NCLEX high yield questions will educate you on how to tackle the NEXT GENERATION NCLEX!
Gastrointestinal System NCLEX Practice Questions and Review
Get ready for your nclex exam with high yield gastrointestinal system NCLEX practice questions and review.
1. A 32-year-old female presents to his primary care physician with complaints of heartburn and regurgitation after meals. She reports a burning sensation in his chest and throat, and occasional nausea. The symptoms have been ongoing for several weeks, and over-the-counter antacids have provided only temporary relief. Which of the following is the most likely diagnosis for this patient?
A. Peptic ulcer disease
B. Gastroesophageal reflux disease (GERD)
C. Gastritis
E. Esophageal cancer
F. Hiatal hernia
G. Pancreatitis
H. Acute cholecystitis
2 A client with cirrhosis is at risk for developing hepatic encephalopathy. Which of the following interventions should the nurse perform to prevent hepatic encephalopathy? Select all that apply.
A. Administer lactulose
B. Administer a high-protein diet
C. Administer neomycin
D. Administer rifaximin
E. Monitor serum ammonia levels
F. Encourage the client to ambulate
G. Administer antihypertensive medication
H. Administer antiemetic medication
3. A patient is diagnosed with acute gastritis and is receiving treatment with proton pump inhibitors (PPIs). Which of the following statements by the patient indicates an understanding of the treatment plan? Select all that apply.
A. “I should take my PPIs with meals.”
B. “I should avoid foods that are spicy or acidic.”
C. “I should avoid drinking alcohol.”
D. “I should take an antacid if I experience heartburn.”
E. “I should continue to take NSAIDs for my chronic pain.”
F. “I should avoid taking any medications that can irritate my stomach.”
4. A 58-year-old female presents to her primary care physician with complaints of difficulty swallowing and a sensation of food getting stuck in her throat. She reports occasional heartburn and regurgitation, but the swallowing difficulties have been ongoing for several months. Which of the following tests is most appropriate to evaluate this patient?
A. Upper endoscopy
B. Barium swallow
C. Esophageal manometry
D. 24-hour pH monitoring
E. Gastric emptying study
F. Abdominal ultrasound
G. Computed tomography (CT) scan
H. Magnetic resonance imaging (MRI)
5 A client who underwent a vagotomy and antrectomy develops dumping syndrome. Which of the following symptoms would the nurse expect to assess in the client? Select all that apply.
A) Bradycardia
B) Tachycardia
C) Hypertension
D) Hypotension
E) Diarrhea
F) Constipation
G) Flushing
H) Blurred vision
6. A 52-year-old male presents to the emergency department with complaints of chest pain and shortness of breath. He reports a burning sensation in his chest and throat, and difficulty swallowing. On physical examination, the patient is tachycardic and has decreased breath sounds on the left side. Which of the following is the most appropriate initial intervention for this patient?
A. Administer aspirin
B. Administer nitroglycerin
C. Administer morphine
D. Perform electrocardiogram (ECG)
E. Perform chest x-ray
F. Administer albuterol nebulizer treatment
G. Administer proton pump inhibitor (PPI)
H. Perform upper endoscopy
7 A client who underwent bariatric surgery reports feeling dizzy and lightheaded. The nurse suspects hypoglycemia. Which of the following interventions should the nurse perform? Select all that apply.
A) Administer insulin
B) Administer glucagon
C) Administer dextrose solution
D) Provide a high-protein snack
E) Administer antihypertensive medication
F) Administer antiemetic medication
G) Check blood glucose level
H) Administer a stool softener
8. A patient complains of frequent heartburn and regurgitation of stomach contents into the mouth. The patient reports taking antacids but not finding relief. The nurse suspects GERD and recommends which intervention would the nurse recommend to manage the patient’s symptoms of GERD?
A. Consuming meals 2-3 hours before bedtime
B. Eating small, frequent meals throughout the day
C. Drinking carbonated beverages with meals
D. Wearing tight-fitting clothes around the waist
E. Lying down after meals
F. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief
G. Increasing intake of fatty and spicy foods
H. Smoking cigarettes to reduce stress
9. A client with cirrhosis is at risk for developing esophageal varices. Which of the following interventions should the nurse perform to prevent bleeding from esophageal varices? Select all that apply.
A) Administer octreotide
B) Administer propranolol
C) Administer vasopressin
D) Monitor for signs of bleeding
E) Encourage a low-sodium diet
F) Encourage the client to avoid strenuous activity
G) Administer anticoagulant medication
H) Administer a proton pump inhibitor
10. A patient with a history of GERD is admitted to the hospital for treatment of a flare-up. The patient’s symptoms include heartburn, regurgitation, and difficulty swallowing. The nurse should anticipate which diagnostic test to be ordered for this patient? Which diagnostic test would the nurse anticipate for a patient with a history of GERD experiencing heartburn, regurgitation, and difficulty swallowing?
A. CT scan of the chest
B. Colonoscopy
C. Upper endoscopy
D. MRI of the abdomen
E. Barium swallow
F. Pulmonary function test
G. Electrocardiogram
H. Complete blood count (CBC)
The NCLEX is a difficult licensing exam. We recommend students do 2500 practice questions. Try the NCLEX review free questions with rationales. For the first time test taker and other students, do questions every day.
11. Which of the following lifestyle modifications is most effective in reducing symptoms and complications of GERD?
A. Eating a low-fat diet
B. Avoiding spicy and acidic foods
C. Eating smaller, more frequent meals
D. Wearing loose-fitting clothing
E. Sleeping on the left side
12. A 50-year-old male presents to the clinic with epigastric pain and discomfort for the past two weeks. He reports the pain to be burning in nature and occurs mostly after eating. He also experiences nausea and vomiting. The nurse suspects peptic ulcer disease. Which of the following are common risk factors for peptic ulcer disease? Select all that apply.
A. Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs)
B. Family history of peptic ulcer disease
C. Alcohol use
D. Cigarette smoking
E. Age over 65 years
F. Regular exercise
13. A 35-year-old female is admitted to the hospital with abdominal pain and vomiting. She reports a history of peptic ulcer disease and has been taking proton pump inhibitors (PPIs) for the past year. The nurse suspects she may have developed a complication of peptic ulcer disease. Which of the following complications should the nurse be most concerned about? Select all that apply.
A. Perforation
B. Obstruction
C. Gastric cancer
D. Hemorrhage
E. Duodenal stricture
F. Esophageal ulceration
14. A client presents to the clinic with complaints of upper abdominal pain that is relieved with eating. Which of the following are risk factors for gastric ulcers? Select all that apply.
A. Family history of gastric ulcers
B. Chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs)
C. Alcohol abuse
D. Smoking
E. High fiber diet
F. Regular exercise
15. A client with a history of gastric ulcer presents to the emergency department with severe abdominal pain and vomiting blood. The client is suspected of having a gastric perforation. Which of the following interventions should the nurse anticipate? Select all that apply.
A. NPO status
B. Insertion of a nasogastric (NG) tube
C. Administration of antibiotics
D. Immediate surgical intervention
E. Initiation of antacids
F. IV fluid resuscitation
16. A patient is admitted to the hospital with complaints of epigastric pain, nausea, and vomiting. The patient reports taking nonsteroidal anti-inflammatory drugs (NSAIDs) frequently for chronic pain. Which of the following risk factors for gastritis is the patient demonstrating? Select all that apply.
A. Infection with Helicobacter pylori
B. Chronic alcohol abuse
C. Frequent NSAID use
D. Smoking
E. Autoimmune disorders
F. Stress
17. A patient with a history of chronic gastritis reports experiencing abdominal pain and black, tarry stools. Which of the following interventions should the nurse implement? Select all that apply.
A. Administer a proton pump inhibitor (PPI).
B. Administer an antacid.
C. Prepare the patient for an upper endoscopy.
D. Encourage the patient to drink clear liquids.
E. Monitor vital signs for signs of shock.
F. Administer an antiemetic medication.
For the first time test taker and other students, do questions every day!
18. A patient with a history of GERD presents to the emergency department with severe chest pain and difficulty breathing. The patient reports taking their prescribed proton pump inhibitor medication but did not experience any relief. The healthcare provider suspects complications from GERD and orders further testing. What is the most likely complication of GERD that the healthcare provider is suspecting in this patient?
A. Gastric ulcer
B. Esophageal cancer
C. Barret’s esophagus
D. Hiatal hernia
E. Diverticulitis
19. A client is diagnosed with duodenal ulcer. Which of the following should the nurse include in the teaching plan? Select all that apply.
B. Avoid drinking alcohol
C. Avoid taking NSAIDs
A. Avoid smoking
D. Eat frequent small meals
E. Avoid fatty foods
F. Avoid taking antibiotics
You’re doing great on NCLEX High Yield Questions GI, keep up the good work and pass your board exam!
20 A client with duodenal ulcer is prescribed antibiotics for H. pylori infection. Which of the following medications may also be prescribed? Select all that apply.
A. Ranitidine
B. Omeprazole
C. Misoprostol
D. Sucralfate
E. Clarithromycin
F. Metoclopramide
21. A client with duodenal ulcer complains of epigastric pain that is relieved with food. Which of the following is the most likely cause of the pain?
A. Increased acid production
B. Decreased acid production
C. Increased mucus production
D. Decreased mucus production
E. Increased gastric motility
22. John, a 35-year-old man, presents to the emergency department with epigastric pain that radiates to his back. He reports the pain started about two hours ago after eating a large meal at a fast-food restaurant. He also reports nausea, vomiting, and dark, tarry stools. Physical examination reveals mild epigastric tenderness. Which of the following is the most likely diagnosis?
A. GERD
B. Gastritis
C. Duodenal ulcer
D. Gastric ulcer
E. Pancreatitis
F. Gall stones
23. Mary, a 50-year-old woman, has a history of duodenal ulcer and is currently taking a proton pump inhibitor (PPI) for treatment. She presents to her primary care provider reporting worsening epigastric pain, despite taking her medication as prescribed. She also reports bloating and nausea. Physical examination is unremarkable. Which of the following is the most appropriate next step in management?
A. Increase the dose of PPI
B. Switch to an H2 receptor antagonist
C. Perform an upper endoscopy
D. Discontinue the medication
E. Start a course of antibiotics
24. Michael, a 60-year-old man, presents to the emergency department with severe abdominal pain, nausea, and vomiting. He reports a history of duodenal ulcer and has not been taking his medication regularly. Physical examination reveals tenderness in the epigastric region and rebound tenderness. Which of the following is the most likely complication of the patient’s duodenal ulcer?
A. Perforation
B. Bleeding
C. Obstruction
D. Infection
E. Cancer
25. Debbie presents to her primary care provider reporting worsening epigastric pain, despite taking her medication as prescribed. She also reports bloating and nausea. Physical examination is unremarkable. She is diagnosed with a duodenal ulcer. Which medications can be prescribed to treat duodenal ulcer? Select all that apply.
A. Proton pump inhibitors (PPIs)
B. H2 receptor antagonists
C. Antibiotics
D. Antacids
E. Beta-blockers
F. Anticholinergic drugs
G. Calcium channel blockers
H. NSAIDs
For the first time test taker and other students, do questions as often as possible to help you get better at selecting the best answer choice.
26. A patient with duodenal ulcer complains of worsening abdominal pain. Which of the following actions should the nurse take? Select all that apply.
A. Administer antacids
B. Elevate the head of the bed
C. Administer pain medication as ordered
D. Assess vital signs
E. Notify the healthcare provider
F Offer the patient ice chips
G. Place the patient in a supine position
27. A client who underwent a gastrectomy complains of nausea, vomiting, and abdominal cramping after consuming a meal. The nurse suspects dumping syndrome. Which of the following interventions should the nurse perform? Select all that apply.
A) Administer metoclopramide before meals
B) Encourage small, frequent meals
C) Instruct the client to drink fluids with meals
D) Administer loperamide before meals
E) Instruct the client to consume high-fat foods
F) Encourage the client to lie down after meals
G) Encourage the client to consume meals quickly
H) Instruct the client to avoid simple carbohydrates
28. A client who underwent bariatric surgery reports experiencing chronic diarrhea. Which of the following interventions should the nurse perform? Select all that apply.
A) Encourage fluid intake
B) Administer loperamide
C) Encourage incentive spirometry
D) Encourage the client to consume high-fiber foods
E) Instruct the client to consume a low-fat diet
F) Instruct the client to consume a high-fat diet
G) Administer a high glucose solution
H) Administer a probiotic supplement
29. A client who underwent bariatric surgery reports feeling depressed and anxious. Which of the following interventions should the nurse perform? Select all that apply.
A) Provide emotional support
B) Encourage the client to join a support group
C) Administer antidepressant medication
D) Refer the client to a mental health professional
E) Encourage the client to participate in regular exercise
F) Instruct the client to consume a high-protein diet
G) Encourage the client to isolate themselves from others
H) Administer anxiolytic medication
30. A client with cirrhosis is experiencing ascites. Which of the following interventions should the nurse perform to manage ascites? Select all that apply.
A) Administer spironolactone
B) Administer furosemide
C) Administer albumin
D) Monitor weight daily
E) Encourage a high-sodium diet
F) Encourage bedrest
G) Perform paracentesis
H) Administer anti-anxiety medication
31 A client has been diagnosed with acute hepatitis. Which of the following interventions should the nurse perform to manage the client’s symptoms? Select all that apply.
A) Administer acetaminophen for pain
B) Encourage bedrest
C) Administer antiviral medication
D) Monitor liver function tests
E) Encourage a high-fat diet
F) Encourage the client to engage in strenuous exercise
G) Administer antiemetic medication
H) Administer vitamin K
32. Which of the following tests is most appropriate for diagnosing Barret’s esophagus in this patient?
A. Upper endoscopy
B. Barium swallow
C. Esophageal manometry
D. pH monitoring
E. Stool culture
33. A client has been diagnosed with chronic hepatitis C. Which of the following interventions should the nurse perform to manage the client’s disease? Select all that apply.
A) Administer interferon
B) Administer ribavirin
C) Monitor liver function tests
D) Administer acetaminophen for pain
E) Encourage a high-fat diet
F) Encourage the client to engage in strenuous exercise
G) Administer antiemetic medication
H) Administer vitamin K
34. A client with hepatitis A is experiencing pruritus and jaundice. Which of the following interventions should the nurse perform to manage pruritus? Select all that apply.
A) Administer cholestyramine
B) Administer corticosteroids
C) Administer diphenhydramine
D) Encourage a high-fat diet
E) Encourage the client to engage in strenuous exercise
F) Administer antiemetic medication
G) Administer vitamin K
H) Monitor liver function tests
35. A client with cirrhosis is experiencing ascites. Which of the following interventions should the nurse perform to manage ascites? Select all that apply.
A) Administer diuretics
B) Administer antiviral medication
C) Monitor fluid intake and output
D) Encourage a high-protein diet
E) Encourage the client to engage in strenuous exercise
F) Administer antiemetic medication
36. A client with cirrhosis is at risk for hepatic encephalopathy. Which of the following interventions should the nurse perform to prevent hepatic encephalopathy? Select all that apply.
A) Administer lactulose
B) Monitor ammonia levels
C) Administer sedatives
D) Administer antibiotics
E) Encourage a low-protein diet
F) Encourage the client to engage in strenuous exercise
37. A client with cirrhosis is experiencing pruritus. Which of the following interventions should the nurse perform to manage pruritus? (Select all that apply.)
A) Administer cholestyramine
B) Administer corticosteroids
C) Administer diphenhydramine
D) Encourage a high-fat diet
E) Encourage the client to engage in strenuous exercise
F) Administer antiemetic medication
38 A client with cirrhosis is experiencing gastrointestinal bleeding. Which of the following interventions should the nurse perform to manage gastrointestinal bleeding? (Select all that apply.)
A) Administer vitamin K
B) Administer proton pump inhibitors
C) Administer antibiotics
D) Administer vasopressin
E) Encourage a high-protein diet
F) Administer antifibrinolytic medication
ANSWERS: NCLEX High Yield Questions GI
For more Questions for NCLEX, ANCC and AANP
1 Correct Answer: B.
Gastroesophageal reflux disease (GERD)Rationale: The patient’s symptoms of heartburn, regurgitation, and a burning sensation in the chest and throat are classic features of GERD. Peptic ulcer disease, gastritis, and esophageal spasm can cause similar symptoms but are less likely in this case. Esophageal cancer is a more serious condition and would require further investigation. Hiatal hernia can contribute to the development of GERD, but it is not a primary diagnosis. Pancreatitis and acute cholecystitis would present with different symptoms.
2 Correct answers: A, D, E
Rationale: Hepatic encephalopathy is a complication of cirrhosis that results from the accumulation of ammonia in the blood due to liver dysfunction. To prevent hepatic encephalopathy, the nurse should administer lactulose or rifaximin to reduce ammonia levels. Monitoring serum ammonia levels can also help identify early signs of hepatic encephalopathy. A high-protein diet can increase ammonia levels and is not recommended. Neomycin, antihypertensive medication, and antiemetic medication are not typically used to prevent hepatic encephalopathy.
3 Correct answers: A, B, C
Rationale: PPIs work by reducing the amount of acid in the stomach, which can help relieve symptoms of gastritis. Patients should take PPIs before meals, as this will help reduce acid production during digestion. Spicy and acidic foods can irritate the stomach and should be avoided. Alcohol can also irritate the stomach and should be avoided. Patients may also take antacids for symptom relief, but should not continue to take NSAIDs or other medications that can irritate the stomach.
4 Correct Answer: A. Upper endoscopy
Rationale: The patient’s symptoms are suggestive of esophageal stricture, which is a narrowing of the esophagus that can occur as a result of GERD. Upper endoscopy is the most appropriate test to evaluate this patient as it allows for direct visualization of the esophagus and can be used to obtain biopsies if necessary. Barium swallow may be used to evaluate for esophageal strictures, but it is less sensitive than upper endoscopy. Esophageal manometry is used to evaluate esophageal motility disorders, and 24-hour pH monitoring is used to evaluate acid reflux. A gastric emptying study is used to evaluate gastric motility disorders. Abdominal ultrasound, CT scan, and MRI are not indicated for the evaluation of GERD.
5 Correct answers: B, D, E
Rationale: Dumping syndrome is a complication of gastric surgery that can occur when food rapidly enters the small intestine, leading to a shift of fluid from the intravascular space to the intestinal lumen. This can cause symptoms such as tachycardia, hypotension, diarrhea, flushing, and sweating. Bradycardia, hypertension, constipation, and blurred vision are not typically associated with dumping syndrome.
6 Correct Answer: E. Perform chest x-ray
Rationale: The patient’s presentation is concerning for a potential complication of GERD, such as aspiration pneumonia or pneumothorax. Therefore, the most appropriate initial intervention is obtain a chest X-ray.
7 Correct answers: C, D, G
Rationale: Hypoglycemia can occur after bariatric surgery due to altered glucose metabolism and decreased food intake. To manage hypoglycemia, the nurse should check the client’s blood glucose level and administer a dextrose solution to raise the blood sugar. A high-protein snack can also be provided to prevent future episodes of hypoglycemia. Insulin and glucagon are not typically used to manage hypoglycemia in this population. Antihypertensive medication, antiemetic medication, and stool softeners are not indicated for hypoglycemia
8 Correct answer: B. Eating small, frequent meals throughout the day
Rationale: Eating smaller, more frequent meals throughout the day can help reduce symptoms of GERD by preventing the stomach from becoming too full and reducing the likelihood of reflux. Consuming meals 2-3 hours before bedtime can also help reduce symptoms, as can avoiding fatty and spicy foods. Drinking carbonated beverages with meals, wearing tight-fitting clothes around the waist, lying down after meals, taking NSAIDs for pain relief, and smoking cigarettes can all exacerbate symptoms of GERD.
9. Correct answers: A, B, D
Rationale: Esophageal varices are a complication of cirrhosis that can lead to life-threatening bleeding. To prevent bleeding from esophageal varices, the nurse should administer octreotide or propranolol to decrease portal pressure and monitor for signs of bleeding, such as hematemesis or melena. Vasopressin and anticoagulant medication are not typically used to prevent bleeding from esophageal varices. A low-sodium diet and avoiding strenuous activity may be recommended to manage ascites, but are not indicated for the prevention of bleeding from esophageal varices.
10 Correct answer: C. Upper endoscopy
Rationale: Upper endoscopy is a diagnostic test used to evaluate the esophagus, stomach, and duodenum. It is often used to evaluate patients with GERD who are experiencing symptoms such as heartburn, regurgitation, and difficulty swallowing. During the procedure, a flexible tube with a camera on the end is inserted through the mouth and into the esophagus, allowing the physician to visualize any inflammation or damage to the esophageal lining. CT scans of the chest, MRI of the abdomen, and pulmonary function tests would not provide information specific to GERD. Colonoscopies are used to evaluate the colon for colon cancer, and a barium swallow is a diagnostic test used to evaluate the esophagus and stomach. Complete blood count and electrocardiogram are not diagnostic tests for GERD.
11 Answer: C. Eating smaller, more frequent meals
Rationale: Eating smaller, more frequent meals helps to reduce pressure on the lower esophageal sphincter and decrease reflux symptoms. Other lifestyle modifications that can help include avoiding trigger foods, maintaining a healthy weight, not lying down after meals, and elevating the head of the bed at night.
12 Answer: A, B, D
Rationale: Chronic use of NSAIDs, family history of peptic ulcer disease, and cigarette smoking are all common risk factors for developing peptic ulcer disease. Alcohol use may also increase the risk but is not as strongly associated as the other factors. Age over 65 years is a risk factor for complications of peptic ulcer disease but not necessarily for developing the disease itself. Regular exercise is not a risk factor.
13 Answer: A, B, D
Rationale: Complications of peptic ulcer disease include perforation, obstruction, and hemorrhage. Gastric cancer is a potential long-term complication but is not an immediate concern in this patient. Duodenal stricture and esophageal ulceration are not common complications of peptic ulcer disease.
14 Correct answer: A, B,C, D
Rationale: Gastric ulcers are commonly associated with risk factors such as a family history of gastric ulcers, chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs), and smoking. Alcohol abuse can also contribute to gastric ulcers, while a high fiber diet and regular exercise may reduce the risk of developing ulcers.
15 Correct answer: A, B, C, D, F
Rationale: A gastric perforation is a medical emergency that requires immediate surgical intervention. The client should be kept NPO (nothing by mouth) to prevent further gastric contents from entering the peritoneal cavity. An NG tube should be inserted to decompress the stomach and prevent further vomiting. Antibiotics should be started to prevent infection. IV fluid resuscitation should be initiated to maintain blood pressure and hydration. Antacids may be given, but they are not the main priority in this situation.
16 Correct answers: C, F
Rationale: Gastritis can be caused by a variety of factors, including infection with H. pylori, chronic alcohol abuse, smoking, autoimmune disorders, frequent use of NSAIDs, and stress. In this case, the patient’s chronic use of NSAIDs and reported chronic pain may be contributing factors to the development of gastritis. Stress can also increase the risk of developing gastritis.
17 Correct answers: A, C, E
Rationale: The presence of black, tarry stools may indicate bleeding in the upper gastrointestinal tract, which can be a complication of chronic gastritis. The patient should be prepared for an upper endoscopy to determine the source and severity of bleeding. PPIs can help reduce acid production and may be administered to help prevent further bleeding. Monitoring vital signs is important to detect signs of shock, which can occur if bleeding is severe. Antacids and antiemetics may be used for symptom relief, but are not the priority interventions in this situation.
18 Answer: C. Barret’s esophagus
Rationale: Barret’s esophagus is a complication of GERD where the lining of the esophagus is damaged and replaced by abnormal cells that increase the risk of esophageal cancer. Symptoms of Barret’s esophagus include heartburn, difficulty swallowing, and chest pain.
19 Answer: A, B, C
Rationale: Avoiding smoking, drinking alcohol and NSAIDs are important to prevent further irritation of the duodenal ulcer. Antibiotics are usually prescribed in the case of H. pylori infection, which is often the underlying cause of duodenal ulcer. Eating frequent small meals and avoiding fatty foods can also help to reduce symptoms.
20 Answer: B, C, E
Rationale: Omeprazole is a proton pump inhibitor that reduces the amount of acid produced in the stomach, which can help to promote healing of the duodenal ulcer. Misoprostol is a prostaglandin analogue that helps to protect the lining of the stomach and duodenum from damage caused by acid. Clarithromycin is an antibiotic commonly used in the treatment of H. pylori infection.
21 Answer: A
Rationale: Epigastric pain that is relieved with food is a classic symptom of duodenal ulcer and is caused by increased acid production in response to the presence of food in the stomach.
22 Answer: C. Duodenal ulcer
Rationale: The patient’s symptoms and presentation are consistent with a duodenal ulcer, including epigastric pain that radiates to the back, nausea, and vomiting. Dark, tarry stools indicate bleeding in the upper gastrointestinal tract, which is a common complication of duodenal ulcers.
23 Answer: C. Perform an upper endoscopy
Rationale: If a patient’s symptoms worsen despite treatment with a PPI, an upper endoscopy should be performed to assess for complications such as bleeding or perforation. Increasing the dose of PPI or switching to an H2 receptor antagonist may not provide additional benefit if there is an underlying complication.
24 Answer: A. Perforation
Rationale: The patient’s symptoms, including severe abdominal pain, tenderness, and rebound tenderness, suggest a perforated duodenal ulcer. Perforation is a serious complication of peptic ulcers and requires urgent surgical intervention.
25 Answer: A, B, and C
Rationale: Proton pump inhibitors and H2 receptor antagonists decrease acid secretion in the stomach, while antibiotics eradicate Helicobacter pylori infection which is a common cause of duodenal ulcer. Antacids can provide symptomatic relief but do not treat the underlying cause. Beta-blockers, anticholinergic drugs, and calcium channel blockers are used to treat other conditions such as hypertension and do not have a direct effect on duodenal ulcers. The goal of medication therapy for duodenal ulcers is to reduce acid secretion in the stomach and eradicate Helicobacter pylori infection.
26 Answer: B, C, D, and E
Rationale: Elevating the head of the bed may help to relieve abdominal pain by decreasing gastric acid reflux. Pain medication can be given as ordered to provide relief. Vital signs should be assessed to monitor for any signs of bleeding. The healthcare provider should be notified if the patient’s condition worsens. Antacids should be avoided if the patient is experiencing severe abdominal pain. Ice chips may be offered to relieve dry mouth, but they will not relieve the pain. Placing the patient in a supine position may exacerbate the pain.
27 Correct answers: B, H, F
Rationale: Dumping syndrome is a complication of gastrectomy that occurs when food rapidly enters the small intestine, leading to a shift of fluid from the intravascular space to the intestinal lumen. This can cause symptoms such as nausea, vomiting, abdominal cramping, diarrhea, and flushing. To manage dumping syndrome, the nurse should encourage the client to eat small, frequent meals and avoid simple carbohydrates. The nurse should also instruct the client to lie down after meals to slow gastric emptying. High-fat foods should be avoided, as they can exacerbate symptoms. Metoclopramide and loperamide are not typically used to manage dumping syndrome.
28. Correct answers: A, B, E
Rationale: Chronic diarrhea can occur after bariatric surgery post op due to altered bowel motility and malabsorption. To manage chronic diarrhea, the nurse should encourage the client to increase fluid intake and administer loperamide as needed. A low-fat diet can also be beneficial in managing diarrhea. Stool softeners, high-fiber foods, high-fat diets, metformin, and probiotic supplements are not typically indicated for chronic diarrhea after bariatric surgery.
29 Correct answers: A, B, D
Rationale: Depression and anxiety are common after bariatric surgery, and can be related to changes in body image, social relationships, and eating behaviors. To manage depression and anxiety, the nurse should provide emotional support and encourage the client to join a support group. Referral to a mental health professional may also be necessary for further evaluation and treatment. Regular exercise and a high-protein diet can improve mood and mental health, but isolation and medication are not typically indicated as interventions for depression and anxiety after bariatric surgery.
30. Correct answers: A, C, D
Rationale: Ascites is a complication of cirrhosis that results from the accumulation of fluid in the peritoneal cavity. To manage ascites, the nurse should administer spironolactone and albumin to decrease fluid volume and maintain serum albumin levels. Daily weight monitoring can also help identify early signs of fluid retention. Furosemide can also be used in conjunction with spironolactone, but a high-sodium diet and bedrest are not recommended. Paracentesis may be necessary in severe cases, but is not typically used as a first-line intervention. Anti-anxiety medication is not indicated for the management of ascites.
31. Correct answers: B, C, D
Rationale: Bedrest is recommended for clients with acute hepatitis B to decrease the risk of complications and to conserve energy. Antiviral medication may be prescribed to manage the underlying viral infection. Monitoring liver function tests can help assess the severity of the disease and guide treatment. Acetaminophen should be avoided due to the risk of hepatotoxicity. A high-fat diet and strenuous exercise are not recommended during the acute phase of the illness. Antiemetic medication may be used to manage nausea and vomiting, but vitamin K is not indicated for the management of acute hepatitis B.
32. Answer: A. Upper endoscopy
Rationale: Upper endoscopy is the most accurate test for diagnosing Barret’s esophagus. It involves passing a flexible tube with a camera down the throat to examine the lining of the esophagus and take biopsies if necessary.
33. Correct answers: A, B, C
Rationale: Interferon and ribavirin are antiviral medications that may be prescribed to manage chronic hepatitis C. Monitoring liver function tests can help assess the effectiveness of treatment and identify complications. Acetaminophen should be avoided due to the risk of hepatotoxicity. A high-fat diet and strenuous exercise are not recommended for clients with chronic hepatitis C. Antiemetic medication may be used to manage nausea and vomiting, but vitamin K is not indicated for the management of chronic hepatitis C.
34 Correct answers: A, C, H
Rationale: Cholestyramine and diphenhydramine may be used to manage pruritus associated with hepatitis A. Monitoring liver function tests can help assess the severity of the disease and guide treatment. Corticosteroids, a high-fat diet, and strenuous exercise are not recommended for clients with hepatitis A. Antiemetic medication and vitamin K are not indicated for the management of pruritus.
35 Correct answer: A
Rationale: Diuretics are the first-line therapy for managing ascites in clients with cirrhosis. Antiviral medication may be prescribed to manage the underlying viral infection, but it does not directly address ascites. Monitoring fluid intake and output is important for assessing the effectiveness of treatment, but it is not a direct intervention. A high-protein diet and strenuous exercise are not recommended for clients with ascites. Antiemetic medication may be used to manage nausea and vomiting, but it is not indicated for the management of ascites.
36 Correct answer: A, B
Rationale: Lactulose is the first-line therapy for preventing and managing hepatic encephalopathy in clients with cirrhosis. Monitoring ammonia levels can help assess the risk of hepatic encephalopathy and guide treatment. Sedatives and antibiotics may exacerbate hepatic encephalopathy and should be used with caution. A low-protein diet may be recommended for clients with hepatic encephalopathy, but it is not a preventive measure. Strenuous exercise should be avoided in clients with cirrhosis.
37 Correct answer: A
Rationale: Cholestyramine is the first-line therapy for managing pruritus associated with cirrhosis. Corticosteroids and diphenhydramine are not recommended for managing pruritus in clients with cirrhosis. A high-fat diet and strenuous exercise are not recommended for clients with cirrhosis. Antiemetic medication may be used to manage nausea and vomiting, but it is not indicated for the management of pruritus.
38 Correct answer: B, C, D
Rationale: Proton pump inhibitors, antibiotics, and vasopressin are all used to manage gastrointestinal bleeding in clients with cirrhosis. Vitamin K is not indicated for the management of gastrointestinal bleeding.
