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MS2-Gastro Nclex Questions

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Terms in this set (133) Original

Which of the following complications is

thought to be the most common cause of
appendicitis?

A. A fecalith
B. Bowel kinking
C. Internal bowel occlusion
D. Abdominal bowel swelling

A. A fecalith is a fecal calculus, or stone,

that occludes the lumen of the appendix
and is the most common cause of
appendicitis. Bowel wall swelling, kinking of
the appendix, and external occlusion, not
internal occlusion, of the bowel by
adhesions can also be causes of
appendicitis.

Which of the following terms best

describes the pain associated with
appendicitis?

A. Aching
B. Fleeting
C. Intermittent
D. Steady

D. The pain begins in the epigastrium or

periumbilical region, then shifts to the right
lower quadrant and becomes steady. The
pain may be moderate to severe.

Which of the following nursing

interventions should be implemented to
manage a client with appendicitis?

A. Assessing for pain

B. Encouraging oral intake of clear fluids
C. Providing discharge teaching
D. Assessing for symptoms of peritonitis

D. The focus of care is to assess for

peritonitis, or inflammation of the
peritoneal cavity. Peritonitis is most
commonly caused by appendix rupture
and invasion of bacteria, which could be
lethal. The client with appendicitis will have
pain that should be controlled with
analgesia. The nurse should discourage
oral intake in preparation of surgery.
Discharge teaching is important; however,
in the acute phase, management should
focus on minimizing preoperative
complications and recognizing when such
may be occurring.

Which of the following definitions best

describes gastritis?

A. Erosion of the gastric mucosa

B. Inflammation of a diverticulum
C. Inflammation of the gastric mucosa
D. Reflux of stomach acid into the
esophagus

C. Gastritis is an inflammation of the gastric

mucosa that may be acute (often resulting
from exposure to local irritants) or chronic
(associated with autoimmune infections or
atrophic disorders of the stomach). Erosion
of the mucosa results in ulceration.
Inflammation of a diverticulum is called
diverticulitis; reflux of stomach acid is
known as gastroesophageal disease.

Which of the following substances is most

likely to cause gastritis?

A. Milk
B. Bicarbonate of soda, or baking soda
C. Enteric coated aspirin
D. Nonsteriodal anti-imflammatory drugs

D. NSAIDS are a common cause of gastritis

because they inhibit prostaglandin
synthesis. Milk, once thought to help
gastritis, has little effect on the stomach
mucosa. Bicarbonate of soda, or baking
soda, may be used to neutralize stomach
acid, but it should be used cautiously
because it may lead to metabolic acidosis.
ASA with enteric coating shouldn't
contribute significantly to gastritis because
the coating limits the aspirin's effect on the
gastric mucosa.

Which of the following definitions best

describes diverticulosis?

A. An inflamed outpouching of the intestine

B. A noninflamed outpouching of the
intestine
C. The partial impairment of the forward
flow of intestinal contents
D. An abnormal protrusion of an organ
through the structure that usually holds it.

B. Diverticulosis involves a noninflamed

outpouching of the intestine. Diverticulitis
involves an inflamed outpouching. The
partial impairment of forward flow of the
intestine is an obstruction; abnormal
protrusion of an organ is a hernia.

Which of the following types of diets is

implicated in the development of
diverticulosis?

A. Low-fiber diet
B. High-fiber diet
C. High-protein diet
D. Low-carbohydrate diet

A. Low-fiber diets have been implicated in

the development of diverticula because
these diets decrease the bulk in the stool
and predispose the person to the
development of constipation. A high-fiber
diet is recommended to help prevent
diverticulosis. A high-protein or low-
carbohydrate diet has no effect on the
development of diverticulosis.

Which of the following mechanisms can

facilitate the development of diverticulosis
into diverticulitis?

A. Treating constipation with chronic

laxative use, leading to dependence on
laxatives
B. Chronic constipation causing an
obstruction, reducing forward flow of
intestinal contents
C. Herniation of the intestinal mucosa,
rupturing the wall of the intestine
D. Undigested food blocking the
diverticulum, predisposing the area to
bacteria invasion.

D. Undigested food can block the

diverticulum, decreasing blood supply to
the area and predisposing the area to
invasion of bacteria. Chronic laxative use is
a common problem in elderly clients, but it
doesn't cause diverticulitis. Chronic
constipation can cause an obstruction—not
diverticulitis. Herniation of the intestinal
mucosa causes an intestinal perforation.

Which of the following symptoms indicated

diverticulosis?

A. No symptoms exist
B. Change in bowel habits
C. Anorexia with low-grade fever
D. Episodic, dull, or steady midabdominal
pain

A. Diverticulosis is an asymptomatic
condition. The other choices are signs and
symptoms of diverticulitis.

Which of the following tests should be

administered to a client suspected of
having diverticulosis?

A. Abdominal ultrasound
B. Barium enema
C. Barium swallow
D. Gastroscopy

B. A barium enema will cause diverticula to

fill with barium and be easily seen on x-ray.
An abdominal US can tell more about
structures, such as the gallbladder, liver,
and spleen, than the intestine. A barium
swallow and gastroscopy view upper GI
structures.

Medical management of the client with

diverticulitis should include which of the
following treatments?

A. Reduced fluid intake

B. Increased fiber in diet
C. Administration of antibiotics
D. Exercises to increase intra-abdominal
pressur

C. Antibiotics are used to reduce the

inflammation. The client isn't typically isn't
allowed anything orally until the acute
episode subsides. Parenteral fluids are
given until the client feels better; then it's
recommended that the client drink eight 8-
ounce glasses of water per day and
gradually increase fiber in the diet to
improve intestinal motility. During the acute
phase, activities that increase intra-
abdominal pressure should be avoided to
decrease pain and the chance of intestinal
obstruction.

Crohn's disease can be described as a

chronic relapsing disease. Which of the
following areas in the GI system may be
involved with this disease?

A. The entire length of the large colon

B. Only the sigmoid area
C. The entire large colon through the layers
of mucosa and submucosa
D. The small intestine and colon; affecting
the entire thickness of the bowel

D. Crohn's disease can involve any segment

of the small intestine, the colon, or both,
affecting the entire thickness of the bowel.
Answers 1 and 3 describe ulcerative colitis,
answer 2 is too specific and therefore, not
likely.

Which area of the alimentary canal is the

most common location for Crohn's
disease?

A. Ascending colon
B. Descending colon
C. Sigmoid colon
D. Terminal ileum

D. Studies have shown that the terminal

ileum is the most common site for
recurrence in clients with Crohn's disease.
The other areas may be involved but aren't
as common.

Which of the following factors is believed

to be linked to Crohn's disease?

A. Constipation
B. Diet
C. Hereditary
D. Lack of exercise

C. Although the definite cause of Crohn's

disease is unknown, it's thought to be
associated with infectious, immune, or
psychological factors. Because it has a
higher incidence in siblings, it may have a
genetic cause.

15. Which of the following factors is

believed to cause ulcerative colitis?

A. Acidic diet
B. Altered immunity
C. Chronic constipation
D. Emotional stress

B. Several theories exist regarding the

cause of ulcerative colitis. One suggests
altered immunity as the cause based on the
extraintestinal characteristics of the disease,
such as peripheral arthritis and cholangitis.
Diet and constipation have no effect on the
development of ulcerative colitis.
Emotional stress can exacerbate the
attacks but isn't believed to be the primary
cause.

Fistulas are most common with which of the

following bowel disorders?

A. Crohn's disease
B. Diverticulitis
C. Diverticulosis
D. Ulcerative colitis

A. The lesions of Crohn's disease are

transmural; that is, they involve all thickness
of the bowel. These lesions may perforate
the bowel wall, forming fistulas with
adjacent structures. Fistulas don't develop
in diverticulitis or diverticulosis. The ulcers
that occur in the submucosal and mucosal
layers of the intestine in ulcerative colitis
usually don't progress to fistula formation
as in Crohn's disease.

Which of the following areas is the most

common site of fistulas in client's with
Crohn's disease?

A. Anorectal
B. Ileum
C. Rectovaginal
D. Transverse colon

A. Fistulas occur in all these areas, but the

anorectal area is most common because of
the relative thinness of the intestinal wall in
this area.

Which of the following associated

disorders may a client with ulcerative colitis
exhibit?

A. Gallstones
B. Hydronephrosis
C. Nephrolithiasis
D. Toxic megacolon

D. Toxic megacolon is extreme dilation of a

segment of the diseased colon caused by
paralysis of the colon, resulting in complete
obstruction. This disorder is associated with
both Crohn's disease and ulcerative colitis.
The other disorders are more commonly
associated with Crohn's disease.

Which of the following associated

disorders may the client with Crohn's
disease exhibit?

A. Ankylosing spondylitis
B. Colon cancer
C. Malabsorption
D. Lactase deficiency

C. Because of the transmural nature of

Crohn's disease lesions, malaborption may
occur with Crohn's disease. Ankylosing
spondylitis and colon cancer are more
commonly associated with ulcerative colitis.
Lactase deficiency is caused by a
congenital defect in which an enzyme isn't
present.

Which of the following symptoms may be

exhibited by a client with Crohn's disease?

A. Bloody diarrhea
B. Narrow stools
C. N/V
D. Steatorrhea

D. Steatorrhea from malaborption can

occur with Crohn's disease. N/V, and
bloody diarrhea are symptoms of ulcerative
colitis. Narrow stools are associated with
diverticular disease.

Which of the following symptoms is

associated with ulcerative colitis?

A. Dumping syndrome
B. Rectal bleeding
C. Soft stools
D. Fistulas

B. In ulcerative colitis, rectal bleeding is the

predominant symptom. Soft stools are
more commonly associated with Crohn's
disease, in which malabsorption is more of
a problem. Dumping syndrome occurs after
gastric surgeries. Fistulas are associated
with Crohn's disease.

If a client had irritable bowel syndrome,

which of the following diagnostic tests
would determine if the diagnosis is Crohn's
disease or ulcerative colitis?

A. Abdominal computed tomography (CT)

scan
B. Abdominal x-ray
C. Barium swallow
D. Colonoscopy with biopsy

D. A colonoscopy with biopsy can be

performed to determine the state of the
colon's mucosal layers, presence of
ulcerations, and level of cytologic
development. An abdominal x-ray or CT
scan wouldn't provide the cytologic
information necessary to diagnose which
disease it is. A barium swallow doesn't
involve the intestine.

Which of the following interventions should

be included in the medical management of
Crohn's disease?

A. Increasing oral intake of fiber

B. Administering laxatives
C. Using long-term steroid therapy
D. Increasing physical activity

C. Management of Crohn's disease may

include long-term steroid therapy to
reduce the inflammation associated with
the deeper layers of the bowel wall. Other
management focuses on bowel rest (not
increasing oral intake) and reducing
diarrhea with medications (not giving
laxatives). The pain associated with Crohn's
disease may require bed rest, not an
increase in physical activity.

In a client with Crohn's disease, which of

the following symptoms should not be a
direct result from antibiotic therapy?

A. Decrease in bleeding
B. Decrease in temperature
C. Decrease in body weight
D. Decrease in the number of stools

C. A decrease in body weight may occur

during therapy due to inadequate dietary
intake, but isn't related to antibiotic therapy.
Effective antibiotic therapy will be noted by
a decrease in temperature, number of
stools, and bleeding.

Surgical management of ulcerative colitis

may be performed to treat which of the
following complications?

A. Gastritis
B. Bowel herniation
C. Bowel outpouching
D. Bowel perforation

D. Perforation, obstruction, hemorrhage,

and toxic megacolon are common
complications of ulcerative colitis that may
require surgery. Herniation and gastritis
aren't associated with irritable bowel
diseases, and outpouching of the bowel is
diverticulosis.

Which of the following medications is most

effective for treating the pain associated
with irritable bowel disease?

A. Acetaminophen
B. Opiates
C. Steroids
D. Stool softeners

C. The pain with irritable bowel disease is

caused by inflammation, which steroids can
reduce. Stool softeners aren't necessary.
Acetaminophen has little effect on the pain,
and opiate narcotics won't treat its
underlying cause (I feel this is untrue—