Chapter 41- Common Gastrointestinal Disorders My Nursing Test Banks

 

1.

A 20-year-old man presents with upper gastrointestinal bleeding. His health history indicates binge drinking on weekends. The nurse inquires about the patients alcohol use and learns that the patient frequently vomits violently after drinking. Which of the following underlying causes should the nurse suspect for this patients bleeding?

A)

Mallory-Weiss tears

B)

Dieulafoys lesions

C)

Peptic ulcer disease

D)

Stress-related erosive syndrome

2.

The nurse places a large-bore nasogastric tube in a patient who has acute upper gastrointestinal bleeding. What is the rationale for this intervention? Select all that apply.

A)

Aspiration of gastric contents

B)

Improvement of ventilation

C)

Decompression

D)

Enteral feeding

E)

Lavage of gastric contents

F)

Control of bleeding

3.

An elderly patient is experiencing lower gastrointestinal bleeding. On questioning the patient, the nurse learns that she consumes little fiber in her diet, takes aspirin daily, and frequently has constipation. The nurse should suspect which of the following as the most likely cause of this patients bleeding?

A)

Hemorrhoids

B)

Crohns disease

C)

Diverticulosis

D)

Ulcerative colitis

4.

The source of lower gastrointestinal bleeding has been found in a patient during colonoscopy. Which of the following should the nurse expect as the next intervention?

A)

Endoscopy

B)

Angiography

C)

Radionucleotide imaging

D)

Thermal coagulation

5.

A patient with small bowel obstruction (SBO) due to adhesions is no longer passing gas. She has a fever and has shown no signs of improvement in 24 hours. There is no evidence of stool or gas in the distal intestine on radiograph. What is the most important intervention for this patient at this point?

A)

Withholding oral food and fluid

B)

Laparoscopic lysis of adhesions

C)

Placement of nasogastric tube

D)

Aggressive treatment with IV fluid and electrolytes

6.

A patient in the critical care unit presents with abdominal pain, distention, and progressive obstipation. The patient is currently being treated for colon cancer and mentions a gradual decrease in amount and size of stool passed in recent weeks. What finding should the nurse most expect in this patient?

A)

Marked leukocytosis

B)

A history of laxative use

C)

Left lower quadrant pain

D)

Iron deficiency

7.

A patient presents with massive colonic dilation in the absence of mechanical obstruction, with electrolyte imbalance. Which of the following would be the most appropriate initial nursing intervention for this patient?

A)

Administer a laxative.

B)

Encourage the patient to walk around his room.

C)

Monitor the patients heart.

D)

Prepare the patient for colonoscopy.

8.

A patient is diagnosed with hepatitis B. The nurse recognizes that which of the following is the most likely etiology for this patients illness?

A)

Sexually transmitted viral infection

B)

Viral infection from ingesting contaminated water

C)

Excessive alcohol consumption

D)

Autoimmune disorder

9.

A patient is diagnosed with cirrhosis. The nurse sees that there is no indication of alcohol use in the patients health history, and the patient denies drinking alcohol. What is another likely cause of this disease that the nurse should suspect?

A)

Peptic ulcer disease

B)

Hepatitis C virus (HCV) infection

C)

Dieulafoys lesions

D)

Diverticulosis

10.

A patient with esophageal variceal bleeding unresponsive to endoscopic therapy is receiving a balloon tamponade tube. Which of the following is an appropriate nursing intervention related to this procedure?

A)

Warm the tube before the physician inserts it.

B)

Lower the head of the bed so that the patients feet are above his heart.

C)

Encourage the patient to cough.

D)

Clean and lubricate the patients nostrils.

11.

The patient has an upper gastrointestinal hemorrhage. What pathological basis does the nurse least expect?

A)

Peptic ulcer disease

B)

Helicobacter pylori infection

C)

Infectious colitis

D)

Esophageal varices

12.

A patient has an acute upper gastrointestinal hemorrhage secondary to esophageal varices. What is the underlying pathophysiology of this type of gastrointestinal hemorrhage?

A)

Helicobacter pylori infection of esophagus, stomach, and duodenum

B)

Prolonged stress from multiple causes

C)

Portal hypertension from cirrhosis or other liver disease

D)

Overwhelming infection of jejunum and ileum

13.

An elderly patient with several comorbidities has experienced a massive upper GI hemorrhage from esophageal varices. No treatment has been initiated yet. What signs and symptoms does the nurse expect?

A)

Tachycardia and hypotension

B)

Alert and oriented times 3

C)

Mild anemia without hypoxemia

D)

Normal peripheral circulation

14.

A patient with a massive upper gastrointestinal hemorrhage is exhibiting signs and symptoms of hypovolemic shock. What initial treatment does the nurse anticipate?

A)

Admission to a general care nursing unit for monitoring

B)

Initial fluid resuscitation with intravenous crystalloids

C)

Diet of clear liquids, advanced as tolerated

D)

Bed rest in semi-Fowlers position

15.

Intravenous vasopressin (Pitressin) has been ordered for a patient with recurrent esophageal varices causing upper gastrointestinal hemorrhage. What is the purpose of this therapy?

A)

Increases systemic blood pressure in shock

B)

Increases myocardial oxygen use and demand

C)

Reduces blood flow to the mesenteric circulation

D)

Causes constriction of the splanchnic arteries

16.

In a patient with a complete small bowel obstruction, what symptoms would the nurse be most likely to find?

A)

Absence of bowel sounds

B)

Acute, intermittent abdominal cramps

C)

Pain increased with emesis

D)

No evidence of hypovolemia

17.

In a patient with acute pancreatitis, what elevation in laboratory study results would the nurse expect?

A)

Serum potassium and calcium

B)

Arterial ionized calcium

C)

Serum amylase and lipase

D)

Arterial partial pressure of oxygen

18.

What is the underlying pathophysiologic process for pancreatitis?

A)

Inflammation from bowel endotoxins

B)

Autodigestion by pancreatic enzymes

C)

Inability of the pancreas to activate its enzymes

D)

Destruction of pancreatic tissue by bile

19.

A patient with acute pancreatitis is being cared for in intensive care. After several days of therapy, the patient has worsening hypoxemia that does not respond to oxygen therapy, lung sounds are diminished, and there is a patchy infiltrate on the chest x-ray. The patient also has a fever, abdominal distention, and severe pain despite narcotic therapy. What complication of pancreatitis does the nurse most suspect?

A)

Acute respiratory distress syndrome (ARDS)

B)

Nonspecific arterial hypoxemia

C)

Compression of lung by abdominal fluid

D)

Hypoventilation secondary to severe pain

20.

A patient with pancreatitis is complaining of pain at a level of 10 on a scale of 0 to 10. The doctor has ordered IV fentanyl citrate (Sublimaze) every 4 hours prn for pain and lorazepam (Ativan) every hour prn for agitation. The last dose was given 3 hours ago. The patients respiratory rate is 22 per minute with full depth. What is the best nursing action?

A)

Obtain an order for meperidine (Demerol) to prevent sphincter of Oddi spasm.

B)

Administer IV fentanyl now, as the patient is in pain.

C)

Administer IV lorazepam for agitation.

D)

Consult the physician for an increase in fentanyl frequency.

21.

Immune serum globulin has been ordered for a patient with acute hepatitis A. What does the nurse emphasize when explaining the purpose of this medication to the patient?

A)

The medication will eradicate the virus.

B)

The medication will significantly ameliorate the symptoms.

C)

This is the vaccine for hepatitis A.

D)

This medication will obviate any need for isolation.

22.

A patient has been diagnosed with hepatitis B virus. While teaching the patient and family, what mode of transmission will the nurse be least likely to include?

A)

Blood

B)

Semen

C)

Saliva

D)

Feces

23.

The patient has been diagnosed with hepatitis C virus (HCV). At present, what is the primary risk factor for HCV transmission?

A)

Lack of hand hygiene by food industry workers

B)

Multiple sexual contacts with either gender

C)

Contaminated needlestick exposure

D)

Contaminated blood transfusions

24.

In a patient with severe hepatic cirrhosis, what laboratory findings would the nurse expect to be decreased?

A)

Serum proteins

B)

Serum amylase

C)

Aspartate aminotransferase (AST)

D)

Prothrombin time (PT)

25.

A patient with severe hepatic cirrhosis has developed severe ascites. What is the most important nursing assessment?

A)

Abdominal girth

B)

Intake and output

C)

Respiratory status

D)

Nutritional intake

26.

A patient with severe ascites is being treated with spironolactone (Aldactone) and furosemide (Lasix). What laboratory test result indicates a complication from this therapy?

A)

Prolonged prothrombin time (PT)

B)

Leukocytosis

C)

Thrombocytopenia

D)

Hypokalemia

27.

A critically ill patient with cirrhosis has developed hepatic encephalopathy. What is the most effective therapeutic management strategy?

A)

Surgical portosystemic shunt

B)

Increased nutritional protein

C)

Lactulose or neomycin enterally

D)

Sedation with midazolam (Versed)

Answer Key

1.

A

2.

A, C, E

3.

C

4.

D

5.

B

6.

D

7.

B

8.

A

9.

B

10.

D

11.

C

12.

C

13.

A

14.

B

15.

D

16.

B

17.

C

18.

B

19.

A

20.

D

21.

B

22.

D

23.

C

24.

A

25.

C

26.

D

27.

C

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