Text Mode Text version of the exam

1. Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic

pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory
report that indicates a serum amylase level of:
A. 45 units/L
B. 100 units/L
C. 300 units/L
D. 500 units/L
2. A male client who is recovering from surgery has been advanced from a clear
liquid diet to a full liquid diet. The client is looking forward to the diet change
because he has been bored with the clear liquid diet. The nurse would offer which
full liquid item to the client?
A. Tea
B. Gelatin
C. Custard
D. Popsicle
3. Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects
of the disorder, the nurse teaches the client about foods that are high in thiamine.
The nurse determines that the client has the best understanding of the dietary
measures to follow if the client states an intension to increase the intake of:
A. Pork
B. Milk
C. Chicken
D. Broccoli
4. Nurse Oliver checks for residual before administering a bolus tube feeding to a
client with a nasogastric tube and obtains a residual amount of 150 mL. What is
appropriate action for the nurse to take?
A. Hold the feeding
B. Reinstill the amount and continue with administering the feeding
C. Elevate the clients head at least 45 degrees and administer the feeding
D. Discard the residual amount and proceed with administering the feeding
5. A nurse is inserting a nasogastric tube in an adult male client. During the
procedure, the client begins to cough and has difficulty breathing. Which of the
following is the appropriate nursing action?

A. Quickly insert the tube

B. Notify the physician immediately
C. Remove the tube and reinsert when the respiratory distress subsides
D. Pull back on the tube and wait until the respiratory distress subsides
6. Nurse Ryan is assessing for correct placement of a nosogartric tube. The nurse
aspirates the stomach contents and check the contents for pH. The nurse verifies
correct tube placement if which pH value is noted?
A. 3.5
B. 7.0
C. 7.35
D. 7.5
7. A nurse is preparing to remove a nasogartric tube from a female client. The nurse
should instruct the client to do which of the following just before the nurse removes
the tube?
A. Exhale
B. Inhale and exhale quickly
C. Take and hold a deep breath
D. Perform a Valsalva maneuver
8. Nurse Joy is preparing to administer medication through a nasogastric tube that is
connected to suction. To administer the medication, the nurse would:
A. Position the client supine to assist in medication absorption
B. Aspirate the nasogastric tube after medication administration to maintain
patency
C. Clamp the nasogastric tube for 30 minutes following administration of the
medication
D. Change the suction setting to low intermittent suction for 30 minutes after
medication administration
9. A nurse is preparing to care for a female client with esophageal varices who has
just has a Sengstaken-Blakemore tube inserted. The nurse gathers supplies,
knowing that which of the following items must be kept at the bedside at all times?
A. An obturator
B. Kelly clamp
C. An irrigation set

D. A pair of scissors
10. Dr. Smith has determined that the client with hepatitis has contracted the
infection form contaminated food. The nurse understands that this client is most
likely experiencing what type of hepatitis?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
11. A client is suspected of having hepatitis. Which diagnostic test result will assist
in confirming this diagnosis?
A. Elevated hemoglobin level
B. Elevated serum bilirubin level
C. Elevated blood urea nitrogen level
D. Decreased erythrocycle sedimentation rate
12. The nurse is reviewing the physicians orders written for a male client admitted
to the hospital with acute pancreatitis. Which physician order should the nurse
question if noted on the clients chart?
A. NPO status
B. Nasogastric tube inserted
C. Morphine sulfate for pain
D. An anticholinergic medication
13. A female client being seen in a physicians office has just been scheduled for a
barium swallow the next day. The nurse writes down which instruction for the client
to follow before the test?
A. Fast for 8 hours before the test
B. Eat a regular supper and breakfast
C. Continue to take all oral medications as scheduled
D. Monitor own bowel movement pattern for constipation
14. The nurse is performing an abdominal assessment and inspects the skin of the
abdomen. The nurse performs which assessment technique next?
A. Palpates the abdomen for size
B. Palpates the liver at the right rib margin
C. Listens to bowel sounds in all for quadrants

D. Percusses the right lower abdominal quadrant

15. Polyethylene glycol-electrlyte solution (GoLYTELY) is prescribed for the female
client scheduled for a colonoscopy. The client begins to experience diarrhea
following administration of the solution. What action by the nurse is appropriate?
A. Start an IV infusion
B. Administer an enema
C. Cancel the diagnostic test
D. Explain that diarrhea is expected
16. The nurse is caring for a male client with a diagnosis of chronic gastritis. The
nurse monitors the client knowing that this client is at risk for which vitamin
deficiency?
A. Vitamin A
B. Vitamin B12
C. Vitamin C
D. Vitamin E
17. The nurse is reviewing the medication record of a female client with acute
gastritis. Which medication, if noted on the clients record, would the nurse
question?
A. Digoxin (Lanoxin)
B. Furosemide (Lasix)
C. Indomethacin (Indocin)
D. Propranolol hydrochloride (Inderal)
18. The nurse is assessing a male client 24 hours following a cholecystectomy. The
nurse noted that the T tube has drained 750 mL of green-brown drainage since the
surgery. Which nursing intervention is appropriate?
A. Clamp the T tube
B. Irrigate the T tube
C. Notify the physician
D. Document the findings
19. The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which
assessment findings would most likely indicate perforation of the ulcer?
A. Bradycardia
B. Numbness in the legs

C. Nausea and vomiting

D. A rigid, board-like abdomen
20. A male client with a peptic ulcer is scheduled for a vagotomy and the client asks
the nurse about the purpose of this procedure. Which response by the nurse best
describes the purpose of a vagotomy?
A. Halts stress reactions
B. Heals the gastric mucosa
C. Reduces the stimulus to acid secretions
D. Decreases food absorption in the stomach
21. The nurse is caring for a female client following a Billroth II procedure. Which
postoperative order should the nurse question and verify?
A. Leg exercises
B. Early ambulation
C. Irrigating the nasogastric tube
D. Coughing and deep-breathing exercises
22. The nurse is providing discharge instructions to a male client following
gastrectomy and instructs the client to take which measure to assist in preventing
dumping syndrome?
A. Ambulate following a meal
B. Eat high carbohydrate foods
C. Limit the fluid taken with meal
D. Sit in a high-Fowlers position during meals
23. The nurse is monitoring a female client for the early signs and symptoms of
dumping syndrome. Which of the following indicate this occurrence?
A. Sweating and pallor
B. Bradycardia and indigestion
C. Double vision and chest pain
D. Abdominal cramping and pain
24. The nurse is preparing a discharge teaching plan for the male client who had
umbilical hernia repair. What should the nurse include in the plan?
A. Irrigating the drain
B. Avoiding coughing

C. Maintaining bed rest

D. Restricting pain medication
25. The nurse is instructing the male client who has an inguinal hernia repair how to
reduce postoperative swelling following the procedure. What should the nurse tell
the client?
A. Limit oral fluid
B. Elevate the scrotum
C. Apply heat to the abdomen
D. Remain in a low-fiber diet
26. The nurse is caring for a hospitalized female client with a diagnosis of ulcerative
colitis. Which finding, if noted on assessment of the client, would the nurse report to
the physician?
A. Hypotension
B. Bloody diarrhea
C. Rebound tenderness
D. A hemoglobin level of 12 mg/dL
27. The nurse is caring for a male client postoperatively following creation of a
colostomy. Which nursing diagnosis should the nurse include in the plan of care?
A. Sexual dysfunction
B. Body image, disturbed
C. Fear related to poor prognosis
D. Nutrition: more than body requirements, imbalanced
28. The nurse is reviewing the record of a female client with Crohns disease. Which
stool characteristics should the nurse expect to note documented in the clients
record?
A. Diarrhea
B. Chronic constipation
C. Constipation alternating with diarrhea
D. Stools constantly oozing form the rectum
29. The nurse is performing a colostomy irrigation on a male client. During the
irrigation, the client begins to complain of abdominal cramps. What is the
appropriate nursing action?
A. Notify the physician

B. Stop the irrigation temporarily

C. Increase the height of the irrigation
D. Medicate for pain and resume the irrigation
30. The nurse is teaching a female client how to perform a colostomy irrigation. To
enhance the effectiveness of the irrigation and fecal returns, what measure should
the nurse instruct the client to do?
A. Increase fluid intake
B. Place heat on the abdomen
C. Perform the irrigation in the evening
D. Reduce the amount of irrigation solution
31. A patient with chronic alcohol abuse is admitted with liver failure. You closely
monitor the patients blood pressure because of which change that is associated
with the liver failure?
A. Hypoalbuminemia
B. Increased capillary permeability
C. Abnormal peripheral vasodilation
D. Excess rennin release from the kidneys
32. Youre assessing the stoma of a patient with a healthy, well-healed colostomy.
You expect the stoma to appear:
A. Pale, pink and moist
B. Red and moist
C. Dark or purple colored
D. Dry and black
33. Youre caring for a patient with a sigmoid colostomy. The stool from this
colostomy is:
A. Formed
B. Semisolid
C. Semiliquid
D. Watery
34. Youre advising a 21 y.o. with a colostomy who reports problems with flatus.
What food should you recommend?
A. Peas

B. Cabbage
C. Broccoli
D. Yogurt
35. You have to teach ostomy self care to a patient with a colostomy. You tell the
patient to measure and cut the wafer:
A. To the exact size of the stoma.
B. About 1/16 larger than the stoma.
C. About 1/8 larger than the stoma.
D. About 1/4 larger than the stoma.
36. Youre performing an abdominal assessment on Brent who is 52 y.o. In which
order do you proceed?
A. Observation, percussion, palpation, auscultation
B. Observation, auscultation, percussion, palpation
C. Percussion, palpation, auscultation, observation
D. Palpation, percussion, observation, auscultation
37. Youre doing preoperative teaching with Gertrude who has ulcerative colitis
who needs surgery to create an ileoanal reservoir. Which information do you
include?
A. A reservoir is created that exits through the abdominal wall.
B. A second surgery is required 12 months after the first surgery.
C. A permanent ileostomy is created.
D. The surgery occurs in two stages.
38. Youre caring for Carin who has just had ileostomy surgery. During the first 24
hours post-op, how much drainage can you expect from the ileostomy?
A. 100 ml
B. 500 ml
C. 1500 ml
D. 5000 ml
39. Youre preparing a teaching plan for a 27 y.o. named Jeff who underwent surgery
to close a temporary ileostomy. Which nutritional guideline do you include in this
plan?
A. There is no need to change eating habits.

B. Eat six small meals a day.

C. Eat the largest meal in the evening.
D. Restrict fluid intake.
40. Arthur has a family history of colon cancer and is scheduled to have a
sigmoidoscopy. He is crying as he tells you, I know that I have colon cancer, too.
Which response is most therapeutic?
A. I know just how you feel.
B. You seem upset.
C. Oh, dont worry about it, everything will be just fine.
D. Why do you think you have cancer?
41. Youre caring for Beth who underwent a Billroth II procedure (surgical removal of
the pylorus and duodenum) for treatment of a peptic ulcer. Which findings suggest
that the patient is developing dumping syndrome, a complication associated with
this procedure?
A. Flushed, dry skin.
B. Headache and bradycardia.
C. Dizziness and sweating.
D. Dyspnea and chest pain.
42. Youre developing the plan of care for a patient experiencing dumping
syndrome after a Billroth II procedure. Which dietary instructions do you include?
A. Omit fluids with meals.
B. Increase carbohydrate intake.
C. Decrease protein intake.
D. Decrease fat intake.
43. Youre caring for Lewis, a 67 y.o. patient with liver cirrhosis who develops
ascites and requires paracentesis. Relief of which symptom indicated that the
paracentesis was effective?
A. Pruritus
B. Dyspnea
C. Jaundice
D. Peripheral Neuropathy
44. Youre caring for Jane, a 57 y.o. patient with liver cirrhosis who develops ascites
and requires paracentesis. Before her paracentesis, you instruct her to:

A. Empty her bladder.

B. Lie supine in bed.
C. Remain NPO for 4 hours.
D. Clean her bowels with an enema.
45. After abdominal surgery, your patient has a severe coughing episode that
causes wound evisceration. In addition to calling the doctor, which intervention is
most appropriate?
A. Irrigate the wound & organs with Betadine.
B. Cover the wound with a saline soaked sterile dressing.
C. Apply a dry sterile dressing & binder.
D. Push the organs back & cover with moist sterile dressings.
46. Youre caring for Betty with liver cirrhosis. Which of the following assessment
findings leads you to suspect hepatic encephalopathy in her?
A. Asterixis
B. Chvosteks sign
C. Trousseaus sign
D. Hepatojugular reflex
47. You are developing a careplan on Sally, a 67 y.o. patient with hepatic
encephalopathy. Which of the following do you include?
A. Administering a lactulose enema as ordered.
B. Encouraging a protein-rich diet.
C. Administering sedatives, as necessary.
D. Encouraging ambulation at least four times a day.
48. You have a patient with achalasia (incomplete muscle relaxtion of the GI tract,
especially sphincter muscles). Which medications do you anticipate to administer?
A. Isosorbide dinitrate (Isordil)
B. Digoxin (Lanoxin)
C. Captopril (Capoten)
D. Propanolol (Inderal)
49. The student nurse is preparing a teaching care plan to help improve nutrition in
a patient with achalasia. You include which of the following:
A. Swallow foods while leaning forward.

B. Omit fluids at mealtimes.

C. Eat meals sitting upright.
D. Avoid soft and semisoft foods.
50. Britney, a 20 y.o. student is admitted with acute pancreatitis. Which laboratory
findings do you expect to be abnormal for this patient?
A. Serum creatinine and BUN
B. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
C. Serum amylase and lipase
D. Cardiac enzymes
51. A patient with Crohns disease is admitted after 4 days of diarrhea. Which of the
following urine specific gravity values do you expect to find in this patient?
A. 1.005
B. 1.011
C. 1.020
D. 1.030
52. Your goal is to minimize Davids risk of complications after a heriorrhaphy. You
instruct the patient to:
A. Avoid the use of pain medication.
B. Cough and deep breathe Q2H.
C. Splint the incision if he cant avoid sneezing or coughing.
D. Apply heat to scrotal swelling.
53. Janice is waiting for discharge instructions after her herniorrhaphy. Which of the
following instructions do you include?
A. Eat a low-fiber diet.
B. Resume heavy lifting in 2 weeks.
C. Lose weight, if obese.
D. Resume sexual activity once discomfort is gone.
54. Develop a teaching care plan for Angie who is about to undergo a liver biopsy.
Which of the following points do you include?
A. Youll need to lie on your stomach during the test.
B. Youll need to lie on your right side after the test.

C. During the biopsy youll be asked to exhale deeply and hold it.
D. The biopsy is performed under general anesthesia.
55. Stephen is a 62 y.o. patient that has had a liver biopsy. Which of the following
groups of signs alert you to a possible pneumothorax?
A. Dyspnea and reduced or absent breath sounds over the right lung
B. Tachycardia, hypotension, and cool, clammy skin
C. Fever, rebound tenderness, and abdominal rigidity
D. Redness, warmth, and drainage at the biopsy site
56. Michael, a 42 y.o. man is admitted to the med-surg floor with a diagnosis of
acute pancreatitis. His BP is 136/76, pulse 96, Resps 22 and temp 101. His past
history includes hyperlipidemia and alcohol abuse. The doctor prescribes an NG
tube. Before inserting the tube, you explain the purpose to patient. Which of the
following is a most accurate explanation?
A. It empties the stomach of fluids and gas.
B. It prevents spasms at the sphincter of Oddi.
C. It prevents air from forming in the small intestine and large intestine.
D. It removes bile from the gallbladder.
57. Jason, a 22 y.o. accident victim, requires an NG tube for feeding. What should
you immediately do after inserting an NG tube for liquid enteral feedings?
A. Aspirate for gastric secretions with a syringe.
B. Begin feeding slowly to prevent cramping.
C. Get an X-ray of the tip of the tube within 24 hours.
D. Clamp off the tube until the feedings begin.
58. Stephanie, a 28 y.o. accident victim, requires TPN. The rationale for TPN is to
provide:
A. Necessary fluids and electrolytes to the body.
B. Complete nutrition by the I.V. route.
C. Tube feedings for nutritional supplementation.
D. Dietary supplementation with liquid protein given between meals.
59. Type A chronic gastritis can be distinquished from type B by its ability to:
A. Cause atrophy of the parietal cells.
B. Affect only the antrum of the stomach.

C. Thin the lining of the stomach walls.

D. Decrease gastric secretions.
60. Matt is a 49 y.o. with a hiatal hernia that you are about to counsel. Health care
counseling for Matt should include which of the following instructions?
A. Restrict intake of high-carbohydrate foods.
B. Increase fluid intake with meals.
C. Increase fat intake.
D. Eat three regular meals a day.
61. Jerod is experiencing an acute episode of ulcerative colitis. Which is priority for
this patient?
A. Replace lost fluid and sodium.
B. Monitor for increased serum glucose level from steroid therapy.
C. Restrict the dietary intake of foods high in potassium.
D. Note any change in the color and consistency of stools.
62. A 29 y.o. patient has an acute episode of ulcerative colitis. What diagnostic test
confirms this diagnosis?
A. Barium Swallow.
B. Stool examination.
C. Gastric analysis.
D. Sigmoidoscopy.
63. Eleanor, a 62 y.o. woman with diverticulosis is your patient. Which interventions
would you expect to include in her care?
A. Low-fiber diet and fluid restrictions.
B. Total parenteral nutrition and bed rest.
C. High-fiber diet and administration of psyllium.
D. Administration of analgesics and antacids.
64. Regina is a 46 y.o. woman with ulcerative colitis. You expect her stools to look
like:
A. Watery and frothy.
B. Bloody and mucoid.
C. Firm and well-formed.

D. Alternating constipation and diarrhea.

65. Donald is a 61 y.o. man with diverticulitis. Diverticulitis is characterized by:
A. Periodic rectal hemorrhage.
B. Hypertension and tachycardia.
C. Vomiting and elevated temperature.
D. Crampy and lower left quadrant pain and low-grade fever.
66. Brenda, a 36 y.o. patient is on your floor with acute pancreatitis. Treatment for
her includes:
A. Continuous peritoneal lavage.
B. Regular diet with increased fat.
C. Nutritional support with TPN.
D. Insertion of a T tube to drain the pancreas.
67. Glenda has cholelithiasis (gallstones). You expect her to complain of:
A. Pain in the right upper quadrant, radiating to the shoulder.
B. Pain in the right lower quadrant, with rebound tenderness.
C. Pain in the left upper quadrant, with shortness of breath.
D. Pain in the left lower quadrant, with mild cramping.
68. After an abdominal resection for colon cancer, Madeline returns to her room
with a Jackson-Pratt drain in place. The purpose of the drain is to:
A. Irrigate the incision with a saline solution.
B. Prevent bacterial infection of the incision.
C. Measure the amount of fluid lost after surgery.
D. Prevent accumulation of drainage in the wound.
69. Anthony, a 60 y.o. patient, has just undergone a bowel resection with a
colostomy. During the first 24 hours, which of the following observations about the
stoma should you report to the doctor?
A. Pink color.
B. Light edema.
C. Small amount of oozing.
D. Trickles of bright red blood.

70. Your teaching Anthony how to use his new colostomy. How much skin should
remain exposed between the stoma and the ring of the appliance?
A. 1/16
B. 1/4
C. 1/2
D. 1
71. Claire, a 33 y.o. is on your floor with a possible bowel obstruction. Which
intervention is priority for her?
A. Obtain daily weights.
B. Measure abdominal girth.
C. Keep strict intake and output.
D. Encourage her to increase fluids.
72. Your patient has a GI tract that is functioning, but has the inability to swallow
foods. Which is the preferred method of feeding for your patient?
A. TPN
B. PPN
C. NG feeding
D. Oral liquid supplements
73. Youre patient is complaining of abdominal pain during assessment. What is
your priority?
A. Auscultate to determine changes in bowel sounds.
B. Observe the contour of the abdomen.
C. Palpate the abdomen for a mass.
D. Percuss the abdomen to determine if fluid is present.
74. Before bowel surgery, Lee is to administer enemas until clear. During
administration, he complains of intestinal cramps. What do you do next?
A. Discontinue the procedure.
B. Lower the height of the enema container.
C. Complete the procedure as quickly as possible.
D. Continue administration of the enema as ordered without making any
adjustments.

75. Leigh Ann is receiving pancrelipase (Viokase) for chronic pancreatitis. Which
observation best indicates the treatment is effective?
A. There is no skin breakdown.
B. Her appetite improves.
C. She loses more than 10 lbs.
D. Stools are less fatty and decreased in frequency.
76. Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab
value is most likely to be elevated?
A. Calcium
B. Glucose
C. Magnesium
D. Potassium
77. Anna is 45 y.o. and has a bleeding ulcer. Despite multiple blood transfusions,
her HGB is 7.5g/dl and HCT is 27%. Her doctor determines that surgical intervention
is necessary and she undergoes partial gastrectomy. Postoperative nursing care
includes:
A. Giving pain medication Q6H.
B. Flushing the NG tube with sterile water.
C. Positioning her in high Fowlers position.
D. Keeping her NPO until the return of peristalsis.
78. Sitty, a 66 y.o. patient underwent a colostomy for ruptured diverticulum. She
did well during the surgery and returned to your med-surg floor in stable condition.
You assess her colostomy 2 days after surgery. Which finding do you report to the
doctor?
A. Blanched stoma
B. Edematous stoma
C. Reddish-pink stoma
D. Brownish-black stoma
79. Sharon has cirrhosis of the liver and develops ascites. What intervention is
necessary to decrease the excessive accumulation of serous fluid in her peritoneal
cavity?
A. Restrict fluids
B. Encourage ambulation

C. Increase sodium in the diet

D. Give antacids as prescribed
80. Katrina is diagnosed with lactose intolerance. To avoid complications with lack
of calcium in the diet, which food should be included in the diet?
A. Fruit
B. Whole grains
C. Milk and cheese products
D. Dark green, leafy vegetables
81. Nathaniel has severe pruritus due to having hepatitis B. What is the best
intervention for his comfort?
A. Give tepid baths.
B. Avoid lotions and creams.
C. Use hot water to increase vasodilation.
D. Use cold water to decrease the itching.
82. Rob is a 46 y.o. admitted to the hospital with a suspected diagnosis of Hepatitis
B. Hes jaundiced and reports weakness. Which intervention will you include in his
care?
A. Regular exercise.
B. A low-protein diet.
C. Allow patient to select his meals.
D. Rest period after small, frequent meals.
83. Youre discharging Nathaniel with hepatitis B. Which statement suggests
understanding by the patient?
A. Now I can never get hepatitis again.
B. I can safely give blood after 3 months.
C. Ill never have a problem with my liver again, even if I drink alcohol.
D. My family knows that if I get tired and start vomiting, I may be getting sick
again.
84. Gail is scheduled for a cholecystectomy. After completion of preoperative
teaching, Gail states,If I lie still and avoid turning after the operation, Ill avoid pain.
Do you think this is a good idea? What is the best response?
A. Youll need to turn from side to side every 2 hours.
B. Its always a good idea to rest quietly after surgery.

C. The doctor will probably order you to lie flat for 24 hours.
D. Why dont you decide about activity after you return from the recovery
room?
85. Youre caring for a 28 y.o. woman with hepatitis B. Shes concerned about the
duration of her recovery. Which response isnt appropriate?
A. Encourage her to not worry about the future.
B. Encourage her to express her feelings about the illness.
C. Discuss the effects of hepatitis B on future health problems.
D. Provide avenues for financial counseling if she expresses the need.
86. Elmer is scheduled for a proctoscopy and has an I.V. The doctor wrote an order
for 5mg of I.V. diazepam(Valium). Which order is correct regarding diazepam?
A. Give diazepam in the I.V. port closest to the vein.
B. Mix diazepam with 50 ml of dextrose 5% in water and give over 15 minutes.
C. Give diazepam rapidly I.V. to prevent the bloodstream from diluting the drug
mixture.
D. Question the order because I.V. administration of diazepam is
contraindicated.
87. Annebell is being discharged with a colostomy, and youre teaching her about
colostomy care. Which statement correctly describes a healthy stoma?
A. At first, the stoma may bleed slightly when touched.
B. The stoma should appear dark and have a bluish hue.
C. A burning sensation under the stoma faceplate is normal.
D. The stoma should remain swollen away from the abdomen.
88. A patient who underwent abdominal surgery now has a gaping incision due to
delayed wound healing. Which method is correct when you irrigate a gaping
abdominal incision with sterile normal saline solution, using a piston syringe?
A. Rapidly instill a stream of irrigating solution into the wound.
B. Apply a wet-to-dry dressing to the wound after the irrigation.
C. Moisten the area around the wound with normal saline solution after the
irrigation.
D. Irrigate continuously until the solution becomes clear or all of the solution is
used.
89. Hepatic encephalopathy develops when the blood level of which substance
increases?

A. Ammonia
B. Amylase
C. Calcium
D. Potassium
90. Your patient recently had abdominal surgery and tells you that he feels a
popping sensation in his incision during a coughing spell, followed by severe pain.
You anticipate an evisceration. Which supplies should you take to his room?
A. A suture kit.
B. Sterile water and a suture kit.
C. Sterile water and sterile dressings.
D. Sterile saline solution and sterile dressings.
91. Findings during an endoscopic exam include a cobblestone appearance of the
colon in your patient. The findings are characteristic of which disorder?
A. Ulcer
B. Crohns disease
C. Chronic gastritis
D. Ulcerative colitis
92. What information is correct about stomach cancer?
A. Stomach pain is often a late symptom.
B. Surgery is often a successful treatment.
C. Chemotherapy and radiation are often successful treatments.
D. The patient can survive for an extended time with TPN.
93. Dark, tarry stools indicate bleeding in which location of the GI tract?
A. Upper colon.
B. Lower colon.
C. Upper GI tract.
D. Small intestine.
94. A patient has an acute upper GI hemorrhage. Your interventions include:
A. Treating hypovolemia.
B. Treating hypervolemia.
C. Controlling the bleeding source.

D. Treating shock and diagnosing the bleeding source.

95. You promote hemodynamic stability in a patient with upper GI bleeding by:
A. Encouraging oral fluid intake.
B. Monitoring central venous pressure.
C. Monitoring laboratory test results and vital signs.
D. Giving blood, electrolyte and fluid replacement.
96. Youre preparing a patient with a malignant tumor for colorectal surgery and
subsequent colostomy. The patient tells you hes anxious. What should your initial
step be in working with this patient?
A. Determine what the patient already knows about colostomies.
B. Show the patient some pictures of colostomies.
C. Arrange for someone who has a colostomy to visit the patient.
D. Provide the patient with written material about colostomy care.
97. Your patient, Christopher, has a diagnosis of ulcerative colitis and has severe
abdominal pain aggravated by movement, rebound tenderness, fever, nausea, and
decreased urine output. This may indicate which complication?
A. Fistula.
B. Bowel perforation.
C. Bowel obstruction.
D. Abscess.
98. A patient has a severe exacerbation of ulcerative colitis. Long-term medications
will probably include:
A. Antacids.
B. Antibiotics.
C. Corticosteroids.
D. Histamine2-receptor blockers.
99. The student nurse is teaching the family of a patient with liver failure. You
instruct them to limit which foods in the patients diet?
A. Meats and beans.
B. Butter and gravies.
C. Potatoes and pastas.
D. Cakes and pastries.

100. An intubated patient is receiving continuous enteral feedings through a Salem

sump tube at a rate of 60ml/hr. Gastric residuals have been 30-40ml when
monitored Q4H. You check the gastric residual and aspirate 220ml. What is your first
response to this finding?
A. Notify the doctor immediately.
B. Stop the feeding, and clamp the NG tube.
C. Discard the 220ml, and clamp the NG tube.
D. Give a prescribed GI stimulant such as metoclopramide (Reglan).
Answers and Rationales
1. Answer C. The normal serum amylase level is 25 to 151 units/L. With chronic
cases of pancreatitis, the rise in serum amylase levels usually does not
exceed three times the normal value. In acute pancreatitis, the value may
exceed five times the normal value. Options A and B are within normal limits.
Option D is an extremely elevated level seen in acute pancreatitis.
2. Answer C. Full liquid food items include items such as plain ice cream,
sherbet, breakfast drinks, milk, pudding and custard, soups that are strained,
and strained vegetable juices. A clear liquid diet consists of foods that are
relatively transparent. The food items in options A, B, and D are clear liquids.
3. Answer A. The client with cirrhosis needs to consume foods high in thiamine.
Thiamine is present in a variety of foods of plant and animal origin. Pork
products are especially rich in this vitamin. Other good food sources include
nuts, whole grain cereals, and legumes. Milk contains vitamins A, D, and B2.
Poultry contains niacin. Broccoli contains vitamins C, E, and K and folic acid
4. Answer A. Unless specifically indicated, residual amounts more than 100 mL
require holding the feeding. Therefore options B, C, and D are incorrect.
Additionally, the feeding is not discarded unless its contents are abnormal in
color or characteristics.
5. Answer D. During the insertion of a nasogastric tube, if the client
experiences difficulty breathing or any respiratory distress, withdraw the tube
slightly, stop the tube advancement, and wait until the distress subsides.
Options B and C are unnecessary. Quickly inserting the tube is not an
appropriate action because, in this situation, it may be likely that the tube
has entered the bronchus.
6. Answer A. If the nasogastric tube is in the stomach, the pH of the contents
will be acidic. Gastric aspirates have acidic pH values and should be 3.5 or
lower. Option B indicates a slightly acidic pH. Option C indicates a neutral pH.
Option D indicates an alkaline pH.
7. Answer C. When the nurse removes a nasogastric tube, the client is
instructed to take and hold a deep breath. This will close the epiglottis. This

allows for easy withdrawal through the esophagus into the nose. The nurse
removes the tube with one smooth, continuous pull.
8. Answer C. If a client has a nasogastric tube connected to suction, the nurse
should wait up to 30 minutes before reconnecting the tube to the suction
apparatus to allow adequate time for medication absorption. Aspirating the
nasogastric tube will remove the medication just administered. Low
intermittent suction also will remove the medication just administered. The
client should not be placed in the supine position because of the risk for
aspiration.
9. Answer D. When the client has a Sengstaken-Blakemore tube, a pair of
scissors must be kept at the clients bedside at all times. The client needs to
be observed for sudden respiratory distress, which occurs if the gastric
balloon ruptures and the entire tube moves upward. If this occurs, the nurse
immediately cuts all balloon lumens and removes the tube. An obturator and
a Kelly clamp are kept at the bedside of a client with a tracheostomy. An
irrigation set may be kept at the bedside, but it is not the priority item.
10.Answer A. Hepatitis A is transmitted by the fecal-oral route via
contaminated food or infected food handlers. Hepatitis B, C, and D are
transmitted most commonly via infected blood or body fluids.
11.Answer B. Laboratory indicators of hepatitis include elevated liver enzyme
levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation
rates, and leukopenia. An elevated blood urea nitrogen level may indicate
renal dysfunction. A hemoglobin level is unrelated to this diagnosis.
12.Answer C. Meperidine (Demerol) rather than morphine sulfate is the
medication of choice to treat pain because morphine sulfate can cause
spasms in the sphincter of Oddi. Options A, B, and D are appropriate
interventions for the client with acute pancreatitis.
13.Answer A. A barium swallow is an x-ray study that uses a substance called
barium for contrast to highlight abnormalities in the gastrointestinal tract.
The client should fast for 8 to 12 hours before the test, depending on
physician instructions. Most oral medications also are withheld before the
test. After the procedure, the nurse must monitor for constipation, which can
occur as a result of the presence of barium in the gastrointestinal tract.
14.Answer C. The appropriate sequence for abdominal examination is
inspection, auscultation, percussion, and palpation. Auscultation is performed
after inspection to ensure that the motility of the bowel and bowel sounds are
not altered by percussion or palpation. Therefore, after inspecting the skin on
the abdomen, the nurse should listen for bowel sounds.
15.Answer D. The solution GoLYTELY is a bowel evacuant used to prepare a
client for a colonoscopy by cleansing the bowel. The solution is expected to
cause a mild diarrhea and will clear the bowel in 4 to 5 hours. Options A, B,
and C are inappropriate actions.

16.Answer B. Chronic gastritis causes deterioration and atrophy of the lining of

the stomach, leading to the loss of the function of the parietal cells. The
source of the intrinsic factor is lost, which results in the inability to absorb
vitamin B12. This leads to the development of pernicious anemia. The client
is not at risk for vitamin A, C, or E deficiency.
17.Answer C. Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug
and can cause ulceration of the esophagus, stomach, or small intestine.
Indomethacin is contraindicated in a client with gastrointestinal disorders.
Furosemide (Lasix) is a loop diuretic. Digoxin is a cardiac medication.
Propranolol (Inderal) is a -adrenergic blocker. Furosemide, digoxin, and
propranolol are not contraindicated in clients with gastric disorders.
18.Answer D. Following cholecystectomy, drainage from the T tube is initially
bloody and then turns to a greenish-brown color. The drainage is measured as
output. The amount of expected drainage will range from 500 to 1000
mL/day. The nurse would document the output.
19.Answer D. Perforation of an ulcer is a surgical emergency and is
characterized by sudden, sharp, intolerable severe pain beginning in the
midepigastric area and spreading over the abdomen, which becomes rigid
and board-like. Nausea and vomiting may occur. Tachycardia may occur as
hypovolemic shock develops. Numbness in the legs is not an associated
finding.
20.Answer C. A vagotomy, or cutting of the vagus nerve, is done to eliminate
parasympathetic stimulation of gastric secretion. Options A, B, and D are
incorrect descriptions of a vagotomy.
21.Answer C. In a Billroth II procedure, the proximal remnant of the stomach is
anastomosed to the proximal jejunum. Patency of the nasogastric tube is
critical for preventing the retention of gastric secretions. The nurse should
never irrigate or reposition the gastric tube after gastric surgery, unless
specifically ordered by the physician. In this situation, the nurse should clarify
the order. Options A, B, and D are appropriate postoperative interventions.
22.Answer C. Dumping syndrome is a term that refers to a constellation of
vasomotor symptoms that occurs after eating, especially following a Billroth II
procedure. Early manifestations usually occur within 30 minutes of eating and
include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the
desire to lie down. The nurse should instruct the client to decrease the
amount of fluid taken at meals and to avoid high-carbohydrate foods,
including fluids such as fruit nectars; to assume a low-Fowlers position during
meals; to lie down for 30 minutes after eating to delay gastric emptying; and
to take antispasmodics as prescribed.
23.Answer A. Early manifestations of dumping syndrome occur 5 to 30 minutes
after eating. Symptoms include vertigo, tachycardia, syncope, sweating,
pallor, palpitations, and the desire to lie down.

24.Answer B. Coughing is avoided following umbilical hernia repair to prevent

disruption of tissue integrity, which can occur because of the location of this
surgical procedure. Bed rest is not required following this surgical procedure.
The client should take analgesics as needed and as prescribed to control
pain. A drain is not used in this surgical procedure, although the client may
be instructed in simple dressing changes.
25.Answer B. Following inguinal hernia repair, the client should be instructed to
elevate the scrotum and apply ice packs while in bed to decrease pain and
swelling. The nurse also should instruct the client to apply a scrotal support
when out of bed. Heat will increase swelling. Limiting oral fluids and a lowfiber diet can cause constipation.
26.Answer C. Rebound tenderness may indicate peritonitis. Bloody diarrhea is
expected to occur in ulcerative colitis. Because of the blood loss, the client
may be hypotensive and the hemoglobin level may be lower than normal.
Signs of peritonitis must be reported to the physician.
27.Answer B. Body image, disturbed relates to loss of bowel control, the
presence of a stoma, the release of fecal material onto the abdomen, the
passage of flatus, odor, and the need for an appliance (external pouch). No
data in the question support options A and C. Nutrition: less than body
requirements, imbalanced is the more likely nursing diagnosis.
28.Answer A. Crohns disease is characterized by nonbloody diarrhea of usually
not more than four to five stools daily. Over time, the diarrhea episodes
increase in frequency, duration, and severity. Options B, C, and D are not
characteristics of Crohns disease.
29.Answer B. If cramping occurs during a colostomy irrigation, the irrigation
flow is stopped temporarily and the client is allowed to rest. Cramping may
occur from an infusion that is too rapid or is causing too much pressure. The
physician does not need to be notified. Increasing the height of the irrigation
will cause further discomfort. Medicating the client for pain is not the
appropriate action in this situation.
30.Answer A. To enhance effectiveness of the irrigation and fecal returns, the
client is instructed to increase fluid intake and to take other measures to
prevent constipation. Options B, C and D will not enhance the effectiveness of
this procedure.
31.Answer A. Blood pressure decreases as the body is unable to maintain
normal oncotic pressure with liver failure, so patients with liver failure require
close blood pressure monitoring. Increased capillary permeability, abnormal
peripheral vasodilation, and excess rennin released from the kidneys arent
direct ramifications of liver failure.
32.Answer B. Good circulation causes tissues to be moist and red, so a healthy,
well-healed stoma appears red and moist.

33.Answer A. A colostomy in the sigmoid colon produces a solid, formed stool.

34.Answer D. High-fiber foods stimulate peristalsis, and a result, flatus. Yogurt
reduces gas formation.
35.Answer B. A proper fit protects the skin, but doesnt impair circulation. A
1/16 should be cut.
36.Answer B. Observation, auscultation, percussion, palpation
37.Answer D. An ileoanal reservoir is created in two stages. The two surgeries
are about 2 to 3 months apart. First, diseased intestines are removed and a
temporary loop ileostomy is created. Second, the loop ileostomy is closed and
stool goes to the reservoir and out through the anus.
38.Answer C. The large intestine absorbs large amounts of water so the initial
output from the ileostomy may be as much as 1500 to 2000 ml/24 hours.
Gradually, the small intestine absorbs more fluid and the output decreases.
39.Answer B. To avoid overloading the small intestine, encourage the patient to
eat six small, regularly spaced meals.
40.Answer B. Making observations about what you see or hear is a useful
therapeutic technique. This way, you acknowledge that you are interested in
what the patient is saying and feeling.
41.Answer C. After a Billroth II procedure, a large amount of hypertonic fluid
enters the intestine. This causes extracellular fluid to move rapidly into the
bowel, reducing circulating blood volume and producing vasomotor
symptoms. Vasomotor symptoms produced by dumping syndrome include
dizziness and sweating, tachycardia, syncope, pallor, and palpitations.
42.Answer A. Gastric emptying time can be delayed by omitting fluids from
your patients meal. A diet low in carbs and high in fat & protein is
recommended to treat dumping syndrome.
43.Answer B. Ascites puts pressure on the diaphragm. Paracentesis is done to
remove fluid and reducing pressure on the diaphragm. The goal is to improve
the patients breathing. The others are signs of cirrhosis that arent relieved
by paracentesis.
44.Answer A. A full bladder can interfere with paracentesis and be punctured
inadvertently.
45.Answer B. Cover the organs with a sterile, nonadherent dressing moistened
with normal saline. Do this to prevent infection and to keep the organs from
drying out.
46.Answer A. Asterixis is an early neurologic sign of hepatic encephalopathy
elicited by asking the patient to hold her arms stretched out. Asterixis is
present if the hands rapidly extend and flex.

47.Answer A. You may administer the laxative lactulose to reduce ammonia

levels in the colon.
48.Answer A. Achalasia is characterized by incomplete relaxation of the LES,
dilation of the lower esophagus, and a lack of esophageal peristalsis. Because
nitrates relax the lower esophageal sphincter, expect to give Isordil orally or
sublingually.
49.Answer C. Eating in the upright position aids in emptying the esophagus.
Doing the opposite of the other three also may be helpful.
50.Answer C. Pancreatitis involves activation of pancreatic enzymes, such as
amylase and lipase. These levels are elevated in a patient with acute
pancreatitis.
51.Answer D. The normal range of specific gravity of urine is 1.010 to 1.025; a
value of 1.030 may be seen with dehydration.
52.Answer C. Teach the pt to avoid activities that increase intra-abdominal
pressure such as coughing, sneezing, or straining with a bowel movement.
53.Answer C. Because obesity weakens the abdominal muscles, advise weight
loss for the patient who has had a hernia repair.
54.Answer B. After a liver biopsy, the patient is placed on the right side to
compress the liver and to reduce the risk of bleeding or bile leakage.
55.Answer A. Signs and Symptoms of pneumothorax include dyspnea and
decreased or absent breath sounds over the affected lung (right lung).
56.Answer A. An NG tube is inserted into the patients stomach to drain fluid
and gas.
57.Answer A. Aspirating the stomach contents confirms correct placement. If an
X-ray is ordered, it should be done immediately, not in 24 hours.
58.Answer B. TPN is given I.V. to provide all the nutrients your patient needs.
TPN isnt a tube feeding nor is it a liquid dietary supplement.
59.Answer A. Type A causes changes in parietal cells.
60.Answer B. Increasing fluids helps empty the stomach. A high carb diet isnt
restricted and fat intake shouldnt be increased.
61.Answer A. Diarrhea d/t an acute episode of ulcerative colitis leads to fluid &
electrolyte losses so fluid replacement takes priority.
62.Answer D. Sigmoidoscopy allows direct observation of the colon mucosa for
changes, and if needed, biopsy.
63.Answer C. She needs a high-fiber diet and a psyllium (bulk laxative) to
promote normal soft stools.
64.Answer B. Stools from ulcerative colitis are often bloody and contain mucus.

65.Answer D. One sign of acute diverticulitis is crampy lower left quadrant pain.
A low-grade fever is another common sign.
66.Answer C. With acute pancreatitis, you need to rest the GI tract by TPN as
nutritional support.
67.Answer A. The gallbladder is located in the RUQ and a frequent sign of
gallstones is pain radiating to the shoulder.
68.Answer D. A Jackson-Pratt drain promotes wound healing by allowing fluid to
escape from the wound.
69.Answer D. After creation of a colostomy, expect to see a stoma that is pink,
slightly edematous, with some oozing. Bright red blood, regardless of
amount, indicates bleeding and should be reported to the doctor.
70.Answer A. Only a small amount of skin should be exposed and more than
1/16 of skin allows the excretement to irritate the skin.
71.Answer B. Measuring abdominal girth provides quantitative information
about increases or decreases in the amount of distention.
72.Answer C. Because the GI tract is functioning, feeding methods involve the
enteral route which bypasses the mouth but allows for a major portion of the
GI tract to be used.
73.Answer B. The first step in assessing the abdomen is to observe its shape
and contour, then auscultate, palpate, and then percuss.
74.Answer B. Lowering the height decreases the amount of flow, allowing him
to tolerate more fluid.
75.Answer D. Pancrelipase provides the exocrine pancreatic enzyme necessary
for proper protein, fat, and carb digestion. With increased fat digestion and
absorption, stools become less frequent and normal in appearance.
76.Answer B. Glucose level increases and diabetes mellitus may result d/t the
pancreatic damage to the islets of langerhans.
77.Answer D. After surgery, she remains NPO until peristaltic activity returns.
This decreases the risk for abdominal distention and obstruction.
78.Answer D. A brownish-black color indicates lack of blood flow, and maybe
necrosis.
79.Answer A. Restricting fluids decrease the amount of body fluid and the
accumulation of fluid in the peritoneal space.
80.Answer D. Dark green, leafy vegetables are rich in calcium.
81.Answer A. For pruritus, care should include tepid sponge baths and use of
emollient creams and lotions.

82.Answer D. Rest periods and small frequent meals is indicated during the
acute phase of hepatitis B.
83.Answer D. Hepatitis B can recur. Patients who have had hepatitis are
permanently barred from donating blood. Alcohol is metabolized by the liver
and should be avoided by those who have or had hepatitis B.
84.Answer A. To prevent venous stasis and improve muscle tone, circulation,
and respiratory function, encourage her to move after surgery.
85.Answer A. Telling her not to worry minimizes her feelings.
86.Answer A. Diazepam is absorbed by the plastic I.V. tubing and should be
given in the port closest to the vein.
87.Answer A. For the first few days to a week, slight bleeding normally occurs
when the stoma is touched because the surgical site is still new. She should
report profuse bleeding immediately.
88.Answer D. To wash away tissue debris and drainage effectively, irrigate the
wound until the solution becomes clear or all the solution is used.
89.Answer A. Ammonia levels increase d/t improper shunting of blood, causing
ammonia to enter systemic circulation, which carries it to the brain.
90.Answer D. Saline solution is isotonic, or close to body fluids in content, and
is used along with sterile dressings to cover an eviscerated wound and keep it
moist.
91.Answer B. Crohns disease penetrates the mucosa of the colon through all
layers and destroys the colon in patches, which creates a cobblestone
appearance.
92.Answer A. Stomach pain is often a late sign of stomach cancer; outcomes
are particularly poor when the cancer reaches that point. Surgery,
chemotherapy, and radiation have minimal positive effects. TPN may
enhance the growth of the cancer.
93.Answer C. Melena is the passage of dark, tarry stools that contain a large
amount of digested blood. It occurs with bleeding from the upper GI tract.
94.Answer A. A patient with an acute upper GI hemorrhage must be treated for
hypovolemia and hemorrhagic shock. You as a nurse cant diagnose the
problem. Controlling the bleeding may require surgery or intensive medical
treatment.
95.Answer D. To stabilize a patient with acute bleeding, NS or LR solution is
given I.V. until BP rises and urine output returns to 30ml/hr.
96.Answer A. Initially, you should assess the patients knowledge about
colostomies and how it will affect his lifestyle.

97.Answer B. An inflammatory condition that affects the surface of the colon,

ulcerative colitis causes friability and erosions with bleeding. Patients with
ulcerative colitis are at increased risk for bowel perforation, toxic megacolon,
hemorrhage, cancer, and other anorectal and systemic complications.
98.Answer C. Medications to control inflammation such as corticosteroids are
used for long-term treatment.
99.Answer A. Meats and beans are high-protein foods. In liver failure, the liver
is unable to metabolize protein adequately, causing protein by-products to
build up in the body rather than be excreted.
100.
Answer B. A gastric residual greater than 2 hours worth of feeding or
100-150ml is considered too high. The feeding should be stopped; NG tube
clamped, and then allow time for the stomach to empty before additional
feeding is added.