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 client’s wife. The question by the nurse that
demonstrates her understanding of Mallory-Weiss tearing is:

A. “Tell me about your husband’s 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 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 client’s 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 Oddi’s 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. Hopelessness
B. Powerlessness
C. Chronic low self-esteem
D. Deficient knowledge

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

13. A female client who has just been diagnosed with hepatitis A asks, “How could I
have gotten this disease?” What is the nurse’s 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 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.

19. A male client undergoes total gastrectomy. Several hours after surgery, the nurse
notes that the client’s 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 sclera.
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 client’s 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 nurse’s 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 diarrheafor

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. Regular diet
B. Skim milk
C. Nothing by mouth
D. 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. 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.

30. Which of the following factors can cause hepatitis A?

A. Contact with infected blood

B. Blood transfusions with infected blood
C. Eating contaminated shellfish
D. Sexual contact with an infected person

Answers and Rationale

1. Answer: D. vitamin K

Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin,

vitamin B12, folic acid, biotin, and nicotinic acid. Therefore, antibiotic therapy may interfere
with synthesis of these substances, including vitamin K. Intestinal bacteria don’t synthesize
vitamins A, D, or E.

2. Answer: B. decreased urine output.

Acute pancreatitis can cause decreased urine output, which results from the renal failure
that sometimes accompanies this condition. Intracranial pressure neither increases nor
decreases in a client with pancreatitis. Tachycardia, not bradycardia, usually is associated
with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused
by a hypovolemic complication, but hypertension usually isn’t related to acute pancreatitis.

3. Answer: B. Lying on the left side with knees bent

For a colonoscopy, the nurse initially should position the client on the left side with knees
bent. Placing the client on the right side with legs straight, prone with the torso elevated, or
bent over with hands touching the floor wouldn’t allow proper visualization of the large
intestine.

4. Answer: A. “Tell me about your husband’s alcohol usage.”

A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the mucous
membrane at the junction of the esophagus and stomach. There is a strong relationship
between ethanol usage, resultant vomiting, and a Mallory-Weiss tear. The bleeding is
coming from the stomach, not from the lungs as would be true in some cases of
tuberculosis. A Mallory-Weiss tear doesn’t occur from chest injuries or falls and isn’t
associated with eating spicy foods.

5. Answer: A. Change the tube feeding solutions and tubing at least every 24 hours.

Tube feeding solutions and tubing should be changed every 24 hours, or more frequently if
the feeding requires it. Doing so prevents contamination and bacterial growth. The head of
the bed should be elevated 30 to 45 degrees continuously to prevent aspiration. Checking
for gastrostomy tube placement is performed before initiating the feedings and every 4
hours during continuous feedings. Clients may ambulate during feedings.

6. Answer: B. 15 to 30 minutes

Meperidine’s onset of action is 15 to 30 minutes. It peaks between 30 and 60 minutes and

has a duration of action of 2 to 4 hours.
7. Answer: C. Purpura and petechiae

A hepatic disorder, such as cirrhosis, may disrupt the liver’s normal use of vitamin K to
produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client
for signs of bleeding, including purpura and petechiae. Dyspnea
and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption.
Gynecomastia and testicular atrophy result from decreased estrogenmetabolism by the
diseased liver.

8. Answer: B. Pancreatitis

Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other
conditions are less likely to exhibit fluid volume deficit.

9. Answer: A. Irrigate the tube with cola.

The nurse should irrigate the tube with cola because its effervescence and acidity are suited
to the purpose, it’s inexpensive, and it’s readily available in most homes. Advancing the NG
tube is inappropriate because the tube is designed to stay in the stomach and isn’t long
enough to reach the intestines. Applying intermittent suction or using a syringe
for aspiration is unlikely to dislodge the material clogging the tube but may create excess
pressure. Intermittent suction may even collapse the tube.

10. Answer: B. morphine may cause spasms of Oddi’s sphincter.

For a client with pancreatitis, the physician will probably avoid prescribing morphine
because this drug may trigger spasms of the sphincter of Oddi (a sphincter at the end of the
pancreatic duct), causing irritation of the pancreas. Meperidine has a somewhat shorter
duration of action than morphine. The two drugs are equally addictive. Morphine isn’t
associated with hepatic dysfunction.

11. Answer: C. Chronic low self-esteem

Young women with Chronic low self-esteem — are at highest risk for anorexia nervosa
because they perceive being thin as a way to improve their self-confidence. Hopelessness
and Powerlessness are inappropriate nursing diagnoses because clients with anorexia
nervosa seldom feel hopeless or powerless; instead, they use food to control their desire to
be thin and hope that restricting food intake will achieve this goal. Anorexia nervosa doesn’t
result from a knowledge deficit, such as one regarding good nutrition.

12. Answer: A. Endoscopy

Endoscopy permits direct evaluation of the upper GI tract and can detect 90% of bleeding
lesions. An upper GI series, or barium study, usually isn’t the diagnostic method of choice,
especially in a client with acute active bleeding who’s vomiting and unstable. An upper GI
series is also less accurate than endoscopy. Although an upper GI series might confirm the
presence of a lesion, it wouldn’t necessarily reveal whether the lesion is bleeding. Hb levels
and HCT, which indicate loss of blood volume, aren’t always reliable indicators of GI
bleeding because a decrease in these values may not be seen for several hours.
Arteriography is an invasive study associated with life-threatening complications and
wouldn’t be used for an initial evaluation.

13. Answer: A. “You may have eaten contaminated restaurant food.”

Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming

food contaminated by infected food handlers. The virus isn’t transmitted by the I.V. route,
blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or
blood transfusion. Hepatitis C can be transmitted by unprotected sex.

14. Answer: B. Obstruction of the appendix reduces arterial flow, leading to ischemia,
inflammation, and rupture of the appendix.

A client with appendicitis is at risk for infection related to inflammation, perforation, and
surgery because obstruction of the appendix causes mucus fluid to build up, increasing
pressure in the appendix and compressing venous outflow drainage. The pressure
continues to rise with venous obstruction; arterial blood flow then decreases, leading to
ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling
continues to raise pressure within the appendix, resulting in gangrene and rupture.
Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.

15. Answer: D. cryoprecipitate and fresh frozen plasma.

The liver is vital in the synthesis of clotting factors, so when it’s diseased or dysfunctional,
as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that
aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate,
which have most of the clotting factors. Although administering whole blood, albumin, and
packed cells will contribute to hemostasis, those products aren’t specifically used to treat
hemostasis. Platelets are helpful, but the best answer is cryoprecipitate and fresh frozen
plasma.

16. Answer: B. “Avoid coffee and alcoholic beverages.”

To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to
avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The
nurse also should teach the client to avoid lying down after meals, which can aggravate
reflux, and to take antacids after eating. The client need not limit fluid intake with meals as
long as the fluids aren’t gastric irritants.

17. Answer: D. Administering I.V. fluids

I.V. infusions containing normal salinesolution and potassium should be given first to

maintain fluid and electrolyte balance. For the client’s comfort and to assist in bowel
decompression, the nurse should prepare to insert an NG tube next. A blood sample is then
obtained for laboratory studies to aid in the diagnosis of bowel obstruction and guide
treatment. Blood studies usually include a complete blood count, serum electrolyte levels,
and blood urea nitrogen level. Pain medication often is withheld until obstruction is
diagnosed because analgesics can decrease intestinal motility.

18. Answer: B. The client is free from esophagitis and achalasia.

Dysphagia may be the reason why a client with esophagitis or achalasia seeks treatment.
Dysphagia isn’t associated with rectal tenesmus, duodenal inflammation, or abnormal
gastric structures.

19. Answer: A. Notify the physician

An NG tube that fails to drain during the postoperative period should be reported to the
physician immediately. It may be clogged, which could increase pressure on the suture site
because fluid isn’t draining adequately. Repositioning or irrigating an NG tube in a client
who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of
suction may cause trauma to GI mucosa or the suture line.

20. Answer: B. Elevated serum lipase

Elevation of serum lipase is the most reliable indicator of pancreatitis because this enzyme
is produced solely by the pancreas. A client’s BUN is typically elevated in relation to renal
dysfunction; the AST, in relation to liver dysfunction; and LD, in relation to damaged
cardiac muscle.

21. Answer: A. yellow sclera.

Yellow sclerae may be the first sign of jaundice, which occurs when the common bile duct is
obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don’t
occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding,
respectively.

22. Answer: D. alcohol abuse and smoking.

Risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and
stress. A sedentary lifestyle and a history of hemorrhoids aren’t risk factors for peptic
ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.

23. Answer: D. Liver

The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure
of the colon, portions of the ascending and transverse colon, and a portion of the
right kidney. The sigmoid colon is located in the left lower quadrant; the appendix, in the
right lower quadrant; and the spleen, in the left upper quadrant.

24. Answer: B. place saline-soaked sterile dressings on the wound.

The nurse should first place saline-soaked sterile dressings on the open wound to prevent
tissue drying and possible infection. Then the nurse should call the physician and take the
client’s vital signs. The dehiscence needs to be surgically closed, so the nurse should never
try to close it.

25. Answer: B. Anticholinergic drugs

Paregoric has an additive effect of constipation when used with anticholinergic

drugs. Antiarrhythmics, anticoagulants, and antihypertensives aren’t known to interact with
paregoric.

26. Answer: A. increasing fluid intake to prevent dehydration.

Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To

avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase
fluid intake. The nurse should teach the client to wear a collection appliance at all times
because ileostomy drainage is incontinent, to avoid high-fiber foods because they may
irritate the intestines, and to avoid enteric-coated medications because the body can’t
absorb them after an ileostomy

27. Answer: C. Nothing by mouth

Shock and bleeding must be controlled before oral intake, so the client should receive
nothing by mouth. A regular diet is incorrect. When the bleeding is controlled, the diet is
gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn’t be
given because it increases gastric acid production, which could prolong bleeding. A liquid
diet is the first diet offered after bleeding and shock are controlled.

28. Answer: B. anorexia, nausea, and vomiting.

Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue,
and weakness. Abdominal pain may occur but doesn’t radiate to the shoulder. Eructation
and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a
sign of advanced hepatic disease, not an early sign of hepatitis A.

29. Answer: C. wash the hands after touching the client.

To maintain enteric precautions, the nurse must wash the hands after touching the client or
potentially contaminated articles and before caring for another client. A private room is
warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash
the hands after touching infective material or is likely to share contaminated articles with
other clients. For enteric precautions, the nurse need not wear a mask and must wear a
gown only if soiling from fecal matter is likely.

30. Answer: C. Eating contaminated shellfish

Hepatitis A can be caused by consuming contaminated water, milk, or food — especially

shellfish from contaminated water. Hepatitis B is caused by blood and sexual contact with
an infected person. Hepatitis C is usually caused by contact with infected blood, including
receiving blood transfusions.