exam 5
A client with a history of cancer that metastasized to the liver has arrived at the outpatient clinic to have a paracentesis performed. The physician anticipates that the client will have more than 5 L of fluid removed. The physician has prescribed intravenous albumin following the procedure. The client asks why she needs "more fluids in my vein." The nurse responds:
"Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water."
A client with a history of cancer that metastasized to the liver has arrived at the outpatient clinic to have a paracentesis performed. The physician anticipates that the client will have more than 5 L of fluid removed. The physician has prescribed intravenous albumin following the procedure. The client asks why she needs "more fluids in my vein." The nurse responds:
"Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water." Large-volume paracentesis (removal of 5 L or more of ascitic fluid) may be done in persons with massive ascites and pulmonary compromise.
When assessing the client with acute pancreatitis, which of these diagnostic tests—consistent with the disease— does the nurse anticipate will be altered?
Amylase and lipase
Which complication of acromegaly can be life threatening?
Cardiac structures increase in size
Many drugs are metabolized and detoxified in the liver. Most drug metabolizing occurs in the central zones of the liver. What condition is caused by these drug-metabolizing actions?
Centrilobular necrosis
All diseases have risk factors. What is the most significant environmental risk factor for pancreatic cancer?
Cigarette smoking In pancreatic cancer, the most significant and reproducible environmental risk factor is cigarette smoking.
A client tells the health care provider that he has been very compliant over the last 2 months in the management of his diabetes. The best diagnostic indicator that would support the client's response would be:
Glycosylated hemoglobin, hemoglobin
A 25-year-old female client exhibits exophthalmos of both eyes. The health care provider recognizes this as a manifestation of:
Graves disease
Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of:
Graves disease
The most common forms of peptic ulcer are duodenal and gastric ulcers. What are the most common risk factors for peptic ulcer disease?
Helicobacter pylori (H. pylori)
A health care provider suspects a client may have developed pancreatitis. Which laboratory value will confirm this diagnosis?
High serum amylase and lipase
A client is diagnosed with Crohn disease. The nurse instructs the client on which type of dietary needs?
High-calorie, vitamin, and protein diet Nutritional deficiencies are common in Crohn disease because of diarrhea, steatorrhea, and other malabsorption problems. A nutritious diet that is high in calories, vitamins, and proteins is recommended.
During periods of fasting and starvation, the glucocorticoid and other corticosteroid hormones are critical for survival because of their stimulation of gluconeogenesis by the liver. When the glucocorticoid hormones remain elevated for extended periods of time, what can occur?
Hyperglycemia
When caring for the client with acute pancreatitis, which alterations does the nurse recognize is consistent with the disease?
Hyperglycemia Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis. The white blood cell count may be increased, and hyperglycemia and an elevated serum bilirubin level may be present.
An extremely lethargic client arrives by ambulance at the emergency department. His blood glucose level is 32 mg/dL (1.78 mmol/L). The nurse will anticipate that this client will be diagnosed with:
Hypoglycemia
A man is brought into the emergency department by paramedics who state that the client passed out on the street. The man smells of alcohol, and when roused says he has not eaten since yesterday. He is wearing a medic alert bracelet that says he is a diabetic. What would the nurse suspect as a diagnosis?
Hypoglycemia Alcohol decreases liver gluconeogenesis, and people with diabetes need to be cautioned about its potential for causing hypoglycemia, especially if alcohol is consumed in large amounts or on an empty stomach.
When caring for the client with portal hypertension and ascites, which dietary intervention does the nurse suggest to prevent the progression of fluid accumulation?
Limit intake of sodium.
A client is suspected of having liver cancer. Which diagnostic test would be ordered to confirm the diagnosis?
MRI of the liver
A woman in her 28th week of pregnancy tests positive for gestational diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?
Random blood glucose 85 mg/dL (4.72 mmol/L) The goals of the nutritional plan for gestational diabetes mellitus (GDM) include normal glucose levels, no ketosis, proper weight gain for the pregnancy, and adequate nutrition for fetal health.
A nurse is completing an abdominal assessment on a client suspected to have appendicitis. When the nurse applies and then releases pressure in the client's right lower quadrant, the client experiences tenderness. The nurse is documenting the presence of:
Rebound tenderness
The nurse assessing a client with a diagnosis of cholelithiasis will look for pain in which area?
Right upper quadrant
The nurse is performing physical assessment of the gastrointestinal tract. In which area does the nurse place the hands for palpation of the liver?
Right upper quadrant The liver is the largest visceral organ in the body, located below the diaphragm in the right hypochondrium or right upper quadrant.
The nurse is caring for a female client with cholelithiasis. When teaching the client about the disease, the nurse includes which of these points?
"Gallstones have developed, which are typically composed of cholesterol." Cholelithiasis or gallstones is caused by precipitation of substances contained in bile, mainly cholesterol and bilirubin. It is most common in women, multiple pregnancies, those taking oral contraceptives or those who are obese.
A middle-aged adult is diagnosed with diverticular disease based on recent history and the results of a computed tomography (CT) scan. Which statement demonstrates an accurate understanding of this diagnosis?
"I suppose I should try to eat a bit more fiber in my diet." Increased bulk/fiber is important in both the prevention and treatment of diverticular disease.
A client is diagnosed with Addison disease. What statement by the client indicates an understanding of the discharge instructions by the nurse?
"I will have to take my medication for the rest of my life."
A nurse educator is conducting a course for newly diagnosed diabetes clients. Which statement by a participant should the nurse follow up first?
"I've had a little sore on the sole of my foot for a few days, but I'm sure it will eventually heal."
A client with a new diagnosis of type 2 diabetes mellitus states, "I am really worried that I might need to take injections. Is there something I can do to avoid that?" What is the best response by the nurse?
"You could regulate your diet, exercise regularly, and lose weight."
The nurse is caring for a client who is a carrier of hepatitis B. Which of these does the nurse teach the family?
"Your loved one may not look ill, but the virus is present in his blood." Infection with HBV and HCV can produce a carrier state in which the person does not have symptoms but harbors the virus and can therefore transmit the disease.
Which pediatric assessment finding would the nurse recognize as an example of precocious puberty?
A 7-year-old female with early menarche
The nurse is reviewing assessment data and determines which client is at highest risk for developing type 2 diabetes?
A 45-year-old obese female with a sedentary lifestyle
Which client likely faces the greatest risk of a gastrointestinal bleed?
A client who takes aspirin with each meal to control symptoms of osteoarthritis The gastric mucosa can be easily damaged by drugs such as aspirin, other NSAIDs, alcohol, or bacterial toxins, resulting in local ischemia, vascular stasis, hypoxia, and tissue necrosis.
The nurse is reviewing the medical history of four clients. The nurse determines that the client at greatest risk for developing peptic ulcer disease is:
A client with a prior diagnosis of Helicobacter pylori and refused treatment
The nurse recognizes hepatic encephalopathy may be aggravated by which situation?
A high-protein meal
A client with multiple pain-related injuries to the back, knees, and hips is admitted with acute liver failure. Upon procuring a medication list, the nurse notes that the client is taking several over-the-counter medications that contain a preparation known to be the drug that most commonly causes liver failure. Which drug is this?
Acetaminophen
A 79-year-old woman reports a recent onset of "nearly constant heartburn." During the assessment interview, she states that she has "lots of aches and pains." She states that she is not on any prescription medications but often takes aspirin for pain. The nurse should suspect what diagnosis?
Acute gastritis Aspirin is often implicated in cases of acute gastritis. H. pylori, gastric cancer, and staphylococcus infections do not normally cause reflux (heartburn) and are not directly linked to aspirin use.
The critical care nurse has just admitted a client with diabetic ketoacidosis (DKA) whose blood glucose level is 877 mg/dL (48.67 mmol/L). The client's breath has a fruity odor and the client is confused. Which of these does the nurse set as the priority at this time?
Administration of intravenous fluids Goals of care for clients with DKA include administration of insulin and intravenous fluid and electrolyte replacement solutions
A client with history of alcohol abuse is brought to the emergency department after a weekend of heavy drinking, experiencing right upper quadrant pain, anorexia, nausea, jaundice and ascites. The nurse identifies these as manifestations of what disorder?
Alcoholic hepatitis
An older adult client presents with loose mucousy stools. The nurse suspects the client has Clostridium difficile. What is a priority assessment for the nurse?
Ask the client about his or her antibiotic use. The diagnosis of C. difficile-associated diarrhea requires a careful history, with particular emphasis on antibiotic use.
Symptoms of gastric cancer include vague epigastric pain, which makes early detection difficult. The nurse would expect a client to undergo which diagnostic examination to determine the location of the gastric cancer?
Barium x-ray
The nurse and nursing student are caring for a client undergoing a severe stressor with release of epinephrine into the bloodstream. The nurse teaches the student that epinephrine will cause which effect on blood glucose levels?
Blood glucose will elevate. Epinephrine, a catecholamine, helps to maintain blood glucose levels during periods of stress. Epinephrine causes glycogenolysis in the liver, thus causing large quantities of glucose to be released into the blood.
The incidence of stomach cancer has significantly decreased in the United States, yet it remains the leading cause of death worldwide. The nurse understands the reason for the high mortality rate in stomach cancer is because of which reason?
Clients have few early symptoms of the disease.
An older adult client expresses concern about straining to pass stools that are small and hard. What term will the health care provider use to document this in this client's chart?
Constipation
A 24-year-old woman undergoing a screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which treatment is most likely to be effective for her?
Corticosteroids and immunosuppressant drugs This woman's hepatitis is probably caused by an autoimmune disorder rather than a virus.
A nurse reading a sigmoidoscopy report notes that a client was found to have skip lesions. The nurse interprets this as an indication of:
Crohn disease Skip lesions, demarcated granulomatous lesions that are surrounded by normal-appearing mucosal tissue, are a characteristic feature of Crohn disease.
Which disorders are grouped under the category of inflammatory bowel disease? Select all that apply.
Crohn disease Ulcerative colitis
Which effect of thyroid hormone deficit alters the function of all major organs in the body?
Decreases metabolism Thyroid hormone has two major functions: it increases metabolism and protein synthesis, and it is necessary for growth and development in children, including mental development and attainment of sexual maturity.
The nurse has been informed that a client is experiencing dysphagia. The nurse interprets this as:
Difficulty when swallowing
A client newly diagnosed with pancreatic cancer is admitted to begin treatment. Which pain descriptors can be associated with adenocarcinomas of the pancreas?
Dull epigastric pain accompanied by back pain, worse when lying flat and relieved by sitting forward.
Pharmacologic treatment for peptic ulcers has changed over the past several decades. The nurse knows that the goal for pharmacologic treatment is focused on:
Eradicating Helicobacter pylori (H. pylori)
A nurse is conducting a health promotion class on healthy cooking. The nurse includes the importance of ensuring that all hamburgers are cooked completely before ingesting to prevent:
Escherichia coli
A health care provider has completed an assessment on a client diagnosed with cirrhosis. The client asks, "What, if any, serious complications are associated with cirrhosis?" Which response is the most accurate for the provider to relay to the client?
Esophageal varices
The nurse is teaching her client with hepatobiliary disease about her diet. She tells her that she may have steatorrhea, which is the malabsorption of which dietary component?
Fat Fats are not absorbed in the upper jejunum and the excretion of fat in the stool is steatorrhea.
The nurse is caring for a client with hepatitis and jaundice. The nurse recognizes that without sufficient circulating bile salts the client will have intolerance to which ingested substance?
Fats Lack of production of bile salts causes malabsorption of fat and fat-soluble vitamins.
Good hand-washing techniques are important in health care. The nurse knows that bacterial infections can be prevented by good hand washing techniques. Which route of transmission is most common for Clostridium difficile?
Fecal-oral transmission
A teenager who has a history of achalasia will likely complain of which clinical manifestation?
Feeling like there is food stuck in the back of the throat Achalasia produces functional obstruction of the esophagus so that food has difficulty passing into the stomach, and the esophagus above the lower esophageal sphincter becomes distended.
Which test can the nurse prepare the client for to determine the differentiation between a benign and malignant thyroid disease?
Fine-needle aspiration biopsy
Crohn disease has a distinguishing pattern in the gastrointestinal (GI) tract. The surface has granulomatous lesions surrounded by normal-appearing mucosal tissue. A complication of the pattern includes:
Fistula formation In Crohn disease all layers of the bowel are involved. Complications of Crohn disease include fistula formation, abdominal abscess formation, and intestinal obstruction. Fistulas are tubelike passages that form connections between different sites in the GI tract.
In clients with acute diarrhea, many require no treatment. However, the nurse knows the priority assessment in all clients with diarrhea is:
Fluid and electrolyte status
A client with chronic pancreatitis is experincing an episode of recurring epigastric pain. The dietitian knows that the client's diet should limit which type of meal to avoid further episodes?
Fried chicken and french fries Of the meal options, fried chicken and french fries should be avoided since a low-fat diet is usually prescribed for clients with chronic pancreatitis.
When caring for the client with hepatic failure, the nurse recognizes that which problem places the client at increased risk for bleeding?
Increased prothrombin time
The nurse is reviewing laboratory results of a client who has liver failure. Which finding would place the client at increased risk for bleeding?
Increased prothrombin time Clients with liver failure have malabsorption of vitamin K (decrease), which impairs the synthesis of clotting factors. An increased prothrombin time (a coagulation factor) places the client at risk for bleeding.
Crohn disease is treated by several measures. Treatment with sulfasalazine will focus on which aspect of this disease?
Inflammatory suppression treatment methods focus on terminating the inflammatory response and promoting healing, maintaining adequate nutrition, and preventing and treating complications.
The diagnosis of type 1 diabetes would be confirmed by which principle?
Insulin is not available for use by the body.
Which metabolic abnormality can lead to the development of type 2 diabetes?
Insulin resistance
The nurse is caring for a client with an elevated serum bilirubin level. The nurse recognizes a high bilirubin level may result in which condition?
Jaundice
The liver has many jobs. One of the most important functions of the liver is to cleanse the portal blood of old and defective blood cells, bacteria in the bloodstream, and any foreign material. Which cells in the liver are capable of removing bacteria and foreign material from the portal blood?
Kupffer cells
While teaching a family member about the development of hepatic encephalopathy, which cause is likely to be mentioned?
Neurotoxin accumulation
An ultrasound confirms appendicitis as the cause of a client's sudden abdominal pain. Which etiologic process is implicated in the development of appendicitis?
Obstruction of the intestinal lumen Appendicitis is thought to be related to intraluminal obstruction with a fecalith, gallstones, tumors, parasites, or lymphatic tissue.
A client with severe hypoglycemia is unconscious. Which method of providing glucose should be avoided?
Orange juice orally
Upon admission, a client tells the nurse that he takes aspirin every 4 hours every day. The nurse determines that this client is at risk for:
Peptic ulcer
Which assessment does the nurse recognize is consistent with signs and symptoms of acute pancreatitis?
Periumbilical pain Abdominal pain is a cardinal manifestation of acute pancreatitis. The pain is usually located in the epigastric or periumbilical region and may radiate to the back, chest, or flank areas. Physical examination findings include fever, tachycardia, hypotension, severe abdominal tenderness, respiratory distress, and abdominal distention.
Which individual is experiencing the effects of a primary endocrine disorder?
Person who has low calcium levels because of the loss of the parathyroid gland
Which sign of congenital hypothyroidism in a neonate is one of the first signs the nurse would pick up on?
Prolonged period of physiologic jaundice ith congenital lack of the thyroid gland, the infant usually appears normal and functions normally at birth because of hormones supplied in utero by the mother. Prolongation of physiologic jaundice, caused by delayed maturation of the hepatic system for conjugating bilirubin, may be the first sign.
An adult client has been diagnosed with gastroesophageal reflux disease (GERD) after reporting ongoing "heartburn" unrelieved with antacids. Which medication should the nurse anticipate being prescribed for this client?
Proton pump inhibitor (PPI)
After several months of persistent heartburn, an adult client has been diagnosed with gastroesophageal reflux disease (GERD). Which treatment regimen is likely to be prescribed for this client's GERD?
Proton pump inhibitors; avoiding large meals; remaining upright after meals
Precocious puberty is a disorder that occurs in both boys and girls. Which condition may occur in adults due to precocious puberty?
Short stature in adults
The nurse is caring for a client diagnosed with hyperthyroidism. Which clinical manifestations are most likely to be seen in this client? Select all that apply.
Shortness of breath Tachycardia Weight loss Fine muscle tremor
The nurse teaches the client that which of these contributed to the development of acute cholelithiasis?
Stasis of bile
A client with malabsorption syndrome is experiencing fatty, bulky, yellow-gray, and foul-smelling stools. The nurse would document this as what type of stool?
Steatorrhea
Which clinical manifestation would lead the nurse to suspect the client has malabsorption syndrome with a deficiency in fat absorption?
Steatorrhea In malabsorption syndrome, there is loss of fat in the stools and failure to absorb the fat-soluable vitamins. This can result in weight loss, steatorrhea, and fat-soluble vitamin deficiency.
A client arrives in the clinic and states to the nurse, "I am tired all the time and have gained weight. My hair is so dry it is breaking." The nurse assesses that the client's face is puffy with edematous eyelids and the outer third of the eyebrows are thinning. What lab test will the nurse prepare the client for that is characteristic of this disorder?
T4 and TSH Diagnosis of hypothyroidism is based on history, physical examination, and laboratory tests. A low serum T4 and elevated TSH levels are characteristic of primary hypothyroidism.
A client is managing diabetes with exercise and diet. The health care provider reviews the client's most recent laboratory results: fasting blood glucose level at 80 mg/dL (4.44 mmol/L) and a hemoglobin A1C of 5% (0.05). Select the response that best identifies the client.
The client is achieving normal glycemic control. The reading for the fasting blood glucose is appropriate, and the hemoglobin A1C level estimates good control of glucose levels over a 6- to 12-week period.
The nurse is educating a newly diagnosed client with Hashimoto thyroiditis who is to be discharged from the acute care facility. What should the nurse be sure to include in the education to prevent complications?
The client should be informed about the signs and symptoms of severe hypothyroidism and the need for early intervention. Prevention is preferable to treatment and entails special attention to high-risk populations, such as women with a history of Hashimoto thyroiditis.
A newborn is screened for congenital hypothyroidism and is found to have the disorder. When educating the mother about the importance of the infant taking thyroid hormone supplement, what should be included in the education?
The infant will have dosage levels adjusted as he grows. Congenital hypothyroidism is treated by hormone replacement. Evidence indicates that it is important to normalize T4 levels as rapidly as possible because a delay is accompanied by poorer psychomotor and mental development.
The community health nurse is teaching about prevention of hepatitis A. Which group does the nurse suggest will benefit from this vaccine?
Those traveling to Third World countries
A nurse providing dietary guidance to a client with celiac disease tells the client that which food should be avoided?
Wheat bread
When assessing the client during the icteric phase of viral hepatitis, which of these findings does the nurse anticipate observing?
Yellow-tinged sclera
A rare condition caused by gastrin-secreting tumors most commonly found in the small intestine or pancreas is called:
Zollinger-Ellison syndrome Zollinger-Ellison syndrome is a rare condition caused by a gastrin-secreting tumor (gastrinoma).
The nurse has been providing dietary teaching to a client diagnosed with irritable bowel syndrome. The nurse determines that the teaching was effective when the client selects:
a bran muffin, fruit, and orange juice.
One of the accepted methods of screening for colorectal cancer is testing for occult blood in the stool. Because it is possible to get a false-positive result on these tests, the nurse would instruct the client to:
avoid nonsteroidal anti-inflammatory drugs (NSAIDs) for 1 week prior to testing.
Which pregnant woman likely faces the greatest risk of developing gestational diabetes? A client who:
is morbidly obese (defined as greater than 100 pounds over ideal weight).
A client has been diagnosed with alcohol-induced liver disease. He admits to the nurse, "I know what the lungs do, and I know what the heart does, but honestly, I have no idea what the liver does in the body." The nurse should tell the client that the liver:
metabolizes most components of food and also cleans the blood of bacteria and drugs. Protein, carbohydrate, and fat metabolism are performed by the liver. As well, it metabolizes drugs and removes bacteria by Kupffer cells. Absorption of nutrients takes place in the intestines. The liver does not produce the bulk of fluids secreted in the GI tract. The liver does not have a primary role in the maintenance of acid-base or electrolyte balance.
A client is admitted to the hospital with a suspected diagnosis of strangulated bowel. The nurse anticipates the client will need:
surgery to release the bowel.
