Med-Surg Practice Test #5: Gastrointestinal

Answer: B. Turn the client onto the side, raise the head of the bed, and call the rapid response team.

Rationale: A drowsy client who is vomiting large amounts of blood is at high risk of aspirating it, so protecting the airway comes first: turn the client to the side, raise the head of the bed, have suction ready and call for emergency help. The low blood pressure and fast heart rate show hypovolemic shock from a variceal bleed, which can be fatal within minutes. Next steps, as the provider and facility protocol direct, usually include two large-bore IV lines, type and crossmatch, blood products, IV octreotide, IV antibiotics and urgent endoscopy for band ligation; some clients need intubation to protect the airway before endoscopy. Option A is wrong: lavage with iced saline is no longer recommended, and placing a tube past fresh varices is a provider decision, not a first nursing action. Option C does not treat bleeding; lactulose lowers ammonia, although a GI bleed can trigger hepatic encephalopathy later. Option D adds nothing when the client is visibly bleeding and unstable.

Answer: C. Ask the client to empty the bladder.

Rationale: Having the client void right before a paracentesis lowers the risk of puncturing a full bladder with the needle. The nurse also confirms consent, records baseline vital signs, weight and abdominal girth, and helps the client sit upright on the edge of the bed or in high Fowler's position so the fluid collects low in the abdomen. Option A is wrong because a long fast is not usually needed for this bedside procedure; follow the provider's and facility's instructions. Option B is wrong because lying flat lets the fluid spread out and makes breathing harder for a client with tense ascites. Option D is not routine; asking the client to void is enough in most cases, and an indwelling catheter adds infection risk. After the procedure the nurse watches for low blood pressure and a fast heart rate (fluid shifting back out of the blood vessels), leaking at the site and signs of infection. After a large-volume tap, the provider may prescribe IV albumin.

Answer: A. Notify the provider right away and keep the client NPO.

Rationale: Sudden severe pain, a rigid board-like abdomen and a client who lies still to avoid movement are classic signs of a perforated ulcer with peritonitis. Pain in the shoulder comes from air or stomach contents irritating the diaphragm. The rising heart rate and falling blood pressure point to early shock. This is a surgical emergency: the nurse notifies the provider at once, keeps the client NPO, and prepares for IV access, IV fluids, a nasogastric tube to suction, IV antibiotics, imaging and likely surgery, as ordered. NSAIDs such as ibuprofen are a leading cause of peptic ulcers and perforation. Option B is wrong because nothing should be given by mouth, and a delay is dangerous. Option C is wrong because this is not gas pain, and moving increases the pain. Option D is wrong because heat can mask worsening signs and does nothing for the cause.

Answer: D. Check that the suction is working and the tubing is not kinked or disconnected, and check the tube's position.

Rationale: The NG tube decompresses the bowel by removing gas and fluid. No drainage plus more distension and nausea means the tube is probably not working, so the nurse assesses the system first: the suction setting and canister, kinks, loose connections and the tube's position at the nose. If the tube is blocked, the nurse irrigates it with saline only if the provider's orders or facility policy allow. With a double-lumen sump tube, the air vent (often blue) is kept open and above the level of the stomach. Option A treats a symptom without fixing the cause. Option B is wrong because suction settings are prescribed by the provider, and high continuous suction can pull the stomach lining into the tube and injure it. Option C is wrong because replacing the tube is not the first step and needs an order. The nurse also monitors intake and output, electrolytes and bowel sounds, and reports signs of strangulation such as fever, constant severe pain or a rising heart rate.

Answer: B. The stoma is dark purple to black and looks dry.

Rationale: A healthy stoma is pink to beefy red and moist, like the inside of the mouth. A stoma that turns dusky, dark purple, brown or black, or looks dry, has lost its blood supply (ischemia leading to necrosis) and must be reported to the surgeon right away. Option A is a healthy stoma. Option C is expected after surgery; swelling gradually goes down over the next several weeks, and the pouch opening is resized as it shrinks. Option D is expected because the stoma has a rich blood supply and bleeds easily when touched. The stoma has no pain nerve endings, so the client will not feel an injury; this is why the pouch opening should fit closely without rubbing. A sigmoid colostomy usually starts working within a few days and its output becomes formed over time.

Answer: A. "I'll drink more fluids and watch for dizziness or dark urine, especially on hot days or when my output goes up."

Rationale: An ileostomy bypasses the colon, which is where most water and salt are normally absorbed. The output stays liquid to pasty, and clients can lose a lot of fluid, sodium and potassium, so dehydration is a major risk. Clients are taught to drink extra fluids, add more on hot days, during exercise or illness, and to report dizziness, dark or scant urine, cramping or output that is much higher than usual. Option B is wrong: formed stool is expected from a sigmoid or descending colostomy, not an ileostomy. Option C is wrong because irrigation is used only for some descending or sigmoid colostomies; an ileostomy drains continuously. Option D is wrong because extended-release and enteric-coated tablets may pass through before they dissolve; the client should ask the provider or pharmacist to review all medications. Other teaching: chew food well and add fibrous foods such as popcorn, nuts, corn and raw vegetables slowly, because they can cause a food blockage.

Answer: D. "The gas used to inflate your abdomen during surgery can irritate the nerve under your diaphragm. Walking and changing position help it pass."

Rationale: During laparoscopic surgery, carbon dioxide gas is used to inflate the abdomen. Leftover gas irritates the diaphragm, and the pain is felt in the shoulder (referred pain through the phrenic nerve). It is common and usually fades over a few days. Walking, changing position and the prescribed pain medication help. Option A is wrong because shoulder pain alone, with stable findings, is expected; the nurse would report fever, worsening or severe abdominal pain, a rigid or distended abdomen, yellow skin or eyes, or bile-colored drainage, which can mean a bile leak or injury. Option B is wrong because the shoulder joint is not injured. Option C is wrong because lying flat and staying in bed does not help the gas pass and raises the risk of blood clots and lung problems. If the client had chest pain, shortness of breath or abnormal vital signs, the nurse would assess further and notify the provider.

Answer: C. "I'll drink a big glass of juice with each meal."

Rationale: Dumping syndrome happens when food moves too quickly from the stomach into the small intestine after gastric surgery, including some weight-loss operations. Early dumping (within about 30 minutes) causes cramping, diarrhea, a fast heart rate, sweating and dizziness. Late dumping (1 to 3 hours after eating) causes symptoms of low blood sugar. Drinking fluids with meals speeds emptying, and juice adds simple sugar, so this statement needs correcting. Clients are usually taught to drink fluids between meals instead, waiting about 30 minutes before and after eating. Options A, B and D are correct: small, frequent meals; lying down briefly after eating to slow emptying; and choosing protein, fat and complex carbohydrates while limiting sweets and simple sugars. Many clients improve over time; a dietitian referral helps.

Answer: A. "Once I'm feeling better, I'll slowly add more fiber, like whole grains, fruits and vegetables, and drink plenty of fluids."

Rationale: During an acute flare the provider may limit the diet, often to clear liquids or low-fiber foods, for a short time. Once symptoms settle, a high-fiber diet with plenty of fluid is recommended to keep stool soft and help prevent future episodes (American Gastroenterological Association guidance). Fiber is added gradually to limit gas and bloating. Option B is wrong because low fiber is only for the acute phase. Option C reflects outdated advice; current evidence does not show that nuts, seeds or popcorn cause diverticulitis, and most clients do not need to avoid them. Option D is wrong because daily stimulant laxatives are not part of prevention and can cause dependence. The client should report fever, worsening abdominal pain, vomiting or rectal bleeding.

Answer: D. Grilled chicken, a baked potato and steamed broccoli

Rationale: Celiac disease is an immune reaction to gluten that damages the lining of the small intestine. The treatment is a strict, lifelong gluten-free diet. Gluten is found in wheat, barley and rye. Plain meat, potatoes, rice, corn, fruit and vegetables are naturally gluten-free, so option D is the safe choice. Option A contains barley and wheat. Option B contains rye. Option C contains wheat in regular pasta, and meatballs are often made with breadcrumbs. Oats are allowed only if labeled gluten-free, because regular oats are often contaminated with wheat. Clients are taught to read labels for hidden gluten (malt, some soy sauces, soups, sauces and processed foods), to avoid cross-contact in shared toasters and cooking water, and to meet with a dietitian. Even small amounts of gluten can damage the intestine without causing symptoms.