1. A patient with chronic alcohol abuse is admitted with liver failure.

You closely monitor the patients blood

pressure because of which change that is associated with the liver failure?

1. Hypoalbuminemia

2. Increased capillary permeability

3. Abnormal peripheral vasodilation

4. Excess rennin release from the kidneys

2. Youre assessing the stoma of a patient with a healthy, well-healed colostomy. You expect the stoma to appear:

1. Pale, pink and moist

2. Red and moist

3. Dark or purple colored

4. Dry and black

3. Youre caring for a patient with a sigmoid colostomy. The stool from this colostomy is:

1. Formed

2. Semisolid

3. Semiliquid

4. Watery

4. Youre advising a 21 y.o. with a colostomy who reports problems with flatus. What food should you recommend?

1. Peas

2. Cabbage

3. Broccoli

4. Yogurt

5. You have to teach ostomy self care to a patient with a colostomy. You tell the patient to measure and cut the

wafer:

1. To the exact size of the stoma.

2. About 1/16 larger than the stoma.

3. About 1/8 larger than the stoma.

4. About 1/4 larger than the stoma.

6. Youre performing an abdominal assessment on Brent who is 52 y.o. In which order do you proceed?

1. Observation, percussion, palpation, auscultation

2. Observation, auscultation, percussion, palpation

3. Percussion, palpation, auscultation, observation

4. Palpation, percussion, observation, auscultation

7. Youre doing preoperative teaching with Gertrude who has ulcerative colitis who needs surgery to create an

ileoanal reservoir. Which information do you include?

1. A reservoir is created that exits through the abdominal wall.

2. A second surgery is required 12 months after the first surgery.

3. A permanent ileostomy is created.

4. The surgery occurs in two stages.

8. Youre caring for Carin who has just had ileostomy surgery. During the first 24 hours post-op, how much drainage

can you expect from the ileostomy?

1. 100 ml

2. 500 ml

3. 1500 ml

4. 5000 ml

9. Youre preparing a teaching plan for a 27 y.o. named Jeff who underwent surgery to close a temporary ileostomy.

Which nutritional guideline do you include in this plan?

1. There is no need to change eating habits.

2. Eat six small meals a day.

3. Eat the largest meal in the evening.

4. Restrict fluid intake.

10. Arthur has a family history of colon cancer and is scheduled to have a sigmoidoscopy. He is crying as he tells

you, I know that I have colon cancer, too. Which response is most therapeutic?

1. I know just how you feel.

2. You seem upset.

3. Oh, dont worry about it, everything will be just fine.

4. Why do you think you have cancer?

11. Youre caring for Beth who underwent a Billroth II procedure (surgical removal of the pylorus and duodenum) for

treatment of a peptic ulcer. Which findings suggest that the patient is developing dumping syndrome, a

complication associated with this procedure?

1. Flushed, dry skin.

2. Headache and bradycardia.

3. Dizziness and sweating.

4. Dyspnea and chest pain.

12. Youre developing the plan of care for a patient experiencing dumping syndrome after a Billroth II procedure.

Which dietary instructions do you include?

1. Omit fluids with meals.

2. Increase carbohydrate intake.

3. Decrease protein intake.

4. Decrease fat intake.

13. Youre caring for Lewis, a 67 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis.

Relief of which symptom indicated that the paracentesis was effective?

1. Pruritus

2. Dyspnea

3. Jaundice

4. Peripheral Neuropathy

14. Youre caring for Jane, a 57 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis.

Before her paracentesis, you instruct her to:

1. Empty her bladder.

2. Lie supine in bed.

3. Remain NPO for 4 hours.

4. Clean her bowels with an enema.

15. After abdominal surgery, your patient has a severe coughing episode that causes wound evisceration. In

addition to calling the doctor, which intervention is most appropriate?

1. Irrigate the wound & organs with Betadine.

2. Cover the wound with a saline soaked sterile dressing.

3. Apply a dry sterile dressing & binder.

4. Push the organs back & cover with moist sterile dressings.

16. Youre caring for Betty with liver cirrhosis. Which of the following assessment findings leads you to suspect

hepatic encephalopathy in her?

1. Asterixis

2. Chvosteks sign

3. Trousseaus sign

4. Hepatojugular reflex

17. You are developing a care plan on Sally, a 67 y.o. patient with hepatic encephalopathy. Which of the following do

you include?

1. Administering a lactulose enema as ordered.

2. Encouraging a protein-rich diet.

3. Administering sedatives, as necessary.

4. Encouraging ambulation at least four times a day.

18. You have a patient with achalasia (incomplete muscle relaxtion of the GI tract, especially sphincter muscles).

Which medications do you anticipate to administer?

1. Isosorbide dinitrate (Isordil)

2. Digoxin (Lanoxin)

3. Captopril (Capoten)

4. Propranolol (Inderal)

19. The student nurse is preparing a teaching care plan to help improve nutrition in a patient with achalasia. You

include which of the following:

1. Swallow foods while leaning forward.

2. Omit fluids at mealtimes.

3. Eat meals sitting upright.

4. Avoid soft and semi soft foods.

20. Britney, a 20 y.o. student is admitted with acute pancreatitis. Which laboratory findings do you expect to be

abnormal for this patient?

1. Serum creatinine and BUN

2. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

3. Serum amylase and lipase

4. Cardiac enzymes

21. A patient with Crohns disease is admitted after 4 days of diarrhea. Which of the following urine specific gravity

values do you expect to find in this patient?

1. 1.005

2. 1.011

3. 1.020

4. 1.030

22. Your goal is to minimize Davids risk of complications after a herniorrhaphy. You instruct the patient to:

1. Avoid the use of pain medication.

2. Cough and deep breathe Q2H.

3. Splint the incision if he cant avoid sneezing or coughing.

4. Apply heat to scrotal swelling.

23. Janice is waiting for discharge instructions after her herniorrhaphy. Which of the following instructions do you

include?

1. Eat a low-fiber diet.

2. Resume heavy lifting in 2 weeks.

3. Lose weight, if obese.

4. Resume sexual activity once discomfort is gone.

24. Develop a teaching care plan for Angie who is about to undergo a liver biopsy. Which of the following points do

you include?

1. Youll need to lie on your stomach during the test.

2. Youll need to lie on your right side after the test.

3. During the biopsy youll be asked to exhale deeply and hold it.

4. The biopsy is performed under general anesthesia.

25. Stephen is a 62 y.o. patient that has had a liver biopsy. Which of the following groups of signs alert you to a

possible pneumothorax?
1. Dyspnea and reduced or absent breath sounds over the right lung

2. Tachycardia, hypotension, and cool, clammy skin

3. Fever, rebound tenderness, and abdominal rigidity

4. Redness, warmth, and drainage at the biopsy site

26. Michael, a 42 y.o. man is admitted to the med-surg floor with a diagnosis of acute pancreatitis. His BP is 136/76,

pulse 96, Resps 22 and temp 101. His past history includes hyperlipidemia and alcohol abuse. The doctor prescribes

an NG tube. Before inserting the tube, you explain the purpose to patient. Which of the following is a most accurate

explanation?

1. It empties the stomach of fluids and gas.

2. It prevents spasms at the sphincter of Oddi.

3. It prevents air from forming in the small intestine and large intestine.

4. It removes bile from the gallbladder.

27. Jason, a 22 y.o. accident victim, requires an NG tube for feeding. What should you immediately do after inserting

an NG tube for liquid enteral feedings?

1. Aspirate for gastric secretions with a syringe.

2. Begin feeding slowly to prevent cramping.

3. Get an X-ray of the tip of the tube within 24 hours.

4. Clamp off the tube until the feedings begin.

28. Stephanie, a 28 y.o. accident victim, requires TPN. The rationale for TPN is to provide:

1. Necessary fluids and electrolytes to the body.

2. Complete nutrition by the I.V. route.

3. Tube feedings for nutritional supplementation.

4. Dietary supplementation with liquid protein given between meals.

29. Type A chronic gastritis can be distinguished from type B by its ability to:

1. Cause atrophy of the parietal cells.

2. Affect only the antrum of the stomach.

3. Thin the lining of the stomach walls.

4. Decrease gastric secretions.

30. Matt is a 49 y.o. with a hiatal hernia that you are about to counsel. Health care counseling for Matt should include

which of the following instructions?

1. Restrict intake of high-carbohydrate foods.

2. Increase fluid intake with meals.

3. Increase fat intake.

4. Eat three regular meals a day.

31. Jerod is experiencing an acute episode of ulcerative colitis. Which is priority for this patient?

1. Replace lost fluid and sodium.

2. Monitor for increased serum glucose level from steroid therapy.

3. Restrict the dietary intake of foods high in potassium.

4. Note any change in the color and consistency of stools.

32. A 29 y.o. patient has an acute episode of ulcerative colitis. What diagnostic test confirms this diagnosis?

1. Barium Swallow.

2. Stool examination.

3. Gastric analysis.

4. Sigmoidoscopy.

33. Eleanor, a 62 y.o. woman with diverticulosis is your patient. Which interventions would you expect to include in

her care?

1. Low-fiber diet and fluid restrictions.

2. Total parenteral nutrition and bed rest.

3. High-fiber diet and administration of psyllium.

4. Administration of analgesics and antacids.

34. Regina is a 46 y.o. woman with ulcerative colitis. You expect her stools to look like:

1. Watery and frothy.

2. Bloody and mucous.

3. Firm and well-formed.

4. Alternating constipation and diarrhea.

35. Donald is a 61 y.o. man with diverticulitis. Diverticulitis is characterized by:

1. Periodic rectal hemorrhage.

2. Hypertension and tachycardia.

3. Vomiting and elevated temperature.

4. Crampy and lower left quadrant pain and low-grade fever.

36. Brenda, a 36 y.o. patient is on your floor with acute pancreatitis. Treatment for her includes:

1. Continuous peritoneal lavage.

2. Regular diet with increased fat.

3. Nutritional support with TPN.

4. Insertion of a T tube to drain the pancreas.

37. Glenda has cholelithiasis (gallstones). You expect her to complain of:

1. Pain in the right upper quadrant, radiating to the shoulder.

2. Pain in the right lower quadrant, with rebound tenderness.

3. Pain in the left upper quadrant, with shortness of breath.

4. Pain in the left lower quadrant, with mild cramping.

38. After an abdominal resection for colon cancer, Madeline returns to her room with a Jackson-Pratt drain in place.

The purpose of the drain is to:

1. Irrigate the incision with a saline solution.

2. Prevent bacterial infection of the incision.

3. Measure the amount of fluid lost after surgery.

4. Prevent accumulation of drainage in the wound.

39. Anthony, a 60 y.o. patient, has just undergone a bowel resection with a colostomy. During the first 24 hours,

which of the following observations about the stoma should you report to the doctor?

1. Pink color.

2. Light edema.

3. Small amount of oozing.

4. Trickles of bright red blood.

40. Your teaching Anthony how to use his new colostomy. How much skin should remain exposed between the

stoma and the ring of the appliance?

1. 1/16

2. 1/4

3. 1/2

4. 1

41. Claire, a 33 y.o. is on your floor with a possible bowel obstruction. Which intervention is priority for her?

1. Obtain daily weights.

2. Measure abdominal girth.

3. Keep strict intake and output.

4. Encourage her to increase fluids.

42. Your patient has a GI tract that is functioning, but has the inability to swallow foods. Which is the preferred

method of feeding for your patient?

1. TPN

2. PPN

3. NG feeding

4. Oral liquid supplements

43. Youre patient is complaining of abdominal pain during assessment. What is your priority?

1. Auscultate to determine changes in bowel sounds.

2. Observe the contour of the abdomen.

3. Palpate the abdomen for a mass.

4. Percuss the abdomen to determine if fluid is present.

44. Before bowel surgery, Lee is to administer enemas until clear. During administration, he complains of intestinal

cramps. What do you do next?

1. Discontinue the procedure.

2. Lower the height of the enema container.

3. Complete the procedure as quickly as possible.

4. Continue administration of the enema as ordered without making any adjustments.

45. Leigh Ann is receiving pancrelipase (Viokase) for chronic pancreatitis. Which observation best indicates the

treatment is effective?
1. There is no skin breakdown.

2. Her appetite improves.

3. She loses more than 10 lbs.

4. Stools are less fatty and decreased in frequency.

46. Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab value is most likely to be elevated?

1. Calcium

2. Glucose

3. Magnesium

4. Potassium

47. Anna is 45 y.o. and has a bleeding ulcer. Despite multiple blood transfusions, her HGB is 7.5g/dl and HCT is 27%.

Her doctor determines that surgical intervention is necessary and she undergoes partial gastrectomy. Postoperative

nursing care includes:

1. Giving pain medication Q6H.

2. Flushing the NG tube with sterile water.

3. Positioning her in high Fowlers position.

4. Keeping her NPO until the return of peristalsis.

48. Sitty, a 66 y.o. patient underwent a colostomy for ruptured diverticulum. She did well during the surgery and

returned to your med-surg floor in stable condition. You assess her colostomy 2 days after surgery. Which finding

do you report to the doctor?

1. Blanched stoma

2. Edematous stoma

3. Reddish-pink stoma

4. Brownish-black stoma

49. Sharon has cirrhosis of the liver and develops ascites. What intervention is necessary to decrease the excessive

accumulation of serous fluid in her peritoneal cavity?

1. Restrict fluids

2. Encourage ambulation

3. Increase sodium in the diet

4. Give antacids as prescribed

50. Katrina is diagnosed with lactose intolerance. To avoid complications with lack of calcium in the diet, which food

should be included in the diet?

1. Fruit

2. Whole grains

3. Milk and cheese products

4. Dark green, leafy vegetables

51. Nathaniel has severe pruritus due to having hepatitis B. What is the best intervention for his comfort?

1. Give tepid baths.

2. Avoid lotions and creams.

3. Use hot water to increase vasodilation.

4. Use cold water to decrease the itching.

52. Rob is a 46 y.o. admitted to the hospital with a suspected diagnosis of Hepatitis B. Hes jaundiced and reports

weakness. Which intervention will you include in his care?

1. Regular exercise.

2. A low-protein diet.

3. Allow patient to select his meals.

4. Rest period after small, frequent meals.

53. Youre discharging Nathaniel with hepatitis B. Which statement suggests understanding by the patient?

1. Now I can never get hepatitis again.

2. I can safely give blood after 3 months.

3. Ill never have a problem with my liver again, even if I drink alcohol.

4. My family knows that if I get tired and start vomiting, I may be getting sick again.

54. Gail is scheduled for a cholecystectomy. After completion of preoperative teaching, Gail states,If I lie still and

avoid turning after the operation, Ill avoid pain. Do you think this is a good idea? What is the best response?

1. Youll need to turn from side to side every 2 hours.

2. Its always a good idea to rest quietly after surgery.

3. The doctor will probably order you to lie flat for 24 hours.

4. Why dont you decide about activity after you return from the recovery room?
55. Youre caring for a 28 y.o. woman with hepatitis B. Shes concerned about the duration of her recovery. Which

response isnt appropriate?

1. Encourage her to not worry about the future.

2. Encourage her to express her feelings about the illness.

3. Discuss the effects of hepatitis B on future health problems.

4. Provide avenues for financial counseling if she expresses the need.

56. Elmer is scheduled for a proctoscopy and has an I.V. The doctor wrote an order for 5mg of I.V. diazepam(Valium).

Which order is correct regarding diazepam?

1. Give diazepam in the I.V. port closest to the vein.

2. Mix diazepam with 50 ml of dextrose 5% in water and give over 15 minutes.

3. Give diazepam rapidly I.V. to prevent the bloodstream from diluting the drug mixture.

4. Question the order because I.V. administration of diazepam is contraindicated.

57. Annabelle is being discharged with a colostomy, and youre teaching her about colostomy care. Which statement

correctly describes a healthy stoma?

1. At first, the stoma may bleed slightly when touched.

2. The stoma should appear dark and have a bluish hue.

3. A burning sensation under the stoma faceplate is normal.

4. The stoma should remain swollen away from the abdomen.

58. A patient who underwent abdominal surgery now has a gaping incision due to delayed wound healing. Which

method is correct when you irrigate a gaping abdominal incision with sterile normal saline solution, using a piston

syringe?

1. Rapidly instill a stream of irrigating solution into the wound.

2. Apply a wet-to-dry dressing to the wound after the irrigation.

3. Moisten the area around the wound with normal saline solution after the irrigation.

4. Irrigate continuously until the solution becomes clear or all of the solution is used.

59. Hepatic encephalopathy develops when the blood level of which substance increases?

1. Ammonia

2. Amylase
3. Calcium

4. Potassium

60. Your patient recently had abdominal surgery and tells you that he feels a popping sensation in his incision

during a coughing spell, followed by severe pain. You anticipate an evisceration. Which supplies should you take to

his room?

1. A suture kit.

2. Sterile water and a suture kit.

3. Sterile water and sterile dressings.

4. Sterile saline solution and sterile dressings.

61. Findings during an endoscopic exam include a cobblestone appearance of the colon in your patient. The

findings are characteristic of which disorder?

1. Ulcer

2. Crohns disease

3. Chronic gastritis

4. Ulcerative colitis

62. What information is correct about stomach cancer?

1. Stomach pain is often a late symptom.

2. Surgery is often a successful treatment.

3. Chemotherapy and radiation are often successful treatments.

4. The patient can survive for an extended time with TPN.

63. Dark, tarry stools indicate bleeding in which location of the GI tract?

1. Upper colon.

2. Lower colon.

3. Upper GI tract.

4. Small intestine.

64. A patient has an acute upper GI hemorrhage. Your interventions include:

1. Treating hypovolemia.

2. Treating hypervolemia.
3. Controlling the bleeding source.

4. Treating shock and diagnosing the bleeding source.

65. You promote hemodynamic stability in a patient with upper GI bleeding by:

1. Encouraging oral fluid intake.

2. Monitoring central venous pressure.

3. Monitoring laboratory test results and vital signs.

4. Giving blood, electrolyte and fluid replacement.

66. Youre preparing a patient with a malignant tumor for colorectal surgery and subsequent colostomy. The patient

tells you hes anxious. What should your initial step be in working with this patient?

1. Determine what the patient already knows about colostomies.

2. Show the patient some pictures of colostomies.

3. Arrange for someone who has a colostomy to visit the patient.

4. Provide the patient with written material about colostomy care.

67. Your patient, Christopher, has a diagnosis of ulcerative colitis and has severe abdominal pain aggravated by

movement, rebound tenderness, fever, nausea, and decreased urine output. This may indicate which complication?

1. Fistula.

2. Bowel perforation.

3. Bowel obstruction.

4. Abscess.

68. A patient has a severe exacerbation of ulcerative colitis. Long-term medications will probably include:

1. Antacids.

2. Antibiotics.

3. Corticosteroids.

4. Histamine2-receptor blockers.

69. The student nurse is teaching the family of a patient with liver failure. You instruct them to limit which foods in

the patients diet?

1. Meats and beans.

2. Butter and gravies.

3. Potatoes and pastas.

4. Cakes and pastries.

70. An intubated patient is receiving continuous enteral feedings through a Salem sump tube at a rate of 60ml/hr.

Gastric residuals have been 30-40ml when monitored Q4H. You check the gastric residual and aspirate 220ml. What

is your first response to this finding?

1. Notify the doctor immediately.

2. Stop the feeding, and clamp the NG tube.

3. Discard the 220ml, and clamp the NG tube.

4. Give a prescribed GI stimulant such as metoclopramide (Reglan).

71. Your patient with peritonitis is NPO and complaining of thirst. What is your priority?

1. Increase the I.V. infusion rate.

2. Use diversion activities.

3. Provide frequent mouth care.

4. Give ice chips every 15 minutes.

72. Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate?

1. He has fresh, active upper GI bleeding.

2. He needs immediate saline gastric lavage.

3. His gastric bleeding occurred 2 hours earlier.

4. He needs a transfusion of packed RBCs.

73. A 53 y.o. patient has undergone a partial gastrectomy for adenocarcinoma of the stomach. An NG tube is in

place and is connected to low continuous suction. During the immediate postoperative period, you expect the

gastric secretions to be which color?

1. Brown.

2. Clear.

3. Red.

4. Yellow.

74. Your patient has a retractable gastric peptic ulcer and has had a gastric vagotomy. Which factor increases as a

result of vagotomy?
1. Peristalsis.

2. Gastric acidity.

3. Gastric motility.

4. Gastric pH.

75. Christina is receiving an enteral feeding that requires a concentration of 80 ml of supplement mixed with 20 ml of

water. How much water do you mix with an 8 oz (240ml) can of feeding?

1. 60 ml.

2. 70 ml.

3. 80 ml.

4. 90 ml.

76. Which stoma would you expect a malodorous, enzyme-rich, caustic liquid output that is yellow, green, or brown?

1. Ileostomy.

2. Ascending colostomy.

3. Transverse colostomy.

4. Descending colostomy.

77. George has a T tube in place after gallbladder surgery. Before discharge, what information or instructions

should be given regarding the T tube drainage?

1. If there is any drainage, notify the surgeon immediately.

2. The drainage will decrease daily until the bile duct heals.

3. First, the drainage is dark green; then it becomes dark yellow.

4. If the drainage stops, milk the tube toward the puncture wound.

78. Your patient Maria takes NSAIDS for her degenerative joint disease, has developed peptic ulcer disease. Which

drug is useful in preventing NSAID-induced peptic ulcer disease?

1. Calcium carbonate (Tums)

2. Famotidine (Pepcid)

3. Misoprostol (Cytotec)

4. Sucralfate (Carafate)

79. The student nurse is participating in colorectal cancer-screening program. Which patient has the fewest risk

factors for colon cancer?

1. Janice, a 45 y.o. with a 25-year history of ulcerative colitis

2. George, a 50 y.o. whose father died of colon cancer

3. Herman, a 60 y.o. who follows a low-fat, high-fiber diet

4. Sissy, a 72 y.o. with a history of breast cancer

80. Youre patient, post-op drainage of a pelvic abscess secondary to diverticulitis, begins to cough violently after

drinking water. His wound has ruptured and a small segment of the bowel is protruding. Whats your priority?

1. Ask the patient what happened, call the doctor, and cover the area with a water-soaked bedsheet.

2. Obtain vital signs, call the doctor, and obtain emergency orders.

3. Have a CAN hold the wound together while you obtain vital signs, call the doctor and flex the patients knees.

4. Have the doctor called while you remain with the patient, flex the patients knees, and cover the wound with sterile towels

soaked in sterile saline solution.

1. Answer: 1. Hypoalbuminemia

Blood pressure decreases as the body is unable to maintain normal oncotic pressure with liver
failure, so patients with liver failure require close blood pressure monitoring. Increased capillary
permeability, abnormal peripheral vasodilation, and excess rennin released from the kidneys
arent direct ramifications of liver failure.

2. Answer: 2. Red and moist

Good circulation causes tissues to be moist and red, so a healthy, well-healed stoma appears
red and moist.

3. Answer: 1. Formed

A colostomy in the sigmoid colon produces a solid, formed stool.

4. Answer: 4. Yogurt

High-fiber foods stimulate peristalsis, and a result, flatus. Yogurt reduces gas formation.

5. Answer: 2. About 1/16 larger than the stoma.

A proper fit protects the skin but doesnt impair circulation. A 1/16 should be cut.

6. Answer: 2. Observation, auscultation, percussion, palpation

Observation, auscultation, percussion, palpation

7. Answer: 4. The surgery occurs in two stages.

An ileoanal reservoir is created in two stages. The two surgeries are about 2 to 3 months apart.
First, diseased intestines are removed and a temporary loop ileostomy is created. Second, the
loop ileostomy is closed and stool goes to the reservoir and out through the anus.

8. Answer: 3. 1500 ml

The large intestine absorbs large amounts of water so the initial output from the ileostomy may
be as much as 1500 to 2000 ml/24 hours. Gradually, the small intestine absorbs more fluid and
the output decreases.

9. Answer: 2. Eat six small meals a day

To avoid overloading the small intestine, encourage the patient to eat six small, regularly spaced
meals.

10. Answer: 2. You seem upset.

Making observations about what you see or hear is a useful therapeutic technique. This way,
you acknowledge that you are interested in what the patient is saying and feeling.

11. Answer: 3. Dizziness and sweating.

After a Billroth II procedure, a large amount of hypertonic fluid enters the intestine. This causes
extracellular fluid to move rapidly into the bowel, reducing circulating blood volume and
producing vasomotor symptoms. Vasomotor symptoms produced by dumping syndrome include
dizziness and sweating, tachycardia, syncope, pallor, and palpitations.

12. Answer: 1. Omit fluids with meals.

Gastric emptying time can be delayed by omitting fluids from your patients meal. A diet low in
carbs and high in fat & protein is recommended to treat dumping syndrome.

13. Answer: 2. Dyspnea

Ascites puts pressure on the diaphragm. Paracentesis is done to remove fluid and reducing
pressure on the diaphragm. The goal is to improve the patients breathing. The others are signs
of cirrhosis that arent relieved by paracentesis.

14. Answer: 1. Empty her bladder.

A full bladder can interfere with paracentesis and be punctured inadvertently.

15. Answer: 2. Cover the wound with a saline-soaked sterile dressing.

Cover the organs with a sterile, nonadherent dressing moistened with normal saline. Do this to
prevent infection and to keep the organs from drying out.

16. Answer: 1. Asterixis

Asterixis is an early neurologic sign of hepatic encephalopathy elicited by asking the patient to
hold her arms stretched out. Asterixis is present if the hands rapidly extend and flex.

17. Answer: 1. Administering a lactulose enema as ordered.

You may administer the laxative lactulose to reduce ammonia levels in the colon.

18. Answer: 1. Isosorbide dinitrate (Isordil)

Achalasia is characterized by incomplete relaxation of the LES, dilation of the lower esophagus,
and a lack of esophageal peristalsis. Because nitrates relax the lower esophageal sphincter,
expect to give Isordil orally or sublingually.

19. Answer: 3. Eat meals sitting upright.

Eating in the upright position aids in emptying the esophagus. Doing the opposite of the other
three also may be helpful.

20. Answer: 3. Serum amylase and lipase

Pancreatitis involves activation of pancreatic enzymes, such as amylase and lipase. These
levels are elevated in a patient with acute pancreatitis.

21. Answer: 4. 1.030

The normal range of specific gravity of urine is 1.010 to 1.025; a value of 1.030 may be seen
with dehydration.

22. Answer: 3. Splint the incision if he cant avoid sneezing or coughing.

Teach the pt to avoid activities that increase intra-abdominal pressure such as coughing,
sneezing, or straining with a bowel movement.

23. Answer: 3. Lose weight, if obese.

Because obesity weakens the abdominal muscles, advise weight loss for the patient who has
had a hernia repair.

24. Answer: 2. Youll need to lie on your right side after the test.

After a liver biopsy, the patient is placed on the right side to compress the liver and to reduce the
risk of bleeding or bile leakage.

25. Answer: 1. Dyspnea and reduced or absent breath sounds over the right lung

Signs and Symptoms of pneumothorax include dyspnea and decreased or absent breath sounds
over the affected lung (right lung).

26. Answer: 1. It empties the stomach of fluids and gas.

An NG tube is inserted into the patients stomach to drain fluid and gas.

27. Answer: 1. Aspirate for gastric secretions with a syringe.

Aspirating the stomach contents confirms correct placement. If an X-ray is ordered, it should be
done immediately, not in 24 hours.

28. Answer: 2. Complete nutrition by the I.V. route.

TPN is given I.V. to provide all the nutrients your patient needs. TPN isnt a tube feeding nor is it
a liquid dietary supplement.

29. Answer: 1. Cause atrophy of the parietal cells.

Type A causes changes in parietal cells.

30. Answer: 2. Increase fluid intake with meals.

Increasing fluids helps empty the stomach. A high carb diet isnt restricted and fat intake
shouldnt be increased.

31. Answer: 1. Replace lost fluid and sodium.

Diarrhea d/t an acute episode of ulcerative colitis leads to fluid & electrolyte losses so fluid
replacement takes priority.

32. Answer: 4. Sigmoidoscopy.

Sigmoidoscopy allows direct observation of the colon mucosa for changes, and if needed,
biopsy.

33. Answer: 3. High-fiber diet and administration of psyllium.

She needs a high-fiber diet and a psyllium (bulk laxative) to promote normal soft stools.

34. Answer: 2. Bloody and mucous.

Stools from ulcerative colitis are often bloody and contain mucus.

35. Answer: 4. Crampy and lower left quadrant pain and low-grade fever.

One sign of acute diverticulitis is crampy lower left quadrant pain. A low-grade fever is another
common sign.

36. Answer: 3. Nutritional support with TPN.

With acute pancreatitis, you need to rest the GI tract by TPN as nutritional support.

37. Answer: 1. Pain in the right upper quadrant, radiating to the shoulder.

The gallbladder is located in the RUQ and a frequent sign of gallstones is pain radiating to the
shoulder.

38. Answer: 4. Prevent accumulation of drainage in the wound.

A Jackson-Pratt drain promotes wound healing by allowing fluid to escape from the wound.
39. Answer: 4. Trickles of bright red blood.

After creation of a colostomy, expect to see a stoma that is pink, slightly edematous, with some
oozing. Bright red blood, regardless of amount, indicates bleeding and should be reported to the
doctor.

40. Answer: 1. 1/16

Only a small amount of skin should be exposed and more than 1/16 of skin allows the
excrement to irritate the skin.

41. Answer: 2. Measure abdominal girth.

Measuring abdominal girth provides quantitative information about increases or decreases in the
amount of distention.

42. Answer: 3. NG feeding

Because the GI tract is functioning, feeding methods involve the enteral route which bypasses
the mouth but allows for a major portion of the GI tract to be used.

43. Answer: 2. Observe the contour of the abdomen.

The first step in assessing the abdomen is to observe its shape and contour, then auscultate,
palpate, and then percuss.

44. Answer: 2. Lower the height of the enema container.

Lowering the height decreases the amount of flow, allowing him to tolerate more fluid.

45. Answer: 4. Stools are less fatty and decreased in frequency.

Pancrelipase provides the exocrine pancreatic enzyme necessary for proper protein, fat, and
carb digestion. With increased fat digestion and absorption, stools become less frequent and
normal in appearance.

46. Answer: 2. Glucose

Glucose level increases and diabetes mellitus may result d/t the pancreatic damage to the islets
of Langerhans.
47. Answer: 4. Keeping her NPO until the return of peristalsis.

After surgery, she remains NPO until peristaltic activity returns. This decreases the risk for
abdominal distention and obstruction.

48. Answer: 4. Brownish-black stoma

A brownish-black color indicates lack of blood flow, and maybe necrosis.

49. Answer: 1. Restrict fluids

Restricting fluids decrease the amount of body fluid and the accumulation of fluid in the
peritoneal space.

50. Answer: 4. Dark green, leafy vegetables

Dark green, leafy vegetables are rich in calcium.

51. Answer: 1. Give tepid baths.

For pruritus, care should include tepid sponge baths and use of emollient creams and lotions.

52. Answer: 4. Rest period after small, frequent meals.

Rest periods and small frequent meals are indicated during the acute phase of hepatitis B.

53. Answer: 4. My family knows that if I get tired and start vomiting, I may be getting sick
again.

Hepatitis B can recur. Patients who have had hepatitis are permanently barred from donating
blood. Alcohol is metabolized by the liver and should be avoided by those who have or had
hepatitis B.

54. Answer: 1. Youll need to turn from side to side every 2 hours.

To prevent venous stasis and improve muscle tone, circulation, and respiratory function,
encourage her to move after surgery.

55. Answer: 1. Encourage her to not worry about the future.

Telling her not to worry minimizes her feelings.

56. Answer: 1. Give diazepam in the I.V. port closest to the vein.

Diazepam is absorbed by the plastic I.V. tubing and should be given in the port closest to the
vein.

57. Answer: 1. At first, the stoma may bleed slightly when touched.

For the first few days to a week, slight bleeding normally occurs when the stoma is touched
because the surgical site is still new. She should report profuse bleeding immediately.

58. Answer: 4. Irrigate continuously until the solution becomes clear or all of the solution
is used.

To wash away tissue debris and drainage effectively, irrigate the wound until the solution
becomes clear or all the solution is used.

59. Answer: 1. Ammonia

Ammonia levels increase d/t improper shunting of blood, causing ammonia to enter systemic
circulation, which carries it to the brain.

60. Answer: 4. Sterile saline solution and sterile dressings.

Saline solution is isotonic, or close to body fluids in content, and is used along with sterile
dressings to cover an eviscerated wound and keep it moist.

61. Answer: 2. Crohns disease

Crohns disease penetrates the mucosa of the colon through all layers and destroys the colon in
patches, which creates a cobblestone appearance.

62. Answer: 1. Stomach pain is often a late symptom.

Stomach pain is often a late sign of stomach cancer; outcomes are particularly poor when
cancer reaches that point. Surgery, chemotherapy, and radiation have minimal positive effects.
TPN may enhance the growth of cancer.

63. Answer: 3. Upper GI tract.

Melena is the passage of dark, tarry stools that contain a large amount of digested blood. It
occurs with bleeding from the upper GI tract.

64. Answer: 1. Treating hypovolemia.

A patient with an acute upper GI hemorrhage must be treated for hypovolemia and hemorrhagic
shock. You as a nurse cant diagnose the problem. Controlling the bleeding may require surgery
or intensive medical treatment.

65. Answer: 4. Giving blood, electrolyte and fluid replacement.

To stabilize a patient with acute bleeding, NS or LR solution is given I.V. until BP rises and urine
output returns to 30ml/hr.

66. Answer: 1. Determine what the patient already knows about colostomies.

Initially, you should assess the patients knowledge about colostomies and how it will affect his
lifestyle.

67. Answer: 2. Bowel perforation.

An inflammatory condition that affects the surface of the colon, ulcerative colitis causes friability
and erosions with bleeding. Patients with ulcerative colitis are at increased risk for bowel
perforation, toxic megacolon, hemorrhage, cancer, and other anorectal and systemic
complications.

68. Answers: 3. Corticosteroids.

Medications to control inflammation such as corticosteroids are used for long-term treatment.

69. Answer: 1. Meats and beans.

Meats and beans are high-protein foods. In liver failure, the liver is unable to metabolize protein
adequately, causing protein by-products to build up in the body rather than be excreted.

70. Answer: 2. Stop the feeding, and clamp the NG tube.

A gastric residual greater than 2 hours worth of feeding or 100-150ml is considered too high.
The feeding should be stopped; NG tube clamped, and then allow time for the stomach to empty
before additional feeding is added.

71. Answer: 3. Provide frequent mouth care.

Frequent mouth care helps relieve dry mouth.

72. Answer: 3. His gastric bleeding occurred 2 hours earlier.

Coffee-ground emesis occurs when there is upper GI bleeding that has undergone gastric
digestion. For blood to appear as coffee-ground emesis, it would have to be digested for
approximately 2 hours.

73. Answer: 3. Red.

Normally, drainage is bloody for the first 24 hours after a partial gastrectomy; then it changes to
brown-tinged and then to yellow or clear.

74. Answer: 4. Gastric pH.

If the vagus nerve is cut as it enters the stomach, gastric acid secretion is decreased, but
intestinal motility is also decreased and gastric emptying is delayed. Because gastric acids are
decreased, gastric pH increases.

75. Answer: 1. 60 ml.

Dosage problem. Its 80/20 = 240/X. X=60.

76. Answer: 1. Ileostomy.

The output from an Ileostomy is described.

77. Answer: 2. The drainage will decrease daily until the bile duct heals.

As healing occurs from the bile duct, bile drains from the tube; the amount of bile should
decrease. Teach the patient to expect dark green drainage and to notify the doctor if drainage
stops.

78. Answer: 3. Misoprostol (Cytotec)

Misoprostol restores prostaglandins that protect the stomach from NSAIDS, which diminish the
prostaglandins.

79. Answer: 3. Herman, a 60 y.o. who follows a low-fat, high-fiber diet

80. Answer: 4. Have the doctor called while you remain with the patient, flex the patients
knees, and cover the wound with sterile towels soaked in sterile saline solution.