ATI RN
NCLEX Questions on Gastrointestinal System Questions
Question 1 of 5
The patient has hepatic encephalopathy. What is a priority nursing intervention to keep the patient safe?
Correct Answer: D
Rationale: The correct answer is D: Prevent constipation to reduce ammonia production. In hepatic encephalopathy, the liver is unable to metabolize ammonia, leading to its accumulation and brain dysfunction. Preventing constipation helps reduce the production of ammonia by promoting regular bowel movements. This is crucial in managing hepatic encephalopathy to prevent worsening of symptoms and improve patient safety. A: Turning the patient every 3 hours is important for preventing pressure ulcers but is not directly related to managing hepatic encephalopathy. B: Encouraging increasing ambulation may be beneficial for overall patient health but does not directly address the priority of reducing ammonia production in hepatic encephalopathy. C: Assisting the patient to the bathroom is important for maintaining hygiene and comfort but does not address the underlying issue of reducing ammonia production in hepatic encephalopathy.
Question 2 of 5
The home health nurse is caring for the patient with tuberculosis who is taking rifampin and isoniazid (INH). The nurse should carefully monitor the patient for which potential side effect?
Correct Answer: B
Rationale: The correct answer is B: Liver disorders. Rifampin and isoniazid are known to potentially cause hepatotoxicity. The nurse should monitor for signs of liver dysfunction such as jaundice, dark urine, abdominal pain, and elevated liver enzymes. Gallstones (A) are not commonly associated with these medications. Bleeding ulcers (C) are not a common side effect of rifampin and isoniazid. Esophagitis (D) is more commonly associated with other medications like bisphosphonates.
Question 3 of 5
Which of the following stimuli activates sensors in the walls of digestive organs?
Correct Answer: D
Rationale: The correct answer is D, all of the above. 1. Breakdown products of digestion activate chemoreceptors in the digestive organs. 2. Distension triggers stretch receptors in the walls of the organs. 3. pH of chyme stimulates pH receptors. 4. All three stimuli work together to regulate and coordinate digestive processes. Therefore, D is correct as all options activate sensors in the walls of digestive organs. Choice A is incorrect because it only refers to chemoreceptors, overlooking the other types of receptors involved. Choice B is incorrect as it only mentions distension, omitting the roles of chemical stimuli. Choice C is incorrect as it solely focuses on pH receptors, neglecting the other types of sensors involved in digestion.
Question 4 of 5
The nurse is assessing a patient who had an abdominal hysterectomy. Which of the following signs of infection should the nurse be most concerned about?
Correct Answer: D
Rationale: The correct answer is D: Purulent drainage from the incision site. Purulent drainage indicates an active infection, requiring immediate attention and intervention to prevent serious complications. Redness and a low-grade fever can be common in the early stages of healing and may not necessarily indicate infection. Complaints of mild cramping are also common post-surgery and may not specifically point to infection. Purulent drainage is a more specific and concerning sign of infection as it indicates the presence of pus and bacteria at the incision site, requiring prompt medical evaluation and treatment to prevent further complications.
Question 5 of 5
Which of the following is an accessory organ of digestion?
Correct Answer: A
Rationale: The correct answer is A: pancreas. The pancreas is an accessory organ of digestion because it produces digestive enzymes that help break down carbohydrates, fats, and proteins in the small intestine. It also secretes bicarbonate to neutralize stomach acid. The esophagus (B) is a part of the digestive tract but not an accessory organ. The stomach (C) and small intestine (D) are primary organs of digestion, not accessory organs.