From Brunners Flashcards
You are caring for a patient who has a diagnosis of syndrome of inappropriate antidiuretic hormone
secretion (SIADH). Your patients plan of care includes assessment of specific gravity every 4 hours. The
results of this test will allow the nurse to assess what aspect of the patients health?
A) Nutritional status
B) Potassium balance
C) Calcium balance
D) Fluid volume status
Ans: D
Feedback:
A specific gravity will detect if the patient has a fluid volume deficit or fluid volume excess. Nutrition, potassium, and calcium levels are not directly indicat
You are caring for a patient admitted with a diagnosis of acute kidney injury. When you review your
patients most recent laboratory reports, you note that the patients magnesium levels are high. You should
prioritize assessment for which of the following health problems?
A) Diminished deep tendon reflexes
B) Tachycardia
C) Cool, clammy skin
D) Acute flank pain
Ans: A
Feedback:
To gauge a patients magnesium status, the nurse should check deep tendon reflexes. If the reflex is
absent, this may indicate high serum magnesium. Tachycardia, flank pain, and cool, clammy skin are not
typically associated with hypermagnesemia.
You are working on a burns unit and one of your acutely ill patients is exhibiting signs and symptoms of
third spacing. Based on this change in status, you should expect the patient to exhibit signs and
symptoms of what imbalance?
A) Metabolic alkalosis
B) Hypermagnesemia
C) Hypercalcemia
D) Hypovolemia
Ans: D
Feedback:
Third-spacing fluid shift, which occurs when fluid moves out of the intravascular space but not into the
intracellular space, can cause hypovolemia. Increased calcium and magnesium levels are not indicators
of third-spacing fluid shift. Burns typically cause acidosis, not alkalosis.
A patient with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that
hyperventilation is the most common cause of which acidbase imbalance?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Increased PaCO2
D) CNS disturbances
Ans: B
Feedback:
The most common cause of acute respiratory alkalosis is hyperventilation. Extreme anxiety can lead to
hyperventilation. Acute respiratory acidosis occurs in emergency situations, such as pulmonary edema, and is exhibited by hypoventilation and decreased PaCO2
. CNS disturbances are found in extreme
hyponatremia and fluid overload.
You are an emergency-room nurse caring for a trauma patient. Your patient has the following arterial
blood gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How would you interpret these results?
A) Respiratory acidosis with no compensation
B) Metabolic alkalosis with a compensatory alkalosis
C) Metabolic acidosis with no compensation
D) Metabolic acidosis with a compensatory respiratory alkalosis
Ans: D
Feedback:
A low pH indicates acidosis (normal pH is 7.35 to 7.45). The PaCO3
is also low, which causes alkalosis. The bicarbonate is low, which causes acidosis. The pH bicarbonate more closely corresponds with a
decrease in pH, making the metabolic component the primary problem.
You are making initial shift assessments on your patients. While assessing one patients peripheral IV
site, you note edema around the insertion site. How should you document this complication related to IV
therapy?
A) Air emboli
B) Phlebitis
C) Infiltration
D) Fluid overload
Ans: C
Feedback:
Infiltration is the administration of nonvesicant solution or medication into the surrounding tissue. This
can occur when the IV cannula dislodges or perforates the wall of the vein. Infiltration is characterized
by edema around the insertion site, leakage of IV fluid from the insertion site, discomfort and coolness
in the area of infiltration, and a significant decrease in the flow rate. Air emboli, phlebitis, and fluid
overload are not indications of infiltration.
You are performing an admission assessment on an older adult patient newly admitted for end-stage
liver disease. What principle should guide your assessment of the patients skin turgor?
A) Overhydration is common among healthy older adults.
B) Dehydration causes the skin to appear spongy.
C) Inelastic skin turgor is a normal part of aging.
D) Skin turgor cannot be assessed in patients over 70.
Ans: C
Feedback:
Inelastic skin is a normal change of aging. However, this does not mean that skin turgor cannot be
assessed in older patients. Dehydration, not overhydration, causes inelastic skin with tenting. Overhydration, not dehydration, causes the skin to appear edematous and spongy.
The physician has ordered a peripheral IV to be inserted before the patient goes for computed
tomography. What should the nurse do when selecting a site on the hand or arm for insertion of an IV
catheter?
A) Choose a hairless site if available.
B) Consider potential effects on the patients mobility when selecting a site.
C) Have the patient briefly hold his arm over his head before insertion.
D) Leave the tourniquet on for at least 3 minutes.
Ans: B
Feedback:
Ideally, both arms and hands are carefully inspected before choosing a specific venipuncture site that
does not interfere with mobility. Instruct the patient to hold his arm in a dependent position to increase
blood flow. Never leave a tourniquet in place longer than 2 minutes. The site does not necessarily need
to be devoid of hair
A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased
intracranial pressure. This solution will increase the number of dissolved particles in the patients blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This
process is best described as which of the following?
A) Hydrostatic pressure
B) Osmosis and osmolality
C) Diffusion
D) Active transport
Ans: B
Feedback:
Osmosis is the movement of fluid from a region of low solute concentration to a region of high solute
concentration across a semipermeable membrane. Hydrostatic pressure refers to changes in water or
volume related to water pressure. Diffusion is the movement of solutes from an area of greater
concentration to lesser concentration; the solutes in an intact vascular system are unable to move so
diffusion normally should not be taking place. Active transport is the movement of molecules against the
concentration gradient and requires adenosine triphosphate (ATP) as an energy source; this process
typically takes place at the cellular level and is not involved in vascular volume changes
You are the surgical nurse caring for a 65-year-old female patient who is postoperative day 1 following a
thyroidectomy. During your shift assessment, the patient complains of tingling in her lips and fingers. She tells you that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle
tone. What electrolyte imbalance should you first suspect?
A) Hypophosphatemia
B) Hypocalcemia
C) Hypermagnesemia
D) Hyperkalemia
Ans: B
Feedback:
Tetany is the most characteristic manifestation of hypocalcemia and hypomagnesemia. Sensations of
tingling may occur in the tips of the fingers, around the mouth, and, less commonly, in the feet. Hypophosphatemia creates central nervous dysfunction, resulting in seizures and coma. Hypermagnesemia creates hypoactive reflexes and somnolence. Signs of hyperkalemia include
paresthesias and anxiety.
A nurse is planning care for a nephrology patient with a new nursing graduate. The nurse states, A
patient in renal failure partially loses the ability to regulate changes in pH. What is the cause of this
partial inability?
A) The kidneys regulate and reabsorb carbonic acid to change and maintain pH.
B) The kidneys buffer acids through electrolyte changes.
C) The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH.
D) The kidneys combine carbonic acid and bicarbonate to maintain a stable pH.
Ans: C
Feedback:
The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as
reabsorb them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis,
the kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. The lungs
regulate and reabsorb carbonic acid to change and maintain pH. The kidneys do not buffer acids through
electrolyte changes; buffering occurs in reaction to changes in pH. Carbonic acid works as the chemical
medium to exchange O2 and CO2
in the lungs to maintain a stable pH whereas the kidneys use
bicarbonate as the chemical medium to maintain a stable pH by moving and eliminating H+
You are caring for a 65-year-old male patient admitted to your medical unit 72 hours ago with pyloric
stenosis. A nasogastric tube placed upon admission has been on low intermittent suction ever since. Upon review of the mornings blood work, you notice that the patients potassium is below reference
range. You should recognize that the patient may be at risk for what imbalance?
A) Hypercalcemia
B) Metabolic acidosis
C) Metabolic alkalosis
D) Respiratory acidosis
Ans: C
Feedback:
Probably the most common cause of metabolic alkalosis is vomiting or gastric suction with loss of
hydrogen and chloride ions. The disorder also occurs in pyloric stenosis in which only gastric fluid is
lost. Vomiting, gastric suction, and pyloric stenosis all remove potassium and can cause hypokalemia. This patient would not be at risk for hypercalcemia; hyperparathyroidism and cancer account for almost
all cases of hypercalcemia. The nasogastric tube is removing stomach acid and will likely raise pH
The nurse is preparing to insert a peripheral IV catheter into a patient who will require fluids and IV
antibiotics. How should the nurse always start the process of insertion?
A) Leave one hand ungloved to assess the site.
B) Cleanse the skin with normal saline.
C) Ask the patient about allergies to latex or iodine.
D) Remove excessive hair from the selected site.
Ans: C
Feedback:
Before preparing the skin, the nurse should ask the patient if he or she is allergic to latex or iodine, which are products commonly used in preparing for IV therapy. A local reaction could result in irritation
to the IV site, or, in the extreme, it could result in anaphylaxis, which can be life threatening. Both hands
should always be gloved when preparing for IV insertion, and latex-free gloves must be used or the
patient must report not having latex allergies. The skin is not usually cleansed with normal saline prior to
insertion. Removing excessive hair at the selected site is always secondary to allergy inquiry.
A patient who is being treated for pneumonia starts complaining of sudden shortness of breath. An
arterial blood gas (ABG) is drawn. The ABG has the following values: pH 7.21, PaCO2 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect?
A) Respiratory acidosis
B) Metabolic alkalosis
C) Respiratory alkalosis
D) Metabolic acidosis
Ans: A
Feedback:
The pH is below 7.40, PaCO2
is greater than 40, and the HCO3
is normal; therefore, it is a respiratory
acidosis, and compensation by the kidneys has not begun, which indicates this was probably an acute
event. The HCO3 of 24 is within the normal range so it is not metabolic alkalosis. The pH of 7.21
indicates an acidosis, not alkalosis. The pH of 7.21 indicates it is an acidosis but the HCO3 of 24 is
within the normal range, ruling out metabolic acidosis.
One day after a patient is admitted to the medical unit, you note that the patient is oliguric. You notify
the acute-care nurse practitioner who orders a fluid challenge of 200 mL of normal saline solution over
15 minutes. This intervention will achieve which of the following?
A) Help distinguish hyponatremia from hypernatremia
B) Help evaluate pituitary gland function
C) Help distinguish reduced renal blood flow from decreased renal function
D) Help provide an effective treatment for hypertension-induced oliguria
Ans: C
Feedback:
If a patient is not excreting enough urine, the health care provider needs to determine whether the depressed renal function is the result of reduced renal blood flow, which is a fluid volume deficit (FVD
or prerenal azotemia), or acute tubular necrosis that results in necrosis or cellular death from prolonged
FVD. A typical example of a fluid challenge involves administering 100 to 200 mL of normal saline
solution over 15 minutes. The response by a patient with FVD but with normal renal function is
increased urine output and an increase in blood pressure. Laboratory examinations are needed to
distinguish hyponatremia from hypernatremia. A fluid challenge is not used to evaluate pituitary gland
function. A fluid challenge may provide information regarding hypertension-induced oliguria, but it is
not an effective treatment.
The community health nurse is performing a home visit to an 84-year-old woman recovering from hip
surgery. The nurse notes that the woman seems uncharacteristically confused and has dry mucous
membranes. When asked about her fluid intake, the patient states, I stop drinking water early in the day
because it is just too difficult to get up during the night to go to the bathroom. What would be the nurses
best response?
A) I will need to have your medications adjusted so you will need to be readmitted to the hospital for a
complete workup.
B) Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we
need to adjust the timing of your fluids.
C) It is normal to be a little confused following surgery, and it is safe not to urinate at night.
D)
If you build up too much urine in your bladder, it can cause you to get confused, especially when
your body is under stress.
Ans: B
Feedback:
In elderly patients, the clinical manifestations of fluid and electrolyte disturbances may be subtle or
atypical. For example, fluid deficit may cause confusion or cognitive impairment in the elderly person. There is no mention of medications in the stem of the question or any specific evidence given for the
need for readmission to the hospital. Confusion is never normal, common, or expected in the elderly. Urinary retention does normally cause confusion.
A 73-year-old man comes into the emergency department (ED) by ambulance after slipping on a small
carpet in his home. The patient fell on his hip with a resultant fracture. He is alert and oriented; his
pupils are equal and reactive to light and accommodation. His heart rate is elevated, he is anxious and
thirsty, a Foley catheter is placed, and 40 mL of urine is present. What is the nurses most likely
explanation for the low urine output?
A) The man urinated prior to his arrival to the ED and will probably not need to have the Foley
catheter kept in place.
B) The man likely has a traumatic brain injury, lacks antidiuretic hormone (ADH), and needs
vasopressin.
C) The man is experiencing symptoms of heart failure and is releasing atrial natriuretic peptide that
results in decreased urine output.
D) The man is having a sympathetic reaction, which has stimulated the reninangiotensinaldosterone
system that results in diminished urine output.
Ans: D
Feedback:
Renin is released by the juxtaglomerular cells of the kidneys in response to decreased renal perfusion. Angiotensin-converting enzyme converts angiotensin I to angiotensin II. Angiotensin II, with its
vasoconstrictor properties, increases arterial perfusion pressure and stimulates thirst. As the sympathetic
nervous system is stimulated, aldosterone is released in response to an increased release of renin, which
decreases urine production. Based on the nursing assessment and mechanism of injury, this is the most
likely causing the lower urine output. The man urinating prior to his arrival to the ED is unlikely; the fall
and hip injury would make his ability to urinate difficult. No assessment information indicates he has a
head injury or heart failure.
A nurse educator is reviewing peripheral IV insertion with a group of novice nurses. How should these
nurses be encouraged to deal with excess hair at the intended site?
A) Leave the hair intact.
B) Shave the area.
C) Clip the hair in the area.
D) Remove the hair with a depilatory.
Ans: C
Feedback:
Hair can be a source of infection and should be removed by clipping; it should not be left at the site. Shaving the area can cause skin abrasions, and depilatories can irritate the skin.
You are the nurse evaluating a newly admitted patients laboratory results, which include several values
that are outside of reference ranges. Which of the following would cause the release of antidiuretic
hormone (ADH)?
A) Increased serum sodium
B) Decreased serum potassium
C) Decreased hemoglobin
D) Increased platelets
Ans: A
Feedback:
Increased serum sodium causes increased thirst and the release of ADH by the posterior pituitary gland. When serum osmolality decreases and thirst and ADH secretions are suppressed, the kidney excretes
more water to restore normal osmolality. Levels of potassium, hemoglobin, and platelets do not directly
affect ADH release.
A newly graduated nurse is admitting a patient with a long history of emphysema. The new nurses
preceptor is going over the patients past lab reports with the new nurse. The nurse takes note that the
patients PaCO2 has been between 56 and 64 mm Hg for several months. The preceptor asks the new
nurse why they will be cautious administering oxygen. What is the new nurses best response?
A) The patients calcium will rise dramatically due to pituitary stimulation.
B) Oxygen will increase the patients intracranial pressure and create confusion.
C) Oxygen may cause the patient to hyperventilate and become acidotic.
D) Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia.
Ans: D
Feedback:
When PaCO2 chronically exceeds 50 mm Hg, it creates insensitivity to CO2
in the respiratory medulla, and the use of oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia. No
information indicates the patients calcium will rise dramatically due to pituitary stimulation. No
feedback system that oxygen stimulates would create an increase in the patients intracranial pressure and
create confusion. Increasing the oxygen would not stimulate the patient to hyperventilate and become
acidotic; rather, it would cause hypoventilation and acidosis.
The nurse is providing care for a patient with chronic obstructive pulmonary disease. When describing
the process of respiration the nurse explains how oxygen and carbon dioxide are exchanged between the
pulmonary capillaries and the alveoli. The nurse is describing what process?
A) Diffusion
B) Osmosis
C) Active transport
D) Filtration
Ans: A
Feedback:
Diffusion is the natural tendency of a substance to move from an area of higher concentration to one of
lower concentration. It occurs through the random movement of ions and molecules. Examples of
diffusion are the exchange of oxygen and carbon dioxide between the pulmonary capillaries and alveoli
and the tendency of sodium to move from the ECF compartment, where the sodium concentration is
high, to the ICF, where its concentration is low. Osmosis occurs when two different solutions are
separated by a membrane that is impermeable to the dissolved substances; fluid shifts through the
membrane from the region of low solute concentration to the region of high solute concentration until
the solutions are of equal concentration. Active transport implies that energy must be expended for the
movement to occur against a concentration gradient. Movement of water and solutes occurring from an
area of high hydrostatic pressure to an area of low hydrostatic pressure is filtration.
When planning the care of a patient with a fluid imbalance, the nurse understands that in the human
body, water and electrolytes move from the arterial capillary bed to the interstitial fluid. What causes
this to occur?
A) Active transport of hydrogen ions across the capillary walls
B) Pressure of the blood in the renal capillaries
C) Action of the dissolved particles contained in a unit of blood
D) Hydrostatic pressure resulting from the pumping action of the heart
Ans: D
Feedback:
An example of filtration is the passage of water and electrolytes from the arterial capillary bed to the
interstitial fluid; in this instance, the hydrostatic pressure results from the pumping action of the heart. Active transport does not move water and electrolytes from the arterial capillary bed to the interstitial
fluid, filtration does. The number of dissolved particles in a unit of blood is concerned with osmolality. The pressure in the renal capillaries causes renal filtration.
The baroreceptors, located in the left atrium and in the carotid and aortic arches, respond to changes in
the circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as
endocrine activities. Sympathetic stimulation constricts renal arterioles, causing what effect?
A) Decrease in the release of aldosterone
B) Increase of filtration in the Loop of Henle
C) Decrease in the reabsorption of sodium
D) Decrease in glomerular filtration
Ans: D
Feedback:
Sympathetic stimulation constricts renal arterioles; this decreases glomerular filtration, increases the
release of aldosterone, and increases sodium and water reabsorption. None of the other listed options
occurs with increased sympathetic stimulation.
You are the nurse caring for a 77-year-old male patient who has been involved in a motor vehicle
accident. You and your colleague note that the patients labs indicate minimally elevated serum
creatinine levels, which your colleague dismisses. What can this increase in creatinine indicate in older
adults?
A) Substantially reduced renal function
B) Acute kidney injury
C) Decreased cardiac output
D) Alterations in ratio of body fluids to muscle mass
Ans: A
Feedback:
Normal physiologic changes of aging, including reduced cardiac, renal, and respiratory function, and
reserve and alterations in the ratio of body fluids to muscle mass, may alter the responses of elderly
people to fluid and electrolyte changes and acidbase disturbances. Renal function declines with age, as
do muscle mass and daily exogenous creatinine production. Therefore, high-normal and minimally
elevated serum creatinine values may indicate substantially reduced renal function in older adults. Acute
kidney injury is likely to cause a more significant increase in serum creatinine.
You are the nurse caring for a patient who is to receive IV daunorubicin, a chemotherapeutic agent. You
start the infusion and check the insertion site as per protocol. During your most recent check, you note
that the IV has infiltrated so you stop the infusion. What is your main concern with this infiltration?
A) Extravasation of the medication
B) Discomfort to the patient
C) Blanching at the site
D) Hypersensitivity reaction to the medication
Ans: A
Normal physiologic changes of aging, including reduced cardiac, renal, and respiratory function, and
reserve and alterations in the ratio of body fluids to muscle mass, may alter the responses of elderly
people to fluid and electrolyte changes and acidbase disturbances. Renal function declines with age, as
do muscle mass and daily exogenous creatinine production. Therefore, high-normal and minimally
elevated serum creatinine values may indicate substantially reduced renal function in older adults. Acute
kidney injury is likely to cause a more significant increase in serum creatinine.
The nurse caring for a patient post colon resection is assessing the patient on the second postoperative
day. The nasogastric tube (NG) remains patent and continues at low intermittent wall suction. The IV is
patent and infusing at 125 mL/hr. The patient reports pain at the incision site rated at a 3 on a 0-to-10
rating scale. During your initial shift assessment, the patient complains of cramps in her legs and a
tingling sensation in her feet. Your assessment indicates decreased deep tendon reflexes (DTRs) and you
suspect the patient has hypokalemia. What other sign or symptom would you expect this patient to
exhibit?
A) Diarrhea
B) Dilute urine
C) Increased muscle tone
D) Joint pain
Ans: B
You are caring for a patient who is being treated on the oncology unit with a diagnosis of lung cancer
with bone metastases. During your assessment, you note the patient complains of a new onset of
weakness with abdominal pain. Further assessment suggests that the patient likely has a fluid volume
deficit. You should recognize that this patient may be experiencing what electrolyte imbalance?
A) Hypernatremia
B) Hypomagnesemia
C) Hypophosphatemia
D) Hypercalcemia
D
A medical nurse educator is reviewing a patients recent episode of metabolic acidosis with members of
the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis?
A) The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance.
B) The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance.
C) The kidneys react rapidly to compensate for imbalances in the body.
D) The kidneys regulate the bicarbonate level in the intracellular fluid.
B
The nurse in the medical ICU is caring for a patient who is in respiratory acidosis due to inadequate
ventilation. What diagnosis could the patient have that could cause inadequate ventilation?
A) Endocarditis
B) Multiple myeloma
C) Guillain-Barr syndrome
D) Overdose of amphetamines
C
The ICU nurse is caring for a patient who experienced trauma in a workplace accident. The patient is
complaining of having trouble breathing with abdominal pain. An ABG reveals the following results: pH
7.28, PaCO2 50 mm Hg, HCO3 23 mEq/L. The nurse should recognize the likelihood of what acidbase
disorder?
A) Respiratory acidosis
B) Metabolic alkalosis
C) Respiratory alkalosis
D) Mixed acidbase disorder
D
A patient has questioned the nurses administration of IV normal saline, asking whether sterile water
would be a more appropriate choice than saltwater. Under what circumstances would the nurse
administer electrolyte-free water intravenously?
A) Never, because it rapidly enters red blood cells, causing them to rupture.
B) When the patient is severely dehydrated resulting in neurologic signs and symptoms
C) When the patient is in excess of calcium and/or magnesium ions
D) When a patients fluid volume deficit is due to acute or chronic renal failure
A
A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in
older adults. What factors contribute to this phenomenon? Select all that apply.
A) Decreased kidney mass
B) Increased conservation of sodium
C) Increased total body water
D) Decreased renal blood flow
E) Decreased excretion of potassium
A D E
You are called to your patients room by a family member who voices concern about the patients status. On assessment, you find the patient tachypnic, lethargic, weak, and exhibiting a diminished cognitive
ability. You also find 3+ pitting edema. What electrolyte imbalance is the most plausible cause of this
patients signs and symptoms?
A) Hypocalcemia
B) Hyponatremia
C) Hyperchloremia
D) Hypophosphatemia
C
Diagnostic testing has been ordered to differentiate between normal anion gap acidosis and high anion
gap acidosis in an acutely ill patient. What health problem typically precedes normal anion gap acidosis?
A) Metastases
B) Excessive potassium intake
C) Water intoxication
D) Excessive administration of chloride
D
The nurse is caring for a patient in metabolic alkalosis. The patient has an NG tube to low intermittent
suction for a diagnosis of bowel obstruction. What drug would the nurse expect to find on the
medication orders?
A) Cimetidine
B) Maalox
C) Potassium chloride elixir
D) Furosemide
A
You are caring for a patient with a diagnosis of pancreatitis. The patient was admitted from a homeless
shelter and is a vague historian. The patient appears malnourished and on day 3 of the patients admission
total parenteral nutrition (TPN) has been started. Why would you know to start the infusion of TPN
slowly?
A) Patients receiving TPN are at risk for hypercalcemia if calories are started too rapidly.
B) Malnourished patients receiving parenteral nutrition are at risk for hypophosphatemia if calories
are started too aggressively.
C) Malnourished patients who receive fluids too rapidly are at risk for hypernatremia.
D) Patients receiving TPN need a slow initiation of treatment in order to allow digestive enzymes to
accumulate
B
You are doing discharge teaching with a patient who has hypophosphatemia during his time in hospital. The patient has a diet ordered that is high in phosphate. What foods would you teach this patient to
include in his diet? Select all that apply.
A) Milk
B) Beef
C) Poultry
D) Green vegetables
E) Liver
A C E
You are caring for a patient with a secondary diagnosis of hypermagnesemia. What assessment finding
would be most consistent with this diagnosis?
A) Hypertension
B) Kussmaul respirations
C) Increased DTRs
D) Shallow respirations
D
A patients most recent laboratory results show a slight decrease in potassium. The physician has opted to
forego drug therapy but has suggested increasing the patients dietary intake of potassium. Which of the
following would be a good source of potassium?
A) Apples
B) Asparagus
C) Carrots
D) Bananas
D
The nurse is assessing the patient for the presence of a Chvosteks sign. What electrolyte imbalance
would a positive Chvosteks sign indicate?
A) Hypermagnesemia
B) Hyponatremia
C) Hypocalcemia
D) Hyperkalemia
Ans: C
A nurse is caring for a patient who is scheduled for a colonoscopy and whose bowel preparation will
include polyethylene glycol electrolyte lavage prior to the procedure. The presence of what health
problem would contraindicate the use of this form of bowel preparation?
A) Inflammatory bowel disease
B) Intestinal polyps
C) Diverticulitis
D) Colon cancer
Ans: A
A nurse is promoting increased protein intake to enhance a patients wound healing. The nurse knows
that enzymes are essential in the digestion of nutrients such as protein. What is the enzyme that initiates
the digestion of protein?
A) Pepsin
B) Intrinsic factor
C) Lipase
D) Amylase
A
A patient has been brought to the emergency department with abdominal pain and is subsequently
diagnosed with appendicitis. The patient is scheduled for an appendectomy but questions the nurse about
how his health will be affected by the absence of an appendix. How should the nurse best respond?
A) Your appendix doesnt play a major role, so you wont notice any difference after you recovery from
surgery.
B) The surgeon will encourage you to limit your fat intake for a few weeks after the surgery, but your
body will then begin to compensate.
C) Your body will absorb slightly fewer nutrients from the food you eat, but you wont be aware of
this.
D) Your large intestine will adapt over time to the absence of your appendix.
A
A patient asks the nursing assistant for a bedpan. When the patient is finished, the nursing assistant
notifies the nurse that the patient has bright red streaking of blood in the stool. What is this most likely a
result of?
A) Diet high in red meat
B) Upper GI bleed
C) Hemorrhoids
D) Use of iron supplements
C
An adult patient is scheduled for an upper GI series that will use a barium swallow. What teaching
should the nurse include when the patient has completed the test?
A) Stool will be yellow for the first 24 hours postprocedure.
B) The barium may cause diarrhea for the next 24 hours.
C) Fluids must be increased to facilitate the evacuation of the stool.
D) Slight anal bleeding may be noted as the barium is passed.
C
A patient has come to the outpatient radiology department for diagnostic testing. Which of the following
diagnostic procedures will allow the care team to evaluate and remove polyps?
A) Colonoscopy
B) Barium enema
C) ERCP
D) Upper gastrointestinal fibroscopy
A
A nurse is caring for a patient with recurrent hematemesis who is scheduled for upper gastrointestinal
fibroscopy (UGF). How should the nurse in the radiology department prepare this patient?
A) Insert a nasogastric tube.
B) Administer a micro Fleet enema at least 3 hours before the procedure.
C) Have the patient lie in a supine position for the procedure.
D) Apply local anesthetic to the back of the patients throat.
D
The nurse is providing health education to a patient scheduled for a colonoscopy. The nurse should
explain that she will be placed in what position during this diagnostic test?
A) In a knee-chest position (lithotomy position)
B) Lying prone with legs drawn toward the chest
C) Lying on the left side with legs drawn toward the chest
D) In a prone position with two pillows elevating the buttocks
C
A patient has sought care because of recent dark-colored stools. As a result, a fecal occult blood test has
been ordered. The nurse should instruct the patient to avoid which of the following prior to collecting a
stool sample?
A) NSAIDs
B) Acetaminophen
C) OTC vitamin D supplements
D) Fiber supplements
A
The nurse is preparing to perform a patients abdominal assessment. What examination sequence should
the nurse follow?
A) Inspection, auscultation, percussion, and palpation
B) Inspection, palpation, auscultation, and percussion
C) Inspection, percussion, palpation, and auscultation
D) Inspection, palpation, percussion, and auscultation
A
A patient who has been experiencing changes in his bowel function is scheduled for a barium enema. What instruction should the nurse provide for postprocedure recovery?
A) Remain NPO for 6 hours postprocedure.
B) Administer a Fleet enema to cleanse the bowel of the barium.
C) Increase fluid intake to evacuate the barium.
D) Avoid dairy products for 24 hours postprocedure.
C
A nurse is caring for a newly admitted patient with a suspected GI bleed. The nurse assesses the patients
stool after a bowel movement and notes it to be a tarry-black color. This finding is suggestive of
bleeding from what location?
A) Sigmoid colon
B) Upper GI tract
C) Large intestine
D) Anus or rectum
B
A nursing student has auscultated a patients abdomen and noted one or two bowel sounds in a 2-minute
period of time. How would you tell the student to document the patients bowel sounds?
A) Normal
B) Hypoactive
C) Hyperactive
D) Paralytic ileus
B
An advanced practice nurse is assessing the size and density of a patients abdominal organs. If the
results of palpation are unclear to the nurse, what assessment technique should be implemented?
A) Percussion
B) Auscultation
C) Inspection
D) Rectal examination
A
A nurse is caring for a patient with biliary colic and is aware that the patient may experience referred
abdominal pain. Where would the nurse most likely expect this patient to experience referred pain?
A) Midline near the umbilicus
B) Below the right nipple
C) Left groin area
D) Right lower abdominal quadrant
B
An inpatient has returned to the medical unit after a barium enema. When assessing the patients
subsequent bowel patterns and stools, what finding should the nurse report to the physician?
A) Large, wide stools
B) Milky white stools
C) Three stools during an 8-hour period of time
D) Streaks of blood present in the stool
D
A nurse in a stroke rehabilitation facility recognizes that the brain regulates swallowing. Damage to what
area of the brain will most affect the patients ability to swallow?
A) Temporal lobe
B) Medulla oblongata
C) Cerebellum
D) Pons
B
A patient is being assessed for a suspected deficit in intrinsic factor synthesis. What diagnostic or
assessment finding is the most likely rationale for this examination of intrinsic factor production?
A) Muscle wasting
B) Chronic jaundice in the absence of liver disease
C) The presence of fat in the patients stool
D) Persistently low hemoglobin and hematocrit
D
A patient with a recent history of intermittent bleeding is undergoing capsule endoscopy to determine the
source of the bleeding. When explaining this diagnostic test to the patient, what advantage should the
nurse describe?
A) The test allows visualization of the entire peritoneal cavity.
B) The test allows for painless biopsy collection.
C) The test does not require fasting.
D) The test is noninvasive.
D
A nurse is caring for a patient admitted with a suspected malabsorption disorder. The nurse knows that
one of the accessory organs of the digestive system is the pancreas. What digestive enzymes does the
pancreas secrete? Select all that apply.
A) Pepsin
B) Lipase
C) Amylase
D) Trypsin
E) Ptyalin
B C D
The nurse is caring for a patient with a duodenal ulcer and is relating the patients symptoms to the
physiologic functions of the small intestine. What do these functions include? Select all that apply.
A) Secretion of hydrochloric acid (HCl)
B) Reabsorption of water
C) Secretion of mucus
D) Absorption of nutrients
E) Movement of nutrients into the bloodstream
C D E
A nurse is performing an abdominal assessment of an older adult patient. When collecting and analyzing
data, the nurse should be cognizant of what age-related change in gastrointestinal structure and function?
A) Increased gastric motility
B) Decreased gastric pH
C) Increased gag reflex
D) Decreased mucus secretion
D
The nurse educator is reviewing the blood supply of the GI tract with a group of medical nurses. The
nurse is explaining the fact that the veins that return blood from the digestive organs and the spleen form
the portal venous system. What large veins will the nurse list when describing this system? Select all that
apply. A) Splenic vein
B) Inferior mesenteric vein
C) Gastric vein
D) Inferior vena cava
E) Saphenous vein
A B C
The physiology instructor is discussing the GI system with the pre-nursing class. What should the
instructor describe as a major function of the GI tract?
A) The breakdown of food particles into cell form for digestion
B) The maintenance of fluid and acid-base balance
C) The absorption into the bloodstream of nutrient molecules produced by digestion
D) The control of absorption and elimination of electrolytes
C
A nurse is providing preprocedure education for a patient who will undergo a lower GI tract study the
following week. What should the nurse teach the patient about bowel preparation?
A) Youll need to fast for at least 18 hours prior to your test.
B) Starting today, take over-the-counter stool softeners twice daily.
C) Youll need to have enemas the day before the test.
D) For 24 hours before the test, insert a glycerin suppository every 4 hours.
C
A patient presents at the walk-in clinic complaining of recurrent sharp stomach pain that is relieved by
eating. The nurse suspects that the patient may have an ulcer. How would the nurse explain the
formation and role of acid in the stomach to the patient?
A) Hydrochloric acid is secreted by glands in the stomach in response to the actual or anticipated
presence of food.
B) As digestion occurs in the stomach, the stomach combines free hydrogen ions from the food to
form acid.
C) The body requires an acidic environment in order to synthesize pancreatic digestive enzymes; the
stomach provides this environment.
D) The acidic environment in the stomach exists to buffer the highly alkaline environment in the
esophagus.
A
Results of a patients preliminary assessment prompted an examination of the patients carcinoembryonic
antigen (CEA) levels, which have come back positive. What is the nurses most appropriate response to
this finding?
A) Perform a focused abdominal assessment.
B) Prepare to meet the patients psychosocial needs.
C) Liaise with the nurse practitioner to perform an anorectal examination.
D) Encourage the patient to adhere to recommended screening protocols.
B
A clinic patient has described recent dark-colored stools;the nurse recognizes the need for fecal occult
blood testing (FOBT). What aspect of the patients current health status would contraindicate FOBT?
A) Gastroesophageal reflux disease (GERD)
B) Peptic ulcers
C) Hemorrhoids
D) Recurrent nausea and vomiting
C
A patient will be undergoing abdominal computed tomography (CT) with contrast. The nurse has
administered IV sodium bicarbonate and oral acetylcysteine (Mucomyst) before the study as ordered. What would indicate that these medications have had the desired therapeutic effect?
A) The patients BUN and creatinine levels are within reference range following the CT.
B) The CT yields high-quality images.
C) The patients electrolytes are stable in the 48 hours following the CT.
D) The patients intake and output are in balance on the day after the CT.
A
A medical patients CA 19-9 levels have become available and they are significantly elevated. How
should the nurse best interpret this diagnostic finding?
A) The patient may have cancer, but other GI disease must be ruled out.
B) The patient most likely has early-stage colorectal cancer.
C) The patient has a genetic predisposition to gastric cancer.
D) The patient has cancer, but the site is unknown.
A
A patient has come to the clinic complaining of blood in his stool. A FOBT test is performed but is
negative. Based on the patients history, the physician suggests a colonoscopy, but the patient refuses, citing a strong aversion to the invasive nature of the test. What other test might the physician order to
check for blood in the stool?
A) A laparoscopic intestinal mucosa biopsy
B) A quantitative fecal immunochemical test
C) Computed tomography (CT)
D) Magnetic resonance imagery (MRI)
B
A nurse is assessing the abdomen of a patient just admitted to the unit with a suspected GI disease.
Inspection reveals several diverse lesions on the patients abdomen. How should the nurse best interpret
this assessment finding?
A) Abdominal lesions are usually due to age-related skin changes.
B) Integumentary diseases often cause GI disorders.
C) GI diseases often produce skin changes.
D) The patient needs to be assessed for self-harm.
C
Probably the most widely used in-office or at-home occult blood test is the Hemoccult II. The patient has
come to the clinic because he thinks there is blood in his stool. When you reviewed his medications, you
noted he is on antihypertensive drugs and NSAIDs for early arthritic pain. You are sending the patient
home with the supplies necessary to perform 2 hemoccult tests on his stool and mail the samples back to
the clinic. What instruction would you give this patient?
A) Take all your medications as usual.
B) Take all your medications except the antihypertensive medications.
C) Dont eat highly acidic foods 72 hours before you start the test.
D) Avoid vitamin C for 72 hours before you start the test.
D
A patients sigmoidoscopy has been successfully completed and the patient is preparing to return home. Which of the following teaching points should the nurse include in the patients discharge education?
A) The patient should drink at least 2 liters of fluid in the next 12 hours.
B) The patient can resume a normal routine immediately.
C) The patient should expect fecal urgency for several hours.
D) The patient can expect some scant rectal bleeding.
B
A nurse is caring for an 83-year-old patient who is being assessed for recurrent and intractable nausea. What age-related change to the GI system may be a contributor to the patients health complaint?
A) Stomach emptying takes place more slowly.
B) The villi and epithelium of the small intestine become thinner.
C) The esophageal sphincter becomes incompetent.
D) Saliva production decreases.
A
A patient has been experiencing significant psychosocial stress in recent weeks. The nurse is aware of
the hormonal effects of stress, including norepinephrine release. Release of this substance would have
what effect on the patients gastrointestinal function? Select all that apply.
A) Decreased motility
B) Increased sphincter tone
C) Increased enzyme release
D) Inhibition of secretions
E) Increased peristalsis
A
A patient with cystic fibrosis takes pancreatic enzyme replacements on a regular basis. The patients
intake of trypsin facilitates what aspect of GI function?
A) Vitamin D synthesis
B) Digestion of fats
C) Maintenance of peristalsis
D) Digestion of proteins
D
The nurse is caring for a patient who has a diagnosis of AIDS. Inspection of the patients mouth reveals
the new presence of white lesions on the patients oral mucosa. What is the nurses most appropriate
response?
A) Encourage the patient to gargle with salt water twice daily.
B) Attempt to remove the lesions with a tongue depressor.
C) Make a referral to the units dietitian.
D) Inform the primary care provider of this finding.
D
A patient has been scheduled for a urea breath test in one months time. What nursing diagnosis most
likely prompted this diagnostic test?
A) Impaired Dentition Related to Gingivitis
B) Risk For Impaired Skin Integrity Related to Peptic Ulcers
C)
Imbalanced Nutrition: Less Than Body Requirements Related to Enzyme Deficiency
D) Diarrhea Related to Clostridium Dif icile Infection
B
A female patient has presented to the emergency department with right upper quadrant pain; the
physician has ordered abdominal ultrasound to rule out cholecystitis (gallbladder infection). The patient
expresses concern to the nurse about the safety of this diagnostic procedure. How should the nurse best
respond?
A) Abdominal ultrasound is very safe, but it cant be performed if youre pregnant.
B) Abdominal ultrasound poses no known safety risks of any kind.
C) Current guidelines state that a person can have up to 3 ultrasounds per year.
D) Current guidelines state that a person can have up to 6 ultrasounds per year.
B
A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the
patients increased risk of bleeding. The nurse recognizes that this risk is related to the patients inability
to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?
A) Alterations in glucose metabolism
B) Retention of bile salts
C) Inadequate production of albumin by hepatocytes
D) Inability of the liver to use vitamin K
D
A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What
technique should the nurse use to palpate the patients liver?
A) Place hand under the right lower abdominal quadrant and press down lightly with the other hand.
B) Place the left hand over the abdomen and behind the left side at the 11th rib.
C) Place hand under right lower rib cage and press down lightly with the other hand.
D) Hold hand 90 degrees to right side of the abdomen and push down firmly.
C
A patient with portal hypertension has been admitted to the medical floor. The nurse should prioritize which of the following assessments related to the manifestations of this health problem?
A) Assessment of blood pressure and assessment for headaches and visual changes
B) Assessments for signs and symptoms of venous thromboembolism
C) Daily weights and abdominal girth measurement
D) Blood glucose monitoring q4h
C
A nurse educator is teaching a group of recent nursing graduates about their occupational risks for
contracting hepatitis B. What preventative measures should the educator promote? Select all that apply.
A) Immunization
B) Use of standard precautions
C) Consumption of a vitamin-rich diet
D) Annual vitamin K injections
E) Annual vitamin B12
injections
A B
A nurse is caring for a patient with cancer of the liver whose condition has required the insertion of a
percutaneous biliary drainage system. The nurses most recent assessment reveals the presence of dark
green fluid in the collection container. What is the nurses best response to this assessment finding?
A) Document the presence of normal bile output.
B) Irrigate the drainage system with normal saline as ordered.
C) Aspirate a sample of the drainage for culture.
D) Promptly report this assessment finding to the primary care provider.
A
A patient who has undergone liver transplantation is ready to be discharged home. Which outcome of
health education should the nurse prioritize?
A) The patient will obtain measurement of drainage from the T-tube.
B) The patient will exercise three times a week.
C) The patient will take immunosuppressive agents as required.
D) The patient will monitor for signs of liver dysfunction.
C
A triage nurse in the emergency department is assessing a patient who presented with complaints of
general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What
assessment question best addresses the possible etiology of this patients presentation?
A) How many alcoholic drinks do you typically consume in a week?
B) To the best of your knowledge, are your immunizations up to date?
C) Have you ever worked in an occupation where you might have been exposed to toxins?
D) Has anyone in your family ever experienced symptoms similar to yours?
A
A nurse is participating in the emergency care of a patient who has just developed variceal bleeding. What intervention should the nurse anticipate?
A) Infusion of intravenous heparin
B) IV administration of albumin
C) STAT administration of vitamin K by the intramuscular route
D) IV administration of octreotide (Sandostatin)
D
A nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment,
the nurse notes that the patient has a flapping tremor of the hands. The nurse should document the
presence of what sign of liver disease?
A) Asterixis
B) Constructional apraxia
C) Fetor hepaticus
D) Palmar erythema
A
A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis
A. What should the nurse advise individuals to obtain who ate at this restaurant and have never received
the hepatitis A vaccine?
A) The hepatitis A vaccine
B) Albumin infusion
C) The hepatitis A and B vaccines
D) An immune globulin injection
D
A participant in a health fair has asked the nurse about the role of drugs in liver disease. What health
promotion teaching has the most potential to prevent drug-induced hepatitis?
A) Finish all prescribed courses of antibiotics, regardless of symptom resolution.
B) Adhere to dosing recommendations of OTC analgesics.
C) Ensure that expired medications are disposed of safely.
D) Ensure that pharmacists regularly review drug regimens for potential interactions.
B
Diagnostic testing has revealed that a patients hepatocellular carcinoma (HCC) is limited to one lobe. The nurse should anticipate that this patients plan of care will focus on what intervention?
A) Cryosurgery
B) Liver transplantation
C) Lobectomy
D) Laser hyperthermia
C
A patient has been diagnosed with advanced stage breast cancer and will soon begin aggressive
treatment. What assessment findings would most strongly suggest that the patient may have developed
liver metastases?
A) Persistent fever and cognitive changes
B) Abdominal pain and hepatomegaly
C) Peripheral edema unresponsive to diuresis
D) Spontaneous bleeding and jaundice
B
A patient is being discharged after a liver transplant and the nurse is performing discharge education. When planning this patients continuing care, the nurse should prioritize which of the following risk
diagnoses?
A) Risk for Infection Related to Immunosuppressant Use
B) Risk for Injury Related to Decreased Hemostasis
C) Risk for Unstable Blood Glucose Related to Impaired Gluconeogenesis
D) Risk for Contamination Related to Accumulation of Ammonia
A
A patient with a liver mass is undergoing a percutaneous liver biopsy. What action should the nurse
perform when assisting with this procedure?
A) Position the patient on the right side with a pillow under the costal margin after the procedure.
B) Administer 1 unit of albumin 90 minutes before the procedure as ordered.
C) Administer at least 1 unit of packed red blood cells as ordered the day before the scheduled
procedure.
D) Confirm that the patients electrolyte levels have been assessed prior to the procedure.
A
A nurse is caring for a patient with hepatic encephalopathy. The nurses assessment reveals that the
patient exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
C
