Test 3
An older woman with cirrhosis has anemia. What pathophysiologic changes may contribute to this patient's anemia? Select all that apply. a. Vitamin B deficiencies b. Stretching of liver capsule c. Vascular congestion of spleen d. Decreased prothrombin production e. Decreased bilirubin conjugation and excretion
A, C, D
A patient with late stage cirrhosis develops portal hypertension. Which complication can develop from this condition? A. Ascites B. Esophageal varices C. Decreased bilirubin D. Decreased spleen size E. Increased albumin levels
A, B
A patient with advanced cirrhosis is nutritionally compromised because of anorexia and an inadequate food intake. What would be an appropriate midday snack for the patient? a. Peanut butter and salt-free crackers b. A fresh tomato sandwich with salt-free butter c. Popcorn with salt-free butter and herbal seasoning d. Canned chicken noodle soup with low-protein bread
A
A patient with oral cancer is not eating. A small-bore feeding tube was inserted, and the patient started on enteral feedings. Which patient goal would best indicate improvement? A.Weight gain of 1 kg in 1 week B.Tolerated the tube feeding without nausea C. Consumed 50% of clear liquid tray this shift D. The feeding tube remained in proper placement
A
A patient with peptic ulcer disease has a slow upper GI source of bleeding. What type of bleeding would the nurse expect? a. Melena b. Occult blood c. Coffee-ground emesis d. Profuse bright-red hematemesis
A
Malnutrition can be a major problem for patients with cirrhosis. Which nursing intervention can help improve nutrient intake? a. Oral hygiene before meals and snacks b. Provide all foods the patient likes to eat c. Improve oral intake by feeding the patient d. Limit snack offers to when the patient is hungry
A
The condition of a patient who has cirrhosis of the liver has deteriorated. Which diagnostic study would best determine id the patient has developed liver cancer? A. MRI scanning B. Serum a-fetoprotein level C. Ventilation/perfusion scan D. Abdominal girth measurement
A
The nurse has completed initial instruction with a patient regarding a weight loss program. The nurse determines that the teaching has been effective when the patient makes which statement? A."I will keep a diary of weekly weights to track my weight loss." B."I plan to lose 4 pounds a week until I reach my 60-pound goal." C."I will restrict my carbohydrate intake to less than 30 g/day to maximize weight loss." D."I will not exercise more than my program requires because the activity increases the appetite.
A
The nurse is caring for a patient with abdominal pain and hematemesis. Which new assessment finding(s) would indicate the patient's condition is declining? A.Pallor and diaphoresis B.Reddened peripheral IV site C.Guaiac-positive diarrhea stools D. Heart rate 90, respiratory rate 20, BP 110/60
A
The nurse teaches a patient who has a body mass index (BMI) of 39 kg/m2 about weight loss. Which diet change would be most appropriate to recommend? A.Decrease fat intake and control portion size. B.Increase vegetables and decrease fluid intake. C.Increase protein intake and avoid carbohydrates. D.Decrease complex carbohydrates and limit fiber.
A
The nurse is caring for a patient after bariatric surgery. What would be included in the plan of care? (Select all that apply.) A. Assist with early ambulation as needed. B.Teach the patient to consume liquids with meals. C.Maintain elevation of the head of bed at 45 degrees. D.Monitor for vomiting as it is a common complication. E.Provide a diet high in carbohydrate and fat intake. F.Assess for incisional pain versus an anastomosis leak.
A, C, D, F
Which assessments would the nurse include when screening a patient for metabolic syndrome? (Select all that apply.) A.Blood pressure B.Resting heart rate C.Physical endurance D.Waist circumference E.Fasting blood glucose
A, D, E
A patient in the emergency department has acute gastrointestinal bleeding. What interventions would the nurse perform? (Select all that apply.) A. Establish 2 large bore IV lines B. Limit intravenous fluids C. Monitor intake and output every shift D. Initiate ECG monitoring E. Obtain vital signs every 8 hours
A,C
The patient has hepatic encephalopathy. What is a priority nursing intervention to keep the patient safe? a. Turn the patient every 3 hours. b. Encourage increasing ambulation. c. Assist the patient to the bathroom. d. Prevent constipation to reduce ammonia production.
C
A nurse in the PACU is caring for a severely obese patient who had surgery to repair a lower leg fracture. Which assessment is most important? A. Cardiac rhythm B.Surgical dressing C.Postoperative pain D.Oxygen saturation
D
A patient is admitted to the emergency department with profuse bright-red hematemesis. During the initial care of the patient, what is the nurse's priority? a. Establish 2 IV sites with large-gauge catheters. b. Perform a focused nursing assessment of the patient's status. c. Obtain a thorough health history to assist in determining the cause of the bleeding. d. Perform a gastric lavage with cool tap water in preparation for endoscopic examination.
B
A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcohol use, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient? A.Barium swallow B.Endoscopic biopsy C.Capsule endoscopy D.Endoscopic ultrasonography
B
A patient with cancer that has metastasized to the liver has symptoms of fluid retention, including edema and ascites. To determine the effectiveness of diuretic therapy on ascites, what should the nurse assess? A. Bowel sounds B. Abdominal girth C. Recent blood work D. Mucous membranes
B
A patient with oral cancer has a history of heavy smoking, excess alcohol intake, and personal neglect. During the patient's early postoperative course, what would the nurse anticipate that the patient may need? a. Oral nutrition supplements b. Drug therapy to prevent substance withdrawal symptoms c. Counseling about lifestyle changes to prevent recurrence of the tumor d. Less pain medication because of cross-tolerance with central nervous system (CNS) depressants
B
Following a patient's esophagogastrostomy for cancer of the esophagus, what is most important for the nurse to do? a. Report any bloody drainage from the NG tube. b. Maintain the patient in semi-Fowler's or Fowler's position. c. Monitor for abdominal distention that may disrupt the surgical site. d. Expect to find decreased breath sounds bilaterally because of the surgical approach.
B
What laboratory test results would the nurse expect in a patient with cirrhosis? a. Serum albumin: 7.0 g/dL (70 g/L) b. Total bilirubin: 3.2 mg/dL (54.7 mmol/L) c. Serum cholesterol: 260 mg/dL (6.7 mmol/L) d. Aspartate aminotransferase (AST): 6.0 U/L (0.1 mkat/L)
B
What would the nurse emphasize when teaching patients at risk for upper GI bleeding to prevent bleeding episodes? a. All stools and vomitus must be tested for the presence of blood. b. The use of over-the-counter (OTC) medications of any kind must be avoided. c. Antacids can be taken with all prescribed medications to prevent gastric irritation. d. Misoprostol (Cytotec) should be used to protect the gastric mucosa in persons with peptic ulcers.
B
When caring for a patient following a glossectomy with dissection of the floor of the mouth and a radical neck dissection for cancer of the tongue, what is the nurse's main concern? a. Achieving pain relief b. Maintaining a patent airway c. Promoting a positive body image d. Giving tube feedings to provide nutrition
B
Which esophageal disorder is described as a precancerous lesion and is associated with GERD? a. Achalasia b. Barrett's esophagus c. Esophageal strictures d. Esophageal diverticula
B
In discussing long-term management with the newly diagnosed patient with alcoholic cirrhosis, what would the nurse teach the patient? a. A daily exercise regimen is important to increase the blood flow through the liver. b. Cirrhosis can be reversed if the patient follows a regimen of proper rest and nutrition. c. Abstinence from alcohol is the most important factor in improvement of the patient's condition. d. The only over-the-counter analgesic that you should take for minor aches and pains is acetaminophen.
C
What must the patient with cirrhosis be monitored for when being treated with diuretics to treat ascites? Select all that apply. a. Gastrointestinal (GI) bleeding b. Hypokalemia c. Renal function d. Body image disturbances e. Increased clotting tendencies
B, C
Question 18 of 22 The nurse is aware of potential complications related to cirrhosis. Which interventions would be included in a safe plan of care? (Select all that apply.) A.Provide a high-protein, low-carbohydrate diet. B.Tell the patient to use soft-bristle toothbrush and electric razor. C.Teach the patient to avoid vigorous blowing of nose and coughing. D.Apply gentle pressure for the shortest possible time after venipuncture. E.Use the smallest gauge needle possible when giving injections or drawing blood. F. Teach the patient to avoid aspirin and nonsteroidal anti-inflammatory (NSAIDs).
B, C, E, F
The nurse provides discharge instructions for a patient with ascites and peripheral edema related to cirrhosis. Which patient statement indicates teaching was effective? A."Lactulose should be taken every day to prevent constipation." B."It is not safe to take acetaminophen up to four times a day for pain." C."Herbs and other spices should be used to season my foods instead of salt." D."I will eat foods high in potassium while taking spironolactone (Aldactone)."
C
A patient is hospitalized with metastatic cancer of the liver. The nurse plans care for the patient based on what knowledge? a. Chemotherapy is highly successful in the treatment of liver cancer. b. The patient will undergo surgery to remove the involved portions of the liver. c. Supportive care that is appropriate for all patients with severe liver damage is indicated. d. Metastatic cancer of the liver is more responsive to treatment than primary carcinoma of the liver.
C
A patient is scheduled for biopsy of a painful tongue ulcer. Based on knowledge of risk factors for oral cancer, what would the nurse specifically ask the patient about when obtaining a history? a. Excessive exposure to sunlight b. Recurrent herpes simplex infections c. Use of any type of tobacco products d. Difficulty swallowing and pain in the ear
C
A patient who had an esophagectomy for esophageal cancer develops increasing pain, fever and dyspnea after starting a full liquid diet. The nurse recognize that these symptoms are most indicative of A. an intolerance to the feedings B. extension of the tumor into the aorta C. leakage of fluids into the mediastinum D. esophageal perforation with fistula formation into the lung
C
The nurse teaching young adults about behaviors that put them at risk for oral cancer includes A. Discouraging use of chewing gum b. avoiding use of perfumed lip gloss C. Avoiding use of smokeless tobacco D. Discouraging drinking of carbonated beverages
C
To treat a cirrhotic patient with hepatic encephalopathy, lactulose, rifaximin (Xifaxan), and a proton pump inhibitor are ordered. The patient's family wants to know why the laxative is ordered. What is the best explanation the nurse can give to the family? a. Use reduces portal venous pressure. b. It will eliminate blood from the GI tract. c. It traps ammonia and eliminates it in the feces. d. It decreases bacteria to decrease ammonia formation.
C
When treating a patient with bleeding esophageal varices, what is the most important nursing action? a. Prepare the patient for immediate portal shunting surgery. b. Perform guaiac testing on all stools to detect occult blood. c. Maintain the patient's airway and prevent aspiration of blood. d. Monitor for the cardiac effects of IV vasopressin and nitroglycerin.
C
Which etiologic manifestations related to esophageal varices occur in the patient with cirrhosis? a. Jaundice, peripheral edema, and ascites from increased intrahepatic pressure and dysfunction b. Loss of the small bile ducts and cholestasis and cirrhosis in patients with other autoimmune disorders c. Development of collateral channels of circulation in inelastic, fragile esophageal veins as a result of portal hypertension d. Scarring and nodular changes in the liver lead to compression of the veins and sinusoids, causing resistance of blood flow through the liver from the portal vein
C
The discharge teaching plan for the patient after an acute episode of upper GI bleeding includes information about the importance of A. Limiting alcohol intake to 1 serving per day B. only takin aspirin with milk or bread products C. avoiding taking aspirin and drugs containing aspirin D. only takin drugs prescribed by the health care provider E. taking all drugs 1 hour before mealtime to prevent further bleeding
C, D
A patient with cirrhosis and esophageal varices that are refractory to treatment undergoes a splenorenal shunt. What would the nurse expect the patient to experience? a. An improved survival rate b. Decreased serum ammonia levels c. Improved metabolism of nutrients d. Improved hemodynamic function and renal perfusion
D
A patient with cirrhosis asks the nurse about the possibility of a liver transplant. What is the best response by the nurse? a. "If you are interested in a transplant, you really should talk to your doctor about it." b. "Liver transplants are indicated only in young people with irreversible liver disease." c. "Rejection is such a problem in liver transplants that it is seldom attempted in patients with cirrhosis." d. "Cirrhosis is an indication for transplantation in some cases. Have you talked to your doctor about this?"
D
A patient with esophageal cancer is scheduled for a partial esophagectomy. Preoperatively, which nursing intervention is the priority? a. Practice turning and deep breathing. b. Brush the teeth and mouth well each day. c. Teach about postoperative tubes and care. d. Encourage a high-calorie, high-protein diet.
D
A patient with upper GI bleeding and melena is treated with several drugs. Which drug would the nurse recognize as a priority to administer before, during, and potentially after endoscopy? a. Oral nizatidine (Axid) b. Epinephrine injection c. Vasopressin injection d. IV esomeprazole (Nexium)
D
The health care provider orders lactulose for a patient with hepatic encephalopathy. Which finding indicates the medication has been effective? A. Relief of constipation B.Relief of abdominal pain C.Decreased liver enzymes D.Decreased ammonia levels
D
The nurse is reviewing self-care for a patient with cirrhosis. Which statement indicates the patient needs further teaching? A."A scrotal support may be more comfortable when I have scrotal edema." B."I need to take good care of my belly and ankle skin where it is swollen." C."I can use pillows to support my head to help me breathe when I am in bed." D."If I notice a fast heart rate or irregular beats, this is normal for cirrhosis."
D
What manifestation does the nurse recognize as an early sign of hepatic encephalopathy? a. Manifests asterixis b. Becomes unconscious c. Has increasing oliguria d. Impaired computational skills
D
When planning care for a patient with cirrhosis, which clinical problem is the highest priority? A.Fluid imbalance B.Impaired tissue integrity C.Impaired nutritional status D.Ineffective breathing pattern
D
Which conditions contribute to the formation of abdominal ascites? a. Esophageal varices contribute to 80% of variceal hemorrhages b. Increased colloidal oncotic pressure caused by decreased albumin production c. Hypoaldosteronism causes increased sodium reabsorption by the renal tubules d. Blood flow through the portal system is obstructed, which causes portal hypertension
D
Which laboratory result indicates to the nurse that management of the patient with upper GI bleeding is effective? a. Hematocrit (Hct) of 35% b. Urinary output of 20 mL/hr c. Urine specific gravity of 1.030 d. Decreasing blood urea nitrogen (BUN)
D
Which patient has the greatest morbidity risk? A. Male 6 ft, 1 in tall; BMI 29 kg/m2 B.Female 5 ft, 6 in tall; weight 150 lbs C.Male with waist circumference 46 in D.Female 5 ft, 10 in tall; obesity class III
D
Question 17 of 22 A patient with cirrhosis has increased abdominal girth from ascites. Which statements describe the pathophysiology of ascites? (Select all that apply.) A.Hepatocytes are unable to convert ammonia to urea. B.Osmoreceptors in the hypothalamus stimulate thirst. C.An enlarged spleen removes blood cells from the circulation. D.Portal hypertension causes leaking of protein and water into the peritoneal cavity. E.Aldosterone is released to stabilize intravascular volume by saving salt and water. F.Inability of the liver to synthesize albumin reducing intravascular oncotic pressure.
D, E, F