1.

The nurse reviewing the record of a client notes that client has history alcohol
abuse. Which type of cirrhosis is caused by long term alcoholism?

A. Cardiac Cirrhosis
B. Biliary Cirrhosis
C. Post necrotic Cirrhosis
D. Laennec’s Cirrhosis.

Answer: D

Laennec’s cirrhosis results from long-term alcohol abuse. Cardiac cirrhosis most
commonly is caused by long-term right-sided congestive heart failure. Exposure to
hepatotoxins, chemicals, or infections, or a metabolic disorder can cause post
necrotic cirrhosis. Biliary cirrhosis results from a decrease in bile flow and is
most commonly caused by long-term obstruction of bile ducts.

2. Oral neomycin has been prescribed for the client with cirrhosis and the nurse
determines that this medication is intended to;

A. Prevent infection.
B. Decrease protein breakdown and ammonia production of bacteria found in the
bowel.
C. Prevent fluid retention and ascites.
D. Prevent restlessness in the client.

Answer: B

Neomycin may be prescribed for the client with portosystemic encephalopathy. It is

a broad-spectrum antibiotic that destroys normal bacteria found in the bowel,
thereby decreasing protein breakdown and ammonia production.

3. A nurse caring for a patient with Sengstaken- Blakemore tube. The physician
arrives on the nursing unit and deflates the esophageal balloon. The nurse should
monitor the patient for;

A. Bloody diarrhea
B. Hematemesis
C. Increase in BP
D. Increase abdominal girth

Answer: B

A Sengstaken-Blakemore tube typically is used in a client with a diagnosis of

cirrhosis and ruptured esophageal varices. The tube has an esophageal and a gastric
balloon. The esophageal balloon exerts pressure on the ruptured esophageal varices
and stops the bleeding. The pressure of the esophageal balloon is released at
intervals to decrease the risk of trauma to esophageal tissues, including
esophageal rupture or necrosis. When the balloon is deflated, the client may begin
to bleed again from the esophageal varices, manifested by vomiting of blood
(hematemesis).

4. A nurse is monitoring the client with Sengstaken Blakemore tube. The client
complains of severe pain of abrupt onset. Which among the nursing interventions is
correct?

A. Cut the tube.

B. Reposition the client
C. Give pain meds.
D. Kink the tube.
Answer: D

Spontaneous rupture of the gastric balloon, upward migration of the tube, and
occlusion of the airway are possible complications associated with a Sengstaken-
Blakemore tube. Esophageal rupture also may occur and is characterized by the
abrupt onset of severe pain. In the event of either of these life-threatening
emergencies, the tube is cut and removed. Place a pair of scissors at bedside.

5. A 36 year old female client has been diagnosed with haemorrhoids. Which of the
following factors in the clients history would be most likely be the primary cause
of her haemorrhoids?

A. Chronic constipation
B. Frequent positional changes
C. Wearing loose clothing.
D. Her job as a nurse.

Answer: A

Hemorrhoids are associated with prolonged sitting or standing, portal hypertension,

increased intra abdominal pressure or valsalva maneuver.

6. The nurse instructs the client not to use sitz bath following hemorrhoidectomy
or at least 12 hours post operatively to avoid which of the following?

A. Bleeding
B. Rectal Spasm
C. Urinary retention
D. Constipation

Answer: A

Applying heat post operatively may cause hemorrhage at surgical site

7. A client diagnosed with inflammatory bowel disease is receiving Total Parenteral

Nutrition.
The basic component of TPN is most likely be;

A. A hypertonic dextrose solution

B. Hypotonic dextrose solution
C. Colloidal dextrose solution
D. Isotonic dextrose solution

Answer: A

TPN is usually a hypertonic glucose solution. The greater the concentration of the
dextrose, the greater the tonicity of the solution. Hypertonic glucose solution are
used to meet the body’s demands in a volume that will not overload the
cardiovascular system.

It supplies nutrients via veins. It supplies carbohydrates in form of dextrose,

fats in emulsified form, proteins in the form of amino acids, vitamins, minerals,
electrolytes and water.

INDICATIONS of PARENTERAL NUTRITION

TYPES of PN

• Clients with non functional GI tracts

• Clients with multiple GI surgeries, GI trauma, severe intolerance to enteral
feeding or Intestinal obstructions.
• May take oral nutrition but not enough to meet nutrients.
• Clients who need to rest the bowel.
• When no other nutritional alternatives available.

TOTAL PARENTERAL NUTRITION

• Subclavian or Int. Jugular Vein are used in short term interventions <4
weeks. If greater than 4 weeks, PICC for longer period. A tunnelled catheter and
vascular access device is used
• When client requires larger conc. Of carbohydrate

PERIPHERAL PARENTERAL NUTRITION

• Administered through peripheral vein typically in the arm.
• Used for short periods (5-7 days)
• Clients need only small concentration of CHO, Fats, and CHON.
• Deliver isotonic, mildly hypertonic solutions.

8. Which of the following nursing interventions would the nurse include in care
plan to prevent air embolism, a complication associated with TPN administration?

A. Instruct patient Valsalva maneuver for IV tubing and cap changes.

B. For tubing and cap changes place the client in High Fowlers Position.
C. Turn the head towards direction of the insertion site.
D. If air embolism is suspected, position client in R side lying position with
the head lower than the feet.

Answer: D

Air embolism is common when catheter system is opened or IV tubing is disconnected,

air enters the tubings during IV changes. To prevent such occurrences, instruct the
patient to do Valsalva maneuver for IV tubing’s and cap changes. Position patient
in Trendelenburg position (If not contraindicated) , turn the head in opposite
direction of the insertion site (increases intrathoracic venous pressure. If air
embolism is suspected, place client in L side lying position with head lower than
feet, clamp IV cath, notify physician and Administer O2 as prescribed.

Signs and Symptoms

Apprehension, Chest pain, dyspnea, hypotension, loud churning sound heard in the
pericardium on auscultation and Respiratory distress.

Other complications include: Infection, hypervolemia, hyper and hypoglycaemia,

pneumothorax.

9. Which of the following indicates complication after TPN therapy?

A. Glycosuria
B. 1-2 weight gain
C. Decreased appetite
D. Hyperthermia

Answer: D
An elevated temperature can be an indication of an infection at the insertion site
or in the catheter. VS should be checked and monitored ever 2 to 4 hours after
initiation of TPN. Glycosuria is expected few days after administration of TPN
because until pancreas is able to adjust by secreting more insulin. Some clients
experienced decrease of appetite during TPN therapy, A gradual weight gain is to be
expected as clients nutritional status improves.

10. A nurse administering TPN understands that the procedure is used to;

A. Treat metabolic acidosis

B. Increase cell nutrition
C. Provide Hydration
D. Reverse positive nitrogen balance

Answer: B

The goal of TPN is to meet client’s nutritional needs. It is not used to treat
metabolic acidosis. In fact, metabolic acidosis and ketoacidosis can result with
TPN administration. TPN is a hypertonic solution containing carbohydrates, amino
acids, electrolytes, minerals, vitamins, and is not used for hydration purposes. It
is used to provide positive nitrogen balance.

NURSING CONSIDERATIONS

• Check PN solution with physician order

• Prevent infection and solution incompatibility: IV meds and BT not given
through IV line.
• Monitor PT and PTT for clients receiving anticoagulants
• Monitor albumin levels
• Monitor for “refeeding syndrome”: Severely Malnourished clients: Sudden drop
in potassium, magnesium and phosphate levels.
• PN should be stored under refrigeration and administered within 24 hours.
• If PN is cloudy or darkened, should not be used.

(11- 13) Situation: The nurse is planning a community education program on how to
prevent the transmission of viral hepatitis.

11. Which of the following behaviours is considered a causal factor in the

transmission of Hepatitis A?

A. Donating blood
B. Consuming shellfish
C. Having multiple sex partners
D. Getting a tattoo recently

Answer: B

Hepatitis A is spread by the fecal-oral route from the ingestion of water, milk or
food, especially shellfish.

12. Which of the following types of hepatitis is considered to be primarily a

sexually transmitted disease?

A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D

Answer: B

Hepatitis B is considered to be a sexually transmitted disease. It can also be

transmitted by percutaneous exposure to infected blood or prenatal transmission
from mother to infant. Hepatitis A is transmitted via the fecal-oral route.
Hepatitis C is primarily transmitted percutaneously and, less frequently, sexually.
Hepatitis D is transmitted percutaneously and HBV surface antigen is necessary for
replication. Hepatitis E is a waterborne virus. Its mode of transmission is also
the same with Hepatitis A. High risk group are those pregnant mothers especially
those in the third trimester of pregnancy due to high mortality rate.

13. The nurse plans care for the client with hepatitis A with the understanding
that the causative virus will be excreted from the client’s body primarily through
the;

A. Skin
B. Feces
C. Urine
D. Blood

Answer: B

The organism causing hepatitis A is transmitted primarily through feces. Viral

hepatitis is not transmitted via the skin or urine. Hepatitis B, C, and D are
transmitted through exposure to blood, but hepatitis A is not.

14. The client who is recovering from hepatitis A continues to complain of

fatigue and malaise. The client asks the nurse, “When will my strength return?”
Which of the following responses by the nurse is most appropriate?

A. “Your fatigue should be gone by now. We will evaluate you for secondary
infection.”
B. “Your fatigue is a side effect of your treatment regimen is complete.”
C. “It is important for you to increase your activity level. That will help you
decrease your fatigue.”
D. “It is normal for you to feel fatigued. The fatigue should go away the next 2
to 4 months.”

Answer: D

During the convalescent or posticteric stage of hepatitis, fatigue and malaise are
the most common complaints. These symptoms usually disappear within 2 to 4 months.
Fatigue and malaise are not evidence of a secondary infection. Hepatitis A is not
treated by drug therapy. It is important that the client continue to balance
activity with periods of rest.

PREICTERIC STAGE ICTERIC STAGE POST ICTERIC STAGE

S/Sx:
Flu like symptoms- malaise and fatigue
Anorexia, N/V, diarrhea
Pain: Headache, muscle aches
Serum Bilirubin and enzyme levels are elevated.

S/Sx:
Jaundice
Pruritus
Brown colored urine
Light colored stools
Decrease of preicteric symptoms

S/Sx:
Increased energy levels
Minimal to (-) GI symptoms
Serum Bilirubin and enzyme levels return to normal

15. Which of the following test results would the nurse use to assess the liver
function of a client with viral hepatitis?

A. Glucose tolerance.
B. Creatinine clearance.
C. Serum transaminase.
D. Serum electrolytes.

Answer: C

Serum levels of bilirubin and liver enzymes, such as alanine aminotransferase (ALT
[formerly SGPT]) and aspartate aminotranferase (AST [formerly SGOT]), are carefully
monitored during hepatitis. They provide important data about liver function. Blood
glucose levels, the creatinine clearance, and serum electrolyte levels provide no
information about liver function.