mcq questions
Chapter 2 — GERD / Metaplasia
A client with chronic gastroesophageal reflux disease has repeated exposure of the lower esophagus to acidic gastric contents. Which cellular adaptation is most likely occurring?
A. Hyperplasia of squamous epithelial cells
B. Necrosis of gastric epithelial cells
C. Metaplasia from squamous to glandular epithelium
D. Atrophy of esophageal smooth muscle
A client asks why GERD can lead to changes in the esophagus over time. Which response is most accurate?
A. Persistent acid exposure causes cells to adapt by changing into a more protective cell type
B. Gastric acid causes immediate cancer in all exposed tissues
C. The esophagus normally contains glandular stomach cells
D. GERD causes the stomach lining to become squamous epithelium
A nurse is reviewing a client’s history of Barrett esophagus. Which statement best explains why this condition matters?
A. It proves the client has acute inflammation only
B. It prevents ulcer formation in the esophagus
C. It means normal cells have permanently disappeared from the body
D. It may increase risk for esophageal ulceration and adenocarcinoma
Which client finding best supports the presence of chronic GERD-related cellular stress?
A. Sudden onset right lower quadrant pain
B. Esophageal squamous cells changing into glandular-type cells
C. Increased RBC production in bone marrow
D. Loss of bile flow into the small intestine
A student explains metaplasia by saying, “It means one mature cell type changes into another mature cell type because of stress.” How should this answer be graded?
A. Incorrect, because metaplasia means cell death
B. Incorrect, because metaplasia occurs only in cancer
C. Correct, because metaplasia is an adaptive response to a persistent stressor
D. Incorrect, because metaplasia is always irreversible
A client with GERD asks why the esophagus is injured by stomach contents. Which explanation is most accurate?
A. The esophagus produces more acid than the stomach
B. The esophagus is designed to absorb bile salts
C. The esophagus contains pancreatic enzymes
D. The esophagus does not have the same acid-protective lining as the stomach
A client with long-standing GERD has metaplastic changes. Which additional finding would be most concerning?
A. Development of esophageal ulcers
B. Temporary heartburn after one spicy meal
C. Increased intestinal villi height
D. Decreased colon motility
The nurse is comparing GERD-related metaplasia with smoking-related bronchial metaplasia. What is the shared mechanism?
A. Both occur from acute blood loss
B. Both are adaptive changes to chronic irritation
C. Both are caused by bacterial invasion
D. Both are examples of normal fetal development
A client’s reflux symptoms improve after the irritant exposure is controlled. Which cellular outcome is possible?
A. Cells must progress to cancer
B. Cells immediately become necrotic
C. Cells lose all ability to adapt
D. Cells may return toward their normal state if the stressor is removed
Which statement best describes why persistent GERD is pathologically important?
A. It causes the stomach to stop producing mucus immediately
B. It causes the pancreas to release enzymes into the esophagus
C. Continued stress may move adaptation toward pathologic change
D. Refluxed acid strengthens normal squamous epithelium
The nurse is teaching a student about normal esophageal lining. Which cell type should the student identify?
A. Tall columnar glandular cells
B. Flat squamous epithelial cells
C. Ciliated respiratory cells
D. Pancreatic acinar cells
A client with chronic GERD develops glandular-type cells in the lower esophagus. Which interpretation is most accurate?
A. The esophagus is adapting to chronic acid exposure
B. The stomach has developed necrosis
C. The pancreas is digesting itself
D. The colon has lost its absorptive function
Which statement by a student needs correction?
A. “Metaplasia can occur in GERD.”
B. “Metaplasia is a response to chronic stress.”
C. “Metaplasia may reverse if the stressor is removed.”
D. “Metaplasia means cells have already become malignant.”
A client with chronic GERD is found to have Barrett esophagus. Which pathophysiologic chain is most accurate?
A. Bacterial infection → mucosal atrophy → pernicious anemia
B. Gallstone obstruction → enzyme activation → autodigestion
C. Acid reflux → squamous epithelial stress → glandular metaplasia
D. Viral infection → hepatocyte necrosis → jaundice
Which factor most directly causes GERD-related metaplasia?
A. Persistent exposure of esophageal cells to acidic gastric contents
B. Increased water absorption in the colon
C. Decreased bilirubin metabolism
D. Inflammation limited to the pancreatic ducts
A client says, “My reflux is just heartburn. It cannot change tissue.” Which response is most accurate?
A. “That is correct; reflux never changes cells.”
B. “Chronic reflux can cause adaptive cellular changes in the esophagus.”
C. “Only infections can cause cellular adaptation.”
D. “Heartburn causes only acute necrosis, not adaptation.”
Which finding best represents the difference between normal stomach lining and normal esophageal lining?
A. The stomach is lined by squamous epithelium, and the esophagus is lined by glandular cells
B. Both are normally lined by pancreatic acinar cells
C. Both are normally lined by stratified cartilage
D. The stomach has tall columnar cells, while the esophagus has flat squamous cells
The nurse understands that metaplasia occurs because cells are trying to:
A. increase blood clotting
B. destroy all local tissue
C. survive persistent environmental stress
D. prevent all immune activation
Which condition is most directly connected to GERD-related metaplasia?
A. Barrett esophagus
B. Ulcerative colitis
C. Chronic pancreatitis
D. Diverticulitis
Which statement best explains the concern with chronic metaplastic tissue in GERD?
A. It always resolves within 24 hours
B. It may become a site for ulceration or adenocarcinoma
C. It prevents further acid exposure
D. It causes immediate gastric perforation
Chapter 3 — Gastritis / Pancreatitis / IBD
A client has abdominal pain, nausea, vomiting, and a history of heavy aspirin use. Which condition is most likely?
A. Crohn disease
B. Acute gastritis
C. Chronic hepatitis
D. Functional fecal incontinence
A client develops gastritis after repeated use of nonsteroidal anti-inflammatory drugs. Which mechanism best explains this process?
A. Reduced prostaglandin protection weakens the gastric mucus barrier
B. Increased bile flow destroys pancreatic cells
C. Overproduction of intrinsic factor causes mucosal injury
D. Increased villi absorption causes gastric bleeding
The nurse is reviewing stomach function. Which function is correctly associated with the stomach?
A. Production of insulin for glucose regulation
B. Absorption of most fats and proteins
C. Protection, digestion, and absorption of water and alcohol
D. Formation of feces from undigested material
A client in shock develops stress-related gastric injury. Which mechanism best explains this complication?
A. Increased pancreatic enzyme release into the colon
B. Blood is shunted away from the gastric mucosa, weakening protection
C. Increased bile secretion protects the stomach lining
D. Excess vitamin B12 destroys parietal cells
A client with acute gastritis develops hematemesis. Which pathophysiologic change most directly explains this finding?
A. Erosion of gastric tissue with hemorrhage
B. Increased water absorption in the colon
C. Failure of the liver to metabolize bilirubin
D. Chronic inflammation limited to the rectum
Which finding would be most concerning in acute gastritis?
A. Mild heartburn after eating
B. Occasional hiccups
C. Loss of appetite
D. Severe hemorrhage with signs of shock
A client has chronic gastritis caused by H. pylori. Which statement best explains why the organism survives in the stomach?
A. It forms RBCs inside the gastric mucosa
B. It produces enzymes that neutralize gastric acid
C. It blocks all bile production
D. It prevents immune cell migration
Which pathophysiologic finding is associated with chronic H. pylori gastritis?
A. Atrophy of epithelial cells and mucous glands
B. Immediate perforation in every case
C. Total destruction of pancreatic acinar cells
D. Continuous inflammation of the rectum only
A client has autoimmune gastritis. Which process is most likely?
A. Antibodies attack gastric parietal cells or intrinsic factor
B. Viral infection destroys hepatocytes
C. Gallstones obstruct pancreatic enzymes
D. Strong colon contractions form diverticula
A client with autoimmune gastritis develops pernicious anemia. Which mechanism explains the anemia?
A. Excess hydrochloric acid destroys RBCs
B. Bile salts fail to emulsify fat
C. Lack of intrinsic factor impairs vitamin B12 absorption
D. Pancreatic enzymes digest RBCs
A client has sudden severe upper abdominal pain radiating to the back, nausea, and vomiting. Which disorder should the nurse suspect?
A. Ulcerative colitis
B. GERD-related metaplasia
C. Functional fecal incontinence
D. Acute pancreatitis
The nurse understands acute pancreatitis is dangerous because pancreatic enzymes:
A. activate prematurely and digest pancreatic tissue
B. prevent bilirubin from entering the blood
C. cause squamous metaplasia in the esophagus
D. decrease colon pressure
A client with a gallstone develops acute pancreatitis. Which sequence is most accurate?
A. Gallstone obstruction → pancreatic enzyme activation → pancreatic autodigestion
B. Acid reflux → esophageal metaplasia → pancreatic fibrosis
C. Viral infection → bilirubin clearance → colon bleeding
D. Constipation → diverticulum formation → enzyme release
A client with chronic alcohol abuse develops chronic pancreatitis. Which structural change is expected over time?
A. Increased villi height and absorption
B. Fibrosis and atrophy of acinar cells
C. Squamous metaplasia of the bronchi only
D. Continuous ulceration of the colon surface
A client with chronic pancreatitis has steatorrhea and weight loss. Which explanation is most accurate?
A. Liver clotting factors are increased
B. Gastric acid is no longer produced
C. Exocrine pancreatic damage impairs digestion and absorption
D. The lower esophageal sphincter is overly tight
Which finding is most consistent with chronic pancreatitis rather than acute pancreatitis?
A. Sudden single episode of upper abdominal pain
B. Short-term reversible gastric mucosal inflammation
C. Jaundice from acute liver inflammation
D. Irreversible cellular and fibrotic tissue changes
A client has Crohn disease. Which location pattern is most typical?
A. Only the rectum and sigmoid colon
B. Anywhere in the GI tract, often small intestine and ascending colon
C. Only the stomach mucosa
D. Only the liver and biliary ducts
Which pathophysiologic feature best supports Crohn disease?
A. Continuous superficial mucosal inflammation beginning in the rectum
B. Patchy skip lesions with transmural inflammation
C. Acute destruction of gastric mucosa by aspirin
D. Antibodies against intrinsic factor only
A client with Crohn disease develops an abnormal passageway between bowel segments. Which term describes this complication?
A. Fistula
B. Jaundice
C. Metaplasia
D. Icterus
A client has ulcerative colitis. Which pattern should the nurse expect?
A. Patchy lesions anywhere from mouth to anus
B. Inflammation exclusively in the large intestine
C. Pancreatic autodigestion
D. Viral inflammation of hepatocytes
A client with ulcerative colitis has frequent bloody diarrhea. Which tissue characteristic explains this finding?
A. Friable mucosa that readily bleeds
B. Loss of intrinsic factor
C. Gallstone obstruction
D. Fibrosis of pancreatic ducts
A client with Crohn disease has nonbloody diarrhea, weight loss, and fatigue. Which mechanism best explains these manifestations?
A. Impaired absorption from intestinal inflammation
B. Loss of gastric acid from vomiting
C. Increased bilirubin breakdown
D. Increased clotting factor synthesis
Which finding is more characteristic of ulcerative colitis than Crohn disease?
A. Granuloma formation throughout all bowel layers
B. Skip lesions in the small intestine
C. Continuous inflammation involving the colon mucosa
D. Fistula formation between bowel loops
Which complication is most severe for Crohn disease?
A. Mild nausea after meals
B. Temporary reflux after lying down
C. Massive infection and shock from obstruction and perforation
D. Increased bile secretion after fatty meals
A client with ulcerative colitis has extensive disease. Which function is most likely impaired?
A. Water and electrolyte absorption
B. Insulin production
C. Vitamin B12 binding by intrinsic factor
D. Gastric acid secretion
Which statement best compares Crohn disease and ulcerative colitis?
A. Both are acute infections caused by bacteria
B. Crohn disease is limited to the colon; ulcerative colitis affects the pancreas
C. Both are chronic inflammatory bowel diseases with different patterns of tissue involvement
D. Ulcerative colitis affects all bowel layers; Crohn affects only the mucosa
A client with chronic H. pylori gastritis is asymptomatic. Which interpretation is most accurate?
A. This cannot be gastritis because symptoms are always severe
B. Some infected clients are asymptomatic carriers
C. Asymptomatic infection means the stomach has no tissue damage risk
D. The infection must be autoimmune instead
A client with autoimmune gastritis reports weakness, fatigue, and light-headedness. Which finding explains these symptoms?
A. Increased pancreatic enzyme release
B. Decreased blood glucose from liver disease
C. Anemia related to impaired vitamin B12 absorption
D. Increased water absorption in the colon
A nurse compares acute gastritis and chronic gastritis. Which statement is accurate?
A. Acute gastritis is usually short-term and reversible when the irritant is removed
B. Chronic gastritis never involves immune cells
C. Acute gastritis is always caused by autoimmunity
D. Chronic gastritis cannot affect gastric acid secretion
A client with ulcerative colitis has long-standing inflammation. Which complication risk is increased?
A. Lung adenocarcinoma
B. Colorectal cancer
C. Pancreatic enzyme activation
D. Pernicious anemia only
Chapter 5 — Hepatitis
A client has inflammation of the liver caused by a viral infection. Which diagnosis best matches this description?
A. Pancreatitis
B. Viral hepatitis
C. Gastritis
D. Diverticulitis
A client with hepatitis reports right upper quadrant pain. Which structure is most responsible for this pain when the liver enlarges?
A. Glisson capsule
B. Gastric mucosa
C. Pancreatic duct
D. Intestinal villi
A client with hepatitis develops jaundice. Which mechanism best explains this finding?
A. Excess RBC production
B. Increased intrinsic factor secretion
C. Bilirubin accumulation from impaired liver function
D. Decreased hydrochloric acid production
Which liver function explains why clients with liver disease are prone to bleeding and bruising?
A. Bile secretion
B. Clotting factor synthesis
C. Insulin secretion
D. Water absorption
A client with hepatitis has clay-colored stools. Which process best explains this finding?
A. Impaired bile flow into the intestine
B. Increased bile salts in stool
C. Increased RBC production in stool
D. Excess pancreatic lipase in stool
A client with hepatitis has dark urine and yellow sclera. Which substance is most directly involved?
A. Potassium
B. Chloride
C. Bilirubin
D. Albumin only
A nurse is reviewing hepatitis transmission. Which route is most associated with hepatitis A?
A. Fecal–oral contact
B. Inhalation of respiratory droplets
C. Vector-borne mosquito transmission
D. Autoimmune destruction of hepatocytes
Which hepatitis viruses are most concerning for transmission through blood and body fluids?
A. HAV and HEV only
B. HBV, HCV, and HDV
C. Influenza and Epstein-Barr only
D. HSV and malaria only
A client has fatigue, anorexia, malaise, headache, and low-grade fever before jaundice appears. Which phase of acute hepatitis is this?
A. Recovery
B. Fulminant
C. Icterus
D. Prodrome
A client with acute hepatitis develops jaundice, dark urine, and clay-colored stools. Which phase is this?
A. Icterus
B. Prodrome
C. Recovery
D. Carrier state
A client recovering from acute hepatitis has improving symptoms, but the liver remains enlarged and tender. Which phase is this?
A. Prodrome
B. Recovery
C. Icterus
D. Chronic carrier phase
Which statement best describes fulminant hepatitis?
A. Mild liver inflammation lasting less than 24 hours
B. Hepatic failure from severe acute hepatitis
C. Chronic pancreatic fibrosis
D. Functional stool retention in children
A client has chronic hepatitis. Which time frame best supports this classification?
A. Liver impairment lasting more than 6 months
B. Symptoms lasting less than 24 hours
C. Jaundice resolving within 1 week
D. Abdominal pain only after fatty meals
Which cellular process helps the liver recover after acute hepatocyte necrosis?
A. Hepatocyte regeneration
B. Permanent loss of all liver cells
C. Conversion of liver cells to squamous epithelium
D. Pancreatic autodigestion
A client with chronic hepatitis develops fibrosis, diffuse scarring, and impaired blood flow. Which condition is this progressing toward?
A. Cirrhosis
B. Acute gastritis
C. Diverticulosis
D. GERD
Which statement best explains portal circulation?
A. Blood from the GI tract, spleen, and pancreas travels to the liver through the portal vein
B. Blood from the lungs travels directly to the stomach mucosa
C. Bile flows from the pancreas into the rectum
D. Lymph drains from the liver into the esophagus
A client with cirrhosis has obstruction of portal circulation. Which effect should the nurse understand?
A. Backup of blood flow to the GI tract, spleen, and pancreas
B. Increased lower esophageal sphincter tone
C. Increased pancreatic enzyme storage only
D. Increased intestinal villi regeneration
Which liver cells function as phagocytes that engulf harmful substances and old RBC components?
A. Parietal cells
B. Acinar cells
C. Kupffer cells
D. G cells
A client with liver disease has impaired detoxification. Which consequence is most concerning?
A. Medications and toxic substances may remain active longer in circulation
B. Gastric acid will digest the colon
C. Intrinsic factor will increase
D. Stool transit will stop immediately
Which liver function is most directly related to fat digestion?
A. Bile secretion
B. RBC production
C. Insulin release
D. Colon water absorption
A client has liver damage that decreases bile production. Which nutrient process is most affected?
A. Protein synthesis in skeletal muscle
B. Fat emulsification and absorption
C. Oxygen diffusion in alveoli
D. Sodium excretion in urine
Which finding indicates serious impaired liver function in hepatitis?
A. Prolonged clotting time
B. Mild headache in prodrome
C. Temporary fatigue
D. Low-grade fever only
A client has hepatitis B surface antigen present. Which interpretation is most accurate?
A. It can occur in acute infection or chronic carrier state
B. It confirms pancreatitis
C. It rules out all hepatitis infection
D. It shows complete immunity only
A client with chronic hepatitis has persistent cell injury. Which cancer risk is increased?
A. Hepatocellular carcinoma
B. Colon adenocarcinoma only
C. Esophageal adenocarcinoma only
D. Pancreatic neuroendocrine tumor only
Which statement best describes why healthcare workers are at risk for hepatitis B, C, and D?
A. Frequent exposure to blood and body fluids
B. Exposure to fatty foods
C. Contact with gastric acid
D. Exposure to cold climates
A client with acute hepatitis has bilirubin in the urine. What does this finding suggest?
A. Liver dysfunction affecting bilirubin handling
B. Normal protein digestion
C. Improved clotting factor synthesis
D. Increased gastric acid protection
Which manifestation is most consistent with the icteric phase of hepatitis?
A. Clay-colored stools
B. Retentive posturing
C. Substernal burning after meals
D. LLQ abdominal pain
A client with hepatitis has low albumin and edema. Which liver function is impaired?
A. Production of plasma proteins
B. Production of pancreatic enzymes
C. Absorption of water in the colon
D. Control of esophageal sphincter tone
Which statement best explains why hepatitis can cause glucose fluctuations?
A. The liver helps store, release, and produce glucose as needed
B. The liver controls defecation reflexes
C. The liver produces insulin
D. The liver absorbs glucose from stool
A client with chronic hepatitis develops widespread hepatocyte damage and impaired portal blood flow. Which outcome is most dangerous?
A. Liver failure and death
B. Temporary heartburn
C. Mild reversible gastric irritation
D. Increased stool retention only
Chapter 9 — Metabolic Acidosis / Metabolic Alkalosis
A client has pH 7.28 and bicarbonate 18 mEq/L. Which imbalance is present?
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Normal acid-base balance
Which mechanism can cause metabolic acidosis?
A. Loss of gastric acid from vomiting
B. Excess bicarbonate intake only
C. Increased loss of bicarbonate from diarrhea
D. Decreased chloride loss
A client has prolonged diarrhea. Which imbalance is most likely?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Respiratory acidosis
A client with metabolic acidosis develops rapid, deep breathing. Which explanation is most accurate?
A. The lungs are compensating by increasing breathing rate and depth
B. The kidneys are producing excess bile
C. The stomach is absorbing bicarbonate
D. The liver is blocking portal circulation
Which laboratory pattern supports metabolic alkalosis?
A. pH below 7.35 and bicarbonate below 24 mEq/L
B. pH above 7.45 and bicarbonate above 31 mEq/L
C. pH below 7.35 and carbon dioxide above normal
D. pH normal with low bicarbonate only
A client has repeated vomiting with loss of gastric acid. Which imbalance is most likely?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Hyperchloremic acidosis
Which manifestation is associated with metabolic acidosis?
A. Anorexia, nausea, weakness, and confusion
B. Yellow sclera and clay-colored stool
C. Bloody diarrhea with rectal urgency
D. Right shoulder pain after fatty meals
A client has renal failure. Which acid-base problem may develop because the kidneys cannot secrete acids effectively?
A. Metabolic alkalosis
B. Metabolic acidosis
C. GERD-related metaplasia
D. Ulcerative colitis
Which electrolyte shift is listed as a compensatory mechanism in metabolic acidosis?
A. Hyperkalemia
B. Hypocalcemia
C. Hypernatremia
D. Hypophosphatemia
A client’s metabolic acidosis is caused by excess chloride. Which anion gap finding is expected?
A. Always increased
B. Always absent
C. Normal anion gap
D. Critically low bicarbonate with high pH
Which condition can increase nonvolatile acids and contribute to metabolic acidosis?
A. Fasting
B. Vomiting
C. Loss of chloride only
D. Excess bicarbonate retention only
A client with metabolic alkalosis has decreased extracellular fluid volume, hypokalemia, and hypochloremia. What is the effect?
A. These changes can impair excretion of excess bicarbonate
B. These changes cause pancreatic autodigestion
C. These changes create skip lesions in the bowel
D. These changes directly cause bilirubin buildup
Which mechanism contributes to metabolic alkalosis?
A. Increased loss of bicarbonate through stool
B. Decreased hydrogen ions
C. Increased nonvolatile acid production
D. Renal failure causing acid retention
A client has pH 7.50 and HCO₃⁻ 34 mEq/L. Which interpretation is correct?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Normal acid-base balance
A client with metabolic acidosis has flushed skin and decreased heart rate. Which process explains these findings?
A. Vasodilation associated with acidosis
B. Bile obstruction from hepatocyte injury
C. Gastric mucosal erosion
D. Colon diverticula bleeding
Which finding is most consistent with metabolic alkalosis?
A. Increased pH from excess bicarbonate
B. Decreased pH from bicarbonate deficit
C. Increased acid secretion by kidneys only
D. Decreased serum pH with increased chloride
A client has lactic acidosis. Which imbalance should the nurse recognize?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. No acid-base disturbance
Which statement about hypoalbuminemia and metabolic acidosis is accurate?
A. Hypoalbuminemia may mask metabolic acidosis because of an alkalizing effect
B. Hypoalbuminemia always causes metabolic alkalosis only
C. Hypoalbuminemia has no effect on acid-base interpretation
D. Hypoalbuminemia confirms respiratory acidosis
A client with metabolic alkalosis may be asymptomatic or show signs related to:
A. extracellular volume depletion or hypokalemia
B. esophageal glandular metaplasia
C. pancreatic necrosis only
D. colon wall herniation
Which clinical situation most strongly supports metabolic alkalosis?
A. Severe diarrhea with bicarbonate loss
B. Ketoacidosis from fasting
C. Recurrent vomiting with loss of hydrogen ions
D. Renal failure with acid retention
Chapter 18 — Diverticular Disease / Functional Fecal Incontinence
A client older than 80 years reports left lower quadrant abdominal pain, fever, nausea, and vomiting. Which condition is most consistent with these findings?
A. Diverticulitis
B. GERD
C. Hepatitis
D. Autoimmune gastritis
A diverticulum is best described as:
A. an ulcer caused by pancreatic enzyme digestion
B. a small sac or pouch along the colon wall
C. a viral infection of hepatocytes
D. a change from squamous to glandular cells
The nurse understands diverticulosis means:
A. inflammation of the pancreas
B. inflammation of the liver
C. presence of diverticula
D. fecal incontinence in children
A client with diverticula develops inflammation after fecal matter becomes trapped in the sacs. Which condition has developed?
A. Metaplasia
B. Diverticulitis
C. Pancreatitis
D. Hepatitis
Which factor is linked to the development of diverticular disease?
A. Chronic constipation
B. Viral hepatitis
C. Loss of intrinsic factor
D. Lower esophageal reflux
A client has chronic constipation. Which process increases risk for diverticula?
A. Decreased intraluminal pressure
B. Increased prolonged pressure on the large intestine wall
C. Increased bile production
D. Increased gastric mucus protection
A client with diverticulitis develops guarding, rigidity, and rebound tenderness. Which complication is most concerning?
A. Peritonitis
B. GERD
C. Barrett esophagus
D. Pernicious anemia
A client with diverticular disease has sudden rectal bleeding. Which mechanism best explains this finding?
A. Trauma to blood vessels supplying the intestinal wall
B. Loss of hydrogen ions from vomiting
C. Failure of bilirubin metabolism
D. Destruction of pancreatic acinar cells
Which client finding best supports diverticulitis rather than uncomplicated diverticulosis?
A. No symptoms
B. Left lower quadrant pain with fever
C. Chronic heartburn after meals
D. Yellow sclera
A client has diverticulitis complicated by perforation. Which outcomes can result?
A. Hemorrhage, abscess, sepsis, or peritonitis
B. Esophageal metaplasia only
C. Increased fat absorption
D. Increased clotting factor synthesis
Functional fecal incontinence is most accurately described as:
A. repeated passage of stool in inappropriate places in a child 4 years or older
B. obstruction of bile flow in the liver
C. inflammation of the pancreas from enzyme activation
D. superficial inflammation of the colon mucosa
A child with functional fecal incontinence holds stool because bowel movements are painful. Which type is most likely?
A. Nonretentive
B. Retentive
C. Viral
D. Autoimmune
Which developmental trigger may contribute to functional fecal incontinence?
A. Starting school
B. Gallstone obstruction
C. Hepatic fibrosis
D. Gastric acid reflux
Which statement best describes functional fecal incontinence?
A. It always results from an anatomic abnormality
B. It occurs only in infants younger than 1 year
C. It can occur in neurologically competent individuals through voluntary stool retention
D. It is caused by viral damage to the liver
A child has a history of hard, painful bowel movements, retentive posturing, and a large fecal mass in the rectum. Which condition is most consistent?
A. Retentive functional fecal incontinence
B. Ulcerative colitis
C. Acute gastritis
D. Metabolic acidosis
Which finding is more consistent with nonretentive functional fecal incontinence?
A. Large fecal mass in rectum
B. Excessive stool retention
C. Hard painful bowel movements
D. Absence of excessive stool and fecal retention
A nurse is differentiating functional fecal incontinence from an organic condition. Which assessment is most important?
A. Presence or absence of neurologic, neuromuscular, endocrine, or anatomic causes
B. Presence of jaundice and clay-colored stools
C. Presence of pancreatic enzyme elevation
D. Presence of Barrett esophagus
Which factor can amplify constipation in children with retentive fecal incontinence?
A. Fear or stress associated with defecation
B. Increased bile flow
C. Pancreatic enzyme activation
D. Hepatocyte regeneration
Which statement best explains why stool retention worsens the problem?
A. Retention increases stool hardness and discomfort, encouraging further withholding
B. Retention causes immediate liver failure
C. Retention improves colon motility
D. Retention decreases fecal mass formation
A child has stool accidents at least monthly for more than 2 months, with no excessive stool retention and no underlying motility disorder. Which classification best fits?
A. Retentive functional fecal incontinence
B. Nonretentive functional fecal incontinence
C. Diverticulitis
D. Crohn disease
Answer Key
Chapter 2
C
A
D
B
C
D
A
B
D
C
B
A
D
C
A
B
D
C
A
B
Chapter 3
B
A
C
B
A
D
B
A
A
C
D
A
A
B
C
D
B
B
A
B
A
A
C
C
A
C
B
C
A
B
Chapter 5
B
A
C
B
A
C
A
B
D
A
B
B
A
A
A
A
A
C
A
A
B
A
A
A
A
A
A
A
A
A
Chapter 9
B
C
A
A
B
B
A
B
A
C
A
A
B
C
A
A
A
A
A
C
Chapter 18
A
B
C
B
A
B
A
A
B
A
A
B
A
C
A
D
A
A
A
B