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. Which statement indicates the development of opioid tolerance?

Larger doses of opioids are needed to control pain compared to several weeks earlier.
Stimulants are needed to counteract the sedating effects of opioids.
The patient becomes anxious about knowing the exact time of the next dose of opioid.
The patient no longer experiences constipation from the usual dose of opioid.

2. When assessing a patient's cultural beliefs about pain, the pain management nurse
asks about:
a family history of pain.
home remedies used to treat pain.
the frequency of visits to health care facilities.
the patient's dietary preferences.

3. When assessing a patient for possible side effects related to acetaminophen
(Tylenol), the pain management nurse asks the patient about the use of:

4. The pain management nurse observes a male patient with complex regional pain
syndrome not wearing his right jacket sleeve. The patient reports intense, right arm pain
on light touch. The nurse recognizes this pain as:

5. A 45-year-old male patient reports pain in his foot that moves up along his calf. The
patient states, "My right foot feels like it is on fire." The patient further describes that he
has no previous history of injuries or falls, and that his pain started yesterday. Which
components of pain assessment has the patient reported?
Aggravating and alleviating factors
Exacerbation, and associated signs and symptoms
Intensity, temporal characteristics, and functional impact
Location, quality, and onset

6. A 53-year-old patient, who is receiving ibuprofen (Motrin) 400 mg, twice a day, for
chronic, low back pain, develops lower extremity edema. The pain management nurse
suspects that the edema is caused by:
a decrease in renal function.
a low creatinine level.
an increase in glomerular filtration rate.
an increase in plasma proteins.

7. A distinguishing feature of a cluster headache is that it occurs:

8. A 73-year-old male patient with cancer is in the hospital for pain control and rates his
pain as a 12 on a numeric pain rating scale of 0 to10. Thirty minutes after administering
IV pain medication, the patient reports no pain relief. The pain management nurse calls
the physician for additional orders for pain medication. The nurse's actions demonstrate:
analgesic titration.
patient advocacy.

9. Which is an accurate statement about the administration of acetaminophen (Tylenol)
to children?
Acetaminophen (Tylenol) affects platelet aggregation.
Acetaminophen (Tylenol) causes gastric irritation.
Acetaminophen (Tylenol) does not have an analgesic ceiling.
Acetaminophen (Tylenol) has an analgesic ceiling.

10. Which behavioral therapy works best to relieve pain with muscle tension and
spasms in patients who are anxious about their pain?
Stress management

11. The pain management nurse follows the recommended protocol for preventing
constipation when starting a patient on opioids by:
adding bulk fiber to the diet.
giving the patient enemas as needed.
increasing fluids and exercise.
using a bowel stimulant and stool softener.

12. A 35-year-old male patient with testicular cancer is joking and playing cards with his
roommate. When assessed by the pain management nurse, the patient rates his pain
as a 7 on a numeric pain rating scale of 0 to 10. The nurse concludes that the patient's
is an emotional reaction to the anticipated pain.
is in anticipation of future pain.
is more indicative of the need for pain medication than the pain rating.
may be in conflict with the pain rating, and accepts the report of pain.

13. An older adult patient is discharged from the hospital with nortriptyline (Pamelor) for
neuropathic pain. Which statement indicates the patient's need for additional education?
I will chew sugarless gum and mints.
I will drink carbonated beverages.
I will take my medication at breakfast.
I will use a humidifier at bedtime.

14. Which nonpharmacologic intervention is difficult to use with older adults who are
cognitively impaired?
Guided imagery
Heat application

15. An 85-year-old male patient, with a history of prostate cancer and metastasis to the
lumbar spine, is receiving methadone (Dolophine), 10 mg, 3 times a day. The patient's
wife tells the pain management nurse that her husband exhibits a lack of motivation,
loss of appetite, and an inability to get out of bed. The nurse initially focuses on the
need for antidepressants.
pain assessment.
physical therapy evaluation.
psychological evaluation.

16. Which medication is the best choice to treat breakthrough pain for a patient who is
currently receiving methadone (Dolophine), 10 mg, every 8 hours?
Methadone (Dolophine)
Immediate release morphine (MS IR)
Sustained release morphine (MS Contin)
Transdermal fentanyl (Duragesic)

17. A 75-year-old female patient comes to the oncology clinic for management of
chronic cancer pain. The patient has been prescribed morphine sulfate (MS Contin), 30
mg, every 12 hours. The patient states that she is taking the medicine only when the
pain becomes severe because of her husband's concern about addiction. The pain
management nurse responds:
It is okay to continue doing what you are doing.
The risk of developing addiction when taking opioids for pain is very low.
We need to consider other alternatives for managing your pain.
You must take the medication as prescribed, regardless of your husband's concerns.

18. The pain management nurse assesses a male patient who has complex regional
pain syndrome. The nurse is concerned about the patient's depressed mood because
he has made comments that he "can't live with this pain." The nurse further assesses
for suicide risk because:
decreased pain thresholds and suicidal thoughts are frequently seen in patients with complex
regional pain syndrome.
suicidal thoughts are common in patients with chronic pain.
suicidal thoughts are often expressed by patients with acute pain.
verbalization of suicidal thoughts is a way for patients to get attention.

19. A focused examination for fibromyalgia includes assessment for:
autonomic changes, peripheral neuropathy, and skin fold tenderness.
morning fatigue, widespread body pain, and focal tenderness.
skin rashes, edema, and constipation.
unilateral weakness, hyperesthesia, and allodynia.

20. Biofeedback is a therapy used to:
develop psycho-physiologic self-regulation.
enhance drug delivery.
increase release of serotonin.
promote neuronal regeneration.

21. The pain management nurse notices a male patient grimacing as he moves from the
bed to a chair. The patient tells the nurse that he is not experiencing any pain. The
nurse's response is to:
clarify the patient's report by reviewing the patient's nonverbal behavior.
confronting the patient's denial of pain.
obtaining an order for pain medication.
supporting the patient's stoic behavior.

22. The pain management nurse assesses a 67-year-old patient for reports of episodic,
sudden-onset, and right-sided facial pain. The patient describes the pain as fleeting,
electric-like, and triggered by light touch and brushing of the teeth. The pain
management nurse suspects:
facet syndrome.
myofascial pain syndrome.
temporomandibular disorder.
trigeminal neuralgia.

23. Which is the most effective method for teaching strengthening exercises to patients
with chronic pain?
Distributing a local listing of strengthening exercise classes
Providing demonstration and return demonstration
Providing handouts with pictures
Viewing a self-instruction video

24. When teaching a 65-year-old patient to use a pain scale, a pain management nurse
anticipates that:
additional time is needed for the patient to process the information.
older adults are unable to use pain scales reliably.
the Pain Assessment in Advanced Dementia Scale is appropriate for the patient.
the patient's family is included in the education sessions.

25. A 51-year-old female patient who has metastatic breast cancer is stabilized on
oxycodone (OxyContin) for her pain. The patient exhausts her family medical leave act,
is forced to leave her job, and, subsequently, loses her health insurance. What is the
pain management nurse's best course of action for the patient?
Encouraging the patient to cut the pain tablets in half to make them last longer
Offering information to the patient about pharmaceutical assistance programs
Preparing the patient to be weaned off of oxycodone (OxyContin)
Providing the patient with information on the nearest free clinic
Question 1
The correct answer is Larger doses of opioids are needed to control pain compared to several weeks
Question 2
The correct answer is home remedies used to treat pain..
Question 3
The correct answer is alcohol..
Question 4
The correct answer is allodynia..
Question 6
The correct answer is a decrease in renal function..
Question 7
The correct answer is unilaterally..
Question 9
The correct answer is Acetaminophen (Tylenol) has an analgesic ceiling..
Question 10
The correct answer is Relaxation.
Question 12
The correct answer is may be in conflict with the pain rating, and accepts the report of pain..
Question 13
The correct answer is I will take my medication at breakfast..
Question 14
The correct answer is Guided imagery.
Question 15
The correct answer is pain assessment..
Question 16
The correct answer is Immediate release morphine (MS IR).
Question 17
The correct answer is The risk of developing addiction when taking opioids for pain is very low..
Question 19
The correct answer is morning fatigue, widespread body pain, and focal tenderness..
Question 20
The correct answer is develop psycho-physiologic self-regulation..
Question 22
The correct answer is trigeminal neuralgia..
Question 23
The correct answer is Providing demonstration and return demonstration.
Question 24
The correct answer is additional time is needed for the patient to process the information..
Which of the following is most important when
assessing a client's pain?
Your Answer: The client's perception of the

Objective: Identify subjective
and objective data to collect and
analyze when assessing pain.

Rationale: Pain is whatever the
client perceives it is. The physical
location of the pain, the client's
vital signs, and the client's
appearing uncomfortable are
objective rather than subjective

Nursing Process: Assessment

Client Need: Psychosocial

Cognitive Level: Analysis

Strategy: Use nursing knowledge
and the process of elimination to
make a selection.

When asked about pain, a client
complains of having severe
discomfort from arthritis. Vital
signs are unchanged, and the
client is calmly watching
television. Which of the following
nursing diagnoses is most
Your Answer: Acute pain

Correct Answer: Chronic pain

Objective: Identify examples of
nursing diagnoses for clients with

Rationale: Clients with chronic
pain often live with their pain and
show no outward signs. Clients
with acute pain are more likely to
show outward signs of pain.
Those with chronic pain may not
exhibit any overt signs, even
when they experience severe

Nursing Process: Assessment

Client Need: Psychosocial

Cognitive Level: Analysis

Strategy: Use nursing knowledge
and the process of elimination to
make a selection

A client with an acute bowel
obstruction is having ischemic
abdominal pain. This type of pain
is best described as:
Your Answer: Intractable

Correct Answer: Visceral

Objective: Identify examples of
nursing diagnoses for clients with

Rationale: Visceral best
describes the client with an acute
bowel obstruction having ischemic
abdominal pain. Somatic is
generalized body
pain. Intractable is pain that
cannot be relieved. Cutaneous is
superficial pain.

Nursing Process: Assessment

Client Need: Physiological

Cognitive Level: Analysis

Strategy: Use nursing knowledge
and the process of elimination to
make a selection.

A postoperative client is
prescribed acetaminophen
(Tylenol) with codeine at
discharge. When performing
discharge teaching, the nurse:
Your Answer: Warns of
signs of

Correct Answer: Recommends
that the client
take milk of
magnesia at

Objective: Individualize a pain
treatment plan based on clinical
and personal goals, while setting
objective outcome criteria by
which to evaluate a client's
response to interventions for

Rationale: Short-term use of
codeine is not addicting. The
client is instructed to take the
medication as often as prescribed
for pain. As the patient recovers,
this will gradually decrease. There
is no validity to the statement in
Answer 3. Milk of Magnesia will
prevent stomach discomfort, a
common side effect of

Process: Implementation

Client Need: Physiological

Cognitive Level: Application

Strategy: Use nursing knowledge
and the process of elimination to
make a selection

While waiting to perform x-rays
on an injured right hand
according to nonpharmacological
pain management practice, pain
can be modulated or reduced if
the nurse:
Your Answer: Turns off the
light and
shuts the

Correct Answer: Applies ice to
the right

Objective: Individualize a pain
treatment plan based on clinical
and personal goals, while setting
objective outcome criteria by
which to evaluate a client's
response to interventions for

Rationale: Applying ice to the
right elbow can help reduce pain.
Frequent assessment is
important, but does not reduce
pain. Answers 2 and 4 are not
considered nonpharmacological
pain management practices.

Process: Implementation

Client Need: Physiological

Cognitive Level: Application

Strategy: Use nursing knowledge
and the process of elimination to
make a selection

An 8-year-old client is crying with
pain after a tonsillectomy. Which
nursing intervention is most
appropriate for this client?
Your Answer: Tell him he is
too big to cry.

Correct Answer: Hold him and

Objective: Individualize a pain
treatment plan based on clinical
and personal goals, while setting
objective outcome criteria by
which to evaluate a client's
response to interventions for

Rationale: Holding and
comforting the client while in pain
is most appropriate. Children
often regress in behavior when ill
or in pain. Punishing, rewarding,
or humiliating the child is not
appropriate. Crying is an
appropriate response to pain.

Process: Implementation

Client Need: Health Promotion
and Maintenance

Cognitive Level: Application

Strategy: Decide what is the best
action for client and situation

Patient-controlled analgesia (PCA)
effectiveness is evaluated by:
Your Answer: When the
client is

Correct Answer: The client's
indicating that
pain is a 1 on
a scale of 1 to

Objective: Identify risks and
benefits of various analgesic
delivery routes and analgesic
delivery technologies.

Rationale: PCA is evaluated by
the client indicates that pain is a
1 on a scale of 1 to 10. Answer 1
is a preset safety interval set by
the physician to prevent
overdose. Many factors determine
the size of the loading dose,
including size of the patient,
amount of medication already
received, and degree of sedation.
Clients in pain may still sleep.

Nursing Process: Evaluation

Client Need: Physiological

Cognitive Level: Analysis

Strategy: Use nursing knowledge
and the process of elimination to
make a selection.

Severe cancer pain is most
effectively treated with analgesics
Your Answer: Sparingly, to
avoid side

Correct Answer: Around the
clock, with
extra doses
available as

Objective: Give an example of
rational polypharmacy described
by the American Pain Society.

Rationale: Analgesics can be
given around the clock as needed.
A bolus may occasionally be
needed for a flare-up of pain. Pain
is better controlled if analgesia is
given before pain returns.
Analgesics are not limited in
severe cancer pain.

Process: Implementation

Client Need: Physiological

Cognitive Level: Application

Strategy: Use nursing knowledge
and the process of elimination to
make a selection.

Both clients and nurses have
misconceptions about pain. Which
statement reflects a
Your Answer: People can
adapt to
severe pain.

Correct Answer: Regular
of analgesics
leads to

Objective: Differentiate
tolerance, dependence, and

Rationale: All of the answers are
true statements except for
Answer 4. The common misbelief
that analgesics lead to addiction
often prevents clients from
receiving the best control of pain
as possible.

Nursing Process: Assessment

Client Need: Safe, Effective Care

Cognitive Level: Analysis

Strategy: Use nursing knowledge
and the process of elimination to
make a selection.

Following surgery, a client has
great difficulty getting out of bed,
walking, and coughing and deep
breathing. Although patient-
controlled analgesia (PCA) is in
place, it is rarely used, even when
suggested by the nurse. This
concerns the nurse. Which
statement is the best way to
address this concern with the
Your Answer: "I noticed you
haven't used your
pain medication
as often as you
could, even
though it is
painful for you to
get out of bed
and to walk.
Many people are
reluctant to take
pain medication.
Tell me what
makes you

Objective: Identify risks and
benefits of various analgesic
delivery routes and analgesic
delivery technologies.
One of the effects created by activation or increased release of substance P is
(A) vasoconstriction.
(B) membrane stabilization.
(C) analgesia.
(D) vasodilation.

2. A 23-year-old female patient, who was recently discharged from the hospital following open
reduction and internal fixation of a fractured femur, suddenly develops severe chest pain. Which of
the following medications in her history would seem to be implicated in the etiology of her pain?
(A) Oral contraceptives
(B) Nonsteroidal anti-inflammatory agents
(C) Opioid analgesics
(D) Benzodiazepines

3. Patients who present with fever and pain of recent onset over the neck, upper back, chest, and
upper limbs should be assessed for the possibility of abscess in the
(A) cervical epidural space.
(B) posterior nasopharynx.
(C) subdiaphragmatic space.
(D) T 7-8 disk space.

4. Disability due to chronic pain is felt to be primarily related to the
(A) number of somatic sites in which pain exists.
(B) reinforcement of pain behaviors.
(C) presence of a life-threatening disease.
(D) presence of neuropathic, as opposed to muscular, pain causes.

5. Further testing with CT scan or MRI is mandatory
in headaches accompanied by all of the following EXCEPT
(A) prolonged long-term, unchanging band-like headaches.
(B) hemiparesis and contralateral sensory deficit.
(C) the appearance of seizures.
(D) olfactory hallucinations.

6. Referral to a multidisciplinary pain center is usually most appropriate when patients demonstrate
evidence of
(A) purely psychiatric mechanisms.
(B) purely neuropathic mechanisms.
(C) both psychological tension and physical muscle tension.
(D) both somatic and psychological factors.

7. Which tricyclic antidepressant is most appropriate for treatment of pain in an 80-year-old male
with postherpetic neuralgia and urinary retention?
(A) Amitriptyline (Elavil)
(B) Doxepin (Sinequan)
(C) Desipramine (Norpramin)
(D) Imipramine (Tofranil)

8. In disability determination under most workers' compensation systems, the presence of pain is
(A) more attention than the underlying physical impairment.
(B) as much attention as the underlying physical impairment.
(C) less attention than the underlying physical
(D) no attention whatsoever.

9. Which of the following is true regarding the use of antidepressants to reduce chronic pain?
(A) Only tertiary amine tricyclics are effective.
(B) Serotonergic agents are not clearly superior to noradrenergic ones.
(C) Serotonin potentiation is a necessary characteristic of effective agents.
(D) Only noradrenergic agents are effective.

10. DREZ lesions have been documented to provide long-term pain relief in
(A) cervical root avulsion.
(B) sciatica.
(C) diabetic neuropathy.
(D) thalamic pain syndrome.

11. A 52-year-old patient presents with a history of acute low back pain, without trauma, which is
unrelieved by bed rest and is associated with paroxysms of pain and an elevated erythrocyte
sedimentation rate. Radiographs of the spine reveal an absent pedicle. The most likely diagnosis is
(A) lupus erythematosus.
(B) multiple myeloma.
(C) metastatic lesion.
(D) disc space infection.

12. Which of the following is true regarding patients with cluster headaches?
(A) They are more likely to be female.
(B) They are likely to lie in a quiet, dark room with an ice pack over the affected temple during an
(C) They are usually nonsmokers and nondrinkers.
(D) They are known to attempt suicide secondary to their pain.

13. Which of the following is true of the physical or sensory component of pain perception?
(A) It is less variable than the anxiety produced by the pain.
(B) It is more variable than the anxiety produced by the pain.
(C) It is generally equal to the anxiety produced by the pain.
(D) It is reduced in patients with hypochondriasis.

14. A patient who has been taking high doses of benzodiazepines and opioids experiences
withdrawal symptoms during detoxification. Which of the following specifically indicates that the
opioid is being tapered too rapidly?
(A) Hyperreflexia
(B) Diaphoresis
(C) Hyperactive bowel sounds
(D) Tachycardia

15. The depression commonly seen in those with chronic pain of nonmalignant origin differs from the
most typical major depressions in that in the former there is likely to be
(A) anhedonia.
(B) weight gain.
(C) guilty ruminations.
(D) insomnia.

16. All of the following are true of migraine headache EXCEPT
(A) Aura (prodrome) is not present in common migraine.
(B) The neurologic symptoms of classic migraine may persist beyond the headache phase.
(C) Ergotamine (Ergostat) is effective in treating acute attacks when used daily for 7-14 days.
(D) 70% of migraine patients have a positive family migraine history.

17. The essential feature of pain that can be used to differentiate it from other somatic sensations is
(A) intensity.
(B) threshold.
(C) chronicity.
(D) unpleasantness.

18. Aching pain in the suprapubic region is most likely caused by abnormalities of the
(A) ureter.
(B) prostate.
(C) coccyx.
(D) sacroiliac joints.
Answer Key:
1. D, 2. A, 3. A, 4. B, 5. A, 6. D, 7. C, 8. C, 9. B, 10. A, 11. C, 12. D, 13. A, 14. C, 15. B, 16. C, 17. D,
18. B

An elderly client is being treated with a fentanyl
transdermal patch for moderate pain. The nurse
advised this client to:
Your Answer: Change the patch site
every 2 hours for the first
48 hours.

Correct Answers: Expect pain relief within 1
hour of application.

Take another oral pain
medication for 24 hours.

Rationale: Fentanyl patches are
replaced every three days, so
answer 1 is incorrect. Answer 2 is
not a good choice because the
peak effect form fentanyl patches
is about 24 hours after the first
application, so the pain needs to
be "covered" by other medications
until the fentanyl reaches its
peak. At this point, other pain
medications should be
discontinued. Persons using a
transdermal patch may shower,
but they should not use soap over
the area of the patch.
Integrated Process: Nursing
Process; Implementation
Cognitive Level: Application
NCLEX-RN Test Plan: Physiological

Pain often is undertreated in the
elderly. What is the rationale
given most often by healthcare
providers for that
Your Answer: Pain is an

Correct Answers: Pain is
merely the
absence of

Pain is

hard to
its quality.

Rationale: For any individual, pain
is what the client says it is.
Answers 1 and 2 are incorrect
because the intensity, quality, and
duration are hard to communicate
effectively for anyone. The last
response is wrong because the
nurse should accept the client's
description of her pain and
respond appropriately.

The safest narcotic choice for an
elderly client with acute pain is:
Your Answer: Oxycodone.

Correct Answer: Morphine

Rationale: Morphine is the "gold
standard" of narcotics for acute
pain. The other choices are
Integrated Process: Nursing
Process; Evaluation
Cognitive Level: Analysis
NCLEX-RN Test Plan: Physiological

An elderly client had abdominal
surgery six hours earlier. When
the nurse asks the client about
pain, the client responds that
there is none. The best
intervention on the part of the
nurse is:
Your Answer: Administer a
PRN dose of
IV pain
medication as

Correct Answer: Question the
client further
discomfort to

assess the
meaning of

Rationale: Answer 3 is correct,
because a denial of pain does not
mean the client is not
experiencing any pain. The client
might have a different meaning
for the term "pain," so the nurse
should explore the situation using
a variety of terms, like
"discomfort" or "aching." Without
a careful assessment, the first
response is inappropriate, and a
postoperative patient who had
abdominal surgery six hours
previously will require medication
in preparation for ambulation.
While assessing the abdominal
dressing is important, unless
there are indications of
complications, the surgeon would
not need to be notified.
Integrated Process: Nursing
Process; Implementation
Cognitive Level: Application
NCLEX-RN Test Plan: Physiological

A resident of the nursing home
has quite severe arthritis. When
administering an analgesic to this
elderly resident, the nurse should:
Your Answer: Make sure
that the
medication is
not a narcotic.

Correct Answer: Give the
before the
session in the
day room.

Rationale: Answer 1 is the correct
response, because when an elder
has chronic pain, as from arthritis,
the analgesic should be given
before an increase in activity that
might aggravate the pain. Answer
2 is incorrect because the goal is
to prevent a higher level of pain.
Narcotics might be appropriate
medication for chronic pain of
Integrated Process: Nursing
Process; Implementation
Cognitive Level: Application
NCLEX-RN Test Plan: Physiological

Two days after surgery, an elderly
client refuses a PRN dose of
analgesic dose for fear of
becoming "hooked." The nurse
should respond by stating that:
Your Answer: Side effects
that occur in
the elderly
mean that
will be
as soon as

Correct Answer: Short-term
use of
narcotics is
not likely to
cause a
person to
dependent on

Rationale: When clients are
experiencing pain that is likely to
be limited in duration, the
decreasing frequency of
administration of medications
means that dependence is not
likely. Answers 1, 3, and 4 are
incorrect statements.
Integrated Process: Nursing
Process: Implementation
Cognitive Level: Application
NCLEX-RN Test Plan: Physiological

When assessing for pain in an
elderly nursing home resident
who has dementia, the nurse
Your Answer: Know that
only family
could reliably
point out pain
in their loved

Correct Answer: Look for signs
of increased
agitation or

Rationale: Answer 2 is correct,
because pain can adversely affect
all body systems of the elderly,
and the nurse needs to carefully
assess all residents with
dementia, especially those who
are nonverbal, for changes in
behavior, because they frequently
are indicators of pain. While
family members can point out
pain in their loved ones reliably,
they are not always present.
Incontinence can occur with acute
pain but is not a typical sign.
Integrated Process: Nursing
Process; Analysis
Cognitive Level: Analysis
NCLEX-RN Test Plan: Physiological

When administering IV analgesics
to the elderly, the nurse should
Your Answer: To "start low and
go slow."

Rationale: As people age, their
response to many medications is
altered. For this reason, the
elderly have higher peak levels
and longer duration of action from
IV analgesics, so dosing is
initiated at lower levels and
titrated upwards slowly. Answers
2 and 3 are incorrect. Answer 4 is
not a correct response because a
"more thorough" assessment
would be important after the
medication is administered.
Integrated Process: Nursing
Process; Implementation
Cognitive Level: Application
NCLEX-RN Test Plan: Physiological

interventions for pain that the
nurse might employ for an elderly
client with osteoporosis would
Your Answer: Evening back

Rationale: Many non-
pharmacological interventions,
such as a back rub, can be
effective in reducing pain. This is
the only response listed that
includes an intervention that
focuses on pain relief. A support
group would offer education and
emotional support. Answers 3 and
4 offer suggestions that could be
used as part of the treatment
designed to interrupt the disease
Integrated Process: Nursing
Process; Implementation
Cognitive Level: Application
NCLEX-RN Test Plan: Physiological

When an elderly client with cancer
experiences "breakthrough pain,"
the nurse should expect that
pharmacological treatment will
Your Answer: Increasing the
dose of the

1. A chronic pain client reports to you, the charge nurse, that the nurse have not been
responding to requests for pain medication. What is your initial action?
a. Check the MARs and nurses notes for the past several days.
b. Ask the nurse educator to give an in-service about pain management.
c. Perform a complete pain assessment and history on the client.
d. Have a conference with the nurses responsible for the care of this client
2. Family members are encouraging your client to tough it out rather than run the risk of
becoming addicted to narcotics. The client is stoically abiding by the familys wishes. Priority
nursing interventions for this client should target which dimension of pain?
a. Sensory
b. Affective
c. Sociocultural
d. Behavioral
e. Cognitive
3. A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities
that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant
medication for this type of pain?
a. Amitriptyline (Elavil)
b. Corticosteroids
c. Methylphenidate (Ritalin)
d. Lorazepam (Ativan)
4. Which client is most likely to receive opioids for extended periods of time?
a. A client with fibrolyalgia
b. A client with phantom limb pain
c. A client with progressive pancreatic cancer
d. A client with trigeminal neuralgia
5. As the charge nurse, you are reviewing the charts of clients who were assigned to a newly
graduated RN. The RN has correctly charted dose and time of medication, but there is no
documentation regarding non-pharmaceutical measures. What action should you take first?
a. Make a note in the nurses file and continue to observe clinical performance
b. Refer the new nurse to the in-service education department.
c. Quiz the nurse about knowledge of pain management
d. Give praise for the correct dose and time and discuss the deficits in charting.
6. In caring for a young child with pain, which assessment tool is the most useful?
a. Simple description pain intensity scale
b. 0-10 numeric pain scale
c. Faces pain-rating scale
d. McGill-Melzack pain questionnaire
7. In applying the principles of pain treatment, what is the first consideration?
a. Treatment is based on client goals.
b. A multidisciplinary approach is needed.
c. The client must be believed about perceptions of own pain.
d. Drug side effects must be prevented and managed.
8. Which route of administration is preferred if immediate analgesia and rapid titration are
a. Intraspinal
b. Patient-controlled analgesia (PCA)
c. Intravenous (IV)
d. Sublingual
9. When titrating an analgesic to manage pain, what is the priority goal?
a. Administer smallest dose that provides relief with the fewest side effects.
b. Titrate upward until the client is pain free.
c. Titrate downwards to prevent toxicity.
d. Ensure that the drug is adequate to meet the clients subjective needs.
10. In educating clients about non-pharmaceutical alternatives, which topic could you delegate
to an experienced LPN/LVN, who will function under your continued support and supervision?
a. Therapeutic touch
b. Use of heat and cold applications
c. Meditation
d. Transcutaneous electrical nerve stimulation (TENS)
11. Place the examples of drugs in the order of usage according to the World Health
Organization (WHO) analgesic ladder.
a. Morphine, hydromorphone, acetaminophen and lorazepam
b. NSAIDs and corticosteroids
c. Codeine, oxycodone and diphenhydramine
_b____, __c___, __a___
12. Which client is at greater risk for respiratory depression while receiving opioids for
a. An elderly chronic pain client with a hip fracture
b. A client with a heroin addiction and back pain
c. A young female client with advanced multiple myeloma
d. A child with an arm fracture and cystic fibrosis
13. A client appears upset and tearful, but denies pain and refuses pain medication, because
my sibling is a drug addict and has ruined out lives. What is the priority intervention for this
a. Encourage expression of fears on past experiences
b. Provide accurate information about use of pain medication
c. Explain that addiction is unlikely among acute care clients.
d. Seek family assistance in resolving this problem.
14. A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What
is one of the first signs of withdrawal?
a. Fever
b. Nausea
c. Diaphoresis
d. Abdominal cramps
15. In caring for clients with pain and discomfort, which task is most appropriate to delegate to
the nursing assistant?
a. Assist the client with preparation of a sitz bath.
b. Monitor the client for signs of discomfort while ambulating
c. Coach the client to deep breathe during painful procedures
d. Evaluate relief after applying a cold application.
16. The physician has ordered a placebo for a chronic pain client. You are newly hired nurse
and you feel very uncomfortable administering the medication. What is the first action that you
should take?
a. Prepare the medication and hand it to the physician
b. Check the hospital policy regarding use of the placebo.
c. Follow a personal code of ethics and refuse to give it.
d. Contact the charge nurse for advice.
17. For a cognitively impaired client who cannot accurately report pain, what is the first action
that you should take?
a. Closely assess for nonverbal signs such as grimacing or rocking.
b. Obtain baseline behavioral indicators from family members.
c. Look at the MAR and chart, to note the time of the last dose and response.
d. Give the maximum PRS dose within the minimum time frame for relief.
18. Which route of administration is preferable for administration of daily analgesics (if all
body systems are functional)?
a. IV
b. IM or subcutaneous
c. Oral
d. Transdermal
e. PCA
19. A first day post-operative client on a PCA pump reports that the pain control is inadequate.
What is the first action you should take?
a. Deliver the bolus dose per standing order.
b. Contact the physician to increase the dose.
c. Try non-pharmacological comfort measures.
d. Assess the pain for location, quality, and intensity.
20. Which non-pharmacological measure is particularly useful for a client with acute
a. Diversional therapy, such as playing cards or board games
b. Massage of back and neck with warmed lotion
c. Side-lying position with knees to chest and pillow against abdomen
d. Transcutaneous electrical nerve stimulation (TENS)
21. What is the best way to schedule medication for a client with constant pain?
a. PRN at the clients request
b. Prior to painful procedures
c. IV bolus after pain assessment
d. Around-the-clock
22. Which client(s) are appropriate to assign to the LPN/LVN, who will function under the
supervision of the RN or team leader? (Choose all that apply.)
a. A client who needs pre-op teaching for use of a PCA pump
b. A client with a leg cast who needs neurologic checks and PRN hydrocodone
c. A client post-op toe amputation with diabetic neuropathic pain
d. A client with terminal cancer and severe pain who is refusing medication
23. For a client who is taking aspirin, which laboratory value should be reported to the
a. Potassium 3.6 mEq/L
b. Hematocrit 41%
c. PT 14 seconds
d. BUN 20 mg/dL
24. Which client(s) would be appropriate to assign to a newly graduated RN, who has recently
completed orientation? (Choose all that apply.)
a. An anxious, chronic pain client who frequently uses the call button
b. A client second day post-op who needs pain medication prior to dressing changes
c. A client with HIV who reports headache and abdominal and pleuritic chest pain
d. A client who is being discharged with a surgically implanted catheter
25. A family member asks you, Why cant you give more medicine? He is still having a lot of
pain. What is your best response?
a. The doctor ordered the medicine to be given every 4 hours.
b. If the medication is given too frequently he could suffer ill effects.
c. Please tell him that I will be right there to check of him.
d. Lets wait about 30-40 minutes. If there is no relief Ill call the doctor.
Answers and Rationale
Here are the answers and rationale for this exam. Counter check your answers to those below and tell
us your scores. If you have any disputes or need more clarification to a certain question, please direct
them to the comments section.
1. Answer: D As charge nurse, you must assess for the performance and attitude of the staff in
relation to this client. After gathering data from the nurses, additional information from the records
and the client can be obtained as necessary. The educator may be of assistance if knowledge deficit
or need for performance improvement is the problem.
2. Answer: C The family is part of the sociocultural dimension of pain. They are influencing the
client should be included in the teaching sessions about the appropriate use of narcotics and about the
adverse effects of pain on the healing process. The other dimensions should be included to help the
client/family understand overall treatment plan and pain mechanism
3. Answer: A Antidepressants such as amitriptyline can be given for diabetic neuropathy.
Corticosteroids are for pain associated with inflammation. Methylphenidate is given to counteract
sedation if the client is on opioids. Lorazepam is an anxiolytic.
4. Answer: C Cancer pain generally worsens with disease progression and the use of opioids is
more generous. Fibromyalgia is more likely to be treated with non-opiod and adjuvant medicatios.
Trigeminal neuralgia is treated with anti-seizure medications such as carbamezapine (Tegretol).
Phantom limb pain usually subsides after ambulation begins.
5. Answer: D In supervising the new RN, good performance should be reinforced first and then
areas of improvement can be addressed. Asking the nurse about knowledge of pain management is
also an option; however, it would be a more indirect and time-consuming approach. Making an ote
and watching do not help the nurse to correct the immediate problem. In-service might be considered
if the problem persists.
6. Answer: C The Faces pain rating scale (depicting smiling, neutral, frowning, crying, etc.) is
appropriate for young children who may have difficulty describing pain or understanding the
correlation of pain to numerical or verbal descriptors. The other tools require abstract reasoning
abilities to make analogies and use of advanced vocabulary.
7. Answer: C The client must be believed and his or her experience of pain must be acknowledged
as valid. The data gathered via client reports can then be applied to other options in developing the
treatment plan.
8. Answer: C the IV route is preferred as the fastest and most amenable to titration. A PCA bolus
can be delivered; however, the pump will limit the dosage that can be delivered unless the parameters
are changed. Intraspinal administration requires special catheter placement and there are more
potential complications with this route. Sublingual is reasonably fast, but not a good route for
titration, medication variety in this form is limited.
9. Answer: A the goal is to control pain while minimizing side effects. For severe pain, the
medication can be titrated upward until pain is controlled. Downward titration occurs when the pain
begins to subside. Adequate dosing is important; however, the concept of controlled dosing applies
more to potent vasoactive drugs.
10. Answer: B Use of heat and cold applications is a standard therapy with guidelines for safe use
and predictable outcomes, and an LPN/LVN will be implementing this therapy in the hospital, under
the supervision of an RN. Therapeutic touch requires additional training and practice. Meditation is
not acceptable to all clients and an assessment of spiritual beliefs should be conducted.
Transcutaneous electrical stimulation is usually applied by a physical
11. Answer: B, C, A Step 1 includes non-opioids and adjuvant drugs. Step 2 includes opioids for
mild pain plus Step 1 drugs and adjuvant drugs as needed. Step 3 includes opioids for severe pain
(replacing Step 2 opioids) and continuing Step 1 drugs and adjuvant drugs as needed.
12. Answer: D at greatest risk are elderly clients, opiate nave clients, and those with underlying
pulmonary disease. The child has two of the three risk factors.
13. Answer: A This client has strong beliefs and emotions related to the issue of sibling addiction.
First, encourage expression. This indicated to the client that the feelings are real and valid. It is also
an opportunity to assess beliefs and fears. Giving facts and information is appropriate at the right
time. Family involvement is important, bearing in mind that their beliefs about drug addiction may be
similar to those of the client.
14. Answer: C Diaphoresis is one of the early signs that occur between 6 and 12 hours. Fever,
nausea, and abdominal cramps are late signs that occur between 48 and 72 hours.
15. Answer: A The nursing assistant is able to assist the client with hygiene issues and knows the
principles of safety and comfort for this procedure. Monitoring the client, teaching techniques, and
evaluating outcomes are nursing responsibilities.
16. Answer: D the charge nurse is a resource person who can help locate and review the policy. If
the physician is insistent, he or she could give the placebo personally, but delaying the administration
does not endanger the health or safety of the client. While following ones own ethical code is
correct, you must ensure that the client is not abandoned and that care continues.
17. Answer: B Complete information from the family should be obtained during the initial
comprehensive history and assessment. If this information is not obtained, the nursing staff will have
to rely on observation of nonverbal behavior and careful documentation to determine pain and relief
18. Answer: C If the gastrointestinal system is function, the oral route is preferred for routine
analgesics because of lower cost and ease of administration. Oral route is also less painful and less
invasive than the IV, IM, subcutaneous, or PCA routes. Transdermal route is slower and medication
availability is limited compared to oral forms.
19. Answer: D Assess the pain for changes in location, quality, and intensity, as well as changes in
response to medication. This assessment will guide the next steps.
20. Answer: C The side-lying, knee-chest position opens retroperitoneal space and provides relief.
The pillow provides a splinting action. Diversional therapy is not the best choice for acute pain,
especially if the activity requires concentration. TENS is more appropriate for chronic muscular pain.
The additional stimulation of massage may be distressing to the client.
21. Answer: D IF the pain is constant, the best schedule is around-the-clock, to provide steady
analgesia and pain control. The other options may actually require higher doses to achieve control
22. Answer: B, C The clients with the cast and the toe amputation are stable clients and need
ongoing assessment and pain management that are within the scope of practice for an LPN/LVN
under the supervision of an RN. The RN should take responsibility for pre-operative teaching, and
the terminal cancer needs a comprehensive assessment to determine the reason for refusal of
23. Answer: C When a client takes aspirin, monitor for increases in PT (normal range 11.0-12.5
seconds in 85%-100%). Also monitor for possible decreases in potassium (normal range 3.5-5.0
mEq/L). If bleeding signs are noted, hematocrit should be monitored (normal range male 42%-52%,
female 37%-47%). An elevated BUN could be seen if the client is having chronic gastrointestinal
bleeding (normal range 10-20 mg/dL).
24. Answer: B A second day post-operative client who needs medication prior to dressing changes
has predictable and routine care that a new nurse can manage. Although chronic pain clients can be
relatively stable, the interaction with this client will be time consuming and may cause the new nurse
to fall behind. The HIV client has complex complaints that require expert assessment skills. The
client pending discharge will need special and detailed instructions.
25. Answer: C directly ask the client about the pain and do a complete pain assessment. This
information will determine which action to take next.

1. The teaching plan for an individual receiving transcutaneous electrical nerve stimulation (TENS)
should include the information that:
a- the client can adjust both voltage and pulsation.
b- one electrode only is used over the painful site.
c- this therapy is useful for very few clients.
d- the electrode wires should be visible to detect early problems.
1. ANS: a
Voltage and pulsation are controlled by the person wearing the device. Positive and negative poles
(electrodes) are placed within several inches of each other. TENS has been shown to relieve pain
effectively in many people.
2. A patient with cancer-related pain and a history of opioid abuse complains of breakthrough pain 2
hours before the next dose of sustained-release morphine sulfate(MS Contin) is due. Which action should
the nurse take first?
a- Suggest the use of alternative therapies such as heat or cold.
b- Administer the prescribed PRN immediate-acting morphine
c- Utilize distraction by talking about things the patient enjoys.
d- Consult with the doctor about increasing the MS Contin dose.
2. ANS: b
The patients pain requires rapid treatment and the nurse should administer the immediate-acting
morphine. Increasing the MS Contin dose and use of alternative therapies also may be needed, but the
initial action should be to use the prescribed analgesic medications.
3. The nurse caring for a client with suspected appendicitis knows that the pain associated with
appendicitis is
a- cutaneous pain.
b- visceral pain.
c- superficial pain.
d-somatic pain.
ANS: b
Visceral pain originates from body organs, or viscera, and often includes pain caused by acute
appendicitis, cholecystitis, inflammation of the biliary and hepatic tract, gastroduodenal disease,
cardiovascular disease, pleurisy, and renal and ureteral colic. Somatic pain is from ligaments, tendons,
bones, blood vessels, and nerves. It is often poorly localized, may produce nausea, and may be
associated with sweating and blood pressure changes. Cutaneous pain would arise from the skin
structures. Superficial pain is not a defining designation.
4.The most effective way for the nurse to administer pain medication to a client who is experiencing
severe pain related to metastatic liver cancer is to
a- administer medication only when other methods of pain relief are ineffective.
b- respond promptly to as-needed (prn) pain requests.
c- dispense pain medications on a regular basis.
d- give only intravenous pain medications.
ANS: c
Patients experiencing pain caused by widespread cancer require routine pain-relieving medication in
order to function, often at higher doses.

5. In providing care to a client with chronic pain, which of the following characteristics or client responses
should the nurse expect?
a- Heart rate, blood pressure, and pulse rate may be normal while the client is experiencing pain.
b- Opioid-based analgesics may have little if any effect on reducing the quality of chronic pain.
c- The client may have adapted so successfully to the presence of chronic pain that measures for relief
are unnecessary.
d- The actual intensity of chronic pain is difficult to assess because the client may complain constantly
ANS: a
Adaptation to the presence of chronic pain is physiologic. Thus, the usual alterations in physiologic
parameters when acute pain is present do not accompany chronic pain.

6. A patient who uses a fentanyl (Duragesic) patch for chronic cancer pain complains to the nurse of the
rapid onset of pain at a level 9 (0 to 10 scale) and requests something for pain that will work quickly.
The nurse will document this as
a. somatic pain.
b. referred pain.
c. breakthrough pain.
d. neuropathic pain.
ANS: c
Pain that occurs beyond the chronic pain already being treated by appropriate analgesics is termed
breakthrough pain. Neuropathic pain is caused by damage to peripheral nerves or the central nervous
system (CNS). Somatic pain is localized and arises from bone, joint, muscle, skin, or connective tissue.
Referred pain is pain that is localized in uninjured tissue.
7- A postoperative client that recently returned from surgery has a morphine PCA pump. The basal rate is
ordered to be 1 mg/hour and the patient can have a 1-mg bolus every 15 minutes. When the nurse
assesses the client, the nurse finds the client stuporous, hard to arouse, with a respiratory rate of 6
breaths/minute. After successfully treating the client, which action by the nurse takes priority? The nurse
a- request the physician order different basal and bolus rates.
b- question the client about how he/she has been using the button on the pump.
c- check the IV pump to ensure the basal rate is set correctly.
d- Ask the physician to discontinue the PCA pump and revert to prn opioids for pain.
ANS: c
The patient exhibited manifestations of opioid toxicity. The ordered dose was well within a safe range for
a postoperative client. On a PCA pump, the demand feature has a lock-out device limiting the amount of
opioid the client can administer. This could have been set incorrectly, allowing the client to overdose
him/herself; however, a sleepy postoperative client often cannot use the demand feature without
reminders. This leaves the basal rate as the most likely source of error and the nurse should check to see
that it was set correctly. Giving prn pain medications often results in undertreatment of pain and should
not be used on a postoperative client. If the pump was set incorrectly, there is no need to adjust the rates.
Questioning the client and re-educating him/her if needed are always appropriate, but it is not the priority
since the pump most likely was set incorrectly.
8- Which physiologic or behavioral manifestation is more commonly associated with acute pain rather
than chronic pain?
a- Reduced tendency to touch or move the affected area
b- Psychosocial withdrawal
c- Inability to concentrate
d-Dry skin and moist oral mucous membranes
ANS: c
The characteristic most common to chronic pain is psychosocial withdrawal. Dry skin and moist mucous
membranes indicate an absence of or physiologic adaptation to the stress response associated with
chronic pain. Clients experiencing either acute or chronic pain tend to protect the painful area. The
inability to concentrate is associated much more with acute pain before any physiologic or behavioral
adaptation has occurred.

9- The nurse instructs the client taking ibuprofen that the drug is effective for pain relief because it acts to
a- slow painful stimuli through type A-delta pain fibers.
b- reduce inflammation and block prostaglandins.c- interrupt the transmission of pain impulses.
d- interfere with the relay of pain information through the dorsal horn.
ANS: b
The site of action of nonsteroidal anti-inflammatory drugs (NSAIDs) is primarily the periphery at the
receptor site, where NSAIDs serve an anti-inflammatory function and prevent the production of

10- When caring for a patient who is receiving epidural morphine, which information obtained by the
nurse indicates that the patient may be experiencing a side effect of the medication?
d. The patient complains of a pounding headache.
c. The patient has not voided for over 10 hours.
b. The patient becomes restless and agitated.
a. The patient has cramping abdominal pain.
ANS: b
Urinary retention is a common side effect of epidural opioids. Headache is not an anticipated side effect
of morphine, although if there is a cerebrospinal fluid leak, the patient may develop a spinal headache.
Sedation (rather than restlessness or agitation) would be a possible side effect. Hypotonic bowel sounds
and constipation (rather than abdominal cramping) are concerns.

1. A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor
the patients blood pressure because of which change that is associated with the
liver failure?
1. Hypoalbuminemia
2. Increased capillary permeability
3. Abnormal peripheral vasodilation
4. Excess rennin release from the kidneys
2. Youre assessing the stoma of a patient with a healthy, well-healed colostomy. You
expect the stoma to appear:
1. Pale, pink and moist
2. Red and moist
3. Dark or purple colored
4. Dry and black
3. Youre caring for a patient with a sigmoid colostomy. The stool from this colostomy is:
1. Formed
2. Semisolid
3. Semiliquid
4. Watery
4. Youre advising a 21 y.o. with a colostomy who reports problems with flatus. What food
should you recommend?
1. Peas
2. Cabbage
3. Broccoli
4. Yogurt
5. You have to teach ostomy self care to a patient with a colostomy. You tell the patient to
measure and cut the wafer:
1. To the exact size of the stoma.
2. About 1/16 larger than the stoma.
3. About 1/8 larger than the stoma.
4. About 1/4 larger than the stoma.
6. Youre performing an abdominal assessment on Brent who is 52 y.o. In which order do
you proceed?
1. Observation, percussion, palpation, auscultation
2. Observation, auscultation, percussion, palpation
3. Percussion, palpation, auscultation, observation
4. Palpation, percussion, observation, auscultation
Answers to Gastrointestinal NCLEX Questions
1. Blood pressure decreases as the body is unable to maintain normal oncotic pressure
with liver failure, so patients with liver failure require close blood pressure
monitoring. Increased capillary permeability, abnormal peripheral vasodilation, and
excess rennin released from the kidneys arent direct ramifications of liver failure.
2. Good circulation causes tissues to be moist and red, so a healthy, well-healed stoma
appears red and moist.
3. A colostomy in the sigmoid colon produces a solid, formed stool.
4. High-fiber foods stimulate peristalsis, and a result, flatus. Yogurt reduces gas
5. A proper fit protects the skin, but doesnt impair circulation. A 1/16 should be cut.
6. Observation, auscultation, percussion, palpation
- See more at: http://nclexpreceptor.com/gastrointestinal-nclex-

. The most common cause of intestinal obstruction is:
A. Adhesions
B. Hernia
C. Volvulus
D. Neoplasms
2. Which of the following listed drug is given with bismuth salt in helicobacter pyroli infection:
A. Antacids
B. Antibiotics
C. Proton-pumb inhibitor
D. H2-receptor antagonists
3. Which type of diarrhea is caused by increased production and secretion of water and electrolytes by the
intestinal mucosa in to the intestinal lumen:
A. Osmotic diarrhea
B. Mixed diarrhea
C. Secretary diarrhea
D. Diarrhea disease
4. Of the following listed insulins, which is most rapid acting;
A. Ultralente
C. Regular
D. Humalog
5. Which of the following categories of laxatives act by drawing water in to the intestine by osmosis?
A. Bulk-formimg (Metamucil)
B. Faecal softeners
C. Stimulants (bisacodyl)
D. Saline agents (milk of magnesia)
6. Celiac sprue is an example of which category of malabsorption:
A. Mucosal disorders causing generalized malabsorption
B. Post-operative malabsorption
C. Infectious diseases causing generalized malabsorption
D. Luminal problems causing malabsorption
7. Which of the following terms is used to describe chronic liver disease in which scar tissue surrounds the portal
A. Compensated cirrhosis
B. Alcoholic cirrhosis
C. Biliary cirrhosis
D. Postnecrotic cirrhosis
8. Which of the following is a hormone secreted by posterior pituitary:
A. Somatostatin
B. Vasopressin
C. Calcitonin
D. Corticosteroids
9. Which of the following listed drug is a proton pump inhibitor?
A. Pantoprazole
B. Ranitidine
C. Sucralfate
D. Famotidine

10. For irrigating colostomy, the irrigation tube must be inserted to the stoma by
A. 5
B. 2
C. 3
D. 4

11. Which of the following listed is a risk factor for colorectal cancer?
A. Age younger than 40 years
B. Low fat, low protein, high fibre diet
C. Familial polyposis
D. History of lung cancer

12. A patient with duodenal ulcer will likely experience:
A. 2-3 hours after meals
B. Vomiting
C. Weight loss
D. Hemorrhage

13. Which of the following terms is used to refer intestinal rumbling which accompanies diarrhoea?
A. Tenesmus
B. Borborygmus
C. Diverticulitis
D. Azotorrhoea

14. The term used to refer to ineffectual straining at stool is:
A. Tenesmus
B. Borborygmus
C. Diverticulitis
D. Azotorrhoea

15. Which of the following disorder is caused by excessive producing of somatotropin?
A. Adrenogenital syndrome
B. Cretinism
C. Acromegaly
D. Dwarfism

16. Which of the following clinical features is associated with Type I diabetic mellitus?
A. Requirement for oral hypoglycaemic agents
B. Presence of islets antibodies
C. Rare ketosis
D. Obesity

17. The faeces expelled through colostomy following sigmoid colostomy is often:
A. Fluid
B. mushy
C. semi-musy
D. solid

18. The recommended procedure for long-term weight loss is
A. jejuno-ileal bypass
B. Roux-en-Y
C. Vertical banded gastroplasty
D. Gastric ring application

19. The digestion of protein is facilitated by:
A. Trypsin
B. Amylase
C. Secretin
D. Lipase

20. Of the following listed oral hypoglycaemic agents, which one exerts their primary action by stimulating the
pancreas to secrete insulin?
A. Biguanides
B. Alpha glucosidase inhibitors
C. Sufonylureas
D. Thiazolidinediones

21. Regional enteritis (Crohns Disease) is characterised by:
A. Transmural thickening
B. Diffuse involvement
C. Exacerbations and remissions
D. Severe diarrhoea

22. Which of the following disorders are characterised by a group of symptoms produced by an excess of free
circulating cortisol from the adrenal cortex?
A. Hashimotos disease
B. Addisons disease
C. Graves disease
D. Cushings diasease

23. A condition characterised by inflammation of thyroid gland, resulting in hypothyroidism:
A. Addisons disease
B. Hashimotos disease
C. Graves disease
D. Cushings diasease

24. Trousseaus sign is positive when:
A. The patient complains of pain in the calf when his foot is dorsiflexed (Homans sign)
B. A sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or
twitching of the mouth, nose and eye. (Chvosteks sign)
C. After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery (Allens
D. Carpopedal spasm is induced by occluding the blood flow to the palm for 3 minutes and with the use of blood
pressure cuff
25. The presence of mucus and pus in the stools suggests:
A. Disorder of the colon
B. Intestinal malabsorption
C. Inflammatory colitis
D. Small bowel disease

26. A test in which a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear
causes spasm or twitching of the mouth, nose and eye is:
A. Chvosteks sign
B. Homans sign
C. Allens test
D. Trousseaus sign

27. A patient is advised to do the following diagnostic tests. Which of the test is performed last in a series?
A. Gall bladder series
B. Barium enema
C. Barium swallow
D. Oral cholecystogram

28. What type of diet is prescribed for a patient for the evening meal who is to undergo cholecystogram the next
A. Low-protein
B. High-carbohydrate
C. Fat-free
D. Liquid

29. For the first 4 to 6 weeks following colostomy, the patient should take:
A. Low-protein
B. High-carbohydrate
C. Low-calorie
D. Low-residue

30. For the purpose of stomach decompression using nasogastric tube, which type of suction pressure and control
is used?
A. Low and continous
B. High and intermittent
C. Low and intermittent
D. High and continuous

1. A 2. B 3. C 4. D 5. D 6. A 7. B 8. B 9. A 10. C
11. C 12. B 13. A 14. A 15.C 16. B 17. D 18. B 19. A 20. C
21. A 22. D 23. B 24. D 25. C 26. A 27.C 28. C 29. D 30.C

Which of the following are aged-related
changes that affect gastrointestinal function?
(Select all that apply.)
Your Answer: Achlorhydria or
insufficient hydrochloric
acid in the stomach

Correct Answers: Decline in sense of taste
and smell, decrease in
salivary secretion

Diminished capacity of
the gastric mucosa to
resist such factors as
Helicobacter pylori

Achlorhydria or
insufficient hydrochloric
acid in the stomach

Decreases in intestinal
absorption, motility,
and blood flow

Gastroesophageal reflux disease
(GERD) weakens the lower
esophageal sphincter, predisposing
older persons to risk for impaired
swallowing. In managing the
symptoms associated with GERD, the
nurse should assign the highest
priority to which of the following
Your Answer: Decrease daily
intake of
vegetables and
water, and

Correct Answer: Eat small,
frequent meals,
and remain in an
upright position

for at least 30
minutes after

Rationale: Small, frequent feedings
requires less release of hydrochloric
acid. Remaining in an upright
position for 30 minutes after meals
prevents reflux into the esophagus.
Nursing Process: Implementation
Client Need: Physiologic Integrity
Taxonomic Level: Analysis

The most frequently used diagnostic
test for persons with GERD is:
Your Answer: An upper

Correct Answer: A barium

Rationale: Persons with GERD should
be referred to a primary care
provider for a thorough cardiac
evaluation to rule out cardiac
disease. The most frequently used
diagnostic test is barium swallow.
Upper endoscopy is the best method
to assess mucosal injury. Acid
perfusion tests usually are not
necessary, and require the
placement of an esophageal probe
above the esophageal sphincter to
collect esophageal contents.
Nursing Process: Assessment
Client Need: Physiologic Integrity
Taxonomic Level: Knowledge

Which of the following are risk
factors associated with nursing home
residents and dysphagia? (Select all
that apply.)
Your Answer: Providing
liquids to the
patient during

Correct Answers: Feeding bed-
bound residents
in the semi-

thin liquids
quickly via a

Busy and
staff who are
assigned a
case-load of
several patients
to feed at the
same scheduled

Rationale: Bed-bound patients
should not be fed in the semi-
reclined position or fed thin liquids
that might quickly drain into the
esophagus before the swallow reflex
is triggered. A heavy caseload of
clients might cause healthcare
providers to rush-feed patients,
resulting in reflux of nutrients and
gastric acid.
Nursing Process: Analysis
Client Need: Physiologic Integrity,
Reduction of Risk Potential
Taxonomic Level: Application

Dysphagia is a cause for aspiration.
Which of the following diseases
would have the diagnosis Risk for
aspiration related to inability to
swallow effectively?
(Select all that apply.)
Your Answer: Crohn's disease
and ulcerative

Correct Answers: Stroke,
especially in the
midbrain and
anterior cortical

disease and

dystrophy and

Rationale: Stroke, especially in the
midbrain and anterior cortical areas,
is the most common cause of
dysphagia in the older person.
Parkinson's disease and Alzheimer's
disease can cause dysphagia by
inhibiting movements of the tongue,
pharynx, or upper esophagus.
Crohn's and ulcerative colitis affect
the G.I. mucosa and submucosa, and
do not usually cause esophageal
reflux or aspiration.
Nursing Process: Evaluation
Client Need: Physiologic Integrity
Taxonomic Level: Evaluation

A videofluoroscope radiographic
evaluation of the swallowing process
usually is prescribed for persons with
difficulty swallowing and risk of
aspiration. Which of the following
nursing diagnoses would be
appropriate after a videofluoroscope
radiographic evaluation?
Your Answer: Risk for fecal

Rationale: Preparation of the
videofluoroscope radiographic
evaluation includes drinking of a
radio opaque solution, which is a
chalk mixture. The chalk mixture is
constipating, and could cause fecal
Nursing Process: Planning
Client Need: Physiologic Integrity
Taxonomic Level: Application

Which of the following statements
are accurate as they relate to
medications used to manage GERD?
(Select all that apply.)
Your Answer: Aluminum-
antacids can

Correct Answers: Magnesium-
antacids can

antacids can

Rationale: Magnesium-containing
antacids can cause diarrhea, and
should be used with caution in older
persons with renal dysfunction.
Aluminum-containing antacids can
cause constipation, osteomalacia,
and hypophosphatemia. Cimetidine
has the greatest chance for adverse
reactions, including erectile
dysfunction, Gynecomastia, and
confusion. Misoprostol's major side
effects are diarrhea and abdominal
Nursing Process: Implementation
Client Need: Physiologic Integrity,
Pharmacologic Therapy
Taxonomic Level: Analysis

The surgical procedure of choice for
older patients with GERD and
Barrett's esophagus that is not
reversible with medical management
Your Answer: Labyrinthectomy.

Correct Answer: Nissen's

Rationale: Older patients with GERD
and Barrett's esophagus require
aggressive treatment with proton
pump inhibitors and regular
endoscopic examination. If the
esophageal erosion does not reverse
with treatment, the surgery of choice
is Nissen's fundoplication, and
involves closing any hiatal hernia
and restoring an antireflux barrier.
Nursing Process: Analysis
Client Need: Physiologic Integrity
Taxonomic Level: Comprehension

Which of the following types of
gastritis is associated with
Helicobacter pylori and duodenal
Your Answer: Erosive

Correct Answer: Antral gland
gastritis (type B)

Rationale: Erosive (hemorrhagic)
gastritis can be caused by ingestion
of substances that irritate the gastric
mucosa. Fundic gland gastritis (type
A) is associated with diffuse severe
mucosal atrophy and the presence of
pernicious anemia. Antral gland
gastritis (type B) is the most
common form of gastritis, and is
associated with Helicobacter pylori
and duodenal ulcers.
Nursing Process: Assessment
Client Need: Physiologic Integrity
Taxonomic Level: Comprehension

Which of the following statements is
accurate about patients diagnosed
with Zollinger-Ellison syndrome?
Your Answer: Treatment of
choice for
syndrome is a

Correct Answer: Peptic ulcer
occurs in 95% of
diagnosed with

Rationale: Peptic ulcers occur in 95%
of patients with Zollinger-Ellison
syndrome. Treatment might include
tumor removal and surgical resection
for older persons without surgical
risk. Persons with Zollinger-Ellison
syndrome have gastric
hypersecretion, and are referred to a
gastroenterologist if symptoms
Nursing Process: Analysis
Client Need: Physiologic Adaptation
Taxonomic Level: Analysis

Which of these agents is a major
contributing factor in the promotion
of peptic ulcer disorder?
Your Answer: Candida albicans

Correct Answer: Helicobacter
pylori infection

Rationale: Recurrence of peptic
ulcers is related to Helicobacter
pylori, use of NSAIDs, smoking, and
continued acid hypersecretion.
Nursing Process: Assessment
Client Need: Physiologic Integrity
Taxonomic Level: Comprehension

Which of the following is not an
indication of diverticulitis?
Your Answer: Leukocytosis

Correct Answer: Diarrhea

Rationale: Diverticulitis is an
infection from colonic diverticula.
Fever, leukocytosis, pain, and/or
abdominal tenderness might be
indicators of diverticulitis.

Nursing Process: Assessment
Client Need: Physiologic Integrity
Taxonomic Level: Comprehension

In planning care for a patient with
ulcerative colitis, the nurse should
anticipate which of the following
diagnostic procedures?
Your Answer: Sigmoidoscopy

Correct Answer: All of the above

Rationale: Diagnosis of ulcerative
colitis is confirmed with the use of
sigmoidoscopy, colonoscopy, and
rectal mucosa biopsy.
Nursing Process: Planning
Client Need: Physiologic Integrity
Taxonomic Level: Comprehension

The most common surgical
procedures for patients with
ulcerative colitis are:
Your Answer: Segmental
resection or

Correct Answer: Subtotal
colectomy and

Rationale: Surgery might be
necessary for functional older
patients with acute disease when
drug therapy fails and when multiple
precancerous lesions are detected.
The most common surgical
procedures are subtotal colectomy
and ileostomy.
Nursing Process: Assessment
Client Need: Physiologic Integrity
Taxonomic Level: Knowledge

Older patients with longstanding or
severe Crohn's disease can exhibit
which of the following?
Your Answer: Hypoalbuminemia

44. Signs and symptoms include pain in the RLQ of the abdomen that may be localize at McBurneys
point. To relieve pain, Mr. Liu should assume which position?
a. Prone
b. Supine, stretched out
c. Sitting
d. Lying with legs drawn upl
Answer: D. Lying with legs drawn up
Rationale: Posturing by lying with legs drawn up can relax the abdominal muscle thus relieve pain.
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
Answer: B. The appendix may have ruptured
Rationale: If a confirmed diagnosis is made and the pain suddenly without any intervention, the appendix
may have ruptured; the pain is lessened because the appendix is no longer distended thus surgery is still
Situation 10: Nurse Nico is caring to a 38-year-old female, G3P3 client who has been diagnosed with
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
Answer: B. Three vaginal delivery pregnancies
Rationale: Hemorrhoids are associated with prolonged sitting, or standing, portal hypertension, chronic
constipation and prolonged intra abdominal pressure as associated with pregnancy and the strain of
vaginal delivery. Her job as a schoolteacher does not require prolong sitting or standing. Age and leg
varicosities are not related to the development of hemorrhoids.
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
Answer: C. Avoid strainining during defecation
Rationale: Straining can increase intra abdominal pressure. Health teachings also include: suggest to eat
high roughage diet, wearing of cotton undergarments and use of sitz bath for 15 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
Answer: B. causes coagulation (clumping) of proteins in the cells of the perianal skin or the lining of the
anal canal
Rationale: Option a are local anesthetics; c are antiseptics and d are keratolytics.
49. Which position would be ideal for the client in the early postoperative period after hemorrhoidectomy?
a. High Fowlers
b. Supine
c. Side lying
d. Trendelenburgs
Answer: C. Side lying
Rationale: Positioning in the early postoperative phase should avoid stress and pressure on the operative
site. The prone and side lying are ideal from a comfort perspective. A high Fowlers or supine position
will place pressure on the operative site and is not recommended. There is no need for trendelenburgs
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
Answer: A. Hemorrhage
Rationale: Applying heat during the immediate postoperative period may cause hemorrhage at the
surgical site. Moist heat may relieve rectal spasms after bowel movements. Urinary retention caused by
reflex spasm may also be relieved by moist heat. Increasing fiber and fluid in the diet can help
Situation 1: Children have a special fascination with the workings of the digestive system. To fully
understand the digestive processes, Nurse Laviga 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
Answer: C. stomach
Rationale: Stomach is a hollow digestive organ in the GI tract. The liver, gall baldder and pancreas are all
solid organs which are part of the hepato-biliary system. Test taking skills: which does not belong to the
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
Answer: D. air and food
Rationale: The laryngopharynx serves as passageway for air and food and so as with the oropharynx.
Option a is nasopharynx. Answers b and c may be correct but air and food is more accuarte.
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
Answer: B. ingestion, mastication, deglutition, digestion, absorption, egestion
Rationale: The digestive processes involve six steps. Ingestion is taking in of food in the mouth;
mastication is the mechanical process where food is converted into bolus; deglutition is the act of
swallowing; digestion is the chemical breakdown of food into chime; absorption occurs in the small
intestines (solutes) and large intestines (water) and egestion/defecation where elimination of feces occur.
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
Answer: A. Gastrin
Rationale: Gastrin stimulates chief cells to produce pepsinogen when foods enter and suppression of
pepsinogen when it leaves and enters the small intestines; it is the major hormone that regulates acid
secretion in the stomach. Pepsin; a gastric protease secreted in an inactive form, pepsinogen, which is
activated by stomach acid that acts to degrade protein. HCl is produced by the parietal cells. Insulin is a
pancreatic hormone.
5. What pancreatic enzyme aids in the digestion of carbohydrates?
a. Lipase
b. Trypsin
c. Amylase
d. Chymotrypsin
Answer: C. Amylase
Rationale: Amylase aids in the digestion of carbohydrates. Trypsin/Chymotrypsin aids in the digestion of
proteins. Lipase aids in the digestion of fats.
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. sims
Answers: A. supine with knees flexed
Rationale: During abdominal examination, positioning the client in supine with knees flexed will promote
relaxation of abdominal muscles. Options b and d are inaccurate in this type of procedure. Lying on back
or supine may be correct but option a is the best answer.
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
Answer: B. Inspection
Rationale: Inspection is the first step in abdominal exam to note the contour and symmetry of abdomen
as well as localized bulging, distention and peristaltic waves. Auscultation is done to determine the
character, location and frequency of bowel sounds. Percussion is to assess tympany or dullness.
Palpation is to asses areas of tenderness and discomfort. Note: In abdominal exam: Inspection,
Auscultation, Percussion and Palpation are the correct order.
8. In order to identify areas of tenderness and swelling, Nurse Dorina must do:
a. deep palpation
b. light palpation
c. percussion
d. palpation
Answer: B. Light palpation
Rationale: Light palpation is done to identify areas of tenderness and swelling. Deep palpation is done to
identify masses in all four quadrants. Test taking skills: one of the opposite is the correct answer
9. Mr. Lim verbalized pain on the right iliac region. Nurse Dorina knows that the organ affected would be
a. liver
b. sigmoid colon
c. appendix
d. duodenum
Answer: C. Appendix
Rationale: Appendix and cecum is located in the right iliac region. Liver and gall baldder is at the right
hypochondriac. Sigmoid colon is at the left iliac. Duodenum, stomach and pancreas is in the epigastric
10. Mr. Lim felt pain upon release of Nurse Dorinas hand. This can be referred as:
a. referred pain
b. rebound tenderness
c. direct tenderness
d. indirect tenderness
Answer: B. Rebound Tenderness
Rationale: Rebound tenderness is pain felt upon sudden release of the examiners hand which in most
cases suggest peritonitis. Referred pain is pain felt in an area remote from the site of origin. Direct
tenderness is localized pain upon palpation. Indirect tenderness is pain outside the area of palpation.
Situation 3: Mrs. Cruz was admitted in the Medical Floor due to pyrosis, dyspepsia and difficulty of
11. Based from the symptoms presented, Nurse Yoshi might suspect:
a. Esophagitis
b. Hiatal hernia
d. Gastric Ulcer
Answer: C. Gastroesophageal Reflux Disease (GERD)
Rationale: GERD is the backflow of gastric or duodenal contents into the esophagus caused by
incompetent lower esophageal sphincter. Pyrosis or heartburn, dyspepsia and dysphagia are cardinal
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
Answer: B. Barium swallow
Rationale: Barium swallow or upper GI series would confirm GERD. Endoscopy is another diagnostic test.
Options a and d are the same. Option c is incorrect.
13. Mrs. Cruz complained of pain and difficulty in swallowing. This term is referred as:
a. Odynophagia
b. Dysphagia
c. Pyrosis
d. Dyspepsia
Answer: A. Odynophagia
Rationale: When difficulty of swallowing is accompanied with pain this is now referred as odynophagia.
Dysphagia is difficulty of swallowing alone.
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
Answer: B. High fat, carbonated and caffeinated beverages
Rationale: All are correct but option b is the best answer. In patients with GERD, this type of diet must be
avoided to avoid backflow of gastric contents. Excessive caffeine reduces the tone of lower esophageal
sphincter. Test Taking Skills: look for the umbrella effect
15. Mrs. Cruz body mass index (BMI) is 25. You can categorized her as:
a. normal
b. overweight
c. underweight
d. obese
Answer: B. Overweight
Rationale: Mr. Cruz BMI belongs to the overweight category (24 26), malnourished (less than 17),
underweight (17 19), normal (20 23), obese (27 30) and morbidly obese (greater than 30). BMI is
weight in kilograms divided by height in square meters.
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
Answer: C. Pain occurs immediately after meal.
Rationale: In gastric ulcer food intake aggravates pain which usually occur 1 hour before meal or
immediately during or after food intake. Options a, b, c suggests duodenal ulcer.
17. What diagnostic test would yield good visualization of the ulcer crater?
a. Endoscopy
b. Gastroscopy
c. Barium Swallow
d. Histology
Answer: A. Endoscopy
Rationale: Endoscopy determines bleeding, pain, difficulty swallowing, and a change in bowel habits. This
would yield good visualization of the ulcer crater. Other options are also diagnostic tests in PUD.
18. Peptic ulcer disease particularly gastric ulcer is thought to be cause by which of the following
a. E. coli
b. H. pylori
c. S. aureus
d. K. pnuemoniae
Answer: B. H. pylori
Rationale: Helicobacter pylori (H. pylori) is a bacteria responsible for most ulcers and many cases of
chronic gastritis (inflammation of the stomach). This organism can weaken the protective coating of the
stomach and duodenum (first part of the small intestines), allowing the damaging digestive juices to
irritate the sensitive lining of these body parts.
19. She is for occult blood test, what specimen will you collect?
a. Blood
b. Urine
c. Stool
d. Gastric Juice
Answer: C. Stool
Rationale: Occult blood test or stool guiac test is a test that detects the presence of hidden (occult) blood
in the stool (bowel movement). The stool guaiac is the most common form of fecal occult blood test
(FOBT) in use today. So stool specimen will be collected.
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
Answer: D. Meatless diet for 48 hours prior to obtaining of specimen
Rationale: Eating meat can cause false positive test result. Using proper stool collection technique,
avoiding certain drugs, and observing dietary restrictions can minimize these measurement errors.
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
Answer: C. The cause of this condition is unknown
Rationale: There is no known cause of IBS, and diagnosis is made by excluding all the other diseases
that cause the symptoms. There is no inflammation if the bowel. Some factors exacerbate the symptoms
including anxiety, fear, stress, depression, some foods and drugs but there do not cause the disease.
22. Which of the following alimentary canal is the most common location for Chrons disease?
a. Descending colon
b. Jejunum
c. Sigmoid Colon
d. Terminal Ileum
Answer: D. Terminal Ileum
Rationale: Chronic inflammatory of GI mucosa occurs anywhere from the mouth to anus but most often in
terminal ileum. Inflammatory lesions are local and involve all layers of the intestinal wall.
23. Which of the following factors is believed to be linked to Chrons disease?
a. Diet
b. Constipation
c. Heredity
d. Lack of exercise
Answer: C. Heredity
Rationale: The cause is unknown but is thought to be multifactorial. Heredity, infectious agents, altered
immunity or autoimmune and environmental are factors to be considered. Test taking skill: which does not
belong? Options a, b, and d are all modifiable factors.
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
Answer: B. Altered immunity
Rationale: refer to rationale for number 23. Test taking skill: which does notbelong? Options a, c and d
are all modifiable factors.
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
Answer: A. A demanding and stressful job.
Rationale: Stress is an environmental factor that is thought to cause ulcerative colitis. Test taking skill:
options b, c, and d are all healthy lifestyles.
Situation 6: A patient was admitted in the Medical Floor at St. Lukes 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 through the structure that usually holds it
Answer: B. A non inflamed outpouching of the intestine.
Rationale: An increase intraluminal pressure causes the outpouching of the colon wall resulting to
diverticulosis. Option a suggests diverticulitis. Test taking skill: one of the opposite is the correct answer.
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
Answer: A. Low Fiber Diet
Rationale: A lack of adequate blood supply and nutrients from the diet such as low fiber foods may
contribute to the development of the disease. Test taking skill: one of the opposite is the correct answer.
28. Which of the following tests should be administered to client with diverticulosis?
a. Proctosocpy
b. Barium enema
c. Barium swallow
d. Gastroscopy
Answer: B. Barium enema
Rationale: Barium enema is used to diagnose diverticulosis, however, this is contraindicated when
diverticulitis is present because of the risk of rupturing the diverticulum. Test taking skill: options b and c
are opposite; one may be the correct answer.
29. To improve Mr. Trinidads 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
Answer: B. Increase fiber in the diet.
Rationale: Patient with diverticulosis must be encouraged to increase roughage in diet such as fruits and
vegetables rich in fiber. Increasing fluid intake 2 3 liters/day unless contraindicated rather reducing.
Administering antibiotics can decrease bowel flora and infection but this is a dependent function of a
30. Upon review of Mr. Trinidads 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
Answer: B. Normal
Rationale: Mr. Trinidads BMI is 23 which is normal. Refer to rationale number 15.
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
Answer: C. passage of stool is more than 3 bowel movements per day (thanks to Budek for the
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
Answer: B. Altered Immunity
Rationale: Diarhhea is an intestinal disorder that is self limiting. Options a, c and d are etiological factors
of diarrhea.
33. What life threatening condition may result in persistent diarrhea?
a. hypokalemia
b. dehydration
c. cardiac dysrhytmias
d. leukocytosis
Answer: C. Cardiac dysrhytmias
Rationale: Due to increase frequency and fluid content in the stools, diarrhea may cause fluid and
electrolyte imbalance such as hypokalemia. Once potassium is depleted, this will affect the contractility of
the heart causing cardiac arrhythmia leading to death.
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
Answer: B. Metabolic acidosis
Rationale: In diarrhea, metabolic acidosis is the acid base imbalance that occurs while in vomiting,
metabolic alkalosis occur. This is a metabolic disorder thats why eliminate options c and d. Tip: Just
remember the sound when youre vomiting (alk alk alk alosis) and the sound of passage of watery stool
(uhhhm uhhh ashhi dosis) hehehe
35. What is the immediate home care management for diarrhea?
a. Milk
b. Imodium
c. Water
d. Oresol
Answer: D. Oresol
Rationale: In the DOH book, oresol is the immediate home care management for diarrhea to prevent
dehydration. Water may not be enough to prevent diarrhea.
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
Answer: A. High pitched tinkling or rumbling bowel sounds
Rationale: Early in the bowel obstruction, the bowel attempts to move the contents past the obstruction
and this is heard as high pitched tinkling bowel sounds. As the obstruction progresses, bowel sounds will
diminish and may finally become absent.
37. Nasogastric tube was inserted to Mr. Sean. The NGTs primary purpose is:
a. nutrition
b. decompression of bowel
c. passage for medication
d. aspiration of gastric contents
Answer: B. Decompression of bowel
Rationale: The NGTs primary purpose is for bowel decompression especially for clients suffering from
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
Answer: A. Absent bowel sounds
Rationale: Post operatively, no bowel sounds are present so this is a normal finding. Bleeding and
hemorrhage must be prevented to avoid complications. Bowel movement occurs only after flatus and
bowel sounds are noted.
39. Client education should be given in order to prevent constipation. Nurse Leonards 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
Answer: A. Use of natural laxatives
Rationale: The use of natural laxatives such as foods and fruits high in fiber is still the best way of
preventing constipation Increasing fluid intake, taking laxatives judiciously and exercise also can prevent
40. Four hours post operatively, Mr. Sean complains of guarding and rigidity of the abdomen. Nurse
Leonards initial intervention is:
a. assess for signs of peritonitis
b. call the physician
c. administer pain medication
d. ignore the client
Answer: A. Assess for signs of peritonitis
Rationale: Assessment precedes intervention. Symptoms presented are signs of peritonitis. Assessment
will provide you the data for prompt intervention.
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
Answer: A. The pain is localized at a position halfway between the umbilicus and the right iliac crest.
Rationale: Pain over McBurneys point, the point halfway between the umbilicus and the iliac crest, is
diagnosis for appendicitis. Options b and c are common with ulcers; option d may suggest ulcerative
colitis or diverticulitis.
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
Answer: A. A fecalith
Rationale: A fecalith is a hard piece of stool which is stone like that commonly obstructs the lumen. Due
to obstruction, inflammation and bacterial invasion can occur. Tumors or foreign bodies may also cause
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
Answer: C. WBC 13, 000/mm3
Rationale: Increase in WBC counts is suggestive of appendicitis because of bacterial invasion and
inflammation. Normal WBC count is 5, 000 10, 000/mm3. Other options are normal values.