ATI RN
Gastrointestinal System Nursing Exam Questions
1. A client has a nasogastric tube inserted at the time of abdominal perineal resection with permanent colostomy. This tube will most likely be removed when the client demonstrates:
- A. Absence of nausea and vomiting.
- B. Passage of mucus from the rectum.
- C. Passage of flatus and feces from the colostomy.
- D. Absence of stomach drainage for 24 hours.
Correct answer: C
Rationale: A sign indicating that a client's colostomy is open and ready to function is passage of feces and flatus. When this occurs, gastric suction is ordinarily discontinued, and the client is allowed to start taking fluids and food orally. Absence of bowel sounds would indicate that the tube should remain in place because peristalsis has not yet returned. Absence of nausea and vomiting is not a criterion for judging whether or not gastric suction should be continued. Passage of mucus from the rectum will not occur in this client because the rectum is removed in this surgery. Absence of stomach drainage is not a criterion for judging whether or not gastric suction should be continued.
2. To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instructions?
- A. Lie down after meals to promote digestion.
- B. Avoid coffee and alcoholic beverages.
- C. Take antacids before meals.
- D. Limit fluids with meals.
Correct answer: B
Rationale: To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that tend to increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client doesn't need to limit fluids with meals as long as the fluids aren't gastric irritants.
3. A client had an abdominal perineal resection with a colostomy 4 days ago and is ready for discharge. Which of the following would be an appropriate expected outcome at this point?
- A. The client maintains a high-fiber diet.
- B. The client discusses concerns about his sexual functioning.
- C. The client maintains bedrest.
- D. The client limits fluid intake to 1000 ml/day.
Correct answer: B
Rationale: Clients often have concerns about their sexuality after a fecal diversion. The nurse should encourage the client to discuss any questions about sexual functioning. The client will not need to maintain a high-fiber diet but will be encouraged to avoid any foods that cause odor and flatulence. The client should be able to ambulate and sit out of bed for several hours at a time at this point. Fluid intake will be encouraged, not restricted.
4. A nurse is providing the client with biliary obstruction a simple overview of the anatomy of the liver and gallbladder. The nurse tells the client that normally the liver stores bile in the gallbladder, which is connected to the liver by the?
- A. Liver canaliculi
- B. Common bile duct
- C. Cystic duct
- D. Right hepatic duct.
Correct answer: C
Rationale: The gallbladder receives bile from the liver through the cystic duct. The liver collects bile in the canaliculi. Bile then flows into the common hepatic duct. From the common hepatic duct, the bile can be stored in the gallbladder through the cystic duct. Otherwise, the bile can flow directly into the duodenum by way of the common bile duct.
5. A client returns from surgery with a sigmoid colostomy. An ostomy appliance is attached. The priority nursing diagnosis for daily observation and care is:
- A. Diarrhea related to alteration in bowel elimination.
- B. Impaired skin integrity related to seepage.
- C. Impaired nutrition: More than body requirements related to high-fat diet.
- D. Impaired physical mobility related to surgical procedure.
Correct answer: B
Rationale: Impaired skin integrity would be the priority nursing diagnosis for daily care of the colostomy because the effluent from the colostomy can be irritating to the skin. Diarrhea isn't a concern at this point. The client will be allowed nothing by mouth until peristalsis returns. The client should get out of bed on the first postoperative day, so mobility shouldn't be a problem.
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