Digestive System Disorder NCLEX Practice Quiz #1 (80
Questions)
1. A patient with chronic alcohol abuse is admitted with liver
failure. You closely monitor the patient’s 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. You’re 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. You’re caring for a patient with a sigmoid colostomy. The
stool from this colostomy is:
1. Formed
2. Semisolid
3. Semiliquid
4. Watery
4. You’re 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. You’re 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. You’re 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. You’re 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. You’re 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, don’t worry about it, everything will be just fine.”
4. “Why do you think you have cancer?”
11. You’re 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. You’re 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. You’re caring for Lewis, a 67 y.o. patient with liver cirrhosis
who develops ascites and requires paracentesis. Relief of
which symptom indicated that the paracentesis was effective?
1. Pruritus
2. Dyspnea
3. Jaundice
4. Peripheral Neuropathy
14. You’re caring for Jane, a 57 y.o. patient with liver cirrhosis
who develops 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. You’re caring for Betty with liver cirrhosis. Which of the
following assessment findings leads you to suspect hepatic
encephalopathy in her?
1. Asterixis
2. Chvostek’s sign
3. Trousseau’s sign
4. Hepatojugular reflex
17. You are developing a careplan 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. Propanolol (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 semisoft 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 Crohn’s 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 David’s risk of complications after
a heriorrhaphy. You instruct the patient to:
1. Avoid the use of pain medication.
2. Cough and deep breathe Q2H.
3. Splint the incision if he can’t 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. “You’ll need to lie on your stomach during the test.”
2. “You’ll need to lie on your right side after the test.”
3. “During the biopsy you’ll 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 distinquished 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 mucoid.
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. You’re 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 Fowler’s 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. He’s 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. You’re 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. “I’ll 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, I’ll avoid pain. Do you think this is a
good idea?” What is the best response?
1. “You’ll need to turn from side to side every 2 hours.”
2. “It’s always a good idea to rest quietly after surgery.”
3. “The doctor will probably order you to lie flat for 24
hours.”
4. “Why don’t you decide about activity after you return
from the recovery room?”
55. You’re caring for a 28 y.o. woman with hepatitis B. She’s
concerned about the duration of her recovery. Which response
isn’t 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. Annebell is being discharged with a colostomy, and you’re
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. Crohn’s 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. You’re preparing a patient with a malignant tumor for
colorectal surgery and subsequent colostomy. The patient tells
you he’s 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
patient’s 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 RBC’s.
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 80ml 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. You’re 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. What’s 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 patient’s
knees.
4. Have the doctor called while you remain with the
patient, flex the patient’s knees, and cover the wound
with sterile towels soaked in sterile saline solution.
 1. A 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 kidney’s aren’t direct ramifications of liver
failure.
2. B Good circulation causes tissues to be moist and
red, so a healthy, well-healed stoma appears red and
moist.
3. A A colostomy in the sigmoid colon produces a solid,
formed stool.
4. D High-fiber foods stimulate peristalsis, and a result,
flatus. Yogurt reduces gas formation.
5. B A proper fit protects the skin, but doesn’t impair
circulation. A 1/16” should be cut.
6. B Observation, auscultation, percussion, palpation
7. D 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. C 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. B To avoid overloading the small intestine, encourage
the patient to eat six small, regularly spaced meals.
10. B 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. C 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. A Gastric emptying time can be delayed by omitting fluids
from your patient’s meal. A diet low in carbs and high in fat &
protein is recommended to treat dumping syndrome.
13. B Ascites puts pressure on the diaphragm. Paracentesis is
done to remove fluid and reducing pressure on the diaphragm.
The goal is to improve the patient’s breathing. The others are
signs of cirrhosis that aren’t relieved by paracentesis.
14. A A full bladder can interfere with paracentesis and be
punctured inadvertently.
15. B 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. A 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. A You may administer the laxative lactulose to reduce
ammonia levels in the colon.
18. A 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. C Eating in the upright position aids in emptying the
esophagus. Doing the opposite of the other three also may be
helpful.
20. C Pancreatitis involves activation of pancreatic enzymes,
such as amylase and lipase. These levels are elevated in a
patient with acute pancreatitis.
21. D 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. C Teach the pt to avoid activities that increase intra-
abdominal pressure such as coughing, sneezing, or straining
with a bowel movement.
23. C Because obesity weakens the abdominal muscles,
advise weight loss for the patient who has had a hernia repair.
24. B 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. A Signs and Symptoms of pneumothorax include dyspnea
and decreased or absent breath sounds over the affected lung
(right lung).
26. A An NG tube is inserted into the patients stomach to drain
fluid and gas.
27. A Aspirating the stomach contents confirms correct
placement. If an X-ray is ordered, it should be done
immediately, not in 24 hours.
28. B TPN is given I.V. to provide all the nutrients your patient
needs. TPN isn’t a tube feeding nor is it a liquid dietary
supplement.
29. A Type A causes changes in parietal cells.
30. B Increasing fluids helps empty the stomach. A high carb
diet isn’t restricted and fat intake shouldn’t be increased.
31. A Diarrhea d/t an acute episode of ulcerative colitis leads
to fluid & electrolyte losses so fluid replacement takes priority.
32. D Sigmoidoscopy allows direct observation of the colon
mucosa for changes, and if needed, biopsy.
33. C She needs a high-fiber diet and a psyllium (bulk
laxative) to promote normal soft stools.
34. B Stools from ulcerative colitis are often bloody and
contain mucus.
35. D One sign of acute diverticulitis is crampy lower left
quadrant pain. A low-grade fever is another common sign.
36. C With acute pancreatitis, you need to rest the GI tract by
TPN as nutritional support.
37. A The gallbladder is located in the RUQ and a frequent
sign of gallstones is pain radiating to the shoulder.
38. D A Jackson-Pratt drain promotes wound healing by
allowing fluid to escape from the wound.
39. D 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. A Only a small amount of skin should be exposed and
more than 1/16” of skin allows the excretement to irritate the
skin.
41. B Measuring abdominal girth provides quantitative
information about increases or decreases in the amount of
distention.
42. C 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. B The first step in assessing the abdomen is to observe its
shape and contour, then auscultate, palpate, and then percuss.
44. B Lowering the height decreases the amount of flow,
allowing him to tolerate more fluid.
45. D 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. B Glucose level increases and diabetes mellitus may
result d/t the pancreatic damage to the islets of langerhans.
47. D After surgery, she remains NPO until peristaltic activity
returns. This decreases the risk for abdominal distention and
obstruction.
48. D A brownish-black color indicates lack of blood flow, and
maybe necrosis.
49. A Restricting fluids decrease the amount of body fluid and 73. C Normally, drainage is bloody for the first 24 hours after a
the accumulation of fluid in the peritoneal space. partial gastrectomy; then it changes to brown-tinged and then
50. D Dark green, leafy vegetables are rich in calcium. to yellow or clear.
51. A For pruritus, care should include tepid sponge baths and 74. D If the vagus nerve is cut as it enters the stomach, gastric
use of emollient creams and lotions. acid secretion is decreased, but intestinal motility is also
52. D Rest periods and small frequent meals is indicated decreased and gastric emptying is delayed. Because gastric
during the acute phase of hepatitis B. acids are decreased, gastric pH increases.
53. D Hepatitis B can recur. Patients who have had hepatitis 75. A Dosage problem. It’s 80/20 = 240/X. X=60.
are permanently barred from donating blood. Alcohol is 76. A The output from an Ileostomy is described.
metabolized by the liver and should be avoided by those who 77. B As healing occurs from the bile duct, bile drains from the
have or had hepatitis B. tube; the amount of bile should decrease. Teach the patient to
54. A To prevent venous stasis and improve muscle tone, expect dark green drainage and to notify the doctor if drainage
circulation, and respiratory function, encourage her to move stops.
after surgery. 78. C Misoprostol restores prostaglandins that protect the
55. A Telling her not to worry minimizes her feelings. stomach from NSAIDS, which diminish the prostaglandins.
56. A Diazepam is absorbed by the plastic I.V. tubing and 79. C
should be given in the port closest to the vein. 80. D
57. A 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. D To wash away tissue debris and drainage effectively,
irrigate the wound until the solution becomes clear or all the
solution is used.
59. A Ammonia levels increase d/t improper shunting of blood,
causing ammonia to enter systemic circulation, which carries it
to the brain.
60. D 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. B Crohn’s disease penetrates the mucosa of the colon
through all layers and destroys the colon in patches, which
creates a cobblestone appearance.
62. A Stomach pain is often a late sign of stomach cancer;
outcomes are particularly poor when the cancer reaches that
point. Surgery, chemotherapy, and radiation have minimal
positive effects. TPN may enhance the growth of the cancer.
63. C 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. A A patient with an acute upper GI hemorrhage must be
treated for hypovolemia and hemorrhagic shock. You as a
nurse can’t diagnose the problem. Controlling the bleeding
may require surgery or intensive medical treatment.
65. D 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. A Initially, you should assess the patient’s knowledge
about colostomies and how it will affect his lifestyle.
67. B 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. C Medications to control inflammation such as
corticosteroids are used for long-term treatment.
69. A 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. B 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. C Frequent mouth care helps relieve dry mouth.
72. C 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.