DMC COLLEGE FOUNDATION INC.

COLLEGE OF NURSING
GASTROINTESTINAL-HEPATOBILIARY
CHAPTER TEST
Directions: Write the number of the best answer. A separate answer sheet is provided. DO NOT
WRITE ANYTHING on this questionnaire.
1. The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is
scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and
begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel
sounds are diminished. Which is the most appropriate nursing intervention?
1. Notify the health care provider.
2. Administer the prescribed pain medication.
3. Call and ask the operating room team to perform the surgery as soon as possible.
4. Reposition the client and apply a heating pad on the warm setting to the client's abdomen.

2. A client has been admitted to the hospital with a diagnosis of acute pancreatitis and the nurse is
assessing the client's pain. What type of pain is consistent with this diagnosis?
1. Burning and aching, located in the left lower quadrant and radiating to the hip
2. Severe and unrelenting, located in the epigastric area and radiating to the back
3. Burning and aching, located in the epigastric area and radiating to the umbilicus
4. Severe and unrelenting, located in the left lower quadrant and radiating to the groin

3. The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Where
should the nurse anticipate the location of the pain?
1. Right lower quadrant, radiating to the back
2. Right lower quadrant, radiating to the umbilicus
3. Right upper quadrant, radiating to the left scapula and shoulder
4. Right upper quadrant, radiating to the right scapula and shoulder

4. A client is admitted to the hospital with viral hepatitis, complaining of "no appetite" and "losing my
taste for food." What instruction should the nurse give the client to provide adequate nutrition?
1. Select foods high in fat.
2. Increase intake of fluids, including juices.
3. Eat a good supper when anorexia is not as severe.
4. Eat less often, preferably only three large meals daily.

5. A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the
client for which expected assessment finding?
1. Malaise
2. Dark stools
3. Weight gain
4. Left upper quadrant discomfort
6. A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate for this
client? Select all that apply.
1. Administer stool softeners as prescribed.
2. Instruct the client to limit fluid intake to avoid urinary retention.
3. Instruct the client to avoid activities that will initiate vasovagal responses.
4. Encourage a high-fiber diet to promote bowel movements without straining.
5. Apply cold packs to the anal-rectal area over the dressing until the packing is removed.
6. Help the client to a Fowler's position to place pressure on the rectal area and decrease
bleeding.
7. The nurse is planning to teach a client with gastroesophageal reflux disease about substances to
avoid. Which items should the nurse include on this list? Select all that apply.
1. Coffee
2. Chocolate
3. Peppermint
4. Nonfat milk
5. Fried chicken
6. Scrambled eggs
8. A client has undergone esophagogastroduodenoscopy. The nurse should place highest
priority on which item as part of the client's care plan?
1. Monitoring the temperature
2. Monitoring complaints of heartburn
3. Giving warm gargles for a sore throat
4. Assessing for the return of the gag reflex
9. The nurse has taught the client about an upcoming endoscopic retrograde
cholangiopancreatography procedure. The nurse determines that the client needs further
information if the client makes which statement?
1. "I know I must sign the consent form."
2. "I hope the throat spray keeps me from gagging."
3. "I'm glad I don't have to lie still for this procedure."
4. "I'm glad some IV medication will be given to relax me."
10. The health care provider has determined that a client with hepatitis has contracted the infection
from contaminated food. The nurse understands that this client is most likely experiencing what
type of hepatitis?
1. Hepatitis A
2. Hepatitis B
3. Hepatitis C
4. Hepatitis D
11. The nurse is caring for a client with a diagnosis of chronic gastritis. The nurse monitors the client,
knowing that this client is at risk for which vitamin deficiency?
1. Vitamin A
2. Vitamin B12
3. Vitamin C
4. Vitamin E
12. The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the
T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing
intervention is most appropriate?
1. Clamp the T-tube.
2. Irrigate the T-tube.
3. Document the findings.
4. Notify the health care provider.
13. The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding
would most likely indicate perforation of the ulcer?
1. Bradycardia
2. Numbness in the legs
3. Nausea and vomiting
4. A rigid, boardlike abdomen
14. The nurse is caring for a client following a Billroth II procedure. Which postoperative prescription
should the nurse question and verify?
1. Leg exercises
2. Early ambulation
3. Irrigating the nasogastric tube
4. Coughing and deep-breathing exercises
15. The nurse is providing discharge instructions to a client following gastrectomy and should instruct
the client to take which measure to assist in preventing dumping syndrome?
1. Ambulate following a meal.
2. Eat high-carbohydrate foods.
3. Limit the fluids taken with meals.
4. Sit in a high Fowler's position during meals.
16. The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of
acute pancreatitis. Which interventions would the nurse expect to be prescribed for the
client? Select all that apply.
1. Administer antacids as prescribed.
2. Encourage coughing and deep breathing.
3. Administer anticholinergics as prescribed.
4. Give small, frequent high-calorie feedings.
5. Maintain the client in a supine and flat position.
6. Give opioid analgesics as prescribed for pain.
17. The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic
should the nurse expect to note documented in the client's record?
1. Diarrhea
2. Chronic constipation
3. Constipation alternating with diarrhea
4. Stool constantly oozing from the rectum
18. The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that there is
documentation of the presence of Asterixis. How should the nurse assess for its presence?
1. Dorsiflex the client's foot.
2. Measure the abdominal girth.
3. Ask the client to extend the arms.
4. Instruct the client to lean forward.
19. The nurse is reviewing the laboratory results for a client with cirrhosis and notes that the
ammonia level is elevated. Which diet does the nurse anticipate to be prescribed for this client?
1. Low-protein diet
2. High-protein diet
3. Moderate-fat diet
4. High-carbohydrate diet
20. The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To
determine whether the problem is currently active, the nurse should assess the client for which
symptom(s) of duodenal ulcer?
1. Weight loss
2. Nausea and vomiting
3. Pain relieved by food intake
4. Pain radiating down the right arm
21. A client with hiatal hernia chronically experiences heartburn following meals. The nurse should
plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia?
1. Lying recumbent following meals
2. Consuming small, frequent, bland meals
3. Raising the head of the bed on 6-inch blocks
4. Taking H2-receptor antagonist medication
22. The nurse is assessing for stoma prolapse in a client with a colostomy. What should the nurse
observe if stoma prolapse occurs?
1. Protruding stoma
2. Sunken and hidden stoma
3. Narrowed and flattened stoma
4. Dark- and bluish-colored stoma
23. A client had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus
from the stoma. What is the correct interpretation by the nurse?
1. This is a normal, expected event.
2. The client is experiencing early signs of ischemic bowel.
3. The client should not have the nasogastric tube removed.
4. This indicates inadequate preoperative bowel preparation.
24. A client has just had surgery to create an ileostomy. The nurse assesses the client in the
immediate postoperative period for which most frequent complication of this type of surgery?
1. Folate deficiency
2. Malabsorption of fat
3. Intestinal obstruction
4. Fluid and electrolyte imbalance
25. The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which
findings indicate this occurrence?
1. Sweating and pallor
2. Bradycardia and indigestion
3. Double vision and chest pain
4. Abdominal cramping and pain
26. A client presents to the emergency department with upper gastrointestinal bleeding and is in
moderate distress. In planning care, what is the priority nursing action for this client?
1. Assessment of vital signs
2. Completion of abdominal examination
3. Insertion of the prescribed nasogastric tube
4. Thorough investigation of precipitating events
27. The nurse is caring for a client with acute pancreatitis and is monitoring the client for paralytic
ileus. Which assessment data should alert the nurse to this occurrence?
 1. Inability to pass flatus
2. Loss of anal sphincter control
3. Severe, constant pain with rapid onset
4. Firm, nontender mass palpable at the lower right costal margin
28. The nurse inspects the color of the drainage from a nasogastric tube on a postoperative client
approximately 24 hours after gastric surgery. Which finding indicates the need to notify the health
care provider?
1. Dark red drainage
2. Dark brown drainage
3. Green-tinged drainage
4. Light yellowish brown drainage
29. The nurse is preparing to discontinue a client's nasogastric tube. The client is positioned
properly, and the tube has been flushed with 15 mL of air to clear secretions. Before removing
the tube, the nurse should make which statement to the client?
1. "Take a deep breath when I tell you and hold it while I remove the tube."
2. "Take a deep breath when I tell you and bear down while I remove the tube."
3. "Take a deep breath when I tell you and slowly exhale while I remove the tube."
4. "Take a deep breath when I tell you and breathe normally while I remove the tube."
30. The nurse is caring for a client with a resolved intestinal obstruction who has a nasogastric tube
in place. The client has tolerated the tube being clamped every 2 hours for 1 hour. The health
care provider has now prescribed that the nasogastric tube be removed. What is
the priority nursing assessment prior to removing the tube?
1. Checking for normal serum electrolyte levels
2. Checking for normal pH of the gastric aspirate
3. Checking for proper nasogastric tube placement
4. Checking for the presence of bowel sounds in all four quadrants
31. A sexually active 20-year-old client has developed viral hepatitis. Which client statement
indicates the need for further teaching?
1. "I should avoid drinking alcohol."
2. "I can go back to work right away."
3. "My partner should get the vaccine."
4. "A condom should be used for sexual intercourse."
32. After performing an initial abdominal assessment on a client with a diagnosis of cholelithiasis, the
nurse documents that the bowel sounds are normal. Which descriptionbest describes "normal
bowel sounds"?
1. Waves of loud gurgles auscultated in all four quadrants
2. Low-pitched swishing auscultated in one or two quadrants
3. Relatively high-pitched clicks or gurgles auscultated in all four quadrants
4. Very high-pitched loud rushes auscultated especially in one or two quadrants
33. After undergoing Billroth I gastric surgery, the client experiences fatigue and complains of
numbness and tingling in the feet and difficulties with balance. On the basis of these symptoms,
the nurse suspects which postoperative complication?
1. Stroke
2. Pernicious anemia
3. Bacterial meningitis
4. Peripheral arterial disease
34. A client experiencing chronic dumping syndrome makes the following comments to the nurse.
Which one indicates the need for further teaching?
1. "I eat at least three large meals each day."
2. "I eat while lying in a semirecumbent position."
3. "I have eliminated taking liquids with my meals."
4. "I eat a high-protein, low- to moderate-carbohydrate diet."
35. The nurse obtains an admission history for a client with suspected peptic ulcer disease. Which
client factor documented by the nurse would increase the risk for peptic ulcer disease?
1. Recently retired from a job
2. Significant other has a gastric ulcer
3. Occasionally drinks one cup of coffee in the morning
4. Takes nonsteroidal anti-inflammatory drugs (NSAIDs) for osteoarthritis

36. A client who has undergone gastric surgery has a nasogastric (NG) tube connected to low
intermittent suction that is not draining properly. Which action should the nurse take initially?
 1. Call the surgeon to report the problem.
2. Reposition the NG tube to the proper location.
3. Check the suction device to make sure it is working.
4. Irrigate the NG tube with saline to remove the obstruction.
37. In performing a physical assessment of a client with a diagnosis of ulcerative colitis, the nurse
should expect which finding?
1. Hypercalcemia
2. Fibrous stricture
3. Frothy, fatty stools
4. Decreased hemoglobin
38. A client with acute ulcerative colitis requests a snack. Which would be the most appropriate
snack for this client?
1. Carrots and ranch dip
2. Whole-grain cereal and milk
3. A cup of popcorn and a cola drink
4. Applesauce and a graham cracker
39. The nurse is teaching the client with viral hepatitis about the stages of the disease. The nurse
should explain to the client that the second stage of this disease is characterized by which
specific assessment findings? Select all that apply.
1. Jaundice
2. Flu-like symptoms
3. Clay-colored stools
4. Dark or tea-colored urine
5. Elevated bilirubin levels
40. The nurse is teaching an older client about measures to prevent constipation. Which statement, if
made by the client, indicates that further teaching is necessary about bowel elimination?
1. "I walk 1 to 2 miles every day."
2. "I need to decrease fiber in my diet."
3. "I have a bowel movement every other day."
4. "I drink six to eight glasses of water every day."
41. The nurse provides dietary instructions to a client with a diagnosis of cholecystitis. Which food
item identified by the client indicates an understanding of foods to avoid?
1. Fresh fruit
2. Brown gravy
3. Fresh vegetables
4. Poultry without skin
42. The nurse is performing an assessment on a client with acute pancreatitis who was admitted to
the hospital. Which assessment question would most specifically elicit information regarding the
pain that is associated with acute pancreatitis?
1. "Does the pain in your stomach radiate to the back?"
2. "Does the pain in your lower abdomen radiate to the hip?"
3. "Does the pain in your lower abdomen radiate to your groin?"
4. "Does the pain in your stomach radiate to your lower middle abdomen?"
43. The nurse is providing instructions to a client with a colostomy about measures to reduce the
odor from the colostomy. Which statement, if made by the client, indicates an understanding of
these measures?
1. "I should be sure to eat at least one cucumber every day."
2. "Beet greens, parsley, or yogurt will help to control the colostomy odor."
3. "I will need to increase my egg intake and try to eat ½ to 1 egg per day."
4. "Green vegetables such as spinach and broccoli will prevent odor, and I should eat these
foods every day."
44. The nurse has provided dietary instructions to a client with a diagnosis of peptic ulcer disease.
Which statement, if made by the client, indicates an understanding of the dietary measures to
take?
1. "Baked foods such as chicken or fish are all right to eat."
2. "Citrus fruits and raw vegetables need to be included in my daily diet."
3. "I can drink beer so long as I consume only a moderate amount each day."
4. "I can drink coffee or tea so long as I limit the amount to two cups daily."

45. The nurse has provided home care instructions to a client who had a subtotal gastrectomy. The
nurse instructs the client regarding the signs and symptoms associated with dumping syndrome.
 Which signs and symptoms, if identified by the client, would indicate an understanding of this
potential complication after gastrointestinal (GI) surgery?
1. Hiccups and diarrhea
2. Constipation and fever
3. Diaphoresis and diarrhea
4. Fatigue and abdominal pain
46. The nurse is providing instructions to a client regarding measures to minimize the risk of dumping
syndrome. The nurse should make which suggestion to the client?
1. Maintain a high-carbohydrate diet.
2. Increase fluid intake, particularly at meal time.
3. Maintain a low Fowler's position while eating.
4. Ambulate for at least 30 minutes following each meal.
47. A client with peptic ulcer disease states that stress frequently causes exacerbation of the
disease. The nurse determines that which item mentioned by the client is most likely to be
responsible for the exacerbation?
1. Sleeping 8 to 10 hours a night
2. Ability to work at home periodically
3. Eating five or six small meals per day
4. Frequent need to work overtime on short notice
48. The nurse is giving dietary instructions to a client who has a new colostomy. The nurse should
encourage the client to eat foods representing which diet for the first 4 to 6 weeks
postoperatively?
1. Low fiber
2. Low calorie
3. High protein
4. High carbohydrate
49. A client with viral hepatitis is discussing with the nurse the need to avoid alcohol and states, "I'm
not sure I can avoid alcohol." What is the most appropriate nursing response?
1. "I don't believe that."
2. "Everything will be all right."
3. "I'm not sure that I understand. Would you please explain?"
4. "I think you should talk more with the health care provider about this."
50. A client is hospitalized with a diagnosis of viral hepatitis. To detect any difficulty in coping with
this disease, the nurse should ask which question?
1. "Do you have a fever?"
2. "Are you losing weight?"
3. "Have you enjoyed having visitors?"
4. "Do you rest sometime during the day?"
51. A client with viral hepatitis states, "I am so yellow." What is the most appropriate nursing
action?
1. Assist the client in expressing feelings.
2. Restrict visitors until the jaundice subsides.
3. Perform most of the activities of daily living for the client.
4. Provide information to the client only when he or she requests it.
52. A client with viral hepatitis has no appetite, and food makes the client nauseated. Which nursing
intervention would be most appropriate?
1. Encourage foods that are high in protein.
2. Monitor for fluid and electrolyte imbalance.
3. Explain that high-fat diets usually are better tolerated.
4. Explain that most daily calories need to be consumed in the evening hours.
53. A nurse has implemented a bowel maintenance program for an unconscious client. The nurse
would evaluate the plan asbest meeting the needs of the client if which method was successful in
stimulating a bowel movement?
1. Fleet enema
2. Fecal disimpaction
3. Glycerin suppository
4. Soap solution enema (SSE)

54. The nurse checks the gastric residual of an unconscious client receiving nasogastric tube
feedings continuously at 50 mL/hr. The nurse notes that the residual is 200 mL. The nurse
determines that the client is experiencing which complication?
 1. Air in the stomach
2. Too slow an infusion rate
3. Delayed gastric emptying
4. Early signs of peptic ulcer
55. The nurse is developing a teaching plan for a client with viral hepatitis. The nurse should plan to
include which information in the teaching session?
1. The diet should be low in calories.
2. Meals should be large to conserve energy.
3. Activity should be limited to prevent fatigue.
4. Alcohol intake should be limited to 2 ounces per day.
56. The nurse is providing care for a client with a Sengstaken-Blakemore tube. The nurse suspects
which diagnosis for this client?
1. Gastritis
2. Bowel obstruction
3. Small bowel tumor
4. Esophageal varices
57. The nurse has been caring for a client who required a Sengstaken-Blakemore tube because
other treatment measures for esophageal varices were unsuccessful. The health care provider
arrives on the nursing unit and deflates the esophageal balloon. After deflation of the balloon, the
nurse should monitor the client most closely for which complication?
1. Hematemesis
2. Bloody diarrhea
3. Swelling of the abdomen
4. An elevated temperature and a rise in blood pressure
58. A client in a long-term care facility is being prepared to be discharged to home in 2 days. The
client has been eating a regular diet for a week; however, he is still receiving intermittent enteral
tube feedings and will need to receive these feedings at home. The client states concern that he
will not be able to continue the tube feedings at home. Which nursing response is most
appropriate at this time?
1. "Do you want to stay here in this facility a few more days?"
2. "Have you discussed your feelings with your health care provider?"
3. "You need to talk to your health care provider about these findings."
4. "Tell me more about your concerns with your diet after going home."
59. The nurse is performing an assessment on a client with a suspected diagnosis of acute
pancreatitis. The nurse will direct the assessment to look for which as a hallmark sign of this
disorder?
1. Hypothermia
2. Epigastric pain radiating to the neck area
3. Severe abdominal pain relieved by vomiting
4. Severe abdominal pain that is unrelieved by vomiting
60. The nurse is reviewing the record of a client admitted to the nursing unit and notes that the client
has a history of Laennec's cirrhosis. This type of cirrhosis is most commonly caused by which
long-term condition?
1. Alcohol abuse
2. Cardiac disease
3. Exposure to chemicals
4. Obstruction to biliary ducts
61. The nurse who is caring for a client with a diagnosis of cirrhosis is monitoring the client for signs
of portal hypertension. Which initial sign, if noted in the client, indicates the presence of portal
hypertension?
1. Weak pulse
2. Hypotension
3. Flat neck veins
4. Crackles on auscultation of the lungs

62. The nurse is developing a plan of care for a client with cirrhosis and ascites. Which nursing
actions should be included in the care plan for this client? Select all that apply.
1. Monitor daily weight.
2. Measure abdominal girth.
 3. Monitor respiratory status.
4. Place the client in a supine position.
5. Assist the client with care as needed.
63. The nurse is monitoring a client with cirrhosis of the liver for signs of hepatic encephalopathy.
Which assessment finding would the nurse note as an early sign of hepatic encephalopathy?
1. Restlessness
2. Complaints of fatigue
3. The presence of asterixis
4. Decreased serum ammonia levels
64. A home care nurse is visiting a client with a diagnosis of pernicious anemia that developed as a
result of gastric surgery. In teaching the client about this condition, the nurse explains that the
stomach lining is producing a decreased amount of intrinsic factor, so the client will need which
medication?
1. An antacid
2. An antibiotic
3. Vitamin B6 injections
4. Vitamin B12 injections
65. A client arrives at the hospital emergency department complaining of acute right lower quadrant
abdominal pain, and appendicitis is suspected. Laboratory tests are performed, and the nurse
notes that the client's white blood cell count is elevated. On the basis of these findings, the nurse
would question which health care provider's prescriptions documented in the client's medical
record?
1. Apply a cold pack to the abdomen.
2. Administer 30 mL of milk of magnesia .
3. Maintain nothing-by-mouth (nil per os [NPO]) status.
4. Initiate an intravenous (IV) line for the administration of IV fluids.
66. A health care provider prescribes a Salem sump tube for gastrointestinal intubation. The nurse
prepares for the insertion and obtains which item from the supply room?
1. A Dobbhoff weighted tube
2. A Sengstaken-Blakemore tube
3. A tube with a large lumen and an air vent
4. A tube with a single lumen that connects to suction
67. The nurse is preparing to insert a nasogastric (NG) tube as prescribed for the purpose of
stomach decompression. The nurse reviews the health care provider's prescriptions and
anticipates that the HCP will prescribe which type of suction pressure and control?
1. High and intermittent
2. Low and intermittent
3. High and continuous
4. Low and continuous
68. The nurse is providing dietary instructions to a client with a diagnosis of irritable bowel syndrome.
The nurse determines that the client understands the instructions if the client states the need to
avoid which food?
1. Rice
2. Corn
3. Broiled chicken
4. Cream of wheat
69. Diphenoxylate hydrochloride with atropine sulfate (Lomotil) is prescribed for a client with
ulcerative colitis. The nurse should monitor the client for which therapeutic effect of this
medication?
1. Decreased diarrhea
2. Decreased cramping
3. Improved intestinal tone
4. Elimination of peristalsis

70. Sulfasalazine (Azulfidine) is prescribed for a client with a diagnosis of ulcerative colitis, and the
care unit nurse instructs the client about the medication. Which statement made by the client
indicates a need for further instruction?
1. "The medication will cause constipation."
2. "I need to take the medication with meals."
 3. "I may have increased sensitivity to sunlight."
4. "This medication should be taken as prescribed."
71. A client with cirrhosis has ascites and excess fluid volume. Which assessment findings does the
nurse anticipate to note as a result of increased abdominal pressure? Select all that apply.
1. Orthopnea, dyspnea
2. Petechiae and ecchymosis
3. Inguinal or umbilical hernia
4. Poor body posture and balance
5. Abdominal distention and tenderness
72. A client has been advanced to a solid diet after undergoing a subtotal gastrectomy. The nurse
caring for the client would perform which action to minimize the risk of dumping syndrome?
1. Remove fluids from the meal tray.
2. Give the client two large meals per day.
3. Ask the client to sit up for 1 hour after eating.
4. Provide concentrated, high-carbohydrate foods.
73. The ambulatory care nurse is providing instructions to a client who is scheduled for a small bowel
biopsy. What should the nurse tell the client?
1. Clear liquids only are allowed on the day of the test.
2. A signed informed consent form will need to be obtained.
3. A tube will be inserted through the rectum to obtain the tissue sample.
4. A full liquid diet will need to be maintained for 48 hours after the procedure.
74. A client has been diagnosed with gastroesophageal reflux disease (GERD). The nurse plans
care, knowing that the client has dysfunction of which part of the digestive system?
1. Chief cells of the stomach
2. Parietal cells of the stomach
3. Lower esophageal sphincter (LES)
4. Upper esophageal sphincter (UES)
75. A client is experienced delayed gastric emptying. The nurse plans care, knowing that dysfunction
of which structures is responsible for the client's symptoms?
1. Ileum
2. Jejunum
3. Pyloric sphincter
4. Cardiac sphincter
76. A client who has had a gastrectomy is not producing sufficient intrinsic factor. The nurse plans
care, knowing that the client has lost the ability to absorb cyanocobalamin (vitamin B 12) in which
abdominal structure?
1. Colon
2. Stomach
3. Large intestine
4. Small intestine
77. A client with a diagnosis of stomach ulcer from gastric hyperacidity asks the nurse why the acid
has not caused an ulcer in the small intestine as well. The nurse responds that the pH of
intestinal contents is raised by bicarbonate, which is present in which area of the body?
1. Bile
2. Parietal cells
3. Liver enzymes
4. Pancreatic juice
78. A client with appendicitis is scheduled for an appendectomy. The nurse providing preoperative
teaching for the client describes the location of the appendix by stating that it is attached to which
part of the gastrointestinal system?
1. Ileum
2. Cecum
3. Rectum
4. Jejunum

79. A nurse is caring for a hospitalized client who has been diagnosed with pancreatitis. The nurse
checks the laboratory results form, anticipating that which enzyme will remain normal in the
client?
1. Lipase
2. Lactase
 3. Trypsin
4. Amylase
80. A nurse is caring for a group of clients on the surgical nursing unit. The nurse anticipates that the
client who underwent which procedure is most likely to have some long-term residual difficulty
with absorption of nutrients?
1. Colectomy
2. Appendectomy
3. Ascending colostomy
4. Small bowel resection
81. A client is experiencing blockage of the common bile duct. The nurse anticipates that the client's
diet will be altered because the client will experience difficulty digesting which nutrient?
1. Fats
2. Proteins
3. Carbohydrates
4. Water-soluble vitamins
82. A hospitalized client with liver disease has a dietary protein restriction. The nurse encourages
intake of which complete proteins to maximize the availability of essential amino acids?
1. Nuts
2. Meats
3. Cereals
4. Vegetables
83. A nurse is reviewing laboratory test results for a client with liver disease and notes that the
client's albumin level is low. The nurse next assesses the client for which physiological effect of
decreased circulating albumin?
1. Cerebral edema
2. Peripheral edema
3. Decreased clotting ability
4. Reflexive increase in total protein level
84. A client with liver dysfunction is having difficulty with protein metabolism. The nurse checks the
laboratory results, expecting that the results of which serum laboratory values will be elevated?
1. Lactase
2. Albumin
3. Ammonia
4. Lactic acid
85. A client is admitted to the hospital with severe weight loss after extreme dieting. The nurse plans
care, knowing that which physiological processes occur in the prolonged absence of adequate
food intake?
1. Lactic acidosis
2. Glycogenolysis
3. Gluconeogenesis
4. Glucose metabolism
86. A nurse is providing a simple overview of the anatomy of the liver and gallbladder for a client
hospitalized with biliary obstruction. The nurse explains that normally the liver stores bile in the
gallbladder and that the liver and gallbladder are connected together by which passageway?
1. Cystic duct
2. Liver canaliculi
3. Common bile duct
4. Right hepatic duct
87. A client with liver dysfunction exhibits low serum levels of thrombin. The nurse provides care,
knowing that this client is most at risk for which complication?
1. Bleeding
2. Infection
3. Dehydration
4. Malnutrition

88. A nurse who is caring for an older client is aware that the client is at risk for prolonged medication
effects as a result of the normal aging process. The nurse would be most concerned with this
effect if the client had a history of disease of which organ?
1. Liver
2. Stomach
 3. Pancreas
4. Gallbladder
89. A hospitalized client is diagnosed with pancreatitis. The nurse plans care, knowing that
production of which substance will be elevated in blood studies for this client?
1. Pepsin
2. Lactase
3. Amylase
4. Enterokinase
90. A client with gastric hypersecretion is scheduled for surgery. The nurse teaches the client that the
procedure will lessen the stomach's production of acid by altering which structure?
1. Portal vein
2. Celiac artery
3. Vagus nerve
4. Pyloric valve
91. Lactulose (Chronulac) is prescribed for a hospitalized client with a diagnosis of hepatic
encephalopathy. Which assessment finding indicates that the client is responding to this
medication therapy as anticipated?
1. Vomiting occurs.
2. The fecal pH is acidic.
3. The client experiences diarrhea.
4. The client is able to tolerate a full diet.
92. Pancreatin (Viokase) is prescribed for a client with postgastrectomy syndrome. Which
assessment finding would indicate a therapeutic effect of this medication?
1. The client's appetite improves.
2. The client experiences weight loss.
3. Vitamin B12 deficiency is controlled.
4. The stool is less fatty and decreases in frequency.
93. The nurse is evaluating the plan of care for a client with peptic ulcer disease (PUD) who is
experiencing acute pain. The nurse determines that the expected outcomes have not been met if
the nursing assessment reveals which result?
1. The client's pain is relieved with histamine-2 receptor antagonists.
2. The client has eliminated any irritating foods from the diet.
3. The client frequently is awakened at 2 am with heartburn.
4. The client reports absence of pain before meals.
94. A client with a history of gastric ulcer complains of a sudden, sharp, severe pain in the
midepigastric area, which then spreads over the entire abdomen. The client's abdomen is rigid
and boardlike on palpation, and the client obtains most comfort from lying in the knee-chest
position. The nurse calls the health care provider immediately, suspecting that the client is
experiencing which complication of peptic ulcer disease?
1. Perforation
2. Obstruction
3. Hemorrhage
4. Intractability
95. A Penrose drain is in place on the first postoperative day in a client who has undergone a
cholecystectomy procedure. Serosanguineous drainage is noted on the dressing covering the
drain. Which nursing intervention is most appropriate?
1. Change the dressing.
2. Continue to monitor the drainage.
3. Notify the health care provider.
4. Use a pen to circle the amount of drainage on the dressing.
96. A nurse assists a health care provider in performing a liver biopsy. After the procedure, the nurse
should place the client in which position?
1. Prone
2. Supine
3. Left side
4. Right side

97. A home care nurse is visiting a client with a diagnosis of pernicious anemia that developed as a
result of gastric surgery. The nurse instructs the client that because the stomach lining produces
a decreased amount of intrinsic factor in this disorder, the client will need which medication?
1. Vitamin B12 injections
 2. Vitamin B6 injections
3. An antibiotic
4. An antacid
98. A client arrives at the hospital emergency department complaining of acute right lower quadrant
abdominal pain. Appendicitis is suspected, and appropriate laboratory tests are performed. The
emergency department nurse reviews the test results and notes that the client's white blood cell
(WBC) count is elevated. The nurse also reviews the prescriptions from the health care provider.
The nurse should contact the HCP to question which prescription if noted in the client's record?
1. Maintain a semi-Fowler's position.
2. Maintain an NPO (nothing by mouth) status.
3. Apply a heating pad to the lower abdomen for comfort.
4. Initiate an intravenous (IV) line with the administration of IV fluids.
99. The nurse is caring for a client who had a subtotal gastrectomy. The nurse should assess the
client for which signs and symptoms of dumping syndrome?
1. Diarrhea, chills, and hiccups
2. Weakness, diaphoresis, and diarrhea
3. Fever, constipation, and rectal bleeding
4. Abdominal pain, elevated temperature, and weakness
100. The nurse is assisting a client with Crohn's disease to ambulate to the bathroom. After the
client has a bowel movement, the nurse should assess the stool for which characteristic that is
expected with this disease?
1. Blood in the stool
2. Chalky gray stool
3. Loose, watery stool
4. Dry, hard, constipated stool