Nursing Board Exams about Gastrointestinal Disorders (NLE 6-10)

Nursing Board Exams Questions

6. The nurse is caring for a client with a colostomy. The client tells the nurse that he makes small pin holes in the drainage bag to help relieve gas. The nurse should teach him that this action:

a. destroys the odor-proof seal.
b. won't affect the colostomy system.
c. is appropriate for relieving the gas in a colostomy system.
d. destroys the moisture-barrier seal.

7. For a client with cirrhosis, deterioration of hepatic function is best indicated by:

a. fatigue and muscle weakness.
b. difficulty in arousal.
c. nausea and anorexia.
d. weight gain.

8. Nursing board exams questions about a client with severe abdominal pain is being evaluated for appendicitis. What is the most common cause of appendicitis?

a. Rupture of the appendix
b. Obstruction of the appendix
c. A high-fat diet
d. A duodenal ulcer

9. A client is scheduled for bowel resection with anastomosis involving the large intestine. Because of the surgical site, the nurse formulates the nursing diagnosis of Risk for infection. To complete the nursing diagnosis statement, the nurse should add which "related-to" phrase?

a. Related to major surgery required by bowel resection
b. Related to the presence of bacteria at the surgical site
c. Related to malnutrition secondary to bowel resection with anastomosis
d. Related to the presence of a nasogastric (NG) tube postoperatively

10. A client with advanced cirrhosis has a prothrombin time (PT) of 15 seconds, compared with a control time of 11 seconds. The nurse expects to administer:

a. spironolactone (Aldactone).
b. phytonadione (Mephyton).
c. furosemide (Lasix).
d. warfarin (Coumadin).

Nursing Board Exam:
Answers and Rationale

6) A
- Any hole, no matter how small, will destroy the odor-proof seal of a drainage bag. Removing the bag or unclamping it is the only appropriate method for relieving gas.

7) B
- Hepatic encephalopathy, a major complication of advanced cirrhosis, occurs when the liver no longer can convert ammonia (a by-product of protein breakdown) into glutamine. This leads to an increased blood level of ammonia — a central nervous system toxin — which causes a decrease in the level of consciousness. Fatigue, muscle weakness, nausea, anorexia, and weight gain occur during the early stages of cirrhosis.

8) B
- Nursing Board Exams Rationale - Appendicitis most commonly results from obstruction of the appendix, which may lead to rupture. A high-fat diet or duodenal ulcer doesn't cause appendicitis; however, a client may require dietary restrictions after an appendectomy.

9) B
- The large intestine normally contains bacteria because its alkaline environment permits growth of organisms that putrefy and break down remaining proteins and indigestible residue. These organisms include Escherichia coli, Aerobacter aerogenes, Clostridium perfringens, and Lactobacillus. Although bowel resection with anastomosis is considered major surgery, it poses no greater risk of infection than any other type of major surgery. Malnutrition seldom follows bowel resection with anastomosis because nutritional absorption (except for some water, sodium, and chloride) is completed in the small intestine. An NG tube is placed through a natural opening, not a wound, and therefore doesn't increase the client's risk of infection.

10) B
- Prothrombin synthesis in the liver requires vitamin K. In cirrhosis, vitamin K is lacking, precluding prothrombin synthesis and, in turn, increasing the client's PT. An increased PT, which indicates clotting time, increases the risk of bleeding. Therefore, the nurse should expect to administer phytonadione (vitamin K1) to promote prothrombin synthesis. Spironolactone and furosemide are diuretics and have no effect on bleeding or clotting time. Warfarin is an anticoagulant that prolongs PT.

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