Med Surg Gastrointestinal NCLEX Questions
Latest Update 2024-2025 Actual Exam Questions
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A client arrives at the hospital emergency department complaining of acute right lower
quadrant abdominal pain, and appendicitis is suspected. Laboratory tests are
performed, and the nurse notes that the client's white blood cell (WBC) count is
elevated. On the basis of these findings, the nurse should question which health care
provider (HCP) prescription documented in the client's medical record?
A. Apply a cold pack to the abdomen.
B. Administer 30 mL of milk of magnesia (MOM).
C. Maintain nothing by mouth (nil per os [NPO]) status.
D. Initiate an intravenous (IV) line for the administration of IV fluids. - CORRECT
ANSWER: B. Administer 30 mL of milk of magnesia (MOM).
Rationale:
Appendicitis should be suspected in a client with an elevated WBC count complaining of
acute right lower abdominal quadrant pain. Laxatives are never prescribed because if
appendicitis is present, the effect of the laxative may cause a rupture with resultant
peritonitis. Cold packs may be prescribed for comfort. The client would be NPO and
given IV fluids in preparation for possible surgery.
A client arrives at the hospital emergency department complaining of acute right lower
quadrant abdominal pain. Appendicitis is suspected, and appropriate laboratory tests
are performed. The emergency department nurse reviews the test results and notes that
the client's white blood cell (WBC) count is elevated. The nurse also reviews the
prescriptions from the health care provider (HCP). The nurse should contact the HCP to
question which prescription if noted in the client's record?
A. Maintain a semi Fowler's position.
B. Maintain on NPO (nothing by mouth) status.
,C.Apply a heating pad to the lower abdomen for comfort.
D. Initiate an intravenous (IV) line with the administration of IV fluids. - CORRECT
ANSWER: C.Apply a heating pad to the lower abdomen for comfort.
Rationale:
Appendicitis should be suspected in a client with an elevated WBC count who is
complaining of acute right lower quadrant abdominal pain. A semi Fowler's position is
maintained for comfort. The client would be on NPO status and given IV fluids in
preparation for possible surgery. Heat should never be applied to the abdomen because
this may increase circulation to the appendix, potentially leading to increased
inflammation and perforation.
A client experiencing chronic dumping syndrome makes the following comments to the
nurse. Which one indicates the need for further teaching?
A. "I eat at least 3 large meals each day."
B. "I eat while lying in a semirecumbent position."
C. "I have eliminated taking liquids with my meals."
D. "I eat a high-protein, low- to moderate-carbohydrate diet." - CORRECT ANSWER: A.
"I eat at least 3 large meals each day."
Rationale:
Dumping syndrome describes a group of symptoms that occur after eating. It is believed
to result from rapid dumping of gastric contents into the small intestine, which causes
fluid to shift into the intestine. Signs and symptoms of dumping syndrome include
diarrhea, abdominal distention, sweating, pallor, palpitations, and syncope. To manage
this syndrome, clients are encouraged to decrease the amount of food taken at each
sitting, eat in a semirecumbent position, eliminate ingesting fluids with meals, and avoid
consumption of high-carbohydrate meals.
A client had a new colostomy created 2 days earlier and is beginning to pass
malodorous flatus from the stoma. What is the correct interpretation by the nurse?
,A. This is a normal, expected event.
B. The client is experiencing early signs of ischemic bowel.
C. The client should not have the nasogastric tube removed.
D. This indicates inadequate preoperative bowel preparation. - CORRECT ANSWER: A.
This is a normal, expected event.
Rationale:
As peristalsis returns following creation of a colostomy, the client begins to pass
malodorous flatus. This indicates returning bowel function and is an expected event.
Within 72 hours of surgery, the client should begin passing stool via the colostomy.
Options 2, 3, and 4 are incorrect interpretations.
A client has a large, deep duodenal ulcer diagnosed by endoscopy. Which sign or
symptom indicative of a complication should the nurse look for during the client's
postprocedure assessment?
A. Bradycardia
B. Nausea and vomiting
C. Numbness in the legs
D. A rigid, boardlike abdomen - CORRECT ANSWER: D. A rigid, boardlike abdomen
Rationale:
The client with a large, deep duodenal ulcer is at risk for perforation of the ulcer. If this
occurs, the client will experience sudden, sharp, intolerable severe pain beginning in the
midepigastric area and spreading over the abdomen, which then becomes rigid and
boardlike. Tachycardia, not bradycardia, may occur as hypovolemic shock develops.
Nausea and vomiting may not occur if the pyloric sphincter is intact. Numbness in the
legs is not an associated finding.
A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate
for this client? Select all that apply.
, A. Administer stool softeners as prescribed.
B. Instruct the client to limit fluid intake to avoid urinary retention.
C. Encourage a high-fiber diet to promote bowel movements without straining.
D. Apply cold packs to the anal-rectal area over the dressing until the packing is
removed.
E. Help the client to a Fowler's position to place pressure on the rectal area and
decrease bleeding. - CORRECT ANSWER: A. Administer stool softeners as prescribed.
C. Encourage a high-fiber diet to promote bowel movements without straining.
D. Apply cold packs to the anal-rectal area over the dressing until the packing is
removed.
Rationale:
Nursing interventions after a hemorrhoidectomy are aimed at management of pain and
avoidance of bleeding and incision rupture. Stool softeners and a high-fiber diet will help
the client to avoid straining, thereby reducing the chances of rupturing the incision. An
ice pack will increase comfort and decrease bleeding. Options 2 and 5 are incorrect
interventions.
A client has just had surgery to create an ileostomy. The nurse assesses the client in the
immediate postoperative period for which most frequent complication of this type of
surgery?
A. Folate deficiency
B. Malabsorption of fat
C. Intestinal obstruction
D. Fluid and electrolyte imbalance - CORRECT ANSWER: D. Fluid and electrolyte
imbalance
Rationale:
A frequent complication that occurs following ileostomy is fluid and electrolyte
imbalance. The client requires constant monitoring of intake and output to prevent this
from occurring. Losses require replacement by intravenous infusion until the client can
tolerate a diet orally. Intestinal obstruction is a less frequent complication. Fat
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