Mount Saint Joseph University

NUR 508, Semester 2, 2015

Hiltz
DKA/HHNKS, LIVER, BILIARY, PANCREAS NCLEX
Each question is worth 2.5 points for a total of 50 pts.

Name:

Alvin L. Rozier

1. A client is admitted to the hospital with a diagnosis of cirrhosis and has

massive ascites. If the patient complains of difficulty breathing, which nursing
intervention could the nurse perform to assist the client with breathing?
a. Reposition from side to side every 2 hours
b. Elevate the head of the bed >45 degrees
c. Auscultate the lung fields every 4 hours
d. Encourage coughing and deep breathing every 2 hours

2. A patient with chronic liver disease reports that his gums bleed
spontaneously. In addition, the RN notices small, hemorrhagic lesions on his
face. The nurse anticipates an order for administration of which of the
following?
a. Bile salts
b. Folic acid
c. Thiamine
d. Vitamin K
3. The RN is assisting the client with hepatic encephalopathy fill out the dietary
menu for lunch. The nurse advises the client to avoid which of the following
entres that may aggravate the clients condition?
a. Tomato soup
b. Ground beef patty
c. Fresh fruit
d. Vegetable lasagna

4. Because of delayed treatment, a client with hepatitis B develops cirrhosis and

is admitted to the medical unit. One potential complication of chronic liver

disease is fluid/electrolyte imbalance. The nurse recognizes this may be

attributed to a decrease in serum albumin level, which leads to:
a. Hemorrhage with subsequent anemia
b. Diminished resistance to bacterial insult
c. Reduction of colloidal osmotic pressure in the blood and subsequent
third spacing of fluid
d. Malnutrition of cells, especially hepatic cells

5. The teacher of a college health course is discussing tattoos with the class.
During the discussion, the nurse warns the students that tattoos have been
associated with which type of hepatitis?
a. Hepatitis A
b. Hepatitis C
c. Hepatitis D
d. Hepatitis E
6. A client has just returned to their hospital room after a liver biopsy. Which of
the following is a complication that the nurse should be aware could occur
within the first few hours following this procedure?
a. Hemorrhage
b. Infection
c. Tension Pneumothorax
d. Anaphylaxis

7. A student nurse is giving a presentation on the major forms of viral hepatitis.

Which of the following would NOT be included as a risk for infection with
Hepatitis C (HCV)?
a. History of frequent blood transfusions
b. Ingestion of contaminated drinking water
c. IV drug use/ needle sharing
d. Unprotected sexual activity with multiple partners

8. The physician prescribes oral pancreatic enzymes for a patient. The nurse
identifies that teaching about enzymes is understood when the client states:
a. I will take them at bedtime.
b. I will take them with meals.
c. ffI will take them first thing in the morning each day.
d. I will take them 2 hours before meals.

9. A client with hepatic encephalopathy is prescribed lactulose. The nurse knows

that the purpose of lactulose in a patient with cirrhosis is:
a. To reduce intestinal edema
b. To reduce abdominal distention
c. To increase urine output

d. To diminish the blood ammonia level

10.A client who is scheduled to have a cholecystectomy expresses anxiety about

having surgery. Which nursing intervention would be the most appropriate to
achieve the outcome of anxiety reduction?
a. Providing the client with information about what to expect
postoperatively
b. Telling the client that it is normal to be afraid
c. Assuring the client that their surgery is a common procedure
d. Stressing the importance of strictly adhering to post-operative
instructions

11.A client with acute pancreatitis has a blood pressure of 88/42, a heart rate of
125 bpm, and respirations of 28/min. Grey Turners sign is present. Which
order should the nurse perform first?
a. Place a peripheral IV
b. tStrict I&O documentation
c. Insert a NG tube
d. Administer 6mg IM morphine for comfort

12.The nurse should monitor the patient with acute pancreatitis for which of the
following complications?
a. Cirrhosis
b. Pneumonia
c. Duodenal perforation
d. Heart failure

13.College freshman are practicing in an overseas study program. When

teaching the group about hepatitis B, the nurse should instruct them on:
a. Water sanitation
b. Single dormitory rooms
c. Safe sexual practices
d. Vaccination for hepatitis D

14.When planning care for a client with viral hepatitis, the nurse should review
lab reports for which of the following abnormal lab values?
a. Decreased blood glucose level
b. Elevated serum potassium
c. Decreased prothrombin time
d. Increased prothrombin time

15.A patient has advanced cirrhosis of the liver. The clients spouse asks the
nurse why his abdomen is swollen, making it very difficult for him to fasten
his pants. How should the nurse respond to provide the most accurate
explanation of the disease process?
a. He must have been eating too many foods with salt in them. Salt pulls
water with it.
b. The swelling in his ankles must have moved closer to his heart so the
fluid circulates better.
c. He must have forgotten to take his daily water pill.
d. Blood is not able to flow readily through the liver now, and the liver
cannot make protein to keep fluid inside the blood vessels.
16.The nurse develops a teaching plan for the client about how to prevent the
transmission of hepatitis A. Which of the following discharge instructions is
appropriate for the client?
a. Spray the house to eliminate infected insects.
b. Tell family members to stay away from the client.
c. Tell the patient and family members to wash hands frequently.
d. Disinfect all clothing, bedding, and eating utensils.

17.A client presents with polyphagia, polydipsia, and oliguria; he also complains
of headache, malaise, and some visual changes. Assessment shows signs of
dehydration. Which diagnosis could be made?
a. Diabetes insipidus
b. Diabetic ketoacidosis
c. Hypoglycemia
d. Type II diabetes mellitus

18.Objectives for treating diabetic ketoacidosis (DKA) include administration of

which treatment?
a. Glucagon
b. Blood products
c. Insulin and IV fluids
d. Antibiotics

19.Which electrolyte imbalance should a nurse be alert for in a patient started

on an insulin drip?
a. Hypercalcemia
b. Hyperkalemia
c. Hypokalemia
d. Hypophosphatemia

20.Which nursing diagnosis would have the highest priority for a patient with
hyperosmolar hyperglycemic nonketotic syndrome (HHNS)?
a. Risk for infection
b. Risk for acute confusion
c. Deficient fluid volume
d. Impaired skin integrity