GI PRACTICE QUESTIONS
A nurse is planning care for a female client has has severe irritable bowel syndrome with diarrhea (IBS-D) and a new prescription for alosetron. Which of the following interventions should the nurse include in the plan of care? A. The client must sign an agreement with the provider before beginning alosetron. B. The client must stop taking alosetron if diarrhea continues for 1 week after beginning the medication. C. The client should expect to have a slower heart rate while taking alosetron. D. The client should use a barrier birth control method because alosetron interacts with oral contraceptives.
A. The client must sign an agreement with the provider before beginning alosetron. Rationale: Alosetron has potentially fatal adverse effects associated with constipation and bowel obstruction. The FDA has allowed alosetron to be placed on the market only if clients sign and adhere to a risk management program, which includes signing a client-provider agreement before starting alosetron.
Which medication is classified as a histamine-2 receptor antagonist? A. Famotidine B. Lansoprazole C. Esomeprazole D. Metronidazole
A. Famotidine
A nurse is teaching a client who will undergo a sigmoidoscopy. Which of the following information about the procedure should the nurse include? (Select all that apply.) A. Increased flatulence can occur following the procedure B. NPO status should be maintained preprocedure C. Conscious sedation is used D. Repositioning will occur throughout the procedure E. Fluid intake is limited the day after the procedure
A. Increased flatulence can occur following the procedure B. NPO status should be maintained preprocedure Rationale: Increased flatulence can occur due to the instillation of air during the procedure. THe client should remain NPO after midnight the night before the procedure.
A nurse is completing an admission assessment for a client who has a small bowel obstruction. Which of the following findings should the nurse report to the provider? (Select all that apply.) A. Emesis prior to insertion of the nasogastric tube B. Urine specific gravity 1.040 C. Hematocrit 60% D. Blood potassium 3.0 mEq/L E. WBC 10,000 uL
B. Urine specific gravity 1.040 C. Hematocrit 60% D. Blood potassium 3.0 mEq/L Rationale: The urine specific gravity is greater than the expected reference range of 1.005 to 1.030. An increased urine specific gravity is an indication of dehydration. The Hct is greater than the expected reference range of 42% to 52% for males and 37% to 47% for females. An elevated Hct indicates hemoconcentration, which is due to dehydration. The potassium is below the expected reference range of 3.5-5.0 mEq/L caused by potassium loss from vomiting. Hypokalemia can cause dysrhythmias, muscle weakness, and lethargy, and requires potassium replacement.
A nurse is providing discharge teaching to a client who had a bleeding duodenal ulcer and has been prescribed omeprazole. Which of the following statements should the nurse include in the teaching? A. "You will need to take this medication for the next 6 months." B. "Taking this medication will decrease your risk of acquiring pneumonia." C. "You should take this medication before breakfast every day." D. "Watch for the serious adverse effects of tachycardia and heart palpitations while taking this medication."
C. "You should take this medication before breakfast every day." Rationale: Clients who have active duodenal ulcer or gastric reflux disease should take omeprazole once daily before a meal (usually breakfast) because the medication is less effective when taken with food.
The nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances to avoid. Which items should the nurse include on this list? (Select all that apply.) A. Coffee B. Chocolate C. Peppermint D. Nonfat milk E. Fried chicken F. Scrambled eggs
A. Coffee B. Chocolate C. Peppermint E. Fried chicken Rationale:Foods that decrease lower esophageal sphincter (LES) pressure and irritate the esophagus will increase reflux and exacerbate the symptoms of GERD and therefore should be avoided. Aggravating substances include coffee, chocolate, peppermint, fried or fatty foods, carbonated beverages, and alcohol. Options 4 and 6 do not promote this effect.
A nurse is planning care for a client who has a small bowel obstruction and a nasogastric (NG) tube in place. Which of the following interventions should the nurse include? (Select all that apply.) A. Document the NG drainage with the client's output B. Irrigate the NG tube every 8 hr C. Assess bowel sounds D. Provide oral hygiene every 2 hr E. Monitor NG tube for placement
A. Document the NG drainage with the client's output C. Assess bowel sounds D. Provide oral hygiene every 2 hr E. Monitor NG tube for placement Rationale: Document the NG drainage as output. This helps determine the amount of fluid replacement needed. Bowel sounds should be assessed to evaluate treatment and resolution of the obstruction. An NG tube promotes mouth breathing. Provide frequent oral hygiene to provide comfort. Check the placement of the NG tube prior to irrigation to prevent aspiration and periodically to prevent an increase in abdominal distention. NG tube should be irrigated every 4 hr to maintain patency.
A nurse in a clinic is teaching a client who has ulcerative colitis. Which of the following statements by the client indicates understanding of the teaching? A. "I will plan to limit fiber in my diet." B. "I will restrict fluid intake during meals." C. "I will switch to black tea instead of drinking coffee." D. "I will try to eat cold foods rather than warm when my stomach feels upset."
A. "I will plan to limit fiber in my diet." Rationale: A low-fiber diet is recommended for the client who has ulcerative colitis to reduce inflammation. Caffeine can increase diarrhea and cramping, so the client should avoid caffeinated beverages, such as black tea. The client should avoid cold foods because these can increase intestinal motility and cause exacerbation of manifestations. A client who has dumping syndrome should avoid fluids with meals.
A nurse working in the ED is admitting a client who has a gastric ulcer and GI bleeding. Which of the following factors in the client's medical history should the nurse report to the provider? A. Arthritis treated with ibuprofen every 8 hours as needed B. Precious tobacco smoking with cessation 5 years ago C. Negative H. pylori breath test 1 year prior D. Prescribed bismuth subsalicylate as needed for GI upset
A. Arthritis treated with ibuprofen every 8 hours as needed Rationale: The nurse should identify that ibuprofen is an NSAID. NSAIDs can cause GI bleeding and are contraindicated for clients who have ulcer disease. NSAIDs inhibit prostaglandin secretion, which decreases blood flow in the GI tract and decreases bicarbonate and mucus secretion. This environment promotes the secretion of gastric acid and needs to be reported to the provider.
A nurse is caring for a client who has an acute exacerbation of Crohn's disease. Which of the following actions should the nurse take? A. Ensure bowel rest B. Offer sparkling water frequently C. Administer a stool softener D. Offer plain warm tea frequently
A. Ensure bowel rest Rationale: Clients who have an exacerbation of Crohn's disease usually requires NPO status to ensure bowel rest and promote healing and recovery.
Diet therapy for clients diagnosed with IBS includes A. High-fiber diet B. Spicy foods C. Fluids with meals D. Caffeinated products
A. High-fiber diet Rationale: A high-fiber diet is prescribed to help control diarrhea and constipation.
A nurse in a provider's office is assessing a client who has GERD. The nurse should expect the client to report which of the following manifestations? (Select all that apply.) A. Regurgitation B. Nausea C. Belching D. Heartburn E. Weight loss
A. Regurgitation B. Nausea C. Belching D. Heartburn
A nurse in a provider's office is assessing a client who has GERD. When documenting the client's history, the nurse should expect the client to report that symptoms worsen with which of the following actions? A. Stair-climbing B. Bending over C. Sitting D. Walking
B. Bending over Rationale: Gastroesophageal reflux symptoms are most evident with activities that increase intraabdominal pressure (e.g., bending over, straining, lifting, and lying down)
A nurse is teaching a client who has a hiatal hernia. Which of the following client statements indicates an understanding of the teaching? A. "I can take my medications with soda." B. "Peppermint tea will increase my indigestion." C. "Wearing an abdominal binder will limit my manifestations." D. "I will drink hot chocolate at bedtime to help me sleep." E. "I can lift weights as a way to exercise."
B. "Peppermint tea will increase my indigestion." Rationale: Peppermint decreases LES pressure and should be avoided by the client who has a hiatal hernia.
A nurse is caring for a client who has recovered from acute diverticulitis. The nurse should instruct the client to increase his intake of which of the following foods when the inflammation subsides? A. Cucumbers and tomatoes B. Cabbage and peaches C. Strawberries and corn D. Figs and nuts
B. Cabbage and peaches Rationale: When the acute inflammation has subsided, the client should increase his intake of foods that are high in fiber, such as wheat bran, whole-grain braid, and fresh fruits and vegetables that do not contain seeds.
Which type of inflammatory bowel disease (IBD) is most likely to cause severe malnourishment? A. Ulcerative colitis B. Crohn's disease
B. Crohn's disease Rationale: Crohn's is most likely to affect the small intestine which is responsible for absorbing the nutrient's from food. If the small intestine is inflamed, it cannot work properly...therefore, there is a major risk of malnourishment issues.
A typical sign/symptom of appendicitis is A. High fever B. Nausea C. LLQ pain D. Pain when pressure is applied to the right lower quadrant
B. Nausea Rationale: Nausea, with or without vomiting, is typically associated with appendicitis. Pain is generally felt in the RLQ. Rebound tenderness, or pain felt upon the release of pressure applied to the abdomen, may be present with appendicitis. Low-grade fever is associated with appendicitis.
A nurse is completing an assessment of a client who has GERD. Which of the following is an expected finding? A. Absence of saliva B. Painful swallowing C. Sweet taste in mouth D. Absence of eructation
B. Painful swallowing Rationale: Painful swallowing is a manifestation of GERD due to esophageal stricture or inflammation. Hypersalivation, a bitter taste in the mouth, and increased burping are also expected findings in a client who has GERD.
A nurse is teaching a female client who has a new prescription for misoprostol to treat peptic ulcer disease. Which of the following client statements should indicate to the nurse that the teaching was effective? A. "I should avoid taking NSAIDs while using this medication." B. "Misoprostol is used to treat stress-induced gastric ulcers." C. "I should avoid becoming pregnant while taking this medication.' D. "This medication is also used to treat dysmenorrhea."
C. "I should avoid becoming pregnant while taking this medication." Rationale: The nurse should identify that misoprostol is contraindicated during pregnancy. It has the potential to stimulate uterine contractions, and the use of misoprostol during pregnancy has been shown to cause partial or complete expulsion of the developing fetus.
A nurse is completing discharge teaching for a client who has infection due to Helicobacter pylori (H. pylori). Which of the following statements by the client indicates understanding of the teaching? A. "I will continue my prescription for corticosteroids." B. "I will schedule a CT scan to monitor improvement." C. "I will take a combination of medications for treatment." D. "I will have my throat swabbed to recheck for this bacteria."
C. "I will take a combination of medications for treatment. Rationale: A combination of antibiotics and an H2 receptor antagonist is used to treat an infection caused by H. pylori.
The nurse is evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse attribute to a duodenal ulcer? A. Vomiting B. Hemorrhage C. Awakening in pain D. Weight loss
C. Awakening in pain Rationale: The client with a duodenal ulcer often awakens between 1 to 2 AM with pain, and ingestion of food brings relief.
The nurse prepares a client for a barium enema. The nurse should place the client on which diet prior to the procedure? A. Nothing by mouth (NPO) 2 days prior B. Soft diet 1 ay prior C. Clear liquids day before D. High-fiber diet 1 to 2 days prior
C. Clear liquids day before Rationale: The nurse should place the client on clear liquids the evening before the procedure, a low-residue diet 1-2 days before the test, and NPO at midnight in preparation for the barium enema.
A nurse is completing an assessment of a client who has a gastric ulcer. Which of the following findings should the nurse expect? (Select all that apply.) A. Client reports pain relieved by eating B. Client states that pain often occurs at night C. Client reports a sensation of bloating D. Client states that pain occurs 30 min to 1 hr after a meal E. Client experiences pain upon palpation of the epigastric region
C. Client reports a sensation of bloating D. Client states that pain occurs 30 min to 1 hr after a meal E. Client experiences pain upon palpation of the epigastric region
The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience A. Weight loss B. Vomiting C. Pain 1.5-3 hours after a meal D. Hemorrhage
C. Pain 1.5-3 hours after a meal
A nurse in a clinic is instructing a client about a fecal occult blood test, which requires mailing three specimens. Which of the following statements by the client indicates understanding? A. "I will continue taking my warfarin while I complete these tests." B. "I'm glad I don't have to follow any special diet at this time." C. "This test determines if I have parasites in my bowel." D. "This is an easy way to screen for colon cancer."
D. "This is an easy way to screen for colon cancer."
A nurse is caring for a client who has diverticulitis and a new prescription for a low-fiber diet. Which of the following food items should the nurse remove from the client's meal tray? A. Canned fruit B. White bread C. Broiled hamburger D. Coleslaw
D. Coleslaw Rationale: Coleslaw contains raw cabbage, which is high fiber. Clients who are following a low-fiber diet should avoid most raw vegetables.
When gastric acid analysis reveals excess secretion of gastric acid, the nurse recognizes which medical diagnoses is supported? A. Chronic atrophic gastritis B. Pernicious anemia C. Gastric cancer D. Duodenal ulcer
D. Duodenal ulcer Rationale: Clients with duodenal ulcers usually secrete an excess amount of hydrochloric acid.
A nurse is updating the plan of care for a client who has dumping syndrome. Which of the following instructions should the nurse include? A. Consume beverages with meals B. Eat 3 large meals per day C. Include high-fiber foods in the diet D. Eat a source of protein with each meal
D. Eat a source of protein with each meal. Rationale: Protein delays gastric emptying.
Crohn's disease and ulcerative colitis are two forms of IBS (irritable bowel syndrome). True or false?
False Rationale: Crohn's disease and ulcerative colitis are two forms of IBD (inflammatory bowel disease).
A nurse is reviewing bowel prep using polyethylene glycol with a client scheduled for a colonoscopy. Which of the following instructions should the nurse include? A. Check with the provider about taking current medications when consuming bowel prep. B. Consume a normal diet until starting the bowel prep. C. Expect the bowel prep to not begin acting until the day after all the prep is consumed. D. Discontinue the bowel prep once feces starts to be expelled.
A. Check with the provider about taking current medications when consuming bowel prep. Rationale: Some medications can be withheld when taking polyethylene glycol due to their lack of absorption.
Crohn's disease is a condition of malabsorption caused by which pathophysiological process? A. Inflammation of all layers of intestinal mucosa B. Gastric resection C. Infectious disase D. Disaccharide deficiency
A. Inflammation of all layers of intestinal mucosa Rationale: Crohn's disease is also known as regional enteritis and can occur anywhere along the GI tract, but most commonly at the distal ileum and in the colon.
A nurse is caring for a client who has acute diverticulitis. While the client has active inflammation, the nurse should instruct the client to include which of the following foods in her diet? A. White bread and plain yogurt B. Shredded wheat cereal and blueberries C. Broccoli and kidney beans D. Oatmeal and fresh pears
A. White bread and plain yogurt Rationale: Because of the acute inflammation of diverticulitis, the client should maintain a diet very low in fiber. The client can consume low-fiber foods like white bread, low-fat milk, yogurt with active cultures, poached eggs, and canned soft fruit.
A nurse is caring for a client who has ulcerative colitis. The provider prescribes bed rest with bathroom privileges. When the client asks the nurse why he has to stay in bed, which of the following responses should the nurse provide? A. "You need to conserve energy at this time." B. "Lying quietly in bed helps slow down the activity in your intestines." C. "Staying in bed promotes the rest and comfort you need." D. "Staying in bed will help prevent injury and and minimize your fall risk."
B. "Lying quietly in bed helps slow down the activity in your intestines." Rationale: The greatest risk to the client is complications from severe diarrhea such as dehydration, electrolyte imbalances, and gastrointestinal bleeding and trauma. Activity restriction can help reduce intestinal peristalsis and diarrhea.
A nurse is administering a client's first dose of sucralfate. Which of the following explanations should the nurse provide about the action of sucralfate? A. "Sucralfate decreases gastric acid secretions." B. "Sucralfate forms a gel-like substance that protects ulcers." C. "Sucralfate inactivates Helicobacter pylori." D. "Sucralfate inhibits the production of gastric acid."
B. "Sucralfate forms a gel-like substance that protects ulcers." Rationale: The primary action of sucralfate is the formation of a gel-like protectant that adheres to the ulcer surface. This protective mechanism lasts for 6 hours and allows the ulcer to heal.
A nurse is teaching a client with Barrett's esophagus who is scheduled to undergo an esophagogastroduodenoscopy (EGD). Which of the following statements should the nurse include in the teaching? A. "This procedure is performed to measure the presence of acid in your esophagus." B. "This procedure can determine how well the lower part of your esophagus works." C. "This procedure is performed while you are under general anesthesia." D. "This procedure can determine if you have colon cancer."
B. "This procedure can determine how well the lower part of your esophagus works." Rationale: An EGD is useful in determining the function of the esophageal lining and the extent of inflammation, potential scarring, and strictures.
A patient had a colonoscopy which showed a "cobble-stone" appearance of the GI lining. This is found in: A. Ulcerative colitis B. Crohn's disease
B. Crohn's disease Rationale: With Crohn's disease, there will be healthy areas of lining with diseased lining. This will give it a cobble-stone appearance. In ulcerative colitis, the diseased areas are continuous and there are not are areas of healthy lining with diseased.
A nurse is completing discharge teaching with a client who has Crohn's disease. Which of the following instructions should the nurse include in the teaching? A. Decrease intake of calorie-dense foods B. Drink canned protein supplements C. Increase intake of high fiber foods D. Eat high-residue foods
B. Drink canned protein supplements Rationale: A high-protein diet is recommended for the client who has Crohn's disease. Canned protein supplements is recommended. A low-fiber diet is also recommended for a client with Crohn's disease to reduce inflammation.
A nurse is reviewing the laboratory data of a client who has an acute exacerbation of Crohn's disease. Which of the following blood laboratory results should the nurse expect to be elevated? (Select all that apply.) A. Hematocrit B. Erythrocyte sedimentation rate C. WBC D. Folic acid E. Albumin
B. Erythrocyte sedimentation rate (ESR) C. WBC
A nurse is providing dietary teaching to a client who has ulcerative colitis. Which of the following food selections by the client indicates an understanding of the teaching? A. Raw vegetable salad with low-fat dressing B. Roast chicken and white rice C. Fresh fruit salad and milk D. Peanut butter and whole wheat bread
B. Roast chicken and white rice Rationale: Clients who have ulcerative colitis are restricted to a low-fiber diet, which omits whole grains and raw fruits and vegetables. Roast chicken with white rice is the best choice.
Which statement correctly identifies a difference between duodenal and gastric ulcers? A. Malignancy is associated with duodenal ulcers B. Vomiting is uncommon in clients with duodenal ulcers C. A gastric ulcer is caused by hypersecretion of stomach acid D. Weight gain may occur with a gastric ulcer.
B. Vomiting is uncommon in clients with duodenal ulcers. Rationale: Weight gain may occur with a duodenal ulcer. Duodenal ulcers cause hypersecretion of stomach acid.
A nurse is teaching a client with a new diagnosis of peptic ulcer disease (PUD) who has a prescription for bismuth subsalicylate. The client asks the nurse, "How will this medication help my ulcer?" Which of the following statements should the nurse make? A. "This medication will decrease prostaglandins." B. "The amount of bicarbonate in your body will be increased." C. "This medication can decrease bacteria in the gastrointestinal tract." D. "This medication acts by increasing blood flow to the stomach."
C. "This medication can decrease bacteria in the gastrointestinal tract." Rationale: The nurse should include in the teaching that bismuth subsalicylate can assist by eliminating the bacteria Helicobacter pylori, which can cause PUD.
