exam 4 Flashcards
(90 cards)
1
Q
A 35-year-old female patient is seen in the clinic complaining of abdominal pain. Which of the following should be included in the history and physical examination?
Digital rectal exam
Pelvic exam
Sexual history
All of the above
A
All of the above
2
Q
A patient comes to the office complaining of constipation. The patient lists all of the
following medications. Which drug could be responsible for the constipation?
Multivitamin
Magnesium hydroxide
Pepto-Bismol®
Ibuprofen
A
A patient comes to the office complaining of constipation. The patient lists all of the
3
Q
A patient is seen with complaints of diarrhea. Which of the following should be included in the patient‘s differential diagnosis?
Gastroenteritis
Inflammatory bowel disease
Lactase deficiency
All of the above
A
All of the above
4
Q
Mr. J. K., 38 years old, is 5 feet 8 inches tall and weighs 189 pounds. He reports that he has had intermittent heartburn for several months and takes Tums® with temporary relief. He has been waking during the night with a burning sensation in his chest. Which additional information would lead you to believe that gastroesophageal reflux disease (GERD) is the cause of his pain?
The pain seems better when he smokes to relieve his nerves.
Coffee and fried foods don‘t bother him,
He wakes at night coughing with a bad taste in his mouth.
All of the above
A
He wakes at night coughing with a bad taste in his mouth.
5
Q
A 29-year-old Englishman is seen in the office with complaints of pain in his chest and belly. He has been suffering the pain for 2 weeks and gets temporary relief from Alka-Seltzer®. The burning pain wakes him at night and radiates up to his chest. Which factor favors a diagnosis of gastric ulcer?
His gender
His age
His use of Alka-Seltzer
His ethnic origin
A
His use of Alka-Seltzer
6
Q
Which of the following is most effective in diagnosing appendicitis?
History and physical
Sedimentation rate
Kidney, ureter, and bladder x-ray
Complete blood count (CBC) with differentials
A
History and physical
7
Q
Which of the following is associated with celiac disease (celiac sprue)?
Malabsorption
Constipation
Rectal bleeding
Esophageal ulceration
A
Malabsorption
7
Q
A 45-year-old patient presents with a chief complaint of generalized abdominal pain. Her physical examination is remarkable for left lower quadrant tenderness. At this time, which of the following should be considered in the differential diagnosis?
Endometriosis
Colon cancer
Diverticulitis
All of the above
A
All of the above
8
Q
A 46-year-old patient is seen in the clinic with abdominal pain. Which of the following tests is essential for this patient?
CBCwith differential
Urine human chorionic gonadotropin
Barium enema
Computed tomography of the abdomen
A
Urine human chorionic gonadotropin
9
Q
A 25-year-old accountant is seen in the clinic complaining of crampy abdominal pain after meals She is often constipated and takes laxatives, which are followed by a couple of days of diarrhea.
She temporarily feels better after a bowel movement. She states she is embarrassed by flatulence and has abdominal distension. She has had no weight loss or blood in her stool. This problem has gone on for about 6 months. What should the next step be?
Obtain a complete history.
Order a barium enema.
Schedule a Bernstein‘s test.
Prescribe a trial of antispasmodics.
A
Obtain a complete history.
10
Q
A 28-year-old patient is seen in the clinic with colicky abdominal pain particular with meals. She has frequent constipation, flatulence, and abdominal distension. Which of the data make a diagnosis of diverticulitis unlikely?
Her age
Frequent constipation
Flatulence
Colicky abdominal pain
A
Her age
11
Q
A 28-year-old patient is seen with complaints of diarrhea. Which of the following responses to the history questions would help the primary care physician (PCP) establish the diagnosis of irritable bowel syndrome?
Feels relief after a bowel movement
Sometimes is constipated
Does not defecate in the middle of the night
All of the above
A
All of the above
12
Q
A patient is diagnosed with GERD, and his endoscopic report reveals the presence of
Barrett‘s epithelium. Which of the following should the PCP include in the explanation of the
pathology report?
This is a premalignant tissue.
This tissue is resistant to gastric acid.
This tissue supports healing of the esophagus.
All of the above
A
All of the above
13
Q
Which of the following dietary instructions should be given to a patient with GERD?
Eliminate coffee.
Drink peppermint tea to relieve stomach distress.
Recline and rest after meals.
Limit the amount of antacids.
A
Eliminate coffee.
14
Q
The patient with GERD should be instructed to eliminate which of these activities?
Swimming
Weight lifting
Golfing
Walking
A
Weight lifting
15
Q
A patient is diagnosed with giardia after a backpacking trip in the mountains. Which
of the following would be an appropriate treatment?
Vancomycin
Penicillin
Metronidazole
Bactrim
A
Metronidazole
16
Q
A 22-year-old is seen complaining of vague belly pain. This type of pain is seen at what point in appendicitis?
Very early
3 to 4 hours after perforation
Late in inflammation
Appendicitis never presents with vague pain.
A
Very early
17
Q
The nurse practitioner (NP) suspects a patient has a peptic ulcer. Which of the following items on the history would lead the NP to this conclusion?
Use of NSAIDs
Cigarette smoker
Ethanol consumption
All of the above
A
All of the above
18
Q
A patient is seen with dark-colored urine, and the urine dipstick reveals a high level of bilirubin.
Which of the following could be a cause of this problem?
Increased breakdown of red blood cells
Inadequate hepatocyte function
Biliary obstruction
All of the above
A
Biliary obstruction
19
Q
A 21-year-old student presents with complaints of fatigue, headache, anorexia, and a runny nose, all of which began about 2 weeks ago. She started taking vitamins and over-the counter cold preparations but feels worse. The smell of food makes her nauseated. Her boyfriend had mononucleosis about a month ago, and she wonders if she might have it also. Examination reveals cervical adenopathy and an enlarged liver and spleen. Which of the following labs would be most helpful in the differential diagnosis at this point?
Stool culture
Liver enzymes
Antihepatitis D virus
Thyroid-stimulating hormone test
A
Antihepatitis D virus
20
Q
On further questioning, the 21-year-old patient with complaints of fatigue, headache, anorexia, and a runny nose explains that she is sexually active only with her boyfriend, does not use injectable drugs, and works as an aide in a day-care center. Which of the following tests would be most helpful in confirming your diagnosis?
Hepatitis A virus (HAV) IgM
HAVIgG
Anti-HAcAg
Anti-HAsAg
A
Hepatitis A virus (HAV) IgM
21
Q
A patient is seen in the clinic with right upper quadrant pain that is radiating to the middle of the back. The NP suspects acute cholelithiasis. The NP should expect which of the following laboratory findings?
Decreased alanine aminotransferase and decreased aspartate aminotransferase
Elevated alkaline phosphatase
Elevated indirect bilirubin
Decreased white blood cells
A
Elevated alkaline phosphatase
22
Q
A patient is seen in the office with complaints of six to seven liquid bowel movements per day. Which of the following assessment findings would lead the NP to a diagnosis of inflammatory bowel disease?
Intermittent constipation with periods of diarrhea
Wakens at night with diarrhea
History of international travel
All of the above
A
History of international travel
23
Q
A patient has acute pancreatitis with seven of the diagnostic criteria from Ranson‘s criteria. In order to plan care, the NP must understand that this criteria score has which of the following meanings?
Ahigh mortality rate
An increased chance of recurrence
A7%chance of the disease becoming chronic
All of the above
A
Ahigh mortality rate
24
Which of the following is part of the treatment plan for the patient with irritable bowel syndrome?
High fiber diet
Tylenol with codeine
Dailylaxatives
Alloftheabove
High fiber diet
25
The nurse, instructing a client about malabsorption syndrome, should include that food is
absorbed in the:
mouth.
bloodstream.
stomach.
small intestine
small intestine
The mouth and stomach are used mostly for digestion. The small intestine is where most of the
absorption of food nutrients occurs. Food is not directly absorbed into the bloodstream.
26
.A client is diagnosed with appendicitis. One of the laboratory tests the nurse would expect to
monitor would be:
serum sodium.
white blood cell (WBC) count.
hemoglobin (Hgb) and hematocrit (Hct).
bilirubin level
white blood cell (WBC) count.
Infection often accompanies the inflammation of the appendix. The nurse would be looking for an elevated WBC count. Serum sodium, hemoglobin, hematocrit, and bilirubin levels are not necessarily indicated in the care of a client diagnosed with appendicitis.
27
.When assessing the pain in a client diagnosed with appendicitis, the nurse would expect to
assess:
extreme pain with slight palpation anywhere on the abdomen.
pain in the upper back when the right lower quadrant is palpated.
more pain when the pressure is released in the right lower quadrant.
no pain when the abdomen is palpated
more pain when the pressure is released in the right lower quadrant.
Typically rebound pain is associated withappendicitis. Rebound pain is described as more pain when pressure is released than when pressure is applied. Appendicitis pain is not associated with pain anywhere on the abdomen upon slight palpation. Appendicitis pain is not typically assessed in the upper back. Appendicitis is associated with pain.
28
A client is being evaluated for symptoms associated with diverticular disease. The nurse realizes that the best diagnostic test to be used to aid in this diagnosis would be:
computed tomography (CT) scan.
barium enema.
ultrasound.
x-ray study
computed tomography (CT) scan
A CT scan is the best method of detecting abscesses and complications evidenced in diverticulitis. Barium enema is contraindicated in acute diverticulitis because of the risk of contamination if there is an existing perforation. An ultrasound or x-rays would not adequately diagnose the presence of the disorder.
29
An elderly client has noted blood in her stool for the past few months. Which information in the medical history would strongly suggest colorectal cancer?
Increased bouts of vomiting
Change in bowel habits
Recent infection in the blood
Decrease in appetit
Change in bowel habits
Change in bowel habits is one of the seven danger signals for cancer. Changes in bowel habits and blood in the stool are common signs of colorectal cancer. Vomiting, decreased appetite, or recent blood infection could be symptoms of other health problems, but they are not necessarily colorectal cancer
30
.The nurse is caring for a client diagnosed with irritable bowel syndrome (IBS) who is
experiencing diarrhea. What medication would the nurse expect to administer?
1.Loperamide (Imodium)
2.Docusate sodium (Colace)
3.Lorazepam (Ativan)
4.Haloperidol (Haldol)
Loperamide (Imodium)
Antidiarrheal agents like Imodium can be given prophylactically or symptomatically on an as
needed basis. Docusate sodium (Colace), lorazepam (Ativan), and haloperidon (Haldol) are not
indicated to treat this disorder.
31
A client complains of acute gastrointestinal distress. While obtaining a health history, the nurse asks about the family history. Which disorder has a familial basis?
1.Hepatitis
2.Ulcerative colitis
3.Appendicitis
4.Bowel obstructions
Ulcerative colitis
Genetic factors have been identified as susceptibility factors for the development of ulcerative
colitis. None of the other choices have a genetic predisposition for developing the disorder.
32
A client diagnosed with appendicitis asks the nurse why this illness occurred. The nurse should
respond that the most common cause of appendicitis is:
1.ulcerative colitis.
2.obstruction of the appendix.
3.low-fat diet.
4.infection.
obstruction of the appendix.
An infection may occur with appendicitis, but the most common cause of infection is an obstruction of the appendix. The obstruction could be caused by lymph tissue, a fecalith, a foreign body, or worms. Ulcerative colitis, low-fat diet, or infection does not cause appendicitis
33
.A young client is experiencing acute abdominal pain. The nurse realizes that the most common cause for this type of pain would be:
appendicitis.
biliary tract disease.
kidney stones.
urinary tract infection
appendicitis
The most common cause of acute abdominal pain is appendicitis. Biliary tract disease is the most common disorder in the elderly, causing pain in the right upper quadrant. Kidney stones and urinary tract infections do not necessarily cause abdominal pain
34
.A client experiencing abdominal pain and diarrhea tells the nurse that he used to smoke. Which of the following gastrointestinal disturbances is this client most likely experiencing?
Irritable bowel syndrome
Crohns disease
Acute appendicitis
Small bowel obstruction
Crohns disease
Current and former smokers appear to have a greater risk of developing Crohns disease than
nonsmokers. Not smoking will not cause irritable bowel syndrome, acute appendicitis, or small
bowel obstruction.
35
.A client has a history of being treated for ulcerative colitis. The nurse realizes that a life
threatening complication of this disorder is:
Crohns disease.
small bowel obstruction.
peptic ulcer disease.
toxic megacolon.
toxic megacolon.
Toxic megacolon is a life-threatening complication of ulcerative colitis, and it requires immediate surgical intervention. Crohns disease, small bowel obstruction, and peptic ulcer disease are not life- threatening complications of ulcerative colitis.
36
The nurse assesses no bowel sounds with occasional splashing sounds over the large intestines. Which of the following do these assessment findings suggest to the nurse?
1.Ulcerative colitis
2.Irritable bowel syndrome
3.Appendicitis
4.Bowel obstruction
Bowel obstruction
Obstruction can be detected with absent bowel sounds and borborygmi or a splashing sound
heard over the large intestine. Absent bowel sounds and borborygmi are not associated with
ulcerative colitis, irritable bowel syndrome, or appendicitis
37
The nurse is instructing a client on diagnostic tests used to screen for colorectal cancer. Which of the following should be included in these instructions?
1.A digital rectal exam should be done annually.
2.A test for fecal occult blood should be done annually.
3.A flexible sigmoidoscopy should be done annually.
4.A colonoscopy should be done every 5 years after age 40
A test for fecal occult blood should be done annually
The nurse should instruct the client to have a fecal occult blood test done annually. A digital rectal exam is not a recommendation for this disease process. A flexible sigmoidoscopy should be done every 5 years after age 50. A colonoscopy should be done every 10 years after age 50.
38
Laparoscopic surgery is scheduled for a client diagnosed with appendicitis. Which of the following may be a result of laparoscopic surgery? (Select all that apply.)
1.No risk of infection
2.Less pain
3.Faster recovery times
4.Maybe more complications
5.Shorter hospital stays
6.Better visualization of the abdominal organs
2.Less pain
3.Faster recovery times
5.Shorter hospital stays
Laparoscopic surgery has less pain and faster recovery times. There are fewer complications, less
bleeding, and less risk of infection so the client has a shorter hospital stay. A risk of infection is
present with all surgical procedures. Laparoscopic surgery does not cause a better visualization
of the abdominal organs
39
.The nurse is assessing a client diagnosed with diverticulitis. Which of the following are clinical
manifestations associated with this disorder? (Select all that apply.)
Constipation or diarrhea
Left lower quadrant abdominal pain
Low-grade fever
Increased excitability
Changes in level of consciousness
Thirst
Constipation or diarrhea
Left lower quadrant abdominal pain
Low-grade fever
In diverticulitis, there may be a chronic asymptomatic condition two-thirds of the time. If there are manifestations, they would likely be constipation or diarrhea, lower abdominal pain in the left lower quadrant, and low-grade fever. Increased excitability, changes in level of consciousness, and thirst are not clinical manifestations of diverticulitis.
40
The nurse is assessing a client diagnosed with irritable bowel syndrome (IBS). Which of the
following characteristics are associated with this disorder? (Select all that apply.)
Recurrent abdominal pain
Abdominal pain that improves with defecation
Pain associated with a change in stool frequency
Pain associated with a change in stool appearance .Pain that occurs only during defecation
Recurrent abdominal pain
Abdominal pain that improves with defecation
Pain associated with a change in stool frequency
Pain associated with a change in stool appearance
IBS is relatively common and is a motility disorder of the gastrointestinal tract. It is characterized by recurrent abdominal pain that improves with defecation. The pain will also appear with a change in stool frequency. The pain is also associated with a change in stool appearance. The pain of IBS does not occur only during defecation and is not associated with passing flatus
41
A client, diagnosed with a vitamin B-12 deficiency, tells the nurse that she does not want to receive injections every month to treat the disorder. Which of the following should the nurse instruct the client regarding the effects of vitamin B-12 deficiency? (Select all that apply.)
1.Paresthesias in the hands
2.Paresthesias in the feet
3.Ataxia
4.Spinal cord degeneration
5.Loss of memory
6.Loss of the sense of smell
1.Paresthesias in the hands
2.Paresthesias in the feet
3.Ataxia
4.Spinal cord degeneration
Vitamin B-12 deficiency produces neurological abnormalities such as symmetrical paresthesias
in the hands and feet, diminished vibratory and proprioceptive sense, ataxia, and spinal cord
degeneration. Vitamin B-12 deficiency does not produce memory loss or loss of smell.
42
The nurse is planning care for a client diagnosed with an acute abdomen. Which of the following nursing diagnoses would be appropriate for this client? (Select all that apply.)
Fear
Deficient fluid volume
Ineffective coping
Acute pain
Risk of infection
Altered self-perception
Fear
Deficient fluid volume
Acute pain
Risk of infection
Nursing diagnoses appropriate for a client diagnosed with an acute abdomen include fear, deficient fluid volume, acute pain, and risk of infection. Ineffective coping and altered self perception would not apply to this client
43
1.Before administering an antacid, the nurse should instruct a client that this medication works in
the:
blood.
stomach.
small intestine.
esophagus
stomach.
Antacids work in the stomach to neutralize stomach acids. They do not work in the esophagus or small intestines. Antacids do not work in the blood
44
.The nurse is assessing a client diagnosed with gastroesophageal reflux disease. Which of the
following should be included in this assessment?
Degree of mouth burning
Difficulty swallowing
Presence of pyrosis
Painful swallowing
Presence of pyrosis
Mouth burning is not a symptom of gastroesophageal reflux disease. Difficulty swallowing or dysphagia is not associated with gastroesophageal reflux disease. Pain when swallowing is
associated with esophagitis, not acid reflux disease. Presence of pyrosis or heartburn should be
assessed in this client.
45
During an assessment, the nurse determines a client is at risk for ulcerative stomatitis and gum disease because the client has a history of:
alcohol intake
smoking.
kissing.
eating.
smoking
Clients who smoke have seven times the risk of developing gum disease. Alcohol intake increases the risk of throat cancer. Ulcerative stomatitis and gum disease is not associated with kissing or eating.
46
A client is diagnosed with a swallowing disorder. The nurse realizes that which type of diet would be indicated for this client?
Regular diet
Clear liquid diet
Mechanical soft diet
Low-fat diet
Mechanical soft diet
Some clients may need a pureed diet or mechanical soft diet, especially if their swallowing difficulty is with the oral phase. Some clients may have difficulty swallowing thin liquids and foods that are tough. The client will most likely have difficulty with a regular or low-fat diet
47
To support the nutritional needs of a client with dysphagia, the nurse realizes that all of the following are mechanisms to provide enteral feeding EXCEPT
nasogastric tube.
percutaneous endoscopic gastrostomy (PEG) tube. jejunostomy tube.
hyperalimentation
.hyperalimentation.
Hyperalimentation is associated with parenteral nutrition, not enteral nutrition. The others are
forms of administration of nutrients into the gastrointestinal tract
48
A client is scheduled for diagnostic tests to determine the ability to swallow. Which of the
following diagnostic tests will provide the best information regarding this clients status?
Pulse oximetry with water
Esophageal transit scintigraphy
Videofluoroscopy
Esophageal manometry
Videofluoroscopy
The gold standard for evaluation of dysphagia is videofluoroscopy or a modified barium
swallow. This test demonstrates the swallowing mechanism. The other tests may be prescribed;
however, they do not provide as much information as the videofluoroscopy
49
A client, diagnosed with a hiatal hernia, will experience which of the following symptoms
most frequently?
1.Nausea
2.Vomiting
3.Diarrhea
4.Heartburn
heartburn
With a hiatal hernia, stomach acids reflux into the esophagus, causing pain and irritation that the
patient will associate with heartburn. Nausea, vomiting, and diarrhea are not symptoms typically
associated with a hiatal hernia.
50
The nurse is instructing a client diagnosed with a hiatal hernia on ways to reduce the symptoms. Which of the following should be included in these instructions?
Eat large meals to keep the stomach full.
Drink lots of liquids so that the stomach does not have to work so hard.
Avoid lying down after meals.
Lie down after eating
Avoid lying down after meals.
Sitting upright or sleeping with the head of the bed elevated helps keep the stomach contents in
the stomach. The meal size should be smaller, and meals should be eaten more often so as not to
overfill the stomach
51
.A client is diagnosed with burning mouth syndrome. Which of the following interventions should be included in this clients plan of care?
1.Assess the condition of the clients teeth.
2.Collect a saliva specimen for analysis.
3.Tell the client to avoid vitamin supplements.
4.Teach the client how to conduct an oral self-assessment daily.
.Assess the condition of the clients teeth.
Interventions for a client diagnosed with burning mouth syndrome include assessing the
condition of the teeth. A saliva specimen is not used to diagnose this disorder. Vitamin supplements do not contribute to this disorder. An oral self-assessment does not need to be
completed every day
52
.During an assessment, the nurse learns that a client is inhaling while swallowing food. Which of the following does this assessment finding suggest to the nurse?
1.The client is recovering from a stroke.
2.The client is at risk for aspiration.
3.The client will experience dyspepsia.
4.The client has esophageal reflux disease.
The client is at risk for aspiration.
In clients with dysphagia, inspiration commonly occurs during swallowing. This increases the
risk for aspiration. This assessment finding does not indicate that the client is recovering from a
stroke
53
1.A client is experiencing brash water. The nurse realizes this symptom is associated with:
1.oral cancer.
gastric ulcers.
dysphagia.
Barretts esophagus
Brash water, or the sensation of the mouth filling with saliva because of acid backflow into the
esophagus, is a symptom of Barretts esophagus. Brash water is not associated with oral cancer,
gastric ulcers, or dysphagia.
54
A client has been prescribed Zantac for gastroesophageal reflux disease. The nurse realizes
this medication is classified as a:
histamine H2-receptor antagonist.
proton pump inhibitor.
prokinetic agent.
antihistamine.
histamine H2-receptor antagonist.
Zantac is a histamine H2-receptor antagonist. This medication is not classified as being a proton
pump inhibitor, prokinetic agent, or antihistamine.
55
A client is diagnosed with peptic ulcer disease caused by NSAID use. Which of the following
would be indicated for this client?
Antibiotic therapy
Treatment similar to a client with peptic ulcer disease
Preparation for surgery
.Insertion of a nasogastric tube for gastric lavage
Treatment similar to a client with peptic ulcer disease
For clients diagnosed with peptic ulcer disease caused by NSAID use, the anti-inflammatory
medication should be discontinued and the client should receive treatment similar to that of
peptic ulcer disease. Surgery is not indicated. Antibiotics are not indicated. Gastric lavage is not
indicated
56
The nurse is instructing a client about symptoms associated with peptic ulcer disease. Which of
the following should be included in these instructions? (Select all that apply.)
Abdominal pain
Pain in the middle of the night
Weight loss
Poor appetite
Bloating
Constipation
Abdominal pain
Pain in the middle of the night
Weight loss
Poor appetite
Bloating
Symptoms of peptic ulcer disease include abdominal pain, pain in the middle of the night; weight loss; poor appetite; and bloating. Constipation is not a symptom of peptic ulcer disease
57
The nurse is planning care for a client diagnosed with oral ulcers. Which of the following should be included in this clients plan of care? (Select all that apply.)
1.Encourage frequent oral hygiene.
2.Rinse mouth with chlorhexidine.
3.Increase consumption of hot fluids.
4.Instruct in the use of topical corticosteroids. 5.Encourage the client to limit smoking.
6.Avoid the use of dental floss
Encourage frequent oral hygiene.
Rinse mouth with chlorhexidine.
Instruct in the use of topical corticosteroids.
Good oral hygiene is essential, and rinsing the mouth with chlorhexidine is recommended.Topical corticosteroids can promote resolution of the ulcers. Drinking hot fluids and smoking may aggravate oral ulcerations and are not included in the plan of care. The client should be instructed to not smoke at all. Dental floss will not cause oral ulcers.
58
The nurse is instructing a client on conducting an oral self-assessment. Which of the following
should be included in the nurses instructions? (Select all that apply.)
1.Check the face for symmetry.
2.Check skin on the face for changes.
3.Check the neck for swellings or lumps.
4.Check inside of cheeks for tenderness.
5.Check the tongue for changes.
6.Check urine for change in color.
1.Check the face for symmetry.
2.Check skin on the face for changes.
3.Check the neck for swellings or lumps.
4.Check inside of cheeks for tenderness.
5.Check the tongue for changes.
When instructing a client on an oral self-assessment, the nurse should include having the client check the face for symmetry; the skin on the face for changes; the neck for swellings or lumps; the inside of the cheeks for tenderness; and the tongue for changes. The urine is not checked when doing an oral self-assessment
59
The nurse is assisting a client with indirect techniques to improve swallowing. Which of the
following are techniques included in the nurses assistance? (Select all that apply.)
1.Tongue mobility exercises
2..Application of ice
3.Repetitive head lift exercises
4.Positioning
5.Range-of-motion exercises for the neck
6.Range-of-motion exercises for the shoulders
1.Tongue mobility exercises
2..Application of ice
3.Repetitive head lift exercises
Indirect techniques to improve swallowing include tongue mobility exercises, application of ice,
and repetitive head lift exercises. Positioning is a compensatory mechanism. Range-of-motion
exercises for the neck or shoulders does not help improve swallowing.
60
.A client is diagnosed with esophageal pain. Which of the following medications would be
indicated for this client? (Select all that apply.)
Vasodilators
Calcium channel blockers
Isosorbide dinitrate
Antibiotics
Antipyretics
Antihistamines
Vasodilators
Calcium channel blockers
Isosorbide dinitrate
The first line of treatment for esophageal pain is often the same medications used to treat angina
of cardiac origin and would include vasodilators, calcium channel blockers, and isosorbide dinitrate. Antibiotics, antipyretics, and antihistamines are not medications used to treat esophageal pain.
61
A child care worker complains of flu-like symptoms. On further assessment, hepatitis is suspected. The nurse realizes that this individual is at risk for which type of hepatitis?
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis A
Hepatitis A virus (HAV) is spread through the fecal-oral route. Child care workers are at greater
risk because of potentially poor hygiene practices. Child care workers are not at the same risk for
contracting hepatitis B, C, or D.
62
An older male is diagnosed with cirrhosis of the liver. The nurse knows that the most likely cause of this problem is:
1.being in the military.
2.traveling to a foreign country.
3.drinking excessive alcohol.
4.eating bad food
.drinking excessive alcohol
The destruction to the liver from alcohol often progresses from fatty liver to alcoholic hepatitis
and culminates in alcoholic cirrhosis. Alcoholic cirrhosis accounts for a great number of individuals diagnosed with this disease. Cirrhosis is not associated with being in the military, traveling to a
foreign country, or eating bad food.
63
When the liver is seriously damaged, ammonia levels can rise in the body. One of the treatments for this is:
administering intravenous (IV) neomycin.
giving vitamin K.
giving lactulose.
starting the patient on insulin
giving lactulose
Lactulose is a laxative that works by pulling water into the stool. It also helps pull ammonia from the blood into the colon for expulsion. IV antibiotics do not reduce serum ammonia levels. Vitamin K controls bleeding, but it does not reduce ammonia levels. Insulin is not used to reduce ammonia levels.
64
.A client is scheduled for a liver biopsy. The nurse realizes that the most important sign to assess for is:
1.infection.
2..bleeding.
3.pain.
nausea and vomiting.
bleeding.
After a liver biopsy, the client is monitored for bleeding or hemorrhage. Infection and pain are of
concern, but they are not the most important signs to be monitored. Nausea and vomiting are not
typically associated with a liver biopsy.
65
The nurse realizes that the organ which is a major site for metastases, harboring and growing cancerous cells that originated in some other part of the body, is the:
spleen.
gallbladder.
liver.
stomach
liver.
In most developed countries, this secondary type of liver cancer is more common than cancer that originates in the liver itself. The spleen, gallbladder, and stomach are not major sites for metastases
66
.A school age child is placed on a waiting list for a liver transplant. The nurse knows that the
most common reason for children to need this type of transplant is because of:
1.cirrhosis due to hepatitis C.
2..biliary atresia.
diabetes.
Crohns disease
biliary atresia.
Biliary atresia is the most common reason for children to have a liver transplant. Cirrhosis due to
hepatitis C is the reason for most adults to have a transplant. Children do not typically need a liver transplant for diabetes or Crohns disease.
67
Because health care workers are at a greater risk of hepatitis B infection, it is recommended that all health care workers:
wash their hands often.
avoid foreign travel.
become vaccinated.
drink bottled water only
become vaccinated.
Because of the risk of blood and body fluid exposure, it is recommended that all health care workers be vaccinated against hepatitis B virus. All health care workers should engage in frequent handwashing, but handwashing is not the primary mechanism to prevent the onset of hepatitis B. Avoiding foreign travel and drinking bottled water only will not reduce the risk of hepatitis B.
68
.A client who usually smokes a pack of cigarettes a day tells the nurse that he cannot stand the
smell of smoke. The nurse realizes that this client is in which phase of hepatitis?
Preicteric
Icteric
Posticteric
Recovery
Preicteric
In the preicteric phase of hepatitis, some smokers will have an aversion to smoking as a first sign of the disease. Smoking is not affected with the icteric or posticteric phases of the disease.Recovery is not a phase of hepatitis
69
A female client is surprised to learn that she has been diagnosed with hemochromatosis. Which
of the following should the nurse respond to this client?
It doesnt affect people until they are in their 50s.
I would ask the doctor if hes sure about the diagnosis.
Females often do not experience the effects of the disease until menopause.
All women have the disorder but not the symptoms
Females often do not experience the effects of the disease until menopause.
Womendonot experience the effects of hemochromatosis until menopause when the regular loss of blood stops. This disorder is a genetic disorder and can affect individuals of all ages. The
nurse should not doubt the physicians diagnosis. All women do not have this disorder.
70
A client is diagnosed with liver disease. Which of the following is one impact of this disorder on a clients fluid and electrolyte status?
1.Hyperkalemia
2.Hypercalcemia
3.Hypernatremia
4.Hyponatremia
Hyponatremia
Liver disease effects the fluid and electrolyte status by causing ascites, edema, hypokalemia, hypocalcemia, and hyponatremia. Liver disease does not cause hyperkalemia, hypercalcemia, or
hypernatremia.
71
The nurse, caring for a client recovering from the placement of a shunt to treat portal hypertension, should assess the client for which of the following complications associated with this surgery?
1.Myocardial infarction
2.Pulmonary emboli
3.Pulmonary edema
4.Decreased peripheral pulses
.Pulmonary edema
Complications after shunt surgery include the development of pulmonary edema. Myocardial
infarction, pulmonary emboli, and decreased peripheral pulses are not complications associated
with this type of surgery.
72
A client is diagnosed with macrovesicular fatty liver. Which of the following should the nurse
instruct this client?
Expect to develop jaundice.
.Avoid all alcohol.
Increase exercise.
Treatment includes antibiotic therapy
.Avoid all alcohol.
The client diagnosed with macrovesicular fatty liver should be instructed to avoid all alcohol.
Jaundice is a symptom of microvesicular fatty liver. The client should be instructed to rest.
Antibiotic therapy is not indicated for macrovesicular fatty liver
73
A client diagnosed with cirrhosis is experiencing the complication of ascites. Which of the following would be considered treatment for this complication?
1.Fluid restriction
2.Low-sodium diet
3.Increased exercise
4..Diuretic therapy
5.Pain medication
6.Bed rest
1.Fluid restriction
2.Low-sodium diet
4.Diuretic therapy
Ascites is the accumulation of fluid in the peritoneal cavity. Treatment strategies include fluid
restriction (1000 to 1500 mL/day), low-sodium diet (200 to 500 mg/day), and diuretic therapy to
remove the excessive fluid. Increased exercise, pain medication, and bed rest are not included as
treatments for this complication.
74
A client is recovering from an endoscopic retrograde cholangiopancreatogram (ERCP). Which of the following should the nurse assess as possible complications from this procedure? (Select all that apply.)
1.Perforation of the stomach
2.Perforated duodenum
3.Pancreatitis
4.Aspiration of gastric contents
5..Anaphylactic reaction to the contrast dye 6.Perforated bladder
1.Perforation of the stomach
2.Perforated duodenum
3.Pancreatitis
4.Aspiration of gastric contents
5..Anaphylactic reaction to the contrast dye
Potential complications of an ERCP are perforated stomach and duodenum, pancreatitis, anaphylactic reaction to the contrast diet, aspiration of gastric contents, and reaction to anesthesia. A perforated bladder is a possible complication from a paracentesis.
75
A client is demonstrating yellow pigmentation of the skin and sclera. Which of the following can be used to describe this clients symptoms? (Select all that apply.)
1.Jaundice
2.Dyspepsia
3..Icterus
4.Sclerosis
5.Kernicterus
6..Cirrhosis
1.Jaundice
3..Icterus
5.Kernicterus
Terms used to describe yellow pigmentation of the skin and sclera include jaundice, icterus, and kernicterus. Dyspepsia, sclerosis, and cirrhosis are not terms used to describe the yellow pigmentation of the skin and sclera.
76
The nurse is providing dietary instruction to a client diagnosed with Wilsons disease. Which of the following should be included in these instructions? (Select all that apply.)
Avoid liver.
Avoid shellfish.
Eat soy products.
Use avocados in salads.
Avoid nectarines.
Avoid mushrooms.
Avoid liver.
Avoid shellfish.
Avoid nectarines.
Avoid mushrooms.
Dietary instruction for a client diagnosed with Wilsons disease include reducing the intake of foods high in copper. This includes avoiding liver, shellfish, soy products, avocado, nectarines, and mushrooms.
77
A client is diagnosed with a disorder of the liver. The nurse realizes this client might experience which of the following? (Select all that apply.)
1.Low vitamin A levels
2.Increased bleeding
3.Poor digestion of fats
4.Insulin resistance
5.Elevated levels of vitamin E
6.Nerve damage
1.Low vitamin A levels
2.Increased bleeding
3.Poor digestion of fats
4.Insulin resistance
6.Nerve damage
Effects of a liver disorder on a client are many. Some of the functions affected by this disorder include low levels of fat soluble vitamins, including A and E; poor synthesis of clotting factors, leading to increased bleeding; poor digestion of fats; insulin resistance; and nerve damage.
78
A client is diagnosed with portal hypertension. The nurse should assess the client for which of the following disorders associated with this diagnosis? (Select all that apply.)
1.Esophageal varices
2.Splenomegaly
3..Hemorrhoids
4.Caput medusae
5..Gastritis
6.Gallstone formation
1.Esophageal varices
2.Splenomegaly
3..Hemorrhoids
4.Caput medusae
Portal hypertension can lead to the development of esophageal varices, splenomegaly, hemorrhoids, and caput medusae. Portal hypertension does not lead to gastritis or gallston formation.
79
The nurse clarifies that unconjugated bilirubin, which is made up of broken-down red
cells, is:
stored in the gallbladder to make bile.
water insoluble bilirubin that must be converted by the liver.
a by-product which is excreted directly into the bowel for excretion.
necessary for digestion of fats.
water insoluble bilirubin that must be converted by the liver.
Unconjugated bilirubin is a water-insoluble product that must be converted in the liver to conjugated
bilirubin (water soluble) so that it may be excreted through the bowel.
80
The patient with cirrhosis has an albumin of 2.8 g/dL. The nurse is aware that normal is 3.5 g/dL to 5 g/dL. Based on these findings, what would the nurse expect the patient to exhibit?
Jaundice
Edema
Copious urine output
Pallor
Edema
Low serum albumin levels result also from excessive loss of albumin into urine or into third space volumes, causing ascites or edema
81
Which nursing intervention should be completed immediately after the physician has performed a needle liver biopsy?
Assisting to ambulate for the bathroom
Keeping the patient on the right side for a minimum of 2 hours
Taking vital signs every 4 hours
Keeping the patient on the left side for a minimum of 4 hours
Keeping the patient on the right side for a minimum of 2 hours
Keep the patient lying on the right side for minimum of 2 hours to splint the puncture site. It compresses the liver capsule against the chest wall to decrease the risk of hemorrhage or bile leak. Vital signs are taken every 15 minutes for 30 minutes, then every 30 minutes for 2 hours.
82
Immediately following a liver biopsy, the patient becomes dyspneic, the pulse increases to 100, and no breath sounds can be heard on the affected side. What should the nurse suspect?
Peritonitis
Pneumothorax
Hemorrhage of the liver
Pleural effusion
Pneumothorax
Pneumothorax is a possible complication of paracentesis. The patients head of the bed should be
raised slightly, but kept on the right side. Oxygen should be administered and the assessment reported to the charge nurse and documented
83
The patients cirrhosis of the liver has also caused a dilation of the veins of the lower esophagus secondary to portal hypertension, resulting in the development of the complication of:
esophageal varices.
diverticulosis.
Crohn disease.
esophageal reflux (GERD)
Esophageal varices
Esophageal varices (a complex of longitudinal, tortuous veins at the lower end of the esophagus)
enlarge and become edematous as the result of portal hypertension
84
The patient with cirrhosis has a rising ammonia level and is becoming disoriented. The patient waves to the nurse as she enters the room. How should the nurse interpret this?
As an attempt to get the nurses attention
As asterixis
As an indication of respiratory obstruction from varices
As spasticity
As asterixis
Asterixis is the flapping tremor seen as the patient deteriorates into ammonia intoxication or hepatic encephalopathy
85
Howdoes the administration of neomycin (Mycifradin) reduce the production of
ammonia?
Byassisting the hepatic cells to regenerate
Byreducing ascites
Bydecreasing the bacteria in the gut
Byhelping to digest fats and proteins
Bydecreasing the bacteria in the gut
The buildup of ammonia can be prevented with the use of lactulose (Chronulac) and neomycin. Ammonia is produced in the gut by bacterial action. By reducing the bacteria, less ammonia is produced
86
The nurse explains that the use of cyclosporine as an immunosuppressant has been successful in the reduction of rejection of liver transplants because the drug:
increases the rate of the regeneration of liver cells.
can overcome complications presented by hepatitis C.
increases blood supply to transplant.
does not suppress bone marrow
does not suppress bone marrow.
Cyclosporine is an immunosuppressant that does not cause bone marrow suppression nor does it
impede healing.
87
family member of a patient asks the nurse about the protein-restricted diet ordered because of advanced liver disease with hepatic encephalopathy. What statement by the nurse would best explain the purpose of the diet?
The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive system
The liver heals better with a high-carbohydrate diet rather than with a diet high in protein
Most people have too much protein in their diets.
The amount in this diet is better for liver healing
The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive system
Because of portal hypertension, the blood flows around the liver, and ammonia made from
protein collects in the brain, causing hallucinations.
The patient with hepatic encephalopathy is on a very low-protein to no-protein diet. The goal of
management of hepatic encephalopathy is the reduction of ammonia formation in the intestines
88
The nurse would make provisions in the plan of care for a person who has had a liver transplant to prevent:
fluid congestion.
fatigue.
infection.
urinary retention.
infection.
Acritical aspect of nursing care following liver transplantation is monitoring for infection. The
major postoperative complications of a liver transplant are rejection and infection.
89
What are the indications for a liver transplant? (Select all that apply.)
Congenital biliary abnormalities
Hepatic malignancy
Chronic hepatitis
Cirrhosis due to alcoholism
Gallbladder disease
Congenital biliary abnormalities
Hepatic malignancy
Chronic hepatitis
Indications for liver transplantation include congenital biliary abnormalities, inborn errors of metabolism, hepatic malignancy (confined to the liver), sclerosing cholangitis, and chronic end stage liver disease
