Med Surg Exam 3 questions

The client diagnosed with liver failure is experiencing pruritus secondary to severe jaundice. Which action by the unlicensed assistive personnel (UAP) warrants intervention by the nurse? 1. The UAP is assisting the client to take a hot soapy shower. 2. The UAP applies an emollient to the client's legs and back. 3. The UAP puts mittens on both hands of the client. 4. The UAP pats the client's skin dry with a clean towel.

1. Hot water increases pruritus, and soap will cause dry skin, which increases pruritus; therefore, the nurse should discuss this with the UAP.

The client two (2) hours postoperative laparoscopic cholecystectomy is complaining of severe pain in the right shoulder. Which nursing intervention should the nurse implement? 1. Apply a heating pad to the abdomen for 15 to 20 minutes. 2. Administer morphine sulfate intravenously after diluting with saline. 3. Contact the surgeon for an order to x-ray the right shoulder. 4. Apply a sling to the right arm, which was injured during surgery.

1. A heating pad should be applied for 15 to 20 minutes to assist the migration of the CO2 used to insufflate the abdomen. Shoulder pain is an expected occurrence.

The client has end-stage liver failure secondary to alcoholic cirrhosis. Which complication indicates the client is at risk for developing hepatic encephalopathy? 1. Gastrointestinal bleeding. 2. Hypoalbuminemia. 3. Splenomegaly. 4. Hyperaldosteronism.

1. Blood in the intestinal tract is digested as a protein, which increases serum ammonia levels and increases the risk of developing hepatic encephalopathy.

Which signs and symptoms should the nurse report to the health-care provider for the client recovering from an open cholecystectomy? Select all that apply. 1. Clay-colored stools. 2. Yellow-tinted sclera. 3. Amber-colored urine. 4. Wound approximated. 5. Abdominal pain.

1. Clay-colored stools are caused by recurring stricture of the common bile duct, which is a sign of post- cholecystectomy syndrome. 2. Yellow-tinted sclera and skin indicate residual effects of stricture of the common bile duct, which is a sign of post-cholecystectomy syndrome. 5. Abdominal pain indicates a residual effect of a stricture of the common bile duct, inflammation, or calculi, which is a sign of post-cholecystectomy syndrome.

The public health nurse is discussing hepatitis B with a group in the community. Which health promotion activities should the nurse discuss with the group? Select all that apply. 1. Do not share needles or equipment. 2. Use barrier protection during sex. 3. Get the hepatitis B vaccine. 4. Obtain immune globulin injections. 5. Avoid any type of hepatotoxic medications.

1. Hepatitis B can be transmitted by sharing any type of needles, especially those used by drug abusers. 2. Hepatitis B can be transmitted through sexual activity; therefore, the nurse should recommend abstinence, mutual monogamy, or barrier protection. 3. Three doses of hepatitis B vaccine pro- vide immunity in 90% of healthy adults.

The nurse writes the problem "imbalanced nutrition: less than body requirements" for the client diagnosed with hepatitis. Which intervention should the nurse include in the plan of care? 1. Provide a high-calorie intake diet. 2. Discuss total parenteral nutrition (TPN). 3. Instruct the client to decrease salt intake. 4. Encourage the client to increase water intake.

1. Sufficient energy is required for heal- ing. Adequate carbohydrate intake can spare protein. The client should eat approximately 16 carbohydrate kilocalories for each kilogram of ideal body weight daily.

The public health nurse is teaching day-care workers. Which type of hepatitis is transmitted by the fecal-oral route via contaminated food, water, or direct contact with an infected person? 1. Hepatitis A. 2. Hepatitis B. 3. Hepatitis C. 4. Hepatitis D.

1. The hepatitis A virus is in the stool of infected people and takes up to two(2) weeks before symptoms develop.

The charge nurse is monitoring client laboratory values. Which value is expected in the client with cholecystitis who has chronic inflammation? 1. An elevated white blood cell count. 2. A decreased lactate dehydrogenase. 3. An elevated alkaline phosphatase. 4. A decreased direct bilirubin level.

1. The white blood cell count should be elevated in clients with chronic inflammation

The client in end-stage liver failure has vitamin K deficiency. Which interventions should the nurse implement? Select all that apply. 1. Avoid rectal temperatures. 2. Use only a soft toothbrush. 3. Monitor the platelet count. 4. Use small-gauge needles. 5. Assess for asterixis.

1. Vitamin K deficiency causes impaired coagulation; therefore, rectal thermometers should be avoided to prevent bleeding. 2. Soft-bristle toothbrushes will help pre- vent bleeding of the gums. 3. Platelet count, PTT/PT, and INR should be monitored to assess coagulation status. 4. Injections should be avoided, if at all possible, because the client is unable to clot, but if they are absolutely necessarily, the nurse should use small- gauge needles.

Which priority teaching information should the nurse discuss with the client to help prevent contracting hep. A? 1.Explain the importance of good hand washing. 2.Tell the client to take the hepatitis B vaccine in three (3) doses. 3.Tell the client not to ingest unsanitary food or water. 4.Discuss how to implement standard precautions.

1.Explain the importance of good hand washing Answer 1: The hepatitis A virus - spread via fecal-oral route, often in contaminated food 2. Hepatitis B is spread through contact with infected blood and body fluids 3. Hepatitis C is transmitted through contact with infected blood and body fluids 4. Hepatitis D infection only causes infection in people who are also infected with Hepatitis B or C"

Which instruction should the nurse discuss with the client who is in the icteric phase of hepatitis C? 1. Decrease alcohol intake. 2. Encourage rest periods. 3. Eat a large evening meal. 4. Drink diet drinks and juices.

2. Adequate rest is needed for maintain- ing optimal immune function.

The nurse is teaching a client recovering from a laparoscopic cholecystectomy. Which statement indicates the discharge teaching is effective? 1. "I will take my lipid-lowering medicine at the same time each night." 2. "I may experience some discomfort when I eat a high-fat meal." 3. "I need someone to stay with me for about a week after surgery." 4. "I should not splint my incision when I deep breathe and cough."

2. After removal of the gallbladder, some clients experience abdominal discomfort when eating fatty foods.

Which assessment data indicate to the nurse the client recovering from an open cholecystectomy may require pain medication?1. The client's pulse is 65 beats per minute. 2. The client has shallow respirations. 3. The client's bowel sounds are 20 per minute. 4. The client uses a pillow to splint when coughing.

2. An open cholecystectomy requires a large incision under the diaphragm. Deep breathing places pressure on the diaphragm and the incision, causing pain. Shallow respirations indicate in- adequate pain control, and the nurse should intervene.

The client diagnosed with liver problems asks the nurse, "Why are my stools clay- colored?" On which scientific rationale should the nurse base the response? 1. There is an increase in serum ammonia level. 2. The liver is unable to excrete bilirubin. 3. The liver is unable to metabolize fatty foods. 4. A damaged liver cannot detoxify vitamins.

2. Bilirubin, the by-product of red blood cell destruction, is metabolized in the liver and excreted via the feces, which causes the feces to be brown in color. If the liver is damaged, the bilirubin is excreted via the urine and skin.

The nurse identifies the client problem "excess fluid volume" for the client in liver failure. Which short-term goal would be most appropriate for this problem? 1. The client will not gain more than two (2) kg a day. 2. The client will have no increase in abdominal girth. 3. The client's vital signs will remain within normal limits. 4. The client will receive a low-sodium diet.

2. Excess fluid volume could be secondary to portal hypertension. Therefore, no increase in abdominal girth would be an appropriate short-term goal, indicating no excess of fluid volume.

The client with hepatitis asks the nurse, "I went to an herbalist, who recommended I take milk thistle. What do you think about the herb?" Which statement is the nurse's best response? 1. "You are concerned about taking an herb." 2. "The herb has been used to treat liver disease." 3. "I would not take anything that is not prescribed." 4. "Why would you want to take any herbs?"

2. Milk thistle has an active ingredient, silymarin, which has been used to treat liver disease for more than 2,000 years. It is a powerful oxidant and promotes liver cell growth.

Which type of precaution should the nurse implement to protect from being exposed to any of the hepatitis viruses? 1. Airborne Precautions. 2. Standard Precautions. 3. Droplet Precautions. 4. Exposure Precautions.

2. Standard Precautions apply to blood, all body fluids, secretions, and excretions, except sweat, regardless of whether they contain visible blood.

What type of precautions should the nurse implement to protect from being exposed to any of the hepatitis viruses? 1. Airborne precautions 2. Standard precautions 3. Droplet precautions 4. Exposure precautions"

2. Standard precautions Correct 2. Standard precautions apply to blood, all body fluids, secretions, and excretions, except sweat, regardless of whether they contain visible blood

The female nurse sticks herself with a contaminated needle. Which action should the nurse implement first? 1. Notify the infection control nurse. 2. Cleanse the area with soap and water. 3. Request postexposure prophylaxis. 4. Check the hepatitis status of the client.

2. The nurse should first clean the needle stick with soap and water and attempt stick bleed to help remove any virus injected into the skin.

The client is admitted with end-stage liver failure and is prescribed the laxative lactulose (Chronulac). Which statement indicates the client needs more teaching concerning this medication? 1. "I should have two to three soft stools a day." 2. "I must check my ammonia level daily." 3. "If I have diarrhea, I will call my doctor." 4. "I should check my stool for any blood."

2. There is no instrument used at home to test daily ammonia levels. The ammonia level is a serum level requiring venipuncture and laboratory diagnostic equipment.

The client diagnosed with end-stage liver failure is admitted with esophageal bleeding. The HCP inserts and inflates a triple-lumen nasogastric tube (Sengstaken- Blakemore). Which nursing intervention should the nurse implement for this treatment? 1. Assess the gag reflex every shift. 2. Stay with the client at all times. 3. Administer the laxative lactulose (Chronulac). 4. Monitor the client's ammonia level.

2. While the balloons are inflated, the client must not be left unattended in case they become dislodged and occlude the airway. This is a safety issue.

The RN is providing discharge information to a client with hep B. The RN instructs the client to prevent transmission via: 1. airborne pathogens 2. blood and body secretions 3. skin contact 4. fecal and oral routes

2. blood and body secretions Hep b is transmitted via blood and body secretions. The RN instructs the client to prevent transmission through correct use of latex condoms, and by not sharing personal care items that may have blood on them. Diseases such as pneumonia are spread by airborne pathogens, hep A is spread by fecal and oral routes. Hep B is not transmitted by skin contact.

The female nurse sticks herself with a dirty needle. Which action should the nurse implement first? 1.Notify the infection control nurse. 2.Cleanse the area with soap and water. 3.Request post-exposure prophylaxis. 4.Check the hepatitis status of the client.

2.Cleanse the area with soap and water. Answer 2. The nurse should first clean the needle stick with soap and water to help remove any virus that is on the skin

The nurse is caring for the immediate postoperative client who had a laparoscopic cholecystectomy. Which task could the nurse delegate to the unlicensed assistive personnel (UAP)? 1. Check the abdominal dressings for bleeding. 2. Increase the IV fluid if the blood pressure is low. 3. Ambulate the client to the bathroom. 4. Auscultate the breath sounds in all lobes.

3. A day surgery client can be ambulated to the bathroom, so this task can be delegated to the UAP.

Which gastrointestinal assessment data should the nurse expect to find when assessing the client in end-stage liver failure? 1. Hypoalbuminemia and muscle wasting. 2. Oligomenorrhea and decreased body hair. 3. Clay-colored stools and hemorrhoids. 4. Dyspnea and caput medusae.

3. Clay-colored stools and hemorrhoids are gastrointestinal effects of liver failure.

The client has had a liver biopsy. Which post-procedure intervention should the nurse implement? 1. Instruct the client to void immediately. 2. Keep the client NPO for eight (8) hours. 3. Place the client on the right side. 4. Monitor BUN and creatinine level.

3. Direct pressure is applied to the site, and then the client is placed on the right side to maintain site pressure.

The RN is providing discharge teaching to a client with hep C. The RN instructs the client to prevent transmission by 1. Avoiding contact with friends and family 2. Not sharing cups and eating utensils 3. Not sharing personal care items such as toothbrushes and razors 4. Hep C cannot be spread so no precautions are needed

3. Not sharing personal care items such as toothbrushes and razors Answer: Hep C is spread through contact with infected blood and can be transmitted through sharing personal care items that may come in contact with a patient's blood such as toothbrush and razors. It is not spread through casual contact

The client is one (1) hour post-endoscopic retrograde cholangiopancreatogram (ERCP). Which intervention should the nurse include in the plan of care? 1. Instruct the client to cough forcefully. 2. Encourage early ambulation. 3. Assess for return of a gag reflex. 4. Administer held medications.

3. The ERCP requires an anesthetic spray be used prior to insertion of the endoscope. If medications, food, or fluid are given orally prior to the return of the gag reflex, the client may aspirate.

Which task is most appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? 1. Draw the serum liver function test. 2. Evaluate the client's intake and output. 3. Perform the bedside glucometer check. 4. Help the ward clerk transcribe orders.

3. The UAP can perform a bedside glucometer check, but the nurse must evaluate the result and determine any action needed.

The client diagnosed with end-stage renal failure and ascites is scheduled for a paracentesis. Which client teaching should the nurse discuss with the client? 1. Explain the procedure will be done in the operating room. 2. Instruct the client a Foley catheter will have to be inserted. 3. Tell the client vital signs will be taken frequently after the procedure. 4. Provide instructions on holding the breath when the HCP inserts the catheter.

3. The client is at risk for hypovolemia; therefore, vital signs will be assessed frequently to monitor for signs of hemorrhaging.

Which assessment question is priority for the nurse to ask the client diagnosed with end-stage liver failure secondary to alcoholic cirrhosis? 1. "How many years have you been drinking alcohol?" 2. "Have you completed an advance directive?" 3. "When did you have your last alcoholic drink?" 4. "What foods did you eat at your last meal?"

3. The nurse must know when the client had the last alcoholic drink to be able to determine when and if the client will experience delirium tremens, the physical withdrawal from alcohol.

The client is diagnosed with end-stage liver failure. The client asks the nurse, "Why is my doctor decreasing the doses of my medications?" Which statement is the nurse's best response? 1. "You are worried because your doctor has decreased the dosage." 2. "You really should ask your doctor. I am sure there is a good reason." 3. "You may have an overdose of the medications because your liver is damaged." 4. "The half-life of the medications is altered because the liver is damaged."

3. This is the main reason the HCP decreases the client's medication dose and is an explanation appropriate for the client.

The nurse assesses a large amount of red drainage on the dressing of a client who is six (6) hours postoperative open cholecystectomy. Which intervention should the nurse implement? 1. Measure the abdominal girth. 2. Palpate the lower abdomen for a mass. 3. Turn client onto side to assess for further drainage. 4. Remove the dressing to determine the source.

3. Turning the client to the side to assess the amount of drainage and possible bleeding is important prior to contacting the surgeon.

The nurse instructs a client diagnosed with hepatitis A about signs and symptoms related to hepatitis that may develop. The one that should be reported to the practitioner is: 1)Fatigue 2)Anorexia 3)Yellow urine 4)Clay-colored stools

4)Clay-colored stools Correct 4: Clay-colored stools are indicative of hepatic obstruction because bile is prevented from entering the intestines.

The client diagnosed with end-stage liver failure is admitted with hepatic encephalopathy. Which dietary restriction should be implemented by the nurse to address this complication? 1. Restrict sodium intake to 2 g/day. 2. Limit oral fluids to 1,500 mL/day. 3. Decrease the daily fat intake. 4. Reduce protein intake to 60 to 80 g/day.

4. Ammonia is a by-product of protein metabolism and contributes to hepatic encephalopathy. Reducing protein in- take should decrease ammonia levels.

The client is in the preicteric phase of hepatitis. Which signs/symptoms should the nurse expect the client to exhibit during this phase? 1. Clay-colored stools and jaundice. 2. Normal appetite and pruritus. 3. Being afebrile and left upper quadrant pain. 4. Complaints of fatigue and diarrhea.

4. "Flu-like" symptoms are the first com- plaints of the client in the preicteric phase of hepatitis, which is the initial phase and may begin abruptly or insidiously.

Which problem is highest priority for the nurse to identify in the client who had an open cholecystectomy surgery? 1. Alteration in nutrition. 2. Alteration in skin integrity. 3. Alteration in urinary pattern. 4. Alteration in comfort.

4. Acute pain management is the highest priority client problem after surgery because pain may indicate a life-threatening problem.

The school nurse is discussing methods to prevent an outbreak of hepatitis A with a group of high school teachers. Which action is the most important to teach the high school teachers? 1. Do not allow students to eat or drink after each other. 2. Drink bottled water as much as possible. 3. Encourage protected sexual activity. 4. Sing the happy birthday song while washing hands.

4. Hepatitis A is transmitted via the fecal-oral route. Good hand washing helps to prevent its spread. Singing the happy birthday song takes approximately 30 seconds, which is how long an individual should wash his or her hands.

Which of the following is not commonly used in acute treatment of an esophageal varices bleed 1. octreotide 2. Variceal ligation 3. proton pump inhibitors 4. Propanolol 5. vasopressin

4. Propanolol 1, 2, 3, 5 are all used in the acute treatment of EV. Propranolol is used to prevent EV or recurrent EV in patients with portal hypertension and is often used in combination with variceal ligation

The client is four (4) hours postoperative open cholecystectomy. Which data warrant immediate intervention by the nurse? 1. Absent bowel sounds in all four (4) quadrants. 2. The T-tube has 60 mL of green drainage. 3. Urine output of 100 mL in the past three (3) hours. 4. Refusal to turn, deep breathe, and cough.

4. Refusing to turn, deep breathe, and cough places the client at risk for pneumonia. This client needs immediate intervention to prevent complications.

Which statement by the client diagnosed with hepatitis warrants immediate intervention by the clinic nurse? 1. "I will not drink any type of beer or mixed drink." 2. "I will get adequate rest so I don't get exhausted." 3. "I had a big hearty breakfast this morning." 4. "I took some cough syrup for this nasty head cold."

4. The client needs to understand some types of cough syrup have alcohol and all alcohol must be avoided to prevent further injury to the liver; therefore, this statement requires intervention.

Which outcome should the nurse identify for the client scheduled to have a cholecystectomy? 1. Decreased pain management. 2. Ambulate first day postoperative. 3. No break in skin integrity. 4. Knowledge of postoperative care.

4. This would be an expected outcome for the client scheduled for surgery. This indicates preoperative teaching has been effective.

The nurse is providing discharge teaching for a client who has just undergone laparoscopic cholecystectomy surgery. Which statement by the client indicates understanding of the instructions? A. "I will have a low-fat diet with small, frequent meals." B. "I will drink fluids between meals rather than with meals." C. "I will drink at least 2 L of fluid daily." D. "I will avoid concentrated sweets and simple carbohydrates."

A. "I will have a low-fat diet with small, frequent meals."

Patient comes into the ER with complaints of hematemesis. The nurse suspects 1. ________ due to the patient's history of 2. __________ which has resulted in 3. _________. Labs drawn on this patient include 4. ________ and 5. ________ A. 1. Esophageal varices 2. ETOH abuse 3. Liver cirrhosis 4. CBC 5. AST/ALT B. 1. Heart failure 2. Smoking 3. Stomach ulcer 4. CBC 6. BMP C. 1. Stomach ulcer 2. ETOH abuse 3. Liver cirrhosis 5. CBC 6. lipase D. Esophageal varices 2. ETOH abuse 4. Liver cirrhosis 5. CBC 6. Amylase

A. 1. Esophageal varices 2. ETOH abuse 3. Liver cirrhosis 4. CBC 5. AST/ALT **although each option may be possible, the most correct option is A because esophageal varices is often a result of ETOH abuse and liver cirrhosis leading to portal hypertension. Option A and D are similar, and a stomach ulcer related to ETOH abuse and liver cirrhosis can cause hematemesis, but amylase and lipase are pancreatic enzymes, and the question does not indicate the patient has pancreatitis. Liver enzymes to see the extent of liver damage would be more plausible.

A patient is admitted with hepatic encephalopathy secondary to cirrhosis. Which meal option selection below should be avoided with this patient? A. Beef tips and broccoli B. Pasta noodles and bread C. Cucumber sandwich with a side of grapes D. Fresh salad with chopped water chestnuts

A. Beef tips and broccoli

A nurse is caring for a client who has cirrhosis. Which of the following medications can the nurse expect to administer to this client? Select all that apply. A. Diuretic B. Beta-blocking agent C. Opioid analgesic D. Lactulose E. Sedative

A. Diuretic can facilitate excretion of excess fluid B. Beta-blocking agents prevent bleeding from varices D. Lactulose aids in the elimination of ammonia in the stool

To prevent the spread of Hepatitis A infection, the nurse is especially careful when doing which of the following? A. Emptying bedpans B. Disposing of food trays C. Changing IV tubing D. Taking an oral temperature

A. Emptying bedpans

You're providing an in-service to new nurse graduates about esophageal varices in patients with cirrhosis. You ask the graduates to list activities that should be avoided by a patient with this condition. Which activities listed are correct: Select all that apply* A. Excessive coughing B. Sleeping on the back C. Drinking juice D. Alcohol consumption E. Straining during a bowel movement F. Vomiting

A. Excessive coughing D. Alcohol consumption E. Straining during a bowel movement F. Vomiting

How is Hepatitis E transmitted? A. Fecal-oral B. Percutaneous C. Mucosal D. Body fluids

A. Fecal-oral

Select all the types of viral Hepatitis that have preventive vaccines available in the United States? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E

A. Hepatitis A B. Hepatitis B The answers are A and B. Currently there is only a vaccine for Hepatitis A and B in the U.S.

A nurse is teaching a client who has hep B about home care. Which of the following instructions should the nurse include in the teaching? Select all that apply. A. Limit physical activity B. Avoid alcohol C. Take acetaminophen for comfort D. Wear a mask when in public places E. Eat small frequent meals

A. Limit physical activity B. Avoid alcohol E. Eat small frequent meals (promote improved nutrition due to presence of anorexia)

A nurse is reviewing risk factors with a client who has cholecystitis. The nurse should identify that which of the following is a risk factor for cholecystitis? A. Obesity B. Rapid weight gain C. Decrease blood triglyceride level D. Male Sex

A. Obesity Obesity is considered a risk factor for the development of cholecystitis

A nurse is completing nutrition teaching for a client who has pancreatitis. Which of the following statements by the client indicates an understanding of the teaching? Select all that apply. A. "I plan to eat small, frequent meals." B. "I will eat easy-to-digest foods with limited spice." C. "I will use skim milk when cooking." D. "I plan to drink regular cola." E. "I will limit alcohol intake to two drinks per day."

A. Small, frequent meals are recommended B. Bland, easy-to-digest foods are recommended C. Low-fat foods are recommended

While assisting a patient with chronic pancreatitis to the bathroom, you note the patient's stool to be oily/greasy in appearance. In your documentation you note this as: A. Steatorrhea B. Melena C. Currant D. Hematochezia

A. Steatorrhea The answer is A. Steatorrhea is an oily/greasy appearance of the stool which can occur in chronic pancreatitis. This occurs due to the inability of the pancreas to produce digestive enzymes which help break down fats. Fats are not being broken down; therefore, it is being excreted into the stool. Melena is used to describe tarry/black stool, hematochezia is used to describe red stools, and currant are jelly type stools.

List the normal values for: ALT AST Bilirubin Ammonia

ALT 7-56 U/L (elevated in hepatitis) AST 10-40 U/L (elevated in hepatitis) Bilirubin <1 mg/dL (elevated in hepatitis) causes jaundice/dark urine Ammonia 15-45 mcg/dL (elevated in hepatitis) manifests as mental status changes

A nurse cares for a client with acute pancreatitis who is prescribed gentamicin (Garamycin) 3 mg/kg/day in 3 divided doses. The client weighs 264 lb. How many milligrams should the nurse administer for each dose? (Record your answer using a whole number.) ____ mg/dose

ANS: 120 mg/dose 264 lb (2.2 lb/kg) = 120 kg. 3 mg/kg/day 120 kg = 360 mg/day. 360 mg/day 3 divided doses = 120 mg/dose.

A nurse cares for a client who is prescribed 4 mg of calcium gluconate to infuse over 5 hours. The pharmacy provides 2 premixed infusion bags with 2 mg of calcium gluconate in 100 mL of D5W. At what rate should the nurse administer this medication? (Record your answer using a whole number.) ____ mL/hr

ANS: 40 mL/hr

A nurse assesses clients at a community health fair. Which client is at greatest risk for the development of hepatitis B? a. A 20-year-old college student who has had several sexual partners b. A 46-year-old woman who takes acetaminophen daily for headaches c. A 63-year-old businessman who travels frequently across the country d. An 82-year-old woman who recently ate raw shellfish for dinner

ANS: A Hepatitis B can be spread through sexual contact, needle sharing, needle sticks, blood transfusions, hemodialysis, acupuncture, and the maternal-fetal route. A person with multiple sexual partners has more opportunities to contract the infection. Hepatitis B is not transmitted through medications, casual contact with other travelers, or raw shellfish. Although an overdose of acetaminophen can cause liver cirrhosis, this is not associated with hepatitis B. Hepatitis E is found most frequently in international travelers. Hepatitis A is spread through ingestion of contaminated shellfish.

A nurse cares for a client with hepatopulmonary syndrome who is experiencing dyspnea with oxygen saturations at 92%. The client states, I do not want to wear the oxygen because it causes my nose to bleed. Get out of my room and leave me alone! Which action should the nurse take? a. Instruct the client to sit in as upright a position as possible. b. Add humidity to the oxygen and encourage the client to wear it. c. Document the clients refusal, and call the health care provider. d. Contact the provider to request an extra dose of the clients diuretic

ANS: A The client with hepatopulmonary syndrome is often dyspneic. Because the oxygen saturation is not significantly low, the nurse should first allow the client to sit upright to see if that helps. If the client remains dyspneic, or if the oxygen saturation drops further, the nurse should investigate adding humidity to the oxygen and seeing whether the client will tolerate that. The other two options may be beneficial, but they are not the best choices. If the client is comfortable, his or her agitation will decrease; this will improve respiratory status

A nurse teaches a client with hepatitis C who is prescribed ribavirin (Copegus). Which statement should the nurse include in this clients discharge education? a. Use a pill organizer to ensure you take this medication as prescribed. b. Transient muscle aching is a common side effect of this medication. c. Follow up with your provider in 1 week to test your blood for toxicity. d. Take your radial pulse for 1 minute prior to taking this medication.

ANS: A Treatment of hepatitis C with ribavirin takes up to 48 weeks, making compliance a serious issue. The nurse should work with the client on a strategy to remain compliant for this length of time. Muscle aching is not a common side effect. The client will be on this medication for many weeks and does not need a blood toxicity examination. There is no need for the client to assess his or her radial pulse prior to taking the medication.

A nurse cares for a client who presents with tachycardia and prostration related to biliary colic. Which actions should the nurse take? (Select all that apply.) a. Contact the provider immediately. b. Lower the head of the bed. c. Decrease intravenous fluids. d. Ask the client to bear down. e. Administer prescribed opioids.

ANS: A, B Clients who are experiencing biliary colic may present with tachycardia, pallor, diaphoresis, prostration, or other signs of shock. The nurse should stay with the client, lower the clients head, and contact the provider or Rapid Response Team for immediate assistance. Treatment for shock usually includes intravenous fluids; therefore, decreasing fluids would be an incorrect intervention. The clients tachycardia is a result of shock, not pain. Performing the vagal maneuver or administering opioids could knock out the clients compensation mechanism.

A nurse assesses a male client who has symptoms of cirrhosis. Which questions should the nurse ask to identify potential factors contributing to this laboratory result? (Select all that apply.) a. How frequently do you drink alcohol? b. Have you ever had sex with a man? c. Do you have a family history of cancer? d. Have you ever worked as a plumber? e. Were you previously incarcerated?

ANS: A, B, E When assessing a client with suspected cirrhosis, the nurse should ask about alcohol consumption, including amount and frequency; sexual history and orientation (specifically men having sex with men); illicit drug use; history of tattoos; and history of military service, incarceration, or work as a firefighter, police officer, or health care provider. A family history of cancer and work as a plumber do not put the client at risk for cirrhosis.

A nurse plans care for a client who has hepatopulmonary syndrome. Which interventions should the nurse include in this clients plan of care? (Select all that apply.) a. Oxygen therapy b. Prone position c. Feet elevated on pillows d. Daily weights e. Physical therapy

ANS: A, C, D Care for a client who has hepatopulmonary syndrome should include oxygen therapy, the head of bed elevated at least 30 degrees or as high as the client wants to improve breathing, elevated feet to decrease dependent edema, and daily weights. There is no need to place the client in a prone position, on the clients stomach. Although physical therapy may be helpful to a client who has been hospitalized for several days, physical therapy is not an intervention specifically for hepatopulmonary syndrome.

A nurse delegates hygiene care for a client who has advanced cirrhosis to an unlicensed nursing personnel (UAP). Which statements should the nurse include when delegating this task to the UAP? (Select all that apply.) a. Apply lotion to the clients dry skin areas. b. Use a basin with warm water to bathe the client. c. For the clients oral care, use a soft toothbrush. d. Provide clippers so the client can trim the fingernails. e. Bathe with antibacterial and water-based soaps.

ANS: A, C, D Clients with advanced cirrhosis often have pruritus. Lotion will help decrease itchiness from dry skin. A soft toothbrush should be used to prevent gum bleeding, and the clients nails should be trimmed short to prevent the client from scratching himself or herself. These clients should use cool, not warm, water on their skin, and should not use excessive amounts of soap.

An infection control nurse develops a plan to decrease the number of health care professionals who contract viral hepatitis at work. Which ideas should the nurse include in this plan? (Select all that apply.) a. Policies related to consistent use of Standard Precautions b. Hepatitis vaccination mandate for workers in high-risk areas c. Implementation of a needleless system for intravenous therapy d. Number of sharps used in client care reduced where possible e. Postexposure prophylaxis provided in a timely manner

ANS: A, C, D, E Nurses should always use Standard Precautions for client care, and policies should reflect this. Needleless systems and reduction of sharps can help prevent hepatitis. Postexposure prophylaxis should be provided immediately. All health care workers should receive the hepatitis vaccinations that are available.

A nurse cares for a client with hepatitis C. The clients brother states, I do not want to contract this infection, so I will not go into his hospital room. How should the nurse respond? a. If you wear a gown and gloves, you will not get this virus. b. Viral hepatitis is not spread through casual contact. c. This virus is only transmitted through a fecal specimen. d. I can give you an update on your brothers status from here.

ANS: B Although family members may be afraid that they will contract hepatitis C, the nurse should educate the clients family about how the virus is spread. Viral hepatitis, or hepatitis C, is spread via blood-to-blood transmission and is associated with illicit IV drug needle sharing, blood and organ transplantation, accidental needle sticks, unsanitary tattoo equipment, and sharing of intranasal cocaine paraphernalia. Wearing a gown and gloves will not decrease the transmission of this virus. Hepatitis C is not spread through casual contact or a fecal specimen. The nurse would be violating privacy laws by sharing the clients status with the brother.

After teaching a client who has alcohol-induced cirrhosis, a nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I cannot drink any alcohol at all anymore. b. I need to avoid protein in my diet. c. I should not take over-the-counter medications. d. I should eat small, frequent, balanced meals.

ANS: B Based on the degree of liver involvement and decreased function, protein intake may have to be decreased. However, some protein is necessary for the synthesis of albumin and normal healing. The other statements indicate accurate understanding of self-care measures for this client.

A telehealth nurse speaks with a client who is recovering from a liver transplant 2 weeks ago. The client states, I am experiencing right flank pain and have a temperature of 101 F. How should the nurse respond? a. The anti-rejection drugs you are taking make you susceptible to infection. b. You should go to the hospital immediately to have your new liver checked out. c. You should take an additional dose of cyclosporine today. d. Take acetaminophen (Tylenol) every 4 hours until you feel better.

ANS: B Fever, right quadrant or flank pain, and jaundice are signs of liver transplant rejection; the client should be admitted to the hospital as soon as possible for intervention. Anti-rejection drugs do make a client more susceptible to infection, but this client has signs of rejection, not infection. The nurse should not advise the client to take an additional dose of cyclosporine or acetaminophen as these medications will not treat the acute rejection.

A nurse cares for a client who is scheduled for a paracentesis. Which intervention should the nurse delegate to an unlicensed assistive personnel (UAP)? a. Have the client sign the informed consent form. b. Assist the client to void before the procedure. c. Help the client lie flat in bed on the right side. d. Get the client into a chair after the procedure.

ANS: B For safety, the client should void just before a paracentesis. The nurse or the provider should have the client sign the consent form. The proper position for a paracentesis is sitting upright in bed or, alternatively, sitting on the side of the bed and leaning over the bedside table. The client will be on bedrest after the procedure.

An emergency room nurse assesses a client after a motor vehicle crash. The nurse notices a steering wheel mark across the clients chest. Which action should the nurse take? a. Ask the client where in the car he or she was sitting during the crash. b. Assess the client by gently palpating the abdomen for tenderness. c. Notify the laboratory to draw blood for blood type and crossmatch. d. Place the client on the stretcher in reverse Trendelenburg position.

ANS: B The liver is often injured by a steering wheel in a motor vehicle crash. Because the clients chest was marked by the steering wheel, the nurse should perform an abdominal assessment. Assessing the clients position in the crash is not needed because of the steering wheel imprint. The client may or may not need a blood transfusion. The client does not need to be in reverse Trendelenburg position.

After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the clients understanding. Which statement by the client indicates a correct understanding of the teaching? a. Some medications have been known to cause hepatitis A. b. I may have been exposed when we ate shrimp last weekend. c. I was infected with hepatitis A through a recent blood transfusion. d. My infection with Epstein-Barr virus can co-infect me with hepatitis A.

ANS: B The route of acquisition of hepatitis A infection is through close personal contact or ingestion of contaminated water or shellfish. Hepatitis A is not transmitted through medications, blood transfusions, or Epstein-Barr virus. Toxic and drug-induced hepatitis is caused from exposure to hepatotoxins, but this is not a form of hepatitis A. Hepatitis B can be spread through blood transfusions. Epstein-Barr virus causes a secondary infection that is not associated with hepatitis A.

A nurse collaborates with an unlicensed assistive personnel (UAP) to provide care for a client who is in the healing phase of acute pancreatitis. Which statements focused on nutritional requirements should the nurse include when delegating care for this client? (Select all that apply.) a. Do not allow the client to eat between meals. b. Make sure the client receives a protein shake. c. Do not allow caffeine-containing beverages. d. Make sure the foods are bland with little spice. e. Do not allow high-carbohydrate food items.

ANS: B, C, D During the healing phase of pancreatitis, the client should be provided small, frequent, moderate- to high-carbohydrate, high-protein, low-fat meals. Protein shakes can be provided to supplement the diet. Foods and beverages should not contain caffeine and should be bland

A nurse cares for a client with pancreatic cancer who is prescribed implanted radioactive iodine seeds. Which actions should the nurse take when caring for this client? (Select all that apply.) a. Dispose of dirty linen in a red biohazard bag. b. Place the client in a private room. c. Wear a lead apron when providing client care. d. Bundle care to minimize exposure to the client. e. Initiate Transmission-Based Precautions.

ANS: B, C, D The client should be placed in a private room and dirty linens kept in the clients room until the radiation source is removed. The nurse should wear a lead apron while providing care, ensuring that the apron always faces the client. The nurse should also bundle care to minimize exposure to the client. Transmission-Based Precautions will not protect the nurse from the implanted radioactive iodine seeds

An emergency room nurse assesses a client with potential liver trauma. Which clinical manifestations should alert the nurse to internal bleeding and hypovolemic shock? (Select all that apply.) a. Hypertension b. Tachycardia c. Flushed skin d. Confusion e. Shallow respirations

ANS: B, D Symptoms of hemorrhage and hypovolemic shock include hypotension, tachycardia, tachypnea, pallor, diaphoresis, cool and clammy skin, and confusion.

A nurse teaches a client who is recovering from acute pancreatitis. Which statements should the nurse include in this clients teaching? (Select all that apply.) a. Take a 20-minute walk at least 5 days each week. b. Attend local Alcoholics Anonymous (AA) meetings weekly. c. Choose whole grains rather than foods with simple sugars. d. Use cooking spray when you cook rather than margarine or butter. e. Stay away from milk and dairy products that contain lactose. f. We can talk to your doctor about a prescription for nicotine patches

ANS: B, D, F The client should be advised to stay sober, and AA is a great resource. The client requires a low-fat diet, and cooking spray is low in fat compared with butter or margarine. If the client smokes, he or she must stop because nicotine can precipitate an exacerbation. A nicotine patch may help the client quit smoking. The client must rest until his or her strength returns. The client requires high carbohydrates and calories for healing; complex carbohydrates are not preferred over simple ones. Dairy products do not cause a problem

A nurse assesses a client who has liver disease. Which laboratory findings should the nurse recognize as potentially causing complications of this disorder? (Select all that apply.) a. Elevated aspartate transaminase b. Elevated international normalized ratio (INR) c. Decreased serum globulin levels d. Decreased serum alkaline phosphatase e. Elevated serum ammonia f. Elevated prothrombin time (PT)

ANS: B, E, F Elevated INR and PT are indications of clotting disturbances and alert the nurse to the increased possibility of hemorrhage. Elevated ammonia levels increase the clients confusion. The other values are abnormal and associated with liver disease but do not necessarily place the client at increased risk for complications.

A nurse cares for a client who has chronic cirrhosis from substance abuse. The client states, All of my family hates me. How should the nurse respond? a. You should make peace with your family. b. This is not unusual. My family hates me too. c. I will help you identify a support system. d. You must attend Alcoholics Anonymous.

ANS: C Clients who have chronic cirrhosis may have alienated relatives over the years because of substance abuse. The nurse should assist the client to identify a friend, neighbor, or person in his or her recovery group for support. The nurse should not minimize the clients concerns by brushing off the clients comment. Attending AA may be appropriate, but this response doesnt address the clients concern. Making peace with the clients family may not be possible. This statement is not client-centered.

After teaching a client who has plans to travel to a non-industrialized country, the nurse assesses the clients understanding regarding the prevention of viral hepatitis. Which statement made by the client indicates a need for additional teaching? a. I should drink bottled water during my travels. b. I will not eat off anothers plate or share utensils. c. I should eat plenty of fresh fruits and vegetables. d. I will wash my hands frequently and thoroughly.

ANS: C The client should be advised to avoid fresh, raw fruits and vegetables because they can be contaminated by tap water. Drinking bottled water, and not sharing plates, glasses, or eating utensils are good ways to prevent illness, as is careful handwashing.

A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of carcinoma of the liver? a. A 22-year-old with a history of blunt liver trauma b. A 48-year-old with a history of diabetes mellitus c. A 66-year-old who has a history of cirrhosis d. An 82-year-old who has chronic malnutrition

ANS: C The risk of contracting a primary carcinoma of the liver is higher in clients with cirrhosis from any cause. Blunt liver trauma, diabetes mellitus, and chronic malnutrition do not increase a persons risk for developing liver cancer

A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? Select all that apply:* A. Increase albumin levels B. Ascites C. Splenomegaly D. Fluid volume deficient E. Esophageal varices

B. Ascites C. Splenomegaly D. Fluid volume deficient...possible answer? E. Esophageal varices

Your patient is diagnosed with acute cholecystitis. The patient is extremely nauseous. A nasogastric tube is inserted with GI decompression. The patient reports a pain rating of 9 on 1-10 scale and states the pain radiates to the shoulder blade. Select all the appropriate nursing interventions for the patient:* A. Encourage the patient to consume clear liquids. B. Administered IV fluids per MD order. C. Provide mouth care routinely. D. Keep the patient NPO. E. Administer analgesic as ordered. F. Maintain low intermittent suction to NG tube.

B. Administered IV fluids per MD order. C. Provide mouth care routinely. D. Keep the patient NPO. E. Administer analgesic as ordered. F. Maintain low intermittent suction to NG tube.

You're assessing a patient's t-tube and note that it is not draining bile. The patient is reporting nausea. The nurse will first? A. Notify the physician B. Assess if the tubing from the t-tube is kinked or clamped. C. Flush the tubing. D. Administer an antiemetic medication per physician order.

B. Assess if the tubing from the t-tube is kinked or clamped.

Which statements below are CORRECT regarding the role of bile? Select all that apply:* A. Bile is created and stored in the gallbladder. B. Bile aids in digestion of fat soluble vitamins, such as A, D, E, and K. C. Bile is released from the gallbladder into the duodenum. D. Bile contains bilirubin.

B. Bile aids in digestion of fat soluble vitamins A, D, E, and K. C. Bile is released from the gallbladder into the duodenum. D. Bile contains bilirubin. When there is a bile duct obstruction in the liver and gallbladder due to liver disease or cholecystitis, bile is not able to be excreted to break down fats in the GI tract and leads to clay-colored stools. Clay colored stools can also indicate a chronic cholecystitis.

During an admission assessment, the nurse notes a client with hepatitis exhibits all of the following signs or symptoms. Which one is not related to hepatitis? A. Anorexia B. Bloody stools C. Dark urine D. Yellow sclera"

B. Bloody stools (B) Rectal bleeding is not related to hepatitis. Further assessment and Tests are needed to identify the cause. A, C and D are expected findings

A nurse is assessing a client who has advanced cirrhosis. The nurse should identify which of the following findings as indicators of hepatic encephalopathy? Select all that apply. A. Anorexia B. Change in orientation C. Asterixis D. Ascites E. Fetor hepaticus

B. Change in orientation C. Asterixis E. Fetor hepaticus (fruity, musty breath odor)

You are receiving shift report on a patient with cirrhosis. The nurse tells you the patient's bilirubin levels are very high. Based on this, what assessment findings may you expect to find during your head-to-toe assessment? Select all that apply:* A. Frothy light-colored urine B. Dark brown urine C. Yellowing of the sclera D. Dark brown stool E. Jaundice of the skin F. Bluish mucous membranes

B. Dark brown urine C. Yellowing of the sclera E. Jaundice of the skin

A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? a. Elevated hemoglobin level B. Elevated serum bilirubin level c. Elevated blood urea nitrogen leveld. d. Decreased erythrocycle sedimentation rate

B. Elevated serum bilirubin level Answer B. Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis

To prevent the spread of hepatitis A virus (HAV) infection the nurse is especially careful when A. Disposing of food trays B. Emptying bed pan C. Taking an oral temperature D. Changing IV tubing"

B. Emptying bed pan Answer: B Rationale: HAV is transmitted primarily person-to-person by the fecal-oral route. Food can be a method of transmission but needs to be fecally contaminated. Since the transmission of hepatitis A is fecal-oral and not saliva or blood like hepatitis B, taking a temperature and changing IV tubing would not spread hepatitis A.

While providing mouth care to a patient with late-stage cirrhosis, you note a pungent, sweet, musty smell to the breath. This is known as: A. Metallic Hepatico B. Fetor Hepaticus C. Hepaticoacidosis D. Asterixis

B. Fetor Hepaticus

A tumor was shown to possess cells that were moderately differentiated. This is considered a? A. Grade I B. Grade II C. Grade III D. Grade IV

B. Grade II

The nurse assess a patient with cirrhosis and finds 4+ pitting edema of the feet and legs and massive ascites. The nurse recognizes that one factor contributing to edema and ascites in patients with cirrhosis is which of the following? A. Increased osmotic pressure caused by elevated blood ammonia levels B. Hyperalderosteronism caused by the liver's ability to inactivate the hormone C. Decreased portacaval pressure with development of collateral circulation in the GI vessels D. Decreased renin-angiotensin response to decreased renal blood flow

B. Hyperalderosteronism caused by the liver's ability to inactivate the hormone

During the icteric phase of hepatitis, the nurse would expect the patient's laboratory results to include which of the following? A. Increased direct (conjugated) serum bilirubin B. Increased direct (conjugated) and indirect (unconjugated) serum bilirubin C. Increased stool urobilinogen D. Increased indirect (unconjugated) serum bilirubin

B. Increased direct (conjugated) and indirect (unconjugated) serum bilirubin

The nurse is caring for an adult client with acute pancreatitis. Which laboratory finding lead the nurse to believe that this diagnosis is correct? A. Total bilirubin 1.0 mg dL B. Lipase 625 units/L C. Calcium 9.0 mg/dL D. Hgb A1C: 14%

B. Lipase 625 units/L NORMAL 0-160

A nurse is caring for a client who has a new diagnosis of Hep C. Which of the following laboratory findings should the nurse expect? A. Presence of immunoglobulin G antibodies B. Positive EIA test C. AST 35 units/L D. ALT 15 IU/L

B. Positive EIA test is an expected laboratory finding in a client who has new diagnosis of hep C.

A nurse is providing discharge teaching to a client who is postoperative following a laparoscopic cholecystectomy. Which of the following instructions should the nurse include in the teaching? Select all that apply. A. Take baths rather than showers B. Resume a diet of choice C. Cleanse the puncture site using mild soap and water D. Remove adhesive strips from the puncture site in 24 hr E. Report nausea and vomiting to the surgeon

B. Resume diet of choice - client is able to resume a regular diet of choice upon discharge C. Cleanse the puncture site using mild soap and water - The client should cleanse the puncture site with soap and water to decrease risk of infection E. Report nausea and vomiting to the surgeon - the client should report nausea, vomiting and abdominal pain to the surgeon

Which position is best for a patient with a t-tube? A. Supine B. Semi-Fowler's C. Right lateral recumbent D. Left lateral recumbent

B. Semi-Fowler's

A nurse is completing preoperative teaching for a client who is scheduled for a laparoscopic cholecystectomy. Which of the following should be included in the teaching? A. "The scope will be passed through your rectum." B. "You might have shoulder pain after surgery." C. "You will have a Jackson-Pratt drain in place after surgery." D. "You should limit how often you walk for 1 to 2 weeks."

B. Shoulder pain is expected postoperatively due to free air that is introduced into the abdomen during laparoscopic surgery

What TNM classification below best describes this finding: very large tumor with 1 regional lymph node involvement, and spread to two regional organs? A. T1N1M2 B. T4N1M1 C. T1N1M1 D. T4N1M2

B. T4N1M1

The category "T" in the TNM system stands for: A. Time B. Tumor (primary) C. Tissue (primary) D. Tumor (secondary)

B. Tumor (primary)

Your patient will be receiving external beam radiation on an outpatient basis. In teaching the patient about what to expect from therapy, you should be sure to include which of the following? A. You will get high doses of radiation throughout your body B. You may experience altered taste sensation C. You will be cured once your treatment is complete D. The skin at the radiated area is unaffected

B. You may experience altered taste sensation

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which of the following responses by the nurse is most appropriate? A. "The hepatitis vaccine will provide immunity from this exposure and future exposures." B. "I am afraid there is nothing you can do since the patient was infectious before admission." C. "You will need to be tested first to make sure you don't have the virus before we can treat you." D. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure.""

C. "You will need to be tested first to make sure you don't have the virus before we can treat you." Correct C: "Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis."

A nurse in a clinic is reviewing the laboratory reports of a client who has suspected cholelithiasis. Which of the following is an expected finding? A. Blood amylase 80 units/L B. WBC 9,000/mm C. Direct bilirubin 2.1 mg/dL D. Alkaline phosphatase 25 units/L

C. Expect the client who has cholelithiasis to have an elevated direct bilirubin level if the bile duct is obstructed. A direct bilirubin level of 2.1 mg/dL is above the expected reference range.

A nurse is assessing a client who has pancreatitis. Which of the following findings should the nurse identify as a manifestation of pancreatitis? A. Generalized cyanosis B. Hyperactive bowel sounds C. Gray-blue discoloration of the skin around the umbilicus D. Wheezing in the lower lung fields

C. Gray-blue discoloration in the periumbilical area is a manifestation of pancreatitis

What is the BEST preventive measure to take to help prevent ALL types of viral Hepatitis? A. Vaccination B. Proper disposal of needles C. Hand hygiene D. Blood and organ donation screening

C. Hand hygiene

During your morning assessment of a patient with cirrhosis, you note the patient is disoriented to person and place. In addition while assessing the upper extremities, the patient's hands demonstrate a flapping motion. What lab result would explain these abnormal assessment findings?* A. Decreased magnesium level B. Increased calcium level C. Increased ammonia level D. Increased creatinine level

C. Increased ammonia level

During your morning assessment of a patient with cirrhosis, you note the patient is disoriented to person and place. In addition while assessing the upper extremities, the patient's hands demonstrate a flapping motion. What lab result would explain these abnormal assessment findings? A. Decreased magnesium level B. Increased calcium level C. Increased ammonia level D. Increased creatinine level

C. Increased ammonia level The answer is C. Based on the assessment findings and the fact the patient has cirrhosis, the patient is experiencing hepatic encephalopathy. This is due to the buildup of toxins in the blood, specifically ammonia. The flapping motion of the hands is called "asterixis". Therefore, an increased ammonia level would confirm these abnormal assessment findings.

The category "N" in the TNM system stands for: A. Number B. Necrosis C. Nodes D. Normal

C. Nodes

A patient has the diagnosis of biliary cirrhosis. You noticed some bruising on his arms and legs and want to follow up on the following lab values consistent with his disease. You know to evaluate which of the following? A. Eosinophils, PT/INR, fibrinogen, and platelets B. Hgb, neutrophils, ESR, and ammonia C. Platelets, PT/INR, Hgb and Vitamin K plasma level D. Bilirubin, PT/INR, Hgb, and total white blood cells

C. Platelets, PT/INR, Hgb and Vitamin K plasma level Patients with cirrhosis are susceptible to bleeding and easy bruising because there is a decrease in the production of bile in the liver, preventing the absorption of vitamin K

Which of the following is NOT a common source of transmission for Hepatitis A? Select all that apply: A. Water B. Food C. Semen D. Blood

C. Semen D. Blood

A patient is prescribed Peginterferon alfa-2a. The nurse will prepare to administer this medication what route? A. Oral B. Intramuscular C. Subcutaneous D. Intravenous

C. Subcutaneous

A nurse is completing an admission assessment of a client who has pancreatitis. Which of the following findings should the nurse expect? A. Pain in RUQ radiating to right shoulder B. Report of pain being worse when sitting upright C. Pain relieved with defecation D. Epigastric pain radiating to the left shoulder

D. A client who has pancreatitis will report severe, boring epigastric pain that radiates to the back, left flank, or left shoulder

During a home health visit, you are assessing how a patient takes the prescribed pancreatic enzyme. The patient is unable to swallow the capsule whole, so they open the capsule and mix the beads inside the capsule with food/drink. Which food or drink is safe for the patient to mix the beads with? A. Pudding B. Ice cream C. Milk D. Applesauce

D. Applesauce The answer is D. The patient should mix the medications with acidic foods like applesauce. It is very important the patient does NOT use alkaline foods for mixing (like dairy products, pudding etc.) because they can damaged the enzyme.

A nurse is reviewing a new prescription for chenodiol with a client who has cholelithiasis. Which of the following information should the nurse include in the teaching? A. This medication is used to decrease acute biliary pain B. This medication requires thyroid function monitoring every 6 months C. This medication is not recommended for clients who have diabetes mellitus D. This medication dissolves gallstones gradually over a period of up to 2 years

D. Chenodiol is a bile acid that gradually dissolves cholesterol-based gall stones. The medication can be taken for up to 2 years

The TNM staging system for cancer can be used to help stage what type of cancer? A. Brain cancer B. Spinal cord cancer C. Leukemia D. Colon cancer

D. Colon cancer The answer is D. The TNM staging system is not used for brain, spinal cord or blood cancers (includes leukemia). It is used for solid tumor cancers.

What is the MOST common transmission route of Hepatitis C? A. Blood transfusion B. Sharps injury C. Long-term dialysis D. IV drug use

D. IV drug use

________ reside in the liver and help remove bacteria, debris, and old red blood cells. A. Hepatocytes B. Langerhan cells C. Enterocytes D. Kupffer cells

D. Kupffer cells The answer is D. Kupffer cells perform this function and are one of the two types of cells found in the liver lobules (the functional units of the liver). These cells play a role in helping the hepatocytes turn parts of the old red blood cells into bilirubin.

A patient has completed the Hepatitis B vaccine series. What blood result below would demonstrate the vaccine series was successful at providing immunity to Hepatitis B? A. Positive IgG B. Positive HBsAg C. Positive IgM D. Positive anti-HBs

D. Positive anti-HBs The answer is D. A positive anti-HBs (Hepatitis B surface antibody) indicates either a past infection of Hepatitis B that is now cleared and the patient is immune, OR that the vaccine has been successful at providing immunity. A positive HBsAg (Hepatitis B surface antigen) indicates an active infection.

A nurse on a medical-surgical unit is admitting a client who has hepatitis B with ascites. Which of the following actions should the nurse include in the plan of care? A. Initiate contact precautions B. Weigh the client weekly C. Measure the abdominal girth at the base of the ribcage D. Provide a high-calorie, high carbohydrate diet

D. The client who has hep B should have a diet high in calories and carbohydrates

A nurse is reviewing the admission laboratory results of a client who has acute pancreatitis. Which of the following findings should the nurse expect? A. Decreased blood lipase level B. Decreased blood amylase level C. Increased blood calcium level D. Increased blood glucose level

D. The client will experience an increased blood glucose level due to pancreatic cell injury, which results in impaired metabolism of carbohydrates due to a decrease in the release of insulin.

A patient with hepatitis B is being discharged in 2 days. In the discharge teaching plan, the nurse should include instructions to do which of the following? A. Have family members get an injection of immunoglobulin B. Follow a low-protein, moderate-carbohydrate, moderate-fat diet C. Avoid alcohol for the first 3 weeks D. Use a condom during sexual intercourse

D. Use a condom during sexual intercourse

A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are: a. whole blood and albumin. b. platelets and packed red blood cells. c. fresh frozen plasma and whole blood. D. cryoprecipitate and frozen plasma.

D. cryoprecipitate and frozen plasma. Answer D. Patients with liver failure have increased PT, decreased clotting factors, and low plt counts The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which has most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, those products aren't specifically used to treat hemostasis. Platelets are helpful, but the best answer is cryoprecipitate and fresh frozen plasma.

When planning care for a patient with cirrhosis, the nurse will give highest priority to which of the following nursing diagnoses? A: Imbalanced nutrition: less than body requirements B: Impaired skin integrity related to edema, ascites, and pruritis C: Excess fluid volume related to portal hypertension and hyperaldosteronism D: Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

D: Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume CORRECT: D: Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, AIRWAY and BREATHING are always the highest priorities.

Which condition is NOT a known cause of cirrhosis? A. Obesity B. Alcohol consumption C. Blockage of the bile duct D. Hepatitis C E. All are known causes of cirrhosis

E. All are known causes of cirrhosis

TRUE or FALSE: A patient with Hepatitis A is contagious about 2 weeks before signs and symptoms appear and 1-3 weeks after the symptoms appear. True False

True

The nurse is caring for a client with sialadenitis. What comfort measures may the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Applying warm compresses b. Massaging salivary glands c. Offering fluids every hour d. Providing lemon-glycerin swabs e. Reminding the client to avoid speaking

a. Applying warm compresses c. Offering fluids every hour ANS: A, C The UAP can apply warm compresses and offer fluids. Massaging salivary glands can be done, but not by the UAP. Lemon-glycerin swabs are drying and should not be used. Speaking has no effect on this condition.

A nurse is providing community education on the seven warning signs of cancer. Which signs are included? (Select all that apply.) a. A sore that does not heal b. Changes in menstrual patterns c. Indigestion or trouble swallowing d. Near-daily abdominal pain e. Obvious change in a mole

a. A sore that does not heal b. Changes in menstrual patterns c. Indigestion or trouble swallowing e. Obvious change in a mole ANS: A, B, C, E The seven warning signs for cancer can be remembered with the acronym CAUTION: changes in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or lump in the breast or elsewhere, indigestion or difficulty swallowing, obvious change in a wart or mole, and nagging cough or hoarseness. Abdominal pain is not a warning sign.

A client is having a temporary tracheostomy placed during surgery for oral cancer. What action by the nurse is best to relieve anxiety? a. Agree on a postoperative communication method. b. Explain that staff will answer the call light promptly. c. Give the client a Magic Slate to write on postoperatively. d. Reassure the client that you will take care of all of his or her needs.

a. Agree on a postoperative communication method. ANS: A Before surgery that interrupts the clients ability to communicate, the nurse, client, and family (if possible) agree upon a method of communication in the postoperative period. The client may or may not prefer a slate and may not be able to communicate in writing. Reassuring the client and telling him or her you will take care of all of his or her needs does not help the client be an active participant in care. Ensuring that the staff will answer the call light promptly will not guarantee this will occur.

A client has a large oral tumor. What assessment by the nurse takes priority? a. Airway b. Breathing c. Circulation d. Nutrition

a. Airway ANS: A Airway always takes priority. Airway must be assessed first and any problems resolved if present.

A nurse works on an oncology unit and delegates personal hygiene to an unlicensed assistive personnel (UAP). What action by the UAP requires intervention from the nurse? a. Allowing a very tired client to skip oral hygiene and sleep b. Assisting clients with washing the perianal area every 12 hours c. Helping the client use a soft-bristled toothbrush for oral care d. Reminding the client to rinse the mouth with water or saline

a. Allowing a very tired client to skip oral hygiene and sleep ANS: A Even though clients may be tired, they still need to participate in hygiene to help prevent infection. The other options are all appropriate.

A nurse cares for a client who is recovering from laparoscopic cholecystectomy surgery. The client reports pain in the shoulder blades. How should the nurse respond? a. Ambulating in the hallway twice a day will help. b. I will apply a cold compress to the painful area on your back. c. Drinking a warm beverage can relieve this referred pain. d. You should cough and deep breathe every hour.

a. Ambulating in the hallway twice a day will help. ANS: A The client who has undergone a laparoscopic cholecystectomy may report free air pain due to retention of carbon dioxide in the abdomen. The nurse assists the client with early ambulation to promote absorption of the carbon dioxide. Cold compresses and drinking a warm beverage would not be helpful. Coughing and deep breathing are important postoperative activities, but they are not related to discomfort from carbon dioxide.

A client on interferon therapy is reporting severe skin itching and irritation. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply moisturizers to dry skin. b. Apply steroid creams to the skin. c. Bathe the client using mild soap. d. Help the client with a hot water bath. e. Teach the client to avoid sunlight.

a. Apply moisturizers to dry skin. c. Bathe the client using mild soap. ANS: A, C The nurse can delegate applying unscented moisturizer and using mild soap for bathing. Steroid creams are not used for this condition. Hot water will worsen the irritation. Client teaching is a nursing function.

A client has thrombocytopenia. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply the clients shoes before getting the client out of bed. b. Assist the client with ambulation. c. Shave the client with a safety razor only. d. Use a lift sheet to move the client up in bed. e. Use the Waterpik on a low setting for oral care.

a. Apply the clients shoes before getting the client out of bed. b. Assist the client with ambulation. d. Use a lift sheet to move the client up in bed. ANS: A, B, D Clients with thrombocytopenia are at risk of significant bleeding even with minor injuries. The nurse instructs the UAP to put the clients shoes on before getting the client out of bed, assist with ambulation, shave the client with an electric razor, use a lift sheet when needed to reposition the client, and use a soft-bristled toothbrush for oral care.

A group of nursing students has entered a futuristic science contest in which they have developed a cure for cancer. Which treatment would most likely be the winning entry? a. Artificial fibronectin infusion to maintain tight adhesion of cells b. Chromosome repair kit to halt rapid division of cancer cells c. Synthetic enzyme transfusion to allow rapid cellular migration d. Telomerase therapy to maintain chromosomal immortality

a. Artificial fibronectin infusion to maintain tight adhesion of cells ANS: A Cancer cells do not have sufficient fibronectin and so do not maintain tight adhesion with other cells. This is part of the mechanism of metastasis. Chromosome alterations in cancer cells (aneuploidy) consist of having too many, too few, or altered chromosome pairs. This does not necessarily lead to rapid cellular division. Rapid cellular migration is part of metastasis. Immortality is a characteristic of cancer cells due to too much telomerase.

A client scheduled for a percutaneous transhepatic cholangiography (PTC) denies allergies to medication. What action by the nurse is best? a. Ask the client about shellfish allergies. b. Document this information on the chart. c. Ensure that the client has a ride home. d. Instruct the client on bowel preparation.

a. Ask the client about shellfish allergies. ANS: A PTC uses iodinated dye, so the client should be asked about seafood allergies, specifically to shellfish. Documentation should occur, but this is not the priority. The client will need a ride home afterward if the procedure is done on an outpatient basis. There is no bowel preparation for PTC.

A clients family members are concerned that telling the client about a new finding of cancer will cause extreme emotional distress. They approach the nurse and ask if this can be kept from the client. What actions by the nurse are most appropriate? (Select all that apply.) a. Ask the family to describe their concerns more fully. b. Consult with a social worker, chaplain, or ethics committee. c. Explain the clients right to know and ask for their assistance. d. Have the unit manager take over the care of this client and family. e. Tell the family that this secret will not be kept from the client.

a. Ask the family to describe their concerns more fully. b. Consult with a social worker, chaplain, or ethics committee. c. Explain the clients right to know and ask for their assistance. ANS: A, B, C The clients right of autonomy means that the client must be fully informed as to his or her diagnosis and treatment options. The nurse cannot ethically keep this information from the client. The nurse can ask the family to explain their concerns more fully so everyone understands the concerns. A social worker, chaplain, or ethics committee can become involved to assist the nurse, client, and family. The nurse should explain the clients right to know and ask the family how best to proceed. The nurse should not abdicate responsibility for this difficult situation by transferring care to another nurse. Simply telling the family that he or she will not keep this secret sets up an adversarial relationship. Explaining this fact along with the concept of autonomy would be acceptable, but this by itself is not.

A client receiving chemotherapy has a white blood cell count of 1000/mm3. What actions by the nurse are most appropriate? (Select all that apply.) a. Assess all mucous membranes every 4 to 8 hours. b. Do not allow the client to eat meat or poultry. c. Listen to lung sounds and monitor for cough. d. Monitor the venous access device appearance with vital signs. e. Take and record vital signs every 4 to 8 hours.

a. Assess all mucous membranes every 4 to 8 hours. c. Listen to lung sounds and monitor for cough. d. Monitor the venous access device appearance with vital signs. e. Take and record vital signs every 4 to 8 hours. ANS: A, C, D, E Depending on facility protocol, the nurse should assess this client for infection every 4 to 8 hours by assessing all mucous membranes, listening to lung sounds, monitoring for cough, monitoring the appearance of the venous access device, and recording vital signs. Eating meat and poultry is allowed.

A client in the emergency department reports difficulty breathing. The nurse assesses the clients appearance as depicted below: What action by the nurse is the priority? a. Assess blood pressure and pulse. b. Attach the client to a pulse oximeter. c. Have the client rate his or her pain. d. Start high-dose steroid therapy.

a. Assess blood pressure and pulse. ANS: A This client has superior vena cava syndrome, in which venous return from the head, neck, and trunk is blocked. Decreased cardiac output can occur. The nurse should assess indicators of cardiac output, including blood pressure and pulse, as the priority. The other actions are also appropriate but are not the priority.

A nurse assesses a client who is recovering from an open Whipple procedure. Which action should the nurse perform first? a. Assess the clients endotracheal tube with 40% FiO2. b. Insert an indwelling Foley catheter to gravity drainage. c. Place the clients nasogastric tube to low intermittent suction. d. Start lactated Ringers solution through an intravenous catheter.

a. Assess the clients endotracheal tube with 40% FiO2. ANS: A Using the ABCs, airway and oxygenation status should always be assessed first, so checking the endotracheal tube is the first action. Next, the nurse should start the IV line (circulation). After that, the Foley catheter can be inserted and the nasogastric tube can be set.

A client with a history of prostate cancer is in the clinic and reports new onset of severe low back pain. What action by the nurse is most important? a. Assess the clients gait and balance. b. Ask the client about the ease of urine flow. c. Document the report completely. d. Inquire about the clients job risks.

a. Assess the clients gait and balance. ANS: A This client has manifestations of spinal cord compression, which can be seen with prostate cancer. This may affect both gait and balance and urinary function. For client safety, assessing gait and balance is the priority. Documentation should be complete. The client may or may not have occupational risks for low back pain, but with his history of prostate cancer, this should not be where the nurse starts investigating.

A client is receiving chemotherapy through a peripheral IV line. What action by the nurse is most important? a. Assessing the IV site every hour b. Educating the client on side effects c. Monitoring the client for nausea d. Providing warm packs for comfort

a. Assessing the IV site every hour ANS: A Intravenous chemotherapy can cause local tissue destruction if it extravasates into the surrounding tissues. Peripheral IV lines are more prone to this than centrally placed lines. The most important intervention is prevention, so the nurse should check hourly to ensure the IV site is patent, or frequently depending on facility policy. Education and monitoring for side effects such as nausea are important for all clients receiving chemotherapy. Warm packs may be helpful for comfort, but if the client reports that an IV site is painful, the nurse needs to assess further.

A client has mucositis. What actions by the nurse will improve the clients nutrition? (Select all that apply.) a. Assist with rinsing the mouth with saline frequently. b. Encourage the client to eat room-temperature foods. c. Give the client hot liquids to hold in the mouth. d. Provide local anesthetic medications to swish and spit. e. Remind the client to brush teeth gently after each meal.

a. Assist with rinsing the mouth with saline frequently. b. Encourage the client to eat room-temperature foods. d. Provide local anesthetic medications to swish and spit. e. Remind the client to brush teeth gently after each meal. ANS: A, B, D, E Mucositis can interfere with nutrition. The nurse can help with rinsing the mouth frequently with water or saline; encouraging the client to eat cool, slightly warm, or room-temperature foods; providing swish-and-spit anesthetics; and reminding the client to keep the mouth clean by brushing gently after each meal. Hot liquids would be painful for the client.

A nurse working with clients who experience alopecia knows that which is the best method of helping clients manage the psychosocial impact of this problem? a. Assisting the client to pre-plan for this event b. Reassuring the client that alopecia is temporary c. Teaching the client ways to protect the scalp d. Telling the client that there are worse side effects

a. Assisting the client to pre-plan for this event ANS: A Alopecia does not occur for all clients who have cancer, but when it does, it can be devastating. The best action by the nurse is to teach the client about the possibility and to give the client multiple choices for preparing for this event. Not all clients will have the same reaction, but some possible actions the client can take are buying a wig ahead of time, buying attractive hats and scarves, and having a hairdresser modify a wig to look like the clients own hair. Teaching about scalp protection is important but does not address the psychosocial impact. Reassuring the client that hair loss is temporary and telling him or her that there are worse side effects are both patronizing and do not give the client tools to manage this condition.

A nurse cares for a client who has obstructive jaundice. The client asks, Why is my skin so itchy? How should the nurse respond? a. Bile salts accumulate in the skin and cause the itching. b. Toxins released from an inflamed gallbladder lead to itching. c. Itching is caused by the release of calcium into the skin. d. Itching is caused by a hypersensitivity reaction.

a. Bile salts accumulate in the skin and cause the itching. ANS: A In obstructive jaundice, the normal flow of bile into the duodenum is blocked, allowing excess bile salts to accumulate on the skin. This leads to itching, or pruritus. The other statements are not accurate.

A client is receiving interleukins along with chemotherapy. What assessment by the nurse takes priority? a. Blood pressure b. Lung assessment c. Oral mucous membranes d. Skin integrity

a. Blood pressure ANS: A Interleukins can cause capillary leak syndrome and fluid shifting, leading to intravascular volume depletion. Although all assessments are important in caring for clients with cancer, blood pressure and other assessments of fluid status take priority.

The nurse caring for oncology clients knows that which form of metastasis is the most common? a. Bloodborne b. Direct invasion c. Lymphatic spread d. Via bone marrow

a. Bloodborne ANS: A Bloodborne metastasis is the most common way for cancer to metastasize. Direct invasion and lymphatic spread are other methods. Bone marrow is not a medium in which cancer spreads, although cancer can occur in the bone marrow.

A nurse assesses a client with cholelithiasis. Which assessment findings should the nurse identify as contributors to this clients condition? (Select all that apply.) a. Body mass index of 46 b. Vegetarian diet c. Drinking 4 ounces of red wine nightly d. Pregnant with twins e. History of metabolic syndrome f. Glycosylated hemoglobin level of 15%

a. Body mass index of 46 d. Pregnant with twins f. Glycosylated hemoglobin level of 15% ANS: A, D, F Obesity, pregnancy, and diabetes are all risk factors for the development of cholelithiasis. A diet low in saturated fats and moderate alcohol intake may decrease the risk. Although metabolic syndrome is a precursor to diabetes, it is not a risk factor for cholelithiasis. The client should be informed of the connection

A nurse in the oncology clinic is providing preoperative education to a client just diagnosed with cancer. The client has been scheduled for surgery in 3 days. What action by the nurse is best? a. Call the client at home the next day to review teaching. b. Give the client information about a cancer support group. c. Provide all the preoperative instructions in writing. d. Reassure the client that surgery will be over soon.

a. Call the client at home the next day to review teaching. ANS: A Clients are often overwhelmed at a sudden diagnosis of cancer and may be more overwhelmed at the idea of a major operation so soon. This stress significantly impacts the clients ability to understand, retain, and recall information. The nurse should call the client at home the next day to review the teaching and to answer questions. The client may or may not be ready to investigate a support group, but this does not help with teaching. Giving information in writing is important (if the client can read it), but in itself will not be enough. Telling the client that surgery will be over soon is giving false reassurance and does nothing for teaching.

An older client has had an instance of drug toxicity and asks why this happens, since the client has been on this medication for years at the same dose. What response by the nurse is best? a. Changes in your liver cause drugs to be metabolized differently. b. Perhaps you dont need as high a dose of the drug as before. c. Stomach muscles atrophy with age and you digest more slowly. d. Your body probably cant tolerate as much medication anymore.

a. Changes in your liver cause drugs to be metabolized differently. ANS: A Decreased liver enzyme activity depresses drug metabolism, which leads to accumulation of drugspossibly to toxic levels. The other options do not accurately explain this age-related change.

A nurse is preparing to administer IV chemotherapy. What supplies does this nurse need? (Select all that apply.) a. Chemo gloves b. Facemask c. Isolation gown d. N95 respirator e. Shoe covers

a. Chemo gloves b. Facemask c. Isolation gown ANS: A, B, C The Occupational Safety and Health Administration (OSHA) and the Oncology Nurses Society have developed safety guidelines for those preparing or administering IV chemotherapy. These include double gloves (or chemo gloves), a facemask, and a gown. An N95 respirator and shoe covers are not required.

A client had an endoscopic retrograde cholangiopancreatography (ERCP). The nurse instructs the client and family about the signs of potential complications, which include what problems? (Select all that apply.) a. Cholangitis b. Pancreatitis c. Perforation d. Renal lithiasis e. Sepsis

a. Cholangitis b. Pancreatitis c. Perforation e. Sepsis ANS: A, B, C, E Possible complications after an ERCP include cholangitis, pancreatitis, perforation, sepsis, and bleeding. Kidney stones are not a complication of ERCP.

A nurse studying cancer knows that job-related risks for developing oral cancer include which occupations? (Select all that apply.) a. Coal miner b. Electrician c. Metal worker d. Plumber e. Textile worker

a. Coal miner c. Metal worker d. Plumber e. Textile worker ANS: A, C, D, E The occupations of coal mining, metal working, plumbing, and textile work produce exposure to polycyclic aromatic hydrocarbons (PAHs), which are known carcinogens. Electricians do not have this risk

The nurse working in the gastrointestinal clinic sees clients who are anemic. What are common causes for which the nurse assesses in these clients? (Select all that apply.) a. Colon cancer b. Diverticulitis c. Inflammatory bowel disease d. Peptic ulcer disease e. Pernicious anemia

a. Colon cancer b. Diverticulitis c. Inflammatory bowel disease d. Peptic ulcer disease ANS: A, B, C, D In adults, the most common cause of anemia is GI bleeding. This is commonly associated with colon cancer, diverticulitis, inflammatory bowel disease, and peptic ulcer disease. Pernicious anemia is not associated with GI bleeding.

The nurse is aware of the 2014 American Cancer Society Screening Guidelines for colon cancer, which include which testing modalities for people over the age of 50? (Select all that apply.) a. Colonoscopy every 10 years b. Colonoscopy every 5 years c. Computed tomography (CT) colonography every 5 years d. Double-contrast barium enema every 10 years e. Flexible sigmoidoscopy every 10 years

a. Colonoscopy every 10 years c. Computed tomography (CT) colonography every 5 years ANS: A, C The options for colon cancer screening for people over the age of 50 include colonoscopy every 10 years and CT colonography, double-contrast barium enema, or flexible sigmoidoscopy every 5 years.

A nurse reads on a hospitalized clients chart that the client is receiving teletherapy. What action by the nurse is best? a. Coordinate continuation of the therapy. b. Place the client on radiation precautions. c. No action by the nurse is needed at this time. d. Restrict visitors to only adults over age 18.

a. Coordinate continuation of the therapy. ANS: A The client needs to continue with radiation therapy, and the nurse can coordinate this with the appropriate department. The client is not radioactive, so radiation precautions and limiting visitors are not necessary.

The nurse working with older clients understands age-related changes in the gastrointestinal system. Which changes does this include? (Select all that apply.) a. Decreased hydrochloric acid production b. Diminished sensation that can lead to constipation c. Fat not digested as well in older adults d. Increased peristalsis in the large intestine e. Pancreatic vessels become calcified

a. Decreased hydrochloric acid production b. Diminished sensation that can lead to constipation c. Fat not digested as well in older adults e. Pancreatic vessels become calcified ANS: A, B, C, E Several age-related changes occur in the gastrointestinal system. These include decreased hydrochloric acid production, diminished nerve function that leads to decreased sensation of the need to pass stool, decreased fat digestion, decreased peristalsis in the large intestine, and calcification of pancreatic vessels.

The nurse working with oncology clients understands that which age-related change increases the older clients susceptibility to infection during chemotherapy? a. Decreased immune function b. Diminished nutritional stores c. Existing cognitive deficits d. Poor physical reserves

a. Decreased immune function ANS: A As people age, there is an age-related decrease in immune function, causing the older adult to be more susceptible to infection than other clients. Not all older adults have diminished nutritional stores, cognitive dysfunction, or poor physical reserves.

A nurse cares for a client who is prescribed lactulose (Heptalac). The client states, I do not want to take this medication because it causes diarrhea. How should the nurse respond? a. Diarrhea is expected; thats how your body gets rid of ammonia b. You may take Kaopectate liquid daily for loose stools. c. Do not take any more of the medication until your stools firm up. d. We will need to send a stool specimen to the laboratory.

a. Diarrhea is expected; thats how your body gets rid of ammonia ANS: A The purpose of administering lactulose to this client is to help ammonia leave the circulatory system through the colon. Lactulose draws water into the bowel with its high osmotic gradient, thereby producing a laxative effect and subsequently evacuating ammonia from the bowel. The client must understand that this is an expected and therapeutic effect for him or her to remain compliant. The nurse should not suggest administering anything that would decrease the excretion of ammonia or holding the medication. There is no need to send a stool specimen to the laboratory because diarrhea is the therapeutic response to this medication.

The nursing student learning about cancer development remembers characteristics of normal cells. Which characteristics does this include? (Select all that apply.) a. Differentiated function b. Large nucleus-to-cytoplasm ratio c. Loose adherence d. Nonmigratory e. Specific morphology

a. Differentiated function d. Nonmigratory e. Specific morphology ANS: A, D, E Normal cells have the characteristics of differentiated function, nonmigratory, specific morphology, a smaller nucleus-to-cytoplasm ratio, tight adherence, and orderly and wellregulated growth.

A nurse prepares to discharge a client with chronic pancreatitis. Which question should the nurse ask to ensure safety upon discharge? a. Do you have a one- or two-story home? b. Can you check your own pulse rate? c. Do you have any alcohol in your home? d. Can you prepare your own meals?

a. Do you have a one- or two-story home? ANS: A A client recovering from chronic pancreatitis should be limited to one floor until strength and activity increase. The client will need a bathroom on the same floor for frequent defecation. Assessing pulse rate and preparation of meals is not specific to chronic pancreatitis. Although the client should be encouraged to stop drinking alcoholic beverages, asking about alcohol availability is not adequate to assess this clients safety.

A nurse assesses a client who is recovering from a Whipple procedure. Which assessment finding alerts the nurse to urgently contact the health care provider? a. Drainage from a fistula b. Absent bowel sounds c. Pain at the incision site d. Nasogastric (NG) tube drainage

a. Drainage from a fistula ANS: A Complications of a Whipple procedure include secretions that drain from a fistula and peritonitis. Absent bowel sounds, pain at the incision site, and NG tube drainage are normal postoperative findings.

The nurse reads a clients chart and sees that the health care provider assessed mucosal erythroplasia. What should the nurse understand that this means for the client? a. Early sign of oral cancer b. Fungal mouth infection c. Inflammation of the gums d. Obvious oral tumor

a. Early sign of oral cancer ANS: A Mucosal erythroplasia is the earliest sign of oral cancer. It is not a fungal infection, inflammation of the gums, or an obvious tumor.

A client hospitalized for chemotherapy has a hemoglobin of 6.1 mg/dL. What medication should the nurse prepare to administer? a. Epoetin alfa (Epogen) b. Filgrastim (Neupogen) c. Mesna (Mesnex) d. Oprelvekin (Neumega)

a. Epoetin alfa (Epogen) ANS: A The clients hemoglobin is low, so the nurse should prepare to administer epoetin alfa, a colony-stimulating factor that increases production of red blood cells. Filgrastim is for neutropenia. Mesna is used to decrease bladder toxicity from some chemotherapeutic agents. Oprelvekin is used to increase platelet count.

The nurse working with oncology clients understands that interacting factors affect cancer development. Which factors does this include? (Select all that apply.) a. Exposure to carcinogens b. Genetic predisposition c. Immune function d. Normal doubling time e. State of euploidy

a. Exposure to carcinogens b. Genetic predisposition c. Immune function ANS: A, B, C The three interacting factors needed for cancer development are exposure to carcinogens, genetic predisposition, and immune function.

A nurse cares for a client with end-stage pancreatic cancer. The client asks, Why is this happening to me? How should the nurse respond? a. I dont know. I wish I had an answer for you, but I dont. b. Its important to keep a positive attitude for your family right now. c. Scientists have not determined why cancer develops in certain people. d. I think that this is a trial so you can become a better person because of it.

a. I dont know. I wish I had an answer for you, but I dont. ANS: A The client is not asking the nurse to actually explain why the cancer has occurred. The client may be expressing his or her feelings of confusion, frustration, distress, and grief related to this diagnosis. Reminding the client to keep a positive attitude for his or her family does not address the clients emotions or current concerns. The nurse should validate that there is no easy or straightforward answer as to why the client has cancer. Telling a client that cancer is a trial is untrue and may diminish the client-nurse relationship.

A client is prescribed cetuximab (Erbitux) for oral cancer and asks the nurse how it works. What response by the nurse is best? a. It blocks epidermal growth factor. b. It cuts off the tumors blood supply. c. It prevents tumor extension. d. It targets rapidly dividing cells.

a. It blocks epidermal growth factor. ANS: A Cetuximab (Erbitux) targets and blocks the epidermal growth factor, which contributes to the growth of oral cancers. The other explanations are not correct.

A client is scheduled for a colonoscopy and the nurse has provided instructions on the bowel cleansing regimen. What statement by the client indicates a need for further teaching? a. Its a good thing I love orange and cherry gelatin. b. My spouse will be here to drive me home. c. I should refrigerate the GoLYTELY before use. d. I will buy a case of Gatorade before the prep.

a. Its a good thing I love orange and cherry gelatin. ANS: A The client should be advised to avoid beverages and gelatin that are red, orange, or purple in color as their residue can appear to be blood. The other statements show a good understanding of the preparation for the procedure.

To promote comfort after a colonoscopy, in what position does the nurse place the client? a. Left lateral b. Prone c. Right lateral d. Supine

a. Left lateral ANS: A After colonoscopy, clients have less discomfort and quicker passage of flatus when placed in the left lateral position.

A client asks the nurse if eating only preservative- and dye-free foods will decrease cancer risk. What response by the nurse is best? a. Maybe; preservatives, dyes, and preparation methods may be risk factors. b. No; research studies have never shown those things to cause cancer. c. There are other things you can do that will more effectively lower your risk. d. Yes; preservatives and dyes are well known to be carcinogens.

a. Maybe; preservatives, dyes, and preparation methods may be risk factors. ANS: A Dietary factors related to cancer development are poorly understood, although dietary practices are suspected to alter cancer risk. Suspected dietary risk factors include low fiber intake and a high intake of red meat or animal fat. Preservatives, preparation methods, and additives (dyes, flavorings, sweeteners) may have cancer-promoting effects. It is correct to say that other things can lower risk more effectively, but this does not give the client concrete information about how to do so, and also does not answer the clients question.

A nurse plans care for a client who has acute pancreatitis and is prescribed nothing by mouth (NPO). With which health care team members should the nurse collaborate to provide appropriate nutrition to this client? (Select all that apply.) a. Registered dietitian b. Nursing assistant c. Clinical pharmacist d. Certified herbalist e. Health care provider

a. Registered dietitian c. Clinical pharmacist e. Health care provider ANS: A, C, E Clients who are prescribed NPO while experiencing an acute pancreatitis episode may need enteral or parenteral nutrition. The nurse should collaborate with the registered dietitian, clinical pharmacist, and health care provider to plan and implement the more appropriate nutritional interventions. The nursing assistant and certified herbalist would not assist with this clinical decision.

A nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding requires action by the nurse? a. Urine output via indwelling urinary catheter is 20 mL/hr b. Blood pressure increases from 110/58 to 120/62 mm Hg c. Respiratory rate decreases from 18 to 14 breaths/min d. A decrease in the clients weight by 6 kg

a. Urine output via indwelling urinary catheter is 20 mL/hr ANS: A Rapid removal of ascetic fluid causes decreased abdominal pressure, which can contribute to hypovolemia. This can be manifested by a decrease in urine output to below 30 mL/hr. A slight increase in systolic blood pressure is insignificant. A decrease in respiratory rate indicates that breathing has been made easier by the procedure. The nurse would expect the clients weight to drop as fluid is removed. Six kilograms is less than 3 pounds and is expected.

The nurse working with clients who have gastrointestinal problems knows that which laboratory values are related to what organ dysfunctions? (Select all that apply.) a. Alanine aminotransferase: biliary system b. Ammonia: liver c. Amylase: liver d. Lipase: pancreas e. Urine urobilinogen: stomach

b. Ammonia: liver d. Lipase: pancreas ANS: B, D Alanine aminotransferase and ammonia are related to the liver. Amylase and lipase are related to the pancreas. Urobilinogen evaluates both hepatic and biliary function.

A client is recovering from an esophagogastroduodenoscopy (EGD) and requests something to drink. What action by the nurse is best? a. Allow the client cool liquids only. b. Assess the clients gag reflex. c. Remind the client to remain NPO. d. Tell the client to wait 4 hours.

b. Assess the clients gag reflex. ANS: B The local anesthetic used during this procedure will depress the clients gag reflex. After the procedure, the nurse should ensure that the gag reflex is intact before offering food or fluids. The client does not need to be restricted to cool beverages only and is not required to wait 4 hours before oral intake is allowed. Telling the client to remain NPO does not inform the client of when he or she can have fluids, nor does it reflect the clients readiness for them.

A client has received a dose of ondansetron (Zofran) for nausea. What action by the nurse is most important? a. Assess the client for a headache. b. Assist the client in getting out of bed. c. Instruct the client to reduce salt intake. d. Weigh the client daily before the client eats.

b. Assist the client in getting out of bed. ANS: B Ondansetron side effects include postural hypotension, vertigo, and bradycardia, all of which increase the clients risk for injury. The nurse should assist the client when getting out of bed. Headache and fluid retention are not side effects of this drug.

A nurse is caring for four clients. After receiving the hand-off report, which client should the nurse see first? a. Client having a radial neck dissection tomorrow who is asking questions b. Client who had a tracheostomy 4 hours ago and needs frequent suctioning c. Client who is 1 day postoperative for an oral tumor resection who is reporting pain d. Client waiting for discharge instructions after a small tumor resection

b. Client who had a tracheostomy 4 hours ago and needs frequent suctioning ANS: B The client who needs frequent suctioning should be seen first to ensure that his or her airway is patent. The client waiting for pain medication should be seen next. The nurse may need to call the surgeon to see the client who is asking questions. The client waiting for discharge instructions can be seen last.

A nurse has conducted a community screening event for oral cancer. What client is the highest priority for referral to a dentist? a. Client who has poor oral hygiene practices b. Client who smokes and drinks daily c. Client who tans for an upcoming vacation d. Client who occasionally uses illicit drugs

b. Client who smokes and drinks daily ANS: B Smoking and alcohol exposure create a high risk for this client. Poor oral hygiene is not related to the etiology of cancer but may cause a tumor to go unnoticed. Tanning is a risk factor, but short-term exposure does not have the same risk as daily exposure to tobacco and alcohol. Illicit drugs are not related to oral cancers.

A client tells the oncology nurse about an upcoming vacation to the beach to celebrate completing radiation treatments for cancer. What response by the nurse is most appropriate? a. Avoid getting salt water on the radiation site. b. Do not expose the radiation area to direct sunlight. c. Have a wonderful time and enjoy your vacation! d. Remember you should not drink alcohol for a year.

b. Do not expose the radiation area to direct sunlight. ANS: B The skin overlying the radiation site is extremely sensitive to sunlight after radiation therapy has been completed. The nurse should inform the client to avoid sun exposure to this area. This advice continues for 1 year after treatment has been completed. The other statements are not appropriate.

The student nurse learning about cellular regulation understands that which process occurs during the S phase of the cell cycle? a. Actual division (mitosis) b. Doubling of DNA c. Growing extra membrane d. No reproductive activity

b. Doubling of DNA ANS: B During the S phase, the cell must double its DNA content through DNA synthesis. Actual division, or mitosis, occurs during the M phase. Growing extra membrane occurs in the G1 phase. During the G0 phase, the cell is working but is not involved in any reproductive activity.

A nurse cares for a client who is prescribed patient-controlled analgesia (PCA) after a cholecystectomy. The client states, When I wake up I am in pain. Which action should the nurse take? a. Administer intravenous morphine while the client sleeps. b. Encourage the client to use the PCA pump upon awakening. c. Contact the provider and request a different analgesic. d. Ask a family member to initiate the PCA pump for the client.

b. Encourage the client to use the PCA pump upon awakening. ANS: B The nurse should encourage the client to use the PCA pump prior to napping and upon awakening. Administering additional intravenous morphine while the client sleeps places the client at risk for respiratory depression. The nurse should also evaluate dosages received compared with dosages requested and contact the provider if the dose or frequency is not adequate. Only the client should push the pain button on a PCA pump.

A client is having a catheter placed in the femoral artery to deliver yttrium-90 beads into a liver tumor. What action by the nurse is most important? a. Assessing the clients abdomen beforehand b. Ensuring that informed consent is on the chart c. Marking the clients bilateral pedal pulses d. Reviewing client teaching done previously

b. Ensuring that informed consent is on the chart ANS: B This is an invasive procedure requiring informed consent. The nurse should ensure that consent is on the chart. The other actions are also appropriate but not the priority.

A client who has been taking antibiotics reports severe, watery diarrhea. About which test does the nurse teach the client? a. Colonoscopy b. Enzyme-linked immunosorbent assay (ELISA) toxin A+B c. Ova and parasites d. Stool culture

b. Enzyme-linked immunosorbent assay (ELISA) toxin A+B ANS: B Clients taking antibiotics are at risk for Clostridium difficile infection. The most common test for this disorder is a stool sample for ELISA toxin A+B. Colonoscopy, ova and parasites, and stool culture are not warranted at this time.

A client with cancer has anorexia and mucositis, and is losing weight. The clients family members continually bring favorite foods to the client and are distressed when the client wont eat them. What action by the nurse is best? a. Explain the pathophysiologic reasons behind the client not eating. b. Help the family show other ways to demonstrate love and caring. c. Suggest foods and liquids the client might be willing to try to eat. d. Tell the family the client isnt able to eat now no matter what they bring.

b. Help the family show other ways to demonstrate love and caring. ANS: B Families often become distressed when their loved ones wont eat. Providing food is a universal sign of caring, and to some people the refusal to eat signifies worsening of the condition. The best option for the nurse is to help the family find other ways to demonstrate caring and love, because with treatment-related anorexia and mucositis, the client is not likely to eat anything right now. Explaining the rationale for the problem is a good idea but does not suggest to the family anything that they can do for the client. Simply telling the family the client is not able to eat does not give them useful information and is dismissive of their concerns.

A nurse obtains a clients health history at a community health clinic. Which statement alerts the nurse to provide health teaching to this client? a. I drink two glasses of red wine each week. b. I take a lot of Tylenol for my arthritis pain. c. I have a cousin who died of liver cancer. d. I got a hepatitis vaccine before traveling.

b. I take a lot of Tylenol for my arthritis pain. ANS: B Acetaminophen (Tylenol) can cause liver damage if taken in large amounts. Clients should be taught not to exceed 4000 mg/day of acetaminophen. The nurse should teach the client about this limitation and should explore other drug options with the client to manage his or her arthritis pain. Two glasses of wine each week, a cousin with liver cancer, and the hepatitis vaccine do not place the client at risk for a liver disorder, and therefore do not require any health teaching.

After teaching a client who is recovering from laparoscopic cholecystectomy surgery, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching? a. Drinking at least 2 liters of water each day is suggested. b. I will decrease the amount of fatty foods in my diet. c. Drinking fluids with my meals will increase bloating. d. I will avoid concentrated sweets and simple carbohydrates.

b. I will decrease the amount of fatty foods in my diet. ANS: B After cholecystectomy, clients need a nutritious diet without a lot of excess fat; otherwise a special diet is not recommended for most clients. Good fluid intake is healthy for all people but is not related to the surgery. Drinking fluids between meals helps with dumping syndrome, which is not seen with this procedure. Restriction of sweets is not required

The student nurse caring for clients who have cancer understands that the general consequences of cancer include which client problems? (Select all that apply.) a. Clotting abnormalities from thrombocythemia b. Increased risk of infection from white blood cell deficits c. Nutritional deficits such as early satiety and cachexia d. Potential for reduced gas exchange e. Various motor and sensory deficits

b. Increased risk of infection from white blood cell deficits c. Nutritional deficits such as early satiety and cachexia d. Potential for reduced gas exchange e. Various motor and sensory deficits ANS: B, C, D, E The general consequences of cancer include reduced immunity and blood-producing functions, altered GI structure and function, decreased respiratory function, and motor and sensory deficits. Clotting problems often occur due to thrombocytopenia (not enough platelets), not thrombocythemia (too many platelets).

For a female client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care? a. Administering aspirin if the temperature exceeds 102° F (38.8° C) b. Inspecting the skin for petechiae once every shift c. Providing for frequent rest periods d. Placing the client in strict isolation

b. Inspecting the skin for petechiae once every shift Answer B. Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.

A client has a platelet count of 9800/mm3. What action by the nurse is most appropriate? a. Assess the client for calf pain, warmth, and redness. b. Instruct the client to call for help to get out of bed. c. Obtain cultures as per the facilitys standing policy. d. Place the client on protective isolation precautions.

b. Instruct the client to call for help to get out of bed. ANS: B A client with a platelet count this low is at high risk for serious bleeding episodes. To prevent injury, the client should be instructed to call for help prior to getting out of bed. Calf pain, warmth, and redness might indicate a deep vein thrombosis, not associated with low platelets. Cultures and isolation relate to low white cell counts.

A nurse is participating in primary prevention efforts directed against cancer. In which activities is this nurse most likely to engage? (Select all that apply.) a. Demonstrating breast self-examination methods to women b. Instructing people on the use of chemoprevention c. Providing vaccinations against certain cancers d. Screening teenage girls for cervical cancer e. Teaching teens the dangers of tanning booths

b. Instructing people on the use of chemoprevention c. Providing vaccinations against certain cancers e. Teaching teens the dangers of tanning booths ANS: B, C, E Primary prevention aims to prevent the occurrence of a disease or disorder, in this case cancer. Secondary prevention includes screening and early diagnosis. Primary prevention activities include teaching people about chemoprevention, providing approved vaccinations to prevent cancer, and teaching teens the dangers of tanning beds. Breast examinations and screening for cervical cancer are secondary prevention methods.

A client presents to the emergency department reporting severe abdominal pain. On assessment, the nurse finds a bulging, pulsating mass in the abdomen. What action by the nurse is the priority? a. Auscultate for bowel sounds. b. Notify the provider immediately. c. Order an abdominal flat-plate x-ray. d. Palpate the mass and measure its size.

b. Notify the provider immediately. ANS: B This observation could indicate an abdominal aortic aneurysm, which could be life threatening and should never be palpated. The nurse notifies the provider at once. An x-ray may be indicated. Auscultation is part of assessment, but the nurses priority action is to notify the provider.

A client in the oncology clinic reports her family is frustrated at her ongoing fatigue 4 months after radiation therapy for breast cancer. What response by the nurse is most appropriate? a. Are you getting adequate rest and sleep each day? b. It is normal to be fatigued even for years afterward. c. This is not normal and Ill let the provider know. d. Try adding more vitamins B and C to your diet.

b. It is normal to be fatigued even for years afterward. ANS: B Regardless of the cause, radiation-induced fatigue can be debilitating and may last for months or years after treatment has ended. Rest and adequate nutrition can affect fatigue, but it is most important that the client understands this is normal.

A nurse cares for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic in appearance, and the family expresses distress that the client is receiving little dietary protein. How should the nurse respond? a. A low-protein diet will help the liver rest and will restore liver function. b. Less protein in the diet will help prevent confusion associated with liver failure. c. Increasing dietary protein will help the client gain weight and muscle mass. d. Low dietary protein is needed to prevent fluid from leaking into the abdomen.

b. Less protein in the diet will help prevent confusion associated with liver failure. ANS: B A low-protein diet is ordered when serum ammonia levels increase and/or the client shows signs of PSE. A low-protein diet helps reduce excessive breakdown of protein into ammonia by intestinal bacteria. Encephalopathy is caused by excess ammonia. A low-protein diet has no impact on restoring liver function. Increasing the clients dietary protein will cause complications of liver failure and should not be suggested. Increased intravascular protein will help prevent ascites, but clients with liver failure are not able to effectively synthesize dietary protein.

The student nurse studying the gastrointestinal system understands that chyme refers to what? a. Hormones that reduce gastric acidity b. Liquefied food ready for digestion c. Nutrients after being absorbed d. Secretions that help digest food

b. Liquefied food ready for digestion ANS: B Before being digested, food must be broken down into a liquid form. This liquid is called chyme. Secretin is the hormone that inhibits acid production and decreases gastric motility. Absorption is carried out as the nutrients produced by digestion move from the lumen of the GI tract into the bodys circulatory system for uptake by individual cells. The secretions that help digest food include hydrochloric acid, bile, and digestive enzymes.

The nurse knows that a client with prolonged prothrombin time (PT) values (not related to medication) probably has dysfunction in which organ? a. Kidneys b. Liver c. Spleen d. Stomach

b. Liver ANS: B Severe acute or chronic liver damage leads to a prolonged PT secondary to impaired synthesis of clotting proteins. The other organs are not related to this issue.

A nurse plans care for a client with acute pancreatitis. Which intervention should the nurse include in this clients plan of care to reduce discomfort? a. Administer morphine sulfate intravenously every 4 hours as needed. b. Maintain nothing by mouth (NPO) and administer intravenous fluids. c. Provide small, frequent feedings with no concentrated sweets. d. Place the client in semi-Fowlers position with the head of bed elevated.

b. Maintain nothing by mouth (NPO) and administer intravenous fluids. ANS: B The client should be kept NPO to reduce GI activity and reduce pancreatic enzyme production. IV fluids should be used to prevent dehydration. The client may need a nasogastric tube. Pain medications should be given around the clock and more frequently than every 4 to 6 hours. A fetal position with legs drawn up to the chest will promote comfort.

After receiving the hand-off report, which client should the oncology nurse see first? a. Client who is afebrile with a heart rate of 108 beats/min b. Older client on chemotherapy with mental status changes c. Client who is neutropenic and in protective isolation d. Client scheduled for radiation therapy today

b. Older client on chemotherapy with mental status changes ANS: B Older clients often do not exhibit classic signs of infection, and often mental status changes are the first observation. Clients on chemotherapy who become neutropenic also often do not exhibit classic signs of infection. The nurse should assess the older client first. The other clients can be seen afterward.

A nurse cares for a client who is recovering from an open Whipple procedure. Which action should the nurse take? a. Clamp the nasogastric tube. b. Place the client in semi-Fowlers position. c. Assess vital signs once every shift. d. Provide oral rehydration.

b. Place the client in semi-Fowlers position. ANS: B Postoperative care for a client recovering from an open Whipple procedure should include placing the client in a semi-Fowlers position to reduce tension on the suture line and anastomosis sites, setting the nasogastric tube to low suction to remove free air buildup and pressure, assessing vital signs frequently to assess fluid and electrolyte complications, and providing intravenous fluids.

A student nurse is providing care to an older client with stomatitis and dysphagia. What action by the student nurse requires the registered nurse to intervene? a. Assisting the client to perform oral care every 2 hours b. Preparing to administer a viscous lidocaine gargle c. Reminding the client not to swallow nystatin (Mycostatin) d. Teaching the client to use a soft-bristled toothbrush

b. Preparing to administer a viscous lidocaine gargle ANS: B Viscous lidocaine gargles or mouthwashes are sometimes prescribed for clients with stomatitis and pain. However, the numbing effect can lead to choking or mouth burns from hot food. This client already has difficulty swallowing, so this medication is not appropriate. Therefore, the nurse should intervene when the student prepares to administer this preparation. The other options are correct actions.

A nurse cares for a client who has cirrhosis of the liver. Which action should the nurse take to decrease the presence of ascites? a. Monitor intake and output. b. Provide a low-sodium diet. c. Increase oral fluid intake. d. Weigh the client daily.

b. Provide a low-sodium diet. ANS: B A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake and output does not control fluid accumulation, nor does weighing the client. These interventions merely assess or monitor the situation. Increasing fluid intake would not be helpful.

A nurse assesses a client who is recovering from a Whipple procedure. Which clinical manifestations alert the nurse to a complication from this procedure? (Select all that apply.) a. Clay-colored stools b. Substernal chest pain c. Shortness of breath d. Lack of bowel sounds or flatus e. Urine output of 20 mL/6 hr

b. Substernal chest pain c. Shortness of breath d. Lack of bowel sounds or flatus e. Urine output of 20 mL/6 hr ANS: B, C, D, E Myocardial infarction (chest pain), pulmonary embolism (shortness of breath), adynamic ileus (lack of bowel sounds or flatus), and renal failure (urine output of 20 mL/6 hr) are just some of the complications for which the nurse must assess the client after the Whipple procedure. Clay-colored stools are associated with cholecystitis and are not a complication of a Whipple procedure

A patient with hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include instructions to: a. Avoid alcohol for the first 3 weeks b. Use a condom during sexual intercourse c. Have family members get an injection of immunoglobin d. Follow a low-protein, moderate-carbohydrate, moderate-fat diet

b. Use a condom during sexual intercourse Answer B Hepatitis B virus may be transmitted by mucosal exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B.

The nurse is caring for a pt who had an open cholecystectomy 24 hrs ago. which of the following actions should the nurse take to assist the pt to maintain an effective breathing pattern? select all that apply a. place in a supine position b. provide analgesics for pain c. encourage coughing and deep breathing d. monitor bowel sounds e. assist with splinting during coughing f. maintain bedrest for 48 hrs after

b. provide analgesics for pain c. encourage coughing and deep breathing e. assist with splinting during coughing Monitoring bowel sounds is a post op nursing interventions, but it does not apply to effective breathing pattern.

As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care during the period of greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed if the client makes which statement? a. "I should avoid blowing my nose." b. "I may need a platelet transfusion if my platelet count is too low." c. "I'm going to take aspirin for my headache as soon as I get home." d. "I will count the number of pads and tampons I use when menstruating."

c. "I'm going to take aspirin for my headache as soon as I get home."

A nurse assesses clients at a community health center. Which client is at highest risk for pancreatic cancer? a. A 32-year-old with hypothyroidism b. A 44-year-old with cholelithiasis c. A 50-year-old who has the BRCA2 gene mutation d. A 68-year-old who is of African-American ethnicity

c. A 50-year-old who has the BRCA2 gene mutation Mutations in both the BRCA2 and p16 genes increase the risk for developing pancreatic cancer in a small number of cases. The other factors do not appear to be linked to increased risk.

Four clients are receiving tyrosine kinase inhibitors (TKIs). Which of these four clients should the nurse assess first? a. Client with dry, itchy, peeling skin b. Client with a serum calcium of 9.2 mg/dL c. Client with a serum potassium of 2.8 mEq/L d. Client with a weight gain of 0.5 pound (1.1 kg) in 1 day

c. Client with a serum potassium of 2.8 mEq/L ANS: C TKIs can cause electrolyte imbalances. This potassium level is very low, so the nurse should assess this client first. Dry, itchy, peeling skin can be a problem in clients receiving biologic response modifiers, and the nurse should assess that client next because of the potential for discomfort and infection. This calcium level is normal. TKIs can also cause weight gain, but the client with the low potassium level is more critical.

A nurse prepares to assess the emotional state of a client with end-stage pancreatic cancer. Which action should the nurse take first? a. Bring the client to a quiet room for privacy. b. Pull up a chair and sit next to the clients bed. c. Determine whether the client feels like talking about his or her feelings. d. Review the health care providers notes about the prognosis for the client.

c. Determine whether the client feels like talking about his or her feelings. ANS: C Before conducting an assessment about the clients feelings, the nurse should determine whether he or she is willing and able to talk about them. If the client is open to the conversation and his or her room is not appropriate, an alternative meeting space may be located. The nurse should be present for the client during this time, and pulling up a chair and sitting with the client indicates that presence. Because the nurse is assessing the clients response to a terminal diagnosis, it is not necessary to have detailed information about the projected prognosis; the nurse knows that the client is facing an end-of-life illness.

A client is admitted with superior vena cava syndrome. What action by the nurse is most appropriate? a. Administer a dose of allopurinol (Aloprim). b. Assess the clients serum potassium level. c. Gently inquire about advance directives. d. Prepare the client for emergency surgery.

c. Gently inquire about advance directives. ANS: C Superior vena cava syndrome is often a late-stage manifestation. After the client is stabilized and comfortable, the nurse should initiate a conversation about advance directives. Allopurinol is used for tumor lysis syndrome. Potassium levels are important in tumor lysis syndrome, in which cell destruction leads to large quantities of potassium being released into the bloodstream. Surgery is rarely done for superior vena cava syndrome.

The nursing instructor explains the difference between normal cells and benign tumor cells. What information does the instructor provide about these cells? a. Benign tumors grow through invasion of other tissue. b. Benign tumors have lost their cellular regulation from contact inhibition. c. Growing in the wrong place or time is typical of benign tumors. d. The loss of characteristics of the parent cells is called anaplasia.

c. Growing in the wrong place or time is typical of benign tumors. ANS: C Benign tumors are basically normal cells growing in the wrong place or at the wrong time. Benign cells grow through hyperplasia, not invasion. Benign tumor cells retain contact inhibition. Anaplasia is a characteristic of cancer cells.

A nurse cares for a client with acute pancreatitis. The client states, I am hungry. How should the nurse reply? a. Is your stomach rumbling or do you have bowel sounds? b. I need to check your gag reflex before you can eat. c. Have you passed any flatus or moved your bowels? d. You will not be able to eat until the pain subsides.

c. Have you passed any flatus or moved your bowels? ANS: C Paralytic ileus is a common complication of acute pancreatitis. The client should not eat until this has resolved. Bowel sounds and decreased pain are not reliable indicators of peristalsis. Instead, the nurse should assess for passage of flatus or bowel movement.

A nurse has taught a client about dietary changes that can reduce the chances of developing cancer. What statement by the client indicates the nurse needs to provide additional teaching? a. Foods high in vitamin A and vitamin C are important. b. Ill have to cut down on the amount of bacon I eat. c. Im so glad I dont have to give up my juicy steaks. d. Vegetables, fruit, and high-fiber grains are important.

c. Im so glad I dont have to give up my juicy steaks. ANS: C To decrease the risk of developing cancer, one should cut down on the consumption of red meats and animal fat. The other statements are correct.

A client is receiving rituximab (Rituxan) and asks how it works. What response by the nurse is best? a. It causes rapid lysis of the cancer cell membranes. b. It destroys the enzymes needed to create cancer cells. c. It prevents the start of cell division in the cancer cells. d. It sensitizes certain cancer cells to chemotherapy.

c. It prevents the start of cell division in the cancer cells. ANS: C Rituxan prevents the initiation of cancer cell division. The other statements are not accurate.

A nurse assesses a client who has cholecystitis. Which clinical manifestation indicates that the condition is chronic rather than acute? a. Temperature of 100.1 F (37.8 C) b. Positive Murphys sign c. Light-colored stools d. Upper abdominal pain after eating

c. Light-colored stools ANS: C Jaundice, clay-colored stools, and dark urine are more commonly seen with chronic cholecystitis. The other symptoms are seen equally with both chronic and acute cholecystitis

A client had an oral tumor removed this morning and now has a tracheostomy. What action by the nurse is the priority? a. Delegate oral care every 4 hours. b. Monitor and record the clients intake. c. Place the client in a high-Fowlers position. d. Remove the inner cannula for cleaning.

c. Place the client in a high-Fowlers position. ANS: C To promote airway clearance, this client should be placed in a semi- or high-Fowlers position. Oral care can be delegated, but that is not the priority. Intake and output should also be recorded but again is not the priority. The inner cannula may or may not need to be cleaned, and the tracheostomy may or may not have a disposable cannula

A client is having an esophagogastroduodenoscopy (EGD) and has been given midazolam hydrochloride (Versed). The clients respiratory rate is 8 breaths/min. What action by the nurse is best? a. Administer naloxone (Narcan). b. Call the Rapid Response Team. c. Provide physical stimulation. d. Ventilate with a bag-valve-mask.

c. Provide physical stimulation. ANS: C For an EGD, clients are given mild sedation but should still be able to follow commands. For shallow or slow respirations after the sedation is given, the nurses first action is to provide a physical stimulation such as a sternal rub and directions to breathe deeply. Naloxone is not the antidote for Versed. The Rapid Response Team is not needed at this point. The client does not need manual ventilation.

A client had a colonoscopy and biopsy yesterday and calls the gastrointestinal clinic to report a spot of bright red blood on the toilet paper today. What response by the nurse is best? a. Ask the client to call back if this happens again today. b. Instruct the client to go to the emergency department. c. Remind the client that a small amount of bleeding is possible. d. Tell the client to come in to the clinic this afternoon.

c. Remind the client that a small amount of bleeding is possible. ANS: C After a colonoscopy with biopsy, a small amount of bleeding is normal. The nurse should remind the client of this and instruct him or her to go to the emergency department for large amounts of bleeding, severe pain, or dizziness.

After teaching a client who is prescribed pancreatic enzyme replacement therapy, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. The capsules can be opened and the powder sprinkled on applesauce if needed. b. I will wipe my lips carefully after I drink the enzyme preparation. c. The best time to take the enzymes is immediately after I have a meal or a snack. d. I will not mix the enzyme powder with food or liquids that contain protein.

c. The best time to take the enzymes is immediately after I have a meal or a snack. ANS: C The enzymes should be taken immediately before eating meals or snacks. If the client cannot swallow the capsules whole, they can be opened up and the powder sprinkled on applesauce, mashed fruit, or rice cereal. The client should wipe his or her lips carefully after drinking the enzyme preparation because the liquid could damage the skin. Protein items will be dissolved by the enzymes if they are mixed together.

The nurse is taking the social history from a patient diagnosed with hepatocellular carcinoma. Which information is significant for this disease? a. The patient worked with asbestos for a short time many years ago. b. The patient has a family history of mental illness. c. The patient has numerous tattoos acquired in prison. d. The patient has smoked two (2) packs of cigarettes a day for 20 years.

c. The patient has numerous tattoos acquired in prison. Rationale: Hepatitis B/C are likely to be transmitted with needles.

A female client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to expect: a. hair loss. b. stomatitis. c. fatigue. d. vomiting.

c. fatigue. Answer C. Radiation therapy may cause fatigue, skin toxicities, and anorexia regardless of the treatment site. Hair loss, stomatitis, and vomiting are site-specific, not generalized, adverse effects of radiation therapy.

Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by: a. breast self-examination. b. mammography. c. fine needle aspiration. d. chest X-ray.

c. fine needle aspiration. Answer C. Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of cancer. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early. Mammography is used to detect tumors that are too small to palpate. Chest X-rays can be used to pinpoint rib metastasis.

A nurse assesses clients on the medical-surgical unit. Which client should the nurse identify as at high risk for pancreatic cancer? a. A 26-year-old with a body mass index of 21 b. A 33-year-old who frequently eats sushi c. A 48-year-old who often drinks wine d. A 66-year-old who smokes cigarettes

d. A 66-year-old who smokes cigarettes ANS: D Risk factors for pancreatic cancer include obesity, older age, high intake of red meat, and cigarette smoking. Sushi and wine intake are not risk factors for pancreatic cancer.

A nurse cares for a client who is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube. Which action should the nurse take first? a. Sedate the client to prevent tube dislodgement. b. Maintain balloon pressure at 15 and 20 mm Hg. c. Irrigate the gastric lumen with normal saline. d. Assess the client for airway patency.

d. Assess the client for airway patency. ANS: D Maintaining airway patency is the primary nursing intervention for this client. The nurse suctions oral secretions to prevent aspiration and occlusion of the airway. The client usually is intubated and mechanically ventilated during this treatment. The client should be sedated, balloon pressure should be maintained between 15 and 20 mm Hg, and the lumen can be irrigated with saline or tap water. However, these are not a higher priority than airway patency

A female client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a fluid and electrolyte imbalance induced by chemotherapy? a. Urine output of 400 ml in 8 hours b. Serum potassium level of 3.6 mEq/L c. Blood pressure of 120/64 to 130/72 mm Hg d. Dry oral mucous membranes and cracked lips

d. Dry oral mucous membranes and cracked lips Answer D. Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include dry oral mucous membranes, cracked lips, decreased urine output (less than 40 ml/hour), abnormally low blood pressure, and a serum potassium level below 3.5 mEq/L.

The nurse has taught a client with cancer ways to prevent infection. What statement by the client indicates that more teaching is needed? a. I should take my temperature daily and when I dont feel well. b. I will wash my toothbrush in the dishwasher once a week. c. I wont let anyone share any of my personal items or dishes. d. Its alright for me to keep my pets and change the litter box.

d. Its alright for me to keep my pets and change the litter box. ANS: D Clients should wash their hands after touching their pets and should not empty or scoop the cat litter box. The other statements are appropriate for self-management.

A nurse assesses a client who is prescribed an infusion of vasopressin (Pitressin) for bleeding esophageal varices. Which clinical manifestation should alert the nurse to a serious adverse effect? a. Nausea and vomiting b. Frontal headache c. Vertigo and syncope d. Mid-sternal chest pain

d. Mid-sternal chest pain ANS: D Mid-sternal chest pain is indicative of acute angina or myocardial infarction, which can be precipitated by vasopressin. Nausea and vomiting, headache, and vertigo and syncope are not side effects of vasopressin.

A nurse is assessing a client with glioblastoma. What assessment is most important? a. Abdominal palpation b. Abdominal percussion c. Lung auscultation d. Neurologic examination

d. Neurologic examination ANS: D A glioblastoma arises in the brain. The most important assessment for this client is the neurologic examination.

Which intervention is appropriate for the nurse caring for a male client in severe pain receiving a continuous I.V. infusion of morphine? a. Assisting with a naloxone challenge test before therapy begins b. Discontinuing the drug immediately if signs of dependence appear c. Changing the administration route to P.O. if the client can tolerate fluids d. Obtaining baseline vital signs before administering the first dose

d. Obtaining baseline vital signs before administering the first dose Answer D. The nurse should obtain the client's baseline blood pressure and pulse and respiratory rates before administering the initial dose and then continue to monitor vital signs throughout therapy. A naloxone challenge test may be administered before using a narcotic antagonist, not a narcotic agonist. The nurse shouldn't discontinue a narcotic agonist abruptly because withdrawal symptoms may occur. Morphine commonly is used as a continuous infusion in clients with severe pain regardless of the ability to tolerate fluids.

A nurse is examining a client reporting right upper quadrant (RUQ) abdominal pain. What technique should the nurse use to assess this clients abdomen? a. Auscultate after palpating. b. Avoid any palpation. c. Palpate the RUQ first. d. Palpate the RUQ last.

d. Palpate the RUQ last. ANS: D If pain is present in a certain area of the abdomen, that area should be palpated last to keep the client from tensing up, which could possibly affect the rest of the examination. Auscultation of the abdomen occurs prior to palpation.

A student nurse asks the nursing instructor what apoptosis means. What response by the instructor is best? a. Growth by cells enlarging b. Having the normal number of chromosomes c. Inhibition of cell growth d. Programmed cell death

d. Programmed cell death ANS: D Apoptosis is programmed cell death. With this characteristic, organs and tissues function with cells that are at their peak of performance. Growth by cells enlarging is hyperplasia. Having the normal number of chromosomes is euploidy. Inhibition of cell growth is contact inhibition.

A client presents to the family practice clinic reporting a week of watery, somewhat bloody diarrhea. The nurse assists the client to obtain a stool sample. What action by the nurse is most important? a. Ask the client about recent exposure to illness. b. Assess the clients stool for obvious food particles. c. Include the date and time on the specimen container. d. Put on gloves prior to collecting the sample.

d. Put on gloves prior to collecting the sample. ANS: D To avoid possible exposure to infectious agents, the nurse dons gloves prior to handling any bodily secretions. Recent exposure to illness is not related to collecting a stool sample. The nurse can visually inspect the stool for food particles, but it still needs analysis in the laboratory. The container should be dated and timed, but safety for the staff and other clients comes first.

A new nurse has been assigned a client who is in the hospital to receive iodine-131 treatment. Which action by the nurse is best? a. Ensure the client is placed in protective isolation. b. Hand off a pregnant client to another nurse. c. No special action is necessary to care for this client. d. Read the policy on handling radioactive excreta.

d. Read the policy on handling radioactive excreta. ANS: D This type of radioisotope is excreted in body fluids and excreta (urine and feces) and should not be handled directly. The nurse should read the facilitys policy for handling and disposing of this type of waste. The other actions are not warranted.

A nurse is assessing a female client who is taking progestins. What assessment finding requires the nurse to notify the provider immediately? a. Irregular menses b. Edema in the lower extremities c. Ongoing breast tenderness d. Red, warm, swollen calf

d. Red, warm, swollen calf ANS: D All clients receiving progestin therapy are at risk for thromboembolism. A red, warm, swollen calf is a manifestation of deep vein thrombosis and should be reported to the provider. Irregular menses, edema in the lower extremities, and breast tenderness are common side effects of the therapy.

After teaching a client who has a history of cholelithiasis, the nurse assesses the clients understanding. Which menu selection made by the client indicates the client clearly understands the dietary teaching? a. Lasagna, tossed salad with Italian dressing, and low-fat milk b. Grilled cheese sandwich, tomato soup, and coffee with cream c. Cream of potato soup, Caesar salad with chicken, and a diet cola d. Roasted chicken breast, baked potato with chives, and orange juice

d. Roasted chicken breast, baked potato with chives, and orange juice ANS: D Clients with cholelithiasis should avoid foods high in fat and cholesterol, such as whole milk, butter, and fried foods. Lasagna, low-fat milk, grilled cheese, cream, and cream of potato soup all have high levels of fat. The meal with the least amount of fat is the chicken breast dinner.

A nurse works with clients who have alopecia from chemotherapy. What action by the nurse takes priority? a. Helping clients adjust to their appearance b. Reassuring clients that this change is temporary c. Referring clients to a reputable wig shop d. Teaching measures to prevent scalp injury

d. Teaching measures to prevent scalp injury ANS: D All of the actions are appropriate for clients with alopecia. However, the priority is client safety, so the nurse should first teach ways to prevent scalp injury.

A client is in the oncology clinic for a first visit since being diagnosed with cancer. The nurse reads in the clients chart that the cancer classification is TISN0M0. What does the nurse conclude about this clients cancer? a. The primary site of the cancer cannot be determined. b. Regional lymph nodes could not be assessed. c. There are multiple lymph nodes involved already. d. There are no distant metastases noted in the report.

d. There are no distant metastases noted in the report. ANS: D TIS stands for carcinoma in situ; N0 stands for no regional lymph node metastasis; and M0 stands for no distant metastasis.

Which statement about carcinogenesis is accurate? a. An initiated cell will always become clinical cancer. b. Cancer becomes a health problem once it is 1 cm in size. c. Normal hormones and proteins do not promote cancer growth. d. Tumor cells need to develop their own blood supply.

d. Tumor cells need to develop their own blood supply. ANS: D Tumors need to develop their own blood supply through a process called angiogenesis. An initiated cell needs a promoter to continue its malignant path. Normal hormones and proteins in the body can act as promoters. A 1-cm tumor is a detectable size, but other events have to occur for it to become a health problem.

A client with cancer is admitted to a short-term rehabilitation facility. The nurse prepares to administer the clients oral chemotherapy medications. What action by the nurse is most appropriate? a. Crush the medications if the client cannot swallow them. b. Give one medication at a time with a full glass of water. c. No special precautions are needed for these medications. d. Wear personal protective equipment when handling the medications.

d. Wear personal protective equipment when handling the medications. ANS: D During the administration of oral chemotherapy agents, nurses must take the same precautions that are used when administering IV chemotherapy. This includes using personal protective equipment. These medications cannot be crushed, split, or chewed. Giving one at a time is not needed.

A female client hospitalized for an unrelated problem has a large pearly-white lesion on her lip, to which she continues to apply lipstick that she will not remove for inspection. The client refuses to discuss the lesion with the nurse or health care provider. What action by the nurse is best? a. Ask the client why her appearance is so important. b. Ignore the lesion since the client will not discuss it. c. Inform the client that early-stage cancer is curable. d. Work with the client to establish a trusting relationship.

d. Work with the client to establish a trusting relationship. ANS: D Clients with oral cancers often have body image difficulties due to the location of the tumor or the results of surgical treatment. This client appears to be using denial to cope with this problem. The nurse should work to establish a helping-trusting relationship in hopes that the client will be amenable to future discussions about the lesion. Asking why questions often puts people on the defensive and should be avoided. Ignoring the lesion is not being an advocate for the client. Education is important, but right now the client is in denial, so this information will not seem relevant to her.

The category "M" in the TNM system gives detail about: A. if the cancer has spread to other parts of the body and if this is the case, how much and the location of it B. the number and location of the lymph nodes that have cancer C. the size of the tumor that is growing into other tissues D. if the cancer cells appear abnormal

A. if the cancer has spread to other parts of the body and if this is the case, how much and the location of it

Which patient below is at MOST risk for developing a complication related to a Hepatitis E infection? A. A 45-year-old male with diabetes. B. A 26-year-old female in the 3rd trimester of pregnancy. C. A 12-year-old female with a ventricle septal defect. D. A 63-year-old male with cardiovascular disease.

B. A 26-year-old female in the 3rd trimester of pregnancy.

Which statements below are CORRECT regarding the role of bile? Select all that apply: A. Bile is created and stored in the gallbladder. B. Bile aids in digestion of fat soluble vitamins, such as A, D, E, and K. C. Bile is released from the gallbladder into the duodenum. D. Bile contains bilirubin.

B. Bile aids in digestion of fat soluble vitamins, such as A, D, E, and K. C. Bile is released from the gallbladder into the duodenum. D. Bile contains bilirubin. Option A is INCORRECT because bile is created in the LIVER (not gallbladder), but bile is stored in the gallbladder.

A 36-year-old patient's lab work show anti-HAV and IgG present in the blood. As the nurse you would interpret this blood work as? A. The patient has an active infection of Hepatitis A. B. The patient has recovered from a previous Hepatitis A infection and is now immune to it. C. The patient is in the preicetric phase of viral Hepatitis. D. The patient is in the icteric phase of viral Hepatitis.

B. The patient has recovered from a previous Hepatitis A infection and is now immune to it. The answer is B. When a patient has anti-HAV (antibodies of the Hepatitis A virus) and IgG, this means the patient HAD a past infection of Hepatitis A but it is now gone, and the patient is immune to Hepatitis A now. If the patient had anti-HAV and IgM, this means the patient has an active infection of Hepatitis A.

A patient with Hepatitis has a bilirubin of 6 mg/dL. What findings would correlate with this lab result? Select all that apply: A. None because this bilirubin level is normal B. Yellowing of the skin and sclera C. Clay-colored stools D. Bluish discoloration on the flanks of the abdomen E. Dark urine F. Mental status changes

B. Yellowing of the skin and sclera C. Clay-colored stools E. Dark urine The answers are B, C, and E. This is associated with a high bilirubin level. A normal bilirubin level is 1 or less.

The liver receives blood from two sources. The _____________ is responsible for pumping blood rich in nutrients to the liver. A. hepatic artery B. hepatic portal vein C. mesenteric artery D. hepatic iliac vein

B. hepatic portal vein

The liver receives it blood supply from two sources. One of these sources is called the _________________, which is a vessel network that delivers blood _____________ in nutrients but ________ in oxygen. A. hepatic artery, low, high B. hepatic portal vein, high, low C. hepatic lobule, high, low D. hepatic vein, low, high

B. hepatic portal vein, high, low The answer is B. Majority of the blood flow to the liver comes from the hepatic portal vein. This vessel network delivers blood HIGH in nutrients (lipids, proteins, carbs etc.) from organs that aid in the digestion of food, but the blood is POOR in oxygen. The organs connected to the hepatic portal vein are: small/large intestine, pancreas, spleen, stomach. Rich oxygenated blood comes from the hepatic artery to the liver.

Which of the following is NOT a role of the liver? A. Removing hormones from the body B. Producing bile C. Absorbing water D. Producing albumin

C. Absorbing water The answer is C. The liver does not absorb water. The intestines are responsible for this function.

A patient had a cholecystectomy and has a t-tube in place. You're helping the nursing student understand how to care for the t-tube. The nursing student asks you where the t-tube is located in the body. Your response is the: A. Cystic duct B. Hepatic duct C. Bile duct D. Pancreatic duct

C. Bile duct

A patient with Hepatitis A asks you about the treatment options for this condition. Your response is? A. Antiviral medications B. Interferon C. Supportive care D. Hepatitis A vaccine

C. Supportive care The answer is C. There is no current treatment for Hepatitis A but supportive care and rest. Treatments for the other types of Hepatitis such as B, C, and D include antiviral or interferon (mainly the chronic cases) along with rest.

Your patient is unable to have a cholecystectomy for the treatment of cholecystitis. Therefore, a cholecystostomy tube is placed to help treat the condition. Which statement about a cholecystostomy (C-Tube) is TRUE? A. The C-Tube is placed in the cystic duct of the gallbladder and helps drain infected bile from the gallbladder. B. Gallstones regularly drain out of the C-Tube, therefore, the nurse should flush the tube regularly to ensure patency. C. The C-Tube is placed through the abdominal wall and directly into the gallbladder where it will drain infected bile from the gallbladder. D. The tubing and drainage bag of the C-Tube should always be level with the insertion site to ensure the tube is draining properly.

C. The C-Tube is placed through the abdominal wall and directly into the gallbladder where it will drain infected bile from the gallbladder.

The physician orders a patient's t-tube to be clamped 1 hour before and 1 hour after meals. You clamp the t-tube as prescribed. While the tube is clamped which finding requires immediate nursing intervention? A. The t-tube is not draining. B. The t-tube tubing is below the patient's waist. C. The patient reports nausea and abdominal pain. D. The patient's stool is brown and formed.

C. The patient reports nausea and abdominal pain.

The nurse helps the patient with a t-tube get up from the bed and sit in the bedside chair. Where will the nurse make it priority to position the tubing and drainage bag of the t-tube? A. Slightly elevated above the t-tube insertion site B. At heart level C. Midline with the t-tube insertion site D. At or below the waist

D. At or below the waist

Which TNM classification has the poorest prognosis? A. T0N0M0 B. T2N2M1 C. T4N1M0 D. T4N3M1

D. T4N3M1

The nurse is caring for a client with bladder cancer and bone metastasis. What signs/symptoms would the nurse recognize as indications of a possible oncological emergency? Select all that apply. a. Facial edema in the morning b. Serum calcium level of 12 mg/dL c. Weight loss of 20 lb in 1 month d. Serum sodium level of 136 mg/dL e. Serum potassium level of 3.4 mg/dL f. Numbness and tingling of the lower extremities

a. Facial edema in the morning b. Serum calcium level of 12 mg/dL f. Numbness and tingling of the lower extremities

An infection control nurse develops a plan to decrease the number of healthcare professionals who contract viral hepatitis at work. Which ideas should the nurse include in this plan? (Select all that apply.) a. Policies related to consistent use of Standard Precautions b. Hepatitis vaccination mandate for workers in high-risk areas c. Implementation of a needleless system for intravenous therapy d. Number of sharps used in client care reduced where possible e. Postexposure prophylaxis provided in a timely manner

a. Policies related to consistent use of Standard Precautions c. Implementation of a needleless system for intravenous therapy d. Number of sharps used in client care reduced where possible e. Postexposure prophylaxis provided in a timely manner Rationale: Nurses should always use StandardPrecautions for client care, and policies should reflect this. Needleless systems and reduction of sharps can help prevent hepatitis. Postexposure prophylaxis should be provided immediately. All healthcare workers should receive the hepatitis vaccinations that are available.

A nurse assesses a client who has liver disease. Which laboratory findings should the nurse recognize as potentially causing complications of this disorder? (Select all that apply.) a. Elevated aspartate transaminase b. Elevated international normalized ratio (INR) c. Decreased serum globulin levels d. Decreased serum alkaline phosphatase e. Elevated serum ammonia f. Elevated prothrombin time (PT)

b. Elevated international normalized ratio (INR) e. Elevated serum ammonia f. Elevated prothrombin time (PT) Rationale: Other values are abnormal and associated with liver disease but do not necessarily place the client at increased risk for complications.

The student nurse caring for clients who have cancer understands that the general consequences of cancer include which client problems? (Select all that apply.) a. Clotting abnormalities from thrombocythemia b. Increased risk of infection from white blood cell deficits c. Nutritional deficits such as early satiety and cachexia d. Potential for reduced gas exchange e. Various motor and sensory deficits

b. Increased risk of infection from white blood cell deficits c. Nutritional deficits such as early satiety and cachexia d. Potential for reduced gas exchange e. Various motor and sensory deficits a. Clotting abnormalities from thrombocythemia ← happens bc of thromboCYTOPENIA

The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? a. Anemia b. Decreased platelets c. Increased uric acid level d. Decreased leukocyte count

c. Increased uric acid level ←tumor lysis syndrome

The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy? a. Restrict all visitors. b. Restrict fluid intake. c. Teach the client and family about the need for hand hygiene. d. Insert an indwelling urinary catheter to prevent skin breakdown.

c. Teach the client and family about the need for hand hygiene.

A client is in the oncology clinic for a first visit since being diagnosed with cancer. The nurse reads in the clients chart that the cancer classification is TISN0M0. What does the nurse conclude about this client's cancer? a. The primary site of the cancer cannot be determined. b. Regional lymph nodes could not be assessed. c. There are multiple lymph nodes involved already. d. There are no distant metastases noted in the report.

d. There are no distant metastases noted in the report.

A patient is admitted to the ER with the following signs and symptoms: very painful mid-epigastric pain felt in the back, elevated glucose, fever, and vomiting. During the head-to-toe assessment, you notice bluish discoloration around the belly button. As the nurse, you know this is called? A. Grey-Turner's Sign B. McBurney's Sign C. Homan's Sign D. Cullen's Sign

D. Cullen's Sign The answer is D. This is known as Cullen's Sign. It represents retroperitoneal bleeding from the leakage of digestive enzymes from the inflamed pancreas into the surrounding tissues which is causing bleeding and it is leaking down to umbilicus tissue. Remember the C in Cullen for "circle" and the belly button forms a circle. The patient can also have Grey-Turner's Sign which is a bluish discoloration at the flanks (side of the abdomen). Remember this by TURNER ("turn her" over on her side) which is where the bluish discoloration will be.

A patient is diagnosed with Hepatitis A. The patient asks how a person can become infected with this condition. You know the most common route of transmission is? A. Blood B. Percutaneous C. Mucosal D. Fecal-oral

D. Fecal-oral

You're caring for a 45 year old patient who is admitted with suspected acute pancreatitis. The patient reports having extreme mid-epigastric pain that radiates to the back. The patient states the pain started last night after eating fast food. As the nurse, you know the two most common causes of acute pancreatitis are: A. High cholesterol and alcohol abuse B. History of diabetes and smoking C. Pancreatic cancer and obesity D. Gallstones and alcohol abuse The answer is D. Main causes of acute pancreatitis are gallstones and alcohol consumption. Heavy, long-term alcohol abuse is the main cause of CHRONIC pancreatitis.

D. Gallstones and alcohol abuse The answer is D. Main causes of acute pancreatitis are gallstones and alcohol consumption. Heavy, long-term alcohol abuse is the main cause of CHRONIC pancreatitis.

A 25-year-old patient was exposed to the Hepatitis A virus at a local restaurant one week ago. What education is important to provide to this patient? A. Inform the patient to notify the physician when signs and symptoms of viral Hepatitis start to appear. B. Reassure the patient the chance of acquiring the virus is very low. C. Inform the patient it is very important to obtain the Hepatitis A vaccine immediately to prevent infection. D. Inform the patient to promptly go to the local health department to receive immune globulin.

D. Inform the patient to promptly go to the local health department to receive immune globulin. The answer is D. Since the patient was exposed to Hepatitis A, the patient would need to take preventive measures to prevent infection because infection is possible. The patient should not wait until signs and symptoms appear because the patient can be contagious 2 weeks BEFORE signs and symptoms appear. The vaccine would not prevent Hepatitis A from this exposure, but from possible future exposures because it takes the vaccine 30 days to start working. The best answer is option D. The patient would need to receive immune globulin to provide temporary immunity within 2 weeks of exposure.

The physician orders a patient with pancreatitis to take a pancreatic enzyme. What assessment finding demonstrates the pancreatic enzymes are working properly? A. Abdominal girth is decreased B. Skin turgor is less than 2 seconds C. Blood glucose is 250 D. Stools appear formed and solid The answer is D. Pancreatic enzymes help the body break down carbs, proteins, and fats because the body is not sufficiently producing digestive enzymes anymore. Hence, the stool will not appear as oily or greasy (decrease in steatorrhea) but appear solid and formed.

D. Stools appear formed and solid The answer is D. Pancreatic enzymes help the body break down carbs, proteins, and fats because the body is not sufficiently producing digestive enzymes anymore. Hence, the stool will not appear as oily or greasy (decrease in steatorrhea) but appear solid and formed.

A 45 year old male has cirrhosis. The patient reports concern about the development of enlarged breast tissue. You explain to the patient that this is happening because? A. The liver cells are removing too much estrogen from the body which causes the testicles to produce excessive amounts of estrogen, and this leads to gynecomastia. B. The liver is producing too much estrogen due to the damage to the liver cells, which causes the level to increase in the body, and this leads to gynecomastia. C. The liver cells are failing to recycle estrogen into testosterone, which leads to gynecomastia. D. The liver cells are failing to remove the hormone estrogen properly from the body, which causes the level to increase in the body, and this leads to gynecomastia.

D. The liver cells are failing to remove the hormone estrogen properly from the body, which causes the level to increase in the body, and this leads to gynecomastia.

The gallbladder is found on the __________ side of the body and is located under the ____________. It stores __________. A. right; pancreas; bilirubin B. left; liver; bile C. right; thymus' bilirubin D. right; liver; bile

D. right; liver; bile

Which stage of cancer is called metastatic cancer and means the cancer has spread to other parts of the body beyond where the cancer started? A. Stage II B. Stage 0 C. Stage III D. Stage I E. Stage IV

E. Stage IV

True or False: All forms of cancer use the same grading system. True False

False The answer is FALSE. Some forms of cancer have they own grading systems, like breast cancer which uses the Nottingham system.

A patient with Hepatitis is extremely confused. The patient is diagnosed with Hepatic Encephalopathy. What lab result would correlate with this mental status change? A. Ammonia 100 mcg/dL B. Bilirubin 7 mg/dL C. ALT 56 U/L D. AST 10 U/L

A. Ammonia 100 mcg/dL The answer is A. When ammonia levels become high (normal 15-45 mcg/dL) it affects brain function. Therefore, the nurse would see mental status changes in a patient with this ammonia level.

Select-ALL-that-apply: In the pancreas, the acinar cells release: A. Amylase B. Somatostatin C. Lipase D. Protease The answers are A, C, and D. Acinar cells secrete digestive enzymes into the pancreatic ducts. These enzymes are: Amylase: breaks down carbs to glucose, Protease: breaks down proteins to amino acids, Lipase: breaks down fats

A. Amylase C. Lipase D. Protease The answers are A, C, and D. Acinar cells secrete digestive enzymes into the pancreatic ducts. These enzymes are: Amylase: breaks down carbs to glucose, Protease: breaks down proteins to amino acids, Lipase: breaks down fats

Select all the signs and symptoms associated with Hepatitis? A. Arthralgia B. Bilirubin 1 mg/dL C. Ammonia 15 mcg/dL D. Dark urine E. Vision changes F. Yellowing of the sclera G. Fever H. Loss of appetite

A. Arthralgia D. Dark urine F. Yellowing of the sclera G. Fever H. Loss of appetite The answers are A, D, F, G, and H. The bilirubin and ammonia levels are normal in these options, but they would be abnormal in Hepatitis. A normal bilirubin is 1 or less, and a normal ammonia is 15-45 mcg/dL.

A patient has lab work drawn and it shows a positive HBsAg. What education will you provide to the patient? A. Avoid sexual intercourse or intimacy such as kissing until blood work is negative. B. The patient is now recovered from a previous Hepatitis B infection and is now immune. C. The patient is not a candidate from antiviral or interferon medications. D. The patient is less likely to develop a chronic infection.

A. Avoid sexual intercourse or intimacy such as kissing until blood work is negative. The answer is A. A positive HBsAg (hepatitis B surface antigen) indicates an active Hepatitis B infection. Therefore, the patient should avoid sexual intercourse and other forms of intimacy until their HBsAg is negative.

A patient, who has recovered from cholecystitis, is being discharged home. What meal options below are best for this patient? A. Baked chicken with steamed carrots and rice B. Broccoli and cheese casserole with gravy and mashed potatoes C. Cheeseburger with fries D. Fried chicken with a baked potato

A. Baked chicken with steamed carrots and rice The answer is A. The patient should eat a low-fat diet and avoid greasy/fatty/gassy foods. Option B is wrong because this contains dairy/animal fat like the cheese and gravy, and broccoli is known to cause gas. Option C and D are greasy food options.

A patient is admitted with hepatic encephalopathy secondary to cirrhosis. Which meal option selection below should be avoided with this patient? A. Beef tips and broccoli rabe B. Pasta noodles and bread C. Cucumber sandwich with a side of grapes D. Fresh salad with chopped water chestnuts

A. Beef tips and broccoli rabe The answer is A. Patients who are experiencing hepatic encephalopathy are having issues with toxin build up in the body, specifically ammonia. Remember that ammonia is the byproduct of protein breakdown, and normally the liver can take the ammonia from the protein breakdown and turn it into urea (but if the cirrhosis is severe enough this can't happen). Therefore, the patient should consume foods LOW in protein until the encephalopathy subsides. Option A is very high in protein while the others are low in protein. Remember meats, legumes, eggs, broccoli rabe, certain grains etc. are high in protein.

You're providing an in-service to new nurse graduates about esophageal varices in patients with cirrhosis. You ask the graduates to list activities that should be avoided by a patient with this condition. Which activities listed are correct: Select all that apply A. Excessive coughing B. Sleeping on the back C. Drinking juice D. Alcohol consumption E. Straining during a bowel movement F. Vomiting

A. Excessive coughing D. Alcohol consumption E. Straining during a bowel movement F. Vomiting The answers are A, D, E, and F. Esophageal varices are dilated vessels that are connected from the throat to the stomach. They can become enlarged due to portal hypertension in cirrhosis and can rupture (this is a medical emergency). The patient should avoid activities that could rupture these vessels, such as excessive cough, vomiting, drinking alcohol, and constipation (straining increases thoracic pressure.)

You're providing an in-service on viral hepatitis to a group of healthcare workers. You are teaching them about the types of viral hepatitis that can turn into chronic infections. Which types are known to cause ACUTE infections ONLY? Select all that apply: A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E

A. Hepatitis A E. Hepatitis E The answers are A and E. Only Hepatitis A and E cause ACUTE infections...not chronic. Hepatitis B, C, and D can cause both acute and chronic infections.

A patient with viral Hepatitis states their flu-like symptoms have subsided. However, they now have yellowing of the skin and sclera along with dark urine. Based on this finding, this is what phase of Hepatitis? A. Icteric B. Posticteric C. Preicteric D. Convalescent

A. Icteric The answer is A. The Preicteric (prodromal) Phase: flulike symptoms...joint pain, fatigue, nausea vomiting, abdominal pain change in taste, liver enzymes and bilirubin increasing....Icteric Phase: decrease in the flu-like symptoms but will have jaundice and dark urine (buildup of bilirubin) yellowing of skin and white part of the eyeball, clay-colored stool (bilirubin not going to stool to give it's normal brown color) enlarged liver and pain in this area....Posticteric (convalescent) Phase: jaundice and dark urine start to subside and stool returns to normal brown color, liver enzymes and bilirubin decrease to normal

Which statements are INCORRECT regarding the anatomy and physiology of the liver? Select all that apply: A. The liver has 3 lobes and 8 segments. B. The liver produces bile which is released into the small intestine to help digest fats. C. The liver turns urea, a by-product of protein breakdown, into ammonia. D. The liver plays an important role in the coagulation process.

A. The liver has 3 lobes and 8 segments. C. The liver turns urea, a by-product of protein breakdown, into ammonia. The liver has 2 lobes (not 3), and the liver turns ammonia (NOT urea), which is a by-product of protein breakdown, into ammonia. All the other statements are true about liver's anatomy and physiology.

A patient is being transferred to your unit with acute cholecystitis. In report the transferring nurse tells you that the patient has a positive Murphy's Sign. You know that this means: A. The patient stops breathing in when the examiner palpates under the ribs on the right upper side of the abdomen at the midclavicular line. B. The patient stops breathing out when the examiner palpates under the ribs on the right upper side of the abdomen at the midclavicular line. C. The patient verbalizes pain when the lower right quadrant is palpated. D. The patient reports pain when pressure is applied to the right lower quadrant but then reports an increase in pain intensity when the pressure is released.

A. The patient stops breathing in when the examiner palpates under the ribs on the right upper side of the abdomen at the midclavicular line.

A patient is diagnosed with Hepatitis D. What statement is true about this type of viral Hepatitis? Select all that apply: A. The patient will also have the Hepatitis B virus. B. Hepatitis D is most common in Southern and Eastern Europe, Mediterranean, and Middle East. C. Prevention of Hepatitis D includes handwashing and the Hepatitis D vaccine. D. Hepatitis D is most commonly transmitted via the fecal-oral route.

A. The patient will also have the Hepatitis B virus. B. Hepatitis D is most common in Southern and Eastern Europe, Mediterranean, and Middle East. The answers are A and B. These are true statements about Hepatitis D. Prevention for Hepatitis D includes handwashing and the Hepatitis B vaccine (since it occurs only with the Hepatitis B virus). It is transmitted via blood.

What is the meaning of cancer is in situ? A. The tumor is found in its original place and has not spread from its original location. B. The tumor is formed outside its original place and has spread within it localized site. C. The tumor is cancerous and may spread. D. The tumor is distant from its original place.

A. The tumor is found in its original place and has not spread from its original location.

Your patient with cirrhosis has severe splenomegaly. As the nurse you will make it priority to monitor the patient for signs and symptoms of? Select all that apply: A. Thrombocytopenia B. Vision changes C. Increased PT/INR D. Leukopenia

A. Thrombocytopenia C. Increased PT/INR D. Leukopenia The answers are A, C, and D. A patient with an enlarged spleen (splenomegaly) due to cirrhosis can experience thrombocytopenia (low platelet count), increased PT/INR (means it takes the patient a long time to stop bleeding), and leukopenia (low white blood cells). The spleen stores platelets and WBCs. An enlarged spleen can develop due to portal hypertension, which causes the platelets and WBCs to become stuck inside the spleen due to the increased pressure in the hepatic vein (hence lowering the count and the body's access to these important cells for survival).

Which statements best describe tumor grading? Select all that apply: A. Tumor grading provides information on how tumor cells look under a microscope. B. Cancer can be graded using the TNM classification system. C. Tumor grading describes the location and size of the main tumor, and if the cancer has spread to other parts of the body like the lymph nodes or other organs. D. A biopsy is used to help grade a tumor.

A. Tumor grading provides information on how tumor cells look under a microscope. D. A biopsy is used to help grade a tumor. The answers are A and D. These options are correct regarding tumor grading. Options B and C describes cancer staging.

From the pancreas and gallbladder, the common bile duct and pancreatic duct open into the ____________ where digestive enzymes and bile flow into the duodenum via the major duodenal papilla which is surrounded by a muscular valve that controls the release of digestive enzymes known as the ______________. A. ampulla of vater, sphincter of Oddi B. papilla of vater, sphincter of Oddi C. minor duodenal papilla, ampulla of vater D. jejunum, sphincter of pylori

A. ampulla of vater, sphincter of Oddi The answer is A. Digestive enzymes from the pancreas duct and bile from the common bile duct flow through the ampulla of vater (this is where the pancreatic duct and common bile duct form together) into the duodenum via the major duodenal papilla (also called the papilla of vater) which is surrounded by the sphincter of Oddi. This sphincter is a muscular valve that controls the release of digestive enzymes/bile and prevents reflux of stomach contents into the pancreas and bile duct.

A patient who received treatment for pancreatitis is being discharged home. You're providing diet teaching to the patient. Which statement by the patient requires immediate re-education about the diet restrictions? A. "It will be hard but I will eat a diet low in fat and avoid greasy foods." B. "It is very important I limit my alcohol intake to no more than 2-3 glasses of wine a week." C. "I will concentrate on eating complex carbohydrates rather than refined carbohydrates." D. "I will purchase foods that are high in protein."

B. "It is very important I limit my alcohol intake to no more than 2-3 glasses of wine a week." The answer is B. A patient with pancreatitis should AVOID any amount of alcohol because of its effects on the pancreas. Remember alcohol is a cause of both acute and chronic pancreatitis. All the other options are correct.

A patient was exposed to Hepatitis B recently. Postexposure precautions include vaccination and administration of HBIg (Hepatitis B Immune globulin). HBIg needs to be given as soon as possible, preferably ___________ after exposure to be effective. A. 2 weeks B. 24 hours C. 1 month D. 7 days

B. 24 hours The answer is B. HBIg should be given 24 hours after exposure to maximum effectiveness of temporary immunity against Hepatitis B. It would be given within 12 hours after birth to an infant born to a mother who has Hepatitis B.

A patient in the emergency room has signs and symptoms associated with cholecystitis. What testing do you anticipate the physician will order to help diagnose cholecystitis? Select all that apply: A. Lower GI series B. Abdominal ultrasound C. HIDA Scan (Hepatobiliary Iminodiacetic AciD scan) D. Colonoscopy

B. Abdominal ultrasound C. HIDA Scan (Hepatobiliary Iminodiacetic AciD scan) The answers are B and C. These two tests can assess for cholecystitis. A lower GI series would not assess the gallbladder but the lower portions of the GI system like the rectum and large intestine. Option D is wrong because it would also assess the lower portions of the GI system.

Your patient is diagnosed with acute cholecystitis. The patient is extremely nauseous. A nasogastric tube is inserted with GI decompression. The patient reports a pain rating of 9 on 1-10 scale and states the pain radiates to the shoulder blade. Select all the appropriate nursing interventions for the patient: A. Encourage the patient to consume clear liquids. B. Administered IV fluids per MD order. C. Provide mouth care routinely. D. Keep the patient NPO. E. Administer analgesic as ordered. F. Maintain low intermittent suction to NG tube.

B. Administered IV fluids per MD order. C. Provide mouth care routinely. D. Keep the patient NPO. E. Administer analgesic as ordered. F. Maintain low intermittent suction to NG tube. The answers are B, C, D, E, and F. The treatment for cholecystitis includes managing pain, managing nausea/vomiting (a NG tube with GI decompression (removal of stomach contents) to low intermittent suction may be ordered to help severe cases), keep patient NPO until signs and symptoms subside, mouth care from vomiting and nasogastric tube, and administer IV fluids to keep the patient hydrated.

Which patients below are at risk for developing complications related to a chronic hepatitis infection, such as cirrhosis, liver cancer, and liver failure? Select all that apply: A. A 55-year-old male with Hepatitis A. B. An infant who contracted Hepatitis B at birth. C. A 32-year-old female with Hepatitis C who reports using IV drugs. D. A 50-year-old male with alcoholism and Hepatitis D. E. A 30-year-old who contracted Hepatitis E.

B. An infant who contracted Hepatitis B at birth. C. A 32-year-old female with Hepatitis C who reports using IV drugs. D. A 50-year-old male with alcoholism and Hepatitis D. The answers are B, C, and D. Infants or young children who contract Hepatitis B are at a very high risk of developing chronic Hepatitis B (which is why option B is correct). Option C is correct because most cases of Hepatitis C turn into chronic cases and IV drug use increases this risk even more. Option D is correct because Hepatitis D occurs when Hepatitis B is present and constant usage of alcohol damages the liver. Therefore, the patient is at high risk of developing chronic hepatitis. Hepatitis A and E tend to only cause acute infections....not chronic.

A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? Select all that apply: A. Increase albumin levels B. Ascites C. Splenomegaly D. Fluid volume deficient E. Esophageal varices

B. Ascites C. Splenomegaly E. Esophageal varices The answer are B, C, and E. Portal Hypertension is where the portal vein becomes narrow due to scar tissue in the liver, which is restricting the flow of blood to the liver. Therefore, pressure becomes increased in the portal vein and affects the organs connected via the vein to the liver. The patient may experience ascites, enlarged spleen "splenomegaly", and esophageal varices etc.

A patient with acute pancreatitis is reporting excessive thirst, excessive voiding, and blurred vision. As the nurse, it is priority you? A. Reassure the patient this is normal with pancreatitis B. Check the patient's blood glucose C. Assist the patient with drinking a simple sugar drink like orange juice D. Provide a dark and calm environment

B. Check the patient's blood glucose The answer is B. Patients with acute pancreatitis are at risk for hyperglycemia (the signs and symptoms the patient are reporting are classic symptoms of hyperglycemia). Remember the endocrine function of the pancreas (which is to release insulin/glucagon etc. is insufficient) so the nurse must monitor the patient's blood glucose levels even if the patient is not diabetic.

You are receiving shift report on a patient with cirrhosis. The nurse tells you the patient's bilirubin levels are very high. Based on this, what assessment findings may you expect to find during your head-to-toe assessment? Select all that apply: A. Frothy light-colored urine B. Dark brown urine C. Yellowing of the sclera D. Dark brown stool E. Jaundice of the skin F. Bluish mucous membranes

B. Dark brown urine C. Yellowing of the sclera E. Jaundice of the skin The answers are B, C, and E. High bilirubin levels are because the hepatocytes are no longer able to properly conjugate the bilirubin because they are damaged. This causes bilirubin to leak into the blood and urine (rather than entering the bile and being excreted in the stool). Therefore, the bilirubin stays in the blood and will enter the urine. This will cause the patient to experience yellowing of the skin, sclera of the eyes, and mucous membranes ("jaundice") and have dark brown urine. The stools would be CLAY-COLORED not dark brown (remember bilirubin normally gives stool it brown color but it will be absent).

The physician orders Lactulose 30 mL by mouth per day for a patient with cirrhosis. What findings below demonstrates the medication is working effectively? Select all that apply: A. Decrease albumin levels B. Decrease in Fetor Hepaticus C. Patient is stuporous. D. Decreased ammonia blood level E. Presence of asterixis

B. Decrease in Fetor Hepaticus D. Decreased ammonia blood level The answer is B and D. A patient with cirrhosis may experience a complication called hepatic encephalopathy. This will cause the patient to become confused (they may enter into a coma), have pungent, musty smelling breath (fetor hepaticus), asterixis (involuntary flapping of the hands) etc. This is due to the buildup of ammonia in the blood, which affects the brain. Lactulose can be prescribed to help decrease the ammonia levels. Therefore, if the medication is working properly to decrease the level of ammonia the patient would have improving mental status (NOT stuporous), decreased ammonia blood level, decreasing or absence of asterixis, and decreased ammonia blood level.

During the posticteric phase of Hepatitis the nurse would expect to find? Select all that apply: A. Increased ALT and AST levels along with an increased bilirubin level B. Decreased liver enzymes and bilirubin level C. Flu-like symptoms D. Resolved jaundice and dark urine

B. Decreased liver enzymes and bilirubin level D. Resolved jaundice and dark urine The answers are B and D. Posticteric (convalescent) Phase: jaundice and dark urine start to subside and stool returns to normal brown color, liver enzymes and bilirubin decrease to normal

A patient is post-op day 4 from a t-tube placement. Which finding below requires you to notify the physician? A. Drainage from the t-tube is yellowish green. B. Drainage from the t-tube within the past 24 hours is approximately 925 cc. C. Blood tinged drainage from the t-tube has decreased. D. Patient reports a decrease in nausea.

B. Drainage from the t-tube within the past 24 hours is approximately 925 cc.

Select all the ways a person can become infected with Hepatitis B: A. Contaminated food/water B. During the birth process C. IV drug use D. Undercooked pork or wild game E. Hemodialysis F. Sexual intercourse

B. During the birth process C. IV drug use E. Hemodialysis F. Sexual intercourse

Your patient with acute pancreatitis is scheduled for a test that will use a scope to assess the pancreas, bile ducts, and gallbladder. The patient asks you, "What is the name of the test I'm going for later today?" You tell the patient it is called: A. MRCP B. ERCP C. CT scan of the abdomen D. EGD

B. ERCP The answer is B. ERCP (Endoscopic Retrograde Cholangio-Pancreatography) is used to diagnosis and sometimes treat the causes of pancreatitis. It will assess the pancreas, bile ducts, and gallbladder. In addition, the doctor may be able to remove gallstones, dilate the blocked ducts with a stent or balloon, drain presenting cysts etc.

The TNM staging system has been used to stage your patient's cancer. The report says: T1N0M0 What is the meaning of N0? A. Cancer in regional lymph node can't be measured B. No cancer present in regional lymph node C. Cancer in distant lymph node can't be measured D. No cancer found in other body parts

B. No cancer present in regional lymph node

On a patient's TNM classification you see a lowercase "p" (pT1) in front of the T on the patient report. This means? A. The cancer has been restaged. B. The cancer was staged based on the findings after surgery. C. The cancer was staged before the treatment began and was based on test results and assessment findings. D. The cancer was staged after therapy was administered.

B. The cancer was staged based on the findings after surgery. The answer is B. The "p" represents pathological staging and this classification is given based on the findings after surgery.

You're providing education to a patient with an active Hepatitis B infection. What will you include in their discharge instructions? Select all that apply: A. "Take acetaminophen as needed for pain." B. "Eat large meals that are spread out through the day." C. "Follow a diet low in fat and high in carbs." D. "Do not share toothbrushes, razors, utensils, drinking cups, or any other type of personal hygiene product." E. "Perform aerobic exercises daily to maintain strength."

C. "Follow a diet low in fat and high in carbs." D. "Do not share toothbrushes, razors, utensils, drinking cups, or any other type of personal hygiene product." The answers are C and D. The patient should NOT take acetaminophen (Tylenol) due to its effective on the liver. The patient should eat small (NOT large), but frequent meals...this may help with the nausea. The patient should rest (not perform aerobic exercises daily) because this will help with liver regeneration.

Which patient below is at MOST risk for CHRONIC pancreatitis? A. A 25 year old female with a family history of gallstones. B. A 35 year old male who reports social drinking of alcohol. C. A 15 year old female with cystic fibrosis. D. A 66 year old female with stomach cancer.

C. A 15 year old female with cystic fibrosis. The answer is C. Patients in options A and B are at slight risk for ACUTE pancreatitis not chronic. Remember the main causes of ACUTE pancreatitis are gallstones and alcohol consumption. In option C, the patient with cystic fibrosis is at MAJOR risk for CHRONIC pancreatitis because they are lacking the protein CFTR which plays a role in the movement of chloride ions to help balance salt and water in the epithelial cells that line the ducts of the pancreas. There is a decreased production of bicarbonate secretion by the epithelial cells. Therefore, this leads to thick mucus in the pancreatic ducts that can lead to blockage of the pancreatic ducts which can cause the digestive enzymes to activate and damage the pancreas. Overtime, the pancreas will experience fibrosis of the pancreas' tissue and will no longer produce digestive enzyme to help with food digestion.

Which statement below is an incorrect statement about can tumor staging? A. Staging describes the main tumor's location and size, and if the cancer has spread to other parts of the body like the lymph nodes or other organs. B. It's useful in developing a treatment plan and if the patient can participant in a clinical trial. C. A cancer stage designated at the time of the cancer diagnosis can change overtime. D. A CT scan, MRI, x-ray, and ultrasound can be used to help stage a cancer.

C. A cancer stage designated at the time of the cancer diagnosis can change overtime. The answer is C. This statement is incorrect. All the other statements are true. It's important to note that the cancer stage designated at the time of the cancer diagnosis does NOT change, and if the cancer spreads or metastases that information is added onto the original category designation.

Inside the pancreas are special cells that secrete digestive enzymes and hormones. The cells that secrete digestive enzymes are known as ______________ cells. A. Islet of Langerhans B. Protease C. Acinar D. Amylase

C. Acinar The answer is C. Acinar cells secrete digestive enzymes such as amylase, protease, and lipase.

The physician writes an order for the administration of Lactulose. What lab result indicates this medication was successful? A. Bilirubin <1 mg/dL B. ALT 8 U/L C. Ammonia 16 mcg/dL D. AST 10 U/L

C. Ammonia 16 mcg/dL The answer is C. Lactulose is ordered to decrease a high ammonia level. It will cause excretion of ammonia via the stool. A normal ammonia level would indicate the medication was successful (normal ammonia level 15-45 mcg/dL).

You're providing a community in-service about gastrointestinal disorders. During your teaching about cholecystitis, you discuss how cholelithiasis can lead to this condition. What are the risk factors for cholelithiasis that you will include in your teaching to the participants? Select all that apply: A. Being male B. Underweight C. Being female D. Older age E. Native American F. Caucasian G. Pregnant H. Family History I. Obesity

C. Being female D. Older age E. Native American G. Pregnant H. Family History I. Obesity Above are all risk factors for Gallstones

You're precepting a nursing student who is helping you provide T-Tube drain care. You explain to the nursing student that the t-shaped part of the drain is located in what part of the biliary tract? A. Cystic duct B. Common hepatic duct C. Common bile duct D. Pancreatic duct

C. Common bile duct The answer is C. The "T-shaped" part of the drain is located in the common bile duct and helps deliver bile to the duodenum (small intestine).

Your recent admission has acute cholecystitis. The patient is awaiting a cholecystostomy. What signs and symptoms are associated with this condition? Select all that apply: A. Right lower quadrant pain with rebound tenderness B. Negative Murphy's Sign C. Epigastric pain that radiates to the right scapula D. Pain and fullness that increases after a greasy or spicy meal E. Fever F. Tachycardia G. Nausea

C. Epigastric pain that radiates to the right scapula D. Pain and fullness that increases after a greasy or spicy meal E. Fever F. Tachycardia G. Nausea

Your patient's tumor grading report stated "well differentiated, Grade I". You know that this means? A. The patient's tumor cells were different in appearance and arrangement compared to what normal cells possess. B. This type of cancer is considered high grade. C. This type of cancer is low grade because the tumor cells have an appearance and arrangement that is similar to normal cells. D. This grade of cancer tends to spread and grow quickly.

C. This type of cancer is low grade because the tumor cells have an appearance and arrangement that is similar to normal cells.

When caring for a client with an internal radiation implant, the nurse should observe which principles? Select all that apply. a. Limiting the time with the client to 1 hour per shift. b. Keeping pregnant women out of the client's room. c. Placing the client in a private room with a private bath. d. Wearing a lead shield when providing direct client care. e. Removing the dosimeter film badge when entering the client's room. f. Allowing individuals younger than 16 years old in the room as long as they are 6 feet away from the client.

b. Keeping pregnant women out of the client's room. c. Placing the client in a private room with a private bath. d. Wearing a lead shield when providing direct client care.

While giving care to a client with an internal cervical radiation implant, the nurse finds the implant in the bed. The nurse should take which initial action? a. Call the health care provider (HCP). b. Reinsert the implant into the vagina. c. Pick up the implant with gloved hands and flush it down the toilet. d. Pick up the implant with long-handled forceps and place it in a lead container.

d. Pick up the implant with long-handled forceps and place it in a lead container.

A nurse works with clients who have alopecia from chemotherapy. What action by the nurse takes priority? a. Helping clients adjust to their appearance b. Reassuring clients that this change is temporary c. Referring clients to a reputable wig shop d. Teaching measures to prevent scalp injury

d. Teaching measures to prevent scalp injury ← safety first