Part 1

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. b. c. d. 45 units/L 100 units/L 300 units/L 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. b. c. d. Tea Gelatin Custard 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. b. c. d. Exhale Inhale and exhale quickly Take and hold a deep breath 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. b. c. d. An obturator Kelly clamp An irrigation set 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. b. c. d. NPO status Nasogastric tube inserted Morphine sulfate for pain 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. b. c. d. Palpates the abdomen for size Palpates the liver at the right rib margin Listens to bowel sounds in all for quadrants 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. b. c. d. Digoxin (Lanoxin) Furosemide (Lasix) Indomethacin (Indocin) 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. b. c. d.

Halts stress reactions Heals the gastric mucosa Reduces the stimulus to acid secretions 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. b. c. d. Leg exercises Early ambulation Irrigating the nasogastric tube 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. b. c. d. Ambulate following a meal Eat high carbohydrate foods Limit the fluid taken with meal 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. b. c. d. Hypotension Bloody diarrhea Rebound tenderness 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

Part 2

1. During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia? a. vitamin A b. vitamin D c. vitamin E d. vitamin K 2. When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: a. increased intracranial pressure. b. decreased urine output. c. bradycardia. d. hypertension. 3. A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially? a. Lying on the right side with legs straight b. Lying on the left side with knees bent

c. Prone with the torso elevated d. Bent over with hands touching the floor 4. A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been spitting up blood. A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the clients wife. The question by the nurse that demonstrates her understanding of MalloryWeiss tearing is: a. Tell me about your husbands alcohol usage. b. Is your husband being treated for tuberculosis? c. Has your husband recently fallen or injured his chest? d. Describe spices and condiments your husband uses on food. 5. Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube? a. Change the tube feeding solutions and tubing at least every 24 hours. b. Maintain the head of the bed at a 15-degree elevation continuously. c. Check the gastrostomy tube for position every 2 days. d. Maintain the client on bed rest during the feedings. 6. A male client is recovering from a small-bowel resection. To relieve pain, the physician prescribes meperidine (Demerol), 75 mg I.M. every 4 hours. How soon after administration should meperidines onset of action occur? a. 5 to 10 minutes b. 15 to 30 minutes c. 30 to 60 minutes d. 2 to 4 hours 7. The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? a. b. c. d. Dyspnea and fatigue Ascites and orthopnea Purpura and petechiae Gynecomastia and testicular atrophy

8. Which condition is most likely to have a nursing diagnosis of fluid volume deficit? a. Appendicitis b. Pancreatitis c. Cholecystitis d. Gastric ulcer 9. While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes clogged. To remedy this problem and teach the clients family how to deal with it at home, what should the nurse do? a. Irrigate the tube with cola. b. Advance the tube into the intestine. c. Apply intermittent suction to the tube. d. Withdraw the obstruction with a 30-ml syringe. 10. A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because:

a. meperidine provides a better, more prolonged analgesic effect. b. morphine may cause spasms of Oddis sphincter. c. meperidine is less addictive than morphine. d. morphine may cause hepatic dysfunction. 11. Mandy, an adolescent girl is admitted to an acute care facility with severe malnutrition. After a thorough examination, the physician diagnoses anorexia nervosa. When developing the plan of care for this client, the nurse is most likely to include which nursing diagnosis? a. b. c. d. Hopelessness Powerlessness Chronic low self esteem Deficient knowledge

12. Which diagnostic test would be used first to evaluate a client with upper GI bleeding? a. b. c. d. Endoscopy Upper GI series Hemoglobin (Hb) levels and hematocrit (HCT) Arteriography

13. A female client who has just been diagnosed with hepatitis A asks, How could I have gotten this disease? What is the nurses best response? a. You may have eaten contaminated restaurant food. b. You could have gotten it by using I.V. drugs. c. You must have received an infected blood transfusion. d. You probably got it by engaging in unprotected sex. 14. When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? a. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. b. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. c. The appendix may develop gangrene and rupture, especially in a middle-aged client. d. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage. 15. A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are: a. whole blood and albumin. b. platelets and packed red blood cells. c. fresh frozen plasma and whole blood. d. cryoprecipitate and fresh frozen plasma. 16. To prevent gastroesophageal reflux in a male 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.

17. The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first? a. Administering pain medication b. Obtaining a blood sample for laboratory studies c. Preparing to insert a nasogastric (NG) tube d. Administering I.V. fluids 18. A female client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? a. The client doesnt 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. 19. A male client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the clients nasogastric (NG) tube has stopped draining. How should the nurse respond? a. Notify the physician b. Reposition the tube c. Irrigate the tube d. Increase the suction level 20. What laboratory finding is the primary diagnostic indicator for pancreatitis? a. Elevated blood urea nitrogen (BUN) b. Elevated serum lipase c. Elevated aspartate aminotransferase (AST) d. Increased lactate dehydrogenase (LD) 21. A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a. yellow sclerae. b. light amber urine. c. circumoral pallor. d. black, tarry stools. 22. Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: a. a sedentary lifestyle and smoking. b. a history of hemorrhoids and smoking. c. alcohol abuse and a history of acute renal failure. d. alcohol abuse and smoking. 23. While palpating a female clients right upper quadrant (RUQ), the nurse would expect to find which of the following structures? a. Sigmoid colon b. Appendix c. Spleen d. Liver

24. A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurses first response is to: a. call the physician. b. place saline-soaked sterile dressings on the wound. c. take a blood pressure and pulse. d. pull the dehiscence closed. 25. The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation? a. Antiarrhythmic drugs b. Anticholinergic drugs c. Anticoagulant drugs d. Antihypertensive drugs 26. A male 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. 27. The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? a. b. c. d. Regular diet Skim milk Nothing by mouth Clear liquids

28. A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: a. severe abdominal pain radiating to the shoulder. b. anorexia, nausea, and vomiting. c. eructation and constipation. d. abdominal ascites. 29. A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: a. b. c. d. place the client in a private room. wear a mask when handling the clients bedpan. wash the hands after touching the client. wear a gown when providing personal care for the client.

30. Which of the following factors can cause hepatitis A? a. b. c. d. Contact with infected blood Blood transfusions with infected blood Eating contaminated shellfish Sexual contact with an infected person

Part 3

1. The client had been diagnosed to have a cholelithiasis. He had undergone laparoscopic cholecystectomy. Which of the following does the nurse recognize as normal signs andsymptoms after the surgery? a) abdominal pain and bloating b) diminished lung sounds c) bile-stained vomitus d) hyperactive bowel sounds 2. The client has been diagnosed to have cancer of the colon. She is for colostomy. The client says, "The doctor told me that there are complications of colostomy." The best initial action by the nurse is a) discuss complications of colostomy to the patient b) provide pre-operation teachings c) ask what are the complications of colostomy d) ask the client to sign consent form 3. A nurse is caring for a client with colostomy created 3 days earlier. The client is beginning to pass malodorous flatus from stoma. The nurse interprets that: a) this is normal, expected event b) this indicates inadequate preoperative bowel preparation c) the client is experiencing early signs of impaired circulation d) the client should not have the nasogastric tube movement 4. A client who has gastrostomy tube for feeding refuses to participate in the plan of care, will not make eye contact and does not speak to family or visitors. A nurse assesses that this client is using which type of coping mechanism? a) self-control b) distancing c) problem-solving d) accepting responsibility 5. A nurse is preparing a diet plan for a post-gastrectomy client to prevent dumping syndrome. Which of the following would not be a component of this teaching plan? a) lie down after eating b) drink liquids with meals c) eat small meals, six times daily d) avoid concentrated sweets

Situation: Mr. Greg, a 49 year old CEO is diagnosed as having ulcer disease. 6. Mr. Greg's ulcer perforates into the peritoneal cavity. To relieve the pain caused by perforation, Mr. Greg is most likely to: a) lie on his left side b) turn into his stomach c) rigidly maintain the supine position d) draw his knees up to his abdomen 7. Mr. Greg is placed on the bland diet and receives medications to decrease gastric acidity. Which medication reduces hydrochloride acid secretion? a) cimetidine (tagamet) b) sucralfate (carafets) c) aluminum hydroxide (amphogel)

d) aspirin 8. Mr. Greg is scheduled for an upper GI series. Which intervention should the nurse perform after procedure? a) testing stool for occult blood b) give the patient a laxative c) assessing for the gag reflex d) administer double dose of antacids to prevent excessive HCL production

9. What diet should the nurse recommend for a child with celiac disease? a) wheat and oats b) rice and corn c) cookies and ice cream d) pasta and noodles 10. Which of the following foods should not be included in the diet of the client with diverticulitis? a) rice and steamed chicken b) tomato and cucumber c) pasta and orange slices d) roasted turkey and spaghetti 11. A client had undergone gastric resection. Which of the following is not to be included in the nursing care plan for the client to prevent dumping syndrome? a) small, frequent feeding b) high protein, low carbohydrate diet c) lying down after meals d) taking fluids with meals 12. When is the best time to administer sucralfate? a) one hour before meals b) 30 minutes after meals c) with meals d) 2 hours after meals 13. Which of the following should the nurse include when giving health teachings in a client with gastroesophageal reflux? a) lie down after meals b) sleep with the head of bed elevated c) eat high carbohydrate diet d) eat low protein diet 14. Which of the following should the nurse advise to a client who had undergone partial gastrectomy? a) drink fluid with meals b) lie down after meals c) increase fats in the diet d) assume upright position during and after meals 15. Which of the following statements when made by the mother of a child with celiac disease indicates that she understands the diet of her child? a) my child can eat rice b) my child can eat oats

c) my child can eat biscuits d) my child can eat pasta

16. Which of the following assessment findings should concern the nurse most, when assessing client who had undergone colonoscopy? a) abdominal distention b) 300 ml of bile-stained vomitus c) complaints of anal pain d) complaints of drowsiness and fatigue 17. A client has hepatic cirrhosis and gastric bleeding. Which of the following tasks may be delegated to the nursing assistant? a) assist the client in taking a bath b) hourly intake and output monitoring c) assist the client to sit before changing the bed linen d) assist the client in ambulation 18. A client diagnosed with gastric ulcer is for discharge. Which of the following should be included by the nurse in the health teachings regarding diet? a) you must eat bland diet b) you can eat most foods as long as they don't bother your stomach c) you should refrain from eating fruits and vegetables d) you should eat low fiber diet 19. The client who was diagnosed to have gastric cancer had undergone gastrectomy. Which of the following statements when made by the client indicates that he understands the health teachings a) I'll take vitamin K for life b) I'll take vitamin B12 for life c) I'll take vitamin C for life d) I'll take vitamin B6 for life 20. The client had been diagnosed to have liver cirrhosis and esophageal varices. Which of the following should the nurse include when giving health teachings? Select all that apply a) avoid spicy foods b) avid straining at stool c) increase fluid intake d) open mouth if coughing or sneezing could not be avoided e) avoid bending or stooping f) take acetaminophen instead of aspirin for pain g) avoid heavy lifting

21. Which of the following findings indicates effectiveness of Viokase? a) abdominal pain relieved b) steatorrhea has decreased c) vomiting has stopped d) jaundice has diminished 22. The client had undergone ileostomy. He has nasogastric tube connected to intermittent suction, with IV fluid and foley catheter. Which of the following physician's instructions requires intervention by thew nurse?

a) remove the NGT on the third day postop b) remove foley catheter after 24 hours c) irrigate ileostomy at bed time d) clear liquid diet once peristalsis returns 23. Which of the following manifestations characterize pancreatitis? a) right upper quadrant pain b) bile-stained vomitus c) epigastric pain that is not relieved by vomiting d) elevated serum calcium

24. The client is diagnosed with acute pancreatitis. Which of the following signs and symptoms will the client manifest? a) right upper quadrant (RUQ) pain b) bluish discoloration at the periumbilical area c) left lower quadrant (LLQ) pain d) pain at the epigastric region 25. The client is diagnosed to have acute pancreatitis. Which laboratory findings signify the diagnosis? a) elevated SGOT, SGPT b) elevated BUN, serum creatinine c) elevated FBS, ESR d) elevated serum amylase, lipase 26. The client had gastrectomy 2 days ago. To prevent dumping syndrome, which of the following is not a component of the interventions? a) eating small frequent meals b) lying down after meals for 30 minutes c) drinking fluids during meals d) avoiding concentrated sugar 27. After liver biopsy, what is the most appropriate next action of the RN? a) take vital signs b) place the client in right sided-lying position c) place the client in semi-fowler's position d) place the client in left sided-lying position 28. A fluid challenge is begun with a postop gastric surgery client. Which assessment will give the best indication of the client's response to this treatment? a) CVP (central venous pressure) reading and hourly urine output b) blood pressure and apical rate c) lung sounds and arterial blood gases d) electrolytes, BUN levels 29. Which of the following facts best explains why the duodenum is not removed during a subtotal gastrectomy? a) the head of the pancreas is adherent to the duodenal wall b) the common bile duct empties into the duodenal villi c) the wall of the jejunum contains no intestinal villi

d) the jejunum receives its blood supply through the duodenum

30. Which of the following expected outcomes should the nurse inform the client after laparoscopic cholecystectomy? a) redness and swelling on the operative site b) serosanguinous drainage on the dressing c) shoulder pain for 24 hours d) nausea and vomiting for 24 hours 31. Which of the following interventions does the nurse expect to give to a client after gastrointestinal series? a) analgesic b) laxative c) antiemetic d) sedative 32. The client has been diagnosed to have acute pancreatitis. Which of the following is not a component of nursing care for the client? a) administer morphine sulfate for pain b) administer calcium supplement as ordered c) administer digestive enzymes with each meal and snack d) administer IV therapy as ordered 33. The client has been diagnosed to have VRE (Vancomycin-resistant enterocolitis).Which of the following is appropriate nursing action when caring for the client? a) wear mask when entering the client's room b) wear gloves when caring for the client c) wear mask and gloves when performing procedures to the client d) wear gown and mask when caring for the client 34. A patient was diagnosed to have Laennec's cirrhosis. Which of the following symptoms should be assessed first? a) inability to write b) jaundice c) increased BUN d) ascites 35. A nurse assists a physician in performing a liver biopsy. After the procedure, which of the following positions should the nurse place the patient? a) prone position b) supine position c) right side-lying position with a pillow under the puncture site d) left side-lying position with a pillow under the puncture site 36. The client had been diagnosed to have acute pancreatitis. Which of the following signs and symptoms most likely are experienced by the client? Select all that apply a) pain in the left upper quadrant of the abdomen b) bile-stained vomitus c) elevated serum amylase d) hypercalcemia e) steatorrhea

f) hypoglycemia g) weight loss 37. The child has been diagnosed to have Hirschprung's disease (Aganglionic megacolon) by rectal biopsy. Which of the following findings most likely is experienced by the child? a) ribbon-like stool b) currant jelly-like stool c) olive-sized mass in the abdomen d) sausage-like mass in the abdomen 38. The nurse assists the physician during paracentesis. In which position does the nurse place the client? a) lying position b) sitting position c) prone position d) side-lying position 39. The client had been diagnosed to have complete intestinal obstruction. Which of the following assessment findings will the nurse expect? a) medium-pitched gurgling sounds b) high-pitched tinkling bowel sounds c) absence of bowel sounds d) increased bowel sounds 40. Which of the following physician's orders for a client with acute pancreatitis should be questioned by the nurse? a) zantac 300mg 1 tablet BID b) morphine sulfate 5mg/IV every 6 hours c) bland, low fat diet d) meperidine hydrochloride 50mg/IV every 4 hours 41. The client with liver cirrhosis has developed esophageal varices. Which of the following should the nurse advise the client to avoid? Select all that apply a) coughing b) straining at stool c) yawning d) bending and stooping e) swallowing f) heavy lifting g) spicy foods 42. The client had undergone Billroth II surgery. Which of the following health teachings should be taken to the client before discharge? Select all that apply a) take dry, high protein foods b) limit concentrated carbohydrates c) lie down in left side-lying position after meals d) take fluids with meals e) take small, frequent meals f) start meal with hot foods and beverages 43. The nurse is taking care of a patient with a positive clostridium difficile culture result. The charge nurse will intervene if she observes the nurse to be a) wearing gloves in handling secretions

b) washing hands before and after entering the room and giving care to the patient c) instructing the patient to wash hands with antimicrobial soap d) wearing gown, gloves, mask, and cap while giving care to the patient 44. After gastrojejunostomy, which of the following instructions should be included in the health teachings of the patient? a) limit carbohydrates in your diet b) increase fluid intake c) avoid lying down after eating d) limit proteins in your diet 45. Arrange in sequence the following actions when cleaning an abdominal incision. a) prepare supplies b) apply sterile gloves c) do hand washing apply clean gloves d) remove soiled dressings e) clean from the top to the bottom of the abdominal incision g) apply sterile dressings - C, D, A, B, E, F

46. A client has Sengstaken-Blakemore tube. The nurse, during change-of-shift report should remind the next shift nurse to: a) keep scissors at bedside b) avoid instilling fluid into the aspiration port c) keep tracheostomy tray at bedside d) deflate the balloon for 15 to 30 minutes every 2 hours 47. The nurse is developing the plan of care for a client receiving continuous ambulatory peritoneal dialysis (CAPD). Which is the priority complication of CAPD to be addressed in the plan of care? a) bleeding b) pain c) outflow problems d) infection Situation: Bobby, a 13 year old is being seen in the emergency room for possible appendicitis. 48. An important nursing action to perform when preparing Bobby for an appendectomy is to: a) administer saline enemas to cleanse the bowels b) apply heat to reduce pain c) measure abdominal girth d) continuously monitor pain 49. Which of the following would indicate that Bobby's appendix has ruptured? a) diaphoresis b) anorexia c) pain at Mc Burney's point d) relief from pain 50. A nurse is making a home health visit and finds the client experiencing right lower quadrant abdominal pain, which has decreased in intensity over the last day. The client also has a rigid abdomen and a temperature of 103.6 F. The nurse should intervene by:

a) administering Tylenol (acetaminophen) for the elevated temperature b) advising the client to increase oral fluids c) asking the client when she last had a bowel movement d) notifying the physician 51.A nurse is working in the emergency room and receives a client with suspected botulism. Which action is a priority for the nurse to initiate? a) administer vaccine for botulism b) initiate isolation c) induce vomiting d) administer antibiotics 52. The nurse is assigned to a 40-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 d0 500 units/L 53. An adult client was diagnosed with acute pancreatitis 9 days ago. The nurse interprets that the client is recovering from this episode if the serum lipase level decreases to which of the following values, which is just below the upper limit of normal? a) 20 unit/L b) 80 unit/L c) 135 unit/L d) 350 unit/L 54. A client who is recently has been started on enteral feedings begins to complain of abdominal cramping, followed by the passage of two liquid stools. A nurse notes that the client has abdominal distention as well. The nurse reviews the nutritional content on the label of the can of feeding to see if it has which of the following ingredients? a) lactose b) sucrose c) fructose d) maltose 55. A nurse 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 intention to increase the intake of: a) pork b) milk c) chicken d) broccoli 56. A nurse is monitoring a postoperative client after abdominal surgery for signs ofcomplications. The nurse assesses the client for the presence of Homan's sign and determines that his sign is positive if which of the following is noted?

a) incisional pain b) absent bowel sounds c) pain with dorsiflexion of the foot d) crackles on auscultation of the lungs

57. A nurse is assessing for correct placement of a nasogastric tube. The nurse aspirates the stomach contents and checks 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

58. An adult client with a history of gastrointestinal bleeding has a platelet count of 300,000 cells/mm3. Which action by the nurse is most appropriate after seeing the laboratory results? a) report the abnormally low count b) report the abnormally high count c) place the client on bleeding precautions d) place the normal report in the client's medical record 59. An adult client with cirrhosis has been following a diet with optimal amounts of protein because neither an excess or a deficiency of protein has been helpful. The nurseevaluates the client's status as being most satisfactory if the total protein level in which of the following values? a) 0.4 g/dL b) 3.7 g/dL c) 6.4 g/dL d) 9.8 g/dL 60. A 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

1. An adult who has cholecystitis reports clay colored stools and moderate jaundice. Which is the best explanation for the presence of clay colored stools and jaundice? 1. There is an obstruction in the pancreatic duct. 2. There are gallstones in the gallbladder. 3. Bile is no longer produced by the gallbladder. 4. There is an obstruction in the common bile duct. 2. Atropine 0.5 mg is ordered for a client having an acute attack of cholecystitis. What is the primary purpose of this drug for this client? To 1. decrease skeletal muscle spasms. 2. increase gastrointestinal peristalsis 3. decrease smooth muscle contractions 4. decrease anxiety

3. Following a cholecystectomy, drainage form the T tube for the first 24 hours postoperative was 350 cc. Proper nursing action in response to this should be to 1. notify the physician .

2. raise the level of the drainage bag to decrease rate of flow. 3. increase the IV flow rate to compensate for the loss. 4. continue to observe and measure drainage. 4. An adult male is admitted to the hospital complaining of burning epigastric pain. He reports to the nurse that he has gained 14 pounds over the last two months. Which nursing response is best? 1. Why were you eating more? 2. Has the weight gain been intentional? 3. Does your weight usually fluctuate this much? 4. How did your eating habits change? 5. An adult male client is admitted with a diagnosis of probable duodenal ulcer. Which of the following laboratory tests would it be most essential for the nurse to assess immediately? 1. Hemoglobin and Hematocrit 2. SGPT and SGOT 3. Na and K 4. BUN and creatinine 6. An adult client is to have a gastroduodenoscopy in the morning. The nurses instructions should include the information that he will be 1. given a general anesthetic during the procedure. 2. given a local anesthetic to ease the discomfort during the procedure. 3. asked to assist by coughing during the procedure. 4. asked to assist by performing a Valsalva maneuver during the procedure. 7. 1. 2. 3. 4. Which nursing intervention is essential immediately following a gastroduodenoscopy? Force fluids. Position him supine. Instruct him not to eat or drink. Encourage coughing and deep breathing.

8. Because a client has a nasogastric tube attached to intermittent drainage the nurse should be particularly alert for the development of which complication? 1. Hypocalcemia. 2. Hypermagnesemia. 3. Hypokalemia. 4. Hypoglycemia. 9. A barium enema is ordered for an adult male client. The nurse is teaching him what to expect regarding the procedure. Which statement should be included in the teaching? 1. Fecal matter must be cleansed from the bowel for good visualization. 2. There will be no food restrictions before the test. 3. He will not have to change positions during the procedure. 4. He will be asked to drink barium during the procedure. 10. An abdomino-perineal resection with a transverse colostomy is planned for an adult male client. Neomycin sulfate p.o. is ordered prior to surgery. The primary purpose for administering this drug is to reduce 1. electrolyte imbalances. 2. bacterial content in the colon. 3. peristaltic action in the colon. 4. feces in the bowel.

11. In preparation for an abdomino-perineal resection the client is placed on a low residue diet. Which of the following food lists is appropriate for him to eat on a low residue diet? 1. Ground lean beef, soft boiled eggs, tea. 2. Lettuce, spinach, corn. 3. Prunes, grapes, apples. 4. Bran cereal, whole wheat toast, coffee. 12. The nurse is caring for a client who has had a colostomy. Which of the following client behaviors is indicative of a willingness to be involved in self-care following a colostomy? 1. Discussing the cost of his hospitalization. 2. Asking what time the surgeon will be in. 3. Asking questions about the equipment being used. 4. Complaining about the noise in the adjacent room. 13. An adult is admitted with a duodenal ulcer. On the second day after admission, the client develops severe, persistent pain radiating to the shoulder. What action should the nurse take first? 1. Notify the physician. 2. Place client in a high-Fowlers position to decrease pressure on the gastric area and shoulder. 3. Examine the client for board-like rigidity of the abdomen. 4. Administer ordered prn pain medication. 14. The client with a duodenal ulcer is ready for discharge. Which statement made by the client indicates a need for more teaching about his diet? 1. Its a good thing I gave up drinking alcohol last year. 2. I will have to drink lots of milk and cream every day. 3. I will stay away from cola drinks after I am discharged. 4. Eating three nutritious meals and snacks every day is okay. 15. A young college student comes to the emergency room with nausea, vomiting and severe abdominal pain of six hours duration. While examining the client the physician asks her to stand on her toes and drop to her heels with a thump. Which of the following interpretations of this procedure is the most accurate? 1. An irritated bowel will become less tender. 2. If the client has an acute inflammation she will feel localized pain in the inflamed area. 3. This procedure will create more flaccid abdominal muscles allowing easier abdominal exam. 4. The client with appendicitis will experience brief relief following this action.

16. The nurse is admitting a client with a diagnosis of appendicitis to the surgical unit. Which question is it essential to ask? 1. When did you last eat? 2. Have you had surgery before? 3. Have you ever had this type of pain before? 4. What do you usually take to relieve your pain? 17. The client with appendicitis asks the nurse for a laxative to help relieve her constipation. The nurse explains to her that laxatives are not given to persons with possible appendicitis. What is the primary reason for this? 1. Laxatives will decrease the spread of infection. 2. Laxatives are not given prior to any type of surgery.

3. The patient does not have true constipation. She only has pressure. 4. Laxatives could cause rupture of the appendix.

18. The nurse is preparing a client with Crohns disease for discharge. Which statement he makes indicates he needs further teaching? 1. Stress can make it worse. 2. Since I have Crohns disease I dont have to worry about colon cancer. 3. I realize I shall always have to monitor my diet. 4. I understand there is a high incidence of familial occurrence with this disease. 19. A client is admitted to the hospital with ulcerative colitis. Admitting orders include a low residue diet. Which food would be contraindicated for this client? 1. Roast beef. 2. Fresh peas. 3. Mashed potatoes. 4. Baked chicken. 20. An adult client is to have a sigmoidoscopy in the morning. What should the nurse plan to do? 1. Give him an enema 1 hour before the examination. 2. Keep him NPO for 8 hours before the examination. 3. Order a low fat, low residue diet for breakfast. 4. Administer enemas until clear this evening. 21. A client has an order for irrigation of a nasogastric tube. What should the nurse do before irrigating the nasogastric tube? 1. Inject a small amount of air while listening with a stethoscope over the stomach for a swoosh. 2. Instill 5 cc of normal saline and observe for development of coughing and dyspnea. 3. Place the end of the nasogastric tube in a glass of water and observe for bubbles. 4. Aspirate and check the pH. 22. The client who has had a hemorrhoidectomy wants to know why she cannot take a sitz bath immediately upon return from the operating room. The nurses response is based upon which of the following concepts? 1. Heat can stimulate bowel movement too quickly after surgery. 2. Patients are generally not awake enough for several hours to safely take sitz baths. 3. Heat applied immediately post-operatively increases the possibility of hemorrhage. 4. Sitting in water before the sutures are removed may cause infection. 23. A client with pancreatitis tells the nurse that he fears nighttime. Which of the following statements most likely relates to the clients concerns? 1. The pain is worse at night and aggravated in the recumbent position. 2. He is afraid of the dark. 3. The mattress is uncomfortable. 4. The pain increases after a day of activity. 24. The client asks how he contracted hepatitis A. He reports all of the following. Which one is most likely related to hepatitis A? 1. He ate home canned tomatoes. 2. He ate oysters his roommate brought home from a fishing trip. 3. He stepped on a nail 2 weeks ago. 4. He donated blood 2 weeks before he got sick.

25. The client has had a liver biopsy. The nurse should position him on his right side with a pillow under his rib cage. What is the primary reason for this position? 1. To immobilize the diaphragm. 2. To facilitate full chest expansion. 3. To minimize the danger of aspiration. 4. To reduce the likelihood of bleeding A male client with a history of cirrhosis and alcoholism is admitted with severe dyspnea resulted to ascites. The nurse should be aware that the ascites is most likely the result of increased a. Pressure in the portal vein b. Production of serum albumin c. Secretion of bile salts d. Interstitial osmotic pressure A client has Gastroesophageal Reflux Disease (GERD). The nurse should teach the client that after every meals, the client should a. Rest in sitting position b. Take a short walk c. Drink plenty of water d. Lie down at least 30 minutes After gastroscopy, an adaptation that indicates major complication would be: a. Nausea and vomiting b. Abdominal distention c. Increased GI motility d. Difficulty in swallowing A client who has undergone a cholecystectomy asks the nurse whether there are any dietary restrictions that must be followed. Nurse Hilary would recognize that the dietary teaching was well understood when the client tells a family member that: a. Most people need to eat a high protein diet for 12 months after surgery b. I should not eat those foods that upset me before the surgery c. I should avoid fatty foods as long as I live d. Most people can tolerate regular diet after this type of surgery Nurse Rachel teaches a client who has been recently diagnosed with hepatitis A about untoward signs and symptoms related to Hepatitis that may develop. The one that should be reported immediately to the physician is: a. Restlessness b. Yellow urine c. Nausea d. Clay- colored stools

1. What laboratory finding is the primary diagnostic indicator for pancreatitis? a. Elevated blood urea nitrogen (BUN) b. Elevated serum lipase c. Elevated aspartate aminotransferase (AST)

d. Increased lactate dehydrogenase (LD)

2. 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.

3. When assessing a client during a routine checkup, the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. Aphthous stomatitisis is best described as: a. a canker sore of the oral soft tissues. b. an acute stomach infection. c. acid indigestion. d. an early sign of peptic ulcer disease. 4. 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. 5. 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

6. 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 7. 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 8. 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. 9. 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." 10. A client with mild diarrhea, fever, and abdominal discomfort is being evaluated for inflammatory bowel disease (IBD). Which statement about IBD is true? 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.

11. 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. 12. 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. 13. 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 14. 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. 15. 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."

16. 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. 17. 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 18. 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. 19. 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 20. 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.

21. 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." 22. 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. 23. 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. 24. 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? a. Atrophy of the gastric mucosa b. Decrease in intestinal flora c. Increase in bile secretion d. Dulling of nerve impulses 25. 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

26. 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 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 27. 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 28. 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 29. A healthy 25-year-old man comes to the physician for a routine examination. His laboratory tests show a serum bilirubin level of 4 mg/dL and a direct bilirubin level of 0.3 mg/dL. The patients liver function tests are normal. Which of the following best explains this patients serum and indirect bilirubin levels? (A) Extrahepatic biliary obstruction (B) Glucuronosyltransferase deficiency (C) Heme oxygenase deficiency (D) Intrahepatic biliary obstruction 30. 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

31. An unconscious 57-year-old man is brought to the emergency department by ambulance with massive, bright red emesis. On arrival, his blood pressure is 80/40 mm Hg and his heart rate is 124/min. He appears jaundiced with multiple spider angiomas on his chest and arms. He has an enlarged abdomen that is dull to percussion and positive for a fluid wave. He has splenomegaly and muscle wasting in his extremities. Which of the following vessel anastomoses is responsible for the patients bleeding? (A) Left gastric artery and left gastric vein (B) Left gastric vein and azygos vein

(C) Paraumbilical vein and inferior epigastric vein (D) Portal vein and inferior vena cava 32. A 43-year-old man with a 20-year history of ulcerative colitis presents to the physician with complaints of worsening bloody diarrhea, progressive fatigue, pruritus, visual disturbances, and arthralgias. On physical examination, he is found to have icteric sclera, finger clubbing, and several small ulcerations with necrotic edges on both legs. Endoscopic retrograde cholangiopancreatography (ERCP) shows alternating strictures and dilations of the bile ducts. Which of the following conditions is consistent with these ERCP findings? (A) Cholelithiasis (B) Pancreatic carcinoma (C) Primary biliary cirrhosis (D) Primary sclerosing cholangitis 33. Practice Test For Nursing Entrance Exam about 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 34. A 65-year-old white woman presents to the emergency department with persistent right upper quadrant pain with nausea and vomiting. Abdominal CT scan reveals a polypoid mass of the gallbladder protruding into the lumen, diffuse thickening of the gallbladder wall, and enlarged lymph nodes. This patient most likely has a history of which of the following? (A) Ascaris lumbricoides (B) Cigarette smoking (C) Gallstones (D) Schistosoma haematobium 35. 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

36. 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

37. A 62-year-old woman has had persistent nausea for 5 years with occasional vomiting. Gastrointestinal endoscopy reveals a small area of gastric mucosa in the fundus without rugal folds, and a biopsy demonstrates welldifferentiated adenocarcinoma confined to the mucosa. Upper gastrointestinal endoscopy performed 5 years ago showed a pattern of gastritis. Microscopy at that time showed chronic inflammation with the presence of Helicobacter pylori. Which of the following best characterizes this patients neoplasm? (A) Favorable prognosis (B) Highest incidence in the United States (C) Linitis plastica (D) Metastases limited to regional lymph nodes 38. Practice Test For Nursing Entrance Exam about a 23-year-old man who presents to the physician with abdominal distention and tenderness with no vomiting or diarrhea. Physical examination shows hepatosplenomegaly. Bowel sounds are normal. On questioning, the patient says that he traveled to eastern South America 1 year ago. Several weeks after returning from his trip, he remembers having fever, diarrhea, weight loss, and funny looking stools. Ultrasonography shows ascites and hepatic periportal fibrosis. Which of the following is most likely responsible for this patients present symptoms? (A) Appendicitis (B) Bowel obstruction (C) Enterocolitis (D) Portal hypertension 39. A 20-year-old man with Crohns disease refractory to treatment with high-dose methylprednisolone is started on therapy with infliximab, a chimeric monoclonal antibody with antiinflammatory effects. This drug is administered intravenously every 2 months and produces substantial improvement in the patients symptoms between doses. Which of the following best describes infliximabs mechanism of action? ( A) Acting as a partial agonist at some estrogen receptors and as an antagonist at others (B) Binding a growth factor receptor to target a cell for killing (C) Binding to and neutralizing a secreted cytokine (D) Inhibiting a fusion protein with tyrosine kinase activity 40. A 2-month-old boy is brought to his pediatrician for a regular check-up. His parents report that he has a poor appetite and is very constipated. He has small bowel movements once a week, which his parents believe are very painful. Although he was at the 75th percentile for both height and weight at birth, he is currently at the 25th percentile for height and is below the 5th percentile for weight. His abdomen is distended, but his bowel sounds are normal and his abdomen does not appear to be tender. Barium enema shows a narrow rectosigmoid with a dilation of the segment above the narrowing, and a rectosigmoid biopsy shows a conspicuous absence of acetylcholinesterasepositive ganglion cells. Which of the following genetic conditions is most commonly associated with this patients disease? (A) Cystic fibrosis (B) Downs syndrome (C) Sickle cell disease (D) Tay-Sachs disease

41. 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 42. A 24-year-old man presents to the physician with diarrhea and abdominal cramps. A fecal occult blood test is positive. On questioning, it is learned that the patient went swimming in a lake during a camping trip 2 days ago. A stool sample is sent for laboratory evaluation. This patient is most likely infected with which of the following? (A) Cryptosporidium (B) Entamoeba histolytica (C) Giardia lamblia (D) Leishmania donovani 43. 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 44. A 10-year-old girl living in New Jersey is brought to the physician because she has had a fever and headache accompanied by abdominal pain and bloody diarrhea. Her stool smear shows leukocytes. A stool culture incubated at 42o C (107.6o F) in a microaerophilic environment shows many comma-shaped organisms each with a single polar flagellum. She has no history of recent travel or sick contacts. She has a pet puppy, which the mother says has had diarrhea for the past week. Based on the above information, the physician suspects bacterial gastroenteritis. The organism responsible for this patients sickness is thought to be associated with the possible later development of which of the following symptoms? (A) Acute renal failure and thrombocytopenia with hemolytic anemia (B) Fever, migratory polyarthritis, and carditis (C) Fever, new murmur, small erythematous lesions on the palms, and splinter hemorrhages on the nail bed (D)Symmetric ascending muscle weakness beginning in the distal lower extremities 45. 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

46. 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 47. 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 48. 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 49. 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 50. 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

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? (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