Gastrointestinal System Disorders NCLEX Challenge Exam (Quiz #2 - 50 Questions) - Nurseslabs

Gastrointestinal
Challenge Exam System

(Quiz Disorders
#2: 50 NCLEX
Questions)
UPDATED ON OCTOBER 17, 2023
BY MATT VERA BSN, R.N.
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1. Question 1 point(s)
During preparation for bowel surgery, a male client receives an antibiotic to reduce
intestinal bacteria. Antibiotic therapy may interfere with the synthesis of which vitamin and
may lead to hypoprothrombinemia?
A. Vitamin A
B. Vitamin D
C. Vitamin E
D. Vitamin K
Correct
Correct Answer: D. Vitamin K
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 the synthesis of these substances, including vitamin K.
Antibiotics, especially those known as cephalosporins, reduce the absorption of
vitamin K in the body. Using them for more than 10 days may lower levels of vitamin
K because these drugs kill not only harmful bacteria but also the bacteria that
make vitamin K.
Option A: Vitamin A is a general term that encompasses various fat-soluble
substances such as retinol, retinyl palmitate, and beta-carotene. In the liver,
retinol is esterified to retinyl esters and stored in the stellate cells. In the
tissues, both retinol and beta-carotene are oxidized to retinal and retinoic
acid, which are essential for vision and gene regulation, respectively. These
active metabolites bind nuclear receptors of the RAR family to control gene
expression.
Option B: Vitamin D is labeled as the “sunshine vitamin,” as it is produced in
the skin on sun exposure. Vitamin D is a hormone obtained through dietary
consumption and skin production. Ultraviolet B (UVB) radiation, wavelength
(290 to 315 nm) converts 7-dehydrocholesterol in the skin to previtamin D.
This previtamin D undergoes heat isomerization and is converted to vitamin
D. Vitamin D from the skin and diet is metabolized in the liver to 25-
hydroxyvitamin D (25 OH D), and 25-hydroxyvitamin D is useful in assessing
vitamin D status.
Option C: Intestinal bacteria don’t synthesize vitamin E. Vitamin E or
tocopherol is a fat-soluble vitamin functioning as an antioxidant, protecting
the cell membrane. As with all fat-soluble vitamins, transport and absorption
require intact fat digestion mechanisms. Fat metabolism involves lipases,
both lingual and gastric, bile salts, pancreatic enzymes, and intestinal
absorption.
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
Correct
Correct Answer: B. Decreased urine output
Acute pancreatitis can cause decreased urine output, which results from the renal
failure that sometimes accompanies this condition. AKI develops late in the course
of acute pancreatitis, usually after failure of other organs. Remarkably, the kidney
was the first organ to fail in only 8.9% of patients with AKI, and only a minority of
patients develop isolated AKI
Option A: Intracranial pressure neither increases nor decreases in a client
with pancreatitis. The causes of increased intracranial pressure (ICP) can be
divided based on the intracerebral components causing elevated pressures.
Generalized swelling of the brain or cerebral edema from a variety of causes
such as trauma, ischemia, hyperammonemia, uremic encephalopathy, and
hyponatremia.
Option C: Tachycardia, not bradycardia, usually is associated with
pulmonary or hypovolemic complications of pancreatitis. Tachycardia and
mild hypotension may result from hypovolemia from sequestration of fluid in
the pancreatic bed. About 60% of patients develop low-grade pyrexia from
peripancreatic inflammation without evident infection.
Option D: Hypotension can be caused by a hypovolemic complication, but
hypertension usually isn’t related to acute pancreatitis. Release into the
systemic circulation of activated enzymes and proteases may cause
endothelial damage leading to extravasation of fluids from the vascular
space, hypovolemia, hypotension, increased abdominal pressure, intense
kidney vasoconstriction, hypercoagulability, and fibrin deposition in the
glomeruli.
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

Correct
Correct Answer: B. Lying on the left side with knees bent
For a colonoscopy, the nurse initially should position the client on the left side with
knees bent. Preparation for a colonoscopy is the biggest complaint that most
patients have about receiving the procedure, and is a primary reason for non-
compliance to screening colonoscopies. The technician or nurse is there to assist
with preserving stability and preventing the patient from rolling forward or
backward. Also, they are there to help provide counter pressure to the abdomen to
assist the endoscopist in navigating corners and turns.
Option A: Placing the client on the right side with legs straight wouldn’t
allow proper visualization of the large intestine. Performing a colonoscopy
requires practice and is a skill that is difficult to master. While watching an
experienced clinician perform a colonoscopy may appear simple, the
technique is something that requires time, patience, and a lot of practice.
Navigating through a cylindrical tube that can flex, dilate, contract, and
move is not an easy task.
Option B: Placing the client prone with the torso elevated wouldn’t allow
proper visualization of the large intestine. The patient should be positioned
in the left lateral decubitus position. Although, some clinicians may prefer
the patient on their back or right side if circumstances require. The legs
being flexed toward the chest help to relax the puborectalis and
pubococcygeus muscles. This allows for easier entry and traversing past the
angle at the sacral prominence.
Option D: Placing the client bent over with hands touching the floor
wouldn’t allow proper visualization of the large intestine. On the left-sided
position, the patient’s legs should be flexed, and pillows should be placed
around their back, head, and between their knees to help prevent injury to
the bony prominence and to help maintain position.
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 the client’s 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.”
Correct
Correct Answer: A. “Tell me about your husband’s alcohol usage.”
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. Mallory-Weiss tears account for an estimated 1-15% of cases of upper
gastrointestinal bleeding. Although the age range varies widely, affected
individuals are generally in middle age (40s-50s), and men reportedly have a
higher incidence than women by a ratio of 2-4:1.
Option B: The bleeding is coming from the stomach, not from the lungs as
would be true in some cases of tuberculosis. The presence of a hiatal hernia
is a predisposing factor and is found in 35-100% of patients with Mallory-
Weiss tears. During retching or vomiting, the transmural pressure gradient is
greater within the hernia than the rest of the stomach, and it is the location
most likely to sustain a tear
Option C: A Mallory-Weiss tear doesn’t occur from chest injuries or falls.
Precipitating factors include retching, vomiting, straining, hiccupping,
coughing, primal scream therapy, blunt abdominal trauma, and
cardiopulmonary resuscitation. In a few cases, no apparent precipitating
factor can be identified. One study reported that 25% of patients had no
identifiable risk factor.
Option D: A Mallory-Weiss tear isn’t associated with eating spicy foods.
Mallory-Weiss tears are usually associated with other mucosal lesions. In
one study, 83% of patients had additional mucosal abnormalities potentially
contributing to bleeding or actually causing retching and vomiting that
would induce these tears.
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.
Correct
Correct Answer: A. Change the tube feeding solutions and tubing at least
every 24 hours.
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 feeding bag should be changed every 24 hours. Food (formula) should
not be left in the bag for more than 4 hours. So, only put 4 hours (or less) worth of
food in the feeding bag at a time.
Option B: The head of the bed should be elevated 30 to 45 degrees
continuously to prevent aspiration. Lying prone/supine during feeding
increases the risk of aspiration and therefore where clinically possible the
child should be placed in an upright position. If unable to sit up for a bolus
feed or if receiving continuous feeding, the head of the bed should be
elevated 30-45 degrees during feeding and for at least 30 minutes after the
feed to reduce the risk of aspiration.
Option C: Checking for gastrostomy tube placement is performed before
initiating the feedings and every 4 hours during continuous feedings.
Correct placement of the tube should be confirmed prior to administration
of an enteral feed by checking the insertion site at the abdominal wall and
observing the client for abdominal pain or discomfort. If the nurse is unsure
regarding the position of the gastrostomy or jejunostomy tube contact the
medical team immediately.
Option D: Clients may ambulate during feedings. Tube feeding doesn’t need
to keep the client from most physical activities. He can run or walk, but the
client should talk to a doctor about yoga or other exercises that work the
abdomen muscles. Even swimming is fine if the incision site has healed and
the water is clean.
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 onset of action occur?
A. 5 to 10 minutes
B. 15 to 30 minutes
C. 30 to 60 minutes
D. 2 to 4 hours
Correct
Correct Answer: B. 15 to 30 minutes
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. Meperidine is in the class of
phenylpiperidine as a hydrochloride salt synthetic form of the opioid. Meperidine is
used for the treatment of moderate to severe pain. It has intramuscular,
subcutaneous, intravenous injection, syrup, and tablet forms.
Option A: Injection should be into large muscle mass, and it is preferable to
subcutaneous injection. Using Meperidine for pain control should be
considered if no other options are available, in which case the duration of
medication use should be limited to less than 48 hours, and the total dosage
administered should not exceed 600 mg in 24 hours.
Option C: For intravenous (IV) injection, inject the dose of 10 mg/ml slowly.
The injection should be a consideration only when an opiate antagonist and
the administration of oxygen and respiratory monitoring facilities are
available. In the 20th century, it was the drug of choice amongst the opioids
in the management of acute pain by most physicians and the management
of some patients with chronic pain. Meperidine is also being used as an
adjunct to preoperative medications to reduce shivering.
Option D: Meperidine has the same mechanism of action as morphine,
which is acting as an agonist to the mu-opioid receptor. The anti-shivering
effect may involve the stimulation of k-opioid receptors.
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
Correct
Correct Answer: C. Purpura and petechiae
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. Petechiae
and purpura result from a wide variety of underlying disorders and may occur at
any age. Petechiae are small (1–3 mm), red, non-blanching macular lesions caused
by intradermal capillary bleeding. Purpura are larger, typically raised lesions
resulting from bleeding within the skin
Option A: Dyspnea and fatigue suggest anemia. When patients with severe
anemia develop a high output state, cardiac failure can ensue causing them
to have shortness of breath from cardiac causes as well. Diseases in other
organs, such as the kidneys and the liver, may cause dyspnea by a
combination of the interactions discussed.
Option B: Ascites and orthopnea are unrelated to vitamin K absorption.
Patients with malignant ascites can have symptoms related to malignancy,
which may include weight loss. On the other hand, patients with ascites due
to heart failure may report dyspnea, orthopnea, and peripheral edema, and
those with chylous ascites report diarrhea, steatorrhea, malnutrition, edema,
nausea, enlarged lymph nodes, early satiety, fevers, and night sweats.
Option D: Gynecomastia and testicular atrophy result from decreased
estrogen metabolism by the diseased liver. Gynecomastia is most commonly
caused by an imbalance between the hormones estrogen and testosterone.
Estrogen controls female traits, including breast growth. Testosterone
controls male traits, such as muscle mass and body hair.
Which condition is most likely to have a nursing diagnosis of fluid volume deficit?
A. Appendicitis
B. Pancreatitis
C. Cholecystitis
D. Gastric ulcer
Correct
Correct Answer: B. Pancreatitis
Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The
other conditions are less likely to exhibit fluid volume deficit. Early fluid therapy is
the cornerstone of treatment and is universally recommended; however, there is a
lack of consensus regarding the type, rate, amount, and endpoints of fluid
replacement. The basic goal of fluid depletion should be to prevent or minimize the
systemic response to inflammatory markers.
Option A: A client with appendicitis may be at risk for deficient fluid volume.
The peritoneum reacts to irritation and infection by producing large amounts
of intestinal fluid, possibly reducing the circulating blood volume, resulting in
dehydration and relative electrolyte imbalances.
Option C: A client with cholecystitis may be at risk for deficient fluid
volume. Prolonged vomiting, gastric aspiration, and restricted oral intake
can lead to deficits in sodium, potassium, and chloride. Maintain accurate
record of I&O, noting output less than intake, increased urine specific
gravity.
Option D: A client with a gastric ulcer may be at risk for deficient fluid
volume. The erosion of an ulcer through the gastric or duodenal mucosal
layer may cause GI bleeding. The client may develop anemia. If bleeding is
brisk, changes in vital signs and physical symptoms of hypovolemia may
develop rapidly.
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 warm water.
B. Advance the tube into the intestine.
C. Apply intermittent suction to the tube.
D. Withdraw the obstruction with a 30-ml syringe.
Correct
Correct Answer: A. Irrigate the tube with warm water.
The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends
warm water as the best initial choice for trying to unclog a feeding tube. First,
attach a 30- or 60-mL piston syringe to the feeding tube and pull back the plunger
to help dislodge the clog. Next, fill the flush syringe with warm water, reattach it to
the tube, and attempt a flush.
Option B: 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. If there is still continued resistance, gently move the syringe
plunger back and forth to help loosen the clog. Then, clamp the tube to
allow the warm water to penetrate the clog for up to 20 minutes.
Option C: Applying intermittent suction or using a syringe for aspiration is
unlikely to dislodge the material clogging the tube but may create excess
pressure.If the patient’s feeding tube becomes clogged, attempt to unclog it
before replacing it, which is both costly and uncomfortable for the patient.
The belief that carbonated beverages or cranberry juice will unclog a
feeding tube is a persistent nursing myth. In fact, these beverages have an
acidic pH that can worsen the occlusion by causing proteins in the EN
formula to precipitate within the tube.
Option D: Intermittent suction may even collapse the tube. Consistently
flushing feeding tubes with water as scheduled during EN therapy and
medication administration is the best way to minimize the risk of occlusions.
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.
Correct
Correct Answer: B. Morphine may cause spasms of Oddi’s sphincter.
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.
Morphine showed an excitatory effect on the sphincter of Oddi, and might be a
cause of Oddi’s sphincter dysfunction(SOD). SO may function as a peristaltic
pump to actively expel fluid from the sphincter segment into the duodenum.
Option A: Meperidine has a somewhat shorter duration of action than
morphine. Morphine is the standard opium-based analgesic with well-known
analgesic effects and side effects. Meperidine (pethidine) is another opioid,
but the use of meperidine is not very popular in countries such as the USA
and Canada, however, it is still used in Iran for pain management in the ED.
Option C: The two drugs are equally addictive. Meperidine appeared to be
safer with a lower risk of addiction when compared to other opioids and
because of the anticholinergic effects associated with less biliary spasm or
renal colic.
Option D: Morphine isn’t associated with hepatic dysfunction. Respiratory
depression is among the more serious adverse reactions with opiate use
that is especially important to monitor in the postoperative patient
population. Other reported side effects include lightheadedness, sedation,
and dizziness.
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
Correct
Correct Answer: C. Chronic low self-esteem
Young women with chronic low self-esteem — are at the highest risk for anorexia
nervosa because they perceive being thin as a way to improve their self-
confidence. Anorexia nervosa is an illness of starvation, brought on by severe
disturbance of body image and a morbid fear of obesity. People with anorexia
nervosa attempt to maintain a weight that’s far below normal for their age and
height.
Option A: Hopelessness is an inappropriate nursing diagnosis because
clients with anorexia nervosa seldom feel hopeless; instead, they use food
to control their desire to be thin and hope that restricting food intake will
achieve this goal. Feelings of personal ineffectiveness, low self-esteem, and
perfectionism are often part of the problem.
Option B: Major physical and psychological changes in adolescence can
contribute to the development of eating disorders. Feelings of
powerlessness and loss of control of feelings (in particular sexual
sensations) lead to an unconscious desire to desexualize self. The patient
often believes that these fears can be overcome by taking control of bodily
appearance, development, and function.
Option D: Anorexia nervosa doesn’t result from a knowledge deficit, such as
one regarding good nutrition. The patient sees herself as weak-willed, even
though part of a person may feel a sense of power and control (dieting,
weight loss). The patient feels helpless to change and requires assistance to
problem-solve methods of control in life situations.
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
Correct
Correct Answer: A. Endoscopy
Endoscopy permits direct evaluation of the upper GI tract and can detect 90% of
bleeding lesions. Endoscopy is the insertion of a long, thin tube directly into the
body to observe an internal organ or tissue in detail. It can also be used to carry
out other tasks including imaging and minor surgery. Endoscopes are minimally
invasive and can be inserted into the openings of the body such as the mouth or
anus. 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.
Option B: 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. An upper gastrointestinal
series (UGI) is a radiographic (X-ray) examination of the upper
gastrointestinal (GI) tract. The esophagus, stomach, and duodenum (first
part of the small intestine) are made visible on X-ray film by a liquid
suspension. This liquid suspension may be barium or a water-soluble
contrast.
Option C: 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. Upper GI bleeding is sometimes fatal,
and the European Society of Gastrointestinal Endoscopy recommends
maintaining Hb levels between 7.0–9.0 g/dl using blood transfusion in order
to reduce mortality.
Option D: Arteriography is an invasive study associated with life-threatening
complications and wouldn’t be used for an initial evaluation. An arteriogram
is an imaging test that uses x-rays and a special dye to see inside the
arteries. It can be used to view arteries in the heart, brain, kidney, and other
parts of the body.
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.”
Correct
Correct Answer: A. “You may have eaten contaminated restaurant food.”
Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by
consuming food contaminated by infected food handlers. The hepatitis A virus
(HAV) is a common infectious etiology of acute hepatitis worldwide. HAV is most
commonly transmitted through the oral-fecal route via exposure to contaminated
food, water, or close physical contact with an infectious person. The virus isn’t
transmitted by the I.V. route, blood transfusions, or unprotected sex.
Option B: Hepatitis B can be transmitted by I.V. drug use. In the United
States, estimates are about 2.2 million people have chronic hepatitis B virus
infection. It is transmitted parenterally and sexually when individuals come in
contact with mucous membranes or body fluids of infected individuals.
Option C: Hepatitis B can be transmitted by blood transfusion. Transfusion
of blood and blood products, injection drug use with shared needles,
needlesticks, or wounds caused by other instruments in healthcare workers
and hemodialysis are all examples of parenteral and percutaneous
exposures, but parenteral mode remains the dominant mode of transmission
both globally and in the United States.
Option D: Hepatitis C can be transmitted by unprotected sex. Transmission
can be parenteral, perinatal, and sexual, with the most common mode being
the sharing of contaminated needles among IV drug users. Also, other high-
risk groups include people who require frequent blood transfusions and
organ transplantation of organs from infected donors.

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.
Correct
Correct Answer: B. Obstruction of the appendix reduces arterial flow, leading
to ischemia, inflammation, and rupture of the appendix.
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.
Option A: Inflammation and bacterial growth follow, and swelling continues
to raise pressure within the appendix, resulting in gangrene and rupture. The
pathophysiology of appendicitis likely stems from obstruction of the
appendiceal orifice. This results in inflammation, localized ischemia,
perforation, and the development of a contained abscess or frank
perforation with resultant peritonitis.
Option C: Geriatric, not middle-aged, clients are especially susceptible to
appendix rupture. Appendicitis occurs most often between the ages of 5
and 45 with a mean age of 28. The incidence is approximately 233/100,000
people. Males have a slightly higher predisposition of developing acute
appendicitis compared to females, with a lifetime incidence of 8.6% for men
and 6.7 % for women.
Option D: When an obstruction is the cause of appendicitis, it leads to an
increase in intraluminal and intramural pressure, resulting in small vessel
occlusion and lymphatic stasis. Once obstructed, the appendix fills with
mucus and becomes distended, and as lymphatic and vascular compromise
advances, the wall of the appendix becomes ischemic and necrotic.
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.
Correct
Correct Answer: D. Cryoprecipitate and fresh frozen plasma.
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.
Option A: Although administering whole blood, albumin, and packed cells
will contribute to hemostasis, those products aren’t specifically used to treat
hemostasis. Whole blood is often divided into component parts for ease of
storage and administration. These typically include Red Blood Cells (RBC),
Platelets (thrombocytes), and Plasma.
Option B: Platelets are helpful, but the best answer is cryoprecipitate and
fresh frozen plasma. Platelets are typically given when patients have a low
platelet count (thrombocytopenia) or have platelets that are dysfunctional,
due to medications or other acquired or inherited lesions.
Option C: The indications for whole blood and blood component transfusion
consist of increasing hemoglobin and oxygenation of tissues, maintaining
adequate blood volume to avoid ischemia and hypovolemic shock, and to
reconstitute platelets, coagulation factors, and other plasma proteins to a
functional status.
To prevent gastroesophageal reflux in a male client with a hiatal hernia, the nurse should
provide which of the following discharge instructions?
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.”
Correct
Correct Answer: B. “Avoid coffee and alcoholic beverages.”
To prevent reflux of stomach acid into the esophagus, the nurse should advise the
client to avoid foods and beverages that increase stomach acids, such as coffee
and alcohol. Instruct the patient regarding avoidance of alcohol, smoking, and
caffeinated beverages. These increase acid production and may cause esophageal
spasms.
Option A: The nurse also should teach the client to avoid lying down after
meals, which can aggravate reflux. Instruct to remain in an upright position
at least 2 hours after meals; avoiding eating 3 hours before bedtime. This
helps control reflux and causes less irritation from reflux action into the
esophagus.
Option C: The nurse also should teach the client to take antacids after
eating. Instruct the patient in medications, effects, side effects, and to
report to the physician if symptoms persist despite medication treatment.
Promotes knowledge, facilitates compliance with treatment, and allows for
prompt identification of potential need for changes in medication regimen to
prevent complications.
Option D: The client need not limit fluid intake with meals as long as the
fluids aren’t gastric irritants. Instruct the patient to avoid highly seasoned
food, acidic juices, alcoholic drinks, bedtime snacks, and foods high in fat.
These can reduce the lower esophageal sphincter pressure.
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
Correct
Correct Answer: D. Administering I.V. fluids.
I.V. infusions containing normal saline solution and potassium should be given first
to maintain fluid and electrolyte balance. Maintenance of bowel rest requires
alternative fluid replacement to correct losses and anemia. Fluids containing
sodium may be restricted in presence of regional enteritis.
Option A: Pain medication often is withheld until the obstruction is
diagnosed because analgesics can decrease intestinal motility. Provide
comfort measures (back rub, reposition) and diversional activities. Promotes
relaxation, refocuses attention, and may enhance coping abilities.
Option B: 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.
Option C: For the client’s comfort and to assist in bowel decompression, the
nurse should prepare to insert an NG tube next. Resume or advance diet as
indicated (clear liquids progressing to bland, low residue; then high-protein,
high-calorie, caffeine-free, non-spicy, and low-fiber as indicated).
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.
Correct
Correct Answer: B. The client is free from esophagitis and achalasia.
Dysphagia may be the reason why a client with esophagitis or achalasia seeks
treatment. Dysphagia is common in patients with erosive esophagitis but is not a
reliable clinical predictor of severe erosive esophagitis. Dysphagia resolved with
PPI therapy in most cases, but persistent dysphagia may indicate failed healing.
Dysphagia isn’t associated with rectal tenesmus, duodenal inflammation, or
abnormal gastric structures.
Option A: Rectal tenesmus can happen for several reasons. The most
common is colon inflammation, either from a noninfectious or infectious
cause. Inflammatory bowel disease (IBD) is one cause of colon
inflammation. IBD is an umbrella term for several long-term conditions
involving chronic inflammation of the gut.
Option C: The most common cause of duodenitis is infection by
Helicobacter pylori (H. pylori) bacteria. Another common cause is the long-
term use of NSAIDs (such as aspirin and ibuprofen). Celiac disease, an
allergy to gluten, causes a particular type of inflammation in the duodenum
along with other changes.
Option D: Dysphagia means difficulty swallowing. For this diagnosis, it is
critical that related symptoms be associated with the act of swallowing a
liquid or solid bolus. When unassociated with swallowing, the sensation of
fullness in the upper esophagus suggests globus hystericus, which is
distinct from dysphagia.
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.
Correct
Correct Answer: A. Notify the physician
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. Nasogastric decompression
has been routinely used in most abdominal operations to prevent the
consequences of postoperative ileus.
Option B: Repositioning an NG tube in a client who has undergone gastric
surgery can disrupt the anastomosis. Routine use of nasogastric tubes after
abdominal operations is intended to hasten the return of bowel function,
prevent pulmonary complications, diminish the risk of anastomotic leakage,
increase patient comfort and shorten hospital stay.
Option C: Irrigating an NG tube in a client who has undergone gastric
surgery can disrupt the anastomosis. Most surgeons traditionally continue
to use nasogastric decompression, believing that its use facilitates a better
surgical field and reduces complications such as nausea, vomiting,
aspiration, and anastomotic leakage caused by postoperative ileus.
Option D: Increasing the level of suction may cause trauma to GI mucosa or
the suture line. The reason to perform such activity may be either
therapeutic, as in patients with distention and vomiting from bowel
obstruction, diagnostic, as in the case of gastrointestinal bleeding or peptic
ulcer disease, or prophylactic, as in patients having major abdominal
surgery.
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)
Correct
Correct Answer: B. Elevated serum lipase
Elevation of serum lipase is the most reliable indicator of pancreatitis because this
enzyme is produced solely by the pancreas. Serum lipase typically increases 3–6
hours after the onset of acute pancreatitis and usually peaks at 24 hours. Unlike
amylase, there is significant reabsorption of lipase in the renal tubules so the
serum concentrations remain elevated for 8–14 days.
Option A: A client’s BUN is typically elevated in relation to renal dysfunction.
A BUN test is done to see how well the kidneys are working. If the kidneys
are not able to remove urea from the blood normally, the BUN level rises.
Heart failure, dehydration, or a diet high in protein can also make the BUN
level higher. Liver disease or damage can lower the BUN level.
Option C: A client’s AST is typically elevated in relation to liver dysfunction.
The elevated AST-to-ALT ratio in alcoholic liver disease results in part from
the depletion of vitamin B6 (pyridoxine) in chronic alcoholics. ALT and AST
both use pyridoxine as a coenzyme, but the synthesis of ALT is more
strongly inhibited by pyridoxine deficiency than is the synthesis of AST.
Option D: A client’s LD is typically elevated in relation to damaged cardiac
muscle. Usually, LDH isoenzyme levels increase 24–72 hours following
myocardial infarction and reach a peak concentration in 3–4 days. Glycogen
phosphorylase BB is released into circulation 2–4 h after onset of cardiac
ischemia and returns to baseline levels 1–2 days after acute myocardial
infarction, making it an early marker.
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 sclera
B. Light amber urine
C. Circumoral pallor
D. Black, tarry stools
Correct
Correct Answer: A. Yellow sclera
Yellow sclera may be the first sign of jaundice, which occurs when the common bile
duct is obstructed. Jaundice can be a sign of a common bile duct obstruction from
an entrapped gallstone. In the presence of jaundice and abdominal pain, often, a
procedure is an indication to go and retrieve the stone to prevent further sequelae.
Option B: Urine normally is light amber. Usually, patients with symptoms
from gallstones present with right upper abdominal pain after eating greasy
or spicy foods. There is often nausea and vomiting. Pain can also be present
in the epigastric area that radiates to the right scapula or mid-back.
Option C: Circumoral pallor doesn’t occur in common bile duct obstruction;
it is a sign of hypoxia, respectively. The classic physical exam finding is a
positive Murphy’s sign, where the pain is elicited on deep palpation to the
right upper quadrant underneath the rib cage upon deep inspiration.
Option D: Black, tarry stools don’t occur in common bile duct obstruction;
they are signs of GI bleeding. Progression of this condition is indicated by
neurologic changes and hypotension (Reynold’s pentad). Other sequelae
are acute pancreatitis with symptoms of midepigastric pain and intractable
vomiting.
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.
Correct
Correct Answer: D. Alcohol abuse and smoking.
Risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse,
smoking, and stress. Peptic ulcer disease (PUD) has various causes; however,
Helicobacter pylori-associated PUD and NSAID-associated PUD account for the
majority of the disease etiology.
Option A: A sedentary lifestyle isn’t a risk factor for peptic ulcers. PUD is a
global problem with a lifetime risk of development ranging from 5% to 10%.
Overall, there is a decrease in the incidence of PUD worldwide due to
improved hygienic and sanitary conditions combined with effective
treatment and judicious use of NSAIDs.
Option B: A history of hemorrhoids isn’t a risk factor for peptic ulcers.
Gastric and duodenal ulcers can be differentiated from the timing of their
symptoms in relation to meals. Nocturnal pain is common with duodenal
ulcers. Those with gastric outlet obstruction commonly report a history of
abdomen bloating and or fullness.
Option C: Chronic renal failure, not acute renal failure, is associated with
duodenal ulcers. The prognosis of PUD is excellent after the underlying
cause is successfully treated. Recurrence of the ulcer may be prevented by
maintaining good hygiene and avoiding alcohol, smoking, and NSAIDs.
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
Correct
Correct Answer: D. Liver
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. Begin palpation over the right lower quadrant, near the anterior
iliac spine. Palpate for the liver with one or two hands palm down moving upward
2-3 cm at a time towards the lower costal margin.
Option A: The sigmoid colon is located in the left lower quadrant. The 40cm
long sigmoid colon is located in the left lower quadrant of the abdomen,
extending from the left iliac fossa to the level of the S3 vertebra.
Option B: The appendix is located in the right lower quadrant. The appendix
sits at the junction of the small intestine and large intestine. It’s a thin tube
about four inches long. Normally, the appendix sits in the lower right
abdomen.
Option C: The spleen is located in the left upper quadrant. The spleen is a
fist-sized organ in the upper left side of the abdomen, next to the stomach
and behind the left ribs. It’s an important part of the immune system, but
one can survive without it.
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 blood pressure and pulse.
D. Pull the dehiscence closed.
Correct
Correct Answer: B. Place saline-soaked sterile dressings on the wound.
The nurse should first place saline-soaked sterile dressings on the open wound to
prevent tissue drying and possible infection. Ask the client to bend the knees to
reduce abdominal tension. Note the color of the tissue before it is covered. Then,
cover the moistened dressings with a sterile drape.
Option A: After placing saline-soaked sterile dressings, the nurse should
call the physician. The bed should be lowered until it is flat or not higher
than 20 degrees. Dehiscence occurs when an incisional wound separates
after surgery; evisceration occurs when an internal bodily organ protrudes
through the incision. Dehiscence and evisceration can be a life-threatening
emergency.
Option C: Take the client’s vital signs and SPO2 while notifying the
physician. Check every 15 minutes and assess for signs of shock. The nurse
may also start a patent IV line with 0.9% sodium chloride solution for
surgery.
Option D: The dehiscence needs to be surgically closed, so the nurse
should never try to close it. Be prepared to insert a nasogastric tube if
ordered, to decompress the stomach. Keep the dressings wet and check the
wound frequently, using a new pair of sterile gloves each time.
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
Correct
Correct Answer: B. Anticholinergic drugs
Paregoric has an additive effect of constipation when used with anticholinergic
drugs. The opiate anhydrous morphine, which is contained in paregoric, can
decrease motility more than loperamide or the combination of diphenoxylate and
atropine can. Antiarrhythmics, anticoagulants, and antihypertensives aren’t known
to interact with paregoric.
Option A: Of the Class III antiarrhythmics, amiodarone is involved in a
significant number of interactions since it is a potent inhibitor of several
cytochrome P450 enzymes. It can significantly impair the metabolism of
digoxin, theophylline and warfarin. Dosages of digoxin and warfarin should
empirically be decreased by one-half when amiodarone therapy is added.
Option C: The anticoagulant effect of warfarin is inhibited by drugs like
barbiturates, rifampin, azathioprine, and carbamazepine, which increase its
clearance by inducing hepatic metabolism. Azathioprine also reduces the
anticoagulant effect of warfarin, presumably through a potentiating effect
on hepatic clearance.
Option D: Nonsteroidal anti-inflammatory drugs (NSAIDs) can induce an
increase in blood pressure (BP) and may potentially reduce the efficacy of
several antihypertensive drugs. Probably the main mechanism of action is
inhibition of prostaglandin (PG) synthesis since NSAIDs have a higher
propensity to increase BP as the regulation of BP (and renal function) is
more PG-dependent and to interact with drugs (diuretics, beta-blockers,
and ACE inhibitors) that may act through the increase of PG formation.
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.
Correct
Correct Answer: A. Increasing fluid intake to prevent dehydration.
Because stool forms in the large intestine, an ileostomy typically drain liquid waste.
To avoid fluid loss through ileostomy drainage, the nurse should instruct the client
to increase fluid intake. Monitor I&O. Note number, character, and amount of
stools; estimate insensible fluid losses (diaphoresis). Measure urine specific
gravity; observe for oliguria. Provides information about overall fluid balance, renal
function, and bowel disease control, as well as guidelines for fluid replacement.
Option B: The nurse should teach the client to wear a collection appliance
at all times because ileostomy drainage is incontinent. Resume or advance
diet as indicated (clear liquids progressing to bland, low residue; then high-
protein, high-calorie, caffeine-free, non-spicy, and low-fiber as indicated).
Option C: The nurse should teach the client to avoid high-fiber foods
because they may irritate the intestines. Avoid or limit foods that might
cause or exacerbate abdominal cramping, flatulence (milk products, foods
high in fiber or fat, alcohol, caffeinated beverages, chocolate, peppermint,
tomatoes, orange juice).
Option D: The nurse should teach the client to avoid enteric-coated
medications because the body can’t absorb them after an ileostomy. Allows
the intestinal tract to readjust to the digestive process. Protein is necessary
for tissue healing integrity. Low bulk decreases peristaltic response to
meals.
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
Correct
Correct Answer: C. Nothing by mouth
Shock and bleeding must be controlled before oral intake, so the client should
receive nothing by mouth. When the bleeding is controlled, the diet is gradually
increased, starting with ice chips and then clear liquids. In patients hospitalized for
acute upper gastrointestinal bleeding due to an ulcer with high risk of rebleeding or
with variceal bleeding, it is recommended to wait at least 48 h after endoscopic
therapy before initiating oral or enteral feeding.
Option A: A regular diet is incorrect. Proton pump inhibitors (PPIs) are
beneficial for both ulcer and non-ulcer diseases as they reduce the risk of
re-bleeding by clot stabilization. Endoscopy should only be performed after
hemodynamic stability has been achieved and should not be delayed by
more than 24 hours.
Option B: Skim milk shouldn’t be given because it increases gastric acid
production, which could prolong bleeding. Further research found that
ingesting milk increases the production of stomach acid, which can worsen
gastritis symptoms. Any relief gastritis sufferers experience after drinking a
glass of milk is likely to be temporary; within a half-hour, symptoms are
usually worse, not better.
Option D: A liquid diet is the first diet offered after bleeding and shock are
controlled. They can be fed with clear liquids soon after endoscopy. Clear
liquids provide the advantage that if the patient starts to bleed again,
sedation and anesthesia can be given within two hours after the last
ingestion
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.
Correct
Correct Answer: B. Anorexia, nausea, and vomiting.
Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting,
fatigue, and weakness. Acute hepatitis usually presents as a self-limited illness;
development of fulminant hepatitis is rare. Typical symptoms of acute infection
include nausea, vomiting, abdominal pain, fatigue, malaise, poor appetite, and
fever; management is with supportive care.
Option A: Abdominal pain may occur but doesn’t radiate to the shoulder.
Extrahepatic manifestations rarely occur but may include pancreatitis, rash,
acute kidney injury with interstitial nephritis or glomerulonephritis,
pneumonitis, pericarditis, hemolysis, and acute cholecystitis.
Option C: Eructation and constipation are common in gallbladder disease,
not hepatitis A. Patients may develop dark urine and pale stools within a
week, followed by jaundice, icteric (yellow-tinted) sclera, and pruritus.
Patients usually have elevated levels of serum alanine aminotransferase,
aspartate aminotransferase, bilirubin, alkaline phosphatase, and lambda-
glutamyl transpeptidase.
Option D: Abdominal ascites is a sign of advanced hepatic disease, not an
early sign of hepatitis A. Ascites is the pathologic accumulation of fluid
within the peritoneal cavity. It is the most common complication of cirrhosis
and occurs in about 50% of patients with decompensated cirrhosis in 10
years. The development of ascites denotes the transition from compensated
to decompensated cirrhosis.
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.
Correct
Correct Answer: C. Wash the hands after touching the client.
To maintain enteric precautions, the nurse must wash the hands after touching the
client or potentially contaminated articles and before caring for another client.
Enteric precautions are taken to prevent infections that are transmitted primarily by
direct or indirect contact with fecal material. They’re indicated for patients with
known or suspected infectious diarrhea or gastroenteritis.
Option A: 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.
Option B: For enteric precautions, the nurse need not wear a mask. While
taking care of the client, the nurse may wear gloves and a gown if she might
have contact with body fluids (stool, urine, saliva). A sign on the door to the
client’s room reminds staff to wear a gown and gloves when inside the room.
Staff will wash their hands before entering and leaving the client’s room.
Option D: For enteric precautions, the nurse must wear a gown only if
soiling from fecal matter is likely. Wash hands before entering and before
leaving the client’s room. Make sure to use soap and water when leaving the
room. Be sure other visitors do this too.
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.
Correct
Correct Answer: C. Eating contaminated shellfish.
Hepatitis A can be caused by consuming contaminated water, milk, or food —
especially shellfish from contaminated water. The most common mode of
transmission of hepatitis A is via the fecal-oral route from contact with food, water,
or objects contaminated by fecal matter from an infected individual. It is more
commonly encountered in developing countries where due to poverty and lack of
sanitation, there is a higher chance of fecal-oral spread.
Option A: Hepatitis B is caused by blood and sexual contact with an
infected person. Transfusion of blood and blood products, injection drug
use with shared needles, needlesticks, or wounds caused by other
instruments in healthcare workers and hemodialysis are all examples of
parenteral and percutaneous exposures, but parenteral mode remains the
dominant mode of transmission both globally and in the United States.
Option B: Hepatitis C is usually caused by contact with infected blood,
including receiving blood transfusions. Transmission can be parenteral,
perinatal, and sexual, with the most common mode being the sharing of
contaminated needles among IV drug users. Also, other high-risk groups
include people who require frequent blood transfusions and organ
transplantation of organs from infected donors.
Option D: Hepatitis B and C can be caused by sexual contact with an
infected person. Intravenous drug users, men who have sex with men,
healthcare workers with exposure to infected body fluids, patients who
require frequent and multiple blood transfusions, people who have multiple
sexual partners, prisoners, partners of hepatitis B virus carriers, and persons
born in endemic areas are all at high risk for hepatitis B virus infection.
The correct sequence for abdominal assessment is:
A. Inspection, percussion, palpation, auscultation.
B. Inspection, auscultation, percussion, palpation.
C. Inspection, palpation, auscultation, percussion.
D. Inspection, percussion, auscultation, palpation.
Correct
Correct Answer: B. Inspection, auscultation, percussion, palpation.
Auscultation is done before percussion and palpation to avoid stimulating
peristaltic movements and distorting auscultatory sounds. The diaphragm of the
stethoscope should be placed on the right side of the umbilicus to listen to the
bowel sounds, and their rate should be calculated after listening for at least two
minutes. Normal bowel sounds are low-pitched and gurgling, and the rate is
normally 2-5/min.
Option A: Begin with the general inspection of the patient and then proceed
to the abdominal area. This should be performed at the foot end of the bed.
The general inspection can give multiple clues regarding the diagnosis of
the patient, for example, yellowish discoloration of the skin (jaundice)
indicates a possible hepatic abnormality.
Option C: There are three stages of palpation that include superficial or
light palpation, deep palpation, and organ palpation, and should be
performed in the same order. Maneuvers specific to certain diseases are
also a part of abdominal palpation. The examiner should begin with
superficial or light palpation from the area furthest from the point of maximal
pain and move systematically through the nine regions of the abdomen.
Option D: A proper technique of percussion is necessary to gain maximum
information regarding abdominal pathology. While percussing, it is important
to appreciate tympany over air-filled structures such as the stomach and
dullness to percussion which may be present due to an underlying mass or
organomegaly (for example, hepatomegaly or splenomegaly).
Peritonitis can occur as a complication of:
A. Septicemia
B. Multiple organ failure
C. Hypovolemic shock
D. Peptic ulcer disease

Correct
Correct Answer: D. Peptic ulcer disease
Perforation is a life-threatening complication of peptic ulcer disease and can result
in peritonitis. Since the peritoneum completely covers the stomach, perforation of
the wall creates a communication between the gastric lumen and the peritoneal
cavity. If the perforation occurs acutely, there is no time for an inflammatory
reaction to wall off the perforation, and the gastric content is free to enter the
general peritoneal cavity, causing chemical peritonitis.
Option A: Septic shock is a serious illness and despite all the advances in
medicine, it still carries high mortality which can exceed 40%. Mortality
does depend on many factors including the type of organism, antibiotic
sensitivity, number of organs affected, and patient age. The more factors
that match SIRS, the higher the mortality.
Option B: The high mortality of patients with multiple organ failure provided
a focus for the problems that ultimately led to death for many patients in the
intensive care unit. The frequency of infection, sepsis, or inflammation in
producing multiple organ failure led to clinical trials of so-called magic
bullets for the treatment of patients with sepsis.
Option C: Patients with volume depletion may complain of thirst, muscle
cramps, and/or orthostatic hypotension. Severe hypovolemic shock can
result in mesenteric and coronary ischemia that can cause abdominal or
chest pain. Agitation, lethargy, or confusion may result from brain
malperfusion.

A patient has become very depressed postoperatively after receiving a colostomy for GI
cancer. He does not participate in his colostomy care or looks at the stoma. An
appropriate nursing diagnosis for this situation is:
A. Ineffective Individual Coping
B. Knowledge Deficit
C. Impaired Adjustment
D. Anxiety
Correct
Correct Answer: A. Ineffective Individual Coping
The patient is dealing with a disturbance in self-concept and difficulty coping with
the newly established stoma. Encourage the patient/SO to verbalize feelings
regarding the ostomy. Acknowledge normality of feelings of anger, depression and
grief over a loss. Discuss daily “ups and downs” that can occur.
Option B: Provide opportunities for patient/SO to view and touch stoma,
using the moment to point out positive signs of healing, normal appearance,
and so forth. Remind the patient that it will take time to adjust, both
physically and emotionally.
Option C: Although integration of stoma into body image can take months
or even years, looking at the stoma and hearing comments (made in a
normal, matter-of-fact manner) can help the patient with this acceptance.
Touching stoma reassures patient/SO that it is not fragile and that slight
movements of stoma actually reflect normal peristalsis.
Option D: Maintain a positive approach during care activities, avoiding
expressions of disdain or revulsion. Do not take angry expressions of the
patient and SO personally. A person who is living with an ostomy can be a
good support system/role model. Helps reinforce teaching (shared
experiences) and facilitates acceptance of change as the patient realizes
“life does go on” and can be relatively normal.

Patients with esophageal varices would reveal the following assessment:
A. Increased blood pressure
B. Increased heart rate
C. Decreased respiratory rate

D. Increased urinary output
Correct
Correct Answer: B. Increased heart rate
Tachycardia is an early sign of compensation for patients with esophageal varices.
Since the portal venous system has no valves, resistance at any level between the
splanchnic vessels and the right side of the heart results in retrograde flow and
elevated pressure. The collaterals slowly enlarge and connect the systemic
circulation to the portal venous system.
Option A: Esophageal varices are a direct result of high blood pressure in
the portal vein. This condition is called portal hypertension. It causes blood
to build up in nearby blood vessels, including those in your esophagus.
Veins begin to dilate and swell as a result of increased blood flow.
Option C: The respiratory rate is not decreased in esophageal varices.
Esophageal varices are the major complication of portal hypertension. It is
detected in about 50% of cirrhosis patients, and approximately 5–15% of
cirrhosis patients show newly formed varices or worsening of varices each
year.
Option D: Effective resuscitation, accurate diagnosis, and early treatment
are key to reducing mortality in variceal bleeding. The aims are not only to
stop bleeding as soon as possible but also to prevent early re-bleeding.
Early rebleeding, as with peptic ulcer disease, is significantly associated
with worsening mortality.

The nurse would anticipate using which medication if sclerotherapy has not been used?
A. Neomycin
B. Propranolol
C. Vasopressin
D. Cimetidine
Correct
Correct Answer: C. Vasopressin
Vasopressin is the drug of choice when sclerotherapy is contraindicated.
Vasoactive drugs stop bleeding in most patients, and emergency sclerotherapy
may carry risks to the patient and is more demanding on the healthcare system.
Sclerotherapy did not appear to be superior to vasoactive drugs in terms of control
of bleeding, the number of transfusions, 42?day rebleeding and mortality, or
rebleeding and mortality before other elective treatments.
Option A: Neomycin is used in preventing encephalopathy when blood is
broken down. Neomycin belongs to a group of antibiotics known as
aminoglycosides. Like others in the aminoglycoside family, neomycin works
by inhibiting bacterial protein synthesis leading to its bactericidal effect.
This group of medications is particularly effective in killing gram-negative
organisms allowing for good coverage of enteric organisms.
Option B: Propranolol may or may not be used to decrease cardiac output
and hepatic venous pressure. Propranolol can be used to ameliorate the
sympathetic response in angina, tachyarrhythmias, prevention of acute
ischemic attacks, migraine prophylaxis, and restless leg syndrome.
Propranolol can be used in almost all cases if the desired result is to slow
contractility and decrease a patient’s heart rate.
Option D: Cimetidine is a drug with the indication of peptic ulcer disease,
gastroesophageal reflux disease, and for dermatological conditions
including warts, urticaria, mastocytosis, and erythropoietic protoporphyria.
This medication is an H2 receptor antagonist.

The nurse must be alert for complications with Sengstaken-Blakemore intubation
including:
A. Pulmonary obstruction
B. Pericardiectomy syndrome
C. Pulmonary embolization
D. Cor pulmonale
Correct
Correct Answer: A. Pulmonary obstruction.
Rupture or deflation of the balloon could result in upper airway obstruction.
Esophageal rupture is a well-known but rarely reported fatal complication of the
management of bleeding esophageal varices with the Sengstaken-Blakemore (SB)
tube. The most common complications of esophageal balloon therapy for varices
include aspiration, esophageal perforation, and pressure necrosis of the mucosa.
The other choices are not related to the tube.
Option B: A pericardiectomy is a procedure done on the sac around the
heart. A surgeon cuts away this sac or a large part of this sac. This allows
the heart to move freely. Pericardiectomy is most often needed in people
with chronic constrictive pericarditis. It’s not usually an option for people
who have had a single instance of pericarditis. With chronic constrictive
pericarditis, the pericardium has become stiff and thick. This is due to
repeated scarring. This scarring constricts the heart’s movement.
Option C: A pulmonary embolism is a blood clot that occurs in the lungs. It
can damage part of the lung due to restricted blood flow, decrease oxygen
levels in the blood, and affect other organs as well. Large or multiple blood
clots can be fatal. The blockage can be life-threatening.
Option D: Cor pulmonale is a condition that most commonly arises out of
complications from high blood pressure in the pulmonary arteries
(pulmonary hypertension). It’s also known as right-sided heart failure
because it occurs within the right ventricle of the heart.

Peptic ulcer disease may be caused by which of the following?
A. Helicobacter pylori
B. Clostridium difficile
C. Candida albicans
D. Staphylococcus aureus
Correct
Correct Answer: A. Helicobacter pylori
Helicobacter pylori is considered to be the major cause of ulcer formation. Peptic
ulcer disease (PUD) has various causes; however, Helicobacter pylori-associated
PUD and NSAID-associated PUD account for the majority of the disease etiology.
H. pylorus is a gram-negative bacillus that is found within the gastric epithelial
cells. This bacterium is responsible for 90% of duodenal ulcers and 70% to 90% of
gastric ulcers. Other choices are not related to ulcer formation.
Option B: Clostridium difficile is a gram-positive bacterium that is the cause
most implicated in antibiotic-associated diarrhea. The emergence of a
newer hypervirulent strain North American pulsed-field gel electrophoresis
type 1 (NAP1) has been attributed to the increase in incidence and severity
of C. difficile infections (CDI) over the last decade.
Option C: Candida albicans is the most prevalent cause of fungal infections
in people. Its species name, Albicans, comes from the Latin word for “white.”
The yeast appears white when cultured on a plate. And in the case of certain
infections, like thrush, it can create white patches.
Option D: Staphylococcus aureus is the most dangerous of all of the many
common staphylococcal bacteria. These Gram-positive, sphere-shaped
(coccal) bacteria often cause skin infections but can cause pneumonia,
heart valve infections, and bone infections.

Pain control with peptic ulcer disease includes all of the following except:
A. Promoting physical and emotional rest.

B. Identifying stressful situations.
C. Eating meals when desired.
D. Administering medications that decrease gastric acidity.
Correct
Correct Answer: C. Eating meals when desired.
Meals should be regularly spaced in a relaxed environment. Instruct the client that
meals should be eaten at regularly spaced intervals in a relaxed setting. An
irregular schedule of meals may interfere with the regular administration of
medications.
Option A: Encourage the use of nonpharmacological pain relief measures
such as distraction, guided imagery. Massage, or music therapy. Non-
pharmacological relaxation techniques will decrease the production of
gastric acid, which in turn will reduce pain.
Option B: Acknowledge awareness of the client’s anxiety.
Acknowledgement of the client’s feelings validates the feelings and
communicates the acceptance of those feelings. Open communication
enables the client to develop a trusting relationship that aids in reducing
anxiety and stress.
Option D: Antacids buffer gastric acid and prevent the formation of peptin.
This mechanism of action promotes the healing of the ulcer. Antibiotics treat
the Helicobacter pylori infection and promote healing of the ulcer. As the
ulcer heals, the client experiences less pain. H2 receptor antagonists block
the secretion of gastric acid.

Nitrosocarcinogen production can be inhibited with the intake of:
A. Vitamin C
B. Vitamin E
C. Carbohydrates
D. Fiber
Correct
Correct Answer: A. Vitamin C
Vitamin C and refrigeration of foods inhibit nitroso carcinogen. Humans are
exposed to a wide range of nitrogen-containing compounds and nitrosating
agents, such as nitrite, nitrate, and nitrogen oxides (NOx), that can react in vivo to
form potentially carcinogenic N-nitroso compounds (NOCs), as well as several
carcinogenic C-nitro(so) or reactive diazo compounds.
Option B: Ascorbic acid, alpha-tocopherol, phenolic compounds, and fruit,
vegetable and plant extracts inhibit NOC formation by destroying nitrosating
agents. Fresh fruits and vegetables (sources of nitrosation inhibitors) exert a
protective effect against various epithelial cancers.
Option C: Although vitamin C has been known to stimulate immune
function, inhibit nitrosamine formation, and block the metabolic activation of
carcinogens, its cancer-preventive effects may be associated mainly with its
protective effects against oxidative stress.
Option D: Vitamin C, not fiber, is considered to be one of the most prevalent
antioxidative components of fruit and vegetables, and it could exert
chemopreventive effects without apparent toxicity at doses higher than the
current recommended dietary allowance of 60 mg/d. It has also been used
as a dietary supplement intended to prevent oxidative stress-mediated
chronic diseases such as cancer, cardiovascular disease, hypertension,
stroke, and neurodegenerative disorder.

The nurse can expect a 60-year old patient with ischemic bowel to report a history of:
A. Diabetes mellitus
B. Asthma
C. Addison's Disease
D. Cancer of the bowel
Correct
Correct Answer: A. Diabetes mellitus
Ischemic bowel occurs in patients over 50 with a history of diabetes mellitus.
Diabetes mellitus is the most common endocrine disorder affecting multiple organs
including the gastrointestinal (GI) tract where manifestations and/or complications
relate to disordered gut motility possibly as a result of autonomic neuropathy.
Option B: Asthma is not related to an ischemic bowel. An increased
prevalence of GI symptoms or complications has been documented in
diabetic patients compared with nondiabetic control subjects including
symptoms from both the upper and lower GI tract such as gastroparesis,
anorexia, vomiting, early satiety, intestinal enteropathy, diarrhea,
constipation, or fecal incontinence.
Option C: Addison disease is an acquired primary adrenal insufficiency. A
primary adrenal insufficiency is termed Addison disease when an
autoimmune process causes the condition. It is a rare but potentially life-
threatening emergency condition. It results from bilateral adrenal cortex
destruction leading to decreased adrenocortical hormones, which may
include cortisol, aldosterone, and androgens.
Option D: Approximately 5% of patients with ischemic colitis have an
obstructing lesion, usually in the distal colon. Half of these patients have
colon cancer while the remainder has strictures caused by disorders such
as diverticulitis, radiation, and previous surgery.

During the initial assessment of a patient post-endoscopy, the nurse notes absent bowel
sounds, tachycardia, and abdominal distention. The nurse would anticipate:
A. Ischemic bowel
B. Peritonitis
C. Hypovolemic shock
D. Perforated bowel
Correct
Correct Answer: D. Perforated bowel
Invasive diagnostic testing can cause perforated bowel. Perforation is widely
recognized as one of the most serious complications of endoscopy of the lower
gastrointestinal tract. The risk of perforation ranges from 0.027% to 0.088% for
flexible sigmoidoscopy, from 0.016% to 0.2% for diagnostic colonoscopy, and up to
5% for therapeutic endoscopy.
Option A: Ischemic bowel is usually not related. As the volume of both
diagnostic and therapeutic endoscopic procedures increases, the absolute
number of perforations will undoubtedly increase even with a relatively
constant perforation rate.
Option B: Peritonitis can be a complication after initial perforation. The risk
factors contributing to perforation are well established in the literature. They
include patient-related factors such as advanced age, female sex,
diverticular disease, previous abdominal surgery, and colonic stricture in
addition to therapeutic procedures such as endoscopic resection and
dilation.
Option C: Hypovolemic shock can occur if peritonitis is allowed to continue.
If the peritoneum is weakened or injured, inflammation and infection can
spread through the peritoneal cavity. Peristaltic action decreases, leading to
bowel obstruction. Large amounts of fluid from the intravascular space
move into the peritoneal cavity, causing hypovolemia and
hemoconcentration.

Which of the following tests can be useful as a diagnostic and therapeutic tool in the
biliary system?
A. Ultrasonography
B. MRI
C. Endoscopic retrograde cholangiopancreatography (ERCP)
D. Computed tomography scan (CT scan)
Correct
Correct Answer: C. Endoscopic retrograde cholangiopancreatography (ERCP)
ERCP permits direct visualization of the pancreatic and common bile ducts. Its
therapeutic value is in retrieving gallstones from the distal and common bile ducts
and dilating strictures. Endoscopic retrograde cholangiopancreatography (ERCP) is
a combined endoscopic and fluoroscopic procedure in which an endoscope is
advanced into the second part of the duodenum, thus allowing other tools to be
passed into the biliary and pancreatic ducts via the major duodenal papilla.
Option A: Ultrasonography aids in the diagnosis of cholecystitis, gallstones,
pancreatitis, and metastatic disease. It also identifies edema, inflammation,
and fatty or fibrotic infiltrates or calcifications. A procedure that uses high-
energy sound waves to look at tissues and organs inside the body. The
sound waves make echoes that form pictures of the tissues and organs on a
computer screen (sonogram). Ultrasonography may be used to help
diagnose diseases, such as cancer.
Option B: MRI detects hepatic neoplasms, cysts, abscesses, and
hematomas. Magnetic resonance imaging ( MRI ) uses a large magnet and
radio waves to look at organs and structures inside the body. Health care
professionals use MRI scans to diagnose a variety of conditions, from torn
ligaments to tumors. MRIs are very useful for examining the brain and spinal
cord.
Option D: A CT Scan can be done without a contrast medium. It can detect
tumors, cysts, pseudocysts, abscesses, hematomas, and obstructions of
the liver, biliary tract and pancreas. The CT scan is essentially an X-ray
study, where a series of rays are rotated around a specified body part, and
computer-generated cross-sectional images are produced. The advantage
of these tomographic images compared to conventional X-rays is that they
contain detailed information of a specified area in cross-section, eliminating
the superimposition of images, which provides a tremendous advantage
over plain films.
To inhibit pancreatic secretions, which pharmacologic agent would you anticipate
administering to a patient with acute pancreatitis?
A. Nitroglycerin
B. Somatostatin
C. Pancrelipase
D. Pepcid
Correct
Correct Answer: B. Somatostatin
Somatostatin, a treatment for acute pancreatitis, inhibits the release of pancreatic
enzymes. Somatostatin produces predominantly neuroendocrine inhibitory effects
across multiple systems. It is known to inhibit GI, endocrine, exocrine, pancreatic,
and pituitary secretions, as well as modify neurotransmission and memory
formation in the CNS.
Option A: Nitroglycerin is a vasodilator and does not affect pancreatic
secretions. Nitroglycerin is a vasodilatory drug used primarily to provide
relief from anginal chest pain. It is currently FDA approved for the acute
relief of an attack or acute prophylaxis of angina pectoris secondary to
coronary artery disease.
Option C: Pancrelipase is an enzyme that aids in the digestion and
absorption of fats and proteins. Pancrelipase refers to a class of
medications designed to treat malabsorption and abdominal pain secondary
to exocrine pancreatic insufficiency. These agents serve as exogenous
versions of digestive hormones and enzymes required for normal digestion
and are ingested with meals to improve digestion, absorption, and
abdominal pain frequently seen in chronic pancreatitis and exocrine
pancreatic insufficiency.
Option D: Pepcid is an H2 blocker and is used to decrease gastric motility.
H2 receptor blockers, or H2 receptor antagonists (H2RAs), are a class of
gastric acid-suppressing agents frequently used in various gastric
conditions. They are FDA-approved for short-term use in treating
uncomplicated gastroesophageal reflux disease (GERD), gastric or duodenal
ulcers, gastric hypersecretion, and mild to infrequent heartburn or
indigestion.
Your patient’s ABG reveals an acidic pH, an acidic CO2, and a normal bicarbonate level.
Which of the following indicates this acid-base disturbance?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Correct
Correct Answer: A. Respiratory acidosis
A pH of 7.35 indicates acidosis, as does an acidic CO2 and bicarbonate. The
primary disturbance of elevated arterial PCO2 is the decreased ratio of arterial
bicarbonate to arterial PCO2, which leads to a lowering of the pH. In the presence
of alveolar hypoventilation, 2 features commonly are seen are respiratory acidosis
and hypercapnia. To compensate for the disturbance in the balance between
carbon dioxide and bicarbonate (HCO3-), the kidneys begin to excrete more acid in
the forms of hydrogen and ammonium and reabsorb more base in the form of
bicarbonate. See also: 8-Step Guide to ABG Analysis: Tic-Tac-Toe Method
Option B: Respiratory alkalosis is 1 of the 4 basic classifications of blood pH
imbalances. Normal human physiological pH is 7.35 to 7.45. A decrease in
pH below this range is acidosis, an increase above this range is alkalosis.
Respiratory alkalosis is by definition a disease state where the body’s pH is
elevated to greater than 7.45 secondary to some respiratory or pulmonary
process.
Option C: Determining the type of metabolic acidosis can help clinicians
narrow down the cause of the disturbance. Acidemia refers to a pH less than
the normal range of 7.35 to 7.45. In addition, metabolic acidosis requires a
bicarbonate value less than 24 mEq/L. Further classification of metabolic
acidosis is based on the presence or absence of an anion gap, or
concentration of unmeasured serum anions.
Option D: HCO3 functions as an alkalotic substance. CO2 functions as an
acidic substance. Therefore, increases in HCO3 or decreases in CO2 will
make blood more alkalotic. The opposite is also true where decreases in
HCO3 or an increase in CO2 will make blood more acidic. CO2 levels are
physiologically regulated by the pulmonary system through respiration,
whereas the HCO3 levels are regulated through the renal system with
reabsorption rates. Therefore, metabolic alkalosis is an increase in serum
HCO3.
A clinical manifestation of acute pancreatitis is epigastric pain. Your nursing intervention to
facilitate relief of pain would place the patient in a:
A. Knee-chest position
B. Semi-Fowler's position
C. Recumbent position
D. Low-Fowler's position
Correct
Correct Answer: A. Knee-chest position
Flexion of the trunk lessens the pain and decreases restlessness. Promote position
of comfort on one side with knees flexed, sitting up, and leaning forward. Reduces
abdominal pressure and tension, providing some measure of comfort and pain
relief. Other positions do not decrease the pain.
Option B: The Semi-Fowler’s position is a position in which a patient,
typically in a hospital or nursing home is positioned on their back with the
head and trunk raised to between 15 and 45 degrees, although 30 degrees
is the most frequently used bed angle.
Option C: The word “lateral” means “to the side,” while “recumbent” means
“lying down.” In the right or left lateral recumbent position, the individual is
lying on their right or left side. This position makes it easier to access a
patient’s side.
Option D: Supine position often increases pain. The Semi-Fowler’s position
is often used for purposes similar to those of the regular Fowler’s position,
including feeding and lung expansion, cardiac or respiratory conditions, and
for patients with a nasogastric tube.

What assessment finding of a patient with acute pancreatitis would indicate a bluish
discoloration around the umbilicus?
A. Grey-Turner's sign
B. Homan's sign
C. Rovsing's sign
D. Cullen's sign
Correct
Correct Answer: D. Cullen’s sign
Cullen’s sign is associated with pancreatitis when a hemorrhage is suspected.
Cullen’s sign is described as superficial edema with bruising in the subcutaneous
fatty tissue around the periumbilical region. It is also known as periumbilical
ecchymosis. It is most often recognized as a result of hemorrhagic pancreatitis.
The sign can take 2–3 days before appearance and may be used as a clinical sign
to help the diagnosis of acute pancreatitis.
Option A: Grey-Turner’s sign is ecchymosis in the flank area suggesting
retroperitoneal bleed. Grey Turner’s sign is an uncommon subcutaneous
manifestation of intra-abdominal pathology that manifests as ecchymosis or
discoloration of the flanks. Classically it correlates with severe acute
necrotizing pancreatitis, often in association with Cullen’s sign (periumbilical
ecchymosis).
Option B: Homan’s sign is called pain elicited by the dorsiflexion of the foot
and suggests deep vein thrombosis. Homan’s sign test also called
dorsiflexion sign test is a physical examination procedure that is used to test
for deep vein thrombosis (DVT). A positive Homan’s sign in the presence of
other clinical signs may be a quick indicator of DVT. Clinical evaluation alone
cannot be relied on for patient management, but when carefully performed,
it remains useful in determining the need for additional testing (like D-dimer
test, ultrasonography, multidetector helical computed axial tomography
(CT), and pulmonary angiography).
Option C: Rovsing’s sign is associated with appendicitis when pain is felt
with pressure at McBurney’s point. Rovsing’s sign is a clinical finding that is
indicative of acute appendicitis (the inflammation and possible infection of
the appendix). A positive Rovsing’s sign is characterized by right lower
abdominal pain upon palpation of the left side of the lower abdomen
A patient with severe cirrhosis of the liver develops hepatorenal syndrome. Which of the
following nursing assessment data would support this?
A. Oliguria and azotemia
B. Metabolic alkalosis
C. Decreased urinary concentration

D. Weight gain of less than 1 lb per week
Correct
Correct Answer: A. Oliguria and azotemia
Hepatorenal syndrome is a functional disorder resulting from a redistribution of
renal blood flow. Oliguria and azotemia occur abruptly as a result of this
complication. Confusion due to hepatic encephalopathy is likely the last and most
severe stage of liver disease as a result of the liver failing to break down toxic
metabolites. Most importantly these patients notice they urinate less frequently in
smaller and smaller volumes as they become oliguric.
Option B: Excess organic acids are not being excreted by the damaged
kidneys, resulting in an elevated concentration of hydrogen ions; decreased
pH occurs, causing metabolic acidosis. Cirrhosis and portal hypertension
can trigger the neurohormonal cascade which leads to the development of
HRS. This, in turn, causes the production and release of vasodilators and
cytokines like nitric oxide and prostaglandins which cause splanchnic and
systemic vasodilation.
Option C: Concentration of the urine is increased with decreased renal
function. The systemic drop in circulating pressure triggers the carotid and
aortic arch baroreceptors to activate three separate compensatory
mechanisms. These include the renin-angiotensin-aldosterone system,
vasopressin release, and activation of the sympathetic nervous system
(SNS).
Option D: With renal insufficiency, significant weight gain is expected due
to fluid retention. The progression of cirrhosis causes a fall in cardiac output
and a fall in systemic vascular resistance in a cycle that induces further renal
vasoconstriction. This leads to further renal hypoperfusion, worsened by
renal vasoconstriction with the endpoint of renal failure.

Which phase of hepatitis would the nurse incur strict precautionary measures at?
A. Icteric
B. Non-icteric
C. Post-icteric
D. Pre-icteric
Correct
Correct Answer: D. Pre-icteric
Pre-icteric is the infective phase and precautionary measures should be strictly
enforced. However, most patients are not always diagnosed during this phase.
Nonspecific symptoms occur; they include profound anorexia, malaise, nausea and
vomiting, a newly developed distaste for cigarettes (in smokers), and often fever or
right upper quadrant abdominal pain. Urticaria and arthralgias occasionally occur,
especially in HBV infection.
Option A: During the icteric phase, precautionary measures should already
be in place. After 3 to 10 days, the urine darkens, followed by jaundice.
Systemic symptoms often regress, and patients feel better despite
worsening jaundice. The liver is usually enlarged and tender, but the edge of
the liver remains soft and smooth. Mild splenomegaly occurs in 15 to 20% of
patients. Jaundice usually peaks within 1 to 2 weeks.
Option B: There is no non-icteric phase. Some manifestations of acute
hepatitis are virus-specific, but in general, acute infection tends to develop
in predictable phases. Acute viral hepatitis is a common, worldwide disease
that has different causes; each type shares clinical, biochemical, and
morphologic features. The term acute viral hepatitis often refers to infection
of the liver by one of the hepatitis viruses.
Option C: During the post-icteric phase, precautionary measures should
already be in place. During this 2- to 4-week period, jaundice fades.
Appetite usually returns after the first week of symptoms. Acute viral
hepatitis usually resolves spontaneously 4 to 8 weeks after symptom onset.

You are caring for Rona, a 35-year-old female in a hepatic coma. Which evaluation criteria
would be the most appropriate?
A. The patient demonstrates an increase in the level of consciousness.
B. The patient exhibits improved skin integrity.
C. The patient experiences no evident signs of bleeding.
D. The patient verbalizes decreased episodes of pain.
Correct
Correct Answer: A. The patient demonstrates an increase in the level of
consciousness.
Increased level of consciousness indicates resolving of a comatose state. Ongoing
assessment of behavior and mental status is important because of the fluctuating
nature of impending hepatic coma. Other options are important evaluations but do
not evaluate a patient in a hepatic coma who is responding to external stimuli.
Option B: Inspect pressure points and skin surfaces closely and routinely.
Gently massage bony prominences or areas of continued stress. Use of
emollient lotions and limiting the use of soap for bathing may help. Keep
linens dry and free of wrinkles.
Option C: Closely assess for signs and symptoms of GI bleeding: check all
secretions for frank or occult blood. Observe color and consistency of
stools, NG drainage, or vomitus. The esophagus and rectum are the most
usual sources of bleeding because of their mucosal fragility and alterations
in hemostasis associated with cirrhosis.
Option D: Use small needles for injections. Apply pressure to small bleeding
and venipuncture sites for longer than usual. Minimizes damage to tissues,
reducing risk of bleeding and hematoma. Encourage the use of soft
toothbrush, electric razor, avoiding straining for stool, vigorous nose
blowing, and so forth.

What is the primary nursing diagnosis for a 4th to 10th-day postoperative liver transplant
patient?
A. Excess Fluid Volume
B. Risk for Rejection
C. Impaired Skin Integrity
D. Decreased Cardiac Output
Correct
Correct Answer: B. Risk for Rejection
Risk for rejection is always a possibility, especially during the 4th to 10th day
postoperatively. LT patients are at risk for several complications. The primary care
NP should be aware of these complications and needs to know when referral back
to a transplant center or hepatologist is appropriate. The most serious issues are
problems with the vasculature of the liver, biliary issues, rejection, and infection.
Lab abnormalities—specifically elevation in alkaline phosphatase, alanine
aminotransferase (ALT), and serum bilirubin levels—are usually the first indication
of a problem in one or more of these areas.
Option A: Post-transplant acute kidney injury (AKI) has been reported to
occur in 9-78% of cases with 10% progressing to end-stage renal failure.
Early identification of potential AKI is crucial to improving patient outcomes
as evidence shows that even small increases in serum creatinine are
associated with a decline in overall mortality.
Option C: Patients are also at risk for specific opportunistic infections in the
early postoperative period. Herpes simplex virus (HSV) reactivation disease
is the most common opportunistic viral infection and can quickly progress to
disseminated multi-organ infection and failure.
Option D: In the first month postoperatively patients are most likely to
develop infections related to the surgical procedure and hospitalization,
such as bacterial and fungal wound infections, urinary tract infections,
bloodstream infections, pneumonia, and Clostridium difficile colitis.
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A. Increased intracranial pressure

B. Decreased urine output

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

A. “Tell me about your husband’s alcohol usage.”

C. “Has your husband recently fallen or injured his chest?”

D. “Describe spices and condiments your husband uses on food.”

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.

A. Dyspnea and fatigue

B. Ascites and orthopnea

C. Purpura and petechiae

D. Gynecomastia and testicular atrophy

A. Irrigate the tube with warm water.

B. Advance the tube into the intestine.

C. Apply intermittent suction to the tube.

D. Withdraw the obstruction with a 30-ml syringe.

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.

C. Chronic low self-esteem

C. Hemoglobin (Hb) levels and hematocrit (HCT)

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.”

14. Question 1 point(s)

C. The appendix may develop gangrene and rupture, especially in a middle-

D. Infection of the appendix diminishes necrotic arterial blood flow and

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.

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.”

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

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.

A. Notify the physician.

B. Reposition the tube.

C. Irrigate the tube.

D. Increase the suction level.

A. Elevated blood urea nitrogen (BUN)

B. Elevated serum lipase

C. Elevated aspartate aminotransferase (AST)