1. Nurse Berlinda is assigned to a 41-year-old client D.

Pull back on the tube and wait until the

who has a diagnosis of chronic pancreatitis. The respiratory distress subsides
nurse reviews the laboratory result, anticipating a
laboratory report that indicates a serum amylase level 6. Question
of: Nurse Ryan is assessing for correct placement of a
nasogastric tube. The nurse aspirates the stomach
A. 45 units/L contents and checks the contents for pH. The nurse
B. 100 units/L verifies correct tube placement if which pH value is
C. 300 units/L noted?
D. 500 units/L
A. 3.5
2. Question B. 7.0
A male client who is recovering from surgery has C. 7.35
been advanced from a clear liquid diet to a full liquid D. 7.5
diet. The client is looking forward to the diet change
because he has been “bored” with the clear liquid 7. Question
diet. The nurse would offer which full liquid item to A nurse is preparing to remove a nasogastric tube
the client? from a female client. The nurse should instruct the
client to do which of the following just before the
A. Tea nurse removes the tube?
B. Gelatin
C. Custard A. Exhale
D. Popsicle B. Inhale and exhale quickly
C. Take and hold a deep breath
3. Question D. Perform a Valsalva maneuver
Nurse Juvy is caring for a client with cirrhosis of the
liver. To minimize the effects of the disorder, the 8. Question
nurse teaches the client about foods that are high in Nurse Joy is preparing to administer medication
thiamine. The nurse determines that the client has the through a nasogastric tube that is connected to
best understanding of the dietary measures to follow suction. To administer the medication, the nurse
if the client states an intention to increase the intake would:
of:
A. Position the client supine to assist in medication
A. Pork absorption
B. Milk B. Aspirate the nasogastric tube after medication
C. Chicken administration to maintain patency
D. Broccoli C. Clamp the nasogastric tube for 30 minutes
following administration of the medication
4. Question D. Change the suction setting to low intermittent
Nurse Oliver checks for residual before administering suction for 30 minutes after medication
a bolus tube feeding to a client with a nasogastric administration
tube and obtains a residual amount of 150 mL. What
is the appropriate action for the nurse to take? 9. Question
A nurse is preparing to care for a female client with
A. Hold the feeding esophageal varices who just had a Sengstaken-
B. Reinstill the amount and continue with Blakemore tube inserted. The nurse gathers supplies,
administering the feeding knowing that which of the following items must be
C. Elevate the client’s head at least 45 degrees and kept at the bedside at all times?
administer the feeding
D. Discard the residual amount and proceed with A. An obturator
administering the feeding B. Kelly clamp
C. An irrigation set
5. Question D. A pair of scissors
A nurse is inserting a nasogastric tube in an adult
male client. During the procedure, the client begins to 10. Question
cough and has difficulty breathing. Which of the Dr. Smith has determined that the client with
following is the appropriate nursing action? hepatitis has contracted the infection from
contaminated food. The nurse understands that this
A. Quickly insert the tube client is most likely experiencing what type of
B. Notify the physician immediately hepatitis?
C. Remove the tube and reinsert when the
respiratory distress subsides A. Hepatitis A
B. Hepatitis B
C. Hepatitis C knowing that this client is at risk for which vitamin
D. Hepatitis D deficiency?

11. Question A. Vitamin A

A client is suspected of having hepatitis. Which B. Vitamin B12
diagnostic test result will assist in confirming this C. Vitamin C
diagnosis? D. Vitamin E

A. Elevated hemoglobin level 17. Question

B. Elevated serum bilirubin level The nurse is reviewing the medication record of a
C. Elevated blood urea nitrogen level female client with acute gastritis. Which medication,
D. Decreased erythrocyte sedimentation rate if noted on the client’s record, would the nurse
question?
12. Question
The nurse is reviewing the physician’s orders written A. Digoxin (Lanoxin)
for a male client admitted to the hospital with acute B. Furosemide (Lasix)
pancreatitis. Which physician order should the nurse C. Indomethacin (Indocin)
question if noted on the client’s chart? D. Propranolol hydrochloride (Inderal)

A. NPO status 18. Question

B. Nasogastric tube inserted The nurse is assessing a male client 24 hours
C. Morphine sulfate for pain following a cholecystectomy. The nurse noted that
D. An anticholinergic medication the T-tube has drained 750 mL of green-brown
drainage since the surgery. Which nursing
13. Question intervention is appropriate?
A female client being seen in a physician’s office has
just been scheduled for a barium swallow the next A. Clamp the T-tube
day. The nurse writes down which instruction for the B. Irrigate the T-tube
client to follow before the test? C. Notify the physician
D. Document the findings
A. Fast for 8 hours before the test
B. Eat a regular supper and breakfast 19. Question
C. Continue to take all oral medications as scheduled The nurse is monitoring a female client with a
D. Monitor own bowel movement pattern for diagnosis of peptic ulcer. Which assessment findings
constipation would most likely indicate perforation of the ulcer?

14. Question A. Bradycardia

The nurse is performing an abdominal assessment B. Numbness in the legs
and inspects the skin of the abdomen. The nurse C. Nausea and vomiting
performs which assessment technique next? D. A rigid, board-like abdomen

A. Palpates the abdomen for size 20. Question

B. Palpates the liver at the right rib margin A male client with a peptic ulcer is scheduled for a
C. Listens to bowel sounds in all four quadrants vagotomy and the client asks the nurse about the
D. Percusses the right lower abdominal quadrant purpose of this procedure. Which response by the
nurse best describes the purpose of a vagotomy?
15. Question
Polyethylene glycol-electrolyte solution A. Halts stress reactions
(GoLYTELY) is prescribed for the female client B. Heals the gastric mucosa
scheduled for a colonoscopy. The client begins to C. Reduces the stimulus to acid secretions
experience diarrhea following the administration of D. Decreases food absorption in the stomach
the solution. What action by the nurse is appropriate?
21. Question
A. Start an IV infusion The nurse is caring for a female client following a
B. Administer an enema Billroth II procedure. Which postoperative order
C. Cancel the diagnostic test should the nurse question and verify?
D. Explain that diarrhea is expected
Incorrect A. Leg exercises
B. Early ambulation
16. Question C. Irrigating the nasogastric tube
The nurse is caring for a male client with a diagnosis D. Coughing and deep-breathing exercises
of chronic gastritis. The nurse monitors the client
22. Question D. Nutrition: more than body requirements,
The nurse is providing discharge instructions to a imbalanced
male client following gastrectomy and instructs the
client to take which measure to assist in preventing 28. Question
dumping syndrome? The nurse is reviewing the record of a female client
with Crohn’s disease. Which stool characteristics
A. Ambulate following a meal should the nurse expect to note documented in the
B. Eat high carbohydrate foods client’s record?
C. Limit the fluid taken with meal
D. Sit in a high-Fowler’s position during meals A. Diarrhea
B. Chronic constipation
23. Question C. Constipation alternating with diarrhea
The nurse is monitoring a female client for the early D. Stools constantly oozing from the rectum
signs and symptoms of dumping syndrome. Which of 29. Question
the following indicate this occurrence? The nurse is performing colostomy irrigation on a
male client. During the irrigation, the client begins to
A. Sweating and pallor complain of abdominal cramps. What is the
B. Bradycardia and indigestion appropriate nursing action?
C. Double vision and chest pain
D. Abdominal cramping and pain A. Notify the physician
B. Stop the irrigation temporarily
24. Question C. Increase the height of the irrigation
The nurse is preparing a discharge teaching plan for D. Medicate for pain and resume the irrigation
the male client who had umbilical hernia repair. What
should the nurse include in the plan? 30. Question
The nurse is teaching a female client how to perform
A. Irrigating the drain a colostomy irrigation. To enhance the effectiveness
B. Avoiding coughing of the irrigation and fecal returns, what measure
C. Maintaining bed rest should the nurse instruct the client to do?
D. Restricting pain medication
A. Increase fluid intake
25. Question B. Place heat on the abdomen
The nurse is instructing the male client who has an C. Perform the irrigation in the evening
inguinal hernia repair how to reduce postoperative D. Reduce the amount of irrigation solution
swelling following the procedure. What should the
nurse tell the client? 31. Question
For a client in hepatic coma, which outcome would
A. Limit oral fluid be the most appropriate?
B. Elevate the scrotum
C. Apply heat to the abdomen A. The client is oriented to time, place, and person.
D. Remain in a low-fiber diet B. The client exhibits no ecchymotic areas.
C. The client increases oral intake to 2,000
26. Question calories/day.
The nurse is caring for a hospitalized female client D. The client exhibits increased serum albumin
with a diagnosis of ulcerative colitis. Which finding, level.
if noted on assessment of the client, would the nurse
report to the physician? 32. Question
Jordin is a client with jaundice who is experiencing
A. Hypotension pruritus. Which nursing intervention would be
B. Bloody diarrhea included in the care plan for the client?
C. Rebound tenderness
D. A hemoglobin level of 12 mg/dL A. Administering vitamin K subcutaneously
B. Applying pressure when giving I.M. injections
27. Question C. Decreasing the client's dietary protein intake
The nurse is caring for a male client postoperatively D. Keeping the client's fingernails short and smooth
following the creation of a colostomy. Which nursing
diagnosis should the nurse include in the plan of 33. Question
care? Marie, a 51-year-old woman, is diagnosed with
cholecystitis. Which diet, when selected by the client,
A. Sexual dysfunction indicates that the nurse’s teaching has been
B. Body image, disturbed successful?
C. Fear related to poor prognosis
A. 4-6 small meals of low-carbohydrate foods daily
 B. High-fat, high-carbohydrate meals D. Dietary plan of a low-fat diet and increased fluid
C. Low-fat, high-carbohydrate meals intake to 2,000 ml/day
D. High-fat, low protein meals
34. Question 39. Question
The hospital administrator had undergone When teaching a client about pancreatic function, the
percutaneous transhepatic cholangiography. Which nurse understands that pancreatic lipase performs
assessment finding indicates complication after the which function?
operation?
A. Transports fatty acids into the brush border
A. Fever and chills B. Breaks down fat into fatty acids and glycerol
B. Hypertension C. Triggers cholecystokinin to contract the
C. Bradycardia gallbladder
D. Nausea and diarrhea D. Breaks down protein into dipeptides and amino
acids
35. Question
When planning home care for a client with hepatitis 40. Question
A, which preventive measure should be emphasized A 52-year-old man was referred to the clinic due to
to protect the client’s family? increased abdominal girth. He is diagnosed with
ascites by the presence of a fluid thrill and shifting
A. Keeping the client in complete isolation dullness on percussion. After administering diuretic
B. Using good sanitation with dishes and shared therapy, which nursing action would be most
bathrooms effective in ensuring safe care?
C. Avoiding contact with blood-soiled clothing or
dressing A. Measuring serum potassium for hyperkalemia
D. Forbidding the sharing of needles or syringes B. Assessing the client for hypervolemia
Correct C. Measuring the client's weight weekly
Correct Answer: B. Using good sanitation with D. Documenting precise intake and output
dishes and shared bathrooms.
41. Question
36. Question Which assessment finding indicates that lactulose is
For Jayvin who is taking antacids, which instruction effective in decreasing the ammonia level in the
would be included in the teaching plan? client with hepatic encephalopathy?

A. "Take the antacids with 8 oz of water." A. Passage of two or three soft stools daily
B. "Avoid taking other medications within 2 hours of B. Evidence of watery diarrhea
this one." C. Daily deterioration in the client's handwriting
C. "Continue taking antacids even when pain D. Appearance of frothy, foul-smelling stools
subsides."
D. "Weigh yourself daily when taking this 42. Question
medication." Nurse Farrah is providing care for Kristoff who has
jaundice. Which statement indicates that the nurse
37. Question understands the rationale for instituting skin care
Which clinical manifestation would the nurse expect measures for the client?
a client diagnosed with acute cholecystitis to exhibit?
A. "Jaundice is associated with pressure ulcer
A. Jaundice, dark urine, and steatorrhea formation."
B. Acute right lower quadrant (RLQ) pain, diarrhea, B. "Jaundice impairs urea production, which
and dehydration produces pruritus."
C. Ecchymosis petechiae, and coffee-ground emesis C. "Jaundice produces pruritus due to impaired bile
D. Nausea, vomiting, and anorexia acid excretion."
D. "Jaundice leads to decreased tissue perfusion and
38. Question subsequent breakdown."
Pierre, who is diagnosed with acute pancreatitis, is
under the care of Nurse Bryan. Which intervention 43. Question
should the nurse include in the care plan for the Which rationale supports explaining the placement of
client? an esophageal tamponade tube in a client who is
A. Administration of vasopressin and insertion of a hemorrhaging?
balloon tamponade
B. Preparation for a paracentesis and administration A. Allowing the client to help insert the tube
of diuretics B. Beginning teaching for home care
C. Maintenance of nothing-by-mouth status and C. Maintaining the client's level of anxiety and
insertion of nasogastric (NG) tube with low alertness
intermittent suction D. Obtaining cooperation and reducing fear
 49. Question
44. Question Which of the following will the nurse include in the
For Rico who has chronic pancreatitis, which nursing care plan for a client hospitalized with viral hepatitis?
intervention would be most helpful?
A. Increase fluid intake to 3000 ml per day
A. Allowing liberalized fluid intake B. Adequate bed rest
B. Counseling to stop alcohol consumption C. Bland diet
C. Encouraging daily exercise D. Administer antibiotics as ordered
D. Modifying dietary protein
50. Question
45. Question Spironolactone (Aldactone) is prescribed for a client
Mr. Hasakusa is in end-stage liver failure. Which with chronic cirrhosis and ascites. The nurse should
interventions should the nurse implement when monitor the client for which of the following
addressing hepatic encephalopathy? Select all that medication-related side effects?
apply.
A. Jaundice
A. Assessing the client's neurologic status every 2 B. Hyperkalemia
hours C. Tachycardia
B. Monitoring the client's hemoglobin and D. Constipation
hematocrit levels QUIZ 2
C. Evaluating the client's serum ammonia level 1. Question
D. Monitoring the client's handwriting daily During preparation for bowel surgery, a male client
E. Preparing to insert an esophageal tamponade tube receives an antibiotic to reduce intestinal bacteria.
F. Making sure the client's fingernails are short Antibiotic therapy may interfere with the synthesis of
Incorrect which vitamin and may lead to
Correct Answers: A, C, & D hypoprothrombinemia?

46. Question A. Vitamin A

For a client with hepatic cirrhosis who has altered B. Vitamin D
clotting mechanisms, which intervention would be C. Vitamin E
most important? D. Vitamin K
2. Question
A. Allowing complete independence of mobility When evaluating a male client for complications of
B. Applying pressure to injection sites acute pancreatitis, the nurse would observe for:
C. Administering antibiotics as prescribed
D. Increasing nutritional intake A. Increased intracranial pressure
B. Decreased urine output
47. Question C. Bradycardia
A client with advanced cirrhosis has been diagnosed D. Hypertension
with hepatic encephalopathy. The nurse expects to
assess for: 3. Question
A male client with a recent history of rectal bleeding
A. Malaise is being prepared for a colonoscopy. How should the
B. Stomatitis nurse position the client for this test initially?
C. Hand tremors
D. Weight loss A. Lying on the right side with legs straight
B. Lying on the left side with knees bent
48. Question C. Prone with the torso elevated
A client diagnosed with chronic cirrhosis who has D. Bent over with hands touching the floor
ascites and pitting peripheral edema also has hepatic
encephalopathy. Which of the following nursing 4. Question
interventions are appropriate to prevent skin A male client with extreme weakness, pallor, weak
breakdown? Select all that apply. peripheral pulses, and disorientation is admitted to
the emergency department. His wife reports that he
A. Range of motion every 4 hours has been “spitting up blood.” A Mallory-Weiss tear is
B. Turn and reposition every 2 hours suspected, and the nurse begins taking the client’s
C. Abdominal and foot massages every 2 hours history from the client’s wife. The question by the
D. Alternating air pressure mattress nurse that demonstrates her understanding of
E. Sit in chair for 30 minutes each shift Mallory-Weiss tearing is:
Correct Answers: B & D
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?” 10. Question
D. “Describe spices and condiments your husband A male client with pancreatitis complains of pain.
uses on food.” The nurse expects the physician to prescribe
meperidine (Demerol) instead of morphine to relieve
5. Question pain because:
Which of the following nursing interventions should
the nurse perform for a female client receiving A. Meperidine provides a better, more prolonged
enteral feedings through a gastrostomy tube? analgesic effect.
B. Morphine may cause spasms of Oddi’s sphincter.
A. Change the tube feeding solutions and tubing at C. Meperidine is less addictive than morphine.
least every 24 hours. D. Morphine may cause hepatic dysfunction.
B. Maintain the head of the bed at a 15-degree
elevation continuously. 11. Question
C. Check the gastrostomy tube for position every 2 Mandy, an adolescent girl is admitted to an acute care
days. facility with severe malnutrition. After a thorough
D. Maintain the client on bed rest during the examination, the physician diagnoses anorexia
feedings. nervosa. When developing the plan of care for this
client, the nurse is most likely to include which
6. Question nursing diagnosis?
A male client is recovering from a small bowel
resection. To relieve pain, the physician prescribes A. Hopelessness
meperidine (Demerol), 75 mg I.M. every 4 hours. B. Powerlessness
How soon after administration should meperidine C. Chronic low self-esteem
onset of action occur? D. Deficient knowledge

A. 5 to 10 minutes 12. Question

B. 15 to 30 minutes Which diagnostic test would be used first to evaluate
C. 30 to 60 minutes a client with upper GI bleeding?
D. 2 to 4 hours
A. Endoscopy
7. Question B. Upper GI series
The nurse is caring for a male client with cirrhosis. C. Hemoglobin (Hb) levels and hematocrit (HCT)
Which assessment findings indicate that the client has D. Arteriography
deficient vitamin K absorption caused by this hepatic
disease? 13. Question
A female client who has just been diagnosed with
A. Dyspnea and fatigue hepatitis A asks, “How could I have gotten this
B. Ascites and orthopnea disease?” What is the nurse’s best response?
C. Purpura and petechiae
D. Gynecomastia and testicular atrophy A. “You may have eaten contaminated restaurant
food.”
8. Question B. “You could have gotten it by using I.V. drugs.”
Which condition is most likely to have a nursing C. “You must have received an infected blood
diagnosis of fluid volume deficit? transfusion.”
D. “You probably got it by engaging in unprotected
A. Appendicitis sex.”
B. Pancreatitis
C. Cholecystitis 14. Question
D. Gastric ulcer When preparing a male client, age 51, for surgery to
Incorrect treat appendicitis, the nurse formulates a nursing
diagnosis of Risk for infection related to
9. Question inflammation, perforation, and surgery. What is the
While a female client is being prepared for discharge, rationale for choosing this nursing diagnosis?
the nasogastric (NG) feeding tube becomes clogged.
To remedy this problem and teach the client’s family A. Obstruction of the appendix may increase venous
how to deal with it at home, what should the nurse drainage and cause the appendix to rupture.
do? B. Obstruction of the appendix reduces arterial flow,
leading to ischemia, inflammation, and rupture of the
A. Irrigate the tube with warm water. appendix.
B. Advance the tube into the intestine. C. The appendix may develop gangrene and rupture,
C. Apply intermittent suction to the tube. especially in a middle-aged client.
D. Withdraw the obstruction with a 30-ml syringe.
 D. Infection of the appendix diminishes necrotic D. Increased lactate dehydrogenase (LD)
arterial blood flow and increases venous drainage.
21. Question
15. Question A male client with cholelithiasis has a gallstone
A female client with hepatitis C develops liver failure lodged in the common bile duct. When assessing this
and GI hemorrhage. The blood products that would client, the nurse expects to note:
most likely bring about hemostasis in the client are:
A. Yellow sclera
A. Whole blood and albumin. B. Light amber urine
B. Platelets and packed red blood cells. C. Circumoral pallor
C. Fresh frozen plasma and whole blood. D. Black, tarry stools
D. Cryoprecipitate and fresh frozen plasma.
22. Question
16. Question Nurse Hannah is teaching a group of middle-aged
To prevent gastroesophageal reflux in a male client men about peptic ulcers. When discussing risk factors
with a hiatal hernia, the nurse should provide which for peptic ulcers, the nurse should mention:
of the following discharge instructions?
A. A sedentary lifestyle and smoking.
A. “Lie down after meals to promote digestion.” B. A history of hemorrhoids and smoking.
B. “Avoid coffee and alcoholic beverages.” C. Alcohol abuse and a history of acute renal failure.
C. “Take antacids with meals.” D. Alcohol abuse and smoking.
D. “Limit fluid intake with meals.”
23. Question
17. Question While palpating a female client’s right upper
The nurse caring for a client with small bowel quadrant (RUQ), the nurse would expect to find
obstruction would plan to implement which nursing which of the following structures?
intervention first?
A. Sigmoid colon
A. Administering pain medication B. Appendix
B. Obtaining a blood sample for laboratory studies C. Spleen
C. Preparing to insert a nasogastric (NG) tube D. Liver
D. Administering I.V. fluids
24. Question
18. Question A male client has undergone a colon resection. While
A female client with dysphagia is being prepared for turning him, wound dehiscence with evisceration
discharge. Which outcome indicates that the client is occurs. The nurse’s first response is to:
ready for discharge?
A. Call the physician.
A. The client doesn’t exhibit rectal tenesmus. B. Place saline-soaked sterile dressings on the
B. The client is free from esophagitis and achalasia. wound.
C. The client reports diminished duodenal C. Take blood pressure and pulse.
inflammation. D. Pull the dehiscence closed.
D. The client has normal gastric structures.
Incorrect 25. Question
The nurse is monitoring a female client receiving
19. Question paregoric to treat diarrhea for drug interactions.
A male client undergoes total gastrectomy. Several Which drugs can produce additive constipation when
hours after surgery, the nurse notes that the client’s given with an opium preparation?
nasogastric (NG) tube has stopped draining. How
should the nurse respond? A. Antiarrhythmic drugs
B. Anticholinergic drugs
A. Notify the physician. C. Anticoagulant drugs
B. Reposition the tube. D. Antihypertensive drugs
C. Irrigate the tube.
D. Increase the suction level. 26. Question
A male client is recovering from an ileostomy that
20. Question was performed to treat inflammatory bowel disease.
What laboratory finding is the primary diagnostic During discharge teaching, the nurse should stress the
indicator for pancreatitis? importance of:

A. Elevated blood urea nitrogen (BUN) A. Increasing fluid intake to prevent dehydration.
B. Elevated serum lipase B. Wearing an appliance pouch only at bedtime.
C. Elevated aspartate aminotransferase (AST) C. Consuming a low-protein, high-fiber diet.
D. Taking only enteric-coated medications. A. Ineffective Individual Coping
B. Knowledge Deficit
27. Question C. Impaired Adjustment
The nurse is caring for a female client with active D. Anxiety
upper GI bleeding. What is the appropriate diet for
this client during the first 24 hours after admission? 34. Question
Patients with esophageal varices would reveal the
A. Regular diet following assessment:
B. Skim milk
C. Nothing by mouth A. Increased blood pressure
D. Clear liquids B. Increased heart rate
C. Decreased respiratory rate
28. Question D. Increased urinary output
A male client has just been diagnosed with hepatitis
A. On assessment, the nurse expects to note: 35. Question
The nurse would anticipate using which medication if
A. Severe abdominal pain radiating to the shoulder. sclerotherapy has not been used?
B. Anorexia, nausea, and vomiting.
C. Eructation and constipation. A. Neomycin
D. Abdominal ascites. B. Propranolol
C. Vasopressin
29. Question D. Cimetidine
A female client with viral hepatitis A is being treated
in an acute care facility. Because the client requires 36. Question
enteric precautions, the nurse should: The nurse must be alert for complications with
Sengstaken-Blakemore intubation including:
A. Place the client in a private room.
B. Wear a mask when handling the client’s bedpan. A. Pulmonary obstruction
C. Wash the hands after touching the client. B. Pericardiectomy syndrome
D. Wear a gown when providing personal care for C. Pulmonary embolization
the client. D. Cor pulmonale

30. Question 37. Question

Which of the following factors can cause hepatitis A? Peptic ulcer disease may be caused by which of the
following?
A. Contact with infected blood.
B. Blood transfusions with infected blood. A. Helicobacter pylori
C. Eating contaminated shellfish. B. Clostridium difficile
D. Sexual contact with an infected person. C. Candida albicans
D. Staphylococcus aureus
31. Question
The correct sequence for abdominal assessment is: 38. Question
Pain control with peptic ulcer disease includes all of
A. Inspection, percussion, palpation, auscultation. the following except:
B. Inspection, auscultation, percussion, palpation.
C. Inspection, palpation, auscultation, percussion. A. Promoting physical and emotional rest.
D. Inspection, percussion, auscultation, palpation. B. Identifying stressful situations.
C. Eating meals when desired.
32. Question D. Administering medications that decrease gastric
Peritonitis can occur as a complication of: acidity.

A. Septicemia 39. Question

B. Multiple organ failure Nitrosocarcinogen production can be inhibited with
C. Hypovolemic shock the intake of:
D. Peptic ulcer disease
A. Vitamin C
33. Question B. Vitamin E
A patient has become very depressed postoperatively C. Carbohydrates
after receiving a colostomy for GI cancer. He does D. Fiber
not participate in his colostomy care or looks at the
stoma. An appropriate nursing diagnosis for this
situation is:
40. Question 46. Question
The nurse can expect a 60-year old patient with What assessment finding of a patient with acute
ischemic bowel to report a history of: pancreatitis would indicate a bluish discoloration
around the umbilicus?
A. Diabetes mellitus
B. Asthma A. Grey-Turner's sign
C. Addison's Disease B. Homan's sign
D. Cancer of the bowel C. Rovsing's sign
D. Cullen's sign
41. Question
During the initial assessment of a patient post- 47. Question
endoscopy, the nurse notes absent bowel sounds, A patient with severe cirrhosis of the liver develops
tachycardia, and abdominal distention. The nurse hepatorenal syndrome. Which of the following
would anticipate: nursing assessment data would support this?

A. Ischemic bowel A. Oliguria and azotemia

B. Peritonitis B. Metabolic alkalosis
C. Hypovolemic shock C. Decreased urinary concentration
D. Perforated bowel D. Weight gain of less than 1 lb per week

42. Question 48. Question

Which of the following tests can be useful as a Which phase of hepatitis would the nurse incur strict
diagnostic and therapeutic tool in the biliary system? precautionary measures at?

A. Ultrasonography A. Icteric
B. MRI B. Non-icteric
C. Endoscopic retrograde cholangiopancreatography C. Post-icteric
(ERCP) D. Pre-icteric
D. Computed tomography scan (CT scan)
49. Question
43. Question You are caring for Rona, a 35-year-old female in a
To inhibit pancreatic secretions, which hepatic coma. Which evaluation criteria would be the
pharmacologic agent would you anticipate most appropriate?
administering to a patient with acute pancreatitis?
A. The patient demonstrates an increase in the level
A. Nitroglycerin of consciousness.
B. Somatostatin B. The patient exhibits improved skin integrity.
C. Pancrelipase C. The patient experiences no evident signs of
D. Pepcid bleeding.
D. The patient verbalizes decreased episodes of pain.
44. Question
Your patient’s ABG reveals an acidic pH, an acidic 50. Question
CO2, and a normal bicarbonate level. Which of the What is the primary nursing diagnosis for a 4th to
following indicates this acid-base disturbance? 10th-day postoperative liver transplant patient?

A. Respiratory acidosis A. Excess Fluid Volume

B. Respiratory alkalosis B. Risk for Rejection
C. Metabolic acidosis C. Impaired Skin Integrity
D. Metabolic alkalosis D. Decreased Cardiac Output
QUIZ 3
45. Question 1. Question
A clinical manifestation of acute pancreatitis is A patient with chronic alcohol abuse is admitted with
epigastric pain. Your nursing intervention to facilitate liver failure. You closely monitor the patient’s blood
relief of pain would place the patient in a: pressure because of which change that is associated
with liver failure?
A. Knee-chest position
B. Semi-Fowler's position A. Hypoalbuminemia
C. Recumbent position B. Increased capillary permeability
D. Low-Fowler's position C. Abnormal peripheral vasodilation
D. Excess renin release from the kidneys
 8. Question
2. Question You’re caring for Carin who has just had ileostomy
You’re assessing the stoma of a patient with a surgery. During the first 24 hours post-op, how much
healthy, well-healed colostomy. You expect the drainage can you expect from the ileostomy?
stoma to appear:
A. 100 ml
A. Pale, pink and moist B. 500 ml
B. Red and moist C. 1500 ml
C. Dark or purple-colored D. 5000 ml
D. Dry and black
9. Question
3. Question You’re preparing a teaching plan for a 27 y.o. named
You’re caring for a patient with a sigmoid colostomy. Jeff who underwent surgery to close a temporary
The stool from this colostomy is: ileostomy. Which nutritional guidelines do you
include in this plan?
A. Formed
B. Semisolid A. There is no need to change eating habits.
C. Semiliquid B. Eat six small meals a day.
D. Watery C. Eat the largest meal in the evening.
D. Restrict fluid intake.
4. Question
You’re advising a 21 y.o. with a colostomy who 10. Question
reports problems with flatus. What food should you Arthur has a family history of colon cancer and is
recommend? scheduled to have a sigmoidoscopy. He is crying as
he tells you, “I know that I have colon cancer, too.”
A. Peas Which response is most therapeutic?
B. Cabbage
C. Broccoli A. “I know just how you feel.”
D. Yogurt B. “You seem upset.”
Incorrect C. “Oh, don’t worry about it, everything will be just
fine.”
5. Question D. “Why do you think you have cancer?”
You have to teach ostomy self-care to a patient with a
colostomy. You tell the patient to measure and cut 11. Question
the wafer: You’re caring for Beth who underwent a Billroth II
procedure (surgical removal of the pylorus and
A. To the exact size of the stoma. duodenum) for treatment of a peptic ulcer. Which
B. About 1/16” larger than the stoma. findings suggest that the patient is developing
C. About 1/8” larger than the stoma. dumping syndrome, a complication associated with
this procedure?
6. Question
You’re performing an abdominal assessment on A. Flushed, dry skin.
Brent who is 52 y.o. In which order do you proceed? B. Headache and bradycardia.
C. Dizziness and sweating.
A. Observation, percussion, palpation, auscultation D. Dyspnea and chest pain.
B. Observation, auscultation, percussion, palpation
C. Percussion, palpation, auscultation, observation 12. Question
D. Palpation, percussion, observation, auscultation You’re developing the plan of care for a patient
experiencing dumping syndrome after a Billroth II
7. Question procedure. Which dietary instructions do you
You’re doing preoperative teaching with Gertrude include?
who has ulcerative colitis who needs surgery to
create an ileoanal reservoir. Which information do A. Omit fluids with meals.
you include? B. Increase carbohydrate intake.
C. Decrease protein intake.
A. A reservoir is created that exits through the D. Decrease fat intake.
abdominal wall.
B. A second surgery is required 12 months after the 13. Question
first surgery. You’re caring for Lewis, a 67 y.o. patient with liver
C. A permanent ileostomy is created. cirrhosis who developed ascites and requires
D. The surgery occurs in two stages. paracentesis. Relief of which symptom indicates that
Incorrect the paracentesis was effective?
A. Pruritus 19. Question
B. Dyspnea The student nurse is preparing a teaching care plan to
C. Jaundice help improve nutrition in a patient with achalasia.
D. Peripheral Neuropathy You include which of the following:

14. Question A. Swallow foods while leaning forward.

You’re caring for Jane, a 57 y.o. patient with liver B. Omit fluids at mealtimes.
cirrhosis who developed ascites and requires C. Eat meals sitting upright.
paracentesis. Before her paracentesis, you instruct her D. Avoid soft and semi soft foods.
to:
20. Question
A. Empty her bladder. Britney, a 20 y.o. student is admitted with acute
B. Lie supine in bed. pancreatitis. Which laboratory findings do you expect
C. Remain NPO for 4 hours. to be abnormal for this patient?
D. Clean her bowels with an enema.
A. Serum creatinine and BUN
15. Question B. Alanine aminotransferase (ALT) and aspartate
After abdominal surgery, your patient has a severe aminotransferase (AST)
coughing episode that causes wound evisceration. In C. Serum amylase and lipase
addition to calling the doctor, which intervention is D. Cardiac enzymes
most appropriate?
21. Question
A. Irrigate the wound & organs with Betadine. A patient with Crohn’s disease is admitted after 4
B. Cover the wound with a saline-soaked sterile days of diarrhea. Which of the following urine-
dressing. specific gravity values do you expect to find in this
C. Apply a dry sterile dressing & binder. patient?
D. Push the organs back & cover with moist sterile
dressings. A. 1.005
B. 1.011
16. Question C. 1.020
You’re caring for Betty with liver cirrhosis. Which of D. 1.030
the following assessment findings leads you to
suspect hepatic encephalopathy in her? 22. Question
Your goal is to minimize David’s risk of
A. Asterixis complications after a herniorrhaphy. You instruct the
B. Chvostek’s sign patient to:
C. Trousseau’s sign
D. Hepatojugular reflux A. Avoid the use of pain medication.
B. Cough and deep breath Q2H.
17. Question C. Splint the incision if he can’t avoid sneezing or
You are developing a care plan for Sally, a 67 y.o. coughing.
patient with hepatic encephalopathy. Which of the D. Apply heat to scrotal swelling.
following do you include?
23. Question
A. Administering a lactulose enema as ordered. Janice is waiting for discharge instructions after her
B. Encouraging a protein-rich diet. herniorrhaphy. Which of the following instructions
C. Administering sedatives, as necessary. do you include?
D. Encouraging ambulation at least four times a day.
A. Eat a low-fiber diet.
18. Question B. Resume heavy lifting in 2 weeks.
You have a patient with achalasia (incomplete muscle C. Lose weight, if obese.
relaxation of the GI tract, especially sphincter D. Resume sexual activity once discomfort is gone.
muscles). Which medications do you anticipate to
administer? 24. Question
Develop a teaching care plan for Angie who is about
A. isosorbide dinitrate (Isordil) to undergo a liver biopsy. Which of the following
B. digoxin (Lanoxin) points do you include?
C. captopril (Capoten)
D. propranolol (Inderal) A. “You’ll need to lie on your stomach during the
test.”
B. “You’ll need to lie on your right side after the
test.”
 C. “During the biopsy, you’ll be asked to exhale 30. Question
deeply and hold it.” Matt is a 49 y.o. with a hiatal hernia that you are
D. “The biopsy is performed under general about to counsel. Health care counseling for Matt
anesthesia.” should include which of the following instructions?

25. Question A. Restrict intake of high-carbohydrate foods.

Stephen is a 62 y.o. patient that has had a liver B. Increase fluid intake with meals.
biopsy. Which of the following groups of signs alert C. Increase fat intake.
you to a possible pneumothorax? D. Eat three regular meals a day.

A. Dyspnea and reduced or absent breath sound over 31. Question

the right lung. Jerod is experiencing an acute episode of ulcerative
B. Tachycardia, hypotension, and cool, clammy skin. colitis. Which is the priority for this patient?
C. Fever, rebound tenderness, and abdominal
rigidity. A. Replace lost fluid and sodium.
D. Redness, warmth, and drainage at the biopsy site. B. Monitor for increased serum glucose level from
steroid therapy.
26. Question C. Restrict the dietary intake of foods high in
Michael, 42 y.o. The man is admitted to the med-surg potassium.
floor with a diagnosis of acute pancreatitis. His BP is D. Note any change in the color and consistency of
136/76, pulse 96, Resps 22, and temp 101. His past stools.
history includes hyperlipidemia and alcohol abuse.
The doctor prescribes an NG tube. Before inserting 32. Question
the tube, you explain the purpose to the patient. A 29 y.o. patient has an acute episode of ulcerative
Which of the following is the most accurate colitis. What diagnostic test confirms this diagnosis?
explanation?
A. Barium Swallow
A. “It empties the stomach of fluids and gas.” B. Stool examination
B. “It prevents spasms at the sphincter of Oddi.” C. Gastric analysis
C. “It prevents air from forming in the small D. Sigmoidoscopy
intestine and large intestine.”
D. “It removes bile from the gallbladder.” 33. Question
Eleanor, a 62 y.o. woman with diverticulosis is your
27. Question patient. Which interventions would you expect to
Jason, a 22 y.o. accident victim, requires an NG tube include in her care?
for feeding. What should you immediately do after
inserting an NG tube for liquid enteral feedings? A. Low-fiber diet and fluid restrictions.
B. Total parenteral nutrition and bed rest.
A. Aspirate for gastric secretions with a syringe. C. High-fiber diet and administration of psyllium.
B. Begin feeding slowly to prevent cramping. D. Administration of analgesics and antacids.
C. Get an X-ray of the tip of the tube within 24
hours. 34. Question
D. Clamp off the tube until the feedings begin. Regina is a 46 y.o. woman with ulcerative colitis.
You expect her stools to look like:
28. Question
Stephanie, a 28 y.o. accident victim, requires TPN. A. Watery and frothy
The rationale for TPN is to provide: B. Bloody and mucous
C. Firm and well-formed
A. Necessary fluids and electrolytes to the body. D. Alternating constipation and diarrhea
B. Complete nutrition by the I.V. route.
C. Tube feedings for nutritional supplementation. 35. Question
D. Dietary supplementation with liquid protein given Donald is a 61 y.o. man with diverticulitis.
between meals. Diverticulitis is characterized by:

29. Question A. Periodic rectal hemorrhage.

Type A chronic gastritis can be distinguished from B. Hypertension and tachycardia.
type B by its ability to: C. Vomiting and elevated temperature.
D. Crampy and lower left quadrant pain and low-
A. Cause atrophy of the parietal cells. grade fever.
B. Affect only the antrum of the stomach.
C. Thin the lining of the stomach walls. 36. Question
D. Decrease gastric secretions. Brenda, a 36 y.o. patient is on your floor with acute
pancreatitis. Treatment for her includes:
 Your patient has a GI tract that is functioning, but has
A. Continuous peritoneal lavage. the inability to swallow foods. Which is the preferred
B. Regular diet with increased fat. method of feeding for your patient?
C. Nutritional support with TPN.
D. Insertion of a T tube to drain the pancreas. A. TPN
B. PPN
37. Question C. NG feeding
Glenda has cholelithiasis (gallstones). You expect her D. Oral liquid supplements
to complain of:
43. Question
A. Pain in the right upper quadrant, radiating to the Your patient is complaining of abdominal pain during
shoulder. assessment. What is your priority?
B. Pain in the right lower quadrant, with rebound
tenderness. A. Auscultate to determine changes in bowel sounds.
C. Pain in the left upper quadrant, with shortness of B. Observe the contour of the abdomen.
breath. C. Palpate the abdomen for a mass.
D. Pain in the left lower quadrant, with mild D. Percuss the abdomen to determine if fluid is
cramping. present.

38. Question 44. Question

After an abdominal resection for colon cancer, Before bowel surgery, Lee is to administer enemas
Madeline returns to her room with a Jackson-Pratt until clear. During administration, he complains of
drain in place. The purpose of the drain is to: intestinal cramps. What do you do next?

A. Irrigate the incision with a saline solution. A. Discontinue the procedure.

B. Prevent bacterial infection of the incision. B. Lower the height of the enema container.
C. Measure the amount of fluid lost after surgery. C. Complete the procedure as quickly as possible.
D. Prevent accumulation of drainage in the wound. D. Continue administration of the enema as ordered
Correct without making any adjustments.

39. Question 45. Question

Anthony, a 60 y.o. patient, has just undergone a Leigh Ann is receiving pancrelipase (Viokase) for
bowel resection with a colostomy. During the first 24 chronic pancreatitis. Which observation best
hours, which of the following observations about the indicates the treatment is effective?
stoma should you report to the doctor?
A. There is no skin breakdown.
A. Pink color B. Her appetite improves.
B. Light edema C. She lost more than 10 lbs.
C. Small amount of oozing D. Stools are less fatty and decrease in frequency.
D. Trickles of bright red blood
46. Question
40. Question Ralph has a history of alcohol abuse and has acute
You’re teaching Anthony how to use his new pancreatitis. Which lab value is most likely to be
colostomy. How much skin should remain exposed elevated?
between the stoma and the ring of the appliance?
A. Calcium
1/16” B. Glucose
1/4” C. Magnesium
1/2” D. Potassium
1”
47. Question
41. Question Anna is 45 y.o. and has a bleeding ulcer. Despite
Claire, a 33 y.o. is on your floor with a possible multiple blood transfusions, her HGB is 7.5g/dl and
bowel obstruction. Which intervention is a priority HCT is 27%. Her doctor determines that surgical
for her? intervention is necessary and she undergoes partial
gastrectomy. Postoperative nursing care includes:
A. Obtain daily weights.
B. Measure abdominal girth. A. Giving pain medication Q6H.
C. Keep strict intake and output. B. Flushing the NG tube with sterile water.
D. Encourage her to increase fluids. C. Positioning her in high Fowler’s position.
D. Keeping her NPO until the return of peristalsis.
42. Question
48. Question Which of the following definitions best describes
Sitty, a 66 y.o. patient underwent a colostomy for a gastritis?
ruptured diverticulum. She did well during the
surgery and returned to your med-surg floor in stable A. Erosion of the gastric mucosa.
condition. You assess her colostomy 2 days after B. Inflammation of a diverticulum.
surgery. Which finding do you report to the doctor? C. Inflammation of the gastric mucosa.
D. Reflux of stomach acid into the esophagus.
A. Blanched stoma
B. Edematous stoma 5. Question
C. Reddish-pink stoma Which of the following substances is most likely to
D. Brownish-black stoma cause gastritis?

49. Question A. Milk

Sharon has cirrhosis of the liver and develops ascites. B. Bicarbonate of soda, or baking soda
What intervention is necessary to decrease the C. Enteric-coated aspirin
excessive accumulation of serous fluid in her D. Nonsteroidal anti-inflammatory drugs
peritoneal cavity?
6. Question
A. Restrict fluids. Which of the following definitions best describes
B. Encourage ambulation. diverticulosis?
C. Increase sodium in the diet.
D. Give antacids as prescribed. A. An inflamed outpouching of the intestine.
B. A noninflamed outpouching of the intestine.
50. Question C. The partial impairment of the forward flow of
Katrina is diagnosed with lactose intolerance. To intestinal contents.
avoid complications with lack of calcium in the diet, D. An abnormal protrusion of an organ through the
which food should be included in the diet? structure that usually holds it.

A. Fruit 7. Question
B. Whole grains Which of the following types of diets is implicated in
C. Milk and cheese products the development of diverticulosis?
D. Dark green, leafy vegetables
A. Low-fiber diet
QUIZ 4 B. High-fiber diet
1. Question C. High-protein diet
Which of the following complications is thought to D. Low-carbohydrate diet
be the most common cause of appendicitis?
8. Question
A. A fecalith Which of the following mechanisms can facilitate the
B. Bowel kinking development of diverticulosis into diverticulitis?
C. Internal bowel occlusion
D. Abdominal bowel swelling A. Treating constipation with chronic laxative use,
leading to dependence on laxatives.
2. Question B. Chronic constipation causing an obstruction,
Which of the following terms best describes the pain reducing forward flow of intestinal contents.
associated with appendicitis? C. Herniation of the intestinal mucosa, rupturing the
wall of the intestine.
A. Aching D. Undigested food blocking the diverticulum,
B. Fleeting predisposing the area to bacterial invasion.
C. Intermittent
D. Steady 9. Question
Which of the following symptoms indicated
3. Question diverticulosis?
Which of the following nursing interventions should
be implemented to manage a client with appendicitis? A. No symptoms exist.
B. Change in bowel habits.
A. Assessing pain. C. Anorexia with low-grade fever.
B. Encouraging oral intake of clear fluids. D. Episodic, dull, or steady midabdominal pain.
C. Providing discharge teaching. Incorrect
D. Assessing for symptoms of peritonitis.
10. Question
4. Question Which of the following tests should be administered
to a client suspected of having diverticulosis?
 17. Question
A. Abdominal ultrasound Which of the following areas is the most common
B. Barium enema site of fistulas in clients with Crohn’s disease?
C. Barium swallow
D. Gastroscopy A. Anorectal
B. Ileum
11. Question C. Rectovaginal
Medical management of the client with diverticulitis D. Transverse colon
should include which of the following treatments?
18. Question
A. Reduced fluid intake. Which of the following associated disorders may a
B. Increased fiber in the diet. client with ulcerative colitis exhibit?
C. Administration of antibiotics.
D. Exercises to increase intra-abdominal pressure. A. Gallstones
B. Hydronephrosis
12. Question C. Nephrolithiasis
Crohn’s disease can be described as a chronic D. Toxic megacolon
relapsing disease. Which of the following areas in the
GI system may be involved with this disease? 19. Question
Which of the following associated disorders may the
A. The entire length of the large colon. client with Crohn’s disease exhibit?
B. Only the sigmoid area.
C. The entire large colon through the layers of A. Ankylosing spondylitis
mucosa and submucosa. B. Colon cancer
D. The small intestine and colon; affecting the entire C. Malabsorption
thickness of the bowel. D. Lactase deficiency

13. Question 20. Question

Which area of the alimentary canal is the most Which of the following symptoms may be exhibited
common location for Crohn’s disease? by a client with Crohn’s disease?

A. Ascending colon A. Bloody diarrhea

B. Descending colon B. Narrow stools
C. Sigmoid colon C. N/V
D. Terminal ileum D. Steatorrhea

14. Question
Which of the following factors is believed to be
linked to Crohn’s disease? 21. Question
Which of the following symptoms is associated with
A. Constipation ulcerative colitis?
B. Diet
C. Hereditary A. Dumping syndrome
D. Lack of exercise B. Rectal bleeding
C. Soft stools
15. Question D. Fistulas
Which of the following factors is believed to cause
ulcerative colitis? 22. Question
If a client had irritable bowel syndrome, which of the
A. Acidic diet following diagnostic tests would determine if the
B. Altered immunity diagnosis is Crohn’s disease or ulcerative colitis?
C. Chronic constipation
D. Emotional stress A. Abdominal computed tomography (CT) scan
B. Abdominal x-ray
16. Question C. Barium swallow
Fistulas are most common with which of the D. Colonoscopy with biopsy
following bowel disorders?
23. Question
A. Crohn’s disease Which of the following interventions should be
B. Diverticulitis included in the medical management of Crohn’s
C. Diverticulosis disease?
D. Ulcerative colitis
A. Increasing oral intake of fiber.
B. Administering laxatives. 30. Question
C. Using long-term steroid therapy. Which of the following diagnostic tests should be
D. Increasing physical activity. performed annually over age 50 to screen for colon
cancer?
24. Question
In a client with Crohn’s disease, which of the A. Abdominal CT scan
following symptoms should not be a direct result of B. Abdominal x-ray
antibiotic therapy? C. Colonoscopy
D. Fecal occult blood test
A. Decrease in bleeding.
B. Decrease in temperature. 31. Question
C. Decrease in body weight. Radiation therapy is used to treat colon cancer before
D. Decrease in the number of stools. surgery for which of the following reasons?

25. Question A. Reducing the size of the tumor.

Surgical management of ulcerative colitis may be B. Eliminating the malignant cells.
performed to treat which of the following C. Curing cancer.
complications? D. Helping the bowel heal after surgery.

A. Gastritis 32. Question

B. Bowel herniation Which of the following symptoms is a client with
C. Bowel outpouching colon cancer most likely to exhibit?
D. Bowel perforation
A. A change in appetite.
26. Question B. A change in bowel habits.
Which of the following medications is most effective C. An increase in body weight.
for treating the pain associated with irritable bowel D. An increase in body temperature.
disease?
33. Question
A. Acetaminophen A client has just had surgery for colon cancer. Which
B. Opiates of the following disorders might the client develop?
C. Steroids
D. Stool softeners A. Peritonitis
B. Diverticulosis
27. Question C. Partial bowel obstruction
During the first few days of recovery from ostomy D. Complete bowel obstruction
surgery for ulcerative colitis, which of the following
aspects should be the first priority of client care? 34. Question
A client with gastric cancer may exhibit which of the
A. Body image following symptoms?
B. Ostomy care
C. Sexual concerns A. Abdominal cramping
D. Skin care B. Constant hunger
C. Feeling of fullness
28. Question D. Weight gain
Colon cancer is most closely associated with which
of the following conditions? 35. Question
Which of the following diagnostic tests may be
A. Appendicitis performed to determine if a client has gastric cancer?
B. Hemorrhoids
C. Hiatal hernia A. Barium enema
D. Ulcerative colitis B. Colonoscopy
C. Gastroscopy
29. Question D. Serum chemistry levels
Which of the following diets is most commonly
associated with colon cancer? 36. Question
A client with gastric cancer can expect to have
A. Low-fiber, high fat surgery for resection. Which of the following should
B. Low-fat, high-fiber be the nursing management priority for the
C. Low-protein, high-carbohydrate preoperative client with gastric cancer?
D. Low carbohydrate, high protein
A. Discharge planning
B. Correction of nutritional deficits
C. Prevention of DVT B. Abdominal pain and rigidity
D. Instruction regarding radiation treatment C. Hyperactive bowel sounds
D. Right upper quadrant pain
37. Question 44. Question
Care for the postoperative client after gastric Which of the following laboratory results would be
resection should focus on which of the following expected in a client with peritonitis?
problems?
A. Partial thromboplastin time above 100 seconds
A. Body image B. Hemoglobin level below 10 mg/dL
B. Nutritional needs C. Potassium level above 5.5 mEq/L
C. Skincare D. White blood cell count above 15,000
D. Spiritual needs
45. Question
38. Which of the following complications of gastric Which of the following therapies is not included in
resection should the nurse teach the client to watch the medical management of a client with peritonitis?
for?
A. Broad-spectrum antibiotics
A. Constipation B. Electrolyte replacement
B. Dumping syndrome C. I.V. fluids
C. Gastric spasm D. Regular diet
D. Intestinal spasms
46. Question
39. Question Which of the following aspects is the priority focus
A client with rectal cancer may exhibit which of the of nursing management for a client with peritonitis?
following symptoms?
A. Fluid and electrolyte balance
A. Abdominal fullness B. Gastric irrigation
B. Gastric fullness C. Pain management
C. Rectal bleeding D. Psychosocial issues
D. Right upper quadrant pain
47. Question
40. Question A client with irritable bowel syndrome is being
A client with which of the following conditions may prepared for discharge. Which of the following meal
be likely to develop rectal cancer? plans should the nurse give the client?

A. Adenomatous polyps A. Low fiber, low-fat

B. Diverticulitis B. High fiber, low-fat
C. Hemorrhoids C. Low fiber, high-fat
D. Peptic ulcer disease D. High-fiber, high-fat

41. Question 48. Question

Which of the following treatments is used for rectal A client presents to the emergency room, reporting
cancer but not for colon cancer? that he has been vomiting every 30 to 40 minutes for
the past 8 hours. Frequent vomiting puts him at risk
A. Chemotherapy for which of the following?
B. Colonoscopy
C. Radiation A. Metabolic acidosis with hyperkalemia
D. Surgical resection B. Metabolic acidosis with hypokalemia
C. Metabolic alkalosis with hyperkalemia
42. Question D. Metabolic alkalosis with hypokalemia
Which of the following conditions is most likely to
directly cause peritonitis? 49. Question
Five days after undergoing surgery, a client develops
A. Cholelithiasis a small bowel obstruction. A Miller-Abbott tube is
B. Gastritis inserted for bowel decompression. Which nursing
C. Perforated ulcer diagnosis takes priority?
D. Incarcerated hernia
A. Imbalanced nutrition: Less than body
43. Question requirements
Which of the following symptoms would a client in B. Acute pain
the early stages of peritonitis exhibit? C. Deficient fluid volume
D. Excess fluid volume
A. Abdominal distention
50. Question 5. Question
When teaching an elderly client how to prevent A client has a percutaneous endoscopic gastrostomy
constipation, which of the following instructions tube inserted for tube feedings. Before starting a
should the nurse include? continuous feeding, the nurse should place the client
in which position?
A. “Drink 6 glasses of fluid each day.”
B. “Avoid grain products and nuts.” A. Semi-Fowlers
C. “Add at least 4 grams of bran to your cereal each B. Supine
morning.” C. Reverse Trendelenburg
D. “Be sure to get regular exercise.” D. High Fowler’s
Correct
6. Question
QUIZ 5 An enema is prescribed for a client with suspected
1. Question appendicitis. Which of the following actions should
In a client with diarrhea, which outcome indicates the nurse take?
that fluid resuscitation is successful?
A. Prepare 750 ml of irrigating solution warmed to
A. The client passes formed stools at regular 100° F.
intervals. B. Question the physician about the order.
B. The client reports a decrease in stool frequency C. Provide privacy and explain the procedure to the
and liquidity. client.
C. The client exhibits firm skin turgor. D. Assist the client to the left lateral Sims position.
D. The client no longer experiences perianal
burning. 7. Question
The client being seen in a physician’s office has just
2. Question been scheduled for a barium swallow the next day.
When teaching a community group about measures to The nurse writes down which of the following
prevent colon cancer, which instruction should the instructions for the client to follow before the test?
nurse include?
A. Fast for 8 hours before the test.
A. “Limit fat intake to 20% to 25% of your total B. Eat a regular supper and breakfast.
daily calories.” C. Continue to take all oral medications as
B. “Include 15 to 20 grams of fiber into your daily scheduled.
diet.” D. Monitor own bowel movement pattern for
C. “Get an annual rectal examination after age 35.” constipation.
D. “Undergo sigmoidoscopy annually after age 50.”
8. Question
3. Question The nurse is monitoring a client for the early signs of
A 30-year old client experiences weight loss, dumping syndrome. Which symptom indicates this
abdominal distention, crampy abdominal pain, and occurrence?
intermittent diarrhea after the birth of her 2nd child.
Diagnostic tests reveal gluten-induced enteropathy. A. Abdominal cramping and pain
Which foods must she eliminate from her diet B. Bradycardia and indigestion
permanently? C. Sweating and pallor
D. Double vision and chest pain
A. Milk and dairy products
B. Protein-containing foods 9. Question
C. Cereal grains (except rice and corn) The nurse is preparing a discharge teaching plan for
D. Carbohydrates the client who had an umbilical hernia repair. Which
4. Question of the following would the nurse include in the plan?
After a right hemicolectomy for treatment of colon
cancer, a 57-year old client is reluctant to turn while A. Restricting pain medication.
on bed rest. Which action by the nurse would be B. Maintaining bedrest.
appropriate? C. Avoiding coughing.
D. Irrigating the drain.
A. Asking a coworker to help turn the client.
B. Explaining to the client why turning is important. 10. Question
C. Allowing the client to turn when he’s ready to do The nurse is caring for a hospitalized client with a
so. diagnosis of ulcerative colitis. Which finding, if
D. Telling the client that the physician’s order states noted on assessment of the client, would the nurse
he must turn every 2 hours. report to the physician?A. Bloody diarrhea

A. Bloody diarrhea
B. Hypotension 16. Question
C. A hemoglobin of 12 mg/dL The nurse instructs the ileostomy client to do which
D. Rebound tenderness of the following as a part of essential care of the
stoma?
11. Question
The nurse is reviewing the record of a client with A. Cleanse the peristomal skin meticulously.
Crohn’s disease. Which of the following stool B. Take in high-fiber foods such as nuts.
characteristics would the nurse expect to note C. Massage the area below the stoma.
documented on the client’s record? D. Limit fluid intake to prevent diarrhea.

A. Chronic constipation 17. Question

B. Diarrhea The client who has undergone the creation of a
C. Constipation alternating with diarrhea. colostomy has a nursing diagnosis of Disturbed body
D. Stool constantly oozes from the rectum. image. The nurse would evaluate that the client is
making the most significant progress toward
12. Question identified goals if the client:
The nurse is performing colostomy irrigation on a
client. During the irrigation, a client begins to A. Watch the nurse empty the colostomy bag.
complain of abdominal cramps. Which of the B. Look at the ostomy site.
following is the most appropriate nursing action? C. Read the ostomy product literature.
D. Practice cutting the ostomy appliance.
A. Notify the physician.
B. Increase the height of the irrigation. 18. Question
C. Stop the irrigation temporarily. The nurse is assessing for stoma prolapse in a client
D. Medicate with dilaudid and resume the irrigation. with a colostomy. The nurse would observe which of
the following if stoma prolapse occurred?
13. Question
The nurse is teaching the client how to perform a A. Sunken and hidden stoma
colostomy irrigation. To enhance the effectiveness of B. Dark- and bluish-colored stoma
the irrigation and fecal returns, what measure should C. Narrowed and flattened stoma
the nurse instruct the client to do? D. Protruding stoma

A. Increase fluid intake. 19. Question

B. Reduce the amount of irrigation solution. The client with a new colostomy is concerned about
C. Perform the irrigation in the evening. the odor from the stool in the ostomy drainage bag.
D. Place heat on the abdomen. The nurse teaches the client to include which of the
following foods in the diet to reduce odor?
14. Question
The nurse is reviewing the physician’s orders written A. Yogurt
for a client admitted with acute pancreatitis. Which B. Broccoli
physician order would the nurse question if noted on C. Cucumbers
the client’s chart? D. Eggs

A. NPO status 20. Question

B. Insert a nasogastric tube The nurse has given instructions to the client with an
C. An anticholinergic medication ileostomy about foods to eat to thicken the stool. The
D. Morphine for pain nurse determines that the client needs further
instructions if the client starts to eat which of the
15. Question following foods to make the stools less watery?
The nurse is doing an admission assessment on a
client with a history of duodenal ulcer. To determine A. Pasta
whether the problem is currently active, the nurse B. Boiled rice
would assess the client for which of the following C. Bran
most frequent symptom(s) of duodenal ulcer? D. Low-fat cheese

A. Pain that is relieved by food intake. 21. Question

B. Pain that radiates down the right arm. The client has just had surgery to create an ileostomy.
C. N/V The nurse assesses the client in the immediate post-
D. Weight loss op period for which of the following most frequent
complications of this type of surgery?

A. Intestinal obstruction
B. Fluid and electrolyte imbalance
C. Malabsorption of fat client to avoid which of the following in managing
D. Folate deficiency this problem?

22. Question A. Lying supine with the legs straight.

The nurse is doing pre-op teaching with the client B. Massaging the abdomen.
who is about to undergo the creation of a Kock C. Using antispasmodic medication.
pouch. The nurse interprets that the client has the best D. Using relaxation techniques.
understanding of the nature of the surgery if the client
makes which of the following statements? 27. Question
A client with ulcerative colitis has an order to begin
A. “I will need to drain the pouch regularly with a salicylate medication to reduce inflammation. The
catheter.” nurse instructs the client to take the medication:
B. “I will need to wear a drainage bag for the rest of
my life.” A. 30 minutes before meals
C. “The drainage from this type of ostomy will be B. On an empty stomach
formed.” C. After meals
D. “I will be able to pass stool from my rectum D. On arising
eventually.”
23. Question 28. Question
The client with a colostomy has an order for During the assessment of a client’s mouth, the nurse
irrigation of the colostomy. The nurse used which notes the absence of saliva. The client is also
solution for irrigation?A. Distilled water complaining of pain near the area of the ear. The
client has been NPO for several days because of the
A. Distilled water insertion of a NG tube. Based on these findings, the
B. Tap water nurse suspects that the client is developing which of
C. Sterile water the following mouth conditions?
D. Lactated Ringer’s
A. Stomatitis
24. Question B. Oral candidiasis
A nurse is monitoring a client admitted to the hospital C. Parotitis
with a diagnosis of appendicitis. The client is D. Gingivitis
scheduled for surgery in 2 hours. The client begins to
complain of increased abdominal pain and begins to 29. Question
vomit. On assessment, the nurse notes that the The nurse evaluates the client’s stoma during the
abdomen is distended and the bowel sounds are initial post-op period. Which of the following
diminished. Which of the following is the most observations should be reported immediately to the
appropriate nursing intervention? physician?

A. Administer dilaudid. A. The stoma is slightly edematous.

B. Notify the physician. B. The stoma is dark red to purple.
C. Call and ask the operating room team to perform C. The stoma oozes a small amount of blood.
the surgery as soon as possible. D. The stoma does not expel stool.
D. Reposition the client and apply a heating pad in a
warm setting to the client’s abdomen. 30. Question
Incorrect When planning care for a client with ulcerative colitis
who is experiencing symptoms, which client care
25. Question activities can the nurse appropriately delegate to an
The client has been admitted with a diagnosis of unlicensed assistant? Select all that apply.
acute pancreatitis. The nurse would assess this client
for pain that is: A. Assessing the client’s bowel sounds.
B. Providing skincare following bowel movements.
A. Severe and unrelenting, located in the epigastric C. Evaluating the client’s response to antidiarrheal
area and radiating to the back. medications.
B. Severe and unrelenting, located in the left lower D. Maintaining intake and output records.
quadrant and radiating to the groin. E. Obtaining the client’s weight.
C. Burning and aching, located in the epigastric area Correct Answer: B, D, and E.
and radiating to the umbilicus.
D. Burning and aching, located in the left lower 31. Question
quadrant and radiating to the hip. Which goal of the client’s care should take priority
during the first days of hospitalization for an
26. Question exacerbation of ulcerative colitis?
The client with Crohn’s disease has a nursing
diagnosis of acute pain. The nurse would teach the A. Promoting self-care and independence.
B. Managing diarrhea. D. Contact the physician regarding the drug
C. Maintaining adequate nutrition. interaction and request a change in the time of dosing
D. Promoting rest and comfort. of the drugs.

32. Question 37. Question

A client’s ulcerative colitis symptoms have been The nurse would teach patients that antacids are
present for longer than 1 week. The nurse recognizes effective in the treatment of hyperacidity because
that the client should be assessed carefully for signs they:
of which of the following complications?
A. Neutralize gastric acid.
A. Heart failure B. Decrease stomach motility.
B. DVT C. Decrease gastric pH.
C. Hypokalemia D. Decrease duodenal pH.
D. Hypocalcemia
38. Question
33. Question The nurse would monitor for which of the following
A client who has ulcerative colitis has persistent adverse reactions to aluminum-containing antacids
diarrhea. He is thin and has lost 12 pounds since the such as aluminum hydroxide (Amphojel)?
exacerbation of his ulcerative colitis. The nurse
should anticipate that the physician will order which A. Diarrhea
of the following treatment approaches to help the B. Constipation
client meet his nutritional needs? C. GI upset
D. Fluid retention
A. Initiate continuous enteral feedings.
B. Encourage a high protein, high-calorie diet. 39. Question
C. Implement total parenteral nutrition. The nurse would question an order for which type of
D. Provide six small meals a day. antacid in patients with chronic renal failure?

34. Question A. Aluminum-containing antacids

Digoxin preparations and absorbents should not be B. Calcium-containing antacids
given simultaneously. As a nurse, you are aware that C. Magnesium-containing antacids
if these agents are given simultaneously, which of the D. All of the above.
following will occur?
40. Question
A. Increased absorption of digoxin. The nurse would monitor a patient using sodium
B. Decreased absorption of digoxin. bicarbonate to treat gastric hyperacidity for signs and
C. Increased absorption of the absorbent. symptoms of:A. Metabolic alkalosis
D. Decreased absorption of the absorbent.
A. Metabolic alkalosis
35. Question B. Metabolic acidosis
When used with hyperacidic disorders of the C. Hyperkalemia
stomach, antacids are given to elevate the gastric pH D. Hypercalcemia
to:
41. Question
A. 2.0 Which of the following nursing diagnoses is
B. 4.0 appropriate for a patient receiving famotidine
C. 6.0 (Pepcid)?
D. >8.0
A. Increased risk for infection due to
36. Question immunosuppression.
One of your patients is receiving digitalis orally and B. Potential risk for bleeding related to
is also to receive an antacid at the same time. Your thrombocytopenia.
most appropriate action, based on the C. Alteration in urinary elimination related to
pharmacokinetics of antacids, is to: retention.
D. Alteration in tissue perfusion related to
A. Delay the digitalis for 1 to 2 hours until the hypertension.
antacid is absorbed.
B. Give the antacid at least 2 to 4 hours before 42. Question
administering the digitalis. Histamine2-receptor antagonists:
C. Administer both medications as ordered and
documented in the nurse’s notes. A. Compete with histamine for binding sites on the
parietal cells.
B. Irreversibly bind to H+/K+ATPase.
 C. Cause a decrease in stomach pH. D. Binding to diarrhea-causing bacteria for
D. Decrease signs and symptoms of allergies related excretion.
to histamine release.
49. Question
43. Question Side effects of loperamide (Imodium) include all of
Proton pump inhibitors cause: the following except?

A. Gastric ulcer formation A. Diarrhea

B. GERD B. Epigastric pain
C. Achlorhydria C. Dry mouth
D. Diverticulosis D. Anorexia
Incorrect
50. Question
44. Question The mechanism of action of diphenoxylate (Lotomil)
A patient unable to tolerate oral medications may be is:
prescribed which of the following proton pump
inhibitors to be administered intravenously? A. An increase in intestinal excretion of water.
B. An increase in intestinal motility.
A. lansoprazole (Prevacid) C. A decrease in peristalsis in the intestinal wall.
B. omeprazole (Prilosec) D. A decrease in the reabsorption of water in the
C. pantoprazole (Protonix) bowel.
D. esomeprazole (Nexium) QUIZ 6
1. Question
45. Question Which of the following conditions can cause a hiatal
When administering sucralfate (Carafate) to a patient hernia?
with a nasogastric tube, it is important to:
A. Increased intrathoracic pressure.
A. Crush the tablet into a fine powder before mixing B. Weakness of the esophageal muscle.
with water. C. Increased esophageal muscle pressure.
B. Administer with a bolus tube feeding. D. Weakness of the diaphragmatic muscle.
C. Allow the tablet to dissolve in water before
administering. 2. Question
D. Administer with an antacid for maximum benefit. Risk factors for the development of Hiatal hernias are
those that lead to increased abdominal pressure.
Which of the following complications can cause
46. Question increased abdominal pressure?
Sucralfate (Carafate) achieves a therapeutic effect by:
A. Obesity
A. Neutralizing gastric acid. B. Volvulus
B. Enhancing gastric absorption. C. Constipation
C. Forming a protective barrier around gastric D. Intestinal obstruction
mucosa.
D. Inhibiting gastric acid secretion. 3. Question
Which of the following symptoms is common with a
47. Question hiatal hernia?
To avoid fecal impaction, psyllium (Metamucil)
should be administered with at least how many A. Left arm pain
ounces of fluid? B. Lower back pain
C. Esophageal reflux
A. 4 D. Abdominal cramping
B. 6
C. 8 4. Question
D. 10 Which of the following tests can be performed to
diagnose a hiatal hernia?
48. Question
Bismuth subsalicylate (Pepto-Bismol), as an A. Colonoscopy
absorbent, has which of the following mechanisms of B. Lower GI series
action? C. Barium swallow
D. Abdominal x-rays
A. Decreased GI motility.
B. Decreased gastric secretions. 5. Question
C. Increased fluid absorption. Which of the following measures should the nurse
focus on for the client with esophageal varices?
 The nurse instructs the nursing assistant on how to
A. Recognizing hemorrhage. provide oral hygiene for a client who cannot perform
B. Controlling blood pressure. this task for himself. Which of the following
C. Encouraging nutritional intake. techniques should the nurse tell the assistant to
D. Teaching the client about varices. incorporate into the client’s daily care?

6. Question A. Assess the oral cavity each time mouth care is

Which of the following tests can be used to diagnose given and record observations.
ulcers? B. Use a soft toothbrush to brush the client’s teeth
after each meal.
A. Abdominal x-ray C. Swab the client’s tongue, gums, and lips with a
B. Barium swallow soft foam applicator every 2 hours.
C. Computed tomography (CT) scan D. Rinse the client’s mouth with mouthwash several
D. Esophagogastroduodenoscopy (EGD) times a day.
12. Question
7. Question A client with suspected gastric cancer undergoes an
Which of the following best describes the method of endoscopy of the stomach. Which of the following
action of medications, such as ranitidine (Zantac), assessments made after the procedure would indicate
which are used in the treatment of peptic ulcer the development of a potential complication?
disease?
A. The client complains of a sore throat.
A. Neutralize acid. B. The client displays signs of sedation.
B. Reduce acid secretions. C. The client experiences a sudden increase in
C. Stimulate gastrin release. temperature.
D. Protect the mucosal barrier. D. The client demonstrates a lack of appetite.
Correct
8. Question
The hospitalized client with GERD is complaining of 13. Question
chest discomfort that feels like heartburn following a A client has been diagnosed with adenocarcinoma of
meal. After administering an ordered antacid, the the stomach and is scheduled to undergo a subtotal
nurse encourages the client to lie in which of the gastrectomy (Billroth II procedure). During
following positions? preoperative teaching, the nurse is reinforcing
information about the procedure. Which of the
A. Supine with the head of the bed flat. following explanations is most accurate?
B. On the stomach with the head flat.
C. On the left side with the head of the bed elevated A. The procedure will result in enlargement of the
30 degrees. pyloric sphincter.
D. On the right side with the head of the bed B. The procedure will result in anastomosis of the
elevated 30 degrees. gastric stump to the jejunum.
C. The procedure will result in removal of the
9. Question duodenum.
The nurse is caring for a client following a Billroth II D. The procedure will result in repositioning of the
procedure. On review of the post-operative orders, vagus nerve.
which of the following, if prescribed, would the nurse
question and verify? 14. Question
After a subtotal gastrectomy, the nurse should
A. Irrigating the nasogastric tube. anticipate that nasogastric tube drainage will be what
B. Coughing and deep breathing exercises. color for about 12 to 24 hours after surgery?
C. Leg exercises
D. Early ambulation A. Dark brown
B. Bile green
10. Question C. Bright red
The nurse is providing discharge instructions to a D. Cloudy white
client following gastrectomy. Which measure will the
nurse instruct the client to follow to assist in 15. Question
preventing dumping syndrome? After a subtotal gastrectomy, care of the client’s
nasogastric tube and drainage system should include
A. Eat high-carbohydrate foods. which of the following nursing interventions?
B. Limit the fluids taken with meals.
C. Ambulate following a meal. A. Irrigate the tube with 30 ml of sterile water every
D. Sit in a high-Fowler's position during meals. hour if needed.
B. Reposition the tube if it is not draining well.
11. Question
 C. Monitor the client for N/V, and abdominal indicate that the client is developing a complication
distention. related to the procedure? Select all that apply.
D. Turn the machine to high suction if the drainage
is sluggish on low suction. A. The client complains of a sore throat.
Incorrect B. The client has a temperature of 100*F.
16. Question C. The client appears drowsy following the
Which of the following would be an expected procedure.
nutritional outcome for a client who has undergone a D. The client complains of epigastric pain.
subtotal gastrectomy for cancer? E. The client experiences hematemesis.

A. Regain weight loss within 1 month after surgery. 22. Question

B. Resume normal dietary intake of three meals per A client with peptic ulcer disease tells the nurse that
day. he has black stools, which he has not reported to his
C. Control nausea and vomiting through regular use physician. Based on this information, which nursing
of antiemetics. diagnosis would be appropriate for this client?
D. Achieve optimal nutritional status through oral or
parenteral feedings. A. Ineffective coping related to fear of diagnosis of
chronic illness.
17. Question B. Deficient knowledge related to unfamiliarity with
The client with GERD complains of a chronic cough. significant signs and symptoms.
The nurse understands that in a client with GERD C. Constipation related to decreased gastric motility.
this symptom may be indicative of which of the D. Imbalanced nutrition: Less than body
following conditions? requirements due to gastric bleeding.

A. Development of laryngeal cancer. 23. Question

B. Irritation of the esophagus. A client with a peptic ulcer reports epigastric pain
C. Esophageal scar tissue formation. that frequently awakens her at night, a feeling of
D. Aspiration of gastric contents. fullness in the abdomen, and a feeling of anxiety
about her health. Based on this information, which
18. Question nursing diagnosis would be most appropriate?
Which of the following dietary measures would be
useful in preventing esophageal reflux? A. Imbalanced Nutrition: Less than Body
Requirements related to anorexia.
A. Eating small, frequent meals. B. Disturbed Sleep Pattern related to epigastric pain.
B. Increasing fluid intake. C. Ineffective Coping related to exacerbation of
C. Avoiding air swallowing with meals. duodenal ulcer.
D. Adding a bedtime snack to the dietary plan. D. Activity Intolerance related to abdominal pain.

19. Question 24. Question

A client is admitted to the hospital after vomiting While caring for a client with peptic ulcer disease,
bright red blood and is diagnosed with a bleeding the client reports that he has been nauseated most of
duodenal ulcer. The client develops a sudden, sharp the day and is now feeling lightheaded and dizzy.
pain in the mid-epigastric area along with a rigid, Based upon these findings, which nursing actions
board-like abdomen. These clinical manifestations would be most appropriate for the nurse to take?
most likely indicate which of the following? Select all that apply.

A. An intestinal obstruction has developed. A. Administering an antacid hourly until nausea

B. Additional ulcers have developed. subsides.
C. The esophagus has become inflamed. B. Monitoring the client’s vital signs.
D. The ulcer has perforated. C. Notifying the physician of the client’s symptoms.
20. Question D. Initiating oxygen therapy.
When obtaining a nursing history on a client with a E. Reassessing the client in an hour.
suspected gastric ulcer, which signs and symptoms
would the nurse expect to see? Select all that apply. 25. Question
A client is to take one daily dose of ranitidine
A. Epigastric pain at night (Zantac) at home to treat her peptic ulcer. The nurse
B. Relief of epigastric pain after eating knows that the client understands proper drug
C. Vomiting administration of ranitidine when she says that she
D. Weight loss will take the drug at which of the following times?

21. Question A. Before meals

The nurse is caring for a client who has had a B. With meals
gastroscopy. Which of the following symptoms may C. At bedtime
D. When pain occurs C. Irrigate the T-tube.
D. Clamp the T-tube.
26. Question
A client has been taking aluminum hydroxide 30 mL 31. Question
six times per day at home to treat his peptic ulcer. He The nurse provides medication instructions to a client
tells the nurse that he has been unable to have a with peptic ulcer disease. Which statement, if made
bowel movement for 3 days. Based on this by the client, indicates the best understanding of the
information, the nurse would determine which of the medication therapy?
following is the most likely cause of the client’s
constipation? A. “The cimetidine (Tagamet) will cause me to
produce less stomach acid.”
A. The client has not been including enough fiber in B. “Sucralfate (Carafate) will change the fluid in my
his diet. stomach.”
B. The client needs to increase his daily exercise. C. “Antacids will coat my stomach.”
C. The client is experiencing a side effect of the D. “Omeprazole (Prilosec) will coat the ulcer and
aluminum hydroxide. help it heal.”
D. The client has developed a gastrointestinal
obstruction. 32. Question
The client with peptic ulcer disease is scheduled for a
27. Question pyloroplasty. The client asks the nurse about the
A client is taking an antacid for treatment of a peptic procedure. The nurse plans to respond knowing that a
ulcer. Which of the following statements best pyloroplasty involves:
indicates that the client understands how to correctly
take the antacid? A. Cutting the vagus nerve.
B. Removing the distal portion of the stomach.
A. “I should take my antacid before I take my other C. Removal of the ulcer and a large portion of the
medications.” cells that produce hydrochloric acid.
B. “I need to decrease my intake of fluids so that I D. An incision and resuturing of the pylorus to relax
don’t dilute the effects of my antacid.” the muscle and enlarge the opening from the stomach
C. “My antacid will be most effective if I take it to the duodenum.
whenever I experience stomach pains.” Incorrect
D. “It is best for me to take my antacid 1 to 3 hours
after meals.”
33. Question
28. Question A client with a peptic ulcer is scheduled for a
The nurse is caring for a client with chronic gastritis. vagotomy. The client asks the nurse about the
The nurse monitors the client, knowing that this purpose of this procedure. The nurse tells the client
client is at risk for which of the following vitamin that the procedure:
deficiencies?
A. Decreases food absorption in the stomach.
A. Vitamin A B. Heals the gastric mucosa.
B. Vitamin B12 C. Halts stress reactions.
C. Vitamin C D. Reduces the stimulus to acid secretions.
D. Vitamin E Incorrect

29. Question 34. Question

The nurse is reviewing the medication record of a The nurse would assess the client experiencing an
client with acute gastritis. Which medication, if noted acute episode of cholecystitis for pain that is located
on the client’s record, would the nurse question? in the right

A. digoxin (Lanoxin) A. Upper quadrant and radiates to the left scapula

B. indomethacin (Indocin) and shoulder.
C. furosemide (Lasix) B. Upper quadrant and radiates to the right scapula
D. propranolol hydrochloride (Inderal) and shoulder.
C. Lower quadrant and radiates to the umbilicus.
30. Question D. Lower quadrant and radiates to the back.
The nurse is assessing a client 24 hours following a
cholecystectomy. The nurse notes that the T-tube has 35. Question
drained 750ml of green-brown drainage. Which Which of the following tasks should be included in
nursing intervention is most appropriate? the immediate postoperative management of a client
who has undergone gastric resection?
A. Notify the physician.
B. Document the findings. A. Monitoring gastric pH to detect complications.
B. Assessing for bowel sounds. C. Preparation for lithotripsy.
C. Providing nutritional support. D. Preparation for surgery.
D. Monitoring for symptoms of hemorrhage.
42. Question
36. Question A client being treated for chronic cholecystitis should
If a gastric acid perforates, which of the following be given which of the following instructions?
actions should not be included in the immediate
management of the client? A. Increase rest.
B. Avoid antacids.
A. Blood replacement C. Increase protein in diet.
B. Antacid administration D. Use anticholinergics as prescribed.
C. Nasogastric tube suction
D. Fluid and electrolyte replacement 43. Question
The client with a duodenal ulcer may exhibit which
37. Question of the following findings during an assessment?
Mucosal barrier fortifiers are used in peptic ulcer
disease management for which of the following A. Hematemesis
indications? B. Malnourishment
C. Melena
A. To inhibit mucus production. D. Pain with eating
B. To neutralize acid production.
C. To stimulate mucus production. 44. Question
D. To stimulate hydrogen ion diffusion back into the The pain of a duodenal ulcer can be distinguished
mucosa. from that of a gastric ulcer by which of the following
Incorrect characteristics?

38. Question A. Early satiety

When counseling a client in ways to prevent B. Pain on eating
cholecystitis, which of the following guidelines is C. Dull upper epigastric pain
most important? D. Pain on an empty stomach

A. Eat a low-protein diet. 45. Question

B. Eat a low-fat, low-cholesterol diet. The client has orders for a nasogastric (NG) tube
C. Limit exercise to 10 minutes/day. insertion. During the procedure, instructions that will
D. Keep weight proportionate to height. assist in the insertion would be:

39. Question A. Instruct the client to tilt his head back for
Which of the following symptoms best describes insertion in the nostril, then flex his neck for the final
Murphy’s sign? insertion.
B. After insertion into the nostril, instruct the client
A. Periumbilical ecchymosis exists. to extend his neck.
B. On deep palpation and release, pain elicited. C. Introduce the tube with the client’s head tilted
C. On deep inspiration, pain is elicited and breathing back, then instruct him to keep his head upright for
stops. final insertion.
D. Abdominal muscles are tightened in anticipation D. Instruct the client to hold his chin down, then
of palpation. back for insertion of the tube.

40. Question 46. Question

Which of the following tests is most commonly used The most important pathophysiological factor
to diagnose cholecystitis? contributing to the formation of esophageal varices
is:
A. Abdominal CT scan
B. Abdominal ultrasound A. Decreased prothrombin formation.
C. Barium swallow B. Decreased albumin formation by the liver.
D. Endoscopy C. Portal hypertension.
D. Increased central venous pressure.
41. Question
Which of the following factors should be the main 47. Question
focus of nursing management for a client hospitalized The client being treated for esophageal varices has a
for cholecystitis? Sengstaken-Blakemore tube inserted to control the
bleeding. The most important assessment is for the
A. Administration of antibiotics. nurse to:
B. Assessment for complications.
 A. Check that the hemostat is on the bedside. 3. Question
B. Monitor IV fluids for the shift. A nursing intervention for a patient with hepatitis B
C. Regularly assess respiratory status. would include which of the following types of
D. Check that the balloon is deflated on a regular isolation.
basis.
A. Universal precautions
48. Question B. Blood transfusions
A female client complains of gnawing epigastric pain C. Enteric isolation
for a few hours after meals. At times, when the pain D. Strict isolation
is severe, vomiting occurs. Specific tests are
indicated to rule out: 4. Question
A patient is admitted with lacerated liver as a result
A. Cancer of the stomach of blunt abdominal trauma. Which of the following
B. Peptic ulcer disease nursing interventions would not be appropriate for
C. Chronic gastritis this patient?
D. Pylorospasm
A. Monitor for respiratory distress.
49. Question B. Monitor for coagulation studies.
When a client has peptic ulcer disease, the nurse C. Administer pain medications as ordered.
would expect a priority intervention to be: D. Administer normal saline, crystalloids as ordered.

A. Assisting in inserting a Miller-Abbott tube. 5. Question

B. Assisting in inserting an arterial pressure line. A male client is recovering from a small bowel
C. Inserting a nasogastric tube. resection. To relieve pain, the physician prescribes
D. Inserting an I.V. meperidine (Demerol), 75 mg I.M. every 4 hours.
How soon after administration should meperidine
50. Question onset of action occur?
A 40-year-old male client has been hospitalized with
peptic ulcer disease. He is being treated with a A. 5 to 10 minutes
histamine receptor antagonist (cimetidine), antacids, B. 15 to 30 minutes
and diet. The nurse doing discharge planning will C. 30 to 60 minutes
teach him that the action of cimetidine is to: D. 2 to 4 hours

A. Reduce gastric acid output. 6. Question

B. Protect the ulcer surface. Nathaniel has severe pruritus due to having hepatitis
C. Inhibit the production of hydrochloric acid (HCl). B. What is the best intervention for his comfort?
D. Inhibit vagus nerve stimulation.
QUIZ 7 A. Give tepid baths.
1. Question B. Avoid lotions and creams.
Which of the following laboratory values would be C. Use hot water to increase vasodilation.
the most important to monitor for a patient with D. Use cold water to decrease the itching.
pancreatic cancer?
7. Question
A. Serum glucose Rob is a 46 y.o. admitted to the hospital with a
B. Radioimmunoassay (RIA) suspected diagnosis of Hepatitis B. He’s jaundiced
C. Creatine phosphokinase (CPK) and reports weakness. Which intervention will you
D. Carcinoembryonic antigen (CEA) include in his care?

2. Question A. Regular exercise.

You observe changes in mentation, irritability, B. A low-protein diet.
restlessness, and decreased concentration in a patient C. Allow the patient to select his meals.
with cancer of the liver. Hepatic encephalopathy is D. Rest period after small, frequent meals.
suspected and the patient is ordered neomycin 8. Question
enemas. Which of the following information in the You’re discharging Nathaniel with hepatitis B.
patient’s history would be a contraindication of this Which statement suggests understanding by the
order? patient?

A. Left nephrectomy A. “Now I can never get hepatitis again.”

B. Glaucoma in both eyes B. “I can safely give blood after 3 months.”
C. Myocardial infarction C. “I’ll never have a problem with my liver again,
D. Peripheral neuropathy even if I drink alcohol.”
D. “My family knows that if I get tired and start
vomiting, I may be getting sick again.”
9. Question A. Rapidly instill a stream of irrigating solution into
Gail is scheduled for a cholecystectomy. After the wound.
completion of preoperative teaching, Gail states,” If I B. Apply a wet-to-dry dressing to the wound after
lie still and avoid turning after the operation, I’ll the irrigation.
avoid pain. Do you think this is a good idea?” What C. Moisten the area around the wound with normal
is the best response? saline solution after the irrigation.
D. Irrigate continuously until the solution becomes
A. “You’ll need to turn from side to side every 2 clear or all of the solution is used.
hours.”
B. “It’s always a good idea to rest quietly after 14. Question
surgery.” Hepatic encephalopathy develops when the blood
C. “The doctor will probably order you to lie flat for level of which substance increases?
24 hours.”
D. “Why don’t you decide about activity after you A. Ammonia
return from the recovery room?” B. Amylase
C. Calcium
10. Question D. Potassium
You’re caring for a 28 y.o. woman with hepatitis B.
She’s concerned about the duration of her recovery. 15. Question
Which response isn’t appropriate? Your patient recently had abdominal surgery and tells
you that he feels a popping sensation in his incision
A. Encourage her to not worry about the future. during a coughing spell, followed by severe pain.
B. Encourage her to express her feelings about the You anticipate an evisceration. Which supplies
illness. should you take to his room?
C. Discuss the effects of hepatitis B on future health
problems. A. A suture kit.
D. Provide avenues for financial counseling if she B. Sterile water and a suture kit.
expresses the need. C. Sterile water and sterile dressings.
D. Sterile saline solution and sterile dressings.
11. Question
Elmer is scheduled for a proctoscopy and has an I.V. 16. Question
The doctor wrote an order for 5mg of I.V. Findings during an endoscopic exam include a
diazepam(Valium). Which order is correct regarding cobblestone appearance of the colon in your patient.
diazepam? The findings are characteristic of which disorder?

A. Give diazepam in the I.V. port closest to the vein. A. Ulcer

B. Mix diazepam with 50 ml of dextrose 5% in water B. Crohn’s disease
and give it over 15 minutes. C. Chronic gastritis
C. Give diazepam rapidly I.V. to prevent the D. Ulcerative colitis
bloodstream from diluting the drug mixture.
D. Question the order because I.V. administration of 17. Question
diazepam is contraindicated. What information is correct about stomach cancer?
12. Question
Annabelle is being discharged with a colostomy, and A. Stomach pain is often a late symptom.
you’re teaching her about colostomy care. Which B. Surgery is often a successful treatment.
statement correctly describes a healthy stoma? C. Chemotherapy and radiation are often successful
treatments.
A. “At first, the stoma may bleed slightly when D. The patient can survive for an extended time with
touched.” TPN.
B. “The stoma should appear dark and have a bluish
hue.” 18. Question
C. “A burning sensation under the stoma faceplate is Dark, tarry stools indicate bleeding in which location
normal.” of the GI tract?
D. “The stoma should remain swollen away from the
abdomen.” A. Upper colon
B. Lower colon
13. Question C. Upper GI tract
A patient who underwent abdominal surgery now has D. Small intestine
a gaping incision due to delayed wound healing.
Which method is correct when you irrigate a gaping 19. Question
abdominal incision with sterile normal saline A patient has an acute upper GI hemorrhage. Your
solution, using a piston syringe? interventions include:
 monitored Q4H. You check the gastric residual and
A. Treating hypovolemia. aspirate 220ml. What is your first response to this
B. Treating hypervolemia. finding?
C. Controlling the bleeding source.
D. Treating shock and diagnosing the bleeding A. Notify the doctor immediately.
source. B. Stop the feeding, and clamp the NG tube.
C. Discard the 220ml and clamp the NG tube.
20. Question D. Give a prescribed GI stimulant such as
You promote hemodynamic stability in a patient with metoclopramide (Reglan).
upper GI bleeding by:
26. Question
A. Encouraging oral fluid intake. Your patient with peritonitis is NPO and complaining
B. Monitoring central venous pressure. of thirst. What is your priority?
C. Monitoring laboratory test results and vital signs.
D. Giving blood, electrolyte, and fluid replacement. A. Increase the I.V. infusion rate.
B. Use diversion activities.
21. Question C. Provide frequent mouth care.
You’re preparing a patient with a malignant tumor D. Give ice chips every 15 minutes.
for colorectal surgery and subsequent colostomy. The
patient tells you he’s anxious. What should your 27. Question
initial step be in working with this patient? Kevin has a history of peptic ulcer disease and vomits
coffee-ground emesis. What does this indicate?
A. Determine what the patient already knows about
colostomies. A. He has fresh, active upper GI bleeding.
B. Show the patient some pictures of colostomies. B. He needs immediate saline gastric lavage.
C. Arrange for someone who has a colostomy to visit C. His gastric bleeding occurred 2 hours earlier.
the patient. D. He needs a transfusion of packed RBCs.
D. Provide the patient with written material about
colostomy care. 28. Question
A 53 y.o. patient has undergone a partial gastrectomy
22. Question for adenocarcinoma of the stomach. An NG tube is in
Your patient, Christopher, has a diagnosis of place and is connected to low continuous suction.
ulcerative colitis and has severe abdominal pain During the immediate postoperative period, you
aggravated by movement, rebound tenderness, fever, expect the gastric secretions to be which color?
nausea, and decreased urine output. This may
indicate which complication? A. Brown
B. Clear
A. Fistula C. Red
B. Bowel perforation D. Yellow
C. Bowel obstruction
D. Abscess 29. Question
A patient has a severe exacerbation of ulcerative Your patient has a retractable gastric peptic ulcer and
colitis. Long-term medications will probably include: has had a gastric vagotomy. Which factor increases
as a result of vagotomy?
A. Antacids
B. Antibiotics A. Peristalsis
C. Corticosteroids B. Gastric acidity
D. Histamine2-receptor blockers C. Gastric motility
D. Gastric pH
24. Question
The student nurse is teaching the family of a patient 30. Question
with liver failure. You instruct them to limit which Christina is receiving an enteral feeding that requires
foods in the patient’s diet? a concentration of 80 ml of supplement mixed with
20 ml of water. How much water do you mix with an
A. Meats and beans 8 oz (240ml) can of feeding?
B. Butter and gravies
C. Potatoes and pasta A. 60 ml
D. Cakes and pastries B. 70 ml
C. 80 ml
25. Question D. 90 ml
An intubated patient is receiving continuous enteral
feedings through a Salem pump tube at a rate of
60ml/hr. Gastric residuals have been 30-40ml when
31. Question D. Have the doctor called while you remain with the
Which stoma would you expect a malodorous, patient, flex the patient’s knees, and cover the wound
enzyme-rich, caustic liquid output that is yellow, with sterile towels soaked in sterile saline solution.
green, or brown?
1. The nurse is reviewing the record of a client with a
A. Ileostomy dx of cirrhosis and notes that there is
B. Ascending colostomy documentation of the presence of asterixis. How
C. Transverse colostomy should the nurse assess for its presence?
D. Descending colostomy
Dorsiflex the foot
32. Question Measure abdominal girth
George has a T tube in place after gallbladder Ask pt to extend the arms
surgery. Before discharge, what information or Instruct pt to lean forward
instructions should be given regarding the T tube
drainage? 2. The nurse is reviewing the lab results for a
pt with cirrhosis and notes that the ammonia
A. “If there is any drainage, notify the surgeon level is elevated. Which diet does the nurse
immediately.” anticipate to be presribed for this pt?
B. “The drainage will decrease daily until the bile
duct heals.” Low-protein
C. “First, the drainage is dark green; then it becomes High-protein
dark yellow.” Moderate-fat
D. “If the drainage stops, milk the tube toward the High-carb
puncture wound.”

33. Question During assessment of a pt with obstructive jaundice,

Your patient Maria takes NSAIDS for her the nurse would expect to find:
degenerative joint disease, and has developed peptic
ulcer disease. Which drug is useful in preventing clay colored stools
NSAID-induced peptic ulcer disease? dark urine and stool
pyrexia and pruritis
A. calcium carbonate (Tums) elevated urinary urobilinogen
B. famotidine (Pepcid)
C. misoprostol (Cytotec) A pt has been told she has NAFLD. The nursing
D. sucralfate (Carafate) teaching plan should include

34. Question a. having genetic testing done

The student nurse is participating in a colorectal b. recommend a heart healthy diet
cancer screening program. Which patient has the c. the necessity to reduce weight rapidly
fewest risk factors for colon cancer? d. avoiding alcohol until liver enzymes return to
normal
A. Janice, a 45 y.o. with a 25-year history of
ulcerative colitis. The pt with advanced cirrhosis asks why his
B. George, a 50 y.o. whose father died of colon abdomen is so swollen. The nurse's best response is
cancer. based on the knowledge that
C. Herman, a 60 y.o. who follows a low-fat, high-
fiber diet. a. a lack of clotting factors promotes the collection of
D. Sissy, a 72 y.o. with a history of breast cancer. blood in the abdominal cavity
b. portal hypertension and hypoalbuminemia cause
35. Question fluid shift into the peritoneal space.
Your patient, post-op drainage of a pelvic abscess c. decreased peristalsis in the GI tract contributes to
secondary to diverticulitis, begins to cough violently gas formation and distention of the bowel
after drinking water. His wound has ruptured and a d. bile salts in the blood irritate the peritoneal
small segment of the bowel is protruding. What’s membranes, causing edema and pocketing of fluid.
your priority?
The health care provider orders lactulose for a patient
A. Ask the patient what happened, call the doctor, with hepatic encephalopathy. The nurse will monitor
and cover the area with a water-soaked bed sheet. for effectiveness of this medication for this pt by
B. Obtain vital signs, call the doctor, and obtain assessing what?
emergency orders.
C. Have a CAN hold the wound together while you a. relief of constipation
obtain vital signs, call the doctor and flex the b. relief of ab pain
patient’s knees. c. decreased liver enzymes
d. decreased ammonia levels d. osmoreceptors in the hypothalamus stimulate
thirst, which causes the stimulation to take in fluid
When planning care for a pt with cirrhosis, the nurse orally
will give highest priority to which nursing diagnosis? e. overactivity of the enlarged spleen results in
increased removal of blood cells from the circulation,
a. impaired skin integrity related to edema, ascites, which decreases the vascular pressure.
and pruritis A, B, C
b. imbalanced nutrition: less than body requirements
related to anorexia The pt with cirrhosis is being taught self care. which
c. excess fluid volume related to portal hypertension statement indicates the pt needs MORE teaching?
and hyperaldosteronism
d. ineffective breathing pattern related to pressure on a. if i notice a fast heart rate and irregular beats, this
diaphragm and reduced lung volume is normal for cirrhosis
b. i need to take good care of my belly and ankle skin
Which nursing interventions would be appropriate to where it is swollen.
achieve this outcome? Select all that apply. c. a scrotal support may be more comfortable when i
have scrotal edema
a. use smallest gauge needle possible when giving d. i can use pillows to support my head to help me
injections or drawing blood.
b. teach pt to avoid straining at stool, vigorous The nurse provides discharge instructions for a 64
blowing of nose, and coughing y.o. women with ascites and peripheral edema related
c. advise pt to use soft-bristle toothbrush and avoid to cirrhosis. Which statement, if made by the pt,
ingestion of irritating food. indicates teaching WAS effective?
d. apply gentle pressure for the shortest possible time
period after performing venipuncture a. it is safe to take acetaminophen up to four times a
e. instruct pt to avoid aspirin and NSAIDs to prevent day for pain
hemorrhage when varices are present. b. lactulose (cephulac) should be taken everyday to
A, B, C, E prevent constipation
c. herbs and other spices should be used to season my
A pt with type 2 diabetes and cirrhosis asks if it foods instead of salt
would be okay to take silymarin (milk thistle) to help d. i will eat foods high in potassium while taking
minimize liver damage. The nurse responds based on spironolactone (aldactone)
what knowledge?

a. milk thistle may affect liver enzymes and thus alter

drug metabolism
b. milk thistle is generally safe in recommended
doses for up to 10 yrs
c. there is unclear scientific evidence for the use of
milk thistle in treating cirrhosis
d. milk thislte may elevate the serum glucose level
and is thus contraindicated in diabetes.

The condition of the pt who has cirrhosis of the liver

has deteriorated. Which diagnostic study would help
determine if the pt has developed liver cancer?

a. serum a-fetoprotein level

b. ventilation/perfusion scan
c. hepatic structure ultasound
d. abdominal girth measurement

The pt with cirrhosis has increased ab girth from

ascites. The nurse should know that this fluid gathers
in the ad for which reasons? Select all that apply.

a. there is decreased colloid oncotic pressure from the

liver's inability to synthesize albumin.
b. hyperaldosteronsim related to damaged
hepatocytes increases sodium and fluid retention
c. portal hypertension pushes proteins from the blood
vessels, causing leaking into the peritoneal cavity