CMSRN Gastrointestinal and Hepatic Care 1 — Questions and Answers
Question 1: A patient with Crohn's disease involving the terminal ileum is at highest risk for deficiency of which nutrient?
- Iron
- Vitamin B12 (Correct answer)
- Folate
- Thiamine
Correct answer: Vitamin B12
The terminal ileum is the exclusive absorption site for vitamin B12, so Crohn's disease affecting this region causes B12 deficiency.
Question 2: Which assessment finding is most indicative of a perforated peptic ulcer requiring emergency intervention?
- Intermittent cramping relieved by antacids
- Sudden severe pain with board-like abdominal rigidity (Correct answer)
- Melena with gradual onset of epigastric pain
- Epigastric burning that worsens between meals
Correct answer: Sudden severe pain with board-like abdominal rigidity
Sudden severe pain with board-like abdominal rigidity indicates peritonitis from gastric contents leaking into the peritoneal cavity, a surgical emergency.
Question 3: A patient with hepatic encephalopathy is prescribed lactulose. What is the primary therapeutic goal of this medication?
- Reduce portal hypertension
- Decrease serum ammonia levels (Correct answer)
- Improve liver enzyme levels
- Prevent formation of esophageal varices
Correct answer: Decrease serum ammonia levels
Lactulose acidifies the colon, trapping ammonia as ammonium ion and promoting its fecal excretion, thereby reducing the serum ammonia causing encephalopathy.
Question 4: A patient with cirrhosis and esophageal varices should be monitored most closely for which immediate life-threatening complication?
- Hepatic coma
- Spontaneous bacterial peritonitis
- Massive upper GI hemorrhage (Correct answer)
- Hepatorenal syndrome
Correct answer: Massive upper GI hemorrhage
Esophageal varices are thin-walled, dilated veins that can rupture suddenly and cause massive, rapidly fatal upper GI hemorrhage.
Question 5: The nurse understands a patient with acute pancreatitis is kept NPO primarily to:
- Prevent aspiration during episodes of nausea
- Rest the pancreas by minimizing enzyme secretion (Correct answer)
- Reduce the risk of wound infection
- Decrease abdominal distension and pain
Correct answer: Rest the pancreas by minimizing enzyme secretion
Oral intake triggers pancreatic enzyme secretion; NPO status eliminates this stimulus, allowing the inflamed pancreas to rest and recover.
Question 6: Which laboratory value is the most specific and sensitive marker the nurse would expect to be elevated in acute pancreatitis?
- Serum lipase (Correct answer)
- Serum bilirubin
- Alkaline phosphatase
- Alanine aminotransferase (ALT)
Correct answer: Serum lipase
Serum lipase is more specific for pancreatic injury than amylase and remains elevated longer, making it the preferred diagnostic marker for acute pancreatitis.
Question 7: A patient who just had a colostomy surgery expresses distress about body image changes. Which nursing intervention is the priority?
- Provide written educational materials about colostomy care
- Encourage the patient to look at and touch the stoma
- Allow the patient to verbalize feelings and validate their concerns (Correct answer)
- Arrange an immediate visit from a certified wound ostomy nurse
Correct answer: Allow the patient to verbalize feelings and validate their concerns
Establishing therapeutic communication by allowing the patient to express feelings and validating concerns is the priority before education or referrals when addressing psychosocial distress.
CMSRN Gastrointestinal and Hepatic Care 1
A patient with Crohn's disease involving the terminal ileum is at highest risk for deficiency of which nutrient?