GASTROINTESTINAL SYSTEM practice exam - answers

and rationale
1. 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 of the following signs and symptoms, if identified by the client, indicates an understanding of
this potential complication following gastrointestinal surgery?
A. Hiccups and diarrhea
B. Fatigue and abdominal pain
C. Constipation and fever
D. Diaphoresis and diarrhea
1. D
Dumping syndrome occurs after gastric surgery because food is not held as long in the stomach and is
dumped into the intestine as hypertonic mass. This causes fluid to shift into the intestine, causing
cardiovascular and gastrointestinal symptoms. Symptoms typically can include weakness, dizziness,
diaphoresis, flushing, hypotension, abdominal pain and distension, hyperactive bowel sounds, and
diarrhea. Options 1, 2, and 3 are incorrect and are not signs of dumping syndrome.
2. A nurse is providing instructions to a client who will collect a stool specimen for occult blood. The
nurse instructs the client to avoid which of the following for 3 days before the collection of the stool
specimen?
A. Milk products
B. Hard cheese
C. Turnips
D. Cottage cheese
2. C
The nurse would instruct the client to avoid red meat, poultry, fish, turnips, horseradish, and foods
such as fruits and vegetables for 3 days before and during testing. These products may alter test
results.
3. Which of the following nursing interventions should have the highest priority during the first hour
after the admission of a client with cholecystitis who is experiencing pain, nausea, and vomiting?
A. Administering pain medication.
B. Completing the admission history.
C. Maintaining hydration.
D. Teaching about planned diagnostic tests.
3. A
1: Administering pain medication would have the highest priority during the first hour after the client's
admission. 2: Completing the admission history can be done after the client's pain is controlled. 3:
Maintaining hydration is important but will be accomplished over time. In the first hour after admission,
the highest priority is pain relief. 4: It is not appropriate to try to teach while a client is in pain.
Teaching about planned diagnostic tests can occur after the client is comfortable.
4. 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?
A. Lying supine with the legs straight
B. Massaging the abdomen
C. Using antispasmodic medication
D. Using relaxation techniques
4. A
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 inflamed
intestinal tissues as the abdominal muscles are stretched.
5. 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.” The most appropriate response is
A. “Everything will be alright.”
B. “I think you should talk more with the doctor about this.”
C. “I don’t believe that.”
D. “I’m not sure that I don’t understand. Would you please explain?”
5. D
Explaining what is vague or clarifying the meaning of what has been said increases the understanding
 for the client and the nurse. False reassurance devalues the client’s feelings. Refusing to consider the
client’s ideas may cause the client to discontinue interaction with the nurse for fear of further
rejection. Placing the client’s feelings on hold by referring the client to the doctor for further
information is a block to communication.

6. A nurse is reviewing the orders of a client admitted to the hospital with a diagnosis of acute
pancreatitis. Select the interventions that the nurse would expect be prescribed for the client.
A. Small, frequent high calorie feedings.
B. Meperidine (Demerol) as prescribed for pain.
C. Maintain the client in a supine and flat position.
D. Encourage coughing and deep breathing.
E. Administer antacids as prescribed.
6. B+D+E
The client with acute pancreatitis normally is placed on an NPO status to rest the pancreas and
suppress gastrointestinal secretions. Because abdominal pain is a prominent symptom of pancreatitis,
pain medications such as meperidine will be prescribed. Some clients experience lessened pain by
assuming positions that flex the trunk and draw the knees up to the chest. A side-lying position with
the head elevated 45-degrees decreases tension on the abdomen and also may help to ease the pain.
The client is susceptible to respiratory infections because the retroperitoneal fluid raises the
diaphragm, which causes the client to take shallow, guarded abdominal breaths. Therefore measures
such as turning, coughing, and deep breathing are instituted. Antacids and anticholinergics may be
prescribed to suppress gastrointestinal secretions.
7. A nurse is performing an assessment on a client with a suspected diagnosis of acute pancreatitis.
The nurse assesses the client, knowing that which of the following is a hallmark sign of this disorder?
A. Severe abdominal pain relieved by vomiting
B. Severe abdominal pain that is unrelieved by vomiting
C. Hypothermia
D. Epigastric pain radiating to the neck area
7. B
Nausea and vomiting are common presenting symptoms of acute pancreatitis. A hallmark sign is
severe abdominal pain that is not relieved by vomiting. The vomitus characteristically consists of
gastric and duodenal contents. Fever is also a common symptom but is usually less than 38 degrees
centigrade. Epigastric pain radiating to the neck area is not a characteristic sign.
8. A 30-year-old woman is admitted to the hospital with complaints of severe abdominal cramping and
diarrhea. The nurse evaluates the effectiveness of the patient's intravenous therapy. Which of the
following laboratory tests BEST reflects hydration status?
A. Erythrocyte sedimentation rate.
B. White blood cell count.
C. Hematocrit.
D. Serum glucose.
8. C
STRATEGY: Think about what each value measures. How does it relate to hydration? CORRECT
ANSWER: (3) relative vol of plasma to RBCs; increased with dehydration, reduced fluid vol excess;
normal: men 42 - 50%, women 40 - 48%; other tests that indicate hydration: BP, urine specific gravity
(normal: 1.010 - 1.030), CVP (normal 3 - 11 cm/H2O) (1) ESR: rate at which RBCs settle out of unclotted
blood in 1 hr; indicates inflammation/necrosis; normal: men 0 - 15 mm/h, women 0 - 20 mm/h (2) WBC:
indicates infection (normal 5,000 - 10,000); reduced: leukopenia, elevated: leukocytosis (4) indicates
insulin production (normal 60 - 110 mg/dL)
9. The nurse provides discharge instructions to a patient with hepatitis B. Which of the following
statements, if made by the patient, would indicate the need for further instruction?
A. "I can never donate blood."
B. "I can never have unprotected sex."
C. "I cannot share needles."
D. "I should avoid drugs and alcohol."
9. D
(4)Hepatitis B is an inflammation of the liver by a virus that results in degeneration and necrosis of
liver cells. This patient statement indicates need for further teaching. The patient should be instructed
that, in order to avoid complications, alcohol should be avoided for six months to one year. Illicit drugs
and toxic chemicals should be avoided Acetaminophe may be taken only when necessary and not
beyond the recommended dosage. (1)Hepatitis B is transmitted by the serum of infected people.
Because all blood and blood products are potential sources of contamination, the patient should not
 donate blood. (2)The major source of transmission is via infected serum. It is also transmitted by body
fluids sue as saliva and semen. The patient should avoid sexual contact until antigen-antibody tests
are negative. When sex is allowed to resume, a condom should be worn and sexual contact should be
refrained from during menstruation. (3)All blood and blood products and any instruments that pierce
the skin and enter the vascular system are potential sources of contamination. Patients are told not to
share needles and to d~ pose of them properly after single use.
10. Which nursing measure would be most effective in helping the client cough and deep breathe after a
cholecystectomy?
A. Having the client take rapid, shallow breaths to decrease pain.
B. Having the client lay on the left side while coughing and deep breathing.
C. Teaching the client to use a folded blanket or pillow to splint the incision.
D. Withholding pain medication so the client can be alert enough to follow the nurse's instructions.
10. C
3: A folded bath blanket or pillow placed over the incision will be most effective in helping the client
cough and deep breathe after a cholecystectomy. 1: Taking rapid, shallow breaths would not be
effective in decreasing pain. 2: Lying on the left side would cause decreased lung expansion. When
possible, the client should be positioned in semi-Fowler's or Fowler's position to promote maximum
lung expansion.. 4: Withholding pain medication will make the client less likely to cough and deep
breathe owing to the discomfort.
11. A client had an abdominal perineal resection with a colostomy 4 days ago and is ready for discharge.
Which of the following would be an appropriate expected outcome at this point?
A. The client maintains a high-fiber diet.
B. The client discusses concerns about his sexual functioning.
C. The client maintains bedrestbed rest.
D. The client limits fluid intake to 1000 ml/day.
11. B
2: Clients often have concerns about their sexuality after a fecal diversion. The nurse should encourage
the client to discuss any questions about sexual functioning. 1: The client will not need to maintain a
high-fiber diet but will be encouraged to avoid any foods that cause odor and flatulence. 3: The client
should be able to ambulate and sit out of bed for several hours at a time at this point. 4: Fluid intake
will be encouraged, not restricted.
12. Before administering an intermitted tube feeding through a nasogastric tube, the nurse assesses for
gastric residual. The nurse understands that this procedure is important to
A. Confirm proper nasogastric tube placement.
B. Observe gastric contents.
C. Assess fluid and electrolyte status.
D. Evaluate absorption of the last feeding.
12. D
All the stomach contents are aspirated and measure before administering a tube feeding. This
procedure measures the gastric residual. The gastric residual is assessed to confirm whether
undigested formula from a previous feeding remains and thereby evaluates absorption of the last
feeding. Assessment of gastric residual is important because administration of a tube feeding to a full
stomach could result in overdistention, thus predisposing the client to regurgitation and possible
aspiration. Options 1, 2, and 3 do not relate to the purpose of assessing residual.
13. Which of the following expected outcomes would be appropriate for the client who has ulcerative
colitis?
A. The client maintains a daily record of intake and output.
B. The client verbalizes the importance of small, frequent feedings.
C. The client uses a heating pad to decrease abdominal cramping.
D. The client accepts that a colostomy is inevitable at some time in his life.
13. B
2: Small, frequent feedings are better tolerated by clients with ulcerative colitis as they lessen the
amount of fecal material present in the gastrointestinal tract and decrease stimulation. 1: The client
does not need to maintain a daily record of intake and output unless an exacerbation of the disease
occurs. 3: A heating pad should not be applied to the intestine as it is inflamed. 4: It is not inevitable
that the client will require surgery to treat the ulcerative colitis as about 85% respond favorably to
conservative therapy. If the severity of the disease mandates surgery, the colon will be removed,
resulting in an ileostomy.
14. The 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
A. Vitamin B12 injections
B. Vitamin B6 injections
C. An antibiotic
D. An antacid
14. A
A lack of the intrinsic factor needed to absorb vitamin B12 occurs in pernicious anemia. Vitamin B12 is
needed for the maturation of red blood cells. Vitamin B6 is not necessarily needed for pernicious
anemia and can be taken orally. An antibiotic and antacids may be prescribed for certain types of
gastric ulcers.
15. When assessing the client with celiac disease, the nurse can expect to find which of the following?
A. Steatorrhea
B. Jaundiced sclerae
C. Clay-colored stools
D. Widened pulse pressure
15. A
Because celiac disease destroys the absorbing surface of the intestine, fat isn't absorbed but is passed
in the stool. Steatorrhea is bulky, fatty stools that have a foul odor. Jaundiced sclerae result from
elevated bilirubin levels. Clay-colored stools are seen with biliary disease when bile flow is blocked.
Celiac disease doesn't cause a widened pulse pressure.
16. A client with viral hepatitis states, “I am so yellow.” The nurse most appropriately would
A. Assist the client in expressing feelings.
B. Do most of the activities of daily living for the client.
C. Provide information to the client only when the client requests it.
D. Restrict visitors until the jaundice subsides.
16. A
To assist the client in adapting to changes in appearance, the nurse must encourage participation in
self-care to foster independence and self-esteem. The nurse should encourage the client to ask
questions to clarify misconceptions, learn ways to prevent the spread of hepatitis to reduce fear, and
make appropriate decisions. The nurse should explore the client’s feelings to discover how that client
feels about the disease process and appearance so as to plan appropriate interventions. Restricting
visitors will reinforce the client’s negative self-esteem.
17. A client has been diagnosed with gastroesophageal reflux disease. The nurse interprets that the
client has dysfunction of which of the following parts of the digestive system?
A. Chief cells of the stomach
B. Parietal cells of the stomach
C. Lower esophageal sphincter
D. Upper esophageal sphincter
17. C
The lower esophageal sphincter is a functional sphincter that normally remains close except when food
or fluids are swallowed. If relaxation of this sphincter occurs, the client could experience symptoms of
gastroesophageal reflux disease. The chief cells of the stomach secrete pepsinogen, a precursor to
pepsin, which helps to digest proteins. The parietal cells of the stomach secrete hydrochloric acid
(gastric acid) and intrinsic factor. The upper esophageal sphincter is formed by the cricopharyngeus
muscle attached to the cricoid cartilage.
18. The nurse is caring for a client on the first postoperative day following a surgical repair of an
abdominal aortic aneurysm. Which nursing diagnosis is the most important for this client?
A. Risk for infection
B. Deficient knowledge
C. Ineffecitve peripheral tissue perfusion
D. Activity intolerance
18. C
Peripheral tissue perfusion is a major concern in the postoperative period following an abdominal
aneurysm repair. Peripheral pulses should be checked frequently during the first 24 hours. A weak or
absent pulse may be a sign of embolization or graft closure, especially if accompanied by a pale, cold,
mottled extremity; the nurse should immediately report this to the surgeon. Risk for
infection, Deficient knowledge, andActivity intolerance are all important nursing diagnoses in the
postoperative client after the nurse has assessed graft patency and peripheral circulation. Generally,
wound infections don't occur until 4 to 7 days after surgery.
19. The client with cirrhosis has ascites and excess fluid volume. Which measure will the nurse include in
the plan of care for this client?
A. Increase the amount of sodium in the diet.
B. Limit the amount of fluids consumed.
C. Encourage frequent ambulation.
D. Administer magnesium antacids.
19. B
Excess fluid volume, related to the accumulation of fluid in the peritoneal and dependent areas of the
body, can occur in the client with cirrhosis. Fluids should be restricted, including fluids given in
medications and meals. Sodium restriction also aids in reducing fluid volume excess. Options 3 and 4
will not assist in reducing excess fluid volume.
20. The client has had a new colostomy created 2 days earlier. The client is beginning to pass
malodorous flatus from the stoma. The nurse interprets that
A. This indicates inadequate preoperative bowel preparation.
B. This is a normal, expected event.
C. The client is experiencing early signs of ischemic bowel.
D. The client should not have the nasogastric tube removed.
20. B
As peristalsis returns following creation of a colostomy, the client begins to pass malodorous flatus.
This indicates returning bowel function and is an expected event. Within 74 hours of surgery, the client
should begin passing stool via the colostomy. Options 1, 3, and 4 are incorrect.
21. The nurse is assessing a 71-year-old female client with ulcerative colitis. Which assessment finding
related to the family will have the greatest impact on the client's rehabilitation after discharge?
A. The family's ability to take care of the client's special diet needs
B. The family's expectation that the client will resume responsibilities and role-related activities
C. Emotional support from the family
D. The family's ability to understand the ups and downs of the illness
21. C
Emotional support from the family is the main need. A special diet doesn't focus on emotional needs.
Role expectations don't address the main issue, but emotional support while the client is fulfilling these
roles is important. The family's ability to understand the ups and downs of the illness will help them
but not the client.
22. The nurse is performing an assessment on a client with acute pancreatitis who was admitted to the
hospital. Which of the following assessment questions most specifically would elicit information
regarding the pain that is associated with acute pancreatitis?
A. “Does the pain in your abdomen radiate to your groin.”
B. “Does the pain in your stomach radiate to the back?”
C. “Does the pain in your stomach radiate to your lower middle abdomen?”
D. “Does the pain in your lower abdomen radiate to the hip?”
22. B
The pain that is associated with acute pancreatitis is often severe and is located in the epigastric
region and radiates to the back. Options 1, 3, and 4 are incorrect because they are not specific for the
pain experienced by the client with pancreatitis.
23. 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 stool less watery?
A. Pasta
B. Boiled rice
C. Bran
D. Low-fat cheese
23. C
Foods that help to 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 to thicken or loosen this liquid drainage.
24. The nurse is caring for a client with an exacerbation of ulcerative colitis. Which of the following
nursing measures should be included in the client's plan of care?
A. Encourage regular use of antidiarrheal medications.
B. Incorporate frequent rest periods into the client's schedule.
C. Have the client maintain a high-fiber diet.
D. Wear a gown when providing direct client care.
24. B
2: It is important for the client to have frequent rest periods. Repeated episodes of diarrhea interrupt
sleep patterns, and poor nutrition may also cause the client to feel weak. If the client is experiencing a
 severe exacerbation of ulcerative colitis, bed rest may be ordered. 1: Antidiarrheal medications can be
used selectively in ulcerative colitis but are not recommended for regular use as they can lead to
colonic dilation. 3: The client should maintain a low-residue, high-calorie, caffeine-free diet. 4: The
nurse does not need to wear a gown when providing direct client care because an infectious organism
is not present.
25. A nurse orientee is preparing to insert a nasogastric tube, and a nurse educator is observing the
procedure. Which of the following supplies if obtained by the nurse orientee would indicate a need foe
further education regarding this procedure?
A. Half-inch or one-inch tape
B. Oil-soluble lubricant
C. A glass of tap water with a straw
D. A 50-mL catheter tip syringe
25. B
Water-soluble lubricant is used to lubricate 3 to 4 inches of the tube at the insertion end. An oil
lubricant is not used because if the tube accidentally goes into the bronchus, pneumonia can develop.
Half-inch tape is used to secure the tube after the correct placement is verified. A 50-mL catheter tip
syringe is used to aspirate gastric contents to confirm placement. The client will be asked to take a sip
of water through a straw to help with the passage of the tube.
26. Which of the following expected outcomes would be most appropriate for a client with peptic ulcer
disease? The client will:
A. verbalize absence of epigastric pain.
B. accept the need to inject himself with vitamin B12 for the rest of his life.
C. understand the need to increase his exercise activity.
D. eliminate stress from his life.
26. A
1: A realistic goal for this client would be to gain relief from epigastric pain. 2: There is no need for
vitamin B12 injections because this client has not had any gastric surgery that would lead to vitamin
B12 deficiency. 3: Exercise should be modified, not increased, because it can stimulate further
production of gastric acid. 4: It is not possible to eliminate stress from a client's life. Instead, the client
should be assisted to develop effective coping and problem-solving strategies as necessary.
27. A nurse is developing a teaching plan for the client with viral hepatitis. The nurse plans to tell the
client which of the following in the teaching session?
A. Activity should be limited to prevent fatigue
B. The diet should be low in calories
C. Meals should be large to conserve energy
D. Alcohol intake should be limited to 2 oz. per day.
27. A
The client with viral hepatitis should limit activity to avoid fatigue during the recuperation period. The
diet should be optimal in calories, proteins, and carbohydrates. The client should take in several small
meals per day. Alcohol is strictly forbidden.
28. After gastric resection surgery, which of the following signs and symptoms would alert the nurse to
the development of a leaking anastomosis?
A. Pain, fever, and abdominal rigidity.
B. Diarrhea with fat in the stool.
C. Palpitations, pallor, and diaphoresis after eating.
D. Feelings of fullness and nausea after eating.
28. A
1: Pain, fever, and abdominal rigidity are signs and symptoms of inflammation or peritonitis caused by
the leaking anastomosis. 2: Diarrhea with fat in the stool is steatorrhea and is not present in peritonitis.
3: Palpitations, pallor, and diaphoresis after eating are vasomotor symptoms of gastric retention. 4:
Feelings of fullness and nausea after eating are not present in peritonitis.
29. 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
A. Vitamin B12 injections.
B. Vitamin B6 injections.
C. An antibiotic.
D. An antacid.
29. A
A lack of the intrinsic factor needed to absorb vitamin B12 occurs in pernicious anemia. Vitamin B12 is
needed for the maturation of red blood cells. Vitamin B6 is not necessarily needed for pernicious
 anemia and can be taken orally. An antibiotic and antacids may be prescribed for certain types of
gastric ulcers.
30. The nurse assesses the client's understanding of the relationship between body position and
gastroesophageal reflux. Which response would indicate that the client understands measures to avoid
problems with reflux while sleeping?
A. "I can elevate the foot of the bed 4 to 6 inches."
B. "I can sleep on my stomach with my head turned to the left."
C. "I can sleep on my back without a pillow under my head."
D. "I can elevate the head of the bed 4 to 6 inches."
30. D
4: Sleeping with the head of the bed elevated encourages movement of food through the esophagus
by gravity. By fostering esophageal acid clearance, gravity helps keep the acidic pepsin and alkaline
biliary secretions from contacting the esophagus. 1: Elevating the foot of the bed does not affect
clearance of esophageal acid. 2: This position will not decrease reflux incidence. 3: Sleeping flat
without a pillow under the head does not enhance clearance.
31. A client with ulcerative colitis is diagnosed with a mild case of the disease. The nurse doing dietary
teaching gives the client examples of foods to eat that represent which of the following therapeutic
diets?

A. High-fat with milk

B. High-protein without milk
C. Low-roughage without milk
D. Low-roughage with milk
31. C
The client with a mild to moderate case of ulcerative colitis often is prescribed a diet that is low in
roughage and does not include milk. This will help to reduce the frequency of diarrhea for this client.
Options A, B, and D are correct.
32. A nurse is inserting a nasogastric tube in an adult client. During the procedure, the client begins to
cough and has difficulty breathing. Which of the following is the most appropriate nursing action?
A. Remove the tube and reinsert when the respiratory distress subsides.
B. Pull back on the tube and wait until the respiratory distress subsides.
C. Quickly insert the tube.
D. Notify the physician immediately.
32. B
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 1 and 4 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.
33. A client who has had gastrectomy is not producing sufficient intrinsic factor. The nurse interprets that
the client has loss the ability to absorb cyanocobalamin (vitamin B12) in the
A. Stomach.
B. Small intestine.
C. Large intestine.
D. Colon.
33. B
Intrinsic factor is produced in the stomach but is used to aid in the absorption of vitamin B12 in the
small intestine. Vitamin B12 is not absorbed in the large intestine (options 3 and 4).
34. The nurse aspirates 40 mL of undigested formula from the client’s nasogastric tube. Before
administering an intermittent tube feeding, the nurse understands that the 40 mL of gastric aspirate
should be
A. Discarded properly and recorded as output on the client’s intake and output record.
B. Poured into the nasogastric tube through a syringe with the plunger removed.
C. Mixed with the formula and poured into the nasogastric tube through a syringe with the plunger
removed.
D. Diluted with water and injected into the nasogastric tube by putting pressure on the plunger.
34. B
After checking the residual feeding contents, the gastric contents are reinstalled into the stomach by
removing the syringe bulb or plunger and pouring the gastric contents into the syringe and through the
nasogastric tube. Gastric contents should be reinstalled to maintain the client’s electrolyte balance.
The gastric contents should be poured into the nasogastric tube through a syringe without a plunger
 and not injected by putting pressure on the plunger. Gastric contents do not need to be mixed with
water or should the contents be discarded.
35. A nurse is preparing to remove a nasogastric tube from a client. The nurse would instruct the client
to do which of the following just before the nurse removes the tube?
A. To perform Valsalva’s maneuver
B. To take hold and hold a deep breath
C. To exhale
D. To inhale and exhale quickly
35. B
When the nurse removes a nasogastric tube, the client is instructed to take and hold a deep breath.
This will be obstructed temporarily during the tube removal. This allows for easy withdrawal through
the esophagus into the nose. The nurse removes the tube with one smooth, continuous pull.
36. The nurse is planning to teach the client with gastroesophageal reflux disease about substances that
will increase the lower esophageal sphincter pressure. Which of the following items would the nurse
include on this list?
A. Fatty foods
B. Nonfat milk
C. Chocolate
D. Coffee
36. B
Foods that increase the lower esophageal sphincter (LES) pressure will decrease reflux, and lessen the
symptoms of gastroesophageal reflux disease (GERD). The food substance that will increase the LES
pressure is nonfat milk. The other substances listed decrease the LES pressure, thus increasing reflux
symptoms. Aggravating substances include chocolate, coffee, fatty foods and alcohol.
37. Lactulose (Chronulac) is prescribed for a client with a diagnosis of hepatic encephalopathy. The nurse
would determine that this medication has had a therapeutic effect if which of following is noted?
A. Increased red blood cell count
B. Decreased serum ammonia level
C. Increased protein level
D. Decreased white blood cell level
37. B
Lactulose is prescribed for the client with hepatic encephalopathy to reduce bacterial breakdown of
protein in the bowel. The medication creates an acidic environment in the bowel and causes the
ammonia to leave the bloodstream and enter the colon. Ammonia then becomes trapped in the bowel.
Lactulose also has a laxative effect that allows for the elimination of the ammonia.
38. A nurse has been caring for a client with a Sengstaken-Blakemore tube. The physician arrives on the
nursing unit and deflates the esophageal balloon. The nurse should monitor the client most closely for
which of the following?
A. Swelling of the abdomen
B. Bloody diarrhea
C. Vomiting blood
D. An elevated temperature and arise in blood pressure
38. C
A Sengstaken-.Blakemore tube is inserted into a client with a diagnosis of cirrhosis and ruptured
esophageal varices. The tube has an esophageal and a gastric balloon. The esophageal balloon exerts
pressure on the bleeding. The pressure of the esophageal balloon is released at intervals to decrease
the risk of trauma to esophageal tissues, including esophageal rupture or necrosis. When the balloon is
deflated the may begin to bleed again from the esophageal varices, noted by vomiting of blood.
39. A client is scheduled for an abdominal perineal resection with permanent colostomy. Which of the
following measures would most likely be included in the plan for the client's preoperative preparation?
A. Keep the client NPO for 2 days before surgery.
B. Administer kanamycin (Kantrex) the night before surgery.
C. Inform the client that chest tubes will be in place after surgery.
D. Advise the client to limit activity.
39. B
2: Antibiotics are administered preoperatively to reduce the bacterial count in the colon. 1: The client
will be placed on a low residue diet to help cleanse the bowel before surgery but typically is not placed
on NPO status until 8 to 12 hours before surgery. Laxatives and enemas may also be administered. 3:
Chest tubes would not be expected postoperatively. 4: There is no need to limit the client's activity
before surgery.
40. The client with chronic pancreatitis needs information on dietary modification to manage the health
problem. The nurse teaches the client to limit which of the following items in the diet?
A. Carbohydrate
B. Protein
C. Fat
D. Water-soluble vitamins
40. C
The client should limit fat in the diet. The client also should take in small meals, which also will reduce
the amount of carbohydrates and protein that the client must digest at any one time. The client does
not need to limit water-soluble vitamins in the diet.
41. 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?
A. Restricting pain medication
B. Maintaining bedrest
C. Avoiding coughing
D. Irrigating the drain
41. C
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.
42. A client has a nasogastric tube inserted at the time of abdominal perineal resection with permanent
colostomy. This tube will most likely be removed when the client demonstrates:
A. Absence of nausea and vomiting.
B. Passage of mucus from the rectum.
C. Passage of flatus and feces from the colostomy.
D. Absence of stomach drainage for 24 hours.
42. C
3: A sign indicating that a client's colostomy is open and ready to function is passage of feces and
flatus. When this occurs, gastric suction is ordinarily discontinued, and the client is allowed to start
taking fluids and food orally. Absence of bowel sounds would indicate that the tube should remain in
place because peristalsis has not yet returned. 1: Absence of nausea and vomiting is not a criterion for
judging whether or not gastric suction should be continued. 2: Passage of mucus from the rectum will
not occur in this client because the rectum is removed in this surgery. 4: Absence of stomach drainage
is not a criterion for judging whether or not gastric suction should be continued.
43. A nurse is performing an abdominal assessment on a client. The nurse determines that which of the
following findings that which of the following findings should be reported to the physician?
A. Concave, midline umbilicus
B. Pulsation between the umbilicus and pubis
C. Bowel sound frequency of 15 sounds per minute
D. Absence of a bruit
43. B
The umbilicus should be in the midline, with a concave appearance. The presence of pulsation between
the umbilicus and the pubis could indicate abdominal aortic aneurysm and should be reported to the
physician. Bowel sounds vary according to the timing of the last meal, and usually range in frequency
from 5 to 35 per minute. Bruits are not normally present.
44. The nurse is doing preoperative 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?
A. “I will need to drain the pouch regularly with a catheter.”
B. “I will need to wear a drainage bag for the rest of my life.”
C. “The drainage from this type of ostomy will be formed.”
D. “I will be able to pass stool from the rectum eventually.”
44. A
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 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 mucous 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 anastomosis were created. This type of operation is a two-stage
procedure.
45. A nurse is caring for a client who has just returned from the operating room following 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 most appropriate
based on this assessment?
A. Notify the physician
B. Document the amount and characteristics of the drainage
C. Apply ice to the stoma site
D. Apply pressure to the site
45. D
During the first 24 to 72 hours following surgery, mucus and serosanguineous drainage are expected
from the stoma. Options 2 and 3 are inappropriate actions. The nurse does not need to notify the
physician because this is an expected finding
46. Cholestyramine resin (Questran Light) is prescribed for the client with an elevated serum cholesterol
level. The nurse would instruct the client to take the medication
A. After meals.
B. Mixed with fruit juice.
C. Via rectal suppository.
D. At least 3 hours before meals.
46. B
Cholestyramine resin binds with bile salts in the intestines to form a compound that is excreted in the
feces. The client should be instructed to mix the medication with 3 to 6 oz of water, milk, fruit juice, or
soup. The medication should be administered before meals. The medication is not administered via
rectal suppository.
47. A client is admitted with a diagnosis of ulcerative colitis. Which of the following symptoms should the
nurse expect the client to report when responding to questions about his bowel elimination pattern?
A. Constipation.
B. Bloody, diarrheal stools.
C. Steatorrhea.
D. Alternating periods of constipation and diarrhea.
47. B
2: Diarrhea is the primary symptom of ulcerative colitis. It is profuse and severe; the client may pass
as many as 15 to 20 watery stools per day. Stools may contain blood, mucus, and pus. The frequent
diarrhea is often accompanied by anorexia and nausea. 1: Constipation is not a sign or symptom of
ulcerative colitis. 3: Steatorrhea (fatty stools) is more typical of pancreatitis and cholecystitis. 4:
Alternating diarrhea and constipation is associated with irritable bowel syndrome.
48. The nurse is caring for a client following a Billroth II procedure. On review of the postoperative orders,
which of the following if prescribed, should the nurse question and verify?
A. Irrigating the nasogastric tube
B. Coughing and deep breathing exercises
C. Leg exercises
D. Early ambulation
48. A
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 B,C, and D are appropriate
postoperative interventions.
49. The nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping
syndrome, the nurse should advise the client to:
A. restrict fluid intake to 1 qt (1,000 ml)/day.
B. drink liquids only with meals.
C. don't drink liquids 2 hours before meals.
D. drink liquids only between meals.
49. D
A client who experiences dumping syndrome after a subtotal gastrectomy should be advised to ingest
liquids between meals rather than with meals. Taking fluids between meals allows for adequate
hydration, reduces the amount of bulk ingested with meals, and aids in preventing rapid gastric
emptying. There is no need to restrict the amount of fluids, just the time when the client drinks fluids.
Drinking liquids with meals increases the risk of dumping syndrome by increasing the amount of bulk
and stimulating rapid gastric emptying. Small amounts of water are allowable before meals.
50. The nurse is irrigating a client's colostomy when she complains of abdominal cramping after
receiving about 100 mL of the irrigating solution. What should the nurse's first response be in this
situation?
A. Stop the flow of solution temporarily.
B. Reposition the client on to her right side.
C. Remove the irrigation tube.
D. Massage the abdomen gently.
50. A
1: The abdominal cramping that can occur during colostomy irrigation results from stimulation of the
colon by the irrigating solution. The nurse's first response should be to temporarily stop the flow of
solution to allow the cramping to subside. 2: Repositioning the client to the right side will not alleviate
the cramping. 3: Removing the tube will not decrease the cramping and will necessitate reinsertion of
the tube when the irrigation is resumed. 4: Massaging the abdomen gently may be soothing to some
clients, but it is not the nurse's first priority action.
51. A nurse teaches a preoperative client about the nasogastric tube that will be inserted in preparation
for surgery. The nurse determines that the client understands when the tube will be removed in the
postoperative period when the client states
A. “When my gastrointestinal system is healed enough.”
B. “When I can tolerate food without vomiting.”
C. “When my bowels begin to function again, and I begin to pass gas.”
D. “When the doctor says so.”
51. C
Nasogastric tubes are discontinues when normal function returns to the gastrointestinal tract. The tube
will be removed before gastrointestinal healing. Food would not be administered unless bowel function
returns. Although the physician determines when the nasogastric tube will be removed, option 4 does
not determine effectiveness of teaching.
52. A Penrose drain is in place on the first postoperative day following a cholecystectomy.
Serosanguineous drainage is noted on the dressing covering the drain. Which nursing intervention is
most appropriate?
A. Notify the physician.
B. Change the dressing.
C. Circle the amount on the dressing with a pen.
D. Continue to monitor the drainage.
52. B
Serosanguineous drainage with a small amount of bile is expected from the Penrose drain for the first
24 hours. Drainage then decreases, and the drain is removed usually within 48 hours. The nurse does
not need to notify the physician. A sterile dressing covers the site and should be changed to prevent
infection and skin excoriation.
53. The nurse is monitoring a client for the early signs and symptoms for dumping syndrome. Which
symptom indicates this occurrence?
A. Abdominal cramping and pain
B. Bradycardia and indigestion
C. Sweating and pallor
D. Double vision and chest pain
53. C
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.
54. Which of the following nursing measures would be inappropriate when caring for a client with a
Cantor tube?
A. Injecting 10 mL of air into the tube to facilitate drainage.
B. Applying a water-soluble lubricant to the client's nares.
C. Coiling extra tubing on the client's bed.
D. Irrigating the tube with 50 mL of normal saline solution.
54. D
4: Intestinal tubes are not irrigated. 1: This nursing measure is appropriate. 2: This nursing measure is
appropriate. 3: This nursing measure is appropriate.
55. Of the following signs and symptoms of bowel obstruction, which is related primarily to small bowel
obstruction rather than large bowel obstruction?
A. Profuse vomiting.
B. Cramping abdominal pain.
C. Abdominal distention.
D. High-pitched bowel sounds above the obstruction.
55. A
1: Profuse vomiting is the classic sign of small bowel obstruction and rarely occurs with large bowel
obstruction. 2: Abdominal discomfort is present in both small and large bowel obstructions. 3:
Abdominal distention occurs with both small and large bowel obstruction but is more common in large
bowel obstruction. 4: High-pitched bowel sounds indicate hyperperistalsis, which occurs early in
obstruction.
56. A nurse is assigned to a 40-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
56. C
The normal serum amylase level is 25 to 151 IU/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 1 and 2 are within normal limits. Option 3 is an
extremely elevated level seen in acute pancreatitis.
57. The client is admitted to the hospital with viral hepatitis, complaining of “no appetite” and “losing my
taste for food.” To provide adequate nutrition, the nurse would instruct the client to
A. Eat a good supper when anorexia is not as severe.
B. Eat less often, preferably only three large meals daily.
C. Increase intake of fluids including juices.
D. Select foods high in fat.
57. C
Although no special diet is required to treat viral hepatitis, it is generally recommended that clients
consume a diet with low-fat content because fat may be tolerated poorly because of decreased bile
production. Small, frequent meals are preferable and may even prevent nausea. Frequently, appetite is
better in the morning, so it is easier to eat a good breakfast. An adequate fluid intake of 2500 to 3000
mL per day that includes nutritional juices is also important.
58. Which of the following techniques would the nurse use first to determine if a nasogastric tube is
positioned in the stomach?
A. Aspirating with a syringe and observing for the return of gastric contents.
B. Irrigating with normal saline and observing for the return of solution.
C. Placing the tube's free end in water and observing for air bubbles.
D. Instilling air and auscultating over the epigastric area for the presence of the tube.
58. A
1: The initial way to determine if a nasogastric tube is in the stomach is to apply suction to the tube
with a syringe and observe for the return of stomach contents. Then the pH of the aspirate can be
measured. This is the method of choice. 2: One would not irrigate until tube placement is confirmed.
Irrigation is not associated with placement confirmation techniques. 3: Observing for air bubbles when
the free end of the tube is placed under water is an unacceptable, unsafe method of determining tube
placement. 4: Another method is to instill air into the tube with a syringe while auscultating over the
epigastric area. Hearing the air enter the stomach helps ensure proper placement, but the method is
not foolproof and is no longer considered an effective or preferred way to determine placement. (SR
3114)
59. Vasopressin (Pitressin) therapy is prescribed for a client with a diagnosis of bleeding esophageal
varices. The nurse is preparing to administer the medication to the client. Which of the following
essential items is needed during the administration of this medication?
A. A cardiac monitor
B. An intubation set
C. A suction setup
D. A tracheotomy set
59. A
The major action of vasopressin is constriction of the splanchnic blood flow. Continuous
electrocardiogram and blood pressure monitoring is essential because of the constrictive effects of the
medication on the coronary arteries. Options 2, 3, and 4 are not essential items required during the
administration of this medication.
60. When preparing the client with hepatitis A for extended convalescence, the nurse teaches the client
about problems that may occur. The nurse knows that the client has understood the teaching when he
says that he is most likely to have difficulty:
A. Controlling abdominal pain.
B. Maintaining a regular bowel elimination pattern.
C. Preventing respiratory complications.
D. Maintaining a positive, optimistic outlook.
60. 4
4: Convalescence after hepatitis A may take weeks or even months. Boredom and depression are
common problems that the client should anticipate. 1: Abdominal pain is not usually a symptom of
hepatitis A. 2: Maintaining a regular bowel elimination pattern is not usually a problem with hepatitis.
3: Problems preventing respiratory complications are unlikely. To support healing, activity is strictly
limited but bed rest is not prescribed.
61. 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. To assess for the presence of this sign, the nurse would do
which of the following?
A. Ask the client to extend the arms.
B. Assess for the client the presence of Homans’ sign.
C. Instruct the client to lean forward.
D. Measurement the abdominal girth.
61. A
Asterixis is irregular flapping movements of the fingers and wrists when the hands and arms are
outstretched, with the palms down, wrists bent up, and fingers spread. Asterixis is the most common
and reliable sign that hepatic encephalopathy is developing. Options B,C, and D are incorrect.
62. A client with a history of gastric ulcer suddenly complains of a sharp-severe pain in the mid epigastric
area, which then spreads over the entire abdomen. The client’s abdomen is rigid and board-like to
palpation, and the client obtains most comfort from lying in the knee-chest position. The nurse calls
the physician immediately suspecting that the client is experiencing which of the following
complications of peptic ulcer disease?
A. Perforation
B. Obstruction
C. Hemorrhage
D. Intractability
62. A
The signs and symptoms described in the question are consistent with perforation of the ulcer, which
then progresses to peritonitis if the perforation is large enough. The client with intestinal obstruction
most likely would complain of abdominal pain, distension, and nausea and vomiting. The client with
hemorrhage would be vomiting blood or coffee-ground-like material or would be expelling black, tarry,
or bloody stools. Intractability is a term that refers to continued symptoms of a disease process,
despite ongoing medical treatment. (SR 7794)
63. The nurse is caring for a client admitted to the hospital with a suspected diagnosis of acute
appendicitis. Which of the following laboratory results would the nurse expect to note if the client
indeed has appendicitis?
A. Leukopenia with a shift to the right
B. Leukocytosis with a shift to the right
C. Leukocytosis with a shift to the left
D. Leukopenia with a shift to the left
63. C
Laboratory findings do not establish the diagnosis of appendicitis, but often moderate elevation of the
white blood cell count (leukocytosis) to 10,000 to 18,000 cells/mm3 occurs with a “shift to the left” (an
increased number of immature white blood cells.).
64. To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which
discharge instructions?
A. Lie down after meals to promote digestion.
B. Avoid coffee and alcoholic beverages.
C. Take antacids before meals.
D. Limit fluids with meals.
64. B
To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods
and beverages that tend to 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 doesn't need to limit fluids with meals as long as the fluids aren't gastric irritants.
65. Which of the following activities should the nurse encourage the client with a peptic ulcer to avoid?
A. Chewing gum.
B. Smoking cigarettes.
C. Eating chocolate.
D. Taking acetaminophen (Tylenol).
65. B
2: Cigarette smoking should be avoided because of its stimulatory effect on gastric secretions. Nicotine
also increases the release of epinephrine, which leads to vasoconstriction. 1: The client may chew gum
if desired. 3: The client may eat chocolate if desired. 4: A client with a peptic ulcer should check with
the physician before taking any over-the-counter drug, but acetaminophen does not typically cause
gastric irritation.
66. A client returns from surgery with a sigmoid colostomy. An ostomy appliance is attached. The priority
nursing diagnosis for daily observation and care is:
A. Diarrhea related to alteration in bowel elimination.
B. Impaired skin integrity related to seepage.
C. Impaired nutrition: More than body requirements related to high-fat diet.
D. Impaired physical mobility related to surgical procedure.
66. B
Impaired skin integrity would be the priority nursing diagnosis for daily care of the colostomy because
the effluent from the colostomy can be irritating to the skin. Diarrhea isn't a concern at this point. The
client will be allowed nothing by mouth until peristalsis returns. The client should get out of bed on the
first postoperative day, so mobility shouldn't be a problem.
67. The nurse provides medication instructions to a client with peptic ulcer disease. Which statement, if
made by the client, indicates best understanding of the medication therapy?
A. “The cimetidine (Tagamet) will cause me to produce less stomach acid.”
B. “Sucralfate (Carafate) will change the fluid in my stomach.”
C. “Antacids will coat my stomach.”
D. “Omeprazole (Prilosec) will coat the ulcer and help it heal.”
67. A
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. (SR 7870)
68. A nurse is developing a plan of care for a client who will be returning to a nursing unit following a
percutaneous transhephatic cholangiogram. The nurse includes which intervention in the
postprocedure plan of care?
A. Place a sandbag over the insertion site.
B. Allow the client bathroom privileges only.
C. Encourage fluid intake.
D. Allow the client to sit in a chair for meals.
68. A
Following this procedure, the nurse monitors the client’s vital signs closely for indications of
hemorrhage and observes the needle insertion site for bleeding and bile leakage. A sandbag is placed
over the insertion site to prevent bleeding. The client is maintained on bedrest, and oral intake is
avoided in the immediate postprocedure period in case surgery is necessary to control hemorrhage of
bile extravasation.
69. The client with a new colostomy is concerned about the odor from stool from the ostomy drainage
bag. The nurse teaches the client to include which of the following foods in the diet to reduce odor?
A. Yogurt
B. Broccoli
C. Cucumbers
D. Eggs
69. A
The client should be taught to include deodorizing foods in the diet, such as beet greens, parsley,
buttermilk, and yogurt. Spinach also reduces odor but is a gas-forming food as well. Broccoli,
cucumber, and eggs are gas-forming foods.
70. The nurse has inserted a nasogastric 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 slowly to advance the nasogastric 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?
A. Continuing to advance the tube to the desired distance
B. Pulling the tube back slightly
C. Checking the back of the pharynx using a tongue blade and flashlight.
D. Instructing the client to breathe slowly and take sips of water.
70. A
As the nasogastric tube is passed through the oropharynx, the gag reflex is stimulated, which may
cause coughing, gagging, or choking. Instead of passing through to the esophagus, the nasogastric
tube may coil around itself in the oropharynx, or it may enter the larynx and obstruct the airway,
pulling the tube back slightly will remove it from the larynx; advancing the tube might position it in the
trachea. Swallowing closes the epiglottis over the trachea and helps move the tube into the
esophagus. Slow breathing helps the client relax to reduce the gag response. The nurse should check
the back of the client’s throat to note if the tube has coiled. The tube may be advanced after the client
relaxes.
71. A nurse is giving dietary instructions to a client who has a new colostomy. The nurse encourages the
client to eat foods representing which of the following diets for the first 4 to 6 weeks postoperatively?
A. High-protein
B. High-carbohydrate
C. Low-calorie
D. Low-residue
71. D
For the first 4 to 6 weeks following colostomy formation, the client should take in a low-residue diet.
Following this period, the client should eat a high-carbohydrate, high-protein diet. The nurse also
instructs the client to add new foods, one at a time, to determine tolerance to that food.
72. 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 makes which statement to the client?
A. “Take a deep breath when I tell you and breathe normally while I remove the tube.”
B. “Take a deep breath when I tell you and bear down while I remove the tube.”
C. “Take a deep breath when I tell you and slowly exhale while I remove the tube.”
D. “Take a deep breath when I tell you and hold it while I remove the tube.”
72. C
The client should take a deep breath because the client’s airway will be obstructed temporarily during
tube removal. The nurse then tells the client to exhale slowly and withdraws the tube during
exhalation. Bearing down could inhibit the removal of the tube. Breathing normally could result in
aspiration of gastric secretions during inhalation. Holding the breath does not facilitate tube removal.
73. The client with a colostomy has an order for irrigation of the colostomy. The nurse uses which
solution for the irrigation?
A. Distilled water
B. Tap water
C. Sterile water
D. Lactated Ringer’s
73. B
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. Options 1, 3, and 4 are incorrect solutions.
74. A client is suspected of having hepatitis. Which diagnostic test results will assist in confirming this
diagnosis?
A. Decreased erythrocyte sedimentation rate
B. Elevated serum bilirubin
C. Elevated hemoglobin
D. Elevated blood urea nitrogen
74. B
Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels,
elevated erythrocyte sedimentation rates, and leucopenia. An elevated blood urea nitrogen may
indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis.
75. A nurse is providing the client with biliary obstruction a simple overview of the anatomy of the liver
and gallbladder. The nurse tells the client that normally the liver stores bile in the gallbladder, which is
connected to the liver by the?
A. Liver canaliculi
B. Common bile duct
C. Cystic duct
D. Right hepatic duct.
75. C
The gallbladder receives bile from the liver through the cystic duct. The liver collects bile in the
canaliculi. Bile then flows into the common hepatic duct. From the common hepatic duct, the bile can
 be stored in the gallbladder through the cystic duct. Otherwise, the bile can flow directly into the
duodenum by way of the common bile duct.
76. A nurse is reviewing the results of serum laboratory studies drawn on a client who is suspected of
having hepatitis. The nurse interprets that an elevation in which of the following studies is the most
specific indicator of the disease?
A. Erythrocyte sedimentation rate
B. Serum bilirubin
C. Hemoglobin
D. Blood urea nitrogen
76. C
Laboratory indicators of hepatitis include elevated liver enzymes, serum bilirubin level, and
erythrocyte sedimentation rate is nonspecific test that indicates the presence of inflammation
somewhere in the body. Elevated blood urea nitrogen may indicate renal dysfunction. A hemoglobin
level is unrelated to this diagnosis.
77. The nurse develops a plan of care for a client with a T tube. Which one of the following nursing
interventions should be included?
A. Inspect skin around the T tube daily for irritation.
B. Irrigate the T tube every 4 hours to maintain patency.
C. Maintain client in a supine position while T tube is in place.
D. Keep T tube clamped except for during mealtimes.
77. A
1: Bile is erosive and extremely irritating to the skin. Therefore, it is essential that skin around the T
tube be kept clean and dry. 2: T tubes are not routinely irrigated; they are irrigated only on order of the
physician. 3: There is no need to maintain the client in a supine position; assist the client into a
position of comfort. 4: T tubes are never clamped without a physician's order. If ordered to be clamped,
however, this typically is done 1 to 2 hours before and after meals.
78. A client with 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
A. Decreases food absorption in the stomach.
B. Heals the gastric mucosa.
C. Halts stress reactions.
D. Reduces the stimulus to acid secretions.
78. D
A vagotomy, or cutting of the vagus nerve, is done to eliminate parasympathetic stimulation of gastric
secretion. Options 1, 2, and 3 are incorrect descriptions of vagotomy.
79. A client is providing instructions to a client who is scheduled for an oral cholecystogram. The nurse
tells the client to
A. Eat a high-fat meal on the evening before the procedure.
B. Maintain strict NPO status on the day of the procedure.
C. Avoid oral except for water on the day of the procedure.
D. Eat a high-fat meal for breakfast on the day of the procedure.
79. C
The nurse instructs the client to eat a fat-free meal the evening before the procedure and then to avoid
oral intake except for water on the day of the procedure. The client may be given a high-fat meal or
drink during the test to stimulate the emptying of the gallbladder.
80. The nurse is scheduling diagnostic tests for a client. If all of the following diagnostic tests are
ordered, which would be performed last?
A. Gallbladder series
B. Barium enema
C. Barium swallow
D. Oral cholecystogram
80. C
A barium swallow should be done after a barium enema or gallbladder series to prevent the contrast
used in the barium swallow from obstructing the view of other organs. It takes several days for
swallowed barium to pass completely out of the gastrointestinal tract.
81. A client with liver dysfunction has low serum levels of thrombin. The nurse provides care, anticipating
that this client is most at risk of
A. Dehydration
B. Malnutrition
C. Bleeding
D. Infection
81. C
Thrombin is produced by the liver and is necessary for normal clotting. The client who has an
insufficient level of this substance is at risk for bleeding.
82. The hospitalized client with gastroesophageal reflux disease is complaining of chest discomfort that
feels like heartburn following a meal. After administering an ordered antacid, the nurse encourages the
client to lie on which of the following positions?
A. Supine with the head of bed flat
B. On the stomach with the head flat
C. On the left side with the head of bed elevated 30 degrees
D. On the right side with the head of bed elevated 30 degrees
82. C
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 or lying on the right side. The left
side-lying position with the head of bed elevated is most likely to give relief to the client.
83. To accurately assess for jaundice in a patient with dark skin pigmentation, the nurse should examine
which body areas?
A. Nail beds
B. Skin on back of the hand
C. Hard palate of the mouth
D. Soles of the feet
83. C
(3) Jaundice is best assessed in the sclera. However, the dark-skinned patient may have normal yellow
pigmentation present in the sclera. Inspection of the hard palate for a yellow color can confirm the
presence of jaundice. (1) Cyanosis is best observed in the nail beds. (2) Skin on the palm of the hand
can indicate jaundice, but not skin on the back of the hand. (4) Jaundice can be assessed on the soles
of the feet in a patient with dark skin. However, it is better assessed in the hard palate
84. A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease.
During discharge teaching for this client, the nurse should stress:
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.
84. A
Because stool is formed 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
also should instruct the client to wear a collection appliance at all times because ileostomy drainage is
incontinent, to avoid high-fiber foods because they can cause intestinal irritation, and to avoid enteric-
coated medications because they can't be absorbed by the body after an ileostomy.
85. 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 in the client’s record?
A. Chronic constipation
B. Diarrhea
C. Constipation alternating with diarrhea
D. Stool constantly oozing from the rectum
85. B
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 1, 3, and
4 are not characteristics of Crohn’s disease.
86. A nurse 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 best understanding of the dietary measures to follow of the client states an intention to increase
intake of:
A. Pork
B. Milk
C. Chicken
D. Broccoli
86. A
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. Broccoli
contains vitamins C, E, and K and folic acid.
87. 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?
A. Digoxin (Lanoxin)
B. Indomethacin (Indocin)
C. Furosemide (Lasix)
D. Propranolol hydrochloride (Inderal)
87. B
Indomethacin (Indocin) is a Nonsteroidal antiinflammatory drug and can cause ulceration of the
esophagus, stomach, duodenum, or small intestine. Indomethacin is contraindicated in a client with
gastrointestinal disorders. Furosemide (Lasix) is a loop diuretic. Digoxin is an antidysrhythmic.
Propranolol (Inderal) is a B- adnergic blocker. Furosemide, digoxin, and propranolol are not
contraindicated in clients with gastric disorders.
88. The nurse is evaluating the plan of care for a client with peptic ulcer disease with a nursing diagnosis
of Acute Pain. The nurse would determine that the client has not met the expected outcomes if the
client states
A. That pain is relieved with histamine H2 receptor antagonists.
B. That irritating foods have been eliminated from the diet.
C. The client is being awakened at 2 AM with heartburn.
D. The client has absence of pain before meals.
88. C
Expected outcomes for the client with peptic ulcer disease experiencing pain include elimination of
irritating foods from the diet, ability to take prescribed medications that will reduce pain, reporting that
the pain is relieved or prevented with medication, and an ability to sleep through the night without
pain. The client who continues to be awakened by pain requires further modification of medication
therapy, which may include adjustment of timing of histamine H2 receptor antagonist or an additional
dose of antacid before the time when pain awakens the client.
89. 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?
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
89. A
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 8to 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.
90. The nurse is caring for a client with cirrhosis. Which manifestations indicate deficient vitamin K
absorption caused by this liver disease?
A. Dyspnea and fatigue
B. Ascites and orthopnea
C. Purpura and petechiae
D. Gynecomastia and testicular atrophy
90. C
A liver disorder, such as cirrhosis, can disrupt the liver's normal use of vitamin K to produce
prothrombin (a clotting factor). Because of this, 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.
91. A client is scheduled for oral cholecystography. Which one of the following actions would the nurse
plan to implement before the test?
A. Have the client drink 1000 mL of water.
B. Ask the client about possible allergies to iodine or shellfish.
C. Administer an intravenous contrast agent the evening before the test.
D. Administer tap-water enemas until clear.
91. B
1: Drinking large amounts of water is indicated for certain kidney or urinary bladder studies, not gall
bladder studies. 2: Iodine compounds used as radiographic contrast agents, such as iopanoic acid
 (Telepaque), should not be administered to the client with iodine and seafood allergies because
anaphylaxis may occur. 3: The contrast agent is administered orally 10 to 12 hours before the test. The
client is NPO after administration of the contrast agent. 4: Enemas are not required for
cholecystography.
92. A client with liver dysfunction is having difficulty with protein metabolism. The nurse anticipates that
the results of which of the following serum laboratory studies will be elevated?
A. Lactic acid
B. Ammonia
C. Albumin
D. Lactase
92. B
During deamination of proteins, the liver splits the amino group from the carbon-containing compound,
which results in formation of ammonia and a carbon residue. The liver then converts the toxic
ammonia substance into urea, which can be excreted by the kidneys. Clients with liver dysfunction
may have high serum ammonia levels as a result.
93. A client with viral hepatitis has no appetite, and food makes the client nauseated. Which of the
following interventions would be most appropriate?
A. Explain that high-fat diets usually are tolerated better.
B. Encourage intake of foods high in protein.
C. Explain that the majority of calories need to be consumed in the evening hours.
D. Monitor for fluid and electrolyte imbalance.
93. D
If nausea occurs and persists, the client will need to be assessed for fluid and electrolyte imbalance.
Explaining to the client that the majority of calories should be eaten in the morning hours is important
because nausea occurs most often in the afternoon and evening. Clients should select a diet high in
calories because energy is required for healing. Protein increases the workload on the liver. Changes in
bilirubin interfere with fat absorption, so low-fat diets are tolerated better.
94. The client with ascites is scheduled for a paracentesis. The nurse is assisting the physician in
performing the procedure. Which of the following positions will the nurse assist the client to assume for
this procedure?
A. Supine
B. Left side-lying
C. Right side-lying
D. Upright position.
94. D
An upright position allows the intestine to float posteriorly and helps prevent intestinal laceration
during catheter insertion.
95. The nurse is caring for a client with a diagnosis of cirrhosis and is monitoring the client for signs of
portal hypertension. Which initial sign, if noted in the client, indicates the presence of portal
hypertension?
A. Flat neck veins
B. Hypotension
C. Weak pulse
D. Crackles on auscultation of the lungs
95. D
Clinical signs and symptoms or portal hypertension are identical to those of heart failure and include
jugular vein distention, lung crackles, and decreased perfusion to all organs. Initially, the client may
have hypertension, flushed skin, and a bounding pulse.
96. A client is admitted to the hospital with acute viral hepatitis. Which of the following signs or
symptoms would the nurse expect to note based on this diagnosis?
A. Spider angiomas
B. Fatigue
C. Pale urine
D. Weight gain
96. B
Common signs of acute viral hepatitis include weight loss, dark urine, and fatigue. The client is
anorexic, possibly from a toxin produced by the diseased liver, and finds food distasteful. The urine
darkens because of excess bilirubin being excreted by the kidneys. Fatigue occurs during all phases of
hepatitis. Spider angiomas small, dilated blood vessels are common in cirrhosis of the liver.
97. The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis. The client is
scheduled for surgery for 2 hours. The client begins to complain of increases abdominal pain and
 begins to vomit. On assessment the nurse notes that the abdomen distended and bowel sounds are
diminished. Which of the following is the most appropriate nursing intervention?
A. Administer the prescribed pain medication.
B. Notify the physician.
C. Call and ask the operating room team to perform the surgery as soon as possible.
D. Reposition the client and apply a heating pad on warm setting to the client’s abdomen.
97. B
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.
98. A nurse is caring for a client diagnose with pancreatitis. The nurse anticipates that the client would
not experience an elevation of which of the following enzymes?
A. Lipase
B. Lactase
C. Amylase
D. Trypsin
98. B
Lactase is produced in the small intestine and aids in splitting neural fats into glycerol and fatty acids.
Lipase, amylase, and trypsin are produced in the pancreas and aid in the digestion of fats, starches,
and proteins, respectively.
99. The client is admitted to the hospital for treatment of acute hepatitis B. Which activity order would
the nurse expect to be prescribed?
A. Bedrest
B. Encourage ambulation
C. Out of bed in a chair
D. No activity restrictions
99. A
Fatigue is a normal response to hepatic cellular damage. During the acute stage, rest is an essential
intervention to reduce the metabolic demands on the liver and its blood supply.
100. The physician orders a Salem sump tube for gastrointestinal intubation. The nurse prepares for the
insertion and obtains which of the following items from the supply room?
A. A tube with a single lumen that connects to suction
B. A tube with a large lumen and an air vent
C. A Sengstaken-Blakemore tube
D. A Dobbhoff weighted tube
100. B
A tube with a large lumen and an air vent is a Salem sump tube. A tube with a single lumen is called a Levin’s tube. A
Sengstaken-Blakemore tube is used to control bleeding in the esophagus. A Dobbhoff weighted tube is used for feedings.
Gastro 3

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

A. Increased intrathoracic pressure
B. Weakness of the esophageal muscle
C. Increased esophageal muscle pressure
D. 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 midepigastric area along with a rigid, boardlike 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

1. 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. 1. Obesity may cause increased abdominal pressure that pushes the lower portion of the stomach into the
thorax.
3. 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. 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. 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. 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. 2. Ranitidine is a histamine-2 receptor antagonist that reduces acid secretion by inhibiting gastrin secretion.
8. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 4. A vagotomy, or cutting the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion.
34. 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 dermatones in the body.
35. 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. 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. 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. 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. 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. 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. 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. 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. 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. 4. Pain on empty stomach is relieved by taking foods or antacids. The other symptoms are those of a gastric
ulcer.
45. 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. 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. 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. 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. 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. 1. These drugs inhibit action of histamine on the H2 receptors of parietal cells, thus reducing gastric acid output.
Gastro 2

1. Which of the following complications is thought to be the most common cause of appendicitis?
A. A fecalith
B. Bowel kinking
C. Internal bowel occlusion
D. 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 bacteria 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 brain 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 co-worker 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.

1. 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. 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. 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. 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. 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. 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. 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. 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. 1. Diverticulosis is an asymptomatic condition. The other choices are signs and symptoms of diverticulitis.
10. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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 (I
feel this is untrue—dilaudid will helpanything!)
27. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 2. After gastric resection, a client may require total parenteral nutrition or jejunostomy tube feedings to maintain
adequate nutritional status.
38. 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 antispasmidics may be given to
slow gastric emptying.
39. 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. 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. 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. 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. 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 chatacteristic of cholecystitis or hepatitis.
44. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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 (damn).
63. 1. To enhance effectiveness of the irrigation and fecal returns, the client is instructed to increase fluid intake and
prevent constipation.
64. 4. Meperidine (Demerol) rather than morphine is the medication of choice because morphine can cause spasm in
the sphincter of Oddi.
65. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 1. The pain associated with acute pancreatitis is often severe and unrelenting, is located in the epigastric region,
and radiates to the back.
76. 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. 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. 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.
79. 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. 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. 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. 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. 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.
Gastro

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?
A. Hypoalbuminemia
B. Increased capillary permeability
C. Abnormal peripheral vasodilation
D. 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 develops ascites and requires paracentesis.
Relief of which symptom indicated that the paracentesis was effective?
1. Pruritus
2. Dyspnea
3. Jaundice
4. Peripheral Neuropathy

14. You’re caring for Jane, a 57 y.o. patient with liver cirrhosis who develops ascites and requires paracentesis.
Before her paracentesis, you instruct her to:
1. Empty her bladder.
2. Lie supine in bed.
3. Remain NPO for 4 hours.
4. Clean her bowels with an enema.

15. After abdominal surgery, your patient has a severe coughing episode that causes wound evisceration. In addition
to calling the doctor, which intervention is most appropriate?
1. Irrigate the wound & organs with Betadine.
2. Cover the wound with a saline soaked sterile dressing.
3. Apply a dry sterile dressing & binder.
4. Push the organs back & cover with moist sterile dressings.

16. You’re caring for Betty with liver cirrhosis. Which of the following assessment findings leads you to suspect
hepatic encephalopathy in her?
1. Asterixis
2. Chvostek’s sign
3. Trousseau’s sign
4. Hepatojugular reflex

17. You are developing a careplan on Sally, a 67 y.o. patient with hepatic encephalopathy. Which of the following do
you include?
1. Administering a lactulose enema as ordered.
2. Encouraging a protein-rich diet.
3. Administering sedatives, as necessary.
4. Encouraging ambulation at least four times a day.

18. You have a patient with achalasia (incomplete muscle relaxtion of the GI tract, especially sphincter muscles).
Which medications do you anticipate to administer?
1. Isosorbide dinitrate (Isordil)
2. Digoxin (Lanoxin)
3. Captopril (Capoten)
4. Propanolol (Inderal)

19. The student nurse is preparing a teaching care plan to help improve nutrition in a patient with achalasia. You
include which of the following:
1. Swallow foods while leaning forward.
2. Omit fluids at mealtimes.
3. Eat meals sitting upright.
4. Avoid soft and semisoft foods.

20. Britney, a 20 y.o. student is admitted with acute pancreatitis. Which laboratory findings do you expect to be
abnormal for this patient?
1. Serum creatinine and BUN
2. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
3. Serum amylase and lipase
4. Cardiac enzymes

21. A patient with Crohn’s disease is admitted after 4 days of diarrhea. Which of the following urine specific gravity
values do you expect to find in this patient?
1. 1.005
2. 1.011
3. 1.020
4. 1.030

22. Your goal is to minimize David’s risk of complications after a heriorrhaphy. You instruct the patient to:
1. Avoid the use of pain medication.
2. Cough and deep breathe Q2H.
3. Splint the incision if he can’t avoid sneezing or coughing.
4. Apply heat to scrotal swelling.

23. Janice is waiting for discharge instructions after her herniorrhaphy. Which of the following instructions do you
include?
1. Eat a low-fiber diet.
2. Resume heavy lifting in 2 weeks.
3. Lose weight, if obese.
4. Resume sexual activity once discomfort is gone.

24. Develop a teaching care plan for Angie who is about to undergo a liver biopsy. Which of the following points do
you include?
1. “You’ll need to lie on your stomach during the test.”
2. “You’ll need to lie on your right side after the test.”
3. “During the biopsy you’ll be asked to exhale deeply and hold it.”
4. “The biopsy is performed under general anesthesia.”

25. Stephen is a 62 y.o. patient that has had a liver biopsy. Which of the following groups of signs alert you to a
possible pneumothorax?
1. Dyspnea and reduced or absent breath sounds over the right lung
2. Tachycardia, hypotension, and cool, clammy skin
3. Fever, rebound tenderness, and abdominal rigidity
4. Redness, warmth, and drainage at the biopsy site

26. Michael, a 42 y.o. man is admitted to the med-surg floor with a diagnosis of acute pancreatitis. His BP is 136/76,
pulse 96, Resps 22 and temp 101. His past history includes hyperlipidemia and alcohol abuse. The doctor prescribes
an NG tube. Before inserting the tube, you explain the purpose to patient. Which of the following is a most accurate
explanation?
1. “It empties the stomach of fluids and gas.”
2. “It prevents spasms at the sphincter of Oddi.”
3. “It prevents air from forming in the small intestine and large intestine.”
4. “It removes bile from the gallbladder.”

27. Jason, a 22 y.o. accident victim, requires an NG tube for feeding. What should you immediately do after inserting
an NG tube for liquid enteral feedings?
1. Aspirate for gastric secretions with a syringe.
2. Begin feeding slowly to prevent cramping.
3. Get an X-ray of the tip of the tube within 24 hours.
4. Clamp off the tube until the feedings begin.

28. Stephanie, a 28 y.o. accident victim, requires TPN. The rationale for TPN is to provide:
1. Necessary fluids and electrolytes to the body.
2. Complete nutrition by the I.V. route.
3. Tube feedings for nutritional supplementation.
4. Dietary supplementation with liquid protein given between meals.

29. Type A chronic gastritis can be distinquished from type B by its ability to:
1. Cause atrophy of the parietal cells.
2. Affect only the antrum of the stomach.
3. Thin the lining of the stomach walls.
4. Decrease gastric secretions.

30. Matt is a 49 y.o. with a hiatal hernia that you are about to counsel. Health care counseling for Matt should include
which of the following instructions?
1. Restrict intake of high-carbohydrate foods.
2. Increase fluid intake with meals.
3. Increase fat intake.
4. Eat three regular meals a day.

31. Jerod is experiencing an acute episode of ulcerative colitis. Which is priority for this patient?
1. Replace lost fluid and sodium.
2. Monitor for increased serum glucose level from steroid therapy.
3. Restrict the dietary intake of foods high in potassium.
4. Note any change in the color and consistency of stools.

32. A 29 y.o. patient has an acute episode of ulcerative colitis. What diagnostic test confirms this diagnosis?
1. Barium Swallow.
2. Stool examination.
3. Gastric analysis.
4. Sigmoidoscopy.

33. Eleanor, a 62 y.o. woman with diverticulosis is your patient. Which interventions would you expect to include in
her care?
1. Low-fiber diet and fluid restrictions.
2. Total parenteral nutrition and bed rest.
3. High-fiber diet and administration of psyllium.
4. Administration of analgesics and antacids.

34. Regina is a 46 y.o. woman with ulcerative colitis. You expect her stools to look like:
1. Watery and frothy.
2. Bloody and mucoid.
3. Firm and well-formed.
4. Alternating constipation and diarrhea.
35. Donald is a 61 y.o. man with diverticulitis. Diverticulitis is characterized by:
1. Periodic rectal hemorrhage.
2. Hypertension and tachycardia.
3. Vomiting and elevated temperature.
4. Crampy and lower left quadrant pain and low-grade fever.

36. Brenda, a 36 y.o. patient is on your floor with acute pancreatitis. Treatment for her includes:
1. Continuous peritoneal lavage.
2. Regular diet with increased fat.
3. Nutritional support with TPN.
4. Insertion of a T tube to drain the pancreas.

37. Glenda has cholelithiasis (gallstones). You expect her to complain of:
1. Pain in the right upper quadrant, radiating to the shoulder.
2. Pain in the right lower quadrant, with rebound tenderness.
3. Pain in the left upper quadrant, with shortness of breath.
4. Pain in the left lower quadrant, with mild cramping.

38. After an abdominal resection for colon cancer, Madeline returns to her room with a Jackson-Pratt drain in place.
The purpose of the drain is to:
1. Irrigate the incision with a saline solution.
2. Prevent bacterial infection of the incision.
3. Measure the amount of fluid lost after surgery.
4. Prevent accumulation of drainage in the wound.

39. Anthony, a 60 y.o. patient, has just undergone a bowel resection with a colostomy. During the first 24 hours,
which of the following observations about the stoma should you report to the doctor?
1. Pink color.
2. Light edema.
3. Small amount of oozing.
4. Trickles of bright red blood.

40. Your teaching Anthony how to use his new colostomy. How much skin should remain exposed between the
stoma and the ring of the appliance?
1. 1/16”
2. 1/4″
3. 1/2”
4. 1”

41. Claire, a 33 y.o. is on your floor with a possible bowel obstruction. Which intervention is priority for her?
1. Obtain daily weights.
2. Measure abdominal girth.
3. Keep strict intake and output.
4. Encourage her to increase fluids.

42. Your patient has a GI tract that is functioning, but has the inability to swallow foods. Which is the preferred
method of feeding for your patient?
1. TPN
2. PPN
3. NG feeding
4. Oral liquid supplements

43. You’re patient is complaining of abdominal pain during assessment. What is your priority?
1. Auscultate to determine changes in bowel sounds.
2. Observe the contour of the abdomen.
3. Palpate the abdomen for a mass.
4. Percuss the abdomen to determine if fluid is present.

44. Before bowel surgery, Lee is to administer enemas until clear. During administration, he complains of intestinal
cramps. What do you do next?
1. Discontinue the procedure.
2. Lower the height of the enema container.
3. Complete the procedure as quickly as possible.
4. Continue administration of the enema as ordered without making any adjustments.

45. Leigh Ann is receiving pancrelipase (Viokase) for chronic pancreatitis. Which observation best indicates the
treatment is effective?
1. There is no skin breakdown.
2. Her appetite improves.
3. She loses more than 10 lbs.
4. Stools are less fatty and decreased in frequency.

46. Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab value is most likely to be elevated?
1. Calcium
2. Glucose
3. Magnesium
4. Potassium

47. Anna is 45 y.o. and has a bleeding ulcer. Despite multiple blood transfusions, her HGB is 7.5g/dl and HCT is
27%. Her doctor determines that surgical intervention is necessary and she undergoes partial gastrectomy.
Postoperative nursing care includes:
1. Giving pain medication Q6H.
2. Flushing the NG tube with sterile water.
3. Positioning her in high Fowler’s position.
4. Keeping her NPO until the return of peristalsis.

48. Sitty, a 66 y.o. patient underwent a colostomy for ruptured diverticulum. She did well during the surgery and
returned to your med-surg floor in stable condition. You assess her colostomy 2 days after surgery. Which finding do
you report to the doctor?
1. Blanched stoma
2. Edematous stoma
3. Reddish-pink stoma
4. Brownish-black stoma

49. Sharon has cirrhosis of the liver and develops ascites. What intervention is necessary to decrease the excessive
accumulation of serous fluid in her peritoneal cavity?
1. Restrict fluids
2. Encourage ambulation
3. Increase sodium in the diet
4. Give antacids as prescribed

50. Katrina is diagnosed with lactose intolerance. To avoid complications with lack of calcium in the diet, which food
should be included in the diet?
1. Fruit
2. Whole grains
3. Milk and cheese products
4. Dark green, leafy vegetables

51. Nathaniel has severe pruritus due to having hepatitis B. What is the best intervention for his comfort?
1. Give tepid baths.
2. Avoid lotions and creams.
3. Use hot water to increase vasodilation.
4. Use cold water to decrease the itching.

52. Rob is a 46 y.o. admitted to the hospital with a suspected diagnosis of Hepatitis B. He’s jaundiced and reports
weakness. Which intervention will you include in his care?
1. Regular exercise.
2. A low-protein diet.
3. Allow patient to select his meals.
4. Rest period after small, frequent meals.

53. You’re discharging Nathaniel with hepatitis B. Which statement suggests understanding by the patient?
1. “Now I can never get hepatitis again.”
2. “I can safely give blood after 3 months.”
3. “I’ll never have a problem with my liver again, even if I drink alcohol.”
4. “My family knows that if I get tired and start vomiting, I may be getting sick again.”

54. Gail is scheduled for a cholecystectomy. After completion of preoperative teaching, Gail states,”If I lie still and
avoid turning after the operation, I’ll avoid pain. Do you think this is a good idea?” What is the best response?
1. “You’ll need to turn from side to side every 2 hours.”
2. “It’s always a good idea to rest quietly after surgery.”
3. “The doctor will probably order you to lie flat for 24 hours.”
4. “Why don’t you decide about activity after you return from the recovery room?”

55. You’re caring for a 28 y.o. woman with hepatitis B. She’s concerned about the duration of her recovery. Which
response isn’t appropriate?
1. Encourage her to not worry about the future.
2. Encourage her to express her feelings about the illness.
3. Discuss the effects of hepatitis B on future health problems.
4. Provide avenues for financial counseling if she expresses the need.

56. Elmer is scheduled for a proctoscopy and has an I.V. The doctor wrote an order for 5mg of I.V.
diazepam(Valium). Which order is correct regarding diazepam?
1. Give diazepam in the I.V. port closest to the vein.
2. Mix diazepam with 50 ml of dextrose 5% in water and give over 15 minutes.
3. Give diazepam rapidly I.V. to prevent the bloodstream from diluting the drug mixture.
4. Question the order because I.V. administration of diazepam is contraindicated.

57. Annebell 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 80ml 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.

1. A 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. B Good circulation causes tissues to be moist and red, so a healthy, well-healed stoma appears red and
moist.
3. A A colostomy in the sigmoid colon produces a solid, formed stool.
4. D High-fiber foods stimulate peristalsis, and a result, flatus. Yogurt reduces gas formation.
5. B A proper fit protects the skin, but doesn’t impair circulation. A 1/16” should be cut.
6. B Observation, auscultation, percussion, palpation
7. D 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. C 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. B To avoid overloading the small intestine, encourage the patient to eat six small, regularly spaced meals.
10. B 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