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Multiple Choice Questions on GIT
     (The answers are given in the drop  down box adjacent to the questions. The answers will be completed soon. The explanation for each answer are given separately in the page.  Please wait for the answers to be corrected. soon you will find the correct answers and explanations)

1.    The nurse suspects an elderly client has  become impacted when the client says:
  1. I have a lot of gas pains
  2. I don’t have much of an appetite
  3. I felt like I have to go and just can’t
  4. I haven’t had a bowel movement for 2 days

2.    A client  hepatic cirrhosis begins to develop slurred speech, confusion, drowsiness, and a flapping tremor. With this evidence of impending hepatic coma, the diet would probably be changed to :
  1. 20 g protein, 2000 calories
  2. 70 g protein, 1200 calories
  3. 80 g protein, 2500 calories
  4. 100 g protein, 1500 calories

3.    After a partial gastrectomy is performed, a client is returned to the unit with an iv solution infusing and a a nasogastric tube in place. The nurse notes that there has been no drainage from nasogastric tube for an hour. There is an order to irrigate the nasogastric tube prn. The nurse should insert:
  1. 30 ml of normal saline and withdraw slowly
  2. 20 ml of air and clamp off suction for 1 hour
  3. 50 ml of saline and increase pressure of suction
  4. 15 ml of distilled water and disconnect suction for 30 mts

4.    When performing a colostomy irrigation the nurse inserts the catheter into the stoma upto
  1. 5 cm (2inches)
  2. 10 cm (4 Inches)
  3. 15 cm (6 inches)
  4. 20 cm ( 8 inches)

5.     When teaching a client to irrigate a colostomy, the nurse indicates that the distance of the container above the stoma should be no more than:
  1. 15 cm (6 inches)
  2. 25 cm (10 inches)
  3. 30 cm (12 inches)
  4. 45 cm (18 inches)

6.       The physician has ordered a rectal tube to help a client relieve abdominal distention following surgery. To achieve maximum effectiveness, the nurse should leave it in place for a period of
  1. 15 minutes
  2. 30 minutes
  3. 45 minutes
  4. 60 minutes

7.     While administering an enema, the maximum safe height at which the container of fluid can be held is :
  1. 30 cm (12 inches)
  2. 37 cm
  3. 45 cm (18 inches)
  4. 66 cm (26 inches)

8.        A client has peptic ulcer in the duodenum. He would probably describe the associated pain as:
  1. An ache radiating to the left side
  2. An intermittent colicky flank pain
  3. A gnawing sensation relieved by food
  4. A generalized abdominal pain intensified by moving

9.        Diagnosis of malabsorption syndrome is made in a client. Striking clinical improvement should be noted after administration of :
  1. Folic acid
  2. Vitamin B12
  3. Corticotropin
  4. A gluten free diet

10.        A flat plate X-ray of the abdomen is ordered for a client. The nurse recognizes that the client should receive:
  1. No special preparation
  2. A low soapsuds enema
  3. Nothing by mouth for 8 hours
  4. A laxative the evening before the X-ray

11.   A pancreatic pseudocyst is:
  1. Generally a malignant growth
  2. Filled with pancreatic enzymes
  3. Cyst containing necrotic tissue and blood
  4. A pouch of undigested  food particles

12.   When teaching a client about intussusception, the nurse explains that it is :
  1. Kinking of the bowel onto itself
  2. A band of connective tissue compressing the bowel
  3. Telescoping of a proximal loop of bowel into a distal loop
  4. A protrusion of an organ or part of an organ through the wall that contains it

13.    Health teaching program for a client who has had a gastrectomy should include:
  1. A warning to avoid all gas forming foods
  2. An explanationof the therapeutic client of a high roughage
  3. Encouragement toresume previous eating habits as soon as possible
  4. A thorough explanation of the dumping syndrome and how to limit or prevent it.

14.   Barium salts used for GI series and barium enemas serve to:
  1. Fluoresce and thus illuminate the alimentary tract
  2. Give off visible light and illuminate the alimentary tract
  3. Dye the alimentary tract and thus provide for color contrast
  4. Absorb X-rays and thus give contrast to the soft tissues of the alimentary tract

15.    A client with a hiatus hernia complains about having difficulty sleeping at night. The appropriate nursing intervention would be:
  1. Make the client sleep on two or three pillows
  2. Eliminate carbohydrates from client’s diet
  3. Suggest drinking a large glass of milk before retiring
  4. Administer antacids such as sodium bicarbonate

16.   APostoperative care for a client who has had a hemorrhoidectomy should include
  1. Occlusive dressings to the area
  2. Encouraging showers when needed
  3. Administration of laxatives and stool softeners
  4. Administration of enemas to promote defecation

17.  a client complains of abdominal cramps during a colostomy irrigation, the nurse should:
  1. Discontinue the irrigation
  2. Lower the container of fluid
  3. Clamp the catheter for a few minutes
  4. Advance the catheter about 2.5 cm (1 inch)

18.  Twenty amino acids are involved in body metabolism, building of various tissues. Of these, 8 are essential amino acids. This means that :
  1. These 8 amino acids can be made by the body because they are essential to life.
  2. These 8 amino acids are essential in body processes and the remainig 14 are not.
  3. The body cannot synthesize these 8 amino acids and thus they must be obtained form the diet
  4. After synthesizing these 8 amino acids, the body uses them in key processes essential for growth

19.   The laboratory test that would indicate that the liver of a client with cirrhosis is compromised and Neomycin enemas might be helpful is :
  1. Ammonia level
  2. White blood count
  3. Culture and sensitivity
  4. Alanine aminotransaminase level

20.  An acute attack of pancreatitis may be precipitated by heavy drinking. Because:
  1. Promotes the formation of calculi in the cystic duct
  2. The pancreas is stimulated to secrete more of insulin than it can immediately produce
  3. The alcohlo alters the composition of enzymes so they aare capable of damaging pancreas
  4. Alcohol increases enzymes secretion and pancreatic duct pressure, which cause bakcflowof enzymes into the pancreas.

21.   When caring for a client with a nasogastric tube attached to suction, the nurse should:
  1. Irrigate the tube with normal saline
  2. Use sterile technique when irrigating the tube
  3. Withdraw the tube quickly when decompression is terminated
  4. Allow the client to have small chips of ice or sips of water unless nauseated.

22.    For an elderly client who has had a subtotal gastrectomy, the wisest dietary guidance would be to :
  1. Increase intake of dietary roughage
  2. Avoid oral feedings for a prolonged period
  3. Gradually resume small easily digestable feedings
  4. Allow the selection of personally preferred foods

23.   A client has taken mega doses of Vitamin A. the nurse questions this practice because:
  1. This vitamin is highly toxic even in small amounts
  2. The liver has great storage capacity for the vitamin, even to toxic amounts
  3. This vitamin cannot be stored, and the excess anount sould saturate the general body tissues.
  4. Although the body’s requirement for the vitamin is very large, the cells can synthesise more as needed

24.   A readily available form of energy although limited in amount, is stored in the liver by conversion of glucose to:
  1. Glycerol
  2. Glycogen
  3. Tissue fat
  4. Amino acids

25.   Which of the following is essential for absorption of fat soluble vitamins in the intestine?
  1. Hydrochloric acid
  2. Bile salts
  3. Lipase
  4. Amylase

26. The nurse would expect a client with cancer of the liver to have difficulty digesting fatty foods because the liver is involved in the production of :
  1. Bile
  2. Lipase
  3. Cholesterol
  4. Amylase

27.    A client  complains of abdominal discomfort following ingestion of milk. The nurse reconizes that this may be the result of a genetic deficiency of the enzyme
  1. Lactase
  2. Maltase
  3. Sucrase
  4. amylase

28.    The earliest indication of parenchymal damage to the liver in clients with hepatitis B is usually :
  1. A rise in bilirubin
  2. An alteration in proteins
  3. A rise in alanine aminotrasferase (ALT)
  4. An elevation of alkaline phosphatase

29.    When caring for a client with an ileostomy the nurse would:
  1. Encourage the client to eat foods high in residue
  2. Explain that th4e drainage can be controlled with daily irrigation
  3. Expect the stoma to start draining on the third postoperative day
  4. Anticipate that emotional stress can increase intestinal peristalsis.

30.    A client who has had a colostomy should follow a diet that is :
  1. Rich in protein
  2. Low in fiber content
  3. High in carbohydrate
  4. As close to normal as possible

31.      A client with ascites has been ordered paracentesis. Before the procedure the nurse should instruct the client to:
  1. Empty the bladder 
  2. Eat foods low in fat
  3. Remain npo for 24 hours
  4. Assume the supine position

32. The nurse explains that visualization of the GI tract after a barium enema is made possible because:
  1. Barium physically colors the intestinal wall.
  2. Barium has the X-ray absorbing properties
  3. Barium has X-ray transmitting properties
  4. Barium chemical interacts with electrolytes.

34.   When teaching  a client to care for a new colostomy, the nurse should advice the client that the irrigations be done at the same time every time every day. The time selected should:
  1. Be approximately 1 hour before breakfast
  2. Provide ample uninterrupted bath room use at home
  3. Approximate the client’s usual daily time for elimination
  4. Be about halfway between the two large meals of the day

36.If intubation is indicated in a client with bleeding oesophageal varices, the type of tube most likely to be used would be a (an)
  1. Levin tube
  2. Salem sump
  3. Miller-Abbott tube
  4. Blakemore-Sengstaken tube

37.    When teaching a client at discharge with a permanent colostomy, the nurse is expected to discuss the :
  1. Need for special clothing
  2. Importance of limiting activity
  3. Periodic dilation of the stoma
  4. Bland, low residue diet regimen

38.   The chief complaint in clients with Vincent’s angina is :
  1. Chest pain
  2. Shortness of breath
  3. Shoulder discomfort
  4. Bleeding oral ulceration

39.   Before scheduling a client for endoscopic retrograde cholangiopancreatography (ERCP) the nurse should assess the client’s :
  1. Urine output
  2. Bilirubin level
  3. Serum glucose
  4. Blood pressure

40.    Fractured mandible is usually immobilized with wires. The life threatening postoperative problem that can develop with this pocedure is :
  1. Infection
  2. Vomiting
  3. Reflux of intestinal contents into the oesophagus
  4. Build up of feces and gas within the large intestine.

41.    A subtotal gastrectomy is performed to treat a client with cancer of the stomach. This client develops dumping syndrome. The dumping syndrome refers to :
  1. Nausea due to a full stomach
  2. Rapid passage of osmotic fluid into the jejunum
  3. Reflux of intestinal contents into the esophagus
  4. Buildup of faeces and gas within the large intestine

42.    Phospho-soda is cathartic, classified as :
  1. saline
  2. Emollient
  3. stimulant
  4. Bulk-forming

43.    When a client has extensive carcinoma of the descending portion of colon with metastasis to the lymph nodes the operative prodedure that would probably be performed is a (an) :
  1. Ileostomy
  2. Colectomy
  3. Colostomy
  4. Caecostomy

44.    Clients with gastrectomy may develop pernicious anaemia  because:
  1. Vitamin B 12 is only absorbed in the stomach
  2. The haemopoietic factor is secreted in the stomach
  3. The parietal cell of the gastric mucosa secrete intrinsic factor
  4. Chief cells in the stomach secrete the extrinsic factor.

45.       In clients with cholecystitis the utilization of bile is interfered with. The ejection of bile into the alimentary tract is controlled by the hormone:
  1. Gastrin
  2. Secretin
  3. Enterocrinin
  4. Cholecystokinin

46.    Before a cholecystectomy a physician order vitamin K . Vitamin K is required for the synthesis of :
  1. Bilirubin
  2. Prothrombin
  3. Thromboplastin
  4. Cholescystokinin

47. Hormone that stimulates the flow of pancreatic enzymes is:
  1. Enterocrinin
  2. Pancreozymin
  3. Enterogastrone
  4. Cholecystokinin

48.A client is admitted three days back for a cerebral vascular accident, he is receiving intermittent feedings through nasogastric tube. The nurse evaluates if a prior feeding has been absorbed by :
  1. Evaluating the intake in relation to the output
  2. Aspirating the residual volume and reinstilling it
  3. Instilling air into the stomach while auscultating
  4. Comparing the client’s body weight to the base line data.

49.    The ascites seen in cirrhosis results in part from:
  1. The escape of lymph into the abdominal cavity directly from the inflamedliver sinusoid.
  2. Increased plasma colloid osmotic pressre due to excessive liver growth and metabolism
  3. The decreased levels of ADH and aldosterone due to increasing metabolic activity in the liver
  4. Compression of the portal vein with resultant increased back pressure in the portal veins system

50.   Acute appendicitis is a condition associated with :
  1. Poor dietary habits
  2. Infection of the bowel
  3. Hypertension and resultant oedema
  4. Compromised circulation to the appendix

51.   The main role of liver in relation to fat metabolism is to:
  1. Produce phospholipids
  2. Store fat for energy reserves
  3. Oxidize fatty acids to produce energy
  4. Convert fat to lipoproteins for transport out into the body

52.    A client is scheduled for a pyloroplasty and vagotomy because of strictures caused by peptic ulcers. The nurse reinforces the client’s understanding of vagotomy by stating, that the vagotomy serves to:
  1. Increase the heart rate
  2. Hasten Gastric emptying
  3. Eliminate pain sensations
  4. Decrease secretions in the stomach

53Neomycin sulfate is administered to clients, before colon surgery to:
  1. Destroy intestinal bacteria
  2. Increase the production vitamin K
  3. Decrease the incidence of any secondary infection
  4. Decrease the possibility of postoperative urinary infection
54.  The assessment finding which indicate the probable presence of a fecal impaction in a client with limited mobility would be :
  1. Tympanites
  2. Faecal liquid seepage
  3. Bright red blood in the stool
  4. Decreased number of blood movements

55.    Varicose veins can be expected in clients with cirrhosis. This is because of :
  1. Increased plasma hydrostatic pressure in veins of the extremities.
  2. Toxic irritating products released into the blood from the diseased organs.
  3. Ballooning of vein walls from decreased venous pressure and incompetent valves.
  4. Decreased plasma protein concentration resulting in the pooling of blood in the venous system.

56.    The nurse should assess the client with cirrhosis for signs of hepatic coma. The classic signs of hepatic coma is
  1. Bile coloured stools
  2. Elevated cholesterol
  3. Flapping hand tremors
  4. Depressed muscle reflexes

57.    The symptoms associated with colitis are:
  1. Leukocytosis, anorexia, weight loss.
  2. Anaemia, haemoptysis, weight loss, abdominal cramps
  3. Fever anaemia, nausea and vomiting leukopenia, diarrhoea
  4. Diarrhoea, anorexia, weight loss abdominal cramps anaemia

58.   The term saturated and unsaturated fatty acids relate to a degree of:
  1. color
  2. Taste
  3. Density
  4. Digestibility

59.  The basic pathophysiologic problem problem of the liver causing oesophageal varices is:
  1. Ascites and oedema
  2. Portal hypertension
  3. Loss of regeneration
  4. Dilated veins and varicosities.

60.    A client has a transeverse loop colostomy. When inserting a catheter for irrigation. The nurse should:
  1. Use an oil-base lubricant
  2. Instruct the client to bear down
  3. Apply gentle but continuous force
  4. Direct it toward the client’s right side

61.        For a client after surgery for a perforated appendix with localized peritonitis, the position that is incicated is :
  1. Sim’s position
  2. Semi-Fowler’s position
  3. Trendelenberg position
  4. Dorsal recumbent position

62.    The hormone secretin and pancreeozymin are secreted by ;
  1. Liver
  2. Adrenals
  3. Pancreas
  4. duodenum

63.    The term  that most accurately describes a client’s lack of interest in food is:
  1. Apathy
  2. Anoxia
  3. Anorexia
  4. Dysphagi
64.    In an effort to prevent hepatic coma with a client with liver dysfunction it may become necessary to:
  1. Give fleet enemas
  2. Eliminate protein from the diet
  3. Prepare for emergency surgery
  4. Eliminate carbohydrate from the diet

65.   A client with a cerebral vascular accident has developed faecal incontinence. When establishing a bowel training program the nurse must remember that the most important factor is :
  1. Use of medication to induce elimination
  2. Plan to schedule a definite time for attempted evacuation
  3. Encourage client’s previous habits in the area of diet and use of laxatives.
  4. Encourage dlient’s timing of elimination  to take advantage of the gastrocolic reflex.

66.    The specific nursing responsibility in preparing a client for a sigmoidoscopy and barium enema includes:
  1. Giving castor oil the afternoon before
  2. Withholding food and fluids for 8 hours
  3. Admininstering soapsuds enema until clear
  4. Ensuring that the client understands what is to happen

67.       As part of preparing a client for sigmoidoscopy, the nurse should
  1. Administer an enema, the morning of the examination
  2. Provide a container for the collection of a stool specimen
  3. Withhold all fluids and foods for 24 hours before examination
  4. Explain to the client that a chalklike substance will have to be swallowed

68.  when teaching an athletic teenager about nutritional intake, the nurse should explain that the carbohydrate food that would provide the quickest source of energy is a :
  1. Glass of milk
  2. Slice of bread
  3. Chocolate candy bar
  4. Glass of orange juice

69.  In clients with liver insufficiency the expected assessment finding would be
  1. Anuria
  2. Fetor hepaticus
  3. Blepharospasm
  4. Globus hystericus
 
70.    The nurse recognizes that a client has an increased risk of developing cancer of the tongue if there is a history of:
  1. Nail biting
  2. Poor dental habit
  3. Frequent gum chewing
  4. Heavy consumption of alcohol

71.   The nurse should assess the client with liver cirrhosis and hepatic coma for :
  1. Icterus
  2. urticaria
  3. Uremia
  4. haemangioma

72.    The nurse administers Neomycin to a client with hepatic cirrhosis to prevent the formation of :
  1. Bile
  2. Urea
  3. Ammonia
  4. haemoglobin

73.    When assessing a client with portal hypertension, the nurse should be alert for signs of :
  1. Liver abscess
  2. Intestinal obstruction
  3. Perforation of the duodenum
  4. Haemorrhage from oesophageal varices

74.    The major posttransfusion viral hepatitis is :
  1. Hepatitis type A
  2. Hepatitis type B
  3. Hepatitis type C
  4. Hepatitis type D

75.    A client has been operated for an incarcerated hernia. The physician returns the incarcerated tissue into the abdominal cavity and uses a mesh to reinforce the muscle wall thereby preventing  future recurrence. This procedure is referred to as a
  1. Herniotomy
  2. Herniectomy
  3. Hernioplasty
  4. Herniorrhaphy

76.    The most cmmon cause of diarrhea in clients receiving full strength tube feeding is :
  1. Increased fiber intake
  2. Bacterial contamination
  3. Inappropriate positioning
  4. High osmolarity of the feedings.

77.    The solution of choice to be used to maintain patency of an intestinal (cantor) tube is :
  1. Sterile water
  2. Isotonic saline
  3. Hypotonic saline
  4. Hypertonic glucose

78.A 20 year old client  is admitted with an acute onset of right lower quadrant pain. Appendicitis is suspected. To determine the etiology of the pain, the client should be assessed for :
  1. Urinary retention
  2. Gastric hyperactivity
  3. Rebound tenderness
  4. Increased lower bowel motility

79.    While helping a client reestablish a regular pattern of defaecation, the nurse should base the teaching on the principle that :
  1. Inactivity produces muscle atonia
  2. The gastrocolic reflex initiates peristalsis
  3. Increased fluid promotes ease of evacuation
  4. Increased potassium is needed for normal neuromuscular irritability

80.   Vitamins are administered parenterally for clients with an inflamed intestine because :
  1. More rapid action results
  2. They are ineffective orally
  3. They decrease colon irritability
  4. Intestinal absorption may be inadequate

81.    Two hours after a subtotal gastrectomy the nurse notes that the drainage from the client’s nasogastric tube is bright red. The priority nursing action should be to :
  1. Notify the physician immediately
  2. Clamp the nasogastric tube for one hour
  3. Recognize this as an expected finding
  4. Irrigate the nasogastric tube with iced saline.

82.    Neomycin is especially useful before colon surgery because it :
  1. Will not afect the kidney
  2. Acts systemically without delay
  3. Is poorly absorbed from the GI tract
  4. Is effective against many organisms

83.When a nurse is caring for a client with ascites, she should understand that the portal vein :
  1. Brings blood towards the liver
  2. Enters the superior venacava from the cranium
  3. Brings venous blood from the intestinal wall to the liver
  4. It’s located superficially on the anteromedial surface of the thigh.

84.    Sigmoidoscopy is a diagnostic measure. For this examination, the client should be placed in the position known as :
  1. Sim’s
  2. Prone
  3. Lithotomy
  4. Knee chest

85.    The primary step in achieving long range goals in the rehabilitation of a client with a new colostomy involves the client’s :
  1. Mastery of techniques of colostomy care
  2. Readiness to accept on altered body function
  3. Awareness of available community resources
  4. Knowledge of the necessary dietary modifictions.

86.  Clients with jaundice are susceptible to postoperative haemorrhage because :
  1. Excess bile salts in the blod inhibit synthesis of prothrombin in the liver
  2. Excess bile salts in the blood inhibit synthesis of vitamin K and prothrombinase in the liver
  3. Decreased bile salts in the blood inactivates prothrombinase and prevent formation of thrombin from prothrombin.
  4. Lack of bile in the intestine causes inadequate vitamin K absorption, which results in inadequate thrombin synthesis in the liver.

87. Vitamin A is a fat soluble vitamin produced by humans and other animals from its precursor carotene (provitamin A). One of the main source of carotene is
  1. oranges
  2. Skim milk
  3. Tomatoes
  4. Leafy greens

88.    When receiving an enema, the client should  be placed in :
  1. Sim’s position
  2. Back lying position
  3. Knee chest position
  4. Mid Fowler position

89.    Prophylaxis for hepatitis B includes the following :
  1. Preventing constipation
  2. Screening of blood donors
  3. Avoiding shellfish in the diet
  4. Mid Fowler position
  5. Limiting hepatotoxic drug therapy

90.    A Client has an appendectomy and develop peritonitis. The nurse should assess the client for elevated temperature and :
  1. Hyperactivity
  2. Extreme hunger
  3. Urinary retention
  4. Local muscular rigidity

91.    The client’s diet after a cholecystectomy should include :
  1. High fat and carbohydrate to meet energy demands
  2. High protein and calories to promote wound healing
  3. Low fat to avoid painful contractions in the area of the wound
  4. Low protein and carbohydrate to avoid excess calories and help the client lose weight

92.  The most therapeutic diet for a client with hepatic cirrhosis would be :
  1. High protein, low carbohydrate, low fat
  2. Low protein, low carbohydrate, high fat, soft
  3. High carbohydrate low saturated fat 1200 calories
  4. Low sodium, protein to tolerance, moderate fat, high calorie, high vitamin, soft

93.    During administration of an enema, if the client complains of intestinal cramps the nurse should :
  1. Give it at a slower rate
  2. Discontinue the procedure
  3. Stop until cramps are gone
  4. Lower the height of the container

94.    A complete protein ( a food protein of high biologic value) is the one that contains:
  1. All 20 of the amino acids in sufficient quantity to meet human requirements
  2. Sufficient quantities of all 8 essential amino acids and 2 semi essential aminoacids that meet the needs of the human body
  3. The 8 essential amino acids in any proportion because the body can always fill in the difference needed
  4. Most of the 20 amino acids, from which the body will make additional amounts of the 8 essential amino acids needed

95.  The most serious complication associated with chronic inflammatory disease of the bowel is:
  1. Paralytic ileus
  2. Bleeding
  3. Perforation
  4. Obstruction

96.    A client has not passed flatus and there are no bowel sounds even on day 4 after abdominal surgery. Paralytic ileus is suspected. In this condition, the interference is caused by :
  1. Decreased blood supply
  2. Impaired neural function
  3. Perforation of the bowel wall
  4. Obstruction of the bowel lumen

97.    The symptoms of portal hypertension in clients with cirrhosis are chiefly the result of :
  1. Infection of the liver parenchyma
  2. Fatty degeneration of kupffer cells
  3. Obstruction of the portal circulation
  4. Obstruction of the cystic and hepatic ducts

98.   The physician orders daily stool examination for a client with chronic bowel inflammation. These stool examination are ordered to determine:
  1. Ova and parasites
  2. Culture and sensitivity
  3. Fat and undigested food
  4. Occult blood and organisms

99.    Before ligation of haemorrhoids, the physician will suggest the client to eat:
  1. Bland diet
  2. Clear liquid diet
  3. High protein diet
  4. Low-residue diet

100.        The end products of protein digestion; aminoacids, are absorbed from the small intestine by :
  1. Simple diffusion because of their small size
  2. Filtration according to the osmotic pressure direction
  3. Active transport with the aid of vitamin B6 (Pyridoxine)
  4. Osmosis caused by their greater concentration in the intestinal lumen.

102.      The most important method of preventing amoebic dysentery is :
  1. Tick control
  2. Sewage disposal
  3. Killing biting gnats
  4. Pasteurization of milk

103    A debilitated is admitted for palliative treatment of cancer of the liver. On admission, the most helpful objective information for future monitoring of the client’s condition would be:
  1. Diet history
  2. Bowel sounds
  3. Present weight
  4. Pain description

104    In an alcoholic client, a high calorie diet fortified with vitamin should be encouraged to protect the tissue damage of :
  1. Liver
  2. Kidney
  3. Adrenals
  4. Pancreas

105   GI bleeding can be treated medically by an IV infusion. A drug commonly used for this purpose is :
  1. Vasopressin (Pitressin)
  2. Neostigmine (Prostigmin)
  3. Propantheline (Pro-Banthine)
  4. Phytonadione (Aquamephyton)

106.  Fat is water insoluble and  cannot travel freely in the blood The compound formed to serve as a vehicle for transoport of fat is :
  1. Lipoprotein
  2. triglyceride
  3. Phospholipid
  4. Plasma protein

107.  A client with haemorrhoids asks what caused this problem to occur. The nurse explains that it generally results from:
  1. Constipation
  2. hypertension
  3. Eating spicy foods
  4. Poor bowel control

108. Many vitamins and minerals regulate the biochemical reactions of cell metabolism by acting as coenzyme. This means that the vitamin or mineral:
  1. Forms a new compound by a series of complex changes
  2. Is not a part of the enzyme controlling a particular reaction.
  3. May be a necessary catalyst for the reaction to proceed.
  4. Prevents unnecessary reactions by neutralizing or controlling the enzyme.

109.  One of the main functions of bile is to :
  1. Split protein
  2. Emulsify fats
  3. Help synthesize vitamins
  4. Produce an acid condition

110.      The goal of dietary management of peptic ulcer disease is to
  1. Provide optimal amounts of all important nutrients
  2. Increase the amount of bulk and roughage in the diet
  3. Eliminate chemical, mechanical and thermal irritation
  4. Promote psychologic support by offering a wide variety of foods

111.    A client  is just returned to the surgical unit after subtotal gastrectomy. Pulmonary complication can be best                prevented by :
  1. Keeping a plastic  airway in place
  2. Maintaining a consistent oxygen flow rate
  3. Ambulating to increase respiratory exchange
  4. Promoting frequent turning  of the client and deep breathing to mobilize pulmonary secretion

112.      The most therapeutic diet for a client recovering from an acute episode of alcoholism would be :
  1. High protein, low carbohydrate, and low fat
  2. Low protein, high carbohydrate, and high fat
  3. High carbohydrate, low saurated fat, 1800 calories
  4. Protein to tolerance, moderate fat, high calorie and high vitamin

113.      Thiamine chloride and nicotinic acid are ordered for a client with alcoholism. These vitamins are needed for the maintenance of :
  1. Elimination
  2. Efficient circulation
  3. The nervous system
  4. Prothrombin formation

114.      When eliciting the health history from a client with colitis, the nurse knows that colitis is commonly associated with:
  1. Chemical stress
  2. Endocrine stress
  3. Physiologic stress
  4. Psychologic stress.

115.      A client  is accustomed to taking enemas periodically to avoid constipation. The nurse should :
  1. Arrange to have enemas ordered
  2. Have the physician order  a daily laxative
  3. Offer the client a large glass of prune juice and warm water each morning
  4. Realize that enemas will be necessary because the normal conditioned reflex has been lost

116.     A client  is admitted for hemorrhoidectomy. The nurse should observe the area for the presence of
  1. Pruritus
  2. Flatulence
  3. Anal stenosis
  4. Rectal bleeding

117.      The nurse should administer a nasogastric tube feeding slowly to reduce the hazard of :
  1. Distention
  2. Flatulence
  3. indigestion
  4. Regurgitation

118.     In the postanesthesia unit the nurse notices a client, who has undergone an abdominal cholecystectomy has serosangui nous fluid on the abdominal dressing. The nurse should:
  1. Change the dressing
  2. Reinforce the dressing
  3. Apply an abdominal binder
  4. Remove the tape and apply Montgomery straps

119.    The break down of triglyceride molecules yield which of the folowing?
  1. Fatty acids
  2. Amino acids
  3. Urea nitrogen
  4. Simple sugars

120.  The major digestive changes in fat are accomplished in the small intestine by a lipase synthesized in the pancreas. This enzymatic activity:
  1. Synthesizes new triglycerides from the dietary fat consumed
  2. Emulsifies the fat globules and reduces their surface tension
  3. Easily breaks down all the dietary fat to fatty acids and glycerol
  4. Splits off all the fatty acids in about 25% of the total dietary fat consumed.

121. The cooked food that is most likely to remain contaminated by the hepatitis Type A virus is :
  1. Canned tuna
  2. Boiled shrimp
  3. Baked haddock
  4. Steamed lobster

122.  Most of the work of changing raw fuel forms of carbohydrates to the usable fuel glucose is accomplished by enzymes located in the :
  1. Mouth
  2. Small intestine
  3. Large intestine
  4. Stomach mucosa

123. The main function of adipose tissue in fat metabolism is synthesis and :
  1. Release of glucose for energy
  2. Regulation of cholesterol
  3. Transport of lipoproteins for fat transport
  4. Storage of triglycerides for energy reserve

124.  Development of obstructive jaundice is evidenced by:
  1. Inadequate absorption of fat soluble vitamin K
  2. Light amber urine, dark brown stools and yellow skin
  3. Dark coloured urine clay colored stool and itchy skin
  4. Straw colored urine putty colored stool and yellow sclerae

125. Function of vitamin C is related to tissue integrity andhaemorrhagic disrder. It performs these functions by :
  1. Preventing, tissue haemorrhage by providing essential blood clotting materials
  2. Preserving the structural integrity of tissue by protecting he4 lipid matrix of cell, walls form peroxidation
  3. Facilitating adequate absorption of calcium and phosphorus for bone formation to prevent bleeding ain the joint
  4. Strengthening capillary walls and structural tissue by cross linking of collagen fibres found in the ground substance of tissues (intercellular cement substance) and thus prevent tissue haemorrhage

126.  Fat is water insoluble and  cannot travel freely in the blood The compound formed to serve as a vehicle for transoport of fat is :
  1. Lipoprotein
  2. triglyceride
  3. Phospholipid
  4. Plasma protein

127.   When assessing a client with cancer of th tongue the specific adaptation the nurse should expect to find is :
  1. Halitosis
  2. Leukoplakia
  3. Bleeding gums
  4. Substernal pain

128.  When a  client expresses  aversion to meals and eats onlysmall amount the nurse should provide:
  1. Nourishment between meals
  2. Small frequent meals
  3. Only foods the client likes in small portion
  4. Supplementary vitamins to stimulate appetite


129.  When teaching a client to include more bulk in the diet, the nurse recognizes that the action of bulk to promote defaecation is a consequence of the ;
  1. Irritating effect of fiber on the bowel wall
  2. Action of the multiflora of the large intestine
  3. Direct chemical stimulation of the colonic musculature
  4. Tendency of smooth muscle to contract when stretched.

130. After incision and drainage of an oral abscess, the client  should be instructed to notify the physician if there is
  1. Foul odour to the breath
  2. Pain and swelling after 1 week
  3. Pain associated with swallowing
  4. Tenderness to the mouth when chewing

131.  A  90 year old client  with a history of diverticulitis is admitted with severe abdominal pain, anorexia, nausea, vomiting  for 24 hours, markedly elevated temperature, and increased WBCs. The most likely primary reason for performing surgery is :
  1. The symptoms exhibited by the client on admission were life threatening
  2. Surgery is usually indicated for clients with a diagnosis of diverticulitis
  3. In some instances diverticulitis is difficult to differentiate from carcinoma except surgically
  4. The client’s age indicated that immediate correction of the potentially fatal condition was needed.

132.  During a percutaneous endoscopic gastrostomy (PEG) tube feeding, the observation that indicates that the client is unable to tolerate a continuation of feeding would be :
  1. A passage of flatus
  2. Epigastric tenderness
  3. A rise of formula in the tube
  4. The rapid flow of the feeding

133.  If the ileum is removed surgically, the individual may suffer from anaemia because:
  1. Folic acid is absorbed only in the terminal ileum
  2. The haemopoietic factor is absorbed only in the terminal ileum
  3. Iron absorption is dependent on simultaneous bile salt absorption in the ileum
  4. The trace elements copper,  cobalt, and nickel required for hemoglobin synthesis are absorbed only in the ileum

134.  Ingestion of fatty foods causes discomfort in clients with cholelithiasis, because :
  1. Fatty foods are hard to digest
  2. Bile flow into the intestine is obstructed
  3. The liver is manufacturing inadequate bile
  4. There is inadequate closure of the ampulla of Vater

135.  The nurse should protect the client’s skin surrounding a colostomy opening by using :
  1. Alcohol
  2. Mineral oil
  3. Skin barriers
  4. Tincture of benzoin

136.  A client  with cirrhosis of the liver has protein deficiency and longstanding poor nutrition. This deficiency leads to :
  1. Decreased bile in the blood
  2. Fat accumulation in the liver tissue
  3. Coagulation of blood in microcirculation
  4. Tissue anabolism and postitive nitrogen balance

137. A client  with an ileostomy should avoid, which of the following sport?
  1. Skiing
  2. Football
  3. Swimming
  4. Track events.

138.  Following pancreatic surgery, clients are at risk for developing respiratory tract infections because of the
  1. Length of time required for surgery
  2. Proximity of the incision to the diaphragm
  3. Lowered resistance caused by bile in the blood
  4. Transfer of bacteria from the pancreas to the blood

139.  A client is ordered to have gastric lavage. When the lavage tube is inserted the client should be placed in
  1. Supine position
  2. Mid-Fowler’s position
  3. High-Fowler’s position
  4. Trendelenburg position

140. An antrectomy may be performed if the client has a diagnosis of :
  1. Cataracts
  2. Otosclerosis
  3. Gastric ulcers
  4. Trigeminal neuralgia

141. To decrease GI irritablity the nurse should teach the client to minimize the use of
  1. Table salt and rice products
  2. Sugar products and proteins
  3. Milk product and cola drinks
  4. Triglycerides and amino acids.

142.  Which of the following statements about vitamin K is correct?
  1. Vitamin K is found in a wide variety of foods so there is no danger of deficiency.
  2. Almost all vitamin K sufficient for metabolic needs is produced by intestinal bacteria
  3. Vitamin K is rarely found in dietary food surces, so a natural deficiency can easily occur
  4. Usually vitamin K can easily be absorbed without assistance, so all that is consumed is absorbed.

143.  When fat compounds accumulate  to abnormal levels in the blood, the diet may be modified to control them. Exclusion of which of the following is most effective in reducing the fat content of blood?
  1. fruits
  2. Grains
  3. Animal fats
  4. Vegetable oils

144.  Identify the following food group which has lowest content of sodium:
  1. milk
  2. meat
  3. fruits
  4. vegetables

145.  The intestinal suction in clients with intestinal obstruction causes an excessive loss of :
  1. Protein enzymes
  2. Energy carbohydrates
  3. Vitamins and minerals
  4. Water and electrolytes

146.  While caring for a client with hepatitis A the nurse should take special precautions to :
  1. Prevent droplet spread of infection
  2. Use caution when bringing food to the client
  3. Use gloves when removing the client’s bed pan
  4. Wear mask and gown before entering the room

147.  The symptoms of gastroesophageal reflux disease (GERD), can be limited by :
  1. Avoiding heavy lifting
  2. Lying down after eating
  3. Increasing fluid intake with meals
  4. Wearing an abdominal binder or girdle

148. When planning dietary teaching for a cient with malabsorption syndreom the nurse should include the need to avoid:
  1. Rice or corn
  2. Milk or cheese
  3. Fruit or fruit juices
  4. Wheat, rye, or oats

149.  A client with colitis makes the decision to have a colectomy as advised by the physician. A significant factor in the client’s decision may have been the knowledge that :
  1. Surgical treatment cures ulcerative colitis.
  2. It would be temporary until the colon heals
  3. Ulcerative colitis can progress to Crohn’s disorders
  4. Without surgery the client would be unable to eat table foods


1.    Because of the presence of feces in the colon, a client with a fecal impaction has the urge to defecate but is unable to. Flatulence may occur as a result of immobility not just obstruction. Anorexia may occur with a fecal impaction but may also be caused by outer conditions. The frequency of bowel movements varies for individuals. It may be normal for this individual. It may be normal for this individual not to have bowel movement for several days
2.    Rationale : Because the liver is unable to detoxify ammonia to urea, and when hepatic coma is inevitable, protein intake should be restricted (20 g proteins and 2000 calories). The other options have relatively high intake of protein, which will increase blood ammonia levels.
3.    Normal saline is used in irrigtion to prevent electrolyte imbalance. Because of the fresh gastric sutures slow and gentle irrigation should be performed. Most surgeons, however prefer gastric instillation. The purpose of irrigation is to maintain the patency of the tube for gastric decompression. Pushing air and clamping the suction tube can result in blocking the nasogastric tube by viscous drainage. Increasing the pressure or disconnecting suction may cause damage to the suture line.
4.    10 cm is far enough to direct the flow of solution into the bowel. Insertion of 5 cm is inadequate fluid may leak back around the catheter. An insertion of 15 cm may cause trauma to the mucosa. An insertion of 8 inches may cause trauma to the mucosa.
5.    A colostomy irrigation is much like a tap water enema. The solution must be held at 45 cm above the stoma, which is high enough to allow flow into the bowel, but not so high that it flows rapidly, or it can cause cramping or mucosal injury. The other potions do not represent maximum height permitted and may not ensure flow of solution into the bowel.
6.    A rectal tube promotes maximum benefits in 30 minutes. This allows adequate time for gas to escape. 15 minutes is not adequate time to permit removal of flatus. Beyond 30 minutes there would be minimal release of flatus.
7.    If the height of the enema fluid container above the anus in increased, the force and rate of flow also icrease if the containeer is raised excessively, damage to the mucosa may and the procedure will be much more difficult for the client to tolerate. The enema container can be held up to 45 cm above the anus. Upto 37 cm is still be considered within safe limits, 66 cm would be too high and could cause mucosal injury.
8.    Eating food relieves the gnawing sensation. Because the acid secretions in the stomach is neutralized by food rather than irritate the intestinal mucosa. An ache radiating to the left side is not specific to duodenal ulcers. An intermittent colicky flank pain may indicate renal colic. A generalized abdominal pain intensified by moving is a generalized symptoms not specific to duodenal ulcers.
9.    Gluten a cereal protein appears to be responsible for morphologic changes of the intestinal mucosa in individuals with nontropical sprue (adult celiac disease). Folic acid, along with antimicrobial agents is used to treat tropical sprue it causes dramatic improvement. Vitamin B12 may be administered if macroccytic anemia or achlorhydria develop, however, it does not correct the major pathology. The use of corticosteroids may be advantageous with either form of sprue; however, this does not produce the same effect as specific treatment already described.
10.    A flat plate film of the abdomen visualizes abdominal organs as they are. No bowel preparation is indicated. The client may eat and drink as tolerated. Preparation is not required.
11.    The pancreatic pseudocyst is an abnormally dilated space that contains blood, necrotic tissue, and enzymes, which is surrounded by connective tissue. The other options are incorrect definitions of a pseudocyst.
12.    Intussusception is the telescoping of prolapse of a segment of the bowel within the lumen of an immediately connecting part. Kinking of the bowel onto itself is volvulus. Adhesions are ands of scar tissue that can compress the bowel. Protrusion of na organ through the wall that cdontain it is called herniation.
13.    Dumping syndrome occur in about 50% of all individuals who have undergone a gastrectomy. The symproms include weakness, heart palpitations, and diaphoresis. It is therefore, important to explain to the client that such symptoms can be minimized by resting after meals in the semi0Fowler position, eating small meals, and omitting concentrated and highly refined carbohydrates. Gas forming foods (option A ) affect rather thean gastric disorders. Option C is inappropriate , because in order to prevent rapid emptying of the stomach eating habits should be modified.
14.    Barium salts used in a GI series and barium enemas coat the inner lining of the GI tract and then absorb X-rays passing through. Thus, they outline the surface features of the tract on photographic plate. Barium does not fluoresce. It has no light emiting properties, nor has any properties f a dye.
15.    Sleeping on pillows raises the upper torso and prevents feflex of the gastric contents through theheria. Eliminating carbohydrates from diet gave have no effect on the mechanical problem of the stomach's contents entering the thoracic cavity. Drinking a large glass of milk before retiring would increase the content of the stomach before lying down, which would aggravate the symptoms associated with a hiatal hernia. The effect of antacids is not long lasting enough to promote a fuill night's sleep, sodium bicarbonate is not the antacid of choice'
16.    Stool softeners and laxatives are administered to avoid straining and constipation. Light dressing are used to promote drainage and healing. Baths are advised to promote healing and cleaning of the area. Enemas may be ordered several days after surgery if the client has not had a bowel movement.
17.    The rapid rate of enema administration or ostomy irrigation often causes abdominal cramping. Additional fluid leads to more discomfort. Cramping will generally subside if the enema tubing is clamped for a few minutes; the procedure can then be continued. Discontinuing the irrigation could lead to ineffective cvacuation of the colon. Lowering the container will decreaqse the rate of flow, but fluid will continue to enter the colon if the container remains above the stoma, indiscriminate advancing of the catheter can injure the mucosa but not relieve the cramping
18.    Essential amino acids are needed to maintain life, but are not synthesized by the body. Option A,B and D are incorrect according to the defination of essential aminoacid. C
19.    Increased ammonia level indicate that the liver is unable to detoxify protein by products. Neomycin reduces the amount of ammonia forming bacteria in the intestine. White bolld cell may indicate infection, however this would have no relationshipto the need for neomycin enema. Culture and sensitivity testing would identify the presence of a microorganism and the medicatio that would be effective in its eradification. It would not be indicated in cirrhosis. Alanine aminotransferase (ALT) is a test to assess for disease but has no relationship to the need for Neomycin enemas
20.    Alcohol stimulates pancreatic enzyme secretion and an increase in pressure in the pancreatic duct The ackflow of enzymes into th epancreatic interstitial spaces results in partial digestion and inflammation of the pancreatic tissue. Alcohol is not associated with formation of calculi. The demand for insulin is unrelated to pancreatitis. Although the volume of secretions increases, the composition remains unchanged.
21.    To ensure continued suction, ther patency of the tube should be maintained. Normal saline is used to prevent fluid and electrolyte disturbance during irrigation. Option B is not correct because the stomach is not considered a sterile body cavity, so medical asepsis not indicated. Option c is inappropriate, care must be taken to avoid traumatizing the mucosa. Option D is inappriate. Ice chips and water represent fluid intake, which must be approved by the physician. Ice chips and water being hypotonic in nature may lower the serum electrolytes.
22.    Small frequent feedings are tolerated best after a subtotal gastrectomy. Option A is inappropriate because roughage may be irritating to the GI tract after surgery. Option B is wrong, because the individual is generally given small amounts of fluid as soon as oedema subsides and then the diet is gradually progressed. Option D is also inappropriate because allowing only food preferences does not ensure inclusion of nutrients necessary for recovery.
23.    Vitamin A is a fat soluble vitamin that accumulates in the body and is not significantly excreted even if extremely large amounts are ingested. After prolonged ingestion of extremely large doses toxic effects (irritability, increased intracranial pressure, fatigue, night sweats, and severe headache) can occur. Option A is wrong because vitamin A is toxic only after prolonged large dosages. optionC is wrong because Vitamin A can be stored in the liver. Option D is wrong because Vitamin A cannot be synthesized in the body.
24.    The liver stores carbohydrates as glycogen which is a polymer of glucose for future energy needs. Glycerol a byproduct of lipids, which combines with three fatty acids to form a triglyceride. Fat is not saved in the liver. Amino acids are not a ready form of energy. Polymer of amino acids form protein.
25.    Bile salts are surfactants that help in absorption and transport of lipids and lipid soluble vitamins across the cells lining the GI tract. Hydrochloric acid is secreated by the stomach and has no role in absorption fats and fat soluble vitamins. Lipas and amylase are enzyme that are involved in digestion of fats and carbohydrates respectively
26.    Fatty acids are insoluble in water dn must combine with bile to form water solble substances for digestion and absorption. Lipase is pancreatic enzyme. Amylase which digests starch is found in saliva and pancreatic juice. Cholesterol is not required for emulsification of fats
27.    Milk and milk products are not tolerated well because they contain lactose; a disaccharide that is broken down by the enzyme lactase to yield to galactose and glucose. Lactose intolerance is commonin theose of afroamerican heritage. Who lack in lactase. Maltase is an enzyme that assists the digestion of maltose, which is not a milk sugar. Sucrase is an enzyme that assists he digestion of sucrose, which is not a milk sugar. Amylase is an enzyme that assists the digestion of starch, which is not a milk sugar.
28.    ALT is also known as glutamate pyruvate transaminase SGPT, that is released early in the course of liver damage. A rise in bilirubin, an  alteration in proteins, or an elevation of alkaline phosphatase are not early signs liver damage.
29.    Emotional stress of any kind can stimulate peristalsis and thereby increase the volume of drainage. The client should be encouraged t eat a diet as normal as possible. Ileostomy drainage is liquefied and continuous, so irrigations are not indicated. The stoma will start to drain within the first 24 hours after surgery.
30.    Although foods that produce gas are generally avoided, the diet of an individual with a colostomy should be as close to normal as possible for optimal physiologic and psychologic adaptation. A high protein diet is important until healing occurs, but a balanced diet generally meets nutritional needs for protein. There is no need to limit fibre, it provides bulk necessary for unconstipated stools. Because absorption of nutrients is unaffected, there is no need to increase carrbohydrate intake.
31.    The bladder must be empty to decrease the chance of puncturing it during the paracentesis. Option B and C are not necessary. Paracentesis is usually peerformed in the Fowler position to assist the flow of fluid by gravity, and not in supine position.
32.    Roast beef, baked potato, carrot and tea ae low in gluten, hence this combination can be served. Flours used in the oroduction of noodle and bread are high in gluten. Popstum is a cereal drink, which is high in gluten.
33.    Because the soft tissues of the GI tract lack sufficient quantities of X-ray absorbing atoms (as are naturally present in the dense calcium salts of bone) an X-ray absorbing coating of barium is used for radiologic studies. Barium does not colour the intestinal wall or absorbs X-rays, or interact with electrolytes.
34.    Ample time in the bathroom must be ensured for the actual irrigation process and fecal returns, which may not be immediate option A and D The availability of adquate time takes precedence ; this would not use the gastrocolic reflex that would occur after eating. Option C This is important; but the availability of adequate time takes precedence.
35.    Blakemore-Sengstaken tube includes an oesophageal balloon that on inflation exerts pressure, which retards hemorrhage. Option A is used for gastric decompression or lavage. It has one lumen. Option B is used for gastric decompression. It has two lumens, one for decompression and one for an air vent. Option C is used for intestinal decompression.
36.    The stoma of a colostomy must be dilated with a lubricated, gloved finger to prevent strictures and subsequent obstruction. Clothing need not be special but should be nonconstricting. Once healing has occurred, activity need not be limited. Diet should be as close to normal for the individual as possible; but gas forming foods should be avoided.
37.    Vincent's angina (trenchmouth) is an infection of the mouth resulting in bleeeding gums, pain on swallowing and talking, and fever. Option A is a symptom related to angina pectoris, resulting from insufficient  oxygenation of myocardial tissue, not Vincent's angina. Option B and C are symptoms related to angina pectoris, and not related to Vincent's angina
38.    ERCP involves the insertion of a cannula into panceratic and common bile ducts during endoscopy. The test is not performed if the client's serum bilirubin is greater than 5 mg/dL, because cannulization may cause oedema which would further increase obstruction to bile flow. Option A, C and D are not related to performing ERCP.
39.    Vomiting may result in aspiration of vomitus because it cannot be expelled, this could cause pneumonia or asphyxia. Infection is not a life threatening problem. Osteomylitis is not life threatening. Bronchospasm is also not life-threatening.
40.    The location of the tumour will usually indicate whether a colostomy (creation of an opening) proximal to the tumour between the colon and the skin surface is needed. An ileostomy is the creation of an opening between the ileum and the skin surface, it would not be done in this condition. A colectomy is the surgical removal of a portion of the colon, with creation of an anstomosis it is generally used in less extensive  carcinoma. A cecostomy is the creation of an opening between the caecum and the skin surface; it is usually a temporary procedure.
41.    Pernicious anaemia is caused by a lack of intrinsic factor produced by the parietal cells of the gastric mucosa that is necessary for B12 to be absorbed in the ileum. Haemopoitic factor is the combination of B12 and intrinsic factor. Chief cells in the stomach secrete the enzymes of the gastric juice, and not extrinsic factor.
45    Cholecystokinin is a widely distributed hormone whose functions include stimulation of gallbladder contraction and release of pancreatic enzymes. It also functions as a neurotransmitter in the CNS. Gastrine stimulates the secretion of gastric juice, secretin promotes the production of bile by the liver and the secretion of pancreatic juice, and enterocrinin stimilates the secretion intestinal juice (succus entericus)
46    Vitamin K is required for the synthesis of prothrombin. It is a fat-soluble vitamin and is not absorbed from the GI tract in the absence of bile. Bilirubin is the bile pigment formed by the breakdown of erythrocytes. Thromboplastin converts prothrombin to thrombin during the normal coagulation process. Cholecystokinin is the hormone that stimulates pancreatic secretion anti contraction of the gallbladder.
47    This is the unique function of pancreozymin, which is secreted by the duodenal mucosa. It particularly affects the production of amylase. Enterocrinin (Option A ) increases intestinal juice secretion. Enterogastrone (option C ) lessens gastric secretion and motility. Cholecystokinin (Option D )stimulates the flow of bile from the gallbladder.
48    The presence of 50 ml of undigested formula may indicate impaired absorption, the volume of the next feeding may need to be reduced or the feeding postponed to reduce the risk of aspiration. Option A evaluates fluid balance andis best performed over a 24 hour period. Option C is a method for evaluating placement. Option D although weighing the client regualarly is important to evaluating overall nutritional  progress it cannot provide information about absorption of a particular fedding.
49    In cirrhosis of the liver, fibrous scarring within the liver parenchyma, most often from alcohol toxicity, compresses the portal veins and causes a backup of blood and increased presure within the portal system. Fluid seeps into the abdominal cavity (ascites) mainly from the surface ot the liver. Lymph does not escaop from the liver sinusoids into the abdominal cavity. Plasma osmotic oncotic pressure is decreased because of decreased albumin production. Secretin of ADH and aldosterone increase as renal blood flow decrease
50    Circulation to the appendix is compromised when appendix is impacted with faecolith or foreign body which cause inflammation.  Option A : Diet patterns do not predisopse the individual to the development of appendicitis. Option B Bowel infections are rare and do not predispose the individual to the development of appendicitis. Option C : Hypertension may cause generalized oedema. But local  oedema would not occur.
51    In the liver a simple protein combines with a lipid to form a lipoprotein. Lipoproteins circulate freely in the blood and can be utilized easily and quickly in various metabolic processes. The liver does not produce phospholipids. Fat is stored in adipose tissue. The liver does not oxidize fat.
52    The vagus nerve stimulates the stomach to sectete hydrchloric acid When it is severed thisneral pathway is interrupted and thereby stomach secretions are decreased. During vagotomy only that portion of vagus nerve, which innervate stomach will be severed and not the one that innervates heart. The vagus nerve that innervates stomach controls hyerochloric acid secretion, not gastric emptying. Vagus nerve is not a sensory nerve.
53    Neomycin sulfate is poorly absorbed from the GI tract and is therefore used for sterilization of intestines prior to bowel surgery. Destruction of intesteinal bacteria decreases production of vitamin  K . Oral administration of neomycin primarily affects intestinal bacteria. Because it is poorly absorbed from the GI tract neomycin sulfate does not affect urinary tract infections.
54    When the bowel is impacted with hardened faeces, there is often seepage of liquid faeces around the obstruction and thus uncontrolled diarrhoea. In tympanites the bowel may become distended if completely obstructed, but this is a late symptom if it occurs at all. Bright red blood in the stool is indicative of lower GI bleeding. There are often frequent liquid bowel movement in the presence of impaction.
55    The increased plasma hydrostatic pressure in veins of the extremities resulting from heart failure or liver cirrhosis, possible combined with a genetic weakness in the vein walls may lead to varicose vein. Toxins are not responsible for varicose veins. Distention of venous walls occurs as a result of increased rather than decreased pressure. Decreased plasma protein causes fluid to move out of the vascular compartment into the interstitial spaces.
56    Accumulation of nitrogenous wastes in hepatic coma affects the nervous system. Flapping tremors and generalized twitching occur in the second stage of this disease. Stools is often clay colored because of biliary obstruction by a cirrhotic liver. Elevated cholesterol levels are ot necessarily present. As encephalopathy progress to coma, all reflexes are absent.
57    Increased secretion of glucocorticoids and acetylcholine tend to increase peristalsis, causing cramping and diarrhoea with subsequent weight loss. As ulceration occurs, loss of blood leads to anaemia. Leukocytosis is not common in this disease. Haemoptysis (coughing up blood from respiratory tract) is not a related symptom. Fever may or may not be a symptoms and leukopenia does not occur.
58    Saturated fats found in animal tissue are more dense than unsaturated fats that are found in vegetable oils. Saturation or unsaturation of fatty acids has no bearing on color, taste, or anything to do with digestibility.
59    Cirrhosis of the liver results in the development of extensive scar tissue within the liver structure; such scar tissue contracts, around hepatic blood vessels, impeding blood flow and raising the pressure in the hepatic portal system. The physiologic response to slowly developing portal circulatory obstruction is the growthof collateral vessels linking portal veins with oesophageal veins; as destruction progresses, the collaterals become so large  that they bulge into the oesophageal lumen and are called oesophageal varices. Ascites and oedema are the result of the pathophysiologic process in the liver, not the cause. The fluid present in the interwsttial spaces and abdominal cavity is the result of portalhypertension and decreased plasma protein. The liver regenerates but in the case of cirrhosis scar tissue is formed. The aricosities are the result of increased portal pressure.
60    A transverse colostomy is an opening created in the transverse colon. The rectal tube should be pointed to the proximal intestine to evacuate the bowel. Water-soluble lubricant is generally used to facilitate insertion. There are no sphincters so bearing down is unnecessary. Continual force may traumatize the mucous, because lack of nerve endings diminishes sensation.
61    The semi-Fowler's position aids in drainage and prvents spread of infection throughout the abdominal cavity. The Sim's sites' position is generally used for administration of enemas or rectal examination; it would not be helpful in draining the area. The Trendelenburg position would contribute to the spread of infection throughout the abdominal cavity. The dorsal recumbent position would not allow for localization of drainage.
62    The duodenum secretes seeveral digestion related hormones, including secretin, which elicits bicarbonate secretion from the pancreas and pancreozymin, which elicits enzyme secretion from the pancreas. It also brings about gallbladder contractrion and secretion of bile. In this function it is known as cholecystokinin. The liver produce bile, which aids in th edigestion of fat, but does not produce any hormone. The adrenals produce glucocorticoids and epinephrine.the hormones secreted by pancreas are insulin and glucagon.


63    The term anorexia refers to loss of appetite. Apathy refers to alack of concern or emotion . Anxia refers to lack of oxygen. Dysphagia refers to difficulty in swallowing.
64    Because protein breakdown gives off ammonia which cannot be detoxified by the liver protein should be eliminated from the diet. Fleet enemas would not affect ammonia levels, which are associated with hepatic coma a neomycin enema would limit intestinal bacteria which breaks down protein, giving off ammonia. Emergency surgery would affect ammonia levels associated with hepatic coma. Eliminating carbohydrate from the diet is unrelated to protein breakdown and rising ammonia levels. It would have no effect.
65    Bowel training is a program for the development reflex that controls regular emptying of the bowel. The key to success in a conditioning program is adherence to a strict time for evacuation based on the client's individual schedule. The indiscriminate use of laxatives can result in depencency. Although encouraging client's previous habits in the area of diet and use of laxatives should be considered, the cerebrovascular accident affects responses of the client by alttering motility peristalsis and sphincter control despite adherence to previous habits. The passage of load into the stomach does stimulate peristalsis bt it is only one factor that should be considered when planning a specific time for evacuation.
66    The diet shuld be high in protein and calorie, low in fat, and gluten free for individuals with malabsorption syndrome. Protein is needed for tissue rebuilding. The client may prefer foods high in gluten, which would precipitate malabsorption. IV therapy is a dependent function and does not provide all the necessary nutrients. Diarrhoea is caused by malabsorption which accounts for the poor nutritional status, once the diarrhoea is corrected, it is essential to compensate by providing a nutritious diet.
67    To promote understanding and allay anxiety, all diagnostic tests should be explained to te client. Castor oil is not given. No need to withhold fluids for 8 hours, even though it is better to withhold foods. No need to give enema.
68    To permit adequate visualization of the mucosa during the signoidoscopy the bowel must be cleansed with a non irritating enema before examination. The stool should be eliminated from the colon by an enema before the examination. Because only the lower bowel is being visualized, keeping the client NPO  is unnecessary. Clear fluids and a laxative may be given the day before to limit faecal residue. The client does nt drink such a substance in preparation for a sigmoidoscopy.
68 Orange juice has a higher proportion of simple sugars, which are readily available for conversion to energy. Milk contains fat and protein (which require a longer digesting time) and lactose, which is a disaccharide. Bread contains proteins and starch, which require a longer time to digest. Candy bars do not contain the high proportion of simple sugars found in orange juice; they also contain fat, which takes longer time to digest.
69    The client's breath has a fetor hepaticus(swet odour) because the liver is not metabolizing the amino acid methionine. Anuria is characteristic of renal failure. Blepharospasm refers to spasm of the eyelid associated with anxiety or cranial nerve pathology. It is unrelated to liver disease. Globus hystericus is a sensation of a lump in the throat, which is associated with acute anxiety; it is unrelated to liver.
70    Heavy alcohol ingestion predisposes an individual to the development of oral cancer. Nail biting has no effect on the development of oral cancer. Poor dental habit does not affect the development of oral cancer. Frequent gum chewing is not a  contributing factor to development of oral cancer.
71    Icterus is a yellowinsh tinge to the skin, often first observed in the sclerae as a  result of accumulation of bilirubin in the body. Urticaria is generally characteristic of an allergic response. Uremia is characteristic of renal failure . Haemangioma is a benign lesion composed of blood vessels.
72    Neomycin destroys intestinal flora which are responsible for breaking down proteins and the release of ammonia. Ammonia at this time is poorly detoxified by the liver and can build up to toxic levels. Bile levels may be elevated because of biliary obstruction by the enlarged liver but are unaffected by Neomycin. Urea is a byproduct of protein metaboismformed in the liver as it detoxifies ammonia. The production of urea is hampered by severe lliver damage and is unaffected by Neomycin. Haemoglobin levels may be lowered as a result of cirrhosis and bleeding but are not increased by administration of Neomycin.
73    The elevated pressure within the portal circulatory system causes elevated pressure in areas of portal systemic collateral circulation (most important in the distal esophagus and proximal stomach). Haemorrhage is a possible complication liver abscesses are not related to portal hypertension. They may occur as a complication f intestinal infection. Intestinal obstruction is not related to portal hypertension. It may be caused by manipulation of the bowel during surgery. Perforation of the duodenum is usually caused by peotic ulcer it is not a direc result of portal hypertension or cirrhosis.
74    Hepatitis C, formerly called non-A, non-B hepatiti is caused by an RNA virus that is transmitted parenterally. The incubation period is 5 to 10 weeks. Hepatiti A also known as infectious hepatitis is caused by  an RNA virus that is transmitted via the fecal oral route. The incubating period is 6 weeks. Hepatitis B is transmitted parenterally sexually and by diredt contact with infected body secretions. The incubation period is 6 months. It is not the maor cause of posttransfusion hepatitis. Hepatitis D is a complication of hepatitis B.

75    Hernioplasty involves not only the reduction of a hernia but also an attempt to change or strengthen the structure to prevent recurrence. Herniotomy means an opening cut into the hernia; it coes not refer to repair of a hernia. There is no such procedure; herniectomy means cutting the hernia. Herniorrhaphy is surgical repair of a hernia
76    High osmolarity (concentration) of many formulae draws fluid into the intestinal tract, causing diarrhoea. Such fedings may need to be diluted initially until the client develops tolerance. Option A is not corrrect, because formulae frequently have reduced fiber content causing; problems with constipation. Option B is not a factor if feeding are administratered as recommended by the manufacturer. Option C may increase the risk of aspiration but does not increase diarrhoea.
77    Isotonic saline most closely resembles normal body fluids; it will not cause an imbalance by pulling extra fluids and electrolytes and of the circulation. Sterile water and hypotonic solutions would allow absorption of fluid into the circulation, resulting in dilution of electrolytes and possible circulatory overload. Hypertonic solutions would drawfluids out of the circulation into the GI tract; glucose provides a medium for bacterial growth.
78    Rebound tenderness is a classic subjective sign of appendicitis. Urinary retention does not cause acute lower right quadrant pain. Gastric hyperacidity causes epigastric not lower right quadrant pain. There is generally decreased bowel motility distal to an inflamed appendix, but not increased lower bowel motility.
79    Because stomach distention after eating results in contractions of the colon (gastrocolic reflex promoting defaecation establishing some regularly of meals that include adequate bulk or fibree will help establish routine patterna of defaecation. Although increased activity and fluid intake facilitate elimination , in general they do not help establish a pattern, increased potassium is not needed for normal elimination.
80    Intestinal absorption may be inadequate because the  mucosa of the intestine is damaged and its ability to absorb vitamins taken orally is greatly impaired although option A is true, the risks associated with IV administration will outweigh the benefits unless other factors are considered. Vitamins are effective orally unless there is disease involving the GI tract that hampers absorption. IV vitamins do not decrease colonic irritability
81    Nasogastric drainage is expected to be bright red at first and gradually darken within the first 24 hoursafter surgery. Since bloody drainage is expected soon after surgery. The physician need not be notified. Nasogastric tube is irrigated only when the ohysician orders because of the danger injury to fine suture line; generally saline at room temperature would be ordered.
82    Because Neomycin is poorly absorbed from the GI tract, most remains in the intestines and exerts its antibiotic efect on the intestinal mucosa. In preparation for GI surgery the level of microbial organisms will be reduced. Noemycin is nephrotoxic. Because t is ooorly abosorbed from the GI tract, the systemic effect is minimal. Neomycin is mainly efective in suppression of intestinal bacteria.
83    The hepatic portal vein carries blood from the capillary beds of the viscera (small and large intestinal walls stomach, spleen pancreas, gallbladder) to the sinusoids of the liver. The hepatic veins drain the liver sinusoids into the inferior vena cava. The other options are wrong
84    This is the preferred position, because it maximally exposes the rectal area and facilitates entry of the sigmoidoscope. The sim's position does not expose the rectal area to the same extent as the knee chest does but can still be used for sigmoidoscopy, if the dlient is unable to maintain the knee chest position. Althoughprone refers to a face down position, the renal area is not exposed . The Lithotomy position is appropriate for gynaecologic examination.

85    The client must be ready to accept changes in body image and function; this acceptance will facilitate mastery of he techniques of colostomy care, special diets, andoptimal use of community resources. Specific knowledge given in Option A , C andD can be imparted only when an individual is ready to learn it requires acceptance of  a new body image.
86    Vitamin K is a fat soluble vitamin that needs bile salts for its absorption from the upper segment of the small intestine. vitaminK is a catalyst in the carboxylation of glutamine. residues in prothrombin do not inhibit prothrombin synhesis. Vitamin K is not synthesized in the liver. Bile salts have no effect on prothrombinase (thromboplastin)
87    Deep green and yellow vegetables contain large quantities of the pigments alpha, bbeta and gamma carotene; beta-carotene is the major chemical precursor of vitamin A in human nutrition. Oranges are considered a god source of both vitamin C and potassium. Levels of vitamin A are higher in whole milk than in skim milk. Tomatoes are a good source of vitamin C. but not carotene
88    To take advantage of the anatomic position of the sigmoid colon and the effect of gravity, the client should be placed in a left Sim's position for the enema. Back lying position, knee chest position and midfowler position does not facilitate the flow of fluid into the sigmoid colon by gravity.
89    Contracting hepatitis B through blood transfusions can be prevented by screening donors and testing the blood. Options A,C, and D do not prevent transmission of hepatitis B .
90    Muscular rigidity over the affected area is a classic sign of peritonitis, Malaise, rather than hyperactivity is often associated with peritonitis. Nausea is a common occurrence with peritonitis. Urinary retension may occur following surgery as a complication.
91    Protein and calories provide energy, both of which are necessary for tissue building. High fat diet is contraindicated because fat requires bile to be absorbed. The gall bladder has been removed; dietary fat intake depends on individual tolerance. The diet in option D is anadequate for tissue repair.
92    Low sodium controls fluid retention, blood pressure and consequently oedema; low protein controls ammonia formation in proportion to the liver's ability to detoxify ammonia in forming urea; moderate fat and high calories and vitamins help repair a log standing nutritional deficit. High proteins diets are contraindicated because of the liver's inability to detoxify ammonia. Protein restriction is based on the liver's ablility to detoxify ammonia; a high fat diet is avoided because of thte related cardiovascular risks and the relaed demand for bile. Regeneration of tissue requires a high calorie diet; 1200 calories is too low.
93    Administering of additional fluid when a client complains of abdominal cramps adds to discomfort because of additional pressure Clamping the tubing for a few minutes, allows the cramps to subside and the enema can be continued . Slowing the rate decreases pressure but does n ot reduce it entirely. Cramps are not a reason to discontinue the enema entirely . Temporary clamping of the tubing usually relieves the cramps andhte procedure can be continued. Lowering the geight of thecontainer will reduce ht eflow of the solution which will decrease pressure but not reduce it entirely.
94    Complete proteins (option B) contain sufficient quantities of all 8 essential amino acids and 2 semi essential (arginine and histidine) amino acids, which are of animal origin. Semiessential aminoacids are essential only during periods of growth. The other options are inappropriate.
95    As a result of chronic irritation, the colon becomes thin and may perforate. Paralytic  ileus may be a complication of surgical intervention involving the intestines or of perforation. Bleeding may vary from a small amount to haemorrhage; this is not the most serious complication. Obstruction rarely occurs, but if it does it is not the most serious complication.
96    Paralytic ileus occurs when neurologic impulses are diminished, as from anaesthesia, infection or surgery. Interference in blood supply would result in necrosis of the bowel, but not paralytic ileus. Perforation of the bowel would result in pain and peritonitis. Obstruction of the bowel lumen would initially cause increased peristalsis and bowel sound.
97    With obstruction of the portal vein there is an increase in pressure in the abdominal veins, which empty into the portal system. These veins develop collaterals to circumvent the obstruction. The collaterals are usually in the paraumbilical haemorrhoidal, and oesophageal areas. Although infection of the liver parenchyma may predispose to the development of cirrhosis, which in turn can cause portal hypertension, but most often it does not cause portal obstruction. Kupffer cells are part of the reticuloendothelial system, which helps prevent infection and does not primarily affect venous pressure. Obstruction of these ducts blocks flow of bile, causing obstructive jaundice.
98    Occult blood in the stool could indicate active bleeding; the stool should also be examined for microorganisms to detect early infection that could easily become systemic by spread through the damaged intestinal mucosa. Stool examination for ova and parasites, culture and sensitivity or occult blood and organisms is not required in this situation.
99    A low residue diet is advised to limit stool formation. Bland diets are usually employed in the management of upper not lower GI disturbances. Although a clear diet is low in residue it does not meet normal nutritional needs. A high protein diet is indicated postoperatively
100    To take advantage of the anatomic position of the sigmoid colon and the effect of gravity, the client should be placed in a left Sim's position for the enema. Back lying position, knee chest position and midfowler position does not facilitate the flow of fluid into the sigmoid colon by gravity.
101    Complete proteins (ption B) contain sufficient quantities of all 8 essential amino acids and 2 semi essential (arginine and histidine) amino acids, which are of animal origin. Semiessential aminoacids are essential only during periods of growth. The other options are inappropriate.
102    As a result of chronic irritation, the colon becomes thin and may perforate.paralytic ileu may be a complication of surgical intervention involving the intestines or of perforation. Bleeding may vary from a small amount to haemorrhage; this is not the most serious complication. Obstruction rarely occurs, but if it does it is not the most serious complication.
103    Paralytic ileus occurs when neurologic impulses re diminished, as from anaesthesia, infection or surgery. Interference in blood supply would result in necrosis of the bowel, but not paralytic ileus. Perforation of the bowel would result in pain and peritonitis. Obstruction of the bowel lumen would initially cause increased peristalsis and bowel sound.
104    With obstruction of the portal vein there is an increase in pressure in the abdominal veins, which empty into the portal system. These veins develop collaterals to circumvent the obstruction. The collaterals are usually in the paraumbilical haemorrhoidal, and oesophageal areas. Although infection of the liver parenchyma may predispose to the development of cirrhosis, which in turn can cause portal hypertension, but most often it does not cause portal obstruction. Kupffer cells are part of the reticuloendothelial system, which helps prevent infection and does not primarily affect venous pressure. Obstruction of these ducts blocks flow of bile, causing obstructive jaundice.
105    Occult blood in the stool could indicate active bleeding; the stool should also be examined for microorganisms to detect early infection that could easily become systemic by spread through the damaged intestinal mucosa. Stool examination for ova and parasites, culture and sensitivity or occult blood and organisms is not required in this situation.
106    Amino acids (option C ) are absorbed into the blood in the intestinal capillaries with the aid of vitamin B6 via the energy-dependent active transport. Aminoacids are fairly large molecules, they are not absorbed by simple diffusion ( option A), passively diffuse. Option B refers to movement across a semipermeable membrane; it does not apply to aminoacids. Option D is inappropriate like the option C.
107    Weight is valuable information that can be helpful to determining the development or extent of ascites. Diet history will not help in monitoring client's condition. Bowel sounds are objective data but do not help monitor the liver. Pain description is a subjective data.
108    The liver detoxifies alcohol and is the organ most often damaged in chronic alcoholism. The high calorie diet prevents tissue break which produces additional amino acids and nitrogen. These organs kidney, adrenal and pancreas are not involved in detoxification of alcohol.
102 Entamoeba histolytica the organism that cause amebic dysentery is transmitted through excreta, hence proper disposal of sewage is required. This is not a tick borne disease. This orgnism is not transmitted by gnats. This organism is not transmitted via milk.
105    Vasopressin is a vasoconstrictor used with great success in controlling GI bleeding. Neostignine inhibits cholinesterase, permitting acetycholine to function it is used primarily for myasthenia gravis. Propantheline is a gastrointestinal anticholinergic. It decreases motility but has no effecgt on bleeding. Phtonadione is vitamin K; it promotes formation of prothrombin in the liver; although this action would be helpful. It would take too long to be of value in an emergency situation.
106    Lipoprotein are simple proteins combined with lipids to facilitate transport of fat in the blood triglyceride is insoluble in water. Phospholipid is insoluble in water. Plasma proteins do not contain fat.
107    Constipation and prolonged standing are the common causes of hemorrhoids. Hypertension does not contribute developmetn of hemorrhoids. Spicy food may  irritate hemorhoids but does not cause hemorrhoids. Bowel control is unrelated to the development of haemorrhoids.
108    Coenzyme is a non protein substance, which in the presence of a suitable enzyme, serves as catalyst for enzyme catalzsed biochemical reactions. Coenzymes do notform new compound. Coenzyme is a nonprotein part of enzyme. The conenzyme does not neutralize the enzymes.
109    The bile salts in ile act as detergents to break large fat droplets into smaller ones (emulsification), providing a larger surface area for the enzymatic action of fat splitting enzymes lipase. Bile does not act on proteins bile does not help synbhesize vieamins; it emulsifies fat and thus, assists in absorption of fat soluble viatmins bile does not have an acid pH.
110    Elimination of chemical, mechanical and thermal irritants will minimize the irritation of the mucosa thereby bleeding or perforation of intestine is avoided. Optimal amounts of all important nutrients is not specific to this client's problem. Increasing the amount of bulk and roughage in the diet may irritate the mucosa and should be decreased. Promote psychologic support by offering a wide variety of foods is not the primary goal, efforts shoould be made to include foods that are psychologically beneficial, byut not at the expense of food, that are nonirritating to mucosa
111    Clients should turned every hour to promote drainage of different lung regions. Deep breathing inflates the alveoli and promotes fluid drainage. A plastic airway in place will be expelled once the gag reflex returns. Maintaining  a constant oxygen flow rate is not generally required unless there is an underlying cardiac or respiratory disease. Ambulating to increase respiratory exchange is inappropriate, because physical effort by individuals with abdominal incisions often reverts to shallow breathing.
112    Protein helps correct severe malnutrition; moderate fat limits the need for  bile; a high caloric, high vitamin diet prevents tissue breakdown. A diet high in protein, carbohydrates, and calories are needed to improve nhutritional status, but therapeutic for a client reovering from alcoholism. Low protein diet will not aid tissue repair and restore nutritional status calories. High carbohydrate, low saturated fat and 1800 calories does not offer enough fat or calories
113    Thiamine and nicotinic acid help utilize glucose for energy needs of nerve activity. These vitamins do not affect elimination of alcohol. These vitamins are not related to circulatory activity. Prothrombin formation in the liver need vitamin K not thiamine and niacin.
114    Personality and psychologic stresses cause of pathologic changes that influence the development of ulcerative colitis. Chemical stress, endocrine stress and physiologic stress may be other causative factors, but psychologic stess is more commonly associated with this disease.
115    Prune juice and warm water can be administered prophylactically by the nurse to promote defaecation. Prune juice irritates the bowel mucosa stimulating peristalsis. Increased fiber in the diet may also improve intestinal motility. The routine use of enemas should be avoided because they promote dependency and can result in electrolyte imbalance. The routine use of laxatives promotes dependency.
116    Rectal bleeding is a common problem when haemorhhoids are present. Pruritus is not a symptom that can be observed. Flatulence is unrelated to haemorryoids. Anal stenosis is not a complication of haemorrhoidectomy.
117    Regurgitation is a hazard, because the cardiac sphincter of the stomach is slightly opened to admit the nasogastric tube. Distension can be diminished by avoiding the instillation of air with the feeding. The speed of feeding does not cause flatulence, but the administrationof air may. Indigestion is not hazardous to the client.
118    The nurse should anticipate drainage and reinforce the surgical dressing as needed changing a dressing at this time unnecessarily increases the  risk of infection. Abdominal binder is rarely ordered and it would interfere with assessment of the dressing. Montgomery straps are utilized when frequent dressing changes are anticipated, they are not appropriate at this time.
119    Triglycerides are made up of fatty acids bonded (esterified) to glycerol, their breakdown releases fatty acids and glycerol. Amino acid, Urea , and simple sugars are not the components of triglyceride.
120    Pancreatic lipase is an enzyme that aids in the digestion of fat by splitting of fatty acids in about 25% of dietary fats. Lipase does not synthesize triglycerides. Emulsification of fats is the function of bile salts. Lipase does not break down all dietary fat
121    The temperature during steaming is never high enough or sustained long enough to kill virus. Canned tuna, boiled shrimp, and baked haddock are processed at extremely high temperatures which sufficiently destroys  the virus.
122    Pancreatic amylase (which enters the small intestine at the sphincter of Oddi) and sucrase and maltase(which are released by epithelial cells covering teh villi in the small intestine) are responsible for converting fuel form of carbohydrated to usable form ; glucose. Ptyalin present in saliva is oly able to bring about limited digestion of starch in the mouth. Digestion of carbohydrates is completed before their arrival in the large intestine, which is concerned primarily with fluid reabsorption. Carbohydrates are not digested in the stomach because of acidic pH.
123    Triglyceride is composed of three fatty acids and a glycerol molecule. When energy is required the fatty acids are mobilized from adipose tissue for fuel. Release of glcose for energy is not the function of adipose tissue; its main function is storage. Regulation of cholesterol is not a function of adipose tissue; cholesterol is produced in the liver. Transport of lipoproteins for fat transport is not the function of adipose tissue in fat metabolism.
124    Dark colored urine, clay colored stool and itchy skin is due to failure of bile to enter the intestines, with subsequent backup into the biliary system and diffusion into the blood. The bilirubin is carried to all body regions, including the skin (itching ) and kidneys (excretion of bile colored urine.). The absence of bilirubin in the intestine results in clay, colored stools. These signs refer to objective findings of all types of jauncice. Inadequate absorption of fat soluble vitamin K is not an objective finding. Light amber colored urine dark brown stools, yellow skin is a reflection of increased serum bilirubin levels and not obstruction. Straw-colored urine, putty colored stool, yellow sclerae is indicative of hyper  bilirubinaemia of unconjugated type (hepatotoxic jaundice).
125    Vitamin C is required for strengthening intercellular cement substance. Option A is the function of Vitamin K . Option B  is the function of vitamin A. option C is the function of vitamin D. 
126    Leukoplakia are white thickened patches that tend to fissure and to become malignant; ulcerations in the mouth or oil the tongue may indicate cancer. Halitosis would not be an early sign or specific to cancer of the mouth. Bleeding gums occur in gingival diseases.  Pain associated with cancer of the tongue would not radiate to the substernal area.
127    Small meals are not as psychologically overwhelming and do not upse the stomach as easily. Small frequent meals ae therefore better tolerated. Nourishment between meals will not help unless attempts are made to provide small frequent meals. Only foods the client likes in small portion does not ensure adequate nutrition; if the portion size is decreased, frequency must be increased. Supplementary vitamins to stimulate appetite is a dependent nursing function
128    Fiber absorbs water, swells and consequently stretches the bowel wall, promoting peristalsis, mass movements, and defaecation. Smooth muscle tends to contract when stretched because of the reflex activity of stretch receptors. Bulk caused by fiber do not irritate the bowel wall. Bacterial action is not involved in the process, by which bulk stimulates defaecation. There is no chemical stimulation.
129    Pain and swelling should subside before 1 week postoperative. Continued pain may indicate infection. The breath may have an odour because of dried blood in the oral cavity, this is to be expected during the postoperative period. Painful swallowing may occur because of generalized trauma resulting from surgery and is to be expected. Tenderness is expected during the postoperative period.
130    The client status is life threatenig and requires immediate intervention, to delay treatment may prove dangerous because symptoms indicate possible perforation. Diverticulitis can in most causes be treated by diet, rest, and antibiotic therapy. Option C is not true with the diagnostic techniques presently available. Age is not the factor; the symptoms indicate possible peritonitis.
131    A rise in the level of formula within the tube indicates a full stomach. Passage of flatus reflects intestinal motility, which does not pose a potential problem. Epigastric tenderness is not necessarily caused by a full stomach. A rapid inflow is the result of holding the container too high or using a feeding tube with large a lumen
132    Vitamin B12 (extrinsic  factor ) combines with intrinsic factor, a substance secreted by parietal cells of the gastric mucosa forming haemopoietic factor. Haemopoietic factor is only absorbed in the terminal iileum. From which it travels to bone marrow and stimulates erythropoiesis. Folic acid is not absorbed in the terminal ileum. Iron absorption does not occur in the ileum. Trace elements are not absorbed in the ileum.
133    When bile does not mix with food in the intestine emulsification of fats cannot occur and fat digestion is retarded. Stomach motility is also reduced, because, increased stomach peristalsis depends on fat digestion in the small intestine. In cholelithiasis, stones in the gall bladder trap bile in the gall bladder that acts as an irritant. Fats once emulsified by bile are readily broken down by digestive enzymes. Chole lithiasis will not affect production of bile salts. In cholelithiasis thete is obstruction to th eflow of bile from the gall bladder, rather than inadequate closure.
135    A skin barrier such as stomadhesive provides a coating that creates a barrier to gastrointestinal enzymes and protects against allergic reactions to the tape on the appliance. Alcohol tend to dry out the skin and mucosal membranes, leading to irritatio and break. Mineral oil is not an effective skin protectant and would interfere with adherence of any appliance. Tincture of benzoin contains alcohol, which is drying and leads to skin irritation.
136    Lipoproteins, a combination of a fat and a simple protein, have not been formed because of poor protein intake. Therefore fat accumulate in the liver. Elevation of bile in the blood occur because of obstruction to hepatic ducts by the enlarged liver. Individuals with cirrhosis of the liver are likely to have bleeding tendencies (rather than clotting) because fo the decreased synthesis of prothrombin. Deficiency of protein results in the breakdown of tissue (catabolism) and negative nitrogen balance.
137    Trauma to the abdominal wall and to the stoma should be avoided, so contact sports such as football are contraindicated. Trauma to the abdominal wall is a minimal risk in the sports such as skiing, swmming and track events.
138    An incision close to the diaphragm (as in surgery of the pancreas) causes a great deal of pain when the client coughs and deep breaths. These clients tend to take shallow breaths, leading to inadequate expansion of the lungs, accumulation of secretions in the lung, and subsequent infection. Length of time required for surgery is untreated to the development of respiratory infections. The elevtion of serum bilirubin in the blood does not affect the immune mechanisms. Pancreatitis is usually an inflammatory condition not an infectious, process.
139    The high Fowler's position promotes optimal entry of lavage tube into the esophagus aided by gravity. Supine position and Mid-fowler's position does not take full advantage of the effect of gravity. Trendelenburg position is the opposite of the desired position.
140    The antrum is responsible for gastrin production, which stimulates hydrochloric acid secretion; its removal reduces HCl  secretion and thus reduces irritation of the gastric mucosa. Cataracts are treated by removal opaque crystalline lens by means of a laser beam, cryotechnique, or surgery. Otosclerosis is treate4d by stapedectomy, mobilization of the stapes or a prosthetic implant. Trigeminal neuralgia is treated by resection of the fifth cranial nerve.
141    Milk and caffeine in cola are chemically irritating to the intestinal mucosa. They also promote secretion of gastric juice, hence they should be avoided or minimized. Salt helps retain water and rice produces bulk both of which promote mobility. Sugar products and proteins is too general; except for those products that contain lactose generally are not irritating to the mucosa; protein also is not irritating. Triglycerides and amino acids are absorbed slowly but are not irritating.
142    Sufficient quantities of  vitamin K is synthesized by intestinal bacteria. The dietary sources of vitami K iclude liver, egg yolk, cheese, tomatoes and green leafy vegetables. Option A (Vitamin K is found in a small variety of foods), option C (it is found in enough foods so that a natural deficiency usually does not occur), and optio D (Vitamin K is not easily absorbed; it is fat soluble and requires bile salts for its absorption)are inappropriate.
143    Exclusion of animal fats, which are high in dense saturated fats effectively reduces the fat content in the blood. Exclusion of fruits has no effect, because it does not contain saturated fats. Exclusion of grains has no effect, since it does not containsaturated fats. Exclusio of vegetable oil has no effecte, because it contains unsaturated fats.
144    Fruits contain less natural sodium than the other foods listed above. Options A, B and D are incorrrect, because milk has higher sodium content than fruit, meat has higher sodium than fruit, and vegetables have higheer sodium content than fruit.
145    Fluid and electrolytes are lost through intestinal decompression (suction); on a daily basis about one-fifth of the total body water is secreted into the GI tract, which is almost completely reabsorbed. Because the client is kept NPO, there would be no stimulus to cause enymes to be ecreted into the GI tract. IB Dextrose supplies some carbohydrates as a source of energy it would not be drawn from storage by intestinal decompression. Because the client is being kept NPO vitamins and minerals are not entering the GI tract and therefore are not lost.
146    The virus is present in the stool of clients with hepatitis Type A so special handling is requird. The virus may also be present in the urie and in the urine and in the nasotracheal secretions. Hepatitis type A is not usually transmitted by droplet spread. Bringing food to a client; requires no precaution, however disposable utensils should be because the client's nasotracheal secretion contain the virus. Wearing mask and gown before entering the room is nt required, since this virus is not transmitted through air.
147    Heavy lifting increases intraabdominal pressure, allowing gastric contents to move up through the lower oesophageal sphincter (regurgitation) causing heartburn (pyrosis). Lying down after eating encourages regurgitation and should be avoided. Increasing fluid intake wit6h meals increases gastric volume, causing distention and reflux. Wearing an abdominal binder or girdle increase intra abdominal pressure and could lead to reflux.
148    Gluten is present in rye, wheat, and oat products hence they should be avoided. Gluten is not found I rice or corn, milk or cheese, or in fruit or fruit juices hence they need not be avoided.
149    When the diseased bowel segment of colon with ulcers is removed, the client's symptoms cease. Surgical removal of a body part is not temporary, but permanent ulcerative colitis is unr3elated to Crohn' disease; clients with ulcerative colitis have an increased risk for colorectal cancer. Option D is not a true statement.




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