CMSRN Gastrointestinal and Hepatic Care 2

Question 1

Which clinical manifestation most specifically differentiates hepatic encephalopathy from other causes of altered mental status?

Accepted Answer

Asterixis (liver flap tremor)

Answer

Hypertension and bradycardia (Cushing's triad)

Answer

Hypoactive bowel sounds

Answer

Elevated white blood cell count

Question 2

A patient with liver cirrhosis develops ascites. The nurse understands the primary pathophysiology involves:

Accepted Answer

Decreased serum albumin and increased portal hypertension

Answer

Elevated serum sodium causing fluid retention

Answer

Elevated liver enzymes causing osmotic fluid shifts

Answer

Decreased antidiuretic hormone production

Question 3

Following a large-volume paracentesis, which finding requires the nurse's most immediate assessment?

Accepted Answer

Hypotension and tachycardia

Answer

Mild soreness at the puncture site

Answer

Low-grade fever within 12 hours

Answer

Decreased urine output at 6 hours

Question 4

A patient diagnosed with hepatitis B asks how the virus is transmitted. The nurse correctly responds that it spreads through:

Accepted Answer

Blood, sexual contact, and perinatal transmission

Answer

The fecal-oral route via contaminated food and water

Answer

Airborne droplets from infected individuals

Answer

Contact with contaminated environmental surfaces

Question 5

A patient with ulcerative colitis is in a severe flare. Which finding most indicates the need for emergency surgical intervention?

Accepted Answer

Toxic megacolon with high fever and massive abdominal distension

Answer

Bloody diarrhea occurring more than 6 times per day

Answer

Serum albumin level of 3.0 g/dL

Answer

Hemoglobin of 10 g/dL with fatigue

Question 6

Which dietary instruction is most essential for a patient newly diagnosed with celiac disease?

Accepted Answer

Eliminate all foods containing gluten

Answer

Avoid all dairy products permanently

Answer

Limit daily protein intake to 50 grams

Answer

Follow a low-residue diet for life

Question 7

A patient is receiving total parenteral nutrition (TPN). Which nursing monitoring parameter is the highest priority?

Accepted Answer

Blood glucose monitoring every 4 to 6 hours

Answer

Daily weights and strict intake and output

Answer

Inspection of the central venous catheter site for infection

Answer

Monitoring of serum electrolyte levels