NCLEX-RN
Gastrointestinal Disorders NCLEX RN Questions
Extract:
The nurse is caring for a client admitted with an exacerbation of Crohn's disease
Item 1 of 1
• History and Physical
A 25-year-old male has had Crohn's disease for over six years. He is admitted to the hospital for severe diarrhea, abdominal pain, and fatigue. The client will be admitted for fluid replacement, antibiotics, steroids, and pain control.
• Physician Orders
• Admit to the medical-surgical unit
• Nothing by mouth (NPO)
• Gastroenterology consultation
• Lactated Ringers at 80 mL/hr
• Metronidazole 500 mg intravenous piggyback q 8 hours
• Methylprednisolone 125 mg intravenously q 12 hours
Question 1 of 5
Drag the words from the word choices below to fill in each blank of the following sentences: The prescribed------------------------------puts the client at risk for complications such as hyperglycemia. To recognize this complication the nurse should monitor the client’s------------------
Correct Answer: C,E
Rationale: Methylprednisolone is a corticosteroid that may cause elevated blood glucose and even hyperglycemia (blood glucose 250 mg/dL or greater). This is a common treatment for exacerbations of inflammatory bowel disorders. Hyperglycemia may complicate outcomes by delaying wound healing and increasing the client’s risk for infection. Thus, the nurse should monitor the capillary blood glucose and collaborate with the primary healthcare provider.
Monitoring the hemoglobin A1C is useful for monitoring the clinical progress of a client with chronic diabetes. This value is collected every 90-120 days and would not be useful during this acute course of steroids.
During an exacerbation of Crohn’s disease, it is likely that the client will be prescribed antibiotics such as metronidazole. The client will also have fluid repletion, and isotonic solutions such as lactated ringers may be given to rehydrate the client.
Extract:
The following scenario applies to the next 1 items
The nurse in the medical-surgical unit cares for a client who is postoperative
Item 1 of 1
Progress Notes
Day 2
Status-post open (partial) gastrectomy. Client reports abdominal pain 6/10 on the Numerical Rating Scale. Client is still receiving patient-controlled analgesia (PCA) of fentanyl. Abdomen is taut with hypoactive bowel sounds in all quadrants. Reports passing no flatus. Endorses occasional nausea with no vomiting. Incision approximated with moderate serosanguinous drainage. Abnormal laboratory data noted: BUN 19 mg/dL (10 – 20 mg/dL); Creatinine 1.0 mg/dL (0.6 – 1.2 mg/dL); Potassium 3.3 mEq/l (3.5 – 5.0 mEq/l). Not tolerating a clear liquid diet, only consuming 10-15% of meals. No VS abnormalities.
Day 3
Status-post open (partial) gastrectomy. Client reports abdominal pain 4/10 on the Numerical Rating Scale. Client is still receiving patient-controlled analgesia (PCA) of fentanyl. Abdomen is distended, with hypoactive bowel sounds in all quadrants. Reports passing no flatus and is hiccuping during the exam. Endorses persistent nausea and occasional vomiting with no relief from prescribed ondansetron. Incision approximated with scant serosanguinous drainage. Abnormal laboratory data noted: BUN 23 mg/dL (10 – 20 mg/dL); Creatinine 1.3 mg/dL (0.6 – 1.2 mg/dL); Potassium 3.1 mEq/l (3.5 – 5.0 mEq/l). Not tolerating a clear liquid diet, nursing reports 0% consumption of meals. VS showed an oral temperature of 99.5°F (37.5°C).
Question 2 of 5
The client is at highest risk for [condition] as evidenced by the client's............and............
Correct Answer: A,C
Rationale: Paralytic ileus (
A) is evidenced by hypoactive bowel sounds, no flatus, and hypokalemia (
C), as low potassium (3.1 mEq/L) can contribute to ileus post-gastrectomy.
Extract:
Question 3 of 5
The nurse is supervising a student nurse performing an abdominal assessment on a client with gastroenteritis. It would indicate effective technique if the student performs the assessment in which order?
Correct Answer: D
Rationale: The correct order for abdominal assessment is inspection, auscultation, percussion, palpation (
D). Auscultation before palpation prevents altering bowel sounds.
Extract:
The emergency department (ED) nurse is caring for a 45-year-old male client.
Item 5 of 6
Laboratory & Imaging Results
0630
Exam: CT Abdomen and Pelvis with IV Contrast
Indication: Acute onset of epigastric abdominal pain, nausea, vomiting.
Findings:
Pancreas: Diffuse enlargement of the pancreas with heterogeneous enhancement. Peripancreatic fat stranding and inflammatory changes are present, most pronounced around the pancreatic head and body. No evidence of necrosis at this time. No discrete mass or cystic lesion noted. Biliary system: Gallbladder is distended with no wall thickening or pericholecystic fluid. No gallstones visualized. Common bile duct is normal in caliber (~5 mm). Liver, spleen, kidneys, and adrenal glands: Normal in appearance. No focal lesions. Bowel: No obstruction or bowel wall thickening noted.
Impression:
Imaging findings are consistent with acute interstitial edematous pancreatitis.
No evidence of pancreatic necrosis or pseudocyst formation at this time.
Nurses’ Notes
0600: The client reports sudden, severe epigastric pain. He has a history of chronic alcohol use disorder (30+ years), GERD, and hypertension. His home medications include pantoprazole and lisinopril. Upon assessment, the client is noted to be alert and oriented x4. He is mildly diaphoretic, with pulses 2+ and regular. Abdomen is distended, guarding on palpation, diminished bowel sounds, and no stool in the last 24 hours. He reports nausea and vomiting, and his pain is worse after eating fatty foods, rated 7/10 and radiating to his back. Breath sounds slightly diminished bilaterally, no adventitious sounds, denies cough or dyspnea. He reports heavy alcohol intake two days ago. Fingerstick glucose is 145 mg/dL (8.06 mmol/L) [70-110 mg/dL; 4-6 mmol/L]. Temperature is 101.3°F (38.5°C), heart rate of 112 bpm, respiratory rate of 24 breaths/min, blood pressure of 98/64 mmHg, and oxygen saturation of 95% on room air.
0630: Physician confirmed the diagnosis of acute pancreatitis based on clinical presentation, laboratory findings, and imaging studies.
1030: Client receiving LR at 150 mL/hr, calcium replacement completed. Urine output over the last 4 hours is 80 mL of dark amber urine. The client reports increased thirst. The abdomen continues to be distended with diminished bowel sounds. He reports that nausea has improved after receiving PRN medication. Increased edema noted in the lower extremities.
Orders
0630
• Ondansetron 4mg IV q6h PRN
• Calcium gluconate 2g IV over 5-10 minutes
• Lactated Ringer’s solution continuous infusion IV rate of 150mL/hr
Question 4 of 5
The nurse is preparing interventions to address the client's needs. Select the four (4) nursing interventions that should be prioritized based on the client's current condition.
Correct Answer: A,B,D,E
Rationale: Low urine output (
A) indicates possible hypovolemia, requiring provider notification. NPO status (
B) prevents pancreatic stimulation. An indwelling catheter (
D) monitors fluid balance accurately. Cardiac monitoring (E) is needed due to tachycardia and hypotension. Trendelenburg (
C) is not indicated, and a low-fat diet (G) is premature.
Extract:
The following scenario applies to the next 1 items
The nurse in the physician's office cares for a client looking to establish care
Item 1 of 1
Nurses' Notes
1709: 58-year-old African American male presents to the office looking to establish primary care. The client has not had a primary healthcare provider in over eleven years. The client requests a physical examination. The client reports that two months ago, he started noticing changes in his bowel habits, which alternate between diarrhea and constipation. The symptoms are accompanied by occasional dark, tarry stools. This past week, he has had constant abdominal pain that has ranged from a 5/10 to a 7/10 on the Numerical Rating Scale. He describes the pain as 'dull.' He reports that his diet has not changed, and he primarily eats red meat and sandwiches made with luncheon meats and occasionally vegetables. Currently, the client takes a daily aspirin and a multivitamin. He reports a medical history of oral herpes simplex and high blood pressure. He is overweight. He smokes cigarettes daily. On assessment, the client is alert and fully oriented, skin is warm and dry. Lung sounds are clear; the apical pulse is regular. Bowel sounds are active in all quadrants, with no abdominal distention. Capillary refill less than 3 seconds. Peripheral pulses palpable, 2+. Vital signs: T 97.5° F (36.4° C), P 97, RR 18, BP 161/92, pulse oximetry reading 96% on room air.
Orders
1719:
• Point of care (POC) hemoglobin and hematocrit
• Guaiac-based fecal occult blood test (gFOBT)
Question 5 of 5
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two (2) actions the nurse should take to address that condition, and two (2) parameters the nurse should monitor to assess the client's progress.
Action to Take
Potential Condition
Parameter to Monitor
Correct Answer: B: Colon cancer; A: Obtain an order for a colonoscopy, educate the client on adopting a high fiber diet; C: Pain level, bowel elimination pattern or habits
Rationale: Dark, tarry stools, changing bowel habits, and abdominal pain suggest colon cancer (
B). Ordering a colonoscopy and promoting a high-fiber diet (
A) aid diagnosis and management. Monitoring pain and bowel patterns (
C) tracks progress.