GASTRIC AND INTESTINAL DISORDER

1. All of the following are causes of esophageal varices except?

a. Obstruction in the common hepatic duct c. Liver cirrhosis
b. Obstruction in the portal circulation d. Portal hypertension
2. A client with Sengstaken- Blakemore tube in place is admitted to the nursing unit from the emergency department. The nurse plans care knowing
that the purpose of this tube, is
a. control ascites
b. control bleeding from gastritis
c. provide temporary tamponade to esophageal varices.
d. Remove ammonia- forming bacteria from the gastrointestinal tract
3. A nurse is caring for a client with a Sengstaken-Blakemore tube, when the client complains of an abrupt onset of severe
pain and respiratory difficulty. Which nursing action is appropriate?
a. Administer the prescribed analgesic. c. Assess the lumens of the tubes.
b. Reposition the client. d. Cut all three lumens of the tube and remove the entire tube.
Situation 3: Mrs. Cruz was admitted in the medical floor due to pyrosis, dyspepsia and difficulty of swallowing, due to incompetent lower esophageal
sphincter.
4. Based from the symptoms presented, Nurse Mei might suspect:
a. esophagitis
b. Hiatal hernia
c. GERD
d. Gastric ulcer
5. What diagnostic test would confirm the type of problem Mrs. Cruz have?
a. barium enema
b. barium swallow
c. colonoscopy
d. lower GI series
6. To avoid reflux, Nurse Mei should advice Mrs. Cruz to avoid which type of diet?
a. cola, coffee and tea
b. high fat, carbonated and caffeinated beverages
c. beer and green tea
d. lechon paksiw and bicol express
7. Which of the following dietary measures would be useful in preventing esophageal reflux?
a. Eating small, frequent meals.
b. Increasing fluid intake.
c. Avoiding air swallowing with meals.
d. Adding a bedtime snack to the dietary plan.
8. 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?
a. development of laryngeal cancer
b. irritation of the esophagus
c. esophageal scar tissue formation
d. aspiration of gastric contents
9. Which of the following can be the surgical procedure for GERD?
a. antrectomy
b. nissen fundoplication
c. Whipples procedure
d. esophagogastroduodenostomy
10. The nurse understands that the primary symptoms of a sliding hiatal hernia are associated with reflux. Therefore, the
nurse should assess the client for which of the following symptoms?
a. Heartburn b. Jaundice. c. Anorexia. d. Stomatitis.
11. A nurse is performing an assessment on a client with a diagnosis of hiatal hernia. The nurse expects the client to make
which statement that is characteristic of this disorder?
a. The pain in my chest is always tight and feels like pressure.
b. "The pain in my chest is worse after a large meal."
c. "The pain in my chest is aggravated by exercise."
d. The pain in my chest is relieved when I lie down."
12. The client has been taking magnesium hydroxide (milk of magnesia) at home in an attempt to control hiatal hernia symptoms. The nurse should
assess the client for which of the following conditions most commonly associated with the ongoing use of magnesium-based antacids?
a. anorexia
b. weight gain
c. diarrhea
d. constipation

13. Which of the following lifestyle modifications should the nurse encourage the client with a hiatal hernia to include in
activities of daily living?
a. Daily aerobic exercise.
b. Eliminating smoking and alcohol use.
c. Balancing activity and rest.
d. Avoiding high-stress situations.
14. The nurse instructs the client on health maintenance activities to help control symptoms from her hiatal hernia. Which
of the following statements would indicate that the client has understood the instructions?
a. "I'll avoid lying down after a meal."
b. "I can still enjoy my potato chips and cola at bedtime."
c. "I wish I didn't have to give up swimming."
d. "If I wear a girdle, I'll have more support for my stomach."
15. What other symptoms will validate the diagnosis of gastric ulcer?
a. right epigastric pain
b. pain occurs when stomach is empty
c. pain occurs immediately after meal
d. pain not relieved by vomiting
16. A client is to take one daily dose of ranitidine(Zantac) at home to treat her peptic ulcer. The nurse knows that the client
understands proper drug administration of ranitidine when she says that she will take the drug at which of the following
times?
a. Before meals.
b. With meals.
c. At bedtime.
d. When pain occurs.
17. Peptic ulcer disease particularly gastric ulcer is thought to be cause by which of the following microorgamisms?
a. E. coli b. H. pylori c. S. aureus d. K. pnuemoniae
18. When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and
symptoms would the nurse expect to assess?
a. Diminished pain after eating.
b. Worsening of epigastric pain after eating.
c. Ravenous appetite.
d. Weight gain.
19. The nursing diagnosis for the client with a duodenal ulcer is Acute pain related to decreased mucosal protection,
increased gastric secretions and burning, cramping, and abdominal pain 2 to 4 hours after meals. The nurse plans to
instruct the client that when this acute pain occurs to:
a. Drink a cup of tea.
b. Take an enteric-coated aspirin.
c. Take an antacid.
d. Drink a cup of cocoa.
20. A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to undergo a subtotal
gastrectomy (Billroth II procedure). During preoperative teaching, the nurse is reinforcing information about the
surgical procedure. Which of the following explanations is most accurate?
a. The procedure will result in enlargement of the pyloric sphincter.
b. The procedure will result in anastomosis of the gastric stump to the jejunum.
c. The procedure will result in removal of the lower portion of the antrum and anastamosis to the duodenum
d. The procedure will result in repositioning of the vagus nerve.
21. A client is resuming a diet after a Billroth II procedure. To minimize complications from eating, the nurse teaches the
client to avoid doing which of the following?
a. Lying down after eating c. Drinking liquids with meals
b. Eating a diet high in protein d. Eating sin small meals per day
22. A clinic nurse is assessing a client who had a total gastrectomy 2 months ago. The nurse checks which of the
following that would indicate a specific complication of this surgical procedure?
a. Signs of vitamin B1 2 and folic acid deficiencies c. Pupillary response to light
b. Blood urea nitrogen levels d. Calcium levels

Situation 9: Mr. Joe Sy, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen.
Admission vital signs reveal an oral temperature of 101.2 0F.
23. Which of the following would confirm a diagnosis of appendicitis?
a. The pain is localized at a position halfway between the umbilicus and the right iliac crest.
b. Mr. Liu describes the pain as occurring 2 hours after eating
 c. The pain subsides after eating
d. The pain is in the left lower quadrant
24. Which of the following complications is thought to be the most common cause of appendicitis?
a. Obstruction of Fecalith found in the median and lateral aspect of the internal os
b. Internal bowel occlusion
c. Bowel kinking
d. A small hard feces in the appendix
25. The doctor ordered for a complete blood count. After the test, Nurse Ray received the result from the laboratory.
Which laboratory values will confirm the diagnosis of appendicitis?
a. RBC 5.5 x 106/mm3 c. WBC 13, 000/mm3
b. Hct 44 % d. Hgb 15 g/dL
26. The patient underwent appendectomy. What is the ideal position of the patient post uncomplicated appendectomy?
a. Prone c. Low fowlers position
b. Lithotomy d. High fowlers position
27. After a few minutes, the pain suddenly stops without any intervention. Nurse Ray might suspect that:
a. the appendix is still distended
b. the appendix may have ruptured
c. an increased in intrathoracic pressure will occur
d. signs and symptoms of peritonitis occur
28. A client who has a history of chronic ulcerative colitis is diagnosed with anemia. The nurse interprets that which factor is most likely responsible
for the anemia?
a. blood loss
b. intestinal hookworm
c. intestinal malabsorption
d. decreased intake of dietary iron
29. Which of the following is usually present and share s/sx between crohns and ulcerative colitis?
a. Abdominal pain and rectal bleeding
b. Passage of pus, mucus and bleeding, abdominal pain
c. Abdominal pain and diarrhea
d. Passage of pus, mucus and bleeding, diarrhea
30. The nurse knows that the allowed diet in a client with crohns and ulcerative colitis are the following?
a. high protein, low fat, high fiber
b. high protein, high fat, low residue
c. low residue, high protein, low fat
d. low residue, low protein low fat
31. Which of the following has been identified as a potential risk factor for the development of colon cancer?
a. Chronic constipation.
b. Long-term use of laxatives.
c. History of smoking.
d. History of inflammatory bowel disease.
32. The nurse is preparing a teaching plan for a community presentation on the prevention and early detection of colon cancer. Which of the
following would the nurse identify to the audience as the most common symptom of colon cancer?
a. abdominal pain
b. diarrhea
c. rectal bleeding
d. abdominal distention
33. Which of the following diet can cause colon cancer?
a. high fat, low fiber diet c. Low residue, and low fat
b. High residue, and high fat d. None of the above
34. The nurse is teaching a client about the modifiable risk factors that can reduce the risk of colorectal cancer. The nurse places highest priority on
which risk factor with this client?
a. age older than 30 years
b. high fat and low fiber diet
c. distant relative with colorectal cancer
d. personal history of ulcerative colitis or gastrointestinal polyps
35. The nurse knows that the consistency of the feces if the patient has colostomy in the transverse colon is?
a. Solid b. Semi mushy c. Mucoid d. Fluids
36. What is the primary nursing diagnosis for a client with a bowel obstruction?
a. fluid volume deficit
b. knowledge deficit
c. pain
d. altered tissue perfusion
37. The nurse is performing an assessment on a client who has developed a paralytic ileus. The clients bowel sounds will be:\
a. hyperactive
b. hypoactive
c. high-pitched
d. blowing
38. Which medication should the nurse expect to administer to a client with constipation?
a. lorazepam (Ativan)
b. Loperamide (Imodium)
c. Flurbiprofen (Ansaid)
d. Docusate sodium (Colace)
39. Which outcome indicates effective client teaching to prevent constipation?
a. the client verbalizes consumption of low fiber foods
b. the client maintains a sedentary lifestyle
c. the client limits water intake to three glasses per day.
d. the client reports engaging in a regular exercise regimen
40. When preparing a client for a hemorrhoidectomy, the nurse should take which action?
a. administer an enema as ordered
b. administer oral antibiotics as prescribed
c. administer topical antibiotics as prescribed
d. administer analgesics as prescribed
LIVER
41. A client is admitted with increased ascites related to cirrhosis. Which nursing diagnosis should receive top priority?
a. fatigue
b. fluid volume excess
c. ineffective breathing pattern
d. altered nutrition : less than body requirements
42. Which of the following nursing measures would be most appropriate for a patient who has ascites?
a. withholding fluids c. encouraging ambulation
b. measuring abdominal girth d. monitoring for pedal edema
43. Before paracentesis, the nurse must instruct the patient to?
a. Drink fluids to prevent dehydration
b. Void at the rectum
c. Void to reduce the size of the bladder
d. Drink fluids so the uterus can pushed upward for good visualization
44. A client with cirrhosis complicated by ascites is admitted to the hospital. The client has stated a in-pound weight gain over the past 7 days and
has edema in both feet and ankles. The clients abdomen is distended, taut, and shiny with striae. The nurse would assign highest priority to which
diagnosis?
a. risk for impaired skin integrity
b. excess fluid volume
c. risk for activity intolerance
d. impaired gas exchange
45. The nurse is assisting a physician with abdominal paracentesis. The nurse assists the client into what position for this procedure?
a. prone
b. supine
c. sitting on the edge of the bed
d. low fowlers on the right side.
46. After the removal of the fluid, you will observe Juan Carlo for:
a. decrease pulse rate
b. increased BP
c. increase pulse rate
d. decrease respiratory rate
47. The nurse is caring for a client who is scheduled to have a liver biopsy. Before the procedure, it is most important for the verse to assess the
clients:
a. tolerance for pain
b. allergy to iodine or shellfish
c. history of nausea and vomiting
d. ability to lie still and hold the breath
48. After the removal of the fluid, you will observe Juan Carlo for:
a. decreased pulse rate
b. increased BP
c. increase pulse rate
d. decrease respiratory
49. After liver biopsy, the nurse must assess the patients for signs of:
a. hepatic encephalopathy
b. decreasing blood pressure and increasing heart rate
c. formation of ascites
d. increasing BP and pulse rate
50. Which of the following is/are signs of hepatic coma
a. asterixis, fetor diabeticus
b. fetor hepaticus, and carpopedal tremors
c. flapping tremors, fetor hepaticus
d. facial twitching, carpopedal spasm
51. Which of the following diet is allowed for a patient with late stage liver cirrhosis?
a. high protein
b. high fat
c. low carbohydrates
d. low protein
52. The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this
hepatic disease?
a. dyspnea and fatigue
b. ascites and orthopnea
c. purpura and petechiae
d. gynecomastia and testicular atrophy
53. A patient with hepatic encephalopathy is about to take neomycin, a aminoglycoside anti-bacterial drug. The nurse
knows that the primary action of this drug due the patient condition is?
a. Kill the bacteria in the liver that causes hepatic encephalopathy
b. To prevent nosocomial infection
c. To diminished ammonia formation
d. To prevent secondary infection
54. A client seen in the ambulatory care clinic has ascites and slight jaundice. The nurse assesses the client for a history of chronic use of which of
the following medications?
a. docusate sodium (Colace)
b. Ranitidine (Zantac)
c. Acetaminophen ( Tylenol)
d. Acetylsalicylic acid ( Aspirin)
55. A client is admitted with increased ascites associated with cirrhosis which nursing diagnosis should receive top priority?
A. fatigue C. ineffective breathing pattern
B. fluid volume excess D. altered nutrition: less than body requirements

PANCREAS
56. What laboratory finding is the primary diagnostic indicator for pancreatitis?
a. elevated blood urea nitrogen (BUN)
b. elevated serum lipase
c. elevated aspartate aminotransferase (AST)
d. increased lactate dehydrogenase (LD)
57. The nurse is performing a health history on a client with chronic calcifying pancreatitis. The nurse expects to most likely note which of the
following when obtaining information regarding the clients health history?
a. weight gain
b. history of smoking
c. chronic use of alcohol
d. abdominal pain relieved with food or antacids

58. A client has been admitted to the hospital with a diagnosis of acute pancreatitis. After medicating the client for pain, the nurse would evaluate for
relief of pain that was located in the :
a. epigastric area and radiating to the umbilicus
b. left lower quadrant and radiating to the hip
c. epigastric area and radiating to the back
d. left lower quadrant and radiating to the groin

59. A nurse is caring for a client with a diagnosis of chronic pancreatitis. The nurse collects data on the client, knowing that which symptom indicates
poor absorption of dietary fats?
a. steatorrhea
b. bloody diarrhea
c. electrolyte disturbance
d. gastrointestinal reflux disease

60. A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a
diagnosis of acute pancreatitis. The clients vital signs are stable, but the clients pain is worsening and radiating to his back. Which intervention
takes priority for this client?
a. placing the client in a semi-fowlers position
b. maintaining NPO status
c. Administering Morphine IV as prescribed
d. Providing mouth care

61. The client with chronic pancreatitis should be monitored closely for the development of which of the following disorders?
a. cholelithiasis
b. hepatitis
c. irritable bowel syndrome
d. diabetes mellitus

62. Of the following, which would be manifested by the patient with acute pancreatitis?
a. (+) homan sign c. Increased muscle strength
b. Increased blood glucose level d. loose tarry stool

GALL BLADDER

63. The group of characteristics that would alert the nurse that a client is at increased risk of developing gallbladder
disease would be female:
a. Over the age of 40, obese
b. Under the age of 40, history of high fat intake
c. Over the age of 40, low serum cholesterol level
d. Under the age of 40, family history of gallbladder stones
64. A nurse has given a client experiencing an acute episode of cholecystitis parenteral pain medication. Thirty minutes
later the nurse determines whether the client obtained relief from the pain that had originated in the:
a. Lower quadrant radiating to the umbilicus
b. Lower quadrant radiating to the back
c. Upper quadrant radiating to the left scapula and shoulder
d. Upper quadrant radiating to the right scapula and shoulder
65. A client has cholelithiasis with possible obstruction of the common bile duct. Before the scheduled cholecystectomy,
nutritional deficiencies and excess should be corrected. A nutritional assessment should be conducted to determine
whether the client:
a. Is deficient in vitamins A, D, and K
b. Eats adequate amount of dietary fiber
c. Consume excessive amounts of protein
d. Has excessive levels of potassium and folic acid
66. What do you call the stone found in the common bile duct?
a. cholelithiasis
b. choledocolithtotolithiasis
c. cholecystolithiasis
d. choledocolithiasis
67. The nurse teaches a client about an upcoming endoscopic retrograde cholangiopancreatography IERCPI procedure.
The nurse determines that the client requires additional information if the client states that:
a. A signed informed consent is necessary. It
b. An anesthetic throat spray will be used.
c. Medication will be given orally for sedation.
d. It is important to lie still during the procedure.
68. A client with cholecystitis is receiving propantheline bromide. The client is given this medication because it :
a. reduces gastric solution production and hypermobility
b. slows emptying of the stomach and reduces chime in the duodenum
c. inhibits contraction of the bile duct and gallbladder
d. decreases bile secretions.
69. A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:
a. yellow sclerae
b. light amber urine
c. circumoral pallor
d. black, tarry stool
70. A client undergoes an abdominal cholecystectomy with common duct exploration. In the immediate post-operative period, the nursing action that
should assume the highest priority for this client is:
a. Irrigating the T-tube frequently
b. Changing the dressing at least twice a day
c. Encouraging coughing and deep breathing
d. Promoting an adequate fluid intake

71. A client is suspected of having a peptic ulcer. When obtaining a history from this client, the nurse should expect the reported pain
to:
a. intensify when the client vomits
b. occur one to three hours after meals
c. increase when the client eats fatty foods
d. begin in the epigastrium and radiate across the abdomen
Rationale: Pain occurs after the stomach empties; ingesting food stimulates gastric secretions, which later act on the gastric mucosa of
the empty stomach, causing the gnawing pain
Option A- Vomiting temporarily alleviates pain because acid secretions are removed.
Option C- There is no intolerance of fats; eating generally alleviates pain
Option D- Pain sharply localized in the epigastrium ; it can radiate across the abdomen if an ulcer has perforated.

72. After an acute episode of upper GI bleeding, a client vomits undigested antacids and complains of severe epigastric pain. The
nursing assessment reveals an absence of bowels sounds, pulse rate of 134, and shallow respirations of 32 per minute. In addition
to calling the physician, the nurse should:
a. Keep the client NPO
b. Start oxygen per nasal cannula at 3 to 4 L per minuta
c. Place the client in the supine position with the legs elevated
d. Ask the client whether any red or black stools have been noted.
Rationale: These are classic indicators of perforated ulcer, for which immediate surgery is indicated; keeping the client NPO should be
anticipated
Option B- Tachycardia and tachypnea re related to pain and possible blood loss; not an airway problem
Oprion C- trendelenburg is the position of choice for shock but the priority is surgery because of perforation
Option D- indicated bleeding in the Gi, not perforation

73. After a subtotal gastrectomy, a client develops dumping syndrome. In addition, about 1 and hours after the initial attack, the
client experiences a second period of feeling shaky. The nurse recognizes that this latter effect is caused by:
a. A second more extensive rise in glucose
b. An overwhelmed insulin- adjusting mechanism
c. A distention of the duodenum from an excessive amount of chyme
d. An overproduction of insulin that occurs in response to the rise on blood glucose
Rationale: The rapid absorption of the carbohydrates, stimulates production of insulin which will result to hypoglycemic symptoms. This
is also known as late dumping syndrome
Option A- hyperglycemia occurs minutes after eating.
Option B- not overwhelmed, but responds immediately resulting to hypoglycemia
Option C- dumping syndrome is not caused by the amount of food that enters the duodenum

74. A client develops a gallstone that becomes lodged in the common bile duct. The physician
schedules an endoscopic sphincterectomy. Preoperative teaching should include information that for the procedure the client
will:
a. Have a spinal anesthetic
b. Receive an epidural block
 c. Have a general anesthetic
d. Receive an intravenous sedative
Rationale: an intravenous sedative is used to make the patient stay calm. Objective question
75. A client undergoes an abdominal cholecystectomy with common duct exploration. In the immediate post-operative period, the
nursing action that should assume the highest priority for this client is:
76. Irrigating the T-tube frequently
77. Changing the dressing at least twice a day
78. Encouraging coughing and deep breathing
79. Promoting an adequate fluid intake
Rationale: prevent atelectasis and pneumonia-priority airway
Option A: T-tube is never irrigated. It drains by gravity
Option B: dressings are not changed in the immediate post-operative period
Option D: The patient is NPO immediate post-op

80. A 40-year old client is admitted with biliary cancer. The associated jaundice gets progressively worse. The nurse should be most
concerned about the potential complication of:
a. Pruritus
b. Bleeding
c. Flatulence
d. Hypokalemia
Rationale: obstruction of bile impairs absorption of fat-soluble vitamin K, clotting is prolonged, priority is bleeding
Option A- deposition of bile salts to the intestine can cause pruritus but is not life-threatening
Option B: flatulence is expected finding in patient with biliary disease but is not life threatening
Option D- obstructive jaundice does not affect potassium levels
81. When teaching the client about the diet following a pancreatoduodenectomy (Whipples procedure performed for cancer of the
pancreas, the statement the nurse should include would be:
a. There are no dietary restrictions; you may eat what you desire
b. your diet should be low in calories to prevent taxing your pancreas
c. Meals should be restricted in protein because of your compromised liver function
d. Low fat meals should be eaten because of interference with your fat digestion mechanism.
Rationale: Malabsorption, impaired delivery of bile to the intestines, fat metabolism is impaired
82. A client with a long history of alcohol abuse is admitted to the hospital with ascites, jaundice and confusion. A diagnosis of hepatic
cirrhosis is made. A nursing priority would be to:
a. Institute safety measures
b. Monitor respiratory status
c. Measure abdominal girth daily
d. Test stool specimens of blood
Rationale: high ammonia levels contribute to deterioration of mental function-hepatic encephalopathy, priority safety!
Option B: the patient will experience dyspnea due ascites, inc. pressure but not relevant to the situation above
Option C: routine procedure to monitor ascites but not priority for confused patients
Option D: priority safety!
83. A client who underwent abdominal surgery who has a nasogastric (NG) tube in place begins to complain of abdominal pain that he
describes as feeling full and uncomfortable. Which assessment should the nurse perform first?
a. Measure abdominal girth
b. Auscultate bowel sounds
c. Assess patency of the NG tube
d. Assess vital signs
Rationale: NGT is placed after surgery for decompression assessment first.! Feeling of fullness may mean gastric distentionthe
tube may be blocked. Patency of the tube should be assessed.
Option A- not relevant to NGT, indicated for ascites
Option B- Bowel sounds after surgery indicated peristalsis and patient can now be fed orally.
Option D- vague term and may not address the concern of the patient
84. Which nursing action is most appropriate for a client hospitalized with acute pancreatitis?
a. Withholding all oral intake, to decrease a pancreatic secretions
b. Administering demerol, as prescribed, to relieve severe pain
c. Limiting I.V. fluids, as ordered, to decrease cardiac workload
d. Keeping the client supine to increase comfort
Rationale: patients with acute pancreatitis should be immediately placed on NPO to rest bowel , and decreases stimulation for the
production of enzymes and subsequent autodigestion, thus pain results.
Option B- Mosphine is the drug of choice
Option C- IV fluids should not be limited. Nutrition can be given through PICC or TPN
Option D: Positioning the client may decrease pain, flexing the knees to the abdomen not supine
85. When preparing a client, age 50 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 the middle-aged clients.
d. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage
Rationale: The appendix becomes inflamed and edematous as a result of becoming kinked or occluded by a fecalith (ie, hardened
mass of stool), tumor, or foreign body. The inflammatory process increases intraluminal pressure, initiating a progressively severe,
generalized or periumbilical pain that becomes localized to the right lower quadrant of the abdomen within a few hours (Brunner 11the
edition pg. 1241) .
*decreases venous outflow
*reduce arterial flow-ischemia-edema-perforation
*it more commonly occurs between the ages of 10 and 30 years (NIH, 2005).
86. A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him
very difficult to arouse. The diagnostic information which best explains the clients behaviour is:
a. Elevated liver enzymes and low serum protein level
b. Subnormal serum glucose and elevated serum ammonia levels
c. Subnormal clotting factors and platelet count.
d. Elevated blood urea nitrogen and creatinine levels and hyperglycemia.
Rationale: declining level of consciousness- encephalopathy (hepatic) due to increase levels of ammonia
Liver problems-can cause hypoglycemia, liver stores glucose
A and C- are results of liver problems but not specific to the keyword declining level of consciousness.

87. A 28 year old client is admitted with inflammatory bowel syndrome (Chrons disease). Which therapies should the nurse expect to
be part of the care plan?
1. Lactulose therapy
2. High-fiber diet
3. High protein milkshakes
4. Anti-diarrheal medications
5. Corticosteroid therapy

a. 245
b. 45
c. 123
d. 145
Rationale: high fiber diets are prohibited to patients with IBD it promotes irritation of the bowel and increase peristalsis- eliminate 2, 1
(lactulose) is a laxative-it promotes peristalsis. High protein foods can also cause irritation of the bowel and diarrhea. Anti-diarrheal
drugs and steroids are part of the therapy. It decreases inflammation and promotes rest of the bowel.
88. As a client recovers from gastric resection, the nurse monitors closely for complications. When the client resumes oral feeding, the
nurse observes for early manifestations of dumping syndrome. The vasomotor disturbances associated with this syndrome usually
occur how soon after eating?
a. Immediately
b. 15 to 30 minutes
c. 1 to 2 hours
d. 2 to 4 hours
Rationale: According to Brunner 11th edition- Vasomotor symptoms occur 10 to 90 minutes after eating are pallor, perspiration,
palpitations, headache, and feelings of warmth, dizziness, and even drowsiness. The nearest time frame is OPTION B. pg. 1224
89. While preparing a client for an upper GI endoscopy (esophagogastroduodenoscopy), the nurse should implement which
interventions?
1. Administer a preparation to cleanse the GI tract, such as Golytely or Fleets Phospha-Soda.
2. Tell the client he shouldnt eat or drink for 6 to 12 hours before the procedure.
3. Tell the client he must be on a clear liquid diet for 24 hours before the procedure
4. Inform the client that hell receive a sedative before the procedure.
5. Tell the client that he may eat and drink immediately after the procedure.

a. 123
b. 124
c. 24
d. 234
Rationale: choices 135 are used for lower GI series or barium enema..
Education regarding dietary changes prior to the study should include a clear liquid diet, with nothing by mouth (NPO) from
midnight the night before the study; however, each physician may prefer a specific bowel preparation for specific studies.Brunner
11th edition, chapter 34, pg. 1133
1-Fleet enema is used to clean the colom-LGIS
3- clear liquid diet is indicated for LGIS and UGIS
UGIS- 12 hours before
LGIS-24 hours, to decrease the bulk of stool
5- NPO after procedure until gag reflex returns
90. Client is admitted at the medical intensive care unit with a diagnosis of pancreatitis. Which nursing intervention is most
appropriate?
a. Providing generous servings at mealtime
b. Reserving an antecubital site for a peripherally inserted central catheter (PICC)
c. Providing the client with plenty of P. O. Fluids
d. Limiting I.V. Fluid intake according to the physicians order

Rationale: if the patient is diagnosed with acute pancreatitis, the patient is placed under NPO. Nutrition is given through PICC or TPN

GASTROINTESTINAL SYSTEM
91. A positive sign of appendicitis is localized and rebound tenderness on palpation at which quadrant on the abdomen?
a. Left upper quadrant
b. Left lower quadrant
c. Right upper quadrant
d. Right lower quadrant

Answer: D. Right lower quadrant

92. The nurse is in charge of care for a client who has undergone an Appendectomy. The nurse understands that post-op care should include
which of the following interventions?
a. Measure the abdominal girth of the client every hour
b. Strictly limit the clients activity
c. Note the first bowel movement of the client after surgery
d. Administer sitz baths two times a day

Answer: C. Noting the clients first bowel movement after surgery is important because this indicates that normal peristalsis has returned. Sitz
baths are used after rectal surgery, not appendectomy. Ambulation is started the day of surgery and is not confined to bathroom privileges. The
abdomen should be auscultated for bowel sounds and palpated for softness, but there is no need to measure the girth every hour.

93. The nurse is in charge of care for a client who has had an Appendectomy, because of a perforated appendix. As the nurse assesses the client
returning from surgery, there is a drain that has been inserted in the incisional site. The nurse knows that the purpose of this drain is to:
a. Decrease the discomfort of the client
b. Provide easy access for wound irrigation
c. Decrease the development of scar tissue
d. Promote drainage of would exudates

Answer: D. Drains are inserted postoperatively in appendectomies when an abscess was present or the appendix was perforated. The purpose is
to promote drainage of exudates from the wound and facilitate healing. A drain is not used for irrigation of the wound. The drain will not minimize
scare tissue development or decrease postoperative discomfort.

94. The nurse is in charge of providing care for a 45-year-old client with Cholecystitis. The nurse expects to observe the following symptoms in this
client except?
a. Steatorrhea
b. Melena
c. Clay colored stools
d. Abdominal pain in the right upper quadrant, which can radiate to the right shoulder

Answer: B. The symptoms that occur with cholecystitis and cholethiasis are usually associated with pain. The client might also exhibit jaundice of
the skin, sclerae, and upper palate. With cholelithiasis, the stones might block the flow of bile from the gallbladder. Symptoms the nurse might
observe include the following: Abdominal pain in right upper quadrant, especially after a fatty meal or a large volume meal. The pain can radiate to
the right shoulder. Abdominal distention, Dyspepsia, Eructation, Flatulence, Fever, Clay-colored stools, Dark urine, Nausea and vomiting, Palpable
mass in the abdomen, Steatorrhea.

95. The nurse is in charge of providing health teaching to a 43-year-old female client diagnosed with Cholecystitis. The nurse determines that the
client understands the diet prescribed to her for recovery after a gallbladder attack, if she states which of the following?
a. I can have tapioca, cooked fruits, and rice.
b. I can have lean meats, mashed potatoes, and non-gas forming vegetables.
c. I can have bread, coffee, tea, and skim milk.
d. I can have eggs, cream and pork.

Answer: D. Antibiotics are administered intravenously, especially if the clients WBC count is elevated. When the client has improved, diet intake is
reinstituted with a gradual introduction of low-fat liquids and a high-protein, high-carbohydrate diet. Foods allowed and foods to avoid for clients
recovering from a gallbladder attack are as follows:

-Foods allowed: Skim milk, cooked fruits, rice, tapioca, lean meats, mashed potatoes, nongas-forming vegetables, bread, coffee, and tea

-Foods to avoid: Eggs, cream, pork, fried foods, cheese, rich dressings, gas-
forming vegetables, and alcohol

96. The nurse is in charge of care for a client diagnosed with Cholecystitis. The nurse understands that which of the following clinical manifestations
are expected to be seen in the client?
a. Dysphagia
b. Diarrhea
 c. Hiccups
d. Fever

Answer: D. is correct. Other clinical manifestations include pain, nausea, vomiting, rebound tenderness upon palpation, flatulence, and indigestion.
Answers A, B, and C are not associated with cholecystitis, so they are incorrect.

97. The nurse is assessing a client with Pancreatitis. Which of the following signs and symptoms would the nurse expect to see in this client?

a. Ascites
b. Diarrhea
c. Hypertension
d. Jaundice

Answer: D. Jaundice may be present in acute pancreatitis owing to obstruction of the biliary tract. Bowel sounds may be decreased or absent, so
diarrhea would not be expected. Hypotension is likely to develop because of pancreatic hemorrhage or toxemia. Ascites develops as a result of
portal hypertension and is common in liver disease, but not in pancreatitis.

98. The client diagnosed with Cirrhosis should be evaluated for which of the following laboratory tests, in order to provide safe care?
a. Serum troponin
b. Prothrombin time
c. Serum lipase
d. Urinalysis

Answer: B. Many clotting factors are produced in the liver, including fibrinogen (factor 1), prothrombin time (factor ii), factor V, serum prothrombin
conversion accelerator (factor VII), factor IX, and factor X. The clients ability to form these factors may be impaired with cirrhosis, putting the client
at risk for bleeding. The prothrombin time will evaluate blood clotting ability, the others will not.

SITUATION: Nurse Charmaine is in charge of a client who was admitted for management of acute episode of cholecystitis.
99. Nurse Charmaine did her admission assessment. She understands that the pain is characterized as:
A. Tenderness that is generalized in the upper epigastric area
B. Pain of the left upper quadrant radiating to the left shoulder
C. Tenderness and rigidity at the left epigastric area radiating to the back
D. Tenderness and rigidity of the upper right abdomen radiating to the midsternal area

ANSWER: D
RATIONALE:
Cholecystitis, an acute inflammation of the gallbladder, which causes pain, tenderness, and rigidity of the upper right abdomen that may radiate
to the midsternal area or right shoulder and is associated with nausea, vomiting and the usual signs of an acute inflammation
OPTION A is INCORRECT. Tenderness that is generalized in the upper epigastric area are commonly seen in client with peptic ulcer disease
OPTION B and C are INCORRECT. Anatomically gallbladder is situated in the right upper quadrant of the abdomen, thus if pain with this
disorder occurs, client will complaint of pain will be on the right upper area, not on the left upper quadrant. Pain in the left upper quadrant may
indicate problems on the pancreas and spleen

100. To confirm the diagnosis of cholecystitis, the attending physician ordered the procedure that can detect gallstones as small as 1 to 2 cm and
inflammation. Nurse Charmaine would prepare the client for which specific diagnostic procedure?
A. Cholangiography B. Gall bladder series C. Ultrasonography D. Oral cholecystogram

ANSWER: C
RATIONALE:
Ultrasonography is the diagnostic procedure of choice for client with suspected cholecystitis because it is rapid and accurate and can be used in
clients with liver dysfunction and jaundice. In addition this procedure does not expose the patient to ionizing radiation. The procedure is more
accurate if the client fast overnight so that the gallbladder is distended. This diagnostic procedure can detect calculi in the gall bladder 95%
accurate
OPTION A, B and D are INCORRECT. These diagnostic procedure are done in clients with cholecystitis however not a procedure of choice due
to its risk of exposing the client to ionizing radiation.