The nurse is monitoring a client

admitted to the hospital with a

diagnosis of appendicitis who 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 bowel sounds are
diminished. Which is the most
appropriate nursing intervention?
1. Notify the health care provider
(HCP).
2. Administer the prescribed pain
medication.
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 the warm setting to
the client's abdomen.
1. Notify the health care provider (HCP)

A client has been admitted to the

hospital with a diagnosis of acute
pancreatitis and the nurse is
assessing the client's pain. What
type of pain is consistent with this
diagnosis?
1. Burning and aching, located in
the left lower quadrant and
radiating to the hip
2. Severe and unrelenting, located
in the epigastric area and radiating
to the back
3. Burning and aching, located in
the epigastric area and radiating to
the umbilicus
4. Severe and unrelenting, located
in the left lower quadrant and
radiating to the groin

2. Severe and unrelenting, located in the epigastric

area and radiating to the back

The nurse is assessing a client

who is experiencing an acute
episode of cholecystitis. Where
should the nurse anticipate the
location of the pain?
1. Right lower quadrant, radiating
to the back
2. Right lower quadrant, radiating
to the umbilicus
3. Right upper quadrant, radiating
to the left scapula and shoulder
4. Right upper quadrant, radiating
to the right scapula and shoulder

4. Right upper quadrant, radiating to the right scapula

and shoulder

A client is admitted to the

hospital with viral hepatitis,
complaining of "no appetite" and
"losing my taste for food." What
instruction should the nurse give
the client to provide adequate
nutrition?
1. Select foods high in fat.
2. Increase intake of fluids,
including juices.
3. Eat a good supper when anorexia
is not as severe.
4. Eat less often, preferably only
three large meals daily.

2. Increase intake of fluids, including juices.

A client has developed hepatitis

A after eating contaminated oysters.
The nurse assesses the client for
which expected assessment
finding?
1. Malaise
2. Dark stools
3. Weight gain
4. Left upper quadrant discomfort

1. Malaise

A client has just had a

hemorrhoidectomy. Which nursing
interventions are appropriate for
this client? Select all that apply.

1. Administer stool softeners as

prescribed.
2. Instruct the client to limit fluid
intake to avoid urinary retention.
3. Instruct the client to avoid
activities that will initiate vasovagal
responses.
4. Encourage a high-fiber diet to
promote bowel movements without
straining.
5. Apply cold packs to the analrectal area over the dressing until
the packing is removed.
6. Help the client to a Fowler's
position to place pressure on the
rectal area and decrease bleeding.

1. Administer stool softeners as prescribed.

4. Encourage a high-fiber diet to promote
bowel movements without straining.

5. Apply cold packs to the anal-rectal area

over the dressing until the packing is removed.

The nurse is planning to teach a

client with gastroesophageal reflux
disease about substances to avoid.
Which items should the nurse
include on this list? Select all that
apply.
1. Coffee
2. Chocolate
3. Peppermint
4. Nonfat milk
5. Fried chicken
6. Scrambled eggs

1. Monitoring the temperature

2. Monitoring complaints of
heartburn
3. Giving warm gargles for a sore
throat
4. Assessing for the return of the
gag reflex
4. Assessing for the return of the gag reflex

The nurse has taught the client

about an upcoming endoscopic
retrograde
cholangiopancreatography
procedure. The nurse determines
that the client needs further
information if the client makes
which statement?
1. "I know I must sign the consent
form."
2. "I hope the throat spray keeps me
from gagging."
3. "I'm glad I don't have to lie still
for this procedure."
4. "I'm glad some IV medication
will be given to relax me."

3. "I'm glad I don't have to lie still for this procedure."

1. Coffee
2. Chocolate

3. Peppermint

The health care provider has

determined that a client with
hepatitis has contracted the
infection from contaminated food.
The nurse understands that this
client is most likelyexperiencing
what type of hepatitis?
1. Hepatitis A
2. Hepatitis B
3. Hepatitis C
4. Hepatitis D

5. Fried chicken

1. Hepatitis A

The nurse is caring for a client

with a diagnosis of chronic gastritis.
The nurse monitors the client,
knowing that this client is at risk for
which vitamin deficiency?
1. Vitamin A

A client has undergone

esophagogastroduodenoscopy. The
nurse should place highest
priority on which item as part of
the client's care plan?

2. Vitamin B12
3. Vitamin C
4. Vitamin E
2. Vitamin B12

The nurse is assessing a client 24

hours following a cholecystectomy.
The nurse notes that the T-tube has
drained 750 mL of green-brown
drainage since the surgery. Which
nursing intervention is most
appropriate?
1. Clamp the T-tube.
2. Irrigate the T-tube.
3. Document the findings.
4. Notify the health care provider.

3. Document the findings.

The nurse is monitoring a client

with a diagnosis of peptic ulcer.
Which assessment finding
would most likely indicate
perforation of the ulcer?
1. Bradycardia
2. Numbness in the legs
3. Nausea and vomiting
4. A rigid, boardlike abdomen

4. A rigid, boardlike abdomen

The nurse is caring for a client

following a Billroth II procedure.
Which postoperative prescription
should the nurse question and
verify?
1. Leg exercises
2. Early ambulation
3. Irrigating the nasogastric tube
4. Coughing and deep-breathing
exercises

2. Eat high-carbohydrate foods.

3. Limit the fluids taken with
meals.
4. Sit in a high Fowler's position
during meals.
3. Limit the fluids taken with meals.

The nurse is reviewing the

prescription for a client admitted to
the hospital with a diagnosis of
acute pancreatitis. Which
interventions would the nurse
expect to be prescribed for the
client? Select all that apply.
1. Administer antacids as
prescribed.
2. Encourage coughing and deep
breathing.
3. Administer anticholinergics as
prescribed.
4. Give small, frequent high-calorie
feedings.
5. Maintain the client in a supine
and flat position.
6. Give opioid analgesics as
prescribed for pain.

3. Irrigating the nasogastric tube

The nurse is providing discharge

instructions to a client following
gastrectomy and should instruct the
client to take which measure to
assist in preventing dumping
syndrome?
1. Ambulate following a meal.

1. Administer antacids as prescribed.

2. Encourage coughing and deep breathing.

3. Administer anticholinergics as prescribed.

6. Give opioid analgesics as prescribed for

pain.

The nurse is reviewing the record

of a client with Crohn's disease.
Which stool characteristic should
the nurse expect to note
documented in the client's record?
1. Diarrhea
2. Chronic constipation
3. Constipation alternating with
diarrhea
4. Stool constantly oozing from the
rectum

1. Diarrhea

The nurse is reviewing the record

of a client with a diagnosis of
cirrhosis and notes that there is
documentation of the presence of
asterixis. How should the nurse
assess for its presence?
1. Dorsiflex the client's foot.
2. Measure the abdominal girth.
3. Ask the client to extend the
arms.
4. Instruct the client to lean
forward.

3. Ask the client to extend the arms.

The nurse is reviewing the

laboratory results for a client with
cirrhosis and notes that the
ammonia level is elevated. Which
diet does the nurse anticipate to be
prescribed for this client?
1. Low-protein diet
2. High-protein diet
3. Moderate-fat diet
4. High-carbohydrate diet

1. Low-protein diet

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 should
assess the client for which
symptom(s) of duodenal ulcer?
1. Weight loss
2. Nausea and vomiting
3. Pain relieved by food intake
4. Pain radiating down the right arm

3. Pain relieved by food intake

A client with hiatal hernia

chronically experiences heartburn
following meals. The nurse should
plan to teach the client to avoid
which action because it is
contraindicated with a hiatal
hernia?

1. Lying recumbent following

meals
2. Consuming small, frequent,
bland meals
3. Raising the head of the bed on 6inch blocks
4. Taking H2-receptor antagonist
medication
1. Lying recumbent following meals

The nurse is assessing for stoma

prolapse in a client with a
colostomy. What should the nurse
observe if stoma prolapse occurs?
1. Protruding stoma
2. Sunken and hidden stoma
3. Narrowed and flattened stoma
4. Dark- and bluish-colored stoma

1. Protruding stoma

A client had a new colostomy

created 2 days earlier and is
beginning to pass malodorous flatus
from the stoma. What is the correct
interpretation by the nurse?
1. This is a normal, expected event.
2. The client is experiencing early
signs of ischemic bowel.
3. The client should not have the
nasogastric tube removed.
4. This indicates inadequate
preoperative bowel preparation.

1. This is a normal, expected event.

A client has just had surgery to

create an ileostomy. The nurse
assesses the client in the immediate
postoperative period for whichmost
frequent complication of this type
of surgery?
1. Folate deficiency
2. Malabsorption of fat
3. Intestinal obstruction
4. Fluid and electrolyte imbalance

4. Fluid and electrolyte imbalance

The nurse is doing preoperative

teaching with a 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 statement?
1. "I will be able to pass stool by
the rectum eventually."
2. "The drainage from this type of
ostomy will be formed."
3. "I will need to drain the pouch
regularly with a catheter."
4. "I will need to wear a drainage
bag for the rest of my life."
3. "I will need to drain the pouch regularly with a
catheter."

The nurse is monitoring a client

for the early signs and symptoms
of dumping syndrome. Which
findings indicate this occurrence?
1. Sweating and pallor
2. Bradycardia and indigestion
3. Double vision and chest pain
4. Abdominal cramping and pain

1. Sweating and pallor

A client presents to the

emergency department with upper
gastrointestinal bleeding and is in
moderate distress. In planning care,
what is the priority nursing action
for this client?
1. Assessment of vital signs
2. Completion of abdominal
examination
3. Insertion of the prescribed
nasogastric tube
4. Thorough investigation of
precipitating events

1. Assessment of vital signs

The nurse is caring for a client

with acute pancreatitis and is
monitoring the client for paralytic
ileus. Which assessment data
should alert the nurse to this
occurrence?

1. Inability to pass flatus

2. Loss of anal sphincter control
3. Severe, constant pain with rapid
onset
4. Firm, nontender mass palpable at
the lower right costal margin
1. Inability to pass flatus

The nurse inspects the color of

the drainage from a nasogastric
tube on a postoperative client
approximately 24 hours after gastric
surgery. Which finding indicates the
need to notify the health care
provider?
1. Dark red drainage
2. Dark brown drainage
3. Green-tinged drainage
4. Light yellowish brown drainage

1. Dark red drainage

The nurse is preparing to

discontinue a client's nasogastric
tube. The client is positioned
properly, and the tube has been
flushed with 15 mL of air to clear
secretions. Before removing the
tube, the nurse should make which
statement to the client?
1. "Take a deep breath when I tell
you and hold it while I remove the
tube."
2. "Take a deep breath when I tell
you and bear down while I remove
the tube."
3. "Take a deep breath when I tell
you and slowly exhale while I
remove the tube."
4. "Take a deep breath when I tell
you and breathe normally while I
remove the tube."

1. "Take a deep breath when I tell you and hold it

while I remove the tube."

The nurse is caring for a client

with a resolved intestinal
obstruction who has a nasogastric

tube in place. The client has

tolerated the tube being clamped
every 2 hours for 1 hour. The health
care provider has now prescribed
that the nasogastric tube be
removed. What is
the priority nursing assessment
prior to removing the tube?
1. Checking for normal serum
electrolyte levels
2. Checking for normal pH of the
gastric aspirate
3. Checking for proper nasogastric
tube placement
4. Checking for the presence of
bowel sounds in all four quadrants
4. Checking for the presence of bowel sounds in all
four quadrants

A sexually active 20-year-old

client has developed viral hepatitis.
Which client statement indicates
the need for further teaching?
1. "I should avoid drinking
alcohol."
2. "I can go back to work right
away."
3. "My partner should get the
vaccine."
4. "A condom should be used for
sexual intercourse."

2. "I can go back to work right away."

The nurse is caring for a client

admitted to the hospital with a
suspected diagnosis of acute
appendicitis. Which laboratory
result should the nurse expect to
note if the client does have
appendicitis?
1. Leukopenia with a shift to the
left
2. Leukocytosis with a shift to the
left
3. Leukopenia with a shift to the

right
4. Leukocytosis with a shift to the
right
2. Leukocytosis with a shift to the left

After performing an initial

abdominal assessment on a client
with a diagnosis of cholelithiasis,
the nurse documents that the bowel
sounds are normal. Which
descriptionbest describes "normal
bowel sounds"?
1. Waves of loud gurgles
auscultated in all four quadrants
2. Low-pitched swishing
auscultated in one or two quadrants
3. Relatively high-pitched clicks or
gurgles auscultated in all four
quadrants
4. Very high-pitched loud rushes
auscultated especially in one or two
quadrants

3. Relatively high-pitched clicks or gurgles

auscultated in all four quadrants

After undergoing Billroth I

gastric surgery, the client
experiences fatigue and complains
of numbness and tingling in the feet
and difficulties with balance. On
the basis of these symptoms, the
nurse suspects which postoperative
complication?
1. Stroke
2. Pernicious anemia
3. Bacterial meningitis
4. Peripheral arterial disease

2. Pernicious anemia

A client experiencing chronic

dumping syndrome makes the
following comments to the nurse.
Which one indicates the need for
further teaching?
1. "I eat at least three large meals
each day."
2. "I eat while lying in a

semirecumbent position."
3. "I have eliminated taking liquids
with my meals."
4. "I eat a high-protein, low- to
moderate-carbohydrate diet."
1. "I eat at least three large meals each day."

The nurse obtains an admission

history for a client with suspected
peptic ulcer disease. Which client
factor documented by the nurse
would increase the risk for peptic
ulcer disease?
1. Recently retired from a job
2. Significant other has a gastric
ulcer
3. Occasionally drinks one cup of
coffee in the morning
4. Takes nonsteroidal antiinflammatory drugs (NSAIDs) for
osteoarthritis

4. Takes nonsteroidal anti-inflammatory drugs

(NSAIDs) for osteoarthritis

A client who has undergone

gastric surgery has a nasogastric
(NG) tube connected to low
intermittent suction that is not
draining properly. Which action
should the nurse take initially?
1. Call the surgeon to report the
problem.
2. Reposition the NG tube to the
proper location.
3. Check the suction device to make
sure it is working.
4. Irrigate the NG tube with saline
to remove the obstruction.

3. Check the suction device to make sure it is

working.

In performing a physical
assessment of a client with a
diagnosis of ulcerative colitis, the
nurse should expect which finding?
1. Hypercalcemia
2. Fibrous stricture

3. Frothy, fatty stools

4. Decreased hemoglobin
4. Decreased hemoglobin

A client with acute ulcerative

colitis requests a snack. Which
would be the most appropriatesnack
for this client?
1. Carrots and ranch dip
2. Whole-grain cereal and milk
3. A cup of popcorn and a cola
drink
4. Applesauce and a graham cracker

4. Applesauce and a graham cracker

The nurse is teaching the client

with viral hepatitis about the stages
of the disease. The nurse should
explain to the client that the second
stage of this disease is characterized
by which specific assessment
findings? Select all that apply.
1. Jaundice
2. Flu-like symptoms
3. Clay-colored stools
4. Dark or tea-colored urine
5. Elevated bilirubin levels

1. Jaundice
3. Clay-colored stools

4. Dark or tea-colored urine

5. Elevated bilirubin levels

The nurse is teaching an older

client about measures to prevent
constipation. Which statement, if
made by the client, indicates
that further teaching is
necessary about bowel
elimination?
1. "I walk 1 to 2 miles every day."
2. "I need to decrease fiber in my
diet."
3. "I have a bowel movement every
other day."
4. "I drink six to eight glasses of
water every day."

2. "I need to decrease fiber in my diet."

The nurse provides dietary

instructions to a client with a
diagnosis of cholecystitis. Which
food item identified by the client
indicates an understanding of foods
to avoid?
1. Fresh fruit
2. Brown gravy
3. Fresh vegetables
4. Poultry without skin

2. Brown gravy

The nurse is performing an

assessment on a client with acute
pancreatitis who was admitted to
the hospital. Which assessment
question would most specifically
elicit information regarding the pain
that is associated with acute
pancreatitis?
1. "Does the pain in your stomach
radiate to the back?"
2. "Does the pain in your lower
abdomen radiate to the hip?"
3. "Does the pain in your lower
abdomen radiate to your groin?"
4. "Does the pain in your stomach
radiate to your lower middle
abdomen?"

1. "Does the pain in your stomach radiate to the

back?"

The nurse is caring for a client

after abdominal surgery and
creation of a colostomy. The nurse
is assessing the client for a
prolapsed stoma and should expect
to note which observation if this is
present?
1. A sunken and hidden stoma
2. A narrow and flattened stoma
3. A stoma that is dusky or bluish
4. A protrusion of the bowel with an
elongated, swollen appearance of
the stoma

4. A protrusion of the bowel with an elongated,

swollen appearance of the stoma

The nurse is providing

instructions to a client with a
colostomy about measures to
reduce the odor from the colostomy.
Which statement, if made by the
client, indicates an understanding of
these measures?
1. "I should be sure to eat at least
one cucumber every day."
2. "Beet greens, parsley, or yogurt
will help to control the colostomy
odor."
3. "I will need to increase my egg
intake and try to eat to 1 egg per
day."
4. "Green vegetables such as
spinach and broccoli will prevent
odor, and I should eat these foods
every day."

2. "Beet greens, parsley, or yogurt will help to control

the colostomy odor."

The nurse has provided dietary

instructions to a client with a
diagnosis of peptic ulcer disease.
Which statement, if made by the
client, indicates an understanding of
the dietary measures to take?
1. "Baked foods such as chicken or
fish are all right to eat."
2. "Citrus fruits and raw vegetables
need to be included in my daily
diet."
3. "I can drink beer so long as I
consume only a moderate amount
each day."
4. "I can drink coffee or tea so long
as I limit the amount to two cups
daily."

1. "Baked foods such as chicken or fish are all right to

eat."

The nurse has provided home

care instructions to a client who had

a subtotal gastrectomy. The nurse

instructs the client regarding the
signs and symptoms associated
with dumping syndrome. Which
signs and symptoms, if identified
by the client, would indicate an
understanding of this potential
complication after gastrointestinal
(GI) surgery?
1. Hiccups and diarrhea
2. Constipation and fever
3. Diaphoresis and diarrhea
4. Fatigue and abdominal pain
3. Diaphoresis and diarrhea

The nurse is providing

instructions to a client regarding
measures to minimize the risk of
dumping syndrome. The nurse
should make which suggestion to
the client?
1. Maintain a high-carbohydrate
diet.
2. Increase fluid intake, particularly
at meal time.
3. Maintain a low Fowler's position
while eating.
4. Ambulate for at least 30 minutes
following each meal.

3. Maintain a low Fowler's position while eating.

A client with peptic ulcer disease

states that stress frequently causes
exacerbation of the disease. The
nurse determines that which item
mentioned by the client is most
likely to be responsible for the
exacerbation?
1. Sleeping 8 to 10 hours a night
2. Ability to work at home
periodically
3. Eating five or six small meals per
day
4. Frequent need to work overtime
on short notice

4. Frequent need to work overtime on short notice

The nurse is giving dietary

instructions to a client who has a
new colostomy. The nurse should
encourage the client to eat foods
representing which diet for the first
4 to 6 weeks postoperatively?
1. Low fiber
2. Low calorie
3. High protein
4. High carbohydrate

1. Low fiber

A client with viral hepatitis is

discussing with the nurse the need
to avoid alcohol and states, "I'm not
sure I can avoid alcohol." What is
the most appropriate nursing
response?
1. "I don't believe that."
2. "Everything will be all right."
3. "I'm not sure that I understand.
Would you please explain?"
4. "I think you should talk more
with the health care provider (HCP)
about this."

3. "I'm not sure that I understand. Would you please

explain?"

A client is hospitalized with a

diagnosis of viral hepatitis. To
detect any difficulty in coping with
this disease, the nurse should ask
which question?
1. "Do you have a fever?"
2. "Are you losing weight?"
3. "Have you enjoyed having
visitors?"
4. "Do you rest sometime during
the day?"

3. "Have you enjoyed having visitors?"

A client with viral hepatitis

states, "I am so yellow." What is
the most appropriate nursing
action?
1. Assist the client in expressing

feelings.
2. Restrict visitors until the jaundice
subsides.
3. Perform most of the activities of
daily living for the client.
4. Provide information to the client
only when he or she requests it.
1. Assist the client in expressing feelings.

A client with viral hepatitis has

no appetite, and food makes the
client nauseated. Which nursing
intervention would be most
appropriate?
1. Encourage foods that are high in
protein.
2. Monitor for fluid and electrolyte
imbalance.
3. Explain that high-fat diets
usually are better tolerated.
4. Explain that most daily calories
need to be consumed in the evening
hours.

2. Monitor for fluid and electrolyte imbalance.

A nurse has implemented a

bowel maintenance program for an
unconscious client. The nurse
would evaluate the plan
asbest meeting the needs of the
client if which method was
successful in stimulating a bowel
movement?
1. Fleet enema
2. Fecal disimpaction
3. Glycerin suppository
4. Soap solution enema (SSE)

3. Glycerin suppository

The nurse checks the gastric

residual of an unconscious client
receiving nasogastric tube feedings
continuously at 50 mL/hr. The
nurse notes that the residual is 200
mL. The nurse determines that the
client is experiencing which

complication?
1. Air in the stomach
2. Too slow an infusion rate
3. Delayed gastric emptying
4. Early signs of peptic ulcer
3. Delayed gastric emptying

The nurse is developing a

teaching plan for a client with viral
hepatitis. The nurse should plan to
include which information in the
teaching session?
1. The diet should be low in
calories.
2. Meals should be large to
conserve energy.
3. Activity should be limited to
prevent fatigue.
4. Alcohol intake should be limited
to 2 ounces per day.

3. Activity should be limited to prevent fatigue.

The nurse is preparing to teach a

client with a new colostomy about
how to perform a colostomy
irrigation. Which information
should the nurse include in the
teaching plan?
1. Use 500 to 1000 mL of warm tap
water.
2. Suspend the irrigant 36 inches
above the stoma.
3. Insert the irrigation cone inch
into the stoma.
4. If cramping occurs, open the
irrigation clamp farther.

1. Use 500 to 1000 mL of warm tap water.

The nurse is providing care for a

client with a Sengstaken-Blakemore
tube. The nurse suspects which
diagnosis for this client?
1. Gastritis
2. Bowel obstruction
3. Small bowel tumor
4. Esophageal varices

4. Esophageal varices

The nurse has been caring for a

client who required a SengstakenBlakemore tube because other
treatment measures for esophageal
varices were unsuccessful. The
health care provider arrives on the
nursing unit and deflates the
esophageal balloon. After deflation
of the balloon, the nurse should
monitor the client most closely for
which complication?
1. Hematemesis
2. Bloody diarrhea
3. Swelling of the abdomen
4. An elevated temperature and a
rise in blood pressure

1. Hematemesis

A client in a long-term care

facility is being prepared to be
discharged to home in 2 days. The
client has been eating a regular diet
for a week; however, he is still
receiving intermittent enteral tube
feedings and will need to receive
these feedings at home. The client
states concern that he will not be
able to continue the tube feedings at
home. Which nursing response
is most appropriate at this time?
1. "Do you want to stay here in this
facility a few more days?"
2. "Have you discussed your
feelings with your health care
provider?"
3. "You need to talk to your health
care provider about these
findings."
4. "Tell me more about your
concerns with your diet after going
home."

4. "Tell me more about your concerns with your diet

after going home."

The nurse is performing an

assessment on a client with a
suspected diagnosis of acute
pancreatitis. The nurse will direct
the assessment to look for which as
a hallmark sign of this disorder?
1. Hypothermia
2. Epigastric pain radiating to the
neck area
3. Severe abdominal pain relieved
by vomiting
4. Severe abdominal pain that is
unrelieved by vomiting

4. Severe abdominal pain that is unrelieved by

vomiting

The nurse is reviewing the record

of a client admitted to the nursing
unit and notes that the client has a
history of Laennec's cirrhosis. This
type of cirrhosis is most commonly
caused by which long-term
condition?
1. Alcohol abuse
2. Cardiac disease
3. Exposure to chemicals
4. Obstruction to biliary ducts

1. Alcohol abuse

The nurse who is caring for a

client with a diagnosis of cirrhosis
is monitoring the client for signs of
portal hypertension.
Which initialsign, if noted in the
client, indicates the presence of
portal hypertension?
1. Weak pulse
2. Hypotension
3. Flat neck veins
4. Crackles on auscultation of the
lungs

4. Crackles on auscultation of the lungs

The nurse is developing a plan of

care for a client with cirrhosis and
ascites. Which nursing actions
should be included in the care plan

for this client? Select all that

apply.
1. Monitor daily weight.
2. Measure abdominal girth.
3. Monitor respiratory status.
4. Place the client in a supine
position.
5. Assist the client with care as
needed.

1. Monitor daily weight.

2. Measure abdominal girth.

3. Monitor respiratory status.

5. Assist the client with care as needed.

The nurse is monitoring a client

with cirrhosis of the liver for signs
of hepatic encephalopathy. Which
assessment finding would the nurse
note as an early sign of hepatic
encephalopathy?
1. Restlessness
2. Complaints of fatigue
3. The presence of asterixis
4. Decreased serum ammonia levels

3. The presence of asterixis

A home care nurse is visiting a

client with a diagnosis of pernicious
anemia that developed as a result of
gastric surgery. In teaching the
client about this condition, the
nurse explains that the stomach
lining is producing a decreased
amount of intrinsic factor, so the
client will need which medication?
1. An antacid
2. An antibiotic
3. Vitamin B6 injections
4. Vitamin B12 injections

4. Vitamin B12 injections

A client arrives at the hospital

emergency department complaining
of acute right lower quadrant
abdominal pain, and appendicitis is
suspected. Laboratory tests are

performed, and the nurse notes that

the client's white blood cell (WBC)
count is elevated. On the basis of
these findings, the nurse would
question which health care
provider's (HCP) prescriptions
documented in the client's medical
record?
1. Apply a cold pack to the
abdomen.
2. Administer 30 mL of milk of
magnesia (MOM).
3. Maintain nothing-by-mouth (nil
per os [NPO]) status.
4. Initiate an intravenous (IV) line
for the administration of IV fluids.
2. Administer 30 mL of milk of magnesia (MOM).

A health care provider (HCP)

prescribes a Salem sump tube for
gastrointestinal intubation. The
nurse prepares for the insertion and
obtains which item from the supply
room?
1. A Dobbhoff weighted tube
2. A Sengstaken-Blakemore tube
3. A tube with a large lumen and an
air vent
4. A tube with a single lumen that
connects to suction

3. A tube with a large lumen and an air vent

The nurse is preparing to insert a

nasogastric (NG) tube as prescribed
for the purpose of stomach
decompression. The nurse reviews
the health care provider's (HCP)
prescriptions and anticipates that
the HCP will prescribe which type
of suction pressure and control?
1. High and intermittent
2. Low and intermittent
3. High and continuous
4. Low and continuous

2. Low and intermittent

The nurse is providing dietary

instructions to a client with a
diagnosis of irritable bowel
syndrome. The nurse determines
that the client understands the
instructions if the client states the
need to avoid which food?
1. Rice
2. Corn
3. Broiled chicken
4. Cream of wheat

assessment findings does the nurse

anticipate to note as a result of
increased abdominal
pressure? Select all that apply.
1. Orthopnea, dyspnea
2. Petechiae and ecchymosis
3. Inguinal or umbilical hernia
4. Poor body posture and balance
5. Abdominal distention and
tenderness

2. Corn

Diphenoxylate hydrochloride
with atropine sulfate (Lomotil) is
prescribed for a client with
ulcerative colitis. The nurse should
monitor the client for which
therapeutic effect of this
medication?
1. Decreased diarrhea
2. Decreased cramping
3. Improved intestinal tone
4. Elimination of peristalsis

1. Decreased diarrhea

Sulfasalazine (Azulfidine) is
prescribed for a client with a
diagnosis of ulcerative colitis, and
the care unit nurse instructs the
client about the medication. Which
statement made by the client
indicates a need for further
instruction?
1. "The medication will cause
constipation."
2. "I need to take the medication
with meals."
3. "I may have increased sensitivity
to sunlight."
4. "This medication should be taken
as prescribed."

1. "The medication will cause constipation."

A client with cirrhosis has ascites

and excess fluid volume. Which

1. Orthopnea, dyspnea
2. Petechiae and ecchymosis

3. Inguinal or umbilical hernia

5. Abdominal distention and tenderness

A client has been advanced to a

solid diet after undergoing a
subtotal gastrectomy. The nurse
caring for the client would perform
which action to minimize the risk of
dumping syndrome?
1. Remove fluids from the meal
tray.
2. Give the client two large meals
per day.
3. Ask the client to sit up for 1 hour
after eating.
4. Provide concentrated, highcarbohydrate foods.

1. Remove fluids from the meal tray.

The ambulatory care nurse is

providing instructions to a client
who is scheduled for a small bowel
biopsy. What should the nurse tell
the client?
1. Clear liquids only are allowed on
the day of the test.
2. A signed informed consent form
will need to be obtained.
3. A tube will be inserted through
the rectum to obtain the tissue
sample.
4. A full liquid diet will need to be

maintained for 48 hours after the

procedure.
2. A signed informed consent form will need to be
obtained.

A client has been diagnosed with

gastroesophageal reflux disease
(GERD). The nurse plans care,
knowing that the client has
dysfunction of which part of the
digestive system?
1. Chief cells of the stomach
2. Parietal cells of the stomach
3. Lower esophageal sphincter
(LES)
4. Upper esophageal sphincter
(UES)

3. Lower esophageal sphincter (LES)

A client is experienced delayed

gastric emptying. The nurse plans
care, knowing that dysfunction of
which structures is responsible for
the client's symptoms?
1. Ileum
2. Jejunum
3. Pyloric sphincter
4. Cardiac sphincter

3. Pyloric sphincter

A client who has had a

gastrectomy is not producing
sufficient intrinsic factor. The nurse
plans care, knowing that the client
has lost the ability to absorb
cyanocobalamin (vitamin B12) in
which abdominal structure?
1. Colon
2. Stomach
3. Large intestine
4. Small intestine

4. Small intestine

A client with a diagnosis of

stomach ulcer from gastric
hyperacidity asks the nurse why the
acid has not caused an ulcer in the
small intestine as well. The nurse

responds that the pH of intestinal

contents is raised by bicarbonate,
which is present in which area of
the body?
1. Bile
2. Parietal cells
3. Liver enzymes
4. Pancreatic juice
4. Pancreatic juice

A client with appendicitis is

scheduled for an appendectomy.
The nurse providing preoperative
teaching for the client describes the
location of the appendix by stating
that it is attached to which part of
the gastrointestinal system?
1. Ileum
2. Cecum
3. Rectum
4. Jejunum

2. Cecum

A nurse is caring for a

hospitalized client who has been
diagnosed with pancreatitis. The
nurse checks the laboratory results
form, anticipating that which
enzyme will remain normal in the
client?
1. Lipase
2. Lactase
3. Trypsin
4. Amylase

2. Lactase

A nurse is caring for a group of

clients on the surgical nursing unit.
The nurse anticipates that the client
who underwent which procedure
is most likely to have some longterm residual difficulty with
absorption of nutrients?
1. Colectomy
2. Appendectomy

3. Ascending colostomy
4. Small bowel resection
4. Small bowel resection

A client with spinal cord injury

(SCI) is participating in a bowel
retraining program. The nurse
develops a plan that is based in part
on the knowledge that defecation is
normally a result of which
phenomena?
1. Sufficiently low water content in
the stool
2. Low intestinal roughage that
promotes easier digestion
3. Constriction of the anal sphincter
based on voluntary control
4. Stimulation of the
parasympathetic reflex center at the
S1 to S4 level in the spinal cord

4. Stimulation of the parasympathetic reflex center at

the S1 to S4 level in the spinal cord

A client is experiencing blockage

of the common bile duct. The nurse
anticipates that the client's diet will
be altered because the client will
experience difficulty digesting
which nutrient?
1. Fats
2. Proteins
3. Carbohydrates
4. Water-soluble vitamins

1. Fats

A hospitalized client with liver

disease has a dietary protein
restriction. The nurse encourages
intake of which complete proteins
to maximize the availability of
essential amino acids?
1. Nuts
2. Meats
3. Cereals
4. Vegetables

2. Meats

A nurse is reviewing laboratory

test results for a client with liver
disease and notes that the client's
albumin level is low. The nurse next
assesses the client for which
physiological effect of decreased
circulating albumin?
1. Cerebral edema
2. Peripheral edema
3. Decreased clotting ability
4. Reflexive increase in total
protein level

2. Peripheral edema

A client with liver dysfunction is

having difficulty with protein
metabolism. The nurse checks the
laboratory results, expecting that
the results of which serum
laboratory values will be elevated?
1. Lactase
2. Albumin
3. Ammonia
4. Lactic acid

3. Ammonia

A client is admitted to the

hospital with severe weight loss
after extreme dieting. The nurse
plans care, knowing that which
physiological processes occur in the
prolonged absence of adequate food
intake?
1. Lactic acidosis
2. Glycogenolysis
3. Gluconeogenesis
4. Glucose metabolism

3. Gluconeogenesis

A nurse is providing a simple

overview of the anatomy of the
liver and gallbladder for a client
hospitalized with biliary
obstruction. The nurse explains that
normally the liver stores bile in the
gallbladder and that the liver and

gallbladder are connected together

by which passageway?
1. Cystic duct
2. Liver canaliculi
3. Common bile duct
4. Right hepatic duct

the stomach's production of acid by

altering which structure?
1. Portal vein
2. Celiac artery
3. Vagus nerve
4. Pyloric valve

1. Cystic duct

3. Vagus nerve

A client with liver dysfunction

exhibits low serum levels of
thrombin. The nurse provides care,
knowing that this client is most at
risk for which complication?
1. Bleeding
2. Infection
3. Dehydration
4. Malnutrition

1. Bleeding

A nurse who is caring for an

older client is aware that the client
is at risk for prolonged medication
effects as a result of the normal
aging process. The nurse would
be mostconcerned with this effect if
the client had a history of disease of
which organ?
1. Liver
2. Stomach
3. Pancreas
4. Gallbladder

1. Liver

A hospitalized client is diagnosed

with pancreatitis. The nurse plans
care, knowing that production of
which substance will be elevated in
blood studies for this client?
1. Pepsin
2. Lactase
3. Amylase
4. Enterokinase

3. Amylase

A client with gastric

hypersecretion is scheduled for
surgery. The nurse teaches the
client that the procedure will lessen

Lactulose (Chronulac) is
prescribed for a hospitalized client
with a diagnosis of hepatic
encephalopathy. Which assessment
finding indicates that the client is
responding to this medication
therapy as anticipated?
1. Vomiting occurs.
2. The fecal pH is acidic.
3. The client experiences diarrhea.
4. The client is able to tolerate a full
diet.
2. The fecal pH is acidic.

Cholestyramine resin (Questran

Light) is prescribed for a client with
an elevated serum cholesterol level.
The nurse should instruct the client
to take the medication in which
way?
1. After meals
2. Mixed with fruit juice
3. Via a rectal suppository
4. At least 3 hours before meals

2. Mixed with fruit juice

Pancreatin (Viokase) is
prescribed for a client with
postgastrectomy syndrome. Which
assessment finding would indicate a
therapeutic effect of this
medication?
1. The client's appetite improves.
2. The client experiences weight
loss.
3. Vitamin B12 deficiency is
controlled.

4. The stool is less fatty and

decreases in frequency.
4. The stool is less fatty and decreases in frequency.

The nurse is evaluating the plan

of care for a client with peptic ulcer
disease (PUD) who is experiencing
acute pain. The nurse determines
that the expected outcomes have
not been met if the nursing
assessment reveals which result?
1. The client's pain is relieved with
histamine-2 receptor antagonists.
2. The client has eliminated any
irritating foods from the diet.
3. The client frequently is
awakened at 2 am with heartburn.
4. The client reports absence of
pain before meals.

3. The client frequently is awakened at 2 am with

heartburn.

A client with a history of gastric

ulcer complains of a sudden, sharp,
severe pain in the midepigastric
area, which then spreads over the
entire abdomen. The client's
abdomen is rigid and boardlike on
palpation, and the client obtains
most comfort from lying in the
knee-chest position. The nurse calls
the health care provider
immediately, suspecting that the
client is experiencing which
complication of peptic ulcer
disease?
1. Perforation
2. Obstruction
3. Hemorrhage
4. Intractability

1. Perforation

A client is readmitted to the

hospital with dehydration after
surgery for creation of an
ileostomy. The nurse assesses that
the client has lost 3 lb of weight,

has poor skin turgor, and has

concentrated urine. The nurse
interprets the client's clinical
picture as correlating most closely
with recent intake of which
medication, which is
contraindicated for the ileostomy
client?
1. Folate (folic acid)
2. Sennosides (Ex-Lax)
3. Ferrous sulfate (Feosol)
4. Cyanocobalamin (vitamin B12)
2. Sennosides (Ex-Lax)

A Penrose drain is in place on the

first postoperative day in a client
who has undergone a
cholecystectomy procedure.
Serosanguineous drainage is noted
on the dressing covering the drain.
Which nursing intervention is most
appropriate?
1. Change the dressing.
2. Continue to monitor the
drainage.
3. Notify the health care provider
(HCP).
4. Use a pen to circle the amount of
drainage on the dressing.

1. Change the dressing.

A nurse assists a health care

provider in performing a liver
biopsy. After the procedure, the
nurse should place the client in
which position?
1. Prone
2. Supine
3. Left side
4. Right side

4. Right side

A home care nurse is visiting a

client with a diagnosis of pernicious
anemia that developed as a result of
gastric surgery. The nurse instructs

the client that because the stomach

lining produces a decreased amount
of intrinsic factor in this disorder,
the client will need which
medication?
1. Vitamin B12 injections
2. Vitamin B6 injections
3. An antibiotic
4. An antacid
1. Vitamin B12 injections

A client arrives at the hospital

emergency department complaining
of acute right lower quadrant
abdominal pain. Appendicitis is
suspected, and appropriate
laboratory tests are performed. The
emergency department nurse
reviews the test results and notes
that the client's white blood cell
(WBC) count is elevated. The nurse
also reviews the prescriptions from
the health care provider (HCP). The
nurse should contact the HCP to
question which prescription if noted
in the client's record?
1. Maintain a semi-Fowler's
position.
2. Maintain an NPO (nothing by
mouth) status.
3. Apply a heating pad to the lower
abdomen for comfort.
4. Initiate an intravenous (IV) line
with the administration of IV fluids.

3. Apply a heating pad to the lower abdomen for

comfort.

The nurse is caring for a client

who is receiving intermittent
feeding via a nasogastric (NG) tube.
Before administering a feeding to
the client, the nurse should perform
which action first?
1. Warm the feeding to 103 F.
2. Check the placement of the tube.

3. Rinse the Asepto syringe with

warm water.
4. Check the last time medications
were given.
2. Check the placement of the tube.

The nurse has given instructions

to a client with hepatitis about postdischarge management during
convalescence. The nurse
determines that further teaching is
needed if the client makes which
statement?
1. "I need to avoid alcohol and
aspirin."
2. "I should eat a highcarbohydrate, low-fat diet."
3. "I can resume a full activity level
within 1 week."
4. "I need to take the prescribed
amounts of vitamin K."

3. "I can resume a full activity level within 1 week."

The nurse is caring for a client

who had a subtotal gastrectomy.
The nurse should assess the client
for which signs and symptoms of
dumping syndrome?
1. Diarrhea, chills, and hiccups
2. Weakness, diaphoresis, and
diarrhea
3. Fever, constipation, and rectal
bleeding
4. Abdominal pain, elevated
temperature, and weakness

2. Weakness, diaphoresis, and diarrhea

The nurse is caring for a client

who has just returned from the
operating room after the creation of
a colostomy. The nurse is assessing
the drainage in the pouch attached
to the site where the colostomy was
formed and notes serosanguineous
drainage. Which nursing action is
appropriate based on this

assessment?
1. Apply ice to the stoma site.
2. Apply pressure to the stoma site.
3. Notify the health care provider
(HCP).
4. Document the amount and
characteristics of the drainage.
4. Document the amount and characteristics of the
drainage.

The clinic nurse is performing an

abdominal assessment on a client
and preparing to auscultate bowel
sounds. The nurse should place the
stethoscope in which quadrant first?

1. A
2. B
3. C
4. D
3. C

The nurse has been caring for a

client with a Sengstaken-Blakemore
tube. The health care provider
arrives on the nursing unit and
deflates the esophageal balloon.
Afterward, the nurse should
monitor the client most closely for
which sign?
1. Hematemesis
2. Bloody diarrhea
3. Swelling of the abdomen
4. An elevated temperature and a
rise in blood pressure

1. Hematemesis

A client has a large, deep

duodenal ulcer diagnosed by
endoscopy. Which sign/symptom
indicative of a complication should
the nurse look for during the client's
postprocedure assessment?
1. Bradycardia
2. Nausea and vomiting
3. Numbness in the legs
4. A rigid board-like abdomen

4. A rigid board-like abdomen

The nurse is assisting a client

with Crohn's disease to ambulate to
the bathroom. After the client has a
bowel movement, the nurse should
assess the stool for which
characteristic that is expected with
this disease?
1. Blood in the stool
2. Chalky gray stool
3. Loose, watery stool
4. Dry, hard, constipated stool

3. Loose, watery stool

The nurse is reviewing the results

of serum laboratory studies for a
client admitted for suspected
hepatitis. Which laboratory finding
is most associated with hepatitis
requiring the nurse to contact the
health care provider?
1. Elevated serum bilirubin level
2. Below normal hemoglobin
concentration
3. Elevated blood urea nitrogen
(BUN) level
4. Elevated erythrocyte
sedimentation rate (ESR)

1. Elevated serum bilirubin level

The nurse is assessing a client

with a duodenal ulcer. The nurse
interprets that which sign/symptom
is most consistent with the typical
presentation of duodenal ulcer?
1. Weight loss
2. Nausea and vomiting
3. Pain that is relieved by food
intake
4. Pain that radiates down the right
arm

3. Pain that is relieved by food intake

The nurse is assisting a health

care provider (HCP) with the
insertion of a Miller-Abbott tube.
The nurse understands that the

procedure places the client at risk

for aspiration and should therefore
implement which action to decrease
the risk of aspiration?
1. Insert the tube with the balloon
inflated.
2. Place the client in a semi- to high
Fowler's position.
3. Instruct the client to cough when
the tube reaches the nasal pharynx.
4. Instruct the client to perform a
Valsalva maneuver if the impulse to
gag and vomit occurs.
2. Place the client in a semi- to high Fowler's position.

A client's nasogastric (NG)

feeding tube has become clogged.
The nurse should take which
action first?
1. Replace the tube.
2. Aspirate the tube.
3. Flush with carbonated liquids.
4. Flush the tube with warm water.

2. Aspirate the tube.

The nurse is obtaining a health

history for a client with chronic
pancreatitis. The health history
is most likely to include which as a
common causative factor in this
client's disorder?
1. Weight gain
2. Use of alcohol
3. Exposure to occupational
chemicals
4. Abdominal pain relieved with
food or antacids

2. Use of alcohol

A client seen in the ambulatory

care clinic has ascites and slight
jaundice. The nurse should assess
the client for a history of chronic
use of which medication?
1. Ibuprofen (Advil)
2. Ranitidine (Zantac)

3. Acetaminophen (Tylenol)
4. Acetylsalicylic acid (aspirin)
3. Acetaminophen (Tylenol)

The nurse teaches a preoperative

client about the use of a nasogastric
(NG) tube for the planned surgery.
Which statement indicates to the
nurse that the client understands
when the tube can be removed in
the postoperative period?
1. "When I can tolerate food
without vomiting."
2. "When my gastrointestinal (GI)
system is healed enough."
3. "When my bowels begin to
function again, and I begin to pass
gas."
4. "When my health care provider
(HCP) says the tube can come out."

3. "When my bowels begin to function again, and I

begin to pass gas."

A client with gastritis asks the

nurse at a screening clinic about
analgesics that will not cause
epigastric distress. The nurse
should tell the client that which
medication is unlikely to cause
epigastric distress?
1. Ecotrin
2. Bufferin
3. Ascriptin
4. Acetaminophen (Tylenol)

4. Acetaminophen (Tylenol)

The nurse is providing dietary

instructions to a client hospitalized
for pancreatitis. Which food should
the nurse instruct the client to
avoid?
1. Chili
2. Bagel
3. Lentil soup
4. Watermelon

1. Chili

A home care nurse visits a client

who was recently diagnosed with
cirrhosis. The nurse provides home
care management instructions to the
client. Which client statement
indicates a need for further
instruction?
1. "I will obtain adequate rest."
2. "I will take Tylenol if I get a
headache."
3. "I should monitor my weight on
a regular basis."
4. "I need to include sufficient
amounts of carbohydrates in my
diet."

2. "I will take Tylenol if I get a headache."

A client with acute pancreatitis is

experiencing severe pain from the
disorder. The nurse determines that
the client understands suggestions
for positioning to reduce pain if he
or she avoids which action?
1. Sitting up
2. Lying flat
3. Leaning forward
4. Drawing the legs up to the chest

2. Lying flat

The nurse is caring for a client

who is receiving bolus feedings via
a nasogastric tube. As the nurse is
finishing the feeding, the client asks
for the bed to be positioned flat for
sleep. The nurse understands that
which is
themost appropriate position for
this client at this time?
1. Head of bed flat, with the client
supine for 60 minutes
2. Head of bed flat, with the client
in the supine position for at least 30
minutes
3. Head of bed elevated 30 to 45
degrees, with the client in the right

lateral position for 60 minutes

4. Head of bed in a semi-Fowler's
position, with the client in the left
lateral position for 60 minutes
3. Head of bed elevated 30 to 45 degrees, with the
client in the right lateral position for 60 minutes

Before administering an
intermittent enteral feeding through
a nasogastric tube, the nurse
assesses for gastric residual. The
nurse understands that this
procedure is important to
accomplish which purpose?
1. Observe the digestion of
formula.
2. Assess fluid and electrolyte
status.
3. Evaluate absorption of the last
feeding.
4. Confirm proper nasogastric tube
placement.

3. Evaluate absorption of the last feeding.

The nurse has inserted a

nasogastric (NG) tube to the level
of the oropharynx and has
repositioned the client's head in a
flexed-forward position. The client
has been asked to begin
swallowing. The nurse starts to
slowly advance the NG tube with
each swallow. The client begins to
cough, gag, and choke. Which
nursing action would least
likely result in proper tube insertion
and promote client relaxation?
1. Pulling the tube back slightly
2. Continuing to advance the tube
to the desired distance
3. Instructing the client to breathe
slowly and take sips of water
4. Checking the back of the
pharynx using a tongue blade and
flashlight

2. Continuing to advance the tube to the desired

distance

The nurse is caring for a client

with acute pancreatitis and is
monitoring the client for paralytic
ileus. Which assessment data would
alert the nurse to this occurrence?
1. Inability to pass flatus
2. Loss of anal sphincter control
3. Severe, constant pain with rapid
onset
4. Firm, nontender mass palpable at
the lower right costal margin

1. Inability to pass flatus

The client with a small bowel

obstruction asks the nurse to
explain the purpose of the
nasogastric tube attached to
continuous gastric suction. The
nurse determines that teaching has
been effective if the client makes
which statement?
1. "It will help to provide me
nourishment."
2. "It will help to relieve the
congestion from excess mucus."
3. "It is used to remove gastric
contents for laboratory analysis."
4. "It will help to remove gas and
fluids from my stomach and
intestine."

4. "It will help to remove gas and fluids from my

stomach and intestine."

A client is scheduled for an upper

gastrointestinal (GI) endoscopy.
Which assessment is essential to
include in the plan of care
following the procedure?
1. Assessing pulses
2. Monitoring urine output
3. Monitoring for rectal bleeding
4. Assessing for the presence of the
gag reflex

4. Assessing for the presence of the gag reflex

A client is diagnosed with a

gastrointestinal (GI) bleed, and the
bleeding has been controlled.
Antacids are prescribed to be
administered every hour. The nurse
administers the antacids and should
plan to maintain an approximate
gastric pH of which value?
1. 3
2. 6
3. 9
4. 15

2. 6

A nurse is caring for a client

admitted to the hospital with a
suspected diagnosis of acute
appendicitis. Which laboratory
result should the nurse expect to
note if the client does have
appendicitis?
1. WBC count of 4000 cells/mm3
2. WBC count of 8000 cells/mm3
3. WBC count of 18,000 cells/mm3
4. WBC count of 26,000 cells/mm3

3. WBC count of 18,000 cells/mm3

The client with acute pancreatitis

is experiencing severe pain from
the disorder. Which position taken
by the client indicates there is
a need for further teaching?
1. Sitting up
2. Lying flat
3. Leaning forward
4. Flexing the left leg

2. Lying flat

A client is admitted to the

hospital with acute viral hepatitis.
Which sign or symptom should the
nurse expect to note based on this
diagnosis?
1. Fatigue
2. Pale urine

3. Weight gain
4. Spider angiomas
1. Fatigue

A nurse manager is providing an

educational session to nursing staff
members about the phases of viral
hepatitis. The nurse manager tells
the staff that which clinical
manifestation(s)
is/are primarily characteristic of
the preicteric phase?
1. Pruritus
2. Right upper quadrant pain
3. Fatigue, anorexia, and nausea
4. Jaundice, dark-colored urine, and
clay-colored stools

3. Fatigue, anorexia, and nausea

A client who has a gastrostomy

tube for feeding refuses to
participate in the plan of care, will
not make eye contact, and does not
speak to the family or visitors.
Which type of coping mechanism
should the nurse assess that this
client is using?
1. Distancing
2. Self-control
3. Problem solving
4. Accepting responsibility

1. Distancing

A nurse is teaching the

postgastrectomy client about
measures to prevent dumping
syndrome. Which statement by the
client indicates a need for further
teaching?
1. "I need to lie down after eating."
2. "I need to drink liquids with
meals."
3. "I need to avoid concentrated
sweets."
4. "I need to eat small meals six
times daily."

2. "I need to drink liquids with meals."

A client has been diagnosed with

pernicious anemia. In planning care
for the client, the nurse should
anticipate that the client will be
treated with which substance?
1. Iron
2. Thiamine
3. Folic acid
4. Vitamin B12

4. Vitamin B12

A client presents to the

emergency department with upper
gastrointestinal (GI) bleeding and is
in moderate distress. In planning
care, which nursing action should
be the first priority for this client?
1. Assessment of vital signs
2. Complete abdominal
examination
3. Thorough investigation of
precipitating events
4. Insertion of a nasogastric tube
and Hematest of emesis

1. Assessment of vital signs

A nurse is reviewing the health

care provider's prescriptions written
for a client admitted to the hospital
with acute pancreatitis. Which
prescription should the nurse
confirm?
1. Full liquid diet
2. Morphine sulfate for pain
3. Nasogastric tube insertion
4. An anticholinergic medication

1. Full liquid diet

A nurse has given post-procedure

instructions to a client who has
undergone a colonoscopy. Which
statement by the client indicates
the need for further teaching?
1. "It is normal to feel gassy or
bloated after the procedure."
2. "The abdominal muscles may be

tender from the procedure."

3. "It is all right to drive once I've
been home for an hour or so."
4. "Intake should be light at first
and then progress to regular
intake."
3. "It is all right to drive once I've been home for an
hour or so."

A nurse is reviewing the

medication record of a client with
acute gastritis. Which medication, if
noted on the client's record, should
the nurse question?
1. Digoxin (Lanoxin)
2. Furosemide (Lasix)
3. Indomethacin (Indocin)
4. Propranolol hydrochloride
(Inderal LA)

3. Indomethacin (Indocin)

A nurse is caring for a client

postoperatively after creation of a
colostomy. What is the appropriate
client problem?
1. Fear
2. Sexual dysfunction
3. Disturbed body image
4. Imbalanced nutrition: more than
body requirements

3. Disturbed body image

A nurse is caring for a

hospitalized client with a diagnosis
of ulcerative colitis. Which finding,
if noted on assessment of the client,
should the nurse report to the health
care provider (HCP)?
1. Hypotension
2. Bloody diarrhea
3. Rebound tenderness
4. A hemoglobin level of 12 mg/dL

3. Rebound tenderness

A nurse is performing colostomy

irrigation on a client. During the
irrigation, the client begins to
complain of abdominal cramps.

What is the appropriate nursing

action?
1. Stop the irrigation temporarily.
2. Increase the height of the
irrigation.
3. Notify the health care provider
(HCP).
4. Medicate for pain and resume the
irrigation.
1. Stop the irrigation temporarily.

The medication history of a

client with peptic ulcer disease
reveals intermittent use of several
medications. The nurse would teach
the client to avoid which of these
medications because of its irritating
effects on the lining of the
gastrointestinal tract?
1. Nizatidine (Axid)
2. Sucralfate (Carafate)
3. Ibuprofen (Motrin IB)
4. Omeprazole (Prilosec)

3. Ibuprofen (Motrin IB)

The nurse should instruct a client

with an ileostomy to include which
action as part of essential care of
the stoma?
1. Massage the area below the
stoma.
2. Take in high-fiber foods such as
nuts.
3. Limit fluid intake to prevent
diarrhea.
4. Cleanse the peristomal skin
meticulously.

4. Cleanse the peristomal skin meticulously.

A client who has undergone

creation of a colostomy has a
concern about body image. What
action by the client indicates
the most significant progress
toward identified goals?
1. Looking at the ostomy site

2. Reading the ostomy product

literature
3. Watching the nurse empty the
ostomy bag
4. Practicing proper cutting of the
ostomy appliance

client states that it will be necessary

to control which factor?
1. Alcohol intake
2. Duodenal ulcer
3. Crohn's disease
4. Diabetes mellitus

4. Practicing proper cutting of the ostomy appliance

1. Alcohol intake

A client with a new colostomy is

concerned about the odor from
stool in the ostomy drainage bag.
The nurse should teach the client to
include which food in the diet to
reduce odor?
1. Eggs
2. Yogurt
3. Broccoli
4. Cucumbers

2. Yogurt

1. Protein

A client with a colostomy has a

prescription for irrigation of the
colostomy. Which solution should
the nurse use for the irrigation?
1. Tap water
2. Sterile water
3. Sterile distilled water
4. Sterile lactated Ringer's

1. Tap water

A client with chronic pancreatitis

needs information on dietary
modification to manage the health
problem. Which item in the diet
should the nurse teach the client to
limit?
1. Fat
2. Protein
3. Carbohydrate
4. Water-soluble vitamins

1. Fat

A nurse has taught the client with

chronic pancreatitis about risk
factor modification to reduce the
incidence of recurrences. The nurse
should determine that the client has
understood the information if the

A client with cirrhosis is

beginning to show signs of hepatic
encephalopathy. The nurse should
plan a dietary consultation to limit
the amount of which ingredient in
the client's diet at this time?
1. Protein
2. Calories
3. Minerals
4. Carbohydrates
A client with cirrhosis
complicated by ascites is admitted
to the hospital. The client reports a
10-lb weight gain over the last 1
weeks. The client has edema of the
feet and ankles, and his abdomen is
distended, taut, and shiny with
striae. Which client problem
is most appropriate at this time?
1. Difficulty with breathing
2. Risk for skin breakdown
3. Difficulty with sleeping
4. Excessive body fluid volume
4. Excessive body fluid volume

A client with Crohn's disease is

experiencing acute pain and the
nurse provides information about
measures to alleviate the pain.
Which statement by the client
indicates the need for further
teaching?
1. "I know I can massage my
abdomen."
2. "I will continue using
antispasmodic medication."

3. "One of the best things I can do

is use relaxation techniques."
4. "The best position for me is to lie
supine with my legs straight."
4. "The best position for me is to lie supine with my
legs straight."

A client with ulcerative colitis

has a prescription to begin a
salicylate medication to reduce
inflammation. What instruction
should the nurse give the client
regarding when to take this
medication?
1. On arising
2. After meals
3. On an empty stomach
4. 30 minutes before meals

2. After meals

A client is admitted to the

hospital with a diagnosis of acute
diverticulitis. What should the
nurse expect to be prescribed for
this client?
1. NPO (nothing by mouth) status
2. Ambulation at least four times
daily
3. Cholinergic medications to
reduce pain
4. Coughing and deep breathing
every 2 hours

1. NPO (nothing by mouth) status

A nurse is participating in a
health screening clinic and is
preparing teaching materials about
colorectal cancer. Which risk factor
for colorectal cancer should the
nurse include?
1. High-fiber, low-fat diet
2. Age older than 30 years
3. Distant relative with colorectal
cancer
4. Personal history of ulcerative
colitis or gastrointestinal polyps

4. Personal history of ulcerative colitis or

gastrointestinal polyps

The nurse should incorporate

which in the dietary plan to ensure
optimal nutrition for the client
during the acute phase of
hepatitis? Select all that apply.
1. Select foods high in protein
content.
2. Consume multiple small meals
throughout the day.
3. Select foods low in
carbohydrates to prevent nausea.
4. Allow the client to select foods
that are most appealing.
5. Eliminate fatty foods from the
meal trays until nausea subsides.
6. Eat a nutritious dinner because it
is typically the best tolerated meal
of the day.

2. Consume multiple small meals throughout

the day.
4. Allow the client to select foods that are
most appealing.
5. Eliminate fatty foods from the meal trays
until nausea subsides.

A nurse is caring for a

postoperative client who has just
returned from surgery for creation
of a colostomy. The nurse inspects
the colostomy stoma and recognizes
that which is a normal assessment
finding for this client?
1. A pale color
2. A purple color
3. A brick-red color
4. A large amount of red drainage

3. A brick-red color

A client is admitted to the

hospital with a diagnosis of acute
pancreatitis. Which would the nurse
expect the client to report about the
pain?
1. The pain is mostly around the

umbilicus and comes and goes.

2. The pain increases when the
client sits up and bends forward.
3. The pain usually increases after
vomiting.
4. Eating helps to decrease the pain.
3. The pain usually increases after vomiting.

The nurse is performing an

admission assessment on a client
who has been admitted to the
hospital with a diagnosis of
suspected gastric ulcer. The nurse is
asking the client questions about
pain. Which statement, if made by
the client, would support the
diagnosis of gastric ulcer?
1. "The pain doesn't usually come
right after I eat."
2. "The pain gets so bad that it
wakes me up at night."
3. "The pain that I get is located on
the right side of my chest."
4. "My pain comes shortly after I
eat, maybe a half-hour or so later."

4. "My pain comes shortly after I eat, maybe a halfhour or so later."

A nurse is caring for a client

diagnosed with suspected acute
pancreatitis. When reviewing the
client's laboratory results, the nurse
interprets that which finding will
support the diagnosis?
1. Elevated serum lipase level
2. Elevated serum bilirubin level
3. Decreased serum trypsin level
4. Decreased serum amylase level

1. Elevated serum lipase level

A nurse is caring for a client

postoperatively following creation
of a colostomy. Which client
problem should the nurse include in
the plan of care?
1. Fear
2. Anxiety

3. Sexual dysfunction
4. Upset about appearance
4. Upset about appearance

A client is experiencing blockage

of the common bile duct. Which
food selection made by the client
indicates the need for further
teaching? 1. Rice
2. Whole milk
3. Broiled fish
4. Baked chicken

2. Whole milk

A nurse is reviewing laboratory

test results for the client with liver
disease and notes that the client's
albumin level is low. Which nursing
action is focused on the
consequence of low albumin
levels?
1. Evaluating for asterixis
2. Inspecting for petechiae
3. Palpating for peripheral edema
4. Evaluating for decreased level of
consciousness

3. Palpating for peripheral edema

Discharge teaching for a client

with chronic pancreatitis should
include which instructions?
1. Alcohol should be consumed in
moderation.
2. Avoid caffeine, because it may
aggravate symptoms.
3. Diet should be high in
carbohydrates, fats, and proteins.
4. Frothy fatty stools indicate that
enzyme replacement is working.

2. Avoid caffeine, because it may aggravate

symptoms.

In which optimal position should

the nurse plan to place the client
after bolus feeding using a
nasogastric tube?
1. Head of bed (HOB) flat, with
client supine for at least 60 minutes

2. HOB elevated 60 to 90 degrees,

with client supine for 15 minutes
3. HOB elevated 10 degrees, with
client in the left lateral position for
60 minutes
4. HOB elevated 30 to 45 degrees,
with client in the right lateral
position for 60 minutes
4. HOB elevated 30 to 45 degrees, with client in the
right lateral position for 60 minutes

A client receiving a cleansing

enema complains of pain and
cramping. The nurse should take
which corrective action?
1. Discontinue the enema.
2. Reassure the client, and continue
the flow.
3. Raise the enema bag so that the
solution can be completed quickly.
4. Clamp the tubing for 30 seconds,
and restart the flow at a slower rate.

4. Clamp the tubing for 30 seconds, and restart the

flow at a slower rate.

A client with a history of

gastrointestinal upset has been
diagnosed with acute diverticulitis.
The nurse should give the client
suggestions for foods to aid in
symptom management that are in
which diet types?
1. A low-fat diet
2. A low-fiber diet
3. A high-protein diet
4. A high-carbohydrate diet

2. A low-fiber diet

A nurse is caring for a client with

cirrhosis. As part of dietary
teaching 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
material if the client states to

increase intake of which food?

1. Pork
2. Milk
3. Chicken
4. Broccoli
1. Pork

A client is resuming a diet after

hemigastrectomy and the nurse
provides dietary instructions.
Which statement by the client
indicates a need for further
teaching?
1. "I plan to lie down after eating."
2. "I will eat six small meals per
day."
3. "I will drink plenty of liquids
with meals."
4. "I know to exclude concentrated
sweets in my diet."

3. "I will drink plenty of liquids with meals."

A client with liver dysfunction

has low serum levels of fibrinogen
and a prolonged prothrombin time
(PT). Based on these findings,
which actions should the nurse plan
to promote the client's
safety? Select all that apply.
1. Monitor serum potassium levels.
2. Weigh client daily, and monitor
trends.
3. Monitor for symptoms of fluid
retention.
4. Provide the client with a soft
toothbrush.
5. Instruct the client to use an
electric razor.
6. Monitor all secretions for frank
or occult blood.

4. Provide the client with a soft toothbrush.

5. Instruct the client to use an electric razor.

6. Monitor all secretions for frank or occult

blood.