MS 2 P1 Part 1

Total points42/50

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Name
ALESNA, FLOREZABELLE M.

Please answer in 60 minutes

42 of 50 points

A client is diagnosed with gastroesophageal reflux disease (GERD). The nurse’s instruction
to the client regarding diet should be to?
1/1
Avoid all raw fruit and vegetables
Focus on three average size meals a day
Decrease intake of fatty foods

Increase intake of milk products

Feedback
Decrease intake of fatty foods is the correct answer. GERD may be aggravated by a fatty diet. A diet low in
fat would decrease the symptoms of GERD. Otheragents which should also be decreased are: cigarette
smoking, caffeine, alcohol, chocolate, and meriperidine (Demerol).

The nurse is caring for a client with gastroenteritis. Which of the following nursing measures
should receive priority in the client’s plan of care?
1/1
Assist the client to wash hands and face before meals
Maintain a clean environment free from odours
Encourage fluids and monitor intake and output

Provide foods the client likes and allow plenty of time for meals

When preparing a client for insertion of a nasogastric tube, it is essential for the nurse to
include which of the following aspects of the procedure?
1/1
Measure the tube from the tip of the nose to the earlobe to the xiphoid process
Tilt the client’s head back when the tube is being inserted
Assist the client to assume a left-side-lying or recumbent position
Instruct the client to avoid swallowing when the tube is felt in the back of the throat
Feedback
It is correct to measure from the tip of the nose to the tip of the earlobe to the xiphoid process prior to
inserting a nasogastric tube to determine correct placement. Instructing the client not to swallow when the
tube is felt in the back of the throat is incorrect, because the nurse would encourage a client to swallow as
the tube is being passed. The client should be in a high-Fowler’s position for insertion of the tube. The
head should be tilted forward when the tube is felt in the throat.

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?
1/1
Fast for 8 hours before the test

Continue to take all oral medications as scheduled

Eat a regular supper and breakfast
Monitor own bowel movement pattern for constipation
Feedback
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.

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?
1/1
TPN
PPN
NG FEEDING

Oral Liquid Supplements

Feedback
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.
Which of the following complications is thought to be the most common cause of
appendicitis?
1/1
fecalith

Bowel kinking
Internal bowel occlusion
Abdominal bowel swelling
Feedback
A fecalith is a fecal calculus, or stone, that occludes the lumen of the appendix and is the most common
cause of appendicitis. Bowel wall swelling, kinking of the appendix, and external occlusion, not internal
occlusion, of the bowel by adhesions can also be causes of appendicitis.

Which of the following laboratory values would be the most important to monitor for a
patient with pancreatic cancer?
1/1
Serum glucose

Radioimmunoassay (RIA)
Creatine phosphokinase (CPK)
Carcinoembryonic antigen (CEA)
Feedback
In pancreatitis, hypersecretion of the insulin from a tumor may affect the islets of Langerhans, resulting in
hyperinsulinemia, a complication of pancreatic cancer. Pancreatitis damages the cells that produce insulin
and glucagon, which are the hormones that control the amount of glucose in the blood. This can lead to an
increase in blood glucose levels.

You’re advising a 21 y.o. with a colostomy who reports problems with flatus. What food
should you recommend?
1/1
Peas
Cabbage
Broccoli
Yogurt

The nurse in the emergency room observes a physician examining a client with possible
appendicitis. The physician presses downward on the right lower quadrant of the abdomen
and asks the client to instruct him when he feels pain (application of pressure or pressure
release). What is the physician assessing for?
1/1
Ascites
Rebound tenderness

Turner’s sign
Rovsing’s sign
Feedback
The option “Rebound tenderness” is correct. Rebound tenderness indicates peritoneal irritation. The client
experiences increased pain when the examiner releases pressure in a positive result of this assessment
technique. The Options “Rovsing’s sign” and “Turner’s sign” are exhibited by other assessment measures,
so they are incorrect. Option “Ascites” is a condition of excessive peritoneal fluid in the abdominal cavity
associated with liver disorders

Based on consensus guidelines from the American College of Gastroenterology (ACG), if

you are the Nurse to advice the patient, when should patients with ulcerative colitis undergo
colonoscopy as screening for colorectal cancer?
1/1
Annually.
Eight years after the diagnosis of ulcerative colitis.

Every 3 years, because pseudopolyps can mask cancer.

Never; the risk of perforation is too high.
Feedback
Colorectal cancer is a well-known complication of chronic ulcerative colitis, with the risk increasing with
longer duration of the illness and higher inflammatory activity.1,2

The timing of the first screening examination and subsequent surveillance intervals have NOT been
studied prospectively; however, consensus guidelines suggest beginning surveillance 8 years after the
diagnosis of ulcerative colitis.1,2

A 59-year-old woman comes in to see you after trying to donate blood at a local blood drive.
She received a letter that said she could not donate at this time, as the routine blood screen
detected HCV infection.She has no symptoms and wants to know what to do next. What do
you tell her?
0/1
Recommend she do nothing until she has some symptoms.
Obtain a more complete history.
Immediately begin treatment with interferon and ribavirin.

Schedule an immediate liver biopsy to stage the infection.

A 42-year-old man presents to the office for follow-up of laboratory testing done at a prior
office visit. The patient has type 2 diabetes mellitus (T2DM) and is noted to be obese, with
a body mass index (BMI) of 39.5 kg/m2.A complete metabolic panel revealed mildly
elevated alanine transaminase (ALT) and aspartate transaminase (AST) concentrations of
75 U/L and 81 U/L, respectively. His most recent glycosylated hemoglobin (HbA1C) is
7.9%. He currently has no complaints. What is the most probable cause of his elevated
asymptomatic liver transaminases?
1/1
Excessive alcohol intake.
Hepatitis C virus (HCV) infection.
Nonalcoholic fatty liver disease (NAFLD).

New-onset cirrhosis.
Feedback
The most common causes of asymptomatic elevations in liver transaminases with the ratio of AST:ALT <2
are NAFLD and alcoholic liver disease.1 His T2DM is a risk factor for NAFLD, as is the metabolic
syndrome.

The patient has no history of excessive alcohol intake, so excessive alcohol intake is ruled out, but note
that the recommendation for men is to consume no more than 28 g alcohol (2 drinks) daily (14 g alcohol is
equivalent to 12 oz beer (5% alcohol), 5 oz wine (12% alcohol), or 1.5 oz 80-proof spirits (eg, gin, rum,
vodka, whiskey).2

Excessive ingestion of alcohol often presents with a ratio of elevation of AST:ALT of >2,1 and the
transaminases in this case are mildly elevated with a ratio of essentially 1:1.

When teaching an elderly client how to prevent constipation, which of the following
instructions should the nurse include?
1/1
“Drink 6 glasses of fluid each day.”
“Avoid grain products and nuts.”
“Add at least 4 grams of bran to your cereal each morning.”
“Be sure to get regular exercise.”

Feedback
Exercise helps prevent constipation. Fluids and dietary fiber promote normal bowel function. The client
should drink eight to ten glasses of fluid each day. Although adding bran to cereal helps prevent
constipation by increasing dietary fiber, the client should start with a small amount and gradually increase
the amount as tolerated to a maximum of 2 grams a day.
A 30-year old client experiences weight loss, abdominal distention, crampy abdominal pain,
and intermittent diarrhea after birth of her 2nd child. Diagnostic tests reveal gluten-induced
enteropathy. Which foods must she eliminate from her diet permanently?
1/1
Milk and dairy products
Protein-containing foods
Cereal grains (except rice and corn)

Carbohydrates
Feedback
To manage gluten-induced enteropathy, the client must eliminate gluten, which means avoiding all cereal
grains except for rice and corn. In initial disease management, clients eat a high calorie, high-protein diet
with mineral and vitamin supplements to help normalize nutritional status.

Which of the following diagnostic tests confirms malabsorption syndrome?

1/1
Complete blood count
Abdominal ultrasound
Panceatic function test
Endoscopy with biopsy

Feedback
Endoscopy with biopsy of the mucosa is the best diagnostic tool. . A complete blood cell count is used to
detect anemia. Pancreatic function tests can assist in the diagnosis of specific disorders. Abdominal
ultrasound is used to look at organs in the abdomen, including the liver, gallbladder, spleen, pancreas, and
kidneys.

A 55-year-old woman with a 35-year history of T2DM comes into the office today with
complaints of nausea and vomiting after eating. She reports that these symptoms have
been present for the past 4 months. She has noted some abdominal pain at times with
eating. Her diabetes is fairly well controlled with a recent A1C of 7.6%.What is the most
likely working diagnosis with the limited history presented?
0/1
GERD.

Barrett’s dysplasia.
NAFLD.
Gastroparesis
The nurse is caring for a client who is receiving total parenteral nutrition (hyperalimentation
and lipids). What is the PRIORITY nursing action on every eight hour shift?
1/1
Monitor blood pressure, temperature and weight
Change the tubing under sterile conditions
Adjust the infusion rate to provide for total volume
Check urine glucose, acetone and specific gravity

Feedback
Check urine glucose, acetone and specific gravity. This is because of the high dextrose and protein
content in parenteral nutrition, the nurse should assess the urine at least every 8 hours.

A 35-year-old woman comes into the office with a chief complaint of diarrhea with bloating
and cramping for the past 6 months. She remarks that most foods can cause this problem
to occur. She has had no weight changes and notes no vomiting. She is concerned that she
may have colon cancer after having “Googled” her signs and symptoms online.Which of the
following signs or symptoms would require further laboratory testing?
0/1
Rectal bleeding.
History of diarrhea and alternating constipation.

Bloating.
Chronicity of the symptoms.

A 29-year-old woman presents to your office with abdominal pain and cramping.Which of
the following tests is the most helpful in ruling out Crohn’s disease?
1/1
Stool tests for ova and parasites.
C-reactive protein.
Stool studies for Clostridium difficile.
Fecal calprotectin.

Feedback
Fecal calprotectin is the most useful test to rule out Crohn’s disease in adults (sensitivity 83%-100%,
specificity 60%-100%).1,2 The other tests may be more helpful in differentiating other causes when a
diagnosis of Crohn’s is being considered.

A patient asks, “Is surgery always the treatment of choice for inflamed salivary glands?”
Your best response would be:
0/1
Surgery is only recommended for children.
Yes, surgery is always the answer.

Elderly is not a candidate for parotidectomy.

The procedure is advised for chronic sialadenitis and uncontrolled pain.

The nurse is assessing a comatose client receiving gastric tube feedings. Which of the
following assessments requires an IMMEDIATE response from the nurse?
1/1
Urine output of 250 cc in past eight hours
Decreased breath sounds in right lower lobe

Decrease in bowel sounds

Aspiration of a residual of 100cc of formula
Feedback
Decreased breath sounds in right lower lobe is the correct option.The most common problem associated
with enteral feedings is atelectasis. Maintain client at 30 degrees during feedings and monitor for signs of
aspiration. Check for tube placement prior to each feeding or every four to eight hours if continuous
feeding.

The healthcare provider performs a paracentesis on a client with ascites and 3 liters of fluid
are removed. Which assessment parameter is most critical for the nurse to monitor
following the procedure?
1/1
Gag reflex.
Breath sounds.
Pedal pulses.
Vital signs.

Feedback
Life-threatening complications such as hypovolemia and sepsis can occur following a paracentesis, and
measurement of vital signs will provide assessment data that will help detect the occurrence of such
complications.Pedal pulses might be assessed to check for circulation in the lower extremities, but are not
indicated for postparacentesis assessment. Reduction of breath sounds may occur as the result of
decreased fluid in the peritoneal cavity, but is a desired outcome, not a complication, of this procedure.
Gag reflex is not affected by a paracentesis procedure.

Which of the following entries on a client’s progress notes is the MOST complete?
1/1
Client’s urinary output adequate
Demerol 75mg administered for severe abdominal pain
100 cc of dark green drainage from Nasogastric tube

Client seems anxious about low salt diet

Feedback
Entries in client records need to be complete, accurate and factual. Records can only be used by third
party payers if they are accurate, reliable and valid.

A patient complains about an inflamed salivary gland below his right ear. The nurse
documents probable inflammation of which glands?
1/1
Submandibular
Buccal
Parotid

Sublingual
Feedback
The parotid glands are a pair of mainly serous salivary glands located below and in front of each ear
canal.

A client with acute appendicitis develops fever, tachycardia, and hypotension. Based on
these assessment findings, the nurse suspects which of the following complications?
1/1
Peritonitis

Bowel ischemia
Intestinal obstruction
Deficient fluid volume
Feedback
Complications of acute appendicitis are perforation, peritonitis, and abscess development. Signs of
peritonitis include abdominal pain and distention, tachycardia, tachypnea, nausea, vomiting, and fever.
Because peritonitis can cause hypovolemic shock, hypotension can develop. Deficient fluid volume would
not cause fever. Intestinal obstruction would
cause abdominal distention, diminished or absent bowel sounds, and abdominal pain. Bowel ischemia has
signs similar to
those found with intestinal obstruction.

All of the following are considered complications of constipation except:

0/1
Hemorrhoids
Fecal impaction
Hypokalemia
Hypertension

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?
1/1
Aspirate for gastric secretions with a syringe.

Begin feeding slowly to prevent cramping.

Get an X-ray of the tip of the tube within 24 hours.
Clamp off the tube until the feedings begin.
Feedback
Aspirating the stomach contents confirms correct placement. If an X-ray is ordered, it should be done
immediately, not in 24 hours.

The nurse is doing an assessment on a client during the first postoperative day after
abdominal surgery. Which of the following manifestations does the nurse report
immediately?
1/1
Inability to void immediately after urinary catheter is removed
Leg swelling and calf pain

Decreased bowel sounds

Mild abdominal distention
Feedback
Clients with pelvic or abdominal procedures are at an increased risk of developing deep vein thrombosis
(DVT). Unilateral edema and calf pain are signs that are consistent with DVT and must be reported
immediately so treatment can begin to prevent pulmonary embolus.

The nurse is caring for a client with cholecystitis. Which clinical manifestation would the
nurse expect the client to exhibit?
1/1
Fever

Dysphagia
Bradycardia
Hiccups
Feedback
Fever is correct. Other clinical manifestations include pain, nausea, vomiting, and rebound tenderness
upon palpation, flatulence, and indigestion. The other options are not associated with cholecystitis, so they
are incorrect.

A client with irritable bowel syndrome is being prepared for discharge. Which of the
following meal plans should the nurse give the client?
1/1
Low fiber, low-fat
High fiber, low-fat

Low fiber, high-fat

High-fiber, high-fat
Feedback
The client with irritable bowel syndrome needs to be on a diet that contains at least 25 grams of fiber per
day. Fatty foods are to be avoided because they may precipitate symptoms.

The nurses on a unit are planning for stoma care for clients who have a stoma for fecal
diversion. Which stomal diversion poses the highest risk for skin breakdown?
1/1
Sigmoid colostomy
Transverse colostomy
Ileal conduit
Ileostomy

A client with acute viral hepatitis has a serum bilirubin of 3.6 mg/dL on admission. A nurse
should expect the client to report:
1/1
A high fever for several days.
Dark orange urine.

Red, irritated eyes.

Tar-colored bowel movements.
Feedback
Dark orange urine is correct because,when total bilirubin is elevated (normal 0 to 0.9 mg/dL),bilirubin is
excreted in the urine, which becomes deep orange and foamy.Bowel movements are clay-colored with
liver disease. Tar-colored stools would be seen with GI bleeding or iron supplements. A high fever for
several days is incorrect because, if there are symptoms other than jaundice, they would be flu-like with
maybe a fever. If the eyes were involved, the sclera would be yellow (jaundiced),not red.
Peptic ulcer disease particularly gastric ulcer is thought to be cause by which of the
following microorgamisms?
1/1
E. coli
H. pylori

S. aureus
K. pnuemoniae
Feedback
Rationalization: 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.

Which of the following measures helps relieve pain to a client with gastritis?
1/1
Avoid foods and beverages that may be irritating to the gastric mucosa.

Monitor fluid intake and output daily to detect early signs of dehydration.
Administer Amoxicillin (Amoxil) twice a day.
Start intravenous fluid therapy.
Feedback
Avoiding irritant foods help relieve abdominal discomfort/pain. Option B & D promotes fluid balance, option
C is for H. pylori infection.

An 82 year-old client complains of chronic constipation. To improve bowel function, the

nurse should FIRST suggest?
1/1
Increasing fiber intake to 20-30 grams daily

Daily use of laxatives

Avoidance of binding foods such as cheese and chocolate
Monitoring a balance between activity and rest
Feedback
The incorporation of high fiber into the diet is an effective way to promote bowel elimination in the elderly.

A client is complaining of epigastric pain after eating. The physician suspects peptic ulcer
disease (PUD) and orders a urea breath test for H. pylori. Which would the nurse include in
the teaching plan for test preparation?
1/1
High-fat meal two hours before the test
Asking the client to bring a sputum sample with her for analysis
Nothing by mouth the night before the test

Clear liquids the day before the test

Feedback
The only preparation for H. pylori urea breath test is NPO after midnight. In this test, the client drinks a
carbon-enriched urea liquid and then CO2 is measured for H. pylori. The options “Clear liquids the day
before the test”, “High-fat meal two hours before the test” and “Asking the client to bring a sputum sample
with her for analysis” are not part of the preparation for an H. pylori urea breath test, so they are incorrect
options.

A 42-year-old man presents to your office with rectal urgency, a feeling of abdominal
fullness, and bright red rectal bleeding for 2 weeks.Physical examination reveals no gross
hemorrhoidal tissue or external skin lesions, but a fecal occult blood test is grossly positive.
1/1
Internal hemorrhoids.
Crohn’s disease.
Ulcerative colitis.

Irritable bowel syndrome (IBS

Feedback
The most likely diagnosis is ulcerative colitis. Ulcerative colitis should be suspected in patients with
hematochezia, urgency, and a sense of pressure.1

She is for occult blood test; what specimen will you collect?
1/1
Blood
Urine
Stool

Gastric Juice
Feedback
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.

Which of the following medical management is recommended for salivary calculus?

0/1
Nephrectomy
Antibiotic therapy
Lithotripsy
Endoscopy

You’re performing an abdominal assessment on Brent who is 52 y.o. In which order do you
proceed?
1/1
Observation, percussion, palpation, auscultation
Observation, auscultation, percussion, palpation

Percussion, palpation, auscultation, observation

Palpation, percussion, observation, auscultation
Feedback
The correct sequence when examining the abdomen is: Observation, auscultation, percussion, palpation

A 34-year-old woman presents to your office with episodic lower abdominal pain and
bloating, which she has had for the past year. She says she has frequent loose stools
without any blood and that her symptoms abate after a loose stool. She has not had any
weight changes and has no history of travel outside the United States. Her appetite is fair,
and she denies fever.Which of the following conditions is the most likely diagnosis?
0/1
Crohn’s disease.
IBS with mixed bowel habits (IBS-M).

Parasitic infection.
IBS with diarrhea (IBS-D).

A 45-year-old man presents to the clinic with complaints of heartburn for the past month. He
says that it wakes him up several times a week. He has tried over-the-counter ranitidine
without much symptom relief.What symptoms would suggest he needs an
esophagogastroduodenoscopy (EGD)?
0/1
Improvement of symptoms with a proton pump inhibitor (PPI).

Weight gain.
Worsening symptoms after ingestion of fried chicken.
Difficulty in swallowing.

For Sliding Hiatal Hernia, all are clinical manifestations except:

1/1
Heartburn
Halitosis

Regurgitation
Dysphagia
Feedback
Rationalization: All are sign and symptoms of sliding hiatal hernia except Halitosis which is present in
Paraesophageal hiatal hernia.

While palpating a female client’s right upper quadrant (RUQ), the nurse would expect to find
which of the following structures?
1/1
Appendix
Sigmoid colon
Spleen
Liver

Feedback
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.

During assessment, the nurse is looking for positive indicators of appendicitis, which
include all of the following except:
1/1
vomiting
low-grade fever
Thrombocytopenia

Abdominal tenderness upon palpation

Feedback
Complete blood count in appendicitis reveals elevated WBC count with an elevation of neutrophils.
Thrombocytopenia is a condition in which you have a low blood platelet count. Options A. B, & D are
expected in appendicitis.

Which sign/symptom should the nurse expect to find in a client diagnosed with ulcerative
colitis?
1/1
Urinary stress incontinence.
Hard, rigid abdomen.
Twenty bloody stools a day.

Oral temperature of 102˚F.

Claire, a 33 y.o. is on your floor with a possible bowel obstruction. Which intervention is
priority for her?
1/1
Obtain daily weights.
Measure abdominal girth.

Keep strict intake and output.

Encourage her to increase fluids.

A patient admitted with inflammatory bowel disease asks the nurse for help with menu
selections. What menu selection is most likely the best choice for this patient?
1/1
Spinach
Tofu

Multigrain bagel
Blueberries
Feedback
Nutritional management of inflammatory bowel disease requires ingestion of a diet that is bland, low
residue, high-protein, and high-vitamin. Tofu meets each of the criteria. Spinach, multigrain bagels, and
blueberries are not low-residue.

The nurse is assessing a client’s gastrointestinal tract. Which of the following subjective
assessments should be included?
1/1
Diarrhoea
Rebound tenderness

Haematuria
Generalized red abdominal rash
Feedback
Assessment includes both subjective and objective data. Rebound tenderness is sudden pain when the
examiner palpating the abdomen removes the examining fingers and the client complains of pain.
Diarrhoea, generalized red abdominal rash, and haematuria are all observable and therefore objective, not
subjective, data.
You refer your patient, a 46-year-old otherwise healthy man, for a colonoscopy because he
has rectal bleeding and pain.The report notes cobble-stoning of the mucosa with some
ulcerations, and areas of “skip” lesions, that is, areas of intestinal inflammation next to
apparently normal mucosa.These findings are most consistent with which illness?
1/1
Crohn’s disease.

Ulcerative colitis.
Familial polyposis syndrome.
IBS.
Feedback
Rectal bleeding is one of the red flag symptoms suggestive of Crohn’s disease. Crohn’s disease is a
transmural process that demonstrates skip lesions with cobble- stoning and ulcerations.1 Strictures are
often found, as well.
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