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GIT C. percussion
Situation 1: Children have a special fascination with D. palpation
the workings of the digestive system. To fully 9. Mr. Lim verbalized pain on the right iliac region.
understand the digestive processes, Nurse Lavigña Nurse Dorina knows that the organ affected would be
must be knowledgeable of the anatomy and the:
physiology of the gastrointestinal system.
1. The alimentary canal is a continuous, coiled, A. liver
hollow muscular tube that winds through the ventral B. sigmoid colon
cavity and is open at both ends. Its solid organs C. appendix
include all of the following except: D. duodenum
10. Mr. Lim felt pain upon release of Nurse Dorina’s
A. liver hand. This can be referred as:
B. gall bladder
C. stomach A. referred pain
D. pancreas B. rebound tenderness
2. Pharynx is lined with mucous membranes and C. direct tenderness
mucous secreting glands to ease the passage of food. D. indirect tenderness
The larygngopharynx serves as passageway for: Situation 3: Mrs. Cruz was admitted in the Medical
Floor due to pyrosis, dyspepsia and difficulty of
A. air only swallowing.
B. air and water 11. Based from the symptoms presented, Nurse Yoshi
C. food, fluids and air might suspect:
D. air and food
3. Once food has been placed in the mouth, both A. Esophagitis
mechanical and chemical digestions begin. The six B. Hiatal hernia
activities of the digestive process are: C. GERD
D. Gastric Ulcer
A. ingestion, mastication, digestion, deglutition, 12. What diagnostic test would confirm the type of
absorption, egestion problem Mrs. Cruz have?
B. ingestion, mastication, deglutition, digestion,
absorption, egestion A. barium enema
C. deglutition, ingestion, mastication, egestion, B. barium swallow
absorption, defecation C. colonoscopy
D. ingestion, digestion, mastication, deglutition, D. lower GI series
absorption, defecation 13. Mrs. Cruz complained of pain and difficulty in
4. Most digestive activity occurs in the pyloric region swallowing. This term is referred as:
of the stomach. What hormone stimulates the chief
cells to produce pepsinogen?
A. Odynophagia
B. Dysphagia
A. Gastrin C. Pyrosis
B. Pepsin D. Dyspepsia
C. HCl 14. To avoid acid reflux, Nurse Yoshi should advice
D. Insulin Mrs. Cruz to avoid which type of diet?
5. What pancreatic enzyme aids in the digestion of
carbohydrates?
A. cola, coffee and tea
B. high fat, carbonated and caffeinated beverages
A. Lipase C. beer and green tea
B. Trypsin D. lechon paksiw and bicol express
C. Amylase 15. Mrs. Cruz’ body mass index (BMI) is 25. You
D. Chymotrypsin can categorized her as:
Situation 2: Nurse Dorina is going to perform an
abdominal examination to Mr. Lim who was admitted
due to on and off pain since yesterday. A. normal
6. How will you position Mr. Lim prior to procedure? B. overweight
C. underweight
D. obese
A. supine with knees flexed Situation 4: Nurse Gloria is the staff nurse assigned
B. prone at the Emergency Department. During her shift, a
C. lying on back patient was rushed – in the ED complaining of severe
D. sim’s heartburn, vomiting and pain that radiates to the
7. To identify any localized bulging, distention and flank. The doctor suspects gastric ulcer.
peristaltic waves, Nurse Dorina must perform which 16. What other symptoms will validate the diagnosis
of the following? of gastric ulcer?

A. Auscultation A. right epigastric pain

B. Inspection B. pain occurs when stomach is empty
C. Palpation C. pain occurs immediately after meal
D. Percussion D. pain not relieved by vomiting
8. In order to identify areas of tenderness and 17. What diagnostic test would yield good
swelling, Nurse Dorina must do: visualization of the ulcer crater?

A. deep palpation A. Endoscopy

B. light palpation B. Gastroscopy
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C. Barium Swallow 26. Which of the following definitions best describes

D. Histology diverticulosis?
18. Peptic ulcer disease particularly gastric ulcer is
thought to be cause by which of the following A. An inflamed outpouching of the intestine
microorgamisms? B. A non – inflamed outpouching of the intestine
C. The partial impairment of the forward flow of
A. E. coli instestinal contents
B. H. pylori D. An abnormal protrusions of an oxygen through
C. S. aureus the structure that usually holds it
D. K. pnuemoniae 27. Which of the following types of diet is implicated
19. She is for occult blood test, what specimen will in the development of diverticulosis?
you collect?
A. Low – fiber diet
A. Blood B. High – fiber diet
B. Urine C. High – protein diet
C. Stool D. Low – carbohydrate diet
D. Gastric Juice 28. Which of the following tests should be
20. Preparation of the client for occult blood administered to client with diverticulosis?
examination is:
A. Proctosocpy
A. Fluid intake limited only to 1 liter/day B. Barium enema
B. NPO for 12 hours prior to obtaining of C. Barium swallow
specimen D. Gastroscopy
C. Increase fluid intake 29. To improve Mr. Trinidad’s condition, your best
D. Meatless diet for 48 hours prior to obtaining of nursing intervention and teaching is:
specimen
Situation 5: IBD is a common inflammatory A. Reduce fluid intake
functional bowel disorder also known as spastic B. Increase fiber in the diet
bowel, functional colitis and mucous colitis. C. Administering of antibiotics
21. The client with IBS asks Nurse June what causes D. Exercise to increase intraabdominal pressure
the disease. Which of the following responses by 30. Upon review of Mr. Trinidad’s chart, Nurse Drew
Nurse June would be most appropriate? noticed that he weighs 121 lbs and his height is 5 ft, 4
in. After computing for his Body Mass Index (BMI),
A. “This is an inflammation of the bowel caused you can categorize him as:
by eating too much roughage”
B. “IBS is caused by a stressful lifestyle” A. obese
C. “The cause of this condition is unknown” B. normal
D. “There is thinning of the intestinal mucosa C. obese
caused by ingestion of gluten” D. underweight
22. Which of the following alimentary canal is the Situation 7: Manny, 6 years old was admitted at
most common location for Chron’s disease? Cardinal Santos Hospital due to increasing frequency
of bowel movements, abdominal cramps and
A. Descending colon distension.
B. Jejunum 31. Diarrhea is said to be the leading cause of
C. Sigmoid Colon morbidity in the Philippines. Nurse Harry knows that
D. Terminal Ileum diarrhea is present if:
23. Which of the following factors is believed to be
linked to Crohn’s disease? A. passage of stool is more than 3 bowel
movements per week
A. Diet B. passage of stool is less than 3 bowel movements
B. Constipation per day
C. Heredity C. passage of stool is more than 3 bowel
D. Lack of exercise movements per day
24. How about ulcerative colitis, which of the D. passage of stool is less than 3 bowel movements
following factors is believed to cause it? per week
32. Diarrhea is believed to be caused by all of the
A. Acidic diet following except
B. Altered immunity
C. Chronic constipation A. increase intestinal secretions
D. Emotional stress B. altered immunity
25. Mr. Jung, had ulcerative colitis for 5 years and C. decrease mucosal absorption
was admitted to the hospital. Which of the following D. altered motility
factors was most likely of greatest significance in 33. What life threatening condition may result in
causing an exacerbation of the disease? persistent diarrhea?

A. A demanding and stressful job A. hypokalemia

B. Changing to a modified vegetarian diet B. dehydration
C. Beginning a weight training program C. cardiac dysrhytmias
D. Walking 2 miles everyday D. leukocytosis
Situation 6: A patient was admitted in the Medical 34. Voluminous, watery stools can deplete fluids and
Floor at St. Luke’s Hospital. He was asymptomatic. electrolytes. The acid base imbalance that can occur
The doctor suspects diverticulosis. is:
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A. metabolic alkalosis
B. metabolic acidosis
C. respiratory acidosis
D. respiratory alkalosis
35. What is the immediate home care management
for diarrhea?
A. Milk
B. Imodium
C. Water
D. Oresol
Situation 8: Mr. Sean is admitted to the hospital with
a bowel obstruction. He complained of colicky pain
and inability to pass stool.
36. Which of these findings by Nurse Leonard, would
indicate that the obstruction is in the early stages?
A. high pitched tinkling or rumbling bowel sounds
B. hypoactive bowel sounds
C. no bowel sounds auscultated
D. normal bowel sounds heard in all four
quadrants
37. Nasogastric tube was inserted to Mr. Sean. The
NGT’s primary purpose is:
A. nutrition
B. decompression of bowel
C. passage for medication
D. aspiration of gastric contents
38. Mr. Sean has undergone surgery. Post –
operatively, which of the following findings is
normal?
A. absent bowel sounds
B. bleeding
C. hemorrhage
D. bowel movement
39. Client education should be given in order to
prevent constipation. Nurse Leonard’s health
teaching should include which of the following?
A. use of natural laxatives
B. fluid intake of 6 glasses per day
C. use of OTC laxatives
D. complete bed rest
40. Four hours post – operatively, Mr. Sean
complains of guarding and rigidity of the abdomen.
Nurse Leonard’s initial intervention is:
A. assess for signs of peritonitis
B. call the physician
C. administer pain medication
D. ignore the client
Situation 9: Mr. Gerald Liu, 19 y/o, is being admitted
to a hospital unit complaining of severe pain in the
lower abdomen. Admission vital signs reveal an oral
temperature of 101.2 0F.
41. Which of the following would confirm a
diagnosis of appendicitis?
A. The pain is localized at a position halfway
between the umbilicus and the right iliac crest.
B. Mr. Liu describes the pain as occurring 2 hours
after eating
C. The pain subsides after eating
D. The pain is in the left lower quadrant
42. Which of the following complications is thought
to be the most common cause of appendicitis?
A. A fecalith
B. Internal bowel occlusion
C. Bowel kinking
D. Abdominal wall swelling
43. The doctor ordered for a complete blood count.
After the test, Nurse Ray received the result from the
laboratory. Which laboratory values will confirm the
diagnosis of appendicitis?
A. RBC 5.5 x 106/mm3
B. Hct 44 %
C. WBC 13, 000/mm3
D. Hgb 15 g/dL
44. Signs and symptoms include pain in the RLQ of
the abdomen that may be localize at McBurney’s
point. To relieve pain, Mr. Liu should assume which
position?
A. Prone
B. Supine, stretched out
C. Sitting
D. Lying with legs drawn upl
45. After a few minutes, the pain suddenly stops
without any intervention. Nurse Ray might suspect
that:
A. the appendix is still distended
B. the appendix may have ruptured
C. an increased in intrathoracic pressure will occur
D. signs and symptoms of peritonitis occur
Situation 10: Nurse Nico is caring to a 38-year-old
female, G3P3 client who has been diagnosed with
hemorrhoids.
46. Which of the following factors would most likely
be a primary cause of her hemorrhoids?
A. Her age
B. Three vaginal delivery pregnancies
C. Her job as a school teacher
D. Varicosities in the legs
47. Client education should include minimizing client
discomfort due to hemorrhoids. Nursing management
should include:
A. Suggest to eat low roughage diet
B. Advise to wear silk undergarments
C. Avoid straining during defecation
D. Use of sitz bath for 30 minutes
48. The doctor orders for Witch Hazel 5 %. Nurse
Nico knows that the action of this astringent is:
A. temporarily relieves pain, burning, and itching
by numbing the nerve endings
B. causes coagulation (clumping) of proteins in the
cells of the perianal skin or the lining of the
anal canal
C. inhibits the growth of bacteria and other
organisms
D. causes the outer layers of skin or other tissues
to disintegrate
49. Which position would be ideal for the client in
the early postoperative period after
hemorrhoidectomy?
A. High Fowler’s
B. Supine
C. Side – lying
D. Trendelenburg’s
50. Nurse Nico instructs her client who has had a
hemorrhoidectomy not to used sitz bath until at least
12 hours postoperatively to avoid which of the
following complications?
A. Hemorrhage
B. Rectal Spasm
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C. Urinary retention
D. Constipation
Answers and Rationales
1. Answer: C. stomach. Stomach is a hollow
digestive organ in the GI tract. The liver, gall
baldder and pancreas are all solid organs which
are part of the hepato-biliary system. Test
taking skills: which does not belong to the
group?
2. Answer: D. air and food. The laryngopharynx
serves as passageway for air and food and so as
with the oropharynx. Option a is nasopharynx.
Answers b and c may be correct but air and
food is more accuarte.
3. Answer: B. ingestion, mastication, deglutition,
digestion, absorption, egestion. The digestive
processes involve six steps. Ingestion is taking
in of food in the mouth; mastication is the
mechanical process where food is converted
into bolus; deglutition is the act of swallowing;
digestion is the chemical breakdown of food
into chime; absorption occurs in the small
intestines (solutes) and large intestines (water)
and egestion/defecation where elimination of
feces occur.
4. Answer: A. Gastrin. Gastrin stimulates chief
cells to produce pepsinogen when foods enter
and suppression of pepsinogen when it leaves
and enters the small intestines; it is the major
hormone that regulates acid secretion in the
stomach. Pepsin; a gastric protease secreted in
an inactive form, pepsinogen, which is activated
by stomach acid that acts to degrade protein.
HCl is produced by the parietal cells. Insulin is
a pancreatic hormone.
5. Answer: C. Amylase. Amylase aids in the
digestion of carbohydrates.
Trypsin/Chymotrypsin aids in the digestion of
proteins. Lipase aids in the digestion of fats.
6. Answers: A. supine with knees flexed. During
abdominal examination, positioning the client
in supine with knees flexed will promote
relaxation of abdominal muscles. Options b and
d are inaccurate in this type of procedure. Lying
on back or supine may be correct but option a is
the best answer.
7. Answer: B. Inspection. Inspection is the first
step in abdominal exam to note the contour and
symmetry of abdomen as well as localized
bulging, distention and peristaltic waves.
Auscultation is done to determine the character,
location and frequency of bowel sounds.
Percussion is to assess tympany or dullness.
Palpation is to asses areas of tenderness and
discomfort. Note: In abdominal exam:
Inspection, Auscultation, Percussion and
Palpation are the correct order.
8. Answer: B. Light palpation. Light palpation is
done to identify areas of tenderness and
swelling. Deep palpation is done to identify
masses in all four quadrants. Test taking skills:
one of the opposite is the correct answer
9. Answer: C. Appendix. Appendix and cecum is
located in the right iliac region. Liver and gall
bladder is at the right hypochondriac. Sigmoid
colon is at the left iliac. Duodenum, stomach
and pancreas is in the epigastric region.
10. Answer: B. Rebound Tenderness. Rebound
tenderness is pain felt upon sudden release of
the examiners hand which in most cases suggest
peritonitis. Referred pain is pain felt in an area
remote from the site of origin. Direct tenderness
is localized pain upon palpation. Indirect
tenderness is pain outside the area of palpation.
11. Answer: C. Gastroesophageal Reflux Disease
(GERD). GERD is the backflow of gastric or
duodenal contents into the esophagus caused by
incompetent lower esophageal sphincter.
Pyrosis or heartburn, dyspepsia and dysphagia
are cardinal symptoms.
12. Answer: B. Barium swallow. Barium swallow
or upper GI series would confirm GERD.
Endoscopy is another diagnostic test. Options a
and d are the same. Option c is incorrect.
13. Answer: A. Odynophagia. When difficulty of
swallowing is accompanied with pain this is
now referred as odynophagia. Dysphagia is
difficulty of swallowing alone.
14. Answer: B. High fat, carbonated and
caffeinated beverages. All are correct but option
b is the best answer. In patients with GERD,
this type of diet must be avoided to avoid
backflow of gastric contents. Excessive caffeine
reduces the tone of lower esophageal sphincter.
Test Taking Skills: look for the umbrella effect
15. Answer: B. Overweight. Mr. Cruz’ BMI
belongs to the overweight category (24 – 26),
malnourished (less than 17), underweight (17 –
19), normal (20 – 23), obese (27– 30) and
morbidly obese (greater than 30). BMI is
weight in kilograms divided by height in square
meters.
16. Answer: C. Pain occurs immediately after
meal.In gastric ulcer food intake aggravates
pain which usually occur ½ – 1 hour before
meal or immediately during or after food intake.
Options a, b, c suggests duodenal ulcer.
17. Answer: A. Endoscopy. Endoscopy determines
bleeding, pain, difficulty swallowing, and a
change in bowel habits. This would yield good
visualization of the ulcer crater. Other options
are also diagnostic tests in PUD.
18. Answer: B. H. pylori. Helicobacter pylori (H.
pylori) is a bacteria responsible for most ulcers
and many cases of chronic gastritis
(inflammation of the stomach). This organism
can weaken the protective coating of the
stomach and duodenum (first part of the small
intestines), allowing the damaging digestive
juices to irritate the sensitive lining of these
body parts.
19. Answer: C. Stool. Occult blood test or stool
guiac test is a test that detects the presence of
hidden (occult) blood in the stool (bowel
movement). The stool guaiac is the most
common form of fecal occult blood test (FOBT)
in use today. So stool specimen will be
collected.
20. Answer: D. Meatless diet for 48 hours prior to
obtaining of specimen. Eating meat can cause
false positive test result. Using proper stool
collection technique, avoiding certain drugs,
and observing dietary restrictions can minimize
these measurement errors.
21. Answer: C. “The cause of this condition is
unknown”. There is no known cause of IBS,
and diagnosis is made by excluding all the other
diseases that cause the symptoms. There is no
inflammation if the bowel. Some factors
exacerbate the symptoms including anxiety,
fear, stress, depression, some foods and drugs
but there do not cause the disease.
22. Answer: d. Terminal Ileum. Chronic
inflammatory of GI mucosa occurs anywhere
from the mouth to anus but most often in
terminal ileum. Inflammatory lesions are local
and involve all layers of the intestinal wall.
Reviwer
23. Answer: C. Heredity. The cause is unknown
but is thought to be multifactorial. Heredity,
infectious agents, altered immunity or
autoimmune and environmental are factors to
be considered. Test taking skill: which does not
belong? Options a, b, and d are all modifiable
factors.
24. Answer: B. Altered immunity. Refer to
rationale for number 23. Test taking skill:
which does not belong? Options a, c and d are
all modifiable factors.
25. Answer: A. A demanding and stressful
job. Stress is an environmental factor that is
thought to cause ulcerative colitis. Test taking
skill: options b, c, and d are all healthy
lifestyles.
26. Answer: B. A non – inflamed outpouching of
the intestine. An increase intraluminal pressure
causes the outpouching of the colon wall
resulting to diverticulosis. Option a suggests
diverticulitis. Test taking skill: one of the
opposite is the correct answer.
27. Answer: A. Low – Fiber Diet. A lack of
adequate blood supply and nutrients from the
diet such as low fiber foods may contribute to
the development of the disease. Test taking
skill: one of the opposite is the correct answer.
28. Answer: B. Barium enema. Barium enema is
used to diagnose diverticulosis, however, this is
contraindicated when diverticulitis is present
because of the risk of rupturing the
diverticulum. Test taking skill: options b and c
are opposite; one may be the correct answer.
29. Answer: B. Increase fiber in the diet. Patient
with diverticulosis must be encouraged to
increase roughage in diet such as fruits and
vegetables rich in fiber. Increasing fluid intake
2 – 3 liters/day unless contraindicated rather
reducing. Administering antibiotics can
decrease bowel flora and infection but this is a
dependent function of a nurse.
30. Answer: B. Normal. Mr. Trinidad’s BMI is 23
which is normal. Refer to rationale number 15.
31. Answer: C. passage of stool is more than 3
bowel movements per day
32. Answer: B. Altered Immunity. Diarhhea is an
intestinal disorder that is self – limiting.
Options a, c and d are etiological factors of
diarrhea.
33. Answer: C. Cardiac dysrhytmias. Due to
increase frequency and fluid content in the
stools, diarrhea may cause fluid and electrolyte
imbalance such as hypokalemia. Once
potassium is depleted, this will affect the
contractility of the heart causing cardiac
arrhythmia leading to death.
34. Answer: B. Metabolic acidosis. In diarrhea,
metabolic acidosis is the acid – base imbalance
that occurs while in vomiting, metabolic
alkalosis occur. This is a metabolic disorder
that’s why eliminate options c and d.
35. Answer: D. Oresol. In the DOH book, oresol is
the immediate home care management for
diarrhea to prevent dehydration. Water may not
be enough to prevent diarrhea.
36. Answer: A. High pitched tinkling or rumbling
bowel sounds. Early in the bowel obstruction,
the bowel attempts to move the contents past
the obstruction and this is heard as high pitched
tinkling bowel sounds. As the obstruction
progresses, bowel sounds will diminish and
may finally become absent.
37. Answer: B. Decompression of bowel. The
NGT’s primary purpose is for bowel
decompression especially for clients suffering
from obstruction.
38. Answer: A. Absent bowel sounds. Post –
operatively, no bowel sounds are present so this
is a normal finding. Bleeding and hemorrhage
must be prevented to avoid
complications. Bowel movement occurs only
after flatus and bowel sounds are noted.
39. Answer: A. Use of natural laxatives. The use of
natural laxatives such as foods and fruits high in
fiber is still the best way of preventing
constipation Increasing fluid intake, taking
laxatives judiciously and exercise also can
prevent this.
40. Answer: A. Assess for signs of
peritonitis. Assessment precedes intervention.
Symptoms presented are signs of peritonitis.
Assessment will provide you the data for
prompt intervention.
41. Answer: A. The pain is localized at a position
halfway between the umbilicus and the right
iliac crest. Pain over McBurney’s point, the
point halfway between the umbilicus and the
iliac crest, is diagnosis for appendicitis. Options
b and c are common with ulcers; option d may
suggest ulcerative colitis or diverticulitis.
42. Answer: A. A fecalith. A fecalith is a hard piece
of stool which is stone like that commonly
obstructs the lumen. Due to obstruction,
inflammation and bacterial invasion can occur.
Tumors or foreign bodies may also cause
obstruction.
43. Answer: C. WBC 13, 000/mm3. Increase in
WBC counts is suggestive of appendicitis
because of bacterial invasion and inflammation.
Normal WBC count is 5, 000 – 10, 000/mm3.
Other options are normal values.
44. Answer: D. Lying with legs drawn
up. Posturing by lying with legs drawn up can
relax the abdominal muscle thus relieve pain.
45. Answer: B. The appendix may have ruptured. If
a confirmed diagnosis is made and the pain
suddenly without any intervention, the appendix
may have ruptured; the pain is lessened because
the appendix is no longer distended thus
surgery is still needed.
46. Answer: B. Three vaginal delivery
pregnancies. Hemorrhoids are associated with
prolonged sitting, or standing, portal
hypertension, chronic constipation and
prolonged intra abdominal pressure as
associated with pregnancy and the strain of
vaginal delivery. Her job as a schoolteacher
does not require prolong sitting or standing.
Age and leg varicosities are not related to the
development of hemorrhoids.
47. Answer: C. Avoid strainining during
defecation. Straining can increase intra
abdominal pressure. Health teachings also
include: suggest to eat high roughage diet,
wearing of cotton undergarments and use of sitz
bath for 15 minutes.
48. Answer: B. causes coagulation(clumping) of
proteins in the cells of the perianal skin or the
lining of the anal canal. Option a are local
anesthetics; c are antiseptics and d are
keratolytics.
49. Answer: C. Side – lying. Positioning in the
early postoperative phase should avoid stress
and pressure on the operative site. The prone
and side – lying are ideal from a comfort
perspective. A high Fowler’s or supine position
will place pressure on the operative site and is
not recommended. There is no need for
trendelenburg’s position.
Reviwer
50. Answer: A. Hemorrhage. Applying heat during
the immediate postoperative period may cause
hemorrhage at the surgical site. Moist heat may
relieve rectal spasms after bowel movements.
Urinary retention caused by reflex spasm may
also be relieved by moist heat. Increasing fiber
and fluid in the diet can help constipation
1. Nurse Berlinda is assigned to a 41-year-old client
who has a diagnosis of chronic pancreatitis. The
nurse reviews the laboratory result, anticipating a
laboratory report that indicates a serum amylase level
of:
A. 45 units/L
B. 100 units/L
C. 300 units/L
D. 500 units/L
2. A male client who is recovering from surgery has
been advanced from a clear liquid diet to a full liquid
diet. The client is looking forward to the diet change
because he has been “bored” with the clear liquid
diet. The nurse would offer which full liquid item to
the client?
A. Tea
B. Gelatin
C. Custard
D. Popsicle
3. Nurse Juvy is caring for a client with cirrhosis of
the liver. To minimize the effects of the disorder, the
nurse teaches the client about foods that are high in
thiamine. The nurse determines that the client has the
best understanding of the dietary measures to follow
if the client states an intension to increase the intake
of:
A. Pork
B. Milk
C. Chicken
D. Broccoli
4. Nurse Oliver 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 appropriate action for the nurse to take?
A. Hold the feeding
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
5. A nurse is inserting a nasogastric tube in an adult
male client. During the procedure, the client begins to
cough and has difficulty breathing. Which of the
following is the appropriate nursing action?
A. Quickly insert the tube
B. Notify the physician immediately
C. Remove the tube and reinsert when the
respiratory distress subsides
D. Pull back on the tube and wait until the
respiratory distress subsides
6. Nurse Ryan is assessing for correct placement of a
nosogartric tube. The nurse aspirates the stomach
contents and check the contents for pH. The nurse
verifies correct tube placement if which pH value is
noted?
A. 3.5
B. 7.0
C. 7.35
D. 7.5
7. A nurse is preparing to remove a nasogartric tube
from a female client. The nurse should instruct the
client to do which of the following just before the
nurse removes the tube?
A. Exhale
B. Inhale and exhale quickly
C. Take and hold a deep breath
D. Perform a Valsalva maneuver
8. Nurse Joy is preparing to administer medication
through a nasogastric tube that is connected to
suction. To administer the medication, the nurse
would:
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 minutes
following administration of the medication
D. Change the suction setting to low intermittent
suction for 30 minutes after medication
administration
9. A nurse is preparing to care for a female client
with esophageal varices who has just has a
Sengstaken-Blakemore tube inserted. The nurse
gathers supplies, knowing that which of the following
items must be kept at the bedside at all times?
A. An obturator
B. Kelly clamp
C. An irrigation set
D. A pair of scissors
10. Dr. Smith has determined that the client with
hepatitis has contracted the infection form
contaminated food. The nurse understands that this
client is most likely experiencing what type of
hepatitis?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
11. A client is suspected of having hepatitis. Which
diagnostic test result will assist in confirming this
diagnosis?
A. Elevated hemoglobin level
B. Elevated serum bilirubin level
C. Elevated blood urea nitrogen level
D. Decreased erythrocycle sedimentation rate
12. The nurse is reviewing the physician’s orders
written for a male client admitted to the hospital with
acute pancreatitis. Which physician order should the
nurse question if noted on the client’s chart?
A. NPO status
B. Nasogastric tube inserted
C. Morphine sulfate for pain
D. An anticholinergic medication
13. A female client being seen in a physician’s office
has just been scheduled for a barium swallow the
next day. The nurse writes down which instruction
for the client to follow before the test?
A. Fast for 8 hours before the test
B. Eat a regular supper and breakfast
C. Continue to take all oral medications as
scheduled
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D. Monitor own bowel movement pattern for
constipation
14. The nurse is performing an abdominal assessment
and inspects the skin of the abdomen. The nurse
performs which assessment technique next?
A. Palpates the abdomen for size
B. Palpates the liver at the right rib margin
C. Listens to bowel sounds in all for quadrants
D. Percusses the right lower abdominal quadrant
15. Polyethylene glycol-electrlyte solution
(GoLYTELY) is prescribed for the female client
scheduled for a colonoscopy. The client begins to
experience diarrhea following administration of the
solution. What action by the nurse is appropriate?
A. Start an IV infusion
B. Administer an enema
C. Cancel the diagnostic test
D. Explain that diarrhea is expected
16. 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
17. The nurse is reviewing the medication record of a
female client with acute gastritis. Which medication,
if noted on the client’s record, would the nurse
question?
A. Digoxin (Lanoxin)
B. Furosemide (Lasix)
C. Indomethacin (Indocin)
D. Propranolol hydrochloride (Inderal)
18. The nurse is assessing a male client 24 hours
following a cholecystectomy. The nurse noted that
the T tube has drained 750 mL of green-brown
drainage since the surgery. Which nursing
intervention is appropriate?
A. Clamp the T tube
B. Irrigate the T tube
C. Notify the physician
D. Document the findings
19. The nurse is monitoring a female client with a
diagnosis of peptic ulcer. Which assessment findings
would most likely indicate perforation of the ulcer?
A. Bradycardia
B. Numbness in the legs
C. Nausea and vomiting
D. A rigid, board-like abdomen
20. A male client with a peptic ulcer is scheduled for
a vagotomy and the client asks the nurse about the
purpose of this procedure. Which response by the
nurse best describes the purpose of a vagotomy?
A. Halts stress reactions
B. Heals the gastric mucosa
C. Reduces the stimulus to acid secretions
D. Decreases food absorption in the stomach
21. The nurse is caring for a female client following a
Billroth II procedure. Which postoperative order
should the nurse question and verify?
A. Leg exercises
B. Early ambulation
C. Irrigating the nasogastric tube
D. Coughing and deep-breathing exercises
22. The nurse is providing discharge instructions to a
male client following gastrectomy and instructs the
client to take which measure to assist in preventing
dumping syndrome?
A. Ambulate following a meal
B. Eat high carbohydrate foods
C. Limit the fluid taken with meal
D. Sit in a high-Fowler’s position during meals
23. The nurse is monitoring a female client for the
early signs and symptoms of dumping syndrome.
Which of the following indicate this occurrence?
A. Sweating and pallor
B. Bradycardia and indigestion
C. Double vision and chest pain
D. Abdominal cramping and pain
24. The nurse is preparing a discharge teaching plan
for the male client who had umbilical hernia repair.
What should the nurse include in the plan?
A. Irrigating the drain
B. Avoiding coughing
C. Maintaining bed rest
D. Restricting pain medication
25. The nurse is instructing the male client who has
an inguinal hernia repair how to reduce postoperative
swelling following the procedure. What should the
nurse tell the client?
A. Limit oral fluid
B. Elevate the scrotum
C. Apply heat to the abdomen
D. Remain in a low-fiber diet
26. The nurse is caring for a hospitalized female
client with a diagnosis of ulcerative colitis. Which
finding, if noted on assessment of the client, would
the nurse report to the physician?
A. Hypotension
B. Bloody diarrhea
C. Rebound tenderness
D. A hemoglobin level of 12 mg/dL
27. The nurse is caring for a male client
postoperatively following creation of a colostomy.
Which nursing diagnosis should the nurse include in
the plan of care?
A. Sexual dysfunction
B. Body image, disturbed
C. Fear related to poor prognosis
D. Nutrition: more than body requirements,
imbalanced
28. The nurse is reviewing the record of a female
client with Crohn’s disease. Which stool
characteristics should the nurse expect to note
documented in the client’s record?
A. Diarrhea
B. Chronic constipation
C. Constipation alternating with diarrhea
D. Stools constantly oozing form the rectum
29. The nurse is performing a colostomy irrigation on
a male client. During the irrigation, the client begins
to complain of abdominal cramps. What is the
appropriate nursing action?
A. Notify the physician
B. Stop the irrigation temporarily
C. Increase the height of the irrigation
D. Medicate for pain and resume the irrigation
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30. The nurse is teaching a female client how to
perform a colostomy irrigation. To enhance the
effectiveness of the irrigation and fecal returns, what
measure should the nurse instruct the client to do?
A. Increase fluid intake
B. Place heat on the abdomen
C. Perform the irrigation in the evening
D. Reduce the amount of irrigation solution
31. 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?
A. Hypoalbuminemia
B. Increased capillary permeability
C. Abnormal peripheral vasodilation
D. Excess rennin release from the kidneys
32. You’re assessing the stoma of a patient with a
healthy, well-healed colostomy. You expect the
stoma to appear:
A. Pale, pink and moist
B. Red and moist
C. Dark or purple colored
D. Dry and black
33. You’re caring for a patient with a sigmoid
colostomy. The stool from this colostomy is:
A. Formed
B. Semisolid
C. Semiliquid
D. Watery
34. You’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
35. You have to teach ostomy self care to a patient
with a colostomy. You tell the patient to measure and
cut the wafer:
A. To the exact size of the stoma.
B. About 1/16” larger than the stoma.
C. About 1/8” larger than the stoma.
D. About 1/4″ larger than the stoma.
36. You’re performing an abdominal assessment on
Brent who is 52 y.o. In which order do you proceed?
A. Observation, percussion, palpation, auscultation
B. Observation, auscultation, percussion, palpation
C. Percussion, palpation, auscultation, observation
D. Palpation, percussion, observation, auscultation
37. You’re doing preoperative teaching with
Gertrude who has ulcerative colitis who needs
surgery to create an ileoanal reservoir. Which
information do you include?
A. A reservoir is created that exits through the
abdominal wall.
B. A second surgery is required 12 months after
the first surgery.
C. A permanent ileostomy is created.
D. The surgery occurs in two stages.
38. 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?
A. 100 ml
B. 500 ml
C. 1500 ml
D. 5000 ml
39. 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?
A. There is no need to change eating habits.
B. Eat six small meals a day.
C. Eat the largest meal in the evening.
D. Restrict fluid intake.
40. 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?
A. “I know just how you feel.”
B. “You seem upset.”
C. “Oh, don’t worry about it, everything will be
just fine.”
D. “Why do you think you have cancer?”
41. 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?
A. Flushed, dry skin.
B. Headache and bradycardia.
C. Dizziness and sweating.
D. Dyspnea and chest pain.
42. You’re developing the plan of care for a patient
experiencing dumping syndrome after a Billroth II
procedure. Which dietary instructions do you
include?
A. Omit fluids with meals.
B. Increase carbohydrate intake.
C. Decrease protein intake.
D. Decrease fat intake.
43. 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?
A. Pruritus
B. Dyspnea
C. Jaundice
D. Peripheral Neuropathy
44. 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:
A. Empty her bladder.
B. Lie supine in bed.
C. Remain NPO for 4 hours.
D. Clean her bowels with an enema.
45. 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?
A. Irrigate the wound & organs with Betadine.
B. Cover the wound with a saline soaked sterile
dressing.
C. Apply a dry sterile dressing & binder.
D. Push the organs back & cover with moist sterile
dressings.
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46. You’re caring for Betty with liver cirrhosis.
Which of the following assessment findings leads
you to suspect hepatic encephalopathy in her?
A. Asterixis
B. Chvostek’s sign
C. Trousseau’s sign
D. Hepatojugular reflex
47. You are developing a careplan on Sally, a 67 y.o.
patient with hepatic encephalopathy. Which of the
following do you include?
A. Administering a lactulose enema as ordered.
B. Encouraging a protein-rich diet.
C. Administering sedatives, as necessary.
D. Encouraging ambulation at least four times a
day.
48. You have a patient with achalasia (incomplete
muscle relaxtion of the GI tract, especially sphincter
muscles). Which medications do you anticipate to
administer?
A. Isosorbide dinitrate (Isordil)
B. Digoxin (Lanoxin)
C. Captopril (Capoten)
D. Propanolol (Inderal)
49. The student nurse is preparing a teaching care
plan to help improve nutrition in a patient with
achalasia. You include which of the following:
A. Swallow foods while leaning forward.
B. Omit fluids at mealtimes.
C. Eat meals sitting upright.
D. Avoid soft and semisoft foods.
50. Britney, a 20 y.o. student is admitted with acute
pancreatitis. Which laboratory findings do you expect
to be abnormal for this patient?
A. Serum creatinine and BUN
B. Alanine aminotransferase (ALT) and aspartate
aminotransferase (AST)
C. Serum amylase and lipase
D. Cardiac enzymes
51. 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?
A. 1.005
B. 1.011
C. 1.020
D. 1.030
52. Your goal is to minimize David’s risk of
complications after a heriorrhaphy. You instruct the
patient to:
A. Avoid the use of pain medication.
B. Cough and deep breathe Q2H.
C. Splint the incision if he can’t avoid sneezing or
coughing.
D. Apply heat to scrotal swelling.
53. Janice is waiting for discharge instructions after
her herniorrhaphy. Which of the following
instructions do you include?
A. Eat a low-fiber diet.
B. Resume heavy lifting in 2 weeks.
C. Lose weight, if obese.
D. Resume sexual activity once discomfort is
gone.
54. Develop a teaching care plan for Angie who is
about to undergo a liver biopsy. Which of the
following points do you include?
A. “You’ll need to lie on your stomach during the
test.”
B. “You’ll need to lie on your right side after the
test.”
C. “During the biopsy you’ll be asked to exhale
deeply and hold it.”
D. “The biopsy is performed under general
anesthesia.”
55. 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?
A. Dyspnea and reduced or absent breath sounds
over the right lung
B. Tachycardia, hypotension, and cool, clammy
skin
C. Fever, rebound tenderness, and abdominal
rigidity
D. Redness, warmth, and drainage at the biopsy
site
56. 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?
A. “It empties the stomach of fluids and gas.”
B. “It prevents spasms at the sphincter of Oddi.”
C. “It prevents air from forming in the small
intestine and large intestine.”
D. “It removes bile from the gallbladder.”
57. 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?
A. Aspirate for gastric secretions with a syringe.
B. Begin feeding slowly to prevent cramping.
C. Get an X-ray of the tip of the tube within 24
hours.
D. Clamp off the tube until the feedings begin.
58. Stephanie, a 28 y.o. accident victim, requires
TPN. The rationale for TPN is to provide:
A. Necessary fluids and electrolytes to the body.
B. Complete nutrition by the I.V. route.
C. Tube feedings for nutritional supplementation.
D. Dietary supplementation with liquid protein
given between meals.
59. Type A chronic gastritis can be distinquished
from type B by its ability to:
A. Cause atrophy of the parietal cells.
B. Affect only the antrum of the stomach.
C. Thin the lining of the stomach walls.
D. Decrease gastric secretions.
60. 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?
A. Restrict intake of high-carbohydrate foods.
B. Increase fluid intake with meals.
C. Increase fat intake.
D. Eat three regular meals a day.
61. Jerod is experiencing an acute episode of
ulcerative colitis. Which is priority for this patient?
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A. Replace lost fluid and sodium.
B. Monitor for increased serum glucose level from
steroid therapy.
C. Restrict the dietary intake of foods high in
potassium.
D. Note any change in the color and consistency of
stools.
62. A 29 y.o. patient has an acute episode of
ulcerative colitis. What diagnostic test confirms this
diagnosis?
A. Barium Swallow.
B. Stool examination.
C. Gastric analysis.
D. Sigmoidoscopy.
63. Eleanor, a 62 y.o. woman with diverticulosis is
your patient. Which interventions would you expect
to include in her care?
A. Low-fiber diet and fluid restrictions.
B. Total parenteral nutrition and bed rest.
C. High-fiber diet and administration of psyllium.
D. Administration of analgesics and antacids.
64. Regina is a 46 y.o. woman with ulcerative colitis.
You expect her stools to look like:
A. Watery and frothy.
B. Bloody and mucoid.
C. Firm and well-formed.
D. Alternating constipation and diarrhea.
65. Donald is a 61 y.o. man with diverticulitis.
Diverticulitis is characterized by:
A. Periodic rectal hemorrhage.
B. Hypertension and tachycardia.
C. Vomiting and elevated temperature.
D. Crampy and lower left quadrant pain and low-
grade fever.
66. Brenda, a 36 y.o. patient is on your floor with
acute pancreatitis. Treatment for her includes:
A. Continuous peritoneal lavage.
B. Regular diet with increased fat.
C. Nutritional support with TPN.
D. Insertion of a T tube to drain the pancreas.
67. Glenda has cholelithiasis (gallstones). You
expect her to complain of:
A. Pain in the right upper quadrant, radiating to the
shoulder.
B. Pain in the right lower quadrant, with rebound
tenderness.
C. Pain in the left upper quadrant, with shortness
of breath.
D. Pain in the left lower quadrant, with mild
cramping.
68. 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:
A. Irrigate the incision with a saline solution.
B. Prevent bacterial infection of the incision.
C. Measure the amount of fluid lost after surgery.
D. Prevent accumulation of drainage in the wound.
69. 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?
A. Pink color.
B. Light edema.
C. Small amount of oozing.
D. Trickles of bright red blood.
70. Your teaching Anthony how to use his new
colostomy. How much skin should remain exposed
between the stoma and the ring of the appliance?
A. 1/16”
B. 1/4″
C. 1/2”
D. 1”
71. Claire, a 33 y.o. is on your floor with a possible
bowel obstruction. Which intervention is priority for
her?
A. Obtain daily weights.
B. Measure abdominal girth.
C. Keep strict intake and output.
D. Encourage her to increase fluids.
72. 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?
A. TPN
B. PPN
C. NG feeding
D. Oral liquid supplements
73. You’re patient is complaining of abdominal pain
during assessment. What is your priority?
A. Auscultate to determine changes in bowel
sounds.
B. Observe the contour of the abdomen.
C. Palpate the abdomen for a mass.
D. Percuss the abdomen to determine if fluid is
present.
74. Before bowel surgery, Lee is to administer
enemas until clear. During administration, he
complains of intestinal cramps. What do you do next?
A. Discontinue the procedure.
B. Lower the height of the enema container.
C. Complete the procedure as quickly as possible.
D. Continue administration of the enema as
ordered without making any adjustments.
75. Leigh Ann is receiving pancrelipase (Viokase)
for chronic pancreatitis. Which observation best
indicates the treatment is effective?
A. There is no skin breakdown.
B. Her appetite improves.
C. She loses more than 10 lbs.
D. Stools are less fatty and decreased in frequency.
76. Ralph has a history of alcohol abuse and has
acute pancreatitis. Which lab value is most likely to
be elevated?
A. Calcium
B. Glucose
C. Magnesium
D. Potassium
77. 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:
A. Giving pain medication Q6H.
B. Flushing the NG tube with sterile water.
C. Positioning her in high Fowler’s position.
D. Keeping her NPO until the return of peristalsis.
78. 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
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condition. You assess her colostomy 2 days after
surgery. Which finding do you report to the doctor?
A. Blanched stoma
B. Edematous stoma
C. Reddish-pink stoma
D. Brownish-black stoma
79. 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?
A. Restrict fluids
B. Encourage ambulation
C. Increase sodium in the diet
D. Give antacids as prescribed
80. Katrina is diagnosed with lactose intolerance. To
avoid complications with lack of calcium in the diet,
which food should be included in the diet?
A. Fruit
B. Whole grains
C. Milk and cheese products
D. Dark green, leafy vegetables
81. Nathaniel has severe pruritus due to having
hepatitis B. What is the best intervention for his
comfort?
A. Give tepid baths.
B. Avoid lotions and creams.
C. Use hot water to increase vasodilation.
D. Use cold water to decrease the itching.
82. 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?
A. Regular exercise.
B. A low-protein diet.
C. Allow patient to select his meals.
D. Rest period after small, frequent meals.
83. You’re discharging Nathaniel 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.”
84. 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?
A. “You’ll need to turn from side to side every 2
hours.”
B. “It’s always a good idea to rest quietly after
surgery.”
C. “The doctor will probably order you to lie flat
for 24 hours.”
D. “Why don’t you decide about activity after you
return from the recovery room?”
85. 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?
A. Encourage her to not worry about the future.
B. Encourage her to express her feelings about the
illness.
C. Discuss the effects of hepatitis B on future
health problems.
D. Provide avenues for financial counseling if she
expresses the need.
86. 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?
A. Give diazepam in the I.V. port closest to the
vein.
B. Mix diazepam with 50 ml of dextrose 5% in
water and give over 15 minutes.
C. Give diazepam rapidly I.V. to prevent the
bloodstream from diluting the drug mixture.
D. Question the order because I.V. administration
of diazepam is contraindicated.
87. Annebell is being discharged with a colostomy,
and you’re teaching her about colostomy care. Which
statement correctly describes a healthy stoma?
A. “At first, the stoma may bleed slightly when
touched.”
B. “The stoma should appear dark and have a
bluish hue.”
C. “A burning sensation under the stoma faceplate
is normal.”
D. “The stoma should remain swollen away from
the abdomen.”
88. 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?
A. Rapidly instill a stream of irrigating solution
into the wound.
B. Apply a wet-to-dry dressing to the wound after
the irrigation.
C. Moisten the area around the wound with normal
saline solution after the irrigation.
D. Irrigate continuously until the solution becomes
clear or all of the solution is used.
89. Hepatic encephalopathy develops when the blood
level of which substance increases?
A. Ammonia
B. Amylase
C. Calcium
D. Potassium
90. 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?
A. A suture kit.
B. Sterile water and a suture kit.
C. Sterile water and sterile dressings.
D. Sterile saline solution and sterile dressings.
91. Findings during an endoscopic exam include a
cobblestone appearance of the colon in your patient.
The findings are characteristic of which disorder?
A. Ulcer
B. Crohn’s disease
C. Chronic gastritis
D. Ulcerative colitis
92. What information is correct about stomach
cancer?
A. Stomach pain is often a late symptom.
B. Surgery is often a successful treatment.
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C. Chemotherapy and radiation are often A. Notify the doctor immediately.

successful treatments. B. Stop the feeding, and clamp the NG tube.
D. The patient can survive for an extended time C. Discard the 220ml, and clamp the NG tube.
with TPN. D. Give a prescribed GI stimulant such as
93. Dark, tarry stools indicate bleeding in which metoclopramide (Reglan).
location of the GI tract? Answers and Rationales

1. Answer C. The normal serum amylase level is

A. Upper colon.
B. Lower colon.
C. Upper GI tract.
D. Small intestine.
94. A patient has an acute upper GI hemorrhage.
Your interventions include:
A. Treating hypovolemia.
B. Treating hypervolemia.
C. Controlling the bleeding source.
D. Treating shock and diagnosing the bleeding
source.
95. You promote hemodynamic stability in a patient
with upper GI bleeding by:
A. Encouraging oral fluid intake.
B. Monitoring central venous pressure.
C. Monitoring laboratory test results and vital
signs.
D. Giving blood, electrolyte and fluid replacement.
96. 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?
A. Determine what the patient already knows
about colostomies.
B. Show the patient some pictures of colostomies.
C. Arrange for someone who has a colostomy to
visit the patient.
D. Provide the patient with written material about
colostomy care.
97. 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?
A. Fistula.
B. Bowel perforation.
C. Bowel obstruction.
D. Abscess.
98. A patient has a severe exacerbation of ulcerative
colitis. Long-term medications will probably include:
A. Antacids.
B. Antibiotics.
C. Corticosteroids.
D. Histamine2-receptor blockers.
99. 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?
A. Meats and beans.
B. Butter and gravies.
C. Potatoes and pastas.
D. Cakes and pastries.
100. 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?
25 to 151 units/L. With chronic cases of
pancreatitis, the rise in serum amylase levels
usually does not exceed three times the normal
value. In acute pancreatitis, the value may
exceed five times the normal value. Options A
and B are within normal limits. Option D is an
extremely elevated level seen in acute
pancreatitis.
2. Answer C. Full liquid food items include items
such as plain ice cream, sherbet, breakfast
drinks, milk, pudding and custard, soups that
are strained, and strained vegetable juices. A
clear liquid diet consists of foods that are
relatively transparent. The food items in options
A, B, and D are clear liquids.
3. Answer A. The client with cirrhosis needs to
consume foods high in thiamine. Thiamine is
present in a variety of foods of plant and animal
origin. Pork products are especially rich in this
vitamin. Other good food sources include nuts,
whole grain cereals, and legumes. Milk contains
vitamins A, D, and B2. Poultry contains niacin.
Broccoli contains vitamins C, E, and K and
folic acid
4. Answer A. Unless specifically indicated,
residual amounts more than 100 mL require
holding the feeding. Therefore options B, C,
and D are incorrect. Additionally, the feeding is
not discarded unless its contents are abnormal
in color or characteristics.
5. Answer D. During the insertion of a nasogastric
tube, if the client experiences difficulty
breathing or any respiratory distress, withdraw
the tube slightly, stop the tube advancement,
and wait until the distress subsides. Options B
and C are unnecessary. Quickly inserting the
tube is not an appropriate action because, in this
situation, it may be likely that the tube has
entered the bronchus.
6. Answer A. If the nasogastric tube is in the
stomach, the pH of the contents will be acidic.
Gastric aspirates have acidic pH values and
should be 3.5 or lower. Option B indicates a
slightly acidic pH. Option C indicates a neutral
pH. Option D indicates an alkaline pH.
7. Answer C. When the nurse removes a
nasogastric tube, the client is instructed to take
and hold a deep breath. This will close the
epiglottis. This allows for easy withdrawal
through the esophagus into the nose. The nurse
removes the tube with one smooth, continuous
pull.
8. Answer C. If a client has a nasogastric tube
connected to suction, the nurse should wait up
to 30 minutes before reconnecting the tube to
the suction apparatus to allow adequate time for
medication absorption. Aspirating the
nasogastric tube will remove the medication
just administered. Low intermittent suction also
will remove the medication just administered.
The client should not be placed in the supine
position because of the risk for aspiration.
9. Answer D. When the client has a Sengstaken-
Blakemore tube, a pair of scissors must be kept
at the client’s bedside at all times. The client
needs to be observed for sudden respiratory
distress, which occurs if the gastric balloon
Reviwer
ruptures and the entire tube moves upward. If
this occurs, the nurse immediately cuts all
balloon lumens and removes the tube. An
obturator and a Kelly clamp are kept at the
bedside of a client with a tracheostomy. An
irrigation set may be kept at the bedside, but it
is not the priority item.
10. Answer A. Hepatitis A is transmitted by the
fecal-oral route via contaminated food or
infected food handlers. Hepatitis B, C, and D
are transmitted most commonly via infected
blood or body fluids.
11. Answer B. Laboratory indicators of hepatitis
include elevated liver enzyme levels, elevated
serum bilirubin levels, elevated erythrocyte
sedimentation rates, and leukopenia. An
elevated blood urea nitrogen level may indicate
renal dysfunction. A hemoglobin level is
unrelated to this diagnosis.
12. Answer C. Meperidine (Demerol) rather than
morphine sulfate is the medication of choice to
treat pain because morphine sulfate can cause
spasms in the sphincter of Oddi. Options A, B,
and D are appropriate interventions for the
client with acute pancreatitis.
13. Answer A. A barium swallow is an x-ray study
that uses a substance called barium for contrast
to highlight abnormalities in the gastrointestinal
tract. The client should fast for 8 to 12 hours
before the test, depending on physician
instructions. Most oral medications also are
withheld before the test. After the procedure,
the nurse must monitor for constipation, which
can occur as a result of the presence of barium
in the gastrointestinal tract.
14. Answer C. The appropriate sequence for
abdominal examination is inspection,
auscultation, percussion, and palpation.
Auscultation is performed after inspection to
ensure that the motility of the bowel and bowel
sounds are not altered by percussion or
palpation. Therefore, after inspecting the skin
on the abdomen, the nurse should listen for
bowel sounds.
15. Answer D. The solution GoLYTELY is a bowel
evacuant used to prepare a client for a
colonoscopy by cleansing the bowel. The
solution is expected to cause a mild diarrhea
and will clear the bowel in 4 to 5 hours. Options
A, B, and C are inappropriate actions.
16. Answer B. Chronic gastritis causes
deterioration and atrophy of the lining of the
stomach, leading to the loss of the function of
the parietal cells. The source of the intrinsic
factor is lost, which results in the inability to
absorb vitamin B12. This leads to the
development of pernicious anemia. The client is
not at risk for vitamin A, C, or E deficiency.
17. Answer C. Indomethacin (Indocin) is a
nonsteroidal anti-inflammatory drug and can
cause ulceration of the esophagus, stomach, or
small intestine. Indomethacin is contraindicated
in a client with gastrointestinal disorders.
Furosemide (Lasix) is a loop diuretic. Digoxin
is a cardiac medication. Propranolol (Inderal) is
a β-adrenergic blocker. Furosemide, digoxin,
and propranolol are not contraindicated in
clients with gastric disorders.
18. Answer D. Following cholecystectomy,
drainage from the T tube is initially bloody and
then turns to a greenish-brown color. The
drainage is measured as output. The amount of
expected drainage will range from 500 to 1000
mL/day. The nurse would document the output.
19. Answer D. Perforation of an ulcer is a surgical
emergency and is characterized by sudden,
sharp, intolerable severe pain beginning in the
midepigastric area and spreading over the
abdomen, which becomes rigid and board-like.
Nausea and vomiting may occur. Tachycardia
may occur as hypovolemic shock develops.
Numbness in the legs is not an associated
finding.
20. Answer C. A vagotomy, or cutting of the vagus
nerve, is done to eliminate parasympathetic
stimulation of gastric secretion. Options A, B,
and D are incorrect descriptions of a vagotomy.
21. Answer C. In a Billroth II procedure, the
proximal remnant of the stomach is
anastomosed to the proximal jejunum. Patency
of the nasogastric tube is critical for preventing
the retention of gastric secretions. The nurse
should never irrigate or reposition the gastric
tube after gastric surgery, unless specifically
ordered by the physician. In this situation, the
nurse should clarify the order. Options A, B,
and D are appropriate postoperative
interventions.
22. Answer C. Dumping syndrome is a term that
refers to a constellation of vasomotor symptoms
that occurs after eating, especially following a
Billroth II procedure. Early manifestations
usually occur within 30 minutes of eating and
include vertigo, tachycardia, syncope, sweating,
pallor, palpitations, and the desire to lie down.
The nurse should instruct the client to decrease
the amount of fluid taken at meals and to avoid
high-carbohydrate foods, including fluids such
as fruit nectars; to assume a low-Fowler’s
position during meals; to lie down for 30
minutes after eating to delay gastric emptying;
and to take antispasmodics as prescribed.
23. Answer A. Early manifestations of dumping
syndrome occur 5 to 30 minutes after eating.
Symptoms include vertigo, tachycardia,
syncope, sweating, pallor, palpitations, and the
desire to lie down.
24. Answer B. Coughing is avoided following
umbilical hernia repair to prevent disruption of
tissue integrity, which can occur because of the
location of this surgical procedure. Bed rest is
not required following this surgical procedure.
The client should take analgesics as needed and
as prescribed to control pain. A drain is not
used in this surgical procedure, although the
client may be instructed in simple dressing
changes.
25. Answer B. Following inguinal hernia repair, the
client should be instructed to elevate the
scrotum and apply ice packs while in bed to
decrease pain and swelling. The nurse also
should instruct the client to apply a scrotal
support when out of bed. Heat will increase
swelling. Limiting oral fluids and a low-fiber
diet can cause constipation.
26. Answer C. Rebound tenderness may indicate
peritonitis. Bloody diarrhea is expected to occur
in ulcerative colitis. Because of the blood loss,
the client may be hypotensive and the
hemoglobin level may be lower than normal.
Signs of peritonitis must be reported to the
physician.
27. Answer B. Body image, disturbed relates to loss
of bowel control, the presence of a stoma, the
release of fecal material onto the abdomen, the
passage of flatus, odor, and the need for an
appliance (external pouch). No data in the
question support options A and C. Nutrition:
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less than body requirements, imbalanced is the
more likely nursing diagnosis.
28. Answer A. Crohn’s disease is characterized by
nonbloody diarrhea of usually not more than
four to five stools daily. Over time, the diarrhea
episodes increase in frequency, duration, and
severity. Options B, C, and D are not
characteristics of Crohn’s disease.
29. Answer B. If cramping occurs during a
colostomy irrigation, the irrigation flow is
stopped temporarily and the client is allowed to
rest. Cramping may occur from an infusion that
is too rapid or is causing too much pressure.
The physician does not need to be notified.
Increasing the height of the irrigation will cause
further discomfort. Medicating the client for
pain is not the appropriate action in this
situation.
30. Answer A. To enhance effectiveness of the
irrigation and fecal returns, the client is
instructed to increase fluid intake and to take
other measures to prevent constipation. Options
B, C and D will not enhance the effectiveness
of this procedure.
31. Answer 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.
32. Answer B. Good circulation causes tissues to be
moist and red, so a healthy, well-healed stoma
appears red and moist.
33. Answer A. A colostomy in the sigmoid colon
produces a solid, formed stool.
34. Answer D. High-fiber foods stimulate
peristalsis, and a result, flatus. Yogurt reduces
gas formation.
35. Answer B. A proper fit protects the skin, but
doesn’t impair circulation. A 1/16” should be
cut.
36. Answer B. Observation, auscultation,
percussion, palpation
37. Answer 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.
38. Answer 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.
39. Answer B. To avoid overloading the small
intestine, encourage the patient to eat six small,
regularly spaced meals.
40. Answer 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.
41. Answer 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.
42. Answer 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.
43. Answer 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.
44. Answer A. A full bladder can interfere with
paracentesis and be punctured inadvertently.
45. Answer 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.
46. Answer 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.
47. Answer A. You may administer the laxative
lactulose to reduce ammonia levels in the colon.
48. Answer 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.
49. Answer C. Eating in the upright position aids in
emptying the esophagus. Doing the opposite of
the other three also may be helpful.
50. Answer C. Pancreatitis involves activation of
pancreatic enzymes, such as amylase and lipase.
These levels are elevated in a patient with acute
pancreatitis.
51. Answer 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.
52. Answer C. Teach the pt to avoid activities that
increase intra-abdominal pressure such as
coughing, sneezing, or straining with a bowel
movement.
53. Answer C. Because obesity weakens the
abdominal muscles, advise weight loss for the
patient who has had a hernia repair.
54. Answer 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.
55. Answer A. Signs and Symptoms of
pneumothorax include dyspnea and decreased
or absent breath sounds over the affected lung
(right lung).
56. Answer A. An NG tube is inserted into the
patients stomach to drain fluid and gas.
57. Answer A. Aspirating the stomach contents
confirms correct placement. If an X-ray is
ordered, it should be done immediately, not in
24 hours.
58. Answer 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.
59. Answer A. Type A causes changes in parietal
cells.
60. Answer B. Increasing fluids helps empty the
stomach. A high carb diet isn’t restricted and fat
intake shouldn’t be increased.
61. Answer A. Diarrhea d/t an acute episode of
ulcerative colitis leads to fluid & electrolyte
losses so fluid replacement takes priority.
62. Answer D. Sigmoidoscopy allows direct
observation of the colon mucosa for changes,
and if needed, biopsy.
63. Answer C. She needs a high-fiber diet and a
psyllium (bulk laxative) to promote normal soft
stools.
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64. Answer B. Stools from ulcerative colitis are
often bloody and contain mucus.
65. Answer D. One sign of acute diverticulitis is
crampy lower left quadrant pain. A low-grade
fever is another common sign.
66. Answer C. With acute pancreatitis, you need to
rest the GI tract by TPN as nutritional support.
67. Answer A. The gallbladder is located in the
RUQ and a frequent sign of gallstones is pain
radiating to the shoulder.
68. Answer D. A Jackson-Pratt drain promotes
wound healing by allowing fluid to escape from
the wound.
69. Answer 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.
70. Answer A. Only a small amount of skin should
be exposed and more than 1/16” of skin allows
the excretement to irritate the skin.
71. Answer B. Measuring abdominal girth provides
quantitative information about increases or
decreases in the amount of distention.
72. Answer 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.
73. Answer B. The first step in assessing the
abdomen is to observe its shape and contour,
then auscultate, palpate, and then percuss.
74. Answer B. Lowering the height decreases the
amount of flow, allowing him to tolerate more
fluid.
75. Answer 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.
76. Answer B. Glucose level increases and diabetes
mellitus may result d/t the pancreatic damage to
the islets of langerhans.
77. Answer D. After surgery, she remains NPO
until peristaltic activity returns. This decreases
the risk for abdominal distention and
obstruction.
78. Answer D. A brownish-black color indicates
lack of blood flow, and maybe necrosis.
79. Answer A. Restricting fluids decrease the
amount of body fluid and the accumulation of
fluid in the peritoneal space.
80. Answer D. Dark green, leafy vegetables are rich
in calcium.
81. Answer A. For pruritus, care should include
tepid sponge baths and use of emollient creams
and lotions.
82. Answer D. Rest periods and small frequent
meals is indicated during the acute phase of
hepatitis B.
83. Answer D. 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.
84. Answer A. To prevent venous stasis and
improve muscle tone, circulation, and
respiratory function, encourage her to move
after surgery.
85. Answer A. Telling her not to worry minimizes
her feelings.
86. Answer A. Diazepam is absorbed by the plastic
I.V. tubing and should be given in the port
closest to the vein.
87. Answer 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.
88. Answer D. To wash away tissue debris and
drainage effectively, irrigate the wound until
the solution becomes clear or all the solution is
used.
89. Answer A. Ammonia levels increase d/t
improper shunting of blood, causing ammonia
to enter systemic circulation, which carries it to
the brain.
90. Answer 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.
91. Answer B. Crohn’s disease penetrates the
mucosa of the colon through all layers and
destroys the colon in patches, which creates a
cobblestone appearance.
92. Answer 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.
93. Answer 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.
94. Answer 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.
95. Answer 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.
96. Answer A. Initially, you should assess the
patient’s knowledge about colostomies and how
it will affect his lifestyle.
97. Answer 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.
98. Answer C. Medications to control inflammation
such as corticosteroids are used for long-term
treatment.
99. Answer 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.
100. Answer 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.
Endocrine
1. Which of the following hormones causes increased
atrial pressure and decreases sodium reabsorption in
the kidneys?
A. Atrial natriuretic peptide
B. PTH
C. Aldosterone
D. Vasopressin
2. Angiotensin I is changed by which of the following
into Angiotensin II?
Reviwer

A. ACE A. Stimulate bone development and growth

B. AVT B. Create beta-adrenergic responses
C. Pepsin C. Cause brain development
D. Adenosine D. Decrease calcium re-absorption
3. Which of the following is not a cause of peripheral 14. Hypercalemia has not been linked with which of
edema? the following?

A. Increased capillary permeability A. Paget’s disease

B. Reduced levels of plasma proteins B. Aldosterone
C. Heart failure C. Sarcoidosis
D. Decreased capillary output D. Malignancy
4. Which of the following during an 15. Which of the following does not require the pre-
electrocardiogram is associated with hypokalemia? cursor progesterone?

A. QRS complex A. Cortisol

B. U wave B. Testosterone
C. PR segment C. ACTH
D. ST segment D. Aldosterone
5. Which of the following is not generally associated 16. Which of the following is the source cell for the
with a 2nd degree (Mobitz Type 1) AV block? secretion Pepsinogen?

A. Usually asymptomatic A. Chief cell

B. Nonsequential (P wave then QRS complex) B. Plasma cell
C. Increased PR segment/interval C. G cell
D. 70% Fatal D. Parietal cell
6. An S3 heart sound is often associated with? 17. Which of the following is the primary activator of
zymogen secretion?
A. CHF
B. COPD A. Somatostatin
C. Atrial fib. B. Secretin
D. Ventricular fib. C. Acetylcholine
7. Mean arterial pressure is the product of: D. Gastrin
18. Which of the following is not a function of
A. TPR x SV Angiotensin II?
B. TPR x CO
C. CO/SV A. Causes release of aldosterone
D. SV/EDV B. Causes vasodilation
8. During phase 3 of the myocardial action potential C. Causes increased posterior pituitary activation
which ion is moving the most? D. Elevates blood pressure
19. Which of the following is not a function of
A. K+ Progesterone?
B. Ca+
C. Na+ A. Causes increased body temperature.
D. Ca2+ B. Causes some smooth muscle relaxation.
9. An ejection fraction can be calculated as: C. Causes increased spiral artery growth
D. Causes activation of FSH
A. SV/TPR 20. Which of the following is not a function of
B. CO/TPR Estrogen?
C. SV/EDV
D. CO/EDV A. Causes breast growth.
10. Which of the following is not a bradykinin effect? B. Causes inhibition of FSH
C. Increased follicle development
A. Elevated capillary permeability D. Decreased overall transport proteins
B. Elevated pain levels
C. Elevated vasodilation response
Answers
D. Elevated prothrombin secretion
11. PAH is secreted in which of the following 1. A. Atrial natriuretic peptide
locations? 2. A. ACE
3. D. Decreased capillary output
A. Distal tubule 4. B. U wave
B. Loop of Henle 5. D. 70% Fatal
C. Collecting tubule 6. A. CHF
D. Proximal tubule 7. B. TPR x CO
12. Which of the following is not an anterior pituitary 8. A. K+
gland secretion? 9. C. SV/EDV
10. D. Elevated prothrombin secretion
A. TSH 11. D. Proximal tubule
B. GH 12. C. Vasopressin
C. Vasopressin 13. D. Decrease calcium re-absorption
D. Prolactin 14. B. Aldosterone
13. Thyroid Hormone T3 does not have which of the 15. C. ACTH
following functions? 16. A. Chief cell
Reviwer

17. C. Acetylcholine 7. A female client with Cushing’s syndrome is

18. B. Causes vasodilation admitted to the medical-surgical unit. During the
19. D. Causes activation of FSH admission assessment, nurse Tyzz notes that the
20. D. Decreased overall transport proteins client is agitated and irritable, has poor memory,
reports loss of appetite, and appears disheveled.
These findings are consistent with which problem?
1. Nurse Ronn is assessing a client with possible
Cushing’s syndrome. In a client with Cushing’s A. Depression
syndrome, the nurse would expect to find: B. Neuropathy
C. Hypoglycemia
A. Hypotension. D. Hyperthyroidism
B. Thick, coarse skin. 8. Nurse Ruth is assessing a client after a
C. Deposits of adipose tissue in the trunk and thyroidectomy. The assessment reveals muscle
dorsocervical area. twitching and tingling, along with numbness in the
D. Weight gain in arms and legs. fingers, toes, and mouth area. The nurse should
2. A male client with primary diabetes insipidus is suspect which complication?
ready for discharge on desmopressin (DDAVP).
Which instruction should nurse Lina provide? A. Tetany
B. Hemorrhage
A. “Administer desmopressin while the suspension C. Thyroid storm
is cold.” D. Laryngeal nerve damage
B. “Your condition isn’t chronic, so you won’t 9. After undergoing a subtotal thyroidectomy, a
need to wear a medical identification bracelet.” female client develops hypothyroidism. Dr. Smith
C. “You may not be able to use desmopressin prescribes levothyroxine (Levothroid), 25 mcg P.O.
nasally if you have nasal discharge or daily. For which condition is levothyroxine the
blockage.” preferred agent?
D. “You won’t need to monitor your fluid intake
and output after you start taking desmopressin.” A. Primary hypothyroidism
3. Nurse Frank is aware that a positive Chvostek’s B. Graves’ disease
sign indicate? C. Thyrotoxicosis
D. Euthyroidism
A. Hypocalcemia 10. Which of these signs suggests that a male client
B. Hyponatremia with the syndrome of inappropriate antidiuretic
C. Hypokalemia hormone (SIADH) secretion is experiencing
D. Hypermagnesemia complications?
4. In a 29-year-old female client who is being
successfully treated for Cushing’s syndrome, nurse A. Tetanic contractions
Lyzette would expect a decline in: B. Neck vein distention
C. Weight loss
A. Serum glucose level. D. Polyuria
B. Hair loss. 11. A female client with a history of
C. Bone mineralization. pheochromocytoma is admitted to the hospital in an
D. Menstrual flow. acute hypertensive crisis. To reverse hypertensive
5. A male client has recently undergone surgical crisis caused by pheochromocytoma, nurse Lyka
removal of a pituitary tumor. Dr. Wong prescribes expects to administer:
corticotropin (Acthar), 20 units I.M. q.i.d. as a
replacement therapy. What is the mechanism of A. phentolamine (Regitine).
action of corticotropin? B. methyldopa (Aldomet).
C. mannitol (Osmitrol).
A. It decreases cyclic adenosine monophosphate D. felodipine (Plendil).
(cAMP) production and affects the metabolic 12. A male client with a history of hypertension is
rate of target organs. diagnosed with primary hyperaldosteronism. This
B. It interacts with plasma membrane receptors to diagnosis indicates that the client’s hypertension is
inhibit enzymatic actions. caused by excessive hormone secretion from which
C. It interacts with plasma membrane receptors to of the following glands?
produce enzymatic actions that affect protein,
fat, and carbohydrate metabolism. A. Adrenal cortex
D. It regulates the threshold for water resorption in B. Pancreas
the kidneys. C. Adrenal medulla
6. Capillary glucose monitoring is being performed D. Parathyroid
every 4 hours for a female client diagnosed with 13. Nurse Troy is aware that the most appropriate for
diabetic ketoacidosis. Insulin is administered using a a client with Addison’s disease?
scale of regular insulin according to glucose results.
At 2 p.m., the client has a capillary glucose level of
A. Risk for infection
250 mg/dl for which he receives 8 U of regular
B. Excessive fluid volume
insulin. Nurse Vince should expect the dose’s:
C. Urinary retention
D. Hypothermia
A. Onset to be at 2 p.m. and its peak to be at 3 p.m. 14. Acarbose (Precose), an alpha-glucosidase
B. Onset to be at 2:15 p.m. and its peak to be at 3 inhibitor, is prescribed for a female client with type 2
p.m. diabetes mellitus. During discharge planning, nurse
C. Onset to be at 2:30 p.m. and its peak to be at 4 Pauleen would be aware of the client’s need for
p.m. additional teaching when the client states:
D. Onset to be at 4 p.m. and its peak to be at 6 p.m.
Reviwer
A. “If I have hypoglycemia, I should eat some
sugar, not dextrose.”
B. “The drug makes my pancreas release more
insulin.”
C. “I should never take insulin while I’m taking
this drug.”
D. “It’s best if I take the drug with the first bite of
a meal.”
15. A female client whose physical findings suggest a
hyperpituitary condition undergoes an extensive
diagnostic workup. Test results reveal a pituitary
tumor, which necessitates a transphenoidal
hypophysectomy. The evening before the surgery,
nurse Jacob reviews preoperative and postoperative
instructions given to the client earlier. Which
postoperative instruction should the nurse
emphasize?
A. “You must lie flat for 24 hours after surgery.”
B. “You must avoid coughing, sneezing, and
blowing your nose.”
C. “You must restrict your fluid intake.”
D. “You must report ringing in your ears
immediately.”
16. Dr. Kennedy prescribes glipizide (Glucotrol), an
oral antidiabetic agent, for a male client with type 2
diabetes mellitus who has been having trouble
controlling the blood glucose level through diet and
exercise. Which medication instruction should the
nurse provide?
A. “Be sure to take glipizide 30 minutes before
meals.”
B. “Glipizide may cause a low serum sodium
level, so make sure you have your sodium level
checked monthly.”
C. “You won’t need to check your blood glucose
level after you start taking glipizide.”
D. “Take glipizide after a meal to prevent
heartburn.”
17. For a diabetic male client with a foot ulcer, the
physician orders bed rest, a wet-to-dry dressing
change every shift, and blood glucose monitoring
before meals and bedtime. Why are wet-to-dry
dressings used for this client?
A. They contain exudate and provide a moist
wound environment.
B. They protect the wound from mechanical
trauma and promote healing.
C. They debride the wound and promote healing
by secondary intention.
D. They prevent the entrance of microorganisms
and minimize wound discomfort.
18. When instructing the female client diagnosed
with hyperparathyroidism about diet, nurse Gina
should stress the importance of which of the
following?
A. Restricting fluids
B. Restricting sodium
C. Forcing fluids
D. Restricting potassium
19. Which nursing diagnosis takes highest priority for
a female client with hyperthyroidism?
A. Risk for imbalanced nutrition: More than body
requirements related to thyroid hormone excess
B. Risk for impaired skin integrity related to
edema, skin fragility, and poor wound healing
C. Body image disturbance related to weight gain
and edema
D. Imbalanced nutrition: Less than body
requirements related to thyroid hormone excess
20. A male client with a tentative diagnosis of
hyperosmolar hyperglycemic nonketotic syndrome
(HHNS) has a history of type 2 diabetes that is being
controlled with an oral diabetic agent, tolazamide
(Tolinase). Which of the following is the most
important laboratory test for confirming this
disorder?
A. Serum potassium level
B. Serum sodium level
C. Arterial blood gas (ABG) values
D. Serum osmolarity
21. A male client has just been diagnosed with type 1
diabetes mellitus. When teaching the client and
family how diet and exercise affect insulin
requirements, Nurse Joy should include which
guideline?
A. “You’ll need more insulin when you exercise or
increase your food intake.”
B. “You’ll need less insulin when you exercise or
reduce your food intake.”
C. “You’ll need less insulin when you increase
your food intake.”
D. “You’ll need more insulin when you exercise or
decrease your food intake.”
22. Nurse Noemi administers glucagon to her diabetic
client, then monitors the client for adverse drug
reactions and interactions. Which type of drug
interacts adversely with glucagon?
A. Oral anticoagulants
B. Anabolic steroids
C. Beta-adrenergic blockers
D. Thiazide diuretics
23. Which instruction about insulin administration
should nurse Kate give to a client?
A. “Always follow the same order when drawing
the different insulins into the syringe.”
B. “Shake the vials before withdrawing the
insulin.”
C. “Store unopened vials of insulin in the freezer
at temperatures well below freezing.”
D. “Discard the intermediate-acting insulin if it
appears cloudy.”
24. Nurse Perry is caring for a female client with type
1 diabetes mellitus who exhibits confusion, light-
headedness, and aberrant behavior. The client is still
conscious. The nurse should first administer:
A. I.M. or subcutaneous glucagon.
B. I.V. bolus of dextrose 50%.
C. 15 to 20 g of a fast-acting carbohydrate such as
orange juice.
D. 10 U of fast-acting insulin.
25. For the first 72 hours after thyroidectomy surgery,
nurse Jamie would assess the female client for
Chvostek’s sign and Trousseau’s sign because they
indicate which of the following?
A. Hypocalcemia
B. Hypercalcemia
C. Hypokalemia
D. Hyperkalemia
Answers and Rationales
1. Answer C. Because of changes in fat
distribution, adipose tissue accumulates in the
trunk, face (moonface), and dorsocervical areas
(buffalo hump). Hypertension is caused by fluid
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retention. Skin becomes thin and bruises easily
because of a loss of collagen. Muscle wasting
causes muscle atrophy and thin extremities.
2. Answer C. Desmopressin may not be absorbed
if the intranasal route is compromised.
Although diabetes insipidus is treatable, the
client should wear medical identification and
carry medication at all times to alert medical
personnel in an emergency and ensure proper
treatment. The client must continue to monitor
fluid intake and output and receive adequate
fluid replacement.
3. Answer A. Chvostek’s sign is elicited by
tapping the client’s face lightly over the facial
nerve, just below the temple. If the client’s
facial muscles twitch, it indicates
hypocalcemia. Hyponatremia is indicated by
weight loss, abdominal cramping, muscle
weakness, headache, and postural hypotension.
Hypokalemia causes paralytic ileus and muscle
weakness. Clients with hypermagnesemia
exhibit a loss of deep tendon reflexes, coma, or
cardiac arrest.
4. Answer A. Hyperglycemia, which develops
from glucocorticoid excess, is a manifestation
of Cushing’s syndrome. With successful
treatment of the disorder, serum glucose levels
decline. Hirsutism is common in Cushing’s
syndrome; therefore, with successful treatment,
abnormal hair growth also declines.
Osteoporosis occurs in Cushing’s syndrome;
therefore, with successful treatment, bone
mineralization increases. Amenorrhea develops
in Cushing’s syndrome. With successful
treatment, the client experiences a return of
menstrual flow, not a decline in it.
5. Answer C. Corticotropin interacts with plasma
membrane receptors to produce enzymatic
actions that affect protein, fat, and carbohydrate
metabolism. It doesn’t decrease cAMP
production. The posterior pituitary hormone,
antidiuretic hormone, regulates the threshold for
water resorption in the kidneys.
6. Answer C. Regular insulin, which is a short-
acting insulin, has an onset of 15 to 30 minutes
and a peak of 2 to 4 hours. Because the nurse
gave the insulin at 2 p.m., the expected onset
would be from 2:15 p.m. to 2:30 p.m. and the
peak from 4 p.m. to 6 p.m.
7. Answer A. Agitation, irritability, poor memory,
loss of appetite, and neglect of one’s
appearance may signal depression, which is
common in clients with Cushing’s syndrome.
Neuropathy affects clients with diabetes
mellitus — not Cushing’s syndrome. Although
hypoglycemia can cause irritability, it also
produces increased appetite, rather than loss of
appetite. Hyperthyroidism typically causes such
signs as goiter, nervousness, heat intolerance,
and weight loss despite increased appetite.
8. Answer A. Tetany may result if the parathyroid
glands are excised or damaged during thyroid
surgery. Hemorrhage is a potential complication
after thyroid surgery but is characterized by
tachycardia, hypotension, frequent swallowing,
feelings of fullness at the incision site, choking,
and bleeding. Thyroid storm is another term for
severe hyperthyroidism — not a complication
of thyroidectomy. Laryngeal nerve damage may
occur postoperatively, but its signs include a
hoarse voice and, possibly, acute airway
obstruction.
9. Answer A. Levothyroxine is the preferred agent
to treat primary hypothyroidism and cretinism,
although it also may be used to treat secondary
hypothyroidism. It is contraindicated in Graves’
disease and thyrotoxicosis because these
conditions are forms of hyperthyroidism.
Euthyroidism, a term used to describe normal
thyroid function, wouldn’t require any thyroid
preparation.
10. Answer B. SIADH secretion causes
antidiuretic hormone overproduction, which
leads to fluid retention. Severe SIADH can
cause such complications as vascular fluid
overload, signaled by neck vein distention. This
syndrome isn’t associated with tetanic
contractions. It may cause weight gain and fluid
retention (secondary to oliguria).
11. Answer A. Pheochromocytoma causes
excessive production of epinephrine and
norepinephrine, natural catecholamines that
raise the blood pressure. Phentolamine, an
alpha-adrenergic blocking agent given by I.V.
bolus or drip, antagonizes the body’s response
to circulating epinephrine and norepinephrine,
reducing blood pressure quickly and effectively.
Although methyldopa is an antihypertensive
agent available in parenteral form, it isn’t
effective in treating hypertensive emergencies.
Mannitol, a diuretic, isn’t used to treat
hypertensive emergencies. Felodipine, an
antihypertensive agent, is available only in
extended-release tablets and therefore doesn’t
reduce blood pressure quickly enough to correct
hypertensive crisis.
12. Answer A. Excessive secretion of aldosterone
in the adrenal cortex is responsible for the
client’s hypertension. This hormone acts on the
renal tubule, where it promotes reabsorption of
sodium and excretion of potassium and
hydrogen ions. The pancreas mainly secretes
hormones involved in fuel metabolism. The
adrenal medulla secretes the catecholamines —
epinephrine and norepinephrine. The
parathyroids secrete parathyroid hormone.
13. Answer A. Addison’s disease decreases the
production of all adrenal hormones,
compromising the body’s normal stress
response and increasing the risk of infection.
Other appropriate nursing diagnoses for a client
with Addison’s disease include Deficient fluid
volume and Hyperthermia. Urinary retention
isn’t appropriate because Addison’s disease
causes polyuria.
14. Answer A. Acarbose delays glucose absorption,
so the client should take an oral form of
dextrose rather than a product containing table
sugar when treating hypoglycemia. The alpha-
glucosidase inhibitors work by delaying the
carbohydrate digestion and glucose absorption.
It’s safe to be on a regimen that includes insulin
and an alpha-glucosidase inhibitor. The client
should take the drug at the start of a meal, not
30 minutes to an hour before.
15. Answer B. After a transsphenoidal
hypophysectomy, the client must refrain from
coughing, sneezing, and blowing the nose for
several days to avoid disturbing the surgical
graft used to close the wound. The head of the
bed must be elevated, not kept flat, to prevent
tension or pressure on the suture line. Within 24
hours after a hypophysectomy, transient
diabetes insipidus commonly occurs; this calls
for increased, not restricted, fluid intake.
Visual, not auditory, changes are a potential
complication of hypophysectomy.
16. Answer A. The client should take glipizide
twice a day, 30 minutes before a meal, because
food decreases its absorption. The drug doesn’t
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cause hyponatremia and therefore doesn’t
necessitate monthly serum sodium
measurement. The client must continue to
monitor the blood glucose level during glipizide
therapy.
17. Answer C. For this client, wet-to-dry dressings
are most appropriate because they clean the foot
ulcer by debriding exudate and necrotic tissue,
thus promoting healing by secondary intention.
Moist, transparent dressings contain exudate
and provide a moist wound environment.
Hydrocolloid dressings prevent the entrance of
microorganisms and minimize wound
discomfort. Dry sterile dressings protect the
wound from mechanical trauma and promote
healing.
18. Answer C. The client should be encouraged to
force fluids to prevent renal calculi formation.
Sodium should be encouraged to replace losses
in urine. Restricting potassium isn’t necessary
in hyperparathyroidism.
19. Answer D. In the client with hyperthyroidism,
excessive thyroid hormone production leads to
hypermetabolism and increased nutrient
metabolism. These conditions may result in a
negative nitrogen balance, increased protein
synthesis and breakdown, decreased glucose
tolerance, and fat mobilization and depletion.
This puts the client at risk for marked nutrient
and calorie deficiency, making Imbalanced
nutrition: Less than body requirements the most
important nursing diagnosis. Options B and C
may be appropriate for a client with
hypothyroidism, which slows the metabolic
rate.
20. Answer D. Serum osmolarity is the most
important test for confirming HHNS; it’s also
used to guide treatment strategies and determine
evaluation criteria. A client with HHNS
typically has a serum osmolarity of more than
350 mOsm/L. Serum potassium, serum sodium,
and ABG values are also measured, but they
aren’t as important as serum osmolarity for
confirming a diagnosis of HHNS. A client with
HHNS typically has hypernatremia and osmotic
diuresis. ABG values reveal acidosis, and the
potassium level is variable.
21. Answer B. Exercise, reduced food intake,
hypothyroidism, and certain medications
decrease the insulin requirements. Growth,
pregnancy, greater food intake, stress, surgery,
infection, illness, increased insulin antibodies,
and certain medications increase the insulin
requirements.
22. Answer A. As a normal body protein, glucagon
only interacts adversely with oral
anticoagulants, increasing the anticoagulant
effects. It doesn’t interact adversely with
anabolic steroids, beta-adrenergic blockers, or
thiazide diuretics.
23. Answer A. The client should be instructed
always to follow the same order when drawing
the different insulins into the syringe. Insulin
should never be shaken because the resulting
froth prevents withdrawal of an accurate dose
and may damage the insulin protein molecules.
Insulin also should never be frozen because the
insulin protein molecules may be damaged.
Intermediate-acting insulin is normally cloudy.
24. Answer C. This client is having a hypoglycemic
episode. Because the client is conscious, the
nurse should first administer a fast-acting
carbohydrate, such as orange juice, hard candy,
or honey. If the client has lost consciousness,
the nurse should administer either I.M. or
subcutaneous glucagon or an I.V. bolus of
dextrose 50%. The nurse shouldn’t administer
insulin to a client who’s hypoglycemic; this
action will further compromise the client’s
condition.
25. Answer A. The client who has undergone a
thyroidectomy is at risk for developing
hypocalcemia from inadvertent removal or
damage to the parathyroid gland. The client
with hypocalcemia will exhibit a positive
Chvostek’s sign (facial muscle contraction
when the facial nerve in front of the ear is
tapped) and a positive Trousseau’s sign (carpal
spasm when a blood pressure cuff is inflated for
a few minutes). These signs aren’t present with
hypercalcemia, hypokalemia, or hyperkalemia
1. An agitated, confused female client arrives in the
emergency department. Her history includes type 1
diabetes mellitus, hypertension, and angina pectoris.
Assessment reveals pallor, diaphoresis, headache, and
intense hunger. A stat blood glucose sample measures
42 mg/dl, and the client is treated for an acute
hypoglycemic reaction. After recovery, nurse Lily
teaches the client to treat hypoglycemia by ingesting:
A. 2 to 5 g of a simple carbohydrate.
B. 10 to 15 g of a simple carbohydrate.
C. 18 to 20 g of a simple carbohydrate.
D. 25 to 30 g of a simple carbohydrate.
2. A female adult client with a history of chronic
hyperparathyroidism admits to being noncompliant.
Based on initial assessment findings, nurse Julia
formulates the nursing diagnosis of Risk for injury.
To complete the nursing diagnosis statement for this
client, which “related-to” phrase should the nurse
add?
A. Related to bone demineralization resulting in
pathologic fractures
B. Related to exhaustion secondary to an
accelerated metabolic rate
C. Related to edema and dry skin secondary to
fluid infiltration into the interstitial spaces
D. Related to tetany secondary to a decreased
serum calcium level
3. Nurse John is assigned to care for a postoperative
male client who has diabetes mellitus. During the
assessment interview, the client reports that he’s
impotent and says he’s concerned about its effect on
his marriage. In planning this client’s care, the most
appropriate intervention would be to:
A. Encourage the client to ask questions about
personal sexuality.
B. Provide time for privacy.
C. Provide support for the spouse or significant
other.
D. Suggest referral to a sex counselor or other
appropriate professional.
4. During a class on exercise for diabetic clients, a
female client asks the nurse educator how often to
exercise. The nurse educator advises the clients to
exercise how often to meet the goals of planned
exercise?
A. At least once a week
B. At least three times a week
C. At least five times a week
D. Every day
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5. Nurse Oliver should expect a client with
hypothyroidism to report which health concerns?
A. Increased appetite and weight loss
B. Puffiness of the face and hands
C. Nervousness and tremors
D. Thyroid gland swelling
6. A female client with hypothyroidism (myxedema)
is receiving levothyroxine (Synthroid), 25 mcg P.O.
daily. Which finding should nurse Hans recognize as
an adverse drug effect?
A. Dysuria
B. Leg cramps
C. Tachycardia
D. Blurred vision
7. A 67-year-old male client has been complaining of
sleeping more, increased urination, anorexia,
weakness, irritability, depression, and bone pain that
interferes with her going outdoors. Based on these
assessment findings, nurse Richard would suspect
which of the following disorders?
A. Diabetes mellitus
B. Diabetes insipidus
C. Hypoparathyroidism
D. Hyperparathyroidism
8. When caring for a male client with diabetes
insipidus, nurse Juliet expects to administer:
A. vasopressin (Pitressin Synthetic).
B. furosemide (Lasix).
C. regular insulin.
D. 10% dextrose.
9. The nurse is aware that the following is the most
common cause of hyperaldosteronism?
A. Excessive sodium intake
B. A pituitary adenoma
C. Deficient potassium intake
D. An adrenal adenoma
10. A male client with type 1 diabetes mellitus has a
highly elevated glycosylated hemoglobin (Hb) test
result. In discussing the result with the client, nurse
Sharmaine would be most accurate in stating:
A. “The test needs to be repeated following a 12-
hour fast.”
B. “It looks like you aren’t following the
prescribed diabetic diet.”
C. “It tells us about your sugar control for the last
3 months.”
D. “Your insulin regimen needs to be altered
significantly.”
11. Following a unilateral adrenalectomy, nurse Betty
would assess for hyperkalemia shown by which of
the following?
A. Muscle weakness
B. Tremors
C. Diaphoresis
D. Constipation
12. Nurse Louie is developing a teaching plan for a
male client diagnosed with diabetes insipidus. The
nurse should include information about which
hormone lacking in clients with diabetes insipidus?
A. antidiuretic hormone (ADH).
B. thyroid-stimulating hormone (TSH).
C. follicle-stimulating hormone (FSH).
D. luteinizing hormone (LH).
13. Early this morning, a female client had a subtotal
thyroidectomy. During evening rounds, nurse Tina
assesses the client, who now has nausea, a
temperature of 105° F (40.5° C), tachycardia, and
extreme restlessness. What is the most likely cause of
these signs?
A. Diabetic ketoacidosis
B. Thyroid crisis
C. Hypoglycemia
D. Tetany
14. For a male client with hyperglycemia, which
assessment finding best supports a nursing diagnosis
of Deficient fluid volume?
A. Cool, clammy skin
B. Distended neck veins
C. Increased urine osmolarity
D. Decreased serum sodium level
15. When assessing a male client with
pheochromocytoma, a tumor of the adrenal medulla
that secretes excessive catecholamine, nurse April is
most likely to detect:
A. a blood pressure of 130/70 mm Hg.
B. a blood glucose level of 130 mg/dl.
C. bradycardia.
D. a blood pressure of 176/88 mm Hg.
16. A male client is admitted for treatment of the
syndrome of inappropriate antidiuretic hormone
(SIADH). Which nursing intervention is appropriate?
A. Infusing I.V. fluids rapidly as ordered
B. Encouraging increased oral intake
C. Restricting fluids
D. Administering glucose-containing I.V. fluids as
ordered
17. A female client has a serum calcium level of 7.2
mg/dl. During the physical examination, nurse Noah
expects to assess:
A. Trousseau’s sign.
B. Homans’ sign.
C. Hegar’s sign.
D. Goodell’s sign.
18. Which outcome indicates that treatment of a male
client with diabetes insipidus has been effective?
A. Fluid intake is less than 2,500 ml/day.
B. Urine output measures more than 200 ml/hour.
C. Blood pressure is 90/50 mm Hg.
D. The heart rate is 126 beats/minute.
19. Jemma, who weighs 210 lb (95 kg) and has been
diagnosed with hyperglycemia tells the nurse that her
husband sleeps in another room because her snoring
keeps him awake. The nurse notices that she has large
hands and a hoarse voice. Which of the following
would the nurse suspect as a possible cause of the
client’s hyperglycemia?
A. Acromegaly
B. Type 1 diabetes mellitus
C. Hypothyroidism
D. Deficient growth hormone
20. Nurse Kate is providing dietary instructions to a
male client with hypoglycemia. To control
hypoglycemic episodes, the nurse should
recommend:
A. Increasing saturated fat intake and fasting in
the afternoon.
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B. Increasing intake of vitamins B and D and
taking iron supplements.
C. Eating a candy bar if light-headedness occurs.
D. Consuming a low-carbohydrate, high-protein
diet and avoiding fasting.
21. An incoherent female client with a history of
hypothyroidism is brought to the emergency
department by the rescue squad. Physical and
laboratory findings reveal hypothermia,
hypoventilation, respiratory acidosis, bradycardia,
hypotension, and nonpitting edema of the face and
pretibial area. Knowing that these findings suggest
severe hypothyroidism, nurse Libby prepares to take
emergency action to prevent the potential
complication of:
A. Thyroid storm.
B. Cretinism.
C. myxedema coma.
D. Hashimoto’s thyroiditis.
22. A male client with type 1 diabetes mellitus asks
the nurse about taking an oral antidiabetic agent.
Nurse Jack explains that these medications are only
effective if the client:
A. prefers to take insulin orally.
B. has type 2 diabetes.
C. has type 1 diabetes.
D. is pregnant and has type 2 diabetes.
23. When caring for a female client with a history of
hypoglycemia, nurse Ruby should avoid
administering a drug that may potentiate
hypoglycemia. Which drug fits this description?
A. sulfisoxazole (Gantrisin)
B. mexiletine (Mexitil)
C. prednisone (Orasone)
D. lithium carbonate (Lithobid)
24. After taking glipizide (Glucotrol) for 9 months, a
male client experiences secondary failure. Which of
the following would the nurse expect the physician to
do?
A. Initiate insulin therapy.
B. Switch the client to a different oral antidiabetic
agent.
C. Prescribe an additional oral antidiabetic agent.
D. Restrict carbohydrate intake to less than 30% of
the total caloric intake.
25. During preoperative teaching for a female client
who will undergo subtotal thyroidectomy, the nurse
should include which statement?
A. “The head of your bed must remain flat for 24
hours after surgery.”
B. “You should avoid deep breathing and
coughing after surgery.”
C. “You won’t be able to swallow for the first day
or two.”
D. “You must avoid hyperextending your neck
after surgery.”
Answers and Rationales
1. Answer B. To reverse hypoglycemia, the
American Diabetes Association recommends
ingesting 10 to 15 g of a simple carbohydrate,
such as three to five pieces of hard candy, two
to three packets of sugar (4 to 6 tsp), or 4 oz of
fruit juice. If necessary, this treatment can be
repeated in 15 minutes. Ingesting only 2 to 5 g
of a simple carbohydrate may not raise the
blood glucose level sufficiently. Ingesting more
than 15 g may raise it above normal, causing
hyperglycemia.
2. Answer A. Poorly controlled
hyperparathyroidism may cause an elevated
serum calcium level. This, in turn, may
diminish calcium stores in the bone, causing
bone demineralization and setting the stage for
pathologic fractures and a risk for injury.
Hyperparathyroidism doesn’t accelerate the
metabolic rate. A decreased thyroid hormone
level, not an increased parathyroid hormone
level, may cause edema and dry skin secondary
to fluid infiltration into the interstitial spaces.
Hyperparathyroidism causes hypercalcemia, not
hypocalcemia; therefore, it isn’t associated with
tetany.
3. Answer D. The nurse should refer this client to
a sex counselor or other professional. Making
appropriate referrals is a valid part of planning
the client’s care. The nurse doesn’t normally
provide sex counseling.
4. Answer B. Diabetic clients must exercise at
least three times a week to meet the goals of
planned exercise — lowering the blood glucose
level, reducing or maintaining the proper
weight, increasing the serum high-density
lipoprotein level, decreasing serum triglyceride
levels, reducing blood pressure, and minimizing
stress. Exercising once a week wouldn’t
achieve these goals. Exercising more than three
times a week, although beneficial, would
exceed the minimum requirement.
5. Answer B. Hypothyroidism (myxedema) causes
facial puffiness, extremity edema, and weight
gain. Signs and symptoms of hyperthyroidism
(Graves’ disease) include an increased appetite,
weight loss, nervousness, tremors, and thyroid
gland enlargement (goiter).
6. Answer C. Levothyroxine, a synthetic thyroid
hormone, is given to a client with
hypothyroidism to simulate the effects of
thyroxine. Adverse effects of this agent include
tachycardia. The other options aren’t associated
with levothyroxine.
7. Answer D. Hyperparathyroidism is most
common in older women and is characterized
by bone pain and weakness from excess
parathyroid hormone (PTH). Clients also
exhibit hypercaliuria-causing polyuria. While
clients with diabetes mellitus and diabetes
insipidus also have polyuria, they don’t have
bone pain and increased sleeping.
Hypoparathyroidism is characterized by urinary
frequency rather than polyuria.
8. Answer A. Because diabetes insipidus results
from decreased antidiuretic hormone
(vasopressin) production, the nurse should
expect to administer synthetic vasopressin for
hormone replacement therapy. Furosemide, a
diuretic, is contraindicated because a client with
diabetes insipidus experiences polyuria. Insulin
and dextrose are used to treat diabetes mellitus
and its complications, not diabetes insipidus.
9. Answer D. An autonomous aldosterone-
producing adenoma is the most common cause
of hyperaldosteronism. Hyperplasia is the
second most frequent cause. Aldosterone
secretion is independent of sodium and
potassium intake as well as of pituitary
stimulation.
10. Answer C. The glycosylated Hb test provides
an objective measure of glycemic control over a
3-month period. The test helps identify trends
or practices that impair glycemic control, and it
doesn’t require a fasting period before blood is
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drawn. The nurse can’t conclude that the result
occurs from poor dietary management or
inadequate insulin coverage.
11. Answer A. Muscle weakness, bradycardia,
nausea, diarrhea, and paresthesia of the hands,
feet, tongue, and face are findings associated
with hyperkalemia, which is transient and
occurs from transient hypoaldosteronism when
the adenoma is removed. Tremors, diaphoresis,
and constipation aren’t seen in hyperkalemia.
12. Answer A. ADH is the hormone clients with
diabetes insipidus lack. The client’s TSH, FSH,
and LH levels won’t be affected.
13. Answer B. Thyroid crisis usually occurs in the
first 12 hours after thyroidectomy and causes
exaggerated signs of hyperthyroidism, such as
high fever, tachycardia, and extreme
restlessness. Diabetic ketoacidosis is more
likely to produce polyuria, polydipsia, and
polyphagia; hypoglycemia, to produce
weakness, tremors, profuse perspiration, and
hunger. Tetany typically causes uncontrollable
muscle spasms, stridor, cyanosis, and possibly
asphyxia.
14. Answer C. In hyperglycemia, urine osmolarity
(the measurement of dissolved particles in the
urine) increases as glucose particles move into
the urine. The client experiences glucosuria and
polyuria, losing body fluids and experiencing
fluid volume deficit. Cool, clammy skin;
distended neck veins; and a decreased serum
sodium level are signs of fluid volume excess,
the opposite imbalance.
15. Answer D. Pheochromocytoma, a tumor of the
adrenal medulla that secretes excessive
catecholamine, causes hypertension,
tachycardia, hyperglycemia, hypermetabolism,
and weight loss. It isn’t associated with the
other options.
16. Answer C. To reduce water retention in a client
with the SIADH, the nurse should restrict
fluids. Administering fluids by any route would
further increase the client’s already heightened
fluid load.
17. Answer A. This client’s serum calcium level
indicates hypocalcemia, an electrolyte
imbalance that causes Trousseau’s sign
(carpopedal spasm induced by inflating the
blood pressure cuff above systolic pressure).
Homans’ sign (pain on dorsiflexion of the foot)
indicates deep vein thrombosis. Hegar’s sign
(softening of the uterine isthmus) and Goodell’s
sign (cervical softening) are probable signs of
pregnancy.
18. Answer A. Diabetes insipidus is characterized
by polyuria (up to 8 L/day), constant thirst, and
an unusually high oral intake of fluids.
Treatment with the appropriate drug should
decrease both oral fluid intake and urine output.
A urine output of 200 ml/hour indicates
continuing polyuria. A blood pressure of 90/50
mm Hg and a heart rate of 126 beats/minute
indicate compensation for the continued fluid
deficit, suggesting that treatment hasn’t been
effective.
19. Answer A. Acromegaly, which is caused by a
pituitary tumor that releases excessive growth
hormone, is associated with hyperglycemia,
hypertension, diaphoresis, peripheral
neuropathy, and joint pain. Enlarged hands and
feet are related to lateral bone growth, which is
seen in adults with this disorder. The
accompanying soft tissue swelling causes
hoarseness and often sleep apnea. Type 1
diabetes is usually seen in children, and newly
diagnosed persons are usually very ill and thin.
Hypothyroidism isn’t associated with
hyperglycemia, nor is growth hormone
deficiency.
20. Answer D. To control hypoglycemic episodes,
the nurse should instruct the client to consume a
low-carbohydrate, high-protein diet, avoid
fasting, and avoid simple sugars. Increasing
saturated fat intake and increasing vitamin
supplementation wouldn’t help control
hypoglycemia.
21. Answer C. Severe hypothyroidism may result in
myxedema coma, in which a drastic drop in the
metabolic rate causes decreased vital signs,
hypoventilation (possibly leading to respiratory
acidosis), and nonpitting edema. Thyroid storm
is an acute complication of hyperthyroidism.
Cretinism is a form of hypothyroidism that
occurs in infants. Hashimoto’s thyroiditis is a
common chronic inflammatory disease of the
thyroid gland in which autoimmune factors play
a prominent role.
22. Answer B. Oral antidiabetic agents are only
effective in adult clients with type 2 diabetes.
Oral antidiabetic agents aren’t effective in type
1 diabetes. Pregnant and lactating women aren’t
prescribed oral antidiabetic agents because the
effect on the fetus is uncertain.
23. Answer A. Sulfisoxazole and other
sulfonamides are chemically related to oral
antidiabetic agents and may precipitate
hypoglycemia. Mexiletine, an antiarrhythmic, is
used to treat refractory ventricular arrhythmias;
it doesn’t cause hypoglycemia. Prednisone, a
corticosteroid, is associated with
hyperglycemia. Lithium may cause transient
hyperglycemia, not hypoglycemia.
24. Answer B. Many clients (25% to 60%) with
secondary failure respond to a different oral
antidiabetic agent. Therefore, it wouldn’t be
appropriate to initiate insulin therapy at this
time. However, if a new oral antidiabetic agent
is unsuccessful in keeping glucose levels at an
acceptable level, insulin may be used in
addition to the antidiabetic agent.
25. Answer D. To prevent undue pressure on the
surgical incision after subtotal thyroidectomy,
the nurse should advise the client to avoid
hyperextending the neck. The client may
elevate the head of the bed as desired and
should perform deep breathing and coughing to
help prevent pneumonia. Subtotal
thyroidectomy doesn’t affect swallowing.