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Unit 1 Liver Biliary
| Question | Answer |
|---|---|
| 1. The patient has a diagnosis of a biliary obstruction from gallstones. What type of jaundice is the patient experiencing, and what serum bilirubin results would be expected? a. Hemolytic jaundice with normal conjugated bilirubin b. Posthepatic icterus w | C |
| 2. The patient had a blood transfusion reaction. What is the best explanation the nurse can give the patient as to why hemolytic jaundice has occurred? a. A malaria parasite has broken apart red blood cells (RBCs) b. It results from liver’s altered abilit | D |
| 3. The patient returned from a 6-week mission trip to Somalia with reports of nausea, malaise, fatigue, and achy muscles. Which type of hepatitis is this patient most likely to have contracted? a. Hepatitis B (HBV) b. Hepatitis C (HCV) c. Hepatitis D (HDV | D |
| 4. Which type of hepatitis is a DNA virus, can be transmitted via exposure to infectious blood or body fluids, is required for HDV to replicate, and increases the risk of the chronic carrier for hepatocellular cancer? a. HAV b. HBV c. HCV d. HEV | B |
| 5. Serologic findings in viral hepatitis include both the presence of viral antigens and antibodies produced in response to the viruses. What laboratory result indicates that the nurse is immune to HBV after vaccination? a. Anti-HBc immunoglobulin (Ig)G | C |
| 6. The patient asks why the serologic test of HBV DNA quantitation is being done. What is the best explanation about the test for the nurse to explain to the patient? a. Shows an ongoing infection with HBV b. Indicates co-infection with HBV and HDV c. Det | D |
| 7. Although HAV antigens are not tested in the blood, they stimulate specific IgM and IgG antibodies. Which antibody indicates there is acute HAV infection? a. Anti-HBc IgG b. Anti-HBc IgM c. Anti-HAV IgG d. Anti-HAV IgM | D |
| 8. What test will be done before prescribing treatment for the patient with positive testing for HCV? a. Anti-HCV b. HCV genotyping c. FibroSure (FibroTest) d. HCV RNA quantitation | B |
| 9. What causes the systemic effects of viral hepatitis? a. Toxins produced by the infected liver b. Impaired portal circulation from fibrosis c. Cholestasis from chemical hepatotoxicity d. Complement system activation by antigen-antibody complexes | D |
| 10. During the incubation period of viral hepatitis, what should the nurse expect the patient to report? a. Dark urine and easy fatigability b. No symptoms except diagnostic results c. Anorexia and right upper quadrant discomfort d. Constipation or diarrh | B |
| 11. The occurrence of acute liver failure is most common in which situation? a. A person with hepatitis A b. A person with hepatitis C c. Antihypertensive medication use d. Use of acetaminophen with alcohol use | D |
| 12. Following a needle stick, what is used as prophylaxis against HBV? a. Interferon b. HBV vaccine c. Hepatitis B immune globulin (HBIG) d. HBIG and HBV vaccine | D |
| 13. The family members of a patient with hepatitis A ask if there is anything that will prevent them from developing the disease. What is the best response by the nurse? a. “No immunization is available for hepatitis A, nor are you likely to get the disea | B |
| 14. A patient diagnosed with chronic hepatitis B asks about drug therapy to treat the disease. What is the most appropriate response by the nurse? a. “Only chronic hepatitis C is treatable and primarily with antiviral agents and interferon.” b. “There are | C |
| 15. The nurse identifies a need for further teaching when the patient with acute hepatitis B makes which statement? a. “I should avoid alcohol completely for at least a year.” b. “I must avoid all physical contact with my family until the jaundice is gone | B |
| 16. What is one of the most challenging nursing interventions to promote healing in the patient with viral hepatitis? a. Providing adequate nutritional intake b. Promoting strict bed rest during the icteric phase c. Providing pain relief without using liv | A |
| 17. When caring for a patient with autoimmune hepatitis, the nurse understands that what about this patient is different from the patient who has viral hepatitis? a. Does not manifest hepatomegaly or jaundice b. Experiences less liver inflammation and dam | C |
| 18. The patient has been newly diagnosed with Wilson’s disease. D-penicillamine, a chelating agent, has been prescribed. What assessment finding should the nurse expect? a. Pruritus b. Acute kidney injury c. Corneal Fleischer rings d. Increased serum iron | C |
| 19. The patient presents with jaundice and itching, steatorrhea, and liver enlargement. This patient has also had ulcerative colitis for several years. What is the most likely diagnosis the nurse should expect for this patient? a. Cirrhosis b. Acute liver | D |
| 20. The patient is an older woman with cirrhosis who has anemia. What pathophysiologic changes may contribute to this patient’s anemia (select all that apply)? a. Vitamin B deficiencies b. Stretching of liver capsule c. Vascular congestion of spleen d. De | ACD |
| 21. Patient-Centered Care: A patient was diagnosed with nonalcoholic fatty liver disease (NAFLD). What treatment measures should the nurse plan to teach the patient about (select all that apply)? a. Weight loss b. Diabetes management c. Ulcerative colitis | ABD |
| 22. Which etiologic manifestations occur in the patient with cirrhosis related to esophageal varices? a. Jaundice, peripheral edema, and ascites from increased intrahepatic pressure and dysfunction b. Loss of the small bile ducts and cholestasis and cirrh | C |
| 23. Which conditions contribute to the formation of abdominal ascites? a. Esophageal varices contribute to 80% of variceal hemorrhages b. Increased colloidal oncotic pressure caused by decreased albumin production c. Hypoaldosteronism causes increased so | D |
| 24. What laboratory test results should the nurse expect to find in a patient with cirrhosis? a. Serum albumin: 7.0 g/dL (70 g/L) b. Total bilirubin: 3.2 mg/dL (54.7 mmol/L) c. Serum cholesterol: 260 mg/dL (6.7 mmol/L) d. Aspartate aminotransferase (AST): | B |
| 25. Malnutrition can be a major problem for patients with cirrhosis. Which nursing intervention can help improve nutrient intake? a. Oral hygiene before meals and snacks b. Provide all foods the patient likes to eat c. Improve oral intake by feeding the p | A |
| 26. The patient being treated with diuretics for ascites from cirrhosis must be monitored for (select all that apply) a. gastrointestinal (GI) bleeding. b. hypokalemia. c. renal function. d. body image disturbances. e. increased clotting tendencies. | BC |
| 27. What patient manifestation does the nurse recognize as an early sign of hepatic encephalopathy? a. Manifests asterixis b. Becomes unconscious c. Has increasing oliguria d. Impaired computational skills | D |
| 28. Patient-Centered Care: To treat a cirrhotic patient with hepatic encephalopathy, lactulose, rifaximin (Xifaxan), and a proton pump inhibitor are ordered. The patient’s family wants to know why the laxative is ordered. What is the best explanation the | C |
| 29. Priority Decision: The patient has hepatic encephalopathy. What is a priority nursing intervention to keep the patient safe? a. Turn the patient every 3 hours. b. Encourage increasing ambulation. c. Assist the patient to the bathroom. d. Prevent cons | C |
| 30. A patient with advanced cirrhosis has a nursing diagnosis of impaired low nutritional intake because of anorexia and an inadequate food intake. What would be an appropriate midday snack for the patient? a. Peanut butter and salt-free crackers b. A fre | B |
| 31. The patient with liver failure has had a liver transplant. What should the nurse teach the patient about care after the transplant? a. Alcohol intake is now okay. b. HBIG will be required to prevent rejection. c. Elevate the head 30 degrees to improve | D |
| 32. Priority Decision: During the treatment of the patient with bleeding esophageal varices, what is the most important thing the nurse should do? a. Prepare the patient for immediate portal shunting surgery. b. Perform guaiac testing on all stools to det | C |
| 33. A patient with cirrhosis that is refractory to other treatments for esophageal varices undergoes a splenorenal shunt. Because of this procedure, what should the nurse expect the patient to experience? a. An improved survival rate b. Decreased serum am | D |
| 34. In discussing long-term management with the newly diagnosed patient with alcoholic cirrhosis, what should the nurse teach the patient? a. A daily exercise regimen is important to increase the blood flow through the liver. b. Cirrhosis can be reversed | C |
| 35. A patient is hospitalized with metastatic cancer of the liver. The nurse plans care for the patient based on what knowledge? a. Chemotherapy is highly successful in the treatment of liver cancer. b. The patient will undergo surgery to remove the invol | C |
| 36. A patient with cirrhosis asks the nurse about the possibility of a liver transplant. What is the best response by the nurse? a. “If you are interested in a transplant, you really should talk to your doctor about it.” b. “Liver transplants are indicate | D |
| 37. Which complication of acute pancreatitis requires prompt surgical drainage to prevent sepsis? a. Tetany b. Pseudocyst c. Pleural effusion d. Pancreatic abscess | D |
| 38. When assessing a patient with acute pancreatitis, the nurse would expect to find a. hyperactive bowel sounds. b. hypertension and tachycardia. c. a temperature greater than 102° F (38.9° C). d. severe left upper quadrant (LUQ) or midepigastric pain. | D |
| 39. Combined with clinical manifestations, what is the laboratory finding that is most commonly used to diagnose acute pancreatitis? a. Increased serum calcium b. Increased serum amylase c. Increased urinary amylase d. Decreased serum glucose | B |
| 40. What treatment measure is used in managing the patient with acute pancreatitis? a. Surgery to remove the inflamed pancreas b. Pancreatic enzyme supplements administered with meals c. Nasogastric (NG) suction to prevent gastric contents from entering t | C |
| 41. A patient with acute pancreatitis has a nursing diagnosis of acute pain resulting from distension of the pancreas and peritoneal irritation. In addition to effective use of analgesics, what should the nurse include in this patient’s plan of care? a. P | C |
| 42. Patient-Centered Care: The nurse determines that further discharge instruction is needed when the patient with acute pancreatitis makes which statement? a. “I should observe for fat in my stools.” b. “I must not use alcohol to prevent future attacks o | C |
| 43. What is the patient with chronic pancreatitis more likely to have than the patient with acute pancreatitis? a. Has acute abdominal pain b. The need to abstain from alcohol c. Malabsorption and diabetes mellitus d. Require a high-carbohydrate, high-pro | C |
| 44. The nurse is teaching a patient with chronic pancreatitis on measures to prevent further attacks. What information should be provided (select all that apply)? a. Avoid nicotine. b. Eat bland foods. c. Observe stools for steatorrhea. d. Eat high-fat, l | ABC |
| 45. What is a risk factor associated with pancreatic cancer? a. Alcohol intake b. Cigarette smoking c. Exposure to asbestos d. Increased dietary intake of spoiled milk products | B |
| 46. In a radical pancreaticoduodenectomy (Whipple procedure) for treatment of cancer of the pancreas, what resection most affects the patient’s nutritional status? a. Duodenum b. Part of the stomach c. Head of the pancreas d. Common bile duct and gall bla | A |
| 47. Which characteristics are most commonly associated with cholelithiasis (select all that apply). a. Obesity b. Age over 40 years c. Multiparous female d. History of excessive alcohol intake e. Family history of gallbladder disease f. Use of estrogen or | ABCEF |
| 48. Acalculous cholecystitis is diagnosed in an older, critically ill patient. Which factors may be associated with this condition (select all that apply)? a. Fasting b. Hypothyroidism c. Parenteral nutrition d. Prolonged immobility e. Streptococcus pneu | ACD |
| 49. A patient with an obstruction of the common bile duct has clay-colored fatty stools among other manifestations. What is the pathophysiologic change that causes this manifestation? a. Water-soluble (conjugated) bilirubin in the blood excreted into the | B |
| 50. The patient with suspected gallbladder disease is scheduled for an ultrasound of the gallbladder. What should the nurse teach the patient about this test? a. It is noninvasive and is a very reliable method of detecting gallstones. b. It is the only te | A |
| 51. What treatment for acute cholecystitis will prevent further stimulation of the gallbladder? a. NPO with NG suction b. Incisional cholecystectomy c. Administration of antiemetics d. Administration of anticholinergics | A |
| 52. After a laparoscopic cholecystectomy, what should the nurse expect to be part of the plan of care? a. Return to work in 2 to 3 weeks b. Be hospitalized for 3 to 5 days postoperatively c. Have a T-tube placed in the common bile duct to provide bile dra | D |
| 53. A patient with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a cholecystectomy. What is the best response by the nurse? a. “A low-fat diet will prevent the development of further gallstones and sho | C |
| 54. What must the nurse do to care for a T-tube in a patient after a cholecystectomy? a. Keep the tube supported and free of kinks. b. Attach the tube to low, continuous suction. c. Clamp the tube when ambulating the patient. d. Irrigate the tube with 10- | A |
| 55. During discharge instructions for a patient following a laparoscopic cholecystectomy, what should the nurse include in the teaching? a. Keep the incision area clean and dry for at least a week. b. Report the need to take pain medication for shoulder p | C |
| 1. A young adult contracts hepatitis from contaminated food. What should the nurse expect serologic testing to reveal during the acute (icteric) phase of the patient’s illness? a. Antibody to hepatitis D (anti-HDV) b. Hepatitis B surface antigen (HBsAg) c | D |
| 2. The nurse evaluates that administration of hepatitis B vaccine to a healthy patient has been effective when the patient’s blood specimen reveals: a. HBsAg. b. anti-HBs. c. anti-HBc IgG. d. anti-HBc IgM. | B |
| 3. A patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action by the nurse is appropriate? a. Schedule the patient for HCV genotype testing. b. Administer the HCV vaccine and immune globulin. c. Teach the patient | A |
| 4. What topic should the nurse plan to teach the patient diagnosed with acute hepatitis B? A.Administering interferon B. Side effects of nucleotide analogs C. Measures for improving appetite d. Ways to increase activity and exercise | C |
| 5. The nurse administering -interferon and ribavirin (Rebetol) to a patient with chronic hepatitis C will plan to monitor for: a. leukopenia. b. hypokalemia. c. polycythemia. d. hypoglycemia. | A |
| 6. Which information from a 70-yr-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C? a. The patient had a blood transfusion in 2005. b. The patient used IV drugs about 20 years ago. c. The patie | B |
| 7. A patient admitted with an abrupt onset of jaundice and nausea has abnormal liver function studies, but serologic testing is negative for viral causes of hepatitis. Which question by the nurse is appropriate? a. “Have you taken corticosteroids?” b. “Do | C |
| 8. Which focused data should the nurse assess after identifying 4+ pitting edema on a patient who has cirrhosis? a. Hemoglobin b. Temperature c. Activity level d. Albumin level | D |
| 9. Which topic is most important to include in teaching for a 41-yr-old patient diagnosed with early alcoholic cirrhosis? a. Taking lactulose b. Avoiding all alcohol use c. Maintaining good nutrition d. Using vitamin B supplements | B |
| 10. 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? a. Withhold both drugs. b. Administer both | D |
| 11. Which action should the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy? a. Request that the patient stand on one foot. b. Ask the patient to extend both arms forward. c. Request that the patient walk with e | B |
| 12. Which finding indicates to the nurse that lactulose is effective for an older adult who has advanced cirrhosis? a. The patient is alert and oriented. b. The patient denies nausea or anorexia. c. The patient’s bilirubin level decreases. d. The patient | A |
| 12. Which finding indicates to the nurse that lactulose is effective for an older adult who has advanced cirrhosis? a. The patient is alert and oriented. b. The patient denies nausea or anorexia. c. The patient’s bilirubin level decreases. d. The patient | B |
| 14. What is most important for the nurse to monitor to detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices? a. Bilirubin levels b. Ammonia levels c. Potassium levels d. Prothrombin time | B |
| 15. A 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. Restrict daily dietary protein intake. b. Reposition the patient every 4 hours. c. Perform passive range of motion tw | D |
| 16. Which finding indicates to the nurse that a patient’s transjugular intrahepatic portosystemic shunt (TIPS) placed 3 months ago has been effective? a. Increased serum albumin level b. Decreased indirect bilirubin level c. Improved alertness and orienta | D |
| 17. How should the nurse prepare a patient with ascites for paracentesis? a. Place the patient on NPO status. b. Assist the patient to lie flat in bed. c. Ask the patient to empty the bladder. d. Position the patient on the right side. | C |
| 18. Which finding is most important for the nurse to communicate to the health care provider about a patient who received a liver transplant 1 week ago? a. Dry palpebral and oral mucosa b. Crackles at bilateral lung bases c. Temperature 100.8° F (38.2° C) | C |
| 19. Which laboratory test result will the nurse monitor to evaluate the effects of therapy for a patient who has acute pancreatitis? a. Lipase b. Calcium c. Bilirubin d. Potassium | A |
| 20. Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient who has acute pancreatitis? a. Nausea and vomiting b. Hypotonic bowel sounds c. Muscle twitching and finger numbness d. Upper abdomina | C |
| 21. What risk factor will the nurse specifically ask about when a patient is being admitted with acute pancreatitis? a. Diabetes b. Alcohol use c. High-protein diet d. Cigarette smoking | D |
| 22. What should the nurse teach a patient with chronic pancreatitis is the time to take the prescribed pancrelipase (Viokase)? a. Bedtime b. Mealtime c. When nauseated d. For abdominal pain | B |
| 23. The nurse recognizes that teaching a patient following a laparoscopic cholecystectomy has been effective when the patient makes which statement? a. “I can take a shower and walk around the house tomorrow.” b. “I need to limit my activities and not ret | A |
| 24. The nurse is caring for a patient who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern? a. The patient reports right upper-quadrant pain with palpation. b. The patient’s hands flap back and forth when the a | B |
| 25. A patient who has cirrhosis and esophageal varices is being treated with propranolol (Inderal). Which finding is the best indicator to the nurse that the medication has been effective? a. The patient reports no chest pain. b. Blood pressure is 130/80 | C |
| 26. Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient who was admitted with bleeding esophageal varices? a. The medication will reduce the risk for aspiration. b. The medication will inhibit development of gastric | C |
| 27. When taking the blood pressure (BP) on the right arm of a patient who has severe acute pancreatitis, the nurse notices carpal spasms of the patient’s right hand. Which action should the nurse take next? a. Ask the patient about any arm pain. b. Retake | C |
| 28. A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to suction. Which information obtained by the nurse indicates that these therapies have been effective? a. Bowel sounds are present. b. Grey Turner sign resolves. c. Electrolyte | D |
| 29. Which assessment finding is of most concern for a patient with acute pancreatitis? a. Absent bowel sounds b. Abdominal tenderness c. Left upper quadrant pain d. Palpable abdominal mass | D |
| 30. Which action will be included in the care for a patient who has recently been diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD)? a. Teach symptoms of variceal bleeding. b. Draw blood for hepatitis serology testing. c. Discuss the ne | D |
| 31. A patient with chronic hepatitis B infection has several medications prescribed. Which medication order requires clarification with the health care provider before administration? a. Tenofovir (Viread) orally once daily b. Adefovir (Hepsera) orally on | D |
| 32. During change-of-shift report, the nurse learns about the following four patients. Which patient requires assessment first? a. A 58-yr-old patient who has compensated cirrhosis and reports anorexia b. A 40-yr-old patient with chronic pancreatitis who | C |
| 33. Which goal has the highest priority in the plan of care for a 26-yr-old patient who was admitted with viral hepatitis, has severe anorexia and fatigue, and is homeless? a. Increase activity level. b. Maintain adequate c. Establish a stable environmen | B |
| 34. Which action should the nurse in the emergency department take first for a new patient who is vomiting blood? a. Insert a large-gauge IV catheter. b. Draw blood for coagulation studies. c. Check blood pressure and heart rate. d. Place the patient in t | C |
| 35. The nurse is planning care for a patient with acute severe pancreatitis. What is the highest priority patient outcome? a. Having fluid and electrolyte balance b. Maintaining normal respiratory function c. Expressing satisfaction with pain control d. D | B |
| 36. The nurse is caring for a patient with pancreatic cancer. Which nursing action is the highest priority? a. Offer psychologic support for depression. b. Offer high-calorie, high-protein dietary choices. c. Administer prescribed opioids to relieve pain | C |
| 37. Which assessment information will be most important for the nurse to report to the health care provider about a patient who has acute cholecystitis? a. The patient’s urine is bright yellow. b. The patient’s stools are tan colored. c. The patient repor | B |
| 38. A patient had an incisional cholecystectomy 6 hours ago. The nurse will place the highest NURSINGTB.COM priority on assisting the patient to: a. perform leg exercises hourly while awake. b. ambulate the evening of the operative day. c. turn, cough, an | C |
| 39. For a patient who has cirrhosis, which nursing action can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP)? a. Assessing the patient for jaundice b. Providing oral hygiene after a meal c. Palpating the abdomen for distention | B |
| 40. Which action will the nurse include in the plan of care for a patient who has been diagnosed with chronic hepatitis B? a. Advise limiting alcohol intake to 1 drink daily. b. Schedule for liver cancer screening every 6 months. c. Initiate administratio | B |
| 41. A patient born in 1955 had hepatitis A infection 1 year ago. According to Centers for Disease Control and Prevention (CDC) guidelines, which action should the nurse include in care when the patient is seen for a routine annual physical examination? a. | C |
| 42. A patient has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider? a. Asterixis and lethargy b. Jaundiced sclera and skin c. Elevated total bilirubin level d. Liver | A |
| 43. A 36-yr-old female patient is receiving treatment for chronic hepatitis B with pegylated interferon (Pegasys). Which finding is important to communicate to the health care provider to suggest a change in therapy? a. Nausea and anorexia b. Weight loss | C |
| 44. A nurse is considering which patient to admit to the same room as a patient who is hospitalized with acute rejection 3 weeks after a liver transplant. Which patient would be the best choice? a. Patient who is receiving chemotherapy for liver cancer b. | D |
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Destinynichimp
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