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 associated with the liver failure?
1. Hypoalbuminemia
2. Increased capillary permeability
3. Abnormal peripheral vasodilation
4. Excess rennin release from the kidneys
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
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 developed 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 developed 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 care plan 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. Propranolol (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 semi soft 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 herniorrhaphy. 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 distinguished 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 mucous.
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. administration of diazepam is contraindicated.
57. Annabelle is being discharged with a colostomy, and you’re teaching her about colostomy
care. Which statement correctly describes a healthy stoma?
1. “At first, the stoma may bleed slightly when touched.”
2. “The stoma should appear dark and have a bluish hue.”
3. “A burning sensation under the stoma faceplate is normal.”
4. “The stoma should remain swollen away from the abdomen.”
58. A patient who underwent abdominal surgery now has a gaping incision due to delayed wound
healing. Which method is correct when you irrigate a gaping abdominal incision with sterile
normal saline solution, using a piston syringe?
1. Rapidly instill a stream of irrigating solution into the wound.
2. Apply a wet-to-dry dressing to the wound after the irrigation.
3. Moisten the area around the wound with normal saline solution after the irrigation.
4. Irrigate continuously until the solution becomes clear or all of the solution is used.
59. Hepatic encephalopathy develops when the blood level of which substance increases?
1. Ammonia
2. Amylase
3. Calcium
4. Potassium
60. Your patient recently had abdominal surgery and tells you that he feels a popping sensation in
his incision during a coughing spell, followed by severe pain. You anticipate an evisceration.
Which supplies should you take to his room?
1. A suture kit.
2. Sterile water and a suture kit.
3. Sterile water and sterile dressings.
4. Sterile saline solution and sterile dressings.
61. Findings during an endoscopic exam include a cobblestone appearance of the colon in your
patient. The findings are characteristic of which disorder?
1. Ulcer
2. Crohn’s disease
3. Chronic gastritis
4. Ulcerative colitis
62. What information is correct about stomach cancer?
1. Stomach pain is often a late symptom.
2. Surgery is often a successful treatment.
3. Chemotherapy and radiation are often successful treatments.
4. The patient can survive for an extended time with TPN.
63. Dark, tarry stools indicate bleeding in which location of the GI tract?
1. Upper colon.
2. Lower colon.
3. Upper GI tract.
4. Small intestine.
64. A patient has an acute upper GI hemorrhage. Your interventions include:
1. Treating hypovolemia.
2. Treating hypervolemia.
3. Controlling the bleeding source.
4. Treating shock and diagnosing the bleeding source.
65. You promote hemodynamic stability in a patient with upper GI bleeding by:
1. Encouraging oral fluid intake.
2. Monitoring central venous pressure.
3. Monitoring laboratory test results and vital signs.
4. Giving blood, electrolyte and fluid replacement.
66. You’re preparing a patient with a malignant tumor for colorectal surgery and subsequent
colostomy. The patient tells you he’s anxious. What should your initial step be in working with
this patient?
1. Determine what the patient already knows about colostomies.
2. Show the patient some pictures of colostomies.
3. Arrange for someone who has a colostomy to visit the patient.
4. Provide the patient with written material about colostomy care.
67. Your patient, Christopher, has a diagnosis of ulcerative colitis and has severe abdominal pain
aggravated by movement, rebound tenderness, fever, nausea, and decreased urine output. This
may indicate which complication?
1. Fistula.
2. Bowel perforation.
3. Bowel obstruction.
4. Abscess.
68. A patient has a severe exacerbation of ulcerative colitis. Long-term medications will probably
include:
1. Antacids.
2. Antibiotics.
3. Corticosteroids.
4. Histamine2-receptor blockers.
69. The student nurse is teaching the family of a patient with liver failure. You instruct them to
limit which foods in the patient’s diet?
1. Meats and beans.
2. Butter and gravies.
3. Potatoes and pastas.
4. Cakes and pastries.
70. An intubated patient is receiving continuous enteral feedings through a Salem sump tube at a
rate of 60ml/hr. Gastric residuals have been 30-40ml when monitored Q4H. You check the gastric
residual and aspirate 220ml. What is your first response to this finding?
1. Notify the doctor immediately.
2. Stop the feeding, and clamp the NG tube.
3. Discard the 220ml, and clamp the NG tube.
4. Give a prescribed GI stimulant such as metoclopramide (Reglan).
71. Your patient with peritonitis is NPO and complaining of thirst. What is your priority?
1. Increase the I.V. infusion rate.
2. Use diversion activities.
3. Provide frequent mouth care.
4. Give ice chips every 15 minutes.
72. Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this
indicate?
1. He has fresh, active upper GI bleeding.
2. He needs immediate saline gastric lavage.
3. His gastric bleeding occurred 2 hours earlier.
4. He needs a transfusion of packed RBC’s.
73. A 53 y.o. patient has undergone a partial gastrectomy for adenocarcinoma of the stomach. An
NG tube is in place and is connected to low continuous suction. During the immediate
postoperative period, you expect the gastric secretions to be which color?
1. Brown.
2. Clear.
3. Red.
4. Yellow.
74. Your patient has a retractable gastric peptic ulcer and has had a gastric vagotomy. Which
factor increases as a result of vagotomy?
1. Peristalsis.
2. Gastric acidity.
3. Gastric motility.
4. Gastric pH.
75. Christina is receiving an enteral feeding that requires a concentration of 80 ml of supplement
mixed with 20 ml of water. How much water do you mix with an 8 oz (240ml) can of feeding?
1. 60 ml.
2. 70 ml.
3. 80 ml.
4. 90 ml.
76. Which stoma would you expect a malodorous, enzyme-rich, caustic liquid output that is
yellow, green, or brown?
1. Ileostomy.
2. Ascending colostomy.
3. Transverse colostomy.
4. Descending colostomy.
77. George has a T tube in place after gallbladder surgery. Before discharge, what information or
instructions should be given regarding the T tube drainage?
1. “If there is any drainage, notify the surgeon immediately.”
2. “The drainage will decrease daily until the bile duct heals.”
3. “First, the drainage is dark green; then it becomes dark yellow.”
4. “If the drainage stops, milk the tube toward the puncture wound.”
78. Your patient Maria takes NSAIDS for her degenerative joint disease, has developed peptic
ulcer disease. Which drug is useful in preventing NSAID-induced peptic ulcer disease?
1. Calcium carbonate (Tums)
2. Famotidine (Pepcid)
3. Misoprostol (Cytotec)
4. Sucralfate (Carafate)
79. The student nurse is participating in colorectal cancer-screening program. Which patient has
the fewest risk factors for colon cancer?
1. Janice, a 45 y.o. with a 25-year history of ulcerative colitis
2. George, a 50 y.o. whose father died of colon cancer
3. Herman, a 60 y.o. who follows a low-fat, high-fiber diet
4. Sissy, a 72 y.o. with a history of breast cancer
80. You’re patient, post-op drainage of a pelvic abscess secondary to diverticulitis, begins to
cough violently after drinking water. His wound has ruptured and a small segment of the bowel is
protruding. What’s your priority?
1. Ask the patient what happened, call the doctor, and cover the area with a water-soaked bedsheet.
2. Obtain vital signs, call the doctor, and obtain emergency orders.
3. Have a CAN hold the wound together while you obtain vital signs, call the doctor and flex the
patient’s knees.
4. Have the doctor called while you remain with the patient, flex the patient’s knees, and cover the
wound with sterile towels soaked in sterile saline solution.

Answers and Rationale

1. Answer: 1. Blood pressure decreases as the body is unable to maintain normal oncotic pressure with
liver failure, so patients with liver failure require close blood pressure monitoring. Increased capillary
permeability, abnormal peripheral vasodilation, and excess rennin released from the kidney’s aren’t
direct ramifications of liver failure.
2. Answer: 2. Good circulation causes tissues to be moist and red, so a healthy, well-healed stoma
appears red and moist.
3. Answer: 1. A colostomy in the sigmoid colon produces a solid, formed stool.
4. Answer: 4. High-fiber foods stimulate peristalsis, and a result, flatus. Yogurt reduces gas formation.
5. Answer: 2. A proper fit protects the skin, but doesn’t impair circulation. A 1/16” should be cut.
6. Answer: 2. Observation, auscultation, percussion, palpation
7. Answer: 4. An ileoanal reservoir is created in two stages. The two surgeries are about 2 to 3 months
apart. First, diseased intestines are removed and a temporary loop ileostomy is created. Second, the
loop ileostomy is closed and stool goes to the reservoir and out through the anus.
8. Answer: 3. The large intestine absorbs large amounts of water so the initial output from the
ileostomy may be as much as 1500 to 2000 ml/24 hours. Gradually, the small intestine absorbs more
fluid and the output decreases.
9. Answer: 2. To avoid overloading the small intestine, encourage the patient to eat six small, regularly
spaced meals.
10. Answer: 2. Making observations about what you see or hear is a useful therapeutic technique. This
way, you acknowledge that you are interested in what the patient is saying and feeling.
11. C After a Billroth II procedure, a large amount of hypertonic fluid enters the intestine. This causes
extracellular fluid to move rapidly into the bowel, reducing circulating blood volume and producing
vasomotor symptoms. Vasomotor symptoms produced by dumping syndrome include dizziness and
sweating, tachycardia, syncope, pallor, and palpitations.
12. A Gastric emptying time can be delayed by omitting fluids from your patient’s meal. A diet low in
carbs and high in fat & protein is recommended to treat dumping syndrome.
13. B Ascites puts pressure on the diaphragm. Paracentesis is done to remove fluid and reducing
pressure on the diaphragm. The goal is to improve the patient’s breathing. The others are signs of
cirrhosis that aren’t relieved by paracentesis.
14. A A full bladder can interfere with paracentesis and be punctured inadvertently.
15. B Cover the organs with a sterile, nonadherent dressing moistened with normal saline. Do this to
prevent infection and to keep the organs from drying out.
16. A Asterixis is an early neurologic sign of hepatic encephalopathy elicited by asking the patient to
hold her arms stretched out. Asterixis is present if the hands rapidly extend and flex.
17. A You may administer the laxative lactulose to reduce ammonia levels in the colon.
18. A Achalasia is characterized by incomplete relaxation of the LES, dilation of the lower esophagus,
and a lack of esophageal peristalsis. Because nitrates relax the lower esophageal sphincter, expect to
give Isordil orally or sublingually.
19. C Eating in the upright position aids in emptying the esophagus. Doing the opposite of the other
three also may be helpful.
20. C Pancreatitis involves activation of pancreatic enzymes, such as amylase and lipase. These levels
are elevated in a patient with acute pancreatitis.
21. D The normal range of specific gravity of urine is 1.010 to 1.025; a value of 1.030 may be seen
with dehydration.
22. C Teach the pt to avoid activities that increase intra-abdominal pressure such as coughing, sneezing,
or straining with a bowel movement.
23. C Because obesity weakens the abdominal muscles, advise weight loss for the patient who has had
a hernia repair.
24. B After a liver biopsy, the patient is placed on the right side to compress the liver and to reduce the
risk of bleeding or bile leakage.
25. A Signs and Symptoms of pneumothorax include dyspnea and decreased or absent breath sounds
over the affected lung (right lung).
26. A An NG tube is inserted into the patients stomach to drain fluid and gas.
27. A Aspirating the stomach contents confirms correct placement. If an X-ray is ordered, it should be
done immediately, not in 24 hours.
28. B TPN is given I.V. to provide all the nutrients your patient needs. TPN isn’t a tube feeding nor is it
a liquid dietary supplement.
29. A Type A causes changes in parietal cells.
30. B Increasing fluids helps empty the stomach. A high carb diet isn’t restricted and fat intake
shouldn’t be increased.
31. A Diarrhea d/t an acute episode of ulcerative colitis leads to fluid & electrolyte losses so fluid
replacement takes priority.
32. D Sigmoidoscopy allows direct observation of the colon mucosa for changes, and if needed, biopsy.
33. C She needs a high-fiber diet and a psyllium (bulk laxative) to promote normal soft stools.
34. B Stools from ulcerative colitis are often bloody and contain mucus.
35. D One sign of acute diverticulitis is crampy lower left quadrant pain. A low-grade fever is another
common sign.
36. C With acute pancreatitis, you need to rest the GI tract by TPN as nutritional support.
37. A The gallbladder is located in the RUQ and a frequent sign of gallstones is pain radiating to the
shoulder.
38. D A Jackson-Pratt drain promotes wound healing by allowing fluid to escape from the wound.
39. D After creation of a colostomy, expect to see a stoma that is pink, slightly edematous, with some
oozing. Bright red blood, regardless of amount, indicates bleeding and should be reported to the doctor.
40. A Only a small amount of skin should be exposed and more than 1/16” of skin allows the
excretement to irritate the skin.
41. B Measuring abdominal girth provides quantitative information about increases or decreases in the
amount of distention.
42. C Because the GI tract is functioning, feeding methods involve the enteral route which bypasses the
mouth but allows for a major portion of the GI tract to be used.
43. B The first step in assessing the abdomen is to observe its shape and contour, then auscultate,
palpate, and then percuss.
44. B Lowering the height decreases the amount of flow, allowing him to tolerate more fluid.
45. D Pancrelipase provides the exocrine pancreatic enzyme necessary for proper protein, fat, and carb
digestion. With increased fat digestion and absorption, stools become less frequent and normal in
appearance.
46. B Glucose level increases and diabetes mellitus may result d/t the pancreatic damage to the islets of
langerhans.
47. D After surgery, she remains NPO until peristaltic activity returns. This decreases the risk for
abdominal distention and obstruction.
48. D A brownish-black color indicates lack of blood flow, and maybe necrosis.
49. A Restricting fluids decrease the amount of body fluid and the accumulation of fluid in the
peritoneal space.
50. D Dark green, leafy vegetables are rich in calcium.
51. A For pruritus, care should include tepid sponge baths and use of emollient creams and lotions.
52. D Rest periods and small frequent meals is indicated during the acute phase of hepatitis B.
53. D Hepatitis B can recur. Patients who have had hepatitis are permanently barred from donating
blood. Alcohol is metabolized by the liver and should be avoided by those who have or had hepatitis B.
54. A To prevent venous stasis and improve muscle tone, circulation, and respiratory function,
encourage her to move after surgery.
55. A Telling her not to worry minimizes her feelings.
56. A Diazepam is absorbed by the plastic I.V. tubing and should be given in the port closest to the
vein.
57. A For the first few days to a week, slight bleeding normally occurs when the stoma is touched
because the surgical site is still new. She should report profuse bleeding immediately.
58. D To wash away tissue debris and drainage effectively, irrigate the wound until the solution
becomes clear or all the solution is used.
59. A Ammonia levels increase d/t improper shunting of blood, causing ammonia to enter systemic
circulation, which carries it to the brain.
60. D Saline solution is isotonic, or close to body fluids in content, and is used along with sterile
dressings to cover an eviscerated wound and keep it moist.
61. B Crohn’s disease penetrates the mucosa of the colon through all layers and destroys the colon in
patches, which creates a cobblestone appearance.
62. A Stomach pain is often a late sign of stomach cancer; outcomes are particularly poor when the
cancer reaches that point. Surgery, chemotherapy, and radiation have minimal positive effects. TPN
may enhance the growth of the cancer.
63. C Melena is the passage of dark, tarry stools that contain a large amount of digested blood. It occurs
with bleeding from the upper GI tract.
64. A A patient with an acute upper GI hemorrhage must be treated for hypovolemia and hemorrhagic
shock. You as a nurse can’t diagnose the problem. Controlling the bleeding may require surgery or
intensive medical treatment.
65. D To stabilize a patient with acute bleeding, NS or LR solution is given I.V. until BP rises and urine
output returns to 30ml/hr.
66. A Initially, you should assess the patient’s knowledge about colostomies and how it will affect his
lifestyle.
67. B An inflammatory condition that affects the surface of the colon, ulcerative colitis causes friability
and erosions with bleeding. Patients with ulcerative colitis are at increased risk for bowel perforation,
toxic megacolon, hemorrhage, cancer, and other anorectal and systemic complications.
68. C Medications to control inflammation such as corticosteroids are used for long-term treatment.
69. A Meats and beans are high-protein foods. In liver failure, the liver is unable to metabolize protein
adequately, causing protein by-products to build up in the body rather than be excreted.
70. B A gastric residual greater than 2 hours worth of feeding or 100-150ml is considered too high. The
feeding should be stopped; NG tube clamped, and then allow time for the stomach to empty before
additional feeding is added.
71. C Frequent mouth care helps relieve dry mouth.
72. C Coffee-ground emesis occurs when there is upper GI bleeding that has undergone gastric
digestion. For blood to appear as coffee-ground emesis, it would have to be digested for approximately
2 hours.
73. C Normally, drainage is bloody for the first 24 hours after a partial gastrectomy; then it changes to
brown-tinged and then to yellow or clear.
74. D If the vagus nerve is cut as it enters the stomach, gastric acid secretion is decreased, but intestinal
motility is also decreased and gastric emptying is delayed. Because gastric acids are decreased, gastric
pH increases.
75. A Dosage problem. It’s 80/20 = 240/X. X=60.
76. A The output from an Ileostomy is described.
77. B As healing occurs from the bile duct, bile drains from the tube; the amount of bile should
decrease. Teach the patient to expect dark green drainage and to notify the doctor if drainage stops.
78. C Misoprostol restores prostaglandins that protect the stomach from NSAIDS, which diminish the
prostaglandins.
79. C
80. D
81. D

1. Which of the following complications is thought to be the most common cause of appendicitis?
1. A fecalith
2. Bowel kinking
3. Internal bowel occlusion
4. Abdominal bowel swelling
2. Which of the following terms best describes the pain associated with appendicitis?
1. Aching
2. Fleeting
3. Intermittent
4. Steady
3. Which of the following nursing interventions should be implemented to manage a client with
appendicitis?
1. Assessing for pain
2. Encouraging oral intake of clear fluids
3. Providing discharge teaching
4. Assessing for symptoms of peritonitis
4. Which of the following definitions best describes gastritis?
1. Erosion of the gastric mucosa
2. Inflammation of a diverticulum
3. Inflammation of the gastric mucosa
4. Reflux of stomach acid into the esophagus
5. Which of the following substances is most likely to cause gastritis?
1. Milk
2. Bicarbonate of soda, or baking soda
3. Enteric coated aspirin
4. Nonsteriodal anti-imflammatory drugs
6. Which of the following definitions best describes diverticulosis?
1. An inflamed outpouching of the intestine
2. A noninflamed outpouching of the intestine
3. The partial impairment of the forward flow of intestinal contents
4. An abnormal protrusion of an organ through the structure that usually holds it.
7. Which of the following types of diets is implicated in the development of diverticulosis?
1. Low-fiber diet
2. High-fiber diet
3. High-protein diet
4. Low-carbohydrate diet
8. Which of the following mechanisms can facilitate the development of diverticulosis into
diverticulitis?
1. Treating constipation with chronic laxative use, leading to dependence on laxatives
2. Chronic constipation causing an obstruction, reducing forward flow of intestinal contents
3. Herniation of the intestinal mucosa, rupturing the wall of the intestine
4. Undigested food blocking the diverticulum, predisposing the area to bacterial invasion.
9. Which of the following symptoms indicated diverticulosis?
1. No symptoms exist
2. Change in bowel habits
3. Anorexia with low-grade fever
4. Episodic, dull, or steady midabdominal pain
10. Which of the following tests should be administered to a client suspected of having
diverticulosis?
1. Abdominal ultrasound
2. Barium enema
3. Barium swallow
4. Gastroscopy
11. Medical management of the client with diverticulitis should include which of the following
treatments?
1. Reduced fluid intake
2. Increased fiber in diet
3. Administration of antibiotics
4. Exercises to increase intra-abdominal pressure
12. Crohn’s disease can be described as a chronic relapsing disease. Which of the following areas
in the GI system may be involved with this disease?
1. The entire length of the large colon
2. Only the sigmoid area
3. The entire large colon through the layers of mucosa and submucosa
4. The small intestine and colon; affecting the entire thickness of the bowel
13. Which area of the alimentary canal is the most common location for Crohn’s disease?
1. Ascending colon
2. Descending colon
3. Sigmoid colon
4. Terminal ileum
14. Which of the following factors is believed to be linked to Crohn’s disease?
1. Constipation
2. Diet
3. Hereditary
4. Lack of exercise
15. Which of the following factors is believed to cause ulcerative colitis?
1. Acidic diet
2. Altered immunity
3. Chronic constipation
4. Emotional stress
16. Fistulas are most common with which of the following bowel disorders?
1. Crohn’s disease
2. Diverticulitis
3. Diverticulosis
4. Ulcerative colitis
17. Which of the following areas is the most common site of fistulas in client’s with Crohn’s
disease?
1. Anorectal
2. Ileum
3. Rectovaginal
4. Transverse colon
18. Which of the following associated disorders may a client with ulcerative colitis exhibit?
1. Gallstones
2. Hydronephrosis
3. Nephrolithiasis
4. Toxic megacolon
19. Which of the following associated disorders may the client with Crohn’s disease exhibit?
1. Ankylosing spondylitis
2. Colon cancer
3. Malabsorption
4. Lactase deficiency
20. Which of the following symptoms may be exhibited by a client with Crohn’s disease?
1. Bloody diarrhea
2. Narrow stools
3. N/V
4. Steatorrhea
21. Which of the following symptoms is associated with ulcerative colitis?
1. Dumping syndrome
2. Rectal bleeding
3. Soft stools
4. Fistulas
22. If a client had irritable bowel syndrome, which of the following diagnostic tests would
determine if the diagnosis is Crohn’s disease or ulcerative colitis?
1. Abdominal computed tomography (CT) scan
2. Abdominal x-ray
3. Barium swallow
4. Colonoscopy with biopsy
23. Which of the following interventions should be included in the medical management of
Crohn’s disease?
1. Increasing oral intake of fiber
2. Administering laxatives
3. Using long-term steroid therapy
4. Increasing physical activity
24. In a client with Crohn’s disease, which of the following symptoms should not be a direct result
from antibiotic therapy?
1. Decrease in bleeding
2. Decrease in temperature
3. Decrease in body weight
4. Decrease in the number of stools
25. Surgical management of ulcerative colitis may be performed to treat which of the following
complications?
1. Gastritis
2. Bowel herniation
3. Bowel outpouching
4. Bowel perforation
26. Which of the following medications is most effective for treating the pain associated with
irritable bowel disease?
1. Acetaminophen
2. Opiates
3. Steroids
4. Stool softeners
27. During the first few days of recovery from ostomy surgery for ulcerative colitis, which of the
following aspects should be the first priority of client care?
1. Body image
2. Ostomy care
3. Sexual concerns
4. Skin care
28. Colon cancer is most closely associated with which of the following conditions?
1. Appendicitis
2. Hemorrhoids
3. Hiatal hernia
4. Ulcerative colitis
29. Which of the following diets is most commonly associated with colon cancer?
1. Low-fiber, high fat
2. Low-fat, high-fiber
3. Low-protein, high-carbohydrate
4. Low carbohydrate, high protein
30. Which of the following diagnostic tests should be performed annually over age 50 to screen
for colon cancer?
1. Abdominal CT scan
2. Abdominal x-ray
3. Colonoscopy
4. Fecal occult blood test
31. Radiation therapy is used to treat colon cancer before surgery for which of the following
reasons?
1. Reducing the size of the tumor
2. Eliminating the malignant cells
3. Curing the cancer
4. Helping the bowel heal after surgery
32. Which of the following symptoms is a client with colon cancer most likely to exhibit?
1. A change in appetite
2. A change in bowel habits
3. An increase in body weight
4. An increase in body temperature
33. A client has just had surgery for colon cancer. Which of the following disorders might the
client develop?
1. Peritonitis
2. Diverticulosis
3. Partial bowel obstruction
4. Complete bowel obstruction
34. A client with gastric cancer may exhibit which of the following symptoms?
1. Abdominal cramping
2. Constant hunger
3. Feeling of fullness
4. Weight gain
35. Which of the following diagnostic tests may be performed to determine if a client has gastric
cancer?
1. Barium enema
2. Colonoscopy
3. Gastroscopy
4. Serum chemistry levels
36. A client with gastric cancer can expect to have surgery for resection. Which of the following
should be the nursing management priority for the preoperative client with gastric cancer?
1. Discharge planning
2. Correction of nutritional deficits
3. Prevention of DVT
4. Instruction regarding radiation treatment
37. Care for the postoperative client after gastric resection should focus on which of the following
problems?
1. Body image
2. Nutritional needs
3. Skin care
4. Spiritual needs
38. Which of the following complications of gastric resection should the nurse teach the client to
watch for?
1. Constipation
2. Dumping syndrome
3. Gastric spasm
4. Intestinal spasms
39. A client with rectal cancer may exhibit which of the following symptoms?
1. Abdominal fullness
2. Gastric fullness
3. Rectal bleeding
4. Right upper quadrant pain
40. A client with which of the following conditions may be likely to develop rectal cancer?
1. Adenomatous polyps
2. Diverticulitis
3. Hemorrhoids
4. Peptic ulcer disease
41. Which of the following treatments is used for rectal cancer but not for colon cancer?
1. Chemotherapy
2. Colonoscopy
3. Radiation
4. Surgical resection
42. Which of the following conditions is most likely to directly cause peritonitis?
1. Cholelithiasis
2. Gastritis
3. Perforated ulcer
4. Incarcerated hernia
43. Which of the following symptoms would a client in the early stages of peritonitis exhibit?
1. Abdominal distention
2. Abdominal pain and rigidity
3. Hyperactive bowel sounds
4. Right upper quadrant pain
44. Which of the following laboratory results would be expected in a client with peritonitis?
1. Partial thromboplastin time above 100 seconds
2. Hemoglobin level below 10 mg/dL
3. Potassium level above 5.5 mEq/L
4. White blood cell count above 15,000
45. Which of the following therapies is not included in the medical management of a client with
peritonitis?
1. Broad-spectrum antibiotics
2. Electrolyte replacement
3. I.V. fluids
4. Regular diet
46. Which of the following aspects is the priority focus of nursing management for a client with
peritonitis?
1. Fluid and electrolyte balance
2. Gastric irrigation
3. Pain management
4. Psychosocial issues
47. A client with irritable bowel syndrome is being prepared for discharge. Which of the following
meal plans should the nurse give the client?
1. Low fiber, low-fat
2. High fiber, low-fat
3. Low fiber, high-fat
4. High-fiber, high-fat
48. A client presents to the emergency room, reporting that he has been vomiting every 30 to 40
minutes for the past 8 hours. Frequent vomiting puts him at risk for which of the following?
1. Metabolic acidosis with hyperkalemia
2. Metabolic acidosis with hypokalemia
3. Metabolic alkalosis with hyperkalemia
4. Metabolic alkalosis with hypokalemia
49. Five days after undergoing surgery, a client develops a small-bowel obstruction. A Miller-
Abbott tube is inserted for bowel decompression. Which nursing diagnosis takes priority?
1. Imbalanced nutrition: Less than body requirements
2. Acute pain
3. Deficient fluid volume
4. Excess fluid volume
50. When teaching an elderly client how to prevent constipation, which of the following
instructions should the nurse include?
1. “Drink 6 glasses of fluid each day.”
2. “Avoid grain products and nuts.”
3. “Add at least 4 grams of bran to your cereal each morning.”
4. “Be sure to get regular exercise.”
51. In a client with diarrhea, which outcome indicates that fluid resuscitation is successful?
1. The client passes formed stools at regular intervals
2. The client reports a decrease in stool frequency and liquidity
3. The client exhibits firm skin turgor
4. The client no longer experiences perianal burning.
52. When teaching a community group about measures to prevent colon cancer, which instruction
should the nurse include?
1. “Limit fat intake to 20% to 25% of your total daily calories.”
2. “Include 15 to 20 grams of fiber into your daily diet.”
3. “Get an annual rectal examination after age 35.”
4. “Undergo sigmoidoscopy annually after age 50.”
53. A 30-year old client experiences weight loss, abdominal distention, crampy abdominal pain,
and intermittent diarrhea after birth of her 2nd child. Diagnostic tests reveal gluten-induced
enteropathy. Which foods must she eliminate from her diet permanently?
1. Milk and dairy products
2. Protein-containing foods
3. Cereal grains (except rice and corn)
4. Carbohydrates
54. After a right hemicolectomy for treatment of colon cancer, a 57-year old client is reluctant to
turn while on bed rest. Which action by the nurse would be appropriate?
1. Asking a coworker to help turn the client
2. Explaining to the client why turning is important.
3. Allowing the client to turn when he’s ready to do so
4. Telling the client that the physician’s order states he must turn every 2 hours
55. A client has a percutaneous endoscopic gastrostomy tube inserted for tube feedings. Before
starting a continuous feeding, the nurse should place the client in which position?
1. Semi-Fowlers
2. Supine
3. Reverse Trendelenburg
4. High Fowler’s
56. An enema is prescribed for a client with suspected appendicitis. Which of the following
actions should the nurse take?
1. Prepare 750 ml of irrigating solution warmed to 100*F
2. Question the physician about the order
3. Provide privacy and explain the procedure to the client
4. Assist the client to left lateral Sim’s position
57. The client being seen in a physician’s office has just been scheduled for a barium swallow the
next day. The nurse writes down which of the following instructions for the client to follow before
the test?
1. Fast for 8 hours before the test
2. Eat a regular supper and breakfast
3. Continue to take all oral medications as scheduled.
4. Monitor own bowel movement pattern for constipation
58. The nurse is monitoring a client for the early signs of dumping syndrome. Which symptom
indicates this occurrence?
1. Abdominal cramping and pain
2. Bradycardia and indigestion
3. Sweating and pallor
4. Double vision and chest pain
59. The nurse is preparing a discharge teaching plan for the client who had an umbilical hernia
repair. Which of the following would the nurse include in the plan?
1. Restricting pain medication
2. Maintaining bedrest
3. Avoiding coughing
4. Irrigating the drain
60. The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which
finding, if noted on assessment of the client, would the nurse report to the physician?
1. Bloody diarrhea
2. Hypotension
3. A hemoglobin of 12 mg/dL
4. Rebound tenderness
61. The nurse is reviewing the record of a client with Crohn’s disease. Which of the following
stool characteristics would the nurse expect to note documented on the client’s record?
1. Chronic constipation
2. Diarrhea
3. Constipation alternating with diarrhea
4. Stool constantly oozing from the rectum
62. The nurse is performing a colostomy irrigation on a client. During the irrigation, a client
begins to complain of abdominal cramps. Which of the following is the most appropriate nursing
action?
1. Notify the physician
2. Increase the height of the irrigation
3. Stop the irrigation temporarily.
4. Medicate with dilaudid and resume the irrigation
63. The nurse is teaching the 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?
1. Increase fluid intake
2. Reduce the amount of irrigation solution
3. Perform the irrigation in the evening
4. Place heat on the abdomen
64. The nurse is reviewing the physician’s orders written for a client admitted with acute
pancreatitis. Which physician order would the nurse question if noted on the client’s chart?
1. NPO status
2. Insert a nasogastric tube
3. An anticholinergic medication
4. Morphine for pain
65. The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To
determine whether the problem is currently active, the nurse would assess the client for which of
the following most frequent symptom(s) of duodenal ulcer?
1. Pain that is relieved by food intake
2. Pain that radiated down the right arm
3. N/V
4. Weight loss
66. The nurse instructs the ileostomy client to do which of the following as a part of essential care
of the stoma?
1. Cleanse the peristomal skin meticulously
2. Take in high-fiber foods such as nuts
3. Massage the area below the stoma
4. Limit fluid intake to prevent diarrhea.
67. The client who has undergone creation of a colostomy has a nursing diagnosis of Disturbed
body image. The nurse would evaluate that the client is making the most significant progress
toward identified goals if the client:
1. Watches the nurse empty the colostomy bag
2. Looks at the ostomy site
3. Reads the ostomy product literature
4. Practices cutting the ostomy appliance
68. The nurse is assessing for stoma prolapse in a client with a colostomy. The nurse would
observe which of the following if stoma prolapse occurred?
1. Sunken and hidden stoma
2. Dark- and bluish-colored stoma
3. Narrowed and flattened stoma
4. Protruding stoma
69. The client with a new colostomy is concerned about the odor from the stool in the ostomy
drainage bag. The nurse teaches the client to include which of the following foods in the diet to
reduce odor?
1. Yogurt
2. Broccoli
3. Cucumbers
4. Eggs
70. The nurse has given instructions to the client with an ileostomy about foods to eat to thicken
the stool. The nurse determines that the client needs further instructions if the client stated to eat
which of the following foods to make the stools less watery?
1. Pasta
2. Boiled rice
3. Bran
4. Low-fat cheese
71. The client has just had surgery to create an ileostomy. The nurse assesses the client in the
immediate post-op period for which of the following most frequent complications of this type of
surgery?
1. Intestinal obstruction
2. Fluid and electrolyte imbalance
3. Malabsorption of fat
4. Folate deficiency
72. The nurse is doing pre-op teaching with the client who is about to undergo creation of a Kock
pouch. The nurse interprets that the client has the best understanding of the nature of the
surgery if the client makes which of the following statements?
1. “I will need to drain the pouch regularly with a catheter.”
2. “I will need to wear a drainage bag for the rest of my life.”
3. “The drainage from this type of ostomy will be formed.”
4. “I will be able to pass stool from my rectum eventually.”
73. The client with a colostomy has an order for irrigation of the colostomy. The nurse used
which solution for irrigation?
1. Distilled water
2. Tap water
3. Sterile water
4. Lactated Ringer’s
74. A nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis. The
client is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal
pain and begins to vomit. On assessment the nurse notes that the abdomen is distended and the
bowel sounds are diminished. Which of the following is the most appropriate nursing
intervention?
1. Administer dilaudid
2. Notify the physician
3. Call and ask the operating room team to perform the surgery as soon as possible
4. Reposition the client and apply a heating pad on a warm setting to the client’s abdomen.
75. The client has been admitted with a diagnosis of acute pancreatitis. The nurse would assess
this client for pain that is:
1. Severe and unrelenting, located in the epigastric area and radiating to the back.
2. Severe and unrelenting, located in the left lower quadrant and radiating to the groin.
3. Burning and aching, located in the epigastric area and radiating to the umbilicus.
4. Burning and aching, located in the left lower quadrant and radiating to the hip.
76. The client with Crohn’s disease has a nursing diagnosis of acute pain. The nurse would teach
the client to avoid which of the following in managing this problem?
1. Lying supine with the legs straight
2. Massaging the abdomen
3. Using antispasmodic medication
4. Using relaxation techniques
77. A client with ulcerative colitis has an order to begin salicylate medication to reduce
inflammation. The nurse instructs the client to take the medication:
1. 30 minutes before meals
2. On an empty stomach
3. After meals
4. On arising
78. During the assessment of a client’s mouth, the nurse notes the absence of saliva. The client is
also complaining of pain near the area of the ear. The client has been NPO for several days
because of the insertion of a NG tube. Based on these findings, the nurse suspects that the client is
developing which of the following mouth conditions?
1. Stomatitis
2. Oral candidiasis
3. Parotitis
4. Gingivitis
79. The nurse evaluates the client’s stoma during the initial post-op period. Which of the
following observations should be reported immediately to the physician?
1. The stoma is slightly edematous
2. The stoma is dark red to purple
3. The stoma oozes a small amount of blood
4. The stoma does not expel stool
80. When planning care for a client with ulcerative colitis who is experiencing symptoms, which
client care activities can the nurse appropriately delegate to a unlicensed assistant? Select all that
apply.
1. Assessing the client’s bowel sounds
2. Providing skin care following bowel movements
3. Evaluating the client’s response to antidiarrheal medications
4. Maintaining intake and output records
5. Obtaining the client’s weight.
81. Which goal of the client’s care should take priority during the first days of hospitalization for
an exacerbation of ulcerative colitis?
1. Promoting self-care and independence
2. Managing diarrhea
3. Maintaining adequate nutrition
4. Promoting rest and comfort
82. A client’s ulcerative colitis symptoms have been present for longer than 1 week. The nurse
recognizes that the client should be assessed carefully for signs of which of the following
complications?
1. Heart failure
2. DVT
3. Hypokalemia
4. Hypocalcemia
83. A client who has ulcerative colitis has persistent diarrhea. He is thin and has lost 12 pounds
since the exacerbation of his ulcerative colitis. The nurse should anticipate that the physician will
order which of the following treatment approaches to help the client meet his nutritional needs?
1. Initiate continuous enteral feedings
2. Encourage a high protein, high-calorie diet
3. Implement total parenteral nutrition
4. Provide six small meals a day.
84. Digoxin preparations and absorbents should not be given simultaneously. As a nurse, you are
aware that if these agents are given simultaneously, which of the following will occur?
1. Increased absorption of digoxin
2. Decreased absorption of digoxin
3. Increased absorption of the absorbent
4. Decreased absorption of the absorbent
85. When used with hyperacidic disorders of the stomach, antacids are given to elevate the gastric
pH to:
1. 2.0
2. 4.0
3. 6.0
4. >8.0
86. One of your patients is receiving digitalis orally and is also to receive an antacid at the same
time. Your most appropriate action, based on the pharmacokinetics of antacids, is to:
1. Delay the digitalis for 1 to 2 hours until the antacid is absorbed
2. Give the antacid at least 2 to 4 hours before administering the digitalis
3. Administer both medications as ordered and document in nurse’s notes
4. Contact the physician regarding the drug interaction and request a change in the time of dosing of the
drugs.
87. The nurse would teach patients that antacids are effective in treatment of hyperacidity
because they:
1. Neutralize gastric acid
2. Decrease stomach motility
3. Decrease gastric pH
4. Decrease duodenal pH
88. The nurse would monitor for which of the following adverse reactions to aluminum-
containing antacids such as aluminum hydroxide (Amphojel)?
1. Diarrhea
2. Constipation
3. GI upset
4. Fluid retention
89. The nurse would question an order for which type of antacid in patients with chronic renal
failure?
1. Aluminum-containing antacids
2. Calcium-containing antacids
3. Magnesium-containing antacids
4. All of the above.
90. The nurse would monitor a patient using sodium bicarbonate to treat gastric hyperacidity for
signs and symptoms of:
1. Metabolic alkalosis
2. Metabolic acidosis
3. Hyperkalemia
4. Hypercalcemia
91. Which of the following nursing diagnoses is appropriate for a patient receiving famotidine
(Pepcid)?
1. Increased risk for infection due to immunosuppression
2. Potential risk for bleeding related to thrombocytopenia.
3. Alteration in urinary elimination related to retention
4. Alteration in tissue perfusion related to hypertension
92. Histamine2-receptor antagonists:
1. Compete with histamine for binding sites on the parietal cells
2. Irreversibly bind to H+/K+ATPase
3. Cause a decrease in stomach pH
4. Decrease signs and symptoms of allergies related to histamine release
93. Proton pump inhibitors:
1. Gastric ulcer formation
2. GERD
3. Achlorhydria
4. Diverticulosis
94. A patient unable to tolerate oral medications may be prescribed which of the following proton
pump inhibitors to be administered intravenously?
1. lansoprazole (Prevacid)
2. omeprazole (Prilosec)
3. pantoprazole (Protonix)
4. esomeprazole (Nexium)
95. When administering sucralfate (Carafate) to a patient with a nasogastric tube, it is important
to:
1. Crush the tablet into a fine powder before mixing with water
2. Administer with a bolus tube feeding
3. Allow the tablet to dissolve in water before administering
4. Administer with an antacid for maximum benefit
96. Sucralfate (Carafate) achieves a therapeutic effect by:
1. Neutralizing gastric acid
2. Enhancing gastric absorption
3. Forming a protective barrier around gastric mucosa
4. Inhibiting gastric acid secretion
97. To avoid fecal impaction, psyllium (Metamucil) should be administered with at least how
many ounces of fluid?
1. 4
2. 6
3. 8
4. 10
98. Bismuth subsalicylate (Pepto-Bismol), as an absorbent, has which of the following
mechanisms of action?
1. Decreased GI motility
2. Decreased gastric secretions
3. Increased fluid absorption
4. Binding to diarrhea-causing bacteria for excretion
99. Side effects of loperamide (Imodium) include all of the following except?
1. Diarrhea
2. epigastric pain
3. Dry mouth
4. Anorexia
100. The mechanism of action of diphenoxylate (Lotomil) is:
1. An increase in intestinal excretion of water
2. An increase in intestinal motility
3. A decrease in peristalsis in the intestinal wall
4. A decrease in the reabsorption of water in the bowel

Answers and Rationale

1. Answer: 1. A fecalith is a fecal calculus, or stone, that occludes the lumen of the appendix and is the
most common cause of appendicitis. Bowel wall swelling, kinking of the appendix, and external
occlusion, not internal occlusion, of the bowel by adhesions can also be causes of appendicitis.
2. Answer: 4. The pain begins in the epigastrium or periumbilical region, then shifts to the right lower
quadrant and becomes steady. The pain may be moderate to severe.
3. Answer: 4. 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. The client with appendicitis will have pain that should be controlled with analgesia. The nurse
should discourage oral intake in preparation of surgery. Discharge teaching is important; however, in
the acute phase, management should focus on minimizing preoperative complications and recognizing
when such may be occurring.
4. Answer: 3. Gastritis is an inflammation of the gastric mucosa that may be acute (often resulting from
exposure to local irritants) or chronic (associated with autoimmune infections or atrophic disorders of
the stomach). Erosion of the mucosa results in ulceration. Inflammation of a diverticulum is called
diverticulitis; reflux of stomach acid is known as gastroesophageal disease.
5. Answer: 4. NSAIDS are a common cause of gastritis because they inhibit prostaglandin synthesis.
Milk, once thought to help gastritis, has little effect on the stomach mucosa. Bicarbonate of soda, or
baking soda, may be used to neutralize stomach acid, but it should be used cautiously because it may
lead to metabolic acidosis. ASA with enteric coating shouldn’t contribute significantly to gastritis
because the coating limits the aspirin’s effect on the gastric mucosa.
6. Answer: 2. Diverticulosis involves a noninflamed outpouching of the intestine. Diverticulitis
involves an inflamed outpouching. The partial impairment of forward flow of the intestine is an
obstruction; abnormal protrusion of an organ is a hernia.
7. Answer: 1. Low-fiber diets have been implicated in the development of diverticula because these
diets decrease the bulk in the stool and predispose the person to the development of constipation. A
high-fiber diet is recommended to help prevent diverticulosis. A high-protein or low-carbohydrate diet
has no effect on the development of diverticulosis.
8. Answer: 4. Undigested food can block the diverticulum, decreasing blood supply to the area and
predisposing the area to invasion of bacteria. Chronic laxative use is a common problem in elderly
clients, but it doesn’t cause diverticulitis. Chronic constipation can cause an obstruction—not
diverticulitis. Herniation of the intestinal mucosa causes an intestinal perforation.
9. Answer: 1. Diverticulosis is an asymptomatic condition. The other choices are signs and symptoms
of diverticulitis.
10. Answer: 2. A barium enema will cause diverticula to fill with barium and be easily seen on x-ray.
An abdominal US can tell more about structures, such as the gallbladder, liver, and spleen, than the
intestine. A barium swallow and gastroscopy view upper GI structures.
11. Answer: 3. Antibiotics are used to reduce the inflammation. The client isn’t typically isn’t allowed
anything orally until the acute episode subsides. Parenteral fluids are given until the client feels better;
then it’s recommended that the client drink eight 8-ounce glasses of water per day and gradually
increase fiber in the diet to improve intestinal motility. During the acute phase, activities that increase
intra-abdominal pressure should be avoided to decrease pain and the chance of intestinal obstruction.
12. Answer: 4. Crohn’s disease can involve any segment of the small intestine, the colon, or both,
affecting the entire thickness of the bowel. Answers 1 and 3 describe ulcerative colitis, answer 2 is too
specific and therefore, not likely.
13. Answer: 4. Studies have shown that the terminal ileum is the most common site for recurrence in
clients with Crohn’s disease. The other areas may be involved but aren’t as common.
14. Answer: 3. Although the definite cause of Crohn’s disease is unknown, it’s thought to be associated
with infectious, immune, or psychological factors. Because it has a higher incidence in siblings, it may
have a genetic cause.
15. Answer: 2. Several theories exist regarding the cause of ulcerative colitis. One suggests altered
immunity as the cause based on the extraintestinal characteristics of the disease, such as peripheral
arthritis and cholangitis. Diet and constipation have no effect on the development of ulcerative colitis.
Emotional stress can exacerbate the attacks but isn’t believed to be the primary cause.
16. Answer: 1. The lesions of Crohn’s disease are transmural; that is, they involve all thickness of the
bowel. These lesions may perforate the bowel wall, forming fistulas with adjacent structures. Fistulas
don’t develop in diverticulitis or diverticulosis. The ulcers that occur in the submucosal and mucosal
layers of the intestine in ulcerative colitis usually don’t progress to fistula formation as in Crohn’s
disease.
17. Answer: 1. Fistulas occur in all these areas, but the anorectal area is most common because of the
relative thinness of the intestinal wall in this area.
18. Answer: 4. Toxic megacolon is extreme dilation of a segment of the diseased colon caused by
paralysis of the colon, resulting in complete obstruction. This disorder is associated with both Crohn’s
disease and ulcerative colitis. The other disorders are more commonly associated with Crohn’s disease.
19. Answer: 3. Because of the transmural nature of Crohn’s disease lesions, malaborption may occur
with Crohn’s disease. Ankylosing spondylitis and colon cancer are more commonly associated with
ulcerative colitis. Lactase deficiency is caused by a congenital defect in which an enzyme isn’t present.
20. Answer: 4. Steatorrhea from malaborption can occur with Crohn’s disease. N/V, and bloody
diarrhea are symptoms of ulcerative colitis. Narrow stools are associated with diverticular disease.
21. Answer: 2. In ulcerative colitis, rectal bleeding is the predominant symptom. Soft stools are more
commonly associated with Crohn’s disease, in which malabsorption is more of a problem. Dumping
syndrome occurs after gastric surgeries. Fistulas are associated with Crohn’s disease.
22. Answer: 4. A colonoscopy with biopsy can be performed to determine the state of the colon’s
mucosal layers, presence of ulcerations, and level of cytologic development. An abdominal x-ray or CT
scan wouldn’t provide the cytologic information necessary to diagnose which disease it is. A barium
swallow doesn’t involve the intestine.
23. Answer: 3. Management of Crohn’s disease may include long-term steroid therapy to reduce the
inflammation associated with the deeper layers of the bowel wall. Other management focuses on bowel
rest (not increasing oral intake) and reducing diarrhea with medications (not giving laxatives). The pain
associated with Crohn’s disease may require bed rest, not an increase in physical activity.
24. Answer: 3. A decrease in body weight may occur during therapy due to inadequate dietary intake,
but isn’t related to antibiotic therapy. Effective antibiotic therapy will be noted by a decrease in
temperature, number of stools, and bleeding.
25. Answer: 4. Perforation, obstruction, hemorrhage, and toxic megacolon are common complications
of ulcerative colitis that may require surgery. Herniation and gastritis aren’t associated with irritable
bowel diseases, and outpouching of the bowel is diverticulosis.
26. Answer: 3. The pain with irritable bowel disease is caused by inflammation, which steroids can
reduce. Stool softeners aren’t necessary. Acetaminophen has little effect on the pain, and opiate
narcotics won’t treat its underlying cause.
27. Answer: 2. Although all of these are concerns the nurse should address, being able to safely manage
the ostomy is crucial for the client before discharge.
28. Answer: 4. Chronic ulcerative colitis, granulomas, and familial polposis seem to increase a person’s
chance of developing colon cancer. The other conditions listed have no known effect on colon cancer
risk.
29. Answer: 1. A low-fiber, high-fat diet reduced motility and increases the chance of constipation. The
metabolic end products of this type of diet are carcinogenic. A low-fat, high-fiber diet is recommended
to prevent colon cancer.
30. Answer: 4. Surface blood vessels of polyps and cancers are fragile and often bleed with the passage
of stools. Abdominal x-ray and CT scan can help establish tumor size and metastasis. A colonoscopy
can help locate a tumor as well as polyps, which can be removed before they become malignant.
31. Answer: 1. Radiation therapy is used to treat colon cancer before surgery to reduce the size of the
tumor, making it easier to be resected. Radiation therapy isn’t curative, can’t eliminate the malignant
cells (though it helps define tumor margins), can could slow postoperative healing.
32. Answer: 2. The most common complaint of the client with colon cancer is a change in bowel habits.
The client may have anorexia, secondary abdominal distention, or weight loss. Fever isn’t associated
with colon cancer.
33. Answer: 1. Bowel spillage could occur during surgery, resulting in peritonitis. Complete or partial
bowel obstruction may occur before bowel resection. Diverticulosis doesn’t result from surgery or
colon cancer.
34. Answer: 3. The client with gastric cancer may report a feeling of fullness in the stomach, but not
enough to cause him to seek medical attention. Abdominal cramping isn’t associated with gastric
cancer. Anorexia and weight loss (not increased hunger or weight gain) are common symptoms of
gastric cancer.
35. Answer: A gastroscopy will allow direct visualization of the tumor. A colonoscopy or a barium
enema would help diagnose colon cancer. Serum chemistry levels don’t contribute data useful to the
assessment of gastric cancer.
36. Answer: 2. Client’s with gastric cancer commonly have nutritional deficits and may be cachectic.
Discharge planning before surgery is important, but correcting the nutrition deficit is a higher priority.
At present, radiation therapy hasn’t been proven effective for gastric cancer, and teaching about it
preoperatively wouldn’t be appropriate. Prevention of DVT also isn’t a high priority to surgery, though
it assumes greater importance after surgery.
37. Answer: 2. After gastric resection, a client may require total parenteral nutrition or jejunostomy
tube feedings to maintain adequate nutritional status.
38. Answer: 2. Dumping syndrome is a problem that occurs postprandially after gastric resection
because ingested food rapidly enters the jejunum without proper mixing and without the normal
duodenal digestive processing. Diarrhea, not constipation, may also be a symptom. Gastric or intestinal
spasms don’t occur, but antispasmodics may be given to slow gastric emptying.
39. Answer: 3. Rectal bleeding is a common symptom of rectal cancer. Rectal cancer may be missed
because other conditions such as hemorrhoids can cause rectal bleeding. Abdominal fullness may occur
with colon cancer, gastric fullness may occur with gastric cancer, and right upper quadrant pain may
occur with liver cancer.
40. Answer: 1. A client with adenomatous polyps has a higher risk for developing rectal cancer than
others do. Clients with diverticulitis are more likely to develop colon cancer. Hemorrhoids don’t
increase the chance of any type of cancer. Clients with peptic ulcer disease have a higher incidence of
gastric cancer.
41. Answer: 3. A client with rectal cancer can expect to have radiation therapy in addition to
chemotherapy and surgical resection of the tumor. A colonoscopy is performed to diagnose the disease.
Radiation therapy isn’t usually indicated in colon cancer.
42. Answer: 3. The most common cause of peritonitis is a perforated ulcer, which can pour
contaminates into the peritoneal cavity, causing inflammation and infection within the cavity. The other
conditions don’t by themselves cause peritonitis. However, if cholelithiasis leads to rupture of the
gallbladder, gastritis leads to erosion of the stomach wall, or an incarcerated hernia leads to rupture of
the intestines, peritonitis may develop.
43. Answer: 2. Abdominal pain causing rigidity of the abdominal muscles is characteristic of
peritonitis. Abdominal distention may occur as a late sign but not early on. Bowel sounds may be
normal or decreased but not increased. Right upper quadrant pain is characteristic of cholecystitis or
hepatitis.
44. Answer: 4. Because of infection, the client’s WBC count will be elevated. A hemoglobin level
below 10 mg/dl may occur from hemorrhage. A PT time longer than 100 seconds may suggest
disseminated intravascular coagulation, a serious complication of septic shock. A potassium level above
5.5 mEq/L may indicate renal failure.
45. Answer: 4. The client with peritonitis usually isn’t allowed anything orally until the source of
peritonitis is confirmed and treated. The client also requires broad-spectrum antibiotics to combat the
infection. I.V. fluids are given to maintain hydration and hemodynamic stability and to replace
electrolytes.
46. Answer: 1. Peritonitis can advance to shock and circulatory failure, so fluid and electrolyte balance
is the priority focus of nursing management. Gastric irrigation may be needed periodically to ensure
patency of the nasogastric tube. Although pain management is important for comfort and psychosocial
care will address concerns such as anxiety, focusing on fluid and electrolyte imbalance will maintain
hemodynamic stability.
47. Answer: 2. The client with irritable bowel syndrome needs to be on a diet that contains at least 25
grams of fiber per day. Fatty foods are to be avoided because they may precipitate symptoms.
48. Answer: 4. Gastric acid contains large amounts of potassium, chloride, and hydrogen ions.
Excessive loss of these substances, such as from vomiting, can lead to metabolic alkalosis and
hypokalemia.
49. Answer: 3. Fluid shifts to the site of the bowel obstruction, causing a fluid deficit in the
intravascular spaces. If the obstruction isn’t resolved immediately, the client may experience an
imbalanced nutritional status (less than body requirements); however, deficient fluid volume takes
priority. The client may also experience pain, but that nursing diagnosis is also of lower priority than
deficient fluid volume.
50. Answer: 4. Exercise helps prevent constipation. Fluids and dietary fiber promote normal bowel
function. The client should drink eight to ten glasses of fluid each day. Although adding bran to cereal
helps prevent constipation by increasing dietary fiber, the client should start with a small amount and
gradually increase the amount as tolerated to a maximum of 2 grams a day.
51. Answer: 3. A client with diarrhea has a nursing diagnosis of Deficient fluid volume related to
excessive fluid loss in the stool. Expected outcomes include firm skin turgor, moist mucous
membranes, and urine output of at least 30 ml/hr. The client also has a nursing diagnosis of diarrhea,
with expected outcomes of passage of formed stools at regular intervals and a decrease in stool
frequency and liquidity. The client is at risk for impaired skin integrity related to irritation from
diarrhea; expected outcomes for this diagnosis include absence of erythema in perianal skin and
mucous membranes and absence of perianal tenderness or burning.
52. Answer: 1. To help prevent colon cancer, fats should account for no more than 20% to 25% of total
daily calories and the diet should include 25 to 30 grams of fiber per day. A digital rectal examination
isn’t recommended as a stand-alone test for colorectal cancer. For colorectal cancer screening, the
American Cancer society advises clients over age 50 to have a flexible sigmoidoscopy every 5 years,
yearly fecal occult blood tests, yearly fecal occult blood tests PLUS a flexible sigmoidoscopy every 5
years, a double-contrast barium enema every 5 years, or a colonoscopy every 10 years.
53. Answer: 3. To manage gluten-induced enteropathy, the client must eliminate gluten, which means
avoiding all cereal grains except for rice and corn. In initial disease management, clients eat a high
calorie, high-protein diet with mineral and vitamin supplements to help normalize nutritional status.
54. Answer: 2. The appropriate action is to explain the importance of turning to avoid postoperative
complications. Asking a coworker to help turn the client would infringe on his rights. Allowing him to
turn when he’s ready would increase his risk for postoperative complications. Telling him he must turn
because of the physician’s orders would put him on the defensive and exclude him from participating in
care decision.
55. Answer: 1. To prevent aspiration of stomach contents, the nurse should place the client in semi-
Fowler’s position. High Fowler’s position isn’t necessary and may not be tolerated as well as semi-
Fowler’s.
56. Answer: 2. Enemas are contraindicated in an acute abdominal condition of unknown origin as well
as after recent colon or rectal surgery or myocardial infarction. The other answers are correct only
when enema administration is appropriate.
57. Answer: 1. A barium swallow is an x-ray study that uses a substance called barium for contrast to
highlight abnormalities in the GI tract. The client should fast for 8 to 12 hours before the test,
depending on the physician instructions. Most oral medications also are withheld before the test. After
the procedure the nurse must monitor for constipation, which can occur as a result of the presence of
barium in the GI tract.
58. Answer: 3. Early manifestations of dumping syndrome occur 5 to 30 minutes after eating.
Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie
down.
59. Answer: 3. Bedrest is not required following this surgical procedure. The client should take
analgesics as needed and as prescribed to control pain. A drain is not used in this surgical procedure,
although the client may be instructed in simple dressing changes. Coughing is avoided to prevent
disruption of the tissue integrity, which can occur because of the location of this surgical procedure.
60. Answer: 4. Rebound tenderness may indicate peritonitis. Blood diarrhea is expected to occur in
ulcerative colitis. Because of the blood loss, the client may be hypotensive and the hemoglobin level
may be lower than normal. Signs of peritonitis must be reported to the physician.
61. Answer: 2. Crohn’s disease is characterized by nonbloody diarrhea of usually not more than four to
five stools daily. Over time, the diarrhea episodes increase in frequency, duration and severity. The
other option are not associated with diarrhea.
62. Answer: 3. If cramping occurs during a colostomy irrigation, the irrigation flow is stopped
temporarily and the client is allowed to rest. Cramping may occur from an infusion that is too rapid or
is causing too much pressure. Increasing the height of the irrigation will cause further discomfort. The
physician does not need to be notified. Medicating the client for pain is not the most appropriate action.
63. Answer: 1. To enhance effectiveness of the irrigation and fecal returns, the client is instructed to
increase fluid intake and prevent constipation.
64. Answer: 4. Meperidine (Demerol) rather than morphine is the medication of choice because
morphine can cause spasm in the sphincter of Oddi.
65. Answer: 1. The most frequent symptom of duodenal ulcer is pain that is relieved by food intake.
These clients generally describe the pain as burning, heavy, sharp, or “hungry” pain that often localizes
in the midepigastric area. The client with duodenal ulcer usually does not experience weight loss or
N/V. These symptoms are usually more typical in the client with a gastric ulcer.
66. Answer: 1. The peristomal skin must receive meticulous cleansing because the ileostomy drainage
has more enzymes and is more caustic to the skin than colostomy drainage. Foods such as nuts and
those with seeds will pass through the ileostomy. The client should be taught that these foods will
remain undigested. The area below the ileostomy may be massaged if needed if the ileostomy becomes
blocked by high fiber foods. Fluid intake should be maintained to at least six to eight glasses of water
per day to prevent dehydration.
67. Answer: 4. The client is expected to have a body image disturbance after colostomy. The client
progresses through normal grieving stages to adjust to this change. The client demonstrates the greatest
deal of acceptance when the client participates in the actual colostomy care. Each of the incorrect
options represents an interest in colostomy care but is a passive activity. The correct option shows the
client is participating in self-care.
68. Answer: 4. A prolapsed stoma is one which the bowel protruded through the stoma. A stoma
retraction is characterized by sinking of the stoma. Ischemia of the stoma would be associated with
dusky or bluish color. A stoma with a narrowed opening at the level of the skin or fascia is said to be
stenosed.
69. Answer: 1. The client should be taught to include deodorizing foods in the diet, such a beet greens,
parsley, buttermilk, and yogurt. Spinach also reduces odor but is a gas forming food as well. Broccoli,
cucumbers, and eggs are gas forming foods.
70. Answer: 3. Foods that help thicken the stool of the client with an ileostomy include pasta, boiled
rice, and low-fat cheese. Bran is high in dietary fiber and thus will increase output of watery stool by
increasing propulsion through the bowel. Ileostomy output is liquid. Addition or elimination of various
foods can help thicken or loosen this liquid drainage.
71. Answer: 2. A major complication that occurs most frequent following an ileostomy is fluid and
electrolyte imbalance. The client requires constant monitoring of intake and output to prevent this from
happening. Losses require replacement by intravenous infusion until the client can tolerate a diet orally.
Intestinal obstruction is a less frequent complication. Fat malabsorption and folate deficiency are
complications that could occur later in the postoperative period.
72. Answer: 1. A Kock pouch is a continent ileostomy. As the ileostomy begins to function, the client
drains it every 3 to 4 hours and then decreases the draining to about 3 times a day or as needed when
full. The client does not need to wear a drainage bag but should wear an absorbent dressing to absorb
mucus drainage from the stoma. Ileostomy drainage is liquid. The client would be able to pass stool
only from the rectum if an ileal-anal pouch or anastamosis were created. This type of operation is a
two-stage procedure.
73. Answer: 2. Warm tap water or saline solution is used to irrigate a colostomy. If the tap water is not
suitable for drinking, then bottled water should be used.
74. Answer: 2. Based on the signs and symptoms presented in the question, the nurse should suspect
peritonitis and should notify the physician. Administering pain medication is not an appropriate
intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis.
Scheduling surgical time is not within the scope of nursing practice, although the physician probably
would perform the surgery earlier than the prescheduled time.
75. Answer: 1. The pain associated with acute pancreatitis is often severe and unrelenting, is located in
the epigastric region, and radiates to the back.
76. Answer: 1. The pain associated with Crohn’s disease is alleviated by the use of analgesics and
antispasmodics and also is reduced by having the client practice relaxation techniques, applying local
cold or heat to the abdomen, massaging the abdomen, and lying with the legs flexed. Lying with the
legs extended is not useful because it increases the muscle tension in the abdomen, which could
aggravate the inflamed intestinal tissues as the abdominal muscles are stretched.
77. Answer: 3. Salicylate compounds act by inhibiting prostaglandin synthesis and reducing
inflammation. The nurse teaches the client to take the medication with a full glass of water and to
increase fluid intake throughout the day. This medication needs to be taken after meals to reduce GI
irritation.
78. Answer: 4. The lack of saliva, pain near the area of the ear, and the prolonged NPO status of the
client should lead the nurse to suspect the development of parotitis, or inflammation of the parotid
gland. Parotitis usually develops in cases of dehydration combined with poor oral hygiene or when
clients have been NPO for an extended period. Preventative measures include the use of sugarless hard
candy or gum to stimulate saliva production, adequate hydration, and frequent mouth care. Stomatitis
(inflammation of the mouth) produces excessive salivation and a sore mouth.
78. Answer: 2. A dark red to purple stoma indicates inadequate blood supply. Mild edema and slight
oozing of blood are normal in the early post-op period. The colostomy would typically not begin
functioning until 2-4 days after surgery.
80. Answer: 2, 4, and 5. The nurse can delegate the following basic care activities to the unlicensed
assistant: providing skin care following bowel movements, maintaining intake and output records, and
obtaining the client’s weight. Assessing the client’s bowel sounds and evaluating the client’s response
to medication are registered nurse activities that cannot be delegated.
81. Answer: 2. Diarrhea is the primary symptom in an exacerbation of ulcerative colitis, and decreasing
the frequency of stools is the first goal of treatment. The other goals are ongoing and will be best
achieved by halting the exacerbation. The client may receive antidiarrheal medications, antispasmodic
agents, bulk hydrophilic agents, or anti-inflammatory drugs.
82. Answer: 3. Excessive diarrhea causes significant depletion of the body’s stores of sodium and
potassium as well as fluid. The client should be closely monitored for hypokalemia and hyponatremia.
Ulcerative colitis does not place the client at risk for heart failure, DVT, or hypocalcemia.
83. Answer: 3. Food will be withheld from the client with severe symptoms of ulcerative colitis to rest
the bowel. To maintain the client’s nutritional status, the client will be started on TPN. Enteral feedings
or dividing the diet into 6 small meals does not allow the bowel to rest. A high-calorie, high-protein diet
will worsen the client’s symptoms.
84. Answer: 2
85. Answer: 1
86. Answer: 4
87. Answer: 1. Antacids work by neutralizing gastric acid, which would cause an increase in pH. They
do not affect gastric motility.
88. Answer: 2. Aluminum- and calcium-containing antacids cause constipation, magnesium-containing
antacids cause diarrhea, and sodium-containing antacids cause sodium and fluid retention.
89. Answer: 3. Magnesium-containing antacids can cause hypermagnesemia in patients with chronic
renal failure. Aluminum-containing antacids may be used as a phosphate binder in patients with chronic
renal failure. Calcium-containing antacids are also appropriate because these patients may be
hypocalcemic.
90. Answer: 1. Solutions containing sodium bicarbonate (a base) can cause metabolic alkalosis. Serum
K and serum calcium would decrease with alkalosis, not increase.
91. Answer: 2. A serious side effect of famotidine is thrombocytopenia, which is manifested by a
decrease in platelet count and an increased risk of bleeding.
92. Answer: 1. Histamine receptor blocking agents decrease gastric acid by competing with histamine
for binding sites on the parietal cells.
93. Answer: 3. Because the proton pump inhibitors stop the final step of acid secretion, they can block
up to 90% of acid secretion, leading to achlorhydria (without acid).
94. Answer: 3. Pantoprazole is the only proton pump inhibitor that is available for intravenous
administration. The other medications in this category may only be administered orally.
95. Answer: C. It is important to give sucralfate on an empty stomach so that it may dissolve and form
a protective barrier over the gastric mucosa. The tablet form will not dissolve in water when crushed; it
must be left whole and allowed to dissolve. Crushing the medication so that it will not dissolve could
lead to clogging of the nasogastric tube and decreased effectiveness of the drug.
96. Answer: 3. Sucralfate has a local effect only on the gastric mucosa. It forms a paste-like substance
in the stomach, which adheres to the gastric lining, protecting against adverse effects related to gastric
acid. It also stimulates healing of any ulcerated areas of the gastric mucosa.
97. Answer: 3. Bulk-forming laxatives must be given with at least 8 ounces of liquid plus additional
liquid each day to prevent intestinal obstruction.
98. Answer: 4. Absorbent antidiarrheal medications bind to diarrhea-causing bacteria to form a
nonabsorbable complex, which is then excreted in the stool.
99. Answer: 1. Side effects associated with loperamide include CNS fatigue and dizziness, epigastric
pain, abdominal cramps, nausea, dry mouth, vomiting, and anorexia. Diarrhea is an indication, not a
side effect.
100. Answer: 3. Diphenoxylate acts on the smooth muscle of the intestinal tract to inhibit GI motility and excessive propulsion of
the GI tract (peristalsis).

1. Which of the following conditions can cause a hiatal hernia?

1. Increased intrathoracic pressure
2. Weakness of the esophageal muscle
3. Increased esophageal muscle pressure
4. Weakness of the diaphragmic muscle
2. Risk factors for the development of hiatal hernias are those that lead to increased abdominal
pressure. Which of the following complications can cause increased abdominal pressure?
1. Obesity
2. Volvulus
3. Constipation
4. Intestinal obstruction
3. Which of the following symptoms is common with a hiatal hernia?
1. Left arm pain
2. Lower back pain
3. Esophageal reflux
4. Abdominal cramping
4. Which of the following tests can be performed to diagnose a hiatal hernia?
1. Colonoscopy
2. Lower GI series
3. Barium swallow
4. Abdominal x-rays
5. Which of the following measures should the nurse focus on for the client with esophageal
varices?
1. Recognizing hemorrhage
2. Controlling blood pressure
3. Encouraging nutritional intake
4. Teaching the client about varices
6. Which of the following tests can be used to diagnose ulcers?
1. Abdominal x-ray
2. Barium swallow
3. Computed tomography (CT) scan
4. Esophagogastroduodenoscopy (EGD)
7. Which of the following best describes the method of action of medications, such as ranitidine
(Zantac), which are used in the treatment of peptic ulcer disease?
1. Neutralize acid
2. Reduce acid secretions
3. Stimulate gastrin release
4. Protect the mucosal barrier
8. The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn
following a meal. After administering an ordered antacid, the nurse encourages the client to lie in
which of the following positions?
1. Supine with the head of the bed flat
2. On the stomach with the head flat
3. On the left side with the head of the bed elevated 30 degrees
4. On the right side with the head of the bed elevated 30 degrees.
9. The nurse is caring for a client following a Billroth II procedure. On review of the post-
operative orders, which of the following, if prescribed, would the nurse question and verify?
1. Irrigating the nasogastric tube
2. Coughing a deep breathing exercises
3. Leg exercises
4. Early ambulation
10. The nurse is providing discharge instructions to a client following gastrectomy. Which
measure will the nurse instruct the client to follow to assist in preventing dumping syndrome?
1. Eat high-carbohydrate foods
2. Limit the fluids taken with meals
3. Ambulate following a meal
4. Sit in a high-Fowlers position during meals
11. The nurse instructs the nursing assistant on how to provide oral hygiene for a client who
cannot perform this task for himself. Which of the following techniques should the nurse tell the
assistant to incorporate into the client’s daily care?
1. Assess the oral cavity each time mouth care is given and record observations
2. Use a soft toothbrush to brush the client’s teeth after each meal
3. Swab the client’s tongue, gums, and lips with a soft foam applicator every 2 hours.
4. Rinse the client’s mouth with mouthwash several times a day.
12. A client with suspected gastric cancer undergoes an endoscopy of the stomach. Which of the
following assessments made after the procedure would indicate the development of a potential
complication?
1. The client complains of a sore throat
2. The client displays signs of sedation
3. The client experiences a sudden increase in temperature
4. The client demonstrates a lack of appetite
13. A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to undergo
a subtotal gastrectomy (Billroth II procedure). During pre-operative teaching, the nurse is
reinforcing information about the procedure. Which of the following explanations is most
accurate?
1. The procedure will result in enlargement of the pyloric sphincter
2. The procedure will result in anastomosis of the gastric stump to the jejunum
3. The procedure will result in removal of the duodenum
4. The procedure will result in repositioning of the vagus nerve
14. After a subtotal gastrectomy, the nurse should anticipate that nasogastric tube drainage will
be what color for about 12 to 24 hours after surgery?
1. Dark brown
2. Bile green
3. Bright red
4. Cloudy white
15. After a subtotal gastrectomy, care of the client’s nasogastric tube and drainage system should
include which of the following nursing interventions?
1. Irrigate the tube with 30 ml of sterile water every hour, if needed.
2. Reposition the tube if it is not draining well
3. Monitor the client for N/V, and abdominal distention
4. Turn the machine to high suction of the drainage is sluggish on low suction.
16. Which of the following would be an expected nutritional outcome for a client who has
undergone a subtotal gastrectomy for cancer?
1. Regain weight loss within 1 month after surgery
2. Resume normal dietary intake of three meals per day
3. Control nausea and vomiting through regular use of antiemetics
4. Achieve optimal nutritional status through oral or parenteral feedings
17. The client with GERD complains of a chronic cough. The nurse understands that in a client
with GERD this symptom may be indicative of which of the following conditions?
1. Development of laryngeal cancer
2. Irritation of the esophagus
3. Esophageal scar tissue formation
4. Aspiration of gastric contents
18. Which of the following dietary measures would be useful in preventing esophageal reflux?
1. Eating small, frequent meals
2. Increasing fluid intake
3. Avoiding air swallowing with meals
4. Adding a bedtime snack to the dietary plan
19. A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a
bleeding duodenal ulcer. The client develops a sudden, sharp pain in the mid epigastric area
along with a rigid, board-like abdomen. These clinical manifestations most likely indicate which
of the following?
1. An intestinal obstruction has developed
2. Additional ulcers have developed
3. The esophagus has become inflamed
4. The ulcer has perforated
20. When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and
symptoms would the nurse expect to see? Select all that apply.
1. Epigastric pain at night
2. Relief of epigastric pain after eating
3. Vomiting
4. Weight loss
21. The nurse is caring for a client who has had a gastroscopy. Which of the following symptoms
may indicate that the client is developing a complication related to the procedure? Select all that
apply.
1. The client complains of a sore throat
2. The client has a temperature of 100*F
3. The client appears drowsy following the procedure
4. The client complains of epigastric pain
5. The client experiences hematemesis
22. A client with peptic ulcer disease tells the nurse that he has black stools, which he has not
reported to his physician. Based on this information, which nursing diagnosis would be
appropriate for this client?
1. Ineffective coping related to fear of diagnosis of chronic illness
2. Deficient knowledge related to unfamiliarity with significant signs and symptoms
3. Constipation related to decreased gastric motility
4. Imbalanced nutrition: Less than body requirements due to gastric bleeding
23. A client with a peptic ulcer reports epigastric pain that frequently awakens her at night, a
feeling of fullness in the abdomen, and a feeling of anxiety about her health. Based on this
information, which nursing diagnosis would be most appropriate?
1. Imbalanced Nutrition: Less than Body Requirements related to anorexia.
2. Disturbed Sleep Pattern related to epigastric pain
3. Ineffective Coping related to exacerbation of duodenal ulcer
4. Activity Intolerance related to abdominal pain
24. While caring for a client with peptic ulcer disease, the client reports that he has been
nauseated most of the day and is now feeling lightheaded and dizzy. Based upon these findings,
which nursing actions would be most appropriate for the nurse to take? Select all that apply.
1. Administering an antacid hourly until nausea subsides.
2. Monitoring the client’s vital signs
3. Notifying the physician of the client’s symptoms
4. Initiating oxygen therapy
5. Reassessing the client on an hour
25. A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The
nurse knows that the client understands proper drug administration of ranitidine when she says
that she will take the drug at which of the following times?
1. Before meals
2. With meals
3. At bedtime
4. When pain occurs
26. A client has been taking aluminum hydroxide 30 mL six times per day at home to treat his
peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days.
Based on this information, the nurse would determine that which of the following is the most
likely cause of the client’s constipation?
1. The client has not been including enough fiber in his diet
2. The client needs to increase his daily exercise
3. The client is experiencing a side effect of the aluminum hydroxide.
4. The client has developed a gastrointestinal obstruction.
27. A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements
best indicates that the client understands how to correctly take the antacid?
1. “I should take my antacid before I take my other medications.”
2. “I need to decrease my intake of fluids so that I don’t dilute the effects of my antacid.”
3. “My antacid will be most effective if I take it whenever I experience stomach pains.”
4. “It is best for me to take my antacid 1 to 3 hours after meals.”
28. The nurse is caring for a client with chronic gastritis. The nurse monitors the client, knowing
that this client is at risk for which of the following vitamin deficiencies?
1. Vitamin A
2. Vitamin B12
3. Vitamin C
4. Vitamin E
29. The nurse is reviewing the medication record of a client with acute gastritis. Which
medication, if noted on the client’s record, would the nurse question?
1. Digoxin (Lanoxin)
2. Indomethacin (Indocin)
3. Furosemide (Lasix)
4. Propranolol hydrochloride (Inderal)
30. The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the
T-tube has drained 750ml of green-brown drainage. Which nursing intervention is most
appropriate?
1. Notify the physician
2. Document the findings
3. Irrigate the T-tube
4. Clamp the T-tube
31. The nurse provides medication instructions to a client with peptic ulcer disease. Which
statement, if made by the client, indicates the best understanding of the medication therapy?
1. “The cimetidine (Tagamet) will cause me to produce less stomach acid.”
2. “Sucralfate (Carafate) will change the fluid in my stomach.”
3. “Antacids will coat my stomach.”
4. “Omeprazole (Prilosec) will coat the ulcer and help it heal.”
32. The client with peptic ulcer disease is scheduled for a pyloroplasty. The client asks the nurse
about the procedure. The nurse plans to respond knowing that a pyloroplasty involves:
1. Cutting the vagus nerve
2. Removing the distal portion of the stomach
3. Removal of the ulcer and a large portion of the cells that produce hydrochloric acid
4. An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the
stomach to the duodenum.
33. A client with a peptic ulcer is scheduled for a vagotomy. The client asks the nurse about the
purpose of this procedure. The nurse tells the client that the procedure:
1. Decreases food absorption in the stomach
2. Heals the gastric mucosa
3. Halts stress reactions
4. Reduces the stimulus to acid secretions
34. The nurse would assess the client experiencing an acute episode of cholecysitis for pain that is
located in the right
1. Upper quadrant and radiates to the left scapula and shoulder
2. Upper quadrant and radiates to the right scapula and shoulder
3. Lower quadrant and radiates to the umbilicus
4. Lower quadrant and radiates to the back
35. Which of the following tasks should be included in the immediate postoperative management
of a client who has undergone gastric resection?
1. Monitoring gastric pH to detect complications
2. Assessing for bowel sounds
3. Providing nutritional support
4. Monitoring for symptoms of hemorrhage
36. If a gastric acid perforates, which of the following actions should not be included in the
immediate management of the client?
1. Blood replacement
2. Antacid administration
3. Nasogastric tube suction
4. Fluid and electrolyte replacement
37. Mucosal barrier fortifiers are used in peptic ulcer disease management for which of the
following indications?
1. To inhibit mucus production
2. To neutralize acid production
3. To stimulate mucus production
4. To stimulate hydrogen ion diffusion back into the mucosa
38. When counseling a client in ways to prevent cholecystitis, which of the following guidelines is
most important?
1. Eat a low-protein diet
2. Eat a low-fat, low-cholesterol diet
3. Limit exercise to 10 minutes/day
4. Keep weight proportionate to height
39. Which of the following symptoms best describes Murphy’s sign?
1. Periumbilical eccymosis exists
2. On deep palpitation and release, pain in elicited
3. On deep inspiration, pain is elicited and breathing stops
4. Abdominal muscles are tightened in anticipation of palpation
40. Which of the following tests is most commonly used to diagnose cholecystitis?
1. Abdominal CT scan
2. Abdominal ultrasound
3. Barium swallow
4. Endoscopy
41. Which of the following factors should be the main focus of nursing management for a client
hospitalized for cholecystitis?
1. Administration of antibiotics
2. Assessment for complications
3. Preparation for lithotripsy
4. Preparation for surgery
42. A client being treated for chronic cholecystitis should be given which of the following
instructions?
1. Increase rest
2. Avoid antacids
3. Increase protein in diet
4. Use anticholinergics as prescribed
43. The client with a duodenal ulcer may exhibit which of the following findings on assessment?
1. Hematemesis
2. Malnourishment
3. Melena
4. Pain with eating
44. The pain of a duodenal ulcer can be distinguished from that of a gastric ulcer by which of the
following characteristics?
1. Early satiety
2. Pain on eating
3. Dull upper epigastric pain
4. Pain on empty stomach
45. The client has orders for a nasogastric (NG) tube insertion. During the procedure,
instructions that will assist in the insertion would be:
1. Instruct the client to tilt his head back for insertion in the nostril, then flex his neck for the final
insertion
2. After insertion into the nostril, instruct the client to extend his neck
3. Introduce the tube with the client’s head tilted back, then instruct him to keep his head upright for
final insertion
4. Instruct the client to hold his chin down, then back for insertion of the tube
46. The most important pathophysiologic factor contributing to the formation of esophageal
varices is:
1. Decreased prothrombin formation
2. Decreased albumin formation by the liver
3. Portal hypertension
4. Increased central venous pressure
47. The client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to
control the bleeding. The most important assessment is for the nurse to:
1. Check that the hemostat is on the bedside
2. Monitor IV fluids for the shift
3. Regularly assess respiratory status
4. Check that the balloon is deflated on a regular basis
48. A female client complains of gnawing epigastric pain for a few hours after meals. At times,
when the pain is severe, vomiting occurs. Specific tests are indicated to rule out:
1. Cancer of the stomach
2. Peptic ulcer disease
3. Chronic gastritis
4. Pylorospasm
49. When a client has peptic ulcer disease, the nurse would expect a priority intervention to be:
1. Assisting in inserting a Miller-Abbott tube
2. Assisting in inserting an arterial pressure line
3. Inserting a nasogastric tube
4. Inserting an I.V.
50. A 40-year-old male client has been hospitalized with peptic ulcer disease. He is being treated
with a histamine receptor antagonist (cimetidine), antacids, and diet. The nurse doing discharge
planning will teach him that the action of cimetidine is to:
1. Reduce gastric acid output
2. Protect the ulcer surface
3. Inhibit the production of hydrochloric acid (HCl)
4. Inhibit vagus nerve stimulation

Answers and Rationale

1. Answer: 4. A hiatal hernia is caused by weakness of the diaphragmic muscle and increased intra-
abdominal—not intrathoracic—pressure. This weakness allows the stomach to slide into the esophagus.
The esophageal supports weaken, but esophageal muscle weakness or increased esophageal muscle
pressure isn’t a factor in hiatal hernia.
2. Answer: 1. Obesity may cause increased abdominal pressure that pushes the lower portion of the
stomach into the thorax.
3. Answer: 3. Esophageal reflux is a common symptom of hiatal hernia. This seems to be associated
with chronic exposure of the lower esophageal sphincter to the lower pressure of the thorax, making it
less effective.
4. Answer: 3. A barium swallow with fluoroscopy shows the position of the stomach in relation to the
diaphragm. A colonoscopy and a lower GI series show disorders of the intestine.
5. Answer: 1. Recognizing the rupture of esophageal varices, or hemorrhage, is the focus of nursing
care because the client could succumb to this quickly. Controlling blood pressure is also important
because it helps reduce the risk of variceal rupture. It is also important to teach the client what varices
are and what foods he should avoid such as spicy foods.
6. Answer: 4. The EGD can visualize the entire upper GI tract as well as allow for tissue specimens and
electrocautery if needed. The barium swallow could locate a gastric ulcer. A CT scan and an abdominal
x-ray aren’t useful in the diagnosis of an ulcer.
7. Answer: 2. Ranitidine is a histamine-2 receptor antagonist that reduces acid secretion by inhibiting
gastrin secretion.
8. Answer: 3. The discomfort of reflux is aggravated by positions that compress the abdomen and the
stomach. These include lying flat on the back or on the stomach after a meal of lying on the right side.
The left side-lying position with the head of the bed elevated is most likely to give relief to the client.
9. Answer: 1. In a Billroth II procedure the proximal remnant of the stomach is anastomased to the
proximal jejunum. Patency of the NG tube is critical for preventing the retention of gastric secretions.
The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically
ordered by the physician. In this situation, the nurse would clarify the order.
10. Answer: 2. The nurse should instruct the client to decrease the amount of fluid taken at meals and to
avoid high carbohydrate foods including fluids such as fruit nectars; to assume a low-Fowler’s position
during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take
antispasmidocs as prescribed.
11. Answer: 2. A soft toothbrush should be used to brush the client’s teeth after each meal and more
often as needed. Mechanical cleaning is necessary to maintain oral health, simulate gingiva, and
remove plaque. Assessing the oral cavity and recording observations is the responsibility of the nurse,
not the nursing assistant. Swabbing with a safe foam applicator does not provide enough friction to
clean the mouth. Mouthwash can be a drying irritant and is not recommended for frequent use.
12. Answer: 3. The most likely complication of an endoscopic procedure is perforation. A sudden
temperature spike with 1 to 2 hours after the procedure is indicative of a perforation and should be
reported immediately to the physician. A sore throat is to be anticipated after an endoscopy. Clients are
given sedatives during the procedure, so it is expected that they will display signs of sedation after the
procedure is completed. A lack of appetite could be the result of many factors, including the disease
process.
13. Answer: 2. A Billroth II procedure bypasses the duodenum and connects the gastric stump directly
to the jejunum. The pyloric sphincter is removed, along with some of the stomach fundus.
14. Answer: 1. About 12 to 24 hours after a subtotal gastrectomy, gastric drainage is normally brown,
which indicates digested blood. Bile green or cloudy white drainage is not expected during the first 12
to 24 hours after a subtotal gastrectomy. Drainage during the first 6 to 12 hours contains some bright
red blood, but large amounts of blood or excessively bloody drainage should be reported to the
physician promptly.
15. Answer: 3. Nausea, vomiting, or abdominal distention indicated that gas and secretions are
accumulating within the gastric pouch due to impaired peristalsis or edema at the operative site and
may indicate that the drainage system is not working properly. Saline solution is used to irrigate
nasogastric tubes. Hypotonic solutions such as water increase electrolyte loss. In addition, a physician’s
order is needed to irrigate the NG tube, because this procedure could disrupt the suture line. After
gastric surgery, only the surgeon repositions the NG tube because of the danger of rupturing or
dislodging the suture line. The amount of suction varies with the type of tube used and is ordered by the
physician. High suction may create too much tension on the gastric suture line.
16. Answer: 4. An appropriate expected outcome is for the client to achieve optimal nutritional status
through the use of oral feedings or total parenteral nutrition (TPN). TPN may be used to supplement
oral intake, or it may be used alone if the client cannot tolerate oral feedings. The client would not be
expected to regain lost weight within 1 month after surgery or to tolerate a normal dietary intake of
three meals per day. Nausea and vomiting would not be considered an expected outcome of gastric
surgery, and regular use of antiemetics would not be anticipated.
17. Answer: 4. Clients with GERD can develop pulmonary symptoms such as coughing, wheezing, and
dyspnea that are caused by the aspiration of gastric contents. GERD does not predispose the client to
the development of laryngeal cancer. Irritation of the esophagus and esophageal scar tissue formation
can develop as a result of GERD. However, GERD is more likely to cause painful and difficult
swallowing.
18. Answer: 1. Esophageal reflux worsens when the stomach is overdistended with food. Therefore, an
important measure is to eat small, frequent meals. Fluid intake should be decreased during meals to
reduce abdominal distention. Avoiding air swallowing does not prevent esophageal reflux. Food intake
in the evening should be strictly limited to reduce the incidence of nighttime reflux, so bedtime snacks
are not recommended.
19. Answer: 4. The body reacts to perforation of an ulcer by immobilizing the area as much as possible.
This results in boardlike muscle rigidity, usually with extreme pain. Perforation is a medical emergency
requiring immediate surgical intervention because peritonitis develops quickly after perforation. An
intestinal obstruction would not cause midepigastric pain. Esophageal inflammation or the development
of additional ulcers would not cause a rigid, boardlike abdomen.
20. Answer: 3 and 4. Vomiting and weight loss are common with gastric ulcers. Clients with a gastric
ulcer are most likely to complain of a burning epigastric pain that occurs about one hour after eating.
Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to complain about
pain that occurs during the night and is frequently relieved by eating.
21. Answer: 2, 4, and 5. Following a gastroscopy, the nurse should monitor the client for complications,
which include perforation and the potential for aspiration. An elevated temperature, complaints of
epigastric pain, or the vomiting of blood (hematemesis) are all indications of a possible perforation and
should be reported promptly. A sore throat is a common occurrence following a gastroscopy. Clients are
usually sedated to decrease anxiety and the nurse would anticipate that the client will be drowsy
following the procedure.
22. Answer: 2. Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease.
Digested blood in the stomach causes it to be black. The odor of the stool is very stinky. Clients with
peptic ulcer disease should be instructed to report the incidence of black stools promptly to their
physician.
23. Answer: 2. Based on the data provided, the most appropriate nursing diagnosis would be Disturbed
Sleep pattern. A client with a duodenal ulcer commonly awakens at night with pain. The client’s
feelings of anxiety do not necessarily indicate that she is coping ineffectively.
24. Answer: 2 and 3. The symptoms of nausea and dizziness in a client with peptic ulcer disease may be
indicative of hemorrhage and should not be ignored. The appropriate nursing actions at this time are for
the nurse to monitor the client’s vital signs and notify the physician of the client’s symptoms. To
administer an antacid hourly or to wait one hour to reassess the client would be inappropriate; prompt
intervention is essential in a client who is potentially experiencing a gastrointestinal hemorrhage. The
nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by
the physician.
25. Answer: 3. Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose
of ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid. Clients who
take the drug twice a day are advised to take it in the morning and at bedtime.
26. Answer: 3. It is most likely that the client is experiencing a side effect of the antacid. Antacids with
aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body. These
precipitate and accumulate in the intestines, causing constipation. Increasing dietary fiber intake or
daily exercise may be a beneficial lifestyle change for the client but is not likely to relieve the
constipation caused by the aluminum hydroxide. Constipation, in isolation from other symptoms, is not
a sign of bowel obstruction.
27. Answer: 4. Antacids are most effective if taken 1 to 3 hours after meals and at bedtime. When an
antacid is taken on an empty stomach, the duration of the drug’s action is greatly decreased. Taking
antacids 1 to 3 hours after a meal lengthens the duration of action, thus increasing the therapeutic action
of the drug. Antacids should be administered about 2 hours after other medications to decrease the
chance of drug interactions. It is not necessary to decrease fluid intake when taking antacids.
28. Answer: 2. Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading
to the loss of the functioning parietal cells. The source of the intrinsic factor is lost, which results in the
inability to absorb vitamin B12. This leads to the development of pernicious anemia.
29. Answer: 2. Indomethacin (Indocin) is a NSAID and can cause ulceration of the esophagus,
stomach, duodenum, or small intestine. Indomethacin is contraindicated in a client with GI disorders.
30. Answer: 2. Following cholecystectomy, drainage from the T-tube is initially bloody and then turns
to green-brown. The drainage is measured as output. The amount of expected drainage will range from
500 to 1000 ml per day. The nurse would document the output.
31. Answer: 1. Cimetidine (Tagamet), a histamine H2 receptor antagonist, will decrease the secretion of
gastric acid. Sucralfate (Carafate) promotes healing by coating the ulcer. Antacids neutralize acid in the
stomach. Omeprazole (Prilosec) inhibits gastric acid secretion.
32. Answer: 4. Option 4 describes the procedure for a pyloroplasty. A vagotomy involves cutting the
vagus nerve. A subtotal gastrectomy involves removing the distal portion of the stomach. A Billroth II
procedure involves removal of the ulcer and a large portion of the tissue that produces hydrochloric
acid.
33. Answer: 4. A vagotomy, or cutting the vagus nerve, is done to eliminate parasympathetic
stimulation of gastric secretion.
34. Answer: 2. During an acute “gallbladder attack,” the client may complain of severe right upper
quadrant pain that radiates to the right scapula and shoulder. This is governed by the pattern on
dermatomes in the body.
35. Answer: 4. The client should be monitored closely for signs and symptoms of hemorrhage, such as
bright red blood in the nasogastric tube suction, tachycardia, or a drop in blood pressure. Gastric pH
may be monitored to evaluate the need for histamine-2 receptor antagonists. Bowel sounds may not
return for up to 72 hours postoperatively. Nutritional needs should be addressed soon after surgery.
36. Answer: 2. Antacids aren’t helpful in perforation. The client should be treated with antibiotics as
well as fluid, electrolyte, and blood replacement. NG tube suction should also be performed to prevent
further spillage of stomach contents into the peritoneal cavity.
37. Answer: 3. The mucosal barrier fortifiers stimulate mucus production and prevent hydrogen ion
diffusion back into the mucosa, resulting in accelerated ulcer healing. Antacids neutralize acid
production.
38. Answer: 4. Obesity is a known cause of gallstones, and maintaining a recommended weight will
help protect against gallstones. Excessive dietary intake of cholesterol is associated with the
development of gallstones in many people. Dietary protein isn’t implicated in cholecystitis. Liquid
protein and low-calorie diets (with rapid weight loss of more than 5 lb [2.3kg] per week) are implicated
as the cause of some cases of cholecystitis. Regular exercise (30 minutes/three times a week) may help
reduce weight and improve fat metabolism. Reducing stress may reduce bile production, which may
also indirectly decrease the chances of developing cholecystitis.
39. Answer: 3. Murphy’s sign is elicited when the client reacts to pain and stops breathing. It’s a
common finding in clients with cholecystitis. Periumbilical ecchymosis, Cullen’s sign, is present in
peritonitis. Pain on deep palpation and release is rebound tenderness. Tightening up abdominal muscles
in anticipation of palpation is guarding.
40. Answer: 2. An abdominal ultrasound can show if the gallbladder is enlarged, if gallstones are
present, if the gallbladder wall is thickened, or if distention of the gallbladder lumen is present. An
abdominal CT scan can be used to diagnose cholecystitis, but it usually isn’t necessary. A barium
swallow looks at the stomach and the duodenum. Endoscopy looks at the esophagus, stomach, and
duodenum.
41. Answer: 2. The client with acute cholecystitis should first be monitored for perforation, fever,
abscess, fistula, and sepsis. After assessment, antibiotics will be administered to reduce the infection.
Lithotripsy is used only for a small percentage of clients. Surgery is usually done after the acute
infection has subsided.
42. Answer: 4. Conservative therapy for chronic cholecystitis includes weight reduction by increasing
physical activity, a low-fat diet, antacid use to treat dyspepsia, and anticholinergic use to relax smooth
muscles and reduce ductal tone and spasm, thereby reducing pain.
43. Answer: 3. The client with a duodenal ulcer may have bleeding at the ulcer site, which shows up as
melena (black tarry poop). The other findings are consistent with a gastric ulcer.
44. Answer: 4. Pain on empty stomach is relieved by taking foods or antacids. The other symptoms are
those of a gastric ulcer.
45. Answer: 1. NG insertion technique is to have the client first tilt his head back for insertion into the
nostril, then to flex his neck forward and swallow. Extension of the neck (2) will impede NG tube
insertion.
46. Answer: 3. As the liver cells become fatty and degenerate, they are no longer able to accommodate
the large amount of blood necessary for homeostasis. The pressure in the liver increases and causes
increased pressure in the venous system. As the portal pressure increases, fluid exudes into the
abdominal cavity. This is called ascites.
47. Answer: 3. The respiratory system can become occluded if the balloon slips and moves up the
esophagus, putting pressure on the trachea. This would result in respiratory distress and should be
assessed frequently. Scissors should be kept at the bedside to cut the tube if distress occurs. This is a
safety intervention.
48. Answer: 2. Peptic ulcer disease is characteristically gnawing epigastric pain that may radiate to the
back. Vomiting usually reflects pyloric spasm from muscular spasm or obstruction. Cancer (1) would
not evidence pain or vomiting unless the pylorus was obstructed.
49. Answer: 3. An NG tube insertion is the most appropriate intervention because it will determine the
presence of active GI bleeding. A Miller-Abbott tube (1) is a weighted, mercury-filled ballooned tube
used to resolve bowel obstructions. There is no evidence of shock or fluid overload in the client;
therefore, an arterial line (2) is not appropriate at this time and an IV (4) is optional.
50. Answer: 1. These drugs inhibit action of histamine on the H2 receptors of parietal cells, thus
reducing gastric acid output.
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 clear liquid 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 intention 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 nasogastric 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 nasogastric 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 from 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 erythrocyte 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-electrolyte 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 from 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

Answers and Rationale

1. Answer: C. 300 units/L
The normal serum amylase level is 25 to 151 units/L. With chronic cases of pancreatitis, the rise in
serum amylase levels usually does not exceed three times the normal value. In acute pancreatitis, the
value may exceed five times the normal value. Options A and B are within normal limits. Option D is
an extremely elevated level seen in acute pancreatitis.
2. Answer: C. Custard
Full liquid food items include items such as plain ice cream, sherbet, breakfast drinks, milk, pudding
and custard, soups that are strained, and strained vegetable juices. A clear liquid diet consists of foods
that are relatively transparent. The food items in options A, B, and D are clear liquids.
3. Answer: A. Pork
The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a variety of
foods of plant and animal origin. Pork products are especially rich in this vitamin. Other good food
sources include nuts, whole grain cereals, and legumes. Milk contains vitamins A, D, and B2. Poultry
contains niacin. Broccoli contains vitamins C, E, and K and folic acid
4. Answer: A. Hold the feeding
Unless specifically indicated, residual amounts more than 100 mL require holding the feeding.
Therefore options B, C, and D are incorrect. Additionally, the feeding is not discarded unless its
contents are abnormal in color or characteristics.
5. Answer: D. Pull back on the tube and wait until the respiratory distress subsides
During the insertion of a nasogastric tube, if the client experiences difficulty breathing or any
respiratory distress, withdraw the tube slightly, stop the tube advancement, and wait until the distress
subsides. Options B and C are unnecessary. Quickly inserting the tube is not an appropriate action
because, in this situation, it may be likely that the tube has entered the bronchus.
6. Answer: A. 3.5
If the nasogastric tube is in the stomach, the pH of the contents will be acidic. Gastric aspirates have
acidic pH values and should be 3.5 or lower. Option B indicates a slightly acidic pH. Option C
indicates a neutral pH. Option D indicates an alkaline pH.
7. Answer: C. Take and hold a deep breath
When the nurse removes a nasogastric tube, the client is instructed to take and hold a deep breath. This
will close the epiglottis. This allows for easy withdrawal through the esophagus into the nose. The
nurse removes the tube with one smooth, continuous pull.
8. Answer: C. Clamp the nasogastric tube for 30 minutes following administration of the
medication
If a client has a nasogastric tube connected to suction, the nurse should wait up to 30 minutes before
reconnecting the tube to the suction apparatus to allow adequate time for medication absorption.
Aspirating the nasogastric tube will remove the medication just administered. Low intermittent suction
also will remove the medication just administered. The client should not be placed in the supine
position because of the risk for aspiration.
9. Answer: D. A pair of scissors
When the client has a Sengstaken-Blakemore tube, a pair of scissors must be kept at the client’s bedside
at all times. The client needs to be observed for sudden respiratory distress, which occurs if the gastric
balloon ruptures and the entire tube moves upward. If this occurs, the nurse immediately cuts all
balloon lumens and removes the tube. An obturator and a Kelly clamp are kept at the bedside of a client
with a tracheostomy. An irrigation set may be kept at the bedside, but it is not the priority item.
10. Answer: A. Hepatitis A
Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers.
Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.
11. Answer: B. Elevated serum bilirubin level
Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels,
elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea nitrogen level may
indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis.
12. Answer: C. Morphine sulfate for pain
Meperidine (Demerol) rather than morphine sulfate is the medication of choice to treat pain because
morphine sulfate can cause spasms in the sphincter of Oddi. Options A, B, and D are appropriate
interventions for the client with acute pancreatitis.
13. Answer: A. Fast for 8 hours before the test
A barium swallow is an x-ray study that uses a substance called barium for contrast to highlight
abnormalities in the gastrointestinal tract. The client should fast for 8 to 12 hours before the test,
depending on physician instructions. Most oral medications also are withheld before the test. After the
procedure, the nurse must monitor for constipation, which can occur as a result of the presence of
barium in the gastrointestinal tract.
14. Answer: C. Listens to bowel sounds in all for quadrants
The appropriate sequence for abdominal examination is inspection, auscultation, percussion, and
palpation. Auscultation is performed after inspection to ensure that the motility of the bowel and bowel
sounds are not altered by percussion or palpation. Therefore, after inspecting the skin on the abdomen,
the nurse should listen for bowel sounds.
15. Answer: D. Explain that diarrhea is expected
The solution GoLYTELY is a bowel evacuant used to prepare a client for a colonoscopy by cleansing
the bowel. The solution is expected to cause a mild diarrhea and will clear the bowel in 4 to 5 hours.
Options A, B, and C are inappropriate actions.
16. Answer: B. Vitamin B12
Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of the
function of the parietal cells. The source of the intrinsic factor is lost, which results in the inability to
absorb vitamin B12. This leads to the development of pernicious anemia. The client is not at risk for
vitamin A, C, or E deficiency.
17. Answer: C. Indomethacin (Indocin)
Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can cause ulceration of the
esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal
disorders. Furosemide (Lasix) is a loop diuretic. Digoxin is a cardiac medication. Propranolol (Inderal)
is a β-adrenergic blocker. Furosemide, digoxin, and propranolol are not contraindicated in clients with
gastric disorders.
18. Answer: D. Document the findings
Following cholecystectomy, drainage from the T tube is initially bloody and then turns to a greenish-
brown color. The drainage is measured as output. The amount of expected drainage will range from 500
to 1000 mL/day. The nurse would document the output.
19. Answer: D. A rigid, board-like abdomen
Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe
pain beginning in the mid epigastric area and spreading over the abdomen, which becomes rigid and
board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops.
Numbness in the legs is not an associated finding.
20. Answer: C. Reduces the stimulus to acid secretions
A vagotomy, or cutting of the vagus nerve, is done to eliminate parasympathetic stimulation of gastric
secretion. Options A, B, and D are incorrect descriptions of a vagotomy.
21. Answer: C. Irrigating the nasogastric tube
In a Billroth II procedure, the proximal remnant of the stomach is anastomosed to the proximal
jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric secretions.
The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically
ordered by the physician. In this situation, the nurse should clarify the order. Options A, B, and D are
appropriate postoperative interventions.
22. Answer: C. Limit the fluid taken with meal
Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after
eating, especially following a Billroth II procedure. Early manifestations usually occur within 30
minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the
desire to lie down. The nurse should instruct the client to decrease the amount of fluid taken at meals
and to avoid high-carbohydrate foods, including fluids such as fruit nectars; to assume a low-Fowler’s
position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take
antispasmodics as prescribed.
23. Answer: A. Sweating and pallor
Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include
vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.
24. Answer: B. Avoiding coughing
Coughing is avoided following umbilical hernia repair to prevent disruption of tissue integrity, which
can occur because of the location of this surgical procedure. Bed rest is not required following this
surgical procedure. The client should take analgesics as needed and as prescribed to control pain. A
drain is not used in this surgical procedure, although the client may be instructed in simple dressing
changes.
25. Answer: B. Elevate the scrotum
Following inguinal hernia repair, the client should be instructed to elevate the scrotum and apply ice
packs while in bed to decrease pain and swelling. The nurse also should instruct the client to apply a
scrotal support when out of bed. Heat will increase swelling. Limiting oral fluids and a low-fiber diet
can cause constipation.
26. Answer: C. Rebound tenderness
Rebound tenderness may indicate peritonitis. Bloody diarrhea is expected to occur in ulcerative colitis.
Because of the blood loss, the client may be hypotensive and the hemoglobin level may be lower than
normal. Signs of peritonitis must be reported to the physician.
27. Answer: B. Body image, disturbed
Body image, disturbed relates to loss of bowel control, the presence of a stoma, the release of fecal
material onto the abdomen, the passage of flatus, odor, and the need for an appliance (external pouch).
No data in the question support options A and C. Nutrition: less than body requirements, imbalanced is
the more likely nursing diagnosis.
28. Answer: A. Diarrhea
Crohn’s disease is characterized by nonbloody diarrhea of usually not more than four to five stools
daily. Over time, the diarrhea episodes increase in frequency, duration, and severity. Options B, C, and
D are not characteristics of Crohn’s disease.
29. Answer: B. Stop the irrigation temporarily
If cramping occurs during a colostomy irrigation, the irrigation flow is stopped temporarily and the
client is allowed to rest. Cramping may occur from an infusion that is too rapid or is causing too much
pressure. The physician does not need to be notified. Increasing the height of the irrigation will cause
further discomfort. Medicating the client for pain is not the appropriate action in this situation.
30. Answer: A. Increase fluid intake
To enhance effectiveness of the irrigation and fecal returns, the client is instructed to increase fluid
intake and to take other measures to prevent constipation. Options B, C and D will not enhance the
effectiveness of this procedure.

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 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 sclera.
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

Answers and Rationale

1. Answer D. Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine,
riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Therefore, antibiotic therapy may
interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don’t synthesize
vitamins A, D, or E.
2. Answer B. Acute pancreatitis can cause decreased urine output, which results from the renal failure
that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a
client with pancreatitis. Tachycardia, not bradycardia, usually is associated with pulmonary or
hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic
complication, but hypertension usually isn’t related to acute pancreatitis.
3. Answer B. For a colonoscopy, the nurse initially should position the client on the left side with knees
bent. Placing the client on the right side with legs straight, prone with the torso elevated, or bent over
with hands touching the floor wouldn’t allow proper visualization of the large intestine.
4. Answer A. A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the
mucous membrane at the junction of the esophagus and stomach. There is a strong relationship between
ethanol usage, resultant vomiting, and a Mallory-Weiss tear. The bleeding is coming from the stomach,
not from the lungs as would be true in some cases of tuberculosis. A Mallory-Weiss tear doesn’t occur
from chest injuries or falls and isn’t associated with eating spicy foods.
5. Answer A. Tube feeding solutions and tubing should be changed every 24 hours, or more frequently
if the feeding requires it. Doing so prevents contamination and bacterial growth. The head of the bed
should be elevated 30 to 45 degrees continuously to prevent aspiration. Checking for gastrostomy tube
placement is performed before initiating the feedings and every 4 hours during continuous feedings.
Clients may ambulate during feedings.
6. Answer B. Meperidine’s onset of action is 15 to 30 minutes. It peaks between 30 and 60 minutes and
has a duration of action of 2 to 4 hours.
7. Answer C. A hepatic disorder, such as cirrhosis, may disrupt the liver’s normal use of vitamin K to
produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of
bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea
are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased
estrogen metabolism by the diseased liver.
8. Answer B. Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other
conditions are less likely to exhibit fluid volume deficit.
9. Answer A. The nurse should irrigate the tube with cola because its effervescence and acidity are
suited to the purpose, it’s inexpensive, and it’s readily available in most homes. Advancing the NG tube
is inappropriate because the tube is designed to stay in the stomach and isn’t long enough to reach the
intestines. Applying intermittent suction or using a syringe for aspiration is unlikely to dislodge the
material clogging the tube but may create excess pressure. Intermittent suction may even collapse the
tube.
10. Answer B. For a client with pancreatitis, the physician will probably avoid prescribing morphine
because this drug may trigger spasms of the sphincter of Oddi (a sphincter at the end of the pancreatic
duct), causing irritation of the pancreas. Meperidine has a somewhat shorter duration of action than
morphine. The two drugs are equally addictive. Morphine isn’t associated with hepatic dysfunction.
11. Answer C. Young women with Chronic low self esteem — are at highest risk for anorexia nervosa
because they perceive being thin as a way to improve their self-confidence. Hopelessness and
Powerlessness are inappropriate nursing diagnoses because clients with anorexia nervosa seldom feel
hopeless or powerless; instead, they use food to control their desire to be thin and hope that restricting
food intake will achieve this goal. Anorexia nervosa doesn’t result from a knowledge deficit, such as
one regarding good nutrition.
12. Answer A. Endoscopy permits direct evaluation of the upper GI tract and can detect 90% of
bleeding lesions. An upper GI series, or barium study, usually isn’t the diagnostic method of choice,
especially in a client with acute active bleeding who’s vomiting and unstable. An upper GI series is also
less accurate than endoscopy. Although an upper GI series might confirm the presence of a lesion, it
wouldn’t necessarily reveal whether the lesion is bleeding. Hb levels and HCT, which indicate loss of
blood volume, aren’t always reliable indicators of GI bleeding because a decrease in these values may
not be seen for several hours. Arteriography is an invasive study associated with life-threatening
complications and wouldn’t be used for an initial evaluation.
13. Answer A. Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by
consuming food contaminated by infected food handlers. The virus isn’t transmitted by the I.V. route,
blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood
transfusion. Hepatitis C can be transmitted by unprotected sex.
14. Answer B. A client with appendicitis is at risk for infection related to inflammation, perforation, and
surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the
appendix and compressing venous outflow drainage. The pressure continues to rise with venous
obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion.
Inflammation and bacterial growth follow, and swelling continues to raise pressure within the
appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially
susceptible to appendix rupture.
15. Answer D. The liver is vital in the synthesis of clotting factors, so when it’s diseased or
dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products
that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which
have most of the clotting factors. Although administering whole blood, albumin, and packed cells will
contribute to hemostasis, those products aren’t specifically used to treat hemostasis. Platelets are
helpful, but the best answer is cryoprecipitate and fresh frozen plasma.
16. Answer B. To prevent reflux of stomach acid into the esophagus, the nurse should advise the client
to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also
should teach the client to avoid lying down after meals, which can aggravate reflux, and to take
antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren’t gastric
irritants.
17. Answer D. I.V. infusions containing normal saline solution and potassium should be given first to
maintain fluid and electrolyte balance. For the client’s comfort and to assist in bowel decompression,
the nurse should prepare to insert an NG tube next. A blood sample is then obtained for laboratory
studies to aid in the diagnosis of bowel obstruction and guide treatment. Blood studies usually include a
complete blood count, serum electrolyte levels, and blood urea nitrogen level. Pain medication often is
withheld until obstruction is diagnosed because analgesics can decrease intestinal motility.
18. Answer B. Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment.
Dysphagia isn’t associated with rectal tenesmus, duodenal inflammation, or abnormal gastric
structures.
19. Answer A. An NG tube that fails to drain during the postoperative period should be reported to the
physician immediately. It may be clogged, which could increase pressure on the suture site because
fluid isn’t draining adequately. Repositioning or irrigating an NG tube in a client who has undergone
gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI
mucosa or the suture line.
20. Answer B. Elevation of serum lipase is the most reliable indicator of pancreatitis because this
enzyme is produced solely by the pancreas. A client’s BUN is typically elevated in relation to renal
dysfunction; the AST, in relation to liver dysfunction; and LD, in relation to damaged cardiac muscle.
21. Answer A. Yellow sclerae may be the first sign of jaundice, which occurs when the common bile
duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don’t occur
in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.
22. Answer D. Risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking,
and stress. A sedentary lifestyle and a history of hemorrhoids aren’t risk factors for peptic ulcers.
Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.
23. Answer D. The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic
flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney.
The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and
the spleen, in the left upper quadrant.
24. Answer B. The nurse should first place saline-soaked sterile dressings on the open wound to
prevent tissue drying and possible infection. Then the nurse should call the physician and take the
client’s vital signs. The dehiscence needs to be surgically closed, so the nurse should never try to close
it.
25. Answer B. Paregoric has an additive effect of constipation when used with anticholinergic drugs.
Antiarrhythmics, anticoagulants, and antihypertensives aren’t known to interact with paregoric.
26. Answer A. Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To
avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake.
The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage
is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-
coated medications because the body can’t absorb them after an ileostomy
27. Answer C. Shock and bleeding must be controlled before oral intake, so the client should receive
nothing by mouth. A regular diet is incorrect. When the bleeding is controlled, the diet is gradually
increased, starting with ice chips and then clear liquids. Skim milk shouldn’t be given because it
increases gastric acid production, which could prolong bleeding. A liquid diet is the first diet offered
after bleeding and shock are controlled.
28. Answer B. Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue,
and weakness. Abdominal pain may occur but doesn’t radiate to the shoulder. Eructation and
constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of
advanced hepatic disease, not an early sign of hepatitis A.
29. Answer C. To maintain enteric precautions, the nurse must wash the hands after touching the client
or potentially contaminated articles and before caring for another client. A private room is warranted
only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after
touching infective material or is likely to share contaminated articles with other clients. For enteric
precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is
likely.
30. Answer C. Hepatitis A can be caused by consuming contaminated water, milk, or food — especially
shellfish from contaminated water. Hepatitis B is caused by blood and sexual contact with an infected
person. Hepatitis C is usually caused by contact with infected blood, including receiving blood
transfusions.
1. The newly admitted client has burns on both legs. The burned areas appear white and leather-
like. No blisters or bleeding are present, and the client states that he or she has little pain. How
should this injury be categorized?
A. Superficial
B. Partial-thickness superficial
C. Partial-thickness deep
D. Full thickness
2. The newly admitted client has a large burned area on the right arm. The burned area appears
red, has blisters, and is very painful. How should this injury be categorized?
A. Superficial
B. Partial-thickness superficial
C. Partial-thickness deep
D. Full thickness
3. The burned client newly arrived from an accident scene is prescribed to receive 4 mg of
morphine sulfate by IV push. What is the most important reason to administer the opioid
analgesic to this client by the intravenous route?
A. The medication will be effective more quickly than if given intramuscularly.
B. It is less likely to interfere with the client’s breathing and oxygenation.
C. The danger of an overdose during fluid remobilization is reduced.
D. The client delayed gastric emptying.
4. Which vitamin deficiency is most likely to be a long-term consequence of a full-thickness burn
injury?
A. Vitamin A
B. Vitamin B
C. Vitamin C
D. Vitamin D
5. Which client factors should alert the nurse to potential increased complications with a burn
injury?
A. The client is a 26-year-old male.
B. The client has had a burn injury in the past.
C. The burned areas include the hands and perineum.
D. The burn took place in an open field and ignited the client’s clothing.
6. The burned client is ordered to receive intravenous cimetidine, an H2 histamine blocking
agent, during the emergent phase. When the client’s family asks why this drug is being given,
what is the nurse’s best response?
A. “To increase the urine output and prevent kidney damage.”
B. “To stimulate intestinal movement and prevent abdominal bloating.”
C. “To decrease hydrochloric acid production in the stomach and prevent ulcers.”
D. “To inhibit loss of fluid from the circulatory system and prevent hypovolemic shock.”
7. At what point after a burn injury should the nurse be most alert for the complication of
hypokalemia?
A. Immediately following the injury
B. During the fluid shift
C. During fluid remobilization
D. During the late acute phase
8. What clinical manifestation should alert the nurse to possible carbon monoxide poisoning in a
client who experienced a burn injury during a house fire?
A. Pulse oximetry reading of 80%
B. Expiratory stridor and nasal flaring
C. Cherry red color to the mucous membranes
D. Presence of carbonaceous particles in the sputum
9. What clinical manifestation indicates that an escharotomy is needed on a circumferential
extremity burn?
A. The burn is full thickness rather than partial thickness.
B. The client is unable to fully pronate and supinate the extremity.
C. Capillary refill is slow in the digits and the distal pulse is absent.
D. The client cannot distinguish the sensation of sharp versus dull in the extremity.
10. What additional laboratory test should be performed on any African American client who
sustains a serious burn injury?
A. Total protein
B. Tissue type antigens
C. Prostate specific antigen
D. Hemoglobin S electrophoresis
11. Which type of fluid should the nurse expect to prepare and administer as fluid resuscitation
during the emergent phase of burn recovery?
A. Colloids
B. Crystalloids
C. Fresh-frozen plasma
D. Packed red blood cells
12. The client with a dressing covering the neck is experiencing some respiratory difficulty. What
is the nurse’s best first action?
A. Administer oxygen.
B. Loosen the dressing.
C. Notify the emergency team.
D. Document the observation as the only action.
13. The client who experienced an inhalation injury 6 hours ago has been wheezing. When the
client is assessed, wheezes are no longer heard. What is the nurse’s best action?
A. Raise the head of the bed.
B. Notify the emergency team.
C. Loosen the dressings on the chest.
D. Document the findings as the only action.
14. Ten hours after the client with 50% burns is admitted, her blood glucose level is 90 mg/dL.
What is the nurse’s best action?
A. Notify the emergency team.
B. Document the finding as the only action.
C. Ask the client if anyone in her family has diabetes mellitus.
D. Slow the intravenous infusion of dextrose 5% in Ringer’s lactate.
15. On admission to the emergency department the burned client’s blood pressure is 90/60, with
an apical pulse rate of 122. These findings are an expected result of what thermal injury–related
response?
A. Fluid shift
B. Intense pain
C. Hemorrhage
D. Carbon monoxide poisoning
16. Twelve hours after the client was initially burned, bowel sounds are absent in all four
abdominal quadrants. What is the nurse’s best action?
A. Reposition the client onto the right side.
B. Document the finding as the only action.
C. Notify the emergency team.
D. Increase the IV flow rate.
17. Which clinical manifestation indicates that the burned client is moving into the fluid
remobilization phase of recovery?
A. Increased urine output, decreased urine specific gravity
B. Increased peripheral edema, decreased blood pressure
C. Decreased peripheral pulses, slow capillary refill
D. Decreased serum sodium level, increased hematocrit
18. What is the priority nursing diagnosis during the first 24 hours for a client with full-thickness
chemical burns on the anterior neck, chest, and all surfaces of the left arm?
A. Risk for Ineffective Breathing Pattern
B. Decreased Tissue Perfusion
C. Risk for Disuse Syndrome
D. Disturbed Body Image
19. All of the following laboratory test results on a burned client’s blood are present during the
emergent phase. Which result should the nurse report to the physician immediately?
A. Serum sodium elevated to 131 mmol/L (mEq/L)
B. Serum potassium 7.5 mmol/L (mEq/L)
C. Arterial pH is 7.32
D. Hematocrit is 52%
20. The client has experienced an electrical injury, with the entrance site on the left hand and the
exit site on the left foot. What are the priority assessment data to obtain from this client on
admission?
A. Airway patency
B. Heart rate and rhythm
C. Orientation to time, place, and person
D. Current range of motion in all extremities
21. In assessing the client’s potential for an inhalation injury as a result of a flame burn, what is
the most important question to ask the client on admission?
A. “Are you a smoker?”
B. “When was your last chest x-ray?”
C. “Have you ever had asthma or any other lung problem?”
D. “In what exact place or space were you when you were burned?”
22. Which information obtained by assessment ensures that the client’s respiratory efforts are
currently adequate?
A. The client is able to talk.
B. The client is alert and oriented.
C. The client’s oxygen saturation is 97%.
D. The client’s chest movements are uninhibited
23. Which information obtained by assessment ensures that the client’s respiratory efforts are
currently adequate?
A. The client is able to talk.
B. The client is alert and oriented.
C. The client’s oxygen saturation is 97%.
D. The client’s chest movements are uninhibited
24. The burned client’s family ask at what point the client will no longer be at increased risk for
infection. What is the nurse’s best response?
A. “When fluid remobilization has started.”
B. “When the burn wounds are closed.”
C. “When IV fluids are discontinued.”
D. “When body weight is normal.”
25. The burned client relates the following history of previous health problems. Which one should
alert the nurse to the need for alteration of the fluid resuscitation plan?
A. Seasonal asthma
B. Hepatitis B 10 years ago
C. Myocardial infarction 1 year ago
D. Kidney stones within the last 6 month
26. The burned client on admission is drooling and having difficulty swallowing. What is the
nurse’s best first action?
A. Assess level of consciousness and pupillary reactions.
B. Ask the client at what time food or liquid was last consumed.
C. Auscultate breath sounds over the trachea and mainstem bronchi.
D. Measure abdominal girth and auscultate bowel sounds in all four quadrants.
27. Which intervention is most important for the nurse to use to prevent infection by cross-
contamination in the client who has open burn wounds?
A. Handwashing on entering the client’s room
B. Encouraging the client to cough and deep breathe
C. Administering the prescribed tetanus toxoid vaccine
D. Changing gloves between cleansing different burn areas
28. In reviewing the burned client’s laboratory report of white blood cell count with differential,
all the following results are listed. Which laboratory finding indicates the possibility of sepsis?
A. The total white blood cell count is 9000/mm3.
B. The lymphocytes outnumber the basophils.
C. The “bands” outnumber the “segs.”
D. The monocyte count is 1,800/mm3.
29. The client has a deep partial-thickness injury to the posterior neck. Which intervention is
most important to use during the acute phase to prevent contractures associated with this injury?
A. Place a towel roll under the client’s neck or shoulder.
B. Keep the client in a supine position without the use of pillows.
C. Have the client turn the head from side to side 90 degrees every hour while awake.
D. Keep the client in a semi-Fowler’s position and actively raise the arms above the head every hour
while awake.
30. The client has severe burns around the right hip. Which position is most important to be
emphasized by the nurse that the client maintain to retain maximum function of this joint?
A. Hip maintained in 30-degree flexion, no knee flexion
B. Hip flexed 90 degrees and knee flexed 90 degrees
C. Hip, knee, and ankle all at maximum flexion
D. Hip at zero flexion with leg flat
31. During the acute phase, the nurse applied gentamicin sulfate (topical antibiotic) to the burn
before dressing the wound. The client has all the following manifestations. Which manifestation
indicates that the client is having an adverse reaction to this topical agent?
A. Increased wound pain 30 to 40 minutes after drug application
B. Presence of small, pale pink bumps in the wound beds
C. Decreased white blood cell count
D. Increased serum creatinine level
32. The client, who is 2 weeks postburn with a 40% deep partial-thickness injury, still has open
wounds. On taking the morning vital signs, the client is found to have a below-normal
temperature, is hypotensive, and has diarrhea. What is the nurse’s best action?
A. Nothing, because the findings are normal for clients during the acute phase of recovery.
B. Increase the temperature in the room and increase the IV infusion rate.
C. Assess the client’s airway and oxygen saturation.
D. Notify the burn emergency team.
33. Which intervention is most important to use to prevent infection by autocontamination in the
burned client during the acute phase of recovery?
A. Changing gloves between wound care on different parts of the client’s body.
B. Avoiding sharing equipment such as blood pressure cuffs between clients.
C. Using the closed method of burn wound management.
D. Using proper and consistent handwashing.
34. When should ambulation be initiated in the client who has sustained a major burn?
A. When all full-thickness areas have been closed with skin grafts
B. When the client’s temperature has remained normal for 24 hours
C. As soon as possible after wound debridement is complete
D. As soon as possible after resolution of the fluid shift
35. What statement by the client indicates the need for further discussion regarding the outcome
of skin grafting (allografting) procedures?
A. “For the first few days after surgery, the donor sites will be painful.”
B. “Because the graft is my own skin, there is no chance it won’t ‘take’.”
C. “I will have some scarring in the area when the skin is removed for grafting.”
D. “Once all grafting is completed, my risk for infection is the same as it was before I was burned.”
36. Which statement by the client indicates correct understanding of rehabilitation after burn
injury?
A. “I will never be fully recovered from the burn.”
B. “I am considered fully recovered when all the wounds are closed.”
C. “I will be fully recovered when I am able to perform all the activities I did before my injury.”
D. “I will be fully recovered when I achieve the highest possible level of functioning that I can.”
37. Which statement made by the client with facial burns who has been prescribed to wear a
facial mask pressure garment indicates correct understanding of the purpose of this treatment?
A. “After this treatment, my ears will not stick out.”
B. “The mask will help protect my skin from sun damage.”
C. “Using this mask will prevent scars from being permanent.”
D. “My facial scars should be less severe with the use of this mask.”
38. What is the priority nursing diagnosis for a client in the rehabilitative phase of recovery from
a burn injury?
A. Acute Pain
B. Impaired Adjustment
C. Deficient Diversional Activity
D. Imbalanced Nutrition: Less than Body Requirements
39. Nurse Faith should recognize that fluid shift in an client with burn injury results from
increase in the:
a. Total volume of circulating whole blood
b. Total volume of intravascular plasma
c. Permeability of capillary walls
d. Permeability of kidney tubules
40. Louie, with burns over 35% of the body, complains of chilling. In promoting the client’s
comfort, the nurse should:
a. Maintain room humidity below 40%
b. Place top sheet on the client
c. Limit the occurrence of drafts
d. Keep room temperature at 80 degrees

Answers & Rationale

Here are the answers and rationale for this exam. Counter check your answers to those below and tell
us your scores. If you have any disputes or need more clarification to a certain question, please direct
them to the comments section.
1. Answer: D
The characteristics of the wound meet the criteria for a full-thickness injury (color that is black, brown,
yellow, white or red; no blisters; pain minimal; outer layer firm and inelastic).
2. Answer: B
The characteristics of the wound meet the criteria for a superficial partialthickness injury (color that is
pink or red; blisters; pain present and high).
3. Answer: C
Although providing some pain relief has a high priority, and giving the drug by the IV route instead of
IM, SC, or orally does increase the rate of effect, the most important reason is to prevent an overdose
from accumulation of drug in the interstitial space during the fluid shift of the emergent phase. When
edema is present, cumulative doses are rapidly absorbed when the fluid shift is resolving. This delayed
absorption can result in lethal blood levels of analgesics.
4. Answer: D
Skin exposed to sunlight activates vitamin D. Partial-thickness burns reduce the activation of vitamin
D. Activation of vitamin D is lost completely in full thickness burns.
5. Answer: C
Burns of the perineum increase the risk for sepsis. Burns of the hands require special attention to ensure
the best functional outcome.
6. Answer: C
Ulcerative gastrointestinal disease may develop within 24 hours after a severe burn as a result of
increased hydrochloric acid production and decreased mucosal barrier. Cimetidine inhibits the
production and release of hydrochloric acid.
7. Answer: C
Hypokalemia is most likely to occur during the fluid remobilization period as a result of dilution,
potassium movement back into the cells, and increased potassium excreted into the urine with the
greatly increased urine output.
8. Answer: C
The saturation of hemoglobin molecules with carbon monoxide and the subsequent vasodilation
induces a “cherry red” color of the mucous membranes in these clients. The other manifestations are
associated with inhalation injury, but not specifically carbon monoxide poisoning.
9. Answer: C
Circumferential eschar can act as a tourniquet when edema forms from the fluid shift, increasing tissue
pressure and preventing blood flow to the distal extremities and increasing the risk for tissue necrosis.
This problem is an emergency and, without intervention, can lead to loss of the distal limb. This
problem can be reduced or corrected with an escharotomy.
10. Answer: D
Sickle cell disease and sickle cell trait are more common among African Americans. Although clients
with sickle cell disease usually know their status, the client with sickle cell trait may not. The fluid,
circulatory, and respiratory alterations that occur in the emergent phase of a burn injury could result in
decreased tissue perfusion that is sufficient to cause sickling of cells, even in a person who only has the
trait. Determining the client’s sickle cell status by checking the percentage of hemoglobin S is essential
for any African American client who has a burn injury.
11. Answer: B
Although not universally true, most fluid resuscitation for burn injuries starts with crystalloid solutions,
such as normal saline and Ringer’s lactate. The burn client rarely requires blood during the emergent
phase unless the burn is complicated by another injury that involved hemorrhage. Colloids and plasma
are not generally used during the fluid shift phase because these large particles pass through the leaky
capillaries into the interstitial fluid, where they increase the osmotic pressure. Increased osmotic
pressure in the interstitial fluid can worsen the capillary leak syndrome and make maintaining the
circulating fluid volume even more difficult.
12. Answer: B
Respiratory difficulty can arise from external pressure. The first action in this situation would be to
loosen the dressing and then reassess the client’s respiratory status.
13. Answer: B
Clients with severe inhalation injuries may sustain such progressive obstruction that they may lose
effective movement of air. When this occurs, wheezing is no longer heard and neither are breath
sounds. The client requires the establishment of an emergency airway and the swelling usually
precludes intubation.
14. Answer: B
Neural and hormonal compensation to the stress of the burn injury in the emergent phase increases liver
glucose production and release. An acute rise in the blood glucose level is an expected client response
and is helpful in the generation of energy needed for the increased metabolism that accompanies this
trauma.
15. Answer: A
Intense pain and carbon monoxide poisoning increase blood pressure. Hemorrhage is unusual in a burn
injury. The physiologic effect of histamine release in injured tissues is a loss of vascular volume to the
interstitial space, with a resulting decrease in blood pressure.
16. Answer: B Decreased or absent peristalsis is an expected response during the emergent phase of
burn injury as a result of neural and hormonal compensation to the stress of injury. No currently
accepted intervention changes this response, and it is not the highest priority of care at this time.
17. Answer: A
The “fluid remobilization” phase improves renal blood flow, increasing diuresis and restoring fluid and
electrolyte levels. The increased water content of the urine reduces its specific gravity.
18. Answer: C
During the emergent phase, fluid shifts into interstitial tissue in burned areas. When the burn is
circumferential on an extremity, the swelling can compress blood vessels to such an extent that
circulation is impaired distal to the injury, necessitating the intervention of an escharotomy. Chemical
burns do not cause inhalation injury.
19. Answer: B
All these findings are abnormal; however, only the serum potassium level is changed to the degree that
serious, life-threatening responses could result. With such a rapid rise in the potassium level, the client
is at high risk for experiencing severe cardiac dysrhythmias and death.
20. Answer: B
The airway is not at any particular risk with this injury. Electric current travels through the body from
the entrance site to the exit site and can seriously damage all tissues between the two sites. Early
cardiac damage from electrical injury includes irregular heart rate, rhythm, and ECG changes.
21. Answer: D
The risk for inhalation injury is greatest when flame burns occur indoors in small, poorly ventilated
rooms. although smoking increases the risk for some problems, it does not predispose the client for an
inhalation injury.
22. Answer: C
Clients may have ineffective respiratory efforts and gas exchange even though they are able to talk,
have good respiratory movement, and are alert. The best indicator for respiratory effectiveness is the
maintenance of oxygen saturation within the normal range.
23. Answer: C
Clients may have ineffective respiratory efforts and gas exchange even though they are able to talk,
have good respiratory movement, and are alert. The best indicator for respiratory effectiveness is the
maintenance of oxygen saturation within the normal range.
24. Answer: B
Intact skin is a major barrier to infection and other disruptions in homeostasis. No matter how much
time has passed since the burn injury, the client remains at great risk for infection as long as any area of
skin is open.
25. Answer: C
It is likely the client has a diminished cardiac output as a result of the old MI and would be at greater
risk for the development of congestive heart failure and
pulmonary edema during fluid resuscitation.
26. Answer: C
Difficulty swallowing and drooling are indications of oropharyngeal edema and can precede pulmonary
failure. The client’s airway is in severe jeopardy and intubation is highly likely to be needed shortly.
27. Answer: A
Cross-contamination occurs when microorganisms from another person or the environment are
transferred to the client. Although all the interventions listed above can help reduce the risk for
infection, only hand washing can prevent cross contamination.
28. Answer: C
Normally, the mature segmented neutrophils (“segs”) are the major population of circulating
leukocytes, constituting 55% to 70% of the total white blood count. Fewer than 3% to 5% of the
circulating white blood cells should be the less mature “band” neutrophils. A left shift occurs when the
bone marrow releases more immature neutrophils than mature neutrophils. Such a shift indicates severe
infection or sepsis, in which the client’s immune system cannot keep pace with the infectious process.
29. Answer: C
The function that would be disrupted by a contracture to the posterior neck is flexion. Moving the head
from side to side prevents such a loss of flexion.
30. Answer: D
Maximum function for ambulation occurs when the hip and leg are maintained at full extension with
neutral rotation. Although the client does not have to spend 24
hours at a time in this position, he or she should be in this position (in bed or standing) more of the time
than with the hip in any degree of flexion.
31. Answer: D
Gentamicin does not stimulate pain in the wound. The small, pale pink bumps in the wound bed are
areas of re-epithelialization and not an adverse reaction. Gentamicin is nephrotoxic and sufficient
amounts can be absorbed through burn wounds to affect kidney function. Any client receiving
gentamicin by any route should have kidney function monitored.
32. Answer: D
These findings are associated with systemic gram-negative infection and sepsis. This is a medical
emergency and requires prompt attention.
33. Answer: A
Autocontamination is the transfer of microorganisms from one area to another area of the same client’s
body, causing infection of a previously uninfected area. Although all techniques listed can help reduce
the risk for infection, only changing gloves between carrying out wound care on difference parts of the
client’s body can prevent autocontamination.
34. Answer: D
Regular, progressive ambulation is initiated for all burn clients who do not have contraindicating
concomitant injuries as soon as the fluid shift resolves. Clients can be ambulated with extensive
dressings, open wounds, and nearly any type of attached lines, tubing, and other equipment.
35. Answer: B
Factors other than tissue type, such as circulation and infection, influence whether and how well a graft
“takes.” The client should be prepared for the possibility that not all grafting procedures will be
successful.
36. Answer: D
Although a return to pre burn functional levels is rarely possible, burned clients are considered fully
recovered or rehabilitated when they have achieved their highest possible level of physical, social, and
emotional functioning.
37. Answer: D
The purpose of wearing the pressure garment over burn injuries for up to 1 year is to prevent
hypertrophic scarring and contractures from forming. Scars will still be present. Although the mask
does provide protection of sensitive newly healed skin and grafts from sun exposure, this is not the
purpose of wearing the mask. The pressure garment will not change the angle of ear attachment to the
head.
38. Answer: B
Recovery from a burn injury requires a lot of work on the part of the client and significant others.
Seldom is the client restored to the preburn level of functioning. Adjustments to changes in appearance,
family structure, employment opportunities, role, and functional limitations are only a few of the
numerous life-changing alterations that must be made or overcome by the client. By the rehabilitation
phase, acute pain from the injury or its treatment is no longer a problem.
39. Answer: C
In burn, the capillaries and small vessels dilate, and cell damage cause the release of a histamine-like
substance. The substance causes the capillary walls to become more permeable and significant
quantities of fluid are lost.
40. Answer: C
A Client with burns is very sensitive to temperature changes because heat is loss in the burn areas.

1. A client is 1 day postoperative after a total hip replacement. The client should be placed in
which of the following position?
a. Supine
b. Semi Fowler’s
c. Orthopneic
d. Trendelenburg
2. A client who has had a plaster of Paris cast applied to his forearm is receiving pain medication.
To detect early manifestations of compartment syndrome, which of these assessments should the
nurse make?
a. Observe the color of the fingers
b. Palpate the radial pulse under the cast
c. Check the cast for odor and drainage
d. Evaluate the response to analgesics
3. After a computer tomography scan with intravenous contrast medium, a client returns to the
unit complaining of shortness of breath and itching. The nurse should be prepared to treat the
client for:
a. An anaphylactic reaction to the dye
b. Inflammation from the extravasation of fluid during injection.
c. Fluid overload from the volume of the infusions
d. A normal reaction to the stress of the diagnostic procedure.
4. While caring for a client with a newly applied plaster of Paris cast, the nurse makes note of all
the following conditions. Which assessment finding requires immediate notification of the
physician?
a. Moderate pain, as reported by the client
b. Report, by client, the heat is being felt under the cast
c. Presence of slight edema of the toes of the casted foot
d. Onset of paralysis in the toes of the casted foot
5. Which of these nursing actions will best promote independence for the client in skeletal
traction?
a. Instruct the client to call for an analgesic before pain becomes severe.
b. Provide an overhead trapeze for client use
c. Encourage leg exercise within the limits of traction
d. Provide skin care to prevent skin breakdown.
6. A client presents in the emergency department after falling from a roof. A fracture of the
femoral neck is suspected. Which of these assessments best support this diagnosis.
a. The client reports pain in the affected leg
b. A large hematoma is visible in the affected extremity
c. The affected extremity is shortened, adducted, and extremely rotated
d. The affected extremity is edematous.
7. The nurse is caring for a client with compound fracture of the tibia and fibula. Skeletal
traction is applied. Which of these priorities should the nurse include in the care plan?
a. Order a trapeze to increase the client’s ambulation
b. Maintain the client in a flat, supine position at all times.
c. Provide pin care at least every hour
d. Remove traction weights for 20 minutes every two hours.
8. To prevent foot drop in a client with Buck’s traction, the nurse should:
a. Place pillows under the client’s heels.
b. Tuck the sheets into the foot of the bed
c. Teach the client isometric exercises
d. Ensure proper body positioning.
9. Which nursing intervention is appropriate for a client with skeletal traction?
a. Pin care
b. Prone positioning
c. Intermittent weights
d. 5lb weight limit
10. In order for Buck’s traction applied to the right leg to be effective, the client should be placed
in which position?
a. Supine
b. Prone
c. Sim’s
d. Lithotomy
11. An elderly client has sustained intertrochanteric fracture of the hip and has just returned
from surgery where a nail plate was inserted for internal fixation. The client has been instructed
that she should not flex her hip. The best explanation of why this movement would be harmful is:
a. It will be very painful for the client
b. The soft tissue around the site will be damaged
c. Displacement can occur with flexion
d. It will pull the hip out of alignment
12. When the client is lying supine, the nurse will prevent external rotation of the lower extremity
by using a:
a. Trochanter roll by the knee
b. Sandbag to the lateral calf
c. Trochanter roll to the thigh
d. Footboard
13. A client has just returned from surgery after having his left leg amputated below the knee.
Physician’s orders include elevation of the foot of the bed for 24 hours. The nurse observes that
the nursing assistant has placed a pillow under the client’s amputated limb. The nursing action is
to:
a. Leave the pillow as his stump is elevated
b. Remove the pillow and elevate the foot of the bed
c. Leave the pillow and elevate the foot of the bed
d. Check with the physician and clarify the orders
14. A client has sustained a fracture of the femur and balanced skeletal traction with a Thomas
splint has been applied. To prevent pressure points from occurring around the top of the splint,
the most important intervention is to:
a. Protect the skin with lotion
b. Keep the client pulled up in bed
c. Pad the top of the splint with washcloths
d. Provide a footplate in the bed
15. The major rationale for the use of acetylsalicylic acid (aspirin) in the treatment of rheumatoid
arthritis is to:
a. Reduce fever
b. Reduce the inflammation of the joints
c. Assist the client’s range of motion activities without pain
d. Prevent extension of the disease process
16. Following an amputation, the advantage to the client for an immediate prosthesis fitting is:
a. Ability to ambulate sooner
b. Less change of phantom limb sensation
c. Dressing changes are not necessary
d. Better fit of the prosthesis
17. One method of assessing for sign of circulatory impairment in a client with a fractured femur
is to ask the client to:
a. Cough and deep breathe
b. Turn himself in bed
c. Perform biceps exercise
d. Wiggle his toes
18. The morning of the second postoperative day following hip surgery for a fractured right hip,
the nurse will ambulate the client. The first intervention is to:
a. Get the client up in a chair after dangling at the bedside.
b. Use a walker for balance when getting the client out of bed
c. Have the client put minimal weight on the affected side when getting up
d. Practice getting the client out of bed by having her slightly flex her hips
19. A young client is in the hospital with his left leg in Buck’s traction. The team leader asks the
nurse to place a footplate on the affected side at the bottom of the bed. The purpose of this action
is to:
a. Anchor the traction
b. Prevent footdrop
c. Keep the client from sliding down in bed
d. Prevent pressure areas on the foot
20. When evaluating all forms of traction, the nurse knows the direction of pull is controlled by
the:
a. Client’s position
b. Rope/pulley system
c. Amount of weight
d. Point of friction
21. When a client has cervical halter traction to immobilize the cervical spine counteraction is
provided by:
a. Elevating the foot of the bed
b. Elevating the head of the bed
c. Application of the pelvic girdle
d. Lowering the head of the bed
22. After falling down the basement steps in his house, a client is brought to the emergency room.
His physician confirms that his leg is fractured. Following application of a leg cast, the nurse will
first check the client’s toes for:
a. Increase in the temperature
b. Change in color
c. Edema
d. Movement
23. A 23 year old female client was in an automobile accident and is now a paraplegic. She is on
an intermittent urinary catheterization program and diet as tolerated. The nurse’s priority
assessment should be to observe for:
a. Urinary retention
b. Bladder distention
c. Weight gain
d. Bower evacuation
24. A female client with rheumatoid arthritis has been on aspirin grain TID and prednisone 10mg
BID for the last two years. The most important assessment question for the nurse to ask related
to the client’s drug therapy is whether she has
a. Headaches
b. Tarry stools
c. Blurred vision
d. Decreased appetite
25. A 7 year old boy with a fractured leg tells the nurse that he is bored. An appropriate
intervention would be to
a. Read a story and act out the part
b. Watch a puppet show
c. Watch television
d. Listen to the radio
26. On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis.
Which of the following would be the nurse most likely to asses:
a. Limited motion of joints
b. Deformed joints of the hands
c. Early morning stiffness
d. Rheumatoid nodules
27. After teaching the client about risk factors for rheumatoid arthritis, which of the following, if
stated by the client as a risk factor, would indicate to the nurse that the client needs additional
teaching?
a. History of Epstein-Barr virus infection
b. Female gender
c. Adults between the ages 60 to 75 years
d. Positive testing for human leukocyte antigen (HLA) DR4 allele
28. When developing the teaching plan for the client with rheumatoid arthritis to promote rest,
which of the following would the nurse expect to instruct the client to avoid during the rest
periods?
a. Proper body alignment
b. Elevating the part
c. Prone lying positions
d. Positions of flexion
29. After teaching the client with severe rheumatoid arthritis about the newly prescribed
medication methotrexate (Rheumatrex O), which of the following statements indicates the need
for further teaching?
a. “I will take my vitamins while I am on this drug”
b. “I must not drink any alcohol while I’m taking this drug”
c. I should brush my teeth after every meal”
d. “I will continue taking my birth control pills”
30. When completing the history and physical examination of a client diagnosed with
osteoarthritis, which of the following would the nurse assess?
a. Anemia
b. Osteoporosis
c. Weight loss
d. Local joint pain
31. At which of the following times would the nurse instruct the client to take ibuprofen (Motrin),
prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation?
a. At bedtime
b. On arising
c. Immediately after meal
d. On an empty stomach
32. When preparing a teaching plan for the client with osteoarthritis who is taking celecoxib
(Celebrex), the nurse expects to explain that the major advantage of celecoxib over diclofenac
(Voltaren), is that the celecoxib is likely to produce which of the following?
a. Hepatotoxicity
b. Renal toxicity
c. Gastrointestinal bleeding
d. Nausea and vomiting
33. After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain
and an inability to move the extremity. The nurse interprets these findings as indicating which of
the following?
a. A developing infection
b. Bleeding in the operative site
c. Joint dislocation
d. Glue seepage into soft tissue
34. Which of the following would the nurse assess in a client with an intracapsular hip fracture?
a. Internal rotation
b. Muscle flaccidity
c. Shortening of the affected leg
d. Absence of pain the fracture area
35. Which of the following would be inappropriate to include when preparing a client for
magnetic resonance imaging (MRI) to evaluate a rupture disc?
a. Informing the client that the procedure is painless
b. Taking a thorough history of past surgeries
c. Checking for previous complaints of claustrophobia
d. Starting an intravenous line at keep-open rate
36. Which of the following actions would be a priority for a client who has been in the
postanesthesia care unit (PACU) for 45 minutes after an above the knee amputation and develops
a dime size bright red spot on the ace bandage above the amputation site?
a. Elevate the stump
b. Reinforcing the dressing
c. Calling the surgeon
d. Drawing a mark around the site
37. A client in the PACU with a left below the knee amputation complains of pain in her left big
toe. Which of the following would the nurse do first?
a. Tell the client it is impossible to feel the pain
b. Show the client that the toes are not there
c. Explain to the client that the pain is real
d. Give the client the prescribed narcotic analgesic
38. The client with an above the knee amputation is to use crutches until the prosthesis is being
adjusted. In which of the following exercises would the nurse instruct the client to best prepare
him for using crutches?
a. Abdominal exercises
b. Isometric shoulder exercises
c. Quadriceps setting exercises
d. Triceps stretching exercises
39. The client with an above the knee amputation is to use crutches until the prosthesis is
properly lifted. When teaching the client about using the crutches, the nurse instructs the client
to support her weight primarily on which of the following body areas?
a. Axillae
b. Elbows
c. Upper arms
d. Hands
40. Three hours ago a client was thrown from a car into a ditch, and he is now admitted to the ED
in a stable condition with vital signs within normal limits, alert and oriented with good coloring
and an open fracture of the right tibia. When assessing the client, the nurse would be especially
alert for signs and symptoms of which of the following?
a. Hemorrhage
b. Infection
c. Deformity
d. Shock
41. The client with a fractured tibia has been taking methocarbamol (Robaxin), when teaching
the client about this drug, which of the following would the nurse include as the drug’s primary
effect?
a. Killing of microorganisms
b. Reduction in itching
c. Relief of muscle spasms
d. Decrease in nervousness
42. A client who has been taking carisoprodol (Soma) at home for a fractured arm is admitted
with a blood pressure of 80/50 mmHg, a pulse rate of 115 bpm, and respirations of 8
breaths/minute and shallow, the nurse interprets these finding as indicating which of the
following?
a. Expected common side effects
b. Hypersensitivity reactions
c. Possible habituating effects
d. Hemorrhage from GI irritation
43. When admitting a client with a fractured extremity, the nurse would focus the assessment on
which of the following first?
a. The area proximal to the fracture
b. The actual fracture site
c. The area distal to the fracture
d. The opposite extremity for baseline comparison
44. A client with fracture develops compartment syndrome. When caring for the client, the nurse
would be alert for which of the following signs of possible organ failure?
a. Rales
b. Jaundice
c. Generalized edema
d. Dark, scanty urine
45. Which of the following would lead the nurse to suspect that a client with a fracture of the
right femur may be developing a fat embolus?
a. Acute respiratory distress syndrome
b. Migraine like headaches
c. Numbness in the right leg
d. Muscle spasms in the right thigh
46. The client who had an open femoral fracture was discharged to her home, where she
developed, fever, night sweats, chills, restlessness and restrictive movement of the fractured leg.
The nurse interprets these finding as indicating which of the following?
a. Pulmonary emboli
b. Osteomyelitis
c. Fat emboli
d. Urinary tract infection
47. When antibiotics are not producing the desired outcome for a client with osteomyelitis, the
nurse interprets this as suggesting the occurrence of which of the following as most likely?
a. Formation of scar tissue interfering with absorption
b. Development of pus leading to ischemia
c. Production of bacterial growth by avascular tissue
d. Antibiotics not being instilled directly into the bone
48. Which of the following would the nurse use as the best method to assess for the development
of deep vein thrombosis in a client with a spinal cord injury?
a. Homan’s sign
b. Pain
c. Tenderness
d. Leg girth
49. The nurse is caring for the client who is going to have an arthogram using a contrast medium.
Which of the following assessments by the nurse are of highest priority?
a. Allergy to iodine or shellfish
b. Ability of the client to remain still during the procedure
c. Whether the client has any remaining questions about the procedure
d. Whether the client wishes to void before the procedure
50. The client immobilized skeletal leg traction complains of being bored and restless. Based on
these complaints, the nurse formulates which of the following nursing diagnoses for this client?
a. Diversional activity deficit
b. Powerlessness
c. Self care deficit
d. Impaired physical mobility
51. The nurse is teaching the client who is to have a gallium scan about the procedure. The nurse
includes which of the following items as part of the instructions?
a. The gallium will be injected intravenously 2 to 3 hours before the procedure
b. The procedure takes about 15 minutes to perform
c. The client must stand erect during the filming
d. The client should remain on bed rest for the remainder of the day after the scan
52. The nurse is assessing the casted extremity of a client. The nurse assesses for which of the
following signs and symptoms indicative of infection?
a. Coolness and pallor of the extremity
b. Presence of a “hot spot” on the cast
c. Diminished distal pulse
d. Dependent edema
53. The client has Buck’s extension applied to the right leg. The nurse plans which of the
following interventions to prevent complications of the device?
a. Massage the skin of the right leg with lotion every 8 hours
b. Give pin care once a shift
c. Inspect the skin on the right leg at least once every 8 hours
d. Release the weights on the right leg for range of motion exercises daily
54. The nurse is giving the client with a left cast crutch walking instructions using the three point
gait. The client is allowed touchdown of the affected leg. The nurse tells the client to advance the:
a. Left leg and right crutch then right leg and left crutch
b. Crutches and then both legs simultaneously
c. Crutches and the right leg then advance the left leg
d. Crutches and the left leg then advance the right leg
55. The client with right sided weakness needs to learn how to use a cane. The nurse plans to
teach the client to position the cane by holding it with the:
a. Left hand and placing the cane in front of the left foot
b. Right hand and placing the cane in front of the right foot
c. Left hand and 6 inches lateral to the left foot
d. Right hand and 6 inches lateral to the left foot
56. The nurse is repositioning the client who has returned to the nursing unit following internal
fixation of a fractured right hip. The nurse uses a:
a. Pillow to keep the right leg abducted during turning
b. Pillow to keep the right leg adducted during turning
c. Trochanter roll to prevent external rotation while turning
d. Trochanter roll to prevent abduction while turning
57. The nurse has an order to get the client out of bed to a chair on the first postoperative day
after a total knee replacement. The nurse plans to do which of the following to protect the knee
joint:
a. Apply a knee immobilizer before getting the client up and elevate the client’s surgical leg while
sitting
b. Apply an Ace wrap around the dressing and put ice on the knee while sitting
c. Lift the client to the bedside change leaving the CPM machine in place
d. Obtain a walker to minimize weight bearing by the client on the affected leg
58. The nurse is caring for the client who had an above the knee amputation two (2) days ago.
The residual limb was wrapped with an elastic compression bandage which has come off. The
nurse immediately:
a. Calls the physician
b. Rewrap the stump with an elastic compression bandage
c. Applies ice to the site
d. Applies a dry sterile dressing and elevates it on a pillow
59. The nurse has taught the client with a below the knee amputation about prosthesis and stump
care. The nurse evaluates that the client states to:
a. Wear a clean nylon stump sock daily
b. Toughen the skin of the stump by rubbing it with alcohol
c. Prevent cracking of the skin of the stump by applying lotion daily
d. Using a mirror to inspect all areas of the stump each day
60. The nurse is caring for a client with a gout. Which of the following laboratory values does the
nurse expect to note in the client?
a. Uric acid level of 8 mg/dl
b. Calcium level of 9 mg/dl
c. Phosphorus level of 3 mg/dl
d. Uric acid level of 5 mg/dl

Answers
Here are the answers for the exam. Unfortunately, rationales are not given. If you need clarifications or
have disputes, please direct them to the comments section and we’ll be glad to give you an explanation.
1. b. Semi Fowler’s
2. d. Evaluate the response to analgesics
3. a. An anaphylactic reaction to the dye
4. d. Onset of paralysis in the toes of the casted foot
5. b. Provide an overhead trapeze for client use
6. c. The affected extremity is shortened, adducted, and extremely rotated
7. c. Provide pin care at least every hour
8. d. Ensure proper body positioning.
9. a. Pin care
10. a. Supine
11. c. Displacement can occur with flexion
12. c. Trochanter roll to the thigh
13. b. Remove the pillow and elevate the foot of the bed
14. c. Pad the top of the splint with washcloths
15. b. Reduce the inflammation of the joints
16. a. Ability to ambulate sooner
17. d. Wiggle his toes
18. d. Practice getting the client out of bed by having her slightly flex her hips
19. b. Prevent footdrop
20. b. Rope/pulley system
21. b. Elevating the head of the bed
22. b. Change in color
23. b. Bladder distention
24. b. Tarry stools
25. c. Watch television
26. c. Early morning stiffness
27. c. Adults between the ages 60 to 75 years
28. d. Positions of flexion
29. d. “I will continue taking my birth control pills”
30. d. Local joint pain
31. c. Immediately after meal
32. c. Gastrointestinal bleeding
33. c. Joint dislocation
34. c. Shortening of the affected leg
35. d. Starting an intravenous line at keep-open rate
36. d. Drawing a mark around the site
37. d. Give the client the prescribed narcotic analgesic
38. d. Triceps stretching exercises
39. d. Hands
40. a. Hemorrhage
41. c. Relief of muscle spasms
42. a. Expected common side effects
43. c. The area distal to the fracture
44. d. Dark, scanty urine
45. a. Acute respiratory distress syndrome
46. b. Osteomyelitis
47. c. Production of bacterial growth by avascular tissue
48. a. Homan’s sign
49. a. Allergy to iodine or shellfish
50. a. Divertional activity deficit
51. a. The gallium will be injected intravenously 2 to 3 hours before the procedure
52. b. Presence of a “hot spot” on the cast
53. c. Inspect the skin on the right leg at least once every 8 hours
54. d. Crutches and the left leg then advance the right leg
55. c. Left hand and 6 inches lateral to the left foot
56. a. Pillow to keep the right leg abducted during turning
57. a. Apply a knee immobilizer before getting the client up and elevate the client’s surgical leg while
sitting
58. b. Rewrap the stump with an elastic compression bandage
59. d. Using a mirror to inspect all areas of the stump each day
60. a. Uric acid level of 8 mg/dl