Gastrointestinal Management

1. A patient presents with persistent nausea and vomiting. Which electrolyte imbalance is most likely? • A. Hyperkalemia • B. Hypocalcemia • C. Hyponatremia • D. Hypokalemia Correct Answer: D. Hypokalemia Rationale: Prolonged vomiting can lead to a loss of potassium (hypokalemia), as potassium is lost in gastric secretions. This can cause muscle weakness, fatigue, and arrhythmias. ________________________________________ 2. Which of the following is the priority nursing intervention for a patient with acute pancreatitis? • A. Encourage oral intake to prevent dehydration • B. Place the patient in a supine position for comfort • C. Initiate IV fluids to prevent hypovolemia • D. Administer antacids to decrease gastric acidity Correct Answer: C. Initiate IV fluids to prevent hypovolemia Rationale: Acute pancreatitis can cause fluid shifts and lead to hypovolemia. The priority intervention is to prevent shock by ensuring adequate fluid replacement. Oral intake is contraindicated until the inflammation resolves. ________________________________________ 3. A nurse is assessing bowel sounds in a patient with suspected bowel obstruction. Which of the following findings is consistent with a bowel obstruction? • A. Hypoactive bowel sounds in all quadrants • B. Hyperactive bowel sounds above the obstruction and hypoactive below it • C. Absent bowel sounds • D. Normal bowel sounds Correct Answer: B. Hyperactive bowel sounds above the obstruction and hypoactive below it Rationale: In bowel obstruction, there is increased peristalsis (hyperactive sounds) above the site of the obstruction as the bowel tries to push contents through, while hypoactive or absent sounds are noted below the obstruction. ________________________________________ 4. The nurse is caring for a patient with peptic ulcer disease (PUD). Which of the following statements by the patient indicates a need for further teaching? • A. "I will avoid drinking coffee and alcohol." • B. "I will take my antacids immediately after meals." • C. "I will try to manage my stress better." • D. "I will avoid taking NSAIDs." Correct Answer: B. "I will take my antacids immediately after meals." Rationale: Antacids should be taken 1-3 hours after meals for maximum effectiveness, not immediately after meals. The other statements are correct. ________________________________________ 5. Which of the following is a classic symptom of appendicitis? • A. Left lower quadrant pain • B. Generalized abdominal discomfort • C. Right lower quadrant pain • D. Mid-epigastric pain Correct Answer: C. Right lower quadrant pain Rationale: The classic symptom of appendicitis is right lower quadrant pain, often referred to as McBurney's point tenderness. ________________________________________ 6. The nurse is teaching a patient with gastroesophageal reflux disease (GERD). Which of the following instructions should be included? • A. "Eat a large meal once daily to avoid frequent meals." • B. "Lie down immediately after eating to promote digestion." • C. "Elevate the head of your bed by 6-12 inches when sleeping." • D. "Drink carbonated beverages to aid in digestion." Correct Answer: C. "Elevate the head of your bed by 6-12 inches when sleeping." Rationale: Elevating the head of the bed helps prevent acid reflux during sleep. Small, frequent meals are preferred, and lying down after eating should be avoided. ________________________________________ 7. A patient with cirrhosis and ascites is prescribed spironolactone. The nurse knows that this medication is prescribed because it is: • A. A loop diuretic that reduces potassium • B. A potassium-sparing diuretic that reduces fluid retention • C. An osmotic diuretic that increases urine output • D. A thiazide diuretic that prevents fluid overload Correct Answer: B. A potassium-sparing diuretic that reduces fluid retention Rationale: Spironolactone is a potassium-sparing diuretic commonly used to treat ascites in liver cirrhosis, as it reduces fluid buildup without causing hypokalemia. ________________________________________ 8. A patient is diagnosed with an upper gastrointestinal (GI) bleed. Which of the following findings should the nurse expect? • A. Bright red blood in stool • B. Coffee-ground emesis • C. Clay-colored stools • D. Dark brown vomit Correct Answer: B. Coffee-ground emesis Rationale: Upper GI bleeding may result in coffee-ground emesis, indicating partially digested blood. Bright red blood in stool suggests lower GI bleeding. ________________________________________ 9. Which of the following laboratory values would the nurse expect in a patient with liver cirrhosis? • A. Elevated albumin levels • B. Decreased bilirubin levels • C. Prolonged prothrombin time (PT) • D. Decreased ammonia levels Correct Answer: C. Prolonged prothrombin time (PT) Rationale: Cirrhosis impairs the liver's ability to produce clotting factors, leading to prolonged PT. Other findings would include decreased albumin, elevated bilirubin, and elevated ammonia levels. ________________________________________ 10. A patient is being treated for esophageal varices. Which medication would the nurse anticipate administering to control bleeding? • A. Omeprazole • B. Octreotide • C. Metoclopramide • D. Sucralfate Correct Answer: B. Octreotide