Galen NSG 3850 Exam 4 | Pathophysiology for
Nurses II (2026) Actual Q&A PDF
1. A nurse is caring for a client with advanced liver disease who has developed
ascites. Which pathophysiological process is the primary etiological factor
contributing to this complication?
A) Portal hypertension
B) Plasma hypoalbuminemia
C) Impaired absorption of fat-soluble vitamins
D) Accumulation of ammonia in the peritoneal cavity
Correct Answer: Plasma hypoalbuminemia
Rationale: Albumin maintains oncotic pressure within the vascular system. In
advanced liver disease, impaired hepatic protein synthesis causes hypoalbuminemia,
allowing fluid to move into the peritoneal cavity. Portal hypertension contributes but
is secondary to the oncotic pressure loss.
2. A client with acute cholecystitis presents with severe right upper quadrant pain,
nausea, and fever after eating a high-fat meal. Which factor contributes most to the
pathological process of this condition?
A) Enzymatic activation causing autoimmune gallbladder stones
B) Lecithin production causing cholesterol solidification
C) Vascular insufficiency causing ischemic injury
D) Cystic duct obstruction
Correct Answer: Cystic duct obstruction
,Rationale: Acute cholecystitis most commonly occurs when a gallstone obstructs the
cystic duct, preventing bile from leaving the gallbladder. This causes bile stasis,
inflammation, and increased intraluminal pressure. Ischemia and infection are
secondary complications.
3. A client with chronic cholelithiasis reports recurrent abdominal discomfort. Which
symptom should the nurse expect the client to report most commonly?
A) Persistent epigastric pain
B) Functional dyspepsia
C) Gray-blue discoloration at the flank
D) Left upper quadrant pain radiating to the back
Correct Answer: Persistent epigastric pain
Rationale: Clients with chronic cholelithiasis frequently experience recurrent
epigastric or right upper quadrant pain, especially after fatty meals. The pain is
caused by intermittent obstruction of bile flow by gallstones.
4. The nurse is discussing the pathogenesis of hepatitis A virus 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."
Correct Answer: "Lack of safe water and poor sanitation are big risk factors."
,Rationale: Hepatitis A is transmitted via the fecal-oral route, often through
contaminated food or water. Poor sanitation and lack of safe water are major risk
factors. It is not a chronic illness and does not require dialysis-related titers.
5. A client with hepatitis C has a positive anti-HCV laboratory value. Which conclusion
should the nurse make?
A) There are antibodies to the virus present.
B) The client is in the early stage of infection.
C) The client has immunity to the virus.
D) The infection is in remission.
Correct Answer: There are antibodies to the virus present.
Rationale: A positive anti-HCV test indicates the presence of antibodies to the
hepatitis C virus, suggesting current or past infection. It does not confirm immunity
or remission and cannot distinguish acute from chronic infection.
6. A client with chronic alcoholism has developed jaundice. The nurse is aware that
the pathogenetic processes of this condition result in:
A) Greenish-yellow staining of body tissues by bilirubin.
B) Decreased plasma proteins and increased urobilinogen.
C) Hepatocytes secrete bile that is supersaturated with cholesterol.
D) Serum IgA is often decreased in clients who have alcoholism.
Correct Answer: Greenish-yellow staining of body tissues by bilirubin.
Rationale: Jaundice in chronic alcoholism results from the liver's inability to
metabolize bilirubin, leading to its accumulation in tissues. This causes the
characteristic greenish-yellow discoloration of skin and sclera.
, 7. A nurse is reviewing laboratory results for a client with suspected hepatitis B. The
client has a positive hepatitis B surface antigen. The nurse should interpret this result
to indicate that the client:
A) Has chronic inflammation.
B) Is recovering from acute disease.
C) Has an active infection.
D) Has a positive titer.
Correct Answer: Has an active infection.
Rationale: A positive HBsAg indicates that the client has an active hepatitis B
infection and is infectious to others. It does not indicate recovery or chronic
inflammation alone.
8. A client with cirrhosis begins showing signs of confusion, altered sleep patterns,
and asterixis. The nurse recognizes these cognitive changes are primarily driven by:
A) Severe fluid retention and protein shifts creating ascites
B) Accumulation of neurotoxins, like ammonia, that bypass hepatic clearance
C) A Type IV delayed hypersensitivity reaction to viral antigens
D) Acute malignant proliferation of immature myeloid blast cells
Correct Answer: Accumulation of neurotoxins, like ammonia, that bypass hepatic
clearance
Rationale: Hepatic encephalopathy results from the liver's inability to clear ammonia
and other neurotoxins. These substances accumulate in the bloodstream and cross
the blood-brain barrier, causing cognitive changes, asterixis, and altered
consciousness.
Nurses II (2026) Actual Q&A PDF
1. A nurse is caring for a client with advanced liver disease who has developed
ascites. Which pathophysiological process is the primary etiological factor
contributing to this complication?
A) Portal hypertension
B) Plasma hypoalbuminemia
C) Impaired absorption of fat-soluble vitamins
D) Accumulation of ammonia in the peritoneal cavity
Correct Answer: Plasma hypoalbuminemia
Rationale: Albumin maintains oncotic pressure within the vascular system. In
advanced liver disease, impaired hepatic protein synthesis causes hypoalbuminemia,
allowing fluid to move into the peritoneal cavity. Portal hypertension contributes but
is secondary to the oncotic pressure loss.
2. A client with acute cholecystitis presents with severe right upper quadrant pain,
nausea, and fever after eating a high-fat meal. Which factor contributes most to the
pathological process of this condition?
A) Enzymatic activation causing autoimmune gallbladder stones
B) Lecithin production causing cholesterol solidification
C) Vascular insufficiency causing ischemic injury
D) Cystic duct obstruction
Correct Answer: Cystic duct obstruction
,Rationale: Acute cholecystitis most commonly occurs when a gallstone obstructs the
cystic duct, preventing bile from leaving the gallbladder. This causes bile stasis,
inflammation, and increased intraluminal pressure. Ischemia and infection are
secondary complications.
3. A client with chronic cholelithiasis reports recurrent abdominal discomfort. Which
symptom should the nurse expect the client to report most commonly?
A) Persistent epigastric pain
B) Functional dyspepsia
C) Gray-blue discoloration at the flank
D) Left upper quadrant pain radiating to the back
Correct Answer: Persistent epigastric pain
Rationale: Clients with chronic cholelithiasis frequently experience recurrent
epigastric or right upper quadrant pain, especially after fatty meals. The pain is
caused by intermittent obstruction of bile flow by gallstones.
4. The nurse is discussing the pathogenesis of hepatitis A virus 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."
Correct Answer: "Lack of safe water and poor sanitation are big risk factors."
,Rationale: Hepatitis A is transmitted via the fecal-oral route, often through
contaminated food or water. Poor sanitation and lack of safe water are major risk
factors. It is not a chronic illness and does not require dialysis-related titers.
5. A client with hepatitis C has a positive anti-HCV laboratory value. Which conclusion
should the nurse make?
A) There are antibodies to the virus present.
B) The client is in the early stage of infection.
C) The client has immunity to the virus.
D) The infection is in remission.
Correct Answer: There are antibodies to the virus present.
Rationale: A positive anti-HCV test indicates the presence of antibodies to the
hepatitis C virus, suggesting current or past infection. It does not confirm immunity
or remission and cannot distinguish acute from chronic infection.
6. A client with chronic alcoholism has developed jaundice. The nurse is aware that
the pathogenetic processes of this condition result in:
A) Greenish-yellow staining of body tissues by bilirubin.
B) Decreased plasma proteins and increased urobilinogen.
C) Hepatocytes secrete bile that is supersaturated with cholesterol.
D) Serum IgA is often decreased in clients who have alcoholism.
Correct Answer: Greenish-yellow staining of body tissues by bilirubin.
Rationale: Jaundice in chronic alcoholism results from the liver's inability to
metabolize bilirubin, leading to its accumulation in tissues. This causes the
characteristic greenish-yellow discoloration of skin and sclera.
, 7. A nurse is reviewing laboratory results for a client with suspected hepatitis B. The
client has a positive hepatitis B surface antigen. The nurse should interpret this result
to indicate that the client:
A) Has chronic inflammation.
B) Is recovering from acute disease.
C) Has an active infection.
D) Has a positive titer.
Correct Answer: Has an active infection.
Rationale: A positive HBsAg indicates that the client has an active hepatitis B
infection and is infectious to others. It does not indicate recovery or chronic
inflammation alone.
8. A client with cirrhosis begins showing signs of confusion, altered sleep patterns,
and asterixis. The nurse recognizes these cognitive changes are primarily driven by:
A) Severe fluid retention and protein shifts creating ascites
B) Accumulation of neurotoxins, like ammonia, that bypass hepatic clearance
C) A Type IV delayed hypersensitivity reaction to viral antigens
D) Acute malignant proliferation of immature myeloid blast cells
Correct Answer: Accumulation of neurotoxins, like ammonia, that bypass hepatic
clearance
Rationale: Hepatic encephalopathy results from the liver's inability to clear ammonia
and other neurotoxins. These substances accumulate in the bloodstream and cross
the blood-brain barrier, causing cognitive changes, asterixis, and altered
consciousness.
