Exam 2 Part 3

1. 1A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that

   1. Apruritus is a common problem with jaundice in this phase.
   2. Bthe patient is most likely to transmit the disease during this phase.
   3. Cgastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B.
   4. Dextrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase.
2. 2A patient with acute hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include instructions to

   1. Aavoid alcohol for the first 3 weeks
   2. Buse a condom during sexual intercourse.
   3. Chave family members get an injection of immunoglobulin.
   4. Dfollow a low-protein, moderate-carbohydrate, moderate-fat diet.
3. 3A patient has been told that she has elevated liver enzymes caused by nonalcoholic fatty liver disease (NAFLD). The nursing teaching plan should include

   1. Ahaving genetic testing done.
   2. Brecommending a heart-healthy diet.
   3. Cthe necessity to reduce weight rapidly.
   4. Davoiding alcohol until liver enzymes return to normal.
4. 4The patient with advanced cirrhosis asks why his abdomen is so swollen. The nurse's response is based on the knowledge that

   1. Aa lack of clotting factors promotes the collection of blood in the abdominal cavity.
   2. Bportal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space.
   3. Cdecreased peristalsis in the GI tract contributes to gas formation and distention of the bowel.
   4. Dbile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid.
5. 5In planning care for a patient with metastatic liver cancer, the nurse should include interventions that

   1. Afocus primarily on symptomatic and comfort measures.
   2. Breassure the patient that chemotherapy offers a good prognosis.
   3. Cpromote the patient's confidence that surgical excision of the tumor will be successful.
   4. Dprovide information necessary for the patient to make decisions regarding liver transplantation.
6. 6Nursing management of the patient with acute pancreatitis includes (select all that apply)

   1. Achecking for signs of hypocalcemia.
   2. Bproviding a diet low in carbohydrates.
   3. Cgiving insulin based on a sliding scale.
   4. Dobserving stools for signs of steatorrhea.
   5. Emonitoring for infection, particularly respiratory tract infection.
7. 7A 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

   1. Acreating a bypass around the obstruction caused by the tumor by joining the gallbladder to the jejunum.
   2. Bresection of the entire pancreas and the distal portion of the stomach, with anastomosis of the common bile duct and the stomach into the duodenum.
   3. Cremoval 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.
   4. Dradical 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. 8The nursing management of the patient with cholecystitis associated with cholelithiasis is based on the knowledge that

   1. Ashock-wave therapy should be tried initially.
   2. Bonce gallstones are removed, they tend not to recur.
   3. Cthe disorder can be successfully treated with oral bile salts that dissolve gallstones.
   4. Dlaparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic.
9. 9Teaching in relation to home management after a laparoscopic cholecystectomy should include

   1. Akeeping the bandages on the puncture sites for 48 hours.
   2. Breporting any bile-colored drainage or pus from any incision.
   3. Cusing over-the-counter antiemetics if nausea and vomiting occur.
   4. Demptying and measuring the contents of the bile bag from the T tube every day.
10. 10The nurse explains to a patient with an episode of acute pancreatitis that the most effective means of relieving pain by suppressing pancreatic secretions is the use of:
    

    1. AAntibiotics
    2. BNPO status
    3. CAntispasmodics
    4. DProton pump inhibitors

11. 11 The patient returned from a 6-week mission trip to Somalia with complaints of nausea, malaise, fatigue, and achy muscles. Which type of hepatitis is this patient most likely to have contracted?

    1. AHepatitis B (HBV)
    2. BHepatitis C (HCV)
    3. CHepatitis D (HDV)
    4. DHepatitis E (HEV)
12. 12Which type of hepatitis is a DNA virus, can be transmitted via exposure to infectious blood or body fluids, is required for HDV to replicate, and increases the risk of the chronic carrier for hepatocellular cancer?

    1. AHepatitis A (HAV)
    2. BHepatitis B (HBV)
    3. CHepatitis C (HCV)
    4. DHepatitis E (HEV)
13. 13Serologic findings in viral hepatitis include both the presence of viral antigens and antibodies produced in response to the viruses. What laboratory result indicates that the nurse is immune to HBV after vaccination?

    1. AAnti-HBcIgG
    2. BSurface antigen HBsAg
    3. CSurface antibody Anti-HBs
    4. DCore antigen Anti-HBcIgM
14. 14The patient asks why the serologic test of HBV DNA quantitation is being done. What is the best rationale for the nurse to explain the test to the patient?

    1. AIndicates ongoing infection with HBV
    2. BIndicates co-infection with HBV and HDV
    3. CIndicates previous infection or immunization to HBV
    4. DIndicates viral replication and effectiveness of therapy for chronic HBV
15. 15Although HAV antigens are not tested in the blood, they stimulate specific immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies. Which antibody indicates there is acute HAV infection?

    1. AAnti-HBc IgG
    2. BAnti-HBc IgM
    3. CAnti-HAV IgG
    4. DAnti-HAV IgM
16. 16What test will be done before prescribing treatment for the patient with positive testing for HCV?
    

    1. AAnti-HCV
    2. BHCV genotyping
    3. CHCV RNA quantitation
    4. DRecombinant immunoblot assay (RIBA)
17. 17What causes the systemic effects of viral hepatitis?

    1. ACholestasis
    2. BImpaired portal circulation
    3. CToxins produced by the infected liver
    4. DActivation of the complement system by antigen-antibody complexes
18. 18During the incubation period of viral hepatitis, what should the nurse expect the patient to report?

    1. APruritus and malaise
    2. BDark urine and easy fatigability
    3. CAnorexia and right upper quadrant discomfort
    4. DConstipation or diarrhea with light-colored stools
19. 19The occurrence of acute liver failure is most common in which situation?

    1. AAn individual with hepatitis A
    2. BAn individual with hepatitis C
    3. CAntihypertensive medication use
    4. DUse of acetaminophen with alcohol abuse
20. 20Following a needle stick, what is used as prophylaxis against HBV?

    1. AInterferon
    2. BHBV vaccine
    3. CHepatitis B immune globulin (HBIG)
    4. DHBV vaccine and HBIG
21. 21 The family members of a patient with hepatitis A ask if there is anything that will prevent them from developing the disease. What is the best response by the nurse?

    1. A“No immunization is available for hepatitis A, nor are you likely to get the disease.”
    2. B“All family members should receive the hepatitis A vaccine to prevent or modify the infection.”
    3. C“Those who have had household or close contact with the patient should receive immune globulin.”
    4. D“Only those individuals who have had sexual contact with the patient should receive immunization.”
22. 22A patient diagnosed with chronic hepatitis B asks about drug therapy to treat the disease. What is the most appropriate response by the nurse?

    1. A“Only chronic hepatitis C is treatable and primarily with antiviral agents and interferon.”
    2. B“There are no specific drug therapies that are effective for treating acute viral hepatitis.”
    3. C“Interferon combined with lamivudine (Epivir) will decrease viral load and prevent complications.”
    4. D“There are no drugs used for the treatment of viral hepatitis because of the risk of additional liver damage.”
23. 23 The nurse identifies a need for further teaching when the patient with hepatitis B makes which statement?

    1. A“I should avoid alcohol completely for as long as a year."
    2. B“I must avoid all physical contact with my family until the jaundice is gone.”
    3. C“I should use a condom to prevent spread of the disease to my sexual partner.”
    4. D“I will need to rest several times a day, gradually increasing my activity as I tolerate it.”
24. 24What is one of the most challenging nursing interventions to promote healing in the patient with viral hepatitis?

    1. AProviding adequate nutritional intake
    2. BPromoting strict bed rest during the icteric phase
    3. CProviding pain relief without using liver-metabolized drugs
    4. DProviding quiet diversional activities during periods of fatigue
25. 25When caring for a patient with autoimmune hepatitis, the nurse understands that what in this patient is different from the patient who has viral hepatitis?

    1. ADoes not manifest hepatomegaly or jaundice
    2. BExperiences less liver inflammation and damage
    3. CIs treated with corticosteroids or other immunosuppressive agents
    4. DIs usually an older adult who has used a wide variety of prescription and over-the-counter drugs
26. 26 The patient is an older woman with cirrhosis who also has anemia. What pathophysiologic changes may contribute to this patient’s anemia (select all that apply)?

    1. AVitamin B deficiencies
    2. BStretching of liver capsule
    3. CVascular congestion of spleen
    4. DDecreased prothrombin production
    5. EDecreased bilirubin conjugation and excretion
27. 27Which manifestations may be seen in the patient with cirrhosis related to esophageal varices?

    1. AJaundice, peripheral edema, and ascites from increased intrahepatic pressure and dysfunction
    2. BLoss of the small bile ducts and cholestasis and cirrhosis in patients with other autoimmune disorders
    3. CDevelopment of collateral channels of circulation in inelastic, fragile esophageal veins as a result of portal hypertension
    4. DScarring and nodular changes in the liver lead to compression of the veins and sinusoids, causing resistance of blood flow through the liver from the portal vein
28. 28Which conditions contribute to the formation of abdominal ascites?

    1. AEsophageal varices contribute to 80% of variceal hemorrhages
    2. BIncreased colloidal oncotic pressure caused by decreased albumin production
    3. CHypoaldosteronism causes increased sodium reabsorption by the renal tubules
    4. DBlood flow through the portal system is obstructed, which causes portal hypertension
29. 29 What laboratory test results should the nurse expect to find in a patient with cirrhosis?

    1. ASerum albumin: 7.0 g/dL
    2. BTotal bilirubin: 3.2 mg/dL
    3. CSerum cholesterol: 260 mg/dL (
    4. DAspartate aminotransferase (AST): 6.0 U/L
30. 30Malnutrition can be a big problem for patients with cirrhosis. Which nursing intervention can help to improve nutrient intake?
    

    1. AOral hygiene before meals and snacks
    2. BProvide all foods the patient likes to eat
    3. CImprove oral intake by feeding the patient
    4. DLimit snack offers to when the patient is hungry
31. 31The patient being treated with diuretics for ascites from cirrhosis must be monitored for (select all that apply)?

    1. AGI bleeding
    2. BHypokalemia
    3. CBody image disturbances
    4. DIncreased clotting tendencies
32. 32What manifestation in the patient does the nurse recognize as an early sign of hepatic encephalopathy?

    1. AManifests asterixis
    2. BBecomes unconscious
    3. CHas increasing oliguria
    4. DIs irritable and lethargic
33. 33 To treat a cirrhotic patient with hepatic encephalopathy, lactulose (Cephulac), rifaximin (Xifaxan), and a proton pump inhibitor are ordered. The patient’s family wants to know why the laxative is ordered. What is the best explanation the nurse can give to the patient’s family?

    1. AIt reduces portal venous pressure.
    2. BIt eliminates blood from the GI tract.
    3. CIt traps ammonia and eliminates it in the feces
    4. DIt decreases bacteria to decrease ammonia formation.
34. 34 The patient has hepatic encephalopathy. What is a priority nursing intervention to keep the patient safe?
    

    1. ATurn the patient every 3 hours.
    2. BEncourage increasing ambulation.
    3. CAssist the patient to the bathroom.
    4. DPrevent constipation to reduce ammonia production.
35. 35A patient with advanced cirrhosis has a nursing diagnosis of imbalanced nutrition: less than body requirements related to anorexia and inadequate food intake. What would be an appropriate midday snack for the patient?

    1. APeanut butter and salt-free crackers
    2. BA fresh tomato sandwich with salt-free butter
    3. CPopcorn with salt-free butter and herbal seasoning
    4. DCanned chicken noodle soup with low-protein bread
36. 36The patient with liver failure has had a liver transplant. What should the nurse teach the patient about care after the transplant?
    

    1. AAlcohol intake is now okay.
    2. BHBIG will be required to prevent rejection.
    3. CElevate the head 30 degrees to improve ventilation when sleeping.
    4. DMonitor closely for infection because of the immunosuppressive medication.
37. 37 During the treatment of the patient with bleeding esophageal varices, what is the most important thing the nurse should do?

    1. APrepare the patient for immediate portal shunting surgery.
    2. BPerform guaiac testing on all stools to detect occult blood
    3. CMaintain the patient’s airway and prevent aspiration of blood.
    4. DMonitor for the cardiac effects of IV vasopressin and nitroglycerin.
38. 38A patient with cirrhosis that is refractory to other treatments for esophageal varices undergoes a portacaval shunt. As a result of this procedure, what should the nurse expect the patient to experience?

    1. AAn improved survival rate
    2. BDecreased serum ammonia levels
    3. CImproved metabolism of nutrients
    4. DImproved hemodynamic function and renal perfusion
39. 39 In discussing long-term management with the patient with alcoholic cirrhosis, what should the nurse advise the patient?
    

    1. AA daily exercise regimen is important to increase the blood flow through the liver.
    2. BCirrhosis can be reversed if the patient follows a regimen of proper rest and nutrition.
    3. CAbstinence from alcohol is the most important factor in improvement of the patient’s condition.
    4. DThe only over-the-counter analgesic that should be used for minor aches and pains is acetaminophen.
40. 40 A patient is hospitalized with metastatic cancer of the liver. The nurse plans care for the patient based on what knowledge?
    

    1. AChemotherapy is highly successful in the treatment of liver cancer.
    2. BThe patient will undergo surgery to remove the involved portions of the liver.
    3. CSupportive care that is appropriate for all patients with severe liver damage is indicated.
    4. DMetastatic cancer of the liver is more responsive to treatment than primary carcinoma of the liver.
41. 41A patient with cirrhosis asks the nurse about the possibility of a liver transplant. What is the best response by the nurse?
    

    1. A“Liver transplants are indicated only in young people with irreversible liver disease.”
    2. B“If you are interested in a transplant, you really should talk to your doctor about it.”
    3. C“Rejection is such a problem in liver transplants that it is seldom attempted in patients with cirrhosis.”
    4. D“Cirrhosis is an indication for transplantation in some cases. Have you talked to your doctor about this?”
42. 42Which complication of acute pancreatitis requires prompt surgical drainage to prevent sepsis?

    1. Atetany
    2. Bpseudocyst
    3. CPleural effusion
    4. DPancreatic abscess
43. 43When assessing a patient with acute pancreatitis, the nurse would expect to find

    1. Ahyperactive bowel sounds.
    2. Bhypertension and tachycardia.
    3. Ca temperature greater than 102°F (38.9°C).
    4. Dsevere midepigastric or left upper quadrant (LUQ) pain.
44. 44 Combined with clinical manifestations, what is the laboratory finding that is most commonly used to diagnose acute pancreatitis?
    

    1. AIncreased serum calcium
    2. BIncreased serum amylase
    3. CIncreased urinary amylase
    4. DDecreased serum glucose
45. 45What treatment measure is used in the management of the patient with acute pancreatitis?

    1. ASurgery to remove the inflamed pancreas
    2. BPancreatic enzyme supplements administered with meals
    3. CNasogastric (NG) suction to prevent gastric contents from entering the duodenum
    4. DEndoscopic pancreatic sphincterotomy using endoscopic retrograde cholangiopancreatography (ERCP)
46. 46A patient with acute pancreatitis has a nursing diagnosis of pain related to distention of the pancreas and peritoneal irritation. In addition to effective use of analgesics, what should the nurse include in this patient’s plan of care?

    1. AProvide diversional activities to distract the patient from the pain.
    2. BProvide small, frequent meals to increase the patient’s tolerance to food.
    3. CPosition the patient on the side with the head of the bed elevated 45 degrees for pain relief.
    4. DAmbulate the patient every 3 to 4 hours to increase circulation and decrease abdominal congestion.
47. 47 The nurse determines that further discharge instruction is needed when the patient with acute pancreatitis makes which statement?

    1. A“I should observe for fat in my stools.”
    2. B“I must not use alcohol to prevent future attacks of pancreatitis.”
    3. C“I shouldn’t eat any salty foods or foods with high amounts of sodium.”
    4. D“I will need to continue to monitor my blood glucose levels until my pancreas is healed.”
48. 48What is the patient with chronic pancreatitis more likely to have than the patient with acute pancreatitis?

    1. AThe need to abstain from alcohol
    2. BExperience acute abdominal pain
    3. CMalabsorption and diabetes mellitus
    4. DRequire a high-carbohydrate, high-protein, low-fat diet
49. 49The nurse is instructing a patient with chronic pancreatitis on measures to prevent further attacks. What information should be provided (select all that apply)?

    1. Aavoid nicotine
    2. Beat bland foods
    3. CObserve stools for steatorrhea.
    4. DEat high-fat, low-protein, high-carbohydrate meals.
    5. ETake prescribed pancreatic enzymes immediately following meals.
50. 50What is a risk factor associated with cancer of the pancreas?

    1. Aalcohol intake
    2. Bcigarette smoking
    3. Cexposure to asbestos
    4. DIncreased dietary intake of spoiled milk products
51. 51Of the following characteristics, identify those that are most commonly associated with cholelithiasis (select all that apply).
    

    1. Aobesity
    2. Bover age 40
    3. Cmultiparous female
    4. Dhistory of excessive alcohol intake
    5. Efamily history of gallbladder disease
    6. FUse of estrogen or oral contraceptives
52. 52Acalculous cholecystitis is diagnosed in an older, critically ill patient. Which factors may be associated with this condition (select all that apply)?
    

    1. Afasting
    2. BHypothyroidism
    3. CParenteral nutrition
    4. DProlonged immobility
    5. EStreptococcus pneumoniae
    6. FAbsence of bile in the intestine
53. 53The patient with suspected gallbladder disease is scheduled for an ultrasound of the gallbladder. What should the nurse explain to the patient about this test?

    1. AIt is noninvasive and is a very reliable method of detecting gallstones.
    2. BIt is used only when other tests cannot be used because of allergy to contrast media.
    3. CIt will outline the gallbladder and the ductal system to enable visualization of stones
    4. DIt is an adjunct to liver function tests to determine whether the gallbladder is inflamed.
54. 54What treatment for acute cholecystitis will prevent further stimulation of the gallbladder?

    1. ANPO w/ NG suction
    2. BIncisional cholecystectomy
    3. CAdministration of antiemetics
    4. DAdministration of anticholinergics
55. 55Following a laparoscopic cholecystectomy, what should the nurse expect to be part of the plan of care?

    1. AReturn to work in 2 to 3 weeks
    2. BBe hospitalized for 3 to 5 days postoperatively
    3. CHave a T-tube placed in the common bile duct to provide bile drainage
    4. DHave up to four small abdominal incisions covered with small dressings
56. 56A patient with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a cholecystectomy. What is the best response by the nurse?

    1. A“A low-fat diet will prevent the development of further gallstones and should be continued.”
    2. B“Yes; because you will not have a gallbladder to store bile, you will not be able to digest fats adequately.”
    3. C“A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile.”
    4. D“Removal of the gallbladder will eliminate the source of your pain associated with fat intake, so you may eat whatever you like.”
57. 57What must the nurse do to care for a T-tube in a patient following a cholecystectomy?

    1. AKeep the tube supported and free of kinks.
    2. BAttach the tube to low, continuous suction.
    3. CClamp the tube when ambulating the patient
    4. DIrrigate the tube with 10-mL sterile saline every 2 to 4 hours.
58. 58 During discharge instructions for a patient following a laparoscopic cholecystectomy, what should the nurse include in the teaching?
    

    1. AKeep the incision areas clean and dry for at least a week
    2. BReport the need to take pain medication for shoulder pain.
    3. CReport any bile-colored or purulent drainage from the incisions
    4. DExpect some postoperative nausea and vomiting for a few days
59. 59The registered nurse determines that the new graduate understands the type(s) of hepatitis that generally develop into a chronic hepatitis infection if the graduate identifies which disease(s)? Select all that apply.

    1. AHepatitis A
    2. BHepatitis B
    3. CHepatitis C
    4. DHepatitis D
    5. EHepatitis E
60. 60A client is diagnosed with hepatitis A. The nurse takes the client’s history. Which employment history is most likely linked to the development of hepatitis A?

    1. AWorks at a plumbing business
    2. BWorks in a hemodialysis unit at a hospital
    3. CWorks as a dishwasher at a local restaurant
    4. DWorks at an occupational arsenic compound business
61. 61A nurse instructs a client with viral hepatitis about the type of diet that should be ingested. Which lunch selected by the client indicates understanding about dietary principles associated with this diagnosis?
    

    1. ATurkey salad, french fries, sherbet
    2. BCottage cheese, mixed fruit salad, milkshake
    3. CSalad, sliced chicken sandwich, gelatin dessert
    4. DCheeseburger, tortilla chips, chocolate pudding
62. 62What will the nurse do to assess a client's response to ongoing serum albumin therapy for cirrhosis of the liver?
    

    1. AMonitor the client's vital signs
    2. BMeasure the client's urine output every half hour
    3. CObtain the client's weight at least once every day
    4. DDetermine the client's urine albumin level each shift.
63. 63A client is admitted to the hospital with Laënnec cirrhosis and chronic pancreatitis. Bile salts (bile acid factor) are prescribed, and the client asks why they are needed. What is the nurse’s best response?
    

    1. A"They stimulate prothrombin production."
    2. B"They aid absorption of fat-soluble vitamins."
    3. C"They promote bilirubin secretion in the urine."
    4. D"They help the common bile duct contract stronger."
64. 64A nurse is providing discharge instructions to a client diagnosed with cirrhosis and varices. Which information should the nurse include in the teaching session? Select all that apply.
    

    1. AAdhering to a low-carbohydrate diet
    2. BAvoiding aspirin and aspirin-containing products
    3. CLimiting alcohol consumption to two drinks weekly
    4. DAvoiding acetaminophen and products containing acetaminophen
    5. EAvoiding coughing, sneezing, and straining to have a bowel movement
65. 65A client with a long history of alcohol abuse is admitted to the hospital with ascites and jaundice. A diagnosis of hepatic cirrhosis is made. Which is a nursing priority?
    

    1. AInstitute fall prevention/safety measures
    2. BMonitor respiratory status
    3. CMeasure abdominal girth daily
    4. DTest stool specimens for blood
66. 66A nurse is caring for a client with hepatic encephalopathy and ascites. Which elements are important to include in this client's diet? Select all that apply.
    

    1. Ahigh fat
    2. BLow sodium
    3. Chigh vitamins
    4. DModerate protein
    5. Elow carbs
67. 67A client with a long history of alcohol abuse develops acute pancreatitis. What should be done to best prevent stimulation of the pancreas?
    

    1. AMaintain the gastric pH at a level less than 3.5.
    2. BEncourage the resumption of activities of daily living
    3. CAdminister the histamine H2-receptor antagonist as prescribed
    4. DEnsure that the nasogastric tube remains in the fundus of the stomach
68. 68Which medication should the nurse question when it is prescribed for a client with acute pancreatitis?
    

    1. ARanitidine
    2. BCimetidine
    3. CMeperidine
    4. DPromethazine
69. 69A client with a history of pancreatitis is scheduled for surgery to excise a pseudocyst of the pancreas. The client asks, "What is a pseudocyst?" Which information should the nurse include in a response to this question?
    

    1. AMalignant growth
    2. BPocket of undigested food particles
    3. CSac filled with pus from necrotic pancreatic tissue
    4. DWalled-off space of pancreatic enzymes and exudate
70. 70A client is admitted with a diagnosis of acute pancreatitis. The medical and nursing measures for this client are aimed toward maintaining nutrition, promoting rest, maintaining fluid and electrolytes, and decreasing anxiety. Which interventions should the nurse implement? Select all that apply.
    

    1. AProvide a low-fat diet
    2. BAdminister analgesics
    3. CTeach relaxation exercises
    4. DEncourage walking in the hall
    5. EMonitor cardiac rate and rhythm
    6. FObserve for signs of hypercalcemia
71. 71A client who is obese and has a history of alcohol abuse is admitted to the hospital with the diagnosis of acute pancreatitis. Which is the initial priority expected client outcome in response to therapy at this time?
    

    1. AReport decreased pain
    2. BInsert nasogastric (NG) tube quickly
    3. CJoin Alcoholics Anonymous
    4. DLose four pounds (1.8 kilograms) a week
72. 72A nurse is teaching a newly admitted client who has acute pancreatitis about dietary restrictions. What should the education include?
    

    1. AUse of IV fluids
    2. BSeason foods sparingly
    3. CEat small meals frequently
    4. DLimit coffee to three cups per day
73. 73A client is admitted to the hospital with severe back and abdominal pain, nausea and occasional vomiting, and an oral temperature of 101° F (38.3° C). The client reports drinking six to eight beers a day. A diagnosis of acute pancreatitis is made. Based on the data presented, what symptom is the primary nursing concern for this client?
    

    1. AAcute pain
    2. BInadequate nutrition
    3. CElectrolyte imbalance
    4. DDisturbed self-concept
74. 74A client has cholelithiasis with possible obstruction of the common bile duct. The nurse performs a nutritional assessment. What is the primary goal for this assessment?
    

    1. ATo determine if follows a high fatty diet
    2. BTo determine if deficient in vitamins A, D, and K
    3. CTo determine if eats adequate amounts of dietary fiber
    4. DTo determine if consumes excessive amounts of protein
75. 75A nurse is caring for a client with cholelithiasis and obstructive jaundice. When assessing this client, the nurse should be alert for which findings that are consistent with these conditions? Select all that apply.
    

    1. AEcchymosis
    2. BYellow sclera
    3. CDark brown stool
    4. DStraw-colored urine
    5. EPain in right upper quadrant
76. 76A primary healthcare provider diagnoses a client with acute cholecystitis with biliary colic. Which clinical findings should the nurse expect when performing a health history and physical assessment? Select all that apply.
    

    1. ADiarrhea with black feces
    2. BIntolerance to foods high in fat
    3. CVomiting of coffee-ground emesis
    4. DGnawing pain when stomach is empty
    5. EPain that radiates to the right shoulder
77. 77A client experiences occasional right upper quadrant pain attributed to cholecystitis. The nurse is providing discharge instructions, including a list of foods that cause dyspepsia. Which foods should be on the list the nurse provided the client?
    

    1. ANuts and popcorn
    2. BMeatloaf and baked potato
    3. CChocolate and boiled shrimp
    4. DFried chicken and buttered corn
78. 78A client with an acute attack of cholecystitis has a cholecystectomy with a choledochostomy. The client returns from surgery with a T-tube connected to a drainage bag. What does the nurse conclude is the purpose of the T-tube?
    

    1. ADecrease edema
    2. BPermit drainage of bile
    3. CInsert antibiotic medication
    4. DProvide for irrigation of the gallbladder
79. 79The serum ammonia level of a client with hepatic cirrhosis and ascites is elevated. What nursing intervention is the priority?

    1. AWeigh the client daily
    2. BRestrict the client's oral fluid intake
    3. CMeasure the client's urine specific gravity
    4. DObserve the client for increasing confusion
80. 80Which type of hepatitis virus spreads through contaminated food and water?
    

    1. AHepatitis A virus
    2. BHepatitis B virus
    3. CHepatitis C virus
    4. DHepatitis D virus
81. 81The nurse is providing discharge instructions to a client who is recovering from an acute case of viral hepatitis. Which statement by the client indicates a need for further education?
    

    1. A"I will avoid alcohol."
    2. B"I will eat small frequent meals."
    3. C"I will take acetaminophen for pain rather than aspirin."
    4. D"I will eat foods high in carbohydrates, moderate in fats, and moderate in proteins."
82. 82A nurse is caring for a client who is positive for hepatitis A. Which precautions should the nurse take?
    

    1. AWear a gown when entering the client's room
    2. BUse caution when bringing in the client's food.
    3. CUse gloves when removing the client's bedpan.
    4. DWear a protective mask when entering the client's room
83. 83A nurse educator of a college health course is discussing tattoos with the class. Which type of hepatitis associated with tattoos should the nurse include in the teaching plan?
    

    1. AA
    2. BC
    3. CD
    4. DE
84. 84A client is at high risk for developing ascites because of cirrhosis of the liver. How should the nurse assess for the presence of ascites?
    

    1. AObserve the client for signs of respiratory distress
    2. BPercuss the client’s abdomen and listen for dull sounds
    3. CPalpate the lower extremities over the tibia and observe for edema.
    4. DListen for decreased or absent bowel sounds while auscultating the abdomen.
85. 85The nurse is administering lactulose to a client with a history of cirrhosis of the liver. The client asks the nurse why this medication is needed because the client is not constipated. How will the nurse respond?
    

    1. A"This medication helps you to stop drinking so much alcohol."
    2. B"This medication helps you relax and not feel anxious."
    3. C"This medication helps you lower the high ammonia level caused by your liver disease."
    4. D"This medication helps you keep your abdomen from being so distended."
86. 86A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone. What should the nurse monitor the client for?
    

    1. Abruising
    2. Btachycardia
    3. CHyperkalemia
    4. DHypoglycemia
87. 87Neomycin is prescribed for a client with cirrhosis. What should the nurse explain is the reason for taking this medication?
    

    1. APrevents an infection
    2. BLimits abdominal distention
    3. CMinimizes intestinal edema
    4. DReduces the blood ammonia level
88. 88A nurse administers lactulose to a client with cirrhosis of the liver. Which laboratory test change leads the nurse to determine that the lactulose is effective?
    

    1. ADecreased amylase
    2. BDecreased ammonia
    3. CIncreased potassium
    4. DIncreased hemoglobin
89. 89A client is diagnosed with acute gastritis secondary to alcoholism and cirrhosis. The client reports frequent nausea, pain that increases after meals, and black, tarry stools. The client recently joined Alcoholics Anonymous. The nurse should give priority to which client history item?
    

    1. ABlack, tarry stools
    2. BFrequent nausea
    3. CJoining Alcoholics Anonymous
    4. DPain that increases after meals
90. 90The nurse is assessing a client with severe cirrhosis and discovers fetor hepaticus. What did the nurse assess?
    

    1. Aurine
    2. Bstool
    3. Chands
    4. Dbreath
91. 91A client is admitted to the hospital with a diagnosis of cirrhosis of the liver. For which assessment signs of hepatic encephalopathy should the nurse assess this client? Select all that apply.
    

    1. AMental confusion
    2. BIncreased cholesterol
    3. CBrown-colored stools
    4. DFlapping hand tremors
    5. EMusty, sweet breath odor
92. 92The nurse is taking care of a client with cirrhosis of the liver and ascites. Which lunch is the best choice for a client with this disorder?
    

    1. AHam sandwich with cheese, whole milk, and potato chips
    2. BPenne pasta, spinach, banana, and decaffeinated iced tea
    3. CBaked lasagna with sausage, salad, and milkshake
    4. DHamburger, french fries, and cola
93. 93A client is admitted to the hospital with a diagnosis of acute pancreatitis. The health care provider's prescriptions include nothing by mouth and total parenteral nutrition (TPN). The nurse explains that the TPN therapy provides what benefit?
    

    1. AIs the easiest method for administering needed nutrition
    2. BIs the safest method for meeting the client's nutritional requirements
    3. CWill satisfy the client's hunger without the discomfort associated with eating
    4. DWill meet the client's nutritional needs without causing the discomfort precipitated by eating
94. 94A client is admitted to the hospital for medical management of acute pancreatitis. Which nursing action is most likely to reduce the pancreatic and gastric secretions of a client with pancreatitis?
    

    1. AEncouraging clear liquids
    2. BObtaining a prescription for morphine
    3. CAssisting the client into a semi-Fowler position
    4. DAdministering prescribed anticholinergic medication
95. 95A nurse reviews the laboratory results of a client with acute pancreatitis. Which test is most significant in determining the client's response to treatment?
    

    1. Aplatelet count
    2. BAmylase level
    3. CRBC count
    4. DErythrocyte sedimentation rate
96. 96A nurse is caring for a client with acute pancreatitis. Which elevated laboratory test result is most indicative of acute pancreatitis?
    

    1. Ablood glucose
    2. BSerum lipase
    3. CSerum bilirubin level
    4. DWBC count
97. 97A client who has a history of alcohol abuse now has recurrent exacerbations of chronic pancreatitis. The nurse asks the client to obtain a stool specimen. When assessing the client's stool, what would the nurse expect to observe?
    

    1. Amelena
    2. BSteatorrhea
    3. CHard, dry stool
    4. DRibbon-shaped stool
98. 98For which clinical indicators should the nurse monitor when caring for a client with cholelithiasis and obstructive jaundice? Select all that apply.
    

    1. Adark urine
    2. Byellow skin
    3. CPain on urination
    4. DClay-colored stool
    5. ECoffee-ground vomitus
99. 99A nurse is caring for a client with cholelithiasis. Which clinical manifestation does the nurse expect if the client develops obstructive jaundice?
    

    1. Ayellow sclera
    2. BPain on urination
    3. Cdark brown stools
    4. DCoffee-ground emesis
100. 100A client with cholelithiasis is scheduled for a lithotripsy. What should the nurse include in the client's teaching plan?
     

     1. AOpioids will be available for postoperative pain
     2. BFever is a common response to this intervention
     3. CAnesthetics are not necessary during the procedure
     4. DHeart palpitations often occur after the procedure
101. 101A client with cholelithiasis has a laser laparoscopic cholecystectomy. What is most appropriate for the nurse to do postoperatively?
     

     1. AMaintain the client's nothing by mouth status for the first 24 hours
     2. BMonitor the client's abdominal incision for bleeding
     3. COffer clear carbonated beverages to the client
     4. DAmbulate the client when the client is alert and oriented
102. 102The nurse is creating a dietary plan for a client with cholecystitis who has been placed on a modified diet. Which will be most appropriate to include in the client’s dietary plan?
     

     1. AOffer soft-textured foods to reduce the digestive burden
     2. BOffer low-cholesterol foods to avoid further formation of gallstones
     3. CIncrease protein intake to promote tissue healing and improve energy reserves
     4. DDecrease fat intake to avoid stimulation of the cholecystokinin mechanism for bile release
103. 103A client who is in a late stage of pancreatic cancer intellectually understands the terminal nature of the illness. What are behaviors that indicate the client is emotionally accepting the impending death?
     

     1. ARevising the client's will and planning a visit to a friend
     2. BAlternately crying and talking openly about death
     3. CGetting second, third, and fourth medical opinions
     4. DRefusing to follow treatments and stating they won't help anyway
104. 104The nurse is providing care for a client diagnosed with invasive pancreatic cancer. The client has a permanent biliary drainage tube (T-tube) inserted to provide palliative care. Which action should the nurse take postoperatively?
     

     1. AMaintain intermittent low suction to limit trauma
     2. BCleanse the area around the insertion site to prevent skin breakdown
     3. CAttach the tube to a negative-pressure drainage system to promote drainage
     4. DReposition the client frequently to increase the flow of bile through the tube.
105. 105A client is hospitalized with a tentative diagnosis of pancreatic cancer. On admission the client asks the nurse, "Do you think I have anything serious, like cancer?" What is the nurse's best reply?
     

     1. A"What makes you think you have cancer?"
     2. B"I don't know if you do; let's talk about it."
     3. C"Why don't you discuss this with your primary healthcare provider?"
     4. D"You needn't worry now; we won't know the answer for a few days."
106. 106A client has a tentative diagnosis of primary biliary cirrhosis. What skin change does the nurse expect to observe when performing a physical assessment?
     

     1. AVitiligo
     2. BHirsutism
     3. CMelanomas
     4. DTelangiectasia
107. 107A client with cirrhosis of the liver and ascites is scheduled to have a paracentesis. What should the nurse do to prepare the client for the procedure?
     

     1. AInstruct the client to void
     2. BTell the client not to eat for four hours
     3. CGive the client the prescribed analgesic.
     4. DHave the client turn to the lateral position
108. 108A nurse is assessing a malnourished client with a history of cirrhosis. The client is experiencing nausea, ascites, and gastrointestinal bleeding. What is the primary cause of the client’s ascites?
     

     1. AA decrease in vitamins to maintain cell coenzyme functions
     2. BA decrease in iron to maintain adequate hemoglobin synthesis
     3. CA decrease in sodium to maintain its concentration in tissue fluid
     4. DA decrease in plasma protein to maintain adequate capillary-tissue circulation
109. 109An age-related finding noted by the nurse during the assessment of the older woman's reproductive system is

     1. Adyspareunia.
     2. Bvaginal dryness.
     3. Cnipple retraction.
     4. Dincreased sensitivity of labia.
110. 110Significant information about a patient's past health history related to the reproductive system should include

     1. Aextent of sexual activity.
     2. Bgeneral satisfaction with sexuality.
     3. Cprevious sexually transmitted infections.
     4. Dself-image and relationships with others.
111. 111To evaluate the female patient's breasts, the nurse would use the examination technique of (select all that apply)

     1. Apalpation
     2. Binspection
     3. Cpercussion
     4. Dauscultation.
112. 112An abnormal finding noted during physical assessment of the male reproductive system is

     1. Adescended testes
     2. Bsymmetric scrotum.
     3. Cslight clear urethral discharge.
     4. Dthe glans covered with prepuce.
113. 113A 72-year-old man asks the nurse whether it is normal for him to become impotent at his age. The best response by the nurse includes what information?

     1. AMost decreased sexual function in older adults is due to psychologic stress.
     2. BPhysiologic changes of aging may require increased stimulation for an erection to occur.
     3. CAlthough the penis decreases in size in older men, there should be no change in sexual function.
     4. DBenign changes in the prostate gland that occur with aging can cause a decreased ability to attain an erection
114. 114A 58-year-old man has difficulty starting a urinary stream and benign prostatic hyperplasia (BPH) is suspected. What is involved in the assessment of the patient for the presence of BPH?

     1. APalpating the scrotum and testes for a mass
     2. BPalpating the base of the penis for enlargement
     3. CPalpating the inguinal ring while the patient bears down
     4. DA digital rectal examination to palpate the prostate gland
115. 115When assessing an aging adult man, what does the nurse note as a normal finding?

     1. ADecreased penis size
     2. BDecreased pubic hair
     3. CA decrease in scrotal color
     4. DUnilateral breast enlargement
116. 116When assessing an aging adult woman, what does the nurse note as a normal finding?

     1. ARectocele
     2. Blarger breasts
     3. Cvaginal dryness
     4. DSevere osteoporosis
117. 117A 25-year-old female patient is at the clinic and says that she has white vaginal drainage and itching. Which etiology would be suspected?

     1. Acancer
     2. BCandidiasis
     3. CTrichomonas vaginalis
     4. DBacterial vaginosis infection
118. 118During examination of the female reproductive system, the nurse would note which finding as abnormal?

     1. AClear vaginal discharge
     2. BPerineal episiotomy scars
     3. CNonpalpable Skene’s glands
     4. DReddened base of the vulva
119. 119You are a community health nurse planning a program on breast cancer screening guidelines for women in the neighborhood. To best promote the participants' learning and adherence, you would include (select all that apply)
     

     1. Aa short audiotape on the BSE procedure.
     2. Ba packet of articles from the medical literature.
     3. Cwritten guidelines for mammography and CBE.
     4. Da discussion of the value of early breast cancer detection.
     5. Ecommunity resources where they can obtain an ultrasound and MRI.
120. 120In teaching a patient who wants to perform BSE, you inform her that the technique involves both the palpation of the breast tissue and

     1. Apalpation of cervical lymph nodes.
     2. Bhard squeezing of the breast tissue.
     3. Ca mammogram to evaluate breast tissue.
     4. Dinspection of the breasts for any changes.
121. 121When discussing risk factors for breast cancer with a group of women, you emphasize that the greatest known risk factor for breast cancer is

     1. Abeing a woman over age 60.
     2. Bexperiencing menstruation for 30 years or more.
     3. Cusing hormone therapy for 5 years for menopausal symptoms.
     4. Dhaving a paternal grandmother with postmenopausal breast cancer.
122. 122A patient with breast cancer has a lumpectomy with sentinel lymph node dissection that is positive for cancer. You explain that, of the other tests done to determine the risk for cancer recurrence or spread, the results that support the more favorable prognosis are (select all that apply)

     1. Awell-differentiated tumor.
     2. Bestrogen receptor–positive tumor.
     3. Coverexpression of HER-2 cell marker.
     4. Dinvolvement of two to four axillary nodes.
     5. Eaneuploidy status from cell proliferation studies
123. 123A modified radical mastectomy has been scheduled for your patient with breast cancer. Postoperatively, to restore arm function on the affected side, you would

     1. Aapply heating pads or blankets to increase circulation.
     2. Bplace daily ice packs to minimize the risk of lymphedema.
     3. Cteach passive exercises with the affected arm in a dependent position.
     4. Demphasize regular exercises for the affected shoulder to increase range of motion.
124. 124 A woman at the health clinic tells the nurse that she does not do breast self-examination (BSE) because it just seems too much of a bother. What is the best response by the nurse about BSE?

     1. AIt reduces mortality from breast cancer in women under the age of 50.
     2. BIt is useful to help women learn how their breasts normally look and feel.
     3. CBSE has little value in detection of cancer and is not recommended anymore.
     4. DBSE is the most common way that malignant tumors of the breast are discovered.
125. 125When teaching a 24-year-old woman who desires to learn BSE, the nurse knows that it is important to do what?

     1. AProvide time for a return demonstration.
     2. BEmphasize the statistics related to breast cancer survival and mortality.
     3. CHave the woman set a consistent monthly date for performing the examination.
     4. DInform the woman that professional examinations are not necessary unless she finds an abnormality.
126. 126Which diagnostic test is most accurate and advantageous in terms of time and expense in diagnosing malignant breast disorders?

     1. ASurgical biopsy
     2. BMammography
     3. CFine-needle aspiration
     4. DCore (core needle) biopsy
127. 127A 24-year-old female patient has breast cancer with estrogen receptor–negative cells. Which genomic assay test can be used to provide information about the likely recurrence and need for chemotherapy?

     1. ACA 27-29
     2. BTNM system
     3. COncotype DX
     4. DMammaPrint
128. 128 While examining a patient’s breasts, the nurse notes multiple, bilateral mobile lumps. To assess the patient further, what is the most appropriate question by the nurse?

     1. A“Do you have a high caffeine intake?”
     2. B“When did you last have a mammogram?”
     3. C“Is there a history of breast cancer in your mother or sisters?”
     4. D“Do the size and tenderness of the lumps change with your menstrual cycle?”
129. 129A patient has fibrocystic changes in her breast. The nurse explains to the patient that this condition is significant because it
     

     1. Acommonly becomes malignant over time.
     2. Bcan be controlled with hormone therapy (HT).
     3. Cmakes it more difficult to examine the breasts.
     4. Dwill eventually cause atrophy of normal breast tissue
130. 130Which patient probably has the highest risk of breast cancer?

     1. A60-year-old obese man
     2. B58-year-old woman with sedentary lifestyle
     3. C55-year-old woman with fibrocystic breast changes
     4. D65-year-old woman with a sister diagnosed with breast cancer
131. 131The nurse would be most concerned when the patient’s breast examination reveals which finding?

     1. AA large, tender, moveable mass in the upper inner quadrant
     2. BAn immobile, hard, nontender lesion in the upper outer quadrant
     3. CA 2- to 3-cm, firm, defined, mobile mass in the lower outer quadrant
     4. DA painful, immobile mass with reddened skin in the upper outer quadrant
132. 132 The best prognosis is indicated in the patient with breast cancer when diagnostic studies reveal

     1. Anegative axillary lymph nodes.
     2. Baneuploid DNA tumor content.
     3. Ccells with high S-phase fractions.
     4. Dan estrogen receptor- and progesterone receptor–negative tumor.
133. 133The health care provider of a patient with a positive biopsy of a 2-cm breast tumor has recommended a lumpectomy with radiation therapy or a modified radical mastectomy as treatment. The patient says that she does not know how to choose and asks the female nurse what she would do if she had to make the choice. What is the best response by the nurse to this patient?
     

     1. A“It doesn’t matter what I would do. It is a decision you have to make for yourself.”
     2. B“There are advantages and disadvantages of both procedures. What do you know about these procedures?”
     3. C“I would choose the modified radical mastectomy because it would ensure that the entire tumor was removed.”
     4. D“The lumpectomy maintains a nearly normal breast but the survival rate is not as good as it is with a mastectomy.”
134. 134A patient undergoing either a mastectomy or a lumpectomy for treatment of breast cancer can also usually expect to undergo what other treatment?

     1. Achemo
     2. Bradiation
     3. Chormonal therapy
     4. DSentinel lymph node dissection
135. 135Lymphatic mapping with sentinel lymph node dissection (SLND) is planned for a patient undergoing a modified radical mastectomy for breast cancer. What does the nurse teach the patient and her family?

     1. AIf one sentinel lymph node is positive for malignant cells, all of the sentinel lymph nodes will be removed.
     2. BIf malignant cells are found in any sentinel nodes, a complete axillary lymph node dissection will be done.
     3. CLymphatic mapping indicates which lymph nodes are most likely to have metastasis and all of those nodes are removed.
     4. DLymphatic mapping with SLND provides metastatic lymph nodes to test for responsiveness to chemotherapy.
136. 136What describes the use of high-dose brachytherapy radiation (select all that apply)?

     1. Amay be completed in 5 days
     2. BFollows local excision of tumor
     3. CAlternative to traditional radiation therapy for early-stage breast cancer
     4. DUsed to treat possible local residual cancer cells following a mastectomy
     5. EUsed to reduce tumor size and stabilize metastatic lesions for pain relief
137. 137A patient with a positive breast biopsy tells the nurse that she read about tamoxifen (Nolvadex) on the Internet and asks about its use. The best response by the nurse includes which information?

     1. ATamoxifen is the primary treatment for breast cancer if axillary lymph nodes are positive for cancer.
     2. BTamoxifen is used only to prevent the development of new primary tumors in women with high risk for breast cancer.
     3. CTamoxifen is the treatment of choice after surgery if the tumor has receptors for estrogen and progesterone on its cells.
     4. DBecause tamoxifen has been shown to increase the risk for uterine cancer, it is used only when other treatment has not been successful.
138. 138During the immediate postoperative period following a mastectomy, the nurse initially institutes which exercises for the affected arm?

     1. AHave the patient brush or comb her hair with the affected arm.
     2. BPerform full passive range-of-motion (ROM) exercises to the affected arm.
     3. CAsk the patient to flex and extend the fingers and wrist of the operative side.
     4. DHave the patient crawl her fingers up the wall, raising her arm above her head.
139. 139Following a modified radical mastectomy, a patient develops lymphedema of the affected arm. What does the nurse teach the patient to do?

     1. AAvoid skin-softening agents on the arm.
     2. BProtect the arm from any type of trauma
     3. CAbduct and adduct the arm at the shoulder hourly.
     4. DKeep the arm positioned so that it is in straight and dependent alignment.
140. 140A patient undergoing surgery and radiation for treatment of breast cancer has a nursing diagnosis of disturbed body image related to absence of the breast. What is an appropriate nursing intervention for this patient?

     1. AProvide the patient with information about surgical breast reconstruction.
     2. BRestrict visitors and phone calls until the patient feels better about herself.
     3. CArrange for a Reach to Recovery visitor or similar resource available in the community.
     4. DEncourage the patient to obtain a permanent breast prosthesis as soon as she is discharged from the hospital.
141. 141A 56-year-old patient is undergoing a mammoplasty for breast reconstruction following a mastectomy 1 year ago. During the preoperative preparation of the patient, what is important for the nurse to do?

     1. ADetermine why the patient is choosing reconstruction surgery rather than the use of an external prosthesis
     2. BEnsure that the patient has realistic expectations about the outcome and possible complications of the surgery.
     3. CInform the patient that implants used for breast reconstruction have been shown to cause immune-related diseases.
     4. DLet the patient know that although the shape will be different from the other breast, the nipple can be reconstructed from other erectile tissue.
142. 142A patient undergoing a modified radical mastectomy for cancer of the breast is going to use tissue expansion and an implant for breast reconstruction. What should the nurse teach the patient about tissue expansion
     

     1. AWeekly injections of water or saline into the expander will be required.
     2. BThe expander cannot be placed until healing from the mastectomy is complete.
     3. CThis method of breast reconstruction uses the patient’s own tissue to replace breast tissue.
     4. DThe nipple from the affected breast will be saved to be grafted onto the reconstructed breast.
143. 143The patient’s breast cancer has metastasized. Which medication for metastasis is better tolerated and has fewer and milder side effects than other chemotherapy medications?

     1. ACapecitabine (Xeloda)
     2. BVinorelbine (Navelbine)
     3. CDoxorubicin (Adriamycin)
     4. DEribulin mesylate (Halaven)
144. 144The individual with the lowest risk for sexually transmitted pelvic inflammatory disease is a woman who uses

     1. Aoral contraceptives
     2. Bbarrier methods of contraception.
     3. Can intrauterine device for contraception.
     4. Da Norplant implant or injectable Depo-Provera for contraception
145. 145The nurse is obtaining a subjective data assessment from a woman reported as a sexual contact of a man with chlamydial infection. The nurse understands that symptoms of chlamydial infection in women

     1. Aare frequently absent.
     2. Bare similar to those of genital herpes.
     3. Cinclude a macular palmar rash in the later stages.
     4. Dmay involve chancres inside the vagina that are not visible.
146. 146A primary HSV infection differs from recurrent HSV episodes in that (select all that apply)

     1. Aonly primary infections are sexually transmitted.
     2. Bsymptoms are less severe during recurrent episodes.
     3. Ctransmission of the virus to a fetus is less likely during primary infection.
     4. Dsystemic manifestations such as fever and myalgia are more common in primary infection.
     5. Elesions from recurrent HSV are more likely to transmit the virus than lesions from primary HSV.
147. 147Explain to the patient with gonorrhea that treatment will include both ceftriaxone and doxycycline because

     1. Amost patients need both drugs to eradicate the organism.
     2. Bcoverage with more than one antibiotic will prevent reinfection.
     3. Cno single agent successfully eradicates both primary and recurrent infections.
     4. Dthe high rate of coexisting chlamydial infection and gonorrhea indicates coverage with both drugs.
148. 148In assessing patients for STIs, the nurse needs to know that many STIs can be asymptomatic. Which STIs can be asymptomatic (select all that apply)?

     1. Asyphilis
     2. BGonorrhea
     3. CGenital warts
     4. DGenital herpes
     5. EChlamydial infection
149. 149To prevent the infection and transmission of STIs, the nurse's teaching plan would include an explanation of

     1. Athe appropriate use of oral contraceptives.
     2. Bsexual positions that can be used to avoid infection.
     3. Cthe necessity of annual Pap tests for patients with HPV.
     4. Dsexual practices that are considered high-risk behaviors.
150. 150Provide emotional support to a patient with an STI by

     1. Aoffering information on how safer sexual practices can prevent STIs.
     2. Bshowing concern when listening to the patient who expresses negative feelings.
     3. Creassuring the patient that the disease is highly curable with appropriate treatment.
     4. Dhelping the patient who received an STI from his or her sexual partner in forgiving the partner.
151. 151The current incidence of sexually transmitted infections (STIs) is related in part to what?

     1. AIncreased social acceptance of homosexuality
     2. BIncreased virulence of organisms causing STIs
     3. CThe use of oral agents rather than condoms as contraceptives
     4. DDevelopment of resistance of microorganisms to common antibiotics
152. 152 In establishing screening programs for populations at high risk for STIs, the nurse recognizes that which microorganism causes nongonococcal urethritis in men and cervicitis in women?

     1. AHerpes simplex virus
     2. BTreponema pallidum
     3. CChlamydia trachomatis
     4. DNeisseria gonorrhoeae
153. 153The laboratory result of a specimen from a 20-year-old female patient shows human papillomavirus (HPV). What would the nurse suspect the patient’s diagnosis to be?

     1. ASyphilis
     2. BGonorrhea
     3. CGenital warts
     4. DGenital herpes
154. 154A female patient with a purulent vaginal discharge is seen at an outpatient clinic. The nurse suspects a diagnosis of gonorrhea. How would this STI be treated?

     1. AOral acyclovir (Zovirax)
     2. BBenzathine penicillin G given IM
     3. CCeftriaxone (Rocephin) IM or oral cefixime (Suprax)
     4. DWould need a second confirmatory test result before treatment
155. 155A 22-year-old woman with multiple sexual partners seeks care after several weeks of experiencing painful and frequent urination and vaginal discharge. Although the results of a culture of cervical secretions are not yet available, the nurse explains to the patient that she will be treated as if she has gonorrhea and chlamydia to prevent

     1. Aobstruction of the fallopian tubes.
     2. Bendocarditis and aortic aneurysms.
     3. Cdisseminated gonococcal infection.
     4. Dpolyarthritis and generalized adenopathy.
156. 156 During evaluation and treatment of gonorrhea in a young man at the health clinic, what is most important for the nurse to question the patient about?

     1. AA prior history of STIs
     2. BWhen the symptoms began
     3. CThe date of his last sexual activity
     4. DThe names of his recent sexual partners
157. 157Which manifestations are characteristic of the late or tertiary stage of syphilis (select all that apply)?

     1. AHF
     2. BTabes dorsalis
     3. CSaccular aneurysms
     4. DMental deterioration
     5. EGeneralized cutaneous rash
     6. FDestructive skin, bone, and soft tissue lesions
158. 158Which stage of syphilis is identified by the absence of clinical manifestations and a positive fluorescent treponemal antibody absorption (FTA-Abs) test?

     1. Alatent
     2. Bprimary
     3. Csecondary
     4. DLate (tertiary)
159. 159 A premarital blood test for syphilis reveals that a woman has a positive Venereal Disease Research Laboratory (VDRL) test. How should the nurse advise the patient?

     1. AA single dose of penicillin will cure the syphilis.
     2. BShe should question her fiancé about prior sexual contacts.
     3. CAdditional testing to detect specific antitreponemal antibodies is necessary.
     4. DA lumbar puncture to evaluate cerebrospinal fluid (CSF) is necessary to rule out active syphilis.
160. 160 Why should the nurse encourage serologic testing for human immunodeficiency virus (HIV) in the patient with syphilis?
     

     1. ASyphilis is more difficult to treat in patients with HIV infection.
     2. BThe presence of HIV infection increases the risk of contracting syphilis.
     3. CThe incidence of syphilis is increased in those with high rates of sexual promiscuity and drug abuse.
     4. DCentral nervous system (CNS) involvement is more common in patients with HIV infection and syphilis.
161. 161A male patient returns to the clinic with a recurrent urethral discharge after being treated for a chlamydial infection 2 weeks ago. Which statement by the patient indicates the most likely cause of the recurrence of his infection?

     1. A“I took the Vibramycin twice a day for a week.”
     2. B“I haven’t told my girlfriend about my infection yet.”
     3. C“I had a couple of beers while I was taking the medication.”
     4. D“I’ve only had sexual intercourse once since my medication was finished.”
162. 162What is the most common way to determine a diagnosis of chlamydial infection in a male patient?

     1. ACultures for chlamydial organisms are positive.
     2. BThe nucleic acid amplification test (NAAT) is positive.
     3. CGram stain smears and cultures are negative for gonorrhea.
     4. DSigns and symptoms of epididymitis or proctitis are also present.
163. 163 What are characteristics of a herpes simplex virus infection (select all that apply)?

     1. ATreatment with acyclovir can cure genital herpes.
     2. BHerpes simplex virus type 2 (HSV-2) is capable of causing only genital lesions.
     3. CRecurrent symptomatic genital herpes may be precipitated by sexual activity and stress.
     4. DTo prevent transmission of genital herpes, condoms should be used when lesions are present.
     5. EThe primary symptom of genital herpes is painful vesicular lesions that rupture and ulcerate.
164. 164During the physical assessment of a female patient with HPV infection, what should the nurse expect to find?

     1. APurulent vaginal discharge
     2. BA painless, indurated lesion on the vulva
     3. CPainful perineal vesicles and ulcerations
     4. DMultiple coalescing gray warts in the perineal area
165. 165What is most important for the nurse to teach the female patient with genital warts?

     1. AHave an annual Papanicolaou (Pap) test.
     2. BApply topical acyclovir faithfully as directed.
     3. CHave her sexual partner treated for the condition.
     4. DUse a contraceptive to prevent pregnancy, which might exacerbate the disease.
166. 166Which STI actively occurring at the time of delivery would indicate the need for a cesarean section delivery of the woman’s baby?
     

     1. ASyphilis
     2. BChlamydia
     3. CGonorrhea
     4. DGenital herpes
167. 167Although an 18-year-old girl knows that abstinence is one way to prevent STIs, she does not consider that as an alternative. She asks the nurse at the clinic if there are other measures for preventing STIs. What should the nurse teach her?

     1. AAbstinence is the only way to prevent STIs.
     2. BVoiding immediately after intercourse will decrease the risk for infection.
     3. CA vaccine can prevent genital warts and cervical cancer caused by some strains of HPV.
     4. DThorough hand washing after contact with genitals can prevent oral-genital spread of STIs.
168. 168Patients with which STI are most likely to avoid obtaining and following treatment measures for their infection?

     1. ASyphilis
     2. BGonorrhea
     3. CHPV infection
     4. DGenital herpes
169. 169An appropriate question to ask the patient with painful menstruation to differentiate primary from secondary dysmenorrhea is

     1. A“Does your pain become worse with activity or overexertion?”
     2. B“Have you had a recent personal crisis or change in your lifestyle?”
     3. C“Is your pain relieved by nonsteroidal antiinflammatory medications?”
     4. D“When in your menstrual history did the pain with your period begin?”
170. 170The nurse should advise the woman recovering from surgical treatment of an ectopic pregnancy that

     1. Ashe has an increased risk for salpingitis.
     2. Bbed rest must be maintained for 12 hours to assist in healing.
     3. Chaving one ectopic pregnancy increases her risk for another.
     4. Dintrauterine devices and infertility treatments should be avoided.
171. 171To prevent or decrease age-related changes that occur after menopause in a patient who chooses not to take hormone therapy, the most important self-care measure to teach is

     1. Amaintaining usual sexual activity.
     2. Bincreasing the intake of dairy products.
     3. Cperforming regular aerobic, weight-bearing exercise.
     4. Dtaking vitamin E and B-complex vitamin supplements.
172. 172The patient's thick, white, and curdlike vaginal discharge and vulvar pruritus are most consistent with

     1. Atrichomoniasis.
     2. Bmonilial vaginitis.
     3. Cbacterial vaginosis.
     4. Dchlamydial cervicitis.
173. 173In caring for a patient with pelvic inflammatory disease, the nurse should place her in semi-Fowler's position. The rationale for this measure is to

     1. Arelieve severe pain.
     2. Bpromote drainage to prevent abscesses.
     3. Cimprove circulation and promote healing.
     4. Dprevent complication of bowel obstruction.
174. 174Nursing responsibilities related to the patient receiving brachytherapy for endometrial cancer include

     1. Amaintaining absolute bed rest.
     2. Bkeeping the patient in high Fowler's position.
     3. Callowing visitors if they stay 3 ft (1 m) from the bed.
     4. Dlimiting direct nurse-to-patient contact to 30 minutes per shift.
175. 175Postoperative goals in caring for the patient who has undergone an abdominal hysterectomy include (select all that apply)

     1. Amonitoring urine output.
     2. Bchanging position frequently.
     3. Crestricting all food for 24 hours.
     4. Dobserving perineal pad for bleeding.
     5. Eencouraging leg exercises to promote circulation.
176. 176Postoperative nursing care for the woman with a gynecologic fistula includes (select all that apply)

     1. Aambulation.
     2. Bbladder training.
     3. Cwarm sitz baths.
     4. Dperineal hygiene
     5. Euse of stool softeners.
177. 177Premenstrual syndrome (PMS) is most likely to be diagnosed in a woman with which occurrence?

     1. ASymptoms can be controlled with the use of progesterone
     2. BThe woman has symptoms only when oral contraceptives are used.
     3. CSymptoms can be correlated with altered serum levels of estrogen and progesterone.
     4. DThe woman has the same symptom pattern following ovulation for two or three consecutive menstrual cycles.
178. 178When teaching a patient with PMS about management of the disorder, the nurse includes the need to

     1. Asupplement the diet with vitamins C and E.
     2. Blimit dietary intake of caffeine and refined sugar.
     3. Cuse estrogen supplements during the luteal phase.
     4. Dlimit exercise and physical activity when symptoms are present.
179. 179What is the rationale for the regular use of nonsteroidal antiinflammatory drugs (NSAIDs) during the first several days of the menstrual period for women who have primary dysmenorrhea?

     1. AThey suppress ovulation and the production of prostaglandins that occur with ovulation.
     2. BThey cause uterine relaxation and small vessel constriction, preventing cramping and abdominal congestion.
     3. CThey inhibit the production of prostaglandins believed to be responsible for menstrual pain and associated symptoms..
     4. DThey block the release of luteinizing hormone, preventing the increase in progesterone associated with maturation of the corpus luteum.
180. 180A 20-year-old woman is a college softball player who participates in strenuous practices and a heavy class schedule. She is describing an absence of menses. What could be contributing to her amenorrhea?

     1. ADecreased sexual activity
     2. BExcess prostaglandin production
     3. CStrenuous exercise or lack of calories
     4. DEndometrial cancer or uterine fibroids
181. 181A young woman who runs vigorously as a form of exercise has not had a menstrual period in more than 6 months. What should the nurse teach her?

     1. ANormal periods will return when she stops running.
     2. BUterine balloon therapy may be necessary to promote uterine sloughing of the overgrown endometrium.
     3. CProgesterone or birth control pills should be used to prevent persistent overgrowth of the endometrium.
     4. DUnopposed progesterone production causes an overgrowth of the endometrium that increases her risk for endometrial cancer.
182. 182A 29-year-old woman is at the clinic with menorrhagia. What finding would the nurse expect in this patient’s assessment?
     

     1. APain with each menstrual period
     2. BExcessive bleeding at irregular intervals
     3. CBleeding or spotting between menstrual periods
     4. DIncreased duration or amount of menstrual bleeding
183. 183A patient is 51 years old and suffered a wrist fracture when she slipped on the ice. She has her uterus and is interested in starting hormone therapy (HT), as she is also experiencing menopause symptoms. What should the nurse include when discussing the risks and benefits of HT with this patient?

     1. ATaking only progestin is suggested for a woman with a uterus.
     2. BTaking both estrogen and progestin may decrease her bone loss.
     3. CThe risk of breast cancer and cardiovascular disease is decreased with HT.
     4. DTaking estrogen and progestin will increase the risk of endometrial cancer.
184. 184A patient with a stage 0 cervical cancer identified from a Papanicolaou (Pap) test asks the nurse what this finding means. The nurse’s response should include which information?

     1. AMalignant cells have extended beyond the cervix to the upper vagina.
     2. BAbnormal cells are present but are confined to the epithelial layer of the cervix.
     3. CAtypical cells characteristic of inflammation but not necessarily malignancy are present.
     4. DThis is a common finding on Pap testing and she will be examined frequently to see whether the abnormal cells spread beyond the cervix.
185. 185 Fertility and normal reproductive function can be maintained when a cancer of the cervix is successfully treated with which therapy?
     

     1. AExternal radiation therapy
     2. BInternal radiation implants
     3. CConization or laser surgery
     4. DCryotherapy or subtotal hysterectomy
186. 186A patient has been diagnosed with cancer of the ovary. In planning care for the patient, what does the nurse recognize that treatment of the patient depends on?

     1. AResults of a direct-needle biopsy of the ovary
     2. BResults of a laparoscopy with multiple biopsies
     3. CWhether the patient desires to maintain fertility
     4. DThe findings of metastasis by ultrasound or computed tomography (CT) scan
187. 187 Which factors are associated with endometrial cancer (select all that apply)?
     

     1. Aobesity
     2. Bsmoking
     3. Cfamily hx
     4. DEarly sexual activity
     5. EEarly menarche and late menopause
     6. FUnopposed estrogen-only replacement therapy
188. 188A 44-year-old woman undergoing a total abdominal hysterectomy asks whether she will need to take estrogen until she reaches the age of menopause. What is the best response by the nurse?

     1. A“Yes, it will help to prevent the more intense symptoms caused by surgically induced menopause.”
     2. B“You are close enough to normal menopause that you probably won’t need additional estrogen.”
     3. C“Because your ovaries won’t be removed, they will continue to secrete estrogen until your normal menopause.”
     4. D“There are so many risks associated with estrogen replacement therapy that it is best to begin menopause now.”
189. 189A disturbed body image needing nursing interventions to assist the patient and family to cope may be seen in any patient undergoing gynecologic surgery. With which surgery will this most likely be expected to occur?

     1. AVaginectomy
     2. BHemivulvectomy
     3. CPelvic exenteration
     4. DRadical hysterectomy
190. 190 When teaching a patient with problems of pelvic support to perform Kegel exercises, what should the nurse tell the patient to do?
     

     1. AContract her muscles as if trying to stop the flow of urine.
     2. BTighten the lower abdominal muscles over the bladder area
     3. CSqueeze all of the perineal muscles as if trying to close the vagina.
     4. DLie on the floor and do leg lifts to strengthen the abdominal muscles.
191. 191An older male patient is experiencing difficulty in initiating voiding and a feeling of incomplete bladder emptying. These symptoms of BPH are primarily caused by

     1. AMaintain normal bowel patterns
     2. BAdjust to temporary ileal conduit
     3. CUrinate within 8 hours postoperatively
     4. DExperience healing of excoriated vaginal and vulvar tissue
192. 192Postoperatively, a patient who has had a laser prostatectomy has continuous bladder irrigation with a three-way urinary catheter with a 30-mL balloon. When he complains of bladder spasms with the catheter in place, the nurse should

     1. Adeflate the catheter balloon to 10 mL to decrease bulk in the bladder.
     2. Bdeflate the catheter balloon and then reinflate to ensure that it is patent.
     3. Cencourage the patient to try to have a bowel movement to relieve colon pressure.
     4. Dexplain that this feeling is normal and that he should not try to urinate around the catheter.
193. 193Which factors would place a patient at higher risk for prostate cancer (select all that apply)?

     1. AOlder than 65 years
     2. BAsian or Native American
     3. CLong-term use of an indwelling urethral catheter
     4. DFather diagnosed and treated for early stage prostate cancer
     5. EPrevious history of undescended testicle and testicular cancer
194. 194A patient scheduled for a prostatectomy for prostate cancer expresses the fear that he will have erectile dysfunction. In responding to this patient, the nurse should keep in mind that

     1. Aerectile dysfunction can occur even with a nerve-sparing procedure.
     2. Bretrograde ejaculation affects sexual function more frequently than erectile dysfunction.
     3. Cthe most common complication of this surgery is postoperative bowel incontinence.
     4. Dpreoperative sexual function is the most important factor in determining postoperative erectile dysfunction.
195. 195 A patient asks the nurse what the difference is between benign prostatic hyperplasia (BPH) and prostate cancer. The best response by the nurse includes what information about BPH?

     1. ABPH is a benign tumor that does not spread beyond the prostate gland
     2. BBPH is a precursor to prostate cancer but does not yet show any malignant changes
     3. CBPH is an enlargement of the gland caused by an increase in the size of existing cells.
     4. DBPH is a benign enlargement of the gland caused by an increase in the number of normal cells.
196. 196 When taking a nursing history from a patient with BPH, the nurse would expect the patient to report

     1. Anocturia, dysuria, and bladder spasms.
     2. Burinary frequency, hematuria, and perineal pain
     3. Curinary hesitancy, postvoid dribbling, and weak urinary stream.
     4. Durinary urgency with a forceful urinary stream and cloudy urine.
197. 197The extent of urinary obstruction caused by BPH can be determined by which diagnostic study?

     1. AA cystometrogram
     2. BTransrectal ultrasound
     3. CUrodynamic flow studies
     4. DPostvoiding catheterization
198. 198What is the effect of finasteride (Proscar) in the treatment of BPH?

     1. AA reduction in the size of the prostate gland
     2. BRelaxation of the smooth muscle of the urethra
     3. CIncreased bladder tone that promotes bladder emptying
     4. DRelaxation of the bladder detrusor muscle promoting urine flow
199. 199On admission to the ambulatory surgical center, a patient with BPH informs the nurse that he is going to have a laser treatment of his enlarged prostate. The nurse plans patient teaching with the knowledge that the patient will need to know what?

     1. AThe effects of general anesthesia
     2. BThe possibility of short-term incontinence
     3. CHome management of an indwelling catheter
     4. DMonitoring for postoperative urinary retention
200. 200What is the most common screening intervention for detecting BPH in men over age 50?

     1. APSA level
     2. Burinalysis
     3. CCystoscopy
     4. Ddigital rectal exam

Description

Med/Surg 2 Quiz on Exam 2 Part 3, created by Nicole Buda on 31/03/2017.

Author

Nicole Buda

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English

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Created on 31 Mar 2017 · updated on 7 Apr 2018

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med/surg 2

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