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- Hepatitis A
- Hepatitis B
- Hepatitis C
- Hepatitis D
being in the military.
traveling to a foreign country.
drinking excessive alcohol.
eating bad food.
administering intravenous (IV) neomycin.
giving vitamin K.
Daniels
Chapter 51 Hepatic, Biliary Tract, and Pancreatic Dysfunction: Nursing Management
MULTIPLE CHOICE
1.A child care worker complains of flu-like symptoms. On further assessment, hepatitis is
suspected. The nurse realizes that this individual is at risk for which type of hepatitis?
ANS: 1
Hepatitis A virus (HAV) is spread through the fecal-oral route. Child care workers are at greater risk
because of potentially poor hygiene practices. Child care workers are not at the same risk for
contracting hepatitis B, C, or D.
2.An older male is diagnosed with cirrhosis of the liver. The nurse knows that the most likely cause
of this problem is:
ANS: 3
The destruction to the liver from alcohol often progresses from fatty liver to alcoholic hepatitis and
culminates in alcoholic cirrhosis. Alcoholic cirrhosis accounts for a great number of individuals
diagnosed with this disease. Cirrhosis is not associated with being in the military, traveling to a
foreign country, or eating bad food.
3.When the liver is seriously damaged, ammonia levels can rise in the body. One of the treatments
for this is:
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- infection.
- bleeding.
- pain.
- nausea and vomiting.
- spleen.
- gallbladder.
- liver.
- stomach.
ANS: 3
Lactulose is a laxative that works by pulling water into the stool. It also helps pull ammonia from the
blood into the colon for expulsion. IV antibiotics do not reduce serum ammonia levels. Vitamin K
controls bleeding, but it does not reduce ammonia levels. Insulin is not used to reduce ammonia
levels.
4.A client is scheduled for a liver biopsy. The nurse realizes that the most important sign to assess
for is:
ANS: 2
After a liver biopsy, the client is monitored for bleeding or hemorrhage. Infection and pain are of
concern, but they are not the most important signs to be monitored. Nausea and vomiting are not
typically associated with a liver biopsy.
5.The nurse realizes that the organ which is a major site for metastases, harboring and
growing cancerous cells that originated in some other part of the body, is the:
ANS: 3
In most developed countries, this secondary type of liver cancer is more common than cancer that
originates in the liver itself. The spleen, gallbladder, and stomach are not major sites for metastases.
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- giving lactulose.
- starting the patient on insulin.
1 It doesnt affect people until they are in their 50s.
2 I would ask the doctor if hes sure about the diagnosis.
3 Females often do not experience the effects of the disease until menopause.
4 All women have the disorder but not the symptoms.
Hyperkalemia
Hypercalcemia
Hypernatremia
ANS: 1
In the preicteric phase of hepatitis, some smokers will have an aversion to smoking as a first sign
of the disease. Smoking is not affected with the icteric or posticteric phases of the disease.
Recovery is not a phase of hepatitis.
9.A female client is surprised to learn that she has been diagnosed with hemochromatosis. Which
of the following should the nurse respond to this client?
ANS: 3
Women do not experience the effects of hemochromatosis until menopause when the regular loss of
blood stops. This disorder is a genetic disorder and can affect individuals of all ages. The nurse
should not doubt the physicians diagnosis. All women do not have this disorder.
- A client is diagnosed with liver disease. Which of the following is one impact of this disorder on
a clients fluid and electrolyte status?
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3 Posticteric
4 Recovery
1 Myocardial infarction
2 Pulmonary emboli
3 Pulmonary edema
4 Decreased peripheral
. pulses
Expect to develop jaundice.
Avoid all alcohol.
Increase exercise.
Treatment includes antibiotic therapy.
4 Hyponatremia
ANS: 4
Liver disease effects the fluid and electrolyte status by causing ascites, edema, hypokalemia,
hypocalcemia, and hyponatremia. Liver disease does not cause hyperkalemia, hypercalcemia, or
hypernatremia.
- The nurse, caring for a client recovering from the placement of a shunt to treat portal
hypertension, should assess the client for which of the following complications associated with
this surgery?
ANS: 3
Complications after shunt surgery include the development of pulmonary edema. Myocardial
infarction, pulmonary emboli, and decreased peripheral pulses are not complications associated with
this type of surgery.
- A client is diagnosed with macrovesicular fatty liver. Which of the following should the
nurse instruct this client?
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1 Jaundice
2 Dyspepsia
3 Icterus
4 Sclerosis
5 Kernicteru
s
6 Cirrhosis
- Avoid liver.
- Avoid shellfish.
- Eat soy products.
ANS: 1, 2, 3, 4, 5
Potential complications of an ERCP are perforated stomach and duodenum, pancreatitis, anaphylactic
reaction to the contrast diet, aspiration of gastric contents, and reaction to anesthesia. A perforated
bladder is a possible complication from a paracentesis.
3.A client is demonstrating yellow pigmentation of the skin and sclera. Which of the following can be
used to describe this clients symptoms? (Select all that apply.)
ANS: 1, 3, 5
Terms used to describe yellow pigmentation of the skin and sclera include jaundice, icterus, and
kernicterus. Dyspepsia, sclerosis, and cirrhosis are not terms used to describe the yellow
pigmentation of the skin and sclera.
4.The nurse is providing dietary instruction to a client diagnosed with Wilsons disease. Which of the
following should be included in these instructions? (Select all that apply.)
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- Perforated bladder
1 Esophageal varices
2 Splenomegaly
- Use avocados in salads.
- Avoid nectarines.
- Avoid mushrooms.
- Low vitamin A levels
- Increased bleeding
- Poor digestion of fats
- Insulin resistance
- Elevated levels of vitamin E
- Nerve damage
ANS: 1, 2, 5, 6
Dietary instruction for a client diagnosed with Wilsons disease include reducing the intake of foods
high in copper. This includes avoiding liver, shellfish, soy products, avocado, nectarines, and
mushrooms.
5.A client is diagnosed with a disorder of the liver. The nurse realizes this client might experience
which of the following? (Select all that apply.)
ANS: 1, 2, 3, 4, 6
Effects of a liver disorder on a client are many. Some of the functions affected by this disorder include
low levels of fat soluble vitamins, including A and E; poor synthesis of clotting factors, leading to
increased bleeding; poor digestion of fats; insulin resistance; and nerve damage.
6.A client is diagnosed with portal hypertension. The nurse should assess the client for which of the
following disorders associated with this diagnosis? (Select all that apply.)
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- Retail store clerk
- Lifeguard
- Computer keyboard operator
- Bus driver
- a rotator cuff tear.
- lateral epicondylitis.
- dislocation of the shoulder.
- patellar tendinopathy.
Chapter 60Musculoskeletal Trauma: Nursing Management
MULTIPLE CHOICE
1.A client tells the nurse that he has pain, swelling, fatigue, and numbness of his hands. The nurse
should assess the client for which of the following occupations?
ANS: 3
Some occupations, sports, and tasks can create repetitive motion injuries or cumulative trauma. A
computer keyboard operator is an occupation with a high incidence of overuse syndrome.
2.A client who plays baseball on the weekends is experiencing an arm injury. The nurse realizes this
client needs to be evaluated for:
ANS: 1
A rotator cuff tear can be caused by extensive overhead movements found in sports and activities
such baseball, softball, tennis, swimming, and volleyball. A dislocation of the shoulder is most
commonly caused by a fall on an outstretched hand and arm. Lateral epicondylitis, or tennis elbow,
is an overuse injury that involves the extensor/supinator muscles that attach to the distal humerus.
Patellar tendinopathy, also known as jumpers knee, is seen in athletes who participate in activities
that require a lot of jumping such as basketball.
3.A client, diagnosed with an ankle sprain, is prescribed ibuprofen to control pain and inflammation.
What instruction should the client receive concerning this medication?
1 Bleeding is not a problem with this medication.
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- It reduces the need for a cast.
- It reduces bleeding, swelling and pain.
- It prevents the need for surgery.
- It immobilizes the muscles and joints. Calling physical therapy for a sling
Checking capillary refill time
Giving pain medication
Starting discharge teaching
ANS: 3
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs should be taken with food to
minimize gastrointestinal irritation. Ibuprofen does not increase photosensitivity; however, bleeding
can be a problem when taking ibuprofen.
4.A client, experiencing a fractured arm, asks the nurse why the splint is being applied. Which of the
following should the nurse respond to this client?
ANS: 2
Splinting of a fractured extremity minimizes bleeding, edema, and pain. Splinting does not reduce the
need for a cast nor prevent the need for surgery. A cast immobilizes the muscles and joints.
5.A client has had a cast applied to immobilize a right ulnar fracture. Which of the following nursing
interventions is most important?
ANS: 2
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2 Take on an empty stomach to maximize its effect.
3 Take with food to minimize gastrointestinal irritation.
4 Wear sunscreen if outside to prevent a burn.
- Exercises
- Corticosteroid injection
- Casting
Avoid hamstring muscle
. exercises.
Stretch before and after exercise.
Wear similar shoes for all
. activities.
Avoid skiing.
Maintain your normal level of activity.
Apply ice to the ankle once a day.
Apply an elastic bandage to the site.
Elevate the extremity every day for 20 to 30 minutes.
ANS: 3
If after 2 to 7 weeks of conservative treatment the carpal tunnel syndrome symptoms do not
improve, corticosteroid injection is recommended. Surgery is not recommended until after
corticosteroid injections have been tried. Exercises are implemented with the use of the splint.
Casting is not a treatment for carpal tunnel syndrome.
9.The nurse is planning care for a client recovering from a meniscal injury. Which of the following
should be included as strategies to avoid future injuries?
ANS: 2
Strategies to prevent future meniscal injuries include having strong thigh and hamstring muscles;
stretching before and after exercise; wearing shoes that fit and are appropriate for the activity; and
when skiing, having bindings that release the skis with a fall.
10.A client with an ankle sprain is instructed to follow RICE. Which of the following should the nurse
instruct the client regarding this process?
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- Avoid overtraining
- Increase intensity of training 10% each day
- Limit warm up exercises
- Avoid shock absorbing footwear
Client states steroid injections will be helpful to reduce the amount of pain.
Client plans to participate in rehabilitation for 5 to 6 months after the injury.
Client resumes sports activities as soon as possible.
Client uses heat to decrease the inflammation and swelling from the injury.
ANS: 3
The nurse should instruct the client to use crutches to allow for the rest of the ankle joint and
relieve pain; apply ice for 20 to 30 minutes 3 to 4 times a day; apply an elastic bandage to the site;
and elevate the ankle for the first 48 hours after the injury.
- The nurse is evaluating the effectiveness of care for a client recovering from an injured
Achilles tendon. Which of the following would indicate that care has been effective?
ANS: 2
Evidence that care has been effective for a client recovering from an injured Achilles tendon would
be that the client plans to participate in rehabilitation for 5 to 6 months after the injury. Steroid
injections are not used for this type of injury. Sports activities should be avoided until the injury has
healed and rehabilitation is completed. Cryotherapy, not heat, is used to decrease the inflammation
and swelling from the injury.
- The nurse is instructing a client on ways to prevent the onset of stress fractures. Which of
the following should be included in these instructions?
ANS: 1
Interventions to prevent the onset of stress fractures include: avoid overtraining; gradually increase
the intensity of workouts by 10% each week; perform adequate warm up exercises; and use shock
absorbing footwear and insoles.
- The nurse suspects a client, recovering from hip replacement surgery, is experiencing an
infection when which of the following is assessed?
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- Cushings syndrome
- Osteomalacia
- Pagets disease
- Heart failure
- Diabetes mellitus
- Chronic obstructive pulmonary disease
- Upper body petechiae
- Cough
- Protein in the urine
- Seizures
- Temperature 102F
- Elevated blood glucose level
ANS: 1, 3, 5, 6
The classical symptoms of the six Ps of compartment syndrome are pain, paresthesia, paresis,
pressure, pallor, and pulselessness. The pink color and paraplegia are not part of the classic Ps.
2.A client is diagnosed with a pathological fracture. For which of the following disease processes
should the nurse assess the client? (Select all that apply.)
ANS: 1, 2, 3
Causes of pathological fractures include Cushings syndrome, osteomalacia, and Pagets disease.
Pathological fractures are not associated with heart failure, diabetes mellitus, or chronic obstructive
pulmonary disease.
3.A client, recovering from a fractured pelvis, begins to have dyspnea and restlessness. The nurse is
concerned that the client is experiencing a fat emboli when which of the following are assessed?
(Select all that apply.)
ANS: 1, 4, 5
Symptoms of fat emboli include hypoxemia, mental status changes, petechiae, seizures, and a body
temperature greater than 101.3F. Cough, protein in the urine, and elevated blood glucose level are not
symptoms of fat emboli.
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- Pain and tenderness of the lower extremity
- Red area on a limb that is warm to the touch
- Unexplained dyspnea
- Chest pain
- Hemoptysis
- Drop in blood pressure
Provide pain medication 30 minutes before stump care.
Wash the stump daily with mild soap and warm water.
Allow the stump to dry open to the air for 10 minutes after washing.
Avoid massaging the stump.
Elevate the stump on a pillow.
Lie prone 10 to 20 minutes every day.
4.The nurse is assessing a client recovering from abdominal surgery for the development of a deep
vein thrombosis. Which of the following would indicate that the client is experiencing this
disorder? (Select all that apply.)
ANS: 1, 2, 3, 4, 5
The client may describe limb pain as aching, cramping, sharp, dull, severe, or mild. Tenderness and
pain of the lower extremity and a red area that is warm to touch are also indications that the
disorder is present. Other signs and symptoms include unexplained dyspnea, chest pain, and
hemoptysis. A drop in blood pressure is not an indication for a deep vein thrombosis.
5.The nurse is planning care for a client recovering from an amputation. Which of the
following should be included in this plan of care? (Select all that apply.)
ANS: 1, 2, 3, 6
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- a tumor.
- tension.
- a migraine.
- cluster
- Aleve
- Aspirin
- Ibuprofen
- Vicodin
- physiological.
- iatrogenic.
- idiopathic.
- psychokinetic.
Chapter 37Degenerative Neurological Dysfunction: Nursing Management
MULTIPLE CHOICE
1.A client is diagnosed with a headache from a secondary cause. The nurse realizes this type of
headache can be caused by:
ANS: 1
Primary headaches are identified when no organic cause can be found. A tumor headache is caused
by a tumor and is classified as a secondary headache.
2.The nurse should instruct a client diagnosed with migraine headaches to be careful not to overdose
on acetaminophen (Tylenol). Which drug should the nurse tell the patient to avoid?
ANS: 4
Vicodin, although a narcotic analgesic, also contains acetaminophen (Tylenol). It is very easy to
overdose on the acetaminophen (Tylenol) component, which can lead to kidney damage. Aleve does
not contain acetaminophen (Tylenol). Aspirin and ibuprofen do not contain acetaminophen (Tylenol).
3.A client is diagnosed with seizures occurring because of hepatic encephalopathy. The nurse realizes
that the cause for this clients seizures would be:
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1 Protect the clients head.
2 Leave the client alone.
3 Give water to the client to avoid dehydration.
4 Place a finger in the clients mouth to avoid swallowing the tongue.
- Prodromal phase
- Aural phase
- Ictal phase
- Postictal phase
ANS: 1
The three major causes for seizures are physiological, iatrogenic, and idiopathic. Physiological
seizures include those that occur with an acquired metabolic disorder such as hepatic
encephalopathy. Iatrogenic causes include new medications or drug or alcohol use. Idiopathic
causes include fevers, fatigue, or strong emotions. Psychokinetic is not a cause for seizures.
4.A client tells the nurse that he sees flashing lights that occur prior to the onset of a seizure. Which of
the following phases of a seizure is this client describing to the nurse?
ANS: 2
In the aural phase a sensation or warning occurs, which the patient often remembers. This warning
can be visual, auditory, gustatory, or visceral in nature. The prodromal phase of a seizure includes
the signs or activity before the seizure such as a headache or feeling depressed. The ictal phase of a
seizure is the actual seizure. The postictal phase is the period immediately following the seizure.
5.A client is experiencing a grand mal seizure. Which of the following should the nurse do during
this seizure?
ANS: 1
One of the most important interventions for a nurse to perform during a seizure is to protect the
clients head from injury. Never give a client a drink during a seizure. Placing a finger in the clients
mouth could be very dangerous to the client and the nurse. Do not leave the client unattended during
a seizure
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