Unit XIII

Digestive & Hepato-biliary Disorders

Critical Concepts

Definitions & Characteristics

Assessment & Pathophysiology
Diagnostic Procedures
Oral & Esophageal Disorders
Gastric & Intestinal Disorders
Hepatic & Biliary Disorders
Pharmacology: Anti-ulcers
Emetics/Anti-emetics
Laxatives / Anti-diarrheal Drugs

Identification

Identify what is described in each statement.

1. A sign seen in appendicitis which produces pain in the right lower quadrant when the left
lower quadrant is palpated. ______________

2. A disorder also called regional enteritis. ____________________

3. A surgical procedure the involves removal of the highly acid-producing portion of the
stomach. ___________________________

4. Microbes that cause carbohydrate food poisoning. ____________

5. Substance needed for vitamin B 12 absorption. _______________

6. Phagocytic cells in the liver. ______________________________

7. A structure in the duodenum facilitates the outflow of bile and pancreatic enzymes.
______________________________________

8. A clotting factor produced in the liver. ______________________

9. Substance in milk that stimulates gastric acid production. _______

10. The opening between the esophagus and stomach. ___________

_______________________________________________________

True or False

Write T if the statement is true and F if it is false.

_____ 1. Albumin is the main substance that maintains colloid oncotic pressure.

_____ 2. Morphine sulfate is the drug of choice in relieving pain due to gallstones.
_____ 3. Malnutrition is the main risk factor of Laennec’s cirrhosis.

_____ 4. Dull gnawing pain that usually wakes a person with peptic ulcer disease at night
indicates the presence of a gastric type of peptic ulcer.

_____ 5. A common side-effect of aluminum-based antacids is constipation.

_____ 6. Histamine type 2 receptor antagonists such as Ranitidine (Zantac) aids in treating
peptic ulcer disease by neutralizing acids in the stomach.

_____ 7. A low-fat diet is most appropriate for a patient who has had a cholecystectomy.

_____ 8. The Miller-Abbott tube is an example of an intestinal tube.

_____ 9. Liver damage is reflected by an increase in the enzyme alanine aminotransferase

(ALT).

_____ 10. Common complications of total parenteral nutrition (TPN) include hypoglycemia,
infection and fluid-electrolyte imbalances.

Matching Type.

Match Column A with column B. Some numbers may have the same answer or
multiple answers.

Set A. Medical Terminology I

Column A Column B
Terms Definition

_____ 1. Fetor hepaticus A. yellowish discoloration of the skin

_____ 2. Steatorrhea B. presence of fats in the stools
_____ 3. Asterixis C. flapping tremors of the hands
_____ 4. Heartburn D. reflux of gastric acids to the esophagus
_____ 5. Jaundice E. ammonia-like odor of the breath

Set B. Medical Terminology II

Column A Column B
Terms Definition

_____ 1. Ascites A. dark, tarry stools

_____ 2. Hematemesis B. painful swallowing
_____ 3. Melena C. fresh blood in the stools
_____ 4. Hematochezia D. vomiting of blood
_____ 5. Odynophagia E. presence of fluids in the abdomen
F. difficulty in swallowing

Set C. Anatomy-Physiology I
 Column A Column B
Anatomy Physiology

_____ 1. Liver A. produces albumin

_____ 2. Pancreas B. secretes mucus only
_____ 3. Stomach C. major site of absorption
_____ 4. Small intestines D. site of protein digestion
_____ 5. Large intestines E. secretes glucagon

Set D. Anatomy-Physiology II

Column A Column B
Anatomy Physiology

_____ 1. Gastrin A. protein digestion

_____ 2. Secretin B. carbohydrate digestion
_____ 3. Cholecystokinin C. fat digestion
_____ 4. Amylase D. stimulates release of fats
_____ 5. Lipase E. reduces acid secretion

Set E. Diagnostic Tests

Column A Column B
Tests Indication

_____ 1. Guaiac test A. direct visualization of ulcers

_____ 2. Barium enema B. detects occult blood in stools
_____ 3. Esophagoscopy C. evaluates ascitic fluid
_____ 4. Paracentesis D. indirectly visualizes lower GI
_____ 5. Liver profile E. monitors hepatic function

Set F. Digestive Disorders

Column A Column B
Digestive Disorder Description

_____ 1. Crohn’s disease A. protrusion of abdominal organs

_____ 2. Ulcerative colitis B. regional enteritis
_____ 3. Pancreatitis C. auto digestion by its own enzymes
_____ 4. Achalasia D. narrowing of esophageal lumen
_____ 5. Hiatal hernia E. infection of the lower GI

Set G. Hepato-biliary Disorders

Column A Column B
Disorder Description

_____ 1. Liver cirrhosis A. inflammation of the liver

_____ 2. Hepatitis B. destruction of liver parenchyme
_____ 3. Choledocholithiasis C. stones in the gall bladder
_____ 4. Cholecystitis D. inflammation of the gallbladder
_____ 5. Cholelithiasis E. stones in the common bile duct

Set H . Pathophysiology of Digestive Disorders

 Column A Column B
Manifestations Pathophysiology

_____ 1. Melena A. fat malabsorption

_____ 2. Hematochezia B. lower GI bleeding
_____ 3. Vomiting C. fluid seeping through obstruction
_____ 4. Watery stools D. upper GI bleeding
_____ 5. Bleeding tendencies E. stimulation of chemotactic
trigger zone (CTZ)

Set I. Pathophysiology of Hepato-biliary Disorders

Column A Column B
Manifestations Pathophysiology

_____ 1. Jaundice A. low urobilinogen in the intestines

_____ 2. Ascites B. high urobilinogen in the blood
_____ 3. Esophageal varices C. high bilirubin level
_____ 4. Tea-colored urine D. portal hypertension
_____ 5. Clay-colored stool E. systemic hypertension

Set J . Pharmacology I

Column A Column B
Medication Action

_____ 1. Ranitidine (Zantac) A. antacid

_____ 2. Bisacodyl (Dulcolax) B. stool softener
_____ 3. Pantoprazole (Protonix) C. histamine type-2 blocker
_____ 4. Docusate sodium (Colace) D. laxative
_____ 5. Calcium carbonate (Tums) E. Proton pump inhibitor

Set K. Pharmacology II

Column A Column B
Medication Indication

_____ 1. Lactulose A. nausea

_____ 2. Interferon B. diarrhea
_____ 3. Milk of Magnesia C. hepatitis
_____ 4. Lomotil D. constipation
_____ 5. Promethazine Hcl (Phenergan) E. hepatic encephalopathy

Multiple Choice

Choose the letter of the BEST answer.

_____1. Individuals who are under chronic stress are prone to develop peptic ulcer disease
because stress:
A. increases the secretion of hydrochloric acid
B. reduces the amount of mucus in the stomach
C. causes constriction on blood vessels of the digestive system
D. enhances the barrier protection of the gastric mucosa
_____ 2. A patient with reflux disorder is prescribed Magnesium hydroxide. A common side
effect of this medication is:
A. nausea and vomiting
B. diarrhea
C. constipation
D. flatulence

_____3. Vagotomy is a surgical procedure used to manage peptic ulcer disease. This is done
for which of the following purposes?
A. Severing the vagus nerve reduces gastric acid secretion.
B. Damaging the vagus nerve increases gastric motility.
C. Cutting the vagus nerve increases mucus secretion.
D. Cutting the vagus nerve decreases pain sensation.

_____4. A patient with gastric ulcer is prescribed Ranitidine (Zantac). Which of the
following statements made by the patient shows that he understood the nurse’s teaching about
this medication?
A. “This pill will neutralize the gastric acids.”
B. “The medicine will inhibit the secretion of acids in my stomach.”
C. “This will promote healing of my gastric ulcer. “
D. “ This pill will increase mucus production in my stomach.”

_____5. Which of the following assessment data suggests the presence of a duodenal ulcer?
A. Presence of hyperactive bowel sounds
B. Persistence of abdominal pain after food intake
C. Frequent belching
D. Relief of abdominal pain after eating

_____6. A patient presents to the clinic with dull left upper quadrant pain. The nurse recalls
that an organ that is located in this part of the abdominal cavity is the
A. appendix
B. liver
C. pancreas
D. gall bladder

_____7. Gastric pain is more commonly assessed as pain in the:

A. left upper quadrant
B. right upper quadrant
C. left lower quadrant
D. right lower quadrant
_____8. Which of the following foods should the nurse instruct the patient with peptic
ulcer disease to avoid? (Select all that apply)
A. Spaghetti and tomato juice
B. Cheeseburger and fries
C. Hotdog with chili and soft drinks
D. Pineapple slices and sago at gulaman
E. Chocolate cake and milk

_____9. Risk factors of peptic ulcer disease include

A. Type B personality and cigarette smoking
B. Type A blood and alcohol ingestion
C. high-fiber foods and Type A personality
D. family history and active lifestyle
_____10. A surgical procedure that involves removing a portion of the stomach and
anastomosing the remaining part with the duodenum is called
A. total gastrectomy
B. bougeinage procedure
C. Billroth I
D. Billroth II

_____11. The nurse taking care of a patient who underwent gastrectomy with Billroth II
should watch out for complications associated with
A. electrolyte imbalances
B. dumping syndrome
C. hypoglycemia
D. wound dehiscence

_____ 12. A patient was rushed to the ED after ingesting paint thinner. Which of the
following is expected to be administered?
A. activated charcoal
B. Syrup of ipecac
C. Liberal amount of clear liquids
D. Golytely

_____ 13. A post-surgical patient is taking Morphine sulfate 2 mg IV q2h prn and Docusate
sodium (Colace) 100 mg po bid. What is the rationale of giving Colace to this patient?
A. It prevents constipation that occurs as a side-effect of narcotics.
B. It treats diarrhea caused by narcotics.
C. It prevents gastric irritation caused by narcotics.
D. It prevents nausea and vomiting caused by narcotics.

_____14. The nurse is conducting a health education session among mothers regarding basic
poison prevention. Which of these statements made by the nurse regarding Ipecac syrup is
true?
A. “This medication is given to prevent vomiting.”
B. “Give this medication with a glass of water.”
C. “If no vomiting occurs, do not give another dose at all.”
D. “It is safe to give several doses of the syrup until vomiting
occurs.”

_____15. A nurse preparing a patient for an esophago-gastroduodenoscopy (EGD) should

instruct the patient to
A. void at least an hour before the procedure
B. withhold food and fluids after midnight prior to the procedure
C. take a light breakfast on the morning of the procedure
D. ask for heavy sedation before the procedure starts

_____16. The nurse assessing for possible gastric bleeding should perform which of the
following diagnostic tests to detect occult blood in the stools?
A. fecalysis
B. fecal ova & parasites
C. Guaiac test
D. photocopy

_____17. The nurse should be alert of signs and symptoms of bowel perforation after an
endoscopy. These may include
A. abdominal tenderness and increased blood pressure
B. tachycardia and abdominal pain
 C. nausea, vomiting and diarrhea
D. low back pain and bradycardia

_____ 18. Which of the following medications can be given to prevent nausea and vomiting?
(Select all that apply)
A. Ondansetron (Zofran)
B. Promethazine HCl (Phenergan)
C. Metoclopramide (Reglan)
D. Hydroxyzine (Vistaril)

_____19. A patient is anxious about her upcoming upper gastrointestinal series. The nurse
attempts to allay the patient’s anxiety by explaining that this procedure involves
A. insertion of a fiber optic tube to visualize the upper digestive organs
B. getting an x-ray of the upper abdomen after ingestion of barium
C. visualization of the abdomen through a CT scan machine
D. thorough physical assessment of the upper gastrointestinal
system

_____20. The nurse should institute in a patient who had lower gastrointestinal series
interventions that will prevent
A. constipation
B. diarrhea
C. abdominal pain
D. bleeding
_____21. Appropriate nursing interventions for a patient after a barium swallow is:
A. Regulate intravenous fluids to KVO rate.
B. Advise patient on bed rest for at least 6 hours.
C. Encourage patient to increase oral fluid intake.
D. Offer mouth care every 2 hours after the procedure.

_____ 22. Medications used to treat or prevent constipation are: (Select all that apply).
A. Diphenoxylate (Lomotil)
B. Magnesium citrate
C. Psyllium hydrophilic mucilloid (Metamucil)
D. Glycerine

_____ 23. Sucralfate (Carafate) is ordered to a patient with peptic ulcer disease. This
medication
A. Suppresses acid secretion in the stomach.
B. Acts as a gastric mucosal protective barrier
C. Neutralizes hydrochloric acid in the stomach
D. Prevents gas formation in the intestines

_____24. Patients who had total gastrectomy are usually given doses of vitamin B12
(cyanocobalamin) to prevent
A. pernicious anemia
B. severe malnutrition
C. peripheral neuropathy
D. iron deficiency anemia

_____25. Twelve hours after surgery for the removal of bleeding ulcers, the nurse observes a
scant amount of sero-sanguineous drainage on the surgical dressing on the abdomen.
The nurse’s initial response is to
A. notify the physician of the possibility of hemorrhage
B. remove the surgical dressing to inspect the wound closely
 C. mark the dressing with a pen and monitor output
D. change the surgical dressing with a sterile dry dressing

_____ 26. Histamine type-2 receptor antagonists reduce acid secretion. Examples of this
category of anti-ulcer drugs include: (Select all that apply)
A. Cimetidine (Tagamet)
B. Ranitidine (Zantac)
C. Famotidine (Pepcid)
D. Chlorpromazine (Thorazine)

_____ 27. A patient newly diagnosed of peptic ulcer disease is prescribed Omeprazole
(Prilosec). This medication is classified as a/an:
A. Proton pump inhibitor
B. Antacid
C. Histamine-2 blocker
D. Anti-cholinergic

_____ 28. A patient is complaining of epigastric pain due to indigestion. The nurse reviews
the patient’s medication order and finds “Calcium carbonate (Tums) 1000 mg po q4h prn for
indigestion.” The nurse is correct if she states which of these to her patient?
A. “This neutralizes the acids in your stomach.”
B. “This is an analgesic, therefore, it will reduce your pain in the stomach.”
C. “Take this with a cup of milk.”
D. “This medication may cause diarrhea.”

_____29. A patient with severe peptic ulcer disease is scheduled to undergo total gastrectomy.
The patient asks the nurse how megaloblastic anemia may develop after the surgery. The
nurse’s best response is:
A. “You will not be able to absorb iron needed for red blood cell formation.”
B. “The intrinsic factor is lost after your stomach is taken out and that is
needed in the synthesis of red blood cells.”
C. “The loss of blood associated with this type of surgery makes you at
risk for this type of anemia.”
D. “This is a medical concern that the surgeon can only answer for
you.”

_____ 30. Which of the following is a nursing consideration for patients taking antacids?
A. Administer antacids before meals.
B. Give the pill with at least 1 glassful of water.
C. Know the patient’s baseline serum electrolyte level.
D. Assess the patient’s liver function prior to giving the drug.

_____31. The nurse should watch out for signs and symptoms of dumping syndrome which
include
A. tachycardia, hyperglycemia, lightheadedness
B. nausea, vomiting, constipation
C. warm flushed skin, hypoglycemia, bradycardia
D. diarrhea, hypertension, frequent flatulence

_____ 32. Which of the following nurse’s instructions to the patient will prevent dumping
syndrome?
A. “Take few minutes of walking after meals.”
B. “Lay down for at least 30 minutes after meals.”
C. “Increase your fluid intake during meals.”
D. “Eat foods that are rich in carbohydrates.”
_____33. The chemoreceptor trigger zone, which when stimulated can cause vomiting, is
found in the
A. Medulla oblongata
B. Adrenal medulla
C. Parietal lobe
D. Gastrointestinal system

_____ 34. A patient is taking Meclizine HCl (Antivert). Which of the following statements is
true about this medication? It is
A. used to prevent nausea and vomiting due to motion sickness.
B. a drug that increases mental alertness.
C. an anti-cholinergic drug.
D. used to treat peptic ulcer.

_____ 35. Which of the following biological agent can cause chronic gastritis?
A. Escherichia coli
B. Helicobacter pylori
C. Staphylococcus aureus
D. Pseudomonas auruginosa

_____ 36. Which of these statements is true about emetics?

A. They are used to induce vomiting when ingested substances are
still in the intestines.
B. They are administered if the patient swallowed a strong acid or alkali.
C. They promote vomiting 2-4 hours after administration.
D. They are given to induce vomiting only when the ingested
substance is known.

_____ 37. Nursing interventions for a patient who has diarrhea and uses anti-diarrheal
medications include these: (Select all that apply)
A. Assess for bowel sounds
B. Monitor fluid intake and output
C. Review laboratory results for electrolyte levels
D. Place patient on NPO

_____ 38. The priority goal of management for patients with diarrhea and vomiting is
A. Maintain adequate level of comfort.
B. Prevent fluid and electrolyte imbalance.
C. Prevent side-effects of medications.
D. Promote adequate oral fluid and nutritional intake

_____ 39. Non-pharmacological management to prevent constipation includes

A. Reduce fluid intake
B. Increase activity level
C. Decrease dietary fiber
D. Regular use of laxatives

_____ 40. Gastroesophageal reflux disorder (GERD) is caused by

A. Incompetent pyloric sphincter
B. Incompetent cardiac sphincter
C. Incompetent upper esophageal sphincter
D. Reflux of bile acids into the stomach

_____ 41. A 49-year old patient is admitted to the medicine floor due to arthritis. He has a
history of peptic ulcer disease (duodenal). He is currently taking Aspirin 325 mg po daily and
Pantoprazole (Protonix) 40 mg po daily. Important nursing actions in caring for patients
taking Aspirin should include which of these?
A. Administer the medication with food or fluid
B. Give the medications before meals
C. Give the medications at least 2 hours apart
D. Not to give these medications with milk

_____ 42. Foods and fluids that may increase acid secretion include: (Select all that
apply)
A. fried and fatty foods
B. milk and milk products
C. caffeine and tea
D. spicy foods

_____ 43. A cancer patient is scheduled for chemotherapy at 1100. Which of the following
medications should the nurse prepare to administer prior to chemotherapy to prevent nausea
and vomiting?
A. Ondansetron (Zofran)
B. Scopolamine (TrandermScop)
C. Diphenoxylate with atropine (Lomotil)
D. Propantheline bromide (Pro-banthine)

_____ 44. A nurse on a medical-surgical unit is taking care of 4 patients. Which among these
patients will most likely receive an order of Docusate sodium (Colace) 100 mg po bid? A
patient with
A. an acute myocardial infarction
B. severe abdominal pain
C. acute appendicitis
D. inflammatory bowel disease

_____45. Medications that can cause gastro-intestinal bleeding include:

A. non-steroidal anti-inflammatory drugs
B. narcotic analgesic
C. proton pump inhibitors
D. histamine type 2 inhibitors

_____46. The nurse identifies the following nursing diagnosis for a patient with diarrhea. The
priority nursing diagnosis would be
A. Fluid volume deficit
B. Altered electrolyte balance
C. Risk for impaired skin integrity
D. Alteration in comfort

_____47. A 34-year old patient presents to the emergency room with complaints of increasing
weakness due to diarrhea and vomiting for 2 days. The nurse reviews the patient’s laboratory
results and finds
A. hyperkalemia and metabolic alkalosis
B. hypokalemia and metabolic acidosis
C. hypokalemia and respiratory acidosis
D. hypernatremia and dehydration

_____48. The most appropriate nursing instruction to a patient who has a smoking history and
admitted with hiatal hernia is to
A. “Avoid heavy lifting and bending.”
 B. “Increase oral fluid intake during meals.”
C. “Take a double dose of antacids when in severe epigastric pain.”
D. “You may smoke to only 1-2 sticks of cigarette per day.”

_____49. A patient presents to the emergency room with severe right lower quadrant pain
and rebound tenderness. The nurse receives the laboratory results and anticipates to find:
A. decreased red blood cell count
B. increased white blood cell count
C. decreased platelet count
D. normal neutrophil count

_____50. The nurse should position a patient with ruptured appendicitis in

A. supine with legs elevated with 1 pillow
B. prone
C. low-Fowler’s
D. left side-lying

_____51. Which of the following actions performed by a nurse to a patient with acute
appendicitis needs an immediate intervention from the charge nurse? The nurse
A. inserts an angiocath to start an IV infusion.
B. administers ordered pain medication.
C. applies warm compress on the affected area.
D. gently palpates the abdomen

_____52. An emergency appendectomy is indicated for a patient with ruptured appendix to

prevent
A. peritonitis
B. chronic appendicitis
C. hypovolemic shock
D. abdominal distention

_____53. The McBurney’s sign is an area of tenderness located between the

A. umbilicus and epigastric area
B. left lower quadrant and the right lower quadrant
C. right anterior iliac spine and the umbilicus
D. right lower and right upper quadrants

_____54. The nurse performs physical assessment on a post-appendectomy patient. The nurse
recognizes peritonitis if the assessment reveals
A. hyperactive bowel sounds
B. rigid, board-like abdomen
C. cold clammy skin and diaphoresis
D. moderate dull pain on the incision site

_____55. The nurse recognizes signs of lower GI bleeding if she observes the patient
exhibiting:
A. hematemesis
B. melena
C. hematochezia
D. steatorrhea

_____56. A patient with achalasia will most likely complain of

A. severe abdominal pain
B. difficulty swallowing
C. presence of blood in the stools
 D. increasing abdominal girth

_____57. The nurse helps meet the nutritional needs of a patient with achalasia by providing
foods that are:
A. high in calories and soft consistency
B. high in fiber and low in calories
C. low in salt and residue
D. thin liquid and low in calories

_____58. A patient with peptic ulcer disease has difficulty sleeping. The patient asks whether
milk is advisable to take before bedtime since milk can help induce sleep. The nurse’s best
response is
A. “You can have a cup of milk if that helps you to sleep.”
B. “I have to ask your physician if that is allowable.”
C. “It is not advisable since milk actually increases acid secretion.”
D. “Just make sure to take the reduced-fat type of milk.”

_____59. A nurse inserts a naso-gastric tube (NGT) in an adult patient. The nurse measures
the length of the tube to be inserted by measuring the patient’s:
A. mouth up to the level of the umbilicus
B. nose to the earlobe to the xiphoid process
C. nose all the way down to the umbilical area
D. ear going down to the nose up to the xiphoid process

_____60. Prior to administering medications via a naso-gastric tube the nurse should:
A. inject 50 ml of sterile water to the tube and auscultate the abdomen for
bowel sounds
B. check for the patency of the tube by flushing it with 30 ml of saline solution
C. aspirate gastric contents and test the acidity of the aspirated
material
D. palpate the area below the xiphoid process to feel the tip of the tube

_____61. The best method to verify placement and position of a Dobhoff tube is for the nurse
to
A. request an order for an abdominal x-ray from the physician
B. ask the patient if the tube is causing any pain or discomfort
C. injects 20 mL of air into the tube and auscultate the abdomen
D. remove the stylet from the tube

_____62. The nurse taking care of a patient with a newly placed percutaneous endoscopic
gastrostomy (PEG) tube should promote healing of the PEG insertion site by cleaning it with
A. half-strength hydrogen peroxide
B. sterile water
C. Sucralfate (Carafate) solution
D. normal saline solution

_____63. A nursing assistant prepares the equipment needed in performing a cleansing

enema, then position the patient in
A. prone with legs spread apart
B. left side-lying with the right knee flexed
C. supine with legs flexed towards the abdomen
D. right-side lying position with legs straight

_____64. A patient with constipation is receiving soap suds enema when he complained of
cramping abdominal pain. The nurse doing the procedure should initially:
 A. stop the enema and remove the rectal tube
B. lower the enema bag then clamp the tubing
C. raise the enema bag and ensure clamp is open
D. instruct the patient to take slow deep breaths

_____65. Which of the following risk factors is associated with the development of
diverticulosis?
A. high-fiber diet
B. constipation
C. active lifestyle
D. young age

_____66. A patient with fecal impaction will most likely manifest which of these signs
initially?
A. abdominal distention
B. hyperactive bowel sounds
C. constipation
D. diarrhea

_____67. The nurse notes that a major characteristic of Crohn’s disease is the presence of
A. severe diarrhea and blood in the stools
B. dehydration and fats in the stools
C. foul smelling, greenish stools
D. hard, formed stools

_____68. A nurse makes an assessment of a patient with ulcerative colitis. Which of these is a
consistent finding with this diagnosis?
A. diarrhea and right lower quadrant pain
B. diarrhea and left lower quadrant pain
C. constipation and right lower quadrant pain
D. constipation and left lower quadrant pain

_____69. Which of the following gastro-intestinal tubes is used to decompress the digestive
system due to an intestinal obstruction?
A. Salem-Sump tube
B. Miller-Abbott tube
C. Dobhoff tube
D. Sengstaken-Blakemore tube

_____70. The nurse delegates to the nursing assistant stool specimen collection from a patient
with diarrhea for a stool culture for ova and parasites . Which of the following is an
appropriate action of the staff? The nursing assistant
A. uses a sterile specimen cup
B. sends the specimen to the lab within an hour after collection
C. puts preservative on the specimen
D. fills the entire specimen cup with stool

_____71. A patient who is admitted for antibiotic therapy due to an infection is complaining
of diarrhea. The nurse reviews the laboratory results of this patient and looks for any
indication for the presence of
A. Staphylococcus aureus
B. Streptococcus pneumoniae
C. Clostridium difficile
D. Hemophilus influenzae
_____72. The nurse educates a group of patients in the health center that the primary risk
factor for colo-rectal cancer is:
A. increasing age
B. faulty diet
C. sedentary lifestyle
D. history of viral infection
_____73. A patient asks the nurse about early sign of colon cancer. An early warning sign of
cancer of the colon is:
A. presence of blood in the stool
B. chronic indigestion
C. change in bowel habits
D. pressure pain on the abdomen

_____74. A patient who is newly diagnosed of gastric cancer asks the nurse about the most
common management of gastric cancer. The nurse tell the patient that it is:
A. surgery
B. chemotherapy
C. radiation therapy
D. immunotherapy

_____75. A 38-year-old female patient with colon cancer is to have a colon resection with
creation of a transverse colostomy temporarily. Which of the following is the patient’s
priority potential nursing diagnosis?
A. Knowledge deficit: colostomy care
B. Body image disturbance
C. Anxiety
D. Anticipatory grieving

_____76. The nurse assesses a patient who has a new colostomy. The nurse notifies the
physician if she sees that the stoma
A. is pink and with scant drainage
B. is swollen and reddish
C. is grayish and bleeding
D. is protruding outside the skin

_____77. The nurse identifies a problem on a patient with colostomy if she makes which of
these observations? The patient
A. eagerly participates in cleaning her own stoma
B. asks questions on daily stoma care
C. looks away while the nurse cleans the stoma
D. carefully holds the adhesive as it is placed on the skin

_____78. A patient who has a descending colostomy may have stools that are
A. watery
B. pasty
C. semi-formed
D. formed

_____79. In performing colostomy irrigation, the nurse should

A. wear a mask, sterile gloves and gown
B. insert no more than 3 inches of the lubricated catheter into the stoma
C. place the enema bag with 500-1500 ml of tap water 2-3 feet above the
stoma
D. gently advance the catheter when a resistance is felt during catheter
insertion
_____80. A patient with new colostomy asks the nurse of any dietary modifications after
discharge. The nurse is correct if she states:
A. “I will give you a list of foods that you cannot eat.”
B. “Let me arrange a consultation with the dietitian.”
C. “You can have usual diet but avoid gas-forming foods.”
D. “Only soft foods and clear liquids are permitted.”

_____81. A characteristic biological marker found among patients with colon cancer is an
increased level of
A. carcinoembyonic antigen (CEA)
B. ectopic adrenocorticotropic hormone (ACTH)
C. oncogenes
D. alkaline phosphatase
_____82. The nightshift nurse reviewing the physician’s orders should question which of the
following orders made for a patient scheduled for appendectomy?
A. Meperidine hydrochloride (Demerol) 25 mg IV q2h prn
B. Cefazolin (Kefzol) 1 g IV an hour prior to surgery
C. Cleansing enema until return flow is clear.
D. NPO after midnight.

_____83. A patient is for discharge after an exacerbation of ulcerative colitis. The patient asks
the nurse how to prevent the symptoms of the disease in the future. The best nursing
statement that reflects an understanding on the nature of the disease is
A. “Try to eat foods that are low in fiber and residue.”
B. “Avoid an active lifestyle and limit alcohol intake.”
C. “Avoid stressful situations as much as possible.”
D. “Increase your fluid intake once diarrhea starts.”

_____84. To meet the nutritional needs of a patient with ulcerative colitis, the nurse should
anticipate for
A. naso-gastric tube insertion
B. Dobhoff tube placement
C. initiation of total parentetal nutrition
D. administration of intravenous fluids

_____85. Dietary management for patients with Crohn’s disease includes a diet that is
A. high in calories and proteins, low in fats
B. low in fats and calories, high in proteins
C. low in calories, fats and residue
D. high in calories, residue and low in proteins

_____86. To prevent diverticulitis, the nurse should instruct patients to do which of these
activities?
A. stop smoking
B. increase fiber in the diet
C. avoid stressful situations
D. treat diarrhea

_____87. A patient with colorectal cancer had an abdomino-perineal resection (APR). To

promote healing, the nurse assists the patient have a warm sitz bath:
A. once daily, before bedtime
B. upon rising in the morning
C. three to four times daily &/or after a bowel movement
D before a bowel movement
_____88. The nurse explains to the patient that gastroesophageal reflux disease (GERD) is
caused by:
A. over activity of the parietal cells in the stomach
B. relaxation of the lower esophageal sphincter
C. reduced pressure in the pyloric sphincter
D. decreased mucus protection in the gastric mucosa

_____89. An appropriate nursing intervention to prevent regurgitation in a patient with gastro

esophageal reflux disease (GERD) is
A. advise patient to sleep in an upright position
B. encourage patient to drink at least 2 glasses of water per meal
C. inform patient that lifting and bending are encouraged
D. promote intake of high-protein and high-carbohydrate foods

_____90. A patient presents to the emergency room with vomiting and diarrhea 4 hours after
attending a party. To find out whether Salmonellosis is the problem, the nurse should ask the
patient about eating foods such as:
A. pasta or cake
B. soft drinks or alcohol
C. fried chicken or egg sandwich
D. pancit or fresh lumpia

_____91. The nurse gathering a patient’s history notes that a major risk factor to chronic
pancreatitis is
A. intake of high calorie foods
B. alcohol consumption
C. previous bacterial infection
D. presence of diabetes mellitus

_____92. A patient’s initial diagnosis of acute pancreatitis is confirmed based on which

laboratory finding?
A. elevated white blood cell count
B. increased serum amylase and lipase
C. high alanine transaminase
D. reduced alkaline phosphatase

_____93. A priority nursing diagnosis for patients with acute pancreatitis is

A. Acute pain
B. Risk for infection
C. Fluid volume excess
D. Altered urinary elimination

_____94. The most appropriate diet for a patient with an acute attack of pancreatitis is
A. nothing by mouth (NPO)
B. clear liquids
C. soft diet
D. diet as tolerated

_____95. The patients asks the nurse what causes pancreatitis. The recalls that pancreatitis is
a/an
A. bacterial infection of the pancreas
B. autodigestion of the pancreas by its enzymes
C. inflammation due to degenerative changes in the pancreas
D. obstruction in the flow of pancreatic enzymes
_____96. An assessment finding that is consistent with pancreatitis is the presence of
A. severe right upper quadrant pain
B. foul smelling stools
C. palpable abdominal mass
D. blood in the urine

_____97. A patient with chronic pancreatitis is advanced to a regular diet. Which of the
following will best aid in digestion?
A. Administer pancreatic enzyme supplements as ordered.
B. Increase intake of oral fluids as tolerated.
C. Encourage intake of high-carbohydrate and high-fat meals.
D. Advise patient to eat in small frequent feedings.

_____98. Which of the following information gathered during the initial patient interview will
help the nurse identify the patient’s risk for cholelithiasis and cholecystitis? The patient
A. is a 28-year-old male.
B. is pregnant for the first time.
C. is 15 kilograms overweight.
D. likes to eat chicken and lean meat

_____99. Assessment findings expected from a patient with calculous cholecystitis include
(select all that apply)
A. jaundice
B. tea-colored urine
C. vague left upper quadrant pain
D. clay-colored stools
E. colicky abdominal pain

_____100. A laboratory result that differentiates whether jaundice is caused by liver disorders
instead of hemolytic disorders is
A. high indirect or unconjugated bilirubin
B. high direct or conjugated bilirubin
C. low total bilirubin
D. low alkaline phosphatase

_____101. A priority nursing diagnosis for a patient with cholelithiasis and cholecystitis is
A. Acute pain
B. Alteration in comfort: pruritus
C. Altered urinary elimination
D. Altered bowel elimination

_____102. The nurse praises the patient for wise choice of foods if a patient with chloecystitis
says that she must have:
A. an adequate intake of proteins
B. a low-calorie diet
C. a low-salt diet
D. a low-fat diet

_____103. The nurse’s action is appropriate if she prepares which of the following pain
medications for a patient complaining of sharp abdominal pain due to cholelithiasis?
A. Morphine sulfate (MS Contin)
B. Meperidine hydrochloride (Demerol)
C. Mefenamic acid (Ponstan)
D. Butorphanon hydrochloride(Stadol)
_____104. The patient with choledocholithiasis asks the nurse why she has clay-colored
stools. The nurse is correct if she explains:
A. “That is a common occurrence of patients with the same diagnosis.”
B. “It is due to the accumulation of the pigment called bilirubin in your
bloodstream.”
C. “The stone in your common bile duct obstructs the flow of bile pigments
to your intestines.”
D. “The increased bilirubin level in your bloodstream is dumped into
your bowels.”

_____105. A patient is admitted for evaluation of gallstones. The most important nursing goal
after an endoscopic retrograde cholangiopancreatography (ERCP) is to
A. maintain adequate fluid intake
B. promote wound healing
C. relieve pain
D. prevent skin breakdown

_____106. The nurse recalls that risk factors of liver cirrhosis include: (Select all that
apply)
A. excessive alcohol intake
B. presence of congestive heart failure
C. malnutrition
D. history of hepatitis
E. intake of hepatotoxic drugs
F. presence of stones in the biliary tree

_____107. Which of the following laboratory findings will alert the nurse of a potential life-
threatening complication of liver cirrhosis?
A. increased bilirubin level
B. reduced prothrombin time
C. increased ammonia level
D. reduced white blood cell count

_____108. An important nursing intervention for patients with liver cirrhosis is to

A. provide diet that is low in calories and salt
B. encourage the use of soft-bristled brush for oral care
C. massage the skin with alcohol
D. administer Acetaminophen (Tylenol) for pain

_____109. The nurse should plan the diet of a patient with liver cirrhosis who has a normal
ammonia level that is
A. rich in calories
B. high in fats
C. low in proteins
D. high in sodium

_____110. A patient with liver failure has an increasing ammonia level in the blood.
The physician ordered Lactulose. The nurse knows that Lactulose is effective if
A. the patient’s ammonia level remains high
B. the patient passes soft or liquid stools
C. the patient’s bowel sounds is hypoactive
D. the patient does not vomit

_____111. Which of the following assessment data tells the nurse that the patient, who
is an account executive with history of alcohol abuse, is developing hepatic encephalopathy?
The patient
A. can recall the exact date and where she is hospitalized
B. appears more jaundiced than the previous day
C. has a urine output of 250 cc in an 8-hour shift
D. is frustrated because she cannot write on her notepad

_____112. Hepatic encephalopathy occurs as a complication of liver cirrhosis because of

A. the liver’s increased metabolism of chemical compounds
B. a rising ammonia level due to impaired liver function
C. accumulation of bilirubin in the brain tissues
D. hemorrhage in the abdominal cavity reduces cerebral perfusion

_____113. The nurse modifies the diet of a patient with impending hepatic
encephalopathy and suggests a
A. low-protein diet
B. high-calorie diet
C. low-fat diet
D. high-carbohydrate diet

_____114. An appropriate nursing intervention for a patient with liver cirrhosis is

A. Provide adequate skin care.
B. Turn the patient from side to side every two hours.
C. Encourage adequate fluid intake of at least 8 glasses per day.
D. Assist patient with frequent ambulation around the room.

_____115. The nurse assesses a patient with acute liver failure and notes ascites if the patient
has
A. a palpable abdominal mass
B. wheezing sound upon expiration
C. painful and tender joints
D. a positive fluid wave in the abdomen

_____116. Patients are prone to develop anasarca as a complication from liver failure because
of:
A. severe inflammation in the liver
B. decreased production of albumin by the liver
C. reduced sodium and water excretion by the kidneys
D. bleeding into the peritoneal cavity

_____117. The nurse monitors a patient with acute liver failure for the development of portal
hypertension. This complication results from
A. impaired circulation within the digestive system
B. massive vasoconstriction of systemic arterioles
C. increased extra cellular fluid volume
D. stress resulting from the disease process

_____118. The nurse suggests to the patient that with portal hypertension, the patient may
need to reduce intake of
A. calories
B. proteins
C. sodium
D. carbohydrates

_____119. Complications of portal hypertension secondary to liver cirrhosis may include:

 A. hemorrhoids and esophageal varices
B. gastric ulcers and cerebral aneurysm
C. ascites and diarrhea
D. encephalopathy and dehydration

_____120. The nurse taking care of a patient with liver cirrhosis with bleeding esophageal
varices anticipates the physician to order which intervention?
A. Prepare patient for paracentesis.
B. Insert a Sengstaken-Blakemore tube.
C. Offer liberal amounts of ice cold fluids orally.
D. Position the patient upright at all times

_____121. The nurses notes the presence of asterixis.

This sign suggests the development of:
A. hepatitis
B. portal hypertension
C. bleeding esophageal varices
D. hepatic encephalopathy
_____122. Prior to paracentesis, the most important nursing instruction is to
A. let the patient have a bowel movement
B. help the patient void in the bathroom
C. offer a light low-fat meal
D. check the patient’s vital signs

_____123. The nurse caring for a patient with Sengstaken-Blakemore tube should have
which of the following at the bedside?
A. a Code Cart
B. a pair of scissors
C. a can of tube feeding
D. a tape measure

_____124. The nurse instructs a patient with esophageal varices to avoid doing which of these
activites?
A. eat more than three meals a day
B. strain at defecation
C. drink ice cold beverages
D. take foods rich in Vitamin K

_____125. The most important nursing intervention after a paracentesis is to

A. assess the vital signs
B. assist with ambulation
C. position the patient on the unaffected side
D. offer sips of water after checking for gag reflex

_____126. The nurse assesses risk factors of constipation in an elderly patient which include:
(Select all that apply.)
A. sedentary lifestyle
B. overuse of laxatives
C. frequent use of antibiotics
D. inadequate fluid intake
E. food intolerance

_____127. The nurse notes that a patient who is confined in bed is passing watery stools
frequently. The nurse should suspect:
A. steatorrhea
 B. constipation
C. fecal impaction
D. bowel incontinence

_____128. Which of these dietary preparations is most appropriate to a patient with diarrhea?
A. bread, milk, ice cream and soup
B. banana, rice, apple sauce, toast
C. fruit slices, pasta, orange juice
D. cheeseburger, french fries, iced tea

_____129. An unconscious patient has bouts of watery stools during the shift. The most
appropriate nursing diagnosis is:
A. Abdominal pain
B. Risk for impaired skin integrity
C. Alteration in comfort
D. Ineffective individual coping

_____130. The nurse monitors the laboratory results of a patient admitted for chronic
diarrhea. Which of these results is most likely an effect of chronic diarrhea?
A. potassium of 3.1 meq/L
B. sodium of 144 meq/L
C. bicarbonate of 28 meq/L
D. calcium of 10 mg/dl

_____131. A patient who is severely malnourished has been ordered to start on total
parenteral nutrition (TPN) the next day. The nurse explains this mode of feeding to the
patient as:
A. “A tube will be inserted into your nose through your stomach to
provide you some food.”
B. “You will be receiving concentrated vitamins and minerals
through injections.”
C. “Nutrients will be provided through an intravenous line that goes
directly into the bloodstream.”
D. “Highly concentrated intravenous fluids will run through a central line.”

_____132. The nurse monitors for complications of hyper-alimentation that includes:

A. hypoglycemia and hypertension
B. hyperglycemia and infection
C. hypotension and pneumonia
D. hypertension and infection

_____133. In providing nursing care to a patient with hepatitis A, the nurse should wear:
A. gloves, gown, goggles and mask
B. gloves, gown and mask
C. gloves and gown
D. gloves

_____134. The nurse is preparing to administer Docusate sodium (Colace) 100 mg bid po.
The stock dose comes in a 5 ml solution which contains of 100 mg docusate sodium (Colace)
per 5 ml. The nurse should administer
___________________ tsp

_____135. A patient who is vomiting is on NPO. The nurse starts the ordered intravenous
fluid Dextrose 5% in water at a rate of 100 ml/hr. The nurse uses an IV line with a drip factor
of 10 drops/mL and prepares a liter of D5W. The IV is regulated at a rate of
 ____________________ gtts/min
_____136. The charge nurse prioritizes the care of 4 patients admitted in the Gastroenterology
Ward. The charge nurse should assign a nurse to first assess a patient with:
A. gastric ulcer vomiting clear yellowish-brown emesis
B. acute pancreatitis with mild dull abdominal pain
C. liver cirrhosis who cannot sign his consent due to tremors
D. cholecystitis mild icteric sclera

_____137. The nurse can safely delegate which of these activities to the nursing aide?
A. Measure the emesis of a patient who just vomited.
B. Apply warm compress to the abdomen of a patient with appendicits.
C. Assess the abdominal girth and presence of fluid wave in a patient with
ascites.
D. Performs colostomy care to a patient who had colostomy.

_____138. The nurse administers medications through a nasogastric tube. Rank the following
nursing actions in sequence.
_____ Inject 10-20 of air through the tube.
_____ Immerse the tube in water and observe for bubbles.
_____ Administer the medication, one at a time.
_____ Flush the tube with 20-30 ml of saline.
_____ Auscultate for gurgling sounds in the epigastria area.
_____ Aspirate syringe for presence gastric contents.

_____139. The nurse’s patient assignment consists of 4 patients. From highest to lowest
priority, in which order should the nurse assess the patients after receiving report? The patient
_____with cirrhosis who became confused and disoriented the previous
shift
_____who is 1 day post-operative with cholecystectomy and a T-tube
inserted
_____with acute pancreatitis who is requesting pain medication
_____with hepatitis B who has questions about his discharge instructions

_____140. Identify the anatomical part where the nurse should assess for auscultation to
verify placement of a nasogastric tube.