SAUNDERS NCLEX QUESTIONS-GASTROINTESTINAL
Lactulose is prescribed for a client with a diagnosis of hepatic encephalopathy. The
nurse should determine that this medication is effective if serum diagnostics reveal
which finding?
1. Increased protein level
2. Increased red blood cell count
3. Decreased serum ammonia level
4. Decreased white blood cell count - Answers :Lactulose is prescribed for the client
with hepatic encephalopathy to reduce bacterial breakdown of protein in the bowel. The
medication creates an acidic environment in the bowel and causes the ammonia to
leave the bloodstream and enter the colon. Ammonia then becomes trapped in the
bowel. Lactulose also has a laxative effect that allows for the elimination of the
ammonia.
The nurse caring for a client diagnosed with inflammatory bowel disease (IBD)
recognizes that which classifications of medications may be prescribed to treat the
disease and induce remission? Select all that apply.
1. Antidiarrheal
2.Antimicrobial
3.Corticosteroid
4.Aminosalicylate
5.Biological therapy
6.Immunosuppressant - Answers :Pharmacological treatment for IBD aims to decrease
the inflammation to induce and then maintain a remission. Five major classes of
medications used to treat IBD are antimicrobials, corticosteroids, aminosalicylates,
biological and targeted therapy, and immunosuppressants. Medications are chosen
based on the location and severity of inflammation. Depending on the severity of the
disease, clients are treated with either a "step-up" or "step-down" approach. The step-
up approach uses less toxic therapies (e.g., aminosalicylates and antimicrobials) first,
and more toxic medications (e.g., biological and targeted therapy) are started when
initial therapies do not work. The step-down approach uses biological and targeted
therapy first. Option 1, antidiarrheals, is incorrect. Although an antidiarrheal may be
used to treat the symptoms of IBD, it does not treat the disease (the inflammation) or
induce remission. In addition, antidiarrheals should be used cautiously in IBD because
of the danger of toxic megacolon (colonic dilation greater than 5 cm).
The nurse is caring for a client admitted to the hospital with a suspected diagnosis of
acute appendicitis. Which laboratory result should the nurse expect to note if the client
does have appendicitis?
1. Leukopenia with a shift to the left
2.Leukocytosis with a shift to the left
3.Leukopenia with a shift to the right
,4.Leukocytosis with a shift to the right - Answers :2.Leukocytosis with a shift to the left
Laboratory findings do not establish the diagnosis of appendicitis, but there is often an
elevation of the white blood cell count (leukocytosis) with a shift to the left (an increased
number of immature white blood cells). Options 1, 3, and 4 are incorrect because they
are not associated findings in acute appendicitis.
The nurse is developing a list of home care instructions for a client being discharged
after a laparoscopic cholecystectomy. Which instructions should the nurse include in the
postoperative discharge plan of care? Select all that apply.
1. Wound care
2.Follow-up care
3.Activity restrictions
4.Dietary instructions
5.Deep-breathing exercises - Answers :1. Wound care
2.Follow-up care
3.Activity restrictions
4.Dietary instructions
The type of planning and instructions required vary with the individual client and the
type of surgery. Specific instructions that this client needs to receive before discharge
should include wound care, activity restrictions, dietary instructions, postoperative
medication instructions, personal hygiene, and follow-up appointments. Deep-breathing
exercises are taught in the preoperative period.
The nurse is providing dietary instructions to a client hospitalized for pancreatitis. Which
food should the nurse instruct the client to avoid?
1. Chili
2.Bagel
3.Lentil soup
4.Watermelon - Answers :The client with pancreatitis needs to avoid alcohol, coffee and
tea, spicy foods, and heavy meals, which stimulate pancreatic secretions, producing
attacks of pancreatitis. The client is instructed in the benefit of eating small, frequent
meals that are high in protein, low in fat, and moderate to high in carbohydrates.
The nurse is caring for a client with a resolved intestinal obstruction who has a
nasogastric tube in place. The primary health care provider has now prescribed that the
nasogastric tube be removed. What is the priority nursing assessment prior to removing
the tube?
1. Checking for normal serum electrolyte levels
2.Checking for normal pH of the gastric aspirate 3.Checking for proper nasogastric tube
placement 4.Checking for the presence of bowel sounds in all 4 quadrants - Answers
, :Distention, vomiting, and abdominal pain are a few of the symptoms associated with
intestinal obstruction. Nasogastric tubes may be used to remove gas and fluid from the
stomach, relieving distention and vomiting. Bowel sounds return to normal as the
obstruction is resolved and normal bowel function is restored. Discontinuing the
nasogastric tube before normal bowel function may result in a return of the symptoms,
necessitating reinsertion of the nasogastric tube. Serum electrolyte levels, pH of the
gastric aspirate, and tube placement are important assessments for the client with a
nasogastric tube in place but would not assist in determining the readiness for removing
the nasogastric tube.
The nurse is caring for a client with acute pancreatitis and is monitoring the client for
paralytic ileus. Which piece of assessment data should alert the nurse to this
occurrence?
1. Inability to pass flatus
2.Loss of anal sphincter control
3.Severe, constant pain with rapid onset
4.Firm, nontender mass palpable at the lower right costal marg - Answers :1. Inability to
pass flatus
An inflammatory reaction such as acute pancreatitis can cause paralytic ileus, the most
common form of nonmechanical obstruction. Inability to pass flatus is a clinical
manifestation of paralytic ileus. Loss of sphincter control is not a sign of paralytic ileus.
Pain is associated with paralytic ileus, but the pain usually manifests as a more constant
generalized discomfort. Option 4 is the description of the physical finding of liver
enlargement. The liver may be enlarged in cases of cirrhosis or hepatitis. Although this
client may have an enlarged liver, an enlarged liver is not a sign of paralytic ileus or
intestinal obstruction.
The nurse is assisting a client with Crohn's disease to ambulate to the bathroom. After
the client has a bowel movement, the nurse should assess the stool for which
characteristic that is expected with this disease?
1. Blood in the stool
2.Chalky gray stool
3.Loose, watery stool
4.Dry, hard, constipated stool - Answers :3.Loose, watery stool
Crohn's disease is characterized by nonbloody diarrhea of usually not more than 4 or 5
stools daily. Over time, the episodes of diarrhea increase in frequency, duration, and
severity. Options 1, 2, and 4 are not characteristics of the stool in Crohn's disease.
A client with a gastric ulcer is scheduled for surgery. The client cannot sign the
operative consent form because of sedation from opioid analgesics that have been
administered. The nurse should take which most appropriateaction in the care of this
client?
Lactulose is prescribed for a client with a diagnosis of hepatic encephalopathy. The
nurse should determine that this medication is effective if serum diagnostics reveal
which finding?
1. Increased protein level
2. Increased red blood cell count
3. Decreased serum ammonia level
4. Decreased white blood cell count - Answers :Lactulose is prescribed for the client
with hepatic encephalopathy to reduce bacterial breakdown of protein in the bowel. The
medication creates an acidic environment in the bowel and causes the ammonia to
leave the bloodstream and enter the colon. Ammonia then becomes trapped in the
bowel. Lactulose also has a laxative effect that allows for the elimination of the
ammonia.
The nurse caring for a client diagnosed with inflammatory bowel disease (IBD)
recognizes that which classifications of medications may be prescribed to treat the
disease and induce remission? Select all that apply.
1. Antidiarrheal
2.Antimicrobial
3.Corticosteroid
4.Aminosalicylate
5.Biological therapy
6.Immunosuppressant - Answers :Pharmacological treatment for IBD aims to decrease
the inflammation to induce and then maintain a remission. Five major classes of
medications used to treat IBD are antimicrobials, corticosteroids, aminosalicylates,
biological and targeted therapy, and immunosuppressants. Medications are chosen
based on the location and severity of inflammation. Depending on the severity of the
disease, clients are treated with either a "step-up" or "step-down" approach. The step-
up approach uses less toxic therapies (e.g., aminosalicylates and antimicrobials) first,
and more toxic medications (e.g., biological and targeted therapy) are started when
initial therapies do not work. The step-down approach uses biological and targeted
therapy first. Option 1, antidiarrheals, is incorrect. Although an antidiarrheal may be
used to treat the symptoms of IBD, it does not treat the disease (the inflammation) or
induce remission. In addition, antidiarrheals should be used cautiously in IBD because
of the danger of toxic megacolon (colonic dilation greater than 5 cm).
The nurse is caring for a client admitted to the hospital with a suspected diagnosis of
acute appendicitis. Which laboratory result should the nurse expect to note if the client
does have appendicitis?
1. Leukopenia with a shift to the left
2.Leukocytosis with a shift to the left
3.Leukopenia with a shift to the right
,4.Leukocytosis with a shift to the right - Answers :2.Leukocytosis with a shift to the left
Laboratory findings do not establish the diagnosis of appendicitis, but there is often an
elevation of the white blood cell count (leukocytosis) with a shift to the left (an increased
number of immature white blood cells). Options 1, 3, and 4 are incorrect because they
are not associated findings in acute appendicitis.
The nurse is developing a list of home care instructions for a client being discharged
after a laparoscopic cholecystectomy. Which instructions should the nurse include in the
postoperative discharge plan of care? Select all that apply.
1. Wound care
2.Follow-up care
3.Activity restrictions
4.Dietary instructions
5.Deep-breathing exercises - Answers :1. Wound care
2.Follow-up care
3.Activity restrictions
4.Dietary instructions
The type of planning and instructions required vary with the individual client and the
type of surgery. Specific instructions that this client needs to receive before discharge
should include wound care, activity restrictions, dietary instructions, postoperative
medication instructions, personal hygiene, and follow-up appointments. Deep-breathing
exercises are taught in the preoperative period.
The nurse is providing dietary instructions to a client hospitalized for pancreatitis. Which
food should the nurse instruct the client to avoid?
1. Chili
2.Bagel
3.Lentil soup
4.Watermelon - Answers :The client with pancreatitis needs to avoid alcohol, coffee and
tea, spicy foods, and heavy meals, which stimulate pancreatic secretions, producing
attacks of pancreatitis. The client is instructed in the benefit of eating small, frequent
meals that are high in protein, low in fat, and moderate to high in carbohydrates.
The nurse is caring for a client with a resolved intestinal obstruction who has a
nasogastric tube in place. The primary health care provider has now prescribed that the
nasogastric tube be removed. What is the priority nursing assessment prior to removing
the tube?
1. Checking for normal serum electrolyte levels
2.Checking for normal pH of the gastric aspirate 3.Checking for proper nasogastric tube
placement 4.Checking for the presence of bowel sounds in all 4 quadrants - Answers
, :Distention, vomiting, and abdominal pain are a few of the symptoms associated with
intestinal obstruction. Nasogastric tubes may be used to remove gas and fluid from the
stomach, relieving distention and vomiting. Bowel sounds return to normal as the
obstruction is resolved and normal bowel function is restored. Discontinuing the
nasogastric tube before normal bowel function may result in a return of the symptoms,
necessitating reinsertion of the nasogastric tube. Serum electrolyte levels, pH of the
gastric aspirate, and tube placement are important assessments for the client with a
nasogastric tube in place but would not assist in determining the readiness for removing
the nasogastric tube.
The nurse is caring for a client with acute pancreatitis and is monitoring the client for
paralytic ileus. Which piece of assessment data should alert the nurse to this
occurrence?
1. Inability to pass flatus
2.Loss of anal sphincter control
3.Severe, constant pain with rapid onset
4.Firm, nontender mass palpable at the lower right costal marg - Answers :1. Inability to
pass flatus
An inflammatory reaction such as acute pancreatitis can cause paralytic ileus, the most
common form of nonmechanical obstruction. Inability to pass flatus is a clinical
manifestation of paralytic ileus. Loss of sphincter control is not a sign of paralytic ileus.
Pain is associated with paralytic ileus, but the pain usually manifests as a more constant
generalized discomfort. Option 4 is the description of the physical finding of liver
enlargement. The liver may be enlarged in cases of cirrhosis or hepatitis. Although this
client may have an enlarged liver, an enlarged liver is not a sign of paralytic ileus or
intestinal obstruction.
The nurse is assisting a client with Crohn's disease to ambulate to the bathroom. After
the client has a bowel movement, the nurse should assess the stool for which
characteristic that is expected with this disease?
1. Blood in the stool
2.Chalky gray stool
3.Loose, watery stool
4.Dry, hard, constipated stool - Answers :3.Loose, watery stool
Crohn's disease is characterized by nonbloody diarrhea of usually not more than 4 or 5
stools daily. Over time, the episodes of diarrhea increase in frequency, duration, and
severity. Options 1, 2, and 4 are not characteristics of the stool in Crohn's disease.
A client with a gastric ulcer is scheduled for surgery. The client cannot sign the
operative consent form because of sedation from opioid analgesics that have been
administered. The nurse should take which most appropriateaction in the care of this
client?
