AH exam 2 (prep u ch 48 and on)
d
Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: . a. are at risk for gallbladder contraction. b. are at risk for hepatic encephalopathy. c. can digest high-fat foods. d. cannot tolerate high-glucose concentration
a (limited to low fat liquid foods)
Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? a. Hot roast beef sandwich with gravy b. Mashed potatoes c. White rice d. Vanilla pudding
a
What initial measure can the nurse implement to reduce risk of injury for a client with liver disease? a. Pad the side rails on the bed b. Apply soft wrist restraints c. Raise all four side rails on the bed d. Prevent visitors, so as not to agitate the client
c
Which type of deficiency results in macrocytic anemia? a. Vitamin C b. Vitamin A c. Folic acid d. Vitamin K
asterixis
aka Liver Flap, a flapping tremor of the hands. When the client extends the arms & hands in front of the body, the hands rapidly flex & extend.
decompression via NG tube
treatment of obstructed small bowel
b
A client who was recently diagnosed with carcinoma of the pancreas and is having a procedure in which the head of the pancreas is removed. In addition, the surgeon will remove the duodenum and stomach, redirecting the flow of secretions from the stomach, gallbladder, and pancreas into the middle section of the small intestine. What procedure is this client having performed? a. cholecystojejunostomy b. radical pancreatoduodenectomy c. total pancreatectomy d. distal pancreatectomy
a, c, d
A nurse cares for a client who is post op from bariatric surgery. What risk factors does the nurse recognize increases the client's risk for developing venous thromboembolism (VTE)? Select all that apply. a. Age b. Gender c. Higher BMI d. History of a VTE e. Ethnicity
d (risk for hemorrhage!)
A nurse cares for a client who is post op open cholecystectomy. Upon assessment, the nurse notes the client's abdomen feels firm to palpation. What is the nurse's priority action? a. Auscultate the bowel sounds b. Ask the client the last bowel movement date c. Prepare to insert a nasogastric tube to intermittent suction d. Contact the health care provider
a, b, c
A nurse is planning care for a client who will undergo bariatric surgery in a week. What goals are acceptable during this point in the client's care? Select all that apply. a. Client will become knowledgeable about the procedure. b. Client will understand preoperative and postoperative dietary restrictions. c. Client will have decreased anxiety about the procedure. d. Client will understand how to maintain normal bowel function. e. Client will become knowledgeable about vitamin requirements.
c
A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? a. Hepatitis B is transmitted primarily by the oral-fecal route. b. Hepatitis A is frequently spread by sexual contact. c. Hepatitis C increases a person's risk for liver cancer. d. Infection with hepatitis G is similar to hepatitis A.
d
A nurse working in a cardiac health care office notes increased risk of certain cardiac conditions as a result of obesity. Which conditions can be associated with obesity? Select all that apply. a. Hypertension b. Coronary artery disease c. Heart failure d. Heart murmur e. Myocardial infarction
a
A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder? a. Edema and inflammation b. Pleural effusion c. Sepsis d. Disseminated intravascular coagulopathy
a
A very ill client with acute cholecystitis is scheduled for surgery. The surgeon plans to create an incision in the common bile duct to remove stones. The nurse correctly documents this surgery in the electronic medical record using which term? a. Choledochostomy b. Cholecystostomy c. Cholecystectomy d. Choledochoduodenostomy
weight/height in inches squared x 703
BMI equation
hypotension, muscle weakness
CM of hypokalemia
RUQ
In what location would the nurse palpate for the liver?
c
The charge nurse was discussing with the nursing student that studies have been published that suggest inflammation increases the risk of heart disease. Which modifiable factor would the nursing student target in teaching clients about prevention of inflammation that can lead to atherosclerosis? a. Avoid use of caffeine b. Encourage use of a multivitamin c. Addressing obesity d. Drink at least 2 liters of water a day
b
The digestion of carbohydrates is aided by a. lipase. b. amylase. c. trypsin. d. secretin.
b
The mode of transmission of hepatitis A virus (HAV) includes which of the following? a. Blood b. Fecal-oral c. Semen d. Saliva
b
The nurse identifies which type of jaundice in an adult experiencing a transfusion reaction? a. Hepatocellular b. Hemolytic c. Obstructive d. Nonobstructive
lactulose
The nurse is administering medications to a client that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent?
d
The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as? a. Constructional apraxia b. Fetor hepaticus c. Ataxia d. Asterixis
c
A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? a. Straw-colored urine b. Reduced hematocrit c. Clay-colored stools d. Elevated urobilinogen in the urine
b
An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true? a. Nearly two-thirds of clients with diabetes mellitus are older than age 60. b. Diabetes mellitus is more common in Hispanics and Blacks than in Whites. c. Type 2 diabetes mellitus is less common than type 1 diabetes mellitus. d. Approximately one-half of the clients diagnosed with type 2 diabetes are obese.
a
What is the recommended dietary treatment for a client with chronic cholecystitis? a. low-fat diet b. high-fiber diet c. low-residue diet d. low-protein diet
a
Which of the following is the most effective strategy to prevent hepatitis B infection? a. Vaccine b. Barrier protection during intercourse c. Covering open sores d. Avoid sharing toothbrushes
a
A 70-year-old client is admitted with acute pancreatitis. The nurse understands that the mortality rate associated with acute pancreatitis increases with advanced age and attributes this to which gerontologic consideration associated with the pancreas? a. Decreases in the physiologic function of major organs b. Increases in the bicarbonate output by the kidneys c. Increases in the rate of pancreatic secretion d. Development of local complications
b
A 70-year-old client is admitted with acute pancreatitis. The nurse understands that the mortality rate associated with acute pancreatitis increases with advanced age and attributes this to which gerontologic consideration associated with the pancreas? a. Increases in the bicarbonate output by the kidneys b. Decreases in the physiologic function of major organs c. Increases in the rate of pancreatic secretion d. Development of local complications
d
A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? a. Monitor pulse oximetry every hour. b. Withhold oral feedings for the client. c. Instruct the client to avoid coughing. d. Reposition the client every 2 hours.
c (elevated for first 24 hrs after sx onset)
A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test? a. Serum calcium b. Serum bilirubin c. Serum amylase d. Serum potassium
c
A client has a blockage of the passage of bile from a stone in the common bile duct. What type of jaundice does the nurse suspect this client has? a. Hemolytic jaundice b. Hepatocellular jaundice c. Obstructive jaundice d. Cirrhosis of the liver
c
A client who has worked for a company that produces paint and varnishing compounds for 24 years is visiting the clinic reporting chronic fatigue, dyspepsia, diarrhea, and a recently developing yellowing of the skin and sclera. The client reports clay-colored stools and frequent nosebleeds. Which type of cirrhosis is the likely cause of the client's symptoms? a. alcoholic b. respiratory c. postnecrotic d. biliary
b
A nurse cares for a client who is 36 hours postoperative from bariatric surgery and is suspected of having a hemorrhage related to the procedure. What is the nurse's understanding of the most likely cause of the hemorrhage? a. Disruption of a staple b. Formation of a gastric ulcer c. Formation of a duodenal ulcer d. Dehiscence of the surgical site
b
A nurse geneticist is researching the gut microbiome and its relationship to disease. What is true regarding the microbiome? a. It is less diverse than human genome. b. It has over 100 times more genes than the human genome. c. Its function has yet to be discovered. d. It has over 10 times more genes than the human genome.
d (ammonia builds up in brain causing cerebral dysfunction)
A physician orders lactulose (Cephulac), 30 ml three times daily, when a client with cirrhosis develops an increased serum ammonia level. To evaluate the effectiveness of lactulose, the nurse should monitor: a. urine output. b. abdominal girth. c. stool frequency. d. level of consciousness (LOC).
b
Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from: a. Excessive diuresis and dehydration. b. The digestion of dietary and blood proteins. c. Severe infections and high fevers. d. Excess potassium loss subsequent to prolonged use of diuretics.
a (bile pigments excreted by kidneys in urine so is very dark!)
Clinical manifestations of common bile duct obstruction include all of the following except: a. Light-colored urine b. Clay-colored feces c. Pruritus d. Jaundice
c, d
The nurse is caring for a patient who has ascites as a result of hepatic dysfunction. What intervention can the nurse provide to determine if the ascites is increasing? (Select all that apply.) a. Measure urine output every 8 hours. b. Assess and document vital signs every 4 hours. c. Measure abdominal girth daily. d. Perform daily weights. e. Monitor number of bowel movements per day.
c
The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason? a. To decrease metabolism b. To depress the central nervous system and increase the pain threshold c. To reduce gastric and pancreatic secretions d. To relieve nausea and vomiting
a
What statement best describes a client with severe or extreme obesity? a. A BMI >40 kg/m2 b. A BMI >35 kg/m2 c. Waist-to-hip ratio <30 inches in females d. Waist-to-hip ratio <33 inches in males
lipase
Which enzyme aids in the digestion of fats?
adhesions
most common cause of small bowel obstruction
18.5-25
normal BMI
choledochostomy
surgical formation of an opening into the common bile duct through the abdominal wall -reserved for clients w acute cholecystitis who may be too ill to undergo a surgical procedure. It involves making an incision in the common duct, usually to remove stones
hypovolemic
untreated small bowel obstruction can lead to which kind of shock
metabolic alkalosis
vomiting can cause which acid base distrubance
b
Which is the most common cause of esophageal varices? a. Jaundice b. Portal hypertension c. Ascites d. Asterixis
b
Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? a. Spironolactone b. Vasopressin c. Nitroglycerin d. Cimetidine
vaccine
Which of the following is the most effective strategy to prevent hepatitis B infection
b
A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? a. Increased serum calcium levels b. Elevated urine amylase levels c. Decreased liver enzyme levels d. Decreased white blood cell count
a
A client with obesity is prescribed orlistat for weight loss. The client asks the nurse, "I understand the medication prevents digestion of fat, but what happens if I eat fat?" What is the nurse's best response? a. "The fat is passed in your stools." b. "The fat is excreted in your urine." c. "The fat is absorbed in your intestines." d. "The fat remains undigested in your stomach."
b
A nurse cares for a client who is post op bariatric surgery and the nurse offers the client a sugar-free beverage. What is the primary purpose of offering a sugar-free beverage? . a. These are less likely to raise the blood sugar. b. These are less likely to cause dumping syndrome c. These ease nausea. d. These ease gastric distention.
b (promotos comfort and gastric emptying)
A nurse cares for a client who is post op bariatric surgery. Which position will the nurse place the client in order to best promote comfort? a. High Fowler's b. Low Fowler's c. Upright d. Lateral
a
A nurse cares for a client who is post op from bariatric surgery. Once able, the nurse encourages oral intake for what primary purpose? a. Stimulate GI peristalsis b. Assess for intact swallowing c. Assess for gastric perforation d. Stimulate digestive hormones
b
A nurse cares for an obese client taking phentermine for weight loss. What client teaching will the nurse include when discussing precautions about the medication? a. "Do not drive while taking this medication." b. "Do not drink alcohol while taking this medication." c. "Take the medication at night before bedtime." d. "Take the medication with a full glass of water."
a
A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has: a. cirrhosis. b. peptic ulcer disease. c. appendicitis. d. cholelithiasis.
c
A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide? a. Cure the cirrhosis. b. Treat the esophageal varices. c. Reduce fluid accumulation and venous pressure. d. Promote optimal neurologic function.
d
A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm the diagnosis of acute pancreatitis? a. Presence of blood in the client's stool and recent hypertension b. Presence of easy bruising and bradycardia c. Adventitious breath sounds and hypertension d. Pain with abdominal distention and hypotension
a
A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition? a. Hepatic encephalopathy b. Portal hypertension c. Asterixis d. Cirrhosis
b
A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: a. severe abdominal pain radiating to the shoulder. b. anorexia, nausea, and vomiting. c. eructation and constipation. d. abdominal ascites.
a
A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? a. Acute pain related to biliary spasms b. Deficient knowledge related to prevention of disease recurrence c. Anxiety related to unknown outcome of hospitalization d. Imbalanced nutrition: Less than body requirements related to biliary inflammation
b
A client is scheduled for a cholecystogram for later in the day. What is the nurse's understanding on the diagnostic use of this exam? a. It visualizes the liver and pancreas. b. It visualizes the gallbladder and bile duct. c. It shows the sizes of the abdominal organs and detects any masses. d. It visualizes the biliary structures and pancreas via endoscopy.
d
A client who has just been diagnosed with hepatitis A asks, "How did I get this disease?" What is the nurse's best response? a. "You could have gotten it by using I.V. drugs." b. "You must have received an infected blood transfusion." c. "You probably got it by engaging in unprotected sex." d. "You may have eaten contaminated restaurant food."
c
A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client? a. Placing the client in a semi-Fowler's position b. Maintaining nothing-by-mouth (NPO) status c. Administering morphine I.V. as ordered d. Providing mouth care
cholelithiasis
A client with calculi in the gallbladder is said to have
b (correct prothrombin deficiency)
A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? a. Potassium b. Vitamin K c. Vitamin B d. Oral bile acids
c
A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a. light amber urine. b. circumoral pallor. c. yellow sclerae. d. black, tarry stools.
c
A client with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement—milk thistle—to help heal the liver. Which is the most appropriate response by the nurse? a. "You should not use herbal supplements in conjunction with medical treatment." b. "Herbal supplements are approved by the FDA, so there should be no problem with their usage if you check with your primary care provider." c. "Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated." d. "You can use milk thistle instead of the medications you have been prescribed."
a
A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client? a. Vitamin A b. Thiamine c. Riboflavin d. Vitamin K
a (no longer colored by bile pigments)
A client with suspected biliary obstruction due to gallstones reports changes to the color of his stools. Which stool color does the nurse recognize as common to biliary obstruction? a. Gray b. Black c. Red d. Green
d
A nurse cares for a client who is obese. The health care provider prescribes orlistat in an effort to help client lose weight, along with diet and exercise. When teaching the client about this medication, what will the nurse include? a. "It decreases your appetite." b. "It works to make you feel full." c. "It binds with enzymes to decrease carbohydrate absorption." d. "It binds with enzymes to help prevent digestion of fat."
a
A nurse cares for a client who wants to know more information about bariatric surgery. The client asks the nurse, "What weight loss can I expect?" What is the nurse's best response? a. "Expect to lose 10-35% of total body weight 2 to 3 years postoperatively." b. "Expect to lose 45-50% of total body weight 2 to 3 years postoperatively." c. "Expect to lose 50 pounds in the first month after surgery." d. "Expect to lose 10-35 pounds in the first month after surgery."
c
A nurse cares for a client with obesity. Which medication that the client takes may be contributing to the client's obesity? a. Topiramate b. Metformin c. Gabapentin d. Bupropion
c
A nurse caring for adults with obesity recognizes that obesity is classified based on BMI. Which BMI does the nurse recognize as Class II obesity? a. 29 kg/m2 b. 34 kg/m2 c. 35 kg/m2 d. 40 kg/m2
c
A nurse epidemiologist examines the overall decrease in life expectancy related to obesity. What finding is true? a. There is a 2-4 year decrease in overall life expectancy for those with obesity. b. There is a 25-30 year decrease in overall life expectancy for those with obesity. c. There is a 6-20 year decrease in overall life expectancy for those with obesity. d. There is a 21-28 year decrease in overall life expectancy for those with obesity
a
A nurse is caring for a client admitted with acute pancreatitis. Which nursing action is most appropriate for a client with this diagnosis? a. Withholding all oral intake, as ordered, to decrease pancreatic secretions b. Administering meperidine, as ordered, to relieve severe pain c. Limiting I.V. fluids, as ordered, to decrease cardiac workload d. Keeping the client supine to increase comfort
c
A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says: a. "I need to keep my inhaler at the bedside." b. "I should eat a high-protein diet." c. "I should become involved in a weight loss program." d. "I should sleep on my side all night long."
c
A nurse is caring for a client who will undergo bariatric surgery. Which nutritional recommendation will the nurse include in the client teaching? a. "Increase your intake of complex carbohydrates." b. "Increase your intake of monounsaturated fats." c. "Increase your intake of plant-based proteins." d. "Increase your intake of fluids at meals."
d
A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation? a. The client didn't take his morning dose of lactulose (Cephulac). b. The client is relaxed and not in pain. c. The client is avoiding the nurse. d, The client's hepatic function is decreasing.
a
A nurse is planning care for a client who will be arriving to the unit postoperatively from bariatric surgery. In an effort to decrease the risk of venous thromboembolism (VTE), which health care provider orders does the nurse anticipate? a. Mechanical compression and prophylactic anticoagulation b. Mechanical compression only c. Prophylactic anticoagulation only d. Early ambulation only
d
A nurse researcher is reviewing data obtained from a developing nation on nutrition and metabolism issues facing that country. What is the nurse's understanding of the "double-burden" many developing nations now face? a. Both low metabolism and high metabolism b. Both obesity and scare food sources c. Both undernutrition and sedentary lifestyles d. Both undernutrition and obesity
b
A nurse researches the cost and financial impact of obesity in America. What is the annual health care cost tied to obesity? a. $118 billion b. $147 billion c. $1 trillion d. $3 trillion
d
A patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding; the abdomen is board-like and no bowel sounds are detected. What is the major concern for this patient? a. The patient requires more pain medication. b. The patient is developing a paralytic ileus. c. The patient has developed peritonitis. d. The patient has developed renal failure.
d
A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse suspect the patient may be experiencing? a. Riboflavin deficiency b. Folic acid deficiency c. Vitamin A deficiency d. Vitamin K deficiency
c
The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highestnursing priority for this client? a. Teaching the client to choose low-fat foods from the menu b. Performing range-of-motion (ROM) leg exercises hourly while the client is awake c. Assisting the client to turn, cough, and deep breathe every 2 hours d. Assisting the client to ambulate the evening of the operative day
c, d, e
The nurse is teaching a group of clients with obesity about the risks of disease associated with obesity. Which respiratory conditions or diseases will the nurse include in the teaching, which are associated with obesity? Select all that apply. a. Central sleep apnea b. Emphysema c. Asthma d. Infection e. Obstructive sleep apnea
c
The nurse plans care for a client with obesity. What does the nurse recognize is the primary pathophysiological reason clients with obesity are at greater risk for developing thromboembolism? a. Increased blood viscosity b. Impaired clotting c. Compromised peripheral blood flow d. Increased fat accumulation in the blood
d
What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct? a. Colonoscopy b. Abdominal x-ray c. Cholecystectomy d. Endoscopic retrograde cholangiopancreatography (ERCP)
d
When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report? a. Yellow-green b. Black and tarry c. Blood tinged d. Clay-colored or whitish
b (reduces pressure on abdominal muscles)
When caring for a client with acute pancreatitis, the nurse should use which comfort measure? a. Administering an analgesic once per shift, as ordered, to prevent drug addiction b. Positioning the client on the side with the knees flexed c. Encouraging frequent visits from family and friends d. Administering frequent oral feedings
b
Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? a. Shock b. Pancreatic necrosis c. MODS d. Tetany
c
Which symptoms will a nurse observe most commonly in clients with pancreatitis? a. black, tarry stools and dark urine b. increased and painful urination c. severe, radiating abdominal pain d. increased appetite and weight gain
b
Which is an age-related change of the hepatobiliary system? a. Increased drug clearance capability b. Decreased blood flow c. Enlarged liver d. Decreased prevalence of gallstones
a
A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client? a. Octreotide b. Spironolactone c. Propranolol d. Lactulose
d
A client is being prepared to undergo laboratory and diagnostic testing to confirm the diagnosis of cirrhosis. Which test would the nurse expect to be used to provide definitive confirmation of the disorder? a. coagulation studies b. Magnetic resonance imaging c. Radioisotope liver scan d. Liver biopsy
d
A client with obesity is prescribed lorcaserin for weight loss. The client reports dry mouth. What is the nurse's best response? a. "How much water are drinking?" b. "Taking this medication with meals decreases this symptom." c. "Your dose may need to be adjusted." d. "This is an expected finding with this medication."
a, c, e
A nurse is educating a community group about coronary artery disease. One member asks about how to avoid coronary artery disease. Which of the following items are considered modifiable risk factors for coronary artery disease? Choose all that apply. a. Hyperlipidemia b. Gender c. Obesity d. Race e. Tobacco use
b
Which condition is most likely to have a nursing diagnosis of fluid volume deficit? a. Appendicitis b. Pancreatitis c. Cholecystitis d. Gastric ulcer
a
A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? a. Relieving abdominal pain b. Preventing fluid volume overload c. Maintaining adequate nutritional status d. Teaching about the disease and its treatment
b
A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? a. Potassium b. Vitamin K c. Vitamin B d. Oral bile acids
b (no oral food or liquid during acute phase, certain foods for chronic)
A student nurse is preparing a plan of care for a client with chronic pancreatitis. What nursing diagnosis related to the care of a client with chronic pancreatitis is the priority? a. Disturbed body image b. Impaired nutrition: less than body requirements c. Nausea d. Anxiety
d
A nurse cares for clients who undergo bariatric surgery due to obesity. When teaching the client on the most successful surgery in clients with very high BMI's, which procedure will the nurse mention? a. Roux-en-Y b. Gastric banding c. Sleeve gastrectomy d. Biliopancreatic diversion with duodenal switch
a
The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi-Fowler's position. What is the nurse's priority assessment of this patient? a. Respiratory assessment related to increased thoracic pressure b. Urinary output related to increased sodium retention c. Peripheral vascular assessment related to immobility d. Skin assessment related to increase in bile salts
a
A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response? a. decompression b. instillation c. gavage d. lavage
b
Which group of clients is at high risk of developing breast cancer? a. Women who do not consume alcohol b. Women who are obese c. Women who have sex with multiple partners d. Women who consume a low-fat, low-calorie diet
c
A client is scheduled for a Roux-en-Y bariatric surgery. When teaching the client about the surgical procedure, which statement will the nurse use? a. "A prosthetic device binds the stomach and creates a very small pouch and restricts oral intake." b. "85% of the stomach is removed surgically, leaving a much smaller tube-like structure." c. "The stomach is stapled to create a very small pouch and part of the small intestine is rerouted." d. "The stomach is stapled to a very small pouch and the entire small intestine is rerouted.
b
Which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels? a. Dry mouth, which makes the client thirsty b. Frequent vomiting, leading to loss of fluid volume c. Acetone in the urine d. High glucose concentration in the blood
b
Which is a clinical manifestation of cholelithiasis? a. Epigastric distress before a meal b. Clay-colored stools c. Abdominal pain in the upper left quadrant d. Nonpalpable abdominal mass
a
A client is admitted to the health care center with severe abdominal pain rated 10 on a 1-to-10 scale, tachycardia, hypertension, and muscle spasms. The nurse immediately administers morphine sulfate 4 mg slow intravenous pyelogram (IVP), as ordered. The nurse plans for which goal after administration of this mediation? a. To increase the client's pain threshold b. To control muscle spasms c. To control blood pressure d. To diagnose the cause of abdominal pain
b
A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is: a. elevated liver enzymes and low serum protein level. b. subnormal serum glucose and elevated serum ammonia levels. c. subnormal clotting factors and platelet count. d. elevated blood urea nitrogen and creatinine levels and hyperglycemia.
d
A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN? a. Auscultate the abdomen for bowel sounds every 4 hours b. Measure abdominal girth every shift c. Monitor for reports of nausea and vomiting d. Measure blood glucose concentration every 4 to 6 hours
c
A nurse cares for a female client of childbearing age who will undergo bariatric surgery. When teaching the client about precautions after surgery, which teaching will the nurse include that is specific to this population? a. "After surgery, your ability to conceive is decreased considerably." b. "You should avoid pregnancy for at least 9 months after surgery" c. "You should avoid pregnancy for at least 18 months after surgery." d. "After surgery, contraceptives have much less efficacy."
b
A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor? a. "You must have the second one in 2 weeks and the third in 1 month." b. "You must have the second one in 1 month and the third in 6 months." c. "You must have the second one in 6 months and the third in 1 year." d. "You must have the second one in 1 year and the third the following year."
d
Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes mellitus. Which of the following explains the cause of this secondary diabetes? a. Ingestion of foods high in sugar b. Inability for the liver to reabsorb serum glucose c. Renal failure d. Dysfunction of the pancreatic islet cells
b
The nurse is working with a client who has difficulty controlling her blood sugar. The overweight client does not adhere to a low-calorie diet and forgets to take medications and check her blood glucose level. The client's glycohemoglobin is 8.5%. When establishing a goal for the client, the nurse first a. Informs the client about what goal the nurse wants the client to achieve b. Collaborates with the client to establish an agreed-upon goal c. Sets the long-term goal as "the client's glycohemoglobin will be 6.9% in 3 months" d. Plans the short-term goal as "the client's blood sugar each AM will be less than 110 mg/dL"
b
When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately? a. Weight loss of 2 pounds in 3 days b. Change in the client's handwriting and/or cognitive performance c. Anorexia for more than 3 days d. Constipation for more than 2 days
c
The nurse observes that a client's medical report indicates that the client has Cushing syndrome. During inspection, the nurse notes that the client's BMI is 31, waist circumference is 40 inches, and localized fat pads exist around the neck and upper part of the back. Which of the following must the nurse keep in mind while planning the client's care? a. A BMI of 31 indicates obesity, and the nurse instructs the patient to keep a record of food actually consumed over the next 3 to 7 days. b. The nurse knows that a waist circumference of 40 places the client at risk. The nurse instructs the client to remember all food consumed over the next 24-hour period. c. The nurse recognizes that the client's obesity may be specifically related to the endocrine disorder. The nurse performs a thorough nutritional assessment. d. Knowing that the client is obese, the nurse plans to provide dietary education to reduce the daily caloric intake using the U.S. Department of Agriculture's MyPlate pyramid.
a
A client with obesity has been taking lorcaserin for several months and presents to the health care provider's office reporting fever and diarrhea. Which life-threatening condition does the nurse suspect? a. Serotonin syndrome b. C-difficile infection c. Acute gastritis d. Cushing's syndrome
a
A client with obesity is diagnosed with type 2 diabetes. In order to promote weight loss in the client and aid in glucose management, which medication will the nurse anticipate the health care provider ordering? a. Metformin b. Glipizide c. Glyburide d. Pioglitazone
a (gives more room for diaphragm reduced increased abdominal pressure)
A critical care nurse is caring for a client with acute pancreatitis. One potentially severe complication involves the respiratory system. Which of the following would be an appropriate intervention to prevent complications associated with the respiratory system? a. Maintain the client in a semi-Fowler's position. b. Administer enteral or parenteral nutrition. c. Carry out wound care as prescribed. d. Withhold oral feedings.
a ( must be over 35 BMI and have chronic condition)
A nurse cares for a client with a BMI of 36 kg/m2 and nonalcoholic fatty liver disease. The client asks the nurse if he is a candidate for bariatric surgery. How should the nurse respond to the client? a. "Yes, your BMI and chronic condition meets the criteria for bariatric surgery." b. "Yes, your chronic condition meets the criteria for bariatric surgery but not your BMI." c. "No, you do not have any qualifying criteria for bariatric surgery." d. "No, you have one qualifying condition but not the other; this excludes you from bariatric surgery."
d
A nurse cares for a client with interstitial pancreatitis. What client teaching will the nurse include when planning care for the client? a. "Normal function returns after about 2 weeks." b. "Inflammation spreads to the surrounding glands." c. "Tissue necrosis occurs within the pancreas." d. "Inflammation is confined to only the pancreas."
c
A nurse prepares community teaching on healthy lifestyle modifications to a group of older adults. When discussing obesity rates of older adults in comparison with the rest of the population, what will the nurse include? a. "Older adults have a greatly reduced prevalence of obesity in comparison to the general population." b. "Older adults have a slightly reduced prevalence of obesity in comparison to the general population." c. "Older adults have a slightly higher prevalence of obesity in comparison to the general population." d. "Older adults have the same prevalence of obesity in comparison to the general population."
