Question 1

During change-of-shift report,the nurse learns about the following four patients.Which patient requires assessment first?

Accepted Answer

A)   40-year-old with chronic pancreatitis who has gnawing abdominal pain
B)   58-year-old who has compensated cirrhosis and is complaining of anorexia
C)   55-year-old with cirrhosis and ascites who has an oral temperature of 102° F (38.8° 
C)  
D)   36-year-old recovering from a laparoscopic cholecystectomy who has severe shoulder pain C

Question 2

For a patient with cirrhosis,which of the following nursing actions can the registered nurse (RN)delegate to unlicensed assistive personnel (UAP)?

Accepted Answer

A)   Assessing the patient for jaundice
B)   Providing oral hygiene after a meal
C)   Palpating the abdomen for distention
D)   Assisting the patient to choose the diet B

Question 3

To prepare a 56-year-old male patient with ascites for paracentesis,the nurse

Accepted Answer

A)   places the patient on NPO status.
B)   assists the patient to lie flat in bed.
C)   asks the patient to empty the bladder.
D)   positions the patient on the right side. C

Question 4

A 67-year-old male patient with acute pancreatitis has a nasogastric (NG)tube to suction and is NPO.Which information obtained by the nurse indicates that these therapies have been effective?

Accepted Answer

A)   Bowel sounds are present.
B)   Grey Turner sign resolves.
C)   Electrolyte levels are normal.
D)   Abdominal pain is decreased.

Question 5

A 38-year-old patient with cirrhosis has ascites and 4+ edema of the feet and legs.Which nursing action will be included in the plan of care?

Accepted Answer

A)   Restrict daily dietary protein intake.
B)   Reposition the patient every 4 hours.
C)   Place the patient on a pressure-relieving mattress.
D)   Perform passive range of motion daily.

Question 6

A serum potassium level of 3.2 mEq/L (3.2 mmol/L)is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone)and furosemide (Lasix).due.Which action should the nurse take?

Accepted Answer

A)   Administer both drugs.
B)   Administer the spironolactone.
C)   Withhold the spironolactone and administer the furosemide.
D)   Withhold both drugs until discussed with the health care provider.

Question 7

The nurse is caring for a 36-year-old patient with pancreatic cancer.Which nursing action is the highest priority?

Accepted Answer

A)   Offer psychologic support for depression.
B)   Offer high-calorie, high-protein dietary choices.
C)   Administer prescribed opioids to relieve pain as needed.
D)   Teach about the need to avoid scratching any pruritic areas.

Question 8

Which response by the nurse best explains the purpose of ranitidine (Zantac)for a patient admitted with bleeding esophageal varices?

Accepted Answer

A)   The medication will reduce the risk for aspiration.
B)   The medication will inhibit development of gastric ulcers.
C)   The medication will prevent irritation of the enlarged veins.
D)   The medication will decrease nausea and improve the appetite.

Question 9

Which action should the nurse in the emergency department take first for a new patient who is vomiting blood?

Accepted Answer

A)   Insert a large-gauge IV catheter.
B)   Draw blood for coagulation studies.
C)   Check blood pressure (BP) , heart rate, and respirations.
D)   Place the patient in the supine position.

Question 10

After an unimmunized individual is exposed to hepatitis B through a needle-stick injury,which actions will the nurse plan to take (select all that apply)?

Accepted Answer

A)   Administer hepatitis B vaccine.
B)   Test for antibodies to hepatitis B.
C)   Teach about á-interferon therapy.
D)   Give hepatitis B immune globulin.
E)   Teach about choices for oral antiviral therapy.

Question 11

A 49-year-old female patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal).Which finding is the best indicator that the medication has been effective?

Accepted Answer

A)   The patient reports no chest pain.
B)   Blood pressure is 140/90 mm Hg.
C)   Stools test negative for occult blood.
D)   The apical pulse rate is 68 beats/minute.

Question 12

A 23-year-old has been admitted with acute liver failure.Which assessment data are most important for the nurse to communicate to the health care provider?

Accepted Answer

A)   Asterixis and lethargy
B)   Jaundiced sclera and skin
C)   Elevated total bilirubin level
D)   Liver 3 cm below costal margin

Question 13

Which laboratory test result will the nurse monitor when evaluating the effects of therapy for a 62-year-old female patient who has acute pancreatitis?

Accepted Answer

A)   Calcium
B)   Bilirubin
C)   Amylase
D)   Potassium

Question 14

Which topic is most important to include in patient teaching for a 41-year-old patient diagnosed with early alcoholic cirrhosis?

Accepted Answer

A)   Maintaining good nutrition
B)   Avoiding alcohol ingestion
C)   Taking lactulose (Cephulac) 
D)   Using vitamin B supplements

Question 15

When taking the blood pressure (BP)on the right arm of a patient with severe acute pancreatitis,the nurse notices carpal spasms of the patient's right hand.Which action should the nurse take next?

Accepted Answer

A)   Ask the patient about any arm pain.
B)   Retake the patient's blood pressure.
C)   Check the calcium level in the chart.
D)   Notify the health care provider immediately.

Question 16

A 53-year-old patient is being treated for bleeding esophageal varices with balloon tamponade.Which nursing action will be included in the plan of care?

Accepted Answer

A)   Instruct the patient to cough every hour.
B)   Monitor the patient for shortness of breath.
C)   Verify the position of the balloon every 4 hours.
D)   Deflate the gastric balloon if the patient reports nausea.

Question 17

The nurse will teach a patient with chronic pancreatitis to take the prescribed pancrelipase (Viokase)

Accepted Answer

A)   at bedtime.
B)   in the morning.
C)   with each meal.
D)   for abdominal pain.

Question 18

Which assessment information will be most important for the nurse to report to the health care provider about a patient with acute cholecystitis?

Accepted Answer

A)   The patient's urine is bright yellow.
B)   The patient's stools are tan colored.
C)   The patient has increased pain after eating.
D)   The patient complains of chronic heartburn.

Question 19

A nurse is considering which patient to admit to the same room as a patient who had a liver transplant 3 weeks ago and is now hospitalized with acute rejection.Which patient would be the best choice?

Accepted Answer

A)   Patient who is receiving chemotherapy for liver cancer
B)   Patient who is receiving treatment for acute hepatitis C
C)   Patient who has a wound infection after cholecystectomy
D)   Patient who requires pain management for chronic pancreatitis

Question 20

Administration of hepatitis B vaccine to a healthy 18-year-old patient has been effective when a specimen of the patient's blood reveals

Accepted Answer

A)   HBsAg.
B)   anti-HBs.
C)   anti-HBc IgG.
D)   anti-HBc IgM.

Exam 40: Nursing Management: Liver,pancreas and Biliary Tract Problems

During change-of-shift report,the nurse learns about the following four patients.Which patient requires assessment first?

For a patient with cirrhosis,which of the following nursing actions can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP) ?

To prepare a 56-year-old male patient with ascites for paracentesis,the nurse

A 67-year-old male patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO.Which information obtained by the nurse indicates that these therapies have been effective?

A 38-year-old patient with cirrhosis has ascites and 4+ edema of the feet and legs.Which nursing action will be included in the plan of care?

A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) .due.Which action should the nurse take?