Med-surg: GI, perioperative & oncology worksheet with answers

What does "coffee-ground" vomit usually indicate?

1. ABile coming back from an obstructed small bowel
2. BA side effect of drinking strong coffee
3. CUndigested food from several days ago
4. DBlood that has been partly digested by stomach acid

Which tool helps assess pain in a person with advanced dementia who cannot report it?

1. AAn observational scale such as PAINAD or Abbey
2. BThe MUST nutrition score
3. CThe Glasgow Coma Scale, scored every hour
4. DA numerical rating scale from 0 to 10, read out slowly

Why are rectal temperatures and suppositories avoided in a patient with neutropenia?

1. AThey make the patient's white cell count fall even further
2. BThey can damage the mucosa and let bacteria into the blood
3. CThey always give falsely low temperature readings
4. DThey interfere with the absorption of chemotherapy

During the first infusion of a monoclonal antibody such as rituximab, which problem is most important to watch for?

1. ASudden hair loss during the infusion
2. BAn infusion reaction, such as fever, rigors or breathlessness
3. CA rise in platelet count above normal
4. DSevere constipation within the first hour of starting the infusion

Which treatment often relieves pain from a bone metastasis?

1. AComplete bed rest for a month
2. BIron supplements by mouth for several months
3. CA diet low in calcium and vitamin D
4. DPalliative radiotherapy to the area

Which task for a stable patient with an established ileostomy can usually be delegated to a trained healthcare assistant (nursing assistant)?

1. ADeciding whether IV fluids are needed
2. BTeaching the patient about high-output risks
3. CEmptying the pouch and measuring the output
4. DAssessing the stoma for signs of necrosis

A colleague suggests giving a saline injection to see whether a patient's pain is "real". What is the best response?

1. ADeceptive placebos are unethical and do not show pain is "fake"
2. BIt is a good idea, as long as the patient is not told about it afterwards
3. CIt should be done only for patients with chronic pain
4. DIt is acceptable if a senior nurse gives the saline

Ten days after chemotherapy, a patient has a temperature of 37.6 °C but feels shivery and unwell, with a pulse of 112/min and BP 95/60 mmHg. What is the correct action?

1. AWait for the neutrophil count before deciding on any treatment
2. BTreat as possible neutropenic sepsis: IV antibiotics within an hour
3. CGive paracetamol and recheck the temperature again in four hours
4. DReassure the patient, because the temperature is still below 38 °C