Med Surg Gastrointestinal NCLEX Questions with Answers Graded A+
The nurse is monitoring a client admitted to the hos-
pital with a diagnosis of appendicitis who is scheduled A. Notify the health care provider (HCP).
for surgery in 2 hours. The client begins to complain of
increased abdominal pain and begins to vomit. On as- Rationale:
sessment, the nurse notes that the abdomen is distended On the basis of the signs and symptoms presented in
and bowel sounds are diminished. Which is the most the question, the nurse should suspect peritonitis and
appropriate nursing intervention? notify the HCP. Administering pain medication is not an
appropriate intervention. Heat should never be applied
A. Notify the health care provider (HCP). to the abdomen of a client with suspected appendicitis
B. Administer the prescribed pain medication. because of the risk of rupture. Scheduling surgical time
C. Call and ask the operating room team to perform is not within the scope of nursing practice, although the
surgery as soon as possible. HCP probably would perform the surgery earlier than the
D. Reposition the client and apply a heating pad on the prescheduled time.
warm setting to the client's abdomen.
A. Administer stool softeners as prescribed.
A client has just had a hemorrhoidectomy. Which nursing
C. Encourage a high-fiber diet to promote bowel move-
interventions are appropriate for this client? Select all that
ments without straining.
apply.
D. Apply cold packs to the anal-rectal area over the dress-
A. Administer stool softeners as prescribed. ing until the packing is removed.
B. Instruct the client to limit fluid intake to avoid urinary
Rationale:
retention.
Nursing interventions after a hemorrhoidectomy are
C. Encourage a high-fiber diet to promote bowel move-
aimed at management of pain and avoidance of bleeding
ments without straining.
and incision rupture. Stool softeners and a high-fiber diet
D. Apply cold packs to the anal-rectal area over the dress-
will help the client to avoid straining, thereby reducing
ing until the packing is removed.
the chances of rupturing the incision. An ice pack will
E. Help the client to a Fowler's position to place pressure
increase comfort and decrease bleeding. Options 2 and
on the rectal area and decrease bleeding.
5 are incorrect interventions.
A. Cottee
The nurse is planning to teach a client with gastroe-
B. Chocolate
sophageal reflux disease (GERD) about substances to
C. Peppermint
,Med Surg Gastrointestinal NCLEX Questions with Answers Graded A+
E. Fried chicken
avoid. Which items should the nurse include on this list?
Select all that apply. Rationale:
Foods that decrease lower esophageal sphincter (LES)
A. Cottee
pressure and irritate the esophagus will increase reflux
B. Chocolate
and exacerbate the symptoms of GERD and therefore
C. Peppermint
should be avoided. Aggravating substances include cof-
D. Nonfat milk
fee, chocolate, peppermint, fried or fatty foods, carbon-
E. Fried chicken
ated beverages, and alcohol. Options 4 and 6 do not
F. Scrambled eggs
promote this ettect.
4. Assessing for the return of the gag reflex
A client has undergone esophagogastroduodenoscopy. Rationale:
The nurse should place highest priority on which item as The nurse places highest priority on assessing for return of
part of the client's care plan? the gag reflex. This assessment addresses the client's air-
way. The nurse also monitors the client's vital signs and for
1. Monitoring the temperature
a sudden increase in temperature, which could indicate
2. Monitoring complaints of heartburn
perforation of the gastrointestinal tract. This complication
3. Giving warm gargles for a sore throat
would be accompanied by other signs as well, such as
4. Assessing for the return of the gag reflex
pain. Monitoring for sore throat and heartburn are also
important; however, the client's airway is the priority.
A. Nuts
The nurse is providing dietary teaching for a client with C. Liver
a diagnosis of chronic gastritis. The nurse instructs the E. Lentils
client to include which foods rich in vitamin B12 in the
diet? Select all that apply. Rationale:
Chronic gastritis causes deterioration and atrophy of the
A. Nuts lining of the stomach, leading to the loss of function of the
B. Corn parietal cells. The source of intrinsic factor is lost, which
C. Liver results in an inability to absorb vitamin B12, leading to
D. Apples development of pernicious anemia. Clients must increase
their intake of vitamin B12 by increasing consumption of
,Med Surg Gastrointestinal NCLEX Questions with Answers Graded A+
E. Lentils foods rich in this vitamin, such as nuts, organ meats, dried
F. Bananas beans, citrus fruits, green leafy vegetables, and yeast.
D. A rigid, boardlike abdomen
The nurse is monitoring a client with a diagnosis of peptic
ulcer. Which assessment finding would most likely indi- Rationale:
cate perforation of the ulcer? Perforation of an ulcer is a surgical emergency and is
characterized by sudden, sharp, intolerable severe pain
A. Bradycardia beginning in the mid-epigastric area and spreading over
B. Numbness in the legs the abdomen, which becomes rigid and boardlike. Nau-
C. Nausea and vomiting sea and vomiting may occur. Tachycardia may occur as
D. A rigid, boardlike abdomen hypovolemic shock develops. Numbness in the legs is not
an associated finding.
C. Irrigating the nasogastric tube
The nurse is caring for a client following a gastrojejunos- Rationale:
tomy (Billroth II procedure). Which postoperative pre- In a gastrojejunostomy (Billroth II procedure), the proxi-
scription should the nurse question and verify? mal remnant of the stomach is anastomosed to the proxi-
mal jejunum. Patency of the nasogastric tube is critical for
A. Leg exercises preventing the retention of gastric secretions. The nurse
B. Early ambulation should never irrigate or reposition the gastric tube af-
C. Irrigating the nasogastric tube ter gastric surgery, unless specifically prescribed by the
D. Coughing and deep-breathing exercises health care provider. In this situation, the nurse should
clarify the prescription. Options 1, 2, and 4 are appropriate
postoperative interventions.
C. Limit the fluids taken with meals.
The nurse is providing discharge instructions to a client
Rationale:
following gastrectomy and should instruct the client to
Dumping syndrome is a term that refers to a constellation
take which measure to assist in preventing dumping syn-
of vasomotor symptoms that occurs after eating, especial-
drome?
ly following a gastrojejunostomy (Billroth II procedure).
Early manifestations usually occur within 30 minutes of
, Med Surg Gastrointestinal NCLEX Questions with Answers Graded A+
eating and include vertigo, tachycardia, syncope, sweat-
ing, pallor, palpitations, and the desire to lie down. The
nurse should instruct the client to decrease the amount
A. Ambulate following a meal.
of fluid taken at meals and to avoid high-carbohydrate
B. Eat high-carbohydrate foods.
foods, including fluids such as fruit nectars; to assume
C. Limit the fluids taken with meals.
a low Fowler's position during meals; to lie down for 30
D. Sit in a high Fowler's position during meals.
minutes after eating to delay gastric emptying; and to take
antispasmodics as prescribed.
A. "I should increase the fiber in my diet."
The nurse is providing discharge teaching for a client Rationale:
with newly diagnosed Crohn's disease about dietary mea- Crohn's disease is an inflammatory disease that can occur
sures to implement during exacerbation episodes. Which anywhere in the gastrointestinal tract but most often af-
statement made by the client indicates a need for further fects the terminal ileum and leads to thickening and scar-
instruction? ring, a narrowed lumen, fistulas, ulcerations, and abscess-
es. It is characterized by exacerbations and remissions. If
A. "I should increase the fiber in my diet."
stress increases the symptoms of the disease, the client
B. "I will need to avoid catteinated beverages."
is taught stress management techniques and may require
C. "I'm going to learn some stress reduction techniques."
additional counseling. The client is taught to avoid gas-
D. "I can have exacerbations and remissions with Crohn's
trointestinal stimulants containing catteine and to follow
disease."
a high-calorie and high-protein diet. A low-fiber diet may
be prescribed, especially during periods of exacerbation.
The nurse is doing an admission assessment on a client
C. Pain relieved by food intake
with a history of duodenal ulcer. To determine whether the
problem is currently active, the nurse should assess the Rationale:
client for which sign(s)/symptom(s) of duodenal ulcer? A frequent symptom of duodenal ulcer is pain that is
relieved by food intake. These clients generally describe
A. Weight loss
the pain as a burning, heavy, sharp, or "hungry" pain that
B. Nausea and vomiting
often localizes in the mid-epigastric area. The client with
C. Pain relieved by food intake
duodenal ulcer usually does not experience weight loss or
D. Pain radiating down the right arm
The nurse is monitoring a client admitted to the hos-
pital with a diagnosis of appendicitis who is scheduled A. Notify the health care provider (HCP).
for surgery in 2 hours. The client begins to complain of
increased abdominal pain and begins to vomit. On as- Rationale:
sessment, the nurse notes that the abdomen is distended On the basis of the signs and symptoms presented in
and bowel sounds are diminished. Which is the most the question, the nurse should suspect peritonitis and
appropriate nursing intervention? notify the HCP. Administering pain medication is not an
appropriate intervention. Heat should never be applied
A. Notify the health care provider (HCP). to the abdomen of a client with suspected appendicitis
B. Administer the prescribed pain medication. because of the risk of rupture. Scheduling surgical time
C. Call and ask the operating room team to perform is not within the scope of nursing practice, although the
surgery as soon as possible. HCP probably would perform the surgery earlier than the
D. Reposition the client and apply a heating pad on the prescheduled time.
warm setting to the client's abdomen.
A. Administer stool softeners as prescribed.
A client has just had a hemorrhoidectomy. Which nursing
C. Encourage a high-fiber diet to promote bowel move-
interventions are appropriate for this client? Select all that
ments without straining.
apply.
D. Apply cold packs to the anal-rectal area over the dress-
A. Administer stool softeners as prescribed. ing until the packing is removed.
B. Instruct the client to limit fluid intake to avoid urinary
Rationale:
retention.
Nursing interventions after a hemorrhoidectomy are
C. Encourage a high-fiber diet to promote bowel move-
aimed at management of pain and avoidance of bleeding
ments without straining.
and incision rupture. Stool softeners and a high-fiber diet
D. Apply cold packs to the anal-rectal area over the dress-
will help the client to avoid straining, thereby reducing
ing until the packing is removed.
the chances of rupturing the incision. An ice pack will
E. Help the client to a Fowler's position to place pressure
increase comfort and decrease bleeding. Options 2 and
on the rectal area and decrease bleeding.
5 are incorrect interventions.
A. Cottee
The nurse is planning to teach a client with gastroe-
B. Chocolate
sophageal reflux disease (GERD) about substances to
C. Peppermint
,Med Surg Gastrointestinal NCLEX Questions with Answers Graded A+
E. Fried chicken
avoid. Which items should the nurse include on this list?
Select all that apply. Rationale:
Foods that decrease lower esophageal sphincter (LES)
A. Cottee
pressure and irritate the esophagus will increase reflux
B. Chocolate
and exacerbate the symptoms of GERD and therefore
C. Peppermint
should be avoided. Aggravating substances include cof-
D. Nonfat milk
fee, chocolate, peppermint, fried or fatty foods, carbon-
E. Fried chicken
ated beverages, and alcohol. Options 4 and 6 do not
F. Scrambled eggs
promote this ettect.
4. Assessing for the return of the gag reflex
A client has undergone esophagogastroduodenoscopy. Rationale:
The nurse should place highest priority on which item as The nurse places highest priority on assessing for return of
part of the client's care plan? the gag reflex. This assessment addresses the client's air-
way. The nurse also monitors the client's vital signs and for
1. Monitoring the temperature
a sudden increase in temperature, which could indicate
2. Monitoring complaints of heartburn
perforation of the gastrointestinal tract. This complication
3. Giving warm gargles for a sore throat
would be accompanied by other signs as well, such as
4. Assessing for the return of the gag reflex
pain. Monitoring for sore throat and heartburn are also
important; however, the client's airway is the priority.
A. Nuts
The nurse is providing dietary teaching for a client with C. Liver
a diagnosis of chronic gastritis. The nurse instructs the E. Lentils
client to include which foods rich in vitamin B12 in the
diet? Select all that apply. Rationale:
Chronic gastritis causes deterioration and atrophy of the
A. Nuts lining of the stomach, leading to the loss of function of the
B. Corn parietal cells. The source of intrinsic factor is lost, which
C. Liver results in an inability to absorb vitamin B12, leading to
D. Apples development of pernicious anemia. Clients must increase
their intake of vitamin B12 by increasing consumption of
,Med Surg Gastrointestinal NCLEX Questions with Answers Graded A+
E. Lentils foods rich in this vitamin, such as nuts, organ meats, dried
F. Bananas beans, citrus fruits, green leafy vegetables, and yeast.
D. A rigid, boardlike abdomen
The nurse is monitoring a client with a diagnosis of peptic
ulcer. Which assessment finding would most likely indi- Rationale:
cate perforation of the ulcer? Perforation of an ulcer is a surgical emergency and is
characterized by sudden, sharp, intolerable severe pain
A. Bradycardia beginning in the mid-epigastric area and spreading over
B. Numbness in the legs the abdomen, which becomes rigid and boardlike. Nau-
C. Nausea and vomiting sea and vomiting may occur. Tachycardia may occur as
D. A rigid, boardlike abdomen hypovolemic shock develops. Numbness in the legs is not
an associated finding.
C. Irrigating the nasogastric tube
The nurse is caring for a client following a gastrojejunos- Rationale:
tomy (Billroth II procedure). Which postoperative pre- In a gastrojejunostomy (Billroth II procedure), the proxi-
scription should the nurse question and verify? mal remnant of the stomach is anastomosed to the proxi-
mal jejunum. Patency of the nasogastric tube is critical for
A. Leg exercises preventing the retention of gastric secretions. The nurse
B. Early ambulation should never irrigate or reposition the gastric tube af-
C. Irrigating the nasogastric tube ter gastric surgery, unless specifically prescribed by the
D. Coughing and deep-breathing exercises health care provider. In this situation, the nurse should
clarify the prescription. Options 1, 2, and 4 are appropriate
postoperative interventions.
C. Limit the fluids taken with meals.
The nurse is providing discharge instructions to a client
Rationale:
following gastrectomy and should instruct the client to
Dumping syndrome is a term that refers to a constellation
take which measure to assist in preventing dumping syn-
of vasomotor symptoms that occurs after eating, especial-
drome?
ly following a gastrojejunostomy (Billroth II procedure).
Early manifestations usually occur within 30 minutes of
, Med Surg Gastrointestinal NCLEX Questions with Answers Graded A+
eating and include vertigo, tachycardia, syncope, sweat-
ing, pallor, palpitations, and the desire to lie down. The
nurse should instruct the client to decrease the amount
A. Ambulate following a meal.
of fluid taken at meals and to avoid high-carbohydrate
B. Eat high-carbohydrate foods.
foods, including fluids such as fruit nectars; to assume
C. Limit the fluids taken with meals.
a low Fowler's position during meals; to lie down for 30
D. Sit in a high Fowler's position during meals.
minutes after eating to delay gastric emptying; and to take
antispasmodics as prescribed.
A. "I should increase the fiber in my diet."
The nurse is providing discharge teaching for a client Rationale:
with newly diagnosed Crohn's disease about dietary mea- Crohn's disease is an inflammatory disease that can occur
sures to implement during exacerbation episodes. Which anywhere in the gastrointestinal tract but most often af-
statement made by the client indicates a need for further fects the terminal ileum and leads to thickening and scar-
instruction? ring, a narrowed lumen, fistulas, ulcerations, and abscess-
es. It is characterized by exacerbations and remissions. If
A. "I should increase the fiber in my diet."
stress increases the symptoms of the disease, the client
B. "I will need to avoid catteinated beverages."
is taught stress management techniques and may require
C. "I'm going to learn some stress reduction techniques."
additional counseling. The client is taught to avoid gas-
D. "I can have exacerbations and remissions with Crohn's
trointestinal stimulants containing catteine and to follow
disease."
a high-calorie and high-protein diet. A low-fiber diet may
be prescribed, especially during periods of exacerbation.
The nurse is doing an admission assessment on a client
C. Pain relieved by food intake
with a history of duodenal ulcer. To determine whether the
problem is currently active, the nurse should assess the Rationale:
client for which sign(s)/symptom(s) of duodenal ulcer? A frequent symptom of duodenal ulcer is pain that is
relieved by food intake. These clients generally describe
A. Weight loss
the pain as a burning, heavy, sharp, or "hungry" pain that
B. Nausea and vomiting
often localizes in the mid-epigastric area. The client with
C. Pain relieved by food intake
duodenal ulcer usually does not experience weight loss or
D. Pain radiating down the right arm
