Gastrointestinal-Hepatobillary NCLEX-RN DRILL

This is a 30 point drill on concepts regarding Management of Clients with Gastrointestinal-Hepatobillary Disorders. Use this to serve as your pretest and post test on the subject Mattter

Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!

1. During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia?

a. vitamin A

b. vitamin D

c. vitamin E

d. vitamin K

2. When evaluating a male client for complications of acute pancreatitis, the nurse would observe for:

a. increased intracranial pressure.

b. decreased urine output.

c. bradycardia.

d. hypertension.

3. A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially?

a. Lying on the right side with legs straight

b. Lying on the left side with knees bent

c. Prone with the torso elevated

d. Bent over with hands touching the floor

4. A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been “spitting up blood.” A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the client’s wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is:

a. “Tell me about your husband’s alcohol usage.”

b. “Is your husband being treated for tuberculosis?”

c. “Has your husband recently fallen or injured his chest?”

d. “Describe spices and condiments your husband uses on food.”

5. Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube?

a. Change the tube feeding solutions and tubing at least every 24 hours.

b. Maintain the head of the bed at a 15-degree elevation continuously.

c. Check the gastrostomy tube for position every 2 days.

d. Maintain the client on bed rest during the feedings.

6. 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’s onset of action occur?

a. 5 to 10 minutes

b. 15 to 30 minutes

c. 30 to 60 minutes

d. 2 to 4 hours

7. The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?

a. Dyspnea and fatigue

b. Ascites and orthopnea

c. Purpura and petechiae

d. Gynecomastia and testicular atrophy

8. Which condition is most likely to have a nursing diagnosis of fluid volume deficit?

a. Appendicitis

b. Pancreatitis

c. Cholecystitis

d. Gastric ulcer

9. While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes clogged. To remedy this problem and teach the client’s family how to deal with it at home, what should the nurse do?

a. Irrigate the tube with cola.

b. Advance the tube into the intestine.

c. Apply intermittent suction to the tube.

d. Withdraw the obstruction with a 30-ml syringe.

10. A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because:

a. meperidine provides a better, more prolonged analgesic effect.

b. morphine may cause spasms of Oddi’s sphincter.

c. meperidine is less addictive than morphine.

d. morphine may cause hepatic dysfunction.

11. Mandy, an adolescent girl is admitted to an acute care facility with severe malnutrition. After a thorough examination, the physician diagnoses anorexia nervosa. When developing the plan of care for this client, the nurse is most likely to include which nursing diagnosis?

a. Hopelessness

b. Powerlessness

c. Chronic low self esteem

d. Deficient knowledge

12. Which diagnostic test would be used first to evaluate a client with upper GI bleeding?

a. Endoscopy

b. Upper GI series

c. Hemoglobin (Hb) levels and hematocrit (HCT)

d. Arteriography

13. A female client who has just been diagnosed with hepatitis A asks, “How could I have gotten this disease?” What is the nurse’s best response?

a. “You may have eaten contaminated restaurant food.”

b. “You could have gotten it by using I.V. drugs.”

c. “You must have received an infected blood transfusion.”

d. “You probably got it by engaging in unprotected sex.”

14. When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?

a. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.

b. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

c. The appendix may develop gangrene and rupture, especially in a middle-aged client.

d. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

15. A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are:

a. whole blood and albumin.

b. platelets and packed red blood cells.

c. fresh frozen plasma and whole blood.

d. cryoprecipitate and fresh frozen plasma.

16. To prevent gastroesophageal reflux in a male client with hiatal hernia, the nurse should provide which discharge instruction?

a. “Lie down after meals to promote digestion.”

b. “Avoid coffee and alcoholic beverages.”

c. “Take antacids with meals.”

d. “Limit fluid intake with meals.”

17. The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first?

a. Administering pain medication

b. Obtaining a blood sample for laboratory studies

c. Preparing to insert a nasogastric (NG) tube

d. Administering I.V. fluids

18. A female client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge?

a. The client doesn’t exhibit rectal tenesmus.

b. The client is free from esophagitis and achalasia.

c. The client reports diminished duodenal inflammation.

d. The client has normal gastric structures.

19. A male client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client’s nasogastric (NG) tube has stopped draining. How should the nurse respond?

a. Notify the physician

b. Reposition the tube

c. Irrigate the tube

d. Increase the suction level

20. What laboratory finding is the primary diagnostic indicator for pancreatitis?

a. Elevated blood urea nitrogen (BUN)

b. Elevated serum lipase

c. Elevated aspartate aminotransferase (AST)

d. Increased lactate dehydrogenase (LD)

21. A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:

a. yellow sclerae.

b. light amber urine.

c. circumoral pallor.

d. black, tarry stools.

22. Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention:

a. a sedentary lifestyle and smoking.

b. a history of hemorrhoids and smoking.

c. alcohol abuse and a history of acute renal failure.

d. alcohol abuse and smoking.

23. While palpating a female client’s right upper quadrant (RUQ), the nurse would expect to find which of the following structures?

a. Sigmoid colon

b. Appendix

c. Spleen

d. Liver

24. A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse’s first response is to:

a. call the physician.

b. place saline-soaked sterile dressings on the wound.

c. take a blood pressure and pulse.

d. pull the dehiscence closed.

25. The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation?

a. Antiarrhythmic drugs

b. Anticholinergic drugs

c. Anticoagulant drugs

d. Antihypertensive drugs

26. A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of:

a. increasing fluid intake to prevent dehydration.

b. wearing an appliance pouch only at bedtime.

c. consuming a low-protein, high-fiber diet.

d. taking only enteric-coated medications.

27. The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission?

a. Regular diet

b. Skim milk

c. Nothing by mouth

d. Clear liquids

28. A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:

a. severe abdominal pain radiating to the shoulder.

b. anorexia, nausea, and vomiting.

c. eructation and constipation.

d. abdominal ascites.

29. A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should:

a. place the client in a private room.

b. wear a mask when handling the client’s bedpan.

c. wash the hands after touching the client.

d. wear a gown when providing personal care for the client.

30. Which of the following factors can cause hepatitis A?

a. Contact with infected blood

b. Blood transfusions with infected blood

c. Eating contaminated shellfish

d. Sexual contact with an infected person

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