NSG 3800 Exam 4 - Comprehensive Adult Health Assessment
Gastrointestinal and Hepatic Disorders ACTUAL 2026
Section 1: Gallstones and Cholecystitis (Questions 1-25)
1. A patient has been diagnosed with cholelithiasis (gallstones). Which lifestyle
modification should the nurse prioritize in patient teaching?
A. Increase dietary fat intake to promote gallbladder emptying
B. Consume a diet low in fat and avoid gas-forming foods
C. Increase protein intake significantly while maintaining high fat consumption
D. Avoid all carbohydrates and focus solely on protein foods
ANSWER: B
Rationale:
A is incorrect: Increasing dietary fat intake would stimulate gallbladder contraction and
could precipitate biliary colic or acute cholecystitis in patients with gallstones. Fat
triggers cholecystokinin release, causing the gallbladder to contract against potentially
obstructed ducts.
B is correct: A low-fat diet reduces the frequency and intensity of gallbladder
contractions, decreasing symptoms. Avoiding gas-forming foods (onions, broccoli,
cabbage, pinto beans) helps prevent additional abdominal discomfort and bloating that
can exacerbate symptoms.
C is incorrect: While adequate protein is important, maintaining high fat consumption
would worsen symptoms and increase the risk of complications. The combination
described would be counterproductive.
D is incorrect: Eliminating all carbohydrates is unnecessary and could lead to nutritional
imbalances. Carbohydrates are an important energy source, and complete avoidance is
not required for gallstone management.
2. A patient presents to the emergency department with suspected acute cholecystitis.
Which clinical manifestation would the nurse expect to assess?
A. Left upper quadrant pain radiating to the left shoulder
B. Severe right upper quadrant pain with fever and nausea
C. Generalized abdominal pain with diarrhea
,D. Epigastric pain relieved by eating
ANSWER: B
Rationale:
A is incorrect: Left upper quadrant pain radiating to the left shoulder is more
characteristic of splenic injury or pancreatic disorders. Gallbladder pathology presents
with right-sided symptoms.
B is correct: Acute cholecystitis classically presents with severe right upper quadrant
(RUQ) pain, fever, nausea, and vomiting. The pain may radiate to the right shoulder or
back due to diaphragmatic irritation. This is known as referred pain.
C is incorrect: Generalized abdominal pain with diarrhea suggests gastroenteritis or
inflammatory bowel disease, not cholecystitis. Cholecystitis typically causes localized
RUQ pain.
D is incorrect: Epigastric pain relieved by eating is characteristic of duodenal ulcers, not
cholecystitis. Gallbladder pain is typically exacerbated by eating, especially fatty foods.
3. A patient with cholecystitis reports clay-colored stools and dark urine. The nurse
recognizes these findings indicate:
A. Resolution of the inflammatory process
B. Biliary obstruction preventing bile from reaching the intestines
C. Normal variation in patients with gallbladder disease
D. Gastrointestinal bleeding
ANSWER: B
Rationale:
A is incorrect: These findings indicate worsening obstruction, not resolution.
Improvement would be indicated by normalization of stool and urine color.
B is correct: Clay-colored (acholic) stools occur when bile cannot reach the intestines
due to biliary obstruction, preventing the normal brown color from bilirubin breakdown.
Dark urine results from conjugated bilirubin being excreted by the kidneys instead of the
intestines. These are classic signs of biliary obstruction.
C is incorrect: These are abnormal findings that indicate significant pathology requiring
intervention, not normal variations.
D is incorrect: Gastrointestinal bleeding would present with melena (black, tarry stools)
or hematochezia (bright red blood), not clay-colored stools. Dark urine in this context is
from bilirubin, not blood.
,4. Which food should the nurse instruct a patient with gallstones to avoid?
A. Lean chicken breast
B. Broccoli and cabbage
C. White rice
D. Applesauce
ANSWER: B
Rationale:
A is incorrect: Lean chicken breast is a low-fat protein source that is generally well-
tolerated by patients with gallstones. It does not excessively stimulate gallbladder
contraction.
B is correct: Broccoli and cabbage are gas-forming foods that can cause abdominal
bloating and discomfort in patients with gallbladder disease. These foods, along with
onions and beans, should be avoided to minimize symptoms.
C is incorrect: White rice is a low-fat, easily digestible carbohydrate that does not
stimulate gallbladder contraction and is generally safe for patients with gallstones.
D is incorrect: Applesauce is a bland, low-fat food that is part of the BRAT diet and is
well-tolerated by patients with gastrointestinal disorders including gallbladder disease.
5. A patient asks why they are experiencing right shoulder pain with their gallbladder
attack. The nurse's best response is:
A. "The pain is referred from diaphragmatic irritation caused by gallbladder
inflammation"
B. "You must have injured your shoulder while sleeping"
C. "Gallbladder disease causes generalized body aches"
D. "This is a sign that the gallstones are moving to your liver"
ANSWER: A
Rationale:
A is correct: Right shoulder pain in cholecystitis is referred pain caused by irritation of
the diaphragm from the inflamed gallbladder. The phrenic nerve (C3-C5) innervates
both the diaphragm and shoulder area, causing the brain to interpret the pain as coming
from the shoulder. This is a classic finding in cholecystitis.
B is incorrect: This dismisses the patient's legitimate symptom and fails to provide
education about the pathophysiology of their condition.
, C is incorrect: Gallbladder disease does not cause generalized body aches. The
shoulder pain is specific and has a distinct pathophysiological mechanism.
D is incorrect: Gallstones do not move to the liver in a way that would cause shoulder
pain. This explanation is anatomically incorrect and would cause unnecessary alarm.
6. The nurse is caring for a patient with acute cholecystitis. Which assessment finding
requires immediate notification of the healthcare provider?
A. Mild nausea after eating
B. Temperature of 101.2°F (38.4°C) with rigid abdomen
C. Occasional right upper quadrant discomfort
D. Patient reports feeling tired
ANSWER: B
Rationale:
A is incorrect: Mild nausea is an expected finding in cholecystitis and does not require
immediate notification, though it should be documented and managed.
B is correct: Fever with a rigid abdomen suggests possible gallbladder perforation,
peritonitis, or severe infection requiring immediate intervention. A rigid abdomen is a
sign of peritoneal irritation and is a medical emergency.
C is incorrect: Occasional RUQ discomfort is an expected finding in cholecystitis and
would not require immediate notification unless it becomes severe or changes
character.
D is incorrect: Fatigue is a nonspecific finding that can occur with any illness and does
not indicate an emergency situation.
7. Which diagnostic test is most specific for diagnosing cholecystitis?
A. Complete blood count (CBC)
B. Hepatobiliary iminodiacetic acid (HIDA) scan
C. Serum amylase
D. Urinalysis
ANSWER: B
Rationale:
A is incorrect: While CBC may show elevated white blood cells indicating infection or
inflammation, it is not specific for cholecystitis and can be elevated in many conditions.
Gastrointestinal and Hepatic Disorders ACTUAL 2026
Section 1: Gallstones and Cholecystitis (Questions 1-25)
1. A patient has been diagnosed with cholelithiasis (gallstones). Which lifestyle
modification should the nurse prioritize in patient teaching?
A. Increase dietary fat intake to promote gallbladder emptying
B. Consume a diet low in fat and avoid gas-forming foods
C. Increase protein intake significantly while maintaining high fat consumption
D. Avoid all carbohydrates and focus solely on protein foods
ANSWER: B
Rationale:
A is incorrect: Increasing dietary fat intake would stimulate gallbladder contraction and
could precipitate biliary colic or acute cholecystitis in patients with gallstones. Fat
triggers cholecystokinin release, causing the gallbladder to contract against potentially
obstructed ducts.
B is correct: A low-fat diet reduces the frequency and intensity of gallbladder
contractions, decreasing symptoms. Avoiding gas-forming foods (onions, broccoli,
cabbage, pinto beans) helps prevent additional abdominal discomfort and bloating that
can exacerbate symptoms.
C is incorrect: While adequate protein is important, maintaining high fat consumption
would worsen symptoms and increase the risk of complications. The combination
described would be counterproductive.
D is incorrect: Eliminating all carbohydrates is unnecessary and could lead to nutritional
imbalances. Carbohydrates are an important energy source, and complete avoidance is
not required for gallstone management.
2. A patient presents to the emergency department with suspected acute cholecystitis.
Which clinical manifestation would the nurse expect to assess?
A. Left upper quadrant pain radiating to the left shoulder
B. Severe right upper quadrant pain with fever and nausea
C. Generalized abdominal pain with diarrhea
,D. Epigastric pain relieved by eating
ANSWER: B
Rationale:
A is incorrect: Left upper quadrant pain radiating to the left shoulder is more
characteristic of splenic injury or pancreatic disorders. Gallbladder pathology presents
with right-sided symptoms.
B is correct: Acute cholecystitis classically presents with severe right upper quadrant
(RUQ) pain, fever, nausea, and vomiting. The pain may radiate to the right shoulder or
back due to diaphragmatic irritation. This is known as referred pain.
C is incorrect: Generalized abdominal pain with diarrhea suggests gastroenteritis or
inflammatory bowel disease, not cholecystitis. Cholecystitis typically causes localized
RUQ pain.
D is incorrect: Epigastric pain relieved by eating is characteristic of duodenal ulcers, not
cholecystitis. Gallbladder pain is typically exacerbated by eating, especially fatty foods.
3. A patient with cholecystitis reports clay-colored stools and dark urine. The nurse
recognizes these findings indicate:
A. Resolution of the inflammatory process
B. Biliary obstruction preventing bile from reaching the intestines
C. Normal variation in patients with gallbladder disease
D. Gastrointestinal bleeding
ANSWER: B
Rationale:
A is incorrect: These findings indicate worsening obstruction, not resolution.
Improvement would be indicated by normalization of stool and urine color.
B is correct: Clay-colored (acholic) stools occur when bile cannot reach the intestines
due to biliary obstruction, preventing the normal brown color from bilirubin breakdown.
Dark urine results from conjugated bilirubin being excreted by the kidneys instead of the
intestines. These are classic signs of biliary obstruction.
C is incorrect: These are abnormal findings that indicate significant pathology requiring
intervention, not normal variations.
D is incorrect: Gastrointestinal bleeding would present with melena (black, tarry stools)
or hematochezia (bright red blood), not clay-colored stools. Dark urine in this context is
from bilirubin, not blood.
,4. Which food should the nurse instruct a patient with gallstones to avoid?
A. Lean chicken breast
B. Broccoli and cabbage
C. White rice
D. Applesauce
ANSWER: B
Rationale:
A is incorrect: Lean chicken breast is a low-fat protein source that is generally well-
tolerated by patients with gallstones. It does not excessively stimulate gallbladder
contraction.
B is correct: Broccoli and cabbage are gas-forming foods that can cause abdominal
bloating and discomfort in patients with gallbladder disease. These foods, along with
onions and beans, should be avoided to minimize symptoms.
C is incorrect: White rice is a low-fat, easily digestible carbohydrate that does not
stimulate gallbladder contraction and is generally safe for patients with gallstones.
D is incorrect: Applesauce is a bland, low-fat food that is part of the BRAT diet and is
well-tolerated by patients with gastrointestinal disorders including gallbladder disease.
5. A patient asks why they are experiencing right shoulder pain with their gallbladder
attack. The nurse's best response is:
A. "The pain is referred from diaphragmatic irritation caused by gallbladder
inflammation"
B. "You must have injured your shoulder while sleeping"
C. "Gallbladder disease causes generalized body aches"
D. "This is a sign that the gallstones are moving to your liver"
ANSWER: A
Rationale:
A is correct: Right shoulder pain in cholecystitis is referred pain caused by irritation of
the diaphragm from the inflamed gallbladder. The phrenic nerve (C3-C5) innervates
both the diaphragm and shoulder area, causing the brain to interpret the pain as coming
from the shoulder. This is a classic finding in cholecystitis.
B is incorrect: This dismisses the patient's legitimate symptom and fails to provide
education about the pathophysiology of their condition.
, C is incorrect: Gallbladder disease does not cause generalized body aches. The
shoulder pain is specific and has a distinct pathophysiological mechanism.
D is incorrect: Gallstones do not move to the liver in a way that would cause shoulder
pain. This explanation is anatomically incorrect and would cause unnecessary alarm.
6. The nurse is caring for a patient with acute cholecystitis. Which assessment finding
requires immediate notification of the healthcare provider?
A. Mild nausea after eating
B. Temperature of 101.2°F (38.4°C) with rigid abdomen
C. Occasional right upper quadrant discomfort
D. Patient reports feeling tired
ANSWER: B
Rationale:
A is incorrect: Mild nausea is an expected finding in cholecystitis and does not require
immediate notification, though it should be documented and managed.
B is correct: Fever with a rigid abdomen suggests possible gallbladder perforation,
peritonitis, or severe infection requiring immediate intervention. A rigid abdomen is a
sign of peritoneal irritation and is a medical emergency.
C is incorrect: Occasional RUQ discomfort is an expected finding in cholecystitis and
would not require immediate notification unless it becomes severe or changes
character.
D is incorrect: Fatigue is a nonspecific finding that can occur with any illness and does
not indicate an emergency situation.
7. Which diagnostic test is most specific for diagnosing cholecystitis?
A. Complete blood count (CBC)
B. Hepatobiliary iminodiacetic acid (HIDA) scan
C. Serum amylase
D. Urinalysis
ANSWER: B
Rationale:
A is incorrect: While CBC may show elevated white blood cells indicating infection or
inflammation, it is not specific for cholecystitis and can be elevated in many conditions.
