Chapter 41: Nursing Assessment: Gastrointestinal System:
Lewis’s Medical-Surgical Nursing, 5th Edition
1. The nurse is performing a nutritional assessment on a patient. Which of the following
information obtained by the nurse is of most concern?
A. Decreased appetite
B. Difficulty chewing food
C. Unintentional weight loss
D. Complaints of indigestion
Answer: C
Explanation: Unintentional weight loss is not a normal finding and can indicate serious
underlying conditions such as cancer or depression. While the other options are common and
require attention, they are not as concerning as unexplained weight loss.
2. The nurse is obtaining a history from a patient who is admitted with jaundice. Which
of the following statements is most indicative of a need for patient 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 need to take an antacid for indigestion several times a week."
D. "I use acetaminophen every 4 hours for persistent pain."
Answer: D
Explanation: High, chronic doses of acetaminophen are hepatotoxic and can cause liver
damage and jaundice. This patient's statement indicates a need for education about the risks
of excessive acetaminophen use.
3. The nurse is caring for a patient who has a history of a total gastrectomy. Which of
the following clinical manifestations should the nurse monitor in the patient?
A. Constipation
B. Dehydration
C. Elevated total cholesterol
D. Cobalamin (B12) deficiency
Answer: D
Explanation: The stomach produces intrinsic factor, which is essential for the absorption of
vitamin B12 in the ileum. A total gastrectomy eliminates this production, leading to a risk of
cobalamin deficiency and pernicious anemia.
4. The nurse is caring for a patient who has an obstruction of the common bile duct.
Which of the following findings should the nurse monitor in this patient?
A. Melena
B. Steatorrhea
C. Decreased serum cholesterol levels
D. Increased serum indirect bilirubin levels
Answer: B
,Explanation: A common bile duct obstruction prevents bile from reaching the small
intestine, which is necessary for the emulsification and absorption of fats. This results in
fatty, foul-smelling stools known as steatorrhea.
5. The nurse is to promote bowel evacuation in a patient with persistent complaints of
constipation? Which of the following times should the nurse suggest that the patient
should 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
Answer: B
Explanation: The gastrocolic reflex, which stimulates the urge to defecate, is most active
after the first meal of the day. Attempting defecation at this time can help promote regular
bowel habits.
6. During change-of-shift report, the nurse receives the following information about a
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 shellfish and iodine in the past.
D. The patient refused to drink the ordered polyethylene glycol.
Answer: D
Explanation: Inadequate bowel preparation prevents proper visualization during a
colonoscopy and necessitates rescheduling the procedure. The other factors do not typically
contraindicate a colonoscopy.
7. The nurse is preparing to assess a patient's liver. When palpating the liver, which of
the following techniques should the nurse implement?
A. Place one hand on the patient's back and press upward and inward with the other hand
below the patient's right costal margin.
B. Place one hand on top of the other and use the upper fingers to apply pressure and the
bottom fingers to feel for the liver edge.
C. Press slowly and firmly over the right costal margin with one hand and withdraw the
fingers quickly after the liver edge is felt.
D. Place one hand under the patient's lower ribs and press the left lower rib cage forward,
palpating below the costal margin with the other hand.
Answer: A
Explanation: This technique, known as "hooking," helps to push the liver forward into a
palpable position below the costal margin and is the correct method for liver palpation.
8. The nurse is listening to a patient's abdomen. Which of the following findings indicate
a need for a focused abdominal assessment?
A. Loud gurgles
,B. High-pitched gurgles
C. Absent bowel sounds
D. Frequent clicking sounds
Answer: C
Explanation: The absence of bowel sounds after listening for a full five minutes is an
abnormal finding that requires further, focused assessment to determine the cause, such as an
ileus or bowel obstruction.
9. The nurse is caring for a patient following a needle biopsy of the liver at the bedside.
Which of the following actions should the nurse implement?
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 post-biopsy coagulation studies.
Answer: C
Explanation: Positioning the patient on the right side with the bed flat helps to splint the
biopsy site against the chest wall and minimize the risk of bleeding. Coagulation studies are
checked prior to the procedure.
10. Which of the following information obtained by the nurse when admitting a patient
who is scheduled for an ultrasound of the gallbladder indicates that the ultrasound may
need to be rescheduled?
A. The patient has a permanent gastrostomy tube.
B. The patient took a laxative the previous evening.
C. The patient ate a low-fat bagel an hour previously.
D. The patient had a high-fat meal the previous evening.
Answer: C
Explanation: A gallbladder ultrasound requires the patient to be NPO for 8-12 hours
beforehand. Food intake causes the gallbladder to contract, making it difficult to visualize
and assess for pathology.
11. The nurse is assessing an alert and independent older-adult patient in the clinic for
malnutrition risk. Which of the following questions is best as the initial assessment
question?
A. "How do you get to the grocery store to buy your food?"
B. "Do you have any difficulty in preparing or eating food?"
C. "Can you tell me the foods that you have eaten over the past 24 hours?"
D. "Are you taking any medications that alter your taste or tolerance of foods?"
Answer: C
Explanation: This open-ended question provides the most comprehensive overview of the
patient's typical dietary intake and is the best starting point for a nutritional assessment.
12. Which of the following information collected by the nurse when caring for a patient
who has just arrived in the recovery area after an esophagogastroduodenoscopy (EGD)
is most important to communicate to the health care provider?
, A. The patient is very sleepy.
B. The oral temperature is 38.7°C (101.7°F).
C. The apical pulse is 104 beats/minute.
D. The patient complains of a sore throat.
Answer: B
Explanation: Fever after an EGD can be a sign of perforation or infection, which is a serious
complication requiring immediate medical intervention.
13. Which of the following assessment findings in a patient who is being admitted to the
hospital is most important to report to the health care provider?
A. Tympany on percussion of the abdomen
B. Liver edge 3 cm below the costal margin
C. Bowel sounds of 20/minute in each quadrant
D. Aortic pulsations visible in the epigastric area
Answer: B
Explanation: A palpable liver edge more than 1-2 cm below the costal margin suggests
hepatomegaly (enlarged liver) and should be reported for further investigation. The other
findings are within normal limits.
14. Which of the following actions by a nursing student when caring for a patient who
has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD)
requires that the RN intervene?
A. Offering the patient a glass of water
B. Positioning the patient on the right side
C. Checking the vital signs every 30 minutes
D. Swabbing the patient's mouth with cold water
Answer: A
Explanation: The patient's gag reflex is suppressed after an EGD due to sedation and local
anesthesia. Offering fluids before the gag reflex has returned places the patient at high risk
for aspiration.
15. The health care provider sees a patient at 10 A.M. and writes a prescription for
endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which of
the following actions that are included in the agency protocol for ERCP should the
nurse take first?
A. Place the patient on NPO status.
B. Administer sedative medications.
C. Ensure the consent form is signed.
D. Explain the procedure to the patient.
Answer: A
Explanation: The patient must be NPO for 6-8 hours prior to an ERCP to reduce the risk of
aspiration during the procedure. This is the most immediate and critical action.
16. The nurse is caring for a patient who has just had a colonoscopy. Which of the
following symptoms should alert the nurse that a perforation has occurred? (Select all
Lewis’s Medical-Surgical Nursing, 5th Edition
1. The nurse is performing a nutritional assessment on a patient. Which of the following
information obtained by the nurse is of most concern?
A. Decreased appetite
B. Difficulty chewing food
C. Unintentional weight loss
D. Complaints of indigestion
Answer: C
Explanation: Unintentional weight loss is not a normal finding and can indicate serious
underlying conditions such as cancer or depression. While the other options are common and
require attention, they are not as concerning as unexplained weight loss.
2. The nurse is obtaining a history from a patient who is admitted with jaundice. Which
of the following statements is most indicative of a need for patient 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 need to take an antacid for indigestion several times a week."
D. "I use acetaminophen every 4 hours for persistent pain."
Answer: D
Explanation: High, chronic doses of acetaminophen are hepatotoxic and can cause liver
damage and jaundice. This patient's statement indicates a need for education about the risks
of excessive acetaminophen use.
3. The nurse is caring for a patient who has a history of a total gastrectomy. Which of
the following clinical manifestations should the nurse monitor in the patient?
A. Constipation
B. Dehydration
C. Elevated total cholesterol
D. Cobalamin (B12) deficiency
Answer: D
Explanation: The stomach produces intrinsic factor, which is essential for the absorption of
vitamin B12 in the ileum. A total gastrectomy eliminates this production, leading to a risk of
cobalamin deficiency and pernicious anemia.
4. The nurse is caring for a patient who has an obstruction of the common bile duct.
Which of the following findings should the nurse monitor in this patient?
A. Melena
B. Steatorrhea
C. Decreased serum cholesterol levels
D. Increased serum indirect bilirubin levels
Answer: B
,Explanation: A common bile duct obstruction prevents bile from reaching the small
intestine, which is necessary for the emulsification and absorption of fats. This results in
fatty, foul-smelling stools known as steatorrhea.
5. The nurse is to promote bowel evacuation in a patient with persistent complaints of
constipation? Which of the following times should the nurse suggest that the patient
should 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
Answer: B
Explanation: The gastrocolic reflex, which stimulates the urge to defecate, is most active
after the first meal of the day. Attempting defecation at this time can help promote regular
bowel habits.
6. During change-of-shift report, the nurse receives the following information about a
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 shellfish and iodine in the past.
D. The patient refused to drink the ordered polyethylene glycol.
Answer: D
Explanation: Inadequate bowel preparation prevents proper visualization during a
colonoscopy and necessitates rescheduling the procedure. The other factors do not typically
contraindicate a colonoscopy.
7. The nurse is preparing to assess a patient's liver. When palpating the liver, which of
the following techniques should the nurse implement?
A. Place one hand on the patient's back and press upward and inward with the other hand
below the patient's right costal margin.
B. Place one hand on top of the other and use the upper fingers to apply pressure and the
bottom fingers to feel for the liver edge.
C. Press slowly and firmly over the right costal margin with one hand and withdraw the
fingers quickly after the liver edge is felt.
D. Place one hand under the patient's lower ribs and press the left lower rib cage forward,
palpating below the costal margin with the other hand.
Answer: A
Explanation: This technique, known as "hooking," helps to push the liver forward into a
palpable position below the costal margin and is the correct method for liver palpation.
8. The nurse is listening to a patient's abdomen. Which of the following findings indicate
a need for a focused abdominal assessment?
A. Loud gurgles
,B. High-pitched gurgles
C. Absent bowel sounds
D. Frequent clicking sounds
Answer: C
Explanation: The absence of bowel sounds after listening for a full five minutes is an
abnormal finding that requires further, focused assessment to determine the cause, such as an
ileus or bowel obstruction.
9. The nurse is caring for a patient following a needle biopsy of the liver at the bedside.
Which of the following actions should the nurse implement?
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 post-biopsy coagulation studies.
Answer: C
Explanation: Positioning the patient on the right side with the bed flat helps to splint the
biopsy site against the chest wall and minimize the risk of bleeding. Coagulation studies are
checked prior to the procedure.
10. Which of the following information obtained by the nurse when admitting a patient
who is scheduled for an ultrasound of the gallbladder indicates that the ultrasound may
need to be rescheduled?
A. The patient has a permanent gastrostomy tube.
B. The patient took a laxative the previous evening.
C. The patient ate a low-fat bagel an hour previously.
D. The patient had a high-fat meal the previous evening.
Answer: C
Explanation: A gallbladder ultrasound requires the patient to be NPO for 8-12 hours
beforehand. Food intake causes the gallbladder to contract, making it difficult to visualize
and assess for pathology.
11. The nurse is assessing an alert and independent older-adult patient in the clinic for
malnutrition risk. Which of the following questions is best as the initial assessment
question?
A. "How do you get to the grocery store to buy your food?"
B. "Do you have any difficulty in preparing or eating food?"
C. "Can you tell me the foods that you have eaten over the past 24 hours?"
D. "Are you taking any medications that alter your taste or tolerance of foods?"
Answer: C
Explanation: This open-ended question provides the most comprehensive overview of the
patient's typical dietary intake and is the best starting point for a nutritional assessment.
12. Which of the following information collected by the nurse when caring for a patient
who has just arrived in the recovery area after an esophagogastroduodenoscopy (EGD)
is most important to communicate to the health care provider?
, A. The patient is very sleepy.
B. The oral temperature is 38.7°C (101.7°F).
C. The apical pulse is 104 beats/minute.
D. The patient complains of a sore throat.
Answer: B
Explanation: Fever after an EGD can be a sign of perforation or infection, which is a serious
complication requiring immediate medical intervention.
13. Which of the following assessment findings in a patient who is being admitted to the
hospital is most important to report to the health care provider?
A. Tympany on percussion of the abdomen
B. Liver edge 3 cm below the costal margin
C. Bowel sounds of 20/minute in each quadrant
D. Aortic pulsations visible in the epigastric area
Answer: B
Explanation: A palpable liver edge more than 1-2 cm below the costal margin suggests
hepatomegaly (enlarged liver) and should be reported for further investigation. The other
findings are within normal limits.
14. Which of the following actions by a nursing student when caring for a patient who
has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD)
requires that the RN intervene?
A. Offering the patient a glass of water
B. Positioning the patient on the right side
C. Checking the vital signs every 30 minutes
D. Swabbing the patient's mouth with cold water
Answer: A
Explanation: The patient's gag reflex is suppressed after an EGD due to sedation and local
anesthesia. Offering fluids before the gag reflex has returned places the patient at high risk
for aspiration.
15. The health care provider sees a patient at 10 A.M. and writes a prescription for
endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which of
the following actions that are included in the agency protocol for ERCP should the
nurse take first?
A. Place the patient on NPO status.
B. Administer sedative medications.
C. Ensure the consent form is signed.
D. Explain the procedure to the patient.
Answer: A
Explanation: The patient must be NPO for 6-8 hours prior to an ERCP to reduce the risk of
aspiration during the procedure. This is the most immediate and critical action.
16. The nurse is caring for a patient who has just had a colonoscopy. Which of the
following symptoms should alert the nurse that a perforation has occurred? (Select all
