Patho Exam 4 Review questions

The nurse is reviewing portal hypertension with a group of staff nurses. Which statement by an attending nurse indicates the need for further review?

"Portal hypertension causes coagulation abnormalities."

Which complications does the nurse suspect in a client when bile is obstructed from flowing into the intestine? Select all that apply.

1. Steatorrhea 3. Jaundice 4. Pruritus

The health-care provider suspects the presence of esophageal varices in a client diagnosed with cirrhosis of the liver. An ultrasound is prescribed and verifies the suspected condition. Which medications does the health-care provider prescribe to prevent esophageal variceal bleeding? Select all that apply.

3. Propranolol 5. Isosorbide mononitrate

Which client benefits from early endoscopic retrograde cholangiopancreatography (ERCP)?

A client with severe gallstone pancreatitis

The nurse is providing care for a client with suspected gallbladder disease. Assessment by the nurse reveals jaundice, dark-colored urine, and upper right quadrant abdominal pain. Based on the assessment findings, which is the most likely cause of the client's condition?

A gallstone lodged in the common bile duct

For which reason does the nurse identify the change of urine color in a client with liver disease?

Accumulation of bilirubin in the bloodstream

The nurse concludes that an obese client is manifesting symptoms from a rare type of hernia. Which finding confirms the condition?

Acute chest pain

On assessing a client with a gastrointestinal disorder, the nurse finds steatorrhea, abdominal distension, and muscle wasting. The health-care provider prescribes corticosteroid therapy for the client. Which instruction does the nurse provide to effectively manage the condition?

Avoid gluten-containing foods

The nurse is assessing a client in the emergency department. The client states, "I have been really sick with an infection and now I have this awful diarrhea." Which type of gastroenteritis does the nurse suspect?

Clostridium difficile

Which is a characteristic feature of ulcerative colitis?

Continuous areas of inflammation in the large intestine

The nurse is providing care for a client admitted with an obstruction of the common bile duct. Which additional condition does the nurse associate with the admitting diagnosis?

Jaundice

The nurse in an intensive care unit (ICU) is providing care for a client diagnosed with encephalopathy due to severe liver disease. Which nonpharmacological treatment is most important for the nurse to initiate?

Pad side rails and protect from physical injury

Which diagnostic procedure does the health-care provider use to confirm advanced chronic pancreatitis with exocrine insufficiency in a client?

Fecal chymotrypsin

The laboratory report of a client is provided here. Which condition does the nurse suspect in the client? Serum albumin 4 g/dL Indirect bilirubin 1.5 mg/dL Prothrombin time 14 sec Alkaline phosphatase 100 U/mL

Gilbert's disease

The nurse is reviewing both the functions and dysfunctions of the pancreas. Which diagnosis related to pancreatic dysfunction is the greatest risk to the client with chronic pancreatitis?

Gland destruction

Which virus helper function is needed for the replication of hepatitis D virus?

Hepatitis B virus (HBV)

The nurse is preparing a client for a laparoscopic fundoplication. Reports on previously performed endoscopy and barium tests are not yet available. On reviewing the medical history, the nurse notes the client complains of dysphagia, substernal burning, and belching. Which condition does the nurse expect to be identified in the client?

Hiatal hernia

After assessing a client with biliary cirrhosis, the nurse identifies the presence of xanthelasmas. Which laboratory test supports the nurse's assessment finding?

Lipid levels

The health-care provider asks a client to lie down facing upwards and flex the right thigh at the hip. The client says, "I cannot do this. This position is hurting my abdomen." Which sign of appendicitis does the nurse recognize in this client?

Psoas sign

The nurse is assessing a client who reports nausea, vomiting, abdominal pain, and discomfort. The nurse finds that the abdomen is firm and peristalsis is visible. The laboratory reports show electrolyte imbalances. Which condition does the nurse anticipate in the client?

Pyloric stenosis

Which hormone produced by the intestine triggers the release of pancreatic enzymes?

Secretin

Which side effect does the nurse expect to observe in a client who is on epinephrine therapy?

Suppression of the urge to defecate

The nurse teaches a group of staff nurses about the diagnosis of irritable bowel syndrome. After the teaching session, an attending nurse is asked to determine the presence of lactose intolerance in a client with irritable bowel syndrome. Which intervention by the nurse indicates effective learning?

The nurse performs a hydrogen breath test on the client.

The nurse is preparing information for a client newly diagnosed with ulcerative colitis. Which information is more likely associated with Crohn's disease than with ulcerative colitis?

The patient is prone to anal fistula and fissure formation.

The nurse is providing care for a client admitted with abdominal pain, abdominal rigidity, and rebound tenderness. The health-care provider suspects appendicitis and prescribes tests to validate the diagnosis. Which test result indicates a more serious diagnosis?

peritoneal fluid with a neutrophil count of 700 cells/mcL

The nurse finds ursodiol in a client's prescription. Which condition does the nurse suspect in the client?

primary biliary cirrhosis

The nurse suspects hepatic encephalopathy in a client with severe liver dysfunction. Which symptom supports the nurse's suspicion?

stupor

Which disorder of the large intestine may require laparoscopic surgery to unwind the intestine?

volvulus

The health-care provider suggests the hepatitis C virus (HCV) genotyping test to a client with liver disease. Which is the most likely rationale for this testing?

To predict the likelihood of response and the duration of treatment

The nurse is reviewing the pathophysiology of nonalcoholic fatty liver disease (NAFLD) with staff nurses. Which statement made by an attending nurse indicates understanding?

"NAFLD is linked to metabolic syndrome."

The nursing instructor is discussing the physical assessment findings for hemorrhoids. Which statement made by the student nurse indicates effective learning?

"Presence of blood in stools may be observed."

The nurse educator is teaching a group of staff nurses about the importance of inserting a nasogastric tube in clients with large bowel obstruction. Which statement made by an attending nurse indicates effective learning?

"A nasogastric tube relieves pressure caused by bowel obstruction."

The nurse is reviewing with a group of staff nurses the use of antibiotics in a client diagnosed with appendicitis. Which statement made by a nurse indicates understanding?

"Antibiotics are administered before an operation and continued until 48 hours after the operation."

The nurse is reviewing the treatment plan for Crohn's disease with staff nurses. Which statement made by a nurse indicates understanding?

"Cholestyramine is prescribed to clients with ileal disease."

The nurse is orienting a group of staff nurses to the laparoscopic cholecystectomy procedure. Which statement by an attending nurse indicates effective learning?

"The client is discharged less than 24 hours after the surgery."

The staff nurses are reviewing precautions to be taken while caring for a client with suspected need of surgery for appendicitis. Which statement made by a nurse indicates understanding?

"The client is not given prediagnosis pain medications."

The nurse instructor is teaching a group of nursing students about the pathophysiology of cholecystitis. The nursing instructor asks, "What happens during chronic cholecystitis?" Which statement by a student nurse indicates effective learning?

"The gallbladder becomes thickened and functions poorly."

The nurse is reviewing the functions of the liver with a group of staff nurses. Which response by one of the attending nurses indicates the need for additional review?

"The liver synthesizes glucagon."

Which suggestions does the nurse provide to a client with chronic pancreatitis? Select all that apply.

1. "You should consume low-fat food." 3. "You should drink plenty of fluids." 5. "You need to eliminate your alcohol intake."

Which findings can the nurse observe in the laboratory reports of a client after 4 weeks of hepatitis A infection? Select all that apply.

1. A rise in liver enzymes 2. Appearance of immunoglobulin M (IgM) antibodies

The client reports nausea, vomiting, abdominal cramping, and diarrhea. On assessment, the nurse finds high-pitched bowel sounds. Which nursing interventions help the client improve the manifestations of the condition? Select all that apply.

1. Administer antibiotics 2. Administer IV fluids 4. Administer antiemetic medications

Which conditions show an elevated level of white blood cells? Select all that apply.

1. Appendicitis 3. Diverticular disease 4. Large bowel obstruction

The laboratory reports of a client with gastritis reveal Helicobacter pylori is the causative organism. Which pathophysiological changes can result from this infection? Select all that apply.

1. Decreased production of pepsin 2. Increased production of gastrin 5. Decreased production of HCl acid

The parent of an adolescent client tells the nurse, "My child complains of a burning sensation in the throat and refuses to eat food." On assessment, the nurse finds the client also has a dry cough. Which teaching does the nurse provide if the client is diagnosed with gastroesophageal reflux disease (GERD)? Select all that apply.

1. Elevate the client's head at 70 degrees for eating 2. Provide small, frequent meals to the client 3. Administer proton pump inhibitors to the client

The nurse finds that a client coughs frequently while eating and makes repeated attempts to swallow. Based on these findings, the health-care team suspects dysphagia in the client. Which additional findings indicate the client is experiencing aspiration pneumonia? Select all that apply.

1. Elevated temperature 5. Auscultation of crackles in the lungs

The laboratory reports of a client with alcoholic liver disease reveal low hemoglobin levels. For which reasons does the nurse recognize this condition? Select all that apply.

1. Hypersplenism 4. Folic acid deficiency

The nurse is caring for a client with glucuronyl transferase enzyme deficiency. The laboratory reports show elevated serum bilirubin levels. Which treatment does the nurse suspect to be effective in the client? Select all that apply.

1. Phenobarbital 2. Phototherapy

The laboratory reports of a client diagnosed with alcoholism show hepatic encephalopathy and portal hypertension. Which nursing interventions will be beneficial for the client? Select all that apply.

1. Provide a low-sodium diet 3. Provide a high-protein diet 5. Encourage the use of thiamine supplements

Prioritize the order of performing the physical examination of the abdomen in a client with bowel disorder. (Enter the number of each step in the proper sequence; do not use commas or spaces.) 1. Inspection 2. Palpation 3. Percussion 4. Auscultation

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Which pathophysiological changes are responsible for pain in a client with acute gastritis? Select all that apply.

2. Eradication of prostaglandins by medications 3. Increased blood supply at the inflammatory area 4. Increased pressure within the layers of the stomach

The radiographic diagnostic reports for a client show the presence of stones in the common bile duct. Which complications does the nurse expect in the client? Select all that apply.

2. Increase in bilirubin levels 3. Increase in bile salts

The nurse is reviewing Ranson's criteria to assess the severity of pancreatitis in a client. Which findings observed in the client by the nurse within a 48-hour period indicate that the client has chronic pancreatitis? Select all that apply.

4. Partial pressure of oxygen of 40 mm Hg 5. Blood urea nitrogen of 1.0 mmol/L

Arrange the processes occurring in four developmental stages of primary biliary cirrhosis in their correct order. (Enter the number of each step in the proper sequence; do not use commas or spaces.) 1. Destruction of the liver cells, fibrotic tissue taking over hepatic cells, and loss of intralobular bile ducts 2. Progression of inflammation 3. Development of micronodular or macronodular cirrhosis 4. Inflammation of the portal triads and destruction of small and medium bile ducts

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The nurse is providing care for a client in the emergency room with an initial presence of pain in the abdomen. Assessment elicits the presence of rebound pain at McBurney's point, an ultrasound is positive for an inflamed appendix, and white blood cells (WBCs) are moderately elevated. Which prescription does the nurse anticipate from the health-care provider?

Administer oral antibiotics and explain continued use at home

The nurse is assessing a client with pain in the right upper quadrant for 4 hours. The client reports the pain is radiating to the upper thoracic region. A laboratory report suggests elevated liver enzymes and serum bilirubin. Which condition does the nurse suspect from the findings?

Biliary colic

A client tells the nurse, "I have intense stomach pain for 3 hours after eating." On assessment the nurse finds abdominal pain and tenderness. The nurse suspects the client has peptic ulcers. Which diagnostic procedure does the nurse expect the health-care provider to prescribe?

Blood test for Helicobacter pylori antibodies

A nurse is caring for a client with cholecystitis and diagnosed with pruritus. Which medication does the nurse expect the health-care provider to prescribe for the client?

Cholestyramine (Questran)

The nurse is assessing a client with episodic abdominal pain, constipation, and flatulence. Upon physical assessment and review of the laboratory findings, the nurse concludes the client has jaundice and elevated serum amylase. Which condition does the nurse suspect in the client?

Chronic pancreatitis

Upon physical examination, the nurse detects abdominal tenderness, increased bowel sounds accompanied by signs of borborygmi, abdominal distension, and tympany on percussion. Which diagnostic test distinguishes Crohn's disease from ulcerative colitis in the client?

Colonoscopy

The nurse is reviewing anatomy and physiology with staff nurses. Which structure does the nurse identify as being at risk for choledocholithiasis?

Common bile duct

Which diagnostic test does the health-care provider order to get the most accurate information related to appendicitis?

Computerized tomography scan

The nurse reviews the colonoscopy report on a client. The nurse concludes that which disorder is diagnosed by the presence of a "cobblestoning" appearance?

Crohn's disease

The nurse is reviewing the medical record of a client admitted with severe malabsorption disorder because of pancreatic enzyme deficiency. The nurse is aware of a variety of disorders that can cause the diagnosis. Which pancreatic disorder does the nurse recognize as being genetically related?

Cystic fibrosis

Which characteristic feature of dumping syndrome does the nurse recognize in a client after bariatric surgery?

Diaphoresis

The nurse is caring for a client with abdominal distention and pain in the right upper quadrant. The nurse suspects a biliary disorder in the client. Which medication does the nurse expect the health-care provider to prescribe for the client to relieve pain?

Dilaudid

While reviewing the medical file of a client with cirrhosis, the nurse finds that the client has steatorrhea. Which reason does the nurse identify for this condition in the client?

Diminished synthesis of bile

A client is admitted into the emergency room with hematemesis; dark urine; and black, tarry feces. On examination, the nurse finds that the client has weight loss and a distended abdomen. Which condition does the nurse suspect in the client?

Esophageal varices

The nurse is providing care for a client diagnosed with Helicobacter pylori. Which diagnostic test result is the nurse least likely to expect?

Fasting serum gastrin level

Which part of the gastrointestinal (GI) tract is involved in the production of protective mucus?

Goblet cells

Which factor is identified as a cause for acute inflammation of the pancreas?

High triglyceride level

The nurse is preparing teaching material to present to a community group about the common risk factors for cholecystitis. Which factor does the nurse include for female attendees?

Incidence of multiple pregnancies

The nurse is reviewing anatomical information about the pancreas. Which conclusion about the function of the pancreas is correct?

It produces a bicarbonate as a natural antacid.

The nurse is providing care for a client with a recent spinal cord injury resulting in paralysis from the midthoracic region downward. The client is unable to initiate or control bowel function, but states to the nurse, "I am going to get bowel training later." Which factor does the nurse consider in response to the client?

Neural control of the large intestine is likely lost

The nurse is using the Ranson's criteria to assess a client's pancreatitis. After 48 hours, which finding validates the client's need to remain hospitalized?

Partial pressure of oxygen less than 60 mm Hg

Which is the largest serous membrane in the body?

Peritoneal serosa

The nurse is providing care for an older adult client who presents with abdominal cramping, abdominal distention, and the inability to have a bowel movement. An abdominal x-ray reveals a distended colon, with loops of dilated bowel superior to an obstruction. Which treatment does the nurse expect to be prescribed?

Placement of a nasogastric tube

The nurse is providing care for a client with renal disease and notices a slight yellowish color of the skin. The client reports recent symptoms of the flu. Which contributing factor does the nurse identify as increasing the client's possibility of hepatitis B?

Renal disease is treated with hemodialysis

A female client is admitted to the hospital with abdominal pain that originates in the umbilical region and radiates to the right lower quadrant. The health-care provider prescribes a urinalysis. In which manner does this help the health-care provider diagnose the client's condition?

Rules out the possibility of a kidney stone or pyelonephritis

A client tells the nurse, "I have had abdominal pain, bloating, visual disturbances, and bone pain for the last 3 to 6 months." On assessment, the nurse finds excessive weight loss and suspects an autoimmune hypersensitivity disorder. Which diagnostic test does the health-care provider recommend for further confirmation?

Serology celiac panel

A client reports fatigue and arthralgia to the nurse. On physical assessment, the nurse finds that the client has hyperpigmentation of the skin. Which laboratory test does the nurse suggest for safe and effective care of the client?

Serum ferritin levels

A health-care provider suspects the presence of hemorrhoids in a client. Which diagnostic test does the health-care provider prescribe to support the suspected diagnosis?

Sigmoidoscopy

The nurse finds a note stating, "Reduction of 15% to 20% from the original stomach size" while reviewing the medical record of an obese client. Which surgical procedure does the nurse expect for this client?

Sleeve gastrectomy

A client is brought to the hospital because of severe abdominal pain, nausea, and vomiting. The client reports increased pain in the abdomen and in the epigastric region radiating to the back when lying supine. During physical assessment, the nurse finds the client has fever and hypotension. Which condition does the nurse suspect from these findings?

The client has acute pancreatitis.

In a client diagnosed with large bowel obstruction, an abdominal x-ray is performed, which shows the presence of free air under the diaphragm. After the diagnosis, the nurse initiates prophylactic antibiotic therapy and fluid replacement therapy per the prescriptions of the health-care provider. Which outcome in the client indicates the effectiveness of the therapy?

The client has normal levels of serum amylase.

The client's laboratory reports indicate high levels of bilirubin. Which conclusion does the nurse infer from the report?

The client has stones in the common bile duct.

The nurse is caring for multiple clients in an acute care setting. Which client does the nurse identify as being at risk for nonalcoholic fatty liver disease (NAFLD)?

The client who is a strict vegetarian

Which client does the nurse expect to be prescribed a tissue biopsy test for confirmation of the disease?

The client with celiac disease

Which client does the nurse instruct to avoid eating or drinking food items that are hot or spicy?

The client with esophagitis

The nurse finds increased glucose levels in a client with chronic pancreatitis. Which does the nurse interpret from the finding?

The client's beta cells are damaged.

For a client diagnosed with terminal ileal disease, the health-care provider prescribes sulfasalazine. Which outcome in the client indicates the effectiveness of the therapy?

The client's gastrointestinal wall is normalized.

The nurse is attending a client 3 days postoperative for removal of a section of small bowel because of injury from a strangulated hernia. The nurse is aware the client is now diagnosed with short-bowel syndrome. Which initial postoperative teaching is most important for the nurse to provide?

The first 3 months will require careful monitoring and nutrition supplements

The nurse is counseling a client about high doses of NSAIDs taken to "keep aches and pains away." The nurse shares that the liver is at risk for damage. The client asks, "What does the liver do, anyway?" Which is the best answer by the nurse?

The liver plays multiple important roles in digestion."

The client with alcoholic liver disease is experiencing bruising, nosebleed, and hematemesis. Which treatment option does the nurse suspect to be effective in this client?

Vitamin K

The health-care provider prescribes a fasting serum gastrin level test and a magnetic resonance imaging (MRI) scan for symptoms of peptic ulcer. On reviewing the test reports, the nurse finds a diagnosis of hypergastrinemia and a tumor. The nurse administers the prescribed proton pump inhibitors. Which condition does the nurse identify?

Zollinger-ellison syndrome

A physical examination of a client elicits the Cullen sign and Grey-Turner sign. Which condition does the nurse suspect in the client?

acute pancreatitis

While assessing a client who has liver dysfunction, the nurse finds the client has shifting abdominal dullness. Which condition does the nurse suspect in the client?

ascites

While assessing a client with liver cirrhosis, the nurse examines the client for indication of encephalopathy. Which manifestation indicates the development of encephalopathy?

asterixis

Which gastrointestinal disorder occurs after bariatric surgery involving removal of part of the stomach?

dumping syndrome

Which part of the stomach most commonly harbors Helicobacter pylori?

fundus

A client with sudden, excruciating abdominal pain; pale skin; and hematemesis is admitted to the emergency room. On assessment, the client acknowledges an overdose of NSAIDs and a history of substance abuse. The health-care provider instructs the nurse to prepare the client for a gastrojejunostomy procedure. Which condition does the nurse anticipate in the client?

peptic ulcer disease