NSG 4100/ NSG 4100 Exam 1 – 2026/2027 Academic Year – Advanced Medical-Surgical Nursing Questions with Verified Answers and Elaborated Solutions

NSG 4100/ NSG 4100 Exam 1 – 2026/2027 Academic Year – Advanced Medical-Surgical Nursing Questions with Verified Answers and Elaborated Solutions 2026 / 2027 Academic Year Q: A nurse is caring for a client with liver failure and is performing an assessment of the client's increased risk of bleeding. The nurse recognizes that this risk is related to the client's 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. Inability of the liver to use vitamin K. Q: A nurse is performing an admission assessment of a client with a diagnosis of cirrhosis. What technique should the nurse use to palpate the client's 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. Place hand under right lower rib cage and press down lightly with the other hand. Q: A client with portal hypertension has been admitted to the medical floor. The nurse should prioritize what assessments? 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. Daily weights and abdominal girth measurement Q: 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) Immunization B) Use of standard precautions Q: A client who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize? A. The client will obtain measurement of drainage from the T-tube. B. The client will exercise three times a week. C. The client will take immunosuppressive agents as required. D. The client will monitor for signs of liver dysfunction. C. The client will take immunosuppressive agents as required. Q: A triage nurse in the emergency department is assessing a client who presented with reports of general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What assessment question best addresses the possible etiology of this client's 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. How many alcoholic drinks do you typically consume in a week? Q: A nurse is participating in the emergency care of a client 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 D. IV administration of octreotide Q: A nurse is caring for a client with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the client 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. Asterixis Q: 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. An immune globulin injection Q: What health promotion teaching should the nurse prioritize to prevent drug-induced hepatitis? A. Finish all prescribed courses of antibiotics, regardless of symptom resolution. B. Adhere to dosing recommendations of over-the-counter analgesics. C. Ensure that expired medications are disposed of safely. D. Ensure that pharmacists regularly review drug regimens for potential interactions. B. Adhere to dosing recommendations of over-the-counter analgesics. Q: Diagnostic testing has revealed that a client's hepatocellular carcinoma (HCC) is limited to one lobe. The nurse should anticipate that this client's plan of care will focus on what intervention? A. Cryosurgery B. Liver transplantation C. Lobectomy D. Laser hyperthermia C. Lobectomy Q: A client has been diagnosed with advanced stage breast cancer and will soon begin aggressive treatment. What assessment findings would most strongly suggest that the client 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. Abdominal pain and hepatomegaly Q: A client is being discharged after a liver transplant and the nurse is performing discharge education. When planning this client's continuing care, the nurse should prioritize what risk diagnosis? 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. Risk for Infection Related to Immunosuppressant Use Q: A nurse is caring for a client with hepatic encephalopathy. The nurse's assessment reveals that the client 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. Stage 3 Q: A client has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The client's current medication regimen includes lactulose four times daily. What desired outcome should the nurse relate to this pharmacologic intervention? A. Two to three 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. Two to three soft bowel movements daily Q: A nurse is performing an admission assessment for an 81-year-old client 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 slightly decreased size of the liver Q: A nurse is caring for a client 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. Orange and foamy urine Q: 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. Following proper hand-washing techniques Q: A client's health care provider has ordered a "liver panel" in response to the client's 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. Alanine aminotransferase (ALT) C. Gamma-glutamyl transferase (GGT) D. Aspartate aminotransferase (AST) Q: A client with liver disease has developed ascites; the nurse is collaborating with the client to develop a nutritional plan. The nurse should prioritize which of the following in the client's 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. Reduction in sodium intake Q: A nurse is amending a client's plan of care in light of the fact that the client has recently developed ascites. What should the nurse include in this client's care plan? A. Mobilization with assistance at least 4 times daily B. Administration of beta-adrenergic blockers as prescribed C. Vitamin B12 injections as prescribed D. Administration of diuretics as prescribed D. Administration of diuretics as prescribed Q: A nurse is caring for a client who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this client's 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. Assessment for variceal bleeding Q: A client 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 client's treatment? A. Decisional conflict B. Deficient knowledge C. Death anxiety D. Disturbed thought processes C. Death Anxiety Q: A client 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 client NPO until the results of test are known. B. Keep client NPO until the client's gag reflex returns. C. Administer analgesia until post-procedure tenderness is relieved. Done D. Give the client a cold beverage to promote swallowing ability. B. Keep client NPO until the client's gag reflex returns. A client with esophageal varices is being cared for in the ICU. The varices have begun to bleed. The client has Ringer lactate at 150 cc/hr infusing. The nurse should also anticipate what intervention? A. Positioning the client supine B. Administering diuretics C. Oxygen by nasal cannula D. Administering volume expanders D. Administering volume expanders A client with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this client's 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 regimen of antiviral medications A group of nurses have attended an in-service on the prevention of occupationally acquired diseases that affect health care providers. What action has the greatest potential to reduce a nurse's 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 clients on airborne precautions A. Disposing of sharps appropriately and not recapping needles A client has been admitted to the critical care unit with a diagnosis of toxic hepatitis. When planning the client's 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. 1, 2, 3, 4, 5 A nurse is caring for a client with cirrhosis secondary to heavy alcohol use. The nurse's most recent assessment reveals subtle changes in the client's cognition and behavior. What is the nurse's most appropriate response? A. Ensure that the client's sodium intake does not exceed recommended levels. B. Report this finding to the primary provider due to the possibility of hepatic encephalopathy. C. Inform the primary provider that the client should be assessed for alcoholic hepatitis. D. Implement interventions aimed at ensuring a calm and therapeutic care environment. B. Report this finding to the primary provider due to the possibility of hepatic encephalopathy. A client with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the client's 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 client positioning A. Administering diuretics C. Implementing fluid restrictions E. Enhancing client positioning A client with liver cancer is being discharged home with a biliary drainage system in place. The nurse should teach the client's 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) Assessing the patency of the drainage catheter A client with cirrhosis has experienced a progressive decline in his health; and liver transplantation is being considered by the interdisciplinary team. How will the client's prioritization for receiving a donor liver be determined? A. By considering the client's age and prognosis B. By objectively determining the client's medical need C. By objectively assessing the client's willingness to adhere to post-transplantation care D. By systematically ruling out alternative treatment options B. By objectively determining the client's medical need A nurse has entered the room of a client with cirrhosis and found the client on the floor. The client reports falling when transferring to the commode. The client's vital signs are within reference ranges and the nurse observes no apparent injuries. What is the nurse's most appropriate action? A. Remove the client's commode and supply a bedpan. B. Complete an incident report and submit it to the unit supervisor. C. Have the client assessed by the primary provider due to the risk of internal bleeding. D. Perform a focused abdominal assessment in order to rule out injury. C. Have the client assessed by the primary provider due to the risk of internal bleeding. A client 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. Delivery of a continuous chemotherapeutic dose A nurse on a solid organ transplant unit is planning the care of a client who will soon be admitted upon immediate recovery following liver transplantation. What aspect of nursing care is the nurse's priority? A. Implementation of infection-control measures B. Close monitoring of skin integrity and color C. Frequent assessment of the client's psychosocial status D. Administration of antiretroviral medications A. Implementation of infection-control measures A 55-year-old female client with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment? A. Destruction of the client's liver tumor B. Restoration of portal vein patency Done C. Destruction of a liver abscess D. Reversal of metastasis A. Destruction of the client's liver tumor A nurse is caring for a client with severe hemolytic jaundice. Laboratory tests show free bilirubin to be 24 mg/dL (408 mmol/L). For what complication is this client at risk? A. Chronic jaundice B. Pigment stones in portal circulation C. Central nervous system damage D. Hepatomegaly C. Central nervous system damage The nurse's review of a client's most recent laboratory results indicates a bilirubin level of 3.0 mg/dL (51 mmol/L). The nurse assesses the client for: A. jaundice. B. bleeding. C. malnutrition. D. hypokalemia. A. jaundice. A nurse is assessing a client who has been diagnosed with cholecystitis, and is experiencing localized abdominal pain. When assessing the characteristics of the client's 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 D. Right shoulder A client has been newly diagnosed with acute pancreatitis and admitted to the acute medical unit. How should the nurse explain the pathophysiology of this client's 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. "The enzymes that your pancreas produces have damaged the pancreas itself." A client's abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the client's 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. Increased bilirubin A nurse who provides care in a community clinic assesses a wide range of individuals. The nurse should identify which client 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 39-year-old man with chronic alcoholism A 37-year-old client presents at the emergency department (ED) reporting nausea and vomiting and severe abdominal pain. The client's abdomen is rigid, and there is bruising to the client's flank. The client's spouse states that the client was on a drinking binge for the past 2 days. The ED nurse should assist in assessing the client for what health problem? A. Severe pancreatitis with possible peritonitis B. Acute cholecystitis C. Chronic pancreatitis D. Acute appendicitis with possible perforation A. Severe pancreatitis with possible peritonitis A client 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 client 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. Have the client refrain from food and fluids after midnight. A client who had surgery for gallbladder disease has just returned to the postsurgical unit from postanesthetic recovery. The nurse caring for this client knows to immediately report what assessment finding to the health care provider? 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. Rigidity of the abdomen A client with chronic pancreatitis had a pancreaticojejunostomy created 3 months ago for relief of pain and to restore drainage of pancreatic secretions. The client has come to the office for a routine postsurgical appointment. The client is frustrated that the pain has not decreased. What is the most appropriate initial response by the nurse? A. "The majority of clients who have a pancreaticojejunostomy have their normal digestion restored but do not achieve pain relief." B. "Pain relief occurs by 6 months in most clients who undergo this procedure, but some people experience a recurrence of their pain." C. "Your health care provider 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. "Pain relief occurs by 6 months in most clients who undergo this procedure, but some people experience a recurrence of their pain." A nurse is caring for a client who has been scheduled for endoscopic retrograde cholangiopancreatography (ERCP) the following day. When providing anticipatory guidance for this client, 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. The use of moderate sedation A client has undergone a laparoscopic cholecystectomy and is being prepared for discharge home. When providing health education, the nurse should prioritize what topic? 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. Signs and symptoms of intra-abdominal complications A nurse is preparing a plan of care for a client 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. Impaired skin integrity A home health nurse is caring for a client 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 client who has had pancreatic surgery? A. Proteinuria and hyperkalemia B. Hemorrhage and hypercalcemia C. Weight loss and hypoglycemia D. Malabsorption and hyperglycemia D. Malabsorption and hyperglycemia A client has had a laparoscopic cholecystectomy. The client is now reporting right shoulder pain. What should the nurse suggest to relieve the pain? A. Aspirin every 4 to 6 hours as prescribed 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. Application of heat 15 to 20 minutes each hour A client returns to the floor after a laparoscopic cholecystectomy. The nurse should assess the client 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. Bile duct injury A client has been treated in the hospital for an episode of acute pancreatitis. The client 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. What is the nurse's most appropriate response? A. Educate the client about the link between alcohol use and pancreatitis. B. Ensure that the client knows the importance of attending follow-up appointments. C. Refer the client to social work or spiritual care. D. Encourage the client to connect with a community-based support group. D. Encourage the client to connect with a community-based support group. A client is being treated for acute pain from an episode of pancreatitis. The nurse has identified a nursing diagnosis of Ineffective Breathing Pattern related to pain secondary to effects of surgery. Which intervention should the nurse perform in order to best address this diagnosis? A. Position the client supine to facilitate diaphragm movement. B. Administer corticosteroids by nebulizer as prescribed. C. Perform oral suctioning as needed to remove secretions. D. Administer analgesic per orders. D. Administer analgesic per orders. A client with gallstones has been prescribed ursodeoxycholic acid (UDCA). The nurse understands that additional teaching is needed regarding this medication when the client states: A. "It is important that I see my health care provider 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. "I will take this medication for 2 weeks and then gradually stop taking it." A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a client 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. Fried chicken A nurse is assessing an older adult client with gallstones. The nurse is aware that the client may not exhibit typical symptoms, and that particular symptoms that may be exhibited in the elderly client may include what examples? A. Fever and pain B. Chills and jaundice C. Nausea and vomiting D. Signs and symptoms of septic shock D. Signs and symptoms of septic shock A nurse is creating a care plan for a client 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 client's 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. Bed rest lowers the metabolic rate and reduces enzyme production. The nurse is caring for a client who has just returned from the ERCP removal of gallstones. The nurse should monitor the client 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. Bleeding and perforation A client with pancreatic cancer has been scheduled for a pancreaticoduodenectomy (Whipple procedure). During health education, the client 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. Gallbladder B. Part of the stomach C. Duodenum D. Part of the common bile duct An adult client has been admitted to the medical unit for the treatment of acute pancreatitis. What nursing action should be included in this client's plan of care? A. Measure the client's abdominal girth daily. B. Limit the use of opioid analgesics. C. Monitor the client for signs of dysphagia. D. Encourage activity as tolerated. A. Measure the client's abdominal girth daily. A community health nurse is caring for a client whose multiple health problems include chronic pancreatitis. During the most recent home visit, the nurse learns that the client is experiencing severe abdominal pain and has vomited 3 times in the past several hours. What is the nurse's most appropriate action? A. Administer a PRN dose of pancreatic enzymes as prescribed. B. Teach the client about the importance of abstaining from alcohol. C. Arrange for the client to be transported to the hospital. D. Insert an NG tube, if available, and stay with the client. C. Arrange for the client to be transported to the hospital. A student nurse is caring for a client who has a diagnosis of acute pancreatitis and who is receiving parenteral nutrition. The student should prioritize which of the following A. Fluid output B. Oral intake C. Blood glucose levels D. BUN and creatinine levels C. Blood glucose levels A client 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. Glucose tolerance test A client has been admitted to the hospital for the treatment of chronic pancreatitis. The client 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 client about expectations and care following surgery B. Educating the client about the management of blood glucose after discharge C. Educating the client about postdischarge lifestyle modifications D. Educating the client about the potential benefits of pancreatic transplantation C. Educating the client about postdischarge lifestyle modifications A client 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 clients 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) Fever, increased heart rate and decreased blood pressure A client 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 client? A. Oral oxycodone B. IV hydromorphone C. IM meperidine D. Oral naproxen B. IV hydromorphone A client has just been diagnosed with chronic pancreatitis. The client is underweight and in severe pain and diagnostic testing indicates that over 80% of the client's pancreas has been destroyed. The client asks the nurse why the diagnosis was not made earlier in the disease process. What would be the nurse's best response? A. "The symptoms of pancreatitis mimic those of much less serious illnesses." B. "Your body doesn't 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. "It's likely that your other organs were compensating for your decreased pancreatic function." C. "Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost." A client has been diagnosed with pancreatic cancer and has been admitted for care. Following initial treatment, the nurse should be aware that the client is most likely to require which of the following situations? A. Inpatient rehabilitation B. Rehabilitation in the home setting C. Intensive physical therapy D. Hospice care D. Hospice care A client is admitted to the ICU with acute pancreatitis. The client's family asks what causes acute pancreatitis. The critical care nurse knows that a majority of clients with acute pancreatitis have what health issue? A. Type 1 diabetes B. An impaired immune system C. Undiagnosed chronic pancreatitis D. An amylase deficiency C. Undiagnosed chronic pancreatitis A client is admitted to the unit with acute cholecystitis. The health care provider has stated that surgery will be scheduled in 4 days. The client asks why the surgery is being put off for a week when he has a "sick gallbladder." What rationale would underlie the nurse's response? A. Surgery is delayed until the client can eat a regular diet without vomiting. B. Surgery is delayed until the acute symptoms subside. C. The client requires aggressive nutritional support prior to surgery. D. Time is needed to determine whether a laparoscopic procedure can be used. B. Surgery is delayed until the acute symptoms subside. A client 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 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. Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure. A client with ongoing back pain, nausea, and abdominal bloating has been diagnosed with cholecystitis secondary to gallstones. The nurse should anticipate that the client will undergo what intervention? A. Laparoscopic cholecystectomy B. Methyl tertiary butyl ether (MTBE) infusion C. Intracorporeal lithotripsy D. Extracorporeal shock wave therapy (ESWL) A. Laparoscopic cholecystectomy A nurse is caring for a client with gallstones who has been prescribed ursodeoxycholic acid (UDCA). The client asks how this medicine is going to help his symptoms. The nurse should be aware of what aspect of this drug's 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. It inhibits the synthesis and secretion of cholesterol. A client presents to the emergency department (ED) reporting severe right upper quadrant pain. The client states that the family doctor said the pain was caused by gallstones. The ED nurse should recognize what possible complication of gallstones? A nurse is providing discharge education to a client 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 D. Foods that are low-residue and low in fat C. Low-fat foods high in proteins and carbohydrates A. Acute pancreatitis B. Atrophy of the gallbladder C. Gallbladder cancer D. Gangrene of the gallbladder D. Gangrene of the gallbladder A client's assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is performing the health interview, what assessment question(s) addresses 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?" 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?" Which client should the nurse prioritize as needing emergent treatment, assuming no other injuries are present except the ones outlined? A. A client with a blunt chest trauma with some difficulty breathing B. A client with a sore neck who was immobilized in the field on a backboard with a cervical collar C. A client with a possible fractured tibia with adequate pedal pulses D. A client with an acute onset of confusion A client with a blunt chest trauma with some difficulty breathing A client has sustained multiple injuries from a gunshot wound while hunting in cold winter weather. The client has waited several hours for rescue and is transported in a helicopter to the emergency department. The nurse recognizes what additional factors are associated with increased mortality for this client? A. Time of injury, hyperhidrosis, and thermal changes B. Comorbidities, location of injury, and gravitational forces C. Hypothermia, acidosis, and coagulopathy D. Venous insufficiency, barometric changes, and fatigue C. Hypothermia, acidosis, and coagulopathy The nurse is admitting a client who is suspected of having heat stroke. What assessment finding would be most consistent with this diagnosis? A. Widening pulse pressure B. Hot, dry skin C. Core body temperature of 99.0°F/37.2°C D. Cheyne-Stokes respirations B. hot, dry skin. A client is brought to the ED by ambulance after swallowing highly acidic toilet bowl cleaner 2 hours earlier. The client is alert and oriented. What is the care team's most appropriate treatment? A. Administering syrup of ipecac B. Performing a gastric lavage C. Giving milk to drink D. Referring to psychiatry C) Giving milk to drink The paramedics bring a client who has suffered a sexual assault to the ED. What is important for the sexual assault nurse examiner to do when assessing a sexual assault victim? A. Respect the client's privacy during assessment. B. Shave all pubic hair for laboratory analysis. C. Place items for evidence in plastic bags. D. Bathe the client before the examination. A. Respect the client's privacy during assessment. A client with a history of major depression is brought to the ED by the client's parents. Which of the following nursing actions is most appropriate? A. Noting that symptoms of physical illness are not relevant to the current diagnosis B. Asking if the client has ever thought about taking their own life C. Conducting interviews in a brief and direct manner D. Arranging for the client to spend time alone to consider their feelings B. Asking if the client has ever thought about taking their own life The nurse is caring for a client with alcohol withdrawal syndrome. What would be an appropriate nursing action to minimize the potential for hallucinations? A. Engage the client in a process of health education. B. Administer opioid analgesics as prescribed. C. Place the client in a private, well-lit room. D. Provide television or a radio as therapeutic distraction C. Place the client in a private, well-lit room. An obtunded client is admitted to the ED after ingesting bleach. The nurse should prepare to assist with what intervention? A. Prompt administration of an antidote B. Gastric lavage C. Administration of activated charcoal D. Helping the client drink large amounts of water D. Helping the client drink large amounts of water A client with multiple injuries is brought to the emergency department by ambulance. The client has had his airway stabilized and is breathing on their own. The nurse does not see any active bleeding, but should suspect internal hemorrhage based on what finding? A. Absence of bruising at contusion sites B. Rapid pulse and decreased capillary refill C. Increased BP with narrowed pulse pressure D. Sudden diaphoresis B) Rapid pulse and decreased capillary refill A client is brought to the emergency room (ER) in an unconscious state and emergency surgery is needed. No family members are present, and the client does not have identification. What action by the nurse is the priority regarding consent for treatment? A. Ask the social worker to come and sign the consent. B. Contact the police to obtain the client's identity. C. Obtain an emergency court order to treat the client. D. Clearly document level of consciousness (LOC) and health status on the client's chart. D. Clearly document level of consciousness (LOC) and health status on the client's chart. A client is brought by friends to the ED after being involved in a motor vehicle accident. The client sustained blunt trauma to the abdomen. What nursing action would be most appropriate for this client? A. Ambulate the client to expel flatus. B. Place the client in a high Fowler position. C. Immobilize the client on a backboard. D. Place the client in a left lateral position. C. Immobilize the client on a backboard. A client with a fractured femur presenting to the ED exhibits cool, moist skin, increased heart rate, and falling BP. The care team should consider the possibility of what complication of the client's injuries? A. Myocardial infarction B. Hypoglycemia C. Hemorrhage D. Peritonitis C. Hemorrhage A client who has been diagnosed with cholecystitis is being discharged home from the ED to be scheduled for later surgery. The client received morphine during the present ED admission and is visibly drowsy. When providing health education to the client, what would be the most appropriate nursing action? A. Give written instructions to client. B. Give verbal instructions to one of the client's family members. C. Telephone the client the next day with verbal instructions. D. Give verbal and written instructions to the client and a family member. D. Give verbal and written instructions to the client and a family member. A client who attempted suicide is being treated in the ED. The client is accompanied by the client's mother, father, and brother. When planning the nursing care of this family, the nurse should perform which of the following actions? A. Refer the family to a psychiatrist in order to provide them with support. B. Explore the causes of the client's suicide attempt with the family. C. Encourage the family to participate in the bedside care of the client. D. Ensure that the family receives appropriate crisis intervention services. D) Ensure that the family receives appropriate crisis intervention services. A client with multiple trauma is brought to the emergency department (ED) by ambulance after a fall while rock climbing. What is a responsibility of the ED nurse in this client's care? A. Intubating the client B. Notifying family members C. Ensuring Intravenous (IV) access D. Testing laboratory specimens C. Ensuring Intravenous (IV) access A client has been brought to the ED after suffering genitourinary trauma in an assault. Initial assessment reveals that the client's bladder is distended. What is the nurse's most appropriate action? A. Withhold fluids from the client. B. Perform intermittent urinary catheterization. C. Insert a narrow-gauge indwelling urinary catheter. D. Await orders following the urologist's assessment. D) Await orders following the urologists assessment. A homeless person is admitted the ED during a blizzard, and is unable to feel the feet and lower legs. Core temperature is noted at 33.2°C (91.8°F). The client is intoxicated with alcohol at the time of admission and is visibly malnourished. What is the triage nurse's priority in the care of this client? A. Addressing the client's hypothermia B. Addressing the client's frostbite in his lower extremities C. Addressing the client's alcohol intoxication D. Addressing the client's malnutrition A. Addressing the client's hypothermia A client admitted to the ED with severe diarrhea and vomiting is subsequently diagnosed with food poisoning. The nurse caring for this client assesses for signs and symptoms of fluid and electrolyte imbalances. For what signs and symptoms would this nurse assess? Select all that apply. A. Dysrhythmias B. Hypothermia C. Hypotension D. Hyperglycemia E. Delirium A) Dysrhythmias C) Hypotension E) Delirium A client is admitted to the ED with an apparent overdose of IV heroin. After stabilizing the client's cardiopulmonary status, the nurse should prepare to perform what intervention? A. Administer a bolus of lactated Ringer. B. Administer naloxone hydrochloride (Narcan). C. Insert an indwelling urinary catheter. D. Perform a focused neurologic assessment. B) Administer naloxone hydrochloride (Narcan). A client is being treated for bites suffered during an assault. After the bites have been examined and documented by a forensic examiner, the nurse should perform what action? A. Apply a dressing saturated with chlorhexidine. B. Wash the bites with soap and water. C. Arrange for the client to receive a hepatitis B vaccination. D. Assess the client's immunization history. B) Wash the bites with soap and water. The ED nurse is planning the care of a client who has been admitted following a sexual assault. The nurse knows that all of the nursing interventions are aimed at what goal? A. Encouraging the client to gain a sense of control over his or her life B. Collecting sufficient evidence to secure a criminal conviction C. Helping the client understand that this will not happen again D. Encouraging the client to verbalize what happened during the assault A. Encouraging the client to gain a sense of control over his or her life The ED nurse admitting a client with a history of depression is screening the client for suicide risk. What assessment question should the nurse ask when screening the client? A. "How would you describe your mood over the past few days?" B. "Have you ever thought about taking your own life?" C. "How do you think that your life is most likely to end?" D. "How would you rate the severity of your depression right now on a 10-point scale?" B) Have you ever thought about taking your own life? A client is brought to the ED by two police officers. The client was found unconscious on the sidewalk, the client's face and hands covered in blood. At present, the client is verbally abusive and is fighting the staff in the ED, but appears medically stable. The decision is made to place the client in restraints. What action should the nurse perform when the client is restrained? A. Frequently assess the client's skin integrity. B. Inform the client about the likelihood of being charged with assault. C. Avoid interacting with the client until the restraints are removed. D. Take the opportunity to perform a full physical assessment. A. Frequently assess the client's skin integrity. An emergency department (ED) nurse is triaging clients according to a triage severity rating. When assigning clients to a triage level, the nurse will consider the clients' acuity as well as what other variable? A. The likelihood of a repeat visit to the ED in the next seven days B. The resources that the client is likely to currently require C. The client's or insurer's ability to cover the cost of care D. Whether other hospitals are on diversionary status and ability to manage the client B. The resources that the client is likely to currently require A client in the critical care unit is prescribed crystalloid intravenous fluids. The nurse anticipates administering which fluid? Select all that apply. A. Normal saline B. Lactated Ringer C. Dextrose 5% in water D. Albumin E. Hetastarch (TM) A. Normal saline B. Lactated Ringer C. Dextrose 5% in water Increased uremia results in metabolic toxins accumulating in the body. How will this manifest in the patient? Pericardial friction rub Your pt's K+ level is reported at 5.9 mEq/L. What do you do next? Notify the MD Your pt with ESRD presents with anorexia, metallic taste in the mouth and mental status changes. This may be indicative of: Uremia The nurse is caring for assigned clients who have end-stage renal disease (ESRD). Which of the following arterial blood gas (ABG) results should the nurse correlate to this condition? pH 7.20, PaO2 80 mm Hg, PaCO2 36 mm Hg, HCO3- 16 mEq/L. 3 multiple choice options Which pt is priority for hemodialysis? A pt with BP of 170/100 3 multiple choice options ESRD increases the pt's risk for developing: PAD Your client reports indigestion. Which OTC med is appropriate for them? Pepcid (H2 blocker) Which of the following activities should be taught to the pt with cirrhosis prior to d/c? Weigh yourself daily and record it 3 multiple choice options Which foods are appropriate for the pt with cirrhosis? Legumes 3 multiple choice options The pt is 3 days s/p left nephrectomy. All of the following are post-op complications except: Small amount of serosanguinous drainage in the Jackson-Pratt 3 multiple choice options CRRT: what is the difference b/w CVVH and CVVHD? CVVH has no dialysate, removes larger volumes of fluid via convection, replacement fluid added, and effective for removal of large molecules CVVHD has dialysate, replacement fluid not administered via the filter in this mode, combines diffusion and convection for solute removal BP 68/34, increased HR, low LOC, ESKD, edematous, resp dullness. What type of intervention do I need? 1. Immediate lifesaving intervention Increased K+, HTN, and tachypnea. What type of intervention do I need? 2. High-risk intervention What dx tests do you anticipate to be ordered for a pt with suspected acute pancreatitis? Lipase and amylase A pt with acute pancreatitis presents to the ED. Which is a priority action? NGT to low intermittent wall suction 3 multiple choice options D/c teaching for the pt with chronic pancreatitis should include: Consulting with their physician on any OTC meds Mr. Miller, 63 y/o is s/p 1 day gastrectomy. Which of the following are signs of potential complications? H+H 7.8/24 3 multiple choice options Women who have had liver transplants can never have children after sx. T/F? False Metabolic acidosis low pH (7.35), low HCO3 (22) *Metabolic Equal What are complications of hemodialysis? Hypotension, bleeding, infection What is the home care for indwelling catheter? - good UOP 30mL/hr - increase fluids - good hand hygiene - use soap/water to cleanse gently - irrigation - anchor tube - minimize manipulation HD for ESRD: what requires immediate response? - low BP - low K+ - monitor fistula for bruit + thrill (is it working? Are they bleeding?) Which electrolytes are most critical to keep stable r/t ESRD? K+ (3-5.5) and Mg (1.5-2.5) What should you always place on an ESRD pt? Cardiac monitor What meds do you hold before HD? BP meds Who qualified for renal replacement therapy? - high K+ or hypotensive - decreased UOP - ESRD - massive blood infection - S/S renal failure What are S/S of dumping syndrome? - increased HR - dizziness - sweating, N/VM bloating - abd pain/cramping - diarrhea I have severe LUQ abd pain that started 24hrs after a heavy meal. I have ecchymosis in flank/umbilicus region. I'm confused with elevated HR and low BP. My skin is cold and clammy. What could I have? Pancreatitis What are early s/s of uremia? Metallic taste, bruises/itching, and muscle cramps *THINK SKIN, MUSCLE, MOUTH What are later s/s of uremia? Changes in LOC and pericarditis What are early s/s of dumping syndrome? High BS and and high HR What are later s/s of dumping syndrome? Low BS and paleness Diet recs for the pt post-op from bariatric post-op? - 6-8 small meals/day no 1 cup - don't drink with meals but b/w meals is OK - drink low cal fluids - encourage electrolyte based foods - PB, cheese, chicken, fish, beans - low carb - 2 protein snacks - low Fowler during and after meals - fiber + protein are GOOD Should we encourage healthier eating habits and wt loss goals pre-op for bariatric sx? YES What are risk factors for bladder cancer? older, white males, occupational exposure from factories What are foods high in phos and potassium? Potatoes, oranges, bananas, and salt substitutes