Silvestri questions test 2

A client is hospitalized with a diagnosis of viral hepatitis. To detect any difficulty in coping with this disease, the nurse should ask which question?

"Have you enjoyed having visitors?"

A nurse is reviewing laboratory test results for a client with liver disease and notes that the client's albumin level is low. The nurse next assesses the client for which physiological effect of decreased circulating albumin?

Peripheral edema

A client in a long-term care facility is being prepared to be discharged to home in 2 days. The client has been eating a regular diet for a week; however, he is still receiving intermittent enteral tube feedings and will need to receive these feedings at home. The client states concern that he will not be able to continue the tube feedings at home. Which nursing response is most appropriate at this time?

Tell me more about your concerns with your diet after going home."

spider angiomas are commonly seen in?

cirrhosis of the liver

The nurse is developing a plan of care for a client with cirrhosis and ascites. Which nursing actions should be included in the care plan for this client? Select all that apply. 1.Monitor daily weight. 2.Measure abdominal girth. 3.Monitor respiratory status. 4.Place the client in a supine position. 5.Assist the client with care as needed.

daily weight, abdominal girth, respiratory status, assist the client as needed

A nurse is caring for a client on a mechanical ventilator who has a nasogastric tube in place. The nurse is assessing the pH of the gastric aspirate and notes that the pH is 4.5. Based on this finding, which nursing action is appropriate?

Administer a dose of a prescribed antacid.

The nurse is reviewing the record of a client admitted to the nursing unit and notes that the client has a history of Laennec's cirrhosis. This type of cirrhosis is most commonly caused by which long-term condition?

Alcohol abuse

A client is experiencing blockage of the common bile duct. The nurse anticipates that the client's diet will be altered because the client will experience difficulty digesting which nutrient?

Fats

A nurse has implemented a bowel maintenance program for an unconscious client. The nurse would evaluate the plan as best meeting the needs of the client if which method was successful in stimulating a bowel movement?

Glycerin suppository

A client's nasogastric (NG) feeding tube has become clogged. The nurse should take which action first?

Aspirate the tube.

The nurse provides dietary instructions to a client with a diagnosis of cholecystitis. Which food item identified by the client indicates an understanding of foods to avoid? fruit gravy vegetables poultry without skin

brown gravy

A nurse is reviewing the health care provider's prescriptions written for a client admitted to the hospital with acute pancreatitis. Which prescription should the nurse confirm?

full liquid diet

The nurse is performing an assessment on a client with acute pancreatitis who was admitted to the hospital. Which assessment question would most specifically elicit information regarding the pain that is associated with acute pancreatitis?

"Does the pain in your stomach radiate to the back?"

A sexually active 20-year-old client has developed viral hepatitis. Which client statement indicates the need for further teaching? 1."A condom should be used for sexual intercourse." 2."My partner should get the vaccine." 3."I can go back to work right away." 4. " should avoid drinking alcohol."

"I can go back to work right away." Rationale:Rest is especially important until laboratory studies show that liver function has returned to normal. The client's activity is increased gradually, and the client should not return to work right away.

The nurse has given instructions to a client with hepatitis about post-discharge management during convalescence. The nurse determines that further teaching is needed if the client makes which statement? 1. need to avoid alcohol and aspirin." 2."I should eat a high-carbohydrate, low-fat diet." 3."I can resume a full activity level within 1 week." 4."I need to take the prescribed amounts of vitamin K."

"I can resume a full activity level within 1 week."

A client experiencing chronic dumping syndrome makes the following comments to the nurse. Which one indicates the need for further teaching? 1."I eat at least three large meals each day." 2."I eat while lying in a semirecumbent position." 3."I have eliminated taking liquids with my meals." 4."I eat a high-protein, low- to moderate-carbohydrate diet."

"I eat at least three large meals each day." rationale: To manage this syndrome, clients are encouraged to decrease the amount of food taken at each sitting, eat in a semirecumbent position, eliminate ingesting fluids with meals, and avoid consumption of high-carbohydrate meals.

The nurse has taught the client about an upcoming endoscopic retrograde cholangiopancreatography procedure. The nurse determines that the client needs further information if the client makes which statement? 1."I know I must sign the consent form." 2."I hope the throat spray keeps me from gagging." 3."I'm glad I don't have to lie still for this procedure." 4."I'm glad some IV medication will be given to relax me.

"I'm glad I don't have to lie still for this procedure."

The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that there is documentation of the presence of asterixis. How should the nurse assess for its presence?

Ask the client to extend the arms.

A client with viral hepatitis states, "I am so yellow." What is the most appropriate nursing action?

Assist the client in expressing feelings.

A client with liver dysfunction exhibits low serum levels of thrombin. The nurse provides care, knowing that this client is most at risk for which complication?

Bleeding

The nurse is caring for a client with a resolved intestinal obstruction who has a nasogastric tube in place. The client has tolerated the tube being clamped every 2 hours for 1 hour. The health care provider has now prescribed that the nasogastric tube be removed. What is the priority nursing assessment prior to removing the tube?

Checking for the presence of bowel sounds in all four quadrants

The nurse is providing dietary instructions to a client hospitalized for pancreatitis. Which food should the nurse instruct the client to avoid?

Chili Rationale:The client with pancreatitis needs to avoid alcohol, coffee and tea, spicy foods, and heavy meals,

A nurse is caring for a client diagnosed with suspected acute pancreatitis. When reviewing the client's laboratory results, the nurse interprets that which finding will support the diagnosis?

Elevated serum lipase level

The nurse is providing care for a client with a Sengstaken-Blakemore tube. The nurse suspects which diagnosis for this client?

Esophageal varices Rationale:A Sengstaken-Blakemore tube may be used in a client with a diagnosis of cirrhosis with ruptured esophageal varices if other treatment measures are unsuccessful.

A client with cirrhosis complicated by ascites is admitted to the hospital. The client reports a 10-lb weight gain over the last 1½ weeks. The client has edema of the feet and ankles, and his abdomen is distended, taut, and shiny with striae. Which client problem is most appropriate at this time?

Excessive body fluid volume

A client with chronic pancreatitis needs information on dietary modification to manage the health problem. Which item in the diet should the nurse teach the client to limit?

Fat Rationale: The client with chronic pancreatitis should limit fat in the diet and also take in small meals, which will reduce the amount of carbohydrates and protein that the client must digest at any one time. The client does not need to limit water-soluble vitamins in the diet.

A client is admitted to the hospital with severe weight loss after extreme dieting. The nurse plans care, knowing that which physiological processes occur in the prolonged absence of adequate food intake?

Gluconeogenesis

The nurse has been caring for a client who required a Sengstaken-Blakemore tube because other treatment measures for esophageal varices were unsuccessful. The health care provider arrives on the nursing unit and deflates the esophageal balloon. After deflation of the balloon, the nurse should monitor the client most closely for which complication?

Hematemesis

A nurse is caring for a hospitalized client who has been diagnosed with pancreatitis. The nurse checks the laboratory results form, anticipating that which enzyme will remain normal in the client? 1.Lipase 2.Lactase 3.Trypsin 4.Amylase

Lactase

The nurse is preparing to insert a nasogastric (NG) tube as prescribed for the purpose of stomach decompression. The nurse reviews the health care provider's (HCP) prescriptions and anticipates that the HCP will prescribe which type of suction pressure and control?

Low and intermittent

The nurse is reviewing the laboratory results for a client with cirrhosis and notes that the ammonia level is elevated. Which diet does the nurse anticipate to be prescribed for this client?

Low-protein diet

A client with a diagnosis of stomach ulcer from gastric hyperacidity asks the nurse why the acid has not caused an ulcer in the small intestine as well. The nurse responds that the pH of intestinal contents is raised by bicarbonate, which is present in which area of the body?

Pancreatic Juice Rationale:Pancreatic juice is rich is bicarbonate, which helps to neutralize the gastric acid in food entering the small intestine from the stomach.

A client is experienced delayed gastric emptying. The nurse plans care, knowing that dysfunction of which structures is responsible for the client's symptoms?

Pyloric sphincter

After performing an initial abdominal assessment on a client with a diagnosis of cholelithiasis, the nurse documents that the bowel sounds are normal. Which description best describes "normal bowel sounds"?

Relatively high-pitched clicks or gurgles auscultated in all four quadrants

Lactulose (Chronulac) is prescribed for a hospitalized client with a diagnosis of hepatic encephalopathy. Which assessment finding indicates that the client is responding to this medication therapy as anticipated?

The fecal pH is acidic.

A client with viral hepatitis is discussing with the nurse the need to avoid alcohol and states, "I'm not sure I can avoid alcohol." What is the most appropriate nursing response?

""I'm not sure that I understand. Would you please explain?"

The nurse is caring for a client admitted to the hospital with a suspected diagnosis of acute appendicitis. Which laboratory result should the nurse expect to note if the client does have appendicitis?

Leukocytosis with a shift to the left

The nurse is providing discharge instructions to a client following gastrectomy and should instruct the client to take which measure to assist in preventing dumping syndrome? Ambulate following a meal. 2.Eat high-carbohydrate foods. 3.Limit the fluids taken with meals. 4.Sit in a high Fowler's position during meals.

Limit the fluids taken with meals.

A client has been diagnosed with gastroesophageal reflux disease (GERD). The nurse plans care, knowing that the client has dysfunction of which part of the digestive system?

Lower esophageal sphincter (LES)

A client with acute pancreatitis is experiencing severe pain from the disorder. The nurse determines that the client understands suggestions for positioning to reduce pain if he or she avoids which action?

Lying flat

The nurse is providing instructions to a client regarding measures to minimize the risk of dumping syndrome. The nurse should make which suggestion to the client?

Maintain a low Fowler's position while eating.

Cholestyramine resin (Questran Light) is prescribed for a client with an elevated serum cholesterol level. The nurse should instruct the client to take the medication in which way?

Mixed with fruit juice

A client with viral hepatitis has no appetite, and food makes the client nauseated. Which nursing intervention would be most appropriate?

Monitor for fluid and electrolyte imbalance

A nurse assists a health care provider in performing a liver biopsy. After the procedure, the nurse should place the client in which position?

Right Side Rationale: To splint and provide pressure at the puncture site, the client is kept on the right side for a minimum of 2 hours after a liver biopsy.

The nurse is performing an assessment on a client with a suspected diagnosis of acute pancreatitis. The nurse will direct the assessment to look for which as a hallmark sign of this disorder?

Severe abdominal pain that is unrelieved by vomiting

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence?

Sweating and pallor Rationale: Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.

The nurse is monitoring a client with cirrhosis of the liver for signs of hepatic encephalopathy. Which assessment finding would the nurse note as an early sign of hepatic encephalopathy?

The presence of asterixis

A home care nurse is visiting a client with a diagnosis of pernicious anemia that developed as a result of gastric surgery. In teaching the client about this condition, the nurse explains that the stomach lining is producing a decreased amount of intrinsic factor, so the client will need which medication?

Vitamin B12 injections

A client has been diagnosed with pernicious anemia. In planning care for the client, the nurse should anticipate that the client will be treated with which substance?

Vitamin b12

The nurse is caring for a client who had a subtotal gastrectomy. The nurse should assess the client for which signs and symptoms of dumping syndrome?

Weakness, diaphoresis, and diarrhea

A client is experiencing blockage of the common bile duct. Which food selection made by the client indicates the need for further teaching?

whole milk

A hospitalized client is diagnosed with pancreatitis. The nurse plans care, knowing that production of which substance will be elevated in blood studies for this client?

Amylase

The nurse is caring for a client who is receiving intermittent feeding via a nasogastric (NG) tube. Before administering a feeding to the client, the nurse should perform which action first?

Check the placement of the tube.

A client who has undergone gastric surgery has a nasogastric (NG) tube connected to low intermittent suction that is not draining properly. Which action should the nurse take initially?

Check the suction device to make sure it is working

A nurse manager is providing an educational session to nursing staff members about the phases of viral hepatitis. The nurse manager tells the staff that which clinical manifestation(s) is/are primarily characteristic of the preicteric phase?

Fatigue, anorexia, and nausea

The nurse is preparing to discontinue a client's nasogastric tube. The client is positioned properly, and the tube has been flushed with 15 mL of air to clear secretions. Before removing the tube, the nurse should make which statement to the client?

"Take a deep breath when I tell you and hold it while I remove the tube."

A client seen in the ambulatory care clinic has ascites and slight jaundice. The nurse should assess the client for a history of chronic use of which medication?

Acetaminophen (Tylenol)

The nurse is developing a teaching plan for a client with viral hepatitis. The nurse should plan to include which information in the teaching session?

Activity should be limited to prevent fatigue.

The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? Select all thatapply. 1. Administer antacids as prescribed. 2.Encourage coughing and deep breathing. 3.Administer anticholinergics as prescribed. 4.Give small, frequent high-calorie feedings. 5.Maintain the client in a supine and flat position. 6.Give opioid analgesics as prescribed for pain.

Administer antacids as prescribed Encourage coughing and deep breathing. Administer anticholinergics as prescribed Give opioid analgesics as prescribed for pain

A client with liver dysfunction is having difficulty with protein metabolism. The nurse checks the laboratory results, expecting that the results of which serum laboratory values will be elevated?

Ammonia

A Penrose drain is in place on the first postoperative day in a client who has undergone a cholecystectomy procedure. Serosanguineous drainage is noted on the dressing covering the drain. Which nursing intervention is most appropriate?

Change the dressing Rationale:Serosanguineous drainage with a small amount of bile is expected from the Penrose drain for the first 24 hours.

The nurse should incorporate which in the dietary plan to ensure optimal nutrition for the client during the acute phase of hepatitis? Select all that apply. 1.Select foods high in protein content. 2.Consume multiple small meals throughout the day. 3.Select foods low in carbohydrates to prevent nausea. 4.Allow the client to select foods that are most appealing. 5.Eliminate fatty foods from the meal trays until nausea subsides. 6.Eat a nutritious dinner because it is typically the best tolerated meal of the day.

Consume multiple small meals throughout the day. Allow the client to select foods that are most appealing. Eliminate fatty foods from the meal trays until nausea subsides.

The nurse who is caring for a client with a diagnosis of cirrhosis is monitoring the client for signs of portal hypertension. Which initial sign, if noted in the client, indicates the presence of portal hypertension?

Crackles on auscultation of the lungs Rationale:Clinical signs and symptoms of portal hypertension are similar to those of heart failure and include jugular vein distention, lung crackles, and decreased perfusion to all organs.

A nurse is providing a simple overview of the anatomy of the liver and gallbladder for a client hospitalized with biliary obstruction. The nurse explains that normally the liver stores bile in the gallbladder and that the liver and gallbladder are connected together by which passageway?

Cystic duct

The nurse inspects the color of the drainage from a nasogastric tube on a postoperative client approximately 24 hours after gastric surgery. Which finding indicates the need to notify the health care provider?

Dark red drainage

The nurse checks the gastric residual of an unconscious client receiving nasogastric tube feedings continuously at 50 mL/hr. The nurse notes that the residual is 200 mL. The nurse determines that the client is experiencing which complication?

Delayed gastric emptying

The nurse has provided home care instructions to a client who had a subtotal gastrectomy. The nurse instructs the client regarding the signs and symptoms associated with dumping syndrome. Which signs and symptoms, if identified by the client, would indicate an understanding of this potential complication after gastrointestinal (GI) surgery?

Diaphoresis and diarrhea

The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is most appropriate?

Document the findings.

The nurse is reviewing the results of serum laboratory studies for a client admitted for suspected hepatitis. Which laboratory finding is most associated with hepatitis requiring the nurse to contact the health care provider?

Elevated serum bilirubin level

The health care provider has determined that a client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis?

Hepatitis A

The nurse is caring for a client with acute pancreatitis and is monitoring the client for paralytic ileus. Which assessment data should alert the nurse to this occurrence

Inability to pass flatus

The nurse is caring for a client following a Billroth II procedure. Which postoperative prescription should the nurse question and verify? Leg exercises 2.Early ambulation 3.Irrigating the nasogastric tube 4.Coughing and deep-breathing exercises

Irrigating the nasogastric tube

The nurse is teaching the client with viral hepatitis about the stages of the disease. The nurse should explain to the client that the second stage of this disease is characterized by which specific assessment findings? Select all that apply 1. Jaundice 2.Flu-like symptoms 3.Clay-colored stools 4.Dark or tea-colored urine 5.Elevated bilirubin levels

Jaundice Clay-colored stools Dark or tea-colored urine Elevated bilirubin level

A hospitalized client with liver disease has a dietary protein restriction. The nurse encourages intake of which complete proteins to maximize the availability of essential amino acids?

Meats

A client with cirrhosis has ascites and excess fluid volume. Which assessment findings does the nurse anticipate to note as a result of increased abdominal pressure? Select all that apply. 1.Orthopnea, dyspnea 2.Petechiae and ecchymosis 3.Inguinal or umbilical hernia 4.Poor body posture and balance 5.Abdominal distention and tenderness

Orthopnea, dyspnea Petechiae and ecchymosis Inguinal or umbilical hernia Abdominal distention and tenderness

A nurse is caring for a client with cirrhosis. As part of dietary teaching to minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the material if the client states to increase intake of which food?

PORK

A nurse is reviewing laboratory test results for the client with liver disease and notes that the client's albumin level is low. Which nursing action is focused on the consequence of low albumin levels?

Palpating for peripheral edema

After undergoing Billroth I gastric surgery, the client experiences fatigue and complains of numbness and tingling in the feet and difficulties with balance. On the basis of these symptoms, the nurse suspects which postoperative complication?

Pernicious anemia

The nurse is assisting a health care provider (HCP) with the insertion of a Miller-Abbott tube. The nurse understands that the procedure places the client at risk for aspiration and should therefore implement which action to decrease the risk of aspiration?

Place the client in a semi- to high Fowler's position.

A client with cirrhosis is beginning to show signs of hepatic encephalopathy. The nurse should plan a dietary consultation to limit the amount of which ingredient in the client's diet at this time?

Protein

A client with liver dysfunction has low serum levels of fibrinogen and a prolonged prothrombin time (PT). Based on these findings, which actions should the nurse plan to promote the client's safety? Select all that apply 1.Monitor serum potassium levels. 2.Weigh client daily, and monitor trends. 3.Monitor for symptoms of fluid retention. 4.Provide the client with a soft toothbrush. 5.Instruct the client to use an electric razor. 6.Monitor all secretions for frank or occult blood.

Provide the client with a soft toothbrush. Instruct the client to use an electric razor. Monitor all secretions for frank or occult blood.

A client has been advanced to a solid diet after undergoing a subtotal gastrectomy. The nurse caring for the client would perform which action to minimize the risk of dumping syndrome?

Remove fluids from the meal tray.

Stages of viral hepatitis

The first (preicteric) stage includes flulike symptoms only. The second (icteric) stage includes the appearance of jaundice and associated symptoms such as elevated bilirubin levels, dark or tea-colored urine, and clay-colored stools. The third (posticteric) stage occurs when the jaundice decreases and the colors of the urine and stool return to normal.

Pancreatin (Viokase) is prescribed for a client with postgastrectomy syndrome. Which assessment finding would indicate a therapeutic effect of this medication?

The stool is less fatty and decreases in frequency. Rationale: Pancreatin aids in the digestion of protein, carbohydrate, and fat in the gastrointestinal tract. It is used to treat steatorrhea associated with postgastrectomy syndrome after bowel resection.

The nurse is obtaining a health history for a client with chronic pancreatitis. The health history is most likely to include which as a common causative factor in this client's disorder?

Use of alcohol

A home care nurse is visiting a client with a diagnosis of pernicious anemia that developed as a result of gastric surgery. The nurse instructs the client that because the stomach lining produces a decreased amount of intrinsic factor in this disorder, the client will need which medication?

Vitamin B12 injections

A nurse has taught the client with chronic pancreatitis about risk factor modification to reduce the incidence of recurrences. The nurse should determine that the client has understood the information if the client states that it will be necessary to control which factor?

alcohol intake