Digestive System Disorders NCLEX Practice Quiz #2 (100 Questions)

This is another set of NCLEX style questions about the Gastrointestinal and Digestive System Disorders. This 100-item exam will test your knowledge about the diseases Appendicitis and Inflammatory Bowel Diseases.

Make the most of yourself, for that is all there is for you.
~ Ralph Waldo Emerson

Topics

Included topics in this practice quiz are:

  • Appendicitis
  • Diverticulitis
  • Inflammatory Bowel Diseases

Guidelines

Follow the guidelines below to make the most out of this exam:

  • Read each question carefully and choose the best answer.
  • You are given one minute per question. Spend your time wisely!
  • Answers and rationales are given below. Be sure to read them.
  • If you need more clarifications, please direct them to the comments section.

Questions

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NCLEX Exam: Digestive System Disorders 2 (100 Items)

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NCLEX Exam: Digestive System Disorders 2 (100 Items)

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1. Which of the following complications is thought to be the most common cause of appendicitis?

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1. A fecalith
2. Bowel kinking
3. Internal bowel occlusion
4. Abdominal bowel swelling

2. Which of the following terms best describes the pain associated with appendicitis?

1. Aching
2. Fleeting
3. Intermittent
4. Steady

3. Which of the following nursing interventions should be implemented to manage a client with appendicitis?

1. Assessing for pain
2. Encouraging oral intake of clear fluids
3. Providing discharge teaching
4. Assessing for symptoms of peritonitis

4. Which of the following definitions best describes gastritis?

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1. Erosion of the gastric mucosa
2. Inflammation of a diverticulum
3. Inflammation of the gastric mucosa
4. Reflux of stomach acid into the esophagus

5. Which of the following substances is most likely to cause gastritis?

1. Milk
2. Bicarbonate of soda, or baking soda
3. Enteric coated aspirin
4. Nonsteriodal anti-imflammatory drugs

6. Which of the following definitions best describes diverticulosis?

1. An inflamed outpouching of the intestine
2. A noninflamed outpouching of the intestine
3. The partial impairment of the forward flow of intestinal contents
4. An abnormal protrusion of an organ through the structure that usually holds it.

7. Which of the following types of diets is implicated in the development of diverticulosis?

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1. Low-fiber diet
2. High-fiber diet
3. High-protein diet
4. Low-carbohydrate diet

8. Which of the following mechanisms can facilitate the development of diverticulosis into diverticulitis?

1. Treating constipation with chronic laxative use, leading to dependence on laxatives
2. Chronic constipation causing an obstruction, reducing forward flow of intestinal contents
3. Herniation of the intestinal mucosa, rupturing the wall of the intestine
4. Undigested food blocking the diverticulum, predisposing the area to bacterial invasion.

9. Which of the following symptoms indicated diverticulosis?

1. No symptoms exist
2. Change in bowel habits
3. Anorexia with low-grade fever
4. Episodic, dull, or steady midabdominal pain

10. Which of the following tests should be administered to a client suspected of having diverticulosis?

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1. Abdominal ultrasound
2. Barium enema
3. Barium swallow
4. Gastroscopy

11. Medical management of the client with diverticulitis should include which of the following treatments?

1. Reduced fluid intake
2. Increased fiber in diet
3. Administration of antibiotics
4. Exercises to increase intra-abdominal pressure

12. Crohn’s disease can be described as a chronic relapsing disease. Which of the following areas in the GI system may be involved with this disease?

1. The entire length of the large colon
2. Only the sigmoid area
3. The entire large colon through the layers of mucosa and submucosa
4. The small intestine and colon; affecting the entire thickness of the bowel

13. Which area of the alimentary canal is the most common location for Crohn’s disease?

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1. Ascending colon
2. Descending colon
3. Sigmoid colon
4. Terminal ileum

14. Which of the following factors is believed to be linked to Crohn’s disease?

1. Constipation
2. Diet
3. Hereditary
4. Lack of exercise

15. Which of the following factors is believed to cause ulcerative colitis?

1. Acidic diet
2. Altered immunity
3. Chronic constipation
4. Emotional stress

16. Fistulas are most common with which of the following bowel disorders?

1. Crohn’s disease
2. Diverticulitis
3. Diverticulosis
4. Ulcerative colitis

17. Which of the following areas is the most common site of fistulas in client’s with Crohn’s disease?

1. Anorectal
2. Ileum
3. Rectovaginal
4. Transverse colon

18. Which of the following associated disorders may a client with ulcerative colitis exhibit?

1. Gallstones
2. Hydronephrosis
3. Nephrolithiasis
4. Toxic megacolon

19. Which of the following associated disorders may the client with Crohn’s disease exhibit?

1. Ankylosing spondylitis
2. Colon cancer
3. Malabsorption
4. Lactase deficiency

20. Which of the following symptoms may be exhibited by a client with Crohn’s disease?

1. Bloody diarrhea
2. Narrow stools
3. N/V
4. Steatorrhea

21. Which of the following symptoms is associated with ulcerative colitis?

1. Dumping syndrome
2. Rectal bleeding
3. Soft stools
4. Fistulas

22. If a client had irritable bowel syndrome, which of the following diagnostic tests would determine if the diagnosis is Crohn’s disease or ulcerative colitis?

1. Abdominal computed tomography (CT) scan
2. Abdominal x-ray
3. Barium swallow
4. Colonoscopy with biopsy

23. Which of the following interventions should be included in the medical management of Crohn’s disease?

1. Increasing oral intake of fiber
2. Administering laxatives
3. Using long-term steroid therapy
4. Increasing physical activity

24. In a client with Crohn’s disease, which of the following symptoms should not be a direct result of antibiotic therapy?

1. Decrease in bleeding
2. Decrease in temperature
3. Decrease in body weight
4. Decrease in the number of stools

25. Surgical management of ulcerative colitis may be performed to treat which of the following complications?

1. Gastritis
2. Bowel herniation
3. Bowel outpouching
4. Bowel perforation

26. Which of the following medications is most effective for treating the pain associated with irritable bowel disease?

1. Acetaminophen
2. Opiates
3. Steroids
4. Stool softeners

27. During the first few days of recovery from ostomy surgery for ulcerative colitis, which of the following aspects should be the first priority of client care?

1. Body image
2. Ostomy care
3. Sexual concerns
4. Skin care

28. Colon cancer is most closely associated with which of the following conditions?

1. Appendicitis
2. Hemorrhoids
3. Hiatal hernia
4. Ulcerative colitis

29. Which of the following diets is most commonly associated with colon cancer?

1. Low-fiber, high fat
2. Low-fat, high-fiber
3. Low-protein, high-carbohydrate
4. Low carbohydrate, high protein

30. Which of the following diagnostic tests should be performed annually over age 50 to screen for colon cancer?

1. Abdominal CT scan
2. Abdominal x-ray
3. Colonoscopy
4. Fecal occult blood test

31. Radiation therapy is used to treat colon cancer before surgery for which of the following reasons?

1. Reducing the size of the tumor
2. Eliminating the malignant cells
3. Curing the cancer
4. Helping the bowel heal after surgery

32. Which of the following symptoms is a client with colon cancer most likely to exhibit?

1. A change in appetite
2. A change in bowel habits
3. An increase in body weight
4. An increase in body temperature

33. A client has just had surgery for colon cancer. Which of the following disorders might the client develop?

1. Peritonitis
2. Diverticulosis
3. Partial bowel obstruction
4. Complete bowel obstruction

34. A client with gastric cancer may exhibit which of the following symptoms?

1. Abdominal cramping
2. Constant hunger
3. Feeling of fullness
4. Weight gain

35. Which of the following diagnostic tests may be performed to determine if a client has gastric cancer?

1. Barium enema
2. Colonoscopy
3. Gastroscopy
4. Serum chemistry levels

36. A client with gastric cancer can expect to have surgery for resection. Which of the following should be the nursing management priority for the preoperative client with gastric cancer?

1. Discharge planning
2. Correction of nutritional deficits
3. Prevention of DVT
4. Instruction regarding radiation treatment

37. Care for the postoperative client after gastric resection should focus on which of the following problems?

1. Body image
2. Nutritional needs
3. Skin care
4. Spiritual needs

38. Which of the following complications of gastric resection should the nurse teach the client to watch for?

1. Constipation
2. Dumping syndrome
3. Gastric spasm
4. Intestinal spasms

39. A client with rectal cancer may exhibit which of the following symptoms?

1. Abdominal fullness
2. Gastric fullness
3. Rectal bleeding
4. Right upper quadrant pain

40. A client with which of the following conditions may be likely to develop rectal cancer?

1. Adenomatous polyps
2. Diverticulitis
3. Hemorrhoids
4. Peptic ulcer disease

41. Which of the following treatments is used for rectal cancer but not for colon cancer?

1. Chemotherapy
2. Colonoscopy
3. Radiation
4. Surgical resection

42. Which of the following conditions is most likely to directly cause peritonitis?

1. Cholelithiasis
2. Gastritis
3. Perforated ulcer
4. Incarcerated hernia

43. Which of the following symptoms would a client in the early stages of peritonitis exhibit?

1. Abdominal distention
2. Abdominal pain and rigidity
3. Hyperactive bowel sounds
4. Right upper quadrant pain

44. Which of the following laboratory results would be expected in a client with peritonitis?

1. Partial thromboplastin time above 100 seconds
2. Hemoglobin level below 10 mg/dL
3. Potassium level above 5.5 mEq/L
4. White blood cell count above 15,000

45. Which of the following therapies is not included in the medical management of a client with peritonitis?

1. Broad-spectrum antibiotics
2. Electrolyte replacement
3. I.V. fluids
4. Regular diet

46. Which of the following aspects is the priority focus of nursing management for a client with peritonitis?

1. Fluid and electrolyte balance
2. Gastric irrigation
3. Pain management
4. Psychosocial issues

47. A client with irritable bowel syndrome is being prepared for discharge. Which of the following meal plans should the nurse give the client?

1. Low fiber, low-fat
2. High fiber, low-fat
3. Low fiber, high-fat
4. High-fiber, high-fat

48. A client presents to the emergency room, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts him at risk for which of the following?

1. Metabolic acidosis with hyperkalemia
2. Metabolic acidosis with hypokalemia
3. Metabolic alkalosis with hyperkalemia
4. Metabolic alkalosis with hypokalemia

49. Five days after undergoing surgery, a client develops a small-bowel obstruction. A Miller-Abbott tube is inserted for bowel decompression. Which nursing diagnosis takes priority?

1. Imbalanced nutrition: Less than body requirements
2. Acute pain
3. Deficient fluid volume
4. Excess fluid volume

50. When teaching an elderly client how to prevent constipation, which of the following instructions should the nurse include?

1. “Drink 6 glasses of fluid each day.”
2. “Avoid grain products and nuts.”
3. “Add at least 4 grams of bran to your cereal each morning.”
4. “Be sure to get regular exercise.”

51. In a client with diarrhea, which outcome indicates that fluid resuscitation is successful?

1. The client passes formed stools at regular intervals
2. The client reports a decrease in stool frequency and liquidity
3. The client exhibits firm skin turgor
4. The client no longer experiences perianal burning.

52. When teaching a community group about measures to prevent colon cancer, which instruction should the nurse include?

1. “Limit fat intake to 20% to 25% of your total daily calories.”
2. “Include 15 to 20 grams of fiber into your daily diet.”
3. “Get an annual rectal examination after age 35.”
4. “Undergo sigmoidoscopy annually after age 50.”

53. A 30-year old client experiences weight loss, abdominal distention, crampy abdominal pain, and intermittent diarrhea after birth of her 2nd child. Diagnostic tests reveal gluten-induced enteropathy. Which foods must she eliminate from her diet permanently?

1. Milk and dairy products
2. Protein-containing foods
3. Cereal grains (except rice and corn)
4. Carbohydrates

54. After a right hemicolectomy for treatment of colon cancer, a 57-year old client is reluctant to turn while on bed rest. Which action by the nurse would be appropriate?

1. Asking a coworker to help turn the client
2. Explaining to the client why turning is important.
3. Allowing the client to turn when he’s ready to do so
4. Telling the client that the physician’s order states he must turn every 2 hours

55. A client has a percutaneous endoscopic gastrostomy tube inserted for tube feedings. Before starting a continuous feeding, the nurse should place the client in which position?

1. Semi-Fowlers
2. Supine
3. Reverse Trendelenburg
4. High Fowler’s

56. An enema is prescribed for a client with suspected appendicitis. Which of the following actions should the nurse take?

1. Prepare 750 ml of irrigating solution warmed to 100*F
2. Question the physician about the order
3. Provide privacy and explain the procedure to the client
4. Assist the client to left lateral Sim’s position

57. The client being seen in a physician’s office has just been scheduled for a barium swallow the next day. The nurse writes down which of the following instructions for the client to follow before the test?

1. Fast for 8 hours before the test
2. Eat a regular supper and breakfast
3. Continue to take all oral medications as scheduled.
4. Monitor own bowel movement pattern for constipation

58. The nurse is monitoring a client for the early signs of dumping syndrome. Which symptom indicates this occurrence?

1. Abdominal cramping and pain
2. Bradycardia and indigestion
3. Sweating and pallor
4. Double vision and chest pain

59. The nurse is preparing a discharge teaching plan for the client who had an umbilical hernia repair. Which of the following would the nurse include in the plan?

1. Restricting pain medication
2. Maintaining bedrest
3. Avoiding coughing
4. Irrigating the drain

60. The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician?

1. Bloody diarrhea
2. Hypotension
3. A hemoglobin of 12 mg/dL
4. Rebound tenderness

61. The nurse is reviewing the record of a client with Crohn’s disease. Which of the following stool characteristics would the nurse expect to note documented on the client’s record?

1. Chronic constipation
2. Diarrhea
3. Constipation alternating with diarrhea
4. Stool constantly oozing from the rectum

62. The nurse is performing a colostomy irrigation on a client. During the irrigation, a client begins to complain of abdominal cramps. Which of the following is the most appropriate nursing action?

1. Notify the physician
2. Increase the height of the irrigation
3. Stop the irrigation temporarily.
4. Medicate with dilaudid and resume the irrigation

63. The nurse is teaching the client how to perform a colostomy irrigation. To enhance the effectiveness of the irrigation and fecal returns, what measure should the nurse instruct the client to do?

1. Increase fluid intake
2. Reduce the amount of irrigation solution
3. Perform the irrigation in the evening
4. Place heat on the abdomen

64. The nurse is reviewing the physician’s orders written for a client admitted with acute pancreatitis. Which physician order would the nurse question if noted on the client’s chart?

1. NPO status
2. Insert a nasogastric tube
3. An anticholinergic medication
4. Morphine for pain

65. 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 would assess the client for which of the following most frequent symptom(s) of duodenal ulcer?

1. Pain that is relieved by food intake
2. Pain that radiated down the right arm
3. N/V
4. Weight loss

66. The nurse instructs the ileostomy client to do which of the following as a part of essential care of the stoma?

1. Cleanse the peristomal skin meticulously
2. Take in high-fiber foods such as nuts
3. Massage the area below the stoma
4. Limit fluid intake to prevent diarrhea.

67. The client who has undergone creation of a colostomy has a nursing diagnosis of Disturbed body image. The nurse would evaluate that the client is making the most significant progress toward identified goals if the client:

1. Watches the nurse empty the colostomy bag
2. Looks at the ostomy site
3. Reads the ostomy product literature
4. Practices cutting the ostomy appliance

68. The nurse is assessing for stoma prolapse in a client with a colostomy. The nurse would observe which of the following if stoma prolapse occurred?

1. Sunken and hidden stoma
2. Dark- and bluish-colored stoma
3. Narrowed and flattened stoma
4. Protruding stoma

69. The client with a new colostomy is concerned about the odor from the stool in the ostomy drainage bag. The nurse teaches the client to include which of the following foods in the diet to reduce odor?

1. Yogurt
2. Broccoli
3. Cucumbers
4. Eggs

70. The nurse has given instructions to the client with an ileostomy about foods to eat to thicken the stool. The nurse determines that the client needs further instructions if the client stated to eat which of the following foods to make the stools less watery?

1. Pasta
2. Boiled rice
3. Bran
4. Low-fat cheese

71. The client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate post-op period for which of the following most frequent complications of this type of surgery?

1. Intestinal obstruction
2. Fluid and electrolyte imbalance
3. Malabsorption of fat
4. Folate deficiency

72. The nurse is doing pre-op teaching with the 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 of the following statements?

1. “I will need to drain the pouch regularly with a catheter.”
2. “I will need to wear a drainage bag for the rest of my life.”
3. “The drainage from this type of ostomy will be formed.”
4. “I will be able to pass stool from my rectum eventually.”

73. The client with a colostomy has an order for irrigation of the colostomy. The nurse used which solution for irrigation?

1. Distilled water
2. Tap water
3. Sterile water
4. Lactated Ringer’s

74. A nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis. The client 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 the bowel sounds are diminished. Which of the following is the most appropriate nursing intervention?

1. Administer dilaudid
2. Notify the physician
3. Call and ask the operating room team to perform the surgery as soon as possible
4. Reposition the client and apply a heating pad on a warm setting to the client’s abdomen.

75. The client has been admitted with a diagnosis of acute pancreatitis. The nurse would assess this client for pain that is:

1. Severe and unrelenting, located in the epigastric area and radiating to the back.
2. Severe and unrelenting, located in the left lower quadrant and radiating to the groin.
3. Burning and aching, located in the epigastric area and radiating to the umbilicus.
4. Burning and aching, located in the left lower quadrant and radiating to the hip.

76. The client with Crohn’s disease has a nursing diagnosis of acute pain. The nurse would teach the client to avoid which of the following in managing this problem?

1. Lying supine with the legs straight
2. Massaging the abdomen
3. Using antispasmodic medication
4. Using relaxation techniques

77. A client with ulcerative colitis has an order to begin salicylate medication to reduce inflammation. The nurse instructs the client to take the medication:

1. 30 minutes before meals
2. On an empty stomach
3. After meals
4. On arising

78. During the assessment of a client’s mouth, the nurse notes the absence of saliva. The client is also complaining of pain near the area of the ear. The client has been NPO for several days because of the insertion of a NG tube. Based on these findings, the nurse suspects that the client is developing which of the following mouth conditions?

1. Stomatitis
2. Oral candidiasis
3. Parotitis
4. Gingivitis

79. The nurse evaluates the client’s stoma during the initial post-op period. Which of the following observations should be reported immediately to the physician?

1. The stoma is slightly edematous
2. The stoma is dark red to purple
3. The stoma oozes a small amount of blood
4. The stoma does not expel stool

80. When planning care for a client with ulcerative colitis who is experiencing symptoms, which client care activities can the nurse appropriately delegate to a unlicensed assistant? Select all that apply.

1. Assessing the client’s bowel sounds
2. Providing skin care following bowel movements
3. Evaluating the client’s response to antidiarrheal medications
4. Maintaining intake and output records
5. Obtaining the client’s weight.

81. Which goal of the client’s care should take priority during the first days of hospitalization for an exacerbation of ulcerative colitis?

1. Promoting self-care and independence
2. Managing diarrhea
3. Maintaining adequate nutrition
4. Promoting rest and comfort

82. A client’s ulcerative colitis symptoms have been present for longer than 1 week. The nurse recognizes that the client should be assessed carefully for signs of which of the following complications?

1. Heart failure
2. DVT
3. Hypokalemia
4. Hypocalcemia

83. A client who has ulcerative colitis has persistent diarrhea. He is thin and has lost 12 pounds since the exacerbation of his ulcerative colitis. The nurse should anticipate that the physician will order which of the following treatment approaches to help the client meet his nutritional needs?

1. Initiate continuous enteral feedings
2. Encourage a high protein, high-calorie diet
3. Implement total parenteral nutrition
4. Provide six small meals a day.

84.  Digoxin preparations and absorbents should not be given simultaneously. As a nurse, you are aware that if these agents are given simultaneously, which of the following will occur?

1. Increased absorption of digoxin
2. Decreased absorption of digoxin
3. Increased absorption of the absorbent
4. Decreased absorption of the absorbent

85. When used with hyperacidic disorders of the stomach, antacids are given to elevate the gastric pH to:

1. 2.0
2. 4.0
3. 6.0
4. >8.0

86. One of your patients is receiving digitalis orally and is also to receive an antacid at the same time. Your most appropriate action, based on the pharmacokinetics of antacids, is to:

1. Delay the digitalis for 1 to 2 hours until the antacid is absorbed
2. Give the antacid at least 2 to 4 hours before administering the digitalis
3. Administer both medications as ordered and document in nurse’s notes
4. Contact the physician regarding the drug interaction and request a change in the time of dosing of the drugs.

87. The nurse would teach patients that antacids are effective in treatment of hyperacidity because they:

1. Neutralize gastric acid
2. Decrease stomach motility
3. Decrease gastric pH
4. Decrease duodenal pH

88. The nurse would monitor for which of the following adverse reactions to aluminum-containing antacids such as aluminum hydroxide (Amphojel)?

1. Diarrhea
2. Constipation
3. GI upset
4. Fluid retention

89. The nurse would question an order for which type of antacid in patients with chronic renal failure?

1. Aluminum-containing antacids
2. Calcium-containing antacids
3. Magnesium-containing antacids
4. All of the above.

90. The nurse would monitor a patient using sodium bicarbonate to treat gastric hyperacidity for signs and symptoms of:

1. Metabolic alkalosis
2. Metabolic acidosis
3. Hyperkalemia
4. Hypercalcemia

91. Which of the following nursing diagnoses is appropriate for a patient receiving famotidine (Pepcid)?

1. Increased risk for infection due to immunosuppression
2. Potential risk for bleeding related to thrombocytopenia.
3. Alteration in urinary elimination related to retention
4. Alteration in tissue perfusion related to hypertension

92. Histamine2-receptor antagonists:

1. Compete with histamine for binding sites on the parietal cells
2. Irreversibly bind to H+/K+ATPase
3. Cause a decrease in stomach pH
4. Decrease signs and symptoms of allergies related to histamine release

93. Proton pump inhibitors:

1. Gastric ulcer formation
2. GERD
3. Achlorhydria
4. Diverticulosis

94. A patient unable to tolerate oral medications may be prescribed which of the following proton pump inhibitors to be administered intravenously?

1. lansoprazole (Prevacid)
2. omeprazole (Prilosec)
3. pantoprazole (Protonix)
4. esomeprazole (Nexium)

95. When administering sucralfate (Carafate) to a patient with a nasogastric tube, it is important to:

1. Crush the tablet into a fine powder before mixing with water
2. Administer with a bolus tube feeding
3. Allow the tablet to dissolve in water before administering
4. Administer with an antacid for maximum benefit

96. Sucralfate (Carafate) achieves a therapeutic effect by:

1. Neutralizing gastric acid
2. Enhancing gastric absorption
3. Forming a protective barrier around gastric mucosa
4. Inhibiting gastric acid secretion

97. To avoid fecal impaction, psyllium (Metamucil) should be administered with at least how many ounces of fluid?

1. 4
2. 6
3. 8
4. 10

98. Bismuth subsalicylate (Pepto-Bismol), as an absorbent, has which of the following mechanisms of action?

1. Decreased GI motility
2. Decreased gastric secretions
3. Increased fluid absorption
4. Binding to diarrhea-causing bacteria for excretion

99. Side effects of loperamide (Imodium) include all of the following except?

1. Diarrhea
2. epigastric pain
3. Dry mouth
4. Anorexia

100. The mechanism of action of diphenoxylate (Lotomil) is:

1. An increase in intestinal excretion of water
2. An increase in intestinal motility
3. A decrease in peristalsis in the intestinal wall
4. A decrease in the reabsorption of water in the bowel

Answers and Rationale

1. Answer: 1. A fecalith

A fecalith is a fecal calculus, or stone, that occludes the lumen of the appendix and is the most common cause of appendicitis. Bowel wall swelling, kinking of the appendix, and external occlusion, not internal occlusion, of the bowel by adhesions can also be causes of appendicitis.

2. Answer: 4. Steady

The pain begins in the epigastrium or periumbilical region, then shifts to the right lower quadrant and becomes steady. The pain may be moderate to severe.

3. Answer: 4. Assessing for symptoms of peritonitis

The focus of care is to assess for peritonitis, or inflammation of the peritoneal cavity. Peritonitis is most commonly caused by appendix rupture and invasion of bacteria, which could be lethal. The client with appendicitis will have pain that should be controlled with analgesia. The nurse should discourage oral intake in preparation for surgery. Discharge teaching is important; however, in the acute phase, management should focus on minimizing preoperative complications and recognizing when such may be occurring.

4. Answer: 3. Inflammation of the gastric mucosa

Gastritis is an inflammation of the gastric mucosa that may be acute (often resulting from exposure to local irritants) or chronic (associated with autoimmune infections or atrophic disorders of the stomach). Erosion of the mucosa results in ulceration. Inflammation of a diverticulum is called diverticulitis; reflux of stomach acid is known as gastroesophageal disease.

5. Answer: 4. Nonsteroidal anti-inflammatory drugs

NSAIDS are a common cause of gastritis because they inhibit prostaglandin synthesis. Milk, once thought to help gastritis, has little effect on the stomach mucosa. Bicarbonate of soda, or baking soda, may be used to neutralize stomach acid, but it should be used cautiously because it may lead to metabolic acidosis. ASA with enteric coating shouldn’t contribute significantly to gastritis because the coating limits the aspirin’s effect on the gastric mucosa.

6. Answer: 2. A noninflamed outpouching of the intestine

Diverticulosis involves a noninflamed outpouching of the intestine. Diverticulitis involves an inflamed outpouching. The partial impairment of forward flow of the intestine is an obstruction; abnormal protrusion of an organ is a hernia.

7. Answer: 1. Low-fiber diet

Low-fiber diets have been implicated in the development of diverticula because these diets decrease the bulk in the stool and predispose the person to the development of constipation. A high-fiber diet is recommended to help prevent diverticulosis. A high-protein or low-carbohydrate diet has no effect on the development of diverticulosis.

8. Answer: 4. Undigested food blocking the diverticulum, predisposing the area to bacterial invasion.

Undigested food can block the diverticulum, decreasing blood supply to the area and predisposing the area to invasion of bacteria. Chronic laxative use is a common problem in elderly clients, but it doesn’t cause diverticulitis. Chronic constipation can cause an obstruction—not diverticulitis. Herniation of the intestinal mucosa causes an intestinal perforation.

9. Answer: 1. No symptoms exist

Diverticulosis is an asymptomatic condition. The other choices are signs and symptoms of diverticulitis.

10. Answer: 2. Barium enema

A barium enema will cause diverticula to fill with barium and be easily seen on x-ray. An abdominal US can tell more about structures, such as the gallbladder, liver, and spleen, than the intestine. A barium swallow and gastroscopy view upper GI structures.

11. Answer: 3. Administration of antibiotics

Antibiotics are used to reduce the inflammation. The client isn’t typically isn’t allowed anything orally until the acute episode subsides. Parenteral fluids are given until the client feels better; then it’s recommended that the client drink eight 8-ounce glasses of water per day and gradually increase fiber in the diet to improve intestinal motility. During the acute phase, activities that increase intra-abdominal pressure should be avoided to decrease pain and the chance of intestinal obstruction.

12. Answer: 4. The small intestine and colon; affecting the entire thickness of the bowel

Crohn’s disease can involve any segment of the small intestine, the colon, or both, affecting the entire thickness of the bowel. Answers 1 and 3 describe ulcerative colitis, answer 2 is too specific and therefore, not likely.

13. Answer: 4. Terminal ileum

Studies have shown that the terminal ileum is the most common site for recurrence in clients with Crohn’s disease. The other areas may be involved but aren’t as common.

14. Answer: 3. Hereditary

Although the definite cause of Crohn’s disease is unknown, it’s thought to be associated with infectious, immune, or psychological factors. Because it has a higher incidence in siblings, it may have a genetic cause.

15. Answer: 2. Altered immunity

Several theories exist regarding the cause of ulcerative colitis. One suggests altered immunity as the cause based on the extraintestinal characteristics of the disease, such as peripheral arthritis and cholangitis. Diet and constipation have no effect on the development of ulcerative colitis. Emotional stress can exacerbate the attacks but isn’t believed to be the primary cause.

16. Answer: 1. Crohn’s disease

The lesions of Crohn’s disease are transmural; that is, they involve all thickness of the bowel. These lesions may perforate the bowel wall, forming fistulas with adjacent structures. Fistulas don’t develop in diverticulitis or diverticulosis. The ulcers that occur in the submucosal and mucosal layers of the intestine in ulcerative colitis usually don’t progress to fistula formation as in Crohn’s disease.

17. Answer: 1. Anorectal

Fistulas occur in all these areas, but the anorectal area is most common because of the relative thinness of the intestinal wall in this area.

18. Answer: 4. Toxic megacolon

Toxic megacolon is extreme dilation of a segment of the diseased colon caused by paralysis of the colon, resulting in complete obstruction. This disorder is associated with both Crohn’s disease and ulcerative colitis. The other disorders are more commonly associated with Crohn’s disease.

19. Answer: 3. Malabsorption

Because of the transmural nature of Crohn’s disease lesions, malabsorption may occur with Crohn’s disease. Ankylosing spondylitis and colon cancer are more commonly associated with ulcerative colitis. Lactase deficiency is caused by a congenital defect in which an enzyme isn’t present.

20. Answer: 4. Steatorrhea

Steatorrhea from malabsorption can occur with Crohn’s disease. N/V, and bloody diarrhea are symptoms of ulcerative colitis. Narrow stools are associated with diverticular disease.

21. Answer: 2. Rectal bleeding

In ulcerative colitis, rectal bleeding is the predominant symptom. Soft stools are more commonly associated with Crohn’s disease, in which malabsorption is more of a problem. Dumping syndrome occurs after gastric surgeries. Fistulas are associated with Crohn’s disease.

22. Answer: 4. Colonoscopy with biopsy

A colonoscopy with biopsy can be performed to determine the state of the colon’s mucosal layers, presence of ulcerations, and level of cytologic development. An abdominal x-ray or CT scan wouldn’t provide the cytologic information necessary to diagnose which disease it is. A barium swallow doesn’t involve the intestine.

23. Answer: 3. Using long-term steroid therapy

Management of Crohn’s disease may include long-term steroid therapy to reduce the inflammation associated with the deeper layers of the bowel wall. Other management focuses on bowel rest (not increasing oral intake) and reducing diarrhea with medications (not giving laxatives). The pain associated with Crohn’s disease may require bed rest, not an increase in physical activity.

24. Answer: 3. Decrease in body weight

A decrease in body weight may occur during therapy due to inadequate dietary intake, but isn’t related to antibiotic therapy. Effective antibiotic therapy will be noted by a decrease in temperature, number of stools, and bleeding.

25. Answer: 4. Bowel perforation

Perforation, obstruction, hemorrhage, and toxic megacolon are common complications of ulcerative colitis that may require surgery. Herniation and gastritis aren’t associated with irritable bowel diseases, and outpouching of the bowel is diverticulosis.

26. Answer: 3. Steroids

The pain with irritable bowel disease is caused by inflammation, which steroids can reduce. Stool softeners aren’t necessary. Acetaminophen has little effect on the pain, and opiate narcotics won’t treat its underlying cause.

27. Answer: 2. Ostomy care

Although all of these are concerns the nurse should address, being able to safely manage the ostomy is crucial for the client before discharge.

28. Answer: 4. Ulcerative colitis

Chronic ulcerative colitis, granulomas, and familial polyposis seem to increase a person’s chance of developing colon cancer. The other conditions listed have no known effect on colon cancer risk.

29. Answer: 1. Low-fiber, high fat

A low-fiber, high-fat diet reduced motility and increases the chance of constipation. The metabolic end products of this type of diet are carcinogenic. A low-fat, high-fiber diet is recommended to prevent colon cancer.

30. Answer: 4. Fecal occult blood test

Surface blood vessels of polyps and cancers are fragile and often bleed with the passage of stools. Abdominal x-ray and CT scan can help establish tumor size and metastasis. A colonoscopy can help locate a tumor as well as polyps, which can be removed before they become malignant.

31. Answer: 1. Reducing the size of the tumor

Radiation therapy is used to treat colon cancer before surgery to reduce the size of the tumor, making it easier to be resected. Radiation therapy isn’t curative, can’t eliminate the malignant cells (though it helps define tumor margins), can could slow postoperative healing.

32. Answer: 2. A change in bowel habits

The most common compla