PRACTICE QUESTIONS-AGACNP UPDATED EXAM
QUESTIONS WITH CORRECT ANSWERS 2026
The most common cause of intestinal obstruction is:
A. Adhesion
B. Tumor
C. Ischemic bowel
D. Umbilical hernia - CORRECT ANSWER -A- adhesion
A firm liver on physical exam is usually associated with:
A. Ascites
B. Passive congestion
C. Cirrhosis
D. Hepatic carcinoma - CORRECT ANSWER -B- Passive congestion
Differential diagnosis of lower GI Bleed - CORRECT ANSWER --Diverticulum hemmorhage
-Occult neoplastic
-Colitis (infectious, ischemic, radiation, ulcerative colitis >Crohn's disease)
-Angiodysplasia
-Anorectal (fissure, hemorrhoid, rectal ulcer)
-Vasculitis
Goals of GI Bleed Resuscitation - CORRECT ANSWER --Volume resuscitation (IV fluids, PRBCs)
-Reverse coagulopathy: (FFP, vit K), platlet goal >50,000
-ICU if vital signs unstable or poor end-organ perfusion
-Labs: H&H, platlet, PT/PTT, LFT, BUN/Creatinine
, What are the vitamin K dependent clotting factors synthesized by the liver? - CORRECT ANSWER
-Factor II, VII, IX, X and proteins C and S
How is the adequacy of vit. K dependent clotting factors estimated? - CORRECT ANSWER -PT
and INR.
Prolongated from impaired coagulation factor synthesis or Vitamin K deficiency. (If PT/INR
normalize after Vit K administration, this indicates Vit K deficiency).
AST and ALT enzymes - CORRECT ANSWER -Elevations-->hepatocellular injury, necrosis. Marked
elevations (>1000) typically occur with acute hepatocellular injury (viral, drugs, ischemia).
AST>2x ALT = alcohol. AST<1 ALT = viral hepatitis
Alkaline phosphatase (ALP) enzyme - CORRECT ANSWER -Elevations-->cholestatic (biliary
obtruction, space-occupying/infiltrative lesions of liver). ALP present in multiple tissues. An
elevated GGT (enzyme) establishes hepatic origin of ALP
Normal value: 50 - 136
alpha-Fetoprotein (AFP) - CORRECT ANSWER -Normal adult level: <10
Insensitive marker for hepatocellular carcinoma. Mild-moderate elevations in acute & chronic
liver inflammation.
Hypoalbuminemia - CORRECT ANSWER -Frequently decreased in chronic liver disease. Also:
chronic inflammation; expanded plasma volume; GI or renal losses.
May be normal in acute liver disease because albumin 1/2 life is 20 days.
Normal value: 3.4 - 5
Bilirubin - CORRECT ANSWER -Degradation product of hemoglobin. Total bili = conjugated +
unconjugated fractions. Normally bilirubin is processed by the liver and conjugated to a pigment
QUESTIONS WITH CORRECT ANSWERS 2026
The most common cause of intestinal obstruction is:
A. Adhesion
B. Tumor
C. Ischemic bowel
D. Umbilical hernia - CORRECT ANSWER -A- adhesion
A firm liver on physical exam is usually associated with:
A. Ascites
B. Passive congestion
C. Cirrhosis
D. Hepatic carcinoma - CORRECT ANSWER -B- Passive congestion
Differential diagnosis of lower GI Bleed - CORRECT ANSWER --Diverticulum hemmorhage
-Occult neoplastic
-Colitis (infectious, ischemic, radiation, ulcerative colitis >Crohn's disease)
-Angiodysplasia
-Anorectal (fissure, hemorrhoid, rectal ulcer)
-Vasculitis
Goals of GI Bleed Resuscitation - CORRECT ANSWER --Volume resuscitation (IV fluids, PRBCs)
-Reverse coagulopathy: (FFP, vit K), platlet goal >50,000
-ICU if vital signs unstable or poor end-organ perfusion
-Labs: H&H, platlet, PT/PTT, LFT, BUN/Creatinine
, What are the vitamin K dependent clotting factors synthesized by the liver? - CORRECT ANSWER
-Factor II, VII, IX, X and proteins C and S
How is the adequacy of vit. K dependent clotting factors estimated? - CORRECT ANSWER -PT
and INR.
Prolongated from impaired coagulation factor synthesis or Vitamin K deficiency. (If PT/INR
normalize after Vit K administration, this indicates Vit K deficiency).
AST and ALT enzymes - CORRECT ANSWER -Elevations-->hepatocellular injury, necrosis. Marked
elevations (>1000) typically occur with acute hepatocellular injury (viral, drugs, ischemia).
AST>2x ALT = alcohol. AST<1 ALT = viral hepatitis
Alkaline phosphatase (ALP) enzyme - CORRECT ANSWER -Elevations-->cholestatic (biliary
obtruction, space-occupying/infiltrative lesions of liver). ALP present in multiple tissues. An
elevated GGT (enzyme) establishes hepatic origin of ALP
Normal value: 50 - 136
alpha-Fetoprotein (AFP) - CORRECT ANSWER -Normal adult level: <10
Insensitive marker for hepatocellular carcinoma. Mild-moderate elevations in acute & chronic
liver inflammation.
Hypoalbuminemia - CORRECT ANSWER -Frequently decreased in chronic liver disease. Also:
chronic inflammation; expanded plasma volume; GI or renal losses.
May be normal in acute liver disease because albumin 1/2 life is 20 days.
Normal value: 3.4 - 5
Bilirubin - CORRECT ANSWER -Degradation product of hemoglobin. Total bili = conjugated +
unconjugated fractions. Normally bilirubin is processed by the liver and conjugated to a pigment
