A 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. Malaise

Rationale: Hepatitis causes gastrointestinal 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.

A client has just had a hemorrhoidectomy. Which
nursing interventions 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. Encourage a high-ber diet to promote bowel
movements without straining.
4. Apply cold packs to the anal-rectal area over the
dressing until the packing is removed.
5. Help the client to a Fowler’s position to place
pressure on the rectal area and decrease bleeding

1. Administer stool softeners as prescribed.
3. Encourage a high-fiber diet to promote bowel movements without straining.
4. Apply cold packs to the anal-rectal area over the dressing until the packing is removed.
Rationale: 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. Options 2 and 5 are incorrect interventions.

The nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances
to avoid. Which items would the nurse include on
this list? Select all that apply.
1. Coffee
2. Chocolate
3. Peppermint
4. Nonfat milk
5. Fried chicken
6. Scrambled eggs

1. Coffee
2. Chocolate
3. Peppermint
5. 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 need to
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 client suspected of having a duodenal ulcer has
undergone esophagogastroduodenoscopy. The nurse
would place highest priority on which item as part
of the client’s care plan?
1. Monitoring the temperature
2. Monitoring complaints of heartburn
3. Giving warm gargles for a sore throat
4. Assessing for the return of the gag reflex

4. Assessing for the return of the gag reflex

Rationale: The nurse places highest priority on assessing for
return of the gag reflex. This assessment addresses the client’s
airway. The nurse also monitors the client’s vital signs and for
a sudden increase in temperature, which could indicate perforation of the gastrointestinal tract. This complication would be
accompanied by other signs as well, such as pain. Monitoring
for sore throat and heartburn are also important; however, the
client’s airway is the priority.

The nurse has taught the client with suspected gallbladder disease about an upcoming endoscopic retrograde cholangiopancreatography (ERCP) procedure. The nurse determines that the client needs further information if the client makes which statement?
1. “I know I must sign the consent form.”
2. “I hope the throat spray keeps me from gagging.”
3. “I’m glad I don’t have to lie still for this procedure.”
4. “I’m glad some intravenous medication will be
given to relax me.”

3. “I’m glad I don’t have to lie still for this procedure.”

Rationale: The client does have to lie still for ERCP, which
takes about 1 hour to perform. The client also has to sign a
consent form. Intravenous sedation is given to relax the client,
and an anesthetic spray is used to help keep the client from
gagging as the endoscope is passed.

The primary health care provider has determined
that a client has contracted hepatitis A based on
flulike symptoms and jaundice. Which statement
made by the client supports this medical diagnosis?
1. “I have had unprotected sex with multiple partners.”
2. “I ate shellfish about 2 weeks ago at a local restaurant.”
3. “I was an intravenous drug abuser in the past and
shared needles.”
4. “I had a blood transfusion 30 years ago after major abdominal surgery.”

2. “I ate shellfish about 2 weeks ago at a local restaurant.”

Rationale: Hepatitis A is transmitted by the fecal-oral route via
contaminated water or food (improperly cooked shellfish), or
infected food handlers. Hepatitis B, C, and D are transmitted
most commonly via infected blood or body fluids, such as in
the cases of intravenous drug abuse, history of blood transfusion, or unprotected sex with multiple partners

The nurse is assessing a client 24 hours after 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. Notify the surgeon.
4. Document the finding

4. Document the finding
Rationale: Following 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/day. The
nurse would document the output.

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, boardlike abdomen

4. A rigid, boardlike abdomen

Rationale: Perforation of an ulcer is a surgical emergency and is
characterized by sudden, sharp, intolerably severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and boardlike. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock
develops. Numbness in the legs is not an associated finding.

A client with severe ulcer disease in the distal stomach undergoes a gastrojejunostomy (Billroth II procedure). Which postoperative prescription would
the nurse question and verify?
1. Leg exercises
2. Early ambulation
3. Irrigating the nasogastric tube
4. Coughing and deep-breathing exercise

3. Irrigating the nasogastric tube

Rationale: In a gastrojejunostomy (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 secretions. The nurse
would never irrigate or reposition the gastric tube after gastric
surgery, unless specifically prescribed by the primary health
care provider. In this situation, the nurse needs to clarify the
prescription. Options 1, 2, and 4 are appropriate postoperative interventions

The nurse is providing discharge instructions to a
client following gastrectomy and would instruct the
client to take which measure to assist in preventing
dumping syndrome?
1. Ambulate following a meal.
2. Limit the fluids taken with meals.
3. Eat cakes and pastries only if they are homemade.
4. Eat three meals a day rather than small frequent
meals

2. Limit the fluids taken with meals.

Rationale: Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after eating, especially following a gastrojejunostomy (Billroth II procedure).
Early manifestations usually occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. The nurse would
instruct the client to decrease the amount of fluid taken at
meals. Complex carbohydrate foods such as oatmeal and other
whole-grain foods high in fiber will help to prevent dumping
syndrome but high sugar foods, such as candy, table sugar,
syrup, sodas and juices, cakes, and pastries need to be avoided
whether they are homemade or store bought. The client needs
to lie down for 15 to 30 minutes after eating to delay gastric
emptying; ambulation will cause rapid gastric emptyin

The nurse is reviewing the prescription for a client
admitted to the hospital with a diagnosis of acute
pancreatitis. Which interventions would the nurse
expect to be prescribed for the client? Select all that
apply.
1. Maintain NPO (nothing by mouth) status.
2. Encourage coughing and deep breathing.
3. Give small, frequent high-calorie feedings.
4. Maintain the client in a supine and at position.
5. Give hydromorphone intravenously as prescribed for pain.
6. Maintain intravenous uids at 10 mL/hr to
keep the vein open.

1. Maintain NPO (nothing by mouth) status.
2. Encourage coughing and deep breathing.
5. Give hydromorphone intravenously as prescribed for pain.

Rationale: The client with acute pancreatitis normally is
placed on NPO status to rest the pancreas and suppress gastrointestinal secretions, so adequate intravenous hydration is
necessary. Because abdominal pain is a prominent symptom
of pancreatitis, pain medications such as hydromorphone are
prescribed. Some clients experience lessened pain by assuming positions that flex the trunk, with the knees drawn up
to the chest. A side-lying position with the head elevated 45
degrees decreases tension on the abdomen and may help
ease the pain. The client is susceptible to respiratory infections because the retroperitoneal fluid raises the diaphragm,
which causes the client to take shallow, guarded abdominal
breaths. Therefore, measures such as turning, coughing, and
deep breathing are instituted.

The nurse is providing discharge teaching for
a client with newly diagnosed Crohn’s disease
about dietary measures to implement during exacerbation episodes. Which statement made by
the client indicates a need for further instruction?
1. “I need to increase the fiber in my diet.”
2. “I will need to avoid caffeinated beverages.”
3. “I’m going to learn some stress-reduction techniques.”
4. “I can have exacerbations and remissions with
Crohn’s disease.”

1. “I need to increase the fiber in my diet.”

Rationale: Crohn’s disease is an inflammatory disease that
can occur anywhere in the gastrointestinal tract but most often
affects the terminal ileum and leads to thickening and scarring, a narrowed lumen, fistulas, ulcerations, and abscesses.
It is characterized by exacerbations and remissions. If stress
increases the symptoms of the disease, the client is taught
stress-management techniques and may require additional
counseling. The client is taught to avoid gastrointestinal stimulants containing caffeine and to follow a high-calorie and
high-protein diet. A low-fiber diet may be prescribed, especially during periods of exacerbation.

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 would
the nurse assess for its presence?
1. Dorsiex the client’s foot.
2. Measure the abdominal girth.
3. Ask the client to extend the arms.
4. Instruct the client to lean forward.

3. Ask the client to extend the arms.

Rationale: Asterixis is irregular flapping movements of the
fingers and wrists when the hands and arms are outstretched,
with the palms down, wrists bent up, and fingers spread.
Asterixis is the most common and reliable sign that hepatic
encephalopathy is developing. Options 1, 2, and 4 are incorrect.

The nurse is reviewing the laboratory results for a client with cirrhosis and notes that the ammonia level is 85 mcg/dL (51 mcmol/L). Which dietary selection does the nurse suggest to the
client?
1. Roast pork
2. Cheese omelet
3. Pasta with sauce
4. Tuna fish sandwich

3. Pasta with sauce

Rationale: Cirrhosis is a chronic, progressive disease of the
liver characterized by diffuse degeneration and destruction of
hepatocytes. The serum ammonia level assesses the ability of
the liver to deaminate protein byproducts. Normal reference
interval is 10 to 80 mcg/dL (6 to 47 mcmol/L). Most of the
ammonia in the body is found in the gastrointestinal tract.
Protein provided by the diet is transported to the liver by the
portal vein. The liver breaks down protein, which results in
the formation of ammonia. Foods high in protein would be
avoided since the client’s ammonia level is elevated above the
normal range; therefore, pasta with sauce would be the best
selection.

Focus on the subject, an ammonia level
of 85 mcg/dL (51 mcmol/L). Realizing that this result is above
the normal range will direct you away from selecting highprotein foods, such as pork, cheese, eggs, and fish

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 manifestation of duodenal ulcer?
1. Weight loss
2. Nausea and vomiting
3. Pain relieved by food intake
4. Pain radiating down the right arm

3. Pain relieved by food intake

Rationale: A frequent symptom of duodenal ulcer is pain that
is relieved by food intake. These clients generally describe the
pain as a burning, heavy, sharp, or “hungry” pain that often
localizes in the midepigastric area. The client with duodenal
ulcer usually does not experience weight loss or nausea and
vomiting. These symptoms are more typical in the client with
a gastric ulcer.

A client with hiatal hernia chronically experiences
heartburn following meals. The nurse would 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. Taking H2-receptor antagonist medication
4. Raising the head of the bed on 6-inch (15 cm) blocks

1. Lying recumbent following meals

Rationale: 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, lying
flat following meals or at night, and eating large or fatty
meals. Relief is obtained with the intake of small, frequent,
and bland meals; use of H2
-receptor antagonists and antacids; and elevation of the thorax following meals and during
sleep.

The nurse is providing care for a client with a bowel
obstruction who had a transverse colostomy created. Which observation requires immediate notication of the primary health care provider?
1. Stoma is beefy red and shiny
2. Purple discoloration of the stoma
3. Skin excoriation around the stoma
4. Semiformed stool noted in the ostomy pouch

2. Purple discoloration of the stoma
Rationale: Ischemia of the stoma would be associated with a
dusky or bluish or purple color. A beefy red and shiny stoma
is normal and expected. Skin excoriation does need to be
addressed and treated, but immediate attention is required for
purple discoloration of the stoma. Semiformed stool is a normal finding.

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 by the nurse?
1. This is a normal, expected event.
2. The client is experiencing early signs of ischemic
bowel.
3. The client should not have the nasogastric tube
removed.
4. This indicates inadequate preoperative bowel
preparation.

1. This is a normal, expected event.

Rationale: 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.
Within 72 hours of surgery, the client would begin passing
stool via the colostomy. Options 2, 3, and 4 are incorrect
interpretations

A client with severe Crohn’s disease 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. Fluid and electrolyte imbalance
Rationale: A frequent complication that occurs following ileostomy is fluid and electrolyte imbalance. The client requires constant monitoring of intake and output to prevent this from occurring. Losses require replacement by intravenous infusion until the
client can tolerate a diet orally. Intestinal obstruction is a less frequent complication. Fat malabsorption and folate deficiency are
complications that could occur later in the postoperative period.

The nurse provides instructions to a client about
measures to treat irritable bowel syndrome (IBS).
Which statement by the client indicates a need for
further teaching?
1. “I need to limit my intake of dietary fiber.”
2. “I need to drink plenty, at least 8 to 10 cups daily.”
3. “I need to eat regular meals and chew my food well.”
4. “I will take the prescribed medications because
they will regulate my bowel patterns.”

1. “I need to limit my intake of dietary fiber.”

Rationale: IBS is a functional gastrointestinal disorder that
causes chronic or recurrent diarrhea, constipation, and/or
abdominal pain and bloating. Dietary fiber and bulk help
produce bulky, soft stools and establish regular bowel elimination habits. Therefore, the client would consume a highfiber diet. Eating regular meals, drinking 8 to 10 cups of liquid
a day, and chewing food slowly help promote normal bowel
function. Medication therapy depends on the main symptoms
of IBS. Bulk-forming laxatives or antidiarrheal agents or other
agents may be prescribed.

The nurse is monitoring a 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. Sweating and pallor
Rationale: 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

The nurse has given instructions to a client with biliary disease who has just been prescribed cholestyramine. Which statement by the client indicates a
need for further instruction?
1. “I will continue to take vitamin supplements.”
2. “This medication will help lower my cholesterol.”
3. “This medication would only be taken with water.”
4. “A high-fiber diet is important while taking this
medication.”

3. “This medication would only be taken with water.”

Rationale: Cholestyramine is a bile acid sequestrant used to
lower the cholesterol level, and treat biliary obstruction and
pruritus associated with biliary disease. Client adherence to
the medication regimen is a problem because of its taste and
palatability. The use of flavored products or fruit juices can
improve the taste. Some side effects of bile acid sequestrants
include constipation and decreased vitamin absorptio

11. The nurse determines that the client needs further
instruction on cimetidine if which statements were
made? Select all that apply.
1. “I will take the cimetidine with my meals.”
2. “I’ll know the medication is working if my diarrhea stops.”
3. “My episodes of heartburn will decrease if the
medication is effective.”
4. “Taking the cimetidine with an antacid will increase its effectiveness.”
5. “I will notify my doctor if I become depressed
or anxious.”
6. “Some of my blood levels will need to be monitored closely since I also take warfarin for atrial
brillation.

1. “I will take the cimetidine with my meals.”
2. “I’ll know the medication is working if my diarrhea stops.”
4. “Taking the cimetidine with an antacid will increase its effectiveness.”
Rationale: Cimetidine, a histamine (H2)-receptor antagonist, helps alleviate the symptom of heartburn, not diarrhea.
Because cimetidine crosses the blood–brain barrier, central
nervous system side and adverse effects, such as mental confusion, agitation, depression, and anxiety, can occur. Food
reduces the rate of absorption, so if cimetidine is taken with
meals, absorption will be slowed. Antacids decrease the
absorption of cimetidine and need to be taken at least 1 hour
apart. If cimetidine is concomitantly administered with warfarin therapy, warfarin doses may need to be reduced, so prothrombin and international normalized ratio results must be
followed.

A client with gastroesophageal reflux disease has a
new prescription for metoclopramide. On review of
the chart, the nurse identifies that this medication
can be safely administered with which condition?
1. Intestinal obstruction
2. Peptic ulcer with melena
3. Diverticulitis with perforation
4. Vomiting following cancer chemotherapy

4. Vomiting following cancer chemotherapy
Rationale: Metoclopramide is a gastrointestinal stimulant
and antiemetic. Because it is a gastrointestinal stimulant, it
is contraindicated with gastrointestinal obstruction, hemorrhage, or perforation. It is used in the treatment of vomiting
after surgery, chemotherapy, or radiation.

A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including clarithromycin, esomeprazole, and amoxicillin.
Which statement by the client indicates the best understanding of the medication regimen?
1. “My ulcer will heal because these medications
will kill the bacteria.”
2. “These medications are taken only when I have
pain from my ulcer.”
3. “The medications will kill the bacteria and stop
the acid production.”
4. “These medications will coat the ulcer and decrease the acid production in my stomach.”

3. “The medications will kill the bacteria and stop the acid production.”
Rationale: Triple therapy for H. pylori infection usually
includes two antibacterial medications and a proton pump
inhibitor. Clarithromycin and amoxicillin are antibacterials.
Esomeprazole is a proton pump inhibitor. These medications
will kill the bacteria and decrease acid production.

8. A client with peptic ulcer disease has been taking
omeprazole for 4 weeks. The ambulatory care nurse
evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom?
1. Diarrhea
2. Heartburn
3. Flatulence
4. Constipation

Heartburn
Rationale: Omeprazole is a proton pump inhibitor classified
as an antiulcer agent. The intended effect of the medication is
relief of pain from gastric irritation, often called heartburn by
clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4.

A client with gastritis who uses nonsteroidal antiinammatory drugs (NSAIDs) has been taking misoprostol. The nurse determines that the misoprostol
is having the intended therapeutic effect if which
finding is noted?
1. Resolved diarrhea
2. Relief of epigastric pain
3. Decreased platelet count
4. Decreased white blood cell count

2. Relief of epigastric pain
Rationale: The client who uses NSAIDs is prone to gastric
mucosal injury. Misoprostol is a gastric protectant and is given
specifically to prevent this occurrence in clients taking NSAIDs
frequently. Diarrhea can be a side effect of the medication but
is not an intended effect. Options 3 and 4 are unrelated to the
purpose of misoprostol.

A client with a gastric ulcer has a prescription for
sucralfate 1 gram by mouth 4 times daily. The
nurse would schedule the medication for which
times?
1. With meals and at bedtime
2. Every 6 hours around the clock
3. One hour after meals and at bedtime
4. One hour before meals and at bedtime

4. One hour before meals and at bedtime
Rationale: Sucralfate is a gastric protectant. The medication
would be scheduled for administration 1 hour before meals
and at bedtime. The medication is timed to allow it to form a
protective coating over the ulcer before food intake stimulates
gastric acid production and mechanical irritation. The other
options are incorrect.

An older client with peptic ulcer disease recently has
been taking cimetidine. The nurse monitors the client for which most frequent central nervous system
side effect of this medication?
1. Tremors
2. Dizziness
3. Confusion
4. Hallucinations

3. Confusion
Rationale: Cimetidine is a histamine (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of
these is confusion. Less common central nervous system side
effects include headache, dizziness, drowsiness, and hallucinations.

A client with chronic pancreatitis has begun medication therapy with pancrelipase. The nurse evaluates
that the medication is having the optimal intended
benefit if which effect is observed?
1. Weight loss
2. Relief of heartburn
3. Reduction of steatorrhea
4. Absence of abdominal pain

3. Reduction of steatorrhea
Rationale: Pancrelipase is a pancreatic enzyme used in clients
with pancreatitis as a digestive aid. The medication would
reduce the amount of fatty stools (steatorrhea). Another
intended effect could be improved nutritional status. It is not
used to treat abdominal pain or heartburn. Its use could result
in weight gain but would not result in weight loss if it is aiding
in digestion

A client with gastroenteritis has an as-needed prescription for ondansetron. For which condition(s)
would the nurse administer this medication?
1. Paralytic ileus
2. Incisional pain
3. Urinary retention
4. Nausea and vomiting

4. Nausea and vomiting
Rationale: Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting
associated with chemotherapy. The other options are incorrect
reasons for administering this medication

A client with gastroenteritis has an as-needed prescription for loperamide hydrochloride. For which
condition would the nurse administer this medication?
1. Constipation
2. Abdominal pain
3. An episode of diarrhea
4. Hematest-positive nasogastric tube drainage

3. An episode of diarrhea
Rationale: Loperamide is an antidiarrheal agent. It is used
to manage acute and chronic diarrhea in conditions such as
inflammatory bowel disease. Loperamide also can be used to
reduce the volume of drainage from an ileostomy. It is not
used for the conditions in options 1, 2, and 4.

A client with Crohn’s disease is scheduled to receive an infusion of infliximab. What intervention
by the nurse will determine the effectiveness of
treatment?
1. Monitoring the leukocyte count for 2 days after
the infusion
2. Checking the frequency and consistency of bowel movements
3. Checking serum liver enzyme levels before and
after the infusion
4. Carrying out a Hematest on gastric uids after
the infusion is completed

2. Checking the frequency and consistency of bowel movements
Rationale: The principal manifestations of Crohn’s disease
are diarrhea and abdominal pain. Infliximab is an immunomodulator that reduces the degree of inflammation in the
colon, thereby reducing the diarrhea. Options 1, 3, and 4 are
unrelated to this medication.