MSNCB Gastrointestinal Nursing 4 — Questions and Answers
Question 1: A patient with esophageal varices undergoes endoscopic band ligation. In the immediate post-procedure period, the nurse should prioritize monitoring for:
- Aspiration pneumonia
- Re-bleeding and hematemesis (Correct answer)
- Esophageal stricture formation
- Spontaneous bacterial peritonitis
Correct answer: Re-bleeding and hematemesis
Re-bleeding is the most immediate life-threatening complication following esophageal variceal banding.
Question 2: Which electrolyte imbalance is a nurse most likely to find in a patient with prolonged nasogastric suctioning?
- Hyperkalemia and metabolic acidosis
- Hypokalemia and metabolic alkalosis (Correct answer)
- Hypernatremia and metabolic acidosis
- Hyponatremia and metabolic acidosis
Correct answer: Hypokalemia and metabolic alkalosis
NG suctioning removes hydrochloric acid and potassium, leading to hypokalemia and hypochloremic metabolic alkalosis.
Question 3: A patient with hepatitis B asks the nurse how the infection is most commonly transmitted. The correct response is:
- Fecal-oral route via contaminated food or water
- Airborne droplets from coughing or sneezing
- Contact with infected blood, sexual contact, and perinatal transmission (Correct answer)
- Insect vectors such as mosquitoes
Correct answer: Contact with infected blood, sexual contact, and perinatal transmission
Hepatitis B is a bloodborne pathogen transmitted through blood, sexual contact, and from mother to infant at birth.
Question 4: A patient is admitted with a small bowel obstruction. Which assessment finding differentiates a complete obstruction from a partial obstruction?
- Presence of nausea and vomiting
- Absence of flatus and bowel sounds (Correct answer)
- Abdominal distension
- Elevated white blood cell count
Correct answer: Absence of flatus and bowel sounds
Absence of flatus (obstipation) and absent bowel sounds distal to the obstruction are hallmarks of a complete small bowel obstruction.
Question 5: When caring for a patient with an ileal pouch-anal anastomosis (J-pouch), the nurse expects the patient to experience which long-term adaptation?
- Permanent ileostomy output requiring pouching
- Six to eight loose stools per day that decrease over time (Correct answer)
- Normal formed stool within 4 weeks post-surgery
- Continuous fecal incontinence requiring pads indefinitely
Correct answer: Six to eight loose stools per day that decrease over time
After J-pouch creation, patients typically have 6–8 stools/day initially, which decreases as the pouch capacity increases over 12–18 months.
Question 6: A patient with chronic liver disease has a serum albumin of 2.0 g/dL. The nurse understands this contributes to ascites primarily because:
- Decreased albumin reduces osmotic pressure, allowing fluid to shift into the peritoneal cavity (Correct answer)
- Low albumin directly stimulates aldosterone release
- Albumin deficiency impairs bile acid synthesis
- Decreased albumin increases portal venous resistance
Correct answer: Decreased albumin reduces osmotic pressure, allowing fluid to shift into the peritoneal cavity
Low serum albumin decreases oncotic pressure, shifting fluid from the vascular space into the peritoneal cavity.
Question 7: A nurse is irrigating a colostomy and notes no return of irrigation fluid after 30 minutes. The most appropriate initial action is to:
- Increase irrigation fluid volume to 2,000 mL
- Reposition the patient and gently advance the cone (Correct answer)
- Remove the irrigation sleeve and apply a clean pouch
- Call the provider immediately for a suspected obstruction
Correct answer: Reposition the patient and gently advance the cone
Repositioning and gently repositioning the irrigation cone often resolves a kinked tube or stoma spasm that blocks fluid return.
MSNCB Gastrointestinal Nursing 4
A patient with esophageal varices undergoes endoscopic band ligation.
In the immediate post-procedure period, the nurse should prioritize monitoring for: