CMSRN Gastrointestinal and Hepatic Care 2 — Questions and Answers
Question 1: Which clinical manifestation most specifically differentiates hepatic encephalopathy from other causes of altered mental status?
- Hypertension and bradycardia (Cushing's triad)
- Asterixis (liver flap tremor) (Correct answer)
- Hypoactive bowel sounds
- Elevated white blood cell count
Correct answer: Asterixis (liver flap tremor)
Asterixis, a flapping tremor of the outstretched hands, is the hallmark neurological sign of hepatic encephalopathy caused by ammonia's toxic effect on the brain.
Question 2: A patient with liver cirrhosis develops ascites. The nurse understands the primary pathophysiology involves:
- Decreased serum albumin and increased portal hypertension (Correct answer)
- Elevated serum sodium causing fluid retention
- Elevated liver enzymes causing osmotic fluid shifts
- Decreased antidiuretic hormone production
Correct answer: Decreased serum albumin and increased portal hypertension
Decreased albumin reduces plasma oncotic pressure while portal hypertension increases hydrostatic pressure, together forcing fluid from the vasculature into the peritoneal cavity.
Question 3: Following a large-volume paracentesis, which finding requires the nurse's most immediate assessment?
- Mild soreness at the puncture site
- Hypotension and tachycardia (Correct answer)
- Low-grade fever within 12 hours
- Decreased urine output at 6 hours
Correct answer: Hypotension and tachycardia
Hypotension and tachycardia following paracentesis signal hypovolemia from rapid fluid shifts or hemorrhage, which requires immediate hemodynamic intervention.
Question 4: A patient diagnosed with hepatitis B asks how the virus is transmitted. The nurse correctly responds that it spreads through:
- The fecal-oral route via contaminated food and water
- Blood, sexual contact, and perinatal transmission (Correct answer)
- Airborne droplets from infected individuals
- Contact with contaminated environmental surfaces
Correct answer: Blood, sexual contact, and perinatal transmission
Hepatitis B is a bloodborne pathogen transmitted via blood and blood products, sexual contact with an infected person, and vertically from infected mother to newborn.
Question 5: A patient with ulcerative colitis is in a severe flare. Which finding most indicates the need for emergency surgical intervention?
- Bloody diarrhea occurring more than 6 times per day
- Toxic megacolon with high fever and massive abdominal distension (Correct answer)
- Serum albumin level of 3.0 g/dL
- Hemoglobin of 10 g/dL with fatigue
Correct answer: Toxic megacolon with high fever and massive abdominal distension
Toxic megacolon is a life-threatening complication requiring emergency colectomy to prevent bowel perforation, peritonitis, and sepsis.
Question 6: Which dietary instruction is most essential for a patient newly diagnosed with celiac disease?
- Avoid all dairy products permanently
- Limit daily protein intake to 50 grams
- Eliminate all foods containing gluten (Correct answer)
- Follow a low-residue diet for life
Correct answer: Eliminate all foods containing gluten
Celiac disease is an autoimmune condition triggered by gluten found in wheat, barley, and rye; complete and permanent dietary elimination is the only definitive treatment.
Question 7: A patient is receiving total parenteral nutrition (TPN). Which nursing monitoring parameter is the highest priority?
- Daily weights and strict intake and output
- Blood glucose monitoring every 4 to 6 hours (Correct answer)
- Inspection of the central venous catheter site for infection
- Monitoring of serum electrolyte levels
Correct answer: Blood glucose monitoring every 4 to 6 hours
The high dextrose concentration in TPN frequently causes hyperglycemia, which must be detected early through regular glucose monitoring to prevent serious metabolic complications.
CMSRN Gastrointestinal and Hepatic Care 2
Which clinical manifestation most specifically differentiates hepatic encephalopathy from other causes of altered mental status?