Angelite Nurses

Situation 1: Children have a special fascination with the workings of the digestive system. To fully understand the digestive processes, Nurse Lavigña must be knowledgeable of the anatomy and physiology of the gastrointestinal system.

1. The alimentary canal is a continuous, coiled, hollow muscular tube that winds through the ventral cavity and is open at both ends. Its solid organs include all of the following except:

a. liver
b. gall bladder
c. stomach
d. pancreas

2. Pharynx is lined with mucous membranes and mucous secreting glands to ease the passage of food. The larygngopharynx serves as passageway for:

a. air only
b. air and water
c. food, fluids and air
d. air and food

3. Once food has been placed in the mouth, both mechanical and chemical digestions begin. The six activities of the digestive process are:

a. ingestion, mastication, digestion, deglutition, absorption, egestion
b. ingestion, mastication, deglutition, digestion, absorption, egestion
c. deglutition, ingestion, mastication, egestion, absorption, defecation
d. ingestion, digestion, mastication, deglutition, absorption, defecation

4. Most digestive activity occurs in the pyloric region of the stomach. What hormone stimulates the chief cells to produce pepsinogen?

a. Gastrin
b. Pepsin
c. HCl
d. Insulin

5. What pancreatic enzyme aids in the digestion of carbohydrates?
a. Lipase
b. Trypsin
c. Amylase
d. Chymotrypsin

Situation 2: Nurse Dorina is going to perform an abdominal examination to Mr. Lim who was admitted due to on and off pain since yesterday.

6. How will you position Mr. Lim prior to procedure?

a. supine with knees flexed
b. prone
c. lying on back
d. sim’s

7. To identify any localized bulging, distention and peristaltic waves, Nurse Dorina must perform which of the following?

a. Auscultation
b. Inspection
c. Palpation
d. Percussion

8. In order to identify areas of tenderness and swelling, Nurse Dorina must do:

a. deep palpation
b. light palpation
c. percussion
d. palpation

9. Mr. Lim verbalized pain on the right iliac region. Nurse Dorina knows that the organ affected would be the:

a. liver
b. sigmoid colon
c. appendix
d. duodenum

10. Mr. Lim felt pain upon release of Nurse Dorina’s hand. This can be referred as:

a. referred pain
b. rebound tenderness
c. direct tenderness
d. indirect tenderness

Situation 3: Mrs. Cruz was admitted in the Medical Floor due to pyrosis, dyspepsia and difficulty of swallowing.

11. Based from the symptoms presented, Nurse Yoshi might suspect:

a. Esophagitis
b. Hiatal hernia
c. GERD
d. Gastric Ulcer

12. What diagnostic test would confirm the type of problem Mrs. Cruz have?

a. barium enema
b. barium swallow
c. colonoscopy
d. lower GI series

13. Mrs. Cruz complained of pain and difficulty in swallowing. This term is referred as:

a. Odynophagia
b. Dysphagia
c. Pyrosis
d. Dyspepsia

14. To avoid acid reflux, Nurse Yoshi should advice Mrs. Cruz to avoid which type of diet?

a. cola, coffee and tea
b. high fat, carbonated and caffeinated beverages
c. beer and green tea
d. lechon paksiw and bicol express

15. Mrs. Cruz’ body mass index (BMI) is 25. You can categorized her as:

a. normal
b. overweight
c. underweight
d. obese

Situation 4: Nurse Gloria is the staff nurse assigned at the Emergency Department. During her shift, a patient was rushed – in the ED complaining of severe heartburn, vomiting and pain that radiates to the flank. The doctor suspects gastric ulcer.

16. What other symptoms will validate the diagnosis of gastric ulcer?

a. right epigastric pain
b. pain occurs when stomach is empty
c. pain occurs immediately after meal
d. pain not relieved by vomiting

17. What diagnostic test would yield good visualization of the ulcer crater?
a. Endoscopy
b. Gastrocopy
c. Barium Swallow
d. Histology

18. Peptic ulcer disease particularly gastric ulcer is thought to be cause by which of the following microorgamisms?

a. E. coli
b. H. pylori
c. S. aureus
d. K. pnuemoniae

19. She is for occult blood test, what specimen will you collect?

a. Blood
b. Urine
c. Stool
d. Gastric Juice

20. Preparation of the client for occult blood examination is:

a. Fluid intake limited only to 1 liter/day
b. NPO for 12 hours prior to obtaining of specimen
c. Increase fluid intake
d. Meatless diet for 48 hours prior to obtaining of specimen

Situation 5: IBD is a common inflammatory functional bowel disorder also known as spastic bowel, functional colitis and mucous colitis.

21. The client with IBS asks Nurse June what causes the disease. Which of the following responses by Nurse June would be most appropriate?

a. “This is an inflammation of the bowel caused by eating too much roughage”
b. “IBS is caused by a stressful lifestyle”
c. “The cause of this condition is unknown”
d. “There is thinning of the intestinal mucosa caused by ingestion of gluten”

22. Which of the following alimentary canal is the most common location for Chron’s disease?

a. Descending colon
b. Jejunum
c. Sigmoid Colon
d. Terminal Ileum

23. Which of the following factors is believed to be linked to Chron’s disease?

a. Diet
b. Constipation
c. Heredity
d. Lack of exercise

24. How about ulcerative colitis, which of the following factors is believed to cause it?

a. Acidic diet
b. Altered immunity
c. Chronic constipation
d. Emotional stress

25. Mr. Jung, had ulcerative colitis for 5 years and was admitted to the hospital. Which of the following factors was most likely of greatest significance in causing an exacerbation of the disease?

a. A demanding and stressful job
b. Changing to a modified vegetarian diet
c. Beginning a weight training program
d. Walking 2 miles everyday

Situation 6: A patient was admitted in the Medical Floor at St. Luke’s Hospital. He was asymptomatic. The doctor suspects diverticulosis.

26. Which of the following definitions best describes diverticulosis?
a. An inflamed outpouching of the intestine
b. A non – inflamed outpouching of the intestine
c. The partial impairment of the forward flow of instestinal contents
d. An abnormal protrusions of an oxygen trough the structure that usually holds it

27. Which of the following types of diet is implicated in the development of diverticulosis?

a. Low – fiber diet
b. High – fiber diet
c. High – protein diet
d. Low – carbohydrate diet

28. Which of the following tests should be administered to client with diverticulosis?

a. Proctosocpy
b. Barium enema
c. Barium swallow
d. Gastroscopy

29. To improve Mr. Trinidad’s condition, your best nursing intervention and teaching is:

a. Reduce fluid intake
b. Increase fiber in the diet
c. Administering of antibiotics
d. Exercise to increase intraabdominal pressure

30. Upon review of Mr. Trinidad’s chart, Nurse Drew noticed that he weighs 121 lbs and his height is 5 ft, 4 in. After computing for his Body Mass Index (BMI), you can categorize him as:

a. obese
b. normal
c. obese
d. underweight

Situation 7: Manny, 6 years old was admitted at Cardinal Santos Hospital due to increasing frequency of bowel movements, abdominal cramps and distension.

31. Diarrhea is said to be the leading cause of morbidity in the Philippines. Nurse Harry knows that diarrhea is present if:

a. passage of stool is more than 3 bowel movements per week
b. passage of stool is less than 3 bowel movements per day
c. passage of stool is more than 3 bowel movements per day
d. passage of stool is less than 3 bowel movements per week

32. Diarrhea is believed to be caused by all of the following except

a. increase intestinal secretions
b. altered immunity
c. decrease mucosal absorption
d. altered motility

33. What life threatening condition may result in persistent diarrhea?

a. hypokalemia
b. dehydration
c. cardiac dysrhytmias
d. leukocytosis

34. Voluminous, watery stools can deplete fluids and electrolytes. The acid base imbalance that can occur is:

a. metabolic alkalosis
b. metabolic acidosis
c. respiratory acidosis
d. respiratory alkalosis

35. What is the immediate home care management for diarrhea?

a. Milk
b. Imodium
c. Water
d. Oresol

Situation 8: Mr. Sean is admitted to the hospital with a bowel obstruction. He complained of colicky pain and inability to pass stool.

36. Which of these findings by Nurse Leonard, would indicate that the obstruction is in the early stages?

a. high pitched tinkling or rumbling bowel sounds
b. hypoactive bowel sounds
c. no bowel sounds auscultated
d. normal bowel sounds heard in all four quadrants

37. Nasogastric tube was inserted to Mr. Sean. The NGT’s primary purpose is:

a. nutrition
b. decompression of bowel
c. passage for medication
d. aspiration of gastric contents

38. Mr. Sean has undergone surgery. Post – operatively, which of the following findings is normal?

a. absent bowel sounds
b. bleeding
c. hemorrhage
d. bowel movement

39. Client education should be given in order to prevent constipation. Nurse Leonard’s health teaching should include which of the following?

a. use of natural laxatives
b. fluid intake of 6 glasses per day
c. use of OTC laxatives
d. complete bed rest

40. Four hours post – operatively, Mr. Sean complains of guarding and rigidity of the abdomen. Nurse Leonard’s initial intervention is:

a. assess for signs of peritonitis
b. call the physician
c. administer pain medication
d. ignore the client

Situation 9: Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F.

41. Which of the following would confirm a diagnosis of appendicitis?

a. The pain is localized at a position halfway between the umbilicus and the right iliac crest.
b. Mr. Liu describes the pain as occurring 2 hours after eating
c. The pain subsides after eating
d. The pain is in the left lower quadrant

42. Which of the following complications is thought to be the most common cause of appendicitis?

a. A fecalith
b. Internal bowel occlusion
c. Bowel kinking
d. Abdominal wall swelling

43. The doctor ordered for a complete blood count. After the test, Nurse Ray received the result from the laboratory. Which laboratory values will confirm the diagnosis of appendicitis?

a. RBC 5.5 x 106/mm3
b. Hct 44 %
c. WBC 13, 000/mm3
d. Hgb 15 g/dL

44. Signs and symptoms include pain in the RLQ of the abdomen that may be localize at McBurney’s point. To relieve pain, Mr. Liu should assume which position?

a. Prone
b. Supine, stretched out
c. Sitting
d. Lying with legs drawn up

45. After a few minutes, the pain suddenly stops without any intervention. Nurse Ray might suspect that:

a. the appendix is still distended
b. the appendix may have ruptured
c. an increased in intrathoracic pressure will occur
d. signs and symptoms of peritonitis occur

Situation 10: Nurse Nico is caring to a 38-year-old female, G3P3 client who has been diagnosed with hemorrhoids.

46. Which of the following factors would most likely be a primary cause of her hemorrhoids?

a. Her age
b. Three vaginal delivery pregnancies
c. Her job as a school teacher
d. Varicosities in the legs

47. Client education should include minimizing client discomfort due to hemorrhoids. Nursing management should include:

a. Suggest to eat low roughage diet
b. Advise to wear silk undergarments
c. Avoid straining during defecation
d. Use of sitz bath for 30 minutes

48. The doctor orders for Witch Hazel 5 %. Nurse Nico knows that the action of this astringent is:

a. temporarily relieves pain, burning, and itching by numbing the nerve endings
b. causes coagulation (clumping) of proteins in the cells of the perianal skin or the lining of the anal canal
c. inhibits the growth of bacteria and other organisms
d. causes the outer layers of skin or other tissues to disintegrate

49. Which position would be ideal for the client in the early postoperative period after hemorrhoidectomy?

a. High Fowler’s
b. Supine
c. Side – lying
d. Trendelenburg’s

50. Nurse Nico instructs her client who has had a hemorrhoidectomy not to used sitz bath until at least 12 hours postoperatively to avoid which of the following complications?

a. Hemorrhage
b. Rectal Spasm
c. Urinary retention
d. Constipation