GASTROINTESTINAL SYSTEM
DISORDERS Practice Exam #4 -
QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
2023/2024
GRADED A+ NEW
1. Question
Which of the following complications is thought to be the most common cause of
appendicitis?
A. A fecalith
B. Bowel kinking
C. Internal bowel occlusion
D. Abdominal bowel swelling
Correct Answer: A. A fecalith
A fecalith is a fecal calculus, or stone, that occludes the lumen of the appendix and is
the most common cause of appendicitis. The cause of appendicitis is usually an
obstruction of the appendiceal lumen. This can be from an appendicolith (stone of the
appendix), or some other mechanical etiologies. Appendiceal tumors such as carcinoid
tumors, intestinal parasites, and hypertrophied lymphatic tissue are all known causes of
appendiceal obstruction and appendicitis.
Option B: Kinking of the appendix is one of the causes of appendicitis. Appendicitis is
inflammation of the vermiform appendix. This is a hollow organ located at the tip of the
cecum, usually in the right lower quadrant of the abdomen.
,Option C: External, not internal, occlusion of the bowel by adhesion is a cause of
appendicitis. When the appendiceal lumen gets obstructed, bacteria will build up in the
appendix and cause acute inflammation with perforation and abscess formation.
Option D: Bowel wall swelling is one of the causes of appendicitis. The pathophysiology
of appendicitis likely stems from obstruction of the appendiceal orifice. This results in
inflammation, localized ischemia, perforation, and the development of a contained
abscess or frank perforation with resultant peritonitis.
2. Question
Which of the following terms best describes the pain associated with
appendicitis?
A. Aching
B. Fleeting
C. Intermittent
D. Steady
Correct Answer: D. Steady
The pain begins in the epigastric or periumbilical region, then shifts to the right lower
quadrant and becomes steady. The pain may be moderate to severe. Classically,
appendicitis presents as an initial generalized or periumbilical abdominal pain that then
localizes to the right lower quadrant. Initially, as the visceral afferent nerve fibers at T8
through T10 are stimulated, and this leads to vague centralized pain.
Option A: Pain upon passive extension of the right leg with the patient in the left lateral
decubitus position is known as psoas sign. This maneuver stretches the psoas major
muscle, which can be irritated by an inflamed retrocecal appendix. Patients often flex
the hip to shorten the psoas major muscle and relieve pain.
Option B: As the appendix becomes more swollen and inflamed, it will irritate the lining
of the abdominal wall, known as the peritoneum. This causes localized, sharp pain in
the right lower part of the abdomen.
Option C: As the appendix becomes more inflamed, and the adjacent parietal
peritoneum is irritated, the pain becomes more localized to the right lower quadrant. The
pain tends to be more constant and severe than the dull, aching pain that occurs when
symptoms start.
3. Question
, Which of the following nursing interventions should be implemented to manage a
client with appendicitis?
A. Assessing pain.
B. Encouraging oral intake of clear fluids.
C. Providing discharge teaching.
D. Assessing for symptoms of peritonitis.
Correct Answer: D. Assessing for symptoms of peritonitis
The focus of care is to assess for peritonitis, or inflammation of the peritoneal cavity.
Peritonitis is most commonly caused by appendix rupture and invasion of bacteria,
which could be lethal. Monitor vital signs. Note onset of fever, chills, diaphoresis,
changes in mentation, reports of increasing abdominal pain. This can be suggestive of
the presence of infection or developing sepsis, abscess, peritonitis.
Option A: The client with appendicitis will have pain that should be controlled with
analgesia. Assess pain, noting location, characteristics, severity (0–10 scale).
Investigate and report changes in pain as appropriate. Keep the client at rest in
semi-Fowler’s position to lessen the pain. Gravity localizes inflammatory exudate into
the lower abdomen or pelvis, relieving abdominal tension, which is accentuated by a
supine position.
Option B: The nurse should discourage oral intake in preparation for surgery. Aperients
should also be avoided as induced peristalsis may cause perforation. If appendicitis has
been diagnosed regular analgesia, usually an opioid depending on the pain severity,
should be given to make the patient comfortable before treatment.
Option C: Discharge teaching is important; however, in the acute phase, management
should focus on minimizing preoperative complications and recognizing when such may
be occurring.
4. Question
Which of the following definitions best describes gastritis?
A. Erosion of the gastric mucosa.
B. Inflammation of a diverticulum.
C. Inflammation of the gastric mucosa.
D. Reflux of stomach acid into the esophagus.
Correct Answer: C. Inflammation of the gastric mucosa.
DISORDERS Practice Exam #4 -
QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
2023/2024
GRADED A+ NEW
1. Question
Which of the following complications is thought to be the most common cause of
appendicitis?
A. A fecalith
B. Bowel kinking
C. Internal bowel occlusion
D. Abdominal bowel swelling
Correct Answer: A. A fecalith
A fecalith is a fecal calculus, or stone, that occludes the lumen of the appendix and is
the most common cause of appendicitis. The cause of appendicitis is usually an
obstruction of the appendiceal lumen. This can be from an appendicolith (stone of the
appendix), or some other mechanical etiologies. Appendiceal tumors such as carcinoid
tumors, intestinal parasites, and hypertrophied lymphatic tissue are all known causes of
appendiceal obstruction and appendicitis.
Option B: Kinking of the appendix is one of the causes of appendicitis. Appendicitis is
inflammation of the vermiform appendix. This is a hollow organ located at the tip of the
cecum, usually in the right lower quadrant of the abdomen.
,Option C: External, not internal, occlusion of the bowel by adhesion is a cause of
appendicitis. When the appendiceal lumen gets obstructed, bacteria will build up in the
appendix and cause acute inflammation with perforation and abscess formation.
Option D: Bowel wall swelling is one of the causes of appendicitis. The pathophysiology
of appendicitis likely stems from obstruction of the appendiceal orifice. This results in
inflammation, localized ischemia, perforation, and the development of a contained
abscess or frank perforation with resultant peritonitis.
2. Question
Which of the following terms best describes the pain associated with
appendicitis?
A. Aching
B. Fleeting
C. Intermittent
D. Steady
Correct Answer: D. Steady
The pain begins in the epigastric or periumbilical region, then shifts to the right lower
quadrant and becomes steady. The pain may be moderate to severe. Classically,
appendicitis presents as an initial generalized or periumbilical abdominal pain that then
localizes to the right lower quadrant. Initially, as the visceral afferent nerve fibers at T8
through T10 are stimulated, and this leads to vague centralized pain.
Option A: Pain upon passive extension of the right leg with the patient in the left lateral
decubitus position is known as psoas sign. This maneuver stretches the psoas major
muscle, which can be irritated by an inflamed retrocecal appendix. Patients often flex
the hip to shorten the psoas major muscle and relieve pain.
Option B: As the appendix becomes more swollen and inflamed, it will irritate the lining
of the abdominal wall, known as the peritoneum. This causes localized, sharp pain in
the right lower part of the abdomen.
Option C: As the appendix becomes more inflamed, and the adjacent parietal
peritoneum is irritated, the pain becomes more localized to the right lower quadrant. The
pain tends to be more constant and severe than the dull, aching pain that occurs when
symptoms start.
3. Question
, Which of the following nursing interventions should be implemented to manage a
client with appendicitis?
A. Assessing pain.
B. Encouraging oral intake of clear fluids.
C. Providing discharge teaching.
D. Assessing for symptoms of peritonitis.
Correct Answer: D. Assessing for symptoms of peritonitis
The focus of care is to assess for peritonitis, or inflammation of the peritoneal cavity.
Peritonitis is most commonly caused by appendix rupture and invasion of bacteria,
which could be lethal. Monitor vital signs. Note onset of fever, chills, diaphoresis,
changes in mentation, reports of increasing abdominal pain. This can be suggestive of
the presence of infection or developing sepsis, abscess, peritonitis.
Option A: The client with appendicitis will have pain that should be controlled with
analgesia. Assess pain, noting location, characteristics, severity (0–10 scale).
Investigate and report changes in pain as appropriate. Keep the client at rest in
semi-Fowler’s position to lessen the pain. Gravity localizes inflammatory exudate into
the lower abdomen or pelvis, relieving abdominal tension, which is accentuated by a
supine position.
Option B: The nurse should discourage oral intake in preparation for surgery. Aperients
should also be avoided as induced peristalsis may cause perforation. If appendicitis has
been diagnosed regular analgesia, usually an opioid depending on the pain severity,
should be given to make the patient comfortable before treatment.
Option C: Discharge teaching is important; however, in the acute phase, management
should focus on minimizing preoperative complications and recognizing when such may
be occurring.
4. Question
Which of the following definitions best describes gastritis?
A. Erosion of the gastric mucosa.
B. Inflammation of a diverticulum.
C. Inflammation of the gastric mucosa.
D. Reflux of stomach acid into the esophagus.
Correct Answer: C. Inflammation of the gastric mucosa.
