Liver/Hep & DKA/HHS Evolve N3 Practice Questions
For which clinical indicators should the nurse monitor when caring for a client with cholelithiasis and obstructive jaundice? Select all that apply. 1-Dark urine 2-Yellow skin 3-Pain on urination 4-Clay-colored stool 5-Coffee-ground vomitus
1-Dark urine 2-Yellow skin 4-Clay-colored stool
A nurse is assessing a client with diabetic ketoacidosis. Which clinical manifestations should the nurse expect? Select all that apply. 1-Dry skin 2-Abdominal pain 3-Kussmaul respirations 4-Absence of ketones in the urine 5-Blood glucose level of less than 72 mg/dL (3.3 mmol/L)
1-Dry skin 2-Abdominal pain 3-Kussmaul respirations
The nurse caring for a client with diabetic ketoacidosis (DKA) can expect to implement which intervention? 1-Intravenous administration of regular insulin 2-Administer insulin glargine subcutaneously at hour of sleep 3-Maintain nothing prescribed orally (NPO) status 4-Intravenous administration of 10% dextrose
1-Intravenous administration of regular insulin
A client is admitted to the hospital with a history of cancer of the liver and jaundice. In relation to the jaundice, the nurse expects the client to report the presence of what symptom? 1-Pruritus 2-Diarrhea 3-Blurred vision 4-Bleeding gums
1-Pruritus
The serum potassium level of a client who has diabetic ketoacidosis is 5.4 mEq/L (5.4 mmol/L). What would the nurse expect to see on the ECG tracing monitor? 1-Abnormal P waves and depressed T waves 2-Peaked T waves and widened QRS complexes 3-Abnormal Q waves and prolonged ST segments 4-Peaked P waves and an increased number of T waves
2-Peaked T waves and widened QRS complexes
A nurse reviews the medical record of a client with ascites. Which client condition may be contributing to the development of ascites? 1-Portal hypotension 2-Kidney malfunction 3-Diminished plasma protein level 4-Decreased production of potassium
3-Diminished plasma protein level
During a client's paracentesis, 1500 mL of fluid is removed. The nurse monitors the client for which sign of a potentially severe response? 1-Abdominal girth decrease 2-Mucous membranes becoming drier 3-Heart rate increases from 80 to 135 4-Blood pressure rises from 130/70 to 190/80
3-Heart rate increases from 80 to 135
A nurse is assessing a client and suspects diabetic ketoacidosis (DKA). What clinical findings support this conclusion? 1-Nervousness and tachycardia 2-Erythema toxicum rash and pruritus 3-Diaphoresis and altered mental state 4-Deep respirations and fruity odor to the breath
4-Deep respirations and fruity odor to the breath
A client with type 1 diabetes who has been adhering to a prescribed insulin regimen is admitted to the hospital in ketoacidosis. Which factor may have precipitated the ketoacidosis? 1-Increased exercise 2-Decreased food intake 3-Working the night shift 4-Upper respiratory infection
4-Upper respiratory infection Infection is a stress that increases adrenocortical secretion of glucocorticoids, which will increase the blood glucose level
A nurse is reviewing discharge plans with a client who is hospitalized with hepatitis A. The nurse concludes that the client understands preventive measures to reduce the risk of spreading the disease when the client makes what statement? 1-"I should wash my hands frequently." 2-"I should launder my clothes separately." 3-"I should put used tissues in the garbage." 4-"I should wear a mask when leaving the house.
1-"I should wash my hands frequently."
A nurse is caring for a client who is admitted to the hospital with ascites and a diagnosis of cirrhosis of the liver. What does the nurse conclude is the probable cause of ascites? 1-Impaired portal venous return 2-Inadequate secretion of bile salts 3-Excess production of serum albumin 4-Decreased interstitial osmotic pressure
1-Impaired portal venous return
A client with ascites has a paracentesis, and 1500 mL of fluid is removed. For which immediate response is it most important for the nurse to monitor? 1-Rapid, thready pulse 2-Decreased peristalsis 3-Respiratory congestion 4-Increase in temperature
1-Rapid, thready pulse
A client with esophageal varices is admitted with hematemesis, and two units of packed red blood cells are prescribed. The client complains of flank pain halfway through the first unit of blood. What should be the nurse's first action? 1-Stop the transfusion. 2-Obtain the vital signs. 3-Assess the pain further. 4-Monitor the hourly urinary output
1-Stop the transfusion.
The nurse administers 2 units of salt-poor albumin to a client with portal hypertension and ascites. What does the nurse explain to the client regarding the purpose of the albumin? 1-It provides nutrients. 2-It increases protein stores. 3-Albumin elevates the circulating blood volume. 4-Albumin temporarily diverts blood flow away from the liver
3-Albumin elevates the circulating blood volume.
Which insulin should the nurse prepare for the emergency treatment of ketoacidosis? 1-Glargine 2-NPH insulin 3-Insulin aspart 4-Insulin detemir
3-Insulin aspart Insulin aspart is a rapid-acting insulin (within 10 to 20 minutes) and is used to meet a client's immediate insulin needs
A nurse is caring for a client who is positive for hepatitis A. Which precautions should the nurse take? 1-Wear a gown when entering the client's room. 2-Use caution when bringing in the client's food. 3-Use gloves when removing the client's bedpan. 4-Wear a protective mask when entering the client's room
3-Use gloves when removing the client's bedpan.
Which client will have the lowest risk for developing hepatoxicity?
The patient taking Daclizumab. Daclizumab is effective for reducing transplant rejection and does not cause hepatoxicity in clients after long-term administration.
A school nurse is teaching a health class of 12-year-olds about hepatitis C. Which statement by a student indicates an understanding of the origin of the disease? 1-"You can catch it while you're getting a tattoo." 2-"You're more likely to get it in crowded living conditions." 3-"The disease is passed from person to person by casual contact." 4-"People working at restaurants can give it to you if they don't wash their hands."
1-"You can catch it while you're getting a tattoo."
A client is about to have a blood transfusion and asks the nurse which type of hepatitis is most frequently transmitted through food. Which type of hepatitis should the nurse teach the client about being most associated with food? 1-A 2-B 3-C 4-D
1-A
A nurse is caring for a client with cirrhosis of the liver. Which laboratory test should the nurse monitor that, when abnormal, might identify a client who may benefit from neomycin enemas? 1-Ammonia level 2-Culture and sensitivity 3-White blood cell count 4-Alanine aminotransferase (ALT) level
1-Ammonia level
A nurse is taking care of a client with cirrhosis of the liver. Which clinical manifestations should the nurse assess in the client? Select all that apply. 1-Ascites 2-Hunger 3-Pruritus 4-Jaundice 5-Headach
1-Ascites 3-Pruritus 4-Jaundice
A client is diagnosed with acute gastritis secondary to alcoholism and cirrhosis. The client reports frequent nausea, pain that increases after meals, and black, tarry stools. The client recently joined Alcoholics Anonymous. The nurse should give priority to which client history item? 1-Black, tarry stools 2-Frequent nausea 3-Joining Alcoholics Anonymous 4-Pain that increases after meals
1-Black, tarry stools
The nurse is providing teaching to a client who recently has been diagnosed with type 1 diabetes. The nurse reinforces the importance of monitoring for ketoacidosis. What are the signs and symptoms of ketoacidosis? Select all that apply. 1-Confusion 2-Hyperactivity 3-Excessive thirst 4-Fruity-scented breath 5-Decreased urinary output
1-Confusion 3-Excessive thirst 4-Fruity-scented breath
A client with a long history of alcohol abuse develops cirrhosis of the liver. The client exhibits the presence of ascites. What does the nurse conclude is the most likely cause of this client's ascites? 1-Impaired portal venous return 2-Impaired thoracic lymph channels 3-Excess production of serum albumin 4-Enhanced hepatic deactivation of aldosterone secretion
1-Impaired portal venous return
A client with Laënnec cirrhosis has a Sengstaken-Blakemore tube in place. The client becomes increasingly confused and tries to climb out of bed. The client's breath becomes fetid. What is the nursing priority? 1-Implement fall precautions/prevention measures 2-Administer the prescribed sedative 3-Notify the primary healthcare provider immediately 4-Provide oxygen via a nasal cannula
1-Implement fall precautions/prevention measures
When preparing a client for a liver biopsy, the nurse explains that during the test the client will be placed in what position? 1-In the supine position, with the right arm raised behind the head 2-On the right side, with the left arm stretched up and over the head 3-On the left side, with the right arm extended out in front across the bed 4-In the prone position, with both elbows flexed and the hands resting on the pillow
1-In the supine position, with the right arm raised behind the head
A client with a 20-year history of excessive alcohol use has developed jaundice and ascites and is admitted to the hospital. What is the priority nursing action during the first 48 hours after the client's admission? 1-Monitor vital signs 2-Increase fluid intake 3-Obtain a foam mattress 4-Improve nutritional status
1-Monitor vital signs
A client with bleeding esophageal varices is to be treated via infusion of medication through an intravenous line. Which medication should the nurse anticipate will be prescribed? 1-Vasopressin 2-Neostigmine 3-Lansoprazole 4-Phytonadione
1-Vasopressin
Which blood gas result should the nurse expect an adolescent with diabetic ketoacidosis to exhibit? 1-pH 7.30, CO2 40 mm Hg, HCO3- 20 mEq/L (20 mmol/L) 2-pH 7.35, CO2 47 mm Hg, HCO3- 24 mEq/L (24 mmol/L) 3-pH 7.46, CO2 30 mm Hg, HCO3- 24 mEq/L (24 mmol/L) 4-pH 7.50, CO2 50 mm Hg, HCO3- 22 mEq/L (22 mmol/L)
1-pH 7.30, CO2 40 mm Hg, HCO3- 20 mEq/L (20 mmol/L)
The nurse is caring for a client with a diagnosis of diabetic ketoacidosis. Which arterial blood gas results are associated with this diagnosis? 1-pH: 7.28; PCO2: 28; HCO3: 18 2-pH: 7.30; PCO2: 54; HCO3: 28 3-pH: 7.50; PCO2: 49; HCO3: 32 4-pH: 7.52; PCO2: 26; HCO3: 20
1-pH: 7.28; PCO2: 28; HCO3: 18 A low pH and bicarbonate reflect metabolic acidosis;
A nurse educator of a college health course is discussing tattoos with the class. Which type of hepatitis associated with tattoos should the nurse include in the teaching plan? 1-A 2-C 3-D 4-E
2-C Hepatitis C is a blood-borne pathogen that can be transmitted via contaminated tattoo needles. Hepatitis A is not a blood-borne pathogen; it is spread through contaminated food or water. Although hepatitis D is a blood-borne pathogen, it can be produced only when the hepatitis B virus is present.
A nurse administers lactulose to a client with cirrhosis of the liver. Which laboratory test change leads the nurse to determine that the lactulose is effective? 1-Decreased amylase 2-Decreased ammonia 3-Increased potassium 4-Increased hemoglobin
2-Decreased ammonia Lactulose destroys intestinal flora that break down protein and in the process give off ammonia.
A school-aged child with type 1 diabetes is admitted to the pediatric unit in ketoacidosis. What sign of ketoacidosis does the nurse expect to identify when assessing the child? 1-Sweating 2-Hyperpnea 3-Bradycardia 4-Hypertension
2-Hyperpnea Deep, rapid breathing (hyperpnea) is an attempt by the respiratory system to eliminate excess carbon dioxide; it is a compensatory mechanism associated with metabolic acidosis.
A client has a paracentesis during which 1500 mL of fluid is removed. The nurse should monitor the client carefully for what reaction? 1-Hypertensive crisis 2-Hypovolemic shock 3-Abdominal distention 4-Tenting of the integument
2-Hypovolemic shock
A client with jaundice associated with hepatitis expresses concern over the change in skin color. What does the nurse explain is the cause of this color change? 1-Stimulation of the liver to produce an excess quantity of bile pigments 2-Inability of the liver to remove normal amounts of bilirubin from the blood 3-Increased destruction of red blood cells during the acute phase of the disease 4-Decreased prothrombin levels, leading to multiple sites of intradermal bleeding
2-Inability of the liver to remove normal amounts of bilirubin from the blood
A client with a history of alcoholism and cirrhosis is admitted with severe dyspnea as a result of ascites. Which process that most likely caused the ascites should the nurse consider when planning care? 1-Increased secretion of bile salts 2-Increased pressure in the portal vein 3-Increased interstitial osmotic pressure 4-Increased production of serum albumin
2-Increased pressure in the portal vein
A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis. Which clinical findings related to this event should the nurse document in the client's clinical record? Select all that apply. 1-Diaphoresis 2-Retinopathy 3-Acetone breath 4-Increased arterial bicarbonate level 5-Decreased arterial carbon dioxide level
3-Acetone breath 5-Decreased arterial carbon dioxide level A fruity odor to the breath (acetone breath) occurs when the ketone level is elevated in ketoacidosis. Metabolic acidosis initiates respiratory compensation in the form of Kussmaul respirations to counteract the effects of ketone buildup, resulting in a decreased arterial carbon dioxide level.
Immediately after a liver biopsy, a client is placed onto the right side. What rationale does the nurse give for this positioning? 1-Decrease pain to provide comfort 2-Support erythropoiesis to increase red blood cell production 3-Compress blood vessels to prevent bleeding 4-Expel fluid trapped in the biliary ducts to promote drainage
3-Compress blood vessels to prevent bleeding
A healthcare provider schedules a paracentesis for a client with ascites. What should the nurse include in the client's teaching plan? 1-Maintaining a supine position during the procedure 2-Consuming a diet low in fat for three days before the procedure 3-Emptying the bladder immediately before the procedure 4-Staying on a liquid diet for 24 hours after the procedure
3-Emptying the bladder immediately before the procedure
The primary health care provider prescribes contact precautions for a client with hepatitis A. What nursing interventions are required for contact precautions? 1-Private room with the door closed 2-Gown, mask, and gloves for all persons entering the room 3-Gown and gloves when handling articles contaminated by urine or feces 4-Gowns and gloves only when handling the client's soiled linen, dishes, or utensils
3-Gown and gloves when handling articles contaminated by urine or feces
Immediately after a liver biopsy the nurse places the client onto the right side. Which reason explains the use of the right side-lying position? 1-Provides the greatest comfort 2-Restores circulating blood volume 3-Helps stop bleeding if any should occur 4-Reduces the fluid trapped in the biliary ducts
3-Helps stop bleeding if any should occur
A client's blood gases reflect diabetic ketoacidosis. Which clinical indicator should the nurse identify when monitoring this client's laboratory values? 1-Increased pH 2-Decreased PO2 3-Increased PCO2 4-Decreased HCO3
4-Decreased HCO3 The bicarbonate-carbonic acid buffer system helps maintain the pH of body fluids; in metabolic acidosis, there is a decrease in bicarbonate because of an increase of metabolic acids.
A nurse is performing the physical assessment of a client admitted to the hospital with a diagnosis of cirrhosis. The nurse expects to observe what skin conditions? Select all that apply. 1-Vitiligo 2-Hirsutism 3-Melanosis 4-Ecchymoses 5-Telangiectasis
4-Ecchymoses 5-Telangiectasis
During the evening after a paracentesis, the nurse identifies that the client, although denying any discomfort, is very anxious. Which action is best for the nurse to take? 1-Offer the client a back rub 2-Administer the prescribed opioid 3-Reinforce the primary healthcare provider's explanation of the procedure 4-Explore the client's concerns while administering the prescribed anxiolytic
4-Explore the client's concerns while administering the prescribed anxiolytic
A client with ascites is scheduled for a paracentesis. To prepare the client for the abdominal paracentesis, what should the nurse do? 1-Shave the client's abdomen. 2-Medicate the client for pain. 3-Encourage the client to drink fluids. 4-Instruct the client to empty the bladder.
4-Instruct the client to empty the bladder.
Neomycin is prescribed for a client with cirrhosis. What should the nurse explain is the reason for taking this medication? 1-Prevents an infection 2-Limits abdominal distention 3-Minimizes intestinal edema 4-Reduces the blood ammonia level
4-Reduces the blood ammonia level
A nurse is developing a discharge plan for a client hospitalized with severe cirrhosis of the liver. What should be included in this plan? 1-The need for a high-protein diet 2-The use of a sedative for relaxation 3-The need to increase fluids 4-The importance of reporting personality changes to the primary healthcare provider
4-The importance of reporting personality changes to the primary healthcare provider
The healthcare provider orders an insulin infusion for a patient admitted to the emergency department in ketoacidosis. The rate of infusion in units per hour is is calculated as: Glucose mg/dL ÷ 100. The pharmacy dispensed 100 units regular insulin in 100 mL normal saline and the client's glucose level is 350 mg/dL. At how many milliliters per hour should the nurse set the IV infusion device to administer the correct amount of medication? Record your answer using one decimal place. _____ mL/hr
The client's glucose = 350 mg/dL. 350 ÷ 100 = 3.5 units/hour. The pharmacy dispensed 100 units regular insulin in 100 mL normal saline. 100/100 = 1:1 ratio. Therefore, 3.5 units/hour = 3.5 mL/hr.
A 5-year-old child is brought into the clinic with lethargy, abdominal ascites, and peripheral and periorbital edema. The history indicates ongoing diarrhea and decreased urine output. The child is found to have nephrotic syndrome and started on corticosteroid therapy. What does the nurse inform the parents that they can expect the child to exhibit after a week or two of medication therapy? 1-Diuresis 2-Formed stools 3-No signs of infection 4-Enhanced physical growth
1-Diuresis
A nurse is caring for a client who just had a liver biopsy. After the procedure, the nurse should monitor for which common complication associated with the biopsy? 1-Hemorrhage 2-Gastroparesis 3-Pulmonary embolism 4-Tension pneumothorax
1-Hemorrhage
Which type of hepatitis virus spreads through contaminated food and water? 1-Hepatitis A virus 2-Hepatitis B virus 3-Hepatitis C virus 4-Hepatitis D virus
1-Hepatitis A virus
A client with ascites has a paracentesis, and 1500 mL of fluid is removed. The nurse recognizes that it is important to monitor the client for what signs of complications that may occur immediately after the procedure? Select all that apply. 1-Rapid, thready pulse 2-Decreased peristalsis 3-Respiratory congestion 4-Increase in temperature 5-Decreased blood pressure
1-Rapid, thready pulse 5-Decreased blood pressure
In addition to hepatitis B, pneumococcal, H. influenza type B, and varicella vaccines, what should the nurse expect a 20-month-old child who has been receiving immunizations on schedule to have had? 1-Two DTaPs, two IPVs, and one MMR 2-Four DTaPs, three IPVs, and one MMR 3-Three DTaPs, two IPVs, and two MMRs 4-Three DTaPs, three IPVs, and three MMRs
2-Four DTaPs, three IPVs, and one MMR
A client has a paracentesis, and the healthcare provider removes 1500 mL of fluid. To monitor for a serious postprocedure complication, what should the nurse assess for? 1-Dry mouth 2-Tachycardia 3-Hypertensive crisis 4-Increased abdominal distention
2-Tachycardia
A client has a tentative diagnosis of primary biliary cirrhosis. What skin change does the nurse expect to observe when performing a physical assessment? 1-Vitiligo 2-Hirsutism 3Melanomas 4-Telangiectasia
4-Telangiectasia
A nurse is caring for a client with cholelithiasis. Which clinical manifestation does the nurse expect if the client develops obstructive jaundice? 1-Yellow sclera 2-Pain on urination 3-Dark brown stools 4-Coffee-ground emesis
1-Yellow sclera
The nurse is caring for a client with type 1 diabetes who is developing ketoacidosis. Which arterial blood gas report is indicative of diabetic ketoacidosis? 1-PCO2: 49, HCO3: 32, pH: 7.50 2-PCO2: 26, HCO3: 20, pH: 7.52 3-PCO2: 54, HCO3: 28, pH: 7.30 4-PCO2: 28, HCO3: 18, pH: 7.28
4-PCO2: 28, HCO3: 18, pH: 7.28
A client is admitted to the hospital with ascites. The client reports drinking a quart (liter) of vodka mixed in orange juice every day for the past three months. To assess the potential for withdrawal symptoms, which question would be appropriate for the nurse to ask the client? 1-"When was your last drink of vodka?" 2-"What prompts your drinking episodes?" 3-"Do you also eat when you drink?" 4-"Why do you mix the vodka with orange juice?
1-"When was your last drink of vodka?"
A nurse is caring for a client with cholelithiasis and obstructive jaundice. When assessing this client, the nurse should be alert for which findings that are consistent with these conditions? Select all that apply. 1-Ecchymosis 2-Yellow sclera 3-Dark brown stool 4-Straw-colored urine 5-Pain in right upper quadrant
1-Ecchymosis 2-Yellow sclera 5-Pain in right upper quadrant
An adolescent with type 1 diabetes is brought to the emergency department in ketoacidosis. The adolescent admits to not adhering to the diabetic regimen. What can the nurse do to help the adolescent become more accepting of the diabetic regimen? 1-Determine what the adolescent has been taught about diabetes. 2-Encourage the adolescent to express feelings about having diabetes. 3-Explain to the parents that it is their responsibility to demonstrate their acceptance. 4-Provide the family with printed materials about the consequences of ineffectively controlled diabetes
2-Encourage the adolescent to express feelings about having diabetes.
A client is admitted to the hospital with slight jaundice and reports of pain on the left side and back. A diagnosis of acute pancreatitis is made. Which common response to acute pancreatitis should the nurse monitor in the client? 1-Crackles 2-Hypovolemia 3-Gastric reflux 4-Jugular vein distention
2-Hypovolemia
A client with a history of hypertension develops pedal edema and hepatomegaly. Which condition does the nurse determine the client is experiencing? 1-Left ventricular failure 2-Right ventricular failure 3-Restrictive pulmonary disease 4-Obstructive pulmonary disease
2-Right ventricular failure
A nurse is teaching a client about prophylactic measures that minimize the risk of contracting hepatitis B. Which actions should be included in this teaching plan? Select all that apply. 1-Preventing constipation 2-Screening of blood donors 3-Avoiding shellfish in the diet 4-Limiting hepatotoxic drug therapy 5-Maintaining a monogamous sexual relationship
2-Screening of blood donors 5-Maintaining a monogamous sexual relationship
A client is admitted to the hospital with ascites. The client reports drinking a quart (liter) of vodka mixed in orange juice every day for the past three months. To assess the potential for withdrawal symptoms, which question would be appropriate for the nurse to ask the client? 1-"When was your last drink of vodka?" 2-"What prompts your drinking episodes?" 3-"Do you also eat when you drink?" 4-"Why do you mix the vodka with orange juice?"
1-"When was your last drink of vodka?"
A child is born to a mother whose hepatitis B status is negative. While assessing the newborn, the nurse finds that the birth weight is 1.8 kg. Which action by the nurse is appropriate in this situation? 1-Administer HepB vaccine to the newborn 1 month after birth. 2-Administer monovalent HepB vaccine to the newborn during discharge. 3-Administer 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth. 4-Administer HepB vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth
1-Administer HepB vaccine to the newborn 1 month after birth. The immune response to the HepB vaccine is not optimum in newborns who weigh less than 2 kg. Because the mother's hepatitis B status is negative, the first dose of HepB vaccine should be administered 1 month after birth
A healthcare provider schedules a paracentesis. What should the nurse instruct the client to do to prepare for the procedure? 1-Empty the bladder before the procedure. 2-Take a laxative the evening before the procedure. 3-Ingest nothing by mouth for eight hours before the procedure. 4-Self-administer a low soapsuds enema two hours before the procedure
1-Empty the bladder before the procedure.
A client is admitted to the hospital with a diagnosis of liver disease, and a liver biopsy is prescribed. After the liver biopsy, how often and for how long should the nurse take the client's vital signs? 1-Every 15 minutes for two hours 2-Every 30 minutes for four hours 3-Every hour for 8 hours 4-Every 2 hours for 12 hours
1-Every 15 minutes for two hours
A client is admitted to the hospital with diabetic ketoacidosis. The nurse concludes that the client's elevated ketone level is caused by incomplete oxidation of which nutrient? 1-Fats 2-Protein 3-Potassium 4-Carbohydrates
1-Fats Incomplete oxidation of fat results in fatty acids that further break down to ketones
A client is diagnosed as having the hepatitis B virus (HBV). The nurse reviews the client's health history for possible situations in which exposure may have occurred. Which event does the nurse determine is most likely the source of this infection? 1-Had a small tattoo on the arm three months ago 2-Assisted in the emergency birth of a baby two weeks ago 3-Worked for a month in an undeveloped area in Mexico four months ago 4-Attended an ecologic conference in a large urban center two months ago
1-Had a small tattoo on the arm three months ago
The nursing instructor determines that the student nurse understands the type(s) of hepatitis that most commonly are spread by consuming contaminated food and water or by fecal contamination if the student identifies which of these diseases? Select all that apply. 1-Hepatitis A 2-Hepatitis B 3-Hepatitis C 4-Hepatitis D 5-Hepatitis E
1-Hepatitis A 5-Hepatitis E
A client with jaundice reports fatigue, abdominal pain, loss of appetite, dark urine, nausea, and vomiting. Which pathogen is most likely responsible for the client's condition? 1-Hepatitis C virus 2-Candida albicans 3-Varicella zoster virus 4-Cryptosporidium muris
1-Hepatitis C virus
A 15-year-old adolescent who has type 1 diabetes mellitus is admitted to the pediatric intensive care unit in ketoacidosis with a blood glucose level of 170 mg/dL (9.4 mmol/L). The adolescent has a history of fluctuating blood glucose readings and difficulty adhering to the therapeutic regimen. A continuous insulin infusion is started. What adverse reaction to the infusion is most important for the nurse to monitor? 1-Hypokalemia 2-Hypovolemia 3-Hypernatremia 4-Hypercalcemia
1-Hypokalemia
A client with diabetic ketoacidosis who is receiving intravenous fluids and insulin complains of tingling and numbness of the fingers and toes and shortness of breath. The cardiac monitor shows the appearance of a U wave. What complication does the nurse suspect? 1-Hypokalemia 2-Hypoglycemia 3-Hypernatremia 4-Hypercalcemia
1-Hypokalemia These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose
A client with diabetic ketoacidosis who is receiving intravenous fluids and insulin reports tingling and numbness of the fingers and toes, and shortness of breath. The nurse identifies a U wave on the cardiac monitor. What should the nurse conclude is causing these clinical findings? 1-Hypokalemia 2-Hyponatremia 3-Hyperglycemia 4-Hypercalcemia
1-Hypokalemia These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose
The nurse is assessing the client admitted with diabetic ketoacidosis. Which statement made by the client indicates a need for further education on sick day management? 1-I will stop taking my insulin when I am ill because I am not eating. 2-I will check my urine for ketones when my blood sugar is over 250. 3-I will alternate drinking Gatorade and water throughout the day while ill. 4-I will continue all my insulin including my glargine when I am sick.
1-I will stop taking my insulin when I am ill because I am not eating.
A nurse is caring for a client with type 1 diabetes who developed ketoacidosis. Which laboratory value supports the presence of diabetic ketoacidosis? 1-Increased serum lipids 2-Decreased hematocrit level 3-Increased serum calcium levels 4-Decreased blood urea nitrogen level
1-Increased serum lipids With diabetic ketoacidosis, serum lipid levels are high because of the increased breakdown of fat. Serum lipid levels can go so high that the serum appears opalescent and creamy. With diabetic ketoacidosis the hematocrit level generally is increased because of dehydration.
An adolescent with a history of type 1 diabetes is admitted in ketoacidosis. What does the nurse suspect as a precipitating cause of this episode of ketoacidosis? 1-Infection 2-Increased exercise 3-Recent weight loss 4-Overdose of insulin
1-Infection The stress of an infection increases the body's metabolism; the presence of glucocorticoids results in hyperglycemia.
A client with a long history of alcohol abuse is admitted to the hospital with ascites and jaundice. A diagnosis of hepatic cirrhosis is made. Which is a nursing priority? 1-Institute fall prevention/safety measures. 2-Monitor respiratory status. 3-Measure abdominal girth daily. 4-Test stool specimens for blood
1-Institute fall prevention/safety measures.
A client with ascites is scheduled to have a paracentesis. What should the nurse include in the plan of care? 1-Instruct the client to urinate before the procedure. 2-Shave hair around the insertion site and 2 to 3 inches (5 to 7.5 cm) beyond the site. 3-Position the client on the side with the hips and knees flexed during the procedure. 4-Measure the abdominal girth two fingerbreadths below the umbilicus immediately before the procedure
1-Instruct the client to urinate before the procedure.
A client with ascites has been scheduled for a paracentesis. What intervention should the nurse implement immediately before the procedure? 1-Instruct the client to void 2-Position the client onto the side 3-Measure the client's abdominal girth 4-Have the client drink a glass of water
1-Instruct the client to void
A client with cirrhosis of the liver and ascites is scheduled to have a paracentesis. What should the nurse do to prepare the client for the procedure? 1-Instruct the client to void. 2-Tell the client not to eat for four hours. 3-Give the client an analgesic. 4-Have the client turn to the lateral position
1-Instruct the client to void.
A client is admitted to the hospital with a diagnosis of diabetic ketoacidosis. What is the initial intervention the nurse should expect the primary healthcare provider to prescribe for this client? 1-Intravenous (IV) fluids 2-Potassium 3-NPH insulin (Novolin N) 4-Sodium polystyrene sulfonate (Kayexalate
1-Intravenous (IV) fluids IV fluids are given to combat dehydration in ketoacidosis and to keep an IV line open for administration of medications
A client is admitted to the hospital with jaundiced skin and acute abdominal pain. What is the nurse's most therapeutic response when the client refuses all visitors? 1-Listen to the client's fears 2-Encourage the client to socialize 3-Grant the client's request about visitors 4-Darken the client's room by pulling the drapes
1-Listen to the client's fears
A client is admitted to the hospital with a diagnosis of cirrhosis of the liver. For which assessment signs of hepatic encephalopathy should the nurse assess this client? Select all that apply. 1-Mental confusion 2-Increased cholesterol 3-Brown-colored stools 4-Flapping hand tremors 5-Musty, sweet breath odor
1-Mental confusion 4-Flapping hand tremors 5-Musty, sweet breath odor
A client with a 20-year history of excessive alcohol use is admitted to the hospital with jaundice and ascites. What is the priority nursing action during the first 48 hours after the client's admission? 1-Monitor the client's vital signs. 2-Increase the client's fluid intake. 3-Improve the client's nutritional status. 4-Determine the client's reasons for drinking
1-Monitor the client's vital signs.
Which is an independent nursing action that should be included in the plan of care for a client after an episode of ketoacidosis? 1-Monitoring for signs of hypoglycemia resulting from treatment 2-Withholding glucose in any form until the situation is corrected 3-Giving fruit juices, broth, and milk as soon as the client is able to take fluids orally 4-Regulating insulin dosage according to the amount of ketones found in the client's urine
1-Monitoring for signs of hypoglycemia resulting from treatment During treatment for acidosis, hypoglycemia may develop; careful observation for this complication should be made by the nurse. Withholding all glucose may cause insulin coma. Whole milk and fruit juices are high in carbohydrates, which are contraindicated immediately following ketoacidosis.
A client is admitted to the ambulatory surgery unit for a liver biopsy. The nurse recalls that which assessment finding will be a cause for the biopsy to be postponed? 1-Signs of bruising 2-Visible hyperactivity 3-Lethargy on the morning of the test 4-Foods high in phytonadione consumed on the day before the test
1-Signs of bruising
The registered nurse determines that the new graduate understands the type(s) of hepatitis that generally develop into a chronic hepatitis infection if the graduate identifies which disease(s)? Select all that apply. 1-Hepatitis A 2-Hepatitis B 3-Hepatitis C 4-Hepatitis D 5-Hepatitis E
2-Hepatitis B 3-Hepatitis C 4-Hepatitis D Hepatitis B and C generally develop into chronic hepatitis. Hepatitis D is an incomplete virus that can become chronic and is dependent on the presence of hepatitis B to survive. Hepatitis A and E are acute, self-limiting infections that resolve over time and do not develop into chronic hepatitis.
A nurse is caring for a client with hepatic encephalopathy and ascites. Which elements are important to include in this client's diet? Select all that apply. 1-High fat 2-Low sodium 3-High vitamins 4-Moderate protein 5-Low carbohydrates
2-Low sodium 3-High vitamins 4-Moderate protein
The nurse is providing care to a client with ascites secondary to liver failure. What is appropriate to include in this client's care? Select all that apply. 1-High protein diet 2-Low sodium diet 3-Daily abdominal girth measurements 4-Encourage increased by mouth fluid intake 5-Daily weights
2-Low sodium diet 3-Daily abdominal girth measurements 5-Daily weights
A client with a history of cirrhosis of the liver develops heart failure. When ventricular bigeminy develops, the provider orders lidocaine. What alterations in lidocaine dosages does the nurse anticipate? 1-Higher to compensate for the impaired liver function 2-Lower because the drug is metabolized at a diminished rate 3-Reduced because other organs will compensate for the sluggish liver 4-Equal to that needed for other clients to provide a loading dose for the myocardium
2-Lower because the drug is metabolized at a diminished rate
The nurse is caring for a client scheduled to have a percutaneous liver biopsy. Which assessment findings warrant the postponement of the procedure? Select all that apply. 1-Hemosiderosis 2-Marked ascites 3-Hepatic cirrhosis 4-Hemoglobin of less than 9 g/dL (90 mmol/L) 5-Platelet count of 150,000/mm3(150 × 109/L)
2-Marked ascites 4-Hemoglobin of less than 9 g/dL (90 mmol/L)
A client with hepatic cirrhosis begins to develop slurred speech, confusion, drowsiness, and a flapping tremor. Which diet can the nurse expect will be prescribed for this client based upon the assessment? 1-No protein 2-Moderate protein 3-High protein 4-Strict protein restriction
2-Moderate protein
A nurse is caring for a postoperative client with diabetes. Which is the most common cause of diabetic ketoacidosis that the nurse needs to consider when caring for this client? 1-Emotional stress 2-Presence of infection 3-Increased insulin dose 4-Inadequate food intake
2-Presence of infection
A client with ascites is scheduled to receive albumin. To have the greatest therapeutic effect, the nurse expects what infusion rate and what oral fluid intake? 1-Slow intravenous (IV) rate and liberal fluid intake 2-Slow IV rate and restricted fluid intake 3-Rapid IV rate and withheld fluid intake 4-Rapid IV rate and moderate fluid intake
2-Slow IV rate and restricted fluid intake
A client with cirrhosis of the liver and ascites has been taking chlorothiazide, a thiazide diuretic. Why did the provider add spironolactone to the client's medication regimen? 1-To stimulate sodium excretion 2-To help prevent potassium loss 3-To increase urine specific gravity 4-To reduce arterial blood pressure
2-To help prevent potassium loss
Which nursing intervention is the priority when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? 1-Providing oxygen 2-Encouraging carbohydrates 3-Administering fluid replacement 4-Teaching facts about dietary principles
3-Administering fluid replacement As a result of osmotic pressures created by an increased serum glucose level, the cells become dehydrated; the client must receive fluid and then insulin.
Which immunization protocol should be followed by a nurse administering a hepatitis B vaccine to an infant whose mother is diagnosed HBsAg-positive during pregnancy? 1-Hepatitis B immune globulin is given within a week after obtaining the mother's laboratory reports. 2-Hepatitis B immune globulin is not administered because the first dose of recombivax HB itself is sufficient. 3-Hepatitis B immune globulin 0.5 mL is given along with the first dose of recombivax HB. 4-Hepatitis B immune globulin is not administered, however the second dose of the hepatitis B vaccine is given after 1 month
3-Hepatitis B immune globulin 0.5 mL is given along with the first dose of recombivax HB.
When preparing a client for a liver biopsy, what should the nurse instruct the client to do? 1-Turn onto the left side after the procedure 2-Breathe normally throughout the procedure 3-Hold the breath at the moment of the actual biopsy 4-Bear down during the insertion of the biopsy needle
3-Hold the breath at the moment of the actual biopsy Holding the breath at the moment of the actual biopsy ensures that the liver does not move as it normally does with regular respiratory excursions; minimizing movement reduces potential injury to the live
A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone. What should the nurse monitor the client for? 1-Bruising 2-Tachycardia 3-Hyperkalemia 4-Hypoglycemia
3-Hyperkalemia Spironolactone is a potassium-sparing diuretic that is used to treat clients with ascites; therefore the nurse should monitor the client for signs and symptoms of hyperkalemia
A nurse is caring for a client with type 1 diabetes who developed ketoacidosis. Which laboratory value supports the presence of diabetic ketoacidosis? 1-Decreased serum glucose levels 2-Decreased serum calcium levels 3-Increased blood urea nitrogen levels 4-Increased serum bicarbonate levels
3-Increased blood urea nitrogen levels
A client suspected of carcinoma of the liver is scheduled for a liver biopsy. For which procedural contraindication should the nurse assess the client? 1-Confusion and disorientation 2-Presence of any infectious disease process 3-International normalized ratio (INR) greater than 4.5 4-Inclusion of foods high in vitamins E and phytonadione in the client's diet
3-International normalized ratio (INR) greater than 4.5
The nurse is assessing a client experiencing diabetic ketoacidosis (DKA). Which unique response associated with DKA that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) should the nurse identify when assessing this client? 1-Fluid loss 2-Glycosuria 3-Kussmaul respirations 4-Increased blood glucose level
3-Kussmaul respirations
A nurse adds 20 mEq of potassium chloride to the intravenous solution of a client with diabetic ketoacidosis. What is the primary purpose for administering this drug? 1-Treat hyperpnea 2-Prevent flaccid paralysis 3-Replace excessive losses 4-Treat cardiac dysrhythmias
3-Replace excessive losses
A nurse instructs a client with viral hepatitis about the type of diet that should be ingested. Which lunch selected by the client indicates understanding about dietary principles associated with this diagnosis? 1-Turkey salad, french fries, sherbet 2-Cottage cheese, mixed fruit salad, milkshake 3-Salad, sliced chicken sandwich, gelatin dessert 4-Cheeseburger, tortilla chips, chocolate pudding
3-Salad, sliced chicken sandwich, gelatin dessert
A client with a history of excessive alcohol use develops hepatic portal hypertension and an elevated serum aldosterone level. For which complications should the nurse assess this client? 1-Chloride depletion and hypovolemia 2-Potassium retention and dysrhythmias 3-Sodium retention and fluid accumulation 4-Calcium depletion and pathologic fractures
3-Sodium retention and fluid accumulation
When discussing a scheduled liver biopsy with a client, the nurse explains that for several hours after the biopsy the client will have to remain in what position? 1-The left side-lying position with the head of the bed elevated 2-A high-Fowler position with both arms supported on several pillows 3-The right side-lying position with pillows placed under the costal margin 4-Any comfortable recumbent position as long as the client remains immobile
3-The right side-lying position with pillows placed under the costal margin
A client with esophageal varices has severe hematemesis, and a Sengstaken-Blakemore tube is inserted. What design and purpose does the tube have? 1-Single-lumen; for gastric lavage 2-Double-lumen; for intestinal decompression 3-Triple-lumen; for esophageal compression 4-Multilumen; for gastric and intestinal decompression
3-Triple-lumen; for esophageal compression
A nurse prepares to administer intravenous (IV) albumin to a client with ascites. What effect does the nurse anticipate? 1-Ascites and blood ammonia levels will decrease. 2-Decreased capillary perfusion and blood pressure. 3-Venous stasis and blood urea nitrogen level will increase. 4-As extravascular fluid decreases, the hematocrit will decrease
4-As extravascular fluid decreases, the hematocrit will decrease
A client has a liver biopsy. Which nursing intervention is appropriate for monitoring or preventing a post-liver biopsy complication? 1-Place the client in a left side-lying position. 2-Keep the client supine on bed rest for six hours. 3-Take the client's pulse and blood pressure every shift. 4-Assess the client for pain in the right upper quadrant
4-Assess the client for pain in the right upper quadrant
A nurse is reviewing the diagnostic blood tests of a client with a diagnosis of type 1 diabetes. Which laboratory results support the nurse's suspicion that the client is experiencing ketoacidosis? 1-Blood glucose of 40 mg/100 mL (2.2 mmol/L), blood pH of 7.37 2-Blood glucose of 130 mg/100 mL (7.2 mmol/L), blood pH of 7.35 3-Blood glucose of 650 mg/100 mL (36.1 mmol/L), blood pH of 7.42 4-Blood glucose of 300 mg/100 mL (16.7 mmol/L), blood pH of 7.20
4-Blood glucose of 300 mg/100 mL (16.7 mmol/L), blood pH of 7.20
The nurse is assessing a client with severe cirrhosis and discovers fetor hepaticus. What did the nurse assess? 1-Urine 2-Stool 3-Hands 4-Breath
4-Breath The client's breath has a sweet odor (fetor hepaticus) because the liver is not metabolizing the food, especially proteins
A client was diagnosed with cancer of the head of the pancreas two months ago. The client is admitted to the hospital with weight loss, severe epigastric pain, and jaundice. When performing the client's assessment, the nurse expects the client's stool to be what color? 1-Green 2-Brown 3-Red-tinged 4-Clay-colored
4-Clay-colored
A client is diagnosed with hepatitis A. The nurse provides the client with information about untoward signs and symptoms related to hepatitis. The nurse instructs the client to contact the primary healthcare provider if the client develops what symptom? 1-Fatigue 2-Anorexia 3-Yellow urine 4-Clay-colored stools
4-Clay-colored stools Clay-colored stools are indicative of hepatic obstruction because bile is prevented from entering the intestines
A client is admitted to the hospital with a diagnosis of cancer of the liver with ascites and is scheduled for a paracentesis. Which nursing intervention is appropriate to include in the client's plan of care? 1-Cleansing the intestinal tract 2-Marking the anesthetic insertion site 3-Discussing the operating room set-up 4-Having the client void before the procedure
4-Having the client void before the procedure
For which clinical indicator associated with a complication of portal hypertension should the nurse assess the client? 1-Liver abscess 2-Intestinal obstruction 3-Perforation of the duodenum 4-Hemorrhage from esophageal varices
4-Hemorrhage from esophageal varices
A client reports pain four hours after a liver biopsy. The nurse identifies that there is leakage of a large amount of bile on the dressing over the biopsy site. What should the nurse do first? 1-Tell the client to remain flat on the back. 2-Medicate the client for pain as prescribed. 3-Monitor the client's vital signs every 10 minutes. 4-Notify the primary healthcare provider immediately.
4-Notify the primary healthcare provider immediately.
The serum ammonia level of a client with hepatic cirrhosis and ascites is elevated. What nursing intervention is the priority? 1-Weigh the client daily. 2-Restrict the client's oral fluid intake. 3-Measure the client's urine specific gravity. 4-Observe the client for increasing confusion
4-Observe the client for increasing confusion
A nurse is performing a health history and physical assessment of a client with cholelithiasis and obstructive jaundice. Which clinical finding should the nurse expect this client to exhibit? 1-Hematuria 2-Bloody stools 3-Straw-colored urine 4-Pain in the right upper quadrant
4-Pain in the right upper quadrant
A client is a candidate for intubation as a result of bleeding esophageal varices. Which type of tube should the nurse anticipate will most likely be used to meet the needs of this client? 1-Levin 2-Salem sump 3-Miller-Abbott 4-Sengstaken-Blakemore
4-Sengstaken-Blakemore
A nurse administers the prescribed regular insulin to a client in diabetic ketoacidosis. In addition, an intravenous (IV) solution with potassium is prescribed even though the serum potassium level is within normal limits. What does the nurse recognize as the reason for potassium administration? 1-Potassium loss occurs rapidly from diaphoresis present during coma. 2-Potassium is carried with glucose to the kidneys to be excreted in the urine in increased amounts. 3-Potassium is quickly used up during the rapid series of catabolic reactions stimulated by insulin and glucose. 4-Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment
4-Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment. Insulin stimulates cellular uptake of glucose and stimulates the sodium/potassium pump, leading to the influx of potassium into cells.
A client who was exposed to hepatitis A asks why an injection of gamma globulin is needed. Before responding, what should the nurse consider about how gamma globulin provides passive immunity? 1-It increases production of short-lived antibodies. 2-It accelerates antigen-antibody union at the hepatic sites. 3-The lymphatic system is stimulated to produce antibodies. 4-The antigen is neutralized by the antibodies that it supplies
4-The antigen is neutralized by the antibodies that it supplies
A client who has liver failure says, "I have complete trust in God and I am sure he will take care of my family even if I am not here." Which concept does this most exemplify? 1-Faith 2-Religion 3-Connectedness 4-Transcendence
1-Faith
A paracentesis is prescribed for a client recently admitted to a medical unit. The nurse recalls that the procedure is performed for what reasons? Select all that apply. 1-Extract peritoneal fluid 2-Improve respiratory status 3-Decrease intrapleural fluid 4-Increase intraabdominal tension 5-Obtain peritoneal fluid for culture
1-Extract peritoneal fluid 2-Improve respiratory status 5-Obtain peritoneal fluid for culture
A client with biliary cirrhosis receives serum albumin therapy. What is the most effective method for the nurse to evaluate the client's response to therapy? 1-Weight daily 2-Vital signs frequently 3-Urine output every half hour 4-Urine albumin level every shif
1-Weight daily The increased osmotic effect of therapy increases the intravascular volume and urinary output; weight loss reflects fluid loss.
A client receiving the medication buspirone is admitted to the hospital with the diagnosis of possible hepatitis. The nurse identifies that the client's sclerae look yellow. What will be the nurse's initial action? 1-Withhold the medication. 2-Give the buspirone with milk. 3-Reduce the dosage of the medication. 4-Ensure that the medication can be given parenterally.
1-Withhold the medication. The medication should be stopped immediately, because jaundice indicates possible liver damage, which prolongs elimination of the drug and may result in toxic accumulation
A client is diagnosed with hepatitis A. The nurse takes the client's history. Which employment history is most likely linked to the development of hepatitis A? 1-Works at a plumbing business 2-Works in a hemodialysis unit at a hospital 3-Works as a dishwasher at a local restaurant 4-Works at an occupational arsenic compound business
1-Works at a plumbing business Hepatitis A primarily is spread via a fecal-oral route; sewage-polluted water may harbor the virus.
A client is diagnosed with esophageal varices and is admitted to the hospital. The healthcare provider prescribes a blood transfusion. Place the following nursing actions in the correct order. 1.Check the client's vital signs. 2.Verify the blood product with another nurse against the client's identification (ID) bracelet. 3.Establish intravenous access with IV normal saline. 4.Monitor the client's vital signs and status according to agency policy
1.Check the client's vital signs. 3.Establish intravenous access with IV normal saline. 2.Verify the blood product with another nurse against the client's identification (ID) bracelet. 4.Monitor the client's vital signs and status according to agency policy
A nurse is providing discharge instructions to a client diagnosed with cirrhosis and varices. Which information should the nurse include in the teaching session? Select all that apply. 1-Adhering to a low-carbohydrate diet 2-Avoiding aspirin and aspirin-containing products 3-Limiting alcohol consumption to two drinks weekly 4-Avoiding acetaminophen and products containing acetaminophen 5-Avoiding coughing, sneezing, and straining to have a bowel movement
2-Avoiding aspirin and aspirin-containing products 4-Avoiding acetaminophen and products containing acetaminophen 5-Avoiding coughing, sneezing, and straining to have a bowel movement
A male client with ascites is to have a paracentesis and has signed the consent. While the nurse is caring for him, he says that he has changed his mind and no longer wants the procedure. Which initial response by the nurse is best? 1-"Why did you sign the consent?" 2-"Can you tell me why you decided to refuse the procedure?" 3-"You are obviously afraid about something concerning the procedure." 4-"Although the procedure is very important, I understand why you changed your mind."
2-"Can you tell me why you decided to refuse the procedure?"
A client is admitted to the hospital with Laënnec cirrhosis and chronic pancreatitis. Bile salts (bile acid factor) are prescribed, and the client asks why they are needed. What is the nurse's best response? 1-"They stimulate prothrombin production." 2-"They aid absorption of fat-soluble vitamins." 3-"They promote bilirubin secretion in the urine." 4-"They help the common bile duct contract stronger."
2-"They aid absorption of fat-soluble vitamins."
The nurse is caring for a client with biliary cancer. The associated jaundice gets progressively worse. The nurse is most concerned about the potential complication of what symptom? 1-Pruritus 2-Bleeding 3-Flatulence 4-Hypokalemia
2-Bleeding
A client is admitted to the hospital for acute gastritis and ascites secondary to alcoholism and cirrhosis. For which condition is it most important for the nurse to assess this client? 1-Nausea 2-Blood in the stool 3-Food intolerances 4-Hourly urinary output
2-Blood in the stool
The nurse is taking care of a client with cirrhosis of the liver and ascites. Which lunch is the best choice for a client with this disorder? 1-Ham sandwich with cheese, whole milk, and potato chips 2-Penne pasta, spinach, banana, and decaffeinated iced tea 3-Baked lasagna with sausage, salad, and milkshake 4-Hamburger, french fries, and cola
2-Penne pasta, spinach, banana, and decaffeinated iced tea
A client is at high risk for developing ascites because of cirrhosis of the liver. How should the nurse assess for the presence of ascites? 1-Observe the client for signs of respiratory distress. 2-Percuss the client's abdomen and listen for dull sounds. 3-Palpate the lower extremities over the tibia and observe for edema. 4-Listen for decreased or absent bowel sounds while auscultating the abdomen
2-Percuss the client's abdomen and listen for dull sounds.
A nurse is caring for a client who is scheduled to have a paracentesis. Immediately before the procedure, the nurse asks the client to void. What is the rationale for asking the client to void? 1-A full bladder decreases the intraabdominal pressure. 2-A full bladder decreases the amount of fluid in the abdominal cavity. 3-A full bladder increases the danger of puncture during the procedure. 4-A full bladder increases the presence of urea in the intraabdominal fluid
3-A full bladder increases the danger of puncture during the procedure.
A client recovering from hepatitis A asks the nurse about returning to work. Which is the best response by the nurse? 1-"As soon as you're feeling less tired, you may go back to work." 2-"Unfortunately, few people fully recover from hepatitis in less than six months." 3-"Gradually increase your activities because relapses may occur in those who return to full activity too soon." 4-"You cannot return to work for six months because the virus will still be in your stools, and you still are communicable."
3-"Gradually increase your activities because relapses may occur in those who return to full activity too soon."
The nurse is providing discharge instructions to a client who is recovering from an acute case of viral hepatitis. Which statement by the client indicates a need for further education? 1-"I will avoid alcohol." 2-"I will eat small frequent meals." 3-"I will take acetaminophen for pain rather than aspirin." 4-"I will eat foods high in carbohydrates, moderate in fats, and moderate in proteins."
3-"I will take acetaminophen for pain rather than aspirin." Acetaminophen is damaging to the liver and is contraindicated in clients with hepatitis. Clients should avoid alcohol, eat small frequent meals, and eat foods high in carbohydrates and moderate in fats and protein.
A client with cirrhosis is scheduled for a liver biopsy. The client asks if there are any risks after the procedure. Which response by the nurse is the best? 1-"There are relatively no risks associated with this procedure." 2-"The major risk is infection at the biopsy site." 3-"The major risk is bleeding postprocedure." 4-"The major risk is liver failure postprocedure."
3-"The major risk is bleeding postprocedure."
The nurse is administering lactulose to a client with a history of cirrhosis of the liver. The client asks the nurse why this medication is needed because the client is not constipated. How will the nurse respond? 1-"This medication helps you to stop drinking so much alcohol." 2-"This medication helps you relax and not feel anxious." 3-"This medication helps you lower the high ammonia level caused by your liver disease." 4-"This medication helps you keep your abdomen from being so distended."
3-"This medication helps you lower the high ammonia level caused by your liver disease."
A client who experiences anorexia and fatigue develops jaundice. A diagnosis of hepatitis A is made. The client's spouse and adult children who still live at home ask whether they should receive gamma globulin. Which is the most appropriate response by the nurse? 1-"Gamma globulin is unnecessary as long as you follow droplet precautions." 2-"Gamma globulin provides passive immunity for hepatitis B, not hepatitis A." 3-"You should call your primary health care provider immediately about getting gamma globulin." 4-"Your family member's type of hepatitis is no longer communicable, and gamma globulin is not required."
3-"You should call your primary health care provider immediately about getting gamma globulin."
A nurse is administering serum albumin intravenously to a client with ascites. In response to this therapy, what does the nurse expect to decrease? 1-Confusion 2-Urinary output 3-Abdominal girth 4-Serum ammonia level
3-Abdominal girth
A client is admitted to the hospital with jaundice. After numerous diagnostic tests, the healthcare provider makes the diagnosis of cancer of the pancreas. What does the nurse conclude is the most likely cause of the client's jaundice? 1-Necrosis of the parenchyma caused by the neoplasm 2-Excessive serum bilirubin caused by red blood cell destruction 3-Obstruction of the common bile duct by the pancreatic neoplasm 4-Impaired liver function, resulting in incomplete bilirubin metabolism
3-Obstruction of the common bile duct by the pancreatic neoplasm
What will the nurse do to assess a client's response to ongoing serum albumin therapy for cirrhosis of the liver? 1-Monitor the client's vital signs. 2-Measure the client's urine output every half hour. 3-Obtain the client's weight at least once every day. 4-Determine the client's urine albumin level each shift
3-Obtain the client's weight at least once every day.
The nurse is providing postprocedure care for a client who had a liver biopsy. To prevent hemorrhage, it is the nurse's highest priority to place the client in what position? 1-Prone 2-High Fowler 3-On the right side 4-Trendelenburg
3-On the right side
A client with Laënnec cirrhosis has ascites and jaundice and is confused. What is the nursing priority when caring for this client? 1-Correcting nutritional deficiencies 2-Measuring abdominal girth every day 3-Providing for the client's physical safety 4-Placing the client in the high-Fowler position
3-Providing for the client's physical safety
A client is diagnosed with diabetic ketoacidosis. Which insulin should the nurse expect the health care provider to prescribe? 1-NPH insulin 2-Inhaled insulin 3-Regular insulin 4-Insulin glargine
3-Regular insulin Regular insulin is short-acting and is usually used for the treatment of diabetic ketoacidosis (DKA).
Which site is best used to inspect a client who is suspected to have jaundice? 1-Skin 2-Palm 3-Sclera 4-Conjunctiva
3-Sclera
The nurse identifies a small amount of bile-colored drainage on the dressing of a client who has had a liver biopsy. What does the nurse conclude? 1-Fluid is leaking into the intestine. 2-The pancreas has been lacerated. 3-This is a typical, expected response. 4-A biliary vessel has been penetrated
4-A biliary vessel has been penetrated
The hepatitis B-positive mother of an infant born earlier in the day wants her infant to receive the hepatitis B immune globulin (HBIG) vaccine. What is the proper dosage of this vaccine? 1-1.0 mL subcutaneously before discharge 2-0.5 mL subcutaneously within 24 hours of birth 3-1.0 mL intramuscularly within 24 hours of birth 4-0.5 mL intramuscularly within 12 hours of birth
4-0.5 mL intramuscularly within 12 hours of birth
A child is diagnosed with hepatitis A. The client's parent expresses concern that the other members of the family may get hepatitis because they all share the same bathroom. What is the nurse's best reply? 1-"I suggest that you buy a commode exclusively for your child's use." 2-"Your child may use the bathroom, but you need to use disposable toilet covers." 3-"You will need to clean the bathroom from top to bottom every time a family member uses it." 4-"All family members, including your child, need to wash their hands after using the bathroom."
4-"All family members, including your child, need to wash their hands after using the bathroom."
The parent of a newborn asks a nurse why, except for hepatitis B vaccine, the immunization schedule does not start until the infant is 2 months old. How should the nurse respond? 1-"A newborn's spleen can't produce efficient antibodies." 2-"Infants younger than 2 months are rarely exposed to infectious disease." 3-"The immunization will attack the infant's immature immune system and cause the disease." 4-"Maternal antibodies interfere with the development of active antibodies by the infant when immunized."
4-"Maternal antibodies interfere with the development of active antibodies by the infant when immunized."
A client with hepatitis B asks the nurse, "Are there any medications to help me get rid of this problem?" Which is the best response by the nurse? 1-"Sedatives can be given to help you relax." 2-"We can give you immune serum globulin." 3-"Vitamin supplements are frequently helpful and hasten recovery." 4-"There are medications to help reduce viral load and liver inflammation.
4-"There are medications to help reduce viral load and liver inflammation.
A client with hepatitis B (HBV) develops cirrhosis and is hospitalized. One potential sequela of chronic liver disease is fluid and electrolyte imbalance. The nurse determines that this may be attributed to a decrease in serum albumin level. Which of these conditions results from this imbalance? 1-Hemorrhage with subsequent anemia 2-Diminished resistance to bacterial insult 3-Malnutrition of cells, especially hepatic cells 4-Reduction of colloidal osmotic pressure in the blood
4-Reduction of colloidal osmotic pressure in the blood
A client with cirrhosis of the liver has a prolonged prothrombin time and a low platelet count. A regular diet is prescribed. What should the nurse instruct the client to do considering the client's condition? 1-Avoid foods high in phytonadione. 2-Check the pulse several times a day. 3-Drink a glass of milk when taking aspirin. 4-Report signs of bleeding no matter how slight.
4-Report signs of bleeding no matter how slight.