ATI RN
Gastrointestinal System Nursing Exam Questions Questions
Question 1 of 5
A Penrose drain is in place on the first postoperative day following a cholecystectomy. Serosanguineous drainage is noted on the dressing covering the drain. Which nursing intervention is most appropriate?
Correct Answer: B
Rationale: The correct answer is B: Change the dressing. This is the most appropriate intervention because serosanguineous drainage can indicate the need for a dressing change to prevent infection and ensure proper wound healing. Changing the dressing will also allow for better assessment of the drainage and the incision site. A: Notifying the physician may not be necessary at this stage since serosanguineous drainage is expected in the early postoperative period. C: Circling the amount on the dressing with a pen does not address the need for a dressing change or further assessment of the drainage. D: Continuing to monitor the drainage is important, but changing the dressing is the immediate action needed to ensure proper wound care.
Question 2 of 5
Which of the following nursing measures would be inappropriate when caring for a client with a Cantor tube?
Correct Answer: D
Rationale: The correct answer is D because irrigating the Cantor tube with normal saline solution is inappropriate. Cantor tubes are typically used for gastric decompression or feeding, and irrigating with normal saline can disrupt the balance of electrolytes in the stomach. Choice A is correct as injecting air helps facilitate drainage. Choice B is correct as lubricant aids in tube insertion. Choice C is incorrect as coiling tubing can cause kinks and hinder drainage.
Question 3 of 5
Of the following signs and symptoms of bowel obstruction, which is related primarily to small bowel obstruction rather than large bowel obstruction?
Correct Answer: A
Rationale: The correct answer is A: Profuse vomiting. In small bowel obstruction, the vomitus is typically profuse, as the small bowel is narrower and more distensible than the large bowel. This leads to rapid accumulation of gastric contents resulting in frequent vomiting. Cramping abdominal pain (B) can occur in both small and large bowel obstruction. Abdominal distention (C) is a common symptom in both types of obstruction due to the accumulation of gas and fluid. High-pitched bowel sounds above the obstruction (D) are indicative of partial obstruction and can be present in both small and large bowel obstruction.
Question 4 of 5
A nurse is assigned to a 40-year-old client who has a diagnosis of chronic pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level of
Correct Answer: C
Rationale: The correct answer is C (300 units/L) because in chronic pancreatitis, there is ongoing inflammation and damage to the pancreas, leading to elevated serum amylase levels. A level of 300 units/L is indicative of pancreatitis. Choices A and B are too low for chronic pancreatitis, and choice D is too high and would typically be seen in acute pancreatitis.
Question 5 of 5
The client is admitted to the hospital with viral hepatitis, complaining of 'no appetite' and 'losing my taste for food.' To provide adequate nutrition, the nurse would instruct the client to
Correct Answer: C
Rationale: The correct answer is C: Increase intake of fluids including juices. This is because viral hepatitis can cause anorexia and a decreased taste for food, leading to poor nutrition. Increasing fluid intake, especially juices, can help provide essential nutrients and prevent dehydration. A: Eating a good supper when anorexia is not as severe may not be effective in addressing the client's overall nutritional needs during the day. B: Eating less often and only three large meals daily can worsen the client's nutritional status and may not address the decreased appetite and taste for food. D: Selecting foods high in fat may not be appropriate for someone with viral hepatitis, as it can exacerbate liver inflammation and contribute to poor nutrition.