GI NCLEX Questions (71-75)

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71. A client receiving parenteral nutrition (PN) complains of nausea, excessive thirst, and increased frequency of voiding. The nurse initially assesses which of the following client data?

a) rectal temperature
b) last serum potasium
c) capillary blood glucose
d) serum blood urea nitrogen and creatinine

72. The nurse provides dietary measures to a client with diverticulosis. The nurse encourages the client to eat foods that are:

a)  high in fat
b) low in fiber
c) high in fiber
d) low roughage

73. A client who undergoes a gastric resection is at risk for developing dumping syndrome. The nurse monitors the client for:

a)  dizziness
b) bradycardia
c) constipation
d) extreme thirst

74. The nurse is caring for a client who is scheduled to have a liver biopsy. Before the procedure, it is most important for the nurse to assess the client's:

a)  tolerance to pain
b) allergy to iodine or shellfish
c) history of nausea and vomiting
d) ability to lie still and hold the breath

75.  A client who has had an abdominal aortic aneurysm repair is 1 day postoperative. The nurse performs an abdominal assessment and notes the absence of bowel sounds. The nurse should:

a) feed the client
b) call the physician immediately
c) remove the nasogastric (NG) tube
d) document the finding and continue to assess  for bowel sounds







GI NCLEX Questions 
Answers and Rationale

71) C

- The symptoms exhibited by the client are consistent with hyperglycemia. The nurse would need to assess the client's blood glucose level to verify these data. Clients receiving PN are at risk for hyperglycemia related to the increased glucose load of the solution. The other options would not provide any information that would correlate with the client's symptoms.

72) C

- Diverticulosis is managed by consumption of a high-fiber diet and prevention of constipation with bran and bulk laxatives. A diet high in fat should be avoided because high-fat foods tend to be low in fiber. A low-roughage diet is similar to a low-fiber diet.

73) A

- Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vasomotor disturbances such as dizziness, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.

74) D

- It is most important for the nurse to assess the client's ability to lie still and hold the breath for the procedure. This helps the physician avoid complications, such as puncturing the lung or other organs. Assessment of allergy to iodine or shellfish is unnecessary for this procedure, because no contrast dye is used. Knowledge of the history related to nausea and vomiting is generally a part of assessment of the gastrointestinal system but has no relationship to the procedure. The client's tolerance for pain is a useful item to know. However, the area will receive a local anesthetic.

75) D

- Bowel sounds may be absent for 3 to 4 days postoperative due to bowel manipulation during surgery. The nurse should document the finding and continue to monitor the client. The NG tube should stay in place if present, and the client is kept NPO until after the onset of bowel sounds. There is no need to call the physician immediately at this time.


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GI NCLEX Questions (66-70)

Welcome to GI NCLEX Questions. Before you begin answering the questions, you may first want to take a peek about the material that will surely help you the pass the NCLEX examination :

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Enjoy answering and I hope that NCLEX Review and Secrets can somehow help you in your future examination. Good Luck.


66. A nurse is caring for a client with acute pancreatitis who has a history of alcoholism. The nurse closely monitors the client for paralytic ileus, knowing that which assessment data indicate this complication of pancreatitis?

a) inability to pass flatus
b) loss of anal sphincter control
c) severe, constant pain with rapid onset
d) firm, nontender mass palpable at the lower right costal margin

67. After performing an initial abdominal assessment on a client with a diagnosis of cholelithiasis, the nurse documents that the bowel sounds are normal. Which of the following descriptions best describes this assessment finding?

a) waves of loud gurgles auscultated in all four quadrants
b) soft gurgling or clicking sounds auscultated in all four quadrants
c) low-pitched swishing sounds auscultated in one or two quadrants
d) very high-pitched loud rushes auscultated especially in one or two quadrants

68. The nurse is assessing a client with a Cantor tube. Which finding indicates correct placement of the tube?

a) a pH of aspirate less than 7.0
b) a pH of aspirate of 7.0 or greater
c) the auscultation of air when inserted into the abdomen
d) the presence of gastric contents when checking residuals

69. Then nurse is assisting the client with hepatic encephalopathy to fill out the dietary menu. The nurse advises the client to avoid which of the following entree items that could aggravate the client's condition?

a) tomato soup
b) fresh fruit plate
c) vegetable lasagna
d) ground beef patty

70. A client with a colostomy is complaining of gas building up in the colostomy bag. The nurse instructs the client that which of the following food items can be consumed to best prevent this problem?

a) yogurt
b) broccoli
c) cabbage
d) cauliflower






GI NCLEX Questions
Answers and Rationale

66) A

- An inflammatory reaction such as acute pancreatitis can cause paralytic ileus, the common form of nonmechanical obstruction. Inability to pass flatus is a clinical manifestation of paralytic ileus. Option 4 is the description of the physical finding of liver enlargement. The liver is usually enlarged in the client with cirrhosis or hepatitis. Although this client may have an enlarged liver, an enlarged liver is not a sign of paralytic ileus. Pain is associated with paralytic ileus, but the pain usually presents as a more constant generalized discomfort. Pain that is severe, constant, and rapid in onset is more likely caused by strangulation of the bowel. Loss of sphincter control is not a sign of paralytic ileus.

67) B

- Although frequency and intensity of bowel sounds will vary depending on the phase of digestion, normal bowel sounds are relatively soft gurgling or clicking sounds that occur irregularly 5 to 35 times per minute. Loud gurgles (borborygmi) indicate hyperperistalsis. Bowel sounds will be higher pitched and loud (hyperresonance) when the intestines are under tension, such as in intestinal obstruction. A swishing or buzzing sound represents turbulent blood flow associated with a bruit. No aortic bruits should be heard.

68) B

- The Cantor tube is an intestinal tube and is used for aspirating intestinal contents. For intestinal intubation the tube is threaded through the nose into the stomach and then through the pylorus, where peristaltic activity of the bowel carries it to the desired intestinal area. The nurse ensures intestinal placement by checking the pH of aspirate. A pH reading greater than 7 indicates intestinal contents; a reading less than 7 indicates gastric contents.

69) D

- Clients with hepatic encephalopathy have impaired ability to convert ammonia to urea and must limit intake of protein and ammonia-containing foods in the diet. The client should avoid foods such as chicken, beef, ham, cheese, buttermilk, onions, peanut butter, and gelatin.

70) A

- Consumption of yogurt, crackers and toast can help to prevent gas. Gas-forming foods include broccoli, mushrooms, cauliflower, onions, peas, and cabbage. These should be avoided by the client with a colostomy until tolerance to them is determined.



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GI NCLEX Questions (71-75)

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GI NCLEX Questions (61-65)

Welcome to GI NCLEX Questions. Before you begin answering the questions, you may first want to take a peek about the material that will surely help you the pass the NCLEX examination :

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Enjoy answering and I hope that NCLEX Review and Secrets can somehow help you in your future examination. Good Luck.


61. A client has had a Miller-Abbot tube in place for 24 hours. Which assessment finding indicates that the tube is located in the intestine?

a) the client is nauseous
b) bowel sounds are absent
c) aspirate from the tube has pH of 7
d) the abdominal radiograph report indicates that the end of the tube is above the pylorus

62. A client is resuming a diet after a Billroth II procedure. To minimize complications from eating, the nurse teaches the client to avoid doing which of the following?

a) lying down after eating
b) eating a diet high in protein
c) drinking liquids with meals
d) eating six small meals per day

63. A physician orders the deflation of the esophageal balloon of a Sengstaken-Blakemore tube in a client. The nurse prepares for the procedure, knowing that the deflation of the esophageal balloon places the client at risk for:

a) gastritis
b) increased ascites
c) esophageal necrosis
d) recurrent hemorrhage from the esophageal varices

64. The nurse is preparing to initiate bolus enteral feedings via nasogastric (NG) tube to a client. Which of the following actions represents safe practice by the nurse?

a) checks the volume of the residual after administering the bolus feeding
b) aspirates gastric contents prior to initiating the feeding and assures that pH is >9
c) elevates the head of the bed to 25 degrees and maintains for 30 minutes after instillation of feeding
d) measures the length of the tube from where it protrudes from the nose to the end and compares to previously documented measurements

65. A nurse has inserted a nasogastric (NG) tube to the level of the oropharynx and has repositioned the client's head in a flexed-forward position. The client has been asked to begin swallowing, and as the nurse starts to slowly advance the NGT with each swallow, the client begins ti gag. Which nursing action would least likely result in proper tube insertion and promote client relaxation?

a) pulling the tube back slightly
b) instructing the client to breathe slowly
c) continuing to advance the tube to the desired distance
d) checking the back of the pharynx using a tongue blade and flashlight







GI NCLEX Questions
Answers and Rationale

61) C

- The Miller-Abbott tube is a nasoenteric tube that is used to decompress the intestine and to correct a bowel obstruction. The end of the tube should be located in the intestine. The pH of the gastric fluid is acidic, and the pH of the intestinal fluid is alkaline (7 or higher). Location of the tube can also be determined by radiographs.

62) C

- The client who has had a Billroth II procedure is at risk for dumping syndrome. The client should avoid drinking liquids with meals to prevent this syndrome. The client should be placed on a dry diet that is high in protein, moderate in fat, and low in carbohydrates. Frequent small meals are encouraged, and the client should avoid concentrated sweets.

63) D

- A Sengstaken-Blakemore tube is inserted in clients with cirrhosis who have ruptured esophageal varices. It has esophageal and gastric balloons. The esophageal balloon exerts pressure on the ruptured esophageal varices and stops the bleeding. The pressure of the esophageal balloon is released at intervals to decrease the risk of trauma to the esophageal tissues, including esophageal rupture or necrosis. When the balloon is deflated, the client may begin to bleed again from the esophageal varices.

64) D

- After initial radiographic confirmation of NG tube placement, methods used to verify nasogastric tube placement include measuring the length of the tube from the point it protrudes from the nose to the end; injecting 10 to 30 mL of air into the tube and auscultating over the left upper quadrant of the abdomen; and aspirating the secretions and checking to see if the pH is between 1 and 5. Fowler's position is recommended for bolus feedings, if permitted, and should be maintained for 1 hour after instillation. Residual should be assessed before administration of the next feeding.

65) C

- As the NG tube is passed through the oropharynx, the gag reflex is stimulated, which may cause gagging. Instead of passing through to the esophagus, the NG tube may coil around itself in the oropharynx, or it may enter the larynx and obstruct the airway. Because the tube may enter the larynx, advancing the tube may position it in the trachea. Slow breathing helps the client relax to reduce the gag response. The tube may be advanced after the client relaxes.


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GI NCLEX Questions (66-70)

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NCLEX Questions Gastrointestinal 56-60

NCLEX Questions Gastrointestinal

56. A nurse is monitoring a postoperative client after abdominal surgery for signs of complications. The nurse assesses the client for the presence of Homan's sign and determines that his sign is positive if which of the following is noted?


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


57. A nurse is assessing for correct placement of a nasogastric tube. The nurse aspirates the stomach contents and checks the contents for pH. The nurse verifies correct tube placement if which pH value is noted?

a) 3.5
b) 7.0
c) 7.35
d) 7.5

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NCLEX Review about Digestive Tract Diseases 51-55

NCLEX Review about Digestive Tract Diseases

51.A nurse is working in the emergency room and receives a client with suspected botulism. Which action is a priority for the nurse to initiate?

a) administer vaccine for botulism
b) initiate isolation
c) induce vomiting
d) administer antibiotics

52. The nurse is assigned to a 40-year old client who has a diagnosis of chronic pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level of:

a) 45 units/L
b) 100 units/L
c) 300 units/L
d0 500 units/L

53. An adult client was diagnosed with acute pancreatitis 9 days ago. The nurse interprets that the client is recovering from this episode if the serum lipase level decreases to which of the following values, which is just below the upper limit of normal?

a) 20 unit/L
b) 80 unit/L
c) 135 unit/L
d) 350 unit/L

54. A client who is recently has been started on enteral feedings begins to complain of abdominal cramping, followed by the passage of two liquid stools. A nurse notes that the client has abdominal distention as well. The nurse reviews the nutritional content on the label of the can of feeding to see if it has which of the following ingredients?

a) lactose
b) sucrose
c) fructose
d) maltose

55. A nurse is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intention to increase the intake of:

a) pork
b) milk
c) chicken
d) broccoli




NCLEX REVIEW ABOUT DIGESTIVE TRACT DISEASES:
ANSWERS AND RATIONALE

51) C

- botulism is food poisoning. Vomiting rids the body toxins.

52)  C

- the normal serum amylase level is 25 to 151 unit/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. Option A and B are within normal limits. Option D is an extremely elevated level seen in acute pancreatitis.

 53) C

- the normal serum lipase level is 10 to 140 units/L. The client who is recovering from acute pancreatitis usually has elevated lipase levels for about 10 days after the onset of symptoms. This makes lipase a valuable test in monitoring the client's pancreatic function because serum amylase levels usually return to normal 3 days after the onset of symptoms. Option C is the only option that contains a value just below the upper limit of normal.

54) A

- several tube feeding formulas contain lactose. A client with an unreported history of lactose intolerance would develop symptoms such as abdominal cramping, distention, and the passage of liquid stool in response to nutritional therapy with these formulas. If the client is diagnosed as lactose intolerant, a lactose-free formula should be prescribed by the physician. This will resolve the client's symptoms and promote adequate nutrition for the client.

55) A

- the client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a variety of foods of plants and animal origin. Pork products are especially rich in this vitamin. Other good food sources include nuts, whole grain cereals, and legumes. Milk contains vitamin A, D, and B2. Poultry contains niacin. Broccoli contains vitamin C, E and K and folic acid.


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NCLEX Review about Digestive System Disorders 46-50

NCLEX Review about Digestive System Disorders

46. A client has Sengstaken-Blakemore tube. The nurse, during change-of-shift report should remind the next shift nurse to:

a) keep scissors at bedside
b) avoid instilling fluid into the aspiration port
c) keep tracheostomy tray at bedside
d) deflate the balloon for 15 to 30 minutes every 2 hours

47. The nurse is developing the plan of care for a client receiving continuous ambulatory peritoneal dialysis (CAPD). Which is the priority complication of CAPD to be addressed in the plan of care?

a) bleeding
b) pain
c) outflow problems
d) infection

Situation: Bobby, a 13 year old is being seen in the emergency room for possible appendicitis.

48. An important nursing action to perform when preparing Bobby for an appendectomy is to:

a) administer saline enemas to cleanse the bowels
b) apply heat to reduce pain
c) measure abdominal girth
d) continuously monitor pain

49. Which of the following would indicate that Bobby's appendix has ruptured?

a) diaphoresis
b) anorexia
c) pain at Mc Burney's point
d) relief from pain

50. A nurse is making a home health visit and finds the client experiencing right lower quadrant abdominal pain, which has decreased in intensity over the last day. The client also has a rigid abdomen and a temperature of 103.6 F. The nurse should intervene by:

a) administering Tylenol (acetaminophen) for the elevated temperature
b) advising the client to increase oral fluids
c) asking the client when she last had a bowel movement
d) notifying the physician




NCLEX REVIEW ABOUT DIGESTIVE SYSTEM DISORDERS:
ANSWERS AND RATIONALE

46) A

- the nurse should keep scissors readily available at bedside for a client with Sengstaken-Blakemore tube. The scissors will be used to cut the tube in case of airway obstruction due to rupture of the gastric balloon and the esophageal balloon goes up into the pharynx.

47) D

- the most common complication of CAPD is infection (peritonitis). This should be given highest priroty when planning the care of the patient undergoing CAPD.

48) D
- Appendicitis is inflammation of the vermiform appendix (4 inches long) which may lead to edema, necrosis, abscess and rupture, and peritonitis. It is common among teenagers and young adults between 10-30 years old. Higher incidence is observed among males and in societies with diet low in fiber and high in refined carbohydrates.

Pain is closely monitored in appendicitis. In most cases, pain medication is not given until prior to surgery or until the diagnosis is confirmed to be able to closely monitor the progression of the disease. A sudden change in the character of pain may indicate rupture or bowel perforation.

• Initially, appendicitis is manifested by acute and generalized pain of the abdomen that comes in waves.
• During the following 4 hours, pain intensifies and localizes at the right lower quadrant pain at the Mc Burney's point between the anterior iliac crest and umbilicus.
• The pain is aggravated by walking, moving and coughing
• Rebound tenderness (relief of pain on palpation and sudden pain on release of pressure) occurs with abdominal rigidity causing the patient to guard the abdomen.
• Patient tends to lie on back or side with knees bent to relieve pain as extension or internal rotation of the hip increases pain.

Other manifestations of appendicitis include:

• Anorexia, nausea and vomiting
• Chills and fever
• Leukocytosis - 10,000
• elevated neutrophils count

To prevent bowel perforation, it is important to avoid:

• enemas
• laxatives
• applying heat over the abdomen
• food and fluids per orem

49) D

50) D
- the patient's manifestations indicate rupture of the appendix and peritonitis.






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NCLEX Review about Digestive Problems 41-45

NCLEX Review about Digestive Problems

41. The client with liver cirrhosis has developed esophageal varices. Which of the following should the nurse advise the client to avoid? Select all that apply

a) coughing
b) straining at stool
c) yawning
d) bending and stooping
e) swallowing
f) heavy lifting
g) spicy foods

42. The client had undergone Billroth II surgery. Which of the following health teachings should be taken to the client before discharge? Select all that apply

a) take dry, high protein foods
b) limit concentrated carbohydrates
c) lie down in left side-lying position after meals
d) take fluids with meals
e) take small, frequent meals
f) start meal with hot foods and beverages

43. The nurse is taking care of a patient with a positive clostridium difficile culture result. The charge nurse will intervene if she observes the nurse to be

a) wearing gloves in handling secretions
b) washing hands before and after entering the room and giving care to the patient
c) instructing the patient to wash hands with antimicrobial soap
d) wearing gown, gloves, mask, and cap while giving care to the patient

44. After gastrojejunostomy, which of the following instructions should be included in the health teachings of the patient?

a) limit carbohydrates in your diet
b) increase fluid intake
c) avoid lying down after eating
d) limit proteins in your diet

45. Arrange in sequence the following actions when cleaning an abdominal incision.

a) prepare supplies
b) apply sterile gloves
c) do hand washing apply clean gloves
d) remove soiled dressings
e) clean from the top to the bottom of the abdominal incision
g) apply sterile dressings




NCLEX REVIEW ABOUT DIGESTIVE PROBLEMS:
ANSWERS AND RATIONALE

41) A, B, D, F, G
- these factors should be avoided by the client with liver cirrhosis to prevent rupture of esophageal varices.

42) A, B, C, E
- these are preventive measures for dumping syndrome. To prevent dumping syndrome, avoid factors that cause rapid emptying of gastric content.

43) D
- clostridium difficile is characterized by severe diarrhea. It requires contact precaution which involves use of gloves and gown only. There is no need to wear mask and cap.

44) A
- after gastric surgery, dumping syndrome should be prevented. Dumping syndrome is caused by rapid emptying of gastric content into the jejunum. The hypertonic gastric content emptied into the jejunum causes shifting of plasma from the intestinal capillaries. This reduces the circulating volume and may lead to shock. Carbohydrates should be limited in the diet because these foods empty the stomach rapidly.

45) C, D, A, B, E, F
- this is the correct sequence of actions when cleaning an abdominal incision. Practice asepsis and infection control measures.



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NCLEX Review about Gastrointestinal Disorder 36-40

NCLEX Review about Gastrointestinal Disorder

36. The client had been diagnosed to have acute pancreatitis. Which of the following signs and symptoms most likely are experienced by the client? Select all that apply

a) pain in the left upper quadrant of the abdomen
b) bile-stained vomitus
c) elevated serum amylase
d) hypercalcemia
e) steatorrhea
f) hypoglycemia
g) weight loss

37. The child has been diagnosed to have Hirschprung's disease (Aganglionic megacolon) by rectal biopsy. Which of the following findings most likely is experienced by the child?

a) ribbon-like stool
b) currant jelly-like stool
c) olive-sized mass in the abdomen
d) sausage-like mass in the abdomen

38. The nurse assists the physician during paracentesis. In which position does the nurse place the client?

a) lying position
b) sitting position
c) prone position
d) side-lying position

39. The client had been diagnosed to have complete intestinal obstruction. Which of the following assessment findings will the nurse expect?

a) medium-pitched gurgling sounds
b) high-pitched tinkling bowel sounds
c) absence of bowel sounds
d) increased bowel sounds

40. Which of the following physician's orders for a client with acute pancreatitis should be questioned by the nurse?

a) zantac 300mg 1 tablet BID
b) morphine sulfate 5mg/IV every 6 hours
c) bland, low fat diet
d) meperidine hydrochloride 50mg/IV every 4 hours





NCLEX REVIEW ABOUT GASTROINTESTINAL DISORDER:
ANSWERS AND RATIONALE

36) A, B, C, E, G
- other signs and symptoms of acute pancreatitis are hypoglycalcemia and hyperglycemia

37) A
- hirschprung's disease is characterized by intestinal obstruction producing ribbon-like stool. Currant jelly stool and sausage-like mass are characteristics of intussusception. Olive-sized mass is a manifestation of pyloric stenosis.

38) B
- paracentesis is aspiration of fluid from the abdominal cavity. Sitting position allows fluid to settle at lower abdomen. This facilitates aspiration of fluids.

39) C
- absence of bowel sounds indicates complete intestinal obstruction. High-pitched tinkling sounds indicate partial intestinal obstruction.

40) B
- morphine sulfate is contraindicated in a client with acute pancreatitis because it causes spasm of sphincter of Oddi. The drug of choice to relieve pain in acute pancreatitis is Demerol (meperidine HCL).




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Online Nursing Practice Test about Gastrointestinal Diseases (31-35)

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31. Which of the following interventions does the nurse expect to give to a client after gastrointestinal series?

a) analgesic
b) laxative
c) antiemetic
d) sedative

32. The client has been diagnosed to have acute pancreatitis. Which of the following is not a component of nursing care for the client?

a) administer morphine sulfate for pain
b) administer calcium supplement as ordered
c) administer digestive enzymes with each meal and snack
d) administer IV therapy as ordered

33. The client has been diagnosed to have VRE (Vancomycin-resistant enterocolitis). Which of the following is appropriate nursing action when caring for the client?

a) wear mask when entering the client's room
b) wear gloves when caring for the client
c) wear mask and gloves when performing procedures to the client
d) wear gown and mask when caring for the client

34. A patient was diagnosed to have Laennec's cirrhosis. Which of the following symptoms should be assessed first?

a) inability to write
b) jaundice
c) increased BUN
d) ascites

35. A nurse assists a physician in performing a liver biopsy. After the procedure, which of the following positions should the nurse place the patient?

a) prone position
b) supine position
c) right side-lying position with a pillow under the puncture site
d) left side-lying position with a pillow under the puncture site



ANSWERS AND RATIONALE

31) B
- BaSO4 which is used as the contrast medium in gastrointestinal series, causes constipation. Therefore, laxative will be administered after the procedure as ordered.

32) A
- morphine SO4 is contraindicated in a client with acute pancreatitis because it causes spasm of the sphincter of Oddi and the pancreas. Demerol is the drug of choice to relieve pain in acute pancreatitis.

33) B
- VRE is characterized by diarrhea. Contact precaution should be implemented, which includes use of gloves and gown when caring for the patient.

34) A
- inability to write indicates presence of asterixis (flapping tremors) this may signal impending hepatic encephalopathy. This is an assessment priority in a client with liver cirrhosis.

35) C
- right side-lying position is intended to apply pressure at the puncture site, and thereby preventing bleeding after liver biopsy.


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NCLEX Review about Gastrointestinal Problems 26-30

NCLEX Review about Gastrointestinal Problems

26. The client had gastrectomy 2 days ago. To prevent dumping syndrome, which of the following is not a component of the interventions?

a) eating small frequent meals
b) lying down after meals for 30 minutes
c) drinking fluids during meals
d) avoiding concentrated sugar

27. After liver biopsy, what is the most appropriate next action of the RN?

a) take vital signs
b) place the client in right sided-lying position
c) place the client in semi-fowler's position
d) place the client in left sided-lying position

28. A fluid challenge is begun with a postop gastric surgery client. Which assessment will give the best indication of the client's response to this treatment?

a) CVP (central venous pressure) reading and hourly urine output
b) blood pressure and apical rate
c) lung sounds and arterial blood gases
d) electrolytes, BUN levels

29. Which of the following facts best explains why the duodenum is not removed during a subtotal gastrectomy?

a) the head of the pancreas is adherent to the duodenal wall
b) the common bile duct empties into the duodenal villi
c) the wall of the jejunum contains no intestinal villi
d) the jejunum receives its blood supply through the duodenum

30. Which of the following expected outcomes should the nurse inform the client after laparoscopic cholecystectomy?

a) redness and swelling on the operative site
b) serosanguinous drainage on the dressing
c) shoulder pain for 24 hours
d) nausea and vomiting for 24 hours




NCLEX REVIEW ABOUT GASTROINTESTINAL PROBLEMS:
ANSWERS AND RATIONALE

26) C
- drinking fluids with meals will further cause rapid emptying of gastric content. To prevent dumping syndrome, the client should drink fluids after meals.

27) B
- after liver biopsy, the RN should place the client in right side-lying position. To apply pressure in the area and prevent bleeding.

28) A
- CVP reading and hourly urine output are the most objective indicators of fluid balance and circulating volume.

29) B
- the duodenum is not removed during subtotal gastrectomy to allow the common bile duct to transport bile into the duodenum

30) C
- abdominal insufflation with carbon dioxide is done during the procedure. This causes bloating and abdominal pain that radiates to the shoulder during the first 24 hours postop.




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NCLEX Review about Gastrointestinal Disorders 21-25

NCLEX Review about Gastrointestinal Disorders

21. Which of the following findings indicates effectiveness of Viokase?

a) abdominal pain relieved
b) steatorrhea has decreased
c) vomiting has stopped
d) jaundice has diminished

22. The client had undergone ileostomy. He has nasogastric tube connected to intermittent suction, with IV fluid and foley catheter. Which of the following physician's instructions requires intervention by thew nurse?

a) remove the NGT on the third day postop
b) remove foley catheter after 24 hours
c) irrigate ileostomy at bed time
d) clear liquid diet once peristalsis returns

23. Which of the following manifestations characterize pancreatitis?

a) right upper quadrant pain
b) bile-stained vomitus
c) epigastric pain that is not relieved by vomiting
d) elevated serum calcium

24. The client is diagnosed with acute pancreatitis. Which of the following signs and symptoms will the client manifest?

a) right upper quadrant (RUQ) pain
b) bluish discoloration at the periumbilical area
c) left lower quadrant (LLQ) pain
d) pain at the epigastric region

25. The client is diagnosed to have acute pancreatitis. Which laboratory findings signify the diagnosis?

a) elevated SGOT, SGPT
b) elevated BUN, serum creatinine
c) elevated FBS, ESR
d) elevated serum amylase, lipase




NCLEX REVIEW ABOUT GASTROINTESTINAL DISORDERS:
ANSWERS AND RATIONALE

21) B
- viokase is a digestive enzyme. If fats are adequately digested. There will be decreased steatorrhea.

22) C
- ileostomy does not require irrigation because it continuously drains watery fecal drainage.

23) B
- pancreatitis is characterized by bile-stained vomitus, LLQ pain, epigastric pain relieved by vomiting, and hypocalcemia.

24) B
- bluish discoloration at the periumbilical region (Cullen's sign) indicates post-hemorrhagic necrosis in acute pancreatitis.

25) D
- elevated serum amylase and lipase signify pancreatitis.




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NCLEX Review about Intestinal Disorders 21-25

NCLEX Review about Intestinal Disorders

16. Which of the following assessment findings should concern the nurse most, when assessing client who had undergone colonoscopy?

a) abdominal distention
b) 300 ml of bile-stained vomitus
c) complaints of anal pain
d) complaints of drowsiness and fatigue

17. A client has hepatic cirrhosis and gastric bleeding. Which of the following tasks may be delegated to the nursing assistant?

a) assist the client in taking a bath
b) hourly intake and output monitoring
c) assist the client to sit before changing the bed linen
d) assist the client in ambulation

18. A client diagnosed with gastric ulcer is for discharge. Which of the following should be included by the nurse in the health teachings regarding diet?

a) you must eat bland diet
b) you can eat most foods as long as they don't bother your stomach
c) you should refrain from eating fruits and vegetables
d) you should eat low fiber diet

19. The client who was diagnosed to have gastric cancer had undergone gastrectomy. Which of the following statements when made by the client indicates that he understands the health teachings

a) I'll take vitamin K for life
b) I'll take vitamin B12 for life
c) I'll take vitamin C for life
d) I'll take vitamin B6 for life

20. The client had been diagnosed to have liver cirrhosis and esophageal varices. Which of the following should the nurse include when giving health teachings? Select all that apply

a) avoid spicy foods
b) avid straining at stool
c) increase fluid intake
d) open mouth if coughing or sneezing could not be avoided
e) avoid bending or stooping
f) take acetaminophen instead of aspirin for pain
g) avoid heavy lifting




NCLEX REVIEW ABOUT INTESTINAL DISORDERS:
ANSWERS AND RATIONALE

16) B
- bile-stained vomitus is a sign of lower GI obstruction . Options A, C, and D are expected findings after colonoscopy.

17) B
- input and output monitoring may be delegated to nursing assistant. the client with hepatic cirrhosis and gastric bleeding should be on bed rest to prevent further bleeding. A, C, and D involve getting the client out of bed, which may cause bleeding.

18) B
- food tolerance varies from individual to individual. There is no need for special diet for the client with gastric ulcer during remission.

19) B
- if a client had undergone gastrectomy, intrinsic factor is no longer produced. Therefore vitamin B12 will not be absorbed. Post-gastrectomy clients are prone to pernicious anemia. Therefore, the client should take vitamin B12 for life.

20) A, B, D, E, G
- to prevent rupture of esophageal varices, the client should avoid spicy foods, straining at stool, bending and stooping, and heavy lifting. The client should open his mouth if coughing and sneezing could not be avoided. Acetaminophen is hepatotoxic; aspirin may cause bleeding and therefore, are contraindicated in the client with liver cirrhosis.




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NCLEX Review about Gastrointestinal Discomfort 9-15

NCLEX Review about Gastrointestinal Discomfort

9. What diet should the nurse recommend for a child with celiac disease?

a) wheat and oats
b) rice and corn
c) cookies and ice cream
d) pasta and noodles

10. Which of the following foods should not be included in the diet of the client with diverticulitis?

a) rice and steamed chicken
b) tomato and cucumber
c) pasta and orange slices
d) roasted turkey and spaghetti

11. A client had undergone gastric resection. Which of the following is not to be included in the nursing care plan for the client to prevent dumping syndrome?

a) small, frequent feeding
b) high protein, low carbohydrate diet
c) lying down after meals
d) taking fluids with meals

12. When is the best time to administer sucralfate?

a) one hour before meals
b) 30 minutes after meals
c) with meals
d) 2 hours after meals

13. Which of the following should the nurse include when giving health teachings in a client with gastroesophageal reflux?

a) lie down after meals
b) sleep with the head of bed elevated
c) eat high carbohydrate diet
d) eat low protein diet

14. Which of the following should the nurse advise to a client who had undergone partial gastrectomy?

a) drink fluid with meals
b) lie down after meals
c) increase fats in the diet
d) assume upright position during and after meals

15. Which of the following statements when made by the mother of a child with celiac disease indicates that she understands the diet of her child?

a) my child can eat rice
b) my child can eat oats
c) my child can eat biscuits
d) my child can eat pasta




NCLEX REVIEW ABOUT GASTROINTESTINAL DISCOMFORT:
ANSWERS AND RATIONALE

9) B
- gluten-free diet is recommended for children with celiac disease. Rice and corn are allowed in the child's diet. Avoid foods that contain barley, rye, oats and wheat.

10) B
- foods with seeds like tomato and cucumber should be avoided by the patient with diverticulitis because the seeds may be trapped in the outpouchings.

11) D
- to prevent dumping syndrome, measures that slow down gastric emptying should be practiced. Fluids should be taken after meals, not with meals.

12) A
- sucralfate is a cytoprotective drug. To coat the ulcer, it should be given on empty stomach.

13) B
- the head of bed should be elevated during sleep to prevent gastroesophageal reflux.

14) B
- after partial gastrectomy, dumping syndrome may occur . Lying down after meals will inhibit rapid emptying of gastric content.

15) A
- celiac disease is gluten-sensitivity enteropathy. The client's diet should be gluten-free. Avoid foods from BROW (barley, rye, oats and wheat). Rice and corn are allowed.


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NCLEX Review about Gastrointestinal Distress 1-5

NCLEX Review about Gastrointestinal Distress

1. The client had been diagnosed to have a cholelithiasis. He had undergone laparoscopic cholecystectomy. Which of the following does the nurse recognize as normal signs and symptoms after the surgery?

a) abdominal pain and bloating
b) diminished lung sounds
c) bile-stained vomitus
d) hyperactive bowel sounds

2. The client has been diagnosed to have cancer of the colon. She is for colostomy. The client says, "The doctor told me that there are complications of colostomy." The best initial action by the nurse is

a) discuss complications of colostomy to the patient
b) provide pre-operation teachings
c) ask what are the complications of colostomy
d) ask the client to sign consent form

3. A nurse is caring for a client with colostomy created 3 days earlier. The client is beginning to pass malodorous flatus from stoma. The nurse interprets that:

a) this is normal, expected event
b) this indicates inadequate preoperative bowel preparation
c) the client is experiencing early signs of impaired circulation
d) the client should not have the nasogastric tube movement

4. A client who has gastrostomy tube for feeding refuses to participate in the plan of care, will not make eye contact and does not speak to family or visitors. A nurse assesses that this client is using which type of coping mechanism?

a) self-control
b) distancing
c) problem-solving
d) accepting responsibility

5. A nurse is preparing a diet plan for a post-gastrectomy client to prevent dumping syndrome. Which of the following would not be a component of this teaching plan?

a) lie down after eating
b) drink liquids with meals
c) eat small meals, six times daily
d) avoid concentrated sweets




NCLEX REVIEW ABOUT GASTROINTESTINAL DISTRESS:
ANSWERS AND RATIONALE

1) A
- carbon dioxide insufflation of the abdomen is done during laparoscopic cholecystectomy. This leads to abdominal pain and bloating 24 hours post-procedure

2) C
- assess what the client knows, before giving teachings. This provides the starting point of discussion

3) A
- passage of flatus indicates return of peristalsis. This is normal, expected event 3 days after colostomy.

4) B
- when a client refuses to communicate, he/she is using distancing as coping mechanism.

5) B
- to prevent dumping syndrome, the client should drink fluids after meals, not with meals. This is to prevent rapid emptying of the stomach.



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NCLEX Review about Bowel Disorders 6-8

NCLEX Review about Bowel Disorders

Situation: Mr. Greg, a 49 year old CEO is diagnosed as having ulcer disease.

6. Mr. Greg's ulcer perforates into the peritoneal cavity. To relieve the pain caused by perforation, Mr. Greg is most likely to:

a) lie on his left side
b) turn into his stomach
c) rigidly maintain the supine position
d) draw his knees up to his abdomen

7. Mr. Greg is placed on the bland diet and receives medications to decrease gastric acidity. Which medication reduces hydrochloride acid secretion?

a) cimetidine (tagamet)
b) sucralfate (carafets)
c) aluminum hydroxide (amphogel)
d) aspirin

8. Mr. Greg is scheduled for an upper GI series. Which intervention should the nurse perform after procedure?

a) testing stool for occult blood
b) give the patient a laxative
c) assessing for the gag reflex
d) administer double dose of antacids to prevent excessive HCL production




NCLEX REVIEW ABOUT BOWEL DISORDERS:
ANSWERS AND RATIONALE

6) D
- Ulcer is the ulceration of the mucosa and underlying structures of the upper gastrointestinal tract caused by conditions in which there is increased acidic gastric secretions or decrease mucus production. Common complication of peptic ulcer are perforation, hemorrhage and obstruction.

Perforation often occurs in duodenal ulcer. When it happens, gastric content is emptied into the peritoneal cavity causing peritonitis (gastric content is acidic, irritates peritoneal cavity and cause inflammation), bacterial septicemia (microorganism from stomach invade peritoneum and gain access to blood) and shock (from bleeding)

When ulcer perforates, the patient experiences sudden severe excruciating and stabbing pain at the epigastrium that spreads to the entire abdomen. The severe abdominal pain caused by perforated ulcer makes the patient assume the fetal position by drawing the knees up in an effort to lessen abdominal muscle tension with the hand clutching the abdomen. The abdominal area becomes tender and rigid.

On examination, the patient will also have a rigid boardlike abdomen with absent bowel sounds. Because after perforation peristalsis diminishes and the patient develops paralytic ileus.

7) A
- Medications for Ulcer

Histamine Receptor Antagonists - Block release of histamine, a hormone which stimulates HCL secretion.
It includes:

• Cimetidine (tagamet)
• Ranitidine (zantac) -side effect free
• Famotidine (pepcid) - given if patient develop adverse reaction with tagamet
• Nizatidine (axid) - newest and most expensive

Side Effects:

• diarrhea - instruct to increase fluids and take with meals
• abdominal cramps
• confusion, dizziness, weakness - avoid driving
• antiandrogenic effect in men: gynecomastia, low libido, impotence

Antacids - neutralizes HCL.
It includes:

• amphojel, alternaGEL, dialume, alucap
• aluminum hydroxide is the antacid of choice because:
  
• a) it neutralizes hydrochloric acid
• b) inhibit pepsin activity
• c) stimulate prostaglandin synthesis

Side Effects:

• constipating - advise to increase fluids
• if with sodium may cause edema
• decreases absorption of phosphate
• if antacid contains calcium, may cause hypercalcemia

Misoprostol (Cytotec) - the drug used for cancer prevention and given to patients on long term aspirin medication. Acts like prostaglandin.

Side Effects:

• crampy abdominal pain
• diarrhea
• contraindicated in pregnant women because it causes uterine contraction

Agents that coat the gastric mucosa such as sulcrafate and bismuth compounds form protective barriers to promote ulcer healing.


Antibiotics - to inhibit H. pylori

• Bismuth compounds - (Pepto-Bismul) - antibacterial effect
• amoxicillin or tetracycline
• metronidazole (flagyl, protostat)

8) B
- Upper GI series, also known as barium swallow, is the x-ray visualization of the esophagus, stomach, duodenum, and upper duodenum. It can detect 80% of peptic ulcers and is the first diagnostic procedure employed as it is also less costly and less invasive than gastroscopy.

• barium swallow - only esophagus is x-rayed
• low bowel series - only small intestines is x-rayed

The purpose of this test is to:

• examination of the structure, position, peristalsis and motility of organs
• detects malposition, tumors, ulceration, inflammation and abnormal anatomy

Preparation:

• tell patient barium is white and has chalky taste
• NPO 6 hours
• allow to swallow barium prepared in milk shake form
• entire tests is about 45 minutes
• films are taken at intervals

After Test:

• give patient laxative to prevent constipation (barium may become hard and difficult to expel)
• expect the stool to be whitish for the next 48-72 hours because of barium
• assess the abdomen for distention and constipation because barium is constipating. Absence of bowel sounds on auscultation may result in barium impaction.

  

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