NSG 3850 Comprehensive Examination
Questions 1-50: Gastrointestinal and Hepatobiliary
Disorders 2026
Question 1
The nurse is caring for a client who has developed ascites as a complication of advanced liver disease.
The nurse recognizes which of the following as the primary etiological risk factor behind this
complication?
A. Portal hypertension
B. Plasma hyperalbuminemia
C. Serum hypoalbuminemia
D. Accumulation of ammonia in the peritoneal cavity
ANSWER✔✨--: C. Serum hypoalbuminemia
Rationale:
Option A (Portal hypertension): While portal hypertension contributes to ascites formation by increasing
hydrostatic pressure, it is not the primary etiological factor. Portal hypertension causes fluid to leak from
the portal venous system, but hypoalbuminemia reduces the opposing oncotic pressure.
Option B (Plasma hyperalbuminemia): This is incorrect because hyperalbuminemia would increase
plasma oncotic pressure and actually help prevent fluid leakage into the peritoneal cavity. Clients with
liver disease typically have decreased albumin production.
,Option C (Serum hypoalbuminemia): Correct. The liver produces albumin, and in advanced liver disease,
albumin synthesis is impaired. Hypoalbuminemia reduces plasma oncotic pressure, allowing fluid to shift
from the vascular space into the peritoneal cavity, resulting in ascites.
Option D (Accumulation of ammonia in the peritoneal cavity): Ammonia accumulation is associated with
hepatic encephalopathy, not ascites. Ammonia is a neurotoxin that affects brain function when the liver
cannot convert it to urea.
Question 2
The nurse is caring for a client diagnosed with acute cholecystitis. Which of the following does the nurse
recognize as the primary contributing factor to the pathological process of this condition?
A. Enzymatic activation causes an autoimmune response in the gallbladder that leads to stone formation
B. Lecithin production by the gallbladder causes the solidification of cholesterol into stones
C. Vascular insufficiency to the gallbladder causes ischemic injury and hardened cystic ducts
D. Cystic duct obstruction causes pathological processes within the gallbladder
ANSWER✔✨--: D. Cystic duct obstruction causes pathological processes within the gallbladder
Rationale:
Option A (Enzymatic activation causes autoimmune response): Acute cholecystitis is not an autoimmune
condition. While enzyme activation does occur, it is a consequence of obstruction and inflammation, not
the primary cause.
Option B (Lecithin production causes solidification of cholesterol): Lecithin is a phospholipid that actually
helps keep cholesterol in solution. Decreased lecithin, not increased production, contributes to stone
formation.
Option C (Vascular insufficiency causes ischemic injury): While ischemia can occur in severe cases as a
complication, it is not the primary initiating factor. The primary pathology involves obstruction and
subsequent inflammation.
,Option D (Cystic duct obstruction causes pathological processes): Correct. Acute cholecystitis typically
begins with obstruction of the cystic duct, often by a gallstone. This obstruction leads to bile stasis,
increased pressure, distension of the gallbladder, and subsequent inflammation and infection.
Question 3
The nurse is caring for a client with chronic cholelithiasis. Which of the following symptoms should the
nurse expect the client to report?
A. Persistent epigastric pain
B. Functional dyspepsia
C. A gray-blue color at the flank
D. Left upper quadrant (LUQ) pain that radiates to the back
ANSWER✔✨--: B. Functional dyspepsia
Rationale:
Option A (Persistent epigastric pain): While epigastric pain can occur with cholelithiasis, it is typically
intermittent (biliary colic) rather than persistent. Pain usually occurs after meals, especially fatty meals.
Option B (Functional dyspepsia): Correct. Clients with chronic cholelithiasis often experience vague
symptoms including functional dyspepsia, which includes symptoms such as bloating, nausea, flatulence,
and belching. These symptoms are often non-specific and may be mistaken for other gastrointestinal
disorders.
Option C (Gray-blue color at the flank): A gray-blue discoloration at the flank (Grey Turner's sign) is
associated with retroperitoneal bleeding, often seen in acute pancreatitis or abdominal trauma, not
cholelithiasis.
Option D (LUQ pain radiating to the back): Left upper quadrant pain radiating to the back is more
characteristic of pancreatitis. Gallbladder pain is typically in the right upper quadrant or epigastric region
and may radiate to the right shoulder or back.
, Question 4
The nurse is discussing the pathogenesis of hepatitis A virus (HAV) with a client who is at increased risk.
Which statement should the nurse include in the discussion?
A. "It is very important to get regular hepatitis titers if you are on dialysis."
B. "Lack of safe water and poor sanitation are big risk factors."
C. "This is a chronic illness with no lifelong immunity."
D. "Do not travel for extended periods overseas."
ANSWER✔✨--: B. "Lack of safe water and poor sanitation are big risk factors."
Rationale:
Option A (Regular hepatitis titers if on dialysis): This statement is more relevant to hepatitis B and C,
which are transmitted through blood and body fluids. Dialysis patients are at increased risk for hepatitis
B and C, not primarily for hepatitis A.
Option B (Lack of safe water and poor sanitation): Correct. Hepatitis A is transmitted via the fecal-oral
route. Poor sanitation, lack of safe drinking water, and inadequate hygiene practices are significant risk
factors. The virus is shed in feces and can contaminate food and water sources.
Option C (Chronic illness with no lifelong immunity): This is incorrect. Hepatitis A does not cause chronic
illness. After infection, the body develops lifelong immunity through the production of IgG antibodies.
Option D (Do not travel overseas): This is too restrictive. While travel to developing countries with poor
sanitation is a risk factor, the nurse should provide education about prevention (vaccination, safe food
and water practices) rather than simply advising against travel.
Question 5
The nurse is caring for a client with hepatitis C virus (HCV) and a positive anti-HCV laboratory value.
Which conclusion should the nurse make?
Questions 1-50: Gastrointestinal and Hepatobiliary
Disorders 2026
Question 1
The nurse is caring for a client who has developed ascites as a complication of advanced liver disease.
The nurse recognizes which of the following as the primary etiological risk factor behind this
complication?
A. Portal hypertension
B. Plasma hyperalbuminemia
C. Serum hypoalbuminemia
D. Accumulation of ammonia in the peritoneal cavity
ANSWER✔✨--: C. Serum hypoalbuminemia
Rationale:
Option A (Portal hypertension): While portal hypertension contributes to ascites formation by increasing
hydrostatic pressure, it is not the primary etiological factor. Portal hypertension causes fluid to leak from
the portal venous system, but hypoalbuminemia reduces the opposing oncotic pressure.
Option B (Plasma hyperalbuminemia): This is incorrect because hyperalbuminemia would increase
plasma oncotic pressure and actually help prevent fluid leakage into the peritoneal cavity. Clients with
liver disease typically have decreased albumin production.
,Option C (Serum hypoalbuminemia): Correct. The liver produces albumin, and in advanced liver disease,
albumin synthesis is impaired. Hypoalbuminemia reduces plasma oncotic pressure, allowing fluid to shift
from the vascular space into the peritoneal cavity, resulting in ascites.
Option D (Accumulation of ammonia in the peritoneal cavity): Ammonia accumulation is associated with
hepatic encephalopathy, not ascites. Ammonia is a neurotoxin that affects brain function when the liver
cannot convert it to urea.
Question 2
The nurse is caring for a client diagnosed with acute cholecystitis. Which of the following does the nurse
recognize as the primary contributing factor to the pathological process of this condition?
A. Enzymatic activation causes an autoimmune response in the gallbladder that leads to stone formation
B. Lecithin production by the gallbladder causes the solidification of cholesterol into stones
C. Vascular insufficiency to the gallbladder causes ischemic injury and hardened cystic ducts
D. Cystic duct obstruction causes pathological processes within the gallbladder
ANSWER✔✨--: D. Cystic duct obstruction causes pathological processes within the gallbladder
Rationale:
Option A (Enzymatic activation causes autoimmune response): Acute cholecystitis is not an autoimmune
condition. While enzyme activation does occur, it is a consequence of obstruction and inflammation, not
the primary cause.
Option B (Lecithin production causes solidification of cholesterol): Lecithin is a phospholipid that actually
helps keep cholesterol in solution. Decreased lecithin, not increased production, contributes to stone
formation.
Option C (Vascular insufficiency causes ischemic injury): While ischemia can occur in severe cases as a
complication, it is not the primary initiating factor. The primary pathology involves obstruction and
subsequent inflammation.
,Option D (Cystic duct obstruction causes pathological processes): Correct. Acute cholecystitis typically
begins with obstruction of the cystic duct, often by a gallstone. This obstruction leads to bile stasis,
increased pressure, distension of the gallbladder, and subsequent inflammation and infection.
Question 3
The nurse is caring for a client with chronic cholelithiasis. Which of the following symptoms should the
nurse expect the client to report?
A. Persistent epigastric pain
B. Functional dyspepsia
C. A gray-blue color at the flank
D. Left upper quadrant (LUQ) pain that radiates to the back
ANSWER✔✨--: B. Functional dyspepsia
Rationale:
Option A (Persistent epigastric pain): While epigastric pain can occur with cholelithiasis, it is typically
intermittent (biliary colic) rather than persistent. Pain usually occurs after meals, especially fatty meals.
Option B (Functional dyspepsia): Correct. Clients with chronic cholelithiasis often experience vague
symptoms including functional dyspepsia, which includes symptoms such as bloating, nausea, flatulence,
and belching. These symptoms are often non-specific and may be mistaken for other gastrointestinal
disorders.
Option C (Gray-blue color at the flank): A gray-blue discoloration at the flank (Grey Turner's sign) is
associated with retroperitoneal bleeding, often seen in acute pancreatitis or abdominal trauma, not
cholelithiasis.
Option D (LUQ pain radiating to the back): Left upper quadrant pain radiating to the back is more
characteristic of pancreatitis. Gallbladder pain is typically in the right upper quadrant or epigastric region
and may radiate to the right shoulder or back.
, Question 4
The nurse is discussing the pathogenesis of hepatitis A virus (HAV) with a client who is at increased risk.
Which statement should the nurse include in the discussion?
A. "It is very important to get regular hepatitis titers if you are on dialysis."
B. "Lack of safe water and poor sanitation are big risk factors."
C. "This is a chronic illness with no lifelong immunity."
D. "Do not travel for extended periods overseas."
ANSWER✔✨--: B. "Lack of safe water and poor sanitation are big risk factors."
Rationale:
Option A (Regular hepatitis titers if on dialysis): This statement is more relevant to hepatitis B and C,
which are transmitted through blood and body fluids. Dialysis patients are at increased risk for hepatitis
B and C, not primarily for hepatitis A.
Option B (Lack of safe water and poor sanitation): Correct. Hepatitis A is transmitted via the fecal-oral
route. Poor sanitation, lack of safe drinking water, and inadequate hygiene practices are significant risk
factors. The virus is shed in feces and can contaminate food and water sources.
Option C (Chronic illness with no lifelong immunity): This is incorrect. Hepatitis A does not cause chronic
illness. After infection, the body develops lifelong immunity through the production of IgG antibodies.
Option D (Do not travel overseas): This is too restrictive. While travel to developing countries with poor
sanitation is a risk factor, the nurse should provide education about prevention (vaccination, safe food
and water practices) rather than simply advising against travel.
Question 5
The nurse is caring for a client with hepatitis C virus (HCV) and a positive anti-HCV laboratory value.
Which conclusion should the nurse make?
