MSNCB Gastrointestinal Nursing 3 — Questions and Answers
Question 1: A patient with a new ileostomy reports watery output of 2,500 mL in 24 hours. The nurse's priority action is to:
- Increase dietary fiber intake
- Assess for signs of dehydration and electrolyte imbalance (Correct answer)
- Apply a larger ostomy pouch
- Administer a bulk-forming laxative
Correct answer: Assess for signs of dehydration and electrolyte imbalance
High ileostomy output >2,000 mL/day places the patient at risk for dehydration, hyponatremia, and hypokalemia.
Question 2: Which laboratory finding is most consistent with a diagnosis of acute pancreatitis?
- Serum lipase >3× upper limit of normal (Correct answer)
- Elevated direct bilirubin
- Decreased serum albumin
- Elevated serum alkaline phosphatase
Correct answer: Serum lipase >3× upper limit of normal
Serum lipase elevated more than three times the upper limit of normal is the most sensitive and specific marker for acute pancreatitis.
Question 3: A patient with GERD is prescribed omeprazole. The nurse should instruct the patient to take this medication:
- At bedtime with a full glass of water
- 30–60 minutes before the first meal of the day (Correct answer)
- With food to reduce GI upset
- As needed when heartburn symptoms occur
Correct answer: 30–60 minutes before the first meal of the day
Proton pump inhibitors are most effective when taken 30–60 minutes before a meal so the drug is active when acid pumps are stimulated.
Question 4: A nurse is assessing a patient with suspected appendicitis. Which finding is described as Rovsing's sign?
- Pain in the RLQ when the left lower quadrant is palpated (Correct answer)
- Increased RLQ pain with internal rotation of the right hip
- RLQ pain elicited by elevation of the right leg against resistance
- Tenderness at McBurney's point on direct palpation
Correct answer: Pain in the RLQ when the left lower quadrant is palpated
Rovsing's sign is RLQ pain that occurs when pressure is applied to the left lower quadrant, suggesting peritoneal irritation.
Question 5: Which diet modification is most appropriate for a patient with diverticulosis (no active diverticulitis)?
- Low-fiber, low-residue diet
- High-fiber diet with adequate fluid intake (Correct answer)
- Clear liquid diet long-term
- High-protein, low-carbohydrate diet
Correct answer: High-fiber diet with adequate fluid intake
A high-fiber diet softens stool and reduces intraluminal pressure, decreasing the risk of diverticular inflammation.
Question 6: A patient with ulcerative colitis is experiencing a severe flare with 10 bloody stools per day. Which complication should the nurse monitor for most urgently?
- Cholelithiasis
- Toxic megacolon (Correct answer)
- Anal fissure
- Hemorrhoids
Correct answer: Toxic megacolon
Toxic megacolon is a life-threatening complication of severe ulcerative colitis characterized by colonic dilation and risk of perforation.
Question 7: A patient recovering from a partial gastrectomy develops diaphoresis, palpitations, and dizziness 20 minutes after eating. The nurse recognizes this as:
- Anastomotic leak
- Early dumping syndrome (Correct answer)
- Late dumping syndrome
- Marginal ulcer formation
Correct answer: Early dumping syndrome
Early dumping syndrome occurs within 15–30 minutes of eating due to rapid emptying of hyperosmolar chyme into the small intestine.
MSNCB Gastrointestinal Nursing 3
A patient with a new ileostomy reports watery output of 2,500 mL in 24 hours.
The nurse's priority action is to: