NSG 3850 Final Exam 4 Comprehensive Nursing Exam:
Gastrointestinal & Hepatic Disorders Questions with
Answers and Rationales 2026
1. The nurse is caring for a client with chronic alcoholism who has jaundice. The nurse
determines the etiological process of this condition is:
A. Increased bile salt excretion
B. An alteration of protein metabolism
C. Hepatic dysfunction in bilirubin metabolism
D. Prehepatic alterations in erythropoiesis
Answer: C. Hepatic dysfunction in bilirubin metabolism
Rationale:
Option A (Incorrect): Increased bile salt excretion is not the cause of jaundice in chronic
alcoholism. In fact, bile salt excretion may be impaired in liver disease.
Option B (Incorrect): While protein metabolism is altered in liver disease, this is not the direct
cause of jaundice. The primary mechanism involves bilirubin processing.
Option C (Correct): Chronic alcoholism leads to hepatic damage, impairing the liver's ability to
conjugate and excrete bilirubin. This results in accumulation of unconjugated bilirubin in the
blood, causing jaundice (yellowing of skin and sclera). The liver normally processes bilirubin
through conjugation and excretion into bile; when this is disrupted, bilirubin levels rise.
,Option D (Incorrect): Prehepatic alterations in erythropoiesis relate to increased red blood cell
destruction, which is not the primary mechanism in alcoholic liver disease. This would be seen
in hemolytic anemias.
2. The nurse is caring for a client who has cholelithiasis. Which of the following should the nurse
identify as a risk factor for this condition?
A. Excessive alcohol abuse
B. Rapid weight loss in an obese individual
C. A nasogastric (NG) tube to low wall suction
D. Hepatitis virus B (HVB)
Answer: B. Rapid weight loss in an obese individual
Rationale:
Option A (Incorrect): Excessive alcohol abuse is a risk factor for pancreatitis and liver disease,
but not primarily for cholelithiasis (gallstones). Gallstones are more commonly associated with
obesity, estrogen use, and rapid weight loss.
Option B (Correct): Rapid weight loss in an obese individual promotes cholesterol
supersaturation in bile, leading to gallstone formation. During rapid weight loss, the liver
releases cholesterol into bile, and gallbladder stasis increases, promoting stone formation. This
is a well-documented risk factor.
Option C (Incorrect): An NG tube to low wall suction does not directly increase the risk of
gallstone formation. Prolonged fasting may increase risk due to gallbladder stasis, but the NG
tube itself is not a direct risk factor.
,Option D (Incorrect): Hepatitis B is a risk factor for liver cirrhosis and hepatocellular carcinoma,
not cholelithiasis. The viral infection affects liver parenchyma, not bile composition or
gallbladder function.
3. The nurse is caring for a client who has chronic cholelithiasis. Which of the following would
the nurse expect the client to report?
A. Abdominal pain upon waking up
B. Left upper quadrant abdominal pain
C. Persistent epigastric pain
D. Right upper quadrant pain radiating to the right shoulder
Answer: C. Persistent epigastric pain
Rationale:
Option A (Incorrect): Abdominal pain upon waking is not characteristic of cholelithiasis.
Gallstone pain typically occurs after meals, especially fatty meals, due to gallbladder
contraction.
Option B (Incorrect): Left upper quadrant pain is more indicative of gastric or pancreatic issues,
not gallbladder disease. Gallbladder pain is typically in the right upper quadrant or epigastric
region.
Option C (Correct): Chronic cholelithiasis often presents with persistent epigastric pain, which
may be dull and aching. This pain can be intermittent and is often associated with meals,
particularly fatty foods, but in chronic cases, it may become more constant.
Option D (Incorrect): Right upper quadrant pain radiating to the right shoulder (referred pain) is
more characteristic of acute cholecystitis, not chronic cholelithiasis. This pattern indicates
diaphragmatic irritation from gallbladder inflammation.
, 4. A client with cirrhosis is experiencing ascites. Which pathophysiological mechanism
contributes most to this condition?
A. Decreased portal venous pressure
B. Increased serum albumin levels
C. Portal hypertension and decreased oncotic pressure
D. Increased lymphatic drainage
Answer: C. Portal hypertension and decreased oncotic pressure
Rationale:
Option A (Incorrect): Portal venous pressure is increased, not decreased, in cirrhosis. Portal
hypertension is a hallmark of cirrhosis and contributes to ascites formation.
Option B (Incorrect): Serum albumin levels are decreased, not increased, in cirrhosis due to
impaired hepatic synthesis. Low albumin reduces plasma oncotic pressure, contributing to fluid
shift into interstitial spaces.
Option C (Correct): Ascites in cirrhosis results from portal hypertension (increased hydrostatic
pressure) and decreased plasma oncotic pressure due to hypoalbuminemia. These forces cause
fluid to leak from the splanchnic circulation into the peritoneal cavity.
Option D (Incorrect): Lymphatic drainage may be increased but cannot compensate for the
massive fluid shifts caused by portal hypertension and hypoalbuminemia. This is not the
primary mechanism.
5. A client with acute pancreatitis reports severe abdominal pain that radiates to the back. The
nurse understands that this pain pattern is due to:
Gastrointestinal & Hepatic Disorders Questions with
Answers and Rationales 2026
1. The nurse is caring for a client with chronic alcoholism who has jaundice. The nurse
determines the etiological process of this condition is:
A. Increased bile salt excretion
B. An alteration of protein metabolism
C. Hepatic dysfunction in bilirubin metabolism
D. Prehepatic alterations in erythropoiesis
Answer: C. Hepatic dysfunction in bilirubin metabolism
Rationale:
Option A (Incorrect): Increased bile salt excretion is not the cause of jaundice in chronic
alcoholism. In fact, bile salt excretion may be impaired in liver disease.
Option B (Incorrect): While protein metabolism is altered in liver disease, this is not the direct
cause of jaundice. The primary mechanism involves bilirubin processing.
Option C (Correct): Chronic alcoholism leads to hepatic damage, impairing the liver's ability to
conjugate and excrete bilirubin. This results in accumulation of unconjugated bilirubin in the
blood, causing jaundice (yellowing of skin and sclera). The liver normally processes bilirubin
through conjugation and excretion into bile; when this is disrupted, bilirubin levels rise.
,Option D (Incorrect): Prehepatic alterations in erythropoiesis relate to increased red blood cell
destruction, which is not the primary mechanism in alcoholic liver disease. This would be seen
in hemolytic anemias.
2. The nurse is caring for a client who has cholelithiasis. Which of the following should the nurse
identify as a risk factor for this condition?
A. Excessive alcohol abuse
B. Rapid weight loss in an obese individual
C. A nasogastric (NG) tube to low wall suction
D. Hepatitis virus B (HVB)
Answer: B. Rapid weight loss in an obese individual
Rationale:
Option A (Incorrect): Excessive alcohol abuse is a risk factor for pancreatitis and liver disease,
but not primarily for cholelithiasis (gallstones). Gallstones are more commonly associated with
obesity, estrogen use, and rapid weight loss.
Option B (Correct): Rapid weight loss in an obese individual promotes cholesterol
supersaturation in bile, leading to gallstone formation. During rapid weight loss, the liver
releases cholesterol into bile, and gallbladder stasis increases, promoting stone formation. This
is a well-documented risk factor.
Option C (Incorrect): An NG tube to low wall suction does not directly increase the risk of
gallstone formation. Prolonged fasting may increase risk due to gallbladder stasis, but the NG
tube itself is not a direct risk factor.
,Option D (Incorrect): Hepatitis B is a risk factor for liver cirrhosis and hepatocellular carcinoma,
not cholelithiasis. The viral infection affects liver parenchyma, not bile composition or
gallbladder function.
3. The nurse is caring for a client who has chronic cholelithiasis. Which of the following would
the nurse expect the client to report?
A. Abdominal pain upon waking up
B. Left upper quadrant abdominal pain
C. Persistent epigastric pain
D. Right upper quadrant pain radiating to the right shoulder
Answer: C. Persistent epigastric pain
Rationale:
Option A (Incorrect): Abdominal pain upon waking is not characteristic of cholelithiasis.
Gallstone pain typically occurs after meals, especially fatty meals, due to gallbladder
contraction.
Option B (Incorrect): Left upper quadrant pain is more indicative of gastric or pancreatic issues,
not gallbladder disease. Gallbladder pain is typically in the right upper quadrant or epigastric
region.
Option C (Correct): Chronic cholelithiasis often presents with persistent epigastric pain, which
may be dull and aching. This pain can be intermittent and is often associated with meals,
particularly fatty foods, but in chronic cases, it may become more constant.
Option D (Incorrect): Right upper quadrant pain radiating to the right shoulder (referred pain) is
more characteristic of acute cholecystitis, not chronic cholelithiasis. This pattern indicates
diaphragmatic irritation from gallbladder inflammation.
, 4. A client with cirrhosis is experiencing ascites. Which pathophysiological mechanism
contributes most to this condition?
A. Decreased portal venous pressure
B. Increased serum albumin levels
C. Portal hypertension and decreased oncotic pressure
D. Increased lymphatic drainage
Answer: C. Portal hypertension and decreased oncotic pressure
Rationale:
Option A (Incorrect): Portal venous pressure is increased, not decreased, in cirrhosis. Portal
hypertension is a hallmark of cirrhosis and contributes to ascites formation.
Option B (Incorrect): Serum albumin levels are decreased, not increased, in cirrhosis due to
impaired hepatic synthesis. Low albumin reduces plasma oncotic pressure, contributing to fluid
shift into interstitial spaces.
Option C (Correct): Ascites in cirrhosis results from portal hypertension (increased hydrostatic
pressure) and decreased plasma oncotic pressure due to hypoalbuminemia. These forces cause
fluid to leak from the splanchnic circulation into the peritoneal cavity.
Option D (Incorrect): Lymphatic drainage may be increased but cannot compensate for the
massive fluid shifts caused by portal hypertension and hypoalbuminemia. This is not the
primary mechanism.
5. A client with acute pancreatitis reports severe abdominal pain that radiates to the back. The
nurse understands that this pain pattern is due to:
