Professional Documents
Culture Documents
1. 100 ml
2. 500 ml
3. 1500 ml
4. 5000 ml
9. Youre 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, dont worry about it, everything will be just fine.
4. Why do you think you have cancer?
11. Youre 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. Youre 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. Youre caring for Lewis, a 67 y.o. patient with liver cirrhosis who developed ascites and
requires paracentesis. Relief of which symptom indicated that the paracentesis was effective?
1. Pruritus
2. Dyspnea
3. Jaundice
4. Peripheral Neuropathy
14. Youre caring for Jane, a 57 y.o. patient with liver cirrhosis who developed ascites and
requires paracentesis. Before her paracentesis, you instruct her to:
1. Empty her bladder.
2. Lie supine in bed.
3. Remain NPO for 4 hours.
4. Clean her bowels with an enema.
15. After abdominal surgery, your patient has a severe coughing episode that causes wound
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 isnt 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 isnt restricted and fat intake
shouldnt 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
prostaglandins.
79. C
80. D
81. D
1. Which of the following complications is thought to be the most common cause of appendicitis?
1. A fecalith
2. Bowel kinking
3. Internal bowel occlusion
4. Abdominal bowel swelling
2. Which of the following terms best describes the pain associated with appendicitis?
1. Aching
2. Fleeting
3. Intermittent
4. Steady
3. Which of the following nursing interventions should be implemented to manage a client with
appendicitis?
1. Assessing for pain
2. Encouraging oral intake of clear fluids
3. Providing discharge teaching
4. Assessing for symptoms of peritonitis
4. Which of the following definitions best describes gastritis?
1. Erosion of the gastric mucosa
2. Inflammation of a diverticulum
3. Inflammation of the gastric mucosa
4. Reflux of stomach acid into the esophagus
5. Which of the following substances is most likely to cause gastritis?
1. Milk
2. Bicarbonate of soda, or baking soda
3. Enteric coated aspirin
4. Nonsteriodal anti-imflammatory drugs
3. Sigmoid colon
4. Terminal ileum
14. Which of the following factors is believed to be linked to Crohns 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. Crohns disease
2. Diverticulitis
3. Diverticulosis
4. Ulcerative colitis
17. Which of the following areas is the most common site of fistulas in clients with Crohns
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 Crohns 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 Crohns 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 Crohns 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
Crohns 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 Crohns 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
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 Ringers
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 clients 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 Crohns 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 clients 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 clients 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 clients bowel sounds
2. Providing skin care following bowel movements
3. Evaluating the clients response to antidiarrheal medications
4. Maintaining intake and output records
5. Obtaining the clients weight.
81. Which goal of the clients 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 clients ulcerative colitis symptoms have been present for longer than 1 week. The nurse
recognizes that the client should be assessed carefully for signs of which of the following
complications?
1. Heart failure
2. DVT
3. Hypokalemia
4. Hypocalcemia
83. A client who has ulcerative colitis has persistent diarrhea. He is thin and has lost 12 pounds
since the exacerbation of his ulcerative colitis. The nurse should anticipate that the physician will
order which of the following treatment approaches to help the client meet his nutritional needs?
1. Initiate continuous enteral feedings
2. Encourage a high protein, high-calorie diet
3. Implement total parenteral nutrition
4. Provide six small meals a day.
84. Digoxin preparations and absorbents should not be given simultaneously. As a nurse, you are
aware that if these agents are given simultaneously, which of the following will occur?
1. Increased absorption of digoxin
99. Side effects of loperamide (Imodium) include all of the following except?
1. Diarrhea
2. epigastric pain
3. Dry mouth
4. Anorexia
100. The mechanism of action of diphenoxylate (Lotomil) is:
1. An increase in intestinal excretion of water
2. An increase in intestinal motility
3. A decrease in peristalsis in the intestinal wall
4. A decrease in the reabsorption of water in the bowel
9. Answer: 1. Diverticulosis is an asymptomatic condition. The other choices are signs and symptoms
of diverticulitis.
10. Answer: 2. A barium enema will cause diverticula to fill with barium and be easily seen on x-ray.
An abdominal US can tell more about structures, such as the gallbladder, liver, and spleen, than the
intestine. A barium swallow and gastroscopy view upper GI structures.
11. Answer: 3. Antibiotics are used to reduce the inflammation. The client isnt typically isnt allowed
anything orally until the acute episode subsides. Parenteral fluids are given until the client feels better;
then its recommended that the client drink eight 8-ounce glasses of water per day and gradually
increase fiber in the diet to improve intestinal motility. During the acute phase, activities that increase
intra-abdominal pressure should be avoided to decrease pain and the chance of intestinal obstruction.
12. Answer: 4. Crohns disease can involve any segment of the small intestine, the colon, or both,
affecting the entire thickness of the bowel. Answers 1 and 3 describe ulcerative colitis, answer 2 is too
specific and therefore, not likely.
13. Answer: 4. Studies have shown that the terminal ileum is the most common site for recurrence in
clients with Crohns disease. The other areas may be involved but arent as common.
14. Answer: 3. Although the definite cause of Crohns disease is unknown, its thought to be associated
with infectious, immune, or psychological factors. Because it has a higher incidence in siblings, it may
have a genetic cause.
15. Answer: 2. Several theories exist regarding the cause of ulcerative colitis. One suggests altered
immunity as the cause based on the extraintestinal characteristics of the disease, such as peripheral
arthritis and cholangitis. Diet and constipation have no effect on the development of ulcerative colitis.
Emotional stress can exacerbate the attacks but isnt believed to be the primary cause.
16. Answer: 1. The lesions of Crohns 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
dont develop in diverticulitis or diverticulosis. The ulcers that occur in the submucosal and mucosal
layers of the intestine in ulcerative colitis usually dont progress to fistula formation as in Crohns
disease.
17. Answer: 1. Fistulas occur in all these areas, but the anorectal area is most common because of the
relative thinness of the intestinal wall in this area.
18. Answer: 4. Toxic megacolon is extreme dilation of a segment of the diseased colon caused by
paralysis of the colon, resulting in complete obstruction. This disorder is associated with both Crohns
disease and ulcerative colitis. The other disorders are more commonly associated with Crohns disease.
19. Answer: 3. Because of the transmural nature of Crohns disease lesions, malaborption may occur
with Crohns 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 isnt present.
20. Answer: 4. Steatorrhea from malaborption can occur with Crohns disease. N/V, and bloody
diarrhea are symptoms of ulcerative colitis. Narrow stools are associated with diverticular disease.
21. Answer: 2. In ulcerative colitis, rectal bleeding is the predominant symptom. Soft stools are more
commonly associated with Crohns disease, in which malabsorption is more of a problem. Dumping
syndrome occurs after gastric surgeries. Fistulas are associated with Crohns disease.
22. Answer: 4. A colonoscopy with biopsy can be performed to determine the state of the colons
mucosal layers, presence of ulcerations, and level of cytologic development. An abdominal x-ray or CT
scan wouldnt provide the cytologic information necessary to diagnose which disease it is. A barium
At present, radiation therapy hasnt been proven effective for gastric cancer, and teaching about it
preoperatively wouldnt be appropriate. Prevention of DVT also isnt a high priority to surgery, though
it assumes greater importance after surgery.
37. Answer: 2. After gastric resection, a client may require total parenteral nutrition or jejunostomy
tube feedings to maintain adequate nutritional status.
38. Answer: 2. Dumping syndrome is a problem that occurs postprandially after gastric resection
because ingested food rapidly enters the jejunum without proper mixing and without the normal
duodenal digestive processing. Diarrhea, not constipation, may also be a symptom. Gastric or intestinal
spasms dont occur, but antispasmodics may be given to slow gastric emptying.
39. Answer: 3. Rectal bleeding is a common symptom of rectal cancer. Rectal cancer may be missed
because other conditions such as hemorrhoids can cause rectal bleeding. Abdominal fullness may occur
with colon cancer, gastric fullness may occur with gastric cancer, and right upper quadrant pain may
occur with liver cancer.
40. Answer: 1. A client with adenomatous polyps has a higher risk for developing rectal cancer than
others do. Clients with diverticulitis are more likely to develop colon cancer. Hemorrhoids dont
increase the chance of any type of cancer. Clients with peptic ulcer disease have a higher incidence of
gastric cancer.
41. Answer: 3. A client with rectal cancer can expect to have radiation therapy in addition to
chemotherapy and surgical resection of the tumor. A colonoscopy is performed to diagnose the disease.
Radiation therapy isnt usually indicated in colon cancer.
42. Answer: 3. The most common cause of peritonitis is a perforated ulcer, which can pour
contaminates into the peritoneal cavity, causing inflammation and infection within the cavity. The other
conditions dont by themselves cause peritonitis. However, if cholelithiasis leads to rupture of the
gallbladder, gastritis leads to erosion of the stomach wall, or an incarcerated hernia leads to rupture of
the intestines, peritonitis may develop.
43. Answer: 2. Abdominal pain causing rigidity of the abdominal muscles is characteristic of
peritonitis. Abdominal distention may occur as a late sign but not early on. Bowel sounds may be
normal or decreased but not increased. Right upper quadrant pain is characteristic of cholecystitis or
hepatitis.
44. Answer: 4. Because of infection, the clients WBC count will be elevated. A hemoglobin level
below 10 mg/dl may occur from hemorrhage. A PT time longer than 100 seconds may suggest
disseminated intravascular coagulation, a serious complication of septic shock. A potassium level above
5.5 mEq/L may indicate renal failure.
45. Answer: 4. The client with peritonitis usually isnt allowed anything orally until the source of
peritonitis is confirmed and treated. The client also requires broad-spectrum antibiotics to combat the
infection. I.V. fluids are given to maintain hydration and hemodynamic stability and to replace
electrolytes.
46. Answer: 1. Peritonitis can advance to shock and circulatory failure, so fluid and electrolyte balance
is the priority focus of nursing management. Gastric irrigation may be needed periodically to ensure
patency of the nasogastric tube. Although pain management is important for comfort and psychosocial
care will address concerns such as anxiety, focusing on fluid and electrolyte imbalance will maintain
hemodynamic stability.
47. Answer: 2. The client with irritable bowel syndrome needs to be on a diet that contains at least 25
grams of fiber per day. Fatty foods are to be avoided because they may precipitate symptoms.
48. Answer: 4. Gastric acid contains large amounts of potassium, chloride, and hydrogen ions.
Excessive loss of these substances, such as from vomiting, can lead to metabolic alkalosis and
hypokalemia.
49. Answer: 3. Fluid shifts to the site of the bowel obstruction, causing a fluid deficit in the
intravascular spaces. If the obstruction isnt resolved immediately, the client may experience an
imbalanced nutritional status (less than body requirements); however, deficient fluid volume takes
priority. The client may also experience pain, but that nursing diagnosis is also of lower priority than
deficient fluid volume.
50. Answer: 4. Exercise helps prevent constipation. Fluids and dietary fiber promote normal bowel
function. The client should drink eight to ten glasses of fluid each day. Although adding bran to cereal
helps prevent constipation by increasing dietary fiber, the client should start with a small amount and
gradually increase the amount as tolerated to a maximum of 2 grams a day.
51. Answer: 3. A client with diarrhea has a nursing diagnosis of Deficient fluid volume related to
excessive fluid loss in the stool. Expected outcomes include firm skin turgor, moist mucous
membranes, and urine output of at least 30 ml/hr. The client also has a nursing diagnosis of diarrhea,
with expected outcomes of passage of formed stools at regular intervals and a decrease in stool
frequency and liquidity. The client is at risk for impaired skin integrity related to irritation from
diarrhea; expected outcomes for this diagnosis include absence of erythema in perianal skin and
mucous membranes and absence of perianal tenderness or burning.
52. Answer: 1. To help prevent colon cancer, fats should account for no more than 20% to 25% of total
daily calories and the diet should include 25 to 30 grams of fiber per day. A digital rectal examination
isnt recommended as a stand-alone test for colorectal cancer. For colorectal cancer screening, the
American Cancer society advises clients over age 50 to have a flexible sigmoidoscopy every 5 years,
yearly fecal occult blood tests, yearly fecal occult blood tests PLUS a flexible sigmoidoscopy every 5
years, a double-contrast barium enema every 5 years, or a colonoscopy every 10 years.
53. Answer: 3. To manage gluten-induced enteropathy, the client must eliminate gluten, which means
avoiding all cereal grains except for rice and corn. In initial disease management, clients eat a high
calorie, high-protein diet with mineral and vitamin supplements to help normalize nutritional status.
54. Answer: 2. The appropriate action is to explain the importance of turning to avoid postoperative
complications. Asking a coworker to help turn the client would infringe on his rights. Allowing him to
turn when hes ready would increase his risk for postoperative complications. Telling him he must turn
because of the physicians orders would put him on the defensive and exclude him from participating in
care decision.
55. Answer: 1. To prevent aspiration of stomach contents, the nurse should place the client in semiFowlers position. High Fowlers position isnt necessary and may not be tolerated as well as semiFowlers.
56. Answer: 2. Enemas are contraindicated in an acute abdominal condition of unknown origin as well
as after recent colon or rectal surgery or myocardial infarction. The other answers are correct only
when enema administration is appropriate.
57. Answer: 1. A barium swallow is an x-ray study that uses a substance called barium for contrast to
highlight abnormalities in the GI tract. The client should fast for 8 to 12 hours before the test,
depending on the physician instructions. Most oral medications also are withheld before the test. After
the procedure the nurse must monitor for constipation, which can occur as a result of the presence of
barium in the GI tract.
58. Answer: 3. Early manifestations of dumping syndrome occur 5 to 30 minutes after eating.
Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie
down.
59. Answer: 3. Bedrest is not required following this surgical procedure. The client should take
analgesics as needed and as prescribed to control pain. A drain is not used in this surgical procedure,
although the client may be instructed in simple dressing changes. Coughing is avoided to prevent
disruption of the tissue integrity, which can occur because of the location of this surgical procedure.
60. Answer: 4. Rebound tenderness may indicate peritonitis. Blood diarrhea is expected to occur in
ulcerative colitis. Because of the blood loss, the client may be hypotensive and the hemoglobin level
may be lower than normal. Signs of peritonitis must be reported to the physician.
61. Answer: 2. Crohns disease is characterized by nonbloody diarrhea of usually not more than four to
five stools daily. Over time, the diarrhea episodes increase in frequency, duration and severity. The
other option are not associated with diarrhea.
62. Answer: 3. If cramping occurs during a colostomy irrigation, the irrigation flow is stopped
temporarily and the client is allowed to rest. Cramping may occur from an infusion that is too rapid or
is causing too much pressure. Increasing the height of the irrigation will cause further discomfort. The
physician does not need to be notified. Medicating the client for pain is not the most appropriate action.
63. Answer: 1. To enhance effectiveness of the irrigation and fecal returns, the client is instructed to
increase fluid intake and prevent constipation.
64. Answer: 4. Meperidine (Demerol) rather than morphine is the medication of choice because
morphine can cause spasm in the sphincter of Oddi.
65. Answer: 1. The most frequent symptom of duodenal ulcer is pain that is relieved by food intake.
These clients generally describe the pain as burning, heavy, sharp, or hungry pain that often localizes
in the midepigastric area. The client with duodenal ulcer usually does not experience weight loss or
N/V. These symptoms are usually more typical in the client with a gastric ulcer.
66. Answer: 1. The peristomal skin must receive meticulous cleansing because the ileostomy drainage
has more enzymes and is more caustic to the skin than colostomy drainage. Foods such as nuts and
those with seeds will pass through the ileostomy. The client should be taught that these foods will
remain undigested. The area below the ileostomy may be massaged if needed if the ileostomy becomes
blocked by high fiber foods. Fluid intake should be maintained to at least six to eight glasses of water
per day to prevent dehydration.
67. Answer: 4. The client is expected to have a body image disturbance after colostomy. The client
progresses through normal grieving stages to adjust to this change. The client demonstrates the greatest
deal of acceptance when the client participates in the actual colostomy care. Each of the incorrect
options represents an interest in colostomy care but is a passive activity. The correct option shows the
client is participating in self-care.
68. Answer: 4. A prolapsed stoma is one which the bowel protruded through the stoma. A stoma
retraction is characterized by sinking of the stoma. Ischemia of the stoma would be associated with
dusky or bluish color. A stoma with a narrowed opening at the level of the skin or fascia is said to be
stenosed.
69. Answer: 1. The client should be taught to include deodorizing foods in the diet, such a beet greens,
parsley, buttermilk, and yogurt. Spinach also reduces odor but is a gas forming food as well. Broccoli,
cucumbers, and eggs are gas forming foods.
70. Answer: 3. Foods that help thicken the stool of the client with an ileostomy include pasta, boiled
rice, and low-fat cheese. Bran is high in dietary fiber and thus will increase output of watery stool by
increasing propulsion through the bowel. Ileostomy output is liquid. Addition or elimination of various
foods can help thicken or loosen this liquid drainage.
71. Answer: 2. A major complication that occurs most frequent following an ileostomy is fluid and
electrolyte imbalance. The client requires constant monitoring of intake and output to prevent this from
happening. Losses require replacement by intravenous infusion until the client can tolerate a diet orally.
Intestinal obstruction is a less frequent complication. Fat malabsorption and folate deficiency are
complications that could occur later in the postoperative period.
72. Answer: 1. A Kock pouch is a continent ileostomy. As the ileostomy begins to function, the client
drains it every 3 to 4 hours and then decreases the draining to about 3 times a day or as needed when
full. The client does not need to wear a drainage bag but should wear an absorbent dressing to absorb
mucus drainage from the stoma. Ileostomy drainage is liquid. The client would be able to pass stool
only from the rectum if an ileal-anal pouch or anastamosis were created. This type of operation is a
two-stage procedure.
73. Answer: 2. Warm tap water or saline solution is used to irrigate a colostomy. If the tap water is not
suitable for drinking, then bottled water should be used.
74. Answer: 2. Based on the signs and symptoms presented in the question, the nurse should suspect
peritonitis and should notify the physician. Administering pain medication is not an appropriate
intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis.
Scheduling surgical time is not within the scope of nursing practice, although the physician probably
would perform the surgery earlier than the prescheduled time.
75. Answer: 1. The pain associated with acute pancreatitis is often severe and unrelenting, is located in
the epigastric region, and radiates to the back.
76. Answer: 1. The pain associated with Crohns disease is alleviated by the use of analgesics and
antispasmodics and also is reduced by having the client practice relaxation techniques, applying local
cold or heat to the abdomen, massaging the abdomen, and lying with the legs flexed. Lying with the
legs extended is not useful because it increases the muscle tension in the abdomen, which could
aggravate the inflamed intestinal tissues as the abdominal muscles are stretched.
77. Answer: 3. Salicylate compounds act by inhibiting prostaglandin synthesis and reducing
inflammation. The nurse teaches the client to take the medication with a full glass of water and to
increase fluid intake throughout the day. This medication needs to be taken after meals to reduce GI
irritation.
78. Answer: 4. The lack of saliva, pain near the area of the ear, and the prolonged NPO status of the
client should lead the nurse to suspect the development of parotitis, or inflammation of the parotid
gland. Parotitis usually develops in cases of dehydration combined with poor oral hygiene or when
clients have been NPO for an extended period. Preventative measures include the use of sugarless hard
candy or gum to stimulate saliva production, adequate hydration, and frequent mouth care. Stomatitis
(inflammation of the mouth) produces excessive salivation and a sore mouth.
78. Answer: 2. A dark red to purple stoma indicates inadequate blood supply. Mild edema and slight
oozing of blood are normal in the early post-op period. The colostomy would typically not begin
functioning until 2-4 days after surgery.
80. Answer: 2, 4, and 5. The nurse can delegate the following basic care activities to the unlicensed
assistant: providing skin care following bowel movements, maintaining intake and output records, and
obtaining the clients weight. Assessing the clients bowel sounds and evaluating the clients response
to medication are registered nurse activities that cannot be delegated.
81. Answer: 2. Diarrhea is the primary symptom in an exacerbation of ulcerative colitis, and decreasing
the frequency of stools is the first goal of treatment. The other goals are ongoing and will be best
achieved by halting the exacerbation. The client may receive antidiarrheal medications, antispasmodic
agents, bulk hydrophilic agents, or anti-inflammatory drugs.
82. Answer: 3. Excessive diarrhea causes significant depletion of the bodys stores of sodium and
potassium as well as fluid. The client should be closely monitored for hypokalemia and hyponatremia.
Ulcerative colitis does not place the client at risk for heart failure, DVT, or hypocalcemia.
83. Answer: 3. Food will be withheld from the client with severe symptoms of ulcerative colitis to rest
the bowel. To maintain the clients 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 clients symptoms.
84. Answer: 2
85. Answer: 1
86. Answer: 4
87. Answer: 1. Antacids work by neutralizing gastric acid, which would cause an increase in pH. They
do not affect gastric motility.
88. Answer: 2. Aluminum- and calcium-containing antacids cause constipation, magnesium-containing
antacids cause diarrhea, and sodium-containing antacids cause sodium and fluid retention.
89. Answer: 3. Magnesium-containing antacids can cause hypermagnesemia in patients with chronic
renal failure. Aluminum-containing antacids may be used as a phosphate binder in patients with chronic
renal failure. Calcium-containing antacids are also appropriate because these patients may be
hypocalcemic.
90. Answer: 1. Solutions containing sodium bicarbonate (a base) can cause metabolic alkalosis. Serum
K and serum calcium would decrease with alkalosis, not increase.
91. Answer: 2. A serious side effect of famotidine is thrombocytopenia, which is manifested by a
decrease in platelet count and an increased risk of bleeding.
92. Answer: 1. Histamine receptor blocking agents decrease gastric acid by competing with histamine
for binding sites on the parietal cells.
93. Answer: 3. Because the proton pump inhibitors stop the final step of acid secretion, they can block
up to 90% of acid secretion, leading to achlorhydria (without acid).
94. Answer: 3. Pantoprazole is the only proton pump inhibitor that is available for intravenous
administration. The other medications in this category may only be administered orally.
95. Answer: C. It is important to give sucralfate on an empty stomach so that it may dissolve and form
a protective barrier over the gastric mucosa. The tablet form will not dissolve in water when crushed; it
must be left whole and allowed to dissolve. Crushing the medication so that it will not dissolve could
lead to clogging of the nasogastric tube and decreased effectiveness of the drug.
96. Answer: 3. Sucralfate has a local effect only on the gastric mucosa. It forms a paste-like substance
in the stomach, which adheres to the gastric lining, protecting against adverse effects related to gastric
acid. It also stimulates healing of any ulcerated areas of the gastric mucosa.
97. Answer: 3. Bulk-forming laxatives must be given with at least 8 ounces of liquid plus additional
liquid each day to prevent intestinal obstruction.
98. Answer: 4. Absorbent antidiarrheal medications bind to diarrhea-causing bacteria to form a
nonabsorbable complex, which is then excreted in the stool.
99. Answer: 1. Side effects associated with loperamide include CNS fatigue and dizziness, epigastric
pain, abdominal cramps, nausea, dry mouth, vomiting, and anorexia. Diarrhea is an indication, not a
side effect.
100. Answer: 3. Diphenoxylate acts on the smooth muscle of the intestinal tract to inhibit GI motility and excessive propulsion of
the GI tract (peristalsis).
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 clients nasogastric tube and drainage system should
include which of the following nursing interventions?
1. Irrigate the tube with 30 ml of sterile water every hour, if needed.
2. Reposition the tube if it is not draining well
3. Monitor the client for N/V, and abdominal distention
4. Turn the machine to high suction of the drainage is sluggish on low suction.
16. Which of the following would be an expected nutritional outcome for a client who has
undergone a subtotal gastrectomy for cancer?
1. Regain weight loss within 1 month after surgery
2. Resume normal dietary intake of three meals per day
3. Control nausea and vomiting through regular use of antiemetics
4. Achieve optimal nutritional status through oral or parenteral feedings
17. The client with GERD complains of a chronic cough. The nurse understands that in a client
with GERD this symptom may be indicative of which of the following conditions?
1. Development of laryngeal cancer
2. Irritation of the esophagus
3. Esophageal scar tissue formation
4. Aspiration of gastric contents
18. Which of the following dietary measures would be useful in preventing esophageal reflux?
1. Eating small, frequent meals
2. Increasing fluid intake
3. Avoiding air swallowing with meals
4. Adding a bedtime snack to the dietary plan
19. A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a
bleeding duodenal ulcer. The client develops a sudden, sharp pain in the mid epigastric area
along with a rigid, board-like abdomen. These clinical manifestations most likely indicate which
of the following?
1. An intestinal obstruction has developed
2. Additional ulcers have developed
3. The esophagus has become inflamed
4. The ulcer has perforated
20. When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and
symptoms would the nurse expect to see? Select all that apply.
1. Epigastric pain at night
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 dont 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 clients 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 Murphys 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 clients 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
8. Answer: 3. The discomfort of reflux is aggravated by positions that compress the abdomen and the
stomach. These include lying flat on the back or on the stomach after a meal of lying on the right side.
The left side-lying position with the head of the bed elevated is most likely to give relief to the client.
9. Answer: 1. In a Billroth II procedure the proximal remnant of the stomach is anastomased to the
proximal jejunum. Patency of the NG tube is critical for preventing the retention of gastric secretions.
The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically
ordered by the physician. In this situation, the nurse would clarify the order.
10. Answer: 2. The nurse should instruct the client to decrease the amount of fluid taken at meals and to
avoid high carbohydrate foods including fluids such as fruit nectars; to assume a low-Fowlers position
during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take
antispasmidocs as prescribed.
11. Answer: 2. A soft toothbrush should be used to brush the clients teeth after each meal and more
often as needed. Mechanical cleaning is necessary to maintain oral health, simulate gingiva, and
remove plaque. Assessing the oral cavity and recording observations is the responsibility of the nurse,
not the nursing assistant. Swabbing with a safe foam applicator does not provide enough friction to
clean the mouth. Mouthwash can be a drying irritant and is not recommended for frequent use.
12. Answer: 3. The most likely complication of an endoscopic procedure is perforation. A sudden
temperature spike with 1 to 2 hours after the procedure is indicative of a perforation and should be
reported immediately to the physician. A sore throat is to be anticipated after an endoscopy. Clients are
given sedatives during the procedure, so it is expected that they will display signs of sedation after the
procedure is completed. A lack of appetite could be the result of many factors, including the disease
process.
13. Answer: 2. A Billroth II procedure bypasses the duodenum and connects the gastric stump directly
to the jejunum. The pyloric sphincter is removed, along with some of the stomach fundus.
14. Answer: 1. About 12 to 24 hours after a subtotal gastrectomy, gastric drainage is normally brown,
which indicates digested blood. Bile green or cloudy white drainage is not expected during the first 12
to 24 hours after a subtotal gastrectomy. Drainage during the first 6 to 12 hours contains some bright
red blood, but large amounts of blood or excessively bloody drainage should be reported to the
physician promptly.
15. Answer: 3. Nausea, vomiting, or abdominal distention indicated that gas and secretions are
accumulating within the gastric pouch due to impaired peristalsis or edema at the operative site and
may indicate that the drainage system is not working properly. Saline solution is used to irrigate
nasogastric tubes. Hypotonic solutions such as water increase electrolyte loss. In addition, a physicians
order is needed to irrigate the NG tube, because this procedure could disrupt the suture line. After
gastric surgery, only the surgeon repositions the NG tube because of the danger of rupturing or
dislodging the suture line. The amount of suction varies with the type of tube used and is ordered by the
physician. High suction may create too much tension on the gastric suture line.
16. Answer: 4. An appropriate expected outcome is for the client to achieve optimal nutritional status
through the use of oral feedings or total parenteral nutrition (TPN). TPN may be used to supplement
oral intake, or it may be used alone if the client cannot tolerate oral feedings. The client would not be
expected to regain lost weight within 1 month after surgery or to tolerate a normal dietary intake of
three meals per day. Nausea and vomiting would not be considered an expected outcome of gastric
surgery, and regular use of antiemetics would not be anticipated.
17. Answer: 4. Clients with GERD can develop pulmonary symptoms such as coughing, wheezing, and
dyspnea that are caused by the aspiration of gastric contents. GERD does not predispose the client to
the development of laryngeal cancer. Irritation of the esophagus and esophageal scar tissue formation
can develop as a result of GERD. However, GERD is more likely to cause painful and difficult
swallowing.
18. Answer: 1. Esophageal reflux worsens when the stomach is overdistended with food. Therefore, an
important measure is to eat small, frequent meals. Fluid intake should be decreased during meals to
reduce abdominal distention. Avoiding air swallowing does not prevent esophageal reflux. Food intake
in the evening should be strictly limited to reduce the incidence of nighttime reflux, so bedtime snacks
are not recommended.
19. Answer: 4. The body reacts to perforation of an ulcer by immobilizing the area as much as possible.
This results in boardlike muscle rigidity, usually with extreme pain. Perforation is a medical emergency
requiring immediate surgical intervention because peritonitis develops quickly after perforation. An
intestinal obstruction would not cause midepigastric pain. Esophageal inflammation or the development
of additional ulcers would not cause a rigid, boardlike abdomen.
20. Answer: 3 and 4. Vomiting and weight loss are common with gastric ulcers. Clients with a gastric
ulcer are most likely to complain of a burning epigastric pain that occurs about one hour after eating.
Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to complain about
pain that occurs during the night and is frequently relieved by eating.
21. Answer: 2, 4, and 5. Following a gastroscopy, the nurse should monitor the client for complications,
which include perforation and the potential for aspiration. An elevated temperature, complaints of
epigastric pain, or the vomiting of blood (hematemesis) are all indications of a possible perforation and
should be reported promptly. A sore throat is a common occurrence following a gastroscopy. Clients are
usually sedated to decrease anxiety and the nurse would anticipate that the client will be drowsy
following the procedure.
22. Answer: 2. Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease.
Digested blood in the stomach causes it to be black. The odor of the stool is very stinky. Clients with
peptic ulcer disease should be instructed to report the incidence of black stools promptly to their
physician.
23. Answer: 2. Based on the data provided, the most appropriate nursing diagnosis would be Disturbed
Sleep pattern. A client with a duodenal ulcer commonly awakens at night with pain. The clients
feelings of anxiety do not necessarily indicate that she is coping ineffectively.
24. Answer: 2 and 3. The symptoms of nausea and dizziness in a client with peptic ulcer disease may be
indicative of hemorrhage and should not be ignored. The appropriate nursing actions at this time are for
the nurse to monitor the clients vital signs and notify the physician of the clients symptoms. To
administer an antacid hourly or to wait one hour to reassess the client would be inappropriate; prompt
intervention is essential in a client who is potentially experiencing a gastrointestinal hemorrhage. The
nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by
the physician.
25. Answer: 3. Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose
of ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid. Clients who
take the drug twice a day are advised to take it in the morning and at bedtime.
26. Answer: 3. It is most likely that the client is experiencing a side effect of the antacid. Antacids with
aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body. These
precipitate and accumulate in the intestines, causing constipation. Increasing dietary fiber intake or
daily exercise may be a beneficial lifestyle change for the client but is not likely to relieve the
constipation caused by the aluminum hydroxide. Constipation, in isolation from other symptoms, is not
39. Answer: 3. Murphys sign is elicited when the client reacts to pain and stops breathing. Its a
common finding in clients with cholecystitis. Periumbilical ecchymosis, Cullens sign, is present in
peritonitis. Pain on deep palpation and release is rebound tenderness. Tightening up abdominal muscles
in anticipation of palpation is guarding.
40. Answer: 2. An abdominal ultrasound can show if the gallbladder is enlarged, if gallstones are
present, if the gallbladder wall is thickened, or if distention of the gallbladder lumen is present. An
abdominal CT scan can be used to diagnose cholecystitis, but it usually isnt necessary. A barium
swallow looks at the stomach and the duodenum. Endoscopy looks at the esophagus, stomach, and
duodenum.
41. Answer: 2. The client with acute cholecystitis should first be monitored for perforation, fever,
abscess, fistula, and sepsis. After assessment, antibiotics will be administered to reduce the infection.
Lithotripsy is used only for a small percentage of clients. Surgery is usually done after the acute
infection has subsided.
42. Answer: 4. Conservative therapy for chronic cholecystitis includes weight reduction by increasing
physical activity, a low-fat diet, antacid use to treat dyspepsia, and anticholinergic use to relax smooth
muscles and reduce ductal tone and spasm, thereby reducing pain.
43. Answer: 3. The client with a duodenal ulcer may have bleeding at the ulcer site, which shows up as
melena (black tarry poop). The other findings are consistent with a gastric ulcer.
44. Answer: 4. Pain on empty stomach is relieved by taking foods or antacids. The other symptoms are
those of a gastric ulcer.
45. Answer: 1. NG insertion technique is to have the client first tilt his head back for insertion into the
nostril, then to flex his neck forward and swallow. Extension of the neck (2) will impede NG tube
insertion.
46. Answer: 3. As the liver cells become fatty and degenerate, they are no longer able to accommodate
the large amount of blood necessary for homeostasis. The pressure in the liver increases and causes
increased pressure in the venous system. As the portal pressure increases, fluid exudes into the
abdominal cavity. This is called ascites.
47. Answer: 3. The respiratory system can become occluded if the balloon slips and moves up the
esophagus, putting pressure on the trachea. This would result in respiratory distress and should be
assessed frequently. Scissors should be kept at the bedside to cut the tube if distress occurs. This is a
safety intervention.
48. Answer: 2. Peptic ulcer disease is characteristically gnawing epigastric pain that may radiate to the
back. Vomiting usually reflects pyloric spasm from muscular spasm or obstruction. Cancer (1) would
not evidence pain or vomiting unless the pylorus was obstructed.
49. Answer: 3. An NG tube insertion is the most appropriate intervention because it will determine the
presence of active GI bleeding. A Miller-Abbott tube (1) is a weighted, mercury-filled ballooned tube
used to resolve bowel obstructions. There is no evidence of shock or fluid overload in the client;
therefore, an arterial line (2) is not appropriate at this time and an IV (4) is optional.
50. Answer: 1. These drugs inhibit action of histamine on the H2 receptors of parietal cells, thus
reducing gastric acid output.
1. Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis.
The nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum
amylase level of:
A. 45 units/L
B. 100 units/L
C. 300 units/L
D. 500 units/L
2. A male client who is recovering from surgery has been advanced from a clear liquid diet to a
full liquid diet. The client is looking forward to the diet change because he has been bored with
the clear liquid diet. The nurse would offer which full liquid item to the client?
A. Tea
B. Gelatin
C. Custard
D. Popsicle
3. Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the
disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines
that the client has the best understanding of the dietary measures to follow if the client states
an intention to increase the intake of:
A. Pork
B. Milk
C. Chicken
D. Broccoli
4. Nurse Oliver checks for residual before administering a bolus tube feeding to a client with a
nasogastric tube and obtains a residual amount of 150 mL. What is appropriate action for the
nurse to take?
A. Hold the feeding
B. Reinstill the amount and continue with administering the feeding
C. Elevate the clients head at least 45 degrees and administer the feeding
D. Discard the residual amount and proceed with administering the feeding
5. A nurse is inserting a nasogastric tube in an adult male client. During the procedure, the client
begins to cough and has difficulty breathing. Which of the following is the appropriate nursing
action?
A. Quickly insert the tube
B. Notify the physician immediately
C. Remove the tube and reinsert when the respiratory distress subsides
D. Pull back on the tube and wait until the respiratory distress subsides
6. Nurse Ryan is assessing for correct placement of a nasogastric tube. The nurse aspirates the
stomach contents and check the contents for pH. The nurse verifies correct tube placement if
which pH value is noted?
A. 3.5
B. 7.0
C. 7.35
D. 7.5
7. A nurse is preparing to remove a nasogastric tube from a female client. The nurse should
instruct the client to do which of the following just before the nurse removes the tube?
A. Exhale
B. Inhale and exhale quickly
C. Take and hold a deep breath
D. Perform a Valsalva maneuver
8. Nurse Joy is preparing to administer medication through a nasogastric tube that is connected
to suction. To administer the medication, the nurse would:
A. Position the client supine to assist in medication absorption
B. Aspirate the nasogastric tube after medication administration to maintain patency
C. Clamp the nasogastric tube for 30 minutes following administration of the medication
D. Change the suction setting to low intermittent suction for 30 minutes after medication administration
9. A nurse is preparing to care for a female client with esophageal varices who has just has a
Sengstaken-Blakemore tube inserted. The nurse gathers supplies, knowing that which of the
following items must be kept at the bedside at all times?
A. An obturator
B. Kelly clamp
C. An irrigation set
D. A pair of scissors
10. Dr. Smith has determined that the client with hepatitis has contracted the
infection from contaminated food. The nurse understands that this client is most likely
experiencing what type of hepatitis?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
11. A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming
this diagnosis?
A. Elevated hemoglobin level
B. Elevated serum bilirubin level
C. Elevated blood urea nitrogen level
D. Decreased erythrocyte sedimentation rate
12. The nurse is reviewing the physicians orders written for a male client admitted to the
hospital with acute pancreatitis. Which physician order should the nurse question if noted on the
clients chart?
A. NPO status
B. Nasogastric tube inserted
C. Morphine sulfate for pain
D. An anticholinergic medication
13. A female client being seen in a physicians office has just been scheduled for a barium swallow
the next day. The nurse writes down which instruction for the client to follow before the test?
A. Fast for 8 hours before the test
B. Eat a regular supper and breakfast
C. Continue to take all oral medications as scheduled
D. Monitor own bowel movement pattern for constipation
14. The nurse is performing an abdominal assessment and inspects the skin of the abdomen. The
nurse performs which assessment technique next?
A. Palpates the abdomen for size
B. Palpates the liver at the right rib margin
C. Listens to bowel sounds in all for quadrants
D. Percusses the right lower abdominal quadrant
15. Polyethylene glycol-electrolyte solution (GoLYTELY) is prescribed for the female client
scheduled for a colonoscopy. The client begins to experience diarrhea following administration of
the solution. What action by the nurse is appropriate?
A. Start an IV infusion
B. Administer an enema
C. Cancel the diagnostic test
D. Explain that diarrhea is expected
16. The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse monitors
the client knowing that this client is at risk for which vitamin deficiency?
A. Vitamin A
B. Vitamin B12
C. Vitamin C
D. Vitamin E
17. The nurse is reviewing the medication record of a female client with acute gastritis. Which
medication, if noted on the clients record, would the nurse question?
A. Digoxin (Lanoxin)
B. Furosemide (Lasix)
C. Indomethacin (Indocin)
D. Propranolol hydrochloride (Inderal)
18. The nurse is assessing a male client 24 hours following a cholecystectomy. The nurse noted
that the T tube has drained 750 mL of green-brown drainage since the surgery. Which nursing
intervention is appropriate?
A. Clamp the T tube
B. Irrigate the T tube
C. Notify the physician
D. Document the findings
19. The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment
findings would most likely indicate perforation of the ulcer?
A. Bradycardia
B. Numbness in the legs
C. Nausea and vomiting
D. A rigid, board-like abdomen
20. A male client with a peptic ulcer is scheduled for a vagotomy and the client asks the nurse
about the purpose of this procedure. Which response by the nurse best describes the purpose of a
vagotomy?
A. Halts stress reactions
B. Heals the gastric mucosa
C. Reduces the stimulus to acid secretions
D. Decreases food absorption in the stomach
21. The nurse is caring for a female client following a Billroth II procedure. Which postoperative
order should the nurse question and verify?
A. Leg exercises
B. Early ambulation
C. Irrigating the nasogastric tube
D. Coughing and deep-breathing exercises
22. The nurse is providing discharge instructions to a male client following gastrectomy and
instructs the client to take which measure to assist in preventing dumping syndrome?
A. Ambulate following a meal
B. Eat high carbohydrate foods
C. Limit the fluid taken with meal
D. Sit in a high-Fowlers position during meals
23. The nurse is monitoring a female client for the early signs and symptoms of dumping
syndrome. Which of the following indicate this occurrence?
A. Sweating and pallor
When the client has a Sengstaken-Blakemore tube, a pair of scissors must be kept at the clients bedside
at all times. The client needs to be observed for sudden respiratory distress, which occurs if the gastric
balloon ruptures and the entire tube moves upward. If this occurs, the nurse immediately cuts all
balloon lumens and removes the tube. An obturator and a Kelly clamp are kept at the bedside of a client
with a tracheostomy. An irrigation set may be kept at the bedside, but it is not the priority item.
10. Answer: A. Hepatitis A
Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers.
Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.
11. Answer: B. Elevated serum bilirubin level
Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels,
elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea nitrogen level may
indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis.
12. Answer: C. Morphine sulfate for pain
Meperidine (Demerol) rather than morphine sulfate is the medication of choice to treat pain because
morphine sulfate can cause spasms in the sphincter of Oddi. Options A, B, and D are appropriate
interventions for the client with acute pancreatitis.
13. Answer: A. Fast for 8 hours before the test
A barium swallow is an x-ray study that uses a substance called barium for contrast to highlight
abnormalities in the gastrointestinal tract. The client should fast for 8 to 12 hours before the test,
depending on physician instructions. Most oral medications also are withheld before the test. After the
procedure, the nurse must monitor for constipation, which can occur as a result of the presence of
barium in the gastrointestinal tract.
14. Answer: C. Listens to bowel sounds in all for quadrants
The appropriate sequence for abdominal examination is inspection, auscultation, percussion, and
palpation. Auscultation is performed after inspection to ensure that the motility of the bowel and bowel
sounds are not altered by percussion or palpation. Therefore, after inspecting the skin on the abdomen,
the nurse should listen for bowel sounds.
15. Answer: D. Explain that diarrhea is expected
The solution GoLYTELY is a bowel evacuant used to prepare a client for a colonoscopy by cleansing
the bowel. The solution is expected to cause a mild diarrhea and will clear the bowel in 4 to 5 hours.
Options A, B, and C are inappropriate actions.
16. Answer: B. Vitamin B12
Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of the
function of the parietal cells. The source of the intrinsic factor is lost, which results in the inability to
absorb vitamin B12. This leads to the development of pernicious anemia. The client is not at risk for
vitamin A, C, or E deficiency.
17. Answer: C. Indomethacin (Indocin)
Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can cause ulceration of the
esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal
disorders. Furosemide (Lasix) is a loop diuretic. Digoxin is a cardiac medication. Propranolol (Inderal)
is a -adrenergic blocker. Furosemide, digoxin, and propranolol are not contraindicated in clients with
gastric disorders.
18. Answer: D. Document the findings
Following cholecystectomy, drainage from the T tube is initially bloody and then turns to a greenishbrown color. The drainage is measured as output. The amount of expected drainage will range from 500
1. During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal
bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to
hypoprothrombinemia?
A. vitamin A
B. vitamin D
C. vitamin E
D. vitamin K
2. When evaluating a male client for complications of acute pancreatitis, the nurse would observe
for:
becomes cloggeD. To remedy this problem and teach the clients family how to deal with it at
home, what should the nurse do?
A. Irrigate the tube with cola.
B. Advance the tube into the intestine.
C. Apply intermittent suction to the tube.
D. Withdraw the obstruction with a 30-ml syringe.
10. A male client with pancreatitis complains of pain. The nurse expects the physician to
prescribe meperidine (Demerol) instead of morphine to relieve pain because:
A. meperidine provides a better, more prolonged analgesic effect.
B. morphine may cause spasms of Oddis sphincter.
C. meperidine is less addictive than morphine.
D. morphine may cause hepatic dysfunction.
11. Mandy, an adolescent girl is admitted to an acute care facility with severe malnutrition. After
a thorough examination, the physician diagnoses anorexia nervosa. When developing the plan of
care for this client, the nurse is most likely to include which nursing diagnosis?
A. Hopelessness
B. Powerlessness
C. Chronic low self esteem
D. Deficient knowledge
12. Which diagnostic test would be used first to evaluate a client with upper GI bleeding?
A. Endoscopy
B. Upper GI series
C. Hemoglobin (Hb) levels and hematocrit (HCT)
D. Arteriography
13. A female client who has just been diagnosed with hepatitis A asks, How could I have gotten
this disease? What is the nurses best response?
A. You may have eaten contaminated restaurant food.
B. You could have gotten it by using I.V. drugs.
C. You must have received an infected blood transfusion.
D. You probably got it by engaging in unprotected sex.
14. When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a
nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is
the rationale for choosing this nursing diagnosis?
A. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.
B. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of
the appendix.
C. The appendix may develop gangrene and rupture, especially in a middle-aged client.
D. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.
15. A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products
that would most likely bring about hemostasis in the client are:
A. whole blood and albumin.
B. platelets and packed red blood cells.
C. fresh frozen plasma and whole blood.
23. While palpating a female clients right upper quadrant (RUQ), the nurse would expect to find
which of the following structures?
A. Sigmoid colon
B. Appendix
C. Spleen
D. Liver
24. A male client has undergone a colon resection. While turning him, wound dehiscence with
evisceration occurs. The nurses first response is to:
A. call the physician.
B. place saline-soaked sterile dressings on the wound.
C. take a blood pressure and pulse.
D. pull the dehiscence closed.
25. The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug
interactions. Which drugs can produce additive constipation when given with an opium
preparation?
A. Antiarrhythmic drugs
B. Anticholinergic drugs
C. Anticoagulant drugs
D. Antihypertensive drugs
26. A male client is recovering from an ileostomy that was performed to treat inflammatory bowel
disease. During discharge teaching, the nurse should stress the importance of:
A. increasing fluid intake to prevent dehydration.
B. wearing an appliance pouch only at bedtime.
C. consuming a low-protein, high-fiber diet.
D. taking only enteric-coated medications.
27. The nurse is caring for a female client with active upper GI bleeding. What is the appropriate
diet for this client during the first 24 hours after admission?
A. Regular diet
B. Skim milk
C. Nothing by mouth
D. Clear liquids
28. A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to
note:
A. severe abdominal pain radiating to the shoulder.
B. anorexia, nausea, and vomiting.
C. eructation and constipation.
D. abdominal ascites.
29. A female client with viral hepatitis A is being treated in an acute care facility. Because the
client requires enteric precautions, the nurse should:
A. place the client in a private room.
B. wear a mask when handling the clients bedpan.
C. wash the hands after touching the client.
D. wear a gown when providing personal care for the client.
10. Answer B. For a client with pancreatitis, the physician will probably avoid prescribing morphine
because this drug may trigger spasms of the sphincter of Oddi (a sphincter at the end of the pancreatic
duct), causing irritation of the pancreas. Meperidine has a somewhat shorter duration of action than
morphine. The two drugs are equally addictive. Morphine isnt associated with hepatic dysfunction.
11. Answer C. Young women with Chronic low self esteem are at highest risk for anorexia nervosa
because they perceive being thin as a way to improve their self-confidence. Hopelessness and
Powerlessness are inappropriate nursing diagnoses because clients with anorexia nervosa seldom feel
hopeless or powerless; instead, they use food to control their desire to be thin and hope that restricting
food intake will achieve this goal. Anorexia nervosa doesnt result from a knowledge deficit, such as
one regarding good nutrition.
12. Answer A. Endoscopy permits direct evaluation of the upper GI tract and can detect 90% of
bleeding lesions. An upper GI series, or barium study, usually isnt the diagnostic method of choice,
especially in a client with acute active bleeding whos vomiting and unstable. An upper GI series is also
less accurate than endoscopy. Although an upper GI series might confirm the presence of a lesion, it
wouldnt necessarily reveal whether the lesion is bleeding. Hb levels and HCT, which indicate loss of
blood volume, arent always reliable indicators of GI bleeding because a decrease in these values may
not be seen for several hours. Arteriography is an invasive study associated with life-threatening
complications and wouldnt be used for an initial evaluation.
13. Answer A. Hepatitis A virus typically is transmitted by the oral-fecal route commonly by
consuming food contaminated by infected food handlers. The virus isnt transmitted by the I.V. route,
blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood
transfusion. Hepatitis C can be transmitted by unprotected sex.
14. Answer B. A client with appendicitis is at risk for infection related to inflammation, perforation, and
surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the
appendix and compressing venous outflow drainage. The pressure continues to rise with venous
obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion.
Inflammation and bacterial growth follow, and swelling continues to raise pressure within the
appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially
susceptible to appendix rupture.
15. Answer D. The liver is vital in the synthesis of clotting factors, so when its diseased or
dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products
that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which
have most of the clotting factors. Although administering whole blood, albumin, and packed cells will
contribute to hemostasis, those products arent specifically used to treat hemostasis. Platelets are
helpful, but the best answer is cryoprecipitate and fresh frozen plasma.
16. Answer B. To prevent reflux of stomach acid into the esophagus, the nurse should advise the client
to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also
should teach the client to avoid lying down after meals, which can aggravate reflux, and to take
antacids after eating. The client need not limit fluid intake with meals as long as the fluids arent gastric
irritants.
17. Answer D. I.V. infusions containing normal saline solution and potassium should be given first to
maintain fluid and electrolyte balance. For the clients comfort and to assist in bowel decompression,
the nurse should prepare to insert an NG tube next. A blood sample is then obtained for laboratory
studies to aid in the diagnosis of bowel obstruction and guide treatment. Blood studies usually include a
complete blood count, serum electrolyte levels, and blood urea nitrogen level. Pain medication often is
withheld until obstruction is diagnosed because analgesics can decrease intestinal motility.
18. Answer B. Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment.
Dysphagia isnt associated with rectal tenesmus, duodenal inflammation, or abnormal gastric
structures.
19. Answer A. An NG tube that fails to drain during the postoperative period should be reported to the
physician immediately. It may be clogged, which could increase pressure on the suture site because
fluid isnt draining adequately. Repositioning or irrigating an NG tube in a client who has undergone
gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI
mucosa or the suture line.
20. Answer B. Elevation of serum lipase is the most reliable indicator of pancreatitis because this
enzyme is produced solely by the pancreas. A clients BUN is typically elevated in relation to renal
dysfunction; the AST, in relation to liver dysfunction; and LD, in relation to damaged cardiac muscle.
21. Answer A. Yellow sclerae may be the first sign of jaundice, which occurs when the common bile
duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools dont occur
in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.
22. Answer D. Risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking,
and stress. A sedentary lifestyle and a history of hemorrhoids arent risk factors for peptic ulcers.
Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.
23. Answer D. The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic
flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney.
The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and
the spleen, in the left upper quadrant.
24. Answer B. The nurse should first place saline-soaked sterile dressings on the open wound to
prevent tissue drying and possible infection. Then the nurse should call the physician and take the
clients vital signs. The dehiscence needs to be surgically closed, so the nurse should never try to close
it.
25. Answer B. Paregoric has an additive effect of constipation when used with anticholinergic drugs.
Antiarrhythmics, anticoagulants, and antihypertensives arent known to interact with paregoric.
26. Answer A. Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To
avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake.
The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage
is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid entericcoated medications because the body cant absorb them after an ileostomy
27. Answer C. Shock and bleeding must be controlled before oral intake, so the client should receive
nothing by mouth. A regular diet is incorrect. When the bleeding is controlled, the diet is gradually
increased, starting with ice chips and then clear liquids. Skim milk shouldnt be given because it
increases gastric acid production, which could prolong bleeding. A liquid diet is the first diet offered
after bleeding and shock are controlled.
28. Answer B. Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue,
and weakness. Abdominal pain may occur but doesnt radiate to the shoulder. Eructation and
constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of
advanced hepatic disease, not an early sign of hepatitis A.
29. Answer C. To maintain enteric precautions, the nurse must wash the hands after touching the client
or potentially contaminated articles and before caring for another client. A private room is warranted
only if the client has poor hygiene for instance, if the client is unlikely to wash the hands after
touching infective material or is likely to share contaminated articles with other clients. For enteric
precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is
likely.
30. Answer C. Hepatitis A can be caused by consuming contaminated water, milk, or food especially
shellfish from contaminated water. Hepatitis B is caused by blood and sexual contact with an infected
person. Hepatitis C is usually caused by contact with infected blood, including receiving blood
transfusions.
1. The newly admitted client has burns on both legs. The burned areas appear white and leatherlike. No blisters or bleeding are present, and the client states that he or she has little pain. How
should this injury be categorized?
A. Superficial
B. Partial-thickness superficial
C. Partial-thickness deep
D. Full thickness
2. The newly admitted client has a large burned area on the right arm. The burned area appears
red, has blisters, and is very painful. How should this injury be categorized?
A. Superficial
B. Partial-thickness superficial
C. Partial-thickness deep
D. Full thickness
3. The burned client newly arrived from an accident scene is prescribed to receive 4 mg of
morphine sulfate by IV push. What is the most important reason to administer the opioid
analgesic to this client by the intravenous route?
A. The medication will be effective more quickly than if given intramuscularly.
B. It is less likely to interfere with the clients breathing and oxygenation.
C. The danger of an overdose during fluid remobilization is reduced.
D. The client delayed gastric emptying.
4. Which vitamin deficiency is most likely to be a long-term consequence of a full-thickness burn
injury?
A. Vitamin A
B. Vitamin B
C. Vitamin C
D. Vitamin D
5. Which client factors should alert the nurse to potential increased complications with a burn
injury?
A. The client is a 26-year-old male.
B. The client has had a burn injury in the past.
C. The burned areas include the hands and perineum.
D. The burn took place in an open field and ignited the clients clothing.
6. The burned client is ordered to receive intravenous cimetidine, an H2 histamine blocking
agent, during the emergent phase. When the clients family asks why this drug is being given,
what is the nurses best response?
A. To increase the urine output and prevent kidney damage.
B. To stimulate intestinal movement and prevent abdominal bloating.
C. To decrease hydrochloric acid production in the stomach and prevent ulcers.
D. To inhibit loss of fluid from the circulatory system and prevent hypovolemic shock.
7. At what point after a burn injury should the nurse be most alert for the complication of
hypokalemia?
A. Immediately following the injury
The characteristics of the wound meet the criteria for a superficial partialthickness injury (color that is
pink or red; blisters; pain present and high).
3. Answer: C
Although providing some pain relief has a high priority, and giving the drug by the IV route instead of
IM, SC, or orally does increase the rate of effect, the most important reason is to prevent an overdose
from accumulation of drug in the interstitial space during the fluid shift of the emergent phase. When
edema is present, cumulative doses are rapidly absorbed when the fluid shift is resolving. This delayed
absorption can result in lethal blood levels of analgesics.
4. Answer: D
Skin exposed to sunlight activates vitamin D. Partial-thickness burns reduce the activation of vitamin
D. Activation of vitamin D is lost completely in full thickness burns.
5. Answer: C
Burns of the perineum increase the risk for sepsis. Burns of the hands require special attention to ensure
the best functional outcome.
6. Answer: C
Ulcerative gastrointestinal disease may develop within 24 hours after a severe burn as a result of
increased hydrochloric acid production and decreased mucosal barrier. Cimetidine inhibits the
production and release of hydrochloric acid.
7. Answer: C
Hypokalemia is most likely to occur during the fluid remobilization period as a result of dilution,
potassium movement back into the cells, and increased potassium excreted into the urine with the
greatly increased urine output.
8. Answer: C
The saturation of hemoglobin molecules with carbon monoxide and the subsequent vasodilation
induces a cherry red color of the mucous membranes in these clients. The other manifestations are
associated with inhalation injury, but not specifically carbon monoxide poisoning.
9. Answer: C
Circumferential eschar can act as a tourniquet when edema forms from the fluid shift, increasing tissue
pressure and preventing blood flow to the distal extremities and increasing the risk for tissue necrosis.
This problem is an emergency and, without intervention, can lead to loss of the distal limb. This
problem can be reduced or corrected with an escharotomy.
10. Answer: D
Sickle cell disease and sickle cell trait are more common among African Americans. Although clients
with sickle cell disease usually know their status, the client with sickle cell trait may not. The fluid,
circulatory, and respiratory alterations that occur in the emergent phase of a burn injury could result in
decreased tissue perfusion that is sufficient to cause sickling of cells, even in a person who only has the
trait. Determining the clients sickle cell status by checking the percentage of hemoglobin S is essential
for any African American client who has a burn injury.
11. Answer: B
Although not universally true, most fluid resuscitation for burn injuries starts with crystalloid solutions,
such as normal saline and Ringers lactate. The burn client rarely requires blood during the emergent
phase unless the burn is complicated by another injury that involved hemorrhage. Colloids and plasma
are not generally used during the fluid shift phase because these large particles pass through the leaky
capillaries into the interstitial fluid, where they increase the osmotic pressure. Increased osmotic
pressure in the interstitial fluid can worsen the capillary leak syndrome and make maintaining the
circulating fluid volume even more difficult.
12. Answer: B
Respiratory difficulty can arise from external pressure. The first action in this situation would be to
loosen the dressing and then reassess the clients respiratory status.
13. Answer: B
Clients with severe inhalation injuries may sustain such progressive obstruction that they may lose
effective movement of air. When this occurs, wheezing is no longer heard and neither are breath
sounds. The client requires the establishment of an emergency airway and the swelling usually
precludes intubation.
14. Answer: B
Neural and hormonal compensation to the stress of the burn injury in the emergent phase increases liver
glucose production and release. An acute rise in the blood glucose level is an expected client response
and is helpful in the generation of energy needed for the increased metabolism that accompanies this
trauma.
15. Answer: A
Intense pain and carbon monoxide poisoning increase blood pressure. Hemorrhage is unusual in a burn
injury. The physiologic effect of histamine release in injured tissues is a loss of vascular volume to the
interstitial space, with a resulting decrease in blood pressure.
16. Answer: B Decreased or absent peristalsis is an expected response during the emergent phase of
burn injury as a result of neural and hormonal compensation to the stress of injury. No currently
accepted intervention changes this response, and it is not the highest priority of care at this time.
17. Answer: A
The fluid remobilization phase improves renal blood flow, increasing diuresis and restoring fluid and
electrolyte levels. The increased water content of the urine reduces its specific gravity.
18. Answer: C
During the emergent phase, fluid shifts into interstitial tissue in burned areas. When the burn is
circumferential on an extremity, the swelling can compress blood vessels to such an extent that
circulation is impaired distal to the injury, necessitating the intervention of an escharotomy. Chemical
burns do not cause inhalation injury.
19. Answer: B
All these findings are abnormal; however, only the serum potassium level is changed to the degree that
serious, life-threatening responses could result. With such a rapid rise in the potassium level, the client
is at high risk for experiencing severe cardiac dysrhythmias and death.
20. Answer: B
The airway is not at any particular risk with this injury. Electric current travels through the body from
the entrance site to the exit site and can seriously damage all tissues between the two sites. Early
cardiac damage from electrical injury includes irregular heart rate, rhythm, and ECG changes.
21. Answer: D
The risk for inhalation injury is greatest when flame burns occur indoors in small, poorly ventilated
rooms. although smoking increases the risk for some problems, it does not predispose the client for an
inhalation injury.
22. Answer: C
Clients may have ineffective respiratory efforts and gas exchange even though they are able to talk,
have good respiratory movement, and are alert. The best indicator for respiratory effectiveness is the
maintenance of oxygen saturation within the normal range.
23. Answer: C
Clients may have ineffective respiratory efforts and gas exchange even though they are able to talk,
have good respiratory movement, and are alert. The best indicator for respiratory effectiveness is the
maintenance of oxygen saturation within the normal range.
24. Answer: B
Intact skin is a major barrier to infection and other disruptions in homeostasis. No matter how much
time has passed since the burn injury, the client remains at great risk for infection as long as any area of
skin is open.
25. Answer: C
It is likely the client has a diminished cardiac output as a result of the old MI and would be at greater
risk for the development of congestive heart failure and
pulmonary edema during fluid resuscitation.
26. Answer: C
Difficulty swallowing and drooling are indications of oropharyngeal edema and can precede pulmonary
failure. The clients airway is in severe jeopardy and intubation is highly likely to be needed shortly.
27. Answer: A
Cross-contamination occurs when microorganisms from another person or the environment are
transferred to the client. Although all the interventions listed above can help reduce the risk for
infection, only hand washing can prevent cross contamination.
28. Answer: C
Normally, the mature segmented neutrophils (segs) are the major population of circulating
leukocytes, constituting 55% to 70% of the total white blood count. Fewer than 3% to 5% of the
circulating white blood cells should be the less mature band neutrophils. A left shift occurs when the
bone marrow releases more immature neutrophils than mature neutrophils. Such a shift indicates severe
infection or sepsis, in which the clients immune system cannot keep pace with the infectious process.
29. Answer: C
The function that would be disrupted by a contracture to the posterior neck is flexion. Moving the head
from side to side prevents such a loss of flexion.
30. Answer: D
Maximum function for ambulation occurs when the hip and leg are maintained at full extension with
neutral rotation. Although the client does not have to spend 24
hours at a time in this position, he or she should be in this position (in bed or standing) more of the time
1. A client is 1 day postoperative after a total hip replacement. The client should be placed in
which of the following position?
a. Supine
b. Semi Fowlers
c. Orthopneic
d. Trendelenburg
2. A client who has had a plaster of Paris cast applied to his forearm is receiving pain medication.
To detect early manifestations of compartment syndrome, which of these assessments should the
nurse make?
a. Observe the color of the fingers
b. Palpate the radial pulse under the cast
c. Check the cast for odor and drainage
d. Evaluate the response to analgesics
3. After a computer tomography scan with intravenous contrast medium, a client returns to the
unit complaining of shortness of breath and itching. The nurse should be prepared to treat the
client for:
a. An anaphylactic reaction to the dye
b. Inflammation from the extravasation of fluid during injection.
c. Fluid overload from the volume of the infusions
d. A normal reaction to the stress of the diagnostic procedure.
4. While caring for a client with a newly applied plaster of Paris cast, the nurse makes note of all
the following conditions. Which assessment finding requires immediate notification of the
physician?
a. Moderate pain, as reported by the client
b. Report, by client, the heat is being felt under the cast
c. Presence of slight edema of the toes of the casted foot
d. Onset of paralysis in the toes of the casted foot
5. Which of these nursing actions will best promote independence for the client in skeletal
traction?
a. Instruct the client to call for an analgesic before pain becomes severe.
b. Provide an overhead trapeze for client use
c. Encourage leg exercise within the limits of traction
d. Provide skin care to prevent skin breakdown.
6. A client presents in the emergency department after falling from a roof. A fracture of the
femoral neck is suspected. Which of these assessments best support this diagnosis.
a. The client reports pain in the affected leg
b. A large hematoma is visible in the affected extremity
c. The affected extremity is shortened, adducted, and extremely rotated
d. The affected extremity is edematous.
7. The nurse is caring for a client with compound fracture of the tibia and fibula. Skeletal
traction is applied. Which of these priorities should the nurse include in the care plan?
a. Order a trapeze to increase the clients ambulation
b. Maintain the client in a flat, supine position at all times.
c. Provide pin care at least every hour
d. Remove traction weights for 20 minutes every two hours.
8. To prevent foot drop in a client with Bucks traction, the nurse should:
a. Place pillows under the clients heels.
b. Tuck the sheets into the foot of the bed
c. Teach the client isometric exercises
d. Ensure proper body positioning.
9. Which nursing intervention is appropriate for a client with skeletal traction?
a. Pin care
b. Prone positioning
c. Intermittent weights
d. 5lb weight limit
10. In order for Bucks traction applied to the right leg to be effective, the client should be placed
in which position?
a. Supine
b. Prone
c. Sims
d. Lithotomy
11. An elderly client has sustained intertrochanteric fracture of the hip and has just returned
from surgery where a nail plate was inserted for internal fixation. The client has been instructed
that she should not flex her hip. The best explanation of why this movement would be harmful is:
a. It will be very painful for the client
b. The soft tissue around the site will be damaged
c. Displacement can occur with flexion
d. It will pull the hip out of alignment
12. When the client is lying supine, the nurse will prevent external rotation of the lower extremity
by using a:
a. Trochanter roll by the knee
b. Sandbag to the lateral calf
26. On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis.
Which of the following would be the nurse most likely to asses:
a. Limited motion of joints
b. Deformed joints of the hands
c. Early morning stiffness
d. Rheumatoid nodules
27. After teaching the client about risk factors for rheumatoid arthritis, which of the following, if
stated by the client as a risk factor, would indicate to the nurse that the client needs additional
teaching?
a. History of Epstein-Barr virus infection
b. Female gender
c. Adults between the ages 60 to 75 years
d. Positive testing for human leukocyte antigen (HLA) DR4 allele
28. When developing the teaching plan for the client with rheumatoid arthritis to promote rest,
which of the following would the nurse expect to instruct the client to avoid during the rest
periods?
a. Proper body alignment
b. Elevating the part
c. Prone lying positions
d. Positions of flexion
29. After teaching the client with severe rheumatoid arthritis about the newly prescribed
medication methotrexate (Rheumatrex O), which of the following statements indicates the need
for further teaching?
a. I will take my vitamins while I am on this drug
b. I must not drink any alcohol while Im taking this drug
c. I should brush my teeth after every meal
d. I will continue taking my birth control pills
30. When completing the history and physical examination of a client diagnosed with
osteoarthritis, which of the following would the nurse assess?
a. Anemia
b. Osteoporosis
c. Weight loss
d. Local joint pain
31. At which of the following times would the nurse instruct the client to take ibuprofen (Motrin),
prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation?
a. At bedtime
b. On arising
c. Immediately after meal
d. On an empty stomach
32. When preparing a teaching plan for the client with osteoarthritis who is taking celecoxib
(Celebrex), the nurse expects to explain that the major advantage of celecoxib over diclofenac
(Voltaren), is that the celecoxib is likely to produce which of the following?
a. Hepatotoxicity
b. Renal toxicity
c. Gastrointestinal bleeding
d. Nausea and vomiting
33. After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain
and an inability to move the extremity. The nurse interprets these findings as indicating which of
the following?
a. A developing infection
b. Bleeding in the operative site
c. Joint dislocation
d. Glue seepage into soft tissue
34. Which of the following would the nurse assess in a client with an intracapsular hip fracture?
a. Internal rotation
b. Muscle flaccidity
c. Shortening of the affected leg
d. Absence of pain the fracture area
35. Which of the following would be inappropriate to include when preparing a client for
magnetic resonance imaging (MRI) to evaluate a rupture disc?
a. Informing the client that the procedure is painless
b. Taking a thorough history of past surgeries
c. Checking for previous complaints of claustrophobia
d. Starting an intravenous line at keep-open rate
36. Which of the following actions would be a priority for a client who has been in the
postanesthesia care unit (PACU) for 45 minutes after an above the knee amputation and develops
a dime size bright red spot on the ace bandage above the amputation site?
a. Elevate the stump
b. Reinforcing the dressing
c. Calling the surgeon
d. Drawing a mark around the site
37. A client in the PACU with a left below the knee amputation complains of pain in her left big
toe. Which of the following would the nurse do first?
a. Tell the client it is impossible to feel the pain
b. Show the client that the toes are not there
c. Explain to the client that the pain is real
d. Give the client the prescribed narcotic analgesic
38. The client with an above the knee amputation is to use crutches until the prosthesis is being
adjusted. In which of the following exercises would the nurse instruct the client to best prepare
him for using crutches?
a. Abdominal exercises
b. Isometric shoulder exercises
c. Quadriceps setting exercises
d. Triceps stretching exercises
39. The client with an above the knee amputation is to use crutches until the prosthesis is
properly lifted. When teaching the client about using the crutches, the nurse instructs the client
Answers
Here are the answers for the exam. Unfortunately, rationales are not given. If you need clarifications or
have disputes, please direct them to the comments section and well be glad to give you an explanation.
1. b. Semi Fowlers
2. d. Evaluate the response to analgesics
3. a. An anaphylactic reaction to the dye
4. d. Onset of paralysis in the toes of the casted foot
5. b. Provide an overhead trapeze for client use
6. c. The affected extremity is shortened, adducted, and extremely rotated
7. c. Provide pin care at least every hour
8. d. Ensure proper body positioning.
9. a. Pin care
10. a. Supine
11. c. Displacement can occur with flexion
12. c. Trochanter roll to the thigh
13. b. Remove the pillow and elevate the foot of the bed
14. c. Pad the top of the splint with washcloths
15. b. Reduce the inflammation of the joints
16. a. Ability to ambulate sooner
17. d. Wiggle his toes
18. d. Practice getting the client out of bed by having her slightly flex her hips
19. b. Prevent footdrop
20. b. Rope/pulley system
21. b. Elevating the head of the bed
22. b. Change in color
23. b. Bladder distention
24. b. Tarry stools
25. c. Watch television
26. c. Early morning stiffness
27. c. Adults between the ages 60 to 75 years
28. d. Positions of flexion
29. d. I will continue taking my birth control pills
30. d. Local joint pain
31. c. Immediately after meal