Chapter 53

A client who was awaiting liver transplantation is excluded from the procedure after the presence of which condition is discovered? A. Colon cancer with metastasis to the liver B. Hypertension C. Hepatic encephalopathy D. Ascites and shortness of breath

A

A health care worker believes that he may have been exposed to hepatitis A. Which intervention is the highest priority to prevent him from developing the disease? A. Requesting vaccination for hepatitis A B. Using a needleless system in daily work C. Getting the three-part hepatitis B vaccine D. Requesting an injection of immunoglobulin

A

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

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.

A

For which of the following patients would the nurse anticipate extracorporeal shock wave lithotripsy for removal of gallstones? A. A client with a history of cholesterol based gallstones B. A morbidly obese client C. A client with minimal ejection on HIDA scan D. A client with acalculous cholecystitis

A

he nurse is caring for a client who is prescribed lactulose. The client states, "I do not want to take this medication because it causes diarrhea." How would the nurse respond? a. "Diarrhea is expected; that's how your body gets rid of ammonia." b. "You may take antidiarrheal medication to prevent 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 as soon as possible."

A

When caring for a client with Laennec's cirrhosis, which of these does the nurse expect to find on assessment? (Select all that apply.) A. Prolonged partial thromboplastin time B. Icterus of skin C. Swollen abdomen D. Elevated magnesium E. Currant jelly stool F. Elevated amylase level

ABC

The nurse is assessing a client with hepatitis C. The client asks the nurse how it was possible to have this disease. What questions might the nurse ask to help the client determine how the disease was contracted? (Select all that apply.) a. "How old are you?" b. "Do you work in health care? c. "Are you receiving hemodialysis?" d. "Do you use IV drugs?" e. "Did you receive blood before 1992?" f. "Have you even been in prison or jail?"

ABCDEF

The nurse is caring for a client who has cirrhosis of the liver. What nursing action is appropriate to help control ascites? a. Monitor intake and output. b. Provide a low-sodium diet. c. Increase oral fluid intake. d. Weigh the patient daily

B

A client has an external percutaneous transhepatic biliary catheter inserted for a biliary obstruction. What health teaching about catheter care would the nurse provide for the client? a. "Cap the catheter drain at night to prevent leakage and skin damage." b. "Position the drainage bag lower than the catheter insertion site." c. "Irrigate the catheter with an ounce of saline every night." d. "Pierce a hole in the top of the drainage bag to get rid of odors."

B

A client is admitted with acute pancreatitis. What priority problem would the nurse expect the client to report? a. Nausea and vomiting b. Severe boring abdominal pain c. Jaundice and itching d. Elevated temperature

B

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

How will the nurse interpret a client's laboratory finding of the presence of immunoglobulin G antibodies directed against hepatitis A (HAV)? A. Active, infectious HAV is present. B. Permanent immunity to HAV is present. C. This is the client's first infection to HAV. D. The risk for infection if exposed to HAV is high.

B

The nurse is caring for a client with hepatic portal-systemic encephalopathy (PSE). The clientis thin and cachectic, and the family expresses distress that the patient is receiving little dietary protein. How would 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 patient gain weight and muscle mass." d. "Low dietary protein is needed to prevent fluid from leaking into the abdomen."

B

When providing community education, the nurse emphasizes that which group should receive immunization for hepatitis B? A. Clients who work with shellfish B. Men who prefer sex with men C. Clients traveling to a third-world country D. Clients with elevations of aspartate aminotransferase and alanine aminotransferase

B

When providing dietary teaching to a client with hepatitis, what practice does the nurse recommend? A. Having a larger meal early in the morning B. Consuming increased carbohydrates and moderate protein C. Restricting fluids to 1500 mL/day D. Limiting alcoholic beverages to once weekly

B

Which activity by the nurse will best relieve symptoms associated with ascites? A. Administering oxygen B. Elevating the head of the bed C. Monitoring serum albumin levels D. Administering intravenous fluid

B

While reading a physician's note, the nurse understands that the patient grimaced on palpation of the right upper abdomen during inspiration. Which of the following terms describe this impression? A. (+) Ker's sign B. (+) Murphy's sign C. (+) Cullen's sign D. (+) Blumberg's sign

B

Which activities are most important for the nurse to teach a client with esophageal varices to prevent harm from bleeding or hemorrhage? Select all that apply. A. Avoid alcoholic beverages. B. Eat soft foods and cool liquids. C. Do not engage in strenuous exercise or heavy lifting. D. Try to eat six smaller meals daily instead of three larger ones. E. Be sure to keep your mouth open when sneezing or coughing. F. Cross your legs only at the ankles when sitting, rather than the knees.

BC

The nurse is assessing a client who has hepatitis C. What extrahepatic complications would the nurse anticipate? (Select all that apply.) a. Pancreatitis b. Polyarthritis c. Heart disease d. Myalgia e. Peptic ulcer disease f. Ulcerative colitis

BCD

A nurse assesses a client who has cholecystitis. Which sign or symptom indicates that thiscondition is chronic rather than acute? a. Temperature of 100.1° F (37.8° C) b. Positive Murphy sign c. Clay-colored stools d. Upper abdominal pain after eating

C

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 another's plate or share utensils. c. I should eat plenty of fresh fruits and vegetables. d. I will wash my hands frequently and thoroughly.

C

After teaching a client who is prescribed pancreatic enzyme replacement therapy, the nurse assesses the client's understanding. Which statement by the client indicates a need for further 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 nurse administers lactulose (Evalose) to a client with cirrhosis for which purpose? A. Provides enzymes necessary to digest dairy products B. Reduces portal pressure C. Promotes gastrointestinal (GI) excretion of ammonia D. Decreases GI bleeding

C

The nurse is caring for a client who has a risk gene for developing cirrhosis. Which racial/ethnic group has this gene most often? a. Blacks b. Asian/Pacific Islanders c. Latinos d. French

C

he nursing team consists of an RN, an LPN/LVN, and a nursing assistant. Which client should be assigned to the RN? A. Client who is taking lactulose and has diarrhea B. Client with hepatitis C who requires a dressing change C. Client with end-stage cirrhosis who needs teaching about a low-sodium diet D. Obtunded client with alcoholic encephalopathy who needs a blood draw

C

The nurse asks a client with liver disease to raise the arms to shoulder level and dorsiflex the hands. A few moments later, the hand begins to flap upward and downward. How does the nurse correctly document this in the medical record? A. Positive Babinski's sign B. Hyperreflexia C. Kehr's sign D. Asterixis

D

When assessing a client with hepatitis B, the nurse anticipates which assessment findings? (Select all that apply.) A. Recent influenza infection B. Brown stool C. Tea-colored urine D. Right upper quadrant tenderness E. Itching

CDE

A client had an open traditional Whipple procedure this morning. For what priority complication would the nurse assess? a. Urinary tract infection b. Chronic kidney disease c. Heart failure d. Fluid and electrolyte imbalances

D

A client is scheduled for a hepatobiliary iminodiacetic acid (HIDA) scan. What would the nurse include in client teaching about this diagnostic test? a. "You'll have to drink a contrast medium right before the test." b. "You'll need to do a bowel prep the nursing before the test." c. "You'll be able to drink liquids up until the test begins." d. "You'll have a large camera close to you during the test."

D

A client with a history of esophageal varices has just been admitted to the emergency department after vomiting a large quantity of blood. Which action does the nurse take first? A. Obtain the charts from the previous admission. B. Listen for bowel sounds in all quadrants. C. Obtain pulse and blood pressure. D. Ask about abdominal pain.

D

The nurse is caring for a client who is scheduled for a paracentesis. Which action is appropriate for the nurse to take? a. Have the client sign the informed consent form. b. Get the patient into a chair before the procedure. c. Help the client lie flat in bed on the right side. d. Assist the client to void before the procedure.

D

When caring for a client whose condition is too unstable to undergo sedation for ERCP, which radiologic study does the nurse anticipate as a diagnostic equivalent alternative? A. HIDA scan B. Abdominal ultrasound C. CT without contrast D. MRCP

D

The nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding would require immediate 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 22 to 16 breaths/min d. A decrease in the client's weight by 3 lb (1.4 kg)

A

The nurse is caring for a client who has cirrhosis of the liver. Which risk factor is the leading cause of cirrhosis? a. Metabolic syndrome b. Liver cancer c. Nonalcoholic fatty liver disease d. Hepatitis C

A

The nurse is teaching a client a client about taking elbasvir for hepatitis C. What information in the client's history would the nurse need prior to drug administration? a. History of hepatitis B b. History of kidney disease c. History of cardiac disease d. History of rectal bleeding

A

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

ACDE

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

ACDF

Which problem for a client with cirrhosis takes priority? A. Insufficient knowledge related to the prognosis of the disease process B. Discomfort related to the progression of the disease process C. Potential for injury related to hemorrhage D. Inadequate nutrition related to an inability to tolerate usual dietary intake

C

When assessing a client for hepatic cancer, the nurse anticipates finding an elevation in which laboratory test result? A. Hemoglobin and hematocrit B. Leukocytes C. Alpha-fetoprotein D. Serum albumin

C

he nurse documents the vital signs of a client diagnosed with acute pancreatitis:Apical pulse = 116 beats/minRespirations = 28 breaths/minBlood pressure = 92/50What complication of acute pancreatitis would the nurse suspect that the client might have? a. Electrolyte imbalance b. Pleural effusion c. Internal bleeding d. Pancreatic pseudocyst

C

After receiving change-of-shift report on these clients, which client does the nurse plan to assess first? A. Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min. B. Adult client admitted with cholecystitis who is experiencing severe right upper quadrant abdominal pain. C. Middle-aged client who has an elevated temperature after undergoing endoscopic retrograde cholangiopancreatography. D. Older adult client who is receiving total parenteral nutrition after a Whipple procedure and has a glucose level of 235 mg/dL (13.1 mmol/L).

A

For which client will the nurse expect extracorporeal shock wave lithotripsy (ESWL) as treatment for gallstones to be contraindicated? A. 30-year-old who is 70 inches (1.75 m) tall and weighs 325 lb (147.2 kg) B. 35-year-old who has cholesterol-based stones C. 45-year-old who has a shellfish allergy and uses hormone replacement therapy D. 55-year-old who has bilateral total knee replacements

A

In addition to remaining infection free, which of the following is a goal in recovery from hepatitis? A. Resting the liver B. Vaccination for HCV C. Controlling fever with Tylenol D. Weight loss to decrease fatty liver

A

In which position will the nurse place a client after an open Whipple procedure for treatment of pancreatic cancer? A. Semi-Fowler position to reduce tension on the suture line B. Prone position to prevent acute respiratory distress syndrome C. Left lateral Sims' position with knees drawn up to the chest to reduce pain D. Right lateral Sims' position with knees drawn up to the chest to reduce pain

A

The family of a client who has hepatic encephalopathy asks why the client is restricted to moderate amounts of dietary protein and has to take lactulose. What is an appropriate response by the nurse? A. "These interventions help to reduce the ammonia level." B. "These interventions help to prevent heart failure." C. "These interventions help the client's jaundice improve." D. "These interventions help to prevent nausea and vomiting."

A

The nurse is caring for a client who had a Whipple surgical procedure yesterday. For what serum laboratory test results would the nurse want to monitor frequently and carefully? A. Blood glucose B. Blood urea nitrogen C. Phosphorus D. Platelet count

A

The nurse is caring for a client who recently had an external percutaneous transhepatic biliary catheter placed for severe biliary obstruction. What is the nurse's priority intervention when caring for this client? A. Keeping the biliary drainage bag below the level of the catheter-insertion site B. Checking the client's blood glucose frequently to monitor for diabetes C. Managing pain with continuous opioid patient-controlled analgesia (PCA) D. Capping the catheter if it starts to leak around the insertion site

A

he nurse assesses a client who has chronic pancreatitis. What assessment findings would the nurse expect for this client? (Select all that apply.) a. Ascites b. Weight gain c. Steatorrhea d. Jaundice e. Polydipsia f. Polyuria

ACDEF

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

ACE

After teaching a client who has chronic pancreatitis and will be discharged with enzyme replacement therapy, a nurse assesses the client's understanding. Which statement by the client indicates a need for further teaching? (Select all that apply.) a. "I will take the enzymes between meals." b. "The enteric-coated preparations cannot be crushed." c. "Swallowing the tables without chewing is best." d. "I will wipe my lips after taking the enzymes." e. "Enzymes should be taken with high-protein foods."

AE

A client has an external percutaneous transhepatic biliary catheter inserted for a biliary obstruction. What health teaching about catheter care would the nurse provide for the client? a. "Cap the catheter drain at night to prevent leakage and skin damage." b. "Position the drainage bag lower than the catheter insertion site." c. "Irrigate the catheter with an ounce of saline every night." d. "Pierce a hole in the top of the drainage bag to get rid of odors."

B

A client is admitted with acute pancreatitis. What priority problem would the nurse expect the client to report? a. Nausea and vomiting b. Severe boring abdominal pain c. Jaundice and itching d. Elevated temperature

B

A client is experiencing an attack of acute pancreatitis. Which nursing intervention is the highest priority for this client? A. Assist the client to assume a position of comfort. B. Administer opioid analgesic medication. C. Do not administer food or fluids by mouth. D. Measure intake and output every shift.

B

A client with chronic cholecystitis reports pruritus, clay-colored stools, and voiding dark, frothy urine. Which priority laboratory finding will the nurse assess? A. Lipase level B. Total bilirubin C. Liver function tests D. White blood cell count

B

The nurse assesses a client with a history of cirrhosis and notes significant fluid within the peritoneal cavity. How is this finding documented? A. jaundice B. hepatomegaly C. ascites D. icterus

C

The nurse documents the vital signs of a client diagnosed with acute pancreatitis: Apical pulse = 116 beats/min Respirations = 28 breaths/min Blood pressure = 92/50 What complication of acute pancreatitis would the nurse suspect that the client might have? a. Electrolyte imbalance b. Pleural effusion c. Internal bleeding d. Pancreatic pseudocyst

C

The nurse is caring for a client who is diagnosed with cirrhosis. Which serum laboratory values will the nurse expect to be within normal limits? A. Prothrombin time B. Serum bilirubin C. Acid phosphatase D. Lactate dehydrogenase (LDH)

C

The nurse is caring for a patient with cirrhosis who has hepatic encephalopathy. Which assessment finding should the nurse report to the primary health care provider? A. Fatigue B. Difficulty sleeping C. Seizure D. Disorientation

C

When caring for a patient with suspected liver trauma, which should the nurse prioritize? A. Stool for occult blood B. Assess ability to swallow C. IV Lactated Ringers D. IV Normal Saline

D

Which assessment technique will the nurse use to most accurately determine increasing ascites in a client with advanced liver cirrhosis and portal hypertension? a. Interpreting the serum albumin value b. Measuring the client's abdominal girth c. Testing stool for presence of occult blood d. Weighing the client daily at the same time of the day

D

Which client is more likely to develop gallstones? A. 42-year-old Caucasian female with colon cancer B. 51-year-old African-American male with a history of hypertension C. 63-year-old Hispanic/Latino female with a history of irritable bowel syndrome D. 70-year-old American-Indian female with obesity

D

Which neuromuscular assessment change indicates to the nurse that a client who has late-stage liver cirrhosis now has encephalopathy? A. Asterixis B. Positive Chvostek sign C. Increased deep tendon reflex responses D. Decreased deep tendon reflex responses

A

Which precaution is most important for the nurse to instruct a client with cirrhosis and his or her family about continuing care in the home? A. Avoid taking acetaminophen or drinking alcohol. B. Maintain one-floor living to prevent excessive fatigue. C. Use cool baths to reduce the sensation of itching. D. Report any change in cognition to the health care provider.

A

Which precaution is most important for the nurse to instruct clients with hepatitis C (HCV) who are receiving drug therapy with any second-generation protease inhibitor? A. Avoid crowds and people who are ill. B. Do not touch these drugs with your bare hands. C. Alternate periods of activity with periods of rest. D. Be sure to take vitamin K supplements with this drug.

A

The nurse is caring for a client who has possible acute pancreatitis. What serum laboratory findings would the nurse expect for this client? (Select all that apply.) a. Elevated amylase b. Elevated lipase c. Elevated glucose d. Decreased calcium e. Elevated bilirubin f. Elevated leukocyte count

ABCDEF

A client was admitted to the hospital yesterday with a diagnosis of acute pancreatitis. What assessment findings will the nurse expect for this client? Select all that apply. A. Severe boring abdominal pain B. Jaundice C. Nausea and/or vomiting D. Decreased serum amylase level E. LeukocytosisF. Dyspnea

ABCEF

Which signs and symptoms will the nurse expect to find on assessment of a client with chronic liver disease who has an elevated serum bilirubin level? Select all that apply. A. Pruritus B. Icterus C. Hypertension D. Jaundice E. Pale, clay-colored stools F. Dark, coffee-colored urine.

ABDEF

A client is scheduled to undergo a liver transplantation. Which nursing intervention is most likely to prevent the complications of bile leakage and abscess formation? A. Preventing hypotension B. Keeping the T-tube in a dependent position C. Administering antibiotic vaccinations D. Administering immune-suppressant drugs

B

The RN has just received the change-of-shift report for the medical unit. Which client should the RN see first? A. Client with ascites who had a paracentesis 2 hours ago and is reporting a headache B. Client with portal-systemic encephalopathy (PSE) who has become increasingly difficult to arouse C. Client with hepatic cirrhosis and jaundice who has hemoglobin of 10.9 g/dL and thrombocytopenia D. Client with hepatitis A who has elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

B

Which client's previous health history will the nurse most associate with a risk for developing postnecrotic cirrhosis of the liver? A. 28-year-old woman who had gallstones 1 year ago and has recently lost 20 lb (9 kg) on a low-calorie, low-fat diet B. 45-year-old man with hepatitis C infection and chronic use of acetaminophen C. 50-year-old man who has many years of excessive alcohol consumption D. 55-year-old woman who has chronic biliary obstruction

B

Which serum electrolyte value in a client with early-stage ascites from chronic liver disease who is taking spironolactone will the nurse report immediately to the primary health care provider? A. Sodium 133 mEq/L (mmol/L) B. Potassium 6.4 mEq/L (mmol/L) C. Chloride 101 mEq/L (mmol/L) D. Calcium 8.9 mg/dL (2.2 mmol/L)

B

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

C

A nurse is assessing a patient suspected of having acute cholecystitis. Which information about the last meal would best align with this diagnosis? A. A clear liquid diet for 18 hours B. NPO due to chronic nausea C. A large fatty meal an hour before onset of pain D. A low fat consistent carb diet

C

The nurse is caring for a client who has cirrhosis from substance abuse. The client states, "All of my family hates me." How would 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."

C

Which client will the nurse recognize as having the most risk factors for cholelithiasis? A. 25-year-old white female athlete who is 10 lb (4.5 kg) underweight and had an appendicitis 2 months ago B. 35-year-old African-American male who is 10 lb (4.5 kg) overweight and is hypertensive C. 50-year-old Mexican-American female who has three children and takes hormone replacement therapy D. 60-year-old Asian-American male who had coronary artery bypass graft surgery 4 weeks ago

C

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

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

Which essential nutrient will the nurse expect to be deficient in a client who has liver cirrhosis and ascites? A. Sodium B. Potassium C. Vitamin C D. Vitamin K

D

When admitting a patient diagnosed with Hepatitis D, what additional finding does the nurse anticipate? A. A hepatitis C infection B. A hepatitis A infection C. A hepatitis B infection D. Recent ingestion of shellfish

C

When planning care for an 80 year old client, which of the following should the nurse keep in mind? A. Hepatic proteins syntheses increases with age B. Liver mass increases with age C. Medication metabolism may be delayed D. Liver enzyme production is unaffected by age

C

Which action by the nurse would most likely help to relieve symptoms associated with ascites? A. Monitoring serum albumin levels B. Lowering the head of the bed C. Administering oxygen therapy D. Administering intravenous fluids

C

Which change in electrolyte values will the nurse expect in a client with acute pancreatitis who reports numbness around the mouth and leg muscle twitching? A. Hyponatremia B. Hypokalemia C. Hypocalcemia D. Hypochloremia

C

Which is the most effective action for the nurse to take to assess adequate bowel function in a client with acute pancreatitis who is at risk for the development of paralytic (adynamic) ileus? A. Observing contents of the nasogastric drainage B. Listening for bowel sounds in all four abdominal quadrants C. Asking the client if he or she has passed flatus or had a stool D. Interpreting the report of a CT scan of the abdomen with contrast medium

C

While admitting a female patient with cirrhosis, the nurse notes multiple bruises in various stages of healing. What is the most likely cause? A. Domestic violence B. An excess of vitamin K C. Decreased absorption of fat-soluble vitamins D. Falls resulting from intoxication

C

While assessing a patient who presented with severe boring abdominal pain, the nursed notes bruising around the umbilicus. Which term correctly identifies this finding. A. Grey-Turner's sign B. Blumberg's sign C. Cullen's sign D. Kehr's sign

C

When caring for a client with acute pancreatitis, which assessment finding requires immediate nursing intervention? A. Heart rate of 105 beats/min B. Serum glucose of 136 mg/dL C. Blood pressure of 102/76mm Hg D. Respiratory rate of 28breaths/min

D

Which client will the nurse recognize as having the highest risk for pancreatic cancer? A. 27-year-old man who is underweight and has opioid use disorder B. 35-year-old woman who is overweight and uses oral contraceptives C. 50-year-old woman who has ductal breast cancer and receiving radiotherapy D. 60-year old man who smokes two packs of cigarettes daily and has liver cirrhosis

D

Which food item will the nurse remove from the dietary tray of a client with hepatic encephalopathy? A. Salad B. Apple C. Bread D. Legumes

D

Which statement by a client with cirrhosis indicates that further instruction is needed about the disease? A. "Cirrhosis is a chronic disease that has scarred my liver." B. "The scars on my liver create problems with blood circulation." C. "Because of the scars on my liver, blood clotting and blood pressure are affected." D. "My liver is scarred, but the cells can regenerate themselves and repair the damage."

D

The nurse is planning care for a client who had a laparoscopic Whipple surgery. For which complications will the nurse assess? Select all that apply. A. Bleeding B. Wound infection C. Intestinal obstruction D. Diabetes mellitus E. Abdominal abscess

ABCDE

The nurse is caring for a client who was recently diagnosed with pancreatic cancer. Whatfactors present risks for developing this type of cancer? (Select all that apply.) a. Diabetes mellitus b. Cirrhosis c. Smoking d. Female gender e. Family history f. Older age

ABCDEF

The nurse is preparing a client who has chronic pancreatitis about how to prevent exacerbations of the disease. Which health teaching will the nurse include? (Select all that apply.) a. "Avoid alcohol ingestion." b. "Be sure and balance rest with activity." c. "Avoid caffeinated beverages." d. "Avoid green, leafy vegetables." e. "Eat small meals and high-calorie snacks."

ABCE

Which signs or symptoms will the nurse assess for in a client who is suspected of having cholecystitis? Select all that apply. A. Anorexia B. Jaundice C. Ascites D. Steatorrhea E. Eructation F. Rebound tenderness

ABDEF

The nurse is caring for a client with early encephalopathy due to cirrhosis of the liver. Which factors may contribute to increased encephalopathy for which the nurse would assess? (Select all that apply.) a. Infection b. GI bleeding c. Irritable bowel syndrome d. Constipation e. Anemia f. Hypovolemia

ABDF

The nurse is caring for clients in the outpatient clinic. Which of these phone calls should the nurse return first? A. Client with hepatitis A reporting severe and ongoing itching B. Client with severe ascites who has a temperature of 101.4° F (38° C) C. Client with cirrhosis who has had a 3-pound weight gain over 2 days D. Client with esophageal varices and mild right upper quadrant pain

B

Which assessment finding requires immediate nursing intervention in a client with severe ascites? A. Confusion B. Temperature 38.2º C C. Tachycardia, rate 110beats/min D. Shallow respirations ,rate 32 breaths/min

D

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

C

What is the nurse's best first action when a client who just had a liver transplant develops oozing around two IV sites as well as has some new bruising? A. Applying pressure to the IV sites B. Checking the client's platelet levels C. Notifying the surgeon immediately D. Documenting the findings as the only action

C

What is the nurse's best response to a client who fears he may have been exposed to hepatitis A while attending a banquet last week after which three restaurant workers were diagnosed with hepatitis A? A. "Which types of food did you eat at the banquet?" B. "If you have no symptoms at this time, you are probably safe." C. "You can receive an immunoglobulin injection to prevent the infection." D. "Contact your primary health care provider about receiving the hepatitis A vaccine."

C

What is the nurse's priority action when a client with ascites reports increased abdominal pain and chills? A. Applying oxygen and making the client NPO B. Notifying the primary health care provider immediately C. Assessing for abdominal rigidity and taking the client's temperature D. Applying a heating blanket and raising the head of the bed to a 45-degree angle

C

What liver problem does the nurse suspect in a client whose liver is hard with a nodular texture and the hepatic enzymes remain normal? A. Prenecrotic inflammation B. Postnecrotic inflammation C. Compensated cirrhosis D. Decompensated cirrhosis

C

After completing a patient assessment, nurse is highly suspicious of acute cholecystitis. Which of the following would be most helpful to include in the recommendation portion of an SBAR to the provider? A. A complete set of vital signs B. Trending of previous lab results C. A contrast enhanced CT scan D. An abdominal ultrasound

D

After teaching a client who has a history of cholelithiasis, the nurse assesses the client's understanding. Which menu selection indicates that the client 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

The RN is caring for a client with end-stage liver disease that has resulted in ascites. Which action does the RN delegate to unlicensed assistive personnel (UAP)? A. Assessing skin integrity and abdominal distention B. Drawing blood from a central venous line for electrolyte studies C. Evaluating laboratory study results for the presence of hypokalemia D. Placing the client in a semi-Fowler's position

D

The nurse is caring for a client scheduled to have a transjugular intrahepatic portal-systemic shunt (TIPS) procedure. What client assessment would the nurse perform prior to this procedure? a. Musculoskeletal assessment b. Neurologic assessment c. Mental health assessment d. Cardiovascular assessment

D

Which assessment technique will the nurse use to most accurately determine increasing ascites in a client with advanced liver cirrhosis and portal hypertension? A. Interpreting the serum albumin value B. Measuring the client's abdominal girth C. Testing stool for the presence of occult blood D. Weighing the client daily at the same time of the day

D

A client had an open traditional Whipple procedure this morning. For what priority complication would the nurse assess? a. Urinary tract infection b. Chronic kidney disease c. Heart failure d. Fluid and electrolyte imbalances

D

Which statement by the client who is prescribed to take pancreatic enzyme replacements indicates a need for further teaching by the nurse? A. "I need to take the enzymes at every meal and with snacks." B. "After taking the enzymes, I should drink a glass of water." C. "I should wipe my mouth in case any of the enzyme got on my lips." D. "I should chew each capsule carefully so that it works in my stomach."

D

Which statement indicates to the nurse that a client who is experiencing frequent episodes of "indigestion" and flatulence may have cholecystitis? A. "My stools are sometimes very dark and tarry looking." B. "Sometimes at night I have bad-tasting fluid in my mouth." C. Usually about a half hour after I eat, I become sweaty and nauseated." D. "My right arm and shoulder always seem to hurt after I eat fried foods."

D

Which teaching will the nurse provide when discharging a client with chronic pancreatitis? A. Weight reduction and daily exercise regimen B. Relaxation techniques and stress management C. Constipation precautions including daily laxative use D. Dietary adjustments to avoid high-fat foods, caffeine, and alcohol

D

While palpating a patient's abdomen, a mass is palpated just below the right thorax associated with increased right upper quadrant pain on palpation. The findings alert the nurse to possible dysfunction in which organ? A. The right kidney B. The spleen C. The pancreas D. The liver

D

A client is admitted to the emergency department with possible acute pancreatitis. What is the nurse's priority assessment at this time? A. Respiratory assessment B. Cardiovascular assessment C. Abdominal assessment D. Pain intensity assessment

A

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

A

A nurse cares for a client with end-stage pancreatic cancer. The client asks, "Why is this happening to me?" How would the nurse respond? a. "I don't know. I wish I had an answer for you, but I don't." b. "It's 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

A nurse is performing hand hygiene after providing patient care. The nurse's hands are not visibly soiled. Which steps in this procedure are performed correctly? A. The nurse uses friction motion when washing for at least 15 seconds. B. The nurse removes all jewelry including a platinum wedding band. C. The nurse uses approximately two teaspoons of liquid soap. D. The nurse keeps hands higher than elbows when placing under faucet.

A

What is the nurse's priority action when caring for a client with acute cholecystitis who now has severe abdominal pain, diaphoresis, heart rate of 118 beats/min, BP 95/70, respirations 32 breaths/min, and temperature 101°F (38.3°C)? A. Initiating the Rapid Response Team B. Assisting the client to a semi-Fowler position C. Administering the prescribed opioid analgesic D. Auscultating the client's abdomen in all four quadrants

A

What will the nurse recognize as the cause of splenomegaly in a client who has cirrhosis? a. Increased pressure in the portal vein causing backflow of blood into the spleen b. The loss of cellular regulation in the liver spreading to the spleen and causing extensive scarring c. Chronic inflammation and infection increasing the spleen's maturation and release of white blood cells d. Direct destruction of spleen cells from alcohol or other toxins causing replacement with scar tissue formation

A

After evaluating vital signs reported by the CNA, which patient would the nurse see first? A. A 57 year old with chronic pancreatitis and abdominal pain at 6/10 B. A 23 yo with acute pancreatitis and an oral temp of 103.4F C. A 34 year old with acute pancreatitis with a BP of 106/ 74 D. A 42 year old with a respiratory rate of 26 after showering

B

How will the nurse interpret a client's laboratory finding of the presence of immunoglobulin G antibodies directed against hepatitis A? a. Active, infectious HAV is present b. Permanent immunity to HAV is present c. This is the client's first infection to HAV d. The risk for infection if exposed to HAV is high

B

The nurse is caring for a client who had a liver transplant last week. For which complication will the nurse teach the client and family to monitor? A. Hypertension B. Infection C. Pulmonary edema D. Acute kidney injury

B

The nurse is caring for a client who has cirrhosis of the liver with esophageal varices. The client's latest prothrombin time was prolonged. The nurse should prioritize assessment for which finding? A. deep vein thrombosis B. hematemesis C. pressure injury D. jaundice

B

When preparing a client to undergo paracentesis, which action is necessary to reduce potential injury as a result of the procedure? A. Encourage the client to take deep breaths and cough. B. Ask the client to void prior to the procedure. C. Position the client with the head of the bed flat. D. Assist the provider to insert a trocar catheter into the abdomen.

B

When the client with cirrhosis refuses her evening dose of lactulose, what is the nurse's best response? A. I will ask pharmacy to reschedule this dose for 9am B. "Tell me what you know about this medication." C. I know it causes diarrhea; but it is for your own good D. You have every right to refuse. I'll return the dose to pharmacy

B

Which client's previous health history will the nurse most associate with a risk for developing post necrotic cirrhosis of the liver?' a. 28 yo woman who had gallstones 1 year ago and has recently lost 20 pounds on a low calorie, low fat diet b. 45 yo male with hepatitis C infection and chronic use of acetaminophen c. 50 woman who has many years of excessive alcohol consumption d. 55 yo woman who has chronic biliary obstruction

B

Which complication in a client with acute necrotizing pancreatitis who develops a temperature spike to 104°F (40°C) will the nurse suspect? A. Pancreatic pseudocyst B. Pancreatic abscess C. Chronic pancreatitis D. Pancreatic cancer

B

Which of the following anastomosis is not included in the Whipple procedure? A.Choledochojejunostomy B. Hepaticojejunostomy C. Pancreatojejunostomy D. Gastrojejunostomy

B

A 26 year old homeless patient diagnosed with hepatitis A (HAV) asks the nurse how she could have become infected. Which does the nurse suggest as a most likely cause? A. sharing needles B. prolonged or excessive alcohol intake C. eating without first washing her hand D. shaving unprotected sex with an infected partner

C

A client is preparing to have a hepatobiliary scan (HIDA scan). What health teaching would the nurse include about what the client can expect during the test? A. "This test measures how inflamed your gallbladder and liver may be." B. "You may eat and drink as much as you'd like before you have this test." C. "You will have to lie still for some time while the camera is very close to your body." D. "I need to know if you are allergic to shellfish because the contrast will be iodine-based."

C

A client who had a Whipple surgical procedure develops an internal fistula between the pancreas and stomach. For which complication would the nurse monitor? A. Peptic ulcer disease B. Cirrhosis C. Peritonitis D. Chronic pancreatitis

C

A nurse assesses a client who has cholecystitis. Which sign or symptom indicates that this condition is chronic rather than acute? a. Temperature of 100.1° F (37.8° C) b. Positive Murphy sign c. Clay-colored stools d. Upper abdominal pain after eating

C

A nurse recognizes that an 80 year old female patient who takes solumedrol for an acute exacerbation of COPD, HCTZ for hypertension, and Lasix for symptoms associated with heart failure has how many risk factors for Drug Induced Pancreatitis? A. 2 B. 3 C. 5 D. 6

C

A patient presents in the fetal position and is suspected of having acute pancreatitis. Knowing the patient will be in the supine position for a CT, which intervention does the nurse prioritize? A. Application of oxygen B. Auscultation of lung sounds C. Administration of IV hydromorphone D. Placing an NG tube to prevent vomiting

C

A young adult client admitted with a diagnosis of cholecystitis from cholelithiasis has severe abdominal pain, nausea, and vomiting. Based on these assessment findings, which client problem is the highest priority for nursing intervention at this time? A. Anxiety B. Risk for dehydration C. Acute pain D. Malnutrition

C

The nurse reads that a patient was excluded from receiving a liver transplant. Which finding in the medical record would best explain this decision? A. The client has a history of alcohol abuse B. Unsteady work history due to prolonged illness C. A history of lung cancer with metastasis to the liver D. The client had a stent placed in the right coronary artery 5 years ago

C

What action will the nurse take when, 12 hours after a traditional cholecystectomy, a client's Jackson-Pratt (JP) drain shows serosanguineous drainage stained with bile? A. Placing the client to the left lateral Sims' position B. Clamping the drain intermittently for 30 minutes every hour C. Measuring the drainage and documenting the findings D. Disconnecting the suction device and gently irrigating the drain with sterile saline

C

A client has been placed on enzyme replacement for treatment of chronic pancreatitis. In teaching the client about this therapy, the nurse advises the client not to mix enzyme preparations with foods containing which element? A. High fat B. High fiber C. Carbohydrates D. Protein

D

A client is scheduled for a hepatobiliary iminodiacetic acid (HIDA) scan. What would the nurse include in client teaching about this diagnostic test? a. "You'll have to drink a contrast medium right before the test." b. "You'll need to do a bowel prep the nursing before the test." c. "You'll be able to drink liquids up until the test begins." d. "You'll have a large camera close to you during the test."

D

A nurse is scheduling a surgical consult for a patient diagnosed with liver cancer. Which of the following is the goal of surgical intervention? A. relieving symptoms B. alleviating pain C. curing the cancer D. reducing or removing the obstructing tumo

D

After teaching a client who has a history of cholelithiasis, the nurse assesses the client's understanding. Which menu selection indicates that the client 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

How would the home care nurse best modify the client's home environment to manage side effects of lactulose? A. Obtains a walker for the client. B. Removes throw rugs to prevent falls C. Rearranges furniture to declutter the home. D. Requests a bedside commode for the client.

D

In discharge planning for a client with ascites r/t cirrhosis, the nurse assesses understanding of signs of infection due to knowledge of which of the following about ascites? A. Increased risk for hepatitis B. Exposure to disease in hospital C. Increased risk for pneumonia D. Increased risk for peritonitis

D

It is essential that the nurse monitor the client returning from hepatic artery embolization for hepatic cancer for which potential complication? A. Right shoulder pain B. Bone marrow suppression C. Polyuria D. Bleeding

D

The nurse collaborates with the registered dietitian nutritionist in providing teaching for a client who has ascites from cirrhosis. What daily dietary restriction would the nurse include in the health teaching? A. Calcium B. Potassium C. Magnesium D. Sodium

D

The nurse is caring for a patient diagnosed with acalculous cholecystitis. Which of the following can be omitted from the teaching plan for this patient? A. Cardiovascular risk factors B. Effects of biliary stasis C. Signs and symptoms of infection D. Treatments for cholelithiasis

D

The nurse is caring for a patient diagnosed with acute pancreatitis. Which of the following would be called to the provider? A. Serum potassium 3.7mmOl/L B. Serum sodium 144 mEq/L C. WBC 10,000/ microliter D. Serum Calcium 6.6 mg/dl

D

The nurse is caring for a patient diagnosed with hepatitis. Which of the following should be reported to the provider? A. abdominal pain B. jaundice C. icterus D. Changes in consciousness or behavior

D

Which of the following would be a later symptom of one diagnosed with liver cancer? A. fatigue B. weight loss C. Right upper quadrant pain D. Jaundice

D

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.

B

The preceptor asks the nursing student why Morphine is prescribed for the patient undergoing HIDA scan. What is the student's best response?A. To increase gallbladder visualization B. To control acute abdominal pain C. To improve pulmonary perfusion D. To slow the patient's respiratory rate

A

The nurse is caring for a client who has late-stage (advanced) cirrhosis. What assessment findings would the nurse expect? (Select all that apply.) a. Jaundice b. Clay-colored stools c. Icterus d. Ascites e. Petechiae f. Dark urine

ABCDEF

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.

ACD

The nurse is teaching assistive personnel (AP) about care of a client who has advanced cirrhosis. Which statements would the nurse include in the staff teaching? (Select all that apply.) a. "Apply lotion to the client's dry skin areas." b. "Use a basin with warm water to bathe the patient." c. "For the patient's oral care, use a soft toothbrush." d. "Provide clippers so the patient can trim the fingernails." e. "Bathe with antibacterial and water-based soaps."

ACD

When caring for a client with portal hypertension, the nurse assesses for which potential complications? (Select all that apply.) A. Esophageal varices B. Hematuria C. Fever D. Ascites E. Hemorrhoids

ADE

After teaching a client who has chronic pancreatitis and will be discharged with enzyme replacement therapy, a nurse assesses the client's understanding. Which statement by the client indicates a need for further teaching? (Select all that apply.) a. "I will take the enzymes between meals." b. "The enteric-coated preparations cannot be crushed." c. "Swallowing the tables without chewing is best." d. "I will wipe my lips after taking the enzymes." e. "Enzymes should be taken with high-protein foods."

AE

The nurse is preparing to teach a client with chronic hepatitis B about lamivudine therapy.What health teaching would the nurse include? a. "Follow up on all appointments to monitor your lab values." b. "Do not take amiodarone at any time while on this drug." c. "Monitor for jaundice, rash, and itchy skin while on this drug." d. "Report any changes in urinary elimination while on this drug."

D

The patient admitted with cholecystitis due to cholelithiasis asks, "Why is my poop so white?" Which is the nurse's appropriate response? A. "The color of stool varies based on diet and is insignificant." B. "The disease is limiting the amount of bile your gallbladder produces." C. "The high fiber carbohydrate, low fat diet has changed the consistency of your stool." D. "The gallstones are blocking digestive fluids that add the color to your bowel movement"

D

When providing discharge teaching to a client with cirrhosis, it is essential for the nurse to emphasize avoidance of which of these? A. Vitamin K-containing products B. Potassium-sparing diuretics C. Nonabsorbable antibiotics D. Nonsteroidal anti-inflammatory drugs (NSAIDs)

D

Which intervention is important for the nurse to include in the plan of care for a client who is to undergo paracentesis later today? A. Measure and record drainage. B. Monitor aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase. C. Obtain informed consent for the procedure. D. Have the client void before the procedure is performed.

D

What will the nurse recognize as the cause of splenomegaly in a client who has cirrhosis? A. Increased pressure in the portal vein causing backflow of blood into the spleen B. The loss of cellular regulation in the liver spreading to the spleen and causing extensive scarring C. Chronic inflammation and infection increasing the spleen's maturation and release of white blood cells D. Direct destruction of spleen cells from alcohol or other toxins causing replacement with scar tissue formation

A

When caring for a client with hepatic encephalopathy, in which situation does the nurse question the use of neomycin (Mycifradin)? A. Kidney failure B. Refractory ascites C. Fetor hepaticus D. Paracentesis scheduled for today

A

Which client will the nurse recognize as having the greatest risk for non-alcoholic fatty liver disease (NAFLD)? A. 45-year-old Latino man who is 30 lb (13.9 kg) overweight and has type 2 diabetes B. 50-year-old white woman who drinks one glass of wine daily and has breast cancer C. 60-year-old black woman who is hypertensive and takes a diuretic daily D. 70-year-old Asian man who has gastroesophageal reflux disease (GERD)

A

The nurse is caring for a client with hepatitis C. The client's brother states, "I do not want to get this infection, so I'm not going into his hospital room." How would the nurse respond? a. "Hepatitis C is not spread through casual contact." b. "If you wear a gown and gloves, you will not get this virus." c. "This virus is only transmitted through a fecal specimen." d. "I can give you an update on your brother's status from here."

A

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

A

A nurse cares for a client with end-stage pancreatic cancer. The client asks, "Why is this happening to me?" How would the nurse respond? a. "I don't know. I wish I had an answer for you, but I don't." b. "It's 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

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.

A

A telehealth nurse speaks with a client who is recovering from a liver transplant 2 weeks ago.The client states, "I'm having right belly pain and have a temperature of 101° F (38.3° C)." How would 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 get checked out." c. "You should take an additional dose of cyclosporine today." d. "Take acetaminophen every 4 hours until you feel better soon."

B

Following paracentesis, during which 2500 mL of fluid was removed, which assessment finding is most important to communicate to the heath-care provider? A. The dressing has a 2-cm area of serous drainage. B. The client's platelet count is 135,000/mm3. C. The client's albumin level is 2.8 mg/dL. D. The client's heart rate is 122 beats/min.

D

How does the home care nurse best modify the client's home environment to manage side effects of lactulose (Evalose)? A. Provides small frequent meals for the client B. Suggests taking daily potassium supplements C. Elevates the head of the bed in high-Fowler's position D. Requests a bedside commode for the client

D

It is essential that the nurse monitor the client returning from hepatic artery embolization for hepatic cancer for which potential complication? A. Right shoulder pain B. Polyuria C. Bone marrow suppression D. Bleeding

D

The nurse is caring for a client who states that her mother had "gallbladder problems" and wonders if she is at risk for this disorder. What major risk factor places women most at risk for gallbladder disease? A. Obesity B. Birth control pills C. Infertility D. Advanced age

A

When assessing a client with hepatitis B, which assessment finding would NOT be an expected finding for hepatitis? A. Recent influenza infection B. Tea-colored urine C. Itching D. Right upper quadrant tenderness

A

Which action will the nurse take first when an 80-year-old client with acute pancreatitis has no breath sounds in the left lower lung lobe? A. Apply oxygen. B. Assess the breath sounds on the right. C. Notify the primary health care provider. D. Document the finding as the only action

A

Which client will the nurse recognize as having the greatest risk for nonalcoholic fatty liver disease? a. 45 yo Latino man who is 30 lb overweight and has type 2 diabetes b. 50 yo white woman who drinks one glass of wine daily and has breast cancer c. 60 yo black woman who is hypertensive and takes a diuretic daily d. 70 yo Asian man who has GERD

A

Which precaution is most important for the nurse to instruct clients with hepatitis C who are receiving drug therapy with any second-generation protease inhibitor? a. Avoid crowds and people who are ill b. Do not touch these drugs with your bare hands c. Alternate periods of activity with periods of rest d. Be sure to take vitamin K supplements with this drug

A

After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the client's understanding. Which statement by the client indicates 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."

B

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.

B

In caring for a client who has undergone paracentesis, which changes in the client's status should be promptly reported to the provider? A. Increased blood pressure, increased respiratory rate B. Decreased blood pressure, increased heart rate C. Increased respiratory rate, increased apical pulse, pallor D. Tachypnea, diaphoresis, increased blood pressure

B

The nurse is caring for a client who is recovering from an open traditional Whipple surgical procedure. What action would the nurse take? a. Clamp the nasogastric tube. b. Place the patient in semi-Fowler position. c. Assess vital signs once every shift. d. Provide oral rehydration.

B

The nurse is caring for a client who is recovering from an open traditional Whipple surgical procedure. What action would the nurse take? a. Clamp the nasogastric tube. b. Place the patient in semi-Fowler position. c. Assess vital signs once every shift. d. Provide oral rehydration.

B

The nurse is caring for a client who just had a paracentesis. Which client finding indicates that the procedure was effective? A. Increased blood pressure B. Decreased weight C. Increased pulse D. Decreased pain

B

The nurse is caring for a female patient with acute cholecystitis. Which statement by the patient indicates an urgent need for further teaching?A. "The pain is a symptom of the bile from my liver being obstructed by stones." B. "I'm not concerned. Gallbladder attacks happen everyday to someone. It's not like it can hurt me." C. "I have been on a high fiber, low fat diet, and drink plenty of water." D. "I understand I can have my gallbladder removed with no visible scars at all."

B

The nurse is preparing and SBAR report to alert the provider of suspected pancreatitis. Which of the following is a symptom associated with acute pancreatitis? A. Intermittent epigastric pain that improves when lying flat. B. constant gnawing mid-abdomen pain that is worse while lying supine C. Right upper quadrant pain accompanied by severe nausea D. Retro peritoneal pain in the lower back and flanks

B

The nurse is teaching a client and family about home care following a transjugular intrahepatic portal-systemic shunt (TIPS) procedure. Which client finding would the nurse teach the family to report to the primary health care provider immediately? A. Decreased ascitic fluid B. Changes in consciousness or behavior C. Fatigue and weakness D. Decreased pulse rate

B

The nurse is teaching a preoperative client who is scheduled for a laparoscopic cholecystectomy ("lap chole"). What statement by the client indicates a need for further teaching? A. "I will likely need oral pain medications for the first few days after my surgery." B. "I should only be hospitalized for 2 to 3 days after my surgery." C. "I will probably not be at risk for complications from this surgery." D. "I should be able to go back to work in the next week or so."

B

What is the priority nursing intervention in the management of a client with decompensated cirrhosis? A. Limiting protein intake B. Managing nausea and vomiting C. Monitoring fluid intake and output D. Elevating the head of bed>30 degrees

B

When caring for a patient diagnosed with pancreatic cancer, the nurse understands that the course of treatment will be guided by which of the following? A. Physician preference B. Biopsy results C. The degree of metastasis D. Analgesia for pain control

B

Which fluid and electrolyte balance assessment action will the nurse perform most often for a client with pancreatic cancer after surgery with a traditional Whipple procedure? A. Using a reflex hammer to check deep tendon reflexes B. Pinching up skin over the sternum and checking for tenting C. Applying a blood pressure cuff and assessing for a Trousseau sign D. Asking the client whether he or she has noticed tingling or numbness around the mouth

B

Which nursing assessment has the highest priority for the nurse to perform on a client admitted in severe pain with acute pancreatitis? A. Asking the client to rate the level of pain B. Measuring heart rate, blood pressure, and oxygen saturation C. Auscultating bowel sounds in all four abdominal quadrants D. Determining the amount of alcoholic beverages the client consumes daily

B

Which statement by a client with cirrhosis indicates that further instruction is needed about the disease? A. "The scars on my liver create problems with blood circulation." B. "My liver is scarred, but the cells can regenerate themselves and repair the damage." C. "Because of the scars on my liver, blood clotting and blood pressure are affected." D. "Cirrhosis is a chronic disease that has scarred my liver."

B

A nurse assesses a client who is recovering from an open traditional Whipple surgical procedure. Which assessment finding(s) alert(s) the nurse to a complication from this surgery? (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

BCDE

A nurse assesses a client who is recovering from an open traditional Whipple surgical procedure. Which assessment finding(s) alert(s) the nurse to a complication from this surgery? (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

BCDE

A nurse assesses a client who has cirrhosis of the liver. Which laboratory findings would the nurse expect in clients with 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)

BEF

After teaching a client who is prescribed pancreatic enzyme replacement therapy, the nurse assesses the client's understanding. Which statement by the client indicates a need for further 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 nurse is caring for a patient awaiting a gallbladder ultrasound. When asked why the patient must be NPO for the study, what is the nurse's best response? A. To prevent vomiting associated with gallbladder disease B. To decrease risk of aspiration during the procedure C. Stomach contents can interfere with imaging D. Your doctor must order a diet

C

The nurse is completing an initial assessment. Which of the following objective cues does NOT cause suspicion for liver disease? A. A flapping tremor of the hands B. White linier striation of the fingernails C. Left upper quadrant pain D. Scratches on the extremities

C

The nurse is teaching a client with gallbladder disease about diet modification. Which meal would the nurse suggest to the client? A. Sausage and scrambled eggs B. Steak and french fries C. Turkey sandwich on wheat bread D. Fried chicken and mashed potatoes

C

What is the nurse's best response to a client who fears he may have been exposed to hepatitis A while attending a banquet last week after which three restaurant workers were diagnosed with hepatitis A? a. Which types of foods did you eat at the banquet? b. If you have no symptoms at this time, you are probably safe c. You can receive an immunoglobulin injection to prevent the infection d. Contact your primary health care provider about receiving hepatitis A vaccine

C

What is the nurses best action when a client who just had a liver transplant develops oozing around two IV sites as well as some new bruising? a. Apply pressure to the IV sites b. Checking the clients platelet levels c. Notifying the surgeon immediately d. Documenting the findings as the only action

C

What liver problem does the nurse suspect in a client whose liver is hard with a nodular texture and the hepatic enzymes remain normal? a. Prenecrotic inflammation b. Postnecrotic inflammation c. Compensated cirrhosis d. Decompensated cirrhosis

C

What teaching does the home health nurse give the family of a client with hepatitis C to prevent the spread of the infection? A. The client must not consume alcohol. B. Avoid sharing the bathroom with the client. C. Members of the household must not share toothbrushes. D. Drink only bottled water and avoid ice.

C

What instruction will the nurse provide to a client to prepare him or her to undergo ultrasonography of the right upper abdominal quadrant to diagnose gallstones? A. Do not eat or drink for at least 6 hours before the test. B. Shower with an antibacterial soap the morning before the test. C. Be sure to have someone come with you who can drive you home. D. A small instrument will be rolled over your upper abdomen and there will be no pain.

D