A provider has just inserted a central venous catheter so a patient can begin total parenteral nutrition. What must happen before the infusion starts?
Confirm placement with a chest x-ray
✓
Test aspirated fluid for an acidic pH
Draw a blood culture from the new line
Check the patient's gag reflex
Correct Answer
Confirm placement with a chest x-ray
A chest x-ray is read before a new central line is used, both to confirm the catheter tip position and to rule out a pneumothorax caused by insertion. Test aspirated fluid for an acidic pH is a check used for gastric feeding tubes, not venous lines. Draw a blood culture from the new line is done only when infection is suspected. Check the patient's gag reflex relates to swallowing safety, not line placement.
Category: Nutrition Support
Question 2
A patient's total parenteral nutrition infusion stops suddenly when the line becomes occluded. Which complication should the nurse watch for?
Hyperglycemia
Hypoglycemia
✓
Fluid overload
Hypernatremia
Correct Answer
Hypoglycemia
Parenteral nutrition delivers a steady, concentrated dextrose load, so an abrupt stop or a rate that runs too slowly can drop the blood glucose. Hyperglycemia is the risk when the solution runs too fast, not when it stops. Fluid overload also comes from an infusion that runs too fast. Hypernatremia is not the expected result of an interrupted infusion.
Category: Nutrition Support
Question 3
During a shift assessment of a patient receiving continuous nasogastric feedings, the nurse finds that the centimeter mark at the nostril no longer matches the documented mark. What should the nurse do first?
Push the tube back in to the documented mark
Retape the tube at the new mark and continue
Hold the feeding and verify tube placement
✓
Flush the tube with water and resume the feeding
Correct Answer
Hold the feeding and verify tube placement
A change in external tube length means the tip may have moved, possibly into the esophagus or airway, so feeding stops until placement is confirmed by the method the provider orders. Push the tube back in to the documented mark is a blind reinsertion that could place the tip in the lung. Retape the tube at the new mark and continue keeps feeding into an unconfirmed location. Flush the tube with water and resume the feeding sends fluid through a tube that may be out of position.
Category: Nutrition Support
Question 4
A patient has just had surgery for cancer of the tongue and floor of the mouth. Which goal takes priority in the immediate postoperative period?
Restoring adequate nutrition
Relieving incisional pain
Teaching tobacco cessation
Maintaining a patent airway
✓
Correct Answer
Maintaining a patent airway
Swelling and surgery in the mouth and throat can block breathing, so frequent airway assessment comes before every other goal. Restoring adequate nutrition is the next priority and may require tube feeding or parenteral nutrition. Relieving incisional pain matters but does not outrank airway. Teaching tobacco cessation is important later, once the patient is stable.
Category: Oral Cavity Disorders
Question 5
A patient being treated for gastritis tells the nurse about several new symptoms. Which one should be reported to the provider right away?
Black, tarry stools
✓
Belching after meals
Mild morning nausea
Upper abdominal fullness after eating
Correct Answer
Black, tarry stools
Dark, tarry stool means blood from the upper GI tract has been digested, so it signals bleeding, the top priority in gastritis and peptic ulcer disease. Belching after meals is a common, nonurgent gastritis complaint. Mild morning nausea is expected with an irritated stomach lining. Upper abdominal fullness after eating is a typical symptom of acute gastritis, not a warning sign.
Category: Upper GI Disorders
Question 6
Why is gastric cancer often advanced by the time it is diagnosed?
It spreads to the liver within a few days
Early symptoms are vague, such as indigestion
✓
Endoscopy cannot detect stomach tumors
It never causes symptoms at any stage
Correct Answer
Early symptoms are vague, such as indigestion
Early complaints of gastric cancer, such as indigestion, poor appetite and early fullness, are easy to dismiss, so most patients with symptoms already have advanced disease. It spreads to the liver within a few days overstates its speed; the late diagnosis comes from vague early symptoms, not from spread within days. Endoscopy cannot detect stomach tumors is false, because endoscopy with biopsy is the usual way to diagnose it. It never causes symptoms at any stage is wrong because weight loss, pain and vomiting of blood can occur.
Category: Upper GI Disorders
Question 7
After abdominal surgery, which finding tells the nurse that the patient's diet can begin to be advanced?
Reporting hunger
Walking in the hallway
Passing flatus
✓
Absence of incisional pain
Correct Answer
Passing flatus
Passing gas shows that peristalsis has returned after anesthesia and bowel handling, so the diet is not advanced until it occurs. Reporting hunger does not prove the bowel is moving. Walking in the hallway helps restore motility but is not evidence that it has returned. Absence of incisional pain says nothing about bowel function.
Category: Lower GI Disorders
Question 8
A patient with a paralytic ileus has worsening abdominal distention and repeated vomiting. Which intervention does the nurse expect to be ordered?
A high-fiber diet
An oral stimulant laxative
Large amounts of oral fluids
A nasogastric tube to suction
✓
Correct Answer
A nasogastric tube to suction
When peristalsis stops, gas and fluid build up above the inactive bowel; a nasogastric tube to suction decompresses the stomach and relieves distention and vomiting until motility returns. A high-fiber diet adds bulk the bowel cannot move. An oral stimulant laxative is unsafe because nothing taken by mouth can pass. Large amounts of oral fluids would worsen distention and vomiting.
Category: Lower GI Disorders
Question 9
A patient with long-standing Crohn disease develops crampy abdominal pain, abdominal distention and vomiting and has not passed gas. Which complication should the nurse suspect?
Bowel obstruction from a stricture
✓
Lactose intolerance
Gastroesophageal reflux
Acute cholecystitis
Correct Answer
Bowel obstruction from a stricture
Crohn inflammation runs through the full thickness of the bowel wall, and repeated healing leaves scar tissue that can narrow the lumen into a stricture; cramping, distention, vomiting and no passage of gas point to obstruction, which the nurse reports promptly. Lactose intolerance causes bloating and diarrhea after dairy, not vomiting with no passage of gas. Gastroesophageal reflux causes heartburn and regurgitation rather than distention. Acute cholecystitis causes right upper quadrant pain, not a distended abdomen with no flatus.
Category: Inflammatory Bowel Disease
Question 10
A patient is hospitalized with a flare of inflammatory bowel disease. Which change should the nurse report promptly as a sign of possible bleeding or infection?
Weight loss over several months
Rising heart rate with falling blood pressure
✓
Aching in the knees
Bloating after meals
Correct Answer
Rising heart rate with falling blood pressure
During a flare, the nurse watches for a rising temperature and heart rate or a falling blood pressure, which can mean hemorrhage, infection or worsening dehydration. Weight loss over several months is a chronic feature of the disease, not an acute warning. Aching in the knees is a known joint manifestation of inflammatory bowel disease that is not an emergency. Bloating after meals is a common symptom rather than a sign of complication.
Category: Inflammatory Bowel Disease
Question 11
While assessing a patient with suspected appendicitis, the nurse presses on the left lower quadrant and the patient reports pain in the right lower quadrant. What is this finding called?
Cullen sign
Murphy sign
Rovsing sign
✓
Chvostek sign
Correct Answer
Rovsing sign
Rovsing sign is right lower quadrant pain produced by pressing the left lower quadrant, a classic finding in appendicitis. Cullen sign is bruising around the umbilicus from bleeding, as in severe pancreatitis. Murphy sign is pain that stops a deep breath during right upper quadrant palpation in cholecystitis. Chvostek sign is facial twitching from low calcium.
Category: Lower GI Disorders
Question 12
A patient newly diagnosed with celiac disease asks which grain is safe to eat. Which grain should the nurse name?
Barley
Rye
Spelt
Rice
✓
Correct Answer
Rice
Rice contains no gluten and is safe on the lifelong gluten-free diet that controls celiac disease. Barley contains gluten. Rye contains gluten. Spelt is a type of wheat and contains gluten.
Category: Lower GI Disorders
Question 13
A patient has had severe diarrhea and now feels thirsty and lightheaded. Which nursing priority comes first?
Restoring fluid balance
✓
Starting a high-fiber diet
Teaching stress reduction
Collecting a food diary
Correct Answer
Restoring fluid balance
Rapid transit through the bowel prevents water reabsorption, and thirst with lightheadedness shows dehydration, so replacing fluid by mouth or IV is the first priority. Starting a high-fiber diet does not correct the fluid loss. Teaching stress reduction addresses a possible trigger later. Collecting a food diary helps find a cause but does nothing for the current deficit.
Category: Lower GI Disorders
Question 14
A patient with cirrhosis has a tense abdomen from a large amount of ascites. Which assessment is the nurse's priority?
Abdominal girth
Respiratory status
✓
Skin integrity
Bowel sounds
Correct Answer
Respiratory status
Large-volume ascites pushes up on the diaphragm and can limit breathing and cause pneumonia, so respiratory status comes first; the nurse encourages deep breathing and incentive spirometry and gives oxygen as ordered. Abdominal girth is tracked daily but does not outrank breathing. Skin integrity matters with edema but is not the priority. Bowel sounds give little information about the danger ascites poses.
Category: Liver Disease
Question 15
A patient with cirrhosis becomes increasingly confused and drowsy. Which laboratory result supports the suspicion of hepatic encephalopathy?
Elevated serum amylase
Low white blood cell count
Elevated serum ammonia
✓
Elevated hemoglobin
Correct Answer
Elevated serum ammonia
A failing liver cannot convert ammonia to urea, and a decline in mental status along with rising ammonia points to hepatic encephalopathy. Elevated serum amylase points to the pancreas. Low white blood cell count does not explain new confusion. Elevated hemoglobin is not linked to encephalopathy.
Category: Liver Disease
Question 16
A patient with end-stage liver disease has oozing from several old venipuncture sites. What does this finding suggest?
Fluid volume excess
Local skin infection
Hepatic encephalopathy
Impaired blood clotting
✓
Correct Answer
Impaired blood clotting
The liver makes most clotting factors, so bleeding from old puncture sites or body openings signals a coagulopathy that must be reported. Fluid volume excess causes edema and weight gain, not oozing. Local skin infection would cause redness and drainage at one site, not bleeding from many. Hepatic encephalopathy shows up as mental status changes.
Category: Liver Disease
Question 17
A patient admitted with acute cholecystitis develops yellow sclera. What does this new finding suggest?
A stone blocking the common bile duct
✓
Dehydration from vomiting
Normal resolution of inflammation
Infection of the surgical incision
Correct Answer
A stone blocking the common bile duct
New jaundice in a patient with gallstones suggests a stone has lodged in the common bile duct and blocked bile flow, which needs urgent removal of the stone, by an endoscopic procedure or surgery. Dehydration from vomiting is signaled by hypotension and low urine output, not yellow eyes. Normal resolution of inflammation would not produce jaundice. Infection of the surgical incision does not apply before surgery and does not cause jaundice.
Category: Biliary and Pancreatic Disorders
Question 18
Which intervention is a priority during the first day of care for a patient with acute pancreatitis?
Strict fluid restriction
Early IV fluid replacement
✓
Withholding all pain medication
Frequent enemas to empty the bowel
Correct Answer
Early IV fluid replacement
Acute pancreatitis causes large fluid shifts and can progress to shock and organ failure, so early IV fluid replacement, guided by close monitoring of vital signs, urine output and breath sounds, is a key priority. Strict fluid restriction would worsen hypovolemia. Withholding all pain medication is wrong because pain management is also a priority. Frequent enemas to empty the bowel have no role in treatment.
Category: Biliary and Pancreatic Disorders
Question 19
On the first day after colostomy surgery, which stoma finding should the nurse report to the provider?
A swollen appearance
A moist surface
A dusky purple color
✓
A beefy red color
Correct Answer
A dusky purple color
A healthy stoma is moist and pink to red; a dusky, purple, black or pale stoma suggests poor blood supply and possible necrosis. A swollen appearance is expected right after surgery and shrinks over the following weeks. A moist surface is normal. A beefy red color is within the healthy range.
Category: Ostomy Care
Question 20
Why is a patient with an ileostomy taught to keep up a generous fluid intake?
Fluids keep the stoma a healthy color
Fluids prevent the pouch from leaking
Fluids reduce odor from the pouch
Output is watery because the colon is bypassed
✓
Correct Answer
Output is watery because the colon is bypassed
An ileostomy brings out the end of the small intestine, so stool never passes through the colon where water is reabsorbed; the liquid output puts the patient at risk for dehydration and electrolyte loss. Fluids keep the stoma a healthy color is incorrect because stoma color depends on blood supply. Fluids prevent the pouch from leaking is wrong; leaks come from poor fit or seal. Fluids reduce odor from the pouch is not the reason; diet and deodorant products address odor.
Category: Ostomy Care