NCLEX-PN
Gastrointestinal NCLEX Questions
Extract:
Question 1 of 5
The nurse is caring for the postoperative client who underwent an open Roux-en-Y gastric bypass. The charge nurse should intervene if which observation is made?
Correct Answer: D
Rationale: A. For the first 24-48 hours postoperatively, the client sips small amounts of clear liquids to avoid nausea, vomiting, and distention and stress on the suture line. B. If used, urinary catheters should be removed within 24 hours after surgery to prevent UTIs and to encourage mobility. The nurse may delegate this task to an LPN. C. The BiPAP mask is used to keep the airway open and should be worn whenever the client is sleeping. D. A bottle of saline and a large-sized syringe may indicate that the client’s NG tube has been or will be irrigated. Manipulating or irrigating an NG tube with too much solution can lead to disruption of the anastomosis in gastric surgeries. If an NG tube is present the surgeon should be consulted before irrigating the tube.
Question 2 of 5
The nurse is caring for a client diagnosed with bulimia nervosa. Which nursing intervention should the nurse implement after the client's evening meal?
Correct Answer: B
Rationale: Staying with the client prevents purging, a key behavior in bulimia, post-meal. Praising eating, exercise, or bedrest does not address purging.
Question 3 of 5
The home health nurse is performing a follow-up visit for the client diagnosed with chronic hepatitis B. The client is being treated with interferon alpha-2b. Which client comment requires further assessment by the nurse?
Correct Answer: B
Rationale: A. Anorexia is commonly seen with hepatitis B. A weight gain of 2 lb in one month would typically not be a cause for concern. B. Bruising can indicate thrombocytopenia, which is an adverse effect of treatment. Thrombocytopenia can also occur from liver dysfunction. C. Avoiding large crowds is appropriate; the client will be at increased risk for infection while taking interferon alpha-2b. D. Fatigue is commonly associated with chronic hepatitis B.
Question 4 of 5
Which task should the nurse delegate to the unlicensed assistive personnel (UAP) to improve the desire to eat in a 14-year-old client diagnosed with anorexia?
Correct Answer: D
Rationale: Encouraging parents to sit with the client is within the UAP’s scope and promotes a supportive eating environment. Administering medication, mouth care, and creating a social atmosphere require RN skills or specific training.
Question 5 of 5
The client's temperature rises to 38°C (100.4°F) on the first postoperative day following abdominal surgery. The nurse interprets this to be:
Correct Answer: B
Rationale: A slight temperature elevation (100.4°F) on the first postoperative day is a normal response to surgical trauma.