Digestive & Gastrointestinal System Disorders | NCLEX Quiz 64

1. You're preparing a patient with a malignant tumor for colorectal surgery and subsequent colostomy. The patient tells you he's anxious. What should your initial step be in working with this patient?

Determine what the patient already knows about colostomies.

Show the patient some pictures of colostomies.

Arrange for someone who has a colostomy to visit the patient.

Provide the patient with written material about colostomy care.

Initially. you should assess the patient’s knowledge about colostomies and how it will affect his lifestyle.

Explanation

Initially. you should assess the patient’s knowledge about colostomies and how it will affect his lifestyle.

2. You promote hemodynamic stability in a patient with upper GI bleeding by:

Encouraging oral fluid intake.

Monitoring central venous pressure.

Monitoring laboratory test results and vital signs.

Giving blood. electrolyte and fluid replacement.

To stabilize a patient with acute bleeding. NS or LR solution is given I.V. until BP rises and urine output returns to 30ml/hr.

Explanation

To stabilize a patient with acute bleeding. NS or LR solution is given I.V. until BP rises and urine output returns to 30ml/hr.

3. Findings during an endoscopic exam include a cobblestone appearance of the colon in your patient. The findings are characteristic of which disorder?

Ulcer

Crohn’s disease

Chronic gastritis

Ulcerative colitis

Crohn’s disease penetrates the mucosa of the colon through all layers and destroys the colon in patches. which creates a cobblestone appearance.

Explanation

Crohn’s disease penetrates the mucosa of the colon through all layers and destroys the colon in patches. which creates a cobblestone appearance.

4. Dark. tarry stools indicate bleeding in which location of the GI tract?

Upper colon.

Lower colon.

Upper GI tract.

Small intestine.

Melena is the passage of dark. tarry stools that contain a large amount of digested blood. It occurs with bleeding from the upper GI tract.

Explanation

Melena is the passage of dark. tarry stools that contain a large amount of digested blood. It occurs with bleeding from the upper GI tract.

5. Your patient. Christopher. has a diagnosis of ulcerative colitis and has severe abdominal pain aggravated by movement. rebound tenderness. fever. nausea. and decreased urine output. This may indicate which complication?

Fistula.

Bowel perforation.

Bowel obstruction.

Abscess.

An inflammatory condition that affects the surface of the colon. ulcerative colitis causes friability and erosions with bleeding. Patients with ulcerative colitis are at increased risk for bowel perforation. toxic megacolon. hemorrhage. cancer. and other anorectal and systemic complications.

Explanation

An inflammatory condition that affects the surface of the colon. ulcerative colitis causes friability and erosions with bleeding. Patients with ulcerative colitis are at increased risk for bowel perforation. toxic megacolon. hemorrhage. cancer. and other anorectal and systemic complications.

6. The student nurse is teaching the family of a patient with liver failure. You instruct them to limit which foods in the patient's diet?

Meats and beans.

Butter and gravies.

Potatoes and pastas.

Cakes and pastries.

Meats and beans are high-protein foods. In liver failure. the liver is unable to metabolize protein adequately. causing protein by-products to build up in the body rather than be excreted.

Explanation

Meats and beans are high-protein foods. In liver failure. the liver is unable to metabolize protein adequately. causing protein by-products to build up in the body rather than be excreted.

7. An intubated patient is receiving continuous enteral feedings through a Salem sump tube at a rate of 60ml/hr. Gastric residuals have been 30-40ml when monitored Q4H. You check the gastric residual and aspirate 220ml. What is your first response to this finding?

Notify the doctor immediately.

Stop the feeding. and clamp the NG tube.

Discard the 220ml. and clamp the NG tube.

Give a prescribed GI stimulant such as metoclopramide (Reglan).

A gastric residual greater than 2 hours worth of feeding or 100-150ml is considered too high. The feeding should be stopped; NG tube clamped. and then allow time for the stomach to empty before additional feeding is added.

Explanation

A gastric residual greater than 2 hours worth of feeding or 100-150ml is considered too high. The feeding should be stopped; NG tube clamped. and then allow time for the stomach to empty before additional feeding is added.

8. What information is correct about stomach cancer?

Stomach pain is often a late symptom.

Surgery is often a successful treatment.

Chemotherapy and radiation are often successful treatments.

The patient can survive for an extended time with TPN.

Stomach pain is often a late sign of stomach cancer; outcomes are particularly poor when cancer reaches that point. Surgery. chemotherapy. and radiation have minimal positive effects. TPN may enhance the growth of cancer.

Explanation

Stomach pain is often a late sign of stomach cancer; outcomes are particularly poor when cancer reaches that point. Surgery. chemotherapy. and radiation have minimal positive effects. TPN may enhance the growth of cancer.

9. A patient has a severe exacerbation of ulcerative colitis. Long-term medications will probably include:

Antacids.

Antibiotics.

Corticosteroids.

Histamine2-receptor blockers.

Medications to control inflammation such as corticosteroids are used for long-term treatment.

Explanation

Medications to control inflammation such as corticosteroids are used for long-term treatment.

10. A patient has an acute upper GI hemorrhage. Your interventions include:

Treating hypovolemia.

Treating hypervolemia.

Controlling the bleeding source.

Treating shock and diagnosing the bleeding source.

A patient with an acute upper GI hemorrhage must be treated for hypovolemia and hemorrhagic shock. You as a nurse can’t diagnose the problem. Controlling the bleeding may require surgery or intensive medical treatment.

Explanation

A patient with an acute upper GI hemorrhage must be treated for hypovolemia and hemorrhagic shock. You as a nurse can’t diagnose the problem. Controlling the bleeding may require surgery or intensive medical treatment.