GI 1
A school-age child in an emergency department has a 2-day history of nausea and vomiting and reports severe right lower quadrant pain. A nurse is preparing the child for an appendectomy. Which of the following statements by the child should the nurse find most concerning?
A. "I am scared and I want to go home."
B. "I am hungry and thirsty."
C. "I’m tired and want to take a nap."
D. "My belly doesn’t hurt anymore."
What is
"My belly doesn’t hurt anymore."
Rationale: Sudden relief of pain can be an early indication of appendix rupture, which is a surgical emergency. Because the greatest risk to the client is peritonitis secondary to a ruptured appendix, this statement is the most concerning.
A nurse is collecting data from a client who has diverticular disease. The nurse should expect the client to report
abdominal pain in which of the following locations?
A. Lower left quadrant
B. Upper left quadrant
C. Lower right quadrant
D. Upper right quadrant
Lower left quadrant
Rationale: The nurse should expect the client to report abdominal pain in the lower left quadrant of the abdomen. The disease is usually found in the sigmoid colon.
A nurse is caring for a client who has a gastrointestinal (GI) bleed. Which of the following findings is the priority for
the nurse to report to the provider?
A. Urine output of 50 mL in 2 hr
B. BUN 21 mg/dL
C. Positive fecal occult blood test
D. 75 mL coffee ground emesis
Rationale: The greatest risk to the client is complications related to hypovolemia from the GI bleed. The nurse should notify the provider of urine output less than 30 mL/hr. This may indicate poor blood flow to the kidneys, possibly resulting from hypovolemia. If left untreated, this can cause acute kidney injury (AKI).
A nurse is reinforcing teaching with a client who has recurrent urinary tract infections (UTIs) about prevention
measures. Which of the following client statements indicates the need for further teaching?
A. "I will need to wipe my perineal area from back to front after urination."
B. "I will need to empty my bladder after having sexual intercourse."
C. "I should avoid taking bubble baths."
D. "I need to drink at least 8 full glasses of liquid each day."
Rationale: Wiping the perineal area from back to front increases the risk for urethral contamination and a resulting UTI.
A nurse is assessing a client with urinary retention. Which finding requires immediate intervention?
(Select all that apply)
A. Suprapubic fullness and tenderness
B. Urinary output of 50 mL in the past 4 hours
C. Bladder scan showing 600 mL of urine
D. Blood pressure 100/68 mm Hg
E. Clear yellow urine when voiding
Correct Answers: A, B, C
Rationale:
A indicates discomfort and possible overdistention.
B is significantly low output (<30 mL/hr is critical).
C confirms retention needing catheterization.
D is within normal limits and not urgent.
E indicates normal urine color and is not concerning.
A nurse is reinforcing teaching with a client who has cholelithiasis and is scheduled for an endoscopic retrograde
cholangiopancreatography. Which of the following statements made by the client indicates an understanding of the teaching?
A. "They are going to examine my gallbladder and ducts."
B. "Soon those shock waves will get rid of my gallstones."
C. "I’ll have an endoscope put down my throat so they can see my gallbladder."
D. "They’ll put medication into my gallbladder to dissolve the stones."
Rationale: For an endoscopic retrograde cholangiopancreatography, the provider passes a flexible fiberoptic endoscope through the client’s esophagus to visualize gastrointestinal structures.
A nurse is reinforcing discharge teaching with a client who has acute gastritis. Which of the following instructions
should the nurse include in the teaching?
A. Limit drinking milk.
B. Take NSAIDs for pain.
C. Consume a glucose-electrolyte solution.
D. Treat nausea with gingko biloba.
Rationale: The nurse should reinforce that hydration and electrolyte balance are important considerations for the client who has gastritis. Sipping a glucose-electrolyte solution, even if the client is nauseated, is usually tolerated and can prevent dehydration and electrolyte imbalances caused by anorexia and vomiting associated with gastritis.
A nurse is reinforcing teaching with a client who has received treatment for kidney stones. The nurse should
remind the client to increase intake of which of the following?
A. Tea
B. Sodium
C. Water
D. Protein
Rationale: Clients who are prone to kidney stones should drink 3 to 4 L of fluid, with most of it water, through the course of each day. This helps keep urine dilute to prevent the concentration and precipitation of substances that form kidney stones.
A nurse is reinforcing teaching with the mother of a toddler who has acute nephrotic syndrome. The nurse should
emphasize the need to report which of the following manifestations to the provider?
A. Yellow nasal discharge
B. Facial edema
C. Poor appetite
D. Irritability
Rationale: Yellow or green nasal discharge is a sign of an upper respiratory infection. Children who have nephrotic syndrome are at constant risk for infection, so the mother should report this manifestation to the provider who can prescribe appropriate and prompt treatment.
The nurse is preparing a client for an intravenous pyelogram (IVP). Which finding should be reported to the healthcare provider before the procedure?
A. History of shellfish allergy
B. Reports of mild dysuria
C. Taking a daily multivitamin
D. 10-year history of hypertension
Correct Answer: A
Rationale:
A is critical because IVP uses iodine contrast and may cause anaphylaxis in patients allergic to shellfish or iodine.
B (dysuria), C (multivitamin), and D (hypertension) do not contraindicate IVP.
A nurse is caring for a client who has cholelithiasis with bile duct obstruction. The nurse should expect which of the
following findings when obtaining the client’s urine specimen?
A. Pale yellow
B. Bright orange
C. Red
D. Amber
Rationale: The nurse should expect this client to have dark or amber-colored urine. The client who has biliary obstruction will experience a backward flow of bile, which must be filtered out of the body by the kidneys.
A nurse is contributing to a teaching plan about the prevention of hepatitis A. The nurse should include that which
of the following activities can spread hepatitis A?
A. Sharing personal hygiene items like razors.
B. Eating uncooked foods.
C. Getting a tattoo.
D. Having vaginal intercourse.
Rationale: The nurse should identify eating uncooked foods as a risk factor for acquiring hepatitis A. Food and shellfish can be contaminated with hepatitis A. The disease is spread through the fecal-oral route.
A nurse is reinforcing teaching with a client who is scheduled for lithotripsy about conditions that can contribute to the formation of renal calculi. Which of the following conditions should the nurse include?
A. Protein in the urine
B. Dehydration
C. Iron deficiency
D. Obesity
Rationale: Inadequate fluid intake and urinary stasis can promote the formation of renal calculi.
A nurse is preparing to collect a specimen from a client for a guaiac test. The client asks what the test will detect in
his stool. Which of the following responses should the nurse make?
A. Blood
B. Lipids
C. Bacteria
D. Bile
Rationale: A guaiac (fecal occult blood) test measures occult blood in the stool and screens for colon cancer.
A client is admitted with severe epigastric pain radiating to the back, nausea, and vomiting. Vital signs: BP 88/56 mm Hg, HR 126 bpm, RR 28/min, Temp 100.4°F (38°C). Which action should the nurse take first?
A. Administer prescribed IV fluids
B. Insert a nasogastric tube to low suction
C. Give prescribed IV morphine
D. Position the client in semi-Fowler’s
Correct Answer: A
Rationale:
Hypotension and tachycardia indicate hypovolemia and shock, common in acute pancreatitis due to third spacing. IV fluid resuscitation is the priority.
NG suction (B) reduces pancreatic stimulation but does not treat shock.
Pain control (C) is important but comes after stabilizing circulation.
Positioning (D) helps comfort but is not lifesaving.
A nurse is caring for a client who has cirrhosis. When delivering the client's lunch tray, which of the following food
selection requires intervention by the nurse?
A. 1 medium baked potato
B. 1 cup of sliced cucumbers in vinegar
C. 1 slice of ham on whole wheat bread
D. 1 240 mL (8 oz) milkshake
Rationale: Ham is high in sodium and can increase fluid retention, leading to edema. Clients who have cirrhosis are prone to edema as the osmotic pressures change due to a decrease in plasma albumin.
The nurse is caring for a client on the third day following abdominal surgery and assesses the absence of bowel
sounds, abdominal distention, and the client passing no flatus. These findings indicate the client is experiencing
which of the following postoperative complications?
A. Health care-associated Clostridium difficile
B. Fecal impaction
C. Paralytic ileus
D. Incisional infection
Rationale: A paralytic ileus in the postoperative client is indicated by the absence of bowel sounds, abdominal distention, and the client passing no stool or flatus. It is often caused by bowel handling during surgery and opioid analgesic use.
A nurse in a provider's office is collecting data from an older adult client who reports a sudden onset of urinary
incontinence. The nurse should collect additional data to determine if the client has which of the following
conditions?
A. Urolithiasis
B. Uremia
C. Diabetic nephropathy
D. Urinary tract infection
Rationale: A sudden onset of urinary incontinence can indicate the presence of a urinary tract infection.
A nurse in a provider’s office is reviewing the health histories of four clients. For which of the following clients
should the nurse anticipate scheduling a colonoscopy?
A. 56-year-old who had a colonoscopy 6 years ago
B. 34-year-old who reports a new onset of constipation
C. 32-year-old who has a sister who died of colon cancer
D. 45 -year-old who has Clostridium difficile
Rationale: A family history of colon cancer indicates a client may be at high risk for colon cancer. For clients who have this risk, colonoscopies are recommended to begin before the age of 50, and are performed more frequently than every 10 years.
Lab results for a client with cirrhosis:
Total bilirubin: 3.2 mg/dL (↑)
Albumin: 2.5 g/dL (↓)
INR: 2.2 (↑)
Ammonia: 85 mcg/dL (↑)
Which findings are consistent with impaired liver function? (Select all that apply)
A. Jaundice and pruritus
B. Easy bruising and prolonged bleeding
C. Peripheral edema and ascites
D. Hypoglycemia during fasting
E. Polycythemia and hypertension
Correct Answers: A, B, C, D
Rationale:
A (↑bilirubin) → jaundice & itching.
B (↑INR) → bleeding risk.
C (↓albumin) → fluid shift & edema.
D (impaired gluconeogenesis) → fasting hypoglycemia.
E (polycythemia, hypertension) are not cirrhosis findings.
A nurse is caring for a client who has cirrhosis and a prescription for lactulose. Following administration, the nurse
should monitor the client for which of the following adverse effects?
A. Dry mouth
B. Diarrhea
C. Headache
D. Peripheral edema
Rationale: The nurse should monitor for diarrhea. Lactulose is a synthetic disaccharide that the small intestine cannot utilize. It causes diarrhea by lowering the pH, so the bacterial flora are changed in the bowel.
A nurse is reinforcing teaching a client who has peptic ulcer disease and is starting therapy with sucralfate. Which
of the following instructions should the nurse include in the teaching?
A. Take the medication with an antacid.
B. Take the medication 1 hr before meals.
C. Store the medication in the refrigerator.
D. Take as needed for pain relief.
Rationale: The nurse should instruct the client to take sucralfate on an empty stomach, 1 hr before meals, and at bedtime for maximum effectiveness.
15.A nurse is assisting in planning care for a client who has cystitis. Which of the following interventions should be
included in the plan of care?
A. Instruct the client to take antibiotics until dysuria is no longer present.
B. Instruct the client to avoid drinking caffeinated beverages.
C. Direct the client to wash underclothing in bleach.
D. Inform the client that taking Vitamin E supplements will decrease the incidence of cystitis.
Rationale: Caffeinated beverages should be avoided by clients who have cystitis as they can irritate the mucosa of the bladder resulting in painful spasms.
A nurse is caring for a client who has been taking warfarin and has a prothrombin time of 30 seconds. Which of the
following medications should the nurse anticipate the provider to prescribe?
A. Vitamin K
B. Heparin
C. Prednisone
D. Ferrous sulfate
Rationale: A prothrombin time of 30 seconds indicates the clotting time is prolonged and bleeding could occur. Vitamin K injection antagonizes the actions of warfarin and serves as an antidote to the medication; therefore, the nurse should anticipate the provider will prescribe vitamin K.
Tab 1: History & Assessment
58-year-old client with obstructive jaundice from suspected gallstones in the common bile duct.
Reports severe itching, dark urine, clay-colored stools, and epigastric pain.
Scheduled for an Endoscopic Retrograde Cholangiopancreatography (ERCP) today.
Tab 2: Labs
Total bilirubin: 5.8 mg/dL (↑)
ALT: 112 U/L (↑)
AST: 130 U/L (↑)
INR: 1.4 (slightly ↑)
Tab 3: Orders
NPO after midnight
Vital signs q4h
Consent for ERCP obtained
Paracentesis PRN for ascites-related discomfort
Which findings indicate a potential complication after ERCP that requires immediate intervention?
(Select all that apply)
A. Temperature 101.6°F (38.7°C) 6 hours post-procedure
B. Mild sore throat and hoarseness
C. Epigastric pain radiating to the back with nausea and vomiting
D. Blood pressure 102/68 mm Hg, pulse 86 bpm
E. Small amount of blood in stool on first bowel movement
Correct Answers: A, C
Rationale:
A indicates possible infection or cholangitis.
C suggests pancreatitis, a known ERCP complication.
B is expected post-endoscopy.
D is stable hemodynamics.
E could occur but small streaks of blood are not an emergency unless persistent or large.