DMMMSU- CCHAMS SY 2021-2022, Second Semester

1. Patient Venus has severe midepigastric or right upper quadrant pain radiating to the back or
referred to the right scapula, belching that leaves a sour taste in the mouth, and flatulence. She most
likely has:

A. appendicitis.

B. acute cholecystitis, acute cholelithiasis, or choledocholithiasis.

C. diverticular disease.

D. acute gastritis.

2. Nurse Vince is researching about Hepatitis, which statement about hepatitis is true?

A. Type A hepatitis can lead to fulminant hepatitis.

B. Type B hepatitis is transmitted via blood products, urine, and other body fluids.

C. Type C hepatitis is transmitted via the fecal-oral route only.

D. Type D hepatitis is mild in severity.

B. Type B hepatitis is transmitted via serum, blood, blood products, and all other body fluids. Type A
hepatitis is mild in severity and won’t lead to fulminant hepatitis. Type C hepatitis is transmitted via
blood and other parenteral means. Type D hepatitis can be severe and lead to fulminant hepatitis

3. When assessing a patient in the early stages of cirrhosis of the liver, what sign would be
anticipated?

A. Jaundice

B. Peripheral edema

C. Ascites

D. Anorexia

Answer: D. Early manifestations of cirrhosis are vague and usually include GI symptoms such as anorexia,
indigestion, nausea, vomiting, or bowel pattern problems

4. Patient Maureen is suspected of appendicitis, which of these interventions is appropriate?

A. Give I.V. fluids, give the patient nothing by mouth, and apply heat to his abdomen for comfort.

B. Give I.V. fluids, give the patient nothing by mouth, and give an enema to clean his bowel before
surgery.

C. Give I.V. fluids; give the patient nothing by mouth, but give analgesics judiciously; and place him in
Fowler’s position to reduce pain.

D. Give clear liquids only along with heat applied to the abdomen for comfort

5. Which measure should the patient with diverticulitis be instructed to integrate into her diet at
home when you as a nurse is giving home instructions prior to discharging the patient?

A. Eating a diet high in digestible fiber

B. Limiting fluid intake

C. Using enemas to relieve constipation

D. Straining with each bowel movement

DMMMSU- CCHAMS SY 2021-2022, Second Semester

Answer: A. A diet high in digestible fiber is recommended to increase stool volume, decrease colonic
transit time, and reduce intraluminal pressure

6. After eating, Patient Dy has inflamed gallbladder and has pain caused by contraction of the
gallbladder. What is the mechanism responsible for this action?

a. Production of bile by the liver

b. Production of secretin by the duodenum

c. Release of gastrin from the stomach antrum

d. Production of cholecystokinin by the duodenum

d. Cholecystokinin is secreted by the duodenal mucosa when fats and amino acids enter the duodenum
and stimulate the gallbladder to release bile to emulsify the fats for digestion. The bile is produced by the
liver but stored in the gallbladder. Secretin stimulates pancreatic bicarbonate secretion. Gastrin
increases gastric motility and acid secretion.

7. A 68-year-old patient is in the office for a physical. She notes that she no longer has regular bowel
movements. Which suggestion by the nurse would be most helpful to the patient?

a. Take an additional laxative to stimulate defecation.

b. Eat less acidic foods to enable the GI system to increase peristalsis.

c. Eat less food at each meal to prevent feces from backing up due to slowed peristalsis.

d. Attempt defecation after breakfast because gastrocolic reflexes increase colon peristalsis at that time.

d. When food enters the stomach and duodenum, the gastrocolic and duodenocolic reflexes are started
and are more active after the first daily meal. Additional laxatives or laxative abuse contribute to
constipation in older adults. Decreasing food intake is not recommended, as many older adults have a
decreased appetite. Fiber and fluids should be increased.

8. A patient is admitted to the hospital with left upper quadrant (LUQ) pain. What organ might be the
source of the pain?

a. Liver

b. Pancreas

c. Appendix

d. Gallbladder

b. The body of the pancreas is in the left upper quadrant, the liver is in the right upper quadrant, the
appendix is in the right lower quadrant, and the gallbladder is in the right upper quadrant.

9. Which laboratory findings should nurse Almira expect in the patient with persistent vomiting?

a. ↓ pH, ↑ sodium, ↓ hematocrit

b.↑ pH, ↓ chloride, ↓ hematocrit

c. ↑ pH, ↓ potassium, ↑ hematocrit

d. ↓ pH, ↓ potassium, ↑ hematocrit

c. The loss of gastric HCl causes metabolic alkalosis and an increase in pH; loss of potassium, sodium,
and chloride; and loss of fluid, which increases the hematocrit.
DMMMSU- CCHAMS SY 2021-2022, Second Semester

10. A patient who has been vomiting for several days from an unknown cause is admitted to the
hospital. What should the nurse anticipate will first be included in interprofessional care?

a. Oral administration of broth and tea

b. IV replacement of fluid and electrolytes

c. Administration of parenteral antiemetics

d. Insertion of a nasogastric (NG) tube for suction

b. The patient with severe or persistent vomiting requires IV replacement of fluids and electrolytes until
able to tolerate oral intake to prevent serious dehydration and electrolyte imbalances. Oral fluids are not
given until vomiting has been relieved and parenteral antiemetics are often not used until a cause of the
vomiting can be established. Nasogastric (NG) intubation may be needed in some cases, but fluid and
electrolyte replacement are the first priority.

11. Patient Enrico has persistent and continuous pain at McBurney’s point. The nursing assessment
reveals rebound tenderness and muscle guarding with the patient preferring to lie still with the right
leg flexed. What should the nursing interventions for this patient include?

a. Laxatives to move the constipated bowel

b. NPO status in preparation for possible appendectomy

c. Parenteral fluids and antibiotic therapy for 6 hours before surgery

d. NG tube inserted to decompress the stomach and prevent aspiration

b. The patient’s manifestations are characteristic of appendicitis. After laboratory test and CT scan
confirmation, the patient will have surgery. Laxatives are not used. The 6 hours of fluids and antibiotics
preoperatively would be used if the appendix was ruptured. The NG tube is more likely to be used with
abdominal trauma.

12. The patient has peritonitis, which is a major complication of ruptured appendix. What treatment
should the nurse plan to include?

a. Peritoneal lavage

b. Peritoneal dialysis

c. IV fluid replacement

d. Increased oral fluid intake

c. IV fluid replacement along with antibiotics, NG suction, analgesics, and potential surgery would be
expected. Peritoneal lavage may be used to determine abdominal trauma. Peritoneal dialysis would not
be performed. Oral fluids would be avoided with peritonitis.

13. What laboratory findings are expected in ulcerative colitis because of diarrhea and vomiting?

a. Increased albumin

b. Elevated white blood cells (WBCs)

c. Decreased serum Na + , K + , Mg + , Cl – , and HCO3 –

d. Decreased hemoglobin (Hgb) and hematocrit (Hct)

c. In the patient with ulcerative colitis, decreased serum Na + , K+ , Mg + , Cl − , and HCO3 − are a result
of diarrhea and vomiting.
DMMMSU- CCHAMS SY 2021-2022, Second Semester

14. For the patient hospitalized with inflammatory bowel disease (IBD), which treatments would be
used to rest the bowel (select all that apply)?

a. NPO

b. IV fluids

c. Bed rest

d. Sedatives

e. NG suction

f. Parenteral nutrition

a, b, e, f. With an acute exacerbation of inflammatory bowel disease (IBD), to rest the bowel the patient
will be NPO, receive IV fluids and parenteral nutrition, and have NG suction. Sedatives may be used to
alleviate stress. Enteral nutrition will be used as soon as possible.

15. A patient with inflammatory bowel disease has a nursing diagnosis of impaired nutritional status;
etiology: decreased nutritional intake and decreased intestinal absorption. Which assessment data
support this nursing diagnosis?

a. Pallor and hair loss

b. Frequent diarrhea stools

c. Anorectal excoriation and pain

d. Hypotension and urine output below 30 mL/hr

a. Signs of malnutrition include pallor from anemia, hair loss, bleeding, cracked gingivae, and muscle
weakness, which support a nursing diagnosis that identifies impaired nutrition. Diarrhea may contribute
to malnutrition but is not a defining characteristic for this patient. Anorectal excoriation and pain relate
to problems with skin integrity. Hypotension relates to problems with fluid deficit.

16. During the incubation period of viral hepatitis, what should the nurse expect the patient to report?

a. Dark urine and easy fatigability

b. No symptoms except diagnostic results

c. Anorexia and right upper quadrant discomfort

d. Constipation or diarrhea with light-colored stools

b. During the incubation period, there are no symptoms, but serologic and enzyme markers of the
disease are present. Earliest symptoms may include anorexia and discomfort in the upper right quadrant
of the abdomen. Pruritus, dark urine, and light-colored stools occur with the onset of jaundice in the
acute phase. Easy fatigability and malaise are seen in the convalescent phase as jaundice disappears.

17. The occurrence of acute liver failure is most common in which situation?

a. A person with hepatitis A

b. A person with hepatitis C

c. Antihypertensive medication use

d. Use of acetaminophen with alcohol use

DMMMSU- CCHAMS SY 2021-2022, Second Semester

d. The most common cause of acute liver failure is drugs, usually acetaminophen in combination with
alcohol. HBV is the second most common cause. HAV is a less common cause.

18. The nurse identifies a need for further teaching when the patient with acute hepatitis B makes
which statement?

a. “I should avoid alcohol completely for at least a year.”

b. “I must avoid all physical contact with my family until the jaundice is gone.”

c. “I should use a condom to prevent spread of the disease to my sexual partner.”

d. “I will need to rest several times a day, gradually increasing my activity as I tolerate it.”

b. The patient with acute hepatitis B is infectious for 4 to 6 months, and precautions to prevent
transmission through percutaneous and sexual contact should be maintained until tests for HbsAg or
anti-HBc IgM are negative. Close contact does not have to be avoided, but close contacts of the patient
should be vaccinated. Alcohol should not be used for at least a year, and rest with increasing activity
during convalescence is recommended

19. The patient is an older woman with cirrhosis who has anemia. What pathophysiologic changes
may contribute to this patient’s anemia (select all that apply)?

a. Vitamin B deficiencies

b. Stretching of liver capsule

c. Vascular congestion of spleen

d. Decreased prothrombin production

e. Decreased bilirubin conjugation and excretion

a, c, d. The anemia of cirrhosis is related to overactivity of the enlarged spleen that removes blood cells
from circulation. Vitamin B deficiencies from altered intake and metabolism of nutrients and decreased
prothrombin production can increase bleeding tendencies. The other options do not contribute to
anemia in the patient with cirrhosis.

20. Which conditions contribute most likely to the formation of abdominal ascites?

a. Esophageal varices contribute to 80% of variceal hemorrhages

b. Increased colloidal oncotic pressure caused by decreased albumin production

c. Hypoaldosteronism causes increased sodium reabsorption by the renal tubules

d. Blood flow through the portal system is obstructed, which causes portal hypertension

d. Blood flow through the portal system is obstructed and causes portal hypertension that increases the
BP in the portal venous system. Decreased albumin production leads to decreased serum colloidal
oncotic pressure that contributes to ascites. Hyperaldosteronism increases sodium and water retention
and contributes to increased fluid retention, hypokalemia, and decreased urinary output. The retained
fluid has low oncotic colloidal pressure. It escapes into the interstitial spaces, causing peripheral edema.
Portal hypertension contributes to esophageal varices. Reduced renal blood flow and increased serum
levels of antidiuretic hormone (ADH) contribute to impaired water excretion and ascites

21.Patient Jambe has hepatic encephalopathy. What is a priority nursing intervention to keep the
patient safe?

a. Turn the patient every 3 hours.

b. Encourage increasing ambulation.

DMMMSU- CCHAMS SY 2021-2022, Second Semester

c. Assist the patient to the bathroom.

d. Prevent constipation to reduce ammonia production.

c. The patient may not be oriented or able to walk to the bathroom alone because of hyperreflexia,
asterixis, or decreased motor coordination. Turning should be done every 2 hours to prevent skin
breakdown. Activity is limited to decrease ammonia as a by-product of protein metabolism. Although
constipation will be prevented, it will not keep the patient safe.

22. The patient with liver failure has had a liver transplant. What should the nurse teach the patient
about care after the transplant?

a. Alcohol intake is now okay.

b. HBIG will be required to prevent rejection.

c. Elevate the head 30 degrees to improve ventilation when sleeping.

d. Monitor closely for infection because of the immunosuppressive medication

d. Monitoring for viral, fungal, and bacterial infection after the liver transplant is essential, as only fever
may be present with an infection. Alcohol will not be any better for the patient after the transplant than
it was before the transplant. HBIG is given for postexposure protection from HBV. The head of the bed is
elevated to improve ventilation with severe ascites.

23. Nurse Pat has taught the client about an upcoming endoscopic retrograde
cholangiopancreatography (ERCP) procedure. The nurse determines that the client needs further
information if the client makes which statement?

a. “I know I must sign the consent form.”

b. “I hope the throat spray keeps me from gagging.”

c. “I’m glad I don’t have to lie still for this procedure.”

d. “I’m glad some intravenous medication will be given to relax me.”

c. The client does have to lie still for ERCP, which takes about 1 hour to perform. The client also has to
sign a consent form. Intravenous sedation is given to relax the client, and an anesthetic spray is used to
help keep the client from gagging as the endoscope is passed.

24. Which complication of acute pancreatitis requires immediate surgical drainage to prevent sepsis?

a. Tetany

b. Pseudocyst

c. Pleural effusion

d. Pancreatic abscess

d. A pancreatic abscess, usually from an infected pseudocyst, is a collection of pus that must be drained
to prevent infection of adjacent organs and sepsis. Tetany from hypocalcemia is treated with IV calcium
gluconate (10%). Although pseudocysts usually resolve spontaneously, they may be treated with
surgical, percutaneous catheter, or endoscopic drainage to prevent perforation. Pleural effusion is
treated by treating the cause (pancreatitis) and monitoring for respiratory distress and oxygen
saturation.

25. Combined with clinical manifestations, what laboratory finding that is most commonly used to
diagnose acute pancreatitis?

a. Increased serum calcium

DMMMSU- CCHAMS SY 2021-2022, Second Semester

b. Increased serum amylase

c. Increased urinary amylase

d. Decreased serum glucose

b. Although serum lipase levels and urinary amylase levels are increased, an increased serum amylase
level is the criterion most commonly used to diagnose acute pancreatitis in the first 24 to 72 hours.
Serum calcium levels are decreased and serum glucose is increased.

26. Which characteristics are most commonly associated with cholelithiasis (select all that apply).

a. Obesity

b. Age over 40 years

c. Multiparous female

d. History of excessive alcohol intake

e. Family history of gallbladder disease

f. Use of estrogen or oral contraceptives

a, b, c, e, f. Incidence of cholelithiasis is higher in women, multiparous women, persons over 40 years of

age, and those with family history and obesity. Postmenopausal women taking estrogen replacement
therapy and younger women on oral contraceptives have a higher incidence. Alcohol intake and diet do
not increase the incidence of cholelithiasis

27. After a laparoscopic cholecystectomy, what should the nurse expect to be part of the plan of care?

a. Return to work in 2 to 3 weeks

b. Be hospitalized for 3 to 5 days postoperatively

c. Have a T-tube placed in the common bile duct to provide bile drainage

d. Have up to 4 small abdominal incisions covered with small dressings

d. The laparoscopic cholecystectomy requires 1 to 4 small abdominal incisions to visualize and remove
the gallbladder, and the patient has small dressings placed over these incisions. The patient with an
incisional cholecystectomy is usually hospitalized for 2 to 3 days, whereas the laparoscopic procedure
allows same-day or next-day discharge with return to work within 1 week. A T-tube is placed in the
common bile duct after exploration of the duct during an incisional cholecystectomy.

28. What treatment for acute cholecystitis will prevent further stimulation of the gallbladder?

a. NPO with NG suction

b. Incisional cholecystectomy

c. Administration of antiemetics

d. Administration of anticholinergics

a. NPO and nasogastric (NG) suction prevent gallbladder stimulation from food or fluids moving
into the duodenum. Laparoscopic cholecystectomy is used more often than incisional
cholecystectomy, but both remove the gallbladder, not its stimulation. Administration of
antiemetics decreases nausea and vomiting but does not decrease gallbladder stimulation.
Anticholinergics counteract the smooth muscle spasms of the bile ducts to decrease pain

29. Which method is preferred for immediate treatment of an acute episode of constipation?
DMMMSU- CCHAMS SY 2021-2022, Second Semester

a. An enema

b. Increased fluid

c. Stool softeners

d. Bulk-forming medication

a. Enemas are fast acting and beneficial in the immediate treatment of acute constipation but should be
limited in their use. Increased fluids can help decrease the incidence of constipation. Stool softeners have
a prolonged action, taking up to 72 hours for an effect. Bulk-forming medication stimulates peristalsis
but takes 24 hours to act.

30. Give 1 Nursing Diagnoses for Hemorrhoid

-Impaired Tissue Integrity

-Constipation

-Acute Pain

-Risk for Bleeding