71.

The female client who has been receiving radiation therapy for
bladder cancer tells the nurse that it feels as if she is voiding
through the vagina. The nurse interprets that the client may be
experiencing:
a) rupture of the bladder
b) the development of a vesicovaginal fistula
c) extreme stress caused by the diagnosis of cancer
d) altered personal sensation as the side effect of radiation
therapy
72. The client with leukemia is receiving busulfan (Myleran) and
allupurinol (Zyloprim) is prescribed for the client. The nurse tells
the client that the purpose of the allupurinol is to prevent:
a) nausea
b) alopecia
c) vomiting
d) hyperuricemia
73. The client receiving chemotherapy is experiencing mucositis.
The nurse advises the client to use which of the following as the
best substance to rinse the mouth?
a) alcohol-based mouthwash
b) hydrogen peroxide mixture
c) lemon-flavored mouthwash
d) weak salt and bicarbonate mouth rinse
74. The community nurse is conducting a health promotion
program and the topic of the discussion relates to the risk factors
for gastric cancer. Which risk factor, if identified by a client,
indicates a need for further discussion?
a) smoking
b) a high-fat diet
c) foods containing nitrates
d) a diet of smoked, highly salted, and spiced food
75. A gastrectomy is performed on a client with gastric cancer. In
the immediate postoperative period, the nurse notes bloody
drainage from the nasogastric tube. Which of the following is the
appropriate nursing intervention?
a) notify the physician
b) measure abdominal girth
c) irrigate the nasogastric tube
d) continue to monitor the drainage
76. The nurse is teaching a client about the risk factors associated
with colorectal cancer. The nurse determines that further teaching
related to colorectal cancer is necessary if the client identifies
which of the following as an associated risk factor?
a) age younger than 50 years
b) history of colorectal polyps
c) family history of colorectal cancer
d) chronic inflammatory bowel disease
77. The nurse is performing an admission assessment on a client
diagnosed with a right colon tumor. The nurse asks the client
about which characteristic symptom of this type of tumor?
a) rectal bleeding
b) flat, ribbon-like stool
c) crampy, colicky abdominal pain
d) alternating constipation and diarrhea
78. The nurse is reviewing the preoperative orders of a client with
a colon tumor who is scheduled for abdominal perineal resection
and notes that the physician has prescribed neomycin (Mycifradin)
for the client. The nurse determines that this medication has been
prescribed primarily:
a) to prevent immune dysfunction
b) because the client has an infection
c) to decrease the bacteria in the bowel
d) because the client is allergic to penicillin
79. The nurse is assessing the perineal wound in a client who has
returned from the operating room following an abdominal perineal
resection and notes serosanguineous drainage from the wound.
Which nursing intervention is most appropriate?
a) notify the physician
b) clamp the penrose drain
c) change the dressing as prescribed
d) remove and replace the perineal packing
80. The nurse is assessing the colostomy of a client who has had
an abdominal perineal resection for a bowel tumor. Which of the
following assessment findings indicates that the colostomy is
beginning to function?
a) absent bowel sounds
b) the passage of flatus
c) the client's ability to tolerate food

d) bloody drainage from the colostomy

//////////////////////////////////////////
26. Which of the following medications is most effective for
treating the pain associated with irritable bowel disease?
1. Acetaminophen
2. Opiates
3. Steroids
4. Stool softeners
27. During the first few days of recovery from ostomy
surgery for ulcerative colitis, which of the following
aspects should be the first priority of client care?
1. Body image
2. Ostomy care
3. Sexual concerns
4. Skin care
28. Colon cancer is most closely associated with which of
the following conditions?
1. Appendicitis
2. Hemorrhoids
3. Hiatal hernia
4. Ulcerative colitis
29. Which of the following diets is most commonly
associated with colon cancer?
1. Low-fiber, high fat
2. Low-fat, high-fiber
3. Low-protein, high-carbohydrate
4. Low carbohydrate, high protein
30. Which of the following diagnostic tests should be
performed annually over age 50 to screen for colon cancer?
1. Abdominal CT scan
2. Abdominal x-ray
3. Colonoscopy
4. Fecal occult blood test
31. Radiation therapy is used to treat colon cancer before
surgery for which of the following reasons?
1. Reducing the size of the tumor
2. Eliminating the malignant cells
3. Curing the cancer
4. Helping the bowel heal after surgery
32. Which of the following symptoms is a client with colon
cancer most likely to exhibit?
1. A change in appetite
2. A change in bowel habits
3. An increase in body weight
4. An increase in body temperature
33. A client has just had surgery for colon cancer. Which of
the following disorders might the client develop?
1. Peritonitis
2. Diverticulosis
3. Partial bowel obstruction
4. Complete bowel obstruction
34. A client with gastric cancer may exhibit which of the
following symptoms?
1. Abdominal cramping
2. Constant hunger
3. Feeling of fullness
4. Weight gain
35. Which of the following diagnostic tests may be
performed to determine if a client has gastric cancer?
1. Barium enema
2. Colonoscopy
3. Gastroscopy
4. Serum chemistry levels
36. A client with gastric cancer can expect to have surgery
for resection. Which of the following should be the nursing
management priority for the preoperative client with
gastric cancer?
1. Discharge planning
2. Correction of nutritional deficits
3. Prevention of DVT
4. Instruction regarding radiation treatment
37. Care for the postoperative client after gastric resection
should focus on which of the following problems?
1. Body image
2. Nutritional needs
3. Skin care
4. Spiritual needs
38. Which of the following complications of gastric
resection should the nurse teach the client to watch for?

1. Constipation
2. Dumping syndrome
3. Gastric spasm
4. Intestinal spasms
39. A client with rectal cancer may exhibit which of the
following symptoms?
1. Abdominal fullness
2. Gastric fullness
3. Rectal bleeding
4. Right upper quadrant pain
40. A client with which of the following conditions may be
likely to develop rectal cancer?
1. Adenomatous polyps
2. Diverticulitis
3. Hemorrhoids
4. Peptic ulcer disease
41. Which of the following treatments is used for rectal
cancer but not for colon cancer?
1. Chemotherapy
2. Colonoscopy
3. Radiation
4. Surgical resection
47. A client with irritable bowel syndrome is being
prepared for discharge. Which of the following meal plans
should the nurse give the client?
1. Low fiber, low-fat
2. High fiber, low-fat
3. Low fiber, high-fat
4. High-fiber, high-fat
48. A client presents to the emergency room, reporting
that he has been vomiting every 30 to 40 minutes for the
past 8 hours. Frequent vomiting puts him at risk for which
of the following?
1. Metabolic acidosis with hyperkalemia
2. Metabolic acidosis with hypokalemia
3. Metabolic alkalosis with hyperkalemia
4. Metabolic alkalosis with hypokalemia
49. Five days after undergoing surgery, a client develops a
small-bowel obstruction. A Miller-Abbott tube is inserted
for bowel decompression. Which nursing diagnosis takes
priority?
1. Imbalanced nutrition: Less than body requirements
2. Acute pain
3. Deficient fluid volume
4. Excess fluid volume
50. When teaching an elderly client how to prevent
constipation, which of the following instructions should the
nurse include?
1. Drink 6 glasses of fluid each day.
2. Avoid grain products and nuts.
3. Add at least 4 grams of bran to your cereal each morning.
4. Be sure to get regular exercise.
51. In a client with diarrhea, which outcome indicates that
fluid resuscitation is successful?
1. The client passes formed stools at regular intervals
2. The client reports a decrease in stool frequency and liquidity
3. The client exhibits firm skin turgor
4. The client no longer experiences perianal burning.
52. When teaching a community group about measures to
prevent colon cancer, which instruction should the nurse
include?
1. Limit fat intake to 20% to 25% of your total daily
calories.
2. Include 15 to 20 grams of fiber into your daily diet.
3. Get an annual rectal examination after age 35.
4. Undergo sigmoidoscopy annually after age 50.
53. A 30-year old client experiences weight loss, abdominal
distention, crampy abdominal pain, and intermittent
diarrhea after birth of her 2nd child. Diagnostic tests
reveal gluten-induced enteropathy. Which foods must she
eliminate from her diet permanently?
1. Milk and dairy products
2. Protein-containing foods
3. Cereal grains (except rice and corn)
4. Carbohydrates
54. After a right hemicolectomy for treatment of colon
cancer, a 57-year old client is reluctant to turn while on
bed rest. Which action by the nurse would be appropriate?

1. Asking a coworker to help turn the client

2. Explaining to the client why turning is important.
3. Allowing the client to turn when hes ready to do so
4. Telling the client that the physicians order states he must turn
every 2 hours
55. A client has a percutaneous endoscopic gastrostomy
tube inserted for tube feedings. Before starting a
continuous feeding, the nurse should place the client in
which position?
1. Semi-Fowlers
2. Supine
3. Reverse Trendelenburg
4. High Fowlers
56. An enema is prescribed for a client with suspected
appendicitis. Which of the following actions should the
nurse take?
1. Prepare 750 ml of irrigating solution warmed to 100*F
2. Question the physician about the order
3. Provide privacy and explain the procedure to the client
4. Assist the client to left lateral Sims position
57. The client being seen in a physicians office has just
been scheduled for a barium swallow the next day. The
nurse writes down which of the following instructions for
the client to follow before the test?
1. Fast for 8 hours before the test
2. Eat a regular supper and breakfast
3. Continue to take all oral medications as scheduled.
4. Monitor own bowel movement pattern for constipation
58. The nurse is monitoring a client for the early signs of
dumping syndrome. Which symptom indicates this
occurrence?
1. Abdominal cramping and pain
2. Bradycardia and indigestion
3. Sweating and pallor
4. Double vision and chest pain
62. The nurse is performing a colostomy irrigation on a
client. During the irrigation, a client begins to complain of
abdominal cramps. Which of the following is the most
appropriate nursing action?
1. Notify the physician
2. Increase the height of the irrigation
3. Stop the irrigation temporarily.
4. Medicate with dilaudid and resume the irrigation
63. The nurse is teaching the 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?
1. Increase fluid intake
2. Reduce the amount of irrigation solution
3. Perform the irrigation in the evening
4. Place heat on the abdomen
66. The nurse instructs the ileostomy client to do which of
the following as a part of essential care of the stoma?
1. Cleanse the peristomal skin meticulously
2. Take in high-fiber foods such as nuts
3. Massage the area below the stoma
4. Limit fluid intake to prevent diarrhea.
67. The client who has undergone creation of a colostomy
has a nursing diagnosis of Disturbed body image. The
nurse would evaluate that the client is making the most
significant progress toward identified goals if the client:
1. Watches the nurse empty the colostomy bag
2. Looks at the ostomy site
3. Reads the ostomy product literature
4. Practices cutting the ostomy appliance
68. The nurse is assessing for stoma prolapse in a client
with a colostomy. The nurse would observe which of the
following if stoma prolapse occurred?
1. Sunken and hidden stoma
2. Dark- and bluish-colored stoma
3. Narrowed and flattened stoma
4. Protruding stoma
69. The client with a new colostomy is concerned about the
odor from the stool in the ostomy drainage bag. The nurse
teaches the client to include which of the following foods
in the diet to reduce odor?1. Yogurt
2. Broccoli
3. Cucumbers
4. Eggs

70. The nurse has given instructions to the client with an

ileostomy about foods to eat to thicken the stool. The
nurse determines that the client needs further instructions
if the client stated to eat which of the following foods to
make the stools less watery?
1. Pasta
2. Boiled rice
3. Bran
4. Low-fat cheese
71. The client has just had surgery to create an ileostomy.
The nurse assesses the client in the immediate post-op
period for which of the following most frequent
complications of this type of surgery?
1. Intestinal obstruction
2. Fluid and electrolyte imbalance
3. Malabsorption of fat
4. Folate deficiency
72. The nurse is doing pre-op teaching with the client who
is about to undergo creation of a Kock pouch. The nurse
interprets that the client has the best understanding of the
nature of the surgery if the client makes which of the
following statements?
1. I will need to drain the pouch regularly with a
catheter.
2. I will need to wear a drainage bag for the rest of my life.
3. The drainage from this type of ostomy will be formed.
4. I will be able to pass stool from my rectum eventually.
73. The client with a colostomy has an order for irrigation
of the colostomy. The nurse used which solution for
irrigation?
1. Distilled water
2. Tap water
3. Sterile water
4. Lactated Ringers
79. The nurse evaluates the clients stoma during the
initial post-op period. Which of the following observations
should be reported immediately to the physician?
1. The stoma is slightly edematous
2. The stoma is dark red to purple
3. The stoma oozes a small amount of blood
4. The stoma does not expel stool
86. One of your patients is receiving digitalis orally and is
also to receive an antacid at the same time. Your most
appropriate action, based on the pharmacokinetics of
antacids, is to:
1. Delay the digitalis for 1 to 2 hours until the antacid is absorbed
2. Give the antacid at least 2 to 4 hours before administering the
digitalis
3. Administer both medications as ordered and document in
nurses notes
4. Contact the physician regarding the drug interaction
and request a change in the time of dosing of the drugs.
87. The nurse would teach patients that antacids are
effective in treatment of hyperacidity because they:
1. Neutralize gastric acid
2. Decrease stomach motility
3. Decrease gastric pH
4. Decrease duodenal Ph
88. The nurse would monitor for which of the following
adverse reactions to aluminum-containing antacids such as
aluminum hydroxide (Amphojel)?
1. Diarrhea
2. Constipation
3. GI upset
4. Fluid retention
89. The nurse would question an order for which type of
antacid in patients with chronic renal failure?
1. Aluminum-containing antacids
2. Calcium-containing antacids
3. Magnesium-containing antacids
4. All of the above.
90. The nurse would monitor a patient using sodium
bicarbonate to treat gastric hyperacidity for signs and
symptoms of:
1. Metabolic alkalosis
2. Metabolic acidosis
3. Hyperkalemia
4. Hypercalcemia

91. Which of the following nursing diagnoses is

appropriate for a patient receiving famotidine (Pepcid)?
1. Increased risk for infection due to immunosuppression
2. Potential risk for bleeding related to thrombocytopenia.
3. Alteration in urinary elimination related to retention
4. Alteration in tissue perfusion related to hypertension
92. Histamine2-receptor antagonists:
1. Compete with histamine for binding sites on the parietal
cells
2. Irreversibly bind to H+/K+ATPase
3. Cause a decrease in stomach pH
4. Decrease signs and symptoms of allergies related to histamine
release
93. Proton pump inhibitors:
1. Gastric ulcer formation
2. GERD
3. Achlorhydria
4. Diverticulosis
94. A patient unable to tolerate oral medications may be
prescribed which of the following proton pump inhibitors
to be administered intravenously?
1. lansoprazole (Prevacid)
2. omeprazole (Prilosec)
3. pantoprazole (Protonix)
4. esomeprazole (Nexium)
95. When administering sucralfate (Carafate) to a patient
with a nasogastric tube, it is important to:
1. Crush the tablet into a fine powder before mixing with water
2. Administer with a bolus tube feeding
3. Allow the tablet to dissolve in water before
administering
4. Administer with an antacid for maximum benefit
96. Sucralfate (Carafate) achieves a therapeutic effect by:
1. Neutralizing gastric acid
2. Enhancing gastric absorption
3. Forming a protective barrier around gastric mucosa
4. Inhibiting gastric acid secretion
97. To avoid fecal impaction, psyllium (Metamucil) should
be administered with at least how many ounces of fluid?
1. 4
2. 6
3. 8
4. 10
98. Bismuth subsalicylate (Pepto-Bismol), as an absorbent,
has which of the following mechanisms of action?
1. Decreased GI motility
2. Decreased gastric secretions
3. Increased fluid absorption
4. Binding to diarrhea-causing bacteria for excretion
99. Side effects of loperamide (Imodium) include all of the
following except?
1. Diarrhea
2. epigastric pain
3. Dry mouth
4. Anorexia
100. The mechanism of action of diphenoxylate (Lotomil)
is:
1. An increase in intestinal excretion of water
2. An increase in intestinal motility
3. A decrease in peristalsis in the intestinal wall
4. A decrease in the reabsorption of water in the bowel
//////////////-----13 compatibility mode
1. A male client has an abnormal result on a Papanicolaou
test. After admitting, he read his chart while the nurse was
out of the room, the client asks what dysplasia means.
Which definition should the nurse provide?
A. Presence of completely undifferentiated tumor cells that dont
resemble cells of the tissues of their origin
B. Increase in the number of normal cells in a normal arrangement
in a tissue or an organ
C. Replacement of one type of fully differentiated cell by another
in tissues where the second type normally isnt found
D. Alteration in the size, shape, and organization of differentiated
cells
2. For a female client with newly diagnosed cancer, the
nurse formulates a nursing diagnosis of Anxiety related to
the threat of death secondary to cancer diagnosis. Which
expected outcome would be appropriate for this client?

A. Client verbalizes feelings of anxiety.

B. Client doesnt guess at prognosis.
C. Client uses any effective method to reduce tension.
D. Client stops seeking information.
3. A male client with a cerebellar brain tumor is admitted
to an acute care facility. The nurse formulates a nursing
diagnosis of Risk for injury. Which related-to phrase
should the nurse add to complete the nursing diagnosis
statement?
A. Related to visual field deficits
B. Related to difficulty swallowing
C. Related to impaired balance
D. Related to psychomotor seizures
4. A female client with cancer is scheduled for radiation
therapy. The nurse knows that radiation at any treatment
site may cause a certain adverse effect. Therefore, the
nurse should prepare the client to expect:
A. hair loss.
B. stomatitis.
C. fatigue.
D. vomiting.
11. The nurse is interviewing a male client about his past
medical history. Which preexisting condition may lead the
nurse to suspect that a client has colorectal cancer?
A. Duodenal ulcers
B. Hemorrhoids
C. Weight gain
D. Polyps
13. A male client with a nagging cough makes an
appointment to see the physician after reading that this
symptom is one of the seven warning signs of cancer. What
is another warning sign of cancer?
A. Persistent nausea
B. Rash
C. Indigestion
D. Chronic ache or pain
14. For a female client newly diagnosed with radiationinduced thrombocytopenia, the nurse should include which
intervention in the plan of care?
A. Administering aspirin if the temperature exceeds 102 F (38.8
C)
B. Inspecting the skin for petechiae once every shift
C. Providing for frequent rest periods
D. Placing the client in strict isolation
16. Which intervention is appropriate for the nurse caring
for a male client in severe pain receiving a continuous I.V.
infusion of morphine?
A. Assisting with a naloxone challenge test before therapy begins
B. Discontinuing the drug immediately if signs of dependence
appear
C. Changing the administration route to P.O. if the client can
tolerate fluids
D. Obtaining baseline vital signs before administering the first
dose
21. A 35 years old client has been receiving chemotherapy
to treat cancer. Which assessment finding suggests that
the client has developed stomatitis (inflammation of the
mouth)?
A. White, cottage cheeselike patches on the tongue
B. Yellow tooth discoloration
C. Red, open sores on the oral mucosa
D. Rust-colored sputum
22. During chemotherapy, an oncology client has a nursing
diagnosis of impaired oral mucous membrane related to
decreased nutrition and immunosuppression secondary to
the cytotoxic effects of chemotherapy. Which nursing
intervention is most likely to decrease the pain of
stomatitis?
A. Recommending that the client discontinue chemotherapy
B. Providing a solution of hydrogen peroxide and water for use as a
mouth rinse
C. Monitoring the clients platelet and leukocyte counts
D. Checking regularly for signs and symptoms of stomatitis
25. A male client is in isolation after receiving an internal
radioactive implant to treat cancer. Two hours later, the
nurse discovers the implant in the bed linens. What should
the nurse do first?
A. Stand as far away from the implant as possible and call for help.
B. Pick up the implant with long-handled forceps and place it in a

lead-lined container.
C. Leave the room and notify the radiation therapy department
immediately.
D. Put the implant back in place, using forceps and a shield for
self-protection, and call for help.
34. Rhea, has malignant lymphoma. As part of her
chemotherapy, the physician prescribes chlorambucil
(Leukeran), 10 mg by mouth daily. When caring for the
client, the nurse teaches her about adverse reactions to
chlorambucil, such as alopecia. How soon after the first
administration of chlorambucil might this reaction occur?
A. Immediately
B. 1 week
C. 2 to 3 weeks
D. 1 month
35. A male client is receiving the cell cyclenonspecific
alkylating agent thiotepa (Thioplex), 60 mg weekly for 4
weeks by bladder instillation as part of a
chemotherapeutic regimen to treat bladder cancer. The
client asks the nurse how the drug works. How does
thiotepa exert its therapeutic effects?
A. It interferes with deoxyribonucleic acid (DNA) replication only.
B. It interferes with ribonucleic acid (RNA) transcription only.
C. It interferes with DNA replication and RNA transcription.
D. It destroys the cell membrane, causing lysis.
37. A female client with cancer is receiving chemotherapy
and develops thrombocytopenia. The nurse identifies
which intervention as the highest priority in the nursing
plan of care?
A. Monitoring temperature
B. Ambulation three times daily
C. Monitoring the platelet count
D. Monitoring for pathological fractures
41. A male client is diagnosed as having a bowel tumor and
several diagnostic tests are prescribed. The nurse
understands that which test will confirm the diagnosis of
malignancy?
A. Biopsy of the tumor
B. Abdominal ultrasound
C. Magnetic resonance imaging
D. Computerized tomography scan
46. Nurse Joy is caring for a client with an internal
radiation implant. When caring for the client, the nurse
should observe which of the following principles?
A. Limit the time with the client to 1 hour per shift
B. Do not allow pregnant women into the clients room
C. Remove the dosimeter badge when entering the clients room
D. Individuals younger than 16 years old may be allowed to go in
the room as long as they are 6 feet away from the client
50. The home health care nurse is caring for a male client
with cancer and the client is complaining of acute pain.
The appropriate nursing assessment of the clients pain
would include which of the following?
A. The clients pain rating
B. Nonverbal cues from the client
C. The nurses impression of the clients pain
D. Pain relief after appropriate nursing intervention
///////////-----1 compatibility mode
1) Before discharge, the nurse scheduled the client who
had a colostomy for colorectal cancer for discharge
instruction about resuming activities. The nurse should
plan to help the client understands that:
A. After surgery, changes in activities must be made to
accommodate for the physiologic changes caused by the
operation.
B. Most sports activities, except for swimming, can be resumed
based on the clients overall physical condition.
C. With counseling and medical guidance, a near normal lifestyle,
including complete sexual function is possible.
D. Activities of daily living should be resumed as quickly as
possible to avoid depression and further dependency.
Q.3) Which of the following characteristics are risk factors
for colorectal cancer?
A. Familial polyposis
B. Age younger than 40
C. Low fat, low protein, high fiber diet
D. History of skin cancer
Q.4) A patient received surgery and chemotherapy for
colon cancer, completing therapy 3 months previously, and

she is now in remission. At a follow-up appointment, she

complains of fatigue following activity and difficulty with
concentration at her weekly bridge games. Which of the
following explanations could account for her symptoms?
A. The symptoms may be the result of anemia caused by
chemotherapy.
B. The patient may be immunosuppressed.
C. The patient may be depressed.
D. The patient may be dehydrated.
Q.5) When teaching a client about the signs of colorectal
cancer, Nurse Trish stresses that the most common
complaint of persons with colorectal cancer is:
A. Abdominal pain
B. Hemorrhoids
C. Change in caliber of stools
D. Change in bowel habits
Q.6) A nurse assigned to the emergency department
evaluates a patient who underwent fiberoptic colonoscopy
18 hours previously. The patient reports increasing
abdominal pain, fever, and chills. Which of the following
conditions poses the most immediate concern?
A. Bowel perforation.
B. Viral gastroenteritis.
C. Colon cancer.
D. Diverticulitis.
Q.7) The nurse is interviewing a male client about his past
medical history. Which preexisting condition may lead the
nurse to suspect that a client has colorectal cancer?
A. Duodenal ulcers
B. Hemorrhoids
C. Weight gain
D. Polyps
Q.8) A temporary colostomy is performed on the client with
colon cancer. The nurse is aware that the proximal end of a
double barrel colostomy:
A. Is the opening on the clients left side
B. Is the opening on the distal end on the clients left side
C. Is the opening on the clients right side
D. Is the opening on the distal right side
Q.9) A client is being evaluated for cancer of the colon. In
preparing the client for barium enema, the nurse should:
A. Give laxative the night before and a cleansing enema in the
morning before the test
B. Render an oil retention enema and give laxative the night
before
C. Instruct the client to swallow 6 radiopaque tablets the evening
before the study
D. Place the client on CBR a day before the study
Q.10) When teaching a client about the signs of colorectal
cancer, Nurse Trish stresses that the most common
complaint of persons with colorectal cancer is:
A. Abdominal pain
B. Hemorrhoids
C. Change in caliber of stools
D. Change in bowel habits
Q.11) The client has a good understanding of the means to
reduce the chances of colon cancer when he states:
A. I will exercise daily.
B. I will include more red meat in my diet.
C. I will have an annual chest x-ray.
D. I will include more fresh fruits and vegetables in my diet.
Q.12) Which of the follow statements provides accurate
information regarding cancer of the colon and rectum?
A. Cancer of the colon and rectum is the second most common
type of internal cancer in the United States.
B. Rectal cancer affects more than twice as many people as colon
cancer.
C. The incidence of colon and rectal cancer decreases with age.
D. There is no hereditary component to colon cancer.
Q.13) Which diet is associated with an increased risk of
colorectal cancer?
A. Low protein, complex carbohydrates
B. High protein, simple carbohydrates
C. High fat, refined carbohydrates
D. Low carbohydrates, complex proteins
Q.14) Discharge instructions for a patient who has been
operated on for colorectal cancer include irrigating the
colostomy. The nurse knows her teaching is effective when
the patient states hell contact the doctor if:

A. He experiences abdominal cramping while the irrigant is

infusing
B. He has difficulty inserting the irrigation tube into the stoma
C. He expels flatus while the return is running out
D. Hes unable to complete the procedure in 1 hour
Q.15) You must rearrange the room assignment for several
clients. Which two clients would best suited to put in the
same room? (Choose the letter that applies).
A. A 35-year-old female with copious, intractable diarrhea and
vomiting
B. A 43-year-old female second day post-operative
cholecystectomy
C. A 53-year-old female with pain related to alcohol-associated
pancreatitis
D. A 62-year-old female with colon cancer receiving chemotherapy
and radiation
///////////------ 1ddd
1. The nurse is caring for a client with cirrhosis of the liver.
The client has developed ascites and requires a
paracentesis. Which of the following symptoms is
associated with ascites and should be relieved by the
paracentesis?
A. Pruritus.
B. Dyspnea.
C. Jaundice.
D. Peripheral neuropathy.
4. The nurse is caring for a client who requires a
nasogastric (NG) tube for feeding. What should the nurse
do immediately after inserting an NG tube for 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.
12. A client underwent a colostomy for a ruptured
diverticulum. He did well throughout the surgery and
returned to the medical-surgical floor in stable condition.
The nurse assesses the client's colostomy stoma 2 days
after surgery. Which assessment finding should the nurse
report immediately to the physician?
A. Blanched stoma.
B. Edematous stoma.
C. Reddish-pink stoma.
D. Brownish-black stoma.
14. A client with cirrhosis of the liver develops ascites.
Which of the following orders would the nurse expect?
A. Restrict fluid to 1000 mL per day.
B. Ambulate 100 ft. three times per day.
C. High-sodium diet.
D. Maalox 30 ml P.O. BID.
17. The nurse is doing teaching with the family of a client
with liver failure. Which of the following foods should the
nurse advise them to limit in the client's diet?
A. Meats and beans.
B. Butter and gravies.
C. Potatoes and pasta.
D. Cakes and pastries.
//////// 11 compatibility mode
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
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
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 meperidine 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. Dyspnea and fatigue
B. Ascites and orthopnea
C. Purpura and petechiae
D. 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.
12. Which diagnostic test would be used first to evaluate a
client with upper GI bleeding?
A. Endoscopy
B. Upper GI series
C. Hemoglobin (Hb) levels and hematocrit (HCT)
D. Arteriography
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
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.
////////////
" A gastrectomy is performed on a client with gastric cancer. In the
immediate postoperative period, the nurse notes bloody drainage
from the nasogastric tube. Which of the following is the
appropriate nursing intervention?"
"a) notify the physician
b) measure abdominal girth
c) irrigate the nasogastric tube
d) continue to monitor the drainage (CORRECT)"
"1. While being prepared for a biopsy, the patient asks the nurse
what the difference is between a benign tumor and a malignant
tumor. The nurse explains that a benign tumor differs from a
malignant tumor in that benign tumors
"a. do not cause damage to adjacent tissue.
b. do not spread to other tissues and organs.
c. are simply an overgrowth of normal cells.
d. frequently recur in the same site."

"11. The nurse is interviewing a male client about his past

medical history. Which preexisting condition may lead the nurse
to suspect that a client has colorectal cancer?
"a. Duodenal ulcers
b. Hemorrhoids
c. Weight gain
d. Polyps"
"74. The community nurse is conducting a health promotion
program and the topic of the discussion relates to the risk factors
for gastric cancer. Which risk factor, if identified by a client,
indicates a need for further discussion?
"a) smoking
b) a high-fat diet
c) foods containing nitrates
d) a diet of smoked, highly salted, and spiced food"
"75. A gastrectomy is performed on a client with gastric cancer.
In the immediate postoperative period, the nurse notes bloody
drainage from the nasogastric tube. Which of the following is the
appropriate nursing intervention?
"a) notify the physician
b) measure abdominal girth
c) irrigate the nasogastric tube
d) continue to monitor the drainage
"A client has been diagnosed with colon cancer of the rectum.
While
completing the preoperative checklist the client asks the nurse
"Where
will my stoma be?" The nurse's best response is
A. right upper quadrant. B. left upper quadrant C. right lower
quadrant D. left lower quadrant
A client undergoes a colonoscopy for colorectal cancer screening.
During the procedure three small polyps were removed. Which
nursing procedures are necessary when caring for the client
immediately after the colonoscopy? "A. Monitor vital signs and
inform her that there may be a small amount of blood in her stool.
B. Observe for signs and symptoms of bowel perforation,
monitor vital signs, and inform her that there may be a
small amount of blood in her stool and to report excessive
blood loss.
C. Observe for signs and symptoms of bowel perforation, monitor
vital signs, and inform her to follow a clear liquid diet.
D. Monitor vital signs and inform her that there may be a small
amount of blood in her stool, and tell her not to drive for two
days."
A client with cancer of the colon who is receiving chemotherapy
tells a nurse that some foods on the metal tray taste bitter. The
nurse would try ti limit which of the following foods that is most
likely to cause this taste for the client? "a) cantaloupe
b) potatoes
c) beef
d) custard"
"A female client with cancer is receiving chemotherapy and
develops thrombocytopenia. The nurse identifies which
intervention as the highest priority in nursing plan of care?
"a) Monitoring temperature
b) Ambulation three times daily
c) Monitoring the platelet count
d) Monitoring for pathological fractures"
A female client with cancer is scheduled for radiation therapy. The
nurse knows that radiation at any treatment site may cause a
certain adverse effect. Therefore, the nurse should prepare the
client to expect: "a. hair loss.
b. stomatitis.
c. fatigue.
d. vomiting.
"A gastrectomy is performed on a client with gastric cancer. Int he
immediate postoperative period, the nurse notes bloody drainage
from the nasogastric tube. Which of the following is the
appropriate nursing intervention.
"1. Notify the physician
2. Measure the abdominal girth
3. Irrigate the nasogastric tube
4. Continue to monitor the drainage
A nurse is reviewing the preoperative prescriptions for a client with
colon tumor who is scheduled for abdominal perineal resection
and notes that the physician has prescribed neomycin (Mycifradin)
for the client. The nurse determines that this medication has been
prescribed primarily for which of the following purposes? 1. To
prevent an immune dysfunction 2. Because the client has an

infection 3. To decrease the bacteria in the bowel 4. Because

the client is allergic to penicillin
A nurse is teaching a client about the risk factors associated with
colorectal cancer the nurse detemines that further teaching
related to colorectal cancer is necessary if the client identifies
which of the following as an associated risk factor? 1. Age
younger than 50 2. history of colorectal polyps 3. family history
of colorectal cancer 4. chronic IBD
A patient who has been told by the health care provider that the
cells in a bowel tumor are poorly differentiated asks the nurse
what is meant by "poorly differentiated." Which response should
the nurse make? "a. ""The cells in your tumor do not look very
different from normal bowel cells.""
b. ""The tumor cells have DNA that is different from your normal
bowel cells.""
c. ""Your tumor cells look more like immature fetal cells
than normal bowel cells.""
d. ""The cells in your tumor have mutated from the normal bowel
cells."""
"A patient with metastatic colorectal cancer is scheduled for both
chemotherapy and radiation therapy. Patient teaching regarding
these
therapies for this patient would include an explanation that:
"A. Chemotherapy can be used to cure colorectal cancer
B. Radiation is routinely used as adjuvant therapy following
surgery
C. Both chemotherapy and radiation can be used as
palliative treatments
D. The patient should expect few if any side effects from chemotherapeutic agents"
"An optimal teaching plan for an outpatient with stomach cancer
receiving radiation therapy should include information about
"a. cancer support groups.
b. avitaminosis, ostomy care, and community resources.
c. prosthetic devices, skin conductance, and grief counseling.
d. wound and skin care, nutrition, drugs, and community
resources "
Chemotherapy is one of the therapeutic modalities for cancer. This
treatment is contraindicated to which of the following conditions?
"a. Recent surgery
b. Pregnancy
c. Bone marrow depression
d. All of the above
"During a routine health examination, a 30-year-old patient tells
the
nurse about a family history of colon cancer. The nurse will plan to:
"a. teach the patient about the need for a colonoscopy at age 50.
b. ask the patient to bring in a stool specimen to test for occult
blood.
c. schedule a sigmoidoscopy to provide baseline data about the
patient.
d. have the patient ask the doctor about specific tests for
colon cancer.
For a female client with newly diagnosed cancer, the nurse
formulates a nursing diagnosis of Anxiety related to the threat of
death secondary to cancer diagnosis. Which expected outcome
would be appropriate for this client? "a) Client verbalizes
feeling of anxiety
b) Client does not guess at prognosis
c) Client uses any effective method to reduce tension
d) Client stops seeking information"
A gastrectomy is performed on a client with gastric cancer. In the
immediate postoperative period, the nurse notes bloody drainage
from the nasogastric tube. Which of the following is the
appropriate nursing intervention?
a) notify the physician
b) measure abdominal girth
c) irrigate the nasogastric tube
d) continue to monitor the drainage
"Which one of the following expected outcomes about nutrition
would be appropriate for a client who has had a total gastrectomy
for gastric cancer? The client will:
"a.) Regain any weight lost within 4 weeks of the surgical
procedure.
b.) Eat three full meals a day without experiencing gastric
complications.
c.) Learn to self-administer enteral feedings every 4 hours.
d.) Maintain adequate nutrition through oral or parenteral
feedings."

RATIONALE: An appropriate expected outcome is for the client to

maintain nutrition either through oral or total parenteral feedings.
Oral and total parenteral nutrition may also be used concurrently.
It is not realistic to expect the client to regain weight loss within 4
weeks of surgery. After surgery, it is recommended that the client
eat six small meals a day rather than three full meals to decrease
symptoms of dumping syndrome. Enteral feedings are not part of
the expected outcome for gastric surgery
Teaching a client who has had recent bowel surgery how to
facilitate the expulsion of feces may include the process of
increasing intra-abdominal pressure. Which of the following best
matches this process? "A.Crede's maneuver.B.Valsalva's
maneuver.C.Heimlich's maneuver.D.Epley's maneuver
The 85-year-old male client diagnosed with cancer of the colon
asks the nurse, "Why did I get this cancer?" Which statement is
the nurse's best response?1.Cancer of the colon is associated
with a lack of fiber in the diet.2.Cancer of the colon has a
greater incidence among those younger than age 50
years.3.Cancer of the colon has no known risk factors.4.Cancer of
the colon is rare among male clients.
The client diagnosed with gastroesophageal reflux disease (GERD)
is at greater risk for which disease? 1.Hiatal
hernia.2.Gastroenteritis.3.Esophageal cancer.4.Gastric cancer.
The client diagnosed with stomach cancer has developed
dissemenated intravascular coagulopathy (DIC). Which
collaborative intervention would the nurse implement? A)
Prepare to administer IV heparin. B) Assess for frank
hemorrhage from venipuncture sites. C) Monitor for decreased
LOC. D) Prepare to administer TPN;
the client with a new colostomy is being discharged. which
statement made by the client indicates the need for further
teaching? 1. "if i notice any skin breakdown, i will call my HCP." 2 .
"i should drink only liquids until the colostomy starts to
work." 3. "i should not take a tub bath until the HCP says it is
okay." 4. "i should not drive or lift more than five poinds."
The client with polyps has watched a video on primary prevention
of colon cancer. The nurse can evaluate teaching effectiveness
when the client states "I should follow:
"1. low sodium low fat high fiber diet."
2. a low fat, low refined sugar and decrease red meat
while eating more fiber."
3. a gluten free, low fat diet."
4. a low carbohydrate, low fat, low tyramine diet.""
The community nurse is conducting a health promotion program
and the topic of the discussion relates to the risk factors for gastric
cancer. which risk factor, if identified by a client, indicates a need
for further discussion?
"1. Smoking
2. A high-fat diet
3. Foods containing nitrates
4. a diet of smoked, highly salted, and spiced food
The day after abdominal surgery, the nurse auscultates the client's
abdomen and notes faint bowel sounds in all four quadrants. The
client also reports experiencing flatus. The nurse interprets these
findings as:
"a. imminent emesis.
b. intestinal blockage.
c. return of peristalsis
d. paralytic ileus."
The home healthcare nurse is caring for a client with cancer and
the client is complaining of acute pain. The most appropriate
nursing assessment of the client's pain would include which of the
following?
"1. the clients pain rating
2. nonverbal cues from the client
3. the nurses impression of the clients pain
4. pain relief after appropriate nursing intervention"
"The most effective treatment method for the nausea and
vomiting that accompany chemotherapy is to:
"A. Administer an oral antiemetic when the client complains of
nausea and vomiting.
B. Administer an antiemetic by intramuscular injection when the
client complains of nausea and vomiting.
C. Administer an antiemetic prior to the antineoplastic
medication.
D. Push fluids prior to administering the antineoplastic
medication."
"The night before surgery for colon cancer, the client refuses the
bowel preparation and angrily threatens to leave the hospital.

Which of the following is the best response?

A. "A tranquilizer will help soothe your nerves and make the
preparation less painful".
B. "I'll call your minister to sit with you until you calm down and
take your medications".
C. "Tell me what is upsetting you and what I can do to
help."
D. "I will call the physician to come and talk to you again about the
surgery"."
"The nurse is caring for a patient one day after an abdominalperineal resection for cancer of the rectum. The nurse should
question which of the following orders?
"1. Discontinue the nasogastric tube.
2. Irrigate the colostomy.
3. Place petrolatum gauze over the stoma.
4. Administer Demerol 50 mg IM for pain."
"The nurse is caring for a patient receiving an initial dose of
chemotherapy to treat a rapidly growing metastatic colon cancer.
The nurse is aware that this patient is at risk for tumor lysis
syndrome (TLS) and will monitor the patient closely for which of
the following abnormalities associated with this oncologic
emergency?
"a. hypokalemia
b. hypocalcemia
c. hypouricemia
d. hypophosphatemia"
The nurse is caring for a patient suffering from anorexia secondary
to chemotherapy. Which of the following strategies would be most
appropriate for the nurse to use to increase the patient's
nutritional intake? "A. Increase intake of liquids at mealtime to
stimulate the appetite
B. Serve three large meals per day plus snacks between each meal
C. Avoid the use of liquid protein supplements to encourage eating
at mealtime
D. Add items such as skim milk powder, cheese, honey, or
peanut butter to selected foods.
"The nurse is caring for clients in an outpatient clinic. Which
information should the nurse teach regarding the American Cancer
Society's recommendations for the early detection of colon
cancer?
"1. Beginning at age 60, a digital rectal examination should be
done yearly.
2. After reaching middle age, a yearly fecal occult blood test
should be done.
3. Have a colonoscopy at age 50 and then once every five
to ten years.
4. A flexible sigmoidoscopy should be done yearly after age 40."
"The nurse is interviewing a male client about his past medical
history.
Which preexisting condition may lead the nurse to suspect that a
client
has colorectal cancer?
"a. Duodenal ulcers
b. Hemorrhoids
c. Weight gain
d. Polyps"
"The nurse is performing an admission assessment on a client
diagnosed with a right colon tumor. The nurse asks the client
about which characteristic symptom of this type of tumor?
"a) rectal bleeding
b) flat, ribbon-like stool
c) crampy, colicky abdominal pain)
d) alternating constipation and diarrhea"
"The nurse is planning care for a 68-year-old patient with an
abdominal
mass and suspected bowel obstruction. Which of the following
factors in
the patient's history increases the patient's risk for colorectal
cancer?
"A. Osteoarthritis
B. History of rectal polyps
C. History of lactose intolerance
D. Use of herbs as dietary supplements"
The Nurse is reviewing the preop orders of a client w/ a colon
tumor who is scheduled for abdominal perineal resection and
notes that the physician prescribed neomycin (Mycifradin) for the
client. The nurse determines that this medication has been
prescribed primarily: "1. To prevent an immune dysfunction
2. Because the client has an infection

3. To decrease the bacteria in the bowel

4. Because the client is allergic a penicillin"
The nurse is teaching a client about the modifiable risk factors
than can reduce the risk for colorectal cancer. The nurse places
the highest priority on discussing which risk factor with this
client?
"A. Age older than 30 years
B. High fat and low fiber diet
C. Distant relative with colorectal cancer
D. Personal history of ulcerative colitis or GI polyps"
The nurse is teaching a client about the risk factors associated
with colorectal cancer. The nurse determines that further teaching
is necessary if the client identifies which of the following as an
associated risk factor? 1. a history of inflammatory bowel disease
2. family history of colon cancer 3. a high fiber diet 4. a diet
high in fats and carbohydrates
The nurse is teaching a client about the risk factors associated
with colorectal cancer. The nurse determines that further teaching
related to colorectal cancer is necessary if the client identifies
which of the following as an associated risk factor?
"a) age younger than 50 years
b) history of colorectal polyps
c) family history of colorectal cancer
d) chronic inflammatory bowel disease"
Colorectal cancer risk factors include age older than 50 years, a
family history of the disease, colorectal polyps, and chronic
inflammatory bowel disease.
"The nurse is teaching a client about the risk factors associated
with colorectal cancer. The nurse determines that further teaching
related to colorectal cancer is necessary if the client identifies
which of the following as an associated risk factor?
"a) age younger than 50 years
b) history of colorectal polyps
c) family history of colorectal cancer
d) chronic inflammatory bowel disease"
"The nurse planning care for the client who
has had an abdominal-perineal resection
for cancer of the colon. Which interventions
should the nurse implement? Select all that
apply.
"1. Provide meticulous skin care to stoma
2. Asess the flank incision
3. Maintain the indwelling catheter
4. Irrigate the JP drains every shift
5. Position the client semirecumbent"
"The nurse understands that cancerous lesions found in the
stomach are the second most common cancer in the world. Which
of the following is a risk factor for these malignant lesions?
"A. Excessive alcohol consumption
B. Being female under 40 years of age
C. Exposure to leaded gasoline
D. A Diet high in vegetables"
The occupational health nurse if preparing a presentation to a
group of factory workers about preventing colon cancer. Which
information should be included in the presentation? "1. Wear a
high-filtration mask when around chemicals.
2. Eat several servings of cruciferous vegetables daily.
3. Take a multiple vitamin every day.
4. Do not engage in high risk sexual behaviors."
"The teaching plan for an outpatient with stomach cancer
receiving radiation therapy should include information about:
"a. cancer support groups, alopecia, and stomatitis
b. avitaminosis, ostomy care, and community resources
c. prosthetic devices, skin conductance, and grief counseling
d. wound and skin care, nutrition, drugs, and community
resources
"What is the best test to diagnose stomach cancer?
"A. Upper endoscopic examination
B. Barium enema
C. Endoscopic retrograde cholangiopancreatogram (ERCP)
D. Magnetic resonance imaging (MRI)
Which symptom, if reported by a client, would lead the nurse to
suspect colon cancer? 1) abdominal cramping 2) constant hunger
3) feeling of fullness, 4) weight gain
/////////
A patient with chronic alcohol abuse is admitted with liver failure.
You closely monitor the patient's blood pressure because of which
change that is associated with the liver failure?
1 Hypoalbuminemia

2 Increased capillary permeability

3 Abnormal peripheral vasodilation
4 Excess rennin release from the kidneys
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?
1 "I know just how you feel."
2 "You seem upset."
3 "Oh, don't worry about it, everything will be just fine."
4"Why do you think you have cancer?"
You're 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?
1. Pruritus
2 Dyspnea
3 Jaundice
4 Peripheral Neuropathy
You're caring for Jane, a 57 y.o. patient with liver cirrhosis who
develops ascites and requires paracentesis. Before her
paracentesis, you instruct her to:
1 Empty her bladder.
2 Lie supine in bed.
3 Remain NPO for 4 hours.
4 Clean her bowels with an enema
You're caring for Betty with liver cirrhosis. Which of the following
assessment findings leads you to suspect hepatic encephalopathy
in her?
a Asterixis
b Chvostek's sign
c Trousseau's sign
d Hepatojugular reflex
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.
Develop a teaching care plan for Angie who is about to undergo a
liver biopsy. Which of the following points do you include?
a. "You'll need to lie on your stomach during the test."
b. "You'll need to lie on your right side after the test."
c. "During the biopsy you'll be asked to exhale deeply and hold it."
d. "The biopsy is performed under general anesthesia.
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
A Signs and Symptoms of pneumothorax include dyspnea and
decreased or absent breath sounds over the affected lung (right
lung).
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."
After an abdominal resection for colon cancer, Madeline Ralph
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.
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

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.
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.
The student nurse is teaching the family of a patient with liver
failure. You instruct them to limit which foods in the patient's diet?
a Meats and beans.
b Butter and gravies.
c Potatoes and pastas.
d Cakes and pastries.
A 53 y.o. patient has undergone a partial gastrectomy for
adenocarcinoma of the stomach. An NG tube is in place and is
connected to low continuous suction. During the immediate
postoperative period, you expect the gastric secretions to be
which color?
a Brown.
b Clear.
c Red.
d Yellow.
George has a T tube in place after gallbladder surgery. Before
discharge, what information or instructions should be given
regarding the T tube drainage?
a "If there is any drainage, notify the surgeon immediately."
b "The drainage will decrease daily until the bile duct
heals."
c "First, the drainage is dark green; then it becomes dark yellow."
d "If the drainage stops, milk the tube toward the puncture
wound."
The student nurse is participating in colorectal cancer-screening
program. Which patient has the fewest risk factors for colon
cancer?
a Janice, a 45 y.o. with a 25-year history of ulcerative colitis
b George, a 50 y.o. whose father died of colon cancer
c Herman, a 60 y.o. who follows a low-fat, high-fiber diet
d Sissy, a 72 y.o. with a history of breast cancer
Which of the following diets is most commonly associated with
colon cancer?
a Low-fiber, high fat
b Low-fat, high-fiber
c Low-protein, high-carbohydrate
d Low carbohydrate, high protein
Radiation therapy is used to treat colon cancer before surgery for
which of the following reasons?
a Reducing the size of the tumor
b Eliminating the malignant cells
c Curing the cancer
d Helping the bowel heal after surgery
Which of the following symptoms is a client with colon cancer most
likely to exhibit?
a A change in appetite
b A change in bowel habits
c An increase in body weight
d An increase in body temperature
A client has just had surgery for colon cancer. Which of the
following disorders might the client develop?
a Peritonitis
b Diverticulosis
c Partial bowel obstruction
d Complete bowel obstruction
A client with gastric cancer may exhibit which of the following
symptoms?
a Abdominal cramping
b Constant hunger
c Feeling of fullness
d Weight gain
Which of the following diagnostic tests may be performed to
determine if a client has gastric cancer?
a Barium enema
b Colonoscopy
c Gastroscopy
d Serum chemistry levels

When teaching a community group about measures to prevent

colon cancer, which instruction should the nurse include?
a "Limit fat intake to 20% to 25% of your total daily
calories."
b "Include 15 to 20 grams of fiber into your daily diet."
c "Get an annual rectal examination after age 35."
d "Undergo sigmoidoscopy annually after age 50."
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
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
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
///// Q compatibility
Q.1) 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. Dyspnea and fatigue
B. Ascites and orthopnea
C. Purpura and petechiae
D. Gynecomastia and testicular atrophy
Q.2) A man is admitted to the nursing care unit with a diagnosis of
cirrhosis. He has a long history of alcohol dependence. During the
late evening following his admission, he becomes increasingly
disoriented and agitated. Which of the following would the client
be least likely to experience?
A. Diaphoresis and tremors.
B. Increased blood pressure and heart rate.
C. Illusions.
D. Delusions of grandeur.
Q.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
Q.4) Which of the following terms is used to describe a chronic
liver disease in which scar tissue surrounds the portal areas?
A. Alcoholic cirrhosis
B. Postnecrotic cirrhosis
C. Biliary cirrhosis
D. Compensated cirrhosis
Q.5) 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
Q.6) A client with advanced cirrhosis of the liver is not tolerating
protein well, as eveidenced by abnormal laboratory values. The
nurse anticipates that which of the following medications will be
prescribed for the client?
A. lactulose (Chronulac)
B. ethacrynic acid (Edecrin)

C. folic acid (Folvite)

D. thiamine (Vitamin B1)
Q.7) The nurse is caring for a client with cirrhosis of the liver who
has developed esophageal varices. The nurse understands that
the best explanation for development of esophageal varices is
which of the following?
A. Chronic low serum protein levels result in inadequate tissue
repair, allowing the esophageal wall to weaken.
B. The enlarged liver presses on the diaphragm, which in turn
presses on the esophageal wall, causing collapse of blood vessels
into the esophageal lumen.
C. Increased portal pressure causes some of the blood that
normally circulates through the liver to be shunted to the
esophageal vessels, increasing their pressure and causing
varicosities. (Correct Answer)
D. The enlarged liver displaces the esophagus toward the left,
tearing the muscle layer of the esophageal blood vessels, which
allows small aneurysms to form along the lower esophageal
vessels.
Q.8) Nurse Cynthia is providing a discharge teaching to a client
with chronic cirrhosis. His wife asks her to explain why there is so
much emphasis on bleeding precautions. Which of the following
provides the most appropriate response?
A. The low protein diet will result in reduced clotting.
B. The increased production of bile decreases clotting factors.
C. The liver affected by cirrhosis is unable to produce clotting
factors.
D. The required medications reduce clotting factors.
Q.9) A Sengstaken-Blakemore tube is inserted in the effort to stop
the bleeding esophageal varices in a patient with complicated liver
cirrhosis. Upon insertion of the tube, the client complains of
difficulty of breathing. The first action of the nurse is to:
A. Deflate the esophageal balloon
B. Monitor VS
C. Encourage him to take deep breaths
D. Notify the MD
Q.10) A client with cirrhosis is at risk for developing complications.
Which condition is the most serious and potentially lifethreatening?
A. Esophageal varices
B. Ascites
C. Peripheral edema
D. Asterixis (liver flap)
Q.11) Situation: Mr. Gonzales was admitted to the hospital with
ascites and jaundice. To rule out cirrhosis of the liver:Which
laboratory test indicates liver cirrhosis?
A. Decreased red blood cell count
B. Decreased serum acid phosphate level
C. Elevated white blood cell count
D. Elevated serum aminotransferase
Q.12) Situation: Mr. Gonzales was admitted to the hospital with
ascites and jaundice. To rule out cirrhosis of the liver:The biopsy of
Mr. Gonzales confirms the diagnosis of cirrhosis. Mr. Gonzales is at
increased risk for excessive bleeding primarily because of:
A. Impaired clotting mechanism
B. Varix formation
C. Inadequate nutrition
D. Trauma of invasive procedure
Q.13) Mr. Gonzales develops hepatic encephalopathy. Which
clinical manifestation is most common with this condition?
A. Increased urine output
B. Altered level of consciousness
C. Decreased tendon reflex
D. Hypotension
Q.14) A nurse is completing an assessment to a client with
cirrhosis. Which of the following nursing assessment is important
to notify the physician?
A. Expanding ecchymosis
B. Ascites and serum albumin of 3.2 g/dl
C. Slurred speech
D. Hematocrit of 37% and hemoglobin of 12g/dl
Q.15) A male client with cirrhosis is complaining of belly pain,
itchiness and his breasts are getting larger and also the abdomen.
The client is so upset because of the discomfort and asks the
nurse why his breast and abdomen are getting larger. Which of the
following is the appropriate nursing response?
A. How much of a difference have you noticed
B. Its part of the swelling your body is experiencing
C. Its probably because you have been less physically active

D. Your liver is not destroying estrogen hormones that all men

produce
Q.16) Which of the following findings would strongly indicate the
possibility of cirrhosis?
A. dry skin
B. hepatomegaly
C. peripheral edema
D. pruritus
Q.17) Which of the following is NOT a liver function?
A. conversion of excess glucose into glycogen for storage
B. conversion of conjugated bilirubin to unconjugated bilirubin
C. regulation blood coagulation
D. production of bile salts
E. conversion of ammonia to urea
Q.18) What is the normal liver span?
A. 8-13cm
B. 2-3cm
C. 1 foot
D. 6-12cm
Q.19) The left hepatic vein divides the left lobe into
A. medial and lateral lobes
B. anterior and posterior halves
C. superior and inferior halves
D. left and right parts of left lobe
Q.20) The left lobe occupies
A. right and left hypochondrium
B. epigastrium and some left hypochondrium
C. right hypochondrium and epigastrium
D. epigastrium and umbilicus
Q.21) The right lobe of the liver occupies epigastrium.
A. True
B. False
Q.22) The fundus of the stomach in relationship to the liver
A. posterior and superior to right lobe
B. anterior and lateral to left lobe
C. posterior and lateral to left lobe
D. inferior to left lobe
Q.23) Ultrasound is the best modality to differentiate a liver cyst
from a solid mass
A. True
B. False
Q.24) Right hepatic vein divides right lobe of the liver into anterior
and posterior halves.
A. True
B. False
Q.25) What separates the right lobe from the left lobe?
A. falciform ligament
B. right hepatic vein
C. ligament teres
D. portal vein
Q.26) The right lobe of the liver is how many times larger than the
left?
A. 2
B. 4
C. 6
D. 8
Q.27) Where is Morison's Pouch located?
A. between liver and right diaphragm
B. between liver and left diaphragm
C. between liver and right kidney
D. between liver and duodenum
Q.28) The liver is suspended from the diaphragm and abdominal
wall by
A. falciform ligament
B. ligament teres
C. ligament venosum
D. subphrenic ligaments
Q.29) The pancreas is ____ to the ____ lobe of the liver.
A. inferior, left
B. inferior, right
C. superior, left
D. inferior, caudate
Q.30) In a female, the liver weighs about
A. 1200 to 1400 g
B. 1400 to 1600 g
C. 1800 mg
D. 1000 g
Q.31) Right Lobe length
A. 15-17 cm

B. 20-22 cm
C. 10-12.5 cm
D. <15 cm
Q.32) Which diagnostic test is best to evaluate liver enlargement
and ascites?
A. Ultrasound
B. X-Ray
C. CT scan
D. Nuclear Medicine
E. Arteriogram
Q.33) CT scan of the liver
A. good for evaluating small masses <1cm
B. good for differentiating cysts vs. solid mass
C. evaluates function of liver
Q.34) Which is the largest lobe of liver?
A. Right
B. Left
C. Quadrate
D. Caudate
/////////
The occupational health nurse is preparing a presentation to a
group of factory workers about preventing colon cancer. Which
information should be included?
1. Wear a high filtration mask around chemicals.
2. Eat several servings of cruciferous vegetables daily.
3. Take a multivitamin daily.
4. Do not engage in high-risk sexual behavior.
The nurse is admitting a male client with a diagnosis of
adenocarcinoma of the rectosigmoid colon. Which assessment
data support this diagnosis?
1. Reports up to 20 bloody stools per day.
2. States he has a feeling of fullness after a heavy meal.
3. Has diarrhea alternating with constipation.
4. Complains of RLQ pain with rebound tenderness.
The 85 y.o. male client diagnosed with colon cancer asks the
nurse, "Why did I get colon cancer?" Which is best response about
colon cancer?
1. Lack of fiber in the diet.
2. Greatest incidence among those younger than 50.
3. Has no known risk factors.
4. Rare among male clients.
The nurse is planning care of a client who has had an abdominal
perineal resection for colon cancer. Which interventions should the
nurse implement? Select all that apply:
1. Provide meticlulous skin care to stoma.
2. Assess the flank incision.
3. Maintain the indwelling catheter.
4. Irrigate the JP drains every shift.
5. Position the client semi-recumbent.
The client who has had an abdominal perineal resection is being
discharged. Which info should nurse teach?
1. The stoma should be a white, blue, or purple color.
2. Limit ambulation to prevent the pouch from coming off.
3. Take pain meds when pain level is at 8.
4. Empty pouch when 1/3 to 1/2 full.
the nurse caring for the pt 1day post op sigmoid resection notes a
moderate amount of dark reddish brown drainage on the midline
abdominal incision. Which intervention is first?
1. Mark the drainage on the dressing with the time and
date.
2. Change the dressing immediately using sterile technique.
3. Notify the health care provider immediately.
4. Reinforce the dressing with a sterile gauze pad.
The nurse is caring for pts in an outpatient clinic. Which info
should the nurse teach regarding the American Cancer Society's
recommendations for early detection of colon cancer?
1. Beginning at age 60, a digital rectal exam should be done
annually.
2. After pt reaches middle age, yearly fecal occult test.
3. At age 50, a colonoscopy, then once every 5-10 years.
4. A flexible sigmoidoscopy should be done yearly after age 40.
The nurse writes a psychosocial problem of "risk for altered sexual
functioning related to new colostomy. Which intervention should
the nurse implement?
1. Tell pt. that there should be no intimacy for at least 3 months.
2. Ensure that the pt and partner are able to change the ostomy
pouch.
3. Demonstrate with charts possible sexual positions for the pt. to
assume.

4. Teach the pt. to protect the pouch from being dislodged

during sex.

/////// which of the following complications

27. During the first few days of recovery from ostomy surgery for
ulcerative colitis, which of the following aspects should be the first
priority of client care?
Body image
Ostomy care
Sexual concerns
Skin care
28. Colon cancer is most closely associated with which of the
following conditions?
Appendicitis
Hemorrhoids
Hiatal hernia
Ulcerative colitis
29. Which of the following diets is most commonly associated
with colon cancer?
Low-fiber, high fat
Low-fat, high-fiber
Low-protein, high-carbohydrate
Low carbohydrate, high protein
30. Which of the following diagnostic tests should be performed
annually over age 50 to screen for colon cancer?
Abdominal CT scan
Abdominal x-ray
Colonoscopy
Fecal occult blood test
31. Radiation therapy is used to treat colon cancer before surgery
for which of the following reasons?
Reducing the size of the tumor
Eliminating the malignant cells
Curing the cancer
Helping the bowel heal after surgery
32. Which of the following symptoms is a client with colon cancer
most likely to exhibit?
A change in appetite
A change in bowel habits
An increase in body weight
An increase in body temperature
33. A client has just had surgery for colon cancer. Which of the
following disorders might the client develop?
Peritonitis
Diverticulosis
Partial bowel obstruction
Complete bowel obstruction
34. A client with gastric cancer may exhibit which of the following
symptoms?
Abdominal cramping
Constant hunger
Feeling of fullness
Weight gain
35. Which of the following diagnostic tests may be performed to
determine if a client has gastric cancer?
Barium enema
Colonoscopy
Gastroscopy
Serum chemistry levels
36. A client with gastric cancer can expect to have surgery for
resection. Which of the following should be the nursing
management priority for the preoperative client with gastric
cancer?
Discharge planning
Correction of nutritional deficits
Prevention of DVT
Instruction regarding radiation treatment
37. Care for the postoperative client after gastric resection
should focus on which of the following problems?
Body image
Nutritional needs
Skin care
Spiritual needs
38. Which of the following complications of gastric resection
should the nurse teach the client to watch for?
Constipation
Dumping syndrome
Gastric spasm
Intestinal spasms

39. A client with rectal cancer may exhibit which of the following
symptoms?
Abdominal fullness
Gastric fullness
Rectal bleeding
Right upper quadrant pain
40. A client with which of the following conditions may be likely
to develop rectal cancer?
Adenomatous polyps
Diverticulitis
Hemorrhoids
Peptic ulcer disease
41. Which of the following treatments is used for rectal cancer
but not for colon cancer?
Chemotherapy
Colonoscopy
Radiation
Surgical resection
52. When teaching a community group about measures to
prevent colon cancer, which instruction should the nurse include?
Limit fat intake to 20% to 25% of your total daily calories.
Include 15 to 20 grams of fiber into your daily diet.
Get an annual rectal examination after age 35.
Undergo sigmoidoscopy annually after age 50.
55. A client has a percutaneous endoscopic gastrostomy tube
inserted for tube feedings. Before starting a continuous feeding,
the nurse should place the client in which position?
Semi-Fowlers
Supine
Reverse Trendelenburg
High Fowlers
57. The client being seen in a physicians office has just been
scheduled for a barium swallow the next day. The nurse writes
down which of the following instructions for the client to follow
before the test?
Fast for 8 hours before the test
Eat a regular supper and breakfast
Continue to take all oral medications as scheduled.
Monitor own bowel movement pattern for constipation
58. The nurse is monitoring a client for the early signs of
dumping syndrome. Which symptom indicates this occurrence?
Abdominal cramping and pain
Bradycardia and indigestion
Sweating and pallor
Double vision and chest pain
62. The nurse is performing a colostomy irrigation on a client.
During the irrigation, a client begins to complain of abdominal
cramps. Which of the following is the most appropriate nursing
action?
Notify the physician
Increase the height of the irrigation
Stop the irrigation temporarily.
Medicate with dilaudid and resume the irrigation
63. The nurse is teaching the 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?
Increase fluid intake
Reduce the amount of irrigation solution
Perform the irrigation in the evening
Place heat on the abdomen
66. The nurse instructs the ileostomy client to do which of the
following as a part of essential care of the stoma?
Cleanse the peristomal skin meticulously
Take in high-fiber foods such as nuts
Massage the area below the stoma
Limit fluid intake to prevent diarrhea.
67. The client who has undergone creation of a colostomy has a
nursing diagnosis of Disturbed body image. The nurse would
evaluate that the client is making the most significant progress
toward identified goals if the client:
Watches the nurse empty the colostomy bag
Looks at the ostomy site
Reads the ostomy product literature
Practices cutting the ostomy appliance
68. The nurse is assessing for stoma prolapse in a client with a
colostomy. The nurse would observe which of the following if
stoma prolapse occurred?
Sunken and hidden stoma
Dark- and bluish-colored stoma

Narrowed and flattened stoma

Protruding stoma
69. The client with a new colostomy is concerned about the odor
from the stool in the ostomy drainage bag. The nurse teaches the
client to include which of the following foods in the diet to reduce
odor?
Yogurt
Broccoli
Cucumbers
Eggs
72. The nurse is doing pre-op teaching with the client who is
about to undergo creation of a Kock pouch. The nurse interprets
that the client has the best understanding of the nature of the
surgery if the client makes which of the following statements?
I will need to drain the pouch regularly with a catheter.
I will need to wear a drainage bag for the rest of my life.
The drainage from this type of ostomy will be formed.
I will be able to pass stool from my rectum eventually.
73. The client with a colostomy has an order for irrigation of the
colostomy. The nurse used which solution for irrigation?
Distilled water
Tap water
Sterile water
Lactated Ringer

78. During the assessment of a clients mouth, the nurse notes

the absence of saliva. The client is also complaining of pain near
the area of the ear. The client has been NPO for several days
because of the insertion of a NG tube. Based on these findings, the
nurse suspects that the client is developing which of the following
mouth conditions?
Stomatitis
Oral candidiasis
Parotitis
Gingivitis
79. The nurse evaluates the clients stoma during the initial postop period. Which of the following observations should be reported
immediately to the physician?
The stoma is slightly edematous
The stoma is dark red to purple
The stoma oozes a small amount of blood
The stoma does not expel stool