NUR 149- POST TEST NO. 1
NAME:__________________________________
SECTION:________________________________
1. What diagnostic test would confirm the diagnosis of GERD? Select all that apply.
1. barium enema
2. barium swallow
3. Fluoroscopy
4. lower GI series
5. Endoscopy
a. 2, 3 and 5
b. 2, 3 and 4
c. 1, 2 and 3
d. All of the above
2. What symptoms will validate the diagnosis of gastric ulcer?
a. right epigastric pain
b. pain occurs when stomach is empty
c. pain occurs immediately after meal
d. pain not relieved by vomiting
3. What diagnostic test would yield good visualization of the ulcer crater?
a. Endoscopy
b. Gastroscopy
c. Barium Swallow
d. Histology
4. Peptic ulcer disease particularly gastric ulcer is thought to be cause by which of the following microorganisms?
a. E. coli
b. H. pylori
c. S. aureus
d. K. pnuemoniae
5. Which emergency complication is increasingly being prevented through surgery for hiatal hernia repair, as likely taught by an
experienced nurse to a new nurse?
a. Severe dysphagia.
b. Esophageal edema.
c. Hernia strangulation.
d. Aspiration.
6. A nurse is assigned to four clients who have been diagnosed with gastric ulcers. Which one of these clients should the nurse
conclude is most at risk to develop gastrointestinal (GI) bleeding?
a. A 40-year-old client who is positive for Helicobacter pylori (H. pylori)
b. A 45-year-old client who drinks 4 ounces of alcohol a day
c. A 70-year-old client who takes aspirin (Ecotrin®) 81 mg daily to prevent coronary artery disease
d. A 30-year-old pregnant client who uses acetaminophen (Tylenol®) as needed for headaches
7. An experienced nurse explains to a new nurse that the definitive diagnosis of peptic ulcer disease (PUD) involves:
a. a urea breath test.
b. upper gastrointestinal endoscopy with biopsy.
c. barium contrast studies.
d. the string test.
8. During a hospital admission history, a nurse suspects gastrointestinal reflux disease (GERD) when the client says:
a. “I have been experiencing headaches immediately after eating.”
b. “I have been waking up at night lately with a burning feeling in my chest.”
c. “I have been waking up at night sweating.”
d. “Immediately after eating I feel sleepy.”
9. The nurse is caring for a client who has
just had an upper GI endoscopy. The client’s vital signs must be taken every 30 minutes for 2 hours after the procedure. The nurse
assigns an unlicensed nursing personnel (UAP) to take the vital signs. One hour later, the UAP reports the client, who was
previously afebrile, has developed a temperature of 101.8° F (38.8° C). What should the nurse do in response to this reported
assessment data?
a. Promptly assess the client for potential perforation.
b. Tell the assistant to change thermometers and retake the temperature.
c. Plan to give the client acetaminophen (Tylenol) to lower the temperature.
d. Ask the assistant to bathe the client with tepid water.
10. What is the most probable interpretation of sudden, sharp pain in the midepigastric region and a rigid, board-like abdomen in a
client diagnosed with a bleeding duodenal ulcer, who initially presented with vomiting bright red blood?
a. An intestinal obstruction has developed.
b. Additional ulcers have developed.
c. The esophagus has become inflamed.
d. The ulcer has perforated.
11. When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms should the nurse expect
to assess? Select all that apply.
1. Epigastric pain at night.
2. Relief of epigastric pain after eating.
3. Vomiting.
4. Weight loss.
5. Melena.
a. 1, 2 and 3
b. 1, 3 and 5
c. 3, 4 and 5
d. 2 and 4 only
12. The nurse is caring for a client who has had a gastroscopy. Which of the following signs and symptoms may indicate that the
client is developing a complication related to the procedure? Select all that apply.
1. The client has a sore throat.
2. The client has a temperature of 100° F (37.8° C).
3.The client appears drowsy following the procedure.
4. The client has epigastric pain.
5. The client experiences hematemesis.
a. 3, 4 and 5
b. 1, 3 and 5
c. 2 and 4 only
d. 4 and 5 only.
13. Considering the client with peptic ulcer disease who reports having black stools without informing the physician, which nursing
diagnosis would be suitable for this client?
a. Ineffective coping related to fear of diagnosis of chronic illness.
b. Deficient knowledge related to unfamiliarity with significant signs and symptoms.
c. Constipation related to decreased gastric motility.
d. Imbalanced nutrition: Less than body requirements related to gastric bleeding.
14. A client with peptic ulcer disease is taking ranitidine (Zantac). What is the expected outcome of this drug?
a. Heal the ulcer.
b. Protect the ulcer surface from acids.
c. Reduce acid concentration.
d. Limit gastric acid secretion.
15. A client with a peptic ulcer reports epigastric pain that frequently awakens her during the night. The nurse should instruct the
client to do which activities? Select all that apply.
1. Obtain adequate rest to reduce stimulation.
2. Eat small, frequent meals throughout the day.
3. Take all medications on time as ordered.
4. Sit up for one hour when awakened at night.
5. Stay away from crowded areas.
a. 1, 2, 3 and 4
b. 2 and 4 only
c. 2, 3 and 4 only
d. 1, 3,4 and 5
16. A client with peptic ulcer disease reports
that he has been nauseated most of the day and is now feeling light-headed and dizzy. Based upon these findings, which nursing
actions would be most appropriate for the nurse to take? Select all that apply.
1. Administering an antacid hourly until nausea subsides.
2. Monitoring the client’s vital signs.
3. Notifying the physician of the client’s symptoms.
4. Initiating oxygen therapy. Reassessing the client in an hour.
a. 1, 2 and 3 only
b. 2 and 3
c. 1 and 4 only
d. 2 and 4
17. Which of the following instructions should the nurse include in the teaching plan for a client who is experiencing
gastroesophageal reflux disease (GERD)?
a. Limit caffeine intake to two cups of coffee per day.
b. Do not lie down for 2 hours after eating.
c. Follow a low-protein diet.
d. Take medications with milk to decrease irritation
18. The client is scheduled to have an upper gastrointestinal tract series of x-rays. Following the x-rays, the nurse should instruct
the client to:
a. Take a laxative.
b. Follow a clear liquid diet.
c. Administer an enema.
d. Take an antiemetic.
19. A client who has been diagnosed with gastroesophageal reflux disease (GERD) complains of heartburn. To decrease the
heartburn, the nurse should instruct the client to eliminate which of the following items from the diet?
a. Lean beef.
b. Air-popped popcorn.
c. Hot chocolate.
d. Raw vegetables.
20. The client with gastroesophageal reflux disease (GERD) complains of a chronic cough. The nurse understands that in a client
with GERD this symptom may be indicative of which of the following conditions?
a. Development of laryngeal cancer.
b. Irritation of the esophagus.
c. Esophageal scar tissue formation.
d. Aspiration of gastric contents.
21. Bethanechol (Urecholine) has been ordered for a client with gastroesophageal reflux disease (GERD). The nurse should assess
the client for which of the following adverse effects?
a. Constipation.
b. Urinary urgency.
c. Hypertension.
d. Dry oral mucosa.
22. The client attends two sessions with the dietitian to learn about diet modifications to minimize gastroesophageal reflux. The
teaching would be considered successful if the client says that she will decrease her intake of which of the following foods?
a. Fats.
b. High-sodium foods.
c. Carbohydrates.
d. High-calcium foods.
23. Which of the following dietary measures would be useful in preventing esophageal reflux?
a. Eating small, frequent meals.
b. Increasing fluid intake.
c. Avoiding air swallowing with meals.
d. Adding a bedtime snack to the dietary plan.
24. Which action should the registered nurse take to accurately determine the length of the nasogastric tube to be inserted in an
adult client?
a. Mark the tube at 10 inches (25.5 cm).
b. Mark the tube at 32 inches (81 cm).
c. Align the tube at the tip of the nose, extend it to the earlobe, and then measure down to the xiphoid process.
d. Align the tube at the tip of the nose, extend it to the earlobe, and then measure down to the top of the sternum.
25. The nurse is inserting a nasogastric tube in an adult client. During the procedure, the client begins to cough and has difficulty
breathing. What is the most appropriate action?
a. Insert the tube quickly.
b. Notify the health care provider immediately.
c. Remove the tube and reinsert it when the respiratory distress subsides.
d. Pull back on the tube and wait until the respiratory distress subsides.
26. The nurse is preparing to administer medication through a nasogastric tube that is connected to suction. To administer the
medication, the nurse should take which action?
a. Position the client supine to assist in medication absorption.
b. Aspirate the nasogastric tube after medication administration to maintain patency.
c. Clamp the nasogastric tube for 30 to 60 minutes following administration of the medication.
d. Change the suction setting to low intermittent suction for 30 minutes after medication administration
27. This diagnostic procedure produces an image of the abdominal organs and structures on the oscilloscope by using sound waves.
a. Radiographic Studies
b. Stool exam
c. Abdominal UTZ
d. Endoscopic procedures
28. This provides cross-sectional images of abdominal organs and structures.
a. Computed tomography
b. Stool exam
c. Abdominal UTZ
d. Endoscopic procedures
29. This is useful in evaluating abdominal soft tissues and provides supplement to UTZ and CT.
a. Computed tomography
b. Stool exam
c. MRI
d. Endoscopic procedures
30. This refers to a direct visualization of internal GI structures using a long, flexible tube containing a fiber optic light source.
a. Computed tomography
b. Stool exam
c. MRI
d. Endoscopic procedures
31. In preparing the patient for MRI, the following are your nursing actions, except.
a. Let the patient wear all her jewelries
b. NPO for 6 to 8 hours
c. Remove jewelries and other metals
d. Remove foil-backed skin patches
32. The following are nursing interventions in preparing patient for endoscopic procedure, except.
a. NPO for 1 to 2 hours
b. NPO for 8 hours
c. Give patient an anesthetic gargle or spray
d. Position in left lateral position
33. This is used to determine the stage and extent of the disease and prognosis for those with GI and colorectal cancer.
a. alpha -fetoprotein
b. Carcinoembryonic antigen
c. Cancer antigen 19-9
d. CA 123
34. This is used to describe an abnormal infrequency or defecation.
a. Diarrhea
b. Constipation
c. Fecal incontinence
d. GERD
35. The following are complications of constipation, except
a. HPN
b. Fecal impact
c. Hemorrhoids
d. Diarrhea
36. Which of the following statements best describes fecal incontinence?
a. It is a common disorder that affects the large intestine characterized by cramping, abdominal pain, bloating, gas, and diarrhea or
constipation, or both.
b. It is the involuntary passage of stool from the rectum.
c. It is an infrequent bowel movements or difficult passage of stools that persists for several weeks or longer.
d. It is condition with loose and watery stools during a bowel movement.
37. The nurse is preparing to administer medication using a client's nasogastric tube. The following are actions should the nurse
take before administering the medication, except.
a. Check the residual volume.
b. Aspirate the stomach contents.
c. Position patient in a side lying position.
d. Test the stomach contents for a pH indicating acidity.
38. The client has been experiencing difficulty and straining when expelling feces. Which intervention should be taught to the client?
a. Explain that some blood in the stool will be normal for the client.
b. Instruct the client in manual removal of feces.
c. Encourage the client to use a cathartic laxative on a daily basis.
d. Place the client on a high-fiber diet.
39. The client is placed on percutaneous gastrostomy (PEG) tube feedings. Which occurrence would warrant immediate intervention
by the nurse?
a. The client tolerates the feedings being infused at 50 mL/hour.
b. The client pulls the nasogastric feeding tube out.
c. The client complains of being thirsty.
d. The client has green, watery stool.
40. Which of the following best defines sialolithiasis?
a. Inflammation of the salivary glands
b. Blockage of salivary ducts by stones
c. Excessive production of saliva
d. Autoimmune disorder affecting the salivary glands
41. Parotitis caused by bacteria is treated with which of the following drug classifications?
a. Analgesics
b. Corticosteroids
c. Antipyretics
d. Antibiotics
42. Which of the following diagnostic tests confirms malabsorption syndrome?
a. Complete blood count
b. Abdominal ultrasound
c. Pancreatic function test
d. Endoscopy with biopsy
43. A patient complains of abdominal pain and distention is suspected of having malabsorption syndrome when he/she has:
a. A bulky, foul-smelling stools with steatorrhea
b. Episodes of constipation and diarrhea
c. Chronic constipation
d. Severe abdominal pain after eating
44. A client with irritable bowel syndrome is being prepared for discharge. Which of the following meal plans should the nurse give
the client?
a. Low fiber, low-fat
b. High fiber, low-fat
c. Low fiber, high-fat
d. High-fiber, high-fat
45. A patient with IBS asks, “How can I manage abdominal discomfort?” Your best response would be:
a. “It is best managed by eating dry crackers.”
b. “Some patients maintain an antidepressant drugs.”
c. “You will be the one to choose what is best for you.”
d. “Abdominal pain can be reduced by avoiding carbonated beverages.”
46. On physical examination, the nurse should be looking for tenderness on palpation at Mcburney’s point, which is located in the:
a. Right lower quadrant
b. Right upper quadrant
c. Left lower quadrant
d. Left upper quadrant
47. Which of the following complications is thought to be the most common cause of appendicitis?
a. A fecalith
b. Bowel kinking
c. Internal bowel occlusion
d. Abdominal bowel swelling
48. An enema is prescribed for a client with suspected appendicitis. Which of the following actions should the nurse take?
a. Prepare 750 ml of irrigating solution warmed to 100*F.
b. Question the physician about the order.
c. Provide privacy and explain the procedure to the client.
d. Assist the client to left lateral Sim’s position.
49. The nurse is teaching about irritable bowel syndrome (IBS). Which of the following would be most important?
a. Reinforcing the need for a balanced diet
b. Encouraging the client to drink 16 ounces of fluid with each meal
c. Telling the client to eat a diet low in fiber
d. Instructing the client to limit his intake of fruits and vegetables
50. A patient with IBS asks, “How can I manage abdominal discomfort?” Your best response would be:
a. “It is best managed by eating dry crackers.”
b. “Some patients maintain an antidepressant drugs.”
c. “You will be the one to choose what is best for you.”
d. “Abdominal pain can be reduced by avoiding carbonated beverages.”
NUR 149- POST TEST NO. 2
MULTIPLE CHOICE. SELECT THE LETTER OF THE CORRECT ANSWER.
1. In planning care for the patient with ulcerative colitis, the nurse identifies which nursing diagnosis as a priority?
A. Anxiety
B. Impaired skin integrity
C. Fluid volume deficit
D. Nutrition altered, less than body requirements
2. The nurse is caring for a patient with a colostomy. The patient asks, “Will I ever be able to swim again?” The nurse’s best
response would be:
A. “Yes, you should be able to swim again, even with the colostomy.”
B. “You should avoid immersing the colostomy in water.” C. “No, you should avoid getting the colostomy wet.”
D. “Don’t worry about that. You will be able to live just like you did before.”
3. The nurse asks a patient about current medications. Which one of the patient’s medications is most likely to cause abdominal
pain
A. Norco (hydrocodone/APAP)
B. Erythrocin (erythromycin)
C. Zyrtec (cetirizine)
D. Aldactone (spironolactone)
4. A client with an ileostomy is being discharged. Which teaching should be included in the plan of care?
A. Using Karaya powder to seal the bag
B. Irrigating the ileostomy daily
C. Using Stomahesive as a skin protector
D. Using a stool softener as needed
5. The nurse is caring for a patient with suspected diverticulitis. The nurse would be most prudent in questioning an order for which
of the following diagnostic tests?
A. Abdominal ultrasound
B. Barium enema
C. Complete blood count
D. Computed tomography (CT) scan
6. A nurse is reviewing the history and physical of a teenager admitted to a hospital with a diagnosis of ulcerative colitis. Based on
this diagnosis, which information should the nurse expect to see on this client’s medical record?
A. Abdominal pain and bloody diarrhea
B. Weight gain and elevated blood glucose
C. Abdominal distension and hypoactive bowel
sounds
D. Heartburn and regurgitation
7. A 30-year-old client is 6 days post–total proctocolectomy with ileostomy creation for ulcerative colitis. During morning report, a
nurse is told that the ileostomy is draining large amounts of liquid stool and the client has been reporting dizziness with ambulation.
Based on this information, which parameters should the nurse assess immediately? SELECT ALL THAT APPLY.
1. Pulse rate for the last 24 hours.
2. Urine output.
3. Weight over the last 3 days.
4. Ability to move the lower extremities.
5. Temperature readings for the last 24 hours.
A. Statement 1, 2, 3 and 5 are correct, Statement 4 is incorrect
B. Statement 2, 3 , 4 and 5 are incorrect, Statement 1 and 5 are correct
C. Statement 2, 4 and 5 are correct, Statement 1 and 3 are correct
D. Statement 1, 3 and 4 are incorrect, Statement 2 and 5 are correct.
E. All Statements are correct.
8. A nurse is caring for a client diagnosed with Crohn’s disease, who has undergone a barium enema that demonstrated the
presence of strictures in the ileum. Based on this finding, the nurse should monitor the client closely for signs of:
A. peritonitis.
B. obstruction.
C. malabsorption.
D. fluid imbalance.
9. While discharging a 25-year-old female client after a small bowel resection for Crohn’s disease, a nurse overhears the client
talking to her husband and realizes that the client needs more education when the client says:
A. “I’m so glad I won’t ever need any more surgeries.”
B. “I’ll need to continue to monitor my weight.”
C. “If I have another exacerbation I know they will
probably put me back on hydrocortisone.”
D. “I will probably have to take vitamin supplements
all of my life.”
10. A client is being admitted to a postsurgical unit following anorectal surgery. A nurse reviews the following postoperative orders
from the surgeon. Which order should the nurse question?
A. Administer morphine sulfate per intravenous bolus before the first defecation
B. Administer sitz bath after each defecation
C. Begin high-fiber diet as soon as client can tolerate
oral intake
D. Position client in supine position with the head of
the bed elevated to 30 degrees.
11. A client is admitted to a hospital for medical treatment of acute diverticulitis. A nurse should anticipate that this client’s
treatment plan will include: SELECT ALL THAT APPLY.
1. NPO (nothing per mouth) status.
2. frequent ambulation.
3. antibiotics.
4. antiemetic medication.
5. deep breathing every 2 hours.
A. Statement 1, 2 and 5 are correct, Statement 3 and 4 are incorrect
B. Statement 1 and 5 are correct, Statement 2, 3 and 4 are incorrect
C. Statement 1, 3 and 4 are incorrect, Statement 2 and 5 are correct
D. All Statements are correct
E. All Statements are incorrect
12. Which of the following is a chronic inflammatory condition that can affect any part of the digestive tract?
A. Gastritis
B. Crohn's disease
C. Irritable bowel syndrome (IBS)
D. Gastroenteritis
13. In Crohn's disease, inflammation can extend through the layers of the digestive tract, potentially leading to:
A. Constipation
B. Ulcers
C. Hemorrhoids
D. Fistulas
14. Common symptoms of Crohn's disease include:
A. Increased appetite
B. Persistent diarrhea
C. Hypertension
D. Improved sense of taste
15. Nutritional deficiencies in individuals with Crohn's disease may occur due to malabsorption, especially of:
A. Vitamin C
B. Vitamin B12
C. Vitamin K
D. Vitamin D
16. Which of the following medications is commonly used in the treatment of Crohn's disease to reduce inflammation?
A. Antibiotics
B. Corticosteroids
C. Antifungals
D. Antivirals
17. Surgical intervention in Crohn's disease may be required for complications such as:
A. Heart failure
B. Respiratory distress
C. Bowel obstruction
D. Renal failure
18. The serum ammonia level of a client with cirrhosis is elevated. As a priority, a nurse should plan to:
A. monitor the client’s temperature every 4 hours.
B. observe for increasing confusion
C. measure the urine specific gravity.
D. restrict the client’s oral fluid intake.
19. A client is hospitalized for conservative treatment of cirrhosis. As part of the collaborative plan of care, a nurse would
anticipate:
A. monitoring the client’s blood sugar.
B. maintaining NPO (nothing by mouth) status.
C. administering antibiotics.
D. encouraging frequent ambulation.
20. While caring for a male client with cirrhosis, a nurse adds the nursing diagnosis Disturbed body image related to physical
manifestations of illness when the client is overheard telling his brother:
A. “I don’t think I can handle this disease.”
B. “I know the doctors say I have liver failure, but I
don’t really believe them.”
C. “I know I should rest more, but I’m just not that
type of person.”
D. “I don’t like the fact that I seem to have breasts
now.”
21. A client diagnosed with cirrhosis is scheduled for a transjugular intrahepatic portosystemic shunt (TIPS) placement. A nurse
realizes the client does not under- stand the procedure when the client says:
A. “I hope my abdominal incision heals better after this procedure then it did when I had my appendix out.”
B. “This procedure should decrease the risk that I might have another episode of bleeding from my esophagus.”
C. “I know the shunt they are placing could become occluded in the future.”
D. “This procedure should keep me from getting so much fluid buildup in my abdomen.”
22. After completing discharge education, a nurse recognizes the need for further teaching when a client, diagnosed with cirrhosis,
says:
A. “I know propranolol (Inderal®) has been ordered to decrease my blood pressure.”
B. “I plan to stop drinking alcohol.”
C. “I am going to work only part-time.”
D. “I know furosemide (Lasix®) will help to keep me
from developing abdominal swelling.”
23. A registered nurse (RN) is caring for a client following a liver biopsy with the assistance of a student nurse. The RN evaluates
that the student understands the post procedure care when the student nurse:
A. plans to monitor vital signs every hour.
B. promotes ambulation 1 hour after the procedure.
C. positions the client on the right side.
D. encourages the client to cough and deep breathe
immediately following the procedure.
24. A nurse is discharging a client after Billroth II surgery (gastrojejunostomy). To assist the client to control dumping syndrome,
the client’s discharge instructions should include:
A. drinking fluids with meals.
B. eating a high-carbohydrate, low-protein diet.
C. waiting at least 5 hours between meals.
D. lying down for 20 to 30 minutes after meals.
25. After Billroth II surgery (gastrojejunostomy), a client experiences weakness, diaphoresis, anxiety, and palpations 2 hours after
a high carbohydrate meal. A nurse should interpret that these symptoms indicate the development of:
A. steatorrhea.
B. duodenal reflux.
C. hypervolemic fluid overload.
D. postprandial hypoglycemia.
26. A 20-year-old male client is admitted to a hospital with an exacerbation of ulcerative colitis. A female nurse goes into the
client’s room to complete an ini- tial assessment, and the client yells, “Get out of here! I’m tired of nurses and doctors looking at
my body all the time!” Which is the nurse’s best action?
A. Leave the room and ask a male colleague to complete the assessment.
B. Verbally acknowledge the client’s frustration and anger.
C. Call the health-care practitioner and ask for a sedative order.
D. Tell the client that gathering data about his current condition will promote effective timely treatment of his health concerns.
27. A 25-year-old client, admitted to the hospital with an exacerbation of ulcerative colitis, is placed on mesalamine (Asacol®),
which is to be administered rectally via enema. The client finds this procedure distasteful and asks the nurse why the medication
cannot be given orally. Which is the best response by the nurse?
A. “It can be given orally; I’ll contact the doctor and see if the change can be made.”
B. “Rectal administration delivers the medication directly to the affected area.”
C. “Oral administration will not be as effective for the disease condition.”
D. “It can be given orally, I’ll make the change and we’ll tell the doctor in the morning.”
28. A 30-year-old client is 6 days post–total proctocolectomy with ileostomy creation for ulcerative colitis. During morning report, a
nurse is told that the ileostomy is draining large amounts of liquid stool and the client has been reporting dizziness with ambulation.
Based on this information, which parameters should the nurse assess immediately? SELECT ALL THAT APPLY.
1. Pulse rate for the last 24 hours.
2. Urine output.
3. Weight over the last 3 days.
4. Ability to move the lower extremities.
5. Temperature readings for the last 24 hours.
A. 1, 2, 3 and 5
B. 2, 3 and 4 only
C. 1, 4 and 5 only
D. 1, 2, 3 and 4
29. A nurse is caring for a client diagnosed with Crohn’s disease, who has undergone a barium enema that demonstrated the
presence of strictures in the ileum. Based on this finding, the nurse should monitor the client closely for signs of:
A. peritonitis.
B. obstruction.
C. malabsorption.
D. fluid imbalance.
30. While conducting a home visit with a client who had a partial resection of the ileum for Crohn’s disease
4 weeks previously, a nurse becomes concerned when the client says:
A. “My stools float and seem to have fat in them.”
B. “I have gained 5 pounds since I left the hospital.”
C. “I am still avoiding milk products.”
D. “I only have two formed stools per day.”
31. A client is being admitted to a postsurgical unit following anorectal surgery. A nurse reviews the following postoperative orders
from the surgeon. Which order should the nurse question?
A. Administer morphine sulfate per intravenous bolus before the first defecation
B. Administer sitz bath after each defecation
C. Begin high-fiber diet as soon as client can tolerate
oral intake
D. Position client in supine position with the head of the bed elevated to 30 degrees.
32. A client is admitted to a hospital for medical treatment of acute diverticulitis. A nurse should anticipate that this client’s
treatment plan will include: SELECT ALL THAT APPLY.
1. NPO (nothing per mouth) status.
2. frequent ambulation.
3. antibiotics.
4. antiemetic medication.
5. deep breathing every 2 hours.
A. 1 and 3
B. 1, 2, 3 and 5
C. 1, 3, 4 and 5
D. 3, 4 and 5
33. A nurse is assessing a client diagnosed with acute diverticulitis. Which finding should make the nurse suspect that the client has
an intestinal perforation?
A. Elevated white blood cells (WBCs)
B. Temperature of 101°F (38.3°C)
C. Absent bowel sounds
D. Abdominal pain
34. A nurse is conducting a home visit with a client who had surgery 3 months ago that involved the creation of a colostomy. When
the nurse arrives at the home, the client’s wife reports that her husband has lost interest in golf, which used to be his passion. She
also says he cries often for no reason, is only able to sleep for a few hours each night, and reports fatigue daily. The wife asks the
nurse for advice. A nurse’s response should be based on the knowledge that:
A. twenty-five percent of all clients develop clinically significant depression after ostomy surgery.
B. athletic activities like golf are not possible after ostomy surgery.
C. after 3 months the client should have accepted his new body image.
D. it is difficult to sleep well with an ostomy.
35. For a client with a newly created colostomy, a nurse creates this diagnosis: risk for sexual dysfunction related to body image
change. To promote satisfying sexual functioning after ostomy surgery, which recommendation should the nurse make to the client?
A. Participate in sexual activity only in a darkened room
B. Utilize self-gratification for the majority of sexual needs
C. Empty and clean the ostomy pouch immediately before sexual activity
D. Utilize only the female superior position for sexual activity
36. Which of the subsequent measures is suitable following a liver transplant?
A. Ensure the patient is in an environment with minimal exposure to bacteria, viruses, and fungi.
B. Utilize antibiotic agents for extended periods to prevent rejection of the transplanted liver.
C. Position the patient in the Trendelenburg position to aid pulmonary drainage.
D. Assess hemodynamic status and intravascular fluid volume by monitoring cardiac output, oxygen saturation, urine output, heart
rate, and blood pressure every 8 hours.
37. Right after a liver biopsy, which of the subsequent complications should the patient be closely observed for?
A. Abdominal cramping
B. Hemorrhage
C. Nausea and vomiting
D. Possible infection
38. Nurse Jah is caring for Malou, who is experiencing jaundice. Which statement by the nurse demonstrates an understanding of
the rationale for implementing skin care measures for the client?
A. “Jaundice is linked to the development of pressure ulcers.”
B. “Jaundice hinders urea production, resulting in pruritus.”
C. “Jaundice causes pruritus due to compromised bile acid excretion.”
D. “Jaundice results in reduced tissue perfusion and consequent breakdown.”
39. Create an instructional care plan for Janet, who is preparing for a liver biopsy. Which of the following details would you
incorporate?
A. “Position yourself on your stomach for the duration of the test.”
B. “Lie on your right side following the test.”
C. “During the biopsy, you will be instructed to exhale deeply and hold your breath.”
D. “The biopsy is conducted under general anesthesia.”
40. You're attending to Cherry, a 57-year-old patient with liver cirrhosis experiencing ascites and needing paracentesis. Prior to the
procedure, you advise her to:
A. Void her bladder.
B. Lie flat on the bed.
C. Maintain NPO status for 4 hours.
D. Prepare her bowels with an enema.
41. Natoy has liver cirrhosis and experiences the development of ascites. What action is essential to reduce the excessive buildup of
serous fluid in his peritoneal cavity?
A. Limit fluid intake
B. Promote walking
C. Raise sodium consumption
D. Administer prescribed antacids
42. Nat2, A 23-year-old male, is referred to the clinic for an enlarged abdomen, diagnosed with ascites through the identification of
fluid thrill and shifting dullness on percussion. Following diuretic therapy administration, which nursing action would be most
effective in ensuring safe care?
A. Monitor serum potassium levels for hyperkalemia.
B. Assess the client for signs of hypervolemia.
C. Record the client's weight on a weekly basis.
D. Document accurate intake and output measurements.
43. A nurse is getting ready to care for a patient admitted to the hospital due to an exacerbation of ulcerative colitis. In anticipation
of this health issue worsening, the nurse expects the patient's stools to exhibit which characteristics?
A. Watery with blood and mucus
B. Hard and black or tarry
C. Dry and streaked with blood
D. Loose with visible fatty streaks
44. Annabelle is being discharged with a colostomy, and you are instructing her on colostomy care. Which statement accurately
characterizes a healthy stoma?
A. "Experiencing a burning sensation under the stoma faceplate is normal."
B. "The stoma should have a dark appearance with a bluish hue."
C. "The stoma should stay swollen and protrude away from the abdomen."
D. "Initially, the stoma may exhibit slight bleeding when touched."
45. 4You’re advising a 21 y.o. with a colostomy who reports problems with flatus. What food should you recommend?
A. Peas
B. Cabbage
C. Broccoli
D. Yogurt
46. Providing guidance to a 21-year-old with a colostomy who mentions issues with gas. What food would you suggest?
A. Peas
B. Cabbage
C. Broccoli
D. Yogurt
47. June, a 33-year-old, is on your unit with a suspected bowel obstruction. What is the priority intervention for him?
A. Obtain daily weights.
B. Measure abdominal girth.
C. Keep strict intake and output.
D. Encourage her to increase fluids.
48. What elements will the nurse incorporate into the care plan for a client admitted to the hospital with viral hepatitis?
A. Elevate fluid intake to 3000 ml daily
B. Ensure sufficient bed rest
C. Follow a bland diet
D. Administer antibiotics as prescribed
49. Carl is experiencing intense pruritus as a result of hepatitis B. What is the most effective intervention to enhance his comfort?
A. Provide lukewarm baths.
B. Refrain from using lotions and creams.
C. Employ hot water to promote vasodilation.
D. Utilize cold water to alleviate the itching.
50. You’re discharging Carl with hepatitis B. Which statement suggests understanding by the patient?
A. “Now I can never get hepatitis again.”
B. “I can safely give blood after 3 months.”
C. “I’ll never have a problem with my liver again, even if I drink alcohol.”
D. “My family knows that if I get tired and start vomiting, I may be getting sick again.”
1. The nurse instructs the unlicensed nursing personnel (UAP)
on how to provide oral hygiene for a client who cannot perform
this task for himself. Which of the following techniques should
the nurse tell the UAP to incorporate into the client’s daily care?
a. Assess the oral cavity each time mouth care is given and
record observations.
b. Use a soft toothbrush to brush the client’s teeth after each
meal.
c. Swab the client’s tongue, gums, and lips with a soft foam
applicator every 2 hours.
d. Rinse the client’s mouth with mouthwash several times a day.
-
-
2. The nurse should instruct the client to avoid which of the
following drugs while taking metoclopramide hydrochloride
(Reglan)?
a. Antacids.
b. Antihypertensives.
c. Anticoagulants.
d. Alcohol.
3. A client with a peptic ulcer has been instructed to avoid
intense physical activity and stress. Which strategy should the
client incorporate into the home care plan?
a. Conduct physical activity in the morning so that he can rest in
the afternoon.
b. Have the family agree to perform the necessary yard work at
home.
~ c. Give up jogging and substitute a less demanding hobby.
d. Incorporate periods of physical and mental rest in his
daily schedule.
~
4. A client with a peptic ulcer reports epigastric pain that
frequently awakens her during the night. The nurse should
instruct the client to do which activities? Select all that apply.
1. Obtain adequate rest to reduce stimulation.
2. Eat small, frequent meals throughout the day.
3. Take all medications on time as ordered.
4. Sit up for one hour when awakened at night.
5. Stay away from crowded areas.
a. 1, 2, 3 and 4
b. 2, 3, 4 and 5
c. 2, 4 and 5 only
d. 3 and 5 only
5. A client with peptic ulcer disease reports that he has been
nauseated most of the day and is now feeling light-headed and
dizzy. Based upon these findings, which nursing actions would
be most appropriate for the nurse to take? Select all that apply.
a. Administering an antacid hourly until nausea subsides.
b. Monitoring the client’s vital signs.
c. Notifying the physician of the client’s symptoms.
d. Initiating oxygen therapy. Reassessing the client in an hour.
~
a. 1, 2, 3 and 4
b. 2, 3, 4 and 5
c. 2, 4 and 5 only
d. 2 and 3 only
6. Cimetidine (Tagamet) may also be used to treat hiatal hernia.
The nurse should understand that this drug is used to prevent
-which of the following?
a. Esophageal reflux.
b. Dysphagia.
c. Esophagitis.
d. Ulcer formation.
7. The nurse finds a client who has been diagnosed with a peptic
ulcer surrounded by papers from his briefcase and arguing on
the telephone with a coworker. The nurse’s response to
observing these actions should be based on knowledge that:
a. Involvement with his job will keep the client from becoming
bored.
b. A relaxed environment will promote ulcer healing.
c. Not keeping up with his job will increase the client’s stress
level.
d. Setting limits on the client’s behavior is an important nursing
responsibility.
~
8. A client with a peptic ulcer has been instructed to avoid
intense physical activity and stress. Which strategy should the
client incorporate into the home care plan?
a. Conduct physical activity in the morning so that he can rest in
the afternoon.
b. Have the family agree to perform the necessary yard work at
home.
c. Give up jogging and substitute a less demanding hobby.
d. Incorporate periods of physical and mental rest in his
daily schedule.
-
9. A client is to take one daily dose of ranitidine (Zantac) at
home to treat her peptic ulcer. The client understands proper
drug administration of ranitidine when she says that she will
take the drug at which of the following times?
a. Before meals.
b. With meals.
c. At bedtime.
d. When pain occurs.
-
10. A client has been taking aluminum hydroxide (Amphojel) 30
mL six times per day at home to treat his peptic ulcer. He tells
the nurse that he has been unable to have a bowel movement for
3 days. Based on this information, the nurse would determine
that which of the following is the most likely cause of the
client’s constipation?
a. The client has not been including enough fiber in his diet.
b. The client needs to increase his daily exercise.
c. The client is experiencing an adverse effect of the
aluminum hydroxide.
d. The client has developed a gastrointestinal obstruction.
-
11. During a hospital admission history, a nurse suspects
irritable bowel syndrome (IBS) when the client says:
a. “I am having a lot of bloody diarrhea.”
b. “I have been vomiting for 2 days.”
c. “I have lost 10 pounds in the last month.”
d. “I have noticed mucus in my stools.”
-
12. A 25-year-old client, admitted to the hospital with an
exacerbation of ulcerative colitis, is placed on mesalamine
(Asacol®), which is to be administered rectally via enema. The
client finds this procedure distasteful and asks the nurse why the
medication cannot be given orally. Which is the best response by
the nurse?
a. “It can be given orally; I’ll contact the doctor and see if the
change can be made.”
b. “Rectal administration delivers the medication directly to
the affected area.”
c. “Oral administration will not be as effective for the disease
condition.”
d. “It can be given orally, I’ll make the change and we’ll tell the
doctor in the morning.”
-
13. A 30-year-old client is 6 days post total proctocolectomy
with ileostomy creation for ulcerative colitis. During morning
report, a nurse is told that the ileostomy is draining large
amounts of liquid stool and the client has been reporting
dizziness with ambulation. Based on this information, which
parameters should the nurse assess immediately? SELECT ALL
THAT APPLY.
1. Pulse rate for the last 24 hours.
2. Urine output.
3. Weight over the last 3 days.
4. Ability to move the lower extremities.
5. Temperature readings for the last 24 hours.
-
a. 2, 4 and 5
b. 1, 3 and 4
c. 1, 2, 3 and 5
d. 1, 3, 4 and 5
e. All of the above
14. A registered nurse (RN) overhears a licensed practi- cal
nurse (LPN) talking with a client who is being prepared for a
total colectomy with the creation of an ileoanal reservoir for
ulcerative colitis. To decrease the client’s anxiety, the RN should
intervene to clarify the information given by the LPN when the
LPN is heard saying:
a. “this surgery will prevent you from developing colon cancer.”
b. “after this surgery you will no longer have ulcerative colitis.”
c. “when you return from surgery you will not be able to eat
solid food for several days.”
d. “you will have an ileostomy when you return from this
surgery.”
-
15. A nurse is caring for a client diagnosed with Crohn’s disease,
who has undergone a barium enema that demonstrated the
presence of strictures in the ileum. Based on this finding, the
nurse should monitor the client closely for signs of:
a. peritonitis.
b. obstruction.
c. malabsorption.
d. fluid imbalance.
-
16. A charge nurse on a medical unit is determining where on
the unit to place a client who is being admitted with
exacerbation of Crohn’s disease. The client is female, 20 years
old, alert and oriented, and has been taking azathioprine
(Imuran®) for disease control. Into which room should the nurse
place the client?
a. Private room right across from the nurses’ station to allow
constant visualization.
b. Room with a 22-year-old female client who also has Crohn’s
disease.
c. Private room with a private bathroom.
d. Room with an older adult female client who is oriented and
on bedrest.
~
17. While conducting a home visit with a client who had a
partial resection of the ileum for Crohn’s disease 4 weeks
previously, a nurse becomes concerned when the client says:
1. “My stools float and seem to have fat in them.”
2. “I have gained 5 pounds since I left the hospital.”
3. “I am still avoiding milk products.”
4. “I only have two formed stools per day.”
~
18. A client has been placed on long-term sulfasalazine
(Azulfidine) therapy for treatment of his ulcerative colitis. The
nurse should encourage the client to eat which of the following
foods to help avoid the nutrient deficiencies that may develop as
a result of this medication?
a. Citrus fruits.
b. Green, leafy vegetables.
c. Eggs.
d. Milk products.
~
19. The nurse is assigning clients for the evening shift. Which of
the following clients are appropriate for the nurse to assign to a
licensed practical nurse to provide client care? Select all that
apply.
1. A client with Crohn’s disease who is receiving total
parenteral nutrition (TPN).
2. A client who underwent inguinal hernia repair surgery 3
hours ago.
3. A client with an intestinal obstruction who needs a Cantor
tube inserted.
4. A client with diverticulitis who needs teaching about his
take-home medications.
5. A client who is experiencing an exacerbation of his
ulcerative colitis.
~
a. Statement 1, 2 and 5 incorrect, Statement 3 and 4 are incorrect
b. Statement 2 and 5 are correct, Statement 1, 3 and 4 are
incorrect
c. Statement 2, 4 and 5 are correct, Statement 1 and 3 are
incorrect
d. Statement 3 and 5 are correct, Statement 1, 2 and 4 are
incorrect
20. A client who has had ulcerative colitis for the past 5 years is
admitted to the hospital with an exacerbation of the disease.
Which of the following factors was most likely of greatest
significance in causing an exacerbation of ulcerative colitis?
a. A demanding and stressful job.
-
b. Changing to a modified vegetarian diet.
c. Beginning a weight-training program.
d. Walking 2 miles every day.
21. When planning care for a client with ulcer- ative colitis who
is experiencing an exacerbation of symptoms, which client care
activities can the nurse appropriately delegate to an unlicensed
assistant? Select all that apply.
1. Assessing the client’s bowel sounds.
2. Providing skin care following bowel movements.
3. Evaluating the client’s response to antidiarrheal medications.
4. Maintaining intake and output records. Obtaining the client’s
weight.
a. 2, 4 and 5
b. 1, 3 and 4
c. 2, and 5
d. All of the above
e. None of the above
-
22. Which goal for the client’s care should take priority during
the first days of hospitalization for an exacerbation of ulcerative
colitis?
a. Promoting self-care and independence.
b. Managing diarrhea.
c. Maintaining adequate nutrition.
d. Promoting rest and comfort.
-
23. The client with ulcerative colitis is following orders for bed
rest with bathroom privileges. When evaluating the effectiveness
of this level of activity, the nurse should determine if the client
has:
a. Conserved energy.
b. Reduced intestinal peristalsis.
c. Obtained needed rest.
~
d. Minimized stress.
24. A client’s ulcerative colitis signs and symptoms have been
present for longer than 1 week. The nurse should assess the
client for signs and symptoms of which of the following
complications?
a. Heart failure.
b. Deep vein thrombosis.
c. Hypokalemia.
d. Hypocalcemia.
~
25. A client who has ulcerative colitis says to the nurse, “I can’t
take this anymore! I’m constantly in pain, and I can’t leave my
room because I need to stay by the toilet. I don’t know how to
deal with this.” Based on these comments, an appropriate
nursing diagnosis for this client would be:
a. Impaired physical mobility related to fatigue.
b. Disturbed thought processes related to pain.
c. Social isolation related to chronic fatigue.
d. Ineffective coping related to chronic abdominal pain.
~
26. A client newly diagnosed with ulcerative colitis who has
been placed on steroids asks the nurse why steroids are
prescribed. The nurse should tell the client?
a. “Ulcerative colitis can be cured by the use of steroids.”
b. “Steroids are used in severe flare-ups because they can
decrease the incidence of bleeding.” C. “Long-term use of
steroids will prolong peri- ods of remission.”
d. “The side effects of steroids outweigh their benefits to clients
with ulcerative colitis.”
~
27. A client who has ulcerative colitis has persistent diarrhea. He
is thin and has lost 12 lb since the exacerbation of his ulcerative
colitis. Which of the following will be most effective in helping
~
the client meet his nutritional needs?
a. Continuous enteral feedings.
b. Following a high-calorie, high-protein diet.
c. Total parenteral nutrition (TPN).
d. Eating six small meals a day.
28. A client with ulcerative colitis is to take sulfasalazine
(Azulfidine). Which of the following instructions should the
nurse provide for the client about taking this medication at
home? Select all that apply.
1. Drink enough fluids to maintain a urine out- put of at least
1,200–1,500 mL per day.
2. Discontinue therapy if symptoms of acute intolerance develop
and notify the health care provider.
3. Stop taking the medication if the urine turns orange-yellow.
4. Avoid activities that require alertness.
5. If dose is missed, skip and continue with the next dose.
~
a. Statement 1, 2 and 4 are incorrect, Statement 3 and 5 are
correct
b. Statement 1, 2 and 4 are correct, Statement 3 and 5 are
incorrect
c. Statement 2, 3 and 4 are incorrect, Statement 1 and 5 are
correct
d. All Statements are correct
e. All Statements are incorrect
~
29. The physician prescribes sulfasalazine (Azulfidine) for the
client with ulcerative colitis to continue taking at home. Which
instruction should the nurse give the client about taking this
medication?
a. Avoid taking it with food.
b. Take the total dose at bedtime.
c. Take it with a full glass (240 mL) of water.
d. Stop taking it if urine turns orange-yellow.
30. After a subtotal gastrectomy, care of the client’s nasogastric
(NG) tube and drainage system should include which of the
following nursing interventions?
a. Irrigate the tube with 30 mL of sterile water every hour, if
needed.
b. Reposition the tube if it is not draining well.
c. Monitor the client for nausea, vomiting, and abdominal
distention.
d. Turn the machine to high suction if the drain- age is sluggish
on low suction.
~
31. A client with ulcerative colitis expresses seri- ous concerns
about her career as an attorney because of the effects of stress on
ulcerative colitis. Which of the following nursing interventions
will be most helpful to the client?
a. Review her current coping mechanisms and develop
alternatives, if needed.
b. Suggest a less stressful career in which she would still use her
education and experience.
c. Suggest that she ask her colleagues to help decrease her stress
by giving her the easier cases.
d. Prepare family members for the fact that she will have to
work part-time.
~
32. Which of the following diets would be most appropriate for
the client with ulcerative colitis?
a. High-calorie, low-protein.
b. High-protein, low-residue.
c. Low-fat, high-fiber.
d. Low-sodium, high-carbohydrate.
~
33. A client who has a history of Crohn’s disease is admitted to
the hospital with fever, diarrhea, cramping, abdominal pain, and
weight loss. The nurse should monitor the client for:
a. Hyperalbuminemia.
b. Thrombocytopenia.
c. Hypokalemia.
d. Hypercalcemia.
-
34. A client with Crohn’s disease has concentrated urine,
decreased urinary output, dry skin with decreased turgor,
hypotension, and weak, thready pulses. The nurse should do
which of the following first?
a. Encourage the client to drink at least 1,000 mL per day.
b. Provide parenteral rehydration therapy ordered by the
physician.
c. Turn and reposition every 2 hours.
d. Monitor vital signs every shift.
-
35. The nurse is developing a plan of care for a client with
Crohn’s disease who is receiving total parenteral nutrition
(TPN). Which of the following interventions should the nurse
include? Select all that apply.
1. Monitoring vital signs once a shift.
-2. Weighing the client daily.
3. Changing the central venous line dressing daily.
4. Monitoring the I.V. infusion rate hourly.
5. Taping all I.V. tubing connections securely.
=
~
a. 2, 4 and 5
b. 1 and 3 only
c. 2 and 4
d. 1, 2, 3 and 5
36. Which of the following should be a priority focus of care for
a client experiencing an exacerbation of Crohn’s disease?
a. Encouraging regular ambulation.
b. Promoting bowel rest.
c. Maintaining current weight.
d. Decreasing episodes of rectal bleeding.
~
37. A client is taking an antacid for treatment of a peptic ulcer.
Which of the following statements best indicates that the client
understands how to correctly take the antacid?
a. “I should take my antacid before I take my other
medications.”
b. “I need to decrease my intake of fluids so that I don’t dilute
the effects of my antacid.”
c. “My antacid will be most effective if I take it whenever I
experience stomach pains.”
D. “It is best for me to take my antacid 1 to 3 hours after
meals.”
~
38. Which of the following would be an expected outcome for a
client with peptic ulcer disease? The client will:
a. Demonstrate appropriate use of analgesics to control pain.
b. Explain the rationale for eliminating alcohol from the diet.
c. Verbalize the importance of monitoring hemoglobin and
hematocrit every 3 months.
d. Eliminate contact sports from his or her life- style.
-
39. The nurse is obtaining a health history from a client who has
a sliding hiatal hernia associated with reflux. The nurse should
ask the client about the presence of which of the following
symptoms?
a. Heartburn.
b. Jaundice.
c. Anorexia.
d. Stomatitis.
-
40. Which of the following factors would most likely contribute
to the development of a client’s hiatal hernia?
a. Having a sedentary desk job.
b. Being 5 feet, 3 inches tall and weighing 190 lb.
c. Using laxatives frequently.
d. Being 40 years old.
~
&
41. he nurse is assessing a client with cirrhosis who has
developed hepatic encephalopathy. The nurse should notify the
physician of a decrease in which lab serum that is a potential
precipitating factor for hepatic encephalopathy?
a. Aldosterone.
b. Creatinine.
c. Potassium.
d. Protein.
42. A client has advanced cirrhosis of the liver. The client’s
spouse asks the nurse why his abdomen is swollen, making it
very difficult for him to fasten his pants. How should the nurse
respond to provide the most accurate explanation of the disease
process?
a. “He must have been eating too many foods with salt in them.
Salt pulls water with it.”
b. “The swelling in his ankles must have moved up closer to his
heart so the fluid circulates better.”
c. “He must have forgotten to take his daily water pill.”
d. “Blood is not able to flow readily through the liver now,
and the liver cannot make protein to keep fluid inside the
blood vessels.”
-
43. A nurse is developing a care plan for a client with hepatic
encephalopathy. Which of the following are goals for the care
for this client? Select all that apply.
1. Preventing constipation.
2. Administering lactulose (Cephulac).
3. Monitoring coordination while walking.
4. Checking the pupil reaction.
5. Providing food and fluids high in carbohydrate.
6. Encouraging physical activity.
-a. 1, 2, 3, 4 and 5
b. 2, 4, and 6 only
c. 1, 2 4 and 5 only
d. 2, 3 and 4 only
e. All of the above
J
44. The nurse is assessing a client who is in the early stages of
cirrhosis of the liver. Which focused assessment is appropriate?
a. Peripheral edema.
b. Ascites.
c. Anorexia.
d. Jaundice.
45. A client with cirrhosis begins to develop ascites.
Spironolactone (Aldactone) is prescribed to treat the ascites. The
nurse should monitor the client closely for which of the
following drug-related adverse effects?
a. Constipation.
b. Hyperkalemia.
c. Irregular pulse.
d. Dysuria.
~
46. The nurse is reviewing the chart information for a client with
increased ascites. The data include: temperature 37.2° C; heart
rate 118; shallow respirations 26; blood pressure 128/76; and
SpO2 89% on room air. Which action should receive priority by
the nurse?
a. Assess heart sounds.
~
b. Obtain an order for blood cultures.
c. Prepare for a paracentesis.
d. Raise the head of the bed.
47. Which of the following positions would be appropriate for a
client with severe ascites?
a. Fowler’s.
b. Side-lying.
c. Reverse Trendelenburg.
d. Sims.
~
-
48. The nurse is planning care for a client being admitted with
bleeding esophageal varices. Vital signs are: Pulse 100;
respiratory rate 22; and blood pressure 100/58. The nurse should
prepare the client for which of the following? Select all that
apply.
1. Administration of intravenous Octreotide(Sandostatin).
2. Endoscopy.
3. Administration of a blood product.
4. Minnesota tube insertion.
5. Trans jugular intrahepatic portosystemic shunt (TIPS)
procedure.
6. Immediate endotracheal intubation.
a. 1, 3 and 5
b. 1, 2, 4 and 6
c. 1, 3, 4 and 6
d. 1, 2 and 3
49. The nurse monitors a client with cirrhosis for the
development of hepatic encephalopathy. Which of the following
would be an indication that hepatic encephalopathy is
developing?
a. Decreased mental status.
-
b. Elevated blood pressure.
c. Decreased urine output.
d. Labored respirations.
50. A client’s serum ammonia level is elevated, and the
G
physician orders 30 mL of lactulose (Cephulac). Which of the
following is an adverse effect of this drug?
a. Increased urine output.
b. Improved level of consciousness.
c. Increased bowel movements.
d. Nausea and vomiting.
51. The nurse is providing discharge instructions for a client
D
with cirrhosis. Which of the following statements best indicates
that the client has under- stood the teaching?
a. “I should eat a high-protein, high-carbohydrate diet to
provide energy.”
b. “It is safer for me to take acetaminophen (Tylenol) for pain
instead of aspirin.”
c. “I should avoid constipation to decrease chances of
bleeding.”
d. “If I get enough rest and follow my diet, it is possible for my
cirrhosis to be cured.”
52. The nurse is preparing a client for a paracentesis for ascites.
The nurse should:
a. Have the client void immediately before the procedure.
b. Place the client in a side-lying position.
c. Initiate an I.V. line to administer sedatives.
d. Place the client on nothing-by-mouth (NPO) status 6 hours
before the procedure.
-
53. Which of the following interventions should the nurse
anticipate incorporating into the client’s plan of care when
~
hepatic encephalopathy initially develops?
a. Inserting a nasogastric (NG) tube.
b. Restricting fluids to 1,000 mL/day.
c. Administering I.V. salt-poor albumin.
d. Implementing a low-protein diet.
54. A client with ascites and peripheral edema is at risk for
impaired skin integrity. To prevent skin breakdown, the nurse
should:
a. Institute range-of-motion (ROM) exercise every 4 hours.
b. Massage the abdomen once a shift.
c. Use an alternating air pressure mattress.
d. Elevate the lower extremities.
-
55. The nurse should institute which of the following measures
to prevent transmission of the hepatitis C virus to health care
personnel?
a. Administering hepatitis C vaccine to all health care
personnel.
b. Decreasing contact with blood and blood- contaminated
fluids.
c. Wearing gloves when emptying the bedpan.
d. Wearing a gown and mask when providing direct care.
56. The nurse is assessing a client with chronic hepatitis B who
is receiving Lamivudine (Epivir). What information is most
important to communicate to the physician?
a. The client’s daily record indicates a 3 kg weight gain over
2 days.
b. The client is complaining of nausea.
c. The client has a temperature of 99° F orally.
d. The client has fatigue
~
57. The nurse is assessing a client with hepatitis and notices that
the AST and ALT lab values have increased. Which of the
following statements by the client requires further instruction by
the nurse?
a. “I require increased periods of rest.”
b. “I follow a low-fat, high carbohydrate diet.”
c. “I eat dry toast to relieve my nausea.”
d. “I take acetaminophen (Tylenol) for arthritis pain.”
-
58. College freshman are participating in a study abroad
program. When teaching them about hepatitis B, the nurse
should instruct the students on:
a. Water sanitation.
b. Single dormitory rooms.
c. Vaccination for hepatitis D
d. Safe sexual practices.
~
59. The nurse is planning a home visit for a client with hepatitis
A. In order to prevent transmission the nurse should focus
teaching on:
a. Proper food handling.
b. Insulin syringe disposal.
c. Alpha-interferon.
d. Use of condoms.
~
60. A client who is recovering from hepatitis A has fatigue and
malaise. The client asks the nurse, “When will my strength
return?” Which of the following responses by the nurse is most
appropriate?
a. “Your fatigue should be gone by now. We will evaluate you
for a secondary infection.”
b. “Your fatigue is an adverse effect of your drug therapy. It will
disappear when your treatment regimen is complete.”
c. “It is important for you to increase your activity level. That
help decrease your fatigue.”
~will
d. “It is normal for you to feel fatigued. The fatigue should
go away in the next 2 to 4 months.”
61. The nurse is developing a plan of care for the client with
viral hepatitis. The nurse should instruct the client to:
a. Obtain adequate bed rest.
b. Increase fluid intake.
c. Take antibiotic therapy as ordered.
-d. Drink 8 oz of an electrolyte solution every day.
62. The nurse should teach the client with viral hepatitis to:
a. Limit caloric intake and reduce weight.
b. Increase carbohydrates and protein in the diet.
c. Avoid contact with others and live separately.
d. Intensify routine exercise and increase strength.
~
63. The nurse develops a teaching plan for the client about how
to prevent the transmission of hepatitis A. Which of the
following discharge instructions is appropriate for the client?
a. Spray the house to eliminate infected insects.
b. Tell family members to try to stay away from the client.
family members to wash their hands frequently.
~ c.d. Tell
Disinfect all clothing and eating utensils.
64. The nurse assesses that the client with hepatitis is
experiencing fatigue, weakness, and a general feeling of
malaise. The client tires rapidly during morning care. Based on
this information, which of the following would be an appropriate
nursing diagnosis?
a. Impaired physical mobility related to malaise.
b. Self-care deficit related to fatigue.
c. Ineffective coping related to long-term illness.
-
d. Activity intolerance related to fatigue.
65. What would be the nurse’s best response to the client’s
expressed feelings of isolation as a result of having hepatitis?
a. “Don’t worry. It’s normal to feel that way.”
b. “Your friends are probably afraid of contracting hepatitis from
you.”
c. “I’m sure you’re imagining that!”
d. “Tell me more about your feelings of isolation.”
~
66. The nurse is preparing a community education program
about preventing hepatitis B infection. Which of the following
would be appropriate to incorporate into the teaching plan?
A. Hepatitis B is relatively uncommon among college students.
B. Frequent ingestion of alcohol can predispose an individual to
development of hepatitis B.
C. Good personal hygiene habits are most effective at preventing
the spread of hepatitis B.
D. The use of a condom is advised for sexual intercourse.
~
67. A nurse admits a male client to a hospital with exacerbation
of asthma. During the admission history, the nurse learns that the
client has a history of chronic hepatitis C. Which precautions
should the nurse plan to implement based on the transmission of
the hepatitis C virus?
a. Airborne
b. Contact
c. Droplet
d. Standard
~
During the emergency insertion of a central venous line in a
O68.
client diagnosed with hepatitis B (HBV), a nurse suffers a
needle-stick injury from a blood-contaminated needle. The nurse
goes directly to the hospital’s occupational health service.
Which immediate treatment should the nurse anticipate
receiving?
a. Administration of hepatitis B immune globulin (HBIG)
and initiation of the hepatitis vaccine if the nurse has not
been previously vaccinated
b. Administration of hepatitis B immune globulin (HBIG)
c. Blood tests for the presence of hepatitis B antigens and
administration of HBIG 1 week later
d. Blood tests for the presence of hepatitis B antigens and
treatment with HBIG if the tests are positive
69. A clinic nurse is administering monovalent Hep B (hepatitis
B vaccine) intramuscularly to a new- born prior to hospital
discharge. Which site is best for the nurse to plan to administer
the injection?
a. Deltoid
b. Ventrogluteal
c. Dorsogluteal
d. Vastus lateralis
·
J
70. A public health nurse is caring for a 10-year-old child who is
diagnosed with hepatitis A. The nurse is instructing the parents
to avoid giving their child oral medications. Which is the nurse’s
rationale for giving this instruction?
a. The child does not need pain medications because there is no
pain associated with hep A.
b. The medication of choice is antibiotics, and the child will be
on those only while hospitalized.
c. Normal medication doses may become dangerous due to
the liver’s inability to detoxify and excrete them.
d. The foods provided will contain all of the natural substances
the child will need for recovery.
71. Which foods should the nurse encourage a client with
diverticulosis to incorporate into the diet? Select all that apply.
1. Bran cereal.
2. Broccoli.
3. Tomato juice.
4. Navy beans.
5. Cheese.
a. 1, 2, and 4 only
b. 2, 3 and 5 only
c. 2 and 4 only
d. 1 and 5 only
72. Which of the following laboratory findings would the nurse
expect to find in a client with diverticulitis?
a. Elevated red blood cell count.
b. Decreased platelet count.
~ c. Elevated white blood cell count.
d. Elevated serum blood urea nitrogen concentration.
73. The nurse is aware that the diagnostic tests typically ordered
for acute diverticulitis do not include a barium enema. The
reason for this is that a barium enema:
~a. Can perforate an intestinal abscess.
b. Would greatly increase the client’s pain.
c. Is of minimal diagnostic value in diverticulitis.
d. Is too lengthy a procedure for the client to tolerate.
74. The nurse should teach the client with diverticulitis to
integrate which of the following into a daily routine at home?
a. Using enemas to relieve constipation.
b. Decreasing fluid intake to increase the formed consistency of
~the stool.
c. Eating a high-fiber diet when symptomatic with diverticulitis.
d. Refraining from straining and lifting activities.
75. After instructing a client with diverticulosis about
appropriate self-care activities, which of the following client
comments indicate effective teaching? Select all that apply.
1. “With careful attention to my diet, my diverticulosis can be
cured.”
2. “Using a cathartic laxative weekly is okay to control bowel
movements.”
3. “I should follow a diet that’s high in fiber.”
S4. “It is important for me to drink at least 2,000 mL of fluid
every day.”
5. “I should exercise regularly.”
-
a. 3, 4 and 5 only
b. 1, 2 and 3 only
c. 4 and 5 only
d. 2, 3 and 5 only
76. A client with diverticular disease is receiving psyllium
hydrophilic mucilloid (Metamucil). The drug has been effective
when the client tells the nurse that he:
~ a. Passes stool without cramping.
b. Does not have diarrhea any longer.
c. Is not as anxious as he was.
d. Does not expel gas like he used to.
77. A client with diverticulitis has developed peritonitis
following diverticular rupture. The nurse should assess the client
to determine which of the following? Select all that apply.
1. Percuss the abdomen to note resonance and tympany.
2. Percuss the liver to note lack of dullness.
3. Monitor the vital signs for fever, tachypnea, and bradycardia.
4. Assess presence of polyphagia and polydipsia.
5. Auscultate bowel sounds to note frequency.
a. 1, 2 and 5
b. 2, 3 and 4
c. 1, 3, 4 and 5
d. 2, 4 and 5
78. A nurse is discharging a client after Billroth II surgery
(gastrojejunostomy). To assist the client to control dumping
syndrome, the client’s discharge instructions should include:
a. drinking fluids with meals.
b. eating a high-carbohydrate, low-protein diet.
~ c. waiting at least 5 hours between meals.
d. lying down for 20 to 30 minutes after meals.
79. After Billroth II surgery (gastrojejunostomy), a client
experiences weakness, diaphoresis, anxiety, and palpations 2
hours after a high carbohydrate meal. A nurse should interpret
that these symptoms indicate the development of:
a. steatorrhea.
b. duodenal reflux.
c. hypervolemic fluid overload.
d. postprandial hypoglycemia.
-
80. A nurse is performing an initial postoperative assessment on
a client following upper gastrointestinal surgery. The client has a
nasogastric tube to low, intermittent suction. To best assess the
client for the presence of bowel sounds, the nurse should:
a. place the stethoscope to the left of the umbilicus.
b. turn off the nasogastric suction.
c. use the bell of the stethoscope.
d. turn the suction on the nasogastric tube to continuous.
-
81. A nurse, caring for a client with a Zenker’s diverticulum,
knows that the priority nursing diagnosis for this client should
be:
a. Pain related to gastric reflux.
b. Risk for aspiration related to regurgitation of food
accumulated in the diverticula.
c. Constipation related to anatomical changes of the sigmoid
colon.
d. Altered nutrition, less than body requirements related to
dysphagia.
~
~
82. A nurse has just received report on a 55-year-old client who
had Billroth II surgery 24 hours ago. The client’s wife is listed
as the designated contact person. Immediately after report, the
client’s son approaches the nurse in the hallway and asks for
information regarding his father’s condition. The nurse’s best
response would be:
a. “What has the surgeon told you about your father?”
b. “Let’s go into your father’s room together and ask him
how he feels.”
c. “Let’s go to a more private place to discuss your father’s
condition.”
d. “Let’s review his medical record together.”
83. A client who is recovering from acute diverticulitis is highly
motivated to prevent another exacerbation of the disease. A
nurse educates the client about the need to increase the amount
of dietary fiber in the diet. The nurse evaluates that teaching has
been effective when the client makes which menu selection for
lunch?
a. A chicken sandwich on whole wheat bread with raw
carrots and celery sticks
b. Baked chicken, mashed potatoes, and herbal tea
X
c. Chicken noodle soup with soda crackers and chocolate
pudding
d. Cooked acorn squash, fried chicken, and pasta
~
84. A nurse is assessing a client diagnosed with acute
diverticulitis. Which finding should make the nurse suspect that
the client has an intestinal perforation?
a. Elevated white blood cells (WBCs)
b. Temperature of 101°F (38.3°C)
c. Absent bowel sounds
d. Abdominal pain
85. The nurse is assisting a client with diverticulosis to select
appropriate foods. Which food should be avoided?
a. Bran flakes
b. Peaches
c. Cucumber and tomato salad
d. Whole wheat bread
86. A client with a history of diverticulitis complains of
abdominal pain, fever, and diarrhea. Which food is most likely
responsible for the client’s symptoms?
a. Mashed potatoes
b. Steamed carrots
c. Baked fish
d. Whole-grain cereal
87. A client with diverticulitis is admitted with nausea, vomiting,
and dehydration. Which finding suggests a complication of
diverticulitis?
a. Pain in the left lower quadrant
b Board-like abdomen
c. Low-grade fever
d. Abdominal distention
88. The nurse is assisting a client with diverticulitis to select
appropriate foods. Which food should be avoided?
a. Bran
b. Fresh peach
c. Tomatoes
- d. Dinner roll
89. The nurse is caring for a patient with suspected diverticulitis.
The nurse would be most prudent in questioning an order for
which of the following diagnostic tests?
a. Abdominal ultrasound
-b. Barium enema
c. Complete blood count
d. Computed tomography (CT) scan
90. A nurse is assessing a client who is 24 hours postgastrointestinal (GI) hemorrhage. The assessment findings
include blood urea nitrogen (BUN) of 40 mg/dL and serum
~ creatinine of 0.8 mg/dL. After reviewing the assessment
findings, the nurse should:
a. immediately call the physician to report these results.
b. monitor urine output as this may be a sign of kidney failure.
c. document the findings and continue monitoring the client.
d. encourage the client to limit his dietary protein intake.
91. A nurse is performing an initial postoperative assessment on
a client following upper gastrointestinal surgery. The client has a
nasogastric tube to low, intermittent suction. To best assess the
client for the presence of bowel sounds, the nurse should:
1. place the stethoscope to the left of the umbilicus.
2. turn off the nasogastric suction.
3. use the bell of the stethoscope.
-4. turn the suction on the nasogastric tube to continuous.
92. The serum ammonia level of a client with cirrhosis is
elevated. As a priority, a nurse should plan to:
a. monitor the client’s temperature every 4 hours.
b. observe for increasing confusion.
c. measure the urine specific gravity.
-d. restrict the client’s oral fluid intake.
93. A nurse is beginning client care and has been as- signed to
the following four clients. Which client should the nurse plan to
assess first?
a. A 50-year-old client who has chronic pancreatitis and is
reporting a pain level of 6 out of 10 on a numeric scale
b. A 47-year-old client with esophageal varices who has
influenza and has been coughing for the last 30 minutes
~ c. A 60-year-old client who had an open cholecystectomy 15
hours ago and has been stable through the night
d. A 54-year-old client with cirrhosis and jaundice who is
reporting itching
94. A Chinese client with diarrhea refuses to drink the
prescribed oral hydration solution and insists on having chicken
broth instead. A nurse’s intervention in this situation should be
based on the knowledge that Chinese clients:
a. know that chicken is a food with yang qualities.
b. believe foods high in sodium should be used to treat diarrhea.
c. believe extra protein is needed to treat diarrhea.
d. mistrust modern medicine and often use simple foods to treat
disease.
~
95. During a hospital admission history, a nurse suspects
irritable bowel syndrome (IBS) when the client says:
a. “I am having a lot of bloody diarrhea.”
b. “I have been vomiting for 2 days.”
- c. “I have lost 10 pounds in the last month.”
d. “I have noticed mucus in my stools.”
96. A registered nurse (RN) overhears a licensed practical nurse
(LPN) talking with a client who is being prepared for a total
colectomy with the creation of an ileoanal reservoir for
ulcerative colitis. To decrease the client’s anxiety, the RN should
intervene to clarify the information given by the LPN when the
LPN is heard saying:
a. “this surgery will prevent you from developing colon cancer.”
b. “after this surgery you will no longer have ulcerative colitis.”
c. “when you return from surgery you will not be able to eat
solid food for several days.”
-d. “you will have an ileostomy when you return from this
surgery.”
97. A family member tells a nurse that her father, who was told
24 hours ago that he has terminal colon can- cer, refuses to see
the family priest. He has also asked that his phone be
disconnected so that he does not need to interact with other
family members and friends. He told his daughter that he has
decided he was never going to pray again in spite of the fact that
previously he has been a very religious person. Based on this
information, which nursing diagnosis should the nurse develop
for this client?
a. Decisional conflict about how to manage his cancer diagnosis
related to lack of experience with terminal illness
b. Risk for spiritual distress related to diagnosis of terminal
cancer
c. Spiritual distress related to anxiety about the diagnosis of
terminal cancer
d. Noncompliance related to spiritual values
~
98. While caring for a surgical client during the first 24 hours
after an abdominal–perineal resection, a nurse should give the
highest priority to:
a. providing a low-residue diet.
b. monitoring the amount and color of stool in the colostomy
bag.
c. assessing perineal dressings and drainage.
d. encouraging observation and acceptance of the colostomy
site.
-
99. A nurse is conducting a home visit with a client who had
surgery 3 months ago that involved the creation of a colostomy.
When the nurse arrives at the home, the client’s wife reports that
her husband has lost interest in golf, which used to be his
passion. She also says he cries often for no reason, is only able
to sleep for a few hours each night, and reports fatigue daily.
The wife asks the nurse for advice. A nurse’s response should be
based on the knowledge that:
a. twenty-five percent of all clients develop clinically
significant depression after ostomy surgery.
b. athletic activities like golf are not possible after ostomy
surgery.
c. after 3 months the client should have accepted his new body
image.
d. it is difficult to sleep well with an ostomy.
~
100. For a client with a newly created colostomy, a nurse creates
this diagnosis: risk for sexual dysfunction related to body image
change. To promote satisfying sexual functioning after ostomy
surgery, which recommendation should the nurse make to the
client?
a. Participate in sexual activity only in a darkened room
b. Utilize self-gratification for the majority of sexual needs
c. Empty and clean the ostomy pouch immediately before
sexual activity
d. Utilize only the female superior position for sexual activity
~
1. A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a
bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric
region along with a rigid, boardlike abdomen. These clinical manifestations most likely
indicate which of the following?
A. An intestinal obstruction has developed.
~
B. Additional ulcers have developed.
C. The esophagus has become inflamed.
D. The ulcer has perforated.
2. The client with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery
elm might be useful in managing the disease. What is the nurse's best response?
~
A. "No, they probably won't be useful. You should use only prescription medications in
your treatment plan."
B. "These herbs could be helpful. However, you should talk with your physician
before adding them to your treatment regimen."
C. "Yes, these are known to be effective in managing this disease, but make sure you
research the herbs thoroughly before taking them."
D. "No, herbs are not useful for managing this disease. You can use any type of over-thecounter drugs though. They have been shown to be safe."
3. A client with peptic ulcer disease tells the nurse that he has black stools, which he has not
reported to his physician. Based on this information, which nursing diagnosis would be
appropriate for this client?
~
A. Ineffective coping related to fear of diagnosis of chronic illness.
B. Deficient knowledge related to unfamiliarity with significant signs and
symptoms.
C. Constipation related to decreased gastric motility.
D. Imbalanced nutrition: Less than body requirements related to gastric bleeding.
4. A client with peptic ulcer disease is taking ranitidine (Zantac). What is the expected
outcome of this drug?
A. Heal the ulcer.
B. Protect the ulcer surface from acids.
C. Reduce acid concentration.
~
D. Limit gastric acid secretion.
5. The client with a history of peptic ulcer disease is admitted into the intensive care unit
with frank gastric bleeding. Which priority intervention should the nurse implement?
~
A. Maintain a strict record of intake and output
B. Insert a nasogastric tube and begin saline lavage
C. Assist the client with keeping a detailed calorie count
D. Provide a quiet environment to promote rest
6. A The client is experiencing bleeding related to peptic ulcer disease (PUD). Which
nursing intervention is the highest priority?
A. Starting a large-bore intravenous (IV)
B. Administering intravenous (IV) pain medication
C. Preparing equipment for intubation
D. Monitoring the client's anxiety level
~
7. The nurse is preparing to teach a client with a peptic ulcer about the diet that should be
followed after discharge. The nurse should explain that the diet will most likely consist of
which of the following?
A. Bland foods.
B. High-protein foods.
C. Any foods that are tolerated.
D. Large amounts of milk.
~
8. The nurse finds a client who has been diagnosed with a peptic ulcer surrounded by papers
from his briefcase and arguing on the telephone with a coworker. The nurse's response to
observing these actions should be based on knowledge that:
~
A. Involvement with his job will keep the client from becoming bored.
B. A relaxed environment will promote ulcer healing.
C. Not keeping up with his job will increase the client's stress level.
D. Setting limits on the client's behavior is an important nursing responsibility.
9. A client with a peptic ulcer has been instructed to avoid intense physical activity and
~
stress. Which strategy should the client incorporate into the home care plan?
A. Conduct physical activity in the morning so that he can rest in the afternoon.
B. Have the family agree to perform the necessary yard work at home.
C. Give up jogging and substitute a less demanding hobby.
D. Incorporate periods of physical and mental rest in his daily schedule.
10. A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer.
The client understands proper drug administration of ranitidine when she says that she
will take the drug at which of the following times?
~
A. Before meals.
B. With meals.
C. At bedtime.
D. When pain occurs.
11. A client has been taking aluminum hydroxide (Amphojel) 30 mL six times per day at
home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel
movement for 3 days. Based on this information, the nurse would determine which of the
following is the most likely cause of the client's constipation?
A. The client has not been including enough fiber in his diet.
B. The client needs to increase his daily exercise.
C. The client is experiencing an adverse effect of the aluminum hydroxide.
D. The client has developed a gastrointestinal obstruction.
-
12. A client is taking an antacid for treatment of a peptic ulcer. Which of the following
~
statements best indicates that the client understands how to correctly take the antacid?
A. "I should take my antacid before I take my other medications."
B. "I need to decrease my intake of fluids so that I don't dilute the effects of my antacid."
C. "My antacid will be most effective if I take it whenever I experience stomach pains."
D. "It is best for me to take my antacid 1 to 3 hours after meals."
13. Which of the following would be an expected outcome for a client with peptic ulcer
-
disease? The client will:
A. Demonstrate appropriate use of analgesics to control pain.
B. Explain the rationale for eliminating alcohol from the diet.
C. Verbalize the importance of monitoring hemoglobin and hematocrit every 3 months.
D. Eliminate contact sports from his or her lifestyle.
14. The nurse is caring for a client diagnosed with rule out peptic ulcer disease. Which test
confirms this diagnosis?
A. Esophagogastroduodenoscopy
B. Magnetic resonance imaging
C. Occult blood test
D. Gastric acid stimulation.
-
15. Which specific data should the nurse obtain from the client who is suspected of having
peptic ulcer disease?
A. History of side effects experienced from all medications
B. Use of non steroidal anti inflammatory drugs (NSAIDs)
C. Any known allergies to drugs and environmental factors
D. Medical histories of at least 3 generations
~
16. Which physical examination should the nurse implement first when assessing the client
diagnosed with peptic ulcer disease?
A. Auscultate the client's bowel sounds in all four quadrants
B. Palpate the abdominal area for tenderness
C. Percuss the abdominal borders to identify organs
D. Assess the tender area progressing to nontender
17. Which problems should the nurse include in the plan of care for the client diagnosed
with peptic ulcer disease to observe for physiological complications?
A. Alteration in bowel elimination patterns
B. Knowledge deficit in the causes of ulcers
C. Inability to cope with changing family roles
D. Potential for alteration in gastric emptying
18. Which expected outcome should the nurse include for a client diagnosed with peptic
ulcer disease?
A. The client's pain is controlled with the use of NSAIDs
B. The client maintains lifestyle modifications
C. The client has no signs and symptoms of hemoptysis
D. The client take s antacids with each meal
~
19. The nurse has been assigned to care for a client diagnosed with peptic ulcer disease.
-
Which assessment data require further intervention?
A. Bowel sour s auscultated 15 times in 1 minute
B. Belching after eating a heavy and fatty meal late at night
C. A decrease in systolic BP of 20 mm Hg from lying to sitting
D. A decreased frequency of distress located in the epigastric region
20. The nurse has administered an antibiotic, a proton pump inhibitor, and Pepto- Bismol
for peptic ulcer disease secondary to H. pylori. Which data would indicate to the nurse
the medications are effective?
A. A decrease in alcohol intake
B. Maintaining a bland diet
C. A return to previous activities
D. A decrease in gastric distress
21. The male client tells the nurse he has been experiencing "heartburn" at night that
~
awakens him. Which assessment question should the nurse ask?
A. "How much weight have you gained recently?"
B. "What have you done to alleviate your heartburn?"
C. "Do you consume a lot of milk and dairy products?"
D. "Have you been around anyone with a stomach virus?"
22. The nurse caring for a client diagnosed with GERD writes about the client's problem of
~
"behavior modification." Which intervention should be included for this problem?
A. Teach the client to sleep with a foam wedge under the head
B. Encourage the client to decrease the amount of smoking
C. Instruct the client to take over-the-counter medication for relief of pain
D. Discuss the need to attend Alcoholics Anonymous to quit drinking
23. The nurse is preparing a client diagnosed with GERD for discharge following an
esophagogastriduodenoscopy. Which statement indicates the client understands the
discharge instructions?
A. "I should not eat for at least one (1) day following this procedure"
"I can lie down whenever I want after a meal. It won't make a difference"
- B.
C. "The stomach contents won't bother my esophagus but will make me nauseous"
D. "I should avoid orange juice and eating tomatoes until my esophagus heals"
24. The nurse is planning the care of a client diagnosed with lower esophageal sphincter
dysfunction. Which dietary modifications should be included in the plan of care?
A. Allow any of the client's favorite foods as long as the amount is limited
B. Have the client perform eructation exercises several times a day
C. Eat four (4) to six (6) small meals a day and limit fluids during mealtimes
D. Encourage the client to consume a glass of red wine with one (1) meal a day
~
25. The nurse is caring for a client diagnosed with GERD. Which nursing intervention
should be implemented?
A. Place the client prone in bed and administer nonsteroidal anti-inflammatory
medications
B. Have the client remain upright at all times and walk for 30 minutes three (3) times a
week
C. Instruct the client to maintain a right lateral side-lying position and take antacids
before meals
D. Elevate the head of the bed 30 degrees and discuss lifestyle modifications with the
client
~
26. The nurse is caring for an adult client diagnosed with GERD. Which condition is the
most common comorbid disease associated with GERD?
A. Adult-onset asthma
B. Pancreatitis
C. Peptic ulcer disease
D. Increased gastric emptying
~
27. The nurse is preparing a client diagnosed with GERD for surgery. Which information
~
warrants notifying the HCP?
A. The client's Bernstein esophageal test was positive
B. The client's abdominal x-ray shows a hiatal hernia
C. The client's WBC count is 14,000/mm^3
D. The client's hemoglobin is 13.8 g/dL
28. Which statement made by the client indicates to the nurse that the client may be
~
experiencing GERD?
A. "My chest hurts when I walk up the stairs in my home:
B. "I take antacid tablets with me wherever I go"
C. "My spouse tells me I snore very loudly at night"
D. "I drink six (6) to seven (7) soft drinks every day
29. The nurse is performing an admission assessment on a client diagnosed with GERD.
Which signs and symptoms would indicate GERD?
A. Pyrosis, water brash, and flatulence
B. Weight loss, dysarthria, and diarrhea
C. Decreased abdominal fat, proteinuria, and constipation
D. Midepigastric pain, positive H. pylori test, and melena
30. Which disease is the client diagnosed with GERD at a greater risk for developing?
~
A. Twenty blood stools a day
B. Oral temperature of 102 degrees Fahrenheit
C. Esophageal cancer
D. Gastric cancer
31. Which of the following instructions should the nurse include in the teaching plan for a
-
client who is experiencing gastroesophageal reflux disease (GERD)?
A. Limit caffeine intake to two cups of coffee per day
B. Do not lie down for 2 hours after eating
C. Follow a low-protein diet
D. Take medications with milk to decrease irritation
32. The client is scheduled to have an upper GI tract series of x-rays. Following the x-rays,
the nurse should instruct the client to:
A. Take a laxative
B. follow a clear liquid diet
C. Administer an enema
D. Take an antiemetic
-
33. A client who has been diagnosed with GERD has heartburn. To decrease the heartburn,
the nurse should instruct the client to eliminate which of the following items from the
diet?
A. Lean beef
B. Air-popped popcorn
-
C. Hot chocolate
D. Raw vegetables
34. The client with GERD has a chronic cough. This symptom may be indicative of which
of the following?
A. Development of laryngeal cancer
B. Irritation of the esophagus
C. Esophageal scar tissue formation
D. Aspiration of gastric contents
-
35. The client attends two sessions with the dietitian to learn about diet modifications to
minimize GERD. The teaching would be considered successful if the client decreases the
intake of which of the following foods?
A. fats
B. high-sodium foods
C. Carbohydrates
D. high calcium foods
-
36. Which of the following dietary measures would be useful in preventing Esophageal
-
reflux?
A. Eating small, frequent meals
B. increasing fluid intake
C. avoiding air swallowing with meals
D. Adding a bedtime snack to the dietary plan
37. The nurse is obtaining a health history from a client who has a sliding hiatal hernia
associated with reflux. The nurse should ask the client about the presence of which of the
following symptoms?
A. Heartburn
B. Jaundice
C. Anorexia
D. Stomatitis
-
38. Which of the following factors would most likely contribute to the development of a
client's hiatal hernia?
A. having a sedentary desk job
B. being 5 feet, 3 inches tall and weighing 190 lbs
C. using laxatives frequently
D. being 40 years old
-
39. Which of the following nursing interventions would most likely promote self-care
~
behaviors in the client with a hiatal hernia?
A. Introduce the client to other people who are successfully managing their care.
B. Include the client's daughter in the teaching so that she can help implement the plan
C. Ask the client to identify other situation in which the client changed health care
habits
D. Provide reassurance that the client will be able to implement all aspects of the plan
successfully.
40. The client has been taking magnesium hydroxide (milk of magnesia) to control hiatal
hernia symptoms. The nurse should assess the client for which of the following
conditions are most commonly associated with the ongoing use of magnesium based
antacids?
A. anorexia
B. weight gain
C. diarrhea
D. constipation
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41. Which of the following lifestyle modifications should the nurse encourage the client
~
with hiatal hernia to include in ADLs?
A. Daily aerobic exercise
B. eliminating smoking and alcohol use
C. balancing activity and rest
D. avoiding high-stress situation
42. In developing a teaching plan for the client with a hiatal hernia, the nurse's assessment
~
of which work-related factors would be most useful?
A. number and length of breaks
B. body mechanics used in lifting
C. temperature in the work area
D. Cleansing solvents used
43. The nurse instructs the client on health maintenance activities to help control symptoms
~
from a hiatal hernia. Which of the following statements would indicate that the client has
understood the instructions?
A. "I'll avoid lying down after a meal."
B. "I can still enjoy my potato chips and cola at bedtime."
C. "I wish I didn't have to give up swimming."
D. "If I wear a girdle, I'll have more support for my stomach."
44. The client asks the nurse if surgery is needed to correct a hiatal hernia. Which reply by
the nurse would be the MOST accurate?
A. "Surgery is usually required, although medical treatment is attempted first."
B. "Hiatal hernia symptoms can usually be successfully managed with diet
modification, medications, and lifestyle changes."
C. "Surgery is not performed for this type of hernia."
D. "A minor surgical procedure to reduce the size of the diaphragmatic opening will
probably be planned."
~
45. Your patient, who is presenting with signs and symptoms of GERD, is scheduled to
-
have a test that assesses the function of the esophagus' ability to squeeze food down into
the stomach and the closure of the lower esophageal sphincter. The patient asks you,
"What is the name of the test I'm having later today?" You tell the patient the name of the
test is:*
A. Lower Esophageal Gastrointestinal Series
B. Transesophageal echocardiogram
C. Esophageal manometry
D. Esophageal pH monitoring
46. After dinner time, during hourly rounding, a patient awakes to report they feel like
"food is coming up" in the back of their throat and that there is a bitter taste in their
mouth. What nursing intervention will you perform next?*
A. Perform deep suctioning
B. Assist the patient into the Semi-Fowler's position
C. Keep the patient NPO
D. Instruct the patient to avoid milk products
~
47. After providing education to a patient with GERD. You ask the patient to list 4 things
they can do to prevent or alleviate signs and symptoms of GERD. Which statement is
INCORRECT?*
A. "It is best to try to consume small meals throughout the day than eat 3 large ones."
B. "I'm disappointed that I will have to limit my intake of peppermint and spearmint
because I love eating those types of hard candies."
C. "It is important I avoid eating right before bedtime."
D. "I will try to lie down after eating a meal to help decrease pressure on the lower
esophageal sphincter."
-
48. What type of hiatal hernia more commonly leads to strangulation as a severe
complication?
A. Sliding hiatal hernias
B. Hernias do not strangulate
C. Paraesophageal hiatal hernias
D. Both types equally lead to strangulation
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49. A 55 year old male presents to his PCP with a chief complaint of heartburn and
difficulty swallowing. His provider notes a congenital short esophagus was discovered on
previous CXR. What does this discovery put the patient at risk for?
~
A. Obesity
B. Sliding hiatal hernias
C. GERD
D. Gastritis
50. Symptoms of a hiatal hernia include all of the following, EXCEPT:
A. Asymptomatic
B. Regurgitation
C. Constipation
D. Dysphagia
-
51. It is a condition where the muscles in your esophagus fail to contract and the esophagus
does not properly deliver food and liquids into your stomach.
~
A. Impaired Esophageal Motility
B. Hiatal Hernia
C. GERD
D. PUD
52. This refers to the part of the stomach that protrudes through the esophageal hiatus of the
diaphragm into the thoracic cavity.
A. Impaired Esophageal Motility
B. Hiatal Hernia
C. GERD
~ D. PUD
53. Which of the following refers to a backflow of gastric duodenal contents into the
esophagus?
A. Impaired Esophageal Motility
B. Hiatal Hernia
~ C. GERD
D. PUD
54. This disorder is frequently referred to as gastric, duodenal, or esophageal ulcer,
depending on its location.
A. Impaired Esophageal Motility
B. Hiatal Hernia
C. GERD
- D. PUD
55. This refers to an excavation or ulceration that penetrates the mucosal wall of the
Gastrointestinal tract.
A. Impaired Esophageal Motility
B. Hiatal Hernia
~C.
D.
GERD
PUD
56. Which of the following refers to the term given to the acute mucosal ulceration of the
duodenal or gastritis area that occurs after a physiologically stressful event.
A. Stress Ulcer
B. Hiatal Hernia
C. GERD
-D. PUD
57. This type of ulcer is common in patients with head injury and brain trauma, which
occurs in the esophagus, stomach or duodenum.
A. Stress Ulcer
B. Cushing’s ulcer
C. Curling ulcer
D. None of the choices
58. This type of ulcer wherein it is frequently observed about 72 hours after extensive
burns and involves the antrum of the stomach or the duodenum.
A. Stress Ulcer
B. Cushing’s ulcer
C. Curling ulcer
D. None of the choices
59. This surgical management of GERD wherein a wrapping of a portion of the gastric
fundus around the sphincter area of the esophagus.
A. Barium swallow
B. ECG
C. X-ray
D. Nissen Fundoplication
60. Which of the following types of impaired esophageal motility is characterized by
impaired peristalsis of smooth muscle of esophagus and impaired relaxation of lower
esophageal sphincter?
A. Stress Ulcer
B. Cushing’s ulcer
C. Achalasia
D. Diffuse esophageal spasm
61. This refers to the inflammation of the gastric or stomach mucosa that can also be acute
or chronic.
A. Gastrointestinal intubation
B. NGT
C. Gastritis
D. IBS
62. Nursing management of the patient with chronic gastritis includes teaching the patient
to:
A. maintain a bland diet with six small meals a day
B. take antacids before meals
C. use NSAIDS instead of aspirin for pain relief
D. eliminate alcohol and caffeine
~
63. "Which of the following types of gastritis is associated with Helicobacter pylori and
duodenal ulcers?
A. Erosive (hemorrhagic) gastritis
B. Fundic gland gastritis (type A)
C. Antral gland gastritis (type B)
D. Aspirin-induced gastric ulcer
64. The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse
~
monitors the client knowing that this client is at risk for which vitamin deficiency?
A. Vitamin A
B. Vitamin B12
C. Vitamin C
D. Vitamin E
65. Which of the following types of gastritis is associated with Helicobacter pylori and
duodenal ulcers?
A. Erosive (hemorrhagic) gastritis
B. Fundic gland gastritis (type A)
C. Antral gland gastritis (type B)
D. Aspirin-induced gastric ulcer
66. "The nurse is caring for the client diagnosed with chronic gastritis. Which symptom(s)
would support this diagnosis?
A. Rapid onset of mid-sternal discomfort.
B. Epigastric pain relieved by eating food
C. Dyspepsia and hematemesis.
D. Nausea and projectile vomiting
67. Which of the following refers to the insertion of a flexible tube into the stomach,
beyond the pylorus into the duodenum or the jejunum?
A. Gastritis
B. IBS
C. Gastrointestinal Intubation
D. Gastrostomy
68. This refers to a large-bore tube inserted through the mouth with a wide outlet for removal of
gastric contents.
A. Gastrostomy
B. Orogastric tube
C. Pipe tube
D. PVC tube
69. Which of the following refers to a surgical procedure in which an opening is created into the
stomach for the purpose of administering food and fluids.
A. Jejustomy
B. Orogastric tube
C. NGT
D. Gastrostomy
70. This refers to a method of providing nutrients to the body by an intravenous route.
A. Jejustomy
B. Orogastric tube
C. NGT
D. Parenteral Nutrition
71. The nurse is preparing to administer medication through a nasogastric tube that is connected
to suction. To administer the medication, the nurse should take which action?
A. Position the client supine to assist in medication absorption.
B. Aspirate the nasogastric tube after medication administration to maintain patency.
C. Clamp the nasogastric tube for 30 to 60 minutes following administration of the
medication.
D. Change the suction setting to low intermittent suction for 30 minutes after medication
Administration.
72. The registered nurse is preparing to insert a nasogastric tube in an adult client. To determine
the accurate measurement of the length of the tube to be inserted, the nurse should take which
action?
A. Mark the tube at 10 inches (25.5 cm).
B. Mark the tube at 32 inches (81 cm).
C. Place the tube at the tip of the nose and measure by extending the tube to the earlobe
and then down to the xiphoid process.
D. Place the tube at the tip of the nose and measure by extending the tube to the earlobe and then
down to the top of the sternum.
73. The nurse checks for residual before administering a bolus tube feeding to a client with a
nasogastric tube and obtains a residual amount of 150 mL. What is the most appropriate action
for the nurse to take?
A. Hold the feeding and reinstill the residual amount.
B. Reinstill the amount and continue with administering the feeding.
C. Elevate the client's head at least 45 degrees and administer the feeding.
D. Discard the residual amount and proceed with administering the feeding.
74. The nurse is inserting a nasogastric tube in an adult client. During the procedure, the client
begins to cough and has difficulty breathing. What is the most appropriate action?
A. Insert the tube quickly.
B. Notify the health care provider immediately.
C. Remove the tube and reinsert it when the respiratory distress subsides.
D. Pull back on the tube and wait until the respiratory distress subsides.
75. This method of tube feeding is administered by gravity into the stomach through a large
syringe.
~
A. Cyclic feeding
B. Continuous feeding
C. Intermittent gravity drip feeding method
D. Bolus feeding
76. This method of tube feeding is given over 8 to 18 hours.
A. Cyclic feeding
B. Continuous feeding
C. Intermittent gravity drip feeding method
D. Bolus feeding
77. This method of tube feeding requires administering feedings over 30 minutes at designated
intervals by a reservoir enteral bag and tubing.
A. Cyclic feeding
B. Continuous feeding
C. Intermittent gravity drip feeding method
D. Bolus feeding
78. This method of tube feeding wherein the delivery of feedings incrementally over long
periods.
A. Cyclic feeding
B. Continuous feeding
C. Intermittent gravity drip feeding method
D. Bolus feeding
79. This refers to one of the most common gastrointestinal problems that results from functional
disorder of intestinal motility.
A. Gastrointestinal intubation
B. Malabsorption
C. Gastritis
D. Irritable Bowel Syndrome
80. Which of the following refers to the inability of the digestive system to absorb one or more
of the major vitamins, minerals and nutrients.
A. Gastrointestinal intubation
B. Malabsorption
C. Gastritis
D. Irritable Bowel Syndrome
81. Which of the following refers to all the changes that food undergoes in the alimentary canal
so that it can be absorbed and metabolized.
A. Metabolism
B. Absorption
C. Digestion
D. Elimination
82. It is the passage of substance through the intestinal mucosa into blood or lymph.
A. Metabolism
B. Absorption
C. Digestion
D. Elimination
83. This refers to the removal of the waste products through defecation.
A. Metabolism
B. Absorption
C. Digestion
D. Elimination
84. Which of the following refers to the “building of compounds” which uses energy.
A. Catabolism
B. Absorption
C. Anabolism
D. Elimination
85. Which of the following refers to the “breaking down of compounds” to release energy.
A. Catabolism
B. Absorption
C. Anabolism
D. Elimination
86. This diagnostic test involves visualization by fluoroscopy of the esophagus and stomach after
the client swallows barium sulphate.
A. Barium enema
B. Barium swallow
C. UTZ
D. Fecal occult blood
87. This diagnostic test produces an image of the abdominal organs and structures on the
oscilloscope by using sound waves.
A. Radiographic studies
B. Abdominal UTZ
C. MRI
D. Endoscopic procedures
88. Which of the following diagnostic tests is useful in evaluating abdominal soft tissues as well
as blood vessels, abscesses, fistulas, neoplasm and other sources of bleeding.
A. Radiographic studies
B. Abdominal UTZ
C. MRI
D. Endoscopic procedures
89. Which of the following diagnostic tests provides a direct visualization of internal
gastrointestinal structures using a long, flexible tube containing a fiber optic light source.
A. Radiographic studies
B. Abdominal UTZ
C. MRI
D. Endoscopic procedures
90. Which of the following diagnostic tests uses manometric catheters to measure intraluminal
pressure in the gastrointestinal structures.
A. Radiographic studies
B. Abdominal UTZ
C. Gastric analysis
D. Motility Studies
191. The nurse is teaching the client how to care for her
ileostomy. The client asks the nurse how long she can wear her
pouch before changing it. The nurse responds:
a. “The pouch is changed only when it leaks.”
b. “You can wear the pouch for about 4 to 7 days.”
c. “You should change the pouch every evening before
bedtime.”
d. “It depends on your activity level and your diet.”
192. A client is scheduled for an ileostomy. Which of the
following interventions would be most helpful in preparing the
client psychologically for the surgery?
a. Include family members in preoperative teaching sessions.
b. Encourage the client to ask questions about managing an
ileostomy.
c. Provide a brief, thorough explanation of all preoperative
and postoperative procedures.
d. Invite a member of the ostomy association to visit the client.
193. A client who is scheduled for an ileostomy has an order for
oral neomycin (Mycifradin) to be administered before surgery.
The intended outcome of administering oral neomycin before
surgery is to:
a. Prevent postoperative bladder infection.
b. Reduce the number of intestinal bacteria.
c. Decrease the potential for postoperative hypo- static
pneumonia.
d. Increase the body’s immunologic response to the stressors of
surgery.
194. 47. A client has returned to the medical surgical unit after
having surgery to create an ileostomy. Which goal has the
highest priority at this time?
a. Providing relief from constipation.
b. Assisting the client with self-care activities.
c. Maintaining fluid and electrolyte balance.
d. Minimizing odor formation.
195. The client asks the nurse, “Is it really possible to lead a
normal life with an ileostomy?” Which action by the nurse
would be the most effective to address this question?
a. Have the client talk with a member of the clergy about these
concerns.
b. Tell the client to worry about those concerns after surgery.
c. Arrange for a person with an ostomy to visit the client
preoperatively.
d. Notify the surgeon of the client’s question.
196. Three weeks after the client has had an ileostomy, the nurse
is following up with instruction about using a skin barrier
around the stoma at all times. The client has been applying the
skin barrier correctly when:
a. There is no odor from the stoma.
b. The client is adequately hydrated.
c. There is no skin irritation around the stoma.
d. The client only changes the ostomy pouch once a day.
197. The nurse should instruct the client with an ileostomy to
report which of the following signs and symptoms immediately?
a. Passage of liquid stool from the stoma.
b. Occasional presence of undigested food in the effluent.
c. Absence of drainage from the ileostomy for 6 or more
hours.
d. Temperature of 99.8° F (37.7° C).
198. The nurse finds the client who has had an ileostomy crying.
The client explains to the nurse, “I’m upset because I know I
won’t be able to have children now that I have an ileostomy.”
Which of the following would be the best response for the
nurse?
a. “Many women with ileostomies decide to adopt. Why don’t
you consider that option?”
b. “Having an ileostomy does not necessarily mean that you
can’t bear children. Let’s talk about your concerns.”
c. “I can understand your reasons for being upset. Having
children must be important to you.”
d. “I’m sure you will adjust to this situation with time. Try not to
be too upset.”
199. The nurse evaluates the client’s understanding of ileostomy
care. Which of the following statements indicates that discharge
teaching has been effective?
a. “I should be able to resume weight lifting in 2 weeks.”
b. “I can return to work in 2 weeks.”
c. “I need to drink at least 3,000 mL a day of fluid.”
d. “I will need to avoid getting my stoma wet while bathing.”
200. A client with a well-managed ileostomy calls the nurse to
report the sudden onset of abdominal cramps, vomiting, and
watery discharge from the ileostomy. The nurse should:
a. Tell the client to take an antiemetic.
b. Encourage the client to increase fluid intake to 3 L/day to
replace fluid lost through vomiting.
c. Instruct the client to take 30 mL of milk of magnesia to
stimulate a bowel movement.
d. Advise the client to notify the physician.