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1. For a client in hepatic coma, which outcome would be the most appropriate?

A. The client is oriented to time, place, and person.

B. The client exhibits no ecchymotic areas.

C. The client increases oral intake to 2,000 calories/day.

D. The client exhibits increased serum albumin level.

2. Jordin is a client with jaundice who is experiencing pruritus. Which nursing intervention would be
included in the care plan for the client?

A. Administering vitamin K subcutaneously

B. Applying pressure when giving I.M. injections

C. Decreasing the client’s dietary protein intake

D. Keeping the client’s fingernails short and smooth

3. Marie, a 51-year-old woman, is diagnosed with cholecystitis. Which diet, when selected by the
client, indicates that the nurse’s teaching has been successful?

A. 4-6 small meals of low-carbohydrate foods daily

B. High-fat, high-carbohydrate meals

C. Low-fat, high-carbohydrate meals

D. High-fat, low protein meals

4. The hospital administrator had undergone percutaneous transhepatic cholangiography. which

assessment finding indicates complication after the operation?

A. Fever and chills

B. Hypertension

C. Bradycardia

D. Nausea and diarrhea

5. When planning home care for a client with hepatitis A, which preventive measure should be
emphasized to protect the client’s family?

A. Keeping the client in complete isolation

B. Using good sanitation with dishes and shared bathrooms

C. Avoiding contact with blood-soiled clothing or dressing

D. Forbidding the sharing of needles or syringes

6. For Jayvin who is taking antacids, which instruction would be included in the teaching plan?

A. “Take the antacids with 8 oz of water.”

B. “Avoid taking other medications within 2 hours of this one.”

C. “Continue taking antacids even when pain subsides.”

D. “Weigh yourself daily when taking this medication.”

7. Which clinical manifestation would the nurse expect a client diagnosed with acute cholecystitis to
exhibit?

A. Jaundice, dark urine, and steatorrhea

B. Acute right lower quadrant (RLQ) pain, diarrhea, and dehydration

C. Ecchymosis petechiae, and coffee-ground emesis

D. Nausea, vomiting, and anorexia

8. Pierre who is diagnosed with acute pancreatitis is under the care of Nurse Bryan. Which
intervention should the nurse include in the care plan for the client?

A. Administration of vasopressin and insertion of a balloon tamponade

B. Preparation for a paracentesis and administration of diuretics

C. Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent
suction

D. Dietary plan of a low-fat diet and increased fluid intake to 2,000 ml/day

9. When teaching a client about pancreatic function, the nurse understands that pancreatic lipase
performs which function?

A. Transports fatty acids into the brush border

B. Breaks down fat into fatty acids and glycerol

C. Triggers cholecystokinin to contract the gallbladder

D. Breaks down protein into dipeptides and amino acids

10. A 52-year-old man was referred to the clinic due to increased abdominal girth. He is diagnosed
with ascites by the presence of a fluid thrill and shifting dullness on percussion. After administering
diuretic therapy, which nursing action would be most effective in ensuring safe care?

A. Measuring serum potassium for hyperkalemia

B. Assessing the client for hypervolemia

C. Measuring the client’s weight weekly

D. Documenting precise intake and output

11. Which assessment finding indicates that lactulose is effective in decreasing the ammonia level in
the client with hepatic encephalopathy?

A. Passage of two or three soft stools daily

B. Evidence of watery diarrhea

C. Daily deterioration in the client’s handwriting

D. Appearance of frothy, foul-smelling stools

12. Nurse Farrah is providing care for Kristoff who has jaundice. Which statement indicates that the
nurse understands the rationale for instituting skin care measures for the client?

A. “Jaundice is associated with pressure ulcer formation.”

B. “Jaundice impairs urea production, which produces pruritus.”

C. “Jaundice produces pruritus due to impaired bile acid excretion.”

D. “Jaundice leads to decreased tissue perfusion and subsequent breakdown.”

13. Which rationale supports explaining the placement of an esophageal tamponade tube in a client
who is hemorrhaging?

A. Allowing the client to help insert the tube

B. Beginning teaching for home care

C. Maintaining the client’s level of anxietyand alertness

D. Obtaining cooperation and reducing fear

14. For Rico who has chronic pancreatitis, which nursing intervention would be most helpful?

A. Allowing liberalized fluid intake

B. Counseling to stop alcohol consumption

C. Encouraging daily exercise

D. Modifying dietary protein

15. Mr. Hasakusa is in end-stage liver failure. Which interventions should the nurse implement when
addressing hepatic encephalopathy? (Select all that apply.)

A. Assessing the client’s neurologic status every 2 hours

B. Monitoring the client’s hemoglobin and hematocrit levels

C. Evaluating the client’s serum ammonia level

D. Monitoring the client’s handwriting daily

E. Preparing to insert an esophageal tamponade tube

F. Making sure the client’s fingernails are short

16. For a client with hepatic cirrhosis who has altered clotting mechanisms, which intervention would
be most important?

A. Allowing complete independence of mobility

B. Applying pressure to injection sites

C. Administering antibiotics as prescribed

D. Increasing nutritional intake

17. A client with advanced cirrhosis has been diagnosed with hepatic encephalopathy. The nurse
expects to assess for:

A. Malaise

B. Stomatitis

C. Hand tremors

D. Weight loss

18. A client diagnosed with chronic cirrhosis who has ascites and pitting peripheral edema also has
hepatic encephalopathy. Which of the following nursing interventions are appropriate to prevent skin
breakdown? (Select all that apply.)

A. Range of motion every 4 hours

B. Turn and reposition every 2 hours

C. Abdominal and foot massages every 2 hours

D. Alternating air pressure mattress

E. Sit in chair for 30 minutes each shift

19. Which of the following will the nurse include in the care plan for a client hospitalized with viral
hepatitis?

A. Increase fluid intake to 3000 ml per day

B. Adequate bed rest

C. Bland diet

D. Administer antibiotics as ordered

20. Spironolactone (Aldactone) is prescribed for a client with chronic cirrhosis and ascites. The nurse
should monitor the client for which of the following medication-related side effects?
A. Jaundice

B. Hyperkalemia

C. Tachycardia

D. Constipation

Answers and Rationale

Here are the answers for this exam. Gauge your performance by counter checking your answers to those
below. If you have any disputes or clarifications, please direct them to the comments section.

1. Answer: A. The client is oriented to time, place, and person.

Hepatic coma is the most advanced stage of hepatic encephalopathy. As hepatic coma resolves,
improvement in the client’s level of consciousness occurs. The client should be able to express
orientation to time, place, and person. Ecchymotic areas are related to decreased synthesis of clotting
factors. Although oral intake may be related to level of consciousness, it is more closely related to
anorexia. The serum albumin level reflects hepatic synthetic ability, not level of consciousness.

2. Answer: D. Keeping the client’s fingernails short and smooth

The client with pruritus experiences itching, which may lead to skin breakdown and possibly infection
from scratching. Keeping his fingernails short and smooth helps prevent skin breakdown and infection
from scratching. Applying pressure when giving I.M. injections and administering vitamin K
subcutaneously are important if the client develops bleeding problems. Decreasing the client’s dietary
intake is appropriate if the client’s ammonia levels are increased.

3. Answer: C. Low-fat, high-carbohydrate meals

For the client with cholecystitis, fat intake should be reduced. The calories from fat should be
substituted with carbohydrates. Reducing carbohydrate intake would be contraindicated. Any diet high
in fat may lead to another attack of cholecystitis.

4. Answer: A. Fever and chills

Septicemia is a common complication after a percutaneous transhepatic cholangiography. Evidence of

fever and chills, possibly indicative of septicemia, is important. Hypotension, not hypertension, is
associated with septicemia. Tachycardia, not bradycardia, is most likely to occur. Nausea and diarrhea
may occur but are not classic signs of sepsis.

5. Answer: B. Using good sanitation with dishes and shared bathrooms

Hepatitis A is transmitted through the fecal oral route or from contaminated water or food. Measures to
protect the family include good handwashing, personal hygiene and sanitation, and use of standard
precautions. Complete isolation is not required. Avoiding contact with blood-soiled clothing or dressings
or avoiding the sharing of needles or syringes are precautions needed to prevent transmission of
hepatitis B.
6. Answer: B. “Avoid taking other medications within 2 hours of this one.”

Antacids neutralize gastric acid and decrease the absorption of other medications. The client should be
instructed to avoid taking other medications within 2 hours of the antacid. Water, which dilutes the
antacid, should not be taken with antacid. A histamine receptor antagonist should be taken even when
pain subsides. Daily weights are indicated if the client is taking a diuretic, not an antacid.

7. Answer: D. Nausea, vomiting, and anorexia

Acute cholecystitis is an acute inflammation of the gallbladder commonly manifested by the following:
anorexia, nausea, and vomiting; biliary colic; tenderness and rigidity the right upper quadrant (RUQ)
elicited on palpation (e.g., Murphy’s sign); fever; fat intolerance; and signs and symptoms of jaundice.
Ecchymosis, petechiae, and coffee-ground emesis are clinical manifestations of esophageal bleeding.
The coffee-ground appearance indicates old bleeding. Jaundice, dark urine, and steatorrhea are clinical
manifestations of the icteric phase of hepatitis.

8. Answer: C. Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with
low intermittent suction

With acute pancreatitis, the client is kept on nothing-by-mouth status to inhibit pancreatic stimulation
and secretion of pancreatic enzymes. NG intubation with low intermittent suction is used to relieve
nausea and vomiting, decrease painful abdominal distention, and remove hydrochloric acid. Vasopressin
would be appropriate for a client diagnosed with bleeding esophageal varices. Paracentesis and diuretics
would be appropriate for a client diagnosed with portal hypertension and ascites. A low-fat diet and
increased fluid intake would further aggravate the pancreatitis.

9. Answer: B. Breaks down fat into fatty acids and glycerol

Lipase hydrolyses or breaks down fat into fatty acids and glycerol. Lipase is not involved with the
transport of fatty acids into the brush border. Fat itself triggers cholecystokinin release. Protein
breakdown into dipeptides and amino acids is the function of trypsin, not lipase.

10. Answer: D. Documenting precise intake and output

For the client with ascites receiving diuretic therapy, careful intake and output measurement is essential
for safe diuretic therapy. Diuretics lead to fluid losses, which if not monitored closely and documented,
could place the client at risk for serious fluid and electrolyte imbalances. Hypokalemia, not
hyperkalemia, commonly occurs with diuretic therapy. Because urine output increases, a client should
be assessed for hypovolemia, not hypervolemia. Weights are also an accurate indicator of fluid balance.
However, for this client, weights should be obtained daily, not weekly.

11. Answer: A. Passage of two or three soft stools daily

Lactulose reduces serum ammonia levels by inducing catharsis, subsequently decreasing colonic pH and
inhibiting fecal flora from producing ammonia from urea. Ammonia is removed with the stool. Two or
three soft stools daily indicate effectiveness of the drug. Watery diarrhea indicates overdose. Daily
deterioration in the client’s handwriting indicates an increase in the ammonia level and worsening of
hepatic encephalopathy. Frothy, foul-smelling stools indicate steatorrhea, caused by impaired fat
digestion.
12. Answer: C. “Jaundice produces pruritus due to impaired bile acid excretion.”

Jaundice is a symptom characterized by increased bilirubin concentration in the blood. Bile acid
excretion is impaired, increasing the bile acids in the skin and causing pruritus. Jaundice is not associated
with pressure ulcer formation. However, edema and hypoalbuminemia are. Jaundice itself does not
impair urea production or lead to decreased tissue perfusion.

13. Answer: D. Obtaining cooperation and reducing fear

An esophageal tamponade tube would be inserted in critical situations. Typically, the client is fearful and
highly anxious. The nurse therefore explains about the placement to help obtain the client’s cooperation
and reduce his fear. This type of tube is used only short term and is not indicated for home use. The
tube is large and uncomfortable. The client would not be helping to insert the tube. A client’s anxiety
should be decreased, not maintained, and depending on the degree of hemorrhage, the client may not
be alert.

14. Answer: B. Counseling to stop alcohol consumption

Chronic pancreatitis typically results from repeated episodes of acute pancreatitis. More than half of
chronic pancreatitis cases are associated with alcoholism. Counseling to stop alcohol consumption
would be the most helpful for the client. Dietary protein modification is not necessary for chronic
pancreatitis. Daily exercise and liberalizing fluid intake would be helpful but not the most beneficial
intervention.

15. Answer: A, C, D

Hepatic encephalopathy results from an increased ammonia level due to the liver’s inability to covert
ammonia to urea, which leads to neurologic dysfunction and possible brain damage. The nurse should
monitor the client’s neurologic status, serum ammonia level, and handwriting. Monitoring the client’s
hemoglobin and hematocrit levels and insertion of an esophageal tamponade tube address esophageal
bleeding. Keeping fingernails short address jaundice.

16. Answer: B. Applying pressure to injection sites

The client with cirrhosis who has altered clotting is at high risk for hemorrhage. Prolonged application of
pressure to injection or bleeding sites is important. Complete independence may increase the client’s
potential for injury, because an unsupervised client may injure himself and bleed excessively. Antibiotics
and good nutrition are important to promote liver regeneration. However, they are not most important
for a client at high risk for hemorrhage.

17. Answer: C. Hand tremors

Hepatic encephalopathy results from the accumulation of neurotoxins in the blood, therefore the nurse
wants to assess for signs of neurological involvement. Flapping of the hands (asterixis), changes in
mentation, agitation, and confusion are common. These clients typically have ascites and edema so
experience weight gain. Malaise and stomatitis are not related to neurological involvement.

18. Answer: B, D
Edematous tissue must receive meticulous care to prevent tissue breakdown. Range of motion exercises
preserve joint function but do not prevent skin breakdown. Abdominal or foot massage will not prevent
skin breakdown but must be cleansed carefully to prevent breaks in skin integrity. The feet should be
kept at the level of heart or higher so Fowler’s position should be employed. An air pressure mattress,
careful repositioning can prevent skin breakdown.

19. Answer: B. Adequate bed rest

Treatment of hepatitis consists of bed rest during the acute phase to reduce metabolic demands on the
liver, thus increasing blood supply and cell regeneration. Forcing fluids, antibiotics, and bland diets are
not part of the treatment plan for viral hepatitis.

20. Answer: B. Hyperkalemia

This is a potassium-sparing diuretic so clients should be monitored closely for hyperkalemia. Diarrhea,
dizziness, and headaches are other more common side effects. Tachycardia, jaundice, and constipation
are not expected side effects of spironolactone (Aldactone).