1.​ A client has an open traditional hiatal hernia repair this morning.

What is the nurse’s

priority for client care at this time?

A. Managing surgical pain

B. Ambulating the client early
C. Preventing respiratory complications
D. Managing the nasogastric tube

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 factors would most likely contribute to the development of a
client's hiatal hernia?

A. Having a sedentary desk job.

B. Being 5 feet, 3 inches tall and weighing 190 lb.
C. Using laxatives frequently.
D. Being 40 years old.

5.​ Which of the following nursing interventions would most likely promote self-care
behaviors in the client with a hiatal hernia?

A. Introduce the client to other people who are successfully managing their care.
B. Include the client's daughter in the teaching so that she can help implement the plan.
C. Ask the client to identify other situations in which he demonstrated responsibility for
himself.
D. Reassure the client that he will be able to implement all aspects of the plan
successfully.
6.​ In developing a teaching plan for the client with a hiatal hernia, the nurse's assessment
of which work-related factors would be most useful?
 A. Number and length of breaks.
B. Body mechanics used in lifting.
C. Temperature in the work area.
D. Cleaning solvents used.

7.​ The nurse instructs the client on health maintenance activities to help control symptoms
from her hiatal hernia. Which of the following statements would indicate that the client
has understood the instructions?

A. "I'll avoid lying down after a meal."

B. "I can still enjoy my potato chips and cola at bedtime."
C. "I wish I didn't have to give up swimming."
D. "If I wear a girdle, I'll have more support for my stomach."

8.​ A 50-year-old female patient is diagnosed with a hiatal hernia and complains of
persistent reflux despite lifestyle modifications. Which intervention should the nurse
recommend first?

A. Initiate a proton pump inhibitor (PPI)

B. Schedule the patient for an upper endoscopy
C. Refer the patient for esophageal pH monitoring
D. Instruct the patient to avoid lying down after meals

9.​ A 45-year-old male patient with a hiatal hernia presents with dysphagia and heartburn.
He is scheduled for surgical repair. During preoperative teaching, the patient asks about
dietary restrictions post-surgery. What should the nurse advise?

A. Avoid carbonated beverages and spicy foods

B. Increase intake of high-fiber foods
C. Consume small, frequent meals
D. Resume regular diet immediately after surgery

10.​A 55-year-old female patient with a hiatal hernia reports frequent nocturnal reflux
symptoms. Which intervention should the nurse suggest to manage nocturnal
symptoms?

A. Elevate the head of the bed during sleep

B. Administer a histamine-2 receptor antagonist (H2RA)
C. Encourage consumption of a large meal before bedtime
D. Instruct the patient to sleep in the supine position
11.​ A 54-year-old man has just arrived in the recovery area after an upper endoscopy.
Which information collected by the nurse is most important to communicate to the health
care provider?

A. The patient is very drowsy.

B. The patient reports a sore throat.
C. The oral temperature is 101.6° F.
D. The apical pulse is 104 beats/minute.

12.​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

13.​The nurse is caring for a client diagnosed with probable gastroesophageal reflux disease
(GERD). What assessment finding(s) would the nurse expect? (Select all that apply.)

A. Dyspepsia
B. Regurgitation
C. Belching
D. Coughing
E. Chest discomfort

14.​A staff educator is reviewing the causes of gastroesophageal reflux disease (GERD) with
new staff nurses. What area of the GI tract should the educator identify as the cause of
reduced pressure associated with GERD?

A. Pyloric sphincter
B. Lower esophageal sphincter
C. Hypopharyngeal sphincter
D. Upper esophageal sphincter

15.​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
16.​Which of the following instructions should the nurse include in the teaching plan for a
client who is experiencing gastroesophageal reflux disease (GERD)?

A. Limit caffeine intake to two cups of coffee per day.

B. Do not lie down for 2 hours after eating.
C. Follow a low-protein diet.
D. Take medications with milk to decrease irritation.

17.​The client with gastroesophageal reflux disease (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.​What response should a nurse offer to a client who asks why he's having a vagotomy to
treat his ulcer?

A. To repair a hole in the stomach

B. to reduce the ability of the stomach to produce acid
C. to prevent the stomach from sliding into the chest
D. to remove a potentially malignant lesion in the stomach

19.​Case Scenario: A 65-year-old male patient presents to the emergency department

complaining of severe chest pain and difficulty swallowing. He has a history of GERD.
Upon examination, he is found to have epigastric tenderness and signs of dehydration.
Which of the following interventions should the nurse prioritize?

A. Administer antacids and pain medications

B. Prepare for immediate surgical repair
C. Elevate the head of the bed and provide oxygen therapy
D. Initiate a continuous nasogastric tube suctioning

20.​The nurse is administering morning medications at 0730. Which medication should have
priority?

A. a proton pump inhibitor

B. A nonnarcotic analgesic
C. A histamine receptor antagonist
D. A mucosal barrier agent
21.​A nurse is caring for a patient who has just been diagnosed with a peptic ulcer. When
teaching the patient about his new diagnosis, how should the nurse best describe a
peptic ulcer?

A. Inflammation of the lining of the stomach

B. Erosion of the lining of the stomach or intestine
C. Bleeding from the mucosa in the stomach
D. Viral invasion of the stomach wall

22.​A patient comes to the clinic complaining of pain in the epigastric region. What
assessment question during the health interview would most help the nurse determine if
the patient has a peptic ulcer?

A. Does your pain resolve when you have something to eat?

B. Do over-the-counter pain medications help your pain?
C. Does your pain get worse if you get up and do some exercise?
D. Do you find that your pain is worse when you need to have a bowel movement?

23.​A patient with a diagnosis of peptic ulcer disease has just been prescribed omeprazole
(Prilosec). How should the nurse best describe this medications therapeutic action?

A. This medication will reduce the amount of acid secreted in your stomach.
B. This medication will make the lining of your stomach more resistant to damage.
C. This medication will specifically address the pain that accompanies peptic ulcer
disease.
D. This medication will help your stomach lining to repair itself.

24.​A patient is receiving education about his upcoming Billroth I procedure

(gastroduodenostomy). This patient should be informed that he may experience which of
the following adverse effects associated with this procedure?

A. Persistent feelings of hunger and thirst

B. Constipation or bowel incontinence
C. Diarrhea and feelings of fullness
D. Gastric reflux and belching

25.​A patient with a history of peptic ulcer disease has presented to the emergency
department (ED) in distress. What assessment finding would lead the ED nurse to
suspect that the patient has a perforated ulcer?

A. The patient has abdominal bloating that developed rapidly.

B. The patient has a rigid, boardlike abdomen that is tender.
C. The patient is experiencing intense lower right quadrant pain.
 D. The patient is experiencing dizziness and confusion with no apparent hemodynamic
changes.

26.​ Diagnostic imaging and physical assessment have revealed that a patient with peptic
ulcer disease has suffered a perforated ulcer. The nurse recognizes that emergency
interventions must be performed as soon as possible in order to prevent the
development of what complication?

A. Peritonitis
B. Gastritis
C. Gastroesophageal reflux
D. Acute pancreatitis

27.​A patient has been diagnosed with peptic ulcer disease and the nurse is reviewing his
prescribed medication regimen with him. What is currently the most commonly used drug
regimen for peptic ulcers?

A. Bismuth salts, antivirals, and histamine-2 (H2) antagonists

B. H2 antagonists, antibiotics, and bicarbonate salts
C. Bicarbonate salts, antibiotics, and ZES
D. Antibiotics, proton pump inhibitors, and bismuth salts

28.​A nurse is caring for a patient who has a diagnosis of GI bleed. During shift assessment,
the nurse finds the patient to be tachycardic and hypotensive, and the patient has an
episode of hematemesis while the nurse is in the room. In addition to monitoring the
patient's vital signs and level of consciousness, what would be a priority nursing action
for this patient?

A. Place the patient in a prone position.

B. Provide the patient with ice water to slow any GI bleeding.
C. Prepare for the insertion of an NG tube.
D. Notify the physician.

29.​A patient with gastritis required hospital treatment for an exacerbation of symptoms and
received a subsequent diagnosis of pernicious anemia due to malabsorption. When
planning the patient's continuing care in the home setting, what assessment question is
most relevant?

A. Does anyone in your family have experience at giving injections?

B. Are you going to be anywhere with strong sunlight in the next few months?
C. Are you aware of your blood type?
D. Do any of your family members have training in first aid?
30.​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

31.​Inflammatory bowel disease (IBD) encompasses two main conditions: Crohn's disease
and ulcerative colitis. Which aspect of the pathophysiology differentiates these two
conditions?

A. Extent of bowel involvement

B. Severity of diarrhea
C. Presence of abdominal pain
D. Family history of IBD

32.​A patient with Crohn's disease experiences transmural inflammation, which can affect
the entire thickness of the intestinal wall. What are the potential complications of
transmural inflammation, and how does this pathophysiological feature differ from that of
ulcerative colitis?

A. Strictures and fistulas; ulcerative colitis primarily involves the mucosa.

B. Abscess formation and pseudopolyps; ulcerative colitis has transmural inflammation.
C. Malabsorption and vitamin deficiencies; ulcerative colitis results in thickening of the
bowel wall.
D. Toxic megacolon and colorectal cancer; ulcerative colitis causes serositis.

33.​A nurse is preparing to provide care for a patient whose exacerbation of ulcerative colitis
has required hospital admission. During an exacerbation of this health problem, the
nurse would anticipate that the patients stools will have what characteristics?

A. Watery with blood and mucus

B. Hard and black or tarry
C. Dry and streaked with blood
D. Loose with visible fatty streaks

34.​A patient has had an ileostomy created for the treatment of irritable bowel disease and
the patient is now preparing for discharge. What should the patient be taught about
changing this device in the home setting?

A. Apply antibiotic ointment as ordered after cleaning the stoma.

B. Apply a skin barrier to the peristomal skin prior to applying the pouch.
C. Dispose of the clamp with each bag change.
 D. Cleanse the area surrounding the stoma with alcohol or chlorhexidine.

35.​The nurse is caring for a client who is prescribed sulfasalazine. Which question would
the nurse ask the client before starting this drug?

A. “Are you taking Vitamin C or B?

B. “Do you have any allergy to sulfa drugs?”
C. “Can you swallow pills pretty easily?”
D. “Do you have insurance to cover this drug?”

36.​A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which
assessment would the nurse complete first?

A. Inspection of oral mucosa

B. Recent dietary intake
C. Heart rate and rhythm
D. Percussion of abdomen

37.​A nurse reviews the electronic health record of a client who has Crohn disease and a
draining fistula. Which documentation would alert the nurse to urgently contact the
primary health care provider for additional prescriptions?

A. Serum potassium of 2.6 mEq/L (2.6 mmol/L)

B. Client ate 20% of breakfast meal
C. White blood cell count of 8200/mm3 (8.2 109/L)
D. Client’s weight decreased by 3 lb (1.4 kg)

38.​The nurse assesses a patient who is recovering from an ileostomy placement. Which
assessment finding would alert the nurse to immediately contact the primary health care
provider?

A. Pale and bluish stoma

B. Liquid stool
C. Ostomy pouch intact
D. Blood-tinged output

39.​The nurse assesses a client with ulcerative colitis. Which complications are paired
correctly with their physiologic processes? (Select all that apply.)

A. Lower gastrointestinal bleeding—erosion of the bowel wall

B. Abscess formation—localized pockets of infection develop in the ulcerated bowel
lining
C. Toxic megacolon—transmural inflammation resulting in pyuria and fecaluria
D. Nonmechanical bowel obstruction—paralysis of colon resulting from colorectal
 cancer
E. Fistula—dilation and colonic ileus caused by paralysis of the colon

40.​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

41.​Diverticulitis is primarily caused by the inflammation and infection of diverticula. What is

the underlying pathophysiological mechanism leading to the development of these
diverticula?

A. Increased peristaltic contractions in the colon

B. Weakness and herniation of the colonic wall
C. Excessive dietary fiber intake
D. Overuse of laxatives

42.​A patient with diverticulitis presents with symptoms of lower left abdominal pain, fever,
and leukocytosis. Which pathophysiological process is primarily responsible for the fever
and leukocytosis in diverticulitis?

A. Localized colonic hemorrhage

B. Obstruction of the colon
C. Perforation and abscess formation
D. Increased sympathetic nervous system activity

43.​What is the pathophysiological link between chronic constipation and the development of
diverticulosis, a precursor to diverticulitis?

A. Chronic constipation leads to an increased intake of dietary fiber.

B. Chronic constipation causes weakening of the colonic wall.
C. Chronic constipation promotes high levels of gastrointestinal motility.
D. Chronic constipation reduces the risk of diverticulosis.

44.​A patient admitted with acute diverticulitis has experienced a sudden increase in
temperature and complains of a sudden onset of exquisite abdominal tenderness. The
nurses rapid assessment reveals that the patients abdomen is uncharacteristically rigid
on palpation. What is the nurses best response?
 A. Administer a Fleet enema as ordered and remain with the patient.
B. Contact the primary care provider promptly and report these signs of perforation.
C. Position the patient supine and insert an NG tube.
D. Page the primary care provider and report that the patient may be obstructed.

45.​Which of the following definitions best describes diverticulosis?

A. An inflamed outpouching of the intestine

B. A noninflamed outpouching of the intestine
C. The partial impairment of the forward flow of intestinal contents
D. An abnormal protrusion of an organ through the structure that usually holds it.

46.​Which of the following types of diets is implicated in the development of diverticulosis?

A. Low-fiber diet
B. High-fiber diet
C. High-protein diet
D. Low-carbohydrate diet

47.​Which of the following mechanisms can facilitate the development of diverticulosis into
diverticulitis?

A. Treating constipation with chronic laxative use, leading to dependence on laxatives

B. Chronic constipation causing an obstruction, reducing forward flow of intestinal
contents
C. Herniation of the intestinal mucosa, rupturing the wall of the intestine
D. Undigested food blocking the diverticulum, predisposing the area to bacterial invasion

48.​Which of the following symptoms indicated diverticulosis?

A. No symptoms exist
B. Change in bowel habits
C. Anorexia with low-grade fever
D. Episodic, dull, or steady midabdominal pain

49.​Which of the following tests should be administered to a client suspected of having

diverticulosis?

A. Abdominal ultrasound
B. Barium enema
C. Barium swallow
D. Gastroscopy
50.​Medical management of the client with diverticulitis should include which of the following
treatments?
 A. Reduced fluid intake
B. Increased fiber in diet
C. Administration of antibiotics
D. Exercises to increase intra-abdominal pressure

51.​A patient is being scheduled for endoscopic retrograde cholangiopancreatography

(ERCP) as soon as possible. Which actions from the agency policy for ERCP should the
nurse take first?

A. Place the patient on NPO status.

B. Administer sedative medications.
C. Ensure the consent form is signed.
D. Teach the patient about the procedure.

52.​A nurse is completing nutritional teaching for a client who has pancreatitis. Which of the
following statements by the client indicates an understanding of the teaching? (SATA)

A. I plan to eat small, frequent meals.

B. I will eat easy-to-digest foods with limited spice
C. I will use skim milk when cooking
D. I plan to drink regular cola
E. I will limit alcohol intake to two drinkers per day

53.​A patient with sudden pain in the left upper quadrant radiating to the back and vomiting
was diagnosed with acute pancreatitis. Which intervention should the nurse include in
the patient's plan of care?

A. Immediately start enteral feeding to prevent malnutrition.

B. Insert an NG and maintain NPO status to allow pancreas to rest.
C. Initiate early prophylactic antibiotic therapy to prevent infection.
D. Administer acetaminophen (Tylenol) every 4 hours for pain relief.

54.​The client is admitted to the medical department with a diagnosis of R/O acute
pancreatitis. What laboratory values should the nurse monitor to confirm this diagnosis?

A. Creatinine and BUN

B. Troponin and CK-MB
C. Serum amylase and lipase
D. Serum bilirubin and calcium

Rationale: Serum amylase levels increase within two to 12 hours of the onset of acute
pancreatitis; lipase elevates and remains elevated for seven to 14 days
55.​The client diagnosed with acute pancreatitis is in pain. Which position should the nurse
assist the client to assume to help decrease the pain?

A. Recommend lying in the prone position with legs extended

B. Maintain a tripod position over the bedside table
C. Place in side-lying position with knees flexed
D. Encourage a supine position with a pillow under the knees

56.​The nurse is preparing to administer A.M. medications to the following clients. Which
medication should the nurse question before administering?

A. Pancreatic enzymes to the client who has finished breakfast.

B. The pain medication, morphine, to the client who has a respiratory rate of 20.
C. The loop diuretic to the client who has a serum potassium level of 3.9 mEq/L.
D. The beta blocker to the client who has an apical pulse of 68 bpm.

57.​The male client diagnosed with chronic pancreatitis calls and reports to the clinic nurse
that he has been having a lot of "gas," along with frothy and very foul-smelling stools.
Which action should the nurse take?

A. Explain that this is common for chronic pancreatitis.

B. Ask the client to bring in a stool specimen to the clinic.
C. Arrange an appointment with the HCP for today.
D. Discuss the need to decrease fat in the diet so that this won't happen.

58.​A 55-year-old man has been newly diagnosed with acute pancreatitis and admitted to
the acute medical unit. How should the nurse most likely explain the pathophysiology of
this patient's health problem?

A. Toxins have accumulated and inflamed your pancreas.

B. Bacteria likely migrated from your intestines and became lodged in your pancreas.
C. A virus that was likely already present in your body has begun to attack your
pancreatic cells.
D. The enzymes that your pancreas produces have damaged the pancreas itself.

59.​A 37-year-old male patient presents at the emergency department (ED) complaining of
nausea and vomiting and severe abdominal pain. The patient's abdomen is rigid, and
there is bruising to the patient's flank. The patient's wife states that he was on a drinking
binge for the past 2 days. The ED nurse should assist in assessing the patient for what
health problem?

A. Severe pancreatitis with possible peritonitis

B. Acute cholecystitis
C. Chronic pancreatitis
 D. Acute appendicitis with possible perforation

60.​A nurse is assessing a client who has pancreatitis. Which of the following actions should
the nurse take to assess the presence of Cullen's sign.

A. Tap lightly at the costovertebral margin on the client's back

B. Palpate the RLQ
C. Inspect the skin around the umbilicus
D. Auscultate the area below the scapula

61.​What is the role of the gallbladder in the digestive process?

A. Production of bile
B. Absorption of nutrients
C. Storage and concentration of bile
D. Regulation of blood glucose levels

62.​A nurse is assessing a patient who has been diagnosed with cholecystitis, and is
experiencing localized abdominal pain. When assessing the characteristics of the
patients pain, the nurse should anticipate that it may radiate to what region?

A. Left upper chest

B. Inguinal region
C. Neck or jaw
D. Right shoulder

63.​ A nurse is educating a patient about cholecystitis and the importance of dietary
changes. The patient asks how dietary fat intake affects the pathophysiology of the
condition. What is the most accurate explanation for the role of dietary fat in
cholecystitis?

A. "Dietary fat enhances the liver's production of bile."

B. "Increased dietary fat leads to gallbladder inflammation."
C. "Fat in your diet helps prevent gallstone formation."
D. "Dietary fat has no impact on cholecystitis."

64.​A client is experiencing severe upper abdominal pain and jaundice. Which finding on the
cholescintigraphy should indicate to the nurse that the client has​cholelithiasis?

A. Obstruction of the cystic duct by a gallstone

B. Viral infection of the gallbladder
C. Accumulation of fat in the wall of the gallbladder
D. Accumulation of bile in the hepatic duct
65.​The nursing management of the patient with cholecystitis associated with cholelithiasis is
based on the knowledge that

A. Shock-wave therapy should be tried initially.

B. Once gallstones are removed, they tend not to recur.
C. The disorder can be successfully treated with oral bile salts that dissolve gallstones.
D. Laparoscopic cholecystectomy is the treatment of choice in most patients who are
symptomatic

66.​Which statements below are CORRECT regarding the role of bile? Select all that apply:

A. Bile is created and stored in the gallbladder.

B. Bile aids in digestion of fat soluble vitamins, such as A, D, E, and K.
C. Bile is released from the gallbladder into the duodenum.
D. Bile contains bilirubin.

67.​A client asks what causes gallstones to form. Which factor should the nurse explain as
being present when these stones are formed? (Select all that apply.)

A. Rapid weight gain

B. Abnormal bile composition
C. Excess cholesterol
D. Inflammation of the gallbladder
E. Biliary stasis

68.​After teaching a client who has a history of cholelithiasis, the nurse assesses the client's
understanding. Which menu selection made by the client indicates the client clearly
understands the dietary teaching?

A. Lasagna, tossed salad with Italian dressing, and low-fat milk

B. Grilled cheese sandwich, tomato soup, and coffee with cream
C. Cream of potato soup, Caesar salad with chicken, and a diet cola
D. Roasted chicken breast, baked potato with chives, and orange juice

69.​A patient who had surgery for gallbladder disease has just returned to the postsurgical
unit from postanesthetic recovery. The nurse caring for this patient knows to immediately
report what assessment finding to the physician?

A. Decreased breath sounds

B. Drainage of bile-colored fluid onto the abdominal dressing
C. Rigidity of the abdomen
D. Acute pain with movement
70.​A nurse is caring for a patient who has been scheduled for endoscopic retrograde
cholangiopancreatography (ERCP) the following day. When providing anticipatory
guidance for this patient, the nurse should describe what aspect of this diagnostic
procedure?

A. The need to protect the incision postprocedure

B. The use of moderate sedation
C. The need to infuse 50% dextrose during the procedure
D. The use of general anesthesia

71.​Which statement to the nurse from a patient with jaundice indicates a need for teaching?

A. "I used cough syrup several times a day last week."

B. "I take a baby aspirin every day to prevent strokes."
C. "I use acetaminophen (Tylenol) every 4 hours for back pain."
D. "I need to take an antacid for indigestion several times a week"

72.​A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis.

What technique should the nurse use to palpate the patient's liver?

A. Place your hand under the right lower abdominal quadrant and press down lightly with
the other hand.
B. Place the left hand over the abdomen and behind the left side at the 11th rib.
C. Place your hand under the right lower rib cage and press down lightly with the other
hand.
D. Hold your hand 90 degrees to the right side of the abdomen and push down firmly.

73.​A patient with portal hypertension has been admitted to the medical floor. The nurse
should prioritize which of the following assessments related to the manifestations of this
health problem?

A. Assessment of blood pressure and assessment for headaches and visual changes
B. Assessments for signs and symptoms of venous thromboembolism
C. Daily weights and abdominal girth measurement
D. Blood glucose monitoring q4h

74.​A triage nurse in the emergency department is assessing a patient who presented with
complaints of general malaise. Assessment reveals the presence of jaundice and
increased abdominal girth. What assessment question best addresses the possible
etiology of this patient's presentation?

A. How many alcoholic drinks do you typically consume in a week?

B. To the best of your knowledge, are your immunizations up to date?
 C. Have you ever worked in an occupation where you might have been exposed to
toxins?
D. Has anyone in your family ever experienced symptoms similar to yours?

75.​A patient is being discharged after a liver transplant and the nurse is performing
discharge education. When planning this patients continuing care, the nurse should
prioritize which of the following risk diagnoses?

A. Risk for Infection Related to Immunosuppressant Use

B. Risk for Injury Related to Decreased Hemostasis
C. Risk for Unstable Blood Glucose Related to Impaired Gluconeogenesis
D. Risk for Contamination Related to Accumulation of Ammonia

76.​A patient has developed hepatic encephalopathy secondary to cirrhosis and is receiving
care on the medical unit. The patient's current medication regimen includes lactulose
(Cephulac) four times daily. What desired outcome should the nurse relate to this
pharmacologic intervention?

A. Two to 3 soft bowel movements daily

B. Significant increase in appetite and food intake
C. Absence of nausea and vomiting
D. Absence of blood or mucus in stool

77.​A nurse is amending a patient's plan of care in light of the fact that the patient has
recently developed ascites. What should the nurse include in this patient's care plan?

A. Mobilization with assistance at least 4 times daily

B. Administration of beta-adrenergic blockers as ordered
C. Vitamin B12 injections as ordered
D. Administration of diuretics as ordered

78.​A nurse is caring for a patient who has been admitted for the treatment of advanced
cirrhosis. What assessment should the nurse prioritize in this patient's plan of care?

A. Measurement of abdominal girth and body weight

B. Assessment for variceal bleeding
C. Assessment for signs and symptoms of jaundice
D. Monitoring of results of liver function testing

79.​A patient with a diagnosis of cirrhosis has developed variceal bleeding and will
imminently undergo variceal banding. What psychosocial nursing diagnosis should the
nurse most likely prioritize during this phase of the patient's treatment?

A. Decisional Conflict
 B. Deficient Knowledge
C. Death Anxiety
D. Disturbed Thought Processes

80.​A patient with a diagnosis of esophageal varices has undergone endoscopy to gauge the
progression of this complication of liver disease. Following the completion of this
diagnostic test, what nursing intervention should the nurse perform?

A. Keep patient NPO until the results of test are known.

B. Keep patient NPO until the patients gag reflex returns.
C. Administer analgesia until post-procedure tenderness is relieved.
D. Give the patient a cold beverage to promote swallowing ability.

81.​A nurse is caring for a patient with cirrhosis secondary to heavy alcohol use. The nurses
most recent assessment reveals subtle changes in the patients cognition and behavior.
What is the nurses most appropriate response?

A. Ensure that the patients sodium intake does not exceed recommended levels.
B. Report this finding to the primary care provider due to the possibility of hepatic
encephalopathy.
C. Inform the primary care provider that the patient should be assessed for alcoholic
hepatitis.
D. Implement interventions aimed at ensuring a calm and therapeutic care environment.

82.​You are caring for a patient with a diagnosis of pancreatitis. The patient was admitted
from a homeless shelter and is a vague historian. The patient appears malnourished and
on day 3 of the patients admission total parenteral nutrition (TPN) has been started. Why
would you know to start the infusion of TPN
slowly?

A. Patients receiving TPN are at risk for hypercalcemia if calories are started too rapidly.
B. Malnourished patients receiving parenteral nutrition are at risk for hypophosphatemia
if calories are started too aggressively.
C. Malnourished patients who receive fluids too rapidly are at risk for hypernatremia.
D. Patients receiving TPN need a slow initiation of treatment in order to allow digestive
enzymes to accumulate

83.​The nurse is caring for a client who has cirrhosis of the liver. What nursing action is
appropriate to help control ascites?

A. Monitor intake and output.

B. Provide a low-sodium diet.
C. Increase oral fluid intake.
D. Weigh the patient daily.
84.​The nurse is caring for a client with hepatic portal-systemic encephalopathy (PSE). The
client is thin and cachectic, and the family expresses distress that the patient is receiving
little dietary protein. How would the nurse respond?

A. “A low-protein diet will help the liver rest and will restore liver function.”
B. “Less protein in the diet will help prevent confusion associated with liver failure.”
C. “Increasing dietary protein will help the patient gain weight and muscle mass.”
D. “Low dietary protein is needed to prevent fluid from leaking into the abdomen.”

85.​The nurse is caring for a client who is scheduled for a paracentesis. Which action is
appropriate for the nurse to take?

A. Have the client sign the informed consent form.

B. Get the patient into a chair before the procedure.
C. Help the client lie flat in bed on the right side.
D. Assist the client to void before the procedure.

86.​A patient admitted to the hospital with cirrhosis of the liver suddenly starts vomiting
blood. What is the priority action that the nurse should take in this situation?

A. Send for endoscopic variceal ligation.

B. Give propronalol orally.
C. Stabilize the patient and manage the airway.
D. Check for signs of cirrhosis

87.​A patient with cirrhosis is being treated with spironolactone (Aldactone) tid and
furosemide (Lasix) bid. The patient's most recent laboratory results indicate a serum
sodium of 134 mEq/L (134 mmol/L) and a serum potassium of 3.2 mEq/L (3.2 mmol/L).
Before notifying the physician, the nurse should

A. administer only the furosemide

B. administer both drugs as ordered
C. administer only the spironolactone
D. Withhold the furosemide and spironolactone

88.​Which data obtained by the nurse during the assessment of a patient with cirrhosis will
be of most concern?

A. The patient's skin has multiple spider-shaped blood vessels on the abdomen.
B. The patient has ascites and a 2-kg weight gain from the previous day.
C. The patient complains of right upper-quadrant pain with abdominal palpation.
D. The patient's hands flap back and forth when the arms are extended.
89.​A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor the
patient's blood pressure because of which change that is associated with the liver
failure?

A. Hypoalbuminemia
B. Increased capillary permeability
C. Abnormal peripheral vasodilation
D. Excess rennin release from the kidneys

90.​You're caring for Lewis, a 67 y.o. patient with liver cirrhosis who develops ascites and
requires paracentesis. Relief of which symptom indicated that the paracentesis was
effective?

A. Pruritus
B. Dyspnea
C. Jaundice
D. Peripheral Neuropathy

91.​How should the nurse determine the correct length of a nasogastric tube for placement
into the stomach?

A. Place the distal tip to the nose, then the ear tip and the end of the xyphoid process.
B. Instruct the patient to lie prone and measure tip of nose to umbilical area.
C. Insert the tube into nose until the tube fills with secretions.
D. Obtain an order from the physician for the number of inches to insert the tube.

92.​Which of the following should be included in the nursing management of a nasogastric

tube?

A. Confirm the placement of the nasogastric tube prior to medication administration.

B. Have the patient sip cool water to stimulate saliva production.
C. Keep the patient in a low-Fowler's position.
D. Connect the tube to continuous wall suction.

93.​The nurse is caring for a patient who has had a nasogastric tube in place for 2 days. The
tube is draining green aspirate. What does this color of aspirate indicate?

A. The tube is in the pleural space.

B. The tube is in the intestine.
C. The tube is in the stomach.
D. The tube is in the esophagus.

94.​When the nurse is inserting a nasogastric tube, in what position should the patient be
placed?
 A. Recovery position
B. Low-Fowler's
C. High-Fowler's
D. Dorsal recumbent

95.​While caring for a patient with a nasogastric tube, how might the nurse best check
correct placement of the tube?

A. Auscultation after injecting air through the tube

B. Assessment of color of aspirate and laboratory testing of the aspirate
C. By taping the tube in place after the initial x-ray that confirms placement
D. A combination of visual assessment of aspirate, pH measurement, and measurement
of tube length

96.​A patient who is having difficulty clearing the airway, has a respiratory rate of 28 and a
temperature of 38.9° C. The patient has a nasogastric tube. What might this assessment
indicate?

A. Angina
B. Hyperglycemia
C. Fistula
D. Aspiration pneumonia

97.​The home care nurse is assessing management of the patient's gastrostomy. Which of
the following statements indicates that the patient is managing the tube correctly?

A. " I clean my stoma twice a day with alcohol."

B. " I am placing sterile dressings on my stoma site."
C. "I am flushing my tube with 30 mL of water after my feeds."
D. "I have been giving my medications all at the same time to avoid hassle."

98.​An elderly patient with Alzheimer's disease begins supplemental tube feedings through a
gastrostomy tube to provide adequate calorie intake. The nurse should be concerned
most with the potential for:

A. Hypoglycemia
B. Fluid volume excess
C. Aspiration
D. Constipation

99.​The nurse is administering total parenteral nutrition (TPN) to a patient who underwent
surgery for gastric cancer. What is a major complication of TPN?
 A. Hyperglycemia
B. Extreme hunger
C. Hypotension
D. Hypoglycemia

100.​ The nurse is initiating parenteral nutrition on a postoperative patient. The nurse will
initiate the therapy by:

A. Starting a rapid infusion rate to meet the patient's nutritional needs

B. Initiating the infusion slowly and monitoring the patient's fluid and glucose tolerance
C. Changing the rate of administration hourly based upon serum electrolyte values
D. Increasing the rate of infusion at meal times to mimic the circadian rhythm of the body