Situation 1: Mito is being rushed into the emergency department due to severe

abdominal pain with abdominal tenderness.

1. Mito is being assessed for possible appendicitis. Which among the following
orders should the nurse question?
a. Administer morphine sulfate to manage pain.
b. Institute nothing per orem for Mito
c. Institute no abdominal palpation especially on the right lower quadrant.
d. Administer prophylactic antibiotics like cefoxitin via IV.
Answer: A
2. Nurse Csa is performing health assessment procedure on Mito. She palpates the
left lower quadrant, and complains of pain on her right lower quadrant. Based on
the procedure done, which of the fMitoollowing sign has been elicited?
a. Psoa’s sign c. Obturator sign
b. Sitkovskiy sign d. Rovsing’s sign
Answer: D
3. Nurse Csa continues to do her assessment on Mito. She palpates the left iliac
fossa, and Mito complains of pain on her right iliac fossa. Based on the
procedure done, which of the following sign has been elicited?
a. Psoa’s sign c. Sitkovskiy sign
b. Perman’s sign d. Obturator sign
Answer: B
4. Immediate removal of the appendix should be done in order to avoid
complications. When appendix ruptured and an abscess has already formed,
which among the following procedures should Nurse Csa anticipate to be
performed?
a. Laparoscopic appendectomy
b. Exploratory laparotomy appendectomy
c. Exploratory laparotomy appendectomy with peritoneal lavage
d. Exploratory laparotomy appendectomy with ileocecal resection
Answer: C
5. Mito is complaining of severe abdominal rigidity at 6am. Nurse Csa is conducting
her rounds at 8am and Mito’s pain disappears. Which among the following
actions is appropriate at this situation?
a. Document the findings as absence of pain means the appendix has been
healed.
b. Call the physician immediately as this is a sign of ruptured appendix.
c. Do nothing and continue to do the rounds as this indicates remission of the
pain.
d. Re-assess the pain as pt might be wrong with the report. Pain should always
be present in appendicitis.
Answer: B

Situation 2: Dame has been rushed to the emergency department due to declining
levels of consciousness.
6. Nurse Rommel conducted an assessment on Dame. Assessment reveals that
she had history of liver disease in the past. After series of test, it shows Dame
has liver cirrhosis with multiple complications. If the peritoneal culture shows
positive infection, Nurse Rommel is correct to assume that Dame is suffering
from what type of peritonitis?
A. Secondary peritonitis
B. Tertiary peritonitis
C. Spontaneous bacterial peritonitis
D. End-stage peritonitis
Answer: C
7. Nurse Rommel is recalling on the different types of peritonitis. One of which is
the secondary peritonitis. He was asked by the head nurse on what are the
possible causes of secondary peritonitis as this can help them formulate a care
plan to address the causes in order to reduce the incidence of such disease. He
is correct to identify which of the following as causes for secondary peritonitis.
Select all that apply.
1. Ruptured appendicitis
2. Perforated stomach due to peptic ulcer disease
3. Gunshot wound
4. Laennec’s cirrhosis
5. Stab wounds
6. Perforated diverticulitis
7. Complicated salpingitis
a. 1, 2, 3, 4 and 5
b. 1, 3, 4, and 5
c. 2, 3, 4, 5, and 6
d. 1, 2, 3, 5 and 6
Answer: D
8. Dame has shown signs of shock. When assessing the vital signs, which among
the following is not associated with shock?
a. Tachypnea
b. Bradycardia
c. Hypotension
d. Hypocapnia
Answer: B
9. Peritonitis is defined as the inflammation of the peritoneum cavity which could
either be infectious or non-infectious in nature. In cases like spontaneous
bacterial peritonitis, which among the following statements regarding the disorder
is correct?
a. There is no direct source of infection but there’s spontaneous inflammation of
the peritoneal cavity.
b. The main culprit are the microorganisms inside the GI tract which leaked due
to perforation or an abscess formation somewhere, causing the infection.
c. This type of peritonitis is caused by nosocomial infections which is
aggravated with co-morbidities like immunosuppression.
d. All of the above statements are related to spontaneous bacterial peritonitis.
 Answer: A
10. Nurse Justin was asked by the head nurse on the different types of antibiotics
that are effective in treating peritonitis. He mentioned about 3 rd generation
cephalosporins. He is correct when he mentions which of the following
medications?
a. Cefaclor (Ceclor)
b. Cephalexin (Keflex)
c. Cefipime (Maxipime)
d. Ceftriaxone (Rocephin)
Answer: D

Situation 7: Indy is admitted in the Medical ward due to abdominal pain and
dehydration.

11. Indy has a history of ulcerative colitis and is diagnosed with anemia. Nurse Frecy
interprets that which factor is most likely responsible for the anemia?
a. Blood loss
b. Intestinal hookworm
c. Intestinal malabsorption
d. Decreased intake of dietary iron
Answer: A
12. Nurse Frecy is reviewing the history of Indy who has ulcerative colitis. Based on
this diagnosis, which information should she expect to see in the patient’s
medical record?
a. Abdominal distention and hypoactive bowel sounds
b. Weight loss and elevated blood glucose
c. Hearburn and regurgitation
d. Bloody diarrhea and tenesmus
Answer: D
13. Nurse Frecy is taking care of another patient, Ezra, who has also ulcerative
colitis. She enters into the patient’s room to complete an initial assessment, and
the patient yells, “Get out of here! I am tired of nurses and doctors looking at my
body all the time!” Which of the following is the best action to be done by Nurse
Frecy?
a. Leave the room and asks a male colleague to complete the assessment.
b. Verbally acknowledge the patient’s frustration and anger.
c. Call the resident physician and ask for a prescription of sedatives.
d. Tell the patient that gathering data about his current condition will promote
effective timely treatment of his health concerns.
Answer: B
14. Ezra is under mesalamine (Asacol) for his ulcerative colitis. This medication is to
be administered rectally via enema. He finds the procedure uncomfortable and
ask Nurse Frecy why the medication cannot be given orally. Which of the
following is the best response of Nurse Frecy?
a. “It can be given orally; I’ll contact the doctor and see if the change can be
made.”
 b. “Rectal administration delivers the medication directly to the affected area.”
c. “Oral administration will not be as effective for the disease condition.”
d. “It can be given orally; I’ll make the change and we’ll tell the doctor in the
morning.”
Answer: B
15. Ezra has undergone total proctocolectomy with ileostomy creation 6 days ago for
his ulcerative colitis. During the morning rounds, Nurse Mon has noticed that the
ileostomy is draining large amounts of liquid stools and the client is been
reporting episodes of dizziness upon ambulation. Based on this information,
which parameters should Nurse Mon assess immediately? Select all that apply.
1. Pulse rate for the last 24 hours
2. Urine output
3. Weight over the past 3 days
4. Ability to move the lower extremities
5. Temperature readings for the last 24 hours
a. 1, 2, 3, and 4
b. 1, 2, 5
c. 2, 3, 5
d. 1, 2, 3, and 5
Answer: D

Situation 8: Stephanie is being admitted in the Medical ward due to exacerbation of

ulcerative colitis.

16. Stephanie is to be insert with central line for her total parenteral nutrition. Nurse
Margareth understood the fact that the most accessible site for TPN insertion is
which of the following veins?
a. Superior vena cava c. Medial cubital vein
b. Subclavian vein d. Femoral vein
Answer: B
17. Stephanie is also to undergo sulfasalazine (Azulfidine). Nurse Margareth hears
Stephanie talking with her family about this medication and recognizes the need
for additional teachings when she states which of the following:
a. “This medication will help control my diarrhea.”
b. “Sulfalazine will decrease the inflammation in my colon.”
c. “After taking this medication for a year, I will be cured.”
d. “The medication will help prevent future exacerbations of my disease.”
Answer: C
18. Stephanie is recovering from her exacerbation of ulcerative colitis. She is now
permitted to eat solid foods. Nurse Margareth recognizes that she understands
the dietary regimen for the disease management when she chooses which of the
following food items?
a. Fried chicken, French fries, and fruit juice
b. Cream of tomato soup, mixed green salad, and whole milk
c. Baked fish, steamed green beans, mashed potatoes with butter, and herbal
tea
 d. Chili and a glass of wine
Answer: C
19. Aaliyah is now recovering from her exacerbations of ulceration colitis and is
ready for discharge. Which among the following statements would need further
instructions regarding management of this disease?
a. “I can now drink my favorite caffeine-free beverages when I get home.”
b. “I will eat my mother’s delicious risotto upon discharge.”
c. “I will avoid taking milk products as it may irritate my colon.”
d. “I will read the labels of the food products when I do my groceries.”
Answer: B
20. Jrenzo is being appraised for proctocolectomy with creation of permanent
ileostomy. The doctor instructed to have him on low fiber diet. For how long
should the low fiber diet be started prior to the surgery?
a. 3-5 days prior to surgery
b. 1 week prior to surgery
c. 12 hours prior to surgery
d. 1 to 2 days prior to surgery.
Answer: D

Situation 9: Jorgeous is admitted in the Medical Ward due to severe malnutrition.

21. Jorgeous is to undergo barium swallow that demonstrated the presence of

strictures in the ileum. Based on this finding, Nurse Anya should monitor her
closely for signs of:
a. Peritonitis c. Malabsorption
b. Obstruction d. Fluid imbalance
Answer: B
22. Jorgeous is to be discharged already after undergoing a small bowel resection
for Crohn’s disease. While doing her morning rounds, Nurse Anya overhears
Jorgeous and her husband and realizes the she needs more education when she
states:
a. “I’m glad I won’t ever need any more surgeries.”
b. “I’ll need to continue to monitor my weight.”
c. “If I have another exacerbation, I know they will probably put me back on
hydrocortisone.”
d. “I will probably have to take vitamin supplements all of my life.”
Answer: A
23. Nurse Mona is the charge nurse on a medical unit and is determining where on
the unit should she place Mon who is being admitted with exacerbation of
Crohn’s disease. Mon is male, 20 years old, alert and oriented, and has been
taking azathioprine (Imuran) for disease control. Into which room should Nurse
Mona place him?
A. Private room right across from the nurses’ station to allow constant
visualization.
B. Room with a 22-year-old Jiemson who has also Crohn’s disease.
C. Private room with a private bathroom.
 D. Room with 67-year-old Mito who is oriented and on bedrest.
Answer: C
24. While conducting weekly checkups to Jiemson who had a partial resection of the
ileum for Crohn’s disease 4 weeks ago, Nurse Mona should be concerned when
Jiemson states which of the following?
a. “My stools float and seem to have fat in them.”
b. “I have gained 5 pounds since I left the hospital.”
c. “I am still avoiding milk products.”
d. “I only have two formed stools per day.”
Answer: A
25. Nurse Mona is providing discharge instructions to Mito who is newly diagnosed
with Crohn’s disease about dietary measures to implement during exacerbation
episodes. Which statement made by Mito indicates a need for additional
explanation?
a. “I should increase my fiber in my diet.”
b. “I will need to avoid caffeinated beverages.”
c. “I’m going to learn some stress reduction techniques.”
d. “I can have remissions and exacerbations in Crohn’s disease and this is
expected.”
Answer: A

Situation 10: Marga is being admitted in the medical unit due to exacerbation of Crohn’s
disease.

26. Nurse Cassie is conducting health teachings regarding corticosteroid therapy for
Marga who has Crohn’s disease. Which among the following statements should
Nurse Cassie intervene if stated by Marga?
a. “I will take this medication with full stomach as this medication is ulcerogenic.”
b. “I will avoid consuming foods high in glucose and salt.”
c. “I will stop taking my medications when symptoms are gone already as this is
a sign of remission.”
d. “I will ask my doctor’s suggestion regarding taking other forms of medications
while taking steroids.”
Answer: C
27. Basing on the common knowledge regarding Crohn’s disease, the common
areas of affection with this disorder will be which of the following?
a. Rectum and the descending colon
b. Duodenum and the antrum of the stomach
c. Cecum and the transverse colon
d. Terminal ileum and the ascending colon
Answer: D
28. Dante is taking sulfasalazine (Azulfidine) for his exacerbation of Crohn’s disease.
Nurse Lyka is conducting her morning rounds and visit Dante’s room. Which
among the following statements would warrant a report to the attending
physician?
 a. “I noticed that my nausea and vomiting episodes were frequent after taking
this medication.”
b. “I took this medication with a glass of water and drank a lot of water all
throughout the day.”
c. “I noticed that two weeks after taking my medication, my urine turns dark
amber in color.”
d. “Stomach upset is one of my complaints with this medication but it can’t be
helped since it really helped in controlling my symptoms.”
Answer: C
29. Nurse Lyka tries to answer Dante’s queries regarding the treatment modalities of
Crohn’s disease. She was reviewing Dante’s past medical records on the
different medications he took for his Crohn’s disease. Dante asks her about
methotrexate and asks what family of medication is this. She is correct when she
responded which of the following?
A. Folic acid analogue antimetabolite
B. Alkylating agent
C. Vinca alkaloids
D. Platinum-based agents
Answer: A
30. Nurse Lyka tries to list down all the possible signs and symptoms concerning
Crohn’s disease. Select all that applies regarding manifestations associated with
this disorder.
1. Steatorrhea
2. Weight loss
3. Skin ulcers
4. Positive String sign
5. Positive Football sign
6. Positive Turner sign
7. Diarrhea
a. 1, 2, 3, 4 and 7
b. 1, 2, 3, 4 and 5
c. 1, 2, 4, 5, and 7
d. 1, 2, 4, 6 and 7
Answer: D

Situation 11: Nurse Kristine is currently reviewing on the different disorders affecting the
hepatobiliary system. Her main focus is cholecystitis.

31. While reviewing Corrine’s medical records, Nurse Kristine notes the diagnosis of
biliary colic. Considering this diagnosis, which additional sign will Nurse Kristine
most likely find in Corrine’s medical record?
a. Bloody diarrhea
b. Heartburn and regurgitation
c. Abdominal distention
d. Severe abdominal pain
Answer: D
 32. Nurse Kristine anticipates that the conservative management for Auddrey with
acute cholecystitis will include which of the following?
a. A bland diet
b. The administration of anticholinergic agents
c. Placing the patient in a supine position with the head of the bed flat
d. Administering laxatives to clear the bowel
Answer: B
33. Nurse Kristine is caring for Zaldy who is 6 hours post open cholecystectomy. The
patient’s T-tube drainage bag is empty, and Nurse Kristine notes slight icteric
jaundice. Which among the following action by Nurse Kristine is most important?
a. Repositioning the patient to promote T-tube drainage.
b. Notifying the resident physician about these findings.
c. Checking the patient’s blood pressure immediately.
d. Recording the findings and continuing to monitor the patient.
Answer: B
34. In preparation for discharging Zaldy after an open cholecystectomy, Nurse
Kristine plans to discuss dietary restrictions. Which information is most
appropriate for her to include in the discussion?
a. Limit oral intake to three meals per day; no snacking
b. Drinking fluids in between meals, rather than with meals
c. Eating a low-fat diet for the next 4 to 6 weeks
d. Decreasing the amount of simple sugars in the diet for the next 2 weeks
Answer: C
35. Nurse Arianne is taking care of Nessel with acute cholecystitis who complains of
severe abdominal pain. In which of the following location is pain usually located
in this disorder?
a. Right upper quadrant paint radiating to the left shoulder and scapula
b. Midepigastric pain radiating to the back
c. Left upper quadrant pain radiating to the left shoulder and scapula
d. Right upper quadrant pain radiating to the right should and scapula
Answer: D

Situation 12: Nurse Simonee is taking care of Hubert with acute cholecystitis secondary
to cholelithiasis.

36. Hubert is to undergo diagnostic imaging to locate the exact location of his
gallbladder stones. Which among the following imaging test is the best for acute
cholecystitis?
a. Percutaneous transhepatic cholangiography
b. Endoscopic retrograde cholangiopancreatography
c. Abdominal X-ray
d. Gastroscopy
Answer: B
37. When patients are contraindicated with ERCP, which among the following test is
recommended to locate and map the gallbladder stones?
a. Barium swallow studies
 b. Intravenous pyelography
c. Percutaneous transhepatic cholangiography
d. Abdominal X-ray
Answer: C
38. Nurse Simonee has taught Hubert about his upcoming endoscopic retrograde
cholangiopancreatography procedure. She determines that Hubert needs further
information if he makes which of the following statement?
a. “I know I must sign the consent form.”
b. “I hope the throat spray keeps me from gagging.”
c. “I’m glad I don’t have to lie for this procedure.”
d. “I’m glad some intravenous medication will be given to relax me.”
Answer: C
39. Nurse Mona is assessing Janry who is experiencing an acute episode of
cholecystitis. Which of these clinical manifestations support this diagnosis?
Select all that apply.
1. Fever
2. Positive Cullen’s sign
3. Complaints of indigestion
4. Palpable mass in the left upper quadrant
5. Pain in the upper right quadrant after a fatty meal
6. Vague lower right abdominal discomfort
a. 1,2,5
b. 1,3,6
c. 1,2,4
d. 1,3,5
Answer: D
40. For patients undergoing ERCP, how will you position the patient initially for this
procedure?
a. Right sim’s
b. Right semi-prone
c. Left semi-prone
d. Left sim’s
Answer: C

Situation 13: Ezra is rushed in the emergency department due to severe abdominal
pain.

41. During a hospital admission history, Nurse Mona will typically find which among
the following as chief complaints for patients with acute pancreatitis?
a. The sudden onset of intense pain in the midepigastric area which radiates to
the back.
b. Persistent abdominal pain in the lower abdomen that has shifted to the lower
right quadrant.
c. Bloody diarrhea with colicky abdominal pain.
d. Mild upper abdominal pain and projectile vomiting.
Answer: A
 42. Which activities should Nurse Mona include for Ezra with acute necrotizing
pancreatitis, implement as part of the collaborative plan of care? Select all that
apply.
1. Administering 1L IV fluid bolus over 1 hour followed by IV fluids at 250cc/hour
2. Initiating nasojejunal enteral feedings
3. Administering IV imipenem-cilastin (Primaxin) 500mg every 6 hours
4. Ambulating the patient 4 times daily
5. Positioning on the left side with head of bed elevated
6. Inserting a Foley catheter
a. 2,3,5 and 6
b. 1,3,5 and 6
c. 1,2,3, and 4
d. 1,2,3, and 6
Answer: D
43. Ezra has been recovering from acute pancreatitis that has been in NPO asks
Nurse Mona when he can begin eating again. Which response by Nurse Mona is
most accurate?
a. “As soon as you start to feel hungry, you can begin eating.”
b. “When you have active bowel sounds and you are passing flatus.”
c. “When your pain is controlled and your serum lipase levels has decreased.”
d. “Oral intake stimulates the pancreas so you will need to be NPO for 2 weeks
from the day your disease was diagnosed to allow the pancreas to heal.”
Answer: C
44. Nurse Mona knows that opioids are the best analgesic of choice for pain
management in patients with acute pancreatitis. Which among the following
medications are included? Select all that apply.
1. Fentanyl (Sublimaze)
2. Morphine sulfate
3. Hydromorphone (Dilaudid)
4. Meperidine hydrochloride (Demerol)
a. 1, 3 and 4
b. 2, 3 and 4
c. 1, 2, and 4
d. 1, 2 and 3
Answer: D
45. Nurse Mona is checking on the laboratory results of Ezra who is diagnosed with
acute pancreatitis. Which among the following is expected?
a. Serum lipase 180 U/L
b. Serum calcium 15.5 mg/dL
c. Fasting blood glucose 98 mg/dL
d. LDH 250 U/L
Answer: A

Situation 14: Nurse Maricar is being assigned in the medical unit for 3 weeks already.
She is taking care of patients with GI disorders.
46. Nurse Maricar is assigned in the medical unit is caring for Petrus 3 days post
admission who has a long history of heavy alcohol abuse. For which most acute
complications related to alcohol abuse should Nurse Maricar monitor? Select all
that apply.
1. Seizures
2. Infections
3. GI bleeding
4. Pancreatitis
5. Dementia
a. 1 and 4
b. 2 and 4
c. 3 and 4
d. 4 and 5
Answer: 1
47. Nurse Maricar notes bluish-black discoloration on Petrus flank area. How should
Nurse Maricar interpret this finding?
a. Positive Murphy sign
b. Positive Blumberg sign
c. Positive Turner’s sign
d. Positive Nakamura sign
Answer: C
48. Petrus is under histamine 2 receptor blocker medication for his acute
pancreatitis. Nurse Maricar is correct when she prepares which among the
following medications?
a. Omeprazole (Prilosec)
b. Famotidine (Pepcid)
c. Cholestyramine (Questran)
d. Pancrealipase (Pancrease)
Answer: B
49. Nurse Maricar is reviewing the doctors order for Petrus who has pancreatitis.
Which among the following should she question?
a. Furosemide 40 mg IVTT q 6 hours
b. Morphine sulfate 10 mg IVTT q 6 hours
c. Imipenem-cilastin (Primaxi) 500 mg IVTT q 6 hours
d. Propantheline bromide (Pro-Banthine) 30 mg IVTT TID
Answer: A
50. In order to classify patient’s severity with pancreatitis, which among the following
is a tool to evaluate patient’s condition with pancreatitis?
a. FIGO criteria
b. Gleason scale
c. Ransons criteria
d. Braden’s scale
Answer: C
51. In setting goals for a client with advanced liver cancer who has poor nutrition,
the nurse determines that which of the following is a realistic desired outcome for
the client? The client will:
a. Have normalized albumin levels.
b. Return to ideal body weight.
c. Gain 1 lb. every 2 weeks.
d. Maintain current weight.

52. A client has a cancer of the liver. The nurse should be most concerned about
which nursing diagnosis?

a. Alteration in nutrition
b. Alteration in skin integrity
c. Ineffective coping
d. Fatigue

53. A registered nurse (RN) is caring for a client following a liver biopsy with the
assistance of a student nurse. The RN evaluates that the student understands
the post procedure care when the student nurse:
a. plans to monitor vital signs every hour.
b. promotes ambulation 1 hour after the procedure.
c. positions the client on the right side.
d. encourages the client to cough and deep breathe immediately following the
procedure

54.A nurse is caring for a client diagnosed with hepatocellular carcinoma who is
exhibiting a paraneoplastic syndrome. For which signs should the nurse assess?
a. Erythrocytosis and hypercalcemia
b. Hyperkalemia and hyperalbuminemia
c. Hypernatremia and hypomagnesemia
d. Hypocalcemia and hyperleukocytosis

55. A client tells a nurse that she has been diagnosed with a 2-cm cancerous
tumor in the liver. The client wants to know what type of treatment should be
anticipated. The nurse’s response should reflect the knowledge that:
a. chemotherapy is the first-line treatment for liver cancer.
b. because of the vascularity of the liver, it is not possible to excise the
cancerous tumor using an open surgical approach.
c. liver transplantation is not an option for clients with liver cancer.
d. radiofrequency ablation has been successful in treating tumors of that
size

56. A client with a diagnosis of cancer in the liver is frequently disruptive and
challenges the nurse. This behavior is probably caused by:
a. Uncertainty and an underlying fear of recurrence.
b. The usual trajectory of a short-term illness.
c. A history of a behavioral illness.
d. The one-time crisis from learning of the diagnosis.

57. A 66-year-old female with liver cancer who is usually meticulous about her
appearance and dress arrives today for her 23rd day of radiation therapy. She
appears disheveled and emotionally labile, and her responses to the usual
questions are a little inappropriate. Her heart rate is 124 bpm, her respirations
are 32 breaths/minute, and her skin is cold and clammy. These findings would
suggest that the nurse should further assess the client for which of the following
conditions?

a. Schizophrenia.
b. Panic disorder.
c. Depression.
d. Delirium.

58. During the nursing shift report, the team leader lists tasks and routines
completed for a terminally ill client of liver cancer. Which of the following kinds of
behavior is the nurse most likely demonstrating when emphasizing the technical
aspects of caring for a dying client?

a. Tactful behavior.
b. Efficient behavior.
c. Objective behavior.
d. Defensive behavior.

59. . A nurse suspects that a client, admitted with upper right-sided abdominal
pain, may have liver cancer when which serum laboratory test result is noted to
be elevated?

a. Creatinine 2
b. Serum fetoprotein (AFP) levels
c. Serum phosphorus levels
d. CA-125

60. Following a shift report on an oncology unit, a nurse determines that which
client with a liver cancer should be assessed first?
a. A client with breast cancer who has an order for ondansetron (Zofran®) 8 mg
intravenously (IV) 30 minutes prior to chemotherapy
b. A client just admitted with a temperature of 101°F (38.3°C), diaphoresis,
and an absolute neutrophil count of 98/mm
c. A client with breast cancer who is scheduled for external beam radiation in 15
minutes
d. None of the above
61. Which of the following clients is at highest risk for colorectal cancer?
a. The client who smokes.
b. The client who eats a vegetarian diet.
c. The client who has been treated for Crohn’s disease for 20 years.
d. The client who has a family history of lung cancer

62. A 42-year-old female is interested in making dietary changes to reduce her

risk of colon cancer. What dietary selections should the nurse suggest?
a. Croissant, granola and peanut butter squares, whole milk.
b. Bran muffin, skim milk, stir-fried broccoli.
c. Granola, bagel with cream cheese, cauliflower salad.
d. Oatmeal, raisin cookies, baked

63. A nurse is checking the laboratory results of a 52-year-old client with colon
cancer admitted for further chemotherapy. The client has lost 30 lb. (13.6 kg)
since initiation of the treatment. Which laboratory result should be reported to the
health care provider?
a. Blood glucose level of 95 mg/dL.
b. Total cholesterol level of 182 mg/dL.
c. Hemoglobin level of 12.3 mg/dL.
d. Albumin level of 2.8 g/dL.

64. A client with colon cancer had a left hemicolectomy 3 weeks previously. The
client is still having difficulty maintaining an adequate oral intake to meet
metabolic needs for optimal healing. Which of the following nutritional support
methods would be most appropriate?
a. Total parenteral nutrition through a central catheter.
b. I.V. infusion of dextrose.
c. Nasogastric feeding tube with protein supplement.
d. Jejunostomy for high caloric feedings

65. A client receiving chemotherapy for metastatic colon cancer is admitted to the
oncology unit due to several days of vomiting. Assessment findings include:
irregular pulse of 120, blood pressure 88/48, respiratory rate of 14, serum
potassium of 2.9 mEq/L, and arterial blood gas—pH 7.46, PCO2 45, PO2 95,
bicarbonate level 29 mEq/L. Which of the following interventions is appropriate
for the nurse to administer to the client?
a. Oxygen at 4L per nasal cannula.
b. Potassium 40 mEq PO now.
c. 5% Dextrose in 0.45% Normal Saline with KCl 40 mEq/L at 125 mL/hour.
d. NaHCO3 75 mEq IV

66. Which of the following gastrointestinal condition is known to predispose to

cancer of the colon?

a. Hemorrhoids
 b. Intussusception
c. Isolated Colonic Polyps
d. Pyloric Stenosis

67. A client has a rectal cancer and is scheduled for an abdominal perineal
resection. What should be the priority nursing care during the post operative
period?
a. Teaching how to irrigate the ileostomy
b. Stopping electrolyte loss in the incisional area
c. Encouraging a high fiber diet
d. Facilitating perineal wound drainage.

68. The client with colon cancer has an abdominal-perineal resection with a
colostomy. Which of the following nursing interventions is most appropriate for
this client in the postoperative period?
a. Maintain the client in a semi-Fowler’s position.
b. Assist the client with warm sitz baths.
c. Administer 30 mL of milk of magnesia to stimulate colostomy activity.
d. Remove the ostomy pouch as needed so the stoma can be assessed.

69. The nurse assesses the client’s stoma during the initial postoperative period.
Which of the following observations should be reported immediately to the
physician?
a. The stoma is slightly edematous.
b. The stoma is dark red to purple.
c. The stoma oozes a small amount of blood.
d. The stoma does not expel stool.

70. While changing the client’s colostomy bag and dressing, the nurse assesses
that the client is ready to participate in her care by noting which of the following?
a. The client asks what time the doctor will visit that day.
b. The client asks about the supplies used during the dressing change.
c. The client talks about something she read in the morning newspaper.
d. The client complains about the way the night nurse changed the dressing.

71. A client with esophageal cancer has abdominal bloating and cramping with no bowel
movement for 5 days. She says she usually has a bowel movement every day
after her morning coffee. Bowel sounds are present in all four quadrants. She received 80
mg of doxorubicin hydrochloride (Adriamycin) 10 days ago. The nurse should contact the
health care provider to request an order for which of the following?
a. A Fleet enema to stimulate peristalsis.
b. A soapsuds enema until clear.
 c. An oral cathartic until the client has a bowel movement; then evaluate the need
for daily stool softeners.
d. A daily stool softener for constipation and a mild opioid for abdominal discomfort.
72. The nurse is assessing a client with chronic
hepatitis B who is receiving Lamivudine (Epivir).
What information is most important to communicate
to the physician?
A. The client’s daily record indicates a 3 kg
weight gain over 2 days.
B. The client is complaining of nausea.
C. The client has a temperature of 99° F orally.
D. The client has fatigue.
73. The nurse is assessing a client with hepatitis
and notices that the AST and ALT lab values have
increased. Which of the following statements by the
client requires further instruction by the nurse?
A. “I require increased periods of rest.”
B. “I follow a low-fat, high carbohydrate diet.”
C. “I eat dry toast to relieve my nausea.”
D. “I take acetaminophen (Tylenol) for arthritis
pain.”
74. College freshman are participating in a study
abroad program. When teaching them about hepatitis
B, the nurse should instruct the students on:
A. Water sanitation.
B. Single dormitory rooms.
C. Vaccination for hepatitis D.
D. Safe sexual practices.
75. Which of the following is normal for a client
during the icteric phase of viral hepatitis?
A. Tarry stools.
B. Yellowed sclera.
C. Shortness of breath.
D. Light, frothy urine.
76. The nurse is planning a home visit for a client
with hepatitis. In order to prevent transmission
the nurse should focus teaching on:
A. Proper food handling.
B. Insulin syringe disposal.
C. Alpha-interferon.
D. Use of condoms.
77. A client who is recovering from hepatitis A
has fatigue and malaise. The client asks the nurse,
“When will my strength return?” Which of the following
responses by the nurse is most appropriate?
A. “Your fatigue should be gone by now. We will
evaluate you for a secondary infection.”
B. “Your fatigue is an adverse effect of your drug
therapy. It will disappear when your treatment
regimen is complete.”
C. “It is important for you to increase your
activity level. That will help decrease your
fatigue.”
D. “It is normal for you to feel fatigued. The
fatigue should go away in the next 2 to 4
months.”
78. The nurse is developing a plan of care for the
client with viral hepatitis. The nurse should instruct
the client to:
A. Obtain adequate bed rest.
B. Increase fluid intake.
C. Take antibiotic therapy as ordered.
D. Drink 8 oz of an electrolyte solution every
day.
79. When planning care for a client with viral
hepatitis, the nurse should review laboratory
reports for which of the following abnormal laboratory
values?
A. Prolonged prothrombin time.
B. Decreased blood glucose level.
C. Elevated serum potassium level.
D. Decreased serum calcium level.
80. The nurse should teach the client with viral
hepatitis to:
A. Limit caloric intake and reduce weight.
B. Increase carbohydrates and protein in the
diet.
C. Avoid contact with others and live separately.
D. Intensify routine exercise and increase
strength.
81. The nurse develops a teaching plan for
the client about how to prevent the transmission
of hepatitis A. Which of the following discharge
instructions is appropriate for the client?
A. Spray the house to eliminate infected insects.
B. Tell family members to try to stay away from
the client.
C. Tell family members to wash their hands frequently.
D. Disinfect all clothing and eating utensils.
82. The nurse assesses that the client with hepatitis
is experiencing fatigue, weakness, and a general
feeling of malaise. The client tires rapidly during
morning care. Based on this information, which of
the following would be an appropriate nursing diagnosis?
A. Impaired physical mobility related to malaise.
B. Self-care deficit related to fatigue.
C. Ineffective coping related to long-term illness.
D. Activity intolerance related to fatigue.
83. What would be the nurse’s best response to
the client’s expressed feelings of isolation as a result
of having hepatitis?
A. “Don’t worry. It’s normal to feel that way.”
B. “Your friends are probably afraid of contracting
hepatitis from you.”
C. “I’m sure you’re imagining that!”
D. “Tell me more about your feelings of isolation.”
84. Interferon alfa-2b (Intron A) has been prescribed
to treat a client with chronic hepatitis B.
The nurse should assess the client for which of the
following adverse effects?
A. Retinopathy.
B. Constipation.
C. Flulike symptoms.
D. Hypoglycemia.
85. The nurse is preparing a community education
program about preventing hepatitis B infection.
Which of the following would be appropriate to
incorporate into the teaching plan?
A. Hepatitis B is relatively uncommon among
college students.
B. Frequent ingestion of alcohol can predispose
an individual to development of hepatitis B.
C. Good personal hygiene habits are most effective
at preventing the spread of hepatitis B.
D. The use of a condom is advised for sexual
intercourse.
86. Which of the following expected outcomes
would be appropriate for a client with viral hepatitis?
The client will:
A. Demonstrate a decrease in fluid retention
related to ascites.
B. Verbalize the importance of reporting bleeding
gums or bloody stools.
C. Limit use of alcohol to two to three drinks per
week.
D. Restrict activity to within the home to prevent
disease transmission.
87. A client with cirrhosis is receiving Lactulose
(Cephulac). During the assessment the nurse notes
increased confusion and asterixis. The nurse should:
A. Assess for GI bleeding.
B. Hold the Lactulose (Cephulac).
C. Increase protein in the diet.
D. Monitor serum bilirubin levels.
88. The nurse is assessing a client with cirrhosis
who has developed hepatic encephalopathy. The
nurse should notify the physician of a decrease in
which lab serum that is a potential precipitating factor
for hepatic encephalopathy?
A. Aldosterone.
B. Creatinine.
C. Potassium.
D. Protein.
89. A client has advanced cirrhosis of the liver.
The client’s spouse asks the nurse why his abdomen
is swollen, making it very difficult for him to
fasten his pants. How should the nurse respond to
provide the most accurate explanation of the disease
process?
A. “He must have been eating too many foods
with salt in them. Salt pulls water with it.”
B. “The swelling in his ankles must have moved
up closer to his heart so the fluid circulates
better.”
C. “He must have forgotten to take his daily
water pill.”
D. “Blood is not able to flow readily through the
liver now, and the liver cannot make protein
to keep fluid inside the blood vessels.”
90. A nurse is developing a care plan for a client
with hepatic encephalopathy. Which of the following
are goals for the care for this client? Select all
that apply.
A. Preventing constipation.
B. Administering lactulose (Cephulac).
C. Monitoring coordination while walking.
D. Checking the pupil reaction.
E. Providing food and fluids high in carbohydrate.
F. Encouraging physical activity.
91. The nurse is assessing a client who is in the
early stages of cirrhosis of the liver. Which focused
assessment is appropriate?
A. Peripheral edema.
B. Ascites.
C. Anorexia.
D. Jaundice.
92. A client with cirrhosis begins to develop
ascites. Spironolactone (Aldactone) is prescribed to
treat the ascites. The nurse should monitor the client
closely for which of the following drug-related
adverse effects?
A. Constipation.
B. Hyperkalemia.
C. Irregular pulse.
D. Dysuria.
93. What diet should be implemented for a client
who is in the early stages of cirrhosis?
A. High-calorie, high-carbohydrate.
B. High-protein, low-fat.
C. Low-fat, low-protein.
D. High-carbohydrate, low-sodium.
94. A client with jaundice has pruritis and states
that he has areas of irritation from scratching. What
measures can the nurse discuss to prevent skin
breakdown? Select all that apply.
A. Avoid lotions containing calamine.
B. Take baking soda baths.
C. Keep nails short and clean.
D. Rub with knuckles instead of nails.
E. Massage skin with alcohol.
F. Increase sodium intake in diet.
95. Which of the following health promotion
activities would be appropriate for the nurse to suggest
that the client with cirrhosis add to the daily
routine at home?
A. Supplement the diet with daily multivitamins.
B. Limit daily alcohol intake.
C. Take a sleeping pill at bedtime.
D. Limit contact with other people whenever
possible.
96. The nurse is reviewing the chart information
for a client with increased ascites. The data include:
temperature 37.2° C; heart rate 118; shallow respirations
26; blood pressure 128/76; and SpO2 89% on
room air. Which action should receive priority by
the nurse?
A. Assess heart sounds.
B. Obtain an order for blood cultures.
C. Prepare for a paracentesis.
D. Raise the head of the bed.
97. Which of the following positions would be
appropriate for a client with severe ascites?
A. Fowler’s.
B. Side-lying.
C. Reverse Trendelenburg.
D. Sims.
98. The client with cirrhosis receives 100 mL
of 25% serum albumin I.V. Which finding would
best indicate that the albumin is having its desired
effect?
A. Increased urine output.
B. Increased serum albumin level.
C. Decreased anorexia.
D. Increased ease of breathing.
99. The nurse is planning care for a client being
admitted with bleeding esophageal varices. Vital
signs are: Pulse 100; respiratory rate 22; and blood
pressure 100/58. The nurse should prepare the client
for which of the following? Select all that apply.
A. Administration of intravenous Octreotide
(Sandostatin).
B. Endoscopy.
C. Administration of a blood product.
D. Minnesota tube insertion.
E. Transjugular intrahepatic portosystemic shunt
(TIPS) procedure.
F. Immediate endotracheal intubation.
100. The physician orders oral neomycin (Mycifradin)
as well as a neomycin enema for a client
with cirrhosis. The expected outcome of this therapy
is to:
A. Reduce abdominal pressure.
B. Prevent straining during defecation.
C. Block ammonia formation.
D. Reduce bleeding within the intestine.