1.

Your patient arrives in the ER with complaints of profuse, sudden vomiting which you
notice has a foul fecal odor to it. Which of the following are you concerned for?
a. A large bowel obstruction
b. Irritable bowel syndrome
c. A small bowel obstruction
d. Peptic ulcer disease
2. You are preparing your patient for discharge who was just diagnosed with peptic ulcer
disease. Which of the following statements made by the patient requires further
education?
a. I should limit the amount of caffeinated beverages I consume
b. I should start exercising regularly
c. It would be better for me to consume smaller, more frequent meals
d. I can take aspirin and/or ibuprofen for pain
3. Your patient presents with complaints of nasal drainage/discharge, sneezing,
itchy/watery eyes, and a sore throat. Upon further evaluation you notice inflammation of
the nasal mucosa. Which of the following are you concerned for?
a. Rhinitis
b. Sinusitis
c. COPD
d. Flu
4. When assessing your patient with COPD, which of the following findings would you be
most concerned for?
a. Dependant edema
b. O2 saturation of 89%
c. Respiration count of 24 breaths per minute
d. PaCO2 value of 45 mmHg
5. You are educating a new nurse on medications given to asthma patients. Which of the
following statements made by the new nurse requires further education?
a. Ipratropium helps to prevent bronchospasms and decrease pulmonary secretions
b. Salmeterol is used to rapidly treat asthma attacks
c. Prednisone and montelukast help in decreasing airway inflammation
d. Albuterol is a short acting, beta-2 agonist
6. Your patient is on a 4 medication regimen including isoniazid, rifampin, pyrazinamide,
and ethambutol. You know that your patient is positive for which of the following
diagnoses?
a. Asthma
b. Pneumonia
c. TB
d. Sinusitis

7. The doctor has ordered labs on your patient - the results are as followed: Lipase - 168
 units/L, Amylase - 242 units/L, and a WBC count of 12,300. Which of the following are
you concerned for?
a. Cirrhosis
b. Hepatitis
c. GERD
d. Pancreatitis
8. Your patient diagnosed with Asthma is on the following medication therapy: albuterol,
salmeterol, prednisone, and ipratropium. They are complaining of a headache, blurred
vision, and palpitations. Which of the following are you concerned for?
a. Ipratropium toxicity
b. Severe persistent asthma
c. Hypoxemia
d. Hypercarbia
9. A newly admitted patient presents with clay colored stool, rebound tenderness, dark
urine, heart rate of 112, and increased belching and flatulence. Which of the following
would be least likely to be included in this patient's plan of care?
a. Medication therapy including chenodiol and ibuprofen
b. A dietary order for a low fat diet
c. An order for a magnetic resonance cholangiopancreatography
d. An order for strict bed rest
10. Your patient presents with abdominal distention, ascites, jaundice, petechiae, and
edema. Their lab results are as followed: ALT - 40 IU/L, AST - 49 IU/L, Protein - 3 g/dL,
Albumin - 2.4 g/dL, and Bilirubin - 1.9 mg/dL. Based on these findings, which of the
following meds would you not want to include in their plan of care?
a. A diuretic
b. Lactulose
c. A sodium supplement
d. A beta-blocking agent
11. Your patient diagnosed with peptic ulcer disease reports pain that occurs 30-60 minutes
after consuming a meal and that is often alleviated at night. Which of the following ulcer
types are you expecting?
a. Duodenal Ulcer
b. Gastric Ulcer
c. Peptic Ulcer
d. Curling’s ulcer
12. You are educating a group of individuals on the risk factors for developing cholecystitis.
Which of the following would you not want to include in your education?
a. Individuals with Type II Diabetes are at an increased risk for this diagnosis
b. Native American’s and Mexican American’s are at an increased risk
c. Individuals who consume a low-calorie, liquid protein diet are at an increased risk
d. Rapid weight gain places an individual at an increased risk for cholecystitis

13. A new nurse is giving you report after assessing a patient’s ostomy. Which of the
 following statements raises concern?
a. The bag was emptied as it was ⅓ - ½ full
b. The stoma appears blue in color and dry
c. A skin barrier and adhesive paste were applied prior to a new ostomy bag
d. The stoma appears pink and moist
14. A family member of your patient diagnosed with Hepatitis A is asking you how this
disease is transmitted. Which of the following would be the correct answer?
a. It is an oral to oral transfer
b. It is a blood transfer
c. It is a coinfection with HBV
d. It is a fecal to oral transfer
15. Your patient presents in the ER with lower abdominal distention, intermittent abdominal
cramping, and ribbon like stools. Labs indicate metabolic acidosis. Which of the following
are you concerned for?
a. Large bowel obstruction
b. Irritable bowel syndrome
c. Small bowel obstruction
d. Hepatitis
16. The doctor is concerned your patient may have pancreatitis and orders a CT with
contrast. Which of the following symptoms would aid in confirming this diagnosis? (select
all that apply)
a. Fruity breath
b. Radiating epigastric pain
c. Increased weight
d. Increased bowel sounds
e. Hand spasms & facial twitching
17. A client has just had surgery to create an ileostomy. The nurse assesses the client in the
immediate postoperative period for which of the following complications? (select all that
apply)
a. Intestinal obstruction
b. Fluid and electrolyte imbalance
c. Malabsorption of fat
d. Folate deficiency
18. While preparing your patient with irritable bowel syndrome for discharge, you educate
them on foods they can include in their diet. Which of the following foods should you
include in your discharge teaching?
a. Fried chicken
b. Corn
c. Pretzels
d. Bagel with cream cheese

19. When making a plan of care for your patient diagnosed with chronic hepatitis B, which of
 the following medications would be an appropriate choice to include?
a. Ribavirin
b. Peginterferon
c. Lactulose
d. Adefovir
20. While assessing your patient with peptic ulcer disease you notice that they are
diaphoretic, pale, and tachycardic. Which of the following complications are you
concerned for?
a. Pyloric obstruction
b. Dumping syndrome
c. Pernicious anemia
d. Perforation

1. C - a small bowel obstruction presents with profuse, sudden vomiting with a fecal odor. A
large bowel obstruction presents with infrequent vomiting
2. D - patients should avoid NSAIDS with peptic ulcer disease d/t increased risk for
bleeding
3. A - sinusitis presents with nasal congestion and inflammation of the mucous membranes
- not nasal mucosa.
4. A - Dependent edema is an indicator of right sided heart failure. O2 saturations can be
expected to be between 88-92% in COPD patients as well as having increased
respiratory rates. A PaCO2 value of 45 mmHg is within the expected range of 35-45
mmHg
5. B - Salmeterol is used to prevent asthma attacks while albuterol is used to rapidly treat
asthma attacks
6. C - TB patients are given a 4 medication regimen which lasts 6-12 months
7. D - increased amylase, lipase, and WBC are indicators of pancreatitis. You would want
to run liver functions tests (ALP, ALT, AST, Bilirubin, protein, ammonia, and albumin) to
test for cirrhosis and/or hepatitis. GERD would be tested through a barium swallow study
and Esophageal pH monitoring
8. A - headache, blurred vision, and palpitations are symptoms of ipratropium toxicity. You
would not suspect hypoxemia or hypercarbia with only this information - you would want
to assess their ABG’s.
9. D - Your patient presents with symptoms of cholelithiasis/cholecystitis. In a patient with
this diagnosis you would want to encourage regular exercise.
10. C - Based on these results you would be concerned for Cirrhosis due to increased ALT
and AST, increased Bilirubin, and decreased protein and albumin. In patients with
cirrhosis you would want to enforce a low sodium diet which would not include
administering a sodium supplement.
11. B - Gastric ulcer pain occurs 30-60 minutes after a meal and is often less painful at
night. Duodenal ulcer pain occurs 1.5-3 hours after a meal and awakens the patient at
night with pain.
12. D - rapid weight loss places a client at an increased risk of cholecystitis - not a rapid
weight gain.
13. B - The stoma should be pink and moist. A stoma that appears bluish/dry or black/purple
in color indicates stomal ischemia/necrosis.
14. D - Hepatitis A is a fecal to oral transfer as well as Hepatitis E. Hepatitis B and C are
blood transfers.
15. A - Large bowel obstruction patients present with lower abdominal distention,
intermittent abdominal cramping and diarrhea or ribbon like stools. Labs would also
indicate metabolic acidosis while a small bowel obstruction would indicate metabolic
alkalosis.
16. A, B, E - In a patient with pancreatitis you would observe decreased weight and
decreased bowel sounds
17. A, B - Malabsorption of fat and folate deficiency are complications that could occur later
in the postoperative period
18. C - a patient with irritable bowel syndrome would want to avoid fried foods, corn, wheat,
dairy, alcohol, spicy food, and caffeine.
19. D - antiviral meds would be the best choice for chronic hepatitis B treatment which
 includes tenofovir, adefovir, and interferon. Lactulose would be a possible treatment for
cirrhosis patients. Peginterferon would be used in combination with other drugs for
hepatitis C.
20. B - Dumping syndrome is a complication of peptic ulcer disease with symptoms
including vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to
lie down