Practice Test Questions

Question 1

Which of the following dairy products is MOST LIKELY to contain the least lactose for those who are lactose intolerant?

1. Whole milk
2. Cheese
3. Regular whole-fat yogurt
4. Greek-style whole-fat yogurt

Answer 1

4

Because Greek-style yogurt is thicker than regular whole-fat yogurt, more of the whey is removed, and the lactose is part of the whey, so those who are lactose intolerant are more likely to tolerate Greek yogurt than other dairy products. Those who are lactose intolerant lack the enzyme needed to digest lactose resulting in stomach cramps, gas and distention, and diarrhea after eating or drinking dairy products. Some dairy products are now lactose-free and Lactaid can be taken to replace the missing enzymes

Question 2

Unless otherwise specified by manufacturer, multi-use vials that have been accessed and used should be discarded within which of the following time periods?

1. One week
2. 14 days
3. 28 days
4. 60 days

Answer 2

3

Unless otherwise specified by manufacturer, multi-use vials that have been accessed and used should be discarded within 28 days. Multi-use vials contain preservatives but can become contaminated with bacteria and provide no protection against viruses. Multi-use vials should be reserved for only one patient whenever possible and should be maintained in a separate space from the treatment area to prevent inadvertent contamination. A new needle and syringe should be used each time the vial is accessed

Question 3

Which of the following is a reversal agent for excessive sedation of a patient who has received a benzodiazepine

1. Atropine
2. Romazicon (Flumazenil)
3. Naloxone (Narcan)
4. N-acetylcysteine

Answer 3

2.

Romazicon (Flumazenil) is a reversal agent for excessive sedation of a patient who has received a benzodiazepine although it does not reverse respiratory depression. Romazicon is administered IV with a beginning dose of 0.2mg over 30 seconds with repeat doses at one-minute intervals as needed. The second dose is 0.3mg and the third and subsequent doses are 0.5mg. Epinephrine is used for emergent treatment of asystole, VF, and PEA; naloxone, for opioids; and N-acetylcysteine, for acetaminophen overdose

Question 4

Following an esophagoscopy to obtain a biopsy of the thoracic esophagus, which of the following symptoms MOST indicates they need for emergent care for perforation?

1. Chest pain, dysphagia, and tachycardia
2. Mild cough and sore throat
3. Nausea and vomiting
4. Local discomfort by no systemic response

Answer 4

1.

Following an esophagoscopy to obtain a biopsy of the thoracic esophagus, chest pain, dysphagia, and tachycardia are indications of the need for emergent care for perforation. Onset of fever is often rapid and Hamann’s sign (crunching, rasping precordial sound coinciding with the heartbeat) is positive because of leakage of air to the mediastinum. Perforation is usually confirmed radiologically although CT or endoscopy may be necessary if the perforation cannot be seen on x-ray

Question 5

A 76-year-old female ate E.coli (0157:H7) contaminated vegetables and developed abdominal cramps and non-bloody diarrhea for 48 hours after which the diarrhea became bloody for 4 days. The patient is MOST at risk for developing which of the following?

1. Intestinal necrosis
2. Small bowel obstruction
3. Intestinal perforation
4. Hemolytic uremic syndrome

Answer 5

4

If a 76-year-old female ate E.coli (0157.H7) contaminated vegetables and developed abdominal cramps and non-bloody diarrhea that persisted for 4 days, the patient is at risk for developing hemolytic uremic syndrome (HUS), which can lead to renal failure. Children under the age of 5 and older adults are most likely to develop HUS. HUS is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure

Question 6

A patient taking metoclopramide has be prescribed haloperidol. For which of the following does this drug combination put the patient at increased risk?

1. Tachycardia
2. Tardive dyskinesia
3. Excessive sedation
4. GI bleeding

Answer 6

2

If a patient taking haloperidol has been prescribed metoclopramide, this drug combination puts the patient at increased risk of developing tardive dyskinesia. Both drugs can cause uncontrollable movement disorders and this combination potentiates the effect and can lead to life-threatening neuroleptic malignant syndrome. The risk of developing tardive dyskinesia with metoclopramide increases with treatment extending beyond 12 weeks. Metoclopramide may also interact with numerous other drugs, including other antipsychotic drugs and phenothiazines

Question 7

If a patient scheduled for colonoscopy has a nose stud and enclosed lip ring, which of the following actions is appropriate

1. Remove the lip ring and tape the nose stud securely
2. Leave both in place
3. Remove both prior to the procedure
4. Remove the nose stud but leave the lip ring in place

Answer 7

3

If a patient scheduled for a colonoscopy has a nose stud and enclosed lip ring, they should both be removed prior to the procedure because they pose the risk of trauma and aspiration if they should become dislodged. Nose studs are removed by applying gentle pressure inside the ring to force the ends apart. Barbell-type jewelry has a bead on the end that is unscrewed in a counter-clockwise direction

Question 8

Cancer of the colon and rectum is primarily which of the following types of cancer?

1. Adenocarcinoma
2. Sarcoma
3. Lymphoma
4. Melanoma

Answer 8

1

Cancer of the colon and rectum is primarily (about 95%) adenocarcinoma, which arises in the epithelial lining of the bowel. Adenocarcinomas often develop from a precancerous polyp. Early detection through screening is essential because colorectal cancers may remain essentially asymptomatic until they are advanced and changes in the bowel habits or rectal bleeding occurs. Hemorrhage may occur if the tumor invades blood vessels, and obstruction may occur as the mass enlarges

Question 9

According to the WHO three-step ladder approach to pain management, if a patient’s abdominal pain associated with colon cancer varies from 4 to 8 on the pain scale, at which of the following steps should pain control be initiated?

1. Step 1
2. Step 2
3. Step 3
4. Whichever step is appropriate at the time of initiation

Answer 9

4

According to the WHO three-step ladder approach to pain management, if a patient’s abdominal pain associated with the colon varies from 4 to 8 on the pain scale, pain control should be initiated at whichever step is most appropriate for the level of pain at the time and may later be adjusted to a higher or lower step. While this is a three-step process, it is not necessary to stat all pain control at step one

Question 10

How soon after collection should duodenal aspirate be transported to the laboratory?

1. Immediately
2. Within 2 hours
3. Within 4 hours
4. Within 24 hours

Answer 10

1

Duodenal aspirate should be immediately transported to the laboratory because it must be examined within 60 minutes of collection. The aspirate should be collected (at least 2mL) in a sterile centrifuge tube. Duodenal aspirates may be useful in diagnosing Giardia duodenalis and Strongyloides stercoralis. Culture and sensitivity may also be done. The specimen should be maintained at room temperature

Question 11

The gastroenterology unit has experienced an outbreak of clostridium difficile infections involving 10 patients over a 2-week period. In order to reduce further transmission of the infection, on which of the following should the staff concentrate their efforts?

1. Antibiotic stewardship
2. Contact precautions/hand hygiene
3. Testing patient stool specimens
4. Limiting patient contacts

Answer 11

2

If the gastroenterology unit has experienced an outbreak of clostridium difficile infections involving 10 patients over a two-week period, in order to reduce transmission of the infection, the nurse and staff members and should concentrate efforts on the utilization of proper contact precautions and hand hygiene as the infection is easily spread through contaminated hands. The spores can remain viable on environmental surfaces for long periods of time. Housekeeping procedures should also be reviewed

Question 12

A patient with Crohn’s disease is to begin treatment with Infliximab, a biologic response modifier. For which of the following should the patient be tested prior to beginning treatment?

1. Anemia
2. Diabetes and hepatitis C
3. TB and hepatitis B
4. Hepatitis A and B

Answer 12

3

If a patient with Crohn’s disease is to begin treatment with Infliximab or any other biologic response modifier, the patient should be tested for TB and hepatitis B prior to the beginning of treatment. Because the drugs have immunosuppressive qualities, they can result in reactivation of both diseases. Biologic response modifiers are also contraindicated for those with a history of lymphoma and may result in severe allergic responses in some patients because they are derived from proteins and not chemicals

Question 13

A Navajo patient tells the nurse that he has “ghost sickness.” Which of the following is the MOST appropriate response?

1. “There is no such disease.”
2. “What do you mean?”
3. “Is that a common name for a real illness?”
4. “How does ghost sickness make you feel?”

Answer 13

4

If a Navajo patient tells the nurse that he has “ghost sickness,” the most appropriate response is “How does ghost sickness make you feel?” This response respects the patient’s perception of the disease and helps the nurse to understand what symptoms the patient is attributing to the disorder. Some Navajo individuals believe that ghost sickness is brought about by evil spirits and believe that a tribal healer may be able to overcome the spirit. Typical symptoms include weakness, nightmares fear, and feelings of suffocation

Question 14

Doppler ultrasound is used primarily to assess which of the following?

1. Size and shape
2. Blood flow
3. Function
4. Consistency (air-filled, fluid-filled)

Answer 14

2

Doppler ultrasound is used primarily to assess blood flow (direction, speed). As part of an abdominal ultrasound, Doppler ultrasound may help identify impaired circulation to the organs as well as changes in blood flow associated with tumors. Doppler imaging differentiates between antegrade (expected forward movement) and retrograde (unexpected movement) blood flow. Doppler imaging is often used to assess hepatic blood flow as different disease processes result in distinctive changes in blood flow

Question 15

The nurse is using the BVMGR (beliefs, values, meanings, goals, and relationships) rubric for implementing spiritual care. To which of the following do these aspects apply?

1. The nurse
2. The culture
3. The patient
4. The organization

Answer 15

3

If the nurse is using the BVMGR (beliefs, values, meanings, goals, and relationships) rubric for implementing spiritual care, these aspects apply to assessment of the patient. That is, the nurse should try to understand the patient’s BVMGR and should not let personal BVMGR intrude and should avoid any indication of proselytizing when the nurse’s BVMGR is at odds with the patient. While the nurse may not share the patient’s belief system, the nurse should always seek to understand and to show respect for it

Question 16

Capsule endoscopy is used primarily to examine which part of the gastrointestinal tract?

1. Small intestine
2. Large intestine
3. Stomach
4. Esophagus

Answer 16

1

Capsule endoscopy is used primarily to examine the small intestine, which, because of its length, is otherwise difficult to assess as it cannot be reached with colonoscopy or Esophagogastroduodenoscopy. The capsule, which is swallowed by the patient, contains a miniature camera and LEDs. The camera wirelessly transmits pictures to a receiver as it passes though the small intestine. The capsule is usually passed anally within 24 to 48 hours although there is a small risk of retention

Question 17

Which of the following increases the risk of aspiration for a patient receiving NG feedings?

1. Head elevated at 45 degree
2. Continuous feeding
3. Young age
4. History of diabetes mellitus

Answer 17

4

A history of diabetes mellitus, major abdominal/thoracic trauma, and neurological disorders increases the risk of aspiration for a patient receiving tube feedings. Patients should be positioned with the head elevated to 45 degrees if possible and supine position avoided. Continuous feedings pose less risk than intermittent or bolus feedings, and the older patient is at greater risk than the younger. Metoclopramide may be given to increase the rate of gastric emptying. The tube should checked for correct position at every feeding or every 4 to 6 hours if feedings are continuous

Question 18

A patient complains of increasing abdominal pain and has been passing 3 to 4 sticky, black foul-smelling stools for 4 days and exhibits postural hypotension, hemoglobin of 9.2mg/dL, and hematocrit of 28%. Which of the following should the nurse suspect?

1. Iron deficiency anemia and intestinal perforation
2. Hemolytic anemia and gastritis
3. Iron deficiency anemia and upper GI bleeding
4. Iron deficiency anemia and lower GI bleeding

Answer 18

3

If a patient complains of increasing abdominal pain and has been passing 3 to 4 sticky foul-smelling stools for 4 days, exhibits postural hypotension, and has a hemoglobin of 9.2mg/dL (92mmol/L) and hematocrit of 28%, the nurse should suspect iron deficiency anemia with upper GI bleeding. The anemia occurs from blood loss (low hemoglobin and hematocrit with normal MCV) and the melena is from blood in the upper GI tract that is exposed to digestive enzymes. The BUN is often elevated because of increased absorption of blood

Question 19

A patient has been prescribed antibiotic therapy and probiotics to help to maintain intestinal flora. Which of the following statements BEST describes the appropriate administration?

1. The antibiotic and the probiotics should be taken simultaneously
2. The antibiotic and the probiotics should be taken at least 2 hours apart
3. The probiotics should be started only after completing the antibiotic
4. The probiotics should be taken for 2 days before beginning the antibiotic

Answer 19

2

If a patient has been prescribed antibiotic therapy and probiotics to help to maintain intestinal flora, the antibiotic and the probiotics at least 2 hours apart because the antibiotic can kill not only the bacteria already present in the intestines but also the bacteria in the probiotics. Probiotics that contain Saccharomyces boulardii also may help reduce toxins produced by clostridium difficile. Patients who are severely immunocompromised and taking long-term broad-spectrum antibiotics have developed sepsis from probiotics, so probiotics should be used with care in these patients

Question 20

The nurse hears a patient’s physician complaining that a patient is “difficult and impatient,” and the nurse tells the physician that the patient is very frightened and acting defensively. Which of the following aspects of care is the nurse exhibiting?

1. Advocacy
2. Patient equality
3. Human dignity preservation
4. Caring practice

Answer 20

1

If the nurse hears a patient’s physician complaining that a patient is “difficult and impatient,” and the nurse tells the physician that the patient is very frightened and acting defensively, the aspect of care that the nurse is exhibiting is advocacy. The nurse is speaking up in defense of the patient and acting for the patient’s benefit in trying to help the physician have a more balanced view of the patient’s behavior

Question 21

Imaging shows that a patient has an intestinal obstruction from a cancerous lesion at the duodenum. The patient is MOST likely to exhibit which of the following signs and symptoms?

1. Copious emesis of undigested food, succession splashing bowel sounds, by absence of abdominal pain or distention
2. Moderate emesis, hyperactive bowel sounds, and upper abdominal pain
3. Moderate abdominal distention, colicky cramping, and hyperactive bowel sounds
4. Marked abdominal distention, some emesis (late), borborygmi, and colicky pain in central and lower abdomen

Answer 21

1

If imaging shows that a patient has an intestinal obstruction from a cancerous lesion at the duodenum, the signs and symptoms likely include copious emesis of undigested food (with no evidence of bile) after eating, succession splashing bowel sounds in the upper quadrant but generally absence of abdominal pain or distention. If the condition persists untreated, the patient may show signs of dehydration and muscle wasting. The stomach may begin to dilate and excessive peristaltic action may be evident

Question 22

Which of the following herbal preparations should the nurse advise a patient to avoid when taking immunosuppressant drugs?

1. Melatonin
2. St. John’s wort
3. Chamomile
4. Curcumin

Answer 22

2

The nurse should advise a patient to avoid taking St. John’s wort when taking immunosuppressant drugs. St. John’s wort is commonly used to treat depression and anxiety; however, it may interact with many different drugs, so if patients indicate an interest in taking the herbal preparation, the nurse should carefully review the patient’s list of drugs. St. John’s wort should also not be taken with antibiotics, birth control pills, antidepressants, warfarin or anticonvulsants

Question 23

If two grounding pads (aka return electrodes) are utilized during a procedure involving electrical cautery, which of the following is a correct placement

1. Upper thigh and lower thigh
2. Left thigh and right calf
3. Right upper thigh and left upper thigh
4. Anterior thigh and posterior thigh

Answer 23

3

If two grounding pads (aka return electrodes) are utilized during a procedure involving electrical cautery, a correct placement is the right upper thigh and the left upper thigh. Grounding pads should be placed at a distance from the surgical site and, if two are utilized, they should be placed equidistantly and symmetrically and never on just one limb as this increases the risk of burns. Using two pads divides the current and reduces risk of burns. The pads must be fully in contact with the skin and placed according to manufacturer’s directions

Question 24

When reviewing medications for a patient with cirrhosis, the nurse must consider that the liver disease may MOST affect which of the following?

1. Absorption
2. Metabolism
3. Distribution
4. Excretion

Answer 24

2

When reviewing medications for a patient with cirrhosis, the nurse must consider that the liver disease may affect drug metabolism, which is the process of biotransformation. While some metabolism occurs in the skeletal muscles, lungs, kidneys, plasma and intestines, most metabolism occurs in the liver through the action of microsomal enzymes (AKA cytochrome P-450 enzymes). These enzymes target primarily lipophilic drugs, which comprise the majority of drugs in common use

Question 25

Ensuring that a patient has given informed consent and understands his or her rights and all of the risks and benefits of a procedure or treatment supports which of the following ethical principles

1. Beneficence
2. Nonmaleficence
3. Justice
4. Autonomy

Answer 25

4

Autonomy is the ethical principle that the individual has the right to make decisions about his/her own care, based on informed consent and understanding of risks and benefits. Beneficence is an ethical principle that involves performing actions that are for the purpose of benefiting another person. Nonmaleficence is an ethical principle hat means healthcare workers should provide care in a manner that does not cause direct intentional harm to the patient. Justice is the ethical principle that relates to the distribution of the limited resources of healthcare benefits to the members of society

Question 26

A patient with inflammatory bowel disease has periodic bouts of severe diarrhea but is unsure of the cause. Which of the following should the nurse advise the patient to do to try to resolve the problem?

1. Maintain a food diary
2. Avoid all milk products
3. Increase fat in diet
4. Increase fiber in diet

Answer 26

1

If a patient with inflammatory bowel disease (IBD) has bouts of severe diarrhea but is unsure of the cause, the nurse should advise the patient to maintain a food diary, writing down all food and fluid intake to see if a pattern emerges. While many patients with IBD are lactose intolerant, testing can show if this is the problem. Increasing fat or fiber in the diet may aggravate the diarrhea

Question 27

Absorption of nutrients from the small bowel is often impaired in older adults because of which of the following?

1. Age-related cellular mutations
2. Decreased muscular contractility
3. Narrowing and lengthening of villi
4. Broadening and shortening of villi

Answer 27

4

Absorption of nutrients from the small bowel is often impaired in older adults because of broadening and shortening of villi, which decreases the surface area available. Additionally, levels of some enzymes decrease. For example, lactase levels may fall, and this can cause increased lactose intolerance. When fecal material moves slowly through the bowel, bacterial overgrowth may occur, and this can affect absorption of nutrients because the bacteria require nutrients and can also cause diarrhea, which interferes with absorption

Question 28

A 72-year-old patients has 3 polyps removed during a routine colonoscopy. Which of the following types of polyps are precancerous?

1. Epithelial Hyperplastic
2. Adenomatous
3. Inflammatory
4. Submucosal (fibroma)

Answer 28

2

If a 72-year-old patient has polyps removed, the type of polyp that is precancerous is the adenomatous polyp, which can include tubular adenomas, tubular villous adenoma, and villous adenoma. Polyps associated with hereditary polyposis syndromes (familial adenomatous polyposis) are also precancerous. Patients with precancerous polyps are generally advised to have routine follow-up colonoscopies every 3 years because of increased risk of colon cancer

Question 29

The nurse is educating a patient who is to be discharged after surgery to remove a cancerous lesion of the colon and create a colostomy. Which of the following foods may cause a noticeable odor?

1. Green beans, raw fruits, spicy foods, and spinach
2. Popcorn, seeds, raw vegetables, and corn
3. Fish, eggs, onions, broccoli, and cabbage
4. Beans, carbonated beverages, strong cheeses and sprouts

Answer 29

3

The nurse is educating a patient who is to be discharged after surgery to remove a cancerous lesion of the colon and create a colostomy. The nurse advises the patient that some foods may cause

• Odor: fish, eggs, onions, broccoli, asparagus and cabbage
• Gas: beans, carbonated beverages, strong cheese, bear and sprouts
• Diarrhea: beer, green beans, coffee, raw fruits, spicy foods, and spinach
• Obstruction: popcorn, seeds, raw vegetables, nuts and corn

Question 30

Following a colonoscopy with removal of polyps, a patient developed abdominal pain with elevated temperature, WBC count and C-reactive protein. Which of the following interventions dose the nurse anticipate initially?

1. Abdominal CT
2. Repeat colonoscopy
3. Antibiotic therapy
4. Exploratory laparotomy

Answer 30

1

If, following a colonoscopy with removal of polyps, a patient developed abdominal pain with elevated temperature, WBC count, and C-reactive protein, the patient should have an abdominal CT to differentiate between thermal injury causing perforation and one causing post-polypectomy electrocoagulation syndrome (transmural burn without perforation). Symptoms for both are similar initially, but post-polypectomy electrocoagulation syndrome heals with conservative treatment while perforation requires surgical repair

Question 31

If a patient develops an infection with a multi-drug resistant organism (MDRO), the nurse anticipates that the patient’s history will show which of the following?

1. Auto-immune disorder
2. Pneumonia
3. Diabetes mellitus
4. Prior antibiotic use

Answer 31

4

If a patient develops an infection with a multi-drug resistant organism (MDRO), the nurse anticipates that the patient’s history will show previous antibiotic use as this is a factor in almost all cases. Other risk factors include prolonged hospitalization and intraabdominal surgery. MDRO infections are increasingly resistant to 2 or more antibiotics, including vancomycin. Restriction of vancomycin use alone has not proven successful in controlling development of MDRO because multiple other antibiotics are implicated

Question 32

The standard triple therapy for H. Pylori-associated peptic ulcer disease includes a proton pump inhibitor BID, Clarithromycin 500mg BID and which of the following?

1. Bismuth subcitrate potassium 140mg qd
2. H-2 receptor antagonist
3. Amoxicillin 1g BID
4. Misoprostol 200mcg QID

Answer 32

3

The standard triple therapy for H. Pylori- associated peptic ulcer disease include a proton pump inhibitor BID, Clarithromycin 500mg BID and amoxicillin 1g BID. Metronidazole 500mg BID may be substituted for amoxicillin for those with penicillin allergy. Treatment is usually continued for 10 to 14 days. Using two antibiotics is especially important because of increasing resistant strains. The standard triple therapy is most commonly utilized, but a standard quadruple therapy and sequential quadruple therapy may also be considered

Question 33

When lifting an item, which of the muscles should be used?

1. The muscles in the legs
2. The muscles in the arms
3. The muscles in the lower back
4. The muscles in the upper back and shoulders

Answer 33

1

When lifting an item, the muscles in the legs should be used. The nurse should stand close to the item or person being lifted and use the leg muscles to support weight rather than the arms or back and should stoop down rather than bending over. If items or people are heavy, then lift devices should be used rather than lifting manually. If items are up high, the nurse should avoid stretching but should use a step stool or gripping device to reach the item

Question 34

When palpating a patient’s abdomen, a positive Murthy’s sign (sudden holding of breath with RUQ palpation) MOST LIKELY indicates which of the following?

1. Appendicitis
2. Cholecystitis
3. Choledocholithiasis
4. Duodenal ulcer

Answer 34

2

When palpating a patient’s abdomen, a positive Murphy’s sign (sudden holding of breath with RUQ palpation) indicates cholecystitis. Murthy’s sign is usually negative with choledocholithiasis although Cholecystitis is most often caused by gallstones that obstruct the flow of bile, causing the gallbladder to swell and become inflamed. However, Cholecystitis may also result from tumors or impaired circulation (common with diabetics) . Typical symptoms include nausea and vomiting and severe middle or RUQ abdominal pain

Question 35

If a patient is receiving methotrexate for maintenance treatment of Crohn’s disease, which laboratory tests should be routinely monitored

1. CBC and renal function tests
2. CBC and sed rate
3. CBC and renal and liver function tests
4. CBC and pancreatic enzymes

Answer 35

3

If a patient is receiving methotrexate for maintenance treatment of Crohn’s disease, laboratory tests that should be routinely monitored include the CBC and renal (creatinine and BUN) and liver function tests. FDA guidelines advise testing at least every 1 to 2 months during therapy, but some authorities recommend testing every 2 to 4 weeks during the first few months of treatment. Adverse effects of methotrexate include renal failure, portal fibrosis, myelosuppression, headache and rash

Question 36

A patient presents with symptoms consistent with diverticulosis. Which of the following imaging techniques does the nurse anticipate will be used to confirm the diagnosis?

1. Colonic contrast studies
2. Colonoscopy
3. Abdominal CT
4. Abdominal ultrasound

Answer 36

2

If a patient presents with symptoms consistent with diverticulosis, the imaging technique that will likely be used to confirm the diagnosis is colonoscopy, which allows biopsy to rule out other disorders and allows visualization of involvement. Ultrasound shows non-specific abnormalities and cannot conclusively diagnose diverticulitis, colonic contrast studies, such as barium enema, have limited value because most diverticula are extraluminal, and it increases the risk of perforation if peritoneal irritation is present.

Question 37

A patient comes to the emergency department with slight jaundice and complaining of clay-colored stools and flu-like symptoms. Which of the following are the primary tests that scan for suspected hepatitis?

1. ALT and AST
2. CBC and differential
3. Bilirubin and LDH
4. Total protein and serum ammonia

Answer 37

1

The primary tests that screen for hepatitis include alanine transaminase (ALT) (normal 5-35units) and aspartate transaminase (AST) (normal 10-40 units). These are liver enzymes that increase with inflammation and damage to hepatic cells. ALT is more specific than AST and usually shows a higher increase. ALT may increase to 10 times normal with acute infection and 2 to 3 times normal which chronic infection, so ALT is used most often to monitor treatment. However, many drugs can affect ALT results, so medication reconciliation is essential

Question 38

Environmental surfaces have been implicated in transmission of which of the following healthcare-associated pathogens?

1. Clostridium difficile only
2. Clostridium difficile and Norovirus only
3. Methicillin-resistant Staphylococcus aureus only
4. Clostridium difficile, Norovirus, and staphylococcus aureus/MRSA

Answer 38

4

Healthcare -associated infections kill almost 100,000 people each year in the United States, and environmental contamination is a factor in 20% to 40% of HAIs, with pathogens carried from environmental surfaces on the hands of healthcare workers. Pathogens that are of increasing concern are Norovirus, clostridium difficile, acinetobacter species, MRSA and vancomycin-resistant enterococcus. Patients admitted to rooms previously occupied by patient infected with these pathogens are at increased risk because the agents are capable of surviving for prolonged periods in the environment

Question 39

Under the Spaulding system, which of the following is classified as a semi-critical item when considering methods for sterilization/ disinfection?

1. Surgical instrument
2. Prosthetic implant
3. Endoscope
4. Blood pressure cuff

Answer 39

3

The Spaulding system of sterilization and disinfection:

1. Critical: Contact sterile tissue or the vascular system, including surgical instruments, IV catheters and prosthetic implants. Contamination poses a high risk of infection, so these items must be sterile
2. Semi-critical: Contact mucous membranes or non-intact skin, including endoscopes, diaphragm fitting rings, and laryngoscope blades. These tissue tend to be more resistant to spores, so these items can be disinfected with high-level disinfectants
3. Non-critical: Contact intact skin only, including patient care items such as blood pressure cuffs and bedpans and environmental surfaces. Decontamination can be done at point of care

Question 40

Following removal of the Esophagogastroduodenoscopy tube, the patient begins to cough violently and appears cyanotic. Which of the following is the MOST appropriate initial intervention?

1. Turn patient onto one side
2. Suction airway and increase supplemental oxygen
3. Reverse sedation
4. Encourage deep breathing and coughing

Answer 40

2

If, following removal of the Esophagogastroduodenoscopy tube, the patient begins to cough violently and appears cyanotic, the most appropriate initial intervention is to suction the airway and increase supplemental oxygen. These symptoms are consistent with aspiration of gastric fluids, which can lead to aspiration pneumonia. The patient needs an x-ray and antibiotic therapy. Patients with gastric bleeding, gastric obstruction, excessive sedation, and older adults are especially at risk of aspiration during endoscopic procedures

Question 41

Which of the following is the CDC-recommended method of routine hand hygiene?

1. Wearing gloves
2. Washing with soap and water
3. Using alcohol-based hand rubs
4. Encourage deep breathing and coughing

Answer 41

3

The CDC recommended method of routine hand hygiene is now using alcohol-based hand rubs. This can be done relatively quickly, and compliance tends to be better than washing hands with soap and water. However, if the hands are visibly soiled or have come into contact with bodily fluids, then they must be thoroughly washed with soap and water to remove all residue. Additionally, if the healthcare provider is exposed to spore-producing microbes, such as B. Anthracis or C. Difficile, or Norovirus, then washing with soap and water is required

Question 42

In regards to reprocessing of single-use devices, the CMS recommends which of the following?

1. No reprocessing
2. In-house reprocessing
3. Reprocessing of class I devices only
4. Use of third-party reprocessors

Answer 42

4

In regard to reprocessing of single-use devices, the CMS recommends use of third-party reprocessors because of the stringency of the regulations by the FDA for reprocessing and the type of equipment needed. The trend is toward increased reprocessing of single-use devices because of the costs of medical care. The FDA categorizes medical devices as class I, II, or III with class I posting the lowest risk to the patient and class III the highest. Requirements for reprocessing of class III devices are more stringent than for class I or II

Question 43

Which of the following is the incubation period for food borne illness caused by salmonella spp?

1. 1 to 6 hours
2. 1 to 3 days
3. 12 to 48 hours
4. 28 days

Answer 43

2

The incubation period for food borne illness caused by salmonella spp. is one to three days, and the infection persists for four to seven days. Symptoms include fever, abdominal cramping, and diarrhea. S. Typhi and S. Paratyphi result in more severe symptoms and typhoid fever. Infection often results from contaminated poultry, eggs, unpasteurized milk products or juices, and raw fruits and vegetables. Outbreaks may occur if the water supply becomes contaminated. Antibiotics are usually contraindicated except for S. Typhi and S paratyphi

Question 44

Constipation is usually defined as which of the following?

1. Fewer than 7 stools per week
2. Fewer than 5 stools per week
3. Fewer than 3 stools per week
4. Fewer than 2 stools per week

Answer 44

3

Constipation is usually defined as fewer than three stools per week although there is considerable individual variation. Some people have two to three stools daily while others only defecate every two or three days, so it’s necessary to determine the normal pattern for a patient when assessing constipation. Constipation is also sometimes described in terms of stool consistency (hard, small) and difficulty defecating (need to strain, splinting). Constipation is most common in patients in their 60’s with rates about 5 times those of younger adults

Question 45

Which of the following is MOST indicated for an inactive patient who has been taking laxatives long-term to treat chronic bouts of constipation and fecal impaction?

1. Stool softeners
2. High fiber diet
3. Exercise program
4. Bowel retraining

Answer 45

4

Bowel retraining strategies include:

1. Keeping a bowel diary for a week
2. Modifying diet and fluid intake to assure normal stool consistency, including increased fiber and fluids, eating meals at scheduled times, and avoiding foods that increase bowel dysfunction
3. Establishing a schedule for defecation, preferably at the same time each day and about 20-30 minutes after a meal
4. Practicing Kegel exercises
5. Using a stimulus to promote defecation, such as enemas, suppositories, or laxatives in the beginning, with a goal to decrease such us. Digital stimulation or hot drinks may be used.
6. Keeping a record of stool consistency and evacuation

Question 46

A patient is receiving enteral feedings. Which of the following is MOST LIKELY to contribute to diarrhea

1. Cold formula
2. Warm formula
3. Hypo-osmolar formula
4. Continuous feeding

Answer 46

1

If a patient is receiving enteral feeding, administration of cold formula is most likely to contribute to diarrhea. Other causes of diarrhea include rapid infusion and bolus feedings, and hyperosmolar formula. If diarrhea occurs, the patient’s feedings should be re-evaluated (rate slowed, change in formula) and fluid balance and electrolyte status assessed. Medications should be assessed and pro-motility medications avoided as they may contribute to diarrhea

Question 47

When undergoing a bowel transit time test, how soon after ingesting markers should the patient return for radiographs

1. 24 hours
2. 2 days
3. 4 days
4. 5 days

Answer 47

4

For the bowel transit time test, patients take capsules that contain radiopaque markers and then continue with their regular diet. They return 5 days later for radiographs. Typically, about 80% of the markers are excreted in 5 days, so if fewer than 20%, slower than normal. This test results are affected by the types of foods and amount of liquids consumed, so results must be evaluated in terms of diet and other factors

Question 48

A patient has developed acne, weight gain, mood swings, and hyperglycemia. Which of the following drugs is MOST LIKELY to cause these symptoms?

1. Balsalazide (Aminosalicylate)
2. Azathioprine (Immunomodulator)
3. Prednisone (Corticosteroid)
4. Infliximab (Biologic)

Answer 48

3

If a patient has developed acne, weight gain, mood swings, and hyperglycemia, the most likely cause is prednisone, a corticosteroid. Corticosteroids are prescribed to suppress the immune response and reduce inflammation, but have numerous adverse effect so they are usually used for short periods rather than extended use. Other possible adverse effects include insomnia, hypertension, osteoporosis, moon fancies, glaucoma, cataracts, and increased risk of infection

Question 49

Which of the following BEST describes the action of omeprazole (Prilosec)

1. Suppresses secretion of gastric acids
2. Speeds gastric emptying
3. Slows intestinal motility
4. Neutralizes gastric secretions

Answer 49

1

Omeprazole (Prilosec), a proton pump inhibitor, suppresses secretion of gastric acids and is used primarily to treat GERD and erosive esophagitis. Omeprazole should be taken on an empty stomach to be most effective. Adverse effects include stomach pain, nausea and vomiting, diarrhea, flatulence, and headache. In rare cases, patients may develop severe myopathy. Drug interactions may occur with methotrexate, clopidogrel, and St. John’s wort

Question 50

Which of the following is the MOST common cause of fecal incontinence?

1. Chronic diarrhea
2. Fecal impaction
3. Neurological impairment
4. Laxative abuse

Answer 50

2

While all of these are important factors in fecal incontinence, the most common cause is fecal impaction, which may result from chronic constipation. Chronic constipation increases pressure on the anal sphincters and can damage nerves and muscles. Additionally, transit time through the large intestine is often slowed with constipation, increasing fluid aspiration and contributing impaction. When stool becomes impacted, the body compensates by increasing fluid in the stool above the impaction, resulting in diarrhea stool leaking about the impaction and through the damaged sphincters

Question 51

In a bowel diary, the Bristol Stool Form Scale is used for which of the following?

1. To describe the frequency of incontinence
2. To differentiate between defecation and incontinence
3. To describe the amount of stool
4. To describe the type of stool

Answer 51

4.

The Bristol stool Form has descriptions and pictures to help people identify the correct type of stool

1. Type 1: Separate small hard lumps of stool that are difficult to pass
2. Type 2: Sausage-shaped lumpy stool
3. Type 3: Sausage-shaped and lumpy but with cracks on the surface
4. Type 4: Long, smooth, soft, snake-like stool
5. Type 5: Soft blobs of stool that are easily passed and have clear-cut edges
6. Type 6: Mushy, fluffy pieces of stool with uneven ragged clear-cut edges
7. Type 7: Watery stool that is entirely liquid

The bowel diary should include the time of each event (defecation, incontinence, and flatus), type of stool amount, activity at the time of incontinence, intake of food and drinks, and all medications

Question 52

A patient has been dieting but complains that she has developed chronic diarrhea. Which of the following items recorded in the patient’s food diary is MOST LIKELY to cause diarrhea?

1. Dietetic hard candy
2. Broccoli
3. Cottage cheese
4. Hard-boiled eggs

Answer 52

1

If a patient has been dieting but complains that she has developed chronic diarrhea, the item on the food log that is most likely the cause is dietetic hard candy. Dietetic candy, diet soda, sugarless gum, and other sugarless products contain sweeteners (such as sorbitol, sucralose, and xylitol) that often cause diarrhea, abdominal distention, and gas, especially if taken in large amounts. The patient should stop eating the dietetic candy until the diarrhea stops and then eat only small amounts to tolerance

Question 53

A patient has prescriptions from four different doctors and admits to taking additional “pills” but can’t recall which ones any gives conflicting information regarding the dosage and frequency of the different medications. Which of the following do these findings MOST LIKELY indicate?

1. Dementia
2. Overdose
3. Poly pharmacy
4. Drug-seeking behavior

Answer 53

3

If a patient has prescriptions from four different doctors and admits to take additional “pills” but can’t recall which ones and gives conflicting information regarding the dosage and frequency of the different medications, the nurse should recognize these findings as an indication of poly pharmacy. Poly pharmacy occurs when patients take too many drugs, some of which may be duplicates or may interact with other drugs, especially when prescriptions are from multiple physicians

Question 54

Which of the following is the MOST common cause of upper GI bleeding?

1. Neoplasm
2. Peptic ulcer disease
3. Post-procedural trauma
4. Esophageal varices

Answer 54

2

The most common cause of Upper GI bleeding is peptic ulcer disease (about 50%) while the most common cause of lower GI bleeding is diverticulosis (about 50%). Symptoms of upper GI bleeding include epigastric pain and hematemesis. Melena may occur with both upper and lower GI bleeding but is most common with upper GI. Treatment varies depending on the cause, but those who are hemodynamically unstable require immediate resuscitation to maintain adequate blood pressure while the patient is being typed and cross-matched for transfusions

Question 55

The nurse is teaching a patient to care for a PEG feeding tube. Which of the following should the nurse advise the patient to do to avoid dumping syndrome?

1. Administer refrigerated formula
2. Increase rate of instillation
3. Stay in semi-Fowler’s position for one hour after feedings
4. Increase volume of water used to flush tube before and after feedings

Answer 55

3

When teaching a patient to care for a PEG feeding tube the gerontological nurse should tell the patient that, in order to prevent dumping syndrome, the patient should stay in semi-Fowler’s position for one hour after feedings as this slows transit time by decreasing the force of gravity. Additionally, formula should be instilled slowly and at room temperature. Small volumes of water should be used to flush the tubing before and after feedings because diluted formula has a faster transit time. Continuous drip also results in less incidence of dumping syndrome than bolus administration

Question 56

The Health Insurance Portability and Accountability Act (HIPAA) regulates which of the following?

1. Rights of the individual related to privacy of health information
2. Transfer of patients from one facility to another
3. Medical trials
4. Workplace safety

Answer 56

1

HIPAA regulations are designed to protect the rights of individuals regarding the privacy of their health information. The nurse must not release any information or documentation about a patient’s condition or treatment without consent. The individual has the right to determine who has access to personal information—which is considered protected health information (PHI)—including health history, condition, treatments in any form, and any documentation. Personal information can be shared with a spouse, legal guardians, and those with durable power of attorney

Question 57

A 69-year-old patient is learning to care for a colostomy but is quite tense and becomes confused about the sequence of actions required. Which of the following is the MOST appropriate teaching strategy?

1. Teach a family member or caregiver to do colostomy care
2. Break the tasks into small steps and teach sequentially
3. Review the entire procedure 3 or 4 times before patient participates
4. Suggest patient try to relax and concentrate

Answer 57

2

If a 69-year-old patient is learning to care for a colostomy but is quite tense and becomes confused about the sequence of actions required, the most appropriate teaching strategy is to breaks the tasks into small steps and teach sequentially. When the patient becomes adept at one step, the patient can begin to learn the next. When patients are ill and stressed, learning can be difficulty and procedures. Such as colostomy care, can seem overwhelming

Question 58

A patient complains of a history of nausea and burning and stabbing epigastric pain, relieved for short periods by antacids or intake of food, and a urea breath test is positive. These findings MOST LIKELY indicate which of the following?

1. Esophagitis
2. Gastritis and Salmonella infection
3. Reflux
4. Duodenal ulcer and Helicobacter pylori infection

Answer 58

4

These symptoms are consistent with a duodenal ulcer, and the positive urea breath test indicates a Helicobacter pylori infection, which is usually treated with a proton pump inhibitor plus Clarithromycin and amoxicillin/metronidazole. About 90% of duodenal ulcers are associated with H.pylori infection. H.pylori weakens the mucosa and results in hypersecretion of gastric acid. Eating may increase pain with gastric ulcers but usually relieves pain with duodenal ulcers. Smoking increases the risk of peptic ulcer disease, and use of NSAIDs increases risk of serious complications such as bleeding or perforation

Question 59

A 60-year-old male has had yearly negative fecal occult blood tests for 10 years. How frequently should the patient have a colonoscopy?

1. Every year
2. Every 5 years
3. Every 10 years
4. Every 2 years until age 70

Answer 59

3.

Every 10 years. Screening should begin at age 50 or those with average risk at age 40 with increased risks. Screening tests include:

1. Colonoscopy - every 10 years. Or as follow-up for abnormalities in other screening: Allows for removal of polyps, small cancerous lesions, and biopsies and provides surveillance of inflammatory bowel disease
2. Fecal occult blood - yearly: checks for blood in stool
3. Flexible sigmoidoscopy - every 5 years: scope checks for polyps or signs of cancer in rectum and lower third of colon
4. Double contrast barium enema - every 5 years: X-ray with contrast to visualize intestinal abnormalities

Question 60

Which of the following is a long double-lumen tube inserted into the small intestine for drainage and decompression?

1. Salem sump
2. Miller-Abbott
3. Cantor
4. Levin

Answer 60

2

Miller-Abbott is a long double-lumen tube inserted into the small intestine for drainage and decompression. The Salem-sump tube is also double lumen but is short and contains a small vein tube within the larger tube to help reduce pressure at the distal eyes to less than 24mmHg in order to prevent tissue damage. The Cantor tube is a single lumen tube that contains an inflatable balloon at the distal end to prevent the tube from migrating. The Levin tube is a single lumen tube with a solid end

Question 61

A patient has had severe watery diarrhea and vomiting for 48 hours. Which electrolyte imbalance is MOST LIKELY to occur?

1. Hypernatremia
2. Hyponatremia
3. Hypercalcemia
4. Hypocalcemia

Answer 61

2

The electrolyte imbalance that is likely to occur with persistent vomiting and diarrhea is hyponatremia. Gastric and intestinal fluids contains high levels of sodium can become depleted with nausea and diarrhea. Hyponatremia is a sodium level of less than 135mEq/L. This type of Hyponatremia resulting from hypovolemia is characterized by dry mucous membranes, orthostatic hypotension, tachycardia and poor skin turgor. The patient may appear weak, stuporous, confused and/or lethargic

Question 62

Most absorption of nutrients occurs in which of the following?

1. Stomach
2. Duodenum
3. Jejunum and ileum
4. Large intestine

Answer 62

3

Most absorption of nutrients occurs in the small intestine, in the jejunum and ileum. The digestive process starts in the mouth as saliva and chewing begin to break down the food that then enters the esophagus and travels to the stomach, where the food is further mixed and broken down by the addition of acids and enzymes. This process continues in the duodenum with most absorption of nutrients occurring in the small intestine. Fluid continues to be absorbed in the large intestine

Question 63

Which of the following types of laxatives/cathartics is the MOST recommended for chronic constipation?

1. Stimulant
2. Lubricant
3. Emollient/wetting
4. Bulk-forming

Answer 63

4

Bulk-forming products, such as psyllium (Metamucil), methycellulose (Citrucel) and polycarbophil (Fibercon) are generally the drugs of choice for chronic constipation because they increase absorption of fluid in the stool, helping increase mass, soften stool, and stimulate peristalsis. Bulk-forming products have few adverse effects and are less irritating to the intestines than other preparations. However, if fluid intake is inadequate, bulk formers can cause obstruction, so they should be avoided with patients who are dehydrated or on fluid restriction

Question 64

How long after PEG is performed is the tract usually mature and well-healed enough for placement of a balloon gastrostomy (G-tube)?

1. 4 to 7 days
2. 2 to 4 weeks
3. 1 to 2 months
4. 3 to 4 months

Answer 64

2

The tract of the PEG usually matures and heals within 2 to 4 weeks. Once the tract has healed, the original PEG tube can generally be replaced with a balloon gastrostomy tube. Gastrostomy tubes with an internal balloon or mushroom tip, measure markings, and an external disk are easier to stabilize, but internal devices should be checked daily by gently pulling until resistance is felt. External stabilizing devices can be applied to the skin to hold the tube in place. The tube may also be taped to the abdomen or secured with a binder

Question 65

Which of the following is the correct response if, in the initial period after surgery for a colostomy, the stoma appears dull and blue-tinged?

1. Notify the physician
2. Observe for further changes
3. No response needed, as this is a normal finding
4. Provide patient with nasal oxygen

Answer 65

1

While the stoma may be edematous in the initial postoperative period, it should appear red to pink, shiny and moist, indicating adequate oxygenation and healthy tissue. If the stoma appears dull and cyanotic (blue to purple to brown/black if the tissue becomes necrotic), the physician should be notified immediately because reoperation to increase blood flow to the tissue may be indicated. The stoma should be assessed for circulatory impairment on a regular schedule after surgery

Question 66

When irrigating a Kock pouch to improve drainage postoperatively, what is the maximal amount of fluid that should be instilled at one time?

1. </= 1000mL
2. </= 500mL
3. </= 100mL
4. </= 40mL

Answer 66

4

The Kock pouch may need to be irrigated postoperatively to promote drainage because of the accumulation of mucus. Also, once the patient begins to eat, drainage may slow, requiring irrigation. Up to 1000mL total of solution (usually tap water) may be needed to flush the pouch but only 30-40mL of fluid should be instilled at one time as the capacity of the pouch is small. The instilled fluid should be drained completely before doing another instillation and the patient observed carefully for abdominal discomfort

Question 67

How soon after collection must an Unpreserved stool be tested for ova and parasites?

1. 30 minutes
2. 60 minutes
3. 2 hours
4. 4 hours

Answer 67

3

Unpreserved stool must be tested for ova and parasites within 2 hours of collection (The same is true for most tests with Unpreserved stool.) However, the stool may be placed in liquid transport media with preservative, such as orange Cary-Blair container, and tested within 14 days for ova and parasites or cultured. WBC count must be carried out on Unpreserved stool. Testing for rotavirus must also be carried out on Unpreserved stool immediately after collection

Question 68

What of the following is the MOST LIKELY cause when a patient with an ileo-anal pouch develops a sudden increase in the frequency of stools as well as bloody diarrhea, fever, and fecal incontinence?

1. Peritonitis
2. Pouchitis
3. Anastomotic leak
4. Fistula formation

Answer 68

2

Increased frequency of stools, bloody diarrhea, fever and fecal incontinence are signs of pouchitis, non-specific inflammation of the pouch. Although the cause is not known, pouchitis may indicate undiagnosed regional enteritis (Crohn’s disease) in some patients although it is more common in patients with ulcerative colitis. Pouchitis is most common in the first two years after surgery. Pouchitis usually responds rapidly to metronidazole, and this helps to differentiate the condition from others that may cause similar symptoms

Question 69

When checking aspirant for a J-PEG tube, which pH value is consistent with possible gastric migration?

1. 0 to 4
2. > 6
3. <6
4. > 7.5

Answer 69

1

The pH of gastric fluids is usually 0 to 4, so this finding may indicate proximal migration of the J-tube. The pH in the small intestine is usually less than 6 while a higher pH such as >7.5 may indicate pulmonary migration. A marked increase in intestinal residual volume may indicate migration. If that occurs, then feedings should be held for at least an hour before pH testing is done. Gastric aspirant is usually curdled and clear to white while intestinal aspirant may be brownish/greenish because of bile staining

Question 70

Which of the following is the first goal of management of enterocutaneous fistula?

1. Control fluid and electrolyte balance
2. Initiate Parenteral nutrition
3. Decrease discharge
4. Complete surgical repair

Answer 70

1

The initial goal of enterocutaneous fistula management is to control fluid and electrolyte imbalance. Dehydration is frequent with high-output fistulae, and patients may develop Hyponatremia and hypokalemia with metabolic acidosis. Parenteral nutrition, if necessary, should be initiated after the fluid/electrolyte balance is re-established. Up to 90% of patients with enterocutaneous fistulae develop malnutrition, and if patients are unable to obtain adequate nutrition orally, then enteral or Parenteral feedings may be indicated, depending on the site of the fistula

Question 71

Which of the following complications outside of the gastrointestinal tract is MOST common with patients with inflammatory bowel disease?

1. Osteoporosis
2. Fibromyalgia
3. Migraines
4. Anemia

Answer 71

4

The complication that is most common outside of the gastrointestinal tract with patients with inflammatory bowel disease is anemia. Patient’s often have poor nutritional status with inadequate protein and iron in their diets and may have blood loss associated with lesions. Osteoporosis is also a common finding, and some patients have experienced other disorders such as interstitial cystitis, fibromyalgia, and migraines. Those with Crohn’s disease often have inflammation of joints and eyes

Question 72

How far away from the skin surface should external fixation device of a PEG tube be placed to prevent buried bumper syndrome?

1. 1 to 2 cm
2. 2 to 3 cm
3. 4 to 5 cm
4. Flush with the skin

Answer 72

1

The external fixation device of a PEG should be place 1 to 2cm above the skin surface to prevent excessive tension that may result in buried bumper syndrome in which the internal fixation device become lodged in the mucosal lining of the gastric wall, resulting in ulceration. Rotating the PEG tube also helps to prevent BBS. Typical symptoms of BBS include increasing abdominal pain and difficulty infusing the feeding solution. If BBS occurs, the PEG must be replaced

Question 73

When inserting a balloon replacement gastrostomy tube, in which of the following positions should the nurse place the patient?

1. Flat supine
2. Head of bed elevated 30 degrees
3. Head of bed elevated 45 degrees
4. Head of bed elevated 60 degrees

Answer 73

2

Insertion of balloon replacement gastrostomy tube:

1. Gather supplies, position patient to 30 degrees
2. Inject 20ml sterile water into balloon port to check leaks, withdraw water and retain filled syringe
3. Move external disk to near distal end and catheter tip
4. Cleanse peristalsis area with NS in spiral movement. Dry skin
5. Insert tube gently to pre-measured distance and inflate balloon
6. Gently pull tube until resistance is met. Slide external bumper to 1.5cm from skin surface
7. Rotate tube in circular motion to ensure free rotation
8. Use 30-60ml syringe to aspirate gastric content. Flush tube with water
9. Apply barriers and mark exit measurement

Question 74

Which of the following is a legal document that specifically designates someone to make decisions regarding medical and end-of-life care if a patient is mentally incompetent?

1. Advance directive
2. Do-not-resuscitate order
3. Durable power of attorney
4. General power of attorney

Answer 74

3

A durable power of attorney is the legal document that designates someone to make decisions regarding medical and end-of-life care if a patient is mentally incompetent. This is a type of advanced directive, which can also include living wills or specific requests of the patient regarding treatment. A do-not-resuscitate order indicates the patient does not want resuscitative treatment for terminal illness or condition. A general power of attorney allows a designated person to make decisions for a person over broader areas, including financial

Question 75

A 30-year-old patient with Crohn’s disease is disabled and uninsured because of illness but unable to afford medications to control the disease. Which of the following is the MOST LIKELY source of financial assistance

1. Medicaid
2. Drug companies
3. Community agency
4. Salvation Army

Answer 75

1

If a 30-year-old patient with Crohn’s disease is disabled and uninsured because of illness but unable to afford medications to control the disease, the most likely source of financial assistance is Medicaid. Medicaid is a joint program of federal and state governments, so eligibility criteria may vary from state to state, but Medicaid provides medical benefits, including the costs of drugs, to people with low income. People with disabilities, which can include Crohn’s disease, are in one of the categories eligible to apply for Medicaid

Question 76

With cardiac arrest, immediate defibrillation is indicated for which of the following?

1. Pulseless electrical activity (PEA)
2. Asystole
3. Ventricular fibrillation/tachycardia (VF/VT)
4. All cardiac abnormalities

Answer 76

3

With cardiac arrest, immediate defibrillation is indicated for ventricular fibrillation and ventricular tachycardia (VF/VT) but is not indicated for pulseless electrical activity (PEA) or asystole because these conditions do not respond. Adrenaline (Epinephrine) (IV 1mg) and vasopressin (40 units) may be repeatedly administered with PEA, asystole, or VF and when two shocks have been unsuccessful. For VF/VT immediate defibrillation should be carried out, followed by CPR for 2 minutes and repeat defibrillation if necessary

Question 77

A patient is scheduled the next day for an abdominal ultrasound to evaluate the liver, pancreas, and bile ducts. Which of the following preparations does the nurse anticipate?

1. No special preparations
2. Fat-free dinner and NPO after midnight
3. Drink 6 glasses of water 60 minutes before the ultrasound
4. NPO after midnight

Answer 77

2

If the patient is scheduled the next day for an abdominal ultrasound to evaluate the liver, pancreas, and bile ducts, the nurse anticipates that the patient will be advised to have a fat-free dinner the evening before and be NPO after midnight. Ultrasound is a non-invasive technique that utilizes high-frequency sound waves to create images (size, shape, contours, consistency) of internal structures. These images are viewed on a monitor during the procedure

Question 78

A 70-year-old patient has advance gastric carcinoma. Which of the following criteria makes the patient eligible for hospice care?

1. The patient has stopped curative treatments but life expectancy is unclear
2. The patient continues curative treatment and life expectancy is 4 months
3. The patient has only palliative care and life expectancy is 12 months
4. The patient has stopped curative treatments and life expectancy is 6 months

Answer 78

4

A 70-year-old patient with advanced gastric carcinoma who has stopped curative treatments and has life expectancy of 6 months or less meets the criteria for Hospice care. Patients under hospice care are allowed palliative treatment to relieve pain, nausea, and other discomforts. Disease specific requirements include AIDS, cancer, liver disease, dementia, kidney disease, cardiac disease, stroke, and neurological disorders. Hospice benefits include medications (to control symptoms), medical equipment, nursing assessment, respite care (up to 5 days) and part-time aides

Question 79

Which of the following is the MOST common site for obstructions of the small intestine?

1. Duodenum
2. Jejunum
3. Ileum
4. Ileocecal junction

Answer 79

3

The most common site for obstruction of the small intestine is the ileum, usually associated with adhesions (70%) with the rest caused by hernias, IBS (which can result in strictures), or malignancies. Over 90% of patients who undergo abdominal surgery eventually develop adhesions. Obstructions of the colon are more likely to be associated with malignancies (60%). Diagnosis of small bowel obstruction is based on physical examination and symptoms and is typically confirmed with abdominal x-ray and/or CT scan

Question 80

Following cholecystectomy, a patient develops a paralytic ileus. Which of the following interventions dose the nurse anticipate?

1. Insertion of NG tube and decompression
2. Surgical intervention
3. Antibiotics and antispasmodics
4. Antibiotics and enteral feedings

Answer 80

1

If a patient who has undergone cholecystectomy develops paralytic ileus, the most likely intervention is insertion of an NG tube and decompression. Antibiotics are generally not indicated. If the patient has been receiving enteral feedings, they should be discontinued. IV resuscitation is indicated while the NG tube is in place and -replacement of electrolytes as needed (especially potassium). Diagnosis is usually confirmed with x-ray and/or CT scan and to rule out mechanical obstruction, which requires surgical intervention

Question 81

Which of the following acid-base disorders is MOST common with acute mesenteric ischemia?

1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic alkalosis
4. Metabolic acidosis

Answer 81

4

The acid-base disorder that is most common with acute mesenteric ischemia is metabolic acidosis. Other laboratory findings include increased WBC count, lactate, and amylase. Presenting symptoms usually include both abdominal pain and melena. Mesenteric ischemia, which can be caused by arterial hypoperfusion, impaired drainage of venous blood, or thrombosis, results in ischemia of the bowl and mild to severe damage of the tissue. In some cases, bowel ischemia can result from non-occlusive causes, such as impaired cardiac output (heart failure, cardiac arrest). In cases associated with occlusive causes, surgical repair is needed

Question 82

If bacteria, such as Escherichia coli, produce extended spectrum beta lactamase (ESBL), which of the following should the nurse anticipate?

1. The bacteria will respond rapidly to antibiotics
2. The bacteria will be resistant to multiple antibiotics
3. The bacteria will become neutralized
4. The bacteria will mutate into a more virulent form

Answer 82

2

If bacteria, such as Escherichia coli, produce extended spectrum beta lactamase (ESBL), the nurse should anticipate that the bacteria will be resistant to multiple antibiotics. The enzymes produced are able to destroy active ingredients found in antibiotics, such as cephalosporins and beta lactamases. ESBLs were first detected in the 1960s in Greece and in 1988 in the US. ESBLs have been associated with diarrhea, skin infections, pneumonia, UTIs, and sepsis. Most ESBL-bacteria respond to carbapenemase at present although CREs pose an increasing threat

Question 83

Which of the following forms of anesthesia is MOST commonly used when a patient requires removal of a foreign object from the rectum?

1. Benzodiazepine and opioid
2. Perianal block
3. Topical lidocaine
4. General anesthesia

Answer 83

1

The form of anesthesia that is most commonly used when a patient requires removal of a foreign object from the rectum is a benzodiazepine to relax the patient and an opioid for pain control. Objects can generally be removed in the ED if they are within 10cm of anus and palpable by digital exam. Patients are usually placed in lithotomy position. An anal or vaginal speculum may be needed to facilitate removal. If an object cannot be safely removed, surgical intervention may be needed.

Question 84

Which of the following is the MOST common positioning for a patient who is undergoing a rigid sigmoidoscopy for a sigmoid volvulus?

1. Lithotomy
2. Prone, knee-chest
3. Left lateral (sims)
4. Right lateral

Answer 84

3

The most common positioning for a patient who is to undergo a rigid sigmoidoscopy for a sigmoid volvulus or other purpose is the left lateral (Sims) position. The patient’s hips should slightly extend beyond the edge of the table, and the patient’s knees should be flexed. A small sandbag is often placed under the left hip. Rigid sigmoidoscopy is usually carried out with sedation, but must be preceded by a digital rectal exam. Rigid sigmoidoscopy is contraindicated with anal stenosis or bowel perforation

Question 85

If a patient has received midazolam for an endoscopic procedure, how soon after administration does the peak effect occur?

1. 60 seconds
2. 3 to 5 minutes
3. 5 to 8 minutes
4. 10 minutes

Answer 85

2

If a patient has received midazolam for an endoscopic procedure, the peak effect occurs within 3 to 5 minutes with duration of 1 to 3 hours. Romazicon (Flumazenil) may be administered as a reversal agent. The narcotic usually administered with midazolam is fentanyl with peak effect occurring within 5 to 8 minutes and the same 1 to 3 hour duration. Naloxone (Narcan) may be administered as a reversal agent

Question 86

A patient is to receive antibiotic prophylaxis for placement of PEG tube. When should the antibiotic be administered?

1. 30 minutes before the procedure
2. During the procedure
3. Immediately after the procedure
4. Within 60 minutes after the procedure

Answer 86

1

If a patient is to receive antibiotic prophylaxis for placement of PEG tube, the antibiotic should be administered 30 minutes before the procedure begins. All patients who are to have PEG placement should receive antibiotic prophylaxis. The most commonly administered prophylaxis is ampicillin (2g) and gentamicin (1.5mg/kg) unless the patient has an allergy to penicillin. In that case, vancomycin (1g) may be administered as an alternative

Question 87

According to Health.gov recommendations for fiber intake, how many grams of fiber should be consumed for each 1000 calories?

1. 10
2. 14
3. 20
4. 24

Answer 87

2

According to health.gov recommendations for fiber intake, 14 grams of fiber should be consumed for each 1000 calories. High fiber foods include beans, lentils, fruit, Brussels sprouts, spinach, corn, sweet potatoes, and whole grain breads and cereals. Some fiber (soluble) dissolves into a viscous gel and other fiber (insoluble) acts like a sponge and soaks up water. Fiber helps to slow gastric emptying, promote a sense of fullness, increase bulk in the stool, and prevent constipation

Question 88

Within 90 seconds of receiving midazolam for an endoscopic procedure, the patient exhibits sighs of anaphylaxis with bronchospasm and severe hypotension. Which of the following is the correct INITIAL emergent response?

1. Administer epinephrine
2. Administer antihistamine
3. Administer corticosteroid
4. Administer romazicon (Flumazenil)

Answer 88

1

If, within 90 seconds of receiving midazolam for an endoscopic procedure, the patient exhibits signs of anaphylaxis with bronchospasm and severe hypotension, the correct initial emergent response is to administer epinephrine. The usual SQ/IM dosage is 0.1%(1:1000) and IV dosage is 0.01% (1:10000). If administered IM, the vastus lateralis muscle of the thigh is the preferred site. Additional medications include albuterol (inhaled), antihistamine (diphenhydramine) corticosteroid and H1 and H2 blockers (Famotidine)

Question 89

A stool specimen to test for clostridium difficile may be held under refrigeration prior to testing for how long?

1. 4 hours
2. 24 hours
3. 3 days
4. 5 days

Answer 89

4

A stool specimen to test for clostridium difficile may be held for 24 hours at room temperature or 5 days under refrigeration at 2 degrees to 8 degrees Celsius. The specimen must remain unpreserved and needs to be very soft, liquid or semi-liquid. Testing cannot be carried out if the stool is hard or formed because the amount of toxin present in the stool is minimal. Additionally, if the patient is infected with C.diff, the patient likely has 3 or more liquid stools daily

Question 90

The esophageal pH probe is usually left in place for what duration of time?

1. 4 hours
2. 12 hours
3. 24 hours
4. 36 hours

Answer 90

3

The esophageal pH probe is usually left in place for 24 hours. It is inserted nasally and attached to a monitor that continually assesses acidity. In some cases, a 48-hour probe is used. This 48 hour probe has a smaller monitor attached to a catheter and is placed at the distal portion of the esophagus. It sends acidity recordings wirelessly to a recorder worn on the body and automatically detaches and passes through the intestinal tract after 48 hours

Question 91

Once a rubber band ligation is carried out for a second-degree hemorrhoid, within how many days does the tissue usually slough off?

1. One day
2. 1 to 3 days
3. 3 to 5 days
4. 7 to 14 days

Answer 91

4

Once a rubber band ligation is carried out for a second-degree hemorrhoid, the tissue usually sloughs off within about 7-14 days. The band is placed about the base of the hemorrhoid, effectively cutting off circulation to the hemorrhoid. Most people experience mild pain/discomfort and may have slight bleeding. However, a small risk of severe bleeding and sepsis exists. Patients should be advised to increase fiber to prevent constipation and to take a Sitz bath after defecation

Question 92

If using the FAITH mnemonic as a guide to a spiritual assessment, the H stands for which of the following?

1. Help
2. Hope
3. History
4. Health

Answer 92

1

If using the FAITH mnemonic as a guide to spiritual assessment, the H stands for Help:

F: is there a faith, religion, or spiritual belief important to you?
A: how does your belief system apply to your health?
I: what involvement do you have in a church or faith community
T: is your treatment affected by your spiritual beliefs?
H: what help can i give you with spiritual concerns?

Question 93

Which of the following is the MOST common reason for sexual dysfunction after an ileostomy/colostomy?

1. Nerve damage
2. Medications
3. Psychological inhibitions
4. Hormonal changes

Answer 93

3

The most common reason for sexual dysfunction after an ileostomy/colostomy is psychological inhibitions. The patient may fear rejection, odor, or spillage and may be unsure of how to broach the subject of the ileostomy/colostomy with a partner. Some patients find coping with the change in body image difficult. Patients often benefit from participating in a support group and from guidance in sexual matters. For example, patients may feel more comfortable wearing undergarments (boxer shorts, crotchless panties) during sexual activity

Question 94

Patients who have had bariatric surgery should generally limit total meal size to which of the following?

1. Less than one-half cup
2. Less than one cup
3. Less than one and a half cups
4. Less than two cups

Answer 94

2

Patient who have had bariatric surgery should generally limit total meal size to less than one cup and should eat 3 meals daily and 2 snacks of protein. The patient should avoid drinking liquids for 15 minutes before meals and 90 minutes after and should avoid liquids that contain calories (sodas, juices, wine/beer). Food choices should be high in nutrition. Patients should be advised to be aware of thirst and to observe urine for signs of dehydration

Question 95

If administering a bolus feeding of 400mL per a gastrostomy tube, the feeding should generally be given over which of the following durations?

1. 1 to 2 minutes
2. 3 to 8 minutes
3. 10 to 15 minutes
4. 20 to 30 minutes

Answer 95

3

If administering a bolus feeding of 400mL per a gastrostomy tube, the feeding should generally be given over 10 to 15 minutes per gravity (raising and lowering the container to control flow). The patient’s response can help to guide administration. If the patient feels suddenly full, the rate should be slowed. Intermittent feedings are usually administered on a regular schedule for about 30 minutes at a time.

Question 96

Following gastric surgery with removal of the pylorus, a patient develops bile reflux gastritis/esophagitis. Which of the following treatments is MOST indicated?

1. Cholestyramine (Questran)
2. Famotidine (Pepcid)
3. Metoclopramide (Reglan)
4. Cimetidine (Tagamet)

Answer 96

1

If, following gastric surgery with removal of the pylorus, a patient develops bile reflux gastritis/esophagitis, the treatment that is most indicated is Cholestyramine (questran). Cholestyramine binds bile acids in the intestines and causes them to be excreted in the feces. Cholestyramine may decrease absorption of numerous drugs/substances (including beta blockers, corticosteroid, fat-soluble vitamins, thiazides, penicillin, and thyroid hormones), so these drugs must be administered 1 hour prior to Cholestyramine or 4 hours after.

Question 97

Which of the following is a cause of exudative diarrhea?

1. Bacterial toxins
2. Intestinal hemorrhage or pancreatic impairment
3. Decreased serum albumin
4. Radiation or chemotherapy

Answer 97

4

Diarrhea:

1. Exudative —radiation and chemotherapy
2. Infectious —infectious agents, such as Clostridium difficile
3. Malabsorptive —decreased serum albumin
4. Osmotic —intestinal hemorrhage, pancreatic impairment, and lactose intolerance
5. Secretory —bacterial toxins and neoplasms

Question 98

In order to prevent contracting an Escherichia coli infection from eating contaminated meat, all ground beef should be cooked to at least which of the following temperatures?

1. 145 F
2. 160 F
3. 175 F
4. 190 F

Answer 98

2

In order to prevent Escherichia coli infection from eating contaminated meat, all ground beef should be cooked to at least 160F, and the temperature should be verified by thermometer as appearance may vary. Raw meats should always be kept separate from other foods, and dairy products and juices should be pasteurized. Fruits and vegetables should be washed under clean running water. Alfalfa sprouts can harbor E.coli, so children under 5, older adults, and patients who are immunocompromised should avoid eating them

Question 99

A hospitalized patient with persistent watery diarrhea is to use the Flexi-seal Fecal Management System. Which of the following is the correct procedure after the cuff is inserted into the rectum?

1. Gently tug on the device to automatically inflate the cuff
2. Use a syringe to withdraw air from the cuff
3. Use a syringe to fill with 45 mL of air
4. Use a syringe to fill with 45 mL of water

Answer 99

4

After the cuff of the Flexi-seal Fecal Management System is inserted into the rectum, the nurse should use a syringe to fill the cuff with 45mL of water. Procedure:

1. Don PPI, place patient in left lateral knee-chest position, and connect catheter to the bag
2. Withdraw air from cuff with syringe
3. Flatten cuff and fold in half, lubricate
4. Insert cuff into rectum and fill cuff with 45mL water with syringe to inflate the balloon end of the cuff
5. Gently tug the cuff into position to seal the rectum

Question 100

Which of the following complications is MOST LIKELY to occur with ulcerative colitis?

1. Abscess
2. Fistula
3. Fissure
4. Obstruction

Answer 100

1

The complication that is most likely to occur with ulcerative colitis is abscess. Abscesses form as tissue ulcerates and becomes inflamed; however, because the disorder involves the superficial mucosa and is not transmural, fistulas, fissures and obstructions (common with Crohn’s disease) usually do not occur. Inflammation generally begins in the rectum and spreads proximally throughout the colon. Patients tend to experience periods of remission and exacerbation, and symptoms may be mild, severe, or fulminant

Question 101

Patients with celiac disease must be advised to avoid foods that contain which of the following?

1. Lactose
2. Purines
3. Gluten
4. Food additives

Answer 101

3

Patients with celiac disease must be advised to avoid food that contain gluten, which is a protein that is found in various grains, such as rye, barley, and wheat. Patients should eat oat products only if they are labeled as gluten-free because they may be contaminated by wheat products during processing in some facilities. Many processed foods and liquids (such as soups, beer, candy, processed meats) contain hidden gluten. Additionally, some medications utilize gluten-containing binding agents

Question 102

Which of the following ethnic groups have the highest prevalence of ulcerative colitis?

1. African Americans
2. Middle Easterners
3. Asians and Hispanics
4. Caucasians and Ashkenazi Jews

Answer 102

4

The ethnic groups with the highest prevalence of ulcerative colitis are caucasians and Ashkenazi (European) Jews. While the cause of ulcerative colitis is not clear, a genetic predisposition appears to play a role as family history is a risk factor. Studies have shown that patients with inflammatory bowel disease, such as ulcerative colitis and Crohn’s disease, are also at increased risk of developing autoimmune disorders, such as multiple sclerosis and arthritis.

Question 103

A 40-year-old patient with a history of Chagas’ disease reports increasing dysphagia, cough, regurgitation, drooling, and heartburn. Which of the following is the MOST LIKELY cause?

1. GERD
2. Gastric ulcer
3. Mega esophagus
4. Esophagitis

Answer 103

3

If a 40-year-old patient with a history of Chagas’ disease reports increasing dysphagia, cough, regurgitation, drooling, and heartburn, the most likely cause is megaesophagus, resulting from destruction of neurons. Patients usually exhibit symptoms between ages 20 and 40 and may also have hypertrophy of the salivary glands, resulting in drooling because of excess saliva. Patients may also develop mega colon, which can lead to fecal impaction and bowel obstruction because of lack of motility.

Question 104

Which of the following is the drug of choice to treat Giardia infection?

1. Metronidazole
2. Iodoquinol
3. Tetracycline
4. Diloxanide furoate

Answer 104

1

The drug of choice to treat Giardia infection is metronidazole (250mg TID for 5 to 7 days). Giardia often contaminates water sources and spreads easily from person to person through fecal contact. Symptoms include abdominal pain/cramping, diarrhea (greasy stools), nausea, and vomiting. Patients often experience weight loss and have persistent symptoms for up to 3 weeks, and some people develop a chronic form of infection that can last for months or years

Question 105

Which of the following is the MOST common test for pinworms?

1. Stool specimen
2. Cellophane test
3. Antibody test
4. C-reactive protein

Answer 105

2

The most common test for pinworms is the cellophane test in which tape is touched to the perianal area several times and then examined under a microscope for eggs. This test has sensitivity of about 90%. The test should be done for 3 days in a row and when the patient first awakens in the morning. Stool specimens are usually negative because only about 5% of those infected have eggs in the stool

Question 106

For moderate sedation, ASA guidelines require monitoring of which of the following?

1. ECG and pulse oximetry
2. EEG
3. ECG
4. Capnography and pulse oximetry

Answer 106

4

For moderate sedation (AKA conscious sedation) ASA guidelines require monitoring of capnography and pulse oximetry. Level of consciousness should be assessed at least every 5 minutes and supplemental oxygen provided unless otherwise contraindicated. Resuscitative equipment and reversal agents (Flumazenil and naloxone) must be available and a person trained in assessment and use available. During the recovery period after the procedure oxygenation, ventilation and circulation should be monitored every 5 to 15 minutes

Question 107

Which of the following is the primary reason for liver transplants?

1. Hepatitis A
2. Hepatitis B
3. Hepatitis C
4. Hepatitis D

Answer 107

3

The primary reason for liver transplants is hepatitis C, which markedly increases risk of liver failure and hepatic cancer. Hepatitis C is spread through contact with blood or items contaminated with blood (shared needles, improperly sterilized equipment) and through sexual contact, tattooing, and piercing. No vaccine is available but antiviral treatments are available and up to 90% effective. Those with hepatitis C must avoid use of alcohol as it may cause progression of the disease.

Question 108

Which of the following is the MOST. Common carbapenem-resistant Enterobacteriaceae (CRE) is the United States?

1. Klebsiella pneumoniae carbapenemase (KPC)
2. New Delhi Metallo-beta-lactamase (NDM-1)
3. Verona Integron-Mediated Metallica-beta-lactamase (VIM)
4. Escherichia coli carbapenemase (ECC)

Answer 108

1

The most common carbapenem-resistant Enterobacteriaceae (CRE) in the United States is Klebsiella pneumoniae carbapenemase (KPC). New Delhi Metallo-beta-lactamase (NDM-1) is found in Pakistan and India. Escherichia coli carbapenemase (ECC), an increasing concern, is found in the Middle East, South American, India, and Southeast Asia. Verona Integron-Mediated Metallo-beta-lactamase (VIM) is found in Southern Europe. Southeast Asia, and scattered cases (Indiana) in the US

Question 109

When examining the abdomen for bowel sounds, for how long should the nurse auscultate before determining bowel sounds are absent?

1. 1 minute
2. 2 minutes
3. 3 minutes
4. 5 minutes

Answer 109

4

When examining the abdomen for bowel sounds, the nurse should auscultate for five minutes before determining that bowel sounds are absent. Most commonly, bowel sounds are heard 5 to 30 times a minute, usually heard best in the RLQ. Abnormal bowel sounds are classified as hyperactive (loud, high-pitched, gurgling), hypoactive (diminished) or absent (silent). Hyperactive sounds are associated with mechanical bowel obstruction (early), diarrhea, gastroenteritis, and use of laxatives. Hypoactive sounds are associated with peritonitis, and paralytic ileus and late obstruction

Question 110

A patient who has recently had formation of an ileostomy suffers from disturbed body image. Which of the following is the BEST nursing interventions?

1. Avoid discussing the colostomy
2. Encourage the patient to verbalize feelings
3. Focus on the positives
4. Provide information about colostomy care

Answer 110

2

If a patient who has recently had formation of an ileostomy suffers from disturbed body image, the best nursing intervention is to encourage the patient to verbalize feelings. The nurse must remain supportive and allow the patient to progress ant his/her own speed in viewing and learning to care for the ileostomy. Some patients may benefit from counseling if their body image issues do not resolve or if they worsen

Question 111

A male patient complains of decreased libido and increasing erectile dysfunction. Which of the following OTC drugs/supplements may be contributing?

1. Cimetidine (Tagamet)
2. Vitamin D
3. Acetaminophen
4. Docusate

Answer 111

1

H2 blockers, such as cimetidine (Tagamet), may decrease libido and increase erectile dysfunction, especially if taken in high doses or frequently during the day. These adverse effects tend to be worse with cimetidine than with other H2 blockers, so the patient may benefit from switching to a different drug or adjusting dosage. The nurse should question the patient about frequency of use and dosage of the drug and encourage the patient to discuss these issues with the physician.

Question 112

Which of the following disinfectants can provide high-level disinfection?

1. Isopropyl alcohol 70%
2. Sodium hypochlorite 6.15%
3. Glutaraldehyde 2%
4. Iodophor germicidal detergent

Answer 112

3

Glutaraldehyde 2%, hydrogen peroxide 7.5%, ortho-phthaladehyde (OPA), as well as various hydrogen peroxide/ peracetic acid combinations can provide high-level disinfection with 12 to 30 minutes of exposure. Manufacturer’s recommendations for dilution and use must be followed carefully. Isopropyl and ethyl alcohol (70-99%), iodophor germicidal detergent, and sodium hypochlorite 5.25-6.15% can be used for intermediate and low-level disinfection at greater than 1 minute exposure

Question 113

Which of the following is the primary treatment for a norovirus infection?

1. Antibiotics
2. Antivirals
3. Antiemetics and antidiarrheals
4. Supportive care and fluids

Answer 113

4

The primary treatment for norovirus infection is supportive care and fluids. Symptoms generally include diarrhea and vomiting with symptoms persisting for 1 to 3 days. Most people do not require treatment, but if diarrhea or vomiting is severe, an antiemetic or antidiarrheal may be prescribed if the patient is younger that 65. If severe dehydration occurs, the patient may require intravenous fluids until able to resume adequate oral intake

Question 114

In which of the following parts of the bowel are fats, proteins, and carbohydrates absorbed?

1. Jejunum
2. Duodenum
3. Ileum
4. Throughout the small bowel

Answer 114

1.

Almost all nutrients are absorbed by the small intestines, with the majority absorbed in the jejunum although some nutrients are absorbed at different parts of the small intestine:

1. Jejunum: Sodium, chloride, fats, proteins, and carbohydrates
2. Ileum: Bile salts and vitamin B-12
3. Duodenum: Iron
4. Throughout the small bowel: Magnesium, phosphate, water, lipids, and potassium

Following a meal, residual wastes travel through the gastrointestinal tract and reach the terminal ileum within about 4 hours. Once in the large intestine, fluid and electrolytes continue to be absorbed and the stool thickens

Question 115

If a patient has persistent dyspepsia/indigestion, which type of food is likely to cause the MOST discomfort?

1. Proteins
2. Carbohydrates
3. Fats
4. All cause similar reactions

Answer 115

3

While all foods can cause dyspepsia/indigestion, fatty foods usually cause the greatest discomfort because they are digested more slowly and stay in the stomach for a longer period of time. Patients with chronic dyspepsia may benefit from a low-fat diet. Some foods (spicy food, lettuce, gas producing vegetables) may also result in increased discomfort. About a fourth of adults experience some degree of dyspepsia, which may include heartburn, bloating, feeling of fullness and belching

Question 116

If assisting with an endoscopic procedure, which of the following PPE should the nurse expect to wear?

1. Gown and gloves
2. Gown, gloves and face mask
3. Gown, gloves, and eye guard
4. Full surgical attire

Answer 116

4

If assisting with an endoscopic procedure, the nurse should expect to wear full surgical attire (gowns, gloves, face mask, eye guard or face shield, hair and foot coverings) as required by CMS. Since 2009, operating rooms and procedure rooms must function under the same guidelines for sterility although endoscopic procedures are generally not considered sterile procedures. However, because of a number of outbreaks associated with endoscopy (such as hepatitis C), more stringent standards are imposed.

Question 117

Which of the following is a common age-related change in the stomach?

1. Increased secretion of gastric acids
2. Decreased production of hydrochloric acid
3. Increased gastric motility and emptying
4. Increased secretion of digestive enzymes

Answer 117

2

A common age-related change in the stomach is decreased production of hydrochloric acid, which results in a slower digestive process. Motility slows and the stomach empties more slowly. The mucosal surface begins to atrophy and degenerate and other gastric acids and digestive enzymes decrease. As the person ages, these changes are likely to result in increased food intolerances and malabsorption (including decreased absorption of vitamin B-12

Question 118

What distance from the anus can a flexible sigmoidoscope examine?

1. 25cm/10 inches
2. 45-50cm/ 16-20 inches
3. 50-75cm/ 20-30 inches
4. 75-100cm/ 30-40 inches

Answer 118

2

The flexible sigmoidoscope can examine a 45 to 50cm/16 to 20 inches distance from the anus, compared to a rigid sigmoidoscope, which can examine only about 25cm/20 inches. Additionally, the flexible sigmoidoscope allows video and still images to be obtained. The rigid sigmoidoscope is used much less frequently with the advent of flexible sigmoidoscope although a rigid sigmoidoscope may be used along with a digital rectal exam for anal/rectal conditions

Question 119

During a gastroscopy, the patient becomes very faint and light-headed and experiences hypotension, bradycardia, and diaphoresis. Which of the following is MOST LIKELY the cause of these symptoms?

1. Vasovagal response
2. Aspiration
3. Over-sedation
4. Perforation

Answer 119

1

If during a gastroscopy a patient becomes faint and light-headed and experiences hypotension, bradycardia, and diaphoresis, the most likely cause of these symptoms is a vasovagal response, which results from stimulation of baroreceptors during the procedure. The patient may briefly lose consciousness during the episode. The sudden drop in blood pressure decreases blood flow to the brain for a brief period. These episodes are usually transient but may be prolonged with depression of the central nervous system from sedation.

Question 120

If a patient has a hiatal hernia, what information is important to prevent symptoms?

1. Avoid reclining for 30 minutes after meals
2. Use two pillows when sleeping
3. Eat small frequent meals
4. Take frequent antacids

Answer 120

3

If a patient has a hiatal hernia, important information to prevent symptoms (heartburn, reflux, dysphagia) includes eating small frequent meals and avoid reclining for at least an hour after meals or eating within two hours of bedtime. The head of the patient’s bed should be elevated on 4 to 8 inch blocks (pillows are not adequate). Medical treatments can include PPI and/or H2 blockers. Some patients may require surgical intervention if symptoms are severe

Question 121

If a chemical spill occurs, which of the following is the BEST initial resource to determine what actions to take?

1. Manufacturer’s hotline
2. Poison center
3. Supervisor
4. Material Data Safety Sheet (MDSS)

Answer 121

4

If a chemical spill occurs, the best initial resource to determine what actions to take is the Material Data Safety Sheet (MDSS), which must be on file for any chemical use. Spills are classified according to size:

1. Small: </=300mL
2. Medium: >300mL
3. Large: >5L

Question 122

Which of the following is the primary purpose of a “time-out” prior to beginning a procedure?

1. To ensure all members of the team are present
2. To prevent surgical/procedural errors
3. To help the team members relax
4. To remind team members of their responsibilities

Answer 122

2

The primary purpose of a “time-out” period prior to beginning a procedure is to prevent surgical/procedural errors. Before a designated team member calls for the time out, all team members who will participate must be present and must communicate. The entire team must agree that they have the correct patient, correct site, and correct procedure. If a patient is to have more than one procedure or team members change, additional time-outs must be called before proceeding.

Question 123

Which of the following is the correct method of administration of vedolizumab (Entyvio), a biologic drug used to treat IBS?

1. Bolus over 1 minute
2. Bolus over 5 minutes
3. Infusion over 15 minutes
4. Infusion over 30 minutes

Answer 123

4

The correct method of administration of vedolizumab (Entyvio) is by infusion over 30 minutes. The drug comes packaged in a powered form and must be reconstituted with 4.8mL of sterile water injected into the vial, which is then swirled to mix for 15 seconds and allowed to sit for 20-30 minutes to dissolve. The vial is then inverted three times and 5mL of solution withdrawn by sterile needle and syringe and injected into 250mL of sterile 0.9% NaCl or Lactated Ringer’s solution

Question 124

The nurse is to mix two medications in one syringe for administration and injects air into vial A and then vial B. Which of the following is the next step?

1. Obtain a new needle and syringe
2. Withdraw medication from vial A
3. Withdraw medication from vial B
4. Withdraw medication from either vial A or vial B

Answer 124

3

If the nurse is to mix two medications for administration and injects air into vial A and then vial B, the next step is to withdraw the medication from vial B while the needle remains in the vial. Once the first medication is obtained, then the needle is inserted into vial A and that medication withdrawn. It is important that the vials are not contaminated with medication from the opposite vial. Prior to mixing medications, a compatibility chart should be assessed to ensure that the two medications can be mixed

Question 125

Gastric aspirate must be neutralized with bicarbonate within which of the following durations after collection?

1. 30 minutes
2. 60 minutes
3. 4 hours
4. 8 hours

Answer 125

1

Gastric aspirate, obtained per an NG tube, must be neutralized with bicarbonate within 30 minutes of collection. For this reason, it is often collected in a special tube that contains bicarbonate. If not, the sample (generally 1mL but up to 5mL may be requested for suspected TB or fungal infections) must be transported to the laboratory immediately and the laboratory personnel alerted that the sample requires neutralization

Question 126

A 28-year-old woman who had gastric bypass surgery (Roux-en Y) experiences bloating, abdominal cramping, nausea, and vomiting within minutes after eating. Her typical meal consists of a small potato, 3 ounces of meat, half a slice of white bread, half a banana, a small piece of cake, and 8 ounces of sweetened iced tea. Which of the following is indicated as an initial treatment?

1. Acarbose to delay carbohydrate absorption
2. Octreotide to slow intestinal emptying
3. Increased protein, reduced carbohydrates, and avoiding drinking during meals
4. Decreased protein, increased carbohydrates, and a glass of juice or milk during meals

Answer 126

3

Dumping syndrome usually responds to a change in dietary habits and is most often caused by carbohydrate intake, so increasing protein, reducing carbohydrates, and avoiding drinking fluids with meals may relieve symptoms. Acarbose is sometimes used with late-onset dumping syndrome (occurring 1 to 3 hours after eating) if other methods are ineffective. Octreotide requires injections and is use only for intractable symptoms because of adverse effects, such as diarrhea, distention, and Cholelithiasis.

Question 127

Prior to a nasogastric tube feeding, a pH check of aspirant reveal a pH of 8. This most likely indicates that the tube tip is in the?

1. Stomach
2. Respiratory system
3. Small intestine
4. Esophagus

Answer 127

2

A pH greater than 7 (alkaline) of aspirant from an NG tube most likely indicates that the tip is in the respiratory system. Gastric fluids tend to be acidic (although this can be altered by medications), so pH usually ranges from 1 to 4. The pH in intestinal fluids is less acidic and should be approximately 6 or higher. Some tubes have pH sensors in place and do not require aspiration to check. Checking pH is not effective with continuous feedings because tube feedings usually have a pH of 6.6 and a neutralizing effect on gastrointestinal pH

Question 128

As part of a bowel-training program, a patient has a daily scheduled defecation. What is the best time to schedule a bowel movement?

1. First thing in the morning after arising
2. At bedtime
3. 2 hours after a meal
4. 20 to 30 minutes after a meal

Answer 128

4

The best time for scheduled evacuation is 20 to 30 minutes after a meal because eating stimulates motility. The scheduled time (usually daily but may be 3-4 times weekly depending on individual habits) should be at the same time each day, so work hours or activities should be considered. Stimulation may include drinking hot liquid or rectal stimulation (inserting a gloved, lubricated finger into the anus and running it around the rim of the sphincters). The best position for defecation is upright and leaning forward with knees elevated slightly. The patient should massage the abdomen, strain, and attempt to tighten abdominal muscles and relax sphincters if possible

Question 129

Post-infectious irritable bowel syndrome (PI-IBS) is most commonly characterized by which of the following?

1. Fever
2. Altered bowel habits with chronic diarrhea
3. Constipation
4. Flu-like symptoms

Answer 129

2

Post-infectious irritable bowel syndrome is a chronic bowel inflammation that develops in some people after acute enteritis, characterized by altered bowel habits, usually with chronic diarrhea and abdominal pain. About two-thirds have predominantly diarrhea, a fourth alternate between constipation and diarrhea, and the remaining have primarily constipation. Onset of symptoms is often abrupt. Symptoms often persist for years, with 40% still reporting symptoms after 6 years. Treatment usually entails antidiarrheal medication and a low fiber diet.

Question 130

In conducting research, which of the following types of studies represents one in which those with a condition (such as infection) are compared to those without the condition?

1. Retrospective cohort study
2. Prospective cohort study
3. Case control study
4. Cross-sectional study

Answer 130

3

Case control studies compare those with a condition (cases) to a group without it (controls) to determine if the affected group has characteristics that are different. Prospective cohort studies choose a group of patients without disease, assess risk factors, and then follow the group over time to determine (prospect for) which ones develop disease. Retrospective cohort studies are initiated after a condition develops and data is collected retrospectively from medical records to evaluate whether members of the cohort selected had exposure and developed disease. Cross-sectional studies assess both disease and exposure at the same time in a target population, evaluating the presence of disease at a point in time.

Question 131

Which of the following is a typical symptom associated with rectoceles?

1. Chronic constipation
2. Chronic diarrhea
3. Pulling sensation in the pelvic area
4. Vaginal discharge

Answer 131

1

Rectoceles can cause chronic constipation and difficulty in passing stool because of weakening of the muscles, contributing to fecal incontinence. Untreated, rectoceles can cause inflammation, ulcerations, and fistula formation. Pessaries may reduce the prolapse. Surgical repair may not correct all symptoms, especially underlying damage to muscles, and can result in surgical trauma to the rectum or sphincters, adding to the risk of incontinence. Rectoceles (rectal prolapses) occur when the muscles between the wall of the vagina and rectum weaken and the rectum prolapses or protrudes

Question 132

A patient being treated for a gastric ulcer has been stable on medications. Which of the following indicates a possible emergent situation that the nurse should report to the physician immediately?

1. Inability to sleep well and generalized anxiety
2. Periodic epigastric pain (heartburn) relieved by medications
3. Nausea after taking prescribed antibiotics
4. Increasing back and epigastric pain unrelieved by medications

Answer 132

4

A patient who has been stable on medications for gastric ulcer and begins to experience increasing back and epigastric pain that is unrelieved by medication may be experiencing erosion of the ulcer through the gastric serosa and into the surrounding organs and tissues, such as the pancreas or biliary tract. Penetration has a less acute presentation than perforation, which usually involves sudden acute abdominal pain (sometimes referred to the right shoulder), hypotension, bradycardia, omitting and abdominal distention and rigidity

Question 133

Peristomal abscess is most commonly associated with which of the following conditions?

1. Crohn’s disease
2. Systemic bacterial infection
3. Paralytic ileus
4. Ulcerative colitis

Answer 133

1

Peristomal abscess is common with active Crohn’s disease distal to the stoma. Crohn’s disease is a form of inflammatory bowel disease in which ulcerations occur in the small and sometimes the large intestines. Peristomal abscess is characterized by open (from fistulae) and closed lesions that are painful, swollen and erythematous. Peristomal abscess may also occur after stoma revision because of contamination from skin bacteria. Colostomy irrigation may result in perforation that causes abscess formation. A Peristomal abscess rarely heals spontaneously but requires surgical incision.

Question 134

Which of the following histamine receptor antagonists should those taking oral contraceptive agents or estrogen avoid?

1. Ranitidine (brand name Zantac)
2. Famotidine (brand name Pepcid)
3. Cimetidine (brand name Tagamet)
4. Nizatidine (brand name Axid)

Answer 134

3

Cimetidine (brand name Tagamet): First developed but used less frequently than others because of inhibition of enzymes that result in drug interactions, especially with contraceptive agents and estrogen. Ranitidine (brand name Zantac): Developed to decrease drug interactions and improve patient tolerance. It’s activity is about 10 times that of cimetidine. Ranitidine was recalled by the FDA due to presence of NDMA, a cancer-causing contaminant, when stored in high temperatures. Famotidine (brand name Pepcid): May be combined with an antacid to increase speed of effects, as it has a slow onset. It may be used pre-surgically to reduce postoperative nausea. Nizatidine (brand name Axid): Latest to be developed and about equal in potency and action to ranitidine.

Question 135

Which test measures the pressure of the anal sphincter muscles, degree of recital sensation, and neural reflexes?

1. Anal wink
2. Bulbocavernosus reflex
3. Endoanal ultrasound
4. Anal manometry

Answer 135

4

Anal manometry measures the pressure of the sphincter muscles, the degree of sensation in the rectum and whether the neural reflexes that control normal bowel movements are intact. Anal wink (anocutaneous reflex, a reflexive contraction of the anus in response to gentle stroking or stimulation of the skin around the rectum) and Bulbocavernosus reflex (s reflexive contraction of the anus in response to natural or electrical stimulation of the Bulbocavernosus muscle of the penis), are used to determine interruption or defect in the reflux arc. Endoanal ultrasound is used to diagnose perianal fistulas and abscesses and to assess sphincter damage

Question 136

Which provision of the National Patient Safety Goals governs getting laboratory test results to the appropriate staff person on time?

1. Improving staff communication
2. Identifying patients correctly
3. Identifying patient safety risks
4. Preventing surgical mistakes

Answer 136

1

Improving staff communication includes ensuring that the appropriate staff person receives laboratory test results on time and establishing a process for taking orders/report and read back for verbal/telephone orders. Other provisions include:

1. Identifying patient correctly: 2 identifiers for medicines, blood, or blood products
2. Using medications safely: complete medicine list, label medications, removing concentrated electrolytes from patient care units
3. Preventing infection: CDC hand washing procedures, infection control guidelines
4. Identifying safety risk: includes fall prevention
5. Preventing surgical mistakes: checklists, marking surgical site, presurgical pause

Question 137

A patient is scheduled for an anal sphincter electromyography. Which of the patient’s medications should be stopped prior to the EMG?

1. Stool softener
2. Anticholinergic
3. Antibiotic
4. Warfarin

Answer 137

2

Anal sphincter electromyography (EMG) assess muscle contractions to determine if the sphincter muscles are contracting properly. Drugs such as muscle relaxants and cholinergic and Anticholinergic preparations can affect the outcome of the test. The procedure begins with the patient lying on the left side. A small lubricated sponge or plug electrode is inserted into the anal canal. Alternately, needle electrodes may be used. The patient must lie still during the procedure or results will be affected. Electrical activity of the anal sphincter muscles is recorded on a computer screen while the patient tightens the sphincter muscles, relaxes, and pushes

Question 138

Which of the following is most important to avoid fluid and electrolyte imbalance with an ileostomy?

1. Increase intake of high fiber foods to slow absorption
2. Increase intake of water with diarrhea
3. Take routine antidiarrheal medication
4. Monitor intake and output

Answer 138

4

Monitoring intake and output is most important in preventing fluid and electrolyte imbalance along with ensuring adequate nutrition. During episodes of diarrhea, the patient should substitute water with a sports drink designed to replenish electrolytes and supply nutrition. With electrolyte imbalance, just increasing the oral intake of fluids is not sufficient because these fluids will be excreted through the kidneys and may not correct the electrolyte imbalance. If stools are too liquid, the patient can increase fiber: and if stools are too dry, sodium. Antidiarrheal agents should not be taken routinely but as necessary when dietary changes are insufficient

Question 139

A patient with a loop ileostomy and a retained distal segment of bowel has copious anal discharge of mucous. Which of the following is the most likely cause?

1. Normal mucous production
2. Diversion colitis
3. Anastomotic leak
4. Fluid and electrolyte imbalance

Answer 139

2

While some mucous discharge is normal, copious discharge is often associated with diversion colitis in which the distal segment becomes inflamed. Treatment includes rectal irrigation and topical steroids as well as oral antibiotics. The perianal area should be cleansed. Applying protective cream or ointment prevents irritation of the skin. The mucous fistula should be checked each time the appliance is changed and mucous gently wiped from the opening. The stoma should remain pink. Changes in color or swelling may indicated compromised circulation or infection

Question 140

According to the ANA Nursing Code of Ethics, nurses must support a patient’s autonomy and self-determination. A 44-year-old Asian woman states a treatment preference but plans to leave the decision to family members. Which of the following actions is correct?

1. Recognize that cultural values regarding individualism vary and respect the patient’s right to be guided by family
2. Try to convince the patient to assert herself
3. Tell the family that the patient should be the one to make the decision
4. Ask the ethics committee to intervene

Answer 140

1

Under the ANA Nursing Code of Ethics, autonomy and self-determination are viewed within the broad context of diverse cultures. The idea of individualism is less important in some cultures, so the nurse must respect and appreciate the patient’s right to be guided by her family. Trying to convince the patient to assert herself may just lead to emotional conflict. This is not an appropriate concern for the ethics committee, because the woman is not being forced to comply with family decisions but choses to do so

Question 141

The nurse is teaching a 50-year-old woman with a colostomy to do irrigations and has prepared written directions and a video, but the patient ignores them, picks up the equipment, and looks at each part, trying to figure it out. The patient’s learning style is probably which of the following?

1. Auditory
2. Visual
3. Kinesthetic
4. Mixed

Answer 141

3

Kinesthetic learners learn best by handling, doing and practicing and should be allowed to handle supplies/equipment with minimal directions. They benefit from demonstrating their understanding by doing the procedure. Visual learners learn best by seeing and reading and benefit from written directions, videos, diagrams, pictures and demonstrations. Auditory learners learn best by listening and talking, so procedures should be explained during demonstrations. Auditory learners learn best by listening and talking, so procedures should be explained during demonstrations. Auditory learners benefit from audiotapes and extra time for questions.

Question 142

A patient who receives multiple transfusions for GI bleeding with citrated blood products must be monitored closely for which of the following?

1. Hyponatremia
2. Hypomagnesemia
3. Hypokalemia
4. Hypocalcemia

Answer 142

4

Patients who receive multiple transfusions with citrated blood products must be carefully monitored for hypocalcemia. Calcium is important for transmitting nerve impulses and regulating muscle contraction and relaxation, including the myocardium . Calcium activates enzymes that stimulate chemical reactions and has a role in coagulation of blood. Values include:

1. Normal values: 8.2-10.2mg/dL
2. Hypocalcemia: less than 8.2mg/dL
3. Critical value: less than 7mg/dL
4. Hypercalcemia: greater than 10.2mg/dL
5. Critical value: greater than 12mg/dL

Question 143

The patient has a Percutaneous endoscopic gastrostomy (PEG) and has developed leakage about the tube. What initial intervention is indicated?

1. Check balloon to ensure adequate inflation
2. Stabilize the tube with the bumper and external stabilizer
3. Replace the tube
4. Apply barrier ointment

Answer 143

2

The PEG tube does not have an inflatable balloon, but the tube should be stabilized by pulling gently to ensure the internal bumper is against the abdominal wall and then sliding the external stabilizer to 1.5cm above skin. Replacing the PEG tube is done only if the leakage cannot be otherwise controlled. Routine skin care, including application of barrier ointment or other skin sealant, is necessary to prevent skin breakdown. In some cases, alginates, foam dressing, gauze, or pouching may be necessary

Question 144

For which of the following is a positive Murphy’s sign an aid in diagnosis?

1. Differentiating Cholecystitis from choledocholithiasis
2. Diagnosing Cholecystitis in geriatric patients
3. Diagnosing pancreatitis
4. Differentiating ascending cholangitis from pancreatitis

Answer 144

1

A positive Murphy’s sign is indicative of Cholecystitis but is negative with choledocholithiasis and ascending cholangitis. This test is not accurate for geriatric patients, so a negative finding dose not rule out Cholecystitis for these patients. To test for Murphy’s sign, hook the fingers under the right coastal margin at the midpoint, palpating deeply, and ask the patient to inhale deeply. Positive result occur with pain causing the patient to stop inspiring. The Rovsing’s sign — pain in the RLQ when left-sided abdominal pressure is applied — suggests appendicitis along with RLQ pain (rebound tenderness) on quick removal of pressure

Question 145

Which of the following is a contraindication for upper GI endoscopy?

1. Reflux disease
2. Esophageal diverticulum
3. Barrett’s esophagus
4. Caustic esophageal injury

Answer 145

2

Esophageal diverticulum is a contraindication for upper GI endoscopy because the scope may enter the diverticulum sac, resulting in perforation. Endoscopy is indicated for complicated reflux disease, such as when a patient exhibits dysphagia or iron deficiency anemia and is routinely used to diagnose, biopsy tissue, assess, and treat Barrett’s esophagus. Endoscopy is usually done within 24 hours after caustic esophageal injuries, such as from accidental or deliberate ingestion of liquid or crystalline alkali, to assess the degree of mucosal tissue damage

Question 146

In evidence-based research, what does persistent erratic findings in tracking and trending suggest?

1. Changes in patient population requiring changes in processes of care
2. Errors in statistical analysis of processes of care
3. Normal day-to-day variations in processes of care
4. Inconsistent or inadequate processes of care

Answer 146

4

While trends will show some normal variation, if the trend becomes erratic and measures are inconsistent, this suggests that the processes of care are not consistent or are inadequate. Tracking and trending is central to developing research-supported, evidence-based practice and is part of continuous quality improvement. Once processes and outcome measurements are selected, then at least one measure should be track for a number of periods of time, usually in increments of 4 weeks or quarterly. This tracking can be used to present graphical representation of results that will show trends

Question 147

Prior to beginning an invasive procedure, which of the following is most important for infection control?

1. Completing a safety pre-procedure checklist
2. Ensuring correct patient, correct procedure
3. Checking patient records to make sure pre-procedure orders have been carried out
4. Providing adequate patient education

Answer 147

1

While all of these are important, studies have shown that completing a safety pre-procedure checklist is highly effective in reducing infections and other complications. Checklists should be standardized according to discipline/procedure and required for all procedures to ensure that infection control and safety practices are followed. Checklists usually include ensuring correct patient, following the correct procedure, and checking patient records to make sure orders hav been carried out. Checklists vary but may include hand washing, use of barrier precautions, and checking for known allergies.

Question 148

A 25-year-old woman who required an ileostomy refuses to look at the stoma or participate in care post-operatively. Which of the following is the most likely to promote cooperation?

1. Refer patient to a psychologist
2. Ask family to intervene
3. Arrange visit with a recovered ostomate
4. Advise patient of the importance of self-care

Answer 148

3

A visit from a recovered ostomate who is functioning well can provide invaluable support. Refusing to look at the stoma or participate in care after surgery is very common as patients grapple with the alteration in body image and anxiety about their role in the family and society, their sexuality, and their ability to resume their normal activities. Family members should be encouraged to learn about ostomy care and to provide support as well, but they may also be very stressed and unsure. Referral to a psychologist may be indicated if the patient cannot overcome her anxiety and fears

Question 149

Over-transfusing must be avoided with treatment for esophageal variceal hemorrhage for which of the following reasons?

1. Underlying coagulopathy
2. Increased central and portal venous pressures
3. Generalized edema
4. Third-space shift

Answer 149

2

Over-transfusing to treat esophageal variceal hemorrhage can result in increased central and portal venous pressures, increasing the risk of rebleeding, so the patient must be monitored very carefully. Coagulopathy is commonly found related to underlying cirrhosis. If actively bleeding, those with an INR above 1.8 to 2.0 or with platelet counts below 50,000 should be treated with fresh frozen plasma (20mL/kg loading, followed by 10mg/kg every 6 hours) or platelets. About half the hemorrhages will stop spontaneously, but over half of these patients experience rebleeding within 7 days.

Question 150

Which of the following laboratory findings 36 hours after hospital admission is predictive of severe pancreatitis?

1. Serum calcium greater than 8mg/dL (2.0mmol/L)
2. BUN decrease less than 5mg/dL
3. Decrease in hematocrit greater than 10%
4. PO2 less than 80mmHg

Answer 150

3

A decrease in hematocrit greater than 10% within 48 hours of hospital admission is predictive of severe pancreatitis. Other warning signs include a BUN greater than 5 mg/dL, serum calcium less than 8mg/dL, a base deficit greater than 4 mEq/L PO2 less than 60 mmHg, and fluid retention/sequestration greater than 6 liters. On admission, indications include age over 55 years, white blood count greater than 16,000, serum glucose greater than 200mg/dL, serum LDH >350IU/L, and Aspartate aminotransferase (AST) greater than 250U/mL.

Question 151

Which of the following actions is an example of Standard I, Quality of Practice, in Standards of Professional Performance of the Standards of Clinical Practice and Role Delineation for Certified Gastroenterology Nurses?

1. Participating in peer review
2. Collecting data regarding quality of care
3. Demonstrating commitment to lifelong learning
4. Mentoring

Answer 151

2

1. Standard I, Quality of Practice: Collecting data and participating in quality of care activities.
2. Professional Practice Evaluation: Participating in performance appraisal, feedback, peer review, and demonstrating cultural competency
3. Education: Having commitment to lifelong learning
4. Collegiality: Sharing with others, mentoring, participating in professional organizations
5. Ethics: Complying with ANA Code of Ethics, maintaining privacy and protecting patient autonomy
6. Collaboration: Collaborating with other health professionals, patient, and family members
7. Research: Participating in research, reading, and utilizing research.
8. Resource Utilization: Considering costs, effectiveness, and safety, and delegating care
9. Leader: Utilizing teamwork and mentoring and promoting the profession

Question 152

Which of the following is the first method to use to clear a blockage in an endoscope’s air channel?

1. Flush with water with a small syringe (1 to 5mL)
2. Flush with water with a large syringe (50mL)
3. Flush with air
4. Remove tube and cleanse with fine wire

Answer 152

1

The first method to use to clear a blockage in one of the endoscopic channels is to flush with water using a small syringe (1 to 5ml). A small syringe applies more water pressure than a larger syringe, although the larger syringe is better for suctioning. Water also applies more pressure than flushing with air and is better able to remove residue that may be blocking the channel. Only if flushing is ineffective should the tube be removed and wire used to cleanse residue. Scrupulous cleaning after use helps to avoid blockage.

Question 153

Which of the following may interfere with the results of the urea breath test and fecal antigen assay for H.pylori infection?

1. Antacids
2. Proton pump inhibitors
3. Anticoagulants
4. Histamine receptor antagonists

Answer 153

2

Proton pump inhibitors and antibiotics may interfere with the results of both the urea breath test and the fecal antigen assay for H.pylori, so PPIs should be discontinued 1 to 2 weeks prior to testing and antibiotics at least 4 weeks prior. If patients cannot discontinue the medications, then serologic ELISA testing may be done, but it has only 80% accuracy compared to 95% accuracy for the breath and fecal tests. Endoscopic testing is usually not recommended for diagnosis, although, if done for other reasons, gastric biopsies may be taken to rule out or diagnose H.pylori

Question 154

Which type of diet is usually recommended for those with chronic pancreatitis?

1. Low protein
2. Low carbohydrate
3. Low fat
4. Gluten free

Answer 154

3

A low-fat diet is usually recommended for those with chronic pancreatitis. Because production of pancreatic enzymes may be impaired, patients may also need to take pancreatic enzymes with meals. If insulin production is affected, then some may require treatment for diabetes with insulin and diet modified to restrict carbohydrates. Since about 45% of those with chronic pancreatitis suffer from alcohol abuse, restricting alcohol intake is critical, so some patients may require referral to substance abuse programs

Question 155

For which complications is a patient who has had Percutaneous transhepatic cholangiography most at risk?

1. Bleeding, peritonitis, and septicemia
2. Bile duct blockage and peritonitis
3. Intestinal perforation
4. Allergic reaction to contrast

Answer 155

1

A patient who has had a Percutaneous transhepatic cholangiography is most at risk for bleeding, peritonitis, and septicemia. During the procedure, a flexible needle is inserted into the liver, increasing risk of bleeding, in order to aspirated bile. A water-soluble contrast agent is injected, the fluoroscopy table tilted, and multiple x-rays taken. Aspirating as much contrast agent and bile as possible prior to removing the needle helps reduce the risk of peritonitis. Antibiotics should be administered to reduce incidence of septicemia

Question 156

The primary purpose of a Transjugular intrahepatic portosystemic shunt (TIPS) is for which of the following?

1. Preventing hyponatremia
2. Preventing biliary blockage
3. Regulating electrolytes
4. Reducing portal hypertension

Answer 156

4

The primary purpose of TIPS is to reduce portal hypertension by treating ascites. A cannula is threaded through the jugular vein to the portal vein and an expandable stent inserted to shunt fluid between the hepatic vein and portal circulation. TIPS is indicated for ascites that does not respond to more conservative treatments and helps to reduce sodium retention so that diuretics can act more effectively. Patients who will be referred for liver transplantation often have a TIPS while awaiting an organ.

Question 157

Which of the following is an appropriate intervention for pain in the right shoulder or scapula after laparoscopic cholecystectomy?

1. Ice pack to the area for 15 to 20 minutes hourly
2. Heating pad to the area for 15 to 20 minutes hourly
3. Range of motion exercise to the right arm
4. Opioid analgesia

Answer 157

2

Applying a heating pad to the right shoulder or scapula area after laparoscopic cholecystectomy for 15 to 20 minutes each hour may help to reduce pain caused by migration of carbon dioxide used for insufflation during the surgical procedure. Pain is usually not severe, so opioids are rarely indicated. Complications are rare, and this procedure is often done on an outpatient basis, but patients should be advised to report vomiting, loss of appetite, increasing pain, temperature, and abdominal distention.

Question 158

Following cholecystectomy, which of the following dietary instructions is appropriate for a patient who experience preoperative fat intolerance?

1. Avoid fat in the diet for at least 6 weeks
2. Add fat into the diet with no restrictions
3. Add fat into the diet in small increments
4. Stay on a low fat diet indefinitely

Answer 158

3

After cholecystectomy, patients who had experienced preoperative fat intolerance should begin to add fat back into the diet in small increments to allow the body to adjust. In some cases, the liver may not produce enough bile to metabolize a high intake of fat and smoke fat restriction (40 to 50g daily) may be indicated. Generally, patients are able to resume eating a normal diet shortly after surgery and should not exhibit signs of dietary intolerance, such as pain, distention, nausea or vomiting

Question 159

For colorectal screening, how often should a patient have a fecal occult blood test done?

1. Every 10 years
2. Every 5 years
3. When symptoms arise
4. Every year

Answer 159

4

Fecal occult blood —yearly: checks for blood in stool. Screening at age 50 with average risk and age 40 with increased risk:

1. Flexible sigmoidoscopy—every 5 years: scope to check for polyps or signs of cancer in rectum and lower third of colon (often done with fecal occult blood test.)
2. Colonoscopy — every 10 years or as follow-up for abnormalities in other screening: longer flexible scope, usually with anesthesia, to check rectum and entire colon, remove polyps, do biopsies, and provide surveillance of inflammatory bowel disease
3. Double contrast barium enema — every 5 years: x-ray with contrast to visualize intestinal abnormalities

Question 160

When marking a nasoenteric tube for an adult patient prior to insertion for enteric feedings, which measurements are needed?

1. Nose to earlobe, earlobe to xiphoid process
2. Nose to earlobe, earlobe to xiphoid process, plus 6 inches (15cm)
3. Nose to earlobe, earlobe to xiphoid process, plus 8 to 10 inches (20-25cm)
4. Nose to earlobe, earlobe to xiphoid process, plus 12 to 14 inches (30-38cm)

Answer 160

3

A nasoenteric tube for an adult should be marked prior to insertion with measurements including the distance from the nose to earlobe, plus earlobe to xiphoid process, plus 8 to 10 inches for enteric placement. Six inches are needed for gastric placement. The nasoenteric tube tip initially placed in the stomach (verified by chest x-ray) and then moves into the small intestine through peristalsis over about 24 hours. Proper placement should be reconfirmed before every feeding by checking tube length measurement, aspirating and observing aspirant, and checking pH.

Question 161

Following lap-band bariatric surgery, total meal size should be restricted to which of the following?

1. One-half cup
2. Less than one cup
3. One and a half cups
4. Two cups

Answer 161

2

Following bariatric surgery, such as the lap band procedure, general guidelines advise limiting total meal intake to less than one cup, with 3 meals daily (containing protein and fiber) and two protein snacks. Patients should be advised to chew slowly and thoroughly and to eat nutrient-rich foods, but should avoid combining food and liquids. Liquids should be taken 90 minutes after meals and up to 15 minutes prior to a meal, but caloric liquids (such as alcoholic beverages and juices) should be avoided.

Question 162

Which of the following is the most serious complication of enteritis caused by Escherichia coli, such as type 0157:H7?

1. Hemolytic uremic syndrome
2. Iron deficiency anemia
3. Severe diarrhea
4. High fever and seizures

Answer 162

1

Hemolytic uremic syndrome (HUS) is the most serious complication of enteritis caused by E.coli, such as type 0157:H7. Children under 5 and the elderly are especially at risk. HUS is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. HUS may affect the neurological system, resulting in seizures, stroke, and coma. About half of those who survive HUS will develop chronic renal problems. Various organs, such as the heart and brain, may be affected because HUS damages the blood vessels and causes clots to form in capillaries and arterioles.

Question 163

A patient with Crohn’s disease experiences small amounts of diarrhea, increasing abdominal distention and pain, vomiting and cramping. Which of the following complications is the most likely cause?

1. Abscess
2. Fistula
3. Colon cancer
4. Intestinal obstruction

Answer 163

4

These symptoms are indicative of intestinal obstruction, which may be partial or complete. Obstructions are common because strictures develop in the bowel from repeated ulcerations of mucoid tissue. Chronic diarrhea is common, and some diarrhea may persist even with obstruction, depending on the location and degree of obstruction. Other common complications include abscesses, fistulas (especially from the small bowel to the skin), fissures, and malnutrition. Lesions associated with Crohn’s disease are most common in the distal ileum and ascending colon.

Question 164

A patient receiving total Parenteral nutrition (TPN) for inflammatory bowel disease should be monitored every 6 hours for which of the following?

1. Hemoglobin and hematocrit
2. Blood glucose level
3. Blood, urea, nitrogen (BUN)
4. Electrolytes

Answer 164

2

Total Parenteral nutrition (TPN) is high in glucose, so patients should have blood glucose levels monitored every 6 hours to evaluate hyperglycemia. Some patients may require insulin during administration of Parenteral nutrition. Symptoms of hyperglycemia may include increased thirst, increased urination, blurred vision and lethargy. Some patients may experience a rebound hypoglycemia when TPN is discontinued. The goal of TPN is usually for the patient to gain about 0.5kg daily. Once the patient’s symptoms decrease and weight stabilizes, the patient is placed on oral elemental feedings.

Question 165

Which of the following is the most effective method of monitoring small changes in abdominal ascetic fluid?

1. Observing patient’s abdomen while patient is in supine position
2. Percussing abdomen
3. Measuring abdominal girth and weighing daily
4. Assessing abdominal fluid wave

Answer 165

3

The most effective method for monitoring small changes in abdominal ascetic fluid is daily measuring of abdominal girth and weighing. This should be done routinely to assess the effectiveness of treatment. A large fluid accumulation may be indicated by bulging flanks with the patient in supine position. Abdominal percussion may also identify ascites, but assessing small increases or decreases is difficult. An abdominal fluid wave is usually not noted until there is a large accumulation of fluid.

Question 166

Considering placement of a permanent colostomy, which anatomical position is the most likely to result in semi-soft, mushy stool?

1. Ascending colon
2. Transverse colon
3. Descending colon
4. Sigmoid colon

Answer 166

3

A permanent colostomy in the descending colon is most likely to result in semi-soft, mushy stool. A colostomy in the ascending colon results in liquid stool, as little absorption has taken place as liquid stool enters the colon from the small intestine. A transverse colostomy results in semi-liquid, somewhat mushy stool. Because the sigmoid colostomy is directly above the rectum, most excess fluid has been absorbed by the proximal colon, so stool tends to be solid.

Question 167

What initial cleaning of an endoscope should be completed in the procedure room?

1. Testing for leakage
2. Flushing all channels with enzymatic detergent
3. Rinsing exterior and all channels with clear water
4. Wiping exterior and flushing the suction channel with water

Answer 167

4

Upon completion of an endoscopic procedure, before the endoscope is removed from the procedure room and taken to the cleaning area, using standard precautions the exterior should be wiped down with a gauze pad to remove discharge and debris (feces, mucus, blood) and then the suction channel and water channel flushed with water until the water runs clear. Once in the cleaning area, procedures will vary depending on whether manual cleaning is completed or automated but usually begin with leak testing and cleaning and flushing with enzymatic detergent prior to placing in high-level disinfectant.

Question 168

Diabetic well controlled on insulin should make which of the following modifications in insulin dosage on the morning of a scheduled endoscopic procedure?

1. Omit dosage
2. Take half a usual dose
3. Take usual dose
4. Delay dosage until after procedure

Answer 168

2

Diabetic patients who are well controlled on insulin are usually advised to take half of their usual dosage on the morning of a scheduled endoscopic procedure. Diabetics who take oral medications to control diabetes should omit the dosage for that morning. Glucose levels should be monitored when the patient arrives for the procedure and the physician is notified if the patient is hypoglycemic (<60mg/dL) or hyperglycemia (>200mg/dL). IV solutions administered may depend on blood glucose level. Those who are hypoglycemic may receive 50% glucose solution, and those who are hyperglycemic, NS.

Question 169

Which type of sedation is usually indicated for flexible sigmoidoscopy?

1. Minimal
2. Moderate/conscious sedation
3. Deep sedation
4. General anesthesia

Answer 169

1

Patients undergoing sigmoidoscopy (rigid or flexible) usually require no or minimal sedation, although patients with low pain threshold or severe anxiety may need moderate/conscious sedation. Moderate sedation (a narcotic such as fentanyl and a benzodiazepine such as midazolam) is usually indicated for endoscopic procedures, such as upper endoscopy and colonoscopy. Procedures that are complicated or prolonged, such as ERCP, may require deep sedation with the same drugs as well as droperidol or propofol. General anesthesia is generally indicated only for complex and surgical procedures because of increased risks associated with general anesthesia.

Question 170

When inserting a small-bore nasogastric tube, which of the following is the best method to verify placement of the tube in the stomach?

1. Aspirating gastric contents and checking pH
2. Injecting air and auscultating the gastric region
3. Taking a chest x-ray
4. Taking an abdominal x-ray

Answer 170

3

The best method to verify placement of a small-bore NG tube is with a chest x-ray. While aspirating fluid may indicate gastric placement, the tip may be in the esophagus. A gastric fluid pH less than 4 usually indicates that the tube is in the stomach, but some medications, such as proton pump inhibitors, may alter pH. Injecting air and auscultating may be inaccurate because the air sounds in the bronchial tree sound similar, and NG tubes can easily enter the trachea and a bronchus. Misplacement into the bronchus may not be evident on abdominal x-ray.

Question 171

Flumazenil should be available as a reversal agent for which of the following drugs commonly used for endoscopic sedation?

1. Fentanyl
2. Droperidol
3. Midazolam
4. Propofol

Answer 171

3

Flumazenil is a reversal agent for benzodiazepines, such as midazolam and diazepam. Flumazenil is usually given in a dose of 02.mg over 15 seconds and can be repeated every minute to a total of 1mg and then at 30 minute to 60 minute intervals because the action of Flumazenil is shorter than that of benzodiazepines. Therefore, patients must be monitored for at least 2 hours after administration to determine if further dosage is required. Naloxone should also be available as a reversal agent for opioids, such as fentanyl and meperidine

Question 172

Which of the following is the best positioning for a patient who is going to undergo a paracentesis?

1. Lying supine with bed flat
2. Side-lying
   3 Fowler’ s position
3. Sitting upright on side of bed or in a chair

Answer 172

4

The best positioning for a paracentesis is for the patient to sit upright on a chair on the side of the bed because this causes the fluid to accumulate in the lower and anterior abdomen, making drainage more effective. Patients who are confined to bed may be placed in the Fowler’s position. Fluid should drain by gravity. The patient must be carefully monitored and VS taken frequently as vascular collapse/hypovolemia may occur as the body compensates for the fluid loss by shifting fluid from the vascular system to the peritoneal cavity

Question 173

When using the air insufflation method for bedside postpyloric placement of an enteral feeding tube, which of the following is the best procedure?

1. Inject 350mL of air and place patient on the right side
2. Administer metoclopramide, 10mg 10 minutes prior to insertion of tube, followed by injecting 350mL of air and placing patient on right side
3. Inject 350mL of air and place patient on left side
4. Administer an opioid and metoclopramide, 10mg 10 minutes prior to insertion of tube, followed by injecting 350mL of air and placing patient on the right side

Answer 173

1

The method that is the most successful for postpyloric placement of enteral feeding tubes is to inject about 350mL of air and place the patient on the right side. An alternate method is to administer the prokinetic metoclopramide to stimulate peristalsis and then to position the patient on the right side. Combining both methods is not indicated. The air insufflation method usually results in faster placement, especially if the patient has received opioids, which tend to slow peristalsis

Question 174

When assisting with upper GI endoscopy, which of the following is the best method to prevent aspiration?

1. Position patient properly
2. Pre-medicate patient with antiemetic
3. Ensure patient has been NPO for at least 12 hours prior to the procedure
4. Suction all accumulated saliva or emesis during the procedure

Answer 174

4

During an upper GI endoscopy procedure it’s important to aggressive suction all accumulated saliva and emesis to prevent aspiration. Pre-medicating with an antiemetic is usually not recommended, and positioning of the patient may have little effect. Recommendations for NPO status prior to endoscopic procedures vary slightly from 6 hours to 8 hours to ensure the stomach has emptied. While the endoscopic procedure may induce vomiting, 12 hours of NPO status is more than required

Question 175

A patient with stage 2 gastric cancer refuses all treatment because of religious convictions. Which of the following is the most appropriate action?

1. Provide the patient with facts about the disease, treatments, and prognosis
2. Ask family members to intervene
3. Remind the patient that he will die without treatment
4. Refer to a psychologist

Answer 175

1

Patients have a right to refuse treatment for religious or other personal reasons, so the most appropriate action is to simply provide the patient with factual information about the disease, treatments, and prognosis in a neutral manner, without trying to coerce or frighten the patients. In some cases, patients may change their minds when presented with information, but the nurse should remain supportive regardless of the patient’s decision. Asking the family to intervene is not appropriate, and refusal of treatment alone does not suggest the need for referral to a psychologist

Question 176

The first recorded gastrointestinal assistant was:

A. Florence Nightingale
B. Frances Reiter
C. Gabriele Schindler
D. B.C. Charaka

Answer 176

C. Gabriele Schindler

Question 177

During what period was medicine so far advanced that they had what is equivalent to today’s subspecialties?

A. Egyptians
B. Pre-Christian era
C. Middle Ages
D. Greeks and Romans

Answer 177

A. Egyptians

Question 178

The individual who first developed the fiberoptic telescope used for GI procedures was:

A. Hippocrates
B. Hopkins
C. Schindler
D. Baird

Answer 178

B. Hopkins

Question 179

The rationale for the rapid adoption of fiberoptic instruments includes:

A. Simplicity, ease of use, and patient safety
B. Complex lens system and noncoherent bundles
C. Perfect imaging and ease of use
D. Combination of noncoherent bundles and coherent bundles to make a perfect image

Answer 179

A. Simplicity, ease of use, and patient safety

Question 180

The first Society of Gastrointestinal Assistants (SGA) was formed in what year?

A. 1968
B. 1976
C. 1972
D. 1974

Answer 180

D. 1974

Question 181

The practice of gastroenterology nursing requires application of the nursing process. The components include:

A. Communication, planning, evaluation, follow-up
B. Assessment, diagnosis, planning, implementation, evaluation
C. Interviewing, observing, communicating, listening
D. Assessment, planning, evaluation, follow-up

Answer 181

B. Assessment, diagnosis, planning, implementation, evaluation

Question 182

A gastroenterology associate is defined as:

A. A nurse who is engaged in the field of gastroenterology
B. An individual trained to function in an assistive role in the GI setting having direct patient care responsibilities
C. An individual with advanced education who is engaged in gastroenterology
D. An individual who is responsible for transporting patients and caring for instruments and equipment

Answer 182

B. An individual trained to function in an assistive role in the GI setting have direct patient care responsibilities

Question 183

Initial assessment of patients on arrival to the gastroenterology unit is usually the responsibility of the:

A. Physician
B. Nurse manager
C. Staff nurse (RN)
D. Associate

Answer 183

C. Staff nurse (RN)

Question 184

A general requirement for a recently graduated nurse who is interested in practicing gastroenterology nursing is:

A. To work for one year on a medical-surgical unit to gain experience
B. To work for a private GI physician to gain knowledge of diagnosis and procedures
C. To work in a special procedures unit for one year
D. To work in an ambulatory care unit to practice skills for one year

Answer 184

A. To work for one year on a medical-surgical unit to gain experience

Question 185

Department management is based upon a theoretical framework that involves:

A. Coordinating the five functions of management
B. Delegating takes to ensure that work is completed
C. Micromanaging all tasks in the unit
D. Ensuring that the employee knows to whom to report

Answer 185

A. Coordinating the five functions of management

Question 186

This management tasks outlines a course of action that is realistic for the unit and involves the development of a purpose, philosophy, goals, and objectives for the unit

A. Planning
B. Organizing
C. Directing
D. Staffing

Answer 186

A. Planning

Question 187

Managerial components of planning include:

A. Forecasting and managing the budget
B. Maintaining a structure of working relationships
C. Assigning work activities
D. Hiring new personnel

Answer 187

A. Forecasting and managing the budget

Question 188

The gastroenterology nurse leader directs through

A. Counseling employees
B. Leading and guiding employees
C. Developing position descriptions
D. Conducting performance appraisals

Answer 188

B. Leading and guiding employees

Question 189

The following are all examples of leadership styles except

A. Democratic
B. Laissez-faire
C. Transformational
D. Autocratic

Answer 189

C. Transformational

Question 190

To determine the staffing budget, it is necessary to calculate:

A. Full-time equivalents and flexible staff
B. Volume of procedures and required staff
C. Qualifications of the required staff
D. Volume and cost of procedures

Answer 190

B. Volume of procedures and required staff

Question 191

A problem-solving approach that integrates research, evidence-based theories, and clinical expertise with evidence from patient assessment, family input, and population preferences and values is called:

A. The tasks unassigned to staff
B. The tasks delegated to staff
C. Evidence-based practice
D. The tasks of other managers

Answer 191

C. Evidence-based practice

Question 192

The process of getting tasks accomplished with the help of theirs and directed towards common organizational and departmental goals is defiance as:

A. Planning
B. Management
C. Staffing
D. Directing

Answer 192

B. Management

Question 193

In an operating budget, salaries, overtime, benefits, and medical-surgical supplies are usually considered

A. Indirect expenses
B. Fixed assets
C. Direct expenses
D. Capital budget items

Answer 193

C. Direct expenses

Question 194

This term represents the use of computer technology to support nursing and includes clinical practice, administration, education, and research

A. Nursing management
B. Nursing administrators
C. Performing a financial forecast
D. Nursing informatics

Answer 194

D. Nursing informatics

Question 195

The most common infectious agents in the clinical setting are

A. Viruses
B. Fungi
C. Helminthes
D. Bacteria
E. Protozoa

Answer 195

D. Bacteria

Question 196

Examples of endogenous infections include

A. Cholangitis following manipulation of an obstructed bile duct
B. Endocarditis in patients with mitral valve regurgitation who have sustained transient bacteremia during esophageal dilation
C. Both A & B

Answer 196

C. Both cholangitis and endocarditis

Question 197

The most frequent exogenous infection associated with endoscopic transmission is

A. Hepatitis C virus
B. Mycobacteria
C. Hepatitis B virus
D. Human immunodeficiency virus (HIV)

Answer 197

B. Mycobacteria

Question 198

According to the Spaulding classification system, examples of critical items are

A. Injection needles
B. Endoscopes
C. Biopsy forceps
D. A&C
E. B&C

Answer 198

D. Injection needles and biopsy forceps

Question 199

Circumstances for endoscopic sterilization may include

A. Reprocessing option for Duodenoscope
B. Use of endoscopes in sterile operative field
C. Use of endoscopes for natural orifice transluminal endoscopic surgery
D. For patients with known HIV, HCV, or HBV
E. A,B,&C

Answer 199

B. Use of endoscopes in sterile operative field

Question 200

The steps for decontamination of endoscopes are

A. Pre-clean, leak test, manual clean, inspect, high-level disinfect (or AER), rinse, and dry
B. Pre-clean, manual clean, high-level disinfect (or AER), inspect, rinse, dry, and leak test
C. Pre-clean, leak test, inspect, high-level disinfect, manual clean, rinse, and dry

Answer 200

A. Pre-clean, leak test, manual clean, inspect, high-level disinfect (or AER), rinse, and dry

Question 201

The standard of care for reprocessing of gastrointestinal endoscopes is

A. Sterilization
B. High-level disinfection

Answer 201

B. High-level disinfection

Question 202

Agents approved for high-level disinfection include

A. Hydrogen peroxide, peracetic acid, green soap, ortho-phthalaldehyde (OPA)
B. Isopropyl alcohol, hydrogen peroxide, peracetic acid, ortho-phthalaldehyde (OPA)
C. Glutaraldehyde, hydrogen peroxide, peracetic acid, ortho-phthalaldehyde (OPA)
D. Glutaraldehyde, hydrogen peroxide, peracetic acid, isopropyl alcohol

Answer 202

C. Glutaraldehyde, hydrogen peroxide, peracetic acid, ortho-phthalaldehyde (OPA)

Question 203

Reprocessing of a Duodenoscope requires

A. Additional steps in all phases of reprocessing
B. Manual flushing of alcohol and drying post high-level disinfection per the manufacturer’s instructions
C. A&B

Answer 203

C. Both A&B

Question 204

The statement that best describes the SGNA position on reprocessing of single-use accessory equipment is

A. Reprocessing is accepted by the FDA as long as third-party processors are registered
B. Critical medical devices originally manufactured and labeled for single-use should not be reused

Answer 204

B. Critical medical devices originally manufactured and labeled for single-use should not be reused

Question 205

An electrical fire that does not involve the patient directly should be handled by

A. Using a Halon extinguisher
B. Throwing water on it
C. Suffocation with a fire blanket
D. Running from the room

Answer 205

A. Using a Halon extinguisher

Question 206

When not being used during the procedure, an ESU device should

A. Be set down on a drape
B. Be placed in the safety holster
C. Remain in the endoscopist’s hand
D. Be handled to an assistant

Answer 206

B. Be placed in the safety holster

Question 207

For laser procedures, the optical density of the protective eyewear used is determined by

A. The physician’s preference
B. The procedure that will be performed
C. Institutional policies and procedures
D. The wavelength of the laser being used

Answer 207

D. The wavelength of the laser being used

Question 208

When ionizing radiation is in use, pregnant health care workers should

A. Wear a lead-lined apron, thyroid collar, and protective eyewear in accordance with institutional guidelines
B. Wear a film badge
C. Limit the dose to the embryo or fetus to 0.5 rem and monitored during the pregnancy
D. All of the above

Answer 208

D. All of the above

Question 209

If a piece of electrical equipment malfunctions during a procedure, is should be

A. Fixed by gastroenterology personnel
B. Removed, replaced, and sequestered
C. Reported per institutional policy
D. Both b and c

Answer 209

D Both B and C

Question 210

If Glutaraldehyde accidentally comes in contact with a healthcare worker’s skin, he or she should

A. Wash the area thoroughly for the time recommended on the safety data sheet
B. Rinse the area with eater only
C. Apply burn ointment
D. Cover the area with a bandage

Answer 210

A. Wash the area thoroughly for the time recommended on the safety data sheet

Question 211

Plans for evacuating patients in the event of an external or internal disaster should be

A. Posted in an obvious location
B. Recorded in institutional policies and procedures manuals
C. Practiced in simulated disaster drills
D. All of the above

Answer 211

D. All of the above

Question 212

If a procedure is scheduled for a latex-allergic patient, the following should be done

A. Schedule the procedure the first of the day
B. Report to FDA immediately
C. Refer the patient to the operating room
D. Both A and B

Answer 212

A. Schedule the procedure the first of the day

Question 213

To avoid accidental injuries to patients and personnel when a laser is in use; it is important to

A. Use protective eyewear
B. Post “laser in use” signs
C. Use non reflective instruments
D. All of the above

Answer 213

D. All of the above

Question 214

Selecting an accrediting organization might be based on, but not limited to, the following considerations

A. Costs
B. Complexity of the services offered
C. Facets of care being examined
D. All of the above

Answer 214

D. All of the above

Question 215

Measurement of comparison for quantitative or qualitative value is called a

A. Standard
B. Guideline
C. Standard of practice
D. Criteria

Answer 215

A. Standard

Question 216

Standard of professional nursing practice consist of which of the following

A. Standards of professional performance
B. Standards of practice
C. State nurse practice acts
D. Both a&b

Answer 216

D. Both a & b

Question 217

Which of the following is not listed as a standard of practice

A. Assessment
B. Planning
C. Communication
D. Evaluation

Answer 217

C. Communication

Question 218

Which federal agency established the “Safe Medical Devices Act”

A. OSHA
B. EPA
C. FDA
D. CDC

Answer 218

C. FDA

Question 219

The CDC guidelines for the prevention and control of hospital-acquired infections

A. Have the force of law
B. Are an accepted compilation of practical, well-founded recommendations
C. Are applicable only to hospital settings
D. Are all based on conclusive scientific research

Answer 219

B. Are an accepted compilation of practical, well-founded recommendations

Question 220

Standard ______ speaks to the Registered nurse developing an individualized, evidence-based plan of care by partnering with the patient and interprofessional team

A. Standard 4 Planning
B. Standard 5 Implementation
C. Standard 9 Communication
D. Standard 16 Resource Utilization

Answer 220

A. Standard 4 Planning

Question 221

The Standard of Professional Performance 8: Culturally Congruent Practice includes all of the following except

A. Demonstrates professional accountability and responsibility for nursing practice
B. Demonstrates respect, equity, and empathy with all heath care consumers
C. Creates inventory of one’ own values and beliefs
D. Considers the effects of discrimination and oppression on practice within and among vulnerable groups

Answer 221

A. Demonstrates professional accountability and responsibility for nursing practice

Question 222

Name the federal regulatory agency responsible for enforcing safety and health regulations in the workplace

A. OSHA
B. EPA
C. CDC
D. DNV GL

Answer 222

A. OSHA

Question 223

Which accrediting body has a single focus on the ambulatory care community?

A. The Joint Commission
B. AAHHS
C. HFAP
D. AAAHC

Answer 223

D. AAAHC

Question 224

Leaders in health care have defined quality as:

A. Identifiable and nor measurable
B. A continuous conformance to meet the needs and expectations of the customers
C. The degree to which actions maximize the probability of having satisfied customers
D. A distinguishable attribute

Answer 224

B. A continuous conformance to meet the needs and expectations of the customers

Question 225

Models of process improvement must be based on which of the following principles

A. Most problems are related to process rather than people
B. The people closest to the process should be involved in improving it
C. Decisions should be made on measurable data
D. All of the above

Answer 225

D. All of the above

Question 226

For indicators to be effective, they must be:

A. Subjective
B. Vague
C. Complex
D. Measurable

Answer 226

D. Measurable

Question 227

Improving quality in the patient care setting should be based on

A. Correcting the immediate problem
B. Finding the person who’s caused the problem
C. Regulatory rules alone
D. Improving the process

Answer 227

D. Improving the process

Question 228

A quality improvement program should include

A. Written, measurable indicators and thresholds
B. Tools for data collection and tabulation
C. Means of evaluating a plan
D. All of the above

Answer 228

D. All of the above

Question 229

True or False: Once an improvement plan is in place it does not need to be reevaluated unless a problem occurs

Answer 229

False

Question 230

Once effective strategy for improving the quality of care is to

A. Provide education and training
B. Assign the manager complete responsibility for making changes
C. Discipline those staff members who are responsible for failure to meet objectives
D. Change the goal and objectives

Answer 230

A. Provide education and training

Question 231

The mission statement of the unit should be

A. Independent of the organizations statement
B. Formulated before a process improvement plan can be developed
C. Reflective of the overall philosophy of the patients
D. Written as the final step in developing a process improvement plan

Answer 231

B. Formulated before a process improvement plan can be developed

Question 232

A best practice model of continuous improvement that focuses on promoting learning from experiences through repetitive and systematic reflection is

A. Six Sigma
B. Positive deviance
C. Plan-Do-Study-Act
D. Chronic Care Model

Answer 232

C. Plan-Do-Study-Act

Question 233

Quantitative measures that assess, monitor, evaluate, and improve the quality of patient care, clinical support services, and organizational functions affecting patient outcomes or health care processes are

A. Indicators
B. Transparency
C. Brainstorming
D. Validity and Reliability

Answer 233

A. Indicators

Question 234

An example of a structure indicator in a gastroenterology unit is

A. Ensure the electrocautery machine is present for the insertion of a PEG tube
B. Assess patient satisfaction regarding services rendered
C. Tabulate the monthly case report
D. Determine the number of patients who has a delayed discharge related to blood pressure problems

Answer 234

A. Ensure the electrocautery machine is present for the insertion of a PEG tube

Question 235

Which statement best describes a null hypothesis

A. A conclusion statement saying that the study results are inconclusive
B. A hypothesis that assumes no relationship between the variables under study
C. A hypothesis to be ignored
D. A hypothesis that was never pursued because the idea was too preposterous

Answer 235

B. A hypothesis that assumes no relationship between the variables under study

Question 236

When conducting research, a placebo is a

A. Treatment
B. Measure of central tendency
C. Theory
D. Sample

Answer 236

A. Treatment

Question 237

The measure that focuses on the spread Among values (calculates how far the numbers in a list are from the average) is called

A. The mean of the sample
B. The mode of the sample
C. The standard deviation
D. The deviation scores

Answer 237

A. The mean of the sample

Question 238

When written by the person who performed the study; a research source is considered a ________

A. Primary source information
B. Secondary source information
C. Clinical impression
D. Theory or interpretation

Answer 238

A. Primary source information

Question 239

The simplest of the probability sampling designs is _________

A. The control group
B. The comparison group
C. The random sample
D. The experimental group

Answer 239

C the random sample

Question 240

The levels of measurement are

A. Nominal, ordinal, standard deviation, and mean
B. Nominal, ordinal, interval, ratio
C. Nominal, range, variability, and mean
D. Nominal, validity, variability, and range

Answer 240

B. Nominal, ordinal, interval, ratio

Question 241

The mode is __________

A. An index of the average position in a set of values
B. A measure of variability
C. The empirical value that occurs most frequently in a set of values
D. Theoretical

Answer 241

C. The empirical value that occurs most frequently in a set of values

Question 242

Standard deviation is an indicator of _________

A. The average
B. The sample size
C. The mean
D. Variability

Answer 242

D. Variability

Question 243

To ensure that human subjects’ rights are maintained, the research study needs approval from __________

A. The hospital administrator
B. The nursing leadership
C. The institutional board of review
D. The executive management committee

Answer 243

C. The institutional board of review

Question 244

The evidence-based practice approach involves the methodical integration of relevant information that embodies current best clinical practices found in the literature

This statement about evidence based practice is

A. True
B. False

Answer 244

A. True

Question 245

The acronym PICOT stands for:

A. Preamble, Indication, Climate, Opportunity, Timeframe
B. Presentation, Improvement, Concentration, Optimism, Timeframe
C. Population, Interventions, Comparison, Outcome, Timeframe
D. Population, Intervention, Concentration, Optimum, Timeframe

Answer 245

C. Population, interventions, comparison, outcome, timeframe

Question 246

In descriptive research design, there is a strict random sampling of the subjects into two distinct groups

A. True
B. False

Answer 246

B. False

Question 247

Correlation studies determine relationships between variables. The relationship is positive or negative

A. True
B. False

Answer 247

A. True

Question 248

In any research study’s it is imperative that moral and ethical rights are ensured. Human subject projection involves protecting the rights of all study subjects, as well as vulnerable subjects who may be incapable of providing informed consent

A. True
B. False

Answer 248

A. True

Question 249

A nursing assessment

A. Is a systematic approach to nursing care
B. Is always comprehensive
C. Is a process of identifying a patient problem
D. Should precede a nursing history

Answer 249

A. Is a systematic approach to nursing care

Question 250

Which statement is true of a general physical assessment of the abdomen

A. The order in which inspection, Palpation, percussion and auscultation are performed is only important if the patient is in pain
B. Percussion and Palpation should be performed before auscultation and inspection
C. Bowel sounds are normal if none is heard in the four abdominal quadrants over a period of four to five minutes
D. Bowel sounds characterized by high-pitched tinkles and peristaltic rushes are abnormal

Answer 250

D. Bowel sounds characterized by high-pitched tinkles and peristaltic rushes are abnorma

Question 251

A pre-procedural assessment includes

A. Determination of baseline vital signs
B. Verification of current medications in use
C. Verification of nothing my mouth (NPO) status
D. All of the above

Answer 251

D. All of the above

Question 252

Validation is the act of:

A. Clarification
B. Verification
C. Repeating a patient’s response twice
D. Checking to be sure a nursing history was taken

Answer 252

B. Verification

Question 253

Which of the following might the gastroenterology nurse record as objective nursing assessment data concerning a patient who presents to the ER with biliary colic?

A. A medical diagnosis of choledocholithiasis
B. “Patient is anxious”
C. “Patient ate peanut butter sandwich and some Swiss cheese yesterday at lunch
D. “Patient is scanning her surroundings with wide open eyes”

Answer 253

D. “Patient is scanning her surroundings with wide open eyes”

Question 254

By which method(s) could a patient’s medication history be validated

A. By asking the patient what medications he or she takes
B. By reading prescription labels on the bottles of medicines the patient provides
C. Both a and b
D. Neither a nor b

Answer 254

C. Both a and b

Question 255

A nurse’s sense of vision, hearing, smell, and touch are important features of

A. The observation of a patient
B. Collection of subjective data
C. A patient diagnostic review
D. Patient interview and data analysis

Answer 255

A. The observation of a patient

Question 256

The purpose of the nursing assessment is to

A. Identify underlying pathology
B. Identify teaching needs
C. Identity human responses to medical conditions, treatments, and changes in activities of daily life
D. Analyze data to identify actual or potential health problems

Answer 256

C. Identify human responses to medical condition, treatments, and changes in activities of daily life

Question 257

A multidisciplinary team approach to patient care is characterized by

A. A coordination of care among practitioners
B. A continuous flow of patient care service
C. A collaborative approach to manage health problems
D. All of the above

Answer 257

D. All of the above

Question 258

A patient returns to the clinic after two weeks of taking a new prescription for reflux. The most appropriate assessment for a follow-up visit is

A. A comprehensive assessment
B. A focused assessment
C. A time-lapsed reassessment
D. A limited assessment

Answer 258

C. A time-lapsed reassessment

Question 259

Which of the following was not one of King’s criteria for making a diagnosis

A. A preexisting series of categories to provide a reference
B. An entity to be diagnosed
C. The existence of a medical pathology
D. A judgement that the assessed phenomenon

Answer 259

C. The existence of a medical pathology

Question 260

The organization responsible for classification of nursing diagnoses is the:

A. American Nurses Association
B. NANDA-I
C. Society of Gastroenterology Nurses and Associates
D. American Medical Association

Answer 260

B. NANDA-I

Question 261

Cholecystitis with Cholelithiasis is an example if a

A. Collaborative diagnosis
B. Nursing diagnosis
C. Medical diagnosis
D. Medical history

Answer 261

C. Medical diagnosis

Question 262

A syndrome is a

A. Problem attended to by all health care professionals
B. Clinical judgment describing a specific cluster of nursing diagnoses that occur together
C. Behavior
D. Condition related to health

Answer 262

B. Clinical judgement describing a specific cluster of nursing diagnoses that occur together

Question 263

A collaborative problem:

A. Requires both nursing and medical intervention to diagnose, prevent, and treat
B. Requires cooperation between nurses responsible for pre-, intra-, and post-procedure patient care
C. Involves the nurse in identification but not treatment
D. Is identified by more than one member of the health care team

Answer 263

A. Requires both nursing and medical intervention to diagnose, prevent, and treat

Question 264

A nursing diagnosis states:

A. Important assessment data from patients health problem
B. The health problem as related to the etiology and as manifested by the signs and symptoms
C. Interdependent nursing interventions for signs and symptoms
D. Outcome criteria for evaluation

Answer 264

B. The health problem as related to the etiology and as manifested by the signs and symptoms

Question 265

Nursing diagnosis focuses on the patient’s

A. Pathology and etiology
B. Pathophysiology
C. Present health problems
D. Health perceptions

Answer 265

C. Present health problems

Question 266

An example of a potential nursing diagnosis for a gastroenterology patient should be

A. Potential burn resulting fro electrosurgery
B. Swallowing, impaired
C. Fluid volume deficit, possible, caused by nausea and pain
D. Skin integrity, potential for impairment

Answer 266

B. Swallowing, impaired

Question 267

A nursing diagnosis for a patient admitted to the endoscopy unit for a diagnostic Esophagogastroduodenoscopy (EGD) who is not responding to treatment for a gastric ulcer might be

A. Knowledge deficit
B. Sensory perception, altered
C. Ineffective therapeutic regimen
D. Airway clearance, ineffective

Answer 267

C. Ineffective therapeutic regimen

Question 268

Which of the following is not a valid reason for planning patient care based on nursing diagnoses?

A. It is required by managed care companies
B. It helps nurse to assign priorities of care
C. It improves the clarity of communication among nurses
D. It emphasizes the collegial relationship between nursing and medicine

Answer 268

A. It is required by managed care companies

Question 269

The nursing care plan and the medical care plan are both

A. Derived from assessment and inferences based on scientific knowledge
B. Are instituted and refined following initial and ongoing assessments
C. Prescribe measures based on bodies of scientific knowledge
D. All of the above

Answer 269

D. All of the above

Question 270

A nursing plan of care

A. Addresses only the biological factors of the patient’s health problems
B. Identifies pathological basis for illness
C. Focuses on the physical condition of the patient
D. Includes only actions that nurses can lawfully perform

Answer 270

D. Includes only actions that nurses can lawfully perform

Question 271

Assessment of the supplies and equipment needed to perform an endoscopic procedure is an example of

A. Initial planning
B. Admission planning
C. Ongoing planning
D. Discharge planning

Answer 271

A. Initial planning

Question 272

Intra-procedural changes in the patient’s health status may affect

A. The nursing diagnosis
B. The expected outcomes
C. The plan of care
D. All of the above

Answer 272

D. All of the above

Question 273

Discharge planning begins on admission and

A. Is the responsibility of the physician
B. Is the responsibility of the nurse
C. Is a multidisciplinary task
D. Should not include patient participation

Answer 273

C. Is a multidisciplinary task

Question 274

To help broaden the array of treatment options available to them, nurses should consult successful colleagues, the literature, standards of care, and

A. The taxonomy of nursing diagnoses
B. The plan of care
C. Patients and their families
D. Physicians

Answer 274

C. Patients and their families

Question 275

In response to a patient’s fluid deficit secondary to persistent diarrhea, which of the following nursing orders would be appropriate for the gastroenterology nurse to write

A. “Increase the IV rate following bouts of diarrhea”
B. Prepare patient for electrosurgery”
C. Monitor vital signs every 2 hours until diarrhea stops. Observe for signs of hypotension with widening pulse pressure”
D. Collect stools for culture in the am and pm

Answer 275

C. Monitor vital signs every 2 hours until diarrhea stops. Observe for signs of hypotension with widening pulse pressure

Question 276

The final product of the planning phase of the nursing process is

A. A well-documented plan of care
B. The clinical pathway
C. A series of outcome statements
D. Nursing interventions

Answer 276

A. A well-documented plan of care

Question 277

The benefits of implementing clinical pathways including all of the following except

A. Supporting the use of evidenced based practice
B. Appearing to provide depersonalized care
C. Improving health care team communication
D. Providing a baseline for care

Answer 277

B. Appearing to provide depersonalized care

Question 278

The implementation phase of the nursing process is characterized by all of the following except that:

A. Evaluation criteria are developed against which the effectiveness of nursing intervention can be measured
B. The nursing plan of care is put in motion
C. The database is updated as data collection continues
D. Nursing care and patient progress are documented and communicated

Answer 278

A. Evaluation criteria are developed against which the effectiveness of nursing intervention can be measured

Question 279

The act of rendering guidance or assisting a patient with problem-solving is

A. Referring
B. Consulting
C. Counseling
D. Teaching

Answer 279

C. Counseling

Question 280

Carrying out the plan of care requires all of the following except

A. Cognitive ability
B. Technical skill
C. Interpersonal skill
D. Delegation

Answer 280

Delegation

Question 281

A gastroenterology nurse might vary the way he or she comforts an anxious 10-year-old boy based on

A. The developmental task of children in the 7-11-year-old age group
B. His willingness to participate in counseling
C. Recent findings concerning the impact of certain words in calming or provoking anxiety
D. All of the above

Answer 281

D. All of the above

Question 282

Assisting with a procedure is

A. An independent nursing activity
B. An interdependent task
C. A dependent nursing activity
D. A non-nursing chore

Answer 282

C. A dependent nursing activity

Question 283

Nurses accomplish patient teaching in four phases, including planning the learning activity, providing learning opportunity, evaluate learning, and

A. Correcting mistakes
B. Diagnosing a patient’s knowledge deficit
C. Explaining the patient’s privacy needs to significant others
D. Helping patients make informed decisions

Answer 283

B. Diagnosing a patient’s knowledge deficit

Question 284

Data collection activities serve three important functions during implementation by each of the following except

A. Comparing new data against the baseline to enable the nurse to identify pattern and trends
B. Collecting data following nursing intervention to allow the nurse to evaluate the effectiveness of the nursing actions according to evaluation criteria listed in the care plan
C. Revising the plan of care as the database is updated
D. Implementing motivational counseling to stimulate drive and ambition

Answer 284

D. Implementing motivational counseling to stimulate drive and ambition

Question 285

A research nurse wants a gastroenterology nurse’s patient to participate in a research study. Whose responsibility is it to obtain the patient’s consent?

A. The research nurse
B. The physician
C. The legal department
D. The gastroenterology nurse

Answer 285

A. The research nurse

Question 286

Suggested guidelines for implementation of nursing care include all of the following except

A. Think critically about the plan of care, always questioning whether routines are really the best method of treatment
B. Consult immediate colleagues, colleagues in related nursing fields, and relevant literature to discover more effective ways of managing health problems
C. Assess the patient to be sure that the action is still necessary before instituting any measure to treat a health problem
D. Document his or her action

Answer 286

D. Document his or her action

Question 287

Ethical confits in nursing are on the rise due to several factors/ these include all of the following except

A. An aging society
B. Increased resources
C. Changes in the financial healthcare arena
D. Changing public expectations of the healthcare system

Answer 287

B. Increased resources

Question 288

The reasons why nursing professionals evaluate the quality of care include all of the following except

A. Nurses recognize that a classification system for nursing diagnoses is important
B. Nurses aim to promote excellence in nursing care
C. Nurses must be accountable to society for the quality of care they provide
D. Nurses want to improve professional performance by identifying deficiencies in care provided and, therefore; educational needs, and to analyze and explain the differences in patterns of practice and results of care

Answer 288

A. Nurse recognize that a classification system for nursing diagnoses is important

Question 289

Criteria are

A. Nationally recognized standards
B. Facts
C. Interventions
D. Measurable

Answer 289

D. Measurable

Question 290

evaluation of nursing care consists of

A. Examining the cost-effectiveness of nursing actions, the efficiency of admission and discharge, and the rate of patient readmission
B. Determining whether a patient has achieved outcomes or is making progress toward goals developed in the outcome identification stage of care, whether nursing interventions chosen to treat identified health problems are effective in reducing or resolving identified health problems, and whether healthcare provided has been effective overall
C. Verifying whether policies and procedures are eliminating problems, whether the doctors are practicing according to the dictums of their specialty, and whether adequate staffing is available in nursing units
D. Examining nursing volumes; identifying structure, process, and outcome criteria; and executing performance appraisals to credit individual resistance to quality practices

Answer 290

B. Determining whether a patient has achieved outcomes or is making progress toward goals developed in the outcome identification stage of care, whether nursing interventions chosen to treat identified health problems are effective in reducing or resolving identified health problems, and whether healthcare provided has been effective overall

Question 291

Evaluative statements

A. Must include the patient’s response to care provided
B. Must describe actual outcomes of care
C. May describe ongoing assessment data used to revise diagnoses and outcomes
D. All of the above

Answer 291

D. All of the above

Question 292

Changes in values, beliefs, and attitudes are difficult to evaluate because

A. They define less measurable behavioral differences
B. Survey questionnaires used to evaluate them are rarely valid
C. There is little value placed on casual conversation with patients
D. All of the above

Answer 292

A. They define less measurable behavior differences

Question 293

A quality improvement (QI) review is

A. An acceptable, expected level of performance established by authority, custom, or consent
B. An ongoing process of review in which data collected over a period of time are used to compare actual practice against standards of practice to determine if the care actually rendered meets a level of quality deemed acceptable within a practice setting
C. A description to help determine whether specific objectives were met during the period of time outlined
D. A statement defining an actual outcome (e.g., skills developed, knowledge obtained, change in health status)

Answer 293

B. An ongoing process of review in which data collected over a period of time are used to com[are actual practice against standards of practice to determine if the care actually rendered meets a level of quality deemed acceptable within a practice setting

Question 294

The evaluation of patient care outcomes should be

A. An independent role of the nurse leader
B. Only performed in the event of a bad outcome
C. Performed jointly by the nurse, the patient, and the rest of the healthcare team involved with the patient’s care
D. Performed by the physician post-procedure

Answer 294

C. Performed jointly by the nurse, the patient, and the rest of the healthcare team involved with the patient’s care

Question 295

Cognitive outcomes

A. Define increases in knowledge
B. Related to changes in the patient’s values, beliefs, and attitudes
C. Address the achievement of new, learned skills
D. None of the above

Answer 295

A. Define increases in knowledge

Question 296

Throughout the evaluation phase of the nursing process

A. Expected patient outcomes are identified
B. Actual patient interventions are performed
C. Outcome achievement is determined
D. A nursing diagnosis is synthesized

Answer 296

C. Outcome achievement is determined

Question 297

In adults the approximate length of the esophagus is

A. 15cm
B. 25cm
C. 35cm
D. 45cm

Answer 297

B. 25cm

Question 298

The outermost layer of the esophagus is made up of

A. Mucosa
B. Submucosa
C. Muscularis
D. Serosa

Answer 298

C. Muscularis

Question 299

The progressive circular muscle contraction initiated by esophageal distention is known as

A. Achalasia
B. Diffuse esophageal spasm
C. Primary peristalsis
D. Secondary peristalsis

Answer 299

D. Secondary peristalsis

Question 300

The first step in the treatment of GERD is

A. Lifestyle modification
B. Drug therapy
C. Dilation
D. Anti reflux surgery

Answer 300

A. Lifestyle modification

Question 301

A form of metaplasia in the esophagus in which normal squamous epithelium is replace by one or more types of columnar epithelium results in

A. Esophageal reflux
B. Esophageal candidiasis
C. Barrett’s esophagus
D. Esophageal cancer

Answer 301

C. Barrett’s esophagus

Question 302

Life-threatening bleeding is a frequent complication of

A. Esophageal varices
B. Esophageal reflux
C. Esophageal tumors
D. Zenker’s diverticulum

Answer 302

A. Esophageal varices

Question 303

Outpouchings of the esophageal wall located immediately above the lower esophageal sphincter are known as

A. Zenker’s diverticula
B. Traction diverticula
C. Epiphrenic diverticula
D. Intramural diverticulosis

Answer 303

Epiphrenic diverticula

Question 304

The most frequently observed foreign-body obstruction in the esophagus of adults is a

A. Coin
B. Piece of bone
C. Hard candy
D. Piece of meat

Answer 304

D. Piece of meat

Question 305

The most common causes of infectious disease in the esophagus include all of the following except

A. Cytomegalovirus
B. Herpes simplex virus
C. Candidiasis
D. Giardiasis

Answer 305

D. Giardiasis

Question 306

Esophageal fistulas in adults are most often caused by

A. Trauma
B. Foreign-body obstruction
C. Cancer
D. Congenital defects

Answer 306

C. Cancer

Question 307

Entry of food into the stomach is controlled by the

A. Lower esophageal sphincter
B. Fundus
C. Pyloric sphincter
D. Antrum

Answer 307

A. Lower esophageal sphincter

Question 308

The layers of the stomach are the mucosa, the submucosa, the muscularis, and the

A. Rugae
B. Cardia
C. Serosa
D. Connective tissue

Answer 308

C. Serosa

Question 309

The parietal cells secrete

A. Mucus
B. Hydrochloric acid and intrinsic factor
C. Pepsinogens
D. Gastrin

Answer 309

B. Hydrochloric acid and intrinsic factor

Question 310

Intrinsic factor is necessary for the

A. Conversion of pepsinogens to pepsin
B. Secretin of mucus
C. Absorption of vitamin B12
D. Secretion of hormones

Answer 310

C. Absorption of vitamin B12

Question 311

The gastric emptying rate is controlled by neural impulses, hormones secreted by the small intestine, and

A. The amount of food ingested
B. The composition of the chyme
C. The amount of gastric secretions
D. Vitamin B12 absorption

Answer 311

B. The composition of the chyme

Question 312

H.pylori infection

A. Has been associated with gastric cancer
B. Is a virus of the stomach
C. Should be treated by surgical resection
D. Is not detectable by biopsy

Answer 312

A. Has been associated with gastric cancer

Question 313

Most gastric cancers are of which of the following types

A. Adenocarcinomas
B. Leiomyosarcomas
C. Sarcomas
D. Lymphomas

Answer 313

A. Adenocarcinomas

Question 314

Cushing’s’ s ulcers are a form of

A. Specific gastritis
B. Nonerosive, nonspecific gastritis
C. Peptic ulcers
D. Stress ulcers

Answer 314

D. Stress ulcers

Question 315

Gastric surgery may lead to rapid gastric empty and a group of disabling symptoms that can cause reactive hypoglycemia. This syndrome is called

A. Curling’s syndrome
B. Paterson-Kelly syndrome
C. Dumping syndrome
D. Cushing’s syndrome

Answer 315

C. Dumping syndrome

Question 316

The best technique for diagnosing a bezoar is

A. Plain x-rays
B. Palpation
C. Gastroscopy
D. Upper GI series

Answer 316

C. Gastroscopy

Question 317

The proximal two-fifths of the small intestine is known as the

A. Duodenum
B. Ileum
C. Jejunum
D. Cecum

Answer 317

C. Jejunum

Question 318

The mucous layer (mucosa) of the small intestine formed villi and is lined with

A. Simple epithelial cells
B. Columnar epithelium
C. Connective tissue
D. Peritoneum

Answer 318

B. Columnar epithelium

Question 319

The principal function of Brunner’s glands is to

A. Synthesize antibodies
B. Absorb nutrients
C. Secrete a viscous, alkaline fluid
D. Secrete hormones

Answer 319

C. Secrete a viscous, alkaline fluid

Question 320

The primary site of absorption for vitamin B12 and bile acids is the

A. Duodenum
B. Jejunum
C. Ileum
D. Stomach

Answer 320

C. Ileum

Question 321

The intestinal contents are constantly being stirred by

A. Active transport
B. Segmenting contractions
C. Peristalsis
D. Shortening and lengthening of the villi

Answer 321

D. Shortening and lengthening of the villi

Question 322

Segmental submucosal inflammation and a cobblestone appearance of the bowel wall is associated with

A. Ulcerative colitis
B. Crohn’s disease
C. Duodenal ulcers
D. Celiac spru

Answer 322

B. Crohn’s disease

Question 323

The most effective treatment for symptomatic Meckel’s diverticulum is

A. Diverticulectomy
B. Antibiotic therapy
C. Bowel resection
D. Dietary modification

Answer 323

A. Diverticulectomy

Question 324

Most peptic ulcers occur in the

A. Stomach
B. Duodenum
C. Ileum
D. Jejunum

Answer 324

B. Duodenum

Question 325

A malabsorption syndrome characterized by gluten intolerance is

A. Cystic fibrosis
B. Whipple disease
C. Tropical sprue
D. Celiac disease

Answer 325

D. Celiac disease

Question 326

Primary carcinomas of the proximal small intestine are virtually all

A. Lymphomas
B. Melanomas
C. Adenocarcinomas
D. Sarcomas

Answer 326

C. Adenocarcinomas

Question 327

The first portion of the large intestine to receive material from the small bowel is the

A. Ileum
B. Cecum
C. Appendix
D. Ascending colon

Answer 327

B. Cecum

Question 328

Small sacculations in the large intestinal wall that are formed by the Tania coli are the

A. Haustra
B. Diverticula
C. Crypts of Lieberkuhn
D. Plicae semilunares

Answer 328

A. Haustra

Question 329

The colonic mucosa is

A. Made up of thousands of finger-like projections called villi
B. Covered with a layer of squamous epithelium
C. Arranged in folds called the plicae circulares
D. Smooth-surfaced

Answer 329

D. Smooth-surfaced

Question 330

Colonic secretion consists primarily of

A. Sodium, chloride, and water
B. Water, mucus, potassium, and bicarbonate
C. Mucus and hormones
D. Bile pigments and toxins

Answer 330

B. Water, mucus, potassium, and bicarbonate

Question 331

The appearance of multiple adenomatous polyps in the GI tract and osteopathic of the mandible, skull and long bones is symptomatic of

A. Osler-Weber-Rendu disease
B. Colorectal cancer
C. Familial adenomatous polyposis (FAP)
D. Gardner syndrome

Answer 331

D. Gardner syndrome

Question 332

Toxic mega colon is a potentially serious complication of

A. Ischemic colitis
B. Ulcerative colitis
C. Pseudomembranous colitis
D. Transmural colitis

Answer 332

B. Ulcerative colitis

Question 333

Mildly symptomatic diverticular disease is most often treated by

A. Diverticulectomy
B. Colon resection
C. Dietary management and hydrophilic colloids or bulk-forming laxatives
D. Colostomy

Answer 333

C. Dietary management and hydrophilic colloids or bulk-forming laxatives

Question 334

Metastatic colorectal cancer most often involves the

A. Small bowel
B. Liver
C. Pancreas
D. Stomach

Answer 334

B. Liver

Question 335

A hollow, fibrous tract leading from the anal canal or rectum to the perianal skin is called a(n)

A. Hemorrhoid
B. Anorectal fissure
C. Anorectal abscess
D. Anorectal fistula

Answer 335

D. Anorectal fistula

Question 336

Encopresis commonly seen in school-age children, particularly boys, is define as

A. Involuntary nocturnal passage of urine
B. Involuntary leakage of stool
C. Nocturnal awakening with abdominal pain
D. Infectious diarrhea with fecal incontinence

Answer 336

B. Involuntary leakage of stool

Question 337

The gallbladder wall is made up of

A. Serosa, muscularis, submucosa, and mucosa
B. Serosa, a fibromuscular layer, and mucosa
C. Muscularis, submucosa, and mucosa
D. Serosa, a fibromuscular layer, submucosa, and mucosa

Answer 337

B. Serosa, a fibromuscular layer, and mucosa

Question 338

Blood is supplied to the gallbladder by the

A. Superior mesenteric artery
B. Hepatic artery
C. Celiac artery
D. Inferior phrenic artery

Answer 338

B. Hepatic artery

Question 339

What is the maximum amount of bile that can be stored in the gallbladder

A. 5ml
B. 10ml
C. 50ml
D. 500ml

Answer 339

C. 50ml

Question 340

What is the major component of the bile that is produced by the liver

A. Cholesterol
B. Bilirubin
C. Bile salts
D. Water

Answer 340

D. Water

Question 341

By far, the most common disease affecting the biliary system is

A. Choledocholithiasis
B. Cholecystitis
C. Cholelithiasis
D. Cholangitis

Answer 341

C. Cholelithiasis

Question 342

Chronic hemolytic disease, total Parenteral nutrition (TPN), and alcoholism are among the risk factors for the formation of

A. Cholesterol gallstones
B. Pigment gallstones
C. Cholangitis
D. Gallbladder cancer

Answer 342

B. Pigment gallstones

Question 343

The primary disadvantage of most non surgical treatment alternative to cholecystectomy is

A. Potential recurrence of Cholelithiasis after cessation of treatment
B. Unpleasant side effects
C. The need for specialized equipment
D. The need for specially trained personal

Answer 343

A. Potential recurrence of Cholelithiasis after cessation of treatment

Question 344

For most patients, the treatment of choice for choledocholithiasis is

A. Sphincteroplasty
B. Cholecystectomy
C. Dissolution of stones using ursodiol or Chenodiol
D. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and stone removal

Answer 344

B. Cholecystectomy

Question 345

The most common cause of Cholecystitis is

A. Cholecystenteric fistula
B. Bacterial infection
C. A gallstone impacted in the cystic duct
D. Gallstone ileus

Answer 345

C. A gallstone impacted in the cystic duct

Question 346

Treatment for cancer of the gallbladder most often involves

A. Supportive and symptomatic measures only
B. Cholecystectomy
C. Pacreaticoduodenectomy
D. Insertion of an internal drainage system

Answer 346

A. Supportive and symptomatic measures only

Question 347

The sphincter of Oddi functions to

A. Regulate bile and pancreatic juice flow
B. Inhibit entry of bile into the pancreatic duct
C. Prevent reflux of intestinal content into the biliary duct
D. All of the above

Answer 347

D. All of the above

Question 348

The majority of the pancreatic tissue is made up of

A. Acinar cells
B. Alpha cells
C. Beta cells
D. Delta cells

Answer 348

A. Acinar cells

Question 349

The endocrine cells of the pancreas are located in the

A. Crypts of Lieberkuhn
B. Islets of Langerhans
C. Ducts of Wirsung
D. Pancreatic lobules

Answer 349

B. Islets of Langerhans

Question 350

The beta cells secrete

A. Somatostatin
B. Glucagon
C. Vasoactive intestinal peptide
D. Insulin

Answer 350

D. Insulin

Question 351

The cephalic phase of pancreatic secretion is stimulated by

A. Gastric distention
B. The sight and smell of food
C. The presence of acidic chyme in the small intestine
D. The presence of alkaline chyme in the small intestine

Answer 351

B. The sight and smell of food

Question 352

The most severe form of pancreatitis is

A. Chronic pancreatitis
B. Necrotizing pancreatitis
C. Interstitial pancreatitis
D. Alcoholic pancreatitis

Answer 352

B. Necrotizing pancreatitis

Question 353

A sac-like structure that is filled with pancreatic fluid 6 weeks after an attack of pancreatitis is called a

A. Pancreatic rest
B. Pancreas divisum
C. Annular pancreas
D. Pseudocyst

Answer 353

D. Pseudocyst

Question 354

The most specific diagnostic and staging test for pancreatic cancer is

A. ERCP
B. PTC
C. Ultrasound
D. EUS

Answer 354

D. EUS

Question 355

Zollinger-Ellison syndrome often results in what clinical manifestation

A. Peptic ulcer disease
B. Steatorrhea
C. Necrolytic migratory erythema
D. Pancreatic cholera syndrome

Answer 355

A. Peptic ulcer disease

Question 356

The preferred treatment for most islet cell tumors is

A. Supportive and palliative measures only
B. Radiotherapy
C. Chemotherapy
D. Surgical excision

Answer 356

D. Surgical excision

Question 357

The definitive diagnostic test for cystic fibrosis is the

A. Sweat electrolyte test
B. Schilling test
C. Bernstein test
D. Serum amylase and lipase level

Answer 357

A. Sweat electrolyte test

Question 358

Pancreatic insufficiency in children is often seen in

A. Malabsorption
B. Steatorrhea
C. Maldigestion
D. Cystic fibrosis

Answer 358

D. Cystic fibrosis

Question 359

The most prevalent clinical feature of Shwachman-Diamond syndrome is

A. Stunted growth
B. Jaundice
C. Pigmented retinopathy
D. Edematous extremities

Answer 359

A. Stunted growth

Question 360

The five leading causes of acute pancreatitis in children are

A. Malabsorption, steatorrhea, maldigestion, infection and tumor
B. High-fat diet, high potassium level, high sugar consumption, high calcium level, and high amylase level
C. Biliary disorders, medications, an idiopathic cause, systemic disease, and trauma
D. Parasitic diseases, immunocompromised state, congenital defects, tumor, and steatorrhea

Answer 360

C. Biliary disorders, medications, an idiopathic cause, systemic disease, and trauma

Question 361

Which organization’s guidelines and recommendations are used in the care and treatment of the cancer patient

A. American Cancer Society (ACS)
B. National Institutes of Health (NIH)
C. National Comprehensive Cancer Network (NCCN)
D. Public Health Department

Answer 361

C. National Comprehensive Cancer Network (NCCN)

Question 362

In the liver, bile is secreted by

A. Sinusoids
B. Hepatocytes
C. Glisson’s capsule
D. Kupffer cells

Answer 362

B. Hepatocytes

Question 363

Seventy-five percent of blood flow into the liver is delivered via the

A. Inferior vena cava
B. Hepatic artery
C. Portal vein
D. Splenic artery

Answer 363

C. Portal vein

Question 364

In the liver, carbohydrates are metabolized to

A. Glycogen
B. Amino acids
C. Ammonia
D. Glycerol

Answer 364

A. Glycogen

Question 365

The primary physiological function of Kupffer cells is

A. Metabolism
B. Production of prothrombin and fibrinogen
C. Vitamin storage
D. Phagocytosis of harmful substances

Answer 365

D. Phagocytosis of harmful substances

Question 366

A definitive diagnosis of cirrhosis is obtained through

A. Observation of Kayser-Fleischer ring on the cornea
B. Ultrasonography or CT scan
C. Palpation of the liver
D. Biopsy of the liver

Answer 366

D. Biopsy of the liver

Question 367

Patients with hemochromatosis must avoid

A. Iron and vitamin C supplements
B. Vegetables
C. Red meat
D. Deep fried seafood

Answer 367

A. Iron and vitamin C supplements

Question 368

HBV infection treatment includes all of the following except

A. Nutritional balanced diet
B. Rest from strenuous physical activity
C. Octreotide
D. IV hydration and electrolyte management

Answer 368

C. Octreotide

Question 369

Accumulation of excessive amounts of copper in certain body tissues is characteristic of

A. Intrahepatic biliary dysplasia
B. Primary liver cancer
C. Wilson’s disease
D. Porphyria

Answer 369

C. Wilson’s disease

Question 370

Chronic, blistering, cutaneous lesions on parts of the skin that are exposed to the sun, mild liver disease, and lack of neuropsychiatric manifestations are characteristics of

A. Acute intermittent porphyria
B. Hereditary porphyria
C. Variegate porphyria
D. Porphyria cutanea tarda

Answer 370

D. Porphyria cutanea tarda

Question 371

The most common cause of ascites is

A. Cancer
B. Portal hypertension secondary to cirrhosis
C. Hepatitis C. Virus infection
D. Heart failure

Answer 371

B. Portal hypertension secondary to cirrhosis

Question 372

Treatment for alcoholic hepatitis can include the following except

A. Alcohol abstinence
B. Corticosteroids
C. Tylenol (acetaminophen)
D. Pentoxil (pentoxifylline)

Answer 372

C. Tylenol

Question 373

Assessing portal hypertension in cirrhosis of the liver is done by

A. Administer a splanchnic vasoconstrictor such as octreotide and monitor its effect
B. Liver biopsy under ultrasound
C. Measure the hepatic vein pressure gradient (HVPG)
D. Perform an EGD to assess for esophageal varices

Answer 373

C. Measure the hepatic vein pressure gradient (HVPG)

Question 374

The most common risk factors for NASH are

A. Poisoning and infectious diseases
B. Obstruction of the hepatic venous outflow tract
C. Obesity, type 2 diabetes, and hyperlipidemia
D. Cholestasis and drug-related hepatotoxic reaction

Answer 374

C. Obesity, type 2 diabetes, and hyperlipidemia

Question 375

When used in a medication order, the abbreviation “ac” indicated that the drug is to be administered”

A. At mealtime
B. At bedtime
C. Before meals
D. As needed

Answer 375

C. Before meals

Question 376

One kilogram is equivalent to approximately:

A. 2.2pounds
B. 22 ounces
C. 20 pounds
D. 1,000 ounces

Answer 376

A. 2.2 pounds

Question 377

Pediatric dosages are usually calculated based on the child’s

A. Weight in kilograms
B. Height and weight
C. Age
D. Surface area

Answer 377

A. Weight in kilograms

Question 378

For optimal effect, antacids should be given

A. Before meals
B. Immediately after meals
C. One hour after meals
D. At bedtime

Answer 378

C. One hour after meals

Question 379

Antacids work by

A. Decreasing acid secretion
B. Coating or protecting mucous lining
C. Reducing total acid load
D. Decreasing gastric pH

Answer 379

C. Reducing total acid load

Question 380

Anticholinergics are primarily used as adjunct therapy for peptic ulcer disease in combination with

A. Cholinergics
B. Sedatives
C. Antacids or H2 blockers
D. Antiflatulents or antiemetics

Answer 380

C. Antacids or H2 blockers

Question 381

Corticosteroids are used most often in gastroenterology in patients who have

A. Inflammatory bowel disease
B. Peptic ulcers
C. Pancreatic exocrine insufficiency
D. Cholelithiasis

Answer 381

A. Inflammatory bowel disease

Question 382

The purpose of glucagon in GI diagnostic testing is to

A. Reduce GI motility
B. Stimulate gastric acid secretion
C. Stimulate production of bile
D. Increase GI motility

Answer 382

A. Reduce GI motility

Question 383

The use of sedatives to achieve moderate sedation for endoscopic procedures requires

A. Ability to continuously monitor the patients
B. Sedation competency by the practitioners
C. Resuscitative equipment readily available
D. All of the above

Answer 383

D. All of the above

Question 384

Omeprazole (Prilosec) is a proton pump inhibitor (PPI) that

A. Inhibits production of stomach acid
B. Can cause bleeding
C. Increases the production of stomach acid
D. Is used to treat ulcerative colitis

Answer 384

A. Inhibits production of stomach acid

Question 385

Salts that dissociate in solution into positive and negative ions are called

A. Anions
B. Cations
C. Electrolytes
D. Colloids

Answer 385

C. Electrolytes

Question 386

The preferred instrument for delivering short-term peripheral IV therapy is an

A. Stainless-steel needle
B. Over-the-needle catheter
C. In-the-needle catheter
D. Cannula

Answer 386

B. Over the needle catheter

Question 387

A peripheral IV cannula would most likely be inserted in the

A. Cephalic vein
B. Femoral vein
C. Superior vena cava
D. Radial artery

Answer 387

A. Cephalic vein

Question 388

The recommended antiseptic for venipuncture site preparation in adults is

A. Alcohol
B. Povidone iodine
C. Chlorehexidine Gluconate
D. Neosporin

Answer 388

C. Chlorehexidine Gluconate

Question 389

Drugs should never be added to blood transfusions because

A. They are incompatible
B. It complicates determination of the source of any adverse reaction
C. Drugs can cause clotting
D. The rate of infusion is too slow

Answer 389

B. It complicates determination of the source of any adverse reaction

Question 390

Central venous catheters are used for long-term IV therapy or for repeated venous access, and

A. Are inserted into large veins
B. Are threaded into the lower third of the superior vena cava
C. Can be used for medication administration
D. All of the above

Answer 390

D. All of the above

Question 391

The following are examples of isotonic solutions except

A. 0.9% NaCl
B. 0.45% NaCl
C. D5W
D. Lactated Ringers

Answer 391

B. O.45% NaCl

Question 392

What is the best substance to transfuse in patients with a decreased oxygen carrying capacity

A. Packed RBCs
B. Platelets
C. Plasma
D. Whole blood

Answer 392

A. Packed RBCs

Question 393

If the patient experiences an adverse reaction to a blood transfusion, the first thing the nurse should do is

A. Assess the patient’s vital signs
B. Stop the transfusion
C. Compare labels on blood containers with the patient’s identification forms
D. Return the blood to the blood bank

Answer 393

B. Stop the transfusion

Question 394

Hemolytic reactions to blood transfusions usually occur

A. Immediately
B. Within the first 5-15 minutes of the transfusion
C. Within 24 hours
D. As long as 6 months after the transfusion

Answer 394

B. Within the first 5-15 minutes of the transfusion

Question 395

Excess glucose is stored in the liver and in the muscles in the form of:

A. Adipose tissue
B. Glycogen
C. Disaccharides
D. Triglycerides

Answer 395

B. Glycogen

Question 396

If a patient is in negative nitrogen balance, that means he or she is:

A. Building new tissue
B. Ingesting the proper amount of protein
C. Eating too much protein
D. Losing more protein than he or she is taking in

Answer 396

D. Losing more protein than he or she is taking in

Question 397

Patients with celiac disease must avoid eating:

A. Gluten
B. Fiber
C. Sodium
D. Protein

Answer 397

A. Gluten

Question 398

Low-fat diets are usually used to control:

A. Steatorrhea and diarrhea
B. Intestinal gas and bloating
C. Ascites
D. Constipation

Answer 398

A. Steatorrhea and diarrhea

Question 399

The primary disadvantage of using a nasogastric feeding tube is:

A. Risk of aspiration
B. Patient discomfort
C. Risk of infection
D. High cost

Answer 399

A. Risk of aspiration

Question 400

Peripheral Parenteral nutrition (PPN) is most appropriate for

A. Patient who need nutritional supplementation for less than 1 week
B. Patients with inadequate fat stores
C. Patients who require concentrated feeding solutions
D. Patients who are eating and getting sufficient calories

Answer 400

A. Patient who need nutritional supplementation for less than 1 week

Question 401

The most common complication in patients receiving total Parenteral nutrients (TPN) is

A. Thoracic injury
B. Air embolism
C. Metabolic imbalance
D. Catheter-related sepsis

Answer 401

D. Catheter-related sepsis

Question 402

Utilizing the 4R GI restoration program “Remove” focuses on eliminating all of the following except for

A. Parasites
B. Viruses
C. GI enzymes
D. Fungi

Answer 402

C. GI enzymes

Question 403

“Regenerate” refers to

A. Introduction of probiotics
B. Providing support for prebiotics
C. Re-introduction of desirable bacteria
D. Providing support for healing and regeneration of GI mucosa

Answer 403

D. Providing support for healing and regeneration of GI mucosa

Question 404

Re-introduction of probiotics into the intestine to reestablish micro flora balance would be part of which program

A. Regenerate
B. Modify
C. Reinoculate
D. Support

Answer 404

C. Reinoculate

Question 405

The enzymes proteases, lipases, and saccharides are part of which concept of GI restoration

A. Regenerate
B. Modify
C. Remove
D. Replace

Answer 405

D. Replace

Question 406

The probiotic responsible for being the first flora to colonize the intestines of newborns is

A. Lactobacillus acidophilus
B. Lactobacillin
C. Lactobacillus bulgaricus
D. Bifidobacterium infantis

Answer 406

D. Bifidobacterium infantis

Question 407

Prebiotics mainly stimulates the growth of

A. Fructo-oligosaccharides
B. Probiotics
C. a&b
D. Bifidobacterium

Answer 407

D. Bifidobacterium

Question 408

Oligosaccharides are classified as

A. Probiotics
B. Prebiotics
C. Disaccharides
D. Short chain fatty acids

Answer 408

B. Prebiotics

Question 409

Fructo-oligosaccharides, lactilol, and insulins belong to a group known as

A. Prebiotics
B. Short chain fatty acids
C. A&B
D. Oligosaccharides

Answer 409

A. Prebiotics

Question 410

The endoscopes used in EGD can visualize the upper GI tract as far as the

A. Pylorus
B. Ampulla of Vater
C. Proximal duodenum
D. Ileocecal valve

Answer 410

C. Proximal duodenum

Question 411

According to ASA guidelines, before moderate sedation or analgesia is provided for an EGD, the adult patient should be NPO from solids or full liquids for at least

A. 2 hours
B. 6 hours
C. 12 hours
D. 24 hours

Answer 411

B. 6 hours

Question 412

The most significant complication(s) associated with ERCP is (are)

A. Perforation
B. Adverse effects of medication
C. Hemorrhage
D. Pancreatitis and sepsis

Answer 412

D. Pancreatitis and sepsis

Question 413

The most common cause(s) of bright red rectal bleeding in adults and children is (are)

A. Inflammatory bowel disease
B. Perforation
C. Hemorrhoids and fissures
D. Bleeding ulcers and varices

Answer 413

C. Hemorrhoids and fissures

Question 414

One contraindication for rigid proctosigmoidoscopy is

A. Severe cardiac arrhythmias
B. Previous rectal surgery
C. Rectal bleeding
D. Rectal pain

Answer 414

A. Severe cardiac arrhythmias

Question 415

The usual bowel preparation for flexible sigmoidoscopy in adults is

A. A single warm tap-water enema
B. Two warm tap-water or sodium biphosphate enemas
C. A two-day liquid diet, followed by a strong laxative
D. Electrolyte lavage

Answer 415

B. Two warm tap-water or sodium biphosphate enemas

Question 416

For an enteroscopy procedure the patient should be positioned in the

A. Prone position
B. Supine position
C. Right lateral position
D. Left lateral position

Answer 416

D. Left lateral position

Question 417

Patients who will undergo colonoscopy usually receive

A. Local anesthesia only
B. IV moderate sedation and analgesia
C. General anesthesia
D. No sedation and analgesia or anesthesia

Answer 417

B. IV moderate sedation and analgesia

Question 418

Distention of the abdomen during flexible sigmoidoscopy is most likely caused by

A. Excessive insufflation of air
B. Excessive amounts of water used for irrigation
C. Perforation
D. Colonic obstruction

Answer 418

A. Excessive insufflation of air

Question 419

Small bowel enteroscopy (SBE) is indicated for patients with

A. Peptic ulcers
B. Inflammatory bowel disease
C. Persistent blood loss with no identifiable source
D. Intestinal polyps

Answer 419

C. Persistent blood loss with no identifiable source

Question 420

Esophageal manometry is contraindicated in patients with

A. Dysphagia
B. Recent gastric or esophageal surgery
C. Diabetes mellitus
D. Noncardiac chest pain

Answer 420

B. Recent gastric or esophageal surgery

Question 421

All the following are advantages of high-resolution impedance manometry (HRM) except

A. Enables the assessment of bolus transit
B. Requires a station pull-through of the LES
C. Enables visualization of the entire esophageal body and sphincters
D. Technically easier to perform and has a better patient tolerance

Answer 421

B. Requires a station pull-through of the LES

Question 422

Esophageal manometry is indicated for each of the following except

A. Evaluation of noncardiac chest pain
B. Preoperative assessment of peristaltic pressure in the esophagus
C. Determination of the location of the LES for pH probe placement
D. Evaluation of patients with symptoms of delayed gastric emptying

Answer 422

D. Evaluation of patients with symptoms of delayed gastric emptying

Question 423

Motility of the esophageal body is best assessed while the patient

A. Performs a series of liquid swallows
B. Performs a series of dry swallows
C. Take a series of deep breaths
D. Holds his or her breath and does not swallow

Answer 423

A. Performs a series of liquid swallows

Question 424

Failed peristalsis or spasm of the esophageal body and incomplete relaxation of the LES are manometric symptoms is associated with

A. Achalasia
B. Diffuse esophageal spasm (DES)
C. Jackhammer esophagus
D. Nonspecific esophageal motility disorders

Answer 424

A. Achalasia

Question 425

Manometric manifestations of advances scleroderma include

A. Simultaneous and repetitive esophageal contractions
B. Aperistalsis in the distal esophageal body and low to absent LES pressure
C. Abnormally high resting LES pressure
D. A mean contraction amplitude at least two standard deviations above normal

Answer 425

B. Aperistalsis in the distal esophageal body and low to absent LES pressure

Question 426

All of the following are true about IEM except

A. IEM is defined as low amplitude or non-transmitted contractions in the distal esophagus
B. IEM is highly associated with GERD
C. Greater than or equal to 50% weak test swallows
D. EGJ outlet obstruction always coexists with IEM

Answer 426

D. EGJ outlet obstruction always coexists with IEM

Question 427

All of the following statements are true with regard to sphincter of Oddi manometry except

A. Indicated in the diagnosis of papillary stenosis
B. Indicated in the diagnosis of motility disorders related to choledocholithiasis and pancreatitis
C. Indicated in the diagnosis of scleroderma
D. Usually obtained during ERCP

Answer 427

C. Indicated in the diagnosis of scleroderma

Question 428

Endoscopic biopsy is contraindicated in patients with

A. Carcinoma
B. Severe coagulopathy
C. Inflammatory bowel disease
D. GI polyps

Answer 428

B. Severe coagulopathy

Question 429

Frozen sections are used when

A. The biopsy specimen will be preserved for a long period of time
B. A fixative is needed to preserve the specimen
C. Immediate denial or confirmation of malignancy is required
D. A pathologist is not immediately available

Answer 429

C. Immediate denial or confirmation of malignancy is required

Question 430

The most likely complication of endoscopic biopsy is

A. Excessive bleeding
B. Infection
C. Tumor seeding
D. Nausea and vomiting

Answer 430

A. Excessive bleeding

Question 431

Suspected esophageal carcinoma is most often sampled using what technique

A. Endoscopic mucosal resection (EMR)
B. Needle aspiration
C. Endoscopic biopsy
D. Polypectomy

Answer 431

C. Endoscopic biopsy

Question 432

Specimens for biopsy of the upper portion of the small bowel are usually taken from what general area

A. The duodenum
B. The jejunum
C. The ileum
D. The ligament of Treitz

Answer 432

D. The ligament of Treitz

Question 433

During EUS-guided FNA, aspiration of tissue is accomplished using suction applied with

A. A syringe
B. A manometer
C. A special cannula
D. A propriety device

Answer 433

A. A syringe

Question 434

The length of time a patient should remain on his or her right side following a liver biopsy is

A. 1-2 hours
B. 4-6 hours
C. 6-8 hours
D. 8-10 hours

Answer 434

A.1-2 hours

Question 435

To prevent pleural cavity or diaphragm puncture during a Percutaneous liver biopsy, insertion of the needle in pediatric patient should be

A. Timed to the patient’s respiratory cycle
B. Done while the patient holds his or her breath on expiration
C. Done slowly
D. Done under ultrasonography or CT guidance

Answer 435

A. Timed to the patient’s respiratory cycle

Question 436

If single-use cytology brushes are sent intact to the laboratory, they should be moistened with

A. Sterile saline
B. Glutaraldehyde
C. Isopentane
D. Cellular fixative

Answer 436

A. Sterile saline

Question 437

Endoscopic submucosal dissection (ESD) requires

A. Use of a specialized knife
B. Use of a cytology brush
C. Use of a sphincterotome
D. Use of a guidewire

Answer 437

A. Use of a specialized knife

Question 438

The usual position of the patient during a barium swallow is

A. Standing
B. Sitting
C. Prone
D. Supine

Answer 438

D. Supine

Question 439

Which of the following is true about the TIPS procedure

A. A Percutaneously created low-resistance channel between the portal vein and the hepatic vein
B. Performed under fluoroscopic guidance
C. Effective in lowering portal pressure
D. All of the above

Answer 439

D. All of the above

Question 440

Patient teaching prior to capsule endoscopy should include which of the following

A. NPO after midnight
B. Iron tablets avoided 1 week prior to the test
C. MRIs must be avoided until confirmed excretion of the capsule
D. Abdominal pain, nausea, or vomiting require calling the physician
E. All of the above

Answer 440

E. All of the above

Question 441

The three-dimensional image produced by CT scan is based on

A. Differences in tissue density
B. Differential transmission of sound waves by different tissues
C. Differential uptake of radioactive isotopes
D. Visualization of radiopaque structures

Answer 441

A. Differences in tissue density

Question 442

Which of the following is true about magnetic resonance cholangiography

A. There is more radiation exposure than with a chest x-ray
B. A major shortcoming is the lack of ability to perform therapeutic interventions
C. The dye (gadolinium) used causes severe nausea
D. The patient must remain NPO after midnight prior to the procedure

Answer 442

B. A major shortcoming is the lack of ability to perform therapeutic interventions

Question 443

Gastric analysis is indicated in patients with all of the following, except

A. Intractable peptic ulcer symptoms
B. Suspected Zollinger-Ellison syndrome
C. Achlorhydria
D. Intolerance to lactose, lactulose, fructose, or sucrose

Answer 443

D. Intolerance to lactose, lactulose, fructose, or sucrose

Question 444

An increase in platelet levels could indicate

A. Myeloproliferative neoplasm
B. Systemic lupus erythematosus (SLE)
C. Cirrhosis
D. Crohn’s disease

Answer 444

A. Myeloproliferative neoplasm

Question 445

Extremely high levels of ALT are indicative of

A. Viral or drug-induced hepatitis
B. Biliary obstruction
C. Hepatocellular injury
D. Hepatic metastasis

Answer 445

A. Viral or drug-induced hepatitis

Question 446

Intrinsic factor is used to evaluate

A. Disaccharide tolerance
B. Vitamin B12 absorption
C. Immunity to hepatitis
D. Bilirubin levels

Answer 446

B. Vitamin B12 absorption

Question 447

The hydrogen/methane breath test is used for all of the following except

A. Small intestinal bacterial overgrowth
B. Short bowel syndrome
C. Diseases of the liver (specifically the biliary tract)
D. Sugar intolerance (lactose, lactulose, fructose, or sucrose)

Answer 447

C. Diseases of the liver (specifically the biliary tract

Question 448

The primary goal of most esophageal dilatation procedure is to

A. Permit passage of the endoscope
B. Allow the patient to eat and drink normally
C. Treat Achalasia
D. Cure esophageal cancer

Answer 448

B. Allow the patient to eat and drink normally

Question 449

Potential complications of esophageal dilation include all of the following except

A. Perforation
B. Aspiration
C. Diarrhea
D. Bleeding

Answer 449

C. Diarrhea

Question 450

A tungsten-filled silicone bougie with a tapered tip is called a

A. Maloney dilator
B. Hurst dilator
C. Balloon dilator
D. Savory-Gilliard dilator

Answer 450

A. Maloney dilator

Question 451

After bougienage with local anesthesia, the patient should remain NPO

A. For 2 hours
B. Until the gag reflux returns
C. Until the possibility of perforation has been ruled out
D. For 8 hours

Answer 451

B. Until the gag reflux returns

Question 452

Indications for bougienage include all of the following except

A. Chemically-induced strictures
B. Esophageal rings or webs
C. Bile duct strictures
D. Esophageal strictures

Answer 452

C. Bile duct strictures

Question 453

The method used most often for dilatation of pyloric stenosis is

A. A polyvinyl chloride dilator
B. A pneumatic balloon
C. A hydrostatic balloon
D. A silicone bougie

Answer 453

C. Hydrostatic balloon

Question 454

A hydrostatic dilating balloon is filled with dilute contrast media because

A. Full-strength contrast medium could crystallize
B. Full-strength contrast medium may cause an allergic reaction
C. It helps stimulate peristalsis, thus aiding passage of the balloon through the upper GI tract
D. It exerts more pressure than water or saline

Answer 454

A. Full-strength contrast medium could crystallize

Question 455

Indication for hydrostatic balloons of the biliary tract include all of the following except

A. Inflammatory strictures
B. Postoperative strictures, especially after liver transplantation
C. Sphincter of Oddi dysfunction
D. Diffuse esophageal spasm with a hypersensitive LES

Answer 455

D. Diffuse esophageal spasm with a hypersensitive LES

Question 456

In pneumatic dilatation, the balloon remains inflated

A. For up to 1 minute
B. For up to 10 minutes
C. Unlit the patient experiences chest pain
D. Until the preset pressure is obtained

Answer 456

A. For up to 1 minute

Question 457

Thermal coagulation of bleeding vessels is achieved in gastroenterology patients by using

A. Mono polar electrocautery
B. Bipolar electrocautery
C. Lasers
D. All of the above

Answer 457

D. All of the above

Question 458

Leakage of current in mono polar electrocoagulation can cause burns to the

A. Endoscopist
B. Patient
C. GI nurse or assistant
D. All of the above

Answer 458

D. All of the above

Question 459

When using bipolar electrocoagulation, all of the following are true except

A. There is less mucosal injury than mono polar
B. A grounding pad is needed
C. Silicone prevents tissue adherence
D. Perforation is a potential complication

Answer 459

B. A grounding pad is needed

Question 460

The type of laser used most often in endoscopic application is

A. Carbon dioxide
B. Nd: YAG
C. Argon
D. KTP/532

Answer 460

B. Nd: YAG

Question 461

Laser fibers used in endoscopic applications are cleaned with

A. Alcohol
B. Glutaraldehyde
C. Hydrogen peroxide
D. Sterile water

Answer 461

C. Hydrogen peroxide

Question 462

The specialized three-lumen tube with esophageal and gastric balloons used for esophagogastric tamponade is called a

A. Sengstaken-Blakemore tube
B. Linton tube
C. Minnesota tube
D. Salem sump tube

Answer 462

A. Sengstaken-Blakemore tube

Question 463

In esophagogastric tamponade, the esophageal ballon should be inflated to what pressure

A. 2.5-4.5mmHg
B. 25-45mmHg
C. 125-145mmHg
D. 1.0psi

Answer 463

B. 25-45mmHg

Question 464

The first line of treatment in patients with actively bleeding varices is usually

A. Hemoclip
B. Balloon tamponade
C. Band ligation
D. Electrocoagulation

Answer 464

C. Band ligation

Question 465

Severe chest pain that persists for more than 24 hours in patients who have undergone sclerotherapy for esophageal varices is most likely a result of

A. Myocardial infarction
B. Residual effects of the sclerosing agent
C. Aspiration pneumonia
D. Perforation

Answer 465

D. Perforation

Question 466

Which of the following statements is false

A. Esophageal varices can be treated with sclerotherapy
B. Multiple-band ligation is often complicated by Overtube trauma
C. Gastric varices do not respond well to invasive treatments
D. Eradication of varices may require an average of 5 sessions

Answer 466

B. Multiple-band ligation is often complicated by Overtube trauma

Question 467

If a patient belches after air is injected into a nasogastric tube, what is the most likely cause

A. The tube is curled in the patients mouth
B. The tube is in the patient’s esophagus
C. Stomach contents are blocking the patient’s airway
D. The tube is blocking the patient’s airway

Answer 467

B. The tube is in the patient’s esophagus

Question 468

Which of the following statements is false with regards to Ogilvie’s syndrome

A. The condition commonly occurs in young children
B. It is also known as a colonic pseudo-obstruction
C. Cecal perforation may result if decompression is not initiated
D. There are no physical barriers affecting the large intestine

Answer 468

A. The condition commonly occurs in young children

Question 469

After the patient’s tolerance of gastric lavage has been established, what volume of irrigation solution is used for each subsequent instillation

A. 50ml
B. 250ml
C. 500ml
D. 1000ml

Answer 469

C. 500ml

Question 470

For biliary decompression a polyethylene tube (inserted via a Duodenoscope) exits and drains to the outside through the patients

A. Mouth
B. Nose
C. Abdominal wall
D. Gastrostomy tube

Answer 470

A. Mouth

Question 471

The most common delayed complication of biliary stent placement is

A. Recurrent jaundice
B. Duodenal perforation
C. Hemorrhage
D. Pancreatitis

Answer 471

A. Recurrent jaundice

Question 472

A rectal tube should be left in place

A. Until decompression is achieved
B. For a maximum of 3 minutes
C. For a maximum of 30 minutes
D. For a maximum of 3 hours

Answer 472

For a maximum of 30 minutes

Question 473

Before abdominal paracentesis, why is it important for the patient to void

A. To keep the patient comfortable during the procedure
B. To reduce intra-abdominal pressure
C. To give a more accurate measure of abdominal girth
D. To avoid injury to the bladder when the needle is inserted

Answer 473

D. To avoid injury to the bladder when the needle is inserted

Question 474

Complications of temporary esophageal expanding stents include all of the following except

A. Post-procedure chest pain
B. Stent occlusion due to bolus of food
C. Esophagitis
D. Confusion

Answer 474

D. Confusion

Question 475

One complication that is unique to pancreatic stenting is

A. Stent migration
B. Stent occlusion
C. Stent-induced pancreatic ductal change
D. GERD

Answer 475

C. Stent-induced pancreatic ductal change

Question 476

Indications for pancreatic stent insertion include all of the following except

A. Pancreatic duct disruption
B. Sphinter of Oddi dysfunction
C. I resolved pancreatitis
D. Colonic pseudo-obstruction

Answer 476

D. Colonic pseudo-obstruction

Question 477

The safest way to remove a large or dangerous foreign body that cannot be pulled through an Overtube is by using

A. A laryngoscope and curved forceps
B. A grasping device
C. A foreign-body hood
D. Surgical intervention

Answer 477

A. A laryngoscope and curved forceps

Question 478

Alkaline substances from a small, button-type battery act rapidly on the mucosa and could lead to

A. Burns and pressure necrosis
B. Perforation
C. Esophagotracheal or esophagogastric fistula
D. All of the above

Answer 478

D. All of the above

Question 479

A polyvinyl Overtube is useful for

A. Removing foreign bodies from the duodenum
B. Removing small, button-type batteries
C. Protecting esophageal mucosa and airway
D. Breaking up food obstructions

Answer 479

C. Protecting esophageal mucosa and airway

Question 480

Most pedunculated polyps are transected by use of

A. Pure cutting current on ESU
B. Cold biopsy forceps
C. Polypectomy snare
D. Surgical intervention only

Answer 480

C. Polypectomy snare

Question 481

The next important step immediately after a polypectomy is

A. Removal of grounding pad to check skin integrity
B. Observation of the patient for abdominal pain
C. Retrieval of the polyp
D. Placement of an endoscopic clipping device to the polypectomy site

Answer 481

C. Retrieval of the polyp

Question 482

Surgical excision of a gastric polyp is indication for

A. Peutz-Jeghers syndrome
B. Intramural polypoid lesions, such as leiomyomas
C. Coagulopathy
D. Small sessile polyps

Answer 482

B. Intramural polypoid lesions, such as leiomyomas

Question 483

A sphincterotomy is contraindicated in patients with

A. Recent myocardial infarction
B. Allergy to glucagon
C. Periampullary diverticula
D. Acute pancreatitis

Answer 483

A. Recent myocardial infarction

Question 484

Which equipment should always be readily available when using a basket to retrieve large ductal stones

A. A nasobiliary drainage kit
B. A mechanical lithotriptor with a pair of wire cutters
C. An ampulla ray balloon dilator
D. An ESU

Answer 484

B. A mechanical lithotriptor with a pair of wire cutters

Question 485

Candidates for extracorporeal shock wave lithotripsy are patients who

A. Have multiple large common bile duct stones
B. Have had a cholecystectomy
C. Have fewer than 3 stones
D. Have larger body mass and poor gallbladder function

Answer 485

C. Have fewer than 3 stones

Question 486

The difference between ESWL and laser lithotripsy is that laser lithotripsy

A. Does not require long-term dissolution therapy
B. Is faster
C. Can be used with a greater number of stones
D. All of the above

Answer 486

D. All of the above

Question 487

Substernal or epigastric pain that increase with respiration and movement of the trunk is association with what portion of the GI tract

A. Cervical esophagus
B. Thoracic esophagus
C. Distal esophagus, near diaphragm
D. Stomach

Answer 487

B. Thoracic esophagus

Question 488

Conservative management of upper GI perforation may include

A. Suction
B. IV nutrition
C. Administration of antibiotics
D. All of the above

Answer 488

D. All of the above

Question 489

Hematochezia is generally a symptom of

A. Bleeding esophageal varices
B. Bleeding ulcer
C. Gastritis
D. Lower GI bleeding

Answer 489

D. Lower GI bleeding

Question 490

In a patient with upper GI bleeding, if the return fluid from a gastric lavage promptly becomes clear. The next step is to

A. Continue lavage
B. Remove the nasogastric tube
C. Use an Ewald tube to remove clots from the stomach
D. Begin balloon tamponade

Answer 490

B. Remove the nasogastric tube

Question 491

In patients suffering from hypovolemic shock, circulation to the heart and the brain initially

A. Increases
B. Decreases
C. Remains the same
D. Stops

Answer 491

A. Increases

Question 492

An important side effect of topical pharyngeal anesthesia is

A. Vomiting
B. Impaired gag reflex
C. Allergic reactions
D. Superficial phlebitis

Answer 492

B. Impaired gag reflex

Question 493

When a patient experiences cardiac arrest, what is the first action the gastroenterology nurse should take

A. Call for help
B. Initiate CPR
C. Attach the patient to a monitoring device
D. Remove family members and visitors from the room

Answer 493

A. Call for help

Question 494

What drug is used to reverse narcotic-induced respiratory depression

A. Atropine
B. Naloxone and/or Flumazenil
C. Midazolam
D. Epinephrine

Answer 494

B. Naloxone and/or Flumazenil

Question 495

To treat a vasovagal attack it is important to

A. Offer fluids
B. Begin CPR
C. Position the patient with the head level with or below the rest of the body
D. Keep the patient warm

Answer 495

C. Position the patient with the head level with or below the rest of the body

Question 496

To avoid aspiration during upper endoscopy, the GI nurse usually

A. Maintain the patient in the supine position
B. Encourages the patient to breath deeply
C. Provides suction if necessary
D. Intubates the patient

Answer 496

C. Provides suction if necessary

Question 497

Complications from laparoscopic fundoplication include all except

A. Gas bloat syndrome
B. Inability to belch
C. Lower success rates than laparotomy fundoplication
D. Recurrence of symptoms

Answer 497

C. Lower success rates than laparotomy fundoplication

Question 498

Esophageal perforation may result from all of the following except

A. H.pylori
B. Peptic ulcer disease
C. Boerhaave’s syndrome
D. Use of esophageal instruments

Answer 498

A. H.pylori

Question 499

A surgical procedure in which the distal portion of the stomach and proximal duodenum have been resected, with the jejunum reanastomosed to the gastric remnant is referred to as

A. Bilroth I
B. Bilroth II
C. Rolex-en-Y
D. Vagotomy

Answer 499

B. Bilroth II

Question 500

A common infant gastric disorder requiring surgical intervention is

A. Foreign body removal
B. Esophageal atresia
C. Hiatal hernia
D. Hypertrophic pyloric stenosis

Answer 500

D. Hypertrophic pyloric stenosis

Question 501

A Whipple procedure involves removal of

A. The pylorus
B. The vagus nerve
C.the lower one-third of the esophagus
D. Fifty percent of the stomach and all of the duodenum

Answer 501

D. Fifty percent of the stomach and all of the duodenum

Question 502

Reason for small bowel resection include all of the following except

A. Congenital anomalies
B. Irritable bowel syndrome
C. Crohn’s disease
D. Trauma

Answer 502

B. Irritable bowel syndrome

Question 503

Hirschsprung’s disease

A. Is the congenital absence of intramural ganglia in the intestinal tract
B. Can be cured with medications
C. Cannot be treated surgically
D. Occurs in 1 in 1,000 births

Answer 503

A. Is the congenital absence of intramural ganglia in the intestinal tract

Question 504

Crohn’s disease

A. Is primary prevalent in people with type A personality
B. Causes severe constipation
C. Is limited to the colon
D. May affect any part of the digestive tract

Answer 504

D. May affect any part of the digestive tract

Question 505

A cancerous lesion within the sigmoid colon or rectosigmoid are commonly treated with

A. Colon transplant
B. Total colectomy
C. Whipple procedure
D. Rectal resection and descending colon anastomosis of the rectal remnant

Answer 505

D. Rectal resection and descending colon anastomosis of the rectal remnant

Question 506

In trans gastric surgery, entry points for access to the peritoneum may include which of the following

A. Mouth
B. Vagina
C. Rectum
D. All of the above

Answer 506

D. All of the above