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
A patient has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the
medical unit. The patients current medication regimen includes lactulose (Cephulac) four times daily. What desired outcome should the nurse relate to this pharmacologic intervention?
A) Two to 3 soft bowel movements daily
B) Significant increase in appetite and food intake
C) Absence of nausea and vomiting
D) Absence of blood or mucus in stool
A
A nurse is performing an admission assessment for an 81-year-old patient who generally enjoys good
health. When considering normal, age-related changes to hepatic function, the nurse should anticipate
what finding?
A) Similar liver size and texture as in younger adults
B) A nonpalpable liver
C) A slightly enlarged liver with palpably hard edges
D) A slightly decreased size of the liver
D
A nurse is caring for a patient with a blocked bile duct from a tumor. What manifestation of obstructive
jaundice should the nurse anticipate?
A) Watery, blood-streaked diarrhea
B) Orange and foamy urine
C) Increased abdominal girth
D) Decreased cognition
B
During a health education session, a participant has asked about the hepatitis E virus. What prevention
measure should the nurse recommend for preventing infection with this virus?
A) Following proper hand-washing techniques
B) Avoiding chemicals that are toxic to the liver
C) Wearing a condom during sexual contact
D) Limiting alcohol intake
A
A patients physician has ordered a liver panel in response to the patients development of jaundice. When
reviewing the results of this laboratory testing, the nurse should expect to review what blood tests?
Select all that apply.
A) Alanine aminotransferase (ALT)
B) C-reactive protein (CRP)
C) Gamma-glutamyl transferase (GGT)
D) Aspartate aminotransferase (AST)
E) B-type natriuretic peptide (BNP)
A C D
A patient with liver disease has developed jaundice; the nurse is collaborating with the patient to develop
a nutritional plan. The nurse should prioritize which of the following in the patients plan?
A) Increased potassium intake
B) Fluid restriction to 2 L per day
C) Reduction in sodium intake
D) High-protein, low-fat diet
C
A nurse is amending a patients plan of care in light of the fact that the patient has recently developed
ascites. What should the nurse include in this patients care plan?
A) Mobilization with assistance at least 4 times daily
B) Administration of beta-adrenergic blockers as ordered
C) Vitamin B12
injections as ordered
D) Administration of diuretics as ordered
D
A nurse is caring for a patient who has been admitted for the treatment of advanced cirrhosis. What
assessment should the nurse prioritize in this patients plan of care?
A) Measurement of abdominal girth and body weight
B) Assessment for variceal bleeding
C) Assessment for signs and symptoms of jaundice
D) Monitoring of results of liver function testing
B
A patient with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo
variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this
phase of the patients treatment?
A) Decisional Conflict
B) Deficient Knowledge
C) Death Anxiety
D) Disturbed Thought Processes
C
A patient with a diagnosis of esophageal varices has undergone endoscopy to gauge the progression of
this complication of liver disease. Following the completion of this diagnostic test, what nursing
intervention should the nurse perform?
A) Keep patient NPO until the results of test are known.
B) Keep patient NPO until the patients gag reflex returns.
C) Administer analgesia until post-procedure tenderness is relieved.
D) Give the patient a cold beverage to promote swallowing ability.
B
A patient with esophageal varices is being cared for in the ICU. The varices have begun to bleed and the
patient is at risk for hypovolemia. The patient has Ringers lactate at 150 cc/hr infusing. What else might
the nurse expect to have ordered to maintain volume for this patient?
A) Arterial line
B) Diuretics
C) Foley catheter
D) Volume expanders
D
A patient with a history of injection drug use has been diagnosed with hepatitis C. When collaborating
with the care team to plan this patients treatment, the nurse should anticipate what intervention?
A) Administration of immune globulins
B) A regimen of antiviral medications
C) Rest and watchful waiting
D) Administration of fresh-frozen plasma (FFP)
B
A group of nurses have attended an inservice on the prevention of occupationally acquired diseases that
affect healthcare providers. What action has the greatest potential to reduce a nurses risk of acquiring
hepatitis C in the workplace?
A) Disposing of sharps appropriately and not recapping needles
B) Performing meticulous hand hygiene at the appropriate moments in care
C) Adhering to the recommended schedule of immunizations
D) Wearing an N95 mask when providing care for patients on airborne precautions
A
A patient has been admitted to the critical care unit with a diagnosis of toxic hepatitis. When planning
the patients care, the nurse should be aware of what potential clinical course of this health problem?
Place the following events in the correct sequence.
1. Fever rises. 2. Hematemesis. 3. Clotting abnormalities. 4. Vascular collapse. 5. Coma.
A) 1, 2, 5, 4, 3
B) 1, 2, 3, 4, 5
C) 2, 3, 1, 4, 5
D) 3, 1, 2, 5, 4
B
A previously healthy adults sudden and precipitous decline in health has been attributed to fulminant
hepatic failure, and the patient has been admitted to the intensive care unit. The nurse should be aware
that the treatment of choice for this patient is what?
A) IV administration of immune globulins
B) Transfusion of packed red blood cells and fresh-frozen plasma (FFP)
C) Liver transplantation
D) Lobectomy
C
A nurse is caring for a patient with cirrhosis secondary to heavy alcohol use. The nurses most recent
assessment reveals subtle changes in the patients cognition and behavior. What is the nurses most
appropriate response?
A) Ensure that the patients sodium intake does not exceed recommended levels.
B) Report this finding to the primary care provider due to the possibility of hepatic encephalopathy.
C) Inform the primary care provider that the patient should be assessed for alcoholic hepatitis.
D) Implement interventions aimed at ensuring a calm and therapeutic care environment.
B
A patient with end-stage liver disease has developed hypervolemia. What nursing interventions would be
most appropriate when addressing the patients fluid volume excess? Select all that apply.
A) Administering diuretics
B) Administering calcium channel blockers
C) Implementing fluid restrictions
D) Implementing a 1500 kcal/day restriction
E) Enhancing patient positioning
A C E
A patient with liver cancer is being discharged home with a biliary drainage system in place. The nurse
should teach the patients family how to safely perform which of the following actions?
A) Aspirating bile from the catheter using a syringe
B) Removing the catheter when output is 15 mL in 24 hours
C) Instilling antibiotics into the catheter
D) Assessing the patency of the drainage catheter
D
A patient with cirrhosis has experienced a progressive decline in his health; and liver transplantation is
being considered by the interdisciplinary team. How will the patients prioritization for receiving a donor
liver be determined?
A) By considering the patients age and prognosis
B) By objectively determining the patients medical need
C) By objectively assessing the patients willingness to adhere to post-transplantation care
D) By systematically ruling out alternative treatment options
B
A nurse has entered the room of a patient with cirrhosis and found the patient on the floor. The patient
states that she fell when transferring to the commode. The patients vital signs are within reference ranges and the nurse observes no apparent injuries. What is the nurses most appropriate action?
A) Remove the patients commode and supply a bedpan.
B) Complete an incident report and submit it to the unit supervisor.
C) Have the patient assessed by the physician due to the risk of internal bleeding.
D) Perform a focused abdominal assessment in order to rule out injury.
C
A patient with liver cancer is being discharged home with a hepatic artery catheter in place. The nurse
should be aware that this catheter will facilitate which of the following?
A) Continuous monitoring for portal hypertension
B) Administration of immunosuppressive drugs during the first weeks after transplantation
C) Real-time monitoring of vascular changes in the hepatic system
D) Delivery of a continuous chemotherapeutic dose
D
A nurse on a solid organ transplant unit is planning the care of a patient who will soon be admitted upon
immediate recovery following liver transplantation. What aspect of nursing care is the nurses priority?
A) Implementation of infection-control measures
B) Close monitoring of skin integrity and color
C) Frequent assessment of the patients psychosocial status
D) Administration of antiretroviral medications
A
A 55-year-old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency
ablation. The nurse should recognize what goal of this treatment?
A) Destruction of the patients liver tumor
B) Restoration of portal vein patency
C) Destruction of a liver abscess
D) Reversal of metastasis
A
A nurse is caring for a patient with severe hemolytic jaundice. Laboratory tests show free bilirubin to be
24 mg/dL. For what complication is this patient at risk?
A) Chronic jaundice
B) Pigment stones in portal circulation
C) Central nervous system damage
D) Hepatomegaly
C
A nurse is assessing a patient who has been diagnosed with cholecystitis, and is experiencing localized
abdominal pain. When assessing the characteristics of the patients pain, the nurse should anticipate that
it may radiate to what region?
A) Left upper chest
B) Inguinal region
C) Neck or jaw
D) Right shoulder
Ans: D
A 55-year-old man has been newly diagnosed with acute pancreatitis and admitted to the acute medical
unit. How should the nurse most likely explain the pathophysiology of this patients health problem?
A) Toxins have accumulated and inflamed your pancreas.
B) Bacteria likely migrated from your intestines and became lodged in your pancreas.
C) A virus that was likely already present in your body has begun to attack your pancreatic cells.
D) The enzymes that your pancreas produces have damaged the pancreas itself.
D
A patients assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is performing the health interview, what assessment questions address likely etiologic factors? Select all
that apply.
A) How many alcoholic drinks do you typically consume in a week?
B) Have you ever been tested for diabetes?
C) Have you ever been diagnosed with gallstones?
D) Would you say that you eat a particularly high-fat diet?
E) Does anyone in your family have cystic fibrosis?
Ans: A, C
A patients abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the patients
laboratory studies, what finding is most closely associated with this diagnosis?
A) Increased bilirubin
B) Decreased serum cholesterol
C) Increased blood urea nitrogen (BUN)
D) Decreased serum alkaline phosphatase level
A
A nurse who provides care in a walk-in clinic assesses a wide range of individuals. The nurse should
identify which of the following patients as having the highest risk for chronic pancreatitis?
A) A 45-year-old obese woman with a high-fat diet
B) An 18-year-old man who is a weekend binge drinker
C) A 39-year-old man with chronic alcoholism
D) A 51-year-old woman who smokes one-and-a-half packs of cigarettes per day
C
A 37-year-old male patient presents at the emergency department (ED) complaining of nausea and
vomiting and severe abdominal pain. The patients abdomen is rigid, and there is bruising to the patients
flank. The patients wife states that he was on a drinking binge for the past 2 days. The ED nurse should
assist in assessing the patient for what health problem?
A) Severe pancreatitis with possible peritonitis
B) Acute cholecystitis
C) Chronic pancreatitis
D) Acute appendicitis with possible perforation
A
A patient has been scheduled for an ultrasound of the gallbladder the following morning. What should
the nurse do in preparation for this diagnostic study?
A) Have the patient refrain from food and fluids after midnight.
B) Administer the contrast agent orally 10 to 12 hours before the study.
C) Administer the radioactive agent intravenously the evening before the study.
D) Encourage the intake of 64 ounces of water 8 hours before the study.
A
A patient who had surgery for gallbladder disease has just returned to the postsurgical unit from
postanesthetic recovery. The nurse caring for this patient knows to immediately report what assessment
finding to the physician?
A) Decreased breath sounds
B) Drainage of bile-colored fluid onto the abdominal dressing
C) Rigidity of the abdomen
D) Acute pain with movement
C
A patient with chronic pancreatitis had a pancreaticojejunostomy created 3 months ago for relief of pain
and to restore drainage of pancreatic secretions. The patient has come to the office for a routine
postsurgical appointment. The patient is frustrated that the pain has not decreased. What is the most
appropriate initial response by the nurse?
A) The majority of patients who have a pancreaticojejunostomy have their normal digestion restored
but do not achieve pain relief.
B) Pain relief occurs by 6 months in most patients who undergo this procedure, but some people
experience a recurrence of their pain.
C) Your physician will likely want to discuss the removal of your gallbladder to achieve pain relief.
D) You are probably not appropriately taking the medications for your pancreatitis and pain, so we
will need to discuss your medication regimen in detail.
B
A nurse is caring for a patient who has been scheduled for endoscopic retrograde
cholangiopancreatography (ERCP) the following day. When providing anticipatory guidance for this
patient, the nurse should describe what aspect of this diagnostic procedure?
A) The need to protect the incision postprocedure
B) The use of moderate sedation
C) The need to infuse 50% dextrose during the procedure
D) The use of general anesthesia
B
A patient has undergone a laparoscopic cholecystectomy and is being prepared for discharge home. When providing health education, the nurse should prioritize which of the following topics?
A) Management of fluid balance in the home setting
B) The need for blood glucose monitoring for the next week
C) Signs and symptoms of intra-abdominal complications
D) Appropriate use of prescribed pancreatic enzymes
C
A nurse is preparing a plan of care for a patient with pancreatic cysts that have necessitated drainage
through the abdominal wall. What nursing diagnosis should the nurse prioritize?
A) Disturbed Body Image
B)
Impaired Skin Integrity
C) Nausea
D) Risk for Deficient Fluid Volume
B
A home health nurse is caring for a patient discharged home after pancreatic surgery. The nurse
documents the nursing diagnosis Risk for Imbalanced Nutrition: Less than Body Requirements on the
care plan based on the potential complications that may occur after surgery. What are the most likely
complications for the patient who has had pancreatic surgery?
A) Proteinuria and hyperkalemia
B) Hemorrhage and hypercalcemia
C) Weight loss and hypoglycemia
D) Malabsorption and hyperglycemia
D
A patient has had a laparoscopic cholecystectomy. The patient is now complaining of right shoulder
pain. What should the nurse suggest to relieve the pain?
A) Aspirin every 4 to 6 hours as ordered
B) Application of heat 15 to 20 minutes each hour
C) Application of an ice pack for no more than 15 minutes
D) Application of liniment rub to affected area
B
A patient returns to the floor after a laparoscopic cholecystectomy. The nurse should assess the patient
for signs and symptoms of what serious potential complication of this surgery?
A) Diabetic coma
B) Decubitus ulcer
C) Wound evisceration
D) Bile duct injury
D
a patient has been treated in the hospital for an episode of acute pancreatitis. the patient has
acknowledged the role that his alcohol use played in the development of his health problem, but has not
expressed specific plans for lifestyle changes after discharge. what is the nurses most appropriate
response?
a) educate the patient about the link between alcohol use and pancreatitis.
b) ensure that the patient knows the importance of attending follow-up appointments.
c) refer the patient to social work or spiritual care.
d) encourage the patient to connect with a community-based support group.
D
A patient is being treated on the acute medical unit for acute pancreatitis. The nurse has identified a
diagnosis of Ineffective Breathing Pattern Related to Pain. What intervention should the nurse perform
in order to best address this diagnosis?
A) Position the patient supine to facilitate diaphragm movement.
B) Administer corticosteroids by nebulizer as ordered.
C) Perform oral suctioning as needed to remove secretions.
D) Maintain the patient in a semi-Fowlers position whenever possible.
D
A patient with gallstones has been prescribed ursodeoxycholic acid (UDCA). The nurse understands that
additional teaching is needed regarding this medication when the patient states:
A) It is important that I see my physician for scheduled follow-up appointments while taking this
medication.
B) I will take this medication for 2 weeks and then gradually stop taking it.
C) If I lose weight, the dose of the medication may need to be changed.
D) This medication will help dissolve small gallstones made of cholesterol.
B
A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a patient
admitted with acute gallbladder inflammation, the nurse will question which of the following foods on
the tray?
A) Fried chicken
B) Mashed potatoes
C) Dinner roll
D) Tapioca pudding
A
A nurse is assessing an elderly patient with gallstones. The nurse is aware that the patient may not
exhibit typical symptoms, and that particular symptoms that may be exhibited in the elderly patient may
include what?
A) Fever and pain
B) Chills and jaundice
C) Nausea and vomiting
D) Signs and symptoms of septic shock
D
A nurse is creating a care plan for a patient with acute pancreatitis. The care plan includes reduced
activity. What rationale for this intervention should be cited in the care plan?
A) Bed rest reduces the patients metabolism and reduces the risk of metabolic acidosis.
B) Reduced activity protects the physical integrity of pancreatic cells.
C) Bed rest lowers the metabolic rate and reduces enzyme production.
D) Inactivity reduces caloric need and gastrointestinal motility.
C
The nurse is caring for a patient who has just returned from the ERCP removal of gallstones. The nurse
should monitor the patient for signs of what complications?
A) Pain and peritonitis
B) Bleeding and perforation
C) Acidosis and hypoglycemia
D) Gangrene of the gallbladder and hyperglycemia
B
A patient with pancreatic cancer has been scheduled for a pancreaticoduodenectomy (Whipple
procedure). During health education, the patient should be informed that this procedure will involve the
removal of which of the following? Select all that apply.
A) Gallbladder
B) Part of the stomach
C) Duodenum
D) Part of the common bile duct
E) Part of the rectum
A B C D
An adult patient has been admitted to the medical unit for the treatment of acute pancreatitis. What
nursing action should be included in this patients plan of care?
A) Measure the patients abdominal girth daily.
B) Limit the use of opioid analgesics.
C) Monitor the patient for signs of dysphagia.
D) Encourage activity as tolerated.
A
A community health nurse is caring for a patient whose multiple health problems include chronic
pancreatitis. During the most recent visit, the nurse notes that the patient is experiencing severe
abdominal pain and has vomited 3 times in the past several hours. What is the nurses most appropriate
action?
A) Administer a PRN dose of pancreatic enzymes as ordered.
B) Teach the patient about the importance of abstaining from alcohol.
C) Arrange for the patient to be transported to the hospital.
D) Insert an NG tube, if available, and stay with the patient.
C
A student nurse is caring for a patient who has a diagnosis of acute pancreatitis and who is receiving
parenteral nutrition. The student should prioritize which of the following assessments?
A) Fluid output
B) Oral intake
C) Blood glucose levels
D) BUN and creatinine levels
C
A patient has a recent diagnosis of chronic pancreatitis and is undergoing diagnostic testing to determine
pancreatic islet cell function. The nurse should anticipate what diagnostic test?
A) Glucose tolerance test
B) ERCP
C) Pancreatic biopsy
D) Abdominal ultrasonography
A
A patient has been admitted to the hospital for the treatment of chronic pancreatitis. The patient has been
stabilized and the nurse is now planning health promotion and educational interventions. Which of the
following should the nurse prioritize?
A) Educating the patient about expectations and care following surgery
B) Educating the patient about the management of blood glucose after discharge
C) Educating the patient about postdischarge lifestyle modifications
D) Educating the patient about the potential benefits of pancreatic transplantation
C
The family of a patient in the ICU diagnosed with acute pancreatitis asks the nurse why the patient has
been moved to an air bed. What would be the nurses best response?
A) Air beds allow the care team to reposition her more easily while shes on bed rest.
B) Air beds are far more comfortable than regular beds and shell likely have to be on bed rest a longtime.
C) The bed automatically moves, so shes less likely to develop pressure sores while shes in bed.
D) The bed automatically moves, so she is likely to have less pain.
C
A patient is receiving care in the intensive care unit for acute pancreatitis. The nurse is aware that
pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis. Consequently, the nurse should assess for what signs or symptoms of this complication?
A) Sudden increase in random blood glucose readings
B) Increased abdominal girth accompanied by decreased level of consciousness
C) Fever, increased heart rate and decreased blood pressure
D) Abdominal pain unresponsive to analgesics
C
A patient has been diagnosed with acute pancreatitis. The nurse is addressing the diagnosis of Acute
Pain Related to Pancreatitis. What pharmacologic intervention is most likely to be ordered for this
patient?
A) Oral oxycodone
B) IV hydromorphone (Dilaudid)
C) IM meperidine (Demerol)
D) Oral naproxen (Aleve)
B
A patient has just been diagnosed with chronic pancreatitis. The patient is underweight and in severe
pain and diagnostic testing indicates that over 80% of the patients pancreas has been destroyed. The
patient asks the nurse why the diagnosis was not made earlier in the disease process. What would be the
nurses best response?
A) The symptoms of pancreatitis mimic those of much less serious illnesses.
B) Your body doesnt require pancreatic function until it is under great stress, so it is easy to go
unnoticed.
C) Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost.
D) Its likely that your other organs were compensating for your decreased pancreatic function.
C
A patient has been diagnosed with pancreatic cancer and has been admitted for care. Following initial
treatment, the nurse should be aware that the patient is most likely to require which of the following?
A) Inpatient rehabilitation
B) Rehabilitation in the home setting
C) Intensive physical therapy
D) Hospice care
D
A patient is admitted to the ICU with acute pancreatitis. The patients family asks what causes acute
pancreatitis. The critical care nurse knows that a majority of patients with acute pancreatitis have what?
A) Type 1 diabetes
B) An impaired immune system
C) Undiagnosed chronic pancreatitis
D) An amylase deficiency
C
A patient is admitted to the unit with acute cholecystitis. The physician has noted that surgery will be
scheduled in 4 days. The patient asks why the surgery is being put off for a week when he has a sick
gallbladder. What rationale would underlie the nurses response?
A) Surgery is delayed until the patient can eat a regular diet without vomiting.
B) Surgery is delayed until the acute symptoms subside.
C) The patient requires aggressive nutritional support prior to surgery.
D) Time is needed to determine whether a laparoscopic procedure can be used.
B
A patient with a cholelithiasis has been scheduled for a laparoscopic cholecystectomy. Why is
laparoscopic cholecystectomy preferred by surgeons over an open procedure?
A) Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure.
B) Laparoscopic cholecystectomy can be performed in a clinic setting, while an open procedure
requires an OR.
C) A laparoscopic approach allows for the removal of the entire gallbladder.
D) A laparoscopic approach can be performed under conscious sedation.
A
A patient with ongoing back pain, nausea, and abdominal bloating has been diagnosed with cholecystitis
secondary to gallstones. The nurse should anticipate that the patient will undergo what intervention?
A) Laparoscopic cholecystectomy
B) Methyl tertiary butyl ether (MTBE) infusion
C) Intracorporeal lithotripsy
D) Extracorporeal shock wave therapy (ESWL)
A
A nurse is caring for a patient with gallstones who has been prescribed ursodeoxycholic acid (UDCA). The patient askshow this medicine is going to help his symptoms. The nurse should be aware of what
aspect of this drugs pharmacodynamics?
A) It inhibits the synthesis of bile.
B) It inhibits the synthesis and secretion of cholesterol.
C) It inhibits the secretion of bile.
D) It inhibits the synthesis and secretion of amylase.
B
A nurse is providing discharge education to a patient who has undergone a laparoscopic
cholecystectomy. During the immediate recovery period, the nurse should recommend what foods?
A) High-fiber foods
B) Low-purine, nutrient-dense foods
C) Low-fat foods high in proteins and carbohydrates
C
A patient presents to the emergency department (ED) complaining of severe right upper quadrant pain. The patient states that his family doctor told him he had gallstones. The ED nurse should recognize what
possible complication of gallstones?
A) Acute pancreatitis
B) Atrophy of the gallbladder
C) Gallbladder cancer
D) Gangrene of the gallbladder
D
A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurses most plausible conclusion based on this assessment finding?
A) The patient should withhold his next scheduled dose of insulin.
B) The patient should promptly eat some protein and carbohydrates.
C) The patients insulin levels are inadequate.
D) The patient would benefit from a dose of metformin (Glucophage).
C
A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would
support checking blood levels for the diagnosis of diabetes?
A) Fasting plasma glucose greater than or equal to 126 mg/dL
B) Random plasma glucose greater than 150 mg/dL
C) Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions
D) Random plasma glucose greater than 126 mg/dL
A
A patient newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline
would be important to teach the patients at this class?
A) Low fat generally indicates low sugar.
B) Protein should constitute 30% to 40% of caloric intake.
C) Most calories should be derived from carbohydrates.
D) Animal fats should be eliminated from the diet.
A
A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus
and her family. The nurse teaches the patient and family that which of the following nonpharmacologic
measures will decrease the bodys need for insulin?
A) Adequate sleep
B) Low stimulation
C) Exercise
D) Low-fat diet
C
A medical nurse is caring for a patient with type 1 diabetes. The patients medication administration
record includes the administration of regular insulin three times daily. Knowing that the patients lunch
tray will arrive at 11:45, when should the nurse administer the patients insulin?
A) 10:45
B) 11:15
C) 11:45
D) 11:50
B
A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic
agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood
glucose. What type of oral antidiabetic agent did the physician prescribe for this patient?
A) A sulfonylurea
B) A biguanide
C) A thiazolidinedione
D) An alpha glucosidase inhibitor
B
A diabetes nurse educator is teaching a group of patients with type 1 diabetes about sick day rules. What
guideline applies to periods of illness in a diabetic patient?
A) Do not eliminate insulin when nauseated and vomiting.
B) Report elevated glucose levels greater than 150 mg/dL.
C) Eat three substantial meals a day, if possible.
D) Reduce food intake and insulin doses in times of illness.
A
The nurse is discussing macrovascular complications of diabetes with a patient. The nurse would address
what topic during this dialogue?
A) The need for frequent eye examinations for patients with diabetes
B) The fact that patients with diabetes have an elevated risk of myocardial infarction
C) The relationship between kidney function and blood glucose levels
D) The need to monitor urine for the presence of albumin
B
A school nurse is teaching a group of high school students about risk factors for diabetes. Which of the
following actions has the greatest potential to reduce an individuals risk for developing diabetes?
A) Have blood glucose levels checked annually.
B) Stop using tobacco in any form.
C) Undergo eye examinations regularly.
D) Lose weight, if obese.
D
A 15-year-old child is brought to the emergency department with symptoms of hyperglycemia and is subsequently diagnosed with diabetes. Based on the fact that the childs pancreatic beta cells are being
destroyed, the patient would be diagnosed with what type of diabetes?
A) Type 1 diabetes
B) Type 2 diabetes
C) Noninsulin-dependent diabetes
D) Prediabetes
A
A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse
is explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe?
A) The tissues in your body are resistant to the action of insulin, making the glucose levels in your
blood increase.
B) Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is
not enough insulin to control it.
C) The amount of glucose that your body makes overwhelms your pancreas and decreases your
production of insulin.
D) Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels
rise because insulin normally breaks it down.
D
An occupational health nurse is screening a group of workers for diabetes. What statement should the
nurse interpret as suggestive of diabetes?
A) Ive always been a fan of sweet foods, but lately Im turned off by them.
B) Lately, I drink and drink and cant seem to quench my thirst.
C) No matter how much sleep I get, it seems to take me hours to wake up.
D) When I went to the washroom the last few days, my urine smelled odd.
B
A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patient
understands the primary treatment for type 2 diabetes when the patient states what?
A) I read that a pancreas transplant will provide a cure for my diabetes.
B) I will take my oral antidiabetic agents when my morning blood sugar is high.
C) I will make sure to follow the weight loss plan designed by the dietitian.
D) I will make sure I call the diabetes educator when I have questions about my insulin.
C
A diabetes nurse educator is presenting the American Diabetes Association (ADA) recommendations for
levels of caloric intake. What do the ADAs recommendations include?
A) 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein
B) 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60%
from protein
C) 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20%
from protein
D) 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20%
from protein
D
An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. The
patient is found to have a blood glucose level of 623 mg/dL. The patients daughter reports that the
patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of
hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority?
A) Administration of antihypertensive medications
B) Administering sodium bicarbonate intravenously
C) Reversing acidosis by administering insulin
D) Fluid and electrolyte replacement
D
A nurse is caring for a patient with type 1 diabetes who is being discharged home tomorrow. What is the
best way to assess the patients ability to prepare and self-administer insulin?
A) Ask the patient to describe the process in detail.
B) Observe the patient drawing up and administering the insulin.
C) Provide a health education session reviewing the main points of insulin delivery.
D) Review the patients first hemoglobin A1C result after discharge.
B
An elderly patient comes to the clinic with her daughter. The patient is a diabetic and is concerned about
foot care. The nurse goes over foot care with the patient and her daughter as the nurse realizes that foot
care is extremely important. Why would the nurse feel that foot care is so important to this patient?
A) An elderly patient with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy.
B) Avoiding foot ulcers may mean the difference between institutionalization and continued
independent living.
C) Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes.
D) Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower
extremities.
B
A diabetic educator is discussing sick day rules with a newly diagnosed type 1 diabetic. The educator is
aware that the patient will require further teaching when the patient states what?
A) I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar
every 2 hours.
B) If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a
day.
C) I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea.
D) I will call the doctor if my blood sugar is over 300 mg/dL or if I have ketones in my urine.
A
Which of the following patients with type 1 diabetes is most likely to experience adequate glucose
control?
A) A patient who skips breakfast when his glucose reading is greater than 220 mg/dL
B) A patient who never deviates from her prescribed dose of insulin
C) A patient who adheres closely to a meal plan and meal schedule
D) A patient who eliminates carbohydrates from his daily intake
C
A 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance
test, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she is
conscientious about her health, and asks the nurse what causes gestational diabetes. The nurse should
explain that gestational diabetes is a result of what etiologic factor?
A) Increased caloric intake during the first trimester
B) Changes in osmolality and fluid balance
C) The effects of hormonal changes during pregnancy
D) Overconsumption of carbohydrates during the first two trimesters
C
A medical nurse is aware of the need to screen specific patients for their risk of hyperglycemic
hyperosmolar syndrome (HHS). In what patient population does hyperosmolar nonketotic syndrome
most often occur?
A) Patients who are obese and who have no known history of diabetes
B) Patients with type 1 diabetes and poor dietary control
C) Adolescents with type 2 diabetes and sporadic use of antihyperglycemics
D) Middle-aged or older people with either type 2 diabetes or no known history of diabetes
D
A nurse is caring for a patient newly diagnosed with type 1 diabetes. The nurse is educating the patient
about self-administration of insulin in the home setting. The nurse should teach the patient to do which
of the following?
A) Avoid using the same injection site more than once in 2 to 3 weeks.
B) Avoid mixing more than one type of insulin in a syringe.
C) Cleanse the injection site thoroughly with alcohol prior to injecting.
D) Inject at a 45 angle.
A
A patient with type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon being
admitted to the hospital for a cholecystectomy, however, the patient has required insulin injections on
two occasions. The nurse would identify what likely cause for this short-term change in treatment?
A) Alterations in bile metabolism and release have likely caused hyperglycemia.
B) Stress has likely caused an increase in the patients blood sugar levels.
C) The patient has likely overestimated her ability to control her diabetes using nonpharmacologic
measures.
D) The patients volatile fluid balance surrounding surgery has likely caused unstable blood sugars.
B
A physician has explained to a patient that he has developed diabetic neuropathy in his right foot. Later
that day, the patient asks the nurse what causes diabetic neuropathy. What would be the nurses best
response?
A) Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have
gone on for years.
B) The cause is not known for sure but it is thought to have something to do with ketoacidosis.
C) The cause is not known for sure but it is thought to involve elevated blood glucose levels over a
period of years.
D) Research has shown that diabetic neuropathy is caused by a combination of elevated glucose levels
and elevated ketone levels.
C
A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin
(Glucophage). Following an ordered increase in the patients daily dose of metformin, the nurse should
prioritize which of the following assessments?
A) Monitoring the patients neutrophil levels
B) Assessing the patient for signs of impaired liver function
C) Monitoring the patients level of consciousness and behavior
D) Reviewing the patients creatinine and BUN levels
D
A patient with a longstanding diagnosis of type 1 diabetes has a history of poor glycemic control. The
nurse recognizes the need to assess the patient for signs and symptoms of peripheral neuropathy. Peripheral neuropathy constitutes a risk for what nursing diagnosis?
A) Infection
B) Acute pain
C) Acute confusion
D) Impaired urinary elimination
A
A patient has been brought to the emergency department by paramedics after being found unconscious. The patients Medic Alert bracelet indicates that the patient has type 1 diabetes and the patients blood
glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention?
A) IV administration of 50% dextrose in water
B) Subcutaneous administration of 10 units of Humalog
C) Subcutaneous administration of 12 to 15 units of regular insulin
D) IV bolus of 5% dextrose in 0.45% NaCl
A
A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing
information on the prevention and management of hypoglycemia, what action should the nurse promote?
A) Always carry a form of fast-acting sugar.
B) Perform exercise prior to eating whenever possible.
C) Eat a meal or snack every 8 hours.
D) Check blood sugar at least every 24 hours.
A
A nurse is teaching basic survival skills to a patient newly diagnosed with type 1 diabetes. What topic
should the nurse address?
A) Signs and symptoms of diabetic nephropathy
B) Management of diabetic ketoacidosis
C) Effects of surgery and pregnancy on blood sugar levels
D) Recognition of hypoglycemia and hyperglycemia
D
A nurse is conducting a class on how to self-manage insulin regimens. A patient asks how long a vial of
insulin can be stored at room temperature before it goes bad. What would be the nurses best answer?
A) If you are going to use up the vial within 1 month it can be kept at room temperature.
B) If a vial of insulin will be used up within 21 days, it may be kept at room temperature.
C) If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature.
D) If a vial of insulin will be used up within 1 week, it may be kept at room temperature.
A
A patient has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the
patient and will implement a program of health education. What is the nurses priority action?
A) Ensure that the patient understands the basic pathophysiology of diabetes.
B) Identify the patients body mass index.
C) Teach the patient survival skills for diabetes.
D) Assess the patients readiness to learn.
D
A student with diabetes tells the school nurse that he is feeling nervous and hungry. The nurse assesses
the child and finds he has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8
mmol/L). What should the school nurse administer?
A) A combination of protein and carbohydrates, such as a small cup of yogurt
B) Two teaspoons of sugar dissolved in a cup of apple juice
C) Half of a cup of juice, followed by cheese and crackers
D) Half a sandwich with a protein-based filling
C
A patient with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for
diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patients initial phase
of treatment?
A) Monitoring the patient for dysrhythmias
B) Maintaining and monitoring the patients fluid balance
C) Assessing the patients level of consciousness
D) Assessing the patient for signs and symptoms of venous thromboembolism
B
A patient has been living with type 2 diabetes for several years, and the nurse realizes that the patient is
likely to have minimal contact with the health care system. In order to ensure that the patient maintains
adequate blood sugar control over the long term, the nurse should recommend which of the following?
A) Participation in a support group for persons with diabetes
B) Regular consultation of websites that address diabetes management
C) Weekly telephone check-ins with an endocrinologist
D) Participation in clinical trials relating to antihyperglycemics
A
A patient with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority
instruction for the nurse to give the patient?
A) Examine feet weekly for redness, blisters, and abrasions.
B) Avoid the use of moisturizing lotions.
C) Avoid hot-water bottles and heating pads.
D) Dry feet vigorously after each bath.
C
A diabetes nurse is assessing a patients knowledge of self-care skills. What would be the most
appropriate way for the educator to assess the patients knowledge of nutritional therapy in diabetes?
A) Ask the patient to describe an optimally healthy meal.
B) Ask the patient to keep a food diary and review it with the nurse.
C) Ask the patients family what he typically eats.
D) Ask the patient to describe a typical days food intake.
B
The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the
presence of microalbuminuria. What is the nurses most appropriate action?
A) Teach the patient about actions to slow the progression of nephropathy.
B) Ensure that the patient receives a comprehensive assessment of liver function.
C) Determine whether the patient has been using expired insulin.
D) Administer a fluid challenge and have the test repeated.
A
A nurse is assessing a patient who has diabetes for the presence of peripheral neuropathy. The nurse
should question the patient about what sign or symptom that would suggest the possible development of
peripheral neuropathy?
A) Persistently cold feet
B) Pain that does not respond to analgesia
C) Acute pain, unrelieved by rest
D) The presence of a tingling sensation
D
A diabetic patient calls the clinic complaining of having a flu bug. The nurse tells him to take his regular
dose of insulin. What else should the nurse tell the patient?
A) Make sure to stick to your normal diet.
B) Try to eat small amounts of carbs, if possible.
C) Ensure that you check your blood glucose every hour.
D) For now, check your urine for ketones every 8 hours.
B
A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and
is experiencing HHS. The nurse should identify what components of HHS? Select all that apply.
A) Leukocytosis
B) Glycosuria
C) Dehydration
D) Hypernatremia
E) Hyperglycemia
B C D E
The nurse is caring for a patient diagnosed with hypothyroidism secondary to Hashimotos thyroiditis. When assessing this patient, what sign or symptom would the nurse expect?
A) Fatigue
B) Bulging eyes
C) Palpitations
D) Flushed skin
A
A patient has been admitted to the post-surgical unit following a thyroidectomy. To promote comfort and
safety, how should the nurse best position the patient?
A) Side-lying (lateral) with one pillow under the head
B) Head of the bed elevated 30 degrees and no pillows placed under the head
C) Semi-Fowlers with the head supported on two pillows
D) Supine, with a small roll supporting the neck
C
A patient with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has
been removed. The nurse caring for the patient should prioritize what question when addressing potential complications?
A) Do you feel any muscle twitches or spasms?
B) Do you feel flushed or sweaty?
C) Are you experiencing any dizziness or lightheadedness?
D) Are you having any pain that seems to be radiating from your bones?
A
The nurse is caring for a patient with a diagnosis of Addisons disease. What sign or symptom is most
closely associated with this health problem?
A) Truncal obesity
B) Hypertension
C) Muscle weakness
D) Moon face
C
The nurse is caring for a patient with Addisons disease who is scheduled for discharge. When teaching
the patient about hormone replacement therapy, the nurse should address what topic?
A) The possibility of precipitous weight gain
B) The need for lifelong steroid replacement
C) The need to match the daily steroid dose to immediate symptoms
D) The importance of monitoring liver function
B
The nurse is teaching a patient that the body needs iodine for the thyroid to function. What food would
be the best source of iodine for the body?
A) Eggs
B) Shellfish
C) Table salt
D) Red meat
C
A patient is prescribed corticosteroid therapy. What would be priority information for the nurse to give
the patient who is prescribed long-term corticosteroid therapy?
A) The patients diet should be low protein with ample fat.
B) The patient may experience short-term changes in cognition.
C) The patient is at an increased risk for developing infection.
D) The patient is at a decreased risk for development of thrombophlebitis and thromboembolism.
C
A nurse caring for a patient with diabetes insipidus is reviewing laboratory results. What is an expected
urinalysis finding?
A) Glucose in the urine
B) Albumin in the urine
C) Highly dilute urine
D) Leukocytes in the urine
C
The nurse caring for a patient with Cushing syndrome is describing the dexamethasone suppression test
scheduled for tomorrow. What does the nurse explain that this test will involve?
A) Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3
hours
B) Administration of dexamethasone IV, followed by an x-ray of the adrenal glands
C) Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next
morning
D) Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after
the drug is administered
C
You are developing a care plan for a patient with Cushing syndrome. What nursing diagnosis would
have the highest priority in this care plan?
A) Risk for injury related to weakness
B) Ineffective breathing pattern related to muscle weakness
C) Risk for loneliness related to disturbed body image
D) Autonomic dysreflexia related to neurologic changes
A
The nurse is performing a shift assessment of a patient with aldosteronism. What assessments should the
nurse include? Select all that apply.
A) Urine output
B) Signs or symptoms of venous thromboembolism
C) Peripheral pulses
D) Blood pressure
E) Skin integrity
A D
The home care nurse is conducting patient teaching with a patient on corticosteroid therapy. To achieve
consistency with the bodys natural secretion of cortisol, when would the home care nurse instruct the
patient to take his or her corticosteroids?
A) In the evening between 4 PM and 6 PM
B) Prior to going to sleep at night
C) At noon every day
D) In the morning between 7 AM and 8 AM
D
A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a
documented history of adrenal insufficiency. Considering the patients history and current symptoms, the
nurse should anticipate that the patient will be instructed to do which of the following?
A) Increase his intake of sodium until the GI symptoms improve.
B) Increase his intake of potassium until the GI symptoms improve.
C) Increase his intake of glucose until the GI symptoms improve.
D) Increase his intake of calcium until the GI symptoms improve.
A
The nurse is caring for a patient with hyperparathyroidism. What level of activity would the nurse expect
to promote?
A) Complete bed rest
B) Bed rest with bathroom privileges
C) Out of bed (OOB) to the chair twice a day
D) Ambulation and activity as tolerated
D
While assisting with the surgical removal of an adrenal tumor, the OR nurse is aware that the patients
vital signs may change upon manipulation of the tumor. What vital sign changes would the nurse expect
to see?
A) Hyperthermia and tachypnea
B) Hypertension and heart rate changes
C) Hypotension and hypothermia
D) Hyperthermia and bradycardia
B
A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that
sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory
finding may be an early indication of parathyroid gland injury or removal?
A) Hyponatremia
B) Hypophosphatemia
C) Hypocalcemia
D) Hypokalemia
C
The nurse is planning the care of a patient with hyperthyroidism. What should the nurse specify in the
patients meal plan?
A) A clear liquid diet, high in nutrients
B) Small, frequent meals, high in protein and calories
C) Three large, bland meals a day
D) A diet high in fiber and plant-sourced fat
B
A patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is
being cared for on the critical care unit. The priority nursing diagnosis for a patient with this condition is
what?
A) Risk for peripheral neurovascular dysfunction
B) Excess fluid volume
C) Hypothermia
D) Ineffective airway clearance
B
A patient with hypofunction of the adrenal cortex has been admitted to the medical unit. What would the
nurse most likely find when assessing this patient?
A) Increased body temperature
B) Jaundice
C) Copious urine output
D) Decreased BP
D
The nurse is assessing a patient diagnosed with Graves disease. What physical characteristics of Graves
disease would the nurse expect to find?
A) Hair loss
B) Moon face
C) Bulging eyes
D) Fatigue
C
A patient with suspected adrenal insufficiency has been ordered an adrenocorticotropic hormone (ACTH) stimulation test. Administration of ACTH caused a marked increase in cortisol levels. How
should the nurse interpret this finding?
A) The patients pituitary function is compromised.
B) The patients adrenal insufficiency is not treatable.
C) The patient has insufficient hypothalamic function.
D) The patient would benefit from surgery.
A
The physician has ordered a fluid deprivation test for a patient suspected of having diabetes insipidus. During the test, the nurse should prioritize what assessments?
A) Temperature and oxygen saturation
B) Heart rate and BP
C) Breath sounds and bowel sounds
D) Color, warmth, movement, and sensation of extremities
B
A nurse works in a walk-in clinic. The nurse recognizes that certain patients are at higher risk for
different disorders than other patients. What patient is at a greater risk for the development of
hypothyroidism?
A) A 75-year-old female patient with osteoporosis
B) A 50-year-old male patient who is obese
C) A 45-year-old female patient who used oral contraceptives
D) A 25-year-old male patient who uses recreational drugs
A
A patient with a recent diagnosis of hypothyroidism is being treated for an unrelated injury. When
administering medications to the patient, the nurse should know that the patients diminished thyroid
function may have what effect?
A) Anaphylaxis
B) Nausea and vomiting
C) Increased risk of drug interactions
D) Prolonged duration of effect
D
A patient has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions
should the nurse include in this patients immediate care? Select all that apply.
A) Administering diuretics to prevent fluid overload
B) Administering beta blockers to reduce heart rate
C) Administering insulin to reduce blood glucose levels
D) Applying interventions to reduce the patients temperature
E) Administering corticosteroids
B D
The nurses assessment of a patient with thyroidectomy suggests tetany and a review of the most recent
blood work corroborate this finding. The nurse should prepare to administer what intervention?
A) Oral calcium chloride and vitamin D
B) IV calcium gluconate
C) STAT levothyroxine
D) Administration of parathyroid hormone (PTH)
B
A patient has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To
prevent adrenal insufficiency, the nurse should ensure that the patient knows to do which of the
following?
A) Take the drug concurrent with levothyroxine (Synthroid).
B) Take each dose of prednisone with a dose of calcium chloride.
C) Gradually replace the prednisone with an OTC alternative.
D) Slowly taper down the dose of prednisone, as ordered.
D
Following an addisonian crisis, a patients adrenal function has been gradually regained. The nurse
should ensure that the patient knows about the need for supplementary glucocorticoid therapy in which
of the following circumstances?
A) Episodes of high psychosocial stress
B) Periods of dehydration
C) Episodes of physical exertion
D) Administration of a vaccine
A
A 30 year-old female patient has been diagnosed with Cushing syndrome. What psychosocial nursing
diagnosis should the nurse most likely prioritize when planning the patients care?
A) Decisional conflict related to treatment options
B) Spiritual distress related to changes in cognitive function
C) Disturbed body image related to changes in physical appearance
D) Powerlessness related to disease progression
C
A patient with pheochromocytoma has been admitted for an adrenalectomy to be performed the
following day. To prevent complications, the nurse should anticipate preoperative administration of which of the following?
A) IV antibiotics
B) Oral antihypertensives
C) Parenteral nutrition
D) IV corticosteroids
D
A patient is undergoing testing for suspected adrenocortical insufficiency. The care team should ensure
that the patient has been assessed for the most common cause of adrenocortical insufficiency. What is
the most common cause of this health problem?
A) Therapeutic use of corticosteroids
B) Pheochromocytoma
C) Inadequate secretion of ACTH
D) Adrenal tumor
A
The nurse providing care for a patient with Cushing syndrome has identified the nursing diagnosis of
risk for injury related to weakness. How should the nurse best reduce this risk?
A) Establish falls prevention measures.
B) Encourage bed rest whenever possible.
C) Encourage the use of assistive devices.
D) Provide constant supervision.
A
A patient with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with
the patient to improve the patients nutritional intake. What foods should a patient with Cushing
syndrome eat to optimize health? Select all that apply.
A) Foods high in vitamin D
B) Foods high in calories
C) Foods high in protein
D) Foods high in calcium
E) Foods high in sodium
A C D
A patient on corticosteroid therapy needs to be taught that a course of corticosteroids of 2 weeks
duration can suppress the adrenal cortex for how long?
A) Up to 4 weeks
B) Up to 3 months
C) Up to 9 months
D) Up to 1 year
D
A patient with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal
hypophysectomy. What would be most important for the nurse to monitor before, during, and after
surgery?
A) Blood glucose
B) Assessment of urine for blood
C) Weight
D) Oral temperature
A
What should the nurse teach a patient on corticosteroid therapy in order to reduce the patients risk of
adrenal insufficiency?
A) Take the medication late in the day to mimic the bodys natural rhythms.
B) Always have enough medication on hand to avoid running out.
C) Skip up to 2 doses in cases of illness involving nausea.
D) Take up to 1 extra dose per day during times of stress.
B
The nurse is caring for a patient at risk for an addisonian crisis. For what associated signs and symptoms
should the nurse monitor the patient? Select all that apply.
A) Epistaxis
B) Pallor
C) Rapid respiratory rate
D) Bounding pulse
E) Hypotension
B C E
A patient has been assessed for aldosteronism and has recently begun treatment. What are priority areas
for assessment that the nurse should frequently address? Select all that apply.
A) Pupillary response
B) Creatinine and BUN levels
C) Potassium level
D) Peripheral pulses
E) BP
C E
A patient who has been taking corticosteroids for several months has been experiencing muscle wasting. The patient has asked the nurse for suggestions to address this adverse effect. What should the nurse
recommend?
A) Activity limitation to conserve energy
B) Consumption of a high-protein diet
C) Use of OTC vitamin D and calcium supplements
D) Passive range-of-motion exercises
B
The nurse is providing care for an older adult patient whose current medication regimen includes
levothyroxine (Synthroid). As a result, the nurse should be aware of the heightened risk of adverse
effects when administering an IV dose of what medication?
A) A fluoroquinalone antibiotic
B) A loop diuretic
C) A proton pump inhibitor (PPI)
D) A benzodiazepine
D
