RN exams gastrointestinal practice questions, set 11
RN exams · gastrointestinal
RN exams gastrointestinal practice questionsset 11
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 RN exams exam guide or more RN exams 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
A patient has questioned the nurses administration of IV normal saline, asking whether sterile water would be a
more appropriate choice than saltwater. Under what circumstances would the nurse administer electrolyte-free water
intravenously?
A. Never, because it rapidly enters red blood cells, causing them to rupture.
B. When the patient is severely dehydrated resulting in neurologic signs and symptoms
C. When the patient is in excess of calcium and/or magnesium ions
D. When a patients fluid volume deficit is due to acute or chronic renal failure
Show answer and rationale
Correct answer: A — Never, because it rapidly enters red blood cells, causing them to rupture.
The correct answer is A because electrolyte-free water, such as sterile water, can rapidly enter red blood cells due to osmotic differences, causing them to swell and potentially rupture, leading to hemolysis. This can result in severe harm to the patient.
Choice B is incorrect because electrolyte-free water is not indicated for severely dehydrated patients with neurologic signs and symptoms. They require electrolytes to correct their imbalances.
Choice C is incorrect as administering electrolyte-free water would not address excess calcium and/or magnesium ions in the body. Specific treatments for hypercalcemia or hypermagnesemia are needed.
Choice D is incorrect because patients with fluid deficits due to renal failure require electrolyte-balanced solutions to manage their condition effectively. Electrolyte-free water would not address the electrolyte imbalances associated with renal failure.
Question 2
How should the nurse explain esomeprazole (Nexium) to a patient with recurring heartburn?
A. It reduces gastroesophageal reflux by increasing the rate of gastric emptying.
B. It neutralizes stomach acid and provides relief of symptoms in a few minutes.
C. It coats and protects the lining of the stomach and esophagus from gastric acid.
D. It treats gastroesophageal reflux disease by decreasing stomach acid production.
Show answer and rationale
Correct answer: D — It treats gastroesophageal reflux disease by decreasing stomach acid production.
The correct answer is D because esomeprazole (Nexium) is a proton pump inhibitor that works by decreasing stomach acid production, thereby treating gastroesophageal reflux disease. This explanation is important for the patient to understand the mechanism of action of the medication.
Choice A is incorrect because esomeprazole does not increase the rate of gastric emptying; instead, it reduces acid production. Choice B is incorrect because esomeprazole does not neutralize stomach acid immediately; it takes a few days to reach its full effect. Choice C is incorrect because esomeprazole does not coat and protect the stomach and esophagus; it works by reducing acid production.
In summary, the correct answer is D because it accurately describes how esomeprazole works to manage recurring heartburn by decreasing stomach acid production, which is essential for treating gastroesophageal reflux disease.
Question 3
When considering tube feedings for a patient with severe protein-calorie malnutrition, what is an advantage of a gastrostomy tube versus a nasogastric (NG) tube?
A. There is less irritation to the nasal and esophageal mucosa.
B. The patient experiences the sights and smells associated with eating.
C. Aspiration resulting from reflux of formulas into the esophagus is less common.
D. Routine checking for placement is not required because gastrostomy tubes do not become displaced.
Show answer and rationale
Correct answer: A — There is less irritation to the nasal and esophageal mucosa.
Step-by-step rationale for why option A is correct:
1. Gastrostomy tube is inserted directly into the stomach, bypassing the esophagus, reducing irritation to nasal and esophageal mucosa.
2. NG tube goes through the nose, potentially causing irritation and discomfort to the mucosa.
3. In severe protein-calorie malnutrition, preservation of mucosal integrity is crucial for nutrient absorption.
4. Hence, choosing a gastrostomy tube minimizes additional stress on already compromised mucosa.
Summary of why other options are incorrect:
- Option B: The sensory experience of eating is unrelated to the nutritional benefits of tube feeding.
- Option C: Aspiration risk is not directly affected by the type of tube used but rather by proper feeding techniques and patient positioning.
- Option D: All feeding tubes require periodic checking for placement to prevent complications, including gastrostomy tubes.
Question 4
A nurse is caring for a client who has just returned from the PACU after a traditional cholecystectomy. In which of the following positions should the nurse place the client?
A. Prone
B. Semi-Fowler's
C. Supported Sims'
D. Dorsal recumbent
Show answer and rationale
Correct answer: B — Semi-Fowler's
The correct answer is B: Semi-Fowler's position. After a traditional cholecystectomy, placing the client in a Semi-Fowler's position (head of the bed elevated at 30-45 degrees) helps promote lung expansion, improve breathing, and reduce the risk of aspiration. This position also helps with comfort and aids in preventing complications such as respiratory issues and surgical site complications.
A: Prone position is incorrect as it involves lying on the stomach and is not appropriate for a client after cholecystectomy due to the risk of putting pressure on the abdomen and surgical site.
C: Supported Sims' position is incorrect as it is typically used for rectal examinations or enemas, not for post-cholecystectomy care.
D: Dorsal recumbent position is incorrect as it involves lying on the back with knees flexed, which may not provide optimal support and comfort for a client post-cholecystectomy.
Question 5
Which information will the nurse provide for a patient with newly diagnosed gastroesophageal reflux disease (GERD)?
A. Peppermint tea may reduce your symptoms.
B. Keep the head of your bed elevated on blocks.
C. You should avoid eating between meals to reduce acid secretion.
D. Vigorous physical activities may increase the incidence of reflux.
Show answer and rationale
Correct answer: B — Keep the head of your bed elevated on blocks.
The correct answer is B: Keep the head of your bed elevated on blocks. Elevating the head of the bed can help prevent stomach acid from flowing back into the esophagus during sleep, reducing nighttime symptoms of GERD. This position helps gravity keep the acid in the stomach.
A: Peppermint tea may actually worsen GERD symptoms as it can relax the lower esophageal sphincter, allowing acid to reflux back into the esophagus.
C: Avoiding eating between meals will not reduce acid secretion and may even lead to larger meals, which can trigger reflux symptoms.
D: Vigorous physical activities can worsen GERD symptoms by increasing intra-abdominal pressure, pushing stomach contents back up into the esophagus.
In summary, the correct answer is B because it directly addresses a practical measure to alleviate GERD symptoms during sleep, while the other choices do not effectively manage the condition.
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Question 6
A nurse is caring for four clients in the medical-surgical inpatient unit. One is a Black woman who has been admitted with pancreatitis, another is a White man who has been admitted with acute low back pain, the third is a Black man with pneumonia, and the fourth is a White woman who has been admitted with cholecystitis. The nurse medicates the Black woman with one oral Percocet tab for 8/10 pain, medicates the White man with two oxycodone tabs for 7/10 pain, does not medicate the Black man as he does not have current pain, and medicates the White woman with 2 mg of IV morphine for 8/10 pain. What is this an example of?
A. Explicit racism
B. Implicit bias
C. Professional standard of care
D. Structural racism
Correct answer:
The correct answer is B: Implicit bias. Implicit bias refers to unconscious attitudes or stereotypes that affect our actions and decisions. In this scenario, the nurse's decision to medicate the Black woman with less potent pain medication compared to the White man with more potent pain medication could be influenced by implicit bias. The nurse may have assumed the Black woman needs less pain relief or may have unconsciously prioritized the White man's pain over hers. This highlights how biases can impact healthcare decisions.
Summary:
A: Explicit racism is not demonstrated in the scenario as there is no overt discrimination based on race.
C: Professional standard of care could be argued, but the unequal treatment based on race suggests bias rather than following professional standards.
D: Structural racism involves systemic inequalities, which are not directly evident in this scenario.
After eating, a patient with an inflamed gallbladder experiences pain caused by contraction of the gallbladder. What is the mechanism responsible for this action?
A. Production of bile by the liver
B. Production of secretin by the duodenum
C. Release of gastrin from the stomach antrum
D. Production of cholecystokinin by the duodenum
Correct answer:
The correct answer is D: Production of cholecystokinin by the duodenum. Cholecystokinin (CCK) is released by the duodenum in response to the presence of fatty acids and amino acids. It stimulates the gallbladder to contract, causing the release of bile into the small intestine to aid in digestion. This is directly related to the patient's symptoms of gallbladder pain after eating, as the contraction of the gallbladder is triggered by CCK.
A: Production of bile by the liver is not the mechanism responsible for the gallbladder contraction.
B: Production of secretin by the duodenum is involved in regulating the pH of the duodenum, not gallbladder contraction.
C: Release of gastrin from the stomach antrum is related to stomach acid secretion, not gallbladder contraction.
In summary, the correct answer, D, is directly related to the mechanism responsible for gallbladder pain after eating,
A client returns from surgery with a sigmoid colostomy. An ostomy appliance is attached. The priority nursing diagnosis for daily observation and care is:
A. Diarrhea related to alteration in bowel elimination.
B. Impaired skin integrity related to seepage.
C. Impaired nutrition: More than body requirements related to high-fat diet.
D. Impaired physical mobility related to surgical procedure.
Correct answer:
The correct answer is B: Impaired skin integrity related to seepage. This is the priority nursing diagnosis because a colostomy appliance can lead to skin breakdown due to seepage of stool, which can cause irritation and skin breakdown. Maintaining skin integrity is crucial to prevent infection and promote healing.
A: Diarrhea is not the priority as it is a common issue after colostomy surgery but can be managed with appropriate interventions.
C: Impaired nutrition is not the priority as it is not specifically related to the immediate care of the colostomy appliance.
D: Impaired physical mobility is not the priority as it is not directly related to the immediate care of the colostomy appliance.
In summary, choice B is the correct answer because maintaining skin integrity is essential for the client's well-being and to prevent complications associated with a colostomy appliance.
A client returns from surgery with a sigmoid colostomy. An ostomy appliance is attached. The priority nursing diagnosis for daily observation and care is:
A. Diarrhea related to alteration in bowel elimination.
B. Impaired skin integrity related to seepage.
C. Impaired nutrition: More than body requirements related to high-fat diet.
D. Impaired physical mobility related to surgical procedure.
Correct answer:
The correct answer is B: Impaired skin integrity related to seepage. This is the priority nursing diagnosis because a colostomy appliance can lead to skin breakdown due to seepage of stool, which can cause irritation and skin breakdown. Maintaining skin integrity is crucial to prevent infection and promote healing.
A: Diarrhea is not the priority as it is a common issue after colostomy surgery but can be managed with appropriate interventions.
C: Impaired nutrition is not the priority as it is not specifically related to the immediate care of the colostomy appliance.
D: Impaired physical mobility is not the priority as it is not directly related to the immediate care of the colostomy appliance.
In summary, choice B is the correct answer because maintaining skin integrity is essential for the client's well-being and to prevent complications associated with a colostomy appliance.
Following a laparoscopic cholecystectomy, what should the nurse expect to be part of the plan of care?
A. Return to work in 2 to 3 weeks
B. Be hospitalized for 3 to 5 days postoperatively
C. Have a T-tube placed in the common bile duct to provide bile drainage
D. Have up to four small abdominal incisions covered with small dressings
Correct answer:
The correct answer is D. After a laparoscopic cholecystectomy, the patient typically has up to four small abdominal incisions that are covered with small dressings. This is because laparoscopic cholecystectomy is a minimally invasive procedure involving small incisions, which do not require extensive wound care. The incisions are small and usually heal well with minimal scarring.
Explanation for why other choices are incorrect:
A: Return to work in 2 to 3 weeks - This is not part of the immediate postoperative plan of care. Patients may need more time to recover before returning to work.
B: Be hospitalized for 3 to 5 days postoperatively - Patients undergoing laparoscopic cholecystectomy typically have a shorter hospital stay, usually 1 to 2 days, not 3 to 5 days.
C: Have a T-tube placed in the common bile duct to provide bile drainage - This is not typically done after a laparoscopic
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
Correct answer:
The correct answer is B: Lying on the left side with knees bent. This position allows for better visualization and access to the colon during the colonoscopy procedure. By lying on the left side, the client's colon is in a more optimal position for the scope to navigate through the colon. Additionally, bending the knees helps to relax the abdominal muscles and make the procedure more comfortable for the client.
Incorrect choices:
A: Lying on the right side with legs straight - This position does not provide optimal access to the colon and may make the procedure more difficult.
C: Prone with the torso elevated - This position is not suitable for a colonoscopy as it does not allow for proper access to the colon.
D: Bent over with hands touching the floor - This position is not recommended for a colonoscopy as it is not conducive to the procedure and may cause discomfort for the client.
In report, the nurse learns that the patient has a transverse colostomy. What should the nurse expect when providing care for this patient?
A. Semiliquid stools with increased fluid requirements
B. Liquid stools in a pouch and increased fluid requirements
C. Formed stools with a pouch, needing irrigation, but no fluid needs
D. Semiformed stools in a pouch with the need to monitor fluid balance
Correct answer:
The correct answer is A: Semiliquid stools with increased fluid requirements. A transverse colostomy is located in the upper part of the colon, where stool consistency is more liquid. This type of colostomy typically produces semiliquid stools due to the shorter transit time in the colon, leading to increased fluid requirements to prevent dehydration.
Summary of other choices:
B: Liquid stools in a pouch and increased fluid requirements - Incorrect because transverse colostomies produce semiliquid stools, not entirely liquid.
C: Formed stools with a pouch, needing irrigation, but no fluid needs - Incorrect as transverse colostomies do not produce formed stools, and fluid intake is necessary.
D: Semiformed stools in a pouch with the need to monitor fluid balance - Incorrect because transverse colostomies produce semiliquid stools, not semiformed, and increased fluid intake is needed.
A nurse is caring for four clients in the medical-surgical inpatient unit. One is a Black woman who has been admitted with pancreatitis, another is a White man who has been admitted with acute low back pain, the third is a Black man with pneumonia, and the fourth is a White woman who has been admitted with cholecystitis. The nurse medicates the Black woman with one oral Percocet tab for 8/10 pain, medicates the White man with two oxycodone tabs for 7/10 pain, does not medicate the Black man as he does not have current pain, and medicates the White woman with 2 mg of IV morphine for 8/10 pain. What is this an example of?
A. Explicit racism
B. Implicit bias
C. Professional standard of care
D. Structural racism
Correct answer:
The correct answer is B: Implicit bias. Implicit bias refers to unconscious attitudes or stereotypes that affect our actions and decisions. In this scenario, the nurse's decision to medicate the Black woman with less potent pain medication compared to the White man with more potent pain medication could be influenced by implicit bias. The nurse may have assumed the Black woman needs less pain relief or may have unconsciously prioritized the White man's pain over hers. This highlights how biases can impact healthcare decisions.
Summary:
A: Explicit racism is not demonstrated in the scenario as there is no overt discrimination based on race.
C: Professional standard of care could be argued, but the unequal treatment based on race suggests bias rather than following professional standards.
D: Structural racism involves systemic inequalities, which are not directly evident in this scenario.
A patient who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in the response?
A. Fiber-containing laxatives may reduce the absorption of fat-soluble vitamins.
B. Dietary sources of fiber should be eliminated to prevent excessive gas formation.
C. Use of this type of laxative to prevent constipation does not cause adverse effects.
D. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.
Correct answer:
Rationale for Correct Answer D:
- Psyllium is a bulk-forming laxative that works by absorbing water in the intestines, forming a gel-like mass that helps with bowel movements.
- Taking large amounts of fluid is essential when using psyllium to prevent the gel-like mass from hardening and causing impaction or bowel obstruction.
- Adequate fluid intake is crucial for the safe and effective use of psyllium as a laxative.
Summary of Incorrect Choices:
- Choice A is incorrect because fiber-containing laxatives like psyllium do not directly impact the absorption of fat-soluble vitamins.
- Choice B is incorrect as dietary sources of fiber should not be eliminated entirely but rather balanced to prevent excessive gas.
- Choice C is incorrect as all medications, including laxatives, can have potential adverse effects; however, psyllium is generally well-tolerated when used appropriately.
A 34-year-old male client has diagnoses of liver failure, ascites, and hepatic encephalopathy secondary to alcohol abuse. The client's family is questioning the care team as to why his abdomen is so large even though he is undernourished and emaciated. Which of the following statements most accurately underlies the explanation that a member of the care team would provide the family?
A. An inordinate amount of interstitial fluid is accumulating in his abdomen.
B. The transcellular component of the intracellular fluid compartment contains far more fluid than normal.
C. Normally small transcellular fluid compartment, or third space, is becoming enlarged.
D. Gravity-dependent plasma is accumulating in his peritoneal cavity.
Correct answer:
The correct answer is C: Normally small transcellular fluid compartment, or third space, is becoming enlarged. In liver failure with ascites, there is an abnormal accumulation of fluid in the peritoneal cavity due to low oncotic pressure from decreased albumin production by the liver. This results in an enlarged transcellular fluid compartment, known as the "third space," leading to the distended abdomen. Options A, B, and D are incorrect because they do not accurately explain the specific fluid compartment enlargement seen in ascites related to liver failure. Option A refers to interstitial fluid, not the transcellular compartment. Option B incorrectly mentions the intracellular fluid compartment, which is not the primary issue in ascites. Option D incorrectly refers to plasma accumulating in the peritoneal cavity, which is not the mechanism behind the abdominal distension in this case.
RN exams gastrointestinal practice questions, set 11 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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