GASTROINTESTINAL REVIEWER

SET A
1) Which of the following tests should be administered to client with diverticulosis?
a. Proctosocopy
b. Barium enema
c. Barium swallow
d. Gastroscopy

Question 1 Explanation: Barium enema is used to diagnose diverticulosis, however, this is

contraindicated when diverticulitis is present because of the risk of rupturing the diverticulum.
Test taking skill: options b and c are opposite; one may be the correct answer.

2) How about ulcerative colitis, which of the following factors is believed to cause it?
a. Acidic die
b. Altered immunity
c. Chronic constipation
d. Emotional stress
Question 2 Explanation: Refer to rationale for number 23. Test taking skill: which does not
belong? Options a, c and d are all modifiable factors

3) Mrs. Cruz’ body mass index (BMI) is 25. You can categorized her as:
a. normal
b. overweight
c. underweight
d. obese
Question 3 Explanation: Mr. Cruz’ BMI belongs to the overweight category (24 – 26),
malnourished (less than 17), underweight (17 – 19), normal (20 – 23), obese (27 – 30) and
morbidly obese (greater than 30). BMI is weight in kilograms divided by height in square meters.

4) Peptic ulcer disease particularly gastric ulcer is thought to be cause by which of the following
microorgamisms?
a. E. coli
b. H. pylori
c. S. aureus
d. K. pnuemoniae
Question 4 Explanation: 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.

5) After a few minutes, the pain suddenly stops without any intervention. Nurse Ray might
suspect that:
a. the appendix is still distended
b. the appendix may have ruptured
 c. an increased in intrathoracic pressure will occur
d. signs and symptoms of peritonitis occur
Question 5 Explanation: If a confirmed diagnosis is made and the pain suddenly without any
intervention, the appendix may have ruptured; the pain is lessened because the appendix is no
longer distended thus surgery is still needed.

6) Mr. Jung, had ulcerative colitis for 5 years and was admitted to the hospital. Which of the
following factors was most likely of greatest significance in causing an exacerbation of the
disease?
a. A demanding and stressful job
b. Changing to a modified vegetarian diet
c. Beginning a weight training program
d. Walking 2 miles everyday
Question 6 Explanation: Stress is an environmental factor that is thought to cause ulcerative
colitis. Test taking skill: options b, c, and d are all healthy lifestyles.

7) The doctor orders for Witch Hazel 5 %. Nurse Nico knows that the action of this astringent is:
a. temporarily relieves pain, burning, and itching by numbing the nerve endings
b. causes coagulation (clumping) of proteins in the cells of the perianal skin or the lining of
the anal canal
c. inhibits the growth of bacteria and other organisms
d. causes the outer layers of skin or other tissues to disintegrate
Question 7 Explanation: Option a are local anesthetics; c are antiseptics and d are keratolytics.

8) Client education should include minimizing client discomfort due to hemorrhoids. Nursing
management should include:
a. Suggest to eat low roughage diet
b. Advise to wear silk undergarments
c. Avoid straining during defecation
d. Use of sitz bath for 30 minutes
Question 8 Explanation: Straining can increase intra abdominal pressure. Health teachings also
include: suggest to eat high roughage diet, wearing of cotton undergarments and use of sitz
bath for 15 minutes.

9) Most digestive activity occurs in the pyloric region of the stomach. What hormone stimulates
the chief cells to produce pepsinogen?
a. Gastrin
b. Pepsin
c. HCl
d. Insulin
Question 9 Explanation: Rationale: Gastrin stimulates chief cells to produce pepsinogen when
foods enter and suppression of pepsinogen when it leaves and enters the small intestines; it is
the major hormone that regulates acid secretion in the stomach. Pepsin; a gastric protease
 secreted in an inactive form, pepsinogen, which is activated by stomach acid that acts to
degrade protein. HCl is produced by the parietal cells. Insulin is a pancreatic hormone.

10) Four hours post – operatively, Mr. Sean complains of guarding and rigidity of the abdomen.
Nurse Leonard’s initial intervention is:
a. assess for signs of peritonitis
b. call the physician
c. administer pain medication
d. ignore the client
Question 10 Explanation: Assessment precedes intervention. Symptoms presented are signs of
peritonitis. Assessment will provide you the data for prompt intervention.

11) She is for occult blood test, what specimen will you collect?
a. Blood
b. Urine
c. Stool
d. Gastric Juice
Question 11 Explanation: 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.

12) Mr. Sean has undergone surgery. Post – operatively, which of the following findings is
normal?
a. absent bowel sounds
b. bleeding
c. hemorrhage
d. bowel movement
Question 12 Explanation: Post – operatively, no bowel sounds are present so this is a normal
finding. Bleeding and hemorrhage must be prevented to avoid complications. Bowel movement
occurs only after flatus and bowel sounds are noted.

13) Which position would be ideal for the client in the early postoperative period after
hemorrhoidectomy?
a. High Fowler’s
b. Supine
c. Side – lying
d. Trendelenburg’s
Question 13 Explanation: Positioning in the early postoperative phase should avoid stress and
pressure on the operative site. The prone and side – lying are ideal from a comfort perspective.
A high Fowler’s or supine position will place pressure on the operative site and is not
recommended. There is no need for trendelenburg’s position.
14) Situation 5: IBD is a common inflammatory functional bowel disorder also known as spastic
bowel, functional colitis and mucous colitisThe client with IBS asks Nurse June what causes
the disease. Which of the following responses by Nurse June would be most appropriate?
a. “The cause of this condition is unknown”
b. “There is thinning of the intestinal mucosa caused by ingestion of gluten”
c. “This is an inflammation of the bowel caused by eating too much roughage”
d. “IBS is caused by a stressful lifestyle”
Question 14 Explanation: There is no known cause of IBS, and diagnosis is made by excluding all
the other diseases that cause the symptoms. There is no inflammation if the bowel. Some
factors exacerbate the symptoms including anxiety, fear, stress, depression, some foods and
drugs but there do not cause the disease.

15) The doctor ordered for a complete blood count. After the test, Nurse Ray received the result
from the laboratory. Which laboratory values will confirm the diagnosis of appendicitis?
a. RBC 5.5 x 106/mm3
b. Hct 44 %
c. WBC 13, 000/mm3
d. Hgb 15 g/dL
Question 15 Explanation: Increase in WBC counts is suggestive of appendicitis because of
bacterial invasion and inflammation. Normal WBC count is 5, 000 – 10, 000/mm3. Other options
are normal values.

16) Upon review of Mr. Trinidad’s chart, Nurse Drew noticed that he weighs 121 lbs and his
height is 5 ft, 4 in. After computing for his Body Mass Index (BMI), you can categorize him as:
a. obese
b. normal
c. overweight
d. underweight
Question 16 Explanation: Mr. Trinidad’s BMI is 23 which is normal. Overweight category (24 –
26), malnourished (less than 17), underweight (17 – 19), normal (20 – 23), obese (27– 30) and
morbidly obese (greater than 30). BMI is weight in kilograms divided by height in square meters.

17) Diarrhea is believed to be caused by all of the following except

a. increase intestinal secretions
b. altered immunity
c. decrease mucosal absorption
d. altered motility
Question 17 Explanation: Diarhhea is an intestinal disorder that is self – limiting. Options a, c and
d are etiological factors of diarrhea.
18) Situation 4: Nurse Gloria is the staff nurse assigned at the Emergency Department. During her
shift, a patient was rushed – in the ED complaining of severe heartburn, vomiting and pain
that radiates to the flank. The doctor suspects gastric ulcer. What other symptoms will
validate the diagnosis of gastric ulcer?
a. right epigastric pain
b. pain occurs when stomach is empty
c. pain occurs immediately after meal
d. pain not relieved by vomiting
Question 18 Explanation: In gastric ulcer food intake aggravates pain which usually occur ½ - 1
hour before meal or immediately during or after food intake. Options a, b, c suggests duodenal
ulcer.

19) To avoid acid reflux, Nurse Yoshi should advice Mrs. Cruz to avoid which type of diet?
a. cola, coffee and tea
b. high fat, carbonated and caffeinated beverages
c. beer and green tea
d. lechon paksiw and bicol express
Question 19 Explanation: All are correct but option b is the best answer. In patients with GERD,
this type of diet must be avoided to avoid backflow of gastric contents. Excessive caffeine
reduces the tone of lower esophageal sphincter. Test Taking Skills: look for the umbrella effect

20) Situation 6: A patient was admitted in the Medical Floor at St. Luke’s Hospital. He was
asymptomatic. The doctor suspects diverticulosis.Which of the following definitions best
describes diverticulosis?
a. An inflamed outpouching of the intestine
b. A non – inflamed outpouching of the intestine
c. The partial impairment of the forward flow of instestinal contents
d. An abnormal protrusions of an oxygen through the structure that usually holds it
Question 20 Explanation: An increase intraluminal pressure causes the outpouching of the colon
wall resulting to diverticulosis. Option a suggests diverticulitis. Test taking skill: one of the
opposite is the correct answer.

21) What pancreatic enzyme aids in the digestion of carbohydrates?

a. Lipase
b. Trypsin
c. Amylase
d. Chymotrypsin
Question 21 Explanation: Amylase aids in the digestion of carbohydrates. Trypsin/Chymotrypsin
aids in the digestion of proteins. Lipase aids in the digestion of fats.

22) Which of the following types of diet is implicated in the development of diverticulosis?
a. Low – fiber diet
b. High – fiber diet
c. High – protein diet
 d. Low – carbohydrate diet
Question 22 Explanation: A lack of adequate blood supply and nutrients from the diet such as
low fiber foods may contribute to the development of the disease. Test taking skill: one of the
opposite is the correct answer.

23) What diagnostic test would yield good visualization of the ulcer crater?
a. Endoscopy
b. Gastroscopy
c. Barium Swallow
d. Histology
Question 23 Explanation: Endoscopy determines bleeding, pain, difficulty swallowing, and a
change in bowel habits. This would yield good visualization of the ulcer crater. Other options are
also diagnostic tests in PUD.

24) To identify any localized bulging, distention and peristaltic waves, Nurse Dorina must perform
which of the following?
a. Auscultation
b. Inspection
c. Palpation
d. Percussion
Question 24 Explanation: RInspection is the first step in abdominal exam to note the contour
and symmetry of abdomen as well as localized bulging, distention and peristaltic waves.
Auscultation is done to determine the character, location and frequency of bowel sounds.
Percussion is to assess tympany or dullness. Palpation is to asses areas of tenderness and
discomfort. Note: In abdominal exam: Inspection, Auscultation, Percussion and Palpation are the
correct order.

25) Mr. Lim verbalized pain on the right iliac region. Nurse Dorina knows that the organ affected
would be the:
a. liver
b. sigmoid colon
c. appendix
d. duodenum
Question 25 Explanation: Appendix and cecum is located in the right iliac region. Liver and gall
bladder is at the right hypochondriac. Sigmoid colon is at the left iliac. Duodenum, stomach and
pancreas is in the epigastric region.

26) Which of the following complications is thought to be the most common cause of
appendicitis?
a. A fecalith
b. Internal bowel occlusion
c. Bowel kinking
d. Abdominal wall swelling
 Question 26 Explanation: A fecalith is a hard piece of stool which is stone like that commonly
obstructs the lumen. Due to obstruction, inflammation and bacterial invasion can occur. Tumors
or foreign bodies may also cause obstruction.

27) Situation 3: Mrs. Cruz was admitted in the Medical Floor due to pyrosis, dyspepsia and
difficulty of swallowing. Based from the symptoms presented, Nurse Yoshi might suspect:
a. Esophagitis
b. Hiatal hernia
c. GERD
d. Gastric Ulcer
Question 27 Explanation: GERD is the backflow of gastric or duodenal contents into the
esophagus caused by incompetent lower esophageal sphincter. Pyrosis or heartburn, dyspepsia
and dysphagia are cardinal symptoms.

28) Situation 10: Nurse Nico is caring to a 38-year-old female, G3P3 client who has been
diagnosed with hemorrhoids. Which of the following factors would most likely be a primary
cause of her hemorrhoids?
a. Her age
b. Three vaginal delivery pregnancies
c. Her job as a school teacher
d. Varicosities in the legs
Question 28 Explanation: Hemorrhoids are associated with prolonged sitting, or standing, portal
hypertension, chronic constipation and prolonged intra abdominal pressure as associated with
pregnancy and the strain of vaginal delivery. Her job as a schoolteacher does not require
prolong sitting or standing. Age and leg varicosities are not related to the development of
hemorrhoids.

29) Which of the following alimentary canal is the most common location for Chron’s disease?
a. Descending colon
b. Jejunum
c. Sigmoid Colon
d. Terminal Ileum
Question 29 Explanation: Chronic inflammatory of GI mucosa occurs anywhere from the mouth
to anus but most often in terminal ileum. Inflammatory lesions are local and involve all layers of
the intestinal wall.

30) Situation 2: Nurse Dorina is going to perform an abdominal examination to Mr. Lim who was
admitted due to on and off pain since yesterday. How will you position Mr. Lim prior to
procedure?
a. supine with knees flexed
b. prone
c. lying on back
d. sim’s
 Question 30 Explanation: During abdominal examination, positioning the client in supine with
knees flexed will promote relaxation of abdominal muscles. Options b and d are inaccurate in
this type of procedure. Lying on back or supine may be correct but option a is the best answer.

31) Preparation of the client for occult blood examination is:

a. Fluid intake limited only to 1 liter/day
b. NPO for 12 hours prior to obtaining of specimen
c. Increase fluid intake
d. Meatless diet for 48 hours prior to obtaining of specimen
Question 31 Explanation: Eating meat can cause false positive test result. Using proper stool
collection technique, avoiding certain drugs, and observing dietary restrictions can minimize
these measurement errors.

32) In order to identify areas of tenderness and swelling, Nurse Dorina must do:
a. deep palpation
b. light palpation
c. percussion
d. palpation
Question 32 Explanation: Light palpation is done to identify areas of tenderness and swelling.
Deep palpation is done to identify masses in all four quadrants. Test taking skills: one of the
opposite is the correct answer

33) Mr. Lim felt pain upon release of Nurse Dorina’s hand. This can be referred as:
a. referred pain
b. rebound tenderness
c. direct tenderness
d. indirect tenderness
Question 33 Explanation: Rebound tenderness is pain felt upon sudden release of the examiners
hand which in most cases suggest peritonitis. Referred pain is pain felt in an area remote from
the site of origin. Direct tenderness is localized pain upon palpation. Indirect tenderness is pain
outside the area of palpation.

34) Situation 1: Children have a special fascination with the workings of the digestive system. To
fully understand the digestive processes, Nurse Lavigña must be knowledgeable of the
anatomy and physiology of the gastrointestinal system. The alimentary canal is a continuous,
coiled, hollow muscular tube that winds through the ventral cavity and is open at both ends.
Its solid organs include all of the following except:
a. liver
b. gall bladder
c. stomach
d. pancreas
Question 34 Explanation: Stomach is a hollow digestive organ in the GI tract. The liver, gall
baldder and pancreas are all solid organs which are part of the hepato-biliary system. Test taking
skills: which does not belong to the group?
35) Nurse Nico instructs her client who has had a hemorrhoidectomy not to used sitz bath until at
least 12 hours postoperatively to avoid which of the following complications?
a. Hemorrhage
b. Rectal Spasm
c. Urinary retention
d. Constipation
Question 35 Explanation: Applying heat during the immediate postoperative period may cause
hemorrhage at the surgical site. Moist heat may relieve rectal spasms after bowel movements.
Urinary retention caused by reflex spasm may also be relieved by moist heat. Increasing fiber
and fluid in the diet can help constipation.

36) Nasogastric tube was inserted to Mr. Sean. The NGT’s primary purpose is:
a. nutrition
b. decompression of bowel
c. passage for medication
d. aspiration of gastric contents
Question 36 Explanation: The NGT’s primary purpose is for bowel decompression especially for
clients suffering from obstruction.

37) What diagnostic test would confirm the type of problem Mrs. Cruz have?
a. barium enema
b. barium swallow
c. colonoscopy
d. lower GI series
Question 37 Explanation: Barium swallow or upper GI series would confirm GERD. Endoscopy is
another diagnostic test. Options a and d are the same. Option c is incorrect.

38) Which of the following factors is believed to be linked to Chron’s disease?

a. Diet
b. Constipation
c. Heredity
d. Lack of exercise
Question 38 Explanation: The cause is unknown but is thought to be multifactorial. Heredity,
infectious agents, altered immunity or autoimmune and environmental are factors to be
considered. Test taking skill: which does not belong? Options a, b, and d are all modifiable
factors.

39) What is the immediate home care management for diarrhea?

a. Milk
b. Imodium
c. Water
d. Oresol
 Question 39 Explanation: Oresol is the immediate home care management for diarrhea to
prevent dehydration. Water may not be enough to prevent diarrhea.

40) Once food has been placed in the mouth, both mechanical and chemical digestions begin. The
six activities of the digestive process are:
a. ingestion, mastication, digestion, deglutition, absorption, egestion
b. ingestion, mastication, deglutition, digestion, absorption, egestion
c. deglutition, ingestion, mastication, egestion, absorption, defecation
d. ingestion, digestion, mastication, deglutition, absorption, defecation
Question 40 Explanation: The digestive processes involve six steps. Ingestion is taking in of food
in the mouth; mastication is the mechanical process where food is converted into bolus;
deglutition is the act of swallowing; digestion is the chemical breakdown of food into chime;
absorption occurs in the small intestines (solutes) and large intestines (water) and
egestion/defecation where elimination of feces occur.

41) Situation 7: Manny, 6 years old was admitted at Cardinal Santos Hospital due to increasing
frequency of bowel movements, abdominal cramps and distension. Diarrhea is said to be the
leading cause of morbidity in the Philippines. Nurse Harry knows that diarrhea is present if:
a. passage of stool is more than 3 bowel movements per week
b. passage of stool is less than 3 bowel movements per day
c. passage of stool is more than 3 bowel movements per day
d. passage of stool is less than 3 bowel movements per week

42) Mrs. Cruz complained of pain and difficulty in swallowing. This term is referred as:
a. Odynophagia
b. Dysphagia
c. Pyrosis
d. Dyspepsia
Question 42 Explanation: When difficulty of swallowing is accompanied with pain this is now
referred as odynophagia. Dysphagia is difficulty of swallowing alone.

43) To improve Mr. Trinidad’s condition, your best nursing intervention and teaching is:
a. Reduce fluid intake
b. Increase fiber in the diet
c. Administering of antibiotics
d. Exercise to increase intraabdominal pressure
Question 43 Explanation: Mr. Trinidad’s BMI is 23 which is normal. Refer to rationale number
15.

44) Pharynx is lined with mucous membranes and mucous secreting glands to ease the passage of
food. The larygngopharynx serves as passageway for:
a. air only
b. air and water
c. food, fluids and air
 d. air and food
Question 44 Explanation: Rationale: The laryngopharynx serves as passageway for air and food
and so as with the oropharynx. Option a is nasopharynx. Answers b and c may be correct but air
and food is more accurate.

45) Client education should be given in order to prevent constipation. Nurse Leonard’s health
teaching should include which of the following?
a. use of natural laxatives
b. fluid intake of 6 glasses per day
c. use of OTC laxatives
d. complete bed rest
Question 45 Explanation: The use of natural laxatives such as foods and fruits high in fiber is still
the best way of preventing constipation Increasing fluid intake, taking laxatives judiciously and
exercise also can prevent this.

46) Voluminous, watery stools can deplete fluids and electrolytes. The acid base imbalance that
can occur is:
a. metabolic alkalosis
b. metabolic acidosis
c. respiratory acidosis
d. respiratory alkalosis
Question 46 Explanation: In diarrhea, metabolic acidosis is the acid – base imbalance that occurs
while in vomiting, metabolic alkalosis occur. This is a metabolic disorder that’s why eliminate
options c and d.

47) What life threatening condition may result in persistent diarrhea?

a. hypokalemia
b. dehydration
c. cardiac dysrhytmias
d. leukocytosis
Question 47 Explanation: Due to increase frequency and fluid content in the stools, diarrhea
may cause fluid and electrolyte imbalance such as hypokalemia. Once potassium is depleted,
this will affect the contractility of the heart causing cardiac arrhythmia leading to death.

48) Signs and symptoms include pain in the RLQ of the abdomen that may be localize at
McBurney’s point. To relieve pain, Mr. Liu should assume which position?
a. Prone
b. Supine, stretched out
c. Sitting
d. Lying with legs drawn up
Question 48 Explanation: Posturing by lying with legs drawn up can relax the abdominal muscle
thus relieve pain.
 49) Situation 8: Mr. Sean is admitted to the hospital with a bowel obstruction. He complained of
colicky pain and inability to pass stool. Which of these findings by Nurse Leonard, would
indicate that the obstruction is in the early stages?
a. high pitched tinkling or rumbling bowel sounds
b. hypoactive bowel sounds
c. no bowel sounds auscultated
d. normal bowel sounds heard in all four quadrants
Question 49 Explanation: Early in the bowel obstruction, the bowel attempts to move the
contents past the obstruction and this is heard as high pitched tinkling bowel sounds. As the
obstruction progresses, bowel sounds will diminish and may finally become absent.

50) Situation 9: Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe
pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 °F.
Which of the following would confirm a diagnosis of appendicitis?
a. The pain is localized at a position halfway between the umbilicus and the right iliac
crest.
b. Mr. Liu describes the pain as occurring 2 hours after eating
c. The pain subsides after eating
d. The pain is in the left lower quadrant
Question 50 Explanation: Pain over McBurney’s point, the point halfway between the umbilicus
and the iliac crest, is diagnosis for appendicitis. Options b and c are common with ulcers; option
d may suggest ulcerative colitis or diverticulitis.

SET B
1) The nurse instructs the nursing assistant on how to provide oral hygiene for a client who
cannot perform this task for himself. Which of the following techniques should the nurse tell
the assistant to incorporate into the client’s daily care?
a. Assess the oral cavity each time mouth care is given and record observations
b. Swab the client’s tongue, gums, and lips with a soft foam applicator every 2 hours.
c. Rinse the client’s mouth with mouthwash several times a day.
d. Use a soft toothbrush to brush the client’s teeth after each meal
Question 1 Explanation: A soft toothbrush should be used to brush the client’s teeth after each
meal and more often as needed. Mechanical cleaning is necessary to maintain oral health,
simulate gingiva, and remove plaque. Assessing the oral cavity and recording observations is the
responsibility of the nurse, not the nursing assistant. Swabbing with a safe foam applicator does
not provide enough friction to clean the mouth. Mouthwash can be a drying irritant and is not
recommended for frequent use.
2) The client has orders for a nasogastric (NG) tube insertion. During the procedure, instructions
that will assist in the insertion would be:
a. Introduce the tube with the client’s head tilted back, then instruct him to keep his head
upright for final insertion
b. After insertion into the nostril, instruct the client to extend his neck
c. Instruct the client to tilt his head back for insertion in the nostril, then flex his neck for
the final insertion
d. Instruct the client to hold his chin down, then back for insertion of the tube
Question 2 Explanation: NG insertion technique is to have the client first tilt his head back for
insertion into the nostril, then to flex his neck forward and swallow. Extension of the neck will
impede NG tube insertion.

3) A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements
best indicates that the client understands how to correctly take the antacid?
a. “My antacid will be most effective if I take it whenever I experience stomach pains.”
b. “It is best for me to take my antacid 1 to 3 hours after meals.”
c. “I should take my antacid before I take my other medications.”
d. “I need to decrease my intake of fluids so that I don’t dilute the effects of my antacid.”
Question 3 Explanation: Antacids are most effective if taken 1 to 3 hours after meals and at
bedtime. When an antacid is taken on an empty stomach, the duration of the drug’s action is
greatly decreased. Taking antacids 1 to 3 hours after a meal lengthens the duration of action,
thus increasing the therapeutic action of the drug. Antacids should be administered about 2
hours after other medications to decrease the chance of drug interactions. It is not necessary to
decrease fluid intake when taking antacids.

4) The most important pathophysiologic factor contributing to the formation of esophageal

varices is:
a. Increased central venous pressure
b. Decreased prothrombin formation
c. Portal hypertension
d. Decreased albumin formation by the liver
Question 4 Explanation: As the liver cells become fatty and degenerate, they are no longer able
to accommodate the large amount of blood necessary for homeostasis. The pressure in the liver
increases and causes increased pressure in the venous system. As the portal pressure increases,
fluid exudes into the abdominal cavity. This is called ascites.

5) The nurse is providing discharge instructions to a client following gastrectomy. Which

measure will the nurse instruct the client to follow to assist in preventing dumping syndrome?
a. Ambulate following a meal
b. Limit the fluids taken with meals
c. Eat high-carbohydrate foods
d. Sit in a high-Fowlers position during meals
Question 5 Explanation: The nurse should instruct the client to decrease the amount of fluid
taken at meals and to avoid high carbohydrate foods including fluids such as fruit nectars; to
 assume a low-Fowler’s position during meals; to lie down for 30 minutes after eating to delay
gastric emptying; and to take antispasmidocs as prescribed.

6) The nurse would assess the client experiencing an acute episode of cholecysitis for pain that
is located in the right
a. Lower quadrant and radiates to the back
b. Lower quadrant and radiates to the umbilicus
c. Upper quadrant and radiates to the right scapula and shoulder
d. Upper quadrant and radiates to the left scapula and shoulder
Question 6 Explanation: During an acute “gallbladder attack,” the client may complain of severe
right upper quadrant pain that radiates to the right scapula and shoulder. This is governed by
the pattern on dermatones in the body.

7) A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to
undergo a subtotal gastrectomy (Billroth II procedure). During pre-operative teaching, the
nurse is reinforcing information about the procedure. Which of the following explanations is
most accurate?
a. The procedure will result in anastomosis of the gastric stump to the jejunum
b. The procedure will result in repositioning of the vagus nerve
c. The procedure will result in removal of the duodenum
d. The procedure will result in enlargement of the pyloric sphincter
Question 7 Explanation: A Billroth II procedure bypasses the duodenum and connects the gastric
stump directly to the jejunum. The pyloric sphincter is removed, along with some of the
stomach fundus.

8) The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn
following a meal. After administering an ordered antacid, the nurse encourages the client to
lie in which of the following positions?
a. On the stomach with the head flat
b. On the left side with the head of the bed elevated 30 degrees
c. On the right side with the head of the bed elevated 30 degrees.
d. Supine with the head of the bed flat
Question 8 Explanation: The discomfort of reflux is aggravated by positions that compress the
abdomen and the stomach. These include lying flat on the back or on the stomach after a meal
of lying on the right side. The left side-lying position with the head of the bed elevated is most
likely to give relief to the client.

9) Which of the following dietary measures would be useful in preventing esophageal reflux?
a. Avoiding air swallowing with meals
b. Adding a bedtime snack to the dietary plan
c. Increasing fluid intake
d. Eating small, frequent meals
Question 9 Explanation: Esophageal reflux worsens when the stomach is overdistended with
food. Therefore, an important measure is to eat small, frequent meals. Fluid intake should be
 decreased during meals to reduce abdominal distention. Avoiding air swallowing does not
prevent esophageal reflux. Food intake in the evening should be strictly limited to reduce the
incidence of nighttime reflux, so bedtime snacks are not recommended.

10) The nurse is caring for a client who has had a gastroscopy. Which of the following symptoms
may indicate that the client is developing a complication related to the procedure? Select all
that apply.
a. The client complains of a sore throat
b. The client appears drowsy following the procedure
c. The client complains of epigastric pain
d. The client experiences hematemesis
e. The client has a temperature of 100ºF
Question 10 Explanation: Following a gastroscopy, the nurse should monitor the client for
complications, which include perforation and the potential for aspiration. An elevated
temperature, complaints of epigastric pain, or the vomiting of blood (hematemesis) are all
indications of a possible perforation and should be reported promptly. A sore throat is a
common occurrence following a gastroscopy. Clients are usually sedated to decrease anxiety
and the nurse would anticipate that the client will be drowsy following the procedure.

11) Which of the following factors should be the main focus of nursing management for a client
hospitalized for cholecystitis?
a. Administration of antibiotics
b. Preparation for surgery
c. Preparation for lithotripsy
d. Assessment for complications
Question 11 Explanation: The client with acute cholecystitis should first be monitored for
perforation, fever, abscess, fistula, and sepsis. After assessment, antibiotics will be administered
to reduce the infection. Lithotripsy is used only for a small percentage of clients. Surgery is
usually done after the acute infection has subsided.

12) Which of the following would be an expected nutritional outcome for a client who has
undergone a subtotal gastrectomy for cancer?
a. Regain weight loss within 1 month after surgery
b. Resume normal dietary intake of three meals per day
c. Achieve optimal nutritional status through oral or parenteral feedings
d. Control nausea and vomiting through regular use of antiemetics
Question 12 Explanation: An appropriate expected outcome is for the client to achieve optimal
nutritional status through the use of oral feedings or total parenteral nutrition (TPN). TPN may
be used to supplement oral intake, or it may be used alone if the client cannot tolerate oral
feedings. The client would not be expected to regain lost weight within 1 month after surgery or
to tolerate a normal dietary intake of three meals per day. Nausea and vomiting would not be
considered an expected outcome of gastric surgery, and regular use of antiemetics would not be
anticipated.
13) While caring for a client with peptic ulcer disease, the client reports that he has been
nauseated most of the day and is now feeling lightheaded and dizzy. Based upon these
findings, which nursing actions would be most appropriate for the nurse to take? Select all
that apply.
a. Reassessing the client on an hour
b. Initiating oxygen therapy
c. Administering an antacid hourly until nausea subsides.
d. Monitoring the client’s vital signs
e. Notifying the physician of the client’s symptoms
Question 13 Explanation: The symptoms of nausea and dizziness in a client with peptic ulcer
disease may be indicative of hemorrhage and should not be ignored. The appropriate nursing
actions at this time are for the nurse to monitor the client’s vital signs and notify the physician
of the client’s symptoms. To administer an antacid hourly or to wait one hour to reassess the
client would be inappropriate; prompt intervention is essential in a client who is potentially
experiencing a gastrointestinal hemorrhage. The nurse would notify the physician of assessment
findings and then initiate oxygen therapy if ordered by the physician.

14) If a gastric acid perforates, which of the following actions should not be included in the
immediate management of the client?
a. Nasogastric tube suction
b. Fluid and electrolyte replacement
c. Antacid administration
d. Blood replacement
Question 14 Explanation: Antacids aren’t helpful in perforation. The client should be treated
with antibiotics as well as fluid, electrolyte, and blood replacement. NG tube suction should also
be performed to prevent further spillage of stomach contents into the peritoneal cavity.

15) A 40-year-old male client has been hospitalized with peptic ulcer disease. He is being treated
with a histamine receptor antagonist (cimetidine), antacids, and diet. The nurse doing
discharge planning will teach him that the action of cimetidine is to:
a. Inhibit the production of hydrochloric acid (HCl)
b. Inhibit vagus nerve stimulation
c. Reduce gastric acid output
d. Protect the ulcer surface
Question 15 Explanation: These drugs inhibit action of histamine on the H2 receptors of parietal
cells, thus reducing gastric acid output.

16) Which of the following tests can be performed to diagnose a hiatal hernia?
a. Lower GI series
b. Colonoscopy
c. Abdominal x-rays
d. Barium swallow
 Question 16 Explanation: A barium swallow with fluoroscopy shows the position of the stomach
in relation to the diaphragm. A colonoscopy and a lower GI series show disorders of the
intestine.

17) The client with GERD complains of a chronic cough. The nurse understands that in a client
with GERD this symptom may be indicative of which of the following conditions?
a. Esophageal scar tissue formation
b. Irritation of the esophagus
c. Development of laryngeal cance
d. Aspiration of gastric contents
Question 17 Explanation: Clients with GERD can develop pulmonary symptoms such as
coughing, wheezing, and dyspnea that are caused by the aspiration of gastric contents. GERD
does not predispose the client to the development of laryngeal cancer. Irritation of the
esophagus and esophageal scar tissue formation can develop as a result of GERD. However,
GERD is more likely to cause painful and difficult swallowing.

18) The client with a duodenal ulcer may exhibit which of the following findings on assessment?
a. Hematemesis
b. Melena
c. Malnourishment
d. Pain with eating
Question 18 Explanation: The client with a duodenal ulcer may have bleeding at the ulcer site,
which shows up as melena (black tarry poop). The other findings are consistent with a gastric
ulcer.

19) A client with peptic ulcer disease tells the nurse that he has black stools, which he has not
reported to his physician. Based on this information, which nursing diagnosis would be
appropriate for this client?
a. Ineffective coping related to fear of diagnosis of chronic illness
b. Imbalanced nutrition: Less than body requirements due to gastric bleeding
c. Deficient knowledge related to unfamiliarity with significant signs and symptoms
d. Constipation related to decreased gastric motility
Question 19 Explanation: Black, tarry stools are an important warning sign of bleeding in peptic
ulcer disease. Digested blood in the stomach causes it to be black. The odor of the stool is very
stinky. Clients with peptic ulcer disease should be instructed to report the incidence of black
stools promptly to their physician.

20) The nurse provides medication instructions to a client with peptic ulcer disease. Which
statement, if made by the client, indicates the best understanding of the medication therapy?
a. “Antacids will coat my stomach.”
b. “Omeprazole (Prilosec) will coat the ulcer and help it heal.”
c. “Sucralfate (Carafate) will change the fluid in my stomach.”
d. “The cimetidine (Tagamet) will cause me to produce less stomach acid.”
 Question 20 Explanation: Cimetidine (Tagamet), a histamine H2 receptor antagonist, will
decrease the secretion of gastric acid. Sucralfate (Carafate) promotes healing by coating the
ulcer. Antacids neutralize acid in the stomach. Omeprazole (Prilosec) inhibits gastric acid
secretion.

21) Which of the following best describes the method of action of medications, such as ranitidine
(Zantac), which are used in the treatment of peptic ulcer disease?
a. Reduce acid secretions
b. Neutralize acid
c. Protect the mucosal barrier
d. Stimulate gastrin release
Question 21 Explanation: Ranitidine is a histamine-2 receptor antagonist that reduces acid
secretion by inhibiting gastrin secretion.

22) A female client complains of gnawing epigastric pain for a few hours after meals. At times,
when the pain is severe, vomiting occurs. Specific tests are indicated to rule out:
a. Pylorospasm
b. Cancer of the stomach
c. Chronic gastritis
d. Peptic ulcer disease
Question 22 Explanation: Peptic ulcer disease is characteristically gnawing epigastric pain that
may radiate to the back. Vomiting usually reflects pyloric spasm from muscular spasm or
obstruction. Cancer would not evidence pain or vomiting unless the pylorus was obstructed.

23) A client with a peptic ulcer reports epigastric pain that frequently awakens her at night, a
feeling of fullness in the abdomen, and a feeling of anxiety about her health. Based on this
information, which nursing diagnosis would be most appropriate?
a. Disturbed Sleep Pattern related to epigastric pain
b. Ineffective Coping related to exacerbation of duodenal ulcer
c. Activity Intolerance related to abdominal pain
d. Imbalanced Nutrition: Less than Body Requirements related to anorexia.
Question 23 Explanation: Based on the data provided, the most appropriate nursing diagnosis
would be Disturbed Sleep pattern. A client with a duodenal ulcer commonly awakens at night
with pain. The client’s feelings of anxiety do not necessarily indicate that she is coping
ineffectively.

24) The nurse is reviewing the medication record of a client with acute gastritis. Which
medication, if noted on the client’s record, would the nurse question?
a. Digoxin (Lanoxin)
b. Propranolol hydrochloride (Inderal)
c. Indomethacin (Indocin)
d. Furosemide (Lasix)
 Question 24 Explanation: Indomethacin (Indocin) is a NSAID and can cause ulceration of the
esophagus, stomach, duodenum, or small intestine. Indomethacin is contraindicated in a client
with GI disorders.

25) Which of the following tasks should be included in the immediate postoperative
management of a client who has undergone gastric resection?
a. Monitoring for symptoms of hemorrhage
b. Monitoring gastric pH to detect complications
c. Providing nutritional support
d. Assessing for bowel sounds
Question 25 Explanation: The client should be monitored closely for signs and symptoms of
hemorrhage, such as bright red blood in the nasogastric tube suction, tachycardia, or a drop in
blood pressure. Gastric pH may be monitored to evaluate the need for histamine-2 receptor
antagonists. Bowel sounds may not return for up to 72 hours postoperatively. Nutritional needs
should be addressed soon after surgery.

26) When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and
symptoms would the nurse expect to see? Select all that apply.
a. Relief of epigastric pain after eating
b. Weight loss
c. Vomiting
d. Epigastric pain at night
Question 26 Explanation: Vomiting and weight loss are common with gastric ulcers. Clients with
a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about one
hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more
likely to complain about pain that occurs during the night and is frequently relieved by eating.

27) The nurse is caring for a client following a Billroth II procedure. On review of the post-
operative orders, which of the following, if prescribed, would the nurse question and verify?
a. Early ambulation
b. Irrigating the nasogastric tube
c. Coughing a deep breathing exercises
d. Leg exercises
Question 27 Explanation: In a Billroth II procedure the proximal remnant of the stomach is
anastomased to the proximal jejunum. Patency of the NG tube is critical for preventing the
retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube
after gastric surgery, unless specifically ordered by the physician. In this situation, the nurse
would clarify the order.

28) Which of the following symptoms best describes Murphy’s sign?

a. On deep inspiration, pain is elicited and breathing stops
b. Abdominal muscles are tightened in anticipation of palpation
c. On deep palpitation and release, pain in elicited
d. Periumbilical eccymosis exists
 Question 28 Explanation: Murphy’s sign is elicited when the client reacts to pain and stops
breathing. It’s a common finding in clients with cholecystitis. Periumbilical ecchymosis, Cullen’s
sign, is present in peritonitis. Pain on deep palpation and release is rebound tenderness.
Tightening up abdominal muscles in anticipation of palpation is guarding.

29) The client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to
control the bleeding. The most important assessment is for the nurse to:
a. Regularly assess respiratory status
b. Monitor IV fluids for the shift
c. Check that the hemostat is on the bedside
d. Check that the balloon is deflated on a regular basis
Question 29 Explanation: The respiratory system can become occluded if the balloon slips and
moves up the esophagus, putting pressure on the trachea. This would result in respiratory
distress and should be assessed frequently. Scissors should be kept at the bedside to cut the
tube if distress occurs. This is a safety intervention.

30) Risk factors for the development of hiatal hernias are those that lead to increased abdominal
pressure. Which of the following complications can cause increased abdominal pressure?
a. Intestinal obstruction
b. Volvulus
c. Obesity
d. Constipation
Question 30 Explanation: Obesity may cause increased abdominal pressure that pushes the
lower portion of the stomach into the thorax.

31) A client with suspected gastric cancer undergoes an endoscopy of the stomach. Which of the
following assessments made after the procedure would indicate the development of a
potential complication?
a. The client displays signs of sedation
b. The client demonstrates a lack of appetite
c. The client complains of a sore throat
d. The client experiences a sudden increase in temperature
Question 31 Explanation: The most likely complication of an endoscopic procedure is
perforation. A sudden temperature spike with 1 to 2 hours after the procedure is indicative of a
perforation and should be reported immediately to the physician. A sore throat is to be
anticipated after an endoscopy. Clients are given sedatives during the procedure, so it is
expected that they will display signs of sedation after the procedure is completed. A lack of
appetite could be the result of many factors, including the disease process.

32) Which of the following symptoms is common with a hiatal hernia?

a. Abdominal cramping
b. Lower back pain
c. Left arm pain
d. Esophageal reflux
 Question 32 Explanation: Esophageal reflux is a common symptom of hiatal hernia. This seems
to be associated with chronic exposure of the lower esophageal sphincter to the lower pressure
of the thorax, making it less effective.

33) The pain of a duodenal ulcer can be distinguished from that of a gastric ulcer by which of the
following characteristics?
a. Early satiety
b. Pain on eating
c. Pain on empty stomach
d. Dull upper epigastric pain
Question 33 Explanation: Pain on empty stomach is relieved by taking foods or antacids. The
other symptoms are those of a gastric ulcer.

34) When counseling a client in ways to prevent cholecystitis, which of the following guidelines is
most important?
a. Limit exercise to 10 minutes/day
b. Eat a low-fat, low-cholesterol diet
c. Eat a low-protein diet
d. Keep weight proportionate to height
Question 34 Explanation: Obesity is a known cause of gallstones, and maintaining a
recommended weight will help protect against gallstones. Excessive dietary intake of cholesterol
is associated with the development of gallstones in many people. Dietary protein isn’t
implicated in cholecystitis. Liquid protein and low-calorie diets (with rapid weight loss of more
than 5 lb [2.3kg] per week) are implicated as the cause of some cases of cholecystitis. Regular
exercise (30 minutes/three times a week) may help reduce weight and improve fat metabolism.
Reducing stress may reduce bile production, which may also indirectly decrease the chances of
developing cholecystitis.

35) A client with a peptic ulcer is scheduled for a vagotomy. The client asks the nurse about the
purpose of this procedure. The nurse tells the client that the procedure:
a. Decreases food absorption in the stomach
b. Reduces the stimulus to acid secretions
c. Heals the gastric mucosa
d. Halts stress reactions
Question 35 Explanation: A vagotomy, or cutting the vagus nerve, is done to eliminate
parasympathetic stimulation of gastric secretion.

36) Which of the following tests can be used to diagnose ulcers?

a. Abdominal x-ray
b. Esophagogastroduodenoscopy (EGD)
c. Computed tomography (CT) scan
d. Barium swallow
 Question 36 Explanation: The EGD can visualize the entire upper GI tract as well as allow for
tissue specimens and electrocautery if needed. The barium swallow could locate a gastric ulcer.
A CT scan and an abdominal x-ray aren’t useful in the diagnosis of an ulcer.

37) Which of the following measures should the nurse focus on for the client with esophageal
varices?
a. Encouraging nutritional intake
b. Recognizing hemorrhage
c. Teaching the client about varices
d. Controlling blood pressure
Question 37 Explanation: Recognizing the rupture of esophageal varices, or hemorrhage, is the
focus of nursing care because the client could succumb to this quickly. Controlling blood
pressure is also important because it helps reduce the risk of variceal rupture. It is also
important to teach the client what varices are and what foods he should avoid such as spicy
foods.

38) When a client has peptic ulcer disease, the nurse would expect a priority intervention to be:
a. Assisting in inserting a Miller-Abbott tube
b. Inserting an I.V.
c. Assisting in inserting an arterial pressure line
d. Inserting a nasogastric tube
Question 38 Explanation: An NG tube insertion is the most appropriate intervention because it
will determine the presence of active GI bleeding. A Miller-Abbott tube is a weighted, mercury-
filled ballooned tube used to resolve bowel obstructions. There is no evidence of shock or fluid
overload in the client; therefore, an arterial line is not appropriate at this time and an IV is
optional.

39) A client has been taking aluminum hydroxide 30 mL six times per day at home to treat his
peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days.
Based on this information, the nurse would determine that which of the following is the most
likely cause of the client’s constipation?
a. The client has not been including enough fiber in his diet
b. The client is experiencing a side effect of the aluminum hydroxide.
c. The client has developed a gastrointestinal obstruction.
d. The client needs to increase his daily exercise
Question 39 Explanation: It is most likely that the client is experiencing a side effect of the
antacid. Antacids with aluminum salt products, such as aluminum hydroxide, form insoluble
salts in the body. These precipitate and accumulate in the intestines, causing constipation.
Increasing dietary fiber intake or daily exercise may be a beneficial lifestyle change for the client
but is not likely to relieve the constipation caused by the aluminum hydroxide. Constipation, in
isolation from other symptoms, is not a sign of bowel obstruction.
40) Which of the following tests is most commonly used to diagnose cholecystitis?
a. Barium swallow
b. Abdominal CT scan
c. Endoscopy
d. Abdominal ultrasound
Question 40 Explanation: An abdominal ultrasound can show if the gallbladder is enlarged, if
gallstones are present, if the gallbladder wall is thickened, or if distention of the gallbladder
lumen is present. An abdominal CT scan can be used to diagnose cholecystitis, but it usually isn’t
necessary. A barium swallow looks at the stomach and the duodenum. Endoscopy looks at the
esophagus, stomach, and duodenum.

41) The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the
T-tube has drained 750ml of green-brown drainage. Which nursing intervention is most
appropriate?
a. Document the findings
b. Irrigate the T-tube
c. Clamp the T-tube
d. Notify the physician
Question 41 Explanation: Following cholecystectomy, drainage from the T-tube is initially bloody
and then turns to green-brown. The drainage is measured as output. The amount of expected
drainage will range from 500 to 1000 ml per day. The nurse would document the output.

42) The client with peptic ulcer disease is scheduled for a pyloroplasty. The client asks the nurse
about the procedure. The nurse plans to respond knowing that a pyloroplasty involves:
a. Removing the distal portion of the stomach
b. Cutting the vagus nerve
c. An incision and resuturing of the pylorus to relax the muscle and enlarge the opening
from the stomach to the duodenum.
d. Removal of the ulcer and a large portion of the cells that produce hydrochloric acid
Question 42 Explanation: An incision and resuturing of the pylorus to relax the muscle and
enlarge the opening from the stomach to the duodenum describes the procedure for a
pyloroplasty. A vagotomy involves cutting the vagus nerve. A subtotal gastrectomy involves
removing the distal portion of the stomach. A Billroth II procedure involves removal of the ulcer
and a large portion of the tissue that produces hydrochloric acid.

43) Which of the following conditions can cause a hiatal hernia?

a. Increased esophageal muscle pressure
b. Weakness of the esophageal muscle
c. Weakness of the diaphragmic muscle
d. Increased intrathoracic pressure
Question 43 Explanation: A hiatal hernia is caused by weakness of the diaphragmic muscle and
increased intra-abdominal—not intrathoracic—pressure. This weakness allows the stomach to
slide into the esophagus. The esophageal supports weaken, but esophageal muscle weakness or
increased esophageal muscle pressure isn’t a factor in hiatal hernia.
44) A client being treated for chronic cholecystitis should be given which of the following
instructions?
a. Use anticholinergics as prescribed
b. Avoid antacids
c. Increase rest
d. Increase protein in diet
Question 44 Explanation: Conservative therapy for chronic cholecystitis includes weight
reduction by increasing physical activity, a low-fat diet, antacid use to treat dyspepsia, and
anticholinergic use to relax smooth muscles and reduce ductal tone and spasm, thereby
reducing pain.

45) A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a
bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric area
along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which
of the following?
a. The ulcer has perforated
b. Additional ulcers have developed
c. An intestinal obstruction has developed
d. The esophagus has become inflamed
Question 45 Explanation: The body reacts to perforation of an ulcer by immobilizing the area as
much as possible. This results in boardlike muscle rigidity, usually with extreme pain. Perforation
is a medical emergency requiring immediate surgical intervention because peritonitis develops
quickly after perforation. An intestinal obstruction would not cause midepigastric pain.
Esophageal inflammation or the development of additional ulcers would not cause a rigid,
boardlike abdomen.

46) After a subtotal gastrectomy, the nurse should anticipate that nasogastric tube drainage will
be what color for about 12 to 24 hours after surgery?
a. Dark brown
b. Bright red
c. Cloudy white
d. Bile green
Question 46 Explanation: About 12 to 24 hours after a subtotal gastrectomy, gastric drainage is
normally brown, which indicates digested blood. Bile green or cloudy white drainage is not
expected during the first 12 to 24 hours after a subtotal gastrectomy. Drainage during the first 6
to 12 hours contains some bright red blood, but large amounts of blood or excessively bloody
drainage should be reported to the physician promptly.

47) Mucosal barrier fortifiers are used in peptic ulcer disease management for which of the
following indications?
a. To stimulate mucus production
b. To neutralize acid production
c. To inhibit mucus production
 d. To stimulate hydrogen ion diffusion back into the mucosa
Question 47 Explanation: The mucosal barrier fortifiers stimulate mucus production and prevent
hydrogen ion diffusion back into the mucosa, resulting in accelerated ulcer healing. Antacids
neutralize acid production.

48) A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The
nurse knows that the client understands proper drug administration of ranitidine when she
says that she will take the drug at which of the following times?
a. Before meals
b. With meals
c. At bedtime
d. When pain occurs
Question 48 Explanation: Ranitidine blocks secretion of hydrochloric acid. Clients who take only
one daily dose of ranitidine are usually advised to take it at bedtime to inhibit nocturnal
secretion of acid. Clients who take the drug twice a day are advised to take it in the morning and
at bedtime.

49) The nurse is caring for a client with chronic gastritis. The nurse monitors the client, knowing
that this client is at risk for which of the following vitamin deficiencies?
a. Vitamin E
b. Vitamin A
c. Vitamin C
d. Vitamin B12
Question 49 Explanation: Chronic gastritis causes deterioration and atrophy of the lining of the
stomach, leading to the loss of the functioning parietal cells. The source of the intrinsic factor is
lost, which results in the inability to absorb vitamin B12. This leads to the development of
pernicious anemia.

50) After a subtotal gastrectomy, care of the client’s nasogastric tube and drainage system should
include which of the following nursing interventions?
a. Irrigate the tube with 30 ml of sterile water every hour, if needed.
b. Turn the machine to high suction of the drainage is sluggish on low suction.
c. Reposition the tube if it is not draining well
d. Monitor the client for N/V, and abdominal distention
Question 50 Explanation: Nausea, vomiting, or abdominal distention indicated that gas and
secretions are accumulating within the gastric pouch due to impaired peristalsis or edema at the
operative site and may indicate that the drainage system is not working properly. Saline solution
is used to irrigate nasogastric tubes. Hypotonic solutions such as water increase electrolyte loss.
In addition, a physician’s order is needed to irrigate the NG tube, because this procedure could
disrupt the suture line. After gastric surgery, only the surgeon repositions the NG tube because
of the danger of rupturing or dislodging the suture line. The amount of suction varies with the
type of tube used and is ordered by the physician. High suction may create too much tension on
the gastric suture line.
SET C
1) Your patient has a GI tract that is functioning, but has the inability to swallow foods. Which is
the preferred method of feeding for your patient?
a. TPN
b. PPN
c. NG feeding
d. Oral liquid supplements
Question 1 Explanation: 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.

2) Leigh Ann is receiving pancrelipase (Viokase) for chronic pancreatitis. Which observation best
indicates the treatment is effective?
a. There is no skin breakdown.
b. Her appetite improves.
c. She loses more than 10 lbs.
d. Stools are less fatty and decreased in frequency.
Question 2 Explanation: 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.

3) Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the
disorder, the nurse teaches the client about foods that are high in thiamine. The nurse
determines that the client has the best understanding of the dietary measures to follow if the
client states an intension to increase the intake of:
a. Pork
b. Milk
c. Chicken
d. Broccoli
Question 3 Explanation: The client with cirrhosis needs to consume foods high in thiamine.
Thiamine is present in a variety of foods of plant and animal origin. Pork products are especially
rich in this vitamin. Other good food sources include nuts, whole grain cereals, and legumes.
Milk contains vitamins A, D, and B2. Poultry contains niacin. Broccoli contains vitamins C, E, and
K and folic acid

4) Nurse Oliver checks for residual before administering a bolus tube feeding to a client with a
nasogastric tube and obtains a residual amount of 150 mL. What is appropriate action for the
nurse to take?
a. Hold the feeding
b. Reinstill the amount and continue with administering the feeding
c. Elevate the client’s head at least 45 degrees and administer the feeding
d. Discard the residual amount and proceed with administering the feeding
 Question 4 Explanation: Unless specifically indicated, residual amounts more than 100 mL
require holding the feeding. Therefore options B, C, and D are incorrect. Additionally, the
feeding is not discarded unless its contents are abnormal in color or characteristics.

5) Nathaniel has severe pruritus due to having hepatitis B. What is the best intervention for his
comfort?
a. Give tepid baths.
b. Avoid lotions and creams.
c. Use hot water to increase vasodilation.
d. Use cold water to decrease the itching.
Question 5 Explanation: For pruritus, care should include tepid sponge baths and use of
emollient creams and lotions.

6) The student nurse is preparing a teaching care plan to help improve nutrition in a patient with
achalasia. You include which of the following:
a. Swallow foods while leaning forward.
b. Omit fluids at mealtimes.
c. Eat meals sitting upright.
d. Avoid soft and semisoft foods.
Question 6 Explanation: Eating in the upright position aids in emptying the esophagus. Doing the
opposite of the other three also may be helpful.

7) Arthur has a family history of colon cancer and is scheduled to have a sigmoidoscopy. He is
crying as he tells you, “I know that I have colon cancer, too.” Which response is most
therapeutic?
a. “I know just how you feel.”
b. “You seem upset.”
c. “Oh, don’t worry about it, everything will be just fine.”
d. “Why do you think you have cancer?”
Question 7 Explanation: 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.

8) 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.
Question 8 Explanation: 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.
9) You’re caring for Lewis, a 67 y.o. patient with liver cirrhosis who develops ascites and
requires paracentesis. Relief of which symptom indicated that the paracentesis was effective?
a. Pruritus
b. Dyspnea
c. Jaundice
d. Peripheral Neuropathy
Question 9 Explanation: 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.

10) The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which
finding, if noted on assessment of the client, would the nurse report to the physician?
a. Hypotension
b. Bloody diarrhea
c. Rebound tenderness
d. A hemoglobin level of 12 mg/dL
Question 10 Explanation: Rebound tenderness may indicate peritonitis. Bloody diarrhea is
expected to occur in ulcerative colitis. Because of the blood loss, the client may be hypotensive
and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to
the physician.

11) A male client with a peptic ulcer is scheduled for a vagotomy and the client asks the nurse
about the purpose of this procedure. Which response by the nurse best describes the purpose
of a vagotomy?
a. Halts stress reactions
b. Heals the gastric mucosa
c. Reduces the stimulus to acid secretions
d. Decreases food absorption in the stomach
Question 11 Explanation: A vagotomy, or cutting of the vagus nerve, is done to eliminate
parasympathetic stimulation of gastric secretion. Options A, B, and D are incorrect descriptions
of a vagotomy.

12) Findings during an endoscopic exam include a cobblestone appearance of the colon in your
patient. The findings are characteristic of which disorder?
a. Ulcer
b. Crohn’s disease
c. Chronic gastritis
d. Ulcerative colitis
Question 12 Explanation: Crohn’s disease penetrates the mucosa of the colon through all layers
and destroys the colon in patches, which creates a cobblestone appearance.

13) Jason, a 22 y.o. accident victim, requires an NG tube for feeding. What should you
immediately do after inserting an NG tube for liquid enteral feedings?
a. Aspirate for gastric secretions with a syringe.
 b. Begin feeding slowly to prevent cramping.
c. Get an X-ray of the tip of the tube within 24 hours.
d. Clamp off the tube until the feedings begin.
Question 13 Explanation: Aspirating the stomach contents confirms correct placement. If an X-
ray is ordered, it should be done immediately, not in 24 hours.

14) 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
Question 14 Explanation: Signs and Symptoms of pneumothorax include dyspnea and decreased
or absent breath sounds over the affected lung (right lung).

15) 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.
Question 15 Explanation: A proper fit protects the skin, but doesn’t impair circulation. A 1/16”
should be cut.

16) Your goal is to minimize David’s risk of complications after a heriorrhaphy. You instruct the
patient to:
a. Avoid the use of pain medication.
b. Cough and deep breathe Q2H.
c. Splint the incision if he can’t avoid sneezing or coughing.
d. Apply heat to scrotal swelling.
Question 16 Explanation: Teach the pt to avoid activities that increase intra-abdominal pressure
such as coughing, sneezing, or straining with a bowel movement.

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

a. Treating hypovolemia.
b. Treating hypervolemia.
c. Controlling the bleeding source.
d. Treating shock and diagnosing the bleeding source.
Question 17 Explanation: 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.
18) After an abdominal resection for colon cancer, Madeline returns to her room with a Jackson-
Pratt drain in place. The purpose of the drain is to:
a. Irrigate the incision with a saline solution.
b. Prevent bacterial infection of the incision.
c. Measure the amount of fluid lost after surgery.
d. Prevent accumulation of drainage in the wound.
Question 18 Explanation: A Jackson-Pratt drain promotes wound healing by allowing fluid to
escape from the wound.

19) A nurse is inserting a nasogastric tube in an adult male client. During the procedure, the
client begins to cough and has difficulty breathing. Which of the following is the appropriate
nursing action?
a. Quickly insert the tube
b. Notify the physician immediately
c. Remove the tube and reinsert when the respiratory distress subsides
d. Pull back on the tube and wait until the respiratory distress subsides
Question 19 Explanation: During the insertion of a nasogastric tube, if the client experiences
difficulty breathing or any respiratory distress, withdraw the tube slightly, stop the tube
advancement, and wait until the distress subsides. Options B and C are unnecessary. Quickly
inserting the tube is not an appropriate action because, in this situation, it may be likely that the
tube has entered the bronchus.

20) You have a patient with achalasia (incomplete muscle relaxtion of the GI tract, especially
sphincter muscles). Which medications do you anticipate to administer?
a. Isosorbide dinitrate (Isordil)
b. Digoxin (Lanoxin)
c. Captopril (Capoten)
d. Propanolol (Inderal)
Question 20 Explanation: 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.

21) The nurse is caring for a male client postoperatively following creation of a colostomy. Which
nursing diagnosis should the nurse include in the plan of care?
a. Sexual dysfunction
b. Body image, disturbed
c. Fear related to poor prognosis
d. Nutrition: more than body requirements, imbalanced
Question 21 Explanation: Body image, disturbed relates to loss of bowel control, the presence of
a stoma, the release of fecal material onto the abdomen, the passage of flatus, odor, and the
need for an appliance (external pouch). No data in the question support options A and C.
Nutrition: less than body requirements, imbalanced is the more likely nursing diagnosis.
22) 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?
a. Notify the doctor immediately.
b. Stop the feeding, and clamp the NG tube.
c. Discard the 220ml, and clamp the NG tube.
d. Give a prescribed GI stimulant such as metoclopramide (Reglan).
Question 22 Explanation: 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.

23) The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment
findings would most likely indicate perforation of the ulcer?
a. Bradycardia
b. Numbness in the legs
c. Nausea and vomiting
d. A rigid, board-like abdomen
Question 23 Explanation: Perforation of an ulcer is a surgical emergency and is characterized by
sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over
the abdomen, which becomes rigid and board-like. Nausea and vomiting may occur. Tachycardia
may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding.

24) Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab value is most likely
to be elevated?
a. Calcium
b. Glucose
c. Magnesium
d. Potassium
Question 24 Explanation: Glucose level increases and diabetes mellitus may result d/t the
pancreatic damage to the islets of langerhans.

25) You’re discharging Nathaniel with hepatitis B. Which statement suggests understanding by
the patient?
a. “Now I can never get hepatitis again.”
b. “I can safely give blood after 3 months.”
c. “I’ll never have a problem with my liver again, even if I drink alcohol.”
d. “My family knows that if I get tired and start vomiting, I may be getting sick again.”
Question 25 Explanation: 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.
26) 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.
Question 26 Explanation: Because obesity weakens the abdominal muscles, advise weight loss
for the patient who has had a hernia repair.

27) Anthony, a 60 y.o. patient, has just undergone a bowel resection with a colostomy. During
the first 24 hours, which of the following observations about the stoma should you report to
the doctor?
a. Pink color.
b. Light edema.
c. Small amount of oozing.
d. Trickles of bright red blood.
Question 27 Explanation: 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.

28) You’re preparing a patient with a malignant tumor for colorectal surgery and subsequent
colostomy. The patient tells you he’s anxious. What should your initial step be in working with
this patient?
a. Determine what the patient already knows about colostomies.
b. Show the patient some pictures of colostomies.
c. Arrange for someone who has a colostomy to visit the patient.
d. Provide the patient with written material about colostomy care.
Question 28 Explanation: Initially, you should assess the patient’s knowledge about colostomies
and how it will affect his lifestyle.

29) Dark, tarry stools indicate bleeding in which location of the GI tract?
a. Upper colon.
b. Lower colon
c. Upper GI tract.
d. Small intestine.
Question 29 Explanation: 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.

30) 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
 Question 30 Explanation: Good circulation causes tissues to be moist and red, so a healthy, well-
healed stoma appears red and moist.

31) Katrina is diagnosed with lactose intolerance. To avoid complications with lack of calcium in
the diet, which food should be included in the diet?
a. Fruit
b. Whole grains
c. Milk and cheese products
d. Dark green, leafy vegetables
Question 31 Explanation: Dark green, leafy vegetables are rich in calcium

32) 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?
a. Blanched stoma
b. Edematous stoma
c. Reddish-pink stoma
d. Brownish-black stoma
Question 32 Explanation: A brownish-black color indicates lack of blood flow, and maybe
necrosis.

33) You’re caring for a patient with a sigmoid colostomy. The stool from this colostomy is:
a. Formed
b. Semisolid
c. Semiliquid
d. Watery
Question 33 Explanation: A colostomy in the sigmoid colon produces a solid, formed stool.

34) Michael, a 42 y.o. man is admitted to the med-surg floor with a diagnosis of acute
pancreatitis. His BP is 136/76, pulse 96, Resps 22 and temp 101. His past history includes
hyperlipidemia and alcohol abuse. The doctor prescribes an NG tube. Before inserting the
tube, you explain the purpose to patient. Which of the following is a most accurate
explanation?
a. “It empties the stomach of fluids and gas.”
b. “It prevents spasms at the sphincter of Oddi.”
c. “It prevents air from forming in the small intestine and large intestine.”
d. “It removes bile from the gallbladder.”
Question 34 Explanation: An NG tube is inserted into the patients stomach to drain fluid and
gas.

35) Hepatic encephalopathy develops when the blood level of which substance increases?
a. Ammonia
b. Amylase
c. Calcium
 d. Potassium
Question 35 Explanation: Ammonia levels increase d/t improper shunting of blood, causing
ammonia to enter systemic circulation, which carries it to the brain.

36) Eleanor, a 62 y.o. woman with diverticulosis is your patient. Which interventions would you
expect to include in her care?
a. Low-fiber diet and fluid restrictions.
b. Total parenteral nutrition and bed rest.
c. High-fiber diet and administration of psyllium.
d. Administration of analgesics and antacids.
Question 36 Explanation: She needs a high-fiber diet and a psyllium (bulk laxative) to promote
normal soft stools.

37) The nurse is reviewing the physician’s orders written for a male client admitted to the
hospital with acute pancreatitis. Which physician order should the nurse question if noted on
the client’s chart?
a. NPO status
b. Nasogastric tube inserted
c. Morphine sulfate for pain
d. An anticholinergic medication
Question 37 Explanation: Meperidine (Demerol) rather than morphine sulfate is the medication
of choice to treat pain because morphine sulfate can cause spasms in the sphincter of Oddi.
Options A, B, and D are appropriate interventions for the client with acute pancreatitis.

38) 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
Question 38 Explanation: 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.

39) The nurse is reviewing the medication record of a female client with acute gastritis. Which
medication, if noted on the client’s record, would the nurse question?
a. Digoxin (Lanoxin)
b. Furosemide (Lasix)
c. Indomethacin (Indocin)
d. Propranolol hydrochloride (Inderal)
Question 39 Explanation: Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and
can cause ulceration of the esophagus, stomach, or small intestine. Indomethacin is
contraindicated in a client with gastrointestinal disorders. Furosemide (Lasix) is a loop diuretic.
 Digoxin is a cardiac medication. Propranolol (Inderal) is a β-adrenergic blocker. Furosemide,
digoxin, and propranolol are not contraindicated in clients with gastric disorders.

40) 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.
Question 40 Explanation: 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.

41) The student nurse is teaching the family of a patient with liver failure. You instruct them to
limit which foods in the patient’s diet?
a. Meats and beans.
b. Butter and gravies.
c. Potatoes and pastas.
d. Cakes and pastries.
Question 41 Explanation: 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.

42) Polyethylene glycol-electrlyte solution (GoLYTELY) is prescribed for the female client
scheduled for a colonoscopy. The client begins to experience diarrhea following
administration of the solution. What action by the nurse is appropriate?
a. Start an IV infusion
b. Administer an enema
c. Cancel the diagnostic test
d. Explain that diarrhea is expected
Question 42 Explanation: The solution GoLYTELY is a bowel evacuant used to prepare a client for
a colonoscopy by cleansing the bowel. The solution is expected to cause a mild diarrhea and will
clear the bowel in 4 to 5 hours. Options A, B, and C are inappropriate actions.

43) The nurse is performing an abdominal assessment and inspects the skin of the abdomen. The
nurse performs which assessment technique next?
a. Palpates the abdomen for size
b. Palpates the liver at the right rib margin
c. Listens to bowel sounds in all for quadrants
d. Percusses the right lower abdominal quadrant
 Question 43 Explanation: The appropriate sequence for abdominal examination is inspection,
auscultation, percussion, and palpation. Auscultation is performed after inspection to ensure
that the motility of the bowel and bowel sounds are not altered by percussion or palpation.
Therefore, after inspecting the skin on the abdomen, the nurse should listen for bowel sounds.

44) 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
Question 44 Explanation: 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.

45) Sharon has cirrhosis of the liver and develops ascites. What intervention is necessary to
decrease the excessive accumulation of serous fluid in her peritoneal cavity?
a. Restrict fluids
b. Encourage ambulation
c. Increase sodium in the diet
d. Give antacids as prescribed
Question 45 Explanation: Restricting fluids decrease the amount of body fluid and the
accumulation of fluid in the peritoneal space.

46) You’re caring for Jane, a 57 y.o. patient with liver cirrhosis who develops ascites and requires
paracentesis. Before her paracentesis, you instruct her to:
a. Empty her bladder.
b. Lie supine in bed.
c. Remain NPO for 4 hours.
d. Clean her bowels with an enema.
Question 46 Explanation: A full bladder can interfere with paracentesis and be punctured
inadvertently.

47) 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
Question 47 Explanation: The normal range of specific gravity of urine is 1.010 to 1.025; a value
of 1.030 may be seen with dehydration.
48) Your patient, Christopher, has a diagnosis of ulcerative colitis and has severe abdominal pain
aggravated by movement, rebound tenderness, fever, nausea, and decreased urine output.
This may indicate which complication?
a. Fistula.
b. Bowel perforation.
c. Bowel obstruction.
d. Abscess.
Question 48 Explanation: 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.

49) Rob is a 46 y.o. admitted to the hospital with a suspected diagnosis of Hepatitis B. He’s
jaundiced and reports weakness. Which intervention will you include in his care?
a. Regular exercise.
b. low-protein diet.
c. Allow patient to select his meals.
d. Rest period after small, frequent meals.
Question 49 Explanation: Rest periods and small frequent meals is indicated during the acute
phase of hepatitis B.

50) Brenda, a 36 y.o. patient is on your floor with acute pancreatitis. Treatment for her includes:
a. Continuous peritoneal lavage.
b. Regular diet with increased fat.
c. Nutritional support with TPN.
d. Insertion of a T tube to drain the pancreas.
Question 50 Explanation: With acute pancreatitis, you need to rest the GI tract by TPN as
nutritional support.

51) The nurse is teaching a female client how to perform a colostomy irrigation. To enhance the
effectiveness of the irrigation and fecal returns, what measure should the nurse instruct the
client to do?
a. Increase fluid intake
b. Place heat on the abdomen
c. Perform the irrigation in the evening
d. Reduce the amount of irrigation solution
Question 51 Explanation: To enhance effectiveness of the irrigation and fecal returns, the client
is instructed to increase fluid intake and to take other measures to prevent constipation.
Options B, C and D will not enhance the effectiveness of this procedure.

52) Annebell is being discharged with a colostomy, and you’re teaching her about colostomy care.
Which statement correctly describes a healthy stoma?
a. “At first, the stoma may bleed slightly when touched.”
b. “The stoma should appear dark and have a bluish hue.”
 c. “A burning sensation under the stoma faceplate is normal.”
d. “The stoma should remain swollen away from the abdomen.”
Question 52 Explanation: 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.

53) Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis.
The nurse reviews the laboratory result, anticipating a laboratory report that indicates a
serum amylase level of:
a. 45 units/L
b. 100 units/L
c. 300 units/L
d. 500 units/L
Question 53 Explanation: The normal serum amylase level is 25 to 151 units/L. With chronic
cases of pancreatitis, the rise in serum amylase levels usually does not exceed three times the
normal value. In acute pancreatitis, the value may exceed five times the normal value. Options A
and B are within normal limits. Option D is an extremely elevated level seen in acute
pancreatitis.

54) Jerod is experiencing an acute episode of ulcerative colitis. Which is priority for this patient?
a. Replace lost fluid and sodium.
b. Monitor for increased serum glucose level from steroid therapy.
c. Restrict the dietary intake of foods high in potassium.
d. Note any change in the color and consistency of stools.
Question 54 Explanation: Diarrhea d/t an acute episode of ulcerative colitis leads to fluid &
electrolyte losses so fluid replacement takes priority.

55) Glenda has cholelithiasis (gallstones). You expect her to complain of:
a. Pain in the right upper quadrant, radiating to the shoulder.
b. Pain in the right lower quadrant, with rebound tenderness.
c. Pain in the left upper quadrant, with shortness of breath.
d. Pain in the left lower quadrant, with mild cramping.
Question 55 Explanation: The gallbladder is located in the RUQ and a frequent sign of gallstones
is pain radiating to the shoulder.

56) You’re caring for a 28 y.o. woman with hepatitis B. She’s concerned about the duration of her
recovery. Which response isn’t appropriate?
a. Encourage her to not worry about the future.
b. Encourage her to express her feelings about the illness.
c. Discuss the effects of hepatitis B on future health problems.
d. Provide avenues for financial counseling if she expresses the need.
Question 56 Explanation: Telling her not to worry minimizes her feelings
57) A patient has a severe exacerbation of ulcerative colitis. Long-term medications will probably
include:
a. Antacids.
b. Antibiotics.
c. Corticosteroids.
d. Histamine2-receptor blockers.
Question 57 Explanation: Medications to control inflammation such as corticosteroids are used
for long-term treatment.

58) A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming
this diagnosis?
a. Elevated hemoglobin level
b. Elevated serum bilirubin level
c. Elevated blood urea nitrogen level
d. Decreased erythrocycle sedimentation rate
Question 58 Explanation: Laboratory indicators of hepatitis include elevated liver enzyme levels,
elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An
elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is
unrelated to this diagnosis.

59) A 29 y.o. patient has an acute episode of ulcerative colitis. What diagnostic test confirms this
diagnosis?
a. Barium Swallow.
b. Stool examination.
c. Gastric analysis.
d. Sigmoidoscopy.
Question 59 Explanation: Sigmoidoscopy allows direct observation of the colon mucosa for
changes, and if needed, biopsy.

60) 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
Question 60 Explanation: High-fiber foods stimulate peristalsis, and a result, flatus. Yogurt
reduces gas formation.

61) Your patient recently had abdominal surgery and tells you that he feels a popping sensation
in his incision during a coughing spell, followed by severe pain. You anticipate an evisceration.
Which supplies should you take to his room?
a. A suture kit.
b. Sterile water and a suture kit.
c. Sterile water and sterile dressings.
 d. Sterile saline solution and sterile dressings.
Question 61 Explanation: 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.

62) Your patient is complaining of abdominal pain during assessment. What is your priority?
a. Auscultate to determine changes in bowel sounds.
b. Observe the contour of the abdomen.
c. Palpate the abdomen for a mass.
d. Percuss the abdomen to determine if fluid is present.
Question 62 Explanation: The first step in assessing the abdomen is to observe its shape and
contour, then auscultate, palpate, and then percuss.

63) You are developing a careplan on Sally, a 67 y.o. patient with hepatic encephalopathy. Which
of the following do you include?
a. Administering a lactulose enema as ordered.
b. Encouraging a protein-rich diet.
c. Administering sedatives, as necessary.
d. Encouraging ambulation at least four times a day.
Question 63 Explanation: You may administer the laxative lactulose to reduce ammonia levels in
the colon.

64) 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.
Question 64 Explanation: 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.

65) Gail is scheduled for a cholecystectomy. After completion of preoperative teaching, Gail
states,”If I lie still and avoid turning after the operation, I’ll avoid pain. Do you think this is a
good idea?” What is the best response?
a. “You’ll need to turn from side to side every 2 hours.”
b. “It’s always a good idea to rest quietly after surgery.”
c. “The doctor will probably order you to lie flat for 24 hours.”
d. “Why don’t you decide about activity after you return from the recovery room?”
Question 65 Explanation: To prevent venous stasis and improve muscle tone, circulation, and
respiratory function, encourage her to move after surgery.

66) Stephanie, a 28 y.o. accident victim, requires TPN. The rationale for TPN is to provide:
a. Necessary fluids and electrolytes to the body.
b. Complete nutrition by the I.V. route.
 c. Tube feedings for nutritional supplementation.
d. Dietary supplementation with liquid protein given between meals.
Question 66 Explanation: 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.

67) Nurse Ryan is assessing for correct placement of a nosogartric tube. The nurse aspirates the
stomach contents and check the contents for pH. The nurse verifies correct tube placement if
which pH value is noted?
a. 3.5
b. 7.0
c. 7.35
d. 7.5
Question 67 Explanation: If the nasogastric tube is in the stomach, the pH of the contents will be
acidic. Gastric aspirates have acidic pH values and should be 3.5 or lower. Option B indicates a
slightly acidic pH. Option C indicates a neutral pH. Option D indicates an alkaline pH.

68) The nurse is reviewing the record of a female client with Crohn’s disease. Which stool
characteristics should the nurse expect to note documented in the client’s record?
a. Diarrhea
b. Chronic constipation
c. Constipation alternating with diarrhea
d. Stools constantly oozing form the rectum
Question 68 Explanation: Crohn’s disease is characterized by nonbloody diarrhea of usually not
more than four to five stools daily. Over time, the diarrhea episodes increase in frequency,
duration, and severity. Options B, C, and D are not characteristics of Crohn’s disease.

69) 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.
Question 69 Explanation: To avoid overloading the small intestine, encourage the patient to eat
six small, regularly spaced meals.

70) The nurse is assessing a male client 24 hours following a cholecystectomy. The nurse noted
that the T tube has drained 750 mL of green-brown drainage since the surgery. Which nursing
intervention is appropriate?
a. Clamp the T tube
b. Irrigate the T tube
c. Notify the physician
d. Document the findings
 Question 70 Explanation: Following cholecystectomy, drainage from the T tube is initially bloody
and then turns to a greenish-brown color. The drainage is measured as output. The amount of
expected drainage will range from 500 to 1000 mL/day. The nurse would document the output.

71) Matt is a 49 y.o. with a hiatal hernia that you are about to counsel. Health care counseling for
Matt should include which of the following instructions?
a. Restrict intake of high-carbohydrate foods
b. Increase fluid intake with meals.
c. Increase fat intake.
d. Eat three regular meals a day.
Question 71 Explanation: Increasing fluids helps empty the stomach. A high carb diet isn’t
restricted and fat intake shouldn’t be increased.

72) The nurse is performing a colostomy irrigation on a male client. During the irrigation, the
client begins to complain of abdominal cramps. What is the appropriate nursing action?
a. Notify the physician
b. the irrigation flow is stopped temporarily and the client is allowed to rest
c. Increase the height of the irrigation
d. Medicate for pain and resume the irrigation
Question 72 Explanation: If cramping occurs during a colostomy irrigation, the irrigation flow is
stopped temporarily and the client is allowed to rest. Cramping may occur from an infusion that
is too rapid or is causing too much pressure. The physician does not need to be notified.
Increasing the height of the irrigation will cause further discomfort. Medicating the client for
pain is not the appropriate action in this situation.

73) The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse monitors
the client knowing that this client is at risk for which vitamin deficiency?
a. Vitamin A
b. Vitamin B12
c. Vitamin C
d. Vitamin E
Question 73 Explanation: Chronic gastritis causes deterioration and atrophy of the lining of the
stomach, leading to the loss of the function of the parietal cells. The source of the intrinsic
factor is lost, which results in the inability to absorb vitamin B12. This leads to the development
of pernicious anemia. The client is not at risk for vitamin A, C, or E deficiency.

74) A male client who is recovering from surgery has been advanced from a clear liquid diet to a
full liquid diet. The client is looking forward to the diet change because he has been “bored”
with the clear liquid diet. The nurse would offer which full liquid item to the client?
a. Tea
b. Gelatin
c. Custard
d. Popsicle
 Question 74 Explanation: Full liquid food items include items such as plain ice cream, sherbet,
breakfast drinks, milk, pudding and custard, soups that are strained, and strained vegetable
juices. A clear liquid diet consists of foods that are relatively transparent. The food items in
options A, B, and D are clear liquids.

75) Your teaching Anthony how to use his new colostomy. How much skin should remain exposed
between the stoma and the ring of the appliance?
a. 1/16”
b. 1/4″
c. 1/2”
d. 1”
Question 75 Explanation: Only a small amount of skin should be exposed and more than 1/16”
of skin allows the excretement to irritate the skin.

76) What information is correct about stomach cancer?

a. Stomach pain is often a late symptom.
b. Surgery is often a successful treatment.
c. Chemotherapy and radiation are often successful treatments.
d. The patient can survive for an extended time with TPN.
Question 76 Explanation: Stomach pain is often a late sign of stomach cancer; outcomes are
particularly poor when the cancer reaches that point. Surgery, chemotherapy, and radiation
have minimal positive effects. TPN may enhance the growth of the cancer.

77) 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
Question 77 Explanation: Pancreatitis involves activation of pancreatic enzymes, such as
amylase and lipase. These levels are elevated in a patient with acute pancreatitis.

78) A nurse is preparing to remove a nasogartric tube from a female client. The nurse should
instruct the client to do which of the following just before the nurse removes the tube?
a. Exhale
b. Inhale and exhale quickly
c. Take and hold a deep breath
d. Perform a Valsalva maneuver
Question 78 Explanation: When the nurse removes a nasogastric tube, the client is instructed to
take and hold a deep breath. This will close the epiglottis. This allows for easy withdrawal
through the esophagus into the nose. The nurse removes the tube with one smooth, continuous
pull.
79) The nurse is instructing the male client who has an inguinal hernia repair how to reduce
postoperative swelling following the procedure. What should the nurse tell the client?
a. Limit oral fluid
b. Elevate the scrotum
c. Apply heat to the abdomen
d. Remain in a low-fiber diet
Question 79 Explanation: Following inguinal hernia repair, the client should be instructed to
elevate the scrotum and apply ice packs while in bed to decrease pain and swelling. The nurse
also should instruct the client to apply a scrotal support when out of bed. Heat will increase
swelling. Limiting oral fluids and a low-fiber diet can cause constipation.

80) 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.”
Question 80 Explanation: 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.

81) Regina is a 46 y.o. woman with ulcerative colitis. You expect her stools to look like:
a. Watery and frothy.
b. Bloody and mucoid.
c. Firm and well-formed.
d. Alternating constipation and diarrhea.
Question 81 Explanation: Stools from ulcerative colitis are often bloody and contain mucus.

82) 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.
Question 82 Explanation: 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.

83) Nurse Joy is preparing to administer medication through a nasogastric tube that is connected
to suction. To administer the medication, the nurse would:
a. Position the client supine to assist in medication absorption
b. Aspirate the nasogastric tube after medication administration to maintain patency
c. Clamp the nasogastric tube for 30 minutes following administration of the medication
 d. Change the suction setting to low intermittent suction for 30 minutes after medication
administration
Question 83 Explanation: If a client has a nasogastric tube connected to suction, the nurse
should wait up to 30 minutes before reconnecting the tube to the suction apparatus to allow
adequate time for medication absorption. Aspirating the nasogastric tube will remove the
medication just administered. Low intermittent suction also will remove the medication just
administered. The client should not be placed in the supine position because of the risk for
aspiration.

84) Elmer is scheduled for a proctoscopy and has an I.V. The doctor wrote an order for 5mg of I.V.
diazepam(Valium). Which order is correct regarding diazepam?
a. Give diazepam in the I.V. port closest to the vein.
b. Mix diazepam with 50 ml of dextrose 5% in water and give over 15 minutes.
c. Give diazepam rapidly I.V. to prevent the bloodstream from diluting the drug mixture.
d. Question the order because I.V. administration of diazepam is contraindicated.
Question 84 Explanation: Diazepam is absorbed by the plastic I.V. tubing and should be given in
the port closest to the vein.

85) 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
Question 85 Explanation: Observation, auscultation, percussion, palpation

86) Dr. Smith has determined that the client with hepatitis has contracted the infection form
contaminated food. The nurse understands that this client is most likely experiencing what
type of hepatitis?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
Question 86 Explanation: Hepatitis A is transmitted by the fecal-oral route via contaminated
food or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via
infected blood or body fluids.

87) Claire, a 33 y.o. is on your floor with a possible bowel obstruction. Which intervention is
priority for her?
a. Obtain daily weights.
b. Measure abdominal girth.
c. Keep strict intake and output.
d. Encourage her to increase fluids.
 Question 87 Explanation: Measuring abdominal girth provides quantitative information about
increases or decreases in the amount of distention.

88) The nurse is caring for a female client following a Billroth II procedure. Which postoperative
order should the nurse question and verify?
a. Leg exercises
b. Early ambulation
c. Irrigating the nasogastric tube
d. Coughing and deep-breathing exercises
Question 88 Explanation: In a Billroth II procedure, the proximal remnant of the stomach is
anastomosed to the proximal jejunum. Patency of the nasogastric tube is critical for preventing
the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube
after gastric surgery, unless specifically ordered by the physician. In this situation, the nurse
should clarify the order. Options A, B, and D are appropriate postoperative interventions.

89) A nurse is preparing to care for a female client with esophageal varices who has just has a
Sengstaken-Blakemore tube inserted. The nurse gathers supplies, knowing that which of the
following items must be kept at the bedside at all times?
a. An obturator
b. Kelly clamp
c. An irrigation set
d. A pair of scissors
Question 89 Explanation: When the client has a Sengstaken-Blakemore tube, a pair of scissors
must be kept at the client’s bedside at all times. The client needs to be observed for sudden
respiratory distress, which occurs if the gastric balloon ruptures and the entire tube moves
upward. If this occurs, the nurse immediately cuts all balloon lumens and removes the tube. An
obturator and a Kelly clamp are kept at the bedside of a client with a tracheostomy. An irrigation
set may be kept at the bedside, but it is not the priority item.

90) A female client being seen in a physician’s office has just been scheduled for a barium
swallow the next day. The nurse writes down which instruction for the client to follow before
the test?
a. Fast for 8 hours before the test
b. Eat a regular supper and breakfast
c. Continue to take all oral medications as scheduled
d. Monitor own bowel movement pattern for constipation
Question 90 Explanation: 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.
91) The nurse is providing discharge instructions to a male client following gastrectomy and
instructs the client to take which measure to assist in preventing dumping syndrome?
a. Ambulate following a meal
b. Eat high carbohydrate foods
c. Limit the fluid taken with meal
d. Sit in a high-Fowler’s position during meals
Question 91 Explanation: Dumping syndrome is a term that refers to a constellation of
vasomotor symptoms that occurs after eating, especially following a Billroth II procedure. Early
manifestations usually occur within 30 minutes of eating and include vertigo, tachycardia,
syncope, sweating, pallor, palpitations, and the desire to lie down. The nurse should instruct the
client to decrease the amount of fluid taken at meals and to avoid high-carbohydrate foods,
including fluids such as fruit nectars; to assume a low-Fowler’s position during meals; to lie
down for 30 minutes after eating to delay gastric emptying; and to take antispasmodics as
prescribed.

92) The nurse is preparing a discharge teaching plan for the male client who had umbilical hernia
repair. What should the nurse include in the plan?
a. Irrigating the drain
b. Avoiding coughing
c. Maintaining bed rest
d. Restricting pain medication
Question 92 Explanation: Coughing is avoided following umbilical hernia repair to prevent
disruption of tissue integrity, which can occur because of the location of this surgical procedure.
Bed rest is not required following this surgical procedure. The client should take analgesics as
needed and as prescribed to control pain. A drain is not used in this surgical procedure, although
the client may be instructed in simple dressing changes.

93) The nurse is monitoring a female client for the early signs and symptoms of dumping
syndrome. Which of the following indicate this occurrence?
a. Sweating and pallor
b. Bradycardia and indigestion
c. Double vision and chest pain
d. Abdominal cramping and pain
Question 93 Explanation: Early manifestations of dumping syndrome occur 5 to 30 minutes after
eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the
desire to lie down.

94) Type A chronic gastritis can be distinquished from type B by its ability to:
a. Cause atrophy of the parietal cells.
b. Affect only the antrum of the stomach.
c. Thin the lining of the stomach walls.
d. Decrease gastric secretions.
Question 94 Explanation: Type A causes changes in parietal cells.
95) You promote hemodynamic stability in a patient with upper GI bleeding by:
a. Encouraging oral fluid intake.
b. Monitoring central venous pressure.
c. Monitoring laboratory test results and vital signs.
d. Giving blood, electrolyte and fluid replacement.
Question 95 Explanation: To stabilize a patient with acute bleeding, NS or LR solution is given
I.V. until BP rises and urine output returns to 30ml/hr.

96) A patient who underwent abdominal surgery now has a gaping incision due to delayed
wound healing. Which method is correct when you irrigate a gaping abdominal incision with
sterile normal saline solution, using a piston syringe?
a. Rapidly instill a stream of irrigating solution into the wound.
b. Apply a wet-to-dry dressing to the wound after the irrigation.
c. Moisten the area around the wound with normal saline solution after the irrigation.
d. Irrigate continuously until the solution becomes clear or all of the solution is used.
Question 96 Explanation: To wash away tissue debris and drainage effectively, irrigate the
wound until the solution becomes clear or all the solution is used.

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

a. Periodic rectal hemorrhage.
b. Hypertension and tachycardia.
c. Vomiting and elevated temperature.
d. Crampy and lower left quadrant pain and low-grade fever.
Question 97 Explanation: One sign of acute diverticulitis is crampy lower left quadrant pain. A
low-grade fever is another common sign.

98) 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
Question 98 Explanation: 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.

99) Before bowel surgery, Lee is to administer enemas until clear. During administration, he
complains of intestinal cramps. What do you do next?
a. Discontinue the procedure.
b. Lower the height of the enema container.
c. Complete the procedure as quickly as possible.
d. Continue administration of the enema as ordered without making any adjustments.
Question 99 Explanation: Lowering the height decreases the amount of flow, allowing him to
tolerate more fluid.
 100) Anna is 45 y.o. and has a bleeding ulcer. Despite multiple blood transfusions, her HGB
is 7.5g/dl and HCT is 27%. Her doctor determines that surgical intervention is necessary and
she undergoes partial gastrectomy. Postoperative nursing care includes:
a. Giving pain medication Q6H.
b. Flushing the NG tube with sterile water.
c. Positioning her in high Fowler’s position.
d. Keeping her NPO until the return of peristalsis.
Question 100 Explanation: After surgery, she remains NPO until peristaltic activity returns. This
decreases the risk for abdominal distention and obstruction.

SET D