EAQ- GI/Hepatic Questions With All Correct
Answers
A client with a history of alcoholism and cirrhosis is admitted with severe
dyspnea as a result of ascites. Which process that most likely caused the
ascites should the nurse consider when planning care?
1
Increased secretion of bile salts
2
Increased pressure in the portal vein
3
Increased interstitial osmotic pressure
4
Increased production of serum albumin correct answer -2
The enlarged cirrhotic liver impinges on the portal system, causing increased
hydrostatic pressure from increased pressure in the portal vein, resulting in
ascites. Bile salts are not responsible for fluid shifts; increased serum bile
results from biliary obstruction, not increased secretion of bile. Interstitial
osmotic pressure is unchanged; decreased intravascular osmotic pressure
accounts for fluid movement into interstitial spaces. The liver's production of
serum albumin is decreased with cirrhosis of the liver.
After an acute episode of upper gastrointestinal (GI) bleeding, a client vomits
undigested antacids and reports having severe epigastric pain. The nursing
assessment reveals an absence of bowel sounds, a pulse rate of 134, and
shallow respirations of 32 per minute. In addition to calling the healthcare
provider, what is the priority nursing action?
1
Prepare the client for surgery.
2
Administer oxygen per nasal catheter.
3
Place in the supine position, with legs elevated.
4
Ask the client if there have been any black stools. correct answer -1
,These symptoms are classic indicators of a perforated ulcer, for which
immediate surgery is indicated; this should be anticipated. Although oxygen
may be helpful, it is not the priority. The symptoms are more indicative of
perforation than of shock, so placing the client in the supine position with legs
elevated is not appropriate at this time. Black, tarry stools indicate bleeding,
not perforation.
Before major abdominal surgery for cancer, a client says to a nurse, "I really
don't think this is cancer at all. I'll bet they won't find anything." Which is the
most appropriate initial response by the nurse?
1
"I can understand why you'd like to believe that."
2
"I hope you're right, although tests indicate cancer."
3
"It must be difficult to be facing such serious surgery."
4
"You think the healthcare provider may have made a wrong diagnosis?"
correct answer -1
The response, "I can understand why you'd like to believe that," indicates
recognition of the client's need to use denial and opens the way for a
discussion of feelings. Some texts, like Comprehensive Review for the NCLEX-
RN Examination 4th edition, labels this response "Acknowledgment" which
means recognizing the client's opinions and statements without imposing
your own values and judgment. The response, "I hope you're right, although
tests indicate cancer," forces reality on the client and blocks a discussion of
feelings. The reply, "It must be difficult to be facing such serious surgery,"
focuses on the surgery, which is not the concern expressed by the client. The
reply, "You think the healthcare provider may have made a wrong diagnosis?"
focuses on the healthcare provider rather than on the client's feelings.
A client eats a meal that contains 13 g of fat, 31 g of carbohydrates, and 5 g of
protein. What is this client's total caloric intake for this meal? Record your
answer using a whole number. ___ calories correct answer -261
Fat contains 9 kilocalories per gram; carbohydrates and proteins contain 4
kilocalories per gram; therefore, 117 + 124 + 20 = 261 kilocalories.
,The nurse identifies a small amount of bile-colored drainage on the dressing
of a client who has had a liver biopsy. What does the nurse conclude?
1
Fluid is leaking into the intestine.
2
The pancreas has been lacerated.
3
This is a typical, expected response.
4
A biliary vessel has been penetrated. correct answer -4
The flow of bile through the puncture site indicates that a biliary vessel was
punctured; this is a common complication after a liver biopsy. Fluid will leak
through the puncture site or into the peritoneum, not the intestine. The
pancreas does not contain bile; it is in the upper left, not upper right,
quadrant. This is a complication, not an expected outcome.
A nurse is assisting a healthcare provider to perform a sigmoidoscopy. In
which position should the nurse place the client for this procedure?
1
Sims
2
Prone
3
Lithotomy
4
Knee-chest correct answer -4
Knee-chest position maximally exposes the rectal area and facilitates entry of
the sigmoidoscope. The Sims position does not expose the rectal area to the
same extent as does the knee-chest position; it can be used for a
sigmoidoscopy if a client is unable to maintain the knee-chest position.
Although prone refers to a facedown position, the rectal area is not exposed.
The lithotomy position is appropriate for gynecologic examinations.
After a subtotal gastrectomy a client demonstrates signs of dumping
syndrome. About 90 minutes after the initial attack, the client reports feeling
shaky. What does the nurse determine is the cause of the latter effect?
1
, A second, more extensive rise in glucose
2
An overwhelmed insulin-adjusting mechanism
3
A distention of the duodenum from an excessive amount of chyme
4
An overproduction of insulin that occurs in response to the rise in blood
glucose correct answer -4
The rapid absorption of carbohydrates from the food mass causes an elevation
of blood glucose, and the insulin response often causes transient
hypoglycemic symptoms. The elevation in insulin usually occurs 90 minutes to
3 hours after eating and is known as late dumping syndrome. The
physiological adaptations related to late dumping syndrome are caused by an
increase in insulin, not glucose. The insulin-adjusting mechanism is not
overwhelmed but responds vigorously, causing rebound hypoglycemia.
Dumping syndrome is related to the high glucose content of food, not the
amount of food, entering the duodenum.
Which should the nurse identify as a risk factor for hyponatremia?
1
Inadequate fluid intake
2
Drainage from a T-tube
3
Total parenteral nutrition
4
Hypertonic tube feedings correct answer -2
Bile is rich in sodium; therefore, continuous bile loss caused by drainage,
fistulas, and excessive vomiting can result in hyponatremia. Inadequate fluid
intake results in hypernatremia, not hyponatremia. Total parenteral nutrition
results in hypernatremia, not hyponatremia. Hypertonic tube feedings result
in hypernatremia, not hyponatremia.
Optimal discharge teaching with regard to dumping syndrome following
gastroduodenostomy should include what information?
1
Encouraging the client to plan for a light walk immediately after meals
Answers
A client with a history of alcoholism and cirrhosis is admitted with severe
dyspnea as a result of ascites. Which process that most likely caused the
ascites should the nurse consider when planning care?
1
Increased secretion of bile salts
2
Increased pressure in the portal vein
3
Increased interstitial osmotic pressure
4
Increased production of serum albumin correct answer -2
The enlarged cirrhotic liver impinges on the portal system, causing increased
hydrostatic pressure from increased pressure in the portal vein, resulting in
ascites. Bile salts are not responsible for fluid shifts; increased serum bile
results from biliary obstruction, not increased secretion of bile. Interstitial
osmotic pressure is unchanged; decreased intravascular osmotic pressure
accounts for fluid movement into interstitial spaces. The liver's production of
serum albumin is decreased with cirrhosis of the liver.
After an acute episode of upper gastrointestinal (GI) bleeding, a client vomits
undigested antacids and reports having severe epigastric pain. The nursing
assessment reveals an absence of bowel sounds, a pulse rate of 134, and
shallow respirations of 32 per minute. In addition to calling the healthcare
provider, what is the priority nursing action?
1
Prepare the client for surgery.
2
Administer oxygen per nasal catheter.
3
Place in the supine position, with legs elevated.
4
Ask the client if there have been any black stools. correct answer -1
,These symptoms are classic indicators of a perforated ulcer, for which
immediate surgery is indicated; this should be anticipated. Although oxygen
may be helpful, it is not the priority. The symptoms are more indicative of
perforation than of shock, so placing the client in the supine position with legs
elevated is not appropriate at this time. Black, tarry stools indicate bleeding,
not perforation.
Before major abdominal surgery for cancer, a client says to a nurse, "I really
don't think this is cancer at all. I'll bet they won't find anything." Which is the
most appropriate initial response by the nurse?
1
"I can understand why you'd like to believe that."
2
"I hope you're right, although tests indicate cancer."
3
"It must be difficult to be facing such serious surgery."
4
"You think the healthcare provider may have made a wrong diagnosis?"
correct answer -1
The response, "I can understand why you'd like to believe that," indicates
recognition of the client's need to use denial and opens the way for a
discussion of feelings. Some texts, like Comprehensive Review for the NCLEX-
RN Examination 4th edition, labels this response "Acknowledgment" which
means recognizing the client's opinions and statements without imposing
your own values and judgment. The response, "I hope you're right, although
tests indicate cancer," forces reality on the client and blocks a discussion of
feelings. The reply, "It must be difficult to be facing such serious surgery,"
focuses on the surgery, which is not the concern expressed by the client. The
reply, "You think the healthcare provider may have made a wrong diagnosis?"
focuses on the healthcare provider rather than on the client's feelings.
A client eats a meal that contains 13 g of fat, 31 g of carbohydrates, and 5 g of
protein. What is this client's total caloric intake for this meal? Record your
answer using a whole number. ___ calories correct answer -261
Fat contains 9 kilocalories per gram; carbohydrates and proteins contain 4
kilocalories per gram; therefore, 117 + 124 + 20 = 261 kilocalories.
,The nurse identifies a small amount of bile-colored drainage on the dressing
of a client who has had a liver biopsy. What does the nurse conclude?
1
Fluid is leaking into the intestine.
2
The pancreas has been lacerated.
3
This is a typical, expected response.
4
A biliary vessel has been penetrated. correct answer -4
The flow of bile through the puncture site indicates that a biliary vessel was
punctured; this is a common complication after a liver biopsy. Fluid will leak
through the puncture site or into the peritoneum, not the intestine. The
pancreas does not contain bile; it is in the upper left, not upper right,
quadrant. This is a complication, not an expected outcome.
A nurse is assisting a healthcare provider to perform a sigmoidoscopy. In
which position should the nurse place the client for this procedure?
1
Sims
2
Prone
3
Lithotomy
4
Knee-chest correct answer -4
Knee-chest position maximally exposes the rectal area and facilitates entry of
the sigmoidoscope. The Sims position does not expose the rectal area to the
same extent as does the knee-chest position; it can be used for a
sigmoidoscopy if a client is unable to maintain the knee-chest position.
Although prone refers to a facedown position, the rectal area is not exposed.
The lithotomy position is appropriate for gynecologic examinations.
After a subtotal gastrectomy a client demonstrates signs of dumping
syndrome. About 90 minutes after the initial attack, the client reports feeling
shaky. What does the nurse determine is the cause of the latter effect?
1
, A second, more extensive rise in glucose
2
An overwhelmed insulin-adjusting mechanism
3
A distention of the duodenum from an excessive amount of chyme
4
An overproduction of insulin that occurs in response to the rise in blood
glucose correct answer -4
The rapid absorption of carbohydrates from the food mass causes an elevation
of blood glucose, and the insulin response often causes transient
hypoglycemic symptoms. The elevation in insulin usually occurs 90 minutes to
3 hours after eating and is known as late dumping syndrome. The
physiological adaptations related to late dumping syndrome are caused by an
increase in insulin, not glucose. The insulin-adjusting mechanism is not
overwhelmed but responds vigorously, causing rebound hypoglycemia.
Dumping syndrome is related to the high glucose content of food, not the
amount of food, entering the duodenum.
Which should the nurse identify as a risk factor for hyponatremia?
1
Inadequate fluid intake
2
Drainage from a T-tube
3
Total parenteral nutrition
4
Hypertonic tube feedings correct answer -2
Bile is rich in sodium; therefore, continuous bile loss caused by drainage,
fistulas, and excessive vomiting can result in hyponatremia. Inadequate fluid
intake results in hypernatremia, not hyponatremia. Total parenteral nutrition
results in hypernatremia, not hyponatremia. Hypertonic tube feedings result
in hypernatremia, not hyponatremia.
Optimal discharge teaching with regard to dumping syndrome following
gastroduodenostomy should include what information?
1
Encouraging the client to plan for a light walk immediately after meals
