NSG 3850 EXAM 4 (VERSION A) – EXAM QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALE | 2027 Q&A | INSTANT DOWNLOAD PDF
1. A client with advanced cirrhosis develops progressive abdominal distention. Which
pathophysiologic change most directly contributes to the development of ascites?
A. Increased plasma oncotic pressure
B. Decreased portal venous pressure
C. Reduced plasma albumin concentration
D. Increased lymphatic drainage
Rationale: Reduced hepatic synthesis of albumin lowers plasma oncotic pressure, promoting
movement of fluid from the intravascular space into the peritoneal cavity. Portal hypertension
also contributes to ascites, but hypoalbuminemia is a major mechanism.
2. A client with acute cholecystitis asks why the gallbladder became inflamed. Which
explanation is most accurate?
A. Obstruction of the cystic duct causes bile retention and gallbladder inflammation
B. Excess pancreatic enzymes directly digest the gallbladder wall
C. Reduced bilirubin production causes ischemia of the gallbladder
D. Increased gastric acid causes inflammation of the gallbladder
Rationale: Acute cholecystitis most commonly results from cystic duct obstruction by a gallstone.
Bile becomes trapped, increasing pressure and promoting inflammation and possible ischemic
injury.
3. A client reports episodic right upper quadrant pain after eating a fatty meal. Which
condition is most consistent with this presentation?
A. Acute appendicitis
B. Cholelithiasis
C. Ulcerative colitis
D. Diverticulitis
Rationale: Gallstones can cause biliary colic when they temporarily obstruct the biliary tract.
Pain commonly occurs after meals, particularly meals high in fat.
4. Which client has the greatest risk for developing cholesterol gallstones?
A. A client with chronic dehydration
B. A client with low serum cholesterol
C. A client with chronic iron deficiency
D. A client who has experienced rapid weight loss
,Rationale: Rapid weight loss increases cholesterol mobilization and can make bile more
cholesterol-rich, promoting crystal and gallstone formation.
5. A client with obstructive jaundice has dark urine and pale, clay-colored stools. Which
explanation accounts for these findings?
A. Increased production of unconjugated bilirubin
B. Reduced delivery of bile pigments into the intestine
C. Excessive destruction of circulating platelets
D. Increased intestinal absorption of bile salts
Rationale: Biliary obstruction prevents conjugated bilirubin from reaching the intestine.
Conjugated bilirubin may instead accumulate in the blood and be excreted in urine, while
reduced intestinal bile pigment contributes to pale stools.
6. Which laboratory marker is most useful for identifying a current hepatitis C infection?
A. Anti-HAV IgG
B. HBsAb
C. Anti-HCV antibody alone
D. HCV RNA
Rationale: HCV RNA detects viral genetic material and indicates current infection. Antibody
testing demonstrates exposure but does not by itself distinguish current infection from a previous
infection.
7. A client has an acute hepatitis A infection. Which serologic finding would the nurse
expect?
A. HBsAg
B. Anti-HCV IgG
C. Anti-HAV IgM
D. Anti-HAV IgG only
Rationale: Anti-HAV IgM is associated with acute or recent hepatitis A infection. Anti-HAV IgG
generally reflects previous infection or immunity.
8. Which exposure is most strongly associated with transmission of hepatitis A?
A. Sharing needles
B. Sexual exposure to infected blood
C. Needlestick injury
D. Contaminated food or water
Rationale: Hepatitis A is primarily transmitted by the fecal-oral route. Poor sanitation and
contaminated food or water increase transmission risk.
, 9. A client is being evaluated for hepatitis B. Which finding indicates current hepatitis B
surface antigenemia?
A. HBsAb
B. Anti-HBc IgG
C. HBsAg
D. Anti-HBs only
Rationale: HBsAg is a marker of hepatitis B infection and indicates that hepatitis B surface
antigen is present in the blood. Anti-HBs is associated with immunity.
10. Which client characteristic is particularly associated with nonalcoholic steatohepatitis
(NASH)?
A. Recurrent blood transfusions
B. Chronic low-calorie intake
C. Obesity and insulin resistance
D. Repeated exposure to contaminated water
Rationale: NASH is strongly associated with metabolic dysfunction, including obesity, insulin
resistance, type 2 diabetes, and dyslipidemia.
11. A client with cirrhosis becomes confused and develops asterixis. Which substance is
most closely associated with the development of hepatic encephalopathy?
A. Bilirubin
B. Creatinine
C. Ammonia
D. Calcium
Rationale: Impaired hepatic detoxification allows ammonia and other neurotoxic substances to
accumulate. Neurologic manifestations can include confusion, altered consciousness, and
asterixis.
12. Which assessment finding would most strongly suggest worsening portal hypertension in
a client with cirrhosis?
A. Bradycardia
B. Increased bowel sounds
C. Esophageal varices
D. Hyperactive deep tendon reflexes
Rationale: Portal hypertension causes blood to be redirected through collateral vessels,
including esophageal veins. These vessels can become enlarged and rupture, producing life-
threatening hemorrhage.
(VERIFIED ANSWERS) PLUS RATIONALE | 2027 Q&A | INSTANT DOWNLOAD PDF
1. A client with advanced cirrhosis develops progressive abdominal distention. Which
pathophysiologic change most directly contributes to the development of ascites?
A. Increased plasma oncotic pressure
B. Decreased portal venous pressure
C. Reduced plasma albumin concentration
D. Increased lymphatic drainage
Rationale: Reduced hepatic synthesis of albumin lowers plasma oncotic pressure, promoting
movement of fluid from the intravascular space into the peritoneal cavity. Portal hypertension
also contributes to ascites, but hypoalbuminemia is a major mechanism.
2. A client with acute cholecystitis asks why the gallbladder became inflamed. Which
explanation is most accurate?
A. Obstruction of the cystic duct causes bile retention and gallbladder inflammation
B. Excess pancreatic enzymes directly digest the gallbladder wall
C. Reduced bilirubin production causes ischemia of the gallbladder
D. Increased gastric acid causes inflammation of the gallbladder
Rationale: Acute cholecystitis most commonly results from cystic duct obstruction by a gallstone.
Bile becomes trapped, increasing pressure and promoting inflammation and possible ischemic
injury.
3. A client reports episodic right upper quadrant pain after eating a fatty meal. Which
condition is most consistent with this presentation?
A. Acute appendicitis
B. Cholelithiasis
C. Ulcerative colitis
D. Diverticulitis
Rationale: Gallstones can cause biliary colic when they temporarily obstruct the biliary tract.
Pain commonly occurs after meals, particularly meals high in fat.
4. Which client has the greatest risk for developing cholesterol gallstones?
A. A client with chronic dehydration
B. A client with low serum cholesterol
C. A client with chronic iron deficiency
D. A client who has experienced rapid weight loss
,Rationale: Rapid weight loss increases cholesterol mobilization and can make bile more
cholesterol-rich, promoting crystal and gallstone formation.
5. A client with obstructive jaundice has dark urine and pale, clay-colored stools. Which
explanation accounts for these findings?
A. Increased production of unconjugated bilirubin
B. Reduced delivery of bile pigments into the intestine
C. Excessive destruction of circulating platelets
D. Increased intestinal absorption of bile salts
Rationale: Biliary obstruction prevents conjugated bilirubin from reaching the intestine.
Conjugated bilirubin may instead accumulate in the blood and be excreted in urine, while
reduced intestinal bile pigment contributes to pale stools.
6. Which laboratory marker is most useful for identifying a current hepatitis C infection?
A. Anti-HAV IgG
B. HBsAb
C. Anti-HCV antibody alone
D. HCV RNA
Rationale: HCV RNA detects viral genetic material and indicates current infection. Antibody
testing demonstrates exposure but does not by itself distinguish current infection from a previous
infection.
7. A client has an acute hepatitis A infection. Which serologic finding would the nurse
expect?
A. HBsAg
B. Anti-HCV IgG
C. Anti-HAV IgM
D. Anti-HAV IgG only
Rationale: Anti-HAV IgM is associated with acute or recent hepatitis A infection. Anti-HAV IgG
generally reflects previous infection or immunity.
8. Which exposure is most strongly associated with transmission of hepatitis A?
A. Sharing needles
B. Sexual exposure to infected blood
C. Needlestick injury
D. Contaminated food or water
Rationale: Hepatitis A is primarily transmitted by the fecal-oral route. Poor sanitation and
contaminated food or water increase transmission risk.
, 9. A client is being evaluated for hepatitis B. Which finding indicates current hepatitis B
surface antigenemia?
A. HBsAb
B. Anti-HBc IgG
C. HBsAg
D. Anti-HBs only
Rationale: HBsAg is a marker of hepatitis B infection and indicates that hepatitis B surface
antigen is present in the blood. Anti-HBs is associated with immunity.
10. Which client characteristic is particularly associated with nonalcoholic steatohepatitis
(NASH)?
A. Recurrent blood transfusions
B. Chronic low-calorie intake
C. Obesity and insulin resistance
D. Repeated exposure to contaminated water
Rationale: NASH is strongly associated with metabolic dysfunction, including obesity, insulin
resistance, type 2 diabetes, and dyslipidemia.
11. A client with cirrhosis becomes confused and develops asterixis. Which substance is
most closely associated with the development of hepatic encephalopathy?
A. Bilirubin
B. Creatinine
C. Ammonia
D. Calcium
Rationale: Impaired hepatic detoxification allows ammonia and other neurotoxic substances to
accumulate. Neurologic manifestations can include confusion, altered consciousness, and
asterixis.
12. Which assessment finding would most strongly suggest worsening portal hypertension in
a client with cirrhosis?
A. Bradycardia
B. Increased bowel sounds
C. Esophageal varices
D. Hyperactive deep tendon reflexes
Rationale: Portal hypertension causes blood to be redirected through collateral vessels,
including esophageal veins. These vessels can become enlarged and rupture, producing life-
threatening hemorrhage.
