ulcer. The nurse knows that this type of peptic ulcer is most commonly associated with which infection? A. Shigella dysenteriae B. Helicobacter pylori (H. pylori) C. Giardia lamblia D. Streptococcus pneumoniae 39. The nurse is documenting pain in a client with a suspected gastric ulcer. At which time does the nurse anticipate the client's pain will typically occur or worsen? A. Right after a meal, and also late at night when the stomach is empty. B. Erratically throughout the day, without any relationship to meals. C. First thing in the morning when digestive juices are lowest. D. Consistently 3 to 4 hours after a meal, relieved by food ingestion. 40. What is a major physiological reason why a client with peptic ulcer disease (PUD) must attend a smoking cessation course? A. Smoking directly increases the bacterial load of H. pylori in the duodenum. B. Nicotine neutralizes the therapeutic effect of prescribed proton pump inhibitors. C. Smoking causes immediate hypersecretion of alkaline pancreatic enzymes. D. Smoking accelerates gastric emptying of liquids, promotes reflux, and reduces mucosal blood flow. 41. The nurse is caring for a client post-gastrectomy. Which long-term intervention is essential to prevent surgically induced pernicious anemia? A. Lifetime vitamin B12 injections. B. A high-carbohydrate, low-protein liquid diet. C. Daily oral iron supplements taken with citrus juices. D. Routine administration of oral folic acid. 42. Which diet and lifestyle factor is associated with an increased risk of developing Irritable Bowel Syndrome (IBS)? A. High-protein diet consisting primarily of egg whites and quinoa. B. Diet rich in lean poultry, white rice, and high fluid intake. C. Diet high in fats, gas-producing foods, carbonated beverages, caffeine, and stress. D. Regular daily exercise and routine physical examinations. 43. The nurse is reviewing the diagnostic criteria for morbid obesity. At what point is a client considered morbidly obese? A. When they exceed their recommended body weight by 100%. B. When they exceed their recommended body weight by 70%. C. When they exceed their recommended body weight by 50%. D. When they exceed their recommended body weight by 90%. 44. A client is 6 feet tall (72 inches) and weighs 150 pounds. According to the textbook review, which value represents their calculated Body Mass Index (BMI)? A. 43.1 B. 66.3 C. 25.0 D. 21.0 45. How is a laparoscopic adjustable gastric banding procedure best described? A. An obstructive bariatric surgery. B. A restrictive bariatric surgery. C. A combined restrictive and malabsorptive surgery. D. A malabsorptive bariatric surgery. 46. The nurse is caring for a client with a gastrostomy tube who receives a bolus feeding of 200 mL every 4 hours. Before administering the feeding, the nurse aspirates a residual of 100 mL. Which action is correct? A. Administer the full 200 mL feeding as scheduled. B. Document the residual and hold the scheduled feeding. C. Discard the residual and administer the full 200 mL feeding. D. Record the residual and administer 100 mL of the scheduled feeding. 47. What is the primary causative agent or condition associated with the development of Barrett's esophagus? A. Gastroesophageal Reflux Disease (GERD) B. Esophageal polyps C. Anorexia nervosa D. Eating hot, spicy foods 48. A nurse is caring for a client who is postoperative after an esophageal resection. Shortly after a tube feeding is initiated, the client suddenly becomes dyspneic and complains of substernal pain. What is the nurse's priority action? A. Ambulate the client in the hallway. B. Notify the charge nurse. C. Stop the feeding immediately. D. Reassure the client that this pain is normal. 49. The nurse is reviewing the health history of a client with suspected oral cancer. Which finding in the history provides the strongest supportive data for this diagnosis? A. Reports of chronic dry mouth (xerostomia) B. History of recurrent oral herpes simplex C. Presence of oral leukoplakia D. History of oral yeast infections (thrush) 50. A client is prescribed Orlistat (Xenical) for weight loss. The nurse should instruct the client that they may experience which common side effect? A. Significant hypoglycemia and bradycardia. B. Urinary retention and skin rash. C. Diarrhea, abdominal cramping, and nausea. D. Severe constipation and dry mouth. 51. Which type of hernia is considered a medical emergency because it cuts off blood supply and can rapidly lead to bowel necrosis? A. Direct inguinal hernia B. Irreducible hernia C. Strangulated hernia D. Indirect inguinal hernia 52. A client with a history of a chronic incarcerated hernia suddenly complains of severe abdominal pain and vomits dark material with a fecal odor. The nurse recognizes these findings as indicators of which complication? A. Acute gastroenteritis B. Hepatitis A transmission C. Duodenal ulcer perforation D. Complete intestinal obstruction 53. The nurse is teaching a client about an upcoming hernioplasty. How should the nurse describe this surgical procedure? A. Manually reducing the hernia using a high-pressure binder. B. Resecting the herniated bowel and creating a temporary colostomy. C. Applying a customized external truss to support the weakness. D. Reducing the hernia and sewing a synthetic mesh over the abdominal wall defect. 54. A client taking bismuth subsalicylate (Pepto-Bismol) is concerned about their stool color. The nurse should educate the client about which common, harmless side effect? A. Black stools B. Clay-colored stools C. Bright red streaks in the stool D. Green liquid stools 55. Which age-related physical change predisposes older adults to the development of diverticula? A. Hyperactive intestinal motility that causes rapid bowel transit. B. Chronic constipation, which increases intra-abdominal pressure and allows mucosal herniation. C. A natural thickening of the muscular layer of the colon. D. An increase in salivary enzymes that degrades the mucosal barrier. 56. A client is diagnosed with diverticulitis. What is the primary clinical reason why this condition requires prompt medical treatment? A. It can cause the sudden development of acute appendicitis. B. It leads to a complete lack of intrinsic factor and pernicious anemia. C. An inflamed diverticulum can perforate, leading to life-threatening peritonitis. D. The inflammation always results in severe duodenal ulceration. 57. Which of the following is a classic example of a mechanical bowel obstruction that the nurse should include in a client teaching session? A. A temporary lack of autonomic innervation to the intestine. B. Bowel hypomotility induced by antidiarrheal medications. C. A tumor that obstructs the lumen of the bowel. D. Paralytic ileus causing cessation of peristalsis. 58. The nurse is aware that a client with chronic ulcerative colitis is at a significantly higher risk for developing which long-term complication? A. Volvulus B. Intussusception C. Colon cancer D. Recurrent urinary tract infections 59. The nurse is teaching a client with inflammatory bowel disease (IBD) about recommended nutritional choices. Which menu selection indicates that teaching was successful? A. Red meat and whole grains B. Green leafy vegetables and high-fat cheese C. Mushy pureed foods only D. White rice and lean poultry 60. A client with peritonitis who had developed a paralytic ileus is assessed by the nurse. The nurse notes that the client has just passed flatus. What is the clinical significance of this finding? A. It indicates worsening gas accumulation and distention. B. It suggests that the nasogastric decompression tube is malfunctioning. C. It represents a normal response to forceful vomiting. D. It indicates the return of intestinal peristalsis. 61. A client with colon cancer is prescribed Bevacizumab (Avastin). The nurse explains that this medication slows cancer cell growth by which mechanism? A. It directly damages the cellular DNA of healthy intestinal tissue. B. It changes the pH of the intracellular fluid to cause lysis. C. It reduces blood flow to the tumor (antiangiogenesis). D. It overhydrates the tumor cells, causing them to burst. 62. What is a highest-priority nursing intervention for a client who is immediately postoperative following the creation of a new ileostomy? A. Change the ostomy appliance wafer every 4 hours. B. Provide emotional support and assist with body image adjustment. C. Administer a strong laxative or stool softener. D. Offer frequent, large solid snacks to stimulate output. 63. A client asks the nurse about the major advantage of receiving a Kock pouch ileostomy compared to a traditional ileostomy. What should the nurse state? A. The client does not have to wear an external collection device. B. The client can expel stool normally from the rectum. C. The pouch only requires evacuation once every 24 hours. D. The pouch can be easily reconnected to the colon later. 64. The nurse is assessing a client's transverse colostomy stoma 1 day postoperative. Which stoma characteristic requires immediate notification of the charge nurse or physician? A. A moist, glistening stoma surface. B. Scant, marginal bleeding from the incision line. C. Mild swelling or edema around the stoma. D. A purplish-red or dusky stoma color. 65. A client with a 4-day-old ileostomy complains of severe abdominal cramping, and the nurse notes a sudden drop in effluent output. Bowel sounds are rapid with a "tinkling" sound. What is the nurse's priority action? A. Turn the client onto their left side to promote drainage. B. Notify the charge nurse or physician immediately, as this indicates an obstruction. C. Irrigate the ileostomy with 500 mL of warm water and a laxative. D. Ambulate the client vigorously down the hallway to relieve gas. 66. An older adult client is hospitalized with diverticulitis. Which analgesic medication is preferred for pain management due to the low risk of toxic metabolite accumulation? A. Nalbuphine hydrochloride (Nubain) B. Meperidine (Demerol) C. Naloxone (Narcan) D. Morphine 67. The nurse is teaching a client with diverticular disease about high-fiber menu selections. Which meal choice indicates that teaching has been successful? A. Grilled chicken breast, sweet corn, and water. B. Turkey sandwich on whole wheat toast, pears, and tea. C. Cheese pizza, a small side salad, and milk. D. Bacon, lettuce, and tomato sandwich on sourdough with orange juice. 68. The nurse is preparing a teaching plan for a client with Crohn's disease who is prescribed Sulfasalazine (Azulfidine). Which instruction should be included? A. Avoid tanning beds or sun exposure, use a backup birth control method if on oral contraceptives, and expect that urine may turn orange. B. Stop the medication immediately if mild abdominal bloating occurs. C. Expect a significant decrease in the effect of oral hypoglycemic agents. D. Take the medication with large doses of iron to prevent anemia. 69. A client is experiencing an acute exacerbation of Inflammatory Bowel Disease (IBD). Which assessment should the nurse include as a priority in the acute care plan? A. Measure abdominal girth every hour and place the client on a high-fat diet. B. Monitor the number and character of stools, check for signs of internal bleeding, and monitor intake & output. C. Auscultate bowel sounds once every 24 hours and avoid assessing for bleeding. D. Weigh the client three times per shift and restrict physical activity completely. 70. The nurse is educating a client on peristomal skin care for a new colostomy. Which instruction is correct? A. Cut the faceplate opening so it leaves a half-inch of exposed skin around the stoma. B. Remove the faceplate gently, wash the area gently without scrubbing, rinse thoroughly, and apply a skin barrier. C. Scrub the peristomal skin vigorously with a stiff brush to remove all stool residue. D. Apply a thick layer of steroid cream directly to the stoma before placing the wafer. 71. The nurse is caring for a client with appendicitis who is experiencing severe pain. The client's pain suddenly resolves completely. What is the clinical significance of this finding? A. The inflammatory process has spontaneously resolved without treatment. B. The appendix may have ruptured, putting the client at risk for peritonitis. C. The client has achieved optimal relief from standard non-pharmacological interventions. D. The appendix has successfully drained its pus back into the cecum. 72. A client is admitted with acute peritonitis. Which clinical manifestation is classically expected during the nursing assessment? A. Hypoactive bowel sounds with complete resolution of pain upon walking. B. An acute abdomen with abrupt onset of diffuse, severe abdominal pain. C. Slow, shallow respirations with a normal, soft abdomen. D. Localized left lower quadrant pain that is completely relieved by lying flat. 73. A client with gastroenteritis has developed severe, watery diarrhea. The nurse knows that rapid propulsion of intestinal contents through the small bowel puts the client at risk for which complication? A. Hyperkalemia and fluid volume overload. B. Severe gastric acid retention and pancreatitis. C. Fluid volume deficit, hypokalemia, and cardiac dysrhythmias. D. Excessive metabolic alkalosis with bradycardia. 74. A client with Crohn's disease is prescribed the therapeutic monoclonal antibody Adalimumab (Humira). Which self-care instruction is correct? A. Understand that the medication will cure Crohn's disease completely within 6 weeks. B. Avoid eating any protein-rich foods while on this therapy. C. Report cold-like symptoms or sore throat, avoid public places with crowds, and learn self-injection techniques. D. Take the medication with food to prevent severe stomach bleeding. 75. How often should an ostomy pouch be emptied to prevent weight-pulling, skin damage, or leakage? A. Strictly once every 24 hours at bedtime. B. Every 30 minutes regardless of the drainage amount. C. Before it becomes half full. D. Only when it is completely filled to capacity. 76. A client with Crohn's disease is acutely ill and requires total bowel rest. The nurse anticipates that the client will receive nutrition via which route? A. Clear liquids consumed in large amounts with meals. B. Parenteral nutrition through hyperalimentation. C. Bolus nasogastric tube feedings every 4 hours. D. A standard soft diet with oral protein supplements. 77. A client is diagnosed with Irritable Bowel Syndrome (IBS). Which of the following beverages should the nurse instruct the client to eliminate from their diet? A. Decaffeinated, non-carbonated tea. B. Warm herbal chamomile tea. C. Carbonated beverages, caffeine, and alcohol. D. Plain mineral water and sports drinks. 78. A client with an ileostomy asks if they can use fecal thickening agents to manage liquid output. What is the nurse's best response? A. You can use thickening agents only if you combine them with daily laxatives. B. Yes, thickening agents are recommended to reduce the frequency of pouch emptying. C. Thickening agents are safe to use as long as you take them with large meals. D. Fecal thickening agents should be avoided because they can cause an obstruction. 79. A client with an ileostomy reports having no drainage for several hours and concerns about a blockage. Which action should the nurse instruct the client to take? A. Perform a high-volume tap water enema through the stoma. B. Vigorously massage the stoma directly with a dry paper towel. C. Place a moist, warm towel on the abdomen, lie down on the side in a fetal position, and drink hot tea if cramping occurs. D. Take a strong over-the-counter laxative immediately. 80. Which of the following dietary items should a client with a colostomy avoid to prevent excessive gas and bag inflation? A. Toast, oatmeal, and white rice. B. Applesauce, bananas, and clear broth. C. Lean poultry, fish, and potatoes. D. Cabbage, broccoli, and beans. 81. A client is diagnosed with Hepatitis A. The nurse understands that this virus is primarily transmitted through which route? A. Fecal-oral route, via contaminated food, water, or shellfish. B. Blood-to-blood contact, such as sharing needles. C. Accidental needle sticks in healthcare environments. D. Unprotected sexual contact with infected partners. 82. When planning care for a client hospitalized with Hepatitis B virus (HBV) infection, which infection control precautions should the nurse implement? A. Standard Precautions B. Strict airborne precautions with an N95 respirator. C. Contact precautions for all routine care. D. Surgical asepsis for all bedside interactions. 83. A client is scheduled for an Endoscopic Retrograde Cholangiopancreatography (ERCP). What is the primary purpose of this procedure? A. A sterile needle aspiration of pleural fluid from the thoracic space. B. An endoscopic examination of the entire large bowel to detect polyps. C. A visual and radiographic examination to identify and treat biliary or pancreatic obstructions. D. A non-invasive ultrasound scan to track gallbladder contraction. 84. The nurse is preparing a client for a colonoscopy. Which dietary instruction is correct for the day before the procedure? A. Drink abundant amounts of orange juice and grape gelatin. B. Eat a high-fiber breakfast, then remain NPO until the procedure. C. Maintain NPO status for 24 hours prior to the exam. D. Consume only a clear liquid diet, avoiding red, orange, or purple beverages or gelatin. 85. A client has just returned to their room after a colonoscopy. What must the nurse verify before allowing the client to consume food or fluids? A. Auscultate hyperactive bowel sounds in all four quadrants. B. Wait exactly 8 hours post-procedure before administering anything. C. Ensure the client's blood glucose is greater than 150 mg/dL. D. Verify that the client has passed flatus, indicating the return of peristalsis. 86. A client is being discharged home following a laparoscopic cholecystectomy. Which discharge instruction regarding wound care is correct? A. Peel off the Steri-Strips immediately upon arriving home. B. Apply a thick layer of antibiotic ointment to the incisions twice daily. C. Remove the outer bandages the day after surgery and shower, leaving the Steri-Strips intact to fall off on their own. D. Keep the surgical incisions completely covered and do not shower for 2 weeks. 87. A client presents to the emergency department with severe nausea, vomiting, fever of 101.2°F, and sharp right upper quadrant abdominal pain radiating to the right scapula. The nurse anticipates a workup for which condition? A. Gastroenteritis B. Acute pancreatitis C. Cholecystitis D. Acute viral hepatitis 88. A client is scheduled for a cholescintigraphy (HIDA scan). How should the nurse explain the purpose of this test to the client? A. To obtain small tissue biopsies from the liver using a hollow needle. B. To track the production and flow of bile and diagnose abnormal contraction of the gallbladder. C. To measure the electrical activity of the gallbladder muscle. D. To visualize and remove gallstones from the pancreatic duct. 89. A client is 4 hours postoperative after a laparoscopic cholecystectomy and reports abdominal fullness, gas pain, and shoulder discomfort. What is the nurse's best action? A. Notify the charge nurse immediately of potential hemorrhage. B. Ambulate the client in the hallway. C. Place the client in a flat, supine position. D. Administer a dose of strong intravenous narcotics. 90. Which of the following assessment findings in a client who underwent a cholecystectomy 3 days ago best indicates that bile flow is no longer obstructed? A. An increase in flatulence. B. The passage of dark brown stools. C. An improvement in client appetite. D. The excretion of dark amber-colored urine. 91. The nurse is caring for a client with acute viral hepatitis. What is the underlying pathophysiology that causes jaundice in this client? A. The hepatitis virus causes massive destruction of red blood cells. B. Kupffer cells produce an excessive amount of normal bile. C. The hepatic artery undergoes severe ischemia, destroying hepatocytes. D. Liver congestion and inflammation obstruct the normal flow of bile. 92. The nurse is reviewing the laboratory results of a client with suspected acute viral hepatitis. Which laboratory value best supports this diagnosis? A. A decreased gamma-glutamyl transpeptidase (GGT) level. B. An increased prothrombin time (PT). C. A decreased alanine aminotransferase (ALT) level. D. A decreased aspartate aminotransferase (AST) level. 93. A college student who has not been immunized against Hepatitis B virus (HBV) reports a high-risk exposure. Which immediate treatment should the nurse anticipate? A. A prescription for a broad-spectrum oral antibiotic. B. A prescription for a 10-day course of oral antivirals. C. An injection of Hepatitis B immune globulin (HBIG) for immediate passive immunity. D. Starting the standard three-dose HBV vaccine series only. 94. The nurse is caring for a client with cirrhosis. Which assessment finding requires the nurse's immediate attention and intervention? A. Yellowing of the sclera and skin. B. New-onset mental confusion or lethargy. C. Horizontal white bands across the fingernails. D. A tight, shiny abdomen with shifting dullness. 95. The nurse is educating a client with cirrhosis about dietary protein sources. Which of the following foods is preferred to reduce the risk of hepatic encephalopathy? A. Lean chicken breast and turkey. B. Raw oysters and shellfish. C. Red beef and pork chops. D. Cottage cheese and quinoa. 96. A client with cirrhosis is prescribed Rifaximin (Xifaxan). The nurse explains that the primary purpose of this medication is to do what? A. Decrease colonic bacteria to reduce ammonia formation. B. Directly dissolve cholesterol-based gallstones. C. Reduce straining during bowel movements to prevent varices. D. Eliminate fluid volume excess in the peritoneal cavity. 97. A client with esophageal varices is prescribed intravenous Vasopressin (Pitressin). Which comorbidity in the client's history requires the nurse to notify the physician immediately? A. Coronary artery disease (CAD) B. Type 2 diabetes mellitus C. Gastroesophageal reflux disease (GERD) D. Fibromyalgia 98. During the assessment of a client admitted with acute pancreatitis, the nurse notes a bluish tinge around the client's umbilicus. What does this finding indicate? A. A sudden spike in serum amylase levels. B. Severe fluid accumulation (ascites) in the peritoneal cavity. C. A retroperitoneal hemorrhage. D. An inflammatory response to a pancreatic pseudocyst. 99. A client with acute pancreatitis complains of severe, steady epigastric pain that radiates to the back. Which non-pharmacological nursing action is a priority to help relieve the pain? A. Encourage the client to eat a small, high-fat meal. B. Instruct the client to sit up and lean forward. C. Place the client in a flat, supine position. D. Apply a hot water bottle directly to the abdomen. 100. The nurse is planning care for a client with ascites related to cirrhosis. Which intervention is correct for peristomal or general skin care? A. Bathe the client in hot water and rub the skin vigorously. B. Bathe the client in tepid water, apply emollients, closely trim fingernails, and turn every 1 to 2 hours. C. Avoid turning the client to prevent peritoneal fluid shifting. D. Apply thick alcohol-based rubs to dry areas to prevent itching.