NR 324 | Adult Health II | Gastrointestinal Disorders (GI Bleed, Liver
Disease) Practice Pack 2026 |Chamberlain College
1. A patient with cirrhosis presents with increased confusion and asterixis.
Which lab value does the nurse expect to be elevated?
A. Serum ammonia
B. Serum creatinine
C. Serum potassium
D. Serum amylase
Answer: A
Rationale: Ammonia is a byproduct of protein metabolism that the liver normally converts
to urea. In liver failure, ammonia accumulates, crossing the blood-brain barrier and causing
hepatic encephalopathy, characterized by confusion and asterixis (flapping tremors).
2. A patient is admitted with an upper gastrointestinal bleed. Which clinical
manifestation should the nurse prioritize as a sign of hypovolemic shock?
A. Bounding peripheral pulses
B. Tachycardia and hypotension
C. Increased urine output
D. Hyperactive bowel sounds
Answer: B
Rationale: Tachycardia is often the earliest sign of compensatory hypovolemia, followed
by hypotension as compensatory mechanisms fail. This indicates significant blood loss
requiring immediate intervention.
,3. Which medication is commonly administered to a patient with esophageal
varices to reduce portal venous pressure?
A. Pantoprazole (Protonix)
B. Furosemide (Lasix)
C. Loperamide (Imodium)
D. Octreotide (Sandostatin)
Answer: D
Rationale: Octreotide is a somatostatin analog that causes splanchnic vasoconstriction,
which reduces portal blood flow and pressure, helping to control bleeding from esophageal
varices.
4. A patient with advanced cirrhosis is scheduled for a paracentesis. What is the
nurse’s priority action before the procedure?
A. Have the patient drink 1 liter of water
B. Place the patient in a prone position
C. Ensure the patient voids to empty the bladder
D. Administer a dose of Vitamin K
Answer: C
Rationale: The patient must void before a paracentesis to move the bladder away from the
abdominal wall, reducing the risk of accidental bladder perforation by the needle.
5. Which dietary modification is most appropriate for a patient with cirrhosis
and significant ascites?
A. High-sodium diet
B. Low-protein diet
C. Low-sodium diet
D. High-fat diet
Answer: C
, Rationale: Sodium restriction is essential in managing ascites because sodium promotes
water retention. Usually, patients are restricted to 2 grams or less per day.
6. A patient has been prescribed Lactulose for hepatic encephalopathy. How
does the nurse evaluate the effectiveness of this medication?
A. Improved level of consciousness
B. Increased appetite
C. Decreased number of bowel movements
D. Increased serum bilirubin
Answer: A
Rationale: Lactulose works by trapping ammonia in the gut and expelling it via diarrhea.
The goal of therapy is reduced serum ammonia, which clinically manifests as improved
mental status and reduced confusion.
7. Which assessment finding is most indicative of a perforated peptic ulcer?
A. Hyperactive bowel sounds and diarrhea
B. Mild epigastric tenderness after eating
C. Rigid, board-like abdomen with severe pain
D. Increased flatulence and bloating
Answer: C
Rationale: Perforation causes gastric contents to spill into the peritoneal cavity, leading to
chemical peritonitis, which results in a rigid, board-like abdomen and intense pain.
8. A patient with liver failure has a prolonged Prothrombin Time (PT). What is
the underlying cause?
A. Increased destruction of platelets by the spleen
B. Decreased synthesis of clotting factors by the liver
C. Vitamin C deficiency
D. Decreased production of red blood cells
Answer: B
Disease) Practice Pack 2026 |Chamberlain College
1. A patient with cirrhosis presents with increased confusion and asterixis.
Which lab value does the nurse expect to be elevated?
A. Serum ammonia
B. Serum creatinine
C. Serum potassium
D. Serum amylase
Answer: A
Rationale: Ammonia is a byproduct of protein metabolism that the liver normally converts
to urea. In liver failure, ammonia accumulates, crossing the blood-brain barrier and causing
hepatic encephalopathy, characterized by confusion and asterixis (flapping tremors).
2. A patient is admitted with an upper gastrointestinal bleed. Which clinical
manifestation should the nurse prioritize as a sign of hypovolemic shock?
A. Bounding peripheral pulses
B. Tachycardia and hypotension
C. Increased urine output
D. Hyperactive bowel sounds
Answer: B
Rationale: Tachycardia is often the earliest sign of compensatory hypovolemia, followed
by hypotension as compensatory mechanisms fail. This indicates significant blood loss
requiring immediate intervention.
,3. Which medication is commonly administered to a patient with esophageal
varices to reduce portal venous pressure?
A. Pantoprazole (Protonix)
B. Furosemide (Lasix)
C. Loperamide (Imodium)
D. Octreotide (Sandostatin)
Answer: D
Rationale: Octreotide is a somatostatin analog that causes splanchnic vasoconstriction,
which reduces portal blood flow and pressure, helping to control bleeding from esophageal
varices.
4. A patient with advanced cirrhosis is scheduled for a paracentesis. What is the
nurse’s priority action before the procedure?
A. Have the patient drink 1 liter of water
B. Place the patient in a prone position
C. Ensure the patient voids to empty the bladder
D. Administer a dose of Vitamin K
Answer: C
Rationale: The patient must void before a paracentesis to move the bladder away from the
abdominal wall, reducing the risk of accidental bladder perforation by the needle.
5. Which dietary modification is most appropriate for a patient with cirrhosis
and significant ascites?
A. High-sodium diet
B. Low-protein diet
C. Low-sodium diet
D. High-fat diet
Answer: C
, Rationale: Sodium restriction is essential in managing ascites because sodium promotes
water retention. Usually, patients are restricted to 2 grams or less per day.
6. A patient has been prescribed Lactulose for hepatic encephalopathy. How
does the nurse evaluate the effectiveness of this medication?
A. Improved level of consciousness
B. Increased appetite
C. Decreased number of bowel movements
D. Increased serum bilirubin
Answer: A
Rationale: Lactulose works by trapping ammonia in the gut and expelling it via diarrhea.
The goal of therapy is reduced serum ammonia, which clinically manifests as improved
mental status and reduced confusion.
7. Which assessment finding is most indicative of a perforated peptic ulcer?
A. Hyperactive bowel sounds and diarrhea
B. Mild epigastric tenderness after eating
C. Rigid, board-like abdomen with severe pain
D. Increased flatulence and bloating
Answer: C
Rationale: Perforation causes gastric contents to spill into the peritoneal cavity, leading to
chemical peritonitis, which results in a rigid, board-like abdomen and intense pain.
8. A patient with liver failure has a prolonged Prothrombin Time (PT). What is
the underlying cause?
A. Increased destruction of platelets by the spleen
B. Decreased synthesis of clotting factors by the liver
C. Vitamin C deficiency
D. Decreased production of red blood cells
Answer: B
