N321 Exam 2 Practice Questions

The most specific laboratory result in the patient with acute pancreatitis is an elevation in which laboratory value? A. Serum bilirubin B. Serum lipase C. Serum trypsin D. Serum lactase

B. Serum lipase

Which white blood cell (WBC) count indicates that perforation may have occurred from appendicitis? A. 2,000/mm3 B. 10,000/mm3 C. 18,000/mm3 D. 20,000/mm3

D. 20,000/mm3

Which of the following characteristics are most commonly associated with cholelithiasis? (Select all that apply.) A. Age over 40 B. Family History of gallbladder disease C. History of excessive alcohol use D. Multiparous female E. Obesity F. Use of estrogen or oral contraceptives

A. Age over 40 B. Family History of gallbladder disease D. Multiparous female E. Obesity F. Use of estrogen or oral contraceptives

A nurse is developing a teaching plan for a client who has an ileostomy and will require stoma care. Which of the following information should the nurse include? A. Empty the pouch when it is 1/2 full. B. Hold pressure on the skin barrier for 10 to 15 sec to secure the seal. C. Clean the peristomal skin four times a day. D. Expect firm fecal content.

A. Empty the pouch when it is 1/2 full.

Which type of hepatitis can be prevented by vaccine? A. Hepatitis B B. Hepatitis C C. Hepatitis E D. Hepatitis G

A. Hepatitis B

A nurse is assessing a client who reports frequent vomiting and diarrhea for the past 3 days. Which of the following findings should the nurse expect? (Select all that apply.) A. Poor skin turgor B. Bradycardia C. Hypotension D. Pale yellow urine E. Flat neck veins

A. Poor skin turgor C. Hypotension E. Flat neck veins

The nurse recognizes which findings as diagnostic for IBS? A. Rome IV and/or Manning Criteria B. CT scan of the abdomen shows inflammatory process C. Blood urea nitrogen and creatinine are elevated D. Patient has abdominal pain and a psychiatric diagnosis

A. Rome IV and/or Manning Criteria

In hopes of promoting a prompt recovery, which of the following aspects will be included in care planning for the client post-surgery for a ruptured appendix? (Select all that apply.) A. Use of incentive spirometer B. Early ambulation as tolerated C. Discontinuation of antibiotic therapy upon client becoming afebrile D. Assistance with turning, coughing, and deep breathing techniques (TCDB) E. Limiting oral fluids

A. Use of incentive spirometer B. Early ambulation as tolerated D. Assistance with turning, coughing, and deep breathing techniques (TCDB)

Which causes are associated with chronic pancreatitis? (Select all that apply.) A. Hyperlipidemia B. Cystic fibrosis C. Spicy food indigestion D. Hereditary disorders of the pancreas E. Hypercalcemia

A. Hyperlipidemia B. Cystic fibrosis D. Hereditary disorders of the pancreas E. Hypercalcemia

The nurse recognizes which as risk factors for cholecystitis? (Select all that apply.) A. Obesity B. Male C. Female D. African American descent E. European descent

A. Obesity C. Female E. European descent

A patient is diagnosed with severe peptic ulcers in the gastrointestinal tract. Which surgical procedure is the patient most likely to have? A. Vagotomy B. Gastrojejunostomy C. Hepaticojejunostomy D. Distal pancreatectomy

A. Vagotomy Rationale: A vagotomy involves surgical resection of the vagus nerve so that stimulation of gastric acid production in the stomach is decreased and the risk of peptic ulcer formation can be reduced.

Which statement by a patient diagnosed with liver trauma indicates understanding of the prescribed plan of care? A. "I will need a liver transplant." B. "I will need a blood transfusion." C. "I am at increased risk for infection." D. "I will never be able to drink alcohol again."

B. "I will need a blood transfusion."

Which point regarding hepatitis B infection indicates a need for further instruction? A. "It has an incubation period of about 45 to 60 days." B. "Its route of transmission is the fecal-oral." C. "It can be prevented by vaccination." D. "It results in chronic infection."

B. "Its route of transmission is the fecal-oral." Rationale: The hepatitis B virus is transmitted via the percutaneous or mucosal blood, body fluids, needles, or sharp instruments. Hepatitis A and E have a fecal-oral route of transmission.

A nurse is providing dietary teaching for a client who is postoperative following a gastrectomy. Which of the following foods should the nurse encourage the client to include in their diet to reduce the risk for dumping syndrome? A. Ice cream B. Eggs C. Grape juice D. Honey

B. Eggs

A nurse is reviewing the laboratory data of a client who has an acute exacerbation of Crohn's disease. Which of the following blood laboratory results should the nurse expect to be evaluated? (Select all that apply.) A. Hematocrit B. Erythrocyte sedimentation rate C. WBC D. Folic acid E. Albumin

B. Erythrocyte sedimentation rate C. WBC

A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following manifestations of peritonitis? A. Hyperactive bowel sounds B. Nausea and vomiting C. Bradycardia D. Increased urinary output

B. Nausea and vomiting

The serum ammonia level of the client with cirrhosis is elevated. What should the nurse do? A. Monitor for temperature elevation. B. Observe for increasing confusion. C. Measure the urine specific gravity. D. Restrict the intake of oral fluids.

B. Observe for increasing confusion. Rationale: Elevated serum ammonia levels may cause neurological changes, such as confusion.

The client with Crohn's disease has undergone a barium enema that showed strictures in the ileum. Based on this finding, the nurse should monitor the client closely for signs of which complication? A. Peritonitis B. Obstruction C. Malabsorption D. Fluid overload

B. Obstruction

The client has diarrhea that has been cultured positive for Clostridium difficile (C. diff). To prevent the spread of infection, the nurse should perform which intervention? A. Wear an isolation gown, gloves, and mask when providing care. B. Perform vigorous hand hygiene using only soap and water. C. Place the client in a private room with negative-pressure airflow. D. Instruct visitors to use the alcohol-based hand wash for self-protection.

B. Perform vigorous hand hygiene using only soap and water. Rationale: Hand washing with soap and water is performed instead of using alcohol-based hand cleaners; alcohol-based cleaners lack sporicidal activity. Even vigorous scrubbing with soap and water does not kill all of the spores. The nurse does not need to wear a mask when caring for the client, unless there is a risk of splatter when the patient is vomiting/having diarrhea.

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

B. Positive EIA test

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

B. Resume a diet of choice C. Cleanse the puncture site using mild soap and water E. Report nausea and vomiting to the surgeon

A nurse is assessing a client who has cirrhosis. Which of the following is an expected finding for this client? A. Moist skin B. Spider angiomas C. Tarry stools D. Blood in the urine

B. Spider angiomas

A nurse is assessing a client in an extended care facility. The nurse should recognize which of the following findings is a manifestation of an obstruction of the large intestine due to a fecal impaction? A. The client reports one bowel movement yesterday B. The client is having small, frequent liquid stools C. The client is flatulent D. The client indicates vomiting once this morning

B. The client is having small, frequent liquid stools

A nurse is preparing to perform Rovsing's sign to determine if the client has appendicitis. Which action is incorrect? A. The nurse performs hand hygiene prior to the assessment. B. The nurse places his or her hands on the right side of the abdomen. C. The nurse provides an explanation of his or her action prior to touching the client. D. The nurse asks the client if he or she has any questions prior to touching the client.

B. The nurse places his or her hands on the right side of the abdomen. Rationale: Rovsing's sign is indicated by referred pain to the RLQ when the LRQ is palpated by the nurse.

A nurse is teaching a client how to prepare for a colonoscopy. Which of the following instructions should the nurse include in the teaching? A. "Refrain from eating or drinking for 2 hr prior to the procedure." B. "Stop taking aspirin the day before the procedure." C. "Drink clear liquids for 24 hr prior to the procedure, and then take nothing by mouth for 6 hr before the procedure." D. "Drink the oral liquid preparation for bowel cleansing slowly the night before the procedure."

C. "Drink clear liquids for 24 hr prior to the procedure, and then take nothing by mouth for 6 hr before the procedure."

A patient is scheduled for surgery for a ruptured appendix and asks the nurse how large the incision will be. How should the nurse respond? A. "Most likely you will have an incision about an inch long." B. "The procedure is often done laparoscopically, so there will be several small incisions." C. "Since your appendix has ruptured a larger incision will be make to irrigate out your abdominal cavity." D. "Typically, they cut from the base of the sternum to the pubic bone."

C. "Since your appendix has ruptured a larger incision will be make to irrigate out your abdominal cavity."

The client recovering from acute pancreatitis who has been NPO asks, "When can I start eating again?" Which response by the nurse is most accurate? A. "As soon as you start to feel hungry you can begin eating." B. "When I hear that your bowel sounds are active and you are passing flatus." C. "When your pain is controlled and your serum lipase level has decreased." D. "You will be NPO for at least more 2 weeks; oral intake stimulates the pancreas."

C. "When your pain is controlled and your serum lipase level has decreased." Rationale: Once pain is controlled and the serum enzyme levels begin to decrease, the client can begin oral intake. These are signs that the pancreas is healing.

The nurse recognizes which patient is at greatest risk for type 1 autoimmune hepatitis? A. A 45-year-old postmenopausal female B. A 30-year-old female with a history of hyperthyroidism C. A 16-year-old female with type 1 diabetes mellitus D. A 12-year-old female with autism

C. A 16-year-old female with type 1 diabetes mellitus

A nurse is teaching a client who has a prescription of a nasogastric tube to treat a pyloric obstruction. Which of the following rationales for the use of the NG tube should the nurse include in the teaching? A. Determine the pH of the gastric secretions. B. Supply nutrients via tube feedings. C. Decompress the stomach. D. Administer medications.

C. Decompress the stomach.

A nurse in a clinic is reviewing the laboratory reports of a client who has suspected cholelithiasis. Which of the following is an expected finding? A. Blood amylase 80 units/L B. WBC 9,000/mm^3 C. Direct bilirubin 2.1 mg/dL D. Alkaline phosphatase 25 units/L

C. Direct bilirubin 2.1 mg/dL Rationale: Expect the client who has cholelithiasis to have an elevated direct bilirubin if the bile duct is obstructed.

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

C. Gray-blue discoloration of the skin around the umbilicus

A nurse is assessing a client who has upper gastrointestinal bleeding. Which of the following findings should the nurse expect? A. Bradycardia B. Bounding peripheral pulses C. Hypotension D. Increased hematocrit levels

C. Hypotension

A nurse is assessing a client who has peritonitis. Which of the following findings should the nurse expect? A. Hyperactive bowel sounds B. Increased urinary output C. Rigid abdomen D. Frequent bowel movements

C. Rigid abdomen

A nurse is providing discharge teaching for a client who has a new colostomy and is concerned about flatus and odor. Which of the following foods should the nurse recommend to the client? A. Eggs B. Fish C. Yogurt D. Broccoli

C. Yogurt

A nurse is caring for a client who has GERD and a new prescription for metoclopramide. The nurse should plan to monitor for which of the following adverse effects? A. Thrombocytopenia B. Hearing loss C. Hypersalivation D. Ataxia

D. Ataxia Rationale: The nurse should plan to monitor the client for extrapyramidal symptoms, such as ataxia.

Which of the following lab tests would the nurse expect to find in a patient with cirrhosis? A. Decreased alkaline phosphatase B. Elevated serum albumin C. Elevated serum cholesterol D. Elevated total bilirubin

D. Elevated total bilirubin

A nurse is planning care for a client who has hepatitis B. Which of the following interventions should the nurse include in the plan? A. Administer antibiotics. B. Provide a diet high in fat. C. Restrict fluids. D. Encourage short periods of ambulation.

D. Encourage short periods of ambulation.

A nurse is assessing a patient who has experienced cirrhosis and subsequent decreased immune status. Which is the nurse most likely to document in the patient's record? A. Risk for injury and bleeding B. Altered nutrition less than body requirements C. Fluid volume deficit D. Impaired skin integrity

D. Impaired skin integrity Rationale: Impaired skin integrity is related to edema, decreased immune status, and accumulation of bile salts.

The nurse should question the administration of which medication in the patient admitted with cholecystitis? A. Acetaminophen B. Demerol C. Ibuprofen D. Morphine

D. Morphine

A nurse is preparing to administer the hepatitis B vaccine to a client. Which of the following techniques should the nurse use to locate the deltoid muscle? A. Locate the center of the arm between the elbow and the shoulder. B. Find the center of the anterior aspect of the thigh. C. Locate the middle third of the anterior thigh between the greater trochanter of the femur and the lateral femoral condyle. D. Place one finger across the acromion process and measure 3 fingerbreadths below to the midpoint and center of the lateral aspect of the upper arm.

D. Place one finger across the acromion process and measure 3 fingerbreadths below to the midpoint and center of the lateral aspect of the upper arm.

Which assessment in the patient with appendicitis is most concerning? A. Development of a fever B. Elevated white blood cell (WBC) count C. Intense pain in the right lower quadrant D. Sudden pain resolution without medication or treatment

D. Sudden pain resolution without medication or treatment Rationale: Changes in pain, particularly if abrupt, may indicate perforation.

Your patient returns to the unit after a renal biopsy. Which of the following is your priority? A. Assess the patient's level of consciousness. B. Monitor the patient for signs and symptoms of a UTI. C. Offer the patient warm compresses to relieve any discomfort. D. Test the urine for presence of blood using the dipstick method.

D. Test the urine for presence of blood using the dipstick method.

Which of the following correctly describes what is occurring in this scenario? "Samuel has cirrhosis from cholangitis. He tells the nurse that the severe pruritus is very irritating." A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis G E. Laennec's cirrhosis F. Biliary cirrhosis G. Nonalcoholic steatohepatitis (NASH) H. Wilson's disease

F. Biliary cirrhosis Rationale: Cholangitis (inflammation of the common bile duct) can lead to biliary cirrhosis if not treated properly. Clients with biliary cirrhosis commonly develop severe itching, or pruritus, because of retention of bile salts.

Which of the following correctly describes what is occurring in this scenario? "Edna has a BMI of 40 and other comorbidities related to cardiac and respiratory dysfunction. The fat around her liver has led to her cirrhosis." A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis G E. Laennec's cirrhosis F. Biliary cirrhosis G. Nonalcoholic steatohepatitis (NASH) H. Wilson's disease

G. Nonalcoholic steatohepatitis (NASH) Rationale: NASH is a type of cirrhosis often seen in obese clients. This is caused by the accumulation of fat in the liver cells, which leads to inflammation of the liver cells and over time results in cirrhosis. Nonalcoholic steatohepatitis can be diagnosed by a liver biopsy.

Which clinical presentation is seen in both acute and chronic pancreatitis? A. Edema B. Hyponatremia C. Hypercalcemia D. Pain

D. Pain

Who is at the highest risk of having appendicitis? A. A 16-year-old male B. A 14-year-old female C. A 32-year-old male D. A 42-year-old female

A. A 16-year-old male Rationale: Appendicitis affects more males than females.

A nurse is planning care for a client who has cirrhosis of the liver. Which of the following actions should the nurse include in the plan? (Select all that apply.) A. Administer furosemide. B. Administer warfarin. C. Implement a low-sodium diet. D. Measure the client's abdominal girth. E. Encourage weight lifting during physical therapy.

A. Administer furosemide. C. Implement a low-sodium diet. D. Measure the client's abdominal girth.

Which actions are most appropriate when caring for a patient with liver cancer? (Select all that apply.) A. Administer nerve blocks locally and directly into the nerves of the abdomen. B. Include plenty of fluids and protein-rich foods in the diet. C. Administer antibiotics and antipyretics to the patient . D. Keep the lower extremities at a lower level. E. Administer nonsteroidal anti-inflammatory medications to the patient.

A. Administer nerve blocks locally and directly into the nerves of the abdomen. C. Administer antibiotics and antipyretics to the patient . E. Administer nonsteroidal anti-inflammatory medications to the patient.

Which abnormal laboratory value associated with liver failure is correct? (Select all that apply.) A. Albumin level is decreased. B. Total bilirubin level is elevated. C. Platelets are increased. D. Partial thromboplastin time is prolonged. E. Ammonia level is decreased.

A. Albumin level is decreased. B. Total bilirubin level is elevated. D. Partial thromboplastin time is prolonged.

Which medications are used to treat acute necrotizing pancreatitis? A. Antibiotics B. Spasmolytics C. Opioid narcotics D. Anticholinergics

A. Antibiotics

Which of the following clinical manifestations would be considered an early sign of hepatic encephalopathy? (Select all that apply.) A. Asterixis B. Irritability & lethargy C. Oliguria D. Unconsciousness

A. Asterixis B. Irritability & lethargy Rationale: Change in mental status is often the very first sign.

Which conditions contribute to the development of abdominal ascites? A. Blood flow through the portal system is obstructed causing portal hypertension. B. Decreased aldosterone causes increased sodium reabsorption by the renal tubules. C. Esophageal varices contribute to 80% of hemorrhages. D. Increased colloidal oncotic pressure is caused by decreased albumin production.

A. Blood flow through the portal system is obstructed causing portal hypertension.

Which nursing care for a patient with acute cholecystitis will prevent further stimulation of the gallbladder? A. Administration of anticholingeric medications B. Administration of antiemetic medications C. NPO with NG suction D. Open cholecystecomy

C. NPO with NG suction

Which clinical manifestation is most likely caused by the accumulation of ammonia and toxins in the blood? A. Ascites B. Portal hypertension and varices C. Hepatic encephalopathy syndrome D. Hepatorenal syndrome

C. Hepatic encephalopathy syndrome

A nurse is reviewing the laboratory values of a client who has colorectal cancer. Which of the following findings should the nurse expect? A. Negative fecal occult blood test B. Decreased serum carcinoembryonic antigen (CEA) level C. Hematocrit 43% D. Hemoglobin 9.1 g/dL

D. Hemoglobin 9.1 g/dL

Excessive amounts of which by-product, or toxin is most closely related to the cause of hepatic encephalopathy? A. Ammonia B. Bilirubin C. Hepatocytes D. Transaminase

A. Ammonia

A patient is hospitalized as the result of an injury in the abdominal area. The computed tomography scan reveals a penetrating trauma of the liver. For which complication should the nurse monitor after the patient's treatment? A. Pneumonia B. Tachycardia C. Abdominal pain D. Low blood pressure

A. Pneumonia Rationale: Pneumonia is a common complication after treatment for liver trauma.

What type of precautions should be implemented for a patient with C. Diff? A. Airborne precautions B. Contact Precautions C. Droplet Precautions D. Standard Precautions

B. Contact Precautions

A nurse is caring for a client who has ulcerative colitis and is teaching the client about the common link with Crohn's disease. Which of the following information should the nurse include? A. Both are inflammatory B. Both begin in the rectum C. Both manifest fistula formation D. Both require frequent surgery

A. Both are inflammatory

Which observation would indicate that the client's appendix had perforated? A. Changes in blood pressure and pulse B. Temperature 99.2°F C. 1+ pitting edema bilaterally lower legs D. Client experiences excessive thirst

A. Changes in blood pressure and pulse

A patient is diagnosed with gallstone-induced pancreatitis. The primary healthcare provider prescribes removal of the gallbladder. Which surgical method is most appropriate in this situation? A. Cholecystectomy B. Distal pancreatectomy C. Pancreaticoduodenectomy D. Endoscopic sphincterotomy

A. Cholecystectomy

Which finding is typically associated with non-alcoholic steatohepatitis cirrhosis? A. Clinical obesity B. Alcoholism C. Evidence of metabolic disease D. History of hepatitis

A. Clinical obesity

A nurse is discussing the precautionary measures that need to be taken to prevent further complications with a patient who has hepatitis. Which statement made by the patient indicates a need for further discussion? A. "I should continue taking acetaminophen as I have in the past." B. "I should take supplements of vitamin A, D, E, and K." C. "I should take small, frequent meals that are low in fat." D. "I should maintain a proper balance of rest and exercise."

A. "I should continue taking acetaminophen as I have in the past."

A nurse is providing discharge teaching for a client with peptic ulcer disease who has a new prescription for famotidine. Which of the following statements by the client indicates understanding of the teaching? A. "I should take this medication at bedtime." B. "I should expect this medication to discolor my stools." C. "I will drink iced tea with my meals and snacks." D. "I will monitor my blood glucose level regularly while taking this medication."

A. "I should take this medication at bedtime."

A nurse is providing discharge teaching for a client who has GERD. Which of the following statements by the client indicates an understanding of the teaching? A. "I will decrease the amount of carbonated beverages I drink." B. "I will avoid drinking liquids for 30 minutes after taking a chewable antacid tablet." C. "I will eat a snack before going to bed." D. "I will lie down for at least 30 minutes after eating each meal."

A. "I will decrease the amount of carbonated beverages I drink."

A nurse is planning care for a client who has cirrhosis and ascites. Which of the following interventions should the nurse include in the plan of care? A. Decrease the client's fluid intake. B. Increase the client's saturated fat intake. C. Increase the client's sodium intake. D. Decrease the client's carbohydrate intake.

A. Decrease the client's fluid intake. Rationale: The nurse should restrict fluids for a client who has cirrhosis and ascites due to the client's risk for increased fluid retention.

The nurse is assessing the laboratory findings of a patient with suspected liver failure. Which laboratory findings support the nurse's suspicion? (Select all that apply.) A. Decreased albumin B. Decreased ammonia C. Prolonged prothrombin time D. Decreased alkaline phosphatase E. Prolonged partial thromboplastin time

A. Decreased albumin C. Prolonged prothrombin time E. Prolonged partial thromboplastin time

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

A. Diuretic B. Beta-blocking agent D. Lactulose

The nurse is caring for a patient with an elevated white blood cell count, fever, and rebound tenderness. What action is a priority? A. Do not allow the patient to eat or drink anything. B. Administer an antipyretic. C. Deliver pain medication as needed. D. Begin IV fluids.

A. Do not allow the patient to eat or drink anything.

The nurse plans teaching for a patient with a new colostomy. The patient refuses to look at the nurse or the stoma, stating "I just can't see myself having this thing." What is the best nursing intervention utilizing therapeutic communication for this patient? A. Encourage the patient to share concerns or ask questions. B. Explain there is nothing he can do about it & he must learn to take care of it. C. Refer the patient to a chaplain to help cope with this situation. D. Tell the patient that learning about it will help prevent stool leakage

A. Encourage the patient to share concerns or ask questions.

A nurse is teaching a client who has constipation. Which of the following should the nurse discuss as causes of constipation? (Select all that apply.) A. Excessive laxative use B. Ignoring the urge to defecate C. Inadequate fluid intake D. Increased fiber in the diet E. Increased activity

A. Excessive laxative use B. Ignoring the urge to defecate C. Inadequate fluid intake

A nurse is assessing a client who has Crohn's disease. Which of the following findings should the nurse expect? A. Fatty diarrheal stools B. Hyperkalemia C. Weight gain D. Sharp epigastric pain

A. Fatty diarrheal stools

A nurse is assessing a client who has an obstruction of the common bile duct resulting from chronic cholecystitis. Which of the following findings should the nurse expect? A. Fatty stools B. Straw-colored urine C. Tenderness in the left upper abdomen D. Ecchymosis of the extremities

A. Fatty stools Rationale: Chronic cholecystitis occurs following several bouts of acute cholecystitis. The repeated episodes of inflammation result in a fibrotic and contracted gallbladder. Because of inflammation in the gallbladder, bile needed to absorb fat and fat-soluble vitamins is unable to enter the bowel, resulting in steatorrhea (fatty stools).

A nurse is interviewing a client who has acute pancreatitis. Which of the following factors should the nurse anticipate finding in the client's history? A. Gallstones B. Hypolipidemia C. COPD D. Diabetes mellitus

A. Gallstones

Which type of hepatitis is considered a chronic illness? A. Hepatitis C B. Hepatitis D C. Hepatitis E D. Hepatitis G

A. Hepatitis C

A nurse is assessing a client postoperative following a gastrectomy. The nurse should identify which of the following findings as an indication of abdominal distention? A. Hiccups B. Hypertension C. Bradycardia D. Chest pain

A. Hiccups Rationale: Following surgery, hiccups can be caused by irritation of the phrenic nerve due to abdominal distension. If the hiccups are intractable, the nurse should anticipate a prescription for chlorpromazine because persistent hiccups are distressful to the client and can lead to complications, such as vomiting.

The nurse is caring for a patient with cirrhosis. What signs would the nurse monitor for in worsening of the disease? (Select all that apply.) A. Jaundice B. Increased appetite C. Laryngitis D. Pedal edema E. Petechiae

A. Jaundice D. Pedal edema E. Petechiae

A nurse is assessing a client who has acute hepatitis B. Which of the following findings should the nurse expect? A. Joint pain B. Obstipation C. Abdominal distention D. Periumbilical discoloration

A. Joint pain

A nurse is teaching a client who has constipation about a high-fiber diet. Which of the following foods should be included as sources of fiber? (Select all that apply.) A. Kidney beans B. Blackberries C. Refined cereals D. Whole wheat bread E. Lean turkey

A. Kidney beans B. Blackberries D. Whole wheat bread

A nurse is caring for a client who has diverticular disease. When palpating the client's abdomen, in which of the following locations should the nurse expect the client to report abdominal pain? A. Lower left quadrant B. Upper left quadrant C. Lower right quadrant D. Upper right quadrant

A. Lower left quadrant

Which of the following is the most important nursing intervention to provide when caring for a patient with bleeding esophageal varices? A. Maintain the patient's airway & prevent aspiration of blood. B. Monitor the patient's cardiac status. C. Perform testing on all stools to check for occult blood. D. Prepare the patient for immediate surgery.

A. Maintain the patient's airway & prevent aspiration of blood.

A nurse is developing a plan of care for a client who has cirrhosis and ascites. Which of the following interventions should the nurse include in the plan? A. Measure the client's abdominal girth daily B. Check mental status once daily C. Provide a daily intake of 4 g of sodium for the client D. Assess the client's breath sounds every 12 hr

A. Measure the client's abdominal girth daily

A patient is diagnosed with gallstones in the bile duct and is scheduled for endoscopic retrograde cholangiopancreatography (ERCP). Which nursing action is most effective for this patient? (Select all that apply.) A. Observing the patient for a systemic inflammatory response after the procedure B. Observing the patient for changes in vital signs after the procedure C. Instructing the patient to drink large amounts of water before the procedure D. Instructing the patient to avoid food in the morning before the procedure E. Instructing the patient to take his or her blood pressure medications in the morning before the procedure

A. Observing the patient for a systemic inflammatory response after the procedure B. Observing the patient for changes in vital signs after the procedure E. Instructing the patient to take his or her blood pressure medications in the morning before the procedure

A nurse is assessing a client who has appendicitis. Which of the following findings should the nurse expect? (Select all that apply.) A. Oral temperature 38.4° C (101.1° F) B. WBC count 6,000/mm3 C. Bloody diarrhea D. Nausea and vomiting E. Right lower quadrant pain

A. Oral temperature 38.4° C (101.1° F) D. Nausea and vomiting E. Right lower quadrant pain

A nurse is reviewing the medication list for a client who has a new diagnosis of a small bowel obstruction. The nurse should withhold which of the following medications? A. Senna B. Ibuprofen C. Omeprazole D. Zolpidem

A. Senna

Which clinical manifestation is found in stage I hepatic encephalopathy? (Select all that apply.) A. Slurred speech B. No response to painful stimulus C. Reversal of day and night sleep patterns D. Impaired writing E. Mood swing

A. Slurred speech C. Reversal of day and night sleep patterns D. Impaired writing

A nurse is caring for a client who has ulcerative colitis. The client has had several exacerbation over the past 3 years. Which of the following instructions should the nurse include in the plan of care to minimize the risk of further exacerbation? (Select all that apply.) A. Use progressive relaxation techniques B. Increase dietary fiber intake C. Drink two 240 mL (8 oz) glasses of milk per day D. Arrange activities to allow for daily rest periods E. Restrict intake of carbonated beverages

A. Use progressive relaxation techniques D. Arrange activities to allow for daily rest periods E. Restrict intake of carbonated beverages

A nurse is providing discharge teaching for a client who has acute pancreatitis and a prescription for fat-soluble vitamin supplements. The nurse should instruct the client to take a supplement for which of the following? A. Vitamin A B. Vitamin B1 C. Vitamin C D. Vitamin B12

A. Vitamin A I like to think of "A fat DEcK of cards" when remembering which vitamins are fat soluble. Vitamins A, D, E, and K are fat-soluble.

A patient is diagnosed with a large bowel obstruction. The nurse will monitor the patient for which of the following findings? A. abdominal distention B. metabolic alkalosis C. projectile vomiting D. referred back pain

A. abdominal distention

Which statement by a nursing student regarding liver cancer indicates a need for further instruction? A. "Hemochromatosis is a risk factor for liver cancer." B. "Secondary liver cancer originates from the liver." C. "Radiofrequency ablation is a mode of treatment for liver cancer." D. "Transcatheter arterial chemoembolization is a mode of treatment for liver cancer."

B. "Secondary liver cancer originates from the liver."

Which of the following laboratory findings is commonly used to diagnose acute pancreatitis? A. Decreased serum glucose B. Increased serum amylase C. Increased serum calcium D. Increased urinary amylase

B. Increased serum amylase

A nurse is providing discharge teaching for a client who has chronic hepatitis C. Which of the following statements by the client indicates understanding of the teaching? A. "I will avoid alcohol until I'm no longer contagious." B. "I will avoid medications that contain acetaminophen." C. "I will decrease my intake of calories." D. "I can donate blood once when I am in remission."

B. "I will avoid medications that contain acetaminophen."

A nurse is caring for a client who has colorectal cancer and is receiving chemotherapy. The client asks the nurse why blood is being drawn for a carcinoembryonic antigen (CEA) level. Which of the following responses should the nurse make? A. "The CEA determines the current stage of your colon cancer." B. "The CEA determines the efficacy of your chemotherapy." C. "The CEA determines if the neutrophil count is below the expected reference range." D. "The CEA determines if you are experiencing occult bleeding from the gastrointestinal tract."

B. "The CEA determines the efficacy of your chemotherapy."

The nurse is educating a high-risk community group about hepatitis. Which statement regarding nonviral forms of hepatitis indicates a need for further instruction? A. "They may result in jaundice." B. "They can be treated by pegylated interferon injections." C. "They may result in hepatomegaly." D. "They can be caused by ingestion, inhalation, or injection of toxins or drugs."

B. "They can be treated by pegylated interferon injections." Rationale: Pegylated interferon injections help with viral suppression and are used to treat viral forms of hepatitis.

A nurse is providing discharge teaching for a client who has chronic pancreatitis. Which of the following statements should the nurse make? A. "You should decrease your caloric intake when abdominal pain is present." B. "You should increase your daily intake of protein." C. "You should increase fat intake when experiencing loose stools." D. "You should limit alcohol intake to 2-3 drinks per week."

B. "You should increase your daily intake of protein."

What does a Ranson score of 3 to 4 indicate in a patient with pancreatitis? A. 2% mortality rate B. 15% mortality rate C. 40% mortality rate D. 100% mortality rate

B. 15% mortality rate

A nurse is assessing clients in a health clinic for risk factors for contracting hepatitis. Which of the following clients is at risk for developing hepatitis C? A. A client who eats raw shellfish B. A client who has multiple tattoos C. A client who works in a child care center D. A client who has recently traveled to a underdeveloped country

B. A client who has multiple tattoos Rationale: Hepatitis C is transmitted via blood-to-blood contact. The nurse should recognize that improperly maintained tattoo equipment may aid in transmission and could increase the client's risk for contracting hepatitis C.

A patient has developed cirrhosis secondary to a lifestyle of heavy drinking. Which of the following statements would be true regarding care of this patient? A. A daily exercise routine is important to increase the blood flow to the liver. B. Abstaining from alcohol is priority in order to improve the patient's condition. C. Cirrhosis can be reversed if the patient adheres to proper rest & nutrition. D. Use of acetaminophen is acceptable the treatment for minor aches and pains.

B. Abstaining from alcohol is priority in order to improve the patient's condition.

Which clinical manifestation detected in the patient with cirrhosis is directly associated with accumulation of ammonia? A. Pruritus B. Altered mental status C. Altered blood pressure and edema D. Petechiae and bleeding

B. Altered mental status

A nurse is preparing to administer a dose of lactulose to a client who has cirrhosis. The client states, "I don't need this medication. I am not constipated." The nurse should explain that in clients who have cirrhosis, lactulose is used to decrease levels of which of the following components in the bloodstream? A. Glucose B. Ammonia C. Potassium D. Bicarbonate

B. Ammonia Rationale: Lactulose, a disaccharide, is a sugar that works as an osmotic diuretic. It prevents absorption of ammonia in the colon. Accumulation of ammonia in the bloodstream, which occurs in pathologic conditions of the liver, such as cirrhosis, may affect the central nervous system, causing hepatic encephalopathy or coma.

A nurse is assessing a client who has peritonitis. Which of the following findings should the nurse expect? A. Bloody diarrhea B. Board-like abdomen C. Periumbilical cyanosis D. Increased bowel sounds

B. Board-like abdomen

The patient is concerned about his abdominal pain and symptoms, which mimic gallbladder disease. He asks the nurse what tests he may need to undergo. Which test is commonly performed to determine dilation of the gallbladder and identify cysts? A. Ultrasound B. Computed tomography (CT) scan C. Hepatobiliary iminodiacetic acid (HIDA) scan D. Endoscopic retrograde cholangiopancreatography (ERCP)

B. Computed tomography (CT) scan Rationale: An ultrasound is used to identify the presence of gallstones and distention in the bile duct. A HIDA scan is used to identify the presence of gallstones. An ERCP is used to visualize the biliary tree and identify the presence of stones.

Which test is most specific for renal function? A. Blood urea nitrogen (BUN) B. Creatinine clearance C. Renal scan D. Serum creatinine

B. Creatinine clearance Rationale: Creatinine clearance is indicative of glomerular filtration rate (GFR).

A nurse is planning care for a client who has a decreased level of consciousness. The client is receiving continuous enteral feedings via a gastrostomy tube due to an inability to swallow. Which of the following is the priority action by the nurse? A. Observe client's respiratory status. B. Elevate the head of the client's bed 30° to 45°. C. Monitor intake and output every 8 hr. D. Check residual volume every 4 to 6 hr.

B. Elevate the head of the client's bed 30° to 45°.

A nurse is providing teaching for a client who has cirrhosis and a new prescription for lactulose. The nurse should include which of the following instructions in the teaching? A. Notify the provider if bloating occurs. B. Expect to have two to three soft stools per day. C. Restrict carbohydrates in the diet. D. Limit oral fluid intake to 1,000 mL per day of clear liquids.

B. Expect to have two to three soft stools per day.

A nurse is providing discharge teaching for a client who has a new prescription for medications to treat peptic ulcer disease. The nurse should inform the client that which of the following medications inhibits gastric acid secretion? A. Calcium carbonate B. Famotidine C. Aluminum hydroxide D. Sucralfate

B. Famotidine

A nurse is reviewing the laboratory results of a client who has acute pancreatitis. Which of the following findings should the nurse expect? A. Blood glucose 110 mg/dL B. Increased amylase C. WBC count 9,000/mm3 D. Decreased bilirubin

B. Increased amylase

A nurse admits a client to the emergency department who reports nausea and vomiting that worsens when he lies down. Antacids do not help. The provider suspects acute pancreatitis. Which of the following laboratory test results should the nurse expect to see? A. Decreased WBC B. Increased serum amylase C. Decreased serum lipase D. Increased serum calcium

B. Increased serum amylase

The nurse is teaching a group of pre-school teachers about hepatitis A. Which is true? (Select all that apply.) A. It can cause chronic infection. B. It can last up to 8 weeks. C. It can be spread only by blood and body fluids. D. It can cause mild symptoms, or sometimes the patient may remain asymptomatic. E. It can cause an elevation in the levels of antihepatitis A immunoglobulin M.

B. It can last up to 8 weeks. D. It can cause mild symptoms, or sometimes the patient may remain asymptomatic. E. It can cause an elevation in the levels of antihepatitis A immunoglobulin M.

Which type of liver cirrhosis is caused by the intake of alcohol? A. Micronodular cirrhosis B. Laënnec's cirrhosis C. Wilson's disease cirrhosis D. Hemochromatosis cirrhosis

B. Laënnec's cirrhosis

A male patient, newly diagnosed with colon cancer, presents to the ER with cramp-like abdominal pain, nausea, projectile vomiting, and dehydration. Which type of obstruction would you suspect based on the patient's history and clinical manifestations? A. Mechanical obstruction of the large intestines B. Mechanical obstruction of the small intestines C. Nonmechanical obstruction of the large intestines D. Nonmechanical obstruction of the small intestines

B. Mechanical obstruction of the small intestines

The nurse instructs the patient to breathe deeply while the nurse palpates the right upper quadrant of the abdomen by placing the fingers and pressing down gently. When this occurs, the patient exhibits pain. Which is observed from this assessment? A. Cullen sign B. Murphy sign C. Chvostek sign D. Grey-Turner sign

B. Murphy sign Rationale: Cullen sign and Grey-Turner sign are observed in acute pancreatitis. Cullen sign is indicated by bruising of the periumbilical area. Grey-Turner sign is indicated by bruising of the flank. Chvostek sign is facial twitching that can be observed by tapping the skin over the facial nerves and is caused by low calcium levels.

Which of the following treatment options is best to utilize in the management of patients with acute pancreatitis? A. ERCP with endoscopic pancreas sphincterotomy B. Nasogastric suction to prevent gastric contents from entering the duodenum. C. Pancreatic enzyme supplements administered with meals. D. Pancreatic surgery to remove areas of the inflamed pancreas.

B. Nasogastric suction to prevent gastric contents from entering the duodenum.

The patient comes to the emergency department with nausea, vomiting, and pain upon deep palpation at the RLQ. How should the nurse document this finding? A. Positive Rovsing's sign B. Pain at McBurney's point C. Rebound tenderness D. Normal findings

B. Pain at McBurney's point

Which patient is demonstrating signs of stage 2 hepatic encephalopathy? A. Patient A: slurred speech, impaired writing, and lethargy B. Patient B: increased drowsiness, disorientation, and mood swings C. Patient C: severe confusion, rigid extremities, and increased deep tendon reflexes D. Patient D: nonresponsive to painful stimuli

B. Patient B: increased drowsiness, disorientation, and mood swings

A nurse is caring for a client who has hepatitis A. The client asks the nurse how he might have contracted the virus. Which of the following is a question the nurse should ask the client? A. "Have you eaten any fresh water fish lately?" B. "Have you received a blood transfusion recently?" C. "Have you been to a third world country in the past?" D. "Do you take any recreational drugs?"

C. "Have you been to a third world country in the past?" Rationale: The nurse should understand Hepatitis A is contracted from fecal-oral route and is particularly prevalent in third world countries and may be the cause of contracting the virus from contaminated food or water. The nurse should ask if the client has eaten any shellfish, not fresh water fish, which may have been caught in contaminated water.

A nurse is providing discharge teaching for a client who has mild diverticulitis. Which of the following statements by the client indicates an understanding of the teaching? A. "I may experience right lower quadrant pain." B. "I will remain active by working in my garden every day." C. "I should eat foods that are low in fiber." D. "I will use a mild laxative every day."

C. "I should eat foods that are low in fiber." Rationale: The nurse should instruct the client to follow a low-fiber diet until the inflammation subsides.

A nurse is providing dietary teaching for a client who has a new diagnosis of celiac disease. Which of the following statements by the client indicates understanding of the teaching? A. "I can return to my regular diet when I am free of symptoms." B. "I will need to avoid taking vitamin supplements while on this diet." C. "I will eat beans to ensure I get enough fiber in my diet." D. "I need to avoid drinking liquids with my meals while on this diet."

C. "I will eat beans to ensure I get enough fiber in my diet."

A nurse is assessing a client who has cirrhosis. Which of the following findings is the priority for the nurse to report to the provider? A. Spider angiomas B. Peripheral edema C. Bloody stools D. Jaundice

C. Bloody stools Rationale: The greatest risk to the client who has cirrhosis of the liver is hemorrhagic shock due to bleeding in the esophageal varices.

The laboratory report of a patient with gallstones reveals increased liver enzymes in the blood. Which medication is most likely to be prescribed to this patient? A. Demerol B. Naproxen C. Chenodiol D. Acetaminophen

C. Chenodiol Rationale: The accumulation of gallstones in the bile duct increases liver enzymes in the blood. Chenodiol is a PO medication used for treating gallstones by dissolving the high cholesterol content and small-sized gallstones.

The nurse is caring for a patient with acute hepatis. Since their appointment one week ago, the nurse notices a yellowish coloring to their skin and sclera. Which additional assessment finding would be consistent with this assessment? A. Yellow halos in field of vision B. Hunger C. Clay colored stools D. Decrease in serum bilirubin levels

C. Clay colored stools Rationale: This is common because the increased levels of bilirubin are not being eliminated thru the feces.

A nurse is providing discharge teaching for a client following an ileostomy. The nurse should instruct the client to report which of the following findings to the provider? A. Intolerance to high-fiber foods B. Liquid ileostomy output C. Dark purple stoma D. Sensation of burning during bowel elimination

C. Dark purple stoma

Which clinical manifestation is a nurse most likely to observe in a patient with liver trauma? A. High hemoglobin B. Decreased respiratory rate C. Elevated liver enzymes D. High blood pressure

C. Elevated liver enzymes

The nurse is caring for a patient with known hepatitis B. A second type of hepatitis is discovered. What type of hepatitis would it be? A. Hepatitis A B. Hepatitis C C. Hepatitis D D. Hepatitis E

C. Hepatitis D Rationale: Hepatitis D occurs only in patients who are infected with the hepatitis B virus because it requires the hepatitis B antigen to replicate. It occurs in conjunction with hepatitis B, and it spreads thru blood and body fluids.

A nursing student is listing the types of hepatitis that are transmitted through infected blood and body fluids. Which example listed by the nursing student indicates a need for further instruction? A. Hepatitis C B. Hepatitis D C. Hepatitis E D. Hepatitis G

C. Hepatitis E

Which of the following problems can occur secondary to treatment of ascites with diuretic therapy? (Select all that apply.) A. Body image disturbance B. GI Bleeding C. Hypokalemia D. Increased blood clotting E. Renal impairment

C. Hypokalemia E. Renal impairment

A nurse is admitting a client who has acute pancreatitis. Which of the following actions should the nurse take first? A. Insert a nasogastric tube for the client B. Administer ceftazidime to the client C. Identify the client's current level of pain D. Instruct the client to remain NPO

C. Identify the client's current level of pain

A nurse is teaching an older adult client who reports constipation. Which of the following instructions should the nurse include in the teaching? A. Bear down hard when defecating. B. Drink four to five glasses of water daily. C. Increase dietary intake of raw vegetables. D. Limit activity.

C. Increase dietary intake of raw vegetables.

Which action performed by a nurse while taking care of a patient with cirrhosis puts the patient at increased risk of complication? A. Providing electrolyte replacements such as potassium B. Administering diuretics C. Increasing amounts of protein in the diet D. Restricting sodium and fluid intake as ordered

C. Increasing amounts of protein in the diet Rationale: Protein intake should be restricted as elevated amounts of protein in the diet may raise ammonia levels and lead to hepatic encephalopathy.

What is the function of the appendix? A. Assists with fecal removal B. Assists with motility C. Its purpose is unknown D. Secretes digestive acid

C. Its purpose is unknown

Which of the following will a patient with chronic pancreatitis be more likely to have compared to a patient with acute pancreatitis? A. Adherence to a high carb, high protein, & low fat diet. B. Experience acute abdominal pain. C. Malabsorption and Diabetes mellitus D. The need to abstain from from alcohol.

C. Malabsorption and Diabetes mellitus

The primary healthcare provider prescribed four different medications for four different patients with acute pancreatitis. Which patient is most likely to have decreased gastric acid secretions? A. Patient A: 42 y/o, gallbladder disease, currently taking opioid narcotics B. Patient B: 22 y/o, smokes cannabis, currently taking a spasmolytic C. Patient C: 67 y/o, alcoholic, currently taking H2 antagonists D. Patient D: 55 y/o, liver cancer, currently taking anticholinergic agents

C. Patient C: 67 y/o, alcoholic, currently taking H2 antagonists

A nurse is teaching a client who has hepatitis A about preventing transmission of the virus. Which of the following strategies should the nurse include in the teaching? A. Avoid eating at fast food restaurants. B. Avoid serving raw foods. C. Practice effective hand hygiene. D. Wear barrier protection during vaginal intercourse.

C. Practice effective hand hygiene.

A nurse in a PACU is assessing a client who has a newly created colostomy. Which of the following findings should the nurse report to the provider? A. Stoma oozing red drainage B. Shiny, moist stoma C. Purplish-colored stoma D. Rosebud-like stoma orifice

C. Purplish-colored stoma

A nurse is planning care for a client who has end-stage cirrhosis of the liver with encephalopathy. Which of the following interventions should the nurse plan to implement to decrease the client's ammonia level? A. Administer diuretics. B. Restrict the client's intake of fluids. C. Reduce the client's intake of protein. D. Administer vitamin K.

C. Reduce the client's intake of protein. Rationale: Ammonia is formed in the gastrointestinal tract by the action of bacteria on protein. Limiting dietary protein intake can assist with decreasing the client's ammonia level. Protein is necessary for healing, so strict limitation of dietary protein is not recommended.

During discharge instructions for a patient following a laparoscopic cholecystectomy, which of the following should the nurse include as part of patient teaching? A. Expect some postoperative nausea and vomiting for a few days B. Keep the incision site clean and dry for at least a week. C. Report any bile-colored or purulent drainage from the incision site D. Report the need to take pain medication for shoulder pain.

C. Report any bile-colored or purulent drainage from the incision site Rationale: Any bile-colored or purulent drainage could indicate complications from the operation, such as any kind of drain blockage. Referred shoulder pain is expected due to the insertion of gas into the peritoneal cavity, so this does not need to be reported.

A nurse is teaching self-management to a client who has hepatitis B. Which of the following instructions should the nurse include in the teaching? A. You may donate blood 6 months after completing the medication regimen. B. Consume a high-protein diet. C. Rest frequently throughout the day. D. Take acetaminophen every 4 hr, as needed, for discomfort

C. Rest frequently throughout the day.

The patient with signs of appendicitis prefers not to take pain medication. What position may help to relieve the pain? A. Head of bed flat with legs extended B. Side lying with legs extended C. Supine with head of bed elevated 30° to 45° with knees flexed D. Prone with arms above the head

C. Supine with head of bed elevated 30° to 45° with knees flexed

In treating a patient with metastatic liver cancer, which of the following statements is most accurate? A. Chemotherapy is highly successful in the treatment of liver cancer. B. Metastatic liver cancer is more responsive to treatment than primary carcinoma of the liver. C. Supportive care is appropriate for all patients with metastatic liver cancer. D. The patient will undergo surgery to remove the affected portions of the liver.

C. Supportive care is appropriate for all patients with metastatic liver cancer.

Which of the following statements most likely explains why the serum BUN could be increased? A. The patient may have nonrenal tissue disease. B. The patient has decreased protein in the urine. C. The patient has impaired renal function. D. The patient has not eaten enough protein.

C. The patient has impaired renal function.

A nurse is assessing a client who has a colostomy. Which of the following findings should the nurse report to the provider? A. The stool is yellow-green. B. The ostomy is draining frequently. C. The stoma is pale in color. D. The skin around the stoma is red.

C. The stoma is pale in color.

A nurse is assessing a client who has hypokalemia as a result of nausea, vomiting, and diarrhea. Which of the following findings should the nurse expect? A. Hyperactive reflexes B. Extreme thirst C. Weak, irregular pulse D. Paresthesia

C. Weak, irregular pulse

The nurse is teaching a patient with a liver disorder about nutritional intake. Which statement made by the patient indicates the need for further teaching? A. "I should limit my daily fat intake." B. "I should fulfill my daily calorie requirement." C. "I should eat small and frequent meals." D. "I should increase the protein content of my diet."

D. "I should increase the protein content of my diet."

A nurse is providing dietary teaching for a client who has chronic pancreatitis. Which of the following food selections by the client indicates understanding of the teaching? A. 8 oz (0.24 L) whole milk B. One slice of beef bologna C. 1 oz (28.3 g) cheddar D. 1 cup (0.24 L) sliced banana

D. 1 cup (0.24 L) sliced banana Rationale: Foods that are high in fat can cause diarrhea for clients who have pancreatitis. One cup of sliced banana, which contains 0.49 g of fat, is a low-fat food option. Clients who have pancreatitis should consume a high-protein and low-fat diet with an adequate amount of carbohydrates and calories.

The nurse is assessing four different patients and documents clinical manifestations. Which patient is most likely to have the illness associated with a tumor on the head of the pancreas? A. Right upper quadrant pain, abdominal tenderness, and fever B. Epigastric pain in the upper left quadrant, anorexia, and indigestion C. Abdominal pain worsening after drinking and eating, oily stools, and weight loss D. Abdominal pain on movement, pruritus on palms, and dark amber-colored urine

D. Abdominal pain on movement, pruritus on palms, and dark amber-colored urine Rationale: Option A describes symptoms of cholecystitis. Option B describes symptoms of acute pancreatitis. Option C describes symptoms of chronic pancreatitis.

A nurse is reviewing the laboratory results of a client who has hepatic cirrhosis. Which of the following laboratory findings should the nurse report to the provider? A. Albumin 4.0 g/dL B. INR 1.0 C. Direct bilirubin 0.5 mg/dL D. Ammonia 180 mcg/dL

D. Ammonia Rationale: The expected reference ranges are as follows —> albumin (3.5-5.0 g/dL), INR (0.8-1.1), direct bilirubin (0.3-1.0 mg/dL), and ammonia (10-80 mcg/dL).

A nurse is reviewing the laboratory data of a client who has acute pancreatitis. The nurse should expect to find an elevation of which of the following values? A. Calcium B. RBC count C. Magnesium D. Amylase

D. Amylase Rationale: Amylase is an enzyme that changes complex sugars into simple sugars that can be used by the body. It is produced by the pancreas and salivary glands and released into the mouth, stomach, and intestines to aid in digestion. The amylase level of a client who has acute pancreatitis usually increases within 12 to 24 hr and can remain elevated for 2 to 3 days.

A patient reports abdominal pain, fever, and vomiting. The primary healthcare provider suspects appendicitis. Which diagnosis will confirm the condition? A. X-ray of abdomen B. Physical assessment C. White blood cell count D. Computed tomography (CT)

D. Computed tomography (CT)

A nurse is caring for a client who has suspected cholecystitis. The nurse should expect the client's urine to appear which of the following colors? A. Pale yellow B. Greenish-brown C. Red D. Dark and foamy

D. Dark and foamy Rationale: The nurse should expect the client to have dark and foamy urine, which indicates the kidneys are filtering excess bilirubin from the blood.

A nurse is assessing a client immediately following a paracentesis for the treatment of ascites. Which of the following findings indicates the procedure was effective? A. Presence of a fluid wave B. Increased heart rate C. Equal pre- and postprocedure weights D. Decreased shortness of breath

D. Decreased shortness of breath

A nurse is administering an IM injection to a client who has hepatitis C. Before placing the syringe and needle in a puncture-resistant container, which of the following actions should the nurse take? A. Recap the needle. B. Place the cap on the bedside table and slide the needle into the cap. C. Wrap the needle with gauze. D. Dispose of the needle uncapped.

D. Dispose of the needle uncapped. Rationale: The nurse should immediately place the uncapped needle in a puncture-resistant container to prevent a needle stick with the contaminated needle.

A nurse is teaching a client about causes of biliary cirrhosis. Which of the following information should the nurse include in the teaching? A. Excessive alcohol consumption B. Hepatitis C C. Hepatotoxic medications D. Obstruction of the bile duct

D. Obstruction of the bile duct

The patient a nurse is caring for is scheduled for a test in which a diagnostic tool uses a contrast media to inject into the bile duct of the liver of a patient . What is this test? A. Esophagogastroduodenoscopy (EGD) B. Liver biopsy C. Endoscopic retrograde cholangiopancreatography (ERCP) D. Percutaneous transhepatic cholangiography

D. Percutaneous transhepatic cholangiography

Which cognitive behavioral finding would the nurse anticipate finding in a patient with cirrhosis who has hepatic encephalopathy? A. Clear speech articulation B. Intact short-term memory C. Intact long-term memory D. Personality changes

D. Personality changes

A nurse is assessing a client who has a duodenal ulcer. Which of the following findings should the nurse expect? A. The client states that the pain is in the upper epigastrium. B. The client is malnourished. C. The client states that ingesting food intensifies the pain. D. The client reports that pain occurs during the night.

D. The client reports that pain occurs during the night

A nurse is creating a plan of care to maintain the skin integrity of a client who experiences frequent diarrhea due to ulcerative colitis. Which of the following interventions should the nurse include in the plan? A. Soak in a sitz bath for 20 min after each stool. B. Administer a soap-suds enema to cleanse the colon. C. Cleanse with antimicrobial scrub and vigorously dry. D. Wipe perianal area with warm water and apply a barrier cream

D. Wipe perianal area with warm water and apply a barrier cream

A nurse is caring for a client who has acute pancreatitis. After treating the client's pain, which of the following should the nurse address as the priority intervention? A. Auscultate the client's lungs. B. Assist the client to a side-lying position. C. Provide oral hygiene. D. Withhold oral fluids and food.

D. Withhold oral fluids and food. Rationale: To rest the pancreas and reduce secretion of pancreatic enzymes, NPO status must be initiated and maintained during the acute phase of pancreatitis. This is the priority intervention to address after the client's pain has been treated.

When emptying the colostomy bag of a patient with a sigmoid colostomy, what would the nurse expect the consistency of the effluent or stool to look like?

formed

The nurse is taking a hospital admission history for the 40-year-old client. The nurse is concerned about possible acute pancreatitis when the client makes which statement? A. "I have sudden-onset intense pain in my upper left abdomen that goes to my back." B. "I had persistent lower abdominal pain that now shifted to the lower right quadrant." C. "My stools are loose and bloody, and I have cramping abdominal pain with spasms." D. "I have this mild pain in my upper abdomen, but I have been vomiting forcefully a lot."

A. "I have sudden-onset intense pain in my upper left abdomen that goes to my back." Rationale: The predominant symptom of acute pancreatitis is severe, deep or piercing, continuous or steady abdominal pain in the upper left quadrant. The pain may radiate to the back because of the retroperitoneal location of the pancreas. Middle-aged individuals are at increased risk for developing acute pancreatitis.

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

A. "I plan to eat small, frequent meals." B. "I will eat easy-to-digest foods with limited space." C. "I will use skim milk when cooking."

A nurse in a clinic is teaching a client who has ulcerative colitis. Which of the following statements by the client indicates understanding of the teaching? A. "I will plan to limit fiber in my diet." B. "I will restrict fluid intake during meals." C. "I will switch to black tea instead of drinking coffee." D. "I will try to eat cold foods rather than warm when my stomach feels upset."

A. "I will plan to limit fiber in my diet." Rationale: A low-fiber diet is recommended for the client who has ulcerative colitis to reduce inflammation.

The nurse is caring for a patient with colorectal cancer who just had a total colectomy with placement of a permanent ileostomy. Which nursing diagnosis is a priority for the immediate postoperative period? A. Disturbed body image B. Acute pain C. Potential for infection D. Knowledge deficit

B. Acute pain

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

B. Change in orientation C. Asterixis E. Fetor hepaticus

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

D. Epigastric pain radiating to the left shoulder

The nurse is assessing the client's incision post-surgery for removal of a ruptured appendix. Since the appendix was ruptured, what would the nurse expect to see? A. A larger incision B. Retention sutures in place C. Steri-strips over a small puncture wound D. Incision covered by an occlusive dressing

A. A larger incision Rationale: If the appendix has ruptured or peritonitis is expected, the surgeon will make a larger incision. Retention sutures may be indicated in obese clients or for complex wounds for which surgical edges cannot be approximated. Puncture wounds are used after a laparoscopic procedure and surgical wounds are not covered with an occlusive dressing.

Which assessment findings are consistent with identification of positive McBurney's point in a client with suspected appendicitis? (Select all that apply.) A. Abdominal tenderness B. Left lower quadrant pain C. Guarding in response to pain D. Right lower quadrant pain E. Hyperactive bowel sounds

A. Abdominal tenderness C. Guarding in response to pain D. Right lower quadrant pain

What increases an individual's risk for C.Diff? (Select all that apply.) A. Antibiotic therapy B. Immunosuppression C. Intake of fatty foods D. Old age E. Sedentary lifestyle

A. Antibiotic therapy B. Immunosuppression D. Old age

A 17 year old male complains of a fever, chills, abdominal pain, & nausea and vomiting. An assessment of his abdomen reveals rebound tenderness. The nurse would suspect a diagnosis of: A. Appendicitis B. Cholecystitis C. Pancreatitis D. Peritonitis

A. Appendicitis

Select the correct statements regarding dietary and alcohol intake when managing the client with chronic pancreatitis. (Select all that apply.) A. Avoid coffee and caffeine for prevention of gastric distress B. Low-fat diet required for malabsorption of fats C. Alcohol should be avoided to minimize pancreatic inflammation D. Maintain a diabetic diet for glycemic control E. Increased caloric intake to combat weight loss F. Total parenteral nutrition for nutritional support

A. Avoid coffee and caffeine for prevention of gastric distress B. Low-fat diet required for malabsorption of fats C. Alcohol should be avoided to minimize pancreatic inflammation E. Increased caloric intake to combat weight loss F. Total parenteral nutrition for nutritional support

You are explaining the differences between Crohn's disease and Ulcerative Colitis to a 20 year old female and her parents. You explain that Ulcerative Colitis commonly presents with... A. Bloody diarrhea B. Nausea and vomiting C. Skin lesions D. Upper abdominal pain

A. Bloody diarrhea

Select the correct statements regarding the use of oral pancreatic enzymes when managing the client with chronic pancreatitis. (Select all that apply.) A. Do not chew to prevent disruption of enteric coating B. Deliver following ingestion of meals C. Provided in extended-release capsules D. Helps digest fats and proteins E. Must be taken with meals F. Must be swallowed whole for therapeutic dose

A. Do not chew to prevent disruption of enteric coating C. Provided in extended-release capsules D. Helps digest fats and proteins E. Must be taken with meals F. Must be swallowed whole for therapeutic dose

The nurse assesses for which finding in a patient with a positive Cullen's sign? A. Periumbilical bruising B. Rebound tenderness C. RUQ pain with radiation to shoulder D. Flank bruising

A. Periumbilical bruising

A nurse is planning care for a client who has a small bowel obstruction and an NG tube in place. Which of the following interventions should the nurse include? (Select all that apply.) A. Document the NG drainage with the client's output B. Irrigate the NG tube every 8 hr C. Assess bowel sounds D. Provide oral hygiene every 2 hr E. Monitor NG tube for placement

A. Document the NG drainage with the client's output C. Assess bowel sounds D. Provide oral hygiene every 2 hr E. Monitor NG tube for placement

Select the correct statements regarding lab findings when managing the client with chronic pancreatitis. (Select all that apply.) A. Elevated amylase and lipase levels B. Decreased alkaline phosphatase C. Decreased bilirubin D. Elevated glucose level E. Decreased potassium level F. Elevated sodium level

A. Elevated amylase and lipase levels D. Elevated glucose level Rationale: As the disease progresses and impairs endocrine functions of the pancreas, serum glucose levels will increase due to the lack of insulin.

A nurse is caring for a client who has a small bowel obstruction from adhesions. Which of the following findings are consistent with this diagnosis? (Select all that apply.) A. Emesis greater than 500 mL with a fecal odor B. Report of spasmodic abdominal pain C. High-pitched bowel sounds D. Abdomen flat with rebound tenderness to palpation E. Laboratory findings indicating metabolic acidosis

A. Emesis greater than 500 mL with a fecal odor B. Report of spasmodic abdominal pain C. High-pitched bowel sounds

Which of the following correctly describes what is occurring in this scenario? "Brian has developed cirrhosis secondary to a fecal-oral virus he obtained when drinking contaminated water while camping years ago." A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis G E. Laennec's cirrhosis F. Biliary cirrhosis G. Nonalcoholic steatohepatitis (NASH) H. Wilson's disease

A. Hepatitis A Rationale: Hepatitis is the inflammation of the liver from a virus that is obtained from oral ingestion of feces, contaminated water, or food. The acute illness is preventable with a vaccination.

A nurse is completing discharge teaching with a client who has irritable bowel syndrome (IBS). Which of the following instructions should the nurse include? A. Keep a food diary to identify triggers to exacerbation B. Consume 15-20 g of fiber daily C. Plan three moderate to large meals per day D. Limit fluid intake to 1 L each day

A. Keep a food diary to identify triggers to exacerbation

Alcoholism is associated with which type of cirrhosis? A. Laënnec's B. Congenital C. Metabolic D. Biliary

A. Laënnec's

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

A. Limit physical activity B. Avoid alcohol E. Eat small frequent meals

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

A. Obesity

Select the correct statements regarding pain when managing the client with chronic pancreatitis. (Select all that apply.) A. Opioids provide best pain relief B. Non-opioids should be avoided C. Described as persistent and recurring D. Described as right lower quadrant abdominal pain E. Focused over epigastric region F. Pain occurs secondary to impaired pain receptors

A. Opioids provide best pain relief C. Described as persistent and recurring E. Focused over epigastric region

A client with chronic pancreatitis may require which type of assistive therapy? A. Pancreatic enzyme replacement therapy B. Plasmapheresis C. Mechanical ventilation D. Hyperbaric oxygen therapy

A. Pancreatic enzyme replacement therapy

The nurse is caring for a client with cirrhosis. What should the nurse monitor as signs of worsening of the disease? (Select all that apply.) A. Petechiae B. Increased appetite C. Laryngitis D. Pedal edema E. Jaundice

A. Petechiae D. Pedal edema E. Jaundice

The client is 6 days post-total proctocolectomy with ileostomy creation for ulcerative colitis. The client's ileostomy is draining large amounts of liquid stool, and the client has dizziness with ambulation. Which parameters should the nurse assess immediately? (Select all that apply.) A. Pulse rate for the last 24 hours B. Urine output for the last 24 hours C. Weight over the last 3 days D. Ability to move the lower extremities E. Temperature readings for the last 24 hours

A. Pulse rate for the last 24 hours B. Urine output for the last 24 hours C. Weight over the last 3 days E. Temperature readings for the last 24 hours Rationale: The nurse should assess these as they are indicative of the patient's hydration status. Large amounts of ileostomy output can result in dehydration, and the dizziness with ambulation could be from dehydration.

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

B. "You might have shoulder pain after surgery." Rationale: Shoulder pain is expected postoperatively due to the free air that is introduced into the abdomen during laparoscopic surgery.

The nurse is reviewing the history and physical (H&P) of a teenager hospitalized with ulcerative colitis. Based on this diagnosis, which information should the nurse expect to see on this client's H&P? A. Heartburn and regurgitation B. Abdominal pain and bloody diarrhea C. Weight gain and elevated blood glucose D. Abdominal distention and hypoactive bowel sounds

B. Abdominal pain and bloody diarrhea Rationale: The primary symptoms of UC are bloody diarrhea and abdominal pain. Weight loss often occurs in severe cases, not weight gain. Bowel sounds are often hyperactive rather than hypoactive.

The nurse assesses for which clinical manifestations in the patient diagnosed with liver cancer? (Select all that apply.) A. Periumbilical pain B. Anorexia C. Hemoptysis D. Fatigue E. Jaundice

B. Anorexia D. Fatigue E. Jaundice

A patient is admitted to the hospital for treatment for diverticulitis. The nurse recognizes which interventions appropriate for this patient? A. High-fiber diet, ambulate frequently, IV fluids, pain medications B. Antibiotics, IV fluids, NPO, NG tube, pain medications C. Laxatives, enemas, diet, pain medications D. Surgery with follow-up physical therapy

B. Antibiotics, IV fluids, NPO, NG tube, pain medications

The nurse is caring for a patient in the emergency department with abdominal pain, fever, nausea, and vomiting. The patient is suspected of having appendicitis. What intervention may the provider order to confirm diagnosis? A. Flat-plate x-ray of the abdomen, chemistry panel B. CT scan, complete blood count (CBC), abdominal assessment for rebound tenderness C. Administer a laxative to see if symptoms improve D. Colonoscopy, esophagogastroduodenoscopy (EGD), and endoscopic retrograde cholangiopancreatogram (ERCP)

B. CT scan, complete blood count (CBC), abdominal assessment for rebound tenderness

A nurse is completing discharge teaching with a client who has Crohn's disease. Which of the following instructions should the nurse include in the teaching? A. Decrease intake of calorie-dense foods B. Drink canned protein supplements C. Increase intake of high fiber foods D. Eat high-residue foods

B. Drink canned protein supplements

Andrew is frightened to have surgery to treat appendicitis. He asks the nurse why surgery is needed, saying, "What's the worst thing that could happen if I just leave it alone?" What complications should the nurse include in the teaching discussion? (Select all that apply.) A. It will heal over time. B. Gangrene can occur and is life-threatening. C. Abscess can happen if the bacterial invasion is slow. D. The pain becomes excruciating. E. Rupture can occur in as little as 24 hours, which results in peritonitis.

B. Gangrene can occur and is life-threatening. C. Abscess can happen if the bacterial invasion is slow. E. Rupture can occur in as little as 24 hours, which results in peritonitis. Rationale: Without treatment for appendicitis, bacterial invasion occurs and an abscess may develop. Gangrene can occur in as little as 24 to 36 hours and is life-threatening. Perforation can occur in as little as 24 hours, but the risk increases after 48 hours and can result in peritonitis, which can also be fatal.

Select the correct statements regarding gastrointestinal prophylaxis therapy when managing the client with chronic pancreatitis. (Select all that apply.) A. Used to restore normal bowel function B. Helps decrease gastric acid secretion C. Relies on histamine blockers D. Relies on proton pump inhibitors E. Increases bulk of stools F. Assists in normalization of bowel frequency

B. Helps decrease gastric acid secretion C. Relies on histamine blockers D. Relies on proton pump inhibitors

Which of the following correctly describes what is occurring in this scenario? "Joanne developed cirrhosis after a contaminated needle stick while working as a nurse. The virus she obtained could have been prevented if she had received the series of three immunizations and developed immunity." A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis G E. Laennec's cirrhosis F. Biliary cirrhosis G. Nonalcoholic steatohepatitis (NASH) H. Wilson's disease

B. Hepatitis B Rationale: Transmission of hepatitis B is percutaneously or mucosal from exposure to blood, body fluids, needles or sharp instruments. The hepatitis B immunization can prevent illness from this virus.

A patient has just been brought to the emergency department by emergency medical services after a motor vehicle accident. What is the first thing the nurse should do? A. Ask the patient if he or she is in pain B. Mental status examination and vital signs C. Ask the patient to move all extremities D. Order laboratory tests

B. Mental status examination and vital signs

A nurse is preparing to administer pancrelipase to a client who has pancreatitis. Which of the following actions should the nurse take? A. Instruct the client to chew the medication before swallowing B. Offer a glass of water following medication administration C. Administer the medication 30 min before meals D. Sprinkle the contents on peanut butter

B. Offer a glass of water following medication administration

Andrew, a 20 year old male, presents at the emergency room with recent onset acute abdominal pain in the lower right quadrant along with nausea, but no vomiting. The healthcare provider makes a diagnosis of appendicitis, and the nurse begins to prepare him for surgery. Andrew is experiencing pain of 4 on a 1 to 10 scale prior to the surgery. Which interventions should be used to alleviate pain? (Select all that apply.) A. Apply warm compress to the right lower quadrant B. Position the client with the knees flexed C. Apply ice pack to the right lower quadrant D. Administer opioid analgesic prior to having the client sign the surgical consent E. Maintain NPO status prior to surgery

B. Position the client with the knees flexed C. Apply ice pack to the right lower quadrant Rationale: Ice can be applied to the right lower quadrant to impede blood flow, helping to decrease inflammation. Positioning the client with the knees flexed will help relieve pressure. Heat is not used as it will increase blood flow to the area and increase inflammation. Pain medication should not be given prior to signing a surgical consent. NPO status should be maintained, but is not considered a comfort measure.

Select the correct statements regarding pancreatic enzyme replacement therapy (PERT) when managing the client with chronic pancreatitis. (Select all that apply.) A. Provides glycogen and amylase B. Provides amylase, lipase, and protease C. Used in the treatment of acute pancreatitis D. Helps to aid in absorption of nutrients E. Causes weight loss, which helps to normalize insulin levels F. Used to correct problems of malabsorption and malnutrition

B. Provides amylase, lipase, and protease D. Helps to aid in absorption of nutrients F. Used to correct problems of malabsorption and malnutrition

The nurse is caring for the client who is 6 hours post-open cholecystectomy. The client's T-tube drainage bag is empty, and the nurse notes slight jaundice of the sclera. Which action by the nurse is most important? A. Reposition the client to promote T-tube drainage. B. Telephone the surgeon to report these findings. C. Ask the NA to obtain a BP. D. Record the findings and continue to monitor the client.

B. Telephone the surgeon to report these findings. Rationale: The T-tube is placed in the common bile duct to ensure patency of the duct. Lack of bile draining into the T-tube and jaundiced sclera are signs of an obstruction to the bile flow. This is most important to report to the surgeon.

The nurse has been assigned to care for four clients. Which client should the nurse plan to assess first? A. The 50-year-old client who has chronic pancreatitis and is reporting a pain level of 6 out of 10 on a numerical scale B. The 47-year-old client with esophageal varices who has influenza and has been coughing for the last 30 minutes C. The 60-year-old client who had an open cholecystectomy 15 hours ago and has been stable through the night D. The 54-year-old client with cirrhosis and jaundice who is reporting having itching all over the body

B. The 47-year-old client with esophageal varices who has influenza and has been coughing for the last 30 minutes Rationale: Bleeding esophageal varices are the most life-threatening complication of cirrhosis. Coughing can precipitate a bleeding episode. The nurse should assess this client first.

Andrew, a 20 year old college student, verbally consents to surgery to treat appendicitis. Which statement about the consent is true? A. Andrew's parents must be contacted since he is younger than 21. B. The consent must be signed before narcotics are administered. C. A verbal consent is acceptable and the nurse can document that. D. The consent cannot be signed until the anesthesiologist sees Andrew.

B. The consent must be signed before narcotics are administered.

A nurse is completing an admission assessment for a client who has a small bowel obstruction. Which of the following findings should the nurse report to the provider? (Select all that apply.) A. Emesis prior to insertion of the nasogastric tube B. Urine specific gravity 1.040 C. Hematocrit 60% D. Blood potassium 3.0 mEq/L E. WBC 10,000/microL

B. Urine specific gravity 1.040 C. Hematocrit 60% D. Blood potassium 3.0 mEq/L

In a patient with cirrhosis, the nursing diagnosis "Risk for injury and bleeding associated with prolonged clotting factors" is most appropriate associated with which disorder? A. Pruritus B. Vitamin K deficiency C. Hyponatremia D. Ascites

B. Vitamin K deficiency

The nurse is performing discharge teaching with Andrew as he is preparing to leave the hospital following his appendectomy. Which statement by him requires additional teaching? A. "I will not drive after taking my pain medication." B. "If my wound opens up, I'll call the surgeon." C. "My antibiotics are used as needed." D. "I'll follow up with my surgeon in 7 days."

C. "My antibiotics are used as needed."

A nurse is teaching a client who has a new prescription for sulfasalazine. Which of the following instructions should the nurse include in the teaching? A. "Take the medication 2 hr after eating." B. "Discontinue this medication if your skin turns yellow-orange." C. "Notify the provider if you experience a sore throat." D. "Expect your stools to turn black."

C. "Notify the provider if you experience a sore throat."

The nurse is caring for the client diagnosed with cirrhosis. After completing discharge education, the nurse recognizes the need for further teaching when the client makes which statement? A. "My cirrhosis was caused from too much alcohol; I plan to stop drinking." B. "I need to rest more; I plan on only going to work on a part-time basis." C. "Propranolol has been ordered to decrease my blood pressure." D. "Furosemide will help to reduce the amount of abdominal fluid."

C. "Propranolol has been ordered to decrease my blood pressure." Rationale: Although propranolol (Inderal) does decrease BP, it is not ordered for this purpose in treating cirrhosis. Prophylactic treatment with a nonselective beta blocker like propranolol has been shown to reduce the risk of bleeding from esophageal varices and to reduce bleeding-related deaths.

A nurse is assessing a client who has been taking prednisone following an exacerbation of inflammatory bowel disease. The nurse should recognize which of the following as the priority? A. Client reports difficulty sleeping B. The client's urine is positive for glucose C. Client reports having an elevated body temperature D. Client reports gaining 4 lb in the last 6 months

C. Client reports having an elevated body temperature

A patient diagnosed with inflammatory bowel disease (IBD) has been prescribed cobalamin & iron injections. What is the rationale for prescribing these medications? A. Alleviate stress B. Combat infection C. Correct malnutrition D. Improve quality of life

C. Correct malnutrition

Which of the following correctly describes what is occurring in this scenario? "John has been diagnosed with cirrhosis of the liver following this infectious disease process. No immunization is available to prevent this chronic illness." A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis G E. Laennec's cirrhosis F. Biliary cirrhosis G. Nonalcoholic steatohepatitis (NASH) H. Wilson's disease

C. Hepatitis C Rationale: Exposure to the hepatitis C virus is the most common cause of cirrhosis. This virus is transferred by blood and body fluids and treated with interferon and antiviral medications.

A 32 year old female presents to the ER with nausea and vomiting and vague abdominal pain for the past 2 days. The nurse's priority intervention would be to... A. Administer IV anti-nausea medication B. Encourage small sips of water or warm tea C. Keep the patient NPO D. Place an NG tube

C. Keep the patient NPO

A patient with ulcerative colitis is admitted to your nursing unit after a total proctocolectomy with formation of a terminal ileum stoma. What is the most important nursing intervention for this patient postoperatively? A. Change the ileostomy appliance every 3-4 hours to prevent leakage of drainage onto the skin. B. Emphasize that the ostomy is temporary and the ileum will be reconnected when the large bowel heals. C. Measure the ileostomy output to determine the status of the patient's fluid balance. D. Teach the patient about the high-fiber, low-carbohydrate diet required to maintain normal ileostomy drainage.

C. Measure the ileostomy output to determine the status of the patient's fluid balance.

A patient is admitted to the ER with acute abdominal pain. Which nursing intervention should the nurse implement first? A. Administration of prescribed analgesics B. Assessment of the pain C. Measurement of vital signs D. Physical assessment of the abdomen

C. Measurement of vital signs Rationale: Measuring the vital signs is the number one indicator of our patient's stability. Assessing any alterations/abnormalities in VS can give us a clue as to what could be causing the pain.

In managing postoperative care for a client who had an appendectomy, which nursing action would be included? A. Positioning the client on the right side for comfort B. Maintaining complete bed rest for the first 24 hours postoperatively C. Monitoring for return of bowel sounds before advancing diet D. Medicating the client for pain relief around the clock

C. Monitoring for return of bowel sounds before advancing diet

Andrew's appendectomy is performed, revealing that the appendix has ruptured. Based on this finding, what should the nurse include in the postoperative care? A. Providing nourishment by administering total parenteral nutrition (TPN) in the postoperative period B. Advancing diet as tolerated within 24 hours of surgery C. Monitoring nasogastric (NG) tube attached to low intermittent suction for drainage D. Maintaining complete bedrest with both side rails up to ensure safety

C. Monitoring nasogastric (NG) tube attached to low intermittent suction for drainage Rationale: Since the appendix has ruptured, the client is at high risk for infection and aspiration of matter released into circulation in the abdominal area. An NG tube hooked up to low intermittent suction will be required in the immediate postoperative period. NPO status is typically maintained until bowel sounds return and the NG tube is withdrawn.

Which order would the nurse question in a client who is admitted for appendicitis? A. Having the client sign the consent form for an appendectomy B. Maintaining NPO status prior to surgery C. Obtaining medical consult for therapeutic management of inflammation D. Monitoring vital signs

C. Obtaining medical consult for therapeutic management of inflammation Rationale: The nurse does not need a consult for management of inflammation. This is something they can treat independently.

Which behavioral finding would the nurse anticipate finding in a client with cirrhosis who has hepatic encephalopathy? A. Intact short-term memory B. Intact long-term memory C. Personality changes D. Clear speech articulation

C. Personality changes

In reviewing diagnostic results of a patient with suspected hepatitis, the nurse correlates which result as consistent with hepatitis A? A. Prolonged prothrombin time (PT) B. Decreased white blood cell count C. Presence of IgM anti-HAV D. Detectable serum HBV DNA

C. Presence of IgM anti-HAV

Elevated ammonia levels can lead to hepatic encephalopathy. Which provider order best reduces this risk in patients with cirrhosis? A. Administer furosemide and spironolactone B. Administer antibiotics C. Restrict protein intake D. Restrict caloric intake

C. Restrict protein intake

Which statement best reflects the difference between acute and chronic pancreatitis? A. The pain from acute pancreatitis is less intense than from chronic pancreatitis. B. Fluid replacement therapy is required only for treatment of acute pancreatitis. C. Once a client has been diagnosed with acute pancreatitis, it will progress rapidly to chronic pancreatitis regardless of the response to treatment intervention. D. Damage to the pancreas can be reversed in acute pancreatitis whereas with chronic pancreatitis both exocrine and endocrine function are compromised.

D. Damage to the pancreas can be reversed in acute pancreatitis whereas with chronic pancreatitis both exocrine and endocrine function are compromised.

Which of the following correctly describes what is occurring in this scenario? "Mark has cirrhosis from a little known and uncommon bloodborne virus. He became sick after multiple blood transfusions for his hemophilia." A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis G E. Laennec's cirrhosis F. Biliary cirrhosis G. Nonalcoholic steatohepatitis (NASH) H. Wilson's disease

D. Hepatitis G Rationale: Hepatitis G was discovered in 1996. It is transmitted by infected blood or blood products, putting patients with hemophilia at greatest risk. Little else is known about this strain. The incubation period and frequency remain unknown. Currently there is no vaccine.

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

D. Increased blood glucose level

Which bed assignment would the admission nurse implement for a client being admitted from the emergency department with acute pancreatitis? A. Surgical floor in a private room B. Medical floor in a semi-private room by the nurse's station C. Coronary cardiac care unit D. Intensive care unit

D. Intensive care unit

In cirrhosis, alterations in blood and lymph flow can lead to what end organ effect of the liver? A. Increased perfusion as a result of ascites B. Increased pressure leading to increased vascularity C. Cellular changes leading to malignancy D. Necrosis

D. Necrosis

A patient with IBD has a nursing diagnosis of imbalanced nutrition: less than body requirements related to decreased nutritional intake and decreased intestinal absorption. Which assessment data supports this nursing diagnosis? A. Anorectal excoriation & pain B. Frequent episodes of diarrhea C. Hypotension & urine output less than 30ml/hr D. Pallor and hair loss

D. Pallor and hair loss Rationale: The nursing diagnosis is "imbalanced nutrition: less than body requirements". Pallor and hair loss are examples of manifestations of malnutrition. The patient may exhibit frequent episodes of diarrhea and anorectal pain, but these symptoms are not caused as a result of decreased nutritional intake.

The nurse receives a patient from the operating room after he undergoes a Whipple procedure. The nurse recognizes that this procedure is indicated for the patient who has which disorder? A. Acute pancreatitis B. Peritonitis C. Cholecystitis D. Pancreatic cancer

D. Pancreatic cancer

Andrew continues to recover from surgery and hopes that the NG tube will be removed soon. What clinical finding supports the removal of the NG tube? A. Client has resumed ambulation with minimal assistance. B. Less pain medication has been administered during a 12-hour shift. C. Client is able to tolerate small sips of liquids without nausea or vomiting. D. Presence of bowel sounds.

D. Presence of bowel sounds.

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

D. Provide a high-calorie, high-carbohydrate diet

The nurse correlates which clinical manifestation with cholecystitis? A. Retroperitoneal pain B. Absence of bowel sounds C. Diarrhea D. RUQ pain

D. RUQ pain

A teenage boy's ultrasound revealed a ruptured appendix. The nurse needs to implement several nursing interventions to properly care for this patient. The priority nursing intervention is: A. Offer the patient small sips of water B. Place an NG tube and connect it to low intermittent wall suction C. Place the patient on their left side and raise the HOB 30 degrees D. Start an IV & administer IV fluids and antibiotics as ordered

D. Start an IV & administer IV fluids and antibiotics as ordered Rationale: Since the appendix has already ruptured, placing the patient on their left side and raising the HOB is no longer indicated. Placing the patient on their left side and increasing the HOB are two methods to reduce intraabdominal pressure and try to prevent rupture. Since the patient's appendix has ruptured, they will be going to surgery and should be kept NPO.

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

D. This medication dissolves gallstones gradually over a period of up to 2 years Rationale: Chenodiol is a bile acid that gradually dissolves cholesterol-based gall stones. The medication can be taken for up to 2 years.

Which of the following correctly describes what is occurring in this scenario? "Paul is being treated for the second most common type of cirrhosis of the liver following a long history of alcoholism and accompanying malnutrition." A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis G E. Laennec's cirrhosis F. Biliary cirrhosis G. Nonalcoholic steatohepatitis (NASH) H. Wilson's disease

E. Laennec's cirrhosis Rationale: Alcoholism and accompanying malnutrition are key assessment findings in the clinical diagnosis of Laënnec's cirrhosis or alcoholic cirrhosis. It is commonly referred to as alcohol-induced cirrhosis.

Which of the following correctly describes what is occurring in this scenario? "Tanya has received a clinical diagnosis of a type of genetic cirrhosis. Client history reveals a metabolic disease affecting copper metabolism." A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis G E. Laennec's cirrhosis F. Biliary cirrhosis G. Nonalcoholic steatohepatitis (NASH) H. Wilson's disease

H. Wilson's disease Rationale: Wilson's disease is a genetic disorder resulting in excessive copper metabolism that can lead to cirrhosis if not properly treated. In these cases, an abnormality of a protein causes excessive accumulation of copper in the liver leading to chronic inflammation. Similarly, in clients with hemochromatosis, an abnormally high accumulation of iron leads to chronic liver inflammation and cirrhosis. Treatment is aimed at decreasing levels of copper and iron respectively.