Gastrointestinal Questions
On the second day
1. An adult who has cholecystitis reports clay colored stools and
moderate jaundice. Which is the best explanation for the presence
of clay colored stools and jaundice?
1. There is an obstruction in the pancreatic duct.
2. There are gallstones in the gallbladder.
3. Bile is no longer produced by the gallbladder.
4. There is an obstruction in the common bile duct.
2. Atropine 0.5 mg is ordered for a client having an acute attack of
cholecystitis. What is the primary purpose of this drug for this
client? To
1. decrease skeletal muscle spasms.
2. increase gastrointestinal peristalsis
3. decrease smooth muscle contractions
4. decrease anxiety
3. Following a cholecystectomy, drainage form the T tube for the
first 24 hours postoperative was 350 cc. Proper nursing action in
response to this should be to
1. notify the physician .
2. raise the level of the drainage bag to decrease rate of flow.
3. increase the IV flow rate to compensate for the loss.
4. continue to observe and measure drainage.
4. An adult male is admitted to the hospital complaining of burning
epigastric pain. He reports to the nurse that he has gained 14
pounds over the last two months. Which nursing response is best?
1. “Why were you eating more?”
2. “Has the weight gain been intentional?”
3. “Does your weight usually fluctuate this much?”
4. “How did your eating habits change?”
5. An adult male client is admitted with a diagnosis of probable
duodenal ulcer. Which of the following laboratory tests would it be
most essential for the nurse to assess immediately?
1. Hemoglobin and Hematocrit
2. SGPT and SGOT
3. Na and K
4. BUN and creatinine
6. An adult client is to have a gastroduodenoscopy in the morning.
The nurse’s instructions should include the information that he will
be
1. given a general anesthetic during the procedure.
2. given a local anesthetic to ease the discomfort during the
procedure.
3. asked to assist by coughing during the procedure.
4. asked to assist by performing a Valsalva maneuver during the
procedure.
7. Which nursing intervention is essential immediately following a
gastroduodenoscopy?
1. Force fluids.
2. Position him supine.
3. Instruct him not to eat or drink.
4. Encourage coughing and deep breathing.
8. Because a client has a nasogastric tube attached to intermittent
drainage the nurse should be particularly alert for the development
of which complication?
1. Hypocalcemia.
2. Hypermagnesemia.
3. Hypokalemia.
4. Hypoglycemia.
9. A barium enema is ordered for an adult male client. The nurse is
teaching him what to expect regarding the procedure. Which
statement should be included in the teaching?
1. Fecal matter must be cleansed from the bowel for good
visualization.
2. There will be no food restrictions before the test.
3. He will not have to change positions during the procedure.
4. He will be asked to drink barium during the procedure.
10. An abdomino-perineal resection with a transverse colostomy is
planned for an adult male client. Neomycin sulfate p.o. is ordered
prior to surgery. The primary purpose for administering this drug is
to reduce
1. electrolyte imbalances.
2. bacterial content in the colon.
3. peristaltic action in the colon.
4. feces in the bowel.
11. In preparation for an abdomino-perineal resection the client is
placed on a low residue diet. Which of the following food lists is
appropriate for him to eat on a low residue diet?
1. Ground lean beef, soft boiled eggs, tea.
2. Lettuce, spinach, corn.
3. Prunes, grapes, apples.
4. Bran cereal, whole wheat toast, coffee.
12. The nurse is caring for a client who has had a colostomy.
Which of the following client behaviors is indicative of a willingness
to be involved in self-care following a colostomy?
1. Discussing the cost of his hospitalization.
2. Asking what time the surgeon will be in.
3. Asking questions about the equipment being used.
4. Complaining about the noise in the adjacent room.
13. An adult is admitted with a duodenal ulcer.
after admission, the client develops severe, persistent pain
radiating to the shoulder. What action should the nurse take first?
1. Notify the physician.
2. Place client in a high-Fowler’s position to decrease pressure on
the gastric area and shoulder.
3. Examine the client for board-like rigidity of the abdomen.
4. Administer ordered prn pain medication.
14. The client with a duodenal ulcer is ready for discharge. Which
statement made by the client indicates a need for more teaching
about his diet?
1. “It’s a good thing I gave up drinking alcohol last year.”
2. “I will have to drink lots of milk and cream every day.”
3. “I will stay away from cola drinks after I am discharged.”
4. “Eating three nutritious meals and snacks every day is okay.”
15. A young college student comes to the emergency room with
nausea, vomiting and severe abdominal pain of six hours duration.
While examining the client the physician asks her to stand on her
toes and drop to her heels with a thump. Which of the following
interpretations of this procedure is the most accurate?
1. An irritated bowel will become less tender.
2. If the client has an acute inflammation she will feel localized
pain in the inflamed area.
3. This procedure will create more flaccid abdominal muscles
allowing easier abdominal exam.
4. The client with appendicitis will experience brief relief following
this action.
16. The nurse is admitting a client with a diagnosis of appendicitis
to the surgical unit. Which question is it essential to ask?
1. “When did you last eat?”
2. “Have you had surgery before?”
3. “Have you ever had this type of pain before?”
4. “What do you usually take to relieve your pain?
17. The client with appendicitis asks the nurse for a laxative to help
relieve her constipation. The nurse explains to her that laxatives
are not given to persons with possible appendicitis. What is the
primary reason for this?
1. Laxatives will decrease the spread of infection.
2. Laxatives are not given prior to any type of surgery.
3. The patient does not have true constipation. She only has
pressure.
4. Laxatives could cause rupture of the appendix.
18. The nurse is preparing a client with Crohn’s disease for
discharge. Which statement he makes indicates he needs further
teaching?
1. “Stress can make it worse.”
2. “Since I have Crohn’s disease I don’t have to worry about colon
cancer.”
3. “I realize I shall always have to monitor my diet.”
4. “I understand there is a high incidence of familial occurrence
with this disease.”
19. A client is admitted to the hospital with ulcerative colitis.
Admitting orders include a low residue diet. Which food would be
contraindicated for this client?
1. Roast beef.
2. Fresh peas.
3. Mashed potatoes.
4. Baked chicken.
20. An adult client is to have a sigmoidoscopy in the morning.
What should the nurse plan to do?
1. Give him an enema 1 hour before the examination.
2. Keep him NPO for 8 hours before the examination.
3. Order a low fat, low residue diet for breakfast.
4. Administer enemas until clear this evening.
21. A client has an order for irrigation of a nasogastric tube. What
should the nurse do before irrigating the nasogastric tube?
1. Inject a small amount of air while listening with a stethoscope
over the stomach for a “swoosh.”
2. Instill 5 cc of normal saline and observe for development of
coughing and dyspnea.
3. Place the end of the nasogastric tube in a glass of water and
observe for bubbles.
4. Aspirate and check the pH.
22. The client who has had a hemorrhoidectomy wants to know
why she cannot take a sitz bath immediately upon return from the
operating room. The nurse’s response is based upon which of the
following concepts?
1. Heat can stimulate bowel movement too quickly after surgery.
2. Patients are generally not awake enough for several hours to
safely take sitz baths.
3. Heat applied immediately post-operatively increases the
possibility of hemorrhage.
4. Sitting in water before the sutures are removed may cause
infection.
23. A client with pancreatitis tells the nurse that he fears nighttime.
Which of the following statements most likely relates to the client’s
concerns?
1. The pain is worse at night and aggravated in the recumbent
position.
2. He is afraid of the dark.
3. The mattress is uncomfortable.
4. The pain increases after a day of activity.
24. The client asks how he contracted hepatitis A. He reports all of
the following. Which one is most likely related to hepatitis A?
1. He ate home canned tomatoes.
2. He ate oysters his roommate brought home from a fishing trip.
3. He stepped on a nail 2 weeks ago.
4. He donated blood 2 weeks before he got sick.
25. The client has had a liver biopsy. The nurse should position
him on his right side with a pillow under his rib cage. What is the
primary reason for this position?
1. To immobilize the diaphragm.
2. To facilitate full chest expansion.
3. To minimize the danger of aspiration.
4. To reduce the likelihood of bleeding
Gastrointestinal Quiz
Answers and Rationale
1. (4) Clay colored stools means bile is not getting
through to the duodenum. The bile duct is obstructed so
bile backs up into the bloodstream causing jaundice.
2. (3) Atropine is an anticholinergic drug , which will
decrease contractions of the gallbladder.
3. (4) 350 cc in 24 hours after surgery is a normal
amount of bile drainage.
4. (4) Weight gain may occur due to increased
consumption of food as the client tries to feed a duodenal
ulcer. “Why” questions are threatening to clients. #3
asks for a yes or no answer. This will not give as much
information as asking about the eating habits.
5. (1) Hgb and Hct would indicate if there had been
any bleeding from the ulcer. SGPT and SGOT
elevations indicate liver damage. Na and K indicate
electrolyte imbalances. BUN and creatinine elevations
would indicate renal disease.
6. (2) Gastroduodenoscopy is visualization of the
esophagus, stomach and duodenal through a flexible
tube inserted orally. The exam is uncomfortable because
the muscles of the GI tract have spasms as the tube is
passed. This causes difficulty swallowing. The client is
usually given a local anesthetic to the posterior pharynx
to reduce the discomfort during the passage of the tube.
He may also be given conscious sedation. He will not
given a general anesthetic because he must be able to
assist by swallowing. Coughing and the performance of
a Valsalva maneuver would impede the passage of the
tube.
7. (3) It is essential to keep him NPO until the cough and
gag reflexes have returned. He should be in a semi-
Fowler's position to reduce edema formation.
8. (3) Potassium is present in GI fluids and is lost during
suctioning.
9. (1) The bowel must be free of fecal material for good
visualization of the bowel. He will be on a clear liquid or
low residue diet for the day preceding the exam. The
client is put in several positions during the test. Barium is
given by enema. It is given by mouth in an upper GI
series.
10. (2) Neomycin is an antibiotic that is poorly
absorbed from the bowel and very effective in killing the
bacteria in the bowel. E. Coli, normal inhabitants of the
bowel, can cause peritonitis if they are released into the
peritoneal cavity during surgery. Neomycin does not
alter electrolyte imbalances, affect peristaltic action or
reduce feces.
11. (1) All of these foods are low in residue. Fruits,
vegetables and whole grains are high in residue.
12. (3) When the client asks questions about the
equipment being used, he indicates a readiness to learn.
None of the other responses indicate a willingness to
learn about his colostomy.
13. (3) The nurse should first do a quick assessment
to determine if the cause of the pain is more apt to be
perforation of the ulcer or something else such as cardiac
pain. If the ulcer has perforated the client's abdomen will
be tender and rigid - board like.
14. (2) Milk and cream are now known to cause
rebound acidity and are not prescribed for ulcer clients.
The other choices all indicate good knowledge. He
should not drink alcohol or cola. Three meals and
snacks will help to keep the stomach from staying empty
for long periods.
15. (2) Rising on the toes will cause pain in
McBurney's area if the appendix is inflamed.
16. (1) When a person is admitted with a possible
appendicitis the nurse should anticipate surgery. It will
be important to know when she last ate when considering
the type of anesthesia so that the chance of aspiration
can be minimized.
17. (4) Laxatives cause increased peristalsis, which
may cause the appendix to rupture. #2 is not a true
statement. Laxatives may well be given prior to
gynecological, rectal and colon surgery. #3 is true but is
not the primary reason why laxatives are not given.
18. (2) Persons with Crohn's disease are at high risk
for the development of colon cancer. The other answers
are all correct.
19. (2) Fresh peas are high in residue. The other
foods are low in residue.
20. (1) An enema 1 hour before the exam will clear the
sigmoid colon. A client having an upper GI series will be
NPO. Low fat diet is indicated prior to a gallbladder
series. Low residue diet is part of the preparation for a
barium enema. Enemas until clear are sometimes
ordered prior to a barium enema.
21. (4) To determine if the tube is in the stomach, the
nurse should aspirate and check the pH. It should be
less than 5. Never instill saline. If the tube were in the
bronchi instead of the stomach, saline would cause
respiratory distress. Placing the end of the tube in a glass
of water does not prove the location of the tube. Injecting
air and listening for a “swoosh” does not tell the nurse
that the tube is in the stomach. The distal end of the
tube could be in the esophagus and still cause a
“swoosh.” Instilling fluid in the esophagus would
increase the risk of aspiration.
22. (3) Heat causes vasodilation. In the immediate
post-operative period this could cause hemorrhaging.
Ice packs will be applied for the first 24 hours. Sitz baths
are ordered after that.
23. (1) The recumbent position aggravates pancreatic
pain. The client will be more comfortable on his side with
his knees flexed.
24. (2) Shellfish that grow in contaminated waters may
have the virus. Home canned tomatoes might cause
food poisoning. Stepping on a nail might cause tetanus.
Donating blood will not cause hepatitis. Receiving blood
might cause hepatitis B or C.
25. (4) The liver is a very vascular organ. It is located
on the right side. Lying on the right side will put pressure
on it and provide hemostasis.
1. During preparation for bowel surgery, a male client receives
an antibiotic to reduce intestinal bacteria. Antibiotic therapy may
interfere with synthesis of which vitamin and may lead to
hypoprothrombinemia?
a. vitamin A
b. vitamin D
c. vitamin E
d. vitamin K
2. When evaluating a male client for complications of acute
pancreatitis, the nurse would observe for:
a. increased intracranial pressure.
b. decreased urine output.
c. bradycardia.
d. hypertension.
3. A male client with a recent history of rectal bleeding is being
prepared for a colonoscopy. How should the nurse position the
client for this test initially?
a. Lying on the right side with legs straight
b. Lying on the left side with knees bent
c. Prone with the torso elevated
d. Bent over with hands touching the floor
4. A male client with extreme weakness, pallor, weak peripheral
pulses, and disorientation is admitted to the emergency
department. His wife reports that he has been “spitting up blood.”
A Mallory-Weiss tear is suspected, and the nurse begins taking a
client history from the client’s wife. The question by the nurse that
demonstrates her understanding of Mallory-Weiss tearing is:
a. “Tell me about your husband’s alcohol usage.”
b. “Is your husband being treated for tuberculosis?”
c. “Has your husband recently fallen or injured his chest?”
d. “Describe spices and condiments your husband uses on food.”
5. Which of the following nursing interventions should the nurse
perform for a female client receiving enteral feedings through a
gastrostomy tube?
a. Change the tube feeding solutions and tubing at least every
24 hours.
b. Maintain the head of the bed at a 15-degree elevation
continuously.
c. Check the gastrostomy tube for position every 2 days.
d. Maintain the client on bed rest during the feedings.
6. A male client is recovering from a small-bowel resection. To
relieve pain, the physician prescribes meperidine (Demerol), 75
mg I.M. every 4 hours. How soon after administration should
meperidine’s onset of action occur?
a. 5 to 10 minutes
b. 15 to 30 minutes
c. 30 to 60 minutes
d. 2 to 4 hours
7. The nurse is caring for a male client with cirrhosis. Which
assessment findings indicate that the client has deficient vitamin K
absorption caused by this hepatic disease?
a. Dyspnea and fatigue
b. Ascites and orthopnea
c. Purpura and petechiae
d. Gynecomastia and testicular atrophy
8. Which condition is most likely to have a nursing diagnosis of
fluid volume deficit?
a. Appendicitis
b. Pancreatitis
c. Cholecystitis
d. Gastric ulcer
9. While a female client is being prepared for discharge, the
nasogastric (NG) feeding tube becomes clogged. To remedy this
problem and teach the client’s family how to deal with it at home,
what should the nurse do?
a. Irrigate the tube with cola.
b. Advance the tube into the intestine.
c. Apply intermittent suction to the tube.
d. Withdraw the obstruction with a 30-ml syringe.
10. A male client with pancreatitis complains of pain. The nurse
expects the physician to prescribe meperidine (Demerol) instead of
morphine to relieve pain because:
a. meperidine provides a better, more prolonged analgesic
effect.
b. morphine may cause spasms of Oddi’s sphincter.
c. meperidine is less addictive than morphine.
d. morphine may cause hepatic dysfunction.
11. Mandy, an adolescent girl is admitted to an acute care facility
with severe malnutrition. After a thorough examination, the
physician diagnoses anorexia nervosa. When developing the plan
of care for this client, the nurse is most likely to include which
nursing diagnosis?
a. Hopelessness
b. Powerlessness
c. Chronic low self esteem
d. Deficient knowledge
12. Which diagnostic test would be used first to evaluate a client
with upper GI bleeding?
a. Endoscopy
b. Upper GI series
c. Hemoglobin (Hb) levels and hematocrit (HCT)
d. Arteriography
13. A female client who has just been diagnosed with hepatitis A
asks, “How could I have gotten this disease?” What is the nurse’s
best response?
a. “You may have eaten contaminated restaurant food.”
b. “You could have gotten it by using I.V. drugs.”
c. “You must have received an infected blood transfusion.”
d. “You probably got it by engaging in unprotected sex.”
14. When preparing a male client, age 51, for surgery to treat
appendicitis, the nurse formulates a nursing diagnosis of Risk for
infection related to inflammation, perforation, and surgery. What is
the rationale for choosing this nursing diagnosis?
a. Obstruction of the appendix may increase venous drainage
and cause the appendix to rupture.
b. Obstruction of the appendix reduces arterial flow, leading to
ischemia, inflammation, and rupture of the appendix.
c. The appendix may develop gangrene and rupture, especially
in a middle-aged client.
d. Infection of the appendix diminishes necrotic arterial blood
flow and increases venous drainage.
15. A female client with hepatitis C develops liver failure and GI
hemorrhage. The blood products that would most likely bring about
hemostasis in the client are:
a. whole blood and albumin.
b. platelets and packed red blood cells.
c. fresh frozen plasma and whole blood.
d. cryoprecipitate and fresh frozen plasma.
16. To prevent gastroesophageal reflux in a male client with
hiatal hernia, the nurse should provide which discharge
instruction?
a. “Lie down after meals to promote digestion.”
b. “Avoid coffee and alcoholic beverages.”
c. “Take antacids with meals.”
d. “Limit fluid intake with meals.”
17. The nurse caring for a client with small-bowel obstruction
would plan to implement which nursing intervention first?
a. Administering pain medication
b. Obtaining a blood sample for laboratory studies
c. Preparing to insert a nasogastric (NG) tube
d. Administering I.V. fluids
18. A female client with dysphagia is being prepared for
discharge. Which outcome indicates that the client is ready for
discharge?
a. The client doesn’t exhibit rectal tenesmus.
b. The client is free from esophagitis and achalasia.
c. The client reports diminished duodenal inflammation.
d. The client has normal gastric structures.
19. A male client undergoes total gastrectomy. Several hours
after surgery, the nurse notes that the client’s nasogastric (NG)
tube has stopped draining. How should the nurse respond?
a. Notify the physician
b. Reposition the tube
c. Irrigate the tube
d. Increase the suction level
20. What laboratory finding is the primary diagnostic indicator for
pancreatitis?
a. Elevated blood urea nitrogen (BUN)
b. Elevated serum lipase
c. Elevated aspartate aminotransferase (AST)
d. Increased lactate dehydrogenase (LD)
21. A male client with cholelithiasis has a gallstone lodged in the
common bile duct. When assessing this client, the nurse expects
to note:
a. yellow sclerae.
b. light amber urine.
c. circumoral pallor.
d. black, tarry stools.
22. Nurse Hannah is teaching a group of middle-aged men about
peptic ulcers. When discussing risk factors for peptic ulcers, the
nurse should mention:
a. a sedentary lifestyle and smoking.
b. a history of hemorrhoids and smoking.
c. alcohol abuse and a history of acute renal failure.
d. alcohol abuse and smoking.
23. While palpating a female client’s right upper quadrant (RUQ),
the nurse would expect to find which of the following structures?
a. Sigmoid colon
b. Appendix
c. Spleen
d. Liver
24. A male client has undergone a colon resection. While turning
him, wound dehiscence with evisceration occurs. The nurse’s first
response is to:
a. call the physician.
b. place saline-soaked sterile dressings on the wound.
c. take a blood pressure and pulse.
d. pull the dehiscence closed.
25. The nurse is monitoring a female client receiving paregoric to
treat diarrhea for drug interactions. Which drugs can produce
additive constipation when given with an opium preparation?
a. Antiarrhythmic drugs
b. Anticholinergic drugs
c. Anticoagulant drugs
d. Antihypertensive drugs
26. A male client is recovering from an ileostomy that was
performed to treat inflammatory bowel disease. During discharge
teaching, the nurse should stress the importance of:
a. increasing fluid intake to prevent dehydration.
b. wearing an appliance pouch only at bedtime.
c. consuming a low-protein, high-fiber diet.
d. taking only enteric-coated medications.
27. The nurse is caring for a female client with active upper GI
bleeding. What is the appropriate diet for this client during the first
24 hours after admission?
a. Regular diet
b. Skim milk
c. Nothing by mouth
d. Clear liquids
28. A male client has just been diagnosed with hepatitis A. On
assessment, the nurse expects to note:
a. severe abdominal pain radiating to the shoulder.
b. anorexia, nausea, and vomiting.
c. eructation and constipation.
d. abdominal ascites.
29. A female client with viral hepatitis A is being treated in an
acute care facility. Because the client requires enteric precautions,
the nurse should:
a. place the client in a private room.
b. wear a mask when handling the client’s bedpan.
c. wash the hands after touching the client.
d. wear a gown when providing personal care for the client.
30. Which of the following factors can cause hepatitis A?
a. Contact with infected blood
b. Blood transfusions with infected blood
c. Eating contaminated shellfish
d. Sexual contact with an infected person
1. Answer D. Intestinal bacteria synthesize such nutritional
substances as vitamin K, thiamine, riboflavin, vitamin B12, folic
acid, biotin, and nicotinic acid. Therefore, antibiotic therapy may
interfere with synthesis of these substances, including vitamin K.
Intestinal bacteria don’t synthesize vitamins A, D, or E.
2. Answer B. Acute pancreatitis can cause decreased urine
output, which results from the renal failure that sometimes
accompanies this condition. Intracranial pressure neither increases
nor decreases in a client with pancreatitis. Tachycardia, not
bradycardia, usually is associated with pulmonary or hypovolemic
complications of pancreatitis. Hypotension can be caused by a
hypovolemic complication, but hypertension usually isn’t related to
acute pancreatitis.
3. Answer B. For a colonoscopy, the nurse initially should
position the client on the left side with knees bent. Placing the
client on the right side with legs straight, prone with the torso
elevated, or bent over with hands touching the floor wouldn’t allow
proper visualization of the large intestine.
4. Answer A. A Mallory-Weiss tear is associated with massive
bleeding after a tear occurs in the mucous membrane at the
junction of the esophagus and stomach. There is a strong
relationship between ethanol usage, resultant vomiting, and a
Mallory-Weiss tear. The bleeding is coming from the stomach, not
from the lungs as would be true in some cases of tuberculosis. A
Mallory-Weiss tear doesn’t occur from chest injuries or falls and
isn’t associated with eating spicy foods.
5. Answer A. Tube feeding solutions and tubing should be
changed every 24 hours, or more frequently if the feeding requires
it. Doing so prevents contamination and bacterial growth. The
head of the bed should be elevated 30 to 45 degrees continuously
to prevent aspiration. Checking for gastrostomy tube placement is
performed before initiating the feedings and every 4 hours during
continuous feedings. Clients may ambulate during feedings.
6. Answer B. Meperidine’s onset of action is 15 to 30 minutes. It
peaks between 30 and 60 minutes and has a duration of action of
2 to 4 hours.
7. Answer C. A hepatic disorder, such as cirrhosis, may disrupt
the liver’s normal use of vitamin K to produce prothrombin (a
clotting factor). Consequently, the nurse should monitor the client
for signs of bleeding, including purpura and petechiae. Dyspnea
and fatigue suggest anemia. Ascites and orthopnea are unrelated
to vitamin K absorption. Gynecomastia and testicular atrophy
result from decreased estrogen metabolism by the diseased liver.
8. Answer B. Hypovolemic shock from fluid shifts is a major
factor in acute pancreatitis. The other conditions are less likely to
exhibit fluid volume deficit.
9. Answer A. The nurse should irrigate the tube with cola
because its effervescence and acidity are suited to the purpose,
it’s inexpensive, and it’s readily available in most homes.
Advancing the NG tube is inappropriate because the tube is
designed to stay in the stomach and isn’t long enough to reach the
intestines. Applying intermittent suction or using a syringe for
aspiration is unlikely to dislodge the material clogging the tube but
may create excess pressure. Intermittent suction may even
collapse the tube.
10. Answer B. For a client with pancreatitis, the physician will
probably avoid prescribing morphine because this drug may trigger
spasms of the sphincter of Oddi (a sphincter at the end of the
pancreatic duct), causing irritation of the pancreas. Meperidine has
a somewhat shorter duration of action than morphine. The two
drugs are equally addictive. Morphine isn’t associated with hepatic
dysfunction.
11. Answer C. Young women with Chronic low self esteem —
are at highest risk for anorexia nervosa because they perceive
being thin as a way to improve their self-confidence. Hopelessness
and Powerlessness are inappropriate nursing diagnoses because
clients with anorexia nervosa seldom feel hopeless or powerless;
instead, they use food to control their desire to be thin and hope
that restricting food intake will achieve this goal. Anorexia nervosa
doesn’t result from a knowledge deficit, such as one regarding
good nutrition.
12. Answer A. Endoscopy permits direct evaluation of the upper
GI tract and can detect 90% of bleeding lesions. An upper GI
series, or barium study, usually isn’t the diagnostic method of
choice, especially in a client with acute active bleeding who’s
vomiting and unstable. An upper GI series is also less accurate
than endoscopy. Although an upper GI series might confirm the
presence of a lesion, it wouldn’t necessarily reveal whether the
lesion is bleeding. Hb levels and HCT, which indicate loss of blood
volume, aren’t always reliable indicators of GI bleeding because a
decrease in these values may not be seen for several hours.
Arteriography is an invasive study associated with life-threatening
complications and wouldn’t be used for an initial evaluation.
13. Answer A. Hepatitis A virus typically is transmitted by the
oral-fecal route — commonly by consuming food contaminated by
infected food handlers. The virus isn’t transmitted by the I.V. route,
blood transfusions, or unprotected sex. Hepatitis B can be
transmitted by I.V. drug use or blood transfusion. Hepatitis C can
be transmitted by unprotected sex.
14. Answer B. A client with appendicitis is at risk for infection
related to inflammation, perforation, and surgery because
obstruction of the appendix causes mucus fluid to build up,
increasing pressure in the appendix and compressing venous
outflow drainage. The pressure continues to rise with venous
obstruction; arterial blood flow then decreases, leading to ischemia
from lack of perfusion. Inflammation and bacterial growth follow,
and swelling continues to raise pressure within the appendix,
resulting in gangrene and rupture. Geriatric, not middle-aged,
clients are especially susceptible to appendix rupture.
15. Answer D. The liver is vital in the synthesis of clotting factors,
so when it’s diseased or dysfunctional, as in hepatitis C, bleeding
occurs. Treatment consists of administering blood products that
aid clotting. These include fresh frozen plasma containing
fibrinogen and cryoprecipitate, which have most of the clotting
factors. Although administering whole blood, albumin, and packed
cells will contribute to hemostasis, those products aren’t
specifically used to treat hemostasis. Platelets are helpful, but the
best answer is cryoprecipitate and fresh frozen plasma.
16. Answer B. To prevent reflux of stomach acid into the
esophagus, the nurse should advise the client to avoid foods and
beverages that increase stomach acid, such as coffee and alcohol.
The nurse also should teach the client to avoid lying down after
meals, which can aggravate reflux, and to take antacids after
eating. The client need not limit fluid intake with meals as long as
the fluids aren’t gastric irritants.
17. Answer D. I.V. infusions containing normal saline solution
and potassium should be given first to maintain fluid and
electrolyte balance. For the client’s comfort and to assist in bowel
decompression, the nurse should prepare to insert an NG tube
next. A blood sample is then obtained for laboratory studies to aid
in the diagnosis of bowel obstruction and guide treatment. Blood
studies usually include a complete blood count, serum electrolyte
levels, and blood urea nitrogen level. Pain medication often is
withheld until obstruction is diagnosed because analgesics can
decrease intestinal motility.
18. Answer B. Dysphagia may be the reason why a client with
esophagitis or achalasia seeks treatment. Dysphagia isn’t
associated with rectal tenesmus, duodenal inflammation, or
abnormal gastric structures.
19. Answer A. An NG tube that fails to drain during the
postoperative period should be reported to the physician
immediately. It may be clogged, which could increase pressure on
the suture site because fluid isn’t draining adequately.
Repositioning or irrigating an NG tube in a client who has
undergone gastric surgery can disrupt the anastomosis. Increasing
the level of suction may cause trauma to GI mucosa or the suture
line.

20. Answer B. Elevation of serum lipase is the most reliable

indicator of pancreatitis because this enzyme is produced solely by
the pancreas. A client’s BUN is typically elevated in relation to
renal dysfunction; the AST, in relation to liver dysfunction; and LD,
in relation to damaged cardiac muscle.

21. Answer A. Yellow sclerae may be the first sign of jaundice,

which occurs when the common bile duct is obstructed. Urine
normally is light amber. Circumoral pallor and black, tarry stools
don’t occur in common bile duct obstruction; they are signs of
hypoxia and GI bleeding, respectively.

22. Answer D. Risk factors for peptic (gastric and duodenal)

ulcers include alcohol abuse, smoking, and stress. A sedentary
lifestyle and a history of hemorrhoids aren’t risk factors for peptic
ulcers. Chronic renal failure, not acute renal failure, is associated
with duodenal ulcers.

23. Answer D. The RUQ contains the liver, gallbladder,

duodenum, head of the pancreas, hepatic flexure of the colon,
portions of the ascending and transverse colon, and a portion of
the right kidney. The sigmoid colon is located in the left lower
quadrant; the appendix, in the right lower quadrant; and the
spleen, in the left upper quadrant.

24. Answer B. The nurse should first place saline-soaked sterile

dressings on the open wound to prevent tissue drying and possible
infection. Then the nurse should call the physician and take the
client’s vital signs. The dehiscence needs to be surgically closed,
so the nurse should never try to close it.

25. Answer B. Paregoric has an additive effect of constipation

when used with anticholinergic drugs. Antiarrhythmics,
anticoagulants, and antihypertensives aren’t known to interact with
paregoric.

26. Answer A. Because stool forms in the large intestine, an

ileostomy typically drains liquid waste. To avoid fluid loss through
ileostomy drainage, the nurse should instruct the client to increase
fluid intake. The nurse should teach the client to wear a collection
appliance at all times because ileostomy drainage is incontinent, to
avoid high-fiber foods because they may irritate the intestines, and
to avoid enteric-coated medications because the body can’t absorb
them after an ileostomy

27. Answer C. Shock and bleeding must be controlled before

oral intake, so the client should receive nothing by mouth. A
regular diet is incorrect. When the bleeding is controlled, the diet is
gradually increased, starting with ice chips and then clear liquids.
Skim milk shouldn’t be given because it increases gastric acid
production, which could prolong bleeding. A liquid diet is the first
diet offered after bleeding and shock are controlled.

28. Answer B. Hallmark signs and symptoms of hepatitis A

include anorexia, nausea, vomiting, fatigue, and weakness.
Abdominal pain may occur but doesn’t radiate to the shoulder.
Eructation and constipation are common in gallbladder disease,
not hepatitis A. Abdominal ascites is a sign of advanced hepatic
disease, not an early sign of hepatitis A.

29. Answer C. To maintain enteric precautions, the nurse must

wash the hands after touching the client or potentially
contaminated articles and before caring for another client. A
private room is warranted only if the client has poor hygiene — for
instance, if the client is unlikely to wash the hands after touching
infective material or is likely to share contaminated articles with
other clients. For enteric precautions, the nurse need not wear a
mask and must wear a gown only if soiling from fecal matter is
likely.

30. Answer C. Hepatitis A can be caused by consuming

contaminated water, milk, or food — especially shellfish from
contaminated water. Hepatitis B is caused by blood and sexual
contact with an infected person. Hepatitis C is usually caused by
contact with infected blood, including receiving blood transfusions.