Test Bank

Question 1

The nurse is providing care to a patient who is hospitalized for complications associated with peptic ulcer
disease. Which data supports the patient is experiencing a gastrointestinal bleed?

1) Tarry stools
2) Pain in the right arm
3) Absent bowel sounds
4) Emesis of undigested food

Answer 1

Feedback
X 1 Tarry stools indicate gastrointestinal bleeding.

2 Referred pain, such as that in the arm, is indicative of penetration to another organ.

3 Absent bowel sounds is indicative of perforation.

4 Emesis of undigested food is indicative of obstruction

Question 2

The nurse is providing care to a patient who is hospitalized for complications associated with peptic ulcer

disease. Which data supports the patient is experiencing penetration to another organ?
1) Tarry stools
2) Pain in the right arm
3) Absent bowel sounds
4) Emesis of undigested food

Answer 2

Feedback
1 Tarry stools indicate gastrointestinal bleeding.

X 2 Referred pain, such as that in the arm, is indicative of penetration to another organ.

3 Absent bowel sounds is indicative of perforation.

4 Emesis of undigested food is indicative of obstruction.

Question 3

. The nurse is providing care to a patient who is hospitalized for complications associated with peptic ulcer

disease. Which data supports the patient is experiencing a perforation?
1) Tarry stools
2) Pain in the right arm
3) Absent bowel sounds
4) Emesis of undigested food

Answer 3

Feedback
1 Tarry stools indicate gastrointestinal bleeding.

2 Referred pain, such as that in the arm, is indicative of penetration to another organ.

X 3 Absent bowel sounds is indicative of perforation.

4 Emesis of undigested food is indicative of obstruction.

Question 4

The nurse is providing care to a patient who is hospitalized for complications associated with peptic ulcer
disease. Which data supports the patient is experiencing an obstruction?

1) Tarry stools
2) Pain in the right arm
3) Absent bowel sounds
4) Emesis of undigested food

Answer 4

1Tarry stools indicate gastrointestinal bleeding.

2 Referred pain, such as that in the arm, is indicative of penetration to another organ.

3 Absent bowel sounds is indicative of perforation.

X 4 Emesis of undigested food is indicative of obstruction.

Question 5

The nurse is conducting an assessment for a patient who is suspected of having peptic ulcer disease. Which is
a risk factor identified in the patient’s health history?
1) Acetaminophen use for pain
2) Hypoparathyroidism
3) Social drinking
4) Sarcoidosis

Answer 5

Feedback
1 NSAID and aspirin, not acetaminophen, use are risk factors for peptic ulcer disease.
2 Hyper-, not hypoparathyroidism, is a risk factor for peptic ulcer disease.
3 Heavy, not social, drinking is a risk factor for peptic ulcer disease.
X 4 Sarcoidosis is a risk factor for the development of peptic ulcer disease.

Question 6

Which assessment data would indicate active bleeding for a patient who is diagnosed with peptic ulcer
disease?
1) Absent bowel sounds
2) Coffee-ground emesis
3) Bright red blood in emesis
4) Black tarry stools with a foul odor

Answer 6

Feedback

1 Absent bowel sounds indicates perforation, not active bleeding.

2 Coffee-ground emesis indicates older blood.

X 3 Bright red blood in the emesis indicates active bleeding.

4 Black tarry stools with a foul odor indicates older blood.

Question 7

The nurse is providing care to a patient who is prescribed levofloxacin-based triple therapy for the treatment
of peptic ulcer disease. Which drugs should the nurse educate this patient about based on this data?

1) Proton pump inhibitor, levofloxacin, and amoxicillin
2) Proton pump inhibitor, amoxicillin, and clarithromycin
3) Proton pump inhibitor, clarithromycin, and metronidazole
4) Proton pump inhibitor, bismuth subsalicylate, metronidazole, and tetracycline

Answer 7

Feedback

X1 These drugs are included in levofloxacin-based triple therapy for peptic ulcer disease.

2 These drugs are included in the sequential therapy for peptic ulcer disease.

3 These drugs are included in triple therapy for peptic ulcer disease when the patient is
allergic to penicillin.

4 These drugs are included in quadruple therapy for peptic ulcer disease.

Question 8

The nurse is providing care to a patient who is prescribed sequential therapy for the treatment of peptic ulcer

disease. Which drugs should the nurse educate this patient about based on this data?
1) Proton pump inhibitor, levofloxacin, and amoxicillin
2) Proton pump inhibitor, amoxicillin, and clarithromycin
3) Proton pump inhibitor, clarithromycin, and metronidazole
4) Proton pump inhibitor, bismuth subsalicylate, metronidazole, and tetracycline

Answer 8

Feedback
1 These drugs are included in levofloxacin-based triple therapy for peptic ulcer disease.

X 2 These drugs are included in the sequential therapy for peptic ulcer disease.

3 These drugs are included in triple therapy for peptic ulcer disease when the patient is

allergic to penicillin.
4 These drugs are included in quadruple therapy for peptic ulcer disease.

Question 9

The nurse is providing care to a patient who is diagnosed with acute gastritis. Which assessment data supports
this diagnosis?
1) Weight gain
2) Epigastric pain
3) Increased appetite
4) Increased blood pressure

Answer 9

Feedback
1 Weight loss is a clinical manifestation associated with acute gastritis.

X 2 Epigastric pain is a clinical manifestation associated with acute gastritis.

3 A decreased, not increased, appetite is a clinical manifestation with acute gastritis.

4 A decreased, not increased, blood pressure is a clinical manifestation of acute gastritis
with acute fluid loss.

Question 10

Which diagnostic test should the nurse anticipate to detect active infection with H. pylori for a patient
diagnosed with gastritis?

1) Guaiac
2) Hematest
3) Hemoccult
4) Urea breathing test

Answer 10

Feedback
1 Guaiac is anticipated to detect blood in the stool for a patient diagnosed with gastritis.
2 Hematest is anticipated to detect blood in the stool for a patient diagnosed with
gastritis.
3 Hemoccult is anticipated to detect blood in the stool for a patient diagnosed with
gastritis.
4 A urea breathing test is anticipated to detect active infection with H. pylori for a patient
who is diagnosed with gastritis.

Question 11

Which food should the nurse encourage for a patient, diagnosed with gastritis, when a clear liquid diet is
prescribed?
1) Milk
2) Broth
3) Pudding
4) Cream soup

Answer 11

Feedback
1 Milk is a heavier liquid.

X 2 Broth is a clear liquid.

3 Pudding is a heavier liquid.

4 Cream soup is a heavier liquid.

Question 12

Which food should the nurse encourage for a patient, diagnosed with gastritis, when a heavier liquid diet is
prescribed?
1) Milk
2) Broth
3) Gelatin
4) Carbonated beverages

Answer 12

Feedback
1 Milk is a heavier liquid.
2 Broth is a clear liquid.
3 Gelatin is a clear liquid.
4 Carbonated beverages are clear liquids.

Question 13

Which medication, acting as a physical barrier, does the nurse anticipate for a patient diagnosed with
gastritis?

1) Maalox
2) Mylanta
3) Pepcid
4) Carafate

Answer 13

Feedback
1 This drug is used to neutralize acid.

2 This drug is used to neutralize acid.

3 This drug is used to decrease the production of gastric acid.

X4 Carafate is a drug that acts as a physical barrier protecting the lining of the stomach
from gastric acid.

Question 14

The nurse is providing education for a patient who is diagnosed with gastritis. Which statement indicates the
need for further education?
1) “I will eat bland, nonspicy foods.”
2) “I will eat smaller, more frequent meals.”
3) “I will take aspirin for headaches from now on.”
4) “I will take an antacid if my symptoms continue.”

Answer 14

Feedback

1 This statement indicates correct understanding.
2 This statement indicates correct understanding.
X 3 Aspirin should be avoided for a patient who is diagnosed with gastritis. This statement
indicates the need for further education.
4 This statement indicates correct understanding.

Question 15

Which is the priority nursing diagnosis when planning care for this patient who is diagnosed with acute
gastritis?
1) Anxiety
2) Acute pain
3) Deficient knowledge
4) Risk for deficient fluid volume

Answer 15

Feedback
1 This statement indicates correct understanding.
2 This statement indicates correct understanding.
3 Aspirin should be avoided for a patient who is diagnosed with gastritis. This statement
indicates the need for further education.
4 This statement indicates correct understanding.

Question 16

Which principal risk factor should the nurse assess for during the health history in a patient who is suspected
of having peptic ulcer disease?
1) Stress
2) Anxiety
3) H. pylori infection
4) Use of acetaminophen

Answer 16

1. Stress is no longer considered a principal risk factor in the development of peptic ulcer
   disease.
   2 Anxiety is no longer considered a principal risk factor in the development of peptic
   ulcer disease.
   X 3 H. pylori infection is a principal risk factor in the development of peptic ulcer disease.
   4 Use of NSAIDs, not acetaminophen, is a principal risk factor in the development of
   peptic ulcer disease.

Question 17

Which diagnostic test should the nurse anticipate to rule out anemia when providing care to a patient
diagnosed with peptic ulcer disease?
1) Hematocrit
2) Stool antigen
3) White blood cell
4) Fecal occult blood

Answer 17

X 1 Hematocrit is used to monitor the patient for anemia.

2 A stool antigen test is a noninvasive test for peptic ulcer disease.

3 A patient’s white blood cell count is used to monitor the patient for peritonitis when diagnosed with peptic ulcer disease.

4 A fecal occult blood test is used to monitor for blood in the stool when diagnosed with peptic ulcer disease.

Question 18

Which diagnostic test should the nurse anticipate to rule out peritonitis when providing care to a patient
diagnosed with peptic ulcer disease?
1) Hematocrit
2) Stool antigen
3) White blood cell
4) Fecal occult blood

Answer 18

1 Hematocrit is used to monitor the patient for anemia.
2 A stool antigen test is a noninvasive test for peptic ulcer disease.
X 3 A patient’s white blood cell count is used to monitor the patient for peritonitis when
diagnosed with peptic ulcer disease.
4 A fecal occult blood test is used to monitor for blood in the stool when diagnosed with
peptic ulcer disease.

Question 19

The nurse is providing discharge instructions for a patient diagnosed with peptic ulcer disease. Which
statement indicates the need for additional education?

1) “I will avoid spicy foods.”
2) “I will be sure to eat a large meal before bedtime.”
3) “I will use acetaminophen rather than aspirin for headache.”
4) “I will avoid caffeinated beverages, such as coffee, as this increases symptoms.”

Answer 19

1 Spicy foods should be avoided; therefore, this statement indicates correct
understanding.

X 2 The patient should avoid eating two hours prior to bedtime; therefore, this statement
indicates the need for further education.

3 Aspirin and NSAIDs should be avoided; therefore, this statement indicates correct
understanding.

4 Caffeine is known to exacerbate peptic ulcer disease; therefore, this statement indicates
correct understanding.

Question 20

The nurse is providing care to a patient who is status post partial gastrectomy for the treatment of gastric
carcinoma. Which should the nurse include in the plan of care to decrease the risk of dumping syndrome?

1) Providing smaller meals at more frequent intervals
2) Providing larger meals at less frequent intervals
3) Providing liquids and solids together
4) Providing liquids only

Answer 20

X1The patient who is status post a partial gastrectomy should be provided small meals at
frequent intervals to decrease the risk for dumping syndrome.

2 Larger meals at less frequent intervals is likely to cause dumping syndrome.

3 To decrease the risk for dumping syndrome, the nurse should offer solids and liquids at
separate times.

4 A liquid only diet is not known to decrease the risk for dumping syndrome.

Question 21

Which assessment data collected by the nurse supports the patient’s diagnosis of advanced gastric cancer?

1) Anorexia
2) Indigestion
3) Epigastric pain
4) Palpable epigastric mass

Answer 21

1 Anorexia is a clinical manifestation with early gastric cancer.
2 Indigestion is a clinical manifestation with early gastric cancer.
3 Epigastric pain is a clinical manifestation with early gastric cancer.
4 A palpable epigastric mass is a clinical manifestation of advanced gastric cancer.

Question 22

Which assessment data collected by the nurse supports the patient’s diagnosis of early gastric cancer?

1) Anorexia
2) Nausea and vomiting
3) Iron-deficiency anemia
4) Palpable epigastric mass

Answer 22

Feedback

X1 Anorexia is a clinical manifestation with early gastric cancer.

2 Nausea and vomiting are clinical manifestations of advanced gastric cancer.

3 Iron-deficiency anemia is a clinical manifestation of advanced gastric cancer.

4 A palpable epigastric mass is a clinical manifestation of advanced gastric cancer.

Question 23

The nurse is providing care to a patient who is diagnosed with peptic ulcer disease. When planning care, which should the nurse include as first-line triple dose therapy for a patient who is allergic to penicillin?
Select all that apply.

1) Amoxicillin
2) Metronidazole
3) Clarithromycin
4) Bismuth subsalicylate
5) Proton pump inhibitor

Answer 23

2, 3, 5

Feedback

1. This is incorrect. Amoxicillin is not included in the first-line triple dose therapy for a patient
   who is allergic to penicillin.

X 2. This is correct. Metronidazole is included in the first-line triple dose therapy for a patient who
is allergic to penicillin.

X 3. This is correct. Clarithromycin is included in the first-line triple dose therapy for a patient who
is allergic to penicillin.

4. This is incorrect. Bismuth subsalicylate is included in the first-line quadruple, not triple, dose
   therapy.

X5. This is correct. A proton pump inhibitor is included in the first-line triple dose therapy for a
patient who is allergic to penicillin.

Question 24

The nurse is providing care to a patient who is diagnosed with peptic ulcer disease. When planning care, which should the nurse include as first-line triple dose therapy? Select all that apply.

1) Amoxicillin
2) Metronidazole
3) Clarithromycin
4) Bismuth subsalicylate
5) Proton pump inhibitor

Answer 24

2,4

1. This is incorrect. Amoxicillin is included in the first-line triple dose therapy for a patient
   diagnosed with peptic ulcer disease.
2. This is correct. Metronidazole is included in the first-line triple dose therapy only for a patient
   who is allergic to penicillin and diagnosed with peptic ulcer disease.
3. This is correct. Clarithromycin is included in the first-line triple dose therapy for a patient who
   is diagnosed with peptic ulcer disease.
4. This is incorrect. Bismuth subsalicylate is included in the first-line quadruple, not triple, dose
   therapy for a patient diagnosed with peptic ulcer disease.
5. This is correct. A proton pump inhibitor is included in the first-line triple dose therapy for a
   patient diagnosed with peptic ulcer disease.

Question 25

The nurse is providing care to a patient who is diagnosed with peptic ulcer disease. When planning care,
which should the nurse include as first-line quadruple dose therapy? Select all that apply.

1) Amoxicillin
2) Metronidazole
3) Clarithromycin
4) Bismuth subsalicylate
5) Proton pump inhibitor

Answer 25

1. This is incorrect. Amoxicillin is included in the first-line triple dose therapy for a patient who
   is diagnosed with peptic ulcer disease.
2. This is correct. Metronidazole is included in first-line quadruple dose therapy for a patient
   who is diagnosed with peptic ulcer disease.
3. This is incorrect. Clarithromycin is included in the first-line triple dose therapy for a patient
   who is diagnosed with peptic ulcer disease.
4. This is incorrect. Bismuth subsalicylate is included in the first-line quadruple dose therapy for
   a patient diagnosed with peptic ulcer disease.
5. This is correct. A proton pump inhibitor is included in the first-line quadruple dose therapy for
   a patient diagnosed with peptic ulcer disease.

Question 26

An older adult African-American patient with a history of celiac disease presents with abdominal cramps,
pain, and diarrhea. The patient denies the use of alcohol, but states, “my favorite foods are steak, cheese, and
ice cream.” Based on this data, which condition does the nurse suspect?
1) Acute pancreatitis
2) Appendicitis
3) Lactase deficiency
4) Food poisoning

Answer 26

Feedback
1 The most common risk factor for pancreatitis is alcohol abuse.
2 Appendicitis usually involves loss of appetite and nausea and/or vomiting soon after
abdominal pain begins.
X3 Lactose intolerance is more common in Native Americans, Asians, Hispanics, and
African-Americans and in those with a history of celiac disease.
4 Food poisoning generally causes some nausea and vomiting.

Question 27

A nurse discusses medications prescribed to a patient who is diagnosed with Crohn’s disease. Which is the
typical prescribed pharmacological option for treatment?
1) Ciprofloxacin (Cipro)
2) Diazepam (Valium)
3) Furosemide (Lasix)
4) Digoxin (Lanoxin)

Answer 27

X Metronidazole (Flagyl) and ciprofloxacin (Cipro) have demonstrated effectiveness in
the treatment of perianal complications. Antibiotics, such as ampicillin (Marcillin),
gentamicin (Garamycin), clindamycin (Cleocin), and metronidazole (Flagyl), are
effective during acute exacerbations.
2 This medication is not appropriate for the treatment of Crohn’s disease.
3 This medication is not appropriate for the treatment of Crohn’s disease.
4 This medication is not appropriate for the treatment of Crohn’s disease.

Question 28

The nurse is interpreting laboratory values for a patient suspected of having ulcerative colitis. Which finding
does the nurse anticipate based on the diagnosis?
1) Protein in the urine
2) Increased sedimentation rate
3) Decreased white blood cell count
4) Antineutrophil cytoplasmic antibodies

Answer 28

Feedback
1 Protein in the urine is not anticipated for a patient diagnosed with ulcerative colitis.
X 2 An increased ESR is anticipated for this patient due to inflammation.
3 A decreased white blood cell count is not anticipated for this patient.
4 Antineutrophil cytoplasmic antibodies is not anticipated for a patient diagnosed with
ulcerative colitis.

Question 29

Which drug prescription should the nurse anticipate for a patient, diagnosed with hemorrhoids, to decrease
pain?
1) Zinc oxide
2) Benzocaine
3) Witch hazel
4) Hydrocortisone

Answer 29

Zinc oxide forms a physical barrier on the skin to prevent irritation of the perianal
region.
X 2 Benzocaine, a local anesthetic, provides temporary relief from burning, itching, and
pain.
3 Witch hazel promotes skin dryness, which helps relieve itching, irritation, and
inflammation.
4 Hydrocortisone reduces inflammation.

Question 30

A patient has just been told that a colectomy and ileostomy are needed to treat a new diagnosis of colon

cancer. Which diagnosis should the nurse use to plan this patient’s preoperative nursing care?
1) Knowledge Deficit
2) Risk for Disuse Syndrome
3) Risk for Perioperative–Positioning Injury
4) Anticipatory Grieving

Answer 30

A patient has just been told that a colectomy and ileostomy are needed to treat a new diagnosis of colon
cancer. Which diagnosis should the nurse use to plan this patient’s preoperative nursing care?
1) Knowledge Deficit
2) Risk for Disuse Syndrome
3) Risk for Perioperative–Positioning Injury
X 4) Anticipatory Grieving

Question 31

Which drug prescription should the nurse anticipate for a patient, diagnosed with hemorrhoids, to promote
skin dryness to relieve inflammation?
1) Zinc oxide
2) Benzocaine
3) Witch hazel
4) Hydrocortisone

Answer 31

1 Zinc oxide forms a physical barrier on the skin to prevent irritation of the perianal
region.
2 Benzocaine, a local anesthetic, provides temporary relief from burning, itching, and
pain.
X 3 Witch hazel promotes skin dryness, which helps relieve itching, irritation, and
inflammation.
4 Hydrocortisone reduces inflammation.

Question 32

Which drug prescription should the nurse anticipate for a patient, diagnosed with hemorrhoids, to form a
physical barrier on the skin to prevent irritation?
1) Zinc oxide
2) Benzocaine
3) Witch hazel
4) Hydrocortisone

Answer 32

X 1 Zinc oxide forms a physical barrier on the skin to prevent irritation of the perianal
region.
2 Benzocaine, a local anesthetic, provides temporary relief from burning, itching, and
pain.
3 Witch hazel promotes skin dryness, which helps relieve itching, irritation, and
inflammation.
4 Hydrocortisone reduces inflammation.

Question 33

The nurse is providing care to a patient who is diagnosed with irritable bowel syndrome (IBS). Which drug
prescription should the nurse anticipate to relieve diarrhea?
1) Tegaserod
2) Loperamide
3) Dicyclomine
4) Amitriptyline

Answer 33

Feedback
1 This drug is a serotonergic agent that causes the release of other neurotransmitters and
results in increased peristalsis, increased intestinal secretion, and decreased visceral
sensitivity.
2 This drug is an antidiarrheal agent that slows bowel transit, enhances water absorption,
and strengthens anal sphincter tone, resulting in fewer stools, but does not relieve pain.
X 3 This drug is an antispasmodic agent that relaxes smooth muscle spasm and GI motility
while also inhibiting gastric secretion.
4 This drug is an antidepressant that blocks norepinephrine reuptake and is believed to
slow transit time and improve pain tolerance.

Question 34

The nurse is providing care to a patient who is diagnosed with irritable bowel syndrome (IBS). Which drug
prescription should the nurse anticipate to provide pain relief?
1) Tegaserod
2) Loperamide
3) Dicyclomine
4) Amitriptyline

Answer 34

Feedback
1 This drug is a serotonergic agent that causes the release of other neurotransmitters and
results in increased peristalsis, increased intestinal secretion, and decreased visceral
sensitivity.
2 This drug is an antidiarrheal agent that slows bowel transit, enhances water absorption,
and strengthens anal sphincter tone, resulting in fewer stools, but does not relieve pain.
3 This drug is an antispasmodic agent that relaxes smooth muscle spasm and GI motility
while also inhibiting gastric secretion.
X 4 This drug is an antidepressant that blocks norepinephrine reuptake and is believed to
slow transit time and improve pain tolerance.

Question 35

The nurse is providing care to a patient who is experiencing five to six loose, nonbloody stools each day.
Which diagnosis does the nurse anticipate when planning care for this patient?
1) Diverticulitis
2) Crohn’s disease
3) Ulcerative colitis
4) Colorectal cancer

Answer 35

1 The assessment data does not support planning care for diverticulitis.
X 2 Crohn’s disease manifests with five to six loose, nonbloody stools each day.

3 The assessment data does not support planning care for ulcerative colitis.
4 The assessment data does not support planning care for colorectal cancer.

Question 36

The nurse is providing care to a patient who is experiencing 10 liquid, bloody stools each day. Which
diagnosis does the nurse anticipate when planning care for this patient?
1) Diverticulitis
2) Crohn’s disease
3) Ulcerative colitis
4) Colorectal cancer

Answer 36

1 The assessment data does not support planning care for diverticulitis.
2 Crohn’s disease manifests with five to six loose, nonbloody stools each day.
X 3 Ulcerative colitis manifests with 10 to 20 loose, bloody stools each day.
4 The assessment data does not support planning care for colorectal cancer.

Question 37

The nurse is providing education to a patient who will receive surgical intervention for the treatment of
ulcerative colitis. Which patient statement indicates correct understanding of a proctocolectomy with a
permanent ileostomy?
1) “My colon and rectum will be removed, and my anus will be closed.”
2) “My colon will be removed, and my ileum is sutured to the anal canal.”
3) “My colon will be removed while the distal portion of my ileum is used to create a
pouch.”
4) “My colon and rectal mucosa will be removed and a reservoir created using a portion of
my ileum.”

Answer 37

X 1 This statement indicates correct understanding of a proctocolectomy with a permanent
ileostomy.
2 This statement indicates correct understanding of an abdominal colectomy with ileoanal
anastomosis.
3 This statement indicates correct understanding of a proctocolectomy with continent
ileostomy, also referred to a Kock pouch.
4 This statement indicates correct understanding of a colectomy, mucosal proctectomy,
and ileal pouch-anal canal anastomosis (IPAA). This procedure is performed in two
steps.

Question 38

The nurse is providing education to a patient who will receive surgical intervention for the treatment of
ulcerative colitis. Which patient statement indicates correct understanding of an abdominal colectomy with
ileoanal anastomosis?
1) “My colon and rectum will be removed, and my anus will be closed.”
2) “My colon will be removed, and my ileum is sutured to the anal canal.”
3) “My colon will be removed while the distal portion of my ileum is used to create a
pouch.”
4) “My colon and rectal mucosa will be removed and a reservoir created using a portion of
my ileum.”

Answer 38

1 This statement indicates correct understanding of a proctocolectomy with a permanent
ileostomy.
X 2 This statement indicates correct understanding of an abdominal colectomy with ileoanal
anastomosis.
3 This statement indicates correct understanding of a proctocolectomy with continent
ileostomy, also referred to a Kock pouch.
4 This statement indicates correct understanding of a colectomy, mucosal proctectomy,
and ileal pouch-anal canal anastomosis (IPAA). This procedure is performed in two
steps

Question 39

The nurse is providing education to a patient who will receive surgical intervention for the treatment of
ulcerative colitis. Which patient statement indicates correct understanding of a proctocolectomy with
continent ileostomy?
1) “My colon and rectum will be removed, and my anus will be closed.”
2) “My colon will be removed, and my ileum is sutured to the anal canal.”
3) “My colon will be removed while the distal portion of my ileum is used to create a
pouch.”
4) “My colon and rectal mucosa will be removed and a reservoir created using a portion of
my ileum.”

Answer 39

1 This statement indicates correct understanding of a proctocolectomy with a permanent
ileostomy.
2 This statement indicates correct understanding of an abdominal colectomy with ileoanal
anastomosis.
X 3 This statement indicates correct understanding of a proctocolectomy with continent
ileostomy, also referred to a Kock pouch.
4 This statement indicates correct understanding of a colectomy, mucosal proctectomy,
and ileal pouch-anal canal anastomosis (IPAA). This procedure is performed in two
steps.

Question 40

The nurse is providing education to a patient who will receive surgical intervention for the treatment of
ulcerative colitis. Which patient statement indicates correct understanding of an ileal pouch–anal anastomosis
(IPAA) procedure?
1) “My colon and rectum will be removed, and my anus will be closed.”
2) “My colon will be removed, and my ileum is sutured to the anal canal.”
3) “My colon will be removed while the distal portion of my ileum is used to create a
pouch.”
4) “My colon and rectal mucosa will be removed and a reservoir created using a portion of
my ileum.”

Answer 40

Feedback
1 This statement indicates correct understanding of a proctocolectomy with a permanent
ileostomy.
2 This statement indicates correct understanding of an abdominal colectomy with ileoanal
anastomosis.
3 This statement indicates correct understanding of a proctocolectomy with continent
ileostomy, also referred to a Kock pouch.
X 4 This statement indicates correct understanding of a colectomy, mucosal proctectomy,
and ileal pouch-anal canal anastomosis (IPAA). This procedure is performed in two
steps

Question 41

The nurse is providing care to a patient who presents to the emergency department (ED) with blunt abdominal
trauma after an automobile accident. Which should the nurse assess for based on the current data?
1) Spleen injury
2) Liver laceration
3) Intestinal obstruction
4) Traumatic brain injury

Answer 41

X 1 Blunt abdominal trauma is likely to cause a spleen injury.
2 Abdominal stab injury is likely to cause a liver laceration.
3 Intestinal obstruction is not likely to occur based on the current data.
4 Traumatic brain injury is not likely to occur based on the current data.

Question 42

The nurse is providing care to a patient who presents to the emergency department (ED) with an abdominal
stab injury. Which should the nurse assess for based on the current data?
1) Spleen injury
2) Liver laceration
3) Intestinal obstruction
4) Traumatic brain injury

Answer 42

Blunt abdominal trauma is likely to cause a spleen injury.
X 2 Abdominal stab injury is likely to cause a liver laceration.
3 Intestinal obstruction is not likely to occur based on the current data.
4 Traumatic brain injury is not likely to occur based on the current data.

Question 43

The nurse is providing care to a patient diagnosed with celiac disease who experiences frequent diarrhea.
Based on this data, the nurse anticipates the patient may also experience which associated problems? Select
all that apply

1) Skin breakdown
2) Fluid and electrolyte imbalance
3) Hair loss
4) Lifestyle issues
5) Sexual dysfunction

Answer 43

1,2,4

Feedback
1. This is correct. Patients with diarrhea may have perianal skin irritation and skin breakdown.
2. This is correct. Diarrhea disturbs the fluid and electrolyte balance and can disrupt normal life
activities.
3. This is incorrect. There is no known direct connection between diarrhea and hair loss or sexual
dysfunction.
4. This is correct. Diarrhea disturbs the fluid and electrolyte balance and can disrupt normal life
activities.
5. This is incorrect. There is no known direct connection between diarrhea and hair loss or sexual
dysfunction.

Question 44

A nurse is caring for a patient who has had a double-barrel colostomy. Which statement is true regarding the
proximal stoma? Select all that apply.
1) Is also called the mucous fistula
2) Diverts feces to the abdominal wall
3) Expels mucus from the distal colon
4) It is a functional stoma
5) Expels mucus from the proximal colon

Answer 44

2,4
Feedback
1. This is incorrect. The distal, not proximal, stoma is synonymous with a mucous fistula.
2. This is correct. The proximal stoma diverts feces to the abdominal wall.
3. This is incorrect. The distal, not proximal, stoma expels mucus from the distal colon.
4. This is correct. The proximal stoma is a functional stoma.
5. This is incorrect. The distal stoma expels mucus from the distal colon. The proximal stoma
does not expel mucus from the proximal colon

Question 45

The nurse is explaining the alteration in normal function to a patient recently diagnosed with gastroesophageal
reflux disease (GERD). Which etiology contributing to GERD will the nurse include in the teaching session?
1) Transient constriction of the lower esophageal sphincter
2) Decreased pressure within the stomach
3) Incompetent lower esophageal sphincter
4) Prolonged constriction of the upper esophageal sphincter

Answer 45

1 The lower esophageal sphincter is normally constricted except during swallowing.
2 Increased pressure in the stomach can cause acid to reflux into the esophagus.
X 3 An incompetent lower esophageal sphincter remains open, allowing gastric acid to
reflux into the esophagus.
4 The action of the upper esophageal sphincter is not a cause of GERD.

Question 46

The nurse is providing care to several patients in an outpatient clinic. Which patient is at high risk of
developing gastroesophageal reflux disorder (GERD)?
1) A patient who is six weeks pregnant
2) A patient who is morbidly obese
3) A patient who follows a strict vegetarian diet
4) A patient who drinks one glass of wine monthly

Answer 46

2
1 Pregnancy is an increasing risk factor in the later stages due to pressure on the stomach.
2 Obesity is a risk factor for GERD.
3 A vegetarian diet is not a risk factor for GERD.
4 Rare alcohol consumption is not as strong a risk factor for GERD as morbid obesity.

Question 47

A patient is admitted to the emergency department reporting a burning pain in the chest of a 7 on a 0 to 10
pain scale. Gastroesophageal reflux disorder (GERD) secondary to hiatal hernia is diagnosed. Based on this
data, which is the priority nursing diagnosis?
1) Anxiety
2) Acute Pain
3) Ineffective Health Maintenance
4) Dysfunctional Gastrointestinal Motility

Answer 47

2

Anxiety may be decreased by relieving pain.
2 Acute pain management is the priority of nursing care.
3 Dysfunctional gastrointestinal motility and ineffective health maintenance are less
urgent.
4 Dysfunctional gastrointestinal motility and ineffective health maintenance are less
urgent.

Question 48

A patient is with a history of gastroesophageal reflux disorder (GERD) presents with metabolic alkalosis.
Based on the data reviewed in the patient’s history, which medication does the nurse suspect contributed to
the current diagnosis?
1) Aluminum hydroxide
2) Omeprazole
3) Ranitidine
4) Metoclopramide

Answer 48

1

Aluminum hydroxide antacids neutralize gastric acid. Overuse of antacids may cause
metabolic acidosis.
2 Omeprazole, ranitidine, and metoclopramide are all GERD medications that do not
cause metabolic alkalosis.
3 Omeprazole, ranitidine, and metoclopramide are all GERD medications that do not
cause metabolic alkalosis.
4 Omeprazole, ranitidine, and metoclopramide are all GERD medications that do not
cause metabolic alkalosis.

Question 49

. An adult patient with a BMI of 39 who smokes 1 pack of cigarettes per day is diagnosed with erosive
esophagitis through upper GI endoscopy. The patient is now refusing all medications and states “I’m not
getting hooked on any pills.” What would the nurse recommend for the multidisciplinary collaborative plan?
1) Interview the patient and spouse for a 24-hour recall of usual food content, intake, and
meal times.
2) Enlist the patient’s son to elevate the foot of the patient’s bed at home six inches.
3) Offer the patient a surgical consult to reduce the necessity of medication.
4) Omit the pharmacist notification of the Multidisciplinary Team meeting about the patient.

Answer 49

1

Weight loss and smoking cessation will improve the symptoms of GERD. Determining
food types, amounts, and times of consumption can help the patient avoid foods that
stimulate acid production and avoid eating prior to lying down.

The head of the bed should be elevated, and the team should recommend this to the
patient rather than enlisting the patient’s son.
3 A surgical consult should come from the primary provider and will not necessarily
reduce the need for medication.
4 The pharmacist should be included in the Multidisciplinary Team meeting to give input
to strategies to improve the patient’s receptivity to medication therapy

Question 50

The nurse has implemented a care plan for an adult patient with gastroesophageal reflux disorder (GERD). On
the next clinic visit, which statement by the patient indicates adherence to the plan of care?
1) “Spandex camisoles are worth heartburn.”
2) “I have switched from margaritas to wine.”
3) “I’ve lost six pounds because I eat every three hours and never before bed.”
4) “I take a TUMS with the ranitidine to make it work better.”

Answer 50

3

1 Although the patient knows tight-fitting spandex camisoles can worsen GERD, she is
not willing to stop wearing them.
2 Changing from margaritas to wine will not improve GERD.
3 Appropriate patient outcomes are freedom from pain and knowledge of lifestyle
changes to manage GERD. Weight loss, small, frequent meals, and avoiding lying
down within three hours of eating indicate correct management.
4 Antacids like TUMS should be avoided within one hour before or after an H2-receptor
blocker like ranitidine.

Question 51

Which data collected by the nurse during the physical assessment indicates the patient is experiencing stage 1
stomatitis?
1) Redness of mucosa
2) Patchy oral ulceration
3) Oral ulcerations that bleed with minor trauma
4) Tissue necrosis with significant bleeding noted

Answer 51

1

Question 52

Which data collected by the nurse during the physical assessment indicates the patient is experiencing stage 2
stomatitis?
1) Redness of mucosa
2) Patchy oral ulceration
3) Oral ulcerations that bleed with minor trauma
4) Tissue necrosis with significant bleeding noted

Answer 52

2

Question 53

Which data collected by the nurse during the physical assessment indicates the patient is experiencing stage 3
stomatitis?
1) Redness of mucosa
2) Patchy oral ulceration
3) Oral ulcerations that bleed with minor trauma
4) Tissue necrosis with significant bleeding noted

Answer 53

3

Question 54

Which data collected by the nurse during the physical assessment indicates the patient is experiencing stage 4
stomatitis?
1) Redness of mucosa
2) Patchy oral ulceration
3) Oral ulcerations that bleed with minor trauma
4) Tissue necrosis with significant bleeding noted

Answer 54

4

Question 55

Which patient activity should the nurse discourage for a patient who is diagnosed with stomatitis?

1) Mouth care after each meal
2) Alcohol-based mouth rinses
3) Soft-bristle toothbrush
4) Regular dental checkups

Answer 55

2

Question 55

Which patient activity should the nurse discourage for a patient who is diagnosed with stomatitis?

1) Mouth care after each meal
2) Alcohol-based mouth rinses
3) Soft-bristle toothbrush
4) Regular dental checkups

Answer 55

2

Question 56

Which diagnostic test should the nurse anticipate when providing care to a patient who is suspected of having
a hiatal hernia?
1) Complete blood count
2) Lower abdominal x-ray
3) Magnetic resonance imaging (MRI)
4) Esophagogastroduodenoscopy (ECG)

Answer 56

4

1 A CBC is not a diagnostic tool for hiatal hernia.
2 An upper, not lower, abdominal x-ray is a diagnostic tool for hiatal hernia.
3 An MRI is not a diagnostic tool for hiatal hernia.
4 An ECG that allows viewing of the esophagus and stomach lining is a diagnostic tool
the nurse anticipates when providing care to a patient who is suspected of having hiatal
hernia.

Question 57

Which common site of metastasis should the nurse anticipate when providing care to a patient diagnosed with
oral cancer?
1) Skin
2) Liver
3) Breast
4) Brain

Answer 57

2

1 Oral cancer is not known to metastasize to the skin.
2 Oral cancer is known to metastasize to the lungs, liver, and bones. Liver enzyme tests
will be monitored to determine liver involvement for a patient diagnosed with oral
cancer.
3 Oral cancer is not known to metastasize to the breast.
4 Oral cancer is not known to metastasize to the brain.

Question 58

Which should the nurse include in the discharge teaching for a patient who is being discharged after a
laparoscopic Nissen fundoplication? Select all that apply.
1) Follow a soft diet for two weeks
2) Avoid foods that are not easy to swallow
3) Take large bites and eat quickly
4) Avoid carbonated beverages
5) No heavy lifting until cleared by surgeon

Answer 58

2,4,5

1. This is incorrect. A soft diet is followed for one, not two, week post procedure.
2. This is correct. Foods that are not easy to swallow should be avoided.
3. This is incorrect. The patient should take small bites and eat slowly.
4. This is correct. Carbonated beverages should be avoided as this activity causes air to be
   swallowed.
5. This is correct. Heavy lifting should be avoided until cleared by the surgeon post procedure.

Question 59

Which should the nurse include in the discharge instruction regarding physical assessment findings that
requires the patient to seek emergent care following a laparoscopic Nissen fundoplication? Select all that
apply.
1) Feeling full with the ability to burp
2) Thick drainage with a foul odor from incision site
3) Difficulty swallowing
4) Abdomen is soft and tender
5) Watery stool

Answer 59

2,3
1. This is incorrect. Feeling full with the inability to burp or vomit indicates the need for
emergent care.
2. This is correct. Thick drainage from the incision site that has a foul odor indicates the need for
emergent care.
3. This is correct. Difficulty swallowing indicates the need for emergent care.
4. This is incorrect. An abdomen that feels hard and painful indicates the need for emergent care.
5. This is incorrect. 2,3

Stools that are black, bloody, or tarry indicate the need for emergent care.

Question 60

Which are risk factors for the development of hiatal hernia? Select all that apply.

1) Obesity
2) Pregnancy
3) Tobacco use
4) Oral sex
5) Alcohol abuse

Answer 60

1,2,3

1. This is correct. Obesity is a risk factor for developing hiatal hernia.
2. This is correct. Pregnancy is a risk factor for developing hiatal hernia.
3. This is correct. Tobacco use, specifically smoking, is a risk factor for hiatal hernia.
4. This is incorrect. Oral sex that causes the transmission of HPV is a risk factor for
   oropharyngeal cancer, not hiatal hernia.
5. This is incorrect. Alcohol abuse is a risk factor for oropharyngeal cancer, not hiatal hernia.

Question 61

Which structure of the gastrointestinal (GI) system is found in the right upper quadrant (RUQ) and is the
primary site of absorption?
1) Stomach
2) Duodenum
3) Sigmoid
4) Large intestine

Answer 61

2

1 The stomach, found in the left upper quadrant, turns the food bolus into chyme.
2 The duodenum is the primary site for digestion, especially chemical digestion. It is
located in the RUQ.
3 The sigmoid colon is found in the left upper quadrant.
4 The large intestine primarily reabsorbs water.

Question 62

The patient reports left upper quadrant (LUQ) pain. Based on this data, which does the nurse suspect?

1) Ruptured spleen
2) Pneumonia
3) Hepatitis
4) Duodenal ulcer

Answer 62

A ruptured spleen would manifest with pain in the LUQ.
2 Pneumonia would manifest with pain in the right upper quadrant (RUQ).
3 Hepatitis would manifest with pain in the right upper quadrant (RUQ).
4 A duodenal ulcer would manifest with pain in the right upper quadrant (RUQ).

Question 63

Which organ functions as a main site for metabolizing drugs and may become impaired with the aging
process?
1) Stomach
2) Liver
3) Spleen
4) Large intestine

Answer 63

2

1 The stomach turns food bolus into chyme.
2 The liver detoxifies a variety of substances such as drugs and alcohol. This function
may become impaired with the aging process.
3 The spleen produces and stores red (RBCs) and white (WBCs) blood cells.
4 The large intestine reabsorbs water.

Question 64

The nurse is assessing a patient who is prescribed an anticholinergic agent. Which assessment finding
indicates the patient is experiencing an adverse reaction to the drug?
1) GI bleeding
2) Hepatic necrosis
3) Diarrhea
4) Hypoactive bowel sounds

Answer 64

4

GI bleeding is an adverse reaction associated with aspirin, not an anticholinergic drug.
2 Hepatic necrosis is an adverse reaction associated with toxic levels of acetaminophen,
not an anticholinergic drug.
3 Diarrhea is an adverse reaction associated with many drugs, but this is not an adverse
reaction associated with an anticholinergic drug.
4 Hypoactive bowel sounds may indicate an adverse drug reaction.

Question 65

. The nurse is providing care to a patient who reports diffuse abdominal pain. Upon assessment, the nurse notes
absent bowel sounds and abdominal distension. Based on this data, which medical diagnosis does the nurse
suspect?
1) Appendicitis
2) Bowel obstruction
3) Cirrhosis
4) Cholelithiasis

Answer 65

2

1 Appendicitis causes abdominal pain; bowel sounds are absent if the appendix perforates
and causes peritonitis.
2 Absent bowel sounds are caused by late bowel obstruction, peritonitis, or paralytic ileus
after surgery in which the bowel was manipulated.
3 Cirrhosis may affect liver size.
4 Cholelithiasis causes abdominal pain.

Question 66

The nurse notes a positive shifting dullness during abdominal percussion. Which diagnosis does this
assessment data support?
1) Ascites
2) Liver enlargement
3) Pancreatitis
4) An abdominal mass

Answer 66

1

1 Shifting dullness indicates abdominal fluid of greater than 500 mL. This finding
supports the diagnosis of ascites.
2 Liver enlargement will cause dullness, but it does not shift.
3 Positive shifting dullness is not indicative of pancreatitis.
4 An abdominal mass will cause dullness, but it does not shift.

Question 67

The nurse notes a positive shifting dullness during abdominal percussion. Which diagnosis does this
assessment data support?
1) Ascites
2) Liver enlargement
3) Pancreatitis
4) An abdominal mass

Answer 67

1

1 Shifting dullness indicates abdominal fluid of greater than 500 mL. This finding
supports the diagnosis of ascites.
2 Liver enlargement will cause dullness, but it does not shift.
3 Positive shifting dullness is not indicative of pancreatitis.
4 An abdominal mass will cause dullness, but it does not shift.

Question 68

Which action by the nurse is appropriate when determining if bowel sounds are absent during the patient
assessment?
1) Palpating the abdomen for two minutes
2) Inspecting the abdomen for 30 seconds
3) Percussing the abdomen for 60 seconds
4) Auscultating the abdomen for five minutes

Answer 68

4

1 Palpation is not the technique used to assess bowel sounds.
2 Inspection is not the technique used to assess bowel sounds.
3 Percussion is not the technique used to assess bowel sounds.
4 Bowel sounds occur every 5 to 15 seconds in an average adult patient. The nurse should
auscultate the abdomen for 5 minutes before determining that bowel sounds are absent.

Question 69

Which is the correct sequence for the abdominal exam?

1) Inspection, palpation, percussion, and auscultation
2) Inspection, percussion, palpation, and auscultation
3) Inspection, auscultation, percussion, and palpation
4) Inspection, auscultation, palpation, and percussion

Answer 69

3

1 This is not the correct order for an abdominal assessment.
2 This is not the correct order for an abdominal assessment.
3 It is important to auscultate before percussion and palpation because the manipulation
that occurs with these techniques may increase the frequency of bowel sounds.
4 This is not the correct order for an abdominal assessment.

Question 70

Which sound would the nurse expect to elicit when percussing the liver?

1) Resonance
2) Hyperresonance
3) Dullness
4) Tympany

Answer 70

3

1 Resonance is a respiratory percussion sound.
2 Hyperresonance is a respiratory percussion sound.
3 Dullness should be heard over the liver (around the fifth to seventh intercostal space).
4 Tympany is percussed over the stomach or intestines filled with air or gas.

Question 71

Which is the normal liver span at the midclavicular line the nurse anticipates when conducting a
gastrointestinal assessment?
1) 3 to 6 cm
2) 4 to 8 cm
3) 6 to 12 cm
4) 12 to 16 cm

Answer 71

3

Question 72

An older adult patient is admitted to the hospital with blunt trauma to the abdomen after an auto accident.
Which finding may indicate intra-abdominal bleeding?
1) Borborygmi
2) Everted umbilicus
3) Visible peristaltic waves
4) Bluish tint around the umbilicus

Answer 72

4

1 Borborygmi is the term used to describe hyperactive bowel sounds.
2 An everted umbilicus is often a normal finding for pregnant patients.
3 Visible peristaltic waves can be a normal finding for pediatric patients.
4 Bluish discoloration around the umbilicus (Cullen’s sign) indicates hemorrhagic
pancreatitis or intraperitoneal bleeding.

Question 73

Which bowel sound noted by the nurse during the gastrointestinal assessment indicates an early bowel
obstruction?
1) Hyperperistaltic
2) Hypoperistaltic
3) Absent
4) Epigastric

Answer 73

1

1 Hyperperistalsis can be a sign of early bowel obstruction.
2 Hypoperistalsis is not a sign of an early bowel obstruction.
3 Absent bowel sounds is a not a sign of an early bowel obstruction.
4 Epigastric bowel sounds are not a sign of an early bowel obstruction.

Question 74

Which structure, located in the right upper quadrant (RUQ) of the abdomen, is assessed by the nurse by
palpation and percussion?
1) Spleen
2) Stomach
3) Sigmoid
4) Liver

Answer 74

4.

1 The spleen is located in the left upper quadrant.
2 The stomach is located in the left upper quadrant.
3 The sigmoid colon is located in the left lower quadrant.
4 The liver is located in the RUQ. The nurse assesses this organ with palpation and
percussion.

Question 75

Which structure is located in the right lower quadrant (RLQ) of the abdomen?

1) Liver
2) Stomach
3) Cecum
4) Sigmoid

Answer 75

3

1 The liver is located in the right upper quadrant.
2 The stomach is located in the left upper quadrant.
3 The cecum is located in the RLQ.
4 The sigmoid is located in the left lower quadrant.

Question 76

Which is the primary system that is assessed by the nurse during an abdominal assessment?

1) Reproductive
2) Urinary
3) Digestive
4) Respiratory

Answer 76

3

1 The reproductive system is assessed during an abdominal assessment; however, this is
not the primary system the nurse is assessing.
2 The urinary system is assessed during an abdominal assessment; however, this is not
the primary system the nurse is assessing.
3 The digestive system is the primary system being assessed during an abdominal
examination.
4 The respiratory system is assessed during an abdominal assessment; however, this is
not the primary system the nurse is assessing.

Question 77

The nurse is assessing a patient who presents with weight loss. Which assessment question is most
appropriate for this patient?
1) “How is your appetite?”
2) “How frequent are your bowel movements?”
3) “When was your last bowel movement?”
4) “What color is your stool?”

Answer 77

1

1 Asking the patient about appetite is appropriate when the patient presents with weight
loss.
2 This question is more appropriate for a patient who is experiencing alterations in bowel
elimination.
3 This question is more appropriate for a patient who is experiencing alterations in bowel
elimination.
4 This question is more appropriate for a patient who is experiencing alterations in bowel
elimination.

Question 78

. When conducting an abdominal assessment, the nurse notes tender unmovable inguinal nodes that are greater
than 1 cm. Which conclusions by the nurse may be appropriate? Select all that apply.
1) Infection
2) Appendicitis
3) Cancer
4) Cholecystitis
5) Lymphoma

Answer 78

1,3,5

1. This is correct. This finding could indicate infection.
2. This is incorrect. This finding is not indicative of appendicitis.
3. This is correct. This finding could indicate cancer.
4. This is incorrect. This finding is not indicative of cholecystitis.
5. This is correct. This finding could indicate lymphoma.

Question 79

The nurse is conducting a health history for a patient who presents with abdominal discomfort. Which
assessment questions are appropriate? Select all that apply.
1) “Where is the pain?”
2) “Was the onset gradual or sudden?”
3) “When was your last menstrual period?”
4) “How is your appetite?”
5) “What have you had to eat in the last 24 hours?”

Answer 79

1,2,3

1. This is correct. This question is appropriate for the patient who presents with abdominal
   discomfort. It is essential for the nurse to determine the exact location of the pain.
2. This is correct. This question is appropriate for a patient who presents with abdominal pain.
   The onset may determine the source of the pain.
3. This is correct. Abdominal pain in female patients may indicate reproductive issues; therefore,
   the nurse should determine the last menstrual period.
4. This is incorrect. This question is more appropriate for a patient who has experienced a change
   in weight.
5. This is incorrect. This question is more appropriate for a patient who has experienced a change
   in weight

Question 80

The nurse is conducting a health history for a patient who presents with weight change. Which assessment
questions are appropriate? Select all that apply.
1) “Where is the pain?”
2) “Was the onset gradual or sudden?”
3) “When was your last menstrual period?”
4) “How is your appetite?”
5) “What have you had to eat in the last 24 hours?”

Answer 80

4,5

1. This is incorrect. This question is more appropriate for a patient who presents with abdominal
   pain.
2. This is incorrect. This question is more appropriate for a patient who presents with abdominal
   pain.
3. This is incorrect. This question is more appropriate for a patient who presents with abdominal
   pain.
4. This is correct. Weight change is assessed by determining the patient’s appetite.
5. This is correct. A 24-hour dietary log is appropriate to further assess a patient who presents
   with a change in weight.

Question 81

The nurse is conducting an abdominal assessment. Which structures can be assessed by palpation in the right
upper quadrant (RUQ)? Select all that apply.
1) Liver
2) Gallbladder
3) Duodenum
4) Spleen
5) Stomach

Answer 81

1,2,3

1. This is correct. The liver is located in the RUQ and assessed by palpation.
2. This is correct. The gallbladder is located in the RUQ and assessed by palpation.
3. This is correct. The duodenum is located in the RUQ and assessed by palpation.
4. This is incorrect. The spleen is located in the left, not right, upper quadrant.
5. This is incorrect. The stomach is located in the left, not right, upper quadrant.

Question 82

The nurse is assessing a patient who experienced blunt force trauma to the umbilical region of the abdomen.
Which structures may be affected based on this information? Select all that apply.
1) Right kidney
2) Ascending colon
3) Ileum
4) Aorta
5) Spine

Answer 82

3,4,5

1. This is incorrect. The right kidney is located in the right lumbar region.
2. This is incorrect. The ascending colon is located in the right lumbar region.
3. This is correct. The ileum is located in the umbilical region.
4. This is correct. The aorta is located in the umbilical region.
5. This is correct. The spine is located in the umbilical region.