NSG 3800 Adult Health Exam 4
Comprehensive Hepatobiliary and Liver Disorders
Examination 2026
SECTION 1: GALLSTONES (CHOLELITHIASIS) - Questions 1-20
Question 1
A patient has been diagnosed with gallstones. What lifestyle modifications should the nurse
teach this patient?
A. High-fat diet to promote gallbladder emptying
B. Diet low in fat, avoid alcohol, and avoid gas-forming foods
C. Increase intake of onions, broccoli, and cabbage
D. High-protein, high-fat diet with regular alcohol consumption
Correct ANSWER: B
Rationale:
A is incorrect: A high-fat diet would actually worsen symptoms by stimulating gallbladder
contraction and causing pain. Patients with gallstones need a low-fat diet to reduce gallbladder
stimulation.
B is correct: Patients with gallstones should follow a diet low in fat to reduce gallbladder
stimulation, avoid alcohol which can irritate the digestive system, and avoid gas-forming foods
like onions, broccoli, cabbage, and pinto beans that can cause discomfort and bloating.
C is incorrect: Onions, broccoli, and cabbage are gas-forming foods that should be avoided as
they can cause increased discomfort and bloating in patients with gallstones.
D is incorrect: While high protein may be acceptable, high-fat diet and alcohol consumption are
contraindicated in patients with gallstones as they can trigger symptoms and complications.
Question 2
Which food should the nurse instruct a patient with gallstones to avoid?
A. Lean chicken breast
,B. Whole grain bread
C. Pinto beans
D. Applesauce
Correct ANSWER: C
Rationale:
A is incorrect: Lean chicken breast is a low-fat protein source that is generally well-tolerated by
patients with gallstones.
B is incorrect: Whole grain bread is acceptable and provides fiber which can be beneficial for
digestive health.
C is correct: Pinto beans are gas-forming foods that should be avoided in patients with
gallstones as they can cause bloating, discomfort, and increased abdominal pressure.
D is incorrect: Applesauce is easily digestible and does not typically cause gas or discomfort in
patients with gallstones.
Question 3
The nurse is teaching a patient about dietary modifications for gallstone management. Which
statement by the patient indicates understanding of the teaching?
A. "I can continue to drink wine with dinner every night."
B. "I should eat more fried foods to help digest the stones."
C. "I will avoid broccoli and beans because they cause gas."
D. "I need to increase my fat intake to prevent stone formation."
Correct ANSWER: C
Rationale:
A is incorrect: Alcohol should be avoided as it can irritate the digestive system and worsen
symptoms in patients with gallstones.
B is incorrect: Fried foods are high in fat and will stimulate gallbladder contraction, causing pain
and potentially worsening the condition.
C is correct: This statement demonstrates understanding that gas-forming foods like broccoli
and beans should be avoided to prevent discomfort and bloating.
D is incorrect: Fat intake should be decreased, not increased, as high-fat foods stimulate
gallbladder contraction and can trigger painful episodes.
,Question 4
What is the primary reason for recommending a low-fat diet in patients with gallstones?
A. To promote weight gain
B. To reduce gallbladder stimulation and prevent painful contractions
C. To increase bile production
D. To prevent constipation
Correct ANSWER: B
Rationale:
A is incorrect: Weight gain is not a goal in gallstone management; in fact, weight loss (if
overweight) may be recommended, but gradually.
B is correct: Fatty foods stimulate the release of cholecystokinin, which causes the gallbladder
to contract. In patients with gallstones, these contractions can cause severe pain (biliary colic)
as stones obstruct the bile ducts.
C is incorrect: The goal is not to increase bile production but to reduce gallbladder stimulation
and symptoms.
D is incorrect: While constipation prevention is important, it is not the primary reason for a low-
fat diet in gallstone patients.
Question 5
Which assessment finding would the nurse expect in a patient with symptomatic gallstones?
A. Pain in the left lower quadrant
B. Pain after consuming a fatty meal
C. Increased appetite
D. Diarrhea after eating
Correct ANSWER: B
Rationale:
A is incorrect: Gallstone pain typically occurs in the right upper quadrant or epigastric area, not
the left lower quadrant.
B is correct: Pain after consuming fatty meals is characteristic of gallstones because fat
stimulates gallbladder contraction, which can cause pain when stones are present.
, C is incorrect: Patients with symptomatic gallstones often have decreased appetite due to fear
of eating and triggering pain.
D is incorrect: While some digestive changes may occur, diarrhea is not a typical primary
symptom of gallstones.
Question 6
The nurse is providing discharge teaching to a patient with gallstones. Which instruction is most
important?
A. Increase intake of dairy products
B. Report severe abdominal pain immediately
C. Take aspirin daily for pain prevention
D. Increase physical activity to dislodge stones
Correct ANSWER: B
Rationale:
A is incorrect: Dairy products, especially full-fat varieties, can trigger gallbladder contraction
and should be limited or chosen in low-fat versions.
B is correct: Severe abdominal pain could indicate complications such as acute cholecystitis,
choledocholithiasis, or pancreatitis, which require immediate medical attention.
C is incorrect: Aspirin is not recommended for preventing gallstone pain and may increase
bleeding risk, especially if surgery becomes necessary.
D is incorrect: Physical activity cannot dislodge gallstones and may actually worsen symptoms
during an acute episode.
Question 7
A patient with gallstones asks the nurse why they experience pain in the right shoulder. What is
the best response?
A. "The pain radiates because the gallstones are moving to your shoulder."
B. "This is referred pain caused by irritation of the diaphragm."
C. "You probably have a separate shoulder problem."
D. "The pain is from muscle tension due to guarding."
Correct ANSWER: B
Rationale:
Comprehensive Hepatobiliary and Liver Disorders
Examination 2026
SECTION 1: GALLSTONES (CHOLELITHIASIS) - Questions 1-20
Question 1
A patient has been diagnosed with gallstones. What lifestyle modifications should the nurse
teach this patient?
A. High-fat diet to promote gallbladder emptying
B. Diet low in fat, avoid alcohol, and avoid gas-forming foods
C. Increase intake of onions, broccoli, and cabbage
D. High-protein, high-fat diet with regular alcohol consumption
Correct ANSWER: B
Rationale:
A is incorrect: A high-fat diet would actually worsen symptoms by stimulating gallbladder
contraction and causing pain. Patients with gallstones need a low-fat diet to reduce gallbladder
stimulation.
B is correct: Patients with gallstones should follow a diet low in fat to reduce gallbladder
stimulation, avoid alcohol which can irritate the digestive system, and avoid gas-forming foods
like onions, broccoli, cabbage, and pinto beans that can cause discomfort and bloating.
C is incorrect: Onions, broccoli, and cabbage are gas-forming foods that should be avoided as
they can cause increased discomfort and bloating in patients with gallstones.
D is incorrect: While high protein may be acceptable, high-fat diet and alcohol consumption are
contraindicated in patients with gallstones as they can trigger symptoms and complications.
Question 2
Which food should the nurse instruct a patient with gallstones to avoid?
A. Lean chicken breast
,B. Whole grain bread
C. Pinto beans
D. Applesauce
Correct ANSWER: C
Rationale:
A is incorrect: Lean chicken breast is a low-fat protein source that is generally well-tolerated by
patients with gallstones.
B is incorrect: Whole grain bread is acceptable and provides fiber which can be beneficial for
digestive health.
C is correct: Pinto beans are gas-forming foods that should be avoided in patients with
gallstones as they can cause bloating, discomfort, and increased abdominal pressure.
D is incorrect: Applesauce is easily digestible and does not typically cause gas or discomfort in
patients with gallstones.
Question 3
The nurse is teaching a patient about dietary modifications for gallstone management. Which
statement by the patient indicates understanding of the teaching?
A. "I can continue to drink wine with dinner every night."
B. "I should eat more fried foods to help digest the stones."
C. "I will avoid broccoli and beans because they cause gas."
D. "I need to increase my fat intake to prevent stone formation."
Correct ANSWER: C
Rationale:
A is incorrect: Alcohol should be avoided as it can irritate the digestive system and worsen
symptoms in patients with gallstones.
B is incorrect: Fried foods are high in fat and will stimulate gallbladder contraction, causing pain
and potentially worsening the condition.
C is correct: This statement demonstrates understanding that gas-forming foods like broccoli
and beans should be avoided to prevent discomfort and bloating.
D is incorrect: Fat intake should be decreased, not increased, as high-fat foods stimulate
gallbladder contraction and can trigger painful episodes.
,Question 4
What is the primary reason for recommending a low-fat diet in patients with gallstones?
A. To promote weight gain
B. To reduce gallbladder stimulation and prevent painful contractions
C. To increase bile production
D. To prevent constipation
Correct ANSWER: B
Rationale:
A is incorrect: Weight gain is not a goal in gallstone management; in fact, weight loss (if
overweight) may be recommended, but gradually.
B is correct: Fatty foods stimulate the release of cholecystokinin, which causes the gallbladder
to contract. In patients with gallstones, these contractions can cause severe pain (biliary colic)
as stones obstruct the bile ducts.
C is incorrect: The goal is not to increase bile production but to reduce gallbladder stimulation
and symptoms.
D is incorrect: While constipation prevention is important, it is not the primary reason for a low-
fat diet in gallstone patients.
Question 5
Which assessment finding would the nurse expect in a patient with symptomatic gallstones?
A. Pain in the left lower quadrant
B. Pain after consuming a fatty meal
C. Increased appetite
D. Diarrhea after eating
Correct ANSWER: B
Rationale:
A is incorrect: Gallstone pain typically occurs in the right upper quadrant or epigastric area, not
the left lower quadrant.
B is correct: Pain after consuming fatty meals is characteristic of gallstones because fat
stimulates gallbladder contraction, which can cause pain when stones are present.
, C is incorrect: Patients with symptomatic gallstones often have decreased appetite due to fear
of eating and triggering pain.
D is incorrect: While some digestive changes may occur, diarrhea is not a typical primary
symptom of gallstones.
Question 6
The nurse is providing discharge teaching to a patient with gallstones. Which instruction is most
important?
A. Increase intake of dairy products
B. Report severe abdominal pain immediately
C. Take aspirin daily for pain prevention
D. Increase physical activity to dislodge stones
Correct ANSWER: B
Rationale:
A is incorrect: Dairy products, especially full-fat varieties, can trigger gallbladder contraction
and should be limited or chosen in low-fat versions.
B is correct: Severe abdominal pain could indicate complications such as acute cholecystitis,
choledocholithiasis, or pancreatitis, which require immediate medical attention.
C is incorrect: Aspirin is not recommended for preventing gallstone pain and may increase
bleeding risk, especially if surgery becomes necessary.
D is incorrect: Physical activity cannot dislodge gallstones and may actually worsen symptoms
during an acute episode.
Question 7
A patient with gallstones asks the nurse why they experience pain in the right shoulder. What is
the best response?
A. "The pain radiates because the gallstones are moving to your shoulder."
B. "This is referred pain caused by irritation of the diaphragm."
C. "You probably have a separate shoulder problem."
D. "The pain is from muscle tension due to guarding."
Correct ANSWER: B
Rationale:
