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Chapter 17 Questions
1. During preparation for bowel surgery, a male client receives
an antibiotic to reduce intestinal bacteria. Antibiotic therapy may
interfere with synthesis of which vitamin and may lead to
A. vitamin A
B. vitamin D
C. vitamin E
D. vitamin K
2. When evaluating a male client for complications of acute
pancreatitis, the nurse would observe for:
A. increased intracranial pressure.
B. decreased urine output.
3. A male client with a recent history of rectal bleeding is being
prepared for a colonoscopy. How should the nurse position the client
for this test initially?
A. Lying on the right side with legs straight
B. Lying on the left side with knees bent
C. Prone with the torso elevated
D. Bent over with hands touching the floor
4. A male client with extreme weakness, pallor, weak peripheral pulses,
and disorientation is admitted to the emergency department. His wife
reports that he has been “spitting up blood.” A Mallory-Weiss tear is
suspected, and the nurse begins taking a client history from the client’s
wife. The question by the nurse that demonstrates her understanding
of Mallory-Weiss tearing is:
A. “Tell me about your husband’s alcohol usage.”
B. “Is your husband being treated for tuberculosis?”
C. “Has your husband recently fallen or injured his chest?”
D. “Describe spices and condiments your husband uses on food.”
5. Which of the following nursing interventions should the nurse
perform for a female client receiving enteral feedings through a
A. Change the tube feeding solutions and tubing at least every 24 hours.
B. Maintain the head of the bed at a 15-degree elevation continuously.
C. Check the gastrostomy tube for position every 2 days.
D. Maintain the client on bed rest during the feedings.
6. A male client is recovering from a small-bowel resection. To
relieve pain, the physician prescribes meperidine (Demerol), 75 mg I.M.
every 4 hours. How soon after administration should meperidine onset
of action occur?
A. 5 to 10 minutes
B. 15 to 30 minutes
C. 30 to 60 minutes
D. 2 to 4 hours
7. The nurse is caring for a male client with cirrhosis. Which assessment
findings indicate that the client has deficient vitamin K absorption
caused by this hepatic disease?
A. Dyspnea and fatigue
B. Ascites and orthopnea
C. Purpura and petechiae
D. Gynecomastia and testicular atrophy
8. Which condition is most likely to have a nursing diagnosis of fluid
D. Gastric ulcer
9. While a female client is being prepared for discharge, the nasogastric
(NG) feeding tube becomes cloggeD. To remedy this problem and teach
the client’s family how to deal with it at home, what should the nurse
A. Irrigate the tube with cola.
B. Advance the tube into the intestine.
C. Apply intermittent suction to the tube.
D. Withdraw the obstruction with a 30-ml syringe.
10. A male client with pancreatitis complains of pain. The nurse expects
the physician to prescribe meperidine (Demerol) instead of morphine to
relieve pain because:
A. meperidine provides a better, more prolonged analgesic effect.
B. morphine may cause spasms of Oddi’s sphincter.
C. meperidine is less addictive than morphine.
D. morphine may cause hepatic dysfunction.
11. Mandy, an adolescent girl is admitted to an acute care facility with
severe malnutrition. After a thorough examination, the physician
diagnoses anorexia nervosa. When developing the plan of care for this
client, the nurse is most likely to include which nursing diagnosis?
C. Chronic low self-esteem
D. Deficient knowledge
12. Which diagnostic test would be used first to evaluate a client with
upper GI bleeding?
B. Upper GI series
C. Hemoglobin (Hb) levels and hematocrit (HCT)
13. A female client who has just been diagnosed with hepatitis A asks,
“How could I have gotten this disease?” What is the nurse’s best
A. “You may have eaten contaminated restaurant food.”
B. “You could have gotten it by using I.V. drugs.”
C. “You must have received an infected blood transfusion.”
D. “You probably got it by engaging in unprotected sex.”
14. When preparing a male client, age 51, for surgery to treat
appendicitis, the nurse formulates a nursing diagnosis of Risk for
infection related to inflammation, perforation, and surgery. What is the
rationale for choosing this nursing diagnosis?
A. Obstruction of the appendix may increase venous drainage and cause the
appendix to rupture.
B. Obstruction of the appendix reduces arterial flow, leading to ischemia,
inflammation, and rupture of the appendix.
C. The appendix may develop gangrene and rupture, especially in a middleaged client.
D. Infection of the appendix diminishes necrotic arterial blood flow and
increases venous drainage.
15. A female client with hepatitis C develops liver failure and GI
hemorrhage. The blood products that would most likely bring about
hemostasis in the client are:
A. whole blood and albumin.
B. platelets and packed red blood cells.
C. fresh frozen plasma and whole blood.
D. cryoprecipitate and fresh frozen plasma.
16. To prevent gastroesophageal reflux in a male client with
hiatal hernia, the nurse should provide which discharge instruction?
A. “Lie down after meals to promote digestion.”
B. “Avoid coffee and alcoholic beverages.”
C. “Take antacids with meals.”
D. “Limit fluid intake with meals.”
17. The nurse caring for a client with small-bowel obstruction would
plan to implement which nursing intervention first?
A. Administering pain medication
B. Obtaining a blood sample for laboratory studies
C. Preparing to insert a nasogastric (NG) tube
D. Administering I.V. fluids
18. A female client with dysphagia is being prepared for discharge.
Which outcome indicates that the client is ready for discharge?
A. The client doesn’t exhibit rectal tenesmus.
B. The client is free from esophagitis and achalasia.
C. The client reports diminished duodenal inflammation.
D. The client has normal gastric structures.
19. A male client undergoes total gastrectomy. Several hours after
surgery, the nurse notes that the client’s nasogastric (NG) tube has
stopped draining. How should the nurse respond?
A. Notify the physician
B. Reposition the tube
C. Irrigate the tube
D. Increase the suction level
20. What laboratory finding is the primary diagnostic indicator for
A. Elevated blood urea nitrogen (BUN)
B. Elevated serum lipase
C. Elevated aspartate aminotransferase (AST)
D. Increased lactate dehydrogenase (LD)
21. A male client with cholelithiasis has a gallstone lodged in the
common bile duct. When assessing this client, the nurse expects to
A. yellow sclera.
B. light amber urine.
C. circumoral pallor.
D. black, tarry stools.
22. Nurse Hannah is teaching a group of middle-aged men about peptic
ulcers. When discussing risk factors for peptic ulcers, the nurse should
A. a sedentary lifestyle and smoking.
B. a history of hemorrhoids and smoking.
C. alcohol abuse and a history of acute renal failure.
D. alcohol abuse and smoking.
23. While palpating a female client’s right upper quadrant (RUQ), the
nurse would expect to find which of the following structures?
A. Sigmoid colon
24. A male client has undergone a colon resection. While turning him,
wound dehiscence with evisceration occurs. The nurse’s first response
A. call the physician.
B. place saline-soaked sterile dressings on the wound.
C. take a blood pressure and pulse.
D. pull the dehiscence closed.
25. The nurse is monitoring a female client receiving paregoric to
treat diarrhea for drug interactions. Which drugs can produce
additive constipation when given with an opium preparation?
A. Antiarrhythmic drugs
B. Anticholinergic drugs
C. Anticoagulant drugs
D. Antihypertensive drugs
26. A male client is recovering from an ileostomy that was performed to
treat inflammatory bowel disease. During discharge teaching, the nurse
should stress the importance of:
A. increasing fluid intake to prevent dehydration.
B. wearing an appliance pouch only at bedtime.
C. consuming a low-protein, high-fiber diet.
D. taking only enteric-coated medications.
27. The nurse is caring for a female client with active upper GI bleeding.
What is the appropriate diet for this client during the first 24 hours
A. Regular diet
B. Skim milk
C. Nothing by mouth
D. Clear liquids
28. A male client has just been diagnosed with hepatitis A. On
assessment, the nurse expects to note:
A. severe abdominal pain radiating to the shoulder.
B. anorexia, nausea, and vomiting.
C. eructation and constipation.
D. abdominal ascites.
29. A female client with viral hepatitis A is being treated in an acute
care facility. Because the client requires enteric precautions, the nurse
A. place the client in a private room.
B. wear a mask when handling the client’s bedpan.
C. wash the hands after touching the client.
D. wear a gown when providing personal care for the client.
30. Which of the following factors can cause hepatitis A?
A. Contact with infected blood
B. Blood transfusions with infected blood
C. Eating contaminated shellfish
D. Sexual contact with an infected person
Answers and Rationale
1. Answer: D. vitamin K
Intestinal bacteria synthesize such nutritional substances as vitamin K,
thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid.
Therefore, antibiotic therapy may interfere with synthesis of these
substances, including vitamin K. Intestinal bacteria don’t synthesize vitamins
A, D, or E.
2. Answer: B. decreased urine output.
Acute pancreatitis can cause decreased urine output, which results from the
renal failure that sometimes accompanies this condition. Intracranial
pressure neither increases nor decreases in a client with pancreatitis.
Tachycardia, not bradycardia, usually is associated with pulmonary or
hypovolemic complications of pancreatitis. Hypotension can be caused by a
hypovolemic complication, but hypertension usually isn’t related to acute
3. Answer: B. Lying on the left side with knees bent
For a colonoscopy, the nurse initially should position the client on the left
side with knees bent. Placing the client on the right side with legs straight,
prone with the torso elevated, or bent over with hands touching the floor
wouldn’t allow proper visualization of the large intestine.
4. Answer: A. “Tell me about your husband’s alcohol usage.”
A Mallory-Weiss tear is associated with massive bleeding after a tear occurs
in the mucous membrane at the junction of the esophagus and stomach.
There is a strong relationship between ethanol usage, resultant vomiting,
and a Mallory-Weiss tear. The bleeding is coming from the stomach, not from
the lungs as would be true in some cases of tuberculosis. A Mallory-Weiss
tear doesn’t occur from chest injuries or falls and isn’t associated with eating
5. Answer: A. Change the tube feeding solutions and tubing at least
every 24 hours.
Tube feeding solutions and tubing should be changed every 24 hours, or
more frequently if the feeding requires it. Doing so prevents contamination
and bacterial growth. The head of the bed should be elevated 30 to 45
degrees continuously to prevent aspiration. Checking for gastrostomy tube
placement is performed before initiating the feedings and every 4 hours
during continuous feedings. Clients may ambulate during feedings.
6. Answer: B. 15 to 30 minutes
Meperidine’s onset of action is 15 to 30 minutes. It peaks between 30 and 60
minutes and has a duration of action of 2 to 4 hours.
7. Answer: C. Purpura and petechiae
A hepatic disorder, such as cirrhosis, may disrupt the liver’s normal use of
vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse
should monitor the client for signs of bleeding, including purpura and
petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are
unrelated to vitamin K absorption. Gynecomastia and testicular atrophy
result from decreased estrogen metabolism by the diseased liver.
8. Answer: B. Pancreatitis
Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis.
The other conditions are less likely to exhibit fluid volume deficit.
9. Answer: A. Irrigate the tube with cola.
The nurse should irrigate the tube with cola because its effervescence and
acidity are suited to the purpose, it’s inexpensive, and it’s readily available in
most homes. Advancing the NG tube is inappropriate because the tube is
designed to stay in the stomach and isn’t long enough to reach the intestines.
Applying intermittent suction or using a syringe for aspiration is unlikely to
dislodge the material clogging the tube but may create excess pressure.
Intermittent suction may even collapse the tube.
10. Answer: B. morphine may cause spasms of Oddi’s sphincter.
For a client with pancreatitis, the physician will probably avoid prescribing
morphine because this drug may trigger spasms of the sphincter of Oddi (a
sphincter at the end of the pancreatic duct), causing irritation of the
pancreas. Meperidine has a somewhat shorter duration of action than
morphine. The two drugs are equally addictive. Morphine isn’t associated
with hepatic dysfunction.
11. Answer: C. Chronic low self-esteem
Young women with Chronic low self-esteem — are at highest risk for
anorexia nervosa because they perceive being thin as a way to improve their
self-confidence. Hopelessness and Powerlessness are inappropriate nursing
diagnoses because clients with anorexia nervosa seldom feel hopeless or
powerless; instead, they use food to control their desire to be thin and hope
that restricting food intake will achieve this goal. Anorexia nervosa doesn’t
result from a knowledge deficit, such as one regarding good nutrition.
12. Answer: A. Endoscopy
Endoscopy permits direct evaluation of the upper GI tract and can detect
90% of bleeding lesions. An upper GI series, or barium study, usually isn’t the
diagnostic method of choice, especially in a client with acute active bleeding
who’s vomiting and unstable. An upper GI series is also less accurate than
endoscopy. Although an upper GI series might confirm the presence of a
lesion, it wouldn’t necessarily reveal whether the lesion is bleeding. Hb levels
and HCT, which indicate loss of blood volume, aren’t always reliable
indicators of GI bleeding because a decrease in these values may not be seen
for several hours. Arteriography is an invasive study associated with lifethreatening complications and wouldn’t be used for an initial evaluation.
13. Answer: A. “You may have eaten contaminated restaurant food.”
Hepatitis A virus typically is transmitted by the oral-fecal route — commonly
by consuming food contaminated by infected food handlers. The virus isn’t
transmitted by the I.V. route, blood transfusions, or unprotected
sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion.
Hepatitis C can be transmitted by unprotected sex.
14. Answer: B. Obstruction of the appendix reduces arterial flow,
leading to ischemia, inflammation, and rupture of the appendix.
A client with appendicitis is at risk for infection related to inflammation,
perforation, and surgery because obstruction of the appendix causes mucus
fluid to build up, increasing pressure in the appendix and compressing
venous outflow drainage. The pressure continues to rise with venous
obstruction; arterial blood flow then decreases, leading to ischemia from lack
of perfusion. Inflammation and bacterial growth follow, and swelling
continues to raise pressure within the appendix, resulting in gangrene and
rupture. Geriatric, not middle-aged, clients are especially susceptible to
15. Answer: D. cryoprecipitate and fresh frozen plasma.
The liver is vital in the synthesis of clotting factors, so when it’s diseased or
dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of
administering blood products that aid clotting. These include fresh frozen
plasma containing fibrinogen and cryoprecipitate, which have most of the
clotting factors. Although administering whole blood, albumin, and packed
cells will contribute to hemostasis, those products aren’t specifically used to
treat hemostasis. Platelets are helpful, but the best answer is cryoprecipitate
and fresh frozen plasma.
16. Answer: B. “Avoid coffee and alcoholic beverages.”
To prevent reflux of stomach acid into the esophagus, the nurse should
advise the client to avoid foods and beverages that increase stomach acid,
such as coffee and alcohol. The nurse also should teach the client to avoid
lying down after meals, which can aggravate reflux, and to take antacids after
eating. The client need not limit fluid intake with meals as long as the fluids
aren’t gastric irritants.
17. Answer: D. Administering I.V. fluids
I.V. infusions containing normal saline solution and potassium should be
given first to maintain fluid and electrolyte balance. For the client’s comfort
and to assist in bowel decompression, the nurse should prepare to insert an
NG tube next. A blood sample is then obtained for laboratory studies to aid
in the diagnosis of bowel obstruction and guide treatment. Blood studies
usually include a complete blood count, serum electrolyte levels, and blood
urea nitrogen level. Pain medication often is withheld until obstruction is
diagnosed because analgesics can decrease intestinal motility.
18. Answer: B. The client is free from esophagitis and achalasia.
Dysphagia may be the reason why a client with esophagitis or achalasia
seeks treatment. Dysphagia isn’t associated with rectal tenesmus, duodenal
inflammation, or abnormal gastric structures.
19. Answer: A. Notify the physician
An NG tube that fails to drain during the postoperative period should be
reported to the physician immediately. It may be clogged, which could
increase pressure on the suture site because fluid isn’t draining adequately.
Repositioning or irrigating an NG tube in a client who has undergone gastric
surgery can disrupt the anastomosis. Increasing the level of suction may
cause trauma to GI mucosa or the suture line.
20. Answer: B. Elevated serum lipase
Elevation of serum lipase is the most reliable indicator of pancreatitis
because this enzyme is produced solely by the pancreas. A client’s BUN is
typically elevated in relation to renal dysfunction; the AST, in relation to liver
dysfunction; and LD, in relation to damaged cardiac muscle.
21. Answer: A. yellow sclera.
Yellow sclerae may be the first sign of jaundice, which occurs when the
common bile duct is obstructed. Urine normally is light amber. Circumoral
pallor and black, tarry stools don’t occur in common bile duct obstruction;
they are signs of hypoxia and GI bleeding, respectively.
22. Answer: D. alcohol abuse and smoking.
Risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse,
smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren’t
risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is
associated with duodenal ulcers.
23. Answer: D. Liver
The RUQ contains the liver, gallbladder, duodenum, head of the pancreas,
hepatic flexure of the colon, portions of the ascending and transverse colon,
and a portion of the right kidney. The sigmoid colon is located in the left
lower quadrant; the appendix, in the right lower quadrant; and the spleen, in
the left upper quadrant.
24. Answer: B. place saline-soaked sterile dressings on the wound.
The nurse should first place saline-soaked sterile dressings on the open
wound to prevent tissue drying and possible infection. Then the nurse
should call the physician and take the client’s vital signs. The dehiscence
needs to be surgically closed, so the nurse should never try to close it.
25. Answer: B. Anticholinergic drugs
Paregoric has an additive effect of constipation when used with
anticholinergic drugs. Antiarrhythmics, anticoagulants, and antihypertensives
aren’t known to interact with paregoric.
26. Answer: A. increasing fluid intake to prevent dehydration.
Because stool forms in the large intestine, an ileostomy typically drains liquid
waste. To avoid fluid loss through ileostomy drainage, the nurse should
instruct the client to increase fluid intake. The nurse should teach the client
to wear a collection appliance at all times because ileostomy drainage is
incontinent, to avoid high-fiber foods because they may irritate the
intestines, and to avoid enteric-coated medications because the body can’t
absorb them after an ileostomy
27. Answer: C. Nothing by mouth
Shock and bleeding must be controlled before oral intake, so the client
should receive nothing by mouth. A regular diet is incorrect. When the
bleeding is controlled, the diet is gradually increased, starting with ice chips
and then clear liquids. Skim milk shouldn’t be given because it increases
gastric acid production, which could prolong bleeding. A liquid diet is the first
diet offered after bleeding and shock are controlled.
28. Answer: B. anorexia, nausea, and vomiting.
Hallmark signs and symptoms of hepatitis A include anorexia, nausea,
vomiting, fatigue, and weakness. Abdominal pain may occur but doesn’t
radiate to the shoulder. Eructation and constipation are common in
gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced
hepatic disease, not an early sign of hepatitis A.
29. Answer: C. wash the hands after touching the client.
To maintain enteric precautions, the nurse must wash the hands after
touching the client or potentially contaminated articles and before caring for
another client. A private room is warranted only if the client has poor hygiene
— for instance, if the client is unlikely to wash the hands after touching
infective material or is likely to share contaminated articles with other clients.
For enteric precautions, the nurse need not wear a mask and must wear a
gown only if soiling from fecal matter is likely.
30. Answer: C. Eating contaminated shellfish
Hepatitis A can be caused by consuming contaminated water, milk, or food
— especially shellfish from contaminated water. Hepatitis B is caused by
blood and sexual contact with an infected person. Hepatitis C is usually
caused by contact with infected blood, including receiving blood