NSG 3850 Final Exam 4 – Hepatic & Biliary
Disorders 2026
Question 1
The nurse is caring for a client with chronic alcoholism who has jaundice. The nurse determines the
etiological process of this condition is:
A. Increased bile salt excretion
B. An alteration of protein metabolism
C. Hepatic dysfunction in bilirubin metabolism
D. Prehepatic alterations in erythropoiesis
Correct Answer: C
A rationale: Increased bile salt excretion is not a cause of jaundice; bile salt retention (not excretion) can
occur in liver disease but does not directly cause yellow discoloration.
B rationale: Altered protein metabolism may lead to decreased albumin and increased ammonia, but it
is not the direct cause of jaundice.
C rationale: Hepatic dysfunction in bilirubin metabolism (conjugation and excretion) leads to
accumulation of unconjugated or conjugated bilirubin, causing jaundice.
D rationale: Prehepatic alterations (e.g., hemolysis) increase bilirubin production but are not the primary
etiology in chronic alcoholic liver disease.
Question 2
,The nurse is caring for a client who has cholelithiasis. Which of the following should the nurse identify as
a risk factor for this condition?
A. Excessive alcohol abuse
B. Rapid weight loss in an obese individual
C. A nasogastric (NG) tube to low wall suction
D. Hepatitis virus B (HVB)
Correct Answer: B
A rationale: Excessive alcohol abuse is a risk factor for pancreatitis and liver cirrhosis, not primarily for
cholesterol gallstones.
B rationale: Rapid weight loss in an obese individual mobilizes cholesterol from adipose tissue,
increasing biliary cholesterol saturation and gallstone formation.
C rationale: NG tube suction may cause fluid and electrolyte imbalances but is not a direct risk factor for
cholelithiasis.
D rationale: Hepatitis B virus causes hepatic inflammation but is not a major risk factor for cholelithiasis.
Question 3
The nurse is caring for a client who has chronic cholelithiasis. Which of the following would the nurse
expect the client to report?
A. Abdominal pain upon waking up
B. Left upper quadrant abdominal pain
C. Persistent epigastric pain
D. Right upper quadrant pain after a fatty meal
Correct Answer: D
,A rationale: Pain upon waking is not characteristic; gallstone pain typically occurs postprandially.
B rationale: Left upper quadrant pain suggests gastric or pancreatic issues, not gallbladder.
C rationale: Persistent epigastric pain can occur but is less specific; classic pain is RUQ or referred to
shoulder.
D rationale: Right upper quadrant pain after a fatty meal occurs when the gallbladder contracts against a
stone, causing biliary colic.
Question 4
A client with chronic alcoholism presents with ascites and spider angiomas. Which laboratory finding
would the nurse expect?
A. Elevated serum albumin
B. Decreased serum ammonia
C. Elevated direct bilirubin
D. Decreased platelet count
Correct Answer: D
A rationale: Albumin is typically decreased in chronic liver disease due to impaired synthesis.
B rationale: Ammonia is often elevated due to decreased hepatic clearance.
C rationale: Both direct and indirect bilirubin may be elevated, but thrombocytopenia is more directly
tied to portal hypertension and splenomegaly.
D rationale: Decreased platelet count results from hypersplenism secondary to portal hypertension.
Question 5
, Which of the following dietary modifications is most appropriate for a client with cholelithiasis prior to
surgery?
A. High-fat, low-carbohydrate diet
B. Low-fat, high-fiber diet
C. High-protein, high-fat diet
D. Clear liquid diet only
Correct Answer: B
A rationale: High-fat diet may trigger biliary colic.
B rationale: Low-fat, high-fiber diet reduces gallbladder stimulation and helps manage symptoms.
C rationale: High-fat intake exacerbates pain.
D rationale: Clear liquids are used post-op or during acute attacks, not long-term pre-op.
Question 6
A nurse is assessing a client with obstructive jaundice secondary to cholelithiasis. Which finding is most
consistent with this condition?
A. Dark urine and clay-colored stools
B. Pale urine and black tarry stools
C. Green urine and diarrhea
D. Hematuria and steatorrhea
Correct Answer: A
A rationale: Dark urine (conjugated bilirubin excreted in urine) and clay-colored stools (lack of bilirubin
in intestines) indicate obstructive jaundice.
Disorders 2026
Question 1
The nurse is caring for a client with chronic alcoholism who has jaundice. The nurse determines the
etiological process of this condition is:
A. Increased bile salt excretion
B. An alteration of protein metabolism
C. Hepatic dysfunction in bilirubin metabolism
D. Prehepatic alterations in erythropoiesis
Correct Answer: C
A rationale: Increased bile salt excretion is not a cause of jaundice; bile salt retention (not excretion) can
occur in liver disease but does not directly cause yellow discoloration.
B rationale: Altered protein metabolism may lead to decreased albumin and increased ammonia, but it
is not the direct cause of jaundice.
C rationale: Hepatic dysfunction in bilirubin metabolism (conjugation and excretion) leads to
accumulation of unconjugated or conjugated bilirubin, causing jaundice.
D rationale: Prehepatic alterations (e.g., hemolysis) increase bilirubin production but are not the primary
etiology in chronic alcoholic liver disease.
Question 2
,The nurse is caring for a client who has cholelithiasis. Which of the following should the nurse identify as
a risk factor for this condition?
A. Excessive alcohol abuse
B. Rapid weight loss in an obese individual
C. A nasogastric (NG) tube to low wall suction
D. Hepatitis virus B (HVB)
Correct Answer: B
A rationale: Excessive alcohol abuse is a risk factor for pancreatitis and liver cirrhosis, not primarily for
cholesterol gallstones.
B rationale: Rapid weight loss in an obese individual mobilizes cholesterol from adipose tissue,
increasing biliary cholesterol saturation and gallstone formation.
C rationale: NG tube suction may cause fluid and electrolyte imbalances but is not a direct risk factor for
cholelithiasis.
D rationale: Hepatitis B virus causes hepatic inflammation but is not a major risk factor for cholelithiasis.
Question 3
The nurse is caring for a client who has chronic cholelithiasis. Which of the following would the nurse
expect the client to report?
A. Abdominal pain upon waking up
B. Left upper quadrant abdominal pain
C. Persistent epigastric pain
D. Right upper quadrant pain after a fatty meal
Correct Answer: D
,A rationale: Pain upon waking is not characteristic; gallstone pain typically occurs postprandially.
B rationale: Left upper quadrant pain suggests gastric or pancreatic issues, not gallbladder.
C rationale: Persistent epigastric pain can occur but is less specific; classic pain is RUQ or referred to
shoulder.
D rationale: Right upper quadrant pain after a fatty meal occurs when the gallbladder contracts against a
stone, causing biliary colic.
Question 4
A client with chronic alcoholism presents with ascites and spider angiomas. Which laboratory finding
would the nurse expect?
A. Elevated serum albumin
B. Decreased serum ammonia
C. Elevated direct bilirubin
D. Decreased platelet count
Correct Answer: D
A rationale: Albumin is typically decreased in chronic liver disease due to impaired synthesis.
B rationale: Ammonia is often elevated due to decreased hepatic clearance.
C rationale: Both direct and indirect bilirubin may be elevated, but thrombocytopenia is more directly
tied to portal hypertension and splenomegaly.
D rationale: Decreased platelet count results from hypersplenism secondary to portal hypertension.
Question 5
, Which of the following dietary modifications is most appropriate for a client with cholelithiasis prior to
surgery?
A. High-fat, low-carbohydrate diet
B. Low-fat, high-fiber diet
C. High-protein, high-fat diet
D. Clear liquid diet only
Correct Answer: B
A rationale: High-fat diet may trigger biliary colic.
B rationale: Low-fat, high-fiber diet reduces gallbladder stimulation and helps manage symptoms.
C rationale: High-fat intake exacerbates pain.
D rationale: Clear liquids are used post-op or during acute attacks, not long-term pre-op.
Question 6
A nurse is assessing a client with obstructive jaundice secondary to cholelithiasis. Which finding is most
consistent with this condition?
A. Dark urine and clay-colored stools
B. Pale urine and black tarry stools
C. Green urine and diarrhea
D. Hematuria and steatorrhea
Correct Answer: A
A rationale: Dark urine (conjugated bilirubin excreted in urine) and clay-colored stools (lack of bilirubin
in intestines) indicate obstructive jaundice.
