NCLEX Gastrointestinal

NCLEX Gastrointestinal Related

Review NCLEX Gastrointestinal related questions and content

The nurse is caring for the newly admitted client with acute necrotizing pancreatitis. Which interventions, if prescribed, should the nurse implement?

  • A. NS 1000 mL IV over 1 hour, then IV fluids at 250 mL/hour
  • B. Initiate nasojejunal enteral feedings with a low-fat formula
  • C. Imipenem-cilastatin 500 mg IV every 6 hours
  • D. Up to chair for meals and ambulate four times daily
  • E. Position left side-lying with head of bed elevated 30 degrees
  • F. Insert a urinary catheter; monitor urine output every 2 hours
Correct Answer: A, B, C, F

Rationale: Giving an IV bolus followed by fluids at 250 mL/hour should be implemented. A large amount of fluids is lost due to third spacing into the retroperitoneum and intraabdominal area. Fluids are needed to prevent hypovolemia and maintain hemodynamic stability. B. Nasojejunal enteral feedings with a low-fat formula should be initiated to decrease the secretion of secretin, meet calorie needs, and maintain a positive nitrogen balance. C. Antibiotics, usually medications of the imipenem class such as imipenem-cilastatin (Primaxin), are used when pancreatitis is complicated by infected pancreatic necrosis. They have greater potency and a broader antimicrobial spectrum than other beta-lactam antibiotics. D. The client should be maintained on bedrest to decrease the metabolic rate and therefore reduce pancreatic secretions. E. Discomfort frequently improves with the client in the supine position rather than side-lying. F. A urinary catheter should be inserted to closely monitor urine output for circulating fluid volume status and to monitor for complications.

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The client is diagnosed with an acute exacerbation of inflammatory bowel disease (IBD). Which food selection would be the best choice for a meal?

  • A. Roast beef on wheat bread and a milk shake.
  • B. Hamburger, french fries, and a cola.
  • C. Pepper steak, brown rice, and iced tea.
  • D. Roasted turkey, instant mashed potatoes, and water.
Correct Answer: D

Rationale: Roasted turkey, instant mashed potatoes, and water are low-residue, easy-to-digest foods suitable for acute IBD exacerbation. Other options are high-fiber or irritating.

The client is diagnosed with an acute exacerbation of IBD. Which priority intervention should the nurse implement?

  • A. Weigh the client daily and document in the client's chart.
  • B. Teach coping strategies such as dietary modifications.
  • C. Record the frequency, amount, and color of stools.
  • D. Monitor the client's oral fluid intake every shift.
Correct Answer: C

Rationale: Recording stool frequency, amount, and color is critical in acute IBD exacerbation to assess disease activity and guide treatment. Weight and fluid monitoring are important but secondary, and teaching is less urgent during an acute phase.

The nurse has administered an antibiotic, a proton pump inhibitor, and Pepto-Bismol for peptic ulcer disease secondary to H. pylori. Which data would indicate to the nurse the medications are effective?

  • A. A decrease in alcohol intake.
  • B. Maintaining a bland diet.
  • C. A return to previous activities.
  • D. A decrease in gastric distress.
Correct Answer: D

Rationale: A decrease in gastric distress (e.g., epigastric pain) indicates effective treatment of H. pylori and ulcer healing. Lifestyle changes like reduced alcohol or bland diets support treatment but are not direct indicators of medication efficacy.

While reviewing the client’s medical records, the nurse notes the diagnosis of biliary colic. Considering this diagnosis, which additional sign will the nurse most likely find in the client’s medical record?

  • A. Bloody diarrhea
  • B. Heartburn and regurgitation
  • C. Abdominal distention
  • D. Severe abdominal pain
Correct Answer: D

Rationale: A. Diarrhea is not related to biliary colic. B. Heartburn and regurgitation are not related to biliary colic. C. Abdominal distention is not related to biliary colic. D. Biliary colic is the term used for the severe pain that is caused by a gallstone lodged in the cystic or common bile duct and/or traveling through the ducts. The presence of the stone causes the duct to spasm, causing severe abdominal pain.

The experienced nurse is instructing the new nurse. The experienced nurse explains that the definitive diagnosis of PUD involves which test?

  • A. A urea breath test
  • B. Upper GI endoscopy with biopsy
  • C. Barium contrast studies
  • D. The string test
Correct Answer: B

Rationale: A. A urea breath test only tests for the presence of Helicobacter pylori (H. pylori). B. The gastric mucosa can be visualized with an endoscope. A biopsy is possible to differentiate PUD from gastric cancer and to obtain tissue specimens to identify H. pylori. These are used to make a definitive diagnosis of PUD. C. Barium studies do not provide an opportunity for biopsy and H. pylori testing. D. A urea breath test and a string test only test for the presence of H . pylori.

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