GI NCLEX Questions/Answers

621. The client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which expected assessment finding? 1.malaise 2.dark stools 3.weight gain 4.left upper quadrant discomfort

1. Hepatitis causes G.I. symptoms such as anorexia, nausea, right upper quadrant discomfort, and weight loss. Fatigue and malaise are common. Stools will be light or clay colored if conjugated Bilirubin is unable to flow out of the liver because of inflammation or obstruction of the bile ducts.

627. The nurse is caring for a client with a diagnosis of chronic gastritis. The nurse monitors the client, knowing that this client is at risk for which vitamin deficiency? 1.vitamin A 2.vitamin B 12 3.vitamin C 4.vitamin E

2. Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of function of the parietal cells. The source of intrinsic factor is lost, which results in an inability to absorb vitamin B12. This leads to pernicious anemia

624. The client has undergone esophagogastroduodenoscopy. The nurse should place highest priority on which item as part of the clients care plan? 1.monitoring the temperature 2.monitoring complaints of heartburn 3.giving warm gargles for sore throat 4.assessing for the return of the gag reflex

4. The highest priority is assessing for return of the gag reflex. This assessment addresses the claims airway, which is priority.

623. The nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances to avoid. Which items should the nurse include on the list? Select all that apply. 1.coffee 2.chocolate 3.peppermint 4.nonfat milk 5.fried chicken 6.scrambled eggs

1, 2, 3, 5 Foods that decrease lower esophagus sprinter pressure and irritate the esophagus will increase reflux and exasperate the symptoms of GERD and therefore should be avoided. Aggravating substances include chocolate, coffee, fried or fatty foods, peppermint, carbonated beverages, and alcohol.

632. The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis which interventions with the nurse expect to be prescribed for the client? Select all that apply. 1.administer antacids as prescribed 2.encourage coughing and deep breathing 3.administer anticholinergics as prescribed 4.give small, frequent high calorie feedings 5.maintain the client in a supine and flat position 6.give meperidine (Demerol) as prescribed for pain

1, 2, 3, 6

622. The client has just had a hemorrhoidectomy. Which nursing intervention's are appropriate for this client? Select all that apply. 1.administer stool softeners as prescribed. 2.instruct the client to limit fluid intake to avoid urinary retention. 3.instruct the client to avoid activities that will initiate vasovagal responses. 4.encourage a high fiber diet to promote bowel movements without straining 5.apply cold packs to the anal-rectal area over the dressing until the packing is removed. 6.help the client to Fowlers position to place pressure on the rectal area and decrease bleeding.

1, 4, 5 Nursing interventions after a hemorrhoidectomy are aimed at management of pain and avoidance of bleeding and incision rupture . Stool softeners and a high fiber diet will help the client avoid straining, thereby reducing the chances of rupturing the incision. An ice pack will increase comfort and decrease bleeding

638. The nurse is assessing fir stoma prolapse in a client with a colostomy. What should the nurse observe if stoma prolapse occurs? 1.protruding stoma 2.sunken and hidden stoma 3.narrowed and flattened stoma 4.dark and bluish colored stoma

1. A prolapsed stoma is one in which the bowel protrudes through the stoma. A stomach retraction is characterized by sinking of the stoma. A stoma with a narrowed opening at the level of the skin or fascia is said to be stenosed. Ischemia of the stoma would be associated with a dusky or bluish color.

639. A client had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct interpretation from the nurse? 1.this is a normal expected event. 2.the client is experiencing early signs of ischemic bowel. 3.to the client should not have the NG tube removed. 4.this indicates inadequate preoperative bowel preparation.

1. As peristalsis returns following creation of a colostomy, the client begins to pass malodorous flatus. This indicates returning bowel function, and is an expected event.

635. The nurse is reviewing the laboratory results for a client with cirrhosis and notes that they ammonia level is elevated. Which diet does the nurse anticipate to be prescribed for this client? 1.low-protein diet 2.high-protein diet 3.moderate fat diet 4.high carbohydrate diet

1. Cirrhosis is a chronic, progressive disease of the liver characterized by diffuse degeneration and destruction of hepatocytes. Most of the ammonia in the body is found in the G.I. tract. Protein provided by the diet is transported to the liver by the portal vein. The liver breaks down proteins, which results in the formation of ammonia. If the client has hepatic encephalopathy, A low-protein diet would be prescribed.

633. The nurse is reviewing the record of the client with Crohn's disease. Which stool characteristic should the nurse expect to note documented in the client's record? 1.diarrhea 2.constipation 3.constipation alternating with diarrhea 4.stool constantly oozing from the rectum

1. Crohn's disease is characterized by non-body diarrhea of usually not more than 4 to 5 stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity.

642. The nurse is monitoring the client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence? 1.sweating and pallor 2.bradycardia and indigestion 3.double vision and chest pain 4.abdominal cramping and pain

1. 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.

626. The healthcare provider has determined that a client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? 1.hepatitis A 2.hepatitis B 3.hepatitis C 4.hepatitis D

1. Hepatitis A is transmitted by the fecal - oral route. Hepatitis B, C and D are transmitted most commonly via infected blood or body fluids.

637. A client with a hiatal hernia chronically experiences heartburn following meals. The nurse should plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia? 1.lying recumbent following meals 2.consuming small, frequent, bland meals 3.raising the head of the bed on 6 inch blocks 4.taking H2 receptor antagonist medication

1. Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm where the esophagus usually is positioned. The client usually experiences pain from reflux caused by ingestion of irritating foods, laying flat following meals or at night, and eating larger fatty meals. Relief is obtained with the intake a small, frequent, and bland meals, use of H2 receptor antagonists and antacids, and elevation of the thorax following meals and during sleep.

617. The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis and 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 at the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention? 1.notify the healthcare provider 2.administer prescribed pain medication 3.call & ask the operating room team to perform the surgery soon as possible 4.reposition the client and place a heating pad on the warm setting to the clients abdomen

1. On the basis of the signs and symptoms presented in the question, the nurse should suspect peritonitis and notify the HCP.

620. The client is admitted to the hospital with viral hepatitis, complaining of "no appetite" and "losing my taste for food". What instructions to the nurse give the client to provide adequate nutrition? 1.select foods high in fat 2.increased intake of fluids, including juices 3.eat a good supper when anorexia is not as severe 4.eat less often, preferably only 3 large meals per day

2. Although no special diet is required to treat viral hepatitis, it is generally recommended that a client consume a low-fat diet as fat maybe tolerated poorly because of decreased bile production. Small, frequent meals are preferable and may even prevent nausea. Frequently, appetite is better in the morning so it is easier to eat a good breakfast. An adequate fluid intake of 2500 to 3000 mL per day that includes nutritional juices is also important.

618. A client has been admitted to the hospital with a diagnosis of acute pancreatitis. And the nurse is assessing clients pain. What type of pain is consistent with this diagnosis? 1.burning and aching, located in the left lower quadrant and radiating to the hip 2.severe and unrelenting, located in the epigastric area and radiating to the back 3.burning and aching, located in the epigastric area and radiating to the umbilicus 4.severe and unrelenting, located in the left lower quadrant and radiating to the groin

2. The pain associated with acute pancreatitis is often severe and unrelenting, is located in the epigastric region, and radiates to the back.

641. The nurse is doing preoperative teaching with a client who is about to undergo creation of a Kock pouch. The nurse interprets that the client has the best understanding of the nature of the surgery if the client makes which statement? 1.I will be able to pass stool by the rectum eventually. 2.the drainage from this type of ostomy will be formed. 3.I will need to drain the pouch regularly with a catheter. 4.I will need to wear a drainage bag for the rest of my life.

3. A Kock pouch is a continent ileostomy. As ileostomy begins to function, the client drains it every 3 to 4 hours and then decreases the draining to about three times a day, or as needed when full.

636. The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse should assess the client for which symptoms of duodenal ulcer? 1.weight loss 2.nausea and vomiting 3.pain relieved by food intake 4.pain radiating down the arm

3. A frequent symptom of duodenal ulcer is pain that is relieved by food intake. These clients generally described the pain as a burning, heavy, sharp, or "hungry" pain that often localizes in the mid epigastric area.

631. The nurse is providing discharge instructions to a client following gastrectomy and should instruct the client to take which measure to assist in preventing dumping syndrome? 1.ambulate following a meal. 2.eat high carbohydrate foods. 3.limit the fluid taken with meals. 4.sit in a high Fowlers position during meals.

3. Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after eating, especially following a Billroth II procedure. Early manifestation 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 take anti-spasmodics as prescribed.

628. The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750 mL of green - brown drainage since the surgery. Which nursing intervention is most appropriate? 1.clamp the T-tube. 2.irrigate the T-tube. 3.documents the findings. 4.notify the healthcare provider

3. Following a cholecystectomy, drainage from the t-tube is initially bloody and then turns a greenish/brown color. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 mL a day. The nurse would document the output.

630. The nurse is caring for a client following a Billroth II procedure. Which post operative prescription should the nurse question and verify? 1.leg exercises 2.early ambulation 3.irrigating the nasogastric tube 3.cough and deep breathing exercises

3. 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 secretion. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically prescribed by the HCP. The nurse should clarify this prescription.

634. The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that there is documentation of the presence of asterixis. How should the nurse assessed for its presence? 1.Dorsiflex the clients foot. 2.measure the abdominal girth. 3.ask the client to extend the arms. 4.instruct the client to lean forward.

3. Asterixis is irregular flapping movements of the fingers and wrists when the hands and arms are outstretched, with palms down, wrist bent up, and fingers spread. Asterixis is the most common and reliable sign that hepatic encephalopathy is developing.

640. The client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which most frequent complication of this type of surgery? 1.folate deficiency 2.malabsorption of fat 3.intestinal obstruction 4.fluid and electrolyte imbalance

4. A frequent complication that occurs following ileostomy is fluid and electrolyte imbalance. The client requires constant monitoring of i's & o's.

619. The nurse is assessing a client who is experiencing acute episode of cholecystitis. Where should the nurse anticipate the location of the pain? 1.right lower quadrant, radiating to the back 2.right lower quadrant, radiating to the umbilicus 3.right upper quadrant, radiating to the left scapula and shoulder 4.right upper quadrant, radiating to the right scapula and shoulder

4. During an acute episode of cholecystitis, the client complains of severe right upper quadrant pain that radiates to the right scapula and shoulder. This is determined by the pattern of dermatomes in the body.

629. The nurse is monitoring a client with a diagnosis of peptic ulcer, which assessment finding would most likely indicate perforation of the ulcer? 1.bradycardia 2.numbness in the legs 3.nausea and vomiting 4 a rigid, board-like abdomen

4. Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the mid epigastric area and spreading over the abdomen, which becomes a rigid and board like. N/V May occur. Tachycardia May occur is hypovolemic shock develops.

The nurse is preparing a client for a liver biopsy. On review of the clients laboratory results of the nurse notes that the clients bleeding time is 10 minutes and the prothrombin time is 35 seconds. What should the nurse do?

Contact the healthcare provider immediately. Bleeding is a primary concern for liver biopsy because of the high vascularity of the liver. A pre-procedure assessment is to check the client status related to the risk for bleeding. Normal bleeding time ranges from 1 to 6 minutes and normal prothrombin time ranges from 9.5 to 11.8 seconds. The client is at risk for bleeding.