GI NCLEX style CHAT 4050 MOD 3

A nurse is caring for four patients with cirrhosis. Which patient should the nurse assess FIRST? A. Patient with ascites and ankle edema B. Patient having three soft stools after lactulose C. Patient with sudden confusion, slurred speech, and decreased LOC D. Patient with jaundice and albumin of 2.5 g/dL

C. Sudden neurological changes may indicate worsening hepatic encephalopathy. Assess neurological status and airway immediately.

A patient with cirrhosis suddenly vomits bright red blood. What is the nurse's PRIORITY action? A. Administer lactulose B. Assess airway, vital signs, and initiate emergency response C. Measure abdominal girth D. Administer spironolactone

B. Suspect ruptured esophageal varices. Prioritize airway protection, hemorrhage assessment, and rapid stabilization.

A patient with cirrhosis has abdominal distention, peripheral edema, and decreased albumin. Which complication should the nurse suspect? A. Hepatic encephalopathy B. Ascites C. Cholecystitis D. Acute pancreatitis

B. Ascites results from portal hypertension, decreased oncotic pressure, and sodium/water retention.

Which nursing interventions are appropriate for a patient with ascites? SELECT ALL THAT APPLY. A. Daily weights B. Strict I&O C. Measure abdominal girth D. Encourage high-sodium foods E. Monitor electrolytes

A, B, C, E. These interventions monitor fluid accumulation and complications. Sodium restriction is commonly prescribed.

A patient with cirrhosis is prescribed spironolactone. Which laboratory value is MOST important to monitor? A. Potassium B. Hemoglobin A1c C. Lipase D. Amylase

A. Spironolactone is potassium-sparing and can cause hyperkalemia.

A patient with cirrhosis develops confusion and asterixis. Which medication should the nurse anticipate administering? A. Pancrelipase B. Lactulose C. Ursodiol D. Spironolactone

B. Lactulose reduces intestinal ammonia burden and is a primary treatment for hepatic encephalopathy.

A patient receiving lactulose for hepatic encephalopathy has three soft bowel movements daily and improved orientation. What should the nurse do? A. Hold all future doses B. Recognize the expected therapeutic response C. Administer an antidiarrheal D. Increase the dose independently

B. Approximately two to three soft bowel movements daily is a common treatment goal, along with improved mental status.

Which findings indicate possible hepatic encephalopathy? SELECT ALL THAT APPLY. A. Asterixis B. Confusion C. Decreased LOC D. Slurred speech E. Positive Murphy sign

A, B, C, D. Hepatic encephalopathy causes neurological changes. Murphy sign is associated with gallbladder inflammation.

A patient with cirrhosis has prolonged PT/INR. What is the nurse's greatest concern? A. Hypoglycemia B. Increased bleeding risk C. Hypercalcemia D. Pancreatic insufficiency

B. The damaged liver produces fewer clotting factors, increasing bleeding risk.

A patient with known esophageal varices develops hematemesis, BP 82/48, and HR 132. Which complication should the nurse suspect? A. Cardiogenic shock B. Hemorrhagic hypovolemic shock C. Neurogenic shock D. Septic shock

B. Ruptured varices can cause massive blood loss and hypovolemic shock.

Which intervention should the nurse anticipate for active esophageal variceal bleeding? A. Urgent endoscopic band ligation B. Oral pancrelipase C. Routine paracentesis D. Oral ursodiol

A. Endoscopic band ligation is used to control bleeding esophageal varices.

A patient asks why they take a nonselective beta blocker for esophageal varices. Which response is correct? A. It increases albumin B. It decreases portal pressure and bleeding risk C. It removes ammonia D. It dissolves gallstones

B. Nonselective beta blockers reduce portal pressure and help prevent variceal hemorrhage.

A nurse is caring for a patient with cirrhosis who develops increasing abdominal distention. Which assessment best evaluates fluid accumulation over time? A. Daily abdominal girth and weight B. Daily pupil checks C. Daily lipase D. Daily blood glucose only

A. Abdominal girth and daily weights help track ascites.

A patient has chronic hepatitis B. Which complications should the nurse monitor for? SELECT ALL THAT APPLY. A. Cirrhosis B. Portal hypertension C. Hepatocellular carcinoma D. Hepatic encephalopathy E. Appendicitis

A, B, C, D. Chronic HBV can cause progressive liver damage and associated complications.

A patient develops hepatitis after consuming contaminated food. Which type is MOST likely? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Chronic hepatitis B

A. Hepatitis A is primarily transmitted through the fecal-oral route.

Which statements about viral hepatitis are correct? SELECT ALL THAT APPLY. A. Hepatitis A does not cause chronic infection B. Hepatitis B can become chronic C. Hepatitis C frequently becomes chronic if untreated D. Hepatitis C has a routine preventive vaccine E. Hepatitis A has a vaccine

A, B, C, E. Hepatitis A is acute only; B and C can become chronic. There is no hepatitis C vaccine.

A nurse sustains a needlestick injury from a patient with hepatitis B. What is the priority action? A. Ignore the exposure B. Wash the site and immediately report the exposure according to protocol C. Start lactulose D. Apply heat

B. Immediate cleansing, reporting, and occupational exposure evaluation are necessary.

Which patient is at greatest risk for hepatitis C? A. Patient who shared injection needles B. Patient who drank contaminated water C. Patient who ate undercooked chicken D. Patient with seasonal allergies

A. Hepatitis C is primarily bloodborne, with shared injection equipment a major transmission route.

A patient with hepatitis C asks about treatment. Which response is appropriate? A. No treatment is available B. Antiviral therapy can treat and often cure hepatitis C C. Lactulose eliminates the virus D. A vaccine cures the infection

B. Direct-acting antiviral medications can cure most hepatitis C infections.

A patient reports persistent RUQ pain, nausea, fever, and tenderness during inspiration with RUQ palpation. Which disorder should the nurse suspect? A. Chronic pancreatitis B. Cholecystitis C. Hepatic encephalopathy D. Esophageal varices

B. Cholecystitis commonly causes persistent RUQ pain and a positive Murphy sign.

Which diagnostic test should the nurse anticipate FIRST for suspected gallstones? A. RUQ ultrasound B. Colonoscopy C. EEG D. Echocardiogram

A. RUQ ultrasound is the first-line imaging test for gallstones.

A patient is admitted with acute cholecystitis. Which interventions should the nurse anticipate? SELECT ALL THAT APPLY. A. NPO initially B. IV fluids C. Analgesics D. Antibiotics when infection is suspected E. High-fat meals

A, B, C, D. Initial management includes bowel rest when indicated, hydration, pain control, and antibiotics when appropriate.

A patient with gallstones develops severe epigastric pain radiating to the back. Which complication should the nurse suspect? A. Acute pancreatitis B. Hepatic encephalopathy C. Ascites D. Esophageal varices

A. Gallstones can obstruct pancreatic drainage and trigger acute pancreatitis.

Which finding is MOST characteristic of acute pancreatitis? A. RUQ pain with Murphy sign B. Severe epigastric pain radiating to the back C. Painless abdominal swelling D. Flapping tremor

B. Severe epigastric pain radiating to the back is a hallmark finding.

Which laboratory value is MOST useful in supporting a diagnosis of acute pancreatitis? A. Lipase B. Albumin C. INR D. Hemoglobin A1c

A. Elevated serum lipase is a key diagnostic finding in acute pancreatitis.

A patient with acute pancreatitis has HR 128, BP 86/50, and decreased urine output. What is the nurse's PRIORITY concern? A. Fluid volume deficit and shock B. Constipation C. Hyperglycemia only D. Chronic malabsorption

A. Acute pancreatitis can cause significant third spacing, hypovolemia, and shock.

Which IV fluid should the nurse anticipate for initial fluid resuscitation in acute pancreatitis? A. Lactated Ringer's B. Dextrose 10% only C. Hypertonic saline D. No IV fluids

A. Lactated Ringer's is commonly preferred for initial resuscitation, with reassessment to avoid fluid overload.

Which complications can occur with severe acute pancreatitis? SELECT ALL THAT APPLY. A. Hypovolemic shock B. Hypocalcemia C. ARDS D. Pancreatic necrosis E. Hepatic encephalopathy as a direct hallmark

A, B, C, D. Severe pancreatitis can cause third spacing, electrolyte disturbances, respiratory failure, and pancreatic necrosis.

A patient with acute pancreatitis develops tingling around the mouth and muscle spasms. Which electrolyte imbalance should the nurse suspect? A. Hypernatremia B. Hypocalcemia C. Hyperkalemia D. Hypermagnesemia

B. Hypocalcemia can occur in severe pancreatitis and may cause neuromuscular irritability.

A patient with acute pancreatitis develops worsening dyspnea and hypoxemia. Which complication is MOST concerning? A. ARDS B. Cholelithiasis C. Ascites D. Chronic hepatitis

A. Severe acute pancreatitis can trigger systemic inflammation and ARDS.

A patient with acute pancreatitis asks when they can eat again. Which response is most appropriate? A. You must remain NPO for several weeks B. Oral feeding may resume early as tolerated when clinically appropriate C. You can only receive TPN D. You must avoid all carbohydrates permanently

B. Early oral or enteral feeding as tolerated is preferred rather than prolonged routine NPO.

A patient with chronic pancreatitis reports greasy, foul-smelling stools and weight loss. What is the most likely cause? A. Excess insulin B. Pancreatic enzyme deficiency C. Increased albumin D. Portal hypertension

B. Chronic pancreatic damage reduces digestive enzyme production, causing malabsorption and steatorrhea.

A patient with chronic pancreatitis is prescribed pancrelipase. Which instruction is MOST important? A. Take it only at bedtime B. Take it with meals and snacks C. Take it only when experiencing pain D. Take it on an empty stomach

B. Pancrelipase replaces digestive enzymes and should be taken with food.

Why should the nurse monitor blood glucose in a patient with chronic pancreatitis? A. Pancreatic damage may reduce insulin production B. Albumin always increases C. Gallstones always cause hypoglycemia D. Lactulose increases insulin

A. Chronic pancreatitis can damage insulin-producing pancreatic cells and lead to diabetes.

Which patient should the nurse assess FIRST? A. Patient with chronic pancreatitis and steatorrhea B. Patient with ascites awaiting daily weight C. Patient with acute pancreatitis, BP 78/42, and HR 138 D. Patient with hepatitis A reporting fatigue

C. Severe hypotension and tachycardia suggest shock requiring immediate assessment and intervention.

A patient with cirrhosis has new confusion and asterixis. Which nursing action is most appropriate? A. Assess neurological status and airway, then administer prescribed therapy B. Encourage alcohol intake C. Restrict all protein permanently D. Delay assessment until morning

A. Acute neurological changes require prompt assessment and treatment for possible hepatic encephalopathy.

A nurse is teaching a patient with cirrhosis about when to seek emergency care. Which symptoms require immediate attention? SELECT ALL THAT APPLY. A. Vomiting blood B. Black tarry stools C. New severe confusion D. Sudden decreased LOC E. Stable mild fatigue

A, B, C, D. These findings may indicate GI hemorrhage or worsening hepatic encephalopathy.