Author: nursedaisy98

ID: 256680
Card Set: Adult Health - Gastrointestinal
Updated: 4/20/2014
Tags: NCLEX RN
Description: Gastrointestinal
Show Answers:
1. The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis
who is scheduled for surgery in 2 hours. The client begins to complain of increased
abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is
distended and bowel sounds are diminished. Which is the most appropriate nursing
intervention?
1. Notify the health care provider (HCP).
2. Administer the prescribed pain medication.
3. Call and ask the operating room team to perform the surgery as soon as possible.
4. Reposition the client and apply a heating pad on the warm setting to the client's abdomen.

1. Notify the health care provider (HCP)

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

2. Severe and unrelenting, located in the epigastric area and radiating to the back

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

4. Right upper quadrant, radiating to the right scapula and shoulder

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

2. Increase intake of fluids, including juices.

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

1. Malaise
6. A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate for
this client? Select all that apply.
1. Administer stool softeners as prescribed.
2. Instruct the client to limit fluid intake to avoid urinary retention.
3. Instruct the client to avoid activities that will initiate vasovagal responses.
4. Encourage a high-fiber diet to promote bowel movements without straining.
5. Apply cold packs to the anal-rectal area over the dressing until the packing is removed.
6. Help the client to a Fowler's position to place pressure on the rectal area and decrease
bleeding.

o 1. Administer stool softeners as prescribed.

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

o 5. Apply cold packs to the anal-rectal area over the dressing until the packing is
removed.

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

o 1. Coffee

o 2. Chocolate

o 3. Peppermint

o 5. Fried chicken

8. A client has undergone esophagogastroduodenoscopy. The nurse should place highest

priority on which item as part of the client's care plan?
1. Monitoring the temperature
2. Monitoring complaints of heartburn
3. Giving warm gargles for a sore throat
4. Assessing for the return of the gag reflex

4. Assessing for the return of the gag reflex

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

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

1. Hepatitis A

11. The nurse is caring for a client with a diagnosis of chronic gastritis. The nurse monitors the
client, knowing that this client is at risk for which vitamin deficiency?
1. Vitamin A
2. Vitamin B12
3. Vitamin C
4. Vitamin E

2. Vitamin B 12

12. The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that
the T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing
intervention is most appropriate?
1. Clamp the T-tube.
2. Irrigate the T-tube.
3. Document the findings.
4. Notify the health care provider.

3. Document the findings.

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

4. A rigid, boardlike abdomen

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

3. Irrigating the nasogastric tube

15. The nurse is providing discharge instructions to a client following gastrectomy and should
instruct the client to take which measure to assist in preventing dumping syndrome?
1. Ambulate following a meal.
 2. Eat high-carbohydrate foods.
3. Limit the fluids taken with meals.
4. Sit in a high Fowler's position during meals.

3. Limit the fluids taken with meals.

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

o 1. Administer antacids as prescribed.

o 2. Encourage coughing and deep breathing.

o 3. Administer anticholinergics as prescribed.

o 6. Give opioid analgesics as prescribed for pain.

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

1. Diarrhea

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

3. Ask the client to extend the arms.

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

20. The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To
determine whether the problem is currently active, the nurse should assess the client for
which symptom(s) of duodenal ulcer?
1. Weight loss
2. Nausea and vomiting
3. Pain relieved by food intake
4. Pain radiating down the right arm

3. Pain relieved by food intake

21. A client with hiatal hernia chronically experiences heartburn following meals. The nurse
should plan to teach the client to avoid which action because it is contraindicated with a
hiatal hernia?
1. Lying recumbent following meals
2. Consuming small, frequent, bland meals
3. Raising the head of the bed on 6-inch blocks
4. Taking H2-receptor antagonist medication

1. Lying recumbent following meals

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

1. Protruding stoma

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

1. This is a normal, expected event.

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

4. Fluid and electrolyte imbalance

25. The nurse is doing preoperative teaching with a client who is about to undergo creation of a
Kock pouch. The nurse interprets that the client has the best understanding of the nature of
 the surgery if the client makes which statement?
1. "I will be able to pass stool by the rectum eventually."
2. "The drainage from this type of ostomy will be formed."
3. "I will need to drain the pouch regularly with a catheter."
4. "I will need to wear a drainage bag for the rest of my life."

3. "I will need to drain the pouch regularly with a catheter."

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

1. Sweating and pallor

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

1. Assessment of vital signs

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

1. Inability to pass flatus

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

1. Dark red drainage

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

1. "Take a deep breath when I tell you and hold it while I remove the tube."

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

4. Checking for the presence of bowel sounds in all four quadrants

32. A sexually active 20-year-old client has developed viral hepatitis. Which client statement
indicates the need for further teaching?
1. "I should avoid drinking alcohol."
2. "I can go back to work right away."
3. "My partner should get the vaccine."
4. "A condom should be used for sexual intercourse."

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

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

2. Leukocytosis with a shift to the left

34. After performing an initial abdominal assessment on a client with a diagnosis of

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

3. Relatively high-pitched clicks or gurgles auscultated in all four quadrants

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

36. A client experiencing chronic dumping syndrome makes the following comments to the
nurse. Which one indicates the need for further teaching?
1. "I eat at least three large meals each day."
2. "I eat while lying in a semirecumbent position."
3. "I have eliminated taking liquids with my meals."
4. "I eat a high-protein, low- to moderate-carbohydrate diet."

1. "I eat at least three large meals each day."

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

4. Takes nonsteroidal anti-inflammatory drugs (NSAIDs) for osteoarthritis

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

3. Check the suction device to make sure it is working.

39. In performing a physical assessment of a client with a diagnosis of ulcerative colitis, the
nurse should expect which finding?
1. Hypercalcemia
2. Fibrous stricture
3. Frothy, fatty stools
4. Decreased hemoglobin

4. Decreased hemoglobin

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

4. Applesauce and a graham cracker

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

o 1. Jaundice

o 3. Clay-colored stools

o 4. Dark or tea-colored urine

o 5. Elevated bilirubin levels

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

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

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

2. Brown gravy

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

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

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

46. The nurse is providing instructions to a client with a colostomy about measures to reduce the
odor from the colostomy. Which statement, if made by the client, indicates an understanding
of these measures?
1. "I should be sure to eat at least one cucumber every day."
2. "Beet greens, parsley, or yogurt will help to control the colostomy odor."
3. "I will need to increase my egg intake and try to eat ½ to 1 egg per day."
4. "Green vegetables such as spinach and broccoli will prevent odor, and I should eat these
foods every day."

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

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

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

48. The nurse has provided home care instructions to a client who had a subtotal gastrectomy.
The nurse instructs the client regarding the signs and symptoms associated with dumping
syndrome. Which signs and symptoms, if identified by the client, would indicate an
understanding of this potential complication after gastrointestinal (GI) surgery?
1. Hiccups and diarrhea
2. Constipation and fever
3. Diaphoresis and diarrhea
4. Fatigue and abdominal pain

3. Diaphoresis and diarrhea

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

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

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

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

1. Low fiber

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

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

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

3. "Have you enjoyed having visitors?"

54. A client with viral hepatitis states, "I am so yellow." What is the most appropriate nursing
action?
1. Assist the client in expressing feelings.
2. Restrict visitors until the jaundice subsides.
3. Perform most of the activities of daily living for the client.
4. Provide information to the client only when he or she requests it.

1. Assist the client in expressing feelings.

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

2. Monitor for fluid and electrolyte imbalance.

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

3. Glycerin suppository

57. The nurse checks the gastric residual of an unconscious client receiving nasogastric tube
feedings continuously at 50 mL/hr. The nurse notes that the residual is 200 mL. The nurse
determines that the client is experiencing which complication?
1. Air in the stomach
2. Too slow an infusion rate
3. Delayed gastric emptying
4. Early signs of peptic ulcer

3. Delayed gastric emptying

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

3. Activity should be limited to prevent fatigue.

59. The nurse is preparing to teach a client with a new colostomy about how to perform a
colostomy irrigation. Which information should the nurse include in the teaching plan?
1. Use 500 to 1000 mL of warm tap water.
2. Suspend the irrigant 36 inches above the stoma.
3. Insert the irrigation cone ½ inch into the stoma.
4. If cramping occurs, open the irrigation clamp farther.

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

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

4. Esophageal varices

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

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

4. "Tell me more about your concerns with your diet after going home."

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

4. Severe abdominal pain that is unrelieved by vomiting

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

1. Alcohol abuse

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

4. Crackles on auscultation of the lungs

66. The nurse is developing a plan of care for a client with cirrhosis and ascites. Which nursing
actions should be included in the care plan for this client? Select all that apply.
1. Monitor daily weight.
2. Measure abdominal girth.
3. Monitor respiratory status.
4. Place the client in a supine position.
5. Assist the client with care as needed.
 o 1. Monitor daily weight.

o 2. Measure abdominal girth.

o 3. Monitor respiratory status.

o 5. Assist the client with care as needed.

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

3. The presence of asterixis

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

4. Vitamin B injections
12

69. A client arrives at the hospital emergency department complaining of acute right lower
quadrant abdominal pain, and appendicitis is suspected. Laboratory tests are performed, and
the nurse notes that the client's white blood cell (WBC) count is elevated. On the basis of
these findings, the nurse would question which health care provider's (HCP) prescriptions
documented in the client's medical record?
1. Apply a cold pack to the abdomen.
2. Administer 30 mL of milk of magnesia (MOM).
3. Maintain nothing-by-mouth (nil per os [NPO]) status.
4. Initiate an intravenous (IV) line for the administration of IV fluids.

2. Administer 30 mL of milk of magnesia (MOM).

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

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

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

2. Low and intermittent

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

2. Corn

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

1. Decreased diarrhea

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

1. "The medication will cause constipation."

75. A client with cirrhosis has ascites and excess fluid volume. Which assessment findings does
the nurse anticipate to note as a result of increased abdominal pressure? Select all that
apply.
1. Orthopnea, dyspnea
2. Petechiae and ecchymosis
3. Inguinal or umbilical hernia
4. Poor body posture and balance
5. Abdominal distention and tenderness

o 1. Orthopnea, dyspnea

o 2. Petechiae and ecchymosis

 o 3. Inguinal or umbilical hernia

o 5. Abdominal distention and tenderness

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

1. Remove fluids from the meal tray.

77. The ambulatory care nurse is providing instructions to a client who is scheduled for a small
bowel biopsy. What should the nurse tell the client?
1. Clear liquids only are allowed on the day of the test.
2. A signed informed consent form will need to be obtained.
3. A tube will be inserted through the rectum to obtain the tissue sample.
4. A full liquid diet will need to be maintained for 48 hours after the procedure.

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

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

3. Lower esophageal sphincter (LES)

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

3. Pyloric sphincter

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

4. Small intestine

81. A client with a diagnosis of stomach ulcer from gastric hyperacidity asks the nurse why the
 acid has not caused an ulcer in the small intestine as well. The nurse responds that the pH of
intestinal contents is raised by bicarbonate, which is present in which area of the body?
1. Bile
2. Parietal cells
3. Liver enzymes
4. Pancreatic juice

4. Pancreatic juice

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

2. Cecum

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

2. Lactase

84. A nurse is caring for a group of clients on the surgical nursing unit. The nurse anticipates
that the client who underwent which procedure is most likely to have some long-term
residual difficulty with absorption of nutrients?
1. Colectomy
2. Appendectomy
3. Ascending colostomy
4. Small bowel resection

4. Small bowel resection

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

4. Stimulation of the parasympathetic reflex center at the S1 to S4 level in the spinal

cord

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

1. Fats

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

2. Meats

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

2. Peripheral edema

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

3. Ammonia

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

3. Gluconeogenesis

91. A nurse is providing a simple overview of the anatomy of the liver and gallbladder for a
client hospitalized with biliary obstruction. The nurse explains that normally the liver stores
bile in the gallbladder and that the liver and gallbladder are connected together by which
passageway?
 1. Cystic duct
2. Liver canaliculi
3. Common bile duct
4. Right hepatic duct

1. Cystic duct

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

1. Bleeding

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

1. Liver

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

3. Amylase

95. A client with gastric hypersecretion is scheduled for surgery. The nurse teaches the client
that the procedure will lessen the stomach's production of acid by altering which structure?
1. Portal vein
2. Celiac artery
3. Vagus nerve
4. Pyloric valve

3. Vagus nerve

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

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

2. Mixed with fruit juice

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

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

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

3. The client frequently is awakened at 2 am with heartburn.

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

1. Perforation

101. A client is readmitted to the hospital with dehydration after surgery for creation of an
ileostomy. The nurse assesses that the client has lost 3 lb of weight, has poor skin turgor, and
has concentrated urine. The nurse interprets the client's clinical picture as
correlating most closely with recent intake of which medication, which is contraindicated
for the ileostomy client?
1. Folate (folic acid)
2. Sennosides (Ex-Lax)
3. Ferrous sulfate (Feosol)
4. Cyanocobalamin (vitamin B12)
 2. Sennosides (Ex-Lax)

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

1. Change the dressing.

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

4. Right side

104. A home care nurse is visiting a client with a diagnosis of pernicious anemia that
developed as a result of gastric surgery. The nurse instructs the client that because the
stomach lining produces a decreased amount of intrinsic factor in this disorder, the client
will need which medication?
1. Vitamin B12 injections
2. Vitamin B6 injections
3. An antibiotic
4. An antacid

1. Vitamin B injections
12

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

3. Apply a heating pad to the lower abdomen for comfort.

106. The nurse is caring for a client who is receiving intermittent feeding via a
nasogastric (NG) tube. Before administering a feeding to the client, the nurse should
perform which action first?
1. Warm the feeding to 103° F.
2. Check the placement of the tube.
3. Rinse the Asepto syringe with warm water.
 4. Check the last time medications were given.

2. Check the placement of the tube.

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

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

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

2. Weakness, diaphoresis, and diarrhea

109. The nurse is caring for a client who has just returned from the operating room after
the creation of a colostomy. The nurse is assessing the drainage in the pouch attached to the
site where the colostomy was formed and notes serosanguineous drainage. Which nursing
action is appropriate based on this assessment?
1. Apply ice to the stoma site.
2. Apply pressure to the stoma site.
3. Notify the health care provider (HCP).
4. Document the amount and characteristics of the drainage.

4. Document the amount and characteristics of the drainage.

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

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

3. C

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

1. Hematemesis

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

4. A rigid board-like abdomen

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

3. Loose, watery stool

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

1. Elevated serum bilirubin level

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

116. The nurse is assisting a health care provider (HCP) with the insertion of a Miller-
Abbott tube. The nurse understands that the procedure places the client at risk for aspiration
and should therefore implement which action to decrease the risk of aspiration?
1. Insert the tube with the balloon inflated.
2. Place the client in a semi- to high Fowler's position.
3. Instruct the client to cough when the tube reaches the nasal pharynx.
4. Instruct the client to perform a Valsalva maneuver if the impulse to gag and vomit occurs.

2. Place the client in a semi- to high Fowler's position.

117. A client's nasogastric (NG) feeding tube has become clogged. The nurse should take
which action first?
1. Replace the tube.
2. Aspirate the tube.
3. Flush with carbonated liquids.
4. Flush the tube with warm water.

2. Aspirate the tube.

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

2. Use of alcohol

119. A client seen in the ambulatory care clinic has ascites and slight jaundice. The nurse
should assess the client for a history of chronic use of which medication?
1. Ibuprofen (Advil)
2. Ranitidine (Zantac)
3. Acetaminophen (Tylenol)
4. Acetylsalicylic acid (aspirin)

3. Acetaminophen (Tylenol)

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

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

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

4. Acetaminophen (Tylenol)

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

1. Chili

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

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

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

2. Lying flat

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

3. Head of bed elevated 30 to 45 degrees, with the client in the right lateral position for
60 minutes

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

3. Evaluate absorption of the last feeding.

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

2. Continuing to advance the tube to the desired distance

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

1. Inability to pass flatus

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

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

130. A client is scheduled for an upper gastrointestinal (GI) endoscopy. Which

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

4. Assessing for the presence of the gag reflex

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

2. 6

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

3. WBC count of 18,000 cells/mm 3

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

2. Lying flat

134. A client is admitted to the hospital with acute viral hepatitis. Which sign or symptom
should the nurse expect to note based on this diagnosis?
1. Fatigue
2. Pale urine
3. Weight gain
4. Spider angiomas

1. Fatigue

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

3. Fatigue, anorexia, and nausea

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

1. Distancing

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

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

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

4. Vitamin B 12

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

1. Assessment of vital signs

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

1. Full liquid diet

141. A nurse has given post-procedure instructions to a client who has undergone a
colonoscopy. Which statement by the client indicates the need for further teaching?
1. "It is normal to feel gassy or bloated after the procedure."
2. "The abdominal muscles may be tender from the procedure."
3. "It is all right to drive once I've been home for an hour or so."
4. "Intake should be light at first and then progress to regular intake."

3. "It is all right to drive once I've been home for an hour or so."

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

3. Indomethacin (Indocin)

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

3. Disturbed body image

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

3. Rebound tenderness

145. A nurse is performing colostomy irrigation on a client. During the irrigation, the
client begins to complain of abdominal cramps. What is the appropriate nursing action?
1. Stop the irrigation temporarily.
2. Increase the height of the irrigation.
3. Notify the health care provider (HCP).
4. Medicate for pain and resume the irrigation.

1. Stop the irrigation temporarily.

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

3. Ibuprofen (Motrin IB)

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

4. Cleanse the peristomal skin meticulously.

148. A client who has undergone creation of a colostomy has a concern about body
image. What action by the client indicates the most significant progress toward identified
goals?
1. Looking at the ostomy site
2. Reading the ostomy product literature
3. Watching the nurse empty the ostomy bag
4. Practicing proper cutting of the ostomy appliance

4. Practicing proper cutting of the ostomy appliance

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

2. Yogurt

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

1. Tap water

151. A client with chronic pancreatitis needs information on dietary modification to

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

1. Fat

152. A nurse has taught the client with chronic pancreatitis about risk factor modification
to reduce the incidence of recurrences. The nurse should determine that the client has
understood the information if the client states that it will be necessary to control which
factor?
1. Alcohol intake
2. Duodenal ulcer
3. Crohn's disease
4. Diabetes mellitus
 1. Alcohol intake

153. A client with cirrhosis is beginning to show signs of hepatic encephalopathy. The
nurse should plan a dietary consultation to limit the amount of which ingredient in the
client's diet at this time?
1. Protein
2. Calories
3. Minerals
4. Carbohydrates

1. Protein

154. A client with cirrhosis complicated by ascites is admitted to the hospital. The client
reports a 10-lb weight gain over the last 1½ weeks. The client has edema of the feet and
ankles, and his abdomen is distended, taut, and shiny with striae. Which client problem
is most appropriate at this time?
1. Difficulty with breathing
2. Risk for skin breakdown
3. Difficulty with sleeping
4. Excessive body fluid volume

4. Excessive body fluid volume

155. A client with Crohn's disease is experiencing acute pain and the nurse provides
information about measures to alleviate the pain. Which statement by the client indicates
the need for further teaching?
1. "I know I can massage my abdomen."
2. "I will continue using antispasmodic medication."
3. "One of the best things I can do is use relaxation techniques."
4. "The best position for me is to lie supine with my legs straight."

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

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

2. After meals

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

1. NPO (nothing by mouth) status

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

4. Personal history of ulcerative colitis or gastrointestinal polyps

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

o 2. Consume multiple small meals throughout the day.

o 4. Allow the client to select foods that are most appealing.

o 5. Eliminate fatty foods from the meal trays until nausea subsides.

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

3. A brick-red color

161. A client is admitted to the hospital with a diagnosis of acute pancreatitis. Which
would the nurse expect the client to report about the pain?
1. The pain is mostly around the umbilicus and comes and goes.
2. The pain increases when the client sits up and bends forward.
3. The pain usually increases after vomiting.
4. Eating helps to decrease the pain.

3. The pain usually increases after vomiting.

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

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

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

1. Elevated serum lipase level

164. A nurse is caring for a client postoperatively following creation of a colostomy.

Which client problem should the nurse include in the plan of care?
1. Fear
2. Anxiety
3. Sexual dysfunction
4. Upset about appearance

4. Upset about appearance

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

2. Whole milk

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

3. Palpating for peripheral edema

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

2. Avoid caffeine, because it may aggravate symptoms.

168. In which optimal position should the nurse plan to place the client after bolus
feeding using a nasogastric tube?
 1. Head of bed (HOB) flat, with client supine for at least 60 minutes
2. HOB elevated 60 to 90 degrees, with client supine for 15 minutes
3. HOB elevated 10 degrees, with client in the left lateral position for 60 minutes
4. HOB elevated 30 to 45 degrees, with client in the right lateral position for 60 minutes

4. HOB elevated 30 to 45 degrees, with client in the right lateral position for 60 minutes

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

4. Clamp the tubing for 30 seconds, and restart the flow at a slower rate.

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

2. A low-fiber diet

171. A nurse is caring for a client with cirrhosis. As part of dietary teaching to minimize
the effects of the disorder, the nurse teaches the client about foods that are high in thiamine.
The nurse determines that the client has the best understanding of the material if the client
states to increase intake of which food?
1. Pork
2. Milk
3. Chicken
4. Broccoli

1. Pork

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

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

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

o 4. Provide the client with a soft toothbrush.

o 5. Instruct the client to use an electric razor.

o 6. Monitor all secretions for frank or occult blood.