MS SAS

SAS 1
1. You’re performing an abdominal assessment on Brent who is 52 y.o. In which order do you
proceed?
A. Observation, percussion, palpation, auscultation
A. Observation, auscultation, percussion, palpation
B. Percussion, palpation, auscultation, observation
C. Palpation, percussion, observation, auscultation
ANSWER:
RATIO:

2. While palpating a female client’s right upper quadrant (RUQ), the nurse would expect to find which
of the following
structures?
A.Sigmoid colon
B.Appendix
C. Spleen
D. Liver
ANSWER:
RATIO:
The liver, gallbladder, duodenum, pancreas head, hepatic flexure of the colon, sections of the
ascending and transverse colon, and a portion of the right kidney make up the RUQ. The sigmoid
colon, appendix, and spleen are all found in the left lower quadrant, with the sigmoid colon in the left
lower quadrant, the appendix in the right lower quadrant, and the spleen in the left upper quadrant.

3. A female client being seen in a physician’s office has just been scheduled for a barium swallow the
next day. The nurse
writes down which instruction for the client to follow before the test?
A. Fast for 8 hours before the test
B. Eat a regular supper and breakfast
C. Continue to take all oral medications as scheduled
D. Monitor own bowel movement pattern for constipation
ANSWER:
RATIO: 
A barium swallow is an x-ray study that uses a substance called barium for contrast to highlight abnormalities in the
gastrointestinal tract. The client should fast for 8 to 12 hours before the test, depending on physician instructions.
Most oral medications also are withheld before the test. After the procedure, the nurse must monitor for constipation,
which can occur as a result of the presence of barium in the gastrointestinal tract.

4. Which diagnostic test would be used first to evaluate a client with upper GI bleeding?
A. Endoscopy
B. Upper GI series
C. Hemoglobin (Hb) levels and hematocrit (HCT)
D. Arteriography
ANSWER:
RATIO:
Endoscopy permits direct evaluation of the upper GI tract and can detect 90% of bleeding lesions.

5. A patient complains about an inflamed salivary gland below his right ear. The nurse documents
probable inflammation of
which gland/s?
A. Buccal
B. Parotid
C. Sublingual
D. Submandibular
ANSWER:
RATIO:

6. Parotitis caused by bacteria is treated with which of the following drug classifications?
A. Analgesics
B. Corticosteroids
C. Antipyretics
D. Antibiotics
ANSWER:
RATIO:
Antibiotics should be administered intravenously in acute bacterial parotitis after obtaining
blood cultures.

7. Which of the following are the possible causes of sialadenitis? Select all that apply.
A. Dehydration
B. Stress
C. Dental extraction
D. Improper oral hygiene
E. Frequent ingestion of cold beverages
ANSWER:
RATIO: Causes of sialadenitis include dehydration, stress, improper oral hygiene, radiation therapy,
malnutrition, and salivary gland calculi

8. A patient asks, “Is surgery always the treatment of choice for inflamed salivary glands?” Your best
response would be:
A. Yes, surgery is always the answer.
B. Surgery is only recommended for children.
C. Elderly is not a candidate for parotidectomy.
D. The procedure is advised for chronic sialadenitis and uncontrolled pain.
ANSWER:
RATIO:

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Education (Department of Nursing) 10 of 10
9. Which of the following conditions described as presence of calculi in the salivary glands?
A. Parotitis
B. Sialolithiasis
C. Sialadenitis
D. Mumps
ANSWER:
RATIO: Sialolithiasis is the medical term for salivary gland stones or calculi that are mostly
composed of calcium phosphate.

10. Which of the following medical management is recommended for salivary calculus?
A. Lithotripsy
B. Antibiotic therapy
C. Nephrectomy
D. Endoscopy
ANSWER:
RATIO:
 SAS 2

1. Acute gastritis is often caused by:

A. Ingestion of strong acids
B. Irritating foods
C. Overuse of Aspirin
D. All of the above
ANSWER:
RATIO:

2. Which of the following definitions best describes gastritis?

A. Erosion of the gastric mucosa
B. Inflammation of a diverticulum
C. Inflammation of the gastric mucosa
D. Reflux of stomach acid into the esophagus
ANSWER:
RATIO: Gastritis is an inflammation of the gastric or stomach mucosa.

3. Which of the following substances is most likely to cause gastritis?

A. Milk
B. Bicarbonate of soda, or baking soda
C. Enteric coated aspirin
D. Nonsteriodal anti-imflammatory drugs
ANSWER:
RATIO: NSAIDS are a common cause of gastritis because they inhibit prostaglandin synthesis.

.
4. The nurse is caring for a client with chronic gastritis. The nurse monitors the client, knowing that
this client is at risk for which of the following vitamin deficiencies?
A.Vitamin A
B. Vitamin B12
C. Vitamin C
D. Vitamin E
ANSWER:
RATIO: Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the
loss of the function of the parietal cells. The source of the intrinsic factor is lost, which results in the
inability to absorb vitamin B12

5. The nurse is reviewing the medication record of a client with gastritis. Which medication, if noted
on the client’s record,would the nurse question?
A. Amoxicillin (Amoxil)
B. Indomethacin (Indocin)
C. Lansoprazole (Prevacid)
D. Clarithromycin (Biazin)
ANSWER:
RATIO: Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can cause
ulceration of the esophagus, stomach, or small intestine. It is contraindicated in patients with
GI disorders.

6. Which of the following treatments should be included in the immediate management of acute
gastritis?
A. Reducing work stress
B. Completing gastric resection
C. Treating the underlying cause
D. Administering enteral tube feedings
ANSWER:
RATIO:

7. Which of the following risk factors can lead to chronic gastritis?

A. Young age
B. Antibiotic usage
C. Gallbladder disease
D. Helicobacter pylori infection
ANSWER:
RATIO:

8. Which of the following factors associates chronic gastritis with pernicious anemia?
A. Chronic blood loss
B. Inability to absorb vitamin B12
C. Overproduction of stomach acid
D. Overproduction of vitamin B12
ANSWER:
RATIO: The source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12
which leads to pernicious anemia.

9. Which of the following measures helps relieve pain to a client with gastritis?
A. Avoid foods and beverages that may be irritating to the gastric mucosa.
B. Monitor fluid intake and output daily to detect early signs of dehydration.
C. Administer Amoxicillin (Amoxil) twice a day.
D. Start intravenous fluid therapy.
ANSWER:
RATIO: Measures to help relieve pain include instructing the patient to avoid foods and
beverages that may be irritating to the gastric mucosa.

10 A patient with gastritis is nauseated and vomited 10 times at home, which of the following nursing
diagnoses is appropriate for this patient? Select all that apply.
A. Acute pain related to irritated stomach mucosa
B. Anxiety related to treatment
C. Imbalanced nutrition, less than body requirements related to inadequate intake of nutrients
D. Risk for imbalanced fluid volume related to insufficient fluid intake and excessive fluid loss
ANSWER:
RATIO:

11. Michael, a 42 y.o. man is admitted to the med-surg floor with a diagnosis of acute pancreatitis. His
BP is 136/76, pulse 96, Resps 22 and temp 101. His past history includes hyperlipidemia and alcohol
abuse. The doctor prescribes an NG tube. Before inserting the tube, you explain the purpose to
patient.Which of the following is a most accurate explanation?
A. “It empties the stomach of fluids and gas.”
B. “It prevents spasms at the sphincter of Oddi.”
C. “It prevents air from forming in the small intestine and large intestine.”
D. “It removes bile from the gallbladder.”
ANSWER:
RATIO:

12. Jason, a 22 y.o. accident victim, requires an NG tube for feeding. What should you immediately do
after inserting an
NG tube for liquid enteral feedings?
A. Aspirate for gastric secretions with a syringe.
B. Begin feeding slowly to prevent cramping.
C. Get an X-ray of the tip of the tube within 24 hours.
D. Clamp off the tube until the feedings begin.
ANSWER:
RATIO: Aspirating the stomach contents confirms correct placement.

13. Stephanie, a 28 y.o. accident victim, requires TPN. The rationale for TPN is to provide:
A. Necessary fluids and electrolytes to the body.
B. Complete nutrition by the I.V. route.
C. Tube feedings for nutritional supplementation.
D. Dietary supplementation with liquid protein given between meals.
ANSWER:
RATIO: TPN is given intravenously to provide all the nutrients the patient needs. TPN is not a tube
feeding nor is it a liquid dietary supplement.

14. Your patient has a GI tract that is functioning, but has the inability to swallow foods. Which is the
preferred method of
feeding for your patient?
A. TPN
B. PPN
C. NG feeding
D. Oral liquid supplements
ANSWER:
RATIO:

15. An intubated patient is receiving continuous enteral feedings through a Salem sump tube at a rate
of 60ml/hr. Gastric
residuals have been 30-40ml when monitored Q4H. You check the gastric residual and aspirate 220ml.
What is your first
response to this finding?
A. Notify the doctor immediately.
B. Stop the feeding, and clamp the NG tube.
C. Discard the 220ml, and clamp the NG tube.
D. Give a prescribed GI stimulant such as metoclopramide (Reglan).
RATIO:
A gastric residual greater than 2-hours worth of feeding or 100-150 ml is considered too high. The
feeding should be stopped, NG tube clamped, and allow time for the stomach to empty before
additional feeding is added.

SAS 3

Situation: Mrs. Dela Cruz was admitted in the Medical Floor due to pyrosis, dyspepsia and
difficulty of swallowing.

1.Based from the symptoms presented, Nurse Melinda might suspect:

A. Esophagitis
B. Hiatal hernia
C. GERD
D. Gastric Ulcer
ANSWER:
RATIO: GERD is the backflow of gastric or duodenal contents into the esophagus caused by
incompetent lower esophageal sphincter. Pyrosis or heartburn, dyspepsia and dysphagia are
cardinal symptoms.

2. What diagnostic test would confirm the type of problem Mrs. Cruz have?
A. barium enema
B. barium swallow
C. colonoscopy
D. lower GI series
ANSWER:
RATIO: Barium swallow or upper GI series would confirm GERD. Endoscopy is another diagnostic
test. Options a and d are the same. Option c is incorrect

3. Mrs. Dela Cruz complained of pain and difficulty in swallowing. The terms are referred as:

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Education (Department of Nursing) 8 of 10
A. Odynophagia
B. Dysphagia
C. Pyrosis
D. Dyspepsia
ANSWER:
RATIO: When difficulty of swallowing is accompanied with pain this is now referred as
odynophagia. Dysphagia is difficulty of swallowing alone

4. To avoid acid reflux, Nurse Melinda should advice Mrs. Dela Cruz to avoid which type of diet?
A. cola, coffee and tea
B. high fat, carbonated and caffeinated beverages
C. beer and green tea
D. All of the above
ANSWER:
RATIO: All are correct but option b is the best answer. In patients with GERD, this type of diet
must be avoided to avoid backflow of gastric contents. Excessive caffeine reduces the tone of
lower esophageal sphincter. Test Taking Skills: look for the umbrella effect

Situation: Nurse Marishka is the staff nurse assigned at the Emergency Department. During her
shift, a patient was rushed in the ED complaining of severe heartburn, vomiting and pain that
radiates to the flank. The doctor suspects gastric ulcer.

5. What other symptoms will validate the diagnosis of gastric ulcer?

A. right epigastric pain
B. pain occurs when stomach is empty
C. pain occurs immediately after meal
D. pain not relieved by vomiting
ANSWER:
RATIO: In gastric ulcer food intake aggravates pain which usually occur ½ - 1 hour before meal or
immediately during or after food intake. Options a, b, c suggests duodenal ulcer.

6. What diagnostic test would yield good visualization of the ulcer crater?
A. Endoscopy
B. Gastroscopy
C. Barium Swallow
D. Histology
ANSWER:
RATIO: Endoscopy determines bleeding, pain, difficulty swallowing, and a change in bowel habits.
This would yield good visualization of the ulcer crater. Other options are also diagnostic tests in
PUD.

7. Peptic ulcer disease particularly gastric ulcer is thought to be cause by which of the following
microorgamisms?
A. E. coli
B. H. pylori
C. S. aureus
D. K. pnuemoniae
ANSWER:
RATIO: Helicobacter pylori (H. pylori) is a bacteria responsible for most ulcers and many cases
of chronic gastritis (inflammation of the stomach). This organism can weaken the protective
coating of the stomach and duodenum (first part of the small intestines), allowing the damaging
digestive juices to irritate the sensitive lining of these body parts.

8. She is for occult blood test; what specimen will you collect?
A. Blood
B. Urine
C. Stool
D. Gastric Juice
ANSWER:
RATIO: Occult blood test or stool guiac test is a test that detects the presence of hidden (occult)
blood in the stool (bowel movement). The stool guaiac is the most common form of fecal occult
blood test (FOBT) in use today. So stool specimen will be collected.

9.What Diagnostic test will confirm Achalasia?

A. Barium Swallow
B. X- ray Studies
C. Manometry
D. Barium Enema
ANSWER:
RATIO: Barium swallow test Barium swallow is one the most common tests for diagnosing
achalasia

10. For Sliding Hiatal Hernia, all are clinical manifestations except:
A. Heartburn
B. Halitosis
C. Regurgitation
D. Dysphagia
ANSWER:
RATIO: The symptoms of a sliding hiatal hernia are belching (eructation), heartburn, difficulty in
swallowing (dysphagia), and the backward flow of food into the throat (regurgitation)

SAS 4

1. You’re performing an abdominal assessment on Brent who is 52 y.o. In which order do you
proceed?
A. Observation, percussion, palpation, auscultation
B. Observation, auscultation, percussion, palpation
C. Percussion, palpation, auscultation, observation
D. Palpation, percussion, observation, auscultation
ANSWER:
RATIO:

2. When teaching an elderly client how to prevent constipation, which of the following instructions
should the nurse
include?
A. “Drink 6 glasses of fluid each day.”
B. “Avoid grain products and nuts.”
C. “Add at least 4 grams of bran to your cereal each morning.”
D. “Be sure to get regular exercise.”
ANSWER:
RATIO:

3. The nurse would monitor for which of the following adverse reactions to aluminum-containing
antacids such as aluminum
hydroxide (Amphojel)?
A. Diarrhea
B. Constipation
C. GI upset
D. Fluid retention
ANSWER:
RATIO:

4. Nursing suggestions to help a person break the constipation habit include all of the following
except:
A. A low-residue, bland diet.
B. A fluid intake of at least 2 L/day.
C. Establishing a regular schedule of exercise.
D. Establishing a regular time for daily elimination.
ANSWER:
RATIO:

5. All of the following are considered complications of constipation except:

A. Hemorrhoids
B. Fecal impaction
C. Hypokalemia
D. Hypertension
ANSWER:

RATIO:

6. In a client with diarrhea, which outcome indicates that fluid resuscitation is successful?
A. The client passes formed stools at regular intervals
B. The client reports a decrease in stool frequency and liquidity
C. The client exhibits firm skin turgor
D. The client no longer experiences perianal burning.
ANSWER:
RATIO: . A client with diarrhea has a nursing diagnosis of Deficient fluid volume related to excessive
fluid loss in the stool. 

7. The mechanism of action of diphenoxylate (Lotomil) is:

A. An increase in intestinal excretion of water
B. An increase in intestinal motility
C. A decrease in peristalsis in the intestinal wall
D. A decrease in the reabsorption of water in the bowel
ANSWER:
RATIO:

8. Which of the following statements best describes fecal incontinence?

A. It is a common disorder that affects the large intestine characterized by cramping, abdominal pain,
bloating, gas, and
diarrhea or constipation, or both.
B. It is the involuntary passage of stool from the rectum.
C. It is an infrequent bowel movements or difficult passage of stools that persists for several weeks or
longer.
D. It is condition with loose and watery stools during a bowel movement.
ANSWER:
RATIO:

9. Which of the following drugs may be administered to patient with diarrhea?

A. Loperamide (Imodium)
B. Bisacodyl (Dulcolax)
C. Senna Concentrate (Senokot)
D. Docusate (Colace)
ANSWER:
RATIO:

10. Which of the following measures helps control fecal incontinence?

A. Increase fiber in the diet during episodes of diarrhea.
B. Initiate a bowel-training program.
C. Encourage use of laxatives 3 times a day.
D. Use incontinence brief/adult diaper.

SAS 5
1. Which of the following best describes Malabsorption syndrome?
A. Are open sores that develop on the inside lining of your stomach and the upper portion of your
small intestine.
B. It is the inability of the digestive system to absorb one or more of the major vitamins, minerals, and
nutrients.
C. It is a digestive disorder that occurs when acidic stomach juices, or food and fluids back up from the
stomach into the
esophagus.
D. An inflammatory disease which can lead to abdominal pain, severe diarrhea, fatigue, and weight
loss.
ANSWER:
RATIO:

2. A patient complains of abdominal pain and distention is suspected of having malabsorption

syndrome when he/she has:
A. A bulky, foul-smelling stools with steatorrhea
B. Episodes of constipation and diarrhea
C. Chronic constipation
D. Severe abdominal pain after eating
ANSWER:
RATIO:
3. Which of the following diagnostic tests confirms malabsorption syndrome?
A. Complete blood count
B. Abdominal ultrasound
C. Panceatic function test
D. Endoscopy with biopsy
ANSWER:
RATIO:

4. Which of the following recommended to a patient with malabsorption syndrome?

A. Encourage patient to eat pasta three times a day.
B. Instruct patient to increase milk consumption.
C. The patient is advised to limit fluid intake.
D. Vitamin supplementation is prescribed.
ANSWER:
RATIO:

5. A client with irritable bowel syndrome is being prepared for discharge. Which of the following meal
plans should the
nurse give the client?
A. Low fiber, low-fat
B. High fiber, low-fat
C. Low fiber, high-fat
D. High-fiber, high-fat
ANSWER:
RATIO: The client with irritable bowel syndrome needs to be on a diet that contains at least 25 grams
of fiber per day. Fatty foods are to be avoided because they may precipitate symptoms.

6. Katrina is diagnosed with lactose intolerance. To avoid complications with lack of calcium in the
diet, which food should
be included in the diet?
A. Fruit
B. Whole grains
C. Milk and cheese products
D. Dark green, leafy vegetables
ANSWER:
RATIO: Dark green, leafy vegetables are rich in calcium

7. A patient with IBS asks, “How can I manage abdominal discomfort?” Your best response would be:
A. “It is best managed by eating dry crackers.”
B. “Some patients maintain an antidepressant drugs.”
C. “You will be the one to choose what is best for you.”
D. “Abdominal pain can be reduced by avoiding carbonated beverages.”
ANSWER:
RATIO:

8. Care for the postoperative client after gastric resection should focus on which of the following
problems?
A. Body image
B. Nutritional needs
C. Skin care
D. Spiritual needs
ANSWER:
RATIO:  After gastric resection, a client may require total parenteral nutrition or jejunostomy tube
feedings to maintain adequate nutritional status.
9. A 30-year old client experiences weight loss, abdominal distention, crampy abdominal pain, and
intermittent diarrhea after birth of her 2nd child. Diagnostic tests reveal gluten-induced enteropathy.
Which foods must she eliminate from her diet permanently?
A. Milk and dairy products
B. Protein-containing foods
C. Cereal grains (except rice and corn)
D. Carbohydrates
ANSWER:
RATIO: To manage gluten-induced enteropathy, the client must eliminate gluten, which means
avoiding all cereal grains except for rice and corn. In initial disease management, clients eat a high
calorie, high-protein diet with mineral and vitamin supplements to help normalize nutritional status.

10. Which of the following conditions cause/s malabsorption? Select all that apply.
A. Celiac disease
B. Lactose intolerance
C. Gastritis
D. Gastric resection
E. GERD

SAS 6
1. During assessment, the nurse is looking for positive indicators of appendicitis, which include all of
the following except:
A. vomiting
B. low-grade fever
C. Thrombocytopenia
D. Abdominal tenderness upon palpation
ANSWER:
RATIO: Thrombocytopenia could not be found in a patient with appendicitis

2. On physical examination, the nurse should be looking for tenderness on palpation at Mcburney’s
point, which is located in the:
A. Right lower quadrant
B. Right upper quadrant
C. Left lower quadrant
D. Left upper quadrant
ANSWER:
RATIO: McBurney’s point is found at the right lower quadrant

3. Which of the following complications is thought to be the most common cause of appendicitis?
A. A fecalith
B. Bowel kinking
C. Internal bowel occlusion
D. Abdominal bowel swelling
ANSWER:
RATIO:

4. An enema is prescribed for a client with suspected appendicitis. Which of the following actions
should the nurse take?
A. Prepare 750 ml of irrigating solution warmed to 100*F.
B. Question the physician about the order.
C. Provide privacy and explain the procedure to the client.
D. Assist the client to left lateral Sim’s position.
ANSWER:
RATIO:

5. A client with acute appendicitis develops fever, tachycardia, and hypotension. Based on these
assessment findings, the nurse suspects which of the following complications?
A. Peritonitis
B. Bowel ischemia
C. Intestinal obstruction
D. Deficient fluid volume
ANSWER:
RATIO:

6. Eleanor, a 62 y.o. woman with diverticulosis is your patient. Which interventions would you expect
to include in her care?
A. Low-fiber diet and fluid restrictions.
B. Total parenteral nutrition and bed rest.
C. High-fiber diet and administration of psyllium.
D. Administration of analgesics and antacids.
ANSWER:
RATIO:

7. Which of the following types of diets is implicated in the development of diverticulosis?

A. Low-fiber diet
B. High-fiber diet
C. High-protein diet
D. Low-carbohydrate diet
ANSWER:
RATIO:

8. Donald is a 61 y.o. man with diverticulitis. Diverticulitis is characterized by:

A. Periodic rectal hemorrhage.
B. Hypertension and tachycardia.
C. Vomiting and elevated temperature.
D. Crampy and lower left quadrant pain and low-grade fever.
ANSWER:
RATIO:

9. Medical management of the client with diverticulitis should include which of the following
treatments?
A. Reduced fluid intake
B. Increased fiber in diet
C. Administration of antibiotics
D. Exercises to increase intra-abdominal pressure
ANSWER:
RATIO:

10. Which of the following mechanisms can facilitate the development of diverticulosis into
diverticulitis?
A. Treating constipation with chronic laxative use, leading to dependence on laxatives
B. Chronic constipation causing an obstruction, reducing forward flow of intestinal contents
C. Herniation of the intestinal mucosa, rupturing the wall of the intestine
D. Undigested food blocking the diverticulum, predisposing the area to bacterial invasion.
ANSWER:
RATIO:

SAS 7
1. A patient admitted with inflammatory bowel disease asks the nurse for help with menu selections.
What menu selection
is most likely the best choice for this patient?
A) Spinach
B) Tofu
C) Multigrain bagel
D) Blueberries
Answer:
Rationale: Nutritional management of inflammatory bowel disease requires ingestion of a diet that is
bland, low-residue, high-protein, and high-vitamin. Tofu meets each of the criteria. Spinach, multigrain
bagels, and blueberries are not low-residue.

2. A nurse is preparing to provide care for a patient whose exacerbation of ulcerative colitis has
required hospital admission. During an exacerbation of this health problem, the nurse would
anticipate that the patients stools will have what characteristics?
A) Watery with blood and mucus
B) Hard and black or tarry
C) Dry and streaked with blood
D) Loose with visible fatty streaks
Answer:
Rationale: The predominant symptoms of ulcerative colitis are diarrhea and abdominal pain. Stools may be
bloody and contain mucus. Stools are not hard, dry, tarry, black or fatty in patients who have ulcerative
colitis

3. Annabelle is being discharged with a colostomy, and you’re teaching her about colostomy care.
Which statement correctly
describes a healthy stoma?
A. “At first, the stoma may bleed slightly when touched.”
B. “The stoma should appear dark and have a bluish hue.”
C. “A burning sensation under the stoma faceplate is normal.”
D. “The stoma should remain swollen away from the abdomen.”
Answer:
Rationale: For the first few days to a week, slight bleeding normally occurs when the stoma is touched
because the surgical site is still new. She should report profuse bleeding immediately.

4.. You’re advising a 21 y.o. with a colostomy who reports problems with flatus. What food should you
recommend?
A. Peas
B. Cabbage
C. Broccoli
D. Yogurt
Answer:
Rationale:

5. Claire, a 33 y.o. is on your floor with a possible bowel obstruction. Which intervention is priority for
her?
A. Obtain daily weights.
B. Measure abdominal girth.
C. Keep strict intake and output.
D. Encourage her to increase fluids.
Answer:
Rationale: Measuring abdominal girth provides quantitative information about increases or decreases
in the amount of distention

SAS 8
1. 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
Answer:
Rationale: For the client with ascites receiving diuretic therapy, careful intake and output measurement is
essential for safe diuretic therapy.

2. Sharon has cirrhosis of the liver and develops ascites. What intervention is necessary to decrease
the excessive accumulation of serous fluid in her peritoneal cavity?
A. Restrict fluids
B. Encourage ambulation
C. Increase sodium in the diet
D. Give antacids as prescribed
Answer:
Rationale: Restricting fluids decrease the amount of body fluid and the accumulation of fluid in the
peritoneal space

3. A client with cirrhosis begins to develop ascites. Spironolactone (Aldactone) is prescribed to treat
the ascites. The nurse should monitor the client closely for which of the following drug-related side
effects?
A. Constipation
B. Hyperkalemia
C. Irregular pulse
D. Dysuria
Answer:
Rationale:  Aldactone can cause potassium retention because it is a potassium sparing diuretic.
Hyperkalemia could eventually lead to irregular heart beat, but this would not be picked up right
away.

4. For which of the following positions would be appropriate for a client with severe ascites?
A. Fowler’s
B. Side-lying
C. Reverse Trendelenburg
D. Sims’
Answer:
Rationale: Ascites can compromise the action of the diaphragm and increase the client's risk of respiratory
problems. Ascites also greatly increases the risk of skin breakdown. Frequent position changes are
important, but the preferred position is Fowler's. Placing the client in Fowler's position helps facilitate the
client's breathing by relieving pressure on the diaphragm. The other positions do not relieve pressure on
the diaphragm.
5. You’re caring for Jane, a 57 y.o. patient with liver cirrhosis who developed ascites and requires
paracentesis. Before her
paracentesis, you instruct her to:
A. Empty her bladder.
B. Lie supine in bed.
C. Remain NPO for 4 hours.
D. Clean her bowels with an enema.
Answer:
Rationale: A full bladder can interfere with paracentesis and be punctured inadvertently.

6. 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.”
Answer:
Rationale: 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.

7. Develop a teaching care plan for Angie who is about to undergo a liver biopsy. Which of the
following points do you include?
A. “You’ll need to lie on your stomach during the test.”
B. “You’ll need to lie on your right side after the test.”
C. “During the biopsy you’ll be asked to exhale deeply and hold it.”
D. “The biopsy is performed under general anesthesia.”
Answer:
Rationale: After a liver biopsy, the patient is placed on the right side to compress the liver and to
reduce the risk of bleeding or bile leakage.

8. Immediately after a liver biopsy, which of the following complications should the client be closely
monitored for?
A. Abdominal cramping
B. Hemorrhage
C. Nausea and vomiting
D. Potential infection
Answer:
Rationale: The most common complication after liver biopsy is pain. Severe abdominal pain should
increase the concern for a significant bleeding complicatio n

9. Which of the following tests confirms that the origin of the disorder is in the liver?
A. Alanine Aminotransferase (ALT)
B. Aspartate Aminotransferase (AST)
C. Gamma-glutamyl Transferase (GGT)
D. Serum Alkaline Phosphatase
Answer:
Rationale: Gamma-glutamyl transferase is most useful to confirm the liver origin of AlP

10. 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
Answer:
Rationale: 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. 

SAS 9
1. 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.
Answer:
Rationale: 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.

2. 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
Answer:
Rationale: 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.

3. Nathaniel has severe pruritus due to having hepatitis B. What is the best intervention for his
comfort?
A. Give tepid baths.
B. Avoid lotions and creams.
C. Use hot water to increase vasodilation.
D. Use cold water to decrease the itching.
Answer:
Rationale: For pruritus, care should include tepid sponge baths and use of emollient creams and
lotions

4. You’re discharging Nathaniel with hepatitis B. Which statement suggests understanding by the
patient?
A. “Now I can never get hepatitis again.”
B. “I can safely give blood after 3 months.”
C. “I’ll never have a problem with my liver again, even if I drink alcohol.”
D. “My family knows that if I get tired and start vomiting, I may be getting sick again.”
Answer:
Rationale: Hepatitis B can recur. Patients who have had hepatitis are permanently barred from
donating blood. 

5. A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this
diagnosis?
A. Elevated hemoglobin level
B. Elevated serum bilirubin level
C. Elevated blood urea nitrogen level
D. Decreased erythrocyte sedimentation rate
Answer:
Rationale: Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum
bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia.

6. A female client who has just been diagnosed with hepatitis A asks, “How could I have gotten this
disease?” What is the nurse’s best response?
A. “You may have eaten contaminated restaurant food.”
B. “You could have gotten it by using I.V. drugs.”
C. “You must have received an infected blood transfusion.”
D. “You probably got it by engaging in unprotected sex.”
Answer:
Rationale: Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming
food contaminated by infected food handlers

7. A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:
A. Severe abdominal pain radiating to the shoulder.
B. Anorexia, nausea, and vomiting.
C. Eructation and constipation.
D. Abdominal ascites.
Answer:
Rationale: Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue,
and weakness.

8. 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
Answer:
Rationale: 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.

9. 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
Answer:
Rationale: 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.

10. 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
Answer:
Rationale: Edematous tissue must receive meticulous care to prevent tissue breakdown. Range of
motion exercises preserve joint function but do not prevent skin breakdown.

11. A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor the
patient’s blood pressure because of which change that is associated with the liver failure?
A. Hypoalbuminemia
B. Increased capillary permeability
C. Abnormal peripheral vasodilation
D. Excess rennin release from the kidneys
Answer:
Rationale: Blood pressure decreases as the body is unable to maintain normal oncotic pressure with
liver failure, so patients with liver failure require close blood pressure monitoring.

12. You’re caring for Betty with liver cirrhosis. Which of the following assessment findings leads you to
suspect hepatic encephalopathy in her?
A. Asterixis
B. Chvostek’s sign
C. Trousseau’s sign
D. Hepatojugular reflex
Answer:
Rationale: Asterixis is an early neurologic sign of hepatic encephalopathy elicited by asking the patient
to hold her arms stretched out. Asterixis is present if the hands rapidly extend and flex

13. Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder,
the nurse teaches the client about foods that are high in thiamine. The nurse determines that the
client has the best understanding of the dietary measures to follow if the client states an intention to
increase the intake of:
A. Pork
B. Milk
C. Chicken
D. Broccoli
Answer:
Rationale: The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a
variety of foods of plant and animal origin. Pork products are especially rich in this vitamin. Other
good food sources include nuts, whole grain cereals, and legumes.

14. The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the
client has deficient
vitamin K absorption caused by this hepatic disease?
A. Dyspnea and fatigue
B. Ascites and orthopnea
C. Purpura and petechiae
D. Gynecomastia and testicular atrophy
Answer:
Rationale: A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to
produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs
of bleeding, including purpura and petechiae.

15. A patient with severe cirrhosis of the liver develops hepatorenal syndrome. Which of the following
nursing assessment data would support this?
A. Oliguria and azotemia
B. Metabolic alkalosis
C. Decreased urinary concentration
D. Weight gain of less than 1 lb. per week
Answer:
Rationale: Hepatorenal syndrome is a functional disorder resulting from a redistribution of renal
blood flow. Oliguria and azotemia occur abruptly as a result of this complication.

SAS 10
1. Which of the following tests is the most accurate for diagnosing liver cancer?
A. Abdominal ultrasound
B. Abdominal flat plate X-ray
C. Cholangiogram
D. Computed tomography (CT) scan
Answer:
Rationale:

2. Which of the following considerations has highest priority when preparing to administer a
medication to a client with liver cancer?
A. Frequency of the medication
B. Purpose of the medication
C. Necessity of the medication
D. Metabolism of the medication
Answer:
Rationale:  The liver is usually not functioning properly and cannot metabolize medications as well as
it normally would if healthy due to the scarring of the tissue. Certain medications are metabolized
primarily by the liver, while other medications are metabolized by other organs. Consideration should
be made for each med ordered to avoid overburdening the liver

3. Early manifestation of a patient with liver cancer includes:

A. Ascites
B. Hepatomegaly
C. Continuous dull abdominal pain at RUQ
D. Jaundice
Answer:
Rationale: Hepatomegaly and Continuous dull abdominal pain at RUQ are early signs while Ascites
and jaundice are alte signs

4. Which of the following are considered as complications of liver transplant? Select all that apply.
A. Hemorrhage
B. Hypertension
C. Infection
D. Hyperglycemia
E. Rejection
Answer:
Rationale:
5. Which of the following interventions is appropriate after liver transplant?
A. Place patient in an environment free from bacteria, viruses, and fungi as possible.
B. Antibiotic agents are used as long-term therapy to prevent rejection of the transplanted liver.
C. Place patient in Trendelenburg position to facilitate pulmonary drainage.
D. Monitor cardiac output, oxygen saturation, urine output, heart rate, and blood pressure every 8
hours to evaluatehemodynamic status and intravascular fluid volume.
Answer:
Rationale: