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1. A client describes abdominal discomfort following ingestion of milk. Which enzyme, as a result of a genetic deficiency, should the nurse consider to be the cause of the clients discomfort?

• Lactase
• Sucrase
• Maltase
• Amylase

2. A client with the diagnosis of cancer of the stomach expresses aversion to meals and eats only small amounts. What should the nurse provide?

• Nourishment between meals
• Small portions more frequently
• Supplementary vitamins to stimulate the client’s appetite
• Only foods the client likes in small portions at mealtimes

3. A client has a suspected peptic ulcer in the duodenum. What should the nurse expect the client to report when describing the pain associated with this disease?

• An ache radiating to the left side
• An intermittent colicky flank pain
• A gnawing sensation relieved by food
• A generalized abdominal pain intensified by moving

4. Which statement by a client who is scheduled for bariatric surgery indicates to the nurse that further preoperative teaching is necessary?

• “I need to eat more high-protein foods.”
• “I’m going to have a figure like a model in about a year.”
• “I’m going to be out of bed and sitting in a chair the first day after surgery.”
• “I will be limiting my intake to 600 to 800 calories a day once I start eating again.”

5. A nurse is teaching an athletic teenager about nutrients that provide the quickest source of energy. Which food selected from a menu indicates to the nurse that the adolescent understands the teaching?

• Glass of milk
• Slice of bread
• Chocolate candy bar
• Glass of orange juice

6. A nurse provides dietary teaching about a low-sodium diet for a client with hypertension. Which nutrient selected by the client indicates an understanding about foods that are low in natural sodium?

• Milk
• Meat
• Fruits
• Vegetables

7. A client with gastroesophageal reflux disease reports having difficulty sleeping at night. What should the nurse instruct the client to do?

• Drink a glass of milk before retiring.
• Elevate the head of the bed on blocks.
• Eliminate carbohydrates from the diet.
• Take antacids such as sodium bicarbonate.

8. A high-cleansing enema is ordered for a client. What is the maximum height at which the container of fluid should be held by the nurse when administering this enema?

• 30 cm (12 inches
• 37 cm (15 inches)
• 51 cm (20 inches
• 66 cm (26 inches)

9. Six weeks after discharge, a client with a jejunoileal bypass for morbid obesity returns to the outpatient clinic reporting palpitations, abdominal cramps, diarrhea, and dizziness 30 minutes after meals. What complication should the nurse consider that the client is most likely experiencing?

• Gastric reflux
• Reflux gastritis
• Dumping syndrome
• Abdominal peritonitis

10. Two hours after a subtotal gastrectomy, the nurse identifies that the drainage from the client’s nasogastric tube is bright red. What should the nurse do first?

• Notify the health care provider.
• Clamp the nasogastric tube for one hour.
• Determine that this is an expected finding.
• Irrigate the nasogastric tube with iced saline.

11. A nurse is caring for a client who is cachectic. What infor­ mation about the function of adipose tissue in fat metabo­ lism is necessary to better address the needs of this client?

• Releases glucose for energy
• Regulates cholesterol production
• Uses lipoproteins for fat transport
• Stores triglycerides for energy reserves

12. A client has a fractured mandible that is immobilized with wires. For which life-threatening postoperative problem should the nurse monitor this client?

• Infection
• Vomiting
• Osteomyelitis
• Bronchospasm

13. A client with esophageal cancer is to receive total parenteral nutrition. A right subclavian catheter is inserted. What should the nurse consider is the primary reason why the health care provider ordered a central line?

• It prevents the development of infection.
• There is less chance of this infusion infiltrating.
• It is more convenient so clients can use their hands.
• large amount of blood helps to dilute the concentrated solution.

14. A health care provider orders an upper GI series and a barium enema. The client asks, “Why do I have to have barium for these tests?” The nurse’s best response is “Barium:

• gives off visible light, illuminating the alimentary tract.”
• provides fluorescence, thereby lighting up the alimentary tract.”
• dyes the structures of the alimentary tract, making them more visible.”
• gives more contrast to the soft tissue of the alimentary tract, allowing absorption of x-rays.”

15. A client with inflammatory bowel disease is receiving total parenteral nutrition (TPN) via an infusion pump. What is most important for the nurse to do when administering TPN?

• Monitor the clients blood glucose level q2h at the bedside with a glucometer.
• Change the TPN solution bag every 24 hours, even if there is solution left in the bag.
• Instruct the client to breathe shallowly when changing the TPN tubing using sterile technique.
• Speed up the rate of the TPN infusion if the amount delivered has fallen behind the prescribed hourly rate.

16. An older adult is returned to the surgical unit after having a subtotal gastrectomy. Which dietary modification should the nurse anticipate that the health care provider will most likely order?

• Increase intake of dietary roughage slowly.
• Avoid oral feedings for a prolonged period.
• Resume small, easily digested feedings gradually.
• Limit intake to self-selection of personally preferred foods.

17. A nurse is teaching a client about the differences between the terms saturated and unsaturated when used in reference to fats. Which important factor in relation to these types of fats should the nurse include in the teaching?

• Taste
• Color
• Density
• Digestibility

18. When an intestinal obstruction is suspected, a client has a nasogastric tube inserted and attached to suction. Lor what response should the nurse critically assess this client?

• Edema
• Belching
• Fluid deficit
• Excessive salivation

19. An exploratory laparotomy is performed on a client with melena, and gastric cancer is discovered. A partial gas­ trectomy is performed, and a jej unostomy tube is surgi­ cally implanted. A nasogastric tube to suction is in place. What should the nurse expect regarding the client’s naso­ gastric tube drainage during the first 24 hours after surgery?

• Green and viscid
• Contain some blood and clots
• Contain large amounts of frank blood
• Similar to coffee grounds in color and consistency

20. A nurse is collecting a health history from a client who has a diagnosis of cancer of the tongue. For which risk factor commonly associated with cancer of the tongue should the nurse assess when collecting the clients history?

• Nail biting
• Poor dental habits
• Frequent gum chewing
• Large consumption of alcohol

21. After a subtotal gastrectomy for cancer of the stomach, a client develops dumping syndrome. The client says, “What does it mean when the health care provider said that I am experiencing dumping syndrome?” What infor­ mation should the nurse include in a response to this question?

• Nausea resulting from a full stomach
• Reflux of gastric contents into the esophagus
• Buildup of flatulence within the large intestine
• Rapid passage of concentrated fluid into the small intestine

22. A nurse is evaluating a client’s response to receiving an intermittent gravity flow percutaneous endoscopic gastros-tomy (PEG) tube feeding. Which clinical finding indicates that the client is unable to tolerate a continuation of the feeding?

• Passage of flatus
• Rise of formula in the tube
• Rapid inflow of the feeding
• Tenderness of epigastric area

23. A nurse is planning a community health program about screening for cancer. Which information recommended by the American Cancer Society (ACS) should the nurse include?

• Mammography should be performed annually after age 35 years for women.
• Fecal occult blood testing should be performed yearly beginning at age 50 years.
• Breast self-examination should be performed monthly beginning at age 30 years.
• Digital rectal exams and PSA testing should be done yearly after age 40 for men.

24. A client is to have gastric gavage. In which position should the nurse place the client when the nasogastric tube is being inserted?

• Supine
• Mid-Fowler
• High-Fowler
• Trendelenburg

25. Three days after admission to the hospital for a brain attack (cerebrovascular accident [CVA]), a client has a nasogastric tube inserted and is receiving continuous tube feedings. What should the nurse do to best evaluate whether the feeding is being absorbed?

• Aspirate for a residual volume.
• Evaluate the intake in relation to the output.
• Instill air into the client’s stomach while auscultating.
• Compare the client’s body weight with the baseline data.

26. A health care provider orders a sigmoidoscopy for one client and a barium enema for another client. What is a nursing responsibility common to preparing both of these clients for these procedures?

• Withholding food for several hours
• Giving castor oil the afternoon before
• Administering soapsuds enemas until clear
• Ensuring an understanding of the procedure

27. A client is scheduled for a sigmoidoscopy. What instruction should the nurse provide the client in preparation for this diagnostic procedure?

• Have an enema the morning of the test
• A chalklike substance will have to be swallowe
• Withhold food for twenty-four hours before the test
• A sterile container will be provided for the collection of a stool specimen.

28. A client is scheduled for a pyloroplasty and vagotomy because of strictures caused by ulcers unresponsive to medical therapy. What information about the purpose of a vagotomy should the nurse include when reviewing the health care providers discussion with the client?

• Increases the heart rate
• Hastens gastric emptying
• Eliminates pain sensations
• Decreases secretions in the stomach

29. A nurse identifies that the client understands information about vitamin K when the client states, Vitamin K is:

• found in a variety of foods, so there is no danger of deficiency.
• easily absorbed without assistance, so everything eaten is absorbed.
• rarely found in dietary foods, so a natural deficiency can easily occur.
• produced in sufficient amounts by intestinal bacteria, so metabolic needs are met.

30. A nurse is preparing a morbidly obese client for gastric bypass surgery. What should the nurse teach the client to do after surgery?

• Take medications in liquid form.
• Lie on the right side for 1 hour after meals.
• Ingest a high-carbohydrate diet once eating is resumed.
• Receive patient-controlled analgesia for 6 days after surgery.

31. After a subtotal gastrectomy a client is returned to the surgi­ cal unit. Which is the best nursing action to prevent pul­ monary complications?

• Ambulating the client to increase respiratory exchange
• Promoting frequent turning and deep breathing to mobi­ lize secretions
• Maintaining a consistent oxygen flow rate to increase oxygen saturation
• Keeping a plastic airway in place to ensure patency of the client’s airway

32. A client is receiving hypertonic tube feedings. What should the nurse consider to be the main reason this client may experience diarrhea?

• Increased fiber intake
• Bacterial contamination
• Inappropriate positioning
• High osmolarity of the feedings

33. A client is admitted to the surgical unit from the postanes­ thesia care unit with a Salem sump nasogastric tube that is to be attached to wall suction. Which nursing action should the nurse implement when caring for this client?

• Use normal saline to irrigate the tube.
• Employ sterile technique when irrigating the tube.
• Withdraw the tube quickly when decompression is terminated.
• Allow the client to have small sips of ice water unless nauseated.

34. After a partial gastrectomy is performed, a client is returned from the postanesthesia care unit to the surgical unit with an IV solution infusing and a nasogastric tube in place. The nurse identifies that there is no nasogastric drainage for 30 minutes. There is an order for instillation of the nasogastric tube prn. The nurse should instill:

• 30 mL of normal saline and continue the suction.
• 20 mL of air and clamp off the suction for 1 hour.
• 50 mL of saline and increase the pressure of the suction.
• 15 mL of distilled water and disconnect the suction for 30 minutes.

35. Which clinical indicator should the nurse identify before scheduling a client for an endoscopic retrograde cholangiopancreatography (ERCP)?

• Urine output
• Bilirubin level
• Blood pressure
• Serum glucose

36. A health care provider schedules a paracentesis. What should the nurse instruct the client to do to prepare for the procedure?

• Empty the bladder before the procedure.
• Take a laxative the evening before the procedure.
• Ingest nothing by mouth for 8 hours before the procedure.
• Self-administer a low soapsuds enema 2 hours before the procedure

37. Which statement made by a client after attending a class on nutrition indicates an understanding of the importance of essential amino acids?

• “Amino acids can be made by the body because they are essential to life.”
• “They come from the diet because they cannot be syn­ thesized in the body.”
• “They are used in key processes essential for growth once they are synthesized by the body.”
• “Essential amino acids are required for metabolism, whereas the other amino acids are not.”

38. During administration of an enema, a client reports having intestinal cramps. What should the nurse do?

• Discontinue the procedure.
• Instill the fluid at a slower rate
• Lower the height of the container.
• Stop the fluid until the cramps subside.

39. A client has a nasogastric feeding tube inserted, and the health care provider orders the prescribed feeding to be instituted immediately. What should the nurse do first?

• Instill normal saline into the tube to maintain patency.
• Obtain an x-ray to verify that the tube is in the stomach.
• Auscultate the epigastric area while instilling 15mL of air.
• Withdraw 30mL of stomach contents to verify tube placement.

40. A client who had an incision and drainage of an oral abscess is to be discharged. For which clinical finding, if it should occur, should the nurse instruct the client to notify the health care provider?

• Foul odor to the breath
• Pain associated with swallowing
• Pain with swelling after one week
• Tenderness in the mouth when chewing

41. Megadoses of vitamin A are taken by a client. Why should the nurse question this practice?

• Vitamin A is highly toxic, even in small amounts.
• The liver has a great storage capacity for vitamin A, even to toxic amounts.
• Vitamin A cannot be stored, therefore excess amounts will saturate the general body tissues.
• Although the body’s requirement for vitamin A is great, the cells can synthesize more as needed.

42. A client is admitted to the hospital with a diagnosis of intestinal obstruction. The health care provider orders intes­ tinal suction via a nasoenteric decompression tube. The loss of which constituents associated with intestinal suctioning is most important to consider when caring for this client?

• Protein enzymes
• Energy carbohydrates
• Vitamins and minerals
• Water and electrolytes

43. When caring for a client who is recovering from a gastrec­ tomy, a nurse is concerned about the potential development of pernicious anemia. What should the nurse conclude may be the cause of this complication?

• Vitamin B12 is just absorbed in the stomach.
• Hemopoietic factor is secreted in the stomach.
• Parietal cells of the stomach secrete the intrinsic factor.
• Chief cells in the stomach promote the secretion of the extrinsic factor.

44. A client with a high cholesterol level says to the nurse, “Why can’t the doctor just give me a medication to eliminate all the cholesterol in my body so it isn’t a problem?” Which factor related to why cholesterol is important in the human body should the nurse include in a response to the client’s question?

• Blood clotting
• Bone formation
• Muscle contraction
• Cellular membranes

45. A nurse is teaching menu planning to a client who has a high triglyceride level. Which nutrient avoided by the client indicates that teaching about foods that are high in fat was understood?

• Fruits
• Grains
• Red meat
• Vegetable oils

46. A client who recently immigrated to the United States has a chronic vitamin A deficiency. What information about vitamin A should the nurse consider when assessing this client for clinical indicators of this deficiency?

• Vitamin A is an integral part of the retina’s pigment called melanin.
• It is a component of the rods and cones, which control color visualization.
• Vitamin A is the material in the cornea that prevents the formation of cataracts.
• It is a necessary element of rhodopsin, which controls responses to light and dark environments.

47. A client with gastric ulcer disease asks the nurse why the health care provider has prescribed metronidazole (Flagyl). The nurse explains, “Antibiotics are prescribed to:

• augment the immune response.”
• potentiate the effect of antacids.”
• treat Helicobacter pylori infection.”
• reduce hydrochloric acid secretion.”

48. A health care provider orders intermittent nasogastric tube feeding to supplement a client’s oral nutritional intake. Which hazard associated with a nasogastric tube feeding will be reduced if the nurse administers this feeding over 30 to 60 minutes?

• Distention
• Flatulence
• Indigestion
• Regurgitation

49. A nurse is preparing a teaching plan for a client with a history of cholelithiasis. Which information about why the ingestion of fatty foods will cause discomfort should the nurse include in the teaching plan?

• Fatty foods are hard to digest.
• Bile flow into the intestine is obstructed.
• The liver is manufacturing inadequate bile.
• There is inadequate closure of the ampulla of Vater.

50. A nurse designs a health teaching program specifically for a client who had a gastrectomy. What should this plan include?

• Information about how to limit and prevent dumping syndrome
• An explanation of the therapeutic effect of a high- roughage diet
• A list of foods that cause gas in the intestine and how to avoid them
• Encouragement to resume previous eating habits as soon as possible