SEED FAITH TRAINING AND REVIEW CENTER

# 333 Magsaysay Avenue, Baguio City| 09195638562 |

Gastrointestinal/Endocrine disorders Evaluation exam II

1. Which nursing diagnosis takes highest priority for a client with hyperthyroidism? a. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess b. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing c. Body image disturbance related to weight gain and edema d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess 2. A client with long-standing type 1 diabetes mellitus is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: a. Impaired adjustment. b. Defensive coping. c. Deficient knowledge. d. Health-seeking behaviors. 3. A 62-year-old client diagnosed with pyelonephritis and possible septicemia has had five urinary tract infections over the past 2 years. She's fatigued from lack of sleep; urinates frequently, even during the night; and has lost weight recently. Tests reveal the following: sodium level 152 mEq/L, osmolarity 340 mOsm/L, glucose level 125 mg/dl, and potassium level 3.8 mEq/L. Which of the following nursing diagnoses is most appropriate for this client? a. Deficient fluid volume related to inability to conserve water b. Imbalanced nutrition: Less than body requirements related to hypermetabolic state c. Deficient fluid volume related to osmotic diuresis induced by hypernatremia d. Imbalanced nutrition: Less than body requirements related to catabolic effects of insulin deficiency 4. A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will prescribe diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client does not comply with the recommended treatment, which complication may arise? a. Cerebral edema b. Hypovolemic shock c. Severe hyperkalemia d. Tetany 5. Following a unilateral adrenalectomy, the nurse would assess for hyperkalemia shown by which of the following? a. Muscle weakness b. Tremors c. Diaphoresis d. Constipation 6. The nurse is assessing a client with hyperthyroidism. What findings should the nurse expect? a. Weight gain, constipation, and lethargy b. Weight loss, nervousness, and tachycardia c. Exophthalmos, diarrhea, and cold intolerance d. Diaphoresis, fever, and decreased sweating 7. Which important instruction concerning the administration of levothyroxine (Synthroid) should the nurse teach a client? a. "Take the drug on an empty stomach." b. "Take the drug with meals." c. "Take the drug in the evening." d. "Take the drug whenever convenient." 8. An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: a. thyroid storm. b. cretinism. c. myxedema coma. d. Hashimoto's thyroiditis. 9. A client is diagnosed with the syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? a. Decreased serum sodium level b. Decreased serum creatinine level c. Increased hematocrit d. Increased blood urea nitrogen (BUN) level 10. A client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem? a. Depression b. Neuropathy c. Hypoglycemia d. Hyperthyroidism 11. A client is transferred to a rehabilitation center after being treated in the hospital for a cerebrovascular accident (CVA). Because the client has a history of Cushing's syndrome (hypercortisolism) and chronic obstructive pulmonary disease (COPD), the nurse formulates a nursing diagnosis of: a. Risk for imbalanced fluid volume related to excessive sodium loss. b. Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion. c. Ineffective health maintenance related to frequent hypoglycemic episodes secondary to Cushing's syndrome. d. Decreased cardiac output related to hypotension secondary to Cushing's syndrome. 12. A client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are only effective if the client: a. prefers to take insulin orally. b. has type 2 diabetes. c. has type 1 diabetes. d. is pregnant and has type 2 diabetes. 13. A client becomes upset when the physician diagnoses diabetes mellitus as the cause of current signs and symptoms. The client tells the nurse, "This must be a mistake. No one in my family has ever had diabetes." Based on this statement, the nurse suspects the client is using which coping mechanism? a. Denial b. Withdrawal c. Anger d. Resolution 14. When instructing the client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of which of the following? a. Restricting fluids b. Restricting sodium c. Forcing fluids d. Restricting potassium 15. The nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse

SEED FAITH TRAINING AND REVIEW CENTER

should state that the physician probably will prescribe daily supplements of calcium and: a. folic acid. b. vitamin D. c. potassium. d. iron. 16. The client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: a. exophthalmos and conjunctival redness b. flushed, warm, moist skin c. systolic murmur at the left sternal border d. decreased body temperature and cold intolerance 17. Which of the following would indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? a. Confusion and seizures b. Sunken eyeballs and spasticity c. Flaccidity and thirst d. Tetany and increased blood urea nitrogen (BUN) levels. 18. A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by: a. dry, waxy swelling and abnormal mucin deposits in the skin. b. protruding eyes and a fixed stare. c. a wide, staggering gait. d. more than 10 beats/minute difference between the apical and radial pulse rates. 19. Which of the following would the nurse expect to find in a client diagnosed with hyperparathyroidism? a. Hypocalcemia b. Hypercalcemia c. Hyperphosphatemia d. Hypophosphaturia 20. The nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? a. Pitting edema of the legs b. An irregular apical pulse c. Dry mucous membranes d. Frequent urination 21. Which of the following is the most critical intervention needed for a client with myxedema coma? a. Administering an oral dose of levothyroxine (Synthroid) b. Warming the client with a warming blanket c. Measuring and recording accurate intake and output d. Maintaining a patent airway 22. A 68-year-old client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, the nurse would suspect which of the following disorders? a. Diabetes mellitus b. Diabetes insipidus c. Hypoparathyroidism d. Hyperparathyroidism 23. The nurse is developing a teaching plan for a client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus? a. antidiuretic hormone (ADH). b. thyroid-stimulating hormone (TSH). c. follicle-stimulating hormone (FSH). d. luteinizing hormone (LH).

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24. The nursing care for the client in addisonian crisis should include which of the following interventions? a. Encouraging independence with activities of daily living (ADLs) b. Allowing ambulation as tolerated c. Offering extra blankets and raising the heat in the room to keep the client warm d. Placing the client in a private room 25. The nurse is explaining the action of insulin to a newly diagnosed diabetic client. During the teaching, the nurse reviews the process of insulin secretion in the body. The nurse is correct when stating that insulin is secreted from the: a. adenohypophysis. b. beta cells of the pancreas. c. alpha cells of the pancreas d. parafollicular cells of the thyroid. 26. Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and propylthiouracil (PTU). The nurse would expect the client's symptoms to subside: a. in a few days. b. in 3 to 4 months. c. immediately. d. in 1 to 2 weeks. 27. Which of the following instructions should be included in the teaching plan for a client requiring insulin? a. Which of the following instructions should be included in the teaching plan for a client requiring insulin? b. Administer insulin at a 45-degree angle into the deltoid muscle. c. Shake the vial of insulin vigorously before withdrawing the medication. d. Draw up clear insulin first when mixing two types of insulin in one syringe. 28. The nurse is assigned to care for a postoperative client who has diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about its effect on his marriage. In planning this client's care, the most appropriate intervention would be to: a. encourage the client to ask questions about personal sexuality. b. provide time for privacy. c. provide support for the spouse or significant other. d. suggest referral to a sex counselor or other appropriate professional. 29. During the first 24 hours after a client is diagnosed with addisonian crisis, which of the following should the nurse perform frequently? a. Weigh the client. b. Test urine for ketones. c. Assess vital signs. d. Administer oral hydrocortisone. 30. A client with newly diagnosed type 2 diabetes mellitus is admitted to the metabolic unit. The primary goal for this admission is education. Which of the following goals should the nurse incorporate into her teaching plan? a. Maintenance of blood glucose levels between 180 and 200 mg/dl b. Smoking reduction but not complete cessation c. An eye examination every 2 years until age 50 d. Exercise and a weight reduction diet 31. During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and: a. sodium. b. potassium. c. magnesium. d. phosphorus.

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32. The nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should: a. use commercial preparations to remove corns. b. cut the toenails by rounding edges. c. wash and inspect the feet daily. d. walk barefoot at least once each day. 33. For a client with Graves' disease, which nursing intervention promotes comfort? a. Restricting intake of oral fluids b. Placing extra blankets on the client's bed c. Limiting intake of high-carbohydrate foods d. Maintaining room temperature in the low-normal range 34. The nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? a. Tetany b. Hemorrhage c. Thyroid storm d. Laryngeal nerve damage 35. In a 28-year-old female client who is being successfully treated for Cushing's syndrome, the nurse would expect a decline in: a. serum glucose level. b. hair loss. c. bone mineralization. d. menstrual flow. 36. Which of the following terms most precisely refers to the incision of the common bile duct for removal of stones? a. Choledochoduodenostomy b. Choledocholithotomy c. Cholecystostomy d. Choledochotomy 37. A certain endocrine disorder can lead to an elevated blood pressure, decreased potassium levels, sodium and water retention, and decreased renin activity. Which of the following is the most likely diagnosis? (A) Addisons disease (B) Hyperthyroidism (C) Pheochromocytoma (D) Primary hyperaldosteronism 38. A 5-year-old girl is brought to the pediatrician by her mother because she has noticed a single soft, nontender mass underneath her daughters tongue. The physician reassures the mother that it is a common congenital ectopic anomaly that does not affect the function of the mass or the hormone it secretes. Hypersecretion of this hormone can cause which of the following conditions? (A) Amenorrhea (B) Cold intolerance (C) Constipation (D) Hyperlipidemia 39. A 34-year-old man with moderately severe ulcerative colitis has been taking oral prednisone for 4 months. Which of the following symptoms is the most likely adverse effect of this drug? (A) Diabetes insipidus (B) Diabetes mellitus (C) Hyperpigmentation of the skin (D) Hypotension 40. A 45-year-old man with type 2 diabetes mellitus undergoes a neurologic examination. The patient is unable to sense the vibration produced by a tuning fork placed on his big toe. Which of the following receptors is most likely affected in this patient? (A) Krause end bulbs (B) Meissners corpuscle

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(C) Merkel nerve endings (D) Pacinian corpuscle 41. A 53-year-old woman with newly diagnosed type 2 diabetes presents to the emergency department complaining of vomiting, severe headache, dizziness, blurry vision, and difficulty breathing. She says that she had been at a cocktail party when the symptoms began. Her skin is notably flushed on physical examination. Which of the following medications is responsible for this reaction? (A) Acarbose (B) Glipizide (C) Glyburide (D) Tolbutamide 42. Louis develops peritonitis and sepsis after surgical repair of ruptures diverticulum. The nurse in charge should expect an assessment of the client to reveal: a. Tachycardia b. Abdominal rigidity c. Bradycardia d. Increased bowel sounds 43. The nurse teaches the patient whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be a. solid b. mushy c. semi-mushy d. fluid 44. A 23-year-old man comes to the physician because of intermittent severe headaches, anxiety, and heart palpitations. While he has no significant medical history, his uncle had similar symptoms. When probed for a deeper family history, he says that his mother and two cousins have had their thyroids removed. Which of the following conditions most likely accounts for the clinical scenario? (A) Acromegaly (B) ACTH-secreting pituitary adenoma (C) Hyperparathyroidism (D) Pheochromocytoma 45. Growth hormone is essential to normal human growth and development, and its secretion is tightly regulated via a feedback control system involving the hypothalamus, the pituitary gland, and the peripheral tissues. Which of the following is a stimulus for the secretion of growth hormone? (A) Hypoglycemia (B) Obesity (C) Pregnancy (D) Somatomedin excess 46. A 66-year-old man with chronic cough, dyspnea, and a 50-pack-year history of cigarette smoking comes to the clinic after noticing blood in his sputum. He says he feels lethargic and has lost 18 kg (40 lb) over the past 3 months with no changes in diet or exercise. Laboratory studies show a serum sodium level of 120 mEq/L. While awaiting CT, the patient suffers a seizure and is rushed to the emergency department. Which of the following is most likely to be elevated in this patient? (A) ACTH (B) ADH (C) Parathyroid hormone (D) Renin 47. A 27-year-old woman presents to a new physician with muscle cramping and spasm. On physical examination, the physician notes shortened fourth and fifth metacarpals and metatarsals, short stature, a round face, and abnormal teeth. Her facial muscles twitched when her facial nerve was tapped, and her wrist twitched with the use of a blood pressure cuff. Laboratory studies show a decreased serum calcium level and a significantly

SEED FAITH TRAINING AND REVIEW CENTER

elevated parathyroid hormone level. There is no evidence of renal disease, thus decreasing the likelihood of renal osteodystrophy. Which of the following is the most common mode of inheritance of this patients disease? (A) Autosomal dominant (B) Autosomal recessive (C) Mitochondrial (D) X-linked dominant 48. A 43-year-old woman presents with fatigue, a 4.5-kg (9.9-lb) weight gain over the past 3 months, cold intolerance, hair loss, and concentration problems. Physical examination is significant for dry, coarse skin and bradycardia. She states that she had some slight swelling of her lower neck several months ago, which resolved without treatment. Results of antithyroglobulin antibody and antinuclear antibody tests are negative, but a thyroid peroxidase antibody test is positive. What other autoimmune diseases will this patient most likely have? (A) Graves disease and pernicious anemia (B) Osteoarthritis and Addisons disease (C) Rheumatoid arthritis and vitiligo (D) Type 1 diabetes mellitus and celiac disease 49. A 45-year-old man comes to his primary care physician complaining of back pain. On questioning, the patient indicates a recent history of polyuria, polydipsia, hypertension, and weight gain. X-ray of the spine shows an L4-L5 compression fracture. Which of the following is most likely to be elevated in this patient? (A) Cortisol (B) Glucagon (C) Growth hormone (D) Insulin 50. A 60-year-old woman with a history of type 2 diabetes mellitus comes to the clinic for a follow- up examination after being placed on a new agent to help her achieve tighter glycemic control. She complains that she has suffered occasional abdominal cramps and diarrhea, adding that she has recently been experiencing increased flatulence, which has become an embarrassing nuisance. Which of the following agents best accounts for this patients complaints? (A) Acarbose (B) Chlorpropamide (C) Glipizide (D) Metformin (E) Orlistat 51. A 42-year-old man visits his primary care physician to discuss possible cholesterol-lowering agents. His last blood test showed that he had elevated LDL cholesterol and triglyceride levels. The physician decides to prescribe gemfibrozil and schedules the man for a follow-up visit in 1 month. Which of the following results are likely to be seen on this patients next blood test? (A) A decrease in LDL cholesterol and a slight increase in triglycerides (B) A decrease in LDL cholesterol with little to no effect on HDL or triglycerides (C) A large decrease in LDL cholesterol, an increase in HDL cholesterol, and a slight decrease in triglycerides (D) A large decrease in triglycerides, a slight decrease in LDL cholesterol, and a slight increase in HDL cholesterol 52. A 76-year-old man with chronic obstructive pulmonary disease presents at his annual clinic visit with complaints of black stools and epigastric pain relieved by meals. He reports a 4.5-kg (10-lb) weight gain over the past 4 months. He has no other medical problems and takes no medications. Physical examination is unremarkable. His plasma calcium and phosphate levels are within the normal ranges. Endoscopy reveals mucosal ulceration in the duodenal bulb. Which of the following is the most likely risk factor for this patients duodenal ulcer?

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(A) Alcohol use (B) Chronic nonsteroidal anti-inflammatory use (C) Excessive salt intake (D) Tobacco use 53. Digestive Disorder Question about a 20-year-old man who presents to his physician with a 2-day history of fever, vomiting, and diarrhea. His laboratory studies are unremarkable except for a serum albumin level of 7.5 g/dL. Which of the following conditions would most likely cause this patients laboratory abnormality? (A) Acute infection (B) Chronic liver disease (C) Dehydration (D) Nephrotic syndrome 54. A 33-year-old man with active gastroesophageal reflux disease returns to his physician for the second time in 2 weeks complaining of a worsening sore throat. The patient was previously diagnosed with penicillin-sensitive Streptococcus pyogenes on throat culture and, because he is allergic to penicillin, was given ciprofloxacin. Suspicious of an interaction, the physician asks the patient if he has been taking any other medications. Which of the following medications is this patient most likely taking? (A) Aspirin (B) Calcium carbonate (C) Cimetidine (D) Misoprostol 55. A 50-year-old alcoholic man presents with intermittent stomach pain that also seems to be present between his shoulder blades. The pain is often associated with nausea and vomiting. He also states that every once in a while he has a few days of bulky, foul-smelling stools. He also says he has been admitted to the hospital several times over the past few years for the same reason. Which of the following is the most likely finding associated with this patients illness? (A) Abdominal air-fluid levels on x-ray (B) Abdominal free air under the right hemidiaphragm on x-ray (C) Pancreatic calcifications on computed tomography (D) Pancreatic cysts 56. A 46-year-old white woman with rheumatoid arthritis presents with severe pruritus. She denies any history of alcohol or drug use. On physical examination, she is found to have icteric sclera, palpebral xanthomas, and hepatomegaly. She tests positive for antimitochondrial antibody and increased alkaline phosphatase activity. Which of the following is most likely responsible for this patients presentation? (A) Destruction of intrahepatic bile ducts (B) Hepatic parenchymal destruction (C) Obstruction of extrahepatic bile ducts (D) Portal vein thrombosis 57. A 10-year-old boy presents to the pediatrician with weight loss and multiple purpuric lesions all over his body. The patient has bulky, greasy yellow stools associated with abdominal pain and flatulence that most often occurs after meals. Which of the following will most likely be seen on bowel biopsy? (A) Benign mucosa (B) Continuous linear mucosal lesions (C) Diffuse severe atrophy and blunting of the villi (D) Foamy macrophages in the lamina propria 58. Digestive Disorder Question about a 26-year-old man with hepatitis C who is being medically treated while he awaits liver transplantation. One of the drugs he is taking causes him to have periodic fevers and chills and a sense of depression that he did not have prior to treatment. Which of the following is most likely responsible for this patients adverse effects?

SEED FAITH TRAINING AND REVIEW CENTER

(A) Intravenous immunoglobulin (B) Lamivudine (C) Pegylated interferon (D) Ribavirin 59. A 19-year-old man presents to the emergency department with a new onset of right lower quadrant abdominal pain. On physical examination, the patient has a temperature of 38.5 C (101.3 F) and a WBC count of 13,000/mm3. Flexion at his hip elicits pain. Release of manual pressure on the abdomen causes more pain than deep palpation. Which of the following is also most likely present in this patient? (A) Abdominal distention (B) Dyspnea (C) Hunger (D) Nausea and vomiting 60. A 4-year-old child is brought to the pediatrician because of abdominal pain, vomiting, and diarrhea containing mucus and blood. The child has a fever of 39.4 C (103 F). On stool culture, the causative organism is shown to be a non-lactose-fermenting and non-hydrogen sulfide-producing bacterium. Which of the following is most likely responsible for the childs illness? (A) Enteroinvasive Escherichia coli (B) Enterotoxigenic Escherichia coli (C) Salmonella spp. (D) Shigella species 61. A 46-year-old white woman with rheumatoid arthritis presents with severe pruritus. She denies any history of alcohol or drug use. On physical examination, she is found to have icteric sclera, palpebral xanthomas, and hepatomegaly. She tests positive for antimitochondrial antibody and increased alkaline phosphatase activity. Which of the following is most likely responsible for this patients presentation? (A) Destruction of intrahepatic bile ducts (B) Hepatic parenchymal destruction (C) Obstruction of extrahepatic bile ducts (D) Portal vein thrombosis 62. A 10-year-old boy presents to the pediatrician with weight loss and multiple purpuric lesions all over his body. The patient has bulky, greasy yellow stools associated with abdominal pain and flatulence that most often occurs after meals. Which of the following will most likely be seen on bowel biopsy? (A) Benign mucosa (B) Continuous linear mucosal lesions (C) Diffuse severe atrophy and blunting of the villi (D) Foamy macrophages in the lamina propria 63. Digestive Disorder Question about a 26-year-old man with hepatitis C who is being medically treated while he awaits liver transplantation. One of the drugs he is taking causes him to have periodic fevers and chills and a sense of depression that he did not have prior to treatment. Which of the following is most likely responsible for this patients adverse effects? (A) Intravenous immunoglobulin (B) Lamivudine (C) Pegylated interferon (D) Ribavirin 64. A 19-year-old man presents to the emergency department with a new onset of right lower quadrant abdominal pain. On physical examination, the patient has a temperature of 38.5 C (101.3 F) and a WBC count of 13,000/mm3. Flexion at his hip elicits pain. Release of manual pressure on the abdomen causes more pain than deep palpation. Which of the following is also most likely present in this patient? (A) Abdominal distention

# 333 Magsaysay Avenue, Baguio City| 09195638562 |

(B) Dyspnea (C) Hunger (D) Nausea and vomiting 65. A 4-year-old child is brought to the pediatrician because of abdominal pain, vomiting, and diarrhea containing mucus and blood. The child has a fever of 39.4 C (103 F). On stool culture, the causative organism is shown to be a non-lactose-fermenting and non-hydrogen sulfide-producing bacterium. Which of the following is most likely responsible for the childs illness? (A) Enteroinvasive Escherichia coli (B) Enterotoxigenic Escherichia coli (C) Salmonella spp. (D) Shigella species 66. An 8-year-old boy presents to the emergency department with a 2-hour history of vomiting after eating dinner at a seafood buffet. Arterial blood gas analysis reveals a pH of 7.50, an bicarbonate level of 34 mEq/L, and partial carbon dioxide pressure of 40 mm Hg. Which of the following best describes the acid-base disturbance occurring in this patient? (A) Metabolic acidosis (B) Metabolic acidosis/respiratory acidosis (C) Metabolic acidosis/respiratory alkalosis (D) Metabolic alkalosis 67. To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? a. "Lie down after meals to promote digestion." b. "Avoid coffee and alcoholic beverages." c. "Take antacids with meals." d. "Limit fluid intake with meals." 68. Digestive Disorder Question about a 27-year-old man who goes to the doctor for an annual physical examination. On rectal examination, masses are palpated. The patient is referred for a colonoscopy, which reveals adenomatous polyps located diffusely throughout the colon. When asked about his family history, the patient states that his father passed away from colon cancer. A diagnosis of familial adenomatous polyposis is suspected, and the patient asks how he got this. Which of the following is the inheritance pattern of this condition? (A) Autosomal dominant (B) Autosomal recessive (C) Autosomal trisomy (D) Sex chromosome abnormality 69. A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's stoma appears dusky. How should the nurse interpret this finding? a. Blood supply to the stoma has been interrupted. b. This is a normal finding 1 day after surgery. c. The ostomy bag should be adjusted. d. An intestinal obstruction has occurred. 70. A 2-year-old girl who has recently been adopted from an impoverished family is brought to the clinic by her adopted parents. They are concerned because the child seems to be having trouble with her vision at in low-light conditions. The vitamin most likely deficient in this child is absorbed by the gastrointestinal system using what mechanism? (A) Apoferritin-mediated transport (B) Intrinsic factor-mediated transport (C) Micelle-mediated transport (D) Sodium-dependent cotransport 71. An 8-year-old boy presents to the emergency department with a 2-hour

SEED FAITH TRAINING AND REVIEW CENTER

history of vomiting after eating dinner at a seafood buffet. Arterial blood gas analysis reveals a pH of 7.50, an bicarbonate level of 34 mEq/L, and partial carbon dioxide pressure of 40 mm Hg. Which of the following best describes the acid-base disturbance occurring in this patient? (A) Metabolic acidosis (B) Metabolic acidosis/respiratory acidosis (C) Metabolic acidosis/respiratory alkalosis (D) Metabolic alkalosis 72. The nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to: a. restrict fluid intake to 1 qt (1,000 ml)/day. b. drink liquids only with meals. c. don't drink liquids 2 hours before meals. d. drink liquids only between meals. 73. A 27-year-old man goes to the doctor for an annual physical examination. On rectal examination, masses are palpated. The patient is referred for a colonoscopy, which reveals adenomatous polyps located diffusely throughout the colon. When asked about his family history, the patient states that his father passed away from colon cancer. A diagnosis of familial adenomatous polyposis is suspected, and the patient asks how he got this. Which of the following is the inheritance pattern of this condition? (A) Autosomal dominant (B) Autosomal recessive (C) Autosomal trisomy (D) Sex chromosome abnormality 74. When evaluating a client for complications of acute pancreatitis, the nurse would observe for: a. increased intracranial pressure. b. decreased urine output. c. bradycardia. d. hypertension. 75. Why are antacids administered regularly, rather than as needed, to treat peptic ulcer disease? a. To keep gastric pH at 3.0 to 3.5 b. To promote client compliance c. To maintain a regular bowel pattern d. To increase pepsin activity 76. A 46-year-old woman comes to the physician because of voluminous, malodorous, bulky stools. The diarrhea usually abates on fasting. Fecal analysis shows an increased stool osmolality and fat content (fecal fat excretion 32 g/ day [normal:< 7 g/day]). Laboratory tests show a sodium level of 149 mEq/L, potassium of 3.5 mEq/L, chloride of 110 mEq/L, and bicarbonate of 18 mEq/L. Which of the following is the pathologic mechanism most likely responsible for the patients presentation? (A) Exudative diarrhea (B) Malabsorption (C) Motility derangement (D) Osmotic diarrhea 77. A client with recent onset of epigastric discomfort is scheduled for an upper GI series (barium swallow). When teaching the client how to prepare for the test, which instruction should the nurse provide? a. "Eat a low-residue diet for 2 days before the test." b. "Eat a clear liquid diet for 2 days before the test." c. "Take a potent laxative the day before the test." d. "Avoid eating or drinking anything for 6 to 8 hours before the test." 78. A client with mild diarrhea, fever, and abdominal discomfort is being evaluated for inflammatory bowel disease (IBD). Which statement about IBD is true?

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a. Diarrhea is the most common sign of IBD. b. Transmural inflammation with fistula formation occurs in ulcerative colitis, one form of IBD. c. Abscesses may occur in IBD as poor nutrition causes breakdown of cells in the GI tract. d. Bowel cancer is common in clients with a history of Crohn's disease, one form of IBD. 79. An elderly client with Alzheimer's disease begins supplemental tube feedings through a gastrostomy tube to provide adequate calorie intake. The nurse should be concerned most with the potential for: a. hyperglycemia. b. fluid volume excess. c. aspiration. d. constipation. 80. The nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? a. Kussmaul's respirations b. Increased urine output c. Decreased appetite d. Diaphoresis 81. A 72-year-old client seeks help for chronic constipation. This is a common problem for elderly clients due to several factors related to aging. Which of the following is one such factor? a. Increased intestinal motility b. Decreased abdominal strength c. Increased intestinal bacteria d. Decreased production of hydrochloric acid 82. A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? a. Pain related to biliary spasms b. Deficient knowledge related to prevention of disease recurrence c. Anxiety related to unknown outcome of hospitalization d. Imbalanced nutrition: Less than body requirements related to biliary inflammation 83. A 17-year-old girl who is being treated with antibiotics for recurrent sinus tract infections presents to the physician with intractable watery diarrhea and cramps. Which of the following is most often associated with this patients condition? (A) Clostridium difficile (B) Clostridium perfringens (C) Escherichia coli (D) Staphylococcus aureus 84. A client had a nephrectomy 2 days ago and is now complaining of abdominal pressure and nausea. The first nursing action should be to a. auscultate bowel sounds. b. palpate the abdomen. c. change the client's position. d. insert a rectal tube. 85. Which of the following types of hepatocellular injury is commonly seen after acetaminophen overdose? (A) Acute hepatitis (B) Centrilobular necrosis (C) Fibrosis (D) Granuloma formation 86. A 35-year-old woman who is HIV-positive presents to the physician with jaundice and right upper quadrant abdominal pain. The patient reports having had multiple episodes of jaundice over the past 10 years. A hepatitis panel is positive for HBsAg and anti-HBc IgM, but negative for HBsAb and

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anti-HAV IgM. Which of the following would most likely be lower than normal in this patient? (A) Albumin (B) Alkaline phosphatase (C) Bilirubin (D) Prothrombin time 87. A 35-year-old woman that is pregnant with her fourth child comes to the physician because of painful gastrointestinal bleeding for the past month. The pain and bleeding are worse when she defecates. Which of the following is the most likely diagnosis? (A) Colorectal carcinoma (B) External hemorrhoids (C) Internal hemorrhoids (D) Perianal abscess 88. A 45-year-old woman who presents to her physician with a 2-day history of right upper quadrant pain, nausea, gas, and vomiting. She reports that her symptoms are worse after she eats a fatty meal. Which of the following substances inhibits the hormone causing her right upper quadrant pain? (A) Cholecystokinin (B) Gastrin (C) Pepsin (D) Somatostatin 89. A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? a. The client doesn't exhibit rectal tenesmus. b. The client is free from esophagitis and achalasia. c. The client reports diminished duodenal inflammation. d. The client has normal gastric structures. 90. A 39-year-old white woman who suffers from polycythemia vera presents to the clinic complaining of severe and constant right upper quadrant pain over the past 2 days. Physical examination reveals an enlarged liver. What other finding would most likely be seen at presentation? (A) Ascites (B) Asterixis (C) Esophageal varices (D) Hyperpigmented skin 91. A client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and ranitidine (Zantac). Before the client is discharged, the nurse should provide which instruction? a. "Eat three balanced meals every day." b. "Stop taking the drugs when your symptoms subside." c. "Avoid aspirin and products that contain aspirin." d. "Increase your intake of fluids containing caffeine." 92. A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of: a. increasing fluid intake to prevent dehydration. b. wearing an appliance pouch only at bedtime. c. consuming a low-protein, high-fiber diet. d. taking only enteric-coated medications. 93. When planning care for a client with a small-bowel obstruction, the nurse should consider the primary goal to be: a. reporting pain relief. b. maintaining fluid balance. c. maintaining body weight. d. reestablishing a normal bowel pattern. 94. A client, age 82, is admitted to an acute care facility for treatment of an acute flare-up of a chronic GI condition. In addition to assessing the client for complications of the current illness, the nurse monitors for age-related changes in the GI tract. Which age-related change increases the risk of anemia?

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a. Atrophy of the gastric mucosa b. Decrease in intestinal flora c. Increase in bile secretion d. Dulling of nerve impulses 95. The physician orders morphine for a client who complains of postoperative abdominal pain. For maximum pain relief, when should the nurse anticipate administering morphine? a. Before the pain becomes severe b. When the pain becomes severe c. Every 3 hours, whether or not the client has pain d. As seldom as possible to avoid morphine dependency 96. Nursing assessment of a client with peritonitis (acute or chronic inflammation of the peritoneum) reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find: a. tenderness and pain in the right upper abdominal quadrant. b. jaundice and vomiting. c. severe abdominal pain with direct palpation or rebound tenderness. d. rectal bleeding and a change in bowel habits. 97. When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function? a. Jaundice b. Pruritus of the arms and legs c. Fatigue during ambulation d. Irritability and drowsiness 98. A client has a newly created colostomy. After participating in counseling with the nurse and receiving support from the spouse, the client decides to change the colostomy pouch unaided. Which behavior suggests that the client is beginning to accept the change in body image? a. The client closes the eyes when the abdomen is exposed. b. The client avoids talking about the recent surgery. c. The client asks the spouse to leave the room. d. The client touches the altered body part. 99. A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: a. place the client in a private room. b. wear a mask when handling the client's bedpan. c. wash the hands after touching the client. d. wear a gown when providing personal care for the client 100. While preparing a client for cholecystectomy, the nurse explains that incentive spirometry will be used after surgery primarily to: a. increase respiratory effectiveness. b. eliminate the need for nasogastric intubation. c. improve nutritional status during recovery. d. decrease the amount of postoperative analgesia needed.