Gastrointestinal Diseases NCLEX Review Questions Part 2

Gastrointestinal Diseases NCLEX Review

Questions Part 2
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:
a. increased intracranial pressure.
b. decreased urine output.
c. bradycardia.
d. hypertension.
3. A male client with a recent history of rectal bleeding is being prepared for a
colonoscopy. How should the nurse position the client for this test initially?
a. Lying on the right side with legs straight
b. Lying on the left side with knees bent
c. Prone with the torso elevated
d. Bent over with hands touching the floor
4. A male client with extreme weakness, pallor, weak peripheral pulses, and
disorientation is admitted to the emergency department. His wife reports that he has
been “spitting up blood.” A Mallory-Weiss tear is suspected, and the nurse begins taking
a client history from the client’s wife. The question by the nurse that demonstrates her
understanding of Mallory-Weiss tearing is:
a. “Tell me about your husband’s alcohol usage.”
b. “Is your husband being treated for tuberculosis?”
c. “Has your husband recently fallen or injured his chest?”
d. “Describe spices and condiments your husband uses on food.”
5. Which of the following nursing interventions should the nurse perform for a female
client receiving enteral feedings through a gastrostomy tube?
a. Change the tube feeding solutions and tubing at least every 24 hours.
b. Maintain the head of the bed at a 15-degree elevation continuously.
c. Check the gastrostomy tube for position every 2 days.
d. Maintain the client on bed rest during the feedings.
6. A male client is recovering from a small-bowel resection. To relieve pain, the
physician prescribes meperidine (Demerol), 75 mg I.M. every 4 hours. How soon after
administration should meperidine’s onset of action occur?
a. 5 to 10 minutes
b. 15 to 30 minutes
c. 30 to 60 minutes
d. 2 to 4 hours
7. The nurse is caring for a male 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
8. Which condition is most likely to have a nursing diagnosis of fluid volume deficit?
a. Appendicitis
b. Pancreatitis
c. Cholecystitis
d. Gastric ulcer
9. While a female client is being prepared for discharge, the nasogastric (NG) feeding
tube becomes clogged. To remedy this problem and teach the client’s 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 Oddi’s 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 nurse’s 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.
d. cryoprecipitate and fresh frozen plasma.
16. To prevent gastroesophageal reflux in a male client with hiatal hernia, the nurse
should provide which discharge instruction?
a. “Lie down after meals to promote digestion.”
b. “Avoid coffee and alcoholic beverages.”
c. “Take antacids with meals.”
d. “Limit fluid intake with meals.”
17. The nurse caring for a client with small-bowel obstruction would plan to implement
which nursing intervention first?
a. Administering pain medication
b. Obtaining a blood sample for laboratory studies
c. Preparing to insert a nasogastric (NG) tube
d. Administering I.V. fluids
18. A female client with dysphagia is being prepared for discharge. Which outcome
indicates that the client is ready for discharge?
a. The client doesn’t exhibit rectal tenesmus.
b. The client is free from esophagitis and achalasia.
c. The client reports diminished duodenal inflammation.
d. The client has normal gastric structures.
19. A male client undergoes total gastrectomy. Several hours after surgery, the nurse
notes that the client’s nasogastric (NG) tube has stopped draining. How should the
nurse respond?
a. Notify the physician
b. Reposition the tube
c. Irrigate the tube
d. Increase the suction level
20. 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)
21. A male 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 stools.
22. Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When
discussing risk factors for peptic ulcers, the nurse should mention:
a. a sedentary lifestyle and smoking.
b. a history of hemorrhoids and smoking.
c. alcohol abuse and a history of acute renal failure.
d. alcohol abuse and smoking.
23. While palpating a female client’s 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 nurse’s 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 client’s bedpan.
c. wash the hands after touching the client.
d. wear a gown when providing personal care for the client.
30. Which of the following factors can cause hepatitis A?
a. Contact with infected blood
b. Blood transfusions with infected blood
c. Eating contaminated shellfish
d. Sexual contact with an infected person

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Gastrointestinal Diseases NCLEX Review

Questions Part 2 Answers and Rationale
1. Answer D. Intestinal bacteria synthesize such nutritional substances as vitamin K,
thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Therefore,
antibiotic therapy may interfere with synthesis of these substances, including vitamin K.
Intestinal bacteria don’t synthesize vitamins A, D, or E.
2. Answer B. Acute pancreatitis can cause decreased urine output, which results from
the renal failure that sometimes accompanies this condition. Intracranial pressure
neither increases nor decreases in a client with pancreatitis. Tachycardia, not
bradycardia, usually is associated with pulmonary or hypovolemic complications of
pancreatitis. Hypotension can be caused by a hypovolemic complication, but
hypertension usually isn’t related to acute pancreatitis.
3. Answer B. For a colonoscopy, the nurse initially should position the client on the left
side with knees bent. Placing the client on the right side with legs straight, prone with
the torso elevated, or bent over with hands touching the floor wouldn’t allow proper
visualization of the large intestine.
4. Answer A. A Mallory-Weiss tear is associated with massive bleeding after a tear
occurs in the mucous membrane at the junction of the esophagus and stomach. There is
a strong relationship between ethanol usage, resultant vomiting, and a Mallory-Weiss
tear. The bleeding is coming from the stomach, not from the lungs as would be true in
some cases of tuberculosis. A Mallory-Weiss tear doesn’t occur from chest injuries or
falls and isn’t associated with eating spicy foods.
5. Answer A. Tube feeding solutions and tubing should be changed every 24 hours, or
more frequently if the feeding requires it. Doing so prevents contamination and
bacterial growth. The head of the bed should be elevated 30 to 45 degrees continuously
to prevent aspiration. Checking for gastrostomy tube placement is performed before
initiating the feedings and every 4 hours during continuous feedings. Clients may
ambulate during feedings.
6. Answer B. Meperidine’s onset of action is 15 to 30 minutes. It peaks between 30 and
60 minutes and has a duration of action of 2 to 4 hours.
7. Answer C. A hepatic disorder, such as cirrhosis, may disrupt the liver’s normal use of
vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should
monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and
fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption.
Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the
diseased liver.
8. Answer B. Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis.
The other conditions are less likely to exhibit fluid volume deficit.
9. Answer A. The nurse should irrigate the tube with cola because its effervescence and
acidity are suited to the purpose, it’s inexpensive, and it’s readily available in most
homes. Advancing the NG tube is inappropriate because the tube is designed to stay in
the stomach and isn’t long enough to reach the intestines. Applying intermittent suction
or using a syringe for aspiration is unlikely to dislodge the material clogging the tube but
may create excess pressure. Intermittent suction may even collapse the tube.
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 isn’t 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 doesn’t 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 isn’t the diagnostic
method of choice, especially in a client with acute active bleeding who’s 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 wouldn’t necessarily reveal whether the
lesion is bleeding. Hb levels and HCT, which indicate loss of blood volume, aren’t 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 wouldn’t 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 isn’t
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 it’s 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
aren’t 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 aren’t 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 client’s 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 isn’t 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 isn’t 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 client’s 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 don’t 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 aren’t 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 client’s 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 aren’t
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 enteric-coated medications
because the body can’t 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 shouldn’t 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 doesn’t 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

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Gastrointestinal Diseases NCLEX Review

Questions Part 1
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 intension 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 client’s 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 nosogartric 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 nasogartric 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
form 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 erythrocycle sedimentation rate
12. The nurse is reviewing the physician’s orders written for a male client admitted to
the hospital with acute pancreatitis. Which physician order should the nurse question if
noted on the client’s 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 physician’s 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-electrlyte 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 client’s 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-Fowler’s 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
b. Bradycardia and indigestion
c. Double vision and chest pain
d. Abdominal cramping and pain
24. The nurse is preparing a discharge teaching plan for the male client who had
umbilical hernia repair. What should the nurse include in the plan?
a. Irrigating the drain
b. Avoiding coughing
c. Maintaining bed rest
d. Restricting pain medication
25. The nurse is instructing the male client who has an inguinal hernia repair how to
reduce postoperative swelling following the procedure. What should the nurse tell the
client?
a. Limit oral fluid
b. Elevate the scrotum
c. Apply heat to the abdomen
d. Remain in a low-fiber diet
26. The nurse is caring for a hospitalized female client with a diagnosis of ulcerative
colitis. Which finding, if noted on assessment of the client, would the nurse report to the
physician?
a. Hypotension
b. Bloody diarrhea
c. Rebound tenderness
d. A hemoglobin level of 12 mg/dL
27. The nurse is caring for a male client postoperatively following creation of a
colostomy. Which nursing diagnosis should the nurse include in the plan of care?
a. Sexual dysfunction
b. Body image, disturbed
c. Fear related to poor prognosis
d. Nutrition: more than body requirements, imbalanced
28. The nurse is reviewing the record of a female client with Crohn’s disease. Which
stool characteristics should the nurse expect to note documented in the client’s record?
a. Diarrhea
b. Chronic constipation
c. Constipation alternating with diarrhea
d. Stools constantly oozing form the rectum
29. The nurse is performing a colostomy irrigation on a male client. During the irrigation,
the client begins to complain of abdominal cramps. What is the appropriate nursing
action?
a. Notify the physician
b. Stop the irrigation temporarily
c. Increase the height of the irrigation
d. Medicate for pain and resume the irrigation
30. The nurse is teaching a female client how to perform a colostomy irrigation. To
enhance the effectiveness of the irrigation and fecal returns, what measure should the
nurse instruct the client to do?
a. Increase fluid intake
b. Place heat on the abdomen
c. Perform the irrigation in the evening
d. Reduce the amount of irrigation solution

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Gastrointestinal Diseases NCLEX Review

Questions Part 1 Answers and Rationale
1. Answer C. The normal serum amylase level is 25 to 151 units/L. With chronic cases of
pancreatitis, the rise in serum amylase levels usually does not exceed three times the
normal value. In acute pancreatitis, the value may exceed five times the normal value.
Options A and B are within normal limits. Option D is an extremely elevated level seen in
acute pancreatitis.
2. Answer C. Full liquid food items include items such as plain ice cream, sherbet,
breakfast drinks, milk, pudding and custard, soups that are strained, and strained
vegetable juices. A clear liquid diet consists of foods that are relatively transparent. The
food items in options A, B, and D are clear liquids.
3. Answer A. The client with cirrhosis needs to consume foods high in thiamine.
Thiamine is present in a variety of foods of plant and animal origin. Pork products are
especially rich in this vitamin. Other good food sources include nuts, whole grain
cereals, and legumes. Milk contains vitamins A, D, and B2. Poultry contains niacin.
Broccoli contains vitamins C, E, and K and folic acid
4. Answer A. Unless specifically indicated, residual amounts more than 100 mL require
holding the feeding. Therefore options B, C, and D are incorrect. Additionally, the
feeding is not discarded unless its contents are abnormal in color or characteristics.
5. Answer D. During the insertion of a nasogastric tube, if the client experiences
difficulty breathing or any respiratory distress, withdraw the tube slightly, stop the tube
advancement, and wait until the distress subsides. Options B and C are unnecessary.
Quickly inserting the tube is not an appropriate action because, in this situation, it may
be likely that the tube has entered the bronchus.
6. Answer A. If the nasogastric tube is in the stomach, the pH of the contents will be
acidic. Gastric aspirates have acidic pH values and should be 3.5 or lower. Option B
indicates a slightly acidic pH. Option C indicates a neutral pH. Option D indicates an
alkaline pH.
7. Answer C. When the nurse removes a nasogastric tube, the client is instructed to take
and hold a deep breath. This will close the epiglottis. This allows for easy withdrawal
through the esophagus into the nose. The nurse removes the tube with one smooth,
continuous pull.
8. Answer C. If a client has a nasogastric tube connected to suction, the nurse should
wait up to 30 minutes before reconnecting the tube to the suction apparatus to allow
adequate time for medication absorption. Aspirating the nasogastric tube will remove
the medication just administered. Low intermittent suction also will remove the
medication just administered. The client should not be placed in the supine position
because of the risk for aspiration.
9. Answer C. When the client has a Sengstaken-Blakemore tube, a pair of scissors must
be kept at the client’s 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 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. 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. 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. 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. 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. 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. 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) 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 β-adrenergic blocker.
Furosemide, digoxin, and propranolol are not contraindicated in clients with gastric
disorders.
18. Answer D. Following cholecystectomy, drainage from the T tube is initially bloody
and then turns to a greenish-brown color. The drainage is measured as output. The
amount of expected drainage will range from 500 to 1000 mL/day. The nurse would
document the output.
19. Answer D. Perforation of an ulcer is a surgical emergency and is characterized by
sudden, sharp, intolerable severe pain beginning in the midepigastric area and
spreading over the abdomen, which becomes rigid and board-like. Nausea and vomiting
may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the
legs is not an associated finding.
20. Answer C. A vagotomy, or cutting of the vagus nerve, is done to eliminate
parasympathetic stimulation of gastric secretion. Options A, B, and D are incorrect
descriptions of a vagotomy.
21. Answer C. In a Billroth II procedure, the proximal remnant of the stomach is
anastomosed to the proximal jejunum. Patency of the nasogastric tube is critical for
preventing the retention of gastric secretions. The nurse should never irrigate or
reposition the gastric tube after gastric surgery, unless specifically ordered by the
physician. In this situation, the nurse should clarify the order. Options A, B, and D are
appropriate postoperative interventions.
22. Answer C. Dumping syndrome is a term that refers to a constellation of vasomotor
symptoms that occurs after eating, especially following a Billroth II procedure. Early
manifestations usually occur within 30 minutes of eating and include vertigo,
tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. The
nurse should instruct the client to decrease the amount of fluid taken at meals and to
avoid high-carbohydrate foods, including fluids such as fruit nectars; to assume a low-
Fowler’s position during meals; to lie down for 30 minutes after eating to delay gastric
emptying; and to take antispasmodics as prescribed.
23. Answer A. 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.
24. Answer B. Coughing is avoided following umbilical hernia repair to prevent
disruption of tissue integrity, which can occur because of the location of this surgical
procedure. Bed rest 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.
25. Answer B. Following inguinal hernia repair, the client should be instructed to elevate
the scrotum and apply ice packs while in bed to decrease pain and swelling. The nurse
also should instruct the client to apply a scrotal support when out of bed. Heat will
increase swelling. Limiting oral fluids and a low-fiber diet can cause constipation.
26. Answer C. Rebound tenderness may indicate peritonitis. Bloody 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.
27. Answer B. Body image, disturbed relates to loss of bowel control, the presence of a
stoma, the release of fecal material onto the abdomen, the passage of flatus, odor, and
the need for an appliance (external pouch). No data in the question support options A
and C. Nutrition: less than body requirements, imbalanced is the more likely nursing
diagnosis.
28. Answer A. Crohn’s disease is characterized by nonbloody diarrhea of usually not
more than four to five stools daily. Over time, the diarrhea episodes increase in
frequency, duration, and severity. Options B, C, and D are not characteristics of Crohn’s
disease.
29. Answer B. 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. The physician does not need
to be notified. Increasing the height of the irrigation will cause further discomfort.
Medicating the client for pain is not the appropriate action in this situation.
30. Answer A. To enhance effectiveness of the irrigation and fecal returns, the client is
instructed to increase fluid intake and to take other measures to prevent constipation.
Options B, C and D will not enhance the effectiveness of this procedure

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