Upper and Lower GI Nclex Practice Questions

Science / Medicine / Surgery Upper and Lower GI NCLEX Practice Questions Terms in this set (25) A 61-year-old patient with suspected bowel B. 8:00 AM, 12:00 PM, and 4:00 PM obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the A nasogastric tube should be checked for patency routinely at 4-hour intervals. day shift staff should check the tube for patency at Thus if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00 what times? AM, 12:00 PM, and 4:00 PM. A. 7:00 AM, 10:00 AM, and 1:00 PM B. 8:00 AM, 12:00 PM, and 4:00 PM C. 9:00 AM and 3:00 PM D. 9:00 AM, 12:00 PM, and 3:00 PM A 72-year-old patient was admitted with epigastric D. Rigid abdomen and vomiting following indigestion pain due to a gastric ulcer. Which patient assessment warrants an urgent change in the A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a nursing plan of care? perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with A. Chest pain relieved with eating or drinking water duodenal ulcers, not gastric ulcers. Back pain 3-4 hours after a meal is more likely B. Back pain 3 or 4 hours after eating a meal to occur with a duodenal ulcer. Burning epigastric pain 1-2 hours after a meal is an C. Burning epigastric pain 90 minutes after expected manifestation of a gastric ulcer related to increased gastric secretions breakfast and does not cause an urgent change in the nursing plan of care. D. Rigid abdomen and vomiting following indigestion After administering a dose of promethazine B. Drowsiness (Phenergan) to a patient with nausea and vomiting, what common temporary adverse effect of the Although being given to this patient as an antiemetic, promethazine also has medication does the nurse explain may be sedative and amnesic properties. For this reason, the patient is likely to experience experienced? drowsiness as an adverse effect of the medication. Tinnitus, reduced hearing, and loss of balance are not side effects of promethazine. A. Tinnitus B. Drowsiness C. Reduced hearing D. Sensation of falling After the nurse teaches a patient with C. "I will have to use herbal teas instead of caffeinated drinks." gastroesophageal reflux disease (GERD) about recommended dietary modifications, which Rationale: Patients with gastroesophageal reflux disease should avoid foods (such statement by the patient indicates that the teaching as tea and coffee) that decrease lower esophageal pressure. Patients should also has been effective? avoid milk, especially at bedtime, as it increases gastric acid secretion. Patients may eat spicy foods, unless these foods cause reflux. Small, frequent meals help A. "I can have a glass of low-fat milk at bedtime." prevent overdistention of the stomach, but patients should avoid late evening B. "I will have to eliminate all spicy foods from my meals and nocturnal snacking. diet." C. "I will have to use herbal teas instead of caffeinated drinks." D. "I should keep something in my stomach all the time to neutralize the excess acids." Upper and Lower GI NCLEX Practice Questions A female patient has a sliding hiatal hernia. What C. Have the patient eat 4 to 6 smaller meals each day. nursing interventions will prevent the symptoms of heartburn and dyspepsia that she is experiencing? Eating smaller meals during the day will decrease the gastric pressure and the symptoms of hiatal hernia. Keeping the patient NPO or in a Trendelenberg position A. Keep the patient NPO. are not safe or realistic for a long period of time for any patient. Varying antacids B. Put the bed in the Trendelenberg position. will only be done with the care provider's prescription, so this is not a nursing C. Have the patient eat 4 to 6 smaller meals each intervention. day. D. Give various antacids to determine which one works for the patient. Following administration of a dose of C. Relief of nausea and vomiting metoclopramide (Reglan) to the patient, the nurse determines that the medication has been effective Metoclopramide is classified as a prokinetic and antiemetic medication. If it is when what is noted? effective, the patient's nausea and vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea. A. Decreased blood pressure B. Absence of muscle tremors C. Relief of nausea and vomiting D. No further episodes of diarrhea Following bowel resection, a patient has a C. Reposition the tube and check for placement. nasogastric (NG) tube to suction, but complains of nausea and abdominal distention. The nurse The tube may be resting against the stomach wall. The first action by the nurse irrigates the tube as necessary as ordered, but the (since this is intestinal surgery and not gastric surgery) is to reposition the tube and irrigating fluid does not return. What should be the check it again for placement. The physician does not need to be notified unless the priority action by the nurse? tube function cannot be restored by the nurse. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed A. Notify the physician. and replaced unless it was no longer in the stomach or the obstruction of the tube B. Auscultate for bowel sounds. could not be relieved. C. Reposition the tube and check for placement. D. Remove the tube and replace it with a new one. The nurse determines that a patient has C. Epigastric pain experienced the beneficial effects of therapy with famotidine (Pepcid) when which symptom is Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl relieved? acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain. Famotidine is not indicated for nausea, belching, and A. Nausea dysphagia. B. Belching C. Epigastric pain D. Difficulty swallowing Upper and Lower GI NCLEX Practice Questions The nurse is caring for a 68-year-old patient D. High-pitched and hyperactive above the area of obstruction admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass, and a Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high- bowel obstruction is suspected. The nurse pitched, sometimes referred to as "tinkling" above the level of the obstruction. This auscultating the abdomen listens for which type of occurs because peristaltic action increases to "push past" the area of obstruction. bowel sounds that are consistent with the patient's As the obstruction becomes complete, bowel sounds decrease and finally clinical picture? become absent. A. Low-pitched and rumbling above the area of obstruction B. High-pitched and hypoactive below the area of obstruction C. Low-pitched and hyperactive below the area of obstruction D. High-pitched and hyperactive above the area of obstruction The nurse is caring for a postoperative patient with D. "This will reduce the amount of HCl in the stomach until the nasogastric tube is a colostomy. The nurse is preparing to administer a removed and you can eat a regular diet again." dose of famotidine (Pepcid) when the patient asks why the medication was ordered since the patient Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus does not have a history of heartburn or minimizes damage to gastric mucosa while the patient is not eating a regular diet gastroesophageal reflux disease (GERD). What after surgery. Famotidine does not prevent air from accumulating in the stomach or response by the nurse would be the most stop the stomach from bleeding. Heartburn is not a side effect of general appropriate? anesthesia. A. "This will prevent air from accumulating in the stomach, causing gas pains." B. "This will prevent the heartburn that occurs as a side effect of general anesthesia." C. "The stress of surgery is likely to cause stomach bleeding if you do not receive it." D. "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again." The nurse is planning care for a 68-year-old patient B. History of colorectal polyps with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history A history of colorectal polyps places this patient at risk for colorectal cancer. This increases the patient's risk for colorectal cancer? tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient. A. Osteoarthritis B. History of colorectal polyps C. History of lactose intolerance D. Use of herbs as dietary supplements The nurse is preparing to administer a dose of D. Increases peristalsis by stimulating nerves in the colon wall bisacodyl (Dulcolax). In explaining the medication to the patient, the nurse would explain that it acts in Bisacodyl is a stimulant laxative that aids in producing a bowel movement by what way? irritating the colon wall and stimulating enteric nerves. It is available in oral and suppository forms. Fiber and bulk forming drugs increase bulk in the stool; water A. Increases bulk in the stool and stool softeners soften feces, and saline and osmotic solutions cause fluid B. Lubricates the intestinal tract to soften feces retention in the intestinal tract. C. Increases fluid retention in the intestinal tract D. Increases peristalsis by stimulating nerves in the colon wall Upper and Lower GI NCLEX Practice Questions The nurse should administer an as-needed dose of B. No bowel movement for 3 days magnesium hydroxide (MOM) after noting what information while reviewing a patient's medical MOM is an osmotic laxative that produces a soft, semisolid stool usually within 15 record? minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days. MOM would not be given for abdominal pain and A. Abdominal pain and bloating bloating, decreased appetite, or signs of hypomagnesemia. B. No bowel movement for 3 days C. A decrease in appetite by 50% over 24 hours D. Muscle tremors and other signs of hypomagnesemia The nurse would question the use of which D. Magnesium hydroxide (Milk of Magnesia) cathartic agent in a patient with renal insufficiency? Milk of Magnesia may cause hypermagnesemia in patients with renal insufficiency. A. Bisacodyl (Dulcolax) The nurse should question this order with the health care provider. Bisacodyl, B. Lubiprostone (Amitiza) lubiprostone, and cascara sagrada are safe to use in patients with renal C. Cascara sagrada (Senekot) insufficiency as long as the patient is not currently dehydrated. D. Magnesium hydroxide (Milk of Magnesia) A patient complains of nausea. When administering A. Tremors a dose of metoclopramide (Reglan), the nurse should teach the patient to report which potential Extrapyramidal side effects, including tremors and tardive dyskinesias, may occur adverse effect? as a result of metoclopramide (Reglan) administration. Constipation, double vision, and numbness in fingers and toes are not adverse effects of metoclopramide. A. Tremors B. Constipation C. Double vision D. Numbness in fingers and toes The patient receiving chemotherapy rings the call Ondansetron is a 5-HT3 receptor antagonist antiemetic that is especially effective bell and reports the onset of nausea. The nurse in reducing cancer chemotherapy-induced nausea and vomiting. Morphine sulfate should prepare an as-needed dose of which may cause nausea and vomiting. Zolpidem does not relieve nausea and vomiting. medication? Dexamethasone is usually used in combination with ondansetron for acute and chemotherapy-induced emesis. A. Morphine sulfate B. Zolpidem (Ambien) C. Ondansetron (Zofran) D. Dexamethasone (Decadron) A patient reports having a dry mouth and asks for D. Promethazine (Phenergan) something to drink. The nurse recognizes that this symptom can most likely be attributed to a A common adverse effect of promethazine, an antihistamine/antiemetic agent, is common adverse effect of which medication that dry mouth; another is blurred vision. Common side effects of digoxin are yellow the patient is taking? halos and bradycardia. Common side effects of cefotetan are nausea, vomiting, stomach pain, and diarrhea. Common side effects of famotidine are headache, A. Digoxin (Lanoxin) abdominal pain, constipation, or diarrhea. B. Cefotetan (Cefotan) C. Famotidine (Pepcid) D. Promethazine (Phenergan) Upper and Lower GI NCLEX Practice Questions The patient who is admitted with a diagnosis of B. Heartburn diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has Mylanta is an antacid that contains both aluminum and magnesium. It is indicated received a dose of Mylanta 30 mL PO. The nurse for the relief of GI discomfort, such as heartburn associated with GERD. Mylanta should evaluate its effectiveness by questioning the can cause both diarrhea and constipation as a side effect. Mylanta does not affect patient as to whether which symptom has been lower abdominal pain. resolved? A. Diarrhea B. Heartburn C. Constipation D. Lower abdominal pain A patient with a history of peptic ulcer disease has A. Providing IV fluids and inserting a nasogastric (NG) tube presented to the emergency department reporting severe abdominal pain and has a rigid, boardlike A perforated peptic ulcer requires IV replacement of fluid losses and continued abdomen that prompts the health care team to gastric aspiration by NG tube. Nothing is given by mouth, and gastric pH testing is suspect a perforated ulcer. What intervention not a priority. Calcium gluconate is not a medication directly relevant to the should the nurse anticipate? patient's suspected diagnosis, and parenteral nutrition is not a priority in the short term. A. Providing IV fluids and inserting a nasogastric (NG) tube B. Administering oral bicarbonate and testing the patient's gastric pH level C. Performing a fecal occult blood test and administering IV calcium gluconate D. Starting parenteral nutrition and placing the patient in a high-Fowler's position The patient with chronic gastritis is being put on a C. Antibiotic(s), proton pump inhibitor, and bismuth combination of medications to eradicate H. pylori. Which drugs does the nurse know will probably be To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and used for this patient? possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori. A. Antibiotic(s), antacid, and corticosteroid B. Antibiotic(s), aspirin, and antiulcer/protectant C. Antibiotic(s), proton pump inhibitor, and bismuth D. Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs) A stroke patient who primarily uses a wheelchair for A. Fecal impaction mobility has diarrhea with fecal incontinence. What should the nurse assess first? Patients with limited mobility are at risk for fecal impactions due to constipation that may lead to liquid stool leaking around the hardened impacted feces, so A. Fecal impaction assessing for fecal impaction is the priority. Perineal hygiene can be assessed at B. Perineal hygiene the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent C. Dietary fiber intake use will be assessed and considered next. D. Antidiarrheal agent use Upper and Lower GI NCLEX Practice Questions Two days following a colectomy for an abdominal A. impaired peristalsis. mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient Until peristalsis returns to normal following anesthesia, the patient may experience based on the knowledge that the symptoms are slowed gastrointestinal motility leading to gas pains and abdominal distention. occurring as a result of Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention. A. impaired peristalsis. B. irritation of the bowel. C. nasogastric suctioning. D. inflammation of the incision site. B. How to deep breathe and cough What information would have the highest priority to be included in preoperative teaching for a 68-year- Because anesthesia, an abdominal incision, and pain can impair the patient's old patient scheduled for a colectomy? respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop A. How to care for the wound atelectasis and pneumonia, which would delay early recovery from surgery and B. How to deep breathe and cough hospital discharge. Care for the wound and location and care of the drains will be C. The location and care of drains after surgery briefly discussed preoperatively, but done again with higher priority after surgery. D. Which medications will be used during surgery Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist. What should the nurse instruct the patient to do to D. Take each dose with a full glass of water or other liquid. best enhance the effectiveness of a daily dose of docusate sodium (Colace)? Docusate lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage. The patient should take the dose A. Take a dose of mineral oil at the same time. with a full glass of water and should increase overall fluid intake, if able, to B. Add extra salt to food on at least one meal tray. enhance effectiveness of the medication. Dietary fiber intake should be a minimum C. Ensure dietary intake of 10 g of fiber each day. of 20 g daily to prevent constipation. Mineral oil and extra salt are not D. Take each dose with a full glass of water or other recommended. liquid. Which clinical manifestations of inflammatory bowel C, D. disease are common to both patients with ulcerative colitis (UC) and Crohn's disease (select Clinical manifestations of UC and Crohn's disease include bloody diarrhea, all that apply)? cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions A. Restricted to rectum B. Strictures are common. C. Bloody, diarrhea stools D. Cramping abdominal pain E. Lesions penetrate intestine. that penetrate the intestine or cause strictures are characteristic of Crohn's disease.