Certified Gastroenterology RN Patient Assessment and Education 4 — Questions and Answers
Question 1: A patient with a new ileostomy asks why output must be monitored closely in the first weeks. The nurse's best response is based on which risk?
- High-volume liquid output can cause dehydration and electrolyte imbalance (Correct answer)
- Ileostomy output is normally formed and infrequent
- The stoma will permanently stop functioning if output is high
- Monitoring is only needed if the patient develops a fever
Correct answer: High-volume liquid output can cause dehydration and electrolyte imbalance
Ileostomy effluent is liquid and high in sodium and water, placing new ostomates at high risk for dehydration.
Question 2: During assessment, the nurse notes a positive Murphy's sign. This finding is most associated with which condition?
- Acute cholecystitis (Correct answer)
- Acute appendicitis
- Splenic rupture
- Diverticulitis
Correct answer: Acute cholecystitis
Murphy's sign, inspiratory arrest during palpation of the right upper quadrant, indicates gallbladder inflammation.
Question 3: Which instruction should the nurse include when teaching a patient to collect a fecal immunochemical test (FIT) at home?
- Collect the sample as directed and return it promptly; no dietary restrictions are required (Correct answer)
- Eat a red-meat-rich diet for three days before collecting the sample
- Stop all medications for one week before testing
- Refrigerate the sample for at least two weeks before mailing
Correct answer: Collect the sample as directed and return it promptly; no dietary restrictions are required
FIT detects human globin specifically, so unlike guaiac testing it requires no dietary or most medication restrictions.
Question 4: A patient with inflammatory bowel disease starting infliximab requires which assessment before the first dose?
- Screening for latent tuberculosis and hepatitis B (Correct answer)
- A 24-hour urine collection for creatinine clearance
- Pulmonary function testing with spirometry
- Baseline audiometry testing
Correct answer: Screening for latent tuberculosis and hepatitis B
Anti-TNF agents can reactivate latent TB and hepatitis B, so screening is mandatory before initiation.
Question 5: The nurse is teaching a patient with diverticulosis about long-term dietary management. Which recommendation is appropriate?
- Eat a high-fiber diet with adequate fluid intake (Correct answer)
- Avoid all nuts, seeds, and popcorn permanently
- Follow a low-residue diet indefinitely
- Limit fluids to prevent diarrhea
Correct answer: Eat a high-fiber diet with adequate fluid intake
Current evidence supports high fiber and fluids for diverticulosis; routine avoidance of nuts and seeds is no longer recommended.
Question 6: When assessing bowel sounds in a patient with a suspected early mechanical small bowel obstruction, the nurse would expect to hear:
- High-pitched, tinkling sounds above the obstruction (Correct answer)
- Completely absent sounds in all quadrants immediately
- Normal soft gurgles every 5 to 15 seconds
- A continuous venous hum over the epigastrium
Correct answer: High-pitched, tinkling sounds above the obstruction
Early mechanical obstruction produces high-pitched, tinkling, hyperactive sounds proximal to the blockage.
Question 7: A patient with chronic liver disease asks why the nurse checks for spider angiomas and palmar erythema. The nurse explains these findings reflect:
- Elevated circulating estrogen due to impaired hepatic metabolism (Correct answer)
- Vitamin C deficiency from poor diet
- A localized allergic skin reaction
- Early signs of skin cancer
Correct answer: Elevated circulating estrogen due to impaired hepatic metabolism
The failing liver cannot metabolize estrogens, producing vascular skin changes like spider angiomas and palmar erythema.
Certified Gastroenterology RN Patient Assessment and Education 4
A patient with a new ileostomy asks why output must be monitored closely in the first weeks.
The nurse's best response is based on which risk?