NURS 5329.

060 Lynlee Gayle

Exam Administration and Analysis

1. You will work with your preceptor to develop 5 MCIs on the content
related to your lecture content. Test Questions. Submit the test
questions you developed here. For each question, designate the correct
answer(s) by asterisk (*). Indicate Blooms cognitive level (use
application or analysis levels only. Note: depending on the situation,
your questions may or may not be used in the exam.
MCI QUESTIONS- Please note: All questions are based on the Blooms cognitive
application level because this was the cognitive level requested by my mentor.
1. After teaching a patient with inflammatory bowel disease (IBD) about diet,
which statement indicates that the patient needs further instruction?
a. I eat strawberry yogurt in the morning for breakfast.
*b. My favorite dessert is butter pecan ice cream.
c. I plan to drink almond milk instead of whole milk.
d. My wife cooks chicken and rice for me during my flare ups.
Rationale: Many patients with IBD are lactose intolerant, symptoms improve
when milk and milk products are avoided. Lactose intolerant patients can use
yogurt as a substitute. High-fat foods also tend to trigger diarrhea. Cold foods
and high fiber foods (Cereal with bran, nuts, raw fruits with peels may
promote diarrhea. Smoking stimulates the GI tract. (Lewis, Pg. 981)
2. Which symptom needs immediate reporting to the physician in a patient
with Peptic Ulcer disease?
a. weight loss
b. bradycardia
*c. severe abdominal pain
d. abdomen soft to palpation
Rationale: Sudden, severe upper abdominal pain is a sign of the initial phase
of perforation, which is a major complication of PUD. Weight loss can be a
symptom associated with peptic ulcers, but is not a symptom that require
immediate reporting to the physician. Patients with perforation typically
experience a rigid and boardlike abdomen. The heart rate is elevated
(tachycardia) and the pulse is weak. (Lewis, pg. 944)
3. A patient presents to the ER with suspected appendicitis. After suspecting
the patient will need an appendectomy, the RN reviews the plan of care and
physician orders. Which of the following physician orders should the RN
question?
a. Nothing by mouth status
*b. Miralax 17 g PRN for constipation
c. Normal Saline 20 ml/kg IV
d. Acetaminophen 15mg/kg PRN for pain

NURS 5329.060 Lynlee Gayle

Rationale: The RN should question the Miralax oder because it is a laxative

which is especially dangerous because the resulting increased peristalsis
may cause perforation of the appendix. The patient will kept on NPO status
until an appendectomy can be ruled out. (Lewis, pg. 974)
4. A nurse is creating a plan of care for a patient with Crohns disease. The
nurse understands that the patient can have lesions in which part of the GI
tract?
a. terminal ileum
b. anus
c. mouth
*d. all of the above
Rationale: Crohns disease can occur anywhere in the GI tract from the
mouth to the anus, but occurs commonly in the terminal ileum and colon.
(Lewis, pg. 977)
5. Which of the following clinical manifestations alerts the nurse that the
patient has Crohns disease, rather than Ulcerative colitis?
a. abdominal cramping
b. frequent diarrhea
c. Teenage onset
*d. severe weight loss
Rationale: Weight loss, often severe is very common in patients with Crohns
disease. Weight loss can be possible in patients with UC but is very rare.
Diarrhea and abdominal cramping are common symptoms of ulcerative colitis
and Crohns disease. The usual age of onset in both UC and Crohns is Teens
to mid-30s. (Lewis, Page 976, Table 43-14)
6. The nurse is providing teaching to a patient about the risk factors for
Gastroesophageal Reflux Disease. Which of the following would be
appropriate for the nurse to include? Select all that apply.
*a. cigarette smoking
*b. hiatal hernia
c. intense physical exertion
*d. obesity
e. age
Rationale: Cigarette smoking, hiatal hernia and obesity are all risk factors for
GERD. Intense physical exertion is a risk factor for a hiatal hernia. (Lewis, pg.
931)
7. Which of the following patients would have the highest risk for developing
upper gastrointestinal cancer?
*a. A 72 year old hispanic male that smokes 1 pack of cigarettes per
day.
b. A 50 year old white male that smokes 2 packs of cigarettes per day.
c. A 76 year old african american male,that is a non-smoker.

NURS 5329.060 Lynlee Gayle

d. A 16 year old obese, white male, that is a non-smoker.
Rationale: The 72 year old hispanic male that smokes one pack of cigarettes
every day has the highest amount of risk factors for upper gastrointestinal
cancer. Risk factors for upper gastrointestinal cancer are smoking, obesity,
age 65-80, hispanics, and african american males. (Lewis, pg. 951).
8. The nurse observes an unlicensed assistive care provider (UAP) taking vital
signs on a patient with C. difficile. Which action by the UAP requires the nurse
to intervene?
*a. Uses hand sanitizer immediately after interaction with the patient.
b. Uses the thermometer in the patients room to take their
temperature.
c. Cleans their hands with soap and water after completing task
d. Dons gloves and gown prior to entering the patients room.
Rationale: C. difficile spores are extremely difficult to kill. Alcohol based hand
sanitizers are ineffective and all staff should clean hands with soap and
water. All visitors and health care providers should wear a gown and gloves
with any contact to patients. Infected patients must be given their own
disposable stethoscopes and thermometers. (Lewis, pg. 964).
9. After teaching to a patient who has recently had an illeostomy created,
which patient statement indicates that teaching related to ileostomy care has
been effective?
a. My diet should be high in fiber for the next few days to promote
peristalsis.
*b. I will change the drainable pouch every 4-7 days; sooner if it
leaks.
c. I should limit my intake of fluids to improve stool consistency.
d. I can resume my activities of daily living as soon as I get home.
Rationale: The patient should change the drainable pouch every 4-7 days
unless leakage occurs. A low fiber diet is ordered initially, and fiber
containing food are gradually introduced. Patients need to increase fluid
intake to 2 to 3 L per day. Normal activities of daily living can be resumed
within 6-8 weeks but should avoid heavy lifting. (Lewis, pg. 993-994.)
10. A patient has just returned to the unit following the placement of an
ostomy. Upon assessment, the nurse notices the stoma is red in color with
mild edema and has a small amount of bleeding from the stoma. Which
action by the nurse is appropriate?
a. Perform a colostomy irrigation
b. Notify the surgeon.
*c. Document the findings.
d. Apply a skin barrier surrounding the ostomy.

NURS 5329.060 Lynlee Gayle

Rationale: The stoma will have mild to moderate edema for 2-3 weeks after
the surgery. The stoma should be pink to red in color and a small amount of
bleeding from the stoma is normal. No action from the nurse is needed
besides documentation of the findings. (Lewis, pg. 992)
11. The nurse is completing an initial assessment for a patient when the
patient states, I have burning pain in my stomach about 1 hour after I eat.
Based on this information,
what should the nurse suspect the patient has?
a. peptic ulcer
b. duodenal ulcer
c. stress related mucosal disease
*d. gastric ulcer
Rationale: The clinical manifestations of gastric ulcers include burning pain 12 hours after meals. In patients with duodenal ulcers, pain normally presents
2-4 hours ager meals and midmorning, mid-afternoon, and middle of the
night. Peptic ulcers are too vague and does not distinguish the type of ulcer.
(Lewis, pg. 943)
12. Which of the following instructions should the nurse include in the
teaching plan for a patient with 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.
Rationale: For 2 to 3 hours after a meal the patient should not be supine.
Caffeinated beverages decrease pressure in the lower esophageal sphincter
and milk increases gastric acid secretion, so these beverages should be
avoided. The client is encouraged to follow a high-protein, low-fat diet, and
avoid foods that are irritating. (Lewis, pg. 933, table 42-9)
1. Include the Test blueprint that was developed for the exam. If
there was no test blueprint, develop one from the exam as it was
administered.

Blueprint for Exam 5: Gastrointestinal

CLASS 11: CARE OF THE PATIENT WITH UPPER GASTRO-INTESTINAL
DISORDERS

21

1. Explain the etiology, clinical manifestations, collaborative care and nursing

management of the patient with upper gastrointestinal bleeding.

2. Describe the etiology, clinical manifestations, complications, collaborative care and

nursing management of the patient with gastroesophageal reflux disease and hiatal

NURS 5329.060 Lynlee Gayle

hernia.

3. Differentiate between acute and chronic gastritis, including risk factors,

pathophysiology, and collaborative care and nursing management.

4. Compare gastric and duodenal ulcers, including pathophysiology, clinical

manifestations, complications, collaborative medical and surgical care and nursing
management.

5. Describe the clinical manifestations, collaborative care and nursing management of

the patient with upper gastrointestinal cancer.

Medications part of 7 questions

CLASS 12: CARE OF THE PATIENT WITH LOWER GASTRO-INTESTINAL

DISORDERS

27

1.

Describe the collaborative care and nursing management of the patient

with acute appendicitis, peritonitis, gastroenteritis, and Clostridium difficile.

2. Contrast ulcerative colitis and Crohns disease, including pathophysiology, clinical

manifestations, complications, collaborative care and nursing management.

Differentiate the pathophysiology, collaborative care and nursing management of

mechanical, neurogenic and vascular bowel obstructions.

Describe the risk factors, clinical manifestations and collaborative management of

the patient with colorectal cancer.

Explain the anatomic and physiologic changes and nursing management of the
patient with an ostomy.

Differentiate the clinical manifestations, collaborative care and nursing

management of diverticulosis and diverticulitis.

Compare and contrast the types of hernias, including etiology, collaborative care
and nursing management.

Describe the types, clinical manifestations, collaborative care and nursing

management of the patient with anorectal conditions.

Discuss the increased incidence of Escherichia coli and Clostridium difficile

infections in hospitalized populations and describe the prevention and care of
each.

Medications part of 11 questions

NURS 5329.060 Lynlee Gayle

Medication Calculations

Total (Includes 4 choose all that apply)

50

2. Overall Test Analysis and Individual Question Analysis

a. See McDonald (2014) chapters 11 and 12 and provide an analysis of the
exam as a whole including
i. Number of items- 50 questions
ii. Number of examinees- 207 examinees
iii.Mean- 83.40096618
iv. Median- 84
v. Low Score- 46
vi.High Score-98
i. KR 20 or reliability coefficient: recommended range
0.583038148
vii. One to two sentences describing your overall evaluation of the
exam. For example: This was an easy/hard exam based on the
mean.
Based on the mean of this exam (83), this exam was a very fair exam.
There was still a
low score of 46 but the majority of the class passed
the exam and with the curve (two
questions were credited) one
student was able to make a 100.
4. Question analysis: See McDonald p. 284 and Evaluate 3 individual
items (does not have to be the one you wrote)
38. Which symptom needs immediate reporting to the physician in a
patient with
Peptic Ulcer disease?
a. weight loss
b. bradycardia
*c. severe abdominal pain
d. abdomen soft to palpation

B (-0.18)

1. P value or item difficulty= 0.76

2. Point biserial for each question option (A-D)= A (-0.07)
C(0.2) D(0)

41. After teaching to a patient who has recently had an illeostomy

created, which
patient statement indicates that teaching related to
ileostomy care has been
effective?
a. My diet should be high in fiber for the next few days to promote
peristalsis.
*b. I will change the drainable pouch every 4-7 days; sooner if it
leaks.
c. I should limit my intake of fluids to improve stool consistency.
d. I can resume my activities of daily living as soon as I get home.
1. P value or item difficulty= 0.84

NURS 5329.060 Lynlee Gayle

2. Point biserial for each question option (A-D)= A (-0.22)
C(-0.06) D(-0.11)

B (0.25)

45. After teaching a patient with inflammatory bowel disease (IBD)

about diet,
which statement indicates that the patient
needs further instruction?
a. I eat strawberry yogurt in the morning for breakfast.
*b. My favorite dessert is butter pecan ice cream.
c. I plan to drink almond milk instead of whole milk.
d. My wife cooks chicken and rice for me during my flare ups.

(0.18) C(0.02)

1. P value or item difficulty= 0.68

2. Point biserial for each question option (A-D)= A (-0.1) B
D(-0.16)

1. Coaching: using Exam Diagnostics Tool (EDT) or other tool

discussed/recommended by preceptor.
Refer to the folder on Blackboard with EDT resources including video
examples.
a. Discuss the testing coaching process using the EDT. Place the
experience in context by providing a sentence or two about the
student you coached. Provide one completed testing coaching
forms you used with the student. Write a narrative reflection about
this experience, including student response.
The student was a young female student that did not have any family
obligations at home and works part time. She seems to be a very good student but
did want recommendations on improvement for tests and future studying habits in
order to be more successful. She seems very dedicated and proactive and have a
great potential for improvement. She was very receptive to answering the
questions in the EDT; she was open and honest and accepted my suggestions well. I
enjoyed talking to her about her future goals, study habits, and evaluating her
progress so that I could adapt my suggestions to her specific needs. It was
refreshing talking to a student that continually seeks areas for improvement, and I
enjoyed working with her.
*Please see the attached EDT, along with the notes related to our meeting.
Grading Criteria Exam Activities and Analysis
Category

Points earned

Test Blueprint

20

NURS 5329.060 Lynlee Gayle

5 submitted questions

20

Test analysis

20

Question analysis

20

Coaching documentation

20

Total

100