GASTROINTESTINAL AND NEUROLOGICAL
MEDICAL – SURGICAL NURSING SPECIALTIES.
PREP Q&A 2025 UPDATED VERSION.
75 Q & A WITH RATIONALE.
Anurse is caring for a client who is receiving total parenteral nutrition (TPN). The
pharmacy suips pdl ey ilnaygetdheincl ie nt’s next container of TPN. Which of the following fluids
should the nurse infuse cuonntitlatihne rnext
o arrives?
o Dextrose 5% in water
Rationale: TPN contains high concentrations of certain nutrients.
Infusing dextrose 5% in water could cause rapid shifts in serum levels of
some substances.
o 0.9% sodium chloride
Rationale: TPN contains high concentrations of certain nutrients.
Infusing 0.9% sodium chloride could cause rapid shifts in serum levels of
some substances.
o Dextrose 10% in water
Rationale: TPN contains high concentrations of dextrose and proteins.
To avoid hypoglycemia, the nurse should infuse dextrose 10% or 20%
in water until the next container of TPN solution arrives.
o Lactated Ringer’s solution
Rationale: TPN contains high concentrations of certain nutrients.
Infusing lactated Ringer’s solution could cause rapid shifts in serum
levels of some substances.
An acute care nurse is caring for an adult client who is undergoing evaluation for a possible brain
tumor. performing a neurological examination, which of following is the most reliable indicator of
cerebral status
o Pupil response
Rationale: The nurse should include pupil response as part of a
neurological examination; however, it is not the most reliable indicator of
cerebral status.
o Deep tendon reflexes
Rationale: The nurse should include deep tendon reflexes as part of a
neurological examination; however, it is not the most reliable indicator
of cerebral status.
o Muscle strength
Rationale: The nurse should include muscle strength as part of a
neurological examination; however, it is not the most reliable indicator of
cerebral status.
, o Level of consciousness
Rationale: The nurse should examine the client’s level of consciousness as
the most reliable indicator of cerebral status.
A nurse in the antepartum unit is caring for a client who is at 36 weeks of gestation and
has pregnancy- induced hypertension. Suddenly, the client reports continuous abdominal
pain and vaginal bleeding. The nurse should suspect which of the following
complications?
o Placenta previa
Rationale: Placenta previa occurs with painless vaginal bleeding.
o Prolapsed cord
Rationale: With a prolapsed umbilical cord, there is no bleeding or pain.
There may be changes in the fetal heart tracing, and the cord might also
become visible.
o Ruptured ovarian cysts
Rationale: A rupture of an ovarian cyst can cause sudden pelvic pain,
but it does not commonly cause vaginal bleeding.
o Abruptio placentae
Rationale: The cardinal signs and symptoms of abruptio placentae
include a rigid board-like abdomen, severe pain, and heavy vaginal
bleeding.
catheter (PICC) line. When assessing the client, the nurse notes that the client's arm seems
swollen above the PICC insertion site. Which of the following actions should the nurse
take first?
o Measure the circumference of both upper arms.
Rationale: The first action to take if the client's arm appears to be swollen
is to measure the arm and compare it to the circumference of the other
arm. If the arm is swollen, it is appropriate to notify the provider who
inserted the PICC line. Swelling could indicate formation of a clot above
the site.
o Notify the provider who inserted the PICC line.
Rationale: It may be necessary to notify the provider, but this is not the
first action the nurse should take.
o Remove the PICC line.
Rationale: It may be necessary to remove the PICC line, but this is not
the first action the nurse should take.
o Apply a cold pack to the client's upper arm.
Rationale: It may be necessary to apply a cold pack to the client's upper
arm, but this is not the first action the nurse should take.
Anurse is planning care for a client who has a GI bleed. Which of the following actions should the
nurse ta first?
o Assess orthostatic blood pressure.
Rationale: The first action the nurse should take using the nursing
, process is to assess the client; therefore, assessing the orthostatic blood
pressure is the first priority to determine if the client is hypovolemic.
o Explain the procedure for an upper GI series.
Rationale: The nurse should explain the procedure for an upper GI series,
but this is not the priority.
o Administer pain medication.
Rationale: The nurse should administer pain medication as needed, but this
is not the priority.
o Test the emesis for blood.
Rationale: The nurse should test the emesis for blood if the client vomits,
but this is not the priority.
, A nurse is providing discharge teaching for a client who has acute pancreatitis and has a
prescription for fat- soluble vitamin supplements. The nurse should instruct the client to
take a supplement for which of the following?
o Vitamin A
Rationale: The nurse should instruct the client that fat-soluble vitamins
include vitamins A, D, E, and K.
o Vitamin B1
Rationale: itamin B1 is not a fat-soluble vitamin.
o Vitamin C
Rationale: Vitamin C is not a fat-soluble vitamin.
o Vitamin B12
Rationale: Vitamin B12 is not a fat-soluble vitamin.
A nurse is caring for a client who has acute pancreatitis. After the client's pain has
been addressed, which of the following is the next intervention to include in the
plan of care?
o Monitor respiratory status every 8 hr.
Rationale: Monitoring respiratory status is an appropriate intervention, but
it is not the next intervention.
o Encourage a side-lying position with knees flexed.
Rationale: Encouraging a side-lying position with knees flexed status is
an appropriate intervention, but it is not the next intervention.
o Provide frequent oral hygiene.
Rationale: Providing frequent oral hygiene status is an appropriate
intervention, but it is not the next intervention.
o Maintain NPO status.
Rationale: To rest the pancreas and reduce secretion of pancreatic
enzymes, oral fluids and food are withheld during the acute phase of
pancreatitis. This is the next intervention to be included in the plan of
care.
A nurse is caring for a client at a rehabilitation center 3 weeks after a cerebrovascular
accident (CVA). Because the client's CVA affected the left side of the brain, which
of the following goals should the nurse anticipate including in the client's
rehabilitation program?
o Establish the ability to communicate effectively.
Rationale: A CVA is an interruption of the blood supply to any part of
the brain, resulting in damaged brain tissue. The left hemisphere is
usually dominant for language.
o Because this client had a left-side CVA, the nurse should
anticipate the client will have some degree of aphasia and
MEDICAL – SURGICAL NURSING SPECIALTIES.
PREP Q&A 2025 UPDATED VERSION.
75 Q & A WITH RATIONALE.
Anurse is caring for a client who is receiving total parenteral nutrition (TPN). The
pharmacy suips pdl ey ilnaygetdheincl ie nt’s next container of TPN. Which of the following fluids
should the nurse infuse cuonntitlatihne rnext
o arrives?
o Dextrose 5% in water
Rationale: TPN contains high concentrations of certain nutrients.
Infusing dextrose 5% in water could cause rapid shifts in serum levels of
some substances.
o 0.9% sodium chloride
Rationale: TPN contains high concentrations of certain nutrients.
Infusing 0.9% sodium chloride could cause rapid shifts in serum levels of
some substances.
o Dextrose 10% in water
Rationale: TPN contains high concentrations of dextrose and proteins.
To avoid hypoglycemia, the nurse should infuse dextrose 10% or 20%
in water until the next container of TPN solution arrives.
o Lactated Ringer’s solution
Rationale: TPN contains high concentrations of certain nutrients.
Infusing lactated Ringer’s solution could cause rapid shifts in serum
levels of some substances.
An acute care nurse is caring for an adult client who is undergoing evaluation for a possible brain
tumor. performing a neurological examination, which of following is the most reliable indicator of
cerebral status
o Pupil response
Rationale: The nurse should include pupil response as part of a
neurological examination; however, it is not the most reliable indicator of
cerebral status.
o Deep tendon reflexes
Rationale: The nurse should include deep tendon reflexes as part of a
neurological examination; however, it is not the most reliable indicator
of cerebral status.
o Muscle strength
Rationale: The nurse should include muscle strength as part of a
neurological examination; however, it is not the most reliable indicator of
cerebral status.
, o Level of consciousness
Rationale: The nurse should examine the client’s level of consciousness as
the most reliable indicator of cerebral status.
A nurse in the antepartum unit is caring for a client who is at 36 weeks of gestation and
has pregnancy- induced hypertension. Suddenly, the client reports continuous abdominal
pain and vaginal bleeding. The nurse should suspect which of the following
complications?
o Placenta previa
Rationale: Placenta previa occurs with painless vaginal bleeding.
o Prolapsed cord
Rationale: With a prolapsed umbilical cord, there is no bleeding or pain.
There may be changes in the fetal heart tracing, and the cord might also
become visible.
o Ruptured ovarian cysts
Rationale: A rupture of an ovarian cyst can cause sudden pelvic pain,
but it does not commonly cause vaginal bleeding.
o Abruptio placentae
Rationale: The cardinal signs and symptoms of abruptio placentae
include a rigid board-like abdomen, severe pain, and heavy vaginal
bleeding.
catheter (PICC) line. When assessing the client, the nurse notes that the client's arm seems
swollen above the PICC insertion site. Which of the following actions should the nurse
take first?
o Measure the circumference of both upper arms.
Rationale: The first action to take if the client's arm appears to be swollen
is to measure the arm and compare it to the circumference of the other
arm. If the arm is swollen, it is appropriate to notify the provider who
inserted the PICC line. Swelling could indicate formation of a clot above
the site.
o Notify the provider who inserted the PICC line.
Rationale: It may be necessary to notify the provider, but this is not the
first action the nurse should take.
o Remove the PICC line.
Rationale: It may be necessary to remove the PICC line, but this is not
the first action the nurse should take.
o Apply a cold pack to the client's upper arm.
Rationale: It may be necessary to apply a cold pack to the client's upper
arm, but this is not the first action the nurse should take.
Anurse is planning care for a client who has a GI bleed. Which of the following actions should the
nurse ta first?
o Assess orthostatic blood pressure.
Rationale: The first action the nurse should take using the nursing
, process is to assess the client; therefore, assessing the orthostatic blood
pressure is the first priority to determine if the client is hypovolemic.
o Explain the procedure for an upper GI series.
Rationale: The nurse should explain the procedure for an upper GI series,
but this is not the priority.
o Administer pain medication.
Rationale: The nurse should administer pain medication as needed, but this
is not the priority.
o Test the emesis for blood.
Rationale: The nurse should test the emesis for blood if the client vomits,
but this is not the priority.
, A nurse is providing discharge teaching for a client who has acute pancreatitis and has a
prescription for fat- soluble vitamin supplements. The nurse should instruct the client to
take a supplement for which of the following?
o Vitamin A
Rationale: The nurse should instruct the client that fat-soluble vitamins
include vitamins A, D, E, and K.
o Vitamin B1
Rationale: itamin B1 is not a fat-soluble vitamin.
o Vitamin C
Rationale: Vitamin C is not a fat-soluble vitamin.
o Vitamin B12
Rationale: Vitamin B12 is not a fat-soluble vitamin.
A nurse is caring for a client who has acute pancreatitis. After the client's pain has
been addressed, which of the following is the next intervention to include in the
plan of care?
o Monitor respiratory status every 8 hr.
Rationale: Monitoring respiratory status is an appropriate intervention, but
it is not the next intervention.
o Encourage a side-lying position with knees flexed.
Rationale: Encouraging a side-lying position with knees flexed status is
an appropriate intervention, but it is not the next intervention.
o Provide frequent oral hygiene.
Rationale: Providing frequent oral hygiene status is an appropriate
intervention, but it is not the next intervention.
o Maintain NPO status.
Rationale: To rest the pancreas and reduce secretion of pancreatic
enzymes, oral fluids and food are withheld during the acute phase of
pancreatitis. This is the next intervention to be included in the plan of
care.
A nurse is caring for a client at a rehabilitation center 3 weeks after a cerebrovascular
accident (CVA). Because the client's CVA affected the left side of the brain, which
of the following goals should the nurse anticipate including in the client's
rehabilitation program?
o Establish the ability to communicate effectively.
Rationale: A CVA is an interruption of the blood supply to any part of
the brain, resulting in damaged brain tissue. The left hemisphere is
usually dominant for language.
o Because this client had a left-side CVA, the nurse should
anticipate the client will have some degree of aphasia and
