🔷 Gastrointestinal
1. A patient with acute pancreatitis reports worsening abdominal pain when lying flat. What is the nurse’s
best initial action?
A. Place the patient in high Fowler's position
B. Administer antiemetics
C. Offer a clear liquid diet
D. Perform abdominal percussion
✅ Answer: A
Rationale: Sitting upright reduces intra-abdominal pressure and improves comfort.
🔔 Nursing Alert (CSLO 1): Monitor respiratory distress due to diaphragmatic pressure from inflammation.
2. Which diagnostic lab value is most specific for acute pancreatitis?
A. ALT
B. AST
C. Lipase
D. Bilirubin
✅ Answer: C
Rationale: Lipase is elevated in both acute and chronic pancreatitis and is more specific than amylase.
3. What is the priority intervention for a patient with hepatic encephalopathy and serum ammonia of 120
mcg/dL?
A. Administer IV glucose
B. Initiate a low-protein diet
C. Administer lactulose as ordered
D. Prepare for dialysis
✅ Answer: C
Rationale: Lactulose promotes ammonia excretion through the bowel.
🔔 Nursing Alert (CSLO 1, 4): Monitor LOC and stool output to evaluate effectiveness.
4. A patient with cirrhosis has new onset confusion and asterixis. What is the nurse’s best action?
A. Check capillary glucose
B. Notify the provider
C. Encourage ambulation
D. Provide extra fluids
,✅ Answer: B
Rationale: Asterixis and confusion suggest worsening hepatic encephalopathy.
🔔 Action Alert (CSLO 1, 6): These are neurologic red flags requiring provider involvement.
5. A patient with chronic pancreatitis is prescribed pancreatic enzyme replacement therapy (PERT). Which
statement indicates correct understanding?
A. “I will take enzymes on an empty stomach.”
B. “I can crush the enzyme capsules.”
C. “I will take the enzymes with meals and snacks.”
D. “I should stop taking them if I feel better.”
✅ Answer: C
Rationale: PERT must be taken with food to aid digestion and prevent malnutrition.
6. What assessment finding is most concerning in a patient with acute pancreatitis?
A. Nausea and vomiting
B. Clay-colored stools
C. Crackles in lungs
D. Pain radiating to the back
✅ Answer: C
Rationale: Crackles may indicate pleural effusion or ARDS—life-threatening complications.
🔔 Nursing Alert (CSLO 1): Monitor respiratory status every 4 hours or more often.
7. A patient is admitted with cirrhosis and significant ascites. What intervention helps monitor fluid status
most accurately?
A. Monitor I&O
B. Measure abdominal girth
C. Check serum sodium
D. Assess daily blood pressure
✅ Answer: B
Rationale: Measuring girth detects ascites progression.
🔔 Action Alert (CSLO 6): Use consistent landmarks to ensure accurate monitoring.
8. Which lab value is most indicative of liver cell injury?
A. Elevated ALT
B. Decreased albumin
, C. Increased bilirubin
D. Increased ammonia
✅ Answer: A
Rationale: ALT is the most specific marker of hepatocellular injury.
9. What teaching should be included for a patient after ERCP?
A. “Expect mild shoulder pain.”
B. “You may eat immediately after.”
C. “Call if you have a fever or severe pain.”
D. “You do not need someone to drive you home.”
✅ Answer: C
Rationale: Fever and pain may signal pancreatitis or perforation post-ERCP.
10. Which nursing diagnosis takes priority for a patient with hepatic encephalopathy?
A. Risk for falls
B. Ineffective airway clearance
C. Impaired memory
D. Imbalanced nutrition
✅ Answer: B
Rationale: Mental status changes may lead to airway compromise.
🔔 Nursing Safety Priority (CSLO 1): Protect airway at all times during altered LOC.
11. A nurse is assessing a client with advanced cirrhosis. Which finding requires immediate intervention?
A. Spider angiomas
B. Anorexia
C. Coffee-ground emesis
D. Yellow sclera
✅ Answer: C
Rationale: Coffee-ground emesis may indicate upper GI bleeding, a life-threatening complication in cirrhosis.
🔔 Nursing Alert (CSLO 1, 6): Initiate bleeding protocol and notify provider immediately.
12. Which statement by a patient with chronic pancreatitis indicates a need for further teaching?
A. “I will avoid alcohol completely.”
B. “I take my enzymes with each meal.”
1. A patient with acute pancreatitis reports worsening abdominal pain when lying flat. What is the nurse’s
best initial action?
A. Place the patient in high Fowler's position
B. Administer antiemetics
C. Offer a clear liquid diet
D. Perform abdominal percussion
✅ Answer: A
Rationale: Sitting upright reduces intra-abdominal pressure and improves comfort.
🔔 Nursing Alert (CSLO 1): Monitor respiratory distress due to diaphragmatic pressure from inflammation.
2. Which diagnostic lab value is most specific for acute pancreatitis?
A. ALT
B. AST
C. Lipase
D. Bilirubin
✅ Answer: C
Rationale: Lipase is elevated in both acute and chronic pancreatitis and is more specific than amylase.
3. What is the priority intervention for a patient with hepatic encephalopathy and serum ammonia of 120
mcg/dL?
A. Administer IV glucose
B. Initiate a low-protein diet
C. Administer lactulose as ordered
D. Prepare for dialysis
✅ Answer: C
Rationale: Lactulose promotes ammonia excretion through the bowel.
🔔 Nursing Alert (CSLO 1, 4): Monitor LOC and stool output to evaluate effectiveness.
4. A patient with cirrhosis has new onset confusion and asterixis. What is the nurse’s best action?
A. Check capillary glucose
B. Notify the provider
C. Encourage ambulation
D. Provide extra fluids
,✅ Answer: B
Rationale: Asterixis and confusion suggest worsening hepatic encephalopathy.
🔔 Action Alert (CSLO 1, 6): These are neurologic red flags requiring provider involvement.
5. A patient with chronic pancreatitis is prescribed pancreatic enzyme replacement therapy (PERT). Which
statement indicates correct understanding?
A. “I will take enzymes on an empty stomach.”
B. “I can crush the enzyme capsules.”
C. “I will take the enzymes with meals and snacks.”
D. “I should stop taking them if I feel better.”
✅ Answer: C
Rationale: PERT must be taken with food to aid digestion and prevent malnutrition.
6. What assessment finding is most concerning in a patient with acute pancreatitis?
A. Nausea and vomiting
B. Clay-colored stools
C. Crackles in lungs
D. Pain radiating to the back
✅ Answer: C
Rationale: Crackles may indicate pleural effusion or ARDS—life-threatening complications.
🔔 Nursing Alert (CSLO 1): Monitor respiratory status every 4 hours or more often.
7. A patient is admitted with cirrhosis and significant ascites. What intervention helps monitor fluid status
most accurately?
A. Monitor I&O
B. Measure abdominal girth
C. Check serum sodium
D. Assess daily blood pressure
✅ Answer: B
Rationale: Measuring girth detects ascites progression.
🔔 Action Alert (CSLO 6): Use consistent landmarks to ensure accurate monitoring.
8. Which lab value is most indicative of liver cell injury?
A. Elevated ALT
B. Decreased albumin
, C. Increased bilirubin
D. Increased ammonia
✅ Answer: A
Rationale: ALT is the most specific marker of hepatocellular injury.
9. What teaching should be included for a patient after ERCP?
A. “Expect mild shoulder pain.”
B. “You may eat immediately after.”
C. “Call if you have a fever or severe pain.”
D. “You do not need someone to drive you home.”
✅ Answer: C
Rationale: Fever and pain may signal pancreatitis or perforation post-ERCP.
10. Which nursing diagnosis takes priority for a patient with hepatic encephalopathy?
A. Risk for falls
B. Ineffective airway clearance
C. Impaired memory
D. Imbalanced nutrition
✅ Answer: B
Rationale: Mental status changes may lead to airway compromise.
🔔 Nursing Safety Priority (CSLO 1): Protect airway at all times during altered LOC.
11. A nurse is assessing a client with advanced cirrhosis. Which finding requires immediate intervention?
A. Spider angiomas
B. Anorexia
C. Coffee-ground emesis
D. Yellow sclera
✅ Answer: C
Rationale: Coffee-ground emesis may indicate upper GI bleeding, a life-threatening complication in cirrhosis.
🔔 Nursing Alert (CSLO 1, 6): Initiate bleeding protocol and notify provider immediately.
12. Which statement by a patient with chronic pancreatitis indicates a need for further teaching?
A. “I will avoid alcohol completely.”
B. “I take my enzymes with each meal.”
