Adult Health Nursing 7th Edition by Cooper Gosnell - Test Bank

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Gosnell -Test Bank
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Adult Health Nursing 7th Edition By Cooper Gosnell -
Test Bank
Sample Test
Chapter 6: Care of the Patient with a Gallbladder, Liver, Biliary Tract, or Exocrine
Pancreatic Disorder
MULTIPLE CHOICE
1. The nurse clarifies that unconjugated bilirubin, which is made up of

broken-down red cells, is:
a. stored in the gallbladder to make bile.

b. water insoluble bilirubin that must be converted by the liver.
c. a by-product which is excreted directly into the bowel for excretion.
d. necessary for digestion of fats.
ANS: B
Unconjugated bilirubin is a water-insoluble product that must be converted in
the liver to conjugated bilirubin (water soluble) so that it may be excreted
through the bowel.
DIF: Cognitive Level: Analysis REF: Page 233 OBJ: 1

TOP: Bilirubin KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
2. The patient with cirrhosis has an albumin of 2.8 g/dL. The nurse is
aware that normal is 3.5 g/dL to 5 g/dL. Based on these findings, what
would the nurse expect the patient to exhibit?
a. Jaundice
b. Edema
c. Copious urine output
d. Pallor
ANS: B
Low serum albumin levels result also from excessive loss of albumin into urine
or into third-space volumes, causing ascites or edema.
TOP: Cirrhosis KEY: Nursing Process Step: Assessment
3. What is an essential nursing measure to prevent injury to the patient

who is to receive a paracentesis?
a. Have patient sign a permit
b. Pad side rails
c. Check for allergy to contrast media or to shellfish
d. Have patient void immediately before procedure
ANS: D
To prevent the puncturing of the bladder, the patient must void immediately
before the procedure. A permit is required but it is not a safety precaution for
the patient. There is no contrast media used in a paracentesis.
DIF: Cognitive Level: Application REF: Page 242 OBJ: 2

TOP: Paracentesis KEY: Nursing Process Step: Implementation
4. What should the nurse expect of a patient with a malabsorption of

vitamin K?
a. Lowered hemoglobin
b. Elevated hematocrit
c. Increased prothrombin time
d. Diminished white blood cell count
ANS: C
Prothrombin times are increased because malabsorption of vitamin K or
inability to produce the clotting factors VII, IX, and X cause the patient to have
bleeding tendencies.

5. A patient was scheduled for a laparoscopic cholecystectomy, but

complications developed and he underwent an open cholecystectomy
with a T-tube inserted into the common bile duct. What is the purpose of
the T-tube?
a. To decompress the duct and relieve pain caused by stimulation of the sphincter of O
b. To improve diaphragmatic expansion and prevention of atelectasis.
c. To shorten postoperative recovery and hasten the healing process.
d. To keep the duct open and allow drainage of the bile until edema resolves.
ANS: D
If the stones are in the common bile duct and edema is present, a biliary
drainage tube, or T-tube, will be inserted to keep the duct open and allow
drainage of the bile until the edema resolves.
DIF: Cognitive Level: Comprehension REF: Page 254, Figure 6-7

OBJ: 8 TOP: Cholecystectomy
KEY: Nursing Process Step: Implementation
6. The nurse caring for a patient who has had an open cholecystectomy
with a T-Tube will:
a. open the T-tube to the air so that it will drain freely.
b. position and secure the drainage bag at the chest level.
c. Place the collection bag so the tube is not kinked.
d. Irrigate the T-tube with normal saline to ensure the free flow of bile.
ANS: B
The T-tube is placed below the level of the common bile duct to prevent the
reflux of bile. The bag must be positioned so the tube is not kinked, or bile
cannot drain from the liver. Normally T-tubes are not irrigated.

TOP: Cholecystectomy KEY: Nursing Process Step:
Implementation
7. Which nursing intervention should be completed immediately after the
physician has performed a needle liver biopsy?
a. Assisting to ambulate for the bathroom
b. Keeping the patient on the right side for a minimum of 2 hours
c. Taking vital signs every 4 hours
d. Keeping the patient on the left side for a minimum of 4 hours
ANS: B
Keep the patient lying on the right side for minimum of 2 hours to splint the
puncture site. It compresses the liver capsule against the chest wall to
decrease the risk of hemorrhage or bile leak. Vital signs are taken every 15
minutes for 30 minutes, then every 30 minutes for 2 hours.

TOP: Liver biopsy KEY: Nursing Process Step: Implementation
8. Immediately following a liver biopsy, the patient becomes dyspneic, the

pulse increases to 100, and no breath sounds can be heard on the
affected side. What should the nurse suspect?
a. Peritonitis
b. Pneumothorax
c. Hemorrhage of the liver
d. Pleural effusion
ANS: B
Pneumothorax is a possible complication of paracentesis. The patient’s head
of the bed should be raised slightly, but kept on the right side. Oxygen should
be administered and the assessment reported to the charge nurse and
documented.
DIF: Cognitive Level: Comprehension REF: Page 236 OBJ: 1

TOP: Pneumothorax KEY: Nursing
Process Step: Implementation
9. Which patient statement indicates that the patient requires additional

teaching about an endoscopic retrograde cholangiopancreatography?
a. “Right after the test, I want breakfast with black coffee.”
b. “The instrument will be put down my throat.”
c. “I haven’t had anything to eat or drink since 9 PM last night.”
d. “My doctor said I could have medicine to relax me before the test.”
ANS: A
After the procedure, keep the patient NPO until the gag reflex returns.

TOP: Diagnostic procedures KEY: Nursing Process Step:
Planning
10. The nurse assisting in the treatment of a patient with ruptured
esophageal varices who has received vasopressin IV will carefully
assess for:
a. Muscular twitching/spasm
b. Hematuria
c. Macular rash on trunk and arms
d. Evidence of cardiac ischemia
ANS: D
Vasopressin is a strong vasoconstrictor given to try to stop the hemorrhage of
the varices. Unfortunately it also constricts all vessels and may cause cardiac
ischemia.

TOP: Vasopressin KEY: Nursing Process Step: Assessment
11. What should the nurse point out as a significant advantage of the
laparoscopic cholecystectomy?
a. Slightly more invasive, but there is less pain
b. Can be performed on all patients of any age
c. Can be performed even when there are large stones present in the bile duct
d. Less invasive procedure
ANS: D
The laparoscopic cholecystectomy is less invasive and causes less pain and a
quick recovery. If there are large stones present a sphincterotomy is done
before the laparoscopic cholecystectomy. Persons with bleeding tendencies,
pathologic conditions of the abdomen, stones in the bile duct, and extensive
adhesions are not good candidates.

TOP: Laparoscopic cholecystectomy KEY: Nursing Process Step:
Implementation
12. What should the nurse explain is the major purpose of the
Sengstaken-Blakemore tube (S/B tube)?
a. Decompress the stomach
b. Control esophageal varices bleeding
c. A route for tube feedings
d. Obtain specimen for gastric analysis
ANS: B
The major purpose of the S/B tube is to control bleeding by pressure against
the vessels in the esophagus. The two balloons of the tube are inflated to put
direct pressure on the esophagus and are anchored by the inflated balloon in
the stomach. The tube can suction blood from the stomach as well.
DIF: Cognitive Level: Analysis REF: Pages 242-243, Figure 6-4
OBJ: 2 TOP: SB tube KEY: Nursing Process Step:
Implementation
13. The patient’s cirrhosis of the liver has also caused a dilation of the
veins of the lower esophagus secondary to portal hypertension,
resulting in the development of the complication of:
a. esophageal varices.
b. diverticulosis.
c. Crohn disease.
d. esophageal reflux (GERD).
ANS: A
Esophageal varices (a complex of longitudinal, tortuous veins at the lower end
of the esophagus) enlarge and become edematous as the result of portal
hypertension.

14. The patient with cirrhosis has a rising ammonia level and is
becoming disoriented. The patient waves to the nurse as she enters the
room. How should the nurse interpret this?
a. As an attempt to get the nurse’s attention
b. As asterixis
c. As an indication of respiratory obstruction from varices
d. As spasticity
ANS: B
Asterixis is the “flapping tremor” seen as the patient deteriorates into ammonia
intoxication or hepatic encephalopathy.

TOP: Encephalopathy KEY: Nursing Process Step:
Assessment
15. How does the administration of neomycin (Mycifradin) reduce the

production of ammonia?
a. By assisting the hepatic cells to regenerate
b. By reducing ascites
c. By decreasing the bacteria in the gut
d. By helping to digest fats and proteins
ANS: C
The buildup of ammonia can be prevented with the use of lactulose
(Chronulac) and neomycin. Ammonia is produced in the gut by bacterial
action. By reducing the bacteria, less ammonia is produced.
DIF: Cognitive Level: Application REF: Page 243| Page 239, Table 6-
1
OBJ: 3 TOP: Encephalopathy
KEY: Nursing Process Step: Implementation
16. What is the most common procedure for the removal of the
gallbladder?
a. Laparoscopic cholecystectomy
b. Cholangiography
c. Open cholecystectomy
d. Choledochostomy
ANS: A
The most recently developed operative procedure, which is now the most
common treatment for cholecystitis and cholelithiasis, is done by way of
endoscopy. It is called laparoscopic cholecystectomy and uses laser cautery
to remove the gallbladder.
DIF: Cognitive Level: Knowledge REF: Page 254 OBJ: 8

TOP: Laparoscopic cholecystectomy KEY: Nursing Process Step:
Planning
17. What should the nurse do to prepare a patient for an oral
cholecystography?
a. Ensure that the patient drinks 500 mL of water before testing
b. Give 4 Oragrafin (ipodate) 5 minutes apart starting at 6 AM
c. Administer 6 Telepaque (iopanoic acid) tablets 5 minutes apart after the evening me
d. Give a fatty meal hour before the test is started
ANS: C
The patient is held NPO and given 6 tablets 5 minutes apart the evening
before the procedure after the evening meal. A fatty meal is given to the
patient after the test is started to stimulate emptying of the gallbladder.

TOP: Oral cholecystography KEY: Nursing Process Step:
Implementation
18. Which of the following is a classic symptom of cholecystitis?
a. Substernal, radiating to the left shoulder and arm
b. Epigastric, radiating to the back
c. Right upper abdomen, radiating to the back or right scapula
d. Left upper abdomen, radiating to the jaw and neck

ANS: C
It localizes in the right upper quadrant epigastric region. The pain radiates
around the mid torso to the right scapular area.
DIF: Cognitive Level: Analysis REF: Pages 252-253

OBJ: 2 TOP: Cholecystitis
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological
Integrity
19. What should the nurse avoid contamination from to prevent the
transmission of hepatitis A?
a. Food or water
b. Blood transfusion
c. Needles
d. Sexual contact
ANS: A
Hepatitis A virus is transmitted when a person puts something in his or her
mouth that is contaminated with fecal material (called fecal-oral transmission).
Teach patients the importance of good handwashing after the bathroom or
changing a diaper, as well as proper food preparation, to prevent the spread
of HAV.
DIF: Cognitive Level: Comprehension REF: Page 247 Box 6-1

OBJ: 5 TOP: Hepatitis KEY: Nursing Process Step:
Planning
20. What is the most appropriate method used by high-risk health

workers to prevent hepatitis B?
a. Hepatitis B vaccine
b. Diligent handwashing
c. Wearing protective gear
d. Hb immune globulin injections
ANS: A
The best preventative measure against the contraction of hepatitis B is HBV
vaccine.
DIF: Cognitive Level: Knowledge REF: Page 247, Safety Precautions

OBJ: 5 TOP: Hepatitis B KEY: Nursing Process Step:
Planning
MSC: NCLEX: Safe, Effective Care Environment
21. The nurse explains that the use of cyclosporine as an

immunosuppressant has been successful in the reduction of rejection of
liver transplants because the drug:
a. increases the rate of the regeneration of liver cells.
b. can overcome complications presented by hepatitis C.

c. increases blood supply to transplant.
d. does not suppress bone marrow.
ANS: D
Cyclosporine is an immunosuppressant that does not cause bone marrow
suppression nor does it impede healing.

TOP: Liver transplant KEY: Nursing Process Step:
Implementation
22. A male patient states that he returned from a 2-week camping trip
a few days ago. He complains of nausea and anorexia, and dark urine.
What additional information would assist in diagnosing hepatitis A?
a. Exposure to blood
b. Recent ingestion of raw fish
c. History of intravenous drug use
d. Multiple sex partners
ANS: B
Hepatitis A spreads by direct contact through the oral-fecal route, usually by
food and water contaminated with feces.
DIF: Cognitive Level: Analysis REF: Page 247, Box 6-1
OBJ: 5 TOP: Hepatitis KEY: Nursing Process Step:
Assessment
23. When caring for an extremely jaundiced patient with cirrhosis,

what should the nurse include provisions for in the plan of care?
a. Encouraging consumption of a high-fat diet
b. Skin care to relieve pruritus
c. Offering foods rich in fat-soluble vitamins
d. Meticulous foot care
ANS: B
Jaundice causes pruritus and can lead to skin lesions and pressure ulcers.

TOP: Cirrhosis KEY: Nursing Process Step: Planning
24. The nurse is aware that an elevated serum amylase is diagnostic

of pancreatitis at an early stage as an elevation can be assessed as
early as _____ after the onset of pancreatic disease.
a. 2 hours
b. 8 hours
c. 24 hours
d. 36 hours
ANS: A
An increase in the serum amylase can be detected as early as 2 hours after
the onset of pancreatic disease. In simple acute pancreatitis, the level returns
to normal in about 36 hours. In chronic disease it remains elevated.

TOP: Serum amylase KEY: Nursing Process Step:
Assessment
25. The 100 lb patient who has been exposed to hepatitis A is to

receive an injection of immune serum globulin. What should the dose
(.02 mL/kg) be?
a. 0.9 mL
b. 1.4 mL
c. 1.6 mL
d. 1.8 mL
ANS: A
100 lb/2.2 = 45.4. 45.4 ´ 0.02 = 0.90
TOP: Immune serum globulin KEY: Nursing Process Step:
Implementation
26. A family member of a patient asks the nurse about the protein-
restricted diet ordered because of advanced liver disease with hepatic
encephalopathy. What statement by the nurse would best explain the
purpose of the diet?
a. “The liver cannot rid the body of ammonia that is made by the breakdown of protein
b. “The liver heals better with a high-carbohydrate diet rather than with a diet high in pr
c. “Most people have too much protein in their diets. The amount in this diet is better fo
“Because of portal hypertension, the blood flows around the liver, and ammonia mad
d.
hallucinations.”
ANS: A
The patient with hepatic encephalopathy is on a very low-protein to no-protein
diet. The goal of management of hepatic encephalopathy is the reduction of
ammonia formation in the intestines.

TOP: Cirrhosis KEY: Nursing Process Step: Implementation
27. The nurse would make provisions in the plan of care for a person
who has had a liver transplant to prevent:
a. fluid congestion.
b. fatigue.
c. infection.
d. urinary retention.
ANS: C
A critical aspect of nursing care following liver transplantation is monitoring for
infection.
The major postoperative complications of a liver transplant are rejection and
infection.

Planning
28. The nurse is aware that the hepatitis A immunization provides

immunity in:
a. 5 days.
b. 10 days.
c. 15 days.
d. 30 days.
ANS: D
Primary immunization with hepatitis A vaccine provides immunity within 30
days.

TOP: Hepatitis A KEY: Nursing Process Step: Planning
29. What is the challenge in encouraging coughing and deep

breathing for a postoperative patient who had an open
cholecystectomy?
a. High placement of incision
b. Excessive nausea
c. Weakened abdominal muscles
d. Poor oxygenation
ANS: A
The high placement of the incision of the cholecystectomy makes the patient
reluctant to cough. Splinting the incision is beneficial.

TOP: Cholecystectomy KEY: Nursing Process Step:
Implementation
30. Why is it advantageous for a live person to be a liver donor?

a. Because the donor is not at risk for any complication
b. Because the recipient is more likely to avoid rejection
c. Because the donor donates only a part of the liver
d. Because the blood supply is more dependable in the donated liver
ANS: C
A live donor may donate only a portion of their liver and within weeks the
donor’s liver has grown to the size to meet the body’s needs. The same is true
for the recipient.

Assessment
31. Which factors are most commonly associated with pancreatitis?
a. Coronary artery disease
b. Alcoholism and biliary tract disease
c. Cirrhosis
d. History of myocardial infarction
ANS: B
Alcoholism and biliary tract disease are the two factors most commonly
associated with pancreatitis.

TOP: Pancreatitis KEY: Nursing Process Step: Assessment
32. A patient with pancreatitis is NPO. The patient asks the nurse why
he is unable to have anything by mouth. Which of the following is the
best response?
a. “Diagnostic tests depend on you not eating anything.”
b. “The pancreas is stimulated whenever you eat or drink, and causes pain.”
c. “Eating causes the need for a bowel movement, which excretes your medication too
d. “Resting your GI tract will cure your pancreatitis.”
ANS: B
Food and fluids are withheld to avoid stimulating pancreatic activity, and IV
fluids are administered.

TOP: Pancreatitis KEY: Nursing Process Step: Implementation
33. Why is morphine contraindicated in the patient with pancreatitis?
a. Demerol (meperidine) is less expensive.

b. Tylenol is more effective at managing this type of pain.
c. Morphine may cause spasms of the sphincter of Oddi.
d. These patients do not experience pain.
ANS: C
A common complaint is constant, severe pain; in such cases, meperidine
(Demerol) PCA is often administered. Morphine may cause spasms of the
sphincter of Oddi.

TOP: Pancreatitis KEY: Nursing Process Step: Intervention
34. Which factors may increase a patient’s risk of developing cancer

of the pancreas?
a. Diet high in carbohydrates and dairy products
b. Cardiovascular disease and glaucoma
c. Tea and cola consumption
d. Cigarette smokers and people with diabetes mellitus
ANS: D
The cause of cancer of the pancreas is unknown, but it is diagnosed more
often in cigarette smokers, people exposed to chemical carcinogens, and
people with diabetes mellitus and pancreatitis.
TOP: Cancer of the pancreas KEY: Nursing Process Step:
Assessment
35. Which assessment would indicate possible gallbladder disease in

an older adult?
a. Dull pain in the right upper quadrant region
b. Changes in color of urine or stool
c. Distention of veins in upper part of body
d. Aching muscles and tenderness in the liver
ANS: B
The incidence of cholelithiasis increases with aging. Assess older adults for
history of changes in stool or urine color. Cirrhosis of the liver may cause
distention in veins in the upper part of the body.
DIF: Cognitive Level: Knowledge REF: Page 257, Life Span

Considerations
OBJ: 2 TOP: Age-related changes
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological
Integrity
36. What should the nurse monitor in caring for the patient
undergoing a paracentesis?
a. The urinary output
b. Hypervolemia
c. Fluid removal over at least 30 minutes
d. Seizure
ANS: C
The fluid removed during a paracentesis is removed over a period of 30 to 90
minutes to prevent sudden changes in blood pressure leading to syncope.
The bed should be in a high Fowler position. Food and fluid restriction is
usually not necessary.

TOP: Paracentesis KEY: Nursing Process Step: Planning
37. A patient with a T-tube for an open cholecystectomy has resumed

oral intake. The T-tube is clamped 2 hours before meals and unclamped
2 hours after meals to aid in the digestion of fat. During the time the
tube is clamped the patient complains of abdominal pain and nausea.
Which intervention is most appropriate?
a. Notify the physician
b. Unclamp the tube immediately
c. Increase the IV fluids
d. Change the T-tube dressing

ANS: B
While the tube is clamped, the patient may show signs of abdominal pain,
nausea, vomiting, etc. Unclamp the tube immediately to allow for drainage
and relief of both nausea and pain.

TOP: Cancer of the pancreas KEY: Nursing Process Step:
Implementation
MULTIPLE RESPONSE
38. What are the indications for a liver transplant? (Select all that
apply.)
a. Congenital biliary abnormalities
b. Hepatic malignancy
c. Chronic hepatitis
d. Cirrhosis due to alcoholism
e. Gallbladder disease
ANS: A, B, C
Indications for liver transplantation include congenital biliary abnormalities,
inborn errors of metabolism, hepatic malignancy (confined to the liver),
sclerosing cholangitis, and chronic end-stage liver disease.
Assessment
39. Which medical interventions and management systems control

the bleeding of esophageal varices? (Select all that apply.)
a. Transfusions
b. Sengstaken-Blakemore tube
c. Band ligation
d. Cryotherapy
e. Portocaval shunt
f. Large doses of vitamin B12
ANS: B, C, E
Band ligation, insertion of the S/B tube, and various shunting surgeries are
helpful in stopping the hemorrhage. Transfusions and water-soluble vitamins
are not beneficial.

TOP: Esophageal varices KEY: Nursing Process Step:
Assessment
40. Dietary teaching for a patient who is treated conservatively for
cholecystitis is necessary to keep the patient comfortable. Which foods
should be avoided? (Select all that apply.)
a. Peanut butter
b. Grilled chicken
c. Rice and pasta
d. Bananas, apples, oranges
e. Whole milk
f. Glazed chocolate doughnuts
ANS: A, E, F
Peanut butter, nuts, chocolate, whole milk, fried foods, and cream and other
fatty foods should be avoided.

TOP: Cholecystitis and cholelithiasis KEY: Nursing Process Step:
Assessment
41. Viral hepatitis may be treated at home. What should be taught to

the patient’s family? (Select all that apply.)
a. Clothes should be laundered separately with hot water.
b. Personal items and drinking glasses should not be shared.

c. Articles soiled with feces do not require extra care.
d. Hands need to be thoroughly washed after toileting.
e. Contaminated items may be disposed of with regular trash.
ANS: A, B, D
For the patient with viral hepatitis being cared for in the home, the family
needs to be taught necessary precautions. Clothes should be laundered
separately with hot water. Personal items used by the patient should not be
shared. Articles soiled with feces must be disinfected. Any contaminated items
should be disposed of properly.

TOP: Hepatitis KEY: Nursing Process Step: Implementation
42. The nurse is aware that the liver synthesizes products essential to
health. Which products are synthesized by the liver? (Select all that
apply.)
a. Intrinsic factor
b. Protein
c. Vitamin K
d. Red blood cells
e. Albumin
ANS: B, E
The liver synthesizes protein and albumin.
DIF: Cognitive Level: Analysis REF: Page 234 OBJ: N/A

TOP: Products synthesized by liver KEY: Nursing Process Step:
Planning
43. What should the nurse do as part of the preparation for an

endoscopic retrograde cholangiopancreatography (ERCP)? (Select all
that apply.)
a. Confirm that a recent chest x-ray is on file
b. Confirm the presence of a consent form
c. Warn patient that the procedure will take about 3 hours
d. Confirm the presence of a prothrombin time/INR
e. Withhold food and drink for 4 hours
ANS: B, D
Before the ERCP the patient will be held NPO for 8 hours. It is necessary that
a consent form be signed as well as evidence of a prothrombin time INR.

TOP: ERCP KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment
COMPLETION
44. ___________ is a condition characterized by yellowing of the

sclera and the skin.
ANS:
Jaundice
Jaundice is the discoloration of body tissues caused by abnormally high blood

levels of bilirubin.

TOP: Jaundice KEY: Nursing Process Step: Assessment
45. The disease that is on the increase because of the growing

obesity population and is associated with coronary artery disease and
use of corticosteroids is_______________.
ANS:
nonalcoholic fatty liver disease (NAFLD)
nonalcoholic fatty liver disease
NAFLD
NAFLD is a disease that is on the rise due to the increasing population of

obese persons. The disease is also associated with CAD and the use of
corticosteroids.

TOP: NAFLD KEY: Nursing Process Step: N/A
46. The tumor marker that is elevated in patients with pancreatic

cancer is______.
ANS:
CA19-9
The tumor marker CA19-9 is elevated in the presence of pancreatic cancer.

TOP: CA19-9 KEY: Nursing Process Step: N/A
47. Hepatitis D is usually seen as a co-infection with __________.
ANS:
hepatitis B
Hepatitis D is usually seen as a coinfection with hepatitis B.
DIF: Cognitive Level: Knowledge REF: Page 247, Box 6-1

OBJ: 6 TOP: Hepatitis KEY: Nursing Process Step: N/A
48. A ___________occurs when the body encapsulates the
autodigestive debris in the pancreatic tissue, frequently becoming an
abscess.
ANS:
pseudocyst
A pseudocyst occurs when the body encapsulates the autodigestive debris in

the pancreatic tissue.
DIF: Cognitive Level: Comprehension REF: Page: 6-63 OBJ: 2

TOP: Pseudocyst KEY: Nursing Process Step: N/A
OTHER
49. The nurse clarifies that deterioration progresses through stages

before presenting with liver disease. Place the stages in order.
(Separate letters by a comma and space as follows: A, B, C, D)
1. Liver disease
2. Inflammation
3. Hepatic insufficiency
4. Destruction
5. Fibrotic regeneration
ANS:
D, B, E, C, A
Liver deterioration follows a pattern of stages: destruction, inflammation,
fibrotic regeneration; hepatic insufficiency then presents as liver disease.

TOP: Pseudocyst KEY: Nursing Process Step: N/A
50. Arrange the normal process of protein metabolism. (Separate

letters by a comma and space as follows: A, B, C, D)
1. Protein enters the blood stream

2. Excreted by kidney
3. Portal vein delivers blood to the liver
4. Conversion to urea
5. Ammonia produced in the bowel
ANS:
A, E, C, D, B
Protein products enter the blood stream and are changed in the bowel to
ammonia; the products then pass through the portal vein to the liver where the
ammonia is converted to urea, which is then excreted by the kidneys.

TOP: Liver destruction KEY: Nursing Process Step:
Implementation.

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INSTANT DOWNLOAD WITH ANSWERS

1. The nurse clarifies that unconjugated bilirubin, which is made up of

a. stored in the gallbladder to make bile.

c. a by-product which is excreted directly into the bowel for excretion.

d. necessary for digestion of fats.

DIF: Cognitive Level: Analysis REF: Page 233 OBJ: 1

c. Copious urine output

3. What is an essential nursing measure to prevent injury to the patient

a. Have patient sign a permit

b. Pad side rails

c. Check for allergy to contrast media or to shellfish

d. Have patient void immediately before procedure

DIF: Cognitive Level: Application REF: Page 242 OBJ: 2

4. What should the nurse expect of a patient with a malabsorption of

c. Increased prothrombin time

d. Diminished white blood cell count

DIF: Cognitive Level: Analysis REF: Page 240 OBJ: 3

5. A patient was scheduled for a laparoscopic cholecystectomy, but

b. To improve diaphragmatic expansion and prevention of atelectasis.

c. To shorten postoperative recovery and hasten the healing process.

DIF: Cognitive Level: Comprehension REF: Page 254, Figure 6-7

a. open the T-tube to the air so that it will drain freely.

b. position and secure the drainage bag at the chest level.

c. Place the collection bag so the tube is not kinked.

DIF: Cognitive Level: Application REF: Page 255 OBJ: 8

a. Assisting to ambulate for the bathroom

b. Keeping the patient on the right side for a minimum of 2 hours

c. Taking vital signs every 4 hours

d. Keeping the patient on the left side for a minimum of 4 hours

DIF: Cognitive Level: Application REF: Page 236 OBJ: 2

8. Immediately following a liver biopsy, the patient becomes dyspneic, the

c. Hemorrhage of the liver

DIF: Cognitive Level: Comprehension REF: Page 236 OBJ: 1

9. Which patient statement indicates that the patient requires additional

a. “Right after the test, I want breakfast with black coffee.”

b. “The instrument will be put down my throat.”

c. “I haven’t had anything to eat or drink since 9 PM last night.”

DIF: Cognitive Level: Analysis REF: Page 239 OBJ: 1

c. Macular rash on trunk and arms

d. Evidence of cardiac ischemia

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a. Slightly more invasive, but there is less pain

b. Can be performed on all patients of any age

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a. Decompress the stomach

b. Control esophageal varices bleeding

c. A route for tube feedings

d. Obtain specimen for gastric analysis

d. esophageal reflux (GERD).

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c. As an indication of respiratory obstruction from varices

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15. How does the administration of neomycin (Mycifradin) reduce the

a. By assisting the hepatic cells to regenerate

c. By decreasing the bacteria in the gut

d. By helping to digest fats and proteins

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a. Ensure that the patient drinks 500 mL of water before testing

b. Give 4 Oragrafin (ipodate) 5 minutes apart starting at 6 AM