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Gastrointestinal & Hepatic NCLEX practice questions

Five NCLEX-style questions on cirrhosis, hepatitis, pancreatitis, bowel disorders, ostomies and enteral feeding. Pick your answer, then open it to see the right choice and why. New questions every week.

1. Question 1

   A nurse is caring for a patient who receives intermittent enteral feedings through an NG tube.Before administering a feeding, the nurse should measure the gastric residual for which of the following purposes?

   • A.To remove gastric acid that might cause dyspepsia
   • B.To identify delayed gastric emptying
   • C.To determine the patient’s electrolyte balance
   • D.To confirm the placement of the NG tube
   Show answer and rationale ▾Answer and rationale ▴

   Answer: B. To identify delayed gastric emptying

   While gastric acid can cause dyspepsia, measuring gastric residual is not primarily done to remove gastric acid. Measuring gastric residual is primarily done to identify delayed gastric emptying. This is important because delayed gastric emptying can lead to complications such as aspiration pneumonia. Gastric residual does not directly determine the patient’s electrolyte balance. While confirming the placement of the NG tube is important, it is not the primary purpose of measuring gastric residual.

2. Question 2

   A nurse is developing a care plan for a patient with a decreased level of consciousness who is receiving continuous enteral feedings through a gastrostomy tube due to an inability to swallow.What should be the nurse’s priority action?

   • A.Observe the patient’s respiratory status.
   • B.Elevate the head of the patient’s bed 30° to 45°.
   • C.Monitor intake and output every 8 hours.
   • D.Check residual volume every 4 to 6 hours.
   Show answer and rationale ▾Answer and rationale ▴

   Answer: B. Elevate the head of the patient’s bed 30° to 45°.

   While observing the patient’s respiratory status is important in all patient care, it is not the priority action in this case. The patient’s decreased level of consciousness and inability to swallow increase the risk of aspiration, which can lead to respiratory complications. Elevating the head of the patient’s bed 30° to 45° is the priority action. A patient who has a decreased level of consciousness and an inability to swallow is at risk for aspiration. Lying down also increases this risk. The priority action by the nurse is to keep the head of the bed elevated to promote gastric emptying and reduce the risk of aspiration. Monitoring intake and output every 8 hours is important for assessing the patient’s hydration status and nutritional needs. However, it is not the priority action in this case. The risk of aspiration due to the patient’s decreased level of consciousness and inability to swallow takes precedence. Checking residual volume every 4 to 6 hours is a standard practice when administering continuous enteral feedings through a gastrostomy tube. It helps to ensure that the patient is tolerating the feedings and not at risk for aspiration due to high gastric residuals. However, in this case, the priority is to prevent aspiration by elevating the head of the bed.

3. Question 3

   A hospitalized client who has an advance directive and healthcare power of attorney is receiving enteral nutrition through a nasogastric (NG) tube. The client vomits and appears to be choking. Which action should the nurse take?

   • A.Elevate the head of bed 45 degrees.
   • B.Irrigate the nasogastric tube with water.
   • C.Review the advanced directive document.
   • D.Perform oropharyngeal suctioning.
   Show answer and rationale ▾Answer and rationale ▴

   Answer: D. Perform oropharyngeal suctioning.

   Elevating the head of the bed is a preventive measure, but in this case, the client is actively choking and requires immediate airway clearance. Irrigating the NG tube could worsen the situation by increasing the volume of fluid in the stomach. Reviewing the advance directive does not address the immediate risk of aspiration. Oropharyngeal suctioning helps remove vomitus from the airway, reducing the risk of aspiration, which is a life-threatening complication of enteral feeding.

4. Question 4

   The nurse is conducting an initial admission assessment for a woman who is a Jehovah's Witness and is scheduled to deliver a baby by Cesarean section within the next 24 hours. Which action should the nurse take?

   • A.Determine the client's decision about homologous blood transfusion.
   • B.Arrange for a ritual meeting together with other Jehovah's Witnesses before surgery.
   • C.Obtain primary source of information from the head of the spiritual group.
   • D.Commend the client for her patience after a long wait in the admission process.
   Show answer and rationale ▾Answer and rationale ▴

   Answer: A. Determine the client's decision about homologous blood transfusion.

   Jehovah’s Witnesses often refuse blood transfusions due to religious beliefs. The nurse should assess the client’s specific preferences regarding blood products, as some may accept alternatives like blood volume expanders. The nurse should respect the client’s religious beliefs but is not responsible for arranging religious meetings. The client’s personal decision regarding medical treatment takes precedence over input from a religious leader. Acknowledging patience is courteous but does not address the medical and ethical concerns of blood transfusion.

5. Question 5

   A client on a mechanical soft diet is experiencing constipation and asks the nurse for a glass of prune juice. After auscultating decreased bowel sounds, which action should the nurse implement?

   • A.Offer to warm the prune juice.
   • B.Advance to a regular diet.
   • C.Restrict oral fluid intake.
   • D.Initiate bowel training protocol.
   Show answer and rationale ▾Answer and rationale ▴

   Answer: A. Offer to warm the prune juice.

   Warm fluids help stimulate peristalsis, promoting bowel movement in clients with constipation. A diet change should be based on provider orders and the client’s condition, not just constipation. Fluids should be encouraged, not restricted, as dehydration worsens constipation. While bowel training may be beneficial, it is not the first action—encouraging natural relief through prune juice is a simpler intervention.