GASTRO REVIEWER

1. Which of the following conditions can cause a hiatal hernia?

A. Increased intrathoracic pressure

B. Weakness of the esophageal muscle
C. Increased esophageal muscle pressure
D. Weakness of the diaphragmic muscle
2. Risk factors for the development of hiatal hernias are those that lead to increased abdominal
pressure. Which of the following complications can cause increased abdominal pressure?

A. Obesity
B. Volvulus
C. Constipation
D. Intestinal obstruction
3. Which of the following symptoms is common with a hiatal hernia?

A. Left arm pain

B. Lower back pain
C. Esophageal reflux
D. Abdominal cramping
4. Which of the following tests can be performed to diagnose a hiatal hernia?

A. Colonoscopy
B. Lower GI series
C. Barium swallow
D. Abdominal x-rays
5. Which of the following measures should the nurse focus on for the client with esophageal varices?

A. Recognizing hemorrhage
B. Controlling blood pressure
C. Encouraging nutritional intake
D. Teaching the client about varices
6. Which of the following tests can be used to diagnose ulcers?

A. Abdominal x-ray
B. Barium swallow
C. Computed tomography (CT) scan
D. Esophagogastroduodenoscopy (EGD)
7. Which of the following best describes the method of action of medications, such as ranitidine
(Zantac), which are used in the treatment of peptic ulcer disease?

A. Neutralize acid
B. Reduce acid secretions
C. Stimulate gastrin release
D. Protect the mucosal barrier
8. The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn
following a meal. After administering an ordered antacid, the nurse encourages the client to lie in which
of the following positions?

A. Supine with the head of the bed flat

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B. On the stomach with the head flat

C. On the left side with the head of the bed elevated 30 degrees
D. On the right side with the head of the bed elevated 30 degrees.
9. The nurse is caring for a client following a Billroth II procedure. On review of the post-operative
orders, which of the following, if prescribed, would the nurse question and verify?

A. Irrigating the nasogastric tube

B. Coughing a deep breathing exercise
C. Leg exercises
D. Early ambulation
10. The nurse is providing discharge instructions to a client following gastrectomy. Which measure will
the nurse instruct the client to follow to assist in preventing dumping syndrome?

A. Eat high-carbohydrate foods

B. Limit the fluids taken with meals
C. Ambulate following a meal
D. Sit in a high-Fowlers position during meals
11. The nurse instructs the nursing assistant on how to provide oral hygiene for a client who cannot
perform this task for himself. Which of the following techniques should the nurse tell the assistant to
incorporate into the client’s daily care?

A. Assess the oral cavity each time mouth care is given and record observations
B. Use a soft toothbrush to brush the client’s teeth after each meal
C. Swab the client’s tongue, gums, and lips with a soft foam applicator every 2 hours.
D. Rinse the client’s mouth with mouthwash several times a day.
12. A client with suspected gastric cancer undergoes an endoscopy of the stomach. Which of the
following assessments made after the procedure would indicate the development of a potential
complication?

A. The client complains of a sore throat

B. The client displays signs of sedation
C. The client experiences a sudden increase in temperature
D. The client demonstrates a lack of appetite
13. A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to undergo a
subtotal gastrectomy (Billroth II procedure). During pre-operative teaching, the nurse is reinforcing
information about the procedure. Which of the following explanations is most accurate?

A. The procedure will result in enlargement of the pyloric sphincter

B. The procedure will result in anastomosis of the gastric stump to the jejunum
C. The procedure will result in removal of the duodenum
D. The procedure will result in repositioning of the vagus nerve
14. After a subtotal gastrectomy, the nurse should anticipate that nasogastric tube drainage will be what
color for about 12 to 24 hours after surgery?

A. Dark brown
B. Bile green
C. Bright red
D. Cloudy white
15. After a subtotal gastrectomy, care of the client’s nasogastric tube and drainage system should include
which of the following nursing interventions?
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A. Irrigate the tube with 30 ml of sterile water every hour, if needed.

B. Reposition the tube if it is not draining well
C. Monitor the client for N/V, and abdominal distention
D. Turn the machine to high suction of the drainage is sluggish on low suction.
16. Which of the following would be an expected nutritional outcome for a client who has undergone a
subtotal gastrectomy for cancer?

A. Regain weight loss within 1 month after surgery

B. Resume normal dietary intake of three meals per day
C. Control nausea and vomiting through regular use of antiemetics
D. Achieve optimal nutritional status through oral or parenteral feedings
17. The client with GERD complains of a chronic cough. The nurse understands that in a client with
GERD this symptom may be indicative of which of the following conditions?

A. Development of laryngeal cancer

B. Irritation of the esophagus
C. Esophageal scar tissue formation
D. Aspiration of gastric contents
18. Which of the following dietary measures would be useful in preventing esophageal reflux?

A. Eating small, frequent meals

B. Increasing fluid intake
C. Avoiding air swallowing with meals
D. Adding a bedtime snack to the dietary plan
19. A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding
duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric area along with a rigid,
boardlike abdomen. These clinical manifestations most likely indicate which of the following?

A. An intestinal obstruction has developed

B. Additional ulcers have developed
C. The esophagus has become inflamed
D. The ulcer has perforated
20. When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and
symptoms would the nurse expect to see? Select all that apply.

A. Epigastric pain at night

B. Relief of epigastric pain after eating
C. Vomiting
D. Weight loss
21. The nurse is caring for a client who has had a gastroscopy. Which of the following symptoms may
indicate that the client is developing a complication related to the procedure? Select all that apply.

A. The client complains of a sore throat

B. The client has a temperature of 100*F
C. The client appears drowsy following the procedure
D. The client complains of epigastric pain
E. The client experiences hematemesis
22. A client with peptic ulcer disease tells the nurse that he has black stools, which he has not reported to
his physician. Based on this information, which nursing diagnosis would be appropriate for this client?
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A. Ineffective coping related to fear of diagnosis of chronic illness

B. Deficient knowledge related to unfamiliarity with significant signs and symptoms
C. Constipation related to decreased gastric motility
D. Imbalanced nutrition: Less than body requirements due to gastric bleeding
23. A client with a peptic ulcer reports epigastric pain that frequently awakens her at night, a feeling of
fullness in the abdomen, and a feeling of anxiety about her health. Based on this information, which
nursing diagnosis would be most appropriate?

A. Imbalanced Nutrition: Less than Body Requirements related to anorexia.

B. Disturbed Sleep Pattern related to epigastric pain
C. Ineffective Coping related to exacerbation of duodenal ulcer
D. Activity Intolerance related to abdominal pain
24. While caring for a client with peptic ulcer disease, the client reports that he has been nauseated most
of the day and is now feeling lightheaded and dizzy. Based upon these findings, which nursing actions
would be most appropriate for the nurse to take? Select all that apply.

A. Administering an antacid hourly until nausea subsides.

B. Monitoring the client’s vital signs
C. Notifying the physician of the client’s symptoms
D. Initiating oxygen therapy
E. Reassessing the client on an hour
25. A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The nurse
knows that the client understands proper drug administration of ranitidine when she says that she will take
the drug at which of the following times?

A. Before meals
B. With meals
C. At bedtime
D. When pain occurs
26. A client has been taking aluminum hydroxide 30 mL six times per day at home to treat his peptic
ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this
information, the nurse would determine that which of the following is the most likely cause of the client’s
constipation?

A. The client has not been including enough fiber in his diet
B. The client needs to increase his daily exercise
C. The client is experiencing a side effect of the aluminum hydroxide.
D. The client has developed a gastrointestinal obstruction.
27. A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best
indicates that the client understands how to correctly take the antacid?

A. “I should take my antacid before I take my other medications.”

B. “I need to decrease my intake of fluids so that I don’t dilute the effects of my antacid.”
C. “My antacid will be most effective if I take it whenever I experience stomach pains.”
D. “It is best for me to take my antacid 1 to 3 hours after meals.”
28. The nurse is caring for a client with chronic gastritis. The nurse monitors the client, knowing that this
client is at risk for which of the following vitamin deficiencies?

A. Vitamin A
B. Vitamin B12
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C. Vitamin C
D. Vitamin E
29. The nurse is reviewing the medication record of a client with acute gastritis. Which medication, if
noted on the client’s record, would the nurse question?

A. Digoxin (Lanoxin)
B. Indomethacin (Indocin)
C. Furosemide (Lasix)
D. Propranolol hydrochloride (Inderal)
30. The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube
has drained 750ml of green-brown drainage. Which nursing intervention is most appropriate?

A. Notify the physician

B. Document the findings
C. Irrigate the T-tube
D. Clamp the T-tube
31. The nurse provides medication instructions to a client with peptic ulcer disease. Which statement, if
made by the client, indicates the best understanding of the medication therapy?

A. “The cimetidine (Tagamet) will cause me to produce less stomach acid.”

B. “Sucralfate (Carafate) will change the fluid in my stomach.”
C. “Antacids will coat my stomach.”
D. “Omeprazole (Prilosec) will coat the ulcer and help it heal.”
32. The client with peptic ulcer disease is scheduled for a pyloroplasty. The client asks the nurse about
the procedure. The nurse plans to respond knowing that a pyloroplasty involves:

A. Cutting the vagus nerve

B. Removing the distal portion of the stomach
C. Removal of the ulcer and a large portion of the cells that produce hydrochloric acid
D. An incision and resuturing of the pylorus to relax the muscle and enlarge the opening
from the stomach to the duodenum.
33. A client with a peptic ulcer is scheduled for a vagotomy. The client asks the nurse about the purpose
of this procedure. The nurse tells the client that the procedure:

A. Decreases food absorption in the stomach

B. Heals the gastric mucosa
C. Halts stress reactions
D. Reduces the stimulus to acid secretions
34. The nurse would assess the client experiencing an acute episode of cholecystitis for pain that is
located in the right

A. Upper quadrant and radiates to the left scapula and shoulder

B. Upper quadrant and radiates to the right scapula and shoulder
C. Lower quadrant and radiates to the umbilicus
D. Lower quadrant and radiates to the back
35. Which of the following tasks should be included in the immediate postoperative management of a
client who has undergone gastric resection?

A. Monitoring gastric pH to detect complications

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B. Assessing for bowel sounds

C. Providing nutritional support
D. Monitoring for symptoms of hemorrhage
36. If a gastric acid perforates, which of the following actions should not be included in the immediate
management of the client?

A. Blood replacement
B. Antacid administration
C. Nasogastric tube suction
D. Fluid and electrolyte replacement
37. Mucosal barrier fortifiers are used in peptic ulcer disease management for which of the following
indications?

A. To inhibit mucus production

B. To neutralize acid production
C. To stimulate mucus production
D. To stimulate hydrogen ion diffusion back into the mucosa
38. When counseling a client in ways to prevent cholecystitis, which of the following guidelines is most
important?

A. Eat a low-protein diet

B. Eat a low-fat, low-cholesterol diet
C. Limit exercise to 10 minutes/day
D. Keep weight proportionate to height
39. Which of the following symptoms best describes Murphy’s sign?

A. Periumbilical eccymosis exists

B. On deep palpitation and release, pain in elicited
C. On deep inspiration, pain is elicited and breathing stops
D. Abdominal muscles are tightened in anticipation of palpation
40. Which of the following tests is most commonly used to diagnose cholecystitis?

A. Abdominal CT scan
B. Abdominal ultrasound
C. Barium swallow
D. Endoscopy
41. Which of the following factors should be the main focus of nursing management for a client
hospitalized for cholecystitis?

A. Administration of antibiotics
B. Assessment for complications
C. Preparation for lithotripsy
D. Preparation for surgery
42. A client being treated for chronic cholecystitis should be given which of the following instructions?

A. Increase rest
B. Avoid antacids
C. Increase protein in diet
D. Use anticholinergics as prescribed
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43. The client with a duodenal ulcer may exhibit which of the following findings on assessment?

A. Hematemesis
B. Malnourishment
C. Melena
D. Pain with eating
44. The pain of a duodenal ulcer can be distinguished from that of a gastric ulcer by which of the
following characteristics?

A. Early satiety
B. Pain on eating
C. Dull upper epigastric pain
D. Pain on empty stomach
45. The client has orders for a nasogastric (NG) tube insertion. During the procedure, instructions that
will assist in the insertion would be:

A. Instruct the client to tilt his head back for insertion in the nostril, then flex his neck for the
final insertion
B. After insertion into the nostril, instruct the client to extend his neck
C. Introduce the tube with the client’s head tilted back, then instruct him to keep his head
upright for final insertion
D. Instruct the client to hold his chin down, then back for insertion of the tube
46. The most important pathophysiologic factor contributing to the formation of esophageal varices is:

A. Decreased prothrombin formation

B. Decreased albumin formation by the liver
C. Portal hypertension
D. Increased central venous pressure
47. The client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to control
the bleeding. The most important assessment is for the nurse to:

A. Check that the hemostat is on the bedside

B. Monitor IV fluids for the shift
C. Regularly assess respiratory status
D. Check that the balloon is deflated on a regular basis
48. A female client complains of gnawing epigastric pain for a few hours after meals. At times, when the
pain is severe, vomiting occurs. Specific tests are indicated to rule out:

A. Cancer of the stomach

B. Peptic ulcer disease
C. Chronic gastritis
D. Pylorospasm
49. When a client has peptic ulcer disease, the nurse would expect a priority intervention to be:

A. Assisting in inserting a Miller-Abbott tube

B. Assisting in inserting an arterial pressure line
C. Inserting a nasogastric tube
D. Inserting an I.V.
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50. A 40-year-old male client has been hospitalized with peptic ulcer disease. He is being treated with a
histamine receptor antagonist (cimetidine), antacids, and diet. The nurse doing discharge planning will
teach him that the action of cimetidine is to:

A. Reduce gastric acid output

B. Protect the ulcer surface
C. Inhibit the production of hydrochloric acid (HCl)
D. Inhibit vagus nerve stimulation