GASTROINTESTINAL EXAM

2023 GASTROINTESTINAL EXAM QUESTIONS & ANSWERS (RATED A+) (GUARANTEED A++) BEST VERSION CHAMBERLAIN COLLEGE OF NURSING 1. Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level of: a. 45 units/L b. 100 units/L c. 300 units/L d. 500 units/L 2. A male client who is recovering from surgery has been advanced from a clearliquid diet to a full liquid diet. The client is looking forward to the diet change because he has been “bored” with the clear liquid diet. The nurse would offer which full liquid item to the client? a. Tea b. Gelatin c. Custard d. Popsicle 3. Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intension to increase the intake of: a. Pork b. Milk c. Chicken d. Broccoli 4. Nurse Oliver checks for residual before administering a bolus tube feeding to a client with a nasogastric tube and obtains a residual amount of 150 mL. What is appropriate action for the nurse to take? a. Hold the feeding b. Reinstill the amount and continue with administering the feeding c. Elevate the client’s head at least 45 degrees and administer the feeding d. Discard the residual amount and proceed with administering the feeding 5. A nurse is inserting a nasogastric tube in an adult male client. During the procedure, the client begins to cough and has difficulty breathing. Which of the following is the appropriate nursing action? a. Quickly insert the tube b. Notify the physician immediately c. Remove the tube and reinsert when the respiratory distress subsides d. Pull back on the tube and wait until the respiratory distress subsides 6. Nurse Ryan is assessing for correct placement of a nosogartric tube. The nurse aspirates the stomach contents and check the contents for pH. The nurse verifies correct tube placement if which pH value is noted? a. 3.5 b. 7.0 c. 7.35 d. 7.5 7. A nurse is preparing to remove a nasogartric tube from a female client. The nurse should instruct the client to do which of the following just before the nurse removes the tube? a. Exhale b. Inhale and exhale quickly c. Take and hold a deep breath d. Perform a Valsalva maneuver 8. Nurse Joy is preparing to administer medication through a nasogastric tube that is connected to suction. To administer the medication, the nurse would: a. Position the client supine to assist in medication absorption b. Aspirate the nasogastric tube after medication administration to maintain patency c. Clamp the nasogastric tube for 30 minutes following administration of the medication d. Change the suction setting to low intermittent suction for 30 minutes after medication administration 9. A nurse is preparing to care for a female client with esophageal varices who has just has a Sengstaken-Blakemore tube inserted. The nurse gathers supplies, knowing that which of the following items must be kept at the bedside at all times? a. An obturator b. Kelly clamp c. An irrigation set d. A pair of scissors 10. Dr. Smith has determined that the client with hepatitis has contracted the infection form contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis D 11. A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? a. Elevated hemoglobin level b. Elevated serum bilirubin level c. Elevated blood urea nitrogen level d. Decreased erythrocycle sedimentation rate 12. The nurse is reviewing the physician’s orders written for a male client admitted to the hospital with acute pancreatitis. Which physician order should the nurse question if noted on the client’s chart? a. NPO status b. Nasogastric tube inserted c. Morphine sulfate for pain d. An anticholinergic medication 13. A female client being seen in a physician’s office has just been scheduled for a barium swallow the next day. The nurse writes down which instruction for the client to follow before the test? a. Fast for 8 hours before the test b. Eat a regular supper and breakfast c. Continue to take all oral medications as scheduled d. Monitor own bowel movement pattern for constipation 14. The nurse is performing an abdominal assessment and inspects the skin of the abdomen. The nurse performs which assessment technique next? a. Palpates the abdomen for size b. Palpates the liver at the right rib margin c. Listens to bowel sounds in all for quadrants d. Percusses the right lower abdominal quadrant 15. Polyethylene glycol-electrlyte solution (GoLYTELY) is prescribed for the female client scheduled for a colonoscopy. The client begins to experience diarrhea following administration of the solution. What action by the nurse is appropriate? a. Start an IV infusion b. Administer an enema c. Cancel the diagnostic test d. Explain that diarrhea is expected 16. The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? a. Vitamin A b. Vitamin B12 c. Vitamin C d. Vitamin E 17. The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the client’s record, would the nurse question? a. Digoxin (Lanoxin) b. Furosemide (Lasix) c. Indomethacin (Indocin) d. Propranolol hydrochloride (Inderal) 18. The nurse is assessing a male client 24 hours following a cholecystectomy. The nurse noted that the T tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is appropriate? a. Clamp the T tube b. Irrigate the T tube c. Notify the physician d. Document the findings 19. The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment findings would most likely indicate perforation of the ulcer? a. Bradycardia b. Numbness in the legs c. Nausea and vomiting d. A rigid, board-like abdomen 20. A male client with a peptic ulcer is scheduled for a vagotomy and the client asks the nurse about the purpose of this procedure. Which response by the nurse best describes the purpose of a vagotomy? a. Halts stress reactions b. Heals the gastric mucosa c. Reduces the stimulus to acid secretions d. Decreases food absorption in the stomach 21. The nurse is caring for a female client following a Billroth II procedure. Which postoperative order should the nurse question and verify? a. Leg exercises b. Early ambulation c. Irrigating the nasogastric tube d. Coughing and deep-breathing exercises 22. The nurse is providing discharge instructions to a male client following gastrectomy and instructs the client to take which measure to assist in preventing dumping syndrome? a. Ambulate following a meal b. Eat high carbohydrate foods c. Limit the fluid taken with meal d. Sit in a high-Fowler’s position during meals 23. The nurse is monitoring a female client for the early signs and symptoms of dumping syndrome. Which of the following indicate this occurrence? a. Sweating and pallor b. Bradycardia and indigestion c. Double vision and chest pain d. Abdominal cramping and pain 24. The nurse is preparing a discharge teaching plan for the male client who had umbilical hernia repair. What should the nurse include in the plan? a. Irrigating the drain b. Avoiding coughing c. Maintaining bed rest d. Restricting pain medication 25. The nurse is instructing the male client who has an inguinal hernia repair how to reduce postoperative swelling following the procedure. What should the nurse tell the client? a. Limit oral fluid b. Elevate the scrotum c. Apply heat to the abdomen d. Remain in a low-fiber diet 26. The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? a. Hypotension b. Bloody diarrhea c. Rebound tenderness d. A hemoglobin level of 12 mg/dL 27. The nurse is caring for a male client postoperatively following creation of a colostomy. Which nursing diagnosis should the nurse include in the plan of care? a. Sexual dysfunction b. Body image, disturbed c. Fear related to poor prognosis d. Nutrition: more than body requirements, imbalanced 28. The nurse is reviewing the record of a female client with Crohn’s disease. Which stool characteristics should the nurse expect to note documented in the client’s record? a. Diarrhea b. Chronic constipation c. Constipation alternating with diarrhea d. Stools constantly oozing form the rectum 29. The nurse is performing a colostomy irrigation on a male client. During the irrigation, the client begins to complain of abdominal cramps. What is the appropriate nursing action? a. Notify the physician b. Stop the irrigation temporarily c. Increase the height of the irrigation d. Medicate for pain and resume the irrigation 30. The nurse is teaching a female client how to perform a colostomy irrigation. To enhance the effectiveness of the irrigation and fecal returns, what measure should the nurse instruct the client to do? a. Increase fluid intake b. Place heat on the abdomen c. Perform the irrigation in the evening d. Reduce the amount of irrigation solution 1. During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia? a. vitamin A b. vitamin D c. vitamin E d. vitamin K 2. When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: a. increased intracranial pressure. b. decreased urine output. c. bradycardia. d. hypertension. 3. A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially? a. Lying on the right side with legs straight b. Lying on the left side with knees bent c. Prone with the torso elevated d. Bent over with hands touching the floor 4. A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been “spitting up blood.” A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the client’s wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is: a. “Tell me about your husband’s alcohol usage.” b. “Is your husband being treated for tuberculosis?” c. “Has your husband recently fallen or injured his chest?” d. “Describe spices and condiments your husband uses on food.” 5. Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube? a. Change the tube feeding solutions and tubing at least every 24 hours. b. Maintain the head of the bed at a 15-degree elevation continuously. c. Check the gastrostomy tube for position every 2 days. d. Maintain the client on bed rest during the feedings. 6. A male client is recovering from a small-bowel resection. To relieve pain, the physician prescribes meperidine ( Demerol), 75 mg I.M. every 4 hours. How soon after administration should meperidine’s onset of action occur? a. 5 to 10 minutes b. 15 to 30 minutes c. 30 to 60 minutes d. 2 to 4 hours 7. The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? a. Dyspnea and fatigue b. Ascites and orthopnea c. Purpura and petechiae d. Gynecomastia and testicular atrophy 8. Which condition is most likely to have a nursing diagnosis of fluid volume deficit? a. Appendicitis b. Pancreatitis c. Cholecystitis d. Gastric ulcer 9. While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes clogged. To remedy this problem and teach the client’s family how to deal with it at home, what should the nurse do? a. Irrigate the tube with cola. b. Advance the tube into the intestine. c. Apply intermittent suction to the tube. d. Withdraw the obstruction with a 30-ml syringe. 10. A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine ( Demerol) instead of morphine to relieve pain because : a. meperidine provides a better, more prolonged analgesic effect. b. morphine may cause spasms of Oddi’s sphincter. c. meperidine is less addictive than morphine. d. morphine may cause hepatic dysfunction. 11. Mandy, an adolescent girl is admitted to an acute care facility with severe malnutrition. After a thorough examination, the physician diagnoses anorexia nervosa. When developing the plan of care for this client, the nurse is most likely to include which nursing diagnosis? a. Hopelessness b. Powerlessness c. Chronic low self esteem d. Deficient knowledge 12. Which diagnostic test would be used first to evaluate a client with upper GI bleeding? a. Endoscopy b. Upper GI series c. Hemoglobin (Hb) levels and hematocrit (HCT) d. Arteriography 13. A female client who has just been diagnosed with hepatitis A asks, “How could I have gotten this disease?” What is the nurse’s best response? a. “You may have eaten contaminated restaurant food.” b. “You could have gotten it by using I.V. drugs.” c. “You must have received an infected blood transfusion.” d. “You probably got it by engaging in unprotected sex.” 14. When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? a. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. b. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. c. The appendix may develop gangrene and rupture, especially in a middle-aged client. d. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage. 15. A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are: a. whole blood and albumin. b. platelets and packed red blood cells. c. fresh frozen plasma and whole blood. d. cryoprecipitate and fresh frozen plasma. 16. To prevent gastroesophageal reflux in a male client with hiatal hernia, the nurse should provide which discharge instruction? a. “Lie down after meals to promote digestion.” b. “Avoid coffee and alcoholic beverages.” c. “Take antacids with meals.” d. “Limit fluid intake with meals.” 17. The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first? a. Administering pain medication b. Obtaining a blood sample for laboratory studies c. Preparing to insert a nasogastric (NG) tube d. Administering I.V. fluids 18. A female client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? a. The client doesn’t exhibit rectal tenesmus. b. The client is free from esophagitis and achalasia. c. The client reports diminished duodenal inflammation. d. The client has normal gastric structures. 19. A male client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client’s nasogastric (NG) tube has stopped draining. How should the nurse respond? a. Notify the physician b. Reposition the tube c. Irrigate the tube d. Increase the suction level 20. What laboratory finding is the primary diagnostic indicator for pancreatitis? a. Elevated blood urea nitrogen (BUN) b. Elevated serum lipase c. Elevated aspartate aminotransferase (AST) d. Increased lactate dehydrogenase (LD) 21. A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a. yellow sclerae. b. light amber urine. c. circumoral pallor. d. black, tarry stools. 22. Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: a. a sedentary lifestyle and smoking. b. a history of hemorrhoids and smoking. c. alcohol abuse and a history of acute renal failure. d. alcohol abuse and smoking. 23. While palpating a female client’s right upper quadrant (RUQ), the nurse would expect to find which of the following structures? a. Sigmoid colon b. Appendix c. Spleen d. Liver 24. A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse’s first response is to: a. call the physician. b. place saline-soaked sterile dressings on the wound. c. take a blood pressure and pulse. d. pull the dehiscence closed. 25. The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation? a. Antiarrhythmic drugs b. Anticholinergic drugs c. Anticoagulant drugs d. Antihypertensive drugs 26. A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of: a. increasing fluid intake to prevent dehydration. b. wearing an appliance pouch only at bedtime. c. consuming a low-protein, high-fiber diet. d. taking only enteric-coated medications. 27. The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? a. Regular diet b. Skim milk c. Nothing by mouth d. Clear liquids 28. A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: a. severe abdominal pain radiating to the shoulder. b. anorexia, nausea, and vomiting. c. eructation and constipation. d. abdominal ascites. 29. A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: a. place the client in a private room. b. wear a mask when handling the client’s bedpan. c. wash the hands after touching the client. d. wear a gown when providing personal care for the client. 30. Which of the following factors can cause hepatitis A? a. Contact with infected blood b. Blood transfusions with infected blood c. Eating contaminated shellfish d. Sexual contact with an infected person 1 . Which of the following is not a specific element of duodenal ulcers? A. Primarily affects males B. Occasional malignancy C. Can lead to weight gain D. Affects people over 65 2 . Which of the following is not a specific element of Hepatitis C? A. Vaccine available B. May be transmitted with sexual contact C. Inflammation of the liver D. Lifetime carrier 3 . Which of the following Vitamins is not stored in the Liver? A. Vitamin A B. Vitamin B C. Vitamin C D. Vitamin D 4 . Which of the following is not a contributor to a condition of ascites? A. Elevated levels of aldosterone B. Hypertension C. Low levels of albumin D. Elevated levels of angiotension I 5 . Which of the following drugs is a histamine blocker and reduces levels of gastric acid? A. Omeprazole (Prilosec) B. Metoclopramide (Reglan) C. Cimetidine (Tagamet) D. Magnesium Hydroxide (Maalox 6 . Which of the following drugs is an antacid? A. Omeprazole (Prilosec) B. Metoclopramide (Reglan) C. Cimetidine (Tagamet) D. Magnesium Hydroxide (Maalox) 7 . Which of the following drugs is a dopamine antagonist? A. Omeprazole (Prilosec) B. Metoclopramide (Reglan) C. Cimetidine (Tagamet) D. Magnesium Hydroxide (Maalox) 8 . Another name for the Whipple procedure is a ________. A. Cholangiopancreatography B. Pancreatoduodenectomy C. Cholangiogram D. Cholecystogram 9 . Which of the following microorganisms has been linked to Parotitis? A. Staphylococcus aureus B. Schistosoma C. Wucheria bancrofti D. Trypanosoma cruzi 10 . What type of cell releases somatostatin? A. b cells B. a cells C. plasma cells D. D cells 11 . What type of cell releases glucagon? A. b cells B. a cells C. plasma cells D. D cells 12 . What type of cell releases insulin? A. b cells B. a cells C. plasma cells D. D cells 13 . Another name for the (Billroth II)procedure is a ________. A. Gastrojejunostomy B. Gastroduodenostomy C. Cholangiogram D. Cholecystogram 14 . Another name for the (Billroth I)procedure is a ________. A. Gastrojejunostomy B. Gastroduodenostomy C. Cholangiogram D. Cholecystogram 15 . Which of the following arteries supplies blood primarily to the Midgut? A. IMA B. Celiac C. SMA D. Axillary 16. Which of the following is not considered a right of medication? A. Dose B. Time C. Route D. Limit 17. Another name for the Myenteric plexus is the ________. A. Submucosal plexus B. Branchial plexus C. Auerbach's plexus D. Lumbar plexus 18. Which of the following enzyme breaks down starches to maltose. A. Amylase B. Lipase C. Trypsinogen D. Pepsin 19. Which of the following is not considered an H2 blocker? A. Ranitidine (Zantac) B. Famotidine (Pepcid) C. Cimetidine (Tagament) D. Sucralfate (Carafate) 20. Which of the following drugs aids in gastric emptying? A. Cisapride (Propulsid) B. Ranitidine (Zantac) C. Famotidine (Pepcid) D. Tranylcypromine sulfate (Parnate) 1. Which of the following is not an education tool required prior to an endoscopic procedure? A the purpose of the procedure . B.what to expect during the procedure C. how long the procedure will take D.preparation required prior to the surgery 2. All are complications of endoscopic procedures EXCEPT? 3. Which patient is most susceptible for acquiring secondary stomatitis? A an AIDs patient suffering from pneumonia . B.an 65 y/o obese female C a 45 y/o male suffering from colon cancer . D a 50 y/o male with CHF . 4. When assessing a client during a routine checkup, the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. Aphthous stomatitis is best described as: A.a canker sore of the oral soft tissues B.an acute stomach infection C.acid indigestion D an early sign of peptic ulcer disease . 5. Which item is unneccessary when examing the oral cavity of a patient with candidiasis? A.gloves B.penlight C.gown D tongue blade . 6. Which of the following is an inappropriate nursing diagnosis for a client with malignant tumors of the oral cavity? A Impaired oral mucous membranes . Defieceint fluid B. volume C.Acute pain D.Risk for ineffective airway clearance 7. The graduate nurse and her preceptor are establishing priorities for their morning assessments. Which client should they assess first? A The newly admitted client with acute abdominal pain . B.The client who needs an abdominal dressing changed (POD 3) C . The client receiving continuous tube feedings who needs the tube-feeding residual checked D.The sleeping client who received pain medication 1 hour ago 8. Gastroesophageal reflux disease is the abnormal _____ of the lower esophageal sphincter. 9. Which foods should a patient with GERD stay away from (multiple answers)? A.Burger King double cheeseburger B.lettuce C.candy canes D.chocolate espresso E.white bread 10.To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? A . Lie down after meals to promote digestion B Avoid coffee and alcoholic beverages . C.Take antacids with meals D.Limit fluid intake with meals 11.Which of the following is not a common symptom of GERD? A.dyspepsia B.regurgitation C.dysphagia D.hyposalivation 12.Which drug class isn't used to treat GERD? A.antacids B.histamine receptor antagonists C.beta blockers D.proton pump inhibitors 13.Which of the following has the least important role in terms of peptic ulcer formation? A.acid B.NSAID use C.prescence of H. pylori D.hypertension 14.A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects this client's stools to be: A.coffee-ground-like B.clay-colored C.black and tarry D.bright red 15.Which diagnostic test would be used first to evaluate a client with upper GI bleeding? A.Endoscopy B.Upper GI series C.Hemoglobin (Hb) levels and hematocrit (HCT D.Arteriography 16.Which of the following isn't a complication of peptic ulcer disease? A.perforation B.GI bleeding C.pyloric obstruction D.pain 17.Which of the following are goals of drug therapy in the treatment of PUD (multiple answers)? A.provide pain relief B.prevent recurrence C.heal ulcerations D.eradicate H. pylori infection 18.An elderly client with Alzheimer's disease begins supplemental tube feedings through a gastrostomy tube to provide adequate calorie intake. The nurse should be concerned most with the potential for: A.hyperglycemia B.fluid volume excess D.constipation 19.A client who underwent abdominal surgery who has a nasogastric (NG) tube in place begins to complain of abdominal pain that he describes as "feeling full and uncomfortable." Which assessment should the nurse perform first? A.Measure abdominal girth B.Auscultate bowel sounds C.Assess patency of the NG tube D.Assess vital signs 20.To verify the placement of a gastric feeding tube, the nurse should perform at least two tests. One test requires instilling air into the tube with a syringe and listening with a stethoscope for air passing into the stomach. Which is another test method? A Aspiration of gastric contents and testing for a pH less than 6 . B.Instillation of 30 ml of water while listening with a stethoscope C.Cessation of reflex gagging D.Ensuring proper measurement of the tube before insertion 21.The nurse is performing an assessment on a client who has developed a paralytic ileus. The client's bowel sounds will be: f a paralytic ileus occurs, bowel sounds will be hypoactive or absent. Hyperactive bowel sounds may signify hunger, intestinal obstruction, or diarrhea. 22.Which of the following would you NOT teach a patient recently diagnosed with irritable bowel syndrome? A.identifying food intolerances and needed dietary modifications B.decreasing fiber intake C . avoiding coffee and and limiting alcohol intake D.stress management 23.Which of the following are appropriate nursing diagnoses for patients with colorectal cancer (multiple answers)? A.Altered level of consciousness B.Disturbed body image C.Deficient fluid volume D.Acute/ chronic pain 24.Which of the following is not a complication of colorectal cancer? 25.Which foods should patients with colorectal cancer avoid (multiple answers)? A.fish and chips B.boiled carrots and broccoli C.beef and cabbage D.concentrated sweets E.whole-grain products 26.A client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse's first response is to: A.call the physician B.place saline-soaked sterile dressings on the wound C.take a blood pressure and pulse D.take a blood pressure and pulse 27.For a client who must undergo colon surgery, the physician orders preoperative cleansing enemas and neomycin sulfate (Mycifradin). The rationale for neomycin use in this client is to: The antibiotic neomycin sulfate (Mycifradin) is prescribed to decrease the bacterial count and reduce the risk of fecal contamination during surgery. 28.Which is the least likely to cause constipation? A.high fiber intake B.being over 75 C.overuse of laxatives D.immobilization 29.A 72-year-old client seeks help for chronic constipation. This is a common problem for elderly clients due to several factors related to aging. Which is one such factor? A.Increased intestinal motility B.Decreased abdominal strength C.Increased gastric aid production D.hyperactive bowel sounds 30.Which medication should the nurse expect to administer to a client with constipation? Docusate sodium, a laxative, is used to treat constipation. It softens the stool by stimulating the secretion of intestinal fluid into the stool. 31.Which outcome indicates effective client teaching to prevent constipation? A . The client verbalizes consumption of low-fiber foods B.The client maintains a sedentary lifestyle C.The client limits water intake to three glasses per day D The client reports engaging in a regular exercise regimen . 32.In regards to appendicitis, the location of pain in the lower, right abdominal quadrant is called: A.Kernig's sign B.Mc Burney's point C.Brudzinski's point D.Schrute's point 33.When preparing a client, age 50, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? A.The appendectomy surgery is very invasive and it puts the client at a risk for infection B Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the . appendix. C.Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage D . The appendix may develop gangrene and rupture, especially in a middle-aged client 34. Which of the following assessment findings suggests early appendicitis? A.nausea and vomiting B.periumbilical pain C.tense positioning D.abdominal rigdity 35. Which of the following is not an appropriate nursing diagnosis related to appendicitis? A.Disturbed body image B.Acute pain C.Risk for infection r/t rupture D.Deficient knowledge 36. While preparing a client for cholecystectomy, the nurse explains that incentive spirometry will be used after surgery primarily to: A increase respiratory effectiveness. . B.eliminate the need for nasogastric intubation. C . improve nutritional status during recovery. D . decrease the amount of postoperative analgesia needed. 37. Which task can the nurse delegate to a nursing assistant? A.Irrigating a nasogastric (NG) tube B.Assisting a client who had surgery three days ago walk down the hallway C . Helping a client who just returned from surgery to the bathroom D.Administering an antacid to a client complaining of heartburn 38. How are ulcerative colitis and Chron's disease definitively diagnosed? A.EGD B.CBC C.stool sample D.colonoscopy 39. What is toxic megacolon (mulitple answers)? A.a complication of ulcerative colitis B.dilation and paralysis of the colon C.a fistula D.a risk factor for pancreatitis 40. A 28-year-old client is admitted with inflammatory bowel syndrome (Crohn's disease). Which therapies should the nurse expect to be part of the care plan? Check all that apply A.Lactulose therapy B.High-fiber diet C.High-protein milkshakes D.Corticosteroid therapy E.Antidiarrheal medications 41. A client is diagnosed with Crohn's disease after undergoing two weeks of testing. The client's boss calls the medical-surgical floor requesting to speak with the nurse manager. He expresses concern over the client and explains that he must know the client's diagnosis for insurance purposes. Which response by the nurse is best? A . "Sure, I understand how demanding insurance companies can be." B "I appreciate your concern, but I can't give out any information." . C . "Why don't you come in, and we can further discuss this issue." D."He has been diagnosed with Crohn's Disease." 42. A client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially? A.Lying on the right side with legs straight B.Lying on the left side with knees bent C.Prone with the torso elevated D.Bent over with hands touching the floor 43. A client has a newly created colostomy. After participating in counseling with the nurse and receiving support from the spouse, the client decides to change the colostomy pouch unaided. Which behavior suggests that the client is beginning to accept the change in body image? A.The client asks his wife to leave the room B.The client closes the eyes when the abdomen is exposed C.The client avoids talking about the recent surgery The client touches the altered body part A patient's vomitus is dark brown and has a coffee-ground appearance. the nurse recognizes that this emsis is charactristic of: a. stomach bleeding b. an intestinal obstruction a. stomach bleeding c. bile reflux d. active bleeding of lower esophagus A patient who has been vomiting for several dasy from an unknown cause is admitted to hospital. the nurse anticipates collaborative care to indlude: a. oral admin of broth and tea d. IV replacement of fluid and b. admin of paretneral antiemetics electrolytes c. insertion of NG tube to suction d. IV replacement of fluid and electrolytes Zofran is prescribed for a patient with cancer chemo induced vomiting. Thed. relieves vomiting centrally by nurse understands this drug: a. is a derivative of cannabis b. has a strong antihistamine effect that provides sedation and slee c. is used only when othertherapies are ineffective d. relieves vomiting centrally by action in the vomiting center and peripherally by promoting gastric emptying A patient with oral cancer has a history of heavy smoking, excessive alcohol intake, and personal neglect. During the patient's early postop course the nurse anticpates that the patient may need: action in the vomiting center and peripherally by promoting gastric emptying a. oral nutritional supplements b. drug therapy to prevent substance withdrawal symptoms c. less pain mes d. counseling the nurse teaches the patient with a hiatal hernia or GERD to control symptoms by: b. drug therapy to prevent substance withdrawal symptoms a. drinking 10-12 oz of water with meals b. spacing six small meals a day c. sleeping wit hthe head of the bed elevated 4-6 inches c. sleeping wit hthe head of the bed elevated 4-6 inches d. perfrming aily exercises of toe touching A patient is returned to the surgical unit following a laparoscopic fundoplication for repair of hiatal hernia with an IV, NG tube t osuction, and several small abdominal incisions. to prevent disruption of the surgical site, it is most important for the nurse to: c. maintain the patency of the NG a. monitor for return of perstalsis tube b. position the patient on the right side c. maintain the patency of the NG tube d. assess abdominal wounds Nursing management of the patient with chronic gastritis includes teaching the patient to: a. maintain a bland diet with six small meals a day a. maintain a bland diet with six small meals a day b. take antacids before meals c. use NSAIDS instead of aspirin for pain relief d. eliminate alcohol and caffeine from diet Patient admitted to ER has profuse bright-red hematemesis. During intial care of the patient, the nurse's first priority is to: a. perform a nursing assessment of patient's status b. establish 2 IV sites a. perform a nursing assessment of patient's status c. obtain a thorough health history d. perform a gastric lavage with cool tap water in prep for endoscopic exam In teaching patients at risk for upper GI bleeding to prevent bleeding b. the use of over the counter meds episodes, the nurse stresses that: of any kind should be avoided a. all stools and vomit must be tested for blood b. the use of over the counter meds of any kind should be avoided c. antacids should be taken with all prescribed meds dd. Cytotec should be used to protect gastric mucosa Management of patient with upper GI bleeding is effective the lab results reveal: a. decreasing BUN a. decreasing BUN b. normal hematocrit c. urine output of 20 ml hr d. specific gravity of 1.03 Regardless of precipitating factor, the injury to mucosal cells in PUD is caused by: a. acid back-diffusion into the mucosa b. ammonia formation in the mucus wall c. breakdown of gastric mucosal barrier d. release of histamine for cells a. acid back-diffusion into the mucosa Patient with an ulcer of the posterior portion of duodenum experiences: a. pain that occurs after not eating all day b. back pain that occurs 2-4 hrs after eating c. midepigastric pain unrelieved with antacids d. high epigastric burning relieved with food intake b. back pain that occurs 2-4 hrs after eating Diagnostic testing is planned fr a patient with suspected peptic ulcer. Most reliable test is: a. endoscopy b. gastric analysis c. barium swallow d. serologic test for H pylori a. endoscopy Nurse teaches a patient with newly diagnosed PUD to a. maintain bland diet b. use alcohol and caffeine in moderation c. eat as normally as possible, eliminating foods that cause pain d. avoid milk and milk products c. eat as normally as possible, eliminating foods that cause pa Teaching is effective when atient with PUD states: a. " I should stop all meds if i develop side effects" b. "i should cintinue treatemnt as long as i have pain" c. "i have learned some relaxation strategies that decrease my stress" d. "i can buy whatever antacids are on sale" c. "i have learned some relaxation strategies that decrease my stress" Patient with history of PUD is hospitalized with symptoms of a perforation. During initial assessment nurse would expect to find: a. vomit of bright red blood c. sudden, severe upper abdominal pain and shoulder pain b. projectile vomiting c. sudden, severe upper abdominal pain and shoulder pain d. hyperactive stomach sounds A patient with NG tube develops nausea and increased upper abominal bowel sounds. Appropriate action is to: a. check the patency of the NG tube b. place client in recumbant position c. assess vital signs d. ecourage deep breathing a. check the patency of the NG tube Following a Billroth 2 procedure, atient develops dumping syndrome. The nurse explains that the symptoms associated wti h this problem are caused by: a. distention of smaller stomach by too much food intake b. hyperglycemia caused by uncontrolled gastric emptying into small intestine c. irritation of stomach lining by reflux of bile salts d. movement of fluid into the bowel because concentrated food and fluids move rapidly into the intesting d. movement of fluid into the bowel because concentrated food fluids move rapidly into the intesting Nurse determines teaching need when patient with dumping syndrome says a. "i should eat bread with every meal" b. "i should avoid drinking fluids with meals" c. i should eat small meals about 6x day" d. "i need t olie down for 30-60 min after meals" a. "i should eat bread with every meal" Patient with cancer of stomach undergoes total gastrecotmy with esophagojejunostomy. Postop the nurse teaches the patient to expect: a. rapid healing b. ability to return to normal dietary habits c. close follow up for development of ulcers d. lifelong intramuscular or intranasal admin of cobalamin d. lifelong intramuscular or intranasal admin of cobalamin The preferred immediate treatment for acute episode of constipation is: a. soapsud enema b. stimulant cthartics c. stool sofenting cathartic d. tap water or hypertonic enemas d. tap water or hypertonic enemas On 2nd postop day, patient who had exploratory laparotomy complains if abdominal distention and gas pains. Best response to this is: a. Abdominal distention occurs as a normal response to inflammation and healing b. Gas pains occur when NG tube is not used during surgery d. This occurs because of bowel immobility caused by anesthesia and manipulation of abdominal contents during surgery c. This is a common complication of abdominl surgery but usualy releived by BM d. This occurs because of bowel immobility caused by anesthesia and manipulation of abdominal contents during surgery Postop patient has nursing diagnosis of pain r/t to immobility, meds, and decreased motility as evidneced by abdominal pain and distention and inability to pass flatus. An apropriate nursing intervention for the patient is to: a. ambulate patient more frequently b. assess abdomen for bowel sounds c. place patient in high fowlers d. withhold narcotics because they decrease bowel motility a. ambulate patient more frequently A 22 yr old calls the clinic complaining of N&V and RLQ abdominal pain. The nurse advises the patient to: a. have the symptoms evaluated by a MD right away b. use a heating pad c. drink at least 2 qts of juice d. take a laxative to empty the bowel before exam at clinic a. have the symptoms evaluated by a MD right away Patient with a gunshot wound to the abdomen develops a bacterial peritonitis after surgery to repair the bowel. The nurse explains to the patient htat this problem is caused prirmarily by: a. immobility and loss of perstaliss of the bowel as reuslt of surgery b. penetration of unsteril foreighn bodies into the abdominal cavity c. spillage of bowel contents int othe normally sterile abdominal cavity d. accumulation of blood and fluid in the abdominal cavity as a result of the trauma c. spillage of bowel contents int othe normally sterile abdominal cavity Patient with ulcerative colitis has a total colectomy with formation of a terminal ileum stoma. an important nursing interention for this patient postop is to: a. measure the ileosotmy output to determine the status of patient's fluid balance b. change ileostomy q 3-4 hrs c. emphasize that ostomy is temporary d. teach about high fiber diet required to maintain normal ostomy drainage a. measure the ileosotmy output to determine the status of patient's fluid balance Patient with inflammatory bwel disease has a nursing diagnosis of imbalanced nutrition: less than body requirements r/t decreased nutritional intake and decreased intestinal absorption. Data to support this is: a. pallor and hair loss b. frequent diarrhea stools c. anorectal excoriation and pain d. hypotension and urine output below 30 ml /hr a. pallor and hair loss Patient asks nurse if his risks for colon cancer are increased due to a polyp. the best response is: a. it is very rare for polyps ot become malignant b. individuals with polyps have a 100% lifetime risk of developing colorectal cancer c. all polyps are abnormal and should be removed, but the risk for cancer depends on the type and if malignant changes are present d. all polyps are premalignant and source of most colon cancer. get colonoscpy q 6 months. c. all polyps are abnormal and should be removed, but the risk for cancer depends on the type and if malignant changes are present Early screening for detection of cancers of the right side of colon in individuals over 50 yrs old should be done q year to include: a. serum CEA levels b. flexible sigmoidoscopy c. digital rectal exam d. fecal testing for occult blood d. fecal testing for occult blood A knowledge of factors associated with colorectal cancer guides the nurse when obtaining a nursing history to ask specifically about: a. usual diet b. history of smoking c. history of alcohol d. environmental exposure to carcinogens a. usual die Upon examining a patient 8 hrs after formation of a colostomy the nurse would expect to find a. hypoactive, high pitched bowel sounds b. brickred, puffy stoma that oozes blood c. purplish stoma, shiny and moist d. small amt of liquid fecal drainage from stome b. brickred, puffy stoma that oozes blood Nurse teaches patient with diverticulosis to a. use anticholinergic drugs routinely to prevent bowel spasm b. have a nannual colonoscopy to detect malignant changes c. maintain a high fiber diet and use bulk laxatives to increase fecal volume d. exclude whole grains c. maintain a high fiber diet and use bulk laxatives to increase fecal volume During an acute attack of diverticulitis, the patient is: a. monitored for signs of peritonitis b. treated with daily med enemas c. prepared for surgery to resect the involved colon d. provided with heathing pad to apply to LLQ a. monitored for signs of peritonitis When assessing a patient with pancreatitits, nurse would expect to find: c. severe midepigastric of LUQ pain a. hyperactive bowel sounds b. hypertension and tachycardia c. severe midepigastric of LUQ pain d. temp greater than 102º Combined with clinical manifestations, the lab finding that is most commonly used to diagnose acute prancreatitis is: a. increased serum lipase c c. increased urinary amylase d. decreased renal amylase creatine clearance c. severe midepigastric of LUQ pain Most effective means of suppressing pancreatic secreation during an episode of pancreatitis is the use of: a. antibiotics b. NPO status c. antispasmotics d. H2R blockers b. NPO status Patient with pancreatitis has nursing dx of pain r/t distention of pancreas and peritoneal irritation. In addition to effective use of analgesics the nurse should: a. provide diversional activiies to distract patient b. provide small frequent meals c. position the patient on the side with the head of the bed elevated 45º d. ambulate the patient q 3-4 hours c. position the patient on the side with the head of the bed elevated 45º the nurse determines tha further discharge instruction is needed whne the patient with acute pancreatititis states: a. "i should observe for fat in my stools" b. "I must not use alcohol to prevent future attacks" c. "I shouldn't eat salty foods" d. "I will need to continue to monitor my blood glucose levels until my pancreas is healed" c. "I shouldn't eat salty foods" Question Answer When do duodenal ulcer pain usually occur? 1-1/2 to 3 hrs after meals, during the night Dumping Syndrome rapid emptying of gastric contents into the small intestine Pancreatitis - first nursing priority pain interventions Pancreatitis - second nursing priority auto digestion of the pancreas What is? Cirrhosis replacement of liver tissue with fibrotic, scar tissue Spider angiomas Fetor hepaticus associated with the liver failure? A. Hypoalbuminemia B. Increased capillary permeability C. Abnormal peripheral vasodilation D. Excess rennin release from the kidneys E. 2. You’re assessing the stoma of a patient with a healthy, well-healed colostomy. You expect the stoma to appear: 1. Pale, pink and moist 2. Red and moist 3. Dark or purple colored 4. Dry and black 3. You’re caring for a patient with a sigmoid colostomy. The stool from this colostomy is: 1. Formed 2. Semisolid 3. Semiliquid 4. Watery What is? asterixis flapping of the hands What is? fetor hepaticus liver breath Carcinoembryonic antigen (CEA) level... will decrease if chemotherapy is being effective in controlling growth of cancer cells Post-OP gastroectomy - nursing priority nasogastric tube patency, to reduce risk of retention of gastric secretions, that can lead to gastric dilation Cirrhosis pt. with elevated ____ should be reported to the HCP? Ammonia, elevated may indicate portal-systemic encephalopathy GERD - best sleeping position left side, with head elevated 6 inches Oxybutynin (Ditropan), used for? alleviate pain with neurogenic or overactive bladder - avoid with GERD Diphenoxylate (Lomotil), used for? decrease gastrointestinal motility 0.45 % sodium chloride IV, used for? fluid replacement, dehydration Ciprofloxacin (Cipro), used for? bacterial gastroenteritis 5% dextrose water, used for? acute gastroenteritis; fluid replacement, dehydration 1. A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor the patient’s blood pressure because of which change that is 4. You’re advising a 21 y.o. with a colostomy who reports problems with flatus. What food should you recommend? 1. Peas 2. Cabbage 3. Broccoli 4. Yogurt 5. You have to teach ostomy self care to a patient with a colostomy. You tell the patient to measure and cut the wafer: 1. To the exact size of the stoma. 2. About 1/16” larger than the stoma. 3. About 1/8” larger than the stoma. 4. About 1/4″ larger than the stoma. 6. You’re performing an abdominal assessment on Brent who is 52 y.o. In which order do you proceed? 1. Observation, percussion, palpation, auscultation 2. Observation, auscultation, percussion, palpation 3. Percussion, palpation, auscultation, observation 4. Palpation, percussion, observation, auscultation 7. You’re doing preoperative teaching with Gertrude who has ulcerative colitis who needs surgery to create an ileoanal reservoir. Which information do you include? 1. A reservoir is created that exits through the abdominal wall. 2. A second surgery is required 12 months after the first surgery. 3. A permanent ileostomy is created. 4. The surgery occurs in two stages. 8. You’re caring for Carin who has just had ileostomy surgery. During the first 24 hours post-op, how much drainage can you expect from the ileostomy? 1. 100 ml 2. 500 ml 3. 1500 ml 4. 5000 ml 9. You’re preparing a teaching plan for a 27 y.o. named Jeff who underwent surgery to close a temporary ileostomy. Which nutritional guideline do you include in this plan? 1. There is no need to change eating habits. 2. Eat six small meals a day. 3. Eat the largest meal in the evening. 4. Restrict fluid intake. 10. Arthur has a family history of colon cancer and is scheduled to have a sigmoidoscopy. He is crying as he tells you, “I know that I have colon cancer, too.” Which response is most therapeutic? 1. “I know just how you feel.” 2. “You seem upset.” 3. “Oh, don’t worry about it, everything will be just fine.” 4. “Why do you think you have cancer?” 11. You’re caring for Beth who underwent a Billroth II procedure (surgical removal of the pylorus and duodenum) for treatment of a peptic ulcer. Which findings suggest that the patient is developing dumping syndrome, a complication associated with this procedure? 1. Flushed, dry skin. 2. Headache and bradycardia. 3. Dizziness and sweating. 4. Dyspnea and chest pain. 12. You’re developing the plan of care for a patient experiencing dumping syndrome after a Billroth II procedure. Which dietary instructions do you include? 1. Omit fluids with meals. 2. Increase carbohydrate intake. 3. Decrease protein intake. 4. Decrease fat intake. 13. You’re caring for Lewis, a 67 y.o. patient with liver cirrhosis who develops ascites and requires paracentesis. Relief of which symptom indicated that the paracentesis was effective? 1. Pruritus 2. Dyspnea 3. Jaundice 4. Peripheral Neuropathy 14. You’re caring for Jane, a 57 y.o. patient with liver cirrhosis who develops ascites and requires paracentesis. Before her paracentesis, you instruct her to: 1. Empty her bladder. 2. Lie supine in bed. 3. Remain NPO for 4 hours. 4. Clean her bowels with an enema. 15. After abdominal surgery, your patient has a severe coughing episode that causes wound evisceration. In addition to calling the doctor, which intervention is most appropriate? 1. Irrigate the wound & organs with Betadine. 2. Cover the wound with a saline soaked sterile dressing. 3. Apply a dry sterile dressing & binder. 4. Push the organs back & cover with moist sterile dressings. 16. You’re caring for Betty with liver cirrhosis. Which of the following assessment findings leads you to suspect hepatic encephalopathy in her? 1. Asterixis 2. Chvostek’s sign 3. Trousseau’s sign 4. Hepatojugular reflex 17. You are developing a careplan on Sally, a 67 y.o. patient with hepatic encephalopathy. Which of the following do you include? 1. Administering a lactulose enema as ordered. 2. Encouraging a protein-rich diet. 3. Administering sedatives, as necessary. 4. Encouraging ambulation at least four times a day. 18. You have a patient with achalasia (incomplete muscle relaxtion of the GI tract, especially sphincter muscles). Which medications do you anticipate to administer? 1. Isosorbide dinitrate (Isordil) 2. Digoxin (Lanoxin) 3. Captopril (Capoten) 4. Propanolol (Inderal) 19. The student nurse is preparing a teaching care plan to help improve nutrition in a patient with achalasia. You include which of the following: 1. Swallow foods while leaning forward. 2. Omit fluids at mealtimes. 3. Eat meals sitting upright. 4. Avoid soft and semisoft foods. 20. Britney, a 20 y.o. student is admitted with acute pancreatitis. Which laboratory findings do you expect to be abnormal for this patient? 1. Serum creatinine and BUN 2. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) 3. Serum amylase and lipase 4. Cardiac enzymes 21. A patient with Crohn’s disease is admitted after 4 days of diarrhea. Which of the following urine specific gravity values do you expect to find in this patient? 1. 1.005 2. 1.011 3. 1.020 4. 1.030 22. Your goal is to minimize David’s risk of complications after a heriorrhaphy. You instruct the patient to: 1. Avoid the use of pain medication. 2. Cough and deep breathe Q2H. 3. Splint the incision if he can’t avoid sneezing or coughing. 4. Apply heat to scrotal swelling. 23. Janice is waiting for discharge instructions after her herniorrhaphy. Which of the following instructions do you include? 1. Eat a low-fiber diet. 2. Resume heavy lifting in 2 weeks. 3. Lose weight, if obese. 4. Resume sexual activity once discomfort is gone. 24. Develop a teaching care plan for Angie who is about to undergo a liver biopsy. Which of the following points do you include? 1. “You’ll need to lie on your stomach during the test.” 2. “You’ll need to lie on your right side after the test.” 3. “During the biopsy you’ll be asked to exhale deeply and hold it.” 4. “The biopsy is performed under general anesthesia.” 25. Stephen is a 62 y.o. patient that has had a liver biopsy. Which of the following groups of signs alert you to a possible pneumothorax? 1. Dyspnea and reduced or absent breath sounds over the right lung 2. Tachycardia, hypotension, and cool, clammy skin 3. Fever, rebound tenderness, and abdominal rigidity 4. Redness, warmth, and drainage at the biopsy site 26. Michael, a 42 y.o. man is admitted to the med-surg floor with a diagnosis of acute pancreatitis. His BP is 136/76, pulse 96, Resps 22 and temp 101. His past history includes hyperlipidemia and alcohol abuse. The doctor prescribes an NG tube. Before inserting the tube, you explain the purpose to patient. Which of the following is a most accurate explanation? 1. “It empties the stomach of fluids and gas.” 2. “It prevents spasms at the sphincter of Oddi.” 3. “It prevents air from forming in the small intestine and large intestine.” 4. “It removes bile from the gallbladder.” 27. Jason, a 22 y.o. accident victim, requires an NG tube for feeding. What should you immediately do after inserting an NG tube for liquid enteral feedings? 1. Aspirate for gastric secretions with a syringe. 2. Begin feeding slowly to prevent cramping. 3. Get an X-ray of the tip of the tube within 24 hours. 4. Clamp off the tube until the feedings begin. 28. Stephanie, a 28 y.o. accident victim, requires TPN. The rationale for TPN is to provide: 1. Necessary fluids and electrolytes to the body. 2. Complete nutrition by the I.V. route. 3. Tube feedings for nutritional supplementation. 4. Dietary supplementation with liquid protein given between meals. 29. Type A chronic gastritis can be distinquished from type B by its ability to: 1. Cause atrophy of the parietal cells. 2. Affect only the antrum of the stomach. 3. Thin the lining of the stomach walls. 4. Decrease gastric secretions. 30. Matt is a 49 y.o. with a hiatal hernia that you are about to counsel. Health care counseling for Matt should include which of the following instructions? 1. Restrict intake of high-carbohydrate foods. 2. Increase fluid intake with meals. 3. Increase fat intake. 4. Eat three regular meals a day. 31. Jerod is experiencing an acute episode of ulcerative colitis. Which is priority for this patient? 1. Replace lost fluid and sodium. 2. Monitor for increased serum glucose level from steroid therapy. 3. Restrict the dietary intake of foods high in potassium. 4. Note any change in the color and consistency of stools. 32. A 29 y.o. patient has an acute episode of ulcerative colitis. What diagnostic test confirms this diagnosis? 1. Barium Swallow. 2. Stool examination. 3. Gastric analysis. 4. Sigmoidoscopy. 33. Eleanor, a 62 y.o. woman with diverticulosis is your patient. Which interventions would you expect to include in her care? 1. Low-fiber diet and fluid restrictions. 2. Total parenteral nutrition and bed rest. 3. High-fiber diet and administration of psyllium. 4. Administration of analgesics and antacids. 34. Regina is a 46 y.o. woman with ulcerative colitis. You expect her stools to look like: 1. Watery and frothy. 2. Bloody and mucoid. 3. Firm and well-formed. 4. Alternating constipation and diarrhea. 35. Donald is a 61 y.o. man with diverticulitis. Diverticulitis is characterized by: 1. Periodic rectal hemorrhage. 2. Hypertension and tachycardia. 3. Vomiting and elevated temperature. 4. Crampy and lower left quadrant pain and low-grade fever. 36. Brenda, a 36 y.o. patient is on your floor with acute pancreatitis. Treatment for her includes: 1. Continuous peritoneal lavage. 2. Regular diet with increased fat. 3. Nutritional support with TPN. 4. Insertion of a T tube to drain the pancreas. 37. Glenda has cholelithiasis (gallstones). You expect her to complain of: 1. Pain in the right upper quadrant, radiating to the shoulder. 2. Pain in the right lower quadrant, with rebound tenderness. 3. Pain in the left upper quadrant, with shortness of breath. 4. Pain in the left lower quadrant, with mild cramping. 38. After an abdominal resection for colon cancer, Madeline returns to her room with a Jackson-Pratt drain in place. The purpose of the drain is to: 1. Irrigate the incision with a saline solution. 2. Prevent bacterial infection of the incision. 3. Measure the amount of fluid lost after surgery. 4. Prevent accumulation of drainage in the wound. 39. Anthony, a 60 y.o. patient, has just undergone a bowel resection with a colostomy. During the first 24 hours, which of the following observations about the stoma should you report to the doctor? 1. Pink color. 2. Light edema. 3. Small amount of oozing. 4. Trickles of bright red blood. 40. Your teaching Anthony how to use his new colostomy. How much skin should remain exposed between the stoma and the ring of the appliance? 1. 1 /16” 2. 1 /4″ 3. 1 /2” 4. 1 ” 41. Claire, a 33 y.o. is on your floor with a possible bowel obstruction. Which intervention is priority for her? 1. Obtain daily weights. 2. Measure abdominal girth. 3. Keep strict intake and output. 4. Encourage her to increase fluids. 42. Your patient has a GI tract that is functioning, but has the inability to swallow foods. Which is the preferred method of feeding for your patient? 1. TPN 2. PPN 3. NG feeding 4. Oral liquid supplements 43. You’re patient is complaining of abdominal pain during assessment. What is your priority? 1. Auscultate to determine changes in bowel sounds. 2. Observe the contour of the abdomen. 3. Palpate the abdomen for a mass. 4. Percuss the abdomen to determine if fluid is present. 44. Before bowel surgery, Lee is to administer enemas until clear. During administration, he complains of intestinal cramps. What do you do next? 1. Discontinue the procedure. 2. Lower the height of the enema container. 3. Complete the procedure as quickly as possible. 4. Continue administration of the enema as ordered without making any adjustments. 45. Leigh Ann is receiving pancrelipase (Viokase) for chronic pancreatitis. Which observation best indicates the treatment is effective? 1. There is no skin breakdown. 2. Her appetite improves. 3. She loses more than 10 lbs. 4. Stools are less fatty and decreased in frequency. 46. Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab value is most likely to be elevated? 1. Calcium 2. Glucose 3. Magnesium 4. Potassium 47. Anna is 45 y.o. and has a bleeding ulcer. Despite multiple blood transfusions, her HGB is 7.5g/dl and HCT is 27%. Her doctor determines that surgical intervention is necessary and she undergoes partial gastrectomy. Postoperative nursing care includes: 1. Giving pain medication Q6H. 2. Flushing the NG tube with sterile water. 3. Positioning her in high Fowler’s position. 4. Keeping her NPO until the return of peristalsis. 48. Sitty, a 66 y.o. patient underwent a colostomy for ruptured diverticulum. She did well during the surgery and returned to your med-surg floor in stable condition. You assess her colostomy 2 days after surgery. Which finding do you report to the doctor? 1. Blanched stoma 2. Edematous stoma 3. Reddish-pink stoma 4. Brownish-black stoma 49. Sharon has cirrhosis of the liver and develops ascites. What intervention is necessary to decrease the excessive accumulation of serous fluid in her peritoneal cavity? 1. Restrict fluids 2. Encourage ambulation 3. Increase sodium in the diet 4. Give antacids as prescribed 50. Katrina is diagnosed with lactose intolerance. To avoid complications with lack of calcium in the diet, which food should be included in the diet? 1. Fruit 2. Whole grains 3. Milk and cheese products 4. Dark green, leafy vegetables 51. Nathaniel has severe pruritus due to having hepatitis B. What is the best intervention for his comfort? 1. Give tepid baths. 2. Avoid lotions and creams. 3. Use hot water to increase vasodilation. 4. Use cold water to decrease the itching. 52. Rob is a 46 y.o. admitted to the hospital with a suspected diagnosis of Hepatitis B. He’s jaundiced and reports weakness. Which intervention will you include in his care? 1. Regular exercise. 2. A low-protein diet. 3. Allow patient to select his meals. 4. Rest period after small, frequent meals. 53. You’re discharging Nathaniel with hepatitis B. Which statement suggests understanding by the patient? 1. “Now I can never get hepatitis again.” 2. “I can safely give blood after 3 months.” 3. “I’ll never have a problem with my liver again, even if I drink alcohol.” 4. “My family knows that if I get tired and start vomiting, I may be getting sick again.” 54. Gail is scheduled for a cholecystectomy. After completion of preoperative teaching, Gail states,”If I lie still and avoid turning after the operation, I’ll avoid pain. Do you think this is a good idea?” What is the best response? 1. “You’ll need to turn from side to side every 2 hours.” 2. “It’s always a good idea to rest quietly after surgery.” 3. “The doctor will probably order you to lie flat for 24 hours.” 4. “Why don’t you decide about activity after you return from the recovery room?” 55. You’re caring for a 28 y.o. woman with hepatitis B. She’s concerned about the duration of her recovery. Which response isn’t appropriate? 1. Encourage her to not worry about the future. 2. Encourage her to express her feelings about the illness. 3. Discuss the effects of hepatitis B on future health problems. 4. Provide avenues for financial counseling if she expresses the need. 56. Elmer is scheduled for a proctoscopy and has an I.V. The doctor wrote an order for 5mg of I.V. diazepam(Valium). Which order is correct regarding diazepam? 1. Give diazepam in the I.V. port closest to the vein. 2. Mix diazepam with 50 ml of dextrose 5% in water and give over 15 minutes. 3. Give diazepam rapidly I.V. to prevent the bloodstream from diluting the drug mixture. 4. Question the order because I.V. administratio