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- Health Sciences
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- AQE Private College, Pretoria, Gauteng
Exam of 185 pages for the course Health Sciences at AQE Private College, Pretoria, Gauteng (bundle test bank)
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abirb.com/testChapter 38: Assessment: Gastrointestinal System
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Harding: Lewis’s Medical-Surgical Nursing, 11th Edition
MULTIPLE CHOICE abirb.com/test
1. Which information about an 80-yr-old male patient at the senior center is of most concern to
the nurse?
a. Decreased appetite abirb.com/test
b. Occasional indigestion
c. Unintended weight loss
d. Difficulty chewing food
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ANS: C
Unintentional weight loss is not a normal finding and may indicate a problem such as cancer
or depression. Poor appetite, difficulty in chewing, and indigestion are common in older
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patients. These will need to be addressed but are not of as much concern as the weight loss.
DIF: Cognitive Level: Analyze (analysis)
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OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
2. An older patient reports chronic constipation. To promote bowel evacuation, when should the
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nurse suggest that the patient attempt defecation?
a. In the mid-afternoon
b. After eating breakfast
c. Right after awakening in the morning
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d. Immediately before the first daily meal
ANS: B
The gastrocolic reflex is most active after the first daily meal. Awakening, the anticipation of
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eating, and mid-afternoon timing do not stimulate these reflexes.
DIF: Cognitive Level: Apply (application)
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TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
3. What condition should the nurse anticipate when caring for a patient with a history of a total
gastrectomy?
a. Constipation
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b. Dehydration
c. Elevated total serum cholesterol
d. abirb.com/test
Cobalamin (vitamin B12) deficiency
ANS: D
The patient with a total gastrectomy does not secrete intrinsic factor, which is needed for
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cobalamin (vitamin B12) absorption. Because the stomach absorbs only small amounts of
water and nutrients, the patient is not at higher risk for dehydration, elevated cholesterol, or
constipation.
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DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
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4. The nurse is caring for a patient with an obstructed common bile duct. What condition should
the nurse expect? abirb.com/test
a. Melena
b. Steatorrhea
c. Decreased serum cholesterol level
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d. Increased serum indirect bilirubin level
ANS: B
A common bile duct obstruction will reduce the absorption of fat in the small intestine,
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leading to fatty stools. Gastrointestinal bleeding is not caused by common bile duct
obstruction. Serum cholesterol levels are increased with biliary obstruction. Direct bilirubin
level is increased with biliary obstruction.
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DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
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5. The nurse receives the following information about a patient who is scheduled for a
colonoscopy. Which information should be communicated to the health care provider before
sending the patient for the procedure?
a. The patient declined to drink the prescribed laxative solution.
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b. The patient has had an allergic reaction to shellfish and iodine.
c. The patient has a permanent pacemaker to prevent bradycardia.
d. The patient is worried about discomfort during the examination.
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ANS: A
If the patient has had inadequate bowel preparation, the colon cannot be visualized and the
procedure would be rescheduled. Because contrast solution is not used during colonoscopy,
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the iodine allergy is not pertinent. Apacem
akerisacontraindication to magnetic resonance imaging but
not to colonoscopy. The nurse should instruct the patient about the sedation used during the
examination to decrease the patient’s anxiety about discomfort.
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DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
6. Which statement to the nurse from a patient with jaundice indicates a need for teaching?
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a. “I used cough syrup several times a day last week.”
b. “I take a baby aspirin every day to prevent strokes.”
c. “I take an antacid for indigestion several times a week”
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d. “I use acetaminophen (Tylenol) every 4 hours for pain.”
ANS: D
Chronic use of high doses of acetaminophen can be hepatotoxic and may have caused the
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patient’s jaundice. The other patient statements require further assessment by the nurse but do
not indicate a need for patient education.
DIF: Cognitive Level: Apply (application)
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TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
7. Which is the correct technique for the nurse to palpate the liver during a head-to-toe physical
assessment? abirb.com/test
a. Place one hand on top of the other and use the upper fingers to apply pressure and
the bottom fingers to feel for the liver edge.
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b. Place one hand on the patient’s back and press upward and inward with the other
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hand below the patient’s right costal margin.
c. Press slowly and firmly over the right costal margin with one hand and withdraw
the fingers quickly after the liver edge is felt.
d. Place one hand under the patient’s lower ribs and press the left lower rib cage
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forward, palpating below the costal margin with the other hand.
ANS: B
The liver is normally not palpable below the costal margin. The nurse needs to push inward
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below the right costal margin while lifting the patient’s back slightly with the left hand. The
other methods will not allow palpation of the liver.
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DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
8. Which finding by the nurse during abdominal auscultation indicates a need for a focused
abdominal assessment? abirb.com/test
a. Loud gurgles
b. High-pitched gurgles
c. Absent bowel sounds abirb.com/test
d. Frequent clicking sounds
ANS: C
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Absent bowel sounds are abnormal and require further assessment by the nurse. The other
sounds may be heard normally.
DIF: Cognitive Level: Apply (application)
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TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
9. What action should the nurse take after assisting with a needle biopsy of the liver at a patient’s
bedside? abirb.com/test
a. Elevate the head of the bed to facilitate breathing.
b. Place the patient on the right side with the bed flat.
c. Check the patient’s postbiopsy coagulation studies.
d. abirb.com/test
Position a sandbag over the liver to provide pressure.
ANS: B
After a biopsy, the patient lies on the right side with the bed flat to splint the biopsy site.
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Coagulation studies are checked before the biopsy. A sandbag does not exert adequate
pressure to splint the site.
DIF: Cognitive Level: Apply (application)
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TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
10. A patient is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which
information obtained by the nurse indicates that the ultrasound may need to be rescheduled?
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a. The patient took a laxative the previous evening.
b. The patient had a high-fat meal the previous evening.
c. The patient has a permanent gastrostomy tube in place.
d. abirb.com/test
The patient ate a low-fat bagel 4 hours ago for breakfast.
ANS: D
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Food intake can cause the gallbladder to contract and result in a suboptimal study. The patient
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should be NPO for 8 to 12 hours before the test. A high-fat meal the previous evening,
laxative use, or a gastrostomy tube will not affect the results of the study.
DIF: Cognitive Level: Apply (application)
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TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
11. The nurse is assessing an alert and independent older adult patient for malnutrition risk.
Which is the most appropriate initial question?
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a.“How do you get to the store to buy your food?”
b.“Can you tell me the food that you ate yesterday?”
c.“Do you have any difficulty in preparing or eating food?”
d. abirb.com/test
“Are you taking any medications that alter your taste for food?”
ANS: B
This question is the most open-ended and will provide the best overall information about the
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patient’s daily intake and risk for poor nutrition. The other questions may be asked, depending
on the patient’s response to the first question.
DIF: Cognitive Level: Analyze (analysis)
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TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
12. A patient has just arrived in the recovery area after an upper endoscopy. Which information
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collected by the nurse is most important to communicate to the health care provider?
a. The patient is very drowsy.
b. The patient reports a sore throat.
c. The oral temperature is 101.4° F.
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d. The apical pulse is 100 beats/min.
ANS: C
A temperature elevation may indicate that an acute perforation has occurred. The other
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assessment data are normal immediately after the procedure.
DIF: Cognitive Level: Analyze (analysis)
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OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
13. An adult with a body mass index (BMI) of 22 kg/m2 is being admitted to the hospital for
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elective knee surgery. Which assessment finding should the nurse report to the health care
provider?
a. Tympany on percussion of the abdomen
b. Liver edge 3 cm below the costal margin
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c. Bowel sounds of 20/min in each quadrant
d. Aortic pulsations visible in the epigastric area
ANS: B abirb.com/test
Normally the lower border of the liver is not palpable below the ribs, so this finding suggests
hepatomegaly. Visible aortic pulsations in the epigastrium, active bowel sounds, and
abdominal tympany are within normal findings for an adult of normal weight.
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DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
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