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GIT C. percussion
Situation 1: Children have a special fascination with D. palpation
the workings of the digestive system. To fully 9. Mr. Lim verbalized pain on the right iliac region.
understand the digestive processes, Nurse Lavigña Nurse Dorina knows that the organ affected would be
must be knowledgeable of the anatomy and the:
physiology of the gastrointestinal system.
1. The alimentary canal is a continuous, coiled, A. liver
hollow muscular tube that winds through the ventral B. sigmoid colon
cavity and is open at both ends. Its solid organs C. appendix
include all of the following except: D. duodenum
10. Mr. Lim felt pain upon release of Nurse Dorina’s
A. liver hand. This can be referred as:
B. gall bladder
C. stomach A. referred pain
D. pancreas B. rebound tenderness
2. Pharynx is lined with mucous membranes and C. direct tenderness
mucous secreting glands to ease the passage of food. D. indirect tenderness
The larygngopharynx serves as passageway for: Situation 3: Mrs. Cruz was admitted in the Medical
Floor due to pyrosis, dyspepsia and difficulty of
A. air only swallowing.
B. air and water 11. Based from the symptoms presented, Nurse Yoshi
C. food, fluids and air might suspect:
D. air and food
3. Once food has been placed in the mouth, both A. Esophagitis
mechanical and chemical digestions begin. The six B. Hiatal hernia
activities of the digestive process are: C. GERD
D. Gastric Ulcer
A. ingestion, mastication, digestion, deglutition, 12. What diagnostic test would confirm the type of
absorption, egestion problem Mrs. Cruz have?
B. ingestion, mastication, deglutition, digestion,
absorption, egestion A. barium enema
C. deglutition, ingestion, mastication, egestion, B. barium swallow
absorption, defecation C. colonoscopy
D. ingestion, digestion, mastication, deglutition, D. lower GI series
absorption, defecation 13. Mrs. Cruz complained of pain and difficulty in
4. Most digestive activity occurs in the pyloric region swallowing. This term is referred as:
of the stomach. What hormone stimulates the chief
cells to produce pepsinogen?
A. Odynophagia
B. Dysphagia
A. Gastrin C. Pyrosis
B. Pepsin D. Dyspepsia
C. HCl 14. To avoid acid reflux, Nurse Yoshi should advice
D. Insulin Mrs. Cruz to avoid which type of diet?
5. What pancreatic enzyme aids in the digestion of
carbohydrates?
A. cola, coffee and tea
B. high fat, carbonated and caffeinated beverages
A. Lipase C. beer and green tea
B. Trypsin D. lechon paksiw and bicol express
C. Amylase 15. Mrs. Cruz’ body mass index (BMI) is 25. You
D. Chymotrypsin can categorized her as:
Situation 2: Nurse Dorina is going to perform an
abdominal examination to Mr. Lim who was admitted
due to on and off pain since yesterday. A. normal
6. How will you position Mr. Lim prior to procedure? B. overweight
C. underweight
D. obese
A. supine with knees flexed Situation 4: Nurse Gloria is the staff nurse assigned
B. prone at the Emergency Department. During her shift, a
C. lying on back patient was rushed – in the ED complaining of severe
D. sim’s heartburn, vomiting and pain that radiates to the
7. To identify any localized bulging, distention and flank. The doctor suspects gastric ulcer.
peristaltic waves, Nurse Dorina must perform which 16. What other symptoms will validate the diagnosis
of the following? of gastric ulcer?

A. Auscultation A. right epigastric pain

B. Inspection B. pain occurs when stomach is empty
C. Palpation C. pain occurs immediately after meal
D. Percussion D. pain not relieved by vomiting
8. In order to identify areas of tenderness and 17. What diagnostic test would yield good
swelling, Nurse Dorina must do: visualization of the ulcer crater?

A. deep palpation A. Endoscopy

B. light palpation B. Gastroscopy
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C. Barium Swallow 26. Which of the following definitions best describes

D. Histology diverticulosis?
18. Peptic ulcer disease particularly gastric ulcer is
thought to be cause by which of the following A. An inflamed outpouching of the intestine
microorgamisms? B. A non – inflamed outpouching of the intestine
C. The partial impairment of the forward flow of
A. E. coli instestinal contents
B. H. pylori D. An abnormal protrusions of an oxygen through
C. S. aureus the structure that usually holds it
D. K. pnuemoniae 27. Which of the following types of diet is implicated
19. She is for occult blood test, what specimen will in the development of diverticulosis?
you collect?
A. Low – fiber diet
A. Blood B. High – fiber diet
B. Urine C. High – protein diet
C. Stool D. Low – carbohydrate diet
D. Gastric Juice 28. Which of the following tests should be
20. Preparation of the client for occult blood administered to client with diverticulosis?
examination is:
A. Proctosocpy
A. Fluid intake limited only to 1 liter/day B. Barium enema
B. NPO for 12 hours prior to obtaining of C. Barium swallow
specimen D. Gastroscopy
C. Increase fluid intake 29. To improve Mr. Trinidad’s condition, your best
D. Meatless diet for 48 hours prior to obtaining of nursing intervention and teaching is:
specimen
Situation 5: IBD is a common inflammatory A. Reduce fluid intake
functional bowel disorder also known as spastic B. Increase fiber in the diet
bowel, functional colitis and mucous colitis. C. Administering of antibiotics
21. The client with IBS asks Nurse June what causes D. Exercise to increase intraabdominal pressure
the disease. Which of the following responses by 30. Upon review of Mr. Trinidad’s chart, Nurse Drew
Nurse June would be most appropriate? noticed that he weighs 121 lbs and his height is 5 ft, 4
in. After computing for his Body Mass Index (BMI),
A. “This is an inflammation of the bowel caused you can categorize him as:
by eating too much roughage”
B. “IBS is caused by a stressful lifestyle” A. obese
C. “The cause of this condition is unknown” B. normal
D. “There is thinning of the intestinal mucosa C. obese
caused by ingestion of gluten” D. underweight
22. Which of the following alimentary canal is the Situation 7: Manny, 6 years old was admitted at
most common location for Chron’s disease? Cardinal Santos Hospital due to increasing frequency
of bowel movements, abdominal cramps and
A. Descending colon distension.
B. Jejunum 31. Diarrhea is said to be the leading cause of
C. Sigmoid Colon morbidity in the Philippines. Nurse Harry knows that
D. Terminal Ileum diarrhea is present if:
23. Which of the following factors is believed to be
linked to Crohn’s disease? A. passage of stool is more than 3 bowel
movements per week
A. Diet B. passage of stool is less than 3 bowel movements
B. Constipation per day
C. Heredity C. passage of stool is more than 3 bowel
D. Lack of exercise movements per day
24. How about ulcerative colitis, which of the D. passage of stool is less than 3 bowel movements
following factors is believed to cause it? per week
32. Diarrhea is believed to be caused by all of the
A. Acidic diet following except
B. Altered immunity
C. Chronic constipation A. increase intestinal secretions
D. Emotional stress B. altered immunity
25. Mr. Jung, had ulcerative colitis for 5 years and C. decrease mucosal absorption
was admitted to the hospital. Which of the following D. altered motility
factors was most likely of greatest significance in 33. What life threatening condition may result in
causing an exacerbation of the disease? persistent diarrhea?

A. A demanding and stressful job A. hypokalemia

B. Changing to a modified vegetarian diet B. dehydration
C. Beginning a weight training program C. cardiac dysrhytmias
D. Walking 2 miles everyday D. leukocytosis
Situation 6: A patient was admitted in the Medical 34. Voluminous, watery stools can deplete fluids and
Floor at St. Luke’s Hospital. He was asymptomatic. electrolytes. The acid base imbalance that can occur
The doctor suspects diverticulosis. is:
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A. metabolic alkalosis D. Abdominal wall swelling

B. metabolic acidosis 43. The doctor ordered for a complete blood count.
C. respiratory acidosis After the test, Nurse Ray received the result from the
D. respiratory alkalosis laboratory. Which laboratory values will confirm the
35. What is the immediate home care management diagnosis of appendicitis?
for diarrhea?
A. RBC 5.5 x 106/mm3
A. Milk B. Hct 44 %
B. Imodium C. WBC 13, 000/mm3
C. Water D. Hgb 15 g/dL
D. Oresol 44. Signs and symptoms include pain in the RLQ of
Situation 8: Mr. Sean is admitted to the hospital with the abdomen that may be localize at McBurney’s
a bowel obstruction. He complained of colicky pain point. To relieve pain, Mr. Liu should assume which
and inability to pass stool. position?
36. Which of these findings by Nurse Leonard, would
indicate that the obstruction is in the early stages? A. Prone
B. Supine, stretched out
A. high pitched tinkling or rumbling bowel sounds C. Sitting
B. hypoactive bowel sounds D. Lying with legs drawn upl
C. no bowel sounds auscultated 45. After a few minutes, the pain suddenly stops
D. normal bowel sounds heard in all four without any intervention. Nurse Ray might suspect
quadrants that:
37. Nasogastric tube was inserted to Mr. Sean. The
NGT’s primary purpose is: A. the appendix is still distended
B. the appendix may have ruptured
A. nutrition C. an increased in intrathoracic pressure will occur
B. decompression of bowel D. signs and symptoms of peritonitis occur
C. passage for medication Situation 10: Nurse Nico is caring to a 38-year-old
D. aspiration of gastric contents female, G3P3 client who has been diagnosed with
38. Mr. Sean has undergone surgery. Post – hemorrhoids.
operatively, which of the following findings is 46. Which of the following factors would most likely
normal? be a primary cause of her hemorrhoids?

A. absent bowel sounds A. Her age

B. bleeding B. Three vaginal delivery pregnancies
C. hemorrhage C. Her job as a school teacher
D. bowel movement D. Varicosities in the legs
39. Client education should be given in order to 47. Client education should include minimizing client
prevent constipation. Nurse Leonard’s health discomfort due to hemorrhoids. Nursing management
teaching should include which of the following? should include:

A. use of natural laxatives A. Suggest to eat low roughage diet

B. fluid intake of 6 glasses per day B. Advise to wear silk undergarments
C. use of OTC laxatives C. Avoid straining during defecation
D. complete bed rest D. Use of sitz bath for 30 minutes
40. Four hours post – operatively, Mr. Sean 48. The doctor orders for Witch Hazel 5 %. Nurse
complains of guarding and rigidity of the abdomen. Nico knows that the action of this astringent is:
Nurse Leonard’s initial intervention is:
A. temporarily relieves pain, burning, and itching
A. assess for signs of peritonitis by numbing the nerve endings
B. call the physician B. causes coagulation (clumping) of proteins in the
C. administer pain medication cells of the perianal skin or the lining of the
D. ignore the client anal canal
Situation 9: Mr. Gerald Liu, 19 y/o, is being admitted C. inhibits the growth of bacteria and other
to a hospital unit complaining of severe pain in the organisms
lower abdomen. Admission vital signs reveal an oral D. causes the outer layers of skin or other tissues
temperature of 101.2 0F. to disintegrate
41. Which of the following would confirm a 49. Which position would be ideal for the client in
diagnosis of appendicitis? the early postoperative period after
hemorrhoidectomy?
A. The pain is localized at a position halfway
between the umbilicus and the right iliac crest. A. High Fowler’s
B. Mr. Liu describes the pain as occurring 2 hours B. Supine
after eating C. Side – lying
C. The pain subsides after eating D. Trendelenburg’s
D. The pain is in the left lower quadrant 50. Nurse Nico instructs her client who has had a
42. Which of the following complications is thought hemorrhoidectomy not to used sitz bath until at least
to be the most common cause of appendicitis? 12 hours postoperatively to avoid which of the
following complications?
A. A fecalith
B. Internal bowel occlusion A. Hemorrhage
C. Bowel kinking B. Rectal Spasm
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C. Urinary retention is localized pain upon palpation. Indirect

D. Constipation tenderness is pain outside the area of palpation.
11. Answer: C. Gastroesophageal Reflux Disease
(GERD). GERD is the backflow of gastric or
Answers and Rationales duodenal contents into the esophagus caused by
incompetent lower esophageal sphincter.
1. Answer: C. stomach. Stomach is a hollow Pyrosis or heartburn, dyspepsia and dysphagia
digestive organ in the GI tract. The liver, gall are cardinal symptoms.
baldder and pancreas are all solid organs which 12. Answer: B. Barium swallow. Barium swallow
are part of the hepato-biliary system. Test or upper GI series would confirm GERD.
taking skills: which does not belong to the Endoscopy is another diagnostic test. Options a
group? and d are the same. Option c is incorrect.
2. Answer: D. air and food. The laryngopharynx 13. Answer: A. Odynophagia. When difficulty of
serves as passageway for air and food and so as swallowing is accompanied with pain this is
with the oropharynx. Option a is nasopharynx. now referred as odynophagia. Dysphagia is
Answers b and c may be correct but air and difficulty of swallowing alone.
food is more accuarte. 14. Answer: B. High fat, carbonated and
3. Answer: B. ingestion, mastication, deglutition, caffeinated beverages. All are correct but option
digestion, absorption, egestion. The digestive b is the best answer. In patients with GERD,
processes involve six steps. Ingestion is taking this type of diet must be avoided to avoid
in of food in the mouth; mastication is the backflow of gastric contents. Excessive caffeine
mechanical process where food is converted reduces the tone of lower esophageal sphincter.
into bolus; deglutition is the act of swallowing; Test Taking Skills: look for the umbrella effect
digestion is the chemical breakdown of food 15. Answer: B. Overweight. Mr. Cruz’ BMI
into chime; absorption occurs in the small belongs to the overweight category (24 – 26),
intestines (solutes) and large intestines (water) malnourished (less than 17), underweight (17 –
and egestion/defecation where elimination of 19), normal (20 – 23), obese (27– 30) and
feces occur. morbidly obese (greater than 30). BMI is
4. Answer: A. Gastrin. Gastrin stimulates chief weight in kilograms divided by height in square
cells to produce pepsinogen when foods enter meters.
and suppression of pepsinogen when it leaves 16. Answer: C. Pain occurs immediately after
and enters the small intestines; it is the major meal.In gastric ulcer food intake aggravates
hormone that regulates acid secretion in the pain which usually occur ½ – 1 hour before
stomach. Pepsin; a gastric protease secreted in meal or immediately during or after food intake.
an inactive form, pepsinogen, which is activated Options a, b, c suggests duodenal ulcer.
by stomach acid that acts to degrade protein. 17. Answer: A. Endoscopy. Endoscopy determines
HCl is produced by the parietal cells. Insulin is bleeding, pain, difficulty swallowing, and a
a pancreatic hormone. change in bowel habits. This would yield good
5. Answer: C. Amylase. Amylase aids in the visualization of the ulcer crater. Other options
digestion of carbohydrates. are also diagnostic tests in PUD.
Trypsin/Chymotrypsin aids in the digestion of 18. Answer: B. H. pylori. Helicobacter pylori (H.
proteins. Lipase aids in the digestion of fats. pylori) is a bacteria responsible for most ulcers
6. Answers: A. supine with knees flexed. During and many cases of chronic gastritis
abdominal examination, positioning the client (inflammation of the stomach). This organism
in supine with knees flexed will promote can weaken the protective coating of the
relaxation of abdominal muscles. Options b and stomach and duodenum (first part of the small
d are inaccurate in this type of procedure. Lying intestines), allowing the damaging digestive
on back or supine may be correct but option a is juices to irritate the sensitive lining of these
the best answer. body parts.
7. Answer: B. Inspection. Inspection is the first 19. Answer: C. Stool. Occult blood test or stool
step in abdominal exam to note the contour and guiac test is a test that detects the presence of
symmetry of abdomen as well as localized hidden (occult) blood in the stool (bowel
bulging, distention and peristaltic waves. movement). The stool guaiac is the most
Auscultation is done to determine the character, common form of fecal occult blood test (FOBT)
location and frequency of bowel sounds. in use today. So stool specimen will be
Percussion is to assess tympany or dullness. collected.
Palpation is to asses areas of tenderness and 20. Answer: D. Meatless diet for 48 hours prior to
discomfort. Note: In abdominal exam: obtaining of specimen. Eating meat can cause
Inspection, Auscultation, Percussion and false positive test result. Using proper stool
Palpation are the correct order. collection technique, avoiding certain drugs,
8. Answer: B. Light palpation. Light palpation is and observing dietary restrictions can minimize
done to identify areas of tenderness and these measurement errors.
swelling. Deep palpation is done to identify 21. Answer: C. “The cause of this condition is
masses in all four quadrants. Test taking skills: unknown”. There is no known cause of IBS,
one of the opposite is the correct answer and diagnosis is made by excluding all the other
9. Answer: C. Appendix. Appendix and cecum is diseases that cause the symptoms. There is no
located in the right iliac region. Liver and gall inflammation if the bowel. Some factors
bladder is at the right hypochondriac. Sigmoid exacerbate the symptoms including anxiety,
colon is at the left iliac. Duodenum, stomach fear, stress, depression, some foods and drugs
and pancreas is in the epigastric region. but there do not cause the disease.
10. Answer: B. Rebound Tenderness. Rebound 22. Answer: d. Terminal Ileum. Chronic
tenderness is pain felt upon sudden release of inflammatory of GI mucosa occurs anywhere
the examiners hand which in most cases suggest from the mouth to anus but most often in
peritonitis. Referred pain is pain felt in an area terminal ileum. Inflammatory lesions are local
remote from the site of origin. Direct tenderness and involve all layers of the intestinal wall.
Reviwer

23. Answer: C. Heredity. The cause is unknown decompression especially for clients suffering
but is thought to be multifactorial. Heredity, from obstruction.
infectious agents, altered immunity or 38. Answer: A. Absent bowel sounds. Post –
autoimmune and environmental are factors to operatively, no bowel sounds are present so this
be considered. Test taking skill: which does not is a normal finding. Bleeding and hemorrhage
belong? Options a, b, and d are all modifiable must be prevented to avoid
factors. complications. Bowel movement occurs only
24. Answer: B. Altered immunity. Refer to after flatus and bowel sounds are noted.
rationale for number 23. Test taking skill: 39. Answer: A. Use of natural laxatives. The use of
which does not belong? Options a, c and d are natural laxatives such as foods and fruits high in
all modifiable factors. fiber is still the best way of preventing
25. Answer: A. A demanding and stressful constipation Increasing fluid intake, taking
job. Stress is an environmental factor that is laxatives judiciously and exercise also can
thought to cause ulcerative colitis. Test taking prevent this.
skill: options b, c, and d are all healthy 40. Answer: A. Assess for signs of
lifestyles. peritonitis. Assessment precedes intervention.
26. Answer: B. A non – inflamed outpouching of Symptoms presented are signs of peritonitis.
the intestine. An increase intraluminal pressure Assessment will provide you the data for
causes the outpouching of the colon wall prompt intervention.
resulting to diverticulosis. Option a suggests 41. Answer: A. The pain is localized at a position
diverticulitis. Test taking skill: one of the halfway between the umbilicus and the right
opposite is the correct answer. iliac crest. Pain over McBurney’s point, the
27. Answer: A. Low – Fiber Diet. A lack of point halfway between the umbilicus and the
adequate blood supply and nutrients from the iliac crest, is diagnosis for appendicitis. Options
diet such as low fiber foods may contribute to b and c are common with ulcers; option d may
the development of the disease. Test taking suggest ulcerative colitis or diverticulitis.
skill: one of the opposite is the correct answer. 42. Answer: A. A fecalith. A fecalith is a hard piece
28. Answer: B. Barium enema. Barium enema is of stool which is stone like that commonly
used to diagnose diverticulosis, however, this is obstructs the lumen. Due to obstruction,
contraindicated when diverticulitis is present inflammation and bacterial invasion can occur.
because of the risk of rupturing the Tumors or foreign bodies may also cause
diverticulum. Test taking skill: options b and c obstruction.
are opposite; one may be the correct answer. 43. Answer: C. WBC 13, 000/mm3. Increase in
29. Answer: B. Increase fiber in the diet. Patient WBC counts is suggestive of appendicitis
with diverticulosis must be encouraged to because of bacterial invasion and inflammation.
increase roughage in diet such as fruits and Normal WBC count is 5, 000 – 10, 000/mm3.
vegetables rich in fiber. Increasing fluid intake Other options are normal values.
2 – 3 liters/day unless contraindicated rather 44. Answer: D. Lying with legs drawn
reducing. Administering antibiotics can up. Posturing by lying with legs drawn up can
decrease bowel flora and infection but this is a relax the abdominal muscle thus relieve pain.
dependent function of a nurse. 45. Answer: B. The appendix may have ruptured. If
30. Answer: B. Normal. Mr. Trinidad’s BMI is 23 a confirmed diagnosis is made and the pain
which is normal. Refer to rationale number 15. suddenly without any intervention, the appendix
31. Answer: C. passage of stool is more than 3 may have ruptured; the pain is lessened because
bowel movements per day the appendix is no longer distended thus
32. Answer: B. Altered Immunity. Diarhhea is an surgery is still needed.
intestinal disorder that is self – limiting. 46. Answer: B. Three vaginal delivery
Options a, c and d are etiological factors of pregnancies. Hemorrhoids are associated with
diarrhea. prolonged sitting, or standing, portal
33. Answer: C. Cardiac dysrhytmias. Due to hypertension, chronic constipation and
increase frequency and fluid content in the prolonged intra abdominal pressure as
stools, diarrhea may cause fluid and electrolyte associated with pregnancy and the strain of
imbalance such as hypokalemia. Once vaginal delivery. Her job as a schoolteacher
potassium is depleted, this will affect the does not require prolong sitting or standing.
contractility of the heart causing cardiac Age and leg varicosities are not related to the
arrhythmia leading to death. development of hemorrhoids.
34. Answer: B. Metabolic acidosis. In diarrhea, 47. Answer: C. Avoid strainining during
metabolic acidosis is the acid – base imbalance defecation. Straining can increase intra
that occurs while in vomiting, metabolic abdominal pressure. Health teachings also
alkalosis occur. This is a metabolic disorder include: suggest to eat high roughage diet,
that’s why eliminate options c and d. wearing of cotton undergarments and use of sitz
35. Answer: D. Oresol. In the DOH book, oresol is bath for 15 minutes.
the immediate home care management for 48. Answer: B. causes coagulation(clumping) of
diarrhea to prevent dehydration. Water may not proteins in the cells of the perianal skin or the
be enough to prevent diarrhea. lining of the anal canal. Option a are local
36. Answer: A. High pitched tinkling or rumbling anesthetics; c are antiseptics and d are
bowel sounds. Early in the bowel obstruction, keratolytics.
the bowel attempts to move the contents past 49. Answer: C. Side – lying. Positioning in the
the obstruction and this is heard as high pitched early postoperative phase should avoid stress
tinkling bowel sounds. As the obstruction and pressure on the operative site. The prone
progresses, bowel sounds will diminish and and side – lying are ideal from a comfort
may finally become absent. perspective. A high Fowler’s or supine position
37. Answer: B. Decompression of bowel. The will place pressure on the operative site and is
NGT’s primary purpose is for bowel not recommended. There is no need for
trendelenburg’s position.
Reviwer

50. Answer: A. Hemorrhage. Applying heat during C. 7.35

the immediate postoperative period may cause D. 7.5
hemorrhage at the surgical site. Moist heat may 7. A nurse is preparing to remove a nasogartric tube
relieve rectal spasms after bowel movements. from a female client. The nurse should instruct the
Urinary retention caused by reflex spasm may client to do which of the following just before the
also be relieved by moist heat. Increasing fiber nurse removes the tube?
and fluid in the diet can help constipation
A. Exhale
B. Inhale and exhale quickly
1. Nurse Berlinda is assigned to a 41-year-old client C. Take and hold a deep breath
who has a diagnosis of chronic pancreatitis. The D. Perform a Valsalva maneuver
nurse reviews the laboratory result, anticipating a 8. Nurse Joy is preparing to administer medication
laboratory report that indicates a serum amylase level through a nasogastric tube that is connected to
of: suction. To administer the medication, the nurse
would:
A. 45 units/L
B. 100 units/L A. Position the client supine to assist in medication
C. 300 units/L absorption
D. 500 units/L B. Aspirate the nasogastric tube after medication
2. A male client who is recovering from surgery has administration to maintain patency
been advanced from a clear liquid diet to a full liquid C. Clamp the nasogastric tube for 30 minutes
diet. The client is looking forward to the diet change following administration of the medication
because he has been “bored” with the clear liquid D. Change the suction setting to low intermittent
diet. The nurse would offer which full liquid item to suction for 30 minutes after medication
the client? administration
9. A nurse is preparing to care for a female client
A. Tea with esophageal varices who has just has a
B. Gelatin Sengstaken-Blakemore tube inserted. The nurse
C. Custard gathers supplies, knowing that which of the following
D. Popsicle items must be kept at the bedside at all times?
3. Nurse Juvy is caring for a client with cirrhosis of
the liver. To minimize the effects of the disorder, the A. An obturator
nurse teaches the client about foods that are high in B. Kelly clamp
thiamine. The nurse determines that the client has the C. An irrigation set
best understanding of the dietary measures to follow D. A pair of scissors
if the client states an intension to increase the intake 10. Dr. Smith has determined that the client with
of: hepatitis has contracted the infection form
contaminated food. The nurse understands that this
A. Pork client is most likely experiencing what type of
B. Milk hepatitis?
C. Chicken
D. Broccoli A. Hepatitis A
4. Nurse Oliver checks for residual before B. Hepatitis B
administering a bolus tube feeding to a client with a C. Hepatitis C
nasogastric tube and obtains a residual amount of 150 D. Hepatitis D
mL. What is appropriate action for the nurse to take? 11. A client is suspected of having hepatitis. Which
diagnostic test result will assist in confirming this
A. Hold the feeding diagnosis?
B. Reinstill the amount and continue with
administering the feeding A. Elevated hemoglobin level
C. Elevate the client’s head at least 45 degrees and B. Elevated serum bilirubin level
administer the feeding C. Elevated blood urea nitrogen level
D. Discard the residual amount and proceed with D. Decreased erythrocycle sedimentation rate
administering the feeding
5. A nurse is inserting a nasogastric tube in an adult 12. The nurse is reviewing the physician’s orders
male client. During the procedure, the client begins to written for a male client admitted to the hospital with
cough and has difficulty breathing. Which of the acute pancreatitis. Which physician order should the
following is the appropriate nursing action? nurse question if noted on the client’s chart?

A. Quickly insert the tube A. NPO status

B. Notify the physician immediately B. Nasogastric tube inserted
C. Remove the tube and reinsert when the C. Morphine sulfate for pain
respiratory distress subsides D. An anticholinergic medication
D. Pull back on the tube and wait until the 13. A female client being seen in a physician’s office
respiratory distress subsides has just been scheduled for a barium swallow the
6. Nurse Ryan is assessing for correct placement of a next day. The nurse writes down which instruction
nosogartric tube. The nurse aspirates the stomach for the client to follow before the test?
contents and check the contents for pH. The nurse
verifies correct tube placement if which pH value is
A. Fast for 8 hours before the test
noted?
B. Eat a regular supper and breakfast
C. Continue to take all oral medications as
A. 3.5 scheduled
B. 7.0
Reviwer

D. Monitor own bowel movement pattern for D. Coughing and deep-breathing exercises
constipation 22. The nurse is providing discharge instructions to a
14. The nurse is performing an abdominal assessment male client following gastrectomy and instructs the
and inspects the skin of the abdomen. The nurse client to take which measure to assist in preventing
performs which assessment technique next? dumping syndrome?

A. Palpates the abdomen for size A. Ambulate following a meal

B. Palpates the liver at the right rib margin B. Eat high carbohydrate foods
C. Listens to bowel sounds in all for quadrants C. Limit the fluid taken with meal
D. Percusses the right lower abdominal quadrant D. Sit in a high-Fowler’s position during meals
15. Polyethylene glycol-electrlyte solution 23. The nurse is monitoring a female client for the
(GoLYTELY) is prescribed for the female client early signs and symptoms of dumping syndrome.
scheduled for a colonoscopy. The client begins to Which of the following indicate this occurrence?
experience diarrhea following administration of the
solution. What action by the nurse is appropriate? A. Sweating and pallor
B. Bradycardia and indigestion
A. Start an IV infusion C. Double vision and chest pain
B. Administer an enema D. Abdominal cramping and pain
C. Cancel the diagnostic test 24. The nurse is preparing a discharge teaching plan
D. Explain that diarrhea is expected for the male client who had umbilical hernia repair.
16. The nurse is caring for a male client with a What should the nurse include in the plan?
diagnosis of chronic gastritis. The nurse monitors the
client knowing that this client is at risk for which A. Irrigating the drain
vitamin deficiency? B. Avoiding coughing
C. Maintaining bed rest
A. Vitamin A D. Restricting pain medication
B. Vitamin B12 25. The nurse is instructing the male client who has
C. Vitamin C an inguinal hernia repair how to reduce postoperative
D. Vitamin E swelling following the procedure. What should the
17. The nurse is reviewing the medication record of a nurse tell the client?
female client with acute gastritis. Which medication,
if noted on the client’s record, would the nurse A. Limit oral fluid
question? B. Elevate the scrotum
C. Apply heat to the abdomen
A. Digoxin (Lanoxin) D. Remain in a low-fiber diet
B. Furosemide (Lasix) 26. The nurse is caring for a hospitalized female
C. Indomethacin (Indocin) client with a diagnosis of ulcerative colitis. Which
D. Propranolol hydrochloride (Inderal) finding, if noted on assessment of the client, would
18. The nurse is assessing a male client 24 hours the nurse report to the physician?
following a cholecystectomy. The nurse noted that
the T tube has drained 750 mL of green-brown A. Hypotension
drainage since the surgery. Which nursing B. Bloody diarrhea
intervention is appropriate? C. Rebound tenderness
D. A hemoglobin level of 12 mg/dL
A. Clamp the T tube 27. The nurse is caring for a male client
B. Irrigate the T tube postoperatively following creation of a colostomy.
C. Notify the physician Which nursing diagnosis should the nurse include in
D. Document the findings the plan of care?
19. The nurse is monitoring a female client with a
diagnosis of peptic ulcer. Which assessment findings A. Sexual dysfunction
would most likely indicate perforation of the ulcer? B. Body image, disturbed
C. Fear related to poor prognosis
A. Bradycardia D. Nutrition: more than body requirements,
B. Numbness in the legs imbalanced
C. Nausea and vomiting 28. The nurse is reviewing the record of a female
D. A rigid, board-like abdomen client with Crohn’s disease. Which stool
20. A male client with a peptic ulcer is scheduled for characteristics should the nurse expect to note
a vagotomy and the client asks the nurse about the documented in the client’s record?
purpose of this procedure. Which response by the
nurse best describes the purpose of a vagotomy? A. Diarrhea
B. Chronic constipation
A. Halts stress reactions C. Constipation alternating with diarrhea
B. Heals the gastric mucosa D. Stools constantly oozing form the rectum
C. Reduces the stimulus to acid secretions 29. The nurse is performing a colostomy irrigation on
D. Decreases food absorption in the stomach a male client. During the irrigation, the client begins
21. The nurse is caring for a female client following a to complain of abdominal cramps. What is the
Billroth II procedure. Which postoperative order appropriate nursing action?
should the nurse question and verify?
A. Notify the physician
A. Leg exercises B. Stop the irrigation temporarily
B. Early ambulation C. Increase the height of the irrigation
C. Irrigating the nasogastric tube D. Medicate for pain and resume the irrigation
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30. The nurse is teaching a female client how to A. 100 ml

perform a colostomy irrigation. To enhance the B. 500 ml
effectiveness of the irrigation and fecal returns, what C. 1500 ml
measure should the nurse instruct the client to do? D. 5000 ml
39. You’re preparing a teaching plan for a 27 y.o.
A. Increase fluid intake named Jeff who underwent surgery to close a
B. Place heat on the abdomen temporary ileostomy. Which nutritional guideline do
C. Perform the irrigation in the evening you include in this plan?
D. Reduce the amount of irrigation solution
31. A patient with chronic alcohol abuse is admitted A. There is no need to change eating habits.
with liver failure. You closely monitor the patient’s B. Eat six small meals a day.
blood pressure because of which change that is C. Eat the largest meal in the evening.
associated with the liver failure? D. Restrict fluid intake.
40. Arthur has a family history of colon cancer and is
A. Hypoalbuminemia scheduled to have a sigmoidoscopy. He is crying as
B. Increased capillary permeability he tells you, “I know that I have colon cancer, too.”
C. Abnormal peripheral vasodilation Which response is most therapeutic?
D. Excess rennin release from the kidneys
32. You’re assessing the stoma of a patient with a A. “I know just how you feel.”
healthy, well-healed colostomy. You expect the B. “You seem upset.”
stoma to appear: C. “Oh, don’t worry about it, everything will be
just fine.”
A. Pale, pink and moist D. “Why do you think you have cancer?”
B. Red and moist 41. You’re caring for Beth who underwent a Billroth
C. Dark or purple colored II procedure (surgical removal of the pylorus and
D. Dry and black duodenum) for treatment of a peptic ulcer. Which
33. You’re caring for a patient with a sigmoid findings suggest that the patient is developing
colostomy. The stool from this colostomy is: dumping syndrome, a complication associated with
this procedure?
A. Formed
B. Semisolid A. Flushed, dry skin.
C. Semiliquid B. Headache and bradycardia.
D. Watery C. Dizziness and sweating.
34. You’re advising a 21 y.o. with a colostomy who D. Dyspnea and chest pain.
reports problems with flatus. What food should you 42. You’re developing the plan of care for a patient
recommend? experiencing dumping syndrome after a Billroth II
procedure. Which dietary instructions do you
include?
A. Peas
B. Cabbage
C. Broccoli A. Omit fluids with meals.
D. Yogurt B. Increase carbohydrate intake.
35. You have to teach ostomy self care to a patient C. Decrease protein intake.
with a colostomy. You tell the patient to measure and D. Decrease fat intake.
cut the wafer: 43. 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
A. To the exact size of the stoma. the paracentesis was effective?
B. About 1/16” larger than the stoma.
C. About 1/8” larger than the stoma.
D. About 1/4″ larger than the stoma. A. Pruritus
36. You’re performing an abdominal assessment on B. Dyspnea
Brent who is 52 y.o. In which order do you proceed? C. Jaundice
D. Peripheral Neuropathy
44. You’re caring for Jane, a 57 y.o. patient with
A. Observation, percussion, palpation, auscultation liver cirrhosis who develops ascites and requires
B. Observation, auscultation, percussion, palpation paracentesis. Before her paracentesis, you instruct her
C. Percussion, palpation, auscultation, observation to:
D. Palpation, percussion, observation, auscultation
37. You’re doing preoperative teaching with
Gertrude who has ulcerative colitis who needs A. Empty her bladder.
surgery to create an ileoanal reservoir. Which B. Lie supine in bed.
information do you include? C. Remain NPO for 4 hours.
D. Clean her bowels with an enema.
45. After abdominal surgery, your patient has a
A. A reservoir is created that exits through the severe coughing episode that causes wound
abdominal wall. evisceration. In addition to calling the doctor, which
B. A second surgery is required 12 months after intervention is most appropriate?
the first surgery.
C. A permanent ileostomy is created.
D. The surgery occurs in two stages. A. Irrigate the wound & organs with Betadine.
38. You’re caring for Carin who has just had B. Cover the wound with a saline soaked sterile
ileostomy surgery. During the first 24 hours post-op, dressing.
how much drainage can you expect from the C. Apply a dry sterile dressing & binder.
ileostomy? D. Push the organs back & cover with moist sterile
dressings.
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46. You’re caring for Betty with liver cirrhosis. 54. Develop a teaching care plan for Angie who is
Which of the following assessment findings leads about to undergo a liver biopsy. Which of the
you to suspect hepatic encephalopathy in her? following points do you include?

A. Asterixis A. “You’ll need to lie on your stomach during the

B. Chvostek’s sign test.”
C. Trousseau’s sign B. “You’ll need to lie on your right side after the
D. Hepatojugular reflex test.”
47. You are developing a careplan on Sally, a 67 y.o. C. “During the biopsy you’ll be asked to exhale
patient with hepatic encephalopathy. Which of the deeply and hold it.”
following do you include? D. “The biopsy is performed under general
anesthesia.”
A. Administering a lactulose enema as ordered. 55. Stephen is a 62 y.o. patient that has had a liver
B. Encouraging a protein-rich diet. biopsy. Which of the following groups of signs alert
C. Administering sedatives, as necessary. you to a possible pneumothorax?
D. Encouraging ambulation at least four times a
day. A. Dyspnea and reduced or absent breath sounds
48. You have a patient with achalasia (incomplete over the right lung
muscle relaxtion of the GI tract, especially sphincter B. Tachycardia, hypotension, and cool, clammy
muscles). Which medications do you anticipate to skin
administer? C. Fever, rebound tenderness, and abdominal
rigidity
A. Isosorbide dinitrate (Isordil) D. Redness, warmth, and drainage at the biopsy
B. Digoxin (Lanoxin) site
C. Captopril (Capoten) 56. Michael, a 42 y.o. man is admitted to the med-
D. Propanolol (Inderal) surg floor with a diagnosis of acute pancreatitis. His
49. The student nurse is preparing a teaching care BP is 136/76, pulse 96, Resps 22 and temp 101. His
plan to help improve nutrition in a patient with past history includes hyperlipidemia and alcohol
achalasia. You include which of the following: abuse. The doctor prescribes an NG tube. Before
inserting the tube, you explain the purpose to patient.
Which of the following is a most accurate
A. Swallow foods while leaning forward. explanation?
B. Omit fluids at mealtimes.
C. Eat meals sitting upright.
D. Avoid soft and semisoft foods. A. “It empties the stomach of fluids and gas.”
50. Britney, a 20 y.o. student is admitted with acute B. “It prevents spasms at the sphincter of Oddi.”
pancreatitis. Which laboratory findings do you expect C. “It prevents air from forming in the small
to be abnormal for this patient? intestine and large intestine.”
D. “It removes bile from the gallbladder.”
57. Jason, a 22 y.o. accident victim, requires an NG
A. Serum creatinine and BUN tube for feeding. What should you immediately do
B. Alanine aminotransferase (ALT) and aspartate after inserting an NG tube for liquid enteral feedings?
aminotransferase (AST)
C. Serum amylase and lipase
D. Cardiac enzymes A. Aspirate for gastric secretions with a syringe.
51. A patient with Crohn’s disease is admitted after 4 B. Begin feeding slowly to prevent cramping.
days of diarrhea. Which of the following urine C. Get an X-ray of the tip of the tube within 24
specific gravity values do you expect to find in this hours.
patient? D. Clamp off the tube until the feedings begin.
58. Stephanie, a 28 y.o. accident victim, requires
TPN. The rationale for TPN is to provide:
A. 1.005
B. 1.011
C. 1.020 A. Necessary fluids and electrolytes to the body.
D. 1.030 B. Complete nutrition by the I.V. route.
52. Your goal is to minimize David’s risk of C. Tube feedings for nutritional supplementation.
complications after a heriorrhaphy. You instruct the D. Dietary supplementation with liquid protein
patient to: given between meals.
59. Type A chronic gastritis can be distinquished
from type B by its ability to:
A. Avoid the use of pain medication.
B. Cough and deep breathe Q2H.
C. Splint the incision if he can’t avoid sneezing or A. Cause atrophy of the parietal cells.
coughing. B. Affect only the antrum of the stomach.
D. Apply heat to scrotal swelling. C. Thin the lining of the stomach walls.
53. Janice is waiting for discharge instructions after D. Decrease gastric secretions.
her herniorrhaphy. Which of the following 60. Matt is a 49 y.o. with a hiatal hernia that you are
instructions do you include? about to counsel. Health care counseling for Matt
should include which of the following instructions?
A. Eat a low-fiber diet.
B. Resume heavy lifting in 2 weeks. A. Restrict intake of high-carbohydrate foods.
C. Lose weight, if obese. B. Increase fluid intake with meals.
D. Resume sexual activity once discomfort is C. Increase fat intake.
gone. D. Eat three regular meals a day.
61. Jerod is experiencing an acute episode of
ulcerative colitis. Which is priority for this patient?
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A. Replace lost fluid and sodium. D. Trickles of bright red blood.

B. Monitor for increased serum glucose level from 70. Your teaching Anthony how to use his new
steroid therapy. colostomy. How much skin should remain exposed
C. Restrict the dietary intake of foods high in between the stoma and the ring of the appliance?
potassium.
D. Note any change in the color and consistency of A. 1/16”
stools. B. 1/4″
62. A 29 y.o. patient has an acute episode of C. 1/2”
ulcerative colitis. What diagnostic test confirms this D. 1”
diagnosis? 71. Claire, a 33 y.o. is on your floor with a possible
bowel obstruction. Which intervention is priority for
A. Barium Swallow. her?
B. Stool examination.
C. Gastric analysis. A. Obtain daily weights.
D. Sigmoidoscopy. B. Measure abdominal girth.
63. Eleanor, a 62 y.o. woman with diverticulosis is C. Keep strict intake and output.
your patient. Which interventions would you expect D. Encourage her to increase fluids.
to include in her care? 72. Your patient has a GI tract that is functioning,
but has the inability to swallow foods. Which is the
A. Low-fiber diet and fluid restrictions. preferred method of feeding for your patient?
B. Total parenteral nutrition and bed rest.
C. High-fiber diet and administration of psyllium. A. TPN
D. Administration of analgesics and antacids. B. PPN
64. Regina is a 46 y.o. woman with ulcerative colitis. C. NG feeding
You expect her stools to look like: D. Oral liquid supplements
73. You’re patient is complaining of abdominal pain
A. Watery and frothy. during assessment. What is your priority?
B. Bloody and mucoid.
C. Firm and well-formed. A. Auscultate to determine changes in bowel
D. Alternating constipation and diarrhea. sounds.
65. Donald is a 61 y.o. man with diverticulitis. B. Observe the contour of the abdomen.
Diverticulitis is characterized by: C. Palpate the abdomen for a mass.
D. Percuss the abdomen to determine if fluid is
A. Periodic rectal hemorrhage. present.
B. Hypertension and tachycardia. 74. Before bowel surgery, Lee is to administer
C. Vomiting and elevated temperature. enemas until clear. During administration, he
D. Crampy and lower left quadrant pain and low- complains of intestinal cramps. What do you do next?
grade fever.
66. Brenda, a 36 y.o. patient is on your floor with A. Discontinue the procedure.
acute pancreatitis. Treatment for her includes: B. Lower the height of the enema container.
C. Complete the procedure as quickly as possible.
A. Continuous peritoneal lavage. D. Continue administration of the enema as
B. Regular diet with increased fat. ordered without making any adjustments.
C. Nutritional support with TPN. 75. Leigh Ann is receiving pancrelipase (Viokase)
D. Insertion of a T tube to drain the pancreas. for chronic pancreatitis. Which observation best
67. Glenda has cholelithiasis (gallstones). You indicates the treatment is effective?
expect her to complain of:
A. There is no skin breakdown.
A. Pain in the right upper quadrant, radiating to the B. Her appetite improves.
shoulder. C. She loses more than 10 lbs.
B. Pain in the right lower quadrant, with rebound D. Stools are less fatty and decreased in frequency.
tenderness. 76. Ralph has a history of alcohol abuse and has
C. Pain in the left upper quadrant, with shortness acute pancreatitis. Which lab value is most likely to
of breath. be elevated?
D. Pain in the left lower quadrant, with mild
cramping. A. Calcium
68. After an abdominal resection for colon cancer, B. Glucose
Madeline returns to her room with a Jackson-Pratt C. Magnesium
drain in place. The purpose of the drain is to: D. Potassium
77. Anna is 45 y.o. and has a bleeding ulcer. Despite
A. Irrigate the incision with a saline solution. multiple blood transfusions, her HGB is 7.5g/dl and
B. Prevent bacterial infection of the incision. HCT is 27%. Her doctor determines that surgical
C. Measure the amount of fluid lost after surgery. intervention is necessary and she undergoes partial
D. Prevent accumulation of drainage in the wound. gastrectomy. Postoperative nursing care includes:
69. Anthony, a 60 y.o. patient, has just undergone a
bowel resection with a colostomy. During the first 24 A. Giving pain medication Q6H.
hours, which of the following observations about the B. Flushing the NG tube with sterile water.
stoma should you report to the doctor? C. Positioning her in high Fowler’s position.
D. Keeping her NPO until the return of peristalsis.
A. Pink color. 78. Sitty, a 66 y.o. patient underwent a colostomy for
B. Light edema. ruptured diverticulum. She did well during the
C. Small amount of oozing. surgery and returned to your med-surg floor in stable
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condition. You assess her colostomy 2 days after C. Discuss the effects of hepatitis B on future
surgery. Which finding do you report to the doctor? health problems.
D. Provide avenues for financial counseling if she
A. Blanched stoma expresses the need.
B. Edematous stoma 86. Elmer is scheduled for a proctoscopy and has an
C. Reddish-pink stoma I.V. The doctor wrote an order for 5mg of I.V.
D. Brownish-black stoma diazepam(Valium). Which order is correct regarding
79. Sharon has cirrhosis of the liver and develops diazepam?
ascites. What intervention is necessary to decrease
the excessive accumulation of serous fluid in her A. Give diazepam in the I.V. port closest to the
peritoneal cavity? vein.
B. Mix diazepam with 50 ml of dextrose 5% in
A. Restrict fluids water and give over 15 minutes.
B. Encourage ambulation C. Give diazepam rapidly I.V. to prevent the
C. Increase sodium in the diet bloodstream from diluting the drug mixture.
D. Give antacids as prescribed D. Question the order because I.V. administration
80. Katrina is diagnosed with lactose intolerance. To of diazepam is contraindicated.
avoid complications with lack of calcium in the diet, 87. Annebell is being discharged with a colostomy,
which food should be included in the diet? and you’re teaching her about colostomy care. Which
statement correctly describes a healthy stoma?
A. Fruit
B. Whole grains A. “At first, the stoma may bleed slightly when
C. Milk and cheese products touched.”
D. Dark green, leafy vegetables B. “The stoma should appear dark and have a
81. Nathaniel has severe pruritus due to having bluish hue.”
hepatitis B. What is the best intervention for his C. “A burning sensation under the stoma faceplate
comfort? is normal.”
D. “The stoma should remain swollen away from
the abdomen.”
A. Give tepid baths. 88. A patient who underwent abdominal surgery now
B. Avoid lotions and creams. has a gaping incision due to delayed wound healing.
C. Use hot water to increase vasodilation. Which method is correct when you irrigate a gaping
D. Use cold water to decrease the itching. abdominal incision with sterile normal saline
82. Rob is a 46 y.o. admitted to the hospital with a solution, using a piston syringe?
suspected diagnosis of Hepatitis B. He’s jaundiced
and reports weakness. Which intervention will you
include in his care? A. Rapidly instill a stream of irrigating solution
into the wound.
B. Apply a wet-to-dry dressing to the wound after
A. Regular exercise. the irrigation.
B. A low-protein diet. C. Moisten the area around the wound with normal
C. Allow patient to select his meals. saline solution after the irrigation.
D. Rest period after small, frequent meals. D. Irrigate continuously until the solution becomes
83. You’re discharging Nathaniel with hepatitis B. clear or all of the solution is used.
Which statement suggests understanding by the 89. Hepatic encephalopathy develops when the blood
patient? level of which substance increases?

A. “Now I can never get hepatitis again.” A. Ammonia

B. “I can safely give blood after 3 months.” B. Amylase
C. “I’ll never have a problem with my liver again, C. Calcium
even if I drink alcohol.” D. Potassium
D. “My family knows that if I get tired and start 90. Your patient recently had abdominal surgery and
vomiting, I may be getting sick again.” tells you that he feels a popping sensation in his
84. Gail is scheduled for a cholecystectomy. After incision during a coughing spell, followed by severe
completion of preoperative teaching, Gail states,”If I pain. You anticipate an evisceration. Which supplies
lie still and avoid turning after the operation, I’ll should you take to his room?
avoid pain. Do you think this is a good idea?” What
is the best response?
A. A suture kit.
B. Sterile water and a suture kit.
A. “You’ll need to turn from side to side every 2 C. Sterile water and sterile dressings.
hours.” D. Sterile saline solution and sterile dressings.
B. “It’s always a good idea to rest quietly after 91. Findings during an endoscopic exam include a
surgery.” cobblestone appearance of the colon in your patient.
C. “The doctor will probably order you to lie flat The findings are characteristic of which disorder?
for 24 hours.”
D. “Why don’t you decide about activity after you
return from the recovery room?” A. Ulcer
85. You’re caring for a 28 y.o. woman with hepatitis B. Crohn’s disease
B. She’s concerned about the duration of her C. Chronic gastritis
recovery. Which response isn’t appropriate? D. Ulcerative colitis
92. What information is correct about stomach
cancer?
A. Encourage her to not worry about the future.
B. Encourage her to express her feelings about the
illness. A. Stomach pain is often a late symptom.
B. Surgery is often a successful treatment.
Reviwer

C. Chemotherapy and radiation are often A. Notify the doctor immediately.

successful treatments. B. Stop the feeding, and clamp the NG tube.
D. The patient can survive for an extended time C. Discard the 220ml, and clamp the NG tube.
with TPN. D. Give a prescribed GI stimulant such as
93. Dark, tarry stools indicate bleeding in which metoclopramide (Reglan).
location of the GI tract? Answers and Rationales

1. Answer C. The normal serum amylase level is

A. Upper colon.
25 to 151 units/L. With chronic cases of
B. Lower colon.
pancreatitis, the rise in serum amylase levels
C. Upper GI tract.
usually does not exceed three times the normal
D. Small intestine.
value. In acute pancreatitis, the value may
94. A patient has an acute upper GI hemorrhage.
exceed five times the normal value. Options A
Your interventions include:
and B are within normal limits. Option D is an
extremely elevated level seen in acute
A. Treating hypovolemia. pancreatitis.
B. Treating hypervolemia. 2. Answer C. Full liquid food items include items
C. Controlling the bleeding source. such as plain ice cream, sherbet, breakfast
D. Treating shock and diagnosing the bleeding drinks, milk, pudding and custard, soups that
source. are strained, and strained vegetable juices. A
95. You promote hemodynamic stability in a patient clear liquid diet consists of foods that are
with upper GI bleeding by: relatively transparent. The food items in options
A, B, and D are clear liquids.
A. Encouraging oral fluid intake. 3. Answer A. The client with cirrhosis needs to
B. Monitoring central venous pressure. consume foods high in thiamine. Thiamine is
C. Monitoring laboratory test results and vital present in a variety of foods of plant and animal
signs. origin. Pork products are especially rich in this
D. Giving blood, electrolyte and fluid replacement. vitamin. Other good food sources include nuts,
96. You’re preparing a patient with a malignant whole grain cereals, and legumes. Milk contains
tumor for colorectal surgery and subsequent vitamins A, D, and B2. Poultry contains niacin.
colostomy. The patient tells you he’s anxious. What Broccoli contains vitamins C, E, and K and
should your initial step be in working with this folic acid
patient? 4. Answer A. Unless specifically indicated,
residual amounts more than 100 mL require
holding the feeding. Therefore options B, C,
A. Determine what the patient already knows
and D are incorrect. Additionally, the feeding is
about colostomies.
not discarded unless its contents are abnormal
B. Show the patient some pictures of colostomies.
C. Arrange for someone who has a colostomy to in color or characteristics.
visit the patient. 5. Answer D. During the insertion of a nasogastric
tube, if the client experiences difficulty
D. Provide the patient with written material about
breathing or any respiratory distress, withdraw
colostomy care.
the tube slightly, stop the tube advancement,
97. Your patient, Christopher, has a diagnosis of
and wait until the distress subsides. Options B
ulcerative colitis and has severe abdominal pain
aggravated by movement, rebound tenderness, fever, and C are unnecessary. Quickly inserting the
tube is not an appropriate action because, in this
nausea, and decreased urine output. This may
situation, it may be likely that the tube has
indicate which complication?
entered the bronchus.
6. Answer A. If the nasogastric tube is in the
A. Fistula. stomach, the pH of the contents will be acidic.
B. Bowel perforation. Gastric aspirates have acidic pH values and
C. Bowel obstruction. should be 3.5 or lower. Option B indicates a
D. Abscess. slightly acidic pH. Option C indicates a neutral
98. A patient has a severe exacerbation of ulcerative pH. Option D indicates an alkaline pH.
colitis. Long-term medications will probably include: 7. Answer C. When the nurse removes a
nasogastric tube, the client is instructed to take
A. Antacids. and hold a deep breath. This will close the
B. Antibiotics. epiglottis. This allows for easy withdrawal
C. Corticosteroids. through the esophagus into the nose. The nurse
D. Histamine2-receptor blockers. removes the tube with one smooth, continuous
99. The student nurse is teaching the family of a pull.
patient with liver failure. You instruct them to limit 8. Answer C. If a client has a nasogastric tube
which foods in the patient’s diet? connected to suction, the nurse should wait up
to 30 minutes before reconnecting the tube to
A. Meats and beans. the suction apparatus to allow adequate time for
B. Butter and gravies. medication absorption. Aspirating the
C. Potatoes and pastas. nasogastric tube will remove the medication
D. Cakes and pastries. just administered. Low intermittent suction also
100. An intubated patient is receiving continuous will remove the medication just administered.
enteral feedings through a Salem sump tube at a rate The client should not be placed in the supine
of 60ml/hr. Gastric residuals have been 30-40ml position because of the risk for aspiration.
when monitored Q4H. You check the gastric residual 9. Answer D. When the client has a Sengstaken-
and aspirate 220ml. What is your first response to this Blakemore tube, a pair of scissors must be kept
finding? at the client’s bedside at all times. The client
needs to be observed for sudden respiratory
distress, which occurs if the gastric balloon
Reviwer

ruptures and the entire tube moves upward. If 19. Answer D. Perforation of an ulcer is a surgical
this occurs, the nurse immediately cuts all emergency and is characterized by sudden,
balloon lumens and removes the tube. An sharp, intolerable severe pain beginning in the
obturator and a Kelly clamp are kept at the midepigastric area and spreading over the
bedside of a client with a tracheostomy. An abdomen, which becomes rigid and board-like.
irrigation set may be kept at the bedside, but it Nausea and vomiting may occur. Tachycardia
is not the priority item. may occur as hypovolemic shock develops.
10. Answer A. Hepatitis A is transmitted by the Numbness in the legs is not an associated
fecal-oral route via contaminated food or finding.
infected food handlers. Hepatitis B, C, and D 20. Answer C. A vagotomy, or cutting of the vagus
are transmitted most commonly via infected nerve, is done to eliminate parasympathetic
blood or body fluids. stimulation of gastric secretion. Options A, B,
11. Answer B. Laboratory indicators of hepatitis and D are incorrect descriptions of a vagotomy.
include elevated liver enzyme levels, elevated 21. Answer C. In a Billroth II procedure, the
serum bilirubin levels, elevated erythrocyte proximal remnant of the stomach is
sedimentation rates, and leukopenia. An anastomosed to the proximal jejunum. Patency
elevated blood urea nitrogen level may indicate of the nasogastric tube is critical for preventing
renal dysfunction. A hemoglobin level is the retention of gastric secretions. The nurse
unrelated to this diagnosis. should never irrigate or reposition the gastric
12. Answer C. Meperidine (Demerol) rather than tube after gastric surgery, unless specifically
morphine sulfate is the medication of choice to ordered by the physician. In this situation, the
treat pain because morphine sulfate can cause nurse should clarify the order. Options A, B,
spasms in the sphincter of Oddi. Options A, B, and D are appropriate postoperative
and D are appropriate interventions for the interventions.
client with acute pancreatitis. 22. Answer C. Dumping syndrome is a term that
13. Answer A. A barium swallow is an x-ray study refers to a constellation of vasomotor symptoms
that uses a substance called barium for contrast that occurs after eating, especially following a
to highlight abnormalities in the gastrointestinal Billroth II procedure. Early manifestations
tract. The client should fast for 8 to 12 hours usually occur within 30 minutes of eating and
before the test, depending on physician include vertigo, tachycardia, syncope, sweating,
instructions. Most oral medications also are pallor, palpitations, and the desire to lie down.
withheld before the test. After the procedure, The nurse should instruct the client to decrease
the nurse must monitor for constipation, which the amount of fluid taken at meals and to avoid
can occur as a result of the presence of barium high-carbohydrate foods, including fluids such
in the gastrointestinal tract. as fruit nectars; to assume a low-Fowler’s
14. Answer C. The appropriate sequence for position during meals; to lie down for 30
abdominal examination is inspection, minutes after eating to delay gastric emptying;
auscultation, percussion, and palpation. and to take antispasmodics as prescribed.
Auscultation is performed after inspection to 23. Answer A. Early manifestations of dumping
ensure that the motility of the bowel and bowel syndrome occur 5 to 30 minutes after eating.
sounds are not altered by percussion or Symptoms include vertigo, tachycardia,
palpation. Therefore, after inspecting the skin syncope, sweating, pallor, palpitations, and the
on the abdomen, the nurse should listen for desire to lie down.
bowel sounds. 24. Answer B. Coughing is avoided following
15. Answer D. The solution GoLYTELY is a bowel umbilical hernia repair to prevent disruption of
evacuant used to prepare a client for a tissue integrity, which can occur because of the
colonoscopy by cleansing the bowel. The location of this surgical procedure. Bed rest is
solution is expected to cause a mild diarrhea not required following this surgical procedure.
and will clear the bowel in 4 to 5 hours. Options The client should take analgesics as needed and
A, B, and C are inappropriate actions. as prescribed to control pain. A drain is not
16. Answer B. Chronic gastritis causes used in this surgical procedure, although the
deterioration and atrophy of the lining of the client may be instructed in simple dressing
stomach, leading to the loss of the function of changes.
the parietal cells. The source of the intrinsic 25. Answer B. Following inguinal hernia repair, the
factor is lost, which results in the inability to client should be instructed to elevate the
absorb vitamin B12. This leads to the scrotum and apply ice packs while in bed to
development of pernicious anemia. The client is decrease pain and swelling. The nurse also
not at risk for vitamin A, C, or E deficiency. should instruct the client to apply a scrotal
17. Answer C. Indomethacin (Indocin) is a support when out of bed. Heat will increase
nonsteroidal anti-inflammatory drug and can swelling. Limiting oral fluids and a low-fiber
cause ulceration of the esophagus, stomach, or diet can cause constipation.
small intestine. Indomethacin is contraindicated 26. Answer C. Rebound tenderness may indicate
in a client with gastrointestinal disorders. peritonitis. Bloody diarrhea is expected to occur
Furosemide (Lasix) is a loop diuretic. Digoxin in ulcerative colitis. Because of the blood loss,
is a cardiac medication. Propranolol (Inderal) is the client may be hypotensive and the
a β-adrenergic blocker. Furosemide, digoxin, hemoglobin level may be lower than normal.
and propranolol are not contraindicated in Signs of peritonitis must be reported to the
clients with gastric disorders. physician.
18. Answer D. Following cholecystectomy, 27. Answer B. Body image, disturbed relates to loss
drainage from the T tube is initially bloody and of bowel control, the presence of a stoma, the
then turns to a greenish-brown color. The release of fecal material onto the abdomen, the
drainage is measured as output. The amount of passage of flatus, odor, and the need for an
expected drainage will range from 500 to 1000 appliance (external pouch). No data in the
mL/day. The nurse would document the output. question support options A and C. Nutrition:
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less than body requirements, imbalanced is the meal. A diet low in carbs and high in fat &
more likely nursing diagnosis. protein is recommended to treat dumping
28. Answer A. Crohn’s disease is characterized by syndrome.
nonbloody diarrhea of usually not more than 43. Answer B. Ascites puts pressure on the
four to five stools daily. Over time, the diarrhea diaphragm. Paracentesis is done to remove fluid
episodes increase in frequency, duration, and and reducing pressure on the diaphragm. The
severity. Options B, C, and D are not goal is to improve the patient’s breathing. The
characteristics of Crohn’s disease. others are signs of cirrhosis that aren’t relieved
29. Answer B. If cramping occurs during a by paracentesis.
colostomy irrigation, the irrigation flow is 44. Answer A. A full bladder can interfere with
stopped temporarily and the client is allowed to paracentesis and be punctured inadvertently.
rest. Cramping may occur from an infusion that 45. Answer B. Cover the organs with a sterile,
is too rapid or is causing too much pressure. nonadherent dressing moistened with normal
The physician does not need to be notified. saline. Do this to prevent infection and to keep
Increasing the height of the irrigation will cause the organs from drying out.
further discomfort. Medicating the client for 46. Answer A. Asterixis is an early neurologic sign
pain is not the appropriate action in this of hepatic encephalopathy elicited by asking the
situation. patient to hold her arms stretched out. Asterixis
30. Answer A. To enhance effectiveness of the is present if the hands rapidly extend and flex.
irrigation and fecal returns, the client is 47. Answer A. You may administer the laxative
instructed to increase fluid intake and to take lactulose to reduce ammonia levels in the colon.
other measures to prevent constipation. Options 48. Answer A. Achalasia is characterized by
B, C and D will not enhance the effectiveness incomplete relaxation of the LES, dilation of
of this procedure. the lower esophagus, and a lack of esophageal
31. Answer A. Blood pressure decreases as the peristalsis. Because nitrates relax the lower
body is unable to maintain normal oncotic esophageal sphincter, expect to give Isordil
pressure with liver failure, so patients with liver orally or sublingually.
failure require close blood pressure monitoring. 49. Answer C. Eating in the upright position aids in
Increased capillary permeability, abnormal emptying the esophagus. Doing the opposite of
peripheral vasodilation, and excess rennin the other three also may be helpful.
released from the kidney’s aren’t direct 50. Answer C. Pancreatitis involves activation of
ramifications of liver failure. pancreatic enzymes, such as amylase and lipase.
32. Answer B. Good circulation causes tissues to be These levels are elevated in a patient with acute
moist and red, so a healthy, well-healed stoma pancreatitis.
appears red and moist. 51. Answer D. The normal range of specific gravity
33. Answer A. A colostomy in the sigmoid colon of urine is 1.010 to 1.025; a value of 1.030 may
produces a solid, formed stool. be seen with dehydration.
34. Answer D. High-fiber foods stimulate 52. Answer C. Teach the pt to avoid activities that
peristalsis, and a result, flatus. Yogurt reduces increase intra-abdominal pressure such as
gas formation. coughing, sneezing, or straining with a bowel
35. Answer B. A proper fit protects the skin, but movement.
doesn’t impair circulation. A 1/16” should be 53. Answer C. Because obesity weakens the
cut. abdominal muscles, advise weight loss for the
36. Answer B. Observation, auscultation, patient who has had a hernia repair.
percussion, palpation 54. Answer B. After a liver biopsy, the patient is
37. Answer D. An ileoanal reservoir is created in placed on the right side to compress the liver
two stages. The two surgeries are about 2 to 3 and to reduce the risk of bleeding or bile
months apart. First, diseased intestines are leakage.
removed and a temporary loop ileostomy is 55. Answer A. Signs and Symptoms of
created. Second, the loop ileostomy is closed pneumothorax include dyspnea and decreased
and stool goes to the reservoir and out through or absent breath sounds over the affected lung
the anus. (right lung).
38. Answer C. The large intestine absorbs large 56. Answer A. An NG tube is inserted into the
amounts of water so the initial output from the patients stomach to drain fluid and gas.
ileostomy may be as much as 1500 to 2000 57. Answer A. Aspirating the stomach contents
ml/24 hours. Gradually, the small intestine confirms correct placement. If an X-ray is
absorbs more fluid and the output decreases. ordered, it should be done immediately, not in
39. Answer B. To avoid overloading the small 24 hours.
intestine, encourage the patient to eat six small, 58. Answer B. TPN is given I.V. to provide all the
regularly spaced meals. nutrients your patient needs. TPN isn’t a tube
40. Answer B. Making observations about what feeding nor is it a liquid dietary supplement.
you see or hear is a useful therapeutic 59. Answer A. Type A causes changes in parietal
technique. This way, you acknowledge that you cells.
are interested in what the patient is saying and 60. Answer B. Increasing fluids helps empty the
feeling. stomach. A high carb diet isn’t restricted and fat
41. Answer C. After a Billroth II procedure, a large intake shouldn’t be increased.
amount of hypertonic fluid enters the intestine. 61. Answer A. Diarrhea d/t an acute episode of
This causes extracellular fluid to move rapidly ulcerative colitis leads to fluid & electrolyte
into the bowel, reducing circulating blood losses so fluid replacement takes priority.
volume and producing vasomotor symptoms. 62. Answer D. Sigmoidoscopy allows direct
Vasomotor symptoms produced by dumping observation of the colon mucosa for changes,
syndrome include dizziness and sweating, and if needed, biopsy.
tachycardia, syncope, pallor, and palpitations. 63. Answer C. She needs a high-fiber diet and a
42. Answer A. Gastric emptying time can be psyllium (bulk laxative) to promote normal soft
delayed by omitting fluids from your patient’s stools.
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64. Answer B. Stools from ulcerative colitis are is touched because the surgical site is still new.
often bloody and contain mucus. She should report profuse bleeding
65. Answer D. One sign of acute diverticulitis is immediately.
crampy lower left quadrant pain. A low-grade 88. Answer D. To wash away tissue debris and
fever is another common sign. drainage effectively, irrigate the wound until
66. Answer C. With acute pancreatitis, you need to the solution becomes clear or all the solution is
rest the GI tract by TPN as nutritional support. used.
67. Answer A. The gallbladder is located in the 89. Answer A. Ammonia levels increase d/t
RUQ and a frequent sign of gallstones is pain improper shunting of blood, causing ammonia
radiating to the shoulder. to enter systemic circulation, which carries it to
68. Answer D. A Jackson-Pratt drain promotes the brain.
wound healing by allowing fluid to escape from 90. Answer D. Saline solution is isotonic, or close
the wound. to body fluids in content, and is used along with
69. Answer D. After creation of a colostomy, sterile dressings to cover an eviscerated wound
expect to see a stoma that is pink, slightly and keep it moist.
edematous, with some oozing. Bright red blood, 91. Answer B. Crohn’s disease penetrates the
regardless of amount, indicates bleeding and mucosa of the colon through all layers and
should be reported to the doctor. destroys the colon in patches, which creates a
70. Answer A. Only a small amount of skin should cobblestone appearance.
be exposed and more than 1/16” of skin allows 92. Answer A. Stomach pain is often a late sign of
the excretement to irritate the skin. stomach cancer; outcomes are particularly poor
71. Answer B. Measuring abdominal girth provides when the cancer reaches that point. Surgery,
quantitative information about increases or chemotherapy, and radiation have minimal
decreases in the amount of distention. positive effects. TPN may enhance the growth
72. Answer C. Because the GI tract is functioning, of the cancer.
feeding methods involve the enteral route which 93. Answer C. Melena is the passage of dark, tarry
bypasses the mouth but allows for a major stools that contain a large amount of digested
portion of the GI tract to be used. blood. It occurs with bleeding from the upper
73. Answer B. The first step in assessing the GI tract.
abdomen is to observe its shape and contour, 94. Answer A. A patient with an acute upper GI
then auscultate, palpate, and then percuss. hemorrhage must be treated for hypovolemia
74. Answer B. Lowering the height decreases the and hemorrhagic shock. You as a nurse can’t
amount of flow, allowing him to tolerate more diagnose the problem. Controlling the bleeding
fluid. may require surgery or intensive medical
75. Answer D. Pancrelipase provides the exocrine treatment.
pancreatic enzyme necessary for proper protein, 95. Answer D. To stabilize a patient with acute
fat, and carb digestion. With increased fat bleeding, NS or LR solution is given I.V. until
digestion and absorption, stools become less BP rises and urine output returns to 30ml/hr.
frequent and normal in appearance. 96. Answer A. Initially, you should assess the
76. Answer B. Glucose level increases and diabetes patient’s knowledge about colostomies and how
mellitus may result d/t the pancreatic damage to it will affect his lifestyle.
the islets of langerhans. 97. Answer B. An inflammatory condition that
77. Answer D. After surgery, she remains NPO affects the surface of the colon, ulcerative
until peristaltic activity returns. This decreases colitis causes friability and erosions with
the risk for abdominal distention and bleeding. Patients with ulcerative colitis are at
obstruction. increased risk for bowel perforation, toxic
78. Answer D. A brownish-black color indicates megacolon, hemorrhage, cancer, and other
lack of blood flow, and maybe necrosis. anorectal and systemic complications.
79. Answer A. Restricting fluids decrease the 98. Answer C. Medications to control inflammation
amount of body fluid and the accumulation of such as corticosteroids are used for long-term
fluid in the peritoneal space. treatment.
80. Answer D. Dark green, leafy vegetables are rich 99. Answer A. Meats and beans are high-protein
in calcium. foods. In liver failure, the liver is unable to
81. Answer A. For pruritus, care should include metabolize protein adequately, causing protein
tepid sponge baths and use of emollient creams by-products to build up in the body rather than
and lotions. be excreted.
82. Answer D. Rest periods and small frequent 100. Answer B. A gastric residual greater than 2
meals is indicated during the acute phase of hours worth of feeding or 100-150ml is
hepatitis B. considered too high. The feeding should be
83. Answer D. Hepatitis B can recur. Patients who stopped; NG tube clamped, and then allow time
have had hepatitis are permanently barred from for the stomach to empty before additional
donating blood. Alcohol is metabolized by the feeding is added.
liver and should be avoided by those who have
or had hepatitis B. Endocrine
84. Answer A. To prevent venous stasis and
improve muscle tone, circulation, and 1. Which of the following hormones causes increased
respiratory function, encourage her to move atrial pressure and decreases sodium reabsorption in
after surgery. the kidneys?
85. Answer A. Telling her not to worry minimizes
her feelings. A. Atrial natriuretic peptide
86. Answer A. Diazepam is absorbed by the plastic B. PTH
I.V. tubing and should be given in the port C. Aldosterone
closest to the vein. D. Vasopressin
87. Answer A. For the first few days to a week, 2. Angiotensin I is changed by which of the following
slight bleeding normally occurs when the stoma into Angiotensin II?
Reviwer

A. ACE A. Stimulate bone development and growth

B. AVT B. Create beta-adrenergic responses
C. Pepsin C. Cause brain development
D. Adenosine D. Decrease calcium re-absorption
3. Which of the following is not a cause of peripheral 14. Hypercalemia has not been linked with which of
edema? the following?

A. Increased capillary permeability A. Paget’s disease

B. Reduced levels of plasma proteins B. Aldosterone
C. Heart failure C. Sarcoidosis
D. Decreased capillary output D. Malignancy
4. Which of the following during an 15. Which of the following does not require the pre-
electrocardiogram is associated with hypokalemia? cursor progesterone?

A. QRS complex A. Cortisol

B. U wave B. Testosterone
C. PR segment C. ACTH
D. ST segment D. Aldosterone
5. Which of the following is not generally associated 16. Which of the following is the source cell for the
with a 2nd degree (Mobitz Type 1) AV block? secretion Pepsinogen?

A. Usually asymptomatic A. Chief cell

B. Nonsequential (P wave then QRS complex) B. Plasma cell
C. Increased PR segment/interval C. G cell
D. 70% Fatal D. Parietal cell
6. An S3 heart sound is often associated with? 17. Which of the following is the primary activator of
zymogen secretion?
A. CHF
B. COPD A. Somatostatin
C. Atrial fib. B. Secretin
D. Ventricular fib. C. Acetylcholine
7. Mean arterial pressure is the product of: D. Gastrin
18. Which of the following is not a function of
A. TPR x SV Angiotensin II?
B. TPR x CO
C. CO/SV A. Causes release of aldosterone
D. SV/EDV B. Causes vasodilation
8. During phase 3 of the myocardial action potential C. Causes increased posterior pituitary activation
which ion is moving the most? D. Elevates blood pressure
19. Which of the following is not a function of
A. K+ Progesterone?
B. Ca+
C. Na+ A. Causes increased body temperature.
D. Ca2+ B. Causes some smooth muscle relaxation.
9. An ejection fraction can be calculated as: C. Causes increased spiral artery growth
D. Causes activation of FSH
A. SV/TPR 20. Which of the following is not a function of
B. CO/TPR Estrogen?
C. SV/EDV
D. CO/EDV A. Causes breast growth.
10. Which of the following is not a bradykinin effect? B. Causes inhibition of FSH
C. Increased follicle development
A. Elevated capillary permeability D. Decreased overall transport proteins
B. Elevated pain levels
C. Elevated vasodilation response
Answers
D. Elevated prothrombin secretion
11. PAH is secreted in which of the following 1. A. Atrial natriuretic peptide
locations? 2. A. ACE
3. D. Decreased capillary output
A. Distal tubule 4. B. U wave
B. Loop of Henle 5. D. 70% Fatal
C. Collecting tubule 6. A. CHF
D. Proximal tubule 7. B. TPR x CO
12. Which of the following is not an anterior pituitary 8. A. K+
gland secretion? 9. C. SV/EDV
10. D. Elevated prothrombin secretion
A. TSH 11. D. Proximal tubule
B. GH 12. C. Vasopressin
C. Vasopressin 13. D. Decrease calcium re-absorption
D. Prolactin 14. B. Aldosterone
13. Thyroid Hormone T3 does not have which of the 15. C. ACTH
following functions? 16. A. Chief cell
Reviwer

17. C. Acetylcholine 7. A female client with Cushing’s syndrome is

18. B. Causes vasodilation admitted to the medical-surgical unit. During the
19. D. Causes activation of FSH admission assessment, nurse Tyzz notes that the
20. D. Decreased overall transport proteins client is agitated and irritable, has poor memory,
reports loss of appetite, and appears disheveled.
These findings are consistent with which problem?
1. Nurse Ronn is assessing a client with possible
Cushing’s syndrome. In a client with Cushing’s A. Depression
syndrome, the nurse would expect to find: B. Neuropathy
C. Hypoglycemia
A. Hypotension. D. Hyperthyroidism
B. Thick, coarse skin. 8. Nurse Ruth is assessing a client after a
C. Deposits of adipose tissue in the trunk and thyroidectomy. The assessment reveals muscle
dorsocervical area. twitching and tingling, along with numbness in the
D. Weight gain in arms and legs. fingers, toes, and mouth area. The nurse should
2. A male client with primary diabetes insipidus is suspect which complication?
ready for discharge on desmopressin (DDAVP).
Which instruction should nurse Lina provide? A. Tetany
B. Hemorrhage
A. “Administer desmopressin while the suspension C. Thyroid storm
is cold.” D. Laryngeal nerve damage
B. “Your condition isn’t chronic, so you won’t 9. After undergoing a subtotal thyroidectomy, a
need to wear a medical identification bracelet.” female client develops hypothyroidism. Dr. Smith
C. “You may not be able to use desmopressin prescribes levothyroxine (Levothroid), 25 mcg P.O.
nasally if you have nasal discharge or daily. For which condition is levothyroxine the
blockage.” preferred agent?
D. “You won’t need to monitor your fluid intake
and output after you start taking desmopressin.” A. Primary hypothyroidism
3. Nurse Frank is aware that a positive Chvostek’s B. Graves’ disease
sign indicate? C. Thyrotoxicosis
D. Euthyroidism
A. Hypocalcemia 10. Which of these signs suggests that a male client
B. Hyponatremia with the syndrome of inappropriate antidiuretic
C. Hypokalemia hormone (SIADH) secretion is experiencing
D. Hypermagnesemia complications?
4. In a 29-year-old female client who is being
successfully treated for Cushing’s syndrome, nurse A. Tetanic contractions
Lyzette would expect a decline in: B. Neck vein distention
C. Weight loss
A. Serum glucose level. D. Polyuria
B. Hair loss. 11. A female client with a history of
C. Bone mineralization. pheochromocytoma is admitted to the hospital in an
D. Menstrual flow. acute hypertensive crisis. To reverse hypertensive
5. A male client has recently undergone surgical crisis caused by pheochromocytoma, nurse Lyka
removal of a pituitary tumor. Dr. Wong prescribes expects to administer:
corticotropin (Acthar), 20 units I.M. q.i.d. as a
replacement therapy. What is the mechanism of A. phentolamine (Regitine).
action of corticotropin? B. methyldopa (Aldomet).
C. mannitol (Osmitrol).
A. It decreases cyclic adenosine monophosphate D. felodipine (Plendil).
(cAMP) production and affects the metabolic 12. A male client with a history of hypertension is
rate of target organs. diagnosed with primary hyperaldosteronism. This
B. It interacts with plasma membrane receptors to diagnosis indicates that the client’s hypertension is
inhibit enzymatic actions. caused by excessive hormone secretion from which
C. It interacts with plasma membrane receptors to of the following glands?
produce enzymatic actions that affect protein,
fat, and carbohydrate metabolism. A. Adrenal cortex
D. It regulates the threshold for water resorption in B. Pancreas
the kidneys. C. Adrenal medulla
6. Capillary glucose monitoring is being performed D. Parathyroid
every 4 hours for a female client diagnosed with 13. Nurse Troy is aware that the most appropriate for
diabetic ketoacidosis. Insulin is administered using a a client with Addison’s disease?
scale of regular insulin according to glucose results.
At 2 p.m., the client has a capillary glucose level of
A. Risk for infection
250 mg/dl for which he receives 8 U of regular
B. Excessive fluid volume
insulin. Nurse Vince should expect the dose’s:
C. Urinary retention
D. Hypothermia
A. Onset to be at 2 p.m. and its peak to be at 3 p.m. 14. Acarbose (Precose), an alpha-glucosidase
B. Onset to be at 2:15 p.m. and its peak to be at 3 inhibitor, is prescribed for a female client with type 2
p.m. diabetes mellitus. During discharge planning, nurse
C. Onset to be at 2:30 p.m. and its peak to be at 4 Pauleen would be aware of the client’s need for
p.m. additional teaching when the client states:
D. Onset to be at 4 p.m. and its peak to be at 6 p.m.
Reviwer

A. “If I have hypoglycemia, I should eat some D. Imbalanced nutrition: Less than body
sugar, not dextrose.” requirements related to thyroid hormone excess
B. “The drug makes my pancreas release more 20. A male client with a tentative diagnosis of
insulin.” hyperosmolar hyperglycemic nonketotic syndrome
C. “I should never take insulin while I’m taking (HHNS) has a history of type 2 diabetes that is being
this drug.” controlled with an oral diabetic agent, tolazamide
D. “It’s best if I take the drug with the first bite of (Tolinase). Which of the following is the most
a meal.” important laboratory test for confirming this
15. A female client whose physical findings suggest a disorder?
hyperpituitary condition undergoes an extensive
diagnostic workup. Test results reveal a pituitary A. Serum potassium level
tumor, which necessitates a transphenoidal B. Serum sodium level
hypophysectomy. The evening before the surgery, C. Arterial blood gas (ABG) values
nurse Jacob reviews preoperative and postoperative D. Serum osmolarity
instructions given to the client earlier. Which 21. A male client has just been diagnosed with type 1
postoperative instruction should the nurse diabetes mellitus. When teaching the client and
emphasize? family how diet and exercise affect insulin
requirements, Nurse Joy should include which
A. “You must lie flat for 24 hours after surgery.” guideline?
B. “You must avoid coughing, sneezing, and
blowing your nose.” A. “You’ll need more insulin when you exercise or
C. “You must restrict your fluid intake.” increase your food intake.”
D. “You must report ringing in your ears B. “You’ll need less insulin when you exercise or
immediately.” reduce your food intake.”
16. Dr. Kennedy prescribes glipizide (Glucotrol), an C. “You’ll need less insulin when you increase
oral antidiabetic agent, for a male client with type 2 your food intake.”
diabetes mellitus who has been having trouble D. “You’ll need more insulin when you exercise or
controlling the blood glucose level through diet and decrease your food intake.”
exercise. Which medication instruction should the 22. Nurse Noemi administers glucagon to her diabetic
nurse provide? client, then monitors the client for adverse drug
reactions and interactions. Which type of drug
A. “Be sure to take glipizide 30 minutes before interacts adversely with glucagon?
meals.”
B. “Glipizide may cause a low serum sodium A. Oral anticoagulants
level, so make sure you have your sodium level B. Anabolic steroids
checked monthly.” C. Beta-adrenergic blockers
C. “You won’t need to check your blood glucose D. Thiazide diuretics
level after you start taking glipizide.” 23. Which instruction about insulin administration
D. “Take glipizide after a meal to prevent should nurse Kate give to a client?
heartburn.”
17. For a diabetic male client with a foot ulcer, the
physician orders bed rest, a wet-to-dry dressing A. “Always follow the same order when drawing
change every shift, and blood glucose monitoring the different insulins into the syringe.”
before meals and bedtime. Why are wet-to-dry B. “Shake the vials before withdrawing the
dressings used for this client? insulin.”
C. “Store unopened vials of insulin in the freezer
at temperatures well below freezing.”
A. They contain exudate and provide a moist D. “Discard the intermediate-acting insulin if it
wound environment. appears cloudy.”
B. They protect the wound from mechanical 24. Nurse Perry is caring for a female client with type
trauma and promote healing. 1 diabetes mellitus who exhibits confusion, light-
C. They debride the wound and promote healing headedness, and aberrant behavior. The client is still
by secondary intention. conscious. The nurse should first administer:
D. They prevent the entrance of microorganisms
and minimize wound discomfort.
18. When instructing the female client diagnosed A. I.M. or subcutaneous glucagon.
with hyperparathyroidism about diet, nurse Gina B. I.V. bolus of dextrose 50%.
should stress the importance of which of the C. 15 to 20 g of a fast-acting carbohydrate such as
following? orange juice.
D. 10 U of fast-acting insulin.
25. For the first 72 hours after thyroidectomy surgery,
A. Restricting fluids nurse Jamie would assess the female client for
B. Restricting sodium Chvostek’s sign and Trousseau’s sign because they
C. Forcing fluids indicate which of the following?
D. Restricting potassium
19. Which nursing diagnosis takes highest priority for
a female client with hyperthyroidism? A. Hypocalcemia
B. Hypercalcemia
C. Hypokalemia
A. Risk for imbalanced nutrition: More than body D. Hyperkalemia
requirements related to thyroid hormone excess Answers and Rationales
B. Risk for impaired skin integrity related to
edema, skin fragility, and poor wound healing 1. Answer C. Because of changes in fat
C. Body image disturbance related to weight gain distribution, adipose tissue accumulates in the
and edema trunk, face (moonface), and dorsocervical areas
(buffalo hump). Hypertension is caused by fluid
Reviwer

retention. Skin becomes thin and bruises easily hypothyroidism. It is contraindicated in Graves’
because of a loss of collagen. Muscle wasting disease and thyrotoxicosis because these
causes muscle atrophy and thin extremities. conditions are forms of hyperthyroidism.
2. Answer C. Desmopressin may not be absorbed Euthyroidism, a term used to describe normal
if the intranasal route is compromised. thyroid function, wouldn’t require any thyroid
Although diabetes insipidus is treatable, the preparation.
client should wear medical identification and 10. Answer B. SIADH secretion causes
carry medication at all times to alert medical antidiuretic hormone overproduction, which
personnel in an emergency and ensure proper leads to fluid retention. Severe SIADH can
treatment. The client must continue to monitor cause such complications as vascular fluid
fluid intake and output and receive adequate overload, signaled by neck vein distention. This
fluid replacement. syndrome isn’t associated with tetanic
3. Answer A. Chvostek’s sign is elicited by contractions. It may cause weight gain and fluid
tapping the client’s face lightly over the facial retention (secondary to oliguria).
nerve, just below the temple. If the client’s 11. Answer A. Pheochromocytoma causes
facial muscles twitch, it indicates excessive production of epinephrine and
hypocalcemia. Hyponatremia is indicated by norepinephrine, natural catecholamines that
weight loss, abdominal cramping, muscle raise the blood pressure. Phentolamine, an
weakness, headache, and postural hypotension. alpha-adrenergic blocking agent given by I.V.
Hypokalemia causes paralytic ileus and muscle bolus or drip, antagonizes the body’s response
weakness. Clients with hypermagnesemia to circulating epinephrine and norepinephrine,
exhibit a loss of deep tendon reflexes, coma, or reducing blood pressure quickly and effectively.
cardiac arrest. Although methyldopa is an antihypertensive
4. Answer A. Hyperglycemia, which develops agent available in parenteral form, it isn’t
from glucocorticoid excess, is a manifestation effective in treating hypertensive emergencies.
of Cushing’s syndrome. With successful Mannitol, a diuretic, isn’t used to treat
treatment of the disorder, serum glucose levels hypertensive emergencies. Felodipine, an
decline. Hirsutism is common in Cushing’s antihypertensive agent, is available only in
syndrome; therefore, with successful treatment, extended-release tablets and therefore doesn’t
abnormal hair growth also declines. reduce blood pressure quickly enough to correct
Osteoporosis occurs in Cushing’s syndrome; hypertensive crisis.
therefore, with successful treatment, bone 12. Answer A. Excessive secretion of aldosterone
mineralization increases. Amenorrhea develops in the adrenal cortex is responsible for the
in Cushing’s syndrome. With successful client’s hypertension. This hormone acts on the
treatment, the client experiences a return of renal tubule, where it promotes reabsorption of
menstrual flow, not a decline in it. sodium and excretion of potassium and
5. Answer C. Corticotropin interacts with plasma hydrogen ions. The pancreas mainly secretes
membrane receptors to produce enzymatic hormones involved in fuel metabolism. The
actions that affect protein, fat, and carbohydrate adrenal medulla secretes the catecholamines —
metabolism. It doesn’t decrease cAMP epinephrine and norepinephrine. The
production. The posterior pituitary hormone, parathyroids secrete parathyroid hormone.
antidiuretic hormone, regulates the threshold for 13. Answer A. Addison’s disease decreases the
water resorption in the kidneys. production of all adrenal hormones,
6. Answer C. Regular insulin, which is a short- compromising the body’s normal stress
acting insulin, has an onset of 15 to 30 minutes response and increasing the risk of infection.
and a peak of 2 to 4 hours. Because the nurse Other appropriate nursing diagnoses for a client
gave the insulin at 2 p.m., the expected onset with Addison’s disease include Deficient fluid
would be from 2:15 p.m. to 2:30 p.m. and the volume and Hyperthermia. Urinary retention
peak from 4 p.m. to 6 p.m. isn’t appropriate because Addison’s disease
7. Answer A. Agitation, irritability, poor memory, causes polyuria.
loss of appetite, and neglect of one’s 14. Answer A. Acarbose delays glucose absorption,
appearance may signal depression, which is so the client should take an oral form of
common in clients with Cushing’s syndrome. dextrose rather than a product containing table
Neuropathy affects clients with diabetes sugar when treating hypoglycemia. The alpha-
mellitus — not Cushing’s syndrome. Although glucosidase inhibitors work by delaying the
hypoglycemia can cause irritability, it also carbohydrate digestion and glucose absorption.
produces increased appetite, rather than loss of It’s safe to be on a regimen that includes insulin
appetite. Hyperthyroidism typically causes such and an alpha-glucosidase inhibitor. The client
signs as goiter, nervousness, heat intolerance, should take the drug at the start of a meal, not
and weight loss despite increased appetite. 30 minutes to an hour before.
8. Answer A. Tetany may result if the parathyroid 15. Answer B. After a transsphenoidal
glands are excised or damaged during thyroid hypophysectomy, the client must refrain from
surgery. Hemorrhage is a potential complication coughing, sneezing, and blowing the nose for
after thyroid surgery but is characterized by several days to avoid disturbing the surgical
tachycardia, hypotension, frequent swallowing, graft used to close the wound. The head of the
feelings of fullness at the incision site, choking, bed must be elevated, not kept flat, to prevent
and bleeding. Thyroid storm is another term for tension or pressure on the suture line. Within 24
severe hyperthyroidism — not a complication hours after a hypophysectomy, transient
of thyroidectomy. Laryngeal nerve damage may diabetes insipidus commonly occurs; this calls
occur postoperatively, but its signs include a for increased, not restricted, fluid intake.
hoarse voice and, possibly, acute airway Visual, not auditory, changes are a potential
obstruction. complication of hypophysectomy.
9. Answer A. Levothyroxine is the preferred agent 16. Answer A. The client should take glipizide
to treat primary hypothyroidism and cretinism, twice a day, 30 minutes before a meal, because
although it also may be used to treat secondary food decreases its absorption. The drug doesn’t
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cause hyponatremia and therefore doesn’t subcutaneous glucagon or an I.V. bolus of

necessitate monthly serum sodium dextrose 50%. The nurse shouldn’t administer
measurement. The client must continue to insulin to a client who’s hypoglycemic; this
monitor the blood glucose level during glipizide action will further compromise the client’s
therapy. condition.
17. Answer C. For this client, wet-to-dry dressings 25. Answer A. The client who has undergone a
are most appropriate because they clean the foot thyroidectomy is at risk for developing
ulcer by debriding exudate and necrotic tissue, hypocalcemia from inadvertent removal or
thus promoting healing by secondary intention. damage to the parathyroid gland. The client
Moist, transparent dressings contain exudate with hypocalcemia will exhibit a positive
and provide a moist wound environment. Chvostek’s sign (facial muscle contraction
Hydrocolloid dressings prevent the entrance of when the facial nerve in front of the ear is
microorganisms and minimize wound tapped) and a positive Trousseau’s sign (carpal
discomfort. Dry sterile dressings protect the spasm when a blood pressure cuff is inflated for
wound from mechanical trauma and promote a few minutes). These signs aren’t present with
healing. hypercalcemia, hypokalemia, or hyperkalemia
18. Answer C. The client should be encouraged to
force fluids to prevent renal calculi formation.
Sodium should be encouraged to replace losses
in urine. Restricting potassium isn’t necessary
in hyperparathyroidism. 1. An agitated, confused female client arrives in the
19. Answer D. In the client with hyperthyroidism, emergency department. Her history includes type 1
excessive thyroid hormone production leads to diabetes mellitus, hypertension, and angina pectoris.
hypermetabolism and increased nutrient Assessment reveals pallor, diaphoresis, headache, and
metabolism. These conditions may result in a intense hunger. A stat blood glucose sample measures
negative nitrogen balance, increased protein 42 mg/dl, and the client is treated for an acute
synthesis and breakdown, decreased glucose hypoglycemic reaction. After recovery, nurse Lily
tolerance, and fat mobilization and depletion. teaches the client to treat hypoglycemia by ingesting:
This puts the client at risk for marked nutrient
and calorie deficiency, making Imbalanced
A. 2 to 5 g of a simple carbohydrate.
nutrition: Less than body requirements the most
B. 10 to 15 g of a simple carbohydrate.
important nursing diagnosis. Options B and C
C. 18 to 20 g of a simple carbohydrate.
may be appropriate for a client with
D. 25 to 30 g of a simple carbohydrate.
hypothyroidism, which slows the metabolic
2. A female adult client with a history of chronic
rate.
hyperparathyroidism admits to being noncompliant.
20. Answer D. Serum osmolarity is the most
Based on initial assessment findings, nurse Julia
important test for confirming HHNS; it’s also
formulates the nursing diagnosis of Risk for injury.
used to guide treatment strategies and determine
To complete the nursing diagnosis statement for this
evaluation criteria. A client with HHNS
client, which “related-to” phrase should the nurse
typically has a serum osmolarity of more than
add?
350 mOsm/L. Serum potassium, serum sodium,
and ABG values are also measured, but they
aren’t as important as serum osmolarity for A. Related to bone demineralization resulting in
confirming a diagnosis of HHNS. A client with pathologic fractures
HHNS typically has hypernatremia and osmotic B. Related to exhaustion secondary to an
diuresis. ABG values reveal acidosis, and the accelerated metabolic rate
potassium level is variable. C. Related to edema and dry skin secondary to
21. Answer B. Exercise, reduced food intake, fluid infiltration into the interstitial spaces
hypothyroidism, and certain medications D. Related to tetany secondary to a decreased
decrease the insulin requirements. Growth, serum calcium level
pregnancy, greater food intake, stress, surgery, 3. Nurse John is assigned to care for a postoperative
infection, illness, increased insulin antibodies, male client who has diabetes mellitus. During the
and certain medications increase the insulin assessment interview, the client reports that he’s
requirements. impotent and says he’s concerned about its effect on
22. Answer A. As a normal body protein, glucagon his marriage. In planning this client’s care, the most
only interacts adversely with oral appropriate intervention would be to:
anticoagulants, increasing the anticoagulant
effects. It doesn’t interact adversely with A. Encourage the client to ask questions about
anabolic steroids, beta-adrenergic blockers, or personal sexuality.
thiazide diuretics. B. Provide time for privacy.
23. Answer A. The client should be instructed C. Provide support for the spouse or significant
always to follow the same order when drawing other.
the different insulins into the syringe. Insulin D. Suggest referral to a sex counselor or other
should never be shaken because the resulting appropriate professional.
froth prevents withdrawal of an accurate dose 4. During a class on exercise for diabetic clients, a
and may damage the insulin protein molecules. female client asks the nurse educator how often to
Insulin also should never be frozen because the exercise. The nurse educator advises the clients to
insulin protein molecules may be damaged. exercise how often to meet the goals of planned
Intermediate-acting insulin is normally cloudy. exercise?
24. Answer C. This client is having a hypoglycemic
episode. Because the client is conscious, the A. At least once a week
nurse should first administer a fast-acting B. At least three times a week
carbohydrate, such as orange juice, hard candy, C. At least five times a week
or honey. If the client has lost consciousness, D. Every day
the nurse should administer either I.M. or
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5. Nurse Oliver should expect a client with 13. Early this morning, a female client had a subtotal
hypothyroidism to report which health concerns? thyroidectomy. During evening rounds, nurse Tina
assesses the client, who now has nausea, a
A. Increased appetite and weight loss temperature of 105° F (40.5° C), tachycardia, and
B. Puffiness of the face and hands extreme restlessness. What is the most likely cause of
C. Nervousness and tremors these signs?
D. Thyroid gland swelling
6. A female client with hypothyroidism (myxedema) A. Diabetic ketoacidosis
is receiving levothyroxine (Synthroid), 25 mcg P.O. B. Thyroid crisis
daily. Which finding should nurse Hans recognize as C. Hypoglycemia
an adverse drug effect? D. Tetany
14. For a male client with hyperglycemia, which
A. Dysuria assessment finding best supports a nursing diagnosis
B. Leg cramps of Deficient fluid volume?
C. Tachycardia
D. Blurred vision A. Cool, clammy skin
7. A 67-year-old male client has been complaining of B. Distended neck veins
sleeping more, increased urination, anorexia, C. Increased urine osmolarity
weakness, irritability, depression, and bone pain that D. Decreased serum sodium level
interferes with her going outdoors. Based on these 15. When assessing a male client with
assessment findings, nurse Richard would suspect pheochromocytoma, a tumor of the adrenal medulla
which of the following disorders? that secretes excessive catecholamine, nurse April is
most likely to detect:
A. Diabetes mellitus
B. Diabetes insipidus A. a blood pressure of 130/70 mm Hg.
C. Hypoparathyroidism B. a blood glucose level of 130 mg/dl.
D. Hyperparathyroidism C. bradycardia.
8. When caring for a male client with diabetes D. a blood pressure of 176/88 mm Hg.
insipidus, nurse Juliet expects to administer: 16. A male client is admitted for treatment of the
syndrome of inappropriate antidiuretic hormone
A. vasopressin (Pitressin Synthetic). (SIADH). Which nursing intervention is appropriate?
B. furosemide (Lasix).
C. regular insulin. A. Infusing I.V. fluids rapidly as ordered
D. 10% dextrose. B. Encouraging increased oral intake
9. The nurse is aware that the following is the most C. Restricting fluids
common cause of hyperaldosteronism? D. Administering glucose-containing I.V. fluids as
ordered
A. Excessive sodium intake 17. A female client has a serum calcium level of 7.2
B. A pituitary adenoma mg/dl. During the physical examination, nurse Noah
C. Deficient potassium intake expects to assess:
D. An adrenal adenoma
10. A male client with type 1 diabetes mellitus has a A. Trousseau’s sign.
highly elevated glycosylated hemoglobin (Hb) test B. Homans’ sign.
result. In discussing the result with the client, nurse C. Hegar’s sign.
Sharmaine would be most accurate in stating: D. Goodell’s sign.
18. Which outcome indicates that treatment of a male
A. “The test needs to be repeated following a 12- client with diabetes insipidus has been effective?
hour fast.”
B. “It looks like you aren’t following the A. Fluid intake is less than 2,500 ml/day.
prescribed diabetic diet.” B. Urine output measures more than 200 ml/hour.
C. “It tells us about your sugar control for the last C. Blood pressure is 90/50 mm Hg.
3 months.” D. The heart rate is 126 beats/minute.
D. “Your insulin regimen needs to be altered 19. Jemma, who weighs 210 lb (95 kg) and has been
significantly.” diagnosed with hyperglycemia tells the nurse that her
11. Following a unilateral adrenalectomy, nurse Betty husband sleeps in another room because her snoring
would assess for hyperkalemia shown by which of keeps him awake. The nurse notices that she has large
the following? hands and a hoarse voice. Which of the following
would the nurse suspect as a possible cause of the
A. Muscle weakness client’s hyperglycemia?
B. Tremors
C. Diaphoresis A. Acromegaly
D. Constipation B. Type 1 diabetes mellitus
12. Nurse Louie is developing a teaching plan for a C. Hypothyroidism
male client diagnosed with diabetes insipidus. The D. Deficient growth hormone
nurse should include information about which 20. Nurse Kate is providing dietary instructions to a
hormone lacking in clients with diabetes insipidus? male client with hypoglycemia. To control
hypoglycemic episodes, the nurse should
A. antidiuretic hormone (ADH). recommend:
B. thyroid-stimulating hormone (TSH).
C. follicle-stimulating hormone (FSH). A. Increasing saturated fat intake and fasting in
D. luteinizing hormone (LH). the afternoon.
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B. Increasing intake of vitamins B and D and than 15 g may raise it above normal, causing
taking iron supplements. hyperglycemia.
C. Eating a candy bar if light-headedness occurs. 2. Answer A. Poorly controlled
D. Consuming a low-carbohydrate, high-protein hyperparathyroidism may cause an elevated
diet and avoiding fasting. serum calcium level. This, in turn, may
21. An incoherent female client with a history of diminish calcium stores in the bone, causing
hypothyroidism is brought to the emergency bone demineralization and setting the stage for
department by the rescue squad. Physical and pathologic fractures and a risk for injury.
laboratory findings reveal hypothermia, Hyperparathyroidism doesn’t accelerate the
hypoventilation, respiratory acidosis, bradycardia, metabolic rate. A decreased thyroid hormone
hypotension, and nonpitting edema of the face and level, not an increased parathyroid hormone
pretibial area. Knowing that these findings suggest level, may cause edema and dry skin secondary
severe hypothyroidism, nurse Libby prepares to take to fluid infiltration into the interstitial spaces.
emergency action to prevent the potential Hyperparathyroidism causes hypercalcemia, not
complication of: hypocalcemia; therefore, it isn’t associated with
tetany.
A. Thyroid storm. 3. Answer D. The nurse should refer this client to
B. Cretinism. a sex counselor or other professional. Making
C. myxedema coma. appropriate referrals is a valid part of planning
D. Hashimoto’s thyroiditis. the client’s care. The nurse doesn’t normally
22. A male client with type 1 diabetes mellitus asks provide sex counseling.
the nurse about taking an oral antidiabetic agent. 4. Answer B. Diabetic clients must exercise at
Nurse Jack explains that these medications are only least three times a week to meet the goals of
effective if the client: planned exercise — lowering the blood glucose
level, reducing or maintaining the proper
weight, increasing the serum high-density
A. prefers to take insulin orally. lipoprotein level, decreasing serum triglyceride
B. has type 2 diabetes. levels, reducing blood pressure, and minimizing
C. has type 1 diabetes. stress. Exercising once a week wouldn’t
D. is pregnant and has type 2 diabetes. achieve these goals. Exercising more than three
23. When caring for a female client with a history of times a week, although beneficial, would
hypoglycemia, nurse Ruby should avoid exceed the minimum requirement.
administering a drug that may potentiate 5. Answer B. Hypothyroidism (myxedema) causes
hypoglycemia. Which drug fits this description? facial puffiness, extremity edema, and weight
gain. Signs and symptoms of hyperthyroidism
A. sulfisoxazole (Gantrisin) (Graves’ disease) include an increased appetite,
B. mexiletine (Mexitil) weight loss, nervousness, tremors, and thyroid
C. prednisone (Orasone) gland enlargement (goiter).
D. lithium carbonate (Lithobid) 6. Answer C. Levothyroxine, a synthetic thyroid
24. After taking glipizide (Glucotrol) for 9 months, a hormone, is given to a client with
male client experiences secondary failure. Which of hypothyroidism to simulate the effects of
the following would the nurse expect the physician to thyroxine. Adverse effects of this agent include
do? tachycardia. The other options aren’t associated
with levothyroxine.
A. Initiate insulin therapy. 7. Answer D. Hyperparathyroidism is most
B. Switch the client to a different oral antidiabetic common in older women and is characterized
agent. by bone pain and weakness from excess
C. Prescribe an additional oral antidiabetic agent. parathyroid hormone (PTH). Clients also
D. Restrict carbohydrate intake to less than 30% of exhibit hypercaliuria-causing polyuria. While
the total caloric intake. clients with diabetes mellitus and diabetes
25. During preoperative teaching for a female client insipidus also have polyuria, they don’t have
who will undergo subtotal thyroidectomy, the nurse bone pain and increased sleeping.
should include which statement? Hypoparathyroidism is characterized by urinary
frequency rather than polyuria.
8. Answer A. Because diabetes insipidus results
A. “The head of your bed must remain flat for 24
from decreased antidiuretic hormone
hours after surgery.”
(vasopressin) production, the nurse should
B. “You should avoid deep breathing and
expect to administer synthetic vasopressin for
coughing after surgery.”
hormone replacement therapy. Furosemide, a
C. “You won’t be able to swallow for the first day
diuretic, is contraindicated because a client with
or two.”
diabetes insipidus experiences polyuria. Insulin
D. “You must avoid hyperextending your neck
and dextrose are used to treat diabetes mellitus
after surgery.”
and its complications, not diabetes insipidus.
Answers and Rationales
9. Answer D. An autonomous aldosterone-
1. Answer B. To reverse hypoglycemia, the producing adenoma is the most common cause
American Diabetes Association recommends of hyperaldosteronism. Hyperplasia is the
ingesting 10 to 15 g of a simple carbohydrate, second most frequent cause. Aldosterone
such as three to five pieces of hard candy, two secretion is independent of sodium and
to three packets of sugar (4 to 6 tsp), or 4 oz of potassium intake as well as of pituitary
fruit juice. If necessary, this treatment can be stimulation.
repeated in 15 minutes. Ingesting only 2 to 5 g 10. Answer C. The glycosylated Hb test provides
of a simple carbohydrate may not raise the an objective measure of glycemic control over a
blood glucose level sufficiently. Ingesting more 3-month period. The test helps identify trends
or practices that impair glycemic control, and it
doesn’t require a fasting period before blood is
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drawn. The nurse can’t conclude that the result diagnosed persons are usually very ill and thin.
occurs from poor dietary management or Hypothyroidism isn’t associated with
inadequate insulin coverage. hyperglycemia, nor is growth hormone
11. Answer A. Muscle weakness, bradycardia, deficiency.
nausea, diarrhea, and paresthesia of the hands, 20. Answer D. To control hypoglycemic episodes,
feet, tongue, and face are findings associated the nurse should instruct the client to consume a
with hyperkalemia, which is transient and low-carbohydrate, high-protein diet, avoid
occurs from transient hypoaldosteronism when fasting, and avoid simple sugars. Increasing
the adenoma is removed. Tremors, diaphoresis, saturated fat intake and increasing vitamin
and constipation aren’t seen in hyperkalemia. supplementation wouldn’t help control
12. Answer A. ADH is the hormone clients with hypoglycemia.
diabetes insipidus lack. The client’s TSH, FSH, 21. Answer C. Severe hypothyroidism may result in
and LH levels won’t be affected. myxedema coma, in which a drastic drop in the
13. Answer B. Thyroid crisis usually occurs in the metabolic rate causes decreased vital signs,
first 12 hours after thyroidectomy and causes hypoventilation (possibly leading to respiratory
exaggerated signs of hyperthyroidism, such as acidosis), and nonpitting edema. Thyroid storm
high fever, tachycardia, and extreme is an acute complication of hyperthyroidism.
restlessness. Diabetic ketoacidosis is more Cretinism is a form of hypothyroidism that
likely to produce polyuria, polydipsia, and occurs in infants. Hashimoto’s thyroiditis is a
polyphagia; hypoglycemia, to produce common chronic inflammatory disease of the
weakness, tremors, profuse perspiration, and thyroid gland in which autoimmune factors play
hunger. Tetany typically causes uncontrollable a prominent role.
muscle spasms, stridor, cyanosis, and possibly 22. Answer B. Oral antidiabetic agents are only
asphyxia. effective in adult clients with type 2 diabetes.
14. Answer C. In hyperglycemia, urine osmolarity Oral antidiabetic agents aren’t effective in type
(the measurement of dissolved particles in the 1 diabetes. Pregnant and lactating women aren’t
urine) increases as glucose particles move into prescribed oral antidiabetic agents because the
the urine. The client experiences glucosuria and effect on the fetus is uncertain.
polyuria, losing body fluids and experiencing 23. Answer A. Sulfisoxazole and other
fluid volume deficit. Cool, clammy skin; sulfonamides are chemically related to oral
distended neck veins; and a decreased serum antidiabetic agents and may precipitate
sodium level are signs of fluid volume excess, hypoglycemia. Mexiletine, an antiarrhythmic, is
the opposite imbalance. used to treat refractory ventricular arrhythmias;
15. Answer D. Pheochromocytoma, a tumor of the it doesn’t cause hypoglycemia. Prednisone, a
adrenal medulla that secretes excessive corticosteroid, is associated with
catecholamine, causes hypertension, hyperglycemia. Lithium may cause transient
tachycardia, hyperglycemia, hypermetabolism, hyperglycemia, not hypoglycemia.
and weight loss. It isn’t associated with the 24. Answer B. Many clients (25% to 60%) with
other options. secondary failure respond to a different oral
16. Answer C. To reduce water retention in a client antidiabetic agent. Therefore, it wouldn’t be
with the SIADH, the nurse should restrict appropriate to initiate insulin therapy at this
fluids. Administering fluids by any route would time. However, if a new oral antidiabetic agent
further increase the client’s already heightened is unsuccessful in keeping glucose levels at an
fluid load. acceptable level, insulin may be used in
17. Answer A. This client’s serum calcium level addition to the antidiabetic agent.
indicates hypocalcemia, an electrolyte
imbalance that causes Trousseau’s sign 25. Answer D. To prevent undue pressure on the
(carpopedal spasm induced by inflating the surgical incision after subtotal thyroidectomy,
blood pressure cuff above systolic pressure). the nurse should advise the client to avoid
Homans’ sign (pain on dorsiflexion of the foot) hyperextending the neck. The client may
indicates deep vein thrombosis. Hegar’s sign elevate the head of the bed as desired and
(softening of the uterine isthmus) and Goodell’s should perform deep breathing and coughing to
sign (cervical softening) are probable signs of help prevent pneumonia. Subtotal
pregnancy. thyroidectomy doesn’t affect swallowing.
18. Answer A. Diabetes insipidus is characterized
by polyuria (up to 8 L/day), constant thirst, and
an unusually high oral intake of fluids.
Treatment with the appropriate drug should
decrease both oral fluid intake and urine output.
A urine output of 200 ml/hour indicates
continuing polyuria. A blood pressure of 90/50
mm Hg and a heart rate of 126 beats/minute
indicate compensation for the continued fluid
deficit, suggesting that treatment hasn’t been
effective.
19. Answer A. Acromegaly, which is caused by a
pituitary tumor that releases excessive growth
hormone, is associated with hyperglycemia,
hypertension, diaphoresis, peripheral
neuropathy, and joint pain. Enlarged hands and
feet are related to lateral bone growth, which is
seen in adults with this disorder. The
accompanying soft tissue swelling causes
hoarseness and often sleep apnea. Type 1
diabetes is usually seen in children, and newly