Nursing textbooks gastrointestinal practice questions
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Nursing textbooks gastrointestinal practice questions
You read GI bleed, liver, and nutrition stems and pick the intervention that protects the patient now. Five of the 15 questions include the correct answer and rationale. The other ten keep answers in the study hub. Continue with the Nursing textbooks exam guide or more Nursing textbooks practice questions.
Five gastrointestinal questions with answers
Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
Which actions are taken to verify the correct placement of a small-bore NG tube immediately after insertion? (Rank your answers in the correct order.)
A. Aspirate the gastric contents, check the pH of contents, and observe the color
B. Confirm the size of the feeding tube after taping
C. Place the distal end of the tube in a glass of water and observe for bubbles indicating air exchange
D. Take an x-ray
E. Flush the tube with 15 to 30 mL of water to ensure its correct placement
Show answer and rationale
Correct answer: D — Take an x-ray
To verify the correct placement of a small-bore NG tube immediately after insertion, the first and most important step is to obtain an x-ray, as this is the gold standard for confirming placement and must be completed before administering any feedings or medications. Once placement is confirmed radiographically, the nurse can then aspirate gastric contents, checking the pH (which should be between 1 and 5) and observing the color, which is typically grassy green, tan, or off-white, indicating gastric placement. Next, the nurse should confirm the tube size and ensure it is securely taped in place to prevent displacement. After verification, the nurse may flush the tube with 15 to 30 mL of water to confirm patency, but this is done only after placement is confirmed, not as a method of verification itself. The water bubble test, which involves placing the distal end of the tube in water to check for bubbles, is outdated and unreliable and should not be used in current clinical practice.
Question 2
The nurse is providing care for a patient with chronic obstructive pulmonary disease. When describing the process of respiration the nurse explains how oxygen and carbon dioxide are exchanged between the pulmonary capillaries and the alveoli. The nurse is describing what process?
A. Diffusion
B. Osmosis
C. Active transport
D. Filtration
Show answer and rationale
Correct answer: A — Diffusion
Diffusion is the natural tendency of a substance to move from an area of higher concentration to one of lower concentration. It occurs through the random movement of ions and molecules. Examples of diffusion are the exchange of oxygen and carbon dioxide between the pulmonary capillaries and alveoli and the tendency of sodium to move from the ECF compartment, where the sodium concentration is high, to the ICF, where its concentration is low. Osmosis occurs when two different solutions are separated by a membrane that is impermeable to the dissolved substances; fluid shifts through the membrane from the region of low solute concentration to the region of high solute concentration until the solutions are of equal concentration. Active transport implies that energy must be expended for the movement to occur against a concentration gradient. Movement of water and solutes occurring from an area of high hydrostatic pressure to an area of low hydrostatic pressure is filtration.
Question 3
Upon shift report, the nurse states the following laboratory values: $\mathrm{pH}, 7.44 ; \mathrm{PCO}_2, 30 \mathrm{mmHg}$; and $\mathrm{HCO}_3, 21 \mathrm{mEq} / \mathrm{L}$ for a client with noted acid-base disturbances. Which acid-base imbalance do both nurses agree is the client's current state?
A. Compensated respiratory alkalosis
B. Uncompensated respiratory alkalosis
C. Compensated metabolic acidosis
D. Compensated metabolic alkalosis
Show answer and rationale
Correct answer: A — Compensated respiratory alkalosis
The question states that the client has a history of acid-base disturbance. The nurse would first note that the $\mathrm{pH}$ has returned to close to normal indicating compensation. The nurse then assess the $\mathrm{PCO}_2$ (normal: 35 to $45 \mathrm{~mm} \mathrm{Hg}$ ) and $\mathrm{HCO}_3$ (normal: 22 to $27 \mathrm{mEq} / \mathrm{L}$ ) levels. In a respiratory condition, the $\mathrm{pH}$ and the $\mathrm{PCO}_2$ move in opposite directions; thus, the $\mathrm{pH}$ rises and the $\mathrm{PCO}_2$ drops (alkalosis) or vice versa (acidosis). In a metabolic condition, the $\mathrm{pH}$ and the bicarbonate move in the same direction; if the $\mathrm{pH}$ is low, the bicarbonate level will be low, also. In this client, the $\mathrm{pH}$ is at the high end of normal, indicating compensation and alkalosis. The $\mathrm{PCO}_2$ is low, indicating a respiratory condition (opposite direction of the $\mathrm{pH}$ ).
Question 4
You are the nurse caring for a patient who is Native American who arrives at the clinic for treatment related to type 2 diabetes. Which question would best provide you with information about the role of food in the patients cultural practices and identify how the patients food preferences could be related to his problem?
A. Do you feel any of your cultural practices have a negative impact on your disease process?
B. What types of foods are served as a part of your cultural practices, and how are they prepared?
C. As a nonnative, I am unaware of your cultural practices. Could you teach me a few practices that may affect your care?
D. Tell me about foods that are important in your culture and how you feel they influence your diabetes.
Show answer and rationale
Correct answer: D — Tell me about foods that are important in your culture and how you feel they influence your diabetes.
The beliefs and practices that have been shared from generation to generation are known as cultural or ethnic patterns. Food plays a significant role in both cultural practices and type 2 diabetes. By asking the question, Tell me about the foods that are important in your culture and how you feel they influence your diabetes, the nurse demonstrates a cultural awareness to the client and allows an open-ended discussion of the disease process and its relationship to cultural practice. An overemphasis on negatives can inhibit assessment and communication. Assessing the types and preparation of foods specific to cultural practices without relating it to diabetes is inadequate. The question, As a nonnative, I am unaware of your cultural practices. Could you teach me a few practices that may affect your care? focuses on care and fails to address the significance of food in cultural practice or diabetes.
Question 5
One day after a patient is admitted to the medical unit, you note that the patient is oliguric. You notify the acute-care nurse practitioner who orders a fluid challenge of 200 mL of normal saline solution over 15 minutes. This intervention will achieve which of the following?
A. Help distinguish hyponatremia from hypernatremia
B. Help evaluate pituitary gland function
C. Help distinguish reduced renal blood flow from decreased renal function
D. Help provide an effective treatment for hypertension-induced oliguria
Show answer and rationale
Correct answer: C — Help distinguish reduced renal blood flow from decreased renal function
If a patient is not excreting enough urine, the health care provider needs to determine whether the depressed renal function is the result of reduced renal blood flow, which is a fluid volume deficit (FVD or prerenal azotemia), or acute tubular necrosis that results in necrosis or cellular death from prolonged FVD. A typical example of a fluid challenge involves administering 100 to 200 mL of normal saline solution over 15 minutes. The response by a patient with FVD but with normal renal function is increased urine output and an increase in blood pressure. Laboratory examinations are needed to distinguish hyponatremia from hypernatremia. A fluid challenge is not used to evaluate pituitary gland function. A fluid challenge may provide information regarding hypertension-induced oliguria, but it is not an effective treatment.
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Question 6
The nurse is managing the care of a client needing gastrointestinal suction and decompression with a Levin tube. Place the steps of initiating suction and decompression in the order the nurse should perform them.
A. Insert the gastric decompression tube.
B. Locate the suction source.
C. Connect the decompression tube to the suction.
D. Select suction according to health care provider prescription.
Correct answer:
The nurse should locate the suction source, usually a wall outlet or portable machine. The nurse should then adjust the suction level on the wall outlet or portable machine to provide the amount and frequency of suction specified by the primary provider. The nurse should select intermittent high, low, or continuous suction when using a Salem sump tube; the nurse should select low intermittent suction when using a Levin tube because the single lumen may adhere to the lining of the stomach during continuous suction (if the tube is used only to obtain specimens for diagnostic purposes, manual suction may be achieved by attaching a syringe to the end of the tube and drawing back on the plunger). Finally, the nurse should insert the gastric decompression tube in accordance with accepted standards and connect it to the suction.
A nurse is conducting a health assessment of an adult patient when the patient asks, Why do you need all this health information and who is going to see it? What is the nurses best response?
A. Please do not worry. It is safe and will be used only to help us with your care. Its accessible to a wide variety of people who are invested in your health.
B. It is good you asked and you have a right to know; your information helps us to provide you with the best possible care, and your records are in a secure place.
C. Your health information is placed on secure Web sites to provide easy access to anyone wishing to see your medical records. This ensures continuity of care.
D. Health information becomes the property of the hospital and we will make sure that no one sees it. Then, in 2 years, we destroy all records and the process starts over.
Correct answer:
Whenever information is elicited from a person through a health history or physical examination, the person has the right to know why the information is sought and how it will be used. For this reason, it is important to explain what the history and physical examination are, how the information will be obtained, and how it will be used. Medical records allow access to health care providers who need the information to provide patients with the best possible care, and the records are always held in a secure environment. Telling the patient not to worry minimizes the patients concern regarding the safety of his or her health information and a wide variety of people should not have access to patients health information. Health information should not be placed on Web sites and health records are not destroyed every 2 years.
The nurse in the medical ICU is caring for a patient who is in respiratory acidosis due to inadequate ventilation. What diagnosis could the patient have that could cause inadequate ventilation?
A. Endocarditis
B. Multiple myeloma
C. Guillain-Barr??® syndrome
D. Overdose of amphetamines
Correct answer:
Respiratory acidosis is always due to inadequate excretion of CO2 with inadequate ventilation, resulting in elevated plasma CO2 concentrations and, consequently, increased levels of carbonic acid. Acute respiratory acidosis occurs in emergency situations, such as acute pulmonary edema, aspiration of a foreign object, atelectasis, pneumothorax, overdose of sedatives, sleep apnea, administration of oxygen to a patient with chronic hypercapnia (excessive CO2 in the blood), severe pneumonia, and acute respiratory distress syndrome. Respiratory acidosis can also occur in diseases that impair respiratory muscles, such as muscular dystrophy, myasthenia gravis, and Guillain-Barr??® syndrome. The other listed diagnoses are not associated with respiratory acidosis.
A 73-year-old man comes into the emergency department (ED) by ambulance after slipping on a small carpet in his home. The patient fell on his hip with a resultant fracture. He is alert and oriented; his pupils are equal and reactive to light and accommodation. His heart rate is elevated, he is anxious and thirsty, a Foley catheter is placed, and 40 mL of urine is present. What is the nurses most likely explanation for the low urine output?
A. The man urinated prior to his arrival to the ED and will probably not need to have the Foley catheter kept in place.
B. The man likely has a traumatic brain injury, lacks antidiuretic hormone (ADH), and needs vasopressin.
C. The man is experiencing symptoms of heart failure and is releasing atrial natriuretic peptide that results in decreased urine output.
D. The man is having a sympathetic reaction, which has stimulated the reninangiotensinaldosterone system that results in diminished urine output.
Correct answer:
Renin is released by the juxtaglomerular cells of the kidneys in response to decreased renal perfusion. Angiotensin-converting enzyme converts angiotensin I to angiotensin II. Angiotensin II, with its vasoconstrictor properties, increases arterial perfusion pressure and stimulates thirst. As the sympathetic nervous system is stimulated, aldosterone is released in response to an increased release of renin, which decreases urine production. Based on the nursing assessment and mechanism of injury, this is the most likely causing the lower urine output. The man urinating prior to his arrival to the ED is unlikely; the fall and hip injury would make his ability to urinate difficult. No assessment information indicates he has a head injury or heart failure.
Nursing students are reviewing information about health care delivery systems in post conference. Which statements describing current U.S. health care delivery practices should be included in the discussion? Select all that apply.
A. Access to care depends only on the ability to pay, not the availability of services.
B. The Patient Protection and Affordable Care Act provides private health care insurance to underserved populations.
C. Every health insurance plan in the Health Insurance Marketplace offers comprehensive coverage, from doctors to medications to hospital visits.
D. The uninsured pay for more than one third of their care out of pocket and are usually charged lower amounts for their care than the insured pay.
E. Fifty years ago, half of the doctors in the United States practiced primary care, but today fewer than one in three do.
Correct answer:
The Health Insurance Marketplace is designed to help people more easily find health insurance that fits their budget. All plans in the Marketplace offer comprehensive coverage, from doctors to medications to hospital visits. There are many fewer primary care providers in the United States than there were 50 years ago. Quality is the right care for the right person at the right time. Access to care depends on both the ability to pay and the availability of services. The Patient Protection and Affordable Care Act provides Medicaid or subsidized coverage to qualifying people with incomes up to 400% of poverty. The uninsured pay for more than one third of their care out of pocket and are often charged higher amounts for their care than the insured pay.
The nurse is caring for a client who is prescribed mesalamine. The client is also taking warfarin. Which of the following interactions should the nurse monitor the client for when he is administered mesalamine with warfarin?
A. Increased risk of immunosuppression
B. Increased blood glucose level
C. Increased risk of bleeding
D. Increased risk of CNS depression
Correct answer:
The client administered mesalamine and warfarin is at an increased risk of bleeding. Warfarin is an anticoagulant used as a blood thinner; mesalamine is an aminosalicylate, which is an aspirin-like compound with anti-inflammatory action. The combination of mesalamine and warfarin does not increase the risk of immunosuppression, increase the blood glucose level, or increase the risk of CNS depression. There is an increased risk of immunosuppression if an aminosalicylate interacts with methotrexate used in cancer and autoimmune conditions. There is an increased blood glucose level when oral hypoglycemic drugs interact with aminosalicylates. There is an increased risk of CNS depression when opioids are administered with aminosalicylates.
The nurse caring for a patient post colon resection is assessing the patient on the second postoperative day. The nasogastric tube (NG) remains patent and continues at low intermittent wall suction. The IV is patent and infusing at 125 mL/hr. The patient reports pain at the incision site rated at a 3 on a 0-to-10 rating scale. During your initial shift assessment, the patient complains of cramps in her legs and a tingling sensation in her feet. Your address foot pain and you suspect the patient has hypokalemia. What other symptom would you expect this patient to exhibit?
A. Diarrhea
B. Dilute urine
C. Increased muscle tone
D. Joint pain
Correct answer:
Manifestations of hypokalemia include fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps, decreased bowel motility, paresthesias (numbness and tingling), and dysrhythmias. If prolonged, hypokalemia can lead to an inability of the kidneys to concentrate urine, causing dilute urine (resulting in polyuria, nocturia) and excessive thirst. Potassium depletion suppresses the release of insulin and results in glucose intolerance. Decreased muscle strength and DTRs can be found on physical assessment. You would expect decreased, not increased, muscle strength with hypokalemia. The patient would not have diarrhea following bowel surgery, and increased bowel motility is inconsistent with hypokalemia.
A client is diagnosed with colon cancer, located in the lower third of the rectum. What does the nurse understand will be the surgical treatment option for this client?
A. Colectomy
B. Segmental resection
C. Abdominoperineal resection
D. A low colectomy
Correct answer:
A cancerous mass in the lower third of the rectum will result in an abdominoperineal resection with a wide excision of the rectum and the creation of a sigmoid colostomy. An encapsulated colorectal tumor may be removed without taking away surrounding healthy tissue. This type of tumor, however, may call for partial or complete surgical removal of the colon (colectomy). Occasionally, the tumor causes a partial or complete bowel obstruction. If the tumor is in the colon and upper third of the rectum, a segmental resection is performed. In this procedure, the surgeon removes the cancerous portion of the colon and rejoins the remaining portions of the GI tract to restore normal intestinal continuity.
The nurse is preparing to administer ondansetron to an older adult client. Which safety warning(s) should the nurse consider when administering the medication? Select all that apply.
A. Do not use if the client has a heart block or prolonged QT interval.
B. Increases sedation if used with opiates.
C. Emphasize prevention. The client must take consistently to prevent nausea and vomiting.
D. Explain that it must be started before travel to be effective.
E. Explain that there is a risk for dehydration.
Correct answer:
When administering ondansetron to an older adult client, the nurse should take extra care to consider safety warnings that advise the nurse to avoid use if a client has a heart block or prolonged QT interval, and should also be mindful that the medication can increase sedation when used with opiates. In addition, the nurse should adhere to guidelines instructing an emphasis on prevention for the client, the older adult client must take the medication consistently to prevent nausea and vomiting. Ondansetron is not given to relieve motion sickness; therefore, beginning the medication before travel is not applicable. Prochlorperazine, not ondansetron, may increase dehydration in older adults.
A nurse is planning care for a nephrology patient with a new nursing graduate. The nurse states, A patient in renal failure partially loses the ability to regulate changes in pH. What is the cause of this partial inability?
A. The kidneys regulate and reabsorb carbonic acid to change and maintain pH.
B. The kidneys buffer acids through electrolyte changes.
C. The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH.
D. The kidneys combine carbonic acid and bicarbonate to maintain a stable pH.
Correct answer:
The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as reabsorb them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis, the kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. The lungs regulate and reabsorb carbonic acid to change and maintain pH. The kidneys do not buffer acids through electrolyte changes; buffering occurs in reaction to changes in pH. Carbonic acid works as the chemical medium to exchange O2 and CO2 in the lungs to maintain a stable pH whereas the kidneys use bicarbonate as the chemical medium to maintain a stable pH by moving and eliminating H+.
About these Nursing textbooks gastrointestinal questions
Nursing textbooks gastrointestinal practice questions for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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