In hepatic encephalopathy, lactulose is given mainly to:

Reduce absorption of ammonia from the colon

Neutralise gastric acid and protect the mucosa

Increase the synthesis of albumin in the liver

A man with alcoholic cirrhosis is admitted after a variceal bleed and is restless at night. Which order should the nurse question before giving it?

Diazepam 10 mg at night for sleep

Lactulose 30 mL three times daily

Gastrointestinal and hepatobiliary disorders

26 AIIMS NORCET (Nursing Officer) practice questions on Gastrointestinal and hepatobiliary disorders, part of Medical-Surgical Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
Three days after an ileostomy, a patient's stoma output is 2,000 mL a day of watery effluent. He feels dizzy on standing and his urine output has fallen. The nurse's priority concern is:
1. APeristomal skin infection
2. BStoma retraction
3. CFluid and sodium depletion
4. DParalytic ileus
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Answer: C · Fluid and sodium depletion
Ileostomy effluent is liquid and rich in sodium and water because the colon, which normally absorbs them, is bypassed. An output above about 1.5 litres a day is high and quickly causes dehydration, low sodium, low magnesium and acute kidney injury, shown here by postural dizziness and falling urine output. The priority is fluid and electrolyte replacement with strict intake and output and daily weights. Oral rehydration solution is preferred to plain water, which increases sodium loss.
- A: Skin irritation is a common problem but is not the cause of these systemic signs.
- B: Retraction changes the stoma level; it does not cause dizziness and oliguria.
- D: Ileus would reduce, not increase, stoma output.
Question 2 · Easy
When teaching a patient to irrigate a descending colostomy, the nurse advises hanging the irrigation bag about:
1. A100-120 cm above the stoma
2. B10-15 cm above the stoma
3. CLevel with the stoma
4. D45-50 cm above the stoma
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Answer: D · 45-50 cm above the stoma
The irrigation container is hung about 45-50 cm (18-20 inches) above the stoma, roughly at shoulder height when seated. This gives a gentle flow of 500-1,000 mL of lukewarm water through a cone tip over 5-10 minutes. A bag hung too high gives a fast, forceful flow with cramping and a risk of bowel perforation, while one hung too low barely flows. Irrigation is suitable only for descending or sigmoid colostomies with formed stool.
- A: At 100-120 cm the flow is too forceful and causes cramps and risk of injury.
- B: At 10-15 cm the pressure is too low for the water to flow well.
- C: At stoma level there is no pressure to drive the water in.
Question 3 · Medium
A patient with bleeding oesophageal varices has a Sengstaken-Blakemore tube in place. Which item must be kept at the bedside?
1. AA pair of scissors
2. BA urinary catheter
3. CA tracheostomy tube
4. DAn oral airway
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Answer: A · A pair of scissors
If the gastric balloon deflates or ruptures, the oesophageal balloon can slip upward into the pharynx and block the airway. Scissors are kept at the bedside so the tube can be cut across, deflating all balloons at once, and pulled out. Balloon pressures, traction and tube markings are checked regularly and the patient's airway is watched closely. The oesophageal balloon is deflated at intervals to prevent mucosal necrosis.
- B: A urinary catheter is not related to this airway emergency.
- C: A tracheostomy tube does not remove the balloon causing the obstruction.
- D: An oral airway cannot pass a balloon blocking the pharynx.
Question 4 · Easy
In hepatic encephalopathy, lactulose is given mainly to:
1. ANeutralise gastric acid and protect the mucosa
2. BRaise the blood glucose level
3. CReduce absorption of ammonia from the colon
4. DIncrease the synthesis of albumin in the liver
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Answer: C · Reduce absorption of ammonia from the colon
Lactulose is broken down by colonic bacteria into acids that lower the colonic pH. In acid conditions ammonia is converted to ammonium ions, which are not absorbed and are passed in the stool. Its laxative effect also shortens transit time and removes nitrogen. The dose is adjusted to give two or three soft stools a day.
- A: Antacids and sucralfate protect the gastric mucosa, not lactulose.
- B: Lactulose is not absorbed and has no glucose-raising role.
- D: Lactulose acts in the gut; it does not affect albumin synthesis.
Question 5 · Hard
A man with alcoholic cirrhosis is admitted after a variceal bleed and is restless at night. Which order should the nurse question before giving it?
1. ARifaximin 550 mg twice daily
2. BVitamin K 10 mg IV daily
3. CDiazepam 10 mg at night for sleep
4. DLactulose 30 mL three times daily
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Answer: C · Diazepam 10 mg at night for sleep
A GI bleed delivers a large protein load to the gut, so ammonia rises and hepatic encephalopathy often follows. Restlessness at night may be an early sign. Benzodiazepines such as diazepam are cleared by the liver, accumulate in cirrhosis and can precipitate or deepen encephalopathy and coma, so the order is queried. Lactulose and rifaximin treat and prevent encephalopathy, and vitamin K is used for a prolonged prothrombin time.
- A: Rifaximin reduces ammonia-producing gut bacteria and is appropriate.
- B: Vitamin K is reasonable when cirrhosis prolongs the prothrombin time.
- D: Lactulose lowers ammonia and is appropriate after a variceal bleed.
Question 6 · Hard
On day 3 of severe acute pancreatitis, a patient complains of tingling around the mouth and has carpal spasm when the BP cuff is inflated. The likely cause is:
1. AHypoglycaemia
2. BHypokalaemia
3. CHypocalcaemia
4. DHypernatraemia
Answer and explanation in LearnFree account
Question 7 · Easy
A healthy new colostomy stoma should look:
1. AMoist and pink to beefy red
2. BPale and dull grey
3. CDark purple or bluish
4. DBlack and dry
Answer and explanation in LearnFree account
Question 8 · Easy
A flapping tremor of the outstretched, dorsiflexed hands (asterixis) in a patient with cirrhosis indicates:
1. AHepatic encephalopathy
2. BParkinson disease
3. CHypoglycaemia
4. DDelirium tremens
Answer and explanation in LearnFree account
Question 9 · Medium
A patient's TPN bag runs out and the pharmacy cannot send the next bag for two hours. The nurse should hang:
1. ARinger's lactate at a slow keep-open rate
2. B0.9% sodium chloride at the TPN rate
3. CNothing, and flush the central line with heparin
4. D10% dextrose at the TPN rate
Answer and explanation in LearnFree account
Question 10 · Medium
A man with a known duodenal ulcer vomits a large amount of bright red blood. His pulse is 124/min and BP 86/54 mmHg. What is the nurse's first action?
1. APass a nasogastric tube and lavage with iced saline
2. BInsert two large-bore IV cannulas and start fluids
3. CGive an oral antacid and observe for more vomiting
4. DSend the patient for endoscopy before giving fluid
Answer and explanation in LearnFree account
Question 11 · Easy
Bluish discolouration of the flanks in severe acute pancreatitis is known as:
1. AGrey Turner sign
2. BCullen sign
3. CMurphy sign
4. DRovsing sign
Answer and explanation in LearnFree account
Question 12 · Medium
Before an abdominal paracentesis for ascites, the nurse asks the patient to:
1. ALie flat on the left side
2. BEmpty the bladder
3. CFast for 12 hours
4. DDrink 500 mL of water
Answer and explanation in LearnFree account
Question 13 · Medium
A patient describes burning epigastric pain that wakes him at about 2 am and is eased by eating. This pattern most suggests:
1. AAcute pancreatitis
2. BDuodenal ulcer
3. CGastric ulcer
4. DAcute cholecystitis
Answer and explanation in LearnFree account
Question 14 · Easy
McBurney point, where tenderness is typical in acute appendicitis, lies:
1. AAt the right costal margin in the mid-clavicular line
2. BMidway between the umbilicus and the xiphisternum
3. COne-third of the way from the right ASIS to the umbilicus
4. DJust above the left inguinal ligament
Answer and explanation in LearnFree account
Question 15 · Medium
A nursing student had three doses of hepatitis B vaccine. Which result shows immunity from the vaccine alone?
1. AAnti-HBs positive, anti-HBc positive, HBsAg negative
2. BAnti-HBs negative, anti-HBc positive, HBsAg positive
3. CAnti-HBs negative, anti-HBc negative, HBsAg negative
4. DAnti-HBs positive, anti-HBc negative, HBsAg negative
Answer and explanation in LearnFree account
Question 16 · Hard
Three hours after a percutaneous liver biopsy, a patient becomes pale and sweaty. Pulse has risen from 84 to 118/min and BP has fallen from 124/80 to 94/58 mmHg. Breath sounds are equal on both sides, he has no breathlessness, and the abdomen is soft without rigidity. The most likely complication is:
1. AA vasovagal reaction to the procedure
2. BBleeding from the liver puncture site
3. CPneumothorax from the biopsy needle
4. DBile peritonitis from a punctured bile duct
Answer and explanation in LearnFree account
Question 17 · Hard
A 45-year-old with a history of peptic ulcer suddenly develops severe epigastric pain spreading over the abdomen and to the right shoulder. The abdomen is board-like and bowel sounds are absent. The most likely complication is:
1. AUpper GI haemorrhage
2. BPyloric obstruction
3. CPerforation
4. DAcute gastritis
Answer and explanation in LearnFree account
Question 18 · Medium
Which regimen is standard triple therapy to eradicate Helicobacter pylori?
1. AA proton pump inhibitor with clarithromycin and amoxicillin
2. BAn H2 blocker with an antacid and sucralfate
3. CA proton pump inhibitor with ranitidine and misoprostol
4. DSucralfate with an antacid and metoclopramide
Answer and explanation in LearnFree account
Question 19 · Hard
A 20-year-old is admitted with suspected acute appendicitis: right iliac fossa pain, temperature 38.2 °C, WBC 14,500/µL. Which order should the nurse question?
1. AKeep the patient nil by mouth
2. BGive a soap-water enema to clear the bowel
3. CStart IV Ringer's lactate
4. DRecord temperature and pulse every 4 hours
Answer and explanation in LearnFree account
Question 20 · Easy
A patient stops breathing in sharply when the nurse presses below the right costal margin during deep inspiration. This positive Murphy sign suggests:
1. AAcute pancreatitis
2. BAcute appendicitis
3. CAcute cholecystitis
4. DPerforated duodenal ulcer
Answer and explanation in LearnFree account
Question 21 · Hard
A woman has jaundice, itching, dark urine and clay-coloured stools. Results: conjugated bilirubin raised, ALP markedly raised, ultrasound shows a common bile duct stone, INR 1.8 (normal about 1.0). Before ERCP, the nurse expects which order?
1. AIV potassium chloride
2. BVitamin K injection
3. COral iron supplement
4. DSubcutaneous heparin
Answer and explanation in LearnFree account
Question 22 · Easy
Which method most reliably confirms the position of a newly inserted fine-bore nasogastric feeding tube before the first feed?
1. AWhoosh test with a stethoscope
2. BChecking that the patient can speak
3. CChest X-ray
4. DBubbling when the end is put in water
Answer and explanation in LearnFree account
Question 23 · Medium
Which position is most likely to ease the pain of a patient with acute pancreatitis?
1. AProne with a pillow under the abdomen
2. BLying flat on the back with legs straight
3. CSitting up and leaning forward with knees flexed
4. DTrendelenburg with the legs raised
Answer and explanation in LearnFree account
Question 24 · Medium
After a partial gastrectomy, a patient feels faint, sweaty and has diarrhoea 15 minutes after meals. Which advice helps most?
1. AWalk briskly for 30 minutes after each meal
2. BAvoid drinking fluids with meals and lie down after eating
3. CTake large meals rich in simple sugars
4. DDrink a large glass of water with each meal
Answer and explanation in LearnFree account
Question 25 · Medium
Which drug is given long term to lower portal pressure and prevent a first bleed from oesophageal varices?
1. AOctreotide
2. BVitamin K
3. CPropranolol
4. DAtenolol
Answer and explanation in LearnFree account

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Gastrointestinal and hepatobiliary disorders

Three days after an ileostomy, a patient's stoma output is 2,000 mL a day of watery effluent. He feels dizzy on standing and his urine output has fallen. The nurse's priority concern is:

When teaching a patient to irrigate a descending colostomy, the nurse advises hanging the irrigation bag about:

A patient with bleeding oesophageal varices has a Sengstaken-Blakemore tube in place. Which item must be kept at the bedside?

In hepatic encephalopathy, lactulose is given mainly to:

A man with alcoholic cirrhosis is admitted after a variceal bleed and is restless at night. Which order should the nurse question before giving it?

On day 3 of severe acute pancreatitis, a patient complains of tingling around the mouth and has carpal spasm when the BP cuff is inflated. The likely cause is:

A healthy new colostomy stoma should look:

A flapping tremor of the outstretched, dorsiflexed hands (asterixis) in a patient with cirrhosis indicates:

A patient's TPN bag runs out and the pharmacy cannot send the next bag for two hours. The nurse should hang:

A man with a known duodenal ulcer vomits a large amount of bright red blood. His pulse is 124/min and BP 86/54 mmHg. What is the nurse's first action?

Bluish discolouration of the flanks in severe acute pancreatitis is known as:

Before an abdominal paracentesis for ascites, the nurse asks the patient to:

A patient describes burning epigastric pain that wakes him at about 2 am and is eased by eating. This pattern most suggests:

McBurney point, where tenderness is typical in acute appendicitis, lies:

A nursing student had three doses of hepatitis B vaccine. Which result shows immunity from the vaccine alone?

A 45-year-old with a history of peptic ulcer suddenly develops severe epigastric pain spreading over the abdomen and to the right shoulder. The abdomen is board-like and bowel sounds are absent. The most likely complication is:

Which regimen is standard triple therapy to eradicate Helicobacter pylori?

A 20-year-old is admitted with suspected acute appendicitis: right iliac fossa pain, temperature 38.2 °C, WBC 14,500/µL. Which order should the nurse question?

A patient stops breathing in sharply when the nurse presses below the right costal margin during deep inspiration. This positive Murphy sign suggests:

A woman has jaundice, itching, dark urine and clay-coloured stools. Results: conjugated bilirubin raised, ALP markedly raised, ultrasound shows a common bile duct stone, INR 1.8 (normal about 1.0). Before ERCP, the nurse expects which order?

Which method most reliably confirms the position of a newly inserted fine-bore nasogastric feeding tube before the first feed?

Which position is most likely to ease the pain of a patient with acute pancreatitis?

After a partial gastrectomy, a patient feels faint, sweaty and has diarrhoea 15 minutes after meals. Which advice helps most?

Which drug is given long term to lower portal pressure and prevent a first bleed from oesophageal varices?