NCLEX RN Exam Bank: GI Bleeds, C. difficile, Liver Failure, Bowel Obstruction & Hepatic Crisis Care

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NCLEX RN Exam Bank: GI Crisis, Bleeds, C. difficile,
Obstruction & Liver Failure




Table of Contents
Subtopic 1: Upper and Lower GI Bleeds—Identification, Monitoring & Interventions
(Questions 1–20) ........................................................................................................... 2
Subtopic 2: Clostridioides difficile Infection, Precautions, Treatment & Complications
(Questions 21–40) ....................................................................................................... 10
Subtopic 3: Bowel Obstruction—Mechanical, Paralytic & Postoperative Monitoring
(Questions 41–60) ....................................................................................................... 18
Subtopic 4: Acute and Chronic Liver Failure—Assessment, Labs & Emergency Care
(Questions 61–80) ....................................................................................................... 27
Subtopic 5: Acute Liver Failure—Pathophysiology, Diagnostics & Emergency Nursing
Management .............................................................................................................. 35
Subtopic 6: Liver Failure—Encephalopathy, Labs & Transplant Evaluation (Questions 101–
120) ........................................................................................................................... 43
Subtopic 7: Pharmacologic Management in GI Crisis (Antibiotics, Lactulose, PPIs,
Octreotide, etc.) .......................................................................................................... 50
Subtopic 8: Gastrointestinal Hemorrhage—Esophageal Varices & Portal Hypertension
(Q141–160) ................................................................................................................. 58
Subtopic 9: Hepatic Encephalopathy—Recognition, Interventions & Medications ........... 67
Subtopic 10: Collaborative Care & Patient Education in GI Crisis Management (Q181–Q200)
.................................................................................................................................. 74

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Subtopic 1: Upper and Lower GI Bleeds—Identification,
Monitoring & Interventions (Questions 1–20)
Question 1:

A patient presents with black, tarry stools and complains of dizziness. What is the most
appropriate initial nursing action?

A. Administer antacids

B. Assess vital signs and orthostatic changes

C. Insert a nasogastric tube

D. Schedule an endoscopy



Correct answer: B. Assess vital signs and orthostatic changes

Rationale: Black, tarry stools suggest upper GI bleeding. The priority is to assess for
hemodynamic instability by checking vital signs and orthostatic hypotension.



Question 2:

Which laboratory value is most indicative of ongoing GI bleeding?

A. Elevated AST

B. Increased serum potassium

C. Decreased hemoglobin and hematocrit

D. Low BUN



Correct answer: C. Decreased hemoglobin and hematocrit

Rationale: A drop in hemoglobin and hematocrit is the hallmark indicator of blood loss
from a GI bleed.



Question 3:

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Which finding would differentiate an upper GI bleed from a lower GI bleed?

A. Nausea and vomiting

B. Melena vs. hematochezia

C. Abdominal distention

D. Guarding and rigidity



Correct answer: B. Melena vs. hematochezia

Rationale: Melena (black, tarry stools) indicates an upper GI bleed; hematochezia (bright
red blood per rectum) suggests a lower GI bleed.



Question 4:

During a GI bleed, which IV fluid is most appropriate to administer initially?

A. 0.45% normal saline

B. 0.9% normal saline

C. D5W

D. Lactulose



Correct answer: B. 0.9% normal saline

Rationale: Isotonic saline is used initially to expand intravascular volume and stabilize the
patient.



Question 5:

Which medication is given intravenously to reduce acid secretion in an upper GI bleed?

A. Calcium carbonate

B. Sucralfate

C. Pantoprazole

D. Metoclopramide

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Correct answer: C. Pantoprazole

Rationale: Proton pump inhibitors like pantoprazole reduce gastric acid and help control
bleeding from ulcers.



Question 6:

A patient with a history of liver cirrhosis presents with vomiting of bright red blood. What is
the likely source of bleeding?

A. Duodenal ulcer

B. Esophageal varices

C. Gastric carcinoma

D. Mallory-Weiss tear



Correct answer: B. Esophageal varices

Rationale: Cirrhotic patients often develop esophageal varices that can rupture and bleed
massively.



Question 7:

Which nursing intervention is crucial when caring for a patient with suspected GI bleed
who is vomiting blood?

A. Encourage clear fluids

B. Place in left lateral position

C. Maintain airway and suction equipment nearby

D. Administer antiemetics only



Correct answer: C. Maintain airway and suction equipment nearby