Situation 1: Children have a special fascination with the workings of the digestive system.

To
fully understand the digestive processes, Nurse Laviga must be knowledgeable of the anatomy
and physiology of the gastrointestinal system.
1. The alimentary canal is a continuous, coiled, hollow muscular tube that winds through
the ventral cavity and is open at both ends. Its solid organs include all of the following
except:
a. liver
b. gall bladder
c. stomach
d. pancreas
2. Pharynx is lined with mucous membranes and mucous secreting glands to ease the
passage of food. The laryngopharynx serves as passageway for:
a. air only
b. air and water
c. food, fluids and air
d. air and food
3. Once food has been placed in the mouth, both mechanical and chemical digestions begin.
The six activities of the digestive process are:
a. ingestion, mastication, digestion, deglutition, absorption, egestion
b. ingestion, mastication, deglutition, digestion, absorption, egestion
c. deglutition, ingestion, mastication, egestion, absorption, defecation
d. ingestion, digestion, mastication, deglutition, absorption, defecation
4. Most digestive activity occurs in the pyloric region of the stomach. What hormone
stimulates the chief cells to produce pepsinogen?
a. Gastrin
b. Pepsin
c. HCl
d. Insulin
5. What pancreatic enzyme aids in the digestion of carbohydrates?
a. Lipase
b. Trypsin
c. Amylase
d. Chymotrypsin

Situation 2: Nurse Dorina is going to perform an abdominal examination to Mr. Lim who was
admitted due to on and off pain since yesterday.
6. How will you position Mr. Lim prior to procedure?
a. supine with knees flexed
b. prone
c. lying on back
d. sims
7. To identify any localized bulging, distention and peristaltic waves, Nurse Dorina must
perform which of the following?
a. Auscultation
b. Inspection
c. Palpation
d. Percussion
8. In order to identify areas of tenderness and swelling, Nurse Dorina must do:
a. deep palpation
b. light palpation
c. percussion
d. palpation
9. Mr. Lim verbalized pain on the right iliac region. Nurse Dorina knows that the organ
affected would be the:
a. liver
b. sigmoid colon
c. appendix
d. duodenum
10. Mr. Lim felt pain upon release of Nurse Dorinas hand. This can be referred as:
a. referred pain
b. rebound tenderness
c. direct tenderness
d. indirect tenderness
Situation 3: Mrs. Cruz was admitted in the Medical Floor due to pyrosis, dyspepsia and difficulty
of swallowing.
11. Based from the symptoms presented, Nurse Yoshi might suspect:

a. Esophagitis
b. Hiatal hernia
c. GERD
d. Gastric Ulcer
12. What diagnostic test would confirm the type of problem Mrs. Cruz have?
a. barium enema
b. barium swallow
c. colonoscopy
d. lower GI series
13. Mrs. Cruz complained of pain and difficulty in swallowing. This term is referred as:
a. Odynophagia
b. Dysphagia
c. Pyrosis
d. Dyspepsia
14. To avoid acid reflux, Nurse Yoshi should advise Mrs. Cruz to avoid which type of diet?
a. cola, coffee and tea
b. high fat, carbonated and caffeinated beverages
c. beer and green tea
d. lechon paksiw and bicol express
15. Mrs. Cruz body mass index (BMI) is 25. You can categorized her as:
a. normal
b. overweight
c. underweight
d. obese
Situation 4: Nurse Gloria is the staff nurse assigned at the Emergency Department. During her
shift, a patient was rushed in the ED complaining of severe heartburn, vomiting and pain that
radiates to the flank. The doctor suspects gastric ulcer.
16. What other symptoms will validate the diagnosis of gastric ulcer?
a. right epigastric pain
b. pain occurs when stomach is empty
c. pain occurs immediately after meal
d. pain not relieved by vomiting
17. What diagnostic test would yield good visualization of the ulcer crater?

a. Endoscopy
b. Gastroscopy
c. Barium Swallow
d. Histology
18. Peptic ulcer disease particularly gastric ulcer is thought to be cause by which of the
following microorganisms?
a. E. coli
b. H. pylori
c. S. aureus
d. K. pneumoniae
19. She is for occult blood test, what specimen will you collect?
a. Blood
b. Urine
c. Stool
d. Gastric Juice
20. Preparation of the client for occult blood examination is:
a. Fluid intake limited only to 1 liter/day
b. NPO for 12 hours prior to obtaining of specimen
c. Increase fluid intake
d. Meatless diet for 48 hours prior to obtaining of specimen
Situation 5: IBD is a common inflammatory functional bowel disorder also known as spastic
bowel, functional colitis and mucous colitis.
21. The client with IBS asks Nurse June what causes the disease. Which of the following
responses by Nurse June would be most appropriate?
a. This is an inflammation of the bowel caused by eating too much roughage
b. IBS is caused by a stressful lifestyle
c. The cause of this condition is unknown
d. There is thinning of the intestinal mucosa caused by ingestion of gluten
22. Which of the following alimentary canal is the most common location for Chrons
disease?
a. Descending colon
b. Jejunum
c. Sigmoid Colon
d. Terminal Ileum

23. Which of the following factors is believed to be linked to Crohns disease?

a. Diet
b. Constipation
c. Heredity
d. Lack of exercise
24. How about ulcerative colitis, which of the following factors is believed to cause it?
a. Acidic diet
b. Altered immunity
c. Chronic constipation
d. Emotional stress
25. Mr. Jung, had ulcerative colitis for 5 years and was admitted to the hospital. Which of
the following factors was most likely of greatest significance in causing an exacerbation of
the disease?
a. A demanding and stressful job
b. Changing to a modified vegetarian diet
c. Beginning a weight training program
d. Walking 2 miles everyday
Situation 6: A patient was admitted in the Medical Floor at St. Lukes Hospital. He was
asymptomatic. The doctor suspects diverticulosis.
26. Which of the following definitions best describes diverticulosis?
a. An inflamed outpouching of the intestine
b. A non inflamed outpouching of the intestine
c. The partial impairment of the forward flow of intestinal contents
d. An abnormal protrusions of an oxygen through the structure that usually holds it
27. Which of the following types of diet is implicated in the development of diverticulosis?
a. Low fiber diet
b. High fiber diet
c. High protein diet
d. Low carbohydrate diet
28. Which of the following tests should be administered to client with diverticulosis?
a. Proctoscopy
b. Barium enema
c. Barium swallow
d. Gastroscopy

29. To improve Mr. Trinidads condition, your best nursing intervention and teaching is:
a. Reduce fluid intake
b. Increase fiber in the diet
c. Administration of antibiotics
d. Exercise to increase intra abdominal pressure
30. Upon review of Mr. Trinidads chart, Nurse Drew noticed that he weighs 121 lbs and his
height is 5 ft, 4 in. After computing for his Body Mass Index (BMI), you can categorize him
as:
a. obese
b. normal
c. obese
d. underweight
Situation 7: Manny, 6 years old was admitted at Cardinal Santos Hospital due to increasing
frequency of bowel movements, abdominal cramps and distension.
31. Diarrhea is said to be the leading cause of morbidity in the Philippines. Nurse Harry
knows that diarrhea is present if:
a. passage of stool is more than 3 bowel movements per week
b. passage of stool is less than 3 bowel movements per day
c. passage of stool is more than 3 bowel movements per day
d. passage of stool is less than 3 bowel movements per week
32. Diarrhea is believed to be caused by all of the following except
a. increase intestinal secretions
b. altered immunity
c. decrease mucosal absorption
d. altered motility
33. What life threatening condition may result in persistent diarrhea?
a. hypokalemia
b. dehydration
c. cardiac dysrhythmias
d. leukocytosis
34. Voluminous, watery stools can deplete fluids and electrolytes. The acid base imbalance
that can occur is:
a. metabolic alkalosis
b. metabolic acidosis

c. respiratory acidosis
d. respiratory alkalosis
35. What is the immediate home care management for diarrhea?
a. Milk
b. Imodium
c. Water
d. Oresol
Situation 8: Mr. Sean is admitted to the hospital with a bowel obstruction. He complained of
colicky pain and inability to pass stool.
36. Which of these findings by Nurse Leonard, would indicate that the obstruction is in the
early stages?
a. high pitched tinkling or rumbling bowel sounds
b. hypoactive bowel sounds
c. no bowel sounds auscultated
d. normal bowel sounds heard in all four quadrants
37. Nasogastric tube was inserted to Mr. Sean. The NGTs primary purpose is:
a. nutrition
b. decompression of bowel
c. passage for medication
d. aspiration of gastric contents
38. Mr. Sean has undergone surgery. Postoperatively, which of the following findings is
normal?
a. absent bowel sounds
b. bleeding
c. hemorrhage
d. bowel movement
39. Client education should be given in order to prevent constipation. Nurse Leonards
health teaching should include which of the following?
a. use of natural laxatives
b. fluid intake of 6 glasses per day
c. use of OTC laxatives
d. complete bed rest
40. Four hours postoperatively, Mr. Sean complains of guarding and rigidity of the
abdomen. Nurse Leonards initial intervention is:

a. assess for signs of peritonitis

b. call the physician
c. administer pain medication
d. ignore the client
Situation 9: Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe
pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F.
41. Which of the following would confirm a diagnosis of appendicitis?
a. The pain is localized at a position halfway between the umbilicus and the right iliac crest.
b. Mr. Liu describes the pain as occurring 2 hours after eating
c. The pain subsides after eating
d. The pain is in the left lower quadrant
42. Which of the following complications is thought to be the most common cause of
appendicitis?
a. A fecalith
b. Internal bowel occlusion
c. Bowel kinking
d. Abdominal wall swelling
43. The doctor ordered for a complete blood count. After the test, Nurse Ray received the
result from the laboratory. Which laboratory values will confirm the diagnosis of
appendicitis?
a. RBC 5.5 x 106/mm3
b. Hct 44 %
c. WBC 13, 000/mm3
d. Hgb 15 g/dL
44. Signs and symptoms include pain in the RLQ of the abdomen that may be localize at
McBurneys point. To relieve pain, Mr. Liu should assume which position?
a. Prone
b. Supine, stretched out
c. Sitting
d. Lying with legs drawn up
45. After a few minutes, the pain suddenly stops without any intervention. Nurse Ray might
suspect that:
a. the appendix is still distended
b. the appendix may have ruptured

c. an increased in intrathoracic pressure will occur

d. signs and symptoms of peritonitis occur
Situation 10: Nurse Nico is caring to a 38-year-old female, G3P3 client who has been diagnosed
with hemorrhoids.
46. Which of the following factors would most likely be a primary cause of her
hemorrhoids?
a. Her age
b. Three vaginal delivery pregnancies
c. Her job as a school teacher
d. Varicosities in the legs
47. Client education should include minimizing client discomfort due to hemorrhoids.
Nursing management should include:
a. Suggest to eat low roughage diet
b. Advise to wear silk undergarments
c. Avoid straining during defecation
d. Use of sitz bath for 30 minutes
48. The doctor orders for Witch Hazel 5 %. Nurse Nico knows that the action of this
astringent is:
a. temporarily relieves pain, burning, and itching by numbing the nerve endings
b. causes coagulation (clumping) of proteins in the cells of the perianal skin or the lining of
the anal canal
c. inhibits the growth of bacteria and other organisms
d. causes the outer layers of skin or other tissues to disintegrate
49. Which position would be ideal for the client in the early postoperative period after
hemorrhoidectomy?
a. High Fowlers
b. Supine
c. Side lying
d. Trendelenburgs
50. Nurse Nico instructs her client who has had a hemorrhoidectomy not to used sitz bath
until at least 12 hours postoperatively to avoid which of the following complications?
a. Hemorrhage
b. Rectal Spasm
c. Urinary retention
d. Constipation

Answers and Rationale

1. Answer: C. stomach
Rationale: Stomach is a hollow digestive organ in the GI tract. The liver, gallbladder and
pancreas are all solid organs which are part of the hepatobiliary system. Test taking skills: which
does not belong to the group?
2. Answer: D. air and food
Rationale: The laryngopharynx serves as passageway for air and food and so as with the
oropharynx. Option a is nasopharynx. Answers b and c may be correct but air and food is more
accurate.
3. Answer: B. ingestion, mastication, deglutition, digestion, absorption, egestion
Rationale: The digestive processes involve six steps. Ingestion is taking in of food in the mouth;
mastication is the mechanical process where food is converted into bolus; deglutition is the act of
swallowing; digestion is the chemical breakdown of food into chyme; absorption occurs in the
small intestines (solutes) and large intestines (water) and egestion/defecation where elimination
of feces occur.
4. Answer: A. Gastrin
Rationale: Gastrin stimulates chief cells to produce pepsinogen when foods enter and
suppression of pepsinogen when it leaves and enters the small intestines; it is the major hormone
that regulates acid secretion in the stomach. Pepsin; a gastric protease secreted in an inactive
form, pepsinogen, which is activated by stomach acid that acts to degrade protein. HCl is
produced by the parietal cells. Insulin is a pancreatic hormone.
5. Answer: C. Amylase
Rationale: Amylase aids in the digestion of carbohydrates. Trypsin/Chymotrypsin aids in the
digestion of proteins. Lipase aids in the digestion of fats.
6. Answers: A. supine with knees flexed
Rationale: During abdominal examination, positioning the client in supine with knees flexed will
promote relaxation of abdominal muscles. Options b and d are inaccurate in this type of
procedure. Lying on back or supine may be correct but option a is the best answer.
7. Answer: B. Inspection
Rationale: Inspection is the first step in abdominal exam to note the contour and symmetry of
abdomen as well as localized bulging, distention and peristaltic waves. Auscultation is done to
determine the character, location and frequency of bowel sounds. Percussion is to assess
tympany or dullness. Palpation is to asses areas of tenderness and discomfort. Note: In
abdominal exam: Inspection, Auscultation, Percussion and Palpation are the correct order.
8.Answer: B. Light palpation
Rationale: Light palpation is done to identify areas of tenderness and swelling. Deep palpation is
done to identify masses in all four quadrants. Test taking skills: one of the opposite is the correct
answer

9. Answer: C. Appendix
Rationale: Appendix and cecum is located in the right iliac region. Liver and gall bladder is at the
right hypochondriac. Sigmoid colon is at the left iliac. Duodenum, stomach and pancreas is in the
epigastric region.
10. Answer: B. Rebound Tenderness
Rationale: Rebound tenderness is pain felt upon sudden release of the examiners hand which in
most cases suggest peritonitis. Referred pain is pain felt in an area remote from the site of origin.
Direct tenderness is localized pain upon palpation. Indirect tenderness is pain outside the area of
palpation.
11. Answer: C. Gastroesophageal Reflux Disease (GERD)
Rationale: GERD is the backflow of gastric or duodenal contents into the esophagus caused by
incompetent lower esophageal sphincter. Pyrosis or
heartburn, dyspepsia and dysphagia are cardinal symptoms.
12. Answer: B. Barium swallow
Rationale: Barium swallow or upper GI series would confirm GERD. Endoscopy is another
diagnostic test. Options a and d are the same. Option c is incorrect.
13. Answer: A. Odynophagia
Rationale: When difficulty of swallowing is accompanied with pain this is now referred as
odynophagia. Dysphagia is difficulty of swallowing alone.
14. Answer: B. High fat, carbonated and caffeinated beverages
Rationale: All are correct but option b is the best answer. In patients with GERD, this type of diet
must be avoided to avoid backflow of gastric contents. Excessive caffeine reduces the tone of
lower esophageal sphincter. Test Taking Skills: look for the umbrella effect.
15. Answer: B. Overweight
Rationale: Mr. Cruz BMI belongs to the overweight category (24 26), malnourished (less than
17), underweight (17 19), normal (20 23), obese (27
30) and morbidly obese (greater than 30). BMI is weight in kilograms divided by height in
square meters.
16. Answer: C. Pain occurs immediately after meal.
Rationale: In gastric ulcer food intake aggravates pain which usually occur 1 hour before
meal or immediately during or after food intake. Options a, b, c suggests duodenal ulcer.
17.Answer: A. Endoscopy
Rationale: Endoscopy determines bleeding, pain, difficulty swallowing, and a change in bowel
habits. This would yield good visualization of the ulcer crater. Other options are also diagnostic
tests in PUD.
18. Answer: B. H. pylori
Rationale: Helicobacter pylori (H. pylori) is a bacteria responsible for most ulcers and many

cases of chronic gastritis (inflammation of the stomach). This organism can weaken the
protective coating of the stomach and duodenum (first part of the small intestines), allowing the
damaging digestive juices to irritate the sensitive lining of these body parts.
19. Answer: C. Stool
Rationale: Occult blood test or stool guaiac test is a test that detects the presence of hidden
(occult) blood in the stool (bowel movement). The stool guaiac is the most common form of
fecal occult blood test (FOBT) in use today. So stool specimen will be collected.
20. Answer: D. Meatless diet for 48 hours prior to obtaining of specimen
Rationale: Eating meat can cause false positive test result. Using proper stool collection
technique, avoiding certain drugs, and observing dietary restrictions can minimize these
measurement errors.
21. Answer: C. The cause of this condition is unknown
Rationale: There is no known cause of IBS, and diagnosis is made by excluding all the other
diseases that cause the symptoms. There is no inflammation if the bowel. Some factors
exacerbate the symptoms including anxiety, fear, stress, depression, some foods and drugs but
there do not cause the disease.
22. Answer: d. Terminal Ileum
Rationale: Chronic inflammatory of GI mucosa occurs anywhere from the mouth to anus but
most often in terminal ileum. Inflammatory lesions are local and involve all layers of the
intestinal wall.
23. Answer: C. Heredity
Rationale: The cause is unknown but is thought to be multifactorial. Heredity, infectious agents,
altered immunity or autoimmune and environmental are factors to be considered. Test taking
skill: which does not belong? Options a, b, and d are all modifiable factors.
24. Answer: B. Altered immunity
Rationale: refer to rationale for number 23. Test taking skill: which does not belong? Options a, c
and d are all modifiable factors.
25. Answer: A. A demanding and stressful job.
Rationale: Stress is an environmental factor that is thought to cause ulcerative colitis. Test taking
skill: options b, c, and d are all healthy lifestyles.
26. Answer: B. A non inflamed outpouching of the intestine.
Rationale: An increase intraluminal pressure causes the outpouching of the colon wall resulting
to diverticulosis. Option a suggests diverticulitis. Test taking skill: one of the opposite is the
correct answer.
27. Answer: A. Low Fiber Diet
Rationale: A lack of adequate blood supply and nutrients from the diet such as low fiber foods

may contribute to the development of the disease. Test taking skill: one of the opposite is the
correct answer.
28. Answer: B. Barium enema
Rationale: Barium enema is used to diagnose diverticulosis, however, this is contraindicated
when diverticulitis is present because of the risk of rupturing the diverticulum. Test taking skill:
options b and c are opposite; one may be the correct answer.
29. Answer: B. Increase fiber in the diet.
Rationale: Patient with diverticulosis must be encouraged to increase roughage in diet such as
fruits and vegetables rich in fiber. Increasing fluid intake 2 to 3 liters/day unless contraindicated
rather reducing. Administering antibiotics can decrease bowel flora and infection but this is a
dependent function of a nurse.
30. Answer: B. Normal
Rationale: Mr. Trinidads BMI is 23 which is normal. Refer to rational number 15.
31. Answer: C. passage of stool is more than 3 bowel movements per day (thanks to Budek
for the correction)
32. Answer: B. Altered Immunity
Rationale: Diarrhea is an intestinal disorder that is self limiting. Options a, c and d are
etiological factors of diarrhea.
33. Answer: C. Cardiac dysrhythmias
Rationale: Due to increase frequency and fluid content in the stools, diarrhea may cause fluid and
electrolyte imbalance such as hypokalemia. Once potassium is depleted, this will affect the
contractility of the heart causing cardiac arrhythmia leading to death.
34. Answer: B. Metabolic acidosis
Rationale: In diarrhea, metabolic acidosis is the acid base imbalance that occurs while in
vomiting, metabolic alkalosis occur. This is a metabolic disorder thats why eliminate options c
and d.
35. Answer: D. Oresol
Rationale: In the DOH book, oresol is the immediate home care management for diarrhea to
prevent dehydration. Water may not be enough to prevent diarrhea.
36. Answer: A. High pitched tinkling or rumbling bowel sounds
Rationale: Early in the bowel obstruction, the bowel attempts to move the contents past the
obstruction and this is heard as high pitched tinkling bowel
sounds. As the obstruction progresses, bowel sounds will diminish and may finally become
absent.

37. Answer: B. Decompression of bowel

Rationale: The NGTs primary purpose is for bowel decompression especially for clients
suffering from obstruction.
38. Answer: A. Absent bowel sounds
Rationale: Postoperatively, no bowel sounds are present so this is a normal finding. Bleeding and
hemorrhage must be prevented to avoid complications. Bowel movement occurs only after flatus
and bowel sounds are noted.
39. Answer: A. Use of natural laxatives
Rationale: The use of natural laxatives such as foods and fruits high in fiber is still the best way
of preventing constipation Increasing fluid intake, taking laxatives judiciously and exercise also
can prevent this.
40. Answer: A. Assess for signs of peritonitis
Rationale: Assessment precedes intervention. Symptoms presented are signs of peritonitis.
Assessment will provide you the data for prompt intervention.
41. Answer: A. The pain is localized at a position halfway between the umbilicus and the
right iliac crest.
Rationale: Pain over McBurneys point, the point halfway between the umbilicus and the iliac
crest, is diagnosis for appendicitis. Options b and c are common with ulcers; option d may
suggest ulcerative colitis or diverticulitis.
42. Answer: A. A fecalith
Rationale: A fecalith is a hard piece of stool which is stone like that commonly obstructs the
lumen. Due to obstruction, inflammation and bacterial invasion can occur. Tumors or foreign
bodies may also cause obstruction.
43. Answer: C. WBC 13, 000/mm3
Rationale: Increase in WBC counts is suggestive of appendicitis because of bacterial invasion
and inflammation. Normal WBC count is 5, 000 10, 000/mm3. Other options are normal
values.
44. Answer: D. Lying with legs drawn up
Rationale: Posturing by lying with legs drawn up can relax the abdominal muscle thus relieve
pain.
45. Answer: B. The appendix may have ruptured
Rationale: If a confirmed diagnosis is made and the pain suddenly without any intervention, the
appendix may have ruptured; the pain is lessened because the appendix is no longer distended
thus surgery is still needed.
46. Answer: B. Three vaginal delivery pregnancies
Rationale: Hemorrhoids are associated with prolonged sitting, or standing, portal hypertension,
chronic constipation and prolonged intra abdominal pressure as associated with pregnancy and

the strain of vaginal delivery. Her job as a schoolteacher does not require prolonged sitting or
standing. Age and leg varicosities are not related to the development of hemorrhoids.
47. Answer: C. Avoid straining during defecation
Rationale: Straining can increase intra abdominal pressure. Health teachings also include:
suggest to eat high roughage diet, wearing of cotton undergarments and use of sitz bath for 15
minutes.
48. Answer: B. causes coagulation(clumping) of proteins in the cells of the perianal skin or
the lining of the anal canal
Rationale: Option a are local anesthetics; c are antiseptics and d are keratolytics.
49. Answer: C. Side lying
Rationale: Positioning in the early postoperative phase should avoid stress and pressure on the
operative site. The prone and side lying are ideal from a comfort perspective. A high Fowlers
or supine position will place pressure on the operative site and is not recommended. There is no
need for trendelenburgs position.
50. Answer: A. Hemorrhage
Rationale: Applying heat during the immediate postoperative period may cause hemorrhage at
the surgical site. Moist heat may relieve rectal spasms after bowel movements. Urinary retention
caused by reflex spasm may also be relieved by moist heat. Increasing fiber and fluid in the diet
can help constipation.