MSNCB Gastrointestinal Nursing 5 — Questions and Answers
Question 1: A patient with peptic ulcer disease is found to be H. pylori positive. The nurse anticipates which treatment regimen?
- Proton pump inhibitor monotherapy for 8 weeks
- Triple therapy: PPI plus clarithromycin plus amoxicillin for 14 days (Correct answer)
- H2 blocker plus bismuth subsalicylate for 7 days
- Antacids and dietary modification only
Correct answer: Triple therapy: PPI plus clarithromycin plus amoxicillin for 14 days
Standard H. pylori eradication uses triple therapy with a PPI, clarithromycin, and amoxicillin for 10–14 days.
Question 2: A patient is scheduled for a barium enema. Which pre-procedure instruction is most important?
- Maintain a full liquid diet for 48 hours before the procedure
- Complete a bowel prep with laxatives and clear liquid diet (Correct answer)
- Avoid aspirin and NSAIDs for one week prior
- Fast for 12 hours with nothing by mouth after midnight
Correct answer: Complete a bowel prep with laxatives and clear liquid diet
Thorough bowel cleansing is essential for a barium enema to ensure adequate visualization of the colon.
Question 3: A nurse assesses a patient post-liver transplant who is receiving tacrolimus. Which finding requires immediate notification of the provider?
- Mild hand tremors
- Serum creatinine rising from 0.9 to 2.4 mg/dL over 48 hours (Correct answer)
- Blood glucose of 130 mg/dL
- Headache rated 3/10
Correct answer: Serum creatinine rising from 0.9 to 2.4 mg/dL over 48 hours
A rapid rise in serum creatinine indicates tacrolimus nephrotoxicity or acute rejection, both requiring urgent evaluation.
Question 4: Which intervention best prevents aspiration when administering a tube feeding via nasogastric tube?
- Administer feedings in the supine position to promote gastric emptying
- Verify tube placement with pH testing of aspirate before each feeding (Correct answer)
- Use a large-bore tube to allow for rapid delivery
- Clamp the tube for 30 minutes after each intermittent feeding
Correct answer: Verify tube placement with pH testing of aspirate before each feeding
Confirming tube placement by measuring the pH of gastric aspirate (pH ≤5.5) helps ensure the tube is in the stomach before feeding.
Question 5: A patient with a new diagnosis of Crohn's disease asks about surgical cure. The nurse's best response is:
- Surgery cures Crohn's disease by removing the affected bowel segment
- Surgery is not an option for Crohn's disease
- Surgery controls complications but does not cure Crohn's disease, as it can recur (Correct answer)
- A colectomy with ileostomy permanently eliminates Crohn's disease
Correct answer: Surgery controls complications but does not cure Crohn's disease, as it can recur
Unlike ulcerative colitis, Crohn's disease is not cured by surgery and frequently recurs at or near the anastomosis.
Question 6: A patient with end-stage liver disease is scheduled for a transjugular intrahepatic portosystemic shunt (TIPS) procedure. The primary goal of this intervention is to:
- Improve hepatic synthetic function
- Reduce portal hypertension to control variceal bleeding and refractory ascites (Correct answer)
- Eliminate the need for liver transplantation
- Reverse hepatic encephalopathy
Correct answer: Reduce portal hypertension to control variceal bleeding and refractory ascites
TIPS creates a shunt between the portal and hepatic veins to decompress the portal system and reduce portal hypertension.
Question 7: Which nursing intervention is highest priority when caring for a patient in the immediate postoperative period following a hemorrhoidectomy?
- Encourage ambulation every 2 hours
- Assess pain level and administer analgesics before bowel movements (Correct answer)
- Apply a rectal tube to minimize pressure on the surgical site
- Administer a Fleet enema to cleanse the operative area
Correct answer: Assess pain level and administer analgesics before bowel movements
Pain management prior to bowel movements is critical to prevent fecal retention, constipation, and wound dehiscence after hemorrhoidectomy.
MSNCB Gastrointestinal Nursing 5
A patient with peptic ulcer disease is found to be H. pylori positive.
The nurse anticipates which treatment regimen?