Gastrointestinal Questions 13. An adult is admitted with a duodenal ulcer.

On the second day

1. An adult who has cholecystitis reports clay colored stools and after admission, the client develops severe, persistent pain
moderate jaundice. Which is the best explanation for the presence radiating to the shoulder. What action should the nurse take first?
of clay colored stools and jaundice? 1. Notify the physician.
1. There is an obstruction in the pancreatic duct. 2. Place client in a high-Fowler’s position to decrease pressure on
2. There are gallstones in the gallbladder. the gastric area and shoulder.
3. Bile is no longer produced by the gallbladder. 3. Examine the client for board-like rigidity of the abdomen.
4. There is an obstruction in the common bile duct. 4. Administer ordered prn pain medication.
2. Atropine 0.5 mg is ordered for a client having an acute attack of 14. The client with a duodenal ulcer is ready for discharge. Which
cholecystitis. What is the primary purpose of this drug for this statement made by the client indicates a need for more teaching
client? To about his diet?
1. decrease skeletal muscle spasms. 1. “It’s a good thing I gave up drinking alcohol last year.”
2. increase gastrointestinal peristalsis 2. “I will have to drink lots of milk and cream every day.”
3. decrease smooth muscle contractions 3. “I will stay away from cola drinks after I am discharged.”
4. decrease anxiety 4. “Eating three nutritious meals and snacks every day is okay.”
3. Following a cholecystectomy, drainage form the T tube for the 15. A young college student comes to the emergency room with
first 24 hours postoperative was 350 cc. Proper nursing action in nausea, vomiting and severe abdominal pain of six hours duration.
response to this should be to While examining the client the physician asks her to stand on her
1. notify the physician . toes and drop to her heels with a thump. Which of the following
2. raise the level of the drainage bag to decrease rate of flow. interpretations of this procedure is the most accurate?
3. increase the IV flow rate to compensate for the loss. 1. An irritated bowel will become less tender.
4. continue to observe and measure drainage. 2. If the client has an acute inflammation she will feel localized
4. An adult male is admitted to the hospital complaining of burning pain in the inflamed area.
epigastric pain. He reports to the nurse that he has gained 14 3. This procedure will create more flaccid abdominal muscles
pounds over the last two months. Which nursing response is best? allowing easier abdominal exam.
1. “Why were you eating more?” 4. The client with appendicitis will experience brief relief following
2. “Has the weight gain been intentional?” this action.
3. “Does your weight usually fluctuate this much?” 16. The nurse is admitting a client with a diagnosis of appendicitis
4. “How did your eating habits change?” to the surgical unit. Which question is it essential to ask?
5. An adult male client is admitted with a diagnosis of probable 1. “When did you last eat?”
duodenal ulcer. Which of the following laboratory tests would it be 2. “Have you had surgery before?”
most essential for the nurse to assess immediately? 3. “Have you ever had this type of pain before?”
1. Hemoglobin and Hematocrit 4. “What do you usually take to relieve your pain?
2. SGPT and SGOT 17. The client with appendicitis asks the nurse for a laxative to help
3. Na and K relieve her constipation. The nurse explains to her that laxatives
4. BUN and creatinine are not given to persons with possible appendicitis. What is the
6. An adult client is to have a gastroduodenoscopy in the morning. primary reason for this?
The nurse’s instructions should include the information that he will 1. Laxatives will decrease the spread of infection.
be 2. Laxatives are not given prior to any type of surgery.
1. given a general anesthetic during the procedure. 3. The patient does not have true constipation. She only has
2. given a local anesthetic to ease the discomfort during the pressure.
procedure. 4. Laxatives could cause rupture of the appendix.
3. asked to assist by coughing during the procedure. 18. The nurse is preparing a client with Crohn’s disease for
4. asked to assist by performing a Valsalva maneuver during the discharge. Which statement he makes indicates he needs further
procedure. teaching?
7. Which nursing intervention is essential immediately following a 1. “Stress can make it worse.”
gastroduodenoscopy? 2. “Since I have Crohn’s disease I don’t have to worry about colon
1. Force fluids. cancer.”
2. Position him supine. 3. “I realize I shall always have to monitor my diet.”
3. Instruct him not to eat or drink. 4. “I understand there is a high incidence of familial occurrence
4. Encourage coughing and deep breathing. with this disease.”
8. Because a client has a nasogastric tube attached to intermittent 19. A client is admitted to the hospital with ulcerative colitis.
drainage the nurse should be particularly alert for the development Admitting orders include a low residue diet. Which food would be
of which complication? contraindicated for this client?
1. Hypocalcemia. 1. Roast beef.
2. Hypermagnesemia. 2. Fresh peas.
3. Hypokalemia. 3. Mashed potatoes.
4. Hypoglycemia. 4. Baked chicken.
9. A barium enema is ordered for an adult male client. The nurse is 20. An adult client is to have a sigmoidoscopy in the morning.
teaching him what to expect regarding the procedure. Which What should the nurse plan to do?
statement should be included in the teaching? 1. Give him an enema 1 hour before the examination.
1. Fecal matter must be cleansed from the bowel for good 2. Keep him NPO for 8 hours before the examination.
visualization. 3. Order a low fat, low residue diet for breakfast.
2. There will be no food restrictions before the test. 4. Administer enemas until clear this evening.
3. He will not have to change positions during the procedure. 21. A client has an order for irrigation of a nasogastric tube. What
4. He will be asked to drink barium during the procedure. should the nurse do before irrigating the nasogastric tube?
10. An abdomino-perineal resection with a transverse colostomy is 1. Inject a small amount of air while listening with a stethoscope
planned for an adult male client. Neomycin sulfate p.o. is ordered over the stomach for a “swoosh.”
prior to surgery. The primary purpose for administering this drug is 2. Instill 5 cc of normal saline and observe for development of
to reduce coughing and dyspnea.
1. electrolyte imbalances. 3. Place the end of the nasogastric tube in a glass of water and
2. bacterial content in the colon. observe for bubbles.
3. peristaltic action in the colon. 4. Aspirate and check the pH.
4. feces in the bowel. 22. The client who has had a hemorrhoidectomy wants to know
11. In preparation for an abdomino-perineal resection the client is why she cannot take a sitz bath immediately upon return from the
placed on a low residue diet. Which of the following food lists is operating room. The nurse’s response is based upon which of the
appropriate for him to eat on a low residue diet? following concepts?
1. Ground lean beef, soft boiled eggs, tea. 1. Heat can stimulate bowel movement too quickly after surgery.
2. Lettuce, spinach, corn. 2. Patients are generally not awake enough for several hours to
3. Prunes, grapes, apples. safely take sitz baths.
4. Bran cereal, whole wheat toast, coffee. 3. Heat applied immediately post-operatively increases the
12. The nurse is caring for a client who has had a colostomy. possibility of hemorrhage.
Which of the following client behaviors is indicative of a willingness 4. Sitting in water before the sutures are removed may cause
to be involved in self-care following a colostomy? infection.
1. Discussing the cost of his hospitalization. 23. A client with pancreatitis tells the nurse that he fears nighttime.
2. Asking what time the surgeon will be in. Which of the following statements most likely relates to the client’s
3. Asking questions about the equipment being used. concerns?
4. Complaining about the noise in the adjacent room. 1. The pain is worse at night and aggravated in the recumbent
position. 13. (3) The nurse should first do a quick assessment
2. He is afraid of the dark. to determine if the cause of the pain is more apt to be
3. The mattress is uncomfortable. perforation of the ulcer or something else such as cardiac
4. The pain increases after a day of activity. pain. If the ulcer has perforated the client's abdomen will
24. The client asks how he contracted hepatitis A. He reports all of be tender and rigid - board like.
the following. Which one is most likely related to hepatitis A?
1. He ate home canned tomatoes. 14. (2) Milk and cream are now known to cause
2. He ate oysters his roommate brought home from a fishing trip. rebound acidity and are not prescribed for ulcer clients.
3. He stepped on a nail 2 weeks ago. The other choices all indicate good knowledge. He
4. He donated blood 2 weeks before he got sick. should not drink alcohol or cola. Three meals and
25. The client has had a liver biopsy. The nurse should position snacks will help to keep the stomach from staying empty
him on his right side with a pillow under his rib cage. What is the for long periods.
primary reason for this position?
1. To immobilize the diaphragm. 15. (2) Rising on the toes will cause pain in
2. To facilitate full chest expansion. McBurney's area if the appendix is inflamed.
3. To minimize the danger of aspiration.
4. To reduce the likelihood of bleeding 16. (1) When a person is admitted with a possible
appendicitis the nurse should anticipate surgery. It will
be important to know when she last ate when considering
Gastrointestinal Quiz the type of anesthesia so that the chance of aspiration
Answers and Rationale can be minimized.

1. (4) Clay colored stools means bile is not getting 17. (4) Laxatives cause increased peristalsis, which
through to the duodenum. The bile duct is obstructed so may cause the appendix to rupture. #2 is not a true
bile backs up into the bloodstream causing jaundice. statement. Laxatives may well be given prior to
gynecological, rectal and colon surgery. #3 is true but is
2. (3) Atropine is an anticholinergic drug , which will not the primary reason why laxatives are not given.
decrease contractions of the gallbladder.
18. (2) Persons with Crohn's disease are at high risk
3. (4) 350 cc in 24 hours after surgery is a normal for the development of colon cancer. The other answers
amount of bile drainage. are all correct.

4. (4) Weight gain may occur due to increased 19. (2) Fresh peas are high in residue. The other
consumption of food as the client tries to feed a duodenal foods are low in residue.
ulcer. “Why” questions are threatening to clients. #3
asks for a yes or no answer. This will not give as much 20. (1) An enema 1 hour before the exam will clear the
information as asking about the eating habits. sigmoid colon. A client having an upper GI series will be
NPO. Low fat diet is indicated prior to a gallbladder
5. (1) Hgb and Hct would indicate if there had been series. Low residue diet is part of the preparation for a
any bleeding from the ulcer. SGPT and SGOT barium enema. Enemas until clear are sometimes
elevations indicate liver damage. Na and K indicate ordered prior to a barium enema.
electrolyte imbalances. BUN and creatinine elevations
would indicate renal disease. 21. (4) To determine if the tube is in the stomach, the
nurse should aspirate and check the pH. It should be
6. (2) Gastroduodenoscopy is visualization of the less than 5. Never instill saline. If the tube were in the
esophagus, stomach and duodenal through a flexible bronchi instead of the stomach, saline would cause
tube inserted orally. The exam is uncomfortable because respiratory distress. Placing the end of the tube in a glass
the muscles of the GI tract have spasms as the tube is of water does not prove the location of the tube. Injecting
passed. This causes difficulty swallowing. The client is air and listening for a “swoosh” does not tell the nurse
usually given a local anesthetic to the posterior pharynx that the tube is in the stomach. The distal end of the
to reduce the discomfort during the passage of the tube. tube could be in the esophagus and still cause a
He may also be given conscious sedation. He will not “swoosh.” Instilling fluid in the esophagus would
given a general anesthetic because he must be able to increase the risk of aspiration.
assist by swallowing. Coughing and the performance of
a Valsalva maneuver would impede the passage of the 22. (3) Heat causes vasodilation. In the immediate
tube. post-operative period this could cause hemorrhaging.
Ice packs will be applied for the first 24 hours. Sitz baths
7. (3) It is essential to keep him NPO until the cough and are ordered after that.
gag reflexes have returned. He should be in a semi-
Fowler's position to reduce edema formation. 23. (1) The recumbent position aggravates pancreatic
pain. The client will be more comfortable on his side with
8. (3) Potassium is present in GI fluids and is lost during his knees flexed.
suctioning.
24. (2) Shellfish that grow in contaminated waters may
9. (1) The bowel must be free of fecal material for good have the virus. Home canned tomatoes might cause
visualization of the bowel. He will be on a clear liquid or food poisoning. Stepping on a nail might cause tetanus.
low residue diet for the day preceding the exam. The Donating blood will not cause hepatitis. Receiving blood
client is put in several positions during the test. Barium is might cause hepatitis B or C.
given by enema. It is given by mouth in an upper GI
series. 25. (4) The liver is a very vascular organ. It is located
on the right side. Lying on the right side will put pressure
10. (2) Neomycin is an antibiotic that is poorly on it and provide hemostasis.
absorbed from the bowel and very effective in killing the
bacteria in the bowel. E. Coli, normal inhabitants of the 1. During preparation for bowel surgery, a male client receives
bowel, can cause peritonitis if they are released into the an antibiotic to reduce intestinal bacteria. Antibiotic therapy may
peritoneal cavity during surgery. Neomycin does not interfere with synthesis of which vitamin and may lead to
alter electrolyte imbalances, affect peristaltic action or hypoprothrombinemia?
reduce feces. a. vitamin A
b. vitamin D
11. (1) All of these foods are low in residue. Fruits, c. vitamin E
vegetables and whole grains are high in residue. d. vitamin K
2. When evaluating a male client for complications of acute
12. (3) When the client asks questions about the pancreatitis, the nurse would observe for:
equipment being used, he indicates a readiness to learn. a. increased intracranial pressure.
None of the other responses indicate a willingness to b. decreased urine output.
learn about his colostomy. c. bradycardia.
d. hypertension.
3. A male client with a recent history of rectal bleeding is being the rationale for choosing this nursing diagnosis?
prepared for a colonoscopy. How should the nurse position the a. Obstruction of the appendix may increase venous drainage
client for this test initially? and cause the appendix to rupture.
a. Lying on the right side with legs straight b. Obstruction of the appendix reduces arterial flow, leading to
b. Lying on the left side with knees bent ischemia, inflammation, and rupture of the appendix.
c. Prone with the torso elevated c. The appendix may develop gangrene and rupture, especially
d. Bent over with hands touching the floor in a middle-aged client.
4. A male client with extreme weakness, pallor, weak peripheral d. Infection of the appendix diminishes necrotic arterial blood
pulses, and disorientation is admitted to the emergency flow and increases venous drainage.
department. His wife reports that he has been “spitting up blood.” 15. A female client with hepatitis C develops liver failure and GI
A Mallory-Weiss tear is suspected, and the nurse begins taking a hemorrhage. The blood products that would most likely bring about
client history from the client’s wife. The question by the nurse that hemostasis in the client are:
demonstrates her understanding of Mallory-Weiss tearing is: a. whole blood and albumin.
a. “Tell me about your husband’s alcohol usage.” b. platelets and packed red blood cells.
b. “Is your husband being treated for tuberculosis?” c. fresh frozen plasma and whole blood.
c. “Has your husband recently fallen or injured his chest?” d. cryoprecipitate and fresh frozen plasma.
d. “Describe spices and condiments your husband uses on food.” 16. To prevent gastroesophageal reflux in a male client with
5. Which of the following nursing interventions should the nurse hiatal hernia, the nurse should provide which discharge
perform for a female client receiving enteral feedings through a instruction?
gastrostomy tube? a. “Lie down after meals to promote digestion.”
a. Change the tube feeding solutions and tubing at least every b. “Avoid coffee and alcoholic beverages.”
24 hours. c. “Take antacids with meals.”
b. Maintain the head of the bed at a 15-degree elevation d. “Limit fluid intake with meals.”
continuously. 17. The nurse caring for a client with small-bowel obstruction
c. Check the gastrostomy tube for position every 2 days. would plan to implement which nursing intervention first?
d. Maintain the client on bed rest during the feedings. a. Administering pain medication
6. A male client is recovering from a small-bowel resection. To b. Obtaining a blood sample for laboratory studies
relieve pain, the physician prescribes meperidine (Demerol), 75 c. Preparing to insert a nasogastric (NG) tube
mg I.M. every 4 hours. How soon after administration should d. Administering I.V. fluids
meperidine’s onset of action occur? 18. A female client with dysphagia is being prepared for
a. 5 to 10 minutes discharge. Which outcome indicates that the client is ready for
b. 15 to 30 minutes discharge?
c. 30 to 60 minutes a. The client doesn’t exhibit rectal tenesmus.
d. 2 to 4 hours b. The client is free from esophagitis and achalasia.
7. The nurse is caring for a male client with cirrhosis. Which c. The client reports diminished duodenal inflammation.
assessment findings indicate that the client has deficient vitamin K d. The client has normal gastric structures.
absorption caused by this hepatic disease? 19. A male client undergoes total gastrectomy. Several hours
a. Dyspnea and fatigue after surgery, the nurse notes that the client’s nasogastric (NG)
b. Ascites and orthopnea tube has stopped draining. How should the nurse respond?
c. Purpura and petechiae a. Notify the physician
d. Gynecomastia and testicular atrophy b. Reposition the tube
8. Which condition is most likely to have a nursing diagnosis of c. Irrigate the tube
fluid volume deficit? d. Increase the suction level
a. Appendicitis 20. What laboratory finding is the primary diagnostic indicator for
b. Pancreatitis pancreatitis?
c. Cholecystitis a. Elevated blood urea nitrogen (BUN)
d. Gastric ulcer b. Elevated serum lipase
9. While a female client is being prepared for discharge, the c. Elevated aspartate aminotransferase (AST)
nasogastric (NG) feeding tube becomes clogged. To remedy this d. Increased lactate dehydrogenase (LD)
problem and teach the client’s family how to deal with it at home, 21. A male client with cholelithiasis has a gallstone lodged in the
what should the nurse do? common bile duct. When assessing this client, the nurse expects
a. Irrigate the tube with cola. to note:
b. Advance the tube into the intestine. a. yellow sclerae.
c. Apply intermittent suction to the tube. b. light amber urine.
d. Withdraw the obstruction with a 30-ml syringe. c. circumoral pallor.
10. A male client with pancreatitis complains of pain. The nurse d. black, tarry stools.
expects the physician to prescribe meperidine (Demerol) instead of 22. Nurse Hannah is teaching a group of middle-aged men about
morphine to relieve pain because: peptic ulcers. When discussing risk factors for peptic ulcers, the
a. meperidine provides a better, more prolonged analgesic nurse should mention:
effect. a. a sedentary lifestyle and smoking.
b. morphine may cause spasms of Oddi’s sphincter. b. a history of hemorrhoids and smoking.
c. meperidine is less addictive than morphine. c. alcohol abuse and a history of acute renal failure.
d. morphine may cause hepatic dysfunction. d. alcohol abuse and smoking.
11. Mandy, an adolescent girl is admitted to an acute care facility 23. While palpating a female client’s right upper quadrant (RUQ),
with severe malnutrition. After a thorough examination, the the nurse would expect to find which of the following structures?
physician diagnoses anorexia nervosa. When developing the plan a. Sigmoid colon
of care for this client, the nurse is most likely to include which b. Appendix
nursing diagnosis? c. Spleen
a. Hopelessness d. Liver
b. Powerlessness 24. A male client has undergone a colon resection. While turning
c. Chronic low self esteem him, wound dehiscence with evisceration occurs. The nurse’s first
d. Deficient knowledge response is to:
12. Which diagnostic test would be used first to evaluate a client a. call the physician.
with upper GI bleeding? b. place saline-soaked sterile dressings on the wound.
a. Endoscopy c. take a blood pressure and pulse.
b. Upper GI series d. pull the dehiscence closed.
c. Hemoglobin (Hb) levels and hematocrit (HCT) 25. The nurse is monitoring a female client receiving paregoric to
d. Arteriography treat diarrhea for drug interactions. Which drugs can produce
13. A female client who has just been diagnosed with hepatitis A additive constipation when given with an opium preparation?
asks, “How could I have gotten this disease?” What is the nurse’s a. Antiarrhythmic drugs
best response? b. Anticholinergic drugs
a. “You may have eaten contaminated restaurant food.” c. Anticoagulant drugs
b. “You could have gotten it by using I.V. drugs.” d. Antihypertensive drugs
c. “You must have received an infected blood transfusion.” 26. A male client is recovering from an ileostomy that was
d. “You probably got it by engaging in unprotected sex.” performed to treat inflammatory bowel disease. During discharge
14. When preparing a male client, age 51, for surgery to treat teaching, the nurse should stress the importance of:
appendicitis, the nurse formulates a nursing diagnosis of Risk for a. increasing fluid intake to prevent dehydration.
infection related to inflammation, perforation, and surgery. What is b. wearing an appliance pouch only at bedtime.
c. consuming a low-protein, high-fiber diet. aspiration is unlikely to dislodge the material clogging the tube but
d. taking only enteric-coated medications. may create excess pressure. Intermittent suction may even
27. The nurse is caring for a female client with active upper GI collapse the tube.
bleeding. What is the appropriate diet for this client during the first
24 hours after admission? 10. Answer B. For a client with pancreatitis, the physician will
a. Regular diet probably avoid prescribing morphine because this drug may trigger
b. Skim milk spasms of the sphincter of Oddi (a sphincter at the end of the
c. Nothing by mouth pancreatic duct), causing irritation of the pancreas. Meperidine has
d. Clear liquids a somewhat shorter duration of action than morphine. The two
28. A male client has just been diagnosed with hepatitis A. On drugs are equally addictive. Morphine isn’t associated with hepatic
assessment, the nurse expects to note: dysfunction.
a. severe abdominal pain radiating to the shoulder.
b. anorexia, nausea, and vomiting. 11. Answer C. Young women with Chronic low self esteem —
c. eructation and constipation. are at highest risk for anorexia nervosa because they perceive
d. abdominal ascites. being thin as a way to improve their self-confidence. Hopelessness
29. A female client with viral hepatitis A is being treated in an and Powerlessness are inappropriate nursing diagnoses because
acute care facility. Because the client requires enteric precautions, clients with anorexia nervosa seldom feel hopeless or powerless;
the nurse should: instead, they use food to control their desire to be thin and hope
a. place the client in a private room. that restricting food intake will achieve this goal. Anorexia nervosa
b. wear a mask when handling the client’s bedpan. doesn’t result from a knowledge deficit, such as one regarding
c. wash the hands after touching the client. good nutrition.
d. wear a gown when providing personal care for the client.
30. Which of the following factors can cause hepatitis A? 12. Answer A. Endoscopy permits direct evaluation of the upper
a. Contact with infected blood GI tract and can detect 90% of bleeding lesions. An upper GI
b. Blood transfusions with infected blood series, or barium study, usually isn’t the diagnostic method of
c. Eating contaminated shellfish choice, especially in a client with acute active bleeding who’s
d. Sexual contact with an infected person vomiting and unstable. An upper GI series is also less accurate
than endoscopy. Although an upper GI series might confirm the
1. Answer D. Intestinal bacteria synthesize such nutritional presence of a lesion, it wouldn’t necessarily reveal whether the
substances as vitamin K, thiamine, riboflavin, vitamin B12, folic lesion is bleeding. Hb levels and HCT, which indicate loss of blood
acid, biotin, and nicotinic acid. Therefore, antibiotic therapy may volume, aren’t always reliable indicators of GI bleeding because a
interfere with synthesis of these substances, including vitamin K. decrease in these values may not be seen for several hours.
Intestinal bacteria don’t synthesize vitamins A, D, or E. Arteriography is an invasive study associated with life-threatening
complications and wouldn’t be used for an initial evaluation.
2. Answer B. Acute pancreatitis can cause decreased urine
output, which results from the renal failure that sometimes 13. Answer A. Hepatitis A virus typically is transmitted by the
accompanies this condition. Intracranial pressure neither increases oral-fecal route — commonly by consuming food contaminated by
nor decreases in a client with pancreatitis. Tachycardia, not infected food handlers. The virus isn’t transmitted by the I.V. route,
bradycardia, usually is associated with pulmonary or hypovolemic blood transfusions, or unprotected sex. Hepatitis B can be
complications of pancreatitis. Hypotension can be caused by a transmitted by I.V. drug use or blood transfusion. Hepatitis C can
hypovolemic complication, but hypertension usually isn’t related to be transmitted by unprotected sex.
acute pancreatitis.
14. Answer B. A client with appendicitis is at risk for infection
3. Answer B. For a colonoscopy, the nurse initially should related to inflammation, perforation, and surgery because
position the client on the left side with knees bent. Placing the obstruction of the appendix causes mucus fluid to build up,
client on the right side with legs straight, prone with the torso increasing pressure in the appendix and compressing venous
elevated, or bent over with hands touching the floor wouldn’t allow outflow drainage. The pressure continues to rise with venous
proper visualization of the large intestine. obstruction; arterial blood flow then decreases, leading to ischemia
from lack of perfusion. Inflammation and bacterial growth follow,
4. Answer A. A Mallory-Weiss tear is associated with massive and swelling continues to raise pressure within the appendix,
bleeding after a tear occurs in the mucous membrane at the resulting in gangrene and rupture. Geriatric, not middle-aged,
junction of the esophagus and stomach. There is a strong clients are especially susceptible to appendix rupture.
relationship between ethanol usage, resultant vomiting, and a
Mallory-Weiss tear. The bleeding is coming from the stomach, not 15. Answer D. The liver is vital in the synthesis of clotting factors,
from the lungs as would be true in some cases of tuberculosis. A so when it’s diseased or dysfunctional, as in hepatitis C, bleeding
Mallory-Weiss tear doesn’t occur from chest injuries or falls and occurs. Treatment consists of administering blood products that
isn’t associated with eating spicy foods. aid clotting. These include fresh frozen plasma containing
fibrinogen and cryoprecipitate, which have most of the clotting
5. Answer A. Tube feeding solutions and tubing should be factors. Although administering whole blood, albumin, and packed
changed every 24 hours, or more frequently if the feeding requires cells will contribute to hemostasis, those products aren’t
it. Doing so prevents contamination and bacterial growth. The specifically used to treat hemostasis. Platelets are helpful, but the
head of the bed should be elevated 30 to 45 degrees continuously best answer is cryoprecipitate and fresh frozen plasma.
to prevent aspiration. Checking for gastrostomy tube placement is
performed before initiating the feedings and every 4 hours during 16. Answer B. To prevent reflux of stomach acid into the
continuous feedings. Clients may ambulate during feedings. esophagus, the nurse should advise the client to avoid foods and
beverages that increase stomach acid, such as coffee and alcohol.
6. Answer B. Meperidine’s onset of action is 15 to 30 minutes. It The nurse also should teach the client to avoid lying down after
peaks between 30 and 60 minutes and has a duration of action of meals, which can aggravate reflux, and to take antacids after
2 to 4 hours. eating. The client need not limit fluid intake with meals as long as
the fluids aren’t gastric irritants.
7. Answer C. A hepatic disorder, such as cirrhosis, may disrupt
the liver’s normal use of vitamin K to produce prothrombin (a 17. Answer D. I.V. infusions containing normal saline solution
clotting factor). Consequently, the nurse should monitor the client and potassium should be given first to maintain fluid and
for signs of bleeding, including purpura and petechiae. Dyspnea electrolyte balance. For the client’s comfort and to assist in bowel
and fatigue suggest anemia. Ascites and orthopnea are unrelated decompression, the nurse should prepare to insert an NG tube
to vitamin K absorption. Gynecomastia and testicular atrophy next. A blood sample is then obtained for laboratory studies to aid
result from decreased estrogen metabolism by the diseased liver. in the diagnosis of bowel obstruction and guide treatment. Blood
studies usually include a complete blood count, serum electrolyte
8. Answer B. Hypovolemic shock from fluid shifts is a major levels, and blood urea nitrogen level. Pain medication often is
factor in acute pancreatitis. The other conditions are less likely to withheld until obstruction is diagnosed because analgesics can
exhibit fluid volume deficit. decrease intestinal motility.

9. Answer A. The nurse should irrigate the tube with cola 18. Answer B. Dysphagia may be the reason why a client with
because its effervescence and acidity are suited to the purpose, esophagitis or achalasia seeks treatment. Dysphagia isn’t
it’s inexpensive, and it’s readily available in most homes. associated with rectal tenesmus, duodenal inflammation, or
Advancing the NG tube is inappropriate because the tube is abnormal gastric structures.
designed to stay in the stomach and isn’t long enough to reach the
intestines. Applying intermittent suction or using a syringe for
19. Answer A. An NG tube that fails to drain during the
postoperative period should be reported to the physician
immediately. It may be clogged, which could increase pressure on
the suture site because fluid isn’t draining adequately.
Repositioning or irrigating an NG tube in a client who has
undergone gastric surgery can disrupt the anastomosis. Increasing
the level of suction may cause trauma to GI mucosa or the suture
line.

20. Answer B. Elevation of serum lipase is the most reliable

indicator of pancreatitis because this enzyme is produced solely by
the pancreas. A client’s BUN is typically elevated in relation to
renal dysfunction; the AST, in relation to liver dysfunction; and LD,
in relation to damaged cardiac muscle.

21. Answer A. Yellow sclerae may be the first sign of jaundice,

which occurs when the common bile duct is obstructed. Urine
normally is light amber. Circumoral pallor and black, tarry stools
don’t occur in common bile duct obstruction; they are signs of
hypoxia and GI bleeding, respectively.

22. Answer D. Risk factors for peptic (gastric and duodenal)

ulcers include alcohol abuse, smoking, and stress. A sedentary
lifestyle and a history of hemorrhoids aren’t risk factors for peptic
ulcers. Chronic renal failure, not acute renal failure, is associated
with duodenal ulcers.

23. Answer D. The RUQ contains the liver, gallbladder,

duodenum, head of the pancreas, hepatic flexure of the colon,
portions of the ascending and transverse colon, and a portion of
the right kidney. The sigmoid colon is located in the left lower
quadrant; the appendix, in the right lower quadrant; and the
spleen, in the left upper quadrant.

24. Answer B. The nurse should first place saline-soaked sterile

dressings on the open wound to prevent tissue drying and possible
infection. Then the nurse should call the physician and take the
client’s vital signs. The dehiscence needs to be surgically closed,
so the nurse should never try to close it.

25. Answer B. Paregoric has an additive effect of constipation

when used with anticholinergic drugs. Antiarrhythmics,
anticoagulants, and antihypertensives aren’t known to interact with
paregoric.

26. Answer A. Because stool forms in the large intestine, an

ileostomy typically drains liquid waste. To avoid fluid loss through
ileostomy drainage, the nurse should instruct the client to increase
fluid intake. The nurse should teach the client to wear a collection
appliance at all times because ileostomy drainage is incontinent, to
avoid high-fiber foods because they may irritate the intestines, and
to avoid enteric-coated medications because the body can’t absorb
them after an ileostomy

27. Answer C. Shock and bleeding must be controlled before

oral intake, so the client should receive nothing by mouth. A
regular diet is incorrect. When the bleeding is controlled, the diet is
gradually increased, starting with ice chips and then clear liquids.
Skim milk shouldn’t be given because it increases gastric acid
production, which could prolong bleeding. A liquid diet is the first
diet offered after bleeding and shock are controlled.

28. Answer B. Hallmark signs and symptoms of hepatitis A

include anorexia, nausea, vomiting, fatigue, and weakness.
Abdominal pain may occur but doesn’t radiate to the shoulder.
Eructation and constipation are common in gallbladder disease,
not hepatitis A. Abdominal ascites is a sign of advanced hepatic
disease, not an early sign of hepatitis A.

29. Answer C. To maintain enteric precautions, the nurse must

wash the hands after touching the client or potentially
contaminated articles and before caring for another client. A
private room is warranted only if the client has poor hygiene — for
instance, if the client is unlikely to wash the hands after touching
infective material or is likely to share contaminated articles with
other clients. For enteric precautions, the nurse need not wear a
mask and must wear a gown only if soiling from fecal matter is
likely.

30. Answer C. Hepatitis A can be caused by consuming

contaminated water, milk, or food — especially shellfish from
contaminated water. Hepatitis B is caused by blood and sexual
contact with an infected person. Hepatitis C is usually caused by
contact with infected blood, including receiving blood transfusions.