MEDSURG:
Assessment of Gastrointestinal System
MULTIPLE CHOICE
1. Which information about an 80-yr-old male patient at the senior center is of most concern to the nurse?
a. Decreased appetite c. Difficulty chewing food
b. Unintended weight loss d. Complaints of indigestion
ANS: B
Unintentional weight loss is not a normal finding and may indicate a problem such as cancer or
depression. Poor appetite, difficulty in chewing, and complaints of indigestion are common in older
patients. These will need to be addressed but are not of as much concern as the weight loss.
2. An older patient reports chronic constipation. To promote bowel evacuation, the nurse will suggest
that the patient attempt defecation
a. in the mid-afternoon.
b. after eating breakfast.
c. right after getting up in the morning.
d. immediately before the first daily meal.
ANS: B
The gastrocolic reflex is most active after the first daily meal. Arising in the morning, the anticipation of
eating, and physical exercise do not stimulate these reflexes.
3. When caring for a patient with a history of a total gastrectomy, the nurse will monitor for
a. constipation.
b. dehydration.
c. elevated total serum cholesterol.
d. cobalamin (vitamin B12) deficiency.
ANS: D
The patient with a total gastrectomy does not secrete intrinsic factor, which is needed for cobalamin
(vitamin B12) absorption. Because the stomach absorbs only small amounts of water and nutrients, the
patient is not at higher risk for dehydration, elevated cholesterol, or constipation.
4. The nurse will plan to monitor a patient with an obstructed common bile duct for
a. melena.
b. steatorrhea.
c. decreased serum cholesterol level.
d. increased serum indirect bilirubin level.
ANS: B
A common bile duct obstruction will reduce the absorption of fat in the small intestine, leading to fatty
stools. Gastrointestinal bleeding is not caused by common bile duct obstruction. Serum cholesterol levels
are increased with biliary obstruction. Direct bilirubin level is increased with biliary obstruction.
5. The nurse receives the following information about a 51-yr-old female patient who is scheduled for a
colonoscopy. Which information should be communicated to the health care provider before sending
the patient for the procedure?
a. The patient has a permanent pacemaker to prevent bradycardia.
b. The patient is worried about discomfort during the examination.
c. The patient has had an allergic reaction to both shellfish and iodine in the past.
GI 1
,d. The patient declined to drink the prescribed polyethylene glycol (GoLYTELY).
GI 2
, ANS: D
If the patient has had inadequate bowel preparation, the colon cannot be visualized and the procedure
should be rescheduled. Because contrast solution is not used during colonoscopy, the iodine allergy is
not pertinent. A pacemaker is a contraindication to magnetic resonance imaging but not to
colonoscopy. The nurse should instruct the patient about the sedation used during the examination to
decrease the patient’s anxiety about discomfort.
6. Which statement to the nurse from a patient with jaundice indicates a need for teaching?
a. “I used cough syrup several times a day last week.”
b. “I take a baby aspirin every day to prevent strokes.”
c. “I use acetaminophen (Tylenol) every 4 hours for back pain.”
d. “I need to take an antacid for indigestion several times a week”
ANS: C
Chronic use of high doses of acetaminophen can be hepatotoxic and may have caused the patient’s
jaundice. The other patient statements require further assessment by the nurse but do not indicate a
need for patient education.
7. To palpate the liver during a head-to-toe physical assessment, the nurse
a. places one hand on the patient’s back and presses upward and inward with the other
hand below the patient’s right costal margin.
b. places one hand on top of the other and uses the upper fingers to apply pressure and the
bottom fingers to feel for the liver edge.
c. presses slowly and firmly over the right costal margin with one hand and withdraws the
fingers quickly after the liver edge is felt.
d. places one hand under the patient’s lower ribs and presses the left lower rib cage forward,
palpating below the costal margin with the other hand.
ANS: A
The liver is normally not palpable below the costal margin. The nurse needs to push inward below the
right costal margin while lifting the patient’s back slightly with the left hand. The other methods will
not allow palpation of the liver.
8. Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal
assessment?
a. Loud gurgles c. Absent bowel sounds
b. High-pitched gurgles d. Frequent clicking sounds
ANS: C
Absent bowel sounds are abnormal and require further assessment by the nurse. The other sounds may
be heard normally.
9. After assisting with a needle biopsy of the liver at a patient’s bedside, the nurse should
a. put pressure on the biopsy site using a sandbag.
b. elevate the head of the bed to facilitate breathing.
c. place the patient on the right side with the bed flat.
d. check the patient’s postbiopsy coagulation studies.
ANS: C
After a biopsy, the patient lies on the right side with the bed flat to splint the biopsy site. Coagulation
studies are checked before the biopsy. A sandbag does not exert adequate pressure to splint the site.
GI 3
, DIF: Cognitive Level: Apply (application) REF: 850
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
GI 4
Assessment of Gastrointestinal System
MULTIPLE CHOICE
1. Which information about an 80-yr-old male patient at the senior center is of most concern to the nurse?
a. Decreased appetite c. Difficulty chewing food
b. Unintended weight loss d. Complaints of indigestion
ANS: B
Unintentional weight loss is not a normal finding and may indicate a problem such as cancer or
depression. Poor appetite, difficulty in chewing, and complaints of indigestion are common in older
patients. These will need to be addressed but are not of as much concern as the weight loss.
2. An older patient reports chronic constipation. To promote bowel evacuation, the nurse will suggest
that the patient attempt defecation
a. in the mid-afternoon.
b. after eating breakfast.
c. right after getting up in the morning.
d. immediately before the first daily meal.
ANS: B
The gastrocolic reflex is most active after the first daily meal. Arising in the morning, the anticipation of
eating, and physical exercise do not stimulate these reflexes.
3. When caring for a patient with a history of a total gastrectomy, the nurse will monitor for
a. constipation.
b. dehydration.
c. elevated total serum cholesterol.
d. cobalamin (vitamin B12) deficiency.
ANS: D
The patient with a total gastrectomy does not secrete intrinsic factor, which is needed for cobalamin
(vitamin B12) absorption. Because the stomach absorbs only small amounts of water and nutrients, the
patient is not at higher risk for dehydration, elevated cholesterol, or constipation.
4. The nurse will plan to monitor a patient with an obstructed common bile duct for
a. melena.
b. steatorrhea.
c. decreased serum cholesterol level.
d. increased serum indirect bilirubin level.
ANS: B
A common bile duct obstruction will reduce the absorption of fat in the small intestine, leading to fatty
stools. Gastrointestinal bleeding is not caused by common bile duct obstruction. Serum cholesterol levels
are increased with biliary obstruction. Direct bilirubin level is increased with biliary obstruction.
5. The nurse receives the following information about a 51-yr-old female patient who is scheduled for a
colonoscopy. Which information should be communicated to the health care provider before sending
the patient for the procedure?
a. The patient has a permanent pacemaker to prevent bradycardia.
b. The patient is worried about discomfort during the examination.
c. The patient has had an allergic reaction to both shellfish and iodine in the past.
GI 1
,d. The patient declined to drink the prescribed polyethylene glycol (GoLYTELY).
GI 2
, ANS: D
If the patient has had inadequate bowel preparation, the colon cannot be visualized and the procedure
should be rescheduled. Because contrast solution is not used during colonoscopy, the iodine allergy is
not pertinent. A pacemaker is a contraindication to magnetic resonance imaging but not to
colonoscopy. The nurse should instruct the patient about the sedation used during the examination to
decrease the patient’s anxiety about discomfort.
6. Which statement to the nurse from a patient with jaundice indicates a need for teaching?
a. “I used cough syrup several times a day last week.”
b. “I take a baby aspirin every day to prevent strokes.”
c. “I use acetaminophen (Tylenol) every 4 hours for back pain.”
d. “I need to take an antacid for indigestion several times a week”
ANS: C
Chronic use of high doses of acetaminophen can be hepatotoxic and may have caused the patient’s
jaundice. The other patient statements require further assessment by the nurse but do not indicate a
need for patient education.
7. To palpate the liver during a head-to-toe physical assessment, the nurse
a. places one hand on the patient’s back and presses upward and inward with the other
hand below the patient’s right costal margin.
b. places one hand on top of the other and uses the upper fingers to apply pressure and the
bottom fingers to feel for the liver edge.
c. presses slowly and firmly over the right costal margin with one hand and withdraws the
fingers quickly after the liver edge is felt.
d. places one hand under the patient’s lower ribs and presses the left lower rib cage forward,
palpating below the costal margin with the other hand.
ANS: A
The liver is normally not palpable below the costal margin. The nurse needs to push inward below the
right costal margin while lifting the patient’s back slightly with the left hand. The other methods will
not allow palpation of the liver.
8. Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal
assessment?
a. Loud gurgles c. Absent bowel sounds
b. High-pitched gurgles d. Frequent clicking sounds
ANS: C
Absent bowel sounds are abnormal and require further assessment by the nurse. The other sounds may
be heard normally.
9. After assisting with a needle biopsy of the liver at a patient’s bedside, the nurse should
a. put pressure on the biopsy site using a sandbag.
b. elevate the head of the bed to facilitate breathing.
c. place the patient on the right side with the bed flat.
d. check the patient’s postbiopsy coagulation studies.
ANS: C
After a biopsy, the patient lies on the right side with the bed flat to splint the biopsy site. Coagulation
studies are checked before the biopsy. A sandbag does not exert adequate pressure to splint the site.
GI 3
, DIF: Cognitive Level: Apply (application) REF: 850
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
GI 4
