NUR 355 ACUTE & CHRONIC HEALTH DISRUPTIONS IN ADULTS I – FINAL
EXAM 5 | 75 QUESTIONS AND ANSWERS | 2026 UPDATE | WITH
COMPLETE SOLUTIONS
1. A patient with cirrhosis is admitted with increasing abdominal distention,
peripheral edema, and a 3-kg weight gain over four days. The nurse reviews
the laboratory results and notes hypoalbuminemia and prolonged
prothrombin time. Which pathophysiologic process best explains the
development of ascites in this patient?
A. Increased hepatic synthesis of albumin causing intravascular fluid
retention
B. Increased plasma oncotic pressure causing fluid movement into the
peritoneum
C. Decreased plasma oncotic pressure combined with portal hypertension
causing fluid movement into the abdominal cavity
D. Increased renal excretion of sodium and water caused by decreased
aldosterone activity
Answer: C
2. A patient with a history of chronic alcohol use is admitted with severe
epigastric pain that radiates to the back, persistent vomiting, and
abdominal tenderness. The provider suspects acute pancreatitis. Which
laboratory result would most strongly support this diagnosis?
A. Markedly elevated serum lipase
B. Decreased serum bilirubin
C. Decreased serum amylase
D. Markedly elevated serum albumin
Answer: A
3. A patient with Crohn’s disease reports frequent diarrhea, abdominal
cramping, and unintended weight loss despite eating regular meals. Which
nursing intervention is most appropriate during an acute exacerbation?
A. Encourage large meals containing raw vegetables and whole grains
B. Restrict all oral fluids until diarrhea completely resolves
pg. 1
, C. Encourage foods high in insoluble fiber to stimulate intestinal motility
D. Provide small, frequent, nutrient-dense meals while monitoring
hydration and nutritional status
Answer: D
4. A patient with a newly created ileostomy asks why the stool coming from
the stoma is more liquid than the stool produced before surgery. Which
response by the nurse is most accurate?
A. “The ileostomy prevents bile from entering the intestinal tract.”
B. “The colon normally absorbs water, and much of the colon has been
bypassed or removed.”
C. “The small intestine produces excess fluid after an ostomy is created.”
D. “The stool is liquid because the stoma is infected.”
Answer: B
5. A patient with cirrhosis becomes increasingly confused and has difficulty
performing simple tasks. The nurse notes asterixis when the patient extends
both arms. Which medication would the nurse anticipate administering to
decrease the absorption of ammonia from the gastrointestinal tract?
A. Lactulose
B. Omeprazole
C. Mesalamine
D. Ondansetron
Answer: A
6. A patient with ulcerative colitis has frequent bloody diarrhea and severe
abdominal cramping. Which finding requires the nurse to notify the
provider immediately because it may indicate toxic megacolon?
A. Mild abdominal discomfort after eating
B. Decreased appetite for one day
C. Increasing abdominal distention accompanied by fever and tachycardia
D. Two loose stools during the previous shift
Answer: C
pg. 2
, 7. A patient who recently underwent partial gastrectomy reports weakness,
diaphoresis, abdominal cramping, and palpitations approximately 30
minutes after eating. Which condition should the nurse suspect?
A. Paralytic ileus
B. Dumping syndrome
C. Acute pancreatitis
D. Gastrointestinal bleeding
Answer: B
8. A patient with suspected upper gastrointestinal bleeding has coffee-ground
emesis, weakness, and a blood pressure of 88/54 mm Hg. Which nursing
action should receive the highest priority?
A. Encourage oral fluids
B. Place the patient in a high-Fowler position and obtain a dietary history
C. Administer a prescribed antidiarrheal medication
D. Assess airway, support circulation, and prepare for rapid fluid or blood
replacement
Answer: D
9. A patient with gastroesophageal reflux disease reports worsening nocturnal
heartburn despite medication therapy. Which teaching should the nurse
provide to reduce reflux symptoms?
A. Eat a large meal immediately before bedtime
B. Remain upright after meals and avoid eating shortly before lying down
C. Drink carbonated beverages with meals
D. Increase intake of high-fat foods to slow gastric emptying
Answer: B
10. A patient with peptic ulcer disease suddenly develops severe abdominal
pain, a rigid abdomen, and signs of shock. Which complication should the
nurse suspect?
A. Gastroesophageal reflux
B. Dumping syndrome
C. Perforation with peritonitis
pg. 3
, D. Irritable bowel syndrome
Answer: C
11. A patient with diverticulosis asks what dietary change can reduce the
likelihood of complications when the patient is not experiencing acute
diverticulitis. Which recommendation is appropriate?
A. Gradually increase dietary fiber and maintain adequate fluid intake
B. Eliminate all fruits and vegetables
C. Maintain a clear-liquid diet permanently
D. Consume a very low-fiber diet indefinitely
Answer: A
12. A patient with acute diverticulitis is admitted with left lower-quadrant
abdominal pain and fever. Which nursing intervention is most appropriate
during the acute inflammatory phase?
A. Encourage vigorous abdominal exercise
B. Administer prescribed antibiotics and monitor for worsening abdominal
findings
C. Encourage a large meal containing raw vegetables
D. Perform frequent rectal examinations
Answer: B
13. A patient with hepatitis B asks the nurse how the infection can be
transmitted to another person. Which response is most accurate?
A. “Transmission occurs primarily through contaminated drinking water.”
B. “Transmission occurs only through respiratory droplets.”
C. “Transmission can occur through infected blood and body fluids,
including sexual and perinatal exposure.”
D. “Transmission occurs primarily through eating undercooked meat.”
Answer: C
14. A patient with chronic liver disease has prolonged bleeding after a minor
venipuncture. Which explanation best describes why this patient is at
increased risk for bleeding?
A. The diseased liver has reduced production of several coagulation factors
pg. 4
EXAM 5 | 75 QUESTIONS AND ANSWERS | 2026 UPDATE | WITH
COMPLETE SOLUTIONS
1. A patient with cirrhosis is admitted with increasing abdominal distention,
peripheral edema, and a 3-kg weight gain over four days. The nurse reviews
the laboratory results and notes hypoalbuminemia and prolonged
prothrombin time. Which pathophysiologic process best explains the
development of ascites in this patient?
A. Increased hepatic synthesis of albumin causing intravascular fluid
retention
B. Increased plasma oncotic pressure causing fluid movement into the
peritoneum
C. Decreased plasma oncotic pressure combined with portal hypertension
causing fluid movement into the abdominal cavity
D. Increased renal excretion of sodium and water caused by decreased
aldosterone activity
Answer: C
2. A patient with a history of chronic alcohol use is admitted with severe
epigastric pain that radiates to the back, persistent vomiting, and
abdominal tenderness. The provider suspects acute pancreatitis. Which
laboratory result would most strongly support this diagnosis?
A. Markedly elevated serum lipase
B. Decreased serum bilirubin
C. Decreased serum amylase
D. Markedly elevated serum albumin
Answer: A
3. A patient with Crohn’s disease reports frequent diarrhea, abdominal
cramping, and unintended weight loss despite eating regular meals. Which
nursing intervention is most appropriate during an acute exacerbation?
A. Encourage large meals containing raw vegetables and whole grains
B. Restrict all oral fluids until diarrhea completely resolves
pg. 1
, C. Encourage foods high in insoluble fiber to stimulate intestinal motility
D. Provide small, frequent, nutrient-dense meals while monitoring
hydration and nutritional status
Answer: D
4. A patient with a newly created ileostomy asks why the stool coming from
the stoma is more liquid than the stool produced before surgery. Which
response by the nurse is most accurate?
A. “The ileostomy prevents bile from entering the intestinal tract.”
B. “The colon normally absorbs water, and much of the colon has been
bypassed or removed.”
C. “The small intestine produces excess fluid after an ostomy is created.”
D. “The stool is liquid because the stoma is infected.”
Answer: B
5. A patient with cirrhosis becomes increasingly confused and has difficulty
performing simple tasks. The nurse notes asterixis when the patient extends
both arms. Which medication would the nurse anticipate administering to
decrease the absorption of ammonia from the gastrointestinal tract?
A. Lactulose
B. Omeprazole
C. Mesalamine
D. Ondansetron
Answer: A
6. A patient with ulcerative colitis has frequent bloody diarrhea and severe
abdominal cramping. Which finding requires the nurse to notify the
provider immediately because it may indicate toxic megacolon?
A. Mild abdominal discomfort after eating
B. Decreased appetite for one day
C. Increasing abdominal distention accompanied by fever and tachycardia
D. Two loose stools during the previous shift
Answer: C
pg. 2
, 7. A patient who recently underwent partial gastrectomy reports weakness,
diaphoresis, abdominal cramping, and palpitations approximately 30
minutes after eating. Which condition should the nurse suspect?
A. Paralytic ileus
B. Dumping syndrome
C. Acute pancreatitis
D. Gastrointestinal bleeding
Answer: B
8. A patient with suspected upper gastrointestinal bleeding has coffee-ground
emesis, weakness, and a blood pressure of 88/54 mm Hg. Which nursing
action should receive the highest priority?
A. Encourage oral fluids
B. Place the patient in a high-Fowler position and obtain a dietary history
C. Administer a prescribed antidiarrheal medication
D. Assess airway, support circulation, and prepare for rapid fluid or blood
replacement
Answer: D
9. A patient with gastroesophageal reflux disease reports worsening nocturnal
heartburn despite medication therapy. Which teaching should the nurse
provide to reduce reflux symptoms?
A. Eat a large meal immediately before bedtime
B. Remain upright after meals and avoid eating shortly before lying down
C. Drink carbonated beverages with meals
D. Increase intake of high-fat foods to slow gastric emptying
Answer: B
10. A patient with peptic ulcer disease suddenly develops severe abdominal
pain, a rigid abdomen, and signs of shock. Which complication should the
nurse suspect?
A. Gastroesophageal reflux
B. Dumping syndrome
C. Perforation with peritonitis
pg. 3
, D. Irritable bowel syndrome
Answer: C
11. A patient with diverticulosis asks what dietary change can reduce the
likelihood of complications when the patient is not experiencing acute
diverticulitis. Which recommendation is appropriate?
A. Gradually increase dietary fiber and maintain adequate fluid intake
B. Eliminate all fruits and vegetables
C. Maintain a clear-liquid diet permanently
D. Consume a very low-fiber diet indefinitely
Answer: A
12. A patient with acute diverticulitis is admitted with left lower-quadrant
abdominal pain and fever. Which nursing intervention is most appropriate
during the acute inflammatory phase?
A. Encourage vigorous abdominal exercise
B. Administer prescribed antibiotics and monitor for worsening abdominal
findings
C. Encourage a large meal containing raw vegetables
D. Perform frequent rectal examinations
Answer: B
13. A patient with hepatitis B asks the nurse how the infection can be
transmitted to another person. Which response is most accurate?
A. “Transmission occurs primarily through contaminated drinking water.”
B. “Transmission occurs only through respiratory droplets.”
C. “Transmission can occur through infected blood and body fluids,
including sexual and perinatal exposure.”
D. “Transmission occurs primarily through eating undercooked meat.”
Answer: C
14. A patient with chronic liver disease has prolonged bleeding after a minor
venipuncture. Which explanation best describes why this patient is at
increased risk for bleeding?
A. The diseased liver has reduced production of several coagulation factors
pg. 4
