NSG 123 HESI ACTUAL EXAM LATEST 2024/2025
QUESTIONS AND VERIFIED CORRECT ANSWERS/ALREADY
GRADED A++
A patient has a NG tube placed and running suction. What lab should the
nurse monitor? - ANSWER BMP - fluid and electrolytes
What are gallstones comprised of? - ANSWER Cholesterol (75%)
Pigment (25%)
Causes of Cholelithiasis - ANSWER In gallstone-prone patients, there is
decreased bile acid synthesis and increased cholesterol synthesis in the
liver, resulting in bile supersaturated with cholesterol, which precipitates out
of the bile to form stones. 2-4 times more common in women than men.
Stone formation is more frequent in people who use oral contraceptives,
estrogens, or clofibrate (Atromid-S); these medications are known to
increase biliary cholesterol saturation
S/S of Cholelithiasis - ANSWER Gallstones may be silent, producing no
pain and only mild GI symptoms. The symptoms may be acute or chronic.
Epigastric distress, such as fullness, abdominal distention, and right upper
quadrant abdominal pain or epigastric pain that radiates to the right
shoulder especially after meals when the gallbladder is stimulated to
release bile. Jaundice can occur.
Cholelithiasis Dietary Teaching - ANSWER The diet immediately after an
episode is usually low-fat liquids. These can include powdered
supplements high in protein and carbohydrate stirred into skim milk.
Cooked fruits, rice or tapioca, lean meats, mashed potatoes, non-gas-
forming vegetables, bread, coffee, or tea may be added as tolerated. The
patient should avoid eggs, cream, pork, fried foods, cheese, rich dressings,
gas-forming vegetables, and alcohol. It is important to remind the patient
that fatty foods may induce an episode of cholecystitis.
Medication Administered for Decreasing Gallstones - ANSWER
Ursodeoxycholic acid (UDCA [Urso, Actigall]) and chenodeoxycholic acid
(chenodiol or CDCA [Chenix]) have been used to dissolve small,
radiolucent gallstones composed primarily of cholesterol. UDCA has fewer
,side effects than chenodiol and can be given in smaller doses to achieve
the same effect.
Six to 12 months of therapy is required in many patients to dissolve stones,
and monitoring of the patient for recurrence of symptoms or the occurrence
of side effects (e.g., GI symptoms, pruritus, headache) is required during
this time. The effective dose of medication depends on body weight
GERD Risk Factors - ANSWER Obesity
Pregnancy
Hiatal hernia
Connective tissue disorders
Delayed stomach emptying
Acid Reflux Risk Factors:
Smoking
Eating fatty or fried foods
Drinking coffee or alcohol
Eating large meals or eating late at night
Medications such as aspirin
What can GERD lead to? - ANSWER Esophageal stricture (narrowing)
Esophageal ulcers
Barrett's Esophagus
Teaching for a patient after an open cholecystectomy - ANSWER
Instructions and explanations are given before surgery about turning and
deep breathing. Postoperative pneumonia and atelectasis can be avoided
by deep-breathing exercises, frequent turning, and early ambulation. The
patient should be informed that drainage tubes and a nasogastric tube and
suction might be required during the immediate postoperative period if an
open cholecystectomy is performed.
Education for T-tube use at home - ANSWER Usually, only a small amount
of serosanguineous fluid drains in the initial 24 hours after surgery;
afterward, the drain is removed.
The drain is typically maintained if there is excess oozing or bile leakage.
Empty the drainage bag attached at least every 8 hours and as needed, to
prevent reflux back into the bile duct.
Take showers not baths to prevent infection of the incision site.
,Patient Education for after a Laparoscopic Cholecystectomy - ANSWER
Provide patient education about managing postoperative pain and reporting
signs and symptoms of intra-abdominal complications, including loss of
appetite, vomiting, pain, distention of the abdomen, and temperature
elevation.
Preoperative Assessment for Open Cholecystectomy - ANSWER Priority
assessment should focus on the client's respiratory status.
If a traditional surgical approach is planned, the high abdominal incision
required during surgery may interfere with full respiratory excursion.
The nurse notes a history of smoking, previous respiratory problems,
shallow respirations, a persistent or ineffective cough, and the presence of
adventitious breath sounds.
Avoid aspirin and NSAIDs - can alter coagulation
What baseline assessments should the nurse identify as possible risk
factors for cholecystectomy surgery? - ANSWER Nutritional status
CBC
BMP
Carbon Dioxide in Laparoscopic Cholecystectomy - ANSWER Carbon
dioxide is used during the procedure
Explain to the patient that they might feel pain in the right shoulder or
scapular area (from migration of the carbon dioxide used to insufflate the
abdominal cavity during the procedure).
Laparoscopic Colecystectomy: 3 Things to do After - ANSWER 1)
Recommend a heating pad for 15 to 20 minutes hourly
2) Encourage the client to ambulate frequently to reduce the bloating
3) Manage nausea, assess bowel sounds for further complications.
Postoperative Complications of Cholecystectomy - ANSWER The client is
observed for indications of infection, leakage of bile into the peritoneal
cavity, and obstruction of bile drainage.
If bile is not draining properly, an obstruction is probably causing bile to be
forced back into the liver and bloodstream.
Because jaundice may result, the nurse should assess the color of the
sclerae and skin.
Clay-colored stool should be reported as this indicates a complication.
, Duodenal vs. Gastric Ulcers S/S - ANSWER The patient with an ulcer
complains of dull, gnawing pain or a burning sensation in the mid-
epigastrium or the back. The pain associated with gastric ulcers most
commonly occurs immediately after eating, whereas the pain associated
with duodenal ulcers most commonly occurs 2 to 3 hours after meals. In
addition, approximately 50% to 80% of patients with duodenal ulcers awake
with pain during the night, whereas 30% to 40% of patients with gastric
ulcers voice this type of complaint. Patients with duodenal ulcers are more
likely to express relief of pain after eating or after taking an antacid than
patients with gastric ulcers.
What disease does H. Pylori Cause? - ANSWER Peptic Ulcer Disease
Testing to Monitor Peptic Ulcer Disease - ANSWER Hemoglobin and
hematocrit
Testing the stool for gross or occult blood
Recording hourly urinary output to detect anuria or oliguria (absence of or
decreased urine production).
Dietary Recommendations for patients with Peptic Ulcer Disease -
ANSWER These can be minimized by avoiding extremes of temperature in
food and beverages and overstimulation from the consumption of alcohol,
coffee (including decaffeinated coffee, which also stimulates acid
secretion), and other caffeinated beverages. In addition, an effort is made
to neutralize acid by eating three regular meals a day. Small, frequent
feedings are not necessary as long as an antacid or an H2 blocker is taken.
Diet compatibility becomes an individual matter: The patient eats foods that
are tolerated and avoids those that produce pain.
What should patients with peptic ulcer disease avoid? - ANSWER Smoking
decreases the secretion of bicarbonate from the pancreas into the
duodenum, resulting in increased acidity of the duodenum. Continued
smoking is also associated with delayed healing of peptic ulcers. Therefore,
the patient is encouraged to stop smoking.
Medications to Avoid with Peptic Ulcer Disease - ANSWER The patient
should avoid aspirin and other NSAIDs as well as alcohol.
Medications administered to treat H. pylori - ANSWER Combination drug
therapy that includes at least two antibiotics and an acid reducer (triple
QUESTIONS AND VERIFIED CORRECT ANSWERS/ALREADY
GRADED A++
A patient has a NG tube placed and running suction. What lab should the
nurse monitor? - ANSWER BMP - fluid and electrolytes
What are gallstones comprised of? - ANSWER Cholesterol (75%)
Pigment (25%)
Causes of Cholelithiasis - ANSWER In gallstone-prone patients, there is
decreased bile acid synthesis and increased cholesterol synthesis in the
liver, resulting in bile supersaturated with cholesterol, which precipitates out
of the bile to form stones. 2-4 times more common in women than men.
Stone formation is more frequent in people who use oral contraceptives,
estrogens, or clofibrate (Atromid-S); these medications are known to
increase biliary cholesterol saturation
S/S of Cholelithiasis - ANSWER Gallstones may be silent, producing no
pain and only mild GI symptoms. The symptoms may be acute or chronic.
Epigastric distress, such as fullness, abdominal distention, and right upper
quadrant abdominal pain or epigastric pain that radiates to the right
shoulder especially after meals when the gallbladder is stimulated to
release bile. Jaundice can occur.
Cholelithiasis Dietary Teaching - ANSWER The diet immediately after an
episode is usually low-fat liquids. These can include powdered
supplements high in protein and carbohydrate stirred into skim milk.
Cooked fruits, rice or tapioca, lean meats, mashed potatoes, non-gas-
forming vegetables, bread, coffee, or tea may be added as tolerated. The
patient should avoid eggs, cream, pork, fried foods, cheese, rich dressings,
gas-forming vegetables, and alcohol. It is important to remind the patient
that fatty foods may induce an episode of cholecystitis.
Medication Administered for Decreasing Gallstones - ANSWER
Ursodeoxycholic acid (UDCA [Urso, Actigall]) and chenodeoxycholic acid
(chenodiol or CDCA [Chenix]) have been used to dissolve small,
radiolucent gallstones composed primarily of cholesterol. UDCA has fewer
,side effects than chenodiol and can be given in smaller doses to achieve
the same effect.
Six to 12 months of therapy is required in many patients to dissolve stones,
and monitoring of the patient for recurrence of symptoms or the occurrence
of side effects (e.g., GI symptoms, pruritus, headache) is required during
this time. The effective dose of medication depends on body weight
GERD Risk Factors - ANSWER Obesity
Pregnancy
Hiatal hernia
Connective tissue disorders
Delayed stomach emptying
Acid Reflux Risk Factors:
Smoking
Eating fatty or fried foods
Drinking coffee or alcohol
Eating large meals or eating late at night
Medications such as aspirin
What can GERD lead to? - ANSWER Esophageal stricture (narrowing)
Esophageal ulcers
Barrett's Esophagus
Teaching for a patient after an open cholecystectomy - ANSWER
Instructions and explanations are given before surgery about turning and
deep breathing. Postoperative pneumonia and atelectasis can be avoided
by deep-breathing exercises, frequent turning, and early ambulation. The
patient should be informed that drainage tubes and a nasogastric tube and
suction might be required during the immediate postoperative period if an
open cholecystectomy is performed.
Education for T-tube use at home - ANSWER Usually, only a small amount
of serosanguineous fluid drains in the initial 24 hours after surgery;
afterward, the drain is removed.
The drain is typically maintained if there is excess oozing or bile leakage.
Empty the drainage bag attached at least every 8 hours and as needed, to
prevent reflux back into the bile duct.
Take showers not baths to prevent infection of the incision site.
,Patient Education for after a Laparoscopic Cholecystectomy - ANSWER
Provide patient education about managing postoperative pain and reporting
signs and symptoms of intra-abdominal complications, including loss of
appetite, vomiting, pain, distention of the abdomen, and temperature
elevation.
Preoperative Assessment for Open Cholecystectomy - ANSWER Priority
assessment should focus on the client's respiratory status.
If a traditional surgical approach is planned, the high abdominal incision
required during surgery may interfere with full respiratory excursion.
The nurse notes a history of smoking, previous respiratory problems,
shallow respirations, a persistent or ineffective cough, and the presence of
adventitious breath sounds.
Avoid aspirin and NSAIDs - can alter coagulation
What baseline assessments should the nurse identify as possible risk
factors for cholecystectomy surgery? - ANSWER Nutritional status
CBC
BMP
Carbon Dioxide in Laparoscopic Cholecystectomy - ANSWER Carbon
dioxide is used during the procedure
Explain to the patient that they might feel pain in the right shoulder or
scapular area (from migration of the carbon dioxide used to insufflate the
abdominal cavity during the procedure).
Laparoscopic Colecystectomy: 3 Things to do After - ANSWER 1)
Recommend a heating pad for 15 to 20 minutes hourly
2) Encourage the client to ambulate frequently to reduce the bloating
3) Manage nausea, assess bowel sounds for further complications.
Postoperative Complications of Cholecystectomy - ANSWER The client is
observed for indications of infection, leakage of bile into the peritoneal
cavity, and obstruction of bile drainage.
If bile is not draining properly, an obstruction is probably causing bile to be
forced back into the liver and bloodstream.
Because jaundice may result, the nurse should assess the color of the
sclerae and skin.
Clay-colored stool should be reported as this indicates a complication.
, Duodenal vs. Gastric Ulcers S/S - ANSWER The patient with an ulcer
complains of dull, gnawing pain or a burning sensation in the mid-
epigastrium or the back. The pain associated with gastric ulcers most
commonly occurs immediately after eating, whereas the pain associated
with duodenal ulcers most commonly occurs 2 to 3 hours after meals. In
addition, approximately 50% to 80% of patients with duodenal ulcers awake
with pain during the night, whereas 30% to 40% of patients with gastric
ulcers voice this type of complaint. Patients with duodenal ulcers are more
likely to express relief of pain after eating or after taking an antacid than
patients with gastric ulcers.
What disease does H. Pylori Cause? - ANSWER Peptic Ulcer Disease
Testing to Monitor Peptic Ulcer Disease - ANSWER Hemoglobin and
hematocrit
Testing the stool for gross or occult blood
Recording hourly urinary output to detect anuria or oliguria (absence of or
decreased urine production).
Dietary Recommendations for patients with Peptic Ulcer Disease -
ANSWER These can be minimized by avoiding extremes of temperature in
food and beverages and overstimulation from the consumption of alcohol,
coffee (including decaffeinated coffee, which also stimulates acid
secretion), and other caffeinated beverages. In addition, an effort is made
to neutralize acid by eating three regular meals a day. Small, frequent
feedings are not necessary as long as an antacid or an H2 blocker is taken.
Diet compatibility becomes an individual matter: The patient eats foods that
are tolerated and avoids those that produce pain.
What should patients with peptic ulcer disease avoid? - ANSWER Smoking
decreases the secretion of bicarbonate from the pancreas into the
duodenum, resulting in increased acidity of the duodenum. Continued
smoking is also associated with delayed healing of peptic ulcers. Therefore,
the patient is encouraged to stop smoking.
Medications to Avoid with Peptic Ulcer Disease - ANSWER The patient
should avoid aspirin and other NSAIDs as well as alcohol.
Medications administered to treat H. pylori - ANSWER Combination drug
therapy that includes at least two antibiotics and an acid reducer (triple
