NCLEX GI Disorders questions
The PrepScore bank has 77 GI Disorders questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Recognize cues and Take action, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
GI bleed (upper vs lower), acute pancreatitis, cirrhosis + portal HTN + ascites, hepatic encephalopathy, bowel obstruction, IBD, peptic ulcer disease, appendicitis, hepatitis A/B/C, multi-patient priority.
Three worked questions
Q1. The infection control nurse reviews viral hepatitis transmission routes with staff. Which routes APPLY? Select all that apply.
- A. Hepatitis A: fecal-oral route (contaminated food/water, poor hand hygiene)
- B. Hepatitis B: parenteral/sexual/perinatal (blood, semen, mother-to-baby; high infectivity)
- C. Hepatitis C: parenteral (blood, IVDU sharing needles, transfusion pre-1992); rare sexual + perinatal
- D. Hepatitis D: only with Hep B coinfection or superinfection (same routes as Hep B)
- E. Hepatitis E: fecal-oral (endemic in developing areas; high mortality in pregnancy)
- F. Airborne droplet (NOT — not transmitted by respiratory route)
Show answer and rationale
Answer: Hepatitis A: fecal-oral route (contaminated food/water, poor hand hygiene)Hepatitis B: parenteral/sexual/perinatal (blood, semen, mother-to-baby; high infectivity)Hepatitis C: parenteral (blood, IVDU sharing needles, transfusion pre-1992); rare sexual + perinatalHepatitis D: only with Hep B coinfection or superinfection (same routes as Hep B)Hepatitis E: fecal-oral (endemic in developing areas; high mortality in pregnancy)
Hepatitis: A fecal-oral, B parenteral/sexual/perinatal, C parenteral, D with B, E fecal-oral. Airborne NOT a route.
Q2. A chronic liver disease patient is being assessed for decompensation. Which findings SUGGEST cirrhosis decompensation? Select all that apply.
- A. New ascites (paracentesis ± SBP workup)
- B. Variceal bleeding (UGIB from esophageal/gastric varices; emergency)
- C. Hepatic encephalopathy (West Haven grades I-IV; ammonia, asterixis, AMS)
- D. Jaundice (bilirubin elevation reflecting failing synthesis/clearance)
- E. Hepatorenal syndrome (HRS — rising Cr without other cause) or hepatopulmonary syndrome (HPS — hypoxemia with shunting)
- F. Stable Child-Pugh A class (OPPOSITE — compensated)
Show answer and rationale
Answer: New ascites (paracentesis ± SBP workup)Variceal bleeding (UGIB from esophageal/gastric varices; emergency)Hepatic encephalopathy (West Haven grades I-IV; ammonia, asterixis, AMS)Jaundice (bilirubin elevation reflecting failing synthesis/clearance)Hepatorenal syndrome (HRS — rising Cr without other cause) or hepatopulmonary syndrome (HPS — hypoxemia with shunting)
Decompensation: new ascites + variceal bleed + HE + jaundice + HRS/HPS. Child-Pugh A is compensated.
Q3. The hepatology nurse reviews West Haven HE grading. Which features correspond CORRECTLY? Select all that apply.
- A. Grade I: Mild — trivial lack of awareness, euphoria/anxiety, shortened attention, slow mentation, sleep-wake reversal
- B. Grade II: Moderate — lethargy, mild confusion, disorientation to time, asterixis, inappropriate behavior
- C. Grade III: Severe — somnolence to semi-stupor, marked confusion, gross disorientation, persistent asterixis, response to stimulation
- D. Grade IV: Coma — unresponsive (decorticate / decerebrate posturing possible); airway protection needed
- E. Asterixis may be present grades I-III but disappears in coma (grade IV)
- F. Grade 0 means severe coma (OPPOSITE — grade 0 is minimal HE; grade IV is coma)
Show answer and rationale
Answer: Grade I: Mild — trivial lack of awareness, euphoria/anxiety, shortened attention, slow mentation, sleep-wake reversalGrade II: Moderate — lethargy, mild confusion, disorientation to time, asterixis, inappropriate behaviorGrade III: Severe — somnolence to semi-stupor, marked confusion, gross disorientation, persistent asterixis, response to stimulationGrade IV: Coma — unresponsive (decorticate / decerebrate posturing possible); airway protection neededAsterixis may be present grades I-III but disappears in coma (grade IV)
West Haven HE I-IV: mild → moderate → severe → coma. Asterixis I-III, disappears in IV. Grade 0 is minimal.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
UGIB = hematemesis + melena (source above Treitz; NSAIDs, varices, ulcer). LGIB = hematochezia (source below Treitz; diverticular, AVM, cancer). Both: 2 large-bore IVs + isotonic + type & cross + monitor + reverse anticoag if active bleed. UGIB → EGD + PPI; LGIB → colonoscopy. Resuscitate before scope.
Lipase ≥ 3x normal + epigastric pain → back. Causes: alcohol + gallstones. Cullen (periumbilical) + Grey Turner (flank) = severe necrotizing pancreatitis. Treatment: NPO + aggressive IV fluids 200-500 mL/hr first 12-24 h + IV opioids (any acceptable — old sphincter of Oddi theory outdated) + monitor (hypocalcemia, ARDS, AKI, sepsis). Resume diet only after pain resolves + lipase trending down.
Pre-procedure: empty bladder + sterile + lateral insertion (LLQ usually). Send fluid: cell count + diff (PMN > 250 = SBP), culture, albumin (SAAG), gram stain, total protein. Large volume (> 5 L) = albumin 6-8 g per L removed to prevent post-paracentesis circulatory dysfunction. Empiric ceftriaxone for suspected SBP. Mild coagulopathy does NOT routinely need transfusion pre-procedure.
Asterixis + confusion + elevated ammonia in cirrhosis. Treatment: lactulose titrated to 2-3 soft BMs per day (not fixed dose) + rifaximin secondary. IDENTIFY TRIGGER: GI bleed, infection (SBP, UTI, pneumonia), constipation, electrolytes (K + Mg), sedatives, TIPS. Maintain protein 1.0-1.5 g/kg — don't severely restrict (outdated). Diarrhea is goal, not side effect (titrate, don't stop).
SBO = bilious vomiting + crampy diffuse pain + early vomiting (usually adhesions). LBO = progressive distention + late feculent vomiting + obstipation (usually cancer). Both: NPO + IV fluids + NG decompression + correct electrolytes. Cecum > 12 cm = imminent perforation, urgent surgery. Watch for strangulation/ischemia (fever, leukocytosis, severe pain, peritonitis, lactate).
Crohn's = ANYWHERE mouth-to-anus, SKIP lesions, TRANSMURAL, fistulas, strictures. UC = CONTINUOUS, rectum start, COLON only, mucosal, bloody diarrhea + tenesmus. Treatment: 5-ASA (UC > Crohn's) + steroids for flare (taper) + biologics. Surgery curative for UC, NOT Crohn's. Watch toxic megacolon (UC) + fistula/abscess (Crohn's).
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many GI Disorders questions does the bank have?
77 multiple-choice items, plus 10 unfolding cases in the GI Disorders pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Recognize cues and Take action, though every step appears.
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