gastrointestinal NCLEX Questions

Question A 58-year-old male patient presents to the clinic with complaints of rectal bleeding, weight loss, and a change in bowel habits. After a thorough assessment, a colonoscopy is performed, and the patient is diagnosed with colorectal cancer. Which of the following interventions should the nurse prioritize in the care plan for this patient?
A. Administering antiemetic medication as prescribed
B. Encouraging a high-fiber diet
C. Monitoring for signs of bowel perforation
D. Providing wound care management
E. Teaching about the importance of regular follow-up colonoscopies

Show the answer: The correct answer is E Rationale: Teaching about the importance of regular follow-up colonoscopies is crucial for patients diagnosed with colorectal cancer as it helps in early detection of any recurrence or the development of new cancers. Regular monitoring through colonoscopies can significantly improve prognosis by identifying and treating lesions at an early stage. This intervention is also essential for assessing the effectiveness of the treatment plan and making necessary adjustments. Unlike the other options, which might be relevant to symptom management, teaching about follow-up care directly impacts the long-term outcomes and surveillance for patients with colorectal cancer. Correct 

Question A patient with a history of Crohn’s disease reports experiencing severe abdominal pain, diarrhea, and fever. Which of the following medications is most likely to be prescribed to manage this patient’s condition effectively?
A. Loperamide
B. Ibuprofen
C. Corticosteroids
D. Calcium supplements
E. Anticholinergic medications

Show the answer: The correct answer is C Rationale: Corticosteroids are commonly prescribed in the management of Crohn’s disease during acute flare-ups due to their potent anti-inflammatory effects. They help reduce the inflammation in the gastrointestinal tract, thereby alleviating symptoms such as severe abdominal pain and diarrhea. Unlike ibuprofen, which can exacerbate gastrointestinal issues, or loperamide, which mainly addresses symptoms of diarrhea without affecting the underlying inflammation, corticosteroids target the root cause of flare-ups. Calcium supplements and anticholinergic medications do not directly address the inflammatory process in Crohn’s disease. 

Question A patient diagnosed with diverticulitis is being educated on dietary modifications. Which of the following dietary recommendations is most appropriate for this patient?
A. Increase intake of red meat
B. Consume a low-fiber diet during acute attacks
C. Avoid hydration
D. Increase dairy products
E. Restrict all forms of fiber

Show the answer: The correct answer is B Rationale: During acute attacks of diverticulitis, a low-fiber diet is recommended to reduce the volume and frequency of bowel movements, thereby allowing the colon to heal. A low-fiber diet minimizes the stress on the inflamed diverticula, reducing symptoms and preventing further complications. In contrast, a high-fiber diet is beneficial when the condition is not in an acute phase to prevent future attacks by promoting regular bowel movements and reducing pressure in the colon. Increasing intake of red meat, avoiding hydration, increasing dairy products, and restricting all forms of fiber are not appropriate recommendations for managing diverticulitis. 

Question A nurse is caring for a patient who recently underwent surgery for ulcerative colitis. The patient is now complaining of abdominal pain and has a fever. Which of the following should be the nurse’s first action?
A. Administering pain medication as prescribed
B. Encouraging the patient to ambulate
C. Assessing the abdominal incision for signs of infection
D. Providing education on dietary modifications
E. Monitoring the patient’s fluid intake and output

Show the answer: The correct answer is C Rationale: The nurse’s first action should be to assess the abdominal incision for signs of infection, especially given the patient’s symptoms of abdominal pain and fever post-surgery. This assessment is critical for early identification and management of potential postoperative complications, such as surgical site infections, which can impact recovery and outcomes. Administering pain medication, encouraging ambulation, providing dietary education, and monitoring fluid balance are important aspects of care but are secondary to addressing the immediate concern of a possible infection. Early intervention can prevent further complications and promote healing. 

Question A 45-year-old patient with a recent diagnosis of irritable bowel syndrome (IBS) is discussing lifestyle modifications with the nurse. Which of the following suggestions by the nurse is most likely to alleviate the patient’s symptoms?
A. Limiting physical activity
B. Increasing the intake of caffeine and alcohol
C. Following a high-fat diet
D. Managing stress through relaxation techniques
E. Ignoring the symptoms and maintaining previous lifestyle habits

Show the answer: The correct answer is D Rationale: Managing stress through relaxation techniques is highly beneficial for patients with irritable bowel syndrome (IBS) as stress can significantly exacerbate symptoms. Techniques such as meditation, yoga, and deep-breathing exercises can help reduce stress levels, potentially decreasing the frequency and severity of IBS symptoms. Limiting physical activity, increasing the intake of caffeine and alcohol, and following a high-fat diet can actually worsen IBS symptoms. Ignoring the symptoms and maintaining previous lifestyle habits does not address the need for managing this condition effectively. 

Question A patient with a history of chronic constipation is advised to increase their dietary fiber intake. Which of the following foods should the nurse recommend as a good source of dietary fiber?
A. White rice
B. Canned peaches
C. Whole grain bread
D. Ice cream
E. Cheese

Show the answer: The correct answer is C Rationale: Whole grain bread is an excellent source of dietary fiber, which is essential for managing chronic constipation. Fiber helps to increase stool bulk and promote regular bowel movements, thereby alleviating constipation. Unlike white rice, canned peaches, ice cream, and cheese, which are low in dietary fiber, whole grain products contain both soluble and insoluble fiber that aid in digestion and prevent constipation. Encouraging the intake of whole grain bread and other high-fiber foods is a key dietary modification for patients struggling with chronic constipation. Correct Answer: C. Whole grain bread

Question A 65-year-old female patient is admitted with a diagnosis of ischemic bowel disease. Which of the following symptoms would the nurse expect to find during the assessment?
A. Intense thirst
B. Sudden onset of abdominal pain
C. Chronic cough
D. Urinary retention
E. Increased appetite

Show the answer: The correct answer is B Rationale: Sudden onset of abdominal pain is a hallmark symptom of ischemic bowel disease, as the condition involves a decrease in blood flow to the intestines, leading to pain. This pain can be severe and may not always correlate with the physical findings, making it a critical symptom for diagnosis. Intense thirst, chronic cough, urinary retention, and increased appetite are not directly associated with ischemic bowel disease. Recognizing the sudden onset of abdominal pain as a key symptom is crucial for timely diagnosis and management of ischemic bowel disease to prevent further complications. 

Question A nurse is educating a patient with a new colostomy about how to care for the stoma. Which of the following statements by the patient indicates a need for further teaching?
A. “I should clean the skin around the stoma with mild soap and water.”
B. “It’s normal for the stoma to be pink and moist.”
C. “I can resume normal activities, including swimming, with my doctor’s approval.”
D. “I will use alcohol-based wipes to clean the stoma.”
E. “I can expect some swelling around the stoma after surgery.”

Show the answer: The correct answer is D Rationale: Using alcohol-based wipes to clean the stoma is incorrect and indicates a need for further teaching. Alcohol can irritate the skin around the stoma, leading to dryness, discomfort, and potential damage to the skin barrier. It’s important for patients to use mild soap and water for cleaning the area to maintain skin integrity and prevent irritation. The other statements reflect appropriate understanding of stoma care, including recognizing the normal appearance of the stoma, the ability to resume activities, and expecting some post-surgical swelling. 

Question A patient with ulcerative colitis is experiencing a severe flare-up. Which of the following dietary adjustments should the nurse recommend to help manage the symptoms?
A. Consuming spicy foods to increase metabolism
B. Increasing dairy products for calcium
C. Eating small, frequent meals
D. Following a high-fat diet
E. Drinking carbonated beverages to ease digestion

Show the answer: The correct answer is C Rationale: Eating small, frequent meals can help manage symptoms of a severe flare-up of ulcerative colitis by ensuring that the digestive system is not overwhelmed by large amounts of food at once. This approach can help reduce the severity of symptoms such as abdominal pain, cramping, and diarrhea. Spicy foods, high-fat diets, and carbonated beverages can exacerbate symptoms, while increasing dairy products may not be advisable for all patients, especially those who are lactose intolerant. The recommendation of small, frequent meals addresses the need to maintain nutrition while minimizing discomfort and potential triggers of flare-ups. 

Irritable Bowel Disease

Most commonly the history is abdominal pain in a female that started in her teens. The patient reports bloating and has alternating constipation and diarrhea. Pain may be relieved by having a bowel movement. Patients may benefit from dietary recommendations and antispasmodics.

Spontaneous Bacterial Peritonitis

Spontaneous bacterial peritonitis can occur in patients with longstanding ascites. By definition, these patients have peritonitis in the absence of an intestinal tract perforation. The treatment is often antibiotic therapy. The administration of albumin decreases the reaccumulating of ascites in patients with cirrhosis. It may not eliminate the accumulation of fluid but it improves outcomes and has been shown to decrease mortality. It is not typically used in patients with ascites secondary to intraperitoneal metastatic disease. Antibiotic treatment includes, for example, fluoroquinolones or third-generation cephalosporin.

Sigmoid Volvulus

Sigmoid volvulus usually occurs in older patients. For example, an elderly patient with about 12 hours of cramping lower abdominal pain, constipation, and vomiting. The physical exam includes abdominal distension, hyperactive bowel sounds, and tenderness with palpation. What are some other causes of large bowel obstructions? Tumors including colorectal cancer, fecal impaction, adhesions, and volvulus can all cause large bowel obstruction. Volvulus may be seen with a lower GI contrast study with proximal dilatation. A volvulus is more common in the left colon but it can occur on the right side and present as a cecal volvulus.

Mesenteric Ischemia

Elderly patients with coronary artery disease (CAD) with months of abdominal pain after eating a meal and weight loss. There is typically no abdominal pain or distension on your physical assessment. Chronic mesenteric ischemia may be treated with surgery.

More: NCLEX GI Questions

NCLEX Style Questions

symptoms of ulcerative colitis flare up

colectomy nursing care plan

Answers to NCLEX-style Questions

NCLEX Musculoskeletal Questions

1. A, C and D
Ulcerative colitis (UC) and Crohn’s disease are two important inflammatory bowel conditions. UC results in ulcers and inflammation of the rectum and large intestine. A, C and D are correct. Patients experience weight loss rather than weight gain.
2. D
Patients should remain prone, and the legs should not be elevated any higher than placing them on a pillow; because the diaphragm muscles needed for effective breathing could be impaired.
3. B
In Fowler’s position the patient, the patient is in the seated positions and the knees may be straight or bent. It promotes oxygenation and relaxation of the abdominal wall muscles.
4. A, B, C, D
All of the above are symptoms of ulcerative colitis. Crohn’s disease is a type of inflammatory bowel disease. It causes abdominal pain, fever, bloating, and diarrhea. It primarily affects the GI tract but can affect the skin, the eyes and cause fatigue.
5. D
Inguinal hernia repair is an outpatient procedure. A catheter will be placed to empty the bladder prior to the procedure. In addition to inspecting the surgical dressing to make sure it is clean, dry and intact. When the catheter is removed, the nurse will ensure that the patient can void.
6. C
Ulcerative colitis may cause proctosigmoiditis or inflammation of the rectum and sigmoid colon. Symptoms include pain, diarrhea, fever and weight loss.
7. C
Pancolitis is a type of ulcerative colitis. It affects the entire colon. Weight loss, diarrhea and fatigue are prominent symptoms. Patients often complain of the urge to have frequent bowel movements.
8. B and C
The two primary inflammatory bowel conditions or Crohn’s disease and ulcerative colitis. Patients complain of abdominal pain, diarrhea or constipation, fever and weight loss.
9. C
There are several main drug types that are used to treat ulcerative colitis and IBD including 5-aminosalicylic acid (5-ASA). They may be pills or suppositories.
10. A, C and D
An ulcerative colitis flare-up occurs when symptoms return after a period of remission. This is characterized by abdominal pain, diarrhea,  and bleeding.