NCLEX : NCLEX

Study concepts, example questions & explanations for NCLEX

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Example Questions

Example Question #3 : Gastrointestinal Conditions

What part of the bowel is most often affected by Crohn's disease?

Possible Answers:

The terminal ileum

The sigmoid colon

The ascending colon

The rectum

Correct answer:

The terminal ileum

Explanation:

While Crohn's disease can affect any part of the alimentary canal, the small intestine, particularly the terminal ileum, is the most common site of serosal inflammation. 

Example Question #4 : Gastrointestinal Conditions

What is the characteristic mucosal alteration seen in ulcerative colitis?

Possible Answers:

Granulomas

Crypt abscess

Skip lesions

Thickened mucosa

Correct answer:

Crypt abscess

Explanation:

The characteristic histological alteration seen in ulcerative colitis is the crypt abscess, in which inflammation causes loss of goblet cells due to neutrophilic exudate in glandular lumens. Granulomas, thickened mucosa, and skip lesions are all seen in Crohn's disease.

Example Question #4 : Gastrointestinal Conditions

Frequent projectile, non-bilious vomiting starting 2-3 weeks after birth is indicative of what condition?

Possible Answers:

Congenital hypertrophic pyloric stenosis

Diverticulitis

Intussusception

Infant gastroesophageal reflux disease (GERD)

Correct answer:

Congenital hypertrophic pyloric stenosis

Explanation:

In congenital hypertrophic pyloric stenosis, the smooth muscle of the pylorus becomes thickened, decreasing the lumen size of the pylorus. This prevents food from passing out of the stomach and into the small intestine, resulting in vomiting which is often projectile and tends to be non-bilious. Intussusception may show vomiting, but the more obvious sign is bloody "currant jelly" stools. Infant gastroesophageal reflux disease (GERD) may result in frequent spitting up, but projectile vomiting is rare. Diverticulitis is generally a condition of the elderly and tends to present as abdominal pain with alterations in bowel function and mild fever. 

Example Question #1 : Identifying Gastrointestinal Conditions

What co-moridity is generally seen with esophageal varices?

Possible Answers:

Cirrhosis

Achalasia

Hiatal hernia

Gastroesophageal reflux disease (GERD)

Correct answer:

Cirrhosis

Explanation:

Esophageal varices are most commonly seen in patients with cirrhosis due to portal hypertension. Gastroesophageal reflux disease (GERD) is associated with esophagitis and occasionally with metaplastic changes. Neither hiatal hernia nor achalasia are associated with esophageal varices.

Example Question #5 : Gastrointestinal Conditions

What sign might indicate Hirshsprung's disease in a newborn?

Possible Answers:

Vomiting within 48 hours of delivery

Failure to pass meconium within 48 hours of delivery

Unrelenting crying

Bloody stool 3-5 days after birth

Correct answer:

Failure to pass meconium within 48 hours of delivery

Explanation:

While an infant with Hirshsprung's disease may have vomiting and bloody stool, the most common sign is failure to pass meconium within 48 hours of delivery. Hirschsprung's disease, which is an absence of innervation to the large intestine, which results in narrowing and constriction of one part of the bowel and dilation of the preceding segment, can be diagnosed by biopsy of the distally narrowed segment of the bowel.

Example Question #6 : Gastrointestinal Conditions

What tissue of the gastrointestinal tract is affected in Celiac disease?

Possible Answers:

Rectum, causing fistulation

Small intestine, causing villous atrophy

Large intestine, causing ulceration

Stomach, causing gastritis

Correct answer:

Small intestine, causing villous atrophy

Explanation:

While individuals with Celiac disease can certainly have gastritis, fistulas, and ulceration due to inflammation, the primary effect of Celiac disease is villous atrophy in the small intestine. Villi become blunted, leading to loss of ability to absorb nutrients, including minerals and fat-soluble vitamins. 

Example Question #7 : Gastrointestinal Conditions

Which of the following refers to bleeding from partial-thickness tears in the mucosa at the junction of the stomach and esophagus?

Possible Answers:

Mallory–Weiss syndrome 

Esophagitis

Barrett's esophagus

Boerhaave's syndrome

Correct answer:

Mallory–Weiss syndrome 

Explanation:

Mallory–Weiss syndrome refers to bleeding from partial-thickness tears in the mucosa at the junction of the stomach and esophagus, often from trauma such as violent retching or coughing. This is compared to Boerhaave's syndrome, which is a full-thickness tear of the esophageal wall. Esophagitis is most commonly caused by gastroesophageal reflux disease (GERD) and does not present with bleeding. Barrett's esophagus refers to a type of metaplasia in the lower esophagus which is thought to be caused by chronic GERD.

Example Question #1161 : Nclex

Full-thickness (transmural) ulceration of the bowel wall occurs in what condition?

Possible Answers:

Crohn's disease

Celiac disease

Irritable bowel syndrome

Ulcerative colitis

Correct answer:

Crohn's disease

Explanation:

Full-thickness (transmural) ulceration of the bowel wall occurs in Crohn's disease. Bowels may also show thickened walls, serosal adhesions, and loss of the regular folds.

In ulcerative colitis, ulceration is restricted to the gut mucosa. Celiac disease results in blunting of intestinal villi, but does not cause ulceration in any form. Irritable bowel syndrome, or IBS, is considered a functional disease as it results in no known pathological tissue changes.

Example Question #11 : Gastrointestinal Conditions

Janelle is a 56 year old woman who is three days post total abdominal hysterectomy. She has not passed gas or had a bowel movement since before surgery. The patient starts vomiting dark brown material. The nurse should be sure to do which of the following? 

Possible Answers:

Place a cool washcloth on the patient's forehead.

Have the patient lay on her left side. 

Report the finding to the next shift.

Administer anti-emetics.

Auscultate for bowel sounds.

Correct answer:

Auscultate for bowel sounds.

Explanation:

The patient is displaying symptoms that could indicate a paralytic ileus. A paralytic ileus is a blockage of the intestine that may result after surgery, most commonly abdominal surgery. During an ileus, the intestine cannot move food through the bowel. A patient with this condition will not have bowel sounds. Constipation, nausea, and vomiting are all considered symptoms of an ileus. 

Example Question #12 : Identifying Gastrointestinal Conditions

The nurse is caring for an 89 year old male who has been admitted for nausea and vomiting. His treatment plan consists of IV fluid replacement of  normal saline at , IV ondansetron PRN, IV prochlorperazine PRN, and an NPO diet. The patient starts to show signs of confusion. The nurse may suspect which of the following? 

Possible Answers:

The NPO order.

New onset of Alzheimer's disease.

The IV fluid composition.

The IV fluid replacement rate.

The patient's anti-emetics.

Correct answer:

The patient's anti-emetics.

Explanation:

Older adults are at high risk for the development of side effects related to medication use. Anti-emetics are commonly administered medications and may cause confusion, especially in older adults.

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