Digestive & Gastrointestinal System Disorders | NCLEX Quiz 81

1. Dr. Smith has determined that the client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis?

Hepatitis A

Hepatitis B

Hepatitis C

Hepatitis D

Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B. C. and D are transmitted most commonly via infected blood or body fluids.

Explanation

Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B. C. and D are transmitted most commonly via infected blood or body fluids.

2. A nurse is preparing to remove a nasogastric tube from a female client. The nurse should instruct the client to do which of the following just before the nurse removes the tube?

Exhale

Inhale and exhale quickly

Take and hold a deep breath

Perform a Valsalva maneuver

When the nurse removes a nasogastric tube. the client is instructed to take and hold a deep breath. This will close the epiglottis. This allows for easy withdrawal through the esophagus into the nose. The nurse removes the tube with one smooth. continuous pull.

Explanation

When the nurse removes a nasogastric tube. the client is instructed to take and hold a deep breath. This will close the epiglottis. This allows for easy withdrawal through the esophagus into the nose. The nurse removes the tube with one smooth. continuous pull.

3. Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis. The nurse reviews the laboratory result. anticipating a laboratory report that indicates a serum amylase level of:

45 units/L

100 units/L

300 units/L

500 units/L

The normal serum amylase level is 25 to 151 units/L. With chronic cases of pancreatitis. the rise in serum amylase levels usually does not exceed three times the normal value. In acute pancreatitis. the value may exceed five times the normal value. Options A and B are within normal limits. Option D is an extremely elevated level seen in acute pancreatitis.

Explanation

The normal serum amylase level is 25 to 151 units/L. With chronic cases of pancreatitis. the rise in serum amylase levels usually does not exceed three times the normal value. In acute pancreatitis. the value may exceed five times the normal value. Options A and B are within normal limits. Option D is an extremely elevated level seen in acute pancreatitis.

4. Nurse Joy is preparing to administer medication through a nasogastric tube that is connected to suction. To administer the medication. the nurse would:

Position the client supine to assist in medication absorption

Aspirate the nasogastric tube after medication administration to maintain patency

Clamp the nasogastric tube for 30 minutes following administration of the medication

Change the suction setting to low intermittent suction for 30 minutes after medication administration

If a client has a nasogastric tube connected to suction. the nurse should wait up to 30 minutes before reconnecting the tube to the suction apparatus to allow adequate time for medication absorption. Aspirating the nasogastric tube will remove the medication just administered. Low intermittent suction also will remove the medication just administered. The client should not be placed in the supine position because of the risk for aspiration.

Explanation

If a client has a nasogastric tube connected to suction. the nurse should wait up to 30 minutes before reconnecting the tube to the suction apparatus to allow adequate time for medication absorption. Aspirating the nasogastric tube will remove the medication just administered. Low intermittent suction also will remove the medication just administered. The client should not be placed in the supine position because of the risk for aspiration.

5. Nurse Oliver checks for residual before administering a bolus tube feeding to a client with a nasogastric tube and obtains a residual amount of 150 mL. What is appropriate action for the nurse to take?

Hold the feeding

Reinstill the amount and continue with administering the feeding

Elevate the client’s head at least 45 degrees and administer the feeding

Discard the residual amount and proceed with administering the feeding

Unless specifically indicated. residual amounts more than 100 mL require holding the feeding. Therefore options B. C. and D are incorrect. Additionally. the feeding is not discarded unless its contents are abnormal in color or characteristics.

Explanation

Unless specifically indicated. residual amounts more than 100 mL require holding the feeding. Therefore options B. C. and D are incorrect. Additionally. the feeding is not discarded unless its contents are abnormal in color or characteristics.

6. Nurse Ryan is assessing for correct placement of a nasogastric tube. The nurse aspirates the stomach contents and checks the contents for pH. The nurse verifies correct tube placement if which pH value is noted?

3.5

7

7.35

7.5

If the nasogastric tube is in the stomach. the pH of the contents will be acidic. Gastric aspirates have acidic pH values and should be 3.5 or lower. Option B indicates a slightly acidic pH. Option C indicates a neutral pH. Option D indicates an alkaline pH.

Explanation

If the nasogastric tube is in the stomach. the pH of the contents will be acidic. Gastric aspirates have acidic pH values and should be 3.5 or lower. Option B indicates a slightly acidic pH. Option C indicates a neutral pH. Option D indicates an alkaline pH.

7. A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking forward to the diet change because he has been "bored" with the clear liquid diet. The nurse would offer which full liquid item to the client?

Tea

Gelatin

Custard

Popsicle

Full liquid food items include items such as plain ice cream. sherbet. breakfast drinks. milk. pudding and custard. soups that are strained. and strained vegetable juices. A clear liquid diet consists of foods that are relatively transparent. The food items in options A. B. and D are clear liquids.

Explanation

Full liquid food items include items such as plain ice cream. sherbet. breakfast drinks. milk. pudding and custard. soups that are strained. and strained vegetable juices. A clear liquid diet consists of foods that are relatively transparent. The food items in options A. B. and D are clear liquids.

8. A nurse is inserting a nasogastric tube in an adult male client. During the procedure. the client begins to cough and has difficulty breathing. Which of the following is the appropriate nursing action?

Quickly insert the tube

Notify the physician immediately

Remove the tube and reinsert when the respiratory distress subsides

Pull back on the tube and wait until the respiratory distress subsides

During the insertion of a nasogastric tube. if the client experiences difficulty breathing or any respiratory distress. withdraw the tube slightly. stop the tube advancement. and wait until the distress subsides. Options B and C are unnecessary. Quickly inserting the tube is not an appropriate action because. in this situation. it may be likely that the tube has entered the bronchus.

Explanation

During the insertion of a nasogastric tube. if the client experiences difficulty breathing or any respiratory distress. withdraw the tube slightly. stop the tube advancement. and wait until the distress subsides. Options B and C are unnecessary. Quickly inserting the tube is not an appropriate action because. in this situation. it may be likely that the tube has entered the bronchus.

9. A nurse is preparing to care for a female client with esophageal varices who just had a Sengstaken-Blakemore tube inserted. The nurse gathers supplies. knowing that which of the following items must be kept at the bedside at all times?

An obturator

Kelly clamp

An irrigation set

A pair of scissors

When the client has a Sengstaken-Blakemore tube. a pair of scissors must be kept at the client’s bedside at all times. The client needs to be observed for sudden respiratory distress. which occurs if the gastric balloon ruptures and the entire tube moves upward. If this occurs. the nurse immediately cuts all balloon lumens and removes the tube. An obturator and a Kelly clamp are kept at the bedside of a client with a tracheostomy. An irrigation set may be kept at the bedside. but it is not the priority item.

Explanation

When the client has a Sengstaken-Blakemore tube. a pair of scissors must be kept at the client’s bedside at all times. The client needs to be observed for sudden respiratory distress. which occurs if the gastric balloon ruptures and the entire tube moves upward. If this occurs. the nurse immediately cuts all balloon lumens and removes the tube. An obturator and a Kelly clamp are kept at the bedside of a client with a tracheostomy. An irrigation set may be kept at the bedside. but it is not the priority item.

10. Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder. the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intention to increase the intake of:

Pork

Milk

Chicken

Broccoli

The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a variety of foods of plant and animal origin. Pork products are especially rich in this vitamin. Other good food sources include nuts. whole grain cereals. and legumes. Milk contains vitamins A. D. and B2. Poultry contains niacin. Broccoli contains vitamins C. E. and K and folic acid

Explanation

The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a variety of foods of plant and animal origin. Pork products are especially rich in this vitamin. Other good food sources include nuts. whole grain cereals. and legumes. Milk contains vitamins A. D. and B2. Poultry contains niacin. Broccoli contains vitamins C. E. and K and folic acid