chapter 46

Question 1

A client contracts hepatitis from contaminated food. During the acute (icteric) phase of the client’s illness, which of the following serological findings should the nurse expect?
a. Antibody to hepatitis D virus (anti-HDV)
b. Hepatitis B surface antigen (HBsAg)
c. Anti-hepatitis A virus immunoglobulin G (anti-HAV IgG)
d. Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)

Answer 1

d. Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)

Question 2

Which of the following findings in a blood specimen indicates that the administration of hepatitis B vaccine to a client has been effective?
a. HBsAg
b. Anti-HBs
c. Anti-HBc IgG
d. Anti-HBc IgM

Answer 2

b. Anti-HBs

Question 3

A client in the outpatient clinic is diagnosed with acute hepatitis C virus (HCV) infection. Which of the following actions by the nurse is best?
a. Schedule the client for HCV genotype testing.
b. Administer immune globulin and the HCV vaccine.
c. Instruct the client on ribavirin treatment.
d. Teach that the infection will resolve in a few months.

Answer 3

a. Schedule the client for HCV genotype testing.

Question 4

The nurse is caring for a client who is diagnosed with acute hepatitis B. Which of the following information should the nurse include in the teaching plan?
a. Ways to increase exercise and activity level
b. Self-administration of a-interferon
c. Adverse effects of nucleoside and nucleotide analogs
d. Measures that will be helpful in improving appetite

Answer 4

d. Measures that will be helpful in improving appetite

Question 5

The nurse is caring for a client with chronic hepatitis C who is prescribed combination therapy of a-interferon and ribavirin. Which of the following findings should the nurse monitor for the presence of hepatitis C in the client?
a. Leukopenia
b. Hypokalemia
c. Polycythemia
d. Hypoglycemia

Answer 5

a. Leukopenia

Question 6

Which of the following clients should alert the nurse that screening for hepatitis C should be done?
a. The client eats frequent meals in fast-food restaurants.
b. The client recently travelled to an undeveloped country.
c. The client had a blood transfusion after surgery in 1998.
d. The client reports a one-time use of IV drugs 20 years ago.

Answer 6

d. The client reports a one-time use of IV drugs 20 years ago.

Question 7

The nurse is caring for a client who is admitted with an abrupt onset of jaundice, nausea, and abnormal liver function studies. Serological testing is negative for viral causes of hepatitis. Which of the following questions by the nurse is best?
a. “Is there any history of IV drug use?”
b. “Are you taking corticosteroids for any reason?”
c. “Do you use any over-the-counter (OTC) drugs?”
d. “Have you recently travelled to a foreign country?”

Answer 7

c. “Do you use any over-the-counter (OTC) drugs?”

Question 8

The nurse is caring for a client with cirrhosis who has 4+ pitting edema of the feet and legs. Which of the following assessments is priority for the nurse to monitor?
a. Hemoglobin
b. Temperature
c. Activity level
d. Albumin

Answer 8

d. Albumin

Question 9

The nurse is preparing a teaching plan for a young adult client who is diagnosed with early alcoholic cirrhosis. Which of the following topics is most important to include in client
teaching?
a. Need to abstain from alcohol
b. Use of vitamin B supplements
c. Maintenance of a nutritious diet
d. Treatment with lactulose

Answer 9

a. Need to abstain from alcohol

Question 10

The nurse is caring for a client with cirrhosis who has scheduled doses of spironolactone and furosemide and has a serum potassium level of 3.2 mmol/L. Which of the following
actions should the nurse take?
a. Give both drugs as scheduled.
b. Administer the spironolactone.
c. Administer the furosemide and withhold the spironolactone.
d. Withhold both drugs until talking with the health care provider.

Answer 10

b. Administer the spironolactone.

Question 11

Which of the following actions should the nurse implement to evaluate the effectiveness of treatment for a client who has hepatic encephalopathy?
a. Request that the client stand on one foot.
b. Ask the client to extend both arms to the front.
c. Instruct the client to perform the Valsalva manoeuvre.
d. Have the client walk a few steps with the eyes closed.

Answer 11

b. Ask the client to extend both arms to the front.

Question 12

The nurse is caring for a client who has advanced cirrhosis and is receiving lactulose. Which of the following findings by the nurse indicates that the medication is effective?
a. The client is alert and oriented.
b. The client denies nausea or anorexia.
c. The client’s bilirubin level decreases.
d. The client has at least one stool daily.

Answer 12

a. The client is alert and oriented.

Question 13

Which of the following nursing actions should be included in the plan of care for a client who is being treated for bleeding esophageal varices with balloon tamponade?
a. Monitor the client for shortness of breath.
b. Encourage the client to cough every 4 hours.
c. Deflate the gastric balloon every 8–12 hours.
d. Verify the position of the balloon every 6 hours.

Answer 13

a. Monitor the client for shortness of breath.

Question 14

The nurse is caring for a client with severe cirrhosis who has an episode of bleeding esophageal varices. Which of the following laboratory tests should the nurse monitor to detect possible complications of the bleeding episode?
a. Bilirubin
b. Ammonia
c. Potassium
d. Prothrombin time

Answer 14

b. Ammonia

Question 15

Which of the following nursing actions should be included in the plan of care for a client with cirrhosis who has ascites and 4+ edema of the feet and legs?
a. Weekly weight of client
b. Reposition the client every 4 hours
c. Restrict sodium intake.
d. Perform passive range-of-motion QID.

Answer 15

c. Restrict sodium intake.

Question 16

The nurse is caring for a client who has had a transjugular intrahepatic portosystemic shunt (TIPS) placement. Which of the following findings indicate that the procedure has been effective?
a. Lower indirect bilirubin level
b. Increase in serum albumin level
c. Decrease in episodes of variceal bleeding
d. Improvement in alertness and orientation

Answer 16

c. Decrease in episodes of variceal bleeding

Question 17

The health care provider plans a paracentesis for a client with ascites caused by liver cancer. Which of the following actions should the nurse implement to prepare the client for the procedure?
a. Place the client on NPO status.
b. Assist the client to lie flat in bed.
c. Ask the client to empty the bladder.
d. Position the client on the right side.

Answer 17

c. Ask the client to empty the bladder.

Question 18

The nurse is assessing a client who had a liver transplant a week previously and obtains the following data. Which of the following findings is most important to communicate to the health care provider?
a. Dry lips and oral mucosa
b. Crackles at both lung bases
c. Temperature 38.2°C (100.8°F)
d. No bowel movement for 4 days

Answer 18

c. Temperature 38.2°C (100.8°F)

Question 19

Which of the following laboratory test results is most important for the nurse to monitor when evaluating the effects of therapy for a client who has acute pancreatitis?
a. Calcium
b. Bilirubin
c. Amylase
d. Potassium

Answer 19

c. Amylase

Question 20

Which of the following assessment findings in a client with acute pancreatitis should the nurse report most quickly to the health care provider?
a. Nausea and vomiting
b. Hypotonic bowel sounds
c. Abdominal tenderness and guarding
d. Muscle twitching and finger numbness

Answer 20

d. Muscle twitching and finger numbness

Question 21

The nurse is obtaining a health history from a client with acute pancreatitis. Which of the following information should the nurse specifically assess when conducting a health history?
a. Alcohol use
b. Diabetes mellitus
c. High-protein diet
d. Cigarette smoking

Answer 21

a. Alcohol use

Question 22

The nurse is educating a client with chronic pancreatitis about the prescribed pancrelipase? At which of the following times should the nurse teach the client to take the medication?
a. Bedtime
b. With every meal
c. Upon arising in the morning
d. As soon as abdominal pain starts

Answer 22

b. With every meal

Question 23

The nurse is providing discharge instructions to a client following a laparoscopic cholecystectomy. Which of the following client statements indicate that the teaching has been effective?
a. “I can remove the bandages on my incisions tomorrow and take a shower.”
b. “I can expect some yellow-green drainage from the incision for a few days.”
c. “I should plan to limit my activities and not return to work for 4–6 weeks.”
d. “I will always need to maintain a low-fat diet since I no longer have a gallbladder.”

Answer 23

a. “I can remove the bandages on my incisions tomorrow and take a shower.”

Question 24

Which of the following data obtained by the nurse during the assessment of a client with cirrhosis is of most concern?
a. The client’s hands flap back and forth when the arms are extended.
b. The client has ascites and a 2-kg weight gain from the previous day.
c. The client’s skin has multiple spider-shaped blood vessels on the abdomen.
d. The client complains of right upper-quadrant pain with abdominal palpation.

Answer 24

a. The client’s hands flap back and forth when the arms are extended.

Question 25

The nurse is caring for a client with cirrhosis and esophageal varices who has a new prescription for propranolol. Which of the following assessment findings is the best indicator that the medication has been effective? a. The apical pulse rate is 68 beats/minute. b. Stools test negative for occult blood. c. The client denies complaints of chest pain. d. Blood pressure is less than 140/90 mm Hg.

Answer 25

b. Stools test negative for occult blood.

Question 26

The nurse is admitting a client with acute bleeding from esophageal varices who asks the nurse the purpose for the ordered pantoprazole. Which of the following responses by the nurse is best? a. The medication will reduce the risk for aspiration. b. The medication will decrease nausea and anorexia. c. The medication will inhibit the development of gastric ulcers. d. The medication will prevent irritation to the esophageal varices.

Answer 26

d. The medication will prevent irritation to the esophageal varices.

Question 27

The nurse is taking the BP of a client with severe acute pancreatitis and notices carpal spasm of the client’s hand. Which of the following actions should the nurse take next? a. Ask the client about any arm pain. b. Retake the client blood pressure. c. Check the calcium level on the chart. d. Notify the health care provider immediately.

Answer 27

c. Check the calcium level on the chart.

Question 28

The nurse is caring for a client with acute pancreatitis who has a nasogastric (NG) tube to suction and is NPO. Which of the following information obtained by the nurse indicates that these therapies have been effective? a. Bowel sounds are present. b. Grey Turner sign resolves. c. Electrolyte levels are normal. d. Abdominal pain is decreased.

Answer 28

d. Abdominal pain is decreased.

Question 29

The nurse is caring for a client with acute pancreatitis. Which of the following findings is of most concern? a. Absent bowel sounds b. Abdominal tenderness c. Left upper quadrant pain d. Palpable abdominal mass

Answer 29

d. Palpable abdominal mass

Question 30

Which of the following actions should be included in the plan of care for a client who has recently been diagnosed with asymptomatic non-alcoholic fatty liver disease (NAFLD)? a. Teach symptoms of variceal bleeding. b. Discuss the need to increase caloric intake. c. Review the client’s current medication list. d. Draw blood for hepatitis serology testing.

Answer 30

c. Review the client’s current medication list.

Question 31

The nurse is caring for a client with chronic hepatitis C infection who has these medications prescribed. Which of the following medications require further discussion with the health care provider prior to administration? a. Ribavirin 600 mg PO bid b. Pegylated a-interferon SUBCUT daily c. Diphenhydramine 25 mg PO every 4 hours PRN itching d. Dimenhydrinate 50 mg PO every 6 hours PRN nausea

Answer 31

b. Pegylated a-interferon SUBCUT daily

Question 32

During change-of-shift report, the nurse learns about the following four clients. Which client requires the most rapid assessment? a. 50-year-old with chronic pancreatitis who has gnawing abdominal pain b. 48-year-old who has compensated cirrhosis and is complaining of anorexia c. 45-year-old with cirrhosis and severe ascites who has an oral temperature of 38.8°C (101.8°F) d. 56-year-old who is recovering from a laparoscopic cholecystectomy and has severe shoulder pain

Answer 32

c. 45-year-old with cirrhosis and severe ascites who has an oral temperature of 38.8°C (101.8°F)

Question 33

The nurse is admitting a client who is homeless and has viral hepatitis with symptoms of severe anorexia and fatigue. Which of the following client goals should have the highest priority when the nurse is developing the plan of care? a. Increase activity level. b. Maintain adequate nutrition. c. Establish a stable home environment. d. Identify the source of exposure to hepatitis.

Answer 33

b. Maintain adequate nutrition.

Question 34

The nurse is admitting a client to the emergency department with pancreatitis who has been vomiting blood. Which of the following actions should the nurse take first? a. Insert a large-gauge IV catheter. b. Draw blood for coagulation studies. c. Check BP, heart rate, and respirations. d. Place the client in the supine position.

Answer 34

c. Check BP, heart rate, and respirations.

Question 35

The nurse is planning care for a client with acute severe pancreatitis. Which of the following client outcomes is priority? a. Expressing satisfaction with pain control b. Developing no ongoing pancreatic problems c. Maintaining normal respiratory function d. Having adequate fluid and electrolyte balance

Answer 35

c. Maintaining normal respiratory function

Question 36

Which of the following nursing actions is a priority when the nurse is caring for a client with pancreatic cancer? a. Offer high-calorie, high-protein dietary choices. b. Offer psychological support for anxiety or depression. c. Educate about the need to avoid scratching pruritic areas. d. Administer prescribed opioids to relieve pain as needed.

Answer 36

d. Administer prescribed opioids to relieve pain as needed.

Question 37

The nurse is admitting a client with acute cholecystitis. Which of the following findings is most important for the nurse to report to the health care provider? a. The client’s urine is bright yellow. b. The client’s stools are clay coloured. c. The client complains of chronic heartburn. d. The client has an increase in pain after eating.

Answer 37

b. The client’s stools are clay coloured.

Question 38

The nurse is caring for a client following an incisional cholecystectomy for cholelithiasis. Which of the following actions is priority for the nurse to implement? a. Client education about low-fat food choices b. Perform leg exercises hourly while awake. c. Ambulate the evening of the operative day. d. Turn, cough, and deep breathe every 2 hours.

Answer 38

d. Turn, cough, and deep breathe every 2 hours.

Question 39

Which of the following diagnoses is often a misdiagnosis for older-adult clients with liver disease? a. Fulminate hepatic failure b. Cirrhosis c. Dementia d. Epstein-Barr virus

Answer 39

c. Dementia