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

You closely
monitor the patient’s blood pressure because of which change that is associated
with the liver failure?

a) Hypoalbuminemia
b) Increased capillary permeability
c) Abnormal peripheral vasodilation
d) Excess rennin release from the kidneys

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

a) Pale, pink and moist

b) Red and moist
c) Dark or purple colored
d) Dry and black

3. You’re caring for a patient with a sigmoid colostomy. The stool from this

colostomy is:

a) Formed
b) Semisolid
c) Semiliquid
d) Watery

4. 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
5. 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.

6. 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

7. You’re doing preoperative teaching with Gertrude who has ulcerative colitis who
needs surgery to create an ileoanal reservoir. Which information do you include?

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.

8. You’re caring for Carin who has just had ileostomy surgery. During the first 24
hours post-op, how much drainage can you expect from the ileostomy?

a) 100 ml
b) 500 ml
c) 1500 ml
d) 5000 ml
9. You’re preparing a teaching plan for a 27 y.o. named Jeff who underwent surgery
to close a temporary ileostomy. Which nutritional guideline do you include in this
plan?

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.

10. Arthur has a family history of coloncancer 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?”

11. You’re caring for Beth who underwent a Billroth II procedure (surgical removal of
the pylorus and duodenum) for treatment of a peptic ulcer. Which findings suggest
that the patient is developing dumping syndrome, a complication associated with
this procedure?

a) Flushed, dry skin.

b) Headache and bradycardia.
c) Dizziness and sweating.
d) Dyspnea and chest pain.

12. You’re developing the plan of care for a patient experiencing dumping syndrome
after a Billroth II procedure. Which dietary instructions do you include?

a) Omit fluids with meals.

b) Increase carbohydrate intake.
c) Decrease protein intake.
d) Decrease fat intake.

13. You’re caring for Lewis, a 67 y.o. patient with liver cirrhosis who developed
ascites and requires paracentesis. Relief of which symptom indicated that the
paracentesis was effective?

a) Pruritus
b) Dyspnea
c) Jaundice
d) Peripheral Neuropathy

14. You’re caring for Jane, a 57 y.o. patient with liver cirrhosis who developed 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.

15. After abdominal surgery, your patient has a severe coughing episode that causes
wound evisceration. In addition to calling the doctor, which intervention is most
appropriate?

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.

16. 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

17. You are developing a care plan 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.

18. 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) Propranolol (Inderal)

19. The student nurse is preparing a teaching care plan to help improve nutrition in a
patient with achalasia. You include which of the following:

a) Swallow foods while leaning forward.

b) Omit fluids at mealtimes.
c) Eat meals sitting upright.
d) Avoid soft and semi soft foods.

20. Britney, a 20 y.o. student is admitted with acute pancreatitis. Which laboratory

findings do you expect to be abnormal for this patient?

a) Serum creatinine and BUN
b) Alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
c) Serum amylase and lipase
d) Cardiac enzymes
21. A patient with Crohn’s disease is admitted after 4 days of diarrhea. Which of the
following urine specific gravity values do you expect to find in this patient?

a) 1.005
b) 1.011
c) 1.020
d) 1.030

22. Your goal is to minimize David’s risk of complications after a herniorrhaphy. 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.

23. 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.

24. 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.”

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

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
26. Michael, a 42 y.o. man is admitted to the med-surg floor with a diagnosis of acute
pancreatitis. His BP is 136/76, pulse 96, Resps 22 and temp 101. His past history
includes hyperlipidemia and alcohol abuse. The doctor prescribes an NG tube.
Before inserting the tube, you explain the purpose to patient. Which of the following
is a most accurate explanation?

1. “It empties the stomach of fluids and gas.”

2. “It prevents spasms at the sphincter of Oddi.”
3. “It prevents air from forming in the small intestine and large intestine.”
4. “It removes bile from the gallbladder.”

27. Jason, a 22 y.o. accident victim, requires an NG tube for feeding

. What should you immediately do after inserting an NG tube for liquid enteral
feedings?

1. Aspirate for gastric secretions with a syringe.

2. Begin feeding slowly to prevent cramping.
3. Get an X-ray of the tip of the tube within 24 hours.
4. Clamp off the tube until the feedings begin.

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

1. Necessary fluids and electrolytes to the body.

2. Complete nutrition by the I.V. route.
3. Tube feedings for nutritional supplementation.
4. Dietary supplementation with liquid protein given between meals.

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

1. Cause atrophy of the parietal cells.

2. Affect only the antrum of the stomach.
3. Thin the lining of the stomach walls.
4. Decrease gastric secretions.

30. Matt is a 49 y.o. with a hiatal herniathat you are about to counsel. Health care
counseling for Matt should include which of the following instructions?

1. Restrict intake of high-carbohydrate foods.

2. Increase fluid intake with meals.
3. Increase fat intake.
4. Eat three regular meals a day.

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

1. Replace lost fluid and sodium.

2. Monitor for increased serum glucoselevel from steroid therapy.
3. Restrict the dietary intake of foods high in potassium.
4. Note any change in the color and consistency of stools.

32. A 29 y.o. patient has an acute episode of ulcerative colitis. What diagnostic

testconfirms this diagnosis?

1. Barium Swallow.
2. Stool examination.
3. Gastric analysis.
4. Sigmoidoscopy.

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

1. Low-fiber diet and fluid restrictions.

2. Total parenteral nutrition and bed rest.
3. High-fiber diet and administration of psyllium.
4. Administration of analgesics and antacids.

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

1. Watery and frothy.

2. Bloody and mucous.
3. Firm and well-formed.
4. Alternating constipation and diarrhea.

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

1. Periodic rectal hemorrhage.

2. Hypertension and tachycardia.
3. Vomiting and elevated temperature.
4. Crampy and lower left quadrant pain and low-grade fever.

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

1. Continuous peritoneal lavage.

2. Regular diet with increased fat.
3. Nutritional support with TPN.
4. Insertion of a T tube to drain the pancreas.

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

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

2. Pain in the right lower quadrant, with rebound tenderness.
3. Pain in the left upper quadrant, with shortness of breath.
4. Pain in the left lower quadrant, with mild cramping.
38. After an abdominal resection for colon cancer, Madeline returns to her room with
a Jackson-Pratt drain in place. The purpose of the drain is to:

1. Irrigate the incision with a saline solution.

2. Prevent bacterial infection of the incision.
3. Measure the amount of fluid lost after surgery.
4. Prevent accumulation of drainage in the wound.

39. Anthony, a 60 y.o. patient, has just undergone a bowel resection with a
colostomy. During the first 24 hours, which of the following observations about the
stoma should you report to the doctor?

1. Pink color.
2. Light edema.
3. Small amount of oozing.
4. Trickles of bright red blood.

40. Your teaching Anthony how to use his new colostomy. How much skin should
remain exposed between the stoma and the ring of the appliance?

1. 1/16”
2. 1/4″
3. 1/2”
4. 1”

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

1. Obtain daily weights.

2. Measure abdominal girth.
3. Keep strict intake and output.
4. Encourage her to increase fluids.
42. Your patient has a GI tract that is functioning, but has the inability to swallow
foods. Which is the preferred method of feeding for your patient?

1. TPN
2. PPN
3. NG feeding
4. Oral liquid supplements

43. You’re patient is complaining of abdominal pain during assessment. What is your
priority?

1. Auscultate to determine changes in bowel sounds.

2. Observe the contour of the abdomen.
3. Palpate the abdomen for a mass.
4. Percuss the abdomen to determine if fluid is present.

44. Before bowel surgery, Lee is to administer enemas until clear. During
administration, he complains of intestinal cramps. What do you do next?

1. Discontinue the procedure.

2. Lower the height of the enema container.
3. Complete the procedure as quickly as possible.
4. Continue administration of the enema as ordered without making any adjustments.

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

1. There is no skin breakdown.

2. Her appetite improves.
3. She loses more than 10 lbs.
4. Stools are less fatty and decreased in frequency.
46. Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab value
is most likely to be elevated?

1. Calcium
2. Glucose
3. Magnesium
4. Potassium

47. Anna is 45 y.o. and has a bleedingulcer. Despite multiple blood transfusions, her
HGB is 7.5g/dl and HCT is 27%. Her doctor determines that surgical intervention is
necessary and she undergoes partial gastrectomy. Postoperative nursing care
includes:

1. Giving pain medication Q6H.

2. Flushing the NG tube with sterile water.
3. Positioning her in high Fowler’s position.
4. Keeping her NPO until the return of peristalsis.

48. Sitty, a 66 y.o. patient underwent a colostomy for ruptured diverticulum. She did
well during the surgery and returned to your med-surg floor in stable condition. You
assess her colostomy 2 days after surgery. Which finding do you report to the
doctor?

1. Blanched stoma
2. Edematous stoma
3. Reddish-pink stoma
4. Brownish-black stoma

49. Sharon has cirrhosis of the liver and develops ascites. What intervention is
necessary to decrease the excessive accumulation of serous fluid in her peritoneal
cavity?
1. Restrict fluids
2. Encourage ambulation
3. Increase sodium in the diet
4. Give antacids as prescribed

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

1. Fruit
2. Whole grains
3. Milk and cheese products
4. Dark green, leafy vegetables

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

1. Give tepid baths.

2. Avoid lotions and creams.
3. Use hot water to increase vasodilation.
4. Use cold water to decrease the itching.

52. Rob is a 46 y.o. admitted to the hospital with a suspected diagnosis of Hepatitis
B. He’s jaundiced and reports weakness. Which intervention will you include in his
care?

1. Regular exercise.
2. A low-protein diet.
3. Allow patient to select his meals.
4. Rest period after small, frequent meals.

53. You’re discharging Nathaniel with hepatitis B. Which statement suggests

understanding by the patient?
1. “Now I can never get hepatitis again.”
2. “I can safely give blood after 3 months.”
3. “I’ll never have a problem with my liver again, even if I drink alcohol.”
4. “My family knows that if I get tired and start vomiting, I may be getting sick again.”

54. Gail is scheduled for a cholecystectomy. After completion of preoperative

teaching, Gail states,”If I lie still and avoid turning after the operation, I’ll avoid pain.
Do you think this is a good idea?” What is the best response?

1. “You’ll need to turn from side to side every 2 hours.”

2. “It’s always a good idea to rest quietly after surgery.”
3. “The doctor will probably order you to lie flat for 24 hours.”
4. “Why don’t you decide about activity after you return from the recovery room?”

55. You’re caring for a 28 y.o. woman with hepatitis B. She’s concerned about the
duration of her recovery. Which response isn’t appropriate?

1. Encourage her to not worry about the future.

2. Encourage her to express her feelings about the illness.
3. Discuss the effects of hepatitis B on future health problems.
4. Provide avenues for financial counseling if she expresses the need.

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

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

2. Mix diazepam with 50 ml of dextrose 5% in water and give over 15 minutes.
3. Give diazepam rapidly I.V. to prevent the bloodstream from diluting the drug mixture.
4. Question the order because I.V. administration of diazepam is contraindicated.

57. Annabelle is being discharged with a colostomy, and you’re teaching her about
colostomy care. Which statement correctly describes a healthy stoma?
1. “At first, the stoma may bleed slightly when touched.”
2. “The stoma should appear dark and have a bluish hue.”
3. “A burning sensation under the stoma faceplate is normal.”
4. “The stoma should remain swollen away from the abdomen.”

58. A patient who underwent abdominal surgery now has a gaping incision due to
delayed wound healing. Which method is correct when you irrigate a gaping
abdominal incision with sterile normal saline solution, using a piston syringe?

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

2. Apply a wet-to-dry dressing to the wound after the irrigation.
3. Moisten the area around the wound with normal saline solution after the irrigation.
4. Irrigate continuously until the solution becomes clear or all of the solution is used.

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

1. Ammonia
2. Amylase
3. Calcium
4. Potassium

60. Your patient recently had abdominal surgery and tells you that he feels a popping
sensation in his incision during a coughing spell, followed by severe pain. You
anticipate an evisceration. Which supplies should you take to his room?

1. A suture kit.
2. Sterile water and a suture kit.
3. Sterile water and sterile dressings.
4. Sterile saline solution and sterile dressings.

61. Findings during an endoscopic exam include a cobblestone appearance of the

colon in your patient. The findings are characteristic of which disorder?
1. Ulcer
2. Crohn’s disease
3. Chronic gastritis
4. Ulcerative colitis

62. What information is correct about stomach cancer?

1. Stomach pain is often a late symptom.

2. Surgery is often a successful treatment.
3. Chemotherapy and radiation are often successful treatments.
4. The patient can survive for an extended time with TPN.

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

1. Upper colon.
2. Lower colon.
3. Upper GI tract.
4. Small intestine.

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

1. Treating hypovolemia.
2. Treating hypervolemia.
3. Controlling the bleeding source.
4. Treating shock and diagnosing the bleeding source.

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

1. Encouraging oral fluid intake.

2. Monitoring central venous pressure.
3. Monitoring laboratory test results and vital signs.
4. Giving blood, electrolyte and fluid replacement.
66. You’re preparing a patient with a malignant tumor for colorectal surgery and
subsequent colostomy. The patient tells you he’s anxious. What should your initial
step be in working with this patient?

1. Determine what the patient already knows about colostomies.

2. Show the patient some pictures of colostomies.
3. Arrange for someone who has a colostomy to visit the patient.
4. Provide the patient with written material about colostomy care.

67. Your patient, Christopher, has a diagnosis of ulcerative colitis and has severe
abdominal pain aggravated by movement, rebound tenderness, fever, nausea, and
decreased urine output. This may indicate which complication?

1. Fistula.
2. Bowel perforation.
3. Bowel obstruction.
4. Abscess.

68. A patient has a severe exacerbation of ulcerative colitis. Long-term medications

will probably include:

1. Antacids.
2. Antibiotics.
3. Corticosteroids.
4. Histamine2-receptor blockers.

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

1. Meats and beans.

2. Butter and gravies.
3. Potatoes and pastas.
4. Cakes and pastries.
70. An intubated patient is receiving continuous enteral feedings through a Salem
sump tube at a rate of 60ml/hr. Gastric residuals have been 30-40ml when monitored
Q4H. You check the gastric residual and aspirate 220ml. What is your first response
to this finding?

1. Notify the doctor immediately.

2. Stop the feeding, and clamp the NG tube.
3. Discard the 220ml, and clamp the NG tube.
4. Give a prescribed GI stimulant such as metoclopramide (Reglan).

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

1. Increase the I.V. infusion rate.

2. Use diversion activities.
3. Provide frequent mouth care.
4. Give ice chips every 15 minutes.

72. Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis.

What does this indicate?

1. He has fresh, active upper GI bleeding.

2. He needs immediate saline gastric lavage.
3. His gastric bleeding occurred 2 hours earlier.
4. He needs a transfusion of packed RBC’s.

73. A 53 y.o. patient has undergone a partial gastrectomy for adenocarcinoma of the
stomach. An NG tube is in place and is connected to low continuous suction. During
the immediate postoperative period, you expect the gastric secretions to be which
color?

1. Brown.
2. Clear.
3. Red.
4. Yellow.

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

1. Peristalsis.
2. Gastric acidity.
3. Gastric motility.
4. Gastric pH.

75. Christina is receiving an enteral feeding that requires a concentration of 80 ml of

supplement mixed with 20 ml of water. How much water do you mix with an 8 oz
(240ml) can of feeding?

1. 60 ml.
2. 70 ml.
3. 80 ml.
4. 90 ml.

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

1. Ileostomy.
2. Ascending colostomy.
3. Transverse colostomy.
4. Descending colostomy.

77. George has a T tube in place after gallbladder surgery. Before discharge, what
information or instructions should be given regarding the T tube drainage?

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

2. “The drainage will decrease daily until the bile duct heals.”
3. “First, the drainage is dark green; then it becomes dark yellow.”
4. “If the drainage stops, milk the tube toward the puncture wound.”

78. Your patient Maria takes NSAIDS for her degenerative joint disease, has

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

1. Calcium carbonate (Tums)

2. Famotidine (Pepcid)
3. Misoprostol (Cytotec)
4. Sucralfate (Carafate)

79. The student nurse is participating in colorectal cancer-screening program. Which

patient has the fewest risk factors for colon cancer?

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

2. George, a 50 y.o. whose father died of colon cancer
3. Herman, a 60 y.o. who follows a low-fat, high-fiber diet
4. Sissy, a 72 y.o. with a history of breast cancer

80. You’re patient, post-op drainage of a pelvic abscess secondary to diverticulitis,

begins to cough violently after drinking water. His wound has ruptured and a small
segment of the bowel is protruding. What’s your priority?

1. Ask the patient what happened, call the doctor, and cover the area with a water-soaked
bedsheet.
2. Obtain vital signs, call the doctor, and obtain emergency orders.
3. Have a CAN hold the wound together while you obtain vital signs, call the doctor and flex
the patient’s knees.
4. Have the doctor called while you remain with the patient, flex the patient’s knees, and
cover the wound with sterile towels soaked in sterile saline solution.
Answers and Rationale

1. Answer: 1. Hypoalbuminemia

Blood pressure decreases as the body is unable to maintain normal oncotic pressure with
liver failure, so patients with liver failure require close blood pressure monitoring. Increased
capillary permeability, abnormal peripheral vasodilation, and excess rennin released from
the kidney’s aren’t direct ramifications of liver failure.

2. Answer: 2. Red and moist

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

3. Answer: 1. Formed

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

4. Answer: 4. Yogurt

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

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

A proper fit protects the skin but doesn’t impair circulation. A 1/16” should be cut.

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

Observation, auscultation, percussion, palpation

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

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

8. Answer: 3. 1500 ml

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

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

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

10. Answer: 2. “You seem upset.”

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

11. Answer: 3. Dizziness and sweating.

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

12. Answer: 1. Omit fluids with meals.

Gastric emptying time can be delayed by omitting fluids from your patient’s meal. A diet low
in carbs and high in fat & protein is recommended to treat dumping syndrome.
13. Answer: 2. Dyspnea

Ascites puts pressure on the diaphragm. Paracentesis is done to remove fluid and reducing
pressure on the diaphragm. The goal is to improve the patient’s breathing. The others are
signs of cirrhosis that aren’t relieved by paracentesis.

14. Answer: 1. Empty her bladder.

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

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

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

16. Answer: 1. Asterixis

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

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

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

18. Answer: 1. Isosorbide dinitrate (Isordil)

Achalasia is characterized by incomplete relaxation of the LES, dilation of the lower

esophagus, and a lack of esophageal peristalsis. Because nitrates relax the lower
esophageal sphincter, expect to give Isordil orally or sublingually.

19. Answer: 3. Eat meals sitting upright.

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

20. Answer: 3. Serum amylase and lipase

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

21. Answer: 4. 1.030

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

22. Answer: 3. Splint the incision if he can’t avoid sneezing or coughing.

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

23. Answer: 3. Lose weight, if obese.

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

24. Answer: 2. “You’ll need to lie on your right side after the test.”

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

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

Signs and Symptoms of pneumothoraxinclude dyspnea and decreased or absent breath

sounds over the affected lung (right lung).
26. Answer: 1. “It empties the stomach of fluids and gas.”

An NG tube is inserted into the patient’s stomach to drain fluid and gas.

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

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

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

TPN is given I.V. to provide all the nutrients your patient needs. TPN isn’t a tube feeding nor
is it a liquid dietary supplement.

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

Type A causes changes in parietal cells.

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

Increasing fluids helps empty the stomach. A high carb diet isn’t restricted and fat intake
shouldn’t be increased.

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

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

32. Answer: 4. Sigmoidoscopy.

Sigmoidoscopy allows direct observation of the colon mucosa for changes, and if needed,
biopsy.
33. Answer: 3. High-fiber diet and administration of psyllium.

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

34. Answer: 2. Bloody and mucous.

Stools from ulcerative colitis are often bloody and contain mucus.

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

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

36. Answer: 3. Nutritional support with TPN.

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

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

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

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

A Jackson-Pratt drain promotes wound healing by allowing fluid to escape from the wound.

39. Answer: 4. Trickles of bright red blood.

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

40. Answer: 1. 1/16”

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

41. Answer: 2. Measure abdominal girth.

Measuring abdominal girth provides quantitative information about increases or decreases

in the amount of distention.

42. Answer: 3. NG feeding

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

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

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

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

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

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

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

46.  Answer: 2. Glucose

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

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

48. Answer: 4. Brownish-black stoma

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

49. Answer: 1. Restrict fluids

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

50. Answer: 4. Dark green, leafy vegetables

Dark green, leafy vegetables are rich in calcium.

51. Answer: 1. Give tepid baths.

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

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

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

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

Hepatitis B can recur. Patients who have had hepatitis are permanently barred from
donating blood. Alcohol is metabolized by the liver and should be avoided by those who
have or had hepatitis B.
54. Answer: 1. “You’ll need to turn from side to side every 2 hours.”

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

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

Telling her not to worry minimizes her feelings.

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

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

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

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

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

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

59. Answer: 1. Ammonia

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

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

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

61. Answer: 2. Crohn’s disease

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

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

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

63. Answer: 3. Upper GI tract.

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

64. Answer: 1. Treating hypovolemia.

A patient with an acute upper GI hemorrhage must be treated for hypovolemia

and hemorrhagic shock. You as a nurse can’t diagnose the problem. Controlling the
bleeding may require surgery or intensive medical treatment.

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

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

66. Answer: 1. Determine what the patient already knows about colostomies.
Initially, you should assess the patient’s knowledge about colostomies and how it will affect
his lifestyle.

67. Answer: 2. Bowel perforation.

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

68. Answers: 3. Corticosteroids.

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

treatment.

69. Answer: 1. Meats and beans.

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

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

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

71. Answer: 3. Provide frequent mouth care.

Frequent mouth care helps relieve dry mouth.

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

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

73. Answer: 3. Red.

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

74. Answer: 4. Gastric pH.

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

75. Answer: 1. 60 ml.

Dosage problem. It’s 80/20 = 240/X. X=60.

76. Answer: 1. Ileostomy.

The output from an Ileostomy is described.

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

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

78. Answer: 3. Misoprostol (Cytotec)

Misoprostol restores prostaglandins that protect the stomach from NSAIDS, which diminish
the prostaglandins.
79. Answer: 3. Herman, a 60 y.o. who follows a low-fat, high-fiber diet

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