LGP

L= A 60-year-old client seek medical attention with symptoms of vomiting blood and passing bloody stools the tentative diagnosis is cirrhosis of the liver which information in the clients health history most likely relates to the development of cirrhosis. Select all that apply A- The client drinks a fifth of whiskey daily B- The client smokes two packs of cigarettes per day C- The client has a history of pancreatitis D- The client has been taking antihypertensive medication for the past 15 years E- The client eat poorly as a consequence of being homeless for five years F- The client has been exposed to asbestos

A, E- cirrhosis is a degenerative liver disease characterized by damaged nonfunctional liver cells the etiology of my Laennec's portal cirrhosis most common form of cirrhosis in the United States is chronic malnutrition and alcoholism chronic Malnutrition is often a consequence of alcoholism and as evidence by weight loss, muscle wasting, hair loss and fatigue

P=The nurse closely watches the client the complications related to acute pancreatitis Which complications pose the greatest risk for the client? Select all that apply A- hyperglycemia B- necrosis of the pancreas C- peritonitis D- development of jaundice E- portal hypertension F- thrombocytopenia

A,B,C- pancreatitis is the inflammation of the pancreas and can be acute or chronic. Causes the pancreatitis are structural abnormalities , abdominal trauma, metabolic disorders, infections, inflammatory bowel disease, alcoholism, and vascular disorders. One serious complication of acute pancreatitis includes hyperglycemia in which there is an imbalance of glucagon, insulin, somatostatin. This is why it is crucial for the nurse to get frequent blood sugar measurements. Another serious complication includes necrosis and hemorrhage in the pancreas. Peritonitis is another serious complication

G= "Client returns from open cholecystectomy with a nasogastric tube, a T-tube for bile drainage, and a Jackson-Pratt (JP) tube for wound drainage in place." The nurse is required to take which actions when emptying the drainage receptacle of the clients JP closed wound drain? Select all that apply A- Empty the drainage into a measuring container B- Adjust the suction setting to low continuous suction C- Squeeze the receptacle to expel air D- Release the roller clamp E- Cover the vent F-Stabilize the drainage tube.

A,C,E,F. A JP closed wound drain involves blood and exudates without using a suction machine. A vacuum or negative pressure is created by expelling air from the receptacle and replacing the cap that covers the vent while still compressing the receptacle. When emptying the receptacle, the cap that covers the vent is opened, the contents of the receptacle are emptied from the open vent and measured, air is expelled from the emptied receptacle, the vent is covered, and the tubing is stabilized to the clients gown or dressing to keep it from tugging at the insertion site

G= "Client returns from open cholecystectomy with a nasogastric tube, a T-tube for bile drainage, and a Jackson-Pratt (JP) tube for wound drainage in place." The nurse should anticipate implementing which interventions to manage this clients t-tube? Select all that apply. A-Record the amount of drainage from the T-tube B- Unclamp the T-tube at hourly intervals C- Keep the T-tube drainage bag parallel with the incision. D- Inspect the skin around the tube for irritation. E- Maintain the client in Fowler's position F-Notify the DR if the drainage changes color

A,D,E,F. A T-tube is inserted to drain bile that is continuously formed by the liver and cannot be stored and concentrated in the gallbladder, which has been surgically removed. The tube is kept unclamped immediate postoperative period. The nurse connects the tube to a collection bag and facilitates drainage by keeping the client in the fowlers position with the drainage bag below the site of insertion. The nurse inspects the skin around the tube because bile may leak around the tube insertion site and irritate the skin. The nurse measures and records the volume of drainage. The drainage may be blood tinged initially, but it should eventually appear greenish brown.

L= "The DR determines the college student has hepatitis A" When the client asks the nurse how the Hep A was acquired, what is the best answer? A-Fecal-oral route B-Insect carriers C-Infected blood D-Wound drainage

A- Infectious Hep A is generally spread by the fecal oral route. In other words, the stool contains the virus, and the pathogen is spread to the mouth of a susceptible individual. Transmission is direct after contact with the stool of a infected person or indirect by ingesting fecal contaminated food or water or food handled by a individual with the virus. The virus is also present in the blood and saliva of an infected person, however transmission thru these routes are rarer.

G="45 year old client suspected of having cholecystitis", If this client is typical of others with cholecystitis, besides localized pain, the client may describe feeling pain that is referred to which area? A- Right shoulder B- Midepigastrium C- Neck or Jaw D- Left Upper arm

A- Right Shoulder. The referred pain is felt in either the right shoulder or in the back at the level of the shoulder blades.

G="45 year old client suspected of having cholecystitis", When describing the discomfort to the nurse, the client is most likely to indicate that the pain worsens at which time? A- Shortly after eating B- When the stomach is empty C- After periods of activity Before rising in the morning

A- Shortly after eating. The characteristic upper right quadrant pain of cholecystitis typically occurs after eating. It is especially aggravated when the meal has a high fat content, which impairs bile flow and causes N/V, distention and flatulence.

G= How would a nurse reestablish negative pressure w/in the JP tube when emptying the drainage bulb reservoir? A- By compressing the bulb reservoir and closing the drainage valve B- By opening the drainage valve, allowing the bulb to fill with air C- By filling the bulb reservoir with sterile normal saline solution. D- By securing the bulb reservoir to the skin near.

A- To establish negative pressure, the vent is uncovered and the bulb is squeezed. Air and drainage are eliminated from the bulb reservoir. After the bulb is squeezed, the bulb is recapped. The JP drain is an example of a closed drainage device.

L= The physician considers performing a liver biopsy to confirm a diagnosis of cirrhosis. If the liver biopsy is performed the nurse must monitor the client immediately after the procedure for which potential complication? A- hemorrhage B- infection C- blood clots D- collapsed lung

A- after a liver biopsy the client is monitor closely for signs of hemorrhage. A person with cirrhosis is at especially high risk for bleeding or hemorrhage because liver disease results in diminished prothrombin . Prothrombinemia causes a pro long delay in the time it takes for blood to clot

L= a MRI confirms the diagnosis of hepatic cirrhosis and reveals a large amount of fluid in the peritoneal cavity. A paracentesis is planned. Which nursing action is most appropriate before assisting with the paracentesis? A- asking the client to void B- withholding food and water C- clipping hair from the clients abdomen D- placing the crash cart outside the clients room

A- an abdominal paracentesis is performed to aspirate abdominal fluid caused by ascites. The bladder is emptied just before a parencentesis. A full bladder maybe punctured as the needle is inserted through the abdominal wall.

L= Which assessment finding this indicates that the cirrhotic clients condition is worsening A- The client is difficult to arouse B- The clients output is 100 ML per hour C- The client develops pancreatitis D- The clients breath smells fruity

A- difficulty in arousing the cirrhotic client indicates a significant neurologic change it is typically a sign that the client is progressing into a hepatic coma,the clients physiologic and safety needs become even more important at this time

G= "Because the client's gallbladder was unable to concentrate and excrete bile, it could not be visualized by cholecystography. The physician orders an ultrasound of the gallbladder. The nurse explains the scheduled procedure to the client", Which comment indicates that the client has an accurate understanding of the preparation necessary for the procedure A- Preparation involves withholding food for approximately 8-12 hours B-I'll need to drink a container of barium just before the x-ray C- I'll be allowed to eat a large test meal the night before the x-ray D- Just before the test, they'll insert a large needle into one of my arm veins.

A. The person undergoing an ultrasound of the gallbladder must not eat food for approximately 8-12 hrs before the test. Restricting food helps to eliminate the presence of gas. Intestinal gas interferes with the transmission of sound waves toward the gallbladder and the scan of the structures image. Water is permitted.

L= after the paracentesis has been performed which nursing responsibility is essential? A- increasing the clients oral fluid intake B- Recording the volume of withdrawn fluid C- administering a prescribed analgesic D- encouraging the client to deep breathe

B- documentation of the total volume of aspirated fluid is essential

P= A 69-year-old client is admitted with a diagnosis of cancer of the pancreas. If this client is typical of most others who develop pancreatic cancer, the nurse would expect which early problem to be the one the client thought treatment for? A- Sharp pain B- Weight loss C- bleeding d- fainting

B- anorexia and weight loss appear early in the onset of cancer of the pancreas

L= If the client cirrhosis is advanced what will the nurse expect to find during the initial health assessment? Select all that apply A- Laboratory results revealing an elevated serum cholesterol level B- The presence of spiderlike blood vessels on the skin C- an unusually large and edematous abdomen D- An abnormally high blood glucose level E- skin that is jaundiced F- vein engorgement around the umbilicus

B, C, E,F- clients who have cirrhosis typically experience chronic fatigue ,nausea ,vomiting ,diarrhea, weight weight-loss, jaundice and a low-grade fever the client also has an enlarged liver and spleen, edema of the legs, feet, and abdomen, bruising and vein engorgement around the umbilicus. The skin of a person with cirrhosis usually manifests multiple vascular lesion with a central red body and radiating branches these are known as spider angiomas or as spider veins. They also usually have scant body hair

L= " A 23 yr old develops jaundice and goes to the clinic. Testing reveals the cause is from Hep B, the nurse gathers info on social history" What info from the clients history indicates a predisposition for acquiring hep b. Select all that apply A- The client moved from Europe B- The client is a sexually active homosexual C- The client abuses alcohol D-The client works in a restaurant E-The client has had a blood transfusion F-The client was punctured with a unused needle

B,E- Sexually active homosexual men are at particularly high risk for acquiring blood borne infections. The source of Hep B virus is the blood of the infected person or carrier. The virus is present in semen, saliva and blood. It is transmitted by sexual contact, contaminated blood products, or puncture with objects or needles that contain traces of infected blood.

L= The doctor orders a MRI instead of the liver biopsy to confirm the diagnosis. Before the MRI study is performed which nursing action is essential? A- administering a pretest sedative B- removing the clients dental bridge C- asking if the client is allergic to opiates D- inserting a Foley retention catheter

B- A MRI produces detailed images section by section using a magnetic field to visualize soft tissue structures such as tumors metallic objects a safety hazard during an MRI consequently internal metal objects such as a dental bridge should be removed jewelry ,chains and medallions are also removed

L= "Several other students are concerned about their risk for getting Hep A" To prevent the spread of Hep A, the nurse correctly advises close contacts receive which medication? A- An antibiotic B-Serum immunoglobulin C- Hepatitis vaccine D-An anti- inflammatory drug.

B- Immunoglobulin, formerly known as gamma globulin, is made from pooled donor serum containing ready made antibodies: it is recommended for post exposure to a person with Hep A. It is most effective if administered from 48 hrs to 2 weeks of exposure.

G= "45 year old client suspected of having cholecystitis", If gallstones obstruct the flow of bile, how would the nurse expect the client's stool's to appear A- Black and tarry B- Light clay- colored C- Brown with bloody mucus D- Greenish yellow

B- Light clay- colored. Bile pigments cause the normal brown appearance of stool. If bile is prevented from entering the small intestine, the stool is likely to appear clay colored.

P= which laboratory test result it elevated provides the best indication that the clients pain is caused by pancreatitis A- serum bilirubin B- serum amylase C- lactose tolerance D- glucose tolerance

B- and elevated serum amylase level is the most reliable evidence of pancreatitis

L= The nurse informs the client who has hepatitis B it is essential to avoid which activity for life? A- Sexual activity B- Donating blood C- Drinking alcohol D- Traveling to foreign countries

B- donating blood is not recommended for people who have hepatitis. The virus remains in the blood years after the person has had the acute illness and can be passed to others. Blood collection personnel are taught to screen and reject any potential donor indicates having jaundice

P= The client has an advance directive that request no aggressive treatment. The client is referred to hospice care. If the client has pain medication ordered every 3 to 4 hours as necessary, which action by the hospice nurse is Miss appropriate to promote maximum comfort at this time? A-give the medication immediately upon request B- administer the medication every three hours C- ask the doctor to prescribe a high dose D- give the medication when the pain is severe

B- it is better to control pain before it escalates. When pain is intense, relief is more difficult to achieve. Peaks and valleys of pain are reduce by ministering pain relieving drugs on a routine schedule throughout a 24 hour. And just when it becomes absolutely necessary to do so. The goal was to keep the client free from pain yet not dull consciousness or the inability to communicate.

P= A 48-year-old client ones to the ER because of severe upper abdominal pain. The client reports that the pain came on suddenly a few hours ago and nothing so far has relieved it. The nurse observes that the client is curled in a fetal position and is rocking back-and-forth. A diagnosis of acute pancreatitis is made. Which action would best assist the nurse in further assessing the clients pain? A- determine if the client can stop moving B- asking the client to rate the pain from 0 to 10 C- observing whether the client is breathing heavily d- giving the client a prescribed pain relieving drug

B- pain is a subjective experience. Asking the client to rate the pain helps to assess it intensity. A numerical rating scale can be used later to evaluate the effectiveness of the pain relief techniques used

L= The seriousness of the clients condition is explain to the client spouse. This spouse is prepared for the possibility of the clients death. When the client spouse begins crying recalling various significant events they shared together which nursing action is most therapeutic at this time? A- offer to call a close family member B- listen to the spouses expression of thoughts C- suggest calling a clergyman from their church D- ask about the spouses future plans

B- working through grief involves dealing with a loss. Reviewing one's life is often a task that takes place in anticipatory grieving. This is therapeutic and should not be suppressed. Therefore active listening is the most appropriate nursing measure

L=After a liver biopsy which nursing order is most appropriate to add to the clients care plan A- ambulate the client twice each shift B- keep the client in high Fowlers position C- position the client on the right side D-elevate the client legs on two pillows

C- by positioning the client on the right side the weight of the body tends to put pressure on the puncture site. This compression helps to reduce or prevent bleeding

L= which laboratory results if elevated is most indicative that the client may develop a hepatic encephalopathy A- serum creatinine B- serum bilirubin C- blood ammonia D- blood urea nitrogen

C- rising levels of ammonia in the blood are toxic to the central nervous system and can cause alterations in consciousness

G= When the nurse assesses the T- tube in the early post operative period, which finding requires immediate action A-The drainage bag is hanging below the abdomen B- The drainage tubing is currently clamped C- The drainage tube is taped to the clients right side D- The drainage volume was 100ml in the past 6 hrs

B. The tube should remain unclamped until beginning to resume oral feedings. Clamping the tube would cause reflux of bile toward the liver

G= "Ultrasound of the clients gallbladder reveals stones in the common bile duct. A laparoscopic cholecystectomy is scheduled", Which statements made by the nurse provide the best explanations of this procedure. Select all that apply A-The procedure will require moderate sedation B- The surgery will require a long period of gastric decompression C- The abdomen will be inflated with carbon dioxide to provide a maximum view. D- There will be 4 small puncture sites E-Most clients return home the evening after the procedure. F-A T-tube is inserted to drain bile until the surgical wound heals.

C,D,E. Laparoscopic cholecystectomy is the preferred surgical procedure for gallbladder removal in about 80% of cases. The procedure involves general sedation, and is performed using a endoscope inserted in one of four sites on the abdomen. Carbon dioxide is used to inflate the abdomen to displace the abdominal structures and make visualization easier. Most clients return home the same evening after the procedure.

G= "45 year old client suspected of having cholecystitis", If the cause of the clients inflamed gallbladder is gallstones, the nurse would anticipate the laboratory data to indicate which finding A-Low RBC count B- Low hemoglobin level C- Elevated cholesterol level D- Elevated serum albumin level

C- Elevated cholesterol level. Evidence suggests that an elevated cholesterol level predisposes certain clients to gallstone formation. The majority of gallstones are thought to form when the bile in the gallbladder is thick, high in cholesterol and low in bile acids

L=Which assessment finding indicates that the client has bleeding from somewhere in the upper G.I. tract A- The client has mid epigastric pain B- The client states I feel nauseated C- The client stools are black and sticky D- The clients abdomen is distended and board like

C- In the absence of the client taking an oral iron supplement black or tarry stools indicate that a significant amount of blood is being lost from the stomach or somewhere in the proximal end of the intestine if the bleeding where from the rectal or anal area the blood would be bright red

P= The doctor needs of the client provide information pancreatic cancer has metastasize, making aggressive treatment on unrealistic . The clients condition is terminal. The client asked the nurse, am I dying?. What is the best response from the nurse? A- yes, you have little time left B- no, you're not going to die C- tell me about how you are feeling D- is there someone you would like me to call

C- The most therapeutic response in this situation is to encourage the client to talk about thoughts and feelings. People who are dying often know without being told that they are terminal.

P= after the client has maintain a NPO status for several days the NG tube is removed and the client is placed on a bland low-fat diet , which food should the nurse remove from the clients breakfast tray A- stewed prunes B- skim milk C- scrambled eggs D- whole wheat toast

C- The nurse would be correct to remove scrambled eggs from the dietary tray of a client on a bland, low-fat diet. One scrambled egg candy made with milk and butter and has approximately 8 g of fat

P= before the client with acute pancreatitis is discharge from hospital, which information is essential for the client to receive? A- The client must never donate blood again B- The client must avoid lifting heavy objects C- The client must not drink alcohol in any form D- The client must forgo taking strong laxatives

C- there is an established relationship between the chronic consumption of alcohol and the incidence of pancreatic us. Once an acute attack of pancreatitis has occurred, the client is at risk for chronic pancreatitis Use of alcohol leads to continued inflammation of the pancreas. It is essential to protect the pancreas from further irritation because serious complications including the destruction of the organ itself , shock and even death can occur

G="45 year old client suspected of having cholecystitis", When the dietician has finished instructing the client about a low fat diet, the nurse knows the client needs more teaching based on which statement A- "I can eat chicken that has been broiled" B- Because fish is good for me, I can still eat a lot of fish" C- I can have a hamburger and fries when I go out to eat D-I guess I'll eat more roasted turkey for dinner

C-I can have a burger and fries when I go out. Greasy fried foods and fatty meats are not allowed on a low fat diet

G= When the client begins to consume food again, which routine for clamping and unclamping the tube should the nurse plan to follow? A-Unclamp the tube during the day B- Unclamp the tube during the night C- Unclamp for 2 hrs. after eating D- Unclamp for 2 hrs before eating

C. Because the bile is essential to digestion, the tube is generally unclamped for up to 2 hrs after a meal is consumed. As healing takes place and edema is reduced, some bile begins draining into the small intestine even when the tube is clamped.

L= "A 20 yr old college student goes to the clinic after developing a sudden onset of flu like symptoms" When the health nurse monitors the clients laboratory test results, which elevated level would strongly suggest a possible liver disorder? A-Serum potassium B- Serum creatinine C- Blood urea nitrogen (BUN) D- Alanine aminotransferase (ALT)

D- Alanine and aspartate aminotransferase, previously called transaminase, are blood tests performed liver function. Liver and other organ diseases result in elevated levels of these particular enzymes. The tests are repeatedly periodically to evaluate the clients response to treatment.

L= The care plan indicates the nurse should monitor the client with the roses each day for signs and symptoms of ascites. To implement this nursing order which nursing action is most appropriate? A-reviewing the clients serum Bilirubin levels B- monitoring the client for vomiting and diarrhea C- pressing on the clients abdomen testing for rebound tenderness D- measuring the clients abdominal circumference

D- Ascites is the collection of fluid within the peritoneal cavity and as a consequence of cirrhosis. It is caused by portal hypertension. Signs of ascites include visible and massive abdominal swelling.

L=" A infection control nurse is consulted on measures for reducing the potential transmission of the Hep A virus to others." On the basis of the routes of transmission for this disease, which infection control measure is essential to include in the clients care plan? A-Wear gloves whenever entering the clients room B-Don a mask and gown when providing direct care C-Maintain the client in a private room at all times D-Perform vigorous hand washing after leaving the room.

D- Conscientious hand washing is the best defense against disease transmission.

P=The doctor orders the insertion of a NG tube and the clients fluid and nutritional needs are temporarily met by IV fluid. While assessing the IV infusion the nurse should report which finding immediately to the charge nurse? A- The tubing is coiled on the top of the mattress B- The container has approximately 100 ML of fluid left C- The fluid is infusing into a vein in the clients non-dominant hand D- less fluid that ordered has infused at this time

D- The nurse assigned to care for a client with an IV infusion has a responsibility to monitor the infusion ensure that it is in stilling the prescribed Volume at the correct rate any volume more or less than prescribed must be reported to the nurse in charge

L= The clients IV line has infiltrated and has to be removed and restarted in a new site. The nurse collaborates with the RN about assisting with these procedures. Which nursing action is most appropriately delegated to the LPN? A- clean the new insertion site with antiseptic B- flush the IV with no more than 1 ML at any given time C- obtain a vile of vitamin K to keep at the bedside D- apply pressure to the old insertion site after IV removal

D- because of the tendency for a client with the cirrhosis to bleed, the lpn should apply sustained pressure for a longer period to prevent hematoma formation and bruising

G= "Client returns from open cholecystectomy with a nasogastric tube, a T-tube for bile drainage, and a Jackson-Pratt tube for wound drainage in place." Immediately after surgery, the nurse assesses the drainage from the T- tube. Which assessment finding best indicates the drainage color is normal at this time? A-Dark red or pale pink B-Clear or transparent C- Bright red or orange D-Greenish yellow or brown

D. The pigment found in bile is derived from hemoglobin. Depending on the concentration of pigment, the normal appearance of bile drainage is green-yellow to orange-brown. Bile is generally clear, but clear is not a color.

L= Which measure is most appropriate if a nurse who has not received a series of vaccinations for Hep B experiences a needle stick injury while caring for this client? A-Obtain immediate immunization with Hep B vaccine B-Receive hep B immunoglobulin within 1 week C- Take penicillin (Pentam) for minimum of 10 days D-Scrub the puncture site with diluted household bleach.

For anyone who has not been vaccinated for hepatitis B the best action after exposure to the blood of someone with hepatitis B is to receive hepatitis B immunoglobulin within 24 hours but no later than seven days