# NCLEX-RN Gastrointestinal Review (Saunders
Questions and Answers) 2023 Edition by Linda
Anne Silvestri, RN, MSN, EdD, ANP-BC, FAAN
---
**01.** A nurse is providing dietary teaching to a client with gastroesophageal reflux disease (GERD).
Which food should the nurse instruct the client to avoid?
A) Apples
B) Oatmeal
C) Chocolate
D) Rice cakes
🔍 RATIONALE💡-- Chocolate contains caffeine and theobromine, which relax the lower esophageal
sphincter and increase gastric acid secretion, worsening GERD. Apples, oatmeal, and rice cakes are
generally safe.
ANSWER💫✔️-- C) Chocolate
---
**02.** A nurse is assessing a client with peptic ulcer disease. Which finding indicates a possible
perforation?
A) Epigastric pain relieved by eating
B) Sudden, sharp upper abdominal pain radiating to the shoulder
C) Nausea and vomiting after meals
D) Dark, tarry stools
,🔍 RATIONALE💡-- Sudden, severe abdominal pain that radiates to the shoulder (referred pain from
diaphragmatic irritation) suggests perforation, a surgical emergency. Dark stools indicate bleeding. Pain
relieved by food is typical of duodenal ulcer.
ANSWER💫✔️-- B) Sudden, sharp upper abdominal pain radiating to the shoulder
---
**03.** A nurse is caring for a client with acute pancreatitis. Which laboratory finding is most specific
for this condition?
A) Elevated serum amylase
B) Elevated serum lipase
C) Elevated liver function tests
D) Hypocalcemia
🔍 RATIONALE💡-- Lipase is more specific and sensitive for pancreatitis than amylase; it remains
elevated longer and is not affected by other abdominal conditions. Amylase can be elevated in other
conditions.
ANSWER💫✔️-- B) Elevated serum lipase
---
**04.** A nurse is teaching a client with a new colostomy about stoma care. Which statement indicates
correct understanding?
A) “I will change the pouch every day to prevent infection.”
B) “My stoma should look dark purple and dry.”
C) “I will cut the skin barrier opening 1‑2 mm larger than my stoma.”
D) “I can use hydrogen peroxide to clean the stoma.”
,🔍 RATIONALE💡-- The skin barrier opening should be cut 1‑2 mm larger than the stoma to prevent skin
irritation. A healthy stoma is pink/red and moist; hydrogen peroxide is too harsh.
ANSWER💫✔️-- C) “I will cut the skin barrier opening 1‑2 mm larger than my stoma.”
---
**05.** A nurse is assessing a client with cirrhosis. Which finding is most suggestive of hepatic
encephalopathy?
A) Spider angiomas
B) Asterixis (flapping tremor)
C) Palmar erythema
D) Gynecomastia
🔍 RATIONALE💡-- Asterixis is a classic sign of hepatic encephalopathy caused by ammonia
accumulation. Spider angiomas, palmar erythema, and gynecomastia are signs of chronic liver disease
but not specific to encephalopathy.
ANSWER💫✔️-- B) Asterixis (flapping tremor)
---
**06.** A nurse is caring for a client with a nasogastric (NG) tube for gastric decompression. Which
finding indicates proper tube placement?
A) Aspirated fluid pH of 3
B) Client reports feeling hungry
C) The nurse hears air bubbles over the epigastrium
D) External tube length is 50 cm
🔍 RATIONALE💡-- Gastric aspirate pH ≤4.0 confirms gastric placement. Auscultation is less reliable;
external length varies; x‑ray is gold standard.
, ANSWER💫✔️-- A) Aspirated fluid pH of 3
---
**07.** A nurse is providing discharge teaching to a client after a laparoscopic cholecystectomy. Which
instruction is correct?
A) “Resume a low‑fat diet gradually.”
B) “You may lift heavy objects immediately.”
C) “Expect severe shoulder pain for 2 weeks.”
D) “Avoid all physical activity for 6 weeks.”
🔍 RATIONALE💡-- After cholecystectomy, a low‑fat diet is recommended initially to prevent diarrhea.
Heavy lifting is avoided for 4‑6 weeks. Mild shoulder pain from CO2 may occur but resolves in days.
ANSWER💫✔️-- A) “Resume a low‑fat diet gradually.”
---
**08.** A nurse is assessing a client with ulcerative colitis. Which finding is expected?
A) Bloody diarrhea
B) Constipation
C) Fistulas
D) Abdominal pain relieved by defecation
🔍 RATIONALE💡-- Ulcerative colitis typically presents with bloody diarrhea, tenesmus, and lower
abdominal pain. Constipation is not typical. Fistulas are more common in Crohn’s disease.
ANSWER💫✔️-- A) Bloody diarrhea
Questions and Answers) 2023 Edition by Linda
Anne Silvestri, RN, MSN, EdD, ANP-BC, FAAN
---
**01.** A nurse is providing dietary teaching to a client with gastroesophageal reflux disease (GERD).
Which food should the nurse instruct the client to avoid?
A) Apples
B) Oatmeal
C) Chocolate
D) Rice cakes
🔍 RATIONALE💡-- Chocolate contains caffeine and theobromine, which relax the lower esophageal
sphincter and increase gastric acid secretion, worsening GERD. Apples, oatmeal, and rice cakes are
generally safe.
ANSWER💫✔️-- C) Chocolate
---
**02.** A nurse is assessing a client with peptic ulcer disease. Which finding indicates a possible
perforation?
A) Epigastric pain relieved by eating
B) Sudden, sharp upper abdominal pain radiating to the shoulder
C) Nausea and vomiting after meals
D) Dark, tarry stools
,🔍 RATIONALE💡-- Sudden, severe abdominal pain that radiates to the shoulder (referred pain from
diaphragmatic irritation) suggests perforation, a surgical emergency. Dark stools indicate bleeding. Pain
relieved by food is typical of duodenal ulcer.
ANSWER💫✔️-- B) Sudden, sharp upper abdominal pain radiating to the shoulder
---
**03.** A nurse is caring for a client with acute pancreatitis. Which laboratory finding is most specific
for this condition?
A) Elevated serum amylase
B) Elevated serum lipase
C) Elevated liver function tests
D) Hypocalcemia
🔍 RATIONALE💡-- Lipase is more specific and sensitive for pancreatitis than amylase; it remains
elevated longer and is not affected by other abdominal conditions. Amylase can be elevated in other
conditions.
ANSWER💫✔️-- B) Elevated serum lipase
---
**04.** A nurse is teaching a client with a new colostomy about stoma care. Which statement indicates
correct understanding?
A) “I will change the pouch every day to prevent infection.”
B) “My stoma should look dark purple and dry.”
C) “I will cut the skin barrier opening 1‑2 mm larger than my stoma.”
D) “I can use hydrogen peroxide to clean the stoma.”
,🔍 RATIONALE💡-- The skin barrier opening should be cut 1‑2 mm larger than the stoma to prevent skin
irritation. A healthy stoma is pink/red and moist; hydrogen peroxide is too harsh.
ANSWER💫✔️-- C) “I will cut the skin barrier opening 1‑2 mm larger than my stoma.”
---
**05.** A nurse is assessing a client with cirrhosis. Which finding is most suggestive of hepatic
encephalopathy?
A) Spider angiomas
B) Asterixis (flapping tremor)
C) Palmar erythema
D) Gynecomastia
🔍 RATIONALE💡-- Asterixis is a classic sign of hepatic encephalopathy caused by ammonia
accumulation. Spider angiomas, palmar erythema, and gynecomastia are signs of chronic liver disease
but not specific to encephalopathy.
ANSWER💫✔️-- B) Asterixis (flapping tremor)
---
**06.** A nurse is caring for a client with a nasogastric (NG) tube for gastric decompression. Which
finding indicates proper tube placement?
A) Aspirated fluid pH of 3
B) Client reports feeling hungry
C) The nurse hears air bubbles over the epigastrium
D) External tube length is 50 cm
🔍 RATIONALE💡-- Gastric aspirate pH ≤4.0 confirms gastric placement. Auscultation is less reliable;
external length varies; x‑ray is gold standard.
, ANSWER💫✔️-- A) Aspirated fluid pH of 3
---
**07.** A nurse is providing discharge teaching to a client after a laparoscopic cholecystectomy. Which
instruction is correct?
A) “Resume a low‑fat diet gradually.”
B) “You may lift heavy objects immediately.”
C) “Expect severe shoulder pain for 2 weeks.”
D) “Avoid all physical activity for 6 weeks.”
🔍 RATIONALE💡-- After cholecystectomy, a low‑fat diet is recommended initially to prevent diarrhea.
Heavy lifting is avoided for 4‑6 weeks. Mild shoulder pain from CO2 may occur but resolves in days.
ANSWER💫✔️-- A) “Resume a low‑fat diet gradually.”
---
**08.** A nurse is assessing a client with ulcerative colitis. Which finding is expected?
A) Bloody diarrhea
B) Constipation
C) Fistulas
D) Abdominal pain relieved by defecation
🔍 RATIONALE💡-- Ulcerative colitis typically presents with bloody diarrhea, tenesmus, and lower
abdominal pain. Constipation is not typical. Fistulas are more common in Crohn’s disease.
ANSWER💫✔️-- A) Bloody diarrhea
