PN Medical-Surgical: Gastrointestinal Practice Quiz with Rationales 2025

1. A nurse is caring for a client who has a percutaneous endoscopic gastrostomy (PEG) tube and is receiving intermittent feedings. Prior to initiating the feeding, which of the following actions should the nurse take first? - Flush the tube with water. - Place the client in semi-Fowlers's position. - Cleanse the skin around the tube site. - Aspirate the tube for residual contents. Rationale: The nurse should apply the ABC priority-setting framework. This framework emphasizes the basic core of human functioning: having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these can indicate a threat to life and is therefore the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. Breathing is the second priority in the ABC priority-setting framework because adequate ventilatory effort is essential for oxygen exchange to occur. Circulation is the third priority in the ABC priority-setting framework because delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them. A client who is receiving PEG tube feedings should be positioned with the head of the bed elevated at least 30° during and after feedings to decrease the risk of aspiration. Therefore, this is the priority action by the nurse. 2. A nurse is caring for a client who is scheduled to undergo an esophagogastroduodenoscopy (EGD). The nurse should identify that this procedure is used to do which of the following? - To visualize polyps in the colon - To detect an ulceration in the stomach - To identify an obstruction in the biliary tract - To determine the presence of free air in the abdomen Rationale: An EGD is used to visualize the esophagus, stomach, and duodenum with a lighted tube to detect a tumor, ulceration, or obstruction. 3. A nurse is teaching a client who has Barrett's esophagus and is scheduled to undergo an esophagogastroduodenoscopy (EGD). Which of the following statements should the nurse include in the teaching? - "This procedure is performed to measure the presence of acid in your esophagus." - "This procedure can determine how well the lower part of your esophagus works." PN Medical-Surgical: Gastrointestinal Practice Quiz with Rationales 2025 - "This procedure is performed while you are under general anesthesia." - "This procedure can determine if you have colon cancer." Rationale: An EGD is useful in determining the function of the esophageal lining and the extent of inflammation, potential scarring, and strictures. 4. A nurse is caring for a client who is dehydrated and is receiving continuous tube feeding through a pump at 75 mL/hr. When the nurse assesses the client at 0800, which of the following findings requires intervention by the nurse? - A full pitcher of water is sitting on the client's bedside table within the client's reach. - The disposable feeding bag is from the previous day at 1000 and contains 200 mL of feeding. - The client is lying on the right side with a visible dependent loop in the feeding tube. - The head of the bed is elevated 20°. Rationale: The head of the bed should be elevated at least 30° (semi-Fowler's position) while the tube feeding is administered. This position uses gravity to help the feeding move down through the digestive system and lessens the possibility of regurgitation. 5. A nurse is caring for a client who is receiving total parenteral nutrition (TPN) therapy and has just returned to the room following physical therapy. The nurse notes that the infusion pump for the client's TPN is turned off. After restarting the infusion pump, the nurse should monitor the client for which of the following findings? - Hypertension - Excessive thirst - Fever - Diaphoresis Rationale: The nurse should recognize that the client has the potential for the development of hypoglycemia due to the sudden withdrawal of the TPN solution. In addition to diaphoresis, other potential manifestations of hypoglycemia can include weakness, anxiety, confusion, and hunger. 6. A nurse is caring for a client who has celiac disease. Which of the following foods should the nurse remove from the client's meal tray? - Wheat toast - Tapioca pudding - Hard-boiled egg - Mash potatoes Rationale: Celiac disease is an autoimmune disorder characterized by a permanent intolerance to wheat, barley, and rye. Wheat toast contains gluten and should be removed from the client's tray. 7. A nurse is caring for a client who is scheduled to undergo a liver biopsy for a suspected malignancy. Which of the following laboratory findings should the nurse monitor prior to the procedure? - Prothrombin time - Serum lipase - Bilirubin - Calcium Rationale: A major complication following a liver biopsy is hemorrhage. Many clients who have liver disease have clotting defects and are at risk for bleeding. Along with the prothrombin time (PT), the activated partial thromboplastin time (aPTT) and the platelet count should be monitored. Liver dysfunction causes the production of blood clotting factors to be reduced, which leads to an increased incidence of bruising, nosebleeds, bleeding from wounds, and gastrointestinal bleeding. This is due to a deficient absorption of vitamin K from the gastrointestinal tract caused by the inability of liver cells to use vitamin K to make prothrombin. 8. A nurse is assessing a client who is experiencing perforation of a peptic ulcer. Which of the following manifestations should the nurse expect? - Increased blood pressure - Decreased heart rate - Yellowing of the skin - Boardlike abdomen Rationale: The nurse should expect the client who is experiencing perforation of a peptic ulcer to exhibit manifestations of a boardlike abdomen and severe pain in the abdomen or back that radiates to the right shoulder. Vomiting of blood and shock can occur if the perforation causes hemorrhaging. 9. A nurse is caring for a client who has a history of cirrhosis and is admitted with a manifestations of hepatic encephalopathy. The nurse should anticipate a prescription for which of the following laboratory tests to determine the possibility of recent excessive alcohol use? - Gamma-glutamyl transferase (GGT) - Alkaline phosphatase (ALP) - Serum bilirubin - Alanine aminotransferase (ALT) Rationale: The GGT laboratory test is specific to the hepatobiliary system in which levels can be raised by alcohol and hepatotoxic drugs. Therefore, it is useful for monitoring drug toxicity and excessive alcohol use.