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1. A client with ulcerative colitis has experienced frequent severe exacerbations over the past several years. The client is admitted to the hospital with intense pain, severe diarrhea, and cachexia. Which therapeutic course should the nurse expect the health care provider to explore with this client?

• Intensive psychotherapy
• Continued medical therapy
• Surgical therapy (colectomy)
• Diet therapy (low-residue, high-protein diet)

2. A nurse obtains daily stool specimens for a client with chronic bowel inflammation. The nurse concludes that these stool examinations were ordered to determine:

• fat content
• occult blood
• ova and parasites
• culture and sensitivity

3. A client had a colon resection and formation of a colostomy 2 days ago. What color does the nurse expect the stoma to be when assessing its viability?

• Pink
• Gray
• Brick red
• Dark purple

4. A client had surgery for a perforated appendix with localized peritonitis. In which position should the nurse place this client?

• Sims
• Semi-Fowler
• Trendelenburg
• Dorsal recumbent

5. A nurse is teaching a client with an acute exacerbation of colitis about the most appropriate diet. Which food selected by the client indicates that the dietary teaching is effective?

• Orange juice
• Scrambled eggs
• Vanilla milkshake
• Creamed potato soup

6. A nurse is teaching a client who has a full-time job how to care for a new colostomy. At which time should the nurse suggest scheduling the colostomy irrigations?

• When it is most convenient for the client
• Approximately a half hour after breakfast
• Halfway between the two largest meals of the day
• At the time the client had bowel movements before surgery

7. A client with hepatitis B asks the nurse, “Are there any medications to help me get rid of this problem?” Which is the best response by the nurse?

• “Sedatives can be given to help you relax.”
• “We can give you immune serum globulin.”
• “Vitamin supplements are frequently helpful and hasten recovery.”
• “There are medications to help reduce viral load and liver inflammation.”

8. A client who is about to have a blood transfusion asks the nurse, “Which type of hepatitis is most frequently transmit-ted by transfusions?” The nurse should respond, “Although the risk is minimal, the type of hepatitis associated with blood transfusions is hepatitis:

• A
• B
• C
• D

9. A female client with the diagnosis of Crohn disease tells the nurse that her boyfriend dates other women. She believes that this behavior causes an increase in her symptoms. What should the nurse do first when counseling this client?

• Help the client explore attitudes about herself.
• Educate the client’s boyfriend about her illness.
• Suggest the client should not see her boyfriend for a while.
• Schedule the client and her boyfriend for a counseling session.

10. A nurse is teaching a class about hepatitis, specifically hepatitis A. Which food should the nurse explain will most likely remain contaminated with the hepatitis A virus after being cooked?

• Canned tuna
• Broiled shrimp
• Baked haddock
• Steamed lobster

11. A self-help group of clients with irritable bowel syndrome have invited a nurse to present a program on nutrition. Which substance should the nurse teach the clients to mini-mize in the diet to decrease GI irritability?

• Cola drinks
• Amino acids
• Rice products
• Sugar products

12. A client with a history of pancreatitis is scheduled for surgery to excise a pseudocyst of the pancreas. The client asks, “What is a pseudocyst?” What information should the nurse include in a response to this question?

• Malignant growth
• Pocket of undigested food particles
• Dilated space of necrotic tissue and blood
• Sack filled with fluid and pancreatic enzymes

13. A nurse is caring for a client who is positive for hepatitis A. What should the nurse do?

• Wear a gown when entering the client’s room
• Use caution when bringing in the client’s food
• Use gloves when removing the client’s bedpan
• Wear a protective mask when entering the client’s room.

14. A client with cirrhosis of the liver has a prolonged prothrombin time and a low platelet count. A regular diet is ordered. What should the nurse instruct the client to do considering the client’s condition?

• Avoid foods high in vitamin K.
• Check the pulse several times a day.
• Drink a glass of milk when taking aspirin.
• Report signs of bleeding no matter how slight.

15. A nurse is caring for a client who is receiving total parenteral nutrition (TPN) after extensive colon surgery. The nurse concludes that the client understands teaching about the purpose of TPN when the client states, “TPN:

• provides short-term nutrition after surgery.”
• assists in providing supplemental nutrition.”
• provides total nutrition when GI function is questionable.”
• assists people who are unable to eat but have active GI function.”

16. A nurse educator of a college health course is discussing tattoos with the class. Which type of hepatitis associated with tattoos should the nurse include in the teaching plan?

• A
• C
• D
• E

17. Thiamine (vitamin B1 and niacin (vitamin B3) are prescribed for a client with alcoholism. Which body function maintained by these vitamins should the nurse include in a teaching plan?

• Neuronal activity
• Bowel elimination
• Efficient circulation
• Prothrombin development

18. A client is admitted to the hospital with a diagnosis of alcohol withdrawal syndrome. What body organ should the nurse teach the client will be protected by the ingestion of a high-calorie diet fortified with vitamins?

• Liver
• Heart
• Pancreas
• Adrenals

19. A client is admitted with anorexia, weight loss, abdominal distention, and abnormal stools. A diagnosis of malabsorption syndrome is made. What nursing action should the nurse implement to best meet this client’s needs?

• Allow the client to eat food preferences.
• Encourage the consumption of high-protein foods.
• Institute IV therapy to improve the client’s hydration.
• Maintain NPO status because food precipitates diarrhea.

20. A nurse is reviewing discharge plans with a client who is hospitalized with hepatitis A. The nurse concludes that the client understands preventive measures to reduce the risk for spreading the disease when the client states, “I should:

• wash my hands frequently."
• launder my clothes separately."
• put used tissues in the garbage.”
• wear a mask when leaving the house."

21. A nurse is teaching a client with a permanent colostomy about self-care in preparation for discharge from the hospital. Which intervention should the nurse discuss with the client?

• Limiting activity
• Wearing special clothing
• Dilating the stoma periodically
• Maintaining a low-residue diet

22. A client in a debilitated state is admitted for palliative treat-ment of cancer of the liver. Which objective information collected by the nurse is most helpful for future monitoring of the client’s condition?

• Diet history
• Bowel sounds
• Present weight
• Pain description

23. A nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The client asks, “What does my drinking have to do with my diagnosis?” What effect of alcohol should the nurse include when responding?

• Promotes the formation of calculi in the cystic duct
• Stimulates the pancreas to secrete more insulin than it can immediately produce
• Alters the composition of enzymes so they are capable of damaging the pancreas
• Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas

24. For which classic clinical finding should the nurse assess the stool of clients with malabsorption syndrome?

• Melena
• Frank blood
• Fat globules
• Currant jelly consistency

25. A nurse is concerned that a client with a diagnosis of cirrhosis of the liver may experience the complication of hepatic coma. For which clinical indicator should the nurse assess this client?

• Icterus
• Urticaria
• Uremic frost
• Hemangioma

26. A Harris flush is ordered to reduce a client’s flatus after abdominal surgery. How many inches should the nurse insert the rectal catheter?

• 2
• 4
• 6
• 8

27. An 18-year-old is admitted with an acute onset of right lower quadrant pain at McBurney’s point. Appendicitis is suspected. For which clinical indicator should the nurse assess the client to determine if the pain is secondary to appendicitis?

• Urinary retention
• Gastric hyperacidity
• Rebound tenderness
• Increased lower bowel motility

28. A client had part of the ileum surgically removed. Why is it necessary for the nurse to monitor the client for clinical indicators of anemia?

• Folic acid is absorbed in the ileum.
• The hemopoietic factor is absorbed in the ileum.
• Iron absorption is dependent on simultaneous bile salt absorption in the ileum.
• The trace elements copper, cobalt, and nickel, required for hemoglobin synthesis, are absorbed in the ileum.

29. A nurse is caring for a client with a new colostomy. Which client outcome is most important for achievement of long- range goals associated with adjusting to a new colostomy?

• Mastery of techniques of colostomy care
• Readiness to accept an altered body function
• Awareness of available community resources
• Knowledge of the necessary dietary modifications

30. After many years of coping with colitis, a client makes the decision to have a colectomy as advised by the health care provider. Which is most likely the significant factor that impacted on the client’s decision?

• It is temporary until the colon heals.
• Surgical treatment cures ulcerative colitis.
• Ulcerative colitis can progress to Crohn disease.
• Without surgery, eating table foods is contraindicated

31. A client is scheduled for a colonoscopy, and the health care provider orders a tap water enema. In which position should the nurse place the client during the enema?

• Left Sims
• Back lying
• Knee chest
• Mid-Fowler

32. Which explanation is most accurate when the nurse teaches a client about intussusception of the bowel?

• Kinking of the bowel onto itself
• A band of connective tissue compressing the bowel
• Telescoping of a proximal loop of bowel into a distal loop
• A protrusion of an organ or part of an organ through the wall that contains it

33. A client with hepatic cirrhosis begins to develop slurred speech, confusion, drowsiness, and a flapping tremor. With this evidence of impending hepatic coma, which diet can the nurse expect will be ordered for this client?

• 20 g of protein, 2000 calories
• 70 g of protein, 1200 calories
• 80 g of protein, 2500 calories
• 100 g of protein, 1500 calories

34. A client with chronic hepatic failure is soon to be dis-charged from the hospital. Which diet should the nurse encourage the client to follow based on the health care provider’s order?

• High-fat
• Low-calorie
• Low-protein
• High-sodium

35. For which clinical indicator associated with a complica-tion of portal hypertension should the nurse assess the client?

• Liver abscess
• Intestinal obstruction
• Perforation of the duodenum
• Hemorrhage from esophageal varices

36. A client is diagnosed as having malabsorption syndrome secondary to celiac sprue. Which intervention should the nurse expect to precipitate a striking clinical improvement in the client?

• Folic acid
• Vitamin B12
• Corticosteroids
• Gluten-free diet

37. A nurse is caring for a client with cirrhosis of the liver. Which laboratory test should the nurse monitor that, when abnormal, might identify a client who may benefit from neomycin enemas?

• Ammonia level
• Culture and sensitivity
• White blood cell count
• Alanine aminotransferase level

38. A client is a candidate for intubation as a result of bleeding esophageal varices. Which type of tube should the nurse anticipate will most likely be used to meet the needs of this client?

• Levin
• Salem sump
• Miller-Abbott
• Blakemore-Sengstaken

39. A client is diagnosed with cancer of the pancreas and is apprehensive and restless. Which nursing action should be included in the plan of care?

• Encouraging expression of concerns
• Administering antibiotics as prescribed
• Teaching the importance of getting rest
• Explaining that everything will be all right

40. A nurse is assessing two clients. One client has ulcerative colitis and the other client has Crohn disease. Which is more likely to be identified in the client with ulcerative colitis than the client with Crohn disease?

• Inclusion of transmural involvement of the small bowel wall
• Correlation with increased malignancy because of malabsorption syndrome
• Pathology beginning proximally with intermittent plaques found along the colon
• Involvement starting distally with rectal bleeding that spreads continuously up the colon

41. Before a cholecystectomy vitamin K is prescribed. Which element, formed in the presence of vitamin K, should the nurse determine is the purpose of administering this medication?

• Bilirubin
• Prothrombin
• Thromboplastin
• Cholecystokinin

42. A nurse instructs a client with viral hepatitis about the type of diet that should be ingested. Which lunch selected by the client indicates understanding about dietary principles asso-ciated with this diagnosis?

• Turkey salad, French fries, sherbet
• Cottage cheese, mixed fruit salad, milkshake
• Salad, sliced chicken sandwich, gelatin dessert
• Cheeseburger, tortilla chips, chocolate pudding

43. A nurse is reviewing the laboratory results of and collecting a health history from a client with a diagnosis of colitis. Which common clinical manifestation of colitis should the nurse expect?

• Weight loss
• Hemoptysis
• Increased red blood cells
• Decreased white blood cellS

44. What should the nurse do when caring for a client with an ileostomy?

• Teach the client to eat foods high in residue.
• Explain that drainage can be controlled with daily irrigations.
• Expect the stoma to start draining on the third postoperative day.
• Anticipate that any emotional stress can increase intestinal peristalsis.

45. Neomycin 1 g is prescribed preoperatively for a client with a diagnosis of cancer of the colon. The client asks why neomycin is being given. Which is the best response by the nurse?

• “It will decrease your kidney function and lessen urine production during surgery.”
• “It will kill the bacteria in your bowel and decrease the risk of infection after surgery.”
• “It is used to alter the body flora, which reduces the spread of the tumor to adjacent organs.”
• “It is used to prevent you from getting an infection, particularly a bladder infection, before surgery.”

46. A client is returned to the surgical unit after an abdominal cholecystectomy. What is the main reason why the nurse should assess for clinical indicators of respiratory complications?

• Length of time required for surgery is prolonged.
• Incision is in close proximity to the client’s diaphragm.
• Client’s resistance is lowered because of bile in the blood.
• Bloodstream is invaded by microorganisms from the biliary tract.

47. A nurse is educating a client with a colostomy of the ascending colon about using a colostomy appliance. Which instruction should the nurse provide to help prevent leakage of stool from the appliance?

• Irrigate the colostomy to establish an expected pattern of elimination
• Empty the appliance when it is approximately one half full with feces
• Use an antiseptic to clean the peristomal skin before applying the appliance
• Select an appliance with a pouch opening of at least 5 cm larger than the stoma

48. A nurse is evaluating a client who has been receiving medical intervention for the diagnosis of Crohn disease. Which expected outcome is most important for this client?

• Does skin care
• Takes oral fluids
• Gains a half pound per week
• Experiences less abdominal cramping

49. A nurse is admitting a client with the diagnosis of malabsorption syndrome to the medical unit at lunchtime. Which foods can be included on the client’s ordered diet?

• Breaded veal cutlet with cheese
• Roast beef sandwich with pickles
• Chicken noodle soup with crackers
• Cheese omelet with chopped spinach

50. A health care provider orders a gastrointestinal endoscopy with a capsule endoscopic device. What should the nurse instruct the client to do?

• Check the recorder every hour.
• Avoid eating food and fluid during the test.
• Avoid stooping and bending during the test.
• Swallow the capsule as soon as it is placed in the mouth.