,NR 324 Adult Health I Exam 4 | Chamberlain
College of Nursing | Latest 2026/2027 Update
(PDF)
1. A nurse is caring for a client with cirrhosis who is scheduled for an elective paracentesis. Which
nursing intervention is the priority before the procedure?
A) Ensure the client voids to empty the bladder
B) Administer a bolus of intravenous albumin
C) Position the client on their right side
D) Instruct the client to remain NPO for 12 hours
Correct Answer: Ensure the client voids to empty the bladder
Rationale: The nurse must ensure the client empties their bladder immediately before a paracentesis
to prevent accidental puncture by the needle. This safety measure is critical because a distended
bladder can easily be perforated during the abdominal entry. Assessment of baseline vital signs and
abdominal girth should also be performed prior to starting the procedure.
2. A client is admitted with acute pancreatitis and reports severe abdominal pain. Which laboratory
result would the nurse expect to be most significantly elevated?
A) Serum Bilirubin
B) Serum Creatinine
C) Serum Potassium
D) Serum Amylase
Correct Answer: Serum Amylase
Rationale: Serum amylase and lipase are the primary biochemical markers used to diagnose acute
pancreatitis because they are released by the damaged pancreas into the bloodstream. Amylase levels
usually rise within 12 hours of the onset of symptoms and return to normal within 48 to 72 hours.
While bilirubin may rise if the bile duct is obstructed, amylase is more specific to the pancreatic
inflammatory process.
,3. A client with Ulcerative Colitis is experiencing an exacerbation. Which clinical manifestation should
the nurse anticipate during the assessment?
A) Frequent bloody stools
B) Pain relief after eating
C) Right lower quadrant pain
D) Constipation
Correct Answer: Frequent bloody stools
Rationale: Ulcerative colitis is characterized by inflammation and ulceration of the colon and rectum,
leading to frequent bloody diarrhea. Pain is typically in the left lower quadrant and may be relieved by
defecation. Crohn's disease, which can affect any part of the GI tract, often presents with right lower
quadrant pain and malabsorption.
4. A nurse is providing discharge teaching to a client with cirrhosis who has ascites. Which statement
by the client indicates correct understanding of the underlying pathophysiology?
A) "The fluid buildup is caused by my liver not making enough clotting factors."
B) "Portal hypertension and low albumin cause fluid to shift into my abdomen."
C) "Decreased peristalsis causes fluid to collect in my belly."
D) "My kidneys are retaining fluid because of the cirrhosis."
Correct Answer: "Portal hypertension and low albumin cause fluid to shift into my abdomen."
Rationale: Ascites in cirrhosis results from portal hypertension, which increases hydrostatic pressure
in the portal system, and hypoalbuminemia, which decreases oncotic pressure. These forces cause
fluid to shift into the peritoneal cavity. Clotting factor deficiency causes bleeding, not ascites.
Decreased peristalsis and renal retention are secondary effects, not the primary mechanism.
5. A client with cirrhosis develops confusion, asterixis, and a fruity breath odor. Which condition
should the nurse suspect?
A) Diabetic ketoacidosis
, B) Hepatic encephalopathy
C) Hypoglycemia
D) Normal expected finding in cirrhosis
Correct Answer: Hepatic encephalopathy
Rationale: Confusion and asterixis (flapping tremor) in a client with cirrhosis are classic signs of
hepatic encephalopathy. The fruity breath odor is due to the accumulation of ammonia and other
toxins that the diseased liver cannot metabolize. This condition requires immediate intervention,
including lactulose administration to reduce ammonia levels.
6. A patient with a gastric ulcer is at risk of developing which complication?
A) Peritonitis
B) Constipation
C) Hyperkalemia
D) Hypertension
Correct Answer: Peritonitis
Rationale: Gastric ulcers can penetrate the stomach wall and cause perforation, leading to peritonitis.
This is a life-threatening emergency requiring immediate surgical intervention. Constipation,
hyperkalemia, and hypertension are not directly associated with gastric ulcer complications.
7. A nurse is teaching a client with GERD about lifestyle modifications. Which instruction should the
nurse include?
A) "Lie down immediately after eating."
B) "Elevate the head of the bed when sleeping."
C) "Eat large meals to reduce stomach acid production."
D) "Increase your intake of citrus fruits."
Correct Answer: "Elevate the head of the bed when sleeping."
College of Nursing | Latest 2026/2027 Update
(PDF)
1. A nurse is caring for a client with cirrhosis who is scheduled for an elective paracentesis. Which
nursing intervention is the priority before the procedure?
A) Ensure the client voids to empty the bladder
B) Administer a bolus of intravenous albumin
C) Position the client on their right side
D) Instruct the client to remain NPO for 12 hours
Correct Answer: Ensure the client voids to empty the bladder
Rationale: The nurse must ensure the client empties their bladder immediately before a paracentesis
to prevent accidental puncture by the needle. This safety measure is critical because a distended
bladder can easily be perforated during the abdominal entry. Assessment of baseline vital signs and
abdominal girth should also be performed prior to starting the procedure.
2. A client is admitted with acute pancreatitis and reports severe abdominal pain. Which laboratory
result would the nurse expect to be most significantly elevated?
A) Serum Bilirubin
B) Serum Creatinine
C) Serum Potassium
D) Serum Amylase
Correct Answer: Serum Amylase
Rationale: Serum amylase and lipase are the primary biochemical markers used to diagnose acute
pancreatitis because they are released by the damaged pancreas into the bloodstream. Amylase levels
usually rise within 12 hours of the onset of symptoms and return to normal within 48 to 72 hours.
While bilirubin may rise if the bile duct is obstructed, amylase is more specific to the pancreatic
inflammatory process.
,3. A client with Ulcerative Colitis is experiencing an exacerbation. Which clinical manifestation should
the nurse anticipate during the assessment?
A) Frequent bloody stools
B) Pain relief after eating
C) Right lower quadrant pain
D) Constipation
Correct Answer: Frequent bloody stools
Rationale: Ulcerative colitis is characterized by inflammation and ulceration of the colon and rectum,
leading to frequent bloody diarrhea. Pain is typically in the left lower quadrant and may be relieved by
defecation. Crohn's disease, which can affect any part of the GI tract, often presents with right lower
quadrant pain and malabsorption.
4. A nurse is providing discharge teaching to a client with cirrhosis who has ascites. Which statement
by the client indicates correct understanding of the underlying pathophysiology?
A) "The fluid buildup is caused by my liver not making enough clotting factors."
B) "Portal hypertension and low albumin cause fluid to shift into my abdomen."
C) "Decreased peristalsis causes fluid to collect in my belly."
D) "My kidneys are retaining fluid because of the cirrhosis."
Correct Answer: "Portal hypertension and low albumin cause fluid to shift into my abdomen."
Rationale: Ascites in cirrhosis results from portal hypertension, which increases hydrostatic pressure
in the portal system, and hypoalbuminemia, which decreases oncotic pressure. These forces cause
fluid to shift into the peritoneal cavity. Clotting factor deficiency causes bleeding, not ascites.
Decreased peristalsis and renal retention are secondary effects, not the primary mechanism.
5. A client with cirrhosis develops confusion, asterixis, and a fruity breath odor. Which condition
should the nurse suspect?
A) Diabetic ketoacidosis
, B) Hepatic encephalopathy
C) Hypoglycemia
D) Normal expected finding in cirrhosis
Correct Answer: Hepatic encephalopathy
Rationale: Confusion and asterixis (flapping tremor) in a client with cirrhosis are classic signs of
hepatic encephalopathy. The fruity breath odor is due to the accumulation of ammonia and other
toxins that the diseased liver cannot metabolize. This condition requires immediate intervention,
including lactulose administration to reduce ammonia levels.
6. A patient with a gastric ulcer is at risk of developing which complication?
A) Peritonitis
B) Constipation
C) Hyperkalemia
D) Hypertension
Correct Answer: Peritonitis
Rationale: Gastric ulcers can penetrate the stomach wall and cause perforation, leading to peritonitis.
This is a life-threatening emergency requiring immediate surgical intervention. Constipation,
hyperkalemia, and hypertension are not directly associated with gastric ulcer complications.
7. A nurse is teaching a client with GERD about lifestyle modifications. Which instruction should the
nurse include?
A) "Lie down immediately after eating."
B) "Elevate the head of the bed when sleeping."
C) "Eat large meals to reduce stomach acid production."
D) "Increase your intake of citrus fruits."
Correct Answer: "Elevate the head of the bed when sleeping."
