NR571/NR 571 FINAL EXAM: (LATEST
2026/2027 UPDATE), COMPLEX DIAGNOSIS
& MANAGEMENT IN ACUTE CARE REVIEW
WITH CORRECT/ACCURATE ANSWERS
AT CHAMBERLAIN COLLEGE OF NURSING
COMPLEX DIAGNOSIS AND MANAGEMENT
IN ACUTE CARE PRACTICUM
Complex Diagnosis & Management in Acute Care
QUESTIONS 1–120 (With Rationales)
1. Which statement regarding alkaline phosphatase (ALP) levels is correct?
A. ALP is never elevated in hepatobiliary disease
B. ALP is severely elevated in all liver diseases
C. ALP is mildly elevated in hepatocellular disease and severely elevated in biliary disease
D. ALP elevation indicates viral hepatitis only
Correct Answer: C
Rationale:
Alkaline phosphatase is produced by bile duct epithelium, so obstruction or cholestasis leads to marked
elevations. In hepatocellular diseases such as viral hepatitis, ALP is typically only mildly elevated compared
to AST and ALT. Severe ALP elevation suggests biliary obstruction, cholangitis, or infiltrative disease.
Therefore, the degree of ALP elevation helps distinguish hepatobiliary pathology.
2. How is Hepatitis A primarily transmitted?
,A. Blood transfusion
B. Sexual contact
C. Fecal–oral route
D. Vertical transmission
Correct Answer: C
Rationale:
Hepatitis A is transmitted via the fecal–oral route, often through contaminated food or water. It is highly
prevalent in developing countries where sanitation is limited. Children are commonly infected and often
asymptomatic, contributing to widespread transmission. Unlike hepatitis B and C, HAV does not cause
chronic infection.
3. Which populations are most at risk for Hepatitis B transmission?
A. Only healthcare workers
B. IV drug users and sexually active individuals
C. Children in developing nations
D. Elderly patients only
Correct Answer: B
Rationale:
Hepatitis B is transmitted via blood and body fluids, including sexual contact and IV drug use. Occupational
exposure and dialysis patients are also at increased risk. Vertical transmission from mother to infant can
occur. Vaccination has significantly reduced incidence in many populations.
4. Which hepatitis virus is the leading cause of cirrhosis and hepatocellular carcinoma
worldwide?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
Correct Answer: B
Rationale:
Hepatitis B is a major global health issue and the leading cause of cirrhosis and liver cancer worldwide.
Chronic infection leads to progressive fibrosis, cirrhosis, and hepatocellular carcinoma. Although Hepatitis C
is common in developed nations, Hepatitis B remains more prevalent globally. Universal vaccination
programs have reduced incidence in many regions.
,5. Hepatitis C is most commonly transmitted through which route?
A. Fecal–oral
B. Sexual contact
C. IV drug use
D. Respiratory droplets
Correct Answer: C
Rationale:
Hepatitis C is primarily transmitted through blood exposure, with IV drug use being the most common route.
Sexual transmission is less efficient than with Hepatitis B. Many patients remain asymptomatic for years,
increasing the risk of chronic infection. Hepatitis C accounts for a significant proportion of chronic liver
disease cases.
6. Hepatitis D requires the presence of which virus to replicate?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Epstein-Barr virus
Correct Answer: B
Rationale:
Hepatitis D is a defective virus that requires Hepatitis B surface antigen to replicate. It can occur as a co-
infection or superinfection, with superinfection leading to more severe disease. Hepatitis D significantly
increases the risk of fulminant hepatitis and cirrhosis. Vaccination against Hepatitis B prevents Hepatitis D
infection.
7. What does a positive Anti-HBc indicate?
A. Immunity from vaccination
B. Current vaccination response
C. Past or ongoing Hepatitis B infection
D. Acute Hepatitis A infection
Correct Answer: C
Rationale:
Anti-HBc antibodies indicate exposure to Hepatitis B virus through natural infection. They are present in
both acute and chronic infections but not in vaccinated individuals. This marker helps differentiate immunity
from vaccination versus natural infection. It remains positive for life after exposure.
, 8. A positive Anti-HBs indicates which of the following?
A. Acute infection
B. Chronic infection
C. Immunity from past infection or vaccination
D. Active viral replication
Correct Answer: C
Rationale:
Anti-HBs antibodies signify immunity to Hepatitis B. This can result from successful vaccination or
recovery from natural infection. The presence of Anti-HBs without Anti-HBc indicates vaccine-induced
immunity. It is a protective antibody.
9. Nonalcoholic steatohepatitis (NASH) is commonly associated with which conditions?
A. Malnutrition and anemia
B. Obesity, diabetes mellitus, and hyperlipidemia
C. Autoimmune disease
D. Viral hepatitis
Correct Answer: B
Rationale:
NASH is part of the spectrum of nonalcoholic fatty liver disease and is strongly associated with metabolic
syndrome. Obesity, type 2 diabetes, and dyslipidemia contribute to hepatic fat accumulation and
inflammation. Over time, NASH can progress to cirrhosis. Lifestyle modification is the cornerstone of
management.
10. What is the primary treatment for NASH?
A. Antiviral therapy
B. Corticosteroids
C. Diet and exercise
D. Liver transplant
Correct Answer: C
Rationale:
Weight loss through diet and exercise is the most effective treatment for NASH. Even modest weight
reduction can improve liver histology and inflammation. No FDA-approved pharmacologic therapies
currently exist. Management focuses on treating underlying metabolic risk factors.
2026/2027 UPDATE), COMPLEX DIAGNOSIS
& MANAGEMENT IN ACUTE CARE REVIEW
WITH CORRECT/ACCURATE ANSWERS
AT CHAMBERLAIN COLLEGE OF NURSING
COMPLEX DIAGNOSIS AND MANAGEMENT
IN ACUTE CARE PRACTICUM
Complex Diagnosis & Management in Acute Care
QUESTIONS 1–120 (With Rationales)
1. Which statement regarding alkaline phosphatase (ALP) levels is correct?
A. ALP is never elevated in hepatobiliary disease
B. ALP is severely elevated in all liver diseases
C. ALP is mildly elevated in hepatocellular disease and severely elevated in biliary disease
D. ALP elevation indicates viral hepatitis only
Correct Answer: C
Rationale:
Alkaline phosphatase is produced by bile duct epithelium, so obstruction or cholestasis leads to marked
elevations. In hepatocellular diseases such as viral hepatitis, ALP is typically only mildly elevated compared
to AST and ALT. Severe ALP elevation suggests biliary obstruction, cholangitis, or infiltrative disease.
Therefore, the degree of ALP elevation helps distinguish hepatobiliary pathology.
2. How is Hepatitis A primarily transmitted?
,A. Blood transfusion
B. Sexual contact
C. Fecal–oral route
D. Vertical transmission
Correct Answer: C
Rationale:
Hepatitis A is transmitted via the fecal–oral route, often through contaminated food or water. It is highly
prevalent in developing countries where sanitation is limited. Children are commonly infected and often
asymptomatic, contributing to widespread transmission. Unlike hepatitis B and C, HAV does not cause
chronic infection.
3. Which populations are most at risk for Hepatitis B transmission?
A. Only healthcare workers
B. IV drug users and sexually active individuals
C. Children in developing nations
D. Elderly patients only
Correct Answer: B
Rationale:
Hepatitis B is transmitted via blood and body fluids, including sexual contact and IV drug use. Occupational
exposure and dialysis patients are also at increased risk. Vertical transmission from mother to infant can
occur. Vaccination has significantly reduced incidence in many populations.
4. Which hepatitis virus is the leading cause of cirrhosis and hepatocellular carcinoma
worldwide?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
Correct Answer: B
Rationale:
Hepatitis B is a major global health issue and the leading cause of cirrhosis and liver cancer worldwide.
Chronic infection leads to progressive fibrosis, cirrhosis, and hepatocellular carcinoma. Although Hepatitis C
is common in developed nations, Hepatitis B remains more prevalent globally. Universal vaccination
programs have reduced incidence in many regions.
,5. Hepatitis C is most commonly transmitted through which route?
A. Fecal–oral
B. Sexual contact
C. IV drug use
D. Respiratory droplets
Correct Answer: C
Rationale:
Hepatitis C is primarily transmitted through blood exposure, with IV drug use being the most common route.
Sexual transmission is less efficient than with Hepatitis B. Many patients remain asymptomatic for years,
increasing the risk of chronic infection. Hepatitis C accounts for a significant proportion of chronic liver
disease cases.
6. Hepatitis D requires the presence of which virus to replicate?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Epstein-Barr virus
Correct Answer: B
Rationale:
Hepatitis D is a defective virus that requires Hepatitis B surface antigen to replicate. It can occur as a co-
infection or superinfection, with superinfection leading to more severe disease. Hepatitis D significantly
increases the risk of fulminant hepatitis and cirrhosis. Vaccination against Hepatitis B prevents Hepatitis D
infection.
7. What does a positive Anti-HBc indicate?
A. Immunity from vaccination
B. Current vaccination response
C. Past or ongoing Hepatitis B infection
D. Acute Hepatitis A infection
Correct Answer: C
Rationale:
Anti-HBc antibodies indicate exposure to Hepatitis B virus through natural infection. They are present in
both acute and chronic infections but not in vaccinated individuals. This marker helps differentiate immunity
from vaccination versus natural infection. It remains positive for life after exposure.
, 8. A positive Anti-HBs indicates which of the following?
A. Acute infection
B. Chronic infection
C. Immunity from past infection or vaccination
D. Active viral replication
Correct Answer: C
Rationale:
Anti-HBs antibodies signify immunity to Hepatitis B. This can result from successful vaccination or
recovery from natural infection. The presence of Anti-HBs without Anti-HBc indicates vaccine-induced
immunity. It is a protective antibody.
9. Nonalcoholic steatohepatitis (NASH) is commonly associated with which conditions?
A. Malnutrition and anemia
B. Obesity, diabetes mellitus, and hyperlipidemia
C. Autoimmune disease
D. Viral hepatitis
Correct Answer: B
Rationale:
NASH is part of the spectrum of nonalcoholic fatty liver disease and is strongly associated with metabolic
syndrome. Obesity, type 2 diabetes, and dyslipidemia contribute to hepatic fat accumulation and
inflammation. Over time, NASH can progress to cirrhosis. Lifestyle modification is the cornerstone of
management.
10. What is the primary treatment for NASH?
A. Antiviral therapy
B. Corticosteroids
C. Diet and exercise
D. Liver transplant
Correct Answer: C
Rationale:
Weight loss through diet and exercise is the most effective treatment for NASH. Even modest weight
reduction can improve liver histology and inflammation. No FDA-approved pharmacologic therapies
currently exist. Management focuses on treating underlying metabolic risk factors.
