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NURS 327 FINAL EXAM QUESTIONS & DETAILED
ANSWERS WITH RATIONALES (WELL VERIFIED) GRADED
A+
A client with gallstones tells the nurse, "The doctor has to do something. Isn't there something he can give me to dissolve them?" What medication does the nurse know may help dissolve the gallstones? - CORRECT ANSWER >>> Chenodiol A client has developed drug-induced hepatitis from a drug reaction to antidepressants. What treatment does the nurse anticipate the client will receive to treat the reaction? - CORRECT ANSWER >>> High-dose corticosteroids A client is seeing the physician for a suspected tumor of the liver. What laboratory study results would indicate that the client may have a primary malignant liver tumor? **- CORRECT ANSWER
** Elevated alpha-fetoprotein A client with advanced cirrhosis has a prothrombin time (PT) of 15 seconds, compared with a control time of 11 seconds. The nurse expects to administer: **- CORRECT ANSWER ** phytonadione (Mephyton). The nurse is caring for a client with hepatitis. Which of the following would lead the nurse to suspect that the client is in the prodromal phase? - CORRECT ANSWER >>> rash A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered? **- CORRECT ANSWER ** Tacrolimus
nurse is taking health history data from a client. Use of which of the following medications would especially alert the nurse to an increased risk of hepatic dysfunction and disease in this client? Select all that apply. - CORRECT ANSWER >>> Acetaminophen Ketoconazole Valproic acid A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client? - CORRECT ANSWER >>> Octreotide Which of the following liver function studies is used to show the size of abdominal organs and the presence of masses? - CORRECT ANSWER >>> Ultrasonography A nurse assesses a patient diagnosed with hepatic encephalopathy. She observes a number of clinical signs, including asterixis and fetor hepaticus; the patient's electroencephalogram (EEG) is abnormal. The nurse documents that the patient is exhibiting signs of which stage of hepatic encephalopathy? - CORRECT ANSWER >>> stage 2 A nurse is responsible for monitoring the diet of a client with hepatic encephalopathy. Which daily protein intake should this 185-pound (84-kilogram) male consume? **- CORRECT ANSWER
** 100 to 126 grams Which position should be used for a client undergoing a paracentesis? **- CORRECT ANSWER ** supine Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? - CORRECT ANSWER >>> vasopressin nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply.
intervention takes priority for this client? - CORRECT ANSWER >>> Administering morphine I.V. as ordered The nurse knows that the serum amylase concentration returns to normal within which time frame? - CORRECT ANSWER >>> 48 hours This example of cholesterol gallstones (left side of picture) is the result of decreased bile acid synthesis and increased cholesterol synthesis in the liver, which in turn, form stones. Cholesterol stones account for what percentage of cases of gallbladder disease in the United States? - CORRECT ANSWER >>> 75 % The patient admitted with acute pancreatitis has passed the acute stage and is now able to tolerate solid foods. What type of diet will increase caloric intake without stimulating pancreatic enzymes beyond the ability of the pancreas to respond? **- CORRECT ANSWER
** Highcarbohydrate, low-protein, low-fat diet The nurse cares for a client with cholecystitis with severe biliary colic symptoms. Which nursing intervention best promotes adequate respirations in a client with these symptoms? - CORRECT ANSWER >>> place the client in semi fowlers position A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? - CORRECT ANSWER >>> relieving abdominal pain A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate? - CORRECT ANSWER >>> Reserving an antecubital site for a peripherally inserted central catheter (PICC) Which term most precisely refers to the incision of the common bile duct for removal of stones?
- CORRECT ANSWER >>> Choledocholithotomy
The nurse knows that the client with cholelithiasis can have a nutritional deficiency. The obstruction of bile flow due to cholelithiasis can interfere with the absorption of - CORRECT ANSWER >>> vitamin A The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of: - CORRECT ANSWER >>> serum lipase A nurse is preparing a client for endoscopic retrograde cholangiopancreatography (ERCP). The client asks what this test is used for. Which statements by the nurse explains how ERCP can determine the difference between pancreatitis and other biliary disorders? Select all that apply.
- CORRECT ANSWER >>> "It can evaluate the presence and location of ductal stones and aid in stone removal." "It can assess the anatomy of the pancreas and the pancreatic and biliary ducts." "It can detect unhealthy tissues in the pancreas and assess for abscesses and pseudocysts." A patient is admitted to the hospital with possible cholelithiasis. What diagnostic test of choice will the nurse prepare the patient for? - CORRECT ANSWER >>> ultrasonography A patient is suspected to have pancreatic carcinoma and is having diagnostic testing to determine insulin deficiency. What would the nurse determine is an indicator for insulin deficiency in this patient? (Select all that apply). - CORRECT ANSWER >>> An abnormal glucose tolerance Glucosuria Hyperglycemia A nurse cares for a client who is post op cholecystectomy due to the development of cholesterol stones. The client asks the nurse, "Why did I develop these stones?" What is the nurse's best response? - CORRECT ANSWER >>> "The stones formed from a component in the bile and are caused by bile acid and fat abnormalities in the bloodstream."
The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? - CORRECT ANSWER >>> 10 - 15 min A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? - CORRECT ANSWER >>> "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin- R taken at 6:30 AM will reach peak effectiveness by: - CORRECT ANSWER >>> 8:30 am Which type of insulin acts most quickly? - CORRECT ANSWER >>> lispro Which information should be included in the teaching plan for a client receiving glargine, which is "peakless" basal insulin? - CORRECT ANSWER >>> do not mix with other insulins The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan? - CORRECT ANSWER >>> When mixing insulin, the regular insulin is drawn up into the syringe first. Which of the following insulins are used for basal dosage? - CORRECT ANSWER >>> Glargine (Lantus) A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? - CORRECT ANSWER >>> The shortacting insulin is withdrawn before the intermediate-acting insulin.
A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction? - CORRECT ANSWER >>> This insulin has no peak action and does not cause a hypoglycemic reaction. A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time? - CORRECT ANSWER >>> 7:45 AM A nurse is preparing the daily care plan for a client with newly diagnosed diabetes mellitus. The priority nursing concern for this client should be: - CORRECT ANSWER >>> providing client education at every opportunity Which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin? - CORRECT ANSWER >>> Sulfonylureas Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain? - CORRECT ANSWER >>> 70% NPH insulin and 30% regular insulin Which of the following medications is considered a glitazone? - CORRECT ANSWER >>> actos What is the duration of regular insulin? - CORRECT ANSWER >>> 4 to 6 hours Which of the following endocrine disorder causes the patient to have dilutional hyponatremia? - CORRECT ANSWER >>> Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Although not designated as endocrine glands, several organs within the body secrete hormones as part of their normal function. Which organ secretes hormones involved in increasing blood pressure and volume and maturation of red blood cells? - CORRECT ANSWER >>> kidneys
A physician has ordered a liver biopsy for a client with cirrhosis whose condition has recently deteriorated. The nurse reviews the client's recent laboratory findings and recognizes that the client is at risk for complications due to: - CORRECT ANSWER >>> low platelet count The nurse is teaching a client who was admitted to the hospital with acute hepatic encephalopathy and ascites about an appropriate diet. The nurse determines that the teaching
has been effective when the client chooses which food choice from the menu? - CORRECT ANSWER >>> Pancakes with butter and honey, and orange juice Which position should be used for a client undergoing a paracentesis? **- CORRECT ANSWER
** supine A client with hepatitis C develops liver failure and GI hemorrhage. The blood products that most likely bring about hemostasis in the client are - CORRECT ANSWER >>> cryoprecipitate and fresh frozen plasma. A client has ascites. Which of the following interventions would the nurse prepare to assist with implementing to help the client control this condition? Select all that apply. **- CORRECT ANSWER ** Instructing the client to remove salty and salted foods from the diet Administering prescribed spironolactone (Aldactone) Assisting with placement of a transjugular intrahepatic portosystemic shunt ** kidneys A physician has ordered a liver biopsy for a client with cirrhosis whose condition has recently deteriorated. The nurse reviews the client's recent laboratory findings and recognizes that the client is at risk for complications due to: - CORRECT ANSWER >>> low platelet count The nurse is teaching a client who was admitted to the hospital with acute hepatic encephalopathy and ascites about an appropriate diet. The nurse determines that the teaching has been effective when the client chooses which food choice from the menu? - CORRECT ANSWER >>> Pancakes with butter and honey, and orange juice Which position should be used for a client undergoing a paracentesis? - CORRECT ANSWER >>> supine A client with hepatitis C develops liver failure and GI hemorrhage. The blood products that most likely bring about hemostasis in the client are - CORRECT ANSWER >>> cryoprecipitate and fresh frozen plasma. A client has ascites. Which of the following interventions would the nurse prepare to assist with implementing to help the client control this condition? Select all that apply. - CORRECT ANSWER >>> Instructing the client to remove salty and salted foods from the diet Administering prescribed spironolactone (Aldactone) Assisting with placement of a transjugular intrahepatic portosystemic shunt A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should the nurse administer to the client before surgery? **- CORRECT ANSWER ** packed red blood cells Which intervention should be included in the plan of care for a client who has undergone a cholecystectomy? - CORRECT ANSWER >>> assessing the color of the sclera every shift Management of a patient with ascites includes nutritional modifications and diuretic therapy. Which of the following interventions would a nurse expect to be part of patient care? Select all that apply. - CORRECT ANSWER >>> Aldactone, an aldosterone-blocking agent would be used. Daily salt intake would be restricted to 2 grams or less. The diuretic will be held if the serum sodium level decreases to <134 m Eq/L.
A nurse is caring for a client in the emergency department who is reporting severe abdominal pain. The client is diagnosed with acute pancreatitis. Which laboratory value indicates further investigation? - CORRECT ANSWER >>> elevated troponin Which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels - CORRECT ANSWER >>> Frequent vomiting, leading to loss of fluid volume A client admitted with severe epigastric abdominal pain radiating to the back is vomiting and reports difficulty breathing. Upon assessment, the nurse determines that the client is experiencing tachycardia and hypotension. Which actions are priority interventions for this client? Select all that apply. - CORRECT ANSWER >>> Administer pain-relieving medication Administer electrolytes Administer plasma Assist the client to a semi-Fowler position What is a major concern for the nurse when caring for a patient with chronic pancreatitis? - CORRECT ANSWER >>> weight loss A nurse cares for an older adult client and teaches the client about age-related changes of the biliary tract. What statements will the nurse include when discussing age-related changes that occur in the pancreas of the older adult? Select all that apply. - CORRECT ANSWER >>> "The pancreas develops fibrous material with age." "The pancreas develops fatty deposits with age." "The pancreas decreases secretion of enzymes with age." "The pancreas decreases bicarbonate secretion with age."
A nurse discusses risk factors of cholelithiasis with a client. Which risk factors will the nurse include in the teaching? Select all that apply. - CORRECT ANSWER >>> Changes in weight Cystic fibrosis Diabetes Obesity A client is instructed to follow a low-fat diet after an inflammatory attack of the gallbladder. Which vitamins will the nurse recommend the client supplement due to the client's dietary restrictions? Select all that apply. - CORRECT ANSWER >>> A D K Essential fatty acids What concepts does the nurse understand about gerontologic considerations related to acute pancreatitis? Select all that apply. - CORRECT ANSWER >>> As the client ages, there is an increased mortality rate for acute pancreatitis. As the client ages, there is an increased risk for the development of multiple organ dysfunction syndrome. As the client ages, the pattern of complications related to acute pancreatitis changes A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: **- CORRECT ANSWER
** deficient knowledge
A client with type 1 diabetes mellitus is being taught about self-injection of insulin. Which fact about site rotation should the nurse include in the teaching? - CORRECT ANSWER >>> use all available injection sites in one area A client with type 1 diabetes is experiencing polyphagia. The nurse knows to assess for which additional clinical manifestation(s) associated with this classic symptom? **- CORRECT ANSWER
** muscle wasting and tissue loss A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate? - CORRECT ANSWER >>> Below-normal serum potassium level A patient with diabetic ketoacidosis (DKA) has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for - CORRECT ANSWER >>> Hypokalemia Which medication is the treatment of choice for pregnant women diagnosed with hyperthyroidism? - CORRECT ANSWER >>> PTU Vision and visual fields are altered in disorders of which of the following endocrine glands? - CORRECT ANSWER >>> pituitary The typical triad of manifestations seen in a client diagnosed with pheochromocytoma does not include which of the following? - CORRECT ANSWER >>> hypotension A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most
** use all available injection sites in one area A client with type 1 diabetes is experiencing polyphagia. The nurse knows to assess for which additional clinical manifestation(s) associated with this classic symptom? - CORRECT ANSWER >>> muscle wasting and tissue loss A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate? - CORRECT ANSWER >>> Below-normal serum potassium level A patient with diabetic ketoacidosis (DKA) has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for - CORRECT ANSWER >>> Hypokalemia Which medication is the treatment of choice for pregnant women diagnosed with hyperthyroidism? - CORRECT ANSWER >>> PTU Vision and visual fields are altered in disorders of which of the following endocrine glands? - CORRECT ANSWER >>> pituitary The typical triad of manifestations seen in a client diagnosed with pheochromocytoma does not include which of the following? - CORRECT ANSWER >>> hypotension A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by: - CORRECT ANSWER >>> a corticotropin-secreting pituitary adenoma.
A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland? - CORRECT ANSWER >>> Adrenal cortex The nurse is administering a medication to a client with hyperthyroidism to block the production of thyroid hormone. The client is not a candidate for surgical intervention at this time. What medication should the nurse administer to the client? - CORRECT ANSWER >>> Propylthiouracil A nurse is assigning beds to four new clients being admitted to the cardiac telemetry floor. Which client should she assign to the bed at the end of the hall, away from the nurses' station? - CORRECT ANSWER >>> A 24-year-old client with unstable hyperthyroidism with sinus tachycardia The nurse is caring for a client who has an excess amount of potassium being excreted and has a serum level of 6.2 mEq/L. What group of adrenal hormones is likely to be impacting the laboratory result? - CORRECT ANSWER >>> mineralcorticoids client with a traumatic brain injury is producing an abnormally large volume of dilute urine. Which alteration to a hormone secreted by the posterior pituitary would the nurse expect to find? - CORRECT ANSWER >>> deficient production of vasopressin A client with hyperthyroidism is concerned about changes in appearance. How can the nurse convey an understanding of the client's concern and promote effective coping strategies? - CORRECT ANSWER >>> Reassure the client that their emotional reactions are a result of the disorder and symptoms can be controlled with effective treatment. A pheochromocytoma is a rare adrenal tumor that causes increased heart rate, blood pressure, and metabolism because of increased levels of circulating: **- CORRECT ANSWER
** Catecholamines.
A nurse assesses a patient diagnosed with hepatic encephalopathy. She observes a number of clinical signs, including asterixis and fetor hepaticus; the patient's electroencephalogram (EEG) is abnormal. The nurse documents that the patient is exhibiting signs of which stage of hepatic encephalopathy? - CORRECT ANSWER >>> stage 2 A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered? **- CORRECT ANSWER
** Tacrolimus
A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply. - CORRECT ANSWER >>> Enlarged liver size Ascites Hemorrhoids Most of the liver's metabolic functions are performed by: - CORRECT ANSWER >>> parenchymal cells. What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention? - CORRECT ANSWER >>> Albumin infusion A nurse practitioner treating a patient who is diagnosed with hepatitis A should provide health care information. Which of the following statements are correct for this disorder? Select all that apply. - CORRECT ANSWER >>> There is a 70% chance that jaundice will occur. Transmission of the virus is possible with oral-anal contact during sex. Typically there is a spontaneous recovery.
Which of the following the are early manifestations of liver cancer? Select all that apply. - CORRECT ANSWER >>> Pain Continuous aching in the back A nurse cares for an older adult client and teaches the client about age-related changes of the biliary tract. What statements will the nurse include when discussing age-related changes that occur in the pancreas of the older adult? Select all that apply. - CORRECT ANSWER >>> "The pancreas develops fibrous material with age." "The pancreas develops fatty deposits with age." "The pancreas decreases secretion of enzymes with age." "The pancreas decreases bicarbonate secretion with age." A client is instructed to follow a low-fat diet after an inflammatory attack of the gallbladder. Which vitamins will the nurse recommend the client supplement due to the client's dietary restrictions? - CORRECT ANSWER >>> A D K Essential fatty acids When caring for a client with acute pancreatitis, the nurse should use which comfort measure? - CORRECT ANSWER >>> Positioning the client on the side with the knees flexed A client with diabetes mellitus is prescribed to switch from animal to synthesized human insulin. Which factor should the nurse monitor when caring for the client? - CORRECT ANSWER >>> Low blood glucose concentration A nurse educator has been invited to a local senior center to discuss health-maintaining strategies for older adults. During a session on nutrition, the nurse discusses diabetes mellitus,
