RNSG 2539 EXAM 2 (2026) ACTUAL EXAM COMPREHENSIVE QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALES (DETAILED & ELABORATED) 2026 TEST!!
Question 1
A nurse is assessing a client admitted with suspected acute pancreatitis. Which clinical
manifestations would support this diagnosis?
A) Brisk capillary refill and hypertension
B) Severe epigastric pain and nausea
C) Right lower quadrant pain and diarrhea
D) Bradycardia and increased appetite
E) Left lower quadrant pain and constipation
Correct Answer: B) Severe epigastric pain and nausea
Rationale: Acute pancreatitis typically presents with sudden, severe epigastric pain that
often radiates to the back, accompanied by nausea and vomiting due to the inflammatory
process and autodigestion of the pancreas.
Question 2
A client is admitted to the hospital to rule out acute pancreatitis. Which item found in the client’s
medical history represents the most common modifiable risk factor for this condition?
A) History of systemic lupus erythematosus
B) Chronic alcoholism
C) Diagnosis of cystic fibrosis
D) Genetic predisposition to hypertriglyceridemia
E) History of appendectomy
Correct Answer: B) Chronic alcoholism
Rationale: Alcoholism and gallstones are the two primary causes of acute pancreatitis.
Alcohol induces changes in pancreatic secretions and causes premature activation of
enzymes within the pancreas.
Question 3
A nurse is preparing discharge teaching for a client with chronic pancreatitis. Which instruction
is essential to include regarding the administration of pancrelipase?
A) Take the medication only if abdominal pain occurs.
B) Take the medication with every meal and snack.
C) Administer the medication two hours after eating.
D) Dissolve the capsule in hot tea before drinking.
E) Take the medication only before bed.
Correct Answer: B) Take the medication with every meal and snack.
Rationale: Pancrelipase is a pancreatic enzyme replacement. It must be taken with all food
intake to mimic the natural release of enzymes and facilitate the digestion of fats, proteins,
and carbohydrates.
, 2
Question 4
When planning care for a client with acute pancreatitis, which nursing diagnosis should be the
highest priority during the first 24 hours?
A) Risk for Social Isolation
B) Deficient Fluid Volume
C) Readfastness for Enhanced Knowledge
D) Disturbed Body Image
E) Impaired Urinary Elimination
Correct Answer: B) Deficient Fluid Volume
Rationale: Clients with acute pancreatitis are at high risk for fluid volume deficit due to
third-spacing of fluids, vomiting, and nasogastric suctioning. Maintaining hemodynamic
stability is a priority.
Question 5
An older adult client with acute pancreatitis is prescribed a nasogastric (NG) tube to low
intermittent suction. What is the primary rationale for this intervention?
A) To provide a route for enteral nutrition
B) To decompress the stomach and reduce pancreatic stimulation
C) To administer oral medications more effectively
D) To prevent the development of a hiatus hernia
E) To monitor the pH of the gastric contents every hour
Correct Answer: B) To decompress the stomach and reduce pancreatic stimulation
Rationale: NG suctioning removes gastric secretions, preventing them from entering the
duodenum. This reduces the release of secretin, thereby "resting" the pancreas and
decreasing the production of pancreatic enzymes.
Question 6
A client with chronic pancreatitis is at risk for edema. Which of the following prescribed
treatments should the nurse monitor most closely as a contributing factor to fluid retention?
A) Pancrelipase administration
B) IV fluid administration
C) Nasogastric tube insertion
D) Total parenteral nutrition (TPN)
E) Opioid analgesics
Correct Answer: B) IV fluid administration
Rationale: Aggressive IV fluid resuscitation is necessary in pancreatitis, but in chronic cases
or in older adults, it can lead to fluid overload and edema if not monitored closely for
cardiovascular and renal tolerance.
Question 7
What is the underlying pathophysiology most characteristic of acute pancreatitis?
, 3
A) The pancreas ceases to produce any insulin.
B) The pancreas becomes distended with air.
C) The pancreas produces enzymes that attack its own tissue.
D) The pancreas develops a bacterial infection from the bloodstream.
E) The pancreas shrinks due to lack of blood flow.
Correct Answer: C) The pancreas produces enzymes that attack its own tissue.
Rationale: Acute pancreatitis is characterized by autodigestion, where pancreatic enzymes
(like trypsin) are activated prematurely inside the pancreas instead of the duodenum,
leading to tissue necrosis and inflammation.
Question 8
A pregnant client at 28 weeks gestation presents with epigastric pain and jaundice. Which
diagnostic test is the safest and most appropriate to determine the presence of gallstones?
A) Contrast-enhanced CT scan
B) Endoscopic retrograde cholangiopancreatography (ERCP)
C) Ultrasonography
D) Percutaneous fine-needle aspiration biopsy
E) Abdominal X-ray
Correct Answer: C) Ultrasonography
Rationale: Ultrasonography is non-invasive, does not involve ionizing radiation, and is
highly sensitive for detecting gallstones (cholelithiasis), making it the preferred initial test
for pregnant clients.
Question 9
During a health interview, the nurse asks a client with suspected pancreatitis about gallstones.
Why is this an important etiologic factor?
A) Gallstones cause the pancreas to produce too much insulin.
B) Gallstones can block the pancreatic duct, triggering enzyme activation.
C) Gallstones lead to a vitamin C deficiency.
D) Gallstones are the only cause of pancreatic cancer.
E) Gallstones prevent the stomach from emptying.
Correct Answer: B) Gallstones can block the pancreatic duct, triggering enzyme activation.
Rationale: Biliary tract disease (gallstones) can cause a blockage at the Ampulla of Vater,
which causes bile to reflux into the pancreatic duct or prevents pancreatic juice from
exiting, leading to autodigestion.
Question 10
A nurse identifies a nursing diagnosis of "Ineffective Breathing Pattern" for a client with acute
pancreatitis. Which intervention should the nurse implement?
A) Maintain the client in a supine position.
B) Administer high-flow oxygen via a non-rebreather mask at all times.
, 4
C) Maintain the client in a semi-Fowler's position.
D) Encourage the client to hold their breath during pain episodes.
E) Perform chest percussion every 2 hours.
Correct Answer: C) Maintain the client in a semi-Fowler's position.
Rationale: A semi-Fowler's position reduces pressure on the diaphragm from the abdominal
distension and ascites common in pancreatitis, which helps improve lung expansion and
oxygenation.
Question 11
A client with acute pancreatitis is placed on bed rest. What is the physiological rationale for this
intervention?
A) To prevent the development of deep vein thrombosis
B) To lower the metabolic rate and reduce pancreatic enzyme production
C) To increase the client's blood pressure
D) To stimulate gastrointestinal motility
E) To promote the drainage of the gallbladder
Correct Answer: B) To lower the metabolic rate and reduce pancreatic enzyme production
Rationale: Bed rest decreases the overall metabolic demands of the body. Since physical
activity stimulates GI secretions, resting helps keep the pancreas "quiet" and reduces the
secretion of enzymes that cause pain and tissue damage.
Question 12
A nurse is monitoring a client who just returned from an ERCP (Endoscopic Retrograde
Cholangiopancreatography). Which complication is a priority to monitor for?
A) Urinary tract infection
B) Perforation or bleeding
C) Increased hair loss
D) Vitamin D toxicity
E) Hypertension
Correct Answer: B) Perforation or bleeding
Rationale: ERCP is an invasive endoscopic procedure. Complications include perforation of
the GI tract, bleeding, and ironically, the induction of acute pancreatitis due to ductal
irritation.
Question 13
A client is scheduled for a Whipple procedure (pancreaticoduodenectomy). The nurse explains
that this involves the removal of which of the following?
A) The spleen and the entire liver
B) The gallbladder, duodenum, and part of the common bile duct
C) The entire stomach and the descending colon
D) The left kidney and the adrenal gland
ANSWERS WITH RATIONALES (DETAILED & ELABORATED) 2026 TEST!!
Question 1
A nurse is assessing a client admitted with suspected acute pancreatitis. Which clinical
manifestations would support this diagnosis?
A) Brisk capillary refill and hypertension
B) Severe epigastric pain and nausea
C) Right lower quadrant pain and diarrhea
D) Bradycardia and increased appetite
E) Left lower quadrant pain and constipation
Correct Answer: B) Severe epigastric pain and nausea
Rationale: Acute pancreatitis typically presents with sudden, severe epigastric pain that
often radiates to the back, accompanied by nausea and vomiting due to the inflammatory
process and autodigestion of the pancreas.
Question 2
A client is admitted to the hospital to rule out acute pancreatitis. Which item found in the client’s
medical history represents the most common modifiable risk factor for this condition?
A) History of systemic lupus erythematosus
B) Chronic alcoholism
C) Diagnosis of cystic fibrosis
D) Genetic predisposition to hypertriglyceridemia
E) History of appendectomy
Correct Answer: B) Chronic alcoholism
Rationale: Alcoholism and gallstones are the two primary causes of acute pancreatitis.
Alcohol induces changes in pancreatic secretions and causes premature activation of
enzymes within the pancreas.
Question 3
A nurse is preparing discharge teaching for a client with chronic pancreatitis. Which instruction
is essential to include regarding the administration of pancrelipase?
A) Take the medication only if abdominal pain occurs.
B) Take the medication with every meal and snack.
C) Administer the medication two hours after eating.
D) Dissolve the capsule in hot tea before drinking.
E) Take the medication only before bed.
Correct Answer: B) Take the medication with every meal and snack.
Rationale: Pancrelipase is a pancreatic enzyme replacement. It must be taken with all food
intake to mimic the natural release of enzymes and facilitate the digestion of fats, proteins,
and carbohydrates.
, 2
Question 4
When planning care for a client with acute pancreatitis, which nursing diagnosis should be the
highest priority during the first 24 hours?
A) Risk for Social Isolation
B) Deficient Fluid Volume
C) Readfastness for Enhanced Knowledge
D) Disturbed Body Image
E) Impaired Urinary Elimination
Correct Answer: B) Deficient Fluid Volume
Rationale: Clients with acute pancreatitis are at high risk for fluid volume deficit due to
third-spacing of fluids, vomiting, and nasogastric suctioning. Maintaining hemodynamic
stability is a priority.
Question 5
An older adult client with acute pancreatitis is prescribed a nasogastric (NG) tube to low
intermittent suction. What is the primary rationale for this intervention?
A) To provide a route for enteral nutrition
B) To decompress the stomach and reduce pancreatic stimulation
C) To administer oral medications more effectively
D) To prevent the development of a hiatus hernia
E) To monitor the pH of the gastric contents every hour
Correct Answer: B) To decompress the stomach and reduce pancreatic stimulation
Rationale: NG suctioning removes gastric secretions, preventing them from entering the
duodenum. This reduces the release of secretin, thereby "resting" the pancreas and
decreasing the production of pancreatic enzymes.
Question 6
A client with chronic pancreatitis is at risk for edema. Which of the following prescribed
treatments should the nurse monitor most closely as a contributing factor to fluid retention?
A) Pancrelipase administration
B) IV fluid administration
C) Nasogastric tube insertion
D) Total parenteral nutrition (TPN)
E) Opioid analgesics
Correct Answer: B) IV fluid administration
Rationale: Aggressive IV fluid resuscitation is necessary in pancreatitis, but in chronic cases
or in older adults, it can lead to fluid overload and edema if not monitored closely for
cardiovascular and renal tolerance.
Question 7
What is the underlying pathophysiology most characteristic of acute pancreatitis?
, 3
A) The pancreas ceases to produce any insulin.
B) The pancreas becomes distended with air.
C) The pancreas produces enzymes that attack its own tissue.
D) The pancreas develops a bacterial infection from the bloodstream.
E) The pancreas shrinks due to lack of blood flow.
Correct Answer: C) The pancreas produces enzymes that attack its own tissue.
Rationale: Acute pancreatitis is characterized by autodigestion, where pancreatic enzymes
(like trypsin) are activated prematurely inside the pancreas instead of the duodenum,
leading to tissue necrosis and inflammation.
Question 8
A pregnant client at 28 weeks gestation presents with epigastric pain and jaundice. Which
diagnostic test is the safest and most appropriate to determine the presence of gallstones?
A) Contrast-enhanced CT scan
B) Endoscopic retrograde cholangiopancreatography (ERCP)
C) Ultrasonography
D) Percutaneous fine-needle aspiration biopsy
E) Abdominal X-ray
Correct Answer: C) Ultrasonography
Rationale: Ultrasonography is non-invasive, does not involve ionizing radiation, and is
highly sensitive for detecting gallstones (cholelithiasis), making it the preferred initial test
for pregnant clients.
Question 9
During a health interview, the nurse asks a client with suspected pancreatitis about gallstones.
Why is this an important etiologic factor?
A) Gallstones cause the pancreas to produce too much insulin.
B) Gallstones can block the pancreatic duct, triggering enzyme activation.
C) Gallstones lead to a vitamin C deficiency.
D) Gallstones are the only cause of pancreatic cancer.
E) Gallstones prevent the stomach from emptying.
Correct Answer: B) Gallstones can block the pancreatic duct, triggering enzyme activation.
Rationale: Biliary tract disease (gallstones) can cause a blockage at the Ampulla of Vater,
which causes bile to reflux into the pancreatic duct or prevents pancreatic juice from
exiting, leading to autodigestion.
Question 10
A nurse identifies a nursing diagnosis of "Ineffective Breathing Pattern" for a client with acute
pancreatitis. Which intervention should the nurse implement?
A) Maintain the client in a supine position.
B) Administer high-flow oxygen via a non-rebreather mask at all times.
, 4
C) Maintain the client in a semi-Fowler's position.
D) Encourage the client to hold their breath during pain episodes.
E) Perform chest percussion every 2 hours.
Correct Answer: C) Maintain the client in a semi-Fowler's position.
Rationale: A semi-Fowler's position reduces pressure on the diaphragm from the abdominal
distension and ascites common in pancreatitis, which helps improve lung expansion and
oxygenation.
Question 11
A client with acute pancreatitis is placed on bed rest. What is the physiological rationale for this
intervention?
A) To prevent the development of deep vein thrombosis
B) To lower the metabolic rate and reduce pancreatic enzyme production
C) To increase the client's blood pressure
D) To stimulate gastrointestinal motility
E) To promote the drainage of the gallbladder
Correct Answer: B) To lower the metabolic rate and reduce pancreatic enzyme production
Rationale: Bed rest decreases the overall metabolic demands of the body. Since physical
activity stimulates GI secretions, resting helps keep the pancreas "quiet" and reduces the
secretion of enzymes that cause pain and tissue damage.
Question 12
A nurse is monitoring a client who just returned from an ERCP (Endoscopic Retrograde
Cholangiopancreatography). Which complication is a priority to monitor for?
A) Urinary tract infection
B) Perforation or bleeding
C) Increased hair loss
D) Vitamin D toxicity
E) Hypertension
Correct Answer: B) Perforation or bleeding
Rationale: ERCP is an invasive endoscopic procedure. Complications include perforation of
the GI tract, bleeding, and ironically, the induction of acute pancreatitis due to ductal
irritation.
Question 13
A client is scheduled for a Whipple procedure (pancreaticoduodenectomy). The nurse explains
that this involves the removal of which of the following?
A) The spleen and the entire liver
B) The gallbladder, duodenum, and part of the common bile duct
C) The entire stomach and the descending colon
D) The left kidney and the adrenal gland
