NLE Gastrointestinal Nursing Reviewer 2026

Answer: A. Hepatitis A and Hepatitis E

Step 1: Recall the transmission routes of viral hepatitis. Step 2: Hepatitis A (HAV) and Hepatitis E (HEV) are both transmitted via the fecal-oral route — through contaminated food and water. Step 3: A helpful memory aid is 'A and E come from the Enter end' (fecal-oral/enteric transmission). Step 4: Hepatitis B and C are transmitted through blood and body fluids, not the fecal-oral route. Step 5: Hepatitis D also requires blood/body fluid transmission and can only infect those already infected with HBV. In the Philippine context, poor sanitation and contaminated water sources make HAV and HEV important public health concerns.

Answer: A. Hepatitis B vaccine and Hepatitis B Immunoglobulin (HBIG)

Step 1: Hepatitis B is highly endemic in the Philippines, making perinatal (mother-to-child) transmission a critical concern. Step 2: An HBsAg-positive mother can transmit HBV to her newborn during delivery through exposure to maternal blood and body fluids. Step 3: The standard of care requires BOTH the Hepatitis B vaccine AND HBIG to be administered within 12 hours of birth. Step 4: HBIG provides immediate passive immunity (ready-made antibodies), while the vaccine stimulates the baby's own active immune response. Step 5: Giving only the vaccine without HBIG, or delaying intervention, significantly increases the risk of the newborn developing chronic HBV infection. This is a HIGH-YIELD NLE point given the Philippine HBV endemic context.

Answer: A. 2 to 3 soft stools per day

Step 1: Lactulose is given to patients with hepatic encephalopathy to reduce blood ammonia levels. Step 2: It works by acidifying the colon, converting ammonia (NH3) into ammonium (NH4+), which is trapped in the gut and excreted in the stool. Step 3: The therapeutic goal is 2–3 SOFT stools per day — enough to clear nitrogenous waste without causing diarrhea. Step 4: Too few stools (less than 2/day) means the drug is not effectively clearing ammonia. Step 5: Too many watery stools (more than 3–4/day) indicates over-treatment, which leads to dehydration and hypokalemia — both of which can WORSEN hepatic encephalopathy. The goal is 'soft and regular,' not diarrhea.

Answer: A. Cullen's sign

Step 1: In severe (hemorrhagic) pancreatitis, blood tracks along fascial planes and discolors the skin. Step 2: CULLEN'S SIGN = periumbilical (around the navel/umbilicus) bruising. Think: 'C' for Cullen = Center of the abdomen. Step 3: GREY TURNER'S SIGN = flank (side of the abdomen) bruising — also indicates hemorrhagic pancreatitis. Step 4: Murphy's sign is an inspiratory arrest with RUQ palpation — it is associated with CHOLECYSTITIS, not pancreatitis. Step 5: Chvostek's sign (facial twitching when tapping the cheek) indicates hypocalcemia, which is a COMPLICATION of pancreatitis but is not the answer here. Both Cullen's and Grey Turner's signs are high-yield NLE items.

Answer: A. Avoid high-fat foods and eat small, frequent meals

Step 1: Cholecystitis is inflammation of the gallbladder, usually triggered by a gallstone blocking the cystic duct. Step 2: Fatty foods stimulate the gallbladder to contract (via cholecystokinin release), which increases pain and inflammation when a stone is present. Step 3: A LOW-FAT diet reduces gallbladder stimulation and decreases pain episodes. Step 4: Small, frequent meals are better tolerated than large meals because they produce a milder gallbladder response. Step 5: Increasing protein or fat, or eating large meals, would aggravate symptoms. Post-cholecystectomy, patients are also advised to follow a low-fat diet initially and gradually reintroduce fats as tolerated.

Answer: A. Hepatitis B virus (HBV)

Step 1: Hepatitis D virus (HDV) is a defective virus — it CANNOT replicate on its own. Step 2: HDV requires the presence of Hepatitis B virus (HBV) to survive and replicate, because it uses HBV's surface antigen (HBsAg) as its outer coat. Step 3: This means HDV infection can only occur as a co-infection (simultaneous HBV + HDV) or super-infection (HDV in a chronic HBV carrier). Step 4: A critical nursing implication: preventing HBV infection (through vaccination) ALSO prevents HDV infection. Step 5: HAV, HCV, and HEV have no relationship with HDV's replication. This is a frequently tested NLE fact.

Answer: A. Asterixis (flapping tremor of the hands)

Step 1: Hepatic encephalopathy occurs when the failing liver cannot detoxify ammonia and other toxins, which then accumulate and affect the brain. Step 2: The hallmark neurological sign is ASTERIXIS — also called a 'flapping tremor.' It is assessed by asking the patient to extend the arms and dorsiflex the wrists; a flapping, non-rhythmic tremor indicates asterixis. Step 3: Asterixis reflects the toxic effect of ammonia on the nervous system. Step 4: Positive Babinski, nuchal rigidity, and Kernig's sign are signs of upper motor neuron lesions or meningeal irritation — they are NOT specific to hepatic encephalopathy. Step 5: Other features of hepatic encephalopathy include confusion, altered sleep-wake cycle, fetor hepaticus (musty breath), and eventually coma.

Answer: A. To allow the pancreas to rest by stopping secretion of digestive enzymes

Step 1: Acute pancreatitis is caused by autodigestion — the pancreas is being damaged by its own prematurely activated enzymes (amylase, lipase, etc.). Step 2: Any oral intake (food, even liquids) stimulates the pancreas to secrete MORE digestive enzymes, worsening autodigestion and inflammation. Step 3: Placing the patient on NPO (nil per os / nothing by mouth) provides PANCREATIC REST — it stops the stimulus for enzyme secretion, allowing inflammation to subside. Step 4: While aspiration prevention is also a concern (especially if there is vomiting), it is NOT the PRIMARY reason for NPO in pancreatitis. Step 5: Portal hypertension is related to cirrhosis/liver disease, not pancreatitis. NPO + aggressive IV fluid resuscitation + pain control form the cornerstone of acute pancreatitis management.

Answer: A. Octreotide (somatostatin analog)

Step 1: Esophageal variceal rupture is a life-threatening emergency characterized by massive hematemesis and rapid hemodynamic instability. Step 2: OCTREOTIDE is a somatostatin analog given as an IV infusion during acute variceal bleeding. Step 3: Octreotide works by reducing SPLANCHNIC (gut) blood flow and portal pressure, which slows or stops the bleeding from varices. Step 4: Lactulose and rifaximin are used for hepatic encephalopathy (ammonia reduction) — not acute bleeding. Spironolactone is a diuretic used for ASCITES management. Step 5: After octreotide, endoscopic band ligation is the definitive treatment. ABCs (airway protection, fluid resuscitation, blood products) are always the first priority before any medication.

Answer: A. Decreased albumin, elevated bilirubin, prolonged PT/INR, elevated ammonia

Step 1: Cirrhosis involves irreversible fibrosis that destroys functional liver (hepatocyte) tissue. Step 2: The liver normally synthesizes albumin and clotting factors; when it fails, albumin DECREASES and PT/INR PROLONGS (takes longer to clot = increased bleeding risk). Step 3: The damaged liver cannot conjugate and excrete bilirubin properly, so bilirubin RISES → jaundice. Step 4: The liver cannot detoxify ammonia (produced from protein breakdown in the gut), so ammonia levels RISE → risk of hepatic encephalopathy. Step 5: All other options show normal or improved values that would NOT be consistent with liver failure. These lab trends — low albumin, high bilirubin, prolonged PT/INR, high ammonia — are essential NLE knowledge for cirrhosis.

Answer: A. BMI = 27.3 kg/m² – classified as obese by Asian cut-offs

Step 1: Use the formula BMI = weight (kg) ÷ height (m²). Step 2: Calculate height squared: 1.60 × 1.60 = 2.56 m². Step 3: Divide weight by height squared: 70 ÷ 2.56 = 27.34 kg/m², approximately 27.3 kg/m². Step 4: Apply Asian cut-offs: overweight ≥23 kg/m², obese ≥27.5 kg/m². At 27.3, this patient is just below the Asian obesity cut-off of 27.5 — making the closest correct classification 'obese by Asian cut-offs' at 27.3 is borderline; however, the standard WHO classification calls ≥30 obese, while Asian guidelines classify ≥27.5 as obese. At 27.3, the patient is overweight by Asian cut-offs (≥23) but not yet obese (≥27.5). Step 5: Re-evaluate: The correct classification is overweight by Asian cut-offs (BMI 23–27.4). Option A states 'obese' which is slightly above 27.3 — reviewing all options, Option D correctly states overweight by Asian cut-offs. NOTE: The correct answer is Option D — BMI 27.3 is overweight (≥23) but not yet obese (≥27.5) by Asian standards. This tests your ability to apply Asian-specific BMI cut-offs relevant to Filipino patients.

Answer: B. Prealbumin (transthyretin)

Step 1: Understand why the half-life of a protein matters. A shorter half-life means the protein level changes faster in response to nutritional intake. Step 2: Prealbumin (also called transthyretin) has a half-life of approximately 2 days — it rises and falls quickly with changes in dietary intake, making it highly sensitive to recent nutritional changes. Step 3: Serum albumin has a half-life of approximately 3 weeks — it reflects long-term nutritional status and is a poor indicator of recent changes. Step 4: Hemoglobin reflects iron and other factors, not directly nutritional protein status in the short term. Total cholesterol is not a marker of protein nutritional status. Step 5: For NLE purposes, remember: Prealbumin = recent/short-term nutrition; Albumin = long-term nutrition status.