NSG 4100 EXAM 3 ACTUAL
Gastrointestinal, Hepatic, Hematologic, and Immune Disorders —
100-Question Practice Exam with Answer Key & Rationales
Section A: Hepatic & Pancreatic Disorders
Question 1: A client with cirrhosis develops ascites. Which mechanism primarily contributes to
this finding?
● A. Increased serum albumin
● B. Portal hypertension and decreased serum albumin causing fluid shift into the
peritoneal cavity
● C. Decreased portal pressure
● D. Excess protein synthesis by the liver
Rationale: Cirrhosis causes portal hypertension and decreased albumin synthesis, reducing
oncotic pressure and promoting fluid shift into the peritoneal cavity, resulting in ascites.
Question 2: A client with cirrhosis and ascites is prescribed spironolactone. What is the primary
reason this diuretic is preferred?
● A. It causes significant potassium loss
● B. It spares potassium, reducing risk of hypokalemia common in liver disease
● C. It has no effect on fluid balance
● D. It is contraindicated in liver disease
Rationale: Spironolactone is potassium-sparing, which is beneficial in cirrhosis since these
clients are already prone to electrolyte imbalances and hyperaldosteronism.
Question 3: A client with cirrhosis develops confusion, asterixis, and a fruity breath odor.
Which condition does the nurse suspect?
● A. Hepatic encephalopathy
● B. Hypoglycemia
● C. Diabetic ketoacidosis
● D. Hepatorenal syndrome
Rationale: Hepatic encephalopathy results from the liver's inability to clear ammonia, leading to
neurotoxic effects such as confusion, asterixis, and altered mental status.
Question 4: A client with hepatic encephalopathy is prescribed lactulose. What is the expected
therapeutic effect?
● A. Increase ammonia absorption
● B. Trap ammonia in the gut and promote its excretion through the stool
● C. Increase serum protein levels
● D. Decrease bowel motility
,Rationale: Lactulose acidifies the colon, converting ammonia to a form that is trapped and
excreted in the stool, lowering serum ammonia levels.
Question 5: A nurse is evaluating the effectiveness of lactulose therapy in a client with hepatic
encephalopathy. Which finding indicates the medication is working?
● A. Fewer than 1 soft stool per day
● B. 2 to 3 soft stools per day with improved mental status
● C. Severe diarrhea with dehydration
● D. No change in bowel pattern
Rationale: The therapeutic goal of lactulose is typically 2-3 soft stools per day, which
corresponds with decreased ammonia levels and improved mental status.
Question 6: A client with esophageal varices develops sudden hematemesis. What is the nurse's
priority action?
● A. Position the client supine and assess vital signs, preparing for possible emergency
intervention
● B. Encourage the client to eat
● C. Administer an oral laxative
● D. Delay treatment until the next scheduled assessment
Rationale: Bleeding esophageal varices are a life-threatening emergency; the nurse should
assess airway, breathing, circulation, and vital signs while preparing for interventions such as
endoscopy or balloon tamponade.
Question 7: A client with esophageal varices is prescribed a nonselective beta blocker such as
propranolol. What is the purpose of this medication?
● A. Increase portal pressure
● B. Reduce portal hypertension and decrease risk of variceal bleeding
● C. Increase heart rate
● D. Treat infection
Rationale: Nonselective beta blockers reduce portal pressure by decreasing cardiac output and
splanchnic blood flow, lowering the risk of variceal hemorrhage.
Question 8: A client with cirrhosis has a prolonged prothrombin time. What is the underlying
cause?
● A. Excess vitamin K
● B. Decreased hepatic synthesis of clotting factors
● C. Increased platelet production
● D. Excess bile production
Rationale: The liver synthesizes most clotting factors; cirrhosis impairs this function, leading to
prolonged PT/INR and increased bleeding risk.
, Question 9: A client with acute pancreatitis reports severe epigastric pain radiating to the back.
Which laboratory finding supports this diagnosis?
● A. Elevated serum lipase and amylase
● B. Decreased white blood cell count
● C. Decreased blood glucose
● D. Elevated hemoglobin
Rationale: Elevated serum lipase and amylase are key diagnostic markers for acute pancreatitis,
reflecting pancreatic enzyme release and tissue injury.
Question 10: A nurse is caring for a client with acute pancreatitis. Which intervention is a
priority for pain and pancreatic rest?
● A. Encourage a high-fat diet immediately
● B. Maintain NPO status and manage pain as prescribed
● C. Encourage large frequent meals
● D. Restrict all IV fluids
Rationale: NPO status reduces pancreatic stimulation and allows the gland to rest, while pain
management is essential for comfort in acute pancreatitis.
Question 11: A client with acute pancreatitis develops hypocalcemia. What is the likely cause?
● A. Excess dietary calcium
● B. Calcium binding with fatty acids released during pancreatic tissue necrosis
(saponification)
● C. Increased parathyroid hormone
● D. Renal failure only
Rationale: In pancreatitis, fat necrosis releases fatty acids that bind calcium (saponification),
leading to hypocalcemia; the nurse should monitor for tetany and Chvostek's/Trousseau's signs.
Question 12: A client with chronic pancreatitis reports steatorrhea and weight loss. What is the
underlying cause?
● A. Excess pancreatic enzyme secretion
● B. Insufficient pancreatic enzymes leading to malabsorption of fats
● C. Excess bile production
● D. Increased gastric acid secretion
Rationale: Chronic pancreatitis damages exocrine pancreatic tissue, reducing enzyme secretion
needed for fat digestion, resulting in steatorrhea and malabsorption.
Question 13: A client with chronic pancreatitis is prescribed pancrelipase. When should this
medication be taken?
● A. On an empty stomach at bedtime
● B. With meals and snacks
● C. Once daily in the morning only
Gastrointestinal, Hepatic, Hematologic, and Immune Disorders —
100-Question Practice Exam with Answer Key & Rationales
Section A: Hepatic & Pancreatic Disorders
Question 1: A client with cirrhosis develops ascites. Which mechanism primarily contributes to
this finding?
● A. Increased serum albumin
● B. Portal hypertension and decreased serum albumin causing fluid shift into the
peritoneal cavity
● C. Decreased portal pressure
● D. Excess protein synthesis by the liver
Rationale: Cirrhosis causes portal hypertension and decreased albumin synthesis, reducing
oncotic pressure and promoting fluid shift into the peritoneal cavity, resulting in ascites.
Question 2: A client with cirrhosis and ascites is prescribed spironolactone. What is the primary
reason this diuretic is preferred?
● A. It causes significant potassium loss
● B. It spares potassium, reducing risk of hypokalemia common in liver disease
● C. It has no effect on fluid balance
● D. It is contraindicated in liver disease
Rationale: Spironolactone is potassium-sparing, which is beneficial in cirrhosis since these
clients are already prone to electrolyte imbalances and hyperaldosteronism.
Question 3: A client with cirrhosis develops confusion, asterixis, and a fruity breath odor.
Which condition does the nurse suspect?
● A. Hepatic encephalopathy
● B. Hypoglycemia
● C. Diabetic ketoacidosis
● D. Hepatorenal syndrome
Rationale: Hepatic encephalopathy results from the liver's inability to clear ammonia, leading to
neurotoxic effects such as confusion, asterixis, and altered mental status.
Question 4: A client with hepatic encephalopathy is prescribed lactulose. What is the expected
therapeutic effect?
● A. Increase ammonia absorption
● B. Trap ammonia in the gut and promote its excretion through the stool
● C. Increase serum protein levels
● D. Decrease bowel motility
,Rationale: Lactulose acidifies the colon, converting ammonia to a form that is trapped and
excreted in the stool, lowering serum ammonia levels.
Question 5: A nurse is evaluating the effectiveness of lactulose therapy in a client with hepatic
encephalopathy. Which finding indicates the medication is working?
● A. Fewer than 1 soft stool per day
● B. 2 to 3 soft stools per day with improved mental status
● C. Severe diarrhea with dehydration
● D. No change in bowel pattern
Rationale: The therapeutic goal of lactulose is typically 2-3 soft stools per day, which
corresponds with decreased ammonia levels and improved mental status.
Question 6: A client with esophageal varices develops sudden hematemesis. What is the nurse's
priority action?
● A. Position the client supine and assess vital signs, preparing for possible emergency
intervention
● B. Encourage the client to eat
● C. Administer an oral laxative
● D. Delay treatment until the next scheduled assessment
Rationale: Bleeding esophageal varices are a life-threatening emergency; the nurse should
assess airway, breathing, circulation, and vital signs while preparing for interventions such as
endoscopy or balloon tamponade.
Question 7: A client with esophageal varices is prescribed a nonselective beta blocker such as
propranolol. What is the purpose of this medication?
● A. Increase portal pressure
● B. Reduce portal hypertension and decrease risk of variceal bleeding
● C. Increase heart rate
● D. Treat infection
Rationale: Nonselective beta blockers reduce portal pressure by decreasing cardiac output and
splanchnic blood flow, lowering the risk of variceal hemorrhage.
Question 8: A client with cirrhosis has a prolonged prothrombin time. What is the underlying
cause?
● A. Excess vitamin K
● B. Decreased hepatic synthesis of clotting factors
● C. Increased platelet production
● D. Excess bile production
Rationale: The liver synthesizes most clotting factors; cirrhosis impairs this function, leading to
prolonged PT/INR and increased bleeding risk.
, Question 9: A client with acute pancreatitis reports severe epigastric pain radiating to the back.
Which laboratory finding supports this diagnosis?
● A. Elevated serum lipase and amylase
● B. Decreased white blood cell count
● C. Decreased blood glucose
● D. Elevated hemoglobin
Rationale: Elevated serum lipase and amylase are key diagnostic markers for acute pancreatitis,
reflecting pancreatic enzyme release and tissue injury.
Question 10: A nurse is caring for a client with acute pancreatitis. Which intervention is a
priority for pain and pancreatic rest?
● A. Encourage a high-fat diet immediately
● B. Maintain NPO status and manage pain as prescribed
● C. Encourage large frequent meals
● D. Restrict all IV fluids
Rationale: NPO status reduces pancreatic stimulation and allows the gland to rest, while pain
management is essential for comfort in acute pancreatitis.
Question 11: A client with acute pancreatitis develops hypocalcemia. What is the likely cause?
● A. Excess dietary calcium
● B. Calcium binding with fatty acids released during pancreatic tissue necrosis
(saponification)
● C. Increased parathyroid hormone
● D. Renal failure only
Rationale: In pancreatitis, fat necrosis releases fatty acids that bind calcium (saponification),
leading to hypocalcemia; the nurse should monitor for tetany and Chvostek's/Trousseau's signs.
Question 12: A client with chronic pancreatitis reports steatorrhea and weight loss. What is the
underlying cause?
● A. Excess pancreatic enzyme secretion
● B. Insufficient pancreatic enzymes leading to malabsorption of fats
● C. Excess bile production
● D. Increased gastric acid secretion
Rationale: Chronic pancreatitis damages exocrine pancreatic tissue, reducing enzyme secretion
needed for fat digestion, resulting in steatorrhea and malabsorption.
Question 13: A client with chronic pancreatitis is prescribed pancrelipase. When should this
medication be taken?
● A. On an empty stomach at bedtime
● B. With meals and snacks
● C. Once daily in the morning only
