Transcript The answer is D - Nursing examinations in India

CGFNS
1
a.
b.
c.
d.
The nurse suspects an elderly client has become
impacted when the client says:
I have a lot of gas pains
I don’t have much of an appetite
I felt like I have to go and just can’t
I haven’t had a bowel movement for 2 days
The answer is C
• Because of the presence of feces in the colon, a client
with a fecal impaction has the urge to defecate but is
unable to. Flatulence may occur as a result of immobility
not just obstruction. Anorexia may occur with a fecal
impaction but may also be caused by outer conditions.
The frequency of bowel movements varies for
individuals. It may be normal for this individual. It may be
normal for this individual not to have bowel movement 2
for several days
a.
b.
c.
d.
A client hepatic cirrhosis begins to develop slurred
speech, confusion, drowsiness, and a flapping tremor.
With this evidence of impending hepatic coma, the diet
would probably be changed to :
20 g protein, 2000 calories
70 g protein, 1200 calories
80 g protein, 2500 calories
100 g protein, 1500 calories
The answer is A
Rationale : Because the liver is unable to detoxify ammonia
to urea, and when hepatic coma is inevitable, protein
intake should be restricted (20 g proteins and 2000
calories). The other options have relatively high intake of
protein, which will increase blood ammonia levels.
3
After a partial gastrectomy is performed, a client is returned to the
unit with an iv solution infusing and a a nasogastric tube in
place. The nurse notes that there has been no drainage from
nasogastric tube for an hour. There is an order to irrigate the
nasogastric tube prn. The nurse should insert:
a. 30 ml of normal saline and withdraw slowly
b. 20 ml of air and clamp off suction for 1 hour
c. 50 ml of saline and increase pressure of suctionj
d. 15 ml of distilled water and disconnect suction for 30 mts
The answer is A
Normal saline is used in irrigtion to prevent electrolyte
imbalance. Because of the fresh gastric sutures slow and
gentle irrigation should be performed. Most surgeons,
however prefer gastric instillation. The purpose of irrigation is
to maintain the patency of the tube for gastric decompression.
Pushing air and clamping the suction tube can result in
blocking the nasogastric tube by viscous drainage. Increasing
the pressure or disconnecting suction may cause damage to
4
the suture line.
When performing a colostomy irrigation the nurse inserts the
catheter into the stoma upto
a. 5 cm (2inches)
b. 10 cm (4 Inches)
c. 15 cm (6 inches)
d. 20 cm ( 8 inches)
The answer is B
10 cm is far enough to direct the flow of solution into the
bowel. Insertion of 5 cm is inadequate fluid may leak
back around the catheter. An insertion of 15 cm may
cause trauma to the mucosa. An insertion of 8 inches
may cause trauma to the mucosa.
5
a.
b.
c.
d.
When teaching a client to irrigate a colostomy, the nurse
indicates that the distance of the container above the
stoma should be no more than:
15 cm (6 inches)
25 cm (10 inches)
30 cm (12 inches)
45 cm (18 inches)
The answer is D
A colostomy irrigation is much like a tap water enema. The
solution must be held at 45 cm above the stoma, which
is high enough to allow flow into the bowel, but not so
high that it flows rapidly, or it can cause cramping or
mucosal injury. The other potions do not represent
maximum height permitted and may not ensure flow of
solution into the bowel.
6
a.
b.
c.
d.
The physician has ordered a rectal tube to help a client
relieve abdominal distention following surgery. To
achieve maximum effectiveness, the nurse should leave
it in place for a period of
15 minutes
30 minutes
45 minutes
60 minutes
The answer is B
A rectal tube promotes maximum benefits in 30 minutes.
This allows adequate time for gas to escape. 15 minutes
is not adequate time to permit removal of flatus. Beyond
30 minutes there would be minimal release of flatus.
7
a.
b.
c.
d.
While administering an enema, the maximum safe height
at which the container of fluid can be held is :
30 cm (12 inches)
37 cm
45 cm (18 inches)
66 cm (26 inches)
The answer is C
If the height of the enema fluid container above the anus in
increased, the force and rate of flow also icrease if the
containeer is raised excessively, damage to the mucosa
may and the procedure will be much more difficult for the
client to tolerate. The enema container can be held up to
45 cm above the anus. Upto 37 cm is still be considered
within safe limits, 66 cm would be too high and could
8
cause mucosal injury.
a.
b.
c.
d.
A client has peptic ulcer in the duodenum. He would
probably describe the associated pain as:
An ache radiating to the left side
An intermittent colicky flank pain
A gnawing sensation relieved by food
A generalized abdominal pain intensified by moving
The answer is C
Eating food relieves the gnawing sensation. Because the
acid secretions in the stomach is neutralized by food
rather than irritate the intestinal mucosa. An ache
radiating to the left side is not specific to duodenal
ulcers. An intermittent colicky flank pain may indicate
renal colic. A generalized abdominal pain intensified by
moving is a generalized symptoms not specific to
duodenal ulcers.
9
a.
b.
c.
d.
Diagnosis of malabsorption syndrome is made in a client.
Striking clinical improvement should be noted after
administration of :
Folic acid
Vitamin B12
The answer is D
Corticotropin
A gluten free diet
Gluten a cereal protein appears to be responsible for
morphologic changes of the intestinal mucosa in individuals
with nontropical sprue (adult celiac disease). Folic acid, along
with antimicrobial agents is used to treat tropical sprue it
causes dramatic improvement. Vitamin B12 may be
administered if macroccytic anemia or achlorhydria develop,
however, it does not correct the major pathology. The use of
corticosteroids may be advantageous with either form of
sprue; however, this does not produce the same effect as
specific treatment already described.
10
a.
b.
c.
d.
A flat plate X-ray of the abdomen is ordered for a client.
The nurse recognizes that the client should receive:
No special preparation
A low soapsuds enema
Nothing by mouth for 8 hours
A laxative the evening before the X-ray
The answer is A
A flat plate film of the abdomen visualizes
abdominal organs as they are. No bowel
preparation is indicated. The client may eat and
drink as tolerated. Preparation is not required.
11
a.
b.
c.
d.
A pancreatic pseudocyst is:
Generally a malignant growth
Filled with pancreatic enzymes
Cyst containing necrotic tissue and blood
A pouch of undigested food particles
The answer is C
The pancreatic pseudocyst is an abnormally dilated space
that contains blood, necrotic tissue, and enzymes, which
is surrounded by connective tissue. The other options
are incorrect definitions of a pseudocyst.
12
a.
b.
c.
d.
When teaching a client about intussusception, the nurse
explains that it is :
Kinking of the bowel onto itself
A band of connective tissue compressing the bowel
Telescoping of a proximal loop of bowel into a distal loop
A protrusion of an organ or part of an organ through the
wall that contains it
The answer is C
Intussusception is the telescoping of prolapse of a segment
of the bowel within the lumen of an immediately
connecting part. Kinking of the bowel onto itself is
volvulus. Adhesions are ands of scar tissue that can
compress the bowel. Protrusion of na organ through the
wall that cdontain it is called herniation.
13
a.
b.
c.
d.
Health teaching program for a client who has had a gastrectomy
should include:
A warning to avoid all gas forming foods
An explanationof the therapeutic client of a high roughage
Encouragement toresume previous eating habits as soon as
possible
A thorough explanation of the dumping syndrome and how to limit or
prevent it.
The answer is D
Dumping syndrome occur in about 50% of all individuals who
have undergone a gastrectomy. The symproms include
weakness, heart palpitations, and diaphoresis. It is therefore,
important to explain to the client that such symptoms can be
minimized by resting after meals in the semi0Fowler position,
eating small meals, and omitting concentrated and highly
refined carbohydrates. Gas forming foods (option A ) affect
rather thean gastric disorders. Option C is inappropriate ,
because in order to prevent rapid emptying of the stomach
eating habits should be modified.
14
Barium salts used for GI series and barium enemas serves
to:
a. Fluoresce and thus illuminate the alimentary tract
b. Give off visible light and illuminate the alimentary tract
c. Dye the alimentary tract and thus provide for color
contrast
d. Absorb X-rays and this give contrast to the soft tissues of
the alimentary tract
The answer is D
Barium salts used in a GI series and barium enemas coat
the inner lining of the GI tract and then absorb X-rays
passing through. Thus, they outline the surface features
of the tract on photographic plate. Barium does not
fluoresce. It has no light emiting properties, nor has any
properties f a dye.
15
a.
b.
c.
d.
A client with a hiatus hernia complains about having
difficulty sleeping at night. The appropriate nursing
interention would be:
Make the client sleep on two or three pillows
Eliminate carbohydrates from client’s diet
Suggest drinking a large glass of milk before retiring
Administer antacids such as sodium bicarbonate
The answer is A
Sleeping on pillows raises the upper torso and prevents feflex of
the gastric contents through theheria. Eliminating
carbohydrates from diet gave have no effect on the mechanical
problem of the stomach’s contents entering the thoracic cavity.
Drinking a large glass of milk before retiring would increase the
content of the stomach before lying down, which would
aggravate the symptoms associated with a hiatal hernia. The
effect of antacids is not long lasting enough to promote a fuill
night’s sleep, sodium bicarbonate is not the antacid of choice’
16
a.
b.
c.
d.
Postoperative care for a client who has had a
hemorrhoidectomy should include
Occlusive dressings to the area
Encouraging showers when needed
Administration of laxatives and stool softeners
Administration of enemas to promote defecation
The answer is C
Stool softeners and laxatives are administered to avoid
straining and constipation. Light dressing are used to
promote drainage and healing. Baths are advised to
promote healing and cleaning of the area. Enemas may
be ordered several days after surgery if the client has not
had a bowel movement.
17
a.
b.
c.
d.
a client complains of abdominal cramps during a
colostomy irrigation, the nurse should:
Discontinue the irrigation
Lower the container of fluid
Clamp the catheter for a few minutes
Advance the catheter about 2.5 cm (1 inch)
The answer is C
The rapid rate of enema administration or ostomy irrigation often
causes abdominal cramping. Additional fluid leads to more
discomfort. Cramping will generally subside if the enema
tubing is clamped for a few minutes; the procedure can then
be continued. Discontinuing the irrigation could lead to
ineffective cvacuation of the colon. Lowering the container will
decreaqse the rate of flow, but fluid will continue to enter the
colon if the container remains above the stoma, indiscriminate
advancing of the catheter can injure the mucosa but not
18
relieve the cramping
a.
b.
c.
d.
Twenty amino acids are involved in body metabolism, building of
various tissues. Of these, 8 are essential amino acids. This means
that :
These 8 amino acids can be made by the body because they are
essential to life.
These 8 amino acids are essential in body processes and the
remainig 14 are not.
The body cannot synthesize these 8 amino acids and thus they
must be obtained form the diet
After synthesizing these 8 amino acids, the body uses them in key
processes essential for growth
Essential amino acids are needed to maintain life, but
are not synthesized by the body. Option A,B and D are
incorrect according to the defination of essential
aminoacid. C
19
a.
b.
c.
d.
The laboratory test that would indicate that the liver of a client
with cirrhosis is compromised and Neomycin enemas might
be helpful is :
Ammonia level
White blood count
Culture and sensitivity
Alanine aminotransaminase level
The answer is A
Increased ammonia level indicate that the liver is unable to
detoxify protein by products. Neomycin reduces the amount of
ammonia forming bacteria in the intestine. White bolld cell
may indicate infection, however this would have no
relationshipto the need for neomycin enema. Culture and
sensitivity testing would identify the presence of a
microorganism and the medicatio that would be effective in its
eradification. It would not be indicated in cirrhosis. Alanine
aminotransferase (ALT) is a test to assess for disease but has
20
no relationship to the need for Neomycin enemas
a.
b.
c.
d.
An acute attack of pancreatitis may be precipitated by heavy
drinking. Because:
Promotes the formation of calculi in the cystic duct
The pancreas is stimulated to secrete more of insulin than it
can immediately produce
The alcohlo alters the composition of enzymes so they aare
capable of damaging pancreas
Alcohol increases enzymes secretion and pancreatic duct
pressure, which cause bakcflowof enzymes into the pancreas.
The answer is D
Alcohol stimulates pancreatic enzyme secretion and an increase
in pressure in the pancreatic duct The ackflow of enzymes
into th epancreatic interstitial spaces results in partial
digestion and inflammation of the pancreatic tissue. Alcohol is
not associated with formation of calculi. The demand for
insulin is unrelated to pancreatitis. Although the volume of
secretions increases, the composition remains unchanged.
21
a.
b.
c.
d.
When caring for a client with a nasogastric tube attached to
suction, the nurse should:
Irrigate the tube with normal saline
Use sterile technique when irrigating the tube
Withdraw the tube quickly when decompression is terminated
Allow the client to have small chips of ice or sips of water
unless nauseated.
The answer is A
To ensure continued suction, ther patency of the tube should be
maintained. Normal saline is used to prevent fluid and
electrolyte disturbance during irrigation. Option B is not
correct because the stomach is not considered a sterile body
cavity, so medical asepsis not indicated. Option c is
inappropriate, care must be taken to avoid traumatizing the
mucosa. Option D is inappriate. Ice chips and water represent
fluid intake, which must be approved by the physician. Ice
chips and water being hypotonic in nature may lower the
22
serum electrolytes.
a.
b.
c.
d.
For an elderly client who has had a subtotal gastrectomy,
the wisest dietary guidance would be to :
Increase intake of dietary roughage
Avoid oral feedings for a prolonged period
Gradually resume small easily digestable feedings
Allow the selection of personally preferred foods
The answer is C
Small frequent feedings are tolerated best after a subtotal
gastrectomy. Option A is inappropriate because roughage
may be irritating to the GI tract after surgery. Option B is
wrong, because the individual is generally given small
amounts of fluid as soon as oedema subsides and then the
diet is gradually progressed. Option D is also inappropriate
because allowing only food preferences does not ensure
inclusion of nutrients necessary for recovery.
23
a.
b.
c.
d.
A client has taken mega doses of Vitamin A. the nurse
questions this practice because:
This vitamin is highly toxic even in small amounts
The liver has great storage capacity for the vitamin, even to
toxic amounts
This vitamin cannot be stored, and the excess anount sould
saturate the general body tissues.
Although the body’s requirement for the vitamin is very large,
the cells can synthesise more as needed
The answer is B
Vitamin A is a fat soluble vitamin that accumulates in the body and is not
significantly excreted even if extremely large amounts are ingested.
After prolonged ingestion of extremely large doses toxic effects
(irritability, increased intracranial pressure, fatigue, night sweats, and
severe headache) can occur. Option A is wrong because vitamin A is
toxic only after prolonged large dosages. optionC is wrong because
Vitamin A can be stored in the liver. Option D is wrong because
24
Vitamin A cannot be synthesized in the body.
a.
b.
c.
d.
A client with liver canceer complains of fatigue because a
readily available form of energy although limited in
amount, is stored in the liver by conversion of glucose to:
Glycerol
glycogen
The answer is B
Tissue fat
Amino acids
The liver stores carbohydrates as glycogen which
is a polymer of glucose for future energy needs.
Glycerol a byproduct of lipids, which combines
with three fatty acids to form a triglyceride. Fat is
not saved in the liver. Amino acids are not a
ready form of energy. Polymer of amino acids
form protein.
25
a.
b.
c.
d.
Which of the following is essential for absorption of fat
soluble vitamins in the intestine?
Hydrochloric acid
Bile salts
Lipase
Amylase
The answer is B
Bile salts are surfactants that help in absorption and
transport of lipids and lipid soluble vitamins across the
cells lining the GI tract. Hydrochloric acid is secreated by
the stomach and has no role in absorption fats and fat
soluble vitamins. Lipas and amylase are enzyme that are
involved in digestion of fats and carbohydrates
26
respectively
a.
b.
c.
d.
The nurse would expect a client with cancer of the liver
to have difficulty digesting fatty foods because the liver is
involved in the production of :
Bile
Lipase
Cholesterol
The answer is A
Amylase
Fatty acids are insoluble in water dn must combine
with bile to form water solble substances for
digestion and absorption. Lipase is pancreatic
enzyme. Amylase which digests starch is found
in saliva and pancreatic juice. Cholesterol is not
27
required for emulsification of fats
a.
b.
c.
d.
A client complains of abdominal discomfort following
ingestion of milk. The nurse reconizes that this may be
the result of a genetic deficiency of the enzyme
Lactase
Maltase
The answer is A
Sucrase
amylase
Milk and milk products are not tolerated well because they
contain lactose; a disaccharide that is broken down by
the enzyme lactase to yield to galactose and glucose.
Lactose intolerance is commonin theose of afroamerican
heritage. Who lack in lactase. Maltase is an enzyme that
assists the digestion of maltose, which is not a milk
sugar. Sucrase is an enzyme that assists he digestion of
sucrose, which is not a milk sugar. Amylase is an
enzyme that assists the digestion of starch, which is not
28
a milk sugar.
a.
b.
c.
d.
A client with ???ng ???
20 g protein, 2000 calories
70 g protein, 1200 calories
80 g protein, 2500 calories
100 g protein, 1500 calories
The answer is A
??? be ???od ammonia levels.
29
a.
b.
c.
d.
The earliest indication of parenchymal damage to the
liver in clients with hepatitis B is usually :
A rise in bilirubin
An alteration in proteins
A rise in alanine aminotrasferase (ALT)
An elevation of alkaline phosphatase
The answer is C
ALT is also known as glutamate pyruvate
transaminase GPT, that is released early in the
course of liver damage. A rise in bilirubin, an
alteration in proteins, or an elevation of alkaline
phosphatase are not early signs liver damage.
30
a.
b.
c.
d.
When caring for a client with an ileostomy the nurse
would:
Encourage the client to eat foods high in residue
Explain that th4e drainage can be controlled with daily
irrigation
Expect the stoma to start draining on the third
postoperative day
Anticipate that emotional stress can increase intestinal
peristalsis.
The answer is D
Emotional stress of any kind can stimulate peristalsis and
thereby increase the volume of drainage. The client
should be encouraged t eat a diet as normal as possible.
Ileostomy drainage is liquefied and continuous, so
irrigations are not indicated. The stoma will start to drain
31
within the first 24 hours after surgery.
32
a.
b.
c.
d.
A client who has had a colostomy should follow a diet
that is :
Rich in protein
Low in fiber content
The answer is D
High in carbohydrate
As close to normal as possible
Although foods that produce gas are generally avoided, the
diet of an individual with a colostomy should be as close
to normal as possible for optimal physiologic and
psychologic adaptation. A high protein diet is important
until healing occurs, but a balanced diet generally meets
nutritional needs for protein. There is no need to limit
fibre, it provides bulk necessary for unconstipated stools.
Because absorption of nutrients is unaffected, there is no
need to increase carrbohydrate intake.
33
a.
b.
c.
d.
A client with ascites has been ordered paracentesis. Before
the procedure the nurse should instruct the client to:
Empty the bladder
Eat foods low in fat
Remain npo for 24 hours
Assume the supine position
The answer is A
The bladder must be empty to decrease the
chance of puncturing it during the paracentesis.
Option B and C are not necessary. Paracentesis
is usually peerformed in the Fowler position to
assist the flow of fluid by gravity, and not in
34
supine position.
a.
b.
c.
d.
A typical food combination that can be served to a client
with malabsorption syndrome is :
Roast beef, baked potato, carrot, and tea.
Cheese omelet, noodles, green beans, coffee
Creamed turkey o toast, tice, green peas, milk
Baked chicken, mashed potatoes with gravy zucchini,
and postum
The answer is A
Roast beef, baked potato, carrot and tea ae low in
gluten, hence this combination can be served.
Flours used in the oroduction of noodle and
bread are high in gluten. Popstum is a cereal
drink, which is high in gluten.
35
a.
b.
c.
d.
The nurse explains that visualization of the GI tract after
a barium enema is made possible because:
Barium physically colors the intestinal wall.
Barium has the X-ray absorbing properties
Barium has X-ray transmitting properties
Barium chemical interacts with electrolytes.
The answer is B
Because the soft tissues of the GI tract lack
sufficient quantities of X-ray absorbing atoms (as
are naturally present in the dense calcium salts
of bone) an X-ray absorbing coating of barium is
used for radiologic studies. Barium does not
colour the intestinal wall or absorbs X-rays, or
36
interact with electrolytes.
a.
b.
c.
d.
When teaching a client to care for a new colostomy, the
nurse should advice the client that the irrigations be done
at the same time every time every day. The time selected
should:
Be approximately 1 hour before breakfast
Provide ample uninterrupted bath room use at home
Approximate the client’s usual daily time for elimination
Be about halfway between the two large meals of the day
The answer is B
Ample time in the bathroom must be ensured for the actual
irrigation process and fecal returns, which may not be
immediate option A and D The availability of adquate time
takes precedence ; this would not use the gastrocolic reflex
that would occur after eating. Option C This is important; but
the availability of adequate time takes precedence.
37
a.
b.
c.
d.
If intubation is indicated in a client with bleeding
oesophageal varices, the type of tube most likely to be
used would be a (an)
Levin tube
Salem sump
Miller-Abbott tube
Blakemore-Sengstaken tube
The answer is D
Blakemore-Sengstaken tube includes an oesophageal balloon
that on inflation exerts pressure, which retards hemorrhage.
Option A is used for gastric decompression or lavage. It has
one lumen. Option B is used for gastric decompression. It has
two lumens, one for decompression and one for an air vent.
Option C is used for intestinal decompression.
38
a.
b.
c.
d.
When teaching a client at discharge with a permanent
colostomy, the nurse is expected to discuss the :
Need for special clothing
Importance of limiting activity
Periodic dilation of the stoma
Bland, low residue diet regimen
The answer is C
The stoma of a colostomy must be dilated with a lubricated,
gloved finger to prevent strictures and subsequent
obstruction. Clothing need not be special but should be
nonconstricting. Once healing has occurred, activity need not
be limited. Diet should be as close to normal for the individual
as possible; but gas forming foods should be avoided.
39
a.
b.
c.
d.
The chief complaint in clients with Vincent’s angina is :
Chest pain
Shortness of breath
Shoulder discomfort
Bleeding oral ulceration
The answer is D
Vincent’s angina (trenchmouth) is an infection of
themouth resulting in bleeeding gums, pain on
swallowing and talking, and fever. Option A is a
symptom related to angina pectoris, resulting from
insufficient oxygenation of myocardial tissue, not
Vincent’s angina. Option B and C are symptoms
related to angina pectoris, and not related to Vincent’s
40
angina
a.
b.
c.
d.
Before scheduling a client for endoscopic retrograde
cholangiopancreatography (ERCP) the nurse should
assess the client’s :
Urine output
Bilirubin level
The answer is B
Serum glucose
Blood pressure
ERCP involves the insertion of a cannula into panceratic
and common bile ducts during endoscopy. The test is not
performed if the client’s serum bilirubin is greater than 5
mg/dL, because cannulization may cause oedema which
would further increase obstruction to bile flow. Option A,
C and D are not related to performing ERCP.
41
a.
b.
c.
d.
A client with ???ng ???
20 g protein, 2000 calories
70 g protein, 1200 calories
80 g protein, 2500 calories
100 g protein, 1500 calories
The answer is A
??? be ???od ammonia levels.
42
a.
b.
c.
d.
A client with ???ng ???
20 g protein, 2000 calories
70 g protein, 1200 calories
80 g protein, 2500 calories
100 g protein, 1500 calories
The answer is A
??? be ???od ammonia levels.
43
a.
b.
c.
d.
Fractured mandible is usually immobilized with
wires. The life threatening postoperative problem
that can develop with this pocedure is :
Infection
The answer is B
Vomiting
Reflux of intestinal contents into the oesophagus
Build up of feces and gas within the large intestine.
• Vomiting may result in aspiration of
vomitus because it cannot be expelled,
this could cause pneumonia or asphyxia.
Infection is not a life threatening problem.
Osteomylitis is not life threatening.
Bronchospasm is also not life-threatening.
44
a.
b.
c.
d.
A subtotal gastrectomy is performed to treat a client with
cancer of the stomach. This client develops dumping
syndrome. The dumping syndrome refers to :
Nausea due to a full stomach
Rapid passage of osmotic fluid into the jejunum
Reflux of intestinal contents into the esophagus
Buildup of faeces and gas within the large intestine
The answer is B
When high osmotic fluid passes rapidly into the small intestine, it causes
hypovolemia. This results in a sympathetic response with tachycardia
diaphoresis. The symptoms are also attributed to a sudden rise and
subsequent fall in blood sugar. The stomach is not full. Its contents are
rapidly emptied into the jejunum. Reflux of intestinal contents would need
reverse peristalsis, which could occur with intestinal obstruction; dumping
syndrome is associated with increased motility originating in the jejunum.
Build up of feces and gas within the large intestine is usually associated
45
with paralytic ileus; dumping syndrome leads to increased intestinal motility.
a.
b.
c.
d.
Phospho-soda is cathartic, classified as :
saline
Emollient
stimulant
Bulk-forming
The answer is A
Phospho-soda is a saline cathartic, which increases the osmotic
pressure within the intestine so that body fluids are drawn into the
bowel stimulating bowel stretching, peristalsis and defaecation.
Emollients have a detergent action softening the stool by
facilitating its absrption of water. Stimulants irritate the mucosa so
that peristalsis is increased. Bulk-forming laxatives are cellulose
derivatives that remain in the intestinal trace and absorb water,
they cause bulk, which stimulates peristalsis.
46
a.
b.
c.
d.
When a client has extensive carcinoma of the
descending portion of colon with metastasis to the lymph
nodes the operative prodedure that would probably be
performed is a (an) :
Ileostomy
Colectomy
The answer is C
Colostomy
Caecostomy
The location of the tumour will usually indicate whether a
colostomy (creation of an opening) proximal to the tumour
between the colon and the skin surface is needed. An ileostomy
is the creation of an opening between the ileum and the skin
surface, it would not be done in this condition. A colectomy is the
surgical removal of a portion of the colon, with creation of an
anstomosis it is generally used in less extensive carcinoma. A
cecostomy is the creation of an opening between the caecum
and the skin surface; it is usually a temporary procedure.
47
a.
b.
c.
d.
Clients with gastrectomy may develop pernicious anaemia
because:
Vitamin B 12 is only absorbed in the stomach
The haemopoietic factor is secreted in the stomach
The parietal cell of the gastric mucosa secrete intrinsic factor
Chief cells in the stomach secrete the extrinsic factor.
The answer is C
Pernicious anaemia is caused by a lack of intrinsic
factor produced by the parietal cells of the
gastric mucosa that is necessary for B12 to be
absorbed in the ileum. Haemopoitic factor is the
combination of B12 and intrinsic factor. Chief
cells in the stomach secrete the enzymes of the
gastric juice, and not extrinsic factor.
48
a.
b.
c.
d.
In clients with cholecystitis the utilization of bile is
interfered with. The ejection of bile into the alimentary
tract is controlled by the hormone:
Gastrin
Secretin
The answer is D
Enterocrinin
Cholecystokinin
Cholecystokinin is a widely distributed hormone whose
functions include stimulation of gallbladder contraction
and release of pancreatic enzymes. It also functions as a
neurotransmitter in the CNS. Gastrine stimulates the
secretion of gastric juice, secretin promotes the
production of bile by the liver and the secretion of
pancreatic juice, and enterocrinin stimilates the secretion
49
intestinal juice (succus entericus)
a.
b.
c.
d.
Before a cholecystectomy a physician order vitamin K .
Vitamin K is required for the synthesis of :
Bilirubin
Prothrombin
Thromboplastin
The answer is B
Cholescystokinin
Vitamin K is required for the synthesis of prothrombin. It is
a fat-soluble vitamin and is not absorbed from the GI
tract in the absence of bile. Bilirubin is the bile pigment
formed by the breakdown of erythrocytes.
Thromboplastin converts prothrombin to thrombin during
the normal coagulation process. Cholecystokinin is the
hormone that stimulates pancreatic secretion anti
contraction of the gallbladder.
50
a.
b.
c.
d.
Hormone that stimulates the flow of pancreatic enzymes is:
Enterocrinin
Pancreozymin
Enterogastrone
Cholecystokinin
The answer is B
This is the unique function of pancreozymin, which
is secreted by the duodenal mucosa. It
particularly affects the production of amylase.
Enterocrinin (Option A ) increases intestinal juice
secretion. Enterogastrone (option C ) lessens
gastric secretion and motility. Cholecystokinin
(Option D )stimulates the flow of bile from the
51
gallbladder.
a.
b.
c.
d.
A client is admitted three days back for a cerebral
vascular accident, he is receiving intermittent feedings
through nasogastric tube. The nurse evaluates if a prior
feeding has been absorbed by :
Evaluating the intake in relation to the output
Aspirating the residual volume and reinstilling it
Instilling air into the stomach while auscultating
Comparing the client’s body weight to the base line data.
The answer is B
The presence of 50 ml of undigested formula may indicate impaired
absorption, the volume of the next feeding may need to be reduced
or the feeding postponed to reduce the risk of aspiration. Option A
evaluates fluid balance andis best performed over a 24 hour period.
Option C is a method for evaluating placement. Option D although
weighing the client regualarly is important to evaluating overall
nutritional progress it cannot provide information about absorption
52
of a particular fedding.
a.
b.
c.
d.
The ascites seen in cirrhosis results in part from:
The escape of lymph into the abdominal cavity directly from
the inflamedliver sinusoid.
Increased plasma colloid osmotic pressre due to excessive
liver growth and metabolism
The decreased levels of ADH and aldosterone due to
increasing metabolic activity in the liver
Compression of the portal vein with resultant increased back
pressure in the portal veins system
The answer is D
In cirrhosis of the liver, fibrous scarring within the liver parenchyma,
most often from alcohol toxicity, compresses the portal veins and
causes a backup of blood and increased presure within the portal
system. Fluid seeps into the abdominal cavity (ascites) mainly from
the surface ot the liver. Lymph does not escaop from the liver
sinusoids into the abdominal cavity. Plasma osmotic oncotic
pressure is decreased because of decreased albumin production.
Secretin of ADH and aldosterone increase as renal blood flow
decrease
53
a.
b.
c.
d.
Acute appendicitis is a condition associated with :
Poor dietary habits
Infection of the bowel
Hypertension and resultant oedema
Compromised circulation to the appendix
The answer is D
Circulation to the appendix is compromised when appendix is
impacted with faecolith or foreign body which cause
inflammation. Option A : Diet patterns do not predisopse the
individual to the development of appendicitis. Option B Bowel
infections are rare and do not predispose the individual to the
development of appendicitis. Option C : Hypertension may
cause generalized oedema. But local oedema would not
54
occur.
a.
b.
c.
d.
The main role of liver in relation to fat metabolism is to:
Produce phospholipids
Store fat for energy reserves
Oxidize fatty acids to produce energy
Convert fat to lipoproteins for transport out into the body
The answer is D
In the liver a simple protein combines with a lipid to
form a lipoprotein. Lipoproteins circulate freely in
the blood and can be utilized easily and quickly
in various metabolic processes. The liver does
not produce phospholipids. Fat is stored in
adipose tissue. The liver does not oxidize fat.
55
a.
b.
c.
d.
A client is scheduled for a pyloroplasty and vagotomy
because of strictures caused by peptic ulcers. The nurse
reinforces the client’s understanding of vagotomy by
stating, that the vagotomy serves to:
Increase the heart rate
Hasten Gastric emptying
Eliminate pain sensations
Decrease secretions in the stomach
The answer is D
The vagus nerve stimulates the stomach to sectete
hydrchloric acid When it is severed thisneral pathway is
interrupted and thereby stomach secretions are
decreased. During vagotomy only that portion of vagus
nerve, which innervate stomach will be severed and not
the one that innervates heart. The vagus nerve that
innervates stomach controls hyerochloric acid secretion,
56
not gastric emptying. Vagus nerve is not a sensory nerve.
a.
b.
c.
d.
Neomycin sulfate is administered to clients, before colon
surgery to:
Destroy intestinal bacteria
Increase the production vitamin K
Decrease the incidence of any secondary infection
Decrease the possibility of postoperative urinary infection
The answer is A
Neomycin sulfate is poorly absorbed from the GI tract and is
therefore used for sterilization of intestines prior to bowel
surgery. Destruction of intesteinal bacteria decreases
production of vitamin K . Oral administration of
neomycin primarily affects intestinal bacteria. Because it
is poorly absorbed from the GI tract neomycin sulfate
does not affect urinary tract infections.
57
a.
b.
c.
d.
The assessment finding which indicate the probable
presence of a fecal impaction in a client with limited
mobility would be :
Tympanites
Faecal liquid seepage
Bright red blood in the stool
Decreased number of blood movements
The answer is B
When the bowel is impacted with hardened faeces, there is
often seepage of liquid faeces around the obstruction
and thus uncontrolled diarrhoea. In tympanites the bowel
may become distended if completely obstructed, but this
is a late symptom if it occurs at all. Bright red blood in
the stool is indicative of lower GI bleeding. There are
often frequent liquid bowel movement in the presence of
58
impaction.
a.
b.
c.
d.
Varicose veins can be expected in clients with cirrhosis. This
is because of :
Increased plasma hydrostatic pressure in veins of the
extremities.
Toxic irritating products released into the blood from the
diseased organs.
Ballooning of vein walls from decreased venous pressure and
incompetent valves.
Decreased plasma protein concentration resulting in the
pooling of blood in the venous system.
The answer is A
The increased plasma hydrostatic pressure in veins of the
extremities resulting from heart failure or liver cirrhosis,
possible combined with a genetic weakness in the vein walls
may lead to varicose vein. Toxins are not responsible for
varicose veins. Distention of venous walls occurs as a result of
increased rather than decreased pressure. Decreased plasma
protein causes fluid to move out of the vascular compartment 59
a.
b.
c.
d.
The nurse should assess the client with cirrhosis for signs
of hepatic coma. The classic signs of hepatic coma is :
Bile coloured stools
Elevated cholesterol
Flapping hand tremors
Depressed muscle reflexes
The answer is C
Accumulation of nitrogenous wastes in hepatic coma
affects the nervous system. Flapping tremors and
generalized twitching occur in the second stage of
this disease. Stools is often clay colored because
of biliary obstruction by a cirrhotic liver. Elevated
cholesterol levels are ot necessarily present. As
encephalopathy progress to coma, all reflexes are
60
absent.
a.
b.
c.
d.
The symptoms associated with colitis are:
Leukocytosis, anorexia, weight loss.
Anaemia, haemoptysis, weight loss, abdominal cramps
Fever anaemia, nausea and vomiting leukopenia,
diarrhoea
Diarrhoea, anorexia, weight loss abdominal cramps
anaemia
The answer is D
Increased secretion of glucocorticoids and acetylcholine
tend to increase peristalsis, causing cramping and
diarrhoea with subsequent weight loss. As ulceration
occurs, loss of blood leads to anaemia. Leukocytosis is
not common in this disease. Haemoptysis (coughing up
blood from respiratory tract) is not a related symptom.
Fever may or may not be a symptoms and leukopenia
61
does not occur.
a.
b.
c.
d.
The term saturated and unsaturated fatty acids relate to
a degree of:
color
Taste
The answer is C
Density
Digestibility
Saturated fats found in animal tissue are more
dense than unsaturated fats that are found in
vegetable oils. Saturation or unsaturation of fatty
acids has no bearing on color, taste, or anything
to do with digestibility.
62
a.
b.
c.
d.
The basic pathophysiologic problem problem of the liver
causing oesophageal varices is:
Ascites and oedema
Portal hypertension
The answer is B
Loss of regeneration
Dilated veins and varicosities.
Cirrhosis of the liver results in the development of extensive scar tissue
within the liver structure; such scar tissue contracts, around hepatic
blood vessels, impeding blood flow and raising the pressure in the
hepatic portal system. The physiologic response to slowly developing
portal circulatory obstruction is the growthof collateral vessels linking
portal veins with oesophageal veins; as destruction progresses, the
collaterals become so large that they bulge into the oesophageal
lumen and are called oesophageal varices. Ascites and oedema are the
result of the pathophysiologic process in the liver, not the cause. The
fluid present in the interwsttial spaces and abdominal cavity is the
result of portalhypertension and decreased plasma protein. The liver
regenerates but in the case of cirrhosis scar tissue is formed. The 63
aricosities are the result of increased portal pressure.
a.
b.
c.
d.
A client has a transeverse loop colostomy. When
inserting a catheter for irrigation. The nurse should:
Use an oil-base lubricant
Instruct the client to bear down
Apply gentle but continuous force
Direct it toward the client’s right side
The answer is D
A transverse colostomy is an opening created in the
transverse colon. The rectal tube should be pointed to
the proximal intestine to evacuate the bowel. Watersoluble lubricant is generally used to facilitate insertion.
There are no sphincters so bearing down is
unnecessary. Continual force may traumatize the
mucous, because lack of nerve endings diminishes
sensation.
64
a.
b.
c.
d.
For a client after surgery for a perforated appendix with
localized peritonitis, the position that is incicated is :
Sim’s position
Semi-Fowler’s position
Trendelenberg position
Dorsal recumbent position
The answer is B
The semi-Fowler’s position aids in drainage and prvents
spread of infection throughout the abdominal cavity. The
Sim’s sites’ position is generally used for administration
of enemas or rectal examination; it would not be helpful
in draining the area. The Trendelenburg position would
contribute to the spread of infection throughout the
abdominal cavity. The dorsal recumbent position would
65
not allow for localization of drainage.
a.
b.
c.
d.
The hormone secretin and pancreeozymin are secreted
by ;
Liver
Adrenals
The answer is D
Pancreas
duodenum
The duodenum secretes seeveral digestion related
hormones, including secretin, which elicits bicarbonate
secretion from the pancreas and pancreozymin, which
elicits enzyme secretion from the pancreas. It also brings
about gallbladder contractrion and secretion of bile. In
this function it is known as cholecystokinin. The liver
produce bile, which aids in th edigestion of fat, but does
not produce any hormone. The adrenals produce
glucocorticoids and epinephrine.the hormones secreted
66
by pancreas are insulin and glucagon.
67
a.
b.
c.
d.
The term that most accurately describes a clients lack of
interest in food is:
Apathy
Anoxia
Anorexia
Dysphagia
The answer is C
The term anorexia refers to loss of appetite.
Apathy refers to alack of concern or emotion .
Anxia refers to lack of oxygen. Dysphagia refers
to difficulty in swallowing.
68
a.
b.
c.
d.
In an effort to prevent hepatic coma with a client with liver
dysfunction it may become necessary to:
Give fleet enemas
Eliminate protein from the diet
Prepare for emergency surgery
Eliminate carbohydrate from the diet
The answer is B
Because protein breakdown gives off ammonia which cannot be
detoxified by the liver protein should be eliminated from the
diet. Fleet enemas would not affect ammonia levels, which
are associated with hepatic coma a neomycin enema would
limit intestinal bacteria which breaks down protein, giving off
ammonia. Emergency surgery would affect ammonia levels
associated with hepatic coma. Eliminating carbohydrate from
the diet is unrelated to protein breakdown and rising ammonia
levels. It would have no effect.
69
a.
b.
c.
d.
A client with a cerebral vascular accident has developed faecal
incontinence. When establishing a bowel training program the nurse must
remember that the most important factor is to:
Use of medication to induce elimination
Plan to schedule a definite time for attempted evacuation
Encourage client’s previous habits in the area of diet and use of laxatives.
Encourage dlient’s timing of elimination to take advantage of the
gastrocolic reflex.
The answer is B
Bowel training is a program for the development reflex that controls regular
emptying of the bowel. The key to success in a conditioning program is
adherence to a strict time for evacuation based on the client’s individual
schedule. The indiscriminate use of laxatives can result in depencency.
Although encouraging client’s previous habits in the area of diet and use of
laxatives should be considered, the cerebrovascular accident affects
responses of the client by alttering motility peristalsis and sphincter control
despite adherence to previous habits. The passage of load into the stomach
does stimulate peristalsis bt it is only one factor that should be considered
when planning a specific time for evacuation.
70
a.
b.
c.
d.
A client is admitted with anorexia, weight loss, abdominal
distention, and abnormal stools. A diagnosis of malabsorption
syndrome is made. To meet the dlient’s needs the nurse should
Allow the client to eat food preferences
Institute IV therapy to improve hydration
Maintain NPO status, because food precipitates diarrhoea
Encourage consumption of meats at mealtime and high protein
snacks.
The answer is D
The diet shuld be high in protein and calorie, low in fat, and gluten
free for individuals with malabsorption syndrome. Protein is
needed for tissue rebuilding. The client may prefer foods high in
gluten, which would precipitate malabsorption. IV therapy is a
dependent function and does not provide all the necessary
nutrients. Diarrhoea is caused by malabsorption which accounts
for the poor nutritional status, once the diarrhoea is corrected, it
is essential to compensate by providing a nutritious diet.
71
a.
b.
c.
d.
The specific nursing responsibility in preparing a client
for a sigmoidoscopy and barium enema includes:
Giving castor oil the afternoon before
Withholding food and fluids for 8 hours
Admininstering soapsuds enema until clear
Ensuring that the client understands what is to happen
The answer is D
To promote understanding and allay anxiety, all
diagnostic tests should be explained to te client.
Castor oil is not given. No need to withhold fluids
for 8 hours, even though it is better to withhold
foods. No need to give enema.
72
a.
b.
c.
d.
As part of preparing a client for sigmoidoscopy, the nurse
should:
Administer an enema, the morning of the examination
Provide a container for the collection of a stool specimen
Withhold all fluids and foods for 24 hours before examination
Explain to the client that a chalklike substance will have to be
swallowed
The answer is A
To permit adequate visualization of the mucosa during the
signoidoscopy the bowel must be cleansed with a non
irritating enema before examination. The stool should be
eliminated from the colon by an enema before the
examination. Because only the lower bowel is being
visualized, keeping the client NPO is unnecessary. Clear
fluids and a laxative may be given the day before to limit
faecal residue. The client does nt drink such a substance in
preparation for a sigmoidoscopy.
73
a.
b.
c.
d.
when teaching an athletic teenager about nutritional intake,
the nurse should explain that the carbohydrate food that
would provide the quickest source of energy is a :
Glass of milk
Slice of bread
Chocolate candy bar
Glass of orange juice
The answer is D
Orange juice has a higher proportion of simple sugars, which are
readily available for conversion to energy. Milk contains fat
and protein (which require a longer digesting time) and
lactose, which is a disaccharide. Bread contains proteins and
starch, which require a longer time to digest. Candy bars do
not contain the high proportion of simple sugars found in
orange juice; they also contain fat, which takes longer time to
74
digest.
a.
b.
c.
d.
In clients with liver insufficiency the expected
assessment finding would be
Anuria
Feror hepaticus
Blepharospasm
Globus hystericus
The answer is B
The client’s breath has a fetor hepaticus(swet odour) because
the liver is not metabolizing the amino acid methionine.
Anuria is characteristic of renal failure. Blepharospasm
refers to spasm of the eyelid associated with anxiety or
cranial nerve pathology. It is unrelated to liver disease.
Globus hystericus is a sensation of a lump in the throat,
which is associated with acute anxiety; it is unrelated to
75
a.
b.
c.
d.
The nurse recognizes that a client has an increased risk
of developing cancer of the tongue if there is a history of:
Nail biting
Poor dental habit
Frequent gum chewing
Heavy consumption of alcohol
The answer is D
Heavy alcohol ingestion predisposes an individual
to the development of oral cancer. Nail biting
has no effect on the development of oral cancer.
Poor dental habit does not affect the
development of oral cancer. Frequent gum
chewing is not a contributing factor to
76
development of oral cancer.
a.
b.
c.
d.
The nurse should assess the client with liver cirrhosis
and hepatic coma for :
Icterus
urticaria
Uremia
haemangioma
The answer is A
Icterus is a yellowinsh tinge to the skin, often first
observed in the sclerae as a result of
accumulation of bilirubin in the body. Urticaria is
generally characteristic of an allergic response.
Uremia is characteristic of renal failure .
Haemangioma is a benign lesion composed of
77
blood vessels.
a.
b.
c.
d.
The nurse administers Neomycin to a client with hepatic
cirrhosis to prevent the formation of :
Bile
Urea
The answer is C
Ammonia
haemoglobin
Neomycin destroys intestinal flora which are responsible for breaking
down proteins and the release of ammonia. Ammonia at this time is
poorly detoxified by the liver and can build up to toxic levels. Bile
levels may be elevated because of biliary obstruction by the enlarged
liver but are unaffected by Neomycin. Urea is a byproduct of protein
metaboismformed in the liver as it detoxifies ammonia. The
production of urea is hampered by severe lliver damage and is
unaffected by Neomycin. Haemoglobin levels may be lowered as a
result of cirrhosis and bleeding but are not increased by
administration of Neomycin.
78
a.
b.
c.
d.
When assessing a client with portal hypertension, the
nurse should be alert for signs of :
Liver abscess
The answer is D
Intestinal obstruction
Perforation of the duodenum
Haemorrhage from oesophageal varices
The elevated pressure within the portal circulatory system
causes elevated pressure in areas of portal systemic
collateral circulation (most important in the distal esophagus
and proximal stomach). Haemorrhage is a possible
complication liver abscesses are not related to portal
hypertension. They may occur as a complication f intestinal
infection. Intestinal obstruction is not related to portal
hypertension. It may be caused by manipulation of the bowel
during surgery. Perforation of the duodenum is usually caused
by peotic ulcer it is not a direc result of portal hypertension or 79
a.
b.
c.
d.
The major posttransfusion viral hepatitis is :
Hepatitis type A
Hepatitis type B
Hepatitis type C
Hepatitis type D
The answer is C
Hepatitis C, formerly called non-A, non-B hepatiti is
caused by an RNA virus that is transmitted
parenterally. The incubation period is 5 to 10 weeks.
Hepatiti A also known as infectious hepatitis is caused
by an RNA virus that is transmitted via the fecal oral
route. The incubating period is 6 weeks. Hepatitis B is
transmitted parenterally sexually and by diredt contact
with infected body secretions. The incubation period is
6 months. It is not the maor cause of posttransfusion
hepatitis. Hepatitis D is a complication of hepatitis B. 80
a.
b.
c.
d.
A client has been operated for an incarcerated hernia.
The physician returns the incarcerated tissue into the
abdominal cavity and uses a mesh to reinforce the
muscle wall thereby preventing future recurrence. This
procedure is referred to as a
Herniotomy
Herniectomy
The answer is C
Hernioplasty
herniorrhaphy
Hernioplasty involves not only the reduction of a hernia
but also an attempt to change or strengthen the
structure to prevent recurrence. Herniotomy means an
opening cut into the hernia; it coes not refer to repair
of a hernia. There is no such procedure; herniectomy
means cutting the hernia. Herniorrhaphy is surgical
81
repair of a hernia
a.
b.
c.
d.
The most cmmon cause of diarrhea in clients receiving
full strength tube feeding is :
Increased fiber intake
Bacterial contamination
The answer is D
Inappropriate positioning
High osmolarity of the feedings.
High osmolarity (concentration) of many formulae draws
fluid into the intestinal tract, causing diarrhoea. Such
fedings may need to be diluted initially until the client
develops tolerance. Option A is not corrrect, because
formulae frequently have reduced fiber content causing;
problems with constipation. Option B is not a factor if
feeding are administratered as recommended by the
manufacturer. Option C may increase the risk of
aspiration but does not increase diarrhoea.
82
a.
b.
c.
d.
The solution of choice to be used to maintain patency of
an intestinal (cantor) tube is :
Sterile water
Isotonic saline
The answer is B
Hypotonic saline
Hypertonic glucose
Isotonic saline most closely resembles normal body
fluids; it will not cause an imbalance by pulling extra
fluids and electrolytes and of the circulation. Sterile
water and hypotonic solutions would allow absorption
of fluid into the circulation, resulting in dilution of
electrolytes and possible circulatory overload.
Hypertonic solutions would drawfluids out of the
circulation into the GI tract; glucose provides a
medium for bacterial growth.
83
a.
b.
c.
d.
A 20 year old client is admitted with an acute onset of right
lower quadrant pain. Appendicitis is suspected. To determine
the etiology of the pain, the client should be assessed for :
Urinary retention
Gastric hyperactivity
Rebound tenderness
Increased lower bowel motility
The answer is C
Rebound tenderness is a classic subjective sign of
appendicitis. Urinary retention does not cause
acute lower right quadrant pain. Gastric
hyperacidity causes epigastric not lower right
quadrant pain. There is generally decreased bowel
motility distal to an inflamed appendix, but not
84
increased lower bowel motility.
While helping a client reestablish a regular pattern of
defaecation, the nurse should base the teaching on the
principle that :
a. Inactivity produces muscle atonia
b. The gastrocolic reflex initiates peristalsis
c. Increased fluid promotes ease of evacuation
d. Increased potassium is needed for normal
neuromuscular irritability
The answer is B
Because stomach distention after eating results in
contractions of the colon (gastrocolic reflex promoting
defaecation establishing some regularly of meals that
include adequate bulk or fibree will help establish routine
patterna of defaecation. Although increased activity and
fluid intake facilitate elimination , in general they do not
help establish a pattern, increased potassium is not
85
a.
b.
c.
d.
Vitamins are administered parenterally for clients with an
inflamed intestine because :
More rapid action results
They are ineffective orally
They decrease colon irritability
Intestinal absorption may be inadequate
The answer is D
Intestinal absorption may be inadequate because the
mucosa of the intestine is damaged and its ability to
absorb vitamins taken orally is greatly impaired although
option A is true, the risks associated with IV
administration will outweigh the benefits unless other
factors are considered. Vitamins are effective orally
unless there is disease involving the GI tract that
hampers absorption. IV vitamins do not decrease colonic
86
irritability
a.
b.
c.
d.
Two hours after a subtotal gastrectomy the nurse notes
that the drainage from the client’s nasogastric tube is
bright red. The priority nursing action should be to :
Notify the physician immediately
Clamp the nasogastric tube for one hour
Recognize this as an expected finding
Irrigate the nasogastric tube with iced saline.
The answer is C
Nasogastric drainage is expected to be bright red at
first and gradually darken within the first 24
hoursafter surgery. Since bloody drainage is
expected soon after surgery. The physician need not
be notified. Nasogastric tube is irrigated only when
the ohysician orders because of the danger injury to
fine suture line; generally saline at room temperature87
a.
b.
c.
d.
Neomycin is especially useful before colon surgery
because it :
Will not afect the kidney
Acts systemically without delay
Is poorly absorbed from the GI tract
Is effective against many organisms
The answer is C
Because Neomycin is poorly absorbed from the GI
tract, most remains in the intestines and exerts its
antibiotic efect on the intestinal mucosa. In
preparation for GI surgery the level of microbial
organisms will be reduced. Noemycin is nephrotoxic.
Because t is ooorly abosorbed from the GI tract, the
systemic effect is minimal. Neomycin is mainly
efective in suppression of intestinal bacteria.
88
a.
b.
c.
d.
When a nurse is caring for a client with ascites, she
should understand that the portal vein :
Brings blood towards the liver
Enters the superior venacava from the cranium
Brings venous blood from the intestinal wall to the liver
It’s located superficially on the anteromedial surface of
the thigh.
The answer is A
The hepatic portal vein carries blood from the
capillary beds of the viscera (small and large
intestinal walls stomach, spleen pancreas,
gallbladder) to the sinusoids of the liver. The
hepatic veins drain the liver sinusoids into the
inferior vena cava. The other options are wrong
89
a.
b.
c.
d.
Sigmoidoscopy is a diagnostic measure. For this
examination, the client should be placed in the position
known as :
Sim’s
Prone
The answer is D
Lithotomy
Knee chest
This is the preferred position, because it maximally
exposes the rectal area and facilitates entry of the
sigmoidoscope. The sim’s position does not expose
the rectal area to the same extent as the knee chest
does but can still be used for sigmoidoscopy, if the
dlient is unable to maintain the knee chest position.
Althoughprone refers to a face down position, the
renal area is not exposed . The Lithotomy position is
appropriate for gynaecologic examination.
90
91
a.
b.
c.
d.
The primary step in achieving long range goals in the
rehabilitation of a client with a new colostomy involves
the client’s :
Mastery of techniques of colostomy care
Readiness to accept on altered body function
Awareness of available community resources
Knowledge of the necessary dietary modifictions.
The answer is B
The client must be ready to accept changes in body
image and function; this acceptance will facilitate
mastery of he techniques of colostomy care, special
diets, andoptimal use of community resources.
Specific knowledge given in Option A , C andD can
be imparted only when an individual is ready to learn
it requires acceptance of a new body image.
92
a.
b.
c.
d.
Clients with jaundice are susceptible to postoperative haemorrhage
because :
Excess bile salts in the blod inhibit synthesis of prothrombin in the liver
Excess bile salts in the blood inhibit synthesis of vitamin K and
prothrombinase in the liver
Decreased bile salts in the blood inactivates prothrombinase and
prevent formation of thrombin from prothrombin.
Lack of bile in the intestine causes inadequate vitamin K absorption,
which results in inadequate thrombin synthesis in the liver.
The answer is D
Vitamin K is a fat soluble vitamin that needs bile salts for its
absorption from the upper segment of the small intestine.
vitaminK is a catalyst in the carboxylation of glutamine.
residues in prothrombin do not inhibit prothrombin
synhesis. Vitamin K is not synthesized in the liver. Bile
salts have no effect on prothrombinase (thromboplastin)
93
a.
b.
c.
d.
Vitamin A is a fat soluble vitamin produced by humans
and other animals from its precursor carotene
(provitamin A). One of the main source of carotene is
oranges
Skim milk
The answer is D
Tomatoes
Leafy greens
Deep green and yellow vegetables contain large
quantities of the pigments alpha, bbeta and gamma
carotene; beta-carotene is the major chemical
precursor of vitamin A in human nutrition. Oranges
are considered a god source of both vitamin C and
potassium. Levels of vitamin A are higher in whole
milk than in skim milk. Tomatoes are a good source
of vitamin C. but not carotene
94
When receiving an enema, the client should be placed in :
a. Sim’s position
b. Back lying position
c. Knee chest position
d. Mid Fowler position
The answer is A
To take advantage of the anatomic position of the
sigmoid colon and the effect of gravity, the client
should be placed in a left Sim’s position for the
enema. Back lying position, knee chest position and
midfowler position does not facilitate the flow of
fluid into the sigmoid colon by gravity.
95
Prophylaxis for hepatitis B includes the following :
a. Preventing constipation
b. Screening of blood donors
The answer is B
c. Avoiding shellfish in the diet
d. Mid Fowler position
e. Limiting hepatotoxic drug therapy
Contracting hepatitis B through blood
transfusions can be prevented by screening
donors and testing the blood. Options A,C,
and D do not prevent transmission of
hepatitis B .
96
A Client has an appendectomy and develop peritonitis. The
nurse should assess the client for elevated temperature
and :
a. Hyperactivity
The answer is D
b. Extreme hunger
c. Urinary retention
d. Local muscular rigidity
Muscular rigidity over the affected area is a classic
sigh of peritonitis, Malaise, rather than hyperactivity
is often associated with peritonitis. Nausea is a
common occurrence with peritonitis. Urinary
retension may occur following surgery as a
complication.
97
The client’s diet after a cholecystectomy should include :
a. High fat and carbohydrate to meet energy demands
b. High protein and calories to promote wound healing
c. Low fat to avoid painful contractions in the area of the wound
d. Low protein and carbohydrate to avoid excess calories and
help the client lose weight
The answer is B
Protein and calories provide energy, both of which are
necessary for tissue building. High fat diet is
contraindicated because fat requires bile to be
absorbed. The gall bladder has been removed;
dietary fat intake depends on individual tolerance.
The diet in option D is anadequate for tissue repair.
98
The most therapeutic diet for a client with hepatic cirrhosis
would be :
a. High protein, low carbohydrate, low fat
b. Low protein, low carbohydrate, high fat, soft
c. High carbohydrate low saturated fat 1200 calories
d. Low sodium, protein to tolerance, moderate fat, high
calorie, high vitamin, soft
The answer is D
Low sodium controls fluid retention, blood pressure and
consequently oedema; low protein controls ammonia
formation in proportion to the liver’s ability to detoxify
ammonia in forming urea; moderate fat and high calories
and vitamins help repair a log standing nutritional deficit.
High proteins diets are contraindicated because of the
liver’s inability to detoxify ammonia. Protein restriction is
based on the liver’s ablility to detoxify ammonia; a high
fat diet is avoided because of thte related cardiovascular
risks and the relaed demand for bile. Regeneration of
tissue requires a high calorie diet; 1200 calories is too
99
low.
During administration of an enema, if the client complains of
intestinal cramps the nurse should :
a. Give it at a slower rate
The answer is C
b. Discontinue the procedure
c.
d.
Stop until cramps are gone
Lower the height of the container
Administering of additional fluid when a client complains of
abdominal cramps adds to discomfort because of additional
pressure Clamping the tubing for a few minutes, allows the
cramps to subside and the enema can be continued . Slowing
the rate decreases pressure but does n ot reduce it entirely.
Cramps are not a reason to discontinue the enema entirely .
Temporary clamping of the tubing usually relieves the cramps
andhte procedure can be continued. Lowering the geight of
thecontainer will reduce ht eflow of the solution which will
decrease pressure but not reduce it entirely.
100
a.
b.
c.
d.
A complete protein ( a food protein of high biologic value) is the
one that contains:
All 20 of the amino acids in sufficient quantity to meet human
requirements
Sufficient quantities of all 8 essential amino acids and 2 semi
essential aminoacids that meet the needs ofhuman body
The 8 essential amino acids in any proportion because the body
can always fill in the difference needed
Most of the 20 amino acids, from which the body will make
additional amounts of the 8 essential amino acids needed
The answer is B
Complete proteins (option B) contain sufficient quantities of
all 8 essential amino acids and 2 semi essential (arginine
and histidine) amino acids, which are of animal origin.
Semiessential aminoacids are essential only during
periods of growth. The other options are inappropriate.
101
a.
b.
c.
d.
The most serious complication associated with chronic
inflammatory disease of the bowel is:
Paralytic ileus
Bleeding
Perforation
The answer is C
Obstruction
As a result of chronic irritation, the colon becomes thin and
may perforate. Paralytic ileus may be a complication of
surgical intervention involving the intestines or of
perforation. Bleeding may vary from a small amount to
haemorrhage; this is not the most serious complication.
Obstruction rarely occurs, but if it does it is not the most
serious complication.
102
a.
b.
c.
d.
A client has not passed flatus and there are no bowel
sounds even on day 4 after abdominal surgery. Paralytic
ileus is suspected. In this condition, the interference is
caused by :
Decreased blood supply
Impaired neural function
Perforation of the bowel wall
Obstruction of the bowel lumen
The answer is B
Paralytic ileus occurs when neurologic impulses are
diminished, as from anaesthesia, infection or surgery.
Interference in blood supply would result in necrosis of
the bowel, but not paralytic ileus. Perforation of the
bowel would result in pain and peritonitis. Obstruction of
the bowel lumen would initially cause increased
peristalsis and bowel sound.
103
a.
b.
c.
d.
The symptoms of portal hypertension in clients with
cirrhosis are chiefly the result of :
Infection of the liver parenchyma
Fatty degeneration of kupffer cells
Obstruction of the portal circulation
Obstruction of the cystic and hepatic ducts
The answer is C
With obstruction of the portal vein there is an increase in pressure in the
abdominal veins, which empty into the portal system. These veins
develop collaterals to circumvent the obstruction. The collaterals are
usually in the paraumbilical haemorrhoidal, and oesophageal areas.
Although infection of the liver parenchyma may predispose to the
development of cirrhosis, which in turn can cause portal
hypertension, but most often it does not cause portal obstruction.
Kupffer cells are part of the reticuloendothelial system, which helps
prevent infection and does not primarily affect venous pressure.
Obstruction of these ducts blocks flow of bile, causing obstructive
104
jaundice.
a.
b.
c.
d.
The physician orders daily stool examination for a client
with chronic bowel inflammation. These stool
examination are ordered to determine:
Ova and parasites
Culture and sensitivity
Fat and undigested food
Occult blood and organisms
The answer is D
Occult blood in the stool could indicate active bleeding; the
stool should also be examined for microorganisms to
detect early infection that could easily become systemic
by spread through the damaged intestinal mucosa. Stool
examination for ova and parasites, culture and sensitivity
or occult blood and organisms is not required in this
situation.
105
a.
b.
c.
d.
Before ligation of haemorrhoids, the physician will
suggest the client to eat:
Bland diet
Clear liquid diet
High protein diet
Low-residue diet
The answer is D
A low residue diet is advised to limit stool formation. Bland
diets are usually employed in the management of upper
not lower GI disturbances. Although a clear diet is low in
residue it does not meet normal nutritional needs. A high
protein diet is indicated postoperatively
106
When receiving an enema, the client should be placed in :
a. Sim’s position
b. Back lying position
c. Knee chest position
d. Mid Fowler position
The answer is A
To take advantage of the anatomic position of the
sigmoid colon and the effect of gravity, the client
should be placed in a left Sim’s position for the
enema. Back lying position, knee chest position and
midfowler position does not facilitate the flow of
fluid into the sigmoid colon by gravity.
107
a.
b.
c.
d.
A complete protein ( a food protein of high biologic value) is the
one that contains:
All 20 of the amino acids in sufficient quantity to meet human
requirements
Sufficient quantities of all 8 essential amino acids and 2 semi
essential aminoacids that meet the needs ofhuman body
The 8 essential amino acids in any proportion because the body
can always fill in the difference needed
Most of the 20 amino acids, from which the body will make
additional amounts of the 8 essential amino acids needed
The answer is B
Complete proteins (ption B) contain sufficient quantities of
all 8 essential amino acids and 2 semi essential (arginine
and histidine) amino acids, which are of animal origin.
Semiessential aminoacids are essential only during
periods of growth. The other options are inappropriate.
108
a.
b.
c.
d.
The most serious complication associated with chronic
inflammatory disease of the bowel is:
Paralytic ileus
Bleeding
Perforation
The answer is C
Obstructin
As a result of chronic irritation, the colon becomes thin and
may perforate.paralytic ileu may be a complication of
surgical intervention involving the intestines or of
perforation. Bleeding may vary from a small amount to
haemorrhage; this is not the most serious complication.
Obstruction rarely occurs, but if it does it is not the most
serious complication.
109
a.
b.
c.
d.
A client has not passed flatus and there are no bowel
sounds even on day 4 after abdominal surgery. Paralytic
ileus is suspected. In this condition, the interference is
caused by :
Decreased blood supply
Impaired neural function
Perforation of the bowel wall
Obstruction of the bowel lumen
The answer is B
Paralytic ileus occurs when neurologic impulses re
diminished, as from anaesthesia, infection or surgery.
Interference in blood supply would result in necrosis of
the bowel, but not paralytic ileus. Perforation of the
bowel would result in pain and peritonitis. Obstruction of
the bowel lumen would initially cause increased
peristalsis and bowel sound.
110
a.
b.
c.
d.
The symptoms of portal hypertension in clients with
cirrhosis are chiefly the result of :
Infection of the liver parenchyma
Fatty degeneration of kupffer cells
Obstruction of the portal circulation
Obstruction of the cystic and hepatic ducts
The answer is C
With obstruction of the portal vein there is an increase in pressure in the
abdominal veins, which empty into the portal system. These veins
develop collaterals to circumvent the obstruction. The collaterals are
usually in the paraumbilical haemorrhoidal, and oesophageal areas.
Although infection of the liver parenchyma may predispose to the
development of cirrhosis, which in turn can cause portal
hypertension, but most often it does not cause portal obstruction.
Kupffer cells are part of the reticuloendothelial system, which helps
prevent infection and does not primarily affect venous pressure.
Obstruction of these ducts blocks flow of bile, causing obstructive111
jaundice.
a.
b.
c.
d.
The physician orders daily stool examination for a client
with chronic bowel inflammation. These stool
examination are ordered to determine:
Ova and parasites
Culture and sensitivity
Fat and undigested food
Occult blood and organisms
The answer is D
Occult blood in the stool could indicate active bleeding; the
stool should also be examined for microorganisms to
detect early infection that could easily become systemic
by spread through the damaged intestinal mucosa. Stool
examination for ova and parasites, culture and sensitivity
or occult blood and organisms is not required in this
situation.
112
a.
b.
c.
d.
The end products of protein digestion; aminoacids, are
absorbed from the small intestine by :
Simple diffusion because of their small size
Filtration according to the osmotic pressure direction
Active transport with the aid of vitamin B6 (Pyridoxine)
Osmosis caused by their greater concentration in the
intestinal lumen.
The answer is C
Amino acids (option C ) are absorbed into the blood in the
intestinal capillaries with the aid of vitamin B6 via the
energy-dependent active transport. Aminoacids are fairly
large molecules, they are not absorbed by simple
diffusion ( option A), passively diffuse. Option B refers to
movement across a semipermeable membrane; it does
not apply to aminoacids. Option D is inappropriate like
113
the option C.
a.
b.
c.
d.
A debilitated is admitted for palliative treatment of cancer
of the liver. On admission, the most helpful objective
information for future monitoring of the client’s condition
would be:
Diet history
Bowel sounds
Present weight
Pain description
The answer is C
Weight is valuable information that can be helpful to
determining the development or extent of ascites. Diet
history will not help in monitoring client’s condition.
Bowel sounds are objective data but do not help monitor
the liver. Pain description is a subjective data.
114
a.
b.
c.
d.
In an alcoholic client, a high calorie diet fortified with
vitamin should be encouraged to protect the tissue
damage of :
Liver
The answer is A
Kidney
Adrenals
Pancreas
The liver detoxifies alcohol and is the organ most often
damaged in chronic alcoholism. The high calorie diet
prevents tissue break which produces additional amino
acids and nitrogen. These organs kidney, adrenal and
pancreas are not involved in detoxification of alcohol.
115
a.
b.
c.
d.
The most important method of preventing amoebic
dysentery is :
Tick control
Sewage disposal
Killing biting gnats
Pasteurization of milk
The answer is B
Entamoeba histolytica the prganism that cause amebic
dysentery is transmitted through excreta, hence proper
disposal of sewage is required. This is not a tick borne
disease. This orgnism is not transmitted by gnats. This
organism is not transmitted via milk.
116
a.
b.
c.
d.
GI bleeding can be treated medically by an IV infusion. A
drug commonly used for this purpose is :
Vasopressin (Pitressin)
Neostigmine (Prostigmin)
Propantheline (Pro-Banthine)
Phytonadione (Aquamephyton)
The answer is A
Vasopressin is a vasoconstrictor used with great success in
controlling GI bleeding. Neostignine inhibits
cholinesterase, permitting acetycholine to function it is
used primarily for myasthenia gravis. Propantheline is a
gastrointestinal anticholinergic. It decreases motility but
has no effecgt on bleeding. Phtonadione is vitamin K; it
promotes formation of prothrombin in the liver; although
this action would be helpful. It would take too long to be 117
of value in an emergency situation.
a.
b.
c.
d.
Fat is water insoluble and cannot travel freely in the
blood The compound formed to serve as a vehicle for
transoport of fat is :
Lipoprotein
triglyceride
Phospholipid
Plasma protein
The answer is A
Lipoprotein are simple proteins combined with
lipids to facilitate transport of fat in the blood
triglyceride is insoluble in water. Phospholipid is
insoluble in water. Plasma proteins do not
contain fat.
118
a.
b.
c.
d.
A client with haemorrhoids asks what caused this
problem to occur. The nurse explains that it generally
results from:
Constipation
The answer is A
hypertension
Eating spicy foods
Poor bowel control
Constipation and prolonged standing are the common
causes of hemorrhoids. Hypertension does not
contribute developmetn of hemorrhoids. Spicy food
may irritate hemorhoids but does not cause
hemorrhoids. Bowel control is unrelated to the
development of haemorrhoids.
119
a.
b.
c.
d.
Many vitamins and minerals regulate the biochemical
reactions of cell metabolism by acting as coenzyme. This
means that the vitamin or mineral:
Forms a new compound by a series of complex changes
Is not a part of the enzyme controlling a particular
reaction.
May be a necessary catalyst for the reaction to proceed.
Prevents unnecessary reactions by neutralizing or
controlling the enzyme.
The answer is C
Coenzyme is a non protein substance, which in the
presence of a suitable enzyme, serves as catalyst for
enzyme catalzsed biochemical reactions. Coenzymes do
notform new compound. Coenzyme is a nonprotein part
of enzyme. The conenzyme does not neutralize the
120
enzymes.
a.
b.
c.
d.
One of the main functions of bile is to :
Split protein
Emulsify fats
Help synthesize vitamins
Produce an acid condition
The answer is B
The bile salts in ile act as detergents to break large fat
droplets into smaller ones (emulsification), providing a
larger surface area for the enzymatic action of fat
splitting enzymes lipase. Bile does not act on proteins
bile does not help synbhesize vieamins; it emulsifies fat
and thus, assists in absorption of fat soluble viatmins bile
does not have an acid pH.
121
a.
b.
c.
d.
The goal of dietary management of peptic ulcer disease is to
Provide optimal amounts of all important nutrients
Increase the amount of bulk and roughage in the diet
Eliminate chemical, mechanical and thermal irritation
Promote psychologic support by offering a wide variety of
foods
The answer is C
Elimination of chemical, mechanical and thermal irritants
will minimize the irritation of the mucosa thereby
bleeding or perforation of intestine is avoided. Optimal
amounts of all important nutrients is not specific to this
client’s problem. Increasing the amount of bulk and
roughage in the diet may irritate the mucosa and should
be decreased. Promote psychologic support by offering a
wide variety of foods is not the primary goal, efforts
shoould be made to include foods that are
psychologically beneficial, byut not at the expense of
122
food, that are nonirritating to mucosa
a.
b.
c.
d.
A client is just returned to the surgical unit after subtotal
gastrectomy. Pulmonary complication can be best
prevented by :
Keeping a plastic airway in place
Maintaining a consistent oxygen flow rate
Ambulating to increase respiratory exchange
Promoting frequent turning of the client and deep
breathing to mobilize pulmonary secretion
The answer is D
Clients should turned every hour to promote drainage of
different lung regions. Deep breathing inflates the alveoli
and promotes fluid drainage. A plastic airway in place will
be expelled once the gag reflex returns. Maintaining a
constant oxygen flow rate is not generally required
unless there is an underlying cardiac or respiratory
disease. Ambulating to increase respiratory exchange is
inappropriate, because physical effort by individuals with123
abdominal incisions often reverts to shallow breathing.
a.
b.
c.
d.
The most therapeutic diet for a client recovering from an
acute episode of alcoholism would be :
High protein, low carbohydrate, and low fat
Low protein, high carbohydrate, and high fat
High carbohydrate, low saurated fat, 1800 calories
Protein to tolerance, moderate fat, high calorie and high
vitamin
The answer is D
Protein helps correct severe malnutrition; moderate fat
limits the need for bile; a high caloric, high vitamin diet
prevents tissue breakdown. A diet high in protein,
carbohydrates, and calories are needed to improve
nhutritional status, but therapeutic for a client reovering
from alcoholism. Low protein diet will not aid tissue
repair and restore nutritional status calories. High
carbohydrate, low saturated fat and 1800 calories does
not offer enough fat or calories
124
a.
b.
c.
d.
Thiamine chloride and nicotinic acid are ordered for a
client with alcoholism. These vitamins are needed for the
maintenance of :
Elimination
Efficient circulation
The nervous system
Prothrombin formation
The answer is C
Thiamine and nicotinic acid help utilize glucose for energy
needs of nerve activity. These vitamins do not affect
elimination of alcohol. These vitamins are not related to
circulatory activity. Prothrombin formation in the liver
need vitamin K not thiamine and niacin.
125
a.
b.
c.
d.
When eliciting the health history from a client with colitis,
the nurse knows that colitis is commonly associated with:
Chemical stress
Endocrine stress
Physiologic stress
Psychologic stress.
The answer is D
Personality and psychologic stresses cause of pathologic
changes that influence the development of ulcerative
colitis. Chemical stress, endocrine stress and physiologic
stress may be other causative factors, but psychologic
stess is more commonly associated with this disease.
126
a.
b.
c.
d.
A client is accustomed to taking enemas periodically to
avoid constipation. The nurse should :
Arrange to have enemas ordered
Have the physician order a daily laxative
Offer the client a large glas of prune juice and warm
water each morning
Realize that enemas will be necessary because the
normal conditioned reflex has been lost
The answer is C
Prune juice and warm water can be administered
prophylactically by the nurse to promote defaecation.
Prune juice irritates the bowel mucosa stimulating
peristalsis. Increased fiber in the diet may also improve
intestinal motility. The routine use of enemas should be
avoided because they promote dependency and can
result in electrolyte imbalance. The routine use of
laxatives promotes dependency.
127
a.
b.
c.
d.
A client is admitted for hemorrhoidectomy. The nurse
should observe the area for the presence of
Pruritus
Flatulence
The answer is D
Anal stenosis
Rectal bleeding
Rectal bleeding is a common problem when
haemorhhoids are present. Pruritus is not a
symptom that can be observed. Flatulence is
unrelated to haemorryoids. Anal stenosis is not a
complication of haemorrhoidectomy.
128
a.
b.
c.
d.
The nurse should administer a nasogastric tube feeding
slowly to reduce the hazard of :
Distention
Flatulence
indigestion
The answer is D
Regurgitation
Regurgitation is a hazard, because the cardiac sphincter of
the stomach is slightly opened to admit the nasogastric
tube. Distension can be diminished by avoiding the
instillation of air with the feeding. The speed of feeding
does not cause flatulence, but the administrationof air
may. Indigestion is not hazardous to the client.
129
a.
b.
c.
d.
In the postanesthesia unit the nurse notices a client, who has
undergone an abdominal cholecystectomy has serosangui
nous fluid on the abdominal dressing. The nurse should:
Change the dressing
Reinforce the dressing
Apply an abdominal binder
Remove the tape and apply Montgomery straps
The answer is B
The nurse should anticipate drainage and reinforce the
surgical dressing as needed changing a dressing at this
time unnecessarily increases the risk of infection.
Abdominal binder is rarely ordered and it would interfere
with assessment of the dressing. Montgomery straps are
utilized when frequent dressing changes are anticipated,
they are not appropriate at this time.
130
a.
b.
c.
d.
The break down of triglyceride molecules yield which of
the folowing?
Fatty acids
Amino acids
Urea nitrogen
Simple sugars
The answer is A
Triglycerides are made up of fatty acids bonded
(esterified) to glycerol, their breakdown releases
fatty acids and glycerol. Amino acid, Urea , and
simple sugars are not the components of
triglyceride.
131
a.
b.
c.
d.
The major digestive changes in fat are accomplished in the
small intestine by a lipase synthesized in the pancreas. This
enzymatic activity:
Synthesizes new triglycerides from the dietary fat consumed
Emulsifies the fat globules and reduces their surface tension
Easily breaks down all the dietary fat to fatty acids and glycerol
Splits off all the fatty acids in about 25% of the total dietary fat
consumed.
The answer is D
Pancreatic lipase is an enzyme that aids in the
digestion of fat by splitting of fatty acids in about
25% of dietary fats. Lipase does not synthesize
triglycerides. Emulsification of fats is the function
of bile salts. Lipase does not break down all
132
dietary fat
a.
b.
c.
d.
The cooked food that is most likely to remain
contaminated by the hepatitis Type A virus is :
Canned tuna
Boiled shrimp
Baked haddock
Steamed lobster
The answer is D
The temperature during steaming is never high
enough or sustained long enough to kill virus.
Canned tuna, boiled shrimp, and baked haddock
are processed at extremely high temperatures
which sufficiently destroys the virus.
133
a.
b.
c.
d.
Most of the work of changing raw fuel forms of
carbohydrates to the usable fuel glucose is accomplished
by enzymes located in the :
Mouth
Small intestine
The answer is B
Large intestine
Stomach mucosa
Pancreatic amylase (which enters the small intestine at the
sphincter of Oddi) and sucrase and maltase(which are
released by epithelial cells covering teh villi in the small
intestine) are responsible for converting fuel form of
carbohydrated to usable form ; glucose. Ptyalin present in
saliva is oly able to bring about limited digestion of starch in
the mouth. Digestion of carbohydrates is completed before
their arrival in the large intestine, which is concerned primarily
with fluid reabsorption. Carbohydrates are not digested in the
stomach because of acidic pH.
134
a.
b.
c.
d.
The main function of adipose tissue in fat metabolism is
synthesis and :
Release of glucose for energy
Regulation of cholesterol
Transport of lipoproteins for fat transport
Storage of triglycerides for energy reserve
The answer is D
Triglyceride is composed of three fatty acids and a glycerol
molecule. When energy is required the fatty acids are
mobilized from adipose tissue for fuel. Release of glcose
for energy is not the function of adipose tissue; its main
function is storage. Regulation of cholesterol is not a
function of adipose tissue; cholesterol is produced in the
liver. Transport of lipoproteins for fat transport is not the
function of adipose tissue in fat metabolism.
135
a.
b.
c.
d.
Development of obstructive jaundice is evidenced by:
Inadequate absorption of fat soluble vitamin K
Light amber urine, dark brown stools and yellow skin
Dark coloured urine clayu colored stool and itchy skin
Straw colored urine putty colored stool and yellow sclerae.
The answer is C
Dark colored urine, clay colored stool and itchy skin is due to failure
of bile to enter the intestines, with subsequent backup into the
biliary system and diffusion into the blood. The bilirubin is carried
to all body regions, including the skin (itching ) and kidneys
(excretion of bile colored urine.). The absence of bilirubin in the
intestine results in clay, colored stools. These signs refer to
objective findings of all types of jauncice. Inadequate absorption
of fat soluble vitamin K is not an objective finding. Light amber
colored urine dark brown stools, yellow skin is a reflection of
increased serum bilirubin levels and not obstruction. Strawcolored urine, putty colored stool, yellow sclerae is indicative of
hyper bilirubinaemia of unconjugated type (hepatotoxic
136
jaundice).
a.
b.
c.
d.
Function of vitamin C is related to tissue integrity
andhaemorrhagic disrder. It performs these functions by :
Preventing, tissue haemorrhage by providing essential blood
clotting materials
Preserving the structural integrity of tissue by protecting he4
lipid matrix of cell, walls form peroxidation
Facilitating adequate absorption of calcium and phosphorus
for bone formation to prevent bleeding ain the joint
Strengthening capillary walls and structural tissue by cross
linking of collagen fibres found in the ground substance of
tissues (intercellular cement substance) and thus prevent
tissue haemorrhage
The answer is D
Vitamin C is required for strengthening intercellular cement
substance. Option A is the function of Vitamin K . Option
B is the function of vitamin A. option C is the function of
137
vitamin D.
A
a.
b.
c.
d.
When assessing a client with cancer of th tongue the
specific adaptation the nurse should expect to find is :
Halitosis
Leukoplakia
Bleeding gums
Substernal pain
The answer is B
Leukoplakia are white thickened patches that tend to
fissure and to become malignant; ulcerations in the
mouth or oil the tongue may indicate cancer. Halitosis
would not be an early sign or specific to cancer of the
mouth. Bleeding gums occur in gingival diseases. Pain
associated with cancer of the tongue would not radiate to
the substernal area.
138
a.
b.
c.
d.
When a client expresses aversion to meals and eats
onlysmall amount the nurse should provide:
Nourishment between meals
Small frequent meals
Only foods the client likes in small portion
Supplementary vitamins to stimulate appetite
The answer is B
Small meals are not as psychologically overwhelming and
do not upse the stomach as easily. Small frequent meals
ae therefore better tolerated. Nourishment between
meals will not help unless attempts are made to provide
small frequent meals. Only foods the client likes in small
portion does not ensure adequate nutrition; if the portion
size is decreased, frequency must be increased.
Supplementary vitamins to stimulate appetite is a
139
dependent nursing function
a.
b.
c.
d.
When teaching a client to include more bulk in the diet,
the nurse recognizes that the action of bulk to promote
defaecation is a consequence of the ;
Irritating effect of fiber on the bowel wall
Action of the multiflora of the large intestine
Direct chemical stimulation of the colonic musculature
Tendency of smooth muscle to contract when stretched.
The answer is D
Fiber absorbs water, swells and consequently stretches the
bowel wall, promoting peristalsis, mass movements, and
defaecation. Smooth muscle tends to contract when
stretched because of the reflex activity of stretch
receptors. Bulk caused by fiber do not irritate the bowel
wall. Bacterial action is not involved in the process, by
which bulk stimulates defaecation. There is no chemical
140
stimulation.
a.
b.
c.
d.
After incision and drainage of an oral abscess, the client
should be instructed to notify the physician if there is :
Foul odour to the breath
Pain and swelling after 1 week
Pain associated with swallowing
Tenderness to the mouth when chewing
The answer is B
Pain and swelling should subside before 1 week
postoperative. Continued pain may indicate infection.
The breath may have an odour because of dried blood in
the oral cavity, this is to be expected during the
postoperative period. Painful swallowing may occur
because of generalized trauma resulting from surgery
and is to be expected. Tenderness is expected during
the postoperative period.
141
a.
b.
c.
d.
A 90 year old client with a history of diverticulitis is admitted with severe
abdominal pain, anorexia, nausea, vomiting for 24 hours, markedly
elevated temperature, and increased WBCs. The most likely primary
reason for performing surgery is :
The symptoms exhibited by the client on admission were life threatening
Surgery is usually indicated for clients with a diagnosis of diverticulitis
In some instances diverticulitis is difficult to differentiate from carcinoma
except surgically
The client’s age indicated that immediate correction of the potentially fatal
condition was needed.
The answer is A
The client status is life threatenig and requires immediate
intervention, to delay treatment may prove dangerous
because symptoms indicate possible perforation.
Diverticulitis can in most causes be treated by diet, rest,
and antibiotic therapy. Option C is not true with the
diagnostic techniques presently available. Age is not the
factor; the symptoms indicate possible peritonitis.
142
a.
b.
c.
d.
During a percutaneous endoscopic gastrostomy (PFG)
tube feeding, the observation that indicates that the client
is unable to tolerate a continuation of feeding would be :
A passage of flatus
Epigastric tenderness
A rise of formula in the tube
The rapid flow of the feeding
The answer is C
A rise in the level of formula within the tube indicates a
full stomach. Passage of flatus reflects intestinal
motility, which does not pose a potential problem.
Epigastric tenderness is not necessarily caused by a
full stomach. A rapid inflow is the result of holding
the container too high or using a feeding tube with
large a lumen
143
a.
b.
c.
d.
If the ileum is removed surgically, the individual may suffer
from anaemia because:
Folic acid is absorbed only in the terminal ileum
The haemopoietic factor is absorbed only in the terminal
ileum
Iron absorption is dependent on simultaneous bile salt
absorption in the ileum
The trace elements copper, cobalt, and nickel required for
hemoglobin synthesis are absorbed only in the ileum
The answer is B
Vitamin B12 (extrinsic factor ) combines with intrinsic factor, a
substance secreted by parietal cells of the gastric mucosa
forming haemopoietic factor. Haemopoietic factor is only
absorbed in the terminal iileum. From which it travels to bone
marrow and stimulates erythropoiesis. Folic acid is not
absorbed in the terminal ileum. Iron absorption does not occur
in the ileum. Trace elements are not absorbed in the ileum.
144
a.
b.
c.
d.
Ingestion of fatty foods causes discomfort in clients with
cholelithiasis, because :
Fatty foods are hard to digest
Bile flow into the intestine is obstructed
The liver is manufacturing inadequate bile
There is inadequate closure of the ampulla of Vater
The answer is B
When bile does not mix with food in the intestine emulsification
of fats cannot occur and fat digestion is retarded. Stomach
motility is also reduced, because, increased stomach
peristalsis depends on fat digestion in the small intestine. In
cholelithiasis, stones in the gall bladder trap bile in the gall
bladder that acts as an irritant. Fats once emulsified by bile
are readily broken down by digestive enzymes. Chole
lithiasis will not affect production of bile salts. In
cholelithiasis thete is obstruction to th eflow of bile from the
145
gall bladder, rather than inadequate closure.
a.
b.
c.
d.
The nurse should protect the client’s skin surrounding a
colostomy opening by using :
Alcohol
Mineral oil
The answer is C
Skin barriers
Tincture of benzoin
A skin barrier such as stomadhesive provides a coating that
creates a barrier to gastrointestinal enzymes and
protects against allergic reactions to the tape on the
appliance. Alcohol tend to dry out the skin and mucosal
membranes, leading to irritatio and break. Mineral oil is
not an effective skin protectant and would interfere with
adherence of any appliance. Tincture of benzoin
contains alcohol, which is drying and leads to skin
irritation.
146
a.
b.
c.
d.
A client with cirrhosis of the liver has protein deficiency
and lonstanding poor nutrition. This deficiency leads to :
Decreased bile in the blood
Fat accumulation in the liver tissue
Coagulation of blood in microcirculation
Tissue anabolism and postitive nitrogen balance
The answer is B
Lipoproteins, a combination of a fat and a simple protein,
have not been formed because of poor protein intake.
Therefore fat accumulate in the liver. Elevation of bile in
the blood occur because of obstruction to hepatic ducts
by the enlarged liver. Individuals with cirrhosis of the liver
are likely to have bleeding tendencies (rather than
clotting) because fo the decreased synthesis of
prothrombin. Deficiency of protein results in the
breakdown of tissue (catabolism) and negative nitrogen147
a.
b.
c.
d.
A client with an ileostomy should avoid, which of the
following sport?
Skiing
Football
Swimming
Track events.
The answer is B
Trauma to the abdominal wall and to the stoma should e
avoided, so contact sports such as football are
contraindicated. Trauma to the abdominal wall is a
minimal risk in the sports such as skiing, swmming and
track events.
148
a.
b.
c.
d.
Following pancreatic surgery, clients are at risk for
developing respiratory tract infections because of the
Length of time required for surgery
Proximity of the incision to the diaphragm
Lowered resistance caused by bile in the blood
Transfer of bacteria from the pancreas to the blood
The answer is B
An incision close to the diaphragm (as in surgery of the
pancreas) causes a great deal of pain when the client
coughs and deep breaths. These clients tend to take
shallow breaths, leading to inadequate expansion of the
lungs, accumulation of secretions in the lung, and
subsequent infection. Length of time required for surgery
is untreated to the development of respiratory infections.
The elevtion of serum bilirubin in the blood does not
affect the immune mechanisms. Pancreatitis is usually
149
an inflammatory condition not an infectious, process.
a.
b.
c.
d.
A client is ordered to have gastric lavage. When the
lavage tube is inserted the client should be placed in
Supine position
Mid-Fowler’s position
High-Fowler’s position
Trendelenburg position
The answer is C
The high Fowler’s position promotes optimal entry of
lavage tube into the esophagus aided by gravity. Supine
position and Mid-fowler’s position does not take full
advantage of the effect of gravity. Trendelenburg position
is the opposite of the desired position.
150
a.
b.
c.
d.
An antrectomy may be performed if the client has a
diagnosis of :
Cataracts
Otosclerosis
Gastric ulcers
Trigeminal neuralgia
The answer is C
The antrum is responsible for gastrin production, which
stimulates hydrochloric acid secretion; its removal
reduces HCl secretion and thus reduces irritation of the
gastric mucosa. Cataracts are treated by removal
opaque crystalline lens by means of a laser beam,
cryotechnique, or surgery. Otosclerosis is treate4d by
stapedectomy, mobilization of the stapes or a prosthetic
implant. Trigeminal neuralgia is treated by resection of
the fifth cranial nerve.
151
a.
b.
c.
d.
To decrease GI irritablity the nurse should teach the
client to minimize the use of
Table salt and rice products
Sugar products and proteins
Milk product and cola drinks
Triglycerides and amino acids.
The answer is C
Milk and caffeine in cola are chemically irritating to the
intestinal mucosa. They also promote secretion of gastric
juice, hence they should be avoided or minimized. Salt
helps retain water and rice produces bulk both of which
promote mobility. Sugar products and proteins is too
general; except for those products that contain lactose
generally are not irritating to the mucosa; protein also is
not irritating. Triglycerides and amino acids are absorbed
152
slowly but are not irritating.
a.
b.
c.
d.
Which of the following statements abut vitamin K is correct?
Vitamin K is found in a wide variety of foods so there is no
danger of deficiency.
Almost all vitamin K sufficient for metabolic needs is produced
by intestinal bacteria
Vitamin K is rarely found in dietary food surces, so a natural
deficiency can easily occur
Usually vitamin K can easily be absorbed without assistance,
so all that is consumed is absorbed.
The answer is B
Sufficient quantities of vitamin K is synthesized by intestinal bacteria.
The dietary sources of vitami K iclude liver, egg yolk, cheese,
tomatoes and green leafy vegetables. Option A (Vitamin K is found
in a small variety of foods), option C (it is found in enough foods so
that a natural deficiency usually does not occur), and optio D
(Vitamin K is not easily absorbed; it is fat soluble and requires bile
153
salts for its absorption)are inappropriate.
a.
b.
c.
d.
When fat compounds accumulate to abnormal levels in
the blood, the diet may be modified to control them.
Exclusion of which of the following is most effective in
reducing the fat content of blood?
fruits
Grains
Animal fats
Vegetable oils
The answer is C
Exclusion of animal fats, which are high in dense saturated
fats effectively reduces the fat content in the blood.
Exclusion of fruits has no effect, because it does not
contain saturated fats. Exclusion of grains has no effect,
since it does not containsaturated fats. Exclusio of
vegetable oil has no effecte, because it contains
unsaturated fats.
154
a.
b.
c.
d.
Identify the following food group which has lowest
content of sodium:
milk
meat
fruits
vegetables
The answer is C
Fruits contain less natural sodium than the other foods
listed above. Options A, B and D are incorrrect, because
milk has higher sodium content than fruit, meat has
higher sodium than fruit, and vegetables have higheer
sodium content than fruit.
155
a.
b.
c.
d.
The intestinal suctio in clients with intestinal obstruction
causes an excessive loss of :
Protein enzymes
Energy carbohydrates
Vitamins and minerals
Water and electrolytes
The answer is D
Fluid and electrolytes are lost through intestinal decompression
(suction); on a daily basis about one-fifth of the total body
water is secreted into the GI tract, which is almost completely
reabsorbed. Because the client is kept NPO, there would be
no stimulus to cause enymes to be ecreted into the GI tract.
IB Dextrose supplies some carbohydrates as a source of
energy it would not be drawn from storage by intestinal
decompression. Because the client is being kept NPO
vitamins and minerals are not entering the GI tract and
therefore are not lost.
156
a.
b.
c.
d.
While caring for a client with hepatitis A the nurse should
take special precautions to :
Prevent droplet spread of infection
Use caution when bringing food to the client
Use gloves when removing the client’s bed pan
Wear mask and gown before entering the room
The answer is C
The virus is present in the stool of clients with hepatitis
Type A so special handling is requird. The virus may also
be present in the urie and in the urine and in the
nasotracheal secretions. Hepatitis type A is not usually
transmitted by droplet spread. Bringing food to a client;
requires no precaution, however disposable utensils
should be because the client’s nasotracheal secretion
contain the virus. Wearing mask and gown before
entering the room is nt required, since this virus is not 157
transmitted through air.
a.
b.
c.
d.
The symptoms of gastroesophageal reflux disease
(GERD), can be limited by :
Avoiding heavy lifting
Lying down after eating
Increasing fluid intake with meals
Wearing an abdominal binder or girdle
The answer is A
Heavy lifting increases intraabdominal pressure, allowing
gastric contents to move up through the lower
oesophageal sphincter (regurgitation) causing heartburn
(pyrosis). Lying down after eating encourages
regurgitation and should be avoided. Increasing fluid
intake wit6h meals increases gastric volume, causing
distention and reflux. Wearing an abdominal binder or
girdle increase intra abdominal pressure and could lead 158
to reflux.
a.
b.
c.
d.
When planning dietary teaching for a cient with
malabsorption syndreom the nurse should include the
need to avoid:
Rice or corn
Milk or cheese
Fruit or fruit juices
Wheat, rye, or oats
The answer is D
Gluten is present in rye, wheat, and oat products
hence they should be avoided. Gluten is not
found I rice or corn, milk or cheese, or in fruit or
fruit juices hence they need not be avoided.
159
a.
b.
c.
d.
A client with colitis makes the decision to have a colectomy
as advised by the physician. A significant factor in the client’s
decision may have been the knowledge that :
Surgical treatment cures ulcerative colitis.
It would be temporary until the colon heals
Ulcerative colitis can progress to Crohn’s disorders
Without surgery the client would be unable to eat table foods
The answer is A
When the diseased bowel segment of colon with ulcers is
removed, th client’s symptoms cease. Surgical removal
of a body part is not temporary, but permanent ulcerative
colitis is unr3elated to Crohn’ disease; clients with
ulcerative colitis have an increased risk for colorectal
cancer. Option D is not a true statement.
160