Text Mode Text version of the exam

1. During preparation for bowel surgery, a

male client receives an antibiotic to
reduce intestinal bacteria. Antibiotic
therapy may interfere with synthesis of
which vitamin and may lead to
hypoprothrombinemia?
A. vitamin A
B. vitamin D
C. vitamin E
D. vitamin K
2. When evaluating a male client for
complications of acute pancreatitis, the
nurse would observe for:
A. increased intracranial pressure.
B. decreased urine output.
C. bradycardia.
D. hypertension.
3. A male client with a recent history of
rectal bleeding is being prepared for a
colonoscopy. How should the nurse
position the client for this test initially?
A. Lying on the right side with legs
straight
B. Lying on the left side with knees
bent
C. Prone with the torso elevated
D. Bent over with hands touching the
floor
4. A male client with extreme weakness,
pallor, weak peripheral pulses, and
disorientation is admitted to the
emergency department. His wife reports
that he has been spitting up blood. A
Mallory-Weiss tear is suspected, and the
nurse begins taking a client history from
the clients wife. The question by the
nurse that demonstrates her
understanding of Mallory-Weiss tearing is:

A.

Tell me about your husbands

alcohol usage.

B. Is your husband being treated for

tuberculosis?
C.

Has your husband recently fallen

or injured his chest?

D.

Describe spices and condiments

your husband uses on food.

5. Which of the following nursing

interventions should the nurse perform for
a female client receiving enteral feedings
through a gastrostomy tube?
A. Change the tube feeding solutions
and tubing at least every 24 hours.
B. Maintain the head of the bed at a
15-degree elevation continuously.
C. Check the gastrostomy tube for
position every 2 days.
D. Maintain the client on bed rest
during the feedings.
6. A male client is recovering from a smallbowel resection. To relieve pain, the
physician prescribes meperidine
(Demerol), 75 mg I.M. every 4 hours. How
soon after administration should
meperidines onset of action occur?
A. 5 to 10 minutes
B. 15 to 30 minutes
C. 30 to 60 minutes
D. 2 to 4 hours
7. The nurse is caring for a male client
with cirrhosis. Which assessment findings
indicate that the client has deficient
vitamin K absorption caused by this
hepatic disease?
A. Dyspnea and fatigue
B. Ascites and orthopnea
C. Purpura and petechiae
D. Gynecomastia and testicular
atrophy

8. Which condition is most likely to have a

nursing diagnosis of fluid volume deficit?
A. Appendicitis
B. Pancreatitis
C. Cholecystitis
D. Gastric ulcer
9. While a female client is being prepared
for discharge, the nasogastric (NG)
feeding tube becomes clogged. To remedy
this problem and teach the clients family
how to deal with it at home, what should
the nurse do?
A. Irrigate the tube with cola.
B. Advance the tube into the
intestine.
C. Apply intermittent suction to the
tube.
D. Withdraw the obstruction with a
30-ml syringe.
10. A male client with pancreatitis
complains of pain. The nurse expects the
physician to prescribe meperidine
(Demerol) instead of morphine to relieve
pain because:
A. meperidine provides a better, more
prolonged analgesic effect.
B. morphine may cause spasms of
Oddis sphincter.
C. meperidine is less addictive than
morphine.
D. morphine may cause hepatic
dysfunction.
11. Mandy, an adolescent girl is admitted
to an acute care facility with severe
malnutrition. After a thorough
examination, the physician diagnoses
anorexia nervosa. When developing the
plan of care for this client, the nurse is
most likely to include which nursing
diagnosis?
A. Hopelessness

B. Powerlessness
C. Chronic low self esteem
D. Deficient knowledge
12. Which diagnostic test would be used
first to evaluate a client with upper GI
bleeding?
A. Endoscopy
B. Upper GI series
C. Hemoglobin (Hb) levels and
hematocrit (HCT)
D. Arteriography
13. A female client who has just been
diagnosed with hepatitis A asks, How
could I have gotten this disease? What is
the nurses best response?
A. You may have eaten contaminated
restaurant food.
B. You could have gotten it by using
I.V. drugs.
C. You must have received an
infected blood transfusion.
D. You probably got it by engaging in
unprotected sex.
14. When preparing a male client, age 51,
for surgery to treat appendicitis, the nurse
formulates a nursing diagnosis of Risk for
infection related to inflammation,
perforation, and surgery. What is the
rationale for choosing this nursing
diagnosis?
A. Obstruction of the appendix may
increase venous drainage and
cause the appendix to rupture.
B. Obstruction of the appendix
reduces arterial flow, leading to
ischemia, inflammation, and
rupture of the appendix.
C. The appendix may develop
gangrene and rupture, especially in
a middle-aged client.

D. Infection of the appendix

diminishes necrotic arterial blood
flow and increases venous
drainage.
15. A female client with hepatitis C
develops liver failure and GI hemorrhage.
The blood products that would most likely
bring about hemostasis in the client are:
A. whole blood and albumin.
B. platelets and packed red blood
cells.
C. fresh frozen plasma and whole
blood.
D. cryoprecipitate and fresh frozen
plasma.
16. To prevent gastroesophageal reflux in
a male client with hiatal hernia, the nurse
should provide which discharge
instruction?
A. Lie down after meals to promote
digestion.
B. Avoid coffee and alcoholic
beverages.
C. Take antacids with meals.
D. Limit fluid intake with meals.
17. The nurse caring for a client with
small-bowel obstruction would plan to
implement which nursing intervention
first?
A. Administering pain medication
B. Obtaining a blood sample for
laboratory studies
C. Preparing to insert a nasogastric
(NG) tube
D. Administering I.V. fluids
18. A female client with dysphagia is being
prepared for discharge. Which outcome
indicates that the client is ready for
discharge?

A. The client doesnt exhibit rectal

tenesmus.
B. The client is free from esophagitis
and achalasia.
C. The client reports diminished
duodenal inflammation.
D. The client has normal gastric
structures.
19. A male client undergoes total
gastrectomy. Several hours after surgery,
the nurse notes that the clients
nasogastric (NG) tube has stopped
draining. How should the nurse respond?
A. Notify the physician
B. Reposition the tube
C. Irrigate the tube
D. Increase the suction level
20. What laboratory finding is the primary
diagnostic indicator for pancreatitis?
A. Elevated blood urea nitrogen (BUN)
B. Elevated serum lipase
C. Elevated aspartate
aminotransferase (AST)
D. Increased lactate dehydrogenase
(LD)
21. A male client with cholelithiasis has a
gallstone lodged in the common bile duct.
When assessing this client, the nurse
expects to note:
A. yellow sclerae.
B. light amber urine.
C. circumoral pallor.
D. black, tarry stools.
22. Nurse Hannah is teaching a group of
middle-aged men about peptic ulcers.
When discussing risk factors for peptic
ulcers, the nurse should mention:
A. a sedentary lifestyle and smoking.

B. a history of hemorrhoids and

smoking.

B. wearing an appliance pouch only at

bedtime.

C. alcohol abuse and a history of

acute renal failure.

C. consuming a low-protein, high-fiber

diet.

D. alcohol abuse and smoking.

D. taking only enteric-coated

medications.

23. While palpating a female clients right

upper quadrant (RUQ), the nurse would
expect to find which of the following
structures?
A. Sigmoid colon
B. Appendix
C. Spleen
D. Liver
24. A male client has undergone a colon
resection. While turning him, wound
dehiscence with evisceration occurs. The
nurses first response is to:
A. call the physician.
B. place saline-soaked sterile
dressings on the wound.

27. The nurse is caring for a female client

with active upper GI bleeding. What is the
appropriate diet for this client during the
first 24 hours after admission?
A. Regular diet
B. Skim milk
C. Nothing by mouth
D. Clear liquids
28. A male client has just been diagnosed
with hepatitis A. On assessment, the nurse
expects to note:
A. severe abdominal pain radiating to
the shoulder.
B. anorexia, nausea, and vomiting.

C. take a blood pressure and pulse.

C. eructation and constipation.

D. pull the dehiscence closed.

D. abdominal ascites.

25. The nurse is monitoring a female client

receiving paregoric to treat diarrhea for
drug interactions. Which drugs can
produce additive constipation when given
with an opium preparation?
A. Antiarrhythmic drugs
B. Anticholinergic drugs
C. Anticoagulant drugs
D. Antihypertensive drugs
26. A male client is recovering from an
ileostomy that was performed to treat
inflammatory bowel disease. During
discharge teaching, the nurse should
stress the importance of:
A. increasing fluid intake to prevent
dehydration.

29. A female client with viral hepatitis A is

being treated in an acute care facility.
Because the client requires enteric
precautions, the nurse should:
A. place the client in a private room.
B. wear a mask when handling the
clients bedpan.
C. wash the hands after touching the
client.
D. wear a gown when providing
personal care for the client.
30. Which of the following factors can
cause hepatitis A?
A. Contact with infected blood
B. Blood transfusions with infected
blood

C. Eating contaminated shellfish

C. Gastric motility.

D. Sexual contact with an infected

person

D. Gastric pH.

31. Your patient with peritonitis is NPO

and complaining of thirst. What is your
priority?
A. Increase the I.V. infusion rate.
B. Use diversion activities.
C. Provide frequent mouth care.
D. Give ice chips every 15 minutes.
32. Kevin has a history of peptic ulcer
disease and vomits coffee-ground emesis.
What does this indicate?
A. He has fresh, active upper GI
bleeding.
B. He needs immediate saline gastric
lavage.
C. His gastric bleeding occurred 2
hours earlier.
D. He needs a transfusion of packed
RBCs.
33. A 53 y.o. patient has undergone a
partial gastrectomy for adenocarcinoma of
the stomach. An NG tube is in place and is
connected to low continuous suction.
During the immediate postoperative
period, you expect the gastric secretions
to be which color?
A. Brown.
B. Clear.
C. Red.
D. Yellow.
34. Your patient has a retractable gastric
peptic ulcer and has had a gastric
vagotomy. Which factor increases as a
result of vagotomy?
A. Peristalsis.
B. Gastric acidity.

35. Christina is receiving an enteral

feeding that requires a concentration of
80ml of supplement mixed with 20 ml of
water. How much water do you mix with
an 8 oz (240ml) can of feeding?
A. 60 ml.
B. 70 ml.
C. 80 ml.
D. 90 ml.
36. Which stoma would you expect a
malodorous, enzyme-rich, caustic liquid
output that is yellow, green, or brown?
A. Ileostomy.
B. Ascending colostomy.
C. Transverse colostomy.
D. Descending colostomy.
37. George has a T tube in place after
gallbladder surgery. Before discharge,
what information or instructions should be
given regarding the T tube drainage?
A. If there is any drainage, notify the
surgeon immediately.
B. The drainage will decrease daily
until the bile duct heals.
C. First, the drainage is dark green;
then it becomes dark yellow.
D. If the drainage stops, milk the
tube toward the puncture wound.
38. Your patient Maria takes NSAIDS for
her degenerative joint disease, has
developed peptic ulcer disease. Which
drug is useful in preventing NSAID-induced
peptic ulcer disease?
A. Calcium carbonate (Tums)
B. Famotidine (Pepcid)
C. Misoprostol (Cytotec)

D. Sucralfate (Carafate)
39. The student nurse is participating in
colorectal cancer-screening program.
Which patient has the fewest risk factors
for colon cancer?
A. Janice, a 45 y.o. with a 25-year
history of ulcerative colitis
B. George, a 50 y.o. whose father died
of colon cancer
C. Herman, a 60 y.o. who follows a
low-fat, high-fiber diet
D. Sissy, a 72 y.o. with a history of
breast cancer
40. Youre patient, post-op drainage of a
pelvic abscess secondary to diverticulitis,
begins to cough violently after drinking
water. His wound has ruptured and a small
segment of the bowel is protruding.
Whats your priority?
A. Ask the patient what happened,
call the doctor, and cover the area
with a water-soaked bedsheet.
B. Obtain vital signs, call the doctor,
and obtain emergency orders.
C. Have a CAN hold the wound
together while you obtain vital
signs, call the doctor and flex the
patients knees.
D. Have the doctor called while you
remain with the patient, flex the
patients knees, and cover the
wound with sterile towels soaked in
sterile saline solution.

Answers and Rationales

1. Answer D. Intestinal bacteria
synthesize such nutritional
substances as vitamin K, thiamine,
riboflavin, vitamin B12, folic acid,
biotin, and nicotinic acid.
Therefore, antibiotic therapy may
interfere with synthesis of these
substances, including vitamin K.

Intestinal bacteria dont synthesize

vitamins A, D, or E.
2. Answer B. Acute pancreatitis can
cause decreased urine output,
which results from the renal failure
that sometimes accompanies this
condition. Intracranial pressure
neither increases nor decreases in
a client with pancreatitis.
Tachycardia, not bradycardia,
usually is associated with
pulmonary or hypovolemic
complications of pancreatitis.
Hypotension can be caused by a
hypovolemic complication, but
hypertension usually isnt related
to acute pancreatitis.
3. Answer B. For a colonoscopy, the
nurse initially should position the
client on the left side with knees
bent. Placing the client on the right
side with legs straight, prone with
the torso elevated, or bent over
with hands touching the floor
wouldnt allow proper visualization
of the large intestine.
4. Answer A. A Mallory-Weiss tear is
associated with massive bleeding
after a tear occurs in the mucous
membrane at the junction of the
esophagus and stomach. There is a
strong relationship between
ethanol usage, resultant vomiting,
and a Mallory-Weiss tear. The
bleeding is coming from the
stomach, not from the lungs as
would be true in some cases of
tuberculosis. A Mallory-Weiss tear
doesnt occur from chest injuries or
falls and isnt associated with
eating spicy foods.
5. Answer A. Tube feeding solutions
and tubing should be changed
every 24 hours, or more frequently
if the feeding requires it. Doing so
prevents contamination and
bacterial growth. The head of the
bed should be elevated 30 to 45
degrees continuously to prevent

aspiration. Checking for

gastrostomy tube placement is
performed before initiating the
feedings and every 4 hours during
continuous feedings. Clients may
ambulate during feedings.
6. Answer B. Meperidines onset of
action is 15 to 30 minutes. It peaks
between 30 and 60 minutes and
has a duration of action of 2 to 4
hours.
7. Answer C. A hepatic disorder,
such as cirrhosis, may disrupt the
livers normal use of vitamin K to
produce prothrombin (a clotting
factor). Consequently, the nurse
should monitor the client for signs
of bleeding, including purpura and
petechiae. Dyspnea and fatigue
suggest anemia. Ascites and
orthopnea are unrelated to vitamin
K absorption. Gynecomastia and
testicular atrophy result from
decreased estrogen metabolism by
the diseased liver.
8. Answer B. Hypovolemic shock
from fluid shifts is a major factor in
acute pancreatitis. The other
conditions are less likely to exhibit
fluid volume deficit.
9. Answer A. The nurse should
irrigate the tube with cola because
its effervescence and acidity are
suited to the purpose, its
inexpensive, and its readily
available in most homes.
Advancing the NG tube is
inappropriate because the tube is
designed to stay in the stomach
and isnt long enough to reach the
intestines. Applying intermittent
suction or using a syringe for
aspiration is unlikely to dislodge
the material clogging the tube but
may create excess pressure.
Intermittent suction may even
collapse the tube.

10. Answer B. For a client with

pancreatitis, the physician will
probably avoid prescribing
morphine because this drug may
trigger spasms of the sphincter of
Oddi (a sphincter at the end of the
pancreatic duct), causing irritation
of the pancreas. Meperidine has a
somewhat shorter duration of
action than morphine. The two
drugs are equally addictive.
Morphine isnt associated with
hepatic dysfunction.
11. Answer C. Young women with
Chronic low self esteem are at
highest risk for anorexia nervosa
because they perceive being thin
as a way to improve their selfconfidence. Hopelessness and
Powerlessness are inappropriate
nursing diagnoses because clients
with anorexia nervosa seldom feel
hopeless or powerless; instead,
they use food to control their desire
to be thin and hope that restricting
food intake will achieve this goal.
Anorexia nervosa doesnt result
from a knowledge deficit, such as
one regarding good nutrition.
12. Answer A. Endoscopy permits
direct evaluation of the upper GI
tract and can detect 90% of
bleeding lesions. An upper GI
series, or barium study, usually
isnt the diagnostic method of
choice, especially in a client with
acute active bleeding whos
vomiting and unstable. An upper GI
series is also less accurate than
endoscopy. Although an upper GI
series might confirm the presence
of a lesion, it wouldnt necessarily
reveal whether the lesion is
bleeding. Hb levels and HCT, which
indicate loss of blood volume,
arent always reliable indicators of
GI bleeding because a decrease in
these values may not be seen for
several hours. Arteriography is an
invasive study associated with life-

threatening complications and

wouldnt be used for an initial
evaluation.
13. Answer A. Hepatitis A virus
typically is transmitted by the oralfecal route commonly by
consuming food contaminated by
infected food handlers. The virus
isnt transmitted by the I.V. route,
blood transfusions, or unprotected
sex. Hepatitis B can be transmitted
by I.V. drug use or blood
transfusion. Hepatitis C can be
transmitted by unprotected sex.
14. Answer B. A client with
appendicitis is at risk for infection
related to inflammation,
perforation, and surgery because
obstruction of the appendix causes
mucus fluid to build up, increasing
pressure in the appendix and
compressing venous outflow
drainage. The pressure continues
to rise with venous obstruction;
arterial blood flow then decreases,
leading to ischemia from lack of
perfusion. Inflammation and
bacterial growth follow, and
swelling continues to raise pressure
within the appendix, resulting in
gangrene and rupture. Geriatric,
not middle-aged, clients are
especially susceptible to appendix
rupture.
15. Answer D. The liver is vital in the
synthesis of clotting factors, so
when its diseased or dysfunctional,
as in hepatitis C, bleeding occurs.
Treatment consists of administering
blood products that aid clotting.
These include fresh frozen plasma
containing fibrinogen and
cryoprecipitate, which have most of
the clotting factors. Although
administering whole blood,
albumin, and packed cells will
contribute to hemostasis, those
products arent specifically used to
treat hemostasis. Platelets are

helpful, but the best answer is

cryoprecipitate and fresh frozen
plasma.
16. Answer B. To prevent reflux of
stomach acid into the esophagus,
the nurse should advise the client
to avoid foods and beverages that
increase stomach acid, such as
coffee and alcohol. The nurse also
should teach the client to avoid
lying down after meals, which can
aggravate reflux, and to take
antacids after eating. The client
need not limit fluid intake with
meals as long as the fluids arent
gastric irritants.
17. Answer D. I.V. infusions containing
normal saline solution and
potassium should be given first to
maintain fluid and electrolyte
balance. For the clients comfort
and to assist in bowel
decompression, the nurse should
prepare to insert an NG tube next.
A blood sample is then obtained for
laboratory studies to aid in the
diagnosis of bowel obstruction and
guide treatment. Blood studies
usually include a complete blood
count, serum electrolyte levels, and
blood urea nitrogen level. Pain
medication often is withheld until
obstruction is diagnosed because
analgesics can decrease intestinal
motility.
18. Answer B. Dysphagia may be the
reason why a client with
esophagitis or achalasia seeks
treatment. Dysphagia isnt
associated with rectal tenesmus,
duodenal inflammation, or
abnormal gastric structures.
19. Answer A. An NG tube that fails to
drain during the postoperative
period should be reported to the
physician immediately. It may be
clogged, which could increase
pressure on the suture site because
fluid isnt draining adequately.

Repositioning or irrigating an NG
tube in a client who has undergone
gastric surgery can disrupt the
anastomosis. Increasing the level
of suction may cause trauma to GI
mucosa or the suture line.
20. Answer B. Elevation of serum
lipase is the most reliable indicator
of pancreatitis because this
enzyme is produced solely by the
pancreas. A clients BUN is typically
elevated in relation to renal
dysfunction; the AST, in relation to
liver dysfunction; and LD, in
relation to damaged cardiac
muscle.
21. Answer A. Yellow sclerae may be
the first sign of jaundice, which
occurs when the common bile duct
is obstructed. Urine normally is
light amber. Circumoral pallor and
black, tarry stools dont occur in
common bile duct obstruction; they
are signs of hypoxia and GI
bleeding, respectively.
22. Answer D. Risk factors for peptic
(gastric and duodenal) ulcers
include alcohol abuse, smoking,
and stress. A sedentary lifestyle
and a history of hemorrhoids arent
risk factors for peptic ulcers.
Chronic renal failure, not acute
renal failure, is associated with
duodenal ulcers.
23. Answer D. The RUQ contains the
liver, gallbladder, duodenum, head
of the pancreas, hepatic flexure of
the colon, portions of the
ascending and transverse colon,
and a portion of the right kidney.
The sigmoid colon is located in the
left lower quadrant; the appendix,
in the right lower quadrant; and the
spleen, in the left upper quadrant.
24. Answer B. The nurse should first
place saline-soaked sterile
dressings on the open wound to
prevent tissue drying and possible

infection. Then the nurse should

call the physician and take the
clients vital signs. The dehiscence
needs to be surgically closed, so
the nurse should never try to close
it.
25. Answer B. Paregoric has an
additive effect of constipation when
used with anticholinergic drugs.
Antiarrhythmics, anticoagulants,
and antihypertensives arent
known to interact with paregoric.
26. Answer A. Because stool forms in
the large intestine, an ileostomy
typically drains liquid waste. To
avoid fluid loss through ileostomy
drainage, the nurse should instruct
the client to increase fluid intake.
The nurse should teach the client
to wear a collection appliance at all
times because ileostomy drainage
is incontinent, to avoid high-fiber
foods because they may irritate the
intestines, and to avoid entericcoated medications because the
body cant absorb them after an
ileostomy
27. Answer C. Shock and bleeding
must be controlled before oral
intake, so the client should receive
nothing by mouth. A regular diet is
incorrect. When the bleeding is
controlled, the diet is gradually
increased, starting with ice chips
and then clear liquids. Skim milk
shouldnt be given because it
increases gastric acid production,
which could prolong bleeding. A
liquid diet is the first diet offered
after bleeding and shock are
controlled.
28. Answer B. Hallmark signs and
symptoms of hepatitis A include
anorexia, nausea, vomiting,
fatigue, and weakness. Abdominal
pain may occur but doesnt radiate
to the shoulder. Eructation and
constipation are common in
gallbladder disease, not hepatitis A.

Abdominal ascites is a sign of

advanced hepatic disease, not an
early sign of hepatitis A.
29. Answer C. To maintain enteric
precautions, the nurse must wash
the hands after touching the client
or potentially contaminated articles
and before caring for another
client. A private room is warranted
only if the client has poor hygiene
for instance, if the client is
unlikely to wash the hands after
touching infective material or is
likely to share contaminated
articles with other clients. For
enteric precautions, the nurse need
not wear a mask and must wear a
gown only if soiling from fecal
matter is likely.
30. Answer C. Hepatitis A can be
caused by consuming
contaminated water, milk, or food
especially shellfish from
contaminated water. Hepatitis B is
caused by blood and sexual
contact with an infected person.
Hepatitis C is usually caused by
contact with infected blood,
including receiving blood
transfusions.
31. Answer C. Frequent mouth care
helps relieve dry mouth.
32. Answer C. Coffee-ground emesis
occurs when there is upper GI
bleeding that has undergone

gastric digestion. For blood to

appear as coffee-ground emesis, it
would have to be digested for
approximately 2 hours.
33. Answer C. Normally, drainage is
bloody for the first 24 hours after a
partial gastrectomy; then it
changes to brown-tinged and then
to yellow or clear.
34. Answer D. If the vagus nerve is
cut as it enters the stomach,
gastric acid secretion is decreased,
but intestinal motility is also
decreased and gastric emptying is
delayed. Because gastric acids are
decreased, gastric pH increases.
35. Answer A. Dosage problem. Its
80/20 = 240/X. X=60.
36. Answer A. The output from an
Ileostomy is described.
37. Answer B. As healing occurs from
the bile duct, bile drains from the
tube; the amount of bile should
decrease. Teach the patient to
expect dark green drainage and to
notify the doctor if drainage stops.
38. Answer C. Misoprostol restores
prostaglandins that protect the
stomach from NSAIDS, which
diminish the prostaglandins.
39. Answer C.

40. Answer D.