Final Exam

Review
HEP B
The nurse is assessing health fair participants
for risks for hepatitis. The nurse recognizes
which client as being at greatest risk for
developing hepatitis B?
a. College student who has had several
sexual partners
b. Woman who takes acetaminophen daily
for headaches
c. Businessman who travels frequently
d. Older woman who has eaten raw shellfish
A
ANS: A
Hepatitis B can be spread through sexual
contact, needle sharing, needle sticks,
blood transfusions, hemodialysis,
acupuncture, and the maternal-fetal
route. A person with multiple sexual
partners has more opportunities to
contract the infection.
HEP A
A client has been diagnosed with hepatitis A. The
nurse evaluates that teaching regarding the
disease is understood when the client makes
which statement?
a. Some medications have been known to
induce hepatitis A.
b. I may have been exposed when we ate
shrimp last weekend.
c. I may have been infected through a recent
blood transfusion.
d. My infection with Epstein-Barr virus can co-
infect me with hepatitis A.
B
hepatitis A infection is through close
personal contact or ingestion of
contaminated water or shellfish.
 A client with hepatitis C is being treated with
ribavirin (Copegus). What nursing action takes
priority?
a. Educating the client on ways to remain
complaint with the drug regimen
b. Teaching the client that transient muscle
aching is a common side effect
c. Ensuring that the client returns to the
clinic each week for follow-up care
d. Showing the client how to take and
record a radial pulse for 1 minute
A client is admitted with end-stage
cirrhosis and severe vomiting. Which
problem should the nurse monitor the
client most carefully for?
a. Intrahepatic bile stasis
b. Bleeding esophageal varices
c. Decreased excretion of bilirubin
d. Accumulation of ascites in the
abdomen
 ANS: B
The portal hypertension that accompanies
end-stage cirrhosis predisposes the client to
esophageal varices. These varices can
rupture from increased pressure in the
esophagus caused by coughing or vomiting.
Bleeding varices can be life threatening.
None of the other assessments take priority
over monitoring for bleeding from
esophageal varices.
A client is admitted with cirrhosis and
hepatopulmonary syndrome. Which
clinical manifestation does the nurse
monitor for progression or resolution of this
problem?
a. Right upper quadrant pain
b. Crackles on auscultation
c. Skin and scleral jaundice
d. Nausea and vomiting
 Crackles on auscultation
 The nurse is assessing a client for asterixis. Which
instruction to the client is most appropriate?
a. Close your eyes and take turns touching your
nose with your fingers.
b. Sit on the edge of the bed and hold your
legs straight out for 30 seconds.
c. Extend your arm, flex your wrist upward, and
extend your fingers.
d. Say EEEEE while I listen to your lungs in the
back on both sides.

ANS: C
 Asterixis, or liver flap, is a tremor in the
clients wrists and fingers. The correct
technique for assessing the presence of
asterixis is to extend the arm, dorsiflex the
wrist, and extend the fingers. The other
directions are not related to asterixis.
 Which laboratory data does the nurse
correlate with advanced disease in a
client with cirrhosis?
a. Elevated serum protein level
b. Elevated serum ammonia level
c. Decreased serum ammonia level
d. Decreased lactate dehydrogenase
level
B
The serum ammonia is elevated in the
presence of advanced disease because
conversion to urea for excretion is
decreased.
 The nurse monitors for which clinical manifestation
in a client with a decreased fecal urobilinogen
concentration?
a. Clay-colored stools
b. Petechiae
c. Asterixis
d. Melena

ANS: A
When fecal urobilinogen levels are decreased as
a result of biliary cirrhosis, the stools become lighter
or clay-colored.
A client has cirrhosis. Which nursing
intervention would be most effective in
controlling ascites?
a. Monitoring intake and output
b. Providing a low sodium diet
c. Increasing oral fluid intake
d. Weighing the client daily
B
A low sodium diet is one means of
controlling fluid collection.
 The nurse is caring for a client with cholecystitis.
Which assessment finding indicates to the nurse
that the condition is chronic rather than acute?
a. Abdomen that is hyperresonant to percussion

b. Hyperactive bowel sounds and diarrhea

c. Clay-colored stools and dark amber urine
d. Rebound tenderness in the right upper
quadrant

ANS: C
 In chronic cholecystitis, bile duct
obstruction results in the absence of
urobilinogen to color the stool. Excess
circulating bilirubin turns the urine dark
and foamy. The other assessment findings
do not correlate with chronic cholecystitis.
 The nurse is caring for a postoperative client who
reports pain in the shoulder blades following
laparoscopic cholecystectomy surgery. Which
direction does the nurse give to the nursing
assistant to help relieve the clients pain?
a. Ambulate the client in the hallway.
b. Apply a cold compress to the clients back.

c. Encourage the client to take sips of hot tea

or broth.
d. Remind the client to cough and deep
breathe every hour.
 ANS: A
The client who has undergone a laparoscopic
cholecystectomy may report free air pain
because of retention of carbon dioxide in the
abdomen. The nurse assists the client with
early ambulation to promote absorption of
the carbon dioxide. Coughing and deep
breathing are important postoperative
activities, but they are not related to
discomfort from carbon dioxide. Cold
compresses and drinking tea would not be
helpful.
 The nurse is providing discharge teaching for a
client who has just undergone laparoscopic
cholecystectomy surgery. Which statement by the
client indicates understanding of the instructions?
a. I will drink at least 2 liters of fluid a day.
b. I need a diet without a lot of fatty foods.
c. I should drink fluids between meals rather
than with meals.
d. I will avoid concentrated sweets and simple
carbohydrates.

ANS: B
 After cholecystectomy, clients need a
nutritious diet without a lot of excess fat;
otherwise a special diet is not
recommended for most clients. Good
fluid intake is healthy for all people but is
not related to the surgery. Drinking fluids
between meals helps with dumping
syndrome, which is not seen with this
operation. Restriction of sweets is not
required.
 The nurse is caring for a client who had a T-
tube placed 3 days ago. Which assessment
finding indicates to the nurse that the
procedure was successful?
a. Sclera that is slightly icteric
b. Positive Blumbergs sign
c. Soft, brown, formed stool this morning
d. Sips of clear liquid tolerated without
nausea

ANS: C
 The nurse is caring for a client with peptic ulcer
disease. The client vomits a large amount of
undigested food after breakfast. Which
intervention does the nurse prepare to provide for
the client?
a. Administer a soap suds cleansing enema.
b. Change the clients diet to clear liquids only.
c. Insert a nasogastric (NG) tube to low
intermittent suction.
d. Administer prochlorperazine (Compazine) 10
mg IM.
 Symptoms of abdominal distention and
nausea and vomiting of undigested food
signal pyloric obstruction. Treatment is aimed
at decompression of the stomach by an NG
tube and restoration of fluid and electrolyte
balance. The client should remain NPO, and a
soap suds cleansing enema is not indicated.
Decompressing the stomach should alleviate
the nausea, but if antiemetics are ordered,
they would not take priority over
decompressing the stomach.
 The nurse is caring for a client with a gastric ulcer
who suddenly develops sharp mid-epigastric pain.
The nurse notes that the clients abdomen is hard
and very tender to light palpation. Which is the
priority action of the nurse?
a. Place the client in a knee-chest position.
b. Prepare the client for emergency surgery.
c. Insert a nasogastric (NG) tube to low
intermittent suction.
d. Assess the clients pain and administer
analgesics.
 ANS: B
Sudden, sharp mid-epigastric pain is
indicative of perforation, which is a surgical
emergency. Pain medication should not be
administered just now because the surgeon
will need to assess the clients abdomen, and
the client will need to sign an operative
permit. The client may assume the knee-chest
position in an attempt to relieve pain. The
provider may order placement of an NG
tube, but this would not take priority over
getting the client ready for surgery.
 The nurse is caring for a client who is at risk for
developing gastritis. Which finding from the clients
history leads the nurse to this conclusion?
a. Client is lactose intolerant and cannot drink
milk.
b. Client recently traveled to Mexico and South
America.
c. Client works at least 60 hours per week in a
stressful job.
d. Client takes naproxen sodium (Naprosyn) 500
mg daily for arthritis pain.
 ANS: D
Motrin and other NSAIDs can cause
gastritis, even if symptoms are not yet
apparent. Stress, travel, and spicy foods
do not increase the risk for gastritis.
 The nurse is providing discharge teaching for a
client who has peptic ulcer disease caused by
Helicobacter pylori infection. Which statement by
the client indicates that additional teaching is
needed?
a. I will avoid drinking coffee, even if it is
decaffeinated.
b. I will take a multivitamin every morning with
breakfast.
c. I will go to my tai chi class to wind down
after a busy day.
d. I will take my medication every day until my
heartburn is gone.
 ANS: D
Long-term medication compliance is crucial
to eradicate Helicobacter pylori and prevent
recurrence. The nurse stresses the importance
of continuing medications for the entire time
prescribed. Decaffeinated coffee is a better
choice than caffeinated coffee for the client
with peptic ulcer disease. Stress management
should also be part of the treatment plan.
Good nutrition is always important.
 The nurse is caring for a client with chronic gastritis.
The client asks the nurse how to prevent another
flare-up of gastritis. Which is the nurses best
response?
a. Join a support group to help you stop
smoking.
b. Take a multivitamin with iron and folic acid
every day.
c. Make sure to include plenty of fresh
vegetables in your diet.
d. Make sure that your weight stays within
normal limits.
 ANS: A
Smoking and stress contribute to the
development of gastritis, so the client
should join a support group to help him
quit smoking. Multivitamins, fiber, and
weight management do not help prevent
gastritis development.
 The nurse is caring for a client with peptic ulcer
disease. Which assessment finding indicates to the
nurse that the client most likely has an ulcer in the
stomach rather than in the duodenum?
a. Body mass index (BMI) is 16.6.
b. Stool is positive for occult blood.
c. Client has had four ulcers in the last 5 years.
d. Hemoglobin is 13 g/dL and hematocrit is 42%.

ANS: A
 A BMI of 17.6 indicates that the client is
underweight (<18.5 is underweight in adults).
This finding is more commonly seen with
gastric ulcers than with duodenal ulcers
because the pain is made worse with food
ingestion. Occult blood and low hemoglobin
and hematocrit levels may be seen with both
gastric and duodenal ulcers. Recurrence is
more commonly seen with duodenal than
with gastric ulcers.
 The nurse is caring for a client who presents with chronic epigastric
pain, heartburn, and anorexia. The client asks the nurse how the
doctor can best determine whether the symptoms are caused by
gastritis. Which is the nurses best response?
a. You will be asked to drink a barium solution while x-rays are
taken of your stomach.
b. The doctor will take a look inside your stomach using a tube
with a light on the end of it.
c. A CT scan of your abdomen will show whether inflammation
is present in your stomach.
d. A blood sample will be sent to the laboratory to determine
whether you have a stomach infection or bleeding.

ANS: B
 Endoscopy
(esophagogastroduodenoscopy) with
biopsy is the best method for diagnosing
gastritis. Computed tomography (CT)
scans, upper GI series, and blood samples
are less accurate for making the diagnosis
of gastritis.
 A client has returned to the nursing unit after
esophagogastroduodenoscopy (EGD). Which
action by the nurse takes priority?
a. Keep the client on strict bedrest for 8
hours.
b. Delegate taking vital signs to the nursing
assistant.
c. Increase the IV rate to flush the kidneys.
d. Assess the clients gag reflex.
 ANS: D
The client will receive moderate sedation and
a numbing agent during the procedure. The
client may temporarily lose his or her gag
reflex; this should be checked before the
client is permitted to eat anything by mouth.
The client does not require strict bedrest for 8
hours or increased fluid to flush the kidneys.
The nurse can delegate the taking of vital
signs to unlicensed assistive personnel (UAP)
such as the nursing assistant, but this is not the
priority.
 The nurse is caring for a client who will undergo a gastrectomy the
following day. Which interventions are included in the
postoperative plan of care for the client? (Select all that apply.)
a. Monitor and record accurate intake and output (I&O).
b. Remind the client to use the incentive spirometer twice daily.

c. Change abdominal dressings daily using medical asepsis.

d. Remind the client daily to use patient-controlled analgesia
(PCA) before pain becomes severe.
e. Keep the head of the clients bed elevated whenever
possible.
f. Irrigate the nasogastric tube with normal saline every 8 hours
PRN.
 ANS: A, D, E
I&O should be recorded to monitor for fluid
overload or deficit. Pain medication is most
effective when taken before pain becomes
severe. Keep the clients head of the bed
elevated to prevent reflux. The spirometer
should be used at least every hour to prevent
atelectasis and pneumonia. Surgical asepsis
(sterile technique) must be used for dressing
changes and the site must be assessed each
shift, necessitating a dressing change each
shift.