Pancreatitis, Cirrhosis, Hyper/Hypothyroidism & Eating Disorder Practice Questions

The nurse is caring for a client diagnosed with cirrhosis of the liver with portal hypertension. The client vomited 500 mL bright red emesis and states that he is feeling lightheaded. In which priority order should the nurse perform these interventions? Arrange the actions in the order they should be performed. All options must be used. - Apply oxygen. - Check the client's blood pressure. - Ensure that 2 large-bore intravenous lines are present with an isotonic solution infusing. - Ask the client if he is taking any nonsteroidal anti-inflammatory medications.

1) Apply Oxygen 2) Ensure that 2 large-bore intravenous lines are present with an isotonic solution infusing. 3) Check the client's blood pressure. 4) Ask the client if he is taking any nonsteroidal anti-inflammatory medications. (The client has an upper gastrointestinal (GI) bleed. Upper GI bleeding is an emergency because it can lead to hypovolemic shock. The first intervention of those listed should be to apply oxygen in an attempt to maximize the amount of oxygen being delivered by the decreased number of red blood cells due to the bleeding. The next action should be to ensure that 2 large-bore intravenous (IV) lines are present and begin replacement of the intravascular fluid volume with an isotonic IV fluid. The nurse should then check the blood pressure. These are all actions to stabilize and assess the client's current condition. The last intervention is to ask the client about nonsteroidal anti-inflammatory medications. Although it is important to identify the cause of the bleeding and obtain a complete history of events leading up to the bleeding episode, this needs to be deferred until emergency care is initiated)

A client has been diagnosed with hyperthyroidism. The nurse monitors for which signs and symptoms indicating a complication of this disorder? Select all that apply. 1. Fever 2. Nausea 3. Lethargy 4. Tremors 5. Confusion 6. Bradycardia

1. Fever 2. Nausea 4. Tremors 5. Confusion (Thyroid storm is an acute and life-threatening complication that occurs in a client with uncontrollable hyperthyroidism. Signs and symptoms of thyroid storm include elevated temperature (fever), nausea, and tremors. In addition, as the condition progresses, the client becomes confused. The client is restless and anxious and experiences tachycardia)

The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. 1. Insomnia 2. Weight loss 3. Bradycardia 4. Constipation 5. Mild heat intolerance

1. Insomnia 2. Weight loss 5. mild heat intolerance (Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, and rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat)

The 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? A) Pork B) Milk C) Chicken D) Broccoli

A) pork (Thiamine is present in a variety of foods of plant and animal origin. Pork products are especially rich in the vitamin. Other good sources include peanuts, asparagus, and whole-grain and enriched cereals)

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? Hoarseness Hypocalcemia Audible stridor Edema at the surgical site

Audible stridor (Thyroidectomy is the removal of the thyroid gland, which is located in the anterior neck. It is very important to monitor airway status, as any swelling to the surgical site could cause respiratory distress. Although all of the options are important for the nurse to monitor, the priority nursing action is to monitor the airway)

A client is admitted with possible hepatic encephalopathy. The nurse determines that which noted serum laboratory abnormality supports this suspicion? A) Protein level of 72 g/L (7.2 g/dL) B) Ammonia level of 98 mcg/dL (60 mcmol/L) C) Magnesium level of 1.7 mEq/L (0.85 mmol/L) D) Total bilirubin level of 1.2 mg/dL (20.5 mcmol/L)

B) Ammonia level of 98 mcg/dL (60 mcmol/L) (The normal serum ammonia level ranges from 10 to 80 mcg/dL (6 to 47 mcmol/L). High levels of ammonia can result in encephalopathy and coma. The other blood levels are not related to hepatic encephalopathy and are also normal values)

The nurse is performing discharge teaching for a client with chronic pancreatitis. Which information should the nurse include? A) Alcohol should be consumed in moderation. B) Avoid caffeine because it may aggravate symptoms. C) Diet should be high in carbohydrates, fats, and proteins. D) Frothy, fatty stools indicate that enzyme replacement is working.

B) Avoid caffeine because it may aggravate symptoms. (Knowing that caffeinated beverages, such as coffee, tea, and soda, will worsen symptoms, such as pain, will direct you to select the correct option. Alcohol can precipitate an attack of pancreatitis and needs to be avoided. The recommended diet is moderate carbohydrates, low fat, and moderate protein. Frothy, fatty stools indicate that the replacement enzyme dose needs to be increased)

The nurse is caring for a female client who was admitted to the mental health unit recently for anorexia nervosa. The nurse enters the client's room and notes that the client is engaged in rigorous push-ups. Which nursing action is most appropriate? A) Interrupt the client and weigh her immediately. B) Interrupt the client and offer to take her for a walk. C) Allow the client to complete her exercise program. D) Tell the client that she is not allowed to exercise rigorously

B) Interrupt the client and offer to take her for a walk. (Clients with anorexia nervosa frequently are preoccupied with rigorous exercise and push themselves beyond normal limits to work off caloric intake. The nurse must provide for appropriate exercise and place limits on rigorous activities. The correct option stops the harmful behavior yet provides the client with an activity to decrease anxiety that is not harmful. Weighing the client immediately reinforces the client's preoccupation with weight. Allowing the client to complete the exercise program can be harmful to the client. Telling the client that she is not allowed to complete the exercise program will increase the client's anxiety)

A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action should the nurse prepare to carry out initially? A) Warm the client. B) Maintain a patent airway. C) Administer thyroid hormone. D) Administer fluid replacement.

B) Maintain a patent airway (Myxedema coma is a rare but serious disorder that results from persistently low thyroid production. Coma can be precipitated by acute illness, rapid withdrawal of thyroid medication, anesthesia and surgery, hypothermia, and the use of sedatives and opioid analgesics. In myxedema coma, the initial nursing action is to maintain a patent airway. Oxygen should be administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones by the intravenous route)

A client is experiencing blockage of the common bile duct. Which food selection made by the client indicates the need for further teaching? A) Rice B) Whole milk C) Broiled fish D) Baked chicken

B) Whole milk (Bile acids or bile salts are produced by the liver to emulsify or break down fats. Blockage of the common bile duct impedes the flow of bile from the gallbladder to the duodenum, thus preventing breakdown of fatty intake. Knowledge of this should direct you to the option of whole milk. Dairy products, such as whole milk, ice cream, butter, and cheese, are high in cholesterol and fat and should be avoided)

The nurse is assigned to care for a client with a Sengstaken-Blakemore tube. Which laboratory result is most focused on evaluating the effectiveness of this tube? A) Sodium B) Creatinine C) Hemoglobin D) Ammonia

C) Hemoglobin (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. The tube has an esophageal and a gastric balloon. The esophageal balloon exerts pressure on the ruptured esophageal varices and stops the bleeding. The gastric balloon holds the tube in the correct position and prevents migration of the esophageal balloon, which could harm the client. Evaluation of the client's hemoglobin level trends will determine if the tube is effective. Sodium, creatinine, and ammonia levels are not related to monitoring for blood loss)

The nurse is caring for a client after thyroidectomy. The client expresses concern about the postoperative voice hoarseness she is experiencing and asks if the hoarseness will subside. The nurse should provide the client with which information? A) It indicates nerve damage. B) The hoarseness is permanent. C) It is normal during this time and will subside. D) It will worsen before it subsides, which may take 6 months.

C) It is normal during this time and will subside (Hoarseness in the postoperative period usually is the result of laryngeal pressure or edema and will resolve within a few days. The client should be reassured that the effects are transitory. The other options are incorrect)

The 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? A) Evaluating for asterixis B) Inspecting for petechiae C) Palpating for peripheral edema D) Evaluating for decreased level of consciousness

C) Palpating for peripheral edema (Albumin is responsible for maintaining the osmolality of the blood. When there is a low albumin level, there is decreased osmotic pressure, which in turn can lead to peripheral edema. The remaining options are incorrect and are not associated with a low albumin level)

A client with cirrhosis is being treated for hypernatremia. On reviewing the laboratory values for the client, the nurse determines that treatment is effective if which laboratory result is noted? A) Urine specific gravity of 1.040 B) Serum sodium value of 150 mEq/L (150 mmol/L) C) Serum sodium value of 145 mEq/L (145 mmol/L) D) Serum osmolality of 300 mOsm/kg (300 mmol/kg)

C) Serum sodium value of 145 mEq/L (145 mmol/L) (Laboratory data reflective of hypernatremia include a serum sodium value greater than 148 mEq/L (148 mmol/L), serum osmolality greater than 295 mOsm/kg (295 mmol/kg), and urine specific gravity greater than 1.030 when the kidneys are functioning normally. The increase in the urine specific gravity is a result of the compensatory attempt by the kidneys to conserve water. Normal serum sodium levels range from 135 to 145 mEq/L (135 to 145 mmol/L). The serum sodium level of 145 mEq/L (145 mmol/L) is the only normal value, indicating that treatment is effective)

A client is admitted to a long-term care facility with the diagnosis of weight loss secondary to anorexia. The primary health care provider prescribes an enteral tube feeding of a standard formula to run at 40 mL/hr. A nursing student is assigned to care for the client, and the nursing instructor asks the student to describe the nursing considerations related to a tube feeding. Which statement, if made by the student, indicates an understanding of this dietary treatment? A) "Enteral tube feedings frequently cause sepsis." B) "Enteral feedings should be refrigerated until just before use." C) "The caloric value of enteral feedings is generally 5 to 10 calories per milliliter." D) "Enteral feedings require the normal digestive capabilities of the gastrointestinal tract."

D) "Enteral feedings require the normal digestive capabilities of the gastrointestinal tract." (Enteral nutrition includes offering nutrients by mouth, nasogastric tube, gastrostomy tubes, or percutaneous endoscopic gastrostomy. The common element with these methods of delivery is the fact that the client must have normal gastrointestinal (GI) digestive capabilities. If the client does not have a normal GI tract, other methods of nutrient delivery must be sought, such as parenteral nutrition. Enteral tube feedings may cause aspiration pneumonia from regurgitation of formula into the lungs; however, they generally are not associated with sepsis. Enteral tube feedings should be given at room temperature to avoid problems with diarrhea. The caloric value of most standard enteral feeding formulas is 1 to 2 calories/mL)

After completing an assessment and reviewing the laboratory test results of a client admitted to the hospital with acute left side abdominal pain, the nurse should take action for which noted serum amylase level? A) 54 Somogyi units/dL (27 U/L) B) 100 Somogyi units/dL (50 U/L) C) 120 Somogyi units/dL (60 U/L) D) 200 Somogyi units/dL (100 U/L)

D) 200 Somogyi units/dL (100 U/L) (The normal serum amylase level ranges from 60 to 120 Somogyi units/dL (30 to 220 U/L), depending on the laboratory running the test. Option 4 is out of range for a serum amylase level and would require action by the nurse. The values in the remaining options are normal serum amylase levels and would not require any action)

The nurse is reviewing the laboratory test results for a client and notes that the albumin level is 3.0 g/dL (30 g/L). The nurse understands that this laboratory value would be noted in which condition? A) Diarrhea B) Dehydration C) Multiple myeloma D) Cirrhosis of the liver

D) Cirrhosis of the liver (The normal albumin level ranges from 3.5 to 5 g/dL (35 to 50 g/L). The albumin level is decreased in many conditions, such as acute infection, ascites, alcoholism, burns, and cirrhosis. The remaining options identify conditions in which the albumin level is increased)

The nurse is caring for a client with cirrhosis of the liver. 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 dietary measures to follow if the client states an intention to increase the intake of which food? A) Milk B) Chicken C) Broccoli D) Legumes

D) Legumes (The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a variety of foods of plant and animal origin. Legumes are especially rich in this vitamin. Other good food sources include nuts, whole-grain cereals, and pork. Milk contains vitamins A, D, and B2. Poultry contains niacin. Broccoli contains vitamins C, E, and K and folic acid)

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 client safety? Select all that apply. A) Monitor serum potassium levels. B) Weigh client daily, and monitor trends. C) Monitor for symptoms of fluid retention. D) Provide the client with a soft toothbrush. E) Instruct the client to use an electric razor. F) Monitor all secretions for frank or occult blood.

D) Provide the client with a soft toothbrush. E) Instruct the client to use an electric razor. F) Monitor all secretions for frank or occult blood. (Fibrinogen is produced by the liver and is necessary for normal clotting. A client who has insufficient levels is at risk for bleeding. The PT is prolonged when one or more of the clotting factors (II, V, VII, or X) is deficient, so the client's risk for bleeding is also increased. A soft toothbrush, an electric razor, and monitoring secretions for evidence of bleeding are measures that provide for client safety)

The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which signs and symptoms are associated with this diagnosis? Select all that apply. 1. Tremors 2. Weight loss 3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face

Feeling cold Loss of body hair Persistent lethargy Puffiness of the face (Feeling cold, hair loss, lethargy, and facial puffiness are signs of hypothyroidism. Tremors and weight loss are signs of hyperthyroidism)