NCLEX-RN: GI Practice Questions

A female client who has just been diagnosed with hepatitis A asks, "How could I have gotten this disease?" What is the nurse's best response? A. "You may have eaten contaminated restaurant food." B. "You could have gotten it by using I.V. drugs." C. "You must have received an infected blood transfusion." D. "You probably got it by engaging in unprotected sex."

A. "You may have eaten contaminated restaurant food."

Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube? A. Change the tube feeding solutions and tubing at least every 24 hours. B. Maintain the head of the bed at a 15-degree elevation continuously. C. Check the gastrostomy tube for position every 2 days. D. Maintain the client on bed rest during the feedings.

A. Change the tube feeding solutions and tubing at least every 24 hours. Rationale: Elevation must be at least 30-45 degrees when on bed. Position is not checked since this is surgically placed, residual is still monitored. Patient should be upright during feedings

A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of: A. increasing fluid intake to prevent dehydration. B. wearing an appliance pouch only at bedtime. C. consuming a low-protein, high-fiber diet. D. taking only enteric-coated medications.

A. increasing fluid intake to prevent dehydration. Rationale: Ileostomy allow excretion of water even before it can be reabsorbed, fluid intake need to be increased to prevent dehydration. Appliance is changed regularly depending on output. Low residue diet needs to be followed and enteric coated medications should not be given.

11. To prevent gastroesophageal reflux in a male client with hiatal hernia, the nurse should provide which discharge instruction? A. "Lie down after meals to promote digestion." B. "Avoid coffee and alcoholic beverages." C. "Take antacids with meals." D. "Limit fluid intake with meals."

B. "Avoid coffee and alcoholic beverages." Rationale: Acidic food, caffeine, alcohol and tobacco products should be avoided. Patient should always stay well hydrated.

10. A client is suspected to have appendicitis. He complains of severe RLQ pain, nausea and vomiting, temperature is at 102 F. Which of the following interventions will be most appropriate? A. Administer 0.5mg Morphine IV push for the pain. B. Administer NS at 100 ml/hr C. Apply warm compress on the RLQ. D. Initiate cleansing enema to prepare for surgery.

B. Administer NS at 100 ml/hr Rationale: Pain medication is avoided until surgery has been scheduled, pain meds can mask signs of rupture. Warm compress and enema are avoided because it can precipitate rupture.

14. What laboratory finding is the primary diagnostic indicator for pancreatitis? A. Elevated blood urea nitrogen (BUN) B. Elevated serum lipase C. Elevated aspartate aminotransferase (AST) D. Increased lactate dehydrogenase (LD)

B. Elevated serum lipase Rationale: Lipase is the best indicator for pancreatitis.

A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially? A. Lying on the right side with legs straight B. Lying on the left side with knees bent C. Prone with the torso elevated D. Bent over with hands touching the floor

B. Lying on the left side with knees bent Rationale: this is the ideal/recommended position for the procedure.

When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? A. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. B. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. C. The appendix may develop gangrene and rupture, especially in a middle-aged client. D. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

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

Which condition is most likely to have a nursing diagnosis of fluid volume deficit? A. Appendicitis B. Pancreatitis C. Cholecystitis D. Gastric ulcer

B. Pancreatitis Rationale: Potential for bleeding internally and the inability to tolerate any form of oral intake.

When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: A. increased intracranial pressure. B. decreased urine output. C. bradycardia. D. hypertension.

B. decreased urine output. Rationale: Pancreatitis can lead to fatal hemorrhaging, decreased urine output may indicate internal bleeding.

A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse's first response is to: A. call the physician. B. place saline-soaked sterile dressings on the wound. C. take a blood pressure and pulse. D. pull the dehisced wound to close.

B. place saline-soaked sterile dressings on the wound. Rationale: Keeping the site moist with a sterile dressing soaked in saline is the recommended first aid for eviscerated organs. Then call the physician for an emergency repair. Manipulating the site is contraindicated.

A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been "spitting up blood." A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the client's wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is: A. "Tell me about your husband's alcohol usage." B. "Is your husband being treated for tuberculosis?" C. "Has your husband recently fallen or injured his chest?" D. "Describe spices and condiments your husband uses on food."

C. "Has your husband recently fallen or injured his chest?" Rationale: this condition is commonly associated with blunt abdominal trauma. Other risk factors include, prolonged vomiting, retching and coughing. Primal scream therapy.

The physician orders a Bernstein test for a client who complains of chest pain. When teaching the client about this test, the nurse explains that it's done to: A. Locate an esophageal mass. B. Evaluate competency of the lower esophageal sphincter. C. Assess for acid perfusion of the esophageal mucosa. D. Detect esophageal inflammation.

C. Assess for acid perfusion of the esophageal mucosa. Rationale: this test is to evaluate chest pain and rule out a potential GI cause if the cardiac workup is negative.

A male client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond? A. Notify the physician B. Reposition the tube C. Check the tube for kinks D. Increase the suction level

C. Check the tube for kinks Rationale: Assessment before interventions.

24. The client who is on long-term NSAID therapy is also receiving Misoprostol. The medication exhibits its therapeutic effect if the client did not experience which of the following symptoms? A. Diarrhea B. Constipation C. Epigastric pain D. Vomiting

C. Epigastric pain Rationale: Misoprostol is a prostaglandin analogue meant to help rebuild the mucosal barrier in the stomach. Absence of epigastric pain is the classic sign of the effectiveness.

Which diagnostic test would be used first to evaluate a client with upper GI bleeding? A. Endoscopy B. Upper GI series C. Hemoglobin (Hb) levels and hematocrit (HCT) D. Arteriography

C. Hemoglobin (Hb) levels and hematocrit (HCT) Rationale: Hemodynamic stability is assessed first in any confirmed case of GI bleed.

The nurse provides health teachings about Sucralfate. Which of the following best describes sucralfate? A. It works by blocking the H2 receptors of the parietal cells. B. It promotes ulcer healing by neutralizing hydrochloric acid. C. It promotes healing by adhering to ulcer surface. D. It suppresses gastric acid secretion.

C. It promotes healing by adhering to ulcer surface.

Sodium Bicarbonate was prescribed to a patient to relieve heartburn. The nurse knows that the medication is contraindicated to which of the following conditions? A. Respiratory acidosis B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory alkalosis

C. Metabolic alkalosis

The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? A. Regular diet B. Skim milk C. Nothing by mouth D. Clear liquids

C. Nothing by mouth Rationale: GI bleed will require complete GI rest, patient needs to be on NPO and if the bleed is from the upper GIT then an NGT needs to be placed for decompression.

The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first? A. Administering pain medication B. Obtaining a blood sample for laboratory studies C. Preparing to insert a nasogastric (NG) tube D. Administering I.V. fluids

C. Preparing to insert a nasogastric (NG) tube Rationale: GI rest will take the highest priority. NGT for decompression and placing the client on NPO will be done first

The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? A. Dyspnea and fatigue B. Ascites and orthopnea C. Purpura and petechiae D. Gynecomastia and testicular atrophy

C. Purpura and petechiae Rationale: deficiency in this vitamin can lead to bleeding tendencies.

A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: A. yellow sclera. B. light amber urine. C. severe RUQ pain D. black, tarry stools.

C. severe RUQ pain Rationale: Pain is the classic sign for biliary obstruction accompanied by nausea and vomiting. Yellow sclera, tea colored urine and jaundice are later signs if the condition does not resolve.

17. While palpating a female client's right upper quadrant (RUQ), the nurse would expect to find which of the following structures? A. Sigmoid colon B. Appendix C. Spleen D. Liver

D. Liver

Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: A. a sedentary lifestyle and smoking. B. a history of hemorrhoids and smoking. C. alcohol abuse and a history of acute renal failure. D. alcohol abuse and smoking.

D. alcohol abuse and smoking. Rationale: Option D has two major risk factors. The other options only one risk factor.

A patient with gastroesophageal reflux disease asks which food will not aggravate his present condition. The nurse should instruct the patient to include which of the following? A. Fried chicken B. Coffee C. Chocolate D. baked chicken breast

D. baked chicken breast

During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia? A. vitamin A B. vitamin D C. vitamin E D. vitamin K

D. vitamin K Rationale: Vitamin K is synthesized by bacterial flora, deficiency in this vitamin can lead to bleeding tendencies

A client is scheduled to have a fundoplication. What statement by the client indicates a need to review preoperative teaching? a. After the operation I can eat anything I want. b. I will have to eat smaller, more frequent meals. c. I will take stool softeners for several weeks. d. This surgery may not totally control my symptoms.

a. After the operation I can eat anything I want. Nutritional and lifestyle changes need to continue after surgery as the procedure does not offer a lifetime cure. The other statements show good understanding.

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention? a. Notify the health care provider (HCP) b. Administer the prescribed pain medication c. Call and ask the the operating room team to perform surgery as soon as possible. d. Reposition the client and apply a heating pad on the warm setting tot he client's abdomen.

a. Notify the health care provider (HCP) Rationale: On the basis of the signs and symptoms presented in the question, the nurse should suspect peritonitis and notify the HCP. Administering pain medication is not an appropriate intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis because of the risk of rupture. Scheduling surgical time is not within the scope of nursing practice, although the HCP probably would perform the surgery earlier than the prescheduled time.

A client with an esophageal tumor is having extreme difficulty swallowing. For what procedure does the nurse prepare this client? a. Enteral tube feeding b. Esophageal dilation c. Nissen fundoplication d. Photodynamic therapy

b. Esophageal dilation Esophageal dilation can provide immediate relief of esophageal strictures that impair swallowing. Enteral tube feeding is a method of providing nutrition when dysphagia is severe, but esophageal dilation would be attempted before this measure is taken. Nissen fundoplication is performed for severe gastroesophageal reflux disease. Photodynamic therapy is performed for esophageal cancer.

A client has been taught about alginic acid and sodium bicarbonate (Gaviscon). What statement by the client indicates that teaching has been effective? a. I can only take this medicine at night. b. I should take this on a full stomach. c. This drug decreases stomach acid. d. This should be taken 1 hour before meals.

b. I should take this on a full stomach. Gaviscon should be taken with food in the stomach. It can be taken with meals at any time. Its mechanism of action is not to decrease stomach acid.

A client with an esophageal tumor has difficulty swallowing and has been working with a speech-language pathologist. What assessment finding by the nurse indicates that the priority goal for this problem is being met? a. Choosing foods that are easy to swallow b. Lungs clear after meals and snacks c. Properly performing swallowing exercises d. Weight unchanged after 2 weeks

b. Lungs clear after meals and snacks All these assessment findings are positive for this client. However, this client is at high risk for aspiration. Clear lungs after eating indicates no aspiration has occurred. Choosing easy-to-swallow foods, performing swallowing checks, and having an unchanged weight do not assess aspiration, and therefore do not indicate that the priority goal has been met.

A client has returned to the nursing unit after an open Nissen fundoplication. The client has an indwelling urinary catheter, a nasogastric (NG) tube to low continuous suction, and two IVs. The nurse notes bright red blood in the NG tube. What action should the nurse take first? a. Document the findings in the chart. b. Notify the surgeon immediately. c. Reassess the drainage in 1 hour. d. Take a full set of vital signs.

d. Take a full set of vital signs. The drainage in the NG tube should initially be brown with old blood. The presence of bright red blood indicates bleeding. The nurse should take a set of vital signs to assess for shock and then notify the surgeon. Documentation should occur but is not the first thing the nurse should do. The nurse should not wait an additional hour to reassess.