MSNCB Gastrointestinal Nursing 2 — Questions and Answers
Question 1: A patient with Crohn's disease is admitted with a fistula between the bowel and bladder. Which assessment finding is most characteristic of an enterovesical fistula?
- Pneumaturia and fecaluria (Correct answer)
- Hematuria and dysuria
- Urinary retention and overflow incontinence
- Proteinuria and pyuria
Correct answer: Pneumaturia and fecaluria
Pneumaturia (air in urine) and fecaluria (fecal matter in urine) are hallmark signs of an enterovesical fistula.
Question 2: A nurse is caring for a patient post-Whipple procedure (pancreaticoduodenectomy). Which early complication requires immediate reporting to the surgeon?
- Blood glucose of 180 mg/dL
- Delayed gastric emptying with nausea
- Amylase-rich drain output exceeding 3× normal serum amylase (Correct answer)
- Mild abdominal distension on post-op day 2
Correct answer: Amylase-rich drain output exceeding 3× normal serum amylase
Drain amylase >3× the upper limit of normal serum amylase on post-op day 3 or later indicates a clinically relevant pancreatic fistula.
Question 3: When teaching a patient with celiac disease, the nurse emphasizes avoiding which grain?
- Rice
- Corn
- Barley (Correct answer)
- Quinoa
Correct answer: Barley
Barley contains hordein, a gluten protein that triggers the autoimmune response in celiac disease.
Question 4: A patient with cirrhosis develops asterixis and confusion. The nurse anticipates which intervention as the priority?
- Administer furosemide IV
- Initiate lactulose therapy (Correct answer)
- Restrict dietary sodium to 2 g/day
- Place a Salem sump tube for gastric decompression
Correct answer: Initiate lactulose therapy
Lactulose reduces intestinal ammonia absorption and is the first-line treatment for hepatic encephalopathy.
Question 5: Which stool characteristic is most associated with an upper GI bleed?
- Bright red blood per rectum
- Tarry, black, malodorous stool (Correct answer)
- Clay-colored stool
- Ribbon-shaped stool
Correct answer: Tarry, black, malodorous stool
Melena (tarry, black, malodorous stool) results from digestion of blood as it transits the GI tract from an upper source.
Question 6: A patient is prescribed total parenteral nutrition (TPN) via a central line. The nurse should monitor most closely for which metabolic complication during the first 24 hours?
- Hyperkalemia
- Refeeding syndrome with hypophosphatemia (Correct answer)
- Metabolic alkalosis
- Hypercalcemia
Correct answer: Refeeding syndrome with hypophosphatemia
Refeeding syndrome causes rapid intracellular shifts of phosphate, potassium, and magnesium when nutrition is restarted after starvation.
Question 7: A patient returns from colonoscopy with polypectomy. Which assessment finding requires immediate intervention?
- Mild abdominal cramping
- Passage of small amounts of blood-tinged stool
- Firm, board-like abdomen with rebound tenderness (Correct answer)
- Low-grade fever of 37.6°C (99.7°F)
Correct answer: Firm, board-like abdomen with rebound tenderness
A rigid, board-like abdomen with rebound tenderness suggests bowel perforation, a surgical emergency.
MSNCB Gastrointestinal Nursing 2
A patient with Crohn's disease is admitted with a fistula between the bowel and bladder.
Which assessment finding is most characteristic of an enterovesical fistula?