Med Surg Exam 3 Test Bank
A 55-year-old man has been newly diagnosed with acute pancreatitis and admitted to the acute medical unit. How should the nurse most likely explain the pathophysiology of this patient's health problem? A) "Toxins have accumulated and inflamed your pancreas." B) "Bacteria likely migrated from your intestines and became lodged in your pancreas." C) "A virus that was likely already present in your body has begun to attack your pancreatic cells." D) "The enzymes that your pancreas produces have damaged the pancreas itself."
D) "The enzymes that your pancreas produces have damaged the pancreas itself."
The nurse is providing care for an older adult patient whose current medication regimen includes levothyroxine (Synthroid). As a result, the nurse should be aware of the heightened risk of adverse effects when administering an IV dose of what medication? A) A fluoroquinalone antibiotic B) A loop diuretic C) A proton pump inhibitor (PPI) D) A benzodiazepine
D) A benzodiazepine
The nurse is caring for a patient with hyperparathyroidism. What level of activity would the nurse expect to promote? A) Complete bed rest B) Bed rest with bathroom privileges C) Out of bed (OOB) to the chair twice a day D) Ambulation and activity as tolerated
D) Ambulation and activity as tolerated
A patient returns to the floor after a laparoscopic cholecystectomy. The nurse should assess the patient for signs and symptoms of what serious potential complication of this surgery? A) Diabetic coma B) Decubitus ulcer C) Wound evisceration D) Bile duct injury
D) Bile duct injury
The nurse is reviewing the history of a patient newly admitted to the unit. This patient has been ordered vasopressin for bleeding esophageal varices. The nurse calls the physician to question the use of vasopressin when she reads that the patient has a history of what? A) Diabetes mellitus B) Chronic kidney disease C) Arthritis D) Coronary artery disease
D) Coronary artery disease
A patient with hypofunction of the adrenal cortex has been admitted to the medical unit. What would the nurse most likely find when assessing this patient? A) Increased body temperature B) Jaundice C) Copious urine output D) Decreased BP
D) Decreased BP
A patient presents to the emergency department (ED) complaining of severe right upper quadrant pain. The patient states that his family doctor told him he had gallstones. The ED nurse should recognize what possible complication of gallstones? A) Acute pancreatitis B) Atrophy of the gallbladder C) Gallbladder cancer D) Gangrene of the gallbladder
D) Gangrene of the gallbladder
A patient with pheochromocytoma has been admitted for an adrenalectomy to be performed the following day. To prevent complications, the nurse should anticipate preoperative administration of which of the following? A) IV antibiotics B) Oral antihypertensives C) Parenteral nutrition D) IV corticosteroids
D) IV corticosteroids
A patient is being treated on the acute medical unit for acute pancreatitis. The nurse has identified a diagnosis of Ineffective Breathing Pattern Related to Pain. What intervention should the nurse perform in order to best address this diagnosis? A) Position the patient supine to facilitate diaphragm movement. B) Administer corticosteroids by nebulizer as ordered. C) Perform oral suctioning as needed to remove secretions. D) Maintain the patient in a semi-Fowler's position whenever possible.
D) Maintain the patient in a semi-Fowler's position whenever possible.
A home health nurse is caring for a patient discharged home after pancreatic surgery. The nurse documents the nursing diagnosis Risk for Imbalanced Nutrition: Less than Body Requirements on the care plan based on the potential complications that may occur after surgery. What are the most likely complications for the patient who has had pancreatic surgery? A) Proteinuria and hyperkalemia B) Hemorrhage and hypercalcemia C) Weight loss and hypoglycemia D) Malabsorption and hyperglycemia
D) Malabsorption and hyperglycemia
The critical care nurse is caring for a patient with cirrhosis. What is an essential nursing function when caring for a patient with cirrhosis? A) Monitoring the patient's oral intake B) Monitoring the patient's support network C) Monitoring the patient for signs of hypervolemia D) Monitoring the patient's mental status
D) Monitoring the patient's mental status
A patient with a recent diagnosis of hypothyroidism is being treated for an unrelated injury. When administering medications to the patient, the nurse should know that the patients diminished thyroid function may have what effect? A) Anaphylaxis B) Nausea and vomiting C) Increased risk of drug interactions D) Prolonged duration of effect
D) Prolonged duration of effect
A nurse is assessing a patient who has been diagnosed with cholecystitis, and is experiencing localized abdominal pain. When assessing the characteristics of the patient's pain, the nurse should anticipate that it may radiate to what region? A) Left upper chest B) Inguinal region C) Neck or jaw D) Right shoulder
D) Right shoulder
A nurse is assessing an elderly patient with gallstones. The nurse is aware that the patient may not exhibit typical symptoms, and that particular symptoms that may be exhibited in the elderly patient may include what? A) Fever and pain B) Chills and jaundice C) Nausea and vomiting D) Signs and symptoms of septic shock
D) Signs and symptoms of septic shock
A patient has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the patient knows to do which of the following? A) Take the drug concurrent with levothyroxine (Synthroid). B) Take each dose of prednisone with a dose of calcium chloride. C) Gradually replace the prednisone with an OTC alternative. D) Slowly taper down the dose of prednisone, as ordered.
D) Slowly taper down the dose of prednisone, as ordered.
A nurse is assessing a 77-year-old male admitted to the unit for suspected liver dysfunction. What assessment finding will the nurse expect to find? A) Liver function results change dramatically in the older adult. B) Metabolism of medications is delayed primarily by the liver. C) The liver is enlarged with hard edges. D) The liver is decreased in size and weight.
D) The liver is decreased in size and weight.
A patient is being discharged home after liver transplantation. The patient still has a hepatic artery catheter in place. What is this hepatic artery catheter for? A) To monitor portal hypertension B) To give immunosuppressive drugs during the first weeks after transplantation C) To monitor vascular changes in the hepatic system D) To deliver a continuous chemotherapeutic dose until completed
D) To deliver a continuous chemotherapeutic dose until completed
The nurse is caring for a patient with liver failure. The nurse understands that patients in liver failure often require vitamin therapy. Which vitamin does the liver require for the synthesis of prothrombin? A) Vitamin B12 B) Vitamin A C) Vitamin D D) Vitamin K
D) Vitamin K
A patient with esophageal varices is being cared for in the ICU. The varices have begun to bleed and the patient is at risk for hypovolemia. The patient has Ringer's lactate at 150 cc/hr infusing. What else might the nurse expect to have ordered to maintain volume for this patient? A) Arterial line B) Central venous catheter C) Foley catheter D) Volume expanders
D) Volume expanders
The nurse is educating a group of people on hepatitis B. One participant asks what is the usual incubation period for hepatitis B. Which of the following responses by the nurse is appropriate? a) "15 to 50 days" b) "Varies from days to years" c) "45 to 160 days" d) "6 to 9 months"
c) "45 to 160 days"
Prolonged hemolytic jaundice, even if mild, predisposes to the formation of what?
pigment stones in the gallbladder, and extremely severe jaundice (levels of free bilirubin exceeding 20 to 25 mg/dL) poses a risk for brainstem damage.
A patient's assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is performing the health interview, what assessment questions address likely etiologic factors? Select all that apply. A) "How many alcoholic drinks do you typically consume in a week?" B) "Have you ever been tested for diabetes?" C) "Have you ever been diagnosed with gallstones?" D) "Would you say that you eat a particularly high-fat diet?" E) "Does anyone in your family have cystic fibrosis?"
A) "How many alcoholic drinks do you typically consume in a week?" C) "Have you ever been diagnosed with gallstones?"
A nurse works in a walk-in clinic. The nurse recognizes that certain patients are at higher risk for different disorders than other patients. What patient is at a greater risk for the development of hypothyroidism? A) A 75-year-old female patient with osteoporosis B) A 50-year-old male patient who is obese C) A 45-year-old female patient who used oral contraceptives D) A 25-year-old male patient who uses recreational drugs
A) A 75-year-old female patient with osteoporosis
A patient has been admitted to the step-down unit with a diagnosis of liver malignancy. The critical care nurse caring for this patient is aware that an early manifestation of liver malignancy, in addition to pain, is what? A) A continuous dull ache in the right upper quadrant, epigastrium, or back B) Weight gain C) An increase in appetite D) Jaundice
A) A continuous dull ache in the right upper quadrant, epigastrium, or back
A patient with a history of postnecrotic cirrhosis is being cared for on your unit. What is this type of cirrhosis often the result of? A) A previous bout of acute viral hepatitis B) Chronic alcoholism C) Bilary obstruction D) Cholangitis
A) A previous bout of acute viral hepatitis
In end-stage liver disease, hypervolemia is always a problem. What nursing interventions would be most appropriate when caring for these patients? (Select all that apply.) A) Administering diuretics B) Giving pain medications C) Implementing fluid restrictions D) Teaching nutrition E) Enhancing patient positioning
A) Administering diuretics C) Implementing fluid restrictions E) Enhancing patient positioning
The nurse is caring for a patient with cancer of the liver. The patient has a percutaneous biliary drainage system. What assessments should the nurse record in the patient's chart? A) Amount and color of drainage B) Temperature of drainage C) Odor of drainage D) Consistency of drainage
A) Amount and color of drainage
The nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment the nurse notes that the patient has a flapping tremor of the hands. What will the nurse document this condition as in the patient's chart? A) Asterixis B) Constructional apraxia C) Fetor hepaticus D) Palmar erythema
A) Asterixis
A patient with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal hypophysectomy. What would be most important for the nurse to monitor before, during, and after surgery? A) Blood glucose B) Assessment of urine for blood C) Weight D) Oral temperature
A) Blood glucose
The triage nurse in the emergency department is assessing a patient who presented with complaints of not feeling well. The patient has ascites and an enlarged liver. The patient reports a history of drinking a 12 pack of beer every evening for the past 15 years. The nurse is aware that the patient is at risk for which disease? A) Cirrhosis B) Renal failure C) Hepatitis D) Cardiovascular disease
A) Cirrhosis
A patient with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the patient should prioritize what question when addressing potential complications? A) Do you feel any muscle twitches or spasms? B) Do you feel flushed or sweaty? C) Are you experiencing any dizziness or lightheadedness? D) Are you having any pain that seems to be radiating from your bones?
A) Do you feel any muscle twitches or spasms?
Following an addisonian crisis, a patients adrenal function has been gradually regained. The nurse should ensure that the patient knows about the need for supplementary glucocorticoid therapy in which of the following circumstances? A) Episodes of high psychosocial stress B) Periods of dehydration C) Episodes of physical exertion D) Administration of a vaccine
A) Episodes of high psychosocial stress
The nurse providing care for a patient with Cushing syndrome has identified the nursing diagnosis of risk for injury related to weakness. How should the nurse best reduce this risk? A) Establish falls prevention measures. B) Encourage bed rest whenever possible. C) Encourage the use of assistive devices. D) Provide constant supervision.
A) Establish falls prevention measures.
The nurse is caring for a patient diagnosed with hypothyroidism secondary to Hashimotos thyroiditis. When assessing this patient, what sign or symptom would the nurse expect? A) Fatigue B) Bulging eyes C) Palpitations D) Flushed skin
A) Fatigue
A patient with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with the patient to improve the patients nutritional intake. What foods should a patient with Cushing syndrome eat to optimize health? Select all that apply. A) Foods high in vitamin D B) Foods high in calories C) Foods high in protein D) Foods high in calcium E) Foods high in sodium
A) Foods high in vitamin D C) Foods high in protein D) Foods high in calcium
A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a patient admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? A) Fried chicken B) Mashed potatoes C) Dinner roll D) Tapioca pudding
A) Fried chicken
A patient with pancreatic cancer has been scheduled for a pancreaticoduodenectomy (Whipple procedure). During health education, the patient should be informed that this procedure will involve the removal of which of the following? Select all that apply. A) Gallbladder B) Part of the stomach C) Duodenum D) Part of the common bile duct E) Part of the rectum
A) Gallbladder B) Part of the stomach C) Duodenum D) Part of the common bile duct
A patient has a recent diagnosis of chronic pancreatitis and is undergoing diagnostic testing to determine pancreatic islet cell function. The nurse should anticipate what diagnostic test? A) Glucose tolerance test B) ERCP C) Pancreatic biopsy D) Abdominal ultrasonography
A) Glucose tolerance test
A patient has been scheduled for an ultrasound of the gallbladder the following morning. What should the nurse do in preparation for this diagnostic study? A) Have the patient refrain from food and fluids after midnight. B) Administer the contrast agent orally 10 to 12 hours before the study. C) Administer the radioactive agent intravenously the evening before the study. D) Encourage the intake of 64 ounces of water 8 hours before the study.
A) Have the patient refrain from food and fluids after midnight.
A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a documented history of adrenal insufficiency. Considering the patients history and current symptoms, the nurse should anticipate that the patient will be instructed to do which of the following? A) Increase his intake of sodium until the GI symptoms improve. B) Increase his intake of potassium until the GI symptoms improve. C) Increase his intake of glucose until the GI symptoms improve. D) Increase his intake of calcium until the GI symptoms improve.
A) Increase his intake of sodium until the GI symptoms improve.
A patient's abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the patient's laboratory studies, what finding is most closely associated with this diagnosis? A) Increased bilirubin B) Decreased serum cholesterol C) Increased blood urea nitrogen (BUN) D) Decreased serum alkaline phosphatase level
A) Increased bilirubin
A patient with ongoing back pain, nausea, and abdominal bloating has been diagnosed with cholecystitis secondary to gallstones. The nurse should anticipate that the patient will undergo what intervention? A) Laparoscopic cholecystectomy B) Methyl tertiary butyl ether (MTBE) infusion C) Intracorporeal lithotripsy D) Extracorporeal shock wave therapy (ESWL)
A) Laparoscopic cholecystectomy
A patient with a cholelithiasis has been scheduled for a laparoscopic cholecystectomy. Why is laparoscopic cholecystectomy preferred by surgeons over an open procedure? A) Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure. B) Laparoscopic cholecystectomy can be performed in a clinic setting, while an open procedure requires an OR. C) A laparoscopic approach allows for the removal of the entire gallbladder. D) A laparoscopic approach can be performed under conscious sedation.
A) Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure.
An adult patient has been admitted to the medical unit for the treatment of acute pancreatitis. What nursing action should be included in this patient's plan of care? A) Measure the patient's abdominal girth daily. B) Limit the use of opioid analgesics. C) Monitor the patient for signs of dysphagia. D) Encourage activity as tolerated.
A) Measure the patient's abdominal girth daily.
You are developing a care plan for a patient with Cushing syndrome. What nursing diagnosis would have the highest priority in this care plan? A) Risk for injury related to weakness B) Ineffective breathing pattern related to muscle weakness C) Risk for loneliness related to disturbed body image D) Autonomic dysreflexia related to neurologic changes
A) Risk for injury related to weakness
A 37-year-old male patient presents at the emergency department (ED) complaining of nausea and vomiting and severe abdominal pain. The patient's abdomen is rigid, and there is bruising to the patient's flank. The patient's wife states that he was on a drinking binge for the past 2 days. The ED nurse should assist in assessing the patient for what health problem? A) Severe pancreatitis with possible peritonitis B) Acute cholecystitis C) Chronic pancreatitis D) Acute appendicitis with possible perforation
A) Severe pancreatitis with possible peritonitis
A student asks the pathophysiology instructor what causes ascites. What would the instructor tell the student is involved in the physiologic process that causes ascites? (Select all that apply.) A) Sodium and water retention B) A damaged liver C) Insufficient renal flow D) Increased lymphatic flow E) Decreased synthesis of immunoglobulin G
A) Sodium and water retention B) A damaged liver D) Increased lymphatic flow
A patient with suspected adrenal insufficiency has been ordered an adrenocorticotropic hormone - 987 (ACTH) stimulation test. Administration of ACTH caused a marked increase in cortisol levels. How should the nurse interpret this finding? A) The patients pituitary function is compromised. B) The patients adrenal insufficiency is not treatable. C) The patient has insufficient hypothalamic function. D) The patient would benefit from surgery.
A) The patients pituitary function is compromised.
A patient is undergoing testing for suspected adrenocortical insufficiency. The care team should ensure that the patient has been assessed for the most common cause of adrenocortical insufficiency. What is the most common cause of this health problem? A) Therapeutic use of corticosteroids B) Pheochromocytoma C) Inadequate secretion of ACTH D) Adrenal tumor
A) Therapeutic use of corticosteroids
How is hepatitis C transmitted? A) Unintentional needlesticks B) Fecal-oral route C) Contaminated food D) Airborne route
A) Unintentional needlesticks
The nurse is performing a shift assessment of a patient with aldosteronism. What assessments should the nurse include? Select all that apply. A) Urine output B) Signs or symptoms of venous thromboembolism C) Peripheral pulses D) Blood pressure E) Skin integrity
A) Urine output D) Blood pressure
A patient with chronic pancreatitis had a Anastomosis of pancreatic duct to jejunum (Roux-en-Y) created 3 months ago for relief of pain and to restore drainage of pancreatic secretions. The patient has come to the office for a routine post surgical appointment. The patient is frustrated that the pain has not decreased. What is the most appropriate initial response by the nurse? A) "The majority of patients who have a pancreatic-duct-to-jejunum have their normal digestion restored but do not achieve pain relief." B) "Pain relief occurs by 6 months in most patients who undergo this procedure, but some people experience a recurrence of their pain." C) "Your physician will likely want to discuss the removal of your gallbladder to achieve pain relief." D) "You are probably not appropriately taking the medications for your pancreatitis and pain, so we will need to discuss your medication regimen in detail."
B) "Pain relief occurs by 6 months in most patients who undergo this procedure, but some people experience a recurrence of their pain."
Toxic hepatitis has a poor prognosis if there is a prolonged period between the exposure to the toxin and the onset of symptoms. There are no effective antidotes. What is the clinical course of toxic hepatitis? 1. Fever rises. 2. Hematemisis. 3. Clotting abnormalities. 4. Vascular collapse. 5. Coma. A) 12543 B) 12345 C) 23145 D) 31254
B) 12345 Fever rises, hematemisis, clotting abnormalities, vascular collapse, and coma
A patient has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this patients immediate care? Select all that apply. A) Administering diuretics to prevent fluid overload B) Administering beta blockers to reduce heart rate C) Administering insulin to reduce blood glucose levels D) Applying interventions to reduce the patients temperature E) Administering corticosteroids
B) Administering beta blockers to reduce heart rate D) Applying interventions to reduce the patients temperature
A patient has had a laparoscopic cholecystectomy. The patient is now complaining of right shoulder pain. What should the nurse suggest to relieve the pain? A) Aspirin every 4 to 6 hours as ordered B) Application of heat 15 to 20 minutes each hour C) Application of an ice pack for no more than 15 minutes D) Application of liniment rub to affected area
B) Application of heat 15 to 20 minutes each hour
The nurse is caring for a patient who has just returned from the ERCP removal of gallstones. The nurse should monitor the patient for signs of what complications? A) Pain and peritonitis B) Bleeding and perforation C) Acidosis and hypoglycemia D) Gangrene of the gallbladder and hyperglycemia
B) Bleeding and perforation
A patient with liver cancer is at the clinic to talk with the physician. The physician tells the patient that it is to risky to do surgery on their hepatic tumor. The patient asks the nurse why surgery is so risky for them. The nurse explains that while surgical resection of the liver tumor is possible in some patients, the risks associated with this procedure increase when the patient has a history of what? A) Oral contraceptive use B) Cirrhosis C) Hypertension D) Prior abdominal surgery
B) Cirrhosis
A patient who has been taking corticosteroids for several months has been experiencing muscle wasting. The patient has asked the nurse for suggestions to address this adverse effect. What should the nurse recommend? A) Activity limitation to conserve energy B) Consumption of a high-protein diet C) Use of OTC vitamin D and calcium supplements D) Passive range-of-motion exercises
B) Consumption of a high-protein diet
You are caring for a patient with advanced cirrhosis. You know that the most significant source of bleeding in a patient with cirrhosis is what? A) Portal hypertension B) Esophageal varices C) Hemolytic jaundice D) Ascites
B) Esophageal varices
A patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on the critical care unit. The priority nursing diagnosis for a patient with this condition is what? A) Risk for peripheral neurovascular dysfunction B) Excess fluid volume C) Hypothermia D) Ineffective airway clearance
B) Excess fluid volume
The physician has ordered a fluid deprivation test for a patient suspected of having diabetes insipidus. During the test, the nurse should prioritize what assessments? A) Temperature and oxygen saturation B) Heart rate and BP C) Breath sounds and bowel sounds D) Color, warmth, movement, and sensation of extremities
B) Heart rate and BP
While assisting with the surgical removal of an adrenal tumor, the OR nurse is aware that the patients vital signs may change upon manipulation of the tumor. What vital sign changes would the nurse expect to see? A) Hyperthermia and tachypnea B) Hypertension and heart rate changes C) Hypotension and hypothermia D) Hyperthermia and bradycardia
B) Hypertension and heart rate changes
The nurses assessment of a patient with thyroidectomy suggests tetany and a review of the most recent blood work corroborate this finding. The nurse should prepare to administer what intervention? A) Oral calcium chloride and vitamin D B) IV calcium gluconate C) STAT levothyroxine D) Administration of parathyroid hormone (PTH)
B) IV calcium gluconate
A nurse is preparing a plan of care for a patient with pancreatic cysts that have necessitated drainage through the abdominal wall. What nursing diagnosis should the nurse prioritize? A) Disturbed Body Image B) Impaired Skin Integrity C) Nausea D) Risk for Deficient Fluid Volume
B) Impaired Skin Integrity
A nurse is caring for a patient with gallstones who has been prescribed ursodeoxycholic acid (UDCA). The patient askshow this medicine is going to help his symptoms. The nurse should be aware of what aspect of this drug's pharmacodynamics? A) It inhibits the synthesis of bile. B) It inhibits the synthesis and secretion of cholesterol. C) It inhibits the secretion of bile. D) It inhibits the synthesis and secretion of amylase.
B) It inhibits the synthesis and secretion of cholesterol.
A patient with bleeding esophageal varices is brought to the emergency department by the paramedics. An immediate endoscopy is performed. What nursing intervention is appropriate? A) Keep patient NPO until results of test are known. B) Keep patient NPO until gag reflex returns. C) Give anesthetic gargles until post-procedure soreness goes away. D) Give anesthetic lozenges 10 minutes before meals.
B) Keep patient NPO until gag reflex returns.
The nurse is caring for a patient at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the patient? Select all that apply. A) Epistaxis B) Pallor C) Rapid respiratory rate D) Bounding pulse E) Hypotension
B) Pallor C) Rapid respiratory rate E) Hypotension
What liver function test is a sensitive indicator of injury to liver cells and useful in detecting acute liver disease such as hepatitis? A) Clotting factors B) Serum aminotransferases C) GGT D) Alkaline phosphatase
B) Serum aminotransferases
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? A) Serum blood urea nitrogen (BUN) level of 8.6 mg/dl B) Serum sodium level of 124 mEq/L C) Hematocrit of 52% D) Serum creatinine level of 0.4 mg/dl
B) Serum sodium level of 124 mEq/L
The nurse is planning the care of a patient with hyperthyroidism. What should the nurse specify in the patients meal plan? A) A clear liquid diet, high in nutrients B) Small, frequent meals, high in protein and calories C) Three large, bland meals a day D) A diet high in fiber and plant-sourced fat
B) Small, frequent meals, high in protein and calories
The nurse is caring for a patient with Addisons disease who is scheduled for discharge. When teaching the patient about hormone replacement therapy, the nurse should address what topic? A) The possibility of precipitous weight gain B) The need for lifelong steroid replacement C) The need to match the daily steroid dose to immediate symptoms D) The importance of monitoring liver function
B) The need for lifelong steroid replacement
A nurse is caring for a patient who has been scheduled for endoscopic retrograde cholangiopancreatography (ERCP) the following day. When providing anticipatory guidance for this patient, the nurse should describe what aspect of this diagnostic procedure? A) The need to protect the incision post-procedure B) The use of moderate sedation C) The need to infuse 50% dextrose during the procedure D) The use of general anesthesia
B) The use of moderate sedation
You are caring for a patient with a blocked bile duct from a tumor. What would you document about the patient's urine? A) Urine is dark amber and concentrated. B) Urine is orange and foamy. C) Urine is rust colored and concentrated. D) Urine is pale yellow and dilute.
B) Urine is orange and foamy.
A patient has just been diagnosed with chronic pancreatitis. The patient is underweight and in severe pain and diagnostic testing indicates that over 80% of the patient's pancreas has been destroyed. The patient asks the nurse why the diagnosis was not made earlier in the disease process. What would be the nurse's best response? A) "The symptoms of pancreatitis mimic those of much less serious illnesses." B) "Your body doesn't require pancreatic function until it is under great stress, so it is easy to go unnoticed." C) "Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost." D) "It's likely that your other organs were compensating for your decreased pancreatic function."
C) "Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost."
A nurse who provides care in a walk-in clinic assesses a wide range of individuals. The nurse should identify which of the following patients as having the highest risk for chronic pancreatitis? A) A 45-year-old obese woman with a high-fat diet B) An 18-year-old man who is a weekend binge drinker C) A 39-year-old man with chronic alcoholism D) A 51-year-old woman who smokes one-and-a-half packs of cigarettes per day
C) A 39-year-old man with chronic alcoholism
The nursing instructor is teaching the senior nursing students about liver disease. What would the instructor teach the students is the most common surgical procedure for liver cancer? A) Cryosurgery B) Liver transplantation C) A lobectomy D) Laser hyperthermia
C) A lobectomy
Postnectrotic cirrhosis is a late result of what? A) Acute bacterial hepatitis B) Hemolytic jaundice C) Acute viral hepatitis D) Chronic biliary obstruction
C) Acute viral hepatitis
The nurse caring for a patient with Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve? A) Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3 hours B) Administration of dexamethasone IV, followed by an x-ray of the adrenal glands C) Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning D) Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after the drug is administered
C) Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning
A patient with portal hypertension has been admitted to the floor you work on. What will you assess for related to portal hypertension? A) Bowel obstruction B) Vitamin A deficiency C) Ascites D) Hepatic encephalopathy
C) Ascites
A nurse is creating a care plan for a patient with acute pancreatitis. The care plan includes reduced activity. What rationale for this intervention should be cited in the care plan? A) Bed rest reduces the patient's metabolism and reduces the risk of metabolic acidosis. B) Reduced activity protects the physical integrity of pancreatic cells. C) Bed rest lowers the metabolic rate and reduces enzyme production. D) Inactivity reduces caloric need and gastrointestinal motility.
C) Bed rest lowers the metabolic rate and reduces enzyme production.
A patient is brought to the emergency department by ambulance. He has hematemesis and alteration in mental status. The patient has tachycardia, cool clammy skin, and hypotension. The patient has a history of alcohol abuse. What would the nurse suspect the patient has? A) Hemolytic jaundice B) Hepatic insufficiency C) Bleeding esophageal varices D) Portal hypertension
C) Bleeding esophageal varices
A student nurse is caring for a patient who has a diagnosis of acute pancreatitis and who is receiving parenteral nutrition. The student should prioritize which of the following assessments? A) Fluid output B) Oral intake C) Blood glucose levels D) BUN and creatinine levels
C) Blood glucose levels
The nurse is assessing a patient diagnosed with Graves disease. What physical characteristics of Graves disease would the nurse expect to find? A) Hair loss B) Moon face C) Bulging eyes D) Fatigue
C) Bulging eyes
A 30 year-old female patient has been diagnosed with Cushing syndrome. What psychosocial nursing diagnosis should the nurse most likely prioritize when planning the patients care? A) Decisional conflict related to treatment options B) Spiritual distress related to changes in cognitive function C) Disturbed body image related to changes in physical appearance D) Powerlessness related to disease progression
C) Disturbed body image related to changes in physical appearance
A patient has been admitted to the hospital for the treatment of chronic pancreatitis. The patient has been stabilized and the nurse is now planning health promotion and educational interventions. Which of the following should the nurse prioritize? A) Educating the patient about expectations and care following surgery B) Educating the patient about the management of blood glucose after discharge C) Educating the patient about postdischarge lifestyle modifications D) Educating the patient about the potential benefits of pancreatic transplantation
C) Educating the patient about postdischarge lifestyle modifications
A patient is receiving care in the intensive care unit for acute pancreatitis. The nurse is aware that pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis. Consequently, the nurse should assess for what signs or symptoms of this complication? A) Sudden increase in random blood glucose readings B) Increased abdominal girth accompanied by decreased level of consciousness C) Fever, increased heart rate and decreased blood pressure D) Abdominal pain unresponsive to analgesics
C) Fever, increased heart rate and decreased blood pressure
A nurse caring for a patient with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding? A) Glucose in the urine B) Albumin in the urine C) Highly dilute urine D) Leukocytes in the urine
C) Highly dilute urine
A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal? A) Hyponatremia B) Hypophosphatemia C) Hypocalcemia D) Hypokalemia
C) Hypocalcemia
A patient has come to the clinic with vague complaints that made the physician suspect liver disease. Laboratory work shows elevated GGT levels. What can elevated GGT levels indicate? A) Hemolytic jaundice B) Cirrohsis C) Liver cell dysfunction D) Viral hepatitis
C) Liver cell dysfunction
A nurse is providing discharge education to a patient who has undergone a laparoscopic cholecystectomy. During the immediate recovery period, the nurse should recommend what foods? A) High-fiber foods B) Low-purine, nutrient-dense foods C) Low-fat foods high in proteins and carbohydrates D) Foods that are low-residue and low in fat
C) Low-fat foods high in proteins and carbohydrates
A critical care nurse is caring for a patient post liver transplantation. The patient has a fall in blood glucose level. What would the nurse do in this instance? A) Give an ampule of D50 every 4 hours B) Monitor an infusion of 5% glucose for the first 24 hours C) Monitor an infusion of 10% glucose for the first 48 hours D) Give an ampule of D50 every 2 hours
C) Monitor an infusion of 10% glucose for the first 48 hours
The nurse is caring for a patient with a diagnosis of Addisons disease. What sign or symptom is most closely associated with this health problem? A) Truncal obesity B) Hypertension C) Muscle weakness D) Moon face
C) Muscle weakness
The nursing instructor is teaching the beginning nursing students how to palpate a liver. What technique will the student nurse use to palpate a patient's liver? A) Place hand under left lower rib cage and press down lightly with the other hand. B) Place the left hand over the abdomen and behind the left side at the 11th rib. C) Place hand under right lower rib cage and press down lightly with the other hand. D) Hold hand 90 degrees to abdomen and push down firmly
C) Place hand under right lower rib cage and press down lightly with the other hand.
A patient has been assessed for aldosteronism and has recently begun treatment. What are priority areas for assessment that the nurse should frequently address? Select all that apply. A) Pupillary response B) Creatinine and BUN levels C) Potassium level D) Peripheral pulses E) BP
C) Potassium level E) BP
A patient who had surgery for gallbladder disease has just returned to the postsurgical unit from postanesthetic recovery. The nurse caring for this patient knows to immediately report what assessment finding to the physician? A) Decreased breath sounds B) Drainage of bile-colored fluid onto the abdominal dressing C) Rigidity of the abdomen D) Acute pain with movement
C) Rigidity of the abdomen
A patient has been admitted to the post-surgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the patient? A) Side-lying (lateral) with one pillow under the head B) Head of the bed elevated 30 degrees and no pillows placed under the head C) Semi-Fowlers with the head supported on two pillows D) Supine, with a small roll supporting the neck
C) Semi-Fowlers with the head supported on two pillows
A patient has undergone a laparoscopic cholecystectomy and is being prepared for discharge home. When providing health education, the nurse should prioritize which of the following topics? A) Management of fluid balance in the home setting B) The need for blood glucose monitoring for the next week C) Signs and symptoms of intra-abdominal complications D) Appropriate use of prescribed pancreatic enzymes
C) Signs and symptoms of intra-abdominal complications
The nurse is caring for a patient with hepatic encephalopathy. The nurse's assessment reveals that the patient exhibits episodes of confusion, is difficult to arouse from sleep, has rigid extremities, and shows EEG abnormalities. Based upon these clinical findings, what is the patient's stage of hepatic encephalopathy? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4
C) Stage 3
A patient is prescribed corticosteroid therapy. What would be priority information for the nurse to give the patient who is prescribed long-term corticosteroid therapy? A) The patients diet should be low protein with ample fat. B) The patient may experience short-term changes in cognition. C) The patient is at an increased risk for developing infection. D) The patient is at a decreased risk for development of thrombophlebitis and thromboembolism.
C) The patient is at an increased risk for developing infection.
A patient who has undergone liver transplantation is ready to be discharged home. The nurse is providing discharge teaching. Which topic will the nurse emphasize the most related to discharge teaching? A) The patient will obtain measurement of drainage from the T-tube. B) The patient will exercise three times a week. C) The patient will take immunosuppressive agents as required. D) The patient will monitor for signs of liver dysfunction.
C) The patient will take immunosuppressive agents as required.
A patient is admitted to the ICU with acute pancreatitis. The patient's family asks what causes acute pancreatitis. The critical care nurse knows that a majority of patients with acute pancreatitis have what? A) Type 1 diabetes B) An impaired immune system C) Undiagnosed chronic pancreatitis D) An amylase deficiency
C) Undiagnosed chronic pancreatitis
