SITUATION: Carlos 25 years old was admitted with a diagnosis of Acute appendicitis.

Nurse Evelyn was

assigned to care for Carlos.

1. One of the lab tests the nurse would expect to see ordered is:
a. Serum sodium c. Hemoglobin (Hgb) and hematocrit (Hct).
b. White blood cell (WBC) count d. Bilirubin Level
2. Which of the ff. laboratory results will support the physician’s diagnosis of acute appendicitis?
A. Leukopenia C. Agranulocytosis
B. Leukocytosis D. Thrombocytopenia
3. Carlos was in acute pain and observed to be restless trying to look for a comfortable position in
bed. Which of the ff. will nurse Evelyn comforted as most comfortable?
A. Lying on either side with both legs flexed
B. Lying on the back in low fowler’s position
C. Sitting up with elbows on knees
D. Prone with pillows
4. The nurse finds a positive Blumberg’s sign in a client with abdominal pain. Which action will the
nurse plan?
a. Have the client be NPO in preparation for surgery.
b. Document this normal finding in the client’s record.
c. Immediately auscultate the client’s abdomen for bowel sounds.
d. Repeat the maneuver with the client in a supine position, with the knees flexed.

5. The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is
scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and
begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds
are diminished. Which is the appropriate nursing intervention?
A. Notify the physician.
B. Administer the prescribed pain medication.
C. Call and ask the operating room team to perform the surgery as soon as possible.
D. Reposition the client and apply a heating pad on warm setting to the site

SITUATION: A 55 years old male client sought admission to Medical Center for pain and discomfort.
The admitting physician noted “a typical peptic ulcer case.”
6. The nurse took the history and initial assessment. Which pain description best describes that of a
client suffering from peptic ulcer?
A. The pain tends to recur at intervals of hours to days
B. Pain is felt near the midline in the epigastrium radiating to the back
C. The pain is periumbilical and felt in-between meals
D. The pain is gnawing, burning usually rhythmic the stomach is empty
7. The medication history of the client reveals intermittent use of several medications. The nurse
would teach the client to avoid which of the ff. medications?
A. Sucralfate (Carafate)
B. Omepazole (Pilosec)
C. Ibuprofen (Motrin)
D. Nizatidine (Axid)
8. The client claims that he has been very careful not to miss a meal and avoiding highly seasoned
foods. He inquires which could have been the cause of his disease. The nurse cites the two most
 common cause of peptic ulcer. Identify these causes. 1) H. pylori infection 2) Playing mahjong 3)
Genetic predisposition 4) Non-Steroidal Anti-Inflammatory Drugs intake 5) Dietary indiscretions
A. 1 and 5 C. 3 and 4
B. 2 and 3 D. 1 and 4

9. The doctor’s order reads “Monitor for signs of perforation.” Which assessment findings of the
nurse would indicate perforation of the ulcer?
A. A rigid broad like abdomen
B. Nausea and vomiting
C. Blood in the stool
D. Numbness in the legs
10. The client is ordered Ranitidine (Zantax) 300 mg once daily. For greatest protection of the gastric
mucosa, the nurse gives the drug at which time schedule?
A. Before dinner C. At bedtime
B. After lunch D. Before breakfast

SITUATION: The vague nature of many gastrointestinal symptoms makes diagnosis of GI problems quite
difficult. A complete patient history and an adequate physical examination are necessary in order to
gather as much information as possible. Although this is routinely done by the admitting physician, a
nursing assessment must be completed as well.

11. The nurse is caring for a client who just had an esophagogastroduodenoscopy (EGD) completed.
The client tells the nurse that her mouth is very dry after the procedure. Which is the nurse’s best
action?
a. Keep the client NPO. c. Offer the client sips of clear liquids.
b. Check the client’s gag reflex. d. Provide the client with a few ice chips.

12. An adult patient is scheduled for an upper GI series that will use a barium swallow. What
teaching should the nurse include when the patient has completed the test?
a. Stool will be yellow for the first 24 hours post-procedure
b. The barium may cause diarrhea
c. Fluids must be increased to facilitate the evacuation of the stool
d. This series includes analysis of gastric secretions
13. A client with peptic ulcer disease says, "I feel so much better now that I've stopped eating." The
nurse realizes that this client is at risk for:
a. Sleep Pattern Disturbance c. Imbalanced Nutrition: Less than Body Requirements
b. Fluid Volume Overload d. Pain
14. Nurse Mon is caring for a client who has recently undergone a Billroth I procedure. He notes that
the client’s reflexes are slowed and the client reports tingling in his feet and hands. Which dietary
recommendations will he make for this client?
a. “Avoid nuts and other legumes.” c. “Eat more shellfish, beef, and salmon.”
b. “Avoid grapefruit and orange juices.” d. “Eat more leafy, dark green vegetables.”
15. A patient hospitalized with an acute exacerbation of ulcerative colitis is having 14 to 16 bloody
stools a day and crampy abdominal pain associated with the diarrhea. The nurse will plan to:
a. Place the patient on NPO status. c. Start bowel preparation for colonoscopy.
 b. Administer Cobalamin (vitamin B12) injections.d. Administer IV metoclopramide (Reglan).
16. While obtaining a nursing history from a patient with IBD, the nurse recognizes that the patient
most likely has ulcerative colitis rather than Crohn’s disease when the patient reports
experiencing:
a. Weight loss. c. Abdominal pain and cramping.
b. Bloody stools. d. Disease onset at age 20.
17. A client who has a history of chronic ulcerative colitis is diagnosed with anemia. The nurse
interprets that which factor is most likely responsible for the anemia?
A. Blood loss C. Intestinal malabsorption
B. Intestinal hookworm D. Decreased intake of dietary iron
18. Joseph was diagnosed with Regional Enteritis and is to receive metronidazole (Flagyl) tablets
1.5grams daily in 3 divided doses for 7 days. Which of the following is the correct dose of the
drug that the client will receive per oral administration?
A. 50mg TID C. 1000mg TID
B. 1,500mg TID D. 500mg TID
19. Crohn’s disease and ulcerative colitis have similarities and differences. Which of the following
statements is accurate about these disorders?
a. Crohn’s disease presents as a protrusion from its normal cavity in a weakened area
b. Ulcerative colitis usually presents with a hard, rigid abdomen
c. Crohn’s disease generally causes pain in the distal ileum
d. Ulcerative colitis doesn’t recur once treated with medication
SITUATION 1: Cedric Diaz is a 43-year-old, self-employed, financial advisor. He was admitted with an
7.4 mg/dL hemoglobin and 22% hematocrit after experiencing acute gastrointestinal hemorrhage related
to peptic ulcer disease (PUD). During the initial admission history, Mr. Diaz stated that his stools "didn't
look right" for a few days before the acute bleeding episode,

20. A nurse is performing a health history and physical assessment Mr. Diaz. The nurse identifies
which of the following risk factors stated by the client as being considered a major risk factor for
peptic ulcer disease?
a. Male gender c. Smoking
b. Family history of peptic ulcer disease d. Use of NSAIDs
21. Which of the following manifestations would the nurse assessing a client recognize as most
representative of the classic symptoms of peptic ulcer disease?
a. Sharp pain that occurs in the epigastric region within an hour after eating
b. Back pain, regurgitation, and vomiting
c. Epigastric pain 2-3 hours after eating or in the middle of the night
d. Dysphagia and heartburn that is made worse by eating

22. The nurse took the medication history of Harold. Which of the following best describes method
of action of medication, such as ranitidine (Zantac) which is used in managing peptic ulcer
disease?
a. Neutralize acid c. Stimulate gastrin release
b. Reduce acid secretion d. Protect the mucosal barrier
SITUATION: Lucy, a staff nurse is assigned in the medical unit during the morning shift. She is
preparing medications for patients assigned to her.

23. One of the patients is receiving antacids therapy for gastric ulcer, Lucy understands that the pain
reducing effect of antacids is due to which of the ff.?
 A. Increase pepsin activity
B. Block histamine receptors
C. Acid neutralizing capacity
D.Release of carbon dioxide gas in the stomach
24. Lucy prepares Esomeprazole Magnesium (Nexium) for her patients with Peptic ulcer. This drug
is classified as:
A. A histamine H receptor antagonist
B. A synthetic prostaglandin compound
C. An alkaline chemical agent
D. A proton pump inhibitor

25. Patient Imogen was rushed to the ER with symptoms of gastric ulcer. Which of the
following signs is consistent with the disorder?
a. Pain occurs 4 hours after eating
b. Pain occurs immediately after eating
c. Pain is relieved by vomiting
d. Pain is relieved by eating

26. Patient Martha with gastric tumor is scheduled for a subtotal gastrectomy (Billroth II).
The nurse explains the procedure to the client and tells that the:
a. Proximal end of the distal stomach is anastomosed to the duodenum
b. Entire stomach is removed and the esophagus is anastomosed to the duodenum
c. Lower portion of the stomach is removed and the remainder is anastomosed to
the jejunum
d. Anthrum of the stomach is removed and the remaining portion is anastomosed to the
duodenum

27. Patient Saunders had Billroth II procedure 3 days ago. Because of the complication
related to the surgery, which of the following should Nurse Finn advise to him? Select all
that apply:
I. Lying down after eating
II. Eating a diet high in protein
III. Drinking liquids after meals
IV. Eating six small meals per day
V. Eating concentrated sweets between meals only

28. the nurse is assigned to a 40-year old patient who has a diagnosis of chronic pancreatitis.
She reviews the laboratory result, anticipating a laboratory report that indicates a serum
amylase level of:
a. 45 units/ L b. 100 units/L c. 300 units/ L d. 500 units/L

29. An adult client was diagnosed with acute pancreatitis 9 days ago. Nurse interprets that he is
recovering from this episode if the serum lipase level decreases to which of the following
values, which is just below the upper limit of normal?
a. 20 units/ L b. 80 units/ L c. 135 units/ L d. 350 units/ L

30. The nurse is reviewing the physician’s orders written for client diagnosed with acute
pancreatitis. Which physician order should the nurse question if noted on chart?
a. NPO status c. Meperidine for pain

b. Nasogastric tube insertion d. An anticholinergic medication

31. A nurse is reviewing the prescription for a client admitted to the hospital with a
diagnosis ofacute pancreatitis. Which of the following interventions would the nurse
expect to be prescribed for the client? Select all that apply.
1. Administer antacids as prescribed.
2. Encourage coughing and deep breathing.
3. Administer anticholinergics as prescribed.
4. Give small, frequent high-calorie feedings.
5. Maintain the client in a supine and flat position.
6. Give Meperidine (Demerol) as prescribed for pain.

32. Client has been admitted to the hospital with a diagnosis of acute pancreatitis and the nurse
is assessing the client’s pain. What type of pain is consistent with this diagnosis?

a. Burning and aching, located in the lower left quadrant and radiating to the hip
b. Severe and unrelenting, located in the epigastric area and radiating to the back
c. Burning and aching, located in the epigastric area and radiating to the umbilicus
d. Severe and unrelenting, located in the lower left quadrant and radiating to the groin

33. Client with chronic pancreatitis needs information on dietary modification to manage the
health problem. Nurse teaches the client to limit which item in the diet?
a. Fat b. Protein c. Carbohydrate d. Water soluble vitamins

34. A client is admitted to the nursing unit in acute abdominal pain. The Physician diagnosed
Peritonitis. Abdominal assessment reveals three of the following findings. Which one wouldn’t
occur with peritonitis?

A. High-pitched bowel sounds

B. Abdominal distension

C. Diffuse abdominal pain

D. Constipation

35. After 2 weeks of medical management and treatment, the client did not improve. The client
developed Hepatic Encephalopathy. Which of the following nursing interventions is appropriate?
 a. Encouraging the client to assume a side-lying position with legs drawn up

b. Provide a high-calorie, high-carbohydrate, and low-protein diet

c. Instruct the client to avoid heavy lifting, pushing, and pulling for 6 weeks
d. Administer pain medication every 4 hours as ordered for severe pain
36. A client admitted to the hospital with a diagno-
sis of cirrhosis has massive ascites and difficulty breathing. The nurse performs which interven-
tion as a priority measure to assist the client with breathing?
a. Repositions side to side every 2 hours
b. Elevates the head of the bed 60 degrees
c. Auscultates the lung fields every 4 hours
d. Encourages deep breathing exercises every 2 hours
37. The home care nurse visits a client who was re- cently diagnosed with cirrhosis and provides
home care management instructions to the cli- ent. Which statement by the client indicates
the need for further instructions?
1 “I will obtain adequate rest.”
2 “I should monitor my weight regularly.”
3 “I should include sufficient carbohydrates in my diet.”
4 “I will take acetaminophen (Tylenol) if I get a headache.”
38. A client with advanced cirrhosis of the liver is not tolerating protein well, as evidenced
by abnormal laboratory values. The nurse antici- pates that which of the following
medications will be prescribed for the client?
1 Folic acid (Folvite)
2 Lactulose (Enulose)
3 Thiamine (vitamin B1)
4 Ethacrynic acid (Edecrin)

39. A client is diagnosed with pernicious anemia. The nurse reviews the client’s health
history for disorders involving which organ responsi- ble for vitamin B12 absorption?
1 Liver
2 Ileum
3 Hepatobiliary
4 Gastrointestinal
40. The nurse is assisting the client with hepatic encephalopathy to fill out the dietary menu.
The nurse advises the client to avoid which of the following entree items that could
aggravate the client’s condition?
a. Tomato soup
b. Fresh fruit plate
c. Vegetable lasagna
d. Ground beef patty

41. A client who undergoes a gastric resection isatrisk for developing dumping syndrome.
Thenurse monitors the clientfor:
a. Dizziness
b. Bradycardia
c. Constipation
d. Extremethirst
42. A client with a gastric tumor is scheduled for a subtotal gastrectomy (Billroth II procedure).
The nurse explains the procedure to the client and tells the client thatthe:
a. Proximal end of the distal stomach isanas- tomosed to theduodenum
b. Entire stomach is removed and theesopha- gus is anastomosed to theduodenum
c. Lower portion of the stomach is removed and the remainder is anastomosed to
the jejunum
d. Antrum of the stomach is removed andthe remaining portion is anastomosed to
the duodenum
43. The physician orders three stool specimens for occult blood from a client who complains
of blood-streaked stools and a 1O-pound weight loss in one month. To ensure valid test
results the nurse should instruct the client to:
a. Avoid eating red meat before testing
b. Test the specimen while it is still warm
c. Discard the first stool of the day and use the next three stools
d. Take three specimens fro m different sections of the fecal sample
44. When a client develops steatorrhea, the nurse should describe this stool as:
a. Dry and rock-hard
b. Clay colored and pasty
c. Bulky and foul smelling
d. Black and blood-streaked
45. To determine when a client who has had a subtotal gastrectomy Can begin oral feedings
after surgery, the nurse must assess for the:
a. Presence of flatulence
b. Extent of incisional pain
c. Stabilization of hematocrit levels
d. Occurrence of dumping syndrome
46. A client who has had a gastric ulcer asks what to do if the epigastric pain occurs. The nurse
would know that the teaching was effective when the client states, "I will:
a. Increase my food intake."
b. Take the aspirin with milk."
c. Eliminate fluids with meals."
d. Take an antacid preparation."

47. Which of the following interventions should be included in the medical management of Crohn’s
disease?
a. Increasing oral intake of fiber
b. Administering laxatives
c. Using long-term steroid therapy
d. Increasing physical activity
48. After a subtotal gastrectomy a client develops the dumping syndrome. In addition, about
two hours after the initial postmeal attack, the client experiences a second period of
discomfort, feeling somewhat shaky." The nurse recognizes that this latter follow-up effect,
which is precipitated by the dumping syndrome, is caused by:
a. The increased use of simple carbohydrates in meals, creating a more prolonged glucose rise
b. The increased fat content and larger amount of seasoned food, creating digestive discom-
fort
c. Hyperglycemia from a rapidly absorbed glucose load, which overwhelms the insulin-
adjusting mechanism
d. Mild hypoglycemia from an overproduction of insulin that occurs in response to the
postprandial blood glucose rise
49. A client who has a history of chronic ulcerative colitis is diagnosed with anemia. The nurse
interprets that which factor is most likely responsible for the anemia?
C. Blood loss C. Intestinal malabsorption
D. Intestinal hookworm D. Decreased intake of dietary iron
50. A patient is receiving treatment for ulcerative colitis by taking Azathioprine. Which
physician’s order would the nurse question if received?

 A. Ambulate the patient twice day

 B. Low-fiber and high-protein diet

 C. Administer varicella vaccine intramuscularly
 D. Administer calcium carbonate by mouth daily