Lippincott Hepatic, Biliary, Endocrine, DM

A nurse is preparing a client for endoscopic retrograde cholangiopancreatography (ERCP). The client asks what this test is used for. Which statements by the nurse explains how ERCP can determine the difference between pancreatitis and other biliary disorders? Select all that apply. "It can assess the anatomy of the pancreas and the pancreatic and biliary ducts." "It is used in the diagnostic evaluation of acute pancreatitis." "It can evaluate the presence and location of ductal stones and aid in stone removal." "It can assess for ecchymosis in the body." "It can detect unhealthy tissues in the pancreas and assess for abscesses and pseudocysts."

"It can assess the anatomy of the pancreas and the pancreatic and biliary ducts." , "It can evaluate the presence and location of ductal stones and aid in stone removal." , "It can detect unhealthy tissues in the pancreas and assess for abscesses and pseudocysts." Rationale:ERCP can determine the difference between pancreatitis and other biliary disorders and is generally used in chronic pancreatitis. It is particularly useful in diagnosis and treatment of clients who have symptoms after biliary tract surgery, clients with intact gallbladders, and clients for whom surgery is particularly hazardous. It can be used to assist with the removal of stones. ERCP is a useful tool in providing anatomic details about the pancreas and biliary ducts. It can evaluate the presence and location of ductal stones and detect changes in the anatomy of the client with pancreatitis, such as obstruction in the pancreatic duct and tissue necrosis due to premature release of pancreatic enzymes, and assess for abscesses and pseudocysts and atrophy of the glands in the body. ERCP is rarely used in the diagnostic evaluation of acute pancreatitis because the clients is acutely ill; however, it may be valuable in treating gallstone pancreatitis.

A client discharged after a laparoscopic cholecystectomy calls the surgeon's office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client? "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated." "This pain is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use."

"This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." Rationale:If pain occurs in the right shoulder or scapular area (from migration of the carbon dioxide used to insufflate the abdominal cavity during the procedure), the nurse may recommend using a heating pad for 15 to 20 minutes hourly, sitting up in a bed or chair, or walking.

A client with end-stage liver disease is scheduled to undergo a liver transplant. The client tells the nurse, "I am worried that my body will reject the liver." Which statement is the nurse's best response to the client? "You would not be scheduled for a transplant if there was a concern about rejection." "The problem of rejection is not as common in liver transplants as in other organ transplants." "It is easier to get a good tissue match with liver transplants than with other types of transplants." "You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs."

"You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs." Rationale:Rejection is a primary concern. A transplanted liver is perceived by the immune system as a foreign antigen. This triggers an immune response, leading to the activation of T lymphocytes that attack and destroy the transplanted liver. Immunosuppressive agents are used as long-term therapy to prevent this response and rejection of the transplanted liver. These agents inhibit the activation of immunocompetent T lymphocytes to prevent the production of effector T cells. Although the 1- and 5-year survival rates have increased dramatically with the use of new immunosuppressive therapies, these advances are not without major side effects. The other statements are inaccurate or will not decrease the client's anxiety.

The physician has ordered an outpatient dexamethasone suppression test to diagnose the cause of Cushing syndrome in a client who works at night, from 11:00 PM to 7:00 AM, and normally sleeps from 8:00 AM to 4:00 PM. The client has been given the dexamethasone. To ensure the most reliable test results, the nurse arranges for the plasma cortisol concentration to be tested at which time? 08:00:00 20:00:00 12:00:00 17:00:00

1700 A dexamethasone suppression test is used to diagnose pituitary and adrenal causes of Cushing syndrome. It can be performed on an outpatient basis. Dexamethasone is administered orally at bedtime, and a plasma cortisol concentration is measured when the client awakens the next day. Often, therefore, the medication is administered late in the evening and the measurement taken around 8:00 AM. However, for this client who sleeps during the day, the medication would be given before the 8:00 AM bedtime, and the plasma concentration would be measured soon after awakening in the late afternoon.

A client newly diagnosed with type 1 diabetes has an unusual increase in blood glucose from bedtime to morning. The physician suspects the client is experiencing insulin waning. Based on this diagnosis, the nurse expects which change to the client's medication regimen? Decreasing evening bedtime dose of intermediate-acting insulin and administering a bedtime snack Increasing morning dose of long-acting insulin Administering a dose of intermediate-acting insulin before the evening meal Changing the time of evening injection of intermediate-acting insulin from dinnertime to bedtime

Administering a dose of intermediate-acting insulin before the evening meal Rationale:Insulin waning is a progressive rise in blood glucose form bedtime to morning. Treatment includes increasing the evening (before dinner or bedtime) dose of intermediate-acting or long-acting insulin or instituting a dose of insulin before the evening meal if that is not already part of the treatment regimen.

The nurse is assessing a client with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply. Report of headache Decreased deep tendon reflexes Agitation Alterations in mood Insomnia

Agitation , Alterations in mood , Insomnia The earliest symptoms of hepatic encephalopathy include both mental status changes and motor disturbances. The client appears confused and unkempt and has alterations in mood and sleep patterns. The client tends to sleep during the day and has restlessness and insomnia at night. To assess for mental deterioration, the nurse will assess general behavior, orientation, and speech as well as cognitive abilities and speech patterns.

Long-term use of antithyroid medication is not generally recommended for elderly clients because of which events? Agranulocytosis and hepatic injury Renal disease and mental confusion Gastrointestinal complications and weight loss Cardiac arrhythmias and fatigue

Agranulocytosis and hepatic injury Rationale:Long-term use of certain antithyroid medications, such as propylthiouracil (PTU), is not recommended for treatment of toxic nodular goiter in older clients because of the risk of side effects. Although rare, evidence indicates that PTU can result in agranulocytosis and hepatic injury. However, use of antithyroid medications versus radioactive iodine or surgery may be the client's preferred choice or the option for some older clients and other ill clients with "limited longevity" who can be monitored at least every 3 months.

A client reporting shortness of breath is admitted with a diagnosis of cirrhosis. A nursing assessment reveals an enlarged abdomen with striae, an umbilical hernia, and 4+ pitting edema of the feet and legs. What is the most important data for the nurse to monitor? Hemoglobin Bilirubin Albumin Temperature

Albumin Rationale: With the movement of albumin from the serum to the peritoneal cavity, the osmotic pressure of the serum decreases. This, combined with increased portal pressure, results in movement of fluid into the peritoneal cavity. The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of ascites and edema.

A nurse is teaching a client about the types of chronic liver disease. The teaching is determined to be effective when the client correctly identifies which type of cirrhosis as being caused by scar tissue surrounding portal areas? Alcoholic cirrhosis Postnecrotic cirrhosis Compensated cirrhosis Biliary cirrhosis

Alcoholic cirrhosis Rationale:Alcoholic cirrhosis, in which the scar tissue characteristically surrounds the portal areas, is most frequently caused by chronic alcoholism and is the most common type of cirrhosis. In postnecrotic cirrhosis, there are broad bands of scar tissue, which are a late result of a previous acute viral hepatitis. In biliary cirrhosis, scarring occurs in the liver around the bile ducts. Compensated cirrhosis is a general term given to the state of liver disease in which the liver continues to be able to function effectively.

The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client? Assisting the client to ambulate the evening of the operative day Teaching the client to choose low-fat foods from the menu Assisting the client to turn, cough, and deep breathe every 2 hours Performing range-of-motion (ROM) leg exercises hourly while the client is awake

Assisting the client to turn, cough, and deep breathe every 2 hours Rationale:Assessment should focus on the client's respiratory status. If a traditional surgical approach is planned, the high abdominal incision required during surgery may interfere with full respiratory excursion. The other nursing actions are also important, but are not as high a priority as ensuring adequate ventilation.

A nurse is caring for a client suspected of having a pituitary tumor that is causing panhypopituitarism. During assessment of the client, which clinical manifestation would the nurse expect to find? Atrophy of the gonads Tachycardia Hypertension Carpopedal spasm

Atrophy of the gonads Rationale:Undersecretion (hyposecretion) commonly involves all of the anterior pituitary hormones and is termed panhypopituitarism. In this condition, the thyroid gland, the adrenal cortex, and the gonads atrophy (shrink) because of loss of tropic-stimulating hormones.

Which is a gerontological consideration associated with the pancreas? Increased rate of pancreatic secretion Increased calcium absorption Increased amount of fibrous material Increased bicarbonate output

Increased amount of fibrous material Rationale:An increase in fibrous material and some fatty deposition occurs in the normal pancreas of people older than 70 years of age. There is a decreased rate of pancreatic secretion and decreased bicarbonate output in older adults. Decreased calcium absorption may also occur.

A client is admitted with diabetic ketoacidosis (DKA). Which order from the physician should the nurse implement first? Administer regular insulin 30 U IV push. Administer sodium bicarbonate 50 mEq IV push. Infuse 0.9% normal saline solution 1 L/hr for 2 hours. Start an infusion of regular insulin at 50 U/hr.

Infuse 0.9% normal saline solution 1 L/hr for 2 hours. Rationale:In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. In dehydrated clients, rehydration is important for maintaining tissue perfusion. Initially, 0.9% sodium chloride (normal saline) solution is administered at a rapid rate, usually 0.5 to 1 L/hr for 2 to 3 hours.

A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released." "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood."

Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." Rationale:Ketones (or ketone bodies) are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Ketones in the urine signal an insulin deficiency and that control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to break down stored fat for energy.

Which enzyme aids in the digestion of fats? Trypsin Amylase Secretin Lipase

Lipase Rationale:Lipase is a pancreatic enzyme that aids in the digestion of fats. Amylase aids in the digestion of carbohydrates. Secretin is responsible for stimulating secretion of pancreatic juice. Trypsin aids in the digestion of protein.

A client with diabetes mellitus is prescribed to switch from animal to synthesized human insulin. Which factor should the nurse monitor when caring for the client? Polyuria Low blood glucose concentration Allergic reactions Hypertonicity

Low blood glucose concentration Rationale:Clients who switch from animal to synthesized human insulin should initially be monitored for low blood glucose concentrations because the human form of insulin is used more effectively. Human insulin causes fewer allergic reactions than insulin obtained from animal sources. Polyuria and hypertonicity are symptoms of diabetes mellitus.

A nurse is planning care for a client with acute pancreatitis. Which client outcome does the nurse assign as the highest priority? Maintaining normal respiratory function Developing no acute complications from the pancreatitis Achieving adequate fluid and electrolyte balance Maintaining satisfactory pain control

Maintaining normal respiratory function Rationale:Airway and breathing are always the priority assessment. Acute pancreatitis produces retroperitoneal edema, elevation of the diaphragm, pleural effusion, and inadequate lung ventilation. Intra-abdominal infection and labored breathing increase the body's metabolic demands, which further decreases pulmonary reserve and can lead to respiratory failure. Maintenance of adequate respiratory function is the priority goal. The other outcomes would also be appropriate for the patient.

A client with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade is used temporarily to control hemorrhage and stabilize the client. In planning care, the nurse gives the highest priority to which goal? Controlling bleeding Relieving the client's anxiety Maintaining fluid volume Maintaining the airway

Maintaining the airway Rationale:Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Maintaining the airway is the highest priority because oxygenation is essential for life. The airway can be compromised by possible displacement of the tube and the inflated balloon into the oropharynx, which can cause life-threatening obstruction of the airway and asphyxiation.

A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN? Measure abdominal girth every shift Auscultate the abdomen for bowel sounds every 4 hours Measure blood glucose concentration every 4 to 6 hours Monitor for reports of nausea and vomiting

Measure blood glucose concentration every 4 to 6 hours Rationale:Enteral or parenteral nutrition may be prescribed. In addition to administering enteral or parenteral nutrition, the nurse monitors the serum glucose concentration every 4 to 6 hours.

A client has undergone a liver biopsy. Which postprocedure position is appropriate? On the right side On the left side Trendelenburg High Fowler

On the right side Rationale:In this position, the liver capsule at the site of penetration is compressed against the chest wall, and the escape of blood or bile through the perforation made for the biopsy is impeded. Positioning the client on his left side is not indicated. Positioning the client in the Trendelenburg position may be indicated if the client is in shock, but is not the position designed for the client after liver biopsy. The high Fowler position is not indicated for the client after liver biopsy.

Which medication is the treatment of choice for pregnant women diagnosed with hyperthyroidism? SSKI Methimazole PTU Potassium iodide

PTU Rationale:Propylthiouracil (PTU), rather than methimazole (MMI), is the treatment of choice during pregnancy for those diagnosed with hyperthyroidism due to the teratogenic effects of MMI.

What initial measure can the nurse implement to reduce risk of injury for a client with liver disease? Pad the side rails on the bed Prevent visitors, so as not to agitate the client Raise all four side rails on the bed Apply soft wrist restraints

Pad the side rails on the bed Rationale:Padding the side rails can reduce injury if the client becomes agitated or restless. Restraints would not be an initial measure to implement. Four side rails are considered a restraint, and this would not be an initial measure to implement. Family and friends generally assist in calming a client.

The nurse is teaching a client who was admitted to the hospital with acute hepatic encephalopathy and ascites about an appropriate diet. The nurse determines that the teaching has been effective when the client chooses which food choice from the menu? Ham and cheese sandwich, baked beans, potatoes, and coffee Omelet with green peppers, onions, mushrooms, and cheese with milk Pancakes with butter and honey, and orange juice Baked chicken with sweet potato french fries, cornbread, and tea

Pancakes with butter and honey, and orange juice Rationale:Teach clients to select a diet high in carbohydrates with protein intake consistent with liver function. The client should identify foods high in carbohydrates and within protein requirements (moderate to high protein in cirrhosis and hepatitis, low protein in hepatic failure). The client with acute hepatic encephalopathy is placed on a low-protein diet to decrease ammonia concentration. The other choices are all higher in protein. The client's ascites indicates that a low-sodium diet is needed, and the other choices are all high in sodium.

A client is admitted to the health care center with hyperglycemia, a 15-pound weight loss, and reports of vague upper and midabdominal pain that increases in intensity at night. The client' health history indicates alcoholism, smoking of a pack of cigarettes daily, and diabetes for the past 20 years. Upon examination the nurse finds swelling in the feet and abdominal ascites. Based on the clinical manifestations, which condition is the most likely diagnosis? Pancreatic carcinoma Acute pancreatitis with edema Pancreatic pseudocysts Cholecystitis

Pancreatic carcinoma Rationale:Pain, jaundice, and weight loss are considered classic signs of pancreatic carcinoma. Other signs include rapid, profound, and progressive weight loss as well as vague upper or midabdominal pain or discomfort unrelated to any gastrointestinal function that is often difficult to describe. It is often more severe at night and is accentuated when lying supine. The formation of ascites is common. An important sign is the onset of symptoms of insulin deficiency: glucosuria, hyperglycemia, and abnormal glucose tolerance. Therefore, diabetes may be an early sign of carcinoma of the pancreas.

Which term describes the passage of a hollow instrument into a cavity to withdraw fluid? Ascites Dialysis Asterixis Paracentesis

Paracentesis

A nurse is gathering equipment and preparing to assist with a sterile bedside procedure to withdraw fluid from a client's abdomen. The procedure tray contains the following equipment: trocar, syringe, needles, and drainage tube. The client is placed in he high Fowler position and a blood pressure cuff is secured around the arm in preparation for which procedure? Paracentesis Liver biopsy Dialysis Abdominal ultrasound

Paracentesis Rationale:Paracentesis is the removal of fluid (ascites) from the peritoneal cavity through a puncture or a small surgical incision through the abdominal wall under sterile conditions. Paracentesis may be used to withdraw ascitic fluid if the accumulated fluid is causing cardiorespiratory compromise. A liver biopsy is removal of tissue from the liver using a scope or surgical instrument. An abdominal ultrasound is a non -invasive procedure using sound waves to produce images. Dialysis is the process of filtering blood as a substitute for normal kidney function.

A client visits the clinic to seek treatment for disturbed sleep cycles and depressed mood. Which glands and hormones help to regulate sleep cycles and mood? Pineal gland, melatonin Parathyroid glands, parathormone Adrenal cortex, corticosteroids Thymus gland, thymosin

Pineal gland, melatonin Rationale:The pineal gland secretes melatonin, which aids in regulating sleep cycles and mood. Melatonin plays a vital role in hypothalamic-pituitary interaction. The thymus gland secretes thymosin and thymopoietin, which aid in developing T lymphocytes. The parathyroid glands secrete parathormone, which increases the levels of calcium and phosphorus in the blood. The adrenal cortex secretes corticosteroids hormones, which influence many organs and structures of the body.

ADH is secreted by which gland? Thyroid Posterior pituitary Anterior pituitary Adrenal

Posterior pituitary Rationale:Antidiuretic hormone (vasopressin) is secreted by the posterior pituitary gland. The anterior pituitary secretes growth hormone. The adrenal gland secretes glucocorticoids and mineralocorticoids. The thyroid gland secretes T3 and T4.

A client who is being tested for syndrome of inappropriate antidiuretic hormone secretion asks the nurse to explain the diagnosis. While explaining, the nurse states that excessive antidiuretic hormone is secreted from which gland? Thyroid Adrenal Anterior pituitary Posterior pituitary

Posterior pituitary Rationale:Antidiuretic hormone is secreted by the posterior pituitary gland.

A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes? Rare ketosis Presence of autoantibodies against islet cells Obesity Altered glucose metabolism

Presence of autoantibodies against islet cells Rationale:There is evidence of an autoimmune response in type 1 diabetes. This is an abnormal response in which antibodies are directed against normal tissues of the body, responding to these tissues as if they were foreign. Autoantibodies against islet cells and against endogenous (internal) insulin have been detected in people at the time of diagnosis and even several years before the development of clinical signs of type 1 diabetes.

Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? Obesity Presence of islet cell antibodies Requirement for oral hypoglycemic agents Rare ketosis

Presence of islet cell antibodies Rationale:Individuals with type 1 diabetes often have islet cell antibodies and are usually thin or demonstrate recent weight loss at the time of diagnosis. These individuals are prone to experiencing ketosis when insulin is absent and require exogenous insulin to preserve life.

Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction? Electroencephalography (EEG) Magnetic resonance imaging (MRI) Radioisotope liver scan Angiography

Radioisotope liver scan Rationale:A radioisotope liver scan assesses liver size and hepatic blood flow and obstruction. MRI is used to identify normal structures and abnormalities of the liver and biliary tree. Angiography is used to visualize hepatic circulation and detect the presence and nature of hepatic masses. EEG is used to detect abnormalities that occur with hepatic coma.

A client with hyperthyroidism is concerned about changes in appearance. How can the nurse convey an understanding of the client's concern and promote effective coping strategies? Reassure the client that their emotional reactions are a result of the disorder and symptoms can be controlled with effective treatment. Refer the client to professional counseling. Encourage the client to participate in outside activities to boost coping strategies. Suggest that the client wear cosmetics to cover any changes in appearance.

Reassure the client that their emotional reactions are a result of the disorder and symptoms can be controlled with effective treatment. Rationale:The client with hyperthyroidism needs reassurance that the emotional reactions being experienced are a result of the disorder and that with effective treatment those symptoms can be controlled. It is important to use a calm, unhurried approach with the client. Stressful experiences should be minimized, and a quiet uncluttered environment should be maintained. The nurse encourages relaxing activities that will not overstimulate the client. It is important to balance periods of activity with rest.

The nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? Select all that apply. Risk for injury related to altered clotting mechanisms Altered nutrition, more than body requirements, related to decreased activity and bed rest Disturbed body image related to changes in appearance, sexual dysfunction, and role function Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort Urinary incontinence related to general debility and muscle wasting

Risk for injury related to altered clotting mechanisms , Disturbed body image related to changes in appearance, sexual dysfunction, and role function , Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort Rationale:Risks for injury, activity intolerance, and disturbed body image are priority nursing diagnoses. The appropriate nursing diagnosis related to nutrition would be altered nutrition, less than body requirements, related to chronic gastritis, decreased gastrointestinal motility, and anorexia. Urinary incontinence is not generally a concern with hepatic cirrhosis.

A nurse is teaching a client about the cause of acute pancreatitis. The nurse evaluates the teaching as effective when the client correctly identifies which condition as a cause of acute pancreatitis? Self-digestion of the pancreas by its own proteolytic enzymes Calcification of the pancreatic duct, leading to its blockage Fibrosis and atrophy of the pancreatic gland Use of loop diuretics to increase the incidence of pancreatitis

Self-digestion of the pancreas by its own proteolytic enzymes Rationale:Self-digestion of the pancreas by its own proteolytic enzymes, principally trypsin, causes acute pancreatitis. Of clients with acute pancreatitis, 80% had undiagnosed chronic pancreatitis. Gallstones enter the common bile duct and lodge at the ampulla of Vater, obstructing the flow of pancreatic juice or causing a reflux of bile from the common bile duct into the pancreatic duct, thus activating the powerful enzymes within the pancreas. Normally, these remain in an inactive form until the pancreatic secretions reach the lumen of the duodenum. Activation of the enzymes can lead to vasodilation, increased vascular permeability, necrosis, erosion, and hemorrhage.

A client with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement—milk thistle—to help heal the liver. Which is the most appropriate response by the nurse? "Herbal supplements are approved by the FDA, so there should be no problem with their usage if you check with your primary care provider." "You can use milk thistle instead of the medications you have been prescribed." "Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated." "You should not use herbal supplements in conjunction with medical treatment."

Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated." Rationale:Many clients who have end-stage liver disease (ESLD) with cirrhosis use the herb milk thistle (Silybum marianum) to treat jaundice and other symptoms. This herb has been used for centuries because of its healing and regenerative properties in liver disease. Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. The natural compound SAM-e (s-adenosylmethionine) may improve outcomes of liver disease by improving liver function, possibly by enhancing antioxidant function. Herbal supplements are used in conjunction with medical treatment and medications. Herbal supplements are not approved by the FDA. Their usage should be discussed with the primary care provider to evaluate their effectiveness and interactions with other treatment regimens.

A client who has been having recurrent attacks of severe abdominal pain over the past few months informs the physician about a 25-pound weight loss in the past year. The nurse attributes which factor as the most likely cause of this weight loss? Vomiting after heavy meals Ingesting a low-fat diet to prevent abdominal pain Skipping meals out of fear of painful attacks Malabsorption

Skipping meals out of fear of painful attacks Rationale:Weight loss is a major problem in chronic pancreatitis. More than 80% of clients experience significant weight loss, which is usually caused by decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack.

Which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin? Thiazolidinediones Alpha-glucosidase inhibitors Sulfonylureas Biguanides

Sulfonylureas Rationale:A functioning pancreas is necessary for sulfonylureas to be effective. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Biguanides facilitate the action of insulin on peripheral receptor sites. Alpha-glucosidase inhibitors delay the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.

The nurse is completing a morning assessment of a client with cirrhosis. Which information obtained by the nurse will be of most concern? The skin on the client's abdomen has multiple spider-shaped blood vessels. The client reports nausea and anorexia. The client has gained 2 kg from the previous day. The client's hands flap back and forth when the arms are extended.

The client's hands flap back and forth when the arms are extended. Rationale:Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy. It indicates that the client has hepatic encephalopathy and, if untreated, a hepatic coma may occur.

A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction? Between 7:00 and 9:00 p.m. Between 4:00 and 6:00 p.m. This insulin has no peak action and does not cause a hypoglycemic reaction. Between 8:00 and 10:00 a.m.

This insulin has no peak action and does not cause a hypoglycemic reaction. Rationale:"Peakless" basal or very long-acting insulins are approved by the U.S. Food and Drug Administration for use as a basal insulin; that is, the insulin is absorbed very slowly over 24 hours and can be given once a day. It has is no peak action.

The physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) . Which does the nurse attribute as the reason for NPO status? To drain the pancreatic bed To avoid inflammation of the pancreas To prevent the occurrence of fibrosis To aid opening up of pancreatic duct

To avoid inflammation of the pancreas Rationale:Pancreatic secretion is increased by food and fluid intake and may cause inflammation of the pancreas.

The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan? There is no need to inject air into the bottle of insulin before withdrawing the insulin. When mixing insulin, the NPH insulin is drawn up into the syringe first. When mixing insulin, the regular insulin is drawn up into the syringe first. If two different types of insulin are ordered, they need to be given in separate injections.

When mixing insulin, the regular insulin is drawn up into the syringe first. Rationale:When rapid-acting or short-acting insulins are to be given simultaneously with longer-acting insulins, they are usually mixed together in the same syringe; the longer-acting insulins must be mixed thoroughly before being drawn into the syringe. The American Diabetic Association recommends that the regular insulin be drawn up first. The most important issues are that patients (1) are consistent in technique, so the wrong dose is not drawn in error or the wrong type of insulin, and (2) do not inject one type of insulin into the bottle containing a different type of insulin. Injecting cloudy insulin into a vial of clear insulin contaminates the entire vial of clear insulin and alters its action.

The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? 1 to 2 hours 3 hours 30 to 40 minutes 10 to 15 minutes

10 to 15 minutes Rationale:The onset of action of rapid-acting lispro insulin is within 10 to 15 minutes. It is used to rapidly reduce the glucose level.

Once digested, what percentage of carbohydrates is converted to glucose? 70 80 100 90

100 Rationale:Once digested, 100% of carbohydrates are converted to glucose. However, approximately 50% of protein foods are also converted to glucose, but this has minimal effect on blood glucose concentration.

Which term is used to describe a chronic liver disease in which scar tissue surrounds the portal areas? Compensated cirrhosis Alcoholic cirrhosis Postnecrotic cirrhosis Biliary cirrhosis

Alcoholic Cirrhosis

When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately? Constipation for more than 2 days Change in the client's handwriting and/or cognitive performance Anorexia for more than 3 days Weight loss of 2 pounds in 3 days

Change in the client's handwriting and/or cognitive performance Rationale:The earliest symptoms of hepatic encephalopathy include mental status changes and motor disturbances. The client will appear confused and unkempt and have altered mood and sleep patterns. Neurologic status should be assessed frequently. Mental status is monitored by the nurse keeping the client's daily record of handwriting and arithmetic performance. The nurse should report any change in mental status immediately. Chronic fatigue, anorexia, dyspepsia, nausea, vomiting, and diarrhea or constipation with accompanying weight loss are regular symptoms of cirrhosis.

Which foods should be avoided following acute gallbladder inflammation? Cooked fruits Coffee Cheese Mashed potatoes

Cheese Rationale:The client should avoid eggs, cream, pork, fried foods, cheese, rich dressings, gas-forming vegetables, and alcohol. It is important to remind the client that fatty foods may induce an episode of cholecystitis. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, non-gas-forming vegetables, bread, coffee, or tea may be consumed as tolerated.

A very ill client with acute cholecystitis is scheduled for surgery. The surgeon plans to create an incision in the common bile duct to remove stones. The nurse correctly documents this surgery in the electronic medical record using which term? Choledochoduodenostomy Choledochostomy Cholecystostomy Cholecystectomy

Choledochostomy Rationale:This procedure is reserved for the client with acute cholecystitis who may be too ill to undergo a surgical procedure. It involves making an incision in the common duct, usually to remove stones (choledochostomy).

Which is a clinical manifestation of cholelithiasis? Clay-colored stools Abdominal pain in the upper left quadrant Epigastric distress before a meal Nonpalpable abdominal mass

Clay-colored stools Rationale:The client with gallstones has clay-colored stools and excruciating upper right quadrant pain that radiates to the back or right shoulder. The excretion of bile pigments by the kidneys makes urine very dark. The feces, no longer colored with bile pigments, are grayish (like putty) or clay colored. The client develops a fever and may have a palpable abdominal mass.

Which diagnostic test is done to determine a suspected pituitary tumor? Measuring blood hormone levels Computed tomography Radioimmunoassay Radiography of the abdomen

Computed tomography Rationale:CT or magnetic resonance imaging is used to diagnose the presence and extent of pituitary tumors.

Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? Cushing syndrome Graves disease Addison disease Hashimoto disease

Cushing syndrome Rationale:The client with Cushing syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension. Regardless of the cause, the normal feedback mechanisms that control the function of the adrenal cortex become ineffective, and the usual diurnal pattern of cortisol is lost. The signs and symptoms of Cushing syndrome are primarily a result of the oversecretion of glucocorticoids and androgens, although mineralocorticoid secretion also may be affected.

The nurse identifies which type of jaundice in an adult experiencing a transfusion reaction? Nonobstructive Hemolytic Obstructive Hepatocellular

Hemolytic Rationale:Hemolytic jaundice occurs because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. This type of jaundice is encountered in clients with hemolytic transfusion reactions and other hemolytic disorders. Obstructive and hepatocellular jaundice are the result of liver disease. Nonobstructive jaundice occurs with hepatitis.

Which nursing assessment is most important in a client diagnosed with ascites? Assessment of the oral cavity for foul-smelling breath Palpation of abdomen for a fluid shift Daily measurement of weight and abdominal girth Auscultation of abdomen

Daily Measurement of weight and abdominal girth Measuring and recording of abdominal girth and body weight daily are essential to assess the progression of ascites and its response to treatment.

Which is an age-related change of the hepatobiliary system? Decreased prevalence of gallstones Decreased blood flow Increased drug clearance capability Enlarged liver

Decreased Blood Flow Age-related changes of the hepatobiliary system include decreased blood flow, decreased drug clearance capability, increased presence of gall stones, and a steady decrease in the size and weight of the liver.

A 70-year-old client is admitted with acute pancreatitis. The nurse understands that the mortality rate associated with acute pancreatitis increases with advanced age and attributes this to which gerontologic consideration associated with the pancreas? Increases in the bicarbonate output by the kidneys Decreases in the physiologic function of major organs Increases in the rate of pancreatic secretion Development of local complications

Decreases in the physiologic function of major organs Rationale:Acute pancreatitis affects people of all ages, but the mortality rate associated with acute pancreatitis increases with advancing age. The pattern of complications changes with age. Younger clients tend to develop local complications; the incidence of multiple organ failure increases with age, possibly as a result of progressive decreases in physiologic function of major organs with increasing age.

A client with a traumatic brain injury is producing an abnormally large volume of dilute urine. Which alteration to a hormone secreted by the posterior pituitary would the nurse expect to find? Increased antidiuretic hormone A deficient amount of somatostatin Deficient production of vasopressin Increased oxytocin

Deficient production of vasopressin Rationale:The most common disorder related to posterior lobe dysfunction is diabetes insipidus, a condition in which abnormally large volumes of dilute urine are excreted as a result of deficient production of vasopressin. Diabetes insipidus may occur following surgical treatment of a brain tumor, secondary to nonsurgical brain tumors, and traumatic brain injury.

Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin? Do not mix with other insulins. Draw up the drug first, then add regular insulin. Administer the total daily dosage in two doses. It is rapidly absorbed and has a fast onset of action.

Do not mix with other insulins

Which dietary modification is used for a client diagnosed with acute pancreatitis? High-fat diet Low-carbohydrate diet High-protein diet Elimination of coffee

Elimination of coffee Rationale:A high-carbohydrate, low-fat, and low-protein diet should be implemented. Alcohol, caffeine, and spicy foods should be avoided.

Which is a clinical manifestation of diabetes insipidus? Weight gain Excessive thirst Excessive activities Low urine output

Excessive thirst Rationale:Urine output may be as high as 20 L in 24 hours. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weight loss develops.

Which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels? Acetone in the urine Frequent vomiting, leading to loss of fluid volume Dry mouth, which makes the client thirsty High glucose concentration in the blood

Frequent vomiting, leading to loss of fluid volume Rationale:Fluid and electrolyte disturbances are common complications because of nausea, vomiting, movement of fluid from the vascular compartment to the peritoneal cavity, diaphoresis, fever, and the use of gastric suction. The nurse assesses the client's fluid and electrolyte status by noting skin turgor and moistness of mucous membranes. The nurse weighs the client daily and carefully measures fluid intake and output, including urine output, nasogastric secretions, and diarrhea.

Antithyroid medications are not generally recommended for elderly patients because of which side effect? Weight loss Mental confusion Fatigue Granulocytopenia

Granulocytopenia Rationale:Antithyroid medications are not generally recommended for elderly clients because of the increased incidence of side effects such as granulocytopenia and the need for frequent monitoring.

Which feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism? Moon face and buffalo hump Cardiac dysrhythmia Hand flexing inward Bulging forehead

Hand flexing inward Rationale:Carpopedal spasm is evidenced by the hand flexing inward. Cardiac dysrhythmia is a symptom of hyperparathyroidism. Moon face and buffalo hump are the symptoms of Cushing syndrome. A bulging forehead is a symptom of acromegaly.

A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition? Asterixis Hepatic encephalopathy Cirrhosis Portal hypertension

Hepatic encephalopathy Rationale:Hepatic encephalopathy is a central nervous system dysfunction resulting from liver disease. It is frequently associated with an elevated ammonia concentration that produces changes in mental status, altered level of consciousness, and coma. Portal hypertension is an elevated pressure in the portal circulation resulting from obstruction of venous flow into and through the liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

Which condition may occur during the postoperative period in a client who underwent adrenalectomy because of sudden withdraw of excessive amounts of catecholamines? Hyperglycemia Hypertension Hypoglycemia Hyporeflexia

Hypoglycemia Rationale:Hypotension and hypoglycemia may occur in the postoperative period because of the sudden withdrawal of excessive amounts of catecholamines. Hypertension and hyporeflexia are not related to the sudden withdraw of excessive amounts of catecholamines.

Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia? Bradycardia Warm moist skin Polyuria Hypotension

Hypotension

The typical triad of manifestations seen in a client diagnosed with pheochromocytoma does not include which of the following? Palpitations Hypotension Diaphoresis Headache

Hypotension Rationale:The typical triad of symptoms seen in clients diagnosed with pheochromocytoma comprises headache, diaphoresis, and palpitations.

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? Increased hunger Numbness Fatigue Dizziness

Increased Hunger

A client with type 1 diabetes is experiencing polyphagia. The nurse knows to assess for which additional clinical manifestation(s) associated with this classic symptom? Weight gain Muscle wasting and tissue loss Altered mental state Dehydration

Muscle wasting and tissue loss Rationale:Polyphagia results from the catabolic state induced by insulin deficiency and the breakdown of proteins and fats. Although clients with type 1 diabetes may experience polyphagia (increased hunger), they may also exhibit muscle wasting, subcutaneous tissue loss, and weight loss due to impaired glucose and protein metabolism and impaired fatty acid storage.

Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? Pancreatic necrosis Tetany MODS Shock

Pancreatic necrosis

Which position should be used for a client undergoing a paracentesis? Upright at the edge of the bed Supine Trendelenburg Prone

Supine

Clients with chronic liver dysfunction have problems with insufficient vitamin intake. Which may occur as a result of vitamin C deficiency? Hypoprothrombinemia Scurvy Night blindness Beriberi

Scurvy

Dilutional hyponatremia occurs in which disorder? Addison disease Diabetes insipidus (DI) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Pheochromocytoma

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Rationale:Clients diagnosed with SIADH exhibit dilutional hyponatremia. They retain fluids and develop a sodium deficiency.

A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test? Serum amylase Serum bilirubin Serum calcium Serum potassium

Serum Amylase

When teaching a client diagnosed with hypothyroidism about medical intervention, which is important for the nurse to communicate? Increased resorption occurs with TH. Normal dosages of sedative agents are prescribed. TH may decrease blood glucose concentrations. TH may increase the effect of digitalis preparation.

TH may increase the effect of digitalis preparation. Rationale:Thyroid hormones may increase the pharmacologic effects of digitalis glycosides, anticoagulant agents, and indomethacin, necessitating careful observation and assessment by the nurse for side effects.

A client has a nasogastric (NG) tube for suction and is NPO after a pancreaticoduodenectomy. Which explanation made by the nurse is the major purpose of this treatment? "The tube provides relief from nausea and vomiting." "The tube allows toxins to be removed." "The tube helps control fluid and electrolyte imbalance." "The tube allows the gastrointestinal tract to rest."

The tube allows the gastrointestinal tract to rest." Rationale:Postoperative management of clients who have undergone a pancreatectomy or a pancreaticoduodenectomy is similar to the management of clients after extensive gastrointestinal or biliary surgery. An NG tube with suction and parenteral nutrition allow the gastrointestinal tract to rest while promoting adequate nutrition.

Which condition indicates an overdose of lactulose? Hypoactive bowel sounds Constipation Watery diarrhea Fecal impaction

Watery Diarrhea

A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition? "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism." "Your body is using protein and fat for energy instead of glucose." "You may be having undiagnosed infections, causing you to lose extra weight." "I will refer you to a dietician who can help you with your weight."

Your body is using protein and fat for energy instead of glucose." Rationale:Persons with type 1 diabetes, particularly those in poor control of the condition, tend to be thin because when the body cannot effectively utilize glucose for energy (no insulin supply), it begins to break down protein and fat as an alternate energy source. Patients may be underweight at the onset of type 1 diabetes because of rapid weight loss from severe hyperglycemia. The goal initially may be to provide a higher-calorie diet to regain lost weight and blood glucose control.

The digestion of carbohydrates is aided by lipase. secretin. amylase. trypsin.

amylase

A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the client's symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis? Assess for excessive sweating Assess the client's ability to move all extremities Assess the client's ability to take a deep breath Assess the client's breath odor

breath odor

A client with type 1 diabetes reports waking up in the middle of the night feeling nervous and confused, with tremors, sweating, and a feeling of hunger. Morning fasting blood glucose readings have been 110 to 140 mg/dL. The client admits to exercising excessively and skipping meals over the past several weeks. Based on these symptoms, the nurse plans to instruct the client to skip the evening neutral protamine Hagedorn insulin dose on days when exercising and skipping meals. check blood glucose at 3:00 a.m. eat a complex carbohydrate snack in the evening before bed. administer an increased dose of neutral protamine Hagedorn insulin in the evening.

check blood glucose at 3:00 a.m. Rationale:In the Somogyi effect, the client has a normal or elevated blood glucose concentration at bedtime, which decreases to hypoglycemic levels at 2 to 3 a.m., and subsequently increases as a result of the production of counter-regulatory hormones. It is important to check blood glucose in the early morning hours to detect the initial hypoglycemia.

Which age-related change may affect diabetes and its management? Decreased renal function Hypotension Increased bowel motility Increased thirst

decreased renal function

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client? Polyuria Blurred vision Polydipsia Hypoglycemia

hypoglycemia

Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine? Hemoglobin Creatinine Ketones Cholesterol

ketones

Cardiac effects of hyperthyroidism include decreased systolic BP. palpitations. bradycardia. decreased pulse pressure.

palpitations. Rationale:Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic BP is elevated.

Cardiac effects of hyperthyroidism include decreased pulse pressure. decreased systolic blood pressure. palpitations. bradycardia.

palpitations. Rationale:Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic blood pressure is elevated.

A client with type 1 diabetes mellitus is being taught about self-injection of insulin. Which fact about site rotation should the nurse include in the teaching? Rotate sites from area to area every other day. Choose a different site at random for each injection. Use all available injection sites within one area. Avoid the abdomen because absorption there is irregular.

use all available injection sites within one area. Rationale:Systematic rotation of injection sites within an anatomic area is recommended to prevent localized changes in fatty tissue. To promote consistency in insulin absorption, the client should be encouraged to use all available injection sites within one area rather than randomly rotating sites from area to area.

The nurse knows that the serum amylase concentration returns to normal within which time frame? 36 hours 48 hours 24 hours 12 hours

48 hours 48-72 Hours

After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate? Administer an oral calcium supplement as ordered. Administer IV calcium gluconate as ordered. Start administering oxygen at 2 L/min via a cannula. Administer a sedative as ordered.

Administer IV calcium gluconate as ordered. Rationale:When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not immediately decrease neuromuscular irritability and seizure activity, sedative agents such as pentobarbital may be administered.

Which is the most common cause of esophageal varices? Jaundice Ascites Asterixis Portal hypertension

Portal Hypertension

The nurse is completing discharge teaching with a client with hyperthyroidism who has been treated with radioactive iodine at an outpatient clinic. The nurse instructs the client to monitor for symptoms of hypothyroidism. watch for symptoms of hyperthyroidism to disappear within 1 week. continue radioactive precautions with all body secretions. discontinue all antithyroid medications.

monitor for symptoms of hypothyroidism. Rationale:Symptoms of hyperthyroidism may be followed later by those of hypothyroidism and myxedema. Hypothyroidism also commonly occurs in clients with previous hyperthyroidism who have been treated with radioiodine or antithyroid medications or thyroidectomy (surgical removal of all or part of the thyroid gland).

What does the nurse recognize as clinical manifestations consistent with ascites? Select all that apply. foul-smelling breath visible distended veins rapid weight gain increased abdominal girth stretch marks

visible distended veins , rapid weight gain , increased abdominal girth , stretch marks The presence and extent of ascites are assessed by percussion of the abdomen. When fluid has accumulated in the peritoneal cavity, the flanks bulge when the patient assumes a supine position. Increased abdominal girth and rapid weight gain are common presenting symptoms of ascites. The patient may be short of breath and uncomfortable from the enlarged abdomen, and striae and distended veins may be visible over the abdominal wall. Foul-smelling breath is not a clinical manifestation of ascites.

Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? 1 month 4 months Over 1 year 7 months

7 months Rationale:Six to 12 months of therapy with UDCA is recommended in clients to dissolve the stones.

A 1200-calorie diet and exercise are prescribed for a client with newly diagnosed type 2 diabetes. The nurse is teaching the client about meal planning using exchange lists. The teaching is determined to be effective based on which statement by the client? "For dinner I ate 2 ounces of sliced turkey, 1 cup mashed sweet potatoes, half a cup of carrots, half a cup of peas, a 3-ounce dinner roll, 1 medium banana, and a diet soda." "For dinner I ate 2 cups of cooked pasta with 3-ounces of boiled shrimp, 1 cup plum tomatoes, half a cup of peas in a garlic-wine sauce, 2 cups fresh strawberries, and ice water with lemon." "For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion; a green salad with 1 teaspoon Italian dressing; 1 cup of watermelon; and a diet soda." "For dinner I ate 4-ounces of sliced roast beef on a bagel with lettuce, tomato, and onion; 1 ounce low-fat cheese; 1 tablespoon mayonnaise; 1 cup fresh strawberry shortcake; and unsweetened iced tea."

"For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion; a green salad with 1 teaspoon Italian dressing; 1 cup of watermelon; and a diet soda." Rationale:There are six main exchange lists: bread/starch, vegetable, milk, meat, fruit, and fat. Foods within one group (in the portion amounts specified) contain equal numbers of calories and are approximately equal in grams of protein, fat, and carbohydrate. Meal plans can be based on a recommended number of choices from each exchange list. Foods on one list may be interchanged with one another, allowing for variety while maintaining as much consistency as possible in the nutrient content of foods eaten. For example, 2 starch = 2 slices bread or a hamburger bun, 3 meat = 3 oz lean beef patty, 1 vegetable = green salad, 1 fat = 1 tbsp salad dressing, 1 fruit = 1 cup watermelon; "free" items like diet soda are optional.

A client with type 2 diabetes has recently been prescribed acarbose, and the nurse is explaining how to take this medication. The teaching is determined to be effective based on which statement by the client? "I will take this medication in the morning, with my first bite of breakfast." "It does not matter what time of day I take this medication." "I will take this medication in the morning, 15 minutes before breakfast." "This medication needs to be taken after the midday meal."

"I will take this medication in the morning, with my first bite of breakfast." Rationale:Alpha-glucosidase inhibitors such as acarbose and miglitol, delay absorption of complex carbohydrates in the intestine and slow entry of glucose into systemic circulation. They must be taken with the first bite of food to be effective.

Which would be included in the teaching plan for a client diagnosed with diabetes mellitus? The only diet change needed in the treatment of diabetes is to stop eating sugar. An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision. Once insulin injections are started in the treatment of type 2 diabetes, they can never be discontinued. Sugar is found only in dessert foods.

An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision. Rationale:Diabetic retinopathy is the leading cause of blindness among people between 20 and 74 years of age in the United States; it occurs in both type 1 and type 2 diabetes. When blood glucose is well controlled, the potential for complications of diabetes is reduced. Several types of foods contain sugar, including cereals, sauces, salad dressings, fruits, and fruit juices. It is not feasible, nor advisable, to remove all sources of sugar from the diet. If the diabetes had been well controlled without insulin before the period of acute stress causing the need for insulin, the client may be able to resume previous methods for control of diabetes when the stress is resolved.

The nurse completing a plan of care for a client with cirrhosis who has ascites and 4+ pitting edema of the feet and legs identifies a nursing diagnosis of risk for impaired skin integrity. Which nursing intervention is appropriate for this problem? Restrict dietary protein intake. Perform passive range-of-motion exercises four times a day. Reposition the client every 4 hours. Arrange for a low air loss bed.

Arrange for a low air loss bed. Initiating the use of an alternating-pressure mattress or low air loss bed decreases the risk for skin breakdown due to prolonged pressure on bony prominences. The other answers do not apply.

Which intervention should be included in the plan of care for a client who has undergone a cholecystectomy? Clamping the T-tube immediately after surgery Placing the client in the semi-Fowler position immediately after surgery Placing the client on NPO (nothing by mouth) status for 2 days after surgery Assessing the color of the sclera every shift

Assessing the color of the sclera every shift Rationale:If bile is not draining properly, an obstruction is probably causing bile to be forced back into the liver and bloodstream. Because jaundice may result, the nurse should assess the color of the sclerae.

Which symptom of thyroid disease is seen in older adults? Restlessness Weight gain Hyperactivity Atrial fibrillation

Atrial fibrillation Rationale:Symptoms seen in older adults include weight loss and atrial fibrillation. Older adults may not experience restlessness or hyperactivity.

A client who had developed jaundice 2 months earlier is brought to the ED after attending a party and developing excruciating pain that radiated over the abdomen and into the back. Upon assessment, which additional symptom would the nurse expect this client to have? Hypertension Weight loss Bile-stained vomiting Warm, dry skin

Bile-stained vomiting Rationale:Nausea and vomiting are common in acute pancreatitis. The emesis is usually gastric in origin but may also be bile stained. Fever, jaundice, mental confusion, and agitation may also occur.

Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)? Client is prone to ketosis Clients demonstrate islet cell antibodies Client is usually thin at diagnosis Blood glucose can be controlled through diet and exercise

Blood glucose can be controlled through diet and exercise

Which clinical manifestation of type 2 diabetes occurs if glucose levels are very high? Hyperactivity Oliguria Blurred vision Increased energy

Blurred vision Rationale:Blurred vision occurs when blood glucose levels are very high. The other clinical manifestations are not consistent with type 2 diabetes.

While the nurse is recording the health history of a client who is scheduled for a thyroid test, the client informs the nurse about an allergy to seafood. What is the nurse's most appropriate response? Inquire about frequent urination Consult the institution's procedure manual Document the allergy and inform the physician Palpate the thyroid gland

Document the allergy and inform the physician Rationale:Recording the health history is an important step in the diagnosis of endocrine disorders. The nurse documents an allergy to iodine, a component of contrast dyes and seafood, and informs the physician. Repeated or forceful palpation of the thyroid in the case of thyroid hyperactivity can result in a sudden release of thyroid hormones, which may have serious implications. Consulting the institution's procedure manual and inquiring about frequent urination are not immediate follow-up actions.

Which type of jaundice seen in adults is the result of increased destruction of red blood cells? Hepatocellular Hemolytic Nonobstructive Obstructive

Hemolytic Rationale:Hemolytic jaundice results because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. Obstructive and hepatocellular jaundice are results of liver disease. Nonobstructive jaundice occurs with hepatitis.

A client with Cushing syndrome is admitted to the hospital. During the initial assessment, the client tells the nurse, "The worst thing about this disease is how awful I look. I want to cry every time I look in the mirror." Which statements by the nurse is the best response? "I can refer you to a support group. Talking to someone may help you feel better." "I do not think you look bad and I am sure your family loves you very much." "I can show you how to change your style of dress so that the changes are not so noticeable." "If treated successfully, the major physical changes will disappear with time."

If treated successfully, the major physical changes will disappear with time." Rationale:If treated successfully, the major physical changes associated with Cushing syndrome disappear with time. The client may benefit from discussion of the effect the changes have had on his or her self-concept and relationships with others. Weight gain and edema may be modified by a low-carbohydrate, low-sodium diet, and a high protein intake may reduce some of the other bothersome symptoms.

A young client with anorexia, fatigue, and jaundice is diagnosed with hepatitis B and has just been admitted to the hospital. The client asks the nurse how long the stay in the hospital will be. In planning care for the client, the nurse identifies impaired psychosocial issues and assigns the highest priority to which client outcome? Reducing the spread of the disease Establishing a stable home environment Identifying the source of exposure to hepatitis Minimizing social isolation

Minimizing social isolation Rationale: The nurse identifies psychosocial issues and concerns, particularly the effects of separation from family and friends if the client is hospitalized during the acute and infective stages. Convalescence may be prolonged, with complete symptomatic recovery sometimes requiring 3 to 4 months or longer. Even if not hospitalized, the client will be unable to attend school and/or work and must avoid sexual contact. Planning is required to minimize social isolation.

A nursing instructor is explaining the pathophysiology and clinical manifestations of pancreatitis to a group of nursing students. The instructor evaluates the teaching as effective when a student correctly identifies which symptom as that most commonly reported by clients with pancreatitis? Severe, radiating abdominal pain Tarry, black stools and dark urine Increased appetite and weight gain Increased and painful urination

Severe, radiating abdominal pain Rationale:Severe abdominal pain is the major symptom of pancreatitis that causes the client to seek medical care. The pain occurs in the midepigastrium. Abdominal pain and tenderness and back pain result from irritation and edema of the inflamed pancreas. Pain is frequently acute in onset, occurring 24 to 48 hours after a very heavy meal or alcohol ingestion; it may be diffuse and difficult to localize.

A client is admitted to the health care center with severe abdominal pain rated 10 on a 1-to-10 scale, tachycardia, hypertension, and muscle spasms. The nurse immediately administers morphine sulfate 4 mg slow intravenous pyelogram (IVP), as ordered. The nurse plans for which goal after administration of this mediation? To control blood pressure To diagnose the cause of abdominal pain To control muscle spasms To increase the client's pain threshold

To increase the client's pain threshold Rationale:Morphine, fentanyl, and hydromorphone act by depressing the central nervous system, thereby increasing the client's pain threshold.

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? Vasopressin Cimetidine Nitroglycerin Spironolactone

Vasopressin Vasopressin may be the initial therapy for esophageal varices because it constricts the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Spironolactone and cimetidine do not decrease portal hypertension.

A client with thyroiditis has undergone surgery and is concerned about the barely visible scar. Which suggestion should the nurse give the client to cope with the condition? Apply medicines to remove the scar Wear clothing that covers the neck Consider cosmetic surgery Undergo a skin graft

Wear clothing that covers the neck Rationale:The nurse may suggest that the client wear clothing that covers the neck and assure the client that the scar is almost invisible. Application of medicines, skin graft, and cosmetic surgery are not appropriate suggestions.

A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan? Smoking reduction but not complete cessation Maintenance of blood glucose levels between 180 and 200 mg/dl Weight reduction through diet and exercise An eye examination every 2 years until age 50

Weight reduction through diet and exercise Rationale:Type 2 diabetes is commonly obesity-related; therefore, weight reduction may enhance the normalization of the blood glucose level. Weight reduction should be achieved by a healthy diet and exercise to increase carbohydrate metabolism. Blood glucose levels should be maintained within normal limits to prevent the development of diabetic complications. Clients with type 1 or 2 diabetes shouldn't smoke at all because of the increased risk of cardiovascular disease. A funduscopic examination should be done yearly to identify early signs of diabetic retinopathy.

A client admitted with severe epigastric abdominal pain radiating to the back is vomiting and reports difficulty breathing. Upon assessment, the nurse determines that the client is experiencing tachycardia and hypotension. Which actions are priority interventions for this client? Select all that apply. Administer a low-fat diet Administer electrolytes Assist the client to a semi-Fowler position Administer plasma Administer pain-relieving medication

administer electrolytes , Assist the client to a semi-Fowler position , Administer plasma , Administer pain-relieving medication Rationale:The nurse promptly reports decreased blood pressure (BP) and reduced urine output, which indicate hypovolemia and shock or renal failure. The treatment goals for acute pancreatitis focus on relieving pain, maintaining circulatory and fluid volume, and decreasing the production of pancreatic enzymes. Intravenous replacement of fluid and electrolytes should begin immediately because of the loss of fluid in the body. If hypotension is evident, plasma should be administered to maintain BP within an acceptable range. Fluids are administered intravenously and may be accompanied by infusion of blood or blood products to maintain blood volume and to prevent or treat hypovolemic shock. Low serum calcium and magnesium concentrations may occur and require prompt treatment. The nurse maintains the client in a semi-Fowler position to decrease pressure on the diaphragm by a distended abdomen and to increase respiratory expansion. A low-fat diet, with small frequent meals, should be initiated after control of symptoms; it is not an immediate priority.

Hypophysectomy is the treatment of choice for which endocrine disorder? Hyperthyroidism Pheochromocytoma Acromegaly Cushing syndrome

cushing syndrome Rationale:Transsphenoidal hypophysectomy is the treatment of choice for clients diagnosed with Cushing syndrome resulting from excessive production of adrenocorticotropic hormone (ACTH) by a tumor of the pituitary gland. Hypophysectomy has an 80% success rate.