RNSG 2539 TEST 2 QUESTIONS AND
ANSWERS ALL CORRECT
The nurse is concerned that a client with potential hepatic failure is at risk for developing
ascites. Which assessment finding supports the development of liver failure as
manifested by ascites?
A) Increased abdominal girth
B) Gallbladder pain
C) Yellow-tinged skin
D) Bleeding and bruising easily - Answer- A) Increased abdominal girth
The nurse is caring for a client who complains of jaundice and pruritus. The healthcare
provider suspects that the client has liver disease. What modifiable risk factor for
cirrhosis of the liver might the nurse see in the client's history?
A) Smokes two packs of cigarettes per day
B) Drinks a six-pack of beer each evening
C) History of occupational exposure to hepatic toxins
D) Family history of fatty liver disease - Answer- B) Drinks a six-pack of beer each
evening
The nurse is identifying risk factors for liver disease among individuals who visit the
community health center. Which does the nurse recognize as factors contributing to
increased risk among certain ethnic groups? Select all that apply.
A) Pollution
B) Variations in alcohol metabolism
C) Stress due to socioeconomic factors
D) Consuming alcohol with food
E) Climate - Answer- B) Variations in alcohol metabolism
C) Stress due to socioeconomic factors
A nurse is caring for a client who was recently admitted for treatment of cirrhosis. The
client is currently experiencing ascites, +3 pitting edema, and oliguria. Which nursing
diagnosis should the nurse select as a priority for this client?
A) Excess Fluid Volume
B) Ineffective Peripheral Tissue Perfusion
C) Deficient Fluid Volume
D) Impaired Skin Integrity - Answer- A) Excess Fluid Volume
The nurse is providing education to the caregivers of a client with cirrhosis of the liver.
The caregivers indicate that they've heard of portal hypertension, but they aren't sure
,which symptoms could indicate that their loved one is experiencing this condition. Which
symptoms of portal hypertension should the nurse discuss with the caregivers?
A) Muscle wasting
B) Hypothermia
C) Bleeding gums
D) Hemorrhoids - Answer- D) Hemorrhoids
The nurse is caring for a client recovering from a liver transplant necessitated by
cirrhosis of the liver. Which postoperative outcome would be a priority for this client?
A) Moist membranes of the mouth
B) Normal serum bilirubin levels
C) Ability to move the legs
D) Normal pupil reaction - Answer- B) Normal serum bilirubin levels
A client with liver cirrhosis begins to drain bright red blood through the nasogastric tube.
Which should the nurse prepare to administer to this client?
A) Vitamin K
B) Ferrous sulfate
C) Platelets
D) Folic acid - Answer- C. Platelets
A client with liver cirrhosis begins to drain bright red blood through the nasogastric tube.
Which should the nurse prepare to administer to this client?
A) Vitamin K
B) Ferrous sulfate
C) Platelets
D) Folic acid - Answer- C. Platelets
A nurse is caring for a client with end-stage liver disease. Which alterations should the
nurse anticipate with this client? Select all that apply.
A) Elevated serum albumin levels due to increased protein synthesis
B) Decreased clotting factor levels due to impaired clotting factor production
C) Hyperglycemia due to disrupted glucose metabolism
D) Increased serum vitamin K due to impaired clearance of fat-soluble vitamins
E) Increased plasma oncotic pressure due to impaired protein metabolism - Answer- B)
Decreased clotting factor levels due to impaired clotting factor production
C) Hyperglycemia due to disrupted glucose metabolism
The nurse is providing care to a client admitted with acute pancreatitis. Which data
support the client's diagnosis? Select all that apply.
A) Severe epigastric pain
B) Nausea and vomiting
C) Elevated temperature
D) Hypotension
E) Steatorrhea - Answer- A) Severe epigastric pain
, B) Nausea and vomiting
C) Elevated temperature
D) Hypotension
The nurse is providing care to a client who is being admitted to rule out acute
pancreatitis. Which item found in the client's history increases the client's risk for this
disease process?
A) Systemic lupus
B) Alcoholism
C) Cystic fibrosis
D) Hypertriglyceridemia - Answer- B) Alcoholism
The nurse is providing care to an older adult client admitted to the medical unit for acute
gastric and left upper abdominal pain radiating to the back. The healthcare provider has
diagnosed the client with chronic pancreatitis. Which items are appropriate to include in
the discharge teaching for this client? Select all that apply.
A) Encouraging a high-fat diet
B) Eliminating alcoholic beverages
C) Properly administering pancrelipase
D) Reporting symptoms of infection
E) Taking antacids - Answer- B) Eliminating alcoholic beverages
C) Properly administering pancrelipase
D) Reporting symptoms of infection
E) Taking antacids
An adult client is admitted to the emergency department with symptoms of acute
pancreatitis. Which nursing diagnoses are appropriate for this client? Select all that
apply.
A) Acute Pain
B) Impaired Swallowing
C) Deficient Fluid Volume
D) Nausea
E) Imbalanced Nutrition: Less than Body Requirement - Answer- A) Acute Pain
C) Deficient Fluid Volume
D) Nausea
E) Imbalanced Nutrition: Less than Body Requirement
The nurse is providing care to an older adult client with a history of alcohol abuse who is
admitted to the hospital with acute pancreatitis. Which treatment options should the
nurse plan for when caring for this client? Select all that apply.
A) Opioid analgesics
B) High-fat diet
C) Total parenteral nutrition
D) Nasogastric tube to suction
E) Pancrelipase administration - Answer- A) Opioid analgesics
C) Total parenteral nutrition
ANSWERS ALL CORRECT
The nurse is concerned that a client with potential hepatic failure is at risk for developing
ascites. Which assessment finding supports the development of liver failure as
manifested by ascites?
A) Increased abdominal girth
B) Gallbladder pain
C) Yellow-tinged skin
D) Bleeding and bruising easily - Answer- A) Increased abdominal girth
The nurse is caring for a client who complains of jaundice and pruritus. The healthcare
provider suspects that the client has liver disease. What modifiable risk factor for
cirrhosis of the liver might the nurse see in the client's history?
A) Smokes two packs of cigarettes per day
B) Drinks a six-pack of beer each evening
C) History of occupational exposure to hepatic toxins
D) Family history of fatty liver disease - Answer- B) Drinks a six-pack of beer each
evening
The nurse is identifying risk factors for liver disease among individuals who visit the
community health center. Which does the nurse recognize as factors contributing to
increased risk among certain ethnic groups? Select all that apply.
A) Pollution
B) Variations in alcohol metabolism
C) Stress due to socioeconomic factors
D) Consuming alcohol with food
E) Climate - Answer- B) Variations in alcohol metabolism
C) Stress due to socioeconomic factors
A nurse is caring for a client who was recently admitted for treatment of cirrhosis. The
client is currently experiencing ascites, +3 pitting edema, and oliguria. Which nursing
diagnosis should the nurse select as a priority for this client?
A) Excess Fluid Volume
B) Ineffective Peripheral Tissue Perfusion
C) Deficient Fluid Volume
D) Impaired Skin Integrity - Answer- A) Excess Fluid Volume
The nurse is providing education to the caregivers of a client with cirrhosis of the liver.
The caregivers indicate that they've heard of portal hypertension, but they aren't sure
,which symptoms could indicate that their loved one is experiencing this condition. Which
symptoms of portal hypertension should the nurse discuss with the caregivers?
A) Muscle wasting
B) Hypothermia
C) Bleeding gums
D) Hemorrhoids - Answer- D) Hemorrhoids
The nurse is caring for a client recovering from a liver transplant necessitated by
cirrhosis of the liver. Which postoperative outcome would be a priority for this client?
A) Moist membranes of the mouth
B) Normal serum bilirubin levels
C) Ability to move the legs
D) Normal pupil reaction - Answer- B) Normal serum bilirubin levels
A client with liver cirrhosis begins to drain bright red blood through the nasogastric tube.
Which should the nurse prepare to administer to this client?
A) Vitamin K
B) Ferrous sulfate
C) Platelets
D) Folic acid - Answer- C. Platelets
A client with liver cirrhosis begins to drain bright red blood through the nasogastric tube.
Which should the nurse prepare to administer to this client?
A) Vitamin K
B) Ferrous sulfate
C) Platelets
D) Folic acid - Answer- C. Platelets
A nurse is caring for a client with end-stage liver disease. Which alterations should the
nurse anticipate with this client? Select all that apply.
A) Elevated serum albumin levels due to increased protein synthesis
B) Decreased clotting factor levels due to impaired clotting factor production
C) Hyperglycemia due to disrupted glucose metabolism
D) Increased serum vitamin K due to impaired clearance of fat-soluble vitamins
E) Increased plasma oncotic pressure due to impaired protein metabolism - Answer- B)
Decreased clotting factor levels due to impaired clotting factor production
C) Hyperglycemia due to disrupted glucose metabolism
The nurse is providing care to a client admitted with acute pancreatitis. Which data
support the client's diagnosis? Select all that apply.
A) Severe epigastric pain
B) Nausea and vomiting
C) Elevated temperature
D) Hypotension
E) Steatorrhea - Answer- A) Severe epigastric pain
, B) Nausea and vomiting
C) Elevated temperature
D) Hypotension
The nurse is providing care to a client who is being admitted to rule out acute
pancreatitis. Which item found in the client's history increases the client's risk for this
disease process?
A) Systemic lupus
B) Alcoholism
C) Cystic fibrosis
D) Hypertriglyceridemia - Answer- B) Alcoholism
The nurse is providing care to an older adult client admitted to the medical unit for acute
gastric and left upper abdominal pain radiating to the back. The healthcare provider has
diagnosed the client with chronic pancreatitis. Which items are appropriate to include in
the discharge teaching for this client? Select all that apply.
A) Encouraging a high-fat diet
B) Eliminating alcoholic beverages
C) Properly administering pancrelipase
D) Reporting symptoms of infection
E) Taking antacids - Answer- B) Eliminating alcoholic beverages
C) Properly administering pancrelipase
D) Reporting symptoms of infection
E) Taking antacids
An adult client is admitted to the emergency department with symptoms of acute
pancreatitis. Which nursing diagnoses are appropriate for this client? Select all that
apply.
A) Acute Pain
B) Impaired Swallowing
C) Deficient Fluid Volume
D) Nausea
E) Imbalanced Nutrition: Less than Body Requirement - Answer- A) Acute Pain
C) Deficient Fluid Volume
D) Nausea
E) Imbalanced Nutrition: Less than Body Requirement
The nurse is providing care to an older adult client with a history of alcohol abuse who is
admitted to the hospital with acute pancreatitis. Which treatment options should the
nurse plan for when caring for this client? Select all that apply.
A) Opioid analgesics
B) High-fat diet
C) Total parenteral nutrition
D) Nasogastric tube to suction
E) Pancrelipase administration - Answer- A) Opioid analgesics
C) Total parenteral nutrition
