Cancers
Which meal plan would be most appropriate to help reduce symptoms of dumping syndrome in a post-gastrectomy patient?
A. Pancakes with syrup, orange juice, and a banana
B. Chicken breast, eggs, and small portion of mashed potatoes
C. Bran cereal with skim milk and raisins
D. Spaghetti with marinara, garlic bread, and sweet tea
Answer: B. Chicken breast, eggs, and small portion of mashed potatoes
Rationale:
This is high protein, moderate fat, low carb — the dumping syndrome dream team. Meals should be small, low in sugar, and not high in fiber. Say “nope” to syrup, milk, and fruit bombs.
A patient who had a total gastrectomy is suddenly reporting epigastric pain, a sense of fullness, tachycardia, and hypotension. The NG tube has not drained recently. What’s the nurse’s best action?
A. Clamp the NG tube and monitor vitals
B. Increase the feeding rate
C. Elevate the HOB and notify the provider
D. Flush the tube with 60 mL of air
Answer: C. Elevate the HOB and notify the provider
Rationale:
The signs point to gastric dilation, a potential complication post-gastrectomy. Elevate to reduce aspiration risk and call the doc — they may order NG irrigation or replacement. Don’t play the "freelance plumber" role without an order!
Which combination of lab values is most consistent with decompensated cirrhosis?
A. Albumin 4.0, AST 20, INR 1.0
B. ALT 55, Ammonia 18, Hgb 14
C. Platelets 75, INR 2.1, Albumin 2.0
D. Bilirubin 0.6, PT 12, AST 22
Answer: C. Platelets 75, INR 2.1, Albumin 2.0
Rationale: Welcome to Liver Dysfunction Land:
Low platelets (spleen congestion),
High INR (clotting issues),
Low albumin (third spacing alert).
All signs point to a liver that’s over it.
A nurse is educating a patient recently exposed to hepatitis A. Which action is most appropriate to prevent the infection?
A. Begin antiviral therapy
B. Administer hepatitis A vaccine only
C. Administer hepatitis A immunoglobulin within 2 weeks
D. Monitor liver enzymes for the next 6 months
Answer: C. Administer hepatitis A immunoglobulin within 2 weeks
Rationale: Hep A post-exposure prevention = IG within 2 weeks to reduce risk. Vaccines are preventive, but not helpful after the fact. No antivirals for Hep A—it’s a hardy lil’ virus, but it doesn't require long-term meds.
A patient is post-op from a Whipple procedure. Which NG tube drainage should the nurse immediately report?
A. Serosanguinous drainage
B. Bile-tinged fluid
C. Clear and odorless output
D. Frank blood and sudden increase in volume
Answer: D. Frank blood and sudden increase in volume
Rationale: Whipple = high risk for anastomotic leakage. Bright red blood and ↑ output = 🚨 ALERT THE TEAM. The others are expected.
A patient is post-op day 4 following an esophagectomy. Which assessment finding requires immediate nursing intervention?
A. NG tube output is dark greenish-yellow
B. Patient reports difficulty swallowing oral liquids
C. Heart rate is 122 bpm and patient is restless
D. HOB is elevated to 30 degrees
Answer: C. Heart rate is 122 bpm and patient is restless
Rationale:
This may indicate shock from an anastomotic leak, which is a serious post-op complication. Tachycardia and changes in mental status (restlessness) are red flags! NG output and HOB position are appropriate, and difficulty swallowing may be expected early post-op.
Which of the following are risk factors for gastric cancer? Select all that apply.
A. Infection with Helicobacter pylori
B. Diet high in smoked, pickled, and salty foods
C. Use of proton pump inhibitors (PPIs)
D. Diet high in fresh fruits and vegetables
E. Chronic ingestion of nitrates
Answers: A, B, E
Rationale:
h. pylori = bacterial bad guy that brings a cytotoxin to the party.
Nitrates, salt, and pickled foods = carcinogenic cuisine.
PPIs actually protect the stomach lining, and fruits/veggies are your gastric superheroes.
Which statement by the student nurse about the TIPS procedure requires correction?
A. “It’s done to reduce portal hypertension.”
B. “It helps relieve ascites and esophageal varices.”
C. “It improves liver detoxification permanently.”
D. “It can increase the risk of encephalopathy.”
Answer: C. “It improves liver detoxification permanently.”
Rationale: TIPS shunts blood around the liver—not through it. So detoxification? Not happening. In fact, toxins like ammonia skip the liver and go straight to the brain. 😵
A patient with hepatitis B is being assessed. Which symptoms are expected? Select all that apply.
A. Arthralgia
B. Dark amber urine
C. Clay-colored stools
D. Severe RUQ pain radiating to back
E. Pruritus
F. Vomiting
Answers: A, B, C, E, F
Rationale:
Classic hepatitis symptoms include:
Arthralgia (joint pain),
Dark urine/clay stools (bilirubin backup),
Itching (bilirubin in the skin),
N/V.
RUQ pain radiating to back? That’s pancreatitis, not hepatitis.
Which enzyme stays elevated the longest during acute pancreatitis?
A. AST
B. Amylase
C. Lipase
D. Bilirubin
Answer: C. Lipase
Rationale: Lipase rises later than amylase but sticks around for up to 2 weeks. It’s your long-haul enzyme, ideal for late diagnosis confirmation.
Which action by the nurse requires correction when caring for a patient with a jejunostomy (J-tube) after an esophagectomy?
A. Flushing the tube with warm water before and after medication administration
B. Monitoring the site for signs of infection
C. Aspirating for residual before feedings
D. Elevating HOB during and after feedings
C. Aspirating for residual before feedings
Rationale:
DO NOT aspirate J-tubes! This can cause mucosal tearing. J-tubes go directly into the small intestine and are not used like gastric tubes. The other actions are appropriate for safe feeding and preventing aspiration.
A patient with early-stage gastric cancer is most likely to report:
A. Nausea and vomiting with bloody emesis
B. Anemia and enlarged lymph nodes
C. Epigastric discomfort not relieved by antacids
D. Constipation and decreased bowel sounds
Answer: C. Epigastric discomfort not relieved by antacids
Rationale:
Early symptoms are super sneaky and vague. Dyspepsia and mild abdominal discomfort often get brushed off until the cancer’s RSVP’d to other tissues. Anemia, lymphadenopathy, and nausea show up fashionably late.
Which of the following are late signs of cirrhosis? Select all that apply.
A. Palmar erythema
B. Petechiae
C. Jaundice
D. Fatigue
E. Weight gain
F. Ascites
Answers: A, B, C, F
Rationale:
A: Palmar erythema = estrogen imbalance
B: Petechiae = clotting issues
C: Jaundice = bilirubin overload
F: Ascites = portal HTN & albumin failure
Fatigue is early, and weight loss is more common (unless you’re counting ascitic fluid as gains 😅).
Which lab value is most indicative of acute pancreatitis?
A. Lipase 10 U/L
B. Amylase 360 U/L
C. AST 22 U/L
D. Albumin 4.0 g/dL
Answer: B. Amylase 360 U/L
Rationale: In acute pancreatitis, amylase goes through the roof fast. Normal is 60–100 U/L. Lipase would also be elevated (but 10 is low). AST and albumin are chillin’ for now.
Which of the following should the nurse include when teaching a client with chronic pancreatitis? Select all that apply.
A. "You may need to take enzyme supplements with meals."
B. "Limit your meals to one large meal daily."
C. "Eat a low-fat, high-carb diet."
D. "Alcohol must be avoided completely."
E. "H2 blockers and PPIs may help neutralize acid."
Answers: A, C, D, E
Rationale:
Pancrelipase = MVP.
Low-fat diet = less stress.
ETOH = pancreas enemy #1.
Acid reducers can help digestion.
One large meal? No way—go with small, frequent meals.
Which clinical manifestation is most commonly reported in a patient with esophageal cancer?
A. Halitosis
B. Dysphagia
C. Persistent hiccups
D. Nausea and vomiting
B. dysphagia
Dysphagia (trouble swallowing) is the #1 hallmark symptom. Unfortunately, esophageal cancer often doesn't scream until it's already moved in and redecorated (aka spread), but when it does, it starts with swallowing issues.
A patient with cirrhosis presents with confusion, hand flapping, and musty breath odor. Which lab value is most concerning?
A. AST 98 U/L
B. Ammonia 94 mcg/dL
C. Albumin 2.5 g/dL
D. INR 1.9
Answer: B. Ammonia 94 mcg/dL
Rationale: Elevated ammonia is the culprit behind hepatic encephalopathy—a must-know complication of liver failure. That hand-flappy asterixis is your big “uh-oh” sign! AST, albumin, and INR are expected to be abnormal, but ammonia is your priority 🚨.
The nurse is explaining the liver’s normal functions to a student. Which statement by the student indicates a need for further teaching?
A. “The liver detoxifies harmful substances like alcohol and medications.”
B. “The liver stores vitamins and minerals, including iron and fat-soluble vitamins.”
C. “The liver breaks down ammonia into uric acid for kidney excretion.”
D. “The liver produces albumin and clotting factors to maintain fluid balance and coagulation.”
Answer: C. “The liver breaks down ammonia into uric acid for kidney excretion.”
Rationale:
Nice try, but the liver converts ammonia into urea, not uric acid (which is related to purine metabolism and gout). The other statements are on point!
Which symptom is most concerning in a patient with chronic pancreatitis?
A. Steatorrhea
B. Flatulence
C. New-onset jaundice
D. Constipation
Answer: C. New-onset jaundice
Rationale: While steatorrhea and bloating are classic chronic signs, jaundice could signal biliary obstruction or pancreatic cancer. It’s the symptom waving a red flag.
A patient newly diagnosed with hepatitis C asks the nurse how it’s spread. Which response is most accurate?
A. “You can get hepatitis C by sharing food or drinks with an infected person.”
B. “The virus is spread primarily through contaminated water.”
C. “It is usually spread through blood-to-blood contact, such as sharing needles.”
D. “It is airborne and spread by droplets, especially during coughing.”
C. “It is usually spread through blood-to-blood contact, such as sharing needles.”
Rationale:
Hep C = blood buddy virus. IV drug use is the biggest risk. It’s not spread through food, casual contact, or the air. Think “needles, not noodles.” 🍜💉
Which of the following are risk factors for developing esophageal cancer? Select all that apply.
A. Chronic GERD
B. Smoking
C. High-fiber diet
D. Alcohol consumption
E. Barrett’s esophagus
F. Excessive use of throat lozenges
Answers: A, B, D, E
Rationale:
Chronic GERD causes inflammation → Barrett’s esophagus → increases cancer risk. Smoking and alcohol are classic carcinogen culprits. Throat lozenges and fiber are not implicated here (unless you're swallowing bricks or licorice-flavored lava).
Which dietary order would be most appropriate for a patient with advanced cirrhosis and stage 2 hepatic encephalopathy?
A. High-protein, high-carb, low-sodium
B. Low-protein, low-carb, high-fat
C. Low-protein, moderate-carb, low-fat
D. High-protein, high-fat, high-carb
Answer: C. Low-protein, moderate-carb, low-fat
Rationale: Protein → ammonia → brain fog. So we scale back protein in hepatic encephalopathy. The carbs and fats help provide energy without that toxic nitrogen load.
Which assessment finding in a patient with cirrhosis requires immediate nursing intervention?
A. Spider angiomas on the upper chest
B. Palmar erythema
C. Coffee-ground emesis
D. Ascites with shortness of breath
Answer: C. Coffee-ground emesis
Rationale:
This could indicate GI bleeding, possibly from ruptured esophageal varices—a medical emergency! The others are expected findings in cirrhosis but not immediately life-threatening.
The nurse is educating a patient with hepatitis about dietary needs. Which statement shows correct understanding?
A. "I should eat a high-protein, low-carb diet."
B. "I should rest after meals to help digestion."
C. "I’ll eat high-calorie meals with moderate protein and fat."
D. "I should avoid all vitamins to reduce liver strain."
C. "I’ll eat high-calorie meals with moderate protein and fat."
Rationale: Nutritional support helps the liver recover. High carbs and calories are key, with moderate protein and fat to prevent ammonia buildup and overload.
The nurse is assessing a patient with acute pancreatitis and notices bluish discoloration on the left flank. What is the priority action?
A. Elevate the legs and apply warm compresses
B. Document the finding and reassess in 2 hours
C. Notify the healthcare provider immediately
D. Administer potassium supplements as ordered
C. Notify the healthcare provider immediately
Rationale:
Turner’s sign = internal bleeding from pancreatic necrosis—yep, a code brown situation. This is not a “let’s wait” kind of bruise. Emergency now, color commentary later.