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Cholecystitis NCLEX Questions

1. The gallbladder is found on the __________ side of the body and is located under the ____________. It
stores __________.
A. right; pancreas; bilirubin
B. left; liver; bile
C. right; thymus' bilirubin
D. right; liver; bile
The gallbladder is found in the RIGHT side of the body and is located under the LIVER. It stores BILE.

2. Which statements below are CORRECT regarding the role of bile? Select all that apply:
A. Bile is created and stored in the gallbladder.
B. Bile aids in digestion of fat-soluble vitamins, such as A, D, E, and K.
C. Bile is released from the gallbladder into the duodenum.
D. Bile contains bilirubin.
Option A is INCORRECT because bile is created in the LIVER (not gallbladder), but bile is stored in the
gallbladder.

3. You’re providing a community in-service about gastrointestinal disorders. During your teaching about
cholecystitis, you discuss how cholelithiasis can lead to this condition. What are the risk factors for
cholelithiasis that you will include in your teaching to the participants? Select all that apply:
A. Being male
B. Underweight
C. Being female
D. Older age
E. Native American
F. Caucasian
G. Pregnant
H. Family History
I. Obesity

4. A patient is being transferred to your unit with acute cholecystitis. In report the transferring nurse tells you
that the patient has a positive Murphy’s Sign. You know that this means:
A. The patient stops breathing in when the examiner palpates under the ribs on the right upper side of the
abdomen at the midclavicular line.
B. The patient stops breathing out when the examiner palpates under the ribs on the right upper side of the
abdomen at the midclavicular line.
C. The patient verbalizes pain when the lower right quadrant is palpated.
D. The patient reports pain when pressure is applied to the right lower quadrant but then reports an increase
in pain intensity when the pressure is released.
Murphy’s Sign can occur with cholecystitis. This occurs when the patient is placed in the supine position and
the examiner palpates under the ribs on the right upper side of the abdomen. The examiner will have the
patient breathe out and then take a deep breath in. The examiner will simultaneously (while the patient is
breathing in) palpate on this area under the ribs at the midclavicular line (hence the location of the gallbladder).
It is a POSITIVE Murphy’s Sign when the patient stops breathing in during palpation due to pain.

5. Your patient is post-op day 3 from a cholecystectomy due to cholecystitis and has a T-Tube. Which finding
during your assessment of the T-Tube requires immediate nursing intervention?
A. The drainage from the T-Tube is yellowish/green in color.
B. There is approximately 750 cc of drainage within the past 24 hours.
C. The drainage bag and tubing is at the patient's waist.
D. The patient is in the Semi-Fowler's position.
A T-Tube should not drain more than about 500 cc of drainage per day (within 24 hours). A T-Tube’s drainage
will go from bloody tinged (fresh post-op) to yellowish/green within 2-3 days. The drainage bag and tubing
should be below the site of insertion (at or below the patient’s waist so gravity can help drainage the bile), and
the patient should be in Semi-Fowler’s to Fowler’s position to help with draining the bile.

6. The physician orders a patient’s T-Tube to be clamped 1 hour before and 1 hour after meals. You clamp the
T-Tube as prescribed. While the tube is clamped which finding requires you to notify the physician?
A. The T-Tube is not draining.
B. The T-Tube tubing is below the patient’s waist.
C. The patient reports nausea and abdominal pain.
D. The patient’s stool is brown and formed.
A nurse should ONLY clamp a T-Tube with a physician’s order. Most physicians will prescribe to clamp the T-
tube 1 hour before and 1 hour after meals. WHY? So, bile will flow down into the small intestine (instead out of
the body) during times when food is in the small intestine to help with the digestion of fats. This is to help the
small intestine adjust to flow of bile (remember normally it received bile when the gallbladder contracted but
now it will flow from the liver to the small intestine continuously). Option C is an abnormal finding. The patient
should not report nausea or abdominal pain when the tube is blocked. This could indicate a serious problem.
Option A is correct because the T-tube should not be draining because it’s clamped. Option B is correct
because the T-tube tubing should be below or at the patient’s waist level. Option D is correct because this
shows the body is digesting fats and bilirubin is exiting the body through the stool (remember bilirubin is found
in the bile and gives stool its brown color…it would be light colored if the bilirubin was not present). You would
NOT want to see steatorrhea (fat/greasy liquid stools) because this shows the bile isn’t being delivered to help
digest the fats.

7. Your recent admission has acute cholecystitis. The patient is awaiting a cholecystostomy. What signs and
symptoms are associated with this condition? Select all that apply:
A. Right lower quadrant pain with rebound tenderness
B. Negative Murphy’s Sign
C. Epigastric pain that radiates to the right scapula
D. Pain and fullness that increases after a greasy or spicy meal
E. Fever
F. Tachycardia
G. Nausea
Option A and B are not associated with cholecystitis, but a POSITIVE Murphy’s Sign is.

8. A patient in the emergency room has signs and symptoms associated with cholecystitis. What testing do you
anticipate the physician will order to help diagnose cholecystitis? Select all that apply:
A. Lower GI series
B. Abdominal ultrasound
C. HIDA Scan (Hepatobiliary Iminodiacetic Acid scan)
D. Colonoscopy
These two tests can assess for cholecystitis. A lower GI series would not assess the gallbladder but the lower
portions of the GI system like the rectum and large intestine. Option D is wrong because it would also assess
the lower portions of the GI system.

9. You’re precepting a nursing student who is helping you provide T-Tube drain care. You explain to the
nursing student that the t-shaped part of the drain is located in what part of the biliary tract?*
A. Cystic duct
B. Common hepatic duct
C. Common bile duct
D. Pancreatic duct
The “T-shaped” part of the drain is located in the common bile duct and helps deliver bile to the duodenum
(small intestine).

10. Your patient is unable to have a cholecystectomy for the treatment of cholecystitis. Therefore, a
cholecystostomy tube is placed to help treat the condition. Which statement about a cholecystostomy (C-Tube)
is TRUE?
A. The C-Tube is placed in the cystic duct of the gallbladder and helps drain infected bile from the gallbladder.
B. Gallstones regularly drain out of the C-Tube, therefore, the nurse should flush the tube regularly to ensure
patency.
C. The C-Tube is placed through the abdominal wall and directly into the gallbladder where it will drain
infected bile from the gallbladder.
D. The tubing and drainage bag of the C-Tube should always be level with the insertion site to ensure the tube
is draining properly.
This is the only correct statement about a cholecystostomy. A cholecystostomy, also sometimes called a C-
Tube, is placed when a patient can’t immediately have the gallbladder removed (cholecystectomy) due to
cholecystitis. It is placed through the abdominal wall and into the gallbladder. It will drain infected bile (NOT
gallstones). The tubing and drainage bag should be at or below waist level so it drains properly.

11. A patient, who has recovered from cholecystitis, is being discharged home. What meal options below are
best for this patient?
A. Baked chicken with steamed carrots and rice
B. Broccoli and cheese casserole with gravy and mashed potatoes
C. Cheeseburger with fries
D. Fried chicken with a baked potato
The patient should eat a low-fat diet and avoid greasy/fatty/gassy foods. Option B is wrong because this
contains dairy/animal fat like the cheese and gravy, and broccoli is known to cause gas. Option C and D are
greasy food options.

12. Your patient is diagnosed with acute cholecystitis. The patient is extremely nauseous. A nasogastric tube is
inserted with GI decompression. The patient reports a pain rating of 9 on 1-10 scale and states the pain
radiates to the shoulder blade. Select all the appropriate nursing interventions for the patient:*
A. Encourage the patient to consume clear liquids.
B. Administered IV fluids per MD order.
 C. Provide mouth care routinely.
D. Keep the patient NPO.
E. Administer analgesic as ordered.
F. Maintain low intermittent suction to NG tube.
The treatment for cholecystitis includes managing pain, managing nausea/vomiting (a NG tube with GI
decompression (removal of stomach contents) to low intermittent suction may be ordered to help severe
cases), keep patient NPO until signs and symptoms subside, mouth care from vomiting and nasogastric tube,
and administer IV fluids to keep the patient hydrated.

Gallbladder NCLEX Questions

1.The nursing management of the patient with cholecystitis associated with cholelithiasis is based on the
knowledge that
A. Shock-wave therapy should be tried initially.
B. Once gallstones are removed, they tend not to recur.
C. The disorder can be successfully treated with oral bile salts that dissolve gallstones.
D. Laparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic

2.Teaching in relation to home management after a laparoscopic cholecystectomy should include

A. Keeping the bandages on the puncture sites for 48 hours.
B. Reporting any bile-colored drainage or pus from any incision.
C. Using over-the-counter antiemetics if nausea and vomiting occur.
D. Emptying and measuring the contents of the bile bag from the T tube every day

3. Which assessment information will be most important for the nurse to report to the health care provider
about a patient with acute cholecystitis?

A. The patient's urine is bright yellow.

B. The patient's stools are tan colored.
C. The patient has increased pain after eating.
D. The patient complains of chronic heartburn.
Tan or grey stools indicate biliary obstruction, which requires rapid intervention to resolve. The other data are
not unusual for a patient with this diagnosis, although the nurse would also report the other assessment
information to the health care provider.

4. Following laparoscopic cholecystectomy, the nurse would expect the patient to

A. return to work in 2 to 3 weeks
B. be hospitalized for 3 to 5 days postoperatively
C. have four small abdominal incisions covered with small dressings
D. have a T tube placed in the common bile duct to provide bile drainage

5. During discharge instructions for a patient following a laparoscopic cholecystectomy, the nurse advises the
patient to
A. keep the incision areas clean and dry for at least a week
B. report the need to take pain medication for shoulder pain
C. report any bile colored or purulent drainage from the incisions
D. expect some postoperative nausea and vomiting for a few days

GALLBLADDER DISORDERS NCLEX QUESTIONS

1.The client is four hours postoperative open cholecystectomy Which data warrant immediate intervention by
the nurse?
1. Absent bowel sounds in all four quadrants
2. The T-tube has 60 mL of green drainage
3. Urine output of 100 mL in the past 3 hours
4. Refusal to turn, deep breathe, and cough
Refusing to turn, deep breathe, and cough places the client at risk for pneumonia. This client needs immediate
intervention to prevent complications.

2. The client two hours postoperative laparoscopic cholecystectomy is complaining of severe pain in the right
shoulder. Which nursing intervention should the nurse implement?
a. Apply a heating pad to the abdomen for 15 - 20 minutes
b. Administer morphine sulfate intravenously after diluting with saline
c. Contact the surgeon for an order to x-ray the right shoulder
d. Apply a sling to the right arm, which was injured during surgery
A heating pad should be applied for 15 to 20 minutes to assist the migration of the CO2 used to insufflate the
abdomen. Shoulder pain is an expected occurrence.

3. The nurse is teaching a client recovering from a laparoscopic cholecystectomy. Which statement indicates
the discharge teaching is effective?
a. I will take my lipid-lowering medicine at the same time each night
b. I may experience some discomfort when I eat a high-fat meal
c. I need someone to stay with me for about a week after surgery
d. I should not splint my incision when I deep breathe and cough
After removal of the gallbladder, some clients experience abdominal discomfort when eating fatty foods.

4. Which signs and symptoms should the nurse report to the health care provider for the client recovering from
an open cholecystectomy? Select all that apply
a. Clay- colored stools
b. Yellow tinted sclera
c. Amber-colored urine.
d. Wound approximated.
e. Abdominal pain
a. Clay- colored stools are caused by recurring stricture of the common bile duct, which is a sign of post
cholecystectomy syndrome.
b. Yellow tinted sclera and skin indicate residual effects of stricture of the common bile duct, which is a sign of
post cholecystectomy syndrome.
e. Abdominal pain indicates a residual effect of a stricture of the common bile duct, inflammation, or calculi,
which is a sign of post cholecystectomy syndrome.

5. The nurse is caring for the immediate postoperative client who had a laparoscopic cholecystectomy. Which
task could the nurse delegate to the unlicensed assistive personnel (UAP)?
a. Check the abdominal dressings for bleeding
b. Increase the IV fluid if the blood pressure is low
c. Ambulate the client to the bathroom
d. Auscultate the breath sounds in all lobes
A day surgery client can be ambulated to the bathroom, so this task can me delegated to the UAP.

6. Which data should the nurse expect to assess in the client who had an upper gastrointestinal (UGI) series?
a. Chalky white stools
b. Increased heart rate
c. A firm hard abdomen
d. Hyperactive bowel sounds
A UGI series requires the client to swallow barium, which passes through the intestines, making the stools a
chalky white color
7. The client is one hour post endoscopic retrograde cholangiopancreatogram (ERCP). Which intervention
should the nurse include in the plan of care?
a. Instruct the client to cough forcefully
b. Encourage early ambulation
c. Assess for return of a gag reflex
d. Administer held medications
The ERCP requires an anesthetic spray be used prior to insertion of the endoscope. If medications, food, or
fluid are given orally prior to the return of the gag reflex, the client may aspirate.

8. Which outcome should the nurse identify for the client scheduled to have a cholecystectomy?
a. Decreased pain management
b. Ambulate first day postoperative
c. No break in skin integrity
d. Knowledge of postoperative care
This would be an expected outcome for the client scheduled for surgery. This indicates preoperative teaching
has been effective.

9. Which assessment data indicate to the nurse the client recovering from an open cholecystectomy may
require pain medication?
1. The client’s pulse is 65 beats per minute
2. The client has shallow respirations
3. The clients bowel sounds are 20 per minute
4. The client uses a pillow to splint when coughing
An open cholecystectomy requires a large incision under the diaphragm. Deep breathing places pressure on
the diaphragm and the incision, causing pain. Shallow respirations indicate inadequate pain control, and the
nurse should intervene.

10. The charge nurse is monitoring client laboratory values. Which value is expected in the client with
cholecystitis who has chronic inflammation?
1. an elevated white blood cell count
2. an decreased lactate dehydrogenase
3. an elevated alkaline phosphatase
4. a decreased direct bilirubin level
The white blood cell count should be elevated in clients with chronic inflammation.

11. Which problem is highest priority for the nurse to identify in the client who had an open cholecystectomy
surgery?
1. Alteration in nutrition
2. Alteration in skin integrity
3. Alteration in urinary pattern
4. Alteration in comfort
Acute pain management is the highest priority client problem after surgery because pain may indicate a life-
threatening problem

12. The nurse assesses a large amount of red drainage on the dressing of a client who is six hours
postoperative open cholecystectomy. Which intervention should the nurse implement?
1. measure the abdominal girth
2. Palpate the lower abdomen for a mass
3. Turn client onto side to assess for further drainage
4. Remove the dressing to determine the source
Turning the client to the side to assess the amount of drainage and possible bleeding is important prior to
contacting the surgeon.

Practice Quiz: Cholecystitis

1. The initial course of treatment for a patient with cholecystitis may include:
A. Analgesics and antibiotics
B. Intravenous fluids.
C. Nasogastric suctioning.
D. All of the above.
Analgesics and antibiotics are primary medications for a patient with cholecystitis, and nasogastric suctioning
is performed to prevent gastric sludge.

2. A patient with cholecystitis is limited to low-fat liquids only. As foods are added to the diet, the patient must
know that the following should be avoided:
A. Cooked fruits.
B. Eggs and cheese.
C. Lean meats.
D. Rice and tapioca.
Eggs and cheese are rich in cholesterol which is contraindicated in patients with cholecystitis.

3. 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.
Assessing the indicators of infection, leakage of bile, and obstruction of bile drainage are all appropriate
measures postoperatively.

4. 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.
For the client with cholecystitis, fat intake should be reduced.

5. 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
Acute cholecystitis is an acute inflammation of the gallbladder commonly manifested by the following: anorexia,
nausea, and vomiting.

CHAPTER 43: Liver, Pancreas, and Biliary Tract Problems (10th Edition) Flashcards Preview
1. A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge
that
a. pruritus is a common problem with jaundice in this phase.
b. the patient is most likely to transmit the disease during this phase.
c. gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B.
d. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase.
2. A patient with acute hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse
should include instructions to
a. avoid alcohol for the first 3 weeks.
b. use a condom during sexual intercourse.
c. have family members get an injection of immunoglobulin.
d. follow a low-protein, moderate-carbohydrate, moderate-fat diet.

3. A patient has been told that she has elevated liver enzymes caused by nonalcoholic fatty liver disease
(NAFLD). The nursing teaching plan should include
a. having genetic testing done.
b. recommending a heart-healthy diet.
c. the necessity to reduce weight rapidly.
d. avoiding alcohol until liver enzymes return to normal.

4. The patient with advanced cirrhosis asks why his abdomen is so swollen. The nurse's response is based on
the knowledge that
a. a lack of clotting factors promotes the collection of blood in the abdominal cavity.
b. portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space.
c. decreased peristalsis in the GI tract contributes to gas formation and distention of the bowel.
d. bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid.

5. In planning care for a patient with metastatic liver cancer, the nurse should include interventions that
a. focus primarily on symptomatic and comfort measures.
b. reassure the patient that chemotherapy offers a good prognosis.
c. promote the patient's confidence that surgical excision of the tumor will be successful.
d. provide information necessary for the patient to make decisions regarding liver transplantation.

6. Nursing management of the patient with acute pancreatitis includes (select all that apply)
a. checking for signs of hypocalcemia.
b. providing a diet low in carbohydrates.
c. giving insulin based on a sliding scale.
d. observing stools for signs of steatorrhea.
e. monitoring for infection, particularly respiratory tract infection.

7. A patient with pancreatic cancer is admitted to the hospital for evaluation of possible treatment options. The
patient asks the nurse to explain the Whipple procedure that the surgeon has described. The explanation
includes the information that a Whipple procedure involves
a. creating a bypass around the obstruction caused by the tumor by joining the gallbladder to the jejunum.
b. resection of the entire pancreas and the distal portion of the stomach, with anastomosis of the common bile
duct and the stomach into the duodenum.
c. removal of part of the pancreas, part of the stomach, the duodenum, and the gallbladder, with joining of the
pancreatic duct, the common bile duct, and the stomach into the jejunum.
d. radical removal of the pancreas, the duodenum, and the spleen, and attachment of the stomach to the
jejunum, which requires oral supplementation of pancreatic digestive enzymes and insulin replacement
therapy.

8. The nursing management of the patient with cholecystitis associated with cholelithiasis is based on the
knowledge that
a. shock-wave therapy should be tried initially.
b. once gallstones are removed, they tend not to recur.
c. the disorder can be successfully treated with oral bile salts that dissolve gallstones.
d. laparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic.

9. Teaching in relation to home management after a laparoscopic cholecystectomy should include

a. keeping the bandages on the puncture sites for 48 hours.
b. reporting any bile-colored drainage or pus from any incision.
c. using over-the-counter antiemetics if nausea and vomiting occur.
d. emptying and measuring the contents of the bile bag from the T tube every day.

10. The nurse provides discharge instructions for a 64-year-old woman with ascites and peripheral edema
related to cirrhosis. Which statement, if made by the patient, indicates teaching was effective?
a. “It is safe to take acetaminophen up to four times a day for pain.”
b. “Lactulose (Cephulac) should be taken every day to prevent constipation.”
c. “Herbs and other spices should be used to season my foods instead of salt.”
d. “I will eat foods high in potassium while taking spironolactone (Aldactone).”

11. The nurse is caring for a group of patients. Which patient is at highest risk for pancreatic cancer?
a. A 38-year-old Hispanic female who is obese and has hyperinsulinemia
b. A 23-year-old who has cystic fibrosis–related pancreatic enzyme insufficiency
c. A 72-year-old African American male who has smoked cigarettes for 50 years
d. A 19-year-old who has a 5-year history of uncontrolled type 1 diabetes mellitus

12. The nurse is caring for a 55-year-old man patient with acute pancreatitis resulting from gallstones. Which
clinical manifestation would the nurse expect the patient to exhibit?
a. Hematochezia
b. Left upper abdominal pain
c. Ascites and peripheral edema
d. Temperature over 102o F (38.9o C)

13. The nurse instructs a 50-year-old woman about cholestyramine to reduce pruritis caused by gallbladder
disease. Which statement by the patient to the nurse indicates she understands the instructions?

a. “This medication will help me digest fats and fat-soluble vitamins.”

b. “I will apply the medicated lotion sparingly to the areas where I itch.”

c. “The medication is a powder and needs to be mixed with milk or juice.”

d. “I should take this medication on an empty stomach at the same time each day.”

14. The nurse is caring for a woman recently diagnosed with viral hepatitis A. Which individual should the
nurse refer for an immunoglobin (IG) injection?
a. A caregiver who lives in the same household with the patient
b. A friend who delivers meals to the patient and family each week
c. A relative with a history of hepatitis A who visits the patient daily
d. A child living in the home who received the hepatitis A vaccine 3 months ago

15. The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed
with acute pancreatitis. What intervention(s) should the nurse expect to include in the patient's plan of care?
a. Immediately start enteral feeding to prevent malnutrition.
b. Insert an NG and maintain NPO status to allow pancreas to rest.
c. Initiate early prophylactic antibiotic therapy to prevent infection.
d. Administer acetaminophen (Tylenol) every 4 hours for pain relief.

16. The patient with cirrhosis has an increased abdominal girth from ascites. The nurse should know that this
fluid gathers in the abdomen for which reasons? Select all that apply.
a. There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin.
b. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention.
c. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity.
d. Osmoreceptors in the hypothalamus stimulate thirst, which causes the stimulation to take in fluids orally.
e. Overactivity of the enlarged spleen results in increased removal of blood cells from the circulation, which
decreases the vascular pressure.

17. When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing
diagnosis?
a. Impaired skin integrity related to edema, ascites, and pruritus
b. Imbalanced nutrition: less than body requirements related to anorexia
c. Excess fluid volume related to portal hypertension and hyperaldosteronism
d. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

18. When teaching the patient with acute hepatitis C (HCV), the patient demonstrates understanding when the
patient makes which statement?
a. "I will use care when kissing my wife to prevent giving it to her."
b. "I will need to take adofevir (Hepsera) to prevent chronic HCV."
c. "Now that I have had HCV, I will have immunity and not get it again."
d. "I will need to be checked for chronic HCV and other liver problems."

19. A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a
serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To what diagnosis does the nurse
attribute these findings?
a. Malnutrition
b. Osteomyelitis
c. Alcohol abuse
d. Diabetes mellitus
20. The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more
teaching?
a. "If I notice a fast heart rate or irregular beats, this is normal for cirrhosis."
b. "I need to take good care of my belly and ankle skin where it is swollen."
c. "A scrotal support may be more comfortable when I have scrotal edema."
d. "I can use pillows to support my head to help me breathe when I am in bed."

21. When providing discharge teaching for the patient after a laparoscopic cholecystectomy, what information
should the nurse include?
a. A lower-fat diet may be better tolerated for several weeks.
b. Do not return to work or normal activities for 3 weeks.
c. Bile-colored drainage will probably drain from the incision.
d. Keep the bandages on and the puncture site dry until it heals.

22. When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin
supplements (select all that apply)? Select all that apply.
a. Vitamin A
b. Vitamin D
c. Vitamin E
d. Vitamin K
e. Vitamin B

23. The patient with a history of lung cancer and hepatitis C has developed liver failure and is considering liver
transplantation. After the comprehensive evaluation, the nurse knows that which factor discovered may be a
contraindication for liver transplantation?
a. Has completed a college education
b. Has been able to stop smoking cigarettes
c. Has well-controlled type 1 diabetes mellitus
d. The chest x-ray showed another lung cancer lesion.

24. The patient with suspected pancreatic cancer is having many diagnostic studies done. Which one can be
used to establish the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment?
a. Spiral CT scan
b. A PET/CT scan
c. Abdominal ultrasound
d. Cancer-associated antigen 19-9

ATI- Cholecystitis and Cholelithiasis (1-5)/ Unit 4.1 (6-31)

1. A nurse is providing discharge teaching to a client who is postoperative following open cholecystectomy
with T-tube placement. Which of the following instructions should the nurse include in the teaching?
(Select all that apply.)
A. Take baths rather than showers.
B. Clamp T-tube for 1 to 2 hr before and after meals.
C. Keep the drainage system above the level of the abdomen.
D. Expect to have the T-tube removed 3 days postoperatively.
E. Report brown-green drainage to the provider.

A. INCORRECT: Soaking in bath water is contraindicated due to the increased risk for introduction of
organisms and infection.
B. CORRECT: The T-tube should be clamped 1 to 2 hr before and after meals to assess tolerance to
food post cholecystectomy, and prior to removal.
C. INCORRECT: The drainage system should not be placed above the level of the gallbladder due to
the risk of infection from the reflux of drainage from the tube into the wound bed.
D. INCORRECT: Diarrhea is common and stools will return to brown color in a week.
E. CORRECT: The drainage bag attached to the T-tube should be emptied every 8 hr

2. A nurse is reviewing nutrition teaching for a client who has cholecystitis. Which of the following food
choices can trigger cholecystitis?
A. Brownie with nuts
B. Bowl of mixed fruit
C. Grilled turkey
D. Baked potato
A. CORRECT: Foods that are high in fat, such as a brownie with nuts, can cause cholecystitis.
B. INCORRECT: Fruits are low in fat and not associated with cholecystitis.
C. INCORRECT: Turkey is low in fat and not associated with cholecystitis.
D. INCORRECT: Baked potatoes are low in fat and not associated with cholecystitis.
3. A nurse is completing preoperative teaching for a client who will undergo a laparoscopic
cholecystectomy. Which of the following should be included in the teaching?
A. "The scope will be passed through your rectum."
B. "You may have shoulder pain after surgery."
C. "The T-tube will remain in place for 1 to 2 weeks."
D. "You should limit how often you walk for 1 to 2 weeks."
A. INCORRECT: Surgery is performed through the rectum during the natural orifice transluminal
endoscopic surgery (NOTES) approach.
B. CORRECT: Shoulder pain occurs due to free air that is introduced into the abdomen during
laparoscopic surgery.
B. INCORRECT: A T-tube is placed during the open surgery approach when the common bile duct
is explored.
D. INCORRECT: The client is instructed to ambulate frequently following a laparoscopic surgical
approach to minimize the free air that has been introduced.

4. A nurse is reviewing a new prescription for ursodiol (Ursodeoxycholic Acid) with a client who has
cholelithiasis. Which of the following should be included in the teaching?
A. This medication reduces biliary spasms.
B. This medication reduces inflammation in the biliary tract.
C. This medication dilates the bile duct to promote passage of bile.
D. This medication dissolves gall stones.
A. INCORRECT: Ursodiol is used to dissolve gall stones.
B. INCORRECT: Ursodiol does not reduce inflammation in the biliary tract.
C. INCORRECT: Ursodiol dissolves gall stones to allow passage of bile in the bile duct.
D. CORRECT: Ursodiol is a bile acid that gradually dissolves cholesterol-based gall stones over a period of up
to 2 years.

5. A nurse in a clinic is reviewing the laboratory reports of a client who has suspected cholelithiasis. Which
of the following is an expected finding?
A. Serum albumin 4.1 g/dL
B. WBC 9,511/uL
C. Direct bilirubin 2.1 mg/dL
D. Serum cholesterol 171 mg/dL
A. INCORRECT: Serum albumin is within the expected reference range and is not an indicator
of cholelithiasis.
B. INCORRECT: An expected finding would be an increased WBC due to inflammation. This finding is
within the expected reference range.
C. CORRECT: This finding is outside the expected reference range and is increased in the client who
has cholelithiasis.
D. INCORRECT: An expected finding for a client who has cholelithiasis is a serum cholesterol greater
than 200 mg/dL.

6. A nurse is completing the admission assessment of a client who has acute pancreatitis. Which of the
following findings is the priority to report?

A. History of cholelithiasis
B. Elevated serum amylase level
C. Decrease in bowel sounds upon auscultation
D. Hand spasms present when blood pressure is checked

7. A nurse is preparing to administer pancrelipase to a client who has pancreatitis. Which of the following
actions should the nurse take?

A. Instruct the client to chew the medication before swallowing.

B. Offer a glass of water following medication administration
C. Administer the medication 30 min before meals
D. Sprinkle the contents on peanut butter

8. A nurse is completing an admission assessment of a client who has pancreatitis. Which of the following
findings should the nurse expect?

A. Pain in right upper quadrant radiating to right shoulder

B. Report of pain being worse when sitting upright
C. Pain relieved with defecation
D. Epigastric pain radiating to the left shoulder

9. A nurse is assessing a client who has pancreatitis. Which of the following actions should the nurse take to
assess the presence of Cullen's sign?
A. Tap lightly at the costovertebral margin on the client's back
B. Palpate the right lower quadrant
C. Inspect the skin around the umbilicus
D. Auscultate the area below the scapula

10. A nurse is completing nutrition teaching for a client who has pancreatitis. Which of the following statements
by the client indicates an understanding of the teaching? (Select all that apply.)

A. "I plan to eat small, frequent meals."

B. "I will eat easy-to-digest foods with limited spice."
C. "I will use skim milk when cooking."
D. "I plan to drink regular cola."
E. "I will limit alcohol intake to two drinks per day."

11. A nurse on a medical-surgical unit is admitting a client who has hepatitis B with ascites. Which of the
following actions should the nurse include in the plan of care?

A. Initiate contact precautions

B. Weight the client weekly
C. Measure abdominal girth 7.5 cm (3 in) above the umbilicus
D. Provide a high-calorie, high-carbohydrate diet

12. A nurse is caring for a client who has a new diagnosis of hepatitis C. Which of the following laboratory
findings should the nurse expect?

A. Presence of immunoglobulin G antibodies (IgG)

B. Positive EIA test
C. Aspartate aminotransferase (AST) 35 units/L
D. Alanine aminotransferase (ALT) 15 IU/L

13. A nurse is assessing a client who has advanced cirrhosis. The nurse should identify which of the following
findings as indicators of hepatic encephalopathy? (Select all that apply.)

A. Anorexia
B. Change in orientation
C. Asterixis
D. Ascites
E. Fetor hepaticus

14. A nurse is caring for a client who has cirrhosis. Which of the following medications can the nurse expect to
administer to this client? (Select all that apply.)

A. Diuretic
B. Beta-blocking agent
C. Opioid analgesic
D. Lactulose
E. Sedative

15. A nurse is teaching a client who has hepatitis B about home care. Which of the following instructions
should the nurse include in the teaching? (Select all that apply.)

A. Limit physical activity

B. Avoid alcohol
C. Take acetaminophen for comfort
D. Wear a mask when in public places
E. Eat small frequent meals

16. A nurse in a provider's office is reviewing the health record of a client who is being evaluated for Graves'
disease. The nurse should identify that which of the following laboratory results is an expected finding?

A. Decreased thyrotropin receptor antibodies

B. Decreased thyroid-stimulating hormone (TSH)
C. Decreased free thyroxine index
D. Decreased triiodothyronine

17. A nurse is reviewing the manifestations of hyperthyroidism with a client. Which of the following findings
should the nurse include? (Select all that apply.)
A. Anorexia
B. Heat intolerance
C. Constipation
D. Palpitations
E. Weight loss
F. Bradycardia

18. A nurse is providing instructions to a client who has Graves; disease and has a new prescription for
propranolol. Which of the following information should the nurse include?

A. "An adverse effect of this medication is jaundice."

B. "Take your pulse before each dose."
C. "The purpose of this medication is to decrease production of thyroid hormone."
D. "You should stop taking this medication if you have a sore throat."
(Propranolol can cause bradycardia)

19. A nurse is preparing to receive a client from the PACU who is postoperative following a thyroidectomy. The
nurse should ensure that which of the following equipment is available? (Select all that apply.)

A. Suction equipment
B. Humidified oxygen
C. Flashlight
D. Tracheostomy tray
E. Chest tube tray

20. A nurse in a provider's office is planning care for a client who has a new diagnosis of Graves' disease and
a new prescription for methimazole. Which of the following interventions should the nurse include in the plan of
care? (Select all that apply.)

A. Monitor CBC
B. Monitor triiodothyronine (T3)
C. Instruct the client to increase consumption of shellfish
D. Advise the client to take the medication at the same time every day
E. Inform the client that an adverse effect of this medication is iodine toxicity

21. A nurse is assessing a client who is 12h postoperative following a thyroidectomy. The nurse should identify
which of the following findings as indicative of thyroid crisis? (Select all that apply.)

A. Bradycardia
B. Hypothermia
C. Dyspnea
D. Abdominal pain
E. Mental confusion

22. A nurse in a provider's office is reviewing laboratory results of a client who is being evaluated for secondary
hypothyroidism. Which of the following laboratory findings is expected for a client who has this condition?

A. Elevated serum T4
B. Decreased serum T3
C. Elevated serum thyroid stimulating hormone
D. Decreased serum cholesterol

23. A nurse is collecting an admission history from a female client who has hypothyroidism. Which of the
following findings should the nurse expect? (Select all that apply.)

A. Diarrhea
B. Menorrhagia
C. Dry skin
D. Increased libido
E. Hoarseness

24. A nurse is reinforcing teaching with a client who has a new prescription for levothyroxine to treat
hypothyroidism. Which of the following information should the nurse include in the teaching? (Select all that
apply.)

A. Weight gain is expected while taking this medication

B. Medication should not be discontinued without the advice of the provider
C. Follow-up serum TSH levels should be obtained
D. Take the medication on an empty stomach
E. Use fiber laxatives for constipation

25. A nurse in an intensive care unit is planning care for a client who has myxedema coma. Which of the
following actions should the nurse include? (Select all that apply.)

A. Observe cardiac monitor for dysrhythmias

B. Observe for evidence of urinary tract infection
C. Initiate IV fluids using 0.9% sodium chloride
D. Administer a levothyroxine IV bolus
E. Provide warmth using a heating pad

26. A nurse in a provider's office is assessing a client who has hypothyroidism and recently began treatment
with thyroid hormone replacement therapy. Which of the following findings should indicate to the nurse that the
client might need a decrease in the dosage of the medication?

A. Hand tremors
B. Bradycardia
C. Pallor
D. Slow speech

27. A nurse is planning care for a client who has Cushing's disease. The nurse should recognize that clients
who have Cushing's disease are at increased risk for which of the following? (Select all that apply.)

A. Infection
B. Gastric ulcer
C. Renal calculi
D. Bone fractures
E. Dysphagia

28. At the beginning of a shift, a nurse is assessing a client who has Cushing's disease. Which of the following
findings is the priority?

A. Weight gain
B. Fatigue
C. Fragile skin
D. Joint pain

29. A nurse is reviewing the laboratory values of a client who has Cushing's disease. Which of the following
findings should the nurse expect for this client? (Select all that apply.)

A. Sodium 150 mEq/L

B. Potassium 3.3 mEq/L
C. Calcium 8.0 mg/dL
D. Lymphocyte count 35%
E. Fasting glucose 145 mg/dL

30. A nurse is caring for a client who is 6 hr postop following a transsphenoidal hypophysectomy. The nurse
should test the client's nasal drainage for the presence of which of the following?

A. RBC's
B. Ketones
C. Glucose
D. Streptococci

31. The nurse is providing discharge teaching for a client who had a transsphenoidal hypophysectomy. Which
of the following instructions should the nurse include? (Select all that apply.)

A. Brush your teeth after every meal or snack

B. Avoid bending at the knees
C. Eat a high-fiber diet
D. Notify the provider of any sweet-tasting drainage
E. Notify the provider of a diminished sense of smell
ch 43 Cholecystitis, Cholelithiasis

1. cholelithiasis-stones in the gallbladder

2. cholecystitis-inflammation of the gallbladder, usually associated with cholelithiasis

3.cholecystectomy-removal of the gallbladder

4. symptoms of acute cholecystitis (4)

-pain and tenderness in RUQ
-pain referred to the right shoulder
-indigestion
-fever

5. symptoms of chronic cholecystitis (4)

-hx of fat intolerance (nausea, anorexia, sensation of fullness after eating high-fat foods)
-dyspepsia
-heartburn
-flatulence

6. symptoms of obstructed bile flow (6)

-jaundice
-dark amber to brown urine
-clay-colored stools
-steatorrhea (fat in stool)
-fever
-increased WBC count

7. postop care for laparoscopic cholecystectomy (5)

-monitor for bleeding
-place pt in Sim's position (on left side with knee flexed)
-encourage deep breathing
-encourage ambulation
-prepare pt for discharge

8. postop care for open cholecystectomy (3)

-ensure adequate ventilation
-prevention of respiratory complications
-T-tube: maintain bile drainage, monitor T-tube function and drainage

9. pt teaching: laparoscopic cholecystectomy (5)

-may have shoulder pain after surgery (due to free air that is introduced into the abdomen)
-remove bandages the day after surgery
-resume normal activities and return to work 1 week after surgery
-low-fat diet for 4-6 weeks
-symptoms of infection: bile-colored drainage, redness, swelling, severe abdominal pain, nausea, vomiting,
chills, fever

10. pt teaching: open cholecystectomy- avoid heavy lifting for 4-6 weeks

11. The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals
cholelithiasis. What is the nurse's priority?
a. Prevent all oral intake.
b. Control abdominal pain.
c. Provide enteral feedings.
d. Avoid dietary cholesterol.

12. The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Which of these
clinical manifestations support this diagnosis? (Select all that apply)
1. fever
2. positive Cullen's sign
3. complaints of indigestion
4. palpable mass in the left upper quadrant
5. pain in the upper right quadrant after a fatty meal
6. vague lower right abdominal discomfort
13. A patient with cholelithiasis is being prepared for surgery. Which patient assessment represents a
contraindication for a cholecystectomy?
a. Low-grade fever of 100°F and dehydration
b. Abscess in the right upper quadrant of the abdomen
c. Multiple obstructions in the cystic and common bile duct
d. Activated partial thromboplastin time (aPTT) of 54 seconds

14. The nurse is assessing a client 24 hrs following a cholecystectomy. The nurse notes that the T-tube has
drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is most appropriate?
1. clamp the T-tube
2. irrigate the T-tube
3. document the findings
4. notify the health care provider

ATI Level 2 Exam A

1. A hospice nurse is caring for a preschooler who has a terminal illness. One of the child's parents tells the
nurse that it is too difficult to cope any longer and has decided to move out of the house. Which of the following
responses should the nurse make?
A: "Let's talk about a few ways you have dealt with stress in the past."
B: "I believe that you will regret that decision. Your family needs your support."
C: "I agree that you have to do what is best for your well-being at this time."
D: "I think you should try to put your feelings aside and focus solely on your child."

2. A nurse is teaching a client way to prevent osteoporotic fractures due to osteoporosis. Which of the following
information should the nurse include in the teaching?
A: "Maintain bone health by eating fruits, vegetables, and protein."
B: "Tamsulosin can slow the progression of bone deterioration."
C: "Walk 20 minutes two times a week to manage osteoporosis."
D: "Start to increase vitamin C and magnesium in your diet."

3. A nurse is teaching a client who has hypothyroidism about taking levothyroxine. Which of the following
statements should the nurse make?
A: "You'll need to take this medication once a day at bedtime."
B: "This medication causes adverse effects if the dosage is too high or too low."
C: "Continuing this medication therapy long-term will eventually cure your hypothyroidism."
D: "Potassium supplements can reduce the effectiveness of this medication."

4. A nurse in an emergency department is assessing a preschooler who has severe dehydration as a result of
gastroenteritis and is receiving isotonic IV fluids. Which of the following findings should the nurse identify as an
indication that the treatment is effective?
A: Urine output 0.5 mL/kg/hr
B: Capillary refill 3 seconds
C: Heart rate 148/min
D: Brisk skin turgor

5. A nurse is caring for a client who has left hemiparesis following a stroke. Which of the following actions
should the nurse take?
A: Use a gait belt and stand on the client's right side to assist with ambulation.
B: Encourage the client to use wide-grip utensils when eating with the right hand.
C: Place personal items on the bedside table close to the bed on the client's left side.
D: Remove rolled toilet paper from the holder for easier access for the client

6. A nurse is teaching about herbal supplements with a group of newly licensed nurses. Which of the following
herbal supplements should the nurse include in the teaching for treating hyperlipidemia?
A: Feverfew
B: Gingko
C: Valerian
D: Garlic

7. A nurse is admitting a client who has an acute bacterial wound infection and a temperature of 39.8° C
(103.6° F). Which of the following actions should the nurse take?
A: Obtain a wound culture 30 min after initiating IV antibiotics.
B: Place a fan on the lowest setting in the client's room.
C: Apply a cooling blanket directly on the client's skin.
D: Set the temperature of the client's room to 22.2° C (72° F).
8. A nurse is assessing a client who is 1 hour postoperative following a transurethral resection of the prostate
(TURP) for treatment of benign prostatic hyperplasia. For which of the following assessment findings should
the nurse notify the provider?
A: Urine color is light pink.
B: The suprapubic area is soft to palpation.
C: The catheter tubing has multiple red clots.
D: The bowel sounds are hypoactive

9. A nurse is planning care for a client who had surgery for osteomyelitis from a past musculoskeletal trauma to
the lower leg. Which of the following interventions should the nurse include in the plan of care?
A: Position the affected leg flat when sitting up in bed.
B: Instruct the client to perform weight-bearing activities on the affected leg.
C: Check for paresthesia of the affected leg.
D: Apply heat to the surgical incision area of the affected leg.

10. A nurse is assessing the eyes and ears of a 2-year-old toddler at a well-child visit. Which of the following
findings should the nurse report to the provider?
A: Presence of a transparent cornea
B: Presence of strabismus
C: Pinna moderately extends outward from the skull
D: Walls of peripheral aspect of auditory canal are pink

11. A nurse is teaching a client who has atherosclerosis about self-care. Which of the following instructions
should the nurse include in the teaching?
A: Consume five to seven servings of red meat per week.
B: Limit daily calorie intake from saturated fat to 18%.
C: Increase fiber intake to at least 30 g per day.
D: Exercise 2 days a week for at least 60 min

12. A nurse is assessing a client who has as an ulcer due to peripheral vascular disease. Which of the
following findings should the nurse identify as an indication that the client has a venous ulcer rather than an
arterial ulcer?
A: Diminished peripheral pulsations in the right lower leg
B: Discoloration and edema of the right ankle
C: Atrophy of the skin and hair loss on the right leg
D: Dependent rubor in the right leg

13. A nurse is providing discharge teaching to a client who is postoperative following a transurethral resection
of the prostate (TURP) for treatment of benign prostatic hyperplasia. Which of the following instructions should
the nurse include in the teaching?
A: "Notify your provider if you notice small pieces of tissue in your urine."
B: "Any urinary incontinence will be permanent."
C: "Expect to see an increase in the amount of semen produced."
D: "Perform Kegel exercises several times throughout the day."

14. A nurse is assessing a client who has left-sided heart failure. Which of the following findings should the
nurse expect? (Select all the apply.)
A: Nocturia
B: Dependent edema
C: Dyspnea
D: Hacking cough
E: Anorexia

15. A nurse is teaching a client who has gastroesophageal reflux disease about ways to prevent reflux. Which
of the following information should the nurse include in the teaching?
A: Drink tomato juice with the breakfast meal.
B: Suck on peppermint when having indigestion.
C: Elevate the head of the bed 10 cm (4 in) using wooden blocks.
D: Plan to finish eating at least 3 hr before bedtime.

16. A nurse is providing teaching for a client who has a new diagnosis of benign prostatic hyperplasia (BPH).
Which of the following instructions should the nurse include to promote elimination?
A: "Drink at least 24 ounces of water each hour."
B: "Void as soon as you feel the urge."
C: "Expect a prescription for a diuretic."
D: "Take an antihistamine each night at bedtime."
17. A nurse is assessing for manifestations of hyponatremia in a client who has been taking twice the
prescribed dose of a diuretic. Which of the following findings should the nurse expect?
A: Increased deep tendon reflexes
B: Hypoactive bowel sounds
C: Decreased level of consciousness
D: Bradycardia

18. A nurse is teaching a client who has asthma how to use a peak flow meter. Which of the following
statements should the nurse identify as an indication the client understands the teaching?
A: "I will blow out as hard as I can before I use the peak flow meter."
B: "I will not take my controller medication if my peak flow meter scores in the yellow zone."
C: "I will base my peak flow meter score on the best of three attempts."
D: "I will go to the emergency room if my peak flow meter is in the green zone."

19. A nurse is assessing a school-age child who has diabetes mellitus and a blood glucose level of 250 mg/dL.
Which of the following findings should the nurse expect?
A: Hyperreflexia
B: Fruity breath odor
C: Sweating
D: Shallow respirations

20. A nurse is assessing a 1-hour-old newborn who has hypothermia, with a temperature of 36.1° C (97° F).
Which of the following manifestations should the nurse expect?
A: Hypoglycemia
B: Flushed skin
C: Tachycardia
D: Hypertonicity

21. A nurse is teaching a client who has type 1 diabetes mellitus about actions to take when having
manifestations of hypoglycemia with a glucometer reading between 40 and 60 mg/dL. Which of the following
instructions should the nurse include?
A: Self-administer 1 mg of glucagon subcutaneously.
B: Self-administer 20 units of regular insulin.
C: Drink 120 mL (4 oz) of skim milk.
D: Drink 120 mL (4 oz) of fruit juice.

22. A nurse is leading a small group discussion in an acute care mental health facility when one client suddenly
begins to experience a panic attack. Which of the following actions should the nurse take?
A: Teach the client how to use breathing techniques while continuing the discussion.
B: Remain with the client until manifestations subside.
C: Speak in a high-pitched louder voice to gain the client's attention.
D: Instruct the client to join another group who is practicing yoga

23. A nurse in an emergency department is caring for a client who has heat stroke. Which of the following
actions should the nurse take to treat this form of hyperthermia?
A: Apply ice packs to the client's axillae, neck, groin, and chest.
B: Administer aspirin to the client
C: Initially offer the client cool, oral fluids.
D: Continue cooling measures until the client's rectal temperature is 37.2º C (99º F).

24. A nurse in a provider's office is completing a preoperative screening for a client who is scheduled for a
knee arthroplasty later that week. Which of the following findings requires the nurse's intervention? (Click on
the exhibit button for additional information about the client. There are three tabs that contain separate
categories of data.)
Exhibit 1: Graphic record
Oral temperature 36.9° C (98.4° F)
Pulse rate 78/min
Respiratory rate 17/min
BP 134/86 mm Hg
Oxygen saturation 95%
Exhibit 2: Diagnostic results
Hgb 15.1 g/dL
Hct 42.4%
Fasting glucose 106 mg/dL
Potassium 4.5 mEq/L
International normalized ratio (INR) 4.2
Exhibit 3: Medication administration record
Enalapril 2.5 mg PO daily
Atorvastatin 10 mg PO daily
Hydrocodone 5 mg/acetaminophen 325 mg PO q 6 hr PRN for joint pain
A: Oxygen saturation
B: Potassium level
C: ACE inhibitor therapy
D: Coagulation time

25. A nurse is planning care for a client who has pneumonia. Which of the following interventions should the
nurse include in the plan?
A: Direct the client to perform incentive spirometry every 2 hr.
B: Titrate oxygen to maintain the client's oxygen saturation level at 90%.
C: Teach the client how to cough up secretions.
D: Maintain the client in a low-Fowler's position

26. A nurse is reviewing the urinalysis results of a client who has completed a 14-day course of ciprofloxacin to
treat pyelonephritis. WHich of the following values should indicate to the nurse that the client has a continuing
infection?
A: Negative nitrites
B: RBCs < 2
C: Positive leukocyte esterase
D: Amber-colored urine

27. A nurse is reviewing the medical record of a client who has a peptic ulcer. Which of the following findings is
a priority to report to the provider?
A: Melena stools
B: Hemoglobin 7.6 mg/dL
C: Weight gain of 1.4 kg (3 lb) in 2 weeks
D: Dyspepsia during the day

28. A nurse is caring for a client who has a fear of open spaces. WHich of the following clinical names for this
fear should the nurse document in the client's medical record?
A: Pyrophobia
B; Agoraphobia
C: Monophobia
D: Astraphobia

29. A nurse on a pediatric unit is admitting a school-age child who has pertussis. Which of the following actions
should the nurse take?
A: Place the child in a room equipped with a positive-pressure airflow system.
B: Place the child in a room equipped with a negative-pressure airflow system.
C: Initiate droplet precautions for the child.
D: Initiate contact precautions for the child.

30. A nurse is teaching a client who has tuberculosis about taking rifampin. Which of the following instructions
should the nurse include?
A: "Expect this medication to give your urine a greenish tinge."
B: "Do not drink alcohol while taking this medication."
C: "Take this medication with food."
D: "Take a stool softener for the duration of therapy with this medication."

31. A nurse is caring for a client who has Cushing's disease. The nurse should identify that the client is at risk
for which of the following acid-base imbalances?
A: Metabolic acidosis
B: Metabolic alkalosis
C: Respiratory acidosis
D: Respiratory alkalosis

32. A nurse is planning care for a client who has chemotherapy-induced anemia and is starting epoetin. Which
of the following interventions should the nurse include in the plan?
A: Shake the medication vial prior to drawing up the medication.
B: Withhold epoetin if hemoglobin is less than 9 g/dL.
C: Initiate contact isolation.
D: Monitor for hypertension.

33. A nurse is assessing a client for manifestations of grief after having a colostomy for removal of colon
cancer. Which of the following findings indicates to the nurse that the client has accepted the loss?
A: Becomes angry when it is time to perform colostomy care
B: Touches the colostomy stoma when the bag is changed
C: Looks away as the nurse empties the colostomy bag
D: Tells others that it will be nice to have a normal bowel movement again

34. A nurse is caring for a client who has respiratory depression following opioid administration to control
cancer-related pain. The client's ABG results are ph 7.28, PaCO2 49 mm Hg, and HCO3 24 mEq/L. Based on
these findings, the nurse should identify that the client has which of the following acid-base imbalances?
A: Metabolic acidosis
B: Metabolic alkalosis
C: Respiratory acidosis
D: Respiratory alkalosis

35. A nurse is teaching a female adult client who is obese about disease management. Which of the following
information should the nurse include in the teaching?
A: Average body fat for women is 15%.
B: Obesity can cause osteoporosis.
C: Morbid obesity is measured as a BMI over 40.
D: Coronary artery disease increases with a waist size of 81.28 cm (32 in).

36. A nurse is assessing a client who is 1 day postoperative following open ileostomy placement to treat an
inflammatory bowel disorder. Which of the following findings is the priority for the nurse to report to the
provider?
A: The stool is a dark green liquid with a small amount of blood.
B: The ileostomy output is 1,000 mL for the past 24 hr.
C: The stoma is purple in color.
D: The output from the NG tube has decreased over the past 24 hr

37. A community health nurse is teaching a group of older adult clients about interventions to prevent
pneumonia. Which of the following instructions should the nurse include in the teaching?
A: "Obtain a pneumococcal vaccination every 2 years."
B: "Contact your provider if you have a fever that lasts 18 hours."
C: "Wash your hands when you return home from running errands."
D: "Avoid exposure to cold air by shopping inside enclosed malls."

38. A nurse is providing discharge teaching for a client who has a hearing impairment. Which of the following
actions should the nurse take?
A: Encourage the client to repeat what the nurse has said.
B: Stand to the side of the client and speak directly into the client's ear.
C: Talk to the client by speaking in a loud tone of voice.
D: Avoid the use of hand gestures and motions when speaking with the client.

39. A nurse is providing postoperative education for a client following a laparoscopic cholecystectomy for
cholelithiasis. Which of the following client statements indicates an understanding of the teaching?
A: "The adhesive bandages on my incision will fall off as the incision heals."
B: "I will be able to take a shower in 1 week."
C: "I will need to follow a liquid diet for the first 3 days after surgery."
D: "I can begin to resume my normal activity level in 2 weeks."

40. A school nurse is assessing a school-age child who has erythema infectiosum (fifth disease). Which of the
following manifestations should the nurse expect?
A: Otitis media
B: Parotitis
C: Facial eruption
D: Lymphadenopathy

41. A nurse is planning care for a client who has renal calculi. WHich of the following interventions should the
nurse include to promote elimination of the calculi?
A: Maintain bedrest until calculi are expelled.
B: Withhold thiazide diuretics.
C: Encourage intake of at least 3 L of fluid each day.
D: Collect all urine for 24 hr in a collection container

42. A nurse is caring for a client who has generalized anxiety disorder and is experiencing a mild level of
anxiety. Which of the following manifestations should the nurse expect?
A: Chest pain
B: Hallucinations
C: Feels unreal
D: Follows directions
43. A nurse on a mental health unit is developing a plan of care for a client who is experiencing a panic level of
anxiety. Which of the following actions should the nurse identify as a priority?A: Reduce environmental
stimulation.
B: Protect the client from harm.
C: Administer an anxiolytic.
D: Encourage physical exercise.

44. A nurse is providing home care instructions to a client who had a short-arm plaster cast applied for a wrist
fracture. Which of the following instructions should the nurse include?
A: Apply heat for the first 48 hr.
B: Wear a sling when resting in bed.
C: Elevate the wrist above heart level.
D: Use a soft-bristle toothbrush to relieve itching under the cast.

45. A nurse is caring for a middle adult female client who has atrial fibrillation and is taking warfarin. The nurse
should recognize which of the following as an adverse effect of the medication and notify the provider?
A: Clay-colored stools
B: Increased menstrual flow
C: Overgrowth of gingival tissue
D: Dry, non-productive cough