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Gastrointestinal Disorders NCLEX Quiz: Questions and Answers Question 1 A patient presents with RUQ abdominal pain with intermittent nausea and vomiting. Laboratory results show mildly elevated alkaline phosphatase and pancreatic enzymes with normal limits. What your presumptive diagnosis? a. Biliary obstruction b. Chronic pancreatitis c. Liver disease d. Peptic ulcer disease ANS: d Question 2 A 41-year-old female presents to the clinic with RUQ abdominal pain accompanied by nausea and vomiting. The pain started within 2 hours of ingesting a typical Cuban meal at the festival in Calle 8. She admits to having similar episodes in the past; however, it feels worse this time. She has low-grade fever. Abdominal examination is positive for RUQ tenderness with respiratory arrest to deep palpation of the RUQ. Laboratory results show elevated WBC; total bilirubin, alkaline phosphatase, and serum amylase are within normal limits. Which of the following diagnostic test, could be initially supportive of the most likely diagnosis? a. Magnetic resonance cholangiopancreatography (MRCP) b. Abdominal X-ray c. Endoscopic retrograde cholangiopancreatography (ERCP)
d. Hepatobiliary imilodiacetic acid scan (HIDA scan) e. Ultrasonography ANS: e Question 3 The best serologic test for detection of acute hepatitis-A infection: a. Positive HBsAb (hepatitis B surface antibody b. Elevated ALT and AST c. Positive HBsAg (hepatitis B surface antigen) d. Positive IgG antibody to HAV e. Positive IgM antibody to HAV ANS: e Question 4 A young gentleman with diagnosed Hep-B virus infection for which he is taking Tenofovir and Entecavir, presents to the clinic with his partner for evaluation. The partner denies symptoms and signs related to hepatitis and his physical examination is unremarkable. The partner's laboratory evaluation shows negative HBAg, negative HBsAb, negative HBcAb. Based on these findings, you would recommend: a. Three doses of Hepatitis-B immunization b. Treatment with immunoglobulins c. Both A and B
b. Metronidazole + Clarirthromycin + Omeprazole c. Amoxicillin + Clarithromycin + Omeprazole + Bismuth subsalicylate d. Misoprostol (Cytotec) combined with Mylanta and Clarithromycin ANS: b Question 7 A patient with persistent symptoms of peptic ulcer disease with bloating and diarrhea presents to the clinic for a follow-up after being prescribed Omeprazole 20 mp orally daily. He endorses partially controlled upper abdominal discomfort, but diarrhea has subsided. You decide to increase Omeprazole frequency to BID and evaluate: a. Metanephrines in seruma and urine b. Fasting serum gastrin levels c. A1c d. Dexamethasone suppression test ANS: b Question 8 Serology results for a female patient read: IgM-HAV: negative IgG-HAV: positive HBsAg: negative HBcAb: negative
HBsAB: positive Question: the FNP would interpret these findings as: a. She has develop immunity to Hep-A virus but is carrier of Hep-B virus. b. She has develop immunity to Hep-A but is at risk for infection with Hep-B virus c. She has develop immunity to both Hep-A and Hep-B viruses d. She had develop immunity to Hep-A virus but has active infection with Hep-B virus. ANS: c Question 9 A patient that has develop immunity to hepatitis-B virus by vaccination would have a serology that shows: a. Positive HBsAb, negative HBcAg, negative HBcAb b. Negative HBsAg, positive HBcAb, positive HBeAb c. Positive HbsAg, positive HBcAb, negative HBcAg d. Positive HBcAb, positive HBeAg ANS: a Question 10 First-line treatment for initial infection with Clostridiodes difficile , as recommended by Infectious Diseases Society of America (IDSA), include: a. Ciprofloxacin b. Fidaxomicin
Question 13 Math the following: Irritable bowel syndrome: Young female college student with episodes of diarrhea that alternate with constipation associated with abdominal pain that relieves with.. Hallmark of Ulcerative colitis: Bloody diarrhea Large bowel obstruction: initially cramping periumbilical pain that becomes constant and diffuse associated with nausea that may occur hours after pain is felt. Hallmark of Crohn disease: Abdominal pain (cramps-like) regardless distribution of the disease. Small bowel obstruction: Initially cramping periumbilical pain that becomes constant and diffuse associated with nausea and vomiting within minutes of the pain started. Colon cancer: High risk in individuals with diet rich in fat or refined carbohydrates. Question 14 A young adult male patient presents to the clinic complaining of loose stools with some mucus and mild abdominal cramps after his return from a trip to Mexico. He denies fever, chills, nausea, or vomiting. He has been otherwise in good health and physical examination is remarkable. How would you manage this case? (Select all that apply). a. Order stool culture for ova and parasite b. Order stools for occult blood c. Prescribe Loperamide d. Recommend follow-up in 72 hours if needed.
e. Recommend to drink plenty of fluids and eat easy to digest foods (eg BRAT diet), take advance diet as tolerated ANS: d Question 15 The FNP would suspect duodenal location of an ulcer for a patient with peptic ulcer disease when: a. Abdominal pain appears within 30 minutes up to 2 hours after ingesting a meal b. Episodes of abdominal pain are in 3-4 hours interval and relieved with food intake c. Abdominal pain is diffuse and relieves with defecation d. Abdominal pain is associated with diarrhea that alternates with constipation. ANS: b
PART 2
- A nurse is caring for a patient with peptic ulcer disease (PUD). Which of the following medications would the nurse expect to administer to decrease gastric acid secretion? A. Sucralfate B. Omeprazole C. Misoprostol D. Aluminum hydroxide ✅ Correct Answer: B. Omeprazole Rationale: Omeprazole is a proton pump inhibitor (PPI) that decreases gastric acid secretion by
C. Sudden relief of pain and rigid abdomen D. Loss of appetite and mild leukocytosis ✅ Correct Answer: C. Sudden relief of pain and rigid abdomen Rationale: A sudden relief of pain followed by a rigid abdomen indicates possible appendiceal rupture, leading to peritonitis, which is a medical emergency. The other findings (A, B, D) are common in appendicitis but do not indicate immediate danger.
- A client with Crohn’s disease is experiencing diarrhea and weight loss. Which dietary recommendation is most appropriate? A. High-fiber diet with dairy products B. Low-residue diet with increased protein C. High-fat diet with frequent snacks D. Increased intake of fresh fruits and vegetables ✅ Correct Answer: B. Low-residue diet with increased protein Rationale: A low-residue diet helps reduce bowel irritation, while increased protein supports tissue healing. High fiber (A, D) and dairy can worsen symptoms. A high-fat diet (C) may be poorly tolerated.
- A nurse is providing discharge instructions to a client with gastroesophageal reflux disease (GERD). Which statement indicates a need for further teaching?
A. "I will eat small, frequent meals." B. "I should avoid lying down right after eating." C. "I can drink coffee as long as I don’t have symptoms." D. "I should elevate the head of my bed at night." ✅ Correct Answer: C. "I can drink coffee as long as I don’t have symptoms." Rationale: Coffee is a known trigger for GERD and should be avoided, even if symptoms are not present. The other choices (A, B, D) are appropriate lifestyle modifications.
- A client with ulcerative colitis is prescribed sulfasalazine. Which instruction should the nurse include in the teaching plan? A. "Take this medication on an empty stomach." B. "Stop taking this medication if your symptoms improve." C. "Increase your fluid intake while taking this medication." D. "Avoid exposure to sunlight while on this drug." ✅ Correct Answer: C. "Increase your fluid intake while taking this medication." Rationale: Sulfasalazine can cause crystalluria, so adequate hydration is important. It should be taken with food (A) and continued even if symptoms improve (B). Photosensitivity is a concern but is not the most important teaching point.
phosphatase (A) and bilirubin (D) are elevated in liver/biliary diseases. Albumin (B) may decrease but is not diagnostic.
- A nurse is educating a patient with hepatitis B. Which statement by the patient indicates correct understanding? A. "I can donate blood six months after recovery." B. "I should avoid alcohol to prevent further liver damage." C. "Hepatitis B is spread through contaminated food or water." D. "Once I recover, I will be immune to hepatitis C." ✅ Correct Answer: B. "I should avoid alcohol to prevent further liver damage." Rationale: Alcohol worsens liver damage in hepatitis. Hepatitis B is spread through blood and body fluids, not food/water (C). Hepatitis B does not confer immunity to hepatitis C (D). Infected individuals should not donate blood (A).
- The nurse is monitoring a patient with a small bowel obstruction. Which finding requires immediate intervention? A. High-pitched bowel sounds B. Abdominal distension C. Vomiting with fecal odor D. Intermittent colicky pain
✅ Correct Answer: C. Vomiting with fecal odor Rationale: Vomiting with a fecal odor indicates complete obstruction and possible ischemia, requiring emergency intervention. Other findings (A, B, D) are common but not immediately life-threatening.
11. The nurse is caring for a patient with esophageal varices. Which
intervention should be the priority?
A. Monitor for signs of bleeding and shock B. Encourage increased fluid intake C. Administer a proton pump inhibitor (PPI) D. Assist with ambulation as tolerated ✅ Correct Answer: A. Monitor for signs of bleeding and shock Rationale: Esophageal varices can rupture, leading to life-threatening hemorrhage. The priority is to monitor for bleeding and signs of hypovolemic shock. Increased fluids (B) may worsen portal hypertension. PPIs (C) help prevent ulcers but do not treat varices. Ambulation (D) is not the primary concern.
12. A client with a history of chronic alcohol use is admitted with acute
pancreatitis. Which intervention should the nurse implement first?
14. A client with a newly created colostomy is anxious about caring for it.
Which response by the nurse is best?
A. "It’s normal to feel anxious. You’ll adapt over time." B. "Don’t worry, colostomies are easy to manage." C. "You should be independent with colostomy care in a few days." D. "I will handle your colostomy care so you don’t have to worry." ✅ Correct Answer: A. "It’s normal to feel anxious. You’ll adapt over time." Rationale: Acknowledging the patient's feelings and offering reassurance fosters emotional support. Dismissing concerns (B) or setting unrealistic expectations (C) is unhelpful. Doing everything for the patient (D) prevents self-care learning.
15. A client with suspected peritonitis reports severe abdominal pain. Which
additional finding should the nurse report immediately?
A. Absent bowel sounds B. Mild nausea and vomiting C. Fever of 100.4°F (38°C) D. Soft, non-distended abdomen
✅ Correct Answer: A. Absent bowel sounds Rationale: Peritonitis can lead to paralytic ileus, indicated by absent bowel sounds, which is an emergency. Mild nausea (B) and low-grade fever (C) are expected. A soft, non-distended abdomen (D) is not consistent with peritonitis.
16. The nurse is teaching a client with celiac disease about diet modifications.
Which food should the client avoid?
A. Rice and grilled chicken B. Baked salmon with steamed vegetables C. Whole wheat pasta with marinara sauce D. Mashed potatoes with butter ✅ Correct Answer: C. Whole wheat pasta with marinara sauce Rationale: Celiac disease requires a strict gluten-free diet, which means avoiding wheat, barley, and rye. Rice (A), salmon (B), and potatoes (D) are gluten-free and safe.
17. A client with a history of GERD is experiencing dysphagia. What
complication should the nurse suspect?
A. Hiatal hernia B. Esophageal stricture
19. The nurse is assessing a client with an upper GI bleed. Which finding is
most concerning?
A. Coffee-ground emesis B. Black, tarry stools C. Bright red blood in vomit D. Hypotension and tachycardia ✅ Correct Answer: D. Hypotension and tachycardia Rationale: Hypotension and tachycardia suggest hypovolemic shock, which is life- threatening. Coffee-ground emesis (A) and black stools (B) indicate an upper GI bleed but are not immediately life-threatening. Bright red blood (C) is concerning but does not indicate shock.
20. A client with hepatic encephalopathy is receiving lactulose. Which finding
indicates the medication is effective?
A. Decreased ascites B. Increased appetite C. Improved level of consciousness D. Normalized liver enzyme levels
✅ Correct Answer: C. Improved level of consciousness Rationale: Lactulose reduces ammonia levels, improving mental status in hepatic encephalopathy. It does not directly affect ascites (A), appetite (B), or liver enzymes (D).
