Rifaximin is given to a patient with hepatic encephalopathy because it:

Reduces ammonia-producing bacteria in the gut

Increases the excretion of bile pigments

Lowers the pressure in the portal vein

Binds and removes potassium in the stool

Why is erythropoietin injection given to patients with chronic kidney disease?

To correct anaemia caused by low renal erythropoietin

To raise the glomerular filtration rate

To prevent renal osteodystrophy

To lower the serum potassium level

On the first day after open cholecystectomy with exploration of the common bile duct, a patient's T-tube has drained 400 mL of bile in 24 hours. The nurse should:

Record it as expected and keep the bag below the wound

Clamp the tube to reduce the bile loss

Raise the drainage bag above the abdomen

Flush the tube with saline every hour

Gastrointestinal, endocrine and renal disorders

25 Kerala PSC Staff Nurse Gr II practice questions on Gastrointestinal, endocrine and renal 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 · Medium
Metformin is usually withheld around a scan with intravenous iodinated contrast because of the risk of:
1. ALactic acidosis
2. BContrast allergy
3. CSevere hypoglycaemia
4. DHyperkalaemia
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Answer: A · Lactic acidosis
Contrast can cause acute kidney injury, and metformin is cleared by the kidneys. If it builds up, it can cause lactic acidosis, which is rare but often fatal. Metformin is held at the time of the study in at-risk patients and restarted after about 48 hours once renal function is stable. Hydration before the scan also protects the kidneys.
- B: Metformin does not raise the risk of contrast allergy.
- C: Metformin alone rarely causes hypoglycaemia.
- D: Hyperkalaemia is not the reason metformin is held.
Question 2 · Medium
Rifaximin is given to a patient with hepatic encephalopathy because it:
1. AIncreases the excretion of bile pigments
2. BLowers the pressure in the portal vein
3. CReduces ammonia-producing bacteria in the gut
4. DBinds and removes potassium in the stool
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Answer: C · Reduces ammonia-producing bacteria in the gut
Rifaximin is a poorly absorbed antibiotic that acts within the bowel. By reducing the bacteria that make ammonia from dietary protein, it lowers blood ammonia and helps prevent recurrent encephalopathy. It is often used together with lactulose. The nurse also watches for precipitating causes such as GI bleeding, constipation, infection and sedatives.
- A: Rifaximin does not act on bile pigment excretion.
- B: Portal pressure is lowered by beta blockers such as propranolol.
- D: Potassium binding is done by resins, not rifaximin.
Question 3 · Medium
Why is erythropoietin injection given to patients with chronic kidney disease?
1. ATo correct anaemia caused by low renal erythropoietin
2. BTo raise the glomerular filtration rate
3. CTo prevent renal osteodystrophy
4. DTo lower the serum potassium level
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Answer: A · To correct anaemia caused by low renal erythropoietin
The kidneys make most of the body's erythropoietin, so CKD causes a normocytic anaemia that adds to fatigue and heart strain. Erythropoiesis-stimulating agents are given subcutaneously or IV. Iron stores must be adequate for them to work. Blood pressure is monitored, since hypertension is a known side effect.
- B: Erythropoietin does not improve kidney function.
- C: Renal bone disease is treated with phosphate binders and vitamin D.
- D: Erythropoietin has no effect on potassium removal.
Question 4 · Hard
On the first day after open cholecystectomy with exploration of the common bile duct, a patient's T-tube has drained 400 mL of bile in 24 hours. The nurse should:
1. AClamp the tube to reduce the bile loss
2. BRecord it as expected and keep the bag below the wound
3. CRaise the drainage bag above the abdomen
4. DFlush the tube with saline every hour
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Answer: B · Record it as expected and keep the bag below the wound
A T-tube drains bile while swelling in the common bile duct settles. About 300-500 mL in the first 24 hours is usual, and the amount falls as bile flows into the duodenum again. The nurse keeps the bag below the wound, avoids kinks, and records the volume and colour. Drainage above about 1,000 mL a day, a sudden stop with pain, or fever and jaundice is reported. The tube is clamped only on the surgeon's order.
- A: Clamping without an order raises duct pressure and can cause a bile leak or cholangitis.
- C: A raised bag lets bile run back into the duct and raises the infection risk.
- D: A T-tube is not irrigated unless the surgeon orders it.
Question 5 · Hard
A patient's blood urea is 150 mg/dL before haemodialysis and 50 mg/dL after. What is the urea reduction ratio (URR)?
1. A75%
2. B33%
3. C67%
4. D50%
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Answer: C · 67%
URR = (pre-urea - post-urea) / pre-urea x 100 = (150 - 50) / 150 x 100 = 66.7%, about 67%. A URR of 65% or more shows adequate dialysis. A value of 33% comes from dividing post-urea by pre-urea, which gives the fraction left, not the fraction removed. Samples must be drawn correctly, with the post sample taken soon after the session ends.
- A: 75% would need a post-urea of about 38 mg/dL.
- B: 33% is post/pre urea, the fraction remaining.
- D: 50% would need a post-urea of 75 mg/dL.
Question 6 · Easy
Pain in the right iliac fossa when the nurse presses on the left iliac fossa is called:
1. AMurphy sign
2. BCullen sign
3. CRovsing sign
4. DPsoas sign
Answer and explanation in LearnFree account
Question 7 · Easy
Kayser-Fleischer rings in the cornea are a sign of:
1. AHaemochromatosis
2. BAlcoholic cirrhosis
3. CWilson disease
4. DHepatitis B infection
Answer and explanation in LearnFree account
Question 8 · Medium
An elderly patient on glibenclamide is found sweaty and confused at night after skipping dinner. The likely cause is:
1. AHyperosmolar state from dehydration
2. BHypoglycaemia from the sulfonylurea
3. CKetoacidosis from insulin deficiency
4. DLactic acidosis from the biguanide
Answer and explanation in LearnFree account
Question 9 · Easy
Which insulin is used for an intravenous infusion in diabetic ketoacidosis?
1. ANPH (isophane) insulin
2. BPremixed 30/70 insulin
3. CInsulin glargine
4. DRegular (soluble) insulin
Answer and explanation in LearnFree account
Question 10 · Medium
To follow ascites accurately, the nurse measures the abdominal girth:
1. AAt the widest point found each time
2. BAt the same marked level each day
3. COnly when the patient feels breathless
4. DAfter a large meal each day
Answer and explanation in LearnFree account
Question 11 · Easy
Exophthalmos with a diffuse toxic goitre is typical of:
1. AGraves disease
2. BHashimoto thyroiditis
3. CToxic multinodular goitre
4. DIodine-deficiency goitre
Answer and explanation in LearnFree account
Question 12 · Medium
Which feature suggests hypoglycaemia rather than hyperglycaemia in a diabetic patient?
1. ADeep, rapid Kussmaul breathing
2. BCold, clammy skin with tremor
3. CDry, flushed skin and thirst
4. DFruity smell of the breath
Answer and explanation in LearnFree account
Question 13 · Hard
A diabetic patient on insulin is found unresponsive on the ward. Capillary glucose is 38 mg/dL and an IV cannula is in place. The nurse's first action is to:
1. ARepeat the glucose test after 15 minutes
2. BGive a sweet drink by mouth
3. CGive IV dextrose as ordered by protocol
4. DHold insulin and inform at the next round
Answer and explanation in LearnFree account
Question 14 · Easy
Fever with rigors, jaundice and right upper abdominal pain (Charcot triad) suggests:
1. APeptic ulcer perforation
2. BAcute cholangitis
3. CAcute appendicitis
4. DViral hepatitis A
Answer and explanation in LearnFree account
Question 15 · Medium
Acute post-streptococcal glomerulonephritis usually follows a streptococcal throat infection by about:
1. A3-6 months
2. B1-3 days
3. C1-2 years
4. D1-3 weeks
Answer and explanation in LearnFree account
Question 16 · Easy
A patient recovering from acute cholecystitis with gallstones is advised a diet low in:
1. AFibre
2. BFat
3. CCarbohydrate
4. DProtein
Answer and explanation in LearnFree account
Question 17 · Easy
Repeated insulin injections into the same spot can cause:
1. ALipohypertrophy
2. BKeloid formation
3. CHyperpigmentation
4. DMuscle atrophy
Answer and explanation in LearnFree account
Question 18 · Medium
Multiple, recurrent peptic ulcers with a very high serum gastrin level suggest:
1. AHelicobacter pylori gastritis
2. BDumping syndrome
3. CZollinger-Ellison syndrome
4. DStress ulcer of critical illness
Answer and explanation in LearnFree account
Question 19 · Easy
Desmopressin is used in central diabetes insipidus because it replaces:
1. ACortisol
2. BAntidiuretic hormone
3. CAldosterone
4. DAtrial natriuretic peptide
Answer and explanation in LearnFree account
Question 20 · Medium
A patient newly diagnosed with coeliac disease asks which food is safe. The nurse names:
1. ARye bread
2. BWheat chapati
3. CBarley soup
4. DRice
Answer and explanation in LearnFree account
Question 21 · Medium
Which finding marks nephrotic syndrome rather than acute nephritic syndrome?
1. ARed cell casts in the urine
2. BProteinuria more than 3.5 g per day
3. CCola-coloured urine
4. DRaised blood pressure
Answer and explanation in LearnFree account
Question 22 · Hard
A man with cirrhosis has 6 litres of ascitic fluid drained by paracentesis. To prevent circulatory collapse and kidney injury afterwards, he should receive:
1. AOral spironolactone
2. BFresh frozen plasma
3. CIntravenous 5% dextrose
4. DIntravenous albumin
Answer and explanation in LearnFree account
Question 23 · Easy
Haemodialysis removes urea and creatinine from blood mainly by:
1. ADiffusion across a semipermeable membrane
2. BActive transport by the dialyser
3. COsmosis of solutes into the blood
4. DFiltration through the glomerulus
Answer and explanation in LearnFree account
Question 24 · Easy
Hepatitis A is mainly transmitted by which route?
1. AFaeco-oral
2. BNeedle-stick injury
3. CSexual contact
4. DBlood transfusion
Answer and explanation in LearnFree account
Question 25 · Hard
A 45-year-old woman has fatigue, weight gain, cold intolerance and constipation. TSH is 18 mIU/L (0.4-4.0) and free T4 is low. The most likely diagnosis is:
1. ASubclinical hypothyroidism
2. BPrimary hypothyroidism
3. CSecondary (pituitary) hypothyroidism
4. DGraves disease
Answer and explanation in LearnFree account

Gastrointestinal, endocrine and renal disorders

Metformin is usually withheld around a scan with intravenous iodinated contrast because of the risk of:

Rifaximin is given to a patient with hepatic encephalopathy because it:

Why is erythropoietin injection given to patients with chronic kidney disease?

On the first day after open cholecystectomy with exploration of the common bile duct, a patient's T-tube has drained 400 mL of bile in 24 hours. The nurse should:

A patient's blood urea is 150 mg/dL before haemodialysis and 50 mg/dL after. What is the urea reduction ratio (URR)?

Pain in the right iliac fossa when the nurse presses on the left iliac fossa is called:

Kayser-Fleischer rings in the cornea are a sign of:

An elderly patient on glibenclamide is found sweaty and confused at night after skipping dinner. The likely cause is:

Which insulin is used for an intravenous infusion in diabetic ketoacidosis?

To follow ascites accurately, the nurse measures the abdominal girth:

Exophthalmos with a diffuse toxic goitre is typical of:

Which feature suggests hypoglycaemia rather than hyperglycaemia in a diabetic patient?

A diabetic patient on insulin is found unresponsive on the ward. Capillary glucose is 38 mg/dL and an IV cannula is in place. The nurse's first action is to:

Fever with rigors, jaundice and right upper abdominal pain (Charcot triad) suggests:

Acute post-streptococcal glomerulonephritis usually follows a streptococcal throat infection by about:

A patient recovering from acute cholecystitis with gallstones is advised a diet low in:

Repeated insulin injections into the same spot can cause:

Multiple, recurrent peptic ulcers with a very high serum gastrin level suggest:

Desmopressin is used in central diabetes insipidus because it replaces:

A patient newly diagnosed with coeliac disease asks which food is safe. The nurse names:

Which finding marks nephrotic syndrome rather than acute nephritic syndrome?

A man with cirrhosis has 6 litres of ascitic fluid drained by paracentesis. To prevent circulatory collapse and kidney injury afterwards, he should receive:

Haemodialysis removes urea and creatinine from blood mainly by:

Hepatitis A is mainly transmitted by which route?

A 45-year-old woman has fatigue, weight gain, cold intolerance and constipation. TSH is 18 mIU/L (0.4-4.0) and free T4 is low. The most likely diagnosis is: