GASTROINTESTINAL AND NEUROLOGICAL
MEDICAL – SURGICAL NURSING SPECIALTIES.
PREP Q&A 2025 UPDATED VERSION.
75 Q & A WITH RATIONALE.
An acute care nurse is caring for an adult client who is undergoing evaluation for a possible brain
tumor. performing a neurological examination, which of following is the most reliable indicator of
cerebral status
o Pupil response
Rationale: The nurse should include pupil response as part of a
neurological examination; however, it is not the most reliable indicator of
cerebral status.
o Deep tendon reflexes
Rationale: The nurse should include deep tendon reflexes as part of a
neurological examination; however, it is not the most reliable indicator
of cerebral status.
o Muscle strength
Rationale: The nurse should include muscle strength as part of a
neurological examination; however, it is not the most reliable indicator of
cerebral status.
o Level of consciousness
Rationale: The nurse should examine the client’s level of consciousness as the most
reliable indicator of cerebral status.
A nurse is assessing a client who has obstruction of the common bile duct due to
cholelithiasis. Which of the following is an expected finding?
o Fatty stools
Rationale: An expected client finding is fatty stools due to biliary
obstruction causing a lack of bile for the absorption of fats in the
intestines
o Straw-colored urine
Rationale: Chronic cholecystitis may result in dark urine not straw-
colored urine due to biliary obstruction.
o Tenderness in the left upper abdomen
Rationale: Chronic cholecystitis may result in tenderness in the right
upper abdomen due to biliary obstruction and inflamed gallbladder.
o Ecchymosis of the extremities
Rationale: Chronic cholecystitis may result in jaundice due to biliary obstruction.
,
A nurse in the antepartum unit is caring for a client who is at 36 weeks of gestation and
has pregnancy- induced hypertension. Suddenly, the client reports continuous abdominal
pain and vaginal bleeding. The nurse should suspect which of the following
complications?
o Placenta previa
Rationale: Placenta previa occurs with painless vaginal bleeding.
o Prolapsed cord
Rationale: With a prolapsed umbilical cord, there is no bleeding or pain.
There may be changes in the fetal heart tracing, and the cord might also
become visible.
o Ruptured ovarian cysts
Rationale: A rupture of an ovarian cyst can cause sudden pelvic pain,
but it does not commonly cause vaginal bleeding.
o Abruptio placentae
Rationale: The cardinal signs and symptoms of abruptio placentae
include a rigid board-like abdomen, severe pain, and heavy vaginal
bleeding.
catheter (PICC) line. When assessing the client, the nurse notes that the client's arm seems
swollen above the PICC insertion site. Which of the following actions should the nurse
take first?
o Measure the circumference of both upper arms.
Rationale: The first action to take if the client's arm appears to be swollen
is to measure the arm and compare it to the circumference of the other
arm. If the arm is swollen, it is appropriate to notify the provider who
inserted the PICC line. Swelling could indicate formation of a clot above
the site.
o Notify the provider who inserted the PICC line.
Rationale: It may be necessary to notify the provider, but this is not the
first action the nurse should take.
o Remove the PICC line.
Rationale: It may be necessary to remove the PICC line, but this is not
the first action the nurse should take.
o Apply a cold pack to the client's upper arm.
Rationale: It may be necessary to apply a cold pack to the client's upper arm, but this is not
the first action the nurse should take.
Anurse is caring for a client who is receiving total parenteral nutrition (TPN). The
pharmacy suips pdl ey ilnaygetdheincl ie nt’s next container of TPN. Which of the following fluids
should the nurse infuse cuonntitlatihne rnext
o arrives?
o Dextrose 5% in water
Rationale: TPN contains high concentrations of certain nutrients.
, Infusing dextrose 5% in water could cause rapid shifts in serum levels of
some substances.
o 0.9% sodium chloride
Rationale: TPN contains high concentrations of certain nutrients.
Infusing 0.9% sodium chloride could cause rapid shifts in serum levels of
some substances.
o Dextrose 10% in water
Rationale: TPN contains high concentrations of dextrose and proteins.
To avoid hypoglycemia, the nurse should infuse dextrose 10% or 20%
in water until the next container of TPN solution arrives.
o Lactated Ringer’s solution
Rationale: TPN contains high concentrations of certain nutrients.
Infusing lactated Ringer’s solution could cause rapid shifts in serum
levels of some substances.
Anurse is planning care for a client who has a GI bleed. Which of the following actions should the
nurse ta first?
o Assess orthostatic blood pressure.
Rationale: The first action the nurse should take using the nursing
process is to assess the client; therefore, assessing the orthostatic blood
pressure is the first priority to determine if the client is hypovolemic.
o Explain the procedure for an upper GI series.
Rationale: The nurse should explain the procedure for an upper GI series,
but this is not the priority.
o Administer pain medication.
Rationale: The nurse should administer pain medication as needed, but this
is not the priority.
o Test the emesis for blood.
Rationale: The nurse should test the emesis for blood if the client vomits,
but this is not the priority.
A client comes to the emergency department reporting nausea and vomiting that
worsens when he lies down. Antacids do not help. The provider suspects acute
pancreatitis. Which of the following laboratory test results should the nurse expect to see
if the client has acute pancreatitis?
o Decreased WBC
Rationale: With acute pancreatitis, WBC is generally elevated.
o Increased serum amylase
Rationale: With acute pancreatitis, serum amylase rises within 24 hr of
the start of the client’s symptoms.
o Decreased serum lipase
Rationale: With acute pancreatitis, serum lipase is generally elevated.
, o Increased serum calcium
Rationale: Hypocalcemia is common with acute pancreatitis.
MEDICAL – SURGICAL NURSING SPECIALTIES.
PREP Q&A 2025 UPDATED VERSION.
75 Q & A WITH RATIONALE.
An acute care nurse is caring for an adult client who is undergoing evaluation for a possible brain
tumor. performing a neurological examination, which of following is the most reliable indicator of
cerebral status
o Pupil response
Rationale: The nurse should include pupil response as part of a
neurological examination; however, it is not the most reliable indicator of
cerebral status.
o Deep tendon reflexes
Rationale: The nurse should include deep tendon reflexes as part of a
neurological examination; however, it is not the most reliable indicator
of cerebral status.
o Muscle strength
Rationale: The nurse should include muscle strength as part of a
neurological examination; however, it is not the most reliable indicator of
cerebral status.
o Level of consciousness
Rationale: The nurse should examine the client’s level of consciousness as the most
reliable indicator of cerebral status.
A nurse is assessing a client who has obstruction of the common bile duct due to
cholelithiasis. Which of the following is an expected finding?
o Fatty stools
Rationale: An expected client finding is fatty stools due to biliary
obstruction causing a lack of bile for the absorption of fats in the
intestines
o Straw-colored urine
Rationale: Chronic cholecystitis may result in dark urine not straw-
colored urine due to biliary obstruction.
o Tenderness in the left upper abdomen
Rationale: Chronic cholecystitis may result in tenderness in the right
upper abdomen due to biliary obstruction and inflamed gallbladder.
o Ecchymosis of the extremities
Rationale: Chronic cholecystitis may result in jaundice due to biliary obstruction.
,
A nurse in the antepartum unit is caring for a client who is at 36 weeks of gestation and
has pregnancy- induced hypertension. Suddenly, the client reports continuous abdominal
pain and vaginal bleeding. The nurse should suspect which of the following
complications?
o Placenta previa
Rationale: Placenta previa occurs with painless vaginal bleeding.
o Prolapsed cord
Rationale: With a prolapsed umbilical cord, there is no bleeding or pain.
There may be changes in the fetal heart tracing, and the cord might also
become visible.
o Ruptured ovarian cysts
Rationale: A rupture of an ovarian cyst can cause sudden pelvic pain,
but it does not commonly cause vaginal bleeding.
o Abruptio placentae
Rationale: The cardinal signs and symptoms of abruptio placentae
include a rigid board-like abdomen, severe pain, and heavy vaginal
bleeding.
catheter (PICC) line. When assessing the client, the nurse notes that the client's arm seems
swollen above the PICC insertion site. Which of the following actions should the nurse
take first?
o Measure the circumference of both upper arms.
Rationale: The first action to take if the client's arm appears to be swollen
is to measure the arm and compare it to the circumference of the other
arm. If the arm is swollen, it is appropriate to notify the provider who
inserted the PICC line. Swelling could indicate formation of a clot above
the site.
o Notify the provider who inserted the PICC line.
Rationale: It may be necessary to notify the provider, but this is not the
first action the nurse should take.
o Remove the PICC line.
Rationale: It may be necessary to remove the PICC line, but this is not
the first action the nurse should take.
o Apply a cold pack to the client's upper arm.
Rationale: It may be necessary to apply a cold pack to the client's upper arm, but this is not
the first action the nurse should take.
Anurse is caring for a client who is receiving total parenteral nutrition (TPN). The
pharmacy suips pdl ey ilnaygetdheincl ie nt’s next container of TPN. Which of the following fluids
should the nurse infuse cuonntitlatihne rnext
o arrives?
o Dextrose 5% in water
Rationale: TPN contains high concentrations of certain nutrients.
, Infusing dextrose 5% in water could cause rapid shifts in serum levels of
some substances.
o 0.9% sodium chloride
Rationale: TPN contains high concentrations of certain nutrients.
Infusing 0.9% sodium chloride could cause rapid shifts in serum levels of
some substances.
o Dextrose 10% in water
Rationale: TPN contains high concentrations of dextrose and proteins.
To avoid hypoglycemia, the nurse should infuse dextrose 10% or 20%
in water until the next container of TPN solution arrives.
o Lactated Ringer’s solution
Rationale: TPN contains high concentrations of certain nutrients.
Infusing lactated Ringer’s solution could cause rapid shifts in serum
levels of some substances.
Anurse is planning care for a client who has a GI bleed. Which of the following actions should the
nurse ta first?
o Assess orthostatic blood pressure.
Rationale: The first action the nurse should take using the nursing
process is to assess the client; therefore, assessing the orthostatic blood
pressure is the first priority to determine if the client is hypovolemic.
o Explain the procedure for an upper GI series.
Rationale: The nurse should explain the procedure for an upper GI series,
but this is not the priority.
o Administer pain medication.
Rationale: The nurse should administer pain medication as needed, but this
is not the priority.
o Test the emesis for blood.
Rationale: The nurse should test the emesis for blood if the client vomits,
but this is not the priority.
A client comes to the emergency department reporting nausea and vomiting that
worsens when he lies down. Antacids do not help. The provider suspects acute
pancreatitis. Which of the following laboratory test results should the nurse expect to see
if the client has acute pancreatitis?
o Decreased WBC
Rationale: With acute pancreatitis, WBC is generally elevated.
o Increased serum amylase
Rationale: With acute pancreatitis, serum amylase rises within 24 hr of
the start of the client’s symptoms.
o Decreased serum lipase
Rationale: With acute pancreatitis, serum lipase is generally elevated.
, o Increased serum calcium
Rationale: Hypocalcemia is common with acute pancreatitis.
