1. A young adult patient is admitted to the hospital for evaluation of right lower quadrant
abdominal pain with nausea and vomiting. Which action would the nurse take?
a. Assist the patient to cough and deep breathe.
b. Palpate the abdomen for rebound tenderness
c. Suggest the patient lie on side, flexing the right leg
d. Encourage the patient to sip, clear noncarbonated liquids.
ANS: C
2. A patient is being admitted with an acute exacerbation of ulcerative colitis reports crampy
abdominal pain and passing 15 bloody stools a day. Which intervention would the nurse include
in the patient’s plan of care?
a. Administer oral metoclopramide
b. Instruct the patient not to eat or drink
c. Administer cobalamin (vitamin B12) injections
d. Teach the patient about total colectomy surgery.
ANS: B
3. A 22-year-old female patient with an exacerbation of ulcerative colitis is having 15-20 stools
daily and has excoriated perianal skin. Which patient behavior indicates that the nurse’s
teaching about skin integrity has been effective?
a. The patient uses incontinence briefs to contain loose stools.
b. The patient uses witch hazel compresses to sooth irritation
c. The patient asks for antidiarrheal medication after each stool.
d. The patient cleans the perianal area with soap after each stool.
ANS: B
4. After a total proctolectomy and permanent ileostomy, the patient tells the nurse, I cannot
manage all these changes. I don’t want to look at the stoma. What is the best action by the
nurse?
a. Reassure the patient that ileostomy care will become easier.
b. Ask the patient about the concerns with stoma management.
c. Develop a detailed written list of ostomy care tasks for the patient.
d. Postpone any teaching until the patient adjusts to the ileostomy.
ANS: B
5. A 51 year old male patient has a new diagnosis of Crohns disease after having frequent diarrhea
and a weight loss of 10 pounds over 2 months. The nurse will plan to teach about
a. Medication use
b. Fluid restriction
c. Enteral nutrition
d. Activity restrictions
ANS: A
6. A 24 year old woman with crohns disease develops a fever and symptoms of a urinary tract
infection with tan, fecal smelling urine. What information will the nurse add to a general
teaching plan about UTIs in order to individualize the teaching for this patient?
a. Bacteria in the perianal area can enter the urethra
b. Fistulas can form between the bowel and bladder
c. Drink adequate fluids to maintain normal hydration
d. Empty the bladder before and after sexual intercourse
ANS: B
7. The nurse is preparing for the annual physical exam of a 43 year old man will plan to teach the
patient about
a. Endoscopy
b. Colonoscopy
c. Computerized tomography screening
d. Carcinoembryonic antigen (CEA) testing
ANS: B
8. A 74 year old patient preparing to undergo a colon resection for cancer of the colon asks about
the elevated carcinoembryonic antigen (CEA) test result. The nurse explains that the test is used
to
a. Identify any metastasis of the cancer
b. Monitor the tumor status after surgery
c. Confirm the diagnosis of a specific type of cancer
d. Determine the need for postoperative chemotherapy
ANS: B
9. Which information will the nurse include in teaching a patient who had a proctolectomy and
ileostomy for ulcerative colitis?
a. Restrict fluid intake to prevent constant liquid drainage from the stoma.
b. Use care when eating high-fiber foods to avoid obstruction of the ileum
c. Irrigate the ileostomy daily to avoid having to wear a drainage appliance
d. Change the pouch everyday to prevent leakage of contents onto the skin
ANS: B
10. A 34 year old female patient with a new ileostomy asks how much drainage to expect. The nurse
explains that after the bowel adjusts to the ileostomy, the usual drainage will be about ___ cups.
a. 2
b. 3
c. 4
d. 5
ANS: A
11. A 42 year old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia.
Which patient teaching will the nurse provide before discharge?
a.
b.
c.
d.
Soak in sitz baths several times a day
Cough 5 times each hour for the next 48 hours.
Avoid use of acetaminophen (Tylenol) for pain.
Apply scrotal support and ice to reduce swelling
ANS: D
12. A 62 year old patient has had a hemorrhoidectomy at an outpatient surgical center. Which
instructions will the nurse include in discharge teaching?
a. Maintain a low-residue diet until the surgical area is healed.
b. Use ice packs on the perianal area to relieve pain and swelling
c. Take prescribed pain medications before a bowel movement is expected.
d. Delay having a bowel movement for several days until the healing has occurred
ANS: C
13. The nurse will plan to teach a patient with Crohns disease who has megaloblastic anemia about
the need for
a. Oral ferrous sulfate tablets
b. Regular blood transfusions
c. Iron dextran (Imferon) infusions
d. Cobalamin (b12) spray or injections
ANS: D
14. Which question from the nurse would help determine if a patients abdominal pain might
indicate irritable bowel syndrome?
a. Have you been passing a lot of gas?
b. What foods affect your bowel patterns?
c. Do you have any abdominal distension?
d. How long have you had abdominal pain?
ANS: D
15. Four hours after a bowel resection, a 74 year old male patient with a nasogastric tube to suction
complains of nausea and abdominal distention. The first action by the nurse should be to
a. Auscultate for hypotonic bowel sounds
b. Notify the patients health care provider
c. Reposition the tube and check for placement
d. Remove the tube and replace it with a new one
ANS: C
16. A 19 year old female is brought to the emergency department with a knife handle protruding
from the abdomen. During the initial assessment of the patient, the nurse should
a. Remove the knife and assess the wound.
b. Determine the presence of rovsing sign
c. Check for circulation and tissue perfusion
d. Insert a urinary catheter and assess for hematuria
ANS: C
17. Which activity in the care of a 48 year old female patient with a new colostomy could the nurse
delegate to UAP?
a. Document the appearance of the stoma
b. Place a pouching system over the ostomy
c. Drain and measure the output from the ostomy
d. Check the skin around the stoma for breakdown
ANS: C
18. Which patient should the nurse assess first after receiving change of shift report?
a. 60 year old patient whose new ileostomy has drained 800 mL over the previous 8 hours
b. 50 year old patient with familial adenomatous polyposis who has occult blood in the stool
c. 40 year old patient with ulcerative colitis who has had six liquid stools in the previous 4
hours
d. 30 year old patient who has abdominal distention and an apical heart rate of 136
beats/minute
ANS: D
19. A 51 year old woman with crohns disease who is taking infliximab (Remicade) calls the nurse in
the outpatient clinic about new symptoms. Which symptom is the most important to
communicate to the health care provider?
a. Fever
b. Nausea
c. Joint pain
d. Headache
ANS: A
20. A 76-year-old patient with obstipation has a fecal impaction and is incontinent of liquid stool.
Which action should the nurse take first?
a. Administer bulk-forming laxatives
b. Assist the patient to sit on the toilet
c. Manually remove the impacted stool
d. Increase the patients oral fluid intake
ANS: C
21. A 72-year-old male patient with dehydration caused by an exacerbation of ulcerative colitis is
receiving 5% dextrose in Normal Salineat 125 ml/hour. Which assessment finding by the nurse is
most important to report to the health care provider?
a. Patient has not voided in the last 4 hours
b. Skin is dry with poor turgor on all extremities
c. Crackles are heard halfway up the posterior chest
d. Patient has had 5 loose stools over the last 6 hours
ANS: C
22. A new 19-year-old patient has familial adenomatous polyposis (FAP). Which action will the nurse
in the gastrointestinal clinic include in the plan of care?
a. Obtain blood samples for DNA analysis
b. Schedule the patient for yearly colonoscopy
c. Provide preoperative teaching about total colectomy
d. Discuss lifestyle modifications to decrease cancer risk
ANS: B
23. After change of shift report, which patient should the nurse assess first?
a. 40-year-old male with celiac disease who has frequent frothy diarrhea
b. 30-year-old female with a femoral hernia who has abdominal pain and vomiting
c. 30-year-old male with ulcerative colitis who has several perianal skin breakdown
d. 40-year-old female with a colostomy bag that is pulling away from the adhesive wafer
ANS: B
24. The nurse is admitting a 67-year-old patient with new-onset- steatorrhea. Which question is
most important for the nurse to ask?
a. How much milk do you usually drink?
b. Have you noticed a recent change in weight loss
c. What time of day do your bowels move?
d. Do you eat meat or other animal products?
ANS: B
25. Which information will the nurse teach a 23-year-old patient with lactose intolerance?
a. Ice cream is relatively low in lactose
b. Live-culture yogurt is usually tolerated
c. Heating milk will break down the lactose
d. Nonfat milk is a better choice than whole milk
ANS: B
26. Which prescribed intervention for a 61-year-old female patient with chronic short bowel
syndrome will the nurse question?
a. Ferrous sulfate (Feosol) 325 mg daily
b. Senna (Senokot) 1 tablet every day
c. Psyllium (Metamucil) 2.1 grams 3 times daily
d. Diphenoxylate with atropine (Lomotil) prn loose stools
ANS: B
27. A 24-year-old female contacts hepatitis from contaminated food. During the acute (icteric)
phase of the patients illness, the nurse would expect serologic testing to reveal
a. Antibody to hepatitis D (anti-HDV)
b. Hepatitis B surface antigen (HBsAg)
c. Anti-hepatitis A virus immunoglobin G (anti-HAV IgG)
d. Anti-hepatitis A virus immunoglobulin (anti-HAV IgM)
ANS: D
28. A 36-year-old male patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV)
infection. Which action by the nurse is appropriate?
a. Schedule the patient for HCV genotype testing.
b. Administer the HCV vaccine and immune globulin.
c. Teach the patient about ribavirin (Rebetol) treatment
d. Explain that the infection will resolve over a few months
ANS: A
29. The nurse will plan to teach the patient diagnosed with acute hepatitis B about
a. Side effects of nucleotide analogs
b. Measures for improving the appetite
c. Ways to increase activity and exercise.
d. Administering a-interferon (Intron A)
ANS: B
30. The nurse administering a-interferon and ribavirin (Rebetol) to a patient with chronic hepatitis C
will plan to monitor for
a. Leukopenia
b. Hypokalemia
c. Polycythemia
d. Hypoglycemia
ANS: A
31. A 55-year-old patient admitted with an abrupt onset of jaundice and nausea has abnormal liver
function studies but serologic testing is negative for viral causes of hepatitis. Which question by
the nurse is the most appropriate?
a. Is there any history of IV drug use?
b. Do you use any OTC drugs
c. Are you taking corticosteroids for any reason?
d. Have you recently traveled to a foreign country?
ANS: B
32. Which topic is most important to include in patient teaching for a 41-year-old patient diagnosed
with early alcoholic cirrhosis?
a. Maintaining good nutrition
b. Avoiding alcohol ingestion
c. Taking lactulose (Cephulac)
d. Using vitamin B supplements
ANS: B
33. A serum potassium of 3.2 mEq/L is reported for a patient with cirrhosis who has scheduled
doses of spironolactone (Aldacton) and furosemide (Lasix) due. Which action should the nurse
take?
a. Administer both drugs
b. Administer the spironolactone
c. Withhold the spironolactone and administer the furosemide
d. Withhold both drugs until discussed with the health care provider.
ANS: B
34. A 53-year-old patient is being treated for bleeding esophageal varices with balloon tamponade.
Which nursing action will be included in the plan of care?
a. Instruct the patient to cough every hour
b. Monitor the patient for shortness of breath
c. Verify the position of the balloon every 4 hours
d. Deflate the gastric balloon if patient reports nausea
ANS: B
35. A 38-year-old patient with cirrhosis has ascites and 4+ edema of the feet and legs. Which
nursing action will be included in the plan of care?
a. Restrict daily dietary protein intake
b. Reposition the patient every 4 hours
c. Place the patient on a pressure-relieving mattress
d. Perform passive range of motion daily
ANS: C
36. Which finding is most important for the nurse to communicate to the health care provider about
a patient who received a liver transplant 1 week ago?
a. Dry palpebral and oral mucosa
b. Crackles at bilateral lung bases
c. Temperature 100.8 F
d. No bowel movement for 4 days
ANS: C
37. Which laboratory test result will the nurse monitor when evaluating the effects of therapy for a
62-year-old female patient who has acute pancreatitis?
a. Calcium
b. Bilirubin
c. Amylase
d. Potassium
ANS: C
(Possible question) Which laboratory test result will the nurse monitor to evaluate the effects of therapy
for a patient who has acute pancreatitis?
a.
b.
c.
d.
Lipase
Calcium
Bilirubin
Potassium
ANS: A
38. The nurse recognizes that teaching a 44-year-old woman following a laparoscopic
cholecystectomy has been effective when the patient states which of the following?
a. I can expect yellow-green drainage from the incision for a few days
b. I can remove the bandages on my incisions tomorrow and take a shower
c. I should plan to limit my activities and not return to work for 4 to 6 weeks
d. I will always need to maintain a low-fat diet since I no longer have a gallbladder
ANS: B
39. A 49-year-old female patient with cirrhosis and esophageal varices has a new prescription for
propranolol (Inderal). Which finding is the best indicator that the medication has been effective?
a. The patient reports no chest pain
b. Blood pressure is 140/90mmHg
c. Stools test negative for occult blood
d. The apical pulse rate is 68 bpm
ANS: C
40. Which response by the nurse best explains the purpose of rantidine (Zantac) for a patient
admitted with bleeding esophageal varices?
a. The medication will reduce the risk for aspiration.
b. The medication will inhibit development of gastric ulcers
c. The medication will prevent irritation of the enlarged veins
d. The medication will decrease nausea and improve the appetite
ANS: C
41. When taking the blood pressure on the right arem of a patient with sever acute pancreatitis, the
nurse notices carpal spasms of the patients right hand. Which action should the nurse take
next?
a. Ask the patient about any arm pain
b. Retake the patient’s blood pressure
c. Check the calcium level in the chart
d. Notify the health provider immediately
ANS: C
42. Which assessment finding is of most concern for a 46-year-old woman with acute pancreatitis?
a. Absent bowel sounds
b. Abdominal tenderness
c. Left upper quadrant pain
d. Palpable abdominal mass
ANS: D
43. Which action will be included in the care for a patient who has recently been diagnoses with
asymptomatic nonalcoholic fatty liver disease (NAFLD)?
a. Teach symptoms of variceal bleeding
b. Draw blood for hepatitis serology testing
c. Discuss the need to increase caloric intake
d. Review the patient’s current medication list
ANS: D
44. During change of shift report, the nurse learns about the following four patients. Which patient
requires assessment first?
a. 40-year-old with chronic pancreatitis who has gnawing abdominal pain
b. 58-year-old who has compensated cirrhosis and is complaining of anorexia
c. 55-year-old with cirrhosis and ascites who has an oral temperature of 102F
d. 36-year-old recovering from a laparoscopic cholecystectomy who has severe shoulder pain
ANS: C
45. Which goal has the highest priority in the plan of care for a 26-year-old homeless patient
admitted with viral hepatitis who has severe anorexia and fatigue?
a. Increase activity level
b. Maintain adequate nutrition
c. Establish a stable environment
d. Identify sources of hepatitis exposure
ANS: B
46. The nurse is planning care for a 48-year-old woman with acute severe pancreatitis. The highest
priority patient outcome is
a. Maintaining normal respiratory function
b. Expressing satisfaction with pain control
c. Developing no outgoing pancreatic disease
d. Having adequate fluid and electrolyte balance
ANS: A
47. The nurse is caring for a 36-year-old patient with pancreatic cancer. Which nursing action is the
highest priority?
a. Offer psychologic support for depression
b. Offer high-calorie, high-protein dietary choices
c. Administer prescribed opiods to relieve pain as needed.
d. Teach about the need to avoid scratching any pruritic areas.
ANS: C
48. Which assessment information will be most important for the nurse to report to the health care
provider about a patient with acute cholecystitis?
a.
b.
c.
d.
The patients urine is bright yellow.
The patients stools are tan colored.
The patient has increased pain after eating
The patient complains of chronic heartburn
ANS: B
49. For a patient with cirrhosis, which of the following nursing actions can the registered nurse
delegate to the UAP?
a. Assessing the patient for jaundice
b. Providing oral hygiene after a meal
c. Palpating the abdomen for distention
d. Assisting the patient to choose the diet
ANS: B
50. A nurse is considering which patient to admit to the same room as a patient who had a liver
transplant 3 weeks ago and is now hospitalized with acute rejection. Which patient would be
the best choice?
a. Patient who is receiving chemotherapy for liver cancer
b. Patient who is receiving treatment for acute hepatitis C
c. Patient who has a wound infection after cholecystectomy
d. Patient who required pain management for chronic pancreatitis
ANS: D