Galen NSG 3850 – Pathophysiology for Nurses II,
Exam 4 / Final content | LATEST UPDATE THIS
YEAR.pdf
Hepatobiliary & Pancreatic Pathophysiology (Q1–45)
1. A client has right upper quadrant pain, fever, and leukocytosis after eating fatty
foods. Which pathophysiologic process best explains these findings?
A. Autoimmune destruction of hepatocytes
B. Obstruction of the cystic duct by gallstones leading to inflammation (acute
cholecystitis)
C. Viral infection of the biliary epithelium
D. Ischemic injury to the pancreatic acinar cells
Gallstones obstruct the cystic duct, causing bile stasis, inflammation, and infection.
2. Which risk factors are most strongly associated with cholesterol gallstone
formation?
A. Male sex, underweight, low-fat diet
B. “Female, Forty, Fat, Fertile” plus rapid weight loss and certain ethnicities
C. Chronic alcohol use and high-protein diet
D. Hypothyroidism and low estrogen levels
Classic “F” risk factors plus rapid weight loss increase cholesterol stones.
3. A client with cirrhosis develops confusion, lethargy, and a flapping tremor of the
hands. Which substance accumulation primarily contributes to these neurologic
changes?
A. Bilirubin
B. Ammonia
,C. Glucose
D. Urea
Liver failure impairs conversion of ammonia to urea, leading to hepatic encephalopathy.
4. Which classic sign is described as a “flapping tremor” of the hands in hepatic
encephalopathy?
A. Chvostek sign
B. Asterixis
C. Babinski sign
D. Trousseau sign
Asterixis is characteristic of hepatic encephalopathy.
5. A client with chronic liver disease has increased portal venous pressure. Which
complication is most directly related to portal hypertension?
A. Decreased splenic size
B. Esophageal varices, ascites, and splenomegaly
C. Increased albumin synthesis
D. Reduced risk of gastrointestinal bleeding
Portal hypertension causes collateral formation (varices), fluid shift (ascites), and splenic
congestion.
6. Which pattern of liver enzyme elevation is most typical in acute viral hepatitis?
A. Normal ALT/AST with elevated alkaline phosphatase only
B. Markedly elevated ALT and AST with possible jaundice
C. Isolated elevation of bilirubin with normal enzymes
D. Low ALT/AST with high GGT only
Hepatocellular injury raises ALT/AST significantly.
7. A client’s hepatitis B serology shows HBsAg positive, anti-HBc IgM positive, and
HBeAg positive. How should the nurse interpret these results?
,A. Past, resolved infection with immunity
B. Acute, highly infectious hepatitis B infection
C. Chronic, low-replicative carrier state
D. Vaccinated with no current infection
HBsAg + anti-HBc IgM indicates acute infection; HBeAg indicates high replication/infectivity.
8. Which hepatitis virus is primarily transmitted via the fecal–oral route and is often
associated with contaminated food or water?
A. Hepatitis B
B. Hepatitis A
C. Hepatitis C
D. Hepatitis D
Hep A is fecal-oral; Hep B, C, D are blood/body fluid–borne.
9. A client with advanced cirrhosis has low serum albumin. Which pathophysiologic
consequence is most directly expected?
A. Increased oncotic pressure and decreased edema
B. Decreased oncotic pressure contributing to edema and ascites
C. Increased clotting factor production
D. Reduced portal vein pressure
Low albumin reduces plasma oncotic pressure, promoting fluid shift to interstitial spaces.
10. Which mechanism best explains spontaneous bacterial peritonitis (SBP) in a
client with cirrhosis and ascites?
A. Direct viral infection of the peritoneum
B. Bacterial translocation from the gut into ascitic fluid with impaired host defenses
C. Autoimmune attack on peritoneal mesothelial cells
D. Chemical irritation from bile leakage
SBP arises from gut bacteria seeding ascitic fluid in the setting of immune dysfunction.
, 11. A client with chronic alcohol use has fatty liver, hepatocyte necrosis,
inflammation, and fibrosis. Which diagnosis best fits this pattern?
A. Nonalcoholic fatty liver disease (NAFLD)
B. Alcoholic hepatitis progressing toward cirrhosis
C. Acute viral hepatitis A
D. Isolated cholestatic jaundice
Alcoholic liver disease shows steatosis, necrosis, inflammation, and fibrosis.
12. Which pathophysiologic change is central to the development of esophageal
varices in cirrhosis?
A. Decreased portal venous pressure
B. Increased resistance to portal blood flow leading to collateral vessel formation
C. Increased hepatic动脉 flow with reduced venous pressure
D. Hyperalbuminemia causing vessel engorgement
Increased intrahepatic resistance drives collateralization, including varices.
13. A client with acute pancreatitis has severe epigastric pain radiating to the back
and elevated lipase. Which initial pathophysiologic event is most accurate?
A. Autoimmune destruction of pancreatic islets
B. Premature activation of pancreatic enzymes within the pancreas causing
autodigestion
C. Bacterial overgrowth in the pancreatic duct
D. Increased insulin secretion leading to hypoglycemia
Acute pancreatitis involves intrapancreatic enzyme activation and tissue injury.
14. Which laboratory pattern is most consistent with obstructive (cholestatic)
jaundice due to a common bile duct stone?
A. Elevated indirect bilirubin with normal alkaline phosphatase
B. Elevated direct bilirubin and elevated alkaline phosphatase
Exam 4 / Final content | LATEST UPDATE THIS
YEAR.pdf
Hepatobiliary & Pancreatic Pathophysiology (Q1–45)
1. A client has right upper quadrant pain, fever, and leukocytosis after eating fatty
foods. Which pathophysiologic process best explains these findings?
A. Autoimmune destruction of hepatocytes
B. Obstruction of the cystic duct by gallstones leading to inflammation (acute
cholecystitis)
C. Viral infection of the biliary epithelium
D. Ischemic injury to the pancreatic acinar cells
Gallstones obstruct the cystic duct, causing bile stasis, inflammation, and infection.
2. Which risk factors are most strongly associated with cholesterol gallstone
formation?
A. Male sex, underweight, low-fat diet
B. “Female, Forty, Fat, Fertile” plus rapid weight loss and certain ethnicities
C. Chronic alcohol use and high-protein diet
D. Hypothyroidism and low estrogen levels
Classic “F” risk factors plus rapid weight loss increase cholesterol stones.
3. A client with cirrhosis develops confusion, lethargy, and a flapping tremor of the
hands. Which substance accumulation primarily contributes to these neurologic
changes?
A. Bilirubin
B. Ammonia
,C. Glucose
D. Urea
Liver failure impairs conversion of ammonia to urea, leading to hepatic encephalopathy.
4. Which classic sign is described as a “flapping tremor” of the hands in hepatic
encephalopathy?
A. Chvostek sign
B. Asterixis
C. Babinski sign
D. Trousseau sign
Asterixis is characteristic of hepatic encephalopathy.
5. A client with chronic liver disease has increased portal venous pressure. Which
complication is most directly related to portal hypertension?
A. Decreased splenic size
B. Esophageal varices, ascites, and splenomegaly
C. Increased albumin synthesis
D. Reduced risk of gastrointestinal bleeding
Portal hypertension causes collateral formation (varices), fluid shift (ascites), and splenic
congestion.
6. Which pattern of liver enzyme elevation is most typical in acute viral hepatitis?
A. Normal ALT/AST with elevated alkaline phosphatase only
B. Markedly elevated ALT and AST with possible jaundice
C. Isolated elevation of bilirubin with normal enzymes
D. Low ALT/AST with high GGT only
Hepatocellular injury raises ALT/AST significantly.
7. A client’s hepatitis B serology shows HBsAg positive, anti-HBc IgM positive, and
HBeAg positive. How should the nurse interpret these results?
,A. Past, resolved infection with immunity
B. Acute, highly infectious hepatitis B infection
C. Chronic, low-replicative carrier state
D. Vaccinated with no current infection
HBsAg + anti-HBc IgM indicates acute infection; HBeAg indicates high replication/infectivity.
8. Which hepatitis virus is primarily transmitted via the fecal–oral route and is often
associated with contaminated food or water?
A. Hepatitis B
B. Hepatitis A
C. Hepatitis C
D. Hepatitis D
Hep A is fecal-oral; Hep B, C, D are blood/body fluid–borne.
9. A client with advanced cirrhosis has low serum albumin. Which pathophysiologic
consequence is most directly expected?
A. Increased oncotic pressure and decreased edema
B. Decreased oncotic pressure contributing to edema and ascites
C. Increased clotting factor production
D. Reduced portal vein pressure
Low albumin reduces plasma oncotic pressure, promoting fluid shift to interstitial spaces.
10. Which mechanism best explains spontaneous bacterial peritonitis (SBP) in a
client with cirrhosis and ascites?
A. Direct viral infection of the peritoneum
B. Bacterial translocation from the gut into ascitic fluid with impaired host defenses
C. Autoimmune attack on peritoneal mesothelial cells
D. Chemical irritation from bile leakage
SBP arises from gut bacteria seeding ascitic fluid in the setting of immune dysfunction.
, 11. A client with chronic alcohol use has fatty liver, hepatocyte necrosis,
inflammation, and fibrosis. Which diagnosis best fits this pattern?
A. Nonalcoholic fatty liver disease (NAFLD)
B. Alcoholic hepatitis progressing toward cirrhosis
C. Acute viral hepatitis A
D. Isolated cholestatic jaundice
Alcoholic liver disease shows steatosis, necrosis, inflammation, and fibrosis.
12. Which pathophysiologic change is central to the development of esophageal
varices in cirrhosis?
A. Decreased portal venous pressure
B. Increased resistance to portal blood flow leading to collateral vessel formation
C. Increased hepatic动脉 flow with reduced venous pressure
D. Hyperalbuminemia causing vessel engorgement
Increased intrahepatic resistance drives collateralization, including varices.
13. A client with acute pancreatitis has severe epigastric pain radiating to the back
and elevated lipase. Which initial pathophysiologic event is most accurate?
A. Autoimmune destruction of pancreatic islets
B. Premature activation of pancreatic enzymes within the pancreas causing
autodigestion
C. Bacterial overgrowth in the pancreatic duct
D. Increased insulin secretion leading to hypoglycemia
Acute pancreatitis involves intrapancreatic enzyme activation and tissue injury.
14. Which laboratory pattern is most consistent with obstructive (cholestatic)
jaundice due to a common bile duct stone?
A. Elevated indirect bilirubin with normal alkaline phosphatase
B. Elevated direct bilirubin and elevated alkaline phosphatase
