HCIV Unit 3 Exam
A patient with Hepatitis A asks you about the treatment options for this condition. Your response is? (RegisteredNurseRN Hepatitis A,B,C,D,E Quiz) A) Antiviral medications B) Interferon C) Supportive care/rest D) Hepatitis A vaccine
C) Supportive care/rest
The nurse's assignment consists of four clients. From highest to lowest priority, in which order should the nurse assess the clients after receiving the morning report? All options must be used. (Lippincott Test 7 pg 473) 1) The client with cirrhosis who became confused and disoriented during the night 2) The client who is 1 day post-op following a cholecystectomy and has a T tube inserted 3) The client with acute pancreatitis who is requesting pain medication 4) The client with hepatitis B who has questions about discharge instructions
1, 3, 2, 4
The nurse is assessing a client with cirrhosis who has developed hepatic encephalopathy. The nurse should notify the HCP of a decrease in which serum lab value that is a potential precipitating factor for hepatic encephalopathy? (Lippincott Test 7 pg 471) A) Aldosterone B) Creatinine C) Potassium D) Protein
C) Potassium Rationale: Hypokalemia is a precipitating factor in hepatic encephalopathy. A decrease in creatinine results form muscle atrophy; an increase in creatinine would indicate renal insufficiency not hepatic encephalopathy. With liver dysfunction, increased aldosterone levels are seen but are not a precipitating factor for hepatic encephalopathy. A decrease in serum protein will decrease colloid osmotic pressure and promote edema, however, it does not cause hepatic encephalopathy.
A 55-year-old male patient is admitted with a massive GI bleed. The patient is at risk for what type of acute kidney injury? (RegisteredNurseRN AKI Quiz) A) Post-renal B) Intra-renal C) Pre-renal D) Intrinsic renal
C) Pre-renal
The nurse is caring for a patient with cirrhosis who has hepatic encephalopathy. Which assessment finding should the nurse report to the HCP? (Iggy Chp. 53 pg 1174) A) Fatigue B) Difficulty sleeping C) Seizure D) Disoreintation
C) Seizure
A 55 year old male patient is diagnosed with chronic kidney disease. The patient's recent GFR was 25 mL/min. What stage of chronic kidney disease is this known as? (RegisteredNurseRN CKD Quiz) A) Stage 1 B) Stage 3 C) Stage 4 D) Stage 5
C) Stage 4
A client with ascites and peripheral edema is at risk for impaired skin integrity. To prevent skin breakdown, what should the nurse do? (Lippincott Test 7 pg 472) A) Institute ROM exercises every 4 hours B) Massage the abdomen once a shift C) Use an alternating air pressure mattress D) Elevate the lower extremities
C) Use an alternating air pressure mattress
The nurse is caring for a client diagnosed with Hep A. Which transmission-based precautions are required when providing care for this client? SATA. (Iggy Chp. 53 pg 1167) A) Place client in a private room B) Wear a mask when handling patient bedpan C) Wear gloves when touching the client D) Wear a gown when providing personal care to this client E) Wear eye goggles when providing care
C, D
Which of the following is not a common source of transmission for Hepatitis A? SATA. (RegisteredNurseRN Hepatitis A,B,C,D,E Quiz) A) Water B) Food C) Semen D) Blood
C, D
You're providing education to a patient with an active Hepatitis B infection. What will you include in their discharge instructions? SATA. (RegisteredNurseRN Hepatitis A,B,C,D,E Quiz) A) "Take acetaminophen as needed for pain." B) "Eat large meals that are spread out through the day." C) "Follow a diet low in fat and high in carbs." D) "Do not share toothbrushes, razors, utensils, drinking cups, or any other type of personal hygiene product." E) "Perform aerobic exercises daily to maintain strength."
C, D
Select all the patients below that are at risk for acute intra-renal injury: (RegisteredNurseRN AKI Quiz) A) A 45-year-old male with a renal calculus B) A 65-year-old male with benign prostatic hyperplasia C) A 25-year-old female receiving chemotherapy D) A 36-year-old female with renal artery stenosis E) A 6-year-old male with acute glomerulonephritis F) An 87-year-old male who is taking an aminoglycoside medication for an infection
C, E, F
A client has advanced cirrhosis of the liver. The client's spouse asks the nurse why his abdomen is swollen, making it very difficult for him to fasten his pants. How should the nurse respond to provide the most accurate explanation of the disease process? (Lippincott Test 7 pg 471) A) "He must have been eating too many foods with salt in them. Salt pulls water with it." B) "The swelling in his ankles must have moved up closer to his heart so the fluid circulates better." C) "He must have forgotten to take his daily water pill." D) "Blood is not able to flow readily through the liver now, and the liver cannot make protein to keep fluid inside the blood vessels."
D) "Blood is not able to flow readily through the liver now, and the liver cannot make protein to keep fluid inside the blood vessels."
Which statement by the client who is prescribed to take pancreatic enzyme replacement indicates a need for further teaching by the nurse? (Iggy Chp. 54 pg 1194) A) "I need to take the enzymes at every meal with snacks." B) "After taking the enzymes, I should drink a glass of water." C) "I should wipe my mouth in case any enzyme got on my lips." D) "I should chew each capsule carefully so that it works in my stomach."
D) "I should chew each capsule carefully so that it works in my stomach."
The nurse is assessing a client with Hep A and notices that the AST and ALT lab values have increased. Which statement by the client indicates the need for further instruction by the nurse? (Lippincott Test 7 pg 469) A) "I require increased periods of rest." B) "I follow a low-fat, high-carb diet." C) "I eat dry toast to relieve my nausea." D) "I take acetaminophen for arthritis pain."
D) "I take acetaminophen for arthritis pain."
A client who is recovering from Hep A has fatigue and malaise. The client asks the nurse, "When will my strength return?" Which response by the nurse is most appropriate? (Lippincott Test 7 pg 469) A) "Your fatigue should be gone by now. We will evaluate you for a secondary infection." B) "Your fatigue is an adverse effect of your drug therapy. It will disappear when your treatment regimen is complete." C) "It is important for you to increase your activity level. That will help decrease your fatigue." D) "It is normal for you to feel fatigued. The fatigue should go away in the next 2-4 months."
D) "It is normal for you to feel fatigued. The fatigue should go away in the next 2-4 months."
The nurse cares for the client with chronic kidney disease. During review of lab results, the nurse notes the client's serum magnesium is increased. Which is the priority question for the nurse to ask the client? (Kaplan) A) "Are you drinking many beverages that contain caffeine?" B) "Do you notice any tremors of your hands or fingers?" C) "How many dairy products do you consume daily?" D) "What OTC medications do you take?"
D) "What OTC medications do you take?" Rationale: Antacids and laxatives may contain high levels of magnesium and should be avoided by clients with CKD because their ability to excrete magnesium is already decreased.
After completing assessment rounds, which client should the nurse discuss with the HCP first? (Lippincott Test 7 pg 472) A) A client with cirrhosis who is depressed and has refused to eat for the past 2 days B) A client with stable vital signs that has been receiving IV ciprofloxacin following a cholecystectomy for 1 day and has developed a rash on the chest and arms C) A client with pancreatitis whose family requests to speak with the HCP regarding the treatment plan D) A client with hepatitis whose pulse was 84 bpm and regular and is now 118 bpm and irregular
D) A client with hepatitis whose pulse was 84 bpm and regular and is now 118 bpm and irregular
During a home health visit, you are assessing how a patient takes the prescribed pancreatic enzyme. The patient is unable to swallow the capsule whole, so they open the capsule and mix the beads inside the capsule with food/drink. Which food or drink is safe for the patient to mix the beads with? (RegisteredNurseRN Acute and Chronic Pancreatitis Quiz) A) Pudding B) Ice cream C) Milk D) Applesauce
D) Applesauce Rationale: The patient should mix the medications with acidic foods like applesauce. It is very important the patient does NOT use alkaline foods for mixing (like dairy products, pudding etc.) because they can damaged the enzyme.
A patient is admitted to the ER with the following signs and symptoms: very painful mid-epigastric pain felt in the back, elevated glucose, fever, and vomiting. During the head-to-toe assessment, you notice bluish discoloration around the belly button. As the nurse, you know this is called? (RegisteredNurseRN Acute and Chronic Pancreatitis Quiz) A) Grey-Turner's Sign B) McBurney's Sign C) Homan's Sign D) Cullen's Sign
D) Cullen's Sign Memory Trick: Cullen starts with a C and the shape of the umbilicus is a Circle
The nurse is caring for a client with esophageal varices. The nurse should discuss which lab report finding with the HCP? (Lippincott Test 7 pg 471) A) Normal serum albumin B) Decreased ammonia C) Slightly decreased levels of calcium D) Elevated PT/INR
D) Elevated PT/INR
The nurse provides care for a client diagnosed with alcoholic cirrhosis. The client is at high risk to develop which complication? (Kaplan) A) Hepatitis B B) Pancreatic cancer C) Weight gain D) Epistaxis
D) Epistaxis Rationale: Bleeding is a complication for clients with cirrhosis due to decreased formation of coagulation factors. Additionally, GI bleeding is also a high risk factor for clients with cirrhosis.
A patient is diagnosed with Hepatitis A. The patient asks how a person can become infected with this condition. You know the most common route of transmission is? (RegisteredNurseRN Hepatitis A,B,C,D,E Quiz) A) Blood B) Percutaneous C) Mucosal D) Fecal-oral
D) Fecal-oral
You're caring for a 45-year-old patient who is admitted with suspected acute pancreatitis. The patient reports having extreme mid-epigastric pain that radiates to the back. The patient states the pain started last night after eating fast food. As the nurse, you know the two most common causes of acute pancreatitis are: (RegisteredNurseRN Acute and Chronic Pancreatitis Quiz) A) High cholesterol and alcohol abuse B) History of diabetes and smoking C) Pancreatic cancer and obesity D) Gallstones and alcohol abuse
D) Gallstones and alcohol abuse
The client with Hep A is experiencing fatigue, weakness, and a general feeling of malaise. The client tires rapidly during morning care. What is the most appropriate goal for this client? (Lippincott Test 7 pg 470) A) Increase mobility B) Learn new self-care skills C) Adapt to new levels of energy D) Gradually increase activity tolerance
D) Gradually increase activity tolerance
The nurse is caring for a client recently diagnosed with Hep C. In reviewing the client's history, what information will be most helpful as the nurse develops a teaching plan? The client: (Lippincott Test 7 pg 469) A) Has a history of exercise-induced asthma B) Is a scientist and is frequently exposed to multiple chemicals C) Traveled to Central America recently and ate uncooked vegetables D) Has a known history of sexually transmitted disease
D) Has a known history of sexually transmitted disease
What is the most common transmission route of Hepatitis C? (RegisteredNurseRN Hepatitis A,B,C,D,E Quiz) A) Blood transfusion B) Sharps injury C) Long-term dialysis D) IV drug use
D) IV drug use
A 25-year-old patient was exposed to the Hepatitis A virus at a local restaurant one week ago. What education is important to provide to this patient? (RegisteredNurseRN Hepatitis A,B,C,D,E Quiz) A) Inform the patient to notify the physician when signs and symptoms of viral Hepatitis start to appear B) Reassure the patient the chance of acquiring the virus is very low C) Inform the patient it is very important to obtain the Hepatitis A vaccine immediately to prevent infection D) Inform the patient to promptly go to the local health department to receive immune globulin
D) Inform the patient to promptly go to the local health department to receive immune globulin
The kidneys are responsible for performing all the following functions EXCEPT: (RegisteredNurseRN CKD Quiz) A) Activating Vitamin D B) Secreting Renin C) Secreting Erythropoietin D) Maintaining cortisol production
D) Maintaining cortisol production
A client is diagnosed with chronic kidney disease. Which finding is expected by the nurse? (Kaplan) A) Hematuria B) Polyuria C) Dysuria D) Oliguria
D) Oliguria
Your patient with chronic kidney disease is scheduled for dialysis in the morning. While examining the patient's telemetry strip, you note tall peaked T-waves. You notify the physician who orders a STAT basic metabolic panel (BMP). What result from the BMP confirms the EKG abnormality? (RegisteredNurseRN CKD Quiz) A) Phosphate 3.2 mg/dL B) Calcium 9.3 mg/dL C) Magnesium 2.2 mg/dL D) Potassium 7.1 mEq/L
D) Potassium 7.1 mEq/L
A client with a history of kidney disease is reporting weakness and lethargy. The client's EKG shows sinus bradycardia with a prolonged PR interval. Which lab value does the nurse expect to find? (Kaplan) A) Potassium 3.0 B) Potassium 3.5 C) Potassium 5.0 D) Potassium 8.5
D) Potassium 8.5
The nurse is reviewing the chart information for a client with increased ascites. The data include the following: temperature 98.9°F, HR 118, shallow respirations 26 breaths/min, BP 128/76, and SpO2 89% on room air. What should the nurse do first? (Lippincott Test 7 pg 471) A) Assess heart sounds B) Obtain a prescription for blood cultures C) Prepare for paracentesis D) Raise the head of the bed
D) Raise the head of the bed
The physician orders a patient with pancreatitis to take a pancreatic enzyme. What assessment finding demonstrates the pancreatic enzymes are working properly? (RegisteredNurseRN Acute and Chronic Pancreatitis Quiz) A) Abdominal girth is decreased B) Skin turgor is less than 2 seconds C) Blood glucose is 250 D) Stools appear formed and solid
D) Stools appear formed and solid
The nurse cares for an elderly client admitted with a diagnosis of Hepatitis A. The client is anorexic, reports weakness, is incontinent of urine, and involuntary of stool. The nurse determines that care is appropriate if which observation is made? (Kaplan) A) The staff caring for the client follows standard precautions B) The client is offered more frequent feeding during the afternoon and evening hours C) The nurse maintains the client on strict bedrest D) The nurse places the client on contact precautions
D) The nurse places the client on contact precautions
The nurse is preparing a community education program about preventing Hep B infection. Which information should be incorporated into the teaching plan? (Lippincott Test 7 pg 470) A) Hep B is relatively uncommon among college students B) Frequent ingestion of alcohol can predispose an individual to development of Hep B C) Good personal hygiene habits are most effective at preventing the spread of Hep B D) The use of condom is advised for sexual intercourse
D) The use of condom is advised for sexual intercourse
A client diagnosed with chronic kidney disease is prescribed a low-protein diet. The nurse understands this diet is prescribed for which reason? (Kaplan) A) To decrease fluid retention B) To increase diaphoresis C) To prevent hypovolemic shock D) To preserve renal function
D) To preserve renal function Rationale: A low-protein diet has favorable metabolic effects that can preserve or save kidney function.
Which precautions should the health care team observe when caring for clients with Hep A? (Lippincott Test 7 pg 472) A) Gowning when entering a client's room B) Wearing a mask when providing care C) Assigning the client to a private room D) Wearing gloves when giving direct care
D) Wearing gloves when giving direct care
The nurse instructs a client diagnosed with chronic kidney disease about the appropriate diet. The nurse determines teaching is effective if the client makes which statement? (Kaplan) A) "I love grilling red bell peppers." B) "My spouse fixes the best pork chops." C) "I have a cheese sandwich every day for lunch." D) "I eat yogurt for breakfast almost every day."
A) "I love grilling red bell peppers." Rationale: Red bell peppers are low in protein, potassium, and sodium which should be restricted in clients with CKD. The are also an excellent source of Vitamins A, C, B6, folic acid, and fiber.
The home health nurse visits a client diagnosed with Hepatitis. It is most important for the nurse to intervene if the client makes which statement? (Kaplan) A) "I take acetaminophen when I get a headache." B) "I have stopped having wine with dinner." C) "I keep my fingernails short." D) "I wash my hands before I eat."
A) "I take acetaminophen when I get a headache."
The nurse is caring for a 38-year-old male with hypertension and stage 1 CKD. The client reports lifestyle changes and feeling "better" and has stopped taking a prescribed diuretic. What is the appropriate nursing response? (Iggy Chp. 63 pg 1387) A) "The diuretic will reduce your BP, which may slow or prevent progression of your CKD." B) "Your HCP prescribed the diuretic because it will reverse the damage caused by kidney disease." C) "Taking medications is a personal decision, and you have the right to decline the prescription." D) "Since you have implemented lifestyle changes, the diuretic is likely not needed."
A) "The diuretic will reduce your BP, which may slow or prevent progression of your CKD."
A client recently diagnosed with Hep C states: "Now that you know what's wrong with me, you can just get me those new drugs to take care of it, right?" What should the nurse tell the client? (Lippincott Test 7 pg 469) A) "There are new anti-viral drugs available that may make treatment more effective and help you tolerate it better." B) "There are drugs to help with the symptoms, but once you have Hep C you will never be cured." C) "The medicine currently used to treat Hep C is very expensive, and your insurance probably will not pay for it." D) "If you continue to make the same lifestyle choices, the medicine will not make any difference."
A) "There are new anti-viral drugs available that may make treatment more effective and help you tolerate it better."
A client is diagnosed with a diagnosis of acute kidney injury. The nurse understands which explanation is the most accurate description of the client's condition? (Kaplan) A) A sudden loss of kidney function due to failure of the renal system circulation or to glomerular or tubular damage B) A progressive deterioration in kidney function that ends fatally when uremia develops C) An inflammation of the kidney pelvis, tubules, and interstitial tissues of one or both kidneys D) An inflammatory process precipitated by chemical changes in the glomeruli of both kidneys
A) A sudden loss of kidney function due to failure the renal system circulation or to glomerular or tubular damage
A patient with Hepatitis is extremely confused. The patient is diagnosed with Hepatic Encephalopathy. What lab result would correlate with this mental status change? (RegisteredNurseRN Hepatitis A,B,C,D,E Quiz) A) Ammonia 100 mcg/dL B) Bilirubin 7 mg/dL C) ALT 56 U/L D) AST 10 U/L
A) Ammonia 100 mcg/dL Rationale: When ammonia levels become high (normal 15-45 mcg/dL) it affects brain function. Therefore, the nurse would see mental status changes in a patient with this ammonia level.
A client with cirrhosis is receiving lactulose. The nurse notes the client is more confused and has asterixis. What should the nurse do next? (Lippincott Test 7 pg 470) A) Assess for GI bleeding B) Withhold the lactulose C) Increase protein in the diet D) Monitor serum bilirubin levels
A) Assess for GI bleeding Rationale: Clients with cirrhosis can develop hepatic encephalopathy caused by increased ammonia levels. Bacterial action on increased protein in the bowel will increase ammonia levels and cause the encephalopathy to worsen. GI bleeding and protein consumed in the diet increase protein in the intestine and can elevate ammonia levels. Lactulose is given to reduce ammonia formation in the intestine and should not be held since neurological symptoms are worsening. Bilirubin is associated with jaundice, not hepatic encephalopathy.
A client had a liver biopsy 1 hour ago. What should the nurse do first? (Lippincott Test 7 pg 470) A) Auscultate lung sounds B) Check for fever C) Obtain a CBC D) Apply packing to the biopsy site
A) Auscultate lung sounds Rationale: Because the biopsy needle insertion site is close to the lung, there is a risk of lung puncture and pneumothorax; therefore, immediately after the procedure, the nurse should determine diminished or absent lung sounds in the right lung.
A patient has lab work drawn and it shows positive for Hepatitis B. What education will you provide to the patient? (RegisteredNurseRN Hepatitis A,B,C,D,E Quiz) A) Avoid sexual intercourse or intimacy such as kissing until blood work is negative B) The patient is now recovered from a previous Hepatitis B infection and is now immune C) The patient is not a candidate for antiviral or interferon medications D) The patient is less likely to develop a chronic infection
A) Avoid sexual intercourse or intimacy such as kissing until blood work is negative
A patient is admitted with hepatic encephalopathy secondary to cirrhosis. Which meal option selection below should be avoided with this patient? (RegisteredNurseRN Cirrhosis Quiz) A) Beef tips and broccoli rabe B) Pasta noodles and bread C) Cucumber sandwich with a side of grapes D) Fresh salad with chopped water chestnuts
A) Beef tips and broccoli rabe Rationale: Patients who are experiencing hepatic encephalopathy are having issues with toxin buildup in the body, specifically ammonia. Remember that ammonia is the by-product of protein breakdown, and normally the liver can take the ammonia from the protein breakdown and turn it into urea (but if the cirrhosis is severe enough this can't happen). Therefore, the patient should consume foods LOW in protein until the encephalopathy subsides. Option A is very high in protein while the others are low in protein. Remember meats, legumes, eggs, broccoli rabe, certain grains etc. are high in protein.
The nurse monitors a client with cirrhosis for the development of hepatic encephalopathy. Which would be an indication that hepatic encephalopathy is developing? (Lippincott Test 7 pg 472) A) Decreased mental status B) Elevated BP C) Decreased urine output D) Labored respirations
A) Decreased mental status
The nurse instructs the family of a client diagnosed with Hepatitis A how to prevent the spread of the disease. It is most important for the nurse to include which instruction? (Kaplan) A) Family members should use separate eating utensils and drinking glasses B) Family members must avoid contact with the client's blood C) Family members cannot donate blood during the next year D) Family members with no signs or symptoms are not infected
A) Family members should use separate eating utensils and drinking glasses
The school nurse is informed that a 6th grade student in the school has been diagnosed with Hepatitis A. It is most important for the nurse to teach the parents of the classmates to observe their children for which symptom? A) Fatigue B) Increased appetite C) Tarry stools D) Pallor
A) Fatigue
Which position would be appropriate for a client with ascites? (Lippincott Test 7 pg 471) A) Fowler's B) Side-lying C) Reverse Trendelenburg D) Sims'
A) Fowler's
The nurse is preparing a client for a paracentesis. What should the nurse do? (Lippincott Test 7 pg 472) A) Have the client void immediately before the procedure B) Place the client in a side-lying position C) Initiate an IV line to administer sedatives D) Place the client on NPO status 6 hours before the procedure
A) Have the client void immediately before the procedure
You're providing an in-service on viral hepatitis to a group of healthcare workers. You are teaching them about the types of viral hepatitis that can turn into chronic infections. Which types are known to cause acute infections only? SATA. (RegisteredNurseRN Hepatitis A,B,C,D,E Quiz) A) Hepatitis A B) Hepatitis B C) Hepatitis C D) None
A) Hepatitis A
What should be implemented for a client who is in the early stages of cirrhosis? (Lippincott Test 7 pg 471) A) High-calorie, high-carb diet B) High-protein, low-fat diet C) Low-fat, low-protein diet D) High-carb, low-sodium diet
A) High-calorie, high-carb diet Rationale: For client's with liver cirrhosis without complications, a high calorie, high carb diet is preferred to provide an adequate supply of nutrients. In the early states of cirrhosis, there is no need to restrict fat, protein, or sodium.
A 65-year-old male patient has a glomerular filtration rate of 55 mL/min. The patient has a history of uncontrolled hypertension and coronary artery disease. You're assessing the new medication orders received for this patient. Which medication ordered by the physician will help treat the patient's hypertension along with providing a protective mechanism to the kidneys? (RegisteredNurseRN CKD Quiz) A) Lisinopril B) Metoprolol C) Amlodipine D) Verapamil
A) Lisinopril
A patient with stage 4 chronic kidney disease asks what type of diet they should follow. You explain the patient should follow a: (RegisteredNurseRN CKD Quiz) A) Low protein, low sodium, low potassium, low phosphate diet B) High protein, low sodium, low potassium, high phosphate diet C) Low protein, high sodium, high potassium, high phosphate diet D) Low protein, low sodium, low potassium, high phosphate diet
A) Low protein, low sodium, low potassium, low phosphate diet
The nurse understands which is the goal of a diet for clients with chronic kidney disease? (Kaplan) A) Lowered intake of protein to decrease BUN B) Lowered intake of carbs to decrease blood glucose C) Lowered intake of fats to decrease blood triglycerides D) Lowered intake of amino acids to decrease triglycerides and serum albumin
A) Lowered intake of protein to decrease BUN
The nurse is developing a teaching plan for the client with viral hepatitis. What information should the nurse include in the plan? (Lippincott Test 7 pg 470) A) Obtain adequate bedrest B) Increase fluid intake C) Take antibiotic therapy as prescribed D) Drink 8 oz of an electrolyte solution every day
A) Obtain adequate bedrest
When planning care for a client with Hep A, the nurse should review lab reports for which lab values? (Lippincott Test 7 pg 470) A) Prolonged prothrombin time B) Decreased blood glucose level C) Elevated serum potassium level D) Decreased serum calcium level
A) Prolonged prothrombin time
A client with cirrhosis who has ascites receives 100 mL of 25% albumin IV. Which finding would best indicate that the albumin is having its desired effect? (Lippincott Test 7 pg 471) A) Reduced ascites B) Increased serum albumin level C) Decreased anorexia D) Increased ease of breathing
A) Reduced ascites Rationale: Normal serum albumin is administered to reduce ascites. Administering serum albumin increases the plasma colloid osmotic pressure, which causes fluid to flow from the tissue space into the plasma. Increased urine output is the best indication that the albumin is having the desired effect. Reduced fluid = reduced ascites
While assisting a patient with chronic pancreatitis to the bathroom, you note the patient's stool to be oily/greasy in appearance. In your documentation, you note this as: (RegisteredNurseRN Acute and Chronic Pancreatitis Quiz) A) Steatorrhea B) Melena C) Currant D) Hematochezia
A) Steatorrhea
Select all the types of viral Hepatitis that have preventive vaccines available in the United States: (RegisteredNurseRN Hepatitis A,B,C,D,E Quiz) A) Hepatitis A B) Hepatitis B C) Hepatitis C D) There are no vaccines for Hepatitis
A, B
The nurse is caring for a client who is diagnosed with cirrhosis. Which serum lab value will the nurse expect to be abnormal? SATA. (Iggy Chp. 53 pg 1161) A) Prothrombin time B) Serum bilirubin C) Albumin D) AST E) LDH F) Acid phosphatase
A, B, C, D, E Rationale: ALT, AST, and LDH are typically elevated because these enzymes are released into the blood during hepatic inflammation. Total serum bilirubin levels also rise because of the inability of the failing liver to excrete bilirubin. Albumin levels decrease as a result of decreased synthesis by the liver. Loss of osmotic proteins such as Albumin promotes the movement of intravascular fluid into the interstitial tissue (ascites). Prothrombin time is prolonged because the liver decreases the production of prothrombin. A patient will experience an increase in ALKALINE phosphatase, not acid phosphatase due to biliary obstruction.
A nurse is developing a care plan for a client with hepatic encephalopathy. Which are goals for the care for this client? SATA. (Lippincott Test 7 pg 471) A) Prevent constipation B) Administer lactulose to reduce blood ammonia levels C) Monitor coordination while walking D) Check the pupil reaction E) Provide food and fluids high in carbs F) Encourage physical activity
A, B, C, D, E Rationale: Constipation leads to increased ammonia production. Lactulose is a hyperosmotic laxative that reduces blood ammonia. Hepatic encephalopathy is considered a toxic or metabolic condition that causes cerebral edema; it affects a person's coordination and pupil reaction to light and accommodation. Because exercise produces ammonia as a by-product of metabolism, physical activity should be limited, not encouraged.
The nurse is teaching an adult recreational drug user about meausures to avoid acquiring Hep A. What information should the nurse include in the instruction? SATA. (Lippincott Test 7 pg 469) A) Observing proper hand washing technique B) Following safe syringe disposal procedures C) Obtaining a vaccination D) Wearing a mask when in crowds E) Using caution with eating fresh fruits and veggies
A, B, C, E
A client was admitted to the hospital yesterday with a diagnosis of acute pancreatitis. What assessment findings will the nurse expect for this client? SATA. (Iggy Chp. 54 pg 1186) A) Severe boring abdominal pain B) Jaundice C) Nausea and/or vomiting D) Decreased serum amylase level E) Leukocytosis F) Dyspnea
A, B, C, E, F
The nurse is caring for a client in end-stage liver failure. Which interventions should be implemented when observing for hepatic encephalopathy? SATA. (Iggy Chp. 53 pg 1165) A) Assess the client's neurologic status as prescribed B) Monitor the client's hemoglobin and hematocrit levels C) Monitor the client's serum ammonia level D) Monitor the client's electrolyte values daily E) Prepare to insert an esophageal balloon tamponade tube F) Make sure the client's fingernails are short
A, C
A patient with acute renal injury has a GFR (glomerular filtration rate) of 40 mL/min. Which signs and symptoms below may this patient present with? SATA. (RegisteredNurseRN AKI Quiz) A) Hypervolemia B) Hypokalemia C) Increased BUN level D) Decreased Creatinine level
A, C Rationale: The glomerular filtration rate indicates how well the glomerulus is filtering the blood. A normal GFR tends to be 90 mL/min or higher. A GFR of 40 mL/min indicates that the kidney's ability to filter the blood is decreased. Therefore, the kidneys will be unable to remove waste and excessive water from the blood...hence hypervolemia and an increased BUN level will present in this patient. The patient will experience HYPERkalemia (not hypo) because the kidneys are unable to remove potassium from the blood.
Your patient with cirrhosis has severe splenomegaly. As the nurse, you will make it a priority to monitor the patient for signs and symptoms of? SATA. (RegisteredNurseRN Cirrhosis Quiz) A) Thrombocytopenia B) Vision changes C) Increased PT/INR D) Leukopenia
A, C, D
You're providing an in-service to new nurse graduates about esophageal varices in patients with cirrhosis. You ask the graduates to list activities that should be avoided by a patient with this condition. Which activities listed are correct? SATA. (RegisteredNurseRN Cirrhosis Quiz) A) Excessive coughing B) Sleeping on the back C) Drinking juice D) Alcohol consumption E) Straining during a bowel movement F) Vomiting
A, D, E, F
Select all the signs and symptoms associated with Hepatitis: (RegisteredNurseRN Hepatitis A,B,C,D,E Quiz) A) Arthralgia (joint stiffness) B) Bilirubin 1 mg/dL C) Ammonia 15 mcg/dL D) Dark urine E) Vision changes F) Yellowing of the sclera G) Fever H) Loss of appetite
A, D, F, G, H
The nurse is preparing a client with stage 3 CKD for discharge. Which client statement indicates the need for further teaching? (Iggy Chp. 63 pg 1383) A) "I will be sure to attend my follow-up appointment with my nephrologist." B) "I will increase my protein intake so my body can heal." C) "I will weigh myself daily and call the doctor if my weight increases by 2 lbs or more." D) "I will take my BP each day and keep a daily log."
B) "I will increase my protein intake so my body can heal."
A client is to be discharged with a prescription for lactulose. The nurse teaches the client how to administer this medication. Which statement would indicate that the client has understood the information? (Lippincott Test 7 pg 472) A) "I will take it with an antacid." B) "I will mix it with apple juice." C) "I will take it with a laxative." D) "I will mixed the crushed tablets in some gelatin."
B) "I will mix it with apple juice."
A patient who received treatment for pancreatitis is being discharged home. You're providing diet teaching to the patient. Which statement by the patient requires immediate re-education about the diet restrictions? (RegisteredNurseRN Acute and Chronic Pancreatitis Quiz) A) "It will be hard but I will eat a diet low in fat and avoid greasy foods." B) "It is very important I limit my alcohol intake to no more than 2-3 glasses of wine a week." C) "I will concentrate on eating complex carbohydrates rather than refined carbohydrates." D) "I will purchase foods that are high in protein."
B) "It is very important I limit my alcohol intake to no more than 2-3 glasses of wine a week."
Which health promotion activity should the nurse suggest that the client with cirrhosis add to the daily routine at home? (Lippincott Test 7 pg 471) A) Supplement the diet with daily multivitamins B) Abstain from drinking alcohol C) Take a sleeping pill at bedtime D) Limit contact with other people whenever possible
B) Abstain from drinking alcohol
The nurse performs discharge teaching for a client with a diagnosis of Hepatitis B. Which precaution is included in the teaching? (Kaplan) A) Burn used paper tissues B) Abstain from unprotected sexual intercourse C) Use special disinfectant in toilet D) Avoid touching family members
B) Abstain from unprotected sexual intercourse
A patient with CKD has a low erythropoietin (EPO) level. The patient is at risk for: (RegisteredNurseRN CKD Quiz) A) Hypercalcemia B) Anemia C) Blood clots D) Hyperkalemia
B) Anemia
A patient with acute pancreatitis is reporting excessive thirst, excessive voiding, and blurred vision. As the nurse, it is a priority you: (RegisteredNurseRN Acute and Chronic Pancreatitis Quiz) A) Reassure the patient this is normal with pancreatitis B) Check the patient's blood glucose C) Assist the patient with drinking a simple sugar drink like orange juice D) Provide a dark and calm environment
B) Check the patient's blood glucose
______________ is solely filtered from the bloodstream via the glomerulus and is NOT reabsorbed back into the bloodstream but is excreted through the urine. (RegisteredNurseRN AKI Quiz) A) Urea B) Creatinine C) Potassium D) Magnesium
B) Creatinine
The nurse should institute which measure to prevent transmission of the Hep C virus to health care personnel? (Lippincott Test 7 pg 473) A) Administering Hep C vaccine to all health care personnel B) Decreasing contact with blood and blood-contaminated fluids C) Wearing gloves when emptying a bedpan D) Wearing a gown and mask when providing direct care
B) Decreasing contact with blood and blood-contaminated fluids
Your patient with acute pancreatitis is scheduled for a test that will use a scope to assess the pancreas, bile ducts, and gallbladder. The patient asks you, "What is the name of the test I'm going for later today?" You tell the patient it is called: (RegisteredNurseRN Acute and Chronic Pancreatitis Quiz) A) MRCP B) ERCP C) CT scan of the abdomen D) EGD
B) ERCP
The nurse identifies which diet best meets the nutritional needs of the client newly diagnosed with cirrhosis? (Kaplan) A) High in fat and low in fiber B) High in protein and low in sodium C) High in calcium and low in fat D) High in iron and low in sodium
B) High in protein and low in sodium Rationale: Clients with cirrhosis can often be malnourished, which makes protein an important part of the diet. Additionally, the client should limit salt intake because salt can lead to complications such as fluid buildup in the abdomen (ascites).
A client with cirrhosis begins to develop ascites. Spironolactone is prescribed to treat the ascites. The nurse should monitor the client closely for which drug-related adverse effect? (Lippincott Test 7 pg 471) A) Constipation B) Hyperkalemia C) Irregular pulse D) Dysuria
B) Hyperkalemia
While assessing morning labs on your patient with CKD. You note the patient's phosphate level is 6.2 mg/dL. As the nurse, you expect to find the calcium level to be? (RegisteredNurseRN CKD Quiz) A) Elevated B) Low C) Normal D) Same as the phosphate level
B) Low
You're developing a nursing care plan for a patient in the diuresis stage of AKI. What nursing diagnosis would you include in the care plan? (RegisteredNurseRN AKI Quiz) A) Excess fluid volume B) Risk for electrolyte imbalance C) Urinary retention D) Acute pain
B) Risk for electrolyte imbalance
A patient with Stage 5 CKD is experiencing extreme pruritus and has several areas of crystallized white deposits on the skin. As the nurse, you know this is due to excessive amounts of what substance found in the blood? (RegisteredNurseRN CKD Quiz) A) Calcium B) Urea C) Phosphate D) Erythropoietin
B) Urea
The nurse is establishing goals for the client with Hep A. Which goal is appropriate? The goal will: (Lippincott Test 7 pg 470) A) Demonstrate a decrease in fluid retention related to ascites B) Verbalize the importance of reporting bleeding gums or bloody stools C) Limit use of alcohol to 2-3 drinks per week D) Restrict activity to within the home to prevent disease transmission
B) Verbalize the importance of reporting bleeding gums or bloody stools
Which finding is normal for a client during icteric phase of Hep A? (Lippincott Test 7 pg 469) A) Tarry stools B) Yellowed sclera C) Shortness of breath D) Light, frothy urine
B) Yellowed sclera
A 36-year-old male patient is diagnosed with acute kidney injury. The patient is voiding 4 L/day of urine. What complication can arise based on the stage of AKI this patient is in? SATA. (RegisteredNurseRN AKI Quiz) A) Water intoxication B) Hypotension C) Low urine specific gravity D) Hypokalemia E) Normal GFR
B, C, D
A client with jaundice has pruritus and areas of irritation from scratching. What measures can the nurse suggest the client use to prevent skin breakdown? SATA. (Lippincott Test 7 pg 471) A) Avoid lotions containing calamine B) Add baking soda to the water in the bath tub C) Keep nails short and clean D) Rub the skin when it itches with knuckles instead of nails E) Massage skin with alcohol F) Increase sodium intake in diet
B, C, D
Which patients below are at risk for developing complications related to chronic hepatitis infection, such as cirrhosis, liver cancer, and liver failure? SATA. (RegisteredNurseRN Hepatitis A,B,C,D,E Quiz) A) A 55-year-old male with Hepatitis A B) An infant who contracted Hepatitis B at birth C) A 32-year-old female with Hepatitis C who reports using IV drugs D) A 50-year-old male with alcoholism
B, C, D
A patient with Hepatitis has a bilirubin of 6 mg/dL. What findings would correlate with this lab result? SATA. (RegisteredNurseRN Hepatitis A,B,C,D,E Quiz) A) None because this bilirubin level is normal B) Yellowing of the skin and sclera C) Clay-colored stools D) Bluish discoloration on the flanks of the abdomen E) Dark urine F) Mental status changes
B, C, E
A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? SATA. (RegisteredNurseRN Cirrhosis Quiz) A) Increase albumin levels B) Ascites C) Splenomegaly D) Fluid volume deficient E) Esophageal varices
B, C, E
The nurse is caring for a 74-year-old client scheduled for a cardiac catheterization with contrast dye. What nursing action is appropriate? SATA. (Iggy Chp. 63 pg 1380) A) Assess creatinine clearance using a 24-hour urine collection test B) Assess for coexisting conditions of diabetes, HF, and kidney disease C) Collaborate with the provider about whether IV fluids should be infused before the test D) Notify the provider regarding changes in serum creatinine from 0.2 to 0.4 in 24-hours E) Alert the provider to a glomerular filtration rate below 60mL/min
B, C, E
Which client will the nurse identify as at risk for acute kidney injury? SATA. (Iggy Chp. 63 pg 1411) A) 68-year-old male with diabetes mellitus B) 16-year-old male football player in preseason practice C) 27-year-old female recovering from shock following a car accident D) 52-year-old male with newly diagnosed hypertension E) 30-year-old female in intensive care receiving multiple IV antibiotics
B, C, E
You are receiving shift report on a patient with cirrhosis. The nurse tells you the patient's bilirubin levels are very high. Based on this, what assessment findings may you expect to find during your head-to-toe assessment? SATA. (RegisteredNurseRN Cirrhosis Quiz) A) Frothy light-colored urine B) Dark brown urine C) Yellowing of the sclera D) Dark brown stool E) Jaundice of the skin F) Bluish mucous membranes
B, C, E
Select all the ways a person can become infected with Hepatitis B: (RegisteredNurseRN Hepatitis A,B,C,D,E Quiz) A) Contaminated food/water B) During the birth process C) IV drug use D) Undercooked pork or wild game E) Hemodialysis F) Sexual intercourse
B, C, E, F
The physician orders Lactulose 30 mL by mouth per day for a patient with cirrhosis. What findings below demonstrate the medication is working effectively? SATA. (RegisteredNurseRN Cirrhosis Quiz) A) Decrease albumin levels B) Decrease in Fetor hepaticus C) Patient is stuporous. D) Decreased ammonia blood level E) Presence of asterixis
B, D
A client with chronic Hep C is experiencing nausea, anorexia, and fatigue. During the health history, the client states that he is homosexual, drinks one to two glasses of wine with dinner, is taking St. John's Wort for a "bit of depression," and takes acetaminophen for frequent headaches. What should the nurse do? SATA. (Lippincott Test 7 pg 469) A) Instruct the client that the wine with meals can be beneficial for cardiovascular health B) Instruct the client to ask the HCP about taking any other medications the client is currently taking C) Instruct the client to increase the protein in his diet and eat less frequently D) Advise the client of the need for additional testing for HIV E) Encourage the client to obtain sufficient rest
B, D, E
Which condition is not a known cause of cirrhosis? (RegisteredNurseRN Cirrhosis Quiz) A) Obesity B) Alcohol consumption C) Blockage of the bile duct D) Hepatitis C E) All are known causes of cirrhosis
E) All are known causes of cirrhosis
The nurse obtains a history from a client with a diagnosis of cirrhosis. Which client statement does the nurse recognize as most directly related to the client's development of cirrhosis? (Kaplan) A) "For the past several weeks I have not slept for more than five hours a night." B) "Since my spouse left me five months ago, I have been eating terribly." C) "I have been drinking about a fifth of vodka a day for the last few years." D) "My spouse was a heavy smoker, and I am concerned about second-hand smoke."
C) "I have been drinking about a fifth of vodka a day for the last few years."
The nurse is providing discharge instructions for a client with cirrhosis. Which statement best indicates that the client has understood the teaching? (Lippincott Test 7 pg 472) A) "I should eat a high-protein, high-carb diet to provide energy." B) "It is safer for me to take acetaminophen for pain instead of aspirin." C) "I should avoid constipation to decrease chances of bleeding." D) "If I get enough rest and follow my diet, it's possible for my cirrhosis to be cured."
C) "I should avoid constipation to decrease chances of bleeding."
The nurse gives discharge instructions to the family of a patient diagnosed with hepatic encephalopathy. The nurse determines further teaching is necessary if the family makes which of the following statements? (Kaplan) A) "We should contact the HCP if our parent is restless at night." B) "Our parent may have some hand tremors." C) "Our parent should eat meat at every meal." D) "Lactulose may cause bloating and cramps."
C) "Our parent should eat meat at every meal." Rationale: Placing a client on a high-protein diet will increase the amount of ammonia in their blood.
The nurse is providing discharge teaching to a client recovering from kidney transplantation. Which client statement indicates understanding? (Iggy Chp. 63 pg 1411) A) "I can stop my medications when my kidney function returns to normal." B) "If my urine output decreases, I will increase my fluids." C) "The anti-rejection medications will be taken for life." D) "I will drink 8 ounces of water with my medications."
C) "The anti-rejection medications will be taken for life."
Which patient below is at the most risk for chronic pancreatitis? (RegisteredNurseRN Acute and Chronic Pancreatitis Quiz) A) A 25-year-old female with a family history of gallstones B) A 35-year-old male who reports social drinking of alcohol C) A 15-year-old female with cystic fibrosis D) A 66-year-old female with stomach cancer
C) A 15-year-old female with cystic fibrosis Rationale: The patient with cystic fibrosis is at MAJOR risk for CHRONIC pancreatitis because they are lacking the protein CFTR which plays a role in the movement of chloride ions to help balance salt and water in the epithelial cells that line the ducts of the pancreas. There is a decreased production of bicarbonate secretion by the epithelial cells. Therefore, this leads to thick mucus in the pancreatic ducts that can lead to blockage of the pancreatic ducts which can cause the digestive enzymes to activate and damage the pancreas. Overtime, the pancreas will experience fibrosis of the pancreas' tissue and will no longer produce digestive enzyme to help with food digestion.
Which patient below is NOT at risk for developing chronic kidney disease? (RegisteredNurseRN CKD Quiz) A) A 58 year old female with uncontrolled hypertension B) A 69 year old male with diabetes mellitus C) A 45 year old female with polycystic ovarian disease D) A 78 year old female with an intrarenal injury
C) A 45 year old female with polycystic ovarian disease
The physician writes an order for the administration of Lactulose. What lab result indicates this medication was successful? (RegisteredNurseRN Hepatitis A,B,C,D,E Quiz) A) Bilirubin <1 mg/dL B) ALT 8 U/L C) Ammonia 16 mcg/dL D) AST 10 U/L
C) Ammonia 16 mcg/dL Rationale: Lactulose is ordered to decrease a high ammonia level. It will cause excretion of ammonia via the stool. A normal ammonia level would indicate the medication was successful (normal ammonia level 15-45 mcg/dL).
The nurse is assessing a client who is in the early stages of cirrhosis of the liver. Which focused assessment is appropriate? (Lippincott Test 7 pg 471) A) Peripheral edema B) Ascites C) Anorexia D) Jaundice
C) Anorexia
The nurse develops a teaching plan for the client about how to prevent the transmission of Hep A. Which discharge instruction is appropriate for the client? (Lippincott Test 7 pg 470) A) Spray the house to eliminate infected insects B) Tell family members to try to stay away from the client C) Ask family members to wash their hands frequently D) Disinfect all clothing and eating utensils
C) Ask family members to wash their hands frequently
The nurse is developing a teaching plan for a client with Hep A. What should the nurse tell the client to do? (Lippincott Test 7 pg 470) A) Limit caloric intake and reduce weight B) Increase carbs and protein in the diet C) Avoid contact with others and sleep in separate rooms D) Intensify routine exercise and increase strength
C) Avoid contact with others and sleep in separate rooms
A client plans to travel to a country where Hepatitis B is common. What should the nurse advise the client about the most effective way to prevent the disease? (Lippincott Test 7 pg 469) A) Drink purified water B) Avoid crowded, enclosed spaces C) Complete the vaccination series D) Observe safe sex practices
C) Complete the vaccination series
What is the best preventive measure to take to help prevent all types of viral Hepatitis? (RegisteredNurseRN Hepatitis A,B,C,D,E Quiz) A) Vaccination B) Proper disposal of needles C) Hand hygiene D) Blood and organ donation screening
C) Hand hygiene
The HCP instructs a client with alcohol-induced cirrhosis to stop drinking alcohol. The nurse should assess the client for which expected outcome? (Lippincott Test 7 pg 472) A) Absence of delirium tremens B) Having a balanced diet C) Improved liver function D) Reduced weight
C) Improved liver function
During your morning assessment of a patient with cirrhosis, you note the patient is disoriented to person and place. In addition while assessing the upper extremities, the patient's hands demonstrate a flapping motion. What lab result would explain these abnormal assessment findings? (RegisteredNurseRN Cirrhosis Quiz) A) Decreased magnesium level B) Increased calcium level C) Increased ammonia level D) Increased creatinine level
C) Increased ammonia level
A client's serum ammonia level is elevated, and the HCP prescribes 30 mL of lactulose. Which effect is common for this drug? (Lippincott Test 7 pg 472) A) Increased urine output B) Improved LOC C) Increased bowel movements D) Nausea and vomiting
C) Increased bowel movements
A patient with an AKI has a urinary output of 350 mL/day. In addition, morning labs showed an increased BUN and creatinine level along with potassium level of 6 mEq/L. What type of diet ordered by the physician is most appropriate for this patient? (RegisteredNurseRN AKI Quiz) A) Low-sodium, high-protein, and low-potassium B) High-protein, low-potassium, and low-sodium C) Low-protein, low-potassium, and low-sodium D) High-protein and high-potassium
C) Low-protein, low-potassium, and low-sodium