GI Questions With All Correct Answers
An adolescent is being seen in the clinic for abdominal pain with a fever. In
what order should the nurse assess the abdomen?
1.Auscultate.
2.Inspect.
3.Palpate.
4.Percuss.
(70) correct answer -A: 2,1,4,3
R: The nurse should first inspect the abdomen for abnormalities. Auscultation
should be done before percussion and palpation as vigorous touching may
disturb the intestines. Percussion is next. Palpation is the last step as it is most
likely to cause pain.
A child is admitted with a diagnosis of possible appendicitis. The child is in
acute pain. Which of the following nursing interventions would be appropriate
prior to surgery to decrease pain? Select all that apply.
1.Offer an ice pack.
2.Apply a heating pad.
3.Encourage the child to assume a position of comfort.
4.Limit the child's activity.
5.Request a prescription for a cathartic.
6. Administer pain medication
(71) correct answer -A: 1,3,4
R:Cold is a vasoconstrictor and supplies some degree of anesthesia. The child
is usually more comfortable on his side with his legs flexed to take the strain
off the inflamed appendix. Limiting the child's activity puts less stress on the
inflamed appendix and lessens the discomfort. Heat increases circulation to an
area, causing more engorgement and pain and, possibly, rupture of the
appendix. Heat is contraindicated in any situation where rupture or
perforation is a possibility. A cathartic is contraindicated when appendicitis is
suspected. Increasing peristalsis can cause the appendix to rupture. Pain
medication masks symptoms of perforation.
, A 10-year old male is 24 hours postappendectomy. He is awake, alert, and
oriented. He tells the nurse that he is experiencing pain. He has a prescription
for morphine 1 to 2 mg PRN pain. What is the priority nursing action in
managing the child's pain?
1.Change the child's position in bed.
2.Obtain vital signs with a pain score.
3.Administer 1 mg morphine as prescribed.
4.Perform a head to toe assessment.
(72) correct answer -A: 2
R: The child is in pain and needs intervention but before the nurse can
determine how to proceed, it is essential to know the client's pain score to
determine the appropriate morphine dose. In addition, the nurse cannot
evaluate the effectiveness of the pain medication if there is no pain score prior
to administering the medication. Changing the child's position and
administering pain medication may be helpful to relieve the child's pain but
the nurse must first know the severity of the pain before determining the
appropriate intervention. The nurse must perform a head to toe assessment
however it is not the priority in managing the child's pain.
A 5-year-old child is experiencing pain after an appendectomy. Which data
collection tool should the nurse use to assess the pain?
1.Visual analog scale.
2.FLACC scale.
3.Numerical pain scale.
4.FACES pain rating scale.
(73) correct answer -A: 4
R: The nurse should use the FACES pain rating scale for children aged three or
older. The visual analog and numerical scales are used with adults. The FLACC
(faces-legs-activity-cry-consolability) scale is a behavioral scale that is
appropriate for very small children or nonverbal children.
An adolescent is being seen in the clinic for abdominal pain with a fever. In
what order should the nurse assess the abdomen?
1.Auscultate.
2.Inspect.
3.Palpate.
4.Percuss.
(70) correct answer -A: 2,1,4,3
R: The nurse should first inspect the abdomen for abnormalities. Auscultation
should be done before percussion and palpation as vigorous touching may
disturb the intestines. Percussion is next. Palpation is the last step as it is most
likely to cause pain.
A child is admitted with a diagnosis of possible appendicitis. The child is in
acute pain. Which of the following nursing interventions would be appropriate
prior to surgery to decrease pain? Select all that apply.
1.Offer an ice pack.
2.Apply a heating pad.
3.Encourage the child to assume a position of comfort.
4.Limit the child's activity.
5.Request a prescription for a cathartic.
6. Administer pain medication
(71) correct answer -A: 1,3,4
R:Cold is a vasoconstrictor and supplies some degree of anesthesia. The child
is usually more comfortable on his side with his legs flexed to take the strain
off the inflamed appendix. Limiting the child's activity puts less stress on the
inflamed appendix and lessens the discomfort. Heat increases circulation to an
area, causing more engorgement and pain and, possibly, rupture of the
appendix. Heat is contraindicated in any situation where rupture or
perforation is a possibility. A cathartic is contraindicated when appendicitis is
suspected. Increasing peristalsis can cause the appendix to rupture. Pain
medication masks symptoms of perforation.
, A 10-year old male is 24 hours postappendectomy. He is awake, alert, and
oriented. He tells the nurse that he is experiencing pain. He has a prescription
for morphine 1 to 2 mg PRN pain. What is the priority nursing action in
managing the child's pain?
1.Change the child's position in bed.
2.Obtain vital signs with a pain score.
3.Administer 1 mg morphine as prescribed.
4.Perform a head to toe assessment.
(72) correct answer -A: 2
R: The child is in pain and needs intervention but before the nurse can
determine how to proceed, it is essential to know the client's pain score to
determine the appropriate morphine dose. In addition, the nurse cannot
evaluate the effectiveness of the pain medication if there is no pain score prior
to administering the medication. Changing the child's position and
administering pain medication may be helpful to relieve the child's pain but
the nurse must first know the severity of the pain before determining the
appropriate intervention. The nurse must perform a head to toe assessment
however it is not the priority in managing the child's pain.
A 5-year-old child is experiencing pain after an appendectomy. Which data
collection tool should the nurse use to assess the pain?
1.Visual analog scale.
2.FLACC scale.
3.Numerical pain scale.
4.FACES pain rating scale.
(73) correct answer -A: 4
R: The nurse should use the FACES pain rating scale for children aged three or
older. The visual analog and numerical scales are used with adults. The FLACC
(faces-legs-activity-cry-consolability) scale is a behavioral scale that is
appropriate for very small children or nonverbal children.
