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1. Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis. The
nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level
of:
a. 45 units/L
b. 100 units/L
c. 300 units/L
d. 500 units/L
2. A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid
diet. The client is looking forward to the diet change because he has been bored with the clear liquid
diet. The nurse would offer which full liquid item to the client?
a. Tea
b. Gelatin
c. Custard
d. Popsicle
3. Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the
nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has
the best understanding of the dietary measures to follow if the client states an intension to increase the
intake of:
a. Pork
b. Milk
c. Chicken
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d. Broccoli
4. Nurse Oliver checks for residual before administering a bolus tube feeding to a client with a
nasogastric tube and obtains a residual amount of 150 mL. What is appropriate action for the nurse to
take?
a. Hold the feeding
b. Reinstill the amount and continue with administering the feeding
c. Elevate the clients head at least 45 degrees and administer the feeding
d. Discard the residual amount and proceed with administering the feeding
5. A nurse is inserting a nasogastric
tube in an adult male client. During the procedure, the client begins to cough and has difficulty
breathing. Which of the following is the appropriate nursing action?
a. Quickly insert the tube
b. Notify the physician immediately
c. Remove the tube and reinsert when the respiratory distress subsides
d. Pull back on the tube and wait until the respiratory distress subsides
6. Nurse Ryan is assessing for correct placement of a nosogartric tube. The nurse aspirates the stomach
contents and check the contents for pH. The nurse verifies correct tube placement if which pH value is
noted?
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a. 3.5
b. 7.0
c. 7.35
d. 7.5
7. A nurse is preparing to remove a nasogartric tube from a female client. The nurse should instruct the
client to do which of the following just before the nurse removes the tube?
a. Exhale
b. Inhale and exhale quickly
c. Take and hold a deep breath
d. Perform a Valsalva maneuver
8. Nurse Joy is preparing to administer medication through a nasogastric tube that is connected to
suction. To administer the medication, the nurse would:
a. Position the client supine to assist in medication absorption
b. Aspirate the nasogastric tube after medication administration to maintain patency
c. Clamp the nasogastric tube for 30 minutes following administration of the medication
d. Change the suction setting to low intermittent suction for 30 minutes after medication administration
9. A nurse is preparing to care for a female client with esophageal varices who has just has a Sengstaken-
Blakemore tube inserted. The nurse gathers supplies, knowing that which of the following items must be
kept at the bedside at all times?
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a. An obturator
b. Kelly clamp
c. An irrigation set
d. A pair of scissors
10. Dr. Smith has determined that the client with hepatitis has contracted the infection form
contaminated food. The nurse understands that this client is most likely experiencing what type of
hepatitis?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
11. A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this
diagnosis?
a. Elevated hemoglobin level
b. Elevated serum bilirubin level
c. Elevated blood urea nitrogen level
d. Decreased erythrocycle sedimentation rate
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12. The nurse is reviewing the physicians orders written for a male client admitted to the hospital with
acute pancreatitis. Which physician order should the nurse question if noted on the clients chart?
a. NPO status
b. Nasogastric tube inserted
c. Morphine sulfate for pain
d. An anticholinergic medication
13. A female client being seen in a physicians office has just been scheduled for a barium swallow the
next day. The nurse writes down which instruction for the client to follow before the test?
a. Fast for 8 hours before the test
b. Eat a regular supper and breakfast
c. Continue to take all oral medications as scheduled
d. Monitor own bowel movement pattern for constipation
14. The nurse is performing an abdominal assessment and inspects the skin of the abdomen. The nurse
performs which assessment technique next?
a. Palpates the abdomen for size
b. Palpates the liver at the right rib margin
c. Listens to bowel sounds in all for quadrants
d. Percusses the right lower abdominal quadrant
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15. Polyethylene glycol-electrlyte solution (GoLYTELY) is prescribed for the female client scheduled for a
colonoscopy. The client begins to experience diarrhea following administration of the solution. What
action by the nurse is appropriate?
a. Start an IV infusion
b. Administer an enema
c. Cancel the diagnostic test
d. Explain that diarrhea is expected
16. The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse monitors the
client knowing that this client is at risk for which vitamin deficiency?
a. Vitamin A
b. Vitamin B12
c. Vitamin C
d. Vitamin E
17. The nurse is reviewing the medication record of a female client with acute gastritis. Which
medication, if noted on the clients record, would the nurse question?
a. Digoxin (Lanoxin)
b. Furosemide (Lasix)
c. Indomethacin (Indocin)
d. Propranolol hydrochloride (Inderal)
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18. The nurse is assessing a male client 24 hours following a cholecystectomy. The nurse noted that the
T tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is
appropriate?
a. Clamp the T tube
b. Irrigate the T tube
c. Notify the physician
d. Document the findings
19. The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment findings
would most likely indicate perforation of the ulcer?
a. Bradycardia
b. Numbness in the legs
c. Nausea and vomiting
d. A rigid, board-like abdomen
20. A male client with a peptic ulcer is scheduled for a vagotomy and the client asks the nurse about the
purpose of this procedure. Which response by the nurse best describes the purpose of a vagotomy?
a. Halts stress reactions
b. Heals the gastric mucosa
c. Reduces the stimulus to acid secretions
d. Decreases food absorption in the stomach
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21. The nurse is caring for a female client following a Billroth II procedure. Which postoperative order
should the nurse question and verify?
a. Leg exercises
b. Early ambulation
c. Irrigating the nasogastric tube
d. Coughing and deep-breathing exercises
22. The nurse is providing discharge instructions to a male client following gastrectomy and instructs the
client to take which measure to assist in preventing dumping syndrome?
a. Ambulate following a meal
b. Eat high carbohydrate foods
c. Limit the fluid taken with meal
d. Sit in a high-Fowlers position during meals
23. The nurse is monitoring a female client for the early signs and symptoms of dumping syndrome.
Which of the following indicate this occurrence?
a. Sweating and pallor
b. Bradycardia and indigestion
c. Double vision and chest pain
d. Abdominal cramping and pain
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24. The nurse is preparing a discharge teaching plan for the male client who had umbilical hernia repair.
What should the nurse include in the plan?
a. Irrigating the drain
b. Avoiding coughing
c. Maintaining bed rest
d. Restricting pain medication
25. The nurse is instructing the male client who has an inguinal hernia repair how to reduce
postoperative swelling following the procedure. What should the nurse tell the client?
a. Limit oral fluid
b. Elevate the scrotum
c. Apply heat to the abdomen
d. Remain in a low-fiber diet
26. The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which
finding, if noted on assessment of the client, would the nurse report to the physician?
a. Hypotension
b. Bloody diarrhea
c. Rebound tenderness
d. A hemoglobin level of 12 mg/dL
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27. The nurse is caring for a male client postoperatively following creation of a colostomy. Which nursing
diagnosis should the nurse include in the plan of care?
a. Sexual dysfunction
b. Body image, disturbed
c. Fear related to poor prognosis
d. Nutrition: more than body requirements, imbalanced
28. The nurse is reviewing the record of a female client with Crohns disease. Which stool characteristics
should the nurse expect to note documented in the clients record?
a. Diarrhea
b. Chronic constipation
c. Constipation alternating with diarrhea
d. Stools constantly oozing form the rectum
29. The nurse is performing a colostomy irrigation on a male client. During the irrigation, the client
begins to complain of abdominal cramps. What is the appropriate nursing action?
a. Notify the physician
b. Stop the irrigation temporarily
c. Increase the height of the irrigation
d. Medicate for pain and resume the irrigation
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30. The nurse is teaching a female client how to perform a colostomy irrigation. To enhance the
effectiveness of the irrigation and fecal returns, what measure should the nurse instruct the client to
do?
a. Increase fluid intake
b. Place heat on the abdomen
c. Perform the irrigation in the evening
d. Reduce the amount of irrigation solution
1. Answer C. The normal serum amylase level is 25 to 151 units/L. With chronic cases of pancreatitis,
the rise in serum amylase levels usually does not exceed three times the normal value. In acute
pancreatitis, the value may exceed five times the normal value. Options A and B are within normal
limits. Option D is an extremely elevated level seen in acute pancreatitis.
2. Answer C. Full liquid food items include items such as plain ice cream, sherbet, breakfast drinks,
milk, pudding and custard, soups that are strained, and strained vegetable juices. A clear liquid diet
consists of foods that are relatively transparent. The food items in options A, B, and D are clear liquids.
3. Answer A. The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in
a variety of foods of plant and animal origin. Pork products are especially rich in this vitamin. Other good
food sources include nuts, whole grain cereals, and legumes. Milk contains vitamins A, D, and B2.
Poultry contains niacin. Broccoli contains vitamins C, E, and K and folic acid
4. Answer A. Unless specifically indicated, residual amounts more than 100 mL require holding the
feeding. Therefore options B, C, and D are incorrect. Additionally, the feeding is not discarded unless its
contents are abnormal in color or characteristics.
5. Answer D. During the insertion of a nasogastric tube, if the client experiences difficulty breathing or
any respiratory distress, withdraw the tube slightly, stop the tube advancement, and wait until the
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distress subsides. Options B and C are unnecessary. Quickly inserting the tube is not an appropriate
action because, in this situation, it may be likely that the tube has entered the bronchus.
6. Answer A. If the nasogastric tube is in the stomach, the pH of the contents will be acidic. Gastric
aspirates have acidic pH values and should be 3.5 or lower. Option B indicates a slightly acidic pH.
Option C indicates a neutral pH. Option D indicates an alkaline pH.
7. Answer C. When the nurse removes a nasogastric tube, the client is instructed to take and hold a
deep breath. This will close the epiglottis. This allows for easy withdrawal through the esophagus into
the nose. The nurse removes the tube with one smooth, continuous pull.
8. Answer C. If a client has a nasogastric tube connected to suction, the nurse should wait up to 30
minutes before reconnecting the tube to the suction apparatus to allow adequate time for medication
absorption. Aspirating the nasogastric tube will remove the medication just administered. Low
intermittent suction also will remove the medication just administered. The client should not be placed
in the supine position because of the risk for aspiration.
9. Answer C. When the client has a Sengstaken-Blakemore tube, a pair of scissors must be kept at the
clients bedside at all times. The client needs to be observed for sudden respiratory distress, which
occurs if the gastric balloon ruptures and the entire tube moves upward. If this occurs, the nurse
immediately cuts all balloon lumens and removes the tube. An obturator and a Kelly clamp are kept at
the bedside of a client with a tracheostomy. An irrigation set may be kept at the bedside, but it is not
the priority item.
10. Answer A. Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food
handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.
11. Answer B. Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum
bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea
nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis.
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12. Answer C. Meperidine (Demerol) rather than morphine sulfate is the medication of choice to treat
pain because morphine sulfate can cause spasms in the sphincter of Oddi. Options A, B, and D are
appropriate interventions for the client with acute pancreatitis.
13. Answer A. A barium swallow is an x-ray study that uses a substance called barium for contrast to
highlight abnormalities in the gastrointestinal tract. The client should fast for 8 to 12 hours before the
test, depending on physician instructions. Most oral medications also are withheld before the test. After
the procedure, the nurse must monitor for constipation, which can occur as a result of the presence of
barium in the gastrointestinal tract.
14. Answer C. The appropriate sequence for abdominal examination is inspection, auscultation,
percussion, and palpation. Auscultation is performed after inspection to ensure that the motility of the
bowel and bowel sounds are not altered by percussion or palpation. Therefore, after inspecting the skinon the abdomen, the nurse should listen for bowel sounds.
15. Answer D. The solution GoLYTELY is a bowel evacuant used to prepare a client for a colonoscopy by
cleansing the bowel. The solution is expected to cause a mild diarrhea and will clear the bowel in 4 to 5
hours. Options A, B, and C are inappropriate actions.
16. Answer B. Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading
to the loss of the function of the parietal cells. The source of the intrinsic factor is lost, which results in
the inability to absorb vitamin B12. This leads to the development of pernicious anemia. The client is not
at risk for vitamin A, C, or E deficiency.
17. Answer C. Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can cause
ulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client
with gastrointestinal disorders. Furosemide (Lasix) is a loop diuretic. Digoxin is a cardiac medication.
Propranolol (Inderal) is a -adrenergic blocker. Furosemide, digoxin, and propranolol are not
contraindicated in clients with gastric disorders.
18. Answer D. Following cholecystectomy, drainage from the T tube is initially bloody and then turns to
a greenish-brown color. The drainage is measured as output. The amount of expected drainage will
range from 500 to 1000 mL/day. The nurse would document the output.
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19. Answer D. Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp,
intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which
becomes rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic
shock develops. Numbness in the legs is not an associated finding.
20. Answer C. A vagotomy, or cutting of the vagus nerve, is done to eliminate parasympathetic
stimulation of gastric secretion. Options A, B, and D are incorrect descriptions of a vagotomy.
21. Answer C. In a Billroth II procedure, the proximal remnant of the stomach is anastomosed to the
proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric
secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless
specifically ordered by the physician. In this situation, the nurse should clarify the order. Options A, B,
and D are appropriate postoperative interventions.
22. Answer C. Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that
occurs after eating, especially following a Billroth II procedure. Early manifestations usually occur within
30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the
desire to lie down. The nurse should instruct the client to decrease the amount of fluid taken at meals
and to avoid high-carbohydrate foods, including fluids such as fruit nectars; to assume a low-Fowlers
position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to takeantispasmodics as prescribed.
23. Answer A. Early manifestations of dumping syndrome occur 5 to 30 minutes after eating.
Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie
down.
24. Answer B. Coughing is avoided following umbilical hernia repair to prevent disruption of tissueintegrity, which can occur because of the location of this surgical procedure. Bed rest is not required
following this surgical procedure. The client should take analgesics as needed and as prescribed to
control pain. A drain is not used in this surgical procedure, although the client may be instructed in
simple dressing changes.
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25. Answer B. Following inguinal hernia repair, the client should be instructed to elevate the scrotum
and apply ice packs while in bed to decrease pain and swelling. The nurse also should instruct the client
to apply a scrotal support when out of bed. Heat will increase swelling. Limiting oral fluids and a low-
fiber diet can cause constipation.
26. Answer C. Rebound tenderness may indicate peritonitis. Bloody diarrhea is expected to occur in
ulcerative colitis. Because of the blood loss, the client may be hypotensive and the hemoglobin level
may be lower than normal. Signs of peritonitis must be reported to the physician.
27. Answer B. Body image, disturbed relates to loss of bowel control, the presence of a stoma, the
release of fecal material onto the abdomen, the passage of flatus, odor, and the need for an appliance
(external pouch). No data in the question support options A and C. Nutrition: less than body
requirements, imbalanced is the more likely nursing diagnosis.
28. Answer A. Crohns disease is characterized by nonbloody diarrhea of usually not more than four to
five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity. Options
B, C, and D are not characteristics of Crohns disease.
29. Answer B. If cramping occurs during a colostomy irrigation, the irrigation flow is stopped
temporarily and the client is allowed to rest. Cramping may occur from an infusion that is too rapid or is
causing too much pressure. The physician does not need to be notified. Increasing the height of the
irrigation will cause further discomfort. Medicating the client for pain is not the appropriate action in
this situation.
30. Answer A. To enhance effectiveness of the irrigation and fecal returns, the client is instructed to
increase fluid intake and to take other measures to prevent constipation. Options B, C and D will not
enhance the effectiveness of this procedure.