Gastrointestinal
NCLEX® practice.

Free practice set · 5 questions

5 more free gastrointestinal NCLEX-RN® practice questions

Real questions from the same bank the app serves. Pick an answer in your head, then open the rationale to see why the correct option holds and why each other option falls short. No account needed for these.

1. Question 1 of 5 · GI Disorders & Nutrition Support

   A 32-year-old woman with short bowel syndrome is receiving parenteral nutrition through a right subclavian triple-lumen central catheter. At 0800 the health care provider orders: "Potassium chloride 20 mEq in 100 mL 0.9% NS, infuse IV over 1 hour x1 dose for hypokalemia." The potassium is stocked on the unit as a premixed concentrated 20 mEq/100 mL bag. Before hanging this bag, the RN should recognize that this medication is classified as which of the following?

   1. AA standard electrolyte replacement that any single RN may verify and hang alone
   2. BA high-alert medication requiring an independent double-check by a second RN
   3. CA medication that can be given through any peripheral IV line without restriction
   4. DA medication whose effect should be evaluated immediately, within 2 to 3 minutes of the infusion starting
   Show the answer and rationale

   Correct answer: B. A high-alert medication requiring an independent double-check by a second RN

   Concentrated potassium chloride is on the ISMP list of high-alert medications because even small dosing, concentration, or rate errors can cause fatal arrhythmias. Any high-alert drug, including this 20 mEq/100 mL KCl order, requires a second RN to independently verify the drug, dose, concentration, pump settings, and client identity against the original order before it is hung, following the ISMP independent double-check standard. Recognizing this classification is the first mental step the RN must take before touching the bag, the line, or the pump. Treating concentrated KCl as an ordinary electrolyte that one nurse can verify alone ignores its high-alert status and removes the safety net designed to catch lethal errors. Concentrated KCl at this strength requires central access, not "any peripheral line," due to its causticity and arrhythmia risk. A 1-hour infusion cannot be meaningfully evaluated at 2 to 3 minutes, and this timing confuses onset/peak assessment with high-alert classification. Recognizing the high-alert designation correctly sets up every downstream safety action for this client's K+ 3.1 mEq/L correction.

   A. A standard electrolyte replacement that any single RN may verify and hang alone

   This reflects the misconception that high-alert electrolytes can be treated like routine medications verified by one nurse. It skips the mandatory independent double-check ISMP requires for concentrated KCl.

   B. A high-alert medication requiring an independent double-check by a second RN

   Concentrated potassium chloride is an ISMP-designated high-alert medication. The rule requires an independent double-check by a second RN before administration because errors in this drug class can be fatal.

   C. A medication that can be given through any peripheral IV line without restriction

   This confuses classification with line selection rules. Concentrated KCl of this strength is not restricted to peripheral-only reasoning here, but calling it unrestricted ignores that its high-alert status still governs administration safeguards.

   D. A medication whose effect should be evaluated immediately, within 2 to 3 minutes of the infusion starting

   This applies an onset/peak timing rule that does not belong to this recognition point. Classifying a drug as high-alert is unrelated to when its effect should be evaluated after a 1-hour infusion.

2. Question 2 of 5 · GI Disorders & Nutrition Support

   The nurse is caring for a 68-year-old man in a long-term care facility who uses nonprescribed oxycodone daily and says he does not believe it is a problem. He has constipation, two recent episodes of excess sedation, respirations 12/min, oxygen saturation 93% on room air, and a newly prescribed daily bowel medication. His daughter is supportive, but he has no transportation for outside appointments. Which action should the nurse take first?

   1. AGive him a quit-date worksheet and instructions to stop immediately, reserving discussion of treatment until he is ready to act.
   2. BTell him to stop using opioids and arrange a daily outside program, without discussing naloxone or alternatives.
   3. CTell him that his opioid use is irresponsible and insist he schedule treatment after discharge from the facility.
   4. DUse an open-ended, nonjudgmental question to explore his concerns, then offer naloxone teaching and an on-site or telehealth MOUD referral.
   Show the answer and rationale

   Correct answer: D. Use an open-ended, nonjudgmental question to explore his concerns, then offer naloxone teaching and an on-site or telehealth MOUD referral.

   The first action is to explore the client's ambivalence with a nonjudgmental, open-ended question while providing immediate overdose-safety teaching and feasible treatment options. He is in precontemplation, so motivational interviewing should raise awareness and invite discussion rather than demand a quit date. Because he continues opioid use and has had excess sedation, naloxone education is needed even if abstinence is not his immediate goal. Medication treatment for opioid use disorder (MOUD), such as buprenorphine or methadone, is evidence-based; an on-site or telehealth referral addresses his transportation barrier. Shaming, premature action tools, “just stop” advice, delayed teaching, omitted safety information, and inaccessible referrals undermine effective care.

   A. Give him a quit-date worksheet and instructions to stop immediately, reserving discussion of treatment until he is ready to act.

   A quit-date worksheet and immediate-abstinence plan are action-stage tools, but this client is precontemplative and has not accepted that use is a problem. The option also postpones evidence-based treatment and immediate naloxone safety information.

   B. Tell him to stop using opioids and arrange a daily outside program, without discussing naloxone or alternatives.

   “Just stop” is not evidence-based treatment for opioid use disorder and does not offer MOUD or recovery support. The outside daily program ignores the transportation barrier, while omitting naloxone fails to reduce overdose risk during ongoing use.

   C. Tell him that his opioid use is irresponsible and insist he schedule treatment after discharge from the facility.

   Shaming the client and insisting on a later appointment damages the therapeutic relationship and can increase resistance. Brief intervention and safety teaching should begin during this encounter; education should not be deferred until discharge or a routine visit.

   D. Use an open-ended, nonjudgmental question to explore his concerns, then offer naloxone teaching and an on-site or telehealth MOUD referral.

   This action matches precontemplation by using motivational interviewing to explore ambivalence instead of pushing immediate action. It also offers evidence-based MOUD and naloxone, which reduces overdose risk while use continues, and adapts referral to the client's lack of transportation.

3. Question 3 of 5 · GI Disorders & Nutrition Support

   A 52-year-old woman in a skilled nursing facility has symptomatic bradycardia after starting daily amiodarone. Transcutaneous pacing is set to demand 70/min and 5 mA. The monitor shows pacing spikes without QRS complexes; her carotid pulse is absent during spikes, BP is 78/46 mm Hg, capillary refill is 4 seconds, urine output has fallen, and she is confused. Potassium is 4.9 mEq/L. What should the RN do first?

   1. APlace a magnet over the pacemaker to restore pacing before changing the output.
   2. BIncrease the pacer output above 5 mA and verify a QRS and carotid pulse with blood pressure.
   3. CSet the transcutaneous pacer to 70/min, then leave the output at 5 mA.
   4. DPalpate the radial pulse during each pacing spike to determine whether capture is occurring.
   Show the answer and rationale

   Correct answer: B. Increase the pacer output above 5 mA and verify a QRS and carotid pulse with blood pressure.

   Increase the transcutaneous pacer output above 5 mA and verify both electrical and mechanical capture. The monitor shows pacing spikes without QRS complexes, indicating electrical noncapture, and the absent carotid pulse, hypotension, poor perfusion, and confusion confirm mechanical noncapture. Output must be increased above the capture threshold, then the RN correlates each paced QRS with a carotid pulse and adequate blood pressure. The rate alone does not create capture. A magnet is not first-line treatment and converts a permanent pacemaker to asynchronous diagnostic mode. Exposed leads require insulated gloves, and MRI safety depends on verified MRI-conditional status, not modern labeling. Analgesia and sedation are also required when the alert client tolerates ongoing transcutaneous pacing.

   A. Place a magnet over the pacemaker to restore pacing before changing the output.

   A magnet is not the first intervention for apparent failure to pace or capture. Magnet placement on a permanent pacemaker generally produces asynchronous fixed-rate pacing for selected diagnostic situations; it does not correct transcutaneous output failure and may create sensing and rhythm risks. Troubleshooting the active pacing system comes first.

   B. Increase the pacer output above 5 mA and verify a QRS and carotid pulse with blood pressure.

   This is correct because pacing spikes without QRS complexes at 5 mA show failure to capture. Increasing output addresses the electrical problem, while checking the carotid pulse and blood pressure confirms mechanical capture before relying on the device. The client’s hypotension and poor perfusion make prompt restoration and verification necessary.

   C. Set the transcutaneous pacer to 70/min, then leave the output at 5 mA.

   Setting the rate does not correct failure to capture. The rate is already 70/min, but the 5-mA output produces spikes without QRS complexes. The RN must titrate output above the capture threshold and confirm a central pulse and adequate blood pressure before relying on transcutaneous pacing.

   D. Palpate the radial pulse during each pacing spike to determine whether capture is occurring.

   A radial pulse is not a reliable confirmation of mechanical capture because electrical interference or pulsatile impedance can create a false tap. Capture should be correlated with the paced QRS and a carotid or femoral pulse, with blood pressure. This action could falsely reassure the RN while the client remains unstable.

4. Question 4 of 5 · GI Disorders & Nutrition Support

   A 79-year-old man in a long-term care facility has alcohol-related cirrhosis and was prescribed daily lactulose after a recent hospitalization. He missed three doses when the supply ran out. Compared with 2 hours ago, BP is 104/62 from 118/70, HR 96 from 82, RR 20 from 16, temperature 37.8°C from 37.1°C, and SpO2 93% from 97% on room air. He is newly disoriented, has asterixis, scant urine, and increasing abdominal distention with a fluid wave; ammonia is 126 mcg/dL. Which action should the nurse take first?

   1. ARepeat vital signs in 4 hours before contacting the provider about the changes.
   2. BReassure the client that confusion is expected in an older adult with cirrhosis and document the behavior.
   3. CPlace the client upright, assess airway and breathing, apply oxygen per protocol, and notify the provider using SBAR.
   4. DPage the provider about the elevated ammonia level and wait for instructions before protecting the airway.
   Show the answer and rationale

   Correct answer: C. Place the client upright, assess airway and breathing, apply oxygen per protocol, and notify the provider using SBAR.

   The nurse should immediately support airway and breathing, then escalate with SBAR. New disorientation, asterixis, missed lactulose, rising pulse and respiratory rate, lower blood pressure, reduced urine output, mild fever, abdominal fluid accumulation, and increased oxygen need identify worsening hepatic encephalopathy with possible evolving infection or poor perfusion, not a benign age-related change. The trend matters before overt collapse. Upright positioning and oxygen support address ABC priorities while SBAR communicates the situation, baseline, assessment, and recommended evaluation. Reassuring the client misses an acute neurologic change; waiting four hours delays time-sensitive evaluation; and reporting ammonia without simultaneous safety action leaves a confused client vulnerable to airway compromise.

   A. Repeat vital signs in 4 hours before contacting the provider about the changes.

   The rising heart rate and respiratory rate, falling blood pressure and oxygen saturation, low-grade fever, and scant urine are early warning changes. Waiting four hours can permit sepsis or other decompensation to progress and violates the need for timely escalation.

   B. Reassure the client that confusion is expected in an older adult with cirrhosis and document the behavior.

   New confusion and asterixis are not expected simply because the client is older. They support worsening hepatic encephalopathy and may also reflect infection, hypoxia, bleeding, or metabolic deterioration, so reassurance and documentation alone delay assessment and treatment.

   C. Place the client upright, assess airway and breathing, apply oxygen per protocol, and notify the provider using SBAR.

   This action addresses the immediate ABC risk from worsening mental status and possible hypoxemia, while structured SBAR promptly communicates the acute trend and needed evaluation. The nurse acts before overt decline rather than waiting for coma, severe hypotension, or respiratory failure.

   D. Page the provider about the elevated ammonia level and wait for instructions before protecting the airway.

   The ammonia result is relevant, but paging and then waiting leaves airway and breathing risks unaddressed in a newly disoriented client. The nurse must provide immediate supportive care and communicate the complete finding cluster and trend using a structured report.

5. Question 5 of 5 · GI Disorders & Nutrition Support

   An RN is caring for a client with short bowel syndrome who receives total parenteral nutrition (TPN) through a single-lumen implanted port. A new order reads: "Potassium chloride 20 mEq in 100 mL 0.9% NaCl, infuse IV over 1 hour via infusion pump, once now for hypokalemia, Dr. Alvarez, today 0900." The client's serum potassium this morning is 3.1 mEq/L. Before administering this medication, what should the RN recognize as required?

   1. AManual programming of the pump rate without using the smart-pump drug library
   2. BAn independent double-check by a second RN of the drug, dose, and pump settings
   3. CA blood glucose check performed 30 minutes after the infusion begins
   4. DDocumentation that the first RN already confirmed the order is correct
   Show the answer and rationale

   Correct answer: B. An independent double-check by a second RN of the drug, dose, and pump settings

   Potassium chloride is an ISMP-designated high-alert medication because even small errors in concentration, rate, or pump programming can cause fatal arrhythmias. This is why the ISMP independent double-check rule requires a second RN to independently verify the drug name, dose, concentration, and pump settings directly against the original order before the infusion begins, rather than simply trusting what the first nurse reports. In this scenario, the client's potassium is 3.1 mEq/L and the order calls for 20 mEq IV, a high-alert electrolyte replacement that mandates this safeguard regardless of how routine the order appears. Option D violates this rule because a verbal confirmation from the first RN is not an independent check; the second nurse must verify against the original order itself. Option A violates the dose-error reduction system rule because bypassing the smart-pump drug library removes the built-in soft and hard limit alerts designed to catch programming errors for high-alert drugs. Option C reflects a timing error unrelated to this decision point; blood glucose monitoring pertains to TPN dextrose or insulin therapy, not to the immediate safety requirement before administering potassium chloride. Only Option B satisfies the recognized standard for safely handling this high-alert medication before it is ever infused.

   A. Manual programming of the pump rate without using the smart-pump drug library

   Wrong. Skipping the smart-pump drug library removes the dose-error reduction system that catches programming mistakes for high-alert infusions like concentrated potassium chloride.

   B. An independent double-check by a second RN of the drug, dose, and pump settings

   Correct. Potassium chloride is a high-alert electrolyte; the ISMP independent double-check rule requires a second RN to verify the drug, dose, and pump settings against the original order before infusion begins.

   C. A blood glucose check performed 30 minutes after the infusion begins

   Wrong. This checks the wrong parameter at the wrong time; glucose monitoring relates to TPN dextrose, not the pre-administration safety step needed for a potassium chloride infusion.

   D. Documentation that the first RN already confirmed the order is correct

   Wrong. Accepting the first RN's word is not independent verification. The second nurse must check the original order directly, not rely on another nurse's statement that it is correct.