NURSING PATHOPHYSIOLOGY EXAM #4A: ALTERATIONS IN DIGESTION &
ELIMINATION (2026/2027) | CASE STUDY & STANDARD QUESTIONS WITH CORRECT
ANSWERS
Advanced Pathophysiology Examination: Focus on Gastrointestinal & Renal Systems | Core Domains:
Upper/Lower GI Disorders, Hepatobiliary Diseases, Pancreatic Disorders, Acute & Chronic Kidney
Disease, and Electrolyte/Acid-Base Imbalances | Graduate-Level Nursing Focus | Case Study & Clinical
Application Exam Format
Exam Structure
This exam for the 2026/2027 cycle is a 50-question assessment featuring detailed case studies (e.g.,
patient with cirrhosis and hepatic encephalopathy, acute renal failure post-surgery) to test the ability to
connect GI/renal pathophysiology with complex metabolic and systemic consequences.
Answer Format
All correct answers must be presented in bold and green, followed by rationales that explain the
cascade from organ dysfunction (e.g., decreased GFR, liver failure) to the specific lab anomalies and
clinical symptoms outlined in the case studies and questions.
Questions (50 Total)
1.
A 30-year-old presents with bloody diarrhea, urgency, and tenesmus. Colonoscopy shows continuous
inflammation from rectum upward.
What condition is most likely?
A. Crohn’s disease
B. Ulcerative colitis
C. Diverticulitis
D. Irritable bowel syndrome
Ulcerative colitis is confined to the colon and rectum, with continuous inflammation starting at the
rectum. Crohn’s can occur anywhere from mouth to anus, with skip lesions and transmural
involvement.
2.
A patient with cirrhosis develops asterixis, confusion, and elevated ammonia.
,What is the priority intervention?
A. Administer lactulose
B. Administer lactulose
C. Give high-protein diet
D. Restrict fluids
Hepatic encephalopathy results from ammonia buildup due to portosystemic shunting. Lactulose
acidifies the colon, trapping ammonia (NH₃ → NH₄⁺) for excretion. Protein restriction is no longer
routine; adequate protein prevents catabolism.
3.
A patient presents with severe epigastric pain radiating to the back, nausea, and elevated lipase.
What is the most common cause?
A. Alcohol abuse
B. Gallstones
C. Hypertriglyceridemia
D. Medications
Gallstones account for 40–70% of acute pancreatitis cases by obstructing the common bile duct, causing
reflux of bile into the pancreatic duct and premature activation of digestive enzymes, leading to
autodigestion.
4.
A patient with severe vomiting has ABG: pH 7.50, PaCO₂ 42 mm Hg, HCO₃⁻ 32 mEq/L.
What acid-base imbalance is present?
A. Respiratory acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Metabolic acidosis
, Loss of gastric acid (HCl) from vomiting causes metabolic alkalosis—elevated pH and HCO₃⁻ with
normal PaCO₂. Treatment includes volume repletion and potassium/chloride replacement.
5.
A patient with chronic atrophic gastritis develops fatigue and numbness in hands/feet. Labs show
macrocytic anemia and low B12.
What is the underlying cause?
A. Iron deficiency
B. Autoimmune destruction of parietal cells and intrinsic factor deficiency
C. Vitamin K malabsorption
D. Excessive gastric acid production
Parietal cells produce intrinsic factor (IF), essential for vitamin B12 absorption in the ileum.
Autoimmune gastritis destroys these cells, leading to B12 deficiency, impaired DNA synthesis, and
megaloblastic anemia with neurological symptoms.
6.
A 30-year-old presents with bloody diarrhea, urgency, and tenesmus. Colonoscopy shows continuous
inflammation from rectum upward.
What condition is most likely?
A. Crohn’s disease
B. Ulcerative colitis
C. Diverticulitis
D. Irritable bowel syndrome
Ulcerative colitis is confined to the colon and rectum, with continuous inflammation starting at the
rectum. Crohn’s can occur anywhere from mouth to anus, with skip lesions and transmural
involvement.
7.
A patient with cirrhosis develops asterixis, confusion, and elevated ammonia.
ELIMINATION (2026/2027) | CASE STUDY & STANDARD QUESTIONS WITH CORRECT
ANSWERS
Advanced Pathophysiology Examination: Focus on Gastrointestinal & Renal Systems | Core Domains:
Upper/Lower GI Disorders, Hepatobiliary Diseases, Pancreatic Disorders, Acute & Chronic Kidney
Disease, and Electrolyte/Acid-Base Imbalances | Graduate-Level Nursing Focus | Case Study & Clinical
Application Exam Format
Exam Structure
This exam for the 2026/2027 cycle is a 50-question assessment featuring detailed case studies (e.g.,
patient with cirrhosis and hepatic encephalopathy, acute renal failure post-surgery) to test the ability to
connect GI/renal pathophysiology with complex metabolic and systemic consequences.
Answer Format
All correct answers must be presented in bold and green, followed by rationales that explain the
cascade from organ dysfunction (e.g., decreased GFR, liver failure) to the specific lab anomalies and
clinical symptoms outlined in the case studies and questions.
Questions (50 Total)
1.
A 30-year-old presents with bloody diarrhea, urgency, and tenesmus. Colonoscopy shows continuous
inflammation from rectum upward.
What condition is most likely?
A. Crohn’s disease
B. Ulcerative colitis
C. Diverticulitis
D. Irritable bowel syndrome
Ulcerative colitis is confined to the colon and rectum, with continuous inflammation starting at the
rectum. Crohn’s can occur anywhere from mouth to anus, with skip lesions and transmural
involvement.
2.
A patient with cirrhosis develops asterixis, confusion, and elevated ammonia.
,What is the priority intervention?
A. Administer lactulose
B. Administer lactulose
C. Give high-protein diet
D. Restrict fluids
Hepatic encephalopathy results from ammonia buildup due to portosystemic shunting. Lactulose
acidifies the colon, trapping ammonia (NH₃ → NH₄⁺) for excretion. Protein restriction is no longer
routine; adequate protein prevents catabolism.
3.
A patient presents with severe epigastric pain radiating to the back, nausea, and elevated lipase.
What is the most common cause?
A. Alcohol abuse
B. Gallstones
C. Hypertriglyceridemia
D. Medications
Gallstones account for 40–70% of acute pancreatitis cases by obstructing the common bile duct, causing
reflux of bile into the pancreatic duct and premature activation of digestive enzymes, leading to
autodigestion.
4.
A patient with severe vomiting has ABG: pH 7.50, PaCO₂ 42 mm Hg, HCO₃⁻ 32 mEq/L.
What acid-base imbalance is present?
A. Respiratory acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Metabolic acidosis
, Loss of gastric acid (HCl) from vomiting causes metabolic alkalosis—elevated pH and HCO₃⁻ with
normal PaCO₂. Treatment includes volume repletion and potassium/chloride replacement.
5.
A patient with chronic atrophic gastritis develops fatigue and numbness in hands/feet. Labs show
macrocytic anemia and low B12.
What is the underlying cause?
A. Iron deficiency
B. Autoimmune destruction of parietal cells and intrinsic factor deficiency
C. Vitamin K malabsorption
D. Excessive gastric acid production
Parietal cells produce intrinsic factor (IF), essential for vitamin B12 absorption in the ileum.
Autoimmune gastritis destroys these cells, leading to B12 deficiency, impaired DNA synthesis, and
megaloblastic anemia with neurological symptoms.
6.
A 30-year-old presents with bloody diarrhea, urgency, and tenesmus. Colonoscopy shows continuous
inflammation from rectum upward.
What condition is most likely?
A. Crohn’s disease
B. Ulcerative colitis
C. Diverticulitis
D. Irritable bowel syndrome
Ulcerative colitis is confined to the colon and rectum, with continuous inflammation starting at the
rectum. Crohn’s can occur anywhere from mouth to anus, with skip lesions and transmural
involvement.
7.
A patient with cirrhosis develops asterixis, confusion, and elevated ammonia.
