GI NCLEX REVIEW QUESTIONS for ADULT GI

A client has been experiencing lower GI difficulties that have increased in severity, and the gastroenterologist is concerned that the client's bowel is not functioning properly. What function of the lower GI tract is most likely to be affected by the client's disorder? A. water and electrolyte absorption B. protein digestion C. fat digestion D. All options are correct.

A Explanation: Disorders of the lower GI tract usually affect movement of feces toward the anus, absorption of water and electrolytes, and elimination of dietary wastes.

A nurse is providing follow-up teaching at a clinic visit for a client recovering from gastric resection. The client reports sweating, diarrhea, nausea, palpitations, and the desire to lie down 15 to 30 minutes after meals. Based on the client's assessment, what will the nurse suspect? A. Dumping syndrome B. Dehiscence of the surgical wound C. Peritonitis D. A normal reaction to surgery

A Explanation: Early manifestations of dumping syndrome occur 15 to 30 minutes after eating. Signs and symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down. Dehiscence of the surgical wound is characterized by pain and a pulling or popping feeling at the surgical site. Peritonitis presents with a rigid, board-like abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.

A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, labored breathing, and appears to be confused. Which complication has the client most likely developed? A. Hemorrhage B. Penetration C. Perforation D. Pyloric obstruction

A Explanation: Signs of hemorrhage following surgery include cool skin, confusion, increased heart rate, labored breathing, and blood in the stool. Signs of penetration and perforation are severe abdominal pain, rigid and tender abdomen, vomiting, elevated temperature, and increased heart rate. Indicators of pyloric obstruction are nausea, vomiting, distended abdomen, and abdominal pain.

A nurse is reviewing lab results for a client with an intestinal obstruction, and infection is suspected. What would be an expected finding? A. leukocytosis; elevated hematocrit; low sodium, potassium, and chloride B. leukopenia, decreased hematocrit; low sodium, potassium, and chloride C. leukocytosis; metabolic alkalosis; elevated sodium, potassium, and chloride D. leukopenia; metabolic acidosis; elevated sodium, potassium, and chloride

A Explanation: Tests of serum electrolytes may indicate low levels of sodium, potassium, and chloride. Metabolic alkalosis is evidenced by arterial blood gas results. A complete blood count (CBC) shows an increased WBC count in instances of infection. The hematocrit level is elevated if dehydration develops.

A client is admitted with a gastrointestinal bleed. What client symptom may indicate a peptic ulcer perforation to the nurse? A. Sudden, severe upper abdominal pain B. Hypertension C. Bradycardia D. Soft abdomen

A Explanation: The client with a peptic ulcer perforation may have symptoms such as sudden, sever upper abdominal pain, vomiting, fainting, an extremely tender and rigid (board-like) abdomen, and hypotension and tachycardia, indicating shock. The client with a bleeding peptic ulcer will not experience hypertension or bradycardia. The client's abdomen with a peptic ulcer bleed will not be soft, but rigid.

A client is admitted from the emergency department with complaints of severe abdominal pain and an elevated white blood cell count. The physician diagnoses appendicitis. The nurse knows the client is at greatest risk for: A. rupture of the appendix. B. ulceration of the appendix. C. inflammation of the gallbladder. D. emotional distress related to the pain.

A Explanation: The most severe complication of appendicitis is rupture of the appendix, which can lead to a life-threatening infection. Ulceration of the appendix and inflammation of the gallbladder aren't risks in appendicitis. Although the client may have emotional distress because of the pain, this factor isn't the greatest risk to the client.

The nurse is working in a diagnostic testing unit focusing on gastrointestinal studies. For which testing procedure is the nurse correct to assess the gag reflex before offering fluids? A. Esophagogastroduodenoscopy B. Sigmoidoscopy C. Peritoneoscopy D. Colonoscopy

A Explanation: The nurse is correct to assess the gag reflex prior to offering fluids for a client having an esophagogastroduodenoscopy (EGD). The other options are lower gastrointestinal studies typically requiring a bowel preparation.

A nurse is caring for a client who is suspected to have developed a peptic ulcer hemorrhage. Which action would the nurse perform first? A. Place the client in a recumbent position with the legs elevated. B. Prepare a peripheral and central line for intravenous infusion. C. Assess vital signs. D. Notify the healthcare provider.

A Explanation: The treatment of hemorrhage includes complete rest for the GI tract, placing the client in a recumbent position with the legs elevated to increase blood flow to vital organs, blood transfusions, and gastric lavage with saline solution. Placing an IV, checking the client's vital signs, and notifying the healthcare provider are important, but not the priority action for the nurse when a client is actively bleeding.

Diagnostic imaging and physical assessment have revealed that a client with peptic ulcer disease has suffered a perforated ulcer. The nurse recognizes that emergency interventions must be performed as soon as possible in order to prevent the development of what complication? A. Peritonitis B. Gastritis C. Gastroesophageal reflux D. Acute pancreatitis

A Explanation: Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. Chemical peritonitis develops within a few hours of perforation and is followed by bacterial peritonitis. Gastritis, reflux, and pancreatitis are not acute complications of a perforated ulcer.

A nurse is providing education to a client with GERD. The client asks what measures can be taken independently to help reduce the symptoms. Which interventions would the nurse recommend? Select all that apply. A. maintaining an upright position following meals B. avoiding foods that intensify symptoms C. sleeping in a supine position D. ensuring intake of food and fluids 2 to 3 hours before bedtime

A, B Explanation: Conservative measures used in the treatment of GERD are maintaining an upright position following meals, avoiding foods that intensify symptoms, elevating the head of the bed when sleeping, and avoiding the intake of food and fluids 2 to 3 hours before bedtime.

Tube feedings are advised for a client who is recovering from oral surgery. The nurse manages the tube feedings to minimize the risk of aspiration. Which measures should the nurse include in the care plan to reduce the risk of aspiration? Select all that apply. A. Place client in semi-Fowler's position during and 30 to 60 minutes after an intermittent feeding. B. Check tube placement and gastric residual prior to feedings. C. Administer 15 to 30 mL of water before and after medications and feedings. D. Change the tube feeding container and tubing.

A, B Explanation: Proper positioning prevents regurgitation. Checking tube placement and gastric residual prior to feedings is another important measure because it prevents improper infusion and vomiting.

A patient comes to the clinic with the complaint, "I think I have an ulcer." What is a characteristic associated with peptic ulcer pain that the nurse should inquire about? Select all that apply. A. Burning sensation localized in the back or mid-epigastrium B. Feeling of emptiness that precedes meals from 1 to 3 hours C. Severe gnawing pain that increases in severity as the day progresses D. Pain that radiates to the shoulder or jaw E. Vomiting without associated nausea

A, B, C Explanation: As a rule, the patient with an ulcer complains of dull, gnawing pain or a burning sensation in the mid-epigastrium or the back. Although vomiting is rare in uncomplicated peptic ulcer, it may be a symptom of a complication of an ulcer.

A client is being treated for diverticulosis. Which points should the nurse include in this client's teaching plan? Select all that apply. A. Do not suppress the urge to defecate. B. Drink at least 8 to 10 large glasses of fluid every day. C. Use bulk-forming laxatives D. Encourage an individualized exercise program E. Avoid high-fiber foods

A, B, C, D Explanation: Avoid constipation; do not suppress the urge to defecate. Consume at least 2 L/day (within limits of the client's cardiac and renal reserve) and include foods that are soft but have increased fiber, such as prepared cereals or soft-cooked vegetables, to increase the bulk of the stool and facilitate peristalsis, thereby promoting defecation. The nurse should encourage daily intake of bulk laxatives such as psyllium. An individualized exercise program is encouraged to improve abdominal muscle tone.

The nurse is caring for a client who has just returned from the PACU after surgery for peptic ulcer disease. For what potential complications does the nurse know to monitor? Select all that apply. A. Hemorrhage B. Inability to clear secretions C. Perforation D. Penetration E. Pyloric obstruction F. Cachexia

A, C, D, E Explanation: Potential complications may include hemorrhage, perforation, penetration, and pyloric obstruction. A client who has had surgery for peptic ulcer disease may have a decreased appetite in the immediate postoperative stage, but it is not something the nurse would monitor for and would not cause cachexia. Inability to clear secretions is generally not a complication of peptic ulcer surgery.

The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also reports unpleasant tastes and odors. Which measure should be included in the client's plan of care? A. Ensure adequate hydration with additional water. B. Provide frequent mouth care. C. Keep the feeding formula refrigerated. D. Flush the tube with water before adding the feedings.

B Explanation: Frequent mouth care helps to relieve the discomfort from dryness and unpleasant odors and tastes. It can be done with the help of ice chips and analgesic throat lozenges, gargles, or sprays. Adequate hydration is essential. If urine output is less than less than 500 mL/day, formula and additional water can be given as ordered. Keeping the feeding formula refrigerated and unopened until it is ready for use and flushing the tube with water before adding feedings are measures to protect the client from infections.

A client has been admitted to the hospital after diagnostic imaging revealed the presence of a gastric outlet obstruction (GOO). What is the nurse's priority intervention? A. Administration of antiemetics B. Insertion of an NG tube for decompression C. Infusion of hypotonic IV solution D. Administration of proton pump inhibitors as prescribed

B Explanation: In treating the client with gastric outlet obstruction, the first consideration is to insert an NG tube to decompress the stomach. This is a priority over fluid or medication administration.

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of: A. A pelvic abscess. B. Peritonitis C. An ileus. D. An abscess under the diaphragm.

B Explanation: Peritonitis is inflammation of the peritoneum, the serous membrane lining the abdominal cavity and covering the viscera. Peritonitis is typically a life-threatening emergency that requires prompt surgical intervention, and typically involves postoperative critical care monitoring due to the risk of sepsis, organ failure, and subsequent infections.

An adult client has been diagnosed with diverticular disease after ongoing challenges with constipation. The client will be treated on an outpatient basis. What components of treatment should the nurse anticipate? Select all that apply. A. Anticholinergic medications B. Increased fiber intake C. Enemas on alternating days D. Reduced fat intake E. Fluid reduction

B, D Explanation: Clients whose diverticular disease does not warrant hospital treatment often benefit from a high-fiber, low-fat diet. Neither enemas nor anticholinergics are indicated, and fluid intake is encouraged.

The nurse is caring for a patient who has had an appendectomy. What is the best position for the nurse to maintain the patient in after the surgery? A. Prone B. Sims' left lateral C. High Fowler's D. Supine with head of bed elevated 15 degrees

C Explanation: After surgery, the nurse places the patient in a high Fowler's position. This position reduces the tension on the incision and abdominal organs, helping to reduce pain.

A client with a gastrojejunostomy is beginning to take solid food. Which finding would lead the nurse to suspect that the client is experiencing dumping syndrome? A. Dry skin B. Slowed heart beat C. Diarrhea D. Hyperglycemia

C Explanation: Clients with a gastrojejunostomy are at risk for developing the dumping syndrome when they begin to take solid food. This syndrome produces weakness, dizziness, sweating, palpitations, abdominal cramps, and diarrhea, which result from the rapid emptying (dumping) of large amounts of hypertonic chyme (a liquid mass of partly digested food) into the jejunum. This concentrated solution in the gut draws fluid from the circulating blood into the intestine, causing hypovolemia. The drop in blood pressure can produce syncope. As the syndrome progresses, the sudden appearance of carbohydrates in the jejunum stimulates the pancreas to secrete excessive amounts of insulin, which in turn causes hypoglycemia.

The nurse is working on a general medical unit. A client is scheduled for an upper gastrointestinal series. Upon return to the nursing unit, what does the nurse identify as the client goal? A. Recover from the general anesthesia B. Decrease nausea and vomiting C. Increase the amount of fluids D. Ambulate independently

C Explanation: The client, returning from an upper gastrointestinal series, needs to increase fluids in an effort to eliminate the barium from the body through a bowel movement. General anesthesia is not used. The client typically does not have nausea and vomiting following the procedure. If the client is able to ambulate independently prior to the procedure, the client will be able to ambulate independently following.

A nurse is providing home care to a client receiving intermittent tube feedings. The client wants to take an over-the-counter allergy medication. The medication would need to be given via feeding tube because the client has difficulty swallowing. The nurse checks the medication and finds that it is a timed-release tablet. Which action by the nurse would be most appropriate? A. Tell the client to dissolve the tablet in water to administer it. B. Have the client mix it with the feeding formula after crushing the tablet. C. Check with the pharmacy for an alternative formulation for the drug. D. State that the client cannot take the drug anymore.

C Explanation: Timed-release medications should not be crushed. Rather, the nurse should check with the pharmacy to see if another formulation (e.g., liquid) is available that can be used safely with a feeding tube. Dissolving the tablet in water, like crushing it, would affect the drug's action, possibly releasing too much of the drug too quickly. Stating that the client cannot take the drug anymore is inappropriate. A change in formulation or possibly a change to another drug in an appropriate formulation would be appropriate.

A client receives tube feedings after an oral surgery. The nurse manages tube feedings to minimize the risk of aspiration. Which measure should the nurse include in the care plan to reduce the risk of aspiration? A. Change the tube feeding container ,tubing, and adjust patient head of bed . B. Avoid cessation of feedings and adjust patient head of bed. C. Use semi-Fowler position during, and 60 minutes after, an intermittent feeding. D. Administer 15 to 30 mL of water before and after medications and feedings.

C Explanation: To minimize the risk of aspiration, it is important to place the client in a semi-Fowler position during, and 60 minutes after, an intermittent feeding because proper positioning prevents regurgitation. Checking tube placement and gastric residual prior to feedings is another important measure because it prevents improper infusion and vomiting. If aspiration is suspected, feeding should be stopped as cessation prevents further problems and allows for treatment of the immediate problem. Changing tube feeding container and tubing, monitoring weight daily, and administering 15 to 30 mL of water before and after medications and feedings are measures to maintain tube function.

The nurse observes the physician palpating the abdomen of a client that is suspected of having acute appendicitis. When the abdomen is pressed in the left lower quadrant the client complains of pain on the right side. What does the nurse understand this assessment technique is referred to? A. Referred pain B. Rebound pain C. Rovsing sign D. Cremasteric reflex

C Explanation: When an examiner deeply palpates the left lower abdominal quadrant and the client feels pain in the right lower quadrant, this is referred to as a positive Rovsing sign and suggests acute appendicitis. Referred pain indicates pain in another area but is not necessarily manipulated by the examiner. Rebound pain is indicated when the pain of palpation is worse when the pressure is off of the site. The cremasteric reflex is a superficial reflex that is present in male clients.

The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching? A. Avoid unprocessed bran. B. Avoid daily exercise. C. Drink 8 to 10 glasses of fluid daily. D. Use laxatives weekly.

C Explanation: The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the physician. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.

A patient with irritable bowel syndrome has been having more frequent symptoms lately and is not sure what lifestyle changes may have occurred. What suggestion can the nurse provide to identify a trigger for the symptoms? A. Document how much fluid is being taken to determine if the patient is overhydrating. B. Discontinue the use of any medication presently being taken to determine if medication is a trigger. C. Begin an exercise regimen and biofeedback to determine if external stress is a trigger. D. Keep a 1- to 2-week symptom and food diary to identify food triggers.

D Explanation: The nurse emphasizes and reinforces good dietary habits (e.g., avoidance of food triggers). A good way to identify problem foods is to keep a 1- to 2-week symptom and food diary.

A client has symptoms suggestive of peritonitis. Nursing management would not include: A. limiting analgesics to avoid the formation of paralytic ileus. B. accurate recording of input and output. C. inserting a nasogastric tube. D. inserting a urinary retention catheter.

A Explanation: Analgesics such as meperidine or IV morphine sulfate are ordered to relieve pain and promote rest. Because hypovolemia can occur from fluids leaking into the peritoneal cavity, input and output are monitored closely to assist in determining fluid replacement. A nasogastric tube is used to relieve abdominal distention by suctioning the accumulated gas and stagnant upper GI fluids. If hypovolemia is present, renal perfusion can become decreased, requiring close monitoring.

A client receiving tube feedings has prescriptions for several drugs. Which drugs would the nurse expect to administer to the client without any special preparation? Select all that apply. A. Liquid stool softener B. Sublingual nitroglycerin C. Enteric-coated aspirin D. Sustained-release antihypertensive E. Acetaminophen tablet

A, B Explanation: Liquid medications do not require any special preparation for administration via a feeding tube. Buccal or sublingual tablets are administered as prescribed. They are absorbed through the mucosa of the cheek or under the tongue and thus would not be administered through the feeding tube. Enteric-coated aspirin and sustained-release antihypertensive could not be given as is through a feeding tube. A change in formulation would be needed. An acetaminophen tablet would need to be crushed and dissolved in water before being given.

The nurse is admitting a client with a diagnosis of diverticulitis and assesses that the client has a board-like abdomen, no bowel sounds, and reports of severe abdominal pain. What is the nurse's first action? A. Start an IV with lactated Ringer's solution. B. Notify the health care provider. C. Administer a retention enema. D. Administer an opioid analgesic.

B Explanation: Abdominal pain, a rigid board-like abdomen, loss of bowel sounds, and signs and symptoms of shock occur with peritonitis. Peritonitis is typically a life-threatening emergency that requires prompt surgical intervention, and typically involves postoperative critical care monitoring due to the risk of sepsis, organ failure, and subsequent infections; thus, the nurse should notify the health care provider.

A client who suffered a stroke had an NG tube inserted to facilitate feeding shortly after admission. The client has since become comatose and the client's family asks the nurse why the physician is recommending the removal of the client's NG tube and the insertion of a gastrostomy tube. What is the nurse's best response? A. It eliminates the risk for infection. B. Feeds can be infused at a faster rate. C. Regurgitation and aspiration are less likely. D. It allows caregivers to provide personal hygiene more easily.

C Explanation: Gastrostomy is preferred over NG feedings in the client who is comatose because the gastroesophageal sphincter remains intact, making regurgitation and aspiration less likely than with NG feedings. Both tubes carry a risk for infection; this change in care is not motivated by the possibility of faster infusion or easier personal care.

A nurse is caring for a client hospitalized with an exacerbation of chronic gastritis. What health promotion topic should the nurse emphasize? A. Strategies for maintaining an alkaline gastric environment B. Safe technique for self-suctioning C. Techniques for positioning correctly to promote gastric healing D. Strategies for avoiding irritating foods and beverages

D Explanation: Measures to help relieve pain include instructing the client to avoid foods and beverages that may be irritating to the gastric mucosa and instructing the client about the correct use of medications to relieve chronic gastritis. An alkaline gastric environment is neither possible nor desirable. There is no plausible need for self-suctioning. Positioning does not have a significant effect on the presence or absence of gastric healing.

A client is in the hospital for the treatment of peptic ulcer disease. The client reports vomiting and a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate? A. Ineffective treatment for the peptic ulcer B. A reaction to the medication given for the ulcer C. Gastric penetration D. Perforation of the peptic ulcer

D Explanation: Signs and symptoms of perforation include the following: Sudden, severe upper abdominal pain (persisting and increasing in intensity), which may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm; vomiting; collapse (fainting); extremely tender and rigid (board-like) abdomen; and hypotension and tachycardia, indicating shock.

When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the initial appropriate action by the nurse? A. Notify the health care provider. B. Irrigate the client's NG tube. C. Place the client in the high-Fowler's position. D. Assess the client's abdomen and vital signs.

D Explanation: Signs and symptoms of perforation includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.

A nurse is caring for a client with a nasogastric tube for feeding. During shift assessment, the nurse auscultates a new onset of bilateral lung crackles and notes a respiratory rate of 30 breaths per minute. The client's oxygen saturation is 89% by pulse oximetry. After ensuring the client's immediate safety, what is the nurse's most appropriate action? A. Perform chest physiotherapy. B. Reduce the height of the client's bed and remove the NG tube. C. Liaise with the dietitian to obtain a feeding solution with lower osmolarity. D. Report possible signs of aspiration pneumonia to the primary provider.

D Explanation: The client should be assessed for further signs of aspiration pneumonia. It is unnecessary to remove the NG tube and chest physiotherapy is not indicated. A different feeding solution will not resolve this complication.

It is important for the nurse to monitor serum electrolytes in a patient with acute diarrhea. Select the electrolyte result that should be immediately reported. A. Chloride of 100 mEq/L B. Sodium of 136 mEq/L C. Calcium of 9 mg/dL D. Potassium of 2.8 mEq/L

D Explanation: The normal serum potassium level is 3.5 to 5 mEq/L. Hypokalemia can be severe if less than 2.5 mEq/L. A potassium result of 2.8 should be reported because it is significantly lower than normal. The other choices are normal levels.

The nurse cares for a client after a gastroscopy for which the client received sedation. The nurse should report which finding to the physician? A. loss of gag reflex B. minor throat pain C. drowsiness D. difficulty swallowing

D Explanation: The nurse should report difficulty swallowing to the physician as this may be a sign of perforation. Loss of gag reflex, minor throat pain, and drowsiness are expected findings after a gastroscopy for which the client received sedation and therefore there is no need to report to the physician