A patient on parenteral nutrition has a capillary glucose of 14.2 mmol/L (256 mg/dL). What should the nurse do?

Report it and give insulin per protocol

Stop the parenteral nutrition at once and recheck in an hour

Double the infusion rate to finish the bag sooner

Ignore it because high glucose is expected on parenteral nutrition

Thirty minutes after a new bag of parenteral nutrition is hung through a central line, the patient has rigors, a temperature of 38.9 °C and a pulse of 118/min. What should the nurse do first?

Stop the infusion and take blood cultures

Slow the infusion to half rate and recheck in one hour

Flush the line with saline and keep the bag running

Give paracetamol and continue the infusion

The main purpose of a nasogastric tube on low intermittent suction in small bowel obstruction is to:

Decompress the stomach and relieve vomiting

Collect a sample to culture the bowel contents

Give oral medicines while the patient is nil by mouth

Feed the patient until the obstruction clears

Soon after admission with haematemesis, a patient turns pale and clammy; BP 88/50 mmHg, pulse 124/min. What is the nurse's priority?

Insert two large-bore IV cannulas and start fluids

Give an oral proton pump inhibitor straight away

Pass a nasogastric tube and lavage with iced water

Prepare him for urgent endoscopy before anything else

On day 2 of severe acute pancreatitis, the nurse finds: pain 6/10, BP 112/70 mmHg, urine 40 mL/h, RR 30/min, SpO2 89% on room air, and fine crackles at both bases. Which finding is the priority?

Rising respiratory rate with SpO2 89%

Gastrointestinal, hepatic and nutrition care

36 Gulf Prometric RN (DHA, DOH, MOH, SCFHS) practice questions on Gastrointestinal, hepatic and nutrition care, part of Adult Health Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A patient on parenteral nutrition has a capillary glucose of 14.2 mmol/L (256 mg/dL). What should the nurse do?
1. AStop the parenteral nutrition at once and recheck in an hour
2. BDouble the infusion rate to finish the bag sooner
3. CIgnore it because high glucose is expected on parenteral nutrition
4. DReport it and give insulin per protocol
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Answer: D · Report it and give insulin per protocol
Hyperglycaemia is a common complication of parenteral nutrition because of its glucose load, and it raises the risk of infection. It is reported and treated with insulin as prescribed, and the regimen may be adjusted. Stopping the infusion suddenly can cause rebound hypoglycaemia.
- A: Abrupt stopping can cause rebound hypoglycaemia.
- B: A faster rate adds more glucose and worsens the problem.
- C: A glucose of 14.2 mmol/L needs treatment and must not be ignored.
Question 2 · Hard
Thirty minutes after a new bag of parenteral nutrition is hung through a central line, the patient has rigors, a temperature of 38.9 °C and a pulse of 118/min. What should the nurse do first?
1. AStop the infusion and take blood cultures
2. BSlow the infusion to half rate and recheck in one hour
3. CFlush the line with saline and keep the bag running
4. DGive paracetamol and continue the infusion
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Answer: A · Stop the infusion and take blood cultures
Sudden fever and rigors soon after a new bag is hung suggest contamination of the infusion or a catheter-related bloodstream infection. The infusion is stopped and kept for culture, blood cultures are taken from the line and a peripheral vein, and the doctor is told. Sepsis screening and early antibiotics follow if the patient meets sepsis criteria.
- B: Slowing the rate still delivers a possibly contaminated infusion.
- C: Flushing pushes organisms into the blood and delays treatment.
- D: Paracetamol masks fever while contaminated fluid keeps running.
Question 3 · Easy
The main purpose of a nasogastric tube on low intermittent suction in small bowel obstruction is to:
1. ADecompress the stomach and relieve vomiting
2. BCollect a sample to culture the bowel contents
3. CGive oral medicines while the patient is nil by mouth
4. DFeed the patient until the obstruction clears
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Answer: A · Decompress the stomach and relieve vomiting
Fluid and gas build up above an obstruction and cause distension, pain and vomiting. A nasogastric tube on suction removes them, eases symptoms and lowers the risk of aspiration while IV fluids correct the losses. The drainage volume and colour are recorded and added to the fluid balance.
- B: Culture of gastric drainage is not the aim of decompression.
- C: Medicines would be suctioned out and are given by another route.
- D: Feeding into an obstructed gut worsens distension and vomiting.
Question 4 · Medium
Soon after admission with haematemesis, a patient turns pale and clammy; BP 88/50 mmHg, pulse 124/min. What is the nurse's priority?
1. AGive an oral proton pump inhibitor straight away
2. BPass a nasogastric tube and lavage with iced water
3. CPrepare him for urgent endoscopy before anything else
4. DInsert two large-bore IV cannulas and start fluids
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Answer: D · Insert two large-bore IV cannulas and start fluids
Hypotension and tachycardia after haematemesis show hypovolaemic shock, so restoring circulating volume comes first. Two large-bore cannulas allow fast fluids and blood, and bloods are taken for group, cross-match and a blood count at the same time. Endoscopy follows once he is resuscitated, and iced-water lavage is no longer used.
- A: An oral drug cannot be given safely to a vomiting, shocked patient.
- B: Iced lavage does not stop bleeding and is outdated.
- C: Endoscopy is done after resuscitation, not before.
Question 5 · Hard
On day 2 of severe acute pancreatitis, the nurse finds: pain 6/10, BP 112/70 mmHg, urine 40 mL/h, RR 30/min, SpO2 89% on room air, and fine crackles at both bases. Which finding is the priority?
1. AUrine output of 40 mL per hour
2. BRising respiratory rate with SpO2 89%
3. CPain rated 6 out of 10
4. DBlood pressure of 112/70 mmHg
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Answer: B · Rising respiratory rate with SpO2 89%
Severe pancreatitis releases inflammatory mediators that can damage the lungs and cause acute respiratory distress syndrome, seen as tachypnoea, falling oxygen saturation and crackles. This threatens breathing and needs oxygen and urgent medical review. The urine output and BP are acceptable, and the pain needs reassessment after the breathing problem is managed.
- A: 40 mL/h is above the minimum of 0.5 mL/kg/h for most adults.
- C: Pain needs attention but breathing comes first.
- D: This blood pressure is adequate.
Question 6 · Hard
A patient with cirrhosis has 7 L of ascitic fluid drained by paracentesis. The order is albumin 8 g for each litre removed, given as 20% albumin solution. What volume should the nurse infuse?
1. A80 mL
2. B280 mL
3. C56 mL
4. D224 mL
Answer and explanation in LearnFree account
Question 7 · Medium
A patient with cirrhosis becomes confused and drowsy over two days. Which finding is the most likely trigger of his hepatic encephalopathy?
1. ABlood pressure of 118/72 mmHg
2. BMild itching of the skin
3. CNo bowel motion for four days
4. DA daily weight loss of 0.5 kg
Answer and explanation in LearnFree account
Question 8 · Easy
Which type of stoma usually passes formed stool?
1. ATransverse colostomy
2. BIleostomy
3. CSigmoid colostomy
4. DAscending colostomy
Answer and explanation in LearnFree account
Question 9 · Hard
A patient with prolonged vomiting from a pyloric obstruction has: pH 7.52, PaCO2 47 mmHg, HCO3- 34 mmol/L, potassium 2.9 mmol/L. How should the nurse interpret this?
1. ARespiratory acidosis with full metabolic compensation
2. BMetabolic acidosis with respiratory compensation
3. CRespiratory alkalosis with metabolic compensation
4. DMetabolic alkalosis with partial respiratory compensation
Answer and explanation in LearnFree account
Question 10 · Medium
A patient with hepatic encephalopathy is on lactulose. The nurse knows the dose is right when the patient has:
1. AEight or more watery stools a day
2. BOne formed stool every two days
3. CNo bowel motion and less flatus
4. DTwo to three soft stools a day
Answer and explanation in LearnFree account
Question 11 · Medium
During the first 24 hours of acute pancreatitis, which nursing priority matters most?
1. AEarly IV fluids with close urine output checks
2. BStrict nil by mouth with parenteral nutrition for a week
3. CWithholding all opioids so the pain can be assessed
4. DStarting a high-fat diet to rest the pancreas
Answer and explanation in LearnFree account
Question 12 · Medium
Which practice is correct for a central venous catheter used for parenteral nutrition?
1. AKeep the same bag running for up to 72 hours
2. BGive IV antibiotics through the nutrition lumen
3. CUse a lumen dedicated to the nutrition only
4. DDraw routine blood samples through the nutrition lumen
Answer and explanation in LearnFree account
Question 13 · Easy
A bag of parenteral nutrition finishes and the next bag has not arrived from pharmacy. What should the nurse hang until it arrives?
1. ALactated Ringer solution at half rate
2. B0.9% sodium chloride at the same rate
3. C10% dextrose at the same rate
4. DNothing; leave the line locked off
Answer and explanation in LearnFree account
Question 14 · Medium
A patient with cirrhosis is admitted with a variceal bleed and terlipressin is started. Which other drug is routinely added to reduce infection and death?
1. AA dose of oral propranolol now
2. BA daily dose of oral warfarin
3. CA short course of IV ceftriaxone
4. DAn infusion of tranexamic acid
Answer and explanation in LearnFree account
Question 15 · Medium
A patient with bowel obstruction has colicky pain and vomiting. Which new finding suggests the bowel has become strangulated?
1. ANausea with occasional vomiting
2. BHigh-pitched bowel sounds
3. CVisible distension of the abdomen
4. DConstant severe pain with fever and tachycardia
Answer and explanation in LearnFree account
Question 16 · Medium
A patient's upper GI bleed has stopped after endoscopy. He is stable, has no heart disease, and his haemoglobin is 82 g/L. The resident asks whether he needs a transfusion. Which reply fits current guidance?
1. AYes; all GI bleeds need transfusion to 120 g/L
2. BNo; the usual threshold is Hb below 70 g/L
3. CYes; transfusion is needed below a level of 100 g/L
4. DNo; transfusion is never given after a GI bleed
Answer and explanation in LearnFree account
Question 17 · Easy
During and after a bolus feed through a gastrostomy tube, the patient should be positioned:
1. AProne with the head turned to one side
2. BWith the head raised at least 30 degrees
3. CLying on the left side with the knees drawn up
4. DFlat on the back with one pillow
Answer and explanation in LearnFree account
Question 18 · Medium
Before starting a feed, the nurse tests aspirate from a nasogastric tube. The unit accepts pH 1 to 5.5 as gastric, and the aspirate is pH 6.5. What should the nurse do?
1. AInject 20 mL of air and listen over the stomach
2. BPush the tube in another 10 cm and start feeding
3. CStart the feed because the pH is close to the accepted range
4. DWithhold the feed, re-test, then X-ray if unsure
Answer and explanation in LearnFree account
Question 19 · Hard
After handover on a surgical unit, which of these patients does the nurse assess first?
1. ACirrhosis, fresh haematemesis, pulse 128/min
2. BDay-2 ileostomy, output 800 mL in 24 hours
3. CDay-1 PEG, asking when he may shower
4. DPancreatitis, pain 5 out of 10 after morphine
Answer and explanation in LearnFree account
Question 20 · Easy
When cutting the opening of a stoma pouch flange, the nurse makes it:
1. AAbout 1 cm larger than the stoma
2. BExactly the same size as the stoma
3. CAbout 2 to 3 mm larger than the stoma
4. DSlightly smaller so it grips the stoma
Answer and explanation in LearnFree account
Question 21 · Medium
Six litres of ascitic fluid are drained from a patient with cirrhosis. Which IV infusion should the nurse expect to give?
1. AThree litres of 0.9% saline
2. B5% dextrose at a fast rate
3. CIV furosemide 40 mg
4. DHuman albumin solution
Answer and explanation in LearnFree account
Question 22 · Easy
Which dietary measure most helps control ascites in a patient with cirrhosis?
1. ARestricting all dietary protein
2. BRestricting dietary sodium
3. CRestricting dietary potassium
4. DDrinking at least 3 litres a day
Answer and explanation in LearnFree account
Question 23 · Easy
A patient's stools have turned dark green-black, but they are formed, not sticky, and he feels well. Which of his regular medicines most likely explains this?
1. AFerrous sulphate
2. BParacetamol
3. CLansoprazole
4. DAmoxicillin
Answer and explanation in LearnFree account
Question 24 · Medium
An ICU patient on continuous nasogastric feeding has a gastric residual volume of 250 mL. Her abdomen is soft, she is not vomiting and bowel sounds are present. What should the nurse do?
1. ARemove the tube and plan for parenteral nutrition
2. BStop the feed for 12 hours and inform the dietitian
3. CDiscard the aspirate and halve the feeding rate
4. DContinue the feed and keep monitoring her tolerance
Answer and explanation in LearnFree account
Question 25 · Hard
A severely malnourished patient started parenteral nutrition yesterday. Today: phosphate 0.42 mmol/L (0.8 to 1.5), potassium 3.1 mmol/L (3.5 to 5.0), magnesium 0.58 mmol/L (0.7 to 1.0). She feels weak and short of breath. What is the most likely problem?
1. AFluid overload from the infusion
2. BHyperglycaemia from the glucose load
3. CCatheter-related bloodstream infection
4. DRefeeding syndrome
Answer and explanation in LearnFree account

11 more Gastrointestinal, hepatic and nutrition care questions

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Gastrointestinal, hepatic and nutrition care

A patient on parenteral nutrition has a capillary glucose of 14.2 mmol/L (256 mg/dL). What should the nurse do?

Thirty minutes after a new bag of parenteral nutrition is hung through a central line, the patient has rigors, a temperature of 38.9 °C and a pulse of 118/min. What should the nurse do first?

The main purpose of a nasogastric tube on low intermittent suction in small bowel obstruction is to:

Soon after admission with haematemesis, a patient turns pale and clammy; BP 88/50 mmHg, pulse 124/min. What is the nurse's priority?

On day 2 of severe acute pancreatitis, the nurse finds: pain 6/10, BP 112/70 mmHg, urine 40 mL/h, RR 30/min, SpO2 89% on room air, and fine crackles at both bases. Which finding is the priority?

A patient with cirrhosis has 7 L of ascitic fluid drained by paracentesis. The order is albumin 8 g for each litre removed, given as 20% albumin solution. What volume should the nurse infuse?

A patient with cirrhosis becomes confused and drowsy over two days. Which finding is the most likely trigger of his hepatic encephalopathy?

Which type of stoma usually passes formed stool?

A patient with prolonged vomiting from a pyloric obstruction has: pH 7.52, PaCO2 47 mmHg, HCO3- 34 mmol/L, potassium 2.9 mmol/L. How should the nurse interpret this?

A patient with hepatic encephalopathy is on lactulose. The nurse knows the dose is right when the patient has:

During the first 24 hours of acute pancreatitis, which nursing priority matters most?

Which practice is correct for a central venous catheter used for parenteral nutrition?

A bag of parenteral nutrition finishes and the next bag has not arrived from pharmacy. What should the nurse hang until it arrives?

A patient with cirrhosis is admitted with a variceal bleed and terlipressin is started. Which other drug is routinely added to reduce infection and death?

A patient with bowel obstruction has colicky pain and vomiting. Which new finding suggests the bowel has become strangulated?

A patient's upper GI bleed has stopped after endoscopy. He is stable, has no heart disease, and his haemoglobin is 82 g/L. The resident asks whether he needs a transfusion. Which reply fits current guidance?

During and after a bolus feed through a gastrostomy tube, the patient should be positioned:

Before starting a feed, the nurse tests aspirate from a nasogastric tube. The unit accepts pH 1 to 5.5 as gastric, and the aspirate is pH 6.5. What should the nurse do?

After handover on a surgical unit, which of these patients does the nurse assess first?

When cutting the opening of a stoma pouch flange, the nurse makes it:

Six litres of ascitic fluid are drained from a patient with cirrhosis. Which IV infusion should the nurse expect to give?

Which dietary measure most helps control ascites in a patient with cirrhosis?

A patient's stools have turned dark green-black, but they are formed, not sticky, and he feels well. Which of his regular medicines most likely explains this?

An ICU patient on continuous nasogastric feeding has a gastric residual volume of 250 mL. Her abdomen is soft, she is not vomiting and bowel sounds are present. What should the nurse do?

A severely malnourished patient started parenteral nutrition yesterday. Today: phosphate 0.42 mmol/L (0.8 to 1.5), potassium 3.1 mmol/L (3.5 to 5.0), magnesium 0.58 mmol/L (0.7 to 1.0). She feels weak and short of breath. What is the most likely problem?