This is an NCLEX practice quiz about the Gastrointestinal and Biliary systems.
Good, better, best. Never let it rest. ‘Til your good is better and your better is best.
In Exam Mode: All questions are shown in random and the results, answers and rationales (if any) will only be given after you’ve finished the quiz. You are given 1 minute per question, a total of 25 minutes in this quiz.
Digestive System Disorders #6 (25 Questions)
Practice Mode: This is an interactive version of the Text Mode. All questions are given in a single page and correct answers, rationales or explanations (if any) are immediately shown after you have selected an answer. No time limit for this exam.
1. The correct sequence for abdominal assessment is:
A. inspection, percussion, palpation, auscultation.
B. inspection, auscultation, palpation, percussion.
C. inspection, palpation, auscultation, percussion.
D. inspection, percussion, auscultation, palpation.
2. Peritonitis can occur as a complication of:
3. A patient has become very depressed postoperatively after receiving colostomy for GI cancer. He does not participate in his colostomy care or look at the stoma. An appropriate nursing diagnosis for this situation is:
4. Patients with esophageal varices would reveal the following assessment:
A. increased blood pressure.
B. increased heart rate.
C. decreased respiratory rate.
D. increased urinary output.
6. The nurse must be alert for complications with Sengstaken-Blakemore intubation including:
A. pulmonary obstruction.
B. pericardiectomy syndrome
C. pulmonary embolization
D. cor pulmonale
7. Peptic ulcer disease may be caused by which of the following?
A. Helicobacter pylori
B. Clostridium difficile
C. Candida albicans
D. Staphylococcus aureus
8. Pain control with peptic ulcer disease includes all of the following except:
A. promoting physical and emotional rest.
B. identifying stressful situations.
C. eating meals when desired.
D. administering medications that decrease gastric acidity.
9. Nitrosocarcinogen production can be inhibited with intake of:
A. vitamin C.
B. vitamin E.
10. The nurse can expect a 60-year old patient with ischemic bowel to report a history of:
11. During initial assessment of a patient post-endoscopy, the nurse notes absent bowel sounds, tachycardia, and abdominal distention. The nurse would anticipate:
12. Which of the following tests can be useful as a diagnostic and therapeutic tool in the biliary system?
C. Endoscopic retrograde cholangiopancreatography (ERCP)
D. Computed tomography scan (CT scan)
13. To inhibit pancreatic secretions, which pharmacologic agent would you anticipate administering to a patient with acute pancreatitis?
14. Your patient’s ABG reveal an acidic pH, an acidic CO2 and a normal bicarbonate level. Which of the following indicates this acid-base disturbance?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
15. A clinical manifestation of acute pancreatitis is epigastric pain. Your nursing intervention to facilitate relief of pain would place the patient in a:
A. knee-chest position
B. semi-Fowler’s position
C. recumbent position
D. low-Fowler’s position
16. What assessment finding of a patient with acute pancreatitis would indicate a bluish discoloration around the umbilicus?
A. Grey-Turner’s sign
B. Homan’s sign
C. Rovsing’s sign
D. Cullen’s sign
17. A patient with severe cirrhosis of the liver develops hepatorenal syndrome. Which of the following nursing assessment data would support this?
A. oliguria and azotemia
B. metabolic alkalosis
C. decreased urinary concentration
D. weight gain of less than 1 lb per week
18. Which phase of hepatitis would the nurse incur strict precautionary measures at?
19. You are caring for Rona, a 35-year-old female in a hepatic coma. Which evaluation criteria would be the most appropriate?
A. The patient demonstrates an increase in level of consciousness.
B. The patient exhibits improved skin integrity.
C. The patient experiences no evident signs of bleeding.
D. The patient verbalize decreased episodes of pain.
20. What is the primary nursing diagnosis for a 4th to 10th day postoperative liver transplant patient?
21. Which of the following laboratory values would be the most important to monitor for a patient with pancreatic cancer?
A. Serum glucose
B. Radioimmunoassay (RIA)
C. Creatine phosphokinase (CPK)
D. Carcinoembryonic antigen (CEA)
22. You observe changes in mentation, irritability, restlessness, and decreased concentration in a patient with cancer of the liver. Hepatic encephalopathy is suspected and the patient is ordered neomycin enemas. Which of the following information in the patient’s history would be a contraindication of this order?
A. left nephrectomy
B. glaucoma in both eyes
C. myocardial infarction
D. peripheral neuropathy
23. A nursing intervention for a patient with hepatitis B would include which of the following types of isolation.
A. Universal precautions
B. Blood transfusions
C. Enteric isolation
D. Strict isolation
24. A patient is admitted with lacerated liver as a result of blunt abdominal trauma. Which of the following nursing interventions would NOT be appropriate for this patient?
25. A male client is recovering from a small-bowel resection. To relieve pain, the physician prescribes meperidine (Demerol), 75 mg I.M. every 4 hours. How soon after administration should meperidine onset of action occur?
A. 5 to 10 minutes
B. 15 to 30 minutes
C. 30 to 60 minutes
D. 2 to 4 hours
Answers and Rationale
1. Answer: B. inspection, auscultation, palpation, percussion
Auscultation is done before palpation to avoid stimulating peristaltic movements and distorting auscultatory sounds.
2. Answer: D. peptic ulcer disease
Perforation is a life-threatening complication of peptic ulcer disease and can result in peritonitis.
3. Answer: A. Ineffective Individual Coping
The patient is dealing with a disturbance in self-concept and difficulty coping with the newly established stoma.
4. Answer: B. increased heart rate.
Tachycardia is an early sign of compensation for patients with esophageal varices.
5. Answer: C. vasopressin
Vasopressin is the drug of choice when sclerotherapy is contraindicated. Neomycin is used in preventing encephalopathy when blood is broken down. Propranolol may or may not be used to decrease cardiac output and hepatic venous pressure.
6. Answer: A. pulmonary obstruction.
Rupture or deflation of the balloon could result in upper airway obstruction. The other choices are not related to the tube.
7. Answer: A. Helicobacter pylori
Helicobacter pylori is considered to be the major cause of ulcer formation. Other choices are not related to ulcer formation.
8. Answer: C. eating meals when desired.
Meals should be regularly spaced in a relaxed environment. Choices A, B, and D are proper interventions in providing pain control.
9. Answer: A. vitamin C.
Vitamin C and refrigeration of foods inhibit nitroso carcinogen.
10. Answer: A. diabetes mellitus
Ischemic bowel occurs in patient over 50 with a history of diabetes mellitus.
11. Answer: D. perforated bowel
Invasive diagnostic testing can cause perforated bowel. Ischemic bowel (Choice A) is usually not related. Peritonitis (Choice B) can be a complication after initial perforation. Hypovolemic shock (Choice C) can occur if peritonitis is allowed to continue.
12. Answer: C. Endoscopic retrograde cholangiopancreatography (ERCP)
ERCP permits direct visualization of the pancreatic and common bile ducts. Its therapeutic value is in retrieving gallstones from the distal and common bile ducts and dilating strictures. Ultrasonography (Option A) aids in the diagnosis of cholecystitis, gallstones, pancreatitis, and metastatic disease. It also identifies edema, inflammation, and fatty or fibrotic infiltrates or calcifications. MRI (Option B) detects hepatic neoplasms, cysts, abscesses, and hematomas. A CT Scan (Option D) can be done with our without a contrast medium. It can detect tumors, cysts, pseudocysts, abscesses, hematomas, and obstructions of the liver, biliary tract and pancreas.
13. Answer: B. Somatostatin
Somatostatin, a treatment for acute pancreatitis, inhibits the release of pancreatic enzymes. Nitroglycerin (Option A) is a vasodilator and does not affect pancreatic secretions. Pancrelipase (Option C) is an enzyme that aids in the digestion and absorption of fats and proteins. Pepcid is an H2 blocker and is used to decrease gastric motility.
14. Answer: A. Respiratory acidosis
A pH of 7.35 indicates acidosis, as does an acidic CO2 and bicarbonate. See also: 8-Step Guide to ABG Analysis: Tic-Tac-Toe Method
15. Answer: A. knee-chest position
Flexion of the trunk lessens the pain and decreases restlessness. Other positions do not decrease the pain.
16. Answer: D. Cullen’s sign
Cullen’s sign is associated with pancreatitis when a hemorrhage is suspected. Grey-Turner’s sign is ecchymosis in the flank area suggesting retroperitoneal bleed. Homan’s sign is cal pain elicited by the dorsiflexion of the foot and suggests deep vein thrombosis. Rovsing’s sign is associated with appendicitis when pain is felt with pressure at McBurney’s point.
17. Answer: A. oliguria and azotemia
- Hepatorenal syndrome is a functional disorder resulting from a redistribution of renal blood flow. Oliguria and azotemia occur abruptly as a result of this complication.
- For Option B, excess organic acids are not being excreted by the damaged kidneys, resulting in an elevated concentration of hydrogen ions; decreased pH occurs, causing metabolic acidosis.
- For Option C, concentration of the urine is increased with decreased renal function.
- For Option D, with renal insufficiency, significant weight gain is expected due to fluid retention.
18. Answer: D. Pre-icteric
Pre-icteric is the infective phase and precautionary measures should be strictly enforced. However, most patients are not always diagnosed during this phase. For Option A and C, precautionary measures should already be in placed. For Option B, there is no non-icteric phase.
19. Answer: A. The patient demonstrates an increase in level of consciousness.
Increased level of consciousness indicates resolving of a comatose state. Other options are important evaluation but do not evaluate a patient in a hepatic coma who is responding to external stimuli.
20. Answer: B. Risk for Rejection
Risk for rejection is always a possibility, especially during the 4th to 10th day postoperatively.
21. Answer: A. Serum glucose
In pancreatitis, hypersecretion of the insulin from a tumor may affect the islets of Langerhans, resulting in hyperinsulinemia, a complication of pancreatic cancer. Options B and D, should also be monitored to measure the effects of therapy, but hypoglycemia may be life-threatening. Creatine phosphokinase is an enzyme that reflects normal tissue catabolism. Elevated serum levels indicate trauma to cells with high CPK content. CPK and CPK-isoenzymes are used to detect a myocardial infarction.
22. Answer: A. left nephrectomy
Neomycin prevents the release of ammonia from the intestinal bacteria flora and from the breakdown of red blood cells. Common side-effects of this drug are nephrotoxicity and ototoxicity. Patients with renal disease or renal impairment should not take this drug. Peripheral neuropathy (Option D) is a chronic complication of diabetes mellitus. Options B and C are not affected by neomycin.
23. Answer: A. Universal precautions
Universal precautions are indicated for the patient with hepatitis B. Hepatitis B is contracted via blood and blood products, body secretions, and punctures from contaminated needles.
24. Answer: C. Administer pain medications as ordered.
Pain medication may mask signs and symptoms of hemorrhage, further decrease blood pressure, and interfere with assessment of neurologic status and additional abdominal injury.
25. Answer B. 15 to 30 minutes
Meperidine onset of action is 15 to 30 minutes. It peaks between 30 and 60 minutes and has a duration of action of 2 to 4 hours.
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