MS 1 Final Exam Review - GI

Question 1

Which assessment finding would the nurse expect when caring for a patient who has gallstones?

1 Tachycardia
2 Hypotension
3 Hyperglycemia
4 Clay-colored stools

Answer 1

4 Clay-colored stools

The presence of gallstones results in bile flow obstruction, which is manifested by fever, clay-colored stools, and dark urine. Tachycardia and hypotension are the clinical manifestations of acute pancreatitis. Hyperglycemia is seen in patients with chronic pancreatitis.

Question 2

Which type of medication increases a patient’s risk for upper gastrointestinal bleeding?

1 Antacids
2 Anticholinergics
3 Tricyclic antidepressants
4 Nonsteroidal antiinflammatory drugs (NSAIDs)

Answer 2

4 Nonsteroidal antiinflammatory drugs (NSAIDs)

NSAIDs may disrupt the production of prostaglandins, which are required for the protection of the stomach’s mucosal lining, and result in upper gastrointestinal bleeding. Antacids are used as an adjunct therapy for the treatment of peptic ulcers. Anticholinergic drugs are used occasionally to treat peptic ulcer disease. Tricyclic antidepressants are used to reduce gastric acid secretions associated with peptic ulcer disease.

Question 3

Which finding indicates that a patient with advanced cirrhosis is experiencing a serious complication?

1 Urine retention
2 Increased blood glucose
3 No bowel movement in three days
4 Frequent nosebleeds and bruising

Answer 3

4 Frequent nosebleeds and bruising

The liver produces clotting factors. As cirrhosis becomes more advanced, the production of clotting factors is disrupted and thereby decreased, making the patient more susceptible to bleeding. Increasing frequency and severity of nosebleeds and bruising would indicate a deterioration in liver function. Urine retention, abnormal blood glucose, and constipation are not directly associated with advanced cirrhosis.

Question 4

A patient reports periumbilical pain that increases after coughing and sneezing. The patient prefers to lie still with the right leg flexed. Which condition does the nurse suspect?

1 Peritonitis
2 Appendicitis
3 Gastroenteritis
4 Ulcerative colitis

Answer 4

2 Appendicitis

Periumbilical pain that increases with coughing and sneezing indicates appendicitis. In this condition, the patients prefer to lie still with the right leg flexed. Peritonitis is characterized by abdominal pain; patients tend to lie still and take shallow breaths. Gastroenteritis is the inflammation of mucosa of stomach and small intestine; it is characterized by diarrhea, vomiting, and abdominal cramping. Ulcerative colitis is a form of inflammatory bowel disease characterized by bloody diarrhea and abdominal pain.

Question 5

Which is a cause of primary peritonitis?

1 Pancreatitis
2 Cirrhosis with ascites
3 Appendicitis with rupture
4 Ischemic bowel disorders

Answer 5

2 Cirrhosis with ascites

Cirrhosis causes a large amount of fluid to build up in the abdominal cavity; this is known as ascites. Ascites is susceptible to bacterial infection, which can cause primary peritonitis. Pancreatitis, appendicitis with rupture, and ischemic bowel disorders are causes of secondary peritonitis.

Question 6

Which diagnostic study is used to diagnose pancreatic adenocarcinoma and monitor the patient’s response to treatment?

1 Abdominal ultrasound
2 Spiral CT scan
3 Cancer-associated antigen 19-9 (CA 19-9)
4 A positron emission tomography (PET)/CT scan

Answer 6

3 Cancer-associated antigen 19-9 (CA 19-9)

CA 19-9 is the tumor marker used for the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment. Although a spiral CT scan may be the initial study done and provides information on metastasis and vascular involvement, the CT and the PET/CT scan or abdominal ultrasound do not provide additional information.

Question 7

The nurse is caring for a patient experiencing diarrhea caused by clostridium difficile. Which is a priority nursing action?

1 Performing effective handwashing
2 Providing antidiarrheal medication
3 Administering mineral oil enemas
4 Placing the patient on airborne isolation

Answer 7

1 Performing effective handwashing

Clostridium difficile is a highly contagious infection. Effective handwashing is crucially important to prevent the transmission to other patients. Antidiarrheal medications will prolong the exposure to this pathogen. Mineral oil enemas are not used to treat this pathogen. Patients with clostridium difficile will be placed on contact, not airborne, isolation.

Question 8

While reviewing the laboratory reports of a patient with chronic inflammation of the gastrointestinal tract, the nurse suspects toxic megacolon in the patient. Which laboratory finding supports the nurse’s suspicion?

1 Increased albumin
2 Increased white blood cell (WBC) count
3 Increased serum sodium
4 Increased magnesium level

Answer 8

2 Increased white blood cell (WBC) count

Chronic inflammation of the gastrointestinal tract indicates inflammatory bowel disease. Toxic megacolon is a condition characterized by swelling and dilation of the large intestine due to severe inflammation of the intestinal wall and accumulation of excess gas. A high WBC count may be a sign of toxic megacolon or perforation. Hypoalbuminemia is present with severe disease because of poor nutrition or protein loss. Decreased serum sodium and magnesium levels occur due to fluid and electrolyte losses from diarrhea and vomiting.