CCRN Practice Questions -GI Exam
2025 Answers
A 25-year-old man is admitted to the critical care unit with complaints of
generalized abdominal pain for 8 hours. The pain began yesterday and has been
becoming increasingly severe. He is lying still with his knees flexed. Physical
examination reveals diffuse tenderness and boardlike rigidity. His temperature is
39° C, blood pressure is 124/68 mm Hg, heart rate is 120 beats/min, and
respiratory rate is 25 breaths/min. He is diagnosed with acute appendicitis with
intestinal perforation. Which description of abdominal pain is most specific to
peritoneal irritation?
a. Generalized pain of the abdominal area
b. Pain lasting longer than 6 hours
c. Pain becoming increasingly severe
d. Pain lessened by lying still with knees flexed - ANSWER-Correct answer: d
Rationale: The pain of peritoneal irritation is lessened by limiting movement and
by flexing the knees to relieve abdominal tension.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 1
,Test-Taking Strategy: Note that option d is the most specific of the answers.
Although options a, b, and c are seen in peritoneal irritation, the most specific to
peritoneal irritation is option d.
A 25-year-old man is admitted to the critical care unit with complaints of
generalized abdominal pain for 8 hours. The pain began yesterday and has been
becoming increasingly severe. He is lying still with his knees flexed. Physical
examination reveals diffuse tenderness and boardlike rigidity. His temperature is
39° C, blood pressure is 124/68 mm Hg, heart rate is 120 beats/min, and
respiratory rate is 25 breaths/min. He is diagnosed with acute appendicitis with
intestinal perforation. The nurse should expect to prepare the patient for which of
the following?
a. Exploratory laparotomy
b. Nasogastric suction
c. Analgesics, sedation, and antipyretics
d. Upper gastrointestinal series - ANSWER-Correct answer: a
Rationale: Immediate exploratory laparotomy is indicated for this patient to
prevent further bacterial contamination and chemical irritation of the peritoneum
because he has obvious indications of peritoneal irritation.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
,Test-Taking Strategy: One approach is to link the boardlike abdomen to an acute
abdomen. Another name for acute abdomen is surgical abdomen or hot belly.
Choose option a.
A 52-year-old man is admitted with hepatic failure caused by chronic alcoholism.
He is nonresponsive to verbal stimuli at this time. Which finding would the nurse
expect in the later stages of hepatic encephalopathy?
a. Asterixis
b. Confusion
c. Pathologic reflexes (e.g., Babinski)
d. Constructional apraxia - ANSWER-Correct answer: c
Rationale: Pathologic reflexes are characteristic of stage IV hepatic encephalopathy.
Asterixis occurs by stage II. Constructional apraxia (the inability to reproduce
simple figures [e.g., a star or triangle]) occurs by stage III. Confusion is mild in
stage I and
becomes progressively worse until the patient is unconscious in stage IV.
Test-Taking Strategy: Think about which finding sounds the worst. Pathologic
reflexes (e.g., Babinski's reflex and grasp reflex) are indications of severe cerebral
failure.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 3
, A 52-year-old man is admitted with hepatic failure caused by chronic alcoholism.
He is nonresponsive to verbal stimuli at this time. Which intervention would not
specifically decrease serum ammonia levels in patients with hepatic
encephalopathy?
a. Administration of rifaximin
b. Administration of lactulose
c. Provision of adequate caloric intake
d. Avoidance of all hepatotoxic agents - ANSWER-Correct answer: d
Rationale: Although avoidance of hepatotoxic agents is important in patients with
liver failure, it only prevents further damage to the liver rather than actually
reducing ammonia level. Rifaximin decreases the bacteria in the gastrointestinal
tract that break down nitrogenous materials (protein) to ammonia. Lactulose
increases ammonia excretion and moves nitrogenous materials through the
gastrointestinal tract more quickly, allowing less time for the bacteria to convert the
nitrogen to ammonia. The restriction of protein in the diet and provision of
sufficient calories (primarily in the form of carbohydrates) to prevent
endogenous protein catabolism decreases the ammonia.
Test-Taking Strategy: The key phrase in the questions is "decrease serum ammonia
levels." Look at the first word of each option. Avoidance (in option d) is not likely
to actively decrease something, although it may prevent further increases.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 4
2025 Answers
A 25-year-old man is admitted to the critical care unit with complaints of
generalized abdominal pain for 8 hours. The pain began yesterday and has been
becoming increasingly severe. He is lying still with his knees flexed. Physical
examination reveals diffuse tenderness and boardlike rigidity. His temperature is
39° C, blood pressure is 124/68 mm Hg, heart rate is 120 beats/min, and
respiratory rate is 25 breaths/min. He is diagnosed with acute appendicitis with
intestinal perforation. Which description of abdominal pain is most specific to
peritoneal irritation?
a. Generalized pain of the abdominal area
b. Pain lasting longer than 6 hours
c. Pain becoming increasingly severe
d. Pain lessened by lying still with knees flexed - ANSWER-Correct answer: d
Rationale: The pain of peritoneal irritation is lessened by limiting movement and
by flexing the knees to relieve abdominal tension.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 1
,Test-Taking Strategy: Note that option d is the most specific of the answers.
Although options a, b, and c are seen in peritoneal irritation, the most specific to
peritoneal irritation is option d.
A 25-year-old man is admitted to the critical care unit with complaints of
generalized abdominal pain for 8 hours. The pain began yesterday and has been
becoming increasingly severe. He is lying still with his knees flexed. Physical
examination reveals diffuse tenderness and boardlike rigidity. His temperature is
39° C, blood pressure is 124/68 mm Hg, heart rate is 120 beats/min, and
respiratory rate is 25 breaths/min. He is diagnosed with acute appendicitis with
intestinal perforation. The nurse should expect to prepare the patient for which of
the following?
a. Exploratory laparotomy
b. Nasogastric suction
c. Analgesics, sedation, and antipyretics
d. Upper gastrointestinal series - ANSWER-Correct answer: a
Rationale: Immediate exploratory laparotomy is indicated for this patient to
prevent further bacterial contamination and chemical irritation of the peritoneum
because he has obvious indications of peritoneal irritation.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
,Test-Taking Strategy: One approach is to link the boardlike abdomen to an acute
abdomen. Another name for acute abdomen is surgical abdomen or hot belly.
Choose option a.
A 52-year-old man is admitted with hepatic failure caused by chronic alcoholism.
He is nonresponsive to verbal stimuli at this time. Which finding would the nurse
expect in the later stages of hepatic encephalopathy?
a. Asterixis
b. Confusion
c. Pathologic reflexes (e.g., Babinski)
d. Constructional apraxia - ANSWER-Correct answer: c
Rationale: Pathologic reflexes are characteristic of stage IV hepatic encephalopathy.
Asterixis occurs by stage II. Constructional apraxia (the inability to reproduce
simple figures [e.g., a star or triangle]) occurs by stage III. Confusion is mild in
stage I and
becomes progressively worse until the patient is unconscious in stage IV.
Test-Taking Strategy: Think about which finding sounds the worst. Pathologic
reflexes (e.g., Babinski's reflex and grasp reflex) are indications of severe cerebral
failure.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 3
, A 52-year-old man is admitted with hepatic failure caused by chronic alcoholism.
He is nonresponsive to verbal stimuli at this time. Which intervention would not
specifically decrease serum ammonia levels in patients with hepatic
encephalopathy?
a. Administration of rifaximin
b. Administration of lactulose
c. Provision of adequate caloric intake
d. Avoidance of all hepatotoxic agents - ANSWER-Correct answer: d
Rationale: Although avoidance of hepatotoxic agents is important in patients with
liver failure, it only prevents further damage to the liver rather than actually
reducing ammonia level. Rifaximin decreases the bacteria in the gastrointestinal
tract that break down nitrogenous materials (protein) to ammonia. Lactulose
increases ammonia excretion and moves nitrogenous materials through the
gastrointestinal tract more quickly, allowing less time for the bacteria to convert the
nitrogen to ammonia. The restriction of protein in the diet and provision of
sufficient calories (primarily in the form of carbohydrates) to prevent
endogenous protein catabolism decreases the ammonia.
Test-Taking Strategy: The key phrase in the questions is "decrease serum ammonia
levels." Look at the first word of each option. Avoidance (in option d) is not likely
to actively decrease something, although it may prevent further increases.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 4
