Gastrointestinal & Hepatic NCLEX Practice Questions

Crohn's: affects any part of the GI tract (often terminal ileum), transmural (full thickness) inflammation, skip lesions, fistulas common, and bloody diarrhea less predominant. UC: confined to large intestine starting at rectum, mucosal inflammation, continuous lesions, bloody/mucoid diarrhea, and higher colon cancer risk with long-standing disease.

NCLEX tests asterixis (flapping hand tremor when wrists extended — also called liver flap), confusion and altered LOC, fetor hepaticus (musty breath), and elevated ammonia levels. Priority interventions include lactulose administration (to reduce ammonia), dietary protein modification during acute episodes, and treating precipitating causes such as GI bleeding or infection.

Small bowel obstruction: colicky abdominal pain, nausea and vomiting (early and frequent), high-pitched hyperactive bowel sounds above the obstruction, abdominal distension. Large bowel obstruction: gradual onset, less vomiting, pronounced distension, low-pitched or absent bowel sounds. Priority nursing actions: NPO status, nasogastric tube insertion for decompression, IV fluid replacement, monitor electrolytes, and assess for strangulation signs (fever, rebound tenderness, increasing pain) that require emergency surgery.

Upper GI bleed: hematemesis (bright red or coffee-ground emesis), melena (black tarry stools), and signs of hypovolemia. Lower GI bleed: hematochezia (bright red blood per rectum). Priority actions: assess hemodynamic stability (vital signs, orthostatic changes), establish large-bore IV access, type and crossmatch, monitor hemoglobin and hematocrit (may not drop immediately), keep NPO, and prepare for possible endoscopy. Notify the provider immediately for any signs of active hemorrhage.

Ileostomy: liquid to semi-formed output, higher risk of dehydration and electrolyte imbalances, empty pouch when one-third full. Colostomy: formed stool (especially descending/sigmoid), may be irrigated on schedule. Key teaching: cut the wafer opening 1/8 inch larger than the stoma, assess stoma color (should be pink/red and moist — dusky or pale indicates compromised circulation), protect peristomal skin with skin barrier, and expected dietary modifications. Report: black stoma color, prolapse, or signs of obstruction.

Key labs: ALT and AST (elevated = hepatocellular damage), bilirubin (elevated = jaundice), albumin (decreased = impaired synthesis, edema), PT/INR (prolonged = impaired clotting factor production), and ammonia (elevated = encephalopathy risk). Cirrhosis complications: portal hypertension leading to esophageal varices (bleeding risk), ascites (fluid restriction, paracentesis, diuretics), hepatorenal syndrome, and coagulopathy. Avoid hepatotoxic medications including acetaminophen.