WORKBOOK (GIT) 10.

What is the primary purpose of having the patient void before

1. A nurse is assigned to four clients who have been diagnosed with gastric paracentesis?
ulcers. Which one of these clients should the nurse conclude is most at risk to a. To provide better visualization of the abdominal cavity
develop gastrointestinal (GI) bleeding? b. To ensure comfort of the patient
a. A 70-year-old client who takes aspirin daily to prevent coronary c. To promote adequate breathing and ventilation
artery disease d. To move the bladder out of the way of the needle
b. A 40-year-old client who is positive for Helicobacter pylori (H. pylori)
c. A 45-year-old client who drinks 4 ounces of alcohol a day 11. A client diagnosed with esophageal varices should be placed in what
d. A 30-year-old pregnant client who uses acetaminophen as needed for position?
headaches a. Flat on bed
b. Modified Trendelenburg
2. An experienced nurse explains to a new nurse that the definitive diagnosis c. Head elevated as tolerated
of peptic ulcer disease involves: d. Sim’s position
a. upper gastrointestinal endoscopy with biopsy.
b. barium contrast studies. 12. A nurse is assessing a client diagnosed with acute diverticulitis. Which
c. a urea breath test. finding should make the nurse suspect that the client has an intestinal
d. the string test. perforation?
a. Temperature of 38.4°C
3. A nurse is discharging a client after Billroth II surgery (gastrojejunostomy). b. Elevated WBC count
To prevent dumping syndrome, the nurse should instruct the client to: c. Abdominal pain
a. Drink fluids with meals d. Absent bowel sounds
b. Lying down for 20 to 30 minutes after meals
c. Ambulate following a meal. 13. The nurse is monitoring a client with appendicitis who is scheduled for
d. Eat a high-carbohydrate and low-protein diet surgery in 2 hours when the client begins to experience abdominal pain and
vomiting. Upon assessment, the patient’s abdomen is distended and the bowel
4. Which among the following are early signs and symptoms of dumping sounds are diminished. What should be the next action of the nurse?
syndrome? a. Notify the health care provider.
a. Abdominal cramping and pain b. Continue monitoring the patient and providing a heat pad.
b. Bradycardia and indigestion c. Call and ask the surgery team to perform the surgery as soon as possible
c. Double vision and chest pain d. Administer the prescribed pain medication.
d. Sweating and pallor
14. A client has just had a hemorrhoidectomy. Which nursing interventions are
5. A patient who underwent Billroth II suddenly complains of weakness, appropriate for this client?
diaphoresis, anxiety, and palpitations 2 hours after a high-carbohydrate meal. Select all that apply.
These manifestations indicate possible development of: i. Instruct the client to limit fluid intake to avoid urinary retention.
a. Postprandial hypoglycemia ii. Encourage a high-fiber diet to promote bowel movements without straining.
b. Steatorrhea iii. Administer stool softeners as prescribed.
c. Duodenal reflux iv. Help the client to a Fowler’s position to place pressure on the rectal area
d. Hypervolemic fluid overload and decrease bleeding.
v. Instruct the client to avoid activities that will initiate vasovagal responses
6. An experienced nurse is most likely to teach a new nurse that surgery to vi. Apply cold packs to the anal-rectal area over the dressing until the packing
repair a hiatal hernia is becoming more common to prevent the emergency is removed.
complication of: a. II, III, VI
a. Hernia strangulation. b. I, IV, V
b. Severe dysphagia. c. II, III, V
c. Aspiration. d. I, III, VI
d. Esophageal edema.
15. Which among the following stool and bowel findings is characteristic of that
7. A client with hiatal hernia chronically experiences heartburn following meals. in Crohn’s disease?
Which among the following actions is contraindicated with a hiatal hernia? a. Constipation alternating with diarrhea
a. Raising the head of bed on 6-inch blocks b. Chronic constipation
b. Lying recumbent after meals c. Diarrhea
c. Consuming small, frequent, bland meals d. Stool constantly oozing from the rectum
d. Taking H2-receptor antagonist medications
16. A client with Crohn’s disease is admitted to the hospital due to fever,
8. A nurse is assessing a client, with a diagnosed inguinal hernia, at a diarrhea, cramping abdominal pain, and weight loss. What should the nurse
scheduled clinic visit. The nurse suspects that the client’s hernia may be monitor the client for?
strangulated when which finding is noted on assessment? a. Hyperalbuminemia
a. Intense abdominal pain b. Thrombocytopenia
b. Constipation c. Hypokalemia
c. Hyperactive bowel sounds d. Hypercalcemia
d. Shortness of breath
17. What is the priority intervention for a client experiencing an exacerbation of
9. Metoclopramide HCl is used in hiatal hernia therapy to accomplish which of Crohn’s disease?
the following objectives? a. Encouraging regular ambulation
a. Increase tone of the esophageal sphincter. b. Promoting bowel rest
b. Neutralize gastric secretions. c. Maintaining current weight
c. Delay gastric emptying. d. Decreasing episodes of rectal bleeding
18. A patient admitted to the hospital with active duodenal ulcer would most 27. Which information should the nurse expect to see on the medical record of
likely report which of the following symptoms? a client with ulcerative colitis?
a. Nausea and vomiting a. Abdominal distention and hypoactive bowel sounds
b. Pain radiating down the arm b. Heartburn and regurgitation
c. Weight loss c. Weight gain and elevated blood glucose
d. Pain relieved by food intake d. Abdominal pain and bloody diarrhea

19. A client had an application of colostomy 2 days earlier and is beginning to 28. A patient is admitted to the hospital due to an exacerbation of his ulcerative
pass malodorous flatus from the stoma. The nurse interprets this correctly as colitis. Which factor is mostly likely of greatest significance in causing the
a. An indication for an insertion of nasogastric tube exacerbation?
b. Inadequate preoperative bowel preparation a. Beginning a weight-training program
c. An early sign of ischemic bowel b. Changing to a modified vegetarian diet
d. A normal and expected event c. A demanding and stressful job
d. Walking 2 miles every day
20. After a preoperative teaching to a client who will undergo creation of a
Kock pouch, which of these statements by the clients will not indicate that 29. What is the priority on the first days of hospitalization of a patient with an
further teaching is required? exacerbation of ulcerative colitis?
a. “I will need to drain the pouch regularly with a catheter.” a. Promoting self-care and independence.
b. “The drainage from this type of ostomy will be formed. b. Managing diarrhea
c. “I will need to wear a drainage bag for the rest of my life.” c. Maintaining adequate nutrition
d. “I will be able to pass stool by the rectum eventually.” d. Promoting rest and comfort

21. For which postoperative condition should the nurse administer a PRN 30. During the morning report, a nurse is told that the ileostomy of a patient 6
prescription of ondansetron? days post-total proctocolectomy is draining large amounts of liquid stool. The
a. Paralytic ileus client experiences dizziness with ambulation. Based on these, which
b. Incisional pain parameters should the nurse assess immediately? Select all that apply.
c. Urinary retention i. PR for the last 24 hours
d. Nausea and vomiting ii. Weight over the last 3 days
iii. Ability to move the lower extremities
22. The nurse is caring for an older patient who has recently been taking iv. Urine output
cimetidine. She should monitor the client for which most frequent central v. Temperature for the last 24 hours
nervous system side effects of this medication? a. I, II, III, V
a. Tremors b. I, II, IV, V
b. Dizziness c. I, II, IV
c. Confusion d. I, II, V
d. Hallucinations No correct answers

23. During a hospital admission history, a nurse suspects irritable bowel 31. The post-anesthesia care unit (PACU) nurse reviews the following
syndrome when the client says: postoperative orders from the surgeon to a client following anorectal surgery.
a. “I have lost 10 pounds in the last month.” Which order should the nurse question?
b. “I am having a lot of bloody diarrhea.” a. Position client in supine position with the head of the bed elevated
c. “I have noticed mucus in my stools.” to 30 degrees.
d. “I have been vomiting for 2 days.” b. Begin high-fiber diet as soon as client can tolerate oral intake
c. Administer sitz bath after each defecation
24. While the nurse is reviewing the orders for a client with suspected d. Administer morphine sulfate per intravenous bolus before the first
appendicitis, which among the following should he question? defecation
a. Keep client on NPO
b. Start Lactated Ringer’s IV at 120cc/hr 32. During the immediate postoperative care of a client after his
c. Withhold analgesic medications abdominal–perineal resection, a nurse should give the highest priority to:
d. Apply heat to abdomen to decrease pain a. Monitoring the amount and color of stool in the colostomy bag.
b. Assessing perineal dressings and drainage.
25. A patient comes to the PACU after an appendectomy for a perforated c. Providing a low-residue diet.
appendix. He had a drain inserted in the incisional site, which serves to: d. Encouraging observation and acceptance of the colostomy site.
a. Minimize development of scar tissue
b. Provide access for wound irrigation 33. For a client with a newly created colostomy, a nurse creates this diagnosis:
c. Promote drainage of wound exudates risk for sexual dysfunction related to body image change. To promote satisfying
d. Decrease postoperative discomfort sexual functioning after ostomy surgery, which recommendation should the
nurse make to the client?
26. The nurse caring for the above client is providing wound care a day after a. Utilize self-gratification for the majority of sexual needs
the appendectomy. Which action should the nurse perform when providing b. Empty and clean the ostomy pouch immediately before sexual
wound care? activity
a. Clean the area around the drain moving away from the drain c. Utilize only the female superior position for sexual activity
b. Remove the drain if wound drainage is just minimal d. Participate in sexual activity only in a darkened room
c. Remove the dressing and leave the incision to open air
d. Gently irrigate the drain to remove exudate
34. The nurse provides information to a client with gastroesophageal reflux 42. Why is barium enema contraindicated with diverticulitis?
disease (GERD) about the factors that contribute to decreased lower a. It can perforate an intestinal abscess.
esophageal sphincter (LES) pressure and worsen the condition. The nurse b. It would greatly increase the client’s pain
should tell the client that the following factors contribute to decreased LES c. It is of minimal diagnostic value in diverticulitis
pressure, except: d. The procedure is too lengthy for the client to tolerate
a. Alcohol and caffeinated beverages
b. Baked potatoes 43. Which among these findings would a nurse expect to find in a patient with
c. Fatty foods diverticulitis?
d. Tomatoes and tomato products a. Elevated WBC count
b. Elevated RBC count
35. A postoperative client has been vomiting and has absent bowel sounds, c. Decreased platelet count
and paralytic ileus has been diagnosed. The health care provider prescribes d. Elevated serum BUN concentration
the insertion of a nasogastric tube. The nurse explains the purpose of the tube
and the insertion procedure to the client. The client says to the nurse, “I’m not 44. After providing health teaching to clients with diverticulosis about
sure I can take any more of this treatment.” Which response should the nurse appropriate self-care activities, which statements by the client would indicate
make to the client? correct understanding? Select all that apply.
a. “It is your right to refuse any treatment. I’ll notify the health care provider.” i. “I should have regular exercise.”
b. “Let’s just put the tube down, so that you can get well.” ii. “I should have a diet that has high fiber.”
c. “You are feeling tired and frustrated with your recovery from iii. “With careful attention to my diet, my diverticulosis can be cured.”
surgery?” iv. “I can use cathartic laxatives weekly to control my bowel movements.”
d. “If you don’t have this tube put down, you will just continue to vomit.” v. “I must drink at least 2L of fluid every day.”
a. I, III, IV, V
36. The nurse prepares to administer an enteral feeding to a client through a b. II, III, IV
nasogastric tube (NGT). Which is the priority intervention for the nurse to c. I, II, V
complete before administering the feeding? d. I, II, IV
a. Auscultating the bowel sounds
b. Determining tube placement 45. What daily activity should a nurse integrate in his discharge teaching for a
c. Measuring the intake and output client with diverticulitis?
d. Establishing the client’s baseline weight a. Refraining from straining and lifting activities
b. Eating a high-fiber diet when symptomatic with diverticulitis
37. The client with gastroesophageal reflux disease (GERD) has a chronic c. Use of enemas to relieve constipation
cough. This symptom may be indicative of which of the following? d. Decreasing fluid intake to increased formed consistency of stool
a. Development of laryngeal cancer
b. Esophageal irritation 46. Which intervention should a nurse include in the client's plan of care to
c. Esophageal scar tissue formation prevent complications associated with total parenteral nutrition (TPN)
d. Aspiration of gastric contents administered through a central line?
a. Perform a clean technique in all dressing changes
38. A 39-year-old female client was diagnosed to have hemorrhoids. Which b. Tape all connections of the system
factor in the client’s history would most likely be a primary cause of her c. Encourage bed rest
condition? d. Cover the insertion site with a moisture proof-dressing
a. Age
b. Varicosities in her legs 47. A client with ulcerative colitis is receiving total parenteral nutrition. The
c. Her job as a schoolteacher basic component of the client’s TPN solution is most likely to be:
d. Three vaginal delivery pregnancies a. Isotonic dextrose solution
b. Hypertonic dextrose solution
39. How should a PACU nurse position a client after hemorrhoidectomy? c. Hypotonic dextrose solution
a. High Fowler’s d. Colloidal dextrose solution
b. Supine
c. Side-lying 48. Nurse Daniel is changing the subclavian dressing of a client receiving TPN.
d. Trendelenburg Upon assessment, the nurse notes the presence of yellow drainage from
around the sutures that are anchoring the catheter. Which action should the
40. A patient who had rectal surgery asks the nurse when the proper timing for nurse take first?
sitz baths is. The nurse answers correctly by stating it is important to take a a. Clean the insertion site and redress the area.
sitz bath: b. Document assessment findings in the chart.
a. First thing in the morning c. Obtain a culture specimen of the drainage.
b. As needed for discomfort or pain
c. After a bowel movement 49. A patient underwent intestinal resection and is currently on NPO. He was
d. At bedtime prescribed TPN. The nurse should:
a. Administer the TPN through a nasogastric or gastrostomy tube.
41. What complication is being prevented when a patient who has had a b. Handle TPN using strict aseptic technique.
hemorrhoidectomy is ordered not to have sitz baths until 12 hours after the c. Auscultate for the presence of bowel sounds prior to TPN administration.
surgery?
a. Hemorrhage 50. Which of the following should the nurse interpret as an indication of
b. Rectal spasm complication after the first few days of TPN therapy?
c. Urine retention a. Glycosuria
d. Constipation b. A 1- to 2-lb weight gain
c. Decreased appetite
d. Elevated temperature