NRNP 6568 WEEK 10 QUIZ KNOWLEDGE CHECK
FALL TERM QUIZ (GRADED A+)
COMPREHENSIVE EXAMINATION 2026
Question 1
A 45-year-old female presents with right upper quadrant pain, nausea, and vomiting after a fatty meal.
Ultrasound reveals gallstones. Which of the following laboratory findings would be most consistent with
acute cholecystitis?
A) Elevated lipase with normal liver function tests
B) Elevated white blood cell count with elevated alkaline phosphatase
C) Elevated amylase with normal bilirubin
D) Decreased platelet count with elevated INR
Correct ANSWER✔✨-: B) Elevated white blood cell count with elevated alkaline phosphatase
Rationale:
A) Elevated lipase with normal liver function tests - Incorrect. Elevated lipase is more characteristic of
pancreatitis rather than acute cholecystitis. While lipase may be slightly elevated in cholecystitis, it is not
the primary laboratory finding.
B) Elevated white blood cell count with elevated alkaline phosphatase - Correct. Acute cholecystitis
typically presents with leukocytosis (elevated WBC) due to inflammation. Alkaline phosphatase is often
elevated due to biliary obstruction or cholestasis. This combination is classic for acute cholecystitis.
C) Elevated amylase with normal bilirubin - Incorrect. Elevated amylase is more indicative of
pancreatitis. While amylase may be mildly elevated in cholecystitis, it is not the most characteristic
finding.
,D) Decreased platelet count with elevated INR - Incorrect. This pattern suggests liver failure or
disseminated intravascular coagulation, not acute cholecystitis. Platelet counts are typically not
decreased in uncomplicated cholecystitis.
Question 2
In a patient with chronic cholecystitis, would you expect to see normal lab values for which of the
following?
A) White blood count
B) Amylase
C) Lipase
D) All of the above
Correct ANSWER✔✨-: C) Lipase
Rationale:
A) White blood count - Incorrect. In chronic cholecystitis, the white blood cell count may be normal or
only mildly elevated. However, during acute exacerbations, WBC count can be elevated. It is not
typically normal in all cases of chronic cholecystitis.
B) Amylase - Incorrect. Amylase may be elevated in chronic cholecystitis if there is associated pancreatic
involvement or if the patient has gallstone pancreatitis. While often normal, it is not reliably normal in
all cases.
C) Lipase - Correct. Lipase is typically normal in chronic cholecystitis unless there is concurrent
pancreatitis. Since chronic cholecystitis primarily affects the gallbladder and biliary tree, pancreatic
enzymes like lipase generally remain within normal limits.
D) All of the above - Incorrect. As explained above, not all these lab values are reliably normal in chronic
cholecystitis. Lipase is the most consistently normal value among the options.
Question 3
What is a common cause of cirrhosis in the United States?
,A) Alcoholic fatty liver disease
B) Alcoholic steatohepatitis
C) Hepatitis
D) All of the above
Correct ANSWER✔✨-: C) Hepatitis
Rationale:
A) Alcoholic fatty liver disease - Incorrect. While alcoholic fatty liver disease is a precursor to cirrhosis, it
is not the most common direct cause. It represents an early stage of alcohol-related liver disease that
can progress to alcoholic steatohepatitis and eventually cirrhosis.
B) Alcoholic steatohepatitis - Incorrect. This is a more advanced stage of alcohol-related liver disease
characterized by inflammation and liver cell injury. While it can lead to cirrhosis, hepatitis C is actually a
more common cause of cirrhosis in the United States.
C) Hepatitis - Correct. Hepatitis C is the leading cause of cirrhosis in the United States, followed by
alcoholic liver disease. Chronic viral hepatitis (particularly hepatitis C and B) accounts for a significant
portion of cirrhosis cases. Hepatitis C infection leads to progressive fibrosis and cirrhosis over 20-30
years in many patients.
D) All of the above - Incorrect. While all these conditions can cause cirrhosis, hepatitis (specifically
hepatitis C) is the most common cause in the United States. The question asks for a common cause, and
hepatitis is the most prevalent etiology.
Question 4
A 55-year-old male with a history of alcohol use disorder presents with jaundice, ascites, and spider
angiomas. Which laboratory finding would be most consistent with his presentation?
A) Elevated AST with AST/ALT ratio > 2
B) Elevated ALT with AST/ALT ratio < 1
C) Normal AST with elevated ALT
D) Elevated AST with normal ALT
, Correct ANSWER✔✨-: A) Elevated AST with AST/ALT ratio > 2
Rationale:
A) Elevated AST with AST/ALT ratio > 2 - Correct. Alcoholic liver disease typically presents with an AST to
ALT ratio greater than 2:1. This pattern is classic for alcohol-induced liver injury. The AST elevation is
often more pronounced than ALT because alcohol causes mitochondrial damage, releasing more AST.
B) Elevated ALT with AST/ALT ratio < 1 - Incorrect. This pattern is more consistent with viral hepatitis,
where ALT is typically higher than AST. In viral hepatitis, ALT is often more elevated because it is more
liver-specific and released during hepatocellular injury.
C) Normal AST with elevated ALT - Incorrect. This pattern is not characteristic of alcoholic liver disease.
Normal AST with elevated ALT might be seen in early stages of some liver diseases, but not in chronic
alcohol-related cirrhosis with jaundice and ascites.
D) Elevated AST with normal ALT - Incorrect. While AST is elevated in alcoholic liver disease, ALT is
typically also elevated, though to a lesser degree. A normal ALT with elevated AST would be unusual in
cirrhosis and would suggest other etiologies.
Question 5
Which of the following medications is contraindicated in a patient with cirrhosis due to the risk of
hepatotoxicity?
A) Acetaminophen
B) Aspirin
C) Ibuprofen
D) All of the above
Correct ANSWER✔✨-: A) Acetaminophen
Rationale:
A) Acetaminophen - Correct. Acetaminophen is contraindicated or should be used with extreme caution
in patients with cirrhosis because it is metabolized in the liver. In cirrhosis, the liver's ability to
FALL TERM QUIZ (GRADED A+)
COMPREHENSIVE EXAMINATION 2026
Question 1
A 45-year-old female presents with right upper quadrant pain, nausea, and vomiting after a fatty meal.
Ultrasound reveals gallstones. Which of the following laboratory findings would be most consistent with
acute cholecystitis?
A) Elevated lipase with normal liver function tests
B) Elevated white blood cell count with elevated alkaline phosphatase
C) Elevated amylase with normal bilirubin
D) Decreased platelet count with elevated INR
Correct ANSWER✔✨-: B) Elevated white blood cell count with elevated alkaline phosphatase
Rationale:
A) Elevated lipase with normal liver function tests - Incorrect. Elevated lipase is more characteristic of
pancreatitis rather than acute cholecystitis. While lipase may be slightly elevated in cholecystitis, it is not
the primary laboratory finding.
B) Elevated white blood cell count with elevated alkaline phosphatase - Correct. Acute cholecystitis
typically presents with leukocytosis (elevated WBC) due to inflammation. Alkaline phosphatase is often
elevated due to biliary obstruction or cholestasis. This combination is classic for acute cholecystitis.
C) Elevated amylase with normal bilirubin - Incorrect. Elevated amylase is more indicative of
pancreatitis. While amylase may be mildly elevated in cholecystitis, it is not the most characteristic
finding.
,D) Decreased platelet count with elevated INR - Incorrect. This pattern suggests liver failure or
disseminated intravascular coagulation, not acute cholecystitis. Platelet counts are typically not
decreased in uncomplicated cholecystitis.
Question 2
In a patient with chronic cholecystitis, would you expect to see normal lab values for which of the
following?
A) White blood count
B) Amylase
C) Lipase
D) All of the above
Correct ANSWER✔✨-: C) Lipase
Rationale:
A) White blood count - Incorrect. In chronic cholecystitis, the white blood cell count may be normal or
only mildly elevated. However, during acute exacerbations, WBC count can be elevated. It is not
typically normal in all cases of chronic cholecystitis.
B) Amylase - Incorrect. Amylase may be elevated in chronic cholecystitis if there is associated pancreatic
involvement or if the patient has gallstone pancreatitis. While often normal, it is not reliably normal in
all cases.
C) Lipase - Correct. Lipase is typically normal in chronic cholecystitis unless there is concurrent
pancreatitis. Since chronic cholecystitis primarily affects the gallbladder and biliary tree, pancreatic
enzymes like lipase generally remain within normal limits.
D) All of the above - Incorrect. As explained above, not all these lab values are reliably normal in chronic
cholecystitis. Lipase is the most consistently normal value among the options.
Question 3
What is a common cause of cirrhosis in the United States?
,A) Alcoholic fatty liver disease
B) Alcoholic steatohepatitis
C) Hepatitis
D) All of the above
Correct ANSWER✔✨-: C) Hepatitis
Rationale:
A) Alcoholic fatty liver disease - Incorrect. While alcoholic fatty liver disease is a precursor to cirrhosis, it
is not the most common direct cause. It represents an early stage of alcohol-related liver disease that
can progress to alcoholic steatohepatitis and eventually cirrhosis.
B) Alcoholic steatohepatitis - Incorrect. This is a more advanced stage of alcohol-related liver disease
characterized by inflammation and liver cell injury. While it can lead to cirrhosis, hepatitis C is actually a
more common cause of cirrhosis in the United States.
C) Hepatitis - Correct. Hepatitis C is the leading cause of cirrhosis in the United States, followed by
alcoholic liver disease. Chronic viral hepatitis (particularly hepatitis C and B) accounts for a significant
portion of cirrhosis cases. Hepatitis C infection leads to progressive fibrosis and cirrhosis over 20-30
years in many patients.
D) All of the above - Incorrect. While all these conditions can cause cirrhosis, hepatitis (specifically
hepatitis C) is the most common cause in the United States. The question asks for a common cause, and
hepatitis is the most prevalent etiology.
Question 4
A 55-year-old male with a history of alcohol use disorder presents with jaundice, ascites, and spider
angiomas. Which laboratory finding would be most consistent with his presentation?
A) Elevated AST with AST/ALT ratio > 2
B) Elevated ALT with AST/ALT ratio < 1
C) Normal AST with elevated ALT
D) Elevated AST with normal ALT
, Correct ANSWER✔✨-: A) Elevated AST with AST/ALT ratio > 2
Rationale:
A) Elevated AST with AST/ALT ratio > 2 - Correct. Alcoholic liver disease typically presents with an AST to
ALT ratio greater than 2:1. This pattern is classic for alcohol-induced liver injury. The AST elevation is
often more pronounced than ALT because alcohol causes mitochondrial damage, releasing more AST.
B) Elevated ALT with AST/ALT ratio < 1 - Incorrect. This pattern is more consistent with viral hepatitis,
where ALT is typically higher than AST. In viral hepatitis, ALT is often more elevated because it is more
liver-specific and released during hepatocellular injury.
C) Normal AST with elevated ALT - Incorrect. This pattern is not characteristic of alcoholic liver disease.
Normal AST with elevated ALT might be seen in early stages of some liver diseases, but not in chronic
alcohol-related cirrhosis with jaundice and ascites.
D) Elevated AST with normal ALT - Incorrect. While AST is elevated in alcoholic liver disease, ALT is
typically also elevated, though to a lesser degree. A normal ALT with elevated AST would be unusual in
cirrhosis and would suggest other etiologies.
Question 5
Which of the following medications is contraindicated in a patient with cirrhosis due to the risk of
hepatotoxicity?
A) Acetaminophen
B) Aspirin
C) Ibuprofen
D) All of the above
Correct ANSWER✔✨-: A) Acetaminophen
Rationale:
A) Acetaminophen - Correct. Acetaminophen is contraindicated or should be used with extreme caution
in patients with cirrhosis because it is metabolized in the liver. In cirrhosis, the liver's ability to
