RN Physiological Integrity: GI/Hepatic/Biliary

1 A nurse manager suspects a staff nurse of substance use disorder (SUD).

Which approach would be the best initial action by the nurse manager?

A. Schedule a staff conference, without the nurse present, to collect information

B. Confront the nurse about the suspicions in a private meeting

C. Consult with human resources personnel about the issue and needed actions

D. Counsel the employee to resign to avoid investigation and rumors

2 An 80-year-old client, experiencing unintentional weight loss, was diagnosis of

malnutrition. The nurse knows that which of these lab tests the most sensitive
measure of nutritional status is.

A. Serum calcium

B. Urine creatinine

C. Serum albumin

D. Urine protein

3 The nurse is caring for a client with cholelithiasis. A hepatobiliary scan

observed biliary stasis. The client asks about non-surgical options. Select all
that apply.

A. Opiods analgesics
B. Endoscopic retrograde cholangiopancreatography
C. Urosodiol and Chenodiol
D. Magnetic resonance cholangiopancreatography
E. Extra corporeal shock wave lithotripsy
F. Laparoscopic cholecystectomy lap chole

4 You attended a conference on de-escalating violence in the work place.

Which of the following statements by the nurse would be appropriate
with a loud, agitated client who is throwing things and slams the door?

A. Ill stay with you awhile if you want.

B. You seem angry, but you are acting like a child.
C. I do not like it when you get angry and say those things.
D. Maybe it would be helpful if you punched your pillow for a while in your room.

1
5 A client is scheduled for a colonoscopy. Which information should be reported
to the health care provider before sending the client for the procedure?

A. The patient refused to drink the ordered polyethylene glycol (Golytely).

B. The patient has an allergic reaction to shellfish and iodine.
C The patient has a permanent pacemaker to prevent bradycardia.
D. The patient is worried about discomfort during the examination.

6 The RN and UAP are caring for a patient who has just returned to the nursing
unit after an esophagogastroduodenoscopy (EGD). Which nursing action
performed by the UAP requires that the RN intervene? The UAP

A. Positions the patient on the right side.

B. Checks the temperature every 30 minutes.
C. Offers the patient a glass of water.
D. Swabs the patients mouth with cold water.

7 When caring for a patient following a needle biopsy of the liver at the bedside,
the nurse should

A. Elevate the head of the bed to facilitate breathing.

B. Check the patients post-biopsy coagulation studies.
C. Place the patient on the right side with the bed flat.
D. Put pressure on the biopsy site using a sandbag.

8 You assess a patient who is a vegan. The most common nutritional deficiency
related to a strict vegan diet would be manifested by

A. Muscle wasting.
B. Bleeding gums.
C. Pallor and changes in sensation and movement of the extremities.
D. Dry, scaly skin and cracked, painful oral mucous membranes.

9 A patient with dysphagia is on continuous tube feedings of a full-strength

commercial formula at 100 ml/hr. The patient has six diarrhea stools the first
day. The action that is most appropriate for the nurse to take first is to

A. Slow the tube feeding flow rate.

B. Discontinue any water intake.
C. Notify the health care provider about the need for a change in formula.
D. Check residuals and hold feedings if residual is 75mL.

2
10 Parenteral nutrition (PN) with a peripherally inserted central catheter (PICC)
was begun at 0800. After 6 hours of PN infusion, the nurse checks the patients
capillary blood glucose level and finds it to be 140 mg/dl. The most appropriate
action by the nurse is to

A. Notify the health care provider of the glucose level.

B. Recheck the capillary blood glucose in 4 hours.

C. Obtain a venous blood glucose specimen.

D. Slow the infusion rate of the PN infusion.

11 The hospital nurse educator is observing a new RN who is caring for a patient
receiving PN through a single-lumen central line inserted in the right
subclavian vein. Which action by the new RN indicates that the RN can safely
care for the patient?

A. The new RN flushes the line after drawing a blood specimen.

B. The new RN reminds the patient to keep the right arm straight.
C. The new RN checks capillary blood glucose every 8 hours.
D. The new RN infuses the PN solution using an infusion pump.

12 A patient with bulimia is on your unit with an electrolyte disorder. Which

patient behavior observed by the nurse is of most concern?
A. The patient only eats about 20% of breakfast.
B. The patient ambulates continuously in the hallway.
C. The patient goes into the bathroom after each meal.
D. The patient asks for laxatives to treat constipation.

13. Which of these nursing actions for a patient who is receiving intermittent tube
feedings through a PEG tube is in the scope of practice for an LPN?

A. Teaching the patient and family how to administer tube feedings

B. Assessing the patients nutritional status at least weekly
C. Determining the need for the addition of water to the feedings
D. Providing skin care to the area around the tube site

14. The nurse notes that the peripheral PN bag is almost empty and a new
PN bag has not yet arrived from the pharmacy. Which action is
appropriate?

A. Decreasing the rate of the current PN infusion to 10 ml/hr until the new bag arrives
B. Infusing 10% dextrose in water until the new PN bag is available from the pharmacy
C. Flushing the peripheral line with saline and wait until the new PN bag is available
D. Monitoring the patients capillary blood glucose until a new PN bag is available

3
15. You attended a conference on catheter related blood stream infections
(CLABSI).What info will you bring back to the staff? Select all that apply

A. Avoid using scissors near the catheter with dressing changes.

B. Maximum patient barrier protection during the line insertion.
C. Sterile technique with vigorous scrub of catheter hub with alcohol.
D. Use force when flushing with the 10mL syringe of normal saline.

16. A patient returns to the surgical nursing unit following a vertical banded
gastroplasty with a nasogastric tube to low, intermittent suction and a PCA
machine for pain control. During the postoperative care of the patient, the nurse
recognizes the need to

A. Promote return of bowel sounds by discouraging excessive PCA use.

B. Maintain patency of the NG tube with frequent normal saline irrigations.
C. Support the surgical incision during coughing to prevent dehiscence of the wound.
D. Position the patient flat in bed on the right side to promote normal stomach emptying.

17. A child who has been NPO during treatment for nausea and vomiting caused
by gastric viruses to start oral intake. Which of these should the nurse offer first?

A. A glass of orange juice

B. A bowl of warm cream of chicken-broth
C. A dish of lemon gelatin
D. A cup of apple juice with lemon

18. You are teaching family health practices to parents of a child with hepatitis.
Which statement demonstrates understanding by the parents?

A. We will wash the clothes separately.

B. Someone else will wash the dishes.
C. Vaccine will not be necessary since we have been exposed.
D. I am glad there are no complications associated with this infection.

19. Which information will the nurse include when teaching a patient with newly
diagnosed GERD?

A. Peppermint tea is a natural way and may be helpful in reducing your symptoms.
B. You will need to sleep upright with pillows.
C. You should avoid eating between meals to reduce acid secretion.
D. Vigorous physical activities may increase the incidence of reflux.

4
20. Cobalamin injections are prescribed for a client with chronic atrophic gastritis.
The nurse determines that teaching regarding the injections has been effective
when the client states,

A. These injections will decrease my risk for developing stomach cancer.

B. These injections will increase the hydrochloric acid in my stomach.
C. The cobalamin injections need to be taken until my inflamed stomach heals.
D. The cobalamin injections will prevent me from becoming anemic.

21. A client with an ulcer related to Helicobacter pylori is treated with triple-drug
therapy. The nurse explains to the LPN that the drugs commonly included in this
regimen include:

A. Famotidine, magnesium/aluminum hydroxide, and pantoprazole.

B. Amoxicillin, clarithromycin, and omeprazole.

C. Sucralfate, mycostatin, and bismuth subsalicylate.

D. Metoclopramide, metronidazole, and promethazine.

22. A client vomiting bright red blood is admitted to the emergency department.
Which assessment should the nurse perform first?

A. Measuring the quantity of any emesis

B. Checking the level of consciousness

C. Auscultating the chest for breath sounds

D. Taking the blood pressure (BP) and pulse

23. A client recovering from a gastrojejunostomy (Billroth II) for treatment of a

perforated duodenal ulcer develops dizziness, weakness, and palpitations, with an
urge to defecate about 20 minutes after eating. To avoid recurrence of these
symptoms, the nurse knows the client understood the teaching when the client:

A. Increases the amount of fluid intake with meals.

B. Lies down for about 30 minutes after eating.

C. Adds more fiber by eating a fiber bar after each meal.

D. Chooses foods that are high in carbohydrates

5
24. A client who requires daily use of a nonsteroidal anti-inflammatory drug
(NSAID) for management of severe rheumatoid arthritis has recently
developed melena. The nurse will anticipate teaching the patient about

A. The use of OTC ranitidine to decrease the risk for peptic ulcers.

B. Requesting the HCP use corticosteroids to treat the arthritis.

C. Substitution of acetaminophen for the NSAID.

D. The benefits of food in protecting the GI mucosa.

25. The health care provider prescribes antacids and Sucralfate for treatment
of a patients peptic ulcer. The nurse will teach the patient to take

A. Sucralfate and antacids together 30 minutes before each meal.

B. Antacids 30 minutes before the Sucralfate.

C. Sucralfate at bedtime and antacids before meals.

D. Antacids after eating and Sucralfate 30 minutes before eating.

26. You attended a conference on celiac disease. Which nursing considerations

should be share with the community nurses? Select all that apply

A. Constipation due to low fiber content of gluten free foods.

B. Clients are at increased risk of developing GI cancers.

C. Celiac is a genetic autoimmune disease that is triggered by gluten.

D. Children under 2 years of age are easy to diagnose.

E. Overlooked sources of gluten include medications and beer.

27. A client came to the emergency department with severe abdominal pain
with rebound tenderness, anorexia, and chills. The vital signs include
temperature 101 F (38.3 C), pulse 130, respirations 34, and blood pressure
(BP) 82/50. Of the following collaborative interventions, which one should the
nurse implement first?

A. Infuse prescribed 1000 ml of lactated Ringers solution over 60 minutes.

B. Administer IV ketorolac 15 mg as prescribed.

C. Give IV ceftriaxone 1 g as prescribed.

D. Obtain a computed tomography (CT) scan of the abdomen with and without contrast.

6
28. A client diagnosed with irritable bowel syndrome (IBS) tells the nurse,
My friends tell me this problem is all in my head. In caring for the client, the
nurse should
A. Discuss the new medication, Linaclotide, which may help with the condition.
B. Inform the patient that IBS has a specific, identifiable cause.
C. Explain that modifications to increase dietary fiber can control the symptoms.
D. Encourage the patient to express feelings and ask questions about IBS.

29. A client hospitalized with an acute exacerbation of ulcerative colitis is

having 14 to 16 bloody stools a day and crampy abdominal pain associated
with the diarrhea. The nurse will as prescribed plan to

A. Place the patient on NPO status.

B. Administer Cobalamin injections.
C. Start bowel preparation for colonoscopy.
D. Administer IV metoclopramide.

30. While obtaining a nursing history from a client with IBD, the nurse
recognizes that the patient most likely has ulcerative colitis rather than
Crohns disease when the patient reports experiencing

A. Weight loss.
B. Bloody stools.
C. Abdominal pain and cramping.
D. Disease onset at age 20.

31. A 26-year-old patient with Crohns disease has had frequent diarrhea and
a weight loss of 10 pounds (4.5 kg) over 2 months. The nurse anticipates the
medical regimen and plans to teach the patient about

A. Antibiotic therapy.
B. Fluid restriction.
C. Monoclonal antibodies.
D. Enteral feedings.

32. A patient presents with sudden onset of sharp twisting deep upper
abdominal pain that radiates to the back with nausea/ vomiting. You assess
hypoactive bowel sounds and abdominal tenderness. The provider orders an
IV infusion, and placement of an NG tube. . Which diagnostic tests are likely
at this time? Select all that apply

A. Serum amylase/lipase
B. Abdominal CT.
C. ERCP.
D. Abdominal ultrasound.
E. ABGs

7
33. James, age 38, is admitted for inpatient treatment for his alcoholism. His
employer told him to seek treatment or be fired. James says, I do not have a
problem with alcohol. I can handle my booze. My boss is a jerk The RNs best
response is:

A. Maybe your boss is mistaken about you, James

B. You are here because of your drinking was interfering with your work
C. Get real James! You are a boozer and you know it
D. Why do you think your boss sent you here, James?

34. Your postoperative assessment of a clients stoma is red and moist with
moderate edema and a small amount of bleeding. The nurse should

A. Document the stoma assessment.

B. Notify the surgeon about the stoma appearance.
C. Monitor the stoma every 30 minutes.
D. Place an ice pack on the stoma to reduce swelling.

35. A patient has a newly formed ileostomy for treatment of ulcerative colitis.
In teaching the patient about the care of the ileostomy, the nurse informs the
patient about the need to

A. Restrict fluid intake to prevent constant liquid drainage from the stoma.
B. Change the pouch every day to prevent leakage of contents onto the skin.
C. Use care when eating high-fiber foods to avoid obstruction of the ileum.
D. Irrigate the ileostomy daily to avoid having to wear a drainage appliance.

36. When implementing the initial plan of care for a patient admitted with
acute diverticulitis, the nurse will

A. Administer IV fluids.
B. Order a diet high in fiber and fluids.
C. Give stool softeners.
D. Prepare the patient for colonoscopy.

37. A 42-year-old patient recently developed abdominal distention, weight

loss, steatorrhea, and flatulence. A diagnosis of adult celiac disease is made,
and treatment is initiated. The nurse determines that teaching about the
treatment of the disease has been effective when the patient says,

A I must take folic acid for the rest of my life.

B. I will avoid dietary wheat, rye, barley, and oats.
C. I will be sure to take all of the ordered antibiotics.
D. I should eat only very low-fat or fat-free foods.

8
38. You attended a staff education conference on substance abuse disorders.
Which psychiatric disorders are related to alcoholism?

A. Korsakoff and Wernicke syndrome.

B. Depression.
C. Paranoia.
D. Hallucinations and Delusions.

39. After being treated with a 10-day course of antibiotics, a 69-year-old

patient tells the nurse about developing frequent, watery diarrhea. The nurse
anticipates that the patient will need to:

A. Prepare for colonoscopy by taking laxatives.

B. Have blood drawn for blood cultures.
C. Bring a stool specimen in to be tested for C. difficile.
D. Schedule a barium enema to check for inflammation.

40. After a patient with inflammatory bowel has had dietary teaching, which
food choice by the patient indicates that the teaching has been successful?

A. Oatmeal with cream, whole-wheat toast, and a banana

B. Corn tortilla taco with chicken, lettuce, tomato, and cheese

C. Roast beef, mashed potatoes, and a tossed green salad

D. Chicken sandwich with mayonnaise on white bread

41. The RN and nursing assistant (NA) are caring for a patient with a paralytic
ileus. Which of these nursing activities is appropriate for the nurse to delegate
to the NA?

A. Irrigation of the NG tube with saline

B. Re taping the NG tube

C. Applying petroleum jelly to the lips

D. Auscultation for bowel sounds

42. An assessment reveals abdominal pain on palpation of the left lower

quadrant with the patient complaints of right lower quadrant pain. The nurse
will document this as

A. McBurneys point.

B. Rebound pain.

C. Rovsings sign.

D. Cullens sign.

9
 43. A nurse in the operating room took a picture of the gallstones and posted
it on social media. What, if any, is the nurse in violation?

A. None, since the clients picture was not taken.

B. None, since it was not intentional snooping.

C. HIPPA violation, the nurse was negligent.

D. HIPPA violation, private health information.

44. Ledipasvir/Sofosbuvir is ordered to treat your client with hepatitis C. How

will you administer this drug (differ from previous protease inhibitors)? The
nurse will plan to:

A. Administer a weekly injection.

B. Administer one pill per day.

C. Administer a combination of pills and an injection weekly.

D. Advocate the use of vitamins and herbal supplements.

45. A patient with cirrhosis has 4+ pitting edema of the feet and legs
and massive ascites had a paracentesis. The priority intervention for
the nurse to monitor post procedure is:

A. Temperature.

B. Blood pressure.

C. Hematocrit.

D. Albumin level

46. Who of the following should the nurse first insert a gastric drainage (NG
tube)? Client who has:

A. Acute pancreatitis.

B. Ingested a toxic substance hour ago.

C. Crohns with and watery mucous diarrhea.

D. Abdominal distention and bile stained emesis.

10
47. A patient with ascites is prescribed spironolactone and furosemide. LABS: a
serum sodium 135 mEq/L and serum potassium 3.2 mEq/L. Before notifying the
health care provider, the nurse should:

A. Administer the furosemide and withhold the spironolactone.

B. Give both drugs as scheduled.

C. Administer the spironolactone.

D. Withhold both drugs until talking with the health care provider.

48. Which assessment of the neurologic status in a patient with portal

systemic encephalopathy would the nurse asks the patient to do?

A. Stand on one foot with arms out.

B. Ambulate heal to toe with the eyes closed.

C. Extend both arms and flex hands.

D. Exhale and perform the Valsalva maneuver.

49. A patient with cancer of the liver has severe ascites, and the health care
provider plans a paracentesis to relieve the fluid pressure on the diaphragm. To
prepare the patient for the procedure, the nurse will: select all that apply

A. Ask the patient to empty the bladder.

B. Position the patient on the right side.

C. Obtain informed consent for the procedure.

D. Assist the patient to lie flat in bed.

E. Start a Venous access device.

50. A patient hospitalized with possible acute pancreatitis has severe abdominal
pain and nausea and vomiting. The nurse would expect the diagnosis to rule out

A. Peptic ulcer.

B. Alcoholism.

C. Gall stones.

D. Pregnancy.

11
51. The nurse identifies the collaborative problem of potential complication:
electrolyte imbalance for a patient with severe acute pancreatitis. Assessment
findings that alert the nurse to electrolyte imbalances associated with acute
pancreatitis include

A. Muscle twitching and finger numbness.

B. Paralytic ileus and abdominal distention.

C. Hypotension.

D. Hyperglycemia.

52. The health care provider prescribes pancreatin for a client with chronic
cystic fibrosis. The nurse teaches the patient that the drug is considered
effective if the patient experiences

A. Normal-appearing stools.

B. Decreased jaundice.

C. Improved appetite.

D. Reduced abdominal pain.

53. A patient who is admitted to the hospital with a sudden onset of severe
right upper-quadrant pain that radiates to the right shoulder is diagnosed with
cholecystitis. Which assessment information will be most important for the
nurse to report to the health care provider?

A. The patient has an increase in pain after eating.

B. The patient needs 4 mg of morphine for pain relief.

C. The patients stools are clay colored.

D. The patients urine is bright yellow.

54. Diane, age 14 has been admitted to the psychiatric unit for anorexia
nervosa. She is emaciated and refuses to eat. What is the most appropriate
response the RN?

A. You know that if you dont eat, you will die.

B. If you continue to refuse to take food orally, you will need to be fed through a
nasogastric tube.

C. You might as well leave if you are not going to follow your therapy regimen.

D. You dont have to eat if you so not want to. It is your choice, but we will have to
lock your bathroom.

12
55. You are a community health nurse in Flint, MI evaluating the parents of a
child who was treated with succimer chelation. Which statement by the parent
is the best indicator of compliance regimen?

A. My child is drinking a quart of liquids each day

B. I have an appointment next month to test my water

C. We have our child wash his hands more frequently

D. No more visits to grandmothers old house

56. The nurse is caring for a client with portal systemic encephalopathy. The
nurse would follow up on which top 5 sign/symptoms? Select all (5)

A. Sleep disturbance.

B. High pitched bowel sounds.

C. Positive Babinski.

D. Slurred speech

E. Asterixis

F. Musty sweet odor to breath.

G. Tetany

57. The newborn has not had a bowel movement in 48 hours since birth.
Abdomen is soft, distended with diminished bowel sounds. The nurse should:

A. Ask the mother to breast-feed since constipation is less common.

B. Provide sugar water to soften the stool.

C. Check the infant for a meconium plug

D. Have the mother kiss her baby and bond frequently

E. Assess the mothers family history for Hirschsprung disease.

58. At nursing care conference on obstructive disorders in the newborn. Which

of the following babies problems presents with projectile vomiting?

A. Male baby with a sausage like mass, knees draw and vomiting bile.

B. Female baby with sunken anterior fontanel who spits up formula.

C. Male baby with a palpable olive shape mass to the right of the umbilicus.

D. Female baby born preterm, poor weight gain and passive regurgitation.

13
59. A newborn with a cleft lip is being fed by the mother. The nurse knows
that this can be challenging. Which behavior by the mother demonstrates
effective feeding pattern?

A. Baby is held in a football hold when bottle feeding

B. Mother uses a bulb syringe when the milk escapes through the nose.

C. Using the sterilized nipples from her baby shower.

D. Holding the babys head in an upright position

60. Which action should the nurse include in the care plan of a client with
advanced liver disease?

A. Avoid cleansing the bowels due to risk of bleeding.

B. Encourage acetaminophen instead of aspirin for headache.

C. Encourage a low protein high calorie diet.

D. Administer sodium polystyrene sulfonate enemas. Od/6/17

14