Name: ________________________________________ Score _______

Date: _________________________ Rating ______

NCM 102- FINAL EXAMINATION

Instruction: Encircle the correct answer. NO ERASURES! GOOD LUCK!

Situation 1: Nurse Anna work as a probationary staff nurse at the Telles Medical Center. During
his shift, he was tasked by his head nurse to conduct a health education session about the
functions of the hepatobiliary and pancreatic system.

1. The majority of blood supply to the liver, which is rich in nutrients from the GI tract,
comes from the:

a. Hepatic art5ery c. Portal artery

b. Hepatic vein d. Portal vein

2. The liver synthesizes prothrombin only if there is enough:

a. Vitamin A c. Vitamin D
b. Vitamin B12 d. Vitamin K

3. The substance necessary for manufacture of bile salts by hepatocytes is:

a. Albumin c. Cholesterol
b. Bilirubin d. Vitamin D

4. Hepatocytes dysfunction results in all of the following except:

a. Decreased serum albumin
b. Elevated serum bilirubin
c. Increased blood ammonia levels
d. Increased level of urea
5. The most common cause of parynchemal cell damage and hepatocellular dysfunction is:

a. Infectious agents c. Metabolic disorders

b. Malnutrition d. Toxins

6. The nurse expects that the diuretic of choice for a patient with ascites would be:

a. Aldactone c. Diamox
b. Ammonium chloride d. Lasix

7. An indicator of probable esophageal varices is:

a. Hematemesis c. Melene
b. A positive guiac test d. All of the above

8. A person who consumes contaminated shellfish would probably develop:

a. Hepatitis B c. Hepatitis D
b. Hepatitis C d. Hepatitis E

9. The hepatitis that is transmitted via the fecal-oral route is:

a. Hepatitis A virus c. Hepatitis C virus

b. Hepatitis B virus d. Hepatitis D virus

10. Choose correct statement about hepatitis B vaccine.

a. All persons at risk should receive active immunization
 b. Evidence suggests that the HIV may be harbored in the vaccine
c. Booster doses are recommended every 5 years
d. One dose in the dorsogluteal muscle is recommended
11. The major causative factor in the etiology of cirrhosis is:
a. Acute viral hepatitis
b. Chronic alcoholism
c. Chronic biliary obstruction
d. Infection (Cholangitis)

12. The most common single cause of death in patient with cirrhosis is:
a. CHF
b. Hepatic encephalopathy
c. Hypovolemic shock
d. Ruptured esophageal varices
13. Nurse Anna knows that the liver is located at the ___________ of the abdomen.

a. RUQ c. RLQ
b. LLQ d. LUQ

14. Bile is synthesize in the liver and transported to the bile ducts via the bile canaculi. What
controls the flow of bile in the duodenum?

a. Cystic duct c. Common bile duct

b. Sphincter of Oddi d. Common hepatic duct

15. Gallbladder is a sac like organ located on the inferior surface of the liver. Nurse Anna is
aware that the gallbladder’s primary purpose is to:

a. Metabolize bilirubin c. Store and concentrate bile

b. Store fat soluble vitamins d. Produce bile

16. What hormone promotes the storage and utilization of food primarily glucose and fats?

a. Glucagon c. Secretin
b. Thyroxine d. Insulin

Situation 2: Nurse Lisa is assessing Mr. Boado who is in the early stages of cirrhosis of the liver.

17. Which early sign would Nurse Lisa anticipates finding?

a. Peripheral edema c. Anorexia

b. Ascites d. Jaundice

18. What diet should be implemented for Mr. Boado who is in the early stages of cirrhosis?
a. High calorie, high carbohydrate
b. High protein, low fat
c. Low fat, low protein
d. High carbohydrate, low sodium

Situation 3: Nurse CJ together with her colleagues at San Lazaro Hospital is conducting a
community education on how to prevent the transmission of hepatitis.

19. Which of the following types is considered to be primarily a sexually transmitted

diseases?

a. Hepa A c. Hepa C
b. Hepa B d. Hepa D
 20. Nurse CJ knows that during icteric phase of viral hepatitis, the client exhibit the
following symptoms?

a. Tarry stools c. Shortness of breath

b. Yellowed sclera d. Light, frothy urine

Situation 4: Mrs Telles, 44 y/old is admitted to the hospital complaining of severe abdominal
pain and extreme nausea and has vomited several times. A diagnosis of cholecystitis from
cholelithiasis was made.

21. The group of characteristics that would alert Nurse Jay that his client has increased risk
of developing gallbladder disease would be female:
a. Over the age of 40, obese
b. Over the age of 40, low cholesterol level
c. Under the age of 40, history of high fat intake
d. Under the age of 40, family history of gallstone

22. Mrs Telles complained of severe RUQ pain. Which of the following would Nurse Jay
anticipates administering to relieve the client’s pain?

a. Meperidine (Demerol)
b. Acetaminophen with codeine
c. Promethazine (Phenergan)
d. Morphine sulfate

23. A laparoscopic cholecystectomy is scheduled. Which of the following instructions should

Nurse Jay include in his discharge plan?
a. Avoid showering for 48 hours after surgery
b. Return to work within one week
c. Change the dressing daily until the incision heals
d. Use acetaminophen (Tylenol) to control fever

Situation 5: Mr Telles was admitted with a history shows an alcohol abuse of excessive intake of
liquor for more than 10 years. Laboratory findings shows high triglyceride levels and
hypercalcemia.

24. The initial diagnosis of pancreatitis is confirmed if Mr Telles blood works show a
significant elevation in which of the following serum values?

a. Amylase c. Potassium
b. Glucose d. Trypsin

25. Which of the following pancreatic enzymes can cause pancreatic damage?
a. Utilization by the intestine
b. Autodigestion of the pancreas
c. Reflux into the pancreas
d. Clogging of the pancreatic duct
26. Mr Telles may exhibit Cullen’s sign on physical examination. Nurse Shakira knows that
Cullen’s sign can be best described as:
a. Distended tortuous veins in the esophagus
b. Yellow- orange discoloration of the skin
c. Bluish discoloration of the left flank area
d. Bluish discoloration of the periumbilical area
27. In alcohol related pancreatitis, which of the following interventions is the best way to
reduce the exacerbation of pain?
 a. Lying supine c. Eating a low-fat diet
b. Taking aspirin d. Abstaining from alcohol

Situation 6: Mr Gibson, 60 year old, is admitted to the hospital with cirrhosis. He has history of
alcoholism and hepatitis B.

28. What should Nurse Anna expect to find on his initial laboratory results?

a. Hypernatremia c. Elevated serum albumin

b. Elevated ALT d. Leukocytosis

29. Mr. Gibson is scheduled for a liver biopsy. What is your priority of care for this patient?
a. Monitor bleeding
b. Encouraging increased activity
c. Controlling blood pressure
d. Providing nutritional support
30. What life threatening complication will result when the liver is destroyed due to hepatitis
B and up to development of chronic hepatitis?

a. Portal hypertension
b. Esophageal varices
c. Liver failure
d. Hepatic encephalopathy

Situation 7: Mrs Carey 49 y/o female was rushed to the ER department because of severe and
steady RUQ pain that radiates to the scapula lasting 2 hours. She has vomited frequently and
experiencing chill.

31. Based from the data presented, Mrs Carey is experiencing which of the following
problems?

a. Acute pancreatitis c. Acute cholecytitis

b. Cholelithiasis d. Hepatic encephalophathy

32. Physical findings revealed a severe pain in the RUQ with inspiratory arrest. Nurse
Beyonce knows, that her client is positive for which of the following signs?

a. Grey Turner’s sign c. Cullen’s sign

b. McBurney’s sign d. Murphy’s sign

Situation – Veronica is scheduled for a liver biopsy. The staff nurse assigned to care for
Veronica is to accompany her to the treatment room.

33. Before a liver biopsy, the nurse should check to see that:
a. A compatible donor blood is available
b. Hemostasis test have been completed
c. Vital signs have been assessed
d. All of the above have been done
34. The nurse begins preparing Veronica for the biopsy by assisting her to correct position,
which is:
a. Jackknife, with her entire back exposed
b. Recumbent, with her right upper abdomen exposed
c. Lying on her right side, with the left upper thoracic area exposed
d. Supine, with the left lateral chest wall exposed
35. Immediately before needle insertion, veronica needs to be instructed to:
a. Breathe slowly and deeply so that the rib cage expansion will be minimized
during needle insertion
b. Inhale and exhale deeply and then hold her breath at the end of expiration
until the needle is inserted
 c. Pant deeply and continue panting during needle insertion so pain perception
will be minimized
d. Take a deep inspiration and not breathe for 30-4o seconds so that area for
needle insertion can be determined, she should then resume normal breathing
for the remainder of the procedure
36. After the biopsy, the nurse assists Veronica to:
a. High Fowler’s position, in which she can effectively take deep breaths and
cough
b. Ambulate while splinting her incision
c. Assume the Trendelenburg position to prevent post biopsy shock
d. The right side-lying position with a pillow placed under the right costal
margin

Situation – Wendy is schedule for a paracentesis because of ascites formation subsequent to

cirrhosis of the liver

37. Before the procedure, the nurse obtain several drainage bottles. She knows that the
maximum amount of fluid to be aspirated at one time is:
a. 1 L
b. 2 L
c. 3 L
d. 4 L

38. The nurse helps Wendy to assume the proper position for a paracentesis, which is:
a. Recumbent so that the fluid will pool to the lower abdomen
b. Lying on her left side so that the fluid will not exert pressure on the liver
c. Semi-fowler’s to avoid shock and provide the most comfort
d. Upright with her feet resting on a support so that the puncture site will be
readily available
39. After the paracentesis, Wendy should be observed for signs of vascular collapsed, which
include all of the following except:

a. Bradycardria c. Oliguria
b. Hy6potension d. Pallor

Situation – Brenda, a 33 y/o obese mother of four, is diagnosed as having acute gallbladder
inflammation. She is 5 ft 4 inches tall and weighs 190 lbs. The physician decides to delay
surgical intervention until Brenda’s acute symptoms subside.

40. Brenda’s initial course of treatment would probably consist of:

a. Analgesics and antibiotics c. Nasogastric suctioning

b. Intravenous fluids d. All of the above

41. After her acute attack, Brenda was limited to low-fat liquids. As foods are added to her
diet, she needs to know that she should avoid:

a. Cooked fruits c. Lean meats

b. Eggs and cheese d. Rice and tapioca

42. Brenda has signed a consent form for removal of her gallbladder and ligation of the cystic
duct and artery. She is scheduled to undergo a:

a. Cholecystectomy c. Choledochostomy
b. Cholecystostomy d. Choledocholithotomy

43. Postoperative nursing observation includes assessing for:

 a. Indicators of infection
b. Leakage of bile into the peritoneal cavity
c. Obstruction of bile drainage
d. All of the above
44. Brenda needs to know that fat restriction is usually lifted after the biliary ducts dilate to
accommodate bile once held by the gallbladder. This takes about:

a. 1 week c. 4 to 6 weeks
b. 2 to 3 weeks d. 2 months

45. The nurse knows that the major cause of chronic pancreatitis is:
a. Long term alcohol consumption
b. Malnutrition
c. Biliary obstruction
d. None of the above
46. An elderly patient presents to the physician’s office with a complaint of exhaustion. The
nurse, aware of the most common hematologic condition affecting the elderly, known to
check the patient’s:

a. WBC count c. Thrombocyte count

b. RBC count d. Levels of plasma proteins

47. The nurse begins to design a nutritional packet of information for a patient diagnosed
with iron deficiency anemia. The nurse would recommend an increased intake of:

a. Fresh citrus fruits c. Organ meats

b. Milk and cheese d. Whole-grain bread

48. A physician prescribes one tablet of ferrous sulfate for a 15 y/o girl who experiences
heavy flow during her menstrual cycle. The nurse advises the patient and her mother that
this OTC preparation must be taken for how many months for iron replenishment to
occur?

a. 1 to 2 c. 6 t0 12
b. 3 to 5 d. Longer than 12 months

49. The most frequent symptoms and complication of anemia is:

a. Bleeding gums c. Fatigue

b. Ecchymosis d. Jaundice

50. The cause of aplastic anemia may:

a. Be related to drugs, chemicals, or radiation damage
b. Be iodpathic
c. Result from certain infections
d. Be related to all of the above
51. During a routine assessment of a patient diagnosed with anemia, the nurse notes the
patient’s beefy red tongue. The nurse knows that this is a sign of what kind of anemia?

a. Autoimmune c. Iron deficieny

b. Folate deficiency d. Megaloblastic anemia

52. A nurse should know that a diagnosis of hemolytic anemia is associated with all of the
following except:
a. Abnormality in the circulation of plasma
b. Decrease in the reticulocyte count
c. Defect in the erythrocyte
d. Elevated indirect bilirubin
53. Absence of intrinsic factor is associated with a Vitamin B12 deficiency, because the
vitamin cannot be bind to be transported for absorption in the:

a. Duodenum c. Jejunum
b. Ileum d. Stomach

54. A diagnostic sign of pernicious anemia is:

a. A smooth, sore, red tongue
b. Exertional dyspnea
c. Pale mucous membranes
d. Weakness
55. The Schilling test is used to diagnosed:

a. Aplastic anemia c. Megaloblastic anemia

b. Iron deficiency anemia d. Pernicious anemia

56. All of the following are inherited forms of sickle cell anemia except:

a. Autoimmune hemolytic c. Thalassemia

b. G6PD deficiency d. Sickle cell anemia

57. A nurse expects an adult patient with sickle cell anemia to have a hemoglobin value of:

a. Approximately 3g/dL c. Between 5 and 7 g/dL

b. Approximately 5g/dL d. Between 7 and 10g/dL

58. Polycythemia vera is characterized by bone marrow overactivity, resulting in the clinical
manifestations of:

a. Angina c. Thrombophlebitis
b. Caludication d. All of the above

59. The common feature of leukemias is:

a. A compensatory polycthemia stimulated bythrombocytopenia
b. An unregulated accumulation of white cells in the bone marrow, which
replace normal marrow elements
c. Increased blood viscosity, resulting from overproduction of white cells
d. Reduced plasma volume in response to a reduced production of cellular
elements
60. Nursing assessment for a patient with leukemia should include observation for:
a. Fever and infection
b. Dehydration
c. Petechiae and ecchymoses
d. All of the above

61. Hemophilia is a hereditary bleeding disorder that:

a. Has a higher incidence among males
b. Is associated with joint bleeding, swelling and damage
c. Is related to a genetic deficiency of a specific blood-clotting factor
d. Is associated with all of the above
62. Hypoprothrombinemia, is the absence of gastrointestinal or biliary dysfunction, may be
caused by a deficiency in:

a. Vitamin A c. Vitamin C
b. Vitamin B12 d. Vitamin K

63. The recommended minimum hemoglobin level for a woman to donate blood is:
 a. 8.0g/dL c. 12.5g/dL
b. 10.5g/dL d. 14g/dL

64. Reflux of food into the esophagus from the stomach is prevented by contraction of the:

a. Ampulla of vater c. Iloececal valve

b. Cardiac sphincter d. Pyloric sphincter

65. The digestion of starches begins in the mouth with the secretion of the enzyme:

a. Lipase c. Ptyalin
b. Pepsin d. Trypsin

66. A hormonal regulatory substance that inhibits stomach contraction is:

a. Acetylcholine c. Norepinephrine
b. Gastrin d. Secretin

67. An enzyme secreted by the gallbladder that is responsible for fat emulsification is:

a. Amylase c. Maltase
b. Bile d. Steapsin

68. During the initial assessment of a patient complaining of increased stomach acid related
to stress, the nurse knows that the physician will want to consider the influence of the
nueroregulator:

a. Gastrin c. Norepinephrine
b. Cholecystokinin d. Secretin

69. Pancreatic secretions into the duodenum:

a. Are stimulated by hormones released in the presence of chime as it passes
through the duodenum
b. Have an alkaline effect on intestinal contents
c. Increase the pH of the food contents
d. Accomplish all of the above
70. Bile, which emulsifies fat enter the duodenum through the:

a. Cystic duct c. Common hepatic duct

b. Common bile duct d. Pancreatic duct

71. During nursing assessment the nurse knows that the most common symptom of patients
with gastrointestinal dysfunction is:

a. Diffuse pain c. Constipation

b. Dyspepsia d. Abdominal bloating

72. A nurse who is investigating a patient’s statement about duodenal pain should assess the:
a. Epigastric area and consider possible radiation of pain to the right subscapular
region
b. Hypogastrium in the right or lower quadrant
c. Left lower quadrant
d. Periumbilical area, followed by t he right lower quadrant
73. Abdominal pain associated with indigestion is usually:
a. Described as crampy or burning
b. In the left lower quadrant
c. Less severe after an intake of fatty foods
d. Relieved by the intake of coarse vegetables, which stimulate peristalsis
74. On examination of a patient’s stool, the nurse suspects the presence of an upper
gastrointestinal bleed when she observes a stool that is:
 a. Clay-colored c. Tarry and black
b. Greasy and foamy d. Threaded with mucus

75. The nurse auscultates the abdomen to assess bowel sounds. She documents five to six
sounds heard in less than 30 seconds. She documents that the patients bowel sounds are:

a. Normal c. Hyperactive
b. Hypoactive d. None of the above

76. Before gastroscopy, the nurse should inform the patient that:
a. He or she must fats for 6 to 12 hours before the examination
b. His or her throat will be sprayed within a local anestethic
c. He or she cannot eat or drink after the surgery until the gag reflex returns (1-2
hours)
d. All of the above are necessary
77. The results of a gastric analysis can be used to diagnosed various disease states. An
excess amount of acid can indicate the presence of:

a. A duodenal ulcer c. A peptic ulcer

b. Gastric cancer d. Pernicious anemia

78. Acute gastritis is often caused by:

a. Ingestion of strong acids c. Overuse of apirin

b. Irritating foods d. All of the above

79. The most common site for peptic ulcer formation is the:

a. Duodenum c. Pylorus
b. Esophagus d. Stomach

80. A symptom that distinguishes a chronic gastric ulcer from a chronic duodenal ulcer is the:
a. Absence of any correlation between the presence of the ulcer and a
malignancy
b. Normal to below- normal secretion of acid
c. Relief of pain after food ingestion
d. Uncommon incidence of vomiting
81. A characteristic associated with peptic ulcer pain is a:
a. Burning sensation localized in the back or midepigatrium
b. Feeling of emptiness that precedes meals from 1 to 3 hours
c. Severe gnawing pain that increases in severity as the day progresses
d. Combination of all of the above
82. The best time to administer an antacid is:
a. With the meal
b. 30 minutes before the meal
c. 1 to 3 hours after the meal
d. Immediately after the meal
83. A Billroth I is a surgical approach to ulcer management whereby:
a. A partial gastrectomy is done with anastomosis of the stomach segment to the
duodenum
b. A sectioned portion of the stomach is joined to the jejunum
c. The antral portion of the stomach is removed and a vagotomy is performed
d. The vagus nerve is cut and gastric drainage is established
84. Nursing interventions associated with peptic ulcers include:
a. Checking the BP and PR every 15 to 20 minutes
b. Frequently monitoring hemoglobin and hematocrit levels
c. Observing stools and vomitus for color, consistency and volume
 d. All of the above

85. The average daily urinary output in an adult is:

a. 0.5L c. 1.5L
b. 1.0L d. 2.5L

86. One of the best indicators of renal function is:

a. Blood urea nitrogen c. Specific gravity

b. Serum creatinine d. Urine osmolality

87. A patient is hemorrhaging from multiple trauma sites. The nurse expects that
compensatory mechanisms associated with hypovolemia would cause all of the following
symptoms except:

a. Hypertension c. Tachycardia
b. Oliguria d. Tachypnea

88. A clinical manifestation not found in hypovolemia is:

a. Muscle weaknes c. Postural hypotension

b. Oliguria d. Bradycardia

89. The nurse should expect that a patient with mild fluid volume excess would be prescribed
a diuretic that blocks sodium reabsorption in the distal tubule such as:

a. Bumex c. Hydrodiuril
b. Demadex d. Lasix

90. Nursing interventions for a patient with a diagnosis of hyponatremia includes all of the
following except:
a. Assessing for symptoms of nausea and malaise
b. Encouraging the intake of low-sodium liquids, such as coffee or tea
c. Monitoring neurologic status
d. Restricting tap water intake
91. One of the dangers of treating hypernatremia is:

a. RBC crenation c. Cerebral edema

b. RBC hydrolysis d. Renal shutdown

92. To supplement a diet with foods high in potassium, the nurse should recommend the
addition of:
a. Fruits such as bananas and apricots
b. Green leafy vegetables
c. Milk and yogurt
d. Nuts and legumes
93. The most characteristic manifestation of hypocalcemia and hypomagnesemia is:
a. Anorexia and nausea
b. Constipation
c. Lack of coordination
d. Tetany
94. Management of hypocalcemia includes all of the following except administration of:
a. Fluid to dilute calcium levels
b. The diuretic furosemide (lasix), without saline, to increase calcium excretion
through the kidneys
 c. Inorganic phosphate salts
d. Intravenous phosphate therapy
95. A clinical manifestation of hypophosphatemia is:
a. Bone pain
b. Parethesia
c. Seizures
d. Tetany

Situation 3 - Mr. Silverio, 56 years old, has had significant problem with alcohol abuse for the
past 15 years. His wife brings him to the emergency department because he is increasingly
confused and is coughing blood. His medical diagnosis is cirrhosis of the liver. He has ascites
and esophageal varices.

96. Assessment of Mr. Silverio would reveal all of the following, except: 
a. Bulging flanks
b. Protruding umbilicus
c. Abdominal distension
d. Bluish discoloration of the umbilicus

97. Which laboratory value would the nurse expect to find in a client as a result of liver
failure? 
a. Decreased serum creatinine 
b. Decreased sodium 
c. Increased ammonia 
d. Restricted sodium

98. The major dietary treatment for ascites calls for: 

a. High protein
b. Increased potassium
c. Restricted fluids
d. Restricted sodium

Situation 11 - Aisa, is a 4-year old with severe anemia. She is seen by the nurse in the clinic.

99. In addition to weakness and fatigue, which of the following problems should the nurse
expect Aisa to exhibit? 
a. Cold, clammy skin 
b. Increased pulse rate 
c. Elevated blood pressure 
d. Cyanosis of the nail beds

100. Which of the following problems associated with anemia best explains why Aisa
becomes dizzy during periods of physical activity? 
a. An inflammation of the inner ear
b. Insufficient cerebral oxygenation 
c. A sudden drop in blood pressure
d. Decreased level of serum glucose

“Doing what’s right today means no regrets tomorrow”

Prepared by: @

@telles10-06-10